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, 2023.
SELECTED FINANCIAL INFORMATION:
Dollars are in thousands, except per share amounts
Q4 2023
Variance
Q4 2023 vs
Q4 2022
Variance
Q4 2023 vs
Q3 2023
Full Year 2023
Variance
2023 vs
2022
Revenue
$
414,035
(34
)
%
(6
)
%
$
2,019,728
(28
)
%
Gross profit margin*
21.9
%
(20
)
bps
(10
)
bps
22.3
%
(10
)
bps
Net income attributable to common stockholders
$
9,038
(77
)
%
(29
)
%
$
72,631
(61
)
%
Diluted EPS
$
0.26
$
(0.79
)
$
(0.10
)
$
2.05
$
(2.97
)
Adjusted EBITDA*
$
20,592
(64
)
%
(24
)
%
$
144,421
(52
)
%
Adjusted EBITDA margin*
5.0
%
(410
)
bps
(120
)
bps
7.2
%
(360
)
bps
Adjusted EPS*
$
0.29
$
(0.80
)
$
(0.10
)
$
2.23
$
(3.04
)
Cash flows from operations
$
12,074
179
%
(83
)
%
$
248,498
85
%
* Represents amounts that are not calculated in accordance with U.S. generally accepted accounting principles (GAAP) and are referred to as non-GAAP measures. Please refer to the accompanying discussion of how these non-GAAP financial measures are calculated and used under “Non-GAAP Financial Measures” and tables reconciling these measures to the closest GAAP measure, below.
Fourth Quarter and Full Year Business Highlights
Fourth quarter Revenue exceeded the high end of our guidance range
Physician Staffing and Education experienced annual double-digit year-over-year revenue growth
Proactively managed our cost structure and drove a full year adjusted EBITDA margin of over 7%
Positive cash flow from operations of $12 million for the quarter and a record year of $249 million
Repaid $73.9 million on the term loan and paid down the ABL, ending the year debt-free
Invested more than $20 million in our core technologies including Intellify® and XperienceTM
Repurchased 6.8% of shares outstanding or 2.3 million shares for $57.6 million in 2023
“We are proud of all we accomplished in 2023, such as successfully rolling out our vendor neutral offering Intellify® and driving growth in our non-travel businesses: physician staffing, education, and homecare,” said John A. Martins, President and Chief Executive Officer of Cross Country Healthcare. He continued, “For the coming year, our goal is to capitalize on the investments we have made in our business by growing our client base and ramping our recent wins, as well as driving operational efficiency to expand our margins. With the health and strength of our balance sheet, we are well positioned to make further strategic investments and accretive acquisitions to meet the evolving needs of our clients.”
Fourth quarter consolidated revenue was $414.0 million, a decrease of 34% year-over-year and 6% sequentially. Consolidated gross profit margin was 21.9%, down 20 basis points year-over-year and 10 basis points sequentially. Net income attributable to common stockholders was $9.0 million compared to $38.8 million in the prior year and $12.8 million in the prior quarter. Diluted earnings per share (EPS) was $0.26 compared to $1.05 in the prior year and $0.36 in the prior quarter. Adjusted earnings before interest, taxes, depreciation, and amortization (EBITDA) was $20.6 million, or 5.0% of revenue, as compared with $57.0 million, or 9.1% of revenue, in the prior year, and $27.2 million, or 6.2% of revenue, in the prior quarter. Adjusted EPS was $0.29 compared to $1.09 in the prior year and $0.39 in the prior quarter.
For the year ended December 31, 2023, consolidated revenue was $2.0 billion, a decrease of 28% year-over-year. Consolidated gross profit margin was 22.3%, down 10 basis points from the prior year. Net income attributable to common stockholders was $72.6 million, or 2.05 per diluted share, compared to $188.5 million, or $5.02 per diluted share, in the prior year. Adjusted EBITDA was $144.4 million, or 7.2% of revenue, as compared with $301.7 million, or 10.8% of revenue, in the prior year. Adjusted EPS was $2.23 compared to $5.27 in the prior year.
Quarterly Business Segment Highlights
Nurse and Allied Staffing
Revenue was $367.2 million, a decrease of 38% year-over-year and 7% sequentially. Contribution income was $33.9 million, a decrease from $69.9 million in the prior year and $39.2 million in the prior quarter. Average field contract personnel on a full-time equivalent (FTE) basis were 9,570 as compared with 12,447 in the prior year and 9,849 in the prior quarter. Revenue per FTE per day was $414 compared to $510 in the prior year and $434 in the prior quarter. As expected, volume declined as clients continue to right-size their needs, and travel bill rates continued to normalize.
Physician Staffing
Revenue was $46.9 million, an increase of 26% year-over-year and 3% sequentially. Contribution income was $1.9 million, an increase from $1.7 million in the prior year and a decrease from $2.6 million in the prior quarter. Total days filled were 23,578 as compared with 21,335 in the prior year and 23,004 in the prior quarter. Revenue per day filled was $1,988 as compared with $1,740 in the prior year and $1,986 in the prior quarter. The year-over-year increase in revenue was primarily due to an increase in volume in several specialties.
Cash Flow and Balance Sheet Highlights
Net cash provided by operating activities for the quarter was $12.1 million. For the year ended December 31, 2023, net cash provided by operating activities was $248.5 million as compared to $134.1 million in the prior year.
During the fourth quarter, the Company repurchased and retired a total of 0.3 million shares of the Company’s common stock for an aggregate price of $6.4 million, at an average market price of $20.98 per share. As of December 31, 2023, the Company had 34.4 million unrestricted shares outstanding and $77.3 million remaining for share repurchase.
At December 31, 2023, the Company had $17.1 million in cash and cash equivalents with no debt outstanding. There were no borrowings drawn under its revolving senior secured asset-based credit facility (ABL), and $13.8 million of letters of credit outstanding. As of December 31, 2023, borrowing base availability under the ABL was $220.6 million, with $206.8 million of excess availability.
Outlook for First Quarter 2024
The guidance below applies only to management’s expectations for the first quarter of 2024.
Q1 2024 Range
Year-over-Year
Sequential
Change
Change
Revenue
$370 million – $380 million
(41)% – (39)%
(11)% – (8)%
Adjusted EBITDA*
$13.0 million – $18.0 million
(75)% – (65)%
(37)% – (13)%
Adjusted EPS*
$0.15 – $0.25
$(0.69) – $(0.59)
$(0.14) – $(0.04)
* Refer to discussion of non-GAAP financial measures and reconciliation tables 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.
INVITATION TO CONFERENCE CALL
The Company will hold its quarterly conference call on Wednesday, February 21, 2024, at 5:00 P.M. Eastern Time to discuss its fourth quarter and full year 2023 financial results. This call will be webcast live and can be accessed at the Company’s website at ir.crosscountry.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 21st through March 6th on the Company’s website and a replay of the conference call will be available by telephone by calling 800-391-9851 from anywhere in the U.S. or 203-369-3268 from non-U.S. locations – Passcode: 4335.
ABOUT CROSS COUNTRY HEALTHCARE
Cross Country Healthcare, Inc. is a market-leading, tech-enabled workforce solutions and advisory firm with 37 years of industry experience and insight. We help clients tackle complex labor-related challenges and achieve high-quality outcomes, while reducing complexity and improving visibility through data-driven insights. Diversity, equality, and inclusion is at the heart of the organization’s overall corporate social responsibility program, and closely aligned with our 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.crosscountry.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 United States generally accepted accounting principles (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 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 and/or 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, 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, 2022, 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,
2023
2022
2023
2023
2022
Revenue from services
$
414,035
$
628,218
$
442,291
$
2,019,728
$
2,806,609
Operating expenses:
Direct operating expenses
323,546
489,276
344,932
1,569,318
2,178,923
Selling, general and administrative expenses
67,566
81,367
69,627
300,391
324,935
Bad debt expense
4,165
2,947
2,355
14,562
9,609
Depreciation and amortization
4,471
3,162
4,540
18,347
12,576
Restructuring costs
863
2
348
2,553
1,861
Legal settlement charges
—
—
—
1,125
—
Impairment charges
—
—
186
719
5,597
Total operating expenses
400,611
576,754
421,988
1,907,015
2,533,501
Income from operations
13,424
51,464
20,303
112,713
273,108
Other expenses (income):
Interest expense
586
3,515
669
8,094
14,391
Loss on early extinguishment of debt
—
1,816
—
1,723
3,728
Other (income) expense, net
(131
)
(217
)
134
2
(1,336
)
Income before income taxes
12,969
46,350
19,500
102,894
256,325
Income tax expense
3,931
7,559
6,688
30,263
67,864
Net income attributable to common stockholders
$
9,038
$
38,791
$
12,812
$
72,631
$
188,461
Net income per share attributable to common stockholders – Basic
$
0.26
$
1.06
$
0.37
$
2.07
$
5.09
Net income per share attributable to common stockholders – Diluted
$
0.26
$
1.05
$
0.36
$
2.05
$
5.02
Weighted average common shares outstanding:
Basic
34,481
36,455
34,954
35,158
37,012
Diluted
34,685
36,926
35,152
35,476
37,536
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,
2023
2022
2023
2023
2022
Adjusted EBITDA:a
Net income attributable to common stockholders
$
9,038
$
38,791
$
12,812
$
72,631
$
188,461
Interest expense
586
3,515
669
8,094
14,391
Income tax expenseb
3,931
7,559
6,688
30,263
67,864
Depreciation and amortization
4,471
3,162
4,540
18,347
12,576
Acquisition and integration-related costs
—
196
13
59
726
Restructuring costsc
863
2
348
2,553
1,861
Legal fees and settlementsd
—
—
—
1,125
—
Impairment chargese
—
—
186
719
5,597
Loss on disposal of fixed assets
44
19
43
87
44
Loss on early extinguishment of debtf
—
1,816
—
1,723
3,728
(Gain) loss on lease terminationg
—
(231
)
96
104
(1,325
)
Other income, net
(175
)
(4
)
(5
)
(189
)
(55
)
Equity compensation
1,166
2,187
1,433
6,579
7,393
System conversion costsh
668
14
425
2,326
455
Adjusted EBITDAa
$
20,592
$
57,026
$
27,248
$
144,421
$
301,716
Adjusted EBITDA margina
5.0
%
9.1
%
6.2
%
7.2
%
10.8
%
Adjusted EPS:i
Numerator:
Net income attributable to common stockholders
$
9,038
$
38,791
$
12,812
$
72,631
$
188,461
Non-GAAP adjustments – pretax:
Acquisition and integration-related costs
—
196
13
59
726
Restructuring costsc
863
2
348
2,553
1,861
Legal fees and settlementsd
—
—
—
1,125
—
Impairment chargese
—
—
186
719
5,597
System conversion costsh
668
14
425
2,326
455
Loss on early extinguishment of debtf
—
1,816
—
1,723
3,728
Tax impact of non-GAAP adjustments
(400
)
(519
)
(208
)
(2,167
)
(3,198
)
Adjusted net income attributable to common stockholders – non-GAAP
$
10,169
$
40,300
$
13,576
$
78,969
$
197,630
Denominator:
Weighted average common shares – basic, GAAP
34,481
36,455
34,954
35,158
37,012
Dilutive impact of share-based payments
204
471
198
318
524
Adjusted weighted average common shares – diluted, non-GAAP
34,685
36,926
35,152
35,476
37,536
Reconciliation:
Diluted EPS, GAAP
$
0.26
$
1.05
$
0.36
$
2.05
$
5.02
Non-GAAP adjustments – pretax:
Acquisition and integration-related costs
—
0.01
—
—
0.02
Restructuring costsc
0.02
—
0.01
0.07
0.05
Legal fees and settlementsd
—
—
—
0.03
—
Impairment chargese
—
—
0.01
0.02
0.15
System conversion costsh
0.03
—
0.01
0.07
0.01
Loss on early extinguishment of debtf
—
0.05
—
0.05
0.10
Tax impact of non-GAAP adjustments
(0.02
)
(0.02
)
—
(0.06
)
(0.08
)
Adjusted EPS, non-GAAPi
$
0.29
$
1.09
$
0.39
$
2.23
$
5.27
Cross Country Healthcare, Inc.
Consolidated Balance Sheets
(Unaudited, amounts in thousands)
December 31,
December 31,
2023
2022
Assets
Current assets:
Cash and cash equivalents
$
17,094
$
3,604
Accounts receivable, net
372,352
641,611
Income taxes receivable
6,898
10,915
Prepaid expenses
7,681
11,067
Insurance recovery receivable
9,097
7,434
Other current assets
2,031
1,042
Total current assets
415,153
675,673
Property and equipment, net
27,339
19,662
Operating lease right-of-use assets
2,599
3,254
Goodwill
135,430
163,268
Other intangible assets, net
54,468
44,723
Deferred tax assets
5,954
7,092
Insurance recovery receivable
25,714
23,058
Cloud computing
5,987
4,460
Other assets
6,673
6,649
Total assets
$
679,317
$
947,839
Liabilities and Stockholders’ Equity
Current liabilities:
Accounts payable and accrued expenses
$
85,333
$
185,507
Accrued compensation and benefits
52,297
72,605
Operating lease liabilities
2,604
4,132
Earnout liability
6,794
7,500
Other current liabilities
1,559
1,896
Total current liabilities
148,587
271,640
Debt
—
148,735
Operating lease liabilities
2,663
4,880
Accrued claims
34,853
35,881
Earnout liability
5,000
18,000
Uncertain tax positions
10,603
7,646
Other liabilities
4,218
3,838
Total liabilities
205,924
490,620
Commitments and contingencies
Stockholders’ equity:
Common stock
4
4
Additional paid-in capital
236,417
292,876
Accumulated other comprehensive loss
(1,385
)
(1,387
)
Retained earnings
238,357
165,726
Total stockholders’ equity
473,393
457,219
Total liabilities and stockholders’ equity
$
679,317
$
947,839
Cross Country Healthcare, Inc.
Segment Dataj
(Unaudited, amounts in thousands)
Three Months Ended
Year-over-
Year
Sequential
December 31,
% of
December 31,
% of
September 30,
% of
% change
% change
2023
Total
2022
Total
2023
Total
Fav (Unfav)
Fav (Unfav)
Revenue from services:
Nurse and Allied Staffing
$
367,155
89
%
$
591,090
94
%
$
396,595
90
%
(38
)%
(7
)%
Physician Staffing
46,880
11
%
37,128
6
%
45,696
10
%
26
%
3
%
$
414,035
100
%
$
628,218
100
%
$
442,291
100
%
(34
)%
(6
)%
Contribution income:k
Nurse and Allied Staffing
$
33,901
$
69,941
$
39,226
(52
)%
(14
)%
Physician Staffing
1,947
1,686
2,576
15
%
(24
)%
35,848
71,627
41,802
(50
)%
(14
)%
Corporate overheadl
17,090
16,803
16,412
(2
)%
(4
)%
Depreciation and amortization
4,471
3,162
4,540
(41
)%
2
%
Restructuring costsc
863
2
348
NM
(148
)%
Impairment chargese
—
—
186
—
%
100
%
Other costs
—
196
13
100
%
100
%
Income from operations
$
13,424
$
51,464
$
20,303
(74
)%
(34
)%
Year Ended
Year-over-
Year
December 31,
% of
December 31,
% of
% change
2023
Total
2022
Total
Fav (Unfav)
Revenue from services:
Nurse and Allied Staffing
$
1,841,428
91
%
$
2,700,383
96
%
(32
)%
Physician Staffing
178,300
9
%
106,226
4
%
68
%
$
2,019,728
100
%
$
2,806,609
100
%
(28
)%
Contribution income:k
Nurse and Allied Staffing
$
196,777
$
355,447
(45
)%
Physician Staffing
9,788
5,508
78
%
206,565
360,955
(43
)%
Corporate overheadl
71,049
67,087
(6
)%
Depreciation and amortization
18,347
12,576
(46
)%
Restructuring costsc
2,553
1,861
(37
)%
Legal settlement chargesd
1,125
—
(100
)%
Impairment chargese
719
5,597
87
%
Other costs
59
726
92
%
Income from operations
$
112,713
$
273,108
(59
)%
Other costs include acquisition and integration-related costs.
NM – Not meaningful
Contacts
Cross Country Healthcare, Inc.
William J. Burns, 561-237-2555
Executive Vice President & Chief Financial Officer
[email protected]