0001628280-22-004263 | 10-K | XBRL Viewer | Cross Country Healthcare INC

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CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 1,036	$ 1,600
Accounts receivable, net of allowances of $6,881 in 2021 and $4,021 in 2020	493,910	170,003
Prepaid expenses	7,648	5,455
Insurance recovery receivable	5,041	4,698
Other current assets	638	1,355
Total current assets	508,273	183,111
Property and equipment, net	15,833	12,351
Operating lease right-of-use assets	7,488	10,447
Goodwill	119,490	90,924
Trade names, indefinite-lived	5,900	5,900
Other intangible assets, net	42,344	34,831
Non-current deferred tax assets	11,525	0
Other non-current assets	21,956	19,409
Total assets	732,809	356,973
Current liabilities:
Accounts payable and accrued expenses	109,753	49,877
Accrued compensation and benefits	65,580	35,540
Current portion of debt	4,176	2,425
Operating lease liabilities - current	4,090	4,509
Income tax payable	7,307	8
Current portion of earnout liability	7,500	0
Other current liabilities	1,364	1,064
Total current liabilities	199,770	93,423
Long-term debt, less current portion	176,366	53,408
Operating lease liabilities - non-current	10,853	15,234
Non-current deferred tax liabilities	190	6,592
Long-term accrued claims	25,314	25,412
Non-current earnout liability	9,000	0
Other long-term liabilities	13,788	7,995
Total liabilities	435,281	202,064
Commitments and contingencies
Stockholders' equity:
Common stock—$0.0001 par value; 100,000,000 shares authorized; 37,023,644 and 36,177,279 shares issued and outstanding at December 31, 2021 and 2020, respectively	4	4
Additional paid-in capital	321,552	310,388
Accumulated other comprehensive loss	(1,293)	(1,280)
Accumulated deficit	(22,735)	(154,737)
Total Cross Country Healthcare, Inc. stockholders' equity	297,528	154,375
Noncontrolling interest in subsidiary	0	534
Total stockholders' equity	297,528	154,909
Total liabilities and stockholders' equity	$ 732,809	$ 356,973

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Accounts receivable, allowance for credit losses	$ 6,881	$ 4,021
Common stock, par value (usd per share)	$ 0.0001	$ 0.0001
Common stock, shares authorized (in shares)	100,000,000	100,000,000
Common stock, shares issued (in shares)	37,023,644	36,177,279
Common stock, shares outstanding (in shares)	37,023,644	36,177,279

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Statement [Abstract]
Revenue from Contract with Customer, Product and Service [Extensible List]	Service	Service	Service
Revenue from services	$ 1,676,652	$ 836,417	$ 822,224
Operating expenses:
Direct operating expenses	1,301,653	633,685	618,215
Selling, general and administrative expenses	215,292	173,809	181,959
Bad debt expense	4,783	3,035	2,008
Depreciation and amortization	9,852	12,671	14,075
Acquisition and integration-related costs	1,068	77	201
Restructuring costs	2,630	6,052	3,571
Legal settlement charges	0	0	1,600
Impairment charges	2,070	16,248	16,306
Total operating expenses	1,537,348	845,577	837,935
Income (loss) from operations	139,304	(9,160)	(15,711)
Other expenses (income):
Interest expense	6,866	2,890	5,306
Loss on derivative	0	0	1,284
Loss on early extinguishment of debt	0	0	1,978
Other (income) expense, net	(770)	280	(68)
Income (loss) before income taxes	133,208	(12,330)	(24,211)
Income tax expense (benefit)	1,206	(188)	31,732
Consolidated net income (loss)	132,002	(12,142)	(55,943)
Less: Net income attributable to noncontrolling interest in subsidiary	0	820	1,770
Net income (loss) attributable to common stockholders	$ 132,002	$ (12,962)	$ (57,713)
Net income (loss) per share attributable to common stockholders - Basic (usd per share)	$ 3.60	$ (0.36)	$ (1.61)
Net loss per share attributable to common stockholders - Diluted (usd per share)	$ 3.53	$ (0.36)	$ (1.61)
Weighted average common shares outstanding:
Basic (shares)	36,689	36,088	35,815
Diluted (shares)	37,392	36,088	35,815

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Statement of Comprehensive Income [Abstract]
Consolidated net income (loss)	$ 132,002	$ (12,142)	$ (55,943)
Other comprehensive (loss) income, before income tax:
Unrealized foreign currency translation (loss) gain	(33)	(40)	47
Unrealized loss on interest rate contracts	0	0	(1,078)
Reclassification adjustment to statement of operations	0	0	1,312
Other comprehensive income (loss), before income tax	(33)	(40)	281
Other Comprehensive Income (Loss), Tax [Abstract]
Income tax effect related to unrealized foreign currency translation (loss) gain	(20)	0	26
Income tax effect related to unrealized loss on interest rate contracts	0	0	(571)
Income tax effect related to reclassification adjustment to statement of operations	0	0	93
Valuation allowance adjustment	0	0	511
Taxes on other comprehensive income (loss)	(20)	0	59
Other comprehensive (loss) income, net of tax	(13)	(40)	222
Comprehensive income (loss)	131,989	(12,182)	(55,721)
Less: Net income attributable to noncontrolling interest in subsidiary	0	820	1,770
Comprehensive income (loss) attributable to common stockholders	$ 131,989	$ (13,002)	$ (57,491)

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) shares in Thousands, $ in Thousands	Total	Workforce Solutions Group, Inc.	Selected, Inc	Common Stock	Common Stock Workforce Solutions Group, Inc.	Common Stock Selected, Inc	Additional Paid-In Capital	Additional Paid-In Capital Workforce Solutions Group, Inc.	Additional Paid-In Capital Selected, Inc	Accumulated Other Comprehensive Loss	Accumulated Deficit	Noncontrolling Interest in Subsidiary
Beginning balance (in shares) at Dec. 31, 2018				35,626
Beginning balance at Dec. 31, 2018	$ 218,198			$ 4			$ 303,048			$ (1,462)	$ (84,062)	$ 670
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Exercise of share options (in shares)				14
Vesting of restricted stock (in shares)				231
Vesting of restricted stock	(801)						(801)
Equity compensation	3,396						3,396
Foreign currency translation adjustment, net of taxes	47									47
Net change in hedging transaction, net of taxes	175									175
Distribution to noncontrolling shareholder	(1,572)											(1,572)
Net (loss) income	(55,943)										(57,713)	1,770
Ending balance (in shares) at Dec. 31, 2019				35,871
Ending balance at Dec. 31, 2019	163,500			$ 4			305,643			(1,240)	(141,775)	868
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Vesting of restricted stock (in shares)				306
Vesting of restricted stock	(658)						(658)
Equity compensation	5,403						5,403
Foreign currency translation adjustment, net of taxes	(40)									(40)
Distribution to noncontrolling shareholder	(1,154)											(1,154)
Net (loss) income	(12,142)										(12,962)	820
Ending balance (in shares) at Dec. 31, 2020				36,177
Ending balance at Dec. 31, 2020	154,909			$ 4			310,388			(1,280)	(154,737)	534
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Vesting of restricted stock (in shares)				479
Vesting of restricted stock	(2,230)						(2,230)
Equity compensation	6,894						6,894
Foreign currency translation adjustment, net of taxes	(13)									(13)
Acquisitions( in shares )					308	60
Acquisitions		$ 5,000	$ 1,500					$ 5,000	$ 1,500
Dissolution of noncontrolling interest	324											324
Distribution to noncontrolling shareholder	(210)											(210)
Net (loss) income	132,002										132,002	0
Ending balance (in shares) at Dec. 31, 2021				37,024
Ending balance at Dec. 31, 2021	$ 297,528			$ 4			$ 321,552			$ (1,293)	$ (22,735)	$ 0

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Cash flows from operating activities
Net (loss) income	$ 132,002	$ (12,142)	$ (55,943)
Adjustments to reconcile net income (loss) to net cash (used in) provided by operating activities:
Depreciation and amortization	9,852	12,671	14,075
Provision for allowances	6,499	4,269	3,243
Deferred income tax (benefit) expense	(9,927)	(932)	31,159
Non-cash lease expense	2,424	3,547	4,989
Impairment charges	2,070	16,248	16,306
Loss on early extinguishment of debt	0	0	1,978
Equity compensation	6,894	5,403	3,396
Other non-cash costs	1,828	990	513
Changes in operating assets and liabilities:
Accounts receivable	(318,420)	(4,745)	(6,642)
Prepaid expenses and other assets	(3,364)	(2,083)	(1,574)
Accounts payable and accrued expenses	83,286	7,239	(1,308)
Operating lease liabilities	(6,753)	(5,872)	(5,820)
Other	7,991	2,611	1,170
Net cash (used in) provided by operating activities	(85,618)	27,204	5,542
Cash flows from investing activities
Acquisitions, net of cash acquired	(26,876)	0	0
Purchases of property and equipment	(7,170)	(4,615)	(2,940)
Net cash used in investing activities	(34,046)	(4,615)	(2,940)
Cash flows from financing activities
Proceeds from term loan	175,000	0	0
Principal payments on term loan	(688)	0	(83,876)
Principal payments on note payable	(2,426)	(2,426)	0
Borrowings under revolving credit facility	0	0	5,000
Repayments on revolving credit facility	0	0	(5,000)
Debt issuance costs	(6,098)	(81)	(2,058)
Proceeds under Senior Secured Asset-Based revolving credit facility	0	0	76,640
Borrowings under Senior Secured Asset-Based revolving credit facility	443,544	420,334	71,934
Repayments on Senior Secured Asset-Based revolving credit facility	(487,753)	(437,900)	(77,600)
Cash paid for shares withheld for taxes	(2,230)	(658)	(801)
Cash payments to noncontrolling shareholder	(210)	(1,153)	(1,573)
Other	(45)	(126)	(265)
Net cash provided by (used in) financing activities	119,094	(22,010)	(17,599)
Effect of exchange rate changes on cash	6	(11)	10
Change in cash and cash equivalents	(564)	568	(14,987)
Cash and cash equivalents at beginning of year	1,600	1,032	16,019
Cash and cash equivalents at end of year	1,036	1,600	1,032
Supplemental disclosure of cash flow information:
Interest paid	5,773	2,666	4,554
Income taxes paid	$ 3,608	$ 612	$ 555

Organization and Basis of Presentation	12 Months Ended
Organization and Basis of Presentation	Dec. 31, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Basis of Presentation	Organization and Basis of Presentation Nature of Business Cross Country Healthcare, Inc. (the Company) was incorporated in Delaware on July 29, 1999 as a business providing travel nurse and allied health staffing services. As of December 31, 2021, the Company provides total talent management services, including strategic workforce solutions, contingent staffing, permanent placement, and consultative services for healthcare customers. The Company places highly qualified healthcare professionals in virtually every specialty and area of expertise. Its diverse client base includes both clinical and nonclinical settings, servicing both public and private acute care and non-acute care hospitals, outpatient clinics, ambulatory-care centers, single and multi-specialty physician practices, rehabilitation facilities, urgent care centers, local and national healthcare systems, managed care providers, both public schools and charter schools, correctional facilities, government facilities, pharmacies, and many other healthcare providers. The consolidated financial statements include the accounts of the Company and its direct and indirect wholly-owned subsidiaries, as well as Cross Country Talent Acquisition Group, LLC, which was a joint venture controlled by the Company but not wholly owned. The Company recorded the ownership interest of the noncontrolling shareholder as noncontrolling interest in subsidiary. Effective December 31, 2020, the sole professional staffing services agreement held by this joint venture was terminated and, as a result, the Company dissolved Cross Country Talent Acquisition Group, LLC in the third quarter of 2021. All intercompany transactions and balances have been eliminated in consolidation. Certain prior year amounts have been reclassified to conform to the current year presentation. See the consolidated balance sheets and statements of cash flows, Note 3 - Revenue Recognition, and Note 18 - Segment Data.

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

Use of Estimates

The preparation of consolidated financial statements in conformity with United States generally accepted accounting principles (U.S. GAAP) requires management to make estimates and assumptions that affect the reported amounts in the consolidated financial statements and accompanying notes. Management has assessed various accounting estimates and other matters, including those that require consideration of forecasted financial information, in context of the unknown future impacts of the current global outbreak of COVID-19 (COVID) using information that is reasonably available to the Company at the time. Significant estimates and assumptions are used for, but not limited to: (i) the valuation of accounts receivable; (ii) goodwill, trade names, and other intangible assets; (iii) other long-lived assets; (iv) revenue recognition; (v) accruals for health, workers’ compensation, and professional liability claims; (vi) valuation of deferred tax assets; (vii) legal contingencies, and (viii) income taxes. Accrued insurance claims and reserves include estimated settlements from known claims and actuarial estimates for claims incurred but not reported. As additional information becomes available to the Company, its future assessment of these estimates, including management's expectations at the time regarding the duration, scope, and severity of the pandemic, as well as other factors, could materially and adversely impact the Company's consolidated financial statements in future reporting periods. Actual results could differ from those estimates.

COVID

The Company continues to closely monitor the COVID pandemic, and prioritize the mental health and well-being of its employees. While operating primarily through a remote workforce, the Company's offices remain open with stringent safety guidelines and procedures in place, including allowing only vaccinated employees on-site, social distancing, and enhanced cleaning at all of its locations. Business travel, including visits to healthcare clients, continues to be somewhat limited at the request of the Company's clients who are continuing to cope with the pandemic twenty-four hours a day/seven days a week.

Throughout the pandemic, the Company has partnered with its clients to deliver flexible solutions aimed at solving their immediate and long-term challenges. It has continued to provide data, industry insights, marketing analytics, and consulting services to assist clients in determining the appropriate rates necessary to attract the supply they need. One of the Company's core values is to act ethically and responsibly, and it has been especially important during this pandemic to be transparent and build trust with its clients to re-enforce long-lasting relationships as both demand and bill rates have increased to unprecedented levels.

Cash and Cash Equivalents

The Company considers all investments with original maturities of three months or less to be cash and cash equivalents. Interest income on cash and cash equivalents was immaterial for the years ended December 31, 2021, 2020, and 2019, and is included in other income (expense), net, in the consolidated statements of operations.

Accounts Receivable, Allowance for Doubtful Accounts, and Concentration of Credit Risk

Accounts receivable potentially subject the Company to concentrations of credit risk. The Company generally does not require collateral and mitigates its credit risk by performing credit evaluations and monitoring at-risk accounts. The allowance for doubtful accounts is established for losses expected to be incurred on accounts receivable balances. Accounts receivable are written off against the allowance for doubtful accounts when the Company determines amounts are no longer collectible. Judgment is required in the estimation of the allowance and the Company evaluates the collectability of its accounts receivable and contract assets based on a combination of factors. The Company bases its allowance for doubtful account estimates on its historical write-off experience, current conditions, an analysis of the aging of outstanding receivable and customer payment patterns, and specific reserves for customers in adverse condition adjusted for current expectations for the customers or industry. Based on the information currently available, the Company also considered current expectations of future economic conditions, including the impact of COVID, when estimating its allowance for doubtful accounts.

The opening balance of the allowance for doubtful accounts is reconciled to the closing balance for expected credit losses as follows:


	2021		2020
Allowance for Doubtful Accounts	(amounts in thousands)
Balance at January 1	$	3,416	$	2,406
Bad Debt Expense	504		539
Write-Offs, net of Recoveries	(699)		(349)
Balance at March 31	3,221		2,596
Bad Debt Expense	466		898
Write-Offs, net of Recoveries	(358)		(532)
Balance at June 30	3,329		2,962
Bad Debt Expense	1,441		946
Write-Offs, net of Recoveries	(138)		(800)
Balance at September 30	4,632		3,108
Bad Debt Expense	2,372		652
Write-Offs, net of Recoveries	(917)		(344)
Balance at December 31	$	6,087	$	3,416

In addition to the allowance for doubtful accounts, the Company maintains a sales allowance for billing-related adjustments which may arise in the ordinary course of business and adjustments to the reserve are recorded as contra-revenue. The balance of this allowance as of December 31, 2021 and December 31, 2020 was $0.8 million and $0.6 million, respectively.

The Company’s contract terms typically require payment between 30 to 60 days from the date of invoice and are considered past due based on the particular negotiated contract terms. The majority of the Company's customers are U.S. based healthcare systems with a significant percentage in acute-care facilities. No single customer accounted for more than 10% of the Company's accounts receivable balance as of December 31, 2021 and 2020, or revenue for the years ended December 31, 2021, 2020, and 2019.

Property and Equipment

Property and equipment are stated at cost, less accumulated depreciation. Depreciation is determined on a straight-line basis over the estimated useful lives of the assets, which generally range from three to ten years. Leasehold improvements are depreciated over the shorter of their estimated useful life or the term of the individual lease. On an annual basis, the Company reviews its property and equipment listings and disposes of assets that are no longer in use.

Certain software development costs have been capitalized. Such costs include charges for consulting services and costs for Company personnel associated with programming, coding, and testing such software. Amortization of capitalized software costs is included in depreciation expense in the consolidated statements of operations and begins when the software is ready for use. See Note 6 - Property and Equipment.

Cloud Computing Arrangements

Implementation costs associated with cloud computing arrangements are capitalized when incurred during the application development phase. In connection with the licensing of software products, the Company has entered into arrangements in which it does not take possession of the software; rather, the software application resides on the vendor's or a third-party's hardware, and the Company accesses and uses the software on an as-needed basis over the Internet or via a dedicated line. Therefore, the cloud computing arrangement does not give rise to an intangible asset. Costs are capitalized in accordance with the Company’s policies for other capitalizable service costs. Amortization is calculated over the contractual term of the cloud computing arrangement and is included in selling, general and administrative expenses in the consolidated statements of operations. As of December 31, 2021 and 2020, the Company has a current asset of $0.5 million and $0.4 million, respectively, included in prepaid expenses and a non-current asset of $4.8 million and $3.2 million, respectively, included in other non-current assets in the consolidated balance sheets that have been capitalized in conjunction with implementations. Amortization of the cloud computing assets was $0.4 million for the year ended December 31, 2021 and immaterial for the years ended December 31, 2020 and 2019.

Leases

The Company determines whether an arrangement constitutes a lease at commencement. Operating leases are included in operating lease right-of-use assets, and operating lease liabilities - current and non-current in the consolidated balance sheets. Finance leases are included in other non-current assets, other current liabilities, and other long-term liabilities in the consolidated balance sheets. See Note 10 - Leases.

Right-of-use assets are measured based on the corresponding lease liability adjusted for: (i) payments made to the lessor at or before the commencement date; (ii) initial direct costs; and (iii) tenant incentives under the lease. Rent expense commences when the lessor makes the underlying asset available to the Company. Lease liabilities are measured based on the present value of the total lease payments not yet paid discounted based on its incremental borrowing rate, as the rate implicit in the lease is not determinable. The Company estimates its incremental borrowing rate based on an analysis of publicly-traded debt securities of companies with credit and financial profiles similar to its own. The variable portion of the lease payments is not included in the right-of-use assets or lease liabilities. Rather, variable payments, other than those dependent upon an index or rate, are expensed when the obligation for those payments is incurred and are included in lease expense in selling, general and administrative expense in the consolidated statements of operations. Rent expense for operating lease payments is recognized on a straight-line basis over the lease term. The Company does not assume renewals or early terminations unless it is reasonably certain to exercise these options at commencement.

Deferred rent credits related to tenant improvement allowances and other leasehold incentives reduced the beginning operating right-of-use asset recognized, and will be recognized as a reduction to future rent expense over the expected remaining term of the respective leases.

The Company leases apartments for eligible field employees under short-term agreements (typically three to six months), which generally coincide with each employee’s staffing contract. Costs relating to these leases are included in direct operating expenses in the consolidated statements of operations.

Business Combinations

Business combinations are accounted for at fair value. The associated acquisition costs are expensed as incurred and recorded as acquisition and integration-related costs; noncontrolling interests, if any, are reflected at fair value at the acquisition date; restructuring costs associated with a business combination are expensed; contingent consideration is measured at fair value at the acquisition date, with changes in the fair value after the acquisition date affecting earnings; and goodwill is determined as the excess of the fair value of the consideration conveyed in the acquisition over the fair value of the net assets acquired. The accounting for business combinations requires estimates and judgments as to expectations for future cash flows of the acquired business, and the allocation of those cash flows to identifiable intangible assets, in determining the estimated fair value for assets and liabilities acquired. The fair values assigned to tangible and intangible assets acquired and liabilities assumed are based on management's estimates and assumptions, including valuations that utilize customary valuation procedures and techniques. If the actual results differ from the estimates and judgments used in these estimates, the amounts recorded in the financial statements could result in a possible impairment of the intangible assets and goodwill or require acceleration of the amortization expense of finite-lived intangible assets. The results of the acquired businesses' operations are included in the consolidated statements of operations of the combined entity beginning on the date of acquisition. See Note 4 - Acquisitions.

Goodwill, Trade Names, and Other Intangible Assets

Goodwill represents the excess of purchase price and related costs over the fair value assigned to the net tangible and identifiable intangible assets of businesses acquired. Other identifiable intangible assets with definite lives are being amortized using the straight-line method over their estimated useful lives which have ranged from 5 to 16 years. Goodwill and certain intangible assets with indefinite lives are not amortized. Instead, these assets are reviewed for impairment annually at the beginning of the fourth quarter, and whenever circumstances change that would more likely than not reduce the fair value of a reporting unit below its carrying amount.

When reviewed, the Company has the option to first assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount, as a basis for determining whether it is necessary to perform the quantitative testing. If it is determined that a quantitative test is necessary or more efficient than a qualitative approach, the Company measures the fair value of its reporting units using a combination of income and market approaches.

The Company performs its annual review on October 1. If the reporting unit’s carrying value exceeds its fair value, an impairment charge is recognized for the amount by which the carrying amount exceeds the reporting unit’s fair value not to exceed the total amount of goodwill allocated to that reporting unit. Additionally, income tax effects from any tax deductible goodwill on the carrying amount of the reporting unit when measuring the goodwill impairment loss is considered, if applicable.

The Company determines its reporting units by identifying its operating segments and any component businesses and aggregates the component businesses if they have similar economic characteristics. The Company had the following reporting units that it reviewed for impairment: (1) Nurse and Allied Staffing; (2) Physician Staffing; and (3) Search.

Management considers historical experience and all available information at the time the fair values of its reporting units are estimated. However, fair values that could be realized in an actual transaction may have differed from those used to evaluate the potential impairment of goodwill.

Long-lived assets and identifiable intangible assets with definite lives are evaluated for impairment. Long-lived assets and definite-lived intangible assets are reviewed for impairment whenever events or changes in circumstances indicate the carrying amount may not be recoverable.

Recoverability of long-lived assets is measured by a comparison of the carrying amount of the asset group to the future undiscounted net cash flow that is expected to be generated by those assets. If such assets are considered to be impaired, the impairment charge recognized is the amount by which the carrying amount of the assets exceeds the fair value of the assets.

Any related impairment losses are recognized in earnings and included in the caption impairment charges in the consolidated statements of operations. See Note 5 - Goodwill, Trade Names, and Other Intangible Assets.

Debt Discount and Debt Issuance Costs

Stated discounts on proceeds and other fees reimbursed to lenders were treated as a discount associated with the respective debt instrument and presented in the balance sheet as an offset to the carrying amount of the debt. Debt issuance costs associated with

the revolving line-of-credit are presented as an asset, included in other non-current assets in the balance sheet. Discounts are amortized to interest expense using the effective interest rate method, or a method that approximates the effective interest rate method, over the expected life of the debt.

Derivative Financial Instruments

The Company was exposed to interest rate risk due to its outstanding senior secured term loan entered into on August 1, 2017 with a variable interest rate. As a result, the Company had entered into an interest rate swap agreement to effectively convert a portion of its variable interest payments to a fixed rate. The principal objective of the interest rate swap was to eliminate or reduce the variability of the cash flows in those interest payments associated with the Company’s long-term debt, thus reducing the impact of interest rate changes on future interest payment cash flows. The Company had determined that the interest rate swap qualified as a cash flow hedge. As the critical terms of the hedging instrument and the hedged forecasted transaction were the same, the Company had concluded that changes in the cash flows attributable to the risk being hedged were expected to completely offset at inception and on an ongoing basis. Changes in the fair value of the interest rate swap agreement designated as a cash flow hedge were recorded as a component of accumulated other comprehensive loss, net of deferred taxes, within stockholders’ equity and were amortized to interest expense over the term of the related debt as the interest payments were made. Interest rate swap payments were included in net cash provided by operating activities in the consolidated statements of cash flows. The Company terminated its interest rate swap agreement on September 26, 2019. See Note 9 - Derivative.

Sales and Other State Non-income Tax Liabilities

The Company's sales and other state non-income tax filings are subject to routine audits by authorities in the jurisdictions where it conducts business in the United States which may result in assessments of additional taxes. The Company accrues sales and other state non-income tax liabilities based on the Company’s best estimate of its probable liability utilizing currently available information and interpretation of relevant tax regulations. Given the nature of the Company’s business, some subjectivity exists as to both whether sales and other state non-income taxes can be assessed on its activity and how the sales tax will ultimately be measured by the relevant jurisdictions. The Company makes a determination for each reporting period whether the estimates for sales and other non-income taxes in certain states should be revised. The expense is included in selling, general and administrative expenses on its consolidated statements of operations and the liability is reflected in sales tax payable within other current liabilities in the consolidated balance sheets.

Insurance Claims

The Company provides workers’ compensation insurance coverage, professional liability coverage, and healthcare benefits for eligible employees. The Company records its estimate of the ultimate cost of, and reserves for, workers' compensation and professional liability benefits based on actuarial models prepared or reviewed by an independent actuary using the Company’s loss history as well as industry statistics. The healthcare insurance accrual is for estimated claims that have occurred but have not been reported and is based on the Company’s historical claim submission patterns. Furthermore, in determining its reserves, the Company includes reserves for estimated claims incurred but not reported as well as unfavorable claims development.

Under circumstances such as in the Company’s insured professional liability and workers' compensation policies, since a right of legal offset does not exist due to the fact that there are three parties to an incurred claim, the insured, the insurer, and the claimant, the related liability to the claimant should be classified separately on a gross basis with a separate related receivable from the insurer recognized as being due from insurance carriers. Accordingly, the Company’s consolidated balance sheets as of December 31, 2021 and 2020 reflect the related short-term liabilities in accrued compensation and benefits and the related long-term liabilities as long-term accrued claims, and the short-term receivable portion as insurance recovery receivable and the long-term portion as non-current insurance recovery receivable. See Note 7 - Balance Sheet Details. The ultimate cost of workers’ compensation, professional liability, and health insurance claims will depend on actual amounts incurred to settle those claims and may differ from the amounts reserved by the Company for those claims.

Workers’ compensation benefits are provided under a partially self-insured plan. The Company has letters of credit to guarantee payments of claims. At December 31, 2021 and 2020, the Company had outstanding approximately $16.7 million and $17.0 million, respectively, of standby letters of credit as collateral to secure the self-insured portion of this plan.

The Company has occurrence-based primary professional liability policies that provide the Company and each working professional in its nurse and allied healthcare business with coverage. The Company has a claims-made professional liability policy for its physicians and advanced practitioners, with a $0.5 million self-insured retention per claim. At both December 31, 2021 and 2020, the Company had outstanding $1.5 million of standby letters of credit as collateral to secure reimbursement of expenses under the existing plan.

Subject to certain limitations, the Company also has umbrella liability coverage for its working nurses and allied healthcare professionals. While this umbrella coverage does not extend to professional liability claims against its independent contractor physicians and advanced practitioners, it does cover claims brought against all of the Company’s subsidiaries for non-patient general liability.

Revenue Recognition

Revenue from the Company’s services is recognized when control of the promised services are transferred to the Company’s customers, in an amount that reflects the consideration it expects to receive in exchange for the service. The Company has concluded that transfer of control of its staffing services, which represents the majority of its revenues, occurs over time as the services are provided.

The following is a description of the nature, amount, timing, and uncertainty of revenue and cash flows from which the Company generates revenue.

Temporary Staffing Revenue

Revenue from temporary staffing is recognized as control of the services is transferred over time and is based on hours worked by the Company’s field staff. The Company recognizes the majority of its revenue at the contractual amount the Company has the right to invoice for services completed to date. Generally, billing to customers occurs weekly, bi-weekly, or monthly and is aligned with the payment of services to the temporary staff. Accounts receivable includes estimated revenue for employees’ and independent contractors’ time worked but not yet invoiced. At December 31, 2021 and December 31, 2020, the Company's estimate of amounts that had been worked but had not been billed totaled $140.0 million and $48.3 million, respectively, and are included in accounts receivable in the consolidated balance sheets.

Other Services Revenue

The Company offers other optional services to its customers that are transferred over time including: managed service programs (MSP) providing agency services (as further described below in Gross Versus Net Policies), recruitment process outsourcing (RPO), other outsourcing services, and retained search services, as well as separately billable travel and housing costs, which in total amount to less than 5% of its consolidated revenue for the years ended December 31, 2021, 2020, and 2019. Generally, billing and payment terms for MSP agency services is consistent with temporary staffing as the customers are similar or the same. Revenue from these services are recognized based on the contractual amount for services completed to date which best depicts the transfer of control of services. The Company does not, in the ordinary course of business, offer warranties or refunds.

Gross Versus Net Policies

The Company records revenue on a gross basis as a principal or on a net basis as an agent depending on the contracted arrangement, as follows:

Managed Service Programs

The Company has certain contracts with healthcare facilities to provide comprehensive services through its MSPs. Under these contractual arrangements, the customer’s orders are filled with either one of the Company's healthcare professionals or a third party's healthcare professionals (subcontractors).

When its healthcare professional is staffed, the Company determined that it acts as a principal in the arrangement, as it is considered the employer of record. Accordingly, revenue is reported on a gross basis in the consolidated statements of operations.

Alternatively, the Company determined that it acts as an agent in the arrangement when a subcontracted healthcare professional is staffed, as the Company does not control the services before they are transferred to the customer. Accordingly, revenue is reported on a net basis in the consolidated statements of operations. The customer is invoiced for the hours worked by the subcontracted healthcare professional multiplied by the hourly bill rate. A subcontractor liability, which is recognized as a reduction of revenue, is established in accrued expenses for the invoiced amount, net of an administrative fee, and is generally payable after the Company has received payment from its customer. The Company’s administrative fee is calculated as a percentage of the customer’s invoice and is recognized over time as the services are rendered by the subcontracted healthcare professional. The Company does not collect or recognize an upfront placement fee.

Physician Staffing

The Physician Staffing business has contracts with its healthcare customers to provide temporary staffing services. The Company uses independent contractors for these services. The Company determined that it acts as a principal in these arrangements and, therefore, revenue is reported on a gross basis in the consolidated statements of operations.

See Note 3 - Revenue Recognition for the Company's revenues disaggregated by revenue source. Sales and usage-based taxes are excluded from revenue.

Contract Costs

All contract fulfillment costs are expensed as incurred to direct operating expenses. There were no contract assets or material contract liabilities as of December 31, 2021 and 2020.

Practical Expedients and Exemptions

For the Company’s contracts that have an original duration of one year or less, the Company uses the practical expedients and has elected to recognize any incremental costs of obtaining these contracts as expensed when incurred. Further, the Company does not disclose the value of unsatisfied performance obligations for: (i) contracts with an original expected length of one year or less; and (ii) contracts for which it recognizes revenue at the amount to which it has the right to invoice for services performed.

Share-Based Compensation

For the years ended December 31, 2021, 2020, and 2019, the Company granted performance-based stock awards and restricted stock for a fixed number of common shares to employees. The Company values its restricted stock awards and the fair value of its performance-based stock awards by reference to its stock price on the date of grant. The Company has elected to recognize compensation expense on a straight-line basis over the requisite service period of the entire award.

The Company granted performance-based stock awards to certain key personnel pursuant to its 2014 Omnibus Incentive Plan, amended and restated on May 23, 2017 (2017 Plan), and replaced by the 2020 Omnibus Incentive Plan, effective for awards granted after May 19, 2020, as described in Note 15 - Stockholders' Equity. Pursuant to the plans, the number of target shares that vest are determined based on the level of attainment of the targets. If a minimum level of performance is attained for the awards, restricted stock is issued based on the level of attainment. The Company recognizes performance-based restricted stock as compensation expense based on the most likely probability of attaining the prescribed performance and over the requisite service period beginning at its grant date and through the date the restricted stock vests.

Compensation expense related to share-based payments is included in selling, general and administrative expenses in the consolidated statements of operations, and totaled $6.9 million, $5.4 million, and $3.4 million during the years ended December 31, 2021, 2020, and 2019, respectively. See Note 15 - Stockholders’ Equity.

Advertising

The Company’s advertising expense consists primarily of online advertising, internet direct marketing, print media, and promotional material. Advertising costs are expensed as incurred and totaled $9.5 million, $6.2 million, and $7.9 million for the years ended December 31, 2021, 2020, and 2019, respectively, and are included in selling, general and administrative expenses in the consolidated statements of operations.

Restructuring Costs

The Company considers restructuring activities to be programs whereby it fundamentally changes its operations, such as closing and consolidating facilities, reducing headcount, and realigning operations in response to changing market conditions. As a result, restructuring costs on the consolidated statements of operations primarily include employee termination costs and lease-related exit costs.

Reconciliations of the employee termination costs and lease-related exit costs beginning and ending liability balance is presented below:


	Year Ended December 31,
	2021				2020				2019
	(amounts in thousands)
	Employee Termination Costs		Lease-Related Exit Costs		Employee Termination Costs		Lease-Related Exit Costs		Employee Termination Costs		Lease-Related Exit Costs
Balance at beginning of period	$	499	$	2,687	$	386	$	1,223	$	556	$	127
Charged to restructuring costs(a)	814		544		2,525		2,190		1,870		1,311
Payments	(1,153)		(808)		(2,412)		(726)		(2,040)		(215)
Balance at end of period	$	160	$	2,423	$	499	$	2,687	$	386	$	1,223

________________

(a) Aside from what is presented in the table above, restructuring costs in the consolidated statements of operations for the years ended December 31, 2021 and 2020 include $1.3 million and $1.1 million, respectively, of ongoing lease costs related to the Company's strategic reduction in its real estate footprint, and an immaterial amount in 2019, which are included as operating lease liabilities - current and non-current in our consolidated balance sheets. Other costs were immaterial for the years ended December 31, 2021, 2020, and 2019.

Income Taxes

Deferred income tax assets and liabilities are determined based upon differences between the financial reporting and tax basis of assets and liabilities, and are measured using the enacted tax rates and laws that will be in effect when the differences are expected to reverse.

The Company recognizes in its financial statements the impact of a tax position if that position is more likely than not of being sustained on audit, based on the technical merits of the position. The Company recognizes interest and penalties related to unrecognized tax benefits in the provision for income taxes.

The Company determines the need for a valuation allowance by assessing the probability of realizing deferred tax assets, taking into consideration all available positive and negative evidence, including historical operating results, expectations of future taxable income, carryforward periods available to the Company for tax reporting purposes, the evaluation of various income tax planning strategies, and other relevant factors. The Company maintains a valuation allowance when it is more likely than not that all or a portion of a deferred tax asset will not be realized based on consideration of all available evidence. Adjustments to the deferred tax valuation allowances are made to earnings in the period when such assessments are made. Significant judgment is required in making this assessment. See Note 14 - Income Taxes.

Comprehensive Income (Loss)

Total comprehensive income (loss) includes net income or loss, foreign currency translation adjustments, and net change in derivative transactions, net of any related deferred taxes and valuation allowance. Certain of the Company’s foreign subsidiaries use their respective local currency as their functional currency. Assets and liabilities of these operations are translated at the exchange rates in effect on the balance sheet date. Income statement items are translated at the average exchange rates for the period. The cumulative impact of currency fluctuations related to the balance sheet translation is included in accumulated other comprehensive loss in the accompanying consolidated balance sheets and was an unrealized loss of $1.3 million at December 31, 2021 and 2020.

The income tax impact related to components of other comprehensive income (loss) for the years ended December 31, 2021 and 2019 is reflected in the consolidated statements of comprehensive income (loss). There was no income tax impact related to components of other comprehensive income (loss) for the year ended December 31, 2020.

Fair Value Measurements

FASB guidance defines fair value, establishes a framework for measuring fair value under U.S. GAAP, and expands disclosures about fair value measurements. The Company’s financial assets and liabilities required to be measured on a recurring basis were its: (i) deferred compensation asset and (ii) deferred compensation liability as of December 31, 2021; and additionally (iii) contingent consideration liabilities as of December 31, 2020. See Note 11 - Fair Value Measurements.

Earnings Per Share

Basic earnings per share is computed by dividing net income available to common stockholders (numerator) by the weighted average number of vested unrestricted common shares outstanding during the period (denominator). Diluted earnings per share gives effect to all dilutive potential common shares outstanding during the period including stock appreciation rights and options and unvested restricted stock, as calculated utilizing the treasury stock method. See Note 16 - Earnings Per Share.

Recently Adopted Accounting Pronouncements

Effective January 1, 2021, the Company adopted ASU No. 2019-12, Income Taxes (Topic 740), Simplifying the Accounting for Income Taxes, which simplifies the accounting for income taxes by removing certain exceptions to the general principles in Topic 740, and improves consistent application of and simplifies U.S. GAAP for other areas of Topic 740 by clarifying and amending existing guidance. The guidance requires either a prospective, retrospective, or modified retrospective approach

depending on the amendment. The Company prospectively adopted this guidance with no material impact on its consolidated financial statements.

Recent Accounting Pronouncements

On October 28, 2021, the FASB issued ASU No. 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers, which requires contract assets and contract liabilities such as deferred revenue acquired in a business combination to be recognized and measured by the acquirer on the acquisition date in accordance with ASC 606, Revenue from Contracts with Customers. Generally, this amendment will result in the acquirer recognizing contract assets and contract liabilities at the same amounts recorded by the acquiree. Historically such amounts were recognized by the acquirer at fair value in acquisition accounting. This guidance is effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. The amendments should be applied prospectively to business combinations occurring on or after the effective date of the amendments. Early adoption is permitted, including adoption in an interim period. The Company is currently in the process of evaluating this standard and expects to adopt this standard in its first quarter of 2023.

On March 12, 2020, the FASB issued ASU No. 2020-04, Reference Rate Reform (Topic 848), Facilitation of the Effects of Reference Rate Reform on Financial Reporting, which provides optional expedients and exceptions for applying U.S. GAAP to contracts, hedging relationships, and other transactions, subject to meeting certain criteria, that reference LIBOR or another reference rate expected to be discontinued. When elected, the optional expedients for contract modifications must be applied

consistently for all eligible contracts or transactions. On January 7, 2021, the FASB issued ASU No. 2021-01, Reference Rate Reform (Topic 848), Scope, to refine the scope of guidance on reference rate reform to apply to derivatives that are affected by the discounting transition. The amendments in these updates are effective as of March 12, 2020 through December 31, 2022. As of December 31, 2021, the Company does not anticipate that this guidance will have a material impact on its consolidated financial statements; however, it will continue to assess the potential impact on its debt contracts and future hedging relationships, if applicable, through the effective period.

Revenue Recognition

12 Months Ended

Dec. 31, 2021

Revenue from Contract with Customer [Abstract]

Revenue Recognition

The Company's revenues from customer contracts are generated from temporary staffing services and other services. Revenue is disaggregated by segment in the following table. See Note 2 - Summary of Significant Accounting Policies.


	Year Ended December 31, 2021
	Nurse And Allied Staffing		Physician Staffing		Total Segments
	(amounts in thousands)
Temporary Staffing Services	$	1,568,974	$	67,843	$	1,636,817
Other Services	36,807		3,028		39,835
Total	$	1,605,781	$	70,871	$	1,676,652


	Year Ended December 31, 2020
	Nurse And Allied Staffing		Physician Staffing		Total Segments
	(amounts in thousands)
Temporary Staffing Services	$	740,441	$	64,819	$	805,260
Other Services	28,042		3,115		31,157
Total	$	768,483	$	67,934	$	836,417









	Year Ended December 31, 2019
	Nurse And Allied Staffing		Physician Staffing		Total Segments
	(amounts in thousands)
Temporary Staffing Services	$	720,393	$	70,261	$	790,654
Other Services	27,226		4,344		31,570
Total	$	747,619	$	74,605	$	822,224

________________

In the first quarter of 2021, the Company modified its reportable segments and, as a result, now discloses the following two reportable segments - Nurse and Allied Staffing and Physician Staffing. Other Services in the amount of $10.5 million and $14.8 million, respectively, included in the previously-reported Search segment have been reclassified to Nurse and Allied Staffing for the years ended December 31, 2020 and 2019. See Note 18 - Segment Data.

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-URI http://asc.fasb.org/topic&trid=49130388

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 10
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130551-203045

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 13
-Subparagraph (b)(2)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130556-203045

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 9
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130550-203045

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (e)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (d)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 15
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130558-203045

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

+ Details

Acquisitions

12 Months Ended

Dec. 31, 2021

Business Combination and Asset Acquisition [Abstract]

Acquisitions

Selected

On December 16, 2021, the Company purchased and acquired substantially all of the assets and assumed certain liabilities of Selected, Inc. for a purchase price of $3.5 million in cash, subject to adjustment, and $1.5 million in shares (or 59,429 shares) of the Company's common stock. The transaction was treated as a purchase of assets for income tax purposes. The acquisition has not been fully integrated as of December 31, 2021.

The sellers are also eligible to receive up to an additional $1.5 million in earnout cash consideration, based on Selected's revenues for each of the twelve-month periods ending on the first and second anniversaries of the first day after the closing date. The liability of $1.5 million is included in non-current earnout liability on the consolidated balance sheets. See Note 11 - Fair Value Measurements.

The acquisition of Selected, Inc. primarily consists of a Software as a Service, subscription-based recruiting and talent matching platform. The acquisition was not significant and has been accounted for using the acquisition method of accounting. Selected's results of operations, since the date of acquisition, are included in the Cross Country Education business unit within the Nurse and Allied Staffing business segment, and are not material.

The Company has not completed its valuation of assets acquired and liabilities assumed. Any necessary adjustments will be finalized within one year from the date of acquisition. As a result, $6.5 million has been recorded as goodwill on the Company's consolidated balance sheet. Associated acquisition-related costs incurred were immaterial and have been included in acquisition and integration-related costs on the Company's consolidated statements of operations for the year ended December 31, 2021. See Note 5 - Goodwill, Trade Names, and Other Intangible Assets.

Cross Country Workforce Solutions Group

On June 8, 2021, the Company purchased and acquired substantially all of the assets and assumed certain liabilities of Workforce Solutions Group, Inc. for a purchase price of $25.0 million in cash and $5.0 million in shares (or 307,730 shares) of the Company's common stock. The parties agreed to a final net working capital reduction of $1.1 million which was received in the fourth quarter of 2021. The transaction was treated as a purchase of assets for income tax purposes.

The sellers are also eligible to receive an earnout based on the business' performance through three years after the acquisition date that could provide up to an additional $15.0 million in cash. The current portion of the liability of $7.5 million is included in current portion of earnout liability and the non-current portion of $7.5 million is included in non-current earnout liability on the consolidated balance sheets. See Note 11 - Fair Value Measurements.

The business has been branded Cross Country Workforce Solutions Group (WSG) and primarily works with local and national healthcare systems and managed care providers to coordinate in-home care services for participants. WSG also provides a range of consulting and talent management solutions to its healthcare clients, including home care staffing, recruitment process outsourcing, contingent workforce evaluation, and talent acquisition.

The following table is an estimate of the assets acquired and liabilities assumed on June 8, 2021:


	(amounts in thousands)
Cash and cash equivalents	$	957
Accounts receivable	11,991
Other current assets	59
Property and equipment	10
Right-of-use assets	1,078
Goodwill	22,066
Other intangible assets	14,200
Total assets acquired	50,361
Accounts payable and accrued expenses	3,562
Accrued compensation and benefits	1,387
Lease liability - current	316
Lease liability - non-current	762
Earnout liability	15,000
Total liabilities assumed	21,027
Net assets acquired	$	29,334

The Company assigned a value to other identifiable intangible assets of $14.2 million in customer relationships with a weighted average estimated useful life of 11.5 years. Substantially all of the accounts receivable acquired have been collected as of December 31, 2021.

The remaining excess purchase price over the fair value of net assets acquired of $22.1 million was recorded as goodwill on the Company's consolidated balance sheet. Associated acquisition-related costs incurred were $1.0 million and have been included in acquisition and integration-related costs on the Company's consolidated statement of operations for the year ended December 31, 2021. See Note 5 - Goodwill, Trade Names, and Other Intangible Assets.

The acquisition was not significant and has been accounted for using the acquisition method of accounting. WSG's results of operations, since the date of acquisition, are included in the Nurse and Allied Staffing business segment, and are not material. The pro-forma impact on the Company's consolidated revenue from services and net income, including the pro forma effect of events that are directly attributable to the acquisition, was not significant.

Advantage

Effective July 1, 2017, the Company acquired all of the assets of Advantage RN, LLC and its subsidiaries (collectively, Advantage). Included in the amount paid at closing were two escrow accounts, the first was $14.5 million which related to tax liabilities and the second was $7.5 million which was to cover any post-close liabilities. On July 28, 2017, $7.3 million related to the tax liabilities was released from escrow. On April 3, 2019, $4.3 million related to the tax liabilities was disbursed to pay

taxes and the remaining $2.9 million was released from escrow to the seller. In the first quarter of 2019, $7.0 million related to the post-close liabilities was released from escrow. In the fourth quarter of 2021, the remaining $0.5 million was released from escrow and returned to the buyer.

Mediscan

On October 30, 2015, the Company completed the acquisition of all of the membership interests of New Mediscan II, LLC, Mediscan Diagnostic Services, LLC, and Mediscan Nursing Staffing, LLC (collectively Mediscan). In connection with the Mediscan acquisition, the Company assumed two contingent purchase price liabilities for a previously acquired business, one that was payable annually based on certain performance criteria for the years 2016 through 2019, and a second performance criteria related to 2019 payable in three equal installments. Payments related to the years 2016 through 2018 were limited to $0.3 million annually and the 2019 year was uncapped. During the year ended December 31, 2019, the Company paid $0.3 million related to the year 2018. In the first quarter of 2020, the total earnout amount related to both 2019 performance criterion of $7.4 million was determined, and the Company paid $0.1 million on the first earnout related to the year 2019. The remaining $7.3 million, related to the second earnout, was converted to a subordinated promissory note payable.

Pursuant to the note payable, the first two installments of $2.4 million each were paid in the second quarter of 2020 and in the first quarter of 2021. The third installment of $2.5 million is to be paid, together with interest at a rate of 2% per annum, accruing from April 1, 2020, on January 31, 2022. As of December 31, 2021, the note payable balance is included in current portion of debt on the consolidated balance sheets.

Goodwill, Trade Names, and Other Intangible Assets

12 Months Ended

Dec. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill, Trade Names, and Other Intangible Assets

The Company had the following acquired intangible assets:


	December 31, 2021						December 31, 2020
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
	(amounts in thousands)
Intangible assets subject to amortization:
Databases	$	30,530	$	18,375	$	12,155	$	30,530	$	15,322	$	15,208
Customer relationships	47,738		17,581		30,157		33,538		14,007		19,531
Non-compete agreements	304		272		32		304		212		92

Other intangible assets, net	$	78,572	$	36,228	$	42,344	$	64,372	$	29,541	$	34,831
Intangible assets not subject to amortization:
Trade names, indefinite-lived					$	5,900					$	5,900

As of December 31, 2021, estimated annual amortization expense is as follows:


Years Ending December 31:	(amounts in thousands)
2022	$	7,175
2023	7,117
2024	6,479
2025	5,921
2026	4,751
Thereafter	10,901
	$	42,344

The changes in the carrying amount of goodwill by reportable segment are as follows:


	Nurse And Allied Staffing		Physician Staffing		Total
	(amounts in thousands)
Balances as of December 31, 2020
Aggregate goodwill acquired	$	367,880	$	43,405	$	411,285
Sale of business	(9,889)		—		(9,889)
Accumulated impairment loss	(269,874)		(40,598)		(310,472)
Goodwill, net of impairment loss	88,117		2,807		90,924

Changes to aggregate goodwill in 2021
Aggregate goodwill acquired (a)	28,566		—		28,566


Balances as of December 31, 2021
Aggregate goodwill acquired	396,446		43,405		439,851
Sale of business	(9,889)		—		(9,889)
Accumulated impairment loss	(269,874)		(40,598)		(310,472)
Goodwill, net of impairment loss	$	116,683	$	2,807	$	119,490

________________

(a) Represents goodwill acquired from the acquisitions of WSG and Selected, calculated as the excess of the fair value of consideration exchanged as compared to the fair value of identifiable net assets acquired. See Note 4 - Acquisitions. During the measurement period, which is not to exceed one year from the acquisition date, the Company may record adjustments to the assets acquired or liabilities assumed, with a corresponding offset to goodwill. Upon conclusion of the measurement period, any subsequent adjustments would be recorded to earnings.

In conjunction with the changes to its segments, the Company now discloses the following two reportable segments - Nurse and Allied Staffing and Physician Staffing. In the table above, goodwill balances and activity previously reported in the Search segment have been reclassified to Nurse and Allied Staffing.

Goodwill, Trade Names, and Other Intangible Assets Impairment

The Company tests reporting units’ goodwill and intangible assets with indefinite lives for impairment annually during the fourth quarter and more frequently if impairment indicators exist. The Company performs quarterly qualitative assessments of significant events and circumstances such as reporting units’ historical and current results, assumptions regarding future performance, strategic initiatives and overall economic factors, including COVID, and macro-economic developments, to determine the existence of potential indicators of impairment and assess if it is more likely than not that the fair value of reporting units or intangible assets is less than their carrying value. If indicators of impairments are identified a quantitative impairment test is performed.

The Company performed its annual quantitative impairment test of goodwill and its indefinite-lived trade name as of October 1, 2021 and determined that the estimated fair value of its reporting units and its indefinite-lived trade name exceeded their respective carrying values.

During the second quarter of 2020, due to the increased negative impact and continuing uncertainty of the COVID pandemic on the business, all reporting units were quantitatively tested. For the Nurse and Allied Staffing and Physician Staffing reporting units, no impairment was identified as the fair value was substantially in excess of the carrying amount of goodwill.

However, the previously-reported Search reporting unit under-performed relative to management’s expectations in the second quarter of 2020. The lower than expected revenue was driven by: (i) the cancellation or postponement of a significant number of working searches, (ii) the decision to delay the hiring of new revenue producers, and (iii) the loss of customers, which were mostly related to the negative impacts of COVID. As a result, the Company performed quantitative testing of the Search reporting unit which resulted in impairment charges of $10.2 million for its goodwill and $0.3 million for its customer relationships.

In order to determine the fair value of the Search reporting unit, the Company used a combination of an income and market approach. The weighting was based on the specific characteristics, risks, and uncertainties of the Search reporting unit. The discounted cash flow that served as the primary basis for the income approach was based on the Company’s discrete financial forecast of revenue, gross profit margins, operating costs, and cash flows. The Company also considered estimated future results, economic and market conditions including the timing and duration of COVID, as well as the impact of planned business and operational strategies which impacted management's estimates of future cash flows, the discount rate, and the estimated long-term growth rate used in the discounted cash flow model. Assumptions used in the market approach were derived including an analysis of a range of valuation multiples of comparable public companies.

As part of evolving its go-to-market strategy, in the second quarter of 2019, the Company began eliminating certain brands across all of its segments. The Company’s rebranding efforts resulted in a $14.5 million write-off of indefinite-lived trade names related to its Nurse and Allied Staffing business segment, which is presented within impairment charges in the consolidated statements of operations for the year ended December 31, 2019.

The Company performed its annual quantitative impairment test of goodwill and its indefinite-lived trade name as of October 1, 2019, and determined that the estimated fair value of its reporting units and its indefinite-lived trade name exceeded their respective carrying values.

Although management believes that the Company's current estimates and assumptions utilized in its quantitative testing are reasonable and supportable, including its assumptions on the impact and timing related to COVID, there can be no assurance that the estimates and assumptions management used for purposes of its qualitative assessment as of December 31, 2021 will prove to be accurate predictions of future performance.

For its long-lived assets and definite-lived intangible assets, the Company reviews for impairment whenever events or changes in circumstances indicate the carrying amount may not be recoverable. During the year ended December 31, 2021, the Company wrote off a discontinued software development project, resulting in an immaterial impairment charge.

Intangible Asset Amortization

In connection with its rebranding efforts, the Company made a decision at the end of 2019 to phase out a trade name by the end of 2020, which as of December 31, 2019 would have been recognized over a weighted average life of 7.5 years. In the second quarter of 2020, the Company further accelerated its rebranding plan and shortened the estimated remaining life of the trade name. Total accelerated amortization resulting from the changes in the estimated remaining life of the trade name was $3.1 million, or $0.09 per share, for the year ended December 31, 2020.

In addition, during the year ended December 31, 2019, the amortization of certain finite-lived trade names was accelerated, which resulted in additional amortization expense related to the Company's Nurse and Allied Staffing and Physician Staffing segments of $2.1 million and $0.8 million, respectively, which impacted the net income (loss) per share attributable to common stockholders of $0.08. If the Company had not accelerated the amortization, it would have been recognized over a weighted average life of 7.8 years.

Property and Equipment

12 Months Ended

Dec. 31, 2021

Property, Plant and Equipment [Abstract]

Property and Equipment

The Company's property and equipment consists of the following:


		December 31,
	Useful Lives	2021		2020
		(amounts in thousands)
Computer equipment	3-5 years	$	4,910	$	3,644
Computer software	3-10 years	18,839		17,416
Office equipment	5-7 years	475		933
Furniture and fixtures	5-7 years	2,475		2,528
Construction in progress	(a) (b)	2,523		473
Leasehold improvements	(b)	4,340		4,370
		33,562		29,364
Less accumulated depreciation and amortization		(17,729)		(17,013)
		$	15,833	$	12,351

_______________

(a) Primarily related to software development.

(b) See Note 2 – Summary of Significant Accounting Policies.

Balance Sheet Details

12 Months Ended

Dec. 31, 2021

Balance Sheet Related Disclosures [Abstract]

Balance Sheet Details


	December 31,
	2021		2020
	(amounts in thousands)
Insurance recovery receivable:
Insurance recovery for health claims	$	300	$	369
Insurance recovery for workers’ compensation claims	2,836		2,629
Insurance recovery for professional liability claims	1,905		1,700
	$	5,041	$	4,698

Other non-current assets:
Insurance recovery for workers’ compensation claims	$	4,861	$	5,352
Insurance recovery for professional liability claims	9,137		7,763
Non-current security deposits	672		786

Deferred compensation assets	1,398		1,156
Net debt issuance costs	991		1,063
Finance lease right-of-use assets	57		102
Cloud computing asset	4,840		3,187
	$	21,956	$	19,409

Accrued compensation and benefits:
Salaries and payroll taxes	$	39,139	$	13,131
Accrual for bonuses and commissions	10,755		7,705
Accrual for workers’ compensation claims	8,394		7,670
Accrual for professional liability claims	2,448		2,499
Accrual for healthcare claims	4,081		3,926
Accrual for vacation	763		609
	$	65,580	$	35,540

Long-term accrued claims:
Accrual for workers’ compensation claims	$	11,777	$	12,692
Accrual for professional liability claims	13,537		12,720
	$	25,314	$	25,412

Other long-term liabilities:
Restructuring	$	1,829	$	2,082
Deferred compensation	2,457		2,475
Long-term note payable	—		2,426
Long-term unrecognized tax benefits	8,994		951

Other	508		61
	$	13,788	$	7,995

Debt

12 Months Ended

Dec. 31, 2021

Debt Disclosure [Abstract]

Debt

The Company's long-term debt consists of the following:


	December 31, 2021				December 31, 2020
	Principal		Debt Issuance Costs		Principal		Debt Issuance Costs
	(amounts in thousands)
Term Loan, interest of 6.50% at December 31, 2021	$	174,312	$	(5,396)	$	—	$	—
Senior Secured Asset-Based Loan, interest of 1.60% and 2.73% at December 31, 2021 and December 31, 2020, respectively	9,200		(991)		53,408		(1,063)
Note Payable, interest of 2.00% per annum	2,426		—		4,851		—
Total debt	185,938		(6,387)		58,259		(1,063)
Less current portion - note payable	2,426		—		2,425		—
Less current portion - term loan	1,750		—		—		—
Long-term debt	$	181,762	$	(6,387)	$	55,834	$	(1,063)

As of December 31, 2021 and 2020, the current portion of the note payable and the term loan is included in current portion of debt on the consolidated balance sheets. The Company has elected to present the debt issuance costs associated with its revolving line-of-credit as an asset, which is included in other non-current assets on the consolidated balance sheets. In addition, the non-current portion of the note payable as of December 31, 2020 is included in other long-term liabilities on the consolidated balance sheets. As a result, the long-term debt in the above table will not agree to long-term debt, net of current portion on the consolidated balance sheets herein.

As of December 31, 2021, the aggregate schedule for maturities of debt are as follows:


	Term Loan		Senior Secured Asset-Based Loan		Note Payable
Through Years Ending December 31:	(amounts in thousands)
2022	$	1,750	$	—	$	2,426
2023	1,750		—		—
2024	1,750		9,200		—
2025	1,750				—
2026	1,750		—		—
Thereafter	165,562		—		—
Total	$	174,312	$	9,200	$	2,426

2021 Term Loan Credit Agreement

On June 8, 2021, the Company entered into a Term Loan Credit Agreement (Term Loan Agreement) with certain lenders identified therein (collectively, the Lenders) and Wilmington Trust, National Association as administrative agent and collateral agent, pursuant to which the Lenders extended to the Company a six-year second lien subordinated term loan in the amount of $100.0 million (term loan). The term loan has an interest rate of one-month London Inter Bank Offered Rate (LIBOR) plus 5.75% per annum, subject to a 0.75% LIBOR floor. The term loan was used to pay the cash consideration, as well as any costs, fees, and expenses in connection with the WSG acquisition (see Note 4 - Acquisition), with the remainder used to pay down a portion of the asset based credit facility. Fees paid in connection with the Term Loan Agreement have been included as debt issuance costs and as a reduction to the carrying amount of the term loan and are expected to be amortized to interest expense over the term of the Term Loan Agreement.

The borrowings under the Term Loan Agreement generally bear interest at a variable rate based on either LIBOR or Base Rate (as defined in the Term Loan Agreement) and are subject to mandatory prepayments of principal payable in quarterly installments, commencing on September 30, 2021, with each installment being in the aggregate principal amount of $0.3 million (subject to adjustment as a result of prepayments) provided that, to the extent not previously paid, the aggregate unpaid principal balance would be due and payable on the maturity date. The Term Loan Agreement contains various restrictions and covenants applicable to the Company and its subsidiaries, including a covenant to maintain a minimum net leverage ratio. The Company was in compliance with this covenant as of December 31, 2021. Obligations under the Term Loan Agreement are secured by substantially all the assets of the borrowers and guarantors under the Term Loan Agreement, subject to customary exceptions.

On November 18, 2021, the Company amended its Term Loan Agreement (Term Loan First Amendment), which provided the Company an incremental term loan in an aggregate amount equal to $75.0 million. Additionally, the Term Loan First Amendment increased the aggregate amount of all increases (as defined in the Term Loan Agreement) to be no greater than $115.0 million. The borrowings will be used primarily to fund organic growth. Commencing on December 31, 2021, installments of the mandatory prepayments will be in the aggregate principal amount of $0.4 million. All other terms, conditions, covenants, and pricing of the Term Loan Agreement remain the same. In conjunction with the Term Loan First Amendment, the Company entered into the Term Loan First Amendment to the Intercreditor Agreement, effective as of November 18, 2021, which sets forth the lien priority, relative rights, and other creditors’ rights issues in respect of the collateral lenders.

The Term Loan Agreement also contains customary events of default. If an event of default under the Term Loan Agreement occurs and is continuing, then the administrative agent or the requisite Lenders may declare any outstanding obligations under the Term Loan Agreement to be immediately due and payable. In addition, the Company or any of its subsidiaries becoming the subject of voluntary or involuntary proceedings under any bankruptcy, insolvency or similar law, constitutes an event of default under the Term Loan Agreement.

The term loan is secured by a second-priority security interest in the collateral as defined in the ABL Credit Agreement (Loan Agreement) (as described below), and Wells Fargo Bank, National Association as agent, as amended by the First Amendment, Second Amendment, and Third Amendment to the Loan Agreement (as described below). The lien priority, relative rights, and other creditors’ rights issues in respect of the collateral lenders are set forth in the Intercreditor Agreement, by and among Wells Fargo Bank, National Association, as first lien agent, and Wilmington Trust, National Association, as second lien agent, as amended, restated, amended and restated, supplemented or otherwise modified from time to time in accordance with the terms thereof dated June 8, 2021 (Intercreditor Agreement).

2019 Loan Agreement

Effective October 25, 2019, the Company terminated its commitments under its prior senior credit facility entered into in August 2017 and entered into an Loan Agreement, by and among the Company and certain of its domestic subsidiaries, as borrowers or guarantors, Wells Fargo, PNC Bank N.A., as well as other Lenders (as defined) from time to time parties thereto. The Loan Agreement provides for a five-year revolving senior secured asset-based credit facility (ABL) in the aggregate principal amount of up to $120.0 million (as described below), including a sublimit for swing loans up to $15.0 million and a $35.0 million sublimit for standby letters of credit.

On June 30, 2020, the Company amended its Loan Agreement (First Amendment), which increased the current aggregate committed size of the ABL from $120.0 million to $130.0 million. All other terms, conditions, covenants, and pricing of the Loan Agreement remained the same.

On March 8, 2021, the Company amended its Loan Agreement (Second Amendment), which increased the current aggregate committed size of the ABL from $130.0 million to $150.0 million, increased certain borrowing base sub-limits, and decreased both the cash dominion event and financial reporting triggers.

On June 8, 2021, the Company amended its Loan Agreement (Third Amendment), which permits the incurrence of indebtedness and grant of security as set forth in the Loan Agreement and in accordance with the Intercreditor Agreement, and provides mechanics relating to a transition away from LIBOR as a benchmark interest rate to a replacement alternative benchmark rate or mechanism for loans made in U.S. dollars.

On November 18, 2021, the Company amended its Loan Agreement (Fourth Amendment), whereby the permitted indebtedness (as defined in the Loan Agreement), was increased to $175.0 million.

These amendments were treated as modifications of debt and, as a result, the associated fees and costs were included in debt issuance costs and will be amortized ratably over the remaining term of the Loan Agreement.

Availability of the ABL commitments is subject to a borrowing base of up to 85% of secured eligible accounts receivable, subject to adjustment at certain quality levels, plus an amount of supplemental availability (as defined by the Loan Agreement), reducing over time in accordance with the terms of the Loan Agreement, minus customary reserves, and subject to customary adjustments. Revolving loans and letters of credit issued under the Loan Agreement reduce availability under the ABL on a dollar-for-dollar basis. Availability under the ABL will be used for general corporate purposes. At December 31, 2021, availability under the ABL was $150.0 million and the Company had $9.2 million of borrowings drawn, as well as $18.2 million of letters of credit outstanding related to workers' compensation and professional liability policies (see Note 2 - Summary of Significant Accounting Policies), leaving $122.6 million available for borrowing.

The initial amounts drawn on the ABL included funds to repay the Company’s then outstanding borrowings of $75.4 million under its August 2017 Credit Facility and $1.3 million for the payment of fees, expenses, and accrued interest, as well as to backstop $21.2 million for outstanding letters of credit. The refinancing was treated as an extinguishment of debt, and, as a result, the Company wrote-off debt issuance costs of approximately $1.4 million in the fourth quarter of 2019, which is included with loss on early extinguishment of debt in the consolidated statements of operations.

As of December 31, 2021, the interest rate spreads and fees under the Loan Agreement were based on LIBOR plus 1.50% for the revolving portion of the borrowing base and LIBOR plus 4.00% on the Supplemental Availability. The Base Rate (as defined by the Loan Agreement) margins would have been 0.50% and 3.00% for the revolving portion and Supplemental Availability, respectively. The LIBOR and Base Rate margins are subject to monthly pricing adjustments, pursuant to a pricing matrix based on the Company’s excess availability under the revolving credit facility. In addition, the facility is subject to an unused line fee, letter of credit fees, and an administrative fee. The unused line fee is 0.375% of the average daily unused portion of the revolving credit facility.

The Loan Agreement contains various restrictions and covenants applicable to the Company and its subsidiaries, including a covenant to maintain a minimum fixed charge coverage ratio. The Company was in compliance with this covenant as of December 31, 2021. Obligations under the ABL are secured by substantially all the assets of the borrowers and guarantors, subject to customary exceptions.

The Loan Agreement also contains customary events of default. If an event of default under the Loan Agreement occurs and remains uncured, then the administrative agent or the requisite lenders may declare any outstanding obligations to be immediately due and payable. In addition, if the Company or any of its subsidiaries becomes the subject of voluntary or involuntary proceedings under any bankruptcy, insolvency or similar law, then any outstanding obligations under the Loan Agreement will automatically become due and payable.

Prior Senior Credit Facility

The Company had a prior senior credit facility that included a revolver and term loan. The term loan was payable in quarterly installments, and the Company had the right at any time to prepay borrowings, in whole or in part, without premium or penalty. During the year ended December 31, 2019, the Company made optional prepayments of $12.5 million on the term loan.

In both the first and third quarters of 2019, the Company amended its prior senior credit facility to reduce the commitment under the revolving credit facility, among other changes. Each of the amendments were treated as modifications and the fees of $0.7 million paid to its lenders were classified as debt issuance costs.

As a result of the reduction in borrowing capacity under the revolving credit facility, as well as the reduction in the term loan due to early prepayments, debt issuance costs of $0.5 million were written off in the year ended December 31, 2019. The write-off of debt issuance costs was included as loss on early extinguishment of debt in the consolidated statements of operations.

In the third quarter of 2019, in contemplation of entering into the Loan Agreement, the Company terminated its interest rate swap agreement associated with its prior senior credit facility by making a cash payment of $1.3 million. As the interest payments related to the swap were no longer expected to occur, the unrealized amount of loss that had accumulated in other comprehensive loss was recognized, resulting in a $1.3 million loss on derivative in the third quarter of 2019. See Note 9 - Derivative.

Note Payable

On October 30, 2015, in connection with the Mediscan acquisition, the Company assumed two contingent purchase price liabilities for a previously acquired business, one that was payable annually based on certain performance criteria for the years 2016 through 2019, and a second performance criterion related to 2019 payable in three equal installments. In the first quarter of 2020, the total earnout amount related to both 2019 performance criteria of $7.4 million was determined, and the Company paid $0.1 million on the first earnout related to the year 2019. The remaining $7.3 million, related to the second earnout, was converted to a subordinated promissory note payable.

The first two installments of $2.4 million each were paid in the second quarter of 2020 and in the first quarter of 2021, respectively. The third installment of $2.5 million is to be paid, together with interest at a rate of 2% per annum, accruing from April 1, 2020, on January 31, 2022. At December 31, 2021, the note payable balance is included in current portion of debt on the consolidated balance sheets. See Note 4 - Acquisitions.

- Definition

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

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-URI http://asc.fasb.org/topic&trid=2208564

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (h)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1C
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Section 50
-Paragraph 1I
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-Paragraph 1I
-Subparagraph (d)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(c))
-URI http://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (g)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1C
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-SubTopic 20
-Section 50
-Paragraph 1C
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1E
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495348-112611

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
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-Paragraph 1B
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1I
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
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-Subparagraph (i)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

+ Details

Derivative	12 Months Ended
Derivative	Dec. 31, 2021
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivative	Derivative Interest Rate Swap In March 2018, the Company entered into an interest rate swap agreement, with an effective date of April 2, 2018 and termination date of August 1, 2022. No initial investments were made to enter into the agreement. The interest rate swap agreement required the Company to pay a fixed rate to the respective counterparty of 2.627% per annum on an amortizing notional amount beginning at $48.8 million (corresponding with the initial term loan payment schedule), and to receive from the respective counterparty, interest payments based on the applicable notional amounts and 1 month USD LIBOR, with no exchanges of notional amounts. At initiation, the interest rate swap effectively fixed the interest rate on 50% of the amortizing balance of the Company’s term debt, exclusive of the credit spread on the debt. The Company anticipated entering into the asset-based credit facility that closed in October 2019. In contemplation of that, the Company terminated its interest rate swap agreement by making a cash payment of $1.3 million on September 26, 2019, which is included in net cash provided by operating activities in the consolidated statements of cash flows. As the forecasted interest payments related to the swap were no longer expected to occur, the unrealized amount of loss that had accumulated in other comprehensive loss was recognized resulting in a $1.3 million loss in the third quarter of 2019, included in loss on derivative in the consolidated statements of operations.

Leases

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Leases

The Company's lease population of its right-of-use asset and lease liabilities is substantially related to the rental of office space. The Company enters into lease agreements as a lessee that may include options to extend or terminate early. Some of these real estate leases require variable payments of property taxes, insurance, and common area maintenance, in addition to base rent. Certain of the leases have provisions for free rent months during the lease term and/or escalating rent payments and, particularly for the Company’s longer-term leases for its corporate offices, it has received incentives to enter into the leases, such as receiving up to a specified dollar amount to construct tenant improvements. These leases do not include residual value guarantees, covenants, or other restrictions. See Note 2 - Summary of Significant Accounting Policies.

Beginning in the second quarter of 2020, in connection with the continuing developments from COVID, the Company expedited restructuring plans and either reduced or fully vacated leased office space. The Company is in the process of seeking to sublet some of the space where possible. The decision and change in the use of space resulted in a right-of-use asset impairment charge of $1.7 million and $4.5 million for the years ended December 31, 2021 and 2020, respectively. This loss

was determined by comparing the fair value of the impacted right-of-use assets to the carrying value of the assets as of the impairment measurement date. The fair value of the right-of-use assets was based on the estimated sublease income for the space taking into consideration the time period it will take to obtain a subtenant, the applicable discount rate, and the sublease rate. Similarly, in the third quarter of 2019, the Company ceased use of several facilities which resulted in a right-of-use asset impairment charge of $1.2 million, included in impairment charges in the consolidated statements of operations. For the years ended December 31, 2021, 2020, and 2019 respectively, the Company wrote off a total of $0.3 million, $1.0 million, and $0.6 million of leasehold improvements and other property and equipment related to these locations. The measurement of the right-of-use asset impairments, using the assumptions described, is a Level 3 fair value measurement. See Note 11 - Fair Value Measurements for a description of Level 3 inputs.

The table below presents the lease-related assets and liabilities included on the consolidated balance sheets:


Classification on Consolidated Balance Sheets:	December 31, 2021			December 31, 2020
	(amounts in thousands)
Operating lease right-of-use assets (a)	$	7,488		$	10,447
Operating lease liabilities - current (a)	$	4,090		$	4,509
Operating lease liabilities - non-current (a)	$	10,853		$	15,234

	December 31, 2021			December 31, 2020
Weighted-average remaining lease term	3.4 years			4.1 years
Weighted average discount rate	6.39		%	6.32		%

________________

(a) Amounts include lease assets and liabilities related to the eight locations added as part of the acquisition of WSG: operating lease right-of-use assets of $0.9 million, operating lease current liabilities of $0.3 million, and operating lease non-current liabilities of $0.6 million.

The table below reconciles the undiscounted cash flows for each of, and total of, the remaining years to the operating lease liabilities (which do not include short-term leases) recorded on the consolidated balance sheets as of December 31, 2021:


Years Ending December 31:	(amounts in thousands)
2022	$	4,913
2023	5,027
2024	3,959
2025	2,762


Total minimum lease payments	16,661
Less: amount of lease payments representing interest	(1,718)
Present value of future minimum lease payments	14,943
Less: operating lease liabilities - current	(4,090)
Operating lease liabilities - non-current	$	10,853

Other Information

The table below provides information regarding supplemental cash flows:


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands)
Supplemental Cash Flow Information:
Cash paid for amounts included in the measurement of operating lease liabilities	$	6,150	$	7,111	$	7,477
Right-of-use assets acquired under operating lease	$	1,059	$	1,587	$	1,229

The components of lease expense are as follows:


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands)
Amounts Included in Consolidated Statements of Operations:
Operating lease expense	$	3,538	$	4,874	$	6,592
Short-term lease expense	$	3,695	$	5,217	$	8,042
Variable and other lease costs	$	1,957	$	1,919	$	2,446

Operating lease expense, short-term lease expense, and variable and other lease costs are included in selling, general and administrative expenses, direct operating expenses, and restructuring costs in the consolidated statements of operations, depending on the nature of the leased asset. Operating lease expense is reported net of sublease income, which is not material.

As of December 31, 2021, the Company does not have any material operating leases which have not yet commenced. The Company has an immaterial amount of finance lease contracts related to other equipment rentals which are not included in the above disclosures.

Fair Value Measurements

12 Months Ended

Dec. 31, 2021

Fair Value Disclosures [Abstract]

Fair Value Measurements

Fair value is defined as the exchange price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. A fair value hierarchy was established which requires an entity to maximize the use of observable inputs and minimize the use of unobservable inputs when measuring fair value. There are three levels of inputs that may be used to measure fair value:

Level 1—Quoted prices in active markets for identical assets or liabilities.

Level 2—Observable inputs other than Level 1 prices, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities.

Level 3—Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities.

Items Measured at Fair Value on a Recurring Basis:

The Company’s financial assets/liabilities required to be measured on a recurring basis were its: (i) deferred compensation asset included in other non-current assets; and (ii) deferred compensation liability included in other long-term liabilities on its consolidated balance sheets.

Deferred compensation—The Company utilizes Level 1 inputs to value its deferred compensation assets and liabilities. The Company’s deferred compensation assets and liabilities are measured using publicly available indices, as per the plan documents.

The estimated fair value of the Company’s financial assets and liabilities measured on a recurring basis is as follows:

Fair Value Measurements


	December 31, 2021		December 31, 2020
	(amounts in thousands)
Financial Assets:
(Level 1)
Deferred compensation asset	$	1,398	$	1,156
Financial Liabilities:
(Level 1)
Deferred compensation liability	$	2,457	$	2,475

Items Measured at Fair Value on a Non-recurring Basis:

The Company's non-financial assets, such as goodwill, trade names, other intangible assets, right-of-use assets, and property and equipment, are measured at fair value when there is an indicator of impairment and are recorded at fair value only when an impairment charge is recognized.

The years ended December 31, 2021, 2020, and 2019 included impairment charges to right-of-use assets along with related property and equipment in connection with leases that were vacated during the years. The year ended December 31, 2020 also included impairment charges to goodwill and other intangible assets primarily related to the previously-reported Search reporting unit. During 2019, the Company recorded impairment charges to trade names related to the Nurse and Allied Staffing reporting unit. Accordingly, as of December 31, 2021 and 2020, these assets were recorded at fair value using Level 3 inputs. See Note 5 - Goodwill, Trade Names, and Other Intangible Assets and Note 10 - Leases for more information about these fair value measurements.

Other Fair Value Disclosures:

Financial instruments not measured or recorded at fair value in the consolidated balance sheets consist of cash and cash equivalents, accounts receivable, and accounts payable and accrued expenses. The estimated fair value of accounts receivable and accounts payable and accrued expenses approximate their carrying amount due to the short-term nature of these instruments. Other financial instruments not measured or recorded at fair value include: (i) note payable, (ii) ABL, (iii) term loan, and (iv) and (v) earnout liabilities, as discussed below.

(i) The Company paid the second installment on its note payable in the first quarter of 2021. The remaining balance is included in current portion of debt on the consolidated balance sheets. Due to its relatively short-term nature, the carrying value of the note payable approximates its fair value. (ii) The carrying amount of the Company's ABL approximates fair value because the interest rates are variable and reflective of market rates. (iii) The estimated fair value of the Company's term loan was calculated applying an interest rate lattice model using Level 2 inputs from available market information. (iv) Potential earnout payments related to the WSG acquisition are contingent upon meeting certain performance requirements based on 2021 through 2023 performance. The Company performed an analysis using multiple forecasted scenarios to determine the fair value of the earnout liability. The earnout liability's carrying amount approximates fair value and is included in current portion of earnout liability and non-current earnout liability on the consolidated balance sheets. (v) Potential earnout payments related to the Selected acquisition are contingent upon meeting certain performance requirements based on 2022 and 2023 revenues. The earnout liability's carrying amount approximates fair value and is included in non-current earnout liability on the consolidated balance sheets.

The carrying amounts and estimated fair value of the Company’s significant financial instruments that were not measured at fair value are as follows:


	December 31, 2021				December 31, 2020
	Carrying Amount		Fair Value		Carrying Amount		Fair Value
	(amounts in thousands)
Financial Liabilities:
(Level 2)
Note Payable	$	2,426	$	2,426	$	4,851	$	4,851
Senior Secured Asset-Based Loan	$	9,200	$	9,200	$	53,408	$	53,408
Term Loan, net	$	174,312	$	174,845	$	—	$	—
Earnout Liability (WSG)	$	15,000	$	15,000	$	—	$	—
Earnout Liability (Selected)	$	1,500	$	1,500	$	—	$	—

Concentration of Risk:

See discussion of credit losses and allowance for doubtful accounts in Note 2 - Summary of Significant Accounting Policies. Overall, based on the large number of customers in differing geographic areas, primarily throughout the United States and its territories, the Company believes the concentration of credit risk is limited.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Employee Benefit Plans	12 Months Ended
Employee Benefit Plans	Dec. 31, 2021
Retirement Benefits [Abstract]
Employee Benefit Plans	Employee Benefit Plans The Company maintains a voluntary defined contribution 401(k) profit-sharing plan covering all eligible employees as defined in the plan documents. The plan provides for a discretionary matching contribution, which is equal to a percentage of each eligible contributing participant’s elective deferral, which the Company, at its sole discretion, determines from year to year. Contributions by the Company, net of forfeitures, under this plan were $1.0 million, $0.5 million, and $1.1 million for the years ended December 31, 2021, 2020, and 2019, respectively. Eligible employees who elect to participate in the plan are generally vested in any existing matching contribution after three years of service with the Company. The Company maintains a 2003 Deferred Compensation Plan and a 2017 Nonqualified Deferred Compensation Plan, each an unfunded non-qualified deferred compensation arrangement, intended to comply with Section 409A of the Internal Revenue Code of 1986, as amended, or the Code. Under the deferred compensation plans, certain designated key employees may elect to defer the receipt of a portion of their annual base salary, bonus and commission to the deferred compensation plans. Generally, payments under the deferred compensation plans automatically commence upon a participant’s retirement, termination of employment, or death during employment. Under certain circumstances described in the deferred compensation plans, participants may receive distributions during employment. In connection with the 2017 Deferred Compensation Plan, the Company elected to invest in amounts consistent with the participants' choices of allocations to funds. Participants of the deferred compensation plans are the Company’s unsecured general creditors with respect to the deferred compensation plan benefits. The liability for the deferred compensation is included in other long-term liabilities in the consolidated balance sheets and was $2.5 million at December 31, 2021 and 2020.

- Definition

The entire disclosure for retirement benefits.

+ References

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+ Details

Contingencies	12 Months Ended
Contingencies	Dec. 31, 2021
Commitments and Contingencies Disclosure [Abstract]
Contingencies	Contingencies Legal Proceedings From time to time, the Company is involved in various litigation, claims, investigations, and other proceedings that arise in the ordinary course of its business. These matters primarily relate to employee-related matters that include individual and collective claims, professional liability, tax, and payroll practices. The Company establishes reserves when available information indicates that a loss is probable and an amount or range of loss can be reasonably estimated. These assessments are performed at least quarterly and are based on the information available to management at the time and involve significant management judgment to determine the probability and estimated amount of potential losses, if any. Based on the available information considered in its reviews, the Company adjusts its loss contingency accruals and its disclosures as may be required. Actual outcomes or losses may differ materially from those estimated by the Company's current assessments, including available insurance recoveries, which would impact the Company's profitability. Adverse developments in existing litigation claims or legal proceedings involving the Company or new claims could require management to establish or increase litigation reserves or enter into unfavorable settlements or satisfy judgments for monetary damages for amounts in excess of current reserves, which could adversely affect the Company's financial results. During the third quarter of 2021, the Company entered into an agreement providing for the reimbursement of $1.6 million in legal fees incurred in 2020 and 2021, relating to the grand jury subpoena previously disclosed in the Company's 2020 Form 10-K. The reimbursement was collected in the fourth quarter of 2021. In the second quarter of 2019, the Company recorded $1.6 million in legal settlement charges related to the resolution of a medical malpractice lawsuit, as well as a 2019 California wage and hour class action settlement agreement. The Company believes the outcome of any outstanding loss contingencies as of December 31, 2021 will not have a material adverse effect on its business, financial condition, results of operations, or cash flows. Sales and Other State Non-income Tax Liabilities The Company's sales and other state non-income tax filings are subject to routine audits by authorities in the jurisdictions where it conducts business in the United States which may result in assessments of additional taxes. The Company accrues sales and other non-income tax liabilities based on the Company's best estimate of its probable liability utilizing currently available information and interpretation of relevant tax regulations. Given the nature of the Company's business, significant subjectivity exists as to both whether sales and other state non-income taxes can be assessed on its activity and how the sales tax will ultimately be measured by the relevant jurisdictions. The Company makes a determination for each reporting period whether the estimates for sales and other non-income taxes in certain states should be revised. The expense is included in selling, general and administrative expenses in the Company's consolidated statements of operations and the liability is reflected in sales tax payable within other current liabilities in its consolidated balance sheets.

Income Taxes

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Income Taxes

The components of the Company's income (loss) before income taxes are as follows:


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands)
United States	$	132,809	$	(12,998)	$	(24,783)
Foreign	399		668		572
Income (loss) before income taxes	$	133,208	$	(12,330)	$	(24,211)

The components of the Company’s income tax expense (benefit) are as follows:


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands)
Current:
Federal	$	5,165	$	25	$	(35)
State	5,638		600		499
Foreign	330		119		109
Total	11,133		744		573
Deferred:
Federal	892		(138)		17,406
State	(10,648)		(818)		13,799
Foreign	(171)		24		(46)
Total	(9,927)		(932)		31,159
Income tax expense (benefit)	$	1,206	$	(188)	$	31,732

Deferred income taxes reflect the Company's net tax effect of temporary differences between the carrying amount of assets and liabilities for financial reporting purposes and the amounts used for income tax purposes.

Significant components of the Company’s deferred tax assets and liabilities are as follows:


	December 31,
	2021		2020
	(amounts in thousands)




























Deferred Tax Assets:
Accrued other and prepaid expenses	$	237	$	1,600
Allowance for doubtful accounts	1,644		909
Intangible assets	9,273		27,036
Net operating loss carryforwards	4,112		20,536

Accrued professional liability claims	1,335		1,525
Accrued workers’ compensation claims	3,097		3,015
Share-based compensation	840		721
Operating lease liabilities	3,790		4,871

Credit carryforwards	41		188
Other	505		—
Gross deferred tax assets	24,874		60,401
Valuation allowance	(20)		(37,472)
	24,854		22,929
Deferred Tax Liabilities:
Depreciation	(1,515)		(1,077)

Indefinite-lived intangibles	(9,993)		(25,546)
Operating lease right-of-use assets	(1,821)		(2,499)
Tax on unrepatriated earnings	(190)		(361)
Other	—		(38)
	(13,519)		(29,521)
Net deferred taxes	$	11,335	$	(6,592)

As of December 31, 2020, the Company determined that it could not sustain a conclusion that it was more likely than not that it would realize any of its deferred tax assets resulting from recent losses, the difficulty of forecasting future taxable income, and other factors. Due to the historical losses from the Company's operations, it had recorded a valuation allowance on its deferred tax assets not more likely than not to be realizable. As of December 31, 2021, and 2020, the Company had valuation allowances on its deferred tax assets of an immaterial amount and $37.5 million, respectively. For the year ended December 31, 2021, the Company recorded a net valuation allowance release of $37.5 million (comprised of $18.4 million related to federal NOLs, $7.5 million related to state NOLs, and $11.6 million related to other net deferred tax assets) on the basis of management’s reassessment of the amount of its deferred tax assets that are more likely than not to be realized. The valuation allowance on certain state NOLs was not released due to the respective expiration periods and specific state taxable income projections.

As of each reporting date, management considers new evidence, both positive and negative, that could affect its view of the future realization of deferred tax assets. As of December 31, 2021, in part because in the current year the Company achieved 12 quarters of cumulative pretax income including permanent items in the U.S. federal tax jurisdiction, management determined that there is sufficient positive evidence to conclude that it is more likely than not that its net deferred tax assets are realizable. The Company believes it has sustained cumulative profits and accordingly, released the valuation allowances on all deferred tax assets but for certain state NOLs due to the respective expiration periods and specific state taxable income projections.

In arriving at its conclusion to release the valuation allowance effective December 31, 2021, the Company considered several positive and negative factors. For the 12 quarters ended December 31, 2021, the Company has $110.3 million in cumulative pretax income including permanent items. The Company has a history of utilizing NOLs prior to expiration. Further, the

Company is forecasting positive pretax book income which is expected to exceed the reversal of its future tax deductions, further proving future estimates of taxable income. The growth estimates are tied to the growing demand for healthcare solutions for the Company's customers, including a growing aging U.S. population, and its customers’ pressure to keep costs down by using the Company's staffing solutions. With regard to negative evidence, the Company does not have any material taxable temporary differences to offset deductible temporary differences and does not have any taxable income available for carryback to offset NOLs. As such, the primary focus of its analysis emphasized the 12-quarter cumulative pretax income analysis and projections of future taxable income.

As of December 31, 2021, the Company utilized 100 percent of the federal net operating loss. The Company had approximately $72.4 million of state net operating loss carryforwards, and an immaterial amount of foreign net operating loss carryforwards. The NOLs expire as follows: state between 2022 and 2040 and foreign between 2022 and 2026. As a result of the 2017 Tax Act, certain state NOLs generated in 2020, 2019, and 2018 carry forward indefinitely.

The reconciliation of income tax computed at the U.S. federal statutory rate to income tax expense (benefit) is as follows:


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands)
Tax at U.S. statutory rate	$	27,974	$	(2,589)	$	(5,084)
State taxes, net of federal benefit	8,573		135		(554)
Noncontrolling interest	(5)		(172)		(372)
Non-deductible items(a)	550		544		562
Foreign tax expense (benefit)	76		1		(58)
Valuation allowances	(37,450)		117		36,224
Uncertain tax positions	1,891		1,110		400


Officers' compensation	344		621		418


Return to provision	44		87		2
Other	(791)		(42)		194
Income tax expense (benefit)	$	1,206	$	(188)	$	31,732

________________

(a) Includes non-deductible meals and incidentals and other miscellaneous non-deductible items.

A reconciliation of the beginning and ending amounts of unrecognized tax benefits is as follows:


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands)
Balance at January 1	$	6,891	$	5,792	$	5,412
Additions based on tax positions related to the current year	1,873		974		1,283
Additions (reductions) based on tax positions related to prior years	—		125		(498)

Reductions as a result of a lapse of applicable statute of limitations	(47)		—		(405)

Other	462		—		—
Balance at December 31	$	9,179	$	6,891	$	5,792

There were no short-term unrecognized tax benefits as of December 31, 2021, 2020, or 2019. Long-term unrecognized tax benefits are included in other long-term liabilities in the consolidated balance sheets and were $9.0 million, $1.0 million, and $0.7 million as of December 31, 2021, 2020, and 2019, respectively. See Note 7 - Balance Sheet Details. As of December 31,

2021, 2020, and 2019, the Company had unrecognized tax benefits, which would affect the effective tax rate if recognized, of $8.6 million, $7.1 million, and $6.0 million, respectively.

The Company recognizes interest and penalties related to unrecognized tax benefits in the provision for income taxes. During the years ended December 31, 2021, 2020, and 2019, interest and penalties were immaterial. The Company has accrued $0.4 million for the payment of interest and penalties at December 31, 2021, and $0.3 million at December 31, 2020 and 2019. Tax years 2012 through 2021 remain open to examination by certain taxing jurisdictions to which the Company is subject to tax.

An unrecognized tax benefit should be presented in the financial statements as a reduction to a deferred tax asset for a net operating loss carryforward if such carryforward would offset the disallowance of the tax position. As a result of the Company’s utilization of its federal net operating loss carryforward and a material amount of state net operating loss carryforwards, the Company reclassified $8.0 million of unrecognized tax benefits from deferred tax assets to long-term liabilities in the year ended December 31, 2021. Further, the Company reclassified $0.5 million, representing the federal benefit of state unrecognized tax benefits, in the tabular rollforward from unrecognized tax benefits to deferred tax assets.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Stockholders' Equity

12 Months Ended

Dec. 31, 2021

Equity [Abstract]

Stockholders' Equity

Stockholders’ Equity

Stock Repurchase Program

During the years ended December 31, 2021, 2020, and 2019, the Company did not repurchase any shares of its common stock.

As of December 31, 2021, the Company has 510,004 shares of common stock under the current share repurchase program available to repurchase, subject to certain conditions in the Company's Loan Agreement and Term Loan Agreement. The Company may repurchase up to an aggregate amount not to exceed $5.0 million pursuant to its Loan Agreement, and $5.5 million pursuant to its Term Loan Agreement, in any fiscal year, or an unlimited amount if the Company meets certain conditions as described in each of the agreements.

Share-Based Payments

On May 19, 2020, the Company's stockholders approved the Cross Country Healthcare, Inc. 2020 Omnibus Incentive Plan (2020 Plan), which replaced the 2017 Omnibus Incentive Plan (2017 Plan), and applies to awards granted after May 19, 2020. The remaining shares available for grant under the 2017 Plan were cancelled and no further awards will be granted under that plan. The 2020 Plan generally mirrors the terms of the 2017 Plan and includes the following provisions: (i) an aggregate share reserve of 3,000,000 shares; (2) annual dollar and share limits of awards granted to employees and consultants, as well as non-employee directors, based on type of award; (3) awards granted generally will be subject to a minimum one-year vesting schedule; and (4) awards may be granted under the 2020 Plan until March 24, 2030.

The Company's 2017 Plan and 2020 Plan (Plans) provide for the issuance of stock options, stock appreciation rights, restricted stock, performance shares, and performance-based cash awards that may be granted with the intent to comply with the “performance-based compensation” exception under Section 162(m) of the Internal Revenue Code, and other stock-based awards, all as defined by the Plans, to eligible employees, consultants and non-employee Directors. The Plans include Section 162(m) performance goals so that certain incentive awards granted to certain executive officers of the Company may qualify as exempt performance-based compensation. However, Section 162(m) of the Internal Revenue Code updated in conjunction with the 2017 Tax Act in November 2018 limits a publicly-held corporation’s federal tax deduction for compensation paid to “covered employees” to $1.0 million per year, for non-performance and performance shares.

Restricted stock awards granted under the Company’s Plans entitle the holder to receive, at the end of a vesting period, a specified number of shares of the Company’s common stock. Share-based compensation expense is measured by the market value of the Company’s stock on the date of grant. The shares vest ratably over a three year period ending on the anniversary date of the grant, and vesting is subject to the employee's continuing employment. There is no partial vesting and any unvested portion is forfeited. Pursuant to the Plans, the number of target shares that are issued for performance-based stock awards are determined based on the level of attainment of the targets.

The following table summarizes restricted stock awards and performance stock awards activity issued under the Plans for the year ended December 31, 2021:


	Restricted Stock Awards			Performance Stock Awards
	Number of Shares	Weighted Average Grant Date Fair Value		Number of Target Shares	Weighted Average Grant Date Fair Value
Unvested restricted stock awards, January 1, 2021	1,345,819	$	7.04	548,151	$	7.64
Granted	483,900	$	13.32	168,324	$	12.69
Vested	(653,758)	$	7.22	—	$	—
Forfeited	(136,506)	$	7.73	(194,309)	$	9.32
Unvested restricted stock awards, December 31, 2021	1,039,455	$	9.75	522,166	$	8.64

Awards granted to non-employee directors under the 2017 Plan prior to the adoption of the 2020 Plan, vest in three equal installments on the first, second, and third anniversaries of the grant date, while restricted shares granted under the 2020 Plan on and subsequent to June 2020 will vest on the first anniversary of such grant date, or earlier subject to retirement eligibility. In addition, effective in the three months ended June 30, 2020, the Company implemented modified guidelines that provide for accelerated vesting of restricted stock grants on the last date of service when a retirement-eligible director retires.

On March 31, 2021, 2020, and 2019, the Company awarded performance stock awards totaling 160,416, 286,415, and 192,939, respectively. The Company awarded an additional 7,908 performance stock awards in the second quarter of 2021. If the minimum level of performance is attained for the 2021, 2020, and 2019 awards, restricted stock will be issued with a vesting date of the third anniversary of such grant date. The level of attainment will be certified within 30 days of the vest date. During the first quarter of 2021, it was determined that the performance stock awards that were granted in 2018 were not earned and, accordingly, those shares were forfeited.

As of December 31, 2021, the Company had approximately $6.1 million of total unrecognized compensation cost related to non-vested restricted stock awards which may be adjusted for future changes in forfeitures. The Company expects to recognize such cost over a weighted average period of 1.48 years. The fair value of shares vested was approximately $8.9 million, $2.7 million, and $2.6 million, for the years ended December 31, 2021, 2020, and 2019, respectively.

As of December 31, 2021, the Company had approximately $2.7 million of total unrecognized compensation cost related to performance stock awards which may be adjusted for future changes in forfeitures. The Company expects to recognize such cost over a weighted average period of 1.28 years, the remaining service period. No shares vested for the years ended December 31, 2021, 2020, and 2019.

During the years ended December 31, 2021, 2020, and 2019, the Company did not issue stock options or stock appreciation rights. The following table represents information about stock options and stock appreciation rights exercised in each year.


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands)


Total intrinsic value of options exercised	$	—	$	1	$	130

The stock appreciation rights could only be settled with stock or cash, at the discretion of the Committee. The stock appreciation rights vested 25% per year over a 4 year period and expired after 7 years. The Company’s policy was to issue new shares from its authorized but unissued balance of common stock outstanding or shares of common stock reacquired by the Company if stock appreciation rights were settled with stock.

The Company recorded compensation expense for stock options based on the estimated fair value of the options on the date of grant using the Black-Scholes option-pricing model. Due to the adoption of the 2014 Plan (previously titled the 2007 Stock Incentive Plan), no further grants have been issued under the Company’s 1999 Plans referred to below.

Earnings Per Share

12 Months Ended

Dec. 31, 2021

Earnings Per Share [Abstract]

Earnings Per Share

The following table sets forth the components of the numerator and denominator for the computation of the basic and diluted earnings per share:


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands, except per share data)
Numerator:



Net income (loss) attributable to common stockholders - Basic and Diluted	$	132,002	$	(12,962)	$	(57,713)

Denominator:
Weighted average common shares - Basic	36,689		36,088		35,815
Effective of diluted shares:
Share-based awards	703		—		—

Weighted average common shares - Diluted	37,392		36,088		35,815

Net income (loss) per share attributable to common stockholders - Basic	$	3.60	$	(0.36)	$	(1.61)

Net income (loss) per share attributable to common stockholders - Diluted	$	3.53	$	(0.36)	$	(1.61)

For the years 2020 and 2019, no tax benefits were assumed for the potentially dilutive shares due to the Company's net operating loss position.

The following table represents the securities that could potentially dilute net income per share attributable to common stockholders in the future that were not included in the computation of diluted net income per share attributable to common stockholders because to do so would have been anti-dilutive for the periods presented.


	Year Ended December 31,
	2021	2020	2019
	(amounts in thousands)
Share-based awards	6	663	335

Related Party Transactions	12 Months Ended
Related Party Transactions	Dec. 31, 2021
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions Prior to December 31, 2020, the Company had a 68% ownership interest in Cross Country Talent Acquisition Group, LLC, a joint venture between the Company and a hospital system. The Company generated revenue providing staffing services to the hospital system of $16.0 million and $25.0 million in 2020 and 2019, respectively, with no activity in 2021. At December 31, 2020, the Company had a receivable balance of $1.7 million and a payable balance of $0.2 million, with no such balances as of December 31, 2021. Effective December 31, 2020, the sole professional staffing services agreement held by its joint venture was terminated, at which time the Company entered into a direct staffing agreement with the hospital system. The Company dissolved Cross Country Talent Acquisition Group, LLC during the third quarter of 2021. The Company has entered into an arrangement for digital marketing services provided by a firm that is related to Mr. Clark, the Company's Co-Founder & Chief Executive Officer. Mr. Clark is a minority shareholder in the firm's parent company and is a member of the parent company's Board of Directors. Management believes the terms of the arrangement are equivalent to those prevailing in an arm's-length transaction and have been approved by the Company through its related party process. The digital marketing firm manages a limited number of digital publishers covering various Company brands for a monthly management fee. In 2021, 2020, and 2019, the Company incurred an immaterial amount in expenses related to these fees. The Company had an immaterial payable balance at December 31, 2021 and no payable balance at December 31, 2020. The Company has provided services to entities affiliated with certain members of the Company’s Board of Directors, which it believes were conducted on terms equivalent to those prevailing in an arm's-length transaction. Revenue related to these transactions was $0.7 million in 2021, and an immaterial amount in both 2020 and 2019. Accounts receivable due from these entities was an immaterial amount at December 31, 2021 and 2020. As a result of the WSG acquisition on June 8, 2021, the Company continues to rent WSG's headquarters. The Chief Executive Officer and Founder of WSG, and currently a business unit president with the Company, is an agent of the lessor. The lease term is from January 1, 2020 through December 31, 2024. The Company paid an immaterial amount in rent expense for these premises for the year ended December 31, 2021, and had no payable balance at December 31, 2021. In the first quarter of 2020, the Company entered into a note payable of $7.3 million related to contingent consideration assumed as part of a prior period acquisition, payable in three equal installments. The payees of the note are controlled by an employee of the sellers who remained with the Company. The first two installments have been paid, leaving a note payable balance of $2.5 million and accrued interest of $0.1 million at December 31, 2021. See Note 4 - Acquisitions.

Segment Data

12 Months Ended

Dec. 31, 2021

Segment Reporting [Abstract]

Segment Data

In the first quarter of 2021, the Company modified its disclosures of reportable segments to better align with its management structure and to reflect how the operating results are regularly reviewed by the chief operating decision maker. As a result, the two reportable segments are now Nurse and Allied Staffing and Physician Staffing, and the results of the previously-reported Search segment have been consolidated within Nurse and Allied Staffing for all periods presented. 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 and local nurse and allied professionals, MSP services, education healthcare services, in-home care services, and outsourcing services. In addition, Nurse and Allied Staffing provides retained search services for healthcare professionals, as well as contingent search and recruitment process outsourcing services. Its clients include: public and private acute-care and non-acute care hospitals, government facilities, local and national healthcare plans, managed care providers, public schools and charter schools, 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.

The Company evaluates performance of each segment primarily based on revenue and contribution income. The Company defines contribution income as income (loss) from operations before depreciation and amortization, acquisition and integration-related costs, restructuring costs, legal settlement charges, impairment charges, and corporate overhead. Contribution income is a financial measure used by the Company when assessing segment performance. 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 information in the following table 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.

Information on operating segments and a reconciliation to income (loss) from operations for the periods indicated are as follows:


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands)
Revenues from services:
Nurse and Allied Staffing	$	1,605,781	$	768,483	$	747,619
Physician Staffing	70,871		67,934		74,605
	$	1,676,652	$	836,417	$	822,224
Contribution income:
Nurse and Allied Staffing	$	205,738	$	74,169	$	63,530
Physician Staffing	4,328		3,619		2,758
	210,066		77,788		66,288

Corporate overhead(a)	55,142		51,900		46,246
Depreciation and amortization	9,852		12,671		14,075



Acquisition and integration-related costs	1,068		77		201
Restructuring costs	2,630		6,052		3,571
Legal settlement charges	—		—		1,600
Impairment charges	2,070		16,248		16,306
Income (loss) from operations	$	139,304	$	(9,160)	$	(15,711)

_______________

(a) 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).

As a result of modifying the Company's reportable segments, revenue in the amount of $10.5 million and $14.8 million, respectively, and contribution loss in the amount of $1.1 million and $0.8 million, respectively, included in the previously-reported Search segment have been reclassified to Nurse and Allied Staffing for the years ended December 31, 2020 and 2019.

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 31
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8924-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Topic 280
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
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-Paragraph 21
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (f)
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Subparagraph (e)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
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-Topic 280
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Topic 280
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-Paragraph 22
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8736-108599

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
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-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8721-108599

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-URI http://asc.fasb.org/topic&trid=2134510

+ Details

Quarterly Financial Data (Unaudited)

12 Months Ended

Dec. 31, 2021

Quarterly Financial Information Disclosure [Abstract]

Quarterly Financial Data (Unaudited)

The following tables contain selected unaudited statements of operations information for each quarter of 2021 and 2020. The following information reflects all normal recurring adjustments necessary for a fair presentation of the information for the periods presented. The operating results for any quarter are not necessarily indicative of results for any future period.


	First Quarter		Second Quarter		Third Quarter		Fourth Quarter
2021	(amounts in thousands, except per share data)
Revenue from services	$	329,241	$	331,827	$	374,905	$	640,679

Gross profit(a)	71,465		72,590		83,794		147,150






Net income attributable to common stockholders	19,448		11,548		23,433		77,573




Net income per share attributable to common stockholders - Basic(b)	$	0.54	$	0.32	$	0.63	$	2.10




Net income per share attributable to common stockholders - Diluted(b)	$	0.53	$	0.31	$	0.62	$	2.07


	First Quarter		Second Quarter		Third Quarter		Fourth Quarter
2020	(amounts in thousands, except per share data)
Revenue from services	$	210,064	$	216,779	$	193,968	$	215,606

Gross profit(a)	49,603		50,734		48,003		54,392



Consolidated net (loss) income	(1,768)		(14,048)		(1,148)		4,822


Net (loss) income attributable to common stockholders	(2,089)		(14,151)		(1,334)		4,612




Net (loss) income per share attributable to common stockholders - Basic and Diluted(b)	$	(0.06)	$	(0.39)	$	(0.04)	$	0.13

________________

(a) Excludes depreciation and amortization.

(b) The sum of the quarterly per share amounts may not equal amounts reported for year-to-date due to the effects of rounding and changes in the number of weighted average shares outstanding used in the calculation.

The following items are the most significant items that impact the comparability and presentation of our consolidated data:

•During the second quarter of 2021, the Company recorded impairment charges of $1.9 million related to ceasing use of certain leased properties. During the second quarter of 2020, the Company recorded impairment charges of $10.5 million related to goodwill and other intangible assets of the Search business, and during the second and third quarters, recorded $4.5 million and $0.9 million, respectively, related to ceasing use of certain leased properties. See Note 5 - Goodwill, Trade Names, and Other Intangible Assets and Note 10 - Leases.

•During the year ended December 31, 2019, the Company accelerated certain finite-lived trade names as part of a rebranding strategy. This resulted in additional amortization expense of $0.7 million, $1.4 million, and $0.9 million, respectively, related to the Nurse and Allied Staffing segment recorded in the first three quarters of 2020.

•On December 16, 2021, the Company acquired substantially all of the assets and assumed certain liabilities of Selected, Inc. and on June 8, 2021, the Company acquired substantially all of the assets and assumed certain liabilities of Workforce Solutions Group, Inc. The acquisitions were not material and have been accounted for using the acquisition method. The results of the acquisitions' operations have been included in the consolidated statements of operations from their dates of acquisition. See Note 4 - Acquisitions.

•The Company incurred restructuring costs primarily comprised of employee termination costs, lease-related exit costs, and reorganization costs as part of planned cost savings initiatives. In the first quarter of 2021, the Company recorded expenses of $1.2 million, recorded expenses in the second quarter of $0.8 million, and recorded immaterial expenses in the third and fourth quarter. In the first quarter of 2020, the Company recorded expenses of $0.6 million, recorded expenses in the second and third quarters of $2.3 million, and recorded expenses of $0.9 million in the fourth quarter.

•During the third quarter of 2021, the Company entered into an agreement for the reimbursement of $1.6 million in legal fees incurred in 2020 and 2021, which were collected in the fourth quarter of 2021, related to a previously-disclosed grand jury subpoena. During the second, third, and fourth quarters of 2020, the Company recorded legal

fees related to an ongoing legal matter outside the normal course of operations of $1.6 million, $0.8 million, and $0.6 million, respectively.

•In the fourth quarter of 2021, the Company benefited from a $37.5 million reversal of valuation allowance on its net deferred tax assets. See Note 14 - Income Taxes.

Schedule II - Valuation and Qualifying Accounts

12 Months Ended

Dec. 31, 2021

SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract]

Schedule II - Valuation and Qualifying Accounts

Schedule II

CROSS COUNTRY HEALTHCARE, INC.

VALUATION AND QUALIFYING ACCOUNTS

FOR THE YEARS ENDED DECEMBER 31, 2021, 2020, AND 2019


	Balance at Beginning of Period		Charged to (Released from) Operations		Write-Offs, Net of Recoveries			Other Changes		Balance at End of Period
	(amounts in thousands)
Allowances for Accounts Receivable
Year Ended December 31, 2021	$	4,021	$	6,499	$	(3,639)	(a)	$	—	$	6,881
Year Ended December 31, 2020	$	3,219	$	4,269	$	(3,467)	(a)	$	—	$	4,021
Year Ended December 31, 2019	$	3,705	$	3,243	$	(3,729)	(a)	$	—	$	3,219

Valuation Allowance for Deferred Tax Assets
Year Ended December 31, 2021	$	37,472	$	(37,449)	$	—		$	(3)	$	20
Year Ended December 31, 2020	$	37,345	$	118	$	—		$	9	$	37,472
Year Ended December 31, 2019	$	1,189	$	36,224	$	—		$	(68)	$	37,345

________________

(a) Uncollectible accounts written off, net of recoveries.

Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

Use of Estimates

Cash and Cash Equivalents

Accounts Receivable, Allowance for Doubtful Accounts, and Concentration of Credit Risk

The opening balance of the allowance for doubtful accounts is reconciled to the closing balance for expected credit losses as follows:


	2021		2020
Allowance for Doubtful Accounts	(amounts in thousands)
Balance at January 1	$	3,416	$	2,406
Bad Debt Expense	504		539
Write-Offs, net of Recoveries	(699)		(349)
Balance at March 31	3,221		2,596
Bad Debt Expense	466		898
Write-Offs, net of Recoveries	(358)		(532)
Balance at June 30	3,329		2,962
Bad Debt Expense	1,441		946
Write-Offs, net of Recoveries	(138)		(800)
Balance at September 30	4,632		3,108
Bad Debt Expense	2,372		652
Write-Offs, net of Recoveries	(917)		(344)
Balance at December 31	$	6,087	$	3,416

Property and Equipment

Cloud Computing Arrangements

Leases

Business Combinations

Goodwill, Trade Names, and Other Intangible Assets

Debt Discount and Debt Issuance Costs

Derivative Financial Instruments

Sales and Other State Non-income Tax Liabilities

Insurance Claims

Revenue Recognition

The following is a description of the nature, amount, timing, and uncertainty of revenue and cash flows from which the Company generates revenue.

Temporary Staffing Revenue

Other Services Revenue

Gross Versus Net Policies

The Company records revenue on a gross basis as a principal or on a net basis as an agent depending on the contracted arrangement, as follows:

Managed Service Programs

Physician Staffing

See Note 3 - Revenue Recognition for the Company's revenues disaggregated by revenue source. Sales and usage-based taxes are excluded from revenue.

Contract Costs

All contract fulfillment costs are expensed as incurred to direct operating expenses. There were no contract assets or material contract liabilities as of December 31, 2021 and 2020.

Practical Expedients and Exemptions

Share-Based Compensation

Advertising

Restructuring Costs

Income Taxes

Comprehensive Income (Loss)

Fair Value Measurements

Earnings Per Share

Recent Accounting Pronouncements

Recently Adopted Accounting Pronouncements

depending on the amendment. The Company prospectively adopted this guidance with no material impact on its consolidated financial statements.

Recent Accounting Pronouncements

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

Schedule of Allowance for Credit Loss

The opening balance of the allowance for doubtful accounts is reconciled to the closing balance for expected credit losses as follows:


	2021		2020
Allowance for Doubtful Accounts	(amounts in thousands)
Balance at January 1	$	3,416	$	2,406
Bad Debt Expense	504		539
Write-Offs, net of Recoveries	(699)		(349)
Balance at March 31	3,221		2,596
Bad Debt Expense	466		898
Write-Offs, net of Recoveries	(358)		(532)
Balance at June 30	3,329		2,962
Bad Debt Expense	1,441		946
Write-Offs, net of Recoveries	(138)		(800)
Balance at September 30	4,632		3,108
Bad Debt Expense	2,372		652
Write-Offs, net of Recoveries	(917)		(344)
Balance at December 31	$	6,087	$	3,416

Schedule of Restructuring Costs

Reconciliations of the employee termination costs and lease-related exit costs beginning and ending liability balance is presented below:


	Year Ended December 31,
	2021				2020				2019
	(amounts in thousands)
	Employee Termination Costs		Lease-Related Exit Costs		Employee Termination Costs		Lease-Related Exit Costs		Employee Termination Costs		Lease-Related Exit Costs
Balance at beginning of period	$	499	$	2,687	$	386	$	1,223	$	556	$	127
Charged to restructuring costs(a)	814		544		2,525		2,190		1,870		1,311
Payments	(1,153)		(808)		(2,412)		(726)		(2,040)		(215)
Balance at end of period	$	160	$	2,423	$	499	$	2,687	$	386	$	1,223

________________

Revenue Recognition (Tables)

12 Months Ended

Dec. 31, 2021

Revenue from Contract with Customer [Abstract]

Schedule of Disaggregation of Revenue


	Year Ended December 31, 2021
	Nurse And Allied Staffing		Physician Staffing		Total Segments
	(amounts in thousands)
Temporary Staffing Services	$	1,568,974	$	67,843	$	1,636,817
Other Services	36,807		3,028		39,835
Total	$	1,605,781	$	70,871	$	1,676,652


	Year Ended December 31, 2020
	Nurse And Allied Staffing		Physician Staffing		Total Segments
	(amounts in thousands)
Temporary Staffing Services	$	740,441	$	64,819	$	805,260
Other Services	28,042		3,115		31,157
Total	$	768,483	$	67,934	$	836,417









	Year Ended December 31, 2019
	Nurse And Allied Staffing		Physician Staffing		Total Segments
	(amounts in thousands)
Temporary Staffing Services	$	720,393	$	70,261	$	790,654
Other Services	27,226		4,344		31,570
Total	$	747,619	$	74,605	$	822,224

Acquisitions (Tables)

12 Months Ended

Dec. 31, 2021

Business Combination and Asset Acquisition [Abstract]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed

The following table is an estimate of the assets acquired and liabilities assumed on June 8, 2021:


	(amounts in thousands)
Cash and cash equivalents	$	957
Accounts receivable	11,991
Other current assets	59
Property and equipment	10
Right-of-use assets	1,078
Goodwill	22,066
Other intangible assets	14,200
Total assets acquired	50,361
Accounts payable and accrued expenses	3,562
Accrued compensation and benefits	1,387
Lease liability - current	316
Lease liability - non-current	762
Earnout liability	15,000
Total liabilities assumed	21,027
Net assets acquired	$	29,334

Goodwill, Trade Names, and Other Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Acquired Intangible Assets

The Company had the following acquired intangible assets:


	December 31, 2021						December 31, 2020
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
	(amounts in thousands)
Intangible assets subject to amortization:
Databases	$	30,530	$	18,375	$	12,155	$	30,530	$	15,322	$	15,208
Customer relationships	47,738		17,581		30,157		33,538		14,007		19,531
Non-compete agreements	304		272		32		304		212		92

Other intangible assets, net	$	78,572	$	36,228	$	42,344	$	64,372	$	29,541	$	34,831
Intangible assets not subject to amortization:
Trade names, indefinite-lived					$	5,900					$	5,900

Schedule of Estimated Annual Amortization Expense

As of December 31, 2021, estimated annual amortization expense is as follows:


Years Ending December 31:	(amounts in thousands)
2022	$	7,175
2023	7,117
2024	6,479
2025	5,921
2026	4,751
Thereafter	10,901
	$	42,344

Schedule of Changes in Carrying Amount of Goodwill by Segment

The changes in the carrying amount of goodwill by reportable segment are as follows:


	Nurse And Allied Staffing		Physician Staffing		Total
	(amounts in thousands)
Balances as of December 31, 2020
Aggregate goodwill acquired	$	367,880	$	43,405	$	411,285
Sale of business	(9,889)		—		(9,889)
Accumulated impairment loss	(269,874)		(40,598)		(310,472)
Goodwill, net of impairment loss	88,117		2,807		90,924

Changes to aggregate goodwill in 2021
Aggregate goodwill acquired (a)	28,566		—		28,566


Balances as of December 31, 2021
Aggregate goodwill acquired	396,446		43,405		439,851
Sale of business	(9,889)		—		(9,889)
Accumulated impairment loss	(269,874)		(40,598)		(310,472)
Goodwill, net of impairment loss	$	116,683	$	2,807	$	119,490

________________

Property and Equipment (Tables)

12 Months Ended

Dec. 31, 2021

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment

The Company's property and equipment consists of the following:


		December 31,
	Useful Lives	2021		2020
		(amounts in thousands)
Computer equipment	3-5 years	$	4,910	$	3,644
Computer software	3-10 years	18,839		17,416
Office equipment	5-7 years	475		933
Furniture and fixtures	5-7 years	2,475		2,528
Construction in progress	(a) (b)	2,523		473
Leasehold improvements	(b)	4,340		4,370
		33,562		29,364
Less accumulated depreciation and amortization		(17,729)		(17,013)
		$	15,833	$	12,351

_______________

(a) Primarily related to software development.

(b) See Note 2 – Summary of Significant Accounting Policies.

Balance Sheet Details (Tables)

12 Months Ended

Dec. 31, 2021

Balance Sheet Related Disclosures [Abstract]

Balance Sheet Details


	December 31,
	2021		2020
	(amounts in thousands)
Insurance recovery receivable:
Insurance recovery for health claims	$	300	$	369
Insurance recovery for workers’ compensation claims	2,836		2,629
Insurance recovery for professional liability claims	1,905		1,700
	$	5,041	$	4,698

Other non-current assets:
Insurance recovery for workers’ compensation claims	$	4,861	$	5,352
Insurance recovery for professional liability claims	9,137		7,763
Non-current security deposits	672		786

Deferred compensation assets	1,398		1,156
Net debt issuance costs	991		1,063
Finance lease right-of-use assets	57		102
Cloud computing asset	4,840		3,187
	$	21,956	$	19,409

Accrued compensation and benefits:
Salaries and payroll taxes	$	39,139	$	13,131
Accrual for bonuses and commissions	10,755		7,705
Accrual for workers’ compensation claims	8,394		7,670
Accrual for professional liability claims	2,448		2,499
Accrual for healthcare claims	4,081		3,926
Accrual for vacation	763		609
	$	65,580	$	35,540

Long-term accrued claims:
Accrual for workers’ compensation claims	$	11,777	$	12,692
Accrual for professional liability claims	13,537		12,720
	$	25,314	$	25,412

Other long-term liabilities:
Restructuring	$	1,829	$	2,082
Deferred compensation	2,457		2,475
Long-term note payable	—		2,426
Long-term unrecognized tax benefits	8,994		951

Other	508		61
	$	13,788	$	7,995

Debt (Tables)

12 Months Ended

Dec. 31, 2021

Debt Disclosure [Abstract]

Schedule of Long-term Debt Instruments

The Company's long-term debt consists of the following:


	December 31, 2021				December 31, 2020
	Principal		Debt Issuance Costs		Principal		Debt Issuance Costs
	(amounts in thousands)
Term Loan, interest of 6.50% at December 31, 2021	$	174,312	$	(5,396)	$	—	$	—
Senior Secured Asset-Based Loan, interest of 1.60% and 2.73% at December 31, 2021 and December 31, 2020, respectively	9,200		(991)		53,408		(1,063)
Note Payable, interest of 2.00% per annum	2,426		—		4,851		—
Total debt	185,938		(6,387)		58,259		(1,063)
Less current portion - note payable	2,426		—		2,425		—
Less current portion - term loan	1,750		—		—		—
Long-term debt	$	181,762	$	(6,387)	$	55,834	$	(1,063)

Schedule of Maturities of Long-term Debt

As of December 31, 2021, the aggregate schedule for maturities of debt are as follows:


	Term Loan		Senior Secured Asset-Based Loan		Note Payable
Through Years Ending December 31:	(amounts in thousands)
2022	$	1,750	$	—	$	2,426
2023	1,750		—		—
2024	1,750		9,200		—
2025	1,750				—
2026	1,750		—		—
Thereafter	165,562		—		—
Total	$	174,312	$	9,200	$	2,426

- Definition

Tabular disclosure of long-debt instruments or arrangements, including identification, terms, features, collateral requirements and other information necessary to a fair presentation. These are debt arrangements that originally required repayment more than twelve months after issuance or greater than the normal operating cycle of the entity, if longer.

+ References

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-Name Accounting Standards Codification
-Topic 210
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-Section S99
-Paragraph 1
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-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 3
-Subparagraph (SX 210.12-04(a))
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Reference 5: http://www.xbrl.org/2003/role/exampleRef
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Reference 7: http://www.xbrl.org/2003/role/exampleRef
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Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
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-Name Accounting Standards Codification
-Topic 942
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-Section 50
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-URI http://asc.fasb.org/extlink&oid=123599511&loc=d3e64711-112823

Reference 11: http://fasb.org/us-gaap/role/ref/legacyRef
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-URI http://asc.fasb.org/extlink&oid=123467817&loc=d3e21475-112644

+ Details

Leases (Tables)

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Supplemental Balance Sheet Information

The table below presents the lease-related assets and liabilities included on the consolidated balance sheets:


Classification on Consolidated Balance Sheets:	December 31, 2021			December 31, 2020
	(amounts in thousands)
Operating lease right-of-use assets (a)	$	7,488		$	10,447
Operating lease liabilities - current (a)	$	4,090		$	4,509
Operating lease liabilities - non-current (a)	$	10,853		$	15,234

	December 31, 2021			December 31, 2020
Weighted-average remaining lease term	3.4 years			4.1 years
Weighted average discount rate	6.39		%	6.32		%

________________

Schedule of Operating Lease Maturity


Years Ending December 31:	(amounts in thousands)
2022	$	4,913
2023	5,027
2024	3,959
2025	2,762


Total minimum lease payments	16,661
Less: amount of lease payments representing interest	(1,718)
Present value of future minimum lease payments	14,943
Less: operating lease liabilities - current	(4,090)
Operating lease liabilities - non-current	$	10,853

Schedule of Lease Costs

The table below provides information regarding supplemental cash flows:


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands)
Supplemental Cash Flow Information:
Cash paid for amounts included in the measurement of operating lease liabilities	$	6,150	$	7,111	$	7,477
Right-of-use assets acquired under operating lease	$	1,059	$	1,587	$	1,229

The components of lease expense are as follows:


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands)
Amounts Included in Consolidated Statements of Operations:
Operating lease expense	$	3,538	$	4,874	$	6,592
Short-term lease expense	$	3,695	$	5,217	$	8,042
Variable and other lease costs	$	1,957	$	1,919	$	2,446

Fair Value Measurements (Tables)

12 Months Ended

Dec. 31, 2021

Fair Value Disclosures [Abstract]

Summary of Estimated Fair Values of Financial Assets and Liabilities Measured on a Recurring Basis

The estimated fair value of the Company’s financial assets and liabilities measured on a recurring basis is as follows:

Fair Value Measurements


	December 31, 2021		December 31, 2020
	(amounts in thousands)
Financial Assets:
(Level 1)
Deferred compensation asset	$	1,398	$	1,156
Financial Liabilities:
(Level 1)
Deferred compensation liability	$	2,457	$	2,475

Schedule of Carrying Amounts and Estimated Fair Values of Significant Financial Instrument that were not Measured at Fair Value

The carrying amounts and estimated fair value of the Company’s significant financial instruments that were not measured at fair value are as follows:


	December 31, 2021				December 31, 2020
	Carrying Amount		Fair Value		Carrying Amount		Fair Value
	(amounts in thousands)
Financial Liabilities:
(Level 2)
Note Payable	$	2,426	$	2,426	$	4,851	$	4,851
Senior Secured Asset-Based Loan	$	9,200	$	9,200	$	53,408	$	53,408
Term Loan, net	$	174,312	$	174,845	$	—	$	—
Earnout Liability (WSG)	$	15,000	$	15,000	$	—	$	—
Earnout Liability (Selected)	$	1,500	$	1,500	$	—	$	—

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Schedule of Components of Loss Before Income Taxes

The components of the Company's income (loss) before income taxes are as follows:


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands)
United States	$	132,809	$	(12,998)	$	(24,783)
Foreign	399		668		572
Income (loss) before income taxes	$	133,208	$	(12,330)	$	(24,211)

Schedule of Components of Income Tax Expense (Benefit)

The components of the Company’s income tax expense (benefit) are as follows:


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands)
Current:
Federal	$	5,165	$	25	$	(35)
State	5,638		600		499
Foreign	330		119		109
Total	11,133		744		573
Deferred:
Federal	892		(138)		17,406
State	(10,648)		(818)		13,799
Foreign	(171)		24		(46)
Total	(9,927)		(932)		31,159
Income tax expense (benefit)	$	1,206	$	(188)	$	31,732

Schedule of Significant Components of Deferred Tax Assets and Liabilities

Significant components of the Company’s deferred tax assets and liabilities are as follows:


	December 31,
	2021		2020
	(amounts in thousands)




























Deferred Tax Assets:
Accrued other and prepaid expenses	$	237	$	1,600
Allowance for doubtful accounts	1,644		909
Intangible assets	9,273		27,036
Net operating loss carryforwards	4,112		20,536

Accrued professional liability claims	1,335		1,525
Accrued workers’ compensation claims	3,097		3,015
Share-based compensation	840		721
Operating lease liabilities	3,790		4,871

Credit carryforwards	41		188
Other	505		—
Gross deferred tax assets	24,874		60,401
Valuation allowance	(20)		(37,472)
	24,854		22,929
Deferred Tax Liabilities:
Depreciation	(1,515)		(1,077)

Indefinite-lived intangibles	(9,993)		(25,546)
Operating lease right-of-use assets	(1,821)		(2,499)
Tax on unrepatriated earnings	(190)		(361)
Other	—		(38)
	(13,519)		(29,521)
Net deferred taxes	$	11,335	$	(6,592)

Schedule of Reconciliation of Income Tax Computed At U. S. Federal Statutory Rate to Income Tax (Benefit) Expense

The reconciliation of income tax computed at the U.S. federal statutory rate to income tax expense (benefit) is as follows:


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands)
Tax at U.S. statutory rate	$	27,974	$	(2,589)	$	(5,084)
State taxes, net of federal benefit	8,573		135		(554)
Noncontrolling interest	(5)		(172)		(372)
Non-deductible items(a)	550		544		562
Foreign tax expense (benefit)	76		1		(58)
Valuation allowances	(37,450)		117		36,224
Uncertain tax positions	1,891		1,110		400


Officers' compensation	344		621		418


Return to provision	44		87		2
Other	(791)		(42)		194
Income tax expense (benefit)	$	1,206	$	(188)	$	31,732

________________

(a) Includes non-deductible meals and incidentals and other miscellaneous non-deductible items.

Schedule of Reconciliation of Beginning and Ending Amounts of Unrecognized Tax Benefits

A reconciliation of the beginning and ending amounts of unrecognized tax benefits is as follows:


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands)
Balance at January 1	$	6,891	$	5,792	$	5,412
Additions based on tax positions related to the current year	1,873		974		1,283
Additions (reductions) based on tax positions related to prior years	—		125		(498)

Reductions as a result of a lapse of applicable statute of limitations	(47)		—		(405)

Other	462		—		—
Balance at December 31	$	9,179	$	6,891	$	5,792

Stockholders' Equity (Tables)

12 Months Ended

Dec. 31, 2021

Equity [Abstract]

Summary of Restricted Stock Award Activity

The following table summarizes restricted stock awards and performance stock awards activity issued under the Plans for the year ended December 31, 2021:


	Restricted Stock Awards			Performance Stock Awards
	Number of Shares	Weighted Average Grant Date Fair Value		Number of Target Shares	Weighted Average Grant Date Fair Value
Unvested restricted stock awards, January 1, 2021	1,345,819	$	7.04	548,151	$	7.64
Granted	483,900	$	13.32	168,324	$	12.69
Vested	(653,758)	$	7.22	—	$	—
Forfeited	(136,506)	$	7.73	(194,309)	$	9.32
Unvested restricted stock awards, December 31, 2021	1,039,455	$	9.75	522,166	$	8.64

Stock Options and Stock Appreciation Rights Granted and Exercised

The following table represents information about stock options and stock appreciation rights exercised in each year.


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands)


Total intrinsic value of options exercised	$	—	$	1	$	130

Earnings Per Share (Tables)

12 Months Ended

Dec. 31, 2021

Earnings Per Share [Abstract]

Schedule of Components of Numerator and Denominator for Computation of Basic and Diluted Earnings per Share

The following table sets forth the components of the numerator and denominator for the computation of the basic and diluted earnings per share:


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands, except per share data)
Numerator:



Net income (loss) attributable to common stockholders - Basic and Diluted	$	132,002	$	(12,962)	$	(57,713)

Denominator:
Weighted average common shares - Basic	36,689		36,088		35,815
Effective of diluted shares:
Share-based awards	703		—		—

Weighted average common shares - Diluted	37,392		36,088		35,815

Net income (loss) per share attributable to common stockholders - Basic	$	3.60	$	(0.36)	$	(1.61)

Net income (loss) per share attributable to common stockholders - Diluted	$	3.53	$	(0.36)	$	(1.61)

Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share


	Year Ended December 31,
	2021	2020	2019
	(amounts in thousands)
Share-based awards	6	663	335

Segment Data (Tables)

12 Months Ended

Dec. 31, 2021

Segment Reporting [Abstract]

Schedule of Information on Operating Segments and Reconciliation to Income From Operations

Information on operating segments and a reconciliation to income (loss) from operations for the periods indicated are as follows:


	Year Ended December 31,
	2021		2020		2019
	(amounts in thousands)
Revenues from services:
Nurse and Allied Staffing	$	1,605,781	$	768,483	$	747,619
Physician Staffing	70,871		67,934		74,605
	$	1,676,652	$	836,417	$	822,224
Contribution income:
Nurse and Allied Staffing	$	205,738	$	74,169	$	63,530
Physician Staffing	4,328		3,619		2,758
	210,066		77,788		66,288

Corporate overhead(a)	55,142		51,900		46,246
Depreciation and amortization	9,852		12,671		14,075



Acquisition and integration-related costs	1,068		77		201
Restructuring costs	2,630		6,052		3,571
Legal settlement charges	—		—		1,600
Impairment charges	2,070		16,248		16,306
Income (loss) from operations	$	139,304	$	(9,160)	$	(15,711)

_______________

Quarterly Financial Data (Unaudited) (Tables)

12 Months Ended

Dec. 31, 2021

Quarterly Financial Information Disclosure [Abstract]

Schedule Quarterly Financial Data


	First Quarter		Second Quarter		Third Quarter		Fourth Quarter
2021	(amounts in thousands, except per share data)
Revenue from services	$	329,241	$	331,827	$	374,905	$	640,679

Gross profit(a)	71,465		72,590		83,794		147,150






Net income attributable to common stockholders	19,448		11,548		23,433		77,573




Net income per share attributable to common stockholders - Basic(b)	$	0.54	$	0.32	$	0.63	$	2.10




Net income per share attributable to common stockholders - Diluted(b)	$	0.53	$	0.31	$	0.62	$	2.07


	First Quarter		Second Quarter		Third Quarter		Fourth Quarter
2020	(amounts in thousands, except per share data)
Revenue from services	$	210,064	$	216,779	$	193,968	$	215,606

Gross profit(a)	49,603		50,734		48,003		54,392



Consolidated net (loss) income	(1,768)		(14,048)		(1,148)		4,822


Net (loss) income attributable to common stockholders	(2,089)		(14,151)		(1,334)		4,612




Net (loss) income per share attributable to common stockholders - Basic and Diluted(b)	$	(0.06)	$	(0.39)	$	(0.04)	$	0.13

________________

(a) Excludes depreciation and amortization.

Summary of Significant Accounting Policies - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended						12 Months Ended
	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Significant Accounting Policies [Line Items]
Restructuring costs	$ 800	$ 1,200	$ 900	$ 2,300	$ 2,300	$ 600	$ 2,630	$ 6,052	$ 3,571
Sales allowance, billing-related adjustments			600				800	600
Prepaid implementation costs			400				500	400
Capitalized implementation costs			3,187				4,840	3,187
Implementation costs, amortization							400	0	0
Outstanding standby letters of credit as collateral			17,000				16,700	17,000
Unbilled contracts receivable			48,300				140,000	48,300
Equity compensation							6,900	5,400	3,400
Advertising costs							9,500	6,200	7,900
Cumulative impact of currency fluctuations			1,300				1,300	1,300
Claims-Based Liability Insurance
Significant Accounting Policies [Line Items]
Self insured retention per claim							500
Letter of credit for malpractice claims			$ 1,500				1,500	1,500
Lease-Related Exit Costs
Significant Accounting Policies [Line Items]
Restructuring costs							$ 544	$ 2,190	$ 1,311
Revenue Benchmark \| Service \| Services
Significant Accounting Policies [Line Items]
Concentration risk percentage							5.00%	5.00%	5.00%
Minimum
Significant Accounting Policies [Line Items]
Threshold period, past due for payment of services provided							30 days
Estimated useful life of assets							3 years
Short term leases period							3 months
Intangible assets- useful life							5 years
Maximum
Significant Accounting Policies [Line Items]
Threshold period, past due for payment of services provided							60 days
Estimated useful life of assets							10 years
Short term leases period							6 months
Intangible assets- useful life							16 years

Summary of Significant Accounting Policies - Allowance for Doubtful Accounts (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2021	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 4,632	$ 3,329	$ 3,221	$ 3,416	$ 3,108	$ 2,962	$ 2,596	$ 2,406	$ 3,416	$ 2,406
Bad debt expense	2,372	1,441	466	504	652	946	898	539	4,783	3,035	$ 2,008
Write-Offs, net of Recoveries	(917)	(138)	(358)	(699)	(344)	(800)	(532)	(349)
Ending balance	$ 6,087	$ 4,632	$ 3,329	$ 3,221	$ 3,416	$ 3,108	$ 2,962	$ 2,596	$ 6,087	$ 3,416	$ 2,406

Summary of Significant Accounting Policies - Reconciliation of Restructuring Liabilities (Details) - USD ($) $ in Thousands	3 Months Ended						12 Months Ended
	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Restructuring Reserve [Roll Forward]
Charged to restructuring costs	$ 800	$ 1,200	$ 900	$ 2,300	$ 2,300	$ 600	$ 2,630	$ 6,052	$ 3,571
Employee Termination Costs
Restructuring Reserve [Roll Forward]
Balance at beginning of period		499				386	499	386	556
Charged to restructuring costs							814	2,525	1,870
Payments							(1,153)	(2,412)	(2,040)
Balance at end of period			499				160	499	386
Lease-Related Exit Costs
Restructuring Reserve [Roll Forward]
Balance at beginning of period		$ 2,687				$ 1,223	2,687	1,223	127
Charged to restructuring costs							544	2,190	1,311
Payments							(808)	(726)	(215)
Balance at end of period			$ 2,687				2,423	2,687	1,223
Strategic Reduction Of Real Estate Footprint
Restructuring Reserve [Roll Forward]
Charged to restructuring costs							$ 1,300	$ 1,100	$ 0

Revenue Recognition - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2021	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Disaggregation of Revenue [Line Items]
Revenue from services	$ 640,679	$ 374,905	$ 331,827	$ 329,241	$ 215,606	$ 193,968	$ 216,779	$ 210,064	$ 1,676,652	$ 836,417	$ 822,224
Temporary Staffing Services
Disaggregation of Revenue [Line Items]
Revenue from services									1,636,817	805,260	790,654
Other Services
Disaggregation of Revenue [Line Items]
Revenue from services									39,835	31,157	31,570
Nurse And Allied Staffing
Disaggregation of Revenue [Line Items]
Revenue from services									1,605,781	768,483	747,619
Nurse And Allied Staffing \| Temporary Staffing Services
Disaggregation of Revenue [Line Items]
Revenue from services									1,568,974	740,441	720,393
Nurse And Allied Staffing \| Other Services
Disaggregation of Revenue [Line Items]
Revenue from services									36,807	28,042	27,226
Physician Staffing
Disaggregation of Revenue [Line Items]
Revenue from services									70,871	67,934	74,605
Physician Staffing \| Temporary Staffing Services
Disaggregation of Revenue [Line Items]
Revenue from services									67,843	64,819	70,261
Physician Staffing \| Other Services
Disaggregation of Revenue [Line Items]
Revenue from services									$ 3,028	$ 3,115	$ 4,344

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8906-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 40
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9031-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 41
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9038-108599

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 4
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130543-203045

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8736-108599

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8736-108599

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 42
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9054-108599

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 5
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130545-203045

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 924
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-URI http://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details

Revenue Recognition- Narrative (Details) $ in Thousands	3 Months Ended								12 Months Ended
Revenue Recognition- Narrative (Details) $ in Thousands	Dec. 31, 2021 USD ($)	Sep. 30, 2021 USD ($)	Jun. 30, 2021 USD ($)	Mar. 31, 2021 USD ($) segment	Dec. 31, 2020 USD ($)	Sep. 30, 2020 USD ($)	Jun. 30, 2020 USD ($)	Mar. 31, 2020 USD ($)	Dec. 31, 2021 USD ($) segment	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)
Disaggregation of Revenue [Line Items]
Number of reportable segments \| segment				2					2
Revenue from services	$ 640,679	$ 374,905	$ 331,827	$ 329,241	$ 215,606	$ 193,968	$ 216,779	$ 210,064	$ 1,676,652	$ 836,417	$ 822,224
Nurse And Allied Staffing
Disaggregation of Revenue [Line Items]
Revenue from services									1,605,781	768,483	747,619
Revision of Prior Period, Adjustment \| Nurse And Allied Staffing
Disaggregation of Revenue [Line Items]
Revenue from services										10,500	14,800
Other Services
Disaggregation of Revenue [Line Items]
Revenue from services									39,835	31,157	31,570
Other Services \| Nurse And Allied Staffing
Disaggregation of Revenue [Line Items]
Revenue from services									$ 36,807	28,042	27,226
Other Services \| Revision of Prior Period, Adjustment \| Nurse And Allied Staffing
Disaggregation of Revenue [Line Items]
Revenue from services										$ 10,500	$ 14,800

- Definition

+ References

+ Details

Acquisitions - Selected (Details) - USD ($) $ in Thousands	Dec. 16, 2021	Dec. 31, 2021	Dec. 31, 2020
Asset Acquisition [Line Items]
Non-current earnout liability		$ 9,000	$ 0
Goodwill		119,490	$ 90,924
Selected, Inc
Asset Acquisition [Line Items]
Cash consideration, gross	$ 3,500
Equity consideration for acquisition value	$ 1,500
Equity consideration for acquisition (in shares)	59,429
Contingent consideration liabilities	$ 1,500
Non-current earnout liability		$ 1,500
Goodwill	$ 6,500

Acquisitions - Workforce Solutions Group (Details) - USD ($) $ in Thousands		12 Months Ended
	Jun. 08, 2021	Dec. 31, 2021	Dec. 31, 2020
Asset Acquisition [Line Items]
Current portion of earnout liability		$ 7,500	$ 0
Non-current earnout liability		9,000	0
Goodwill		119,490	$ 90,924
Workforce Solutions Group, Inc.
Asset Acquisition [Line Items]
Cash consideration, gross	$ 25,000
Equity consideration for acquisition value	$ 5,000
Equity consideration for acquisition (in shares)	307,730
Net working capital adjustment	$ 1,100
Business performance, term	3 years
Contingent consideration liabilities	$ 15,000
Current portion of earnout liability		7,500
Non-current earnout liability		7,500
Other intangible assets	14,200
Goodwill	22,066
Associated acquisition related costs		$ 1,000
Workforce Solutions Group, Inc. \| Customer relationships
Asset Acquisition [Line Items]
Other intangible assets	$ 14,200
Weighted average useful life of assets acquired	11 years 6 months

Acquisitions - Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Jun. 08, 2021	Dec. 31, 2020
Business Acquisition [Line Items]
Goodwill	$ 119,490		$ 90,924
Workforce Solutions Group, Inc.
Business Acquisition [Line Items]
Cash and cash equivalents		$ 957
Accounts receivable		11,991
Other current assets		59
Property and equipment		10
Right-of-use assets		1,078
Goodwill		22,066
Other intangible assets		14,200
Total assets acquired		50,361
Accounts payable and accrued expenses		3,562
Accrued compensation and benefits		1,387
Lease liability - current		316
Lease liability - non-current		762
Earnout liability		15,000
Total liabilities assumed		21,027
Net assets acquired		$ 29,334

Acquisitions - Advantage (Details) - Advantage - USD ($) $ in Millions				3 Months Ended
	Apr. 03, 2019	Jul. 28, 2017	Jul. 01, 2017	Dec. 31, 2021	Mar. 31, 2019
Business Acquisition [Line Items]
Escrow payment related to tax liabilities			$ 14.5
Escrow payment related to post-close liabilities			$ 7.5
Release of escrow to seller	$ 2.9	$ 7.3		$ 0.5	$ 7.0
Escrow disbursed to pay taxes	$ 4.3

Acquisitions - Mediscan (Details) - USD ($) $ in Thousands	3 Months Ended			12 Months Ended
Acquisitions - Mediscan (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Business Acquisition [Line Items]
Payments of notes payable				$ 2,426	$ 2,426	$ 0
Mediscan
Business Acquisition [Line Items]
Recognition of earnout payment liability			$ 7,400
Payment for contingent liability			100
Mediscan \| Earnout Notes Payable
Business Acquisition [Line Items]
Earnout performance criterion, conversion to note payable			$ 7,300
Payments of notes payable	$ 2,400	$ 2,400
Notes payable				$ 2,500
Stated interest rate (percent)				2.00%
Assumed Additional Contingent Purchase Price Liabilities \| Mediscan
Business Acquisition [Line Items]
Contingent consideration, range of outcomes, high							$ 300	$ 300	$ 300
Payments for previous acquisition						$ 300

Goodwill, Trade Names, and Other Intangible Assets - Acquired Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Finite-Lived and Indefinite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 78,572	$ 64,372
Accumulated Amortization	36,228	29,541
Net Carrying Amount	42,344	34,831
Trade names, indefinite-lived	5,900	5,900
Databases
Finite-Lived and Indefinite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	30,530	30,530
Accumulated Amortization	18,375	15,322
Net Carrying Amount	12,155	15,208
Customer relationships
Finite-Lived and Indefinite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	47,738	33,538
Accumulated Amortization	17,581	14,007
Net Carrying Amount	30,157	19,531
Non-compete agreements
Finite-Lived and Indefinite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	304	304
Accumulated Amortization	272	212
Net Carrying Amount	$ 32	$ 92

Goodwill, Trade Names, and Other Intangible Assets - Estimated Annual Amortization Expense (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
2022	$ 7,175
2023	7,117
2024	6,479
2025	5,921
2026	4,751
Thereafter	10,901
Net Carrying Amount	$ 42,344	$ 34,831

Goodwill, Trade Names, and Other Intangible Assets - Changes in Carrying Amount of Goodwill by Segment (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($)
Goodwill balances
Aggregate goodwill acquired, beginning of period	$ 411,285
Accumulated impairment loss, beginning of period	(310,472)
Goodwill, net of impairment loss, beginning of period	90,924
Aggregate goodwill acquired	28,566
Aggregate goodwill acquired, end of period	439,851
Accumulated impairment loss, end of period	(310,472)
Goodwill, net of impairment loss, end of period	119,490
Sale of business
Goodwill balances
Aggregate goodwill acquired, beginning of period	9,889
Aggregate goodwill acquired, end of period	9,889
Nurse And Allied Staffing
Goodwill balances
Aggregate goodwill acquired, beginning of period	367,880
Accumulated impairment loss, beginning of period	(269,874)
Goodwill, net of impairment loss, beginning of period	88,117
Aggregate goodwill acquired	28,566
Aggregate goodwill acquired, end of period	396,446
Accumulated impairment loss, end of period	(269,874)
Goodwill, net of impairment loss, end of period	116,683
Nurse And Allied Staffing \| Sale of business
Goodwill balances
Aggregate goodwill acquired, beginning of period	9,889
Aggregate goodwill acquired, end of period	9,889
Physician Staffing
Goodwill balances
Aggregate goodwill acquired, beginning of period	43,405
Accumulated impairment loss, beginning of period	(40,598)
Goodwill, net of impairment loss, beginning of period	2,807
Aggregate goodwill acquired	0
Aggregate goodwill acquired, end of period	43,405
Accumulated impairment loss, end of period	(40,598)
Goodwill, net of impairment loss, end of period	2,807
Physician Staffing \| Sale of business
Goodwill balances
Aggregate goodwill acquired, beginning of period	0
Aggregate goodwill acquired, end of period	$ 0

Goodwill, Trade Names, and Other Intangible Assets - Narrative (Details) $ / shares in Units, $ in Millions	3 Months Ended					12 Months Ended
	Mar. 31, 2021 segment	Sep. 30, 2020 USD ($)	Jun. 30, 2020 USD ($)	Mar. 31, 2020 USD ($)	Jun. 30, 2019 USD ($)	Dec. 31, 2021 segment	Dec. 31, 2020 USD ($) $ / shares	Dec. 31, 2019 USD ($) $ / shares
Goodwill and Intangible Assets Disclosure [Line Items]
Number of reportable segments \| segment	2					2
Trade Names
Goodwill and Intangible Assets Disclosure [Line Items]
Weighted average amortization period if not accelerated								7 years 6 months
Accelerated amortization resulting from the changes in the estimated remaining life of the trade name (in dollars per share) \| $ / shares							$ 0.09
Impact on net (loss) income per share \| $ / shares								$ 0.08
Trade Names \| Accelerated Amortization
Goodwill and Intangible Assets Disclosure [Line Items]
Amortization of assets							$ 3.1
Search Services
Goodwill and Intangible Assets Disclosure [Line Items]
Impairment charges for goodwill			$ 10.2
Search Services \| Customer relationships
Goodwill and Intangible Assets Disclosure [Line Items]
Impairment charges for intangible assets			0.3
Nurse And Allied Staffing
Goodwill and Intangible Assets Disclosure [Line Items]
Amortization of assets		$ 0.9	$ 1.4	$ 0.7
Nurse And Allied Staffing \| Trade Names
Goodwill and Intangible Assets Disclosure [Line Items]
Impairment of intangibles indefinite lived					$ 14.5
Nurse And Allied Staffing \| Trade Names
Goodwill and Intangible Assets Disclosure [Line Items]
Weighted average amortization period if not accelerated								7 years 9 months 18 days
Nurse And Allied Staffing \| Trade Names \| Accelerated Amortization
Goodwill and Intangible Assets Disclosure [Line Items]
Amortization of assets								$ 2.1
Physician Staffing \| Trade Names
Goodwill and Intangible Assets Disclosure [Line Items]
Weighted average amortization period if not accelerated								7 years 9 months 18 days
Physician Staffing \| Trade Names \| Accelerated Amortization
Goodwill and Intangible Assets Disclosure [Line Items]
Amortization of assets								$ 0.8

Property and Equipment (Details) - USD ($) $ in Thousands	12 Months Ended
Property and Equipment (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Property and equipment	$ 33,562	$ 29,364
Less accumulated depreciation and amortization	(17,729)	(17,013)
Property and equipment, net of accumulated depreciation and amortization	15,833	12,351
Computer equipment
Property, Plant and Equipment [Line Items]
Property and equipment	4,910	3,644
Computer software
Property, Plant and Equipment [Line Items]
Property and equipment	18,839	17,416
Office equipment
Property, Plant and Equipment [Line Items]
Property and equipment	475	933
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Property and equipment	2,475	2,528
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment	2,523	473
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment	$ 4,340	$ 4,370
Minimum
Property, Plant and Equipment [Line Items]
Estimated useful life	3 years
Minimum \| Computer equipment
Property, Plant and Equipment [Line Items]
Estimated useful life	3 years
Minimum \| Computer software
Property, Plant and Equipment [Line Items]
Estimated useful life	3 years
Minimum \| Office equipment
Property, Plant and Equipment [Line Items]
Estimated useful life	5 years
Minimum \| Furniture and fixtures
Property, Plant and Equipment [Line Items]
Estimated useful life	5 years
Maximum
Property, Plant and Equipment [Line Items]
Estimated useful life	10 years
Maximum \| Computer equipment
Property, Plant and Equipment [Line Items]
Estimated useful life	5 years
Maximum \| Computer software
Property, Plant and Equipment [Line Items]
Estimated useful life	10 years
Maximum \| Office equipment
Property, Plant and Equipment [Line Items]
Estimated useful life	7 years
Maximum \| Furniture and fixtures
Property, Plant and Equipment [Line Items]
Estimated useful life	7 years

Balance Sheet Details (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Balance Sheet Related Disclosures [Abstract]
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]	Other non-current assets	Other non-current assets
Insurance recovery receivable:
Insurance recovery for health claims	$ 300	$ 369
Insurance recovery for workers’ compensation claims	2,836	2,629
Insurance recovery for professional liability claims	1,905	1,700
Insurance recovery receivable	5,041	4,698
Other non-current assets:
Insurance recovery for workers’ compensation claims	4,861	5,352
Insurance recovery for professional liability claims	9,137	7,763
Non-current security deposits	672	786
Deferred compensation assets	1,398	1,156
Net debt issuance costs	991	1,063
Finance lease right-of-use assets	57	102
Cloud computing asset	4,840	3,187
Other non-current assets	21,956	19,409
Accrued compensation and benefits:
Salaries and payroll taxes	39,139	13,131
Accrual for bonuses and commissions	10,755	7,705
Accrual for workers’ compensation claims	8,394	7,670
Accrual for professional liability claims	2,448	2,499
Accrual for healthcare claims	4,081	3,926
Accrual for vacation	763	609
Accrued compensation and benefits	65,580	35,540
Long-term accrued claims:
Accrual for workers’ compensation claims	11,777	12,692
Accrual for professional liability claims	13,537	12,720
Long-term accrued claims	25,314	25,412
Other long-term liabilities:
Restructuring	1,829	2,082
Deferred compensation	2,457	2,475
Long-term note payable	0	2,426
Long-term unrecognized tax benefits	8,994	951
Other	508	61
Other long-term liabilities	$ 13,788	$ 7,995

DEBT - Long-term Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Total debt	$ 185,938	$ 58,259
Debt Issuance Costs	(6,387)	(1,063)
Current portion of debt	4,176	2,425
Long-term debt, less current portion	$ 181,762	$ 55,834
Senior Secured Asset-Based Loan \| Senior Secured Asset-Based Loan
Debt Instrument [Line Items]
Interest rate at period end (percent)	1.60%	2.73%
Total debt	$ 9,200	$ 53,408
Debt Issuance Costs	$ (991)	(1,063)
2021 Term Loan Credit Agreement \| Term Loan
Debt Instrument [Line Items]
Interest rate at period end (percent)	6.50%
Total debt	$ 174,312	0
Debt Issuance Costs	(5,396)	0
Current portion of debt	$ 1,750	$ 0
Earnout Notes Payable \| Note Payable
Debt Instrument [Line Items]
Stated interest rate (percent)	2.00%	2.00%
Total debt	$ 2,426	$ 4,851
Debt Issuance Costs	0	0
Current portion of debt	$ 2,426	$ 2,425

DEBT - Maturities of Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Total debt	$ 185,938	$ 58,259
Senior Secured Asset-Based Loan \| Senior Secured Asset-Based Loan
Debt Instrument [Line Items]
2022	0
2023	0
2024	9,200
2025
2026	0
Thereafter	0
Total debt	9,200	53,408
2021 Term Loan Credit Agreement \| Term Loan
Debt Instrument [Line Items]
2022	1,750
2023	1,750
2024	1,750
2025	1,750
2026	1,750
Thereafter	165,562
Total debt	174,312	0
Earnout Notes Payable \| Note Payable
Debt Instrument [Line Items]
2022	2,426
2023	0
2024	0
2025	0
2026	0
Thereafter	0
Total debt	$ 2,426	$ 4,851

Debt -2021 Term Loan Credit Agreement (Details) - Term Loan - USD ($)	Nov. 18, 2021	Jun. 08, 2021
2021 Term Loan Credit Agreement
Debt Instrument [Line Items]
Debt term		6 years
Face amount	$ 75,000,000	$ 100,000,000
Quarterly installment amount	400,000	$ 300,000
2021 Term Loan Credit Agreement \| LIBOR
Debt Instrument [Line Items]
Interest margin (percent)		5.75%
Interest margin floor (percent)		0.75%
2021 Term Loan Credit Agreement, Aggregate Amount of all Increases
Debt Instrument [Line Items]
Face amount	$ 115,000,000

Debt - 2019 Loan Agreement (Details) - USD ($)		3 Months Ended	12 Months Ended
Debt - 2019 Loan Agreement (Details) - USD ($)	Oct. 25, 2019	Dec. 31, 2019	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Nov. 18, 2021	Mar. 08, 2021	Jun. 30, 2020
Line of Credit Facility [Line Items]
Amount of indebtedness permitted from other sources						$ 175,000,000
Debt issuance costs	$ 1,300,000		$ 6,098,000	$ 81,000	$ 2,058,000
Amended And Restated Credit Agreement
Line of Credit Facility [Line Items]
Repayments of outstanding debt	$ 75,400,000
Amended And Restated Credit Agreement, Early Extinguishment of Debt
Line of Credit Facility [Line Items]
Write off of debt issuance costs		$ 1,400,000
Senior Secured Asset-Based Loan
Line of Credit Facility [Line Items]
Line of credit term	5 years
Maximum borrowing capacity	$ 120,000,000		150,000,000				$ 150,000,000	$ 130,000,000
Borrowing base, percentage of assets	85.00%
Long-term debt, less current portion			9,200,000
Letters of credit outstanding	$ 21,200,000		18,200,000
Remaining borrowing capacity			$ 122,600,000
Unused commitment fee percentage			0.375%
Senior Secured Asset-Based Loan \| LIBOR
Line of Credit Facility [Line Items]
Interest margin (percent)			1.50%
Senior Secured Asset-Based Loan \| Base Rate
Line of Credit Facility [Line Items]
Interest margin (percent)			0.50%
Senior Secured Asset-Based Loan \| Swingline Sublimit
Line of Credit Facility [Line Items]
Maximum borrowing capacity	15,000,000
Senior Secured Asset-Based Loan \| Standby Letters Of Credit Sublimit
Line of Credit Facility [Line Items]
Maximum borrowing capacity	$ 35,000,000.0
Senior Secured Asset-Based Loan, Supplemental Activities Lending \| LIBOR
Line of Credit Facility [Line Items]
Interest margin (percent)			4.00%
Senior Secured Asset-Based Loan, Supplemental Activities Lending \| Base Rate
Line of Credit Facility [Line Items]
Interest margin (percent)			3.00%

Debt - Prior Senior Credit Facility (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended	12 Months Ended
	Sep. 30, 2019	Sep. 30, 2019	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Line of Credit Facility [Line Items]
Loss on derivative liability			$ 0	$ 0	$ 1,284
Interest Rate Swap \| Cash Flow Hedging
Line of Credit Facility [Line Items]
Payment for derivative termination	$ 1,300
Loss on derivative liability	$ 1,300
Amended And Restated Credit Agreement
Line of Credit Facility [Line Items]
Payments of debt restructuring costs		$ 700
Amended And Restated Credit Agreement \| Term Loan, net
Line of Credit Facility [Line Items]
Payment for debt prepayment					12,500
Amended And Restated Credit Agreement, Reduction In Borrowing Capacity
Line of Credit Facility [Line Items]
Write off of debt issuance costs					$ 500

Debt - Note Payable (Details) $ in Thousands		3 Months Ended			12 Months Ended
Debt - Note Payable (Details) $ in Thousands	Oct. 30, 2015 liability	Mar. 31, 2021 USD ($)	Jun. 30, 2020 USD ($)	Mar. 31, 2020 USD ($)	Dec. 31, 2021 USD ($) installment	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)
Debt Instrument [Line Items]
Payments of notes payable					$ 2,426	$ 2,426	$ 0
Mediscan
Debt Instrument [Line Items]
Number of contingent liabilities assumed \| liability	2
Recognition of earnout payment liability				$ 7,400
Payment for contingent liability				100
Mediscan \| Earnout Notes Payable
Debt Instrument [Line Items]
Earnout performance criterion, conversion to note payable				$ 7,300
Note payable, number of installments paid \| installment					2
Payments of notes payable		$ 2,400	$ 2,400
Notes payable					$ 2,500
Stated interest rate (percent)					2.00%

Derivative (Details) - USD ($)	3 Months Ended	12 Months Ended
Derivative (Details) - USD ($)	Sep. 30, 2019	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Mar. 31, 2018
Derivative [Line Items]
Loss on derivative liability		$ 0	$ 0	$ 1,284,000
Term Loan, net \| Senior Debt
Derivative [Line Items]
Debt fixed interest rate					50.00%
Interest Rate Swap
Derivative [Line Items]
Derivative fixed interest rate					2.627%
Derivative, notional amount					$ 48,800,000
Interest Rate Swap \| Cash Flow Hedging
Derivative [Line Items]
Payment for derivative termination	$ 1,300,000
Loss on derivative liability	$ 1,300,000

Leases - Narrative (Details) - USD ($) $ in Millions	3 Months Ended	12 Months Ended
Leases - Narrative (Details) - USD ($) $ in Millions	Sep. 30, 2019	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Right of use impairment charge	$ 1.2	$ 1.7	$ 4.5
Impairment of long-lived assets held-for-use		$ 0.3	$ 1.0	$ 0.6

Leases - Balance Sheet Information (Details) $ in Thousands	Jun. 08, 2021 location	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)
Lessee, Lease, Description [Line Items]
Number of locations acquired \| location	8
Operating lease right-of-use assets		$ 7,488	$ 10,447
Operating lease liabilities - current		4,090	4,509
Operating lease liabilities - non-current		$ 10,853	$ 15,234
Weighted-average remaining lease term		3 years 4 months 24 days	4 years 1 month 6 days
Weighted average discount rate		6.39%	6.32%
Workforce Solutions Group Inc Member
Lessee, Lease, Description [Line Items]
Operating lease right-of-use assets		$ 900
Operating lease liabilities - current		300
Operating lease liabilities - non-current		$ 600

Leases - Operating Lease Liability Maturity (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
2022	$ 4,913
2023	5,027
2024	3,959
2025	2,762
Total minimum lease payments	16,661
Less: amount of lease payments representing interest	(1,718)
Present value of future minimum lease payments	14,943
Less: operating lease liabilities - current	(4,090)	$ (4,509)
Operating lease liabilities - non-current	$ 10,853	$ 15,234

Leases - Other Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Cash paid for amounts included in the measurement of operating lease liabilities	$ 6,150	$ 7,111	$ 7,477
Right-of-use assets acquired under operating lease	1,059	1,587	1,229
Operating lease expense	3,538	4,874	6,592
Short-term lease expense	3,695	5,217	8,042
Variable and other lease costs	$ 1,957	$ 1,919	$ 2,446

Fair Value Measurements - Estimated Fair values Assets and Liabilities Measured on Recurring Basis (Details) - Level 1 - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Deferred compensation liability
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Deferred compensation liability	$ 2,457	$ 2,475
Deferred compensation asset
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Deferred compensation asset	$ 1,398	$ 1,156

Fair Value Measurements - Financial Instruments that were not Measured at Fair Value (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 16, 2021	Jun. 08, 2021	Dec. 31, 2020
Workforce Solutions Group, Inc.
Fair Value, Option, Quantitative Disclosures [Line Items]
Earnout liabilities			$ 15,000
Selected, Inc
Fair Value, Option, Quantitative Disclosures [Line Items]
Earnout liabilities		$ 1,500
Level 2 \| Carrying Amount \| Workforce Solutions Group, Inc.
Fair Value, Option, Quantitative Disclosures [Line Items]
Earnout liabilities	$ 15,000			$ 0
Level 2 \| Carrying Amount \| Selected, Inc
Fair Value, Option, Quantitative Disclosures [Line Items]
Earnout liabilities	1,500			0
Level 2 \| Fair Value \| Workforce Solutions Group, Inc.
Fair Value, Option, Quantitative Disclosures [Line Items]
Earnout liabilities	15,000			0
Level 2 \| Fair Value \| Selected, Inc
Fair Value, Option, Quantitative Disclosures [Line Items]
Earnout liabilities	1,500			0
Senior Secured Asset-Based Loan \| Level 2 \| Carrying Amount
Fair Value, Option, Quantitative Disclosures [Line Items]
Senior Secured Asset-Based Loan	9,200			53,408
Senior Secured Asset-Based Loan \| Level 2 \| Fair Value
Fair Value, Option, Quantitative Disclosures [Line Items]
Senior Secured Asset-Based Loan	9,200			53,408
Earnout Notes Payable \| Level 2 \| Carrying Amount
Fair Value, Option, Quantitative Disclosures [Line Items]
Debt instrument	2,426			4,851
Earnout Notes Payable \| Level 2 \| Fair Value
Fair Value, Option, Quantitative Disclosures [Line Items]
Debt instrument	2,426			4,851
Term Loan \| Level 2 \| Carrying Amount
Fair Value, Option, Quantitative Disclosures [Line Items]
Debt instrument	174,312			0
Term Loan \| Level 2 \| Fair Value
Fair Value, Option, Quantitative Disclosures [Line Items]
Debt instrument	$ 174,845			$ 0

Employee Benefit Plans (Details) - USD ($) $ in Thousands	12 Months Ended
Employee Benefit Plans (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Retirement Benefits [Abstract]
Company contribution net of forfeitures	$ 1,000	$ 500	$ 1,100
Employer match vesting duration	3 years
Deferred compensation liabilities	$ 2,457	$ 2,475

Contingencies (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
Contingencies (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Sep. 30, 2021
Commitments and Contingencies Disclosure [Abstract]
Legal fees to be recovered					$ 1,600
Legal settlement charges	$ 1,600	$ 0	$ 0	$ 1,600

Income Taxes - Components of Income (Loss) Before Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
United States	$ 132,809	$ (12,998)	$ (24,783)
Foreign	399	668	572
Income (loss) before income taxes	$ 133,208	$ (12,330)	$ (24,211)

- Definition

Amount of income (loss) from continuing operations, including income (loss) from equity method investments, before deduction of income tax expense (benefit), and income (loss) attributable to noncontrolling interest.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8906-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
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-Section 50
-Paragraph 32
-Subparagraph (f)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
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-Name Accounting Standards Codification
-Topic 940
-SubTopic 20
-Section 25
-Paragraph 1
-URI http://asc.fasb.org/extlink&oid=123384075&loc=d3e41242-110953

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
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-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8736-108599

Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 220
-SubTopic 10
-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(10))
-URI http://asc.fasb.org/extlink&oid=123367319&loc=SL114868664-224227

Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 944
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(8))
-URI http://asc.fasb.org/extlink&oid=120400993&loc=SL114874131-224263

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 235
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-05(b)(2))
-URI http://asc.fasb.org/extlink&oid=120399901&loc=d3e537907-122884

Reference 9: http://www.xbrl.org/2003/role/exampleRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 31
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8924-108599

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-04(15))
-URI http://asc.fasb.org/extlink&oid=120399700&loc=SL114874048-224260

+ Details

Income Taxes - Components of Income Tax Expense (Benefit) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Current:
Federal	$ (5,165)	$ (25)	$ 35
State	5,638	600	499
Foreign	330	119	109
Total	11,133	744	573
Deferred:
Federal	892	(138)	17,406
State	(10,648)	(818)	13,799
Foreign	(171)	24	(46)
Total	(9,927)	(932)	31,159
Income tax expense (benefit)	$ 1,206	$ (188)	$ 31,732

Income Taxes - Significant Components of Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Deferred Tax Assets:
Accrued other and prepaid expenses	$ 237	$ 1,600
Allowance for doubtful accounts	1,644	909
Intangible assets	9,273	27,036
Net operating loss carryforwards	4,112	20,536
Accrued professional liability claims	1,335	1,525
Accrued workers’ compensation claims	3,097	3,015
Share-based compensation	840	721
Operating lease liabilities	3,790	4,871
Credit carryforwards	41	188
Other	505	0
Gross deferred tax assets	24,874	60,401
Valuation allowance	(20)	(37,472)
Deferred tax assets	24,854	22,929
Deferred Tax Liabilities:
Depreciation	(1,515)	(1,077)
Indefinite-lived intangibles	(9,993)	(25,546)
Operating lease right-of-use assets	(1,821)	(2,499)
Tax on unrepatriated earnings	(190)	(361)
Other	0	(38)
Deferred tax liabilities	(13,519)	(29,521)
Net deferred taxes	$ 11,335
Net deferred taxes		$ (6,592)

Income Taxes - Narrative (Details) - USD ($)	3 Months Ended	12 Months Ended	36 Months Ended
Income Taxes - Narrative (Details) - USD ($)	Dec. 31, 2021	Dec. 31, 2021	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Income Tax Contingency [Line Items]
Valuation allowance	$ 20,000	$ 20,000	$ 20,000	$ 37,472,000
Change in valuation allowance	37,500,000	37,500,000
Cumulative pretax income for preceding 12 quarters			110,300,000
Unrecognized tax benefits	9,179,000	9,179,000	9,179,000	6,891,000	$ 5,792,000	$ 5,412,000
Unrecognized tax benefits, which would affect the effective tax rate	8,600,000	8,600,000	8,600,000	7,100,000	6,000,000
Unrecognized tax benefit accrued interest and penalties	400,000	400,000	400,000	300,000	300,000
Unrecognized tax benefits, amount reclassified from deferred tax assets to noncurrent liabilities		8,000,000
Deferred tax assets, amount reclassified from unrecognized tax benefits		500,000
Other Current Liabilities
Income Tax Contingency [Line Items]
Unrecognized tax benefits	0	0	0	0	0
Other Noncurrent Liabilities
Income Tax Contingency [Line Items]
Unrecognized tax benefits	9,000,000	9,000,000	9,000,000	$ 1,000,000	$ 700,000
U.S.
Income Tax Contingency [Line Items]
Change in valuation allowance		18,400,000
State
Income Tax Contingency [Line Items]
Change in valuation allowance		7,500,000
Net operating loss carryforwards	72,400,000	72,400,000	72,400,000
Other Income Tax Authority
Income Tax Contingency [Line Items]
Change in valuation allowance		11,600,000
Foreign Tax Authority
Income Tax Contingency [Line Items]
Net operating loss carryforwards	$ 0	$ 0	$ 0

Income Taxes - Reconciliation of Income Tax Computed At U. S. Federal Statutory Rate to Income Tax (Benefit) Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Tax at U.S. statutory rate	$ 27,974	$ (2,589)	$ (5,084)
State taxes, net of federal benefit	8,573	135	(554)
Noncontrolling interest	(5)	(172)	(372)
Non-deductible items	550	544	562
Foreign tax expense (benefit)	76	1	(58)
Valuation allowances	(37,450)	117	36,224
Uncertain tax positions	1,891	1,110	400
Officers' compensation	344	621	418
Return to provision	44	87	2
Other	(791)	(42)	194
Income tax expense (benefit)	$ 1,206	$ (188)	$ 31,732

Income Taxes - Reconciliation of Beginning and Ending Balance of Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Balance at January 1	$ 6,891	$ 5,792	$ 5,412
Additions based on tax positions related to the current year	1,873	974	1,283
Additions based on tax positions related to prior years	0	125
Reductions based on tax positions related to prior years			(498)
Reductions as a result of a lapse of applicable statute of limitations	(47)	0	(405)
Other	462	0	0
Balance at December 31	$ 9,179	$ 6,891	$ 5,792

Stockholders' Equity - Stock Repurchase Program (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock left remaining to repurchase under the plan (in shares)	510,004
ABL Credit Agreement
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Maximum annual repurchase amount	$ 5.0
Term Loan Agreement
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Maximum annual repurchase amount	$ 5.5
Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock repurchase and retirement (in shares)	0	0	0

Stockholders' Equity - Share-Based Payments (Details) - Omnibus Plan				3 Months Ended	12 Months Ended
	Mar. 31, 2021 shares	Mar. 31, 2020 shares	Mar. 31, 2019 shares	Jun. 30, 2021 shares	Dec. 31, 2021 USD ($) installment	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)	May 19, 2020 shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares reserved for future issuance (in shares) \| shares								3,000,000
Performance shares, attainment level certification period					30 days
Board of Directors
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of vesting installments \| installment					3
Restricted Stock Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock vesting period					3 years
Pretax of total unrecognized compensation cost related to non-vested restricted stock awards					$ 6,100,000
Pretax total unrecognized compensation cost related to share options- period					1 year 5 months 23 days
Fair value of shares vested					$ 8,900,000	$ 2,700,000	$ 2,600,000
Performance Stock Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares issued (in shares) \| shares	160,416	286,415	192,939	7,908
Pretax of total unrecognized compensation cost related to non-vested restricted stock awards					$ 2,700,000
Pretax total unrecognized compensation cost related to share options- period					1 year 3 months 10 days
Fair value of shares vested					$ 0	$ 0	$ 0
Stock Appreciation Rights
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock vesting period					4 years
Stock vesting percentage per year					25.00%
Stock expiration period					7 years
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock vesting period					1 year

Stockholders' Equity - Summary of Restricted Stock Award Activity and Performance Stock Awards (Details)	12 Months Ended
	Dec. 31, 2021 $ / shares shares
Restricted Stock Awards
Number of Shares
Unvested restricted stock awards, beginning balance (in shares) \| shares	1,345,819
Granted (in shares) \| shares	483,900
Vested (in shares) \| shares	(653,758)
Forfeited (in shares) \| shares	(136,506)
Unvested restricted stock awards, ending balance (in shares) \| shares	1,039,455
Weighted average grant date fair value
Unvested restricted stock awards, beginning balance (usd per share) \| $ / shares	$ 7.04
Granted (usd per share) \| $ / shares	13.32
Vested (usd per share) \| $ / shares	7.22
Forfeited (usd per share) \| $ / shares	7.73
Unvested restricted stock awards, ending balance (usd per share) \| $ / shares	$ 9.75
Performance Stock Awards
Number of Shares
Unvested restricted stock awards, beginning balance (in shares) \| shares	548,151
Granted (in shares) \| shares	168,324
Vested (in shares) \| shares	0
Forfeited (in shares) \| shares	(194,309)
Unvested restricted stock awards, ending balance (in shares) \| shares	522,166
Weighted average grant date fair value
Unvested restricted stock awards, beginning balance (usd per share) \| $ / shares	$ 7.64
Granted (usd per share) \| $ / shares	12.69
Vested (usd per share) \| $ / shares	0
Forfeited (usd per share) \| $ / shares	9.32
Unvested restricted stock awards, ending balance (usd per share) \| $ / shares	$ 8.64

Stockholders' Equity - Stock Options and Stock Appreciation Rights Granted and Exercised (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Equity [Abstract]
Total intrinsic value of options exercised	$ 0	$ 1	$ 130

Earnings Per Share - Components of Numerator and Denominator for Computation of Basic and Diluted Earnings per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2021	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Numerator:
Net income (loss) attributable to common stockholders - Basic									$ 132,002	$ (12,962)	$ (57,713)
Net income (loss) attributable to common stockholders - Diluted									$ 132,002	$ (12,962)	$ (57,713)
Denominator:
Weighted average common shares - Basic (shares)									36,689	36,088	35,815
Effective of diluted shares:
Share-based awards (shares)									703	0	0
Weighted average common shares - Diluted (shares)									37,392	36,088	35,815
Net income (loss) per share attributable to common stockholders - Basic (usd per share)	$ 2.10	$ 0.63	$ 0.32	$ 0.54	$ 0.13	$ (0.04)	$ (0.39)	$ (0.06)	$ 3.60	$ (0.36)	$ (1.61)
Net income (loss) per share attributable to common stockholders - Diluted (usd per share)	$ 2.07	$ 0.62	$ 0.31	$ 0.53	$ 0.13	$ (0.04)	$ (0.39)	$ (0.06)	$ 3.53	$ (0.36)	$ (1.61)

Earnings Per Share - Antidilutive Securities (Details) - shares shares in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based awards
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities (in shares)	6	663	335

Related Party Transactions (Details)	12 Months Ended
Related Party Transactions (Details)	Dec. 31, 2021 USD ($) installment	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)	Dec. 30, 2020	Mar. 31, 2020 USD ($) installment
Corporate Joint Venture
Related Party Transaction [Line Items]
Percent ownership in joint venture unit				68.00%
Revenue from related parties	$ 0	$ 16,000,000	$ 25,000,000
Receivable balance with joint venture	0	1,700,000
Due to joint venture	0	200,000
Chief Executive Officer
Related Party Transaction [Line Items]
Due to joint venture	0	0
Health Care System Affiliated With A Board Member
Related Party Transaction [Line Items]
Revenue from related parties	700,000	$ 0	$ 0
Mediscan \| Earnout Notes Payable
Related Party Transaction [Line Items]
Notes payable	$ 2,500,000				$ 7,300,000
Note payable, number of payment installments \| installment					3
Note payable, number of installments paid \| installment	2
Interest payable	$ 100,000

Segment Data - Additional Information (Details) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2021 USD ($)	Sep. 30, 2021 USD ($)	Jun. 30, 2021 USD ($)	Mar. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Sep. 30, 2020 USD ($)	Jun. 30, 2020 USD ($)	Mar. 31, 2020 USD ($)	Dec. 31, 2021 USD ($) segment	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)
Segment Reporting Information [Line Items]
Number of operating segments \| segment									2
Revenue from services	$ 640,679	$ 374,905	$ 331,827	$ 329,241	$ 215,606	$ 193,968	$ 216,779	$ 210,064	$ 1,676,652	$ 836,417	$ 822,224
Contribution income									210,066	77,788	66,288
Nurse And Allied Staffing
Segment Reporting Information [Line Items]
Revenue from services									1,605,781	768,483	747,619
Contribution income									$ 205,738	74,169	63,530
Revision of Prior Period, Adjustment \| Nurse And Allied Staffing
Segment Reporting Information [Line Items]
Revenue from services										10,500	14,800
Contribution income										$ (1,100)	$ (800)

- Definition

+ References

+ Details

Segment Data - Operating Segments (Details) - USD ($) $ in Thousands	3 Months Ended									12 Months Ended
	Dec. 31, 2021	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Jun. 30, 2019	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Segment Reporting, Reconciling Item for Operating Profit (Loss) from Segment to Consolidated [Line Items]
Revenues from services	$ 640,679	$ 374,905	$ 331,827	$ 329,241	$ 215,606	$ 193,968	$ 216,779	$ 210,064		$ 1,676,652	$ 836,417	$ 822,224
Contribution income										210,066	77,788	66,288
Corporate overhead										55,142	51,900	46,246
Depreciation and amortization										9,852	12,671	14,075
Acquisition and integration-related costs										1,068	77	201
Restructuring costs			$ 800	$ 1,200	$ 900	$ 2,300	$ 2,300	$ 600		2,630	6,052	3,571
Legal settlement charges									$ 1,600	0	0	1,600
Impairment charges										2,070	16,248	16,306
Income (loss) from operations										139,304	(9,160)	(15,711)
Nurse And Allied Staffing
Segment Reporting, Reconciling Item for Operating Profit (Loss) from Segment to Consolidated [Line Items]
Revenues from services										1,605,781	768,483	747,619
Contribution income										205,738	74,169	63,530
Physician Staffing
Segment Reporting, Reconciling Item for Operating Profit (Loss) from Segment to Consolidated [Line Items]
Revenues from services										70,871	67,934	74,605
Contribution income										$ 4,328	$ 3,619	$ 2,758

Quarterly Financial Data (Unaudited) (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2021	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Quarterly Financial Information Disclosure [Abstract]
Revenue from services	$ 640,679	$ 374,905	$ 331,827	$ 329,241	$ 215,606	$ 193,968	$ 216,779	$ 210,064	$ 1,676,652	$ 836,417	$ 822,224
Gross profit	147,150	83,794	72,590	71,465	54,392	48,003	50,734	49,603
Consolidated net income					4,822	(1,148)	(14,048)	(1,768)	132,002	(12,142)	(55,943)
Net income attributable to common stockholders	$ 77,573	$ 23,433	$ 11,548	$ 19,448	$ 4,612	$ (1,334)	$ (14,151)	$ (2,089)	$ 132,002	$ (12,962)	$ (57,713)
Net (loss) income per share attributable to common stockholders - Basic (usd per share)	$ 2.10	$ 0.63	$ 0.32	$ 0.54	$ 0.13	$ (0.04)	$ (0.39)	$ (0.06)	$ 3.60	$ (0.36)	$ (1.61)
Net income (loss) per share attributable to common stockholders - Diluted (usd per share)	$ 2.07	$ 0.62	$ 0.31	$ 0.53	$ 0.13	$ (0.04)	$ (0.39)	$ (0.06)	$ 3.53	$ (0.36)	$ (1.61)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Impairment charges									$ 2,070	$ 16,248	$ 16,306
Restructuring costs			$ 800	$ 1,200	$ 900	$ 2,300	$ 2,300	$ 600	2,630	6,052	3,571
Legal fees to be recovered		$ 1,600
Legal fees					$ 600	800	1,600
Change in valuation allowance	$ 37,500								37,500
Nurse And Allied Staffing
Quarterly Financial Information Disclosure [Abstract]
Revenue from services									$ 1,605,781	$ 768,483	$ 747,619
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Amortization of assets						900	1,400	$ 700
Goodwill and Intangible Assets \| Search Services
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Impairment charges							10,500
Leased Property
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Impairment charges			$ 1,900			$ 900	$ 4,500

Schedule II - Valuation and Qualifying Accounts (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Allowances for Accounts Receivable
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	$ 4,021	$ 3,219	$ 3,705
Charged to (Released from) Operations	6,499	4,269	3,243
Write-Offs, Net of Recoveries	(3,639)	(3,467)	(3,729)
Other Changes	0	0	0
Balance at End of Period	6,881	4,021	3,219
Valuation Allowance for Deferred Tax Assets
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	37,472	37,345	1,189
Charged to (Released from) Operations	(37,449)	118	36,224
Write-Offs, Net of Recoveries	0	0	0
Other Changes	(3)	9	(68)
Balance at End of Period	$ 20	$ 37,472	$ 37,345