SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

____________________



x☒			QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended September 30, 2021

For the transition period from to

Commission File No.: 001-16753

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,~~ 8840 Cypress Waters Boulevard	Suite ~~100~~ ~~San Diego, California~~ 300		~~92130~~
Dallas	Texas	75019
(Address of Principal Executive Offices)			(Zip Code)

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

____________________

Securities registered pursuant to Section 12(b) of the Act:


Title of Each Class	Trading Symbol	Name of each exchange on which registered
Common Stock, $0.01 par value	AMN	New York Stock Exchange

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~~“emerging growth ~~company"~~company” in Rule 12b-2 of the Exchange Act. ~~(Check one):~~

Large accelerated filerx

☒

Accelerated filer o

☐

Non-accelerated filero

☐

Smaller reporting companyo

☐

Emerging growth companyo

☐

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, 2017~~,3, 2021, there were ~~47,772,333~~47,275,009 shares of common stock, $0.01 par value, outstanding.

TABLE OF CONTENTS


Item		Page

	PART I - FINANCIAL INFORMATION

1.	Condensed Consolidated Financial Statements (unaudited):	1
	Condensed Consolidated Balance Sheets, As of September 30, 2021 and December 31, 2020	1
	Condensed Consolidated Statements of Comprehensive Income, For the Three and Nine Months Ended September 30, 2021 and 2020	2
	Condensed Consolidated Statements of Stockholders’ Equity, For the Nine Months Ended September 30, 2021 and 2020	3
	Condensed Consolidated Statements of Cash Flows, For the Nine Months Ended September 30, 2021 and 2020	4
	Notes to Unaudited Condensed Consolidated Financial Statements	6
2.	Management’s Discussion and Analysis of Financial Condition and Results of Operations	16
3.	Quantitative and Qualitative Disclosures about Market Risk	26
4.	Controls and Procedures	26

	PART II - OTHER INFORMATION


1.	Legal Proceedings	27
1A.	Risk Factors	27
2.	Unregistered Sales of Equity Securities and Use of Proceeds	27
3.	Defaults Upon Senior Securities	27
4.	Mine Safety Disclosures	27
5.	Other Information	27
6.	Exhibits	28
	Signatures	29

Item Page

PART I - FINANCIAL INFORMATION

1.
Condensed Consolidated Financial Statements (unaudited):
1

Condensed Consolidated Balance Sheets, As of September 30, 2017 and December 31, 2016
1

Condensed Consolidated Statements of Comprehensive Income, For the Three and Nine Months Ended September 30, 2017 and 2016
2

Condensed Consolidated Statements of Cash Flows, For the Nine Months Ended September 30, 2017 and 2016
3

Notes to Unaudited Condensed Consolidated Financial Statements
5
2.
Management’s Discussion and Analysis of Financial Condition and Results of Operations
14
3.
Quantitative and Qualitative Disclosures about Market Risk
22
4.
Controls and Procedures
23

PART II - OTHER INFORMATION

1.
Legal Proceedings
24
1A.
Risk Factors
24
2.
Unregistered Sales of Equity Securities and Use of Proceeds
24
3.
Defaults Upon Senior Securities
24
4.
Mine Safety Disclosures
24
5.
Other Information
24
6.
Exhibits
25

Signatures
26

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, 2021		December 31, 2020
ASSETS
Current assets:
Cash and cash equivalents	$	137,041	$	29,213
Accounts receivable, net of allowances of $6,148 and $7,043 at September 30, 2021 and December 31, 2020, respectively	570,101		376,099
Accounts receivable, subcontractor	141,626		73,985
Prepaid expenses	19,367		13,629
Other current assets	31,396		40,809
Total current assets	899,531		533,735
Restricted cash, cash equivalents and investments	63,603		61,347
Fixed assets, net of accumulated depreciation of $190,578 and $161,752 at September 30, 2021 and December 31, 2020, respectively	127,762		116,174
Operating lease right-of-use assets	36,487		77,735
Other assets	157,909		135,120
Goodwill	893,283		864,485
Intangible assets, net of accumulated amortization of $262,253 and $215,234 at September 30, 2021 and December 31, 2020, respectively	530,422		564,911
Total assets	$	2,708,997	$	2,353,507
LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:
Accounts payable and accrued expenses	$	284,094	$	167,881
Accrued compensation and benefits	321,938		213,414

Current portion of notes payable	—		4,688
Current portion of operating lease liabilities	14,396		15,032
Deferred revenue	17,904		11,004
Other current liabilities	2,854		10,938
Total current liabilities	641,186		422,957

Notes payable, net of unamortized fees and premium	842,027		857,961
Deferred income taxes, net	61,187		67,205
Operating lease liabilities	15,004		77,800
Other long-term liabilities	107,115		107,907
Total liabilities	1,666,519		1,533,830
Commitments and contingencies	0		0
Stockholders’ equity:
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at September 30, 2021 and December 31, 2020	—		—
Common stock, $0.01 par value; 200,000 shares authorized; 49,836 issued and 47,275 outstanding at September 30, 2021 and 49,614 issued and 47,053 outstanding at December 31, 2020	498		496
Additional paid-in capital	480,364		468,726
Treasury stock, at cost; 2,561 shares at September 30, 2021 and December 31, 2020	(119,143)		(119,143)
Retained earnings	680,729		469,558
Accumulated other comprehensive income	30		40
Total stockholders’ equity	1,042,478		819,677
Total liabilities and stockholders’ equity	$	2,708,997	$	2,353,507

September 30, 2017 December 31, 2016
ASSETS
Current assets:
Cash and cash equivalents $ 19,625
$ 10,622
Accounts receivable, net of allowances of $11,381 and $11,376 at September 30, 2017 and December 31, 2016, respectively 343,596
341,977
Accounts receivable, subcontractor 37,200
49,233
Prepaid expenses 15,832
14,189
Other current assets 26,220
34,607
Total current assets 442,473
450,628
Restricted cash, cash equivalents and investments 34,380
31,287
Fixed assets, net of accumulated depreciation of $94,531 and $84,865 at September 30, 2017 and December 31, 2016, respectively 68,188
59,954
Other assets 73,962
57,534
Goodwill 340,596
341,754
Intangible assets, net of accumulated amortization of $85,990 and $72,057 at September 30, 2017 and December 31, 2016, respectively 231,791
245,724
Total assets $ 1,191,390
$ 1,186,881
LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:
Accounts payable and accrued expenses $ 117,934
$ 137,512
Accrued compensation and benefits 111,984
107,993
Current portion of notes payable, less unamortized fees —
3,750
Deferred revenue 9,609
8,924
Other current liabilities 5,440
16,611
Total current liabilities 244,967
274,790

Notes payable, less unamortized fees 319,652
359,192
Deferred income taxes, net 11,899
21,420
Other long-term liabilities 82,673
82,096
Total liabilities 659,191
737,498
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, 2016 484
481
Additional paid-in capital 451,136
452,491
Treasury stock, at cost (630 and 443 shares at September 30, 2017 and December 31, 2016, respectively) (20,358 ) (13,261 )
Retained earnings 101,062
9,671
Accumulated other comprehensive income (loss) (125 ) 1
Total stockholders’ equity 532,199
449,383
Total liabilities and stockholders’ equity $ 1,191,390
$ 1,186,881

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 September 30,				Nine Months Ended September 30,
	2017			2016		2017			2016				2021		2020		2021		2020
Revenue	$	494,406		$	472,636	$	1,479,378		$	1,414,367		Revenue	$	877,800	$	551,631	$	2,621,190	$	1,762,443
Cost of revenue	334,867			318,169		997,051			953,249			Cost of revenue	571,935		366,998		1,745,914		1,178,204
Gross profit	159,539			154,467		482,327			461,118			Gross profit	305,865		184,633		875,276		584,239
Operating expenses:												Operating expenses:
Selling, general and administrative	100,579			99,995		299,325			297,359			Selling, general and administrative	173,932		111,235		491,773		394,537
Depreciation and amortization	8,132			7,789		23,759			21,888
Depreciation and amortization (exclusive of depreciation included in cost of revenue)												Depreciation and amortization (exclusive of depreciation included in cost of revenue)	26,104		26,936		74,098		69,096
Total operating expenses	108,711			107,784		323,084			319,247			Total operating expenses	200,036		138,171		565,871		463,633
Income from operations	50,828			46,683		159,243			141,871			Income from operations	105,829		46,462		309,405		120,606
Interest expense, net, and other	4,837			3,016		14,895			9,065			Interest expense, net, and other	5,223		12,564		24,278		35,061
Income before income taxes	45,991			43,667		144,348			132,806			Income before income taxes	100,606		33,898		285,127		85,545
Income tax expense	17,863			16,371		52,957			53,319			Income tax expense	26,583		7,831		73,956		24,188
Net income	$	28,128		$	27,296	$	91,391		$	79,487		Net income	$	74,023	$	26,067	$	211,171	$	61,357

Other comprehensive income (loss):												Other comprehensive income (loss):
Foreign currency translation and other	(73		)	40		(111		)	165			Foreign currency translation and other	11		(14)		(10)		(119)
Cash flow hedge, net of income taxes	—			231		(15		)	(343		)
Other comprehensive income (loss)	(73		)	271		(126		)	(178		)	Other comprehensive income (loss)	11		(14)		(10)		(119)

Comprehensive income	$	28,055		$	27,567	$	91,265		$	79,309		Comprehensive income	$	74,034	$	26,053	$	211,161	$	61,238

Net income per common share:												Net income per common share:
Basic	$	0.59		$	0.57	$	1.91		$	1.66		Basic	$	1.55	$	0.55	$	4.43	$	1.29
Diluted	$	0.57		$	0.55	$	1.85		$	1.61		Diluted	$	1.54	$	0.55	$	4.40	$	1.29
Weighted average common shares outstanding:												Weighted average common shares outstanding:
Basic	47,912			48,049		47,870			47,993			Basic	47,737		47,476		47,666		47,406
Diluted	49,445			49,410		49,480			49,287			Diluted	48,080		47,676		48,022		47,647

See accompanying notes to unaudited condensed consolidated financial statements.

AMN HEALTHCARE SERVICES, INC.


	Common Stock			Additional Paid-in Capital		Treasury Stock			Retained Earnings		Accumulated Other Comprehensive Income		Total
	Shares	Amount				Shares	Amount
Balance, December 31, 2019	49,283	$	493	$	455,193	(2,561)	$	(119,143)	$	400,047	$	152	$	736,742

Equity awards vested and exercised, net of shares withheld for payroll taxes	140	1		(4,354)		—	—		—		—		(4,353)
Cumulative-effect adjustment from adoption of the credit loss standard, net of tax	—	—		—		—	—		(1,154)		—		(1,154)
Share-based compensation	—	—		4,927		—	—		—		—		4,927
Comprehensive income (loss)	—	—		—		—	—		12,965		(47)		12,918
Balance, March 31, 2020	49,423	$	494	$	455,766	(2,561)	$	(119,143)	$	411,858	$	105	$	749,080

Equity awards vested and exercised, net of shares withheld for payroll taxes	119	1		(289)		—	—		—		—		(288)
Share-based compensation	—	—		6,347		—	—		—		—		6,347
Comprehensive income (loss)	—	—		—		—	—		22,325		(58)		22,267
Balance, June 30, 2020	49,542	$	495	$	461,824	(2,561)	$	(119,143)	$	434,183	$	47	$	777,406

Equity awards vested and exercised, net of shares withheld for payroll taxes	8	—		(158)		—	—		—		—		(158)
Share-based compensation	—	—		3,772		—	—		—		—		3,772
Comprehensive income (loss)	—	—		—		—	—		26,067		(14)		26,053
Balance, September 30, 2020	49,550	$	495	$	465,438	(2,561)	$	(119,143)	$	460,250	$	33	$	807,073


	Common Stock			Additional Paid-in Capital		Treasury Stock			Retained Earnings		Accumulated Other Comprehensive Income		Total
	Shares	Amount				Shares	Amount
Balance, December 31, 2020	49,614	$	496	$	468,726	(2,561)	$	(119,143)	$	469,558	$	40	$	819,677

Equity awards vested and exercised, net of shares withheld for payroll taxes	132	1		(5,259)		—	—		—		—		(5,258)

Share-based compensation	—	—		9,287		—	—		—		—		9,287
Comprehensive income (loss)	—	—		—		—	—		70,378		(24)		70,354
Balance, March 31, 2021	49,746	$	497	$	472,754	(2,561)	$	(119,143)	$	539,936	$	16	$	894,060

Equity awards vested and exercised, net of shares withheld for payroll taxes	78	1		(471)		—	—		—		—		(470)
Share-based compensation	—	—		6,019		—	—		—		—		6,019
Comprehensive income	—	—		—		—	—		66,770		3		66,773
Balance, June 30, 2021	49,824	$	498	$	478,302	(2,561)	$	(119,143)	$	606,706	$	19	$	966,382

Equity awards vested and exercised, net of shares withheld for payroll taxes	12	—		(527)		—	—		—		—		(527)
Share-based compensation	—	—		2,589		—	—		—		—		2,589
Comprehensive income	—	—		—		—	—		74,023		11		74,034
Balance, September 30, 2021	49,836	$	498	$	480,364	(2,561)	$	(119,143)	$	680,729	$	30	$	1,042,478

See accompanying notes to unaudited condensed consolidated financial statements.

AMN HEALTHCARE SERVICES, INC.


	Nine Months Ended September 30,
	2021		2020
Cash flows from operating activities:
Net income	$	211,171	$	61,357
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization (inclusive of depreciation included in cost of revenue)	75,871		70,077
Non-cash interest expense and other	(4,541)		3,727
Write-off of fees on credit facilities and senior notes	158		1,773
Change in fair value of contingent consideration	—		(1,700)
Increase in allowance for credit losses and sales credits	2,103		7,580
Provision for deferred income taxes	(4,328)		(17,923)
Share-based compensation	17,895		15,046
Loss on disposal or sale of fixed assets	386		3,664
Amortization of discount on investments	(41)		(96)
Net loss on deferred compensation balances	96		798
Non-cash lease expense	(257)		244
Changes in assets and liabilities, net of effects from acquisitions:
Accounts receivable	(196,342)		15,151
Accounts receivable, subcontractor	(67,641)		16,414
Income taxes receivable	5,472		6,157
Prepaid expenses	(5,695)		(3,361)
Other current assets	3,411		2,977
Other assets	780		3,378

Accounts payable and accrued expenses	112,183		(5,484)
Accrued compensation and benefits	96,666		7,630
Other liabilities	(26,268)		29,592

Deferred revenue	6,276		(32)
Restricted investments balance	16		12
Net cash provided by operating activities	227,371		216,981

Cash flows from investing activities:
Purchase and development of fixed assets	(38,710)		(27,357)
Purchase of investments	(32,437)		(37,418)
Proceeds from maturity of investments	40,000		21,500
Purchase of equity investment	(500)		—
Payments to fund deferred compensation plan	(6,094)		(7,171)
Proceeds from sale of equity investment	78		303
Purchase of convertible promissory notes	—		(490)
Cash paid for acquisitions, net of cash and restricted cash received	(41,264)		(476,491)
Cash paid for other intangibles	(90)		(1,400)
Cash received for working capital adjustments for prior year acquisitions	—		66
Net cash used in investing activities	(79,017)		(528,458)

Nine Months Ended September 30,
2017 2016
Cash flows from operating activities:
Net income $ 91,391
$ 79,487
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization 23,759
21,888
Non-cash interest expense and other 1,718
1,180
Change in fair value of contingent consideration 66
(88 )
Increase in allowances for doubtful accounts and sales credits 9,012
6,746
Provision for deferred income taxes (9,512 ) (3,209 )
Share-based compensation 7,720
8,795
Excess tax benefits from share-based compensation —
(2,764 )
Loss on disposal or sale of fixed assets 130
45
Amortization of discount on investments (112 ) —
Changes in assets and liabilities, net of effects from acquisitions:
Accounts receivable (10,631 ) (42,594 )
Accounts receivable, subcontractor 12,033
8,681
Income taxes receivable (1,854 ) 6,160
Prepaid expenses (1,643 ) (195 )
Other current assets 10,155
(10,109 )
Other assets (5,204 ) (4,295 )
Accounts payable and accrued expenses (20,442 ) (791 )
Accrued compensation and benefits 3,991
10,761
Other liabilities (5,112 ) 5,736
Deferred revenue 678
256
Restricted cash, cash equivalents and investments balance (9,761 ) (870 )
Net cash provided by operating activities 96,382
84,820

Cash flows from investing activities:
Purchase and development of fixed assets (17,168 ) (17,705 )
Purchase of investments (11,021 ) —
Proceeds from maturity of investments 17,200
—
Change in restricted cash, cash equivalents and investments balance 601
—
Payments to fund deferred compensation plan (10,056 ) (5,665 )
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 )


	Nine Months Ended September 30,
	2021		2020
Cash flows from financing activities:

Payments on term loans	(21,875)		(203,125)
Proceeds from term loans	—		250,000
Payments on revolving credit facility	(70,000)		(205,000)
Proceeds from revolving credit facility	70,000		245,000
Proceeds from senior notes	—		202,000


Payment of financing costs	—		(6,898)
Earn-out payments to settle contingent consideration liabilities for prior acquisitions	(3,100)		(10,622)
Cash paid for shares withheld for taxes	(6,255)		(4,798)
Net cash provided by (used in) financing activities	(31,230)		266,557
Effect of exchange rate changes on cash	(10)		(119)
Net increase (decrease) in cash, cash equivalents and restricted cash	117,114		(45,039)
Cash, cash equivalents and restricted cash at beginning of period	83,990		153,962
Cash, cash equivalents and restricted cash at end of period	$	201,104	$	108,923

Supplemental disclosures of cash flow information:
Cash paid for amounts included in the measurement of operating lease liabilities	$	35,066	$	15,079
Cash paid for interest (net of $248 and $300 capitalized for the nine months ended September 30, 2021 and 2020, respectively)	$	19,301	$	13,848
Cash paid for income taxes	$	72,863	$	30,727
Acquisitions:
Fair value of tangible assets acquired in acquisitions, net of cash and restricted cash received	$	1,906	$	35,704
Goodwill	28,135		274,427
Intangible assets	12,440		228,000
Liabilities assumed	(1,217)		(61,640)



Net cash paid for acquisitions	$	41,264	$	476,491
Supplemental disclosures of non-cash investing and financing activities:
Purchase of fixed assets recorded in accounts payable and accrued expenses	$	5,080	$	1,007

See accompanying notes to unaudited condensed consolidated financial statements.

AMN HEALTHCARE SERVICES, INC.

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.~~States (“U.S. GAAP”). Please refer to the Company’s audited consolidated financial statements and the related notes for the fiscal year ended December 31, ~~2016,~~2020, contained in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, ~~2016,~~2020, filed with the Securities and Exchange Commission on February ~~17, 2017~~26, 2021 (“~~2016~~2020 Annual Report”).

The preparation of financial statements in conformity with ~~accounting principles generally accepted in the United States~~U.S. GAAP requires management to make a number of estimates and assumptions relating to the reporting of assets and liabilities and the disclosure of contingent assets and liabilities at the dates of the financial statements and the reported amounts of revenue and expenses during the reporting periods. On an ongoing basis, the Company evaluates its estimates, including those related to intangible assets purchased in a business combination, asset impairments, accruals for self-insurance, compensation and related benefits, accounts receivable, contingencies and litigation, ~~earn-out~~contingent consideration liabilities associated with acquisitions, and income taxes. Actual results could differ from those estimates under different assumptions or conditions. The impact of the novel coronavirus (COVID-19) pandemic did not have a material effect on the Company’s estimates as of September 30, 2021.

Recently Adopted Accounting Pronouncements

In ~~March 2016,~~December 2019, the Financial Accounting Standards Board (“FASB”) issued Accounting ~~Standards~~Standard Update (“ASU”) ~~2016-09, “Stock Compensation - Improvements to Employee Share-Based Payment Accounting.~~2019-12, “Simplifying the Accounting for Income Taxes.” The ~~guidance attempts~~standard is expected to ~~simplify the~~reduce cost and complexity related to accounting for ~~share-based payment transactions in several areas, including~~income taxes. The new guidance eliminates certain exceptions and clarifies and amends existing guidance to promote consistent application among reporting entities. Depending on the ~~following: income tax consequences, classification of awards as either equity~~amended guidance within this standard, adoption is to be applied on a retrospective, modified retrospective or ~~liabilities, forfeitures, expected term, and statement of cash flows classification.~~prospective basis. The Company adopted this ~~pronouncement prospectively beginning~~standard effective January 1, ~~2017. Accordingly, the prior period has not been adjusted~~2021, and the ~~primary effects~~adoption did not have a material effect on the Company’s consolidated financial statements.

In January 2020, the FASB issued ASU 2020-01, “Clarifying the Interactions between Topic 321, Topic 323, and Topic 815.” The new guidance clarifies the interactions between accounting standards that apply to equity investments without readily determinable fair values. Specifically, it addresses the accounting for the transition into and out of the equity method. The Company adopted this standard effective January 1, 2021 on a prospective basis, and the adoption ~~for~~did not have a material effect on the ~~current period are as follows:~~Company’s consolidated financial statements.

Cash, Cash Equivalents and Restricted Cash

The Company ~~recorded $56~~considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. Cash and ~~$5,381 of tax benefits within income tax expense~~cash equivalents include currency on hand, deposits with financial institutions, money market funds, commercial paper and other highly liquid investments. Restricted cash and cash equivalents primarily includes cash and commercial paper that serve as collateral for the ~~three~~Company’s captive insurance subsidiary claim payments. See Note (7), “Fair Value Measurement” for additional information.

The following table provides a reconciliation of cash, cash equivalents and ~~nine months ended September 30, 2017, respectively,~~restricted cash reported within the accompanying condensed consolidated balance sheets and 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;~~amounts presented in the accompanying condensed consolidated statements of cash flows.


	September 30, 2021		December 31, 2020
Cash and cash equivalents	$	137,041	$	29,213
Restricted cash and cash equivalents (included in other current assets)	18,118		18,626
Restricted cash, cash equivalents and investments	63,603		61,347
Total cash, cash equivalents and restricted cash and investments	218,762		109,186
Less restricted investments	(17,658)		(25,196)
Total cash, cash equivalents and restricted cash	$	201,104	$	83,990

The Company ~~continued~~records accounts receivable at the invoiced amount. Accounts receivable are non-interest bearing. The Company maintains an allowance for expected credit losses based on the Company’s historical write-off experience, an assessment of its customers’ financial conditions and available information that is relevant to ~~estimate~~assessing the ~~number~~collectability of ~~awards expected to be forfeited in accordance with its existing accounting policy,~~cash flows, which ~~is to estimate forfeitures when recording share-based compensation expense;~~includes current conditions and forecasts about future economic conditions.

The ~~Company excluded the excess tax benefits from the assumed proceeds available to repurchase shares~~following table provides a reconciliation of activity in the ~~computation of its diluted earnings per share~~allowance for ~~the three and nine months ended September 30, 2017. The effect of this change on its diluted earnings per share was not significant; and~~credit losses for accounts receivable:

~~For the nine months ended September 30, 2017, cash flows related to excess tax benefits were classified as an operating activity.~~


	2021		2020
Balance as of January 1,	$	7,043	$	3,332
Adoption of the credit loss standard, cumulative-effect adjustment to retained earnings	—		1,334
Provision for expected credit losses	325		5,178
Amounts written off charged against the allowance	(1,220)		(1,333)

Balance as of September 30,	$	6,148	$	8,511

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

As set forth below, the Company completed ~~three~~2 acquisitions ~~during 2016. The Company~~from January 1, 2020 through September 30, 2021, which were accounted for ~~each acquisition~~ using the acquisition method of accounting. Accordingly, itthe Company recorded the tangible and intangible assets acquired and liabilities assumed at their estimated fair values as of the applicable date of acquisition. ~~For each~~Since the applicable date of acquisition, the Company ~~did not incur any material~~has revised the allocation of the purchase price to the tangible and intangible assets acquired and liabilities assumed based on analysis of information that has been made available through September 30, 2021. The allocations will continue to be updated through the measurement period, if necessary. The Company recognizes acquisition-related ~~costs.~~costs in selling, general and administrative expenses in the consolidated statements of comprehensive income.

~~Peak Provider Solutions~~Synzi and SnapMD Acquisition

On ~~June 3, 2016,~~April 7, 2021, the Company completed its acquisition of ~~Peak Provider Solutions~~Synzi Holdings, Inc. (“~~Peak”~~Synzi”)~~, which provides remote medical coding~~ and ~~consulting solutions~~its wholly-owned subsidiary, SnapMD, LLC (“SnapMD”). Synzi is a virtual care communication platform that enables organizations to ~~hospitals~~conduct virtual visits and ~~physician medical groups nationwide. The addition of Peak has expanded the Company’s workforce solutions~~use secure messaging, text, and ~~enables the Company~~email for clinician-to-patient and clinician-to-clinician communications. SnapMD is a full-service virtual care management company, specializing in providing software to ~~offer services in coding diagnosis and procedure codes, which is critical~~enable healthcare providers to ~~clinical quality reporting and the financial health of healthcare organizations.~~better engage with their patients. The initial purchase price of ~~$52,125 included (1) $51,645~~$42,240 consisted entirely of cash consideration paid upon acquisition. The acquisition was funded primarily 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.Senior Credit Facility (as defined below). The results of ~~Peak~~Synzi and SnapMD have been included in the Company’s ~~other~~technology and workforce solutions segment since the date of acquisition. During the ~~third~~second quarter of ~~2016,~~2021, $92 was returned to the Company in respect of the final working capital settlement.

The preliminary allocation of the $42,148 purchase price, which was reduced by the final working capital settlement, consisted of (1) $2,790 of fair value of tangible assets acquired, which included $884 cash received, (2) $1,217 of liabilities assumed, (3) $12,440 of identified intangible assets, and (4) $28,135 of goodwill, of which $6,085 is deductible for tax purposes. The provisional items pending finalization are income tax related matters and the assessment of additional information related to determining the fair value of certain assets acquired and liabilities assumed. The fair value of intangible assets primarily includes $10,890 of developed technology and $1,220 of trademarks with a weighted average useful life of approximately seven years.

Stratus Video Acquisition

On February 14, 2020, the Company completed its acquisition of Stratus Video, a remote video interpreting company that provides healthcare interpretation via remote video, over the phone, and onsite in-person, all supported by proprietary technology platforms. The initial purchase price of $485,568 consisted entirely of cash consideration paid upon acquisition. The acquisition was funded primarily through (1) borrowings under the Company’s $400,000 secured revolving credit facility (the “Senior Credit Facility”), provided for under a credit agreement (the “New Credit Agreement”), and (2) the Second Amendment (as defined in Note (6) below) to the New Credit Agreement, which provided $250,000 of additional available borrowings to the Company. The Senior Credit Facility, New Credit Agreement and Second Amendment are more fully described in Note (6), “Notes Payable and Credit Agreement.” The results of Stratus Video have been included in the Company’s technology and workforce solutions segment since the date of acquisition. During the second quarter of 2020, an additional ~~$275~~$99 of cash consideration was paid to the selling shareholders ~~for~~in respect of the final working capital settlement. The Company incurred $10,548 of acquisition-related costs during the nine months ended September 30, 2020 as a result of its acquisition of Stratus Video.

The allocation of the ~~$52,400~~$485,667 purchase price, which included the additional cash consideration paid for the final working capital settlement and was finalized during the first quarter of 2021, consisted of (1) ~~$5,658~~ $44,092of fair value of tangible assets acquired, which included $9,176 cash received, (2) ~~$9,346~~$56,059 of liabilities assumed, (3) ~~$19,220~~$228,000 of identified intangible assets, and (4) ~~$36,868~~$269,634 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$10,182 is deductible for tax purposes. The intangible assets acquired have a weighted average useful life of approximately ~~fifteen~~seventeen years. The following table summarizes the fair value and useful life of each intangible asset ~~acquired:~~acquired as of the acquisition date:


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

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

During the third quarter of 2020, the Company revised the estimated useful lives for the tradenames and trademarks intangible assets as a result of its plan to rebrand the language services business. Based on this change in circumstances since the date of acquisition, the Company determined that the remaining useful lives of the assets are 5 years and is amortizing the remaining value on a straight-line basis over the remaining useful life. The Company will continue to evaluate the remaining useful lives of other intangible assets impacted by its brand consolidation efforts.

Approximately $35,329 of revenue and $8,322 of income before income taxes of Stratus Video were included in the unaudited condensed consolidated statement of comprehensive income for the three months ended September 30, 2020. Approximately $78,080 of revenue and $13,787 of income before income taxes of Stratus Video were included in the unaudited condensed consolidated statement of comprehensive income for the nine months ended September 30, 2020.

Pro Forma Financial Information (Unaudited)

The following summary presents unaudited pro forma consolidated results of operations of the Company as if the acquisition of Stratus Video had occurred on January 1, 2019, which gives effect to certain adjustments, including acquisition-related costs of $1,023 and $11,662, that were reclassified from the three and nine months ended September 30, 2020, respectively, to the three and nine months ended September 30, 2019, respectively. The unaudited pro forma financial information is not necessarily indicative of the operating results that would have occurred had the acquisition been consummated as of the date indicated, nor is it necessarily indicative of the Company’s future operating results.


	Three Months Ended September 30,		Nine Months Ended September 30,
	2020			2020
Revenue	$	551,631		$	1,776,315
Income from operations	$	50,465		$	135,618
Net income	$	29,030		$	71,434

Revenue primarily consists of fees earned from the temporary staffing and permanent placement of healthcare professionals, executives, and ~~executives~~leaders (clinical and operational). The Company also generates revenue from its software as ~~well as from the Company’s SaaS-based technology,~~a service (“SaaS”)-based technologies, including ~~its~~ vendor management systems and scheduling software, and outsourced workforce services, including language interpretation and recruitment process outsourcing. The Company recognizes revenue when control of its ~~scheduling software.~~services is transferred to its customers, in an amount that reflects the consideration the Company expects to be entitled to receive in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by ~~the~~clinical and non-clinical healthcare ~~professional or executive.~~professionals. Under the Company’s managed services program (“MSP”) arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own ~~pool~~network of healthcare professionals along with those of third-party subcontractors. Revenue and the related direct costs under MSP arrangements are recorded in accordance with the accounting guidance on reporting revenue gross as a principal versus net as an agent. When the Company uses subcontractors and acts as an agent, revenue is recorded net of the related subcontractor’s expense. ~~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~~permanent placement and ~~permanent placement~~outsourced workforce services is recognized as the services are ~~provided and upon successful placements. The~~rendered. Depending on the arrangement, the Company’s SaaS-based revenue is recognized either as the services are rendered or ratably over the applicable arrangement’s service period. ~~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. While payment terms vary by the type of customer and the services rendered, the term between invoicing and when payment is due is not significant. During the nine months ended September 30, 2021 and 2020, previously deferred revenue recognized as revenue was $10,515 and $11,408, respectively.

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

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

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

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

See Note (5), “Segment Information,” for additional information regarding the Company’s revenue disaggregated by service type.

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, 2017 and~~ ~~2016, respectively:~~share:

Share-based awards to purchase 1021 and 1426 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,~~2021, respectively, because the effect of these instruments was anti-dilutive. Share-based awards to purchase 1184 and 1879 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, ~~2016~~2020, respectively, because the effect of these instruments was anti-dilutive.

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

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

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


	Three Months Ended September 30,				Nine Months Ended September 30,
	2021		2020		2021		2020
Revenue
Nurse and allied solutions	$	627,049	$	382,699	$	1,908,195	$	1,251,509
Physician and leadership solutions	150,663		109,116		430,523		355,580
Technology and workforce solutions	100,088		59,816		282,472		155,354
	$	877,800	$	551,631	$	2,621,190	$	1,762,443
Segment operating income
Nurse and allied solutions	$	92,564	$	52,923	$	283,768	$	173,706
Physician and leadership solutions	19,301		15,538		62,366		45,432
Technology and workforce solutions	47,210		25,680		131,952		62,814
	159,075		94,141		478,086		281,952
Unallocated corporate overhead	23,867		16,490		74,915		76,223
Depreciation and amortization	26,104		26,936		74,098		69,096
Depreciation (included in cost of revenue)	686		481		1,773		981
Share-based compensation	2,589		3,772		17,895		15,046
Interest expense, net, and other	5,223		12,564		24,278		35,061
Income before income taxes	$	100,606	$	33,898	$	285,127	$	85,545

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


	Three Months Ended September 30, 2021
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Temporary staffing	$	627,049	$	132,848	$	—	$	759,897
Permanent placement	—		17,815		—		17,815
Outsourced workforce	—		—		58,802		58,802
SaaS-based technologies	—		—		41,286		41,286
Total revenue	$	627,049	$	150,663	$	100,088	$	877,800

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 solutions 111,415
108,553
322,473
320,420
Other workforce solutions 80,058
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 solutions 14,438
14,026
39,028
43,634
Other workforce solutions 19,890
20,867
61,788
56,311
75,135
72,289
235,454
218,462
Unallocated corporate overhead 13,698
15,113
44,732
45,908
Depreciation and amortization 8,132
7,789
23,759
21,888
Share-based compensation 2,477
2,704
7,720
8,795
Interest expense, net, and other 4,837
3,016
14,895
9,065
Income before income taxes $ 45,991
$ 43,667
$ 144,348
$ 132,806


	Three Months Ended September 30, 2020
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Temporary staffing	$	382,699	$	95,648	$	—	$	478,347
Permanent placement	—		13,468		—		13,468
Outsourced workforce	—		—		38,159		38,159
SaaS-based technologies	—		—		21,657		21,657
Total revenue	$	382,699	$	109,116	$	59,816	$	551,631


	Nine Months Ended September 30, 2021
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Temporary staffing	$	1,908,195	$	379,814	$	—	$	2,288,009
Permanent placement	—		50,709		—		50,709
Outsourced workforce	—		—		164,595		164,595
SaaS-based technologies	—		—		117,877		117,877
Total revenue	$	1,908,195	$	430,523	$	282,472	$	2,621,190


	Nine Months Ended September 30, 2020
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Temporary staffing	$	1,251,509	$	310,945	$	—	$	1,562,454
Permanent placement	—		44,635		—		44,635
Outsourced workforce	—		—		87,705		87,705
SaaS-based technologies	—		—		67,649		67,649
Total revenue	$	1,251,509	$	355,580	$	155,354	$	1,762,443

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


	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Balance, January 1, 2021	$	339,015	$	152,800	$	372,670	$	864,485
Goodwill adjustment for Stratus Video acquisition	—		—		663		663

Goodwill from Synzi and SnapMD acquisition	—		—		28,135		28,135

Balance, September 30, 2021	$	339,015	$	152,800	$	401,468	$	893,283
Accumulated impairment loss as of December 31, 2020 and September 30, 2021	$	154,444	$	60,495	$	—	$	214,939

6. NOTES PAYABLE AND CREDIT AGREEMENT

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
On February 9, 2018, the Company entered into the New Credit Agreement with several lenders to provide for the $400,000 Senior Credit Facility to replace its then-existing credit facilities. On June 14, 2019, the Company entered into the first amendment to the New Credit Agreement (the “First Amendment”) to provide for, among other things, a $150,000 secured term loan credit facility (the “Term Loan”). The Company fully repaid all amounts under the Term Loan in 2019. On February 14, 2020, the Company entered into the second amendment to the New Credit Agreement (the “Second Amendment”) to provide for, among other things, a $250,000 secured term loan credit facility (the “Additional Term Loan”). The Second Amendment (together with the New Credit Agreement and the First Amendment, collectively, the “Amended Credit Agreement”) extended the maturity date of the Senior Credit Facility to be coterminous with the Additional Term Loan. The Company used the proceeds from the Additional Term Loan, together with a drawdown of a portion of the Senior Credit Facility, to complete its acquisition of Stratus Video as more fully described in Note (2), “Acquisitions.” The Company repaid

its outstanding indebtedness under the Additional Term Loan in the first quarter of 2021. The maturity date of the Senior Credit Facility is February 14, 2025.

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—3—Fair Value Measurement” of the ~~2016~~2020 Annual Report. The Company has not changed the valuation techniques or inputs it uses for its fair value measurement during the nine months ended September 30, ~~2017.~~2021.

Assets and Liabilities Measured on a Recurring Basis

~~The Company’s restricted~~Beginning in the third quarter of 2021, the Company invests a portion of its cash and cash equivalents ~~that serve as collateral for the Company’s outstanding letters of credit~~

~~typically consist of~~in non-federally insured money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs.

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

The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company 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. The Company’s cash equivalents also include commercial paper classified as Level 2 in the fair value hierarchy. Of the ~~$28,538~~$126,584 commercial paper issued and outstanding as of September 30, ~~2017, $5,076~~2021, $17,658 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, ~~2016,~~2020, the Company had ~~$25,610~~$58,345 commercial paper issued and outstanding, of which ~~$11,152~~$25,196 had original maturities greater than three months and were considered available-for-sale securities.

The Company’s ~~interest rate swap was~~contingent consideration liabilities associated with acquisitions are 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 or a simulation-based methodology for the acquired companies, which are Level 3 inputs. The Company recognizes changes to the fair value of its contingent consideration liabilities in selling, general and administrative expenses in the condensed consolidated statements of comprehensive income.

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, 2021
	Total		Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Money market funds	$	31,569	$	31,569	$	—	$	—
Deferred compensation	(117,020)		(117,020)		—		—
Commercial paper	126,584		—		126,584		—

Fair Value Measurements as of December 31, 2016
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
$ —
$ —
Commercial paper 25,610
—
25,610
—
Interest rate swap asset 24
—
24
—
Acquisition contingent consideration earn-out liabilities (6,816 ) —
—
(6,816 )

Level 3 Information

The following ~~table sets~~tables set 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 )


	2021		2020
Balance as of July 1,	$	—	$	(8,100)




Change in fair value of contingent consideration liability from b4health acquisition	—		6,700
Balance as of September 30,	$	—	$	(1,400)

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, 2016 3,000
—
Settlement of HSG earn-out for year ended December 31, 2016 1,930
—
Balance as of September 30, $ (1,952 ) $ (6,752 )


	2021		2020
Balance as of January 1,	$	(8,000)	$	(23,100)
Settlement of Advanced contingent consideration liability for year ended December 31, 2019	—		20,000
Settlement of b4health contingent consideration liability for year ended December 31, 2020	8,000		—





Change in fair value of contingent consideration liability from b4health acquisition	—		1,700
Balance as of September 30,	$	—	$	(1,400)

Assets Measured on a Non-Recurring Basis

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

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

The Company’s equity investment represents an investment in a non-controlled corporation without a readily determinable market value. The Company has elected to measure the investment at cost minus impairment, if any, plus or minus changes resulting from observable price changes. The fair value is determined by using quoted prices for identical or similar investments of the same issuer, which are Level 2 inputs, and other information available to the Company such as the rights and obligations of the securities. The Company recognizes changes to the fair value of its equity investment in interest expense, net, and other in the condensed consolidated statements of comprehensive income. The balance of the equity investment was $22,633 and $15,449 as of September 30, 2021 and December 31, 2020, respectively.

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, and no impairment charges recorded during the nine months ended September 30, ~~2017~~2021 and ~~2016.~~2020.

Fair Value of Financial Instruments

The ~~carrying amount~~Company is required to disclose the fair value of financial instruments for which it is practicable to estimate the value, even though these instruments are not recognized at fair value in the consolidated balance sheets. The fair value of the Company’s 4.625% senior notes ~~approximate their fair values. The~~due 2027 (the “2027 Notes”) and 4.000% senior notes ~~were issued~~due 2029 (the “2029 Notes”) was estimated using quoted market prices in ~~October 2016~~active markets for identical liabilities, which are Level 1 inputs. The carrying amounts and ~~have a fixed rate~~estimated fair value of ~~5.125%. There have been no changes~~the 2027 Notes and the 2029 Notes are presented in ~~available rates for similar debt since~~ the ~~date of issuance.~~following table. See additional information regarding the 2027 Notes and the 2029 Notes in ~~“Item 8. Financial~~Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of ~~our 2016~~the 2020 Annual Report.


	As of September 30, 2021				As of December 31, 2020
	Carrying Amount		Estimated Fair Value		Carrying Amount		Estimated Fair Value
2027 Notes	$	500,000	$	518,750	$	500,000	$	521,250
2029 Notes	350,000		359,625		350,000		357,000

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

7.8. LEASES

During the three months ended September 30, 2021, the Company entered into an arrangement to terminate the lease agreement (as amended to date) for its office space in San Diego. The termination will occur in 2 phases: the first phase terminates the Company’s right to use certain floors effective February 28, 2022 and the second phase reduces the remaining lease term to December 31, 2024 from its original termination date of July 31, 2027. As a result of the arrangement, which was accounted for as a modification, the Company paid a termination fee of $17,000, remeasured the lease liability using its incremental borrowing rate as the discount rate, and recorded decreases to its operating lease liabilities and right-of-use assets of $27,340 during the three months ended September 30, 2021. Prior to the modification, the total remaining lease payments for this office lease were $62,487. Under the modified lease terms, the total remaining lease payments (excluding the termination fee paid during the three months ended September 30, 2021) are $9,564.

9. 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,~~2021, the Company is no longer subject to state, local or foreign examinations by tax authorities for tax years before ~~2006,~~2011, and the Company is no longer subject to U.S. federal income or payroll tax examinations for tax years before 2011. The Company’s tax years 2007, 2008, 2009 and 2010 had been under audit by the Internal Revenue Service (“IRS”) 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 IRS 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.2017.

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.

CARES Act

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

8.The Company has deferred payment of the employer’s share of payroll taxes of $48,452, which is included in accrued compensation and benefits and other long-term liabilities in the consolidated balance sheet as of September 30, 2021, with half of such taxes to be paid by the end of 2021 and the other half to be paid by the end of 2022. The Company has claimed an employee retention employment tax credit of $1,756.

10. 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,~~compensation, contract, competitor disputes and employee-related matters and include individual and ~~collective~~class action lawsuits, as well as inquiries and investigations by governmental agencies regarding the Company’s employment and compensation practices. Additionally, some of the Company’s clients may also become subject to claims, governmental inquiries and investigations, and legal actions relating to services provided by the Company’s healthcare professionals. Depending upon the particular facts and circumstances, the

Company may also be subject to indemnification obligations under its contracts with such clients relating to these matters. The Company accrues for contingencies and records a liability when management believes an adverse outcome from a loss contingency is both probable and the amount, or a range, can be reasonably estimated. Significant judgment is required to determine both probability of loss and the estimated amount. The Company reviews its loss contingencies at least quarterly and adjusts its accruals and/or disclosures to reflect the impact of negotiations, settlements, rulings, advice of legal counsel, or other new information, as deemed necessary. The most significant

matters for which the Company has established loss contingencies are class actions related to wage and hour claims under California and Federal law. Specifically, among other claims in these lawsuits, it is alleged that certain expense reimbursements should be considered wages and included in the regular rate of pay for purposes of calculating overtime rates.

On May 26, 2016, former travel nurse Verna Maxwell Clarke filed a complaint against AMN Services, LLC, in California Superior Court in Los Angeles County. The Company removed the case to the United States District Court for the Central District of California (Case No. 2:16-cv-04132-DSF-KS) (the “Clarke Matter”). The complaint asserts that, due to the Company’s per diem adjustment practices, traveling nurses’ per diem benefits should be included in their regular rate of pay for the purposes of calculating their overtime compensation. On June 26, 2018, the district court denied the plaintiffs’ Motion for Summary Judgment in its entirety, and granted the Company’s Motion for Summary Judgment with respect to the Plaintiffs’ per diem and overtime claims. ~~Management currently~~The plaintiffs filed an appeal of the judgment relating to the per diem claims with the Ninth Circuit Court of Appeals (the “Ninth Circuit”). On February 8, 2021, a three-judge panel of the Ninth Circuit issued an opinion that reversed the district court’s granting of the Company’s Motion for Summary Judgment and remanded the matter to the district court instructing the district to enter partial summary judgment in favor of the Plaintiffs. On May 7, 2021, the Ninth Circuit issued an order denying the Company’s petition for rehearing. On August 26, 2021, the Company filed a Petition for Writ of Certiorari in the United States Supreme Court seeking review of the Ninth Circuit’s decision. At this time, it is unknown whether the Supreme Court will consider the appeal.

On May 2, 2019, former travel nurse Sara Woehrle filed a complaint against AMN Services, LLC, and Providence Health System – Southern California in California Superior Court in Los Angeles County. The Company removed the case to the United States District Court for the Central District of California (Case No. 2:19-cv-05282 DSF-KS). The complaint asserts that, due to the Company’s per diem adjustment practices, traveling nurses’ per diem benefits should be included in their regular rate of pay for the purposes of calculating their overtime compensation. The Complaint also alleges that the putative class members were denied required meal periods, denied proper overtime compensation, were not compensated for all time worked, including reporting time and training time, and received non-compliant wage statements. The Company has reached a preliminary agreement to settle this matter in its entirety. Final settlement is not expected until the fourth quarter of 2022.

The Company believes ~~the probable loss related to these~~that its wage and hour ~~claims~~practices, including those associated with the cases described above, conform with the applicable law in all material respects. However, because of the February 2021 ruling by the Ninth Circuit in the Clarke Matter and the inherent uncertainty of litigation, the Company is not ~~material~~able to reasonably predict if any matter will be resolved in a manner that is materially adverse to the Company. Accordingly, the Company recorded an increase to its accruals established in connection with the matters described above amounting to $20,000 during the fourth quarter of 2020, and the ~~amount accrued by~~ultimate resolution could result in a loss of up to $15,000, excluding penalties, in excess of the amounts currently accrued. For all other matters, the Company ~~for such claims~~ is ~~not material~~unable to currently estimate the possible loss or range of loss beyond the amounts already accrued. Loss contingencies accrued as of September 30, ~~2017. However, losses ultimately incurred for such claims could materially differ from amounts already accrued by the Company.~~

~~With regards to outstanding loss contingencies as of September 30, 2017, which~~2021 are included in accounts payable and accrued expenses and other long-term liabilities in the 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.sheets.

9.11. BALANCE SHEET DETAILS

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


	September 30, 2021		December 31, 2020
Other current assets:
Restricted cash and cash equivalents	$	18,118	$	18,626
Income taxes receivable	1,119		6,591
Other	12,159		15,592
Other current assets	$	31,396	$	40,809

Fixed assets:
Furniture and equipment	$	54,634	$	47,355
Software	254,090		220,971
Leasehold improvements	9,616		9,600
	318,340		277,926
Accumulated depreciation	(190,578)		(161,752)
Fixed assets, net	$	127,762	$	116,174

Other assets:
Life insurance cash surrender value	$	114,037	$	98,161
Other	43,872		36,959
Other assets	$	157,909	$	135,120

Accounts payable and accrued expenses:
Trade accounts payable	$	48,468	$	28,089
Subcontractor payable	147,776		79,364
Accrued expenses	60,414		37,849
Loss contingencies	11,627		7,613
Professional liability reserve	6,773		8,897
Other	9,036		6,069
Accounts payable and accrued expenses	$	284,094	$	167,881

Accrued compensation and benefits:
Accrued payroll	$	114,299	$	59,721
Accrued bonuses and commissions	66,215		34,514
Accrued travel expense	2,673		1,998
Health insurance reserve	6,627		5,590
Workers compensation reserve	10,297		10,244
Deferred compensation	117,020		97,184
Other	4,807		4,163
Accrued compensation and benefits	$	321,938	$	213,414







Other long-term liabilities:
Workers compensation reserve	$	20,716	$	20,930
Professional liability reserve	31,768		31,997
Unrecognized tax benefits	5,403		5,447

Other	49,228		49,533
Other long-term liabilities	$	107,115	$	107,907

September 30, 2017 December 31, 2016
Other current assets:
Restricted cash and cash equivalents $ 16,215
$ 20,271
Other 10,005
14,336
Other current assets $ 26,220
$ 34,607

Fixed assets:
Furniture and equipment $ 28,202
$ 25,582
Software 126,492
112,405
Leasehold improvements 8,025
6,832
162,719
144,819
Accumulated depreciation (94,531 ) (84,865 )
Fixed assets, net $ 68,188
$ 59,954

Other assets:
Life insurance cash surrender value $ 45,835
$ 32,190
Other 28,127
25,344
Other assets $ 73,962
$ 57,534

Accounts payable and accrued expenses:
Trade accounts payable $ 24,166
$ 33,392
Subcontractor payable 38,167
51,973
Accrued expenses 45,690
37,251
Professional liability reserve 7,048
10,254
Other 2,863
4,642
Accounts payable and accrued expenses $ 117,934
$ 137,512

Accrued compensation and benefits:
Accrued payroll $ 31,840
$ 30,917
Accrued bonuses 16,755
26,992
Accrued travel expense 3,488
2,972
Accrued health insurance reserve 3,708
3,189
Accrued workers compensation reserve 8,301
8,406
Deferred compensation 45,771
32,690
Other 2,121
2,827
Accrued compensation and benefits $ 111,984
$ 107,993

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
Professional liability reserve 40,033
37,338
Deferred rent 14,602
13,274
Unrecognized tax benefits 7,240
8,464
Other 2,323
4,312
Other long-term liabilities $ 82,673
$ 82,096

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,~~2020, filed with the Securities and Exchange Commission (“SEC”) on February ~~17, 2017~~26, 2021 (“~~2016~~2020 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~~organizations across the nation. As an innovative ~~workforce~~total talent solutions partner, our managed services programs, or “MSP,” vendor management systems, or “VMS,” ~~recruitment process outsourcing, or “RPO,”~~ workforce ~~optimization~~consulting services, ~~medical coding and consulting~~predictive modeling, staff scheduling, credentialing services, revenue cycle solutions, language services, and the placement of physicians, nurses, allied healthcare professionals and healthcare ~~executives~~leaders 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~~physician and leadership solutions, and (3) ~~other~~technology and workforce solutions. For the three months ended September 30, ~~2017,~~2021, we recorded revenue of ~~$494.4~~$877.8 million, as compared to ~~$472.6 million for the same period last year. For the three months ended September 30, 2017, we recorded net income of $28.1 million, as compared to $27.3~~$551.6 million for the same period last year. For the nine months ended September 30, ~~2017,~~2021, we recorded revenue of ~~$1,479.4~~$2,621.2 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~~$1,762.4 million for the same period last year.

Nurse and allied solutions segment revenue comprised ~~62%~~73% and 71% of total consolidated revenue for ~~both~~ the nine months ended September 30, ~~2017~~2021 and ~~2016.~~2020, 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. We also provide revenue cycle solutions, which include skilled labor solutions for remote medical coding, clinical documentation improvement, case management, and clinical data registry, and provide auditing and advisory services.

~~Locum tenens~~Physician and leadership solutions segment revenue comprised ~~22%~~16% and ~~23%~~20% of total consolidated revenue for the nine months ended September 30, ~~2017~~2021 and ~~2016,~~2020, respectively. Through our ~~locum tenens~~physician and leadership 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~~We also recruit physicians and healthcare ~~facility~~leaders for permanent placement and ~~physician practice group clients to fill temporary vacancies created by vacation~~place interim leaders 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~~executives across all healthcare ~~organizations throughout the United States, including hospitals, health systems, medical groups, occupational medical clinics, psychiatric facilities, government institutions, and insurance entities.~~settings. The interim healthcare professionals we place ~~are recruited nationwide and~~ are typically placed on contracts with assignment lengths ranging from a few days up to one ~~year.~~year, and a growing number of these placements are under our managed services solution.

~~Other~~Technology and workforce solutions segment revenue comprised ~~16%~~11% and ~~15%~~9% of total consolidated revenue for the nine months ended September 30, ~~2017~~2021 and ~~2016,~~2020, respectively. Through our ~~other~~technology and 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,~~language services, (2) ~~placing interim leaders and executives across all healthcare settings, (3) a~~ software-as-a-service (“SaaS”) VMS technologies through which our clients can manage ~~all of~~ their temporary staffing needs, (3) workforce optimization services that include consulting, data analytics, predictive modeling, and SaaS-based scheduling technology, (4) ~~RPO~~recruitment process outsourcing 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~~telehealth services, (6) ~~medical coding and related consulting~~credentialing services, and (7) ~~workforce optimization services~~flex pool management and other outsourced solutions services.

As part of our long-term growth strategy to add value for our clients, healthcare professionals, and shareholders, on April 7, 2021 and February 14, 2020, we acquired Synzi, including its wholly-owned subsidiary SnapMD, and Stratus Video (which we have since rebranded as AMN Language Services), respectively. Synzi and SnapMD offer virtual care technology platforms; Synzi focuses on the care management and home health markets and primarily serves as a patient communication and engagement platform, while SnapMD focuses on the outpatient market and primarily serves as a clinical communication and documentation platform. See additional information in the accompanying Note (2), “Acquisitions.”

Operating Metrics

We monitor the following key metrics to help us evaluate our financial condition and performance, identify trends affecting our businesses, and make strategic decisions:

•average travelers on assignment represents the average number of nurse and allied healthcare professionals on assignment during the period;

•bill rates represent the hourly straight-time rates that ~~include consulting, data analytics, predictive modeling,~~we bill to clients;

•billable hours represent hours worked by our healthcare professionals that we are able to bill on client engagements;

•days filled is calculated by dividing total locum tenens hours filled during the period by eight hours;

•revenue per day filled is calculated by dividing revenue of our locum tenens business by days filled for the period; and ~~SaaS-based scheduling technology.~~

•bill-to-pay spreads represent the differential between wages paid to healthcare professionals and amounts billed to clients.

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~~trends, and since early 2020 through present, the COVID-19 pandemic has impacted demand. When the imposition of ~~Labor Statistics’ survey data reflect near record levels~~“shelter-in-place” orders and the suspension of elective and “non-essential” healthcare ~~job openings and quits, which we view as positive trends for the healthcare staffing industry. At the same time, the entire healthcare industry continues to face uncertainty related~~services occurred in March 2020 in response to the ~~potential dismantling, or significant change to certain aspects~~COVID-19 health crisis, demand for many of ~~the Affordable Care Act, which could impact the reimbursements upon which~~ our ~~clients depend. The uncertainty has impacted the~~businesses declined significantly. With these orders and suspensions lifted, general utilization of healthcare ~~services~~has continued to improve and has generally returned to pre-COVID-19 levels. Since late 2020, we have been experiencing historically high demand for ~~our services.~~nurses and certain allied healthcare professionals. Recently, demand across all segments and business lines has been above pre-COVID-19 levels.

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 ofIn our nurse and allied ~~revenue derived~~solutions segment, prior to the COVID-19 pandemic, our ability to recruit enough nurses to meet the then-current demand levels was impacted by the tight labor market and modest bill rate increases. At the peak of the pandemic, demand for nurses was most concentrated in specialties including ICU and telemetry nurses. Now, the current historic demand levels are dispersed across many specialties. Our clients are faced with increased labor shortages resulting from nurse burnout, attrition, retirements and, to a lesser extent, the impact of mandatory vaccination requirements. Bill rates and wages for these nurses have continued to remain well above prior year levels due to the significantly higher demand and our ~~managed services program clients.~~clients’ need to frequently fill positions quickly. Although the number of nurses on travel assignments has increased since July 2020, our ability to adequately meet the high client demand is constrained by the tight labor market along with nurse burnout and the other aforementioned issues related to the pandemic.

The overall demand in our allied staffing division reached all-time highs in the third quarter. We saw record quarterly demand in our respiratory, laboratory, and radiology specialties, while our rehab therapy specialty saw its largest new demand quarter since 2019. The increased demand in some of these specialties was driven by COVID-19 hospitalizations, testing, and vaccination support. Demand in other modalities were driven by the continued surge in elective procedures as more of the population has become comfortable re-entering physician offices and outpatient centers. The return to in-person schools and additional federal funding has driven our school modality to strong year-over-year increases in all healthcare specialties.

In our ~~locum tenens~~physician and leadership solutions segment, wedemand has recovered and now exceeds pre-pandemic levels. We have seen ~~a decline in~~particularly higher demand infor certain specialties, such as ~~hospitalists that has negatively impacted~~anesthesiologists, certified registered nurse anesthetists and advanced practice clinicians, in our ~~volumes~~locum tenens division. Longer term, we expect continued strong core demand resulting from an increased level of burnout and ~~as a result, revenue in this segment. In addition, we made organizational and~~turnover of healthcare leadership ~~changes in this business and are making operational changes to improve performance. We are beginning to see the positive impact of these changes and improving demand in most specialties.~~roles.

In our ~~other~~technology and workforce solutions segment, our ~~interim leadership~~VMS technologies experienced increased utilization and ~~vendor management systems~~revenue growth this year due to increased demand levels and elevated bill rates.

The utilization of our language services business continued to grow as healthcare utilization returned to more normal activities and with the need and importance of these services having been demonstrated during the pandemic.

The demand for our recruitment process outsourcing increased in the third quarter as clients look for solutions to help address the increased labor shortages and the need to address vacancies in their permanent roles. We expect this increased demand to continue in the current constrained labor market.

As our businesses ~~are growing.~~have continued to grow, we have increased our sales and operations workforce to support our clients and healthcare professionals. We ~~are experiencing declines in~~have also increased spending to support our ~~permanent placement businesses that we believe are primarily related to operational execution~~current team members and ~~are making organizational changes designed to improve our performance.~~retain talent.

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 intangible assets purchased in a business combination, asset impairments, accruals for self-insurance, compensation and related benefits, accounts receivable, contingencies and litigation, ~~earn-out~~contingent consideration (“earn-out”) liabilities associated with acquisitions, 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 ~~Update~~Updates (“~~ASU”~~ASUs”) ~~2016-09~~ described in ~~Item 1. Condensed Consolidated Financial Statements—~~the accompanying Note 1, “Basis of Presentation,” as compared to the critical accounting policies and estimates described in our ~~2016~~2020 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~~physician and leadership solutions, and (3) ~~other~~technology and workforce solutions. The ~~Peak acquisition impacts~~Stratus Video, Synzi and SnapMD acquisitions impact the comparability of the results between the three and nine months ended September 30, ~~2017~~2021 and ~~2016.~~2020 depending on the timing of the applicable acquisition. Our historical results are not necessarily indicative of our future results of operations.


	Three Months Ended September 30,				Nine Months Ended September 30,
	2021		2020		2021		2020
Unaudited Condensed Consolidated Statements of Operations:
Revenue	100.0	%	100.0	%	100.0	%	100.0	%
Cost of revenue	65.2		66.5		66.6		66.9
Gross profit	34.8		33.5		33.4		33.1
Selling, general and administrative	19.8		20.2		18.8		22.4
Depreciation and amortization	2.9		4.9		2.8		3.9
Income from operations	12.1		8.4		11.8		6.8
Interest expense, net, and other	0.6		2.3		0.9		1.9
Income before income taxes	11.5		6.1		10.9		4.9
Income tax expense	3.1		1.4		2.8		1.4
Net income	8.4	%	4.7	%	8.1	%	3.5	%

Three Months Ended September 30, Nine Months Ended September 30,
2017 2016 2017 2016
Unaudited Condensed Consolidated Statements of Operations:
Revenue 100.0 % 100.0 % 100.0 % 100.0 %
Cost of revenue 67.7
67.3
67.4
67.4
Gross profit 32.3
32.7
32.6
32.6
Selling, general and administrative 20.3
21.2
20.2
21.0
Depreciation and amortization 1.7
1.6
1.6
1.6
Income from operations 10.3
9.9
10.8
10.0
Interest expense, net, and other 1.0
0.6
1.0
0.6
Income before income taxes 9.3
9.3
9.8
9.4
Income tax expense 3.6
3.5
3.6
3.8
Net income 5.7 % 5.8 % 6.2 % 5.6 %

Comparison of Results for the Three Months Ended September 30, ~~2017~~2021 to the Three Months Ended September 30, ~~2016~~2020

Revenue. Revenue increased 5%59% to ~~$494.4~~$877.8 million for the three months ended September 30, ~~2017~~2021 from ~~$472.6~~$551.6 million for the same period in ~~2016, all of which was~~2020, primarily attributable to higher organic ~~growth.~~revenue across our segments.

Nurse and allied solutions segment revenue increased 6%64% to ~~$302.9~~$627.0 million for the three months ended September 30, ~~2017~~2021 from ~~$286.8~~$382.7 million for the same period in ~~2016.~~2020. The ~~$16.1~~$244.3 million increase was primarily attributable to a 4%34% increase in the average number of ~~healthcare professionals~~travelers on assignment, ~~and a 2%~~an approximately 18% increase in the average bill rate, and an approximately $22.0 million increase in labor disruption revenue during the three months ended September 30, ~~2017~~.2021.

~~Locum tenens~~Physician and leadership solutions segment revenue increased 3%38% to ~~$111.4~~$150.7 million for the three months ended September 30, ~~2017~~2021 from ~~$108.6~~$109.1 million for the same period in ~~2016.~~2020, with the prior year significantly impacted by a demand decline related to the pandemic. The ~~$2.8~~$41.6 million increase was primarily attributable to a 4%23% increase in the number of days filled and a 6% increase in the revenue per day filled in our locum tenens business during the three months ended September 30, ~~2017, partially offset by~~2021, as we have seen a ~~1% decrease~~return of core business demand and volume. Our interim leadership business experienced an approximately 60% growth primarily due to recovery in ~~the number of days filled.~~demand, growth in core business and COVID-19 project work. Our physician permanent placement and executive search businesses grew 33% as search counts have returned to pre-COVID-19 levels.

~~Other~~Technology and workforce solutions segment revenue increased 4%67% to ~~$80.1~~$100.1 million for the three months ended September 30, ~~2017~~2021 from ~~$77.3~~$59.8 million for the same period in ~~2016.~~2020. The ~~$2.8~~$40.3 million increase was primarily attributable to growth inwithin our VMS, language services, and ~~interim leadership~~outsourced solutions businesses. Revenue growth for our language services and VMS businesses ~~partially offset by declines in our permanent placement businesses~~was 33% and 113%, respectively, during the three months ended September 30, ~~2017.~~2021.

~~Gross Profit~~. ~~Gross profit increased 3% to $159.5 million for~~For the three months ended September 30, ~~2017~~2021 and 2020, revenue under our MSP arrangements comprised approximately 52% and 49% of our consolidated revenue, 69% and 67% of our nurse and allied solutions segment revenue, 16% and 16% of our physician and leadership solutions segment revenue, and 3% and less than 1% of our technology and workforce solutions segment revenue, respectively.

Gross Profit. Gross profit increased 66% to $305.9 million for the three months ended September 30, 2021 from ~~$154.5~~$184.6 million for the same period in ~~2016,~~2020, representing gross margins of ~~32.3%~~34.8% and ~~32.7%~~33.5%, respectively. The ~~decrease~~increase in consolidated gross margin for the three months ended September 30, 2021, as compared to the same period in 2020, was primarily due to ~~an unfavorable change in sales mix, higher insurance costs in our other workforce solutions segment and lower bill-pay spreads in the locum tenens solutions segment, partially offset by~~ a higher gross margin in relation to the higher revenue in our nurse and allied solutions segment, driven primarily by ~~lower direct costs during~~higher labor disruption revenue and an additional $5.6 million of favorable actuarial-based decreases in our workers compensation reserves within the ~~three months ended September 30, 2017.~~segment, and a change in sales mix resulting from higher revenue in our technology and workforce solutions segment and its higher margins as compared to our staffing businesses. Gross margin by reportable segment for the three months ended September 30, ~~2017~~2021 and ~~2016~~2020 was ~~27.3%~~29.3% and ~~26.7%~~27.4% for nurse and allied solutions, ~~30.1%~~34.8% and ~~31.2%~~36.7% for ~~locum tenens~~physician and leadership solutions, and ~~54.1%~~69.4% and ~~56.7%~~66.1% for ~~other~~technology and workforce solutions, respectively.

Selling, General and Administrative Expenses. Selling, general and administrative (“SG&A”) expenses were ~~$100.6~~$173.9 million, representing ~~20.3%~~19.8% of revenue, for the three months ended September 30, ~~2017,~~2021, as compared to ~~$100.0~~$111.2 million, representing ~~21.2%~~20.2% of revenue, for the same period in ~~2016.~~2020. The increase in SG&A expenses was primarily due to higher ~~bad debt expense partially offset by operating leverage on~~employee compensation and benefits and other expenses associated with our revenue growth and a $3.9 million increase related to acquisition, integration, changes in the ~~higher revenue~~fair value of contingent consideration liabilities from acquisitions, restructuring, 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~~extraordinary legal expenses. SG&A expenses broken down among the reportable segments, unallocated corporate overhead, and share-based compensation are as follows:


						(In Thousands)
	(In Thousands) Three Months Ended September 30,					Three Months Ended September 30,
	2017		2016			2021		2020
Nurse and allied solutions	$	41,884	$	39,312	Nurse and allied solutions	$	91,449	$	52,067
Locum tenens solutions	19,075		19,881
Other workforce solutions	23,445		22,985
Physician and leadership solutions					Physician and leadership solutions	33,070		24,537
Technology and workforce solutions					Technology and workforce solutions	22,957		14,369
Unallocated corporate overhead	13,698		15,113		Unallocated corporate overhead	23,867		16,490
Share-based compensation	2,477		2,704		Share-based compensation	2,589		3,772
	$	100,579	$	99,995		$	173,932	$	111,235

Depreciation and Amortization Expenses. Amortization expense decreased ~~slightly~~18% to ~~$4.7~~$16.0 million for the three months ended September 30, ~~2017~~2021 from ~~$4.8~~$19.6 million for the same period in ~~2016.~~2020, primarily attributable to the reduction of useful lives of certain tradename intangible assets during the third quarter of 2020, which was partially offset by additional amortization expenses related to the intangible assets acquired in the Synzi and SnapMD acquisition. Depreciation expense (exclusive of depreciation included in cost of revenue) increased ~~13%~~38% to ~~$3.4~~$10.1 million for the three months ended September 30, ~~2017~~2021 from ~~$3.0~~$7.3 million for the same period in ~~2016,~~2020, primarily attributable to an increase in purchased and developed hardware and software placed in service for our ongoing information technology investments to support our total talent solutions initiatives and to optimize our internal front and ~~back office information technology initiatives.~~

~~Interest Expense, Net,~~back-office systems. Additionally, $0.7 million and ~~Other~~. ~~Interest~~$0.5 million of depreciation expense ~~net, and other, was $4.8 million during the~~ ~~three months ended September 30, 2017~~ ~~as compared to $3.0 million~~ for ~~the same period~~our language services business is included in ~~2016. The increase is primarily due to higher interest bearing Notes (as defined below)~~cost of revenue for the three months ended September 30, ~~2017, as compared to~~2021 and 2020, respectively.

Interest Expense, Net, and Other. Interest expense, net, and other was $5.2 million during the ~~term loans and revolver in the same period last year.~~

~~Income Tax Expense~~. ~~Income tax expense was $17.9 million for the~~ three months ended September 30, ~~2017~~2021 as compared to ~~income tax expense of $16.4~~$12.6 million for the same period in ~~2016, reflecting effective income~~2020. The decrease was primarily due to a $5.4 million gain related to the change in fair value of an equity investment and a lower average debt outstanding balance during the three months ended September 30, 2021, which resulted from repayments of the Credit Facilities (as defined below). The overall decrease was partially offset by a higher weighted average interest rate during the three months ended September 30, 2021, which was primarily due to the issuances of higher interest bearing senior notes during the third and fourth quarters of 2020.

Income Tax Expense. Income tax ~~rates of 39% and 37%~~expense was $26.6 million for the three months ended September 30, ~~2017~~2021 as compared to $7.8 million for the same period in 2020, reflecting effective income tax rates of 26% and ~~2016,~~23% for the three months ended September 30, 2021 and 2020, respectively. The ~~difference~~increase in the effective income tax rate was primarily attributable to the ~~relationship~~recognition of ~~pre-tax~~a $0.6 million discrete tax benefit for fair value changes in the cash surrender value of our Company Owned Life Insurance (“COLI”) during the three months ended September 30, 2021 compared to a $1.6 million discrete tax benefit for COLI during the same period in 2020, in relation to income ~~to permanent differences related to unrecognized tax benefits.~~before income taxes of $100.6 million and $33.9 million for the three months ended September 30, 2021 and 2020, respectively. We currently estimate our annual effective ~~income~~ tax rate to be approximately ~~38%~~26% for ~~2017.~~2021.

Comparison of Results for the Nine Months Ended September 30, ~~2017~~2021 to the Nine Months Ended September 30, ~~2016~~2020

Revenue. Revenue increased 5%49% to ~~$1,479.4~~$2,621.2 million for the nine months ended September 30, ~~2017~~2021 from ~~$1,414.4~~$1,762.4 million for the same period in ~~2016, due~~2020, primarily attributable to higher organic revenue across our segments along with additional revenue of ~~$12.4~~$22.5 million ~~resulting~~ from our ~~Peak acquisition in June 2016 with the remainder of the increase driven by 4% organic growth.~~Stratus Video, Synzi and SnapMD acquisitions.

Nurse and allied solutions segment revenue increased 5%52% to ~~$917.2~~$1,908.2 million for the nine months ended September 30, ~~2017~~2021 from ~~$877.2~~$1,251.5 million for the same period in ~~2016.~~2020. The ~~$40.0~~$656.7 million increase was primarily attributable to an approximately 22% increase in the average bill rate, a 5%21% increase in the average number of ~~healthcare professionals~~travelers on assignment, ~~and~~ a 3%2% increase in ~~the average bill rate~~billable hours, and an approximately $21.0 million increase in labor disruption revenue during the nine months ended September 30, ~~2017. The increase was partially offset by an approximately $28.0 million decrease in labor disruption revenue~~2021.

Physician and ~~the impact of one less calendar day due to last year being a leap year.~~

~~Locum tenens~~leadership solutions segment revenue ~~was $322.5~~increased 21% to $430.5 million for the nine months ended September 30, ~~2017, as compared to $320.4~~2021 from $355.6 million for the same period in ~~2016.~~2020. The ~~$2.1~~$74.9 million increase was primarily attributable to a 4%14% increase in the number of days filled and a 6% increase in the revenue per day filled in our locum tenens business during the nine months ended September 30, ~~2017, partially offset~~2021, which was driven in part by COVID-19 project work as well as a ~~3% decrease~~return in core demand and volume. The revenue increase was also attributable to growth in our interim leadership, physician permanent placement, and executive search businesses due to an increase in overall demand as engagement counts have experienced growth and search counts have returned to pre-COVID-19 levels along with COVID-19 project work. Our interim leadership business experienced an approximately 25% growth, while our physician permanent placement and executive search businesses grew 13% during the ~~number of days filled.~~nine months ended September 30, 2021.

~~Other~~Technology and workforce solutions segment revenue increased ~~11%~~82% to ~~$239.7~~$282.5 million for the nine months ended September 30, ~~2017~~2021 from ~~$216.8~~$155.4 million for the same period in ~~2016. Of the $22.9~~2020. The $127.1 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 organic growth inwithin our VMS, ~~interim leadership,~~language services, and ~~workforce optimization~~outsourced solutions businesses ~~partially offset by declines in~~along with additional revenue of $22.5 million from our ~~permanent placement~~Stratus Video, Synzi and ~~recruitment process outsourcing businesses~~SnapMD acquisitions during the nine months ended September 30, ~~2017.~~2021. Revenue growth for our language services and VMS businesses was 71% and 92%, respectively, during the nine months ended September 30, 2021.

For the nine months ended September 30, 2021 and 2020, revenue under our MSP arrangements comprised approximately 55% and 49% of our consolidated revenue, 73% and 65% of our nurse and allied solutions segment revenue, 15% and 17% of our physician and leadership solutions segment revenue, and 2% and less than 1% of our technology and workforce solutions segment revenue, respectively.

Gross Profit. Gross profit increased 5%50% to ~~$482.3~~$875.3 million for the nine months ended September 30, ~~2017~~2021 from ~~$461.1~~$584.2 million for the same period in ~~2016,~~2020, representing gross margins of ~~32.6% for both periods. Consolidated~~33.4% and 33.1%, respectively. The increase in consolidated gross margin was consistent with the prior year primarily due to a higher gross margin 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 duringfor the nine months ended September 30, ~~2017.~~2021, as compared to the same period in 2020, was primarily due to a change in sales mix resulting from higher revenue in our technology and workforce solutions segment and its higher margins as compared to our staffing businesses, which was partially offset by a lower margin in our physician and leadership solutions segment driven by the interim leadership business. Gross margin by reportable segment for the nine months ended September 30, ~~2017~~2021 and ~~2016~~2020 was 27.6% and ~~26.7%~~27.6% for nurse and allied ~~soluti~~

~~ons, 30.2%~~solutions, 36.1% and ~~31.2%~~36.6% for ~~locum tenens~~physician and leadership solutions, and ~~54.9%~~68.3% and ~~58.6%~~69.5% for ~~other~~technology and workforce solutions, respectively.

Selling, General and Administrative Expenses. SG&A expenses were ~~$299.3~~$491.8 million, representing ~~20.2%~~18.8% of revenue, for the nine months ended September 30, ~~2017,~~2021, as compared to ~~$297.4~~$394.5 million, representing ~~21.0%~~22.4% of revenue, for the same period in ~~2016.~~2020. The increase in SG&A expenses was primarily due to ~~$1.9 million of additional SG&A expenses from the Peak acquisition~~higher employee compensation and benefits and other expenses associated with our revenue ~~growth,~~growth. The overall increase was partially offset by ~~an additional $2.0 million favorable actuarial-based decrease in our professional liability reserves and $2.1~~a $16.0 million decrease related to acquisition, integration, changes in ~~acquisition~~the fair value of contingent consideration liabilities from acquisitions, restructuring, 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.~~extraordinary legal expenses. SG&A expenses broken down among the reportable segments, unallocated corporate overhead, and share-based compensation are as follows:


						(In Thousands)
	(In Thousands) Nine Months Ended September 30,					Nine Months Ended September 30,
	2017		2016			2021		2020
Nurse and allied solutions	$	118,464	$	115,755	Nurse and allied solutions	$	243,306	$	172,256
Locum tenens solutions	58,507		56,247
Other workforce solutions	69,902		70,654
Physician and leadership solutions					Physician and leadership solutions	92,899		84,820
Technology and workforce solutions					Technology and workforce solutions	62,758		46,192
Unallocated corporate overhead	44,732		45,908		Unallocated corporate overhead	74,915		76,223
Share-based compensation	7,720		8,795		Share-based compensation	17,895		15,046
	$	299,325	$	297,359		$	491,773	$	394,537

Depreciation and Amortization Expenses. Amortization expense ~~increased~~decreased 2% to ~~$13.9~~$47.0 million for the nine months ended September 30, ~~2017~~2021 from ~~$13.6~~$48.1 million for the same period in ~~2016,~~2020, primarily attributable to the reduction of useful lives of certain tradename intangible assets during the third quarter of 2020, which was partially offset by additional amortization ~~expense~~expenses related to the intangible assets acquired in the ~~Peak acquisition.~~Stratus Video, Synzi and SnapMD acquisitions. Depreciation expense (exclusive of depreciation included in cost of revenue) increased ~~18%~~29% to ~~$9.8~~$27.1 million for the nine months ended September 30, ~~2017~~2021 from ~~$8.3~~$21.0 million for the same period in ~~2016,~~2020, 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 information technology investments to support our total talent solutions initiatives and to optimize our internal front and ~~back office information technology initiatives.~~back-office systems. Additionally, $1.8 million and $1.0 million of depreciation expense for our language services business is included in cost of revenue for the nine months ended September 30, 2021 and 2020, respectively.

Interest Expense, Net, and Other. Interest expense, net, and other was ~~$14.9~~$24.3 million during the nine months ended September 30, ~~2017~~2021 as compared to ~~$9.1~~$35.1 million for the same period in ~~2016.~~2020. The ~~increase is~~decrease was primarily due to ~~higher interest bearing Notes (as defined below) for~~a $6.7 million gain related to the change in fair value of an equity investment and a lower average debt outstanding balance during the nine months ended September 30, ~~2017, as compared~~2021, which resulted from repayments of the Credit Facilities. The overall decrease was partially offset by a higher weighted average interest rate during the nine months ended September 30, 2021, which was primarily due to the ~~term loans~~issuances of higher interest bearing senior notes during the third and ~~revolver in the same period last year.~~fourth quarters of 2020.

Income Tax Expense. Income tax expense was ~~$53.0~~$74.0 million for the nine months ended September 30, ~~2017~~2021 as compared to ~~income tax expense of $53.3~~$24.2 million for the same period in ~~2016,~~2020, reflecting effective income tax rates of ~~37%~~26% and ~~40%~~28% for the nine months ended September 30, ~~2017~~2021 and ~~2016,~~2020, respectively. The ~~difference~~decrease in the effective income tax rate was primarily attributable to nondeductible meals per diem and officers compensation expenses of $5.0 million during the ~~relationship~~nine months ended September 30, 2021 compared to $4.2 million during the same period in 2020, in relation to income before income taxes of ~~pre-tax income to permanent differences related to unrecognized tax benefits~~$285.1 million and ~~excess tax benefit from the adoption of ASU 2016-09, “Stock Compensation - Improvements to Employee Share-Based Payment Accounting” in the first quarter of 2017, which resulted in recording a $5.4~~$85.5 million ~~reduction in income tax expense~~ for the nine months ended September 30, 2017. Prior to adoption, this amount would 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 volatility in our effective tax rate depending upon the amount of exercise or vesting activity from our share-based awards. See additional information in Item 1. Condensed Consolidated Financial Statements—Note 1 “Basis 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 2017.2021 and 2020, respectively.

Liquidity and Capital Resources

In summary, our cash flows were:


	(In Thousands)
	Nine Months Ended September 30,
	2021		2020

Net cash provided by operating activities	$	227,371	$	216,981
Net cash used in investing activities	(79,017)		(528,458)
Net cash provided by (used in) financing activities	(31,230)		266,557

Historically, our primary liquidity requirements have been for acquisitions, working capital requirements, and debt service under our credit facilities and ~~the Notes.~~senior notes. We have funded these requirements through internally generated cash flow and funds borrowed under our credit facilities. During the ~~third~~first quarter of ~~2017,~~2021, we paid off the remaining balance of our $250.0 million secured term ~~debt.~~loan credit facility (the “Additional Term Loan”). As of September 30, ~~2017, zero~~2021, (1) no amount was drawn ~~from $258.8~~with $379.2 million of available credit under ~~the~~our $400.0 million secured revolving credit facility (the ~~“Revolver”~~“Senior Credit Facility” and, together with the Additional Term Loan, the “Credit Facilities”) ~~and~~, (2) the aggregate principal amount of our ~~5.125% Senior Notes~~4.625% senior notes due ~~2024~~2027 (the ~~“Notes”~~“2027 Notes”) outstanding equaled ~~$325.0~~$500.0 million and (3) the aggregate principal amount of our 4.000% senior notes due 2029 (the “2029 Notes”) outstanding equaled $350.0 million. We describe in further detail our amended credit agreement, under which ~~our term loan and Revolver~~the Credit Facilities are governed, the 2027 Notes, and the 2029 Notes in ~~“Item 8. Financial~~Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of our ~~2016~~2020 Annual ~~Report on Form 10-K.~~Report.

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 ~~Revolver~~Senior Credit Facility will be sufficient to fund our operations, including expected capital expenditures, for at least the next ~~year.~~12 months. We intend to finance potential future acquisitions ~~either~~ with cash provided from operations, borrowings under the ~~Revolver,~~Senior Credit Facility or other borrowings under our amended 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 nine months ended September 30, ~~2017~~2021 was ~~$96.4~~$227.4 million, compared to ~~$84.8~~$217.0 million for the same period in ~~2016.~~2020. The increase in net cash provided by operating activities was primarily attributable to (1) an increase in net income excluding non-cash expenses of $154.0 million primarily due to improved operating results in our nurse and allied solutions and technology and workforce solutions segments, (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 discussed in Item 1. Condensed Consolidated Financial Statements—Note (1), “Basis of Presentation.” The overallan increase ~~was partially offset by (1) a decrease~~ in accounts payable and accrued expenses between periods of $117.7 million primarily due to an increase in associate vendor usage and timing of payments, ~~(2) additional cash paid for income taxes during the nine months ended September 30, 2017 as compared to the same period last year,~~ and (3) an increase in accrued compensation and benefits between periods of $89.0 million primarily due to increases in pay rates, billable hours, and the average number of travelers on assignment in our nurse and allied solutions segment and increased employee compensation and benefits. The overall increase in net cash ~~cash equivalents~~provided by operating activities was partially offset by (1) an increase in accounts receivable and ~~investments attributable~~subcontractor receivables between periods of $295.5 million due to ~~cash payments made~~a higher average receivables balance in the current year, which was due to increases in revenue and associate vendor usage along with timing of collections, and (2) a decrease in other liabilities between periods of $55.9 million primarily due to our ~~captive insurance entity,~~election in the prior year to defer employer payroll taxes in accordance with the Coronavirus Aid, Relief and Economic Security Act (the “CARES Act”) and the payment of a lease termination fee during the third quarter of 2021, which ~~are restricted for use~~was partially offset by an increase in accruals established in connection with a legal matter during the ~~captive for future claim payments and, to a lesser extent, its working capital needs.~~fourth quarter of 2020. Our Days Sales Outstanding (“DSO”) was 6460 days at ~~each of~~ September 30, ~~2017,~~2021, 55 days at December 31, ~~2016,~~2020, and 59 days at September 30, ~~2016.~~2020.

Investing Activities

Net cash used in investing activities for the nine months ended September 30, ~~2017~~2021 was ~~$23.4~~$79.0 million, compared to ~~$241.3~~$528.5 million for the same period in ~~2016.~~2020. 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~~$41.3 million used for acquisitions during the nine months ended September 30, ~~2016 and (2) net $6.2~~2021, as compared to $476.5 million ~~restricted investment proceeds related to our captive insurance entity~~ during the nine months ended September 30, ~~2017. The overall decrease was partially offset by (1) a $2.0 million equity investment~~2020, and (2) ~~$10.1~~net proceeds of restricted investments related to our captive insurance company of $7.6 million ~~of payments to fund the deferred compensation plan~~ during the nine months ended September 30, ~~2017~~2021, as compared to ~~$5.7~~a net purchase of $15.9 million ~~of payments~~ during the nine months ended September 30, ~~2016. Capital~~2020. In addition, capital expenditures were ~~$17.2~~$38.7 million and ~~$17.7~~$27.4 million for the nine months ended September 30, ~~2017~~2021 and ~~2016,~~2020, respectively.

Financing Activities

Net cash used in financing activities during the nine months ended September 30, ~~2017~~2021 was ~~$63.8~~$31.2 million, primarily due to (1) ~~the repayment~~repayments of ~~$44.1~~$70.0 million under ~~our term loans,~~the Senior Credit Facility and $21.9 million under the Additional Term Loan, (2) ~~$3.7 million for acquisition contingent consideration earn-out payments, (3) $7.1 million paid in connection with the repurchase of our common stock, and (4) $9.1~~$6.3 million in cash paid for shares withheld for payroll taxes resulting from the vesting of employee equity ~~awards.~~awards, and (3) $3.1 million for acquisition earn-out payments, partially offset by borrowings of $70.0 million under the Senior Credit Facility. Net cash provided by financing activities during the nine months ended September 30, ~~2016~~2020 was ~~$162.4~~$266.6 million,, primarily due to (1) borrowings of ~~$124.0~~$245.0 million under the ~~Revolver~~Senior Credit Facility and ~~$75.0~~$250.0 million ~~of borrowings~~ under ~~a new term loan under our amended credit agreement~~the Additional Term Loan, which were primarily used to fund our ~~BES~~Stratus Video acquisition, and ~~HSG acquisitions,~~(2) $202.0 million of gross proceeds received in connection with the issuance of an additional $200.0 million aggregate principal amount of 4.625% senior notes due 2027 (the “New 2027 Notes”), which were issued at a price of 101.000% of the aggregate principal amount, partially offset by (1) ~~the repayment~~repayments of ~~$8.4 million under our term loans and $24.0~~$205.0 million under the ~~Revolver,~~Senior Credit Facility and $203.1 million under the Additional Term Loan, (2) ~~$5.6~~$10.6 million for acquisition earn-out payments, (3) $4.8 million in cash paid for shares withheld for payroll taxes resulting from the vesting of employee equity ~~awards.~~awards, and (4) $6.9 million payment of financing costs in connection with our amended credit agreement and the issuance of the New 2027 Notes.

At September 30, ~~2017~~,2021, we maintained outstanding standby letters of credit totaling ~~$20.2~~$23.0 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~~$23.0 million of outstanding letters of credit, we have collateralized ~~$4.0~~$2.2 million in cash and cash equivalents and the remaining ~~amounts are~~$20.8 million is collateralized by the ~~Revolver.~~Senior Credit Facility. Outstanding standby letters of credit at December 31, ~~2016~~2020 totaled ~~$15.4~~$24.1 million.

Off-Balance Sheet Arrangements

At September 30, ~~2017~~,2021, we did not have any off-balance sheet ~~arrangement~~arrangements that ~~has~~have or isare 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 during the nine months ended September 30, 2021 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 ~~2016~~2020 Annual Report ~~that occurred during~~other than the ~~nine months ended September 30, 2017.~~following: (i) the borrowings and repayments under our amended credit agreement, which are described in the accompanying Note (2), “Acquisitions,” and Note (6), “Notes Payable and Credit Agreement,” and (ii) the modification to the operating lease of our office space in San Diego as described in the accompanying Note (8), “Leases.”

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,~~October 2021, the FASB issued ASU ~~2016-02, “Leases.~~2021-08, “Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers.” ~~This standard requires organizations that lease assets~~The new guidance will require companies to apply the definition of a performance obligation under Accounting Standards Codification (“ASC”) Topic 606, Revenue from Contracts with Customers, to recognize and measure contract assets and contract liabilities, such as deferred revenue, relating to contracts with customers that are acquired in a business combination. Under existing guidance, an acquirer generally recognizes assets acquired and liabilities assumed in a business combination, including contract assets and contract liabilities arising from revenue contracts with customers, at their acquisition-date fair values in accordance with ASC Subtopic 820-10, Fair Value Measurements—Overall. Generally, this new guidance will result in the acquirer recognizing acquired contract assets and liabilities ~~created~~on the same basis that would have been recorded by ~~those leases. The~~the acquiree prior to the acquisition under ASC Topic 606. This 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~~is 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.~~2022, with early adoption permitted. We are currently evaluating the ~~approach we will take and the~~ impact of adopting this ~~new~~ standard ~~on our consolidated financial statements and related disclosures.~~

In August 2016, the FASB issued ASU 2016-15, “Statement of 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. Early adoption is permitted, including adoption in an interim period. 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.

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.

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 impact of 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 demand or supply trends, 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 ~~2016~~2020 Annual Report and include but are not limited to:

•the effects of the COVID-19 pandemic on our business, financial condition and results of operations;

•the duration and extent to which hospitals and other healthcare entities adjust their utilization of temporary nurses and allied healthcare professionals, physicians, healthcare leaders and other healthcare professionals and workforce technology applications as a result of the suspension or reinstitution of restrictions placed on non-essential and elective healthcare as a result of the COVID-19 pandemic;

•the duration that individuals may continue to forgo non-essential and elective healthcare as restrictions and recommendations are reinstituted in parts of the country and lifted in others;

•the extent and duration that a significant spike in unemployment that has resulted from the COVID-19 pandemic will cause an increase in under- and uninsured patients and a corresponding reduction in overall healthcare utilization and demand for our services;

•the extent to which the COVID-19 pandemic may disrupt our operations due to the unavailability of our employees or healthcare professionals because of illness, risk of illness, quarantines, travel restrictions, mandatory vaccination requirements, desire to travel and work on temporary assignments or other factors that limit our existing or potential workforce and pool of candidates;

•the severity and duration of the impact the COVID-19 pandemic has on the financial condition and cash flow of many hospitals and healthcare systems such that it impairs their ability to make payments to us, timely or otherwise, for services rendered;

•the effects of economic downturns or slow recoveries, which could result in less demand for our services, pricing pressures and ~~pricing pressures;~~negatively impact payments terms and collectability of accounts receivable;

~~the negative effects that intermediary organizations may have on our ability to secure new and profitable contracts with our clients;~~

•the negative effects that intermediary organizations may have on our ability to secure new and profitable contracts;

•the level of consolidation and concentration of buyers of healthcare workforce, staffing and technology solutions, which could affect the pricing of our services and our ability to mitigate concentration risk;

•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 ~~internal~~staffing management and recruiting efforts, through predictive analytics, online recruiting, telemedicine or otherwise, which may negatively affect our revenue, results of operations, and cash flows;

•the ~~uncertainty regarding the dismantling of certain aspects~~repeal 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 recruit and retain sufficient quality healthcare professionals at reasonable costs, which could increase our operating costs and negatively affect our business and profitability;

•any inability on our part to grow and operate our business profitably in compliance with federal and state ~~healthcare industry~~ regulation, including privacy laws, conduct of operations, costs and payment for services and payment for referrals as well as laws regarding employment and compensation 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~~violations of employment, privacy and wage regulations and other legal theories of liability asserted against us, which could subject us to substantial liabilities;

~~security breaches and other~~•any technology disruptions ~~that could compromise~~or our ~~information and expose us to liability, which could cause our business and reputation to suffer and could subject us to substantial liabilities;~~

•any failure to further develop and evolve our current workforce solutions technology offerings and capabilities, which may harm our business;

•disruption to or failures of our SaaS-based ~~technology within certain of our service offerings~~technologies, or our inability to adequately protect our intellectual property rights with respect to such ~~technology, which~~technologies or sufficiently protect the privacy of personal information, could reduce client satisfaction, harm our reputation and negatively affect our business;

•security breaches and cybersecurity incidents, including ransomware, that could compromise our information and systems, which could adversely affect our business operations and reputation and could subject us to substantial liabilities;

•any inability on our part to quickly and properly credential and match quality healthcare professionals with suitable placements, which may adversely affect demand for our services;

•any inability on our part to continue to attract, develop and retain our sales and operations team members, which may deteriorate our operations;

•our increasing dependence on third parties, including offshore vendors, for the execution of certain critical functions;

~~cybersecurity risks and cyber incidents, which could adversely affect our business or disrupt our operations;~~

•any inability to consummate and effectively incorporate acquisitions into our business operations, which may adversely affect our long-term growth and our results of operations;

•businesses we acquire may have liabilities or adverse operating issues, which could harm our operating results;

•any increase to our business and operating risks as we develop new services and clients, enter new lines of business, and focus more of our business on providing a full range of client solutions;

•any inability on our part to maintain our positive brand awareness and ~~identity;~~identity, which may adversely affect our results of operation;

~~any inability on~~•the expansion of social media platforms presents new risks and challenges, which could cause damage to our ~~part to consummate and effectively incorporate acquisitions into our business operations;~~brand reputation;

•any recognition ~~by us~~ of an impairment to the substantial amount of goodwill or indefinite-lived ~~intangibles;~~intangibles on our balance sheet;

•our indebtedness, which could adversely affect our ability to raise additional capital to fund operations, limit our ability to react to changes in the ~~effect of significant adverse adjustments by~~economy or our industry, and expose us to ~~our insurance-related accruals, which could decrease our earnings or increase our losses, as~~interest rate risk to the ~~case may be;~~extent of any variable rate debt;

~~our significant indebtedness and any inability on our part to generate sufficient cash flow to service our debt; and~~

•the effect of significant adverse adjustments to our insurance-related accruals on our balance sheet, which could decrease our earnings or increase our losses and negatively impact our cash flows.

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,~~2021, 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.~~2021. During the three and nine months ended September 30, ~~2017,~~2021, 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~~Interim Principal 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~~Interim Principal Financial Officer have concluded that our disclosure controls and procedures as of September 30, ~~2017~~2021 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~~Interim Principal 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, ~~2017~~2021 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.~~Information with respect to this item may be found in the accompanying Note (9), “Commitments and Contingencies: Legal Proceedings,” which is incorporated herein by reference.

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 ~~2016~~2020 Annual Report. The risk factors described in our 2020 Annual Report are not the only risks we face. Factors we currently do not know, factors that we currently consider immaterial or factors that are not specific to us, such as general economic conditions, may also materially adversely affect our business or our consolidated operating results, financial condition or cash flows.

Item 2. Unregistered Sales of Equity Securities and Use of Proceeds

From time to time, we may repurchase our common stock in the open market pursuant to programs approved by our Board. We may repurchase our common stock for a variety of reasons, such as acquiring shares to offset dilution related to equity-based incentives and optimizing our capital structure. On November 1, 2016, our Board authorized us to repurchase up to $150.0 million of our outstanding common stock in the open market. Under the repurchase program announced on November 1, 2016 (the “Company Repurchase Program”), share purchases may be made from time to time beginning in the fourth quarter of 2016, depending on prevailing market conditions and other considerations. The Company Repurchase Program has no expiration date and may be discontinued or suspended at any time.

During the nine months ended September 30, 2021, we did not repurchase any shares of common stock. We describe in further detail our repurchase program and the shares repurchased thereunder in Part II, Item 5, “Market For Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities” set forth in our 2020 Annual Report.

Item 3. Defaults Upon Senior Securities

Item 4. Mine Safety Disclosures

Item 5. Other Information


*						Filed herewith.


*						~~Filed herewith.~~

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.


AMN HEALTHCARE SERVICES, INC.

/S/ SUSAN R. SALKA
Susan R. Salka President and Chief Executive Officer (Principal Executive Officer)


~~AMN HEALTHCARE SERVICES, INC.~~

/S/ CHRISTOPHER S.S~~USAN~~ ~~R. SALKA~~CHWARTZ
~~Susan R. Salka~~ ~~President and Chief Executive Officer~~ Christopher S. Schwartz Controller (Interim Principal ~~Executive~~Financial Officer)

/S~~/ BRIAN~~ ~~M. SCOTT~~

~~Brian M. Scott~~

~~Chief Accounting Officer,~~

~~Chief Financial Officer and Treasurer~~

~~(Principal Accounting and Financial Officer)~~



Exhibit Number						Description

~~31.1~~ 10.1						Lease Termination Agreement, dated as of September 9, 2021, between Kilroy Realty, L.P. and AMN Healthcare, Inc.*

31.1						Certification by Susan R. Salka pursuant to Rule 13a-14(a) of the Securities Exchange Act of 1934.*

31.2						Certification by ~~Brian M. Scott~~Christopher S. Schwartz pursuant to Rule 13a-14(a) of the Securities Exchange Act of 1934.*

32.1						Certification by Susan R. Salka pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.*

32.2						Certification by ~~Brian M. Scott~~Christopher S. Schwartz pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.*

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.*



	September 30, 2017			December 31, 2016
ASSETS
Current assets:
Cash and cash equivalents	$	19,625		$	10,622
Accounts receivable, net of allowances of $11,381 and $11,376 at September 30, 2017 and December 31, 2016, respectively	343,596			341,977
Accounts receivable, subcontractor	37,200			49,233
Prepaid expenses	15,832			14,189
Other current assets	26,220			34,607
Total current assets	442,473			450,628
Restricted cash, cash equivalents and investments	34,380			31,287
Fixed assets, net of accumulated depreciation of $94,531 and $84,865 at September 30, 2017 and December 31, 2016, respectively	68,188			59,954
Other assets	73,962			57,534
Goodwill	340,596			341,754
Intangible assets, net of accumulated amortization of $85,990 and $72,057 at September 30, 2017 and December 31, 2016, respectively	231,791			245,724
Total assets	$	1,191,390		$	1,186,881
LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:
Accounts payable and accrued expenses	$	117,934		$	137,512
Accrued compensation and benefits	111,984			107,993
Current portion of notes payable, less unamortized fees	—			3,750
Deferred revenue	9,609			8,924
Other current liabilities	5,440			16,611
Total current liabilities	244,967			274,790

Notes payable, less unamortized fees	319,652			359,192
Deferred income taxes, net	11,899			21,420
Other long-term liabilities	82,673			82,096
Total liabilities	659,191			737,498
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, 2016	484			481
Additional paid-in capital	451,136			452,491
Treasury stock, at cost (630 and 443 shares at September 30, 2017 and December 31, 2016, respectively)	(20,358		)	(13,261		)
Retained earnings	101,062			9,671
Accumulated other comprehensive income (loss)	(125		)	1
Total stockholders’ equity	532,199			449,383
Total liabilities and stockholders’ equity	$	1,191,390		$	1,186,881

~~For the quarterly period ended September 30, 2017~~OR

TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

~~For the transition period from~~ to