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What changed in AMN HEALTHCARE SERVICES INC's 10-K — 2024 vs 2025

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Paragraph-level year-over-year comparison of AMN HEALTHCARE SERVICES INC's 2024 and 2025 10-K annual filings, covering the Business, Risk Factors, Legal Proceedings, Cybersecurity, MD&A and Market Risk sections. Every new, removed and edited paragraph is highlighted side-by-side so you can see exactly what management changed in the 2025 report.

+252 added−230 removedSource: 10-K (2026-02-20) vs 10-K (2025-02-21)

Top changes in AMN HEALTHCARE SERVICES INC's 2025 10-K

252 paragraphs added · 230 removed · 194 edited across 7 sections

Item 1. Business

Business — how the company describes what it does

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Biggest changeOur leading competitors vary by segment and include Amergis, Aya Healthcare, CHG Healthcare Services, Cross Country Healthcare, HealthTrust Workforce Solutions, Ingenovis Health, Jackson Healthcare, LanguageLine Solutions, and Medical Solutions. When recruiting for healthcare professionals, in addition to other executive search and staffing firms, we also compete with hospital systems that have developed their own recruitment departments and internal travel agencies.
Biggest changeWhen recruiting for healthcare professionals, in addition to other executive search and staffing firms, we also compete with hospital systems that have developed their own recruitment departments and internal travel agencies. Licensure For Our Business 7 Table of Contents Some states require state licensure for businesses that employ, assign and/or place healthcare professionals.
We expect this will enable us to expand our strategic customer relationships, while driving more recurring revenue, improve margin mix, and be less sensitive to economic cycles. 1 Table of Contents Over the past decade, our business has evolved beyond traditional healthcare staffing and recruitment services; we have become a strategic total talent solutions partner with our clients.
We expect this will enable 1 Table of Contents us to expand our strategic customer relationships, while driving more recurring revenue, improve margin mix, and be less sensitive to economic cycles. Over the past decade, our business has evolved beyond traditional healthcare staffing and recruitment services; we have become a strategic total talent solutions partner with our clients.
We believe that our comprehensive suite of total talent solutions, our commitment to quality and service excellence, our execution capabilities, and our national footprint create a compelling value proposition for our existing and prospective clients that give us distinct, scalable advantages over smaller, local and regional competitors and companies whose solution offerings, sales and execution capabilities are not as robust.
We believe that our comprehensive suite of total talent solutions, our commitment to quality and service excellence, our expertise and execution capabilities, and our national footprint create a compelling value proposition for our existing and prospective clients that give us distinct, scalable advantages over smaller, local and regional competitors and companies whose solution offerings, sales and execution capabilities are not as robust.
No other client healthcare system or single client facility comprised more than 5% of our consolidated revenue for the fiscal year ended December 31, 2024. Our Industry The primary healthcare service markets in which we compete are U.S. temporary and contract healthcare staffing, workforce vendor neutral (i.e., VMS) and managed service programs, locum tenens, and language services.
No other client healthcare system or single client facility comprised more than 5% of our consolidated revenue for the fiscal year ended December 31, 2025. Our Industry The primary healthcare service markets in which we compete are U.S. temporary and contract healthcare staffing, workforce vendor neutral (i.e., VMS) and managed service programs, locum tenens, and language services.
During 2024, the largest percentages of our revenue were concentrated in California, New York and Texas. More than half of our temporary and contract healthcare professional assignments occur at acute-care hospitals. In addition to acute-care hospitals, we provide services to sub-acute healthcare facilities, physician groups, rehabilitation centers, schools, home health service providers and ambulatory surgery centers.
During 2025, the largest percentages of our revenue were concentrated in California, New York and Texas. More than half of our temporary and contract healthcare professional assignments occur at acute-care hospitals. In addition to acute-care hospitals, we provide services to sub-acute healthcare facilities, physician groups, rehabilitation centers, schools, home health service providers and ambulatory surgery centers.
These services are all supported by proprietary technology platforms which enable real-time routing of video and audio calls, drive client efficiency with an in-person scheduling mobile application, and power interoperability with multiple telehealth platforms and EMRs. (10) Vendor Management Systems .
These services are all supported by proprietary technology platforms which enable real-time routing of video and audio calls, drive client efficiency with an in-person scheduling mobile application, and power interoperability with multiple telehealth platforms and EMRs. (11) Vendor Management Systems .
We enable clients to build, manage and optimize their healthcare talent to deliver great patient outcomes and experiences. Our talent network includes thousands of highly skilled, experienced professionals who trust us to place them in environments that expand and leverage their qualifications and expertise.
We enable clients to build, manage and optimize their healthcare talent to deliver quality patient outcomes and experiences. Our talent network includes thousands of highly skilled, experienced professionals who trust us to place them in environments that expand and leverage their qualifications and expertise.
While reports differ on the existence and extent of current and future healthcare professional shortages, many regions of the United States are experiencing a shortage of physicians and nurses that we believe will persist in the future. The Association of American Medical Colleges estimates a nationwide physician shortage up to 86,000 by 2036.
While reports differ on the existence and extent of current and future healthcare professional shortages, many regions of the United States are experiencing a shortage of physicians and nurses that we believe will persist in the future. The Association of American Medical Colleges estimates a nationwide physician 6 Table of Contents shortage up to 86,000 by 2036.
This business line provides us greater access to the “C-suite” of our clients and prospective clients, which we believe helps improve our visibility as a strategic partner to them and helps provide us with cross-selling opportunities. Talent Planning & Acquisition 4 Table of Contents (7) Managed Services Programs .
This business line provides us greater access to the “C-suite” of our clients and prospective clients, which we believe helps improve our visibility as a strategic partner to them and helps provide us with cross-selling opportunities. Talent Planning & Acquisition (7) Managed Services Programs .
Our solutions enable our clients to build a quality, cost effective workforce, increase efficiency, and elevate the patient experience. Our comprehensive suite of talent solutions provides management, staffing, recruitment, language services, technology, predictive and market analytics, and related services to build and manage all or part of our clients’ healthcare workforce needs.
Our solutions enable our clients to build a quality, cost effective workforce, increase efficiency, and elevate the patient experience. Our comprehensive suite of talent solutions provides management, staffing, recruitment, language services, technology and related services to build and manage all or part of our clients’ healthcare workforce needs.
We recruit our healthcare professionals, depending on the particular service line, under the following brands: AMN Healthcare, Nursefinders, O’Grady Peyton International, Connetics, Medical Search International, DRW Healthcare Staffing, and B.E. Smith. Our recruiting strategy is supported by innovative and effective digital-first marketing programs that focus on lead management, including our digital presence on websites, social media, and mobile applications.
We recruit our healthcare professionals, depending on the particular service line, under the following brands: AMN Healthcare, Nursefinders, O’Grady Peyton International, Connetics, and B.E. Smith. Our recruiting strategy is supported by innovative and effective digital-first marketing programs that focus on lead management, including our digital presence on websites, social media, and mobile applications.
Our Services In 2024, we conducted our business through three reportable segments: (1) nurse and allied solutions, (2) physician and leadership solutions, and (3) technology and workforce solutions.
Our Services In 2025, we conducted our business through three reportable segments: (1) nurse and allied solutions, (2) physician and leadership solutions, and (3) technology and workforce solutions.
Board Oversight 3 Table of Contents Our Board of Directors plays an active role in overseeing our human capital management strategy and programs. Our Talent and Compensation Committee provides oversight of our human capital management programs, including talent strategies, compensation plans and policies, and talent acquisition, development, engagement and retention.
Board Oversight Our Board of Directors plays an active role in overseeing our human capital management strategy and programs. Our Talent and Compensation Committee provides oversight of our human capital management programs, including talent strategies, compensation plans and policies, and talent acquisition, development, engagement and retention.
We believe the prevalence of workforce solutions, such as MSP, VMS, RPO and workforce optimization tools, in the healthcare industry is still underpenetrated in comparison with non-healthcare sectors. During 2024, approximately 45% of our consolidated revenues were generated through MSP relationships. Industry Competition The healthcare staffing and workforce solutions industry is highly competitive.
We believe the prevalence of workforce solutions, such as MSP, VMS, RPO and workforce optimization tools, in the healthcare industry is still underpenetrated in comparison with non-healthcare sectors. During 2025, approximately 48% of our consolidated revenues were generated through MSP relationships. Industry Competition The healthcare staffing and workforce solutions industry is highly competitive.
We also offer full-service, permanent physician search (also referred to as physician permanent placement) across many specialties and modalities, specializing in recruiting and placing top physicians and advanced practitioner talent in jobs across the country. (5) Interim Leadership Staffing . We provide executive and clinical leadership interim staffing.
We also offer full-service, permanent 4 Table of Contents physician search (also referred to as physician permanent placement) across many specialties and modalities, specializing in recruiting and placing top physicians and advanced practitioner talent in jobs across the country. (5) Interim Leadership Staffing . We provide executive and clinical leadership interim staffing.
Throughout 2024, nearly 500 team members were promoted or transferred internally into new positions, representing approximately 17% of our corporate team members. Our professional development education assistance program provides reimbursement to our corporate team members to advance their knowledge and skills through certificate and degree programs.
Throughout 2025, nearly 500 team members were promoted or transferred internally into new positions, representing approximately 19% of our corporate team members. Our professional development education assistance program provides reimbursement to our corporate team members to advance their knowledge and skills through certificate and degree programs.
AMN Language Services provides healthcare interpretation services via proprietary platforms that enable video remote interpretation, over the phone interpretation, onsite interpretation, and telehealth interoperability, with more than 375 health systems, more than 2,600 hospitals, and thousands of clinics using our solutions.
AMN Language Services provides healthcare interpretation services via proprietary platforms that enable video remote interpretation, over the phone interpretation, onsite interpretation, and telehealth interoperability, with more than 400 health systems, more than 2,700 hospitals, and thousands of clinics using our solutions.
Our clients include many of the largest and most prestigious and progressive health care systems in the country. Kaiser Foundation Hospitals (and its affiliates), to whom we provide clinical managed services, comprised approximately 16% of our consolidated revenue and 23% of our nurse and allied solutions segment revenue for the fiscal year ended December 31, 2024.
Our clients include many of the largest and most prestigious and progressive health care systems in the country. Kaiser Foundation Hospitals (and its affiliates), to whom we provide clinical managed services, comprised approximately 22% of our consolidated revenue and 32% of our nurse and allied solutions segment revenue for the fiscal year ended December 31, 2025.
We believe an MSP increases efficiencies and often provides cost savings while enhancing provider experiences. We often use our own VMS technology as part of our staffing-led and vendor-neutral MSPs, which we believe further enhances the value of our service offering.
We believe an MSP increases efficiencies and often provides cost savings while enhancing the healthcare professional experience. We often use our own VMS technology as part of our staffing-led and vendor-neutral MSPs, which we believe further enhances the value of our service offering.
A pronounced shift in U.S. age demographics is expected to boost growth of national health spending, projected by the Centers for Medicare & Medicaid Services to grow at average annual rates of 4.9% and 5.6% from 2025-2026 and 2027-2032, respectively, while Medicare spending growth is projected to increase to average annual rates of 7.1% and 7.6% for the same time periods, respectively.
A pronounced shift in U.S. age demographics is expected to boost growth of national health spending, projected by the Centers for Medicare & Medicaid Services to grow at average annual rates of 5.6% and 5.3% from 2026-2027 and 2028-2033, respectively, while Medicare spending growth is projected to increase to average annual rates of 8.9% and 7.4% for the same time periods, respectively.
ShiftWise Flex is also integrated with AMN Passport, our top clinician-rated mobile application with more than 270,000 registered users as of January 2025.
ShiftWise Flex is also integrated with AMN Passport, our top clinician-rated mobile application with more than 340,000 registered users as of January 2026.
Our team members are located across the country, and we have offices in Dallas, TX; San Diego, CA; Boca Raton, FL; Florham Park, NJ; and Atlanta, GA. As of December 31, 2024, we had 2,968 corporate team members, which includes both full-time and part-time employees.
Our team members are located across the country, and we have offices in Dallas, TX; San Diego, CA; Boca Raton, FL; and Atlanta, GA. As of December 31, 2025, we had 2,664 corporate team members, which includes both full-time and part-time employees.
We expanded our portfolio to serve a diverse and growing set of healthcare talent-related needs. In addition to our traditional staffing services, our suite of healthcare workforce solutions includes managed services programs (“MSP”), vendor management systems (“VMS”), medical language interpretation services, predictive labor analytics, workforce optimization technology and consulting, clinical labor scheduling, recruitment process outsourcing (“RPO”), and revenue cycle solutions.
We expanded our portfolio to serve a diverse and growing set of healthcare talent-related needs. In addition to our traditional staffing and search services, our suite of healthcare workforce solutions includes managed services programs (“MSP”), vendor management systems (“VMS”), medical language interpretation services, consulting, recruitment process outsourcing (“RPO”), and revenue cycle solutions.
We also provide a variety of other voluntary programs to support 2 Table of Contents the health and well-being of our team members and their families, such as health and flexible spending accounts, family leave, adoption assistance, education assistance, retirement plans, employee assistance programs, and financial wellness programs.
We also provide a variety of other voluntary programs to support the health and well-being of our team members and their families, such as health and flexible spending accounts, family leave, adoption assistance, education assistance, retirement plans with matching employer contributions, employee assistance programs and financial wellness programs.
While our team members’ backgrounds and experiences are broad, here is a snapshot of the demographics of our corporate team members as of December 31, 2024: 68% of our team members are women; 73% of our supervisor through senior manager roles are held by women; 44% of our board of directors are women; 37% of our team members identify as black, indigenous, or people of color (“BIPOC”); our team is 57% Millennials, 32% Generation X, 6% Baby Boomers, and 5% Generation Z; and team members self-identified as veterans, disabled, and LGBTQ+, each representing approximately 3% of our team.
While our team members’ backgrounds and experiences are broad, here is a snapshot of the demographics of our corporate team members as of December 31, 2025: 69% of our team members are women; 68% of our supervisor through senior manager roles are held by women; 56% of our board of directors are women; 36% of our team members identify as black, indigenous, or people of color (“BIPOC”); our team is 57% Millennials, 33% Generation X, 5% Baby Boomers, and 5% Generation Z; and team members self-identified as veterans, disabled, and LGBTQ+, each representing approximately 3% of our team.
As of December 31, 2024, more than 45% of our corporate team members participate in one or more ERG. Each ERG is sponsored by one or more members of our executive team, and in 2024, AMN’s collective ERGs hosted more than 150 member events and meetings.
As of December 31, 2025, more than 40% of our corporate team members participate in one or more ERG. Each ERG is sponsored by one or more members of our executive team, and in 2025, AMN’s collective ERGs hosted more than 180 member events and meetings.
During the fourth quarter of 2024, we had an average of (1) 9,206 nurses, allied and other healthcare professionals, (2) 257 executive and clinical leadership interim staff, and (3) 2,819 medically qualified interpreters working for us. This does not include independent contractors, such as our locum tenens and contract interpreters, who were not our employees in 2024.
During the fourth quarter of 2025, we had an average of (1) 8,722 nurses, allied and other healthcare professionals, (2) 234 executive and clinical leadership interim staff, and (3) 2,670 medically qualified interpreters working for us. This does not include independent contractors, such as our locum tenens and contract interpreters, who were not our employees in 2025.
To assess the engagement of our team members and take action to mitigate risks associated with workforce engagement, development and retention, we conducted our annual survey to assess team member engagement, with 79% enterprise participation. In 2024, we continued our focus on creating opportunities for team members to build connections with colleagues through our ten employee resource groups (“ERG”).
To assess the engagement of our team members and take action to mitigate risks associated with workforce engagement, development and retention, we conducted our annual survey to assess team member engagement, with 79% enterprise participation and an overall engagement score of 78%. 3 Table of Contents In 2025, we continued our focus on creating opportunities for team members to build connections with colleagues through our eleven employee resource groups (“ERG”).
Our VMS technologies provide, among other things, control over a wide variety of tasks via a single system and consolidated reporting. In 2024, we had approximately $2.0 billion in spend flow through our VMS programs, for which we typically earn a fee as a percentage of spend. (11) Scheduling and Staff Planning .
Our VMS technologies provide, among other things, control over a wide variety of tasks via a single system and consolidated reporting. In 2025, we had approximately $1.4 billion in spend flow through our VMS programs, for which we typically earn a fee as a percentage of spend.
In 2024, we had approximately $2.0 billion in spend under management through our MSPs and approximately 45% of our consolidated revenue flowed through MSP relationships. Together with the vendor-neutral spend through our VMS programs (as discussed below), we had approximately $4.0 billion of spend under management during 2024. (8) Recruitment Solutions .
In 2025, we had approximately $1.8 billion in spend under management through our MSPs and approximately 48% of our consolidated revenue flowed through MSP relationships. Together with the vendor-neutral spend through our VMS programs (as discussed below), we had approximately $3.3 billion of spend under management during 2025. (8) Recruitment Solutions .
These technology investments provide a more seamless and efficient workflow for our team members, our healthcare professionals and our clients. For example, during 2024, we launched WorkWise, a healthcare technology solution that quantifies staffing demand with predictive scheduling, automates workforce and vendor management in one solution, and seeks to improve the clinician experience.
These technology investments provide a more seamless and efficient workflow for our team members, our healthcare professionals and our clients. For example, in 2024, we launched WorkWise, a healthcare technology platform, bringing together our technology solutions that quantify staffing demand with predictive scheduling, automate workforce and vendor management in one solution, and seek to improve the clinician experience.
According to the U.S. Census Bureau, the number of adults age 65 or older grew by 9.4% from 6 Table of Contents 2020 to 2023 and is projected to grow an estimated 31% between 2022 and 2035.
According to the U.S. Census Bureau, the number of adults age 65 or older grew by 13.0% from 2020 to 2024 and is projected to grow an estimated 31% between 2022 and 2035.
Word-of-mouth referrals from the thousands of current and former healthcare professionals we have placed enhance our effectiveness at reaching healthcare professionals. 5 Table of Contents Our process to attract and retain healthcare professionals for temporary assignments and permanent placement depends on (1) offering a large selection of assignments and placements in a variety of geographies and settings with opportunities for career development, (2) creating competitive compensation packages, (3) developing passionate, knowledgeable recruiters and service professionals who understand the needs of our healthcare professionals and provide a personalized approach, and (4) maintaining a reputation for service excellence.
Our process to attract and retain healthcare professionals for temporary assignments and permanent placement depends on (1) offering a large selection of assignments and placements in a variety of geographies and settings with opportunities for career development, (2) creating competitive compensation packages, (3) developing passionate, knowledgeable recruiters and service professionals who understand the needs of our healthcare professionals and provide a personalized approach, and (4) maintaining a reputation for service excellence.
In 2024, we continued to prioritize engaging with our team members through quarterly town halls and an enterprise-wide company meeting with our chief executive officer and other senior executives.
Team Member Communication and Engagement Team member engagement is of critical importance to our success. In 2025, we continued to prioritize engaging with our team members through quarterly town halls and an enterprise-wide company meeting with our chief executive officer and other senior executives.
Compliance with these laws, rules and regulations has not had, and is not expected to have, a material effect on our capital expenditures, results of operations, or competitive position. Additional Information We maintain a corporate website at www.amnhealthcare.com.
Additionally, individual states often have regulations governing healthcare staffing agencies and technology platforms, requiring registration and various types of certifications and reporting. Compliance with these laws, rules and regulations has not had, and is not expected to have, a material effect on our capital expenditures, results of operations, or competitive position. Additional Information We maintain a corporate website at www.amnhealthcare.com.
The locum tenens staffing market consists of many small- to mid-sized companies with only a small number of national competitors of which we are one.
In nurse and allied staffing, we compete with several national competitors together with numerous smaller, regional and local companies. The locum tenens staffing market consists of many small- to mid-sized companies with only a small number of national competitors of which we are one.
Our Healthcare Professionals The recruitment of a sufficient number of qualified healthcare professionals to work on temporary assignments and for placement at healthcare organizations is critical to the success of our business.
These fluctuations can vary slightly in intensity from year to year. 5 Table of Contents Our Healthcare Professionals The recruitment of a sufficient number of qualified healthcare professionals to work on temporary assignments and for placement at healthcare organizations is critical to the success of our business.
Employee Well-being Our commitment to supporting the mental, physical, and economic well-being of our team members and healthcare professionals continued throughout 2024. The care, support and safety of our frontline healthcare professionals remains at the forefront for us.
To support these objectives, our human capital management strategy focuses on talent acquisition, engagement, retention, employee well-being and belonging. Employee Well-being Our commitment to supporting the mental, physical, and economic well-being of our team members and healthcare professionals continued throughout 2025. The care, support and safety of our frontline healthcare professionals remains at the forefront for us.
In addition, the healthcare professionals who we employ or independently contract with are required to be individually licensed or certified under applicable state laws. We believe we take appropriate and reasonable steps to validate that our healthcare professionals possess all necessary licenses and certifications.
We believe we are currently licensed in all states that require such licenses and take measures to ensure compliance with all state licensure requirements. In addition, the healthcare professionals who we employ or independently contract with are required to be individually licensed or certified under applicable state laws.
Development of a broad base of healthcare professionals and corporate team members who feel valued, respected and supported is essential to driving shareholder value and achieving our long-term growth objectives. To support these objectives, our human capital management strategy focuses on talent acquisition, engagement, retention, employee well-being and belonging.
Human Capital Management Our human capital management strategy is a foundation of our business strategy as we strive to address the short- and long-term talent needs of our clients. Development of a broad base of healthcare professionals and corporate team members who feel valued, respected and supported is essential to driving shareholder value and achieving our long-term growth objectives.
We provide technology and data intelligence that enable sustainable, long-term improvement and offer flexible solution options and agile, scalable processes in our pay-for-performance model. Technology (9) Language Interpretation .
We provide technology and data intelligence that enable sustainable, long-term improvement and offer flexible solution options and agile, scalable processes in our pay-for-performance model. (9) Staff Planning . We provide consulting services to our clients to evaluate their staffing spend and offer recommendations for savings by optimizing workforce and scheduling capabilities. Technology (10) Language Interpretation .
We design our internal processes to ensure that the healthcare professionals that we directly place with clients have the appropriate experience, credentials and skills. Our nurse, allied healthcare and locum tenens staffing divisions have received Joint Commission certification. We have also obtained our Credentials Verification Organization certification from the National Committee for Quality Assurance.
We believe we take appropriate and reasonable steps to validate that our healthcare professionals possess all necessary licenses and certifications. We design our internal processes to ensure that the healthcare professionals that we directly place with clients have the appropriate experience, credentials and skills. Our nurse, allied healthcare and locum tenens staffing divisions have received Joint Commission certification.
We have also updated AMN Passport, our top clinician-rated mobile application, to allow users to see their impact on the patients they support. The app now includes an impact tracker in user profiles that shows the amount of patient care hours they provide and how many communities they serve over their career with us.
The app includes an impact tracker in user profiles that shows the amount of patient care hours they provide and how many communities they serve over their career with us.
In 2024, we had a 98% completion rate for our ethics and compliance training program, which includes, but is not limited to, training on our Code of Conduct, harassment prevention and cybersecurity. Team Member Communication and Engagement Team member engagement is of critical importance to our success.
Our training and development programs include curriculum that promotes our values-based culture and commitment to ethics and compliance. In 2025, we had a 97% completion rate for our ethics and compliance training program, which includes, but is not limited to, training on our Code of Conduct, harassment prevention and cybersecurity.
We believe our investments in technology systems will help us realize greater scale, agility, speed, and cost efficiencies and will improve the experience for our healthcare professionals and clients. Human Capital Management Our human capital management strategy is a foundation of our business strategy as we strive to address the short- and long-term talent needs of our clients.
We believe our investments in technology systems and AI will help us realize meaningfully greater scale, agility, speed, and cost efficiencies and will improve the experience for our healthcare professionals and clients.
We have provided our healthcare professionals with additional support through access to employee assistance programs, on demand mental health resources through nonprofit partners and third-party vendors, wellness products and services to care for them while they are caring for our communities.
We provide our healthcare professionals with support through access to employee assistance programs, on demand mental health resources, wellness products and services to care for them while they are caring for our communities. In 2 Table of Contents addition, our top clinician-rated mobile application, AMN Passport, allows users to see their impact on the patients they support.
Additionally, our mentorship program allows team members the opportunity to connect with colleagues across the company to support their development, strengthen their skills, and deepen relationships. Approximately 10% of our team members were enrolled in the mentoring program during 2024, which resulted in approximately 100 mentoring connections.
Additionally, our mentorship program allows team members the opportunity to connect with colleagues across the company to support their development, strengthen their skills, and deepen relationships. These programs are supplemented with resources from our corporate memberships in large industry associations, to which every team member has access.
Government Regulation 7 Table of Contents We are subject to the laws of the United States and certain foreign jurisdictions in which we operate and the rules and regulations of various governing bodies, which may differ among jurisdictions. Additionally, individual states often have regulations governing healthcare staffing agencies and technology platforms, requiring registration and various types of certifications and reporting.
We have also obtained our Credentials Verification Organization certification from the National Committee for Quality Assurance. Government Regulation We are subject to the laws of the United States and certain foreign jurisdictions in which we operate and the rules and regulations of various governing bodies, which may differ among jurisdictions.
As compared to many private firms, we also offer transparency and financial and operational controls, which we believe further enhance the value of our service offering. In its 2024 ratings for MSPs, HRO Today recognized AMN Healthcare in the Baker’s Dozen for overall quality of services, breadth of services and size of deals.
As compared to many private firms, we also offer transparency and financial and operational controls, which we believe further enhance the value of our service offering. We are a leading provider of nurse, allied and locum tenens staffing in the United States.
We also provide consulting services to our clients to evaluate their staffing spend and offer recommendations for savings by optimizing workforce and scheduling capabilities. We typically experience modest seasonal fluctuations during our fiscal year, and they tend to vary among our businesses and reportable segments. These fluctuations can vary slightly in intensity from year to year.
We typically experience modest seasonal fluctuations during our fiscal year, and they tend to vary among our businesses and reportable segments.
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These programs are supplemented with resources from our corporate memberships in large industry associations, to which every team member has access. Our training and development programs include curriculum that promotes our values-based culture and commitment to ethics and compliance.
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As part of our ongoing efforts to enhance our digital ecosystem, we expanded AMN Passport to include locum tenens, extending the platform’s functionality to support their workforce experience. This enhancement enables locum tenens providers to discover new opportunities while also managing their shifts and schedules in one centralized place.
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We offer Smart Square, healthcare scheduling software that combines demand forecasting (predictive analytics) with robust scheduling functionality, enterprise transparency, patented open shift management, and business intelligence tools all-in-one application. The SaaS platform provides fast implementations and is utilized in acute care, clinics, ancillary, long-term care and senior care settings.
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Through integration with third party scheduling solutions, we have broadened access and streamlined workflows, providing providers with improved visibility and coordination across their assignments. AMN’s Event Management System (“EMS”) is a fully integrated platform that supports large-scale labor disruption events by coordinating end-to-end operational workflows across recruitment, scheduling, credentialing, logistics, and supplier management.
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We are a leading provider of nurse, allied and locum tenens staffing in the United States. With the historic levels of demand as a result of the COVID-19 pandemic, the healthcare staffing industry grew significantly and has been further fragmented. In nurse and allied staffing, we compete with several national competitors together with numerous smaller, regional and local companies.
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In 2025, the system was expanded to provide comprehensive coverage for both AMN-sourced clinicians and external suppliers, improving readiness, speed, and operational oversight during strike events. EMS enhances AMN’s ability to mobilize workforce resources efficiently, increases data transparency, and strengthens overall execution for complex, high-volume labor actions, further advancing our position as a leader in labor disruption staffing.
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Licensure For Our Business Some states require state licensure for businesses that employ, assign and/or place healthcare professionals. We believe we are currently licensed in all states that require such licenses and take measures to ensure compliance with all state licensure requirements.
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We are increasing investments in automation and AI-enabled technology to improve efficiency and speed across our operations, with positive early results in functions including recruiting, credentialing and candidate engagement.
Added
Word-of-mouth referrals from the thousands of current and former healthcare professionals we have placed enhance our effectiveness at reaching healthcare professionals.
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Our leading competitors vary by segment and include Amergis, Aya Healthcare, CHG Healthcare Services, Cross Country Healthcare, HealthTrust Workforce Solutions, Ingenovis Health, Jackson Healthcare, LanguageLine Solutions, Medical Solutions and Proprio.

Item 1A. Risk Factors

Risk Factors — what could go wrong, per management

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Biggest changeAs a result of the ACA, the uninsured population has declined significantly. If there is a rollback of aspects of the ACA, such as Medicaid expansion, it may lead to a reduction in demand for healthcare services and the demand for our services may decline.
Biggest changeIf there is a rollback of aspects of the ACA, such as Medicaid expansion, or expiration of subsidies, or changes to eligibility and enrollment rules or reduced access to tax credits, it may lead to a reduction in demand for healthcare services and the demand for our services may decline. 10 Table of Contents Since the healthcare regulatory landscape continues to evolve and because future legislative or administrative actions cannot be predicted, significant change or even prolonged uncertainty could negatively affect demand for our services, operating results and our overall business performance.
These covenants limit our ability to, among other things: 17 Table of Contents • incur or guarantee additional indebtedness or issue certain preferred equity, • pay dividends on, redeem, repurchase, or make distributions in respect of our capital stock, prepay, redeem, or repurchase certain debt or make other restricted payments, • make certain investments, • create, or permit to exist, certain liens, • sell assets, • enter into sale/leaseback transactions, • enter into agreements restricting restricted subsidiaries’ ability to pay dividends or make other payments, • consolidate, merge, sell, or otherwise dispose of all or substantially all of our assets, • enter into certain transactions with affiliates, and • designate restricted subsidiaries as unrestricted subsidiaries.
These covenants limit our ability to, among other things: • incur or guarantee additional indebtedness or issue certain preferred equity, • pay dividends on, redeem, repurchase, or make distributions in respect of our capital stock, prepay, redeem, or repurchase certain debt or make other restricted payments, • make certain investments, • create, or permit to exist, certain liens, • sell assets, • enter into sale/leaseback transactions, • enter into agreements restricting restricted subsidiaries’ ability to pay dividends or make other payments, • consolidate, merge, sell, or otherwise dispose of all or substantially all of our assets, • enter into certain transactions with affiliates, and • designate restricted subsidiaries as unrestricted subsidiaries.
In addition, the restrictive covenants in our credit agreement require us to maintain specified financial ratios and satisfy other financial condition tests. Although we were in compliance with the financial ratios and financial condition tests set forth in our credit agreement on December 31, 2024, we cannot provide assurance that we will continue to be.
In addition, the restrictive covenants in our credit agreement require us to maintain specified financial ratios and satisfy other financial condition tests. Although we were in compliance with the financial ratios and financial condition tests set forth in our credit agreement on December 31, 2025, we cannot provide assurance that we will continue to be.
With the 8 Table of Contents advent of technology and more sophisticated staffing management and recruitment processes, including internal “travel,” other healthcare staffing models, and the increasing adoption of AI technologies, clients may be able to successfully increase the efficiency and effectiveness of their internal staffing management and recruiting efforts, through more effective planning and analytic tools, internet- or social media-based recruiting or otherwise.
With the advent of technology and more sophisticated staffing management and recruitment processes, including internal “travel,” other healthcare staffing models, and the increasing adoption of AI technologies, clients may be able to successfully increase the efficiency and effectiveness of their internal staffing management and recruiting efforts, through more effective planning and analytic tools, internet- or social media-based recruiting or otherwise.
If that were to occur, we may further increase our allowance for expected credit losses and our days sales outstanding would be negatively affected. 9 Table of Contents If we are unable to anticipate and quickly respond to changing marketplace conditions, such as alternative modes of healthcare delivery, reimbursement and client needs, we may not remain competitive.
If that were to occur, we may further increase our allowance for expected credit losses and our days sales outstanding would be negatively affected. If we are unable to anticipate and quickly respond to changing marketplace conditions, such as alternative modes of healthcare delivery, reimbursement and client needs, we may not remain competitive.
However, the failure or inability to perform on the part of one or more of these critical partners has caused and could in the future cause disruptions and increased costs. We are also dependent on security measures that some of our third-party vendors and customers are taking to protect their own systems and infrastructures.
However, the failure or inability to perform on the part of one or more of these critical partners has caused and could in the future cause disruptions and increased costs. We are also dependent on security measures that some of our third-party vendors 15 Table of Contents and customers are taking to protect their own systems and infrastructures.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note ( 4 ) , Goodwill and Identifiable Intangible Assets.” We may have additional impairment losses in connection with our periodic evaluation of our goodwill and intangible assets.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note ( 5 ) , Goodwill and Identifiable Intangible Assets.” We may have additional impairment losses in connection with our periodic evaluation of our goodwill and intangible assets.
A reclassification of our locum tenens to employees from independent contractors could result in liability that would have a significant negative impact on our profitability for the period in which such reclassification was implemented, and would require changes to our payroll and 12 Table of Contents related business processes, which could be costly.
A reclassification of our locum tenens to employees from independent contractors could result in liability that would have a significant negative impact on our profitability for the period in which such reclassification was implemented, and would require changes to our payroll and related business processes, which could be costly.
Because the techniques used to obtain unauthorized access, disable or degrade service, or sabotage systems change frequently and may not immediately produce signs of intrusion, we may be unable to anticipate these incidents or techniques, timely discover them, or implement adequate preventative measures.
Because the techniques used to obtain unauthorized access, disable or degrade service, or sabotage systems change frequently and may not immediately produce signs of intrusion, we may be unable to 14 Table of Contents anticipate these incidents or techniques, timely discover them, or implement adequate preventative measures.
The risk factors described below qualify all forward-looking statements we make, including forward-looking statements within this section entitled “Risk Factors.” To develop and prioritize the following risk factors, we review risks to our business that are informed by our formal Enterprise Risk Management program, industry trends, the external market and financial environment as well as dialogue with leaders throughout our organization.
The risk factors described below qualify all forward-looking statements we make, including forward-looking statements within this section entitled “Risk Factors.” To develop and prioritize the following risk factors, we review risks to our business that are informed by our formal Enterprise Risk Management program, industry trends, the external market and financial environment as well as dialogue with 8 Table of Contents leaders throughout our organization.
We maintain various types of insurance coverage for many types of claims, including professional liability, errors and omissions, employment practices and cyber, through commercial insurance carriers and a wholly-owned captive insurance 11 Table of Contents company and for other claims such as wage and hour practices and competition actions, we are uninsured.
We maintain various types of insurance coverage for many types of claims, including professional liability, errors and omissions, employment practices and cyber, through commercial insurance carriers and a wholly-owned captive insurance company and for other claims such as wage and hour practices and competition actions, we are uninsured.
And in certain instances, our debt instruments may limit our ability to redeem or prepay some or all of the outstanding principal amount prior to maturity, or in other instances, require the payment of premium in excess of the principal amount.
And in certain instances, our debt instruments may limit 17 Table of Contents our ability to redeem or prepay some or all of the outstanding principal amount prior to maturity, or in other instances, require the payment of premium in excess of the principal amount.
In particular, our growth efforts place substantial additional demands on our management and other team members, as well as on our information, financial, administrative, compliance and operational systems. We may not be able to manage these demands successfully.
In particular, our growth efforts place substantial additional demands on our management and other team members, as well as on our information, financial, administrative, compliance and operational systems. We may not be able to manage these 16 Table of Contents demands successfully.
Roughly 35 states are part of the Enhanced Nurse Compact and over 20 states are part of the Physical Therapy Licensure Compact and Interstate Medical Compact Acts. A decline or change in interstate compact laws can impact our business.
Roughly 43 states are part of the Enhanced Nurse Compact and over 40 states are part of the Physical Therapy Licensure Compact and Interstate Medical Compact Acts. A decline or change in interstate compact laws can impact our business.
There also is a potential for intentional and deliberate attacks to our systems, including ransomware, that may lead to service interruptions, data corruption, data theft or data unavailability.
There also is a potential for intentional and deliberate attacks to our systems, including ransomware, that may lead to service interruptions, data corruption, data theft 13 Table of Contents or data unavailability.
Like all employers, we must also comply with various laws and regulations relating to employment and pay practices and from time to time may be subject to individual, representative and class action lawsuits related to alleged wage and hour violations under California and Federal law.
Like all employers, we must also comply with various laws and regulations relating to employment and pay practices and from time to time have been or may in the future be subject to individual, representative and class action lawsuits related to alleged wage and hour violations under California and Federal law.
Demand for staffing services is sensitive to changes in economic activity. Many healthcare facilities utilize temporary healthcare professionals to accommodate an increase in hospital admissions. Conversely, when hospital admissions decrease in economic downturns or periods of high inflation, due to reduced consumer spending, the demand for our temporary healthcare professionals typically declines.
Many healthcare facilities utilize temporary healthcare professionals to accommodate an increase in hospital admissions. Conversely, when hospital admissions decrease in economic downturns or periods of high inflation, due to reduced consumer spending, the demand for our temporary healthcare professionals typically declines.
The economic impact of the COVID-19 pandemic negatively impacted the financial condition of many hospitals and healthcare systems, and our clients continue to face cost pressures and in turn are looking to decrease expenses, including for contingent labor and other services.
The economic impact of the COVID-19 pandemic negatively impacted the financial condition of many hospitals and healthcare systems, and our clients continue to face cost pressures and in turn are looking to decrease expenses, including for contingent labor and other services. Demand for our services has been and may in the future be impacted by these cost pressures.
For example, Kaiser Foundation Hospitals (and its affiliates) (collectively, “Kaiser”) comprised approximately 16% of our consolidated revenue in 2024.
For example, Kaiser Foundation Hospitals (and its affiliates) (collectively, “Kaiser”) comprised approximately 22% of our consolidated revenue in 2025.
The loss of key officers and management personnel could adversely affect our business and operating results. We believe that the success of our business strategy and our ability to maintain our recent levels of profitability depends on the continued employment of our senior executive team.
The loss of key officers and management personnel could adversely affect our business and operating results. We believe that the success of our business strategy and our ability to maintain our recent levels of profitability depends on the continued employment of our senior executive team. All of our executive officers are employees at will with standard severance agreements.
We determine the adequacy of our accruals by evaluating legal matters, our historical experience and trends, related to both insurance claims and payments, information provided to us by our insurance brokers, attorneys, third-party administrators and actuarial firms as well as industry experience and trends.
We determine the adequacy of our accruals by evaluating legal matters, our historical experience and trends, related to both insurance claims and payments, information provided to us by our insurance brokers, attorneys, third-party administrators and actuarial firms as well as industry experience and trends. If such information collectively indicates that our accruals are understated, we provide for additional accruals.
In the ordinary course of our business, we collect and store sensitive data, such as our proprietary business information and that of our clients as well as personally identifiable information of our healthcare professionals and team members, including full names, social security numbers, addresses, birth dates and payroll-related information, in our data centers, on our networks and in hosted SaaS-based solutions provided by third parties.
In the ordinary course of our business, we collect and store sensitive data, such as our proprietary business information and that of our clients as well as personally identifiable information of our healthcare professionals and team members in our data centers, on our networks and in hosted SaaS-based solutions provided by third parties.
As of December 31, 2024, our total indebtedness, net of unamortized fees and premium, equaled $1,055.9 million.
As of December 31, 2025, our total indebtedness, net of unamortized fees and premium, equaled $767.1 million.
The Company’s use of AI may also lead to novel and urgent cybersecurity risks, including access to or the misuse of personal data. 14 Table of Contents Any such access, disclosure or other loss of information could (1) result in legal claims or proceedings, liability under laws that protect the privacy of personal information and regulatory penalties, (2) disrupt our operations and the services we provide to our clients and (3) damage our reputation, any of which could adversely affect our profitability, revenue and competitive position.
Any such access, disclosure or other loss of information could (1) result in legal claims or proceedings, liability under laws that protect the privacy of personal information and regulatory penalties, (2) disrupt our operations and the services we provide to our clients and (3) damage our reputation, any of which could adversely affect our profitability, revenue and competitive position.
If we are unable to anticipate changing marketplace conditions, adapt our current business model to adequately meet changing conditions in the healthcare industry and develop and successfully implement innovative services, we may not remain competitive. Consolidation of healthcare delivery organizations could negatively affect pricing of our services and increase our concentration risk.
If we are unable to anticipate changing marketplace conditions, adapt our current business model to adequately meet changing conditions in the healthcare industry and develop and successfully implement innovative services, we may not remain competitive.
Visa retrogression, where the date(s) that determine availability for applying for a visa are moved to a later date, has had and may in the future have a negative impact on our international nursing volumes. Additionally, other changes in immigration policy, laws and processes could negatively impact our financial performance.
Visa retrogression, where the date(s) that determine availability for applying for a visa are moved to a later date, has had and may in the future have a negative impact on our international nursing volumes.
All of our executive officers are employees at will with standard 15 Table of Contents severance agreements. If members of our executive team become unable or unwilling to continue in their present positions, our business and financial results could be adversely affected. Our inability to maintain our positive brand awareness and identity may adversely affect our results of operations.
If members of our executive team become unable or unwilling to continue in their present positions, our business and financial results could be adversely affected. Our inability to maintain our positive brand awareness and identity may adversely affect our results of operations.
If our current or planned systems do not adequately support our operations, are damaged or disrupted or if we are unable to replace, repair, maintain or expand them, it may adversely affect our business operations and our profitability.
If our current or planned systems do not adequately support our operations, are damaged or disrupted or if we are unable to replace, repair, maintain or expand them, it may adversely affect our business operations and our profitability. Our business could be harmed if we fail to further develop and evolve our current talent solutions technology offerings and capabilities.
If we identify an impairment, we record a non-cash charge to earnings. During the year ended December 31, 2024, we recognized goodwill impairment losses totaling $222.5 million. See additional information in “Item 8.
If we identify an impairment, we record a non-cash charge to earnings. During the year ended December 31, 2025, we recognized a goodwill impairment loss totaling $109.5 million and a long-lived assets impairment loss totaling $18.3 million . See additional information in “Item 8.
Consolidation of healthcare delivery organizations provides them with greater leverage in negotiating pricing for services. Consolidations may also result in us losing our ability to work with certain clients because the party acquiring or consolidating with our client may have a previously established service provider they elect to maintain.
Consolidations may also result in us losing our ability to work with certain clients because the party acquiring or consolidating with our client may have a previously established service provider they elect to maintain.
If this occurs, it could increase our employee costs and expenses and could negatively impact our profitability. In addition, Federal or state taxing authorities may take the position that locum tenens are employees exposing us to additional wage and insurance claims and employment and payroll-related taxes.
In addition, Federal or state taxing authorities may take the position that locum tenens are employees exposing us to additional wage and insurance claims and employment and payroll-related taxes.
As we incorporate AI and machine learning into our business there are uncertainties in the legal regulatory regime relating to AI that may require significant resources to modify and maintain our business practices to comply with U.S. and non-U.S. laws, the nature of which cannot be determined at this time.
While we believe that our business practices, including pricing and competitive conduct, comply with all applicable laws and regulations, we may nonetheless be subject to inquiries, claims or investigations which could negatively impact our reputation and business. 11 Table of Contents As we incorporate AI and machine learning into our business there are uncertainties in the legal regulatory regime relating to AI that may require significant resources to modify and maintain our business practices to comply with U.S. and non-U.S. laws, the nature of which cannot be determined at this time.
As our business continues to evolve and we provide a wider range of services, we will become increasingly dependent upon our employees, particularly those operating in business environments less familiar to us.
As our business continues to evolve and we provide a wider range of services, we will become increasingly dependent upon our employees, particularly those operating in business environments less familiar to us. Failure to identify, hire, train and retain talented employees who share our values could have a negative effect on our reputation and our business.
The performance, reliability and security of our technology-enabled services, including our language interpretation services and SaaS-based technologies, such as AMN Language Services, ShiftWise Flex, Medefis, b4health, and Avantas Smart Square are critical to such offerings’ operations, reputation and ability to attract new clients. Some of our clients rely on our SaaS-based technologies to perform certain of their operational functions.
The performance, reliability and security of our technology-enabled services, including our language interpretation services and SaaS-based technologies, such as AMN Language Services, ShiftWise Flex, Medefis, and b4health, our Event Management System and clinician facing app, AMN Passport, are critical to such offerings’ operations, reputation and ability to attract new clients and clinicians.
Accordingly, any degradation, errors, defects, disruptions or other performance problems with our SaaS-based technologies could damage our or our clients’ operations and reputations and negatively affect our business. If any of these problems occur, our clients may, among other things, terminate their agreements with us or make indemnification or other claims against us, which may also negatively affect us.
If any of these problems occur, our clients may, among other things, terminate their agreements with us or make indemnification or other claims against us, which may also negatively affect us.
Failure to identify, hire, train and retain talented employees who share our values could have a negative effect on our reputation and our business. 16 Table of Contents The demands that our current and future growth place on our people and systems, controls, compliance efforts, policies and procedures may exceed the benefits of such growth, and our operating results may suffer, at least in the short-term, and perhaps in the long-term.
The demands that our current and future growth place on our people and systems, controls, compliance efforts, policies and procedures may exceed the benefits of such growth, and our operating results may suffer, at least in the short-term, and perhaps in the long-term.
This may require the acquisition of equipment and software and the development of new proprietary software and capabilities, either internally or through independent consultants, which may require significant investment of capital.
To achieve our strategic objectives and to remain competitive, we must continue to develop and enhance our talent solutions technology offerings and capabilities. This may require the acquisition of equipment and software and the development of new proprietary software and capabilities, either internally or through independent consultants, which may require significant investment of capital.
The COVID-19 pandemic disrupted, and any other future outbreak of illness or other public health crises or reemergence or future strain of COVID-19 may also disrupt, our operations due to the unavailability of our corporate team members or healthcare professionals due to illness, risk of illness, quarantines, travel restrictions, vaccine mandates or other factors that limit our existing or potential workforce and pool of candidates.
Pandemic-related disruptions also affected our operations due to the unavailability of our corporate team members or healthcare professionals caused by illness, quarantines, travel restrictions, vaccine mandates and other factors that limited our workforce and pool of candidates. Similar challenges could arise in future public health crises.
Certain state laws regarding classification of independent contractors have been modified in the past few years and as a result, we have altered our classification of certain locum tenens providers in certain instances. Other states and/or the Federal government may choose to adopt similar restrictions that may require us to expand our employee classifications for locum tenens.
Certain state laws regarding classification of independent contractors have been modified in the past few years and as a result, we have altered our 12 Table of Contents classification of certain locum tenens providers in certain instances.
In a situation such as ransomware attack, our access to critical business information and ability to conduct business may be interrupted or impaired. Further, unauthorized use or misuse of AI by the Company’s employees, vendors or others may result in disclosure of confidential Company and customer data.
In a situation such as ransomware attack, our access to critical business information and ability to conduct business may be interrupted or impaired.
Additionally, outbreaks of illness, public health crises or reemergence or future strain of COVID-19 could occur and may have similar or even more significant impact on our business. Economic downturns, inflation and slow recoveries could result in less demand from clients and pricing pressure that could negatively impact our financial condition.
Additionally, outbreaks of illness, public health crises or reemergence or future strain of COVID-19 could occur and may have similar or even more significant impact on our business. The repeal of or changes to the Patient Protection and Affordable Care Act (“ACA”) may negatively affect the demand for our services.
In addition, we have and may in the future experience negative financial effects related a pandemic or other future outbreaks of illness due to higher workers’ compensation and health insurance costs, for which we are largely self-insured, and payroll costs associated with quarantine of our healthcare professionals.
In addition, we have incurred and may in the future incur higher workers’ compensation and health insurance costs, for which we are largely self-insured, along with increased payroll costs related to quarantines. We may also be subject to claims regarding the health and safety of our healthcare professionals and our corporate team members in such circumstances.
Initially, in 2020, demand for some temporary healthcare professionals and services decreased as the demand for non-essential and elective healthcare was initially negatively impacted by the COVID-19 pandemic. As the pandemic subsided, demand and bill rates, especially in our nurse and allied solutions businesses, decreased from the levels seen during the pandemic.
Initially, demand for some temporary healthcare professionals and services declined as non-essential and elective healthcare was postponed. As the pandemic progressed, demand and bill rates, particularly in our nurse and allied solutions businesses, rose sharply and then declined. The subsequent decline in demand and bill rates negatively affected our revenue, financial condition, and results of operations.
In addition, our inability to establish relationships with these intermediaries may result in us losing our ability to work with certain healthcare facilities.
In addition, our inability to establish relationships with these intermediaries may result in us losing our ability to work with certain healthcare facilities. The widespread outbreak of illness or other public health crisis could have an adverse effect on our business, financial condition and results of operations .
We could be negatively affected by the widespread outbreak of an illness or any other public health crisis. The COVID-19 pandemic negatively impacted the global economy and created significant volatility and disruption of financial markets. Demand for our staffing services and workforce technology solutions fluctuated over the course of the COVID-19 pandemic.
Public health crises have adversely affected our business in the past and could negatively impact our business again in the future. The COVID-19 pandemic significantly disrupted the global economy and financial markets and its effects materially impacted demand for our staffing services and workforce technology solutions.
This may lead to claims and investigations into pricing and competitive conduct in the healthcare staffing industry. While we believe that our business practices, including pricing and competitive conduct, comply with all applicable laws and regulations, we may nonetheless be subject to inquiries, claims or investigations which could negatively impact our reputation and business.
This may lead to claims and investigations into pricing and competitive conduct in the healthcare staffing industry.
If such information collectively indicates that our accruals are understated, we provide for additional accruals; a significant increase to these accruals would decrease our earnings.
A significant increase to these accruals would decrease our earnings. 18 Table of Contents
Removed
Such new technologies and processes could reduce the demand for our services, which could negatively affect our business. The widespread outbreak of illness or other public health crisis could have an adverse effect on our business, financial condition and results of operations .
Added
Such new technologies and processes could reduce the demand for our services, which could negatively affect our business. Economic downturns, inflation and slow recoveries could result in less demand from clients and pricing pressure that could negatively impact our financial condition. Demand for staffing services is sensitive to changes in economic activity.
Removed
This decrease in demand has had a negative impact on our revenue, financial condition, and results of operations. However, we are unable to predict the duration and extent to which demand for our services or bill rates will be negatively impacted.
Added
Consolidation of healthcare delivery organizations could negatively affect pricing of our services and increase our concentration risk. 9 Table of Contents Consolidation of healthcare delivery organizations provides them with greater leverage in negotiating pricing for services.
Removed
We may also be subject to claims regarding the health and safety of our healthcare professionals and our corporate team members.
Added
Since its enactment in 2010, the ACA has significantly expanded access to health insurance, resulting in a substantial reduction in the uninsured population.
Removed
Demand for our services may be impacted by these cost pressures and we may be subject to claims from these clients relating to the ability to provide services under terms and conditions that they believe are fair and reasonable.
Added
Our business depends heavily on the regulatory environment governing healthcare delivery, reimbursement, workforce requirements and insurance coverage. Federal and state governments regularly consider, adopt, revise, or rescind policies that affect healthcare providers, payers, and the broader healthcare labor market.
Removed
The repeal or significant erosion of the Patient Protection and Affordable Care Act (“ACA”) without a corresponding replacement may negatively affect the demand for our services. 10 Table of Contents In 2010, the adoption of the ACA brought significant reforms to the health care system that included, among other things, a requirement that all individuals have health insurance (with limited exceptions).
Added
These changes may include modifications to licensure or credentialing requirements, reimbursement methodologies, staffing mandates, scope‑of‑practice rules, worker classification standards, or federal payment programs.
Removed
Our business could be harmed if we fail to further develop and evolve our current talent solutions technology offerings and capabilities. 13 Table of Contents To achieve our strategic objectives and to remain competitive, we must continue to develop and enhance our talent solutions technology offerings and capabilities.
Added
Uncertainty or shifts in administrative priorities, such as changes in enforcement guidance and regulatory interpretation can influence the financial condition and staffing needs of our clients, which in turn can impact demand for our staffing and workforce solutions.
Added
Additionally, other changes in immigration policy, laws and processes or uncertainty about such policies or uncertainty about enforcement of such policies could also negatively impact other aspects of our business, including demand for our Language Services business, and our financial performance.
Added
Other states and/or the Federal government may choose to adopt similar restrictions that may require us to expand our employee classifications for locum tenens. If this occurs, it could increase our employee costs and expenses and could negatively impact our profitability.
Added
Some of our clients rely on our SaaS-based technologies to perform certain of their operational functions. Accordingly, any degradation, errors, defects, disruptions or other performance problems with our SaaS-based technologies could damage our or our clients’ operations and reputations and negatively affect our business.
Added
Further, unauthorized use or misuse of AI by the Company’s employees, vendors or others may result in system failures, disruption to business processes, potential misuse of proprietary confidential information, infringement on third-party rights, or disclosure of confidential Company and customer data.
Added
The Company’s use of AI may also lead to novel and urgent cybersecurity risks, including access to or the misuse of personal data.

Item 1C. Cybersecurity

Cybersecurity — threats and controls disclosure

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Biggest changeAMN’s Privacy function, which reports up through our Chief Legal Officer, works collaboratively with the Information Security function to create and review policies, standards and processes.
Biggest changeAMN’s Privacy function, which reports up through our Chief Legal Officer, works collaboratively with the Information Security function to create and review policies, standards and processes. In addition to updating the Audit Committee, our Chief Legal Officer provides regular updates to the Corporate Governance and Compliance Committee, as well as other members of our senior management as appropriate.
Our team members receive annual training to understand the behaviors necessary to protect company and personal information and receive annual training on privacy laws and requirements. We also offer ongoing practice and education for team members to recognize and report suspicious activity, including phishing campaigns.
Our team members receive annual training to understand the behaviors necessary to protect company and personal information and receive annual training on privacy laws and requirements.
The Company has experienced cyber threats resulting in immaterial cyber incidents and expects cyber threats to continue with varying levels of sophistication. 19 Table of Contents
We also offer ongoing practice and education for team members to recognize and report suspicious activity, including phishing campaigns. 19 Table of Contents The Company has experienced cyber threats resulting in immaterial cyber incidents and expects cyber threats to continue with varying levels of sophistication.
Removed
In addition to updating the Audit Committee, the CIO and Vice President, Information & Security, and Privacy team provide regular updates to the Corporate Governance and Compliance Committee, as well as our Chief Executive Officer and other members of our senior management as appropriate.

Item 2. Properties

Properties — owned and leased real estate

1 edited+0 added−0 removed1 unchanged
Biggest changeWe set forth below our principal leased office spaces as of December 31, 2024 together with our business segments that utilize them: Location Square Feet Dallas, Texas (all segments) 92,420 San Diego, California (all segments) 50,519 See additional information in “Item 8. Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note (5) , Leases.”
Biggest changeWe set forth below our principal leased office spaces as of December 31, 2025 together with our business segments that utilize them: Location Square Feet Dallas, Texas (all segments) 92,420 San Diego, California (all segments) 50,519 See additional information in “Item 8. Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note ( 6 ) , Leases.”

Item 5. Market for Registrant's Common Equity

Market for Common Equity — stock, dividends, buybacks

8 edited+0 added−0 removed10 unchanged
Biggest changeThe graph below compares the total return on our common stock with the total return of (i) the Russell 2000 Index, and (ii) the S&P Healthcare Services Select Industry Index (“SPSIHP”), assuming an investment of $100 on December 31, 2019 in our common stock and the stocks comprising the Russell 2000 Index and the SPSIHP, respectively. 12/31/19 12/31/20 12/31/21 12/31/22 12/31/23 12/31/24 AMN Healthcare Services, Inc. 100.00 109.53 196.32 165.01 120.17 38.39 Russell 2000 100.00 119.96 137.74 109.59 128.14 142.93 SPSIHP 100.00 133.81 147.19 118.22 124.34 126.92
Biggest changeThe graph below compares the total return on our common stock with the total return of (i) the Russell 2000 Index, and (ii) the S&P Healthcare Services Select Industry Index (“SPSIHP”), assuming an investment of $100 on December 31, 2020 in our common stock and the stocks comprising the Russell 2000 Index and the SPSIHP, respectively. 12/31/20 12/31/21 12/31/22 12/31/23 12/31/24 12/31/25 AMN Healthcare Services, Inc. 100.00 179.24 150.65 109.71 35.05 23.09 Russell 2000 100.00 114.82 91.35 106.82 119.14 134.40 SPSIHP 100.00 110.00 88.35 92.92 94.85 113.00
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note (8) , Notes Payable and Credit Agreement.” The information required by Item 201(d) of Regulation S-K is incorporated by reference to the table set forth in Item 12 of this Annual Report on Form 10-K. 21 Table of Contents Performance Graph This performance graph shall not be deemed “filed” with the SEC or subject to Section 18 of the Exchange Act, nor shall it be deemed incorporated by reference in any of our filings under the Exchange Act or the Securities Act.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note ( 9 ) , Notes Payable and Credit Agreement.” The information required by Item 201(d) of Regulation S-K is incorporated by reference to the table set forth in Item 12 of this Annual Report on Form 10-K. 21 Table of Contents Performance Graph This performance graph shall not be deemed “filed” with the SEC or subject to Section 18 of the Exchange Act, nor shall it be deemed incorporated by reference in any of our filings under the Exchange Act or the Securities Act.
As of December 31, 2024, we have repurchased 12.6 million shares of our common stock at an average price of $89.04 per share excluding broker’s fees under the Company Repurchase Program, resulting in an aggregate purchase price of $1,123.3 million, excluding the effect of excise taxes, since 2016. See “Item 8.
As of December 31, 2025, we have repurchased 12.6 million shares of our common stock at an average price of $89.04 per share excluding broker’s fees under the Company Repurchase Program, resulting in an aggregate purchase price of $1,123.3 million, excluding the effect of excise taxes, since 2016. See “Item 8.
Such repurchases or exchanges, if any, will be upon such terms and at such prices as we may determine, and will depend on prevailing market conditions, our liquidity requirements, contractual restrictions and other factors. The amounts involved may be material. During 2024, we did not repurchase any shares of our common stock.
Such repurchases or exchanges, if any, will be upon such terms and at such prices as we may determine, and will depend on prevailing market conditions, our liquidity requirements, contractual restrictions and other factors. The amounts involved may be material. During 2025, we did not repurchase any shares of our common stock.
During the fiscal year ended December 31, 2024, we did not sell any equity securities that were not registered under the Securities Act. From time to time, we may repurchase our common stock in the open market pursuant to programs approved by our board of directors (the “Board”).
During the fiscal year ended December 31, 2025, we did not sell any equity securities that were not registered under the Securities Act. From time to time, we may repurchase our common stock in the open market pursuant to programs approved by our board of directors (the “Board”).
On November 10, 2021, February 17, 2022, June 15, 2022, and February 16, 2023, we announced increases to the repurchase program totaling $1,200.0 million. These increases brought the total authorization of the repurchase program to $1,350.0 million, of which $226.7 million remained as of December 31, 2024.
On November 10, 2021, February 17, 2022, June 15, 2022, and February 16, 2023, we announced increases to the repurchase program totaling $1,200.0 million. These increases brought the total authorization of the repurchase program to $1,350.0 million, of which $226.7 million remained as of December 31, 2025.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note (10)(b) , Capital Stock—Treasury Stock.” All share repurchases to date were made under the Company Repurchase Program, which is the only repurchase program of the Company currently in effect.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note (11) (b), Capital Stock—Treasury Stock.” All share repurchases to date were made under the Company Repurchase Program, which is the only repurchase program of the Company currently in effect.
Item 5. Market For Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities Our common stock trades on the New York Stock Exchange under the symbol “AMN.” As of February 18, 2025, there were 17 stockholders of record of our common stock, one of which was Cede & Co., a nominee for The Depository Trust Company.
Item 5. Market For Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities Our common stock trades on the New York Stock Exchange under the symbol “AMN.” As of February 17, 2026, there were 14 stockholders of record of our common stock, one of which was Cede & Co., a nominee for The Depository Trust Company.

Item 7. Management's Discussion & Analysis

Management's Discussion & Analysis (MD&A) — revenue / margin commentary

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Biggest changeOn and after October 1, 2022, we may redeem all or a portion of the 2027 Notes upon not less than 30 nor more than 60 days’ notice, at the redemption prices (expressed in percentages of principal amount on the redemption date) set forth below, plus accrued and unpaid interest, if any, to (but excluding) the redemption date, if redeemed during the twelve month period commencing on October 1 of the years set forth below: Period Redemption Price 2022 102.313 % 2023 101.156 % 2024 and thereafter 100.000 % Upon the occurrence of specified change of control events as defined in the indenture governing the 2027 Notes, we must offer to repurchase the 2027 Notes at 101% of the principal amount, plus accrued and unpaid interest, if any, to (but excluding) the purchase date.
Biggest changeInterest on the 2031 Notes will be payable semi-annually in arrears on January 15 and July 15 of each year, commencing July 15, 2026. 30 Table of Contents At any time and from time to time on and after October 15, 2027, we will be entitled at our option to redeem all or a portion of the 2031 Notes upon not less than 10 nor more than 60 days’ notice, at the redemption prices (expressed in percentages of principal amount on the redemption date) set forth below, plus accrued and unpaid interest, if any, to (but excluding) the redemption date (subject to the right of holders of record of the 2031 Notes on the relevant record date to receive interest due on the relevant interest payment date), if redeemed during the twelve month period commencing on October 15, of the years set forth below: Period Redemption Price 2027 103.250 % 2028 101.625 % 2029 and thereafter 100.000 % At any time and from time to time prior to October 15, 2027 we may also redeem the 2031 Notes with the net cash proceeds of certain equity offerings in an aggregate principal amount not to exceed 40% of the aggregate principal amount of the 2031 Notes issued, at a redemption price (expressed as a percentage of principal amount) of 106.500% of the principal amount thereof plus accrued and unpaid interest, if any, to (but excluding) the applicable redemption date.
We also recruit physicians and healthcare leaders for permanent placement and place interim leaders and executives across all healthcare settings. The interim healthcare leaders and executives we place are typically placed on contracts with assignment lengths ranging from a few days to one year.
We also recruit physicians and healthcare leaders and executives for permanent placement and place interim leaders and executives across all healthcare settings. The interim healthcare leaders and executives we place are typically placed on contracts with assignment lengths ranging from a few days to one year.
Our 23 Table of Contents market growth strategy continues to focus on broadening and investing, both organically and through strategic acquisitions, in service and technology offerings beyond our traditional temporary staffing and permanent placement services, to include more strategic and recurring revenue sources from innovative talent solutions offerings such as MSP, VMS, workforce optimization service, and other technology-enabled services.
Our market growth strategy continues to focus on broadening and investing, both organically and through strategic acquisitions, in 23 Table of Contents service and technology offerings beyond our traditional temporary staffing and permanent placement services, to include more strategic and recurring revenue sources from innovative talent solutions offerings such as MSP, VMS, workforce optimization service, and other technology-enabled services.
For intangible assets purchased in a business acquisition, the estimated fair values of the assets received are used to establish their recorded values, which may become impaired in the future. In accordance with accounting guidance on goodwill and other intangible assets, we perform annual impairment analysis to assess the recoverability of goodwill and indefinite-lived intangible assets.
For intangible assets purchased in a business acquisition, the estimated fair values of the assets received are used to establish their recorded values, which may become impaired in the future. In accordance with accounting guidance on goodwill and other intangible assets, we perform an annual impairment analysis to assess the recoverability of goodwill and indefinite-lived intangible assets.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note (5) , Leases.” We also have various obligations and working capital requirements, such as certain tax and legal matters, contingent consideration and other liabilities, that are recorded on our consolidated balance sheets. See additional information in “Item 8.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note ( 6 ) , Leases.” We also have various obligations and working capital requirements, such as certain tax and legal matters, contingent consideration and other liabilities, that are recorded on our consolidated balance sheets. See additional information in “Item 8.
Interest on the 2029 Notes will be payable semi-annually in arrears on April 15 and October 15 of each year, commencing April 15, 2021.
The 2029 Notes will mature on April 15, 2029. Interest on the 2029 Notes will be payable semi-annually in arrears on April 15 and October 15 of each year, commencing April 15, 2021.
Net cash used in financing activities for 2024 was primarily due to (1) repayments of $375.0 million under the Senior Credit Facility (as defined below), (2) $4.8 million in cash paid for shares withheld for payroll taxes resulting from the vesting of employee equity awards, and (3) $3.7 million in cash paid for excise tax on prior year share repurchases, partially offset by borrowings of $125.0 million under the Senior Credit Facility.
Net cash used in financing activities for 2024 was primarily due to (1) repayments of $375.0 million under the Senior Credit Facility, (2) $4.8 million in cash paid for shares withheld for payroll taxes resulting from the vesting of employee equity awards, and (3) $3.7 million in cash paid for excise tax on prior year share repurchases, partially offset by borrowings of $125.0 million under the Senior Credit Facility.
These covenants are subject to a number of important exceptions and qualifications. The indenture governing the 2029 Notes contains affirmative covenants and events of default that are customary for indentures governing high yield securities. The 2029 Notes and the guarantees are not subject to any registration rights agreement.
These covenants are subject to a number of important exceptions and qualifications. The indenture governing the 2031 Notes contains affirmative covenants and events of default that are customary for indentures governing high yield securities. The 2031 Notes and the guarantees are not subject to any registration rights agreement.
These covenants are subject to a number of important exceptions and qualifications. The indenture governing the 2027 Notes contains affirmative covenants and events of default that are customary for indentures governing high yield securities.
These covenants are subject to a number of important exceptions and qualifications. The indenture governing the 2029 Notes contains affirmative covenants and events of default that are customary for indentures governing high yield securities.
As such, prior to the quantitative impairment test of our goodwill as of October 31, 2024, we evaluated the recoverability of the carrying amounts of asset groups within the nurse and allied solutions and physician and leadership solutions reporting units and determined that the undiscounted cash flows for all the asset groups tested were above their respective carrying amounts.
Prior to the quantitative impairment test of our goodwill as of October 31, 2025, we evaluated the recoverability of the carrying amounts of asset groups within the nurse and allied solutions and physician and leadership solutions reporting units and determined that the undiscounted cash flows for all the asset groups tested were above their respective carrying amounts.
We review these provisions at least quarterly and adjust these provisions accordingly to reflect the impact of negotiations, settlements, rulings, advice of legal counsel, and updated information. We generally record changes in accruals related to legal matters in selling, general and administrative expenses in the consolidated statements of comprehensive income (loss).
We review these provisions at least quarterly and adjust these provisions accordingly to reflect the impact of negotiations, settlements, rulings, advice of legal counsel, and updated information. We generally record changes in accruals related to legal matters in selling, general and 34 Table of Contents administrative expenses in the consolidated statements of comprehensive income (loss).
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note (3) , Fair Value Measurement, Note (6) , Balance Sheet Details, Note (7) , Income Taxes, and Note (12) , Commitments and Contingencies.” In addition to our cash requirements, we have a share repurchase program authorized by our board of directors, which does not require the purchase of any minimum number of shares and may be suspended or discontinued at any time.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note ( 4 ) , Fair Value Measurement, Note ( 7 ) , Balance Sheet Details, Note ( 8 ) , Income Taxes, and Note (1 3 ) , Commitments and Contingencies.” In addition to our cash requirements, we have a share repurchase program authorized by our board of directors, which does not require the purchase of any minimum number of shares and may be suspended or discontinued at any time.
We believe that the amount or estimable range of reasonably possible loss beyond the accruals that we have established, will not, either individually or in the aggregate, have a material adverse effect on our business, consolidated financial position, 33 Table of Contents results of operations, or cash flows with respect to loss contingencies for legal and other contingencies as of December 31, 2024.
We believe that the amount or estimable range of reasonably possible loss beyond the accruals that we have established, will not, either individually or in the aggregate, have a material adverse effect on our business, consolidated financial position, results of operations, or cash flows with respect to loss contingencies for legal and other contingencies as of December 31, 2025.
As part of our long-term growth strategy to add value for our clients, healthcare professionals, and stockholders, we acquired MSI Systems Corp. and DrWanted.com LLC (together “MSDR”) on November 30, 2023 and Connetics on May 13, 2022. See additional information in “Item 8.
As part of our long-term growth strategy to add value for our clients, healthcare professionals, and stockholders, we acquired MSI Systems Corp. and DrWanted.com LLC (together “MSDR”) on November 30, 2023. See additional information in “Item 8.
The Company engaged a third-party valuation specialist to assist in the determination of the WACC, which ranged from 13.5% to 14.0% for our reporting units in the most recent impairment test.
The Company engaged a third-party valuation specialist to assist in the determination of the WACC, which ranged from 11.0% to 14.0% for our reporting units in the most recent impairment test.
As of December 31, 2024, we were in compliance with the various covenants under our debt instruments. We describe in further detail our Amended Credit Agreement (as defined below), under which our Senior Credit Facility is governed, the 2027 Notes, and the 2029 Notes in “Item 8.
As of December 31, 2025, we were in compliance with the various covenants under our debt instruments. We describe in further detail our Amended Credit Agreement (as defined below), under which our Senior Credit Facility is governed, the 2029 Notes and the 2031 Notes in “Item 8.
Our total talent solutions include vendor neutral and managed services programs (“MSP”), clinical and interim healthcare leaders, temporary staffing, permanent placement, executive search, vendor management systems (“VMS”), recruitment process outsourcing, predictive modeling, language services, revenue cycle solutions, and other services.
Our total talent solutions include vendor neutral and managed services programs (“MSP”), clinical and interim healthcare leaders, temporary staffing, permanent placement, executive search, vendor management systems (“VMS”), recruitment process outsourcing, language services, revenue cycle solutions, labor disruption and other services.
Through our technology and workforce solutions segment, we provide hospitals and other healthcare facilities with a range of workforce solutions, including: (1) language services, (2) software-as-a-service (“SaaS”)-based VMS technologies through which our clients can self-manage the procurement of contingent clinical labor and their internal float pool, (3) workforce optimization services that include consulting, data analytics, predictive modeling, and SaaS-based scheduling technology, and (4) recruitment process outsourcing services in which we recruit, hire and/or onboard permanent clinical and nonclinical positions on behalf of our clients.
Through our technology and workforce solutions segment, we provide hospitals and other healthcare facilities with a range of workforce solutions, including: (1) language services, (2) software-as-a-service (“SaaS”)-based VMS technologies through which our clients can self-manage the procurement of contingent clinical labor and their internal float pool, (3) workforce optimization services that include advisory, planning, and analytics, and (4) recruitment process outsourcing services in which we recruit, hire and/or onboard permanent clinical and nonclinical positions on behalf of our clients.
Letters of Credit As of December 31, 2024, we maintained outstanding standby letters of credit totaling $20.9 million as collateral in relation to our workers’ compensation insurance agreements and a corporate office lease agreement.
Letters of Credit As of December 31, 2025, we maintained outstanding standby letters of credit totaling $20.8 million as collateral in relation to our workers’ compensation insurance agreements and a corporate office lease agreement.
Outstanding standby letters of credit at December 31, 2023 totaled $21.3 million. 30 Table of Contents Critical Accounting Policies and Estimates Our critical accounting policies are those that we believe are both important to the portrayal of our financial condition and results and require our most difficult, subjective or complex judgments, often as a result of the need to make estimates about the effect of matters that are inherently uncertain.
Outstanding standby letters of credit at December 31, 2024 totaled $20.9 million. 31 Table of Contents Critical Accounting Policies and Estimates Our critical accounting policies are those that we believe are both important to the portrayal of our financial condition and results and require our most difficult, subjective or complex judgments, often as a result of the need to make estimates about the effect of matters that are inherently uncertain.
The indenture governing the 2027 Notes contains covenants that, among other things, restrict our ability to: • sell assets, • pay dividends or make other distributions on capital stock, make payments in respect of subordinated indebtedness or make other restricted payments, • make certain investments, • incur or guarantee additional indebtedness or issue preferred stock, 29 Table of Contents • create certain liens, • enter into agreements that restrict dividends or other payments from our restricted subsidiaries, • consolidate, merge or transfer all or substantially all of our assets, • engage in transactions with affiliates, and • create unrestricted subsidiaries.
The indenture governing the 2031 Notes contains covenants that, among other things, restrict our ability to: • sell assets; • pay dividends or make other distributions on capital stock, make payments in respect of subordinated indebtedness or make other restricted payments; • make certain investments; • incur or guarantee additional indebtedness or issue preferred stock; • create certain liens; • enter into agreements that restrict dividends or other payments to us; • consolidate, merge or transfer all or substantially all of their assets; • engage in transactions with affiliates; and • create unrestricted subsidiaries.
Selling, General and Administrative Expenses . Selling, general and administrative (“SG&A”) expenses consist predominantly of compensation and benefits costs for corporate employees, in addition to professional service fees, legal matter accruals and other overhead costs. SG&A expenses were $632.5 million, representing 21.2% of revenue, for 2024, as compared to $756.2 million, representing 20.0% of revenue, for 2023.
Selling, general and administrative (“SG&A”) expenses consist predominantly of compensation and benefits costs for corporate employees, in addition to professional service fees, legal matter accruals and other overhead costs. SG&A expenses were $593.0 million, representing 21.7% of revenue, for 2025, as compared to $632.5 million, representing 21.2% of revenue, for 2024.
In addition, capital expenditures were $80.9 million, $103.7 million and $75.8 million for the years ended December 31, 2024, 2023 and 2022, respectively. Our capital expenditures in recent years were primarily related to ongoing technology investments to support our tech-centric total talent solutions initiatives and to optimize our internal front and back-office systems.
In addition, capital expenditures were $35.6 million, $80.9 million and $103.7 million for the years ended December 31, 2025, 2024 and 2023, respectively. Our capital expenditures in recent years were primarily related to ongoing technology investments to support our tech-centric total talent solutions initiatives and to optimize our internal front and back-office systems.
Our Days Sales Outstanding (“DSO”) was 55 and 70 days at December 31, 2024 and December 31, 2023, respectively. Our consolidated results for the year ended December 31, 2023 included only one month of MSDR’s revenue, but our consolidated balance sheet included the full amount of MSDR’s accounts receivable.
Our Days Sales Outstanding (“DSO”) was 47 as of December 31, 2025, 55 days as of December 31, 2024, and 70 days as of December 31, 2023. Our consolidated results for the year ended December 31, 2023 included only one month of MSDR’s revenue, but our consolidated balance sheet included the full amount of MSDR’s accounts receivable.
Management’s Discussion and Analysis of Financial Condition and Results of Operations—Results of Operations—Comparison of Results for the Year Ended December 31, 2023 to the Year Ended December 31, 2022” of our 2023 Annual Report on Form 10-K.
Management’s Discussion and Analysis of Financial Condition and Results of Operations—Results of Operations—Comparison of Results for the Year Ended December 31, 2024 to the Year Ended December 31, 2023” of our 2024 Annual Report on Form 10-K.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note (8) , Notes Payable and Credit Agreement.” As of December 31, 2024, the total of our contractual obligations under operating leases with initial terms in excess of one year was $50.2 million. We describe in further detail our operating lease arrangements in “Item 8.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note ( 9 ) , Notes Payable and Credit Agreement.” As of December 31, 2025, the total of our contractual obligations under operating leases with initial terms in excess of one year was $42.3 million. We describe in further detail our operating lease arrangements in “Item 8.
For periods between the actuarial studies, we record accruals based on loss rates provided in the most recent actuarial study and management’s review of loss history. Expense recognized for accruals (inclusive of actuarial-based adjustments) was $7.8 million, $5.5 million and $7.2 million for the years ended December 31, 2024, 2023 and 2022, respectively.
For periods 33 Table of Contents between the actuarial studies, we record accruals based on loss rates provided in the most recent actuarial study and management’s review of loss history. Expense recognized for accruals (inclusive of actuarial-based adjustments) was $18.9 million, $7.8 million and $5.5 million for the years ended December 31, 2025, 2024 and 2023, respectively.
We consider the following assumptions used in the income and market approaches to be significant assumptions in estimating the fair value of our reporting units: revenue growth rates, long-term growth rates, weighted average cost of capital, and selection of market multiples.
We consider the following assumptions used in the income approach to be significant assumptions in estimating the fair value of our reporting units: revenue growth rates and weighted-average cost of capital.
Excluding the acquisition of MSDR, our DSO was 66 days at December 31, 2023. Investing Activities Net cash used in investing activities for 2024, 2023 and 2022 was $79.9 million, $412.5 million and $170.7 million, respectively.
Excluding the acquisition of MSDR, our DSO was 66 days at December 31, 2023. Investing Activities Net cash provided by (used in) investing activities for 2025, 2024 and 2023 was $4.3 million, $(79.9) million and $(412.5) million, respectively.
We intend to finance potential future acquisitions with cash provided from operations, borrowings under our Senior Credit Facility, or other borrowings under our Amended Credit Agreement, bank loans, debt or equity offerings, or some combination of the foregoing. The following discussion provides further details of our liquidity and capital resources.
We intend to finance potential future acquisitions with cash provided from operations, borrowings under our Senior Credit Facility, or other borrowings under our Amended Credit Agreement, bank loans, debt or equity offerings, or some combination of the foregoing.
Of the $20.9 million of outstanding letters of credit, we have collateralized approximately $0.6 million in cash and cash equivalents and the remaining approximately $20.4 million is collateralized by the Senior Credit Facility.
Of the $20.8 million of outstanding letters of credit, we have collateralized approximately $0.7 million in cash and cash equivalents and the remaining approximately $20.2 million is collateralized by the Senior Credit Facility.
Liquidity and Capital Resources In summary, our cash flows were: (In Thousands) Years Ended December 31, 2024 2023 2022 Net cash provided by operating activities $ 320,418 $ 372,165 $ 653,733 Net cash used in investing activities (79,938) (412,493) (170,710) Net cash provided by (used in) financing activities (259,448) 10,729 (591,865) Net decrease in cash, cash equivalents and restricted cash (18,968) $ (29,599) $ (108,842) Historically, our primary liquidity requirements have been for acquisitions, working capital requirements, and debt service under our credit facilities and senior notes.
Liquidity and Capital Resources In summary, our cash flows were: (In Thousands) Years Ended December 31, 2025 2024 2023 Net cash provided by operating activities $ 269,457 $ 320,418 $ 372,165 Net cash provided by (used in) investing activities 4,302 (79,938) (412,493) Net cash provided by (used in) financing activities (295,893) (259,448) 10,729 Net decrease in cash, cash equivalents and restricted cash $ (22,134) $ (18,968) $ (29,599) Historically, our primary liquidity requirements have been for acquisitions, working capital requirements, and debt service under our credit facilities and senior notes.
Years Ended December 31, 2024 2023 2022 Consolidated Statements of Operations: Revenue 100.0 % 100.0 % 100.0 % Cost of revenue 69.2 67.0 67.3 Gross profit 30.8 33.0 32.7 Selling, general and administrative 21.2 20.0 17.9 Depreciation and amortization 5.5 4.1 2.5 Goodwill impairment losses 7.5 — — Income (loss) from operations (3.4) 8.9 12.3 Interest expense, net, and other 2.4 1.4 0.7 Income (loss) before income taxes (5.8) 7.5 11.6 Income tax expense (benefit) (0.9) 1.9 3.1 Net income (loss) (4.9) % 5.6 % 8.5 % Comparison of Results for the Year Ended December 31, 2024 to the Year Ended December 31, 2023 Revenue .
Years Ended December 31, 2025 2024 2023 Consolidated Statements of Operations: Revenue 100.0 % 100.0 % 100.0 % Cost of revenue 71.7 69.2 67.0 Gross profit 28.3 30.8 33.0 Selling, general and administrative 21.7 21.2 19.8 Depreciation and amortization 5.3 5.5 4.1 Gain on sale of disposal group (1.4) — — Goodwill impairment losses 4.0 7.5 — Long-lived assets impairment loss 0.7 — 0.2 Income (loss) from operations (2.0) (3.4) 8.9 Interest expense, net, and other 1.7 2.4 1.4 Income (loss) before income taxes (3.7) (5.8) 7.5 Income tax expense (benefit) (0.2) (0.9) 1.9 Net income (loss) (3.5) % (4.9) % 5.6 % Comparison of Results for the Year Ended December 31, 2025 to the Year Ended December 31, 2024 Revenue .
Income tax benefit was $25.6 million for 2024 as compared to income tax expense of $73.6 million for 2023, reflecting effective income tax rates of 15% and 26% for these periods, respectively.
Income tax benefit was $(5.4) million for 2025 as compared to income tax benefit of $(25.6) million for 2024, reflecting effective income tax rates of 5% and 15% for these periods, respectively.
The overall decline was partially offset by a change in sales mix resulting from lower revenue in our nurse and allied solutions segment. Gross margin by reportable segment for 2024 and 2023 was 24.5% and 26.4% for nurse and allied solutions, 29.7% and 34.3% for physician and leadership solutions, and 58.9% and 66.2% for technology and workforce solutions, respectively.
The overall decline was partially offset by a change in sales mix resulting from lower revenue in our nurse and allied solutions segment. Gross margin by reportable segment for 2025 and 2024 was 23.0% and 24.5% for nurse and allied solutions, 27.6% and 29.7% for physician and leadership solutions, and 52.7% and 58.9% for technology and workforce solutions, respectively.
For 2024 and 2023, revenue under our MSP arrangements comprised approximately 45% and 54% of our consolidated revenue, 67% and 72% for nurse and allied solutions segment revenue, 15% and 20% for physician and leadership solutions segment revenue, and 3% and 2% of our technology and workforce solutions segment revenue, respectively. Cost of Revenue .
For 2025 and 2024, revenue under our MSP arrangements comprised approximately 48% and 45% of our consolidated revenue, 71% and 67% for nurse and allied solutions segment revenue, 18% and 15% for physician and leadership solutions segment revenue, and 3% and 3% of our technology and workforce solutions segment revenue, respectively. Cost of Revenue .
Goodwill impairment losses of $123.3 million and $99.2 million were recognized in the nurse and allied solutions segment and physician and leadership solutions segment, respectively, during the year ended December 31, 2024. See additional information in “Item 8.
A goodwill impairment loss of $109.5 million was recognized in the physician and leadership solutions segment during the year ended December 31, 2025 as compared to $123.3 million and $99.2 million in the nurse and allied solutions segment and physician and leadership solutions segment, respectively, during the year ended December 31, 2024. See additional information in “Item 8.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note (7) , Income Taxes, and Note ( 4 ) , Goodwill and Identifiable Assets.” Comparison of Results for the Year Ended December 31, 2023 to the Year Ended December 31, 2022 We describe in detail the comparison of results for the years ended December 31, 2023 and 2022 in “Item 7.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note ( 8 ) , Income Taxes, and Note (3) , Sale of Disposal Group.” Comparison of Results for the Year Ended December 31, 2024 to the Year Ended December 31, 2023 We describe in detail the comparison of results for the years ended December 31, 2024 and 2023 in “Item 7.
Financing Activities 28 Table of Contents Net cash provided by (used in) financing activities for 2024, 2023 and 2022 was $(259.4) million, $10.7 million and $(591.9) million, respectively.
Financing Activities Net cash provided by (used in) financing activities for 2025, 2024 and 2023 was $(295.9) million, $(259.4) million and $10.7 million, respectively.
The following table 32 Table of Contents presents the case reserves, IBNR losses and excess liability as estimated by the most recently obtained actuarial study that make up our accrual for professional liability as of December 31, 2024 and 2023: (In Thousands) December 31, 2024 2023 Case reserves (1) $ 11,590 $ 8,503 IBNR losses (1) 21,823 24,893 Excess liability (2) 13,289 11,256 Total accrual $ 46,702 $ 44,652 (1) The provisions for case reserves and estimated IBNR losses are presented net of excess liability.
The following table presents the case reserves, IBNR losses and excess liability as estimated by the most recently obtained actuarial study that make up our accrual for professional liability as of December 31, 2025 and 2024: (In Thousands) December 31, 2025 2024 Case reserves (1) $ 17,735 $ 11,590 IBNR losses (1) 23,586 21,823 Excess liability (2) 12,618 13,289 Total accrual $ 53,939 $ 46,702 (1) The provisions for case reserves and estimated IBNR losses are presented net of excess liability.
There have been no other new accounting pronouncements issued but not yet adopted that are expected to materially affect our consolidated financial condition or results of operations.
We are currently evaluating the impact of adopting this standard on our consolidated financial statements and disclosures. There have been no other new accounting pronouncements issued but not yet adopted that are expected to materially affect our consolidated financial condition or results of operations.
The decline in consolidated gross margin for the year ended December 31, 2024 was primarily due to (1) lower margins in our nurse and allied solutions and physician and leadership solutions segments driven by higher provider pay packages, including housing, travel and allowances and (2) a lower margin in our technology and workforce solution segment primarily due to a change in sales mix resulting from lower revenue in our higher-margin VMS business and higher revenue in our lower-margin language services business.
The decline in consolidated gross margin for the year ended December 31, 2025 was primarily due to (1) lower margins in our nurse and allied solutions and physician and leadership solutions segments driven by compression in clinician pay packages, including housing, travel and allowances and (2) a lower margin in our technology 26 Table of Contents and workforce solutions segment primarily due to pricing pressure for our language services business due to increased market competition and a shift in sales mix resulting from reduced revenue in our higher-margin VMS business and the sale of our Smart Square healthcare scheduling software.
Business—Our Services.” We believe we are recognized as a market-leading innovator in providing healthcare talent solutions in the United States. We seek to advance our position through a number of strategies that focus on market penetration, expansion of our talent solutions, increasing operational efficiency and scalability and increasing our supply of qualified healthcare professionals.
We seek to advance our position through a number of strategies that focus on market penetration, expansion of our talent solutions, increasing operational efficiency and scalability and increasing our supply of qualified healthcare professionals.
Revenue decreased 21% to $2,983.8 million for 2024 from $3,789.3 million for 2023, attributable to a decline in organic revenue across our segments with the greatest decline in our nurse and allied solutions segment. Nurse and allied solutions segment revenue decreased 31% to $1,815.7 million for 2024 from $2,624.5 million for 2023.
Revenue decreased 8% to $2,730.4 million for 2025 from $2,983.8 million for 2024, attributable to a decline in organic revenue across our segments with the greatest decline in our nurse and allied solutions segment.
The $808.8 million decrease was primarily attributable to a $592.1 million decline driven by a 24% decrease in the average number of travelers on assignment, a $257.0 million decline driven by an approximately 10% decrease in the average bill rate, and a $41.1 million decline driven by a 2% decrease in average billable hours during the year ended December 31, 2024.
The $168.4 million decrease was primarily attributable to a $240.1 million decline driven by a 14% decrease in the average number of travelers on assignment, a $32.0 million decline driven by a 2% decrease in the average bill rate, and a $14.4 million decline driven by a 1% decrease in average billable hours during the year ended December 31, 2025.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note (2) , Acquisitions.” We typically experience modest seasonal fluctuations during our fiscal year and they tend to vary among our business segments. These fluctuations can vary slightly in intensity from year to year. Over the past five years, these quarterly fluctuations have been muted in our consolidated results.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note (3) , Sale of Disposal Group.” We typically experience modest seasonal fluctuations during our fiscal year and they tend to vary among our business segments. These fluctuations can vary slightly in intensity from year to year.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note (8) , Notes Payable and Credit Agreement.” 4.625% Senior Notes Due 2027 On August 13, 2020, AMN Healthcare, Inc., a wholly owned subsidiary of the Company, completed the issuance of an additional $200.0 million aggregate principal amount of 4.625% senior notes due 2027 (the “New 2027 Notes”), which were issued at a price of 101.000% of the aggregate principal amount.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note ( 9 ) , Notes Payable and Credit Agreement.” 4.000% Senior Notes Due 2029 On October 20, 2020, AMN Healthcare, Inc., a wholly owned subsidiary of the Company, completed the issuance of $350.0 million aggregate principal amount of 4.000% Senior Notes due 2029 (the “2029 Notes”).
As of December 31, 2024, we do not have any indefinite-lived intangible assets. We performed a quantitative impairment test of our goodwill as of October 31, 2024 and determined that the estimated fair values of the nurse and allied solutions and physician and leadership solutions reporting units were below their respective carrying amounts.
As of December 31, 2025, we do not have any indefinite-lived intangible assets . During the second quarter of 2025, we performed a quantitative impairment test of our goodwill as of May 31, 2025 and determined that the estimated fair value of the physician and leadership solutions reporting unit was below its respective carrying amount.
SG&A expenses broken down among the reportable segments, unallocated corporate overhead, and share-based 26 Table of Contents compensation are as follows: (In Thousands) Years Ended December 31, 2024 2023 Nurse and allied solutions $ 270,467 $ 330,252 Physician and leadership solutions 137,600 134,505 Technology and workforce solutions 91,590 118,977 Unallocated corporate overhead 109,515 154,484 Share-based compensation 23,317 18,020 $ 632,489 $ 756,238 Depreciation and Amortization Expenses .
SG&A expenses broken down among the reportable segments, unallocated corporate overhead, and share-based compensation are as follows: (In Thousands) Years Ended December 31, 2025 2024 Nurse and allied solutions $ 252,307 $ 270,467 Physician and leadership solutions 135,263 137,600 Technology and workforce solutions 86,413 91,590 Unallocated corporate overhead 88,356 109,515 Share-based compensation 30,683 23,317 $ 593,022 $ 632,489 Depreciation and Amortization Expenses .
As a result of a decline in demand, revenue in our interim leadership business experienced a decline of $21.3 million (or 16%), while our physician permanent placement and executive search businesses declined $21.4 million (or 31%) during 2024. Technology and workforce solutions segment revenue decreased 11% to $439.5 million for 2024 from $495.0 million for 2023.
Our interim leadership business experienced a decline of $21.8 million (or 19%) and our physician permanent placement and executive search businesses declined $9.3 million (or 20%) during 2025. Technology and workforce solutions segment revenue decreased 12% to $386.7 million for 2025 from $439.5 million for 2024.
The 2027 Notes and the guarantees are not subject to any registration rights agreement. 4.000% Senior Notes Due 2029 On October 20, 2020, AMN Healthcare, Inc., a wholly owned subsidiary of the Company, completed the issuance of $350.0 million aggregate principal amount of 4.000% Senior Notes due 2029 (the “2029 Notes”). The 2029 Notes will mature on April 15, 2029.
The 2029 Notes and the guarantees are not subject to any registration rights agreement. 6.500% Senior Notes Due 2031 On October 6, 2025, AMN Healthcare, Inc., a wholly owned subsidiary of AMN Healthcare Services, Inc. (the “Company”), completed the issuance of $400.0 million aggregate principal amount of 6.500% Senior Notes due 2031 (the “2031 Notes”).
Nurse and allied solutions segment revenue comprised 61% and 69% of total consolidated revenue for the years ended December 31, 2024 and 2023, respectively. Physician and leadership solutions segment revenue comprised 24% and 18% of total consolidated revenue for the years ended December 31, 2024 and 2023, respectively.
Physician and leadership solutions segment revenue comprised 26% and 24% of total consolidated revenue for the years ended December 31, 2025 and 2024, respectively. Technology and workforce solutions segment revenue comprised 14% and 15% of total consolidated revenue for the years ended December 31, 2025 and 2024, respectively.
The overall decrease in net cash provided by operating activities was partially offset by (1) an increase in accrued compensation and benefits between periods of $68.8 million primarily due to bonuses and commissions that were paid during the first quarter of 2023, (2) an increase in other liabilities between periods of $54.7 million primarily due to client deposits related to labor disruption services in the current year, and (3) an increase in accounts payable and accrued expenses between periods of $28.6 million primarily due to (a) a larger decrease in the subcontractor payable balance in the prior year as compared to the current year primarily attributable to declines in associate vendor usage and (b) a decrease in the accrued expenses balance in the current year as a result of a decrease in operating expenses associated with our revenue decline and timing of payments, partially offset by a payment of the legal settlement amount for the Clarke matter in the current year.
The overall decrease in net cash provided by operating activities was partially offset by (1) an increase in accounts payable and accrued expenses between periods of $134.3 million primarily due to payment of the legal settlement amount for the Clarke matter in the prior year and a smaller reduction in subcontractor payables in the current year as a result of a larger decline in associate vendor usage in the prior year and timing of payments, (2) an increase in deferred revenue between periods of $7.4 million primarily related to upfront consideration for labor disruption services, and (3) a decrease in income taxes receivable between periods of $7.2 million primarily due to a larger overpayment of estimated taxes in the prior year compared to the current year.
In the discounted cash flow method, each reporting unit’s estimated future cash flows are discounted at a rate that is consistent with a weighted-average cost of capital (WACC), which represents the after-tax rate of return required by a market participant, which is based on observed market return data and company-specific risk factors.
Keeping all other assumptions constant, a change in the projected revenue growth over the forecast period of 50 basis points would have increased or reduced the goodwill impairment loss recognized in the second quarter of 2025 by approximately 4%. 32 Table of Contents In the discounted cash flow method, each reporting unit’s estimated future cash flows are discounted at a rate that is consistent with a weighted-average cost of capital (WACC), which represents the after-tax rate of return required by a market participant, which is based on observed market return data and company-specific risk factors.
The overall decrease was partially offset by a $50.0 million increase in labor disruption revenue. Physician and leadership solutions segment revenue increased 9% to $728.6 million for 2024 from $669.7 million for 2023.
The overall decrease was partially offset by a $127.9 million increase in labor disruption revenue. Physician and leadership solutions segment revenue decreased 4% to $696.4 million for 2025 from $728.6 million for 2024. The $32.2 million decrease was attributable to lower revenue across all businesses within the segment.
The acquisitions during the three years ended December 31, 2024 impact the comparability of the results between the years presented. See additional information in “Item 8. Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note (2) , Acquisitions.” Our historical results are not necessarily indicative of our results of operations to be expected in the future.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note (2) , Acquisitions and Note ( 3 ) , Sale of Disposal Group.” Our historical results are not necessarily indicative of our results of operations to be expected in the future.
Demand for our interim leadership and search businesses in the fourth quarter was below prior year, but demand in our interim leadership business was up sequentially. Demand for these businesses has been impacted by healthcare organizations deferring hiring decisions or increasing insourcing.
Demand for our search business was lower as compared to prior year and prior quarter. Both businesses have been impacted by healthcare organizations deferring hiring decisions or increasing insourcing.
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note (4) , Goodwill and Identifiable Intangible Assets.” Interest Expense, Net, and Other . Interest expense, net, and other, was $69.9 million for 2024 as compared to $54.1 million for 2023. The increase was primarily due to a higher average debt outstanding balance during 2024. Income Tax Expense .
Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements— Note (5) , Goodwill and Identifiable Intangible Assets.” Interest Expense, Net, and Other . Interest expense, net, and other, was $45.6 million for 2025 as compared to $69.9 million for 2024.
Cost of revenue, which consists predominantly of compensation, benefits, housing, travel and allowance costs for healthcare professionals and medically qualified interpreters, decreased 19% to $2,064.4 million for 2024 from $2,539.7 million for 2023.
Cost of revenue, which consists predominantly of compensation, benefits, housing, travel and allowance costs for healthcare professionals and medically qualified interpreters, decreased 5% to $1,956.4 million for 2025 from $2,064.4 million for 2024. The $108.0 million decrease was primarily attributable to a decrease in our nurse and allied solutions segment.
Certified registered nurse anesthetists (CRNAs) continue to be the largest specialty for our locum tenens staffing business. Revenue per day filled increased in the 24 Table of Contents fourth quarter as compared to both the prior year and prior quarter.
In our physician and leadership solutions segment, demand for our locum tenens staffing business in the fourth quarter increased from the prior quarter and was in line with the prior year. Certified registered nurse anesthetists (CRNAs) continue to be the largest specialty for our locum tenens staffing business.
Operating Metrics In addition to our consolidated and segment financial results, we monitor the following key metrics to help us evaluate our results of operations and financial condition and make strategic decisions.
Even if somewhat recurrent over the long term, labor disruption events are unpredictable and have driven spikes in demand and related financial outcomes when they happen. Operating Metrics In addition to our consolidated and segment financial results, we monitor the following key metrics to help us evaluate our results of operations and financial condition and make strategic decisions.
Net cash provided by financing activities for 2023 was primarily due to borrowings of $815.0 million under the Senior Credit Facility, partially offset by (1) $424.7 million paid in connection with the repurchase of our common stock, (2) repayments of $355.0 million under the Senior Credit Facility, and (3) $13.1 million in cash paid for shares withheld for payroll taxes resulting from the vesting of employee equity awards.
Net cash used in financing activities for 2025 was primarily due to (1) the repayment of $500.0 million related to the redemption of the 2027 Notes, (2) repayments of $315.0 million under the Senior Credit Facility (as defined below), (3) $8.8 million of financing costs paid in connection with the Amended Credit Agreement (as defined below) and the issuance of the 2031 Notes (as defined below), and (4) $2.1 million in cash paid for shares withheld for payroll taxes resulting from the vesting of employee equity awards, partially offset by (1) proceeds received in connection with the issuance of the 2031 Notes of $400.0 million and (2) borrowings of $130.0 million under the Senior Credit Facility.
For the year ended December 31, 2024, we recorded revenue of $2,983.8 million, as compared to $3,789.3 million for 2023. We recorded net income (loss) of $(147.0) million for 2024, as compared to $210.7 million for 2023.
For the year ended December 31, 2025, we recorded revenue of $2,730.4 million, as compared to $2,983.8 million for 2024. We recorded net loss of $(95.7) million for 2025, as compared to $(147.0) million for 2024. Nurse and allied solutions segment revenue comprised 60% and 61% of total consolidated revenue for the years ended December 31, 2025 and 2024, respectively.
VMS bill rates in the fourth quarter were down sequentially and year over year. Results of Operations The following table sets forth, for the periods indicated, certain statements of operations data as a percentage of revenue. Our results of operations include three reportable segments: (1) nurse and allied solutions, (2) physician and leadership solutions, and (3) technology and workforce solutions.
Volumes and bill rates in our VMS business were both lower compared to the prior year and prior quarter. Results of Operations The following table sets forth, for the periods indicated, certain statements of operations data as a percentage of revenue.
We have funded these requirements through internally generated cash flow and funds borrowed under our credit facilities and senior notes. 27 Table of Contents As of December 31, 2024, (1) $210.0 million was drawn with $519.6 million of available credit under the Senior Credit Facility (as defined below), (2) the aggregate principal amount of our 2027 Notes (as defined below) outstanding was $500.0 million, and (3) the aggregate principal amount of our 2029 Notes (as defined below) outstanding was $350.0 million.
As of December 31, 2025, (1) $25.0 million was drawn with $404.8 million of available credit under the Senior Credit Facility (as defined below), (2) the aggregate principal amount of our 2029 Notes (as defined below) outstanding was $350.0 million, and (3) the aggregate principal amount of our 2031 Notes (as defined below) outstanding was $400.0 million.
Amortization expense increased 3% to $92.8 million for 2024 from $89.8 million for 2023, primarily attributable to additional amortization expense related to the intangible assets acquired in the MSDR acquisition, partially offset by having more intangible assets fully amortized during the year ended December 31, 2024.
Amortization expense decreased 16% to $78.0 million for 2025 from $92.8 million for 2024, primarily attributable to having more intangible assets fully amortized during the year ended December 31, 2025. Depreciation expense (exclusive of depreciation included in cost of revenue) decreased 6% to $69.8 million for 2025 from $74.3 million for 2024, primarily attributable to the mix of depreciable assets.
Revenue in our locum tenens business grew $101.6 million (or 22%) during 2024 primarily due to the favorable impact of $23.9 million as a result of a 6% increase in the revenue per day filled on an organic basis and additional revenue of $121.2 million in connection with the MSDR acquisition, partially offset by a $43.5 million decline driven by a 10% decrease in the number of days filled on an organic basis.
Revenue in our locum tenens business declined slightly during 2025 primarily due to a $42.9 million decline driven by an 8% decrease in the number of days filled, partially offset by a $41.7 million increase driven by an 8% increase in the revenue per day filled.
Operating Activities Net cash provided by operating activities for 2024, 2023 and 2022 was $320.4 million, $372.2 million and $653.7 million, respectively.
The following discussion provides further details of our liquidity and capital resources. 28 Table of Contents Operating Activities Net cash provided by operating activities for 2025, 2024 and 2023 was $269.5 million, $320.4 million and $372.2 million, respectively.
We are currently evaluating the impact of adopting this standard on our disclosures. In November 2024, the FASB issued ASU 2024-03, “Income Statement—Reporting Comprehensive Income—Expense Disaggregation Disclosures (Subtopic 220-40): Disaggregation of Income Statement Expenses,” which is intended to improve disclosures about the expenses of public entities.
Recent Accounting Pronouncements In November 2024, the FASB issued ASU 2024-03, “Income Statement—Reporting Comprehensive Income—Expense Disaggregation Disclosures (Subtopic 220-40): Disaggregation of Income Statement Expenses”.
The year-over-year decrease from 2023 to 2024 in net cash used in investing activities was primarily attributable to (1) no cash paid for acquisitions in 2024 as compared to $292.2 million in 2023 and (2) $8.4 million of payments to fund the deferred compensation plan in 2024 as compared to $24.9 million in 2023.
The year-over-year change from 2024 to 2025 in net cash provided by (used in) investing activities was primarily attributable to (1) proceeds from the sale of disposal group of $65.3 million in 2025, (2) a net purchase of investments of $25.4 million in 2025 as compared to net proceeds of investments of $7.7 million in 2024, and (3) $6.4 million of payments to fund the deferred compensation plan that were offset with $6.4 million of proceeds from settlements of company-owned life insurance policies in 2025 as compared to $8.4 million of payments in 2024.
Cost of revenue broken down among the reportable segments is as follows: (In Thousands) Years Ended December 31, 2024 2023 Nurse and allied solutions $ 1,371,660 $ 1,932,099 Physician and leadership solutions 511,959 440,230 Technology and workforce solutions 180,786 167,344 $ 2,064,405 $ 2,539,673 Gross Profit .
Cost of revenue broken down among the reportable segments is as follows: (In Thousands) Years Ended December 31, 2025 2024 Nurse and allied solutions $ 1,269,045 $ 1,371,660 Physician and leadership solutions 504,503 511,959 Technology and workforce solutions 182,823 180,786 $ 1,956,371 $ 2,064,405 The decrease in our nurse and allied solutions segment was primarily attributable to a $97.8 million decrease in provider pay package costs, including housing, travel and allowances, primarily due to the aforementioned decrease in the average number of travelers on assignment.
Keeping all other assumptions constant and excluding the effect of deferred income taxes, a change in the WACC of 50 basis points would have increased or reduced the goodwill impairment losses by approximately $30.0 million.
As a result, we recognized an impairment loss on the customer relationships intangible assets of $18.3 million during the second quarter of 2025. Keeping all other assumptions constant, a change in WACC and projected revenue growth of 50 basis points would have increased or reduced the impairment loss by approximately 3% and 1%, respectively.
The increase in our physician and leadership solutions segment was driven by a $71.8 million increase in provider pay package costs, primarily due to the MSDR acquisition. The increase in our technology and workforce solutions segment was primarily attributable to $13.1 million of higher compensation and benefits mainly from the aforementioned increase in minutes in our language services business.
The decrease in our physician and leadership solutions segment was primarily driven by a $14.5 million decrease in provider pay package costs in our interim leadership business, primarily due to aforementioned decline in demand, partially offset by a $7.3 million increase in provider pay package costs in our locum tenens business.
Keeping all other assumptions constant and excluding the effect of deferred income taxes, a change in the revenue growth rates over the entire forecast period of 25 basis points would have increased or reduced the goodwill impairment losses by approximately $37.0 million.
Keeping all other assumptions constant, a change in the projected revenue growth over the forecast period of 50 basis points would have increased or reduced the excess fair value over the carrying value by approximately 2% for the nurse and allied solutions reporting unit, approximately 1% for the physician and leadership solutions reporting unit, and approximately 8% for the technology and workforce solutions reporting unit.
Additionally, $6.7 million and $6.0 million of depreciation expense for our language services business is included in cost of revenue for 2024 and 2023, respectively. Goodwill Impairment Losses .
Additionally, $8.7 million and $6.7 million of depreciation expense for our language services business is included in cost of revenue for 2025 and 2024, respectively. Gain on Sale of Disposal Group . A gain on sale of disposal group of $(39.1) million was recognized during the year ended December 31, 2025. See additional information in “Item 8.
Bill rates in the fourth quarter were flat to the prior quarter after a modest sequential decline, which we believe indicates stabilization of market rates. In our physician and leadership solutions segment, demand for our locum tenens staffing business in the fourth quarter declined from the prior year though it was higher compared with the prior quarter.
Bill rates for the nurse and allied solutions segment in the fourth quarter were slightly higher than prior quarter and flat compared to prior year, indicating stabilization of market rates.
The new guidance addresses investor requests for enhanced income tax information primarily through requiring disclosure of additional information about and further disaggregation of the rate reconciliation and income taxes paid. This standard is effective on a prospective basis for fiscal years beginning after December 15, 2024, with early adoption permitted.
The ASU clarifies interim disclosure requirements and the applicability of Topic 270. The amendment of current guidance provides further clarity about the current interim disclosure requirements. This standard is effective on either a prospective or retrospective basis for fiscal years beginning after December 15, 2027, including interim periods within those fiscal years, with early adoption permitted.
The new guidance requires more detailed information about the types of expenses in commonly presented expense captions (such as cost of sales and selling, general, and administrative expenses) and requires public entities to disclose, on an annual and interim basis, the amounts of expenses included in each relevant expense caption presented on the face of the income statement within continuing operations, in a tabular format.
The guidance requires public entities to disclose, in the notes to the financial statement, a disaggregation of certain expense categories that are included within the line items presented on the face of income statements, on an annual and interim basis.
Staffing volumes for our nurse and allied solutions segment during the fourth quarter were flat to the prior quarter after sequential declines throughout 2023 and 2024. Visa retrogression has negatively impacted international nurse volumes, which we expect to continue into next year. Additionally, we supported a significant labor disruption event in the fourth quarter, which favorably impacted the segment’s revenue.
The increase in staffing volume was due to strong winter orders and volume in travel nursing, seasonal growth in allied staffing for schools, and a return to modest growth of the international nurse business after nine quarters of decline. Additionally, we supported a significant labor disruption event in the fourth quarter which favorably impacted the segment’s revenue.
Technology and workforce solutions segment revenue comprised 15% and 13% of total consolidated revenue for the years ended December 31, 2024 and 2023, respectively. For a description of the services we provide under each of our business segments, please see, “Item 1.
For a description of the services we provide under each of our business segments, please see, “Item 1. Business—Our Services.” We believe we are recognized as a market-leading innovator in providing healthcare talent solutions in the United States.

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Item 7A. Quantitative and Qualitative Disclosures About Market Risk

Market Risk — interest-rate, FX, commodity exposure

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Biggest changeA 100 basis point increase in interest rates on our variable rate debt would not have resulted in a material effect on our consolidated financial statements for 2024. A 100 basis point change in interest rates as of December 31, 2024 would not have resulted in a material effect on the fair value of our investment portfolio.
Biggest changeA 100 basis point increase in interest rates on our variable rate debt would not have resulted in a material effect on our consolidated financial statements for 2025. A 100 basis point change in interest rates as of December 31, 2025 would not have resulted in a material effect on the fair value of our investment portfolio.
Item 7A. Quantitative and Qualitative Disclosures about Market Risk Market risk is the risk of loss arising from adverse changes in market rates and prices, such as interest rates, foreign currency exchange rates and commodity prices. During 2024, our primary exposure to market risk was interest rate risk associated with our variable interest debt instruments and our investment portfolio.
Item 7A. Quantitative and Qualitative Disclosures about Market Risk Market risk is the risk of loss arising from adverse changes in market rates and prices, such as interest rates, foreign currency exchange rates and commodity prices. During 2025, our primary exposure to market risk was interest rate risk associated with our variable interest debt instruments and our investment portfolio.
During 2024, we generated substantially all of our revenue in the United States. Accordingly, we believe that our foreign currency risk is immaterial. 34 Table of Contents
During 2025, we generated substantially all of our revenue in the United States. Accordingly, we believe that our foreign currency risk is immaterial. 35 Table of Contents

Other AMN 10-K year-over-year comparisons