恩赛因集团公布2024年第三季度业绩；
提升年度盈利和营业收入展望
明天，2024年10月25日上午10:00太平洋时间将举行电话会议和网络研讨会。
加州圣胡安卡皮斯特拉诺 - 2024年10月24日 - 恩赛因集团公司（纳斯达克： ENSG）是Ensign(TM)公司集团的母公司，该集团提供后期保健服务并投资于长期保健行业，主要涉及技术护理和老年人居住设施，宣布2024年第三季度营运结果，报告按通用会计原则计算的每股稀释收益为1.34美元，调整后每股收益(1) 为1.39美元，均为截至2024年9月30日的季度。
精彩亮点包括:
▪依据GAAP，净利润为7840万美元，较前一年同季增长22.8%。调整后的净利润(1) 为8110万美元，比上一年同季增长17.7%。
▪本季每股稀释盈利按照GAAP标准为1.34美元，较前一年同季增长20.7%。 调整后每股稀释盈利(1) 为1.39美元，较前一年同季增长15.8%。
▪在过去一年第一季度中，相同设施和转型设施的入住率分别增加了2.8%和4.8%。此外，在第二季度相较于上一季度，相同设施和转型设施的入住率分别增加了1.1%和1.6%。
▪在去年同季相比，店内和过渡设施的熟练服务营业收入分别增长了7.3%和7.5%。
▪相同设施和转型熟练天数分别比上年同季增加了6.1%和17.0%。相同设施和转型熟练天数分别比第二季度按顺序增加了2.6%和3.4%。
▪同一设施和过渡性设施管理的营业收入分别同比上年同期增长11.2%和22.4%。
▪本季度的合并GAAP和调整后营业收入均为10.8亿美元，较去年同期增加了15.0%。
▪标准扛旗者(2) 本季营业收入为2440万美元，较去年同期增加16.4%。基金运用率为1480万美元，较去年同期增加8.6%。
(1)见「依据通用会计原则（GAAP）转换为非通用会计原则（Non-GAAP）财务资讯」。
(2)我们的熟练服务和标杆部门在Form 10-Q的第8条款中有明确的定义和概述。
营运结果
「我们当地的领导层一直在稳健地推动优秀的临床和财务表现，我们很高兴地宣布又一个创纪录的季度，」恩赛因的首席执行官Barry Port说。「当我们在最近收购的桶中新增了53个新业务时，我们尤其对这些结果印象深刻。我们的模式主要依赖当地集群和现有业务来支持我们新收购的业务，而这些当地集群在同时将新业务整合到集群中并在现有业务上取得出色成果方面展现了他们的实力。具体来说，在该季度，我们看到同店入住率增长至81.7%，较去年同期增长2.8%，为同店入住率确立了新的最高水平，这在我们在这样的季度通常经历入住率较弱的情况下尤为值得注意。我们还看到同样的技术日数分别在同店和过渡业务中增长了3.3%和14.1%，较去年同期分别增加。这种增长不是因为任何一种关系或市场，而是在所有付款方中均有改善。此外，我们的管理护理普查分别对同店和过渡业务年同比增长了9.1%和23.2%，这是我们业务中非常重要且不断增长的部分，也表明了我们的领导人正在不断赢得信任，实现高质量的结果，」Port补充说。
「展望未来时，我们对于解锁现有投资组合中我们看到的巨大潜力感到兴奋。长期以来，我们成功的关键之一是拥有数条实现持续成果的途径，不依赖于新的收购。我们当地的CEO和COO不懈地努力改进并适应各自市场的需求，同时，他们继续拉动各种杠杆，增加专业混合度，将入住率提升至数十个最成熟的同店营运水准，其中许多远高于我们的同店平均水准。与此同时，正如我们本季所展示的，我们准备好了，并将继续以非常有吸引力的价格收购低占有率的营运，这将带来长期的上升斜坡，并有多年的增长潜力。」Port表示。
Port表示，《由于本季我们优秀的人才结构和入住率增长，以及我们最近收购持续的强势，我们将我们2024年度每股稀释盈利指引提高和调整为每股5.46至5.52美元，高于之前的每股5.38至5.50美元。我们2024年度盈利指引的新中间值相较于我们2023年的结果增加了15.1%以上，比我们2022年的结果高出32.6%。我们还将我们的年度营业收入指引提高到42.5亿至42.6亿美元，高于我们之前的指引42亿至42.2亿美元，以反映本季的增长和我们预计将在年底前完成的收购。我们对完成2024年感到兴奋，并期待2025年，我们对合作伙伴将在继续管理和创新的同时平衡新收购业务的增加充满信心。
就公司的成长而言，恩赛因的首席投资长兼执行副总裁查德·基奇表示：“正如我们预期的，我们持续新增投资组合，对于本季度及其后增加的十二个新运营，其中包括三项房地产资产，我们感到非常兴奋，将本年度收购的运营数量提高至27。我们持续看到大量健康之路新收购机会，并正在推进我们预计在第四季度及明年进行交割的若干新增事项。我们坚持，特别是在眼前机遇众多的时候，依靠一套经验验证的交易标准，确保我们保持纪律，以健康之路的方式增长。当我们看到对于股东在短期和长期都具有增值作用的交易时，我们已经并将继续增长。我们还很高兴在新邦或市场中建立集群，特别是在我们有很大潜力增加密度的市场中，预期在接下来的几个月中，在一些我们较新的市场中实现额外增长。”
恩赛因公司的执行副总裁兼首席财务官苏珊·斯纳珀报告称，公司的流动性仍然强劲，手头现金约为53210万美元，信贷额度下可用资金为57210万美元。斯纳珀女士还指出：“管理层的年度指引基于大约5850万股稀释加权平均普通股的基础，税率为25.0%。此外，该指引假设正常化的健康保险成本和管理层对于报销率的当前期望，以及排除一些来自业务之外的特定费用，与收购相关的费用和以股份形式的补偿。
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.