BOCA RATON, Fla.–(BUSINESS WIRE)–Cross Country Healthcare, Inc. (the “Company”) (Nasdaq: CCRN) today announced financial results for its fourth quarter and full year ended December 31, 2022.
SELECTED FINANCIAL INFORMATION:
Dollars are in thousands, except per share amounts
Q4 2022
Variance
Q4 2022 vs
Q4 2021
Variance
Q4 2022 vs
Q3 2022
Full Year 2022
Variance
2022 vs
2021
Revenue
$
628,218
(2
)
%
(1
)
%
$
2,806,609
67
%
Gross profit margin*
22.1
%
(90
)
bps
(50
)
bps
22.4
%
—
bps
Net income attributable to common stockholders
$
38,791
(50
)
%
11
%
$
188,461
43
%
Diluted EPS
$
1.05
$
(1.02
)
$
0.12
$
5.02
$
1.49
Adjusted EBITDA*
$
57,026
(30
)
%
(11
)
%
$
301,716
86
%
Adjusted EBITDA margin*
9.1
%
(350
)
bps
(90
)
bps
10.8
%
110
bps
Adjusted EPS*
$
1.09
$
(0.31
)
$
0.02
$
5.27
$
2.21
Cash flows from operations
$
4,320
106
%
(97
)
%
$
134,050
257
%
* Refer to accompanying tables and discussion of non-GAAP (Generally Accepted Accounting Principles) financial measures below.
Business Highlights
Double-digit year-over-year annual revenue growth across all segments
Launched our proprietary vendor management system IntellifyTM
Strengthened our position in the talent management landscape through the December HireUp acquisition
Expanded our locum tenens portfolio through the Mint and Lotus acquisitions
Repurchased 1.4 million shares of common stock for $35.3 million in 2022
$100 million total optional prepayments on the term loan reducing the balance 58% year over year
Hosted our first Investor Day in the third quarter of 2022
Added two independent directors with deep technology and healthcare expertise to the Board
“We are extremely proud of all we accomplished in 2022, from achieving our highest annual revenue and profitability in Company history to transforming Cross Country into a digitally innovative enterprise with comprehensive workforce solutions and an unwavering commitment to clinical excellence,” said John A. Martins, President and Chief Executive Officer of Cross Country Healthcare. He continued, “Thanks to the investments in our people and technology, as well as strategic acquisitions, we are fundamentally a different organization today and I believe we are well-positioned for continued success.”
Fourth quarter consolidated revenue was $628.2 million, a slight decrease from the prior year and prior quarter. Consolidated gross profit margin was 22.1%, down 90 basis points year-over-year and 50 basis points sequentially. Net income attributable to common stockholders was $38.8 million compared to $77.6 million in the prior year and $34.8 million in the prior quarter. Diluted earnings per share (EPS) was $1.05 compared to $2.07 in the prior year and $0.93 in the prior quarter. Adjusted earnings before interest, taxes, depreciation, and amortization (EBITDA) was $57.0 million or 9.1% of revenue, as compared with $80.9 million or 12.6% of revenue in the prior year, and $63.8 million or 10.0% of revenue in the prior quarter. Adjusted EPS was $1.09 compared to $1.40 in the prior year and $1.07 in the prior quarter.
For the year ended December 31, 2022, consolidated revenue was $2.8 billion, an increase of 67% year-over-year. Consolidated gross profit margin was 22.4%, consistent with the prior year. Net income attributable to common stockholders was $188.5 million, or 5.02 per diluted share, compared to $132.0 million, or $3.53 per diluted share, in the prior year. Adjusted EBITDA was $301.7 million or 10.8% of revenue, as compared with $162.1 million or 9.7% of revenue in the prior year. Adjusted EPS was $5.27 compared to $3.06 in the prior year.
Quarterly Business Segment Highlights
Nurse and Allied Staffing
Revenue was $591.1 million, a decrease of 5% year-over-year and 3% sequentially. Contribution income was $69.9 million, a decrease from $92.4 million in the prior year and $77.8 million in the prior quarter. Average field contract personnel on a full-time equivalent (FTE) basis were 12,447 as compared with 11,520 in the prior year and 12,524 in the prior quarter. Revenue per FTE per day was $510 compared to $582 in the prior year and $526 in the prior quarter. The increase in average number of FTEs as compared to the prior year was primarily due to headcount growth in nurse and allied. As expected, average bill rates were down sequentially in the low single digits.
Physician Staffing
Revenue was $37.1 million, an increase of 84% year-over-year and 56% sequentially. Contribution income was $1.7 million, an increase from $1.4 million in the prior year and $0.8 million in the prior quarter. Total days filled were 21,335 as compared with 12,739 in the prior year and 13,219 in the prior quarter. Revenue per day filled was $1,740 as compared with $1,588 in the prior year and $1,803 in the prior quarter. The increase in revenue was primarily due to an increase in volume in several specialties. The increase in contribution income was driven by higher revenue, partially offset by higher direct costs.
Cash Flow and Balance Sheet Highlights
Cash flow provided by operations for the quarter was $4.3 million, primarily due to a slowdown in collections in the fourth quarter. For the year ended December 31, 2022, cash flow provided by operations was $134.1 million compared to cash flow used in operations of $85.6 million in the prior year.
During the fourth quarter, the Company repurchased and retired a total of 0.4 million shares of the Company’s common stock for an aggregate price of $10.9 million, at an average market price of $31.23 per share. As of December 31, 2022, the Company had 36.3 million unrestricted shares outstanding and $76.2 million remaining for share repurchase. In November 2022, the Company entered into a Rule 10b5-1 repurchase plan to allow for share repurchases during the Company’s blackout periods.
On October 3, 2022, the Company acquired Mint Medical Physician Staffing, LP and Lotus Medical Staffing LLC. The purchase price included $27.0 million in cash and $3.6 million in shares of the Company’s common stock. The Company acquired HireUp Leadership, Inc. on December 13, 2022. The purchase price included $6.0 million in cash and $0.8 million in shares of the Company’s common stock. In addition to its scheduled payments, on June 23, 2022 and October 26, 2022, the Company made optional prepayments of $50.0 million, totaling $100.0 million, on its term loan to reduce interest costs.
At December 31, 2022, the Company had $3.6 million in cash and cash equivalents and $73.9 million principal balance on its term loan, with $76.8 million of borrowings drawn under its revolving senior secured asset-based credit facility (ABL), and $18.2 million of letters of credit outstanding. As of December 31, 2022, borrowing base availability under the ABL was $300.0 million, with $205.0 million of excess availability.
Outlook for First Quarter 2023
The guidance below applies only to management’s expectations for the first quarter of 2023.
Q1 2023 Range
Year-over-Year
Sequential
Change
Change
Revenue
$590 million – $600 million
(25)% – (24)%
(6)% – (4)%
Adjusted EBITDA*
$44.0 million – $49.0 million
(55)% – (50)%
(23)% – (14)%
Adjusted EPS*
$0.70 – $0.80
$(1.00) – $(0.90)
$(0.39) – $(0.29)
* Refer to discussion of non-GAAP financial measures below.
The above estimates are based on current management expectations and, as such, are forward-looking and actual results may differ materially. The above ranges do not include the potential impact of any future divestitures, mergers, acquisitions, or other business combinations, changes in debt structure, or future significant share repurchases. We reaffirm our 2023 annual targets of a minimum $2.2 billion in revenue and $200 million in Adjusted EBITDA.
See accompanying non-GAAP financial measures and tables below.
INVITATION TO CONFERENCE CALL
The Company will hold its quarterly conference call on Wednesday, February 22, 2023, at 5:00 P.M. Eastern Time to discuss its fourth quarter and full year 2022 financial results. This call will be a live webcast and can be accessed on the Company’s website at ir.crosscountryhealthcare.com or by dialing 888-566-1290 from anywhere in the U.S. or by dialing 773-799-3776 from non-U.S. locations – Passcode: Cross Country. A replay of the webcast will be available from February 22nd through March 8th on the Company’s website and a replay of the conference call will be available by telephone by calling 800-813-5529 from anywhere in the U.S. or 203-369-3826 from non-U.S. locations – Passcode: 9863.
ABOUT CROSS COUNTRY HEALTHCARE
Cross Country Healthcare, Inc. is a leading tech-enabled workforce solutions and advisory firm with 36 years of industry experience and insight. We solve complex labor-related challenges for customers while providing high-quality outcomes and exceptional patient care. As a multi-year Best of Staffing® award winner, we are committed to an exceptionally high level of service to our clients and our homecare, education, and clinical and non-clinical healthcare professionals. Our locum tenens line of business, Cross Country Locums, has been certified by the National Committee for Quality Assurance (NCQA), the leader in healthcare accreditation, since 2001. We are the first publicly traded staffing firm to obtain The Joint Commission Certification, which we still hold with a Letter of Distinction. Cross Country Healthcare is rated as the top staffing and recruiting employer for women by InHerSights, and Certified™ by Great Place to Work®. For three consecutive years, we have received the Top Workplaces USA award from Energage and have also been recognized with the Top Workplaces Award for Diversity, Equity & Inclusion Practices and the Top Workplaces Awards for Innovation and Leadership. We have recently been awarded the Women Executive Leadership Elevate Award, recognizing gender diversity in our Boardroom. We have a history of investing in diversity, equality, and inclusion as a key component of the organization’s overall corporate social responsibility program, closely aligned with its core values to create a better future for its people, communities, and its stockholders.
Copies of this and other press releases, as well as additional information about the Company, can be accessed online at ir.crosscountryhealthcare.com. Stockholders and prospective investors can also register to automatically receive the Company’s press releases, filings with the Securities and Exchange Commission (SEC), and other notices by e-mail.
NON-GAAP FINANCIAL MEASURES
This press release and the accompanying financial statement tables reference non-GAAP financial measures, such as gross profit margin, adjusted EBITDA, and adjusted EPS. Such non-GAAP financial measures are provided as additional information and should not be considered substitutes for, or superior to, financial measures calculated in accordance with U.S. GAAP. Such non-GAAP financial measures are provided for consistency and comparability to prior year results; furthermore, management believes they are useful to investors when evaluating the Company’s performance as they exclude certain items that management believes are not indicative of the Company’s future operating performance. Pro forma measures, if applicable, are adjusted to include the results of our acquisitions, and exclude the results of divestments, as if the transactions occurred in the beginning of the periods mentioned. Such non-GAAP financial measures may differ materially from the non-GAAP financial measures used by other companies. The financial statement tables that accompany this press release include a reconciliation of each non-GAAP financial measure to the most directly comparable U.S. GAAP financial measure and a more detailed discussion of each financial measure; as such, the financial statement tables should be read in conjunction with the presentation of these non-GAAP financial measures.
In addition, forward-looking adjusted EBITDA and adjusted EPS for fiscal 2023 exclude potential charges or gains that may be recorded during the fiscal year, including among other things, the potential impact of any future divestitures, mergers, acquisitions, or other business combinations, changes in debt structure, or future significant share repurchases. We have not attempted to provide reconciliations of such forward-looking non-GAAP earnings guidance to the comparable GAAP measure, as permitted by Item 10(e)(1)(i)(B) of Regulation S-K, because the impact and timing of these potential charges or gains is inherently uncertain and difficult to predict and is unavailable without unreasonable efforts. In addition, the Company believes such reconciliations would imply a degree of precision and certainty that could be confusing to investors. Such items could have a substantial impact on GAAP measures of our financial performance.
FORWARD LOOKING STATEMENTS
In addition to historical information, this press release contains statements relating to our future results (including certain projections and business trends) that are “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), and the Private Securities Litigation Reform Act of 1995, and are subject to the “safe harbor” created by those sections. Forward-looking statements consist of statements that are predictive in nature, depend upon or refer to future events. Words such as “expects”, “anticipates”, “intends”, “plans”, “believes”, “estimates”, “suggests”, “appears”, “seeks”, “will”, “could”, and variations of such words and similar expressions are intended to identify forward-looking statements. These statements involve known and unknown risks, uncertainties and other factors that may cause our actual results and performance to be materially different from any future results or performance expressed or implied by these forward-looking statements. These factors include, but are not limited to, the following: the overall macroeconomic environment, including increased inflation and interest rates, demand for the healthcare services we provide, both nationally and in the regions in which we operate, the ongoing impacts of the coronavirus pandemic on our business, financial condition, and results of operations, our ability to attract and retain qualified nurses, physicians and other healthcare personnel, costs and availability of short-term housing for our travel healthcare professionals, the functioning of our information systems, the effect of cyber security risks and cyber incidents on our business, the effect of existing or future government regulation and federal and state legislative and enforcement initiatives on our business, our customers’ ability to pay us for our services, our ability to successfully implement our acquisition and development strategies, including our ability to successfully integrate acquired businesses and realize synergies from such acquisitions, the effect of liabilities and other claims asserted against us, the effect of competition in the markets we serve, our ability to successfully defend the Company, its subsidiaries, and its officers and directors on the merits of any lawsuit or determine its potential liability, if any, and other factors, including, without limitation, the risk factors set forth in Item 1A. “Risk Factors” in the Company’s Annual Report on Form 10-K for the year ended December 31, 2021, as filed and updated in our Quarterly Reports on Form 10-Q and other filings with the SEC. You should consult any further disclosures the Company makes on related subjects in its filings with the SEC.
Although we believe that these statements are based upon reasonable assumptions, we cannot guarantee future results and readers are cautioned not to place undue reliance on these forward-looking statements, which reflect management’s opinions only as of the date of this press release. There can be no assurance that (i) we have correctly measured or identified all of the factors affecting our business or the extent of these factors’ likely impact, (ii) the available information with respect to these factors on which such analysis is based is complete or accurate, (iii) such analysis is correct, or (iv) our strategy, which is based in part on this analysis, will be successful. Except as may be required by law, the Company undertakes no obligation to update or revise forward-looking statements. All references to “the Company”, “we”, “us”, “our”, or “Cross Country” in this press release mean Cross Country Healthcare, Inc. and its consolidated subsidiaries.
Cross Country Healthcare, Inc.
Consolidated Statements of Operations
(Unaudited, amounts in thousands, except per share data)
Three Months Ended
Year Ended
December 31,
December 31,
September 30,
December 31,
December 31,
2022
2021
2022
2022
2021
Revenue from services
$
628,218
$
640,679
$
636,098
$
2,806,609
$
1,676,652
Operating expenses:
Direct operating expenses
489,276
493,529
492,553
2,178,923
1,301,653
Selling, general and administrative expenses
81,171
65,774
80,216
324,209
215,292
Bad debt expense
2,947
2,372
1,101
9,609
4,783
Depreciation and amortization
3,162
2,720
3,214
12,576
9,852
Acquisition and integration-related costs
196
83
490
726
1,068
Restructuring costs
2
239
2,493
1,861
2,630
Impairment charges
—
—
3,856
5,597
2,070
Total operating expenses
576,754
564,717
583,923
2,533,501
1,537,348
Income from operations
51,464
75,962
52,175
273,108
139,304
Other expenses (income):
Interest expense
3,515
2,817
3,498
14,391
6,866
Loss on early extinguishment of debt
1,816
—
—
3,728
—
Other income, net
(217
)
(154
)
(27
)
(1,336
)
(770
)
Income before income taxes
46,350
73,299
48,704
256,325
133,208
Income tax expense (benefit)
7,559
(4,274
)
13,911
67,864
1,206
Net income attributable to common stockholders
$
38,791
$
77,573
$
34,793
$
188,461
$
132,002
Net income per share attributable to common stockholders – Basic
$
1.06
$
2.10
$
0.94
$
5.09
$
3.60
Net income per share attributable to common stockholders – Diluted
$
1.05
$
2.07
$
0.93
$
5.02
$
3.53
Weighted average common shares outstanding:
Basic
36,455
36,974
37,101
37,012
36,689
Diluted
36,926
37,736
37,492
37,536
37,392
Cross Country Healthcare, Inc.
Reconciliation of Non-GAAP Financial Measures
(Unaudited, amounts in thousands)
Three Months Ended
Year Ended
December 31,
December 31,
September 30,
December 31,
December 31,
2022
2021
2022
2022
2021
Adjusted EBITDA:a
Net income attributable to common stockholders
$
38,791
$
77,573
$
34,793
$
188,461
$
132,002
Interest expense
3,515
2,817
3,498
14,391
6,866
Income tax expense (benefit)b
7,559
(4,274
)
13,911
67,864
1,206
Depreciation and amortization
3,162
2,720
3,214
12,576
9,852
Acquisition and integration-related costsc
196
83
490
726
1,068
Restructuring costsd
2
239
2,493
1,861
2,630
Legal settlements and feese
—
12
—
—
(1,141
)
Impairment chargesf
—
—
3,856
5,597
2,070
Loss on disposal of fixed assets
19
159
—
44
219
Loss on early extinguishment of debtg
1,816
—
—
3,728
—
Gain on lease terminationh
(231
)
(308
)
(9
)
(1,325
)
(542
)
Other income, net
(4
)
(5
)
(19
)
(55
)
(447
)
Equity compensation
2,187
1,637
1,491
7,393
6,894
Applicant tracking system costsi
14
280
74
455
1,376
Adjusted EBITDAa
$
57,026
$
80,933
$
63,792
$
301,716
$
162,053
Adjusted EBITDA margina
9.1
%
12.6
%
10.0
%
10.8
%
9.7
%
Adjusted EPS:j
Numerator:
Net income attributable to common stockholders
$
38,791
$
77,573
$
34,793
$
188,461
$
132,002
Non-GAAP adjustments – pretax:
Acquisition and integration-related costsc
196
83
490
726
1,068
Restructuring costsd
2
239
2,493
1,861
2,630
Legal settlements and feese
—
12
—
—
(1,141
)
Impairment chargesf
—
—
3,856
5,597
2,070
Applicant tracking system costsi
14
280
74
455
1,376
Loss on early extinguishment of debtg
1,816
—
—
3,728
—
Nonrecurring income tax adjustmentsk
—
(25,188
)
—
—
(23,246
)
Tax impact of non-GAAP adjustments
(519
)
(158
)
(1,802
)
(3,198
)
(172
)
Adjusted net income attributable to common stockholders – non-GAAP
$
40,300
$
52,841
$
39,904
$
197,630
$
114,587
Denominator:
Weighted average common shares – basic, GAAP
36,455
36,974
37,101
37,012
36,689
Dilutive impact of share-based payments
471
762
391
524
703
Adjusted weighted average common shares – diluted, non-GAAP
36,926
37,736
37,492
37,536
37,392
Reconciliation:
Diluted EPS, GAAP
$
1.05
$
2.07
$
0.93
$
5.02
$
3.53
Non-GAAP adjustments – pretax:
Acquisition and integration-related costsc
0.01
—
0.01
0.02
0.03
Restructuring costsd
—
—
0.07
0.05
0.06
Legal settlements and feese
—
—
—
—
(0.02
)
Impairment chargesf
—
—
0.10
0.15
0.05
Applicant tracking system costsi
—
—
—
0.01
0.03
Loss on early extinguishment of debtg
0.05
—
—
0.10
—
Nonrecurring income tax adjustmentsk
—
(0.67
)
—
—
(0.62
)
Tax impact of non-GAAP adjustments
(0.02
)
—
(0.04
)
(0.08
)
—
Adjusted EPS, non-GAAPj
$
1.09
$
1.40
$
1.07
$
5.27
$
3.06
Cross Country Healthcare, Inc.
Consolidated Balance Sheets
(Unaudited, amounts in thousands)
December 31,
December 31,
2022
2021
Assets
Current assets:
Cash and cash equivalents
$
3,604
$
1,036
Accounts receivable, net
641,611
493,910
Income taxes receivable
10,915
—
Prepaid expenses
11,067
7,648
Insurance recovery receivable
7,434
5,041
Other current assets
1,042
638
Total current assets
675,673
508,273
Property and equipment, net
19,662
15,833
Operating lease right-of-use assets
3,254
7,488
Goodwill
163,268
119,490
Other intangible assets, net
44,723
48,244
Non-current deferred tax assets
7,092
11,525
Non-current insurance recovery receivable
23,058
13,998
Other non-current assets
11,109
7,958
Total assets
$
947,839
$
732,809
Liabilities and Stockholders’ Equity
Current liabilities:
Accounts payable and accrued expenses
$
185,507
$
109,753
Accrued compensation and benefits
72,605
65,580
Current portion of debt
—
4,176
Operating lease liabilities – current
4,132
4,090
Income tax payable
20
7,307
Current portion of earnout liability
7,500
7,500
Other current liabilities
1,876
1,364
Total current liabilities
271,640
199,770
Non-current debt, less current portion
148,735
176,366
Operating lease liabilities – non-current
4,880
10,853
Non-current accrued claims
35,881
25,314
Non-current earnout liability
18,000
9,000
Uncertain tax positions – non-current
7,646
8,994
Other non-current liabilities
3,838
4,984
Total liabilities
490,620
435,281
Commitments and contingencies
Stockholders’ equity:
Common stock
4
4
Additional paid-in capital
292,876
321,552
Accumulated other comprehensive loss
(1,387
)
(1,293
)
Retained earnings (accumulated deficit)
165,726
(22,735
)
Total stockholders’ equity
457,219
297,528
Total liabilities and stockholders’ equity
$
947,839
$
732,809
Contacts
Cross Country Healthcare, Inc.
William J. Burns, 561-237-2555
Executive Vice President & Chief Financial Officer
[email protected]
