UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
____________________
FORM 10-Q
____________________
xQUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
 For the quarterly period ended September 30, 2017March 31, 2018
 OR
oTRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
 
For the transition period from                       to                     
Commission File No.: 001-16753

amnlogoa01a01a01a09.jpg
AMN HEALTHCARE SERVICES, INC.
(Exact Name of Registrant as Specified in Its Charter)

Delaware 06-1500476
(State or Other Jurisdiction of
Incorporation or Organization)
 
(I.R.S. Employer
Identification No.)
  
12400 High Bluff Drive, Suite 100
San Diego, California
 92130
(Address of Principal Executive Offices) (Zip Code)

Registrant’s Telephone Number, Including Area Code: (866) 871-8519
____________________

Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.  Yes  x  No  o
Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).  Yes  x No  o
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and "emerging growth company" in Rule 12b-2 of the Exchange Act. (Check one):
Large accelerated filer   x
 
Accelerated filer   o
 
Non-accelerated filer  o
Smaller reporting company o
 
Emerging growth company o
  
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. o
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange
Act).  Yes   o  No  x
As of November 1, 2017May 2, 2018, there were 47,772,33347,855,091 shares of common stock, $0.01 par value, outstanding.
 

TABLE OF CONTENTS
 
Item Page Page
  
PART I - FINANCIAL INFORMATION PART I - FINANCIAL INFORMATION 
  
1.
2.
3.
4.
  
PART II - OTHER INFORMATION PART II - OTHER INFORMATION 
  
  
1.
1A.
2.
3.
4.
5.
6.


PART I - FINANCIAL INFORMATION

Item 1. Condensed Consolidated Financial Statements

AMN HEALTHCARE SERVICES, INC.
 
CONDENSED CONSOLIDATED BALANCE SHEETS
(Unaudited and in thousands, except par value)
 
September 30, 2017 December 31, 2016March 31, 2018 December 31, 2017
ASSETS      
Current assets:      
Cash and cash equivalents$19,625
 $10,622
$54,499
 $15,147
Accounts receivable, net of allowances of $11,381 and $11,376 at September 30, 2017 and December 31, 2016, respectively343,596
 341,977
Accounts receivable, net of allowances of $10,106 and $9,801 at March 31, 2018 and December 31, 2017, respectively338,600
 350,496
Accounts receivable, subcontractor37,200
 49,233
39,027
 41,012
Prepaid expenses15,832
 14,189
18,880
 16,505
Other current assets26,220
 34,607
38,364
 50,993
Total current assets442,473
 450,628
489,370
 474,153
Restricted cash, cash equivalents and investments34,380
 31,287
60,236
 64,315
Fixed assets, net of accumulated depreciation of $94,531 and $84,865 at September 30, 2017 and December 31, 2016, respectively68,188
 59,954
Fixed assets, net of accumulated depreciation of $101,182 and $97,889 at March 31, 2018 and December 31, 2017, respectively75,530
 73,431
Other assets73,962
 57,534
84,112
 74,366
Goodwill340,596
 341,754
340,596
 340,596
Intangible assets, net of accumulated amortization of $85,990 and $72,057 at September 30, 2017 and December 31, 2016, respectively231,791
 245,724
Intangible assets, net of accumulated amortization of $95,073 and $90,685 at March 31, 2018 and December 31, 2017, respectively222,708
 227,096
Total assets$1,191,390
 $1,186,881
$1,272,552
 $1,253,957
LIABILITIES AND STOCKHOLDERS’ EQUITY      
Current liabilities:      
Accounts payable and accrued expenses$117,934
 $137,512
$122,402
 $130,319
Accrued compensation and benefits111,984
 107,993
117,415
 121,423
Current portion of notes payable, less unamortized fees
 3,750
Deferred revenue9,609
 8,924
8,746
 8,384
Other current liabilities5,440
 16,611
2,616
 5,146
Total current liabilities244,967
 274,790
251,179
 265,272
      
Notes payable, less unamortized fees319,652
 359,192
320,034
 319,843
Deferred income taxes, net11,899
 21,420
21,922
 27,036
Other long-term liabilities82,673
 82,096
80,201
 79,279
Total liabilities659,191
 737,498
673,336
 691,430
Commitments and contingencies

 



 

Stockholders’ equity:      
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at September 30, 2017 and December 31, 2016
 
Common stock, $0.01 par value; 200,000 shares authorized; 48,402 issued and 47,772 outstanding, respectively, at September 30, 2017 and 48,055 issued and 47,612 outstanding, respectively, at December 31, 2016484
 481
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at March 31, 2018 and December 31, 2017
 
Common stock, $0.01 par value; 200,000 shares authorized; 48,760 issued and 47,830 outstanding, respectively, at March 31, 2018 and 48,411 issued and 47,481 outstanding, respectively, at December 31, 2017488
 484
Additional paid-in capital451,136
 452,491
445,285
 453,351
Treasury stock, at cost (630 and 443 shares at September 30, 2017 and December 31, 2016, respectively)(20,358) (13,261)
Treasury stock, at cost (930 shares at March 31, 2018 and December 31, 2017)(33,425) (33,425)
Retained earnings101,062
 9,671
186,999
 142,229
Accumulated other comprehensive income (loss)(125) 1
Accumulated other comprehensive loss(131) (112)
Total stockholders’ equity532,199
 449,383
599,216
 562,527
Total liabilities and stockholders’ equity$1,191,390
 $1,186,881
$1,272,552
 $1,253,957
 
See accompanying notes to unaudited condensed consolidated financial statements.

AMN HEALTHCARE SERVICES, INC.
 
CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME
(Unaudited and in thousands, except per share amounts)
 
Three Months Ended September 30, Nine Months Ended September 30,Three Months Ended March 31,
2017 2016 2017 20162018 2017
Revenue$494,406
 $472,636
 $1,479,378
 $1,414,367
$522,489
 $495,169
Cost of revenue334,867
 318,169
 997,051
 953,249
354,665
 333,393
Gross profit159,539
 154,467
 482,327
 461,118
167,824
 161,776
Operating expenses:          
Selling, general and administrative100,579
 99,995
 299,325
 297,359
104,737
 102,073
Depreciation and amortization8,132
 7,789
 23,759
 21,888
7,886
 7,668
Total operating expenses108,711
 107,784
 323,084
 319,247
112,623
 109,741
Income from operations50,828
 46,683
 159,243
 141,871
55,201
 52,035
Interest expense, net, and other4,837
 3,016
 14,895
 9,065
5,335
 5,130
Income before income taxes45,991
 43,667
 144,348
 132,806
49,866
 46,905
Income tax expense17,863
 16,371
 52,957
 53,319
7,185
 14,897
Net income$28,128
 $27,296
 $91,391
 $79,487
$42,681
 $32,008
          
Other comprehensive income (loss):          
Foreign currency translation and other(73) 40
 (111) 165
(19) 3
Cash flow hedge, net of income taxes
 231
 (15) (343)
 43
Other comprehensive income (loss)(73) 271
 (126) (178)(19) 46
          
Comprehensive income$28,055
 $27,567
 $91,265
 $79,309
$42,662
 $32,054
          
Net income per common share:          
Basic$0.59
 $0.57
 $1.91
 $1.66
$0.89
 $0.67
Diluted$0.57
 $0.55
 $1.85
 $1.61
$0.87
 $0.65
Weighted average common shares outstanding:          
Basic47,912
 48,049
 47,870
 47,993
47,733
 47,782
Diluted49,445
 49,410
 49,480
 49,287
49,116
 49,520
          
 
See accompanying notes to unaudited condensed consolidated financial statements.


AMN HEALTHCARE SERVICES, INC.
 
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(Unaudited and in thousands)
Nine Months Ended September 30,Three Months Ended March 31,
2017 20162018 2017 *As Adjusted
Cash flows from operating activities:      
Net income$91,391
 $79,487
$42,681
 $32,008
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization23,759
 21,888
7,886
 7,668
Non-cash interest expense and other1,718
 1,180
600
 579
Loss on debt extinguishment574
 
Change in fair value of contingent consideration66
 (88)
 23
Increase in allowances for doubtful accounts and sales credits9,012
 6,746
2,257
 5,408
Provision for deferred income taxes(9,512) (3,209)(5,113) (4,900)
Share-based compensation7,720
 8,795
2,864
 2,681
Excess tax benefits from share-based compensation
 (2,764)
Loss on disposal or sale of fixed assets130
 45
5
 65
Amortization of discount on investments(112) 
(15) 
Changes in assets and liabilities, net of effects from acquisitions:      
Accounts receivable(10,631) (42,594)9,154
 1,787
Accounts receivable, subcontractor12,033
 8,681
1,985
 395
Income taxes receivable(1,854) 6,160
9,881
 361
Prepaid expenses(1,643) (195)(2,375) (5,309)
Other current assets10,155
 (10,109)2,825
 266
Other assets(5,204) (4,295)(89) (3,139)
Accounts payable and accrued expenses(20,442) (791)(7,816) (1,599)
Accrued compensation and benefits3,991
 10,761
(4,007) (8,351)
Other liabilities(5,112) 5,736
(1,498) 16,825
Deferred revenue678
 256
(52) (84)
Restricted cash, cash equivalents and investments balance(9,761) (870)
Restricted investments balance(12) 
Net cash provided by operating activities96,382
 84,820
59,735
 44,684
      
Cash flows from investing activities:      
Purchase and development of fixed assets(17,168) (17,705)(5,703) (5,498)
Purchase of investments(11,021) 
(2,086) (4,804)
Proceeds from maturity of investments17,200
 
2,900
 2,000
Change in restricted cash, cash equivalents and investments balance601
 
Payments to fund deferred compensation plan(10,056) (5,665)(4,724) (4,998)
Equity investment(2,000) 
Cash paid for acquisitions, net of cash received
 (216,553)
Cash paid for working capital adjustments and holdback liability for prior year acquisitions(1,000) (1,348)
Net cash used in investing activities(23,444) (241,271)(9,613) (13,300)

 Nine Months Ended September 30,
 2017 2016
Cash flows from financing activities:   
Capital lease repayments
 (6)
Payments on term loans(44,063) (8,438)
Proceeds from term loans
 75,000
Payments on revolving credit facility
 (24,000)
Proceeds from revolving credit facility
 124,000
Repurchase of common stock(7,097) 
Payment of financing costs
 (448)
Earn-out payments for prior acquisitions(3,677) (900)
Proceeds from termination of derivative contract85
 
Cash paid for shares withheld for taxes(9,072) (5,554)
Excess tax benefits from equity awards vested and exercised
 2,764
Net cash provided by (used in) financing activities(63,824) 162,418
Effect of exchange rate changes on cash(111) 165
Net increase in cash and cash equivalents9,003
 6,132
Cash and cash equivalents at beginning of period10,622
 9,576
Cash and cash equivalents at end of period$19,625
 $15,708
    
Supplemental disclosures of cash flow information:   
Cash paid for interest (net of $113 and $158 capitalized for the nine months ended September 30, 2017 and 2016, respectively)$9,395
 $7,106
Cash paid for income taxes$65,998
 $52,684
Acquisitions:   
Fair value of tangible assets acquired in acquisitions, net of cash received$
 $18,789
Goodwill
 136,521
Intangible assets
 89,064
Liabilities assumed
 (21,921)
Holdback provision
 (1,830)
Earn-out liabilities
 (4,070)
Net cash paid for acquisitions$
 $216,553
Supplemental disclosures of non-cash investing and financing activities:   
Purchase of fixed assets recorded in accounts payable and accrued expenses$3,156
 $1,370
 Three Months Ended March 31,
 2018 2017 *As Adjusted
Cash flows from financing activities:   
Payments on term loans
 (938)
Payment of financing costs(2,331) 
Earn-out payments for prior acquisitions(1,713) (3,677)
Cash paid for shares withheld for taxes(10,926) (7,313)
Net cash used in financing activities(14,970) (11,928)
Effect of exchange rate changes on cash(19) 4
Net increase in cash, cash equivalents and restricted cash35,133
 19,460
Cash, cash equivalents and restricted cash at beginning of period98,894
 51,028
Cash, cash equivalents and restricted cash at end of period$134,027
 $70,488
    
Supplemental disclosures of cash flow information:   
Cash paid for interest (net of $104 and $22 capitalized for the three months ended March 31, 2018 and 2017, respectively)$201
 $545
Cash paid for income taxes$2,731
 $2,812
    
Supplemental disclosures of non-cash investing and financing activities:   
Purchase of fixed assets recorded in accounts payable and accrued expenses$2,860
 $2,440
* See Note (1) for a summary of adjustments.
See accompanying notes to unaudited condensed consolidated financial statements.

AMN HEALTHCARE SERVICES, INC.
 
NOTES TO UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(in thousands, except per share amounts)
 
1. BASIS OF PRESENTATION
The condensed consolidated balance sheets and related condensed consolidated statements of comprehensive income and cash flows contained in this Quarterly Report on Form 10-Q (this “Quarterly Report”), which are unaudited, include the accounts of AMN Healthcare Services, Inc. and its wholly-owned subsidiaries (collectively, the “Company”). All significant intercompany balances and transactions have been eliminated in consolidation. In the opinion of management, all entries necessary for a fair presentation of such unaudited condensed consolidated financial statements have been included. These entries consisted of all normal recurring items. The results of operations for the interim period are not necessarily indicative of the results to be expected for any other interim period or for the entire fiscal year or for any future period.
The unaudited condensed consolidated financial statements do not include all information and notes necessary for a complete presentation of financial position, results of operations and cash flows in conformity with accounting principles generally accepted in the United States. Please refer to the Company’s audited consolidated financial statements and the related notes for the fiscal year ended December 31, 2016,2017, contained in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2016,2017, filed with the Securities and Exchange Commission on February 17, 16, 2018 (“2017 (“2016 Annual Report”).
The preparation of financial statements in conformity with accounting principles generally accepted in the United States 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 asset impairments, accruals for self-insurance, compensation and related benefits, accounts receivable, contingencies and litigation, earn-out liabilities, and income taxes. Actual results could differ from those estimates under different assumptions or conditions.
Recently Adopted Accounting Pronouncements

In March 2016,May 2014, the Financial Accounting Standards Board (“FASB”) issued Accounting StandardsStandard Update (“ASU”("ASU") 2016-09, “Stock Compensation - Improvements to Employee Share-Based Payment Accounting.2014-09, Revenue from Contracts with Customers (Topic 606).” The FASB also issued a series of other ASUs, which update ASU 2014-09 (collectively, the “new revenue recognition standard”). This new standard replaces all previous U.S. GAAP guidance attemptson this topic and eliminates all industry-specific guidance. The new revenue recognition standard provides a unified model to simplifydetermine when and how revenue is recognized. The core principle is that a company should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration for which the entity expects to be entitled in exchange for those goods or services. The Company adopted this standard effective January 1, 2018, using the modified retrospective transition method applied to those contracts which were not completed as of that date. Revenue from substantially all of our contracts with customers continues to be recognized over time as services are rendered. The Company recognized the cumulative effect of adopting this guidance as an adjustment to its opening balance of retained earnings of $2,089, net of tax, primarily related to capitalization of contract costs. Prior period amounts are not retrospectively adjusted and continue to be reported in accordance with the accounting standards in effect for share-based payment transactionsthose periods. The impact of the adoption of the new standard was not material to the Company’s condensed consolidated financial statements for the quarter ended March 31, 2018. The Company expects the impact to be immaterial on an ongoing basis. See additional information regarding revenue recognition and disaggregated revenue in several areas, includingNote (2), “Revenue Recognition” and Note (4), “Segment Information,” respectively.

In August 2016, the following: income tax consequences, classificationFASB issued ASU 2016-15, “Statement of awards as either equity or liabilities, forfeitures, expected term,Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments.” The standard provides guidance on how certain cash receipts and payments are presented and classified in the statement of cash flows. For public entities, ASU 2016-15 is effective for fiscal years beginning after December 15, 2017, and interim periods within those annual periods, and requires a retrospective approach. The Company adopted this standard effective January 1, 2018 and the adoption did not have a material effect on the Company’s consolidated financial statements.
In November 2016, the FASB issued ASU 2016-18, “Statement of Cash Flows (Topic 230): Restricted Cash.” The standard requires that a statement of cash flows classification.explains the change during the period in the total of cash, cash equivalents, and amounts generally described as restricted cash or restricted cash equivalents (collectively, "restricted cash"). Therefore, restricted cash should be included with cash and cash equivalents when reconciling the beginning-of-period and end-of-period total amounts shown on the statement of cash flows. The new guidance is effective for interim and annual periods beginning after December 15, 2017. The Company adopted this pronouncement prospectively beginningstandard retrospectively effective January 1, 2017. Accordingly,2018 and included certain

restricted cash amounts for the prior period has not been adjusted andended March 31, 2017 within the primary effectsaccompanying condensed consolidated statements of cash flows. These adjustments had no effect on previously reported results of operations or retained earnings. The following table provides a summary of the adoption for the current period are as follows:adjustments from amounts previously reported.
 Three Months Ended March 31, 2017
 As Previously Reported Adjustments As Adjusted
Cash flows from operating activities:     
Changes in assets and liabilities:  

  
Other Current Assets2,945
 (2,679) 266
Restricted cash, cash equivalents and investments balance4,951
 (4,951) 
Net cash provided by operating activities52,314
 (7,630) 44,684
      
Cash flows from investing activities     
Change in restricted cash, cash equivalents and investments balance(1) 1
 
Net cash used in investing activities(13,301) 1
 (13,300)
      
Net increase in cash, cash equivalents and restricted cash$27,089
 $(7,629) $19,460
Cash, cash equivalents and restricted cash at the beginning of period10,622
 40,406
 51,028
Cash, cash equivalents and restricted cash at the end of period$37,711
 $32,777
 $70,488
The Company recorded $56following table provides a reconciliation of cash, cash equivalents and $5,381 of tax benefitsrestricted cash reported within income tax expense for the threeaccompanying condensed consolidated balance sheets and nine months ended September 30, 2017, respectively, related notes to the excess tax benefit on share-based compensation. Prior to adoption, this amount would have been recorded as additional paid-in capital;
The Company continued to estimate the number of awards expected to be forfeited in accordance with its existing accounting policy, which is to estimate forfeitures when recording share-based compensation expense;
The Company excluded the excess tax benefits from the assumed proceeds available to repurchase sharesamounts presented in the computationaccompanying condensed consolidated statements of its diluted earnings per share for the three and nine months ended September 30, 2017. The effect of this change on its diluted earnings per share was not significant; andcash flows.
For the nine months ended September 30, 2017, cash flows related to excess tax benefits were classified as an operating activity.
 March 31, 2018 December 31, 2017
Cash and cash equivalents$54,499
 $15,147
Restricted cash and cash equivalents (included in other current assets)24,579
 25,506
Restricted cash, cash equivalents and investments60,236
 64,315
Total cash, cash equivalents and restricted cash and investments139,314
 104,968
Less restricted investments(5,287) (6,074)
Total cash, cash equivalents and restricted cash$134,027
 $98,894

There were no other material impacts to the Company's consolidated financial statements as a result of adopting thisthese updated standard.

2. BUSINESS COMBINATIONS
As set forth below, the Company completed three acquisitions during 2016. The Company accounted for each acquisition using the acquisition method of accounting. Accordingly, it recorded the tangible and intangible assets acquired and liabilities assumed at their estimated fair values as of the applicable date of acquisition. For each acquisition, the Company did not incur any material acquisition-related costs.
Peak Provider Solutions Acquisition
On June 3, 2016, the Company completed its acquisition of Peak Provider Solutions (“Peak”), which provides remote medical coding and consulting solutions to hospitals and physician medical groups nationwide. The addition of Peak has expanded the Company’s workforce solutions and enables the Company to offer services in coding diagnosis and procedure codes, which is critical to clinical quality reporting and the financial health of healthcare organizations. The initial purchase price of $52,125 included (1) $51,645 cash consideration paid upon acquisition, funded through cash-on-hand, net of cash received, and borrowings under the Company’s revolving credit facility, and (2) a contingent earn-out payment of up to $3,000 with an estimated fair value of $480 as of the acquisition date. The contingent earn-out payment was based on the operating results of Peak for the year ending December 31, 2016, which resulted in no earn-out payment. As the acquisition was not considered significant, pro forma information has not been provided. The results of Peak have been included in the Company’s other workforce solutions segment since the date of acquisition. During the third quarter of 2016, an additional $275 of cash consideration was paid to the selling shareholders for the final working capital settlement.
The allocation of the $52,400 purchase price, which included the additional cash consideration paid for the final working capital settlement, consisted of (1) $5,658 of fair value of tangible assets acquired, (2) $9,346 of liabilities assumed, (3) $19,220 of identified intangible assets, and (4) $36,868 of goodwill, none of which is deductible for tax purposes. The fair value of intangible assets primarily includes $7,600 of trademarks and $11,500 of customer relationships with a weighted average useful life of approximately thirteen years.
HealthSource Global Staffing Acquisition
On January 11, 2016, the Company completed its acquisition of HealthSource Global Staffing (“HSG”), which provides labor disruption and rapid response staffing. The acquisition helps the Company expand its service lines and provide clients with rapid response staffing services. The initial purchase price of $8,511 included (1) $2,799 cash consideration paid upon acquisition, funded through cash-on-hand, net of cash received, and settlement of the pre-existing relationship between AMN and HSG, (2) $2,122 cash holdback for potential indemnification claims, and (3) a tiered contingent earn-out payment of up to $4,000 with an estimated fair value of $3,590 as of the acquisition date. The contingent earn-out payment is comprised of (A) up to $2,000 based on the operating results of HSG for the year ending December 31, 2016, of which, $1,930 was paid in March 2017, and (B) up to $2,000 based on the operating results of HSG for the year ending December 31, 2017. As the acquisition was not considered significant, pro forma information has not been provided. The results of HSG have been included in the Company’s nurse and allied solutions segment since the date of acquisition. During the third quarter of 2016, the final working capital settlement resulted in $292 due from the selling shareholders to the Company, which was settled through a reduction to a cash holdback.
The allocation of the $8,219 purchase price, which was reduced by the final working capital settlement, consisted of (1) $1,025 of fair value of tangible assets acquired, (2) $3,698 of liabilities assumed, (3) $3,944 of identified intangible assets, and (4) $6,948 of goodwill, none of which is deductible for tax purposes. The intangible assets include the fair value of trademarks, customer relationships, staffing databases, and covenants not to compete with a weighted average useful life of approximately eight years.
B.E. Smith Acquisition
On January 4, 2016, the Company completed its acquisition of B.E. Smith (“BES”), a full-service healthcare interim leadership placement and executive search firm, for $162,232 in cash, net of cash received, and settlement of the pre-existing relationship between AMN and BES. BES places interim leaders and executives across all healthcare settings, including acute care hospitals, academic medical and children’s hospitals, physician practices, and post-acute care providers. The acquisition provides the Company additional access to healthcare executives and enhances its integrated services to hospitals, health systems, and other healthcare facilities across the nation. To help finance the acquisition, the Company entered into the First Amendment to the Credit Agreement (the “First Amendment”), which provided $125,000 of additional available borrowings to the Company. The First Amendment was more fully described in “Item 8. Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of our 2016 Annual Report. The results of BES have been included in the Company’s other workforce solutions segment since the date of acquisition. During the second quarter of 2016, $524 was returned to the Company for the final working capital settlement.

The allocation of the $161,708 purchase price, which was reduced by the final working capital settlement, consisted of (1) $11,953 of fair value of tangible assets acquired, (2) $7,272 of liabilities assumed, (3) $65,900 of identified intangible assets, and (4) $91,127 of goodwill, most of which is deductible for tax purposes. The intangible assets acquired have a weighted average useful life of approximately fifteen years. The following table summarizes the fair value and useful life of each intangible asset acquired:
   Fair Value Useful Life
     (in years)
Identifiable intangible assets   
 Tradenames and Trademarks $26,300
 20
 Customer Relationships 25,700
 12
 Staffing Database 13,000
 10
 Non-Compete Agreements 900
 5
   $65,900
  
standards.

3.2. REVENUE RECOGNITION
Revenue primarily consists of fees earned from the temporary and permanent placement of healthcare professionals and executives as well as from the Company’s SaaS-based technology, including its vendor management systems and its scheduling software. Revenue is recognized when control of these services is transferred to the customers, in an amount that reflects the consideration the Company expects to be entitled to in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by theclinical and non-clinical healthcare professional or executive.professionals. Under the Company’s managed services program arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own poolnetwork 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. Payables to subcontractors of $38,167 and $51,973 were included in accounts payable and accrued expenses in the unaudited condensed consolidated balance sheet as of September 30, 2017 and the consolidated balance sheet as of December 31, 2016, respectively. Revenue from recruitment andexecutive search, physician permanent placement, and recruitment process outsourcing services is recognized as the services are provided and upon successful placements.rendered. The Company’s SaaS-based revenue is recognized ratably over the applicable arrangement’s service period. Fees
The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. During the three months ended March 31, 2018, the amount recognized as revenue that was previously deferred was not material.

Under the new revenue standard, the Company has elected to apply the following practical expedients and optional exemptions:
Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within selling, general and administrative expenses.
Recognize revenue in the amount of consideration to which the Company has a right to invoice the customer if that amount corresponds directly with the value to the customer of the Company’s services completed to date.
Exemptions from disclosing the value of unsatisfied performance obligations for (i) contracts with an original expected length of one year or less, (ii) contracts for which revenue is recognized in the amount of consideration to which the Company has a right to invoice for services performed and (iii) contracts for which variable consideration is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct service that forms part of a single performance obligation.
See additional information regarding adoption of the new revenue standard in Note (1), “Basis of Presentation” and additional disclosures required by the new revenue standard in Note (4), “Segment Information.”

4.3. NET INCOME PER COMMON SHARE
Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the reporting period. The following table sets forth the computation of basic and diluted net income per common share for the three months and nine months ended September 30, 2017March 31, 2018 and 20162017, respectively:
Three Months Ended September 30, Nine Months Ended September 30,Three Months Ended March 31,
2017 2016 2017 20162018 2017
Net income$28,128
 $27,296
 $91,391
 $79,487
$42,681
 $32,008
          
Net income per common share - basic$0.59
 $0.57
 $1.91
 $1.66
$0.89
 $0.67
Net income per common share - diluted$0.57
 $0.55
 $1.85
 $1.61
$0.87
 $0.65
          
Weighted average common shares outstanding - basic47,912
 48,049
 47,870
 47,993
47,733
 47,782
Plus dilutive effect of potential common shares1,533
 1,361
 1,610
 1,294
1,383
 1,738
Weighted average common shares outstanding - diluted49,445
 49,410
 49,480
 49,287
49,116
 49,520
Share-based awards to purchase 10 and 149 shares of common stock were not included in the above calculation of diluted net income per common share for the three and nine months ended September 30, 2017, respectively, because the effect of these instruments was anti-dilutive. Share-based awards to purchase 11 and 18 shares of common stock were not included in the above calculation of diluted net income per common share for the three and nine months ended September 30, 2016March 31, 2018 because the effect of these instruments was anti-dilutive.

5.4. SEGMENT INFORMATION

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

The following table provides a reconciliation of revenue and operating income by reportable segment to consolidated results and was derived from each segment’s internal financial information as used for corporate management purposes:
 Three Months Ended September 30, Nine Months Ended September 30,
 2017 2016 2017 2016
Revenue       
Nurse and allied solutions$302,933
 $286,810
 $917,183
 $877,197
Locum tenens solutions111,415
 108,553
 322,473
 320,420
Other workforce solutions80,058
 77,273
 239,722
 216,750
 $494,406
 $472,636
 $1,479,378
 $1,414,367
Segment operating income       
Nurse and allied solutions$40,807
 $37,396
 $134,638
 $118,517
Locum tenens solutions14,438
 14,026
 39,028
 43,634
Other workforce solutions19,890
 20,867
 61,788
 56,311
 75,135
 72,289
 235,454
 218,462
Unallocated corporate overhead13,698
 15,113
 44,732
 45,908
Depreciation and amortization8,132
 7,789
 23,759
 21,888
Share-based compensation2,477
 2,704
 7,720
 8,795
Interest expense, net, and other4,837
 3,016
 14,895
 9,065
Income before income taxes$45,991
 $43,667
 $144,348
 $132,806
The following table summarizes the activity related to the carrying value of goodwill by reportable segment:
 Nurse and Allied Solutions Locum Tenens Solutions Other Workforce Solutions Total
Balance, January 1, 2017$104,306
 $19,743
 $217,705
 $341,754
Goodwill adjustment for HSG acquisition(1,199) 
 
 (1,199)
Goodwill adjustment for Peak acquisition
 
 41
 41
Balance, September 30, 2017$103,107
 $19,743
 $217,746
 $340,596
Accumulated impairment loss as of December 31, 2016 and September 30, 2017$154,444
 $53,940
 $6,555
 $214,939
 Three Months Ended March 31,
 2018 2017
Revenue   
Nurse and allied solutions$338,179
 $313,523
Locum tenens solutions103,117
 102,843
Other workforce solutions81,193
 78,803
 $522,489
 $495,169
Segment operating income   
Nurse and allied solutions$51,805
 $45,980
Locum tenens solutions9,958
 12,219
Other workforce solutions19,851
 19,857
 81,614
 78,056
Unallocated corporate overhead15,663
 15,672
Depreciation and amortization7,886
 7,668
Share-based compensation2,864
 2,681
Interest expense, net, and other5,335
 5,130
Income before income taxes$49,866
 $46,905
The Company offers a comprehensive managed services program, in which the Company manages all or a portion of a client's contingent staffing needs. This service includes both the placement of the Company's own healthcare professionals and the utilization of other staffing agencies to fulfill the client's staffing needs. See additional information in Note (2), “Revenue Recognition.” For the three months ended March 31, 2018 and 2017, revenue under the Company’s managed services program arrangements comprised approximately 63% and 57% for nurse and allied solutions revenue, 14% and 12% for locum tenens solutions revenue and 9% and 7% for other workforce solutions revenue, respectively.

5. NEW CREDIT AGREEMENT


On February 9, 2018, the Company entered into a credit agreement (the “New Credit Agreement”) with several lenders to provide for a $400,000 secured revolving credit facility (the “Senior Credit Facility”) to replace its then-existing credit facilities. The Senior Credit Facility includes a $50,000 sublimit for the issuance of letters of credit and a $50,000 sublimit for swingline loans. The obligations of the Company under the New Credit Agreement and the Senior Credit Facility 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 LIBOR plus a spread of 1.00% to 2.00% or a base rate plus a spread of 0.00% to 1.00%. The applicable spread is determined quarterly based upon the Company’s consolidated net leverage ratio. The Senior Credit Facility is available for working capital, capital expenditures, permitted acquisitions and general corporate purposes. The maturity date of the Senior Credit Facility is February 9, 2023.

In connection with obtaining the New Credit Agreement, the Company incurred $2,331 in fees paid to lenders and other third parties, which were capitalized and are amortized to interest expense over the term of the New Credit Facility. In addition, the Company wrote off $574 of unamortized financing fees during the three months ended March 31, 2018 relating to the prior credit facilities.

6. FAIR VALUE MEASUREMENT
 
The Company’s valuation techniques and inputs used to measure fair value and the definition of the three levels (Level 1, Level 2, and Level 3) of the fair value hierarchy are disclosed in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note 4—Fair Value Measurement” of the 20162017 Annual Report. The Company has not changed the valuation techniques or inputs it uses for its fair value measurement during the ninethree months ended September 30, 2017.March 31, 2018.
Assets and Liabilities Measured on a Recurring Basis
The Company’s restricted cash equivalents that serve as collateral for the Company’s outstanding letters of credit
typically consist of money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs.

The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company primarily consist of commercial paper that is measured at observable market prices for identical securities that are traded in less active markets, which are Level 2 inputs. Of the $28,538$30,911 commercial paper issued and outstanding as of September 30, 2017, $5,076March 31, 2018, $5,287 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, 2016,2017, the Company had $25,610$28,708 commercial paper issued and outstanding, of which $11,152$6,074 had original maturities greater than three months and were considered available-for-sale securities.
The Company’s interest rate swap was measured at fair value using a discounted cash flow analysis that includes the contractual terms, including the period to maturity, and Level 2 observable market-based inputs, including interest rate curves. The fair value of the swap was determined by netting the discounted future fixed cash receipts payments and the discounted expected variable cash receipts. The variable cash receipts were based on an expectation of future interest rates (forward curves) derived from observable market interest rate yield curves. The valuation also considered credit risk adjustments that were necessary to reflect the probability of default by the counterparty or the Company, which were considered Level 3 inputs. On May 3, 2017, the Company terminated the remaining interest rate swap.
The Company’s contingent consideration liabilities are measured at fair value using probability-weighted discounted cash flow analysis for the acquired companies, which are Level 3 inputs.
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 September 30, 2017Fair Value Measurements as of March 31, 2018
Total 
Quoted Prices in
Active Markets
for Identical
Assets
(Level 1)
 Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3)Total 
Quoted Prices in
Active Markets
for Identical
Assets
(Level 1)
 Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3)
Money market funds$4,026
 $4,026
 $
 $
$2,720
 $2,720
 $
 $
Commercial paper28,538
 
 28,538
 
30,911
 
 30,911
 
Acquisition contingent consideration earn-out liabilities(1,952) 
 
 (1,952)

Fair Value Measurements as of December 31, 2016Fair Value Measurements as of December 31, 2017
Total 
Quoted Prices in
Active Markets
for Identical
Assets
(Level 1)
 Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3)Total 
Quoted Prices in
Active Markets
for Identical
Assets
(Level 1)
 Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3)
Money market funds$4,627
 $4,627
 $
 $
$2,713
 $2,713
 $
 $
Commercial paper25,610
 
 25,610
 
28,708
 
 28,708
 
Interest rate swap asset24
 
 24
 
Acquisition contingent consideration earn-out liabilities(6,816) 
 
 (6,816)(2,070) 
 
 (2,070)
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:
 Three Months Ended September 30,
 2017 2016
Balance as of July 1,$(1,932)
$(7,054)
Change in fair value of contingent consideration earn-out liability from Peak acquisition
 480
Change in fair value of contingent consideration earn-out liability from TFS acquisition
 (94)
Change in fair value of contingent consideration earn-out liability from HSG acquisition(20) (84)
Balance as of September 30,$(1,952) $(6,752)
 Nine Months Ended September 30,
 2017 2016
Balance as of January 1,$(6,816) $(3,770)
Settlement of TFS earn-out for year ended December 31, 2015
 1,000
Contingent consideration earn-out liability from HSG acquisition on January 11, 2016
 (3,590)
Contingent consideration earn-out liability from Peak acquisition on June 3, 2016
 (480)
Change in fair value of contingent consideration earn-out liability from Avantas acquisition
 660
Change in fair value of contingent consideration earn-out liability from TFS acquisition
 (859)
Change in fair value of contingent consideration earn-out liability from HSG acquisition(66) (193)
Change in fair value of contingent consideration earn-out liability from Peak acquisition
 480
Settlement of TFS earn-out for year ended December 31, 20163,000
 
Settlement of HSG earn-out for year ended December 31, 20161,930
 
Balance as of September 30,$(1,952) $(6,752)
 Three Months Ended March 31,
 2018 2017
Balance as of January 1,$(2,070)
$(6,816)
Settlement of TFS earn-out for year ended December 31, 2016
 3,000
Settlement of HSG earn-out for year ended December 31, 201670
 1,930
Change in fair value of contingent consideration earn-out liability from HSG acquisition
 (23)
Settlement of HSG earn-out for year ended December 31, 20172,000
 
Balance as of March 31,$
 $(1,909)
Assets Measured on a Non-Recurring Basis
The Company applies fair value techniques on a non-recurring basis associated with valuing potential impairment losses related to its goodwill, indefinite-lived intangible assets, long-lived assets, and equity investments.
The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever circumstances occur indicating that goodwill might be impaired. The Company determines the fair value of its reporting units based on a combination of inputs, including the market capitalization of the Company, as well as Level 3 inputs such as

discounted cash flows, which are not observable from the market, directly or indirectly. The Company determines the fair value of its indefinite-lived intangible assets using the income approach (relief-from-royalty method) based on Level 3 inputs.
There were no triggering events identified and no indication of impairment of the Company’s goodwill, indefinite-lived intangible assets, long-lived assets, or equity investments during the ninethree months ended September 30, 2017March 31, 2018 and 2016.

2017.
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. As of March 31, 2018, the Company's senior notes have a carrying amount of $325,000 and an estimated fair value of $323,375. As of December 31, 2017, the Company’s senior notes approximate theirhad a carrying amount of $325,000 and an estimated fair values.value of $335,156. Quoted market prices in active markets for identical liabilities based inputs (level 1) were used to estimate fair value. The senior notes were issued in October 2016 and have a fixed rate of 5.125%. There have been no changes in available rates for similar debt since the date of issuance. See additional information in “Item 8. Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of our 20162017 Annual Report.
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.

7. INCOME TAXES
The Company is subject to taxation in the U.S. and various states and foreign jurisdictions. With few exceptions, as of September 30, 2017,March 31, 2018, the Company is no longer subject to state, local or foreign examinations by tax authorities for tax years before 2006, and the Company is no longer subject to U.S. federal income or payroll tax examinations for tax years before 2011.2013. The IRS conducted, completed and settled audits of the Company’s 2007-2010 and 2011-2012 tax years 2007, 2008, 2009related to income and 2010 had been under audit by the Internal Revenue Service (“IRS”)employment tax issues for several years and in 2014, the IRS issued the Company its Revenue Agent Report (“RAR”) and an Employment Tax Examination Report (“ETER”). The RAR proposed adjustments to the Company’s taxable income for 2007-2010 and net operating loss carryforwards for 2005 and 2006, resulting from the proposed disallowance of certain per diems paid to the Company’s healthcare professionals, and the ETER proposed assessments for additional payroll tax liabilities and penalties for tax years 2009 and 2010 related to the Company’s treatment of certain non-taxable per diem allowances and travel benefits. The positions in the RAR and ETER were mutually exclusive, and contained multiple tax positions, some of which were contrary to each other. The Company filed a Protest Letter for both the RAR and ETER positions in 2014 and the Company received a final determination from the IRSbenefits in July 2015 on both the RAR adjustments and ETER assessments, effectively settling these audits with the IRS for $7,200 (including interest) during the third quarter of 2015. As a result of the settlement, the Company recorded federal income tax benefits of approximately $12,200 during the quarter ended September 30, 2015, state income tax benefits (net of federal tax impact) of $568 for the year ended December 31, 2016, and expects to record state income tax benefits (net of federal tax impact) of approximately $1,200 by fiscal year 2019, when the various state statutes are projected to lapse.November 2017 respectively.

The IRS conducted and completed a separate audit of the Company’s 2011 and 2012 tax years that focused on income and employment tax issues similar to those raised in the 2007 through 2010 examination. The IRS completed its audit during the quarter ended March 31, 2015, and issued its RAR and ETER to the Company with proposed adjustments to the Company’s taxable income for 2011 and 2012 and net operating loss carryforwards from 2010 and assessments for additional payroll tax liabilities and penalties for 2011 and 2012 related to the Company’s treatment of certain non-taxable per diem allowances and travel benefits. The positions in the RAR and ETER for the 2011 and 2012 years are mutually exclusive and contain multiple tax positions, some of which are contrary to each other. The Company filed a Protest Letter for both the RAR and ETER in April 2015 and the matter is currently at IRS Appeals. The Company has been meeting and working with the IRS Appeals office and anticipates a resolution within the next twelve months. The IRS began an audit of the Company’s 2013 tax year during the quarter ended June 30, 2015. The Company believes its reserve for unrecognized tax benefits and contingent tax issues is adequate with respect to all open years. Notwithstanding the foregoing, the Company could adjust its provision for income taxes and contingent tax liability based on future developments.

Immaterial Tax Correction Related to Prior Periods

During the first quarter of 2018, the Company identified an error related to the income tax treatment of fair value changes in the cash surrender value of its Company Owned Life Insurance (COLI) for prior years. These fair value changes had not previously been included as a net tax benefit in the provision for prior periods. In accordance with ASC 250, Accounting Changes and Error Corrections, management evaluated the materiality of the error from qualitative and quantitative perspectives, and concluded that the error was not material to the consolidated financial statements of prior years, nor is it believed to be material to 2018’s full year consolidated financial statements. As result, the Company recorded a net tax benefit of $2,501 in the three months ended March 31, 2018 to adjust for this immaterial error correction.

Tax Cuts and Jobs Act

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

The Tax Act changes that affected the Company in 2017 are primarily tax rate changes on certain deferred tax assets (“DTAs”) and deferred tax liabilities (“DTLs”). The staff of the Securities and Exchange Commission issued Staff Accounting Bulletin No. 118 (“SAB 118”), which provides guidance on accounting for the tax effects of the Tax Act. SAB 118 provides a measurement period that should not extend beyond one year from the Tax Act enactment date for companies to complete the accounting under ASC 740. To the extent that a company’s accounting for certain income tax effects of the Tax Act is incomplete but it is able to determine a reasonable estimate, it must record a provisional estimate in the financial statements.

The Tax Act also establishes new tax laws that will affect 2018 and beyond, including, but not limited to, (1) reduction of the U.S. federal corporate tax rate; (2) the repeal of the domestic production activity deduction; (3) limitations on the deductibility of certain executive compensation; and (4) limitations on various entertainment and meals deductions.


The Company's accounting for certain elements of the Tax Act is incomplete, primarily relating to executive compensation and accounting methods. However, the Company was able to make reasonable estimates of these elements and, therefore, recorded provisional adjustments for these items.

8. COMMITMENTS AND CONTINGENCIES: LEGAL PROCEEDINGS

From time to time, the Company is involved in various lawsuits, claims, investigations, and proceedings that arise in the ordinary course of business. These matters typically relate to professional liability, tax, payroll, contract, competitor disputes and employee-related matters and include individual and collective lawsuits, as well as inquiries and investigations by governmental agencies regarding the Company’s employment practices. Additionally, some of the Company’s clients may also become subject to claims, governmental inquiries and investigations, and legal actions relating to services provided by the Company’s healthcare professionals. Depending upon the particular facts and circumstances, the Company may also be subject to indemnification obligations under its contracts with such clients relating to these matters. The Company records a liability when management believes an adverse outcome from a loss contingency is both probable and the amount, or a range, can be reasonably estimated. Significant judgment is required to determine both probability of loss and the estimated amount. The Company reviews its loss contingencies at least quarterly and adjusts its accruals and/or disclosures to reflect the impact of negotiations, settlements, rulings, advice of legal counsel, or other new information, as deemed necessary. The most significant

matters for which the Company has established loss contingencies are class actions related to wage and hour claims. Management currentlyclaims under California and Federal law. Specifically, among other claims in these lawsuits, it is alleged that certain expense reimbursements should be included in the regular rate of pay for purposes of calculating overtime rates, and that employees were not afforded required breaks or compensated for all time worked. While the Company believes the probable loss related to thesethat its wage and hour claimspractices conform with law in all material respects, litigation is always subject to inherent uncertainty, and the Company is not material and the amount accrued byable to reasonably predict if any matter will be resolved in a manner that is materially adverse to the Company for such claims is not material as of September 30, 2017. However, losses ultimately incurred for such claims could materially differ frombeyond the amounts already accrued by the Company.accrued.
With regards to outstanding loss contingencies as of September 30, 2017,March 31, 2018, which are included in accounts payable and accrued expenses in the condensed consolidated balance sheet, the Company believes that such matters will not, either individually or in the aggregate, have a material adverse effect on its business, consolidated financial position, results of operations, or cash flows.


9. BALANCE SHEET DETAILS

The consolidated balance sheets detail is as follows as of September 30, 2017March 31, 2018 and December 31, 2016:

2017:
 September 30, 2017 December 31, 2016 March 31, 2018 December 31, 2017
Other current assets:        
Restricted cash and cash equivalents $16,215
 $20,271
 $24,579
 $25,506
Income tax receivable 6,017
 15,898
Other 10,005
 14,336
 7,768
 9,589
Other current assets $26,220
 $34,607
 $38,364
 $50,993
        
Fixed assets:        
Furniture and equipment $28,202
 $25,582
 $29,758
 $29,494
Software 126,492
 112,405
 138,824
 132,770
Leasehold improvements 8,025
 6,832
 8,130
 9,056
 162,719
 144,819
 176,712
 171,320
Accumulated depreciation (94,531) (84,865) (101,182) (97,889)
Fixed assets, net $68,188
 $59,954
 $75,530
 $73,431
        
Other assets:        
Life insurance cash surrender value $45,835
 $32,190
 $53,386
 $48,145
Other 28,127
 25,344
 30,726
 26,221
Other assets $73,962
 $57,534
 $84,112
 $74,366
        
Accounts payable and accrued expenses:        
Trade accounts payable $24,166
 $33,392
 $26,245
 $31,420
Subcontractor payable 38,167
 51,973
 39,659
 41,786
Accrued expenses 45,690
 37,251
 45,517
 40,403
Professional liability reserve 7,048
 10,254
 7,972
 7,672
Other 2,863
 4,642
 3,009
 9,038
Accounts payable and accrued expenses $117,934
 $137,512
 $122,402
 $130,319
        
Accrued compensation and benefits:        
Accrued payroll $31,840
 $30,917
 $34,834
 $33,923
Accrued bonuses 16,755
 26,992
 13,768
 19,489
Accrued travel expense 3,488
 2,972
 2,999
 3,256
Accrued health insurance reserve 3,708
 3,189
Accrued workers compensation reserve 8,301
 8,406
Health insurance reserve 3,702
 3,658
Workers compensation reserve 8,075
 8,553
Deferred compensation 45,771
 32,690
 52,115
 49,330
Other 2,121
 2,827
 1,922
 3,214
Accrued compensation and benefits $111,984
 $107,993
 $117,415
 $121,423
        
Other current liabilities:    
Acquisition related liabilities $2,981
 $6,921
Other 2,459
 9,690
Other current liabilities $5,440
 $16,611
    
Other long-term liabilities:        
Workers’ compensation reserve $18,475
 $18,708
Workers compensation reserve $18,638
 $19,074
Professional liability reserve 40,033
 37,338
 39,033
 38,964
Deferred rent 14,602
 13,274
 14,785
 14,744
Unrecognized tax benefits 7,240
 8,464
 5,695
 5,270
Deferred revenue 1,769
 960
Other 2,323
 4,312
 281
 267
Other long-term liabilities $82,673
 $82,096
 $80,201
 $79,279


10. SUBSEQUENT EVENTS

Phillips DiPisa and Leaders For Today Acquisition

On April 6, 2018, the Company completed its acquisition of Phillips DiPisa and Leaders For Today (“PDA and LFT”) for $30,000 and a tiered contingent earn-out payment of up to $7,000. PDA and LFT offer a range of leadership staffing and permanent placement solutions for the healthcare industry. The acquisition was funded out of cash on hand.

MedPartners Acquisition

On April 9, 2018, the Company completed its acquisition of MedPartners HIM, LLC (“MedPartners”) for $195,000 in cash and a tiered contingent earn-out payment of up to $20,000. MedPartners provides case management, clinical documentation improvement, medical coding and registry services to hospitals and physician medical groups nationwide. On April 9, 2018, the Company borrowed $195,000 under the New Credit Agreement to fund the acquisition. The New Credit Agreement is more fully described in Note (5), “New Credit Agreement.”



Item 2. Management’s Discussion and Analysis of Financial Condition and Results
of Operations
 
The following discussion should be read in conjunction with our consolidated financial statements and the notes thereto and other financial information included elsewhere herein and in our Annual Report on Form 10-K for the fiscal year ended December 31, 2016,2017, filed with the Securities and Exchange Commission (“SEC”) on February 17, 16, 2018 (“2017 (“2016 Annual Report”). Certain statements in this “Management’s Discussion and Analysis of Financial Condition and Results of Operations” are “forward-looking statements.” See “Special Note Regarding Forward-Looking Statements.” We undertake no obligation to update the forward-looking statements in this Quarterly Report. References in this Quarterly Report to “AMN Healthcare,” the “Company,” “we,” “us” and “our” refer to AMN Healthcare Services, Inc. and its wholly owned subsidiaries.
Overview of Our Business
 
We provide healthcare workforce solutions and staffing services to healthcare facilities across the nation. As an innovative workforce solutions partner, our managed services programs, or “MSP,” vendor management systems, or “VMS,” recruitment process outsourcing, or “RPO,” workforce optimizationconsulting services, medical coding and consulting services,predictive modeling, staff scheduling, mid-revenue cycle management and the placement of physicians, nurses, allied healthcare professionals and healthcare executives into temporary and permanent positions enable our clients to successfully reduce staffing complexity, increase efficiency and lead their organizations within the rapidly evolving healthcare environment. Our clients include acute and sub-acute care hospitals, community health centers and clinics, physician practice groups, retail and urgent care centers, home health facilities, and many other healthcare settings. Our clients utilize our workforce solutions and healthcare staffing services to strategically plan for and meet their workforce needs in an economically beneficial manner. Our managed services program and vendor management systems enable healthcare organizations to increase their efficiency by managing all of their supplemental workforce needs through one company or technology.
We conduct business through three reportable segments: (1) nurse and allied solutions, (2) locum tenens solutions, and (3) other workforce solutions. For the three months ended September 30, 2017,March 31, 2018, we recorded revenue of $494.4$522.5 million, as compared to $472.6$495.2 million for the same period last year. For the three months ended September 30, 2017,March 31, 2018, we recorded net income of $28.1$42.7 million, as compared to $27.3 million for the same period last year. For the nine months ended September 30, 2017, we recorded revenue of $1,479.4 million, as compared to $1,414.4 million for the same period last year. For the nine months ended September 30, 2017, we recorded net income of $91.4 million, as compared to $79.5$32.0 million for the same period last year.
Nurse and allied solutions segment revenue comprised 62%65% and 63% of total consolidated revenue for both the ninethree months ended September 30,March 31, 2018 and 2017, and 2016.respectively. Through our nurse and allied solutions segment, we provide hospitals and other healthcare facilities with a comprehensive managed services solution in which we manage and staff all of the temporary nursing and allied staffing needs of a client and traditional clinical staffing solutions of variable assignment lengths.
 
Locum tenens solutions revenue comprised 22%20% and 23%21% of total consolidated revenue for the ninethree months ended September 30,March 31, 2018 and 2017, and 2016, respectively. Through our locum tenens solutions segment, we provide a comprehensive managed services solution in which we manage all of the locum tenens needs of a client and place physicians of all specialties, as well as dentists and other advanced practice providers, with clients on a temporary basis as independent contractors. These locum tenens providers are used by our healthcare facility and physician practice group clients to fill temporary vacancies created by vacation and leave schedules and to bridge the gap while they seek permanent candidates or explore expansion. Our locum tenens clients represent a diverse group of healthcare organizations throughout the United States, including hospitals, health systems, medical groups, occupational medical clinics, psychiatric facilities, government institutions, and insurance entities. The professionals we place are recruited nationwide and are typically placed on contracts with assignment lengths ranging from a few days up to one year.
 
Other workforce solutions segment revenue comprised 16%15% and 15%16% of total consolidated revenue for the ninethree months ended September 30,March 31, 2018 and 2017, and 2016, respectively. Through our other workforce solutions segment, we provide hospitals and other healthcare facilities with a range of workforce solutions, including: (1) identifying and recruiting physicians and healthcare leaders for permanent placement, (2) placing interim leaders and executives across all healthcare settings, (3) a software-as-a-service (“SaaS”) VMS through which our clients can manage all of their temporary staffing needs, (4) RPO services that leverage our expertise and support systems to replace or complement a client’s existing internal recruitment function for permanent placement needs, (5) an education program that provides custom healthcare education, research, professional practice tools, and professional development services, (6) medical codingmid-revenue cycle management and related consulting services, and (7) workforce optimization services that include consulting, data analytics, predictive modeling, and SaaS-based scheduling technology.

As part of our long-term growth strategy to add value for our clients, healthcare professionals, and shareholders, on April 6, 2018 and April 9, 2018, we acquired Phillips DiPisa and Leaders For Today (“PDA and LFT”) and MedPartners HIM, LLC (“MedPartners”), respectively. MedPartners provides mid-revenue cycle management solutions, including case management, clinical documentation improvement, medical coding and registry services to hospitals and physician medical groups nationwide. PDA and LFT offer a range of leadership staffing and permanent placement solutions for the healthcare industry. See additional information in the accompanying Note (10), “Subsequent Events.”


Recent Trends

Demand for our temporary and permanent placement staffing services is driven in part by U.S. economic and labor trends.
The U.S. Bureau of Labor Statistics’ survey data reflectreflects near record levels of healthcare job openings and quits, which wequits. We view this data, along with a nearly 20-year-low unemployment rate and continued economic growth as positive trends for the healthcare staffing industry. At the same time, the entireThe low unemployment rate has led to some wage growth to attract healthcare industry continuesprofessionals. We work to face uncertainty relatedpass these increases on to the potential dismantling, or significant change to certain aspects of, the Affordable Care Act, which could impact the reimbursements upon which our clients depend. The uncertainty has impacted the utilization of healthcare services and demand for our services.but have experienced margin pressure in some divisions, particularly locum tenens.

We continue to see the benefits of our workforce solutions strategy, particularly with our managed services programs. As
a result of our ongoing focus on these strategic relationships, we continue to increase the percentage of our nurse and allied
revenue derived from our managed services program clients.

In our nurse and allied solutions segment, demand for our services remains stable. Although we continue to negotiate bill rate increases, our clients are decreasing the portion of nursing placements utilizing premium bill rates, which has lowered the overall average bill rate in this segment.

In our locum tenens solutions segment, we have seen a decline in demand in certain specialties such as hospitalistsfrom some large physician practice management firms that has negatively impacted our hospitalist volumes and, as a result, revenue in this segment. In addition,Additionally, we made organizationalare in the process of making operating model changes and leadershipimplementing new front and back office technologies in locum tenens. Although these changes in this business and are making operational changesexpected to improve performance. We are beginning to see thehave a long-term positive impact ofon our growth and profitability, in the short-term, these changes have been disruptive to our productivity and improvingrevenue, and we expect this to continue through the third quarter of 2018. Other than the above-mentioned influences, overall, demand in most specialties.for our locum tenens solutions segment is above prior year.

In our other workforce solutions segment, our interim leadership, workforce consulting, and vendormid-revenue cycle management systems businesses are growing. We are experiencing declines inWith respect to our permanent placement businesses, that we believe are primarily related tohave made organizational and operational execution and are making organizational changes designed to improve our performance.performance in 2018 that have resulted in sequential improvement from prior quarter.

Critical Accounting Policies and Estimates
The preparation of our consolidated financial statements in conformity with United States generally accepted accounting principles (“U.S. GAAP”) requires us to make estimates and judgments that affect our reported amounts of assets and liabilities, revenue and expenses, and related disclosures of contingent assets and liabilities. On an ongoing basis, we evaluate our estimates, including those related to asset impairments, accruals for self-insurance, compensation and related benefits, accounts receivable, contingencies and litigation, earn-out liabilities, and income taxes. We base these estimates on the information that is currently available to us and on various other assumptions that we believe are reasonable under the circumstances. Actual results could vary from these estimates under different assumptions or conditions. If these estimates differ significantly from actual results, our consolidated financial statements and future results of operations may be materially impacted. There have been no material changes in our critical accounting policies and estimates, other than the adoption of the Accounting Standards UpdateUpdates (“ASU”ASUs”) 2016-09 described in Item 1. Condensed Consolidated Financial Statements—Note 1, “Basis of Presentation,” as compared to the critical accounting policies and estimates described in our 20162017 Annual Report.
 
 

Results of Operations
The following table sets forth, for the periods indicated, selected unaudited condensed consolidated statements of operations data as a percentage of revenue. Our results of operations include three reportable segments: (1) nurse and allied solutions, (2) locum tenens solutions, and (3) other workforce solutions. The Peak acquisition impacts the comparability of the results between the three and nine months ended September 30, 2017 and 2016. Our historical results are not necessarily indicative of our future results of operations.
Three Months Ended September 30, Nine Months Ended September 30,Three Months Ended March 31,
2017 2016 2017 20162018 2017
Unaudited Condensed Consolidated Statements of Operations:          
Revenue100.0% 100.0% 100.0% 100.0%100.0% 100.0%
Cost of revenue67.7
 67.3
 67.4
 67.4
67.9
 67.3
Gross profit32.3
 32.7
 32.6
 32.6
32.1
 32.7
Selling, general and administrative20.3
 21.2
 20.2
 21.0
20.0
 20.6
Depreciation and amortization1.7
 1.6
 1.6
 1.6
1.5
 1.6
Income from operations10.3
 9.9
 10.8
 10.0
10.6
 10.5
Interest expense, net, and other1.0
 0.6
 1.0
 0.6
1.1
 1.0
Income before income taxes9.3
 9.3
 9.8
 9.4
9.5
 9.5
Income tax expense3.6
 3.5
 3.6
 3.8
1.3
 3.0
Net income5.7% 5.8% 6.2% 5.6%8.2% 6.5%
 
Comparison of Results for the Three Months Ended September 30, 2017March 31, 2018 to the Three Months Ended September 30, 2016March 31, 2017
 
RevenueRevenue increased 5%6% to $494.4$522.5 million for the three months ended September 30, 2017March 31, 2018 from $472.6$495.2 million for the same period in 2016, all of which was organic growth.2017, primarily attributable to the higher revenue in our nurse and allied solutions segment.
Nurse and allied solutions segment revenue increased 6%8% to $302.9$338.2 million for the three months ended September 30, 2017March 31, 2018 from $286.8$313.5 million for the same period in 2016.2017. The $16.1$24.7 million increase was primarily attributable to a 4%6% increase in the average number of healthcare professionals on assignment, andpartially offset by a 2% increasedecrease in the average bill rate during the three months ended September 30, 2017March 31, 2018.
 Locum tenens solutions segment revenue increased 3%slightly to $111.4$103.1 million for the three months ended September 30, 2017March 31, 2018 from $108.6102.8 million for the same period in 2016.2017. The $2.8$0.3 million increase was primarily attributable to a 4%5% increase in the revenue per day filled during the three months ended September 30, 2017,March 31, 2018, partially offset by a 1%4% decrease in the number of days filled.
Other workforce solutions segment revenue increased 4%3% to $80.1$81.2 million for the three months ended September 30, 2017March 31, 2018 from $77.378.8 million for the same period in 2016.2017. The $2.8$2.4 million increase was primarily attributable to growth in our VMS, and interim leadership and mid-revenue cycle management businesses, partially offset by declines in our permanent placement businesses during the three months ended September 30, 2017.March 31, 2018.
 
Gross Profit. Gross profit increased 3%4% to $159.5$167.8 million for the three months ended September 30, 2017March 31, 2018 from $154.5$161.8 million for the same period in 2016,2017, representing gross margins of 32.3%32.1% and 32.7%, respectively. The decrease in consolidated gross margin was due to an unfavorable change in salesbusiness mix higher insurance costs in our other workforce solutions segment and a lower bill-pay spreadsbill-to-pay spread in the locum tenens solutions segment, partially offset by a higher gross margin in the nurse and allied solutions segment driven primarily by lower direct costs during the three months ended September 30, 2017.March 31, 2018. Gross margin by reportable segment for the three months ended September 30,March 31, 2018 and 2017 was 28.0% and 2016 was 27.3% and 26.7%27.7% for nurse and allied solutions, 30.1%28.7% and 31.2%30.7% for locum tenens solutions, and 54.1%53.6% and 56.7%55.0% for other workforce solutions, respectively.
 
Selling, General and Administrative Expenses. Selling, general and administrative (“SG&A”) expenses were $100.6$104.7 million, representing 20.3%20.0% of revenue, for the three months ended September 30, 2017,March 31, 2018, as compared to $100.0$102.1 million, representing 21.2%20.6% of revenue, for the same period in 2016.2017. The increase in SG&A expenses was primarily due to higher bad debt expenseemployee compensation expenses, partially offset by operating leverage on the higher revenue and lower acquisition and integration costs as compared to the same period last year. The decrease in unallocated corporate overhead was primarily attributable to lower

acquisition and integration costs and employee compensation expenses.revenue. SG&A expenses broken down

among the reportable segments, unallocated corporate overhead, and share-based compensation are as follows:      
(In Thousands)
Three Months Ended September 30,
(In Thousands)
Three Months Ended March 31,
2017 20162018 2017
Nurse and allied solutions$41,884
 $39,312
$42,985
 $40,877
Locum tenens solutions19,075
 19,881
19,591
 19,359
Other workforce solutions23,445
 22,985
23,634
 23,484
Unallocated corporate overhead13,698
 15,113
15,663
 15,672
Share-based compensation2,477
 2,704
2,864
 2,681
$100,579
 $99,995
$104,737
 $102,073
Depreciation and Amortization Expenses. Amortization expense decreased slightly4% to $4.7$4.4 million for the three months ended September 30, 2017March 31, 2018 from $4.8$4.6 million for the same period in 2016.2017, with the decrease primarily attributable to having more intangible assets fully amortized during the three months ended March 31, 2018. Depreciation expense increased 13% to $3.4$3.5 million for the three months ended September 30, 2017March 31, 2018 from $3.0$3.1 million for the same period in 2016,2017, primarily attributable to an increase in purchased and developed hardware and software placed in service for our ongoing front and back office information technology initiatives.
Interest Expense, Net, and OtherInterest expense, net, and other, was $4.8$5.3 million during the three months ended September 30, 2017March 31, 2018 as compared to $3.0$5.1 million for the same period in 2016.2017. The increase is primarily due to higher interest bearing Notes (as defined below) forthe write-off of unamortized deferred financing fees in connection with the refinancing of our credit facilities during the three months ended September 30, 2017, as compared toMarch 31, 2018, partially offset by additional interest from the term loans and revolverloan outstanding during the three months ended March 31, 2017. See additional information in the same period last year.accompanying Note (5), “New Credit Agreement.”
Income Tax Expense. Income tax expense was $17.9$7.2 million for the three months ended September 30, 2017March 31, 2018 as compared to income tax expense of $16.4$14.9 million for the same period in 2016,2017, reflecting effective income tax rates of 39%14% and 37%32% for the three months ended September 30,March 31, 2018 and 2017, and 2016, respectively. The difference in the effective income tax rate was primarily attributable to the relationshipimpact of pre-tax incomethe Tax Cuts and Jobs Act of 2017 (the “Tax Act”) which reduced the U.S. federal corporate tax rate from 35 percent to permanent differences21 percent, effective 2018. In addition, the Company recorded a net tax benefit of $2.5 million during the three months ended March 31, 2018 to adjust for the tax treatment of fair value changes in the cash surrender value of its Company Owned Life Insurance ("COLI") for prior years. These fair value changes had not previously been included as a benefit in the tax provisions of the related to unrecognized tax benefits.years. The decrease in the rate was partially offset by provisions of the Tax Act which disallowed certain fringe benefits, meals and entertainment deductions and performance based compensation for covered employees (Chief Executive Officer, Chief Financial Officer and the top three highest paid executive officers). We currently estimate our annual effective income tax rate to be approximately 38%25% for 2017.

Comparison of Results for2018. The 14% effective tax rate in the Nine Months Ended September 30, 2017 to the Nine Months Ended September 30, 2016

RevenueRevenue increased 5% to $1,479.4 million for the ninethree months ended September 30, 2017 from $1,414.4 million for the same period in 2016, due to additional revenue of $12.4 million resultingMach 31, 2018 differs from our Peak acquisition in June 2016 with the remainderestimated annual effective income tax rate of the increase driven by 4% organic growth.
Nurse and allied solutions segment revenue increased 5% to $917.2 million for the nine months ended September 30, 2017 from $877.2 million for the same period in 2016. The $40.0 million increase was primarily attributable to a 5% increase in the average number of healthcare professionals on assignment and a 3% increase in the average bill rate during the nine months ended September 30, 2017. The increase was partially offset by an approximately $28.0 million decrease in labor disruption revenue and the impact of one less calendar day due to last year being a leap year.
Locum tenens solutions segment revenue was $322.5 million for the nine months ended September 30, 2017, as compared to $320.4 million for the same period in 2016. The $2.1 million increase was primarily attributable to a 4% increase in the revenue per day filled during the nine months ended September 30, 2017, partially offset by a 3% decrease in the number of days filled.
Other workforce solutions segment revenue increased 11% to $239.7 million for the nine months ended September 30, 2017 from $216.8 million for the same period in 2016. Of the $22.9 million increase, $12.4 million was attributable to the additional revenue in connection with the Peak acquisition in June 2016 with the remainder primarily attributable to growth in our VMS, interim leadership, and workforce optimization businesses, partially offset by declines in our permanent placement and recruitment process outsourcing businesses during the nine months ended September 30, 2017.

Gross Profit. Gross profit increased 5% to $482.3 million for the nine months ended September 30, 2017 from $461.1 million for the same period in 2016, representing gross margins of 32.6% for both periods. Consolidated gross margin was consistent with the prior year25% primarily due to a higher gross margindiscrete tax benefit of $4.5 million in the nurse and allied solutions segment driven primarily by lower direct costs, offset by lower bill-pay spreads in the locum tenens solutions segment and an unfavorable change in sales mix in our other workforce solutions segment during the ninethree months ended September 30, 2017. Gross margin by reportable segment for the nine months ended September 30, 2017 and 2016 was 27.6% and 26.7% for nurse and allied soluti

ons, 30.2% and 31.2% for locum tenens solutions, and 54.9% and 58.6% for other workforce solutions, respectively.

Selling, General and Administrative Expenses. SG&A expenses were $299.3 million, representing 20.2% of revenue, for the nine months ended September 30, 2017, as compared to $297.4 million, representing 21.0% of revenue, for the same period in 2016. The increase in SG&A expenses was primarily due to $1.9 million of additional SG&A expenses from the Peak acquisition and other expenses associated with our revenue growth, offset by an additional $2.0 million favorable actuarial-based decrease in our professional liability reserves and $2.1 million decrease in acquisition and integration costs as comparedMarch 31, 2018 relating to the same period last year. The decrease in unallocated corporate overhead was primarily attributable to lower acquisition and integration costs. SG&A expenses broken down among the reportable segments, unallocated corporate overhead, and share-based compensation are as follows:
 (In Thousands)
Nine Months Ended September 30,
 2017 2016
Nurse and allied solutions$118,464
 $115,755
Locum tenens solutions58,507
 56,247
Other workforce solutions69,902
 70,654
Unallocated corporate overhead44,732
 45,908
Share-based compensation7,720
 8,795
 $299,325
 $297,359
Depreciation and Amortization Expenses. Amortization expense increased 2% to $13.9 million for the nine months ended September 30, 2017 from $13.6 million for the same period in 2016, primarily attributable to additional amortization expense related to the intangible assets acquired in the Peak acquisition. Depreciation expense increased 18% to $9.8 million for the nine months ended September 30, 2017 from $8.3 million for the same period in 2016, primarily attributable to fixed assets acquired as part of the Peak acquisition and an increase in purchased and developed hardware and software placed in service for our ongoing front and back office information technology initiatives.
Interest Expense, Net, and OtherInterest expense, net, and other, was $14.9 million during the nine months ended September 30, 2017 as compared to $9.1 million for the same period in 2016. The increase is primarily due to higher interest bearing Notes (as defined below) for the nine months ended September 30, 2017, as compared to the term loans and revolver in the same period last year.
Income Tax Expense. Income tax expense was $53.0 million for the nine months ended September 30, 2017 as compared to income tax expense of $53.3 million for the same period in 2016, reflecting effective income tax rates of 37% and 40% for the nine months ended September 30, 2017 and 2016, respectively. The difference in the effective income tax rate was primarily attributable to the relationship of pre-tax income to permanent differences related to unrecognized tax benefits and excess tax benefit from the adoptionapplication of ASU 2016-09, “Stock Compensation - Improvements to Employee Share-Based Payment Accounting” and the out of period discrete tax benefit of $2.5 million recorded in the first quarter of 2017, which resulted in recording a $5.4 million reduction in income tax expense for the ninethree months ended September 30, 2017. PriorMarch 31, 2018 relating to adoption, this amount wouldCOLI as discussed above. We have been recorded as additional paid-in capital. Since the majority of our equity awards vest during the first quarter of the year, we do not anticipate the recording of additional excess tax benefits of this magnitude for the remainder of the year. This change could create future volatilitydescribed in our effective tax rate depending upon the amount of exercise or vesting activity from our share-based awards. See additional informationfurther detail on ASU 2016-09 in Item 1. Condensed“Item 8. Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note 1 “Basis(1)(r), Recently Adopted Accounting Pronouncements” of Presentation.” Including the impact of the adoption of ASU 2016-09, we currently estimate our annual effective income tax rate to be approximately 38% for 2017.2017 Annual Report on Form 10-K.


Liquidity and Capital Resources
 
In summary, our cash flows were:

(In Thousands)
Nine Months Ended September 30,
(In Thousands)
Three Months Ended March 31,
2017 20162018 
2017
*As Adjusted
  
Net cash provided by operating activities$96,382
 $84,820
$59,735
 $44,684
Net cash used in investing activities(23,444) (241,271)(9,613) (13,300)
Net cash provided by (used in) financing activities(63,824) 162,418
Net cash used in financing activities(14,970) (11,928)
* See Note (1) to the accompanying Condensed Consolidated Financial Statements, “Basis of Presentation” for a summary of adjustments resulting from the adoption of ASU 2016-18, “Statement of Cash Flows (Topic 230): Restricted Cash.”

Historically, our primary liquidity requirements have been for acquisitions, working capital requirements, and debt service under our credit facilities and the Notes. We have funded these requirements through internally generated cash flow and funds borrowed under our credit facilities. During the third quarter of 2017, we paid off the remaining balance of our term debt. On February 9, 2018, we replaced our then-existing credit agreement with our New Credit Agreement (as defined below). As of September 30, 2017March 31, 2018, zero was drawn from $258.8$389.8 million of available credit under the revolving credit facility (the “Revolver”)Senior Credit Facility (as defined below) and the aggregate principal amount of our 5.125% Senior Notes due 2024 (the “Notes”) outstanding equaled $325.0 million. We describe in further detail our amended credit agreement,New Credit Agreement, under which our term loan and Revolver areSenior Credit Facility is governed, and the Notes in “Item 8. Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of our 20162017 Annual Report on Form 10-K.
In April 2015, we entered into an interest rate swap agreement to minimize our exposure to interest rate fluctuations on $100 million of our outstanding variable rate debt under one of our term loans for which we pay a fixed rate of 0.983% per annum and receive a variable rate equal to floating one-month LIBOR. This agreement expires on March 30, 2018, and no initial investment was made to enter into this agreement. On October 3, 2016, we reduced the interest rate swap notional amount to $40 million. On May 3, 2017, we terminated the remaining interest rate swap.
We believe that cash generated from operations and available borrowings under the Revolverour Senior Credit Facility will be sufficient to fund our operations, including expected capital expenditures, for at least the next year.12 months and beyond. We intend to finance potential future acquisitions either with cash provided from operations, borrowings under the Revolver,our Senior Credit Facility or other borrowings under our New Credit Agreement, bank loans, debt or equity offerings, or some combination of the foregoing. The following discussion provides further details of our liquidity and capital resources.
 
Operating Activities
 
Net cash provided by operating activities for the ninethree months ended September 30, 2017March 31, 2018 was $96.4$59.7 million, compared to $84.844.7 million for the same period in 2016.2017. The increase in net cash provided by operating activities was primarily attributable to (1) improved operating results, (2) a decrease in accounts receivable and subcontractor receivable between periods due to timing of collections, and (3) excess tax benefits on the vesting of employee equity awards resulting from the adoption of a new accounting pronouncement discusseddecrease in Item 1. Condensed Consolidated Financial Statements—Note (1), “Basis of Presentation.”income taxes receivable. The overall increase was partially offset by (1) a decrease in accounts payable and accrued expenses between periods due to timing of payments and (2) additional cash paid fora decrease in income taxes during the nine months ended September 30, 2017 as compared to the same period last year, and (3) an increase in the cash, cash equivalents and investments attributable to cash payments made to our captive insurance entity, which are restricted for use by the captive for future claim payments and, to a lesser extent, its working capital needs.payable between periods. Our Days Sales Outstanding (“DSO”) was 6458 days at each of September 30, 2017,March 31, 2018, 63 days at December 31, 2016,2017, and September 30, 2016.61 days at March 31, 2017.
 
Investing Activities
 
Net cash used in investing activities for the ninethree months ended September 30, 2017March 31, 2018 was $23.4$9.6 million, compared to $241.313.3 million for the same period in 2016.2017. The decrease was primarily due to (1) no cash paid for acquisitions during the nine months ended September 30, 2017 as compared to $216.6 million used for acquisitions during the nine months ended September 30, 2016 and (2) net $6.2 millionproceeds from restricted investment proceedsinvestments related to our captive insurance entitycompany of $0.8 million during the ninethree months ended September 30, 2017. The overall decrease was partially offset by (1) a $2.0 million equity investment and (2) $10.1 million of payments to fund the deferred compensation plan during the nine months ended September 30, 2017March 31, 2018, as compared to $5.7a net purchase of $2.8 million of payments during the ninethree months ended September 30, 2016.March 31, 2017. Capital expenditures were $17.2$5.7 million and $17.7$5.5 million for the ninethree months ended September 30,March 31, 2018 and 2017, and 2016, respectively.


Financing Activities

Net cash used in financing activities during the ninethree months ended September 30, 2017March 31, 2018 was $63.8$15.0 million, primarily due to (1) $2.3 million payment of financing costs in connection with the repayment of $44.1 million under our term loans,new credit agreement, (2) $3.7$1.7 million for acquisition contingent consideration earn-out payments, and (3) $7.1 million paid in connection with the repurchase of our common stock, and (4) $9.1$10.9 million in cash paid for shares withheld for payroll taxes resulting from the vesting of employee equity awards. Net cash provided by financing activities during the ninethree months ended September 30, 2016March 31, 2017 was $162.4$11.9 million,, primarily due to borrowings of $124.0$3.7 million under the Revolverfor acquisition contingent consideration earn-out payments and $75.0$7.3 million of borrowings under a new term loan under our amended credit agreement to fund our BES and HSG acquisitions, partially offset by (1) the repayment of $8.4 million under our term loans and $24.0 million under the Revolver, and (2) $5.6 millionin cash paid for shares withheld for payroll taxes resulting from the vesting of employee equity awards.

New Credit Agreement

On February 9, 2018, we entered into a credit agreement (the “New Credit Agreement”) with several lenders to provide for a $400 million secured revolving credit facility (the “Senior Credit Facility”) to replace our then-existing Credit Agreement. The Senior Credit Facility includes a $50 million sublimit for the issuance of letters of credit and a $50 million sublimit for swingline loans. Our obligations under the New Credit Agreement and the Senior Credit Facility are secured by substantially all of our assets. Borrowings under the Senior Credit Facility bear interest at floating rates, at our option, based upon either LIBOR plus a spread of 1.00% to 2.00% or a base rate plus a spread of 0.00% to 1.00%. The applicable spread is determined quarterly based upon our consolidated net leverage ratio. The Senior Credit Facility is available for working capital, capital expenditures, permitted acquisitions and general corporate purposes. The maturity date of the Senior Credit Facility is February 9, 2023.

In connection with obtaining the New Credit Agreement, we incurred $2.3 million in fees paid to lenders and other third parties, which were capitalized and are amortized to interest expense over the term of the Senior Credit Facility. In addition, we wrote off $0.6 million of unamortized financing fees during three months ended March 31, 2018 related to our prior credit facilities. To help finance the MedPartners acquisition, we borrowed $195.0 million from the Senior Credit Facility in April 2018. The acquisition is more fully described in Note (10) to the accompanying Condensed Consolidated Financial Statements, “Subsequent Events.”

 Letters of Credit
 At September 30, 2017March 31, 2018, we maintained outstanding standby letters of credit totaling $20.2$12.9 million as collateral in relation to our professional liability insurance agreements, workers’ compensation insurance agreements and a corporate office lease agreement. Of the $20.2$12.9 million of outstanding letters of credit, we have collateralized $4.0$2.7 million in cash and cash equivalents and the remaining amounts are collateralized by the Revolver.Senior Credit Facility. Outstanding standby letters of credit at December 31, 20162017 totaled $15.4$22.0 million.
 
Off-Balance Sheet Arrangements
 At September 30, 2017March 31, 2018, we did not have any off-balance sheet arrangement that has or is reasonably likely to have a current or future effect on our financial condition, changes in financial condition, revenues or expenses, results of operations, liquidity, capital expenditures, or capital resources that is material to investors.
Contractual Obligations
There have been no material changes, other than the New Credit Agreement described in the accompanying Note (5), “New Credit Agreement” and the associated borrowings described in the accompanying Note (10), “Subsequent Events,” to the table entitled “Contractual Obligations” in Part II, Item 7, “Management’s Discussion and Analysis of Financial Condition and Results of Operations” set forth in our 20162017 Annual Report that occurred during the ninethree months ended September 30, 2017.March 31, 2018.

Recent Accounting Pronouncements
In May 2014, the Financial Accounting Standards Board (“FASB”) issued new accounting guidance related to revenue recognition. This new standard will replace all current U.S. GAAP guidance on this topic and eliminate all industry-specific guidance. The new revenue recognition standard provides a unified model to determine when and how revenue is recognized. The core principle is that a company should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration for which the entity expects to be entitled in exchange for those goods or services. This guidance can be applied either retrospectively to each period presented or as a cumulative-effect adjustment as of the date of adoption. In July 2015, the FASB voted to amend the guidance by approving a one-year delay in the effective date of the new standard to 2018. In addition, the FASB has also issued several amendments to the standard which clarify certain aspects of the guidance, including principal versus agent consideration and identifying performance obligations. We expect to complete our evaluation of the impact of the accounting and disclosure requirements on our consolidated financial statements, business processes, controls and systems during the fourth quarter of 2017. This includes reviewing current accounting policies and practices to identify potential impact of the accounting and disclosure requirements on our business processes, controls and system. The extent of the impact of the adoption of this new standard is subject to the completion of our assessment by the end of 2017. We will adopt this standard in the first quarter of 2018, and apply the modified retrospective approach.
In February 2016, the FASB issued ASU 2016-02, “Leases.” This standard requires organizations that lease assets to recognize the assets and liabilities created by those leases. The standard also will require disclosures to help investors and other financial statement users better understand the amount, timing, and uncertainty of cash flows arising from leases. The ASU becomes effective for public companies for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2018. We are required to adopt the guidance on a modified retrospective basis and can elect to apply optional practical expedients. We are currently evaluatingin the approach we will take andprocess of analyzing the impact of adopting this new standard and evaluating the impact on our consolidated financial statementsstatements. This includes reviewing current accounting policies and related disclosures.
In August 2016,practices to identify potential differences that would result from applying the FASB issued ASU 2016-15, “Statementrequirements under the new standard. We expect to complete the evaluation and validate results by the end of Cash Flows (Topic 230): Classificationthe third quarter of Certain Cash Receipts2018. We expect to complete the evaluation of the impact of the accounting and Cash Payments.” Thedisclosure requirements on our business processes, controls and systems by the end of the fourth quarter of 2018. We will adopt this standard provides guidance on how certain cash receipts and payments are presented and classified in the statementfirst quarter of cash flows. For public entities, ASU 2016-15 is effective for fiscal years beginning

after December 15, 2017,2019, and interim periods within those annual periods, and requires aapply the modified retrospective approach. EarlyThe adoption is permitted, including adoption in an interim period. We are currently evaluating the timing of this new standard’s adoptionstandard will result in a significant increase to our consolidated balance sheet for lease liabilities and the effect that adopting it will have on our financial statements and related disclosures.
In November 2016, the FASB issued ASU 2016-18, “Statement of Cash Flows (Topic 230): Restricted Cash.” The standard requires that a statement of cash flows explain the change during the period in the total of cash, cash equivalents, and amounts generally described as restricted cash or restricted cash equivalents. Therefore, amounts generally described as restricted cash and restricted cash equivalents should be included with cash and cash equivalents when reconciling the beginning-of-period and end-of-period total amounts shown on the statement of cash flows. The new guidance is effective for interim and annual periods beginning after December 15, 2017 and early adoption is permitted. The amendment will be adopted retrospectively. We are currently evaluating the timing of this new standard’s adoption and the effect that adopting it will have on our financial statements and related disclosures.right-of-use assets, which has not yet been quantified.
In January 2017, the FASB issued ASU 2017-04, “Intangibles – Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment.” The standard simplifies the subsequent measurement of goodwill by removing the requirement to perform a hypothetical purchase price allocation to compute the implied fair value of goodwill to measure impairment. Instead, any goodwill impairment will equal the amount by which a reporting unit’s carrying value exceeds its fair value, not to exceed the carrying amount of goodwill. Further, the guidance eliminates the requirements for any reporting unit with a zero or negative carrying amount to perform a qualitative assessment and, if it fails that qualitative test, to perform Step 2 of the goodwill impairment test. This standard is effective for annual or any interim goodwill impairment test in fiscal years beginning after December 15, 2019, with early adoption permitted for impairment tests performed after January 1, 2017. While we continue to assess the potential impacttiming of adopting this standard, we do not expect the adoption of this standard to have a material impact on our consolidated financial statements.
There have been no other new accounting pronouncements issued but not yet adopted that are expected to materially affect our consolidated financial condition or results of operations.


Special Note Regarding Forward-Looking Statements
This Quarterly Report 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. We base these forward-looking statements on our expectations, estimates, forecasts, and projections about future events and about the industry in which we operate. Forward-looking statements are identified by words such as “believe,” “anticipate,” “expect,” “intend,” “plan,” “will,” “should,” “would,” “project,” “may,” variations of such words, and other similar expressions. In addition, any statements that refer to projections of financial items, anticipated growth, future growth and revenues, future economic conditions and performance, plans, objectives and strategies for future operations, expectations, or other characterizations of future events or circumstances are forward-looking statements. All forward-looking statements involve risks and uncertainties. Our actual results could differ materially from those discussed in, or implied by, these forward-looking statements. Factors that could cause actual results to differ materially from those implied by the forward-looking statements in this Quarterly Report are set forth in our 20162017 Annual Report and include but are not limited to:
the effects of economic downturns or slow recoveries, which could result in less demand for our services and pricing pressures;
any inability on our part to anticipate and quickly respond to changing marketplace conditions, such as alternative modes of healthcare delivery, reimbursement, or client needs;
the negative effects that intermediary organizations may have on our ability to secure new and profitable contracts with our clients;
the level of consolidation and concentration of buyers of healthcare workforce solutions and staffing services, which could affect the pricing of our services and our ability to mitigate concentration risk;
any inability on our part to anticipate and quickly respond to changing marketplace conditions, such as alternative modes of healthcare delivery, reimbursement, or client needs;
the ability of our clients to retain and increase the productivity of their permanent staff, or their ability to increase the efficiency and effectiveness of their internalstaffing management and recruiting efforts, through predictive analytics, online recruiting or otherwise, which may negatively affect our revenue, results of operations, and cash flows;
the uncertainty regarding the dismantling of certain aspectsrepeal or significant erosion of the Patient Protection and Affordable Care Act that may significantly reduce the number of individuals who maintain health insurance or reduce the subsidies and reimbursements to our clients, which, in turn,without a corresponding replacement may negatively affect the demand for our services;

any inability on our part to grow and operate our business profitably in compliance with federal and state healthcare industry regulation, including conduct of operations, costs and payment for services and payment for referrals as well as laws regarding employment practices and government contracting; 
any challenge to the classification of certain of our healthcare professionals as independent contractors, which could adversely affect our profitability;
the effect of investigations, claims, and legal proceedings alleging medical malpractice, violation of employment and wage regulations and other legal theories of liability asserted against us, which could subject us to substantial liabilities;
security breaches and other disruptions that could compromise our information and expose us to liability, which could cause our business and reputation to suffer and could subject us to substantial liabilities;
any inability ontechnology disruptions or our partinability to implement new infrastructure and technology systems effectively or technology disruptions, either of which may adversely affect our operating results and our ability to manage our business effectively;
disruption to or failures of our SaaS-based technology within certain of our service offerings or our inability to adequately protect our intellectual property rights with respect to such technology, which could reduce client satisfaction, harm our reputation, and negatively affect our business;
our dependence on third parties for the executioneffect of certain critical functions;
cybersecurity risks and cyber incidents, which could adversely affect our business orand disrupt our operations;
any inability on our part to recruit and retain sufficient quality healthcare professionals at reasonable costs;costs, which could increase our operating costs and negatively affect our business and profitability;
any inability on our part to properly screen and match quality healthcare professionals with suitable placements;placements, which may adversely affect demand for our services;

any inability on our part to successfully attract, develop and retain a sufficient number of quality sales and operations personnel;
our increasing dependence on third parties for the execution of certain critical functions;
the loss of our key officers and management personnel, which could adversely affect our business and operating results;
any inability to consummate and effectively integrate acquisitions into our business operations may adversely affect our long-term growth and our results of operations;
any inability on our part to maintain our positive brand awareness and identity;
any inability on our part to consummate and effectively incorporate acquisitions into our business operations;
any recognition by us of an impairment to the substantial amount of goodwill or indefinite-lived intangibles;intangibles on our balance sheet;
our substantial indebtedness and any inability on our part to generate sufficient cash flow to service our debt, which could adversely affect our ability to raise additional capital to fund operations and limit our ability to react to changes in the economy or our industry;
the terms of our debt instruments that impose restrictions on us that may affect our ability to successfully operate our business; and
the effect of significant adverse adjustments by us to our insurance-related accruals, which could decrease our earnings or increase our losses, as the case may be;
our significant indebtedness and any inability on our part to generate sufficient cash flow to service our debt; and
the terms of our debt instruments that impose restrictions on us that may affect our ability to successfully operate our business.

be.
Item 3. Quantitative and Qualitative Disclosures about Market Risk
Market risk is the risk of loss arising from adverse changes in market rates and prices, such as interest rates, foreign currency exchange rates, and commodity prices. During the three and nine months ended September 30, 2017,March 31, 2018, our primary exposure to market risk was interest rate risk associated with our variable interest debt instruments. In April 2015, we entered into an interest rate swap agreement to minimize our exposure to interest rate fluctuations on $100 million of our outstanding variable rate debt under one of our term loans for which we pay a fixed rate of 0.983% per annum and receive a variable rate equal to floating one-month LIBOR. In connection with the issuance and sale of the Notes and repayment of a portion of the Term Loans, we reduced the interest rate swap notional amount to $40 million in the fourth quarter of 2016. On May 3, 2017, we terminated the remaining interest rate swap after further repayment of the Term Loans. During the third quarter of 2017, we paid off the remaining balance of the Term Loans. A 100 basis point increase in interest rates on our variable rate debt would

not have resulted in a material effect on our unaudited condensed consolidated financial statements for the three and nine months ended September 30, 2017.March 31, 2018. During the three and nine months ended September 30, 2017,March 31, 2018, we generated substantially all of our revenue in the United States. Accordingly, we believe that our foreign currency risk is immaterial.
Item 4. Controls and Procedures
We carried out an evaluation, under the supervision and with the participation of our management, including our Chief Executive Officer and Chief Financial Officer, of the effectiveness of our disclosure controls and procedures, as defined in Rules 13a-15(e) and 15d-15(e) of the Securities Exchange Act of 1934. Based on that evaluation, our Chief Executive Officer and Chief Financial Officer have concluded that our disclosure controls and procedures as of September 30, 2017March 31, 2018 were effective to ensure that information required to be disclosed by us in reports that we file or submit under the Securities Exchange Act of 1934 is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms, and that such information is accumulated and communicated to management, including our Chief Executive Officer and Chief Financial Officer, as appropriate, to allow timely decisions regarding required disclosure.
 
There were no changes in our internal control over financial reporting that occurred during the quarter ended September 30, 2017March 31, 2018 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.

PART II - OTHER INFORMATION
 
Item 1. Legal Proceedings
None.

Item 1A. Risk Factors
We do not believe that there have been any material changes to the risk factors disclosed in Part I, Item 1A of our 20162017 Annual Report.

Item 2. Unregistered Sales of Equity Securities and Use of Proceeds
None.

Item 3. Defaults Upon Senior Securities
None.

Item 4. Mine Safety Disclosures
Not applicable.

Item 5. Other Information
None.

Item 6. Exhibits
 
Exhibit
Number
 Description
   
2.1
4.1
10.1
10.2
10.3
10.4
10.5
31.1 
   
 
   
 
   
 
   
101.INS XBRL Instance Document.*
   
101.SCH XBRL Taxonomy Extension Schema Document.*
   
101.CAL XBRL Taxonomy Extension Calculation Linkbase Document.*
   
101.DEF XBRL Taxonomy Extension Definition Linkbase Document.*
   
101.LAB XBRL Taxonomy Extension Label Linkbase Document.*
   
101.PRE XBRL Taxonomy Extension Presentation Linkbase Document.*
 
* Filed herewith.
   
   
   

SIGNATURES
 
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.

Date: November 3, 2017May 4, 2018
 
AMN HEALTHCARE SERVICES, INC.
 
/S/    SUSAN R. SALKA
Susan R. Salka
President and Chief Executive Officer
(Principal Executive Officer)

 
Date: November 3, 2017May 4, 2018
 

 
/S/    BRIAN M. SCOTT
Brian M. Scott
Chief Accounting Officer,
Chief Financial Officer and Treasurer
(Principal Accounting and Financial Officer)

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