0001142750-23-000006 | 10-K | XBRL Viewer | AMN Healthcare Services INC

Notes Payable and Credit Agreement

12 Months Ended

Dec. 31, 2022

(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 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 extended the maturity date of the Senior Credit Facility to February 14, 2025, which was coterminous with the Additional Term Loan. The Company used the proceeds from the Additional Term Loan, together with a drawdown of a portion of the Senior Credit Facility, to complete its acquisition of Stratus Video, as more fully described in Note (2), “Acquisitions.” The Additional Term Loan was 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 Company fully repaid all amounts under the Additional Term Loan in the first quarter of 2021.

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 Senior Credit Facility. 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 Senior Credit Facility.

On February 10, 2023, the Company entered into the third amendment to the New Credit Agreement (the “Third Amendment”). The Third Amendment (together with the New Credit Agreement, the First Amendment and the Second Amendment, collectively, the “Amended Credit Agreement”) provides for, among other things, the following: (i) an extension of the maturity date of the Senior Credit Facility to February 10, 2028, (ii) an increase to the Senior Credit Facility to $750,000, and (iii) a transition from LIBOR to a SOFR-based interest rate. The obligations of the Company under the Amended Credit Agreement are secured by substantially all of the assets of the Company.

Borrowings under the Senior Credit Facility bear interest at floating rates, at the Company’s option, based upon either SOFR 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 Senior Credit Facility, which includes a $125,000 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. At February 10, 2023, $45,000 was drawn in the ordinary course of business and there was $683,592 of available credit under the Senior Credit Facility.

(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 are being treated as a single series with the Existing 2027 Notes and have the same terms (other than issue price, issue date and the date from which interest accrues) as those of the Existing 2027 Notes. The 2027 Notes are unsecured obligations of the Company and the interest 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. The 2029 Notes are unsecured obligations of the Company and the interest 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 5.125% senior notes due 2024 (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.

(d) Debt Balances

Outstanding debt balances as of December 31, 2022 and 2021 consisted of the following:


	As of December 31,
	2022		2021



2027 Notes	$	500,000	$	500,000
2029 Notes	350,000		350,000
Total debt outstanding	850,000		850,000
Less unamortized fees and premium	(6,495)		(7,678)

Long-term portion of notes payable	$	843,505	$	842,322

At December 31, 2022, with $21,408 of outstanding letters of credit collateralized by the Senior Credit Facility, there was $378,592 of available credit under the Senior Credit Facility.

(e) Letters of Credit

At December 31, 2022, the Company maintained outstanding standby letters of credit totaling $21,962 as collateral in relation to its workers compensation insurance agreements and a corporate office lease agreement. Of the $21,962 outstanding letters of credit, the Company has collateralized $554 in cash and cash equivalents and the remaining $21,408 is collateralized by the Senior Credit Facility. Outstanding standby letters of credit at December 31, 2021 totaled $23,562.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

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+ Details

Goodwill and Identifiable Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2022

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Acquired Intangible Assets By Major Class

As of December 31, 2022 and 2021, the Company had the following acquired intangible assets:


	As of December 31, 2022						As of December 31, 2021
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Intangible assets subject to amortization:
Staffing databases	$	41,036	$	(24,784)	$	16,252	$	36,836	$	(19,857)	$	16,979
Customer relationships	478,122		(179,795)		298,327		445,169		(150,255)		294,914
Tradenames and trademarks	260,140		(121,576)		138,564		256,889		(81,522)		175,367
Non-compete agreements	7,555		(6,035)		1,520		6,495		(4,621)		1,874
Acquired technology	51,306		(29,137)		22,169		47,320		(21,994)		25,326
	$	838,159	$	(361,327)	$	476,832	$	792,709	$	(278,249)	$	514,460

Schedule of Estimated Amortization Expense

Based on the net carrying amount of intangible assets subject to amortization, the estimated future amortization expense as of December 31, 2022 is as follows:


	Amount
Year ending December 31, 2023	$	86,525
Year ending December 31, 2024	76,029
Year ending December 31, 2025	60,131
Year ending December 31, 2026	51,538
Year ending December 31, 2027	49,022
Thereafter	153,587
	$	476,832

Schedule of Goodwill

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


	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Balance, January 1, 2021	$	339,015	$	152,800	$	372,670	$	864,485
Goodwill adjustment for Stratus Video acquisition	—		—		663		663
Goodwill from Synzi and SnapMD acquisition	—		—		27,193		27,193
Balance, December 31, 2021	339,015		152,800		400,526		892,341
Goodwill adjustment for Synzi and SnapMD acquisition	—		—		33		33
Goodwill from Connetics acquisition	42,990		—		—		42,990
Balance, December 31, 2022	$	382,005	$	152,800	$	400,559	$	935,364
Accumulated impairment loss as of December 31, 2021 and 2022	$	154,444	$	60,495	$	—	$	214,939

- Definition

Tabular disclosure of goodwill by reportable segment and in total which includes a rollforward schedule.

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+ Details

Income Taxes

12 Months Ended

Dec. 31, 2022

Income Tax Disclosure [Abstract]

Income Taxes

The provision for income taxes from operations for the years ended December 31, 2022, 2021 and 2020 consists of the following:


	Years Ended December 31,
	2022		2021		2020
Current income taxes:
Federal	$	145,217	$	98,795	$	32,673
State	42,051		34,025		9,813
Total	187,268		132,820		42,486
Deferred income taxes:
Federal	(20,173)		(12,992)		(15,092)
State	(4,442)		(3,295)		(6,536)
Total	(24,615)		(16,287)		(21,628)
Provision for income taxes from operations	$	162,653	$	116,533	$	20,858

The Company’s income tax expense differs from the amount that would have resulted from applying the federal statutory rate of 21% for 2022, 2021 and 2020 to pretax income from operations because of the effect of the following items during the years ended December 31, 2022, 2021 and 2020:


	Years Ended December 31,
	2022		2021		2020
Tax expense at federal statutory rate	$	127,390	$	93,223	$	19,220
State taxes, net of federal benefit	29,711		23,990		4,161
Non-deductible expenses	—		—		3,621
Share-based compensation	(2,383)		(1,460)		(2,311)

Unrecognized tax benefit	3,245		(680)		(78)
Other, net	4,690		1,460		(3,755)
Income tax expense from operations	$	162,653	$	116,533	$	20,858

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, 2022 and 2021:


	December 31,
	2022		2021
Deferred tax assets:
Share-based compensation	$	7,556	$	6,954
Deferred compensation	32,962		30,513
Accrued bonus	22,437		24,636
Accrued payroll taxes	—		6,427
Accrued expenses	30,178		19,899

Operating lease liabilities	4,532		6,472
Net operating losses	5,803		8,815
Loss contingencies	10,857		8,528
Workers compensation insurance	6,661		6,476
Other	3,749		2,731
Total deferred tax assets	$	124,735	$	121,451
Deferred tax liabilities:
Intangibles	$	(114,967)	$	(126,535)
Fixed assets	(21,739)		(28,824)
Operating lease right-of-use assets	(4,228)		(7,269)
Other	(6,514)		(6,637)
Total deferred tax liabilities	$	(147,448)	$	(169,265)

Net deferred tax liabilities	$	(22,713)	$	(47,814)

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, 2022 is $27,321, primarily related to the Stratus Video and Synzi acquisitions, which begins to expire by 2030. The amount of state NOL carryforward that is available for use in years subsequent to December 31, 2022 is $617, primarily related to the Stratus Video and Synzi acquisitions, which expires in 2039. The Stratus Video and Synzi acquisitions are more fully described in Note (2), “Acquisitions.”

A summary of the changes in the amount of unrecognized tax benefits (excluding interest and penalties) for 2022, 2021 and 2020 is as follows:


	2022		2021		2020
Beginning balance of unrecognized tax benefits	$	4,067	$	4,916	$	4,937
Additions based on tax positions related to the current year	1,464		504		667
Additions based on tax positions of prior years	1,966		—		255
Reductions for tax positions of prior years	—		(301)		—
Reductions due to lapse of applicable statute of limitation	(517)		(1,052)		(943)

Ending balance of unrecognized tax benefits	$	6,980	$	4,067	$	4,916

At December 31, 2022, if recognized, approximately $7,181 net of $1,191 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 $1,390, $564 and $530 of accrued interest related to unrecognized tax benefits at December 31, 2022, 2021 and 2020, respectively. The amount of interest expense recognized in 2022, 2021 and 2020 was $826, $34 and $37, respectively.

The Company is subject to taxation in the U.S. and various states and foreign jurisdictions. With few exceptions, as of December 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 2019.

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 the fourth quarter of 2021 and the remaining balance was paid during the fourth quarter of 2022. The Company claimed an employee retention employment tax credit of $1,756 during 2020 and 2021.

- 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.

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+ Details

Fair Value Measurement

12 Months Ended

Dec. 31, 2022

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 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’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 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. From time to time, the Company invests a portion of its cash and cash equivalents in commercial paper classified as Level 2 in the fair value hierarchy. Of the $31,536 commercial paper issued and outstanding as of December 31, 2022, none had original maturities greater than three months. Of the $80,596 commercial paper issued and outstanding as of December 31, 2021, none had original maturities greater than three months.

The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company also include corporate bonds that are measured using readily available pricing sources that utilize observable market data, including the current interest rate for comparable instruments, which are Level 2 inputs. As of December 31, 2022, the Company had $25,095 corporate bonds issued and outstanding, all of which had original maturities greater than three months and were considered available-for-sale securities. As of December 31, 2021,the Company had $29,159 corporate bonds issued and outstanding, of which $27,958 had original maturities greater than three months and were considered available-for-sale securities.

The fair value of our available-for-sale securities as of December 31, 2022, by remaining contractual maturities, are presented in the following table:


	Fair Value
Due in one year or less	$	9,809
Due after one year through five years	15,286
	$	25,095

Expected maturities may differ from stated due dates because borrowers may have the ability to call or prepay obligations with or without call or prepayment penalties.

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, 2022								Fair Value Measurements as of December 31, 2021
Assets (Liabilities)	Level 1		Level 2		Level 3		Total		Level 1		Level 2		Level 3		Total
Money market funds	$	36,895	$	—	$	—	$	36,895	$	91,454	$	—	$	—	$	91,454
Deferred compensation	(128,465)		—		—		(128,465)		(119,617)		—		—		(119,617)
Corporate bonds	—		25,095		—		25,095		—		29,159		—		29,159
Commercial paper	—		31,536		—		31,536		—		80,596		—		80,596
Acquisition contingent consideration liabilities	—		—		(5,070)		(5,070)		—		—		—		—

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:


	2022		2021
Balance as of January 1,	$	—	$	(8,000)
Settlement of b4health contingent consideration liability for year ended December 31, 2020	—		8,000
Contingent consideration liability from Connetics acquisition on May 13, 2022	(8,000)		—
Change in fair value of contingent consideration liability from Connetics acquisition	2,930		—
Balance as of December 31,	$	(5,070)	$	—

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 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 consolidated statements of comprehensive income. The balance of the equity investment was $19,204 and $22,633 as of December 31, 2022 and 2021, respectively.

There were no triggering events identified, no indication of impairment of the Company’s goodwill, indefinite-lived intangible assets, or long-lived assets and no impairment charges recorded for the aforementioned assets during the three years ended December 31, 2022 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 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 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, 2022				As of December 31, 2021
	Carrying Amount		Estimated Fair Value		Carrying Amount		Estimated Fair Value
2027 Notes	$	500,000	$	460,000	$	500,000	$	517,500
2029 Notes	350,000		300,125		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

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, 2022	Dec. 31, 2021	Dec. 31, 2020	Oct. 01, 2019
Debt Instrument [Line Items]
Write-off of fees on credit facilities and senior notes					$ 0	$ 158,000	$ 4,956,000
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	500,000,000		$ 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%
Aggregate principal amount		$ 350,000,000			$ 350,000,000	$ 350,000,000
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]
Interest rate	5.125%
Extinguishment of debt	$ 325,000,000
Payments for redemption premium and accrued and unpaid interest	$ 9,857,000
Write-off of fees on credit facilities and senior notes							$ 2,992,000

Leases

12 Months Ended

Dec. 31, 2022

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 2 years.

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

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 near the end of the first quarter of 2023. The initial term of the lease is approximately 11 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.

The components of lease expense were as follows:


	Years Ended December 31,
	2022		2021		2020
Operating lease cost	$	16,439	$	23,495	20,176
Short-term lease cost	5,787		6,056		8,702
Variable and other lease cost	3,129		2,485		2,526
Net lease cost	$	25,355	$	32,036	$	31,404

The maturities of lease liabilities as of December 31, 2022 were as follows:


	Operating Leases
Year ending December 31, 2023	$	8,501
Year ending December 31, 2024	6,695
Year ending December 31, 2025	2,741
Year ending December 31, 2026	112
Year ending December 31, 2027	—
Thereafter	—
Total lease payments	18,049
Less imputed interest	(599)
Present value of lease liabilities	$	17,450

The weighted average remaining lease term and discount rate as of December 31, 2022 and 2021 were as follows:


	December 31,
	2022		2021
Weighted average remaining lease term	2 years		3 years
Weighted average discount rate	3.1	%	2.6	%

Income Taxes - Provision for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Current income taxes:
Federal	$ 145,217	$ 98,795	$ 32,673
State	42,051	34,025	9,813
Total	187,268	132,820	42,486
Deferred income taxes:
Federal	(20,173)	(12,992)	(15,092)
State	(4,442)	(3,295)	(6,536)
Total	(24,615)	(16,287)	(21,628)
Income tax expense from operations	$ 162,653	$ 116,533	$ 20,858

- Definition

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

+ References + Details

Leases (Tables)

12 Months Ended

Dec. 31, 2022

Leases [Abstract]

Schedule of Components of Lease Expense

The components of lease expense were as follows:


	Years Ended December 31,
	2022		2021		2020
Operating lease cost	$	16,439	$	23,495	20,176
Short-term lease cost	5,787		6,056		8,702
Variable and other lease cost	3,129		2,485		2,526
Net lease cost	$	25,355	$	32,036	$	31,404

Schedule of Maturities of Lease Liabilities

The maturities of lease liabilities as of December 31, 2022 were as follows:


	Operating Leases
Year ending December 31, 2023	$	8,501
Year ending December 31, 2024	6,695
Year ending December 31, 2025	2,741
Year ending December 31, 2026	112
Year ending December 31, 2027	—
Thereafter	—
Total lease payments	18,049
Less imputed interest	(599)
Present value of lease liabilities	$	17,450

Schedule of Assumptions used for Operating Leases

The weighted average remaining lease term and discount rate as of December 31, 2022 and 2021 were as follows:


	December 31,
	2022		2021
Weighted average remaining lease term	2 years		3 years
Weighted average discount rate	3.1	%	2.6	%

Fair Value Measurement - Fair Value of Financial Instruments (Details) - Senior Notes - USD ($)	Dec. 31, 2022	Dec. 31, 2021	Oct. 20, 2020	Aug. 13, 2020	Oct. 01, 2019
2027 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	$ 500,000,000	$ 500,000,000		$ 200,000,000	$ 300,000,000
Estimated Fair Value	460,000,000	517,500,000
2029 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	350,000,000	350,000,000	$ 350,000,000
Estimated Fair Value	$ 300,125,000	$ 353,500,000

Summary of Significant Accounting Policies (Policies)	12 Months Ended
Summary of Significant Accounting Policies (Policies)	Dec. 31, 2022
Accounting Policies [Abstract]
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.
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, money market funds, commercial paper and other highly liquid investments. See Note (3), “Fair Value Measurement” for additional information.
Restricted Cash, Cash Equivalents and Investments	Restricted Cash, Cash Equivalents and 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 (3), “Fair Value Measurement” for additional information.
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 (typically 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 and 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. 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 those 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 intangible assets 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. Liabilities include provisions for estimated incurred but not yet reported (“IBNR”) losses, 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 insurance programs through its wholly-owned captive insurance subsidiary, which primarily provides coverage, on an occurrence basis, for professional liability within its nurse and allied solutions segment. In addition, the Company maintains excess insurance coverage through a commercial carrier for losses above the per occurrence retention. Losses covered by excess insurance are included in the accrual for professional liability, as the Company remains liable to the extent commercial carriers do not meet their obligations. 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.
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. 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. 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. 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.
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.
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, cash equivalents and restricted cash equivalents and investment balances may be invested in non-federally insured money market funds, commercial paper and corporate bonds.
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 Company’s long-term self-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. The Company has three reportable segments: (1) nurse and allied solutions, (2) physician and leadership solutions, and (3) technology and workforce solutions. The nurse and allied solutions segment includes the Company’s travel nurse staffing (including international nurse staffing and rapid response nurse staffing), labor disruption staffing, local staffing, international nurse and allied permanent placement, allied staffing and revenue cycle solutions businesses. The physician and leadership solutions segment includes the Company’s locum tenens staffing, healthcare interim leadership staffing, executive search, and physician permanent placement businesses. The technology and workforce solutions segment includes the Company’s language services, vendor management systems (“VMS”), workforce optimization, virtual care, credentialing solutions, and outsourced solutions businesses. The Company’s chief operating decision maker relies on internal management reporting processes that provide revenue and operating income by reportable segment for making financial decisions and allocating resources. Segment operating income represents income before income taxes plus depreciation, amortization of intangible assets, share-based compensation, interest expense, net, and other, and unallocated corporate overhead. The Company’s management does not evaluate, manage or measure performance of segments using asset information; accordingly, asset information by segment is not prepared or disclosed.

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 (in shares) at Dec. 31, 2019			49,283,000
Beginning balance at Dec. 31, 2019	$ 736,742	$ (1,154)	$ 493	$ 455,193	$ (119,143)	$ 400,047	$ (1,154)	$ 152
Beginning balance (in shares) at Dec. 31, 2019					(2,561,000)
Statement of Stockholders' Equity [Roll Forward]
Repurchase of common stock into treasury (in shares)	0
Equity awards vested, net of shares withheld for taxes (in shares)			331,000
Equity awards vested, net of shares withheld for taxes	$ (6,929)		$ 3	(6,932)
Share-based compensation	20,465			20,465
Comprehensive income (loss)	70,553					70,665		(112)
Ending balance (in shares) at Dec. 31, 2020			49,614,000
Ending balance at Dec. 31, 2020	$ 819,677		$ 496	468,726	$ (119,143)	469,558		40
Ending balance (in shares) at Dec. 31, 2020					(2,561,000)
Statement of Stockholders' Equity [Roll Forward]
Repurchase of common stock into treasury (in shares)	(25,000)				(25,000)
Repurchase of common stock into treasury	$ (2,688)				$ (2,688)
Equity awards vested, net of shares withheld for taxes (in shares)			235,000
Equity awards vested, net of shares withheld for taxes	(7,232)		$ 2	(7,234)
Share-based compensation	25,217			25,217
Comprehensive income (loss)	$ 327,053					327,388		(335)
Ending balance (in shares) at Dec. 31, 2021	47,263,000		49,849,000
Ending balance at Dec. 31, 2021	$ 1,162,027		$ 498	486,709	$ (121,831)	796,946		(295)
Ending balance (in shares) at Dec. 31, 2021	(2,586,000)				(2,586,000)
Statement of Stockholders' Equity [Roll Forward]
Repurchase of common stock into treasury (in shares)	(5,644,000)				(5,644,000)
Repurchase of common stock into treasury	$ (576,767)				$ (576,767)
Equity awards vested, net of shares withheld for taxes (in shares)			260,000
Equity awards vested, net of shares withheld for taxes	(15,098)		$ 3	(15,101)
Share-based compensation	30,066			30,066
Comprehensive income (loss)	$ 443,406					444,050		(644)
Ending balance (in shares) at Dec. 31, 2022	41,879,000		50,109,000
Ending balance at Dec. 31, 2022	$ 1,043,634		$ 501	$ 501,674	$ (698,598)	$ 1,240,996		$ (939)
Ending balance (in shares) at Dec. 31, 2022	(8,230,000)				(8,230,000)

Acquisitions (Tables)

12 Months Ended

Dec. 31, 2022

Business Combination and Asset Acquisition [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	$	32,800	15
	Staffing database	4,200		5
	Tradenames and trademarks	3,200		5
		$	40,200

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


		Fair Value		Useful Life
				(in years)
Identifiable intangible assets
	Customer relationships	$	171,000	20
	Tradenames and trademarks	40,000		5 - 10
	Developed technology	16,000		5
	Interpreter database	1,000		4
		$	228,000

Schedule of Pro forma Financial Information

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


	Year Ended December 31,
	2020
Revenue	$	2,407,586
Income from operations	165,196
Net income	81,422

Fair Value Measurement - Reconciliation of Changes in Contingent Consideration Liabilities (Details) - Level 3 - Acquisition contingent consideration liabilities - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Fair Value, Recurring
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ 0	$ (8,000)
Ending balance	(5,070)	0
b4health
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of b4health contingent consideration liability for year ended December 31, 2020	0	8,000
Connetics Communications, LLC
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent consideration liability from Connetics acquisition on May 13, 2022	(8,000)	0
Change in fair value of contingent consideration liability from Connetics acquisition	$ 2,930	$ 0

Retirement Plans - Deferred Compensation Plan (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Deferred Compensation Arrangement with Individual, Postretirement Benefits [Line Items]
Cash surrender value of life insurance	$ 117,139	$ 115,095
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	$ 18,023	$ 8,951	$ 2,845

Summary of Significant Accounting Policies - Allowance for Credit Losses (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 6,838	$ 7,043
Provision for expected credit losses	27,622	1,206
Amounts written off charged against the allowance	(2,550)	(1,411)
Ending balance	$ 31,910	$ 6,838

Summary of Significant Accounting Policies - Segment Information (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($) segment	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)
Accounting Policies [Abstract]
Number of reportable segments \| segment	3
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	$ 5,243,242	$ 3,984,235	$ 2,393,714
Segment operating income	647,101	477,998	149,265
Depreciation and amortization	133,007	101,152	92,766
Depreciation (included in cost of revenue)	4,104	2,545	1,421
Share-based compensation	30,066	25,217	20,465
Interest expense, net, and other	40,398	34,077	57,742
Income before income taxes	606,703	443,921	91,523
Travel nurse staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	2,912,677	2,168,507	1,230,396
Labor disruption services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	112,160	110,520	7,137
Local staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	142,724	124,977	53,218
Allied staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	806,491	586,099	408,560
Locum tenens staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	428,133	352,650	277,428
Interim leadership staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	184,819	170,236	130,800
Temporary staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	4,587,004	3,512,989	2,107,539
Permanent placement
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	93,395	71,357	58,394
Language services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	216,120	180,891	116,054
Vendor management systems
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	265,525	148,532	69,756
Other technologies
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	29,553	29,043	23,557
Technology-enabled services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	511,198	358,466	209,367
Talent planning and acquisition
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	51,645	41,423	18,414
Nurse and Allied Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	3,982,453	2,990,103	1,699,311
Nurse and Allied Solutions \| Travel nurse staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	2,912,677	2,168,507	1,230,396
Nurse and Allied Solutions \| Labor disruption services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	112,160	110,520	7,137
Nurse and Allied Solutions \| Local staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	142,724	124,977	53,218
Nurse and Allied Solutions \| Allied staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	806,491	586,099	408,560
Nurse and Allied Solutions \| Locum tenens staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Interim leadership staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Temporary staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	3,974,052	2,990,103	1,699,311
Nurse and Allied Solutions \| Permanent placement
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	8,401	0	0
Nurse and Allied Solutions \| Language services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Vendor management systems
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Other technologies
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Technology-enabled services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Talent planning and acquisition
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	697,946	594,243	466,622
Physician and Leadership Solutions \| Travel nurse staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Labor disruption services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Local staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Allied staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Locum tenens staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	428,133	352,650	277,428
Physician and Leadership Solutions \| Interim leadership staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	184,819	170,236	130,800
Physician and Leadership Solutions \| Temporary staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	612,952	522,886	408,228
Physician and Leadership Solutions \| Permanent placement
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	84,994	71,357	58,394
Physician and Leadership Solutions \| Language services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Vendor management systems
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Other technologies
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Technology-enabled services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Talent planning and acquisition
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	562,843	399,889	227,781
Technology and Workforce Solutions \| Travel nurse staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Labor disruption services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Local staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Allied staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Locum tenens staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Interim leadership staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
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 \| Language services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	216,120	180,891	116,054
Technology and Workforce Solutions \| Vendor management systems
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	265,525	148,532	69,756
Technology and Workforce Solutions \| Other technologies
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	29,553	29,043	23,557
Technology and Workforce Solutions \| Technology-enabled services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	511,198	358,466	209,367
Technology and Workforce Solutions \| Talent planning and acquisition
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	51,645	41,423	18,414
Operating Segments
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	5,243,242	3,984,235	2,393,714
Segment operating income	967,947	730,328	387,559
Operating Segments \| Nurse and Allied Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	3,982,453	2,990,103	1,699,311
Segment operating income	576,226	461,311	232,005
Operating Segments \| Physician and Leadership Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	697,946	594,243	466,622
Segment operating income	92,331	81,439	62,342
Operating Segments \| Technology and Workforce Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	562,843	399,889	227,781
Segment operating income	299,390	187,578	93,212
Corporate, Non-Segment
Segment Reporting Information, Profit (Loss) [Abstract]
Unallocated corporate overhead	$ 153,669	$ 123,416	$ 123,642

Acquisitions - Schedule of Intangible Assets Acquired (Details) - USD ($) $ in Thousands				3 Months Ended
	May 13, 2022	Dec. 31, 2021	Feb. 14, 2020	Sep. 30, 2020	Dec. 31, 2022	Mar. 31, 2021
Tradenames and trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Useful Life		6 years
Connetics Communications, LLC
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 40,200				$ 40,200
Connetics Communications, LLC \| Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 32,800
Useful Life	15 years
Connetics Communications, LLC \| Staffing database
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 4,200
Useful Life	5 years
Connetics Communications, LLC \| Tradenames and trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 3,200
Useful Life	5 years
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

Capital Stock	12 Months Ended
Capital Stock	Dec. 31, 2022
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, 2022 and 2021, 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. On November 10, 2021, February 17, 2022 and June 15, 2022 the Company announced increases to the share repurchase program totaling $700,000 for a total of $850,000 of repurchase authorization as of December 31, 2022. 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, 2022, the Company repurchased 5,644 shares of its common stock at an average price of $102.16 per share excluding broker’s fees, resulting in an aggregate purchase price of $576,767. During the year ended December 31, 2021, the Company repurchased 25 shares of its common stock at an average price of $108.97 per share excluding broker’s fees, resulting in an aggregate purchase price of $2,688. During the year ended December 31, 2020, the Company did not repurchase any shares of its common stock. On February 7, 2023, the Company’s board of directors approved an increase to the share repurchase program of up to an additional $500,000 of repurchases of its outstanding common stock. Since December 31, 2022, and through February 22, 2023, the Company has repurchased 923 shares of its common stock at an average price of $108.40 per share excluding broker’s fees, resulting in an aggregate purchase price of $100,028.

- Definition

The entire disclosure for shareholders' equity comprised of portions attributable to the parent entity and noncontrolling interest, including other comprehensive income. Includes, but is not limited to, balances of common stock, preferred stock, additional paid-in capital, other capital and retained earnings, accumulated balance for each classification of other comprehensive income and amount of comprehensive income.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Acquisitions

12 Months Ended

Dec. 31, 2022

Business Combination and Asset Acquisition [Abstract]

Acquisitions

The Company accounted for each acquisition set forth below using the acquisition method of accounting. Accordingly, the Company recorded the tangible and intangible assets acquired and liabilities assumed at their estimated fair values as of the applicable date of acquisition. Since the applicable date of acquisition, the Company has revised the allocation of the purchase price to the tangible and intangible assets acquired and liabilities assumed based on analysis of information that has been made available through December 31, 2022. The allocations will continue to be updated through the measurement period, if necessary. The goodwill recognized for these acquisitions is attributable to expected growth as the Company leverages its brand and diversifies its services offered to clients, including potential revenue growth and margin expansion. The Company recognizes acquisition-related costs in selling, general and administrative expenses in the consolidated statements of comprehensive income.

Connetics Acquisition

On May 13, 2022, the Company completed its acquisition of Connetics Communications, LLC (“Connetics”), which specializes in the direct hire recruitment and permanent placement of international nurse and allied health professionals with healthcare facilities in the United States. The initial purchase price of $78,764 included (1) $70,764 cash consideration paid upon acquisition, funded through cash on hand, and (2) contingent consideration (earn-out payment) of up to $12,500 with an estimated fair value of $8,000 as of the acquisition date. The contingent earn-out payment is based on the operating results of Connetics for the twelve months ending May 31, 2023. The results of Connetics have been included in the Company’s nurse and allied solutions segment since the date of acquisition. During the fourth quarter of 2022, $231 was returned to the Company in respect of the final working capital settlement.

The preliminary allocation of the $78,533 purchase price, which was reduced by the final working capital settlement during the fourth quarter of 2022, consisted of (1) $3,567 of fair value of tangible assets acquired, which included $963 cash received, (2) $8,224 of liabilities assumed, (3) $40,200 of identified intangible assets, and (4) $42,990 of goodwill, of which $34,990 is deductible for tax purposes. The intangible assets acquired have a weighted average useful life of approximately thirteen years. The following table summarizes the fair value and useful life of each intangible asset acquired as of the acquisition date:


		Fair Value		Useful Life
				(in years)
Identifiable intangible assets
	Customer relationships	$	32,800	15
	Staffing database	4,200		5
	Tradenames and trademarks	3,200		5
		$	40,200

Synzi and SnapMD Acquisition

On April 7, 2021, the Company completed its acquisition of Synzi Holdings, Inc. (“Synzi”) and its wholly-owned subsidiary, SnapMD, LLC (“SnapMD”). Synzi is a virtual care communication platform that enables organizations to conduct virtual visits and use secure messaging, text, and email for clinician-to-patient and clinician-to-clinician communications. SnapMD is a full-service virtual care management company, specializing in providing software to enable healthcare providers to better engage with their patients. The initial purchase price of $42,240 consisted entirely of cash consideration paid upon acquisition. The acquisition was funded primarily through borrowings under the Senior Credit Facility (as defined below). The results of Synzi and SnapMD have been included in the Company’s technology and workforce solutions segment since the date of acquisition. During the second quarter of 2021, $92 was returned to the Company in respect of the final working capital settlement.

The allocation of the $42,148 purchase price, which was reduced by the final working capital settlement and was finalized during the second quarter of 2022, consisted of (1) $2,757 of fair value of tangible assets acquired, which included $884 cash received, (2) $275 of liabilities assumed, (3) $12,440 of identified intangible assets, and (4) $27,226 of goodwill, of which $6,044 is deductible for tax purposes. The fair value of intangible assets primarily includes $10,890 of developed technology and $1,220 of trademarks with a weighted average useful life of approximately seven years.

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 Senior Credit Facility, New Credit Agreement and 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 in respect of 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 and was finalized during the first quarter of 2021, consisted of (1) $44,092 of fair value of tangible assets acquired, which included $9,176 cash received, (2) $56,059 of liabilities assumed, (3) $228,000 of identified intangible assets, and (4) $269,634 of goodwill, of which $10,182 is deductible for tax purposes. The intangible assets acquired have a weighted average useful life of approximately seventeen years. The following table summarizes the fair value and useful life of each intangible asset acquired as of the acquisition date:


		Fair Value		Useful Life
				(in years)
Identifiable intangible assets
	Customer relationships	$	171,000	20
	Tradenames and trademarks	40,000		5 - 10
	Developed technology	16,000		5
	Interpreter database	1,000		4
		$	228,000

During the third quarter of 2020, the Company revised the estimated useful lives for the tradenames and trademarks intangible assets as a result of its plan to rebrand the language 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 is amortizing the remaining value on a straight-line basis over the remaining useful life.

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.

Pro Forma Financial Information (Unaudited)

The following summary presents unaudited pro forma consolidated results of operations of the Company as if the acquisition of Stratus Video had occurred on January 1, 2019, which gives effect to certain adjustments, including acquisition-related costs of $14,468 that were reclassified from the year ended December 31, 2020 to 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.


	Year Ended December 31,
	2020
Revenue	$	2,407,586
Income from operations	165,196
Net income	81,422

Retirement Plans	12 Months Ended
Retirement Plans	Dec. 31, 2022
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 $31,409, $13,157 and $4,256 for the years ended December 31, 2022, 2021 and 2020, respectively. Employer contribution expenses for the year ended December 31, 2022 include one-time contributions and a temporary increase to the discretionary matching contribution for a portion of the year. The Company has a deferred compensation plan for certain executives and 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 variable compensation 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 $18,023, $8,951 and $2,845 for the years ended December 31, 2022, 2021 and 2020, respectively. Employer contribution expenses for the year ended December 31, 2022 include one-time contributions and a temporary increase to the discretionary matching contribution for a portion of the year.. In connection with the administration of the Plan, the Company has purchased company-owned life insurance policies insuring the lives of certain officers and employees. The cash surrender value of these policies was $117,139 and $115,095 at December 31, 2022 and 2021, 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.

+ References

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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Income Taxes - Operating Loss Carryforwards (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Federal
Operating Loss Carryforwards
Operating loss carryforwards	$ 27,321
State
Operating Loss Carryforwards
Operating loss carryforwards	$ 617

Summary of Significant Accounting Policies - Concentration of Credit Risk (Details)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
One Customer \| Consolidated Revenue \| Customer Concentration Risk
Concentration Risk [Line Items]
Concentration risk percentage	18.00%	17.00%	14.00%

Summary of Significant Accounting Policies - Net Income per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Accounting Policies [Abstract]
Common stock excluded from calculation of EPS (in shares)	19	33	41
Computation of Basic and Diluted Net Income Per Common Share [Abstract]
Net income	$ 444,050	$ 327,388	$ 70,665
Net income	$ 444,050	$ 327,388	$ 70,665
Net income per common share - basic (in dollars per share)	$ 9.96	$ 6.87	$ 1.49
Net income per common share - diluted (in dollars per share)	$ 9.90	$ 6.81	$ 1.48
Weighted average common shares outstanding - basic (in shares)	44,591	47,685	47,424
Plus dilutive effect of potential common shares (in shares)	279	360	266
Weighted average common shares outstanding - diluted (in shares)	44,870	48,045	47,690

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

Share-Based Compensation - Share Based Compensation Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Share-Based Payment Arrangement [Abstract]
Share-based employee compensation, before tax	$ 30,066	$ 25,217	$ 20,465
Related income tax benefits	(7,817)	(6,556)	(5,321)
Share-based employee compensation, net of tax	$ 22,249	$ 18,661	$ 15,144

Share-Based Compensation (Tables)

12 Months Ended

Dec. 31, 2022

Share-Based Payment Arrangement [Abstract]

Schedule of RSU and PRSU Activity for Non-vested Awards

The following table summarizes RSU and PRSU activity for the years ended December 31, 2022, 2021 and 2020:


	Number of Shares	Weighted Average Grant Date Fair Value per Share
Unvested at January 1, 2019	758	$	52.45
Granted—RSUs	271	$	60.02
Granted—PRSUs (1)	155	$	64.59
Vested	(283)	$	49.18
Canceled/forfeited	(184)	$	53.84
Unvested at December 31, 2020	717	$	58.88
Granted—RSUs	290	$	85.30
Granted—PRSUs (1)	186	$	97.46
Vested	(280)	$	56.05
Canceled/forfeited	(158)	$	65.69
Unvested at December 31, 2021	755	$	78.13
Granted—RSUs	200	$	109.66
Granted—PRSUs (1)	190	$	92.65
Vested	(405)	$	72.43
Canceled/forfeited	(75)	$	82.13
Unvested at December 31, 2022	665	$	94.79

(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 is as follows:



	Number Outstanding	Weighted- Average Exercise Price per Share
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, 2022, 2021 and 2020 was as follows:


	Years Ended December 31,
	2022		2021		2020
Share-based employee compensation, before tax	$	30,066	$	25,217	$	20,465
Related income tax benefits	(7,817)		(6,556)		(5,321)
Share-based employee compensation, net of tax	$	22,249	$	18,661	$	15,144

Leases - Maturity of Lease Liabilities (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Lessee, Operating Lease, Liability, to be Paid [Abstract]
2023	$ 8,501
2024	6,695
2025	2,741
2026	112
2027	0
Thereafter	0
Total lease payments	18,049
Less imputed interest	(599)
Present value of lease liabilities	$ 17,450

Goodwill and Identifiable Intangible Assets

12 Months Ended

Dec. 31, 2022

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Identifiable Intangible Assets

As of December 31, 2022 and 2021, the Company had the following acquired intangible assets:


	As of December 31, 2022						As of December 31, 2021
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Intangible assets subject to amortization:
Staffing databases	$	41,036	$	(24,784)	$	16,252	$	36,836	$	(19,857)	$	16,979
Customer relationships	478,122		(179,795)		298,327		445,169		(150,255)		294,914
Tradenames and trademarks	260,140		(121,576)		138,564		256,889		(81,522)		175,367
Non-compete agreements	7,555		(6,035)		1,520		6,495		(4,621)		1,874
Acquired technology	51,306		(29,137)		22,169		47,320		(21,994)		25,326
	$	838,159	$	(361,327)	$	476,832	$	792,709	$	(278,249)	$	514,460

As a result of developments in its brand consolidation efforts, the Company reassessed the useful lives of its tradenames and trademarks intangible assets during the fourth quarter of 2021. This assessment included tradenames and trademarks related to the Company's locums tenens, interim leadership, local staffing, physician permanent placement, allied, and VMS businesses. As a result, the Company concluded (a) that the useful lives for $89,400 of tradenames and trademarks that were previously not subject to amortization were no longer considered to be indefinite and (b) to revise the estimated useful lives for $19,766 of tradenames and trademarks. Prior to assigning useful lives to the previously indefinite-lived intangible assets, the Company tested the assets for impairment, concluding that they were not impaired. Effective December 31, 2021, these tradenames and trademarks intangible assets were assigned a weighted average useful life of approximately six years. The Company is amortizing their carrying values on a straight-line basis over the remaining useful lives.

Aggregate amortization expense for intangible assets was $83,078 and $63,015 for the years ended December 31, 2022 and 2021, respectively. Based on the net carrying amount of intangible assets subject to amortization, the estimated future amortization expense as of December 31, 2022 is as follows:


	Amount
Year ending December 31, 2023	$	86,525
Year ending December 31, 2024	76,029
Year ending December 31, 2025	60,131
Year ending December 31, 2026	51,538
Year ending December 31, 2027	49,022
Thereafter	153,587
	$	476,832

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


	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Balance, January 1, 2021	$	339,015	$	152,800	$	372,670	$	864,485
Goodwill adjustment for Stratus Video acquisition	—		—		663		663
Goodwill from Synzi and SnapMD acquisition	—		—		27,193		27,193
Balance, December 31, 2021	339,015		152,800		400,526		892,341
Goodwill adjustment for Synzi and SnapMD acquisition	—		—		33		33
Goodwill from Connetics acquisition	42,990		—		—		42,990
Balance, December 31, 2022	$	382,005	$	152,800	$	400,559	$	935,364
Accumulated impairment loss as of December 31, 2021 and 2022	$	154,444	$	60,495	$	—	$	214,939

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Cash flows from operating activities:
Net income	$ 444,050	$ 327,388	$ 70,665
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization (inclusive of depreciation included in cost of revenue)	137,111	103,697	94,187
Non-cash interest expense and other	5,330	(4,067)	4,349
Write-off of fees on credit facilities and senior notes	0	158	4,956
Change in fair value of contingent consideration	(2,930)	0	4,900
Increase in allowance for credit losses and sales credits	57,999	6,263	6,535
Provision for deferred income taxes	(24,615)	(16,287)	(21,628)
Share-based compensation	30,066	25,217	20,465
Net loss (gain) on deferred compensation balances	(526)	20	1,646
Loss on disposal or sale of fixed assets	1,560	2,707	4,322
Net loss (gain) on investments in available-for-sale securities	749	(52)	(109)
Non-cash lease expense	5,497	3,806	(589)
Changes in assets and liabilities, net of effects from acquisitions:
Accounts receivable	57,921	(419,533)	(7,338)
Accounts receivable, subcontractor	(29,007)	(165,734)	(1,271)
Income taxes receivable	(8,875)	6,591	(412)
Prepaid expenses	53,806	(58,788)	(1,342)
Other current assets	17,775	(21,999)	2,322
Other assets	210	3,262	3,220
Accounts payable and accrued expenses	48,782	256,118	5,562
Accrued compensation and benefits	(10,506)	129,235	25,856
Other liabilities	(126,566)	122,685	41,640
Deferred revenue	(4,098)	4,320	(1,119)
Restricted investments balance	0	349	9
Net cash provided by operating activities	653,733	305,356	256,826
Cash flows from investing activities:
Purchase and development of fixed assets	(75,831)	(53,573)	(37,702)
Purchase of investments	(13,152)	(60,719)	(48,311)
Proceeds from sale and maturity of investments	14,384	57,660	32,800
Purchase of equity investment	0	(500)	0
Proceeds from sale of equity investment	68	78	527
Purchase of convertible promissory notes	0	0	(490)
Payments to fund deferred compensation plan	(21,518)	(7,565)	(7,171)
Cash paid for initial direct costs	0	(1,429)	0
Cash paid for acquisitions, net of cash and restricted cash received	(69,570)	(41,264)	(476,491)
Cash paid for other intangibles	(5,091)	(90)	(1,400)
Cash received for working capital adjustments for prior year acquisitions	0	0	66
Net cash used in investing activities	(170,710)	(107,402)	(538,172)
Cash flows from financing activities:
Payments on term loans	0	(21,875)	(228,125)
Proceeds from term loans	0	0	250,000
Payments on revolving credit facility	0	(70,000)	(245,000)
Proceeds from revolving credit facility	0	70,000	245,000
Proceeds from senior notes	0	0	552,000
Redemption of senior notes	0	0	(333,330)
Repurchase of common stock	(576,767)	(2,688)	0
Payment of financing costs	0	0	(11,508)
Earn-out payments to settle contingent consideration liabilities for prior acquisitions	0	(3,100)	(10,622)
Cash paid for shares withheld for taxes	(15,098)	(7,232)	(6,929)
Net cash provided by (used in) financing activities	(591,865)	(34,895)	211,486
Effect of exchange rate changes on cash	0	(335)	(112)
Net increase (decrease) in cash, cash equivalents and restricted cash	(108,842)	162,724	(69,972)
Cash, cash equivalents and restricted cash at beginning of year	246,714	83,990	153,962
Cash, cash equivalents and restricted cash at end of year	137,872	246,714	83,990
Supplemental disclosures of cash flow information:
Cash paid for amounts included in the measurement of operating lease liabilities	13,337	39,865	20,052
Cash paid for interest (net of $703, $349 and $389 capitalized in 2022, 2021 and 2020, respectively)	37,518	38,085	22,652
Cash paid for income taxes	213,807	106,379	46,258
Acquisitions:
Fair value of tangible assets acquired in acquisitions, net of cash and restricted cash received	2,604	1,906	35,733
Goodwill	42,990	27,193	268,971
Intangible assets	40,200	12,440	228,000
Liabilities assumed	(8,224)	(275)	(56,213)
Contingent consideration liabilities	(8,000)	0	0
Net cash paid for acquisitions	69,570	41,264	476,491
Supplemental disclosures of non-cash investing and financing activities:
Purchase of fixed assets recorded in accounts payable and accrued expenses	$ 5,643	$ 3,719	$ 3,103

Acquisitions - Connetics Acquisition (Details) - USD ($) $ in Thousands		3 Months Ended	12 Months Ended
	May 13, 2022	Dec. 31, 2022	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Business Acquisition [Line Items]
Cash consideration			$ 69,570	$ 41,264	$ 476,491
Fair value of contingent earn-out		$ 5,070	5,070	0
Goodwill		935,364	935,364	$ 892,341	$ 864,485
Connetics Communications, LLC
Business Acquisition [Line Items]
Purchase price	$ 78,764
Cash consideration	70,764
Contingent earn-out based on future operating performance (up to)	12,500
Fair value of contingent earn-out	8,000
Cash returned to the Company for final working capital settlement		231
Purchase price, net of working capital adjustment		78,533
Fair value of tangible assets acquired		3,567	3,567
Cash received		963	963
Liabilities assumed		8,224	8,224
Identified intangible assets	$ 40,200	40,200	40,200
Goodwill		$ 42,990	42,990
Intangible assets acquired, weighted average useful life		13 years
Goodwill expected to be tax deductible		$ 34,990	$ 34,990

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 64,524	$ 180,928
Accounts receivable, net of allowances of $31,910 and $6,838 at December 31, 2022 and 2021, respectively	675,650	789,131
Accounts receivable, subcontractor	268,726	239,719
Prepaid expenses	18,708	72,460
Other current assets	66,037	66,830
Total current assets	1,093,645	1,349,068
Restricted cash, cash equivalents and investments	61,218	64,482
Fixed assets, net of accumulated depreciation of $227,617 and $189,954 at December 31, 2022 and 2021, respectively	149,276	127,114
Operating lease right-of-use assets	16,266	27,771
Other assets	155,750	156,670
Goodwill	935,364	892,341
Intangible assets, net of accumulated amortization of $361,327 and $278,249 at December 31, 2022 and 2021, respectively	476,832	514,460
Total assets	2,888,351	3,131,906
Current liabilities:
Accounts payable and accrued expenses	476,452	425,257
Accrued compensation and benefits	333,244	354,381
Current portion of operating lease liabilities	8,090	11,383
Deferred revenue	11,825	15,950
Other current liabilities	28,322	162,419
Total current liabilities	857,933	969,390
Notes payable, net of unamortized fees and premium	843,505	842,322
Deferred income taxes, net	22,713	47,814
Operating lease liabilities	9,360	13,364
Other long-term liabilities	111,206	96,989
Total liabilities	1,844,717	1,969,879
Commitments and contingencies
Stockholders’ equity:
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at December 31, 2022 and 2021	0	0
Common stock, $0.01 par value; 200,000 shares authorized; 50,109 issued and 41,879 outstanding at December 31, 2022 and 49,849 issued and 47,263 outstanding at December 31, 2021	501	498
Additional paid-in capital	501,674	486,709
Treasury stock, at cost; 8,230 and 2,586 shares at December 31, 2022 and 2021, respectively	(698,598)	(121,831)
Retained earnings	1,240,996	796,946
Accumulated other comprehensive loss	(939)	(295)
Total stockholders’ equity	1,043,634	1,162,027
Total liabilities and stockholders’ equity	$ 2,888,351	$ 3,131,906

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2022

Accounting Policies [Abstract]

Reconciliation of Cash, Cash Equivalents and Restricted Cash

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


	December 31, 2022		December 31, 2021
Cash and cash equivalents	$	64,524	$	180,928
Restricted cash and cash equivalents (included in other current assets)	37,225		29,262
Restricted cash, cash equivalents and investments	61,218		64,482
Total cash, cash equivalents and restricted cash and investments	162,967		274,672
Less restricted investments	(25,095)		(27,958)
Total cash, cash equivalents and restricted cash	$	137,872	$	246,714

Reconciliation of Activity in the Allowance For Credit Losses

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


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

Provision for expected credit losses	27,622		1,206
Amounts written off charged against the allowance	(2,550)		(1,411)

Balance as of December 31,	$	31,910	$	6,838

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, 2022, 2021 and 2020, respectively:


	Years Ended December 31,
	2022		2021		2020
Net income	$	444,050	$	327,388	$	70,665

Net income per common share - basic	$	9.96	$	6.87	$	1.49
Net income per common share - diluted	$	9.90	$	6.81	$	1.48

Weighted average common shares outstanding - basic	44,591		47,685		47,424
Plus dilutive effect of potential common shares	279		360		266
Weighted average common shares outstanding - diluted	44,870		48,045		47,690

Schedule of Reconciliation of Revenue and Segment Operating Income by Reportable Segment to Consolidated Results

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


	Years Ended December 31,
	2022		2021		2020
Revenue
Nurse and allied solutions	$	3,982,453	$	2,990,103	$	1,699,311
Physician and leadership solutions	697,946		594,243		466,622
Technology and workforce solutions	562,843		399,889		227,781
	$	5,243,242	$	3,984,235	$	2,393,714
Segment operating income
Nurse and allied solutions	$	576,226	$	461,311	$	232,005
Physician and leadership solutions	92,331		81,439		62,342
Technology and workforce solutions	299,390		187,578		93,212
	967,947		730,328		387,559
Unallocated corporate overhead	153,669		123,416		123,642
Depreciation and amortization	133,007		101,152		92,766
Depreciation (included in cost of revenue)	4,104		2,545		1,421
Share-based compensation	30,066		25,217		20,465
Interest expense, net, and other	40,398		34,077		57,742
Income before income taxes	$	606,703	$	443,921	$	91,523

Schedule of Revenue Disaggregated by Service Type

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


		Year Ended December 31, 2022
		Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
	Travel nurse staffing	$	2,912,677	$	—	$	—	$	2,912,677
	Labor disruption services	112,160		—		—		112,160
	Local staffing	142,724		—		—		142,724
	Allied staffing	806,491		—		—		806,491
	Locum tenens staffing	—		428,133		—		428,133
	Interim leadership staffing	—		184,819		—		184,819
Temporary staffing		3,974,052		612,952		—		4,587,004
Permanent placement		8,401		84,994		—		93,395
	Language services	—		—		216,120		216,120
	Vendor management systems	—		—		265,525		265,525
	Other technologies	—		—		29,553		29,553
Technology-enabled services		—		—		511,198		511,198
Talent planning and acquisition		—		—		51,645		51,645
Total revenue		$	3,982,453	$	697,946	$	562,843	$	5,243,242


		Year Ended December 31, 2021
		Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
	Travel nurse staffing	$	2,168,507	$	—	$	—	$	2,168,507
	Labor disruption services	110,520		—		—		110,520
	Local staffing	124,977		—		—		124,977
	Allied staffing	586,099		—		—		586,099
	Locum tenens staffing	—		352,650		—		352,650
	Interim leadership staffing	—		170,236		—		170,236
Temporary staffing		2,990,103		522,886		—		3,512,989
Permanent placement		—		71,357		—		71,357
	Language services	—		—		180,891		180,891
	Vendor management systems	—		—		148,532		148,532
	Other technologies	—		—		29,043		29,043
Technology-enabled services		—		—		358,466		358,466
Talent planning and acquisition		—		—		41,423		41,423
Total revenue		$	2,990,103	$	594,243	$	399,889	$	3,984,235


		Year Ended December 31, 2020
		Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
	Travel nurse staffing	$	1,230,396	$	—	$	—	$	1,230,396
	Labor disruption services	7,137		—		—		7,137
	Local staffing	53,218		—		—		53,218
	Allied staffing	408,560		—		—		408,560
	Locum tenens staffing	—		277,428		—		277,428
	Interim leadership staffing	—		130,800		—		130,800
Temporary staffing		1,699,311		408,228		—		2,107,539
Permanent placement		—		58,394		—		58,394
	Language services	—		—		116,054		116,054
	Vendor management systems	—		—		69,756		69,756
	Other technologies	—		—		23,557		23,557
Technology-enabled services		—		—		209,367		209,367
Talent planning and acquisition		—		—		18,414		18,414
Total revenue		$	1,699,311	$	466,622	$	227,781	$	2,393,714

Acquisitions - Business Acquisition, Pro Forma Financial Information (Details) - Stratus Video - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Acquisition related costs	$ 11,467
Revenue	2,407,586
Income from operations	165,196
Net income	81,422
Acquisition-related Costs
Business Acquisition [Line Items]
Acquisition related costs	$ (14,468)	$ 14,468

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2022

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

(a) General

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

(b) Principles of Consolidation

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

The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make a number of estimates and assumptions relating to the reporting of assets and liabilities and the disclosure of contingent assets and liabilities at the dates of the financial statements and the reported amounts of revenue and expenses during the reporting periods. On an ongoing basis, the Company evaluates its estimates, including those related to goodwill and indefinite-lived intangible assets, professional liability reserve, contingent liabilities 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.

(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, money market funds, commercial paper and other highly liquid investments. See Note (3), “Fair Value Measurement” for additional information.

(e) Restricted Cash, Cash Equivalents and 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 (3), “Fair Value Measurement” for additional information.


	December 31, 2022		December 31, 2021
Cash and cash equivalents	$	64,524	$	180,928
Restricted cash and cash equivalents (included in other current assets)	37,225		29,262
Restricted cash, cash equivalents and investments	61,218		64,482
Total cash, cash equivalents and restricted cash and investments	162,967		274,672
Less restricted investments	(25,095)		(27,958)
Total cash, cash equivalents and restricted cash	$	137,872	$	246,714

(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 (typically 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 and 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. Lease expense is recognized on a straight-line basis over the lease term.

(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 those 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 intangible assets 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. Liabilities include provisions for estimated incurred but not yet reported (“IBNR”) losses, 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 insurance programs through its wholly-owned captive insurance subsidiary, which primarily provides coverage, on an occurrence basis, for professional liability within its nurse and allied solutions segment. In addition, the Company maintains excess insurance coverage through a commercial carrier for losses above the per occurrence retention. Losses covered by excess insurance are included in the accrual for professional liability, as the Company remains liable to the extent commercial carriers do not meet their obligations.

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

(k) Revenue Recognition

Revenue primarily consists of fees earned from the temporary 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. 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.

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.

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.

(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.

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


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

Provision for expected credit losses	27,622		1,206
Amounts written off charged against the allowance	(2,550)		(1,411)

Balance as of December 31,	$	31,910	$	6,838

The provision for expected credit losses for the year ended December 31, 2022 was primarily the result of recent developments that raised concern with a specific customer’s ability to meet its financial obligations, and uncertainty regarding the collectability of cash flows from other customers due primarily to the current macroeconomic outlook.

(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 18%, 17% and 14% of the consolidated revenue of the Company for the years ended December 31, 2022, 2021 and 2020, 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, cash equivalents and restricted cash equivalents and investment balances may be invested in non-federally insured money market funds, commercial paper and corporate bonds. As of December 31, 2022 and 2021, there were $162,967 and $274,672, respectively, of cash, cash equivalents and restricted cash, cash equivalents and investments, a portion of which was invested in non-federally insured money market funds, commercial paper and corporate bonds. 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 Company’s long-term self-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 19, 33 and 41 shares of common stock for the years ended December 31, 2022, 2021 and 2020, 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, 2022, 2021 and 2020, respectively:


	Years Ended December 31,
	2022		2021		2020
Net income	$	444,050	$	327,388	$	70,665

Net income per common share - basic	$	9.96	$	6.87	$	1.49
Net income per common share - diluted	$	9.90	$	6.81	$	1.48

Weighted average common shares outstanding - basic	44,591		47,685		47,424
Plus dilutive effect of potential common shares	279		360		266
Weighted average common shares outstanding - diluted	44,870		48,045		47,690

See Note (10), “Capital Stock” for additional information regarding share repurchases that occurred after December 31, 2022.

(r) Segment Information

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

permanent placement businesses. The technology and workforce solutions segment includes the Company’s language services, vendor management systems (“VMS”), workforce optimization, virtual care, credentialing solutions, and outsourced solutions businesses.

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


	Years Ended December 31,
	2022		2021		2020
Revenue
Nurse and allied solutions	$	3,982,453	$	2,990,103	$	1,699,311
Physician and leadership solutions	697,946		594,243		466,622
Technology and workforce solutions	562,843		399,889		227,781
	$	5,243,242	$	3,984,235	$	2,393,714
Segment operating income
Nurse and allied solutions	$	576,226	$	461,311	$	232,005
Physician and leadership solutions	92,331		81,439		62,342
Technology and workforce solutions	299,390		187,578		93,212
	967,947		730,328		387,559
Unallocated corporate overhead	153,669		123,416		123,642
Depreciation and amortization	133,007		101,152		92,766
Depreciation (included in cost of revenue)	4,104		2,545		1,421
Share-based compensation	30,066		25,217		20,465
Interest expense, net, and other	40,398		34,077		57,742
Income before income taxes	$	606,703	$	443,921	$	91,523

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


		Year Ended December 31, 2022
		Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
	Travel nurse staffing	$	2,912,677	$	—	$	—	$	2,912,677
	Labor disruption services	112,160		—		—		112,160
	Local staffing	142,724		—		—		142,724
	Allied staffing	806,491		—		—		806,491
	Locum tenens staffing	—		428,133		—		428,133
	Interim leadership staffing	—		184,819		—		184,819
Temporary staffing		3,974,052		612,952		—		4,587,004
Permanent placement		8,401		84,994		—		93,395
	Language services	—		—		216,120		216,120
	Vendor management systems	—		—		265,525		265,525
	Other technologies	—		—		29,553		29,553
Technology-enabled services		—		—		511,198		511,198
Talent planning and acquisition		—		—		51,645		51,645
Total revenue		$	3,982,453	$	697,946	$	562,843	$	5,243,242


		Year Ended December 31, 2021
		Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
	Travel nurse staffing	$	2,168,507	$	—	$	—	$	2,168,507
	Labor disruption services	110,520		—		—		110,520
	Local staffing	124,977		—		—		124,977
	Allied staffing	586,099		—		—		586,099
	Locum tenens staffing	—		352,650		—		352,650
	Interim leadership staffing	—		170,236		—		170,236
Temporary staffing		2,990,103		522,886		—		3,512,989
Permanent placement		—		71,357		—		71,357
	Language services	—		—		180,891		180,891
	Vendor management systems	—		—		148,532		148,532
	Other technologies	—		—		29,043		29,043
Technology-enabled services		—		—		358,466		358,466
Talent planning and acquisition		—		—		41,423		41,423
Total revenue		$	2,990,103	$	594,243	$	399,889	$	3,984,235


		Year Ended December 31, 2020
		Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
	Travel nurse staffing	$	1,230,396	$	—	$	—	$	1,230,396
	Labor disruption services	7,137		—		—		7,137
	Local staffing	53,218		—		—		53,218
	Allied staffing	408,560		—		—		408,560
	Locum tenens staffing	—		277,428		—		277,428
	Interim leadership staffing	—		130,800		—		130,800
Temporary staffing		1,699,311		408,228		—		2,107,539
Permanent placement		—		58,394		—		58,394
	Language services	—		—		116,054		116,054
	Vendor management systems	—		—		69,756		69,756
	Other technologies	—		—		23,557		23,557
Technology-enabled services		—		—		209,367		209,367
Talent planning and acquisition		—		—		18,414		18,414
Total revenue		$	1,699,311	$	466,622	$	227,781	$	2,393,714

Goodwill and Identifiable Intangible Assets - Changes in the Carrying Amount of Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Goodwill [Roll Forward]
Beginning balance	$ 892,341	$ 864,485
Ending balance	935,364	892,341
Accumulated impairment loss	214,939	214,939
Nurse and Allied Solutions
Goodwill [Roll Forward]
Beginning balance	339,015	339,015
Ending balance	382,005	339,015
Accumulated impairment loss	154,444	154,444
Physician and Leadership Solutions
Goodwill [Roll Forward]
Beginning balance	152,800	152,800
Ending balance	152,800	152,800
Accumulated impairment loss	60,495	60,495
Technology and Workforce Solutions
Goodwill [Roll Forward]
Beginning balance	400,526	372,670
Ending balance	400,559	400,526
Accumulated impairment loss	0	0
Stratus Video
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		663
Stratus Video \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		0
Stratus Video \| Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		0
Stratus Video \| Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		663
Synzi and SnapMD
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	33
Goodwill from acquisition		27,193
Synzi and SnapMD \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	0
Goodwill from acquisition		0
Synzi and SnapMD \| Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	0
Goodwill from acquisition		0
Synzi and SnapMD \| Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	33
Goodwill from acquisition		$ 27,193
Connetics Communications, LLC
Goodwill [Roll Forward]
Goodwill from acquisition	42,990
Ending balance	42,990
Connetics Communications, LLC \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill from acquisition	42,990
Connetics Communications, LLC \| Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill from acquisition	0
Connetics Communications, LLC \| Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill from acquisition	$ 0

Cover Page - USD ($)	12 Months Ended
Cover Page - USD ($)	Dec. 31, 2022	Feb. 20, 2023	Jun. 30, 2022
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2022
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			$ 4,731,008,379
Entity Common Stock, Shares Outstanding (excluding treasury shares)		41,066,415
Documents Incorporated by Reference	Portions of the registrant’s definitive proxy statement for the annual meeting of stockholders scheduled to be held on May 17, 2023 have been incorporated by reference into Part III of this Form 10-K.
Entity Central Index Key	0001142750
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	FY
Amendment Flag	false

Balance Sheet Details (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Other current assets:
Restricted cash and cash equivalents	$ 37,225	$ 29,262
Income taxes receivable	8,875	0
Other	19,937	37,568
Other current assets	66,037	66,830
Prepaid expenses:
Prepaid payroll deposits	0	60,014
Other	18,708	12,446
Prepaid expenses	18,708	72,460
Fixed assets:
Furniture and equipment	51,408	43,134
Software	323,418	265,137
Leasehold improvements	2,067	8,797
Fixed assets, gross	376,893	317,068
Accumulated depreciation	(227,617)	(189,954)
Fixed assets, net	149,276	127,114
Accounts payable and accrued expenses:
Trade accounts payable	78,057	77,325
Subcontractor payable	295,259	261,689
Accrued expenses	73,885	61,220
Loss contingencies	14,638	10,400
Professional liability reserve	7,756	7,127
Other	6,857	7,496
Accounts payable and accrued expenses	476,452	425,257
Accrued compensation and benefits:
Accrued payroll	63,857	98,817
Accrued bonuses and commissions	96,760	105,155
Accrued travel expense	2,033	3,058
Health insurance reserve	7,790	6,041
Workers compensation reserve	12,113	12,384
Deferred compensation	128,465	119,617
Other	22,226	9,309
Accrued compensation and benefits	333,244	354,381
Other current liabilities:
Income taxes payable	0	21,162
Acquisition related liabilities	5,070	0
Client deposits	21,466	141,102
Other	1,786	155
Other current liabilities	28,322	162,419
Other long-term liabilities:
Workers compensation reserve	23,841	24,130
Professional liability reserve	36,214	34,544
Unrecognized tax benefits	8,372	4,633
Other	42,779	33,682
Other long-term liabilities	$ 111,206	$ 96,989

Consolidated Statements of Comprehensive Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Statement of Comprehensive Income [Abstract]
Revenue	$ 5,243,242	$ 3,984,235	$ 2,393,714
Cost of revenue	3,526,558	2,674,634	1,601,936
Gross profit	1,716,684	1,309,601	791,778
Operating expenses:
Selling, general and administrative	936,576	730,451	549,747
Depreciation and amortization (exclusive of depreciation included in cost of revenue)	133,007	101,152	92,766
Total operating expenses	1,069,583	831,603	642,513
Income from operations	647,101	477,998	149,265
Interest expense, net, and other	40,398	34,077	57,742
Income before income taxes	606,703	443,921	91,523
Income tax expense	162,653	116,533	20,858
Net income	444,050	327,388	70,665
Other comprehensive loss:
Unrealized losses on available-for-sale securities, net, and other	(644)	(335)	(112)
Other comprehensive loss	(644)	(335)	(112)
Comprehensive income	$ 443,406	$ 327,053	$ 70,553
Net income per common share:
Basic (in dollars per share)	$ 9.96	$ 6.87	$ 1.49
Diluted (in dollars per share)	$ 9.90	$ 6.81	$ 1.48
Weighted average common shares outstanding:
Basic (in shares)	44,591	47,685	47,424
Diluted (in shares)	44,870	48,045	47,690

Fair Value Measurement (Tables)

12 Months Ended

Dec. 31, 2022

Fair Value Disclosures [Abstract]

Schedule of Available-for-Sale Securities

The fair value of our available-for-sale securities as of December 31, 2022, by remaining contractual maturities, are presented in the following table:


	Fair Value
Due in one year or less	$	9,809
Due after one year through five years	15,286
	$	25,095

Expected maturities may differ from stated due dates because borrowers may have the ability to call or prepay obligations with or without call or prepayment penalties.

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, 2022								Fair Value Measurements as of December 31, 2021
Assets (Liabilities)	Level 1		Level 2		Level 3		Total		Level 1		Level 2		Level 3		Total
Money market funds	$	36,895	$	—	$	—	$	36,895	$	91,454	$	—	$	—	$	91,454
Deferred compensation	(128,465)		—		—		(128,465)		(119,617)		—		—		(119,617)
Corporate bonds	—		25,095		—		25,095		—		29,159		—		29,159
Commercial paper	—		31,536		—		31,536		—		80,596		—		80,596
Acquisition contingent consideration liabilities	—		—		(5,070)		(5,070)		—		—		—		—

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:


	2022		2021
Balance as of January 1,	$	—	$	(8,000)
Settlement of b4health contingent consideration liability for year ended December 31, 2020	—		8,000
Contingent consideration liability from Connetics acquisition on May 13, 2022	(8,000)		—
Change in fair value of contingent consideration liability from Connetics acquisition	2,930		—
Balance as of December 31,	$	(5,070)	$	—

Schedule of Carrying Amounts and Estimated Fair Value of Notes

The carrying amounts and estimated fair value of 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, 2022				As of December 31, 2021
	Carrying Amount		Estimated Fair Value		Carrying Amount		Estimated Fair Value
2027 Notes	$	500,000	$	460,000	$	500,000	$	517,500
2029 Notes	350,000		300,125		350,000		353,500

Leases - Assumptions Used for Operating Leases (Details)	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Weighted average remaining lease term	2 years	3 years
Weighted average discount rate	3.10%	2.60%

Capital Stock (Details) - USD ($)	2 Months Ended	7 Months Ended	12 Months Ended
Capital Stock (Details) - USD ($)	Feb. 22, 2023	Jun. 15, 2022	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Feb. 07, 2023	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)			$ 850,000,000				$ 150,000,000
Stock repurchase program, authorized cumulative amount		$ 700,000,000
Treasury stock acquired (in shares)			5,644,000	25,000	0
Treasury stock acquired (in dollars per share)			$ 102.16	$ 108.97
Aggregate purchase price of treasury stock			$ 576,767,000	$ 2,688,000
Subsequent Event
Treasury Stock, Number of Shares and Restriction Disclosures [Abstract]
Stock repurchase program, additional authorized amount						$ 500,000,000
Treasury stock acquired (in shares)	923,000
Treasury stock acquired (in dollars per share)	$ 108.40
Aggregate purchase price of treasury stock	$ 100,028,000

Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Deferred tax assets:
Share-based compensation	$ 7,556	$ 6,954
Deferred compensation	32,962	30,513
Accrued bonus	22,437	24,636
Accrued payroll taxes	0	6,427
Accrued expenses	30,178	19,899
Operating lease liabilities	4,532	6,472
Net operating losses	5,803	8,815
Loss contingencies	10,857	8,528
Workers compensation insurance	6,661	6,476
Other	3,749	2,731
Total deferred tax assets	124,735	121,451
Deferred tax liabilities:
Intangibles	(114,967)	(126,535)
Fixed assets	(21,739)	(28,824)
Operating lease right-of-use assets	(4,228)	(7,269)
Other	(6,514)	(6,637)
Total deferred tax liabilities	(147,448)	(169,265)
Net deferred tax liabilities	$ (22,713)	$ (47,814)

Income Taxes - CARES Act (Details) - USD ($) $ in Thousands	24 Months Ended
Income Taxes - CARES Act (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Deferred payroll taxes, CARES Act		$ 48,452
Employee retention employment tax credit, CARES Act	$ 1,756

Income Taxes - Income Tax Reconciliation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income tax reconciliation
Tax expense at federal statutory rate	$ 127,390	$ 93,223	$ 19,220
State taxes, net of federal benefit	29,711	23,990	4,161
Non-deductible expenses	0	0	3,621
Share-based compensation	(2,383)	(1,460)	(2,311)
Unrecognized tax benefit	3,245	(680)	(78)
Other, net	4,690	1,460	(3,755)
Income tax expense from operations	$ 162,653	$ 116,533	$ 20,858

- Definition

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

+ References + Details

Fair Value Measurement - Schedule of Available-for-sale Securities (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Debt Securities, Available-for-sale, Maturity, Allocated and Single Maturity Date, Fair Value [Abstract]
Due in one year or less	$ 9,809
Due after one year through five years	15,286
Total	$ 25,095

Summary of Significant Accounting Policies - Share-Based Compensation (Details)	12 Months Ended
	Dec. 31, 2022
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%

Balance Sheet Details

12 Months Ended

Dec. 31, 2022

Balance Sheet Related Disclosures [Abstract]

Balance Sheet Details

The consolidated balance sheets detail is as follows:


	December 31,
	2022		2021
Other current assets:
Restricted cash and cash equivalents	$	37,225	$	29,262
Income taxes receivable	8,875		—
Other	19,937		37,568
Other current assets	$	66,037	$	66,830

Prepaid expenses:
Prepaid payroll deposits	$	—	$	60,014
Other	18,708		12,446
Prepaid expenses	$	18,708	$	72,460

Fixed assets:
Furniture and equipment	$	51,408	$	43,134
Software	323,418		265,137
Leasehold improvements	2,067		8,797
	376,893		317,068
Accumulated depreciation	(227,617)		(189,954)
Fixed assets, net	$	149,276	$	127,114

Accounts payable and accrued expenses:
Trade accounts payable	$	78,057	$	77,325
Subcontractor payable	295,259		261,689
Accrued expenses	73,885		61,220
Loss contingencies	14,638		10,400
Professional liability reserve	7,756		7,127
Other	6,857		7,496
Accounts payable and accrued expenses	$	476,452	$	425,257

Accrued compensation and benefits:
Accrued payroll	$	63,857	$	98,817
Accrued bonuses and commissions	96,760		105,155
Accrued travel expense	2,033		3,058
Health insurance reserve	7,790		6,041
Workers compensation reserve	12,113		12,384
Deferred compensation	128,465		119,617
Other	22,226		9,309
Accrued compensation and benefits	$	333,244	$	354,381

Other current liabilities:
Income taxes payable	$	—	$	21,162
Acquisition related liabilities	5,070		—
Client deposits	21,466		141,102
Other	1,786		155
Other current liabilities	$	28,322	$	162,419


	December 31,
	2022		2021
Other long-term liabilities:
Workers compensation reserve	$	23,841	$	24,130
Professional liability reserve	36,214		34,544

Unrecognized tax benefits	8,372		4,633
Other	42,779		33,682
Other long-term liabilities	$	111,206	$	96,989

Income Taxes - Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Beginning balance of unrecognized tax benefits	$ 4,067	$ 4,916	$ 4,937
Additions based on tax positions related to the current year	1,464	504	667
Additions based on tax positions of prior years	1,966	0	255
Reductions for tax positions of prior years	0	(301)	0
Reductions due to lapse of applicable statute of limitation	(517)	(1,052)	(943)
Ending balance of unrecognized tax benefits	6,980	4,067	4,916
Unrecognized tax benefits that would affect the effective tax rate, net of temporary differences	7,181
Temporary differences that would affect the effective tax rate	1,191
Accrued interest and penalties related to uncertain tax positions	1,390	564	530
Interest and penalties recognized	$ 826	$ 34	$ 37

Label	Element	Value
Accounting Standards Update [Extensible Enumeration]	us-gaap_AccountingStandardsUpdateExtensibleList	Accounting Standards Update 2016-13 [Member]

- Definition

Indicates amendment to accounting standards.

+ References

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+ Details

Share-Based Compensation - Summary of Restricted Stock Units (Details) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Number of Shares
Unvested, beginning balance (in shares)	755	717	758
Vested (in shares)	(405)	(280)	(283)
Canceled/forfeited/expired (in shares)	(75)	(158)	(184)
Unvested, ending balance (in shares)	665	755	717
Weighted Average Grant Date Fair Value per Share
Unvested, beginning balance (in dollars per share)	$ 78.13	$ 58.88	$ 52.45
Vested (in dollars per share)	72.43	56.05	49.18
Canceled/forfeited/expired (in dollars per share)	82.13	65.69	53.84
Unvested, ending balance (in dollars per share)	$ 94.79	$ 78.13	$ 58.88
Restricted Stock Units (RSUs)
Number of Shares
Granted (in shares)	200	290	271
Weighted Average Grant Date Fair Value per Share
Granted (in dollars per share)	$ 109.66	$ 85.30	$ 60.02
Performance Restricted Stock Units (PRSUs)
Number of Shares
Granted (in shares)	190	186	155
Weighted Average Grant Date Fair Value per Share
Granted (in dollars per share)	$ 92.65	$ 97.46	$ 64.59

Notes Payable and Credit Agreement (Tables)

12 Months Ended

Dec. 31, 2022

Debt Disclosure [Abstract]

Schedule of Outstanding Debt

Outstanding debt balances as of December 31, 2022 and 2021 consisted of the following:


	As of December 31,
	2022		2021



2027 Notes	$	500,000	$	500,000
2029 Notes	350,000		350,000
Total debt outstanding	850,000		850,000
Less unamortized fees and premium	(6,495)		(7,678)

Long-term portion of notes payable	$	843,505	$	842,322

Acquisitions - Synzi and SnapMD Acquisition (Details) - USD ($) $ in Thousands		3 Months Ended
	Apr. 07, 2021	Jun. 30, 2022	Jun. 30, 2021	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Business Acquisition [Line Items]
Goodwill				$ 935,364	$ 892,341	$ 864,485
Synzi
Business Acquisition [Line Items]
Purchase price	$ 42,240
Cash returned to the Company for final working capital settlement			$ 92
Purchase price, net of working capital adjustment		$ 42,148
Fair value of tangible assets acquired		2,757
Cash received		884
Liabilities assumed		275
Identified intangible assets		12,440
Goodwill		27,226
Goodwill expected to be tax deductible		$ 6,044
Weighted average useful life of intangible assets		7 years
Synzi \| Developed technology
Business Acquisition [Line Items]
Identified intangible assets		$ 10,890
Synzi \| Trademarks
Business Acquisition [Line Items]
Identified intangible assets		$ 1,220

Leases - Components of Lease Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Operating lease cost	$ 16,439	$ 23,495	$ 20,176
Short-term lease cost	5,787	6,056	8,702
Variable and other lease cost	3,129	2,485	2,526
Net lease cost	$ 25,355	$ 32,036	$ 31,404

Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Statement of Cash Flows [Abstract]
Interest capitalized	$ 703	$ 349	$ 389

Share-Based Compensation - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2020	Dec. 31, 2021
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
RSUs and Performance Shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized compensation cost	$ 28,293
Unrecognized compensation cost, weighted average remaining period	1 year 9 months 18 days
Aggregate intrinsic value	$ 68,348		$ 92,346
Equity Plan \| Stock Options and Stock Appreciation Rights
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Contractual life	10 years
Equity Plan \| RSUs and Performance Shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of equity awards reserved for future issuance (in shares)	2,414,000		2,548,000
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)	181,000

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2022

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, 2022, 2021 and 2020 consists of the following:


	Years Ended December 31,
	2022		2021		2020
Current income taxes:
Federal	$	145,217	$	98,795	$	32,673
State	42,051		34,025		9,813
Total	187,268		132,820		42,486
Deferred income taxes:
Federal	(20,173)		(12,992)		(15,092)
State	(4,442)		(3,295)		(6,536)
Total	(24,615)		(16,287)		(21,628)
Provision for income taxes from operations	$	162,653	$	116,533	$	20,858

Schedule of Income Tax Reconciliation


	Years Ended December 31,
	2022		2021		2020
Tax expense at federal statutory rate	$	127,390	$	93,223	$	19,220
State taxes, net of federal benefit	29,711		23,990		4,161
Non-deductible expenses	—		—		3,621
Share-based compensation	(2,383)		(1,460)		(2,311)

Unrecognized tax benefit	3,245		(680)		(78)
Other, net	4,690		1,460		(3,755)
Income tax expense from operations	$	162,653	$	116,533	$	20,858

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, 2022 and 2021:


	December 31,
	2022		2021
Deferred tax assets:
Share-based compensation	$	7,556	$	6,954
Deferred compensation	32,962		30,513
Accrued bonus	22,437		24,636
Accrued payroll taxes	—		6,427
Accrued expenses	30,178		19,899

Operating lease liabilities	4,532		6,472
Net operating losses	5,803		8,815
Loss contingencies	10,857		8,528
Workers compensation insurance	6,661		6,476
Other	3,749		2,731
Total deferred tax assets	$	124,735	$	121,451
Deferred tax liabilities:
Intangibles	$	(114,967)	$	(126,535)
Fixed assets	(21,739)		(28,824)
Operating lease right-of-use assets	(4,228)		(7,269)
Other	(6,514)		(6,637)
Total deferred tax liabilities	$	(147,448)	$	(169,265)

Net deferred tax liabilities	$	(22,713)	$	(47,814)

Schedule of Unrecognized Tax Benefits

A summary of the changes in the amount of unrecognized tax benefits (excluding interest and penalties) for 2022, 2021 and 2020 is as follows:


	2022		2021		2020
Beginning balance of unrecognized tax benefits	$	4,067	$	4,916	$	4,937
Additions based on tax positions related to the current year	1,464		504		667
Additions based on tax positions of prior years	1,966		—		255
Reductions for tax positions of prior years	—		(301)		—
Reductions due to lapse of applicable statute of limitation	(517)		(1,052)		(943)

Ending balance of unrecognized tax benefits	$	6,980	$	4,067	$	4,916

Goodwill and Identifiable Intangible Assets - Additional Information (Details) - USD ($) $ in Thousands		3 Months Ended	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2021	Dec. 31, 2022	Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]
Aggregate amortization expense, intangible assets			$ 83,078	$ 63,015
Tradenames and trademarks
Finite-Lived Intangible Assets [Line Items]
Intangible asset, no longer considered infinite-lived		$ 89,400
Finite-lived intangible assets, amount with estimated useful lives revised		$ 19,766
Useful life	6 years

Summary of Significant Accounting Policies - Fixed Assets (Details)	12 Months Ended
	Dec. 31, 2022
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

Retirement Plans - 401(k) Retirement Savings Plan (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Retirement Benefits [Abstract]
Employer contributions, net of forfeitures	$ 31,409	$ 13,157	$ 4,256

Share-Based Compensation

12 Months Ended

Dec. 31, 2022

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. Pursuant to the Equity Plan, stock options and stock

appreciation rights (“SARs”) granted had a maximum contractual life of ten years. 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. As of December 31, 2022 and 2021, 2,414 and 2,548 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, 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, 2022, 181 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 performance conditions being achieved) 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 the years ended December 31, 2022, 2021 and 2020:


	Number of Shares	Weighted Average Grant Date Fair Value per Share
Unvested at January 1, 2019	758	$	52.45
Granted—RSUs	271	$	60.02
Granted—PRSUs (1)	155	$	64.59
Vested	(283)	$	49.18
Canceled/forfeited	(184)	$	53.84
Unvested at December 31, 2020	717	$	58.88
Granted—RSUs	290	$	85.30
Granted—PRSUs (1)	186	$	97.46
Vested	(280)	$	56.05
Canceled/forfeited	(158)	$	65.69
Unvested at December 31, 2021	755	$	78.13
Granted—RSUs	200	$	109.66
Granted—PRSUs (1)	190	$	92.65
Vested	(405)	$	72.43
Canceled/forfeited	(75)	$	82.13
Unvested at December 31, 2022	665	$	94.79

(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, 2022, there was $28,293 unrecognized compensation cost related to unvested RSUs and PRSUs. The Company expects to recognize such cost over a period of 1.8 years. As of December 31, 2022 and 2021, the aggregate intrinsic value of the RSUs and PRSUs outstanding was $68,348 and $92,346, 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. Stock appreciation rights (“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 is as follows:



	Number Outstanding	Weighted- Average Exercise Price per Share
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 for 2020.

Share-Based Compensation

Total share-based compensation expense for the years ended December 31, 2022, 2021 and 2020 was as follows:


	Years Ended December 31,
	2022		2021		2020
Share-based employee compensation, before tax	$	30,066	$	25,217	$	20,465
Related income tax benefits	(7,817)		(6,556)		(5,321)
Share-based employee compensation, net of tax	$	22,249	$	18,661	$	15,144

Audit Information	12 Months Ended
Audit Information	Dec. 31, 2022
Audit Information [Abstract]
Auditor Name	KPMG LLP
Auditor Location	San Diego, California
Auditor Firm ID	185

Notes Payable and Credit Agreement - Debt Balances (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Total debt outstanding	$ 850,000	$ 850,000
Less unamortized fees and premium	(6,495)	(7,678)
Long-term portion of notes payable	843,505	842,322
Senior Notes \| 2027 Notes
Debt Instrument [Line Items]
Total debt outstanding	500,000	500,000
Senior Notes \| 2029 Notes
Debt Instrument [Line Items]
Total debt outstanding	$ 350,000	$ 350,000

- Definition

Amount, excluding unamortized premium (discount) and debt issuance cost, of long-term debt. Excludes lease obligation.

+ References + Details

Commitments and Contingencies (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Pending Litigation \| Wage and Hour Claims
Loss Contingencies [Line Items]
Litigation matters accrual	$ 46,225

Summary of Significant Accounting Policies - Restricted Cash, Cash Equivalents and Investments (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Accounting Policies [Abstract]
Cash and cash equivalents	$ 64,524	$ 180,928
Restricted cash and cash equivalents (included in other current assets)	37,225	29,262
Restricted cash, cash equivalents and investments	61,218	64,482
Total cash, cash equivalents and restricted cash and investments	162,967	274,672
Less restricted investments	(25,095)	(27,958)
Total cash, cash equivalents and restricted cash	$ 137,872	$ 246,714	$ 83,990	$ 153,962

Notes Payable and Credit Agreement - The Company’s Credit Agreement and Related Credit Facilities (Details) - USD ($)	Feb. 10, 2023	Feb. 14, 2020	Dec. 31, 2022	Dec. 31, 2021	Jun. 14, 2019	Feb. 09, 2018
Debt Instrument [Line Items]
Term loan			$ 843,505,000	$ 842,322,000
Term Loan Credit Facility
Debt Instrument [Line Items]
Debt issuance fees incurred		$ 4,144,000
Unamortized debt issuance costs		1,681,000
Senior Credit Facility \| Line of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity						$ 400,000,000
Available credit			$ 378,592,000
Senior Credit Facility \| Line of Credit \| Subsequent Event
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 750,000,000
Proceeds from revolving credit facility	45,000,000
Available credit	$ 683,592,000
Secured Debt \| Term Loan Credit Facility
Debt Instrument [Line Items]
Term loan		$ 250,000,000			$ 150,000,000
Annual amortization percentage, first year		2.50%
Annual amortization percentage, after first year		5.00%
Revolving Credit Facility and Secured Debt \| Term Loan Credit Facility \| Subsequent Event \| Minimum \| SOFR
Debt Instrument [Line Items]
Basis spread on variable rate	1.00%
Revolving Credit Facility and Secured Debt \| Term Loan Credit Facility \| Subsequent Event \| Minimum \| Base Rate
Debt Instrument [Line Items]
Basis spread on variable rate	0.00%
Revolving Credit Facility and Secured Debt \| Term Loan Credit Facility \| Subsequent Event \| Maximum \| SOFR
Debt Instrument [Line Items]
Basis spread on variable rate	1.75%
Revolving Credit Facility and Secured Debt \| Term Loan Credit Facility \| Subsequent Event \| Maximum \| Base Rate
Debt Instrument [Line Items]
Basis spread on variable rate	0.75%
Letter of Credit, Sublimit \| Line of Credit \| Subsequent Event
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 125,000,000
Revolving Credit Facility, Swing Line Loan \| Line of Credit \| Subsequent Event
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 75,000,000

Goodwill and Identifiable Intangible Assets - Acquired Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 838,159	$ 792,709
Accumulated Amortization	(361,327)	(278,249)
Net Carrying Amount	476,832	514,460
Staffing databases
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	41,036	36,836
Accumulated Amortization	(24,784)	(19,857)
Net Carrying Amount	16,252	16,979
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	478,122	445,169
Accumulated Amortization	(179,795)	(150,255)
Net Carrying Amount	298,327	294,914
Tradenames and trademarks
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	260,140	256,889
Accumulated Amortization	(121,576)	(81,522)
Net Carrying Amount	138,564	175,367
Non-compete agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	7,555	6,495
Accumulated Amortization	(6,035)	(4,621)
Net Carrying Amount	1,520	1,874
Acquired technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	51,306	47,320
Accumulated Amortization	(29,137)	(21,994)
Net Carrying Amount	$ 22,169	$ 25,326

Commitments and Contingencies	12 Months Ended
Commitments and Contingencies	Dec. 31, 2022
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. On June 26, 2018, the district court denied the plaintiffs’ Motion for Summary Judgment in its entirety, and granted the Company’s Motion for Summary Judgment with respect to the plaintiffs’ per diem and overtime claims. The plaintiffs filed an appeal of the judgment relating to the per diem claims with the Ninth Circuit Court of Appeals (the “Ninth Circuit”). On February 8, 2021, the Ninth Circuit issued an opinion that reversed the district court’s granting of the Company’s Motion for Summary Judgment and remanded the matter to the district court instructing the district to enter partial summary judgment in favor of the plaintiffs. On August 26, 2021, the Company filed a Petition for Writ of Certiorari in the United States Supreme Court seeking review of the Ninth Circuit’s decision, which was denied on December 13, 2021. This case is proceeding in the United States District Court. On May 2, 2019, former travel nurse Sara Woehrle filed a complaint against AMN Services, LLC, and Providence Health System – Southern California in California Superior Court in Los Angeles County. The Company removed the case to the United States District Court for the Central District of California (Case No. 2:19-cv-05282 DSF-KS). The complaint asserts that, due to the Company’s per diem adjustment practices, traveling nurses’ per diem benefits should be included in their regular rate of pay for the purposes of calculating their overtime compensation. The complaint also alleges that the putative class members were denied required meal periods, denied proper overtime compensation, were not compensated for all time worked, including reporting time and training time, and received non-compliant wage statements. The Company has reached an agreement to settle this matter in its entirety and is awaiting court approval. Final approval of the settlement is expected in early 2023. Because of the inherent uncertainty of litigation, the Company is not able to reasonably predict if any matter will be resolved in a manner that is materially adverse to the Company. The Company has recorded accruals in connection with the matters described above amounting to $46,225. The Company is currently unable to estimate the possible loss or range of loss beyond amounts already accrued. Loss contingencies accrued are included in accounts payable and accrued expenses and other long-term liabilities in the consolidated balance sheets.

Fair Value Measurement - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Oct. 20, 2020
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Asset impairment charges	$ 0	$ 0	$ 0
2029 Notes \| Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate				4.00%
Fair Value, Nonrecurring \| Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity investment balance	19,204,000	22,633,000
Commercial paper \| Fair Value, Recurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	31,536,000	80,596,000
Commercial paper \| Fair Value, Recurring \| 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	31,536,000	80,596,000
Securities classified as available-for-sale	0	0
Corporate bonds \| Fair Value, Recurring \| 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	25,095,000	29,159,000
Securities classified as available-for-sale	$ 25,095,000	$ 27,958,000

Balance Sheet Details (Tables)

12 Months Ended

Dec. 31, 2022

Balance Sheet Related Disclosures [Abstract]

Schedule of Supplemental Balance Sheet Disclosures

The consolidated balance sheets detail is as follows:


	December 31,
	2022		2021
Other current assets:
Restricted cash and cash equivalents	$	37,225	$	29,262
Income taxes receivable	8,875		—
Other	19,937		37,568
Other current assets	$	66,037	$	66,830

Prepaid expenses:
Prepaid payroll deposits	$	—	$	60,014
Other	18,708		12,446
Prepaid expenses	$	18,708	$	72,460

Fixed assets:
Furniture and equipment	$	51,408	$	43,134
Software	323,418		265,137
Leasehold improvements	2,067		8,797
	376,893		317,068
Accumulated depreciation	(227,617)		(189,954)
Fixed assets, net	$	149,276	$	127,114

Accounts payable and accrued expenses:
Trade accounts payable	$	78,057	$	77,325
Subcontractor payable	295,259		261,689
Accrued expenses	73,885		61,220
Loss contingencies	14,638		10,400
Professional liability reserve	7,756		7,127
Other	6,857		7,496
Accounts payable and accrued expenses	$	476,452	$	425,257

Accrued compensation and benefits:
Accrued payroll	$	63,857	$	98,817
Accrued bonuses and commissions	96,760		105,155
Accrued travel expense	2,033		3,058
Health insurance reserve	7,790		6,041
Workers compensation reserve	12,113		12,384
Deferred compensation	128,465		119,617
Other	22,226		9,309
Accrued compensation and benefits	$	333,244	$	354,381

Other current liabilities:
Income taxes payable	$	—	$	21,162
Acquisition related liabilities	5,070		—
Client deposits	21,466		141,102
Other	1,786		155
Other current liabilities	$	28,322	$	162,419


	December 31,
	2022		2021
Other long-term liabilities:
Workers compensation reserve	$	23,841	$	24,130
Professional liability reserve	36,214		34,544

Unrecognized tax benefits	8,372		4,633
Other	42,779		33,682
Other long-term liabilities	$	111,206	$	96,989

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Accounts receivable, allowance	$ 31,910	$ 6,838
Accumulated depreciation	227,617	189,954
Accumulated amortization	$ 361,327	$ 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)	50,109,000	49,849,000
Common stock, shares outstanding (in shares)	41,879,000	47,263,000
Treasury stock (in shares)	8,230,000	2,586,000

Notes Payable and Credit Agreement - Letters of Credit (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Standby Letters of Credit
Line of Credit Facility [Line Items]
Debt collateral	$ 554
Letters of credit, amount outstanding	21,962	$ 23,562
Senior Credit Facility \| Line of Credit
Line of Credit Facility [Line Items]
Debt collateral	21,408
Available credit	$ 378,592

Goodwill and Identifiable Intangible Assets - Estimated Future Amortization (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract]
Year ending December 31, 2023	$ 86,525
Year ending December 31, 2024	76,029
Year ending December 31, 2025	60,131
Year ending December 31, 2026	51,538
Year ending December 31, 2027	49,022
Thereafter	153,587
Net Carrying Amount	$ 476,832	$ 514,460

Acquisitions - Stratus Video Acquisition (Details) - USD ($)			3 Months Ended			12 Months Ended
	Dec. 31, 2021	Feb. 14, 2020	Mar. 31, 2021	Sep. 30, 2020	Jun. 30, 2020	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Jun. 14, 2019	Feb. 09, 2018
Business Acquisition [Line Items]
Cash consideration						$ 69,570,000	$ 41,264,000	$ 476,491,000
Term loan	$ 842,322,000					843,505,000	842,322,000
Goodwill	$ 892,341,000					935,364,000	892,341,000	864,485,000
Revenue						5,243,242,000	3,984,235,000	2,393,714,000
Income before income taxes						$ 606,703,000	$ 443,921,000	91,523,000
Tradenames and trademarks
Business Acquisition [Line Items]
Useful life	6 years
Senior Credit Facility \| Line of Credit
Business Acquisition [Line Items]
Term loan										$ 400,000,000
Secured Debt \| Term Loan Credit Facility
Business Acquisition [Line Items]
Term loan		$ 250,000,000							$ 150,000,000
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			44,092,000
Cash and restricted cash received			9,176,000
Liabilities assumed			56,059,000
Identified intangible assets		228,000,000	228,000,000
Goodwill			269,634,000
Goodwill expected to be tax deductible			$ 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

Leases - Additional Information (Details) $ in Thousands	12 Months Ended
Leases - Additional Information (Details) $ in Thousands	Dec. 31, 2022 option	Dec. 31, 2021 USD ($) phase	Mar. 31, 2022 USD ($)
Leases [Abstract]
Option to renew (or more) \| option	1
Option to extend, term (up to)	10 years
Option to terminate, term (within)	2 years
Number of phases of lease termination agreement \| phase		2
Payments of lease termination fee		$ 17,000
Operating lease, right-of-use asset, decrease from modification		27,340
Operating lease, liability, decrease from modification		27,340
Remaining lease payments, premodification		62,487
Remaining lease payments, postmodification		$ 9,564
Future undiscounted lease payments			$ 29,514
Lessee, operating lease, lease not yet commenced, term of contract			11 years

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