0001142750-22-000014 | 10-Q | XBRL Viewer | AMN Healthcare Services INC

Cover Page - shares	3 Months Ended
Cover Page - shares	Mar. 31, 2022	May 04, 2022
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2022
Document Transition Report	false
Entity File Number	001-16753
Entity Registrant Name	AMN HEALTHCARE SERVICES, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	06-1500476
Entity Address, Address Line One	8840 Cypress Waters Boulevard
Entity Address, Address Line Two	Suite 300
Entity Address, City or Town	Dallas
Entity Address, State or Province	TX
Entity Address, Postal Zip Code	75019
City Area Code	866
Local Phone Number	871-8519
Title of 12(b) Security	Common Stock, $0.01 par value
Trading Symbol	AMN
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding (excluding treasury shares)		44,717,910
Entity Central Index Key	0001142750
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q1
Amendment Flag	false

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 113,482	$ 180,928
Accounts receivable, net of allowances of $7,470 and $6,838 at March 31, 2022 and December 31, 2021, respectively	979,709	789,131
Accounts receivable, subcontractor	290,311	239,719
Prepaid expenses	39,087	72,460
Other current assets	56,177	66,830
Total current assets	1,478,766	1,349,068
Restricted cash, cash equivalents and investments	65,904	64,482
Fixed assets, net of accumulated depreciation of $200,173 and $189,954 at March 31, 2022 and December 31, 2021, respectively	129,652	127,114
Operating lease right-of-use assets	21,144	27,771
Other assets	166,018	156,670
Goodwill	892,375	892,341
Intangible assets, net of accumulated amortization of $297,897 and $278,249 at March 31, 2022 and December 31, 2021, respectively	494,813	514,460
Total assets	3,248,672	3,131,906
Current liabilities:
Accounts payable and accrued expenses	497,297	425,257
Accrued compensation and benefits	446,899	354,381
Current portion of operating lease liabilities	8,963	11,383
Deferred revenue	15,824	15,950
Other current liabilities	178,598	162,419
Total current liabilities	1,147,581	969,390
Notes payable, net of unamortized fees and premium	842,618	842,322
Deferred income taxes, net	66,340	47,814
Operating lease liabilities	12,038	13,364
Other long-term liabilities	99,163	96,989
Total liabilities	2,167,740	1,969,879
Commitments and contingencies
Stockholders’ equity:
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at March 31, 2022 and December 31, 2021	0	0
Common stock, $0.01 par value; 200,000 shares authorized; 50,013 issued and 45,129 outstanding at March 31, 2022 and 49,849 issued and 47,263 outstanding at December 31, 2021	500	498
Additional paid-in capital	488,535	486,709
Treasury stock, at cost; 4,884 and 2,586 shares at March 31, 2022 and December 31, 2021	(349,855)	(121,831)
Retained earnings	942,954	796,946
Accumulated other comprehensive loss	(1,202)	(295)
Total stockholders’ equity	1,080,932	1,162,027
Total liabilities and stockholders’ equity	$ 3,248,672	$ 3,131,906

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Accounts receivable, allowance	$ 7,470	$ 6,838
Accumulated depreciation - fixed assets	200,173	189,954
Accumulated amortization	$ 297,897	$ 278,249
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	10,000,000	10,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	200,000,000	200,000,000
Common stock, shares issued (in shares)	50,013,000	49,849,000
Common stock, shares outstanding (in shares)	45,129,000	47,263,000
Treasury stock (in shares)	4,884,000	2,586,000

Condensed Consolidated Statements of Comprehensive Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Statement of Comprehensive Income [Abstract]
Revenue	$ 1,552,538	$ 885,945
Cost of revenue	1,056,370	597,077
Gross profit	496,168	288,868
Operating expenses:
Selling, general and administrative	257,579	161,212
Depreciation and amortization (exclusive of depreciation included in cost of revenue)	30,656	23,254
Total operating expenses	288,235	184,466
Income from operations	207,933	104,402
Interest expense, net, and other	9,589	8,944
Income before income taxes	198,344	95,458
Income tax expense	52,336	25,080
Net income	146,008	70,378
Other comprehensive loss:
Unrealized losses on available-for-sale securities, net, and other	(907)	(24)
Other comprehensive loss	(907)	(24)
Comprehensive income	$ 145,101	$ 70,354
Net income per common share:
Basic (in dollars per share)	$ 3.11	$ 1.48
Diluted (in dollars per share)	$ 3.09	$ 1.47
Weighted average common shares outstanding:
Basic (in shares)	46,913	47,600
Diluted (in shares)	47,208	47,916

Condensed Consolidated Statements of Stockholders' Equity - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Treasury Stock	Retained Earnings	Accumulated Other Comprehensive Income
Beginning balance (in shares) at Dec. 31, 2020		49,614		2,561
Beginning balance at Dec. 31, 2020	$ 819,677	$ 496	$ 468,726	$ (119,143)	$ 469,558	$ 40
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)		132
Equity awards vested, net of shares withheld for payroll taxes	(5,258)	$ 1	(5,259)
Share-based compensation	9,287		9,287
Comprehensive income (loss)	70,354				70,378	(24)
Ending balance (in shares) at Mar. 31, 2021		49,746		2,561
Ending balance at Mar. 31, 2021	894,060	$ 497	472,754	$ (119,143)	539,936	16
Beginning balance (in shares) at Dec. 31, 2021		49,849		2,586
Beginning balance at Dec. 31, 2021	1,162,027	$ 498	486,709	$ (121,831)	796,946	(295)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Repurchase of common stock into treasury (in shares)				(2,298)
Repurchase of common stock into treasury	(228,024)			$ (228,024)
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)		164
Equity awards vested, net of shares withheld for payroll taxes	(9,431)	$ 2	(9,433)
Share-based compensation	11,259		11,259
Comprehensive income (loss)	145,101				146,008	(907)
Ending balance (in shares) at Mar. 31, 2022		50,013		4,884
Ending balance at Mar. 31, 2022	$ 1,080,932	$ 500	$ 488,535	$ (349,855)	$ 942,954	$ (1,202)

- 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.

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+ Details

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Cash flows from operating activities:
Net income	$ 146,008	$ 70,378
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization (inclusive of depreciation included in cost of revenue)	31,510	23,725
Non-cash interest expense and other	479	(761)
Write-off of fees on credit facilities and senior notes	0	158
Increase in allowance for credit losses and sales credits	3,432	4,391
Provision for deferred income taxes	18,526	1,928
Share-based compensation	11,259	9,287
Loss on disposal or sale of fixed assets	241	353
Net loss (gain) on investments	174	(30)
Net loss (gain) on deferred compensation balances	(570)	370
Non-cash lease expense	2,880	(429)
Changes in assets and liabilities, net of effects from acquisitions:
Accounts receivable	(194,044)	(191,271)
Accounts receivable, subcontractor	(50,592)	(64,382)
Income taxes receivable	0	6,591
Prepaid expenses	33,373	(6,190)
Other current assets	12,180	4,226
Other assets	(342)	(331)
Accounts payable and accrued expenses	70,988	103,278
Accrued compensation and benefits	96,486	64,985
Other liabilities	18,353	9,039
Deferred revenue	(126)	3,794
Restricted investments balance	0	22
Net cash provided by operating activities	200,215	39,131
Cash flows from investing activities:
Purchase and development of fixed assets	(13,590)	(11,607)
Purchase of investments	(4,018)	(10,299)
Proceeds from sale and maturity of investments	6,885	25,200
Purchase of equity investment	0	(500)
Payments to fund deferred compensation plan	(12,584)	0
Proceeds from sale of equity investment	68	0
Net cash provided by (used in) investing activities	(23,239)	2,794
Cash flows from financing activities:
Payments on term loans	0	(21,875)
Payments on revolving credit facility	0	(15,000)
Proceeds from revolving credit facility	0	70,000
Repurchase of common stock	(228,024)	0
Earn-out payments to settle contingent consideration liabilities for prior acquisitions	0	(3,100)
Cash paid for shares withheld for taxes	(9,431)	(5,258)
Net cash provided by (used in) financing activities	(237,455)	24,767
Effect of exchange rate changes on cash	(183)	(24)
Net increase (decrease) in cash, cash equivalents and restricted cash	(60,662)	66,668
Cash, cash equivalents and restricted cash at beginning of period	246,714	83,990
Cash, cash equivalents and restricted cash at end of period	186,052	150,658
Supplemental disclosures of cash flow information:
Cash paid for amounts included in the measurement of operating lease liabilities	4,230	4,894
Cash paid for interest (net of $121 and $102 capitalized for the three months ended March 31, 2022 and 2021, respectively)	196	320
Cash paid for income taxes	9,824	5,566
Supplemental disclosures of non-cash investing and financing activities:
Purchase of fixed assets recorded in accounts payable and accrued expenses	$ 4,771	$ 3,788

Condensed Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Statement of Cash Flows [Abstract]
Interest capitalized	$ 121	$ 102

Basis of Presentation

3 Months Ended

Mar. 31, 2022

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Basis of Presentation

BASIS OF PRESENTATION

The condensed consolidated balance sheets and related condensed consolidated statements of comprehensive income and cash flows contained in this Quarterly Report on Form 10-Q (this “Quarterly Report”), which are unaudited, include the accounts of AMN Healthcare Services, Inc. and its wholly-owned subsidiaries (collectively, the “Company”). All significant intercompany balances and transactions have been eliminated in consolidation. In the opinion of management, all entries necessary for a fair presentation of such unaudited condensed consolidated financial statements have been included. These entries consisted of all normal recurring items. The results of operations for the interim period are not necessarily indicative of the results to be expected for any other interim period or for the entire fiscal year or for any future period.

The unaudited condensed consolidated financial statements do not include all information and notes necessary for a complete presentation of financial position, results of operations and cash flows in conformity with accounting principles generally accepted in the United States (“U.S. GAAP”). Please refer to the Company’s audited consolidated financial statements and the related notes for the fiscal year ended December 31, 2021, contained in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2021, filed with the Securities and Exchange Commission on February 24, 2022 (the “2021 Annual Report”).

The preparation of financial statements in conformity with U.S. GAAP requires management to make a number of estimates and assumptions relating to the reporting of assets and liabilities and the disclosure of contingent assets and liabilities at the dates of the financial statements and the reported amounts of revenue and expenses during the reporting periods. On an ongoing basis, the Company evaluates its estimates, including those related to intangible assets purchased in a business combination, asset impairments, accruals for self-insurance, compensation and related benefits, accounts receivable, contingencies and litigation, contingent consideration liabilities associated with acquisitions, and income taxes. Actual results could differ from those estimates under different assumptions or conditions.

Cash, Cash Equivalents and Restricted Cash

The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. Cash and cash equivalents include currency on hand, deposits with financial institutions, money market funds, commercial paper and other highly liquid investments. Restricted cash and cash equivalents primarily includes cash, corporate bonds and commercial paper that serve as collateral for the Company’s captive insurance subsidiary claim payments. See Note (6), “Fair Value Measurement” for additional information.

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


	March 31, 2022		December 31, 2021
Cash and cash equivalents	$	113,482	$	180,928
Restricted cash and cash equivalents (included in other current assets)	30,860		29,262
Restricted cash, cash equivalents and investments	65,904		64,482
Total cash, cash equivalents and restricted cash and investments	210,246		274,672
Less restricted investments	(24,194)		(27,958)
Total cash, cash equivalents and restricted cash	$	186,052	$	246,714

Accounts Receivable

The Company records accounts receivable at the invoiced amount. Accounts receivable are non-interest bearing. The Company maintains an allowance for expected credit losses based on the Company’s historical write-off experience, an assessment of its customers’ financial conditions and available information that is relevant to assessing the collectability of cash flows, which includes current conditions and forecasts about future economic conditions.

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


	2022		2021
Balance as of January 1,	$	6,838	$	7,043

Provision for expected credit losses	1,166		244
Amounts written off charged against the allowance	(534)		(237)

Balance as of March 31,	$	7,470	$	7,050

Acquisitions	3 Months Ended
Acquisitions	Mar. 31, 2022
Business Combination and Asset Acquisition [Abstract]
Acquisitions	ACQUISITIONS As set forth below, the Company completed one acquisition during the period of January 1, 2021 through March 31, 2022, which was accounted for using the acquisition method of accounting. Accordingly, the Company recorded the tangible and intangible assets acquired and liabilities assumed at their estimated fair values as of the date of acquisition. Since the 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 March 31, 2022. The allocation will continue to be updated through the measurement period, if necessary. The Company did not incur any material acquisition-related costs. Synzi and SnapMD Acquisition On April 7, 2021, the Company completed its acquisition of Synzi Holdings, Inc. (“Synzi”) and its wholly-owned subsidiary, SnapMD, LLC (“SnapMD”). Synzi is a virtual care communication platform that enables organizations to conduct virtual visits and use secure messaging, text, and email for clinician-to-patient and clinician-to-clinician communications. SnapMD is a full-service virtual care management company, specializing in providing software to enable healthcare providers to better engage with their patients. The initial purchase price of $42,240 consisted entirely of cash consideration paid upon acquisition. The acquisition was funded primarily through borrowings under the Company’s $400,000 senior secured revolving credit facility (the “Senior Credit Facility”). See additional information regarding the Senior Credit Facility in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2021 Annual Report. The results of Synzi and SnapMD have been included in the Company’s technology and workforce solutions segment since the date of acquisition. During the second quarter of 2021, $92 was returned to the Company in respect of the final working capital settlement. The preliminary allocation of the $42,148 purchase price, which was reduced by the final working capital settlement, consisted of (1) $2,756 of fair value of tangible assets acquired, which included $884 cash received, (2) $275 of liabilities assumed, (3) $12,440 of identified intangible assets, and (4) $27,227 of goodwill, of which $6,044 is deductible for tax purposes. The fair value of intangible assets primarily includes $10,890 of developed technology and $1,220 of trademarks with a weighted average useful life of approximately seven years.

Revenue Recognition	3 Months Ended
Revenue Recognition	Mar. 31, 2022
Revenue from Contract with Customer [Abstract]
Revenue Recognition	REVENUE RECOGNITION Revenue primarily consists of fees earned from the temporary staffing and permanent placement of healthcare professionals, executives, and leaders (clinical and operational). The Company also generates revenue from technology-enabled services, including language interpretation and vendor management systems, and talent planning and acquisition services, including recruitment process outsourcing. The Company recognizes revenue when control of its services is transferred to its customers, in an amount that reflects the consideration the Company expects to be entitled to receive in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by clinical and non-clinical healthcare professionals. Under the Company’s managed services program (“MSP”) arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own network of healthcare professionals along with those of third-party subcontractors. Revenue and the related direct costs under MSP arrangements are recorded in accordance with the accounting guidance on reporting revenue gross as a principal versus net as an agent. When the Company uses subcontractors and acts as an agent, revenue is recorded net of the related subcontractor’s expense. Revenue from permanent placement and recruitment process outsourcing services is recognized as the services are rendered. Depending on the arrangement, the Company’s technology-enabled service revenue is recognized either as the services are rendered or ratably over the applicable arrangement’s service period. The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. While payment terms vary by the type of customer and the services rendered, the term between invoicing and when payment is due is not significant. The Company has elected to apply the following practical expedients and optional exemptions related to contract costs and revenue recognition: •Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within selling, general and administrative expenses. •Recognize revenue in the amount of consideration that the Company has a right to invoice the customer if that amount corresponds directly with the value to the customer of the Company’s services completed to date. •Exemptions from disclosing the value of unsatisfied performance obligations for (i) contracts with an original expected length of one year or less, (ii) contracts for which revenue is recognized in the amount of consideration that the Company has a right to invoice for services performed and (iii) contracts for which variable consideration is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct service that forms part of a single performance obligation. See Note (5), “Segment Information,” for additional information regarding the Company’s revenue disaggregated by service type.

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

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+ Details

Net Income Per Common Share

3 Months Ended

Mar. 31, 2022

Earnings Per Share [Abstract]

Net Income Per Common Share

NET INCOME PER COMMON SHARE

Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the reporting period. The following table sets forth the computation of basic and diluted net income per common share:


	Three Months Ended March 31,
		2022		2021
Net income		$	146,008	$	70,378

Net income per common share - basic		$	3.11	$	1.48
Net income per common share - diluted		$	3.09	$	1.47

Weighted average common shares outstanding - basic		46,913		47,600
Plus dilutive effect of potential common shares		295		316
Weighted average common shares outstanding - diluted		47,208		47,916

Share-based awards to purchase 160 and 22 shares of common stock were not included in the above calculation of diluted net income per common share for the three months ended March 31, 2022 and 2021, respectively, because the effect of these instruments was anti-dilutive.

Since March 31, 2022, and through May 6, 2022, the Company repurchased 718 shares of its common stock at an average price of $96.67 per share excluding broker’s fee, resulting in an aggregate purchase price of $69,412.

Segment Information

3 Months Ended

Mar. 31, 2022

Segment Reporting [Abstract]

Segment Information

SEGMENT INFORMATION

The Company’s operating segments are identified in the same manner as they are reported internally and used by the Company’s chief operating decision maker for the purpose of evaluating performance and allocating resources. The Company has three reportable segments: (1) nurse and allied solutions, (2) physician and leadership solutions, and (3) technology and workforce solutions. The nurse and allied solutions segment includes the Company’s travel nurse staffing, rapid response nurse staffing and labor disruption, allied staffing, local staffing, and revenue cycle solutions businesses. The physician and leadership solutions segment includes the Company’s locum tenens staffing, healthcare interim leadership staffing, executive search, and physician permanent placement businesses. The technology and workforce solutions segment includes the Company’s language services, vendor management systems, workforce optimization, telehealth, credentialing, and outsourced solutions businesses.

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

The following table provides a reconciliation of revenue and operating income by reportable segment to consolidated results and was derived from each segment’s internal financial information as used for corporate management purposes:


	Three Months Ended March 31,
		2022		2021
Revenue
Nurse and allied solutions		$	1,228,039	$	656,661
Physician and leadership solutions		179,506		140,756
Technology and workforce solutions		144,993		88,528
		$	1,552,538	$	885,945
Segment operating income
Nurse and allied solutions		$	195,089	$	101,530
Physician and leadership solutions		20,381		21,216
Technology and workforce solutions		78,880		42,089
		294,350		164,835
Unallocated corporate overhead		43,648		27,421
Depreciation and amortization		30,656		23,254
Depreciation (included in cost of revenue)		854		471
Share-based compensation		11,259		9,287
Interest expense, net, and other		9,589		8,944
Income before income taxes		$	198,344	$	95,458

The following tables present the Company’s revenue disaggregated by service type. Prior period amounts have been reclassified to conform with current period presentation. These reclassifications have no impact on total revenue by reportable segment.


	Three Months Ended March 31, 2022
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Travel nurse staffing	$	970,109	$	—	$	—	$	970,109

Local staffing	44,057		—		—		44,057
Allied staffing	213,873		—		—		213,873
Locum tenens staffing	—		112,672		—		112,672
Interim leadership staffing	—		44,354		—		44,354
Temporary staffing	1,228,039		157,026		—		1,385,065
Permanent placement	—		22,480		—		22,480
Language services	—		—		49,238		49,238
Vendor management systems	—		—		75,022		75,022
Other technologies	—		—		7,658		7,658
Technology-enabled services	—		—		131,918		131,918
Talent planning and acquisition	—		—		13,075		13,075
Total revenue	$	1,228,039	$	179,506	$	144,993	$	1,552,538

The Company did not generate material revenue from labor disruption services during the three months ended March 31, 2022.


	Three Months Ended March 31, 2021
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Travel nurse staffing	$	498,275	$	—	$	—	$	498,275
Labor disruption services	619		—		—		619
Local staffing	27,685		—		—		27,685
Allied staffing	130,082		—		—		130,082
Locum tenens staffing	—		86,355		—		86,355
Interim leadership staffing	—		38,859		—		38,859
Temporary staffing	656,661		125,214		—		781,875
Permanent placement	—		15,542		—		15,542
Language services	—		—		41,005		41,005
Vendor management systems	—		—		31,801		31,801
Other technologies	—		—		6,120		6,120
Technology-enabled services	—		—		78,926		78,926
Talent planning and acquisition	—		—		9,602		9,602
Total revenue	$	656,661	$	140,756	$	88,528	$	885,945

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


	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Balance, January 1, 2022	$	339,015	$	152,800	$	400,526	$	892,341


Goodwill adjustment for Synzi and SnapMD acquisition	—		—		34		34

Balance, March 31, 2022	$	339,015	$	152,800	$	400,560	$	892,375
Accumulated impairment loss as of December 31, 2021 and March 31, 2022	$	154,444	$	60,495	$	—	$	214,939

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

+ References

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+ Details

Fair Value Measurement

3 Months Ended

Mar. 31, 2022

Fair Value Disclosures [Abstract]

Fair Value Measurement

FAIR VALUE MEASUREMENT

The Company’s valuation techniques and inputs used to measure fair value and the definition of the three levels (Level 1, Level 2, and Level 3) of the fair value hierarchy are disclosed in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (3), Fair Value Measurement” of the 2021 Annual Report. The Company has not changed the valuation techniques or inputs it uses for its fair value measurement during the three months ended March 31, 2022.

Assets and Liabilities Measured on a Recurring Basis

The Company invests a portion of its cash and cash equivalents in non-federally insured money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs.

The Company has a deferred compensation plan for certain executives and employees, which is composed of deferred compensation and all related income and losses attributable thereto. The Company’s obligation under its deferred compensation plan is measured at fair value based on quoted market prices of the participants’ elected investments, which are Level 1 inputs.

The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company include commercial paper that is measured at observable market prices for identical securities that are traded in less active markets, which are Level 2 inputs. The Company’s cash equivalents also include commercial paper classified as Level 2 in the fair value hierarchy. Of the $41,685 commercial paper issued and outstanding as of March 31, 2022, none had original maturities greater than three months and were considered available-for-sale securities. As of December 31, 2021, the Company had $80,596 commercial paper issued and outstanding, of which none had original maturities greater than three months and were considered available-for-sale securities.

The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company also include corporate bonds that are measured using readily available pricing sources that utilize observable market data, including the current interest rate for comparable instruments, which are Level 2 inputs. Of the $25,474 corporate bonds issued and outstanding as of March 31, 2022, $24,194 had original maturities greater than three months and were considered available-for-sale securities. As of December 31, 2021, the Company had $29,159 corporate bonds issued and outstanding, of which $27,958 had original maturities greater than three months and were considered available-for-sale securities.

The Company’s contingent consideration liabilities associated with acquisitions are measured at fair value using a probability-weighted discounted cash flow analysis or a simulation-based methodology for the acquired companies, which are Level 3 inputs. The Company recognizes changes to the fair value of its contingent consideration liabilities in selling, general and administrative expenses in the condensed consolidated statements of comprehensive income. There were no contingent consideration liabilities outstanding as of both March 31, 2022 and December 31, 2021.

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 March 31, 2022
	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	$	31,481	$	31,481	$	—	$	—
Deferred compensation	(128,438)		(128,438)		—		—
Corporate bonds	25,474		—		25,474		—
Commercial paper	41,685		—		41,685		—


	Fair Value Measurements as of December 31, 2021
	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	$	91,454	$	91,454	$	—	$	—
Deferred compensation	(119,617)		(119,617)		—		—
Corporate bonds	29,159		—		29,159		—
Commercial paper	80,596		—		80,596		—

Level 3 Information

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


	2021
Balance as of January 1,	$	(8,000)

Settlement of b4health contingent consideration liability for year ended December 31, 2020	8,000






Balance as of March 31,	$	—

Assets Measured on a Non-Recurring Basis

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

The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever events or changes in circumstances indicate that it is more likely than not that an impairment exists. The Company determines the fair value of its reporting units based on a combination of inputs, including the market capitalization of the Company, as well as Level 3 inputs such as discounted cash flows, which are not observable from the market, directly or indirectly. The Company determines the fair value of its indefinite-lived intangible assets using the income approach (relief-from-royalty method) based on Level 3 inputs.

The Company’s equity investment represents an investment in a non-controlled corporation without a readily determinable market value. The Company has elected to measure the investment at cost minus impairment, if any, plus or minus changes resulting from observable price changes. The fair value is determined by using quoted prices for identical or similar investments of the same issuer, which are Level 2 inputs, and other information available to the Company such as the rights and obligations of the securities. The Company recognizes changes to the fair value of its equity investment in interest expense, net, and other in the condensed consolidated statements of comprehensive income. The balance of the equity investment was $22,633 as of both March 31, 2022 and December 31, 2021.

There were no triggering events identified, no indication of impairment of the Company’s goodwill, indefinite-lived intangible assets, long-lived assets, or equity investments, and no impairment charges recorded during the three months ended March 31, 2022 and 2021.

Fair Value of Financial Instruments

The Company is required to disclose the fair value of financial instruments for which it is practicable to estimate the value, even though these instruments are not recognized at fair value in the consolidated balance sheets. The fair value of the Company’s 4.625% senior notes due 2027 (the “2027 Notes”) and 4.000% senior notes due 2029 (the “2029 Notes”) was estimated using quoted market prices in active markets for identical liabilities, which are Level 1 inputs. The carrying amounts and estimated fair value of the 2027 Notes and the 2029 Notes are presented in the following table. See additional information regarding the 2027 Notes and the 2029 Notes in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2021 Annual Report.


	As of March 31, 2022				As of December 31, 2021
	Carrying Amount		Estimated Fair Value		Carrying Amount		Estimated Fair Value
2027 Notes	$	500,000	$	486,875	$	500,000	$	517,500
2029 Notes	350,000		323,750		350,000		353,500

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

- Definition

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

+ References + Details

Income Taxes	3 Months Ended
Income Taxes	Mar. 31, 2022
Income Tax Disclosure [Abstract]
Income Taxes	INCOME TAXES The Company is subject to taxation in the U.S. and various states and foreign jurisdictions. With few exceptions, as of March 31, 2022, the Company is no longer subject to state, local or foreign examinations by tax authorities for tax years before 2011, and the Company is no longer subject to U.S. federal income or payroll tax examinations for tax years before 2018. The Company believes its liability for unrecognized tax benefits and contingent tax issues is adequate with respect to all open years. Notwithstanding the foregoing, the Company could adjust its provision for income taxes and contingent tax liability based on future developments. CARES Act On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”) was enacted and signed into law in response to the COVID-19 pandemic. Among other things, the CARES Act contains significant business tax provisions, including a deferral of payment of employer payroll taxes and an employer retention credit for employer payroll taxes. The Company deferred payment of the employer’s share of payroll taxes of $48,452. Approximately half of such taxes was paid during 2021 and the other half is to be paid by the end of 2022, which is included in accrued compensation and benefits in the consolidated balance sheets as of both March 31, 2022 and December 31, 2021. The Company claimed an employee retention tax credit of $1,756.

- 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

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Commitments and Contingencies	3 Months Ended
Commitments and Contingencies	Mar. 31, 2022
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	COMMITMENTS AND CONTINGENCIES Legal Proceedings From time to time, the Company is involved in various lawsuits, claims, investigations, and proceedings that arise in the ordinary course of business. These matters typically relate to professional liability, tax, compensation, contract, competitor disputes and employee-related matters and include individual and class action lawsuits, as well as inquiries and investigations by governmental agencies regarding the Company’s employment and compensation practices. Additionally, some of the Company’s clients may also become subject to claims, governmental inquiries and investigations, and legal actions relating to services provided by the Company’s healthcare professionals. Depending upon the particular facts and circumstances, the Company may also be subject to indemnification obligations under its contracts with such clients relating to these matters. The Company accrues for contingencies and records a liability when management believes an adverse outcome from a loss contingency is both probable and the amount, or a range, can be reasonably estimated. Significant judgment is required to determine both probability of loss and the estimated amount. The Company reviews its loss contingencies at least quarterly and adjusts its accruals and/or disclosures to reflect the impact of negotiations, settlements, rulings, advice of legal counsel, or other new information, as deemed necessary. The most significant matters for which the Company has established loss contingencies are class actions related to wage and hour claims under California and Federal law. Specifically, among other claims in these lawsuits, it is alleged that certain expense reimbursements should be considered wages and included in the regular rate of pay for purposes of calculating overtime rates. On May 26, 2016, former travel nurse Verna Maxwell Clarke filed a complaint against AMN Services, LLC, in California Superior Court in Los Angeles County. The Company removed the case to the United States District Court for the Central District of California (Case No. 2:16-cv-04132-DSF-KS) (the “Clarke Matter”). The complaint asserts that, due to the Company’s per diem adjustment practices, traveling nurses’ per diem benefits should be included in their regular rate of pay for the purposes of calculating their overtime compensation. On June 26, 2018, the district court denied the plaintiffs’ Motion for Summary Judgment in its entirety, and granted the Company’s Motion for Summary Judgment with respect to the plaintiffs’ per diem and overtime claims. The plaintiffs filed an appeal of the judgment relating to the per diem claims with the Ninth Circuit Court of Appeals (the “Ninth Circuit”). On February 8, 2021, a three-judge panel of the Ninth Circuit issued an opinion that reversed the district court’s granting of the Company’s Motion for Summary Judgment and remanded the matter to the district court instructing the district to enter partial summary judgment in favor of the plaintiffs. On August 26, 2021, the Company filed a Petition for Writ of Certiorari in the United States Supreme Court seeking review of the Ninth Circuit’s decision, which was denied on December 13, 2021. This case is proceeding in the United States District Court. On May 2, 2019, former travel nurse Sara Woehrle filed a complaint against AMN Services, LLC, and Providence Health System – Southern California in California Superior Court in Los Angeles County. The Company removed the case to the United States District Court for the Central District of California (Case No. 2:19-cv-05282 DSF-KS). The complaint asserts that, due to the Company’s per diem adjustment practices, traveling nurses’ per diem benefits should be included in their regular rate of pay for the purposes of calculating their overtime compensation. The complaint also alleges that the putative class members were denied required meal periods, denied proper overtime compensation, were not compensated for all time worked, including reporting time and training time, and received non-compliant wage statements. The Company has reached an agreement to settle this matter in its entirety and is awaiting court approval. Final settlement is not expected until the fourth quarter of 2022. The Company believes that its current wage and hour practices conform with the applicable law in all material respects. Because of the inherent uncertainty of litigation, the Company is not able to reasonably predict if any matter will be resolved in a manner that is materially adverse to the Company. The Company has recorded accruals in connection with the matters described above amounting to $37,225. The Company is currently unable to estimate the possible loss or range of loss beyond amounts already accrued. Loss contingencies accrued as of both March 31, 2022 and December 31, 2021 are included in accounts payable and accrued expenses and other long-term liabilities in the consolidated balance sheets. Operating Leases In the first quarter of 2022, the Company entered into a lease agreement for an office building located in Dallas, Texas, with future undiscounted lease payments of approximately $29,514, excluding lease incentives. Because the Company does not control the underlying asset during the construction period, the Company is not considered the owner of the asset under construction for accounting purposes. The lease will commence upon completion of the construction of the office building which is expected be in the first quarter of 2023. The initial term of the lease is approximately eleven years with options to renew the lease during the lease term. A right-of-use asset and lease liability will be recognized in the consolidated balance sheet in the period the lease commences.

Balance Sheet Details

3 Months Ended

Mar. 31, 2022

Balance Sheet Related Disclosures [Abstract]

Balance Sheet Details

BALANCE SHEET DETAILS

The consolidated balance sheets detail is as follows:


	March 31, 2022		December 31, 2021
Other current assets:
Restricted cash and cash equivalents	$	30,860	$	29,262

Other	25,317		37,568
Other current assets	$	56,177	$	66,830

Prepaid expenses:
Prepaid payroll deposits	$	18,922	$	60,014
Other	20,165		12,446
Prepaid expenses	39,087		72,460

Fixed assets:
Furniture and equipment	$	45,309	$	43,134
Software	277,271		265,137
Leasehold improvements	7,245		8,797
	329,825		317,068
Accumulated depreciation	(200,173)		(189,954)
Fixed assets, net	$	129,652	$	127,114

Other assets:
Life insurance cash surrender value	$	123,803	$	115,096
Other	42,215		41,574
Other assets	$	166,018	$	156,670

Accounts payable and accrued expenses:
Trade accounts payable	$	88,986	$	77,325
Subcontractor payable	295,291		261,689
Accrued expenses	84,355		61,220
Loss contingencies	9,940		10,400
Professional liability reserve	7,267		7,127
Other	11,458		7,496
Accounts payable and accrued expenses	$	497,297	$	425,257

Accrued compensation and benefits:
Accrued payroll	$	174,368	$	98,817
Accrued bonuses and commissions	115,153		105,155
Accrued travel expense	3,852		3,058
Health insurance reserve	5,908		6,041
Workers compensation reserve	12,651		12,384
Deferred compensation	128,438		119,617
Other	6,529		9,309
Accrued compensation and benefits	$	446,899	$	354,381

Other current liabilities:

Income taxes payable	45,105		21,162
Client deposits	133,062		141,102
Other	431		155
Other current liabilities	$	178,598	$	162,419


	March 31, 2022		December 31, 2021
Other long-term liabilities:
Workers compensation reserve	$	24,518	$	24,130
Professional liability reserve	36,284		34,544
Unrecognized tax benefits	4,679		4,633

Other	33,682		33,682
Other long-term liabilities	$	99,163	$	96,989

Basis of Presentation (Policies)

3 Months Ended

Mar. 31, 2022

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Use of Estimates

Cash, Cash Equivalents and Restricted Cash

Accounts Receivable

Revenue Recognition

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

The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. While payment terms vary by the type of customer and the services rendered, the term between invoicing and when payment is due is not significant.

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

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

•Recognize revenue in the amount of consideration that the Company has a right to invoice the customer if that amount corresponds directly with the value to the customer of the Company’s services completed to date.

•Exemptions from disclosing the value of unsatisfied performance obligations for (i) contracts with an original expected length of one year or less, (ii) contracts for which revenue is recognized in the amount of consideration that the Company has a right to invoice for services performed and (iii) contracts for which variable consideration is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct service that forms part of a single performance obligation.

Net Income per Common Share

Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the reporting period.

Segment Information

Fair Value of Assets and Liabilities

Assets and Liabilities Measured on a Recurring Basis

The Company invests a portion of its cash and cash equivalents in non-federally insured money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs.

Assets Measured on a Non-Recurring Basis

Fair Value of Financial Instruments


	As of March 31, 2022				As of December 31, 2021
	Carrying Amount		Estimated Fair Value		Carrying Amount		Estimated Fair Value
2027 Notes	$	500,000	$	486,875	$	500,000	$	517,500
2029 Notes	350,000		323,750		350,000		353,500

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

- Definition

Disclosure of accounting policy for revenue from contract with customer.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 17
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130561-203045

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 20
-Subparagraph (d)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130566-203045

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 18
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130563-203045

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-URI http://asc.fasb.org/topic&trid=49130388

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 20
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130566-203045

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 18
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130563-203045

Reference 7: http://www.xbrl.org/2003/role/exampleRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section 50
-Paragraph 4
-Subparagraph (e)
-URI http://asc.fasb.org/extlink&oid=123372394&loc=d3e18823-107790

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 20
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130566-203045

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 19
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130564-203045

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 20
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130566-203045

+ Details

Basis of Presentation (Tables)

3 Months Ended

Mar. 31, 2022

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Reconciliation of Cash, Cash Equivalents and Restricted Cash


	March 31, 2022		December 31, 2021
Cash and cash equivalents	$	113,482	$	180,928
Restricted cash and cash equivalents (included in other current assets)	30,860		29,262
Restricted cash, cash equivalents and investments	65,904		64,482
Total cash, cash equivalents and restricted cash and investments	210,246		274,672
Less restricted investments	(24,194)		(27,958)
Total cash, cash equivalents and restricted cash	$	186,052	$	246,714

Reconciliation of Activity in Allowance for Credit Losses for Accounts Receivable

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


	2022		2021
Balance as of January 1,	$	6,838	$	7,043

Provision for expected credit losses	1,166		244
Amounts written off charged against the allowance	(534)		(237)

Balance as of March 31,	$	7,470	$	7,050

Net Income Per Common Share (Tables)

3 Months Ended

Mar. 31, 2022

Earnings Per Share [Abstract]

Computation of Basic and Diluted Net Income Per Common Share

The following table sets forth the computation of basic and diluted net income per common share:


	Three Months Ended March 31,
		2022		2021
Net income		$	146,008	$	70,378

Net income per common share - basic		$	3.11	$	1.48
Net income per common share - diluted		$	3.09	$	1.47

Weighted average common shares outstanding - basic		46,913		47,600
Plus dilutive effect of potential common shares		295		316
Weighted average common shares outstanding - diluted		47,208		47,916

Segment Information (Tables)

3 Months Ended

Mar. 31, 2022

Segment Reporting [Abstract]

Reconciliation of Revenue and Segment Operating Income by Reportable Segment


	Three Months Ended March 31,
		2022		2021
Revenue
Nurse and allied solutions		$	1,228,039	$	656,661
Physician and leadership solutions		179,506		140,756
Technology and workforce solutions		144,993		88,528
		$	1,552,538	$	885,945
Segment operating income
Nurse and allied solutions		$	195,089	$	101,530
Physician and leadership solutions		20,381		21,216
Technology and workforce solutions		78,880		42,089
		294,350		164,835
Unallocated corporate overhead		43,648		27,421
Depreciation and amortization		30,656		23,254
Depreciation (included in cost of revenue)		854		471
Share-based compensation		11,259		9,287
Interest expense, net, and other		9,589		8,944
Income before income taxes		$	198,344	$	95,458

Disaggregation of Revenue


	Three Months Ended March 31, 2022
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Travel nurse staffing	$	970,109	$	—	$	—	$	970,109

Local staffing	44,057		—		—		44,057
Allied staffing	213,873		—		—		213,873
Locum tenens staffing	—		112,672		—		112,672
Interim leadership staffing	—		44,354		—		44,354
Temporary staffing	1,228,039		157,026		—		1,385,065
Permanent placement	—		22,480		—		22,480
Language services	—		—		49,238		49,238
Vendor management systems	—		—		75,022		75,022
Other technologies	—		—		7,658		7,658
Technology-enabled services	—		—		131,918		131,918
Talent planning and acquisition	—		—		13,075		13,075
Total revenue	$	1,228,039	$	179,506	$	144,993	$	1,552,538

The Company did not generate material revenue from labor disruption services during the three months ended March 31, 2022.


	Three Months Ended March 31, 2021
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Travel nurse staffing	$	498,275	$	—	$	—	$	498,275
Labor disruption services	619		—		—		619
Local staffing	27,685		—		—		27,685
Allied staffing	130,082		—		—		130,082
Locum tenens staffing	—		86,355		—		86,355
Interim leadership staffing	—		38,859		—		38,859
Temporary staffing	656,661		125,214		—		781,875
Permanent placement	—		15,542		—		15,542
Language services	—		—		41,005		41,005
Vendor management systems	—		—		31,801		31,801
Other technologies	—		—		6,120		6,120
Technology-enabled services	—		—		78,926		78,926
Talent planning and acquisition	—		—		9,602		9,602
Total revenue	$	656,661	$	140,756	$	88,528	$	885,945

Summary of Goodwill by Reportable Segment

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


	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Balance, January 1, 2022	$	339,015	$	152,800	$	400,526	$	892,341


Goodwill adjustment for Synzi and SnapMD acquisition	—		—		34		34

Balance, March 31, 2022	$	339,015	$	152,800	$	400,560	$	892,375
Accumulated impairment loss as of December 31, 2021 and March 31, 2022	$	154,444	$	60,495	$	—	$	214,939

Fair Value Measurement (Tables)

3 Months Ended

Mar. 31, 2022

Fair Value Disclosures [Abstract]

Schedule of Financial Assets and Liabilities Measured at Fair Value on Recurring Basis

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


	Fair Value Measurements as of March 31, 2022
	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	$	31,481	$	31,481	$	—	$	—
Deferred compensation	(128,438)		(128,438)		—		—
Corporate bonds	25,474		—		25,474		—
Commercial paper	41,685		—		41,685		—


	Fair Value Measurements as of December 31, 2021
	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	$	91,454	$	91,454	$	—	$	—
Deferred compensation	(119,617)		(119,617)		—		—
Corporate bonds	29,159		—		29,159		—
Commercial paper	80,596		—		80,596		—

Reconciliations of Changes in the Fair Value of Contingent Consideration Liabilities

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


	2021
Balance as of January 1,	$	(8,000)

Settlement of b4health contingent consideration liability for year ended December 31, 2020	8,000






Balance as of March 31,	$	—

Schedule of Fair Value of Financial Instruments

See additional information regarding the 2027 Notes and the 2029 Notes in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2021 Annual Report.


	As of March 31, 2022				As of December 31, 2021
	Carrying Amount		Estimated Fair Value		Carrying Amount		Estimated Fair Value
2027 Notes	$	500,000	$	486,875	$	500,000	$	517,500
2029 Notes	350,000		323,750		350,000		353,500

Balance Sheet Details (Tables)

3 Months Ended

Mar. 31, 2022

Balance Sheet Related Disclosures [Abstract]

Schedule of Supplemental Balance Sheet Disclosures

The consolidated balance sheets detail is as follows:


	March 31, 2022		December 31, 2021
Other current assets:
Restricted cash and cash equivalents	$	30,860	$	29,262

Other	25,317		37,568
Other current assets	$	56,177	$	66,830

Prepaid expenses:
Prepaid payroll deposits	$	18,922	$	60,014
Other	20,165		12,446
Prepaid expenses	39,087		72,460

Fixed assets:
Furniture and equipment	$	45,309	$	43,134
Software	277,271		265,137
Leasehold improvements	7,245		8,797
	329,825		317,068
Accumulated depreciation	(200,173)		(189,954)
Fixed assets, net	$	129,652	$	127,114

Other assets:
Life insurance cash surrender value	$	123,803	$	115,096
Other	42,215		41,574
Other assets	$	166,018	$	156,670

Accounts payable and accrued expenses:
Trade accounts payable	$	88,986	$	77,325
Subcontractor payable	295,291		261,689
Accrued expenses	84,355		61,220
Loss contingencies	9,940		10,400
Professional liability reserve	7,267		7,127
Other	11,458		7,496
Accounts payable and accrued expenses	$	497,297	$	425,257

Accrued compensation and benefits:
Accrued payroll	$	174,368	$	98,817
Accrued bonuses and commissions	115,153		105,155
Accrued travel expense	3,852		3,058
Health insurance reserve	5,908		6,041
Workers compensation reserve	12,651		12,384
Deferred compensation	128,438		119,617
Other	6,529		9,309
Accrued compensation and benefits	$	446,899	$	354,381

Other current liabilities:

Income taxes payable	45,105		21,162
Client deposits	133,062		141,102
Other	431		155
Other current liabilities	$	178,598	$	162,419


	March 31, 2022		December 31, 2021
Other long-term liabilities:
Workers compensation reserve	$	24,518	$	24,130
Professional liability reserve	36,284		34,544
Unrecognized tax benefits	4,679		4,633

Other	33,682		33,682
Other long-term liabilities	$	99,163	$	96,989

Basis of Presentation - Reconciliation of Cash, Cash Equivalents and Restricted Cash (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021	Mar. 31, 2021	Dec. 31, 2020
Accounting Policies [Abstract]
Cash and cash equivalents	$ 113,482	$ 180,928
Restricted cash and cash equivalents (included in other current assets)	30,860	29,262
Restricted cash, cash equivalents and investments	65,904	64,482
Total cash, cash equivalents and restricted cash and investments	210,246	274,672
Less restricted investments	(24,194)	(27,958)
Total cash, cash equivalents and restricted cash	$ 186,052	$ 246,714	$ 150,658	$ 83,990

Basis of Presentation - Reconciliation of Activity in Allowance for Credit Losses for Accounts Receivable (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 6,838	$ 7,043
Provision for expected credit losses	1,166	244
Amounts written off charged against the allowance	(534)	(237)
Ending balance	$ 7,470	$ 7,050

Acquisitions - Narrative (Details)			3 Months Ended
Acquisitions - Narrative (Details)	Mar. 31, 2022 USD ($)	Apr. 07, 2021 USD ($)	Mar. 31, 2022 USD ($) acquisition	Jun. 30, 2021 USD ($)	Dec. 31, 2021 USD ($)	Feb. 09, 2018 USD ($)
Business Acquisition [Line Items]
Number of acquisitions \| acquisition			1
Goodwill	$ 892,375,000		$ 892,375,000		$ 892,341,000
Synzi
Business Acquisition [Line Items]
Cash consideration		$ 42,240,000
Cash returned to the Company for final working capital settlement				$ 92,000
Purchase price, net of working capital adjustment	42,148,000
Fair value of tangible assets acquired	2,756,000		2,756,000
Cash received	884,000		884,000
Liabilities assumed	275,000		275,000
Identifiable intangible assets	12,440,000		12,440,000
Goodwill	27,227,000		27,227,000
Goodwill expected to be deductible for tax purposes	$ 6,044,000		$ 6,044,000
Intangible assets acquired, weighted average useful life		7 years
Synzi \| Developed Technology Rights
Business Acquisition [Line Items]
Identifiable intangible assets		$ 10,890,000
Synzi \| Trademarks
Business Acquisition [Line Items]
Identifiable intangible assets		$ 1,220,000
Revolving Credit Facility \| Line of Credit
Business Acquisition [Line Items]
Maximum borrowing capacity						$ 400,000,000

Net Income Per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	1 Months Ended	3 Months Ended
	May 06, 2022	Mar. 31, 2022	Mar. 31, 2021
Net income		$ 146,008	$ 70,378
Net income per common share - basic (in dollars per share)		$ 3.11	$ 1.48
Net income per common share - diluted (in dollars per share)		$ 3.09	$ 1.47
Weighted average common shares outstanding - basic (in shares)		46,913	47,600
Plus dilutive effect of potential common shares (in shares)		295	316
Weighted average common shares outstanding - diluted (in shares)		47,208	47,916
Common stock excluded from calculation of EPS (in shares)		160	22
Subsequent Event
Treasury stock (in shares)	718
Treasury Stock (in dollars per share)	$ 96.67
Aggregate purchase price	$ 69,412

Segment Information - Narrative (Details)	3 Months Ended
Segment Information - Narrative (Details)	Mar. 31, 2022 segment
Segment Reporting [Abstract]
Number of reportable segments	3

Segment Information - Reconciliation of Revenue and Segment Operating Income by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 1,552,538	$ 885,945
Segment operating income	207,933	104,402
Depreciation and amortization	30,656	23,254
Depreciation (included in cost of revenue)	854	471
Share-based compensation	11,259	9,287
Interest expense, net, and other	9,589	8,944
Income before income taxes	198,344	95,458
Nurse and allied solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	1,228,039	656,661
Physician and leadership solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	179,506	140,756
Technology and workforce solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	144,993	88,528
Operating segments
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	1,552,538	885,945
Segment operating income	294,350	164,835
Operating segments \| Nurse and allied solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	1,228,039	656,661
Segment operating income	195,089	101,530
Operating segments \| Physician and leadership solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	179,506	140,756
Segment operating income	20,381	21,216
Operating segments \| Technology and workforce solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	144,993	88,528
Segment operating income	78,880	42,089
Unallocated corporate overhead
Segment Reporting, Revenue Reconciling Item [Line Items]
Unallocated corporate overhead	$ 43,648	$ 27,421

Segment Information - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Segment Reporting Information [Line Items]
Revenue	$ 1,552,538	$ 885,945
Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	1,228,039	656,661
Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	179,506	140,756
Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	144,993	88,528
Travel nurse staffing
Segment Reporting Information [Line Items]
Revenue	970,109	498,275
Travel nurse staffing \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	970,109	498,275
Travel nurse staffing \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Travel nurse staffing \| Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Labor disruption services
Segment Reporting Information [Line Items]
Revenue		619
Labor disruption services \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue		619
Labor disruption services \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue		0
Labor disruption services \| Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue		0
Local staffing
Segment Reporting Information [Line Items]
Revenue	44,057	27,685
Local staffing \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	44,057	27,685
Local staffing \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Local staffing \| Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Allied staffing
Segment Reporting Information [Line Items]
Revenue	213,873	130,082
Allied staffing \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	213,873	130,082
Allied staffing \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Allied staffing \| Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Locum tenens staffing
Segment Reporting Information [Line Items]
Revenue	112,672	86,355
Locum tenens staffing \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Locum tenens staffing \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	112,672	86,355
Locum tenens staffing \| Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Interim leadership staffing
Segment Reporting Information [Line Items]
Revenue	44,354	38,859
Interim leadership staffing \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Interim leadership staffing \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	44,354	38,859
Interim leadership staffing \| Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Temporary staffing
Segment Reporting Information [Line Items]
Revenue	1,385,065	781,875
Temporary staffing \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	1,228,039	656,661
Temporary staffing \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	157,026	125,214
Temporary staffing \| Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Permanent placement
Segment Reporting Information [Line Items]
Revenue	22,480	15,542
Permanent placement \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Permanent placement \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	22,480	15,542
Permanent placement \| Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Language services
Segment Reporting Information [Line Items]
Revenue	49,238	41,005
Language services \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Language services \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Language services \| Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	49,238	41,005
Vendor management systems
Segment Reporting Information [Line Items]
Revenue	75,022	31,801
Vendor management systems \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Vendor management systems \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Vendor management systems \| Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	75,022	31,801
Other technologies
Segment Reporting Information [Line Items]
Revenue	7,658	6,120
Other technologies \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Other technologies \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Other technologies \| Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	7,658	6,120
Technology-enabled services
Segment Reporting Information [Line Items]
Revenue	131,918	78,926
Technology-enabled services \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Technology-enabled services \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Technology-enabled services \| Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	131,918	78,926
Talent planning and acquisition
Segment Reporting Information [Line Items]
Revenue	13,075	9,602
Talent planning and acquisition \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Talent planning and acquisition \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Talent planning and acquisition \| Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	$ 13,075	$ 9,602

Segment Information - Summary of Goodwill by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Dec. 31, 2021
Goodwill [Roll Forward]
Goodwill, beginning balance	$ 892,341
Goodwill adjustment for Synzi and SnapMD acquisition	34
Goodwill, ending balance	892,375
Accumulated impairment loss	214,939	$ 214,939
Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	339,015
Goodwill adjustment for Synzi and SnapMD acquisition	0
Goodwill, ending balance	339,015
Accumulated impairment loss	154,444	154,444
Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	152,800
Goodwill adjustment for Synzi and SnapMD acquisition	0
Goodwill, ending balance	152,800
Accumulated impairment loss	60,495	60,495
Technology and workforce solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	400,526
Goodwill adjustment for Synzi and SnapMD acquisition	34
Goodwill, ending balance	400,560
Accumulated impairment loss	$ 0	$ 0

Fair Value Measurement - Narrative (Details) - USD ($)	3 Months Ended
Fair Value Measurement - Narrative (Details) - USD ($)	Mar. 31, 2022	Mar. 31, 2021	Dec. 31, 2021	Oct. 20, 2020	Aug. 13, 2020
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Estimated fair value of contingent earn-out payment	$ 0		$ 0
Asset impairment charges	0	$ 0
2027 Notes \| Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate					4.625%
2029 Notes \| Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate				4.00%
Fair Value, Measurements, Nonrecurring \| Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity investment balance	22,633,000		22,633,000
Commercial paper \| Fair Value, Measurements, Recurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	41,685,000		80,596,000
Commercial paper \| Fair Value, Measurements, Recurring \| Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	41,685,000		80,596,000
Securities classified as available-for-sale	0		0
Corporate bonds \| Fair Value, Measurements, Recurring \| Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	25,474,000		29,159,000
Securities classified as available-for-sale	$ 24,194,000		$ 27,958,000

Fair Value Measurement - Financial Assets and Liabilities (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Deferred compensation
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	$ (128,438)	$ (119,617)
Deferred compensation \| Quoted Prices in Active Markets for Identical Assets (Level 1)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	(128,438)	(119,617)
Deferred compensation \| Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Deferred compensation \| Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
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	31,481	91,454
Money market funds \| Quoted Prices in Active Markets for Identical Assets (Level 1)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	31,481	91,454
Money market funds \| Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Money market funds \| Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Corporate bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	25,474	29,159
Corporate bonds \| Quoted Prices in Active Markets for Identical Assets (Level 1)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Corporate bonds \| Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	25,474	29,159
Corporate bonds \| Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	41,685	80,596
Commercial paper \| Quoted Prices in Active Markets for Identical Assets (Level 1)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Commercial paper \| Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	41,685	80,596
Commercial paper \| Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	$ 0	$ 0

Fair Value Measurement - Reconciliation of Changes in Contingent Consideration Liabilities (Details) - Level 3 - Acquisition contingent consideration liabilities - Fair Value, Measurements, Recurring $ in Thousands	3 Months Ended
	Mar. 31, 2021 USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ (8,000)
Ending balance	0
b4health
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of contingent consideration liability	$ 8,000

Fair Value Measurement - Fair Value of Financial Instruments (Details) - Senior Notes - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
2027 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	$ 500,000	$ 500,000
Estimated Fair Value	486,875	517,500
2029 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	350,000	350,000
Estimated Fair Value	$ 323,750	$ 353,500

Income Taxes (Details) $ in Thousands	Mar. 31, 2022 USD ($)
Income Tax Disclosure [Abstract]
Deferred payroll taxes, CARES Act	$ 48,452
Employee retention tax credit, CARES Act	$ 1,756

Commitments and Contingencies (Details) $ in Thousands	Mar. 31, 2022 USD ($)
Commitments and Contingencies [Line Items]
Future undiscounted lease payments	$ 29,514
Lease term	11 years
Wage and Hour claims \| Pending Litigation
Commitments and Contingencies [Line Items]
Litigation matters accrual	$ 37,225

Balance Sheet Details (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Other current assets:
Restricted cash and cash equivalents	$ 30,860	$ 29,262
Other	25,317	37,568
Other current assets	56,177	66,830
Prepaid expenses:
Prepaid payroll deposits	18,922	60,014
Other	20,165	12,446
Prepaid expenses	39,087	72,460
Fixed assets:
Furniture and equipment	45,309	43,134
Software	277,271	265,137
Leasehold improvements	7,245	8,797
Fixed assets, gross	329,825	317,068
Accumulated depreciation	(200,173)	(189,954)
Fixed assets, net	129,652	127,114
Other assets:
Life insurance cash surrender value	123,803	115,096
Other	42,215	41,574
Other assets	166,018	156,670
Accounts payable and accrued expenses:
Trade accounts payable	88,986	77,325
Subcontractor payable	295,291	261,689
Accrued expenses	84,355	61,220
Loss contingencies	9,940	10,400
Professional liability reserve	7,267	7,127
Other	11,458	7,496
Accounts payable and accrued expenses	497,297	425,257
Accrued compensation and benefits:
Accrued payroll	174,368	98,817
Accrued bonuses and commissions	115,153	105,155
Accrued travel expense	3,852	3,058
Health insurance reserve	5,908	6,041
Workers compensation reserve	12,651	12,384
Deferred compensation	128,438	119,617
Other	6,529	9,309
Accrued compensation and benefits	446,899	354,381
Other current liabilities:
Income taxes payable	45,105	21,162
Client deposits	133,062	141,102
Other	431	155
Other current liabilities	178,598	162,419
Other long-term liabilities:
Workers compensation reserve	24,518	24,130
Professional liability reserve	36,284	34,544
Unrecognized tax benefits	4,679	4,633
Other	33,682	33,682
Other long-term liabilities	$ 99,163	$ 96,989