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Segment Data
 12 Months Ended
Dec. 31, 2024
Segment Reporting [Abstract]  
Segment Data Segment Data
 
The Company has two operating and reportable segments, Nurse and Allied Staffing and Physician Staffing, which align with its management structure and reflect how the operating results are regularly reviewed by the Chief Executive Officer, who the Company has determined to be its Chief Operating Decision Maker (CODM). The Company’s segments offer services to its customers as described below:
 
•Nurse and Allied Staffing - Nurse and Allied Staffing provides traditional staffing, recruiting, and value-added total talent solutions including: temporary and permanent placement of travel nurse and allied professionals, per diem, and healthcare leaders within nursing, allied, human resources, and finance, MSP services, education healthcare services, in-home care services, and outsourcing services. In addition, Nurse and Allied Staffing provides executive search services for healthcare professionals, as well as contingent search and recruitment process outsourcing services, and offers the Company's SaaS-based, proprietary, vendor management technology, Intellify® to facilities to manage all or a portion of their agency services. Its customers include: public and private acute-care hospitals, non-acute care hospitals, government facilities, local healthcare plans, national healthcare plans, managed care providers, public schools, charter schools, academic medical centers, Programs of All-Inclusive Care for the Elderly (PACE) programs, outpatient clinics, ambulatory care facilities, physician practice groups, and many other healthcare providers throughout the United States.
 
•Physician Staffing - Physician Staffing provides physicians in many specialties, as well as certified registered nurse anesthetists, nurse practitioners, and physician assistants as independent contractors on temporary assignments throughout the United States at various healthcare facilities, such as acute and non-acute care facilities, medical group practices, government facilities, and managed care organizations.
 
Revenue, and the profit and loss measure of contribution income, are reported to the CODM by each of the operating segments to assess performance. Contribution income is the profit and loss measure used by the CODM to allocate operating and capital resources to each segment. The Company defines contribution income as income (loss) from operations before depreciation and amortization, acquisition and integration-related (benefits) costs, restructuring (benefits) costs, legal and other losses, impairment charges, and corporate overhead. Management believes that its measure of contribution income is most consistent with that used to measure the corresponding amounts on its consolidated financial statements.

The information in the following tables is derived from the segments’ internal financial information as used for corporate management purposes. Certain corporate expenses are not allocated to and/or among the operating segments. Those include corporate overhead and the remaining line items below contribution income in the consolidated column in the tables below, and are presented to the CODM on a consolidated basis only.
 
Information on reportable segments and a reconciliation to loss before income taxes for the period indicated are as follows:

Year Ended December 31, 2024
Nurse and Allied StaffingPhysician StaffingConsolidated
(amounts in thousands)
Revenue from services$1,145,419 $198,585 $1,344,004 
Direct operating expenses911,566 158,186 
Employee compensation100,038 20,436 
Benefits9,054 2,797 
Marketing7,695 713 
Credit loss expense (income)21,479 (47)
Divisional corporate G&A15,905 382 
Other segment items(a)
7,081 769 
Contribution Income$72,601 $15,349 $87,950 
Reconciliation of profit or loss:
Corporate overhead(b)
68,507 
Depreciation and amortization18,200 
Acquisition and integration-related costs4,219 
Restructuring costs4,333 
Legal and other losses6,668 
Impairment charges2,888 
Interest expense2,188 
Interest income(2,050)
Other income, net(605)
Loss before income taxes$(16,398)
_______________

(a) For each reportable segment, the other segment items category includes the following expenses: rent, insurance, maintenance, utilities, professional services, office, software and hardware, taxes, and miscellaneous employee expenses.
(b) Corporate overhead includes unallocated executive leadership and other centralized corporate functional support costs such as finance, IT, legal, human resources, and marketing, as well as public company expenses and corporate-wide projects (initiatives).
Information on reportable segments and a reconciliation to income before income taxes for the period indicated are as follows:

Year Ended December 31, 2023
Nurse and Allied StaffingPhysician StaffingConsolidated
(amounts in thousands)
Revenue from services$1,841,428 $178,300 $2,019,728 
Direct operating expenses1,430,128 139,190 
Employee compensation144,471 23,207 
Benefits15,704 2,353 
Marketing10,452 852 
Credit loss expense13,587 975 
Divisional corporate G&A21,550 505 
Other segment items(a)
8,759 1,430 
Contribution Income$196,777 $9,788 $206,565 
Reconciliation of profit or loss:
Corporate overhead(b)
71,049 
Depreciation and amortization18,347 
Acquisition and integration-related costs59 
Restructuring costs2,553 
Legal and other losses1,125 
Impairment charges719 
Interest expense8,094 
Loss on early extinguishment of debt1,723 
Interest income(83)
Other expense, net85 
Income before income taxes$102,894 
_______________

(a) For each reportable segment, the other segment items category includes the following expenses: rent, insurance, maintenance, utilities, professional services, office, software and hardware, taxes, and miscellaneous employee expenses.
(b) Corporate overhead includes unallocated executive leadership and other centralized corporate functional support costs such as finance, IT, legal, human resources, and marketing, as well as public company expenses and corporate-wide projects (initiatives).
Information on reportable segments and a reconciliation to income before income taxes for the period indicated are as follows:

Year Ended December 31, 2022
Nurse and Allied StaffingPhysician StaffingConsolidated
(amounts in thousands)
Revenue from services$2,697,155 $106,226 $2,803,381 
Direct operating expenses2,098,219 80,704 
Employee compensation171,057 15,740 
Benefits13,983 1,341 
Marketing14,518 821 
Credit loss expense9,340 269 
Divisional corporate G&A26,622 844 
Other segment items(a)
11,197 999 
Contribution Income$352,219 $5,508 $357,727 
Reconciliation of profit or loss:
Corporate overhead(b)
67,087 
Depreciation and amortization12,576 
Acquisition and integration-related costs726 
Restructuring costs1,861 
Impairment charges5,597 
Interest expense14,391 
Loss on early extinguishment of debt3,728 
Interest income(10)
Other income, net(1,326)
Income before income taxes$253,097 
_______________

(a) For each reportable segment, the other segment items category includes the following expenses: rent, insurance, maintenance, utilities, professional services, office, software and hardware, taxes, and miscellaneous employee expenses.
(b) Corporate overhead includes unallocated executive leadership and other centralized corporate functional support costs such as finance, IT, legal, human resources, and marketing, as well as public company expenses and corporate-wide projects (initiatives).
Revenue is based on services provided. In 2024, 2023, and 2022, revenue was generated primarily in the U.S., and all of the Company’s long-lived assets were located in the U.S. and India. The Company provides its staffing services and workforce solutions in all 50 states. The India location is a cost center with no revenues and an immaterial amount of long-lived assets. The Company had no intersegment revenues between reportable segments for the years ended December 31, 2024, 2023, and 2022.

The Company does not evaluate, manage, or measure performance of segments using asset information; accordingly, total asset information by segment is not prepared or disclosed.

The accounting policies of the segments are the same as those described in Note 2 – Summary of Significant Accounting Policies, which also provides information about major customers.

See the tables in Note 3 - Revenue Recognition, which present segment revenues by services.