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AMN Healthcare Announces Fourth Quarter and Full Year 2008 Results

February 26, 2009
Revenue up 5% over prior year; annual, quarterly results within company guidance
PRNewswire-FirstCall
SAN DIEGO

AMN Healthcare Services, Inc. (NYSE: AHS) today announced operating results within guidance for the fourth quarter and full-year 2008. Highlights include:

  --  Full year 2008 revenue of $1.22 billion, up 5% over prior year
  --  Full year 2008 pro forma diluted EPS of $1.06 compared to $1.04 in
      prior year, GAAP diluted EPS of $1.02 compared to $1.04
  --  Full year gross margin of 26.0%, unchanged from prior year
  --  Q4 2008 revenue of $296 million, up 3% over last year
  --  Q4 2008 pro forma diluted EPS of $0.24 compared to $0.25 last year,
      GAAP diluted EPS of $0.23 compared to $0.25
  --  Q4 2008 cash flow from operations of $14 million, full year 2008 of
      $64 million


"Today, AMN Healthcare is growing market share, making investments in the future, and maintaining our strong cash flow and a healthy balance sheet in the economic downturn," said Susan R. Nowakowski, President and Chief Executive Officer of AMN Healthcare. "Our strategy of leveraging the advantages of our size, leadership position, differentiated business model and diversified service lines will allow us to continue outperforming our competitors. It was the execution of this strategy and the dedication of our employees that allowed AMN to increase market share and achieve record revenue and EBITDA results in 2008.

"While not as impacted as many other sectors, the slowing economic conditions and higher unemployment have negatively impacted demand for our services, most notably in nurse staffing," Nowakowski added. "During the first quarter of 2009, we have taken several steps to align our business infrastructure accordingly, focusing on maximizing operating efficiencies and reducing overhead costs, while still preserving our ability to deliver the superior quality and service levels our clients expect from AMN Healthcare."

For the full year 2008, Nurse and Allied revenue was $844 million, up 5% over last year including acquisitions, Locum Tenens revenue was $322 million, up 4%, and Physician Permanent Placement revenue was $51 million, flat with prior year.

For the fourth quarter of 2008, revenue for the Nurse and Allied staffing segment was $207 million, an increase of 5% from the same quarter last year including acquisitions. The Locum Tenens staffing segment generated revenue of $76 million, an increase of 0.3% from the same quarter last year, and the Physician Permanent Placement segment provided revenue of $12 million, a decrease of 7% from the same quarter last year primarily due to a sales reserve adjustment.

Full year gross margin of 26.0% for 2008 remained unchanged from the prior year. Gross margin during the fourth quarter was 25.7% compared to 26.6% for the same quarter last year, mainly reflecting the lower revenue mix from our higher margin business lines such as international nursing and physician permanent placement.

Selling, general and administrative ("SG&A") expenses for the full year 2008 were 18.9% as a percentage of revenue, as compared to 18.7% for 2007. SG&A decreased to 18.6% of revenue in the fourth quarter of 2008 from 19.6% in the same quarter last year due mainly to the effects of cost saving initiatives the company began implementing during the quarter, combined with lower bad debt expense and a favorable actuarial-based insurance reserve adjustment.

For the full year 2008, income tax expense was 43.9% of taxable income as compared to 40.1% for 2007. Income tax expense was 47.5% of taxable income in the fourth quarter as compared to 39.5% in the same quarter last year. These higher effective tax rates reflect the tax matter we identified in the third quarter of 2008.

Full year GAAP diluted earnings per share was $1.02 and included the negative impacts of $0.02 for sales reserve adjustments, $0.03 for restructuring charges and legal expenses associated with our pharmacy staffing business, and $0.04 for the tax matter. Fourth quarter GAAP diluted earnings per share of $0.23 included $0.01 for the sales reserve adjustment and $0.03 expense for the tax matter.

Total debt outstanding at December 31, 2008 was $146.3 million, yielding a leverage ratio of 1.5. Total average diluted shares outstanding for the fourth quarter of 2008 were 32.9 million.

Revenue and Earnings Guidance

The current economic environment is making it more difficult to forecast annual financial performance and to provide meaningful guidance. Therefore, management will continue to share general business trends but will no longer provide specific financial guidance. During the first few months of 2009, the general business trends have been as follows: demand has slowed for most of our business lines, most significantly for nursing, where volumes declined by double-digit percentage amounts both sequentially and year over year. There has also been a moderation in the rate of price increases, though pricing erosion is not expected. Based on these trends, first quarter consolidated revenue is expected to decline in the low to mid-teens, in percentage terms, over prior year.

Nowakowski added, "Our team has been proactively reducing external vendor and internal costs to better align the business infrastructure with the recent and expected lower demand levels to preserve profit margins and cash flow. We are confident that our leadership position combined with our seasoned management, sales and service team, along with our focus on solid financial fundamentals will allow us to continue building market share and successfully weather the challenging economic conditions."

Company Summary

AMN Healthcare Services, Inc. is the largest healthcare staffing company in the United States and the largest nationwide provider in all three of its business segments: travel nurse and allied staffing, locum tenens staffing (temporary physician staffing), and physician permanent placement services. AMN Healthcare recruits healthcare professionals both nationally and internationally and places them on variable lengths of assignments and in permanent positions at acute-care hospitals, physician practice groups and other healthcare settings throughout the United States. For more information, visit http://www.amnhealthcare.com/.

Conference Call on February 26, 2008

AMN Healthcare Services, Inc.'s fourth quarter 2008 conference call will be held on Thursday, February 26, 2009, at 5:00 p.m., Eastern Time. A live webcast of the call can be accessed through AMN Healthcare's website at http://www.amnhealthcare.com/investors. Please log in at least 10 minutes prior to the conference call in order to download the applicable audio software. Interested parties may participate live via telephone by dialing (800) 230-1059 in the U.S. or (612) 332-1213 internationally. Following the conclusion of the call, a replay of the webcast will be available at the company's website. Alternatively, a telephonic replay of the call will be available at 7:30 p.m. Eastern Time on February 26, 2009, and can be accessed until March 12, 2009 at midnight Eastern Time, by calling (800) 475-6701 in the U.S. or (320) 365-3844 internationally, with access code 982568.

This earnings release contains certain non-GAAP financial information. These measures are not in accordance with, or an alternative to, generally accepted accounting principles in the United States ("GAAP"), and may be different from non-GAAP measures reported by other companies. From time to time, additional information regarding non-GAAP financial measures may be made available on the Company's website at http://www.amnhealthcare.com/investors.

Forward-Looking Statements

This earnings release contains "forward-looking statements" within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. Such statements include anticipated first quarter consolidated revenues and expectations, and Ms. Nowakowski's comments including those regarding the company's growing market share, outperforming competitors, not expecting price erosion and preserving profit margin and cash flow. We based these forward-looking statements on our current expectations and projections about future events. Our actual results could differ materially from those discussed in, or implied by, these forward-looking statements. Forward-looking statements are identified by words such as "believe," "anticipate," "expect," "intend," "plan," "will," "may" and other similar expressions. In addition, any statements that refer to expectations, projections or other characterizations of future events or circumstances are forward-looking statements. The following factors could cause our actual results to differ materially from those implied by the forward-looking statements in this earnings release: our ability to sustain our business in a significant economic downturn; our ability to continue to recruit qualified temporary and permanent healthcare professionals at reasonable costs; our ability to retain qualified temporary healthcare professionals for multiple assignments at reasonable costs; our ability to attract and retain sales and operational personnel; our ability to enter into contracts with hospitals, healthcare facility clients, affiliated healthcare networks and physician practice groups on terms attractive to us and to secure orders related to those contracts; our ability to demonstrate the value of our services to our healthcare and facility clients, which may be impacted by the role of intermediaries such as vendor management companies; the general level of patient occupancy and utilization of services at our hospital and healthcare facility clients' facilities, including the potential impact on such utilization caused by adoption of alternative modes of healthcare delivery, which utilization may influence demand for our services; the overall level of demand for services offered by temporary and permanent healthcare staffing providers; the ability of our hospital, healthcare facility and physician practice group clients to retain and increase the productivity of their permanent staff; the variation in pricing of the healthcare facility contracts under which we place temporary healthcare professionals; our ability to successfully design our strategic growth, acquisition and integration strategies and to implement those strategies, which includes our ability to obtain credit at reasonable terms to complete acquisitions, integrate acquired companies' accounting, management information, human resource and other administrative systems, and implement or remediate controls, procedures and policies at acquired companies; our ability to leverage our cost structure; access to and undisrupted performance of our management information and communication systems, including use of the Internet, and our candidate and client databases and payroll and billing software systems; our ability to keep our web sites operational at a reasonable cost and without service interruptions; the effect of existing or future government legislation and regulation; our ability to grow and operate our business in compliance with legislation and regulations, including regulations that may affect our clients and, in turn, affect demand for our services, such as Medicare reimbursement rates which may negatively affect both orders and client receivables; the challenge to the classification of certain of our healthcare professionals as independent contractors; the impact of medical malpractice and other claims asserted against us; the disruption or adverse impact to our business as a result of a terrorist attack or breach of security of our data systems; our ability to carry out our business strategy and maintain sufficient cash flow and capital structure to support our business; our ability to meet our financial covenants, which if not met, could adversely affect our liquidity; the loss of key officers and management personnel that could adversely affect our ability to remain competitive; the effect of recognition by us of an impairment to goodwill; our ability to maintain and enhance the brand identities we have developed, at reasonable costs; and the effect of adjustments by us to accruals for self-insured retentions. Other factors that could cause actual results to differ from those implied by the forward-looking statements contained in this earnings release are set forth in the Company's Annual Report on Form 10-K for the year ended December 31, 2007, its Quarterly Reports on Form 10-Q and its Current Reports on Form 8-K. These statements reflect the Company's current beliefs and are based upon information currently available to it. Be advised that developments subsequent to this earnings release are likely to cause these statements to become outdated with the passage of time. The Company does not intend, however, to update the guidance provided today prior to its next earnings release.

  (Logo: http://www.newscom.com/cgi-bin/prnh/20060718/LATU121LOGO)


                             AMN Healthcare Services, Inc.
                       Condensed Consolidated Statements of Income
                     (dollars in thousands, except per share amounts)
                                      (unaudited)

                       Three Months Ended           Twelve Months Ended
                           December 31,                December 31,
                    2008    2007 (1)  % Chg     2008     2007 (1)     % Chg

  Revenue         $295,902  $285,899    3.5% $1,217,200 $1,164,022      4.6%
  Cost of
   revenue         219,966   209,936    4.8%    900,211    860,857      4.6%
    Gross profit    75,936    75,963    0.0%    316,989    303,165      4.6%
                     25.7%     26.6%              26.0%      26.0%
  Expenses:
    Selling,
     general and
     administrative 55,176    55,910   -1.3%    230,656    218,250      5.7%
                     18.6%     19.6%              18.9%      18.7%
    Depreciation
     and
     amortization    3,581     3,209   11.6%     14,439     11,674     23.7%

     Total
      expenses      58,757    59,119   -0.6%    245,095    229,924      6.6%
  Income from
   operations       17,179    16,844    2.0%     71,894     73,241     -1.8%
                      5.8%      5.9%               5.9%       6.3%
  Interest
   expense, net      2,669     2,928   -8.8%     10,690     12,457    -14.2%
  Income before
   income taxes     14,510    13,916    4.3%     61,204     60,784      0.7%
  Income tax
   expense           6,886     5,491   25.4%     26,847     24,403     10.0%
  Net income        $7,624    $8,425   -9.5%    $34,357    $36,381     -5.6%
                      2.6%      2.9%               2.8%       3.1%
  Net income
   per common
   share:
    Basic            $0.23     $0.25   -8.0%      $1.03      $1.06     -2.8%
    Diluted          $0.23     $0.25   -8.0%      $1.02      $1.04     -1.9%

  Weighted
   average
   common shares
   outstanding:
    Basic           32,575    33,828   -3.7%     33,375     34,377     -2.9%
    Diluted         32,870    34,232   -4.0%     33,811     34,880     -3.1%

  (1) Net income during the three and twelve months ended December 31, 2007
      was revised by $(0.6) million and $(0.2) million for the three and
      twelve months ended December 31, 2007 to reflect an immaterial
      correction of an error related to an issue regarding the
      deductibility of lodging per diem payments for income tax purposes.


                               AMN Healthcare Services, Inc.
                       Supplemental Financial and Operating Data
                     (dollars in thousands, except operating data)
                                        (unaudited)

                  Three Months Ended          Twelve Months Ended
                      December 31,                December 31,
                       % of           % of           % of             % of
               2008    Rev    2007    Rev    2008     Rev     2007     Rev
  Revenue
    Nurse
     and
     allied
     health-
     care
     staffing $207,313      $196,654        $843,747        $802,034
    Locum
     tenens
     staffing   76,413        76,179         321,954         310,525
    Physician
     permanent
     placement
     services   12,176        13,066          51,499          51,463
              $295,902      $285,899      $1,217,200      $1,164,022

  Reconciliation of Non-GAAP Items:

  Adjusted
   EBITDA(1)
    Nurse
     and
     allied
     health-
     care
     staffing  $14,240  6.9% $14,557  7.4%   $60,189  7.1%   $57,597   7.2%
    Locum
     tenens
     staffing    6,025  7.9%   4,254  5.6%    22,614  7.0%    22,867   7.4%
    Physician
     permanent
     placement
    Services     2,886 23.7%   3,414 26.1%    12,852 25.0%    12,843  25.0%
                23,151  7.8%  22,225  7.8%    95,655  7.9%    93,307   8.0%
  Depreciation
   and
   amortization  3,581         3,209          14,439          11,674
  Non-cash
   stock-based
   compensation  2,391         2,172           9,322           8,392
  Interest
   expense, net  2,669         2,928          10,690          12,457
  Income
   before
   income
   taxes        14,510        13,916          61,204          60,784
  Income
   tax
  expense        6,886         5,491          26,847          24,403
  Net
   income (2)   $7,624        $8,425         $34,357         $36,381

                                      Three Months        Twelve Months
                                         Ended                Ended
                                            December 31, 2008
  GAAP based diluted earnings
   per share (EPS)                        $0.23                $1.02

  Adjustments:

  Sales reserve adjustment                0.01                 0.02
  Rx Pro Health restructuring
   and legal expenses                     0.00                 0.03
                                          0.01                 0.05
  Pro Forma diluted
   earnings per share (3)                $0.24                $1.06*

  (*)Amount does not sum due to rounding


                     Three Months Ended            Twelve Months Ended
                         December 31,                   December 31,
                       2008      2007     % Chg      2008     2007    % Chg
  Gross Margin
    Nurse and
     allied
     healthcare
     staffing          23.6%     24.4%               23.9%     23.8%
    Locum
     tenens
     staffing          26.0%     26.1%               26.3%     26.0%
    Physician
     permanent
     placement
     services          58.7%     61.8%               59.4%     61.3%

  Operating
   Data:
    Nurse and
     allied
     healthcare
     staffing
       Average
        travelers
        on
        assignment(4)  6,865     6,645      3.3%     7,036     6,897   2.0%
       Revenue
        per
        traveler
        per day(5)   $328.25   $321.68      2.0%   $327.65   $318.60   2.8%
       Gross
        profit
        per traveler
        per day(5)    $77.41    $78.47     -1.4%    $78.34    $75.80   3.4%

    Locum tenens
     staffing
       Days
        filled (6)    53,145    51,639      2.9%   222,341   218,576   1.7%
       Revenue
        per day
        filled(6)  $1,437.82 $1,475.22     -2.5% $1,448.02 $1,420.67   1.9%
       Gross
        profit
        per day
        filled(6)    $374.37   $385.62     -2.9%   $380.68   $369.73   3.0%


                                   As of December 31,
                                2008              2007
  Leverage Ratio (7)             1.5               1.6

  (1) Adjusted EBITDA represents net income plus interest expense (net of
      interest income), income taxes, depreciation and amortization and
      non-cash stock-based compensation expense. Management presents
      adjusted EBITDA because it believes that adjusted EBITDA is a useful
      supplement to net income as an indicator of operating performance.
      Management believes that adjusted EBITDA is an industry-wide
      financial measure that is useful both to management and investors
      when evaluating the company's performance. Management also uses
      adjusted EBITDA for planning purposes. Management uses adjusted
      EBITDA to evaluate the company's performance because it believes that
      adjusted EBITDA more accurately reflects the company's results, as it
      excludes certain items, in particular non-cash stock-based
      compensation charges that management believes are not indicative of
      the company's operating performance. However, adjusted EBITDA is not
      intended to represent cash flows for the period, nor has it been
      presented as an alternative to operating or net income as an
      indicator of operating performance, and it should not be considered
      in isolation or as a substitute for measures of performance prepared
      in accordance with United States generally accepted accounting
      principles (GAAP). As defined, adjusted EBITDA is not necessarily
      comparable to other similarly titled captions of other companies due
      to potential inconsistencies in the method of calculation. While
      management believes that some of the items excluded from adjusted
      EBITDA are not indicative of the company's operating performance,
      these items do impact the income statement, and management therefore
      utilizes adjusted EBITDA as an operating performance measure in
      conjunction with GAAP measures such as net income.

  (2) Net income during the three months ended December 31, 2007 was
      revised by $(0.6) million and $(0.2) million respectively, to reflect
      an immaterial correction of an error related to an issue regarding
      the deductibility of lodging per diem payments for income tax
      purposes.

  (3) Pro forma EPS represents GAAP EPS plus certain restructuring and
      legal expenses, and sales reserve adjustments. Management presents
      pro forma EPS because it believes that pro forma EPS is a useful
      supplement to diluted earnings per share as an indicator of operating
      performance. Management believes such a measure provides a picture of
      the company's results that is more comparable among periods since it
      excludes the impact of items that may recur occasionally, but tend to
      be irregular as to timing, thereby distorting comparisons between
      periods. However, investors should note that this non-GAAP measure
      involves judgment by management (in particular, judgment as to what
      is classified as a special item to be excluded from pro forma EPS).
      As defined, pro forma EPS is not necessarily comparable to other
      similarly titled captions of other companies due to potential
      inconsistencies in the method of calculation. While management
      believes that some of the items excluded from pro forma EPS are not
      indicative of the company's operating performance, these items do
      impact the income statement, and management therefore utilizes pro
      forma EPS as an operating performance measure in conjunction with
      GAAP measures such as GAAP EPS.

  (4) Average travelers on assignment represents the average number of
      nurse and allied healthcare professionals on assignment during the
      period presented.

  (5) Revenue per traveler per day and gross profit per traveler per day
      represent the revenue and gross profit of the company's nurse and
      allied healthcare staffing segment divided by average travelers on
      assignment, divided by the number of days in the period presented.

  (6) Days filled is calculated by dividing the locum tenens hours filled
      during the period by 8 hours. Revenue per day filled and gross profit
      per day filled represent revenue and gross profit of the company's
      locum tenens staffing segment divided by days filled for the period
      presented.

  (7) Leverage ratio represents the ratio of the total debt outstanding at
      the end of the period to the Adjusted EBITDA for the past twelve
      months.


                          AMN Healthcare Services, Inc.
                       Condensed Consolidated Balance Sheets
                                (in thousands)
                                 (unaudited)

                                    December 31, September 30, December 31,
                                         2008        2008       2007 (1)
  Assets
  Current assets:
    Cash and cash equivalents          $11,316      $7,805     $18,495
    Accounts receivable, net           182,562     191,053     184,741
    Prepaid expenses                     9,523      10,121       9,583
    Income taxes receivable              3,440       1,103           -
    Deferred income taxes, net          18,085      18,113      18,116
    Other current assets                 4,901       4,233       2,048
      Total current assets             229,827     232,428     232,983

  Fixed assets, net                     24,018      24,645      24,600
  Goodwill, net                        252,875     252,823     241,266
  Intangible assets, net               122,845     124,050     113,535
  Deposits and other assets             13,252      14,645      11,274

        Total assets                  $642,817    $648,591    $623,658

  Liabilities and stockholders'
   equity
  Current liabilities:
    Bank overdraft                      $3,995        $457          $-
    Accounts payable and accrued
     expenses                           24,420      28,126      22,231
    Accrued compensation and benefits   44,871      49,976      43,446
    Income tax payable                       -           -       2,774
    Revolving credit facility           31,500      36,500           -
    Current portion of notes payable    14,580      14,949      26,616
    Deferred revenue                     7,184       7,971       7,647
    Other current liabilities           14,722      14,567      28,169
      Total current liabilities        141,272     152,546     130,883

  Notes payable, less current portion  100,236     106,512     120,352
  Deferred income taxes, net            58,466      58,962      61,124
  Other long-term liabilities           58,710      55,289      45,099
      Total liabilities                358,684     373,309     357,458

  Stockholders' equity                 284,133     275,282     266,200

      Total liabilities and
       stockholders' equity           $642,817    $648,591    $623,658

  (1) Other current liabilities, other long-term liabilities and
      stockholder's equity were revised by $2.3 million, $7.6 million
      and $9.9 million, respectively, as of December 31, 2007, to
      reflect an immaterial correction of an error related to an issue
      regarding the deductibility of lodging per diem payments for
      income tax purposes.


                            AMN Healthcare Services, Inc.
                     Condensed Consolidated Cash Flow Statement
                                 (in thousands)
                                   (unaudited)

                           Three Months Ended      Twelve Months Ended
                        December 31, December 31, December 31, December 31,
                            2008        2007         2008         2007

  Net cash provided by
   operating activities    $13,802     $25,326      $63,694      $79,636

  Net cash used in
   investing activities     (1,819)     (2,656)     (48,247)     (14,629)

  Net cash used in
   financing activities     (8,296)    (10,316)     (22,334)     (50,923)

  Effect of exchange
   rates on cash              (176)        (29)        (292)         (11)

    Net increase
     (decrease) in cash
     and cash equivalents    3,511      12,325       (7,179)      14,073

    Cash and cash
     equivalents at
     beginning of
     period                  7,805       6,170       18,495        4,422

    Cash and cash
     equivalents at
     end of period         $11,316     $18,495      $11,316      $18,495


  Contact:
  David C. Dreyer
  Chief Financial Officer
  Christopher Powell
  Director, Investor Relations
  866.861.3229

First Call Analyst:
FCMN Contact: christopher.powell@amnhealthcare.com

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http://photoarchive.ap.org/
PRN Photo Desk, photodesk@prnewswire.com

SOURCE: AMN Healthcare Services, Inc.

CONTACT: David C. Dreyer, Chief Financial Officer, or Christopher
Powell, Director, Investor Relations, both of AMN Healthcare Services, Inc.,
1-866-861-3229

Web Site: http://www.amnhealthcare.com/

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