Operating expenses across all Extended Warranty companies were down about $600,000 excluding PWSC, which reflects initiatives put in place at Geminus and PWI since Brian Cosgrove took over both businesses about a year ago, as well as a continued scrutiny of all expense line items. Also contributing to Extended Warranty results is the investment income earned from our float and any gains or losses on other investments. As JT discussed, in the second quarter of — sorry, the third quarter of 2022, IWS had very favorable realized gains from some of its investments, as well as a release of GAP product reserves, that’s G-A-P product reserves. These totaled about $1.1 million and we didn’t realize similar results in 2023. As we’ve discussed before, we invest our float, which was about $45 million at September 30, 2023, in U.S. bonds, municipal securities, and high-quality corporate bonds with an average duration of 2 to 3 years.
As prior investments mature, we are able to reinvest at the current higher interest rates. This has resulted in TTM investment income as of 9/30/23 of $953,000 compared to just $369,000 for the year ago period. We believe the long-term outlook for Extended Warranty remains healthy and we continue to believe this is an attractive business to hold in our portfolio. At KSX, adjusted EBITDA was $1.1 million or 14.5% of segment revenue in the third quarter of 2023 compared to $778,000 or 20.4% of segment revenue in the third quarter of last year. And as a reminder, last year included just Ravix. At Ravix, profitability was up slightly compared to the prior year as the decline in revenue was essentially offset by a higher gross margin of 34.7% in the third quarter of 2023 versus 28% in the year ago quarter.
The decline in revenue was due to a decrease in billable hours from lower-than-expected number of new clients that was partially offset by an increase in billing rates, the latter due to a shift in services mix, as well as price increases. CSuite delivered gross margin of 35.6%, which was in line with our expectations, but on lower-than-expected revenues. CSuite continues to rebuild its pipeline, which was disrupted during the acquisition process and has hired a business development team member to focus on its pipeline of opportunities. SNS delivered gross margin of 26.9%, which was higher than our expectations, but on lower-than-expected revenues. We continue to see a shift in mix from travel staffing to per diem staffing. Year-to-date, 58% of the shifts were per diem, which is the same year-to-date figure as the first 6 months of 2023.
Also, the total number of shifts in Q3 2023 was down 20% to that in the year ago quarter. As a reminder, when we purchased SNS, our purchase price was based on go-forward results being lower than recent historical results at the time of acquisition, as we believe that staffing rates and the number of shifts were referred to levels more in line with those experienced pre-pandemic. At SNS, near-term growth is expected to come from expanding its base of travel nurses, as well as an expansion into new geographic areas. SNS has more seasonality than our other businesses, and the number of travel shifts is expected to improve as travel demand increases during the upcoming cold and flu season. Given we acquired SPI in early September, its contribution to the current quarter results was minimal.
We plan to discuss SPI more on future calls. Turning now to our balance sheet. At the end of the third quarter of 2023, we had cash and cash equivalents of $20.2 million, compared to $64.2 million at the end of 2022. Cash used in operating activities from continuing operations was $9.6 million for the 9 months ended September 30, 2023, compared to cash provided by operations of $4.9 million in the first 9 months of last year. Our cash balance has been impacted by the following items this year: $5 million payment of TruPS deferred interest in Q1 of 2023; $2 million for the release of the Mendota escrow in Q1; $1.8 million of management fees paid in Q1 and Q2 of this year related to the final sale of commercial real estate investments; lower operating income from the Extended Warranty segment; $16.7 million of cash received from holders exercising warrants; and $3.3 million from the sale of Limbach stock.
Our total outstanding debt is comprised of bank loans and 1 remaining trance of TruPS debt. Debt associated with the VA Lafayette is included in a separate line item on our balance sheet as liabilities held for sale. As a result, we had total outstanding debt of $40.9 million at the end of the third quarter of 2023, compared with $102.1 million at the end of last year. Net debt decreased to $20.8 million as of September 30, 2023, compared to $30.9 million at the end of last year — I’m sorry, $37.9 million at the end of last year. Earlier this year, the Board approved a one-year securities repurchase program. Through October 31, 2023, we have repurchased 1,093,861 of our warrants and repurchased just over 250,000 shares of our common stock.
