恩賽因集團公佈2024年第三季度業績；
提升年度盈利和營業收入展望
明天，2024年10月25日上午10:00太平洋時間將舉行電話會議和網絡研討會。
加州聖胡安卡皮斯特拉諾 - 2024年10月24日 - 恩賽因集團公司（納斯達克： ENSG）是Ensign(TM)公司集團的母公司，該集團提供後期保健服務並投資於長期保健行業，主要涉及技術護理和老年人居住設施，宣布2024年第三季度營運結果，報告按通用會計原則計算的每股稀釋收益為1.34美元，調整後每股收益(1) 為1.39美元，均為截至2024年9月30日的季度。
精彩亮點包括:
▪依據GAAP，凈利潤為7840萬美元，較前一年同季增長22.8%。調整後的凈利潤(1) 為8110萬美元，比上一年同季增長17.7%。
▪本季每股稀釋盈利按照GAAP標準為1.34美元，較前一年同季增長20.7%。 調整後每股稀釋盈利(1) 為1.39美元，較前一年同季增長15.8%。
▪在過去一年第一季度中，相同設施和轉型設施的入住率分別增加了2.8%和4.8%。此外，在第二季度相較於上一季度，相同設施和轉型設施的入住率分別增加了1.1%和1.6%。
▪在去年同季相比，店內和過渡設施的熟練服務營業收入分別增長了7.3%和7.5%。
▪相同設施和轉型熟練天數分別比上年同季增加了6.1%和17.0%。相同設施和轉型熟練天數分別比第二季度按順序增加了2.6%和3.4%。
▪同一設施和過渡性設施管理的營業收入分別同比上年同期增長11.2%和22.4%。
▪本季度的合併GAAP和調整後營業收入均為10.8億美元，較去年同期增加了15.0%。
▪標準扛旗者(2) 本季營業收入為2440萬美元，較去年同期增加16.4%。基金運用率為1480萬美元，較去年同期增加8.6%。
(1)見「依據通用會計原則（GAAP）轉換為非通用會計原則（Non-GAAP）財務資訊」。
(2)我們的熟練服務和標杆部門在Form 10-Q的第8條款中有明確的定義和概述。
營運結果
「我們當地的領導層一直在穩健地推動優秀的臨床和財務表現，我們很高興地宣布又一個創紀錄的季度，」恩賽因的首席執行官Barry Port說。「當我們在最近收購的桶中新增了53個新業務時，我們尤其對這些結果印象深刻。我們的模式主要依賴當地集群和現有業務來支持我們新收購的業務，而這些當地集群在同時將新業務整合到集群中並在現有業務上取得出色成果方面展現了他們的實力。具體來說，在該季度，我們看到同店入住率增長至81.7%，較去年同期增長2.8%，為同店入住率確立了新的最高水平，這在我們在這樣的季度通常經歷入住率較弱的情況下尤為值得注意。我們還看到同樣的技術日數分別在同店和過渡業務中增長了3.3%和14.1%，較去年同期分別增加。這種增長不是因為任何一種關係或市場，而是在所有付款方中均有改善。此外，我們的管理護理普查分別對同店和過渡業務年同比增長了9.1%和23.2%，這是我們業務中非常重要且不斷增長的部分，也表明了我們的領導人正在不斷贏得信任，實現高質量的結果，」Port補充說。
「展望未來時，我們對於解鎖現有投資組合中我們看到的巨大潛力感到興奮。長期以來，我們成功的關鍵之一是擁有數條實現持續成果的途徑，不依賴於新的收購。我們當地的CEO和COO不懈地努力改進並適應各自市場的需求，同時，他們繼續拉動各種槓桿，增加專業混合度，將入住率提升至數十個最成熟的同店營運水準，其中許多遠高於我們的同店平均水準。與此同時，正如我們本季所展示的，我們準備好了，並將繼續以非常有吸引力的價格收購低佔有率的營運，這將帶來長期的上升斜坡，並有多年的增長潛力。」Port表示。
Port表示，《由於本季我們優秀的人才結構和入住率增長，以及我們最近收購持續的強勢，我們將我們2024年度每股稀釋盈利指引提高和調整為每股5.46至5.52美元，高於之前的每股5.38至5.50美元。我們2024年度盈利指引的新中間值相較於我們2023年的結果增加了15.1%以上，比我們2022年的結果高出32.6%。我們還將我們的年度營業收入指引提高到42.5億至42.6億美元，高於我們之前的指引42億至42.2億美元，以反映本季的增長和我們預計將在年底前完成的收購。我們對完成2024年感到興奮，並期待2025年，我們對合作夥伴將在繼續管理和創新的同時平衡新收購業務的增加充滿信心。
就公司的成長而言，恩賽因的首席投資長兼執行副總裁查德·基奇表示：“正如我們預期的，我們持續新增投資組合，對於本季度及其後增加的十二個新運營，其中包括三項房地產資產，我們感到非常興奮，將本年度收購的運營數量提高至27。我們持續看到大量健康之路新收購機會，並正在推進我們預計在第四季度及明年進行交割的若干新增事項。我們堅持，特別是在眼前機遇眾多的時候，依靠一套經驗驗證的交易標準，確保我們保持紀律，以健康之路的方式增長。當我們看到對於股東在短期和長期都具有增值作用的交易時，我們已經並將繼續增長。我們還很高興在新邦或市場中建立集群，特別是在我們有很大潛力增加密度的市場中，預期在接下來的幾個月中，在一些我們較新的市場中實現額外增長。”
恩賽因公司的執行副總裁兼首席財務官蘇珊·斯納珀報告稱，公司的流動性仍然強勁，手頭現金約為53210萬美元，信貸額度下可用資金為57210萬美元。斯納珀女士還指出：“管理層的年度指引基於大約5850萬股稀釋加權平均普通股的基礎，稅率為25.0%。此外，該指引假設正常化的健康保險成本和管理層對於報銷率的當前期望，以及排除一些來自業務之外的特定費用，與收購相關的費用和以股份形式的補償。
A discussion of the Company's use of non-GAAP financial measures is set forth below. A reconciliation of net income to adjusted EBT, EBITDA, adjusted EBITDAR, adjusted EBITDA and FFO for Standard Bearer, as well as a reconciliation of GAAP earnings per share, net income to adjusted net income and adjusted net earnings per share appear in the financial data portion of this release. More complete information is contained in the Company’s Quarterly Report on Form 10-Q for the period ended September 30, 2024, which is expected to be filed with the SEC today and can be viewed on the Company’s website at http://www.ensigngroup.net.
Growth and Real Estate Highlights
Mr. Keetch added additional commentary on the Company’s continued acquisition activity. “We were very happy to complete several new acquisitions during the quarter and since across four of our 14 states. We continue to prioritize growth in our established geographies as it allows our clusters to work together with their acute care partners to provide a comprehensive solution to their healthcare needs. In particular, we are very excited to grow in Colorado where we have deep and long-standing relationships with the healthcare community.
The recent acquisitions include the following leased operations:
•Prairie Ridge Health and Rehabilitation, a 102-bed skilled nursing facility located in Overland Park, Kansas;
•City Park Healthcare and Rehabilitation Center, a 125-bed skilled nursing facility located in Denver, Colorado;
•Desert Willow Health and Rehabilitation Center, a 106-bed skilled nursing facility located in Pueblo, Colorado;
•Junction Creek Health and Rehabilitation Center, a 133-bed skilled nursing facility located in Durango, Colorado;
•Pelican Pointe Health and Rehabilitation Center, a 104-bed skilled nursing facility located in Windsor, Colorado;
•Riverbend Health and Rehabilitation Center, a 100-bed skilled nursing facility located in Loveland, Colorado;
•Broadview Health and Rehabilitation Center, a 100-bed skilled nursing facility located in Greeley, Colorado;
•Westlake Lodge Health and Rehabilitation Center, a 107-bed skilled nursing facility located in Greeley, Colorado; and
•Linden Place Health and Rehabilitation Center, a 110-bed skilled nursing facility located in Longmont, Colorado.
Standard Bearer also announced the following real estate acquisitions, all of which are operated by an Ensign-affiliate effective as of the acquisition date:
•Holly Heights Care and Rehabilitation, a 133-bed skilled nursing facility located in Denver, Colorado;
•Greater Southside Health and Rehabilitation, a 76-bed skilled nursing facility located in Des Moines, Iowa; and
•St. Joseph Rehabilitation and Care Center and Skyview Villa Assisted Living, a healthcare campus with 83 bed skilled nursing beds and 20 assisted living units in Norfolk, Nebraska.
Ensign's growing portfolio consists of 323 healthcare operations, 30 of which also include senior living operations, across 14 states. Ensign now owns 122 real estate assets, 92 of which it operates. Keetch noted that Ensign’s overall strategy will continue to include both leasing and acquiring the real estate and that the Company is actively looking for performing and underperforming operations in several states.
The Company continues to provide additional disclosure on Standard Bearer, which is comprised of 117 owned properties. Of these assets, 88 are leased to an Ensign-affiliated operator and 30 are leased to third-party operators. Keetch noted that each of these properties are subject to triple-net, long-term leases and generated rental revenue of $24.4 million for the quarter, of which $20.2 million was derived from Ensign affiliated operations. For the quarter, Ensign reported $14.8 million in FFO.
The Company paid a quarterly cash dividend of $0.06 per share of Ensign common stock. Ms. Snapper noted that the Company’s liquidity remains strong and that the Company plans to continue its long history of paying dividends into the future, noting that in December of 2023, the Company increased the annual dividend for the 21st consecutive year.
Conference Call
A live webcast will be held Friday, October 25, 2024, at 10:00 a.m. Pacific time (1:00 p.m. Eastern time) to discuss Ensign’s third quarter financial results. To listen to the webcast, or to view any financial or statistical information required by SEC Regulation G, please visit the Investors Relations section of Ensign’s website at http://investor.ensigngroup.net. The webcast will be recorded and will be available for replay via the website until 5:00 p.m. Pacific time on Friday, November 29, 2024.
About Ensign™
The Ensign Group, Inc.'s independent subsidiaries provide a broad spectrum of skilled nursing and senior living services, physical, occupational and speech therapies and other rehabilitative and healthcare services at 323 healthcare facilities in Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, South Carolina, Tennessee, Texas, Utah, Washington and Wisconsin. As part of its investment strategy, the Company will also acquire, lease and own healthcare real estate to service the post-acute care continuum through acquisition and investment opportunities in healthcare properties. Ensign’s new business venture operating subsidiaries also offer several other post-acute-related services, including mobile x-ray, emergency and non-emergency transportation services, long-term care pharmacy and other consulting services also across several states. Each of these operations is operated by a separate, independent subsidiary that has its own management, employees and assets. References herein to the consolidated "Company" and "its" assets and activities, as well as the use of the terms "we," "us," "its" and similar verbiage, are not meant to imply that The Ensign Group, Inc. has direct operating assets, employees or revenue, or that any of the facilities, the Service Center, Standard Bearer or the captive insurance subsidiary are operated by the same entity. More information about Ensign is available at http://www.ensigngroup.net.
Safe Harbor Statement under the Private Securities Litigation Reform Act of 1995:
This press release contains, and the related conference call and webcast will include forward-looking statements that are based on management’s current expectations, assumptions and beliefs about its business, financial performance, operating results, the industry in which it operates and other future events. Forward-looking statements can often be identified by words such as "anticipates," "expects," "intends," "plans," "predicts," "believes," "seeks," "estimates," "may," "will," "should," "would," "could," "potential," "continue," "ongoing," similar expressions, and variations or negatives of these words. These forward-looking statements include, but are not limited to, statements regarding growth prospects, future operating and financial performance, and acquisition activities. They are not guarantees of future results and are subject to risks, uncertainties and assumptions that could cause actual results to materially and adversely differ from those expressed in any forward-looking statement.
These risks and uncertainties relate to the Company’s business, its industry and its common stock and include: reduced prices and reimbursement rates for its services; its ability to acquire, develop, manage or improve operations, its ability to manage its increasing borrowing costs as it incurs additional indebtedness to fund the acquisition and development of operations; its ability to access capital on a cost-effective basis to continue to successfully implement its growth strategy; its operating margins and profitability could suffer if it is unable to grow and manage effectively its increasing number of operations; competition from other companies in the acquisition, development and operation of facilities; its ability to defend claims and lawsuits, including professional liability claims alleging that our services resulted in personal injury, and other regulatory-related claims; and the application of existing or proposed government regulations, or the adoption of new laws and regulations, that could limit its business operations, require it to incur significant expenditures or limit its ability to relocate its operations if necessary. Additionally, our business and operations continue to be impacted by the unprecedented nature of the changes in the regulations and environment, as such, we are unable to predict the full extent and duration of the financial impact of these changes on our business, financial condition and results of operations. Therefore, our actual results could differ materially and adversely from those expressed in any forward-looking statements as a result of various factors. Readers should not place undue reliance on any forward-looking statements and are encouraged to review the Company’s periodic filings with the Securities and Exchange Commission, including its Form 10-Q and 10-K, for a more complete discussion of the risks and other factors that could affect Ensign’s business, prospects and any forward-looking statements. Except as required by the federal securities laws, Ensign does not undertake any obligation to publicly update or revise any forward-looking statements, whether as a result of new information, future events, changing circumstances or any other reason after the date of this press release.
Contact Information
Investor/Media Relations, The Ensign Group, Inc., (949) 487-9500, ir@ensigngroup.net.
SOURCE: The Ensign Group, Inc.
THE ENSIGN GROUP, INC.
UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF INCOME
| Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
| 2024 | 2023 | 2024 | 2023 | ||||||||||||||||||||
| (In thousands, except per share data) | |||||||||||||||||||||||
| REVENUE | |||||||||||||||||||||||
| Service revenue | $ | 1,076,092 | $ | 935,324 | $ | 3,111,151 | $ | 2,733,343 | |||||||||||||||
| Rental revenue | 5,684 | 5,467 | 17,082 | 15,634 | |||||||||||||||||||
| TOTAL REVENUE | $ | 1,081,776 | $ | 940,791 | $ | 3,128,233 | $ | 2,748,977 | |||||||||||||||
| Expense: | |||||||||||||||||||||||
| Cost of services | 859,992 | 741,069 | 2,479,615 | 2,160,080 | |||||||||||||||||||
| Rent—cost of services | 54,792 | 50,357 | 159,940 | 146,754 | |||||||||||||||||||
| General and administrative expense | 56,180 | 51,127 | 169,532 | 156,448 | |||||||||||||||||||
| Depreciation and amortization | 21,474 | 18,446 | 61,619 | 53,154 | |||||||||||||||||||
| TOTAL EXPENSES | $ | 992,438 | $ | 860,999 | $ | 2,870,706 | $ | 2,516,436 | |||||||||||||||
| Income from operations | 89,338 | 79,792 | 257,527 | 232,541 | |||||||||||||||||||
| Other income (expense): | |||||||||||||||||||||||
| Interest expense | (2,024) | (2,024) | (6,028) | (6,083) | |||||||||||||||||||
| Interest income | 7,607 | 5,259 | 21,151 | 12,785 | |||||||||||||||||||
| Other income (expense) | 3,753 | (982) | 7,686 | 2,237 | |||||||||||||||||||
| Other income, net | $ | 9,336 | $ | 2,253 | $ | 22,809 | $ | 8,939 | |||||||||||||||
| Income before provision for income taxes | 98,674 | 82,045 | 280,336 | 241,480 | |||||||||||||||||||
| Provision for income taxes | 20,107 | 18,077 | 61,628 | 53,453 | |||||||||||||||||||
| NET INCOME | $ | 78,567 | $ | 63,968 | $ | 218,708 | $ | 188,027 | |||||||||||||||
| Less: net income attributable to noncontrolling interests | 123 | 105 | 422 | 319 | |||||||||||||||||||
| Net income attributable to The Ensign Group, Inc. | $ | 78,444 | $ | 63,863 | $ | 218,286 | $ | 187,708 | |||||||||||||||
| NET INCOME PER SHARE ATTRIBUTABLE TO THE ENSIGN GROUP INC. | |||||||||||||||||||||||
| Basic | $ | 1.38 | $ | 1.14 | $ | 3.86 | $ | 3.38 | |||||||||||||||
| Diluted | $ | 1.34 | $ | 1.11 | $ | 3.76 | $ | 3.28 | |||||||||||||||
| WEIGHTED AVERAGE COMMON SHARES OUTSTANDING | |||||||||||||||||||||||
| Basic | 56,776 | 55,829 | 56,553 | 55,582 | |||||||||||||||||||
| Diluted | 58,444 | 57,337 | 58,125 | 57,245 | |||||||||||||||||||
THE ENSIGN GROUP, INC.
UNAUDITED CONDENSED CONSOLIDATED BALANCE SHEETS
(In thousands)
| September 30, 2024 | December 31, 2023 | ||||||||||
| ASSETS | |||||||||||
| Current assets: | |||||||||||
| Cash and cash equivalents | $ | 532,066 | $ | 509,626 | |||||||
Accounts receivable—less allowance for doubtful accounts of $9,822 and $9,348 at September 30, 2024 and December 31, 2023, respectively | 554,091 | 485,039 | |||||||||
| Investments—current | 38,969 | 17,229 | |||||||||
| Prepaid income taxes | 25,960 | 3,830 | |||||||||
| Prepaid expenses and other current assets | 45,844 | 31,206 | |||||||||
| Total current assets | $ | 1,196,930 | $ | 1,046,930 | |||||||
| Property and equipment, net | 1,217,689 | 1,090,771 | |||||||||
| Right-of-use assets | 1,904,181 | 1,756,430 | |||||||||
| Insurance subsidiary deposits and investments | 115,496 | 92,687 | |||||||||
| Deferred tax assets | 65,193 | 67,124 | |||||||||
| Restricted and other assets | 45,753 | 40,205 | |||||||||
| Intangible assets, net | 6,676 | 6,525 | |||||||||
| Goodwill | 77,241 | 76,869 | |||||||||
| TOTAL ASSETS | $ | 4,629,159 | $ | 4,177,541 | |||||||
| LIABILITIES AND EQUITY | |||||||||||
| Current liabilities: | |||||||||||
| Accounts payable | $ | 90,274 | $ | 92,811 | |||||||
| Accrued wages and related liabilities | 353,563 | 332,568 | |||||||||
| Lease liabilities—current | 93,868 | 82,526 | |||||||||
| Accrued self-insurance liabilities—current | 57,989 | 54,664 | |||||||||
| Other accrued liabilities | 169,195 | 168,228 | |||||||||
| Current maturities of long-term debt | 4,051 | 3,950 | |||||||||
| Total current liabilities | $ | 768,940 | $ | 734,747 | |||||||
| Long-term debt—less current maturities | 142,577 | 145,497 | |||||||||
| Long-term lease liabilities—less current portion | 1,777,566 | 1,639,326 | |||||||||
| Accrued self-insurance liabilities—less current portion | 126,037 | 111,246 | |||||||||
| Other long-term liabilities | 63,092 | 49,408 | |||||||||
| Total equity | 1,750,947 | 1,497,317 | |||||||||
| TOTAL LIABILITIES AND EQUITY | $ | 4,629,159 | $ | 4,177,541 | |||||||
THE ENSIGN GROUP, INC.
UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(In thousands)
The following table presents selected data from our condensed consolidated statements of cash flows for the periods presented:
| Nine Months Ended September 30, | |||||||||||
| 2024 | 2023 | ||||||||||
| NET CASH PROVIDED BY/(USED IN): | |||||||||||
| Operating activities | $ | 246,730 | $ | 291,397 | |||||||
| Investing activities | (223,465) | (137,754) | |||||||||
| Financing activities | (825) | (2,043) | |||||||||
| Net increase in cash and cash equivalents | $ | 22,440 | $ | 151,600 | |||||||
| Cash and cash equivalents beginning of period | 509,626 | 316,270 | |||||||||
| Cash and cash equivalents at end of period | $ | 532,066 | $ | 467,870 | |||||||
THE ENSIGN GROUP, INC.
UNAUDITED RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION
(In thousands, except per share data)
RECONCILIATION OF GAAP TO NON-GAAP NET INCOME
The following table reconciles GAAP net income to Non-GAAP net income for the periods presented:
| Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
| 2024 | 2023 | 2024 | 2023 | ||||||||||||||||||||
| Net income attributable to The Ensign Group, Inc. | $ | 78,444 | $ | 63,863 | $ | 218,286 | $ | 187,708 | |||||||||||||||
| Non-GAAP adjustments | |||||||||||||||||||||||
Stock-based compensation expense(a) | 9,183 | 7,237 | 26,406 | 22,691 | |||||||||||||||||||
Litigation(b) | (555) | 2,783 | (1,425) | 1,965 | |||||||||||||||||||
| Cost of services - loss on long-lived assets and gain on business interruption recoveries | 486 | (259) | 2,335 | (1,009) | |||||||||||||||||||
Cost of services - acquisition related costs(c) | 239 | 150 | 518 | 722 | |||||||||||||||||||
| General and administrative - costs incurred related to system implementations | 89 | — | 2,522 | 875 | |||||||||||||||||||
Depreciation and amortization - patient base(d) | 236 | 135 | 449 | 182 | |||||||||||||||||||
Provision for income taxes on Non-GAAP adjustments(e) | (6,981) | (4,946) | (16,157) | (13,274) | |||||||||||||||||||
| Non-GAAP Net Income | $ | 81,141 | $ | 68,963 | $ | 232,934 | $ | 199,860 | |||||||||||||||
| Average number of diluted shares outstanding | 58,444 | 57,337 | 58,125 | 57,245 | |||||||||||||||||||
| Diluted Earnings Per Share | $ | 1.34 | $ | 1.11 | $ | 3.76 | $ | 3.28 | |||||||||||||||
| Adjusted Diluted Earnings Per Share | $ | 1.39 | $ | 1.20 | $ | 4.01 | $ | 3.49 | |||||||||||||||
| Footnotes: | |||||||||||||||||||||||
| (a) Represents stock-based compensation expense incurred. | |||||||||||||||||||||||
| Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
| 2024 | 2023 | 2024 | 2023 | ||||||||||||||||||||
| Cost of services | $ | 6,007 | $ | 5,053 | $ | 17,326 | $ | 15,271 | |||||||||||||||
| General and administrative | 3,176 | 2,184 | 9,080 | 7,420 | |||||||||||||||||||
| Total Non-GAAP adjustment | $ | 9,183 | $ | 7,237 | $ | 26,406 | $ | 22,691 | |||||||||||||||
| (b) Represents specific proceedings and adjustments arising outside of the ordinary course of business. | |||||||||||||||||||||||
| Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
| 2024 | 2023 | 2024 | 2023 | ||||||||||||||||||||
| Cost of services | $ | — | $ | — | $ | (1,634) | $ | (818) | |||||||||||||||
| General and administrative | (555) | 2,783 | 209 | 2,783 | |||||||||||||||||||
| Total Non-GAAP adjustment | $ | (555) | $ | 2,783 | $ | (1,425) | $ | 1,965 | |||||||||||||||
| (c) Represents costs incurred to acquire operations that are not capitalizable. | |||||||||||||||||||||||
| (d) Represents amortization expenses related to patient base intangible assets at newly acquired skilled nursing and senior living facilities. | |||||||||||||||||||||||
| (e) Represents an adjustment to the provision for income tax to our historical year to date effective tax rate of 25.0%. | |||||||||||||||||||||||
THE ENSIGN GROUP, INC.
UNAUDITED RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION
(In thousands)
The table below reconciles net income to EBITDA, Adjusted EBITDA and Adjusted EBITDAR for the periods presented:
| Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
| 2024 | 2023 | 2024 | 2023 | ||||||||||||||||||||
| Consolidated Statements of Income Data: | |||||||||||||||||||||||
| Net income | $ | 78,567 | $ | 63,968 | $ | 218,708 | $ | 188,027 | |||||||||||||||
| Less: Net income attributable to noncontrolling interests | 123 | 105 | 422 | 319 | |||||||||||||||||||
| Interest income | 7,607 | 5,259 | 21,151 | 12,785 | |||||||||||||||||||
| Add: Provision for income taxes | 20,107 | 18,077 | 61,628 | 53,453 | |||||||||||||||||||
| Depreciation and amortization | 21,474 | 18,446 | 61,619 | 53,154 | |||||||||||||||||||
| Interest expense | 2,024 | 2,024 | 6,028 | 6,083 | |||||||||||||||||||
| EBITDA | $ | 114,442 | $ | 97,151 | $ | 326,410 | $ | 287,613 | |||||||||||||||
| Adjustments to EBITDA: | |||||||||||||||||||||||
| Stock-based compensation expense | 9,183 | 7,237 | 26,406 | 22,691 | |||||||||||||||||||
Litigation(a) | (555) | 2,783 | (1,425) | 1,965 | |||||||||||||||||||
| Loss on long-lived assets and gain on business interruption recoveries | 486 | (259) | 2,335 | (1,009) | |||||||||||||||||||
Acquisition related costs(b) | 239 | 150 | 518 | 722 | |||||||||||||||||||
| Costs incurred related to system implementations | 89 | — | 2,522 | 875 | |||||||||||||||||||
| ADJUSTED EBITDA | $ | 123,884 | $ | 107,062 | $ | 356,766 | $ | 312,857 | |||||||||||||||
| Rent—cost of services | 54,792 | 50,357 | 159,940 | 146,754 | |||||||||||||||||||
| ADJUSTED EBITDAR | $ | 178,676 | $ | 516,706 | |||||||||||||||||||
(a) Litigation relates to specific proceedings and adjustments arising outside of the ordinary course of business.
(b) Costs incurred to acquire operations that are not capitalizable.
The table below reconciles income before provision for income taxes to Adjusted EBT for the periods presented:
| Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
| 2024 | 2023 | 2024 | 2023 | ||||||||||||||||||||
| Consolidated statements of income data: | (In thousands) | ||||||||||||||||||||||
| Income before provision for income taxes | $ | 98,674 | $ | 82,045 | $ | 280,336 | $ | 241,480 | |||||||||||||||
| Stock-based compensation expense | 9,183 | 7,237 | 26,406 | 22,691 | |||||||||||||||||||
Litigation(a) | (555) | 2,783 | (1,425) | 1,965 | |||||||||||||||||||
| Loss on long-lived assets and gain on business interruption recoveries | 486 | (259) | 2,335 | (1,009) | |||||||||||||||||||
Acquisition related costs(b) | 239 | 150 | 518 | 722 | |||||||||||||||||||
| Costs incurred related to system implementations | 89 | — | 2,522 | 875 | |||||||||||||||||||
Depreciation and amortization - patient base(c) | 236 | 135 | 449 | 182 | |||||||||||||||||||
| ADJUSTED EBT | $ | 108,352 | $ | 92,091 | $ | 311,141 | $ | 266,906 | |||||||||||||||
(a) Litigation relates to specific proceedings and adjustments arising outside of the ordinary course of business.
(b) Costs incurred to acquire operations that are not capitalizable.
(c) Included in depreciation and amortization are amortization expenses related to patient base intangible assets at newly acquired skilled nursing and senior living facilities.
THE ENSIGN GROUP, INC.
UNAUDITED SELECT PERFORMANCE INDICATORS
The following tables summarize our selected performance indicators for our skilled services segment along with other statistics, for each of the dates or periods presented:
| Three Months Ended September 30, | |||||||||||||||||||||||
| 2024 | 2023 | Change | % Change | ||||||||||||||||||||
| TOTAL FACILITY RESULTS: | (Dollars in thousands) | ||||||||||||||||||||||
| Skilled services revenue | $ | 1,033,113 | $ | 902,967 | $ | 130,146 | 14.4 | % | |||||||||||||||
| Number of facilities at period end | 282 | 258 | 24 | 9.3 | % | ||||||||||||||||||
Number of campuses at period end(1) | 29 | 26 | 3 | 11.5 | % | ||||||||||||||||||
| Actual patient days | 2,407,709 | 2,190,540 | 217,169 | 9.9 | % | ||||||||||||||||||
| Occupancy percentage — Operational beds | 80.9 | % | 78.9 | % | 2.0 | % | 2.5 | % | |||||||||||||||
| Skilled mix by nursing days | 29.7 | % | 29.1 | % | 0.6 | % | 2.1 | % | |||||||||||||||
| Skilled mix by nursing revenue | 48.5 | % | 48.4 | % | 0.1 | % | 0.2 | % | |||||||||||||||
| Three Months Ended September 30, | |||||||||||||||||||||||
| 2024 | 2023 | Change | % Change | ||||||||||||||||||||
SAME FACILITY RESULTS:(2) | (Dollars in thousands) | ||||||||||||||||||||||
| Skilled services revenue | $ | 756,424 | $ | 705,059 | $ | 51,365 | 7.3 | % | |||||||||||||||
| Number of facilities at period end | 193 | 193 | — | — | % | ||||||||||||||||||
Number of campuses at period end(1) | 25 | 25 | — | — | % | ||||||||||||||||||
| Actual patient days | 1,743,823 | 1,696,360 | 47,463 | 2.8 | % | ||||||||||||||||||
| Occupancy percentage — Operational beds | 81.7 | % | 79.5 | % | 2.2 | % | 2.8 | % | |||||||||||||||
| Skilled mix by nursing days | 31.6 | % | 30.6 | % | 1.0 | % | 3.3 | % | |||||||||||||||
| Skilled mix by nursing revenue | 50.2 | % | 49.6 | % | 0.6 | % | 1.2 | % | |||||||||||||||
| Three Months Ended September 30, | |||||||||||||||||||||||
| 2024 | 2023 | Change | % Change | ||||||||||||||||||||
TRANSITIONING FACILITY RESULTS:(3) | (Dollars in thousands) | ||||||||||||||||||||||
| Skilled services revenue | $ | 127,869 | $ | 118,904 | $ | 8,965 | 7.5 | % | |||||||||||||||
| Number of facilities at period end | 40 | 40 | — | — | % | ||||||||||||||||||
Number of campuses at period end(1) | 1 | 1 | — | — | % | ||||||||||||||||||
| Actual patient days | 337,906 | 330,468 | 7,438 | 2.3 | % | ||||||||||||||||||
| Occupancy percentage — Operational beds | 76.9 | % | 73.4 | % | 3.5 | % | 4.8 | % | |||||||||||||||
| Skilled mix by nursing days | 21.8 | % | 19.1 | % | 2.7 | % | 14.1 | % | |||||||||||||||
| Skilled mix by nursing revenue | 38.9 | % | 35.3 | % | 3.6 | % | 10.2 | % | |||||||||||||||
| Three Months Ended September 30, | |||||||||||||||||||||||
| 2024 | 2023 | Change | % Change | ||||||||||||||||||||
RECENTLY ACQUIRED FACILITY RESULTS:(4) | (Dollars in thousands) | ||||||||||||||||||||||
| Skilled services revenue | $ | 148,820 | $ | 77,978 | $ | 70,842 | NM | ||||||||||||||||
| Number of facilities at period end | 49 | 24 | 25 | NM | |||||||||||||||||||
Number of campuses at period end(1) | 3 | — | 3 | NM | |||||||||||||||||||
| Actual patient days | 325,980 | 159,694 | 166,286 | NM | |||||||||||||||||||
| Occupancy percentage — Operational beds | 81.3 | % | 84.3 | % | NM | NM | |||||||||||||||||
| Skilled mix by nursing days | 28.0 | % | 35.3 | % | NM | NM | |||||||||||||||||
| Skilled mix by nursing revenue | 47.8 | % | 57.2 | % | NM | NM | |||||||||||||||||
| Three Months Ended September 30, | |||||||||||||||||||||||
| 2024 | 2023 | Change | % Change | ||||||||||||||||||||
FACILITY CLOSED RESULTS:(5) | (Dollars in thousands) | ||||||||||||||||||||||
| Skilled services revenue | $ | — | $ | 1,026 | $ | (1,026) | NM | ||||||||||||||||
| Actual patient days | — | 4,018 | (4,018) | NM | |||||||||||||||||||
| Occupancy percentage — Operational beds | — | % | 82.8 | % | NM | NM | |||||||||||||||||
(1)Campus represents a facility that offers both skilled nursing and senior living services. Revenue and expenses related to skilled nursing and senior living services have been allocated and recorded in the respective operating segment.
(2)Same Facility results represent all facilities purchased prior to January 1, 2021.
(3)Transitioning Facility results represent all facilities purchased from January 1, 2021 to December 31, 2022.
(4)Recently Acquired Facility (Acquisitions) results represent all facilities purchased on or subsequent to January 1, 2023.
(5)Facility Closed results represent one closed operation during 2024 due to the transitioning of an intermediate care facility program to group home setting, which is included in All Other category. The operation revenue was excluded from Same Facilities results for the three months ended September 30, 2023 for comparison purposes.
| Nine Months Ended September 30, | |||||||||||||||||||||||
| 2024 | 2023 | Change | % Change | ||||||||||||||||||||
| TOTAL FACILITY RESULTS: | (Dollars in thousands) | ||||||||||||||||||||||
| Skilled services revenue | $ | 2,994,000 | $ | 2,638,090 | $ | 355,910 | 13.5 | % | |||||||||||||||
| Number of facilities at period end | 282 | 258 | 24 | 9.3 | % | ||||||||||||||||||
Number of campuses at period end(1) | 29 | 26 | 3 | 11.5 | % | ||||||||||||||||||
| Actual patient days | 6,962,308 | 6,363,107 | 599,201 | 9.4 | % | ||||||||||||||||||
| Occupancy percentage — Operational beds | 80.4 | % | 78.3 | % | 2.1 | % | 2.7 | % | |||||||||||||||
| Skilled mix by nursing days | 30.2 | % | 30.7 | % | (0.5) | % | (1.6) | % | |||||||||||||||
| Skilled mix by nursing revenue | 48.8 | % | 50.6 | % | (1.8) | % | (3.6) | % | |||||||||||||||
| Nine Months Ended September 30, | |||||||||||||||||||||||
| 2024 | 2023 | Change | % Change | ||||||||||||||||||||
SAME FACILITY RESULTS:(2) | (Dollars in thousands) | ||||||||||||||||||||||
| Skilled services revenue | $ | 2,244,572 | $ | 2,096,752 | $ | 147,820 | 7.0 | % | |||||||||||||||
| Number of facilities at period end | 193 | 193 | — | — | % | ||||||||||||||||||
Number of campuses at period end(1) | 25 | 25 | — | — | % | ||||||||||||||||||
| Actual patient days | 5,157,784 | 5,000,020 | 157,764 | 3.2 | % | ||||||||||||||||||
| Occupancy percentage — Operational beds | 81.2 | % | 79.0 | % | 2.2 | % | 2.8 | % | |||||||||||||||
| Skilled mix by nursing days | 31.8 | % | 32.1 | % | (0.3) | % | (0.9) | % | |||||||||||||||
| Skilled mix by nursing revenue | 50.2 | % | 51.6 | % | (1.4) | % | (2.7) | % | |||||||||||||||
| Nine Months Ended September 30, | |||||||||||||||||||||||
| 2024 | 2023 | Change | % Change | ||||||||||||||||||||
TRANSITIONING FACILITY RESULTS:(3) | (Dollars in thousands) | ||||||||||||||||||||||
| Skilled services revenue | $ | 374,989 | $ | 350,048 | $ | 24,941 | 7.1 | % | |||||||||||||||
| Number of facilities at period end | 40 | 40 | — | — | % | ||||||||||||||||||
Number of campuses at period end(1) | 1 | 1 | — | — | % | ||||||||||||||||||
| Actual patient days | 995,438 | 969,585 | 25,853 | 2.7 | % | ||||||||||||||||||
| Occupancy percentage — Operational beds | 75.5 | % | 72.6 | % | 2.9 | % | 4.0 | % | |||||||||||||||
| Skilled mix by nursing days | 21.7 | % | 20.9 | % | 0.8 | % | 3.8 | % | |||||||||||||||
| Skilled mix by nursing revenue | 38.4 | % | 38.7 | % | (0.3) | % | (0.8) | % | |||||||||||||||
| Nine Months Ended September 30, | |||||||||||||||||||||||
| 2024 | 2023 | Change | % Change | ||||||||||||||||||||
RECENTLY ACQUIRED FACILITY RESULTS:(4) | (Dollars in thousands) | ||||||||||||||||||||||
| Skilled services revenue | $ | 373,865 | $ | 188,216 | $ | 185,649 | NM | ||||||||||||||||
| Number of facilities at period end | 49 | 24 | 25 | NM | |||||||||||||||||||
Number of campuses at period end(1) | 3 | — | 3 | NM | |||||||||||||||||||
| Actual patient days | 807,004 | 379,708 | 427,296 | NM | |||||||||||||||||||
| Occupancy percentage — Operational beds | 82.0 | % | 85.2 | % | NM | NM | |||||||||||||||||
| Skilled mix by nursing days | 30.3 | % | 38.3 | % | NM | NM | |||||||||||||||||
| Skilled mix by nursing revenue | 51.0 | % | 61.2 | % | NM | NM | |||||||||||||||||
| Nine Months Ended September 30, | |||||||||||||||||||||||
| 2024 | 2023 | Change | % Change | ||||||||||||||||||||
FACILITY CLOSED RESULTS:(5) | (Dollars in thousands) | ||||||||||||||||||||||
| Skilled services revenue | $ | 574 | $ | 3,074 | $ | (2,500) | NM | ||||||||||||||||
| Actual patient days | 2,082 | 13,794 | (11,712) | NM | |||||||||||||||||||
| Occupancy percentage — Operational beds | 52.6 | % | 90.7 | % | NM | NM | |||||||||||||||||
(1)Campus represents a facility that offers both skilled nursing and senior living services. Revenue and expenses related to skilled nursing and senior living services have been allocated and recorded in the respective operating segment.
(2)Same Facility results represent all facilities purchased prior to January 1, 2021.
(3)Transitioning Facility results represent all facilities purchased from January 1, 2021 to December 31, 2022.
(4)Recently Acquired Facility (Acquisitions) results represent all facilities purchased on or subsequent to January 1, 2023.
(5)Facility Closed results represent a closed operation during the nine months ended September 30, 2024 due to the transitioning of an intermediate care facility program to group home setting, which is included in All Other category. The operation revenue was excluded from Same Facilities results for the nine months ended September 30, 2024 and 2023 for comparison purposes.
THE ENSIGN GROUP, INC.
SKILLED NURSING AVERAGE DAILY REVENUE RATES AND
PERCENT OF SKILLED NURSING REVENUE AND DAYS BY PAYOR
(Unaudited)
The following tables reflect the change in skilled nursing average daily revenue rates by payor source, excluding services that are not covered by the daily rate(1):
| Three Months Ended September 30, | |||||||||||||||||||||||||||||||||||||||||||||||
| Same Facility | Transitioning | Acquisitions | Total | ||||||||||||||||||||||||||||||||||||||||||||
| 2024 | 2023 | 2024 | 2023 | 2024 | 2023 | 2024 | 2023 | ||||||||||||||||||||||||||||||||||||||||
| SKILLED NURSING AVERAGE DAILY REVENUE RATES | |||||||||||||||||||||||||||||||||||||||||||||||
| Medicare | $ | 751.70 | $ | 719.45 | $ | 703.43 | $ | 682.72 | $ | 836.11 | $ | 861.36 | $ | 761.27 | $ | 735.66 | |||||||||||||||||||||||||||||||
| Managed care | 553.94 | 543.40 | 525.98 | 529.60 | 582.80 | 626.63 | 553.85 | 546.36 | |||||||||||||||||||||||||||||||||||||||
| Other skilled | 631.53 | 581.59 | 566.54 | 484.78 | 618.15 | 424.56 | 625.47 | 562.61 | |||||||||||||||||||||||||||||||||||||||
| Total skilled revenue | 635.52 | 612.95 | 609.64 | 586.49 | 724.79 | 746.45 | 644.15 | 622.12 | |||||||||||||||||||||||||||||||||||||||
| Medicaid | 292.95 | 277.34 | 272.74 | 256.72 | 305.33 | 297.45 | 291.49 | 275.09 | |||||||||||||||||||||||||||||||||||||||
| Private and other payors | 280.39 | 262.53 | 240.69 | 237.31 | 328.69 | 348.46 | 280.84 | 262.97 | |||||||||||||||||||||||||||||||||||||||
| Total skilled nursing revenue | $ | 399.86 | $ | 378.34 | $ | 342.49 | $ | 317.22 | $ | 425.50 | $ | 460.15 | $ | 395.24 | $ | 374.85 | |||||||||||||||||||||||||||||||
(1) The rates are based on contractually agreed-upon amounts or rates, excluding the estimates of variable consideration under the revenue recognition standard, Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) Topic 606 and state relief funding during the three months ended September 30, 2023.
| Nine Months Ended September 30, | |||||||||||||||||||||||||||||||||||||||||||||||
| Same Facility | Transitioning | Acquisitions | Total | ||||||||||||||||||||||||||||||||||||||||||||
| 2024 | 2023 | 2024 | 2023 | 2024 | 2023 | 2024 | 2023 | ||||||||||||||||||||||||||||||||||||||||
| SKILLED NURSING AVERAGE DAILY REVENUE RATES | |||||||||||||||||||||||||||||||||||||||||||||||
| Medicare | $ | 748.98 | $ | 713.73 | $ | 698.74 | $ | 670.68 | $ | 846.75 | $ | 859.42 | $ | 759.90 | $ | 724.85 | |||||||||||||||||||||||||||||||
| Managed care | 550.36 | 529.39 | 524.39 | 518.66 | 585.08 | 613.87 | 550.73 | 532.41 | |||||||||||||||||||||||||||||||||||||||
| Other skilled | 623.28 | 592.05 | 516.66 | 494.20 | 610.19 | 480.91 | 613.37 | 576.60 | |||||||||||||||||||||||||||||||||||||||
| Total skilled revenue | 632.93 | 610.20 | 599.35 | 588.55 | 736.74 | 751.07 | 641.47 | 618.43 | |||||||||||||||||||||||||||||||||||||||
| Medicaid | 295.40 | 272.75 | 270.47 | 248.33 | 303.66 | 286.80 | 292.35 | 269.05 | |||||||||||||||||||||||||||||||||||||||
| Private and other payors | 280.71 | 262.31 | 249.88 | 237.21 | 331.04 | 347.78 | 281.39 | 261.99 | |||||||||||||||||||||||||||||||||||||||
| Total skilled nursing revenue | $ | 401.33 | $ | 380.01 | $ | 339.45 | $ | 318.15 | $ | 437.60 | $ | 469.52 | $ | 396.61 | $ | 375.58 | |||||||||||||||||||||||||||||||
The following tables set forth our percentage of skilled nursing patient revenue and days by payor source for the periods presented:
| Three Months Ended September 30, | |||||||||||||||||||||||||||||||||||||||||||||||
| Same Facility | Transitioning | Acquisitions | Total | ||||||||||||||||||||||||||||||||||||||||||||
| 2024 | 2023 | 2024 | 2023 | 2024 | 2023 | 2024 | 2023 | ||||||||||||||||||||||||||||||||||||||||
| PERCENTAGE OF SKILLED NURSING REVENUE | |||||||||||||||||||||||||||||||||||||||||||||||
| Medicare | 20.1 | % | 20.7 | % | 19.9 | % | 17.3 | % | 29.9 | % | 40.9 | % | 21.5 | % | 22.0 | % | |||||||||||||||||||||||||||||||
| Managed care | 20.7 | 20.2 | 14.5 | 13.1 | 12.7 | 12.1 | 18.8 | 18.6 | |||||||||||||||||||||||||||||||||||||||
| Other skilled | 9.4 | 8.7 | 4.5 | 4.9 | 5.2 | 4.2 | 8.2 | 7.8 | |||||||||||||||||||||||||||||||||||||||
| Skilled mix | 50.2 | % | 49.6 | % | 38.9 | % | 35.3 | % | 47.8 | % | 57.2 | % | 48.5 | % | 48.4 | % | |||||||||||||||||||||||||||||||
| Private and other payors | 7.4 | 7.9 | 8.3 | 9.4 | 8.4 | 6.5 | 7.6 | 8.0 | |||||||||||||||||||||||||||||||||||||||
| Medicaid | 42.4 | 42.5 | 52.8 | 55.3 | 43.8 | 36.3 | 43.9 | 43.6 | |||||||||||||||||||||||||||||||||||||||
| TOTAL SKILLED NURSING | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | |||||||||||||||||||||||||||||||
| Three Months Ended September 30, | |||||||||||||||||||||||||||||||||||||||||||||||
| Same Facility | Transitioning | Acquisitions | Total | ||||||||||||||||||||||||||||||||||||||||||||
| 2024 | 2023 | 2024 | 2023 | 2024 | 2023 | 2024 | 2023 | ||||||||||||||||||||||||||||||||||||||||
| PERCENTAGE OF SKILLED NURSING DAYS | |||||||||||||||||||||||||||||||||||||||||||||||
| Medicare | 10.7 | % | 10.9 | % | 9.7 | % | 8.0 | % | 15.2 | % | 21.9 | % | 11.2 | % | 11.2 | % | |||||||||||||||||||||||||||||||
| Managed care | 14.9 | 14.1 | 9.4 | 7.8 | 9.2 | 8.9 | 13.4 | 12.7 | |||||||||||||||||||||||||||||||||||||||
| Other skilled | 6.0 | 5.6 | 2.7 | 3.3 | 3.6 | 4.5 | 5.1 | 5.2 | |||||||||||||||||||||||||||||||||||||||
| Skilled mix | 31.6 | % | 30.6 | % | 21.8 | % | 19.1 | % | 28.0 | % | 35.3 | % | 29.7 | % | 29.1 | % | |||||||||||||||||||||||||||||||
| Private and other payors | 10.5 | 11.5 | 11.9 | 12.5 | 11.0 | 8.5 | 10.8 | 11.5 | |||||||||||||||||||||||||||||||||||||||
| Medicaid | 57.9 | 57.9 | 66.3 | 68.4 | 61.0 | 56.2 | 59.5 | 59.4 | |||||||||||||||||||||||||||||||||||||||
| TOTAL SKILLED NURSING | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | |||||||||||||||||||||||||||||||
| Nine Months Ended September 30, | |||||||||||||||||||||||||||||||||||||||||||||||
| Same Facility | Transitioning | Acquisitions | Total | ||||||||||||||||||||||||||||||||||||||||||||
| 2024 | 2023 | 2024 | 2023 | 2024 | 2023 | 2024 | 2023 | ||||||||||||||||||||||||||||||||||||||||
| PERCENTAGE OF SKILLED NURSING REVENUE | |||||||||||||||||||||||||||||||||||||||||||||||
| Medicare | 20.7 | % | 22.9 | % | 19.5 | % | 21.4 | % | 33.4 | % | 43.4 | % | 22.1 | % | 24.2 | % | |||||||||||||||||||||||||||||||
| Managed care | 20.4 | 20.1 | 14.2 | 12.1 | 13.1 | 13.4 | 18.7 | 18.5 | |||||||||||||||||||||||||||||||||||||||
| Other skilled | 9.1 | 8.6 | 4.7 | 5.2 | 4.5 | 4.4 | 8.0 | 7.9 | |||||||||||||||||||||||||||||||||||||||
| Skilled mix | 50.2 | % | 51.6 | % | 38.4 | % | 38.7 | % | 51.0 | % | 61.2 | % | 48.8 | % | 50.6 | % | |||||||||||||||||||||||||||||||
| Private and other payors | 7.2 | 7.5 | 8.7 | 8.8 | 7.8 | 6.2 | 7.5 | 7.6 | |||||||||||||||||||||||||||||||||||||||
| Medicaid | 42.6 | 40.9 | 52.9 | 52.5 | 41.2 | 32.6 | 43.7 | 41.8 | |||||||||||||||||||||||||||||||||||||||
| TOTAL SKILLED NURSING | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | |||||||||||||||||||||||||||||||
| Nine Months Ended September 30, | |||||||||||||||||||||||||||||||||||||||||||||||
| Same Facility | Transitioning | Acquisitions | Total | ||||||||||||||||||||||||||||||||||||||||||||
| 2024 | 2023 | 2024 | 2023 | 2024 | 2023 | 2024 | 2023 | ||||||||||||||||||||||||||||||||||||||||
| PERCENTAGE OF SKILLED NURSING DAYS | |||||||||||||||||||||||||||||||||||||||||||||||
| Medicare | 11.1 | % | 12.2 | % | 9.5 | % | 10.2 | % | 17.2 | % | 23.7 | % | 11.6 | % | 12.6 | % | |||||||||||||||||||||||||||||||
| Managed care | 14.9 | 14.4 | 9.2 | 7.4 | 9.8 | 10.2 | 13.5 | 13.1 | |||||||||||||||||||||||||||||||||||||||
| Other skilled | 5.8 | 5.5 | 3.0 | 3.3 | 3.3 | 4.4 | 5.1 | 5.0 | |||||||||||||||||||||||||||||||||||||||
| Skilled mix | 31.8 | % | 32.1 | % | 21.7 | % | 20.9 | % | 30.3 | % | 38.3 | % | 30.2 | % | 30.7 | % | |||||||||||||||||||||||||||||||
| Private and other payors | 10.4 | 11.0 | 12.0 | 11.8 | 10.3 | 8.3 | 10.6 | 10.9 | |||||||||||||||||||||||||||||||||||||||
| Medicaid | 57.8 | 56.9 | 66.3 | 67.3 | 59.4 | 53.4 | 59.2 | 58.4 | |||||||||||||||||||||||||||||||||||||||
| TOTAL SKILLED NURSING | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | |||||||||||||||||||||||||||||||
THE ENSIGN GROUP, INC.
UNAUDITED REVENUE BY PAYOR SOURCE
The following tables set forth our service revenue by payor source and as a percentage of total service revenue for the periods presented:
| Three Months Ended September 30, | |||||||||||||||||||||||
| 2024 | 2023 | ||||||||||||||||||||||
| Revenue | % of Revenue | Revenue | % of Revenue | ||||||||||||||||||||
Medicaid(1)(2) | $ | 425,642 | 39.6 | % | $ | 374,838 | 40.1 | % | |||||||||||||||
| Medicare | 263,594 | 24.5 | 237,531 | 25.4 | |||||||||||||||||||
| Medicaid — skilled | 65,907 | 6.1 | 62,452 | 6.6 | |||||||||||||||||||
| Total Medicaid and Medicare | $ | 755,143 | 70.2 | % | $ | 674,821 | 72.1 | % | |||||||||||||||
| Managed care | 202,528 | 18.8 | 170,747 | 18.3 | |||||||||||||||||||
Private and other(3) | 118,421 | 11.0 | 89,756 | 9.6 | |||||||||||||||||||
| SERVICE REVENUE | $ | 1,076,092 | 100.0 | % | $ | 935,324 | 100.0 | % | |||||||||||||||
(1) Medicaid payor includes revenue for senior living operations.
(2) Medicaid payor includes revenue related to state relief funding during the three months ended September 30, 2023.
(3) Private and other also includes revenue from senior living operations and all revenue generated in other ancillary services.
| Nine Months Ended September 30, | |||||||||||||||||||||||
| 2024 | 2023 | ||||||||||||||||||||||
| Revenue | % of Revenue | Revenue | % of Revenue | ||||||||||||||||||||
Medicaid(1) | $ | 1,227,565 | 39.5 | % | $ | 1,074,883 | 39.3 | % | |||||||||||||||
| Medicare | 788,046 | 25.3 | 733,335 | 26.8 | |||||||||||||||||||
| Medicaid — skilled | 192,185 | 6.2 | 182,394 | 6.7 | |||||||||||||||||||
| Total Medicaid and Medicare | $ | 2,207,796 | 71.0 | % | $ | 1,990,612 | 72.8 | % | |||||||||||||||
| Managed care | 581,654 | 18.7 | 488,511 | 17.9 | |||||||||||||||||||
Private and other(2) | 321,701 | 10.3 | 254,220 | 9.3 | |||||||||||||||||||
| SERVICE REVENUE | $ | 3,111,151 | 100.0 | % | $ | 2,733,343 | 100.0 | % | |||||||||||||||
(1) Medicaid payor includes revenue for senior living operations.
(2) Medicaid payor includes revenue related to state relief funding during the nine months ended September 30, 2023.
(3) Private and other also includes revenue from senior living operations and all revenue generated in other ancillary services.
THE ENSIGN GROUP, INC.
UNAUDITED RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION BY SEGMENT
(In thousands)
Skilled Services
The table below reconciles net income to EBITDA and Adjusted EBITDA for the skilled services reportable segment for the periods presented:
| Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
| 2024 | 2023 | 2024 | 2023 | ||||||||||||||||||||
| Statements of Income Data: | |||||||||||||||||||||||
Segment income(a) | $ | 128,489 | $ | 117,816 | $ | 377,483 | $ | 348,169 | |||||||||||||||
| Depreciation and amortization | 11,541 | 9,936 | 32,988 | 28,417 | |||||||||||||||||||
| EBITDA | $ | 140,030 | $ | 127,752 | $ | 410,471 | $ | 376,586 | |||||||||||||||
| Adjustments to EBITDA: | |||||||||||||||||||||||
| Stock-based compensation expense | 5,783 | 4,879 | 16,690 | 14,740 | |||||||||||||||||||
Litigation(b) | — | — | 2,100 | — | |||||||||||||||||||
| Gain on business interruption recoveries | — | (259) | — | (1,009) | |||||||||||||||||||
| ADJUSTED EBITDA | $ | 145,813 | $ | 132,372 | $ | 429,261 | $ | 390,317 | |||||||||||||||
(a) Segment income reflects profit or loss from operations before provision for income taxes and impairment charges from operations. General and administrative expenses are not allocated to the skilled services segment for purposes of determining segment profit or loss.
(b) Litigation relates to specific proceedings arising outside of the ordinary course of business.
Standard Bearer
The following table sets forth details of operating results for our revenue and earnings, and their respective components, by Standard Bearer for the periods presented:
| Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
| 2024 | 2023 | 2024 | 2023 | ||||||||||||||||||||
| Rental revenue generated from third-party tenants | $ | 4,195 | $ | 4,004 | $ | 12,588 | $ | 11,576 | |||||||||||||||
| Rental revenue generated from Ensign's independent subsidiaries | 20,234 | 16,976 | 57,396 | 49,035 | |||||||||||||||||||
| TOTAL RENTAL REVENUE | $ | 24,429 | $ | 20,980 | $ | 69,984 | $ | 60,611 | |||||||||||||||
Segment income(a) | 7,274 | 7,165 | 21,892 | 21,517 | |||||||||||||||||||
| Depreciation and amortization | 7,484 | 6,429 | 21,479 | 18,528 | |||||||||||||||||||
FFO(b) | $ | 14,758 | $ | 13,594 | $ | 43,371 | $ | 40,045 | |||||||||||||||
(b) FFO, in accordance with the definition used by the National Association of Real Estate Investment Trusts, means net income attributable to common stockholders, computed in accordance with U.S. GAAP, excluding gains or losses from sale of real estate, insurance recoveries related to real estate and impairment of long-lived assets, while including depreciation and amortization related to real estate to earnings.
Discussion of Non-GAAP Financial Measures
EBITDA consists of net income before (a) interest income, (b) provision for income taxes, (c) depreciation and amortization and (d) interest expense. Adjusted EBITDA consists of net income before (a) interest income, (b) provision for income taxes, (c) depreciation and amortization, (d) interest expense, (e) stock-based compensation expense, (f) acquisition related costs, (g) costs incurred related to system implementations, (h) litigation arising outside of the ordinary course of business and (i) loss on long-lived assets and gain on business interruption recoveries. Adjusted EBITDAR consists of net income before (a) interest income, (b) provision for income taxes, (c) depreciation and amortization, (d) interest expense, (e) rent-cost of services, (f) stock-based compensation expense, (g) acquisition related costs, (h) costs incurred related to system implementations, (i) litigation arising outside of the ordinary course of business and (j) loss on long-lived assets and gain on business interruption recoveries. Adjusted EBT consists of net income before (a) provision for income taxes, (b) stock-based compensation expense, (c) acquisition related costs, (d) costs incurred related to system implementations, (e) litigation arising outside of the ordinary course of business, (f) loss on long-lived assets and gain on business interruption recoveries and (g) depreciation and amortization of patient base intangible assets. Funds from Operations (FFO) for our Standard Bearer segment consists of segment income, excluding depreciation and amortization related to real estate, gains or losses from the sale of real estate, insurance recoveries related to real estate and impairment of long-lived assets. The Company believes that the presentation of adjusted net income, adjusted earnings per share, EBITDA, adjusted EBITDA, adjusted EBT and FFO provides important supplemental information to management and investors to evaluate the Company’s operating performance. Adjusted EBITDAR is a financial valuation measure that is not specified in GAAP. This measure is not displayed as a performance measure as it excludes rent expense, which is a normal and recurring operating expense. The Company believes disclosure of adjusted net income, adjusted net income per share, EBITDA, adjusted EBITDA, adjusted EBITDAR, adjusted EBT and FFO has substance because the excluded revenues and expenses are infrequent in nature and are variable in nature, or do not represent current revenues or cash expenditures. A material limitation associated with the use of these measures as compared to the GAAP measures of net income and diluted earnings per share is that they may not be comparable with the calculation of net income and diluted earnings per share for other companies in the Company's industry. These non-GAAP financial measures should not be relied upon to the exclusion of GAAP financial measures. For further information regarding why the Company believes that this non-GAAP measures provide useful information to investors, the specific manner in which management uses these measures, and some of the limitations associated with the use of these measures, please refer to the Company's periodic filings with the Securities and Exchange Commission, including its Annual Report on Form 10-K and Quarterly Report on Form 10-Q. The Company’s periodic filings are available on the SEC's website at www.sec.gov or under the "Financials" link of the Investor Relations section on Ensign’s website at http://www.ensigngroup.net.