AMN Healthcare Announces First Quarter 2021 Results

AMN Healthcare Services, Inc. (NYSE: AMN), the leader and innovator in total talent solutions for healthcare organizations across the United States, today announced its first quarter 2021 financial results. Financial highlights are as follows:

Dollars in millions, except per share amounts.

^{* See "Non-GAAP Measures” below for a discussion of our use of non-GAAP items and the table entitled "Non-GAAP Reconciliation Tables” for a reconciliation of non-GAAP items.}

Business Highlights

• First quarter revenue and earnings were the highest in company history.
• All reportable segments had higher demand and placement trends over Q4 2020 as overall healthcare utilization rises across acute and non-acute settings.
• Revenue of $886 million was 47% above prior year, with organic growth of 44%. Growth was driven most by nurse and allied staffing along with our language services and vendor management systems businesses.
• Operating cash flow in the quarter was $39 million, and our leverage ratio at quarter end was 2.2 to 1.
• In early April, we completed the acquisition of Synzi Holdings Inc., a virtual care communication platform that expands our solutions for the home health and outpatient care markets.

"We are in extraordinary times for our country and by far the most dynamic in the history of AMN. We want to express our profound gratitude for the way our healthcare professionals and team members are responding when our clients and communities need them most,” said Susan R. Salka, Chief Executive Officer of AMN Healthcare. "Our work in the healthcare community is vital as we are supporting many facets of healthcare delivery during this time of transition. While the pandemic has moved to a later stage, increasing non-COVID patient volumes, high job vacancy rates and heightened burnout are creating significant need. AMN is uniquely positioned to bring technology solutions and talent to help our clients efficiently address these workforce challenges.

"The impact of severe shortages of talent within healthcare will have lasting effects,” Ms. Salka said. "To ensure AMN is well-prepared to continue evolving and delivering on our promise of total talent solutions, we are increasing investments in our team and technologies, in particular our digital capabilities. At the same time, we are making greater investments in building talent solutions for all reaches of the care continuum. Last month, we were thrilled to close the acquisition of Synzi, adding technology-enabled virtual care solutions for the outpatient and home health markets, where more healthcare will be delivered in the future.”

First Quarter 2021 Results

Consolidated revenue for the quarter was $886 million, a 47% increase over prior year and 40% higher than prior quarter. On an organic basis, consolidated revenue was up 44% over prior year. Consolidated revenue in the quarter included approximately $25 million from vaccination-related projects. Net income was $70 million (7.9% of revenue), or $1.47 per diluted share, compared with $13 million (2.2% of revenue), or $0.27 per diluted share, in the same quarter last year. Adjusted diluted EPS in the first quarter was $1.70.

Revenue for the Nurse and Allied Solutions segment was $657 million up 55% year over year and 47% sequentially. Travel nurse staffing revenue grew 74% year over year. Allied division revenue was higher by 17% year over year. Revenue cycle solutions revenue was down more than 30% from prior year though improved by 8% sequentially.

The Physician and Leadership Solutions segment reported revenue of $141 million, up 2% year over year and 27% sequentially. Locum tenens revenue was $86 million, up 9% year over year and 27% sequentially. Year-over-year growth in locums was driven by stronger revenue per day filled, while sequential growth also saw an 18% increase in days filled. Interim leadership revenue was lower by 3% year over year while growing 34% sequentially. Our physician and leadership search businesses had sequential revenue growth of 12% though being 16% lower compared with a year ago.

Technology and Workforce Solutions segment revenue was $89 million for an increase of 120% year over year (up 84% organic), driven by our February 2020 acquisition of Stratus Video, now known as AMN Language Services. Our language services business achieved $41 million revenue in the quarter with growth in new clients and same-client volumes. Our vendor management systems business rode the healthcare staffing market's strength, growing revenue 91% year over year.

Consolidated gross margin was 32.6%, 90 basis points lower year over year and down 30 basis points sequentially. Year over year, the lower gross margin was driven in large part by margin compression in the Nurse and Allied segment and a higher mix of revenue from this segment. The sequential variance stemmed primarily from the segment mix shift driven by Nurse and Allied growth.

Consolidated SG&A expenses were $161 million, or 18.2% of revenue, compared with $146 million, or 24.3% of revenue, in the same quarter last year. SG&A was $155 million, or 24.6% of revenue, in the previous quarter. The year-over-year increase in SG&A costs was driven by higher employee and related expenses. SG&A margin declined due to operating leverage on increased revenue.

Income from operations was $104 million with an operating margin of 11.8%, compared with $36 million and 5.9%, respectively, in the same quarter last year. Adjusted EBITDA was $141 million, a year-over-year increase of 90%. Adjusted EBITDA margin was 15.9%, representing an increase of 360 basis points year over year.

At March 31, 2021, cash and cash equivalents totaled $78 million. Cash flow from operations was $39 million for the quarter, and capital expenditures were $12 million. The Company ended the quarter with total debt outstanding of $905 million and a leverage ratio of 2.2 to 1 as defined under our credit agreement.

Acquisition of Synzi

In April 2021, we completed the acquisition of Synzi, a full-service virtual care management company, for $42.5 million in cash. Synzi provides virtual care and remote patient monitoring platforms in the home health and outpatient markets. These solutions enable organizations to conduct virtual visits and use secure messaging, text, and email for clinician-to-patient and clinician-to-clinician communications.

"I am excited to welcome the talented Synzi team to the AMN family,” Ms. Salka said. "We believe the combination of the Synzi platform and AMN services will give us a strong offering for post-acute care. Health systems' continuum of care is expanding, and we will use the AMN-Synzi combination to help our clients expand their scope of care.”

Second Quarter 2021 Outlook

^{*Note: Guidance percentage metrics are approximate. For a reconciliation of adjusted EBITDA margin, see the table entitled "Reconciliation of Guidance Operating Margin to Guidance Adjusted EBITDA Margin” below.}

Revenue in the second quarter of 2021 is expected to be 33-36% higher than prior year. Nurse and Allied Solutions segment revenue is expected to grow 34-37% year over year. Within this segment, we expect travel nurse staffing revenue to be up 30-33% from prior year. Allied revenue is expected to grow by about 38-40% year over year. In the Physician and Leadership Solutions segment, revenue is expected to be up approximately 20% from prior year. Technology and Workforce Solutions segment revenue is expected to increase by 60-65% compared with the year-ago period. Revenue guidance includes approximately $30 million from vaccination-related projects.

Second quarter estimates for certain other financial items include depreciation of $8 million, non-cash amortization expense of $16 million, stock-based compensation expense of $6 million, interest expense of $10 million, integration and other expenses of $3 million, and an adjusted tax rate of 28%.

Conference Call on May 6, 2021

AMN Healthcare Services, Inc. (NYSE: AMN), the leader and innovator in total talent solutions for healthcare, will host a conference call to discuss its first quarter 2021 financial results and outlook on Thursday, May 6, 2021 at 5:00 p.m. Eastern Time. A live webcast of the call can be accessed through AMN Healthcare’s website at http://ir.amnhealthcare.com. Please log in at least 10 minutes prior to the conference call in order to download the applicable audio software. Interested parties may participate live via telephone by dialing (833) 968-2219 in the U.S. or +1 778-560-2894 internationally and using passcode 5248833. Following the conclusion of the call, a replay of the webcast will be available at the Company’s website. Alternatively, a telephonic replay of the call will be available starting at 8:00 p.m. Eastern Time on May 6, 2021 and can be accessed until 11:59 p.m. Eastern Time on May 20, 2021 by calling (800) 585-8367 in the U.S. or +1 416-621-4642 internationally, with access code 5248833.

About AMN Healthcare

AMN Healthcare is the leader and innovator in total talent solutions for healthcare organizations across the nation. The Company provides access to the most comprehensive network of quality healthcare professionals through its innovative recruitment strategies and breadth of career opportunities. With insights and expertise, AMN Healthcare helps providers optimize their workforce to successfully reduce complexity, increase efficiency and improve patient outcomes. AMN total talent solutions include managed services programs, clinical and interim healthcare leaders, temporary staffing, executive search solutions, vendor management systems, recruitment process outsourcing, predictive modeling, language services, revenue cycle solutions, credentialing, and other services. Clients include acute-care hospitals, community health centers and clinics, physician practice groups, retail and urgent care centers, home health facilities, schools and many other healthcare settings. AMN Healthcare is committed to fostering and maintaining a diverse team that reflects the communities we serve. Our commitment to the inclusion of many different backgrounds, experiences and perspectives enables our innovation and leadership in the healthcare services industry.

The Company’s common stock is listed on the New York Stock Exchange under the symbol "AMN.” For more information about AMN Healthcare, visit www.amnhealthcare.com, where the Company posts news releases, investor presentations, webcasts, SEC filings and other material information. The Company also utilizes email alerts and Really Simple Syndication ("RSS”) as routine channels to supplement distribution of this information. To register for email alerts and RSS, visit http://ir.amnhealthcare.com.

Non-GAAP Measures

This earnings release and the non-GAAP reconciliation tables included with the earnings release contain certain non-GAAP financial information, which the Company provides as additional information, and not as an alternative, to the Company’s condensed consolidated financial statements presented in accordance with GAAP. These non-GAAP financial measures include (1) adjusted EBITDA, (2) adjusted EBITDA margin, (3) adjusted net income and (4) adjusted diluted EPS. The Company provides such non-GAAP financial measures because management believes that they are useful to both management and investors as a supplement, and not as a substitute, when evaluating the Company’s operating performance. Additionally, management believes that adjusted EBITDA, adjusted EBITDA margin, adjusted net income and adjusted diluted EPS serve as industry-wide financial measures. The Company uses adjusted EBITDA for making financial decisions, allocating resources and for determining certain incentive compensation objectives. The non-GAAP measures in this release are not in accordance with, or an alternative to, GAAP measures and may be different from non-GAAP measures, or may be calculated differently than other similarly titled non-GAAP measures, reported by other companies. They should not be used in isolation to evaluate the Company’s performance. A reconciliation of non-GAAP measures identified in this release, along with further detail about the use and limitations of certain of these non-GAAP measures, may be found below in the table entitled "Non-GAAP Reconciliation Tables” under the caption entitled "Reconciliation of Non-GAAP Items” and the footnotes thereto or on the Company’s website at https://ir.amnhealthcare.com/financials/quarterly-results/default.aspx. Additionally, from time to time, additional information regarding non-GAAP financial measures, including pro forma measures, may be made available on the Company’s website.

Forward-Looking Statements

This press release contains "forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. Forward-looking statements include, among others, statements concerning the impact and duration of severe talent shortages, the growth opportunity for our total talent solutions, our positioning and ability to serve our clients with our talent solutions, the effect that the COVID-19 pandemic is having on the healthcare market and its job vacancy rates, the impact that the Company's Synzi acquisition will have on the Company's ability to deliver services to the outpatient and home care markets, second quarter 2021 volumes, rates and hours worked for our travel nurse business, second quarter 2021 revenue projections for our travel nurse and allied businesses and each of our Nurse and Allied Solutions, Physician and Leadership Solutions and Technology and Workforce Solutions segments, and our second quarter 2021 guidance for consolidated revenue, gross margin, operating margin, SG&A as a percent of revenue, adjusted EBITDA margin, depreciation expense, non-cash amortization expense, stock-based compensation expense, interest expense, integration and other expenses, and adjusted tax rate. The Company bases these forward-looking statements on its current expectations, estimates and projections about future events and the industry in which it operates using information currently available to it. Actual results could differ materially from those discussed in, or implied by, these forward-looking statements. Forward-looking statements are also identified by words such as "believe,” "project," "anticipate,” "expect,” "intend,” "plan,” "will,” "may,” "estimates,” variations of such words and other similar expressions. In addition, any statements that refer to expectations, projections or other characterizations of future events or circumstances are forward-looking statements.

The targets and expectations noted in this release depend upon, among other factors, (i) the magnitude and duration of the effects of the COVID-19 pandemic on demand trends, our business, its financial condition and our results of operations, (ii) our ability to effectively address client demand by attracting and placing nurses and other clinicians, (iii) our ability to recruit and retain sufficient quality healthcare professionals at reasonable costs, (iv) our ability to anticipate and quickly respond to changing marketplace conditions, such as alternative modes of healthcare delivery, reimbursement, or client needs, (v) our ability to manage the pricing impact that the COVID-19 pandemic and consolidation of healthcare delivery organizations may have on our business, (vi) the duration of the period that hospitals and other healthcare entities decrease their utilization of temporary employees, physicians, leaders and other workforce technology applications as a result of the suspension of or restrictions placed on non-essential and elective healthcare as a result of the COVID-19 pandemic, (vii) the duration of the period that individuals may continue to forego non-essential and elective healthcare as "safer at home” restrictions and recommendations lift, (viii) our ability to develop and evolve our current technology offerings and capabilities and implement new infrastructure and technology systems to optimize our operating results and manage our business effectively, (ix) our ability to comply with extensive and complex federal and state laws and regulations related to the conduct of our operations, costs and payment for services and payment for referrals as well as laws regarding employment practices, (x) our ability to consummate and effectively incorporate acquisitions into our business, (xi) the extent to which "shelter-in-place” orders, quarantines and restrictions on travel and mass gatherings that were ordered earlier in the year to slow the spread of the COVID-19 virus may be reinstituted as infection rates continue to climb in many parts of the country, (xii) the extent and duration of the period that a significant spike in unemployment that has resulted from the COVID-19 pandemic will cause an increase in under- and uninsured patients and a corresponding reduction in overall healthcare utilization and demand for our services, (xiii) the extent to which the COVID-19 pandemic may disrupt our operations due to the unavailability of our employees or healthcare professionals due to illness, risk of illness, quarantines, travel restrictions or other factors that limit our existing or potential workforce and pool of candidates, and (xiv) the severity and duration of the impact the COVID-19 pandemic has on the financial condition and cash flow of many hospitals and healthcare systems such that it impairs their ability to make payments to us, timely or otherwise, for services rendered.

For a discussion of additional risk factors and a more complete discussion of some of the cautionary statements noted above that could cause actual results to differ from those implied by the forward-looking statements contained in this press release, please refer to our most recent Annual Report on Form 10-K for the year ended December 31, 2020. Be advised that developments subsequent to this press release are likely to cause these statements to become outdated and the Company is under no obligation (and expressly disclaims any such obligation) to update or revise any forward-looking statements whether as a result of new information, future events, or otherwise.

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