News Release Details
The Ensign Group Reports Fourth Quarter and Fiscal Year 2022 Results; Issues 2023 Guidance
Highlights Include:
- GAAP diluted earnings per share for the year was
$3.95 and adjusted diluted earnings per share(1) for the year was$4.14 , an increase of 13.7% over the prior year. - GAAP diluted earnings per share for the quarter was
$1.06 , an increase of 23.3%, and adjusted diluted earnings per share(1) was$1.10 , an increase of 13.4%, both over the prior year quarter. - Consolidated GAAP revenues for the year were
$3 .025 billion, an increase of$398 .5 million or 15.1% over the prior year. - Total skilled services(2) revenue was
$2 .9 billion for the year, an increase of 15.2% over the prior year, and was$777 .6 million for the quarter, an increase of 16.5% over the prior year quarter. - Same store and transitioning occupancy increased by 2.9% and 4.3%, respectively, over the prior year quarter and increased by 1.0% and 0.8%, respectively, sequentially over the third quarter.
- Standard Bearer(2) revenue was
$19 .4 million for the quarter, an increase of 26.0% from prior year quarter, and$72 .9 million for the year, an increase of 25.5% from prior year. FFO was$13 .0 million for the quarter and$49 .5 million for the year. - GAAP net income was
$60 .5 million and adjusted net income(1) was$62 .7 million for the quarter, an increase of 24.1% and 14.1%, respectively, over the prior year quarter. - GAAP net income was
$224 .7 million and adjusted net income(1) was$235 .7 million for the year, an increase of 15.4% and 13.8%, respectively, over the prior year.
(1) See "Reconciliation of GAAP to Non-GAAP Financial Information".
(2) Our Skilled Services and Standard Bearer Segments are defined and outlined in Note 8 on Form 10-K.
Operating Results
“We were pleased to announce another record quarter. These results demonstrate yet again that our local leaders and their teams continue to be the examples of post-acute excellence as they wade through the evolving landscape in each of their markets,” said
Port noted that the Company has also made progress in improving our skilled mix, noting that during the quarter, same store operations grew their skilled mix revenue by 9.1% over the prior year quarter. “When compared to pre-Covid levels, our skilled mix has remained elevated, showing just how important high-quality post-acute services are within the continuum of care. We’ve always been confident that our skilled mix would continue to be strong, but we are very pleased to see continuous fundamental growth in skilled mix, which is not being driven by Covid, as it demonstrates the increasing and sustainable demand for skilled post-acute services. We are excited about the upcoming year and are confident that our partners will continue to manage and innovate through all the lingering challenges on the labor front. When we consider the current health of our organization, combined with our culture and proven local leadership strategy, we are well-positioned to have another outstanding year in 2023,” he added.
Speaking to the Company’s financial health,
A discussion of the company's use of non-GAAP financial measures is set forth below. A reconciliation of net income to EBITDA, adjusted EBITDAR, adjusted EBITDA, FFO for our real estate segment, 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 Annual Report on Form 10-K for the period ended
Growth and Real Estate Highlights
The recent acquisitions include the following operations:
Brodie Ranch Nursing and Rehabilitation, a 120-bed skilled nursing facility inAustin, Texas ;Onion Creek Nursing and Rehabilitation Center , a 125-bed skilled nursing facility inAustin, Texas ;Riverside Nursing and Rehabilitation Center , a 122-bed skilled nursing facility inAustin, Texas ;West Oaks Nursing and Rehabilitation Center , a 125-bed skilled nursing facility inAustin, Texas ;Lakeside Nursing and Rehabilitation Center , a 118-bed skilled nursing facility inSan Antonio, Texas ;Mystic Park Nursing and Rehabilitation Center , a 119-bed skilled nursing facility inSan Antonio, Texas ;Brighton Care Center , a 108-bed skilled nursing facility located inBrighton, Colorado ;Malley Transitional Care Center , a 162-bed skilled nursing facility located inNorthglenn, Colorado Oak Harbor Healthcare , a 132-bed skilled nursing facility inMount Pleasant, South Carolina ;Oak View Health and Rehabilitation, a 190-bed skilled nursing facility inConway, South Carolina ;- Lila Doyle Post Acute, a 120-bed skilled nursing facility located in
Seneca, South Carolina ; - Fountain Hills Post Acute, a 64-bed skilled nursing facility in
Fountain Hills, Arizona ; Alamitos Belmont Health and Rehabilitation, a 94-bed skilled nursing facility located inLong Beach, California ;- Beachside Nursing Center, a 59-bed skilled nursing facility located in
Huntington Beach, California ; Broadway by the Sea, a 95-bed skilled nursing facility located inLong Beach, California ;Chatsworth Park Health Care Center , a 128-bed skilled nursing facility located inChatsworth, California ;Coventry Court Health Center , a 95-bed skilled nursing facility located inAnaheim, California ;- Danville Post Acute Rehabilitation, a 49-bed skilled nursing facility located in
Danville, California ; - Edgewater Skilled Nursing Center, an 81-bed skilled nursing facility located in
Long Beach, California ; - Fairfield Post Acute Rehabilitation, a 99-bed skilled nursing facility located in
Fairfield, California ; Fairmont Rehabilitation Hospital , a 59-bed skilled nursing facility located inLodi, California ;- Garden View Post Acute Rehabilitation, a 97-bed skilled nursing facility located in
Baldwin Park, California ; Grand Terrace Health Care Center , a 59-bed skilled nursing facility located inGrand Terrace, California ;Lake Balboa Care Center , a 50-bed skilled nursing facility located inVan Nuys, California ;Lomita Post Acute Care Center , a 68-bed skilled nursing facility located inLomita, California ;New Orange Hills , a 143-bed skilled nursing facility located inOrange, California ;Pacifica Nursing andRehabilitation Center , a 68-bed skilled nursing facility located inPacifica, California ;Palm Terrace Care Center , a 70-bed skilled nursing facility located inRiverside, California ; andRamona Nursing andRehabilitation Center , a 148-bed skilled nursing facility located inDanville, California .
In total, these additions bring Ensign's growing portfolio to 288 healthcare operations, 26 of which also include senior living operations, across thirteen states. Ensign now owns 108 real estate assets, 79 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.
Standard Bearer also announced the following real estate acquisitions, all of which are operated by an independent operating subsidiary of Ensign, during the quarter:
- Fountain Hills Post Acute, a 64-bed skilled nursing facility in
Fountain Hills, Arizona ; and - Lila Doyle Post Acute, a 120-bed skilled nursing facility located in
Seneca, South Carolina .
The Company continues to provide additional disclosure on Standard Bearer, which is comprised of 103 properties owned by the Company and leased to 75 affiliated skilled nursing and senior living operations and 29 senior living operations that are leased to
The Company paid a quarterly cash dividend of
Conference Call
A live webcast will be held
About Ensign™
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 in 2023 continue to be impacted by the COVID-19 pandemic. Because of the unprecedented nature of the pandemic, we are unable to predict the full extent and duration of the financial impact of COVID-19 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
Contact Information
Investor/Media Relations,
SOURCE:
CONSOLIDATED STATEMENTS OF INCOME
Three Months Ended |
Year Ended |
||||||||||||||
2022 | 2021 | 2022 | 2021 | ||||||||||||
(In thousands, except per share data) | |||||||||||||||
REVENUE | |||||||||||||||
Service revenue | $ | 805,325 | $ | 688,994 | $ | 3,008,711 | $ | 2,611,476 | |||||||
Rental revenue | 4,207 | 4,148 | 16,757 | 15,985 | |||||||||||
TOTAL REVENUE | $ | 809,532 | $ | 693,142 | $ | 3,025,468 | $ | 2,627,461 | |||||||
Expense: | |||||||||||||||
Cost of services | 633,529 | 535,063 | 2,354,434 | 2,019,879 | |||||||||||
Rent—cost of services | 41,152 | 35,837 | 153,049 | 139,371 | |||||||||||
General and administrative expense | 42,775 | 42,026 | 158,805 | 151,761 | |||||||||||
Depreciation and amortization | 16,880 | 14,602 | 62,355 | 55,985 | |||||||||||
TOTAL EXPENSES | 734,336 | 627,528 | 2,728,643 | 2,366,996 | |||||||||||
Income from operations | 75,196 | 65,614 | 296,825 | 260,465 | |||||||||||
Other (expense) income: | |||||||||||||||
Interest expense | (2,067 | ) | (1,865 | ) | (8,931 | ) | (6,849 | ) | |||||||
Other income | 4,322 | 2,271 | 1,195 | 4,388 | |||||||||||
Other income (expense), net | 2,255 | 406 | (7,736 | ) | (2,461 | ) | |||||||||
Income before provision for income taxes | 77,451 | 66,020 | 289,089 | 258,004 | |||||||||||
Provision for income taxes | 16,932 | 17,059 | 64,437 | 60,279 | |||||||||||
NET INCOME | 60,519 | 48,961 | 224,652 | 197,725 | |||||||||||
Less: net income (loss) attributable to noncontrolling interests | 48 | 221 | (29 | ) | 3,073 | ||||||||||
Net income attributable to |
$ | 60,471 | $ | 48,740 | $ | 224,681 | $ | 194,652 | |||||||
NET INCOME PER SHARE ATTRIBUTABLE TO THE |
|||||||||||||||
Basic | $ | 1.10 | $ | 0.89 | $ | 4.09 | $ | 3.57 | |||||||
Diluted | $ | 1.06 | $ | 0.86 | $ | 3.95 | $ | 3.42 | |||||||
WEIGHTED AVERAGE COMMON SHARES OUTSTANDING | |||||||||||||||
Basic | 55,087 | 54,653 | 54,887 | 54,486 | |||||||||||
Diluted | 56,973 | 56,839 | 56,871 | 56,925 |
CONSOLIDATED BALANCE SHEETS
2022 | 2021 | ||||
(In thousands) | |||||
ASSETS | |||||
Current assets: | |||||
Cash and cash equivalents | $ | 316,270 | $ | 262,201 | |
Accounts receivable—less allowance for doubtful accounts of |
408,432 | 328,731 | |||
Investments—current | 15,441 | 13,763 | |||
Prepaid income taxes | 4,643 | 5,452 | |||
Prepaid expenses and other current assets | 36,339 | 29,562 | |||
Total current assets | 781,125 | 639,709 | |||
Property and equipment, net | 992,010 | 888,434 | |||
Right-of-use assets | 1,450,995 | 1,138,872 | |||
Insurance subsidiary deposits and investments | 67,652 | 54,097 | |||
Deferred tax assets | 39,643 | 33,147 | |||
Restricted and other assets | 37,291 | 29,516 | |||
Intangible assets, net | 2,465 | 2,652 | |||
76,869 | 60,469 | ||||
Other indefinite-lived intangibles | 3,972 | 3,727 | |||
TOTAL ASSETS | $ | 3,452,022 | $ | 2,850,623 | |
LIABILITIES AND EQUITY | |||||
Current liabilities: | |||||
Accounts payable | $ | 77,087 | $ | 58,116 | |
Accrued wages and related liabilities | 289,810 | 278,770 | |||
Lease liabilities—current | 65,796 | 52,181 | |||
Accrued self-insurance liabilities—current | 48,187 | 40,831 | |||
Other accrued liabilities | 97,309 | 89,410 | |||
Current maturities of long-term debt | 3,883 | 3,760 | |||
Total current liabilities | 582,072 | 523,068 | |||
Long-term debt—less current maturities | 149,269 | 152,883 | |||
Long-term lease liabilities—less current portion | 1,355,113 | 1,056,515 | |||
Accrued self-insurance liabilities—less current portion | 83,495 | 69,308 | |||
Other long-term liabilities | 33,273 | 27,135 | |||
Total equity | 1,248,800 | 1,021,714 | |||
TOTAL LIABILITIES AND EQUITY | $ | 3,452,022 | $ | 2,850,623 |
CONSOLIDATED STATEMENTS OF CASH FLOWS
The following table presents selected data from our consolidated statements of cash flows for the periods presented:
Year Ended |
|||||||
2022 | 2021 | ||||||
NET CASH PROVIDED BY/(USED IN): | (In thousands) | ||||||
Operating activities | $ | 272,513 | $ | 275,684 | |||
Investing activities | (186,182 | ) | (173,907 | ) | |||
Financing activities | (32,262 | ) | (76,138 | ) | |||
Net increase in cash and cash equivalents | 54,069 | 25,639 | |||||
Cash and cash equivalents beginning of period | 262,201 | 236,562 | |||||
Cash and cash equivalents at end of period | $ | 316,270 | $ | 262,201 |
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 net income to Non-GAAP net income for the periods presented:
Three Months Ended |
Year Ended |
||||||||||||||
2022 | 2021 | 2022 | 2021 | ||||||||||||
Net income attributable to |
$ | 60,471 | $ | 48,740 | $ | 224,681 | $ | 194,652 | |||||||
Non-GAAP adjustments | |||||||||||||||
Stock-based compensation expense(a) | 6,039 | 4,909 | 22,720 | 18,678 | |||||||||||
Results related to operations not at full capacity(b) | — | — | — | 657 | |||||||||||
Other income - gain on sale of a business | — | (902 | ) | — | (902 | ) | |||||||||
Cost of services - gain on sale of assets and business interruption recoveries | (913 | ) | (1,825 | ) | (4,380 | ) | (2,365 | ) | |||||||
Cost of services - legal finding(c) | 68 | — | 4,280 | — | |||||||||||
Interest expense - write off deferred financing fees(d) | — | — | 566 | — | |||||||||||
Cost of services - acquisition related costs(e) | 253 | 50 | 669 | 384 | |||||||||||
Depreciation and amortization - patient base(f) | 107 | — | 320 | 42 | |||||||||||
General and administrative - real estate transactions and other related costs(g) | — | 5,232 | — | 5,689 | |||||||||||
General and administrative - costs incurred related to new systems implementation(h) | 682 | 69 | 1,072 | 186 | |||||||||||
Provision for income taxes on Non-GAAP adjustments(i) | (3,990 | ) | (1,328 | ) | (14,215 | ) | (9,814 | ) | |||||||
Non-GAAP income | $ | 62,717 | $ | 54,945 | $ | 235,713 | $ | 207,207 | |||||||
Average number of diluted shares outstanding | 56,973 | 56,839 | 56,871 | 56,925 | |||||||||||
Diluted Earnings Per Share | |||||||||||||||
Net income | $ | 1.06 | $ | 0.86 | $ | 3.95 | $ | 3.42 | |||||||
Adjusted Diluted Earnings Per Share | |||||||||||||||
Net Income | $ | 1.10 | $ | 0.97 | $ | 4.14 | $ | 3.64 | |||||||
Footnotes: | |||||||||||||||
(a) Represents stock-based compensation expense incurred. | |||||||||||||||
Three Months Ended |
Year Ended |
||||||||||||||
2022 | 2021 | 2022 | 2021 | ||||||||||||
Cost of services | $ | 3,959 | $ | 3,209 | $ | 14,897 | $ | 11,791 | |||||||
General and administrative | 2,080 | 1,700 | 7,823 | 6,887 | |||||||||||
Total Non-GAAP adjustment | $ | 6,039 | $ | 4,909 | $ | 22,720 | $ | 18,678 | |||||||
(b) Represents results to operations not at full capacity | |||||||||||||||
Three Months Ended |
Year Ended |
||||||||||||||
2022 | 2021 | 2022 | 2021 | ||||||||||||
Revenue | $ | — | $ | — | $ | — | $ | (456 | ) | ||||||
Cost of services | — | — | — | 1,041 | |||||||||||
Rent | — | — | — | 38 | |||||||||||
Depreciation and amortization | — | — | — | 34 | |||||||||||
Total Non-GAAP adjustment | $ | — | $ | — | $ | — | $ | 657 | |||||||
(c) Legal finding against our non-emergent transportation subsidiary. | |||||||||||||||
(d) Represents the write off of deferred financing fees associated with the amendment of the credit facility. | |||||||||||||||
(e) Represents costs incurred to acquire operations that are not capitalizable. | |||||||||||||||
(f) Included in depreciation and amortization are amortization expenses related to patient base intangible assets at newly acquired skilled nursing and senior living facilities. | |||||||||||||||
(g) Real estate transactions and other related costs include costs incurred related to the formation of Standard Bearer and other real estate related activities. | |||||||||||||||
(h) Represents system implementation costs that are not capitalizable. | |||||||||||||||
(i) Represents an adjustment to the provision for income tax to our historical year to date effective tax rate of 25.0%. |
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 |
Year Ended |
||||||||||||||
2022 | 2021 | 2022 | 2021 | ||||||||||||
Consolidated Statements of Income Data: | |||||||||||||||
Net income | $ | 60,519 | $ | 48,961 | $ | 224,652 | $ | 197,725 | |||||||
Less: net income (loss) attributable to noncontrolling interests | 48 | 221 | (29 | ) | 3,073 | ||||||||||
Add: Other (income) expense, net | (2,255 | ) | (406 | ) | 7,736 | 2,461 | |||||||||
Provision for income taxes | 16,932 | 17,059 | 64,437 | 60,279 | |||||||||||
Depreciation and amortization | 16,880 | 14,602 | 62,355 | 55,985 | |||||||||||
EBITDA | $ | 92,028 | $ | 79,995 | $ | 359,209 | $ | 313,377 | |||||||
Adjustments to EBITDA: | |||||||||||||||
Stock-based compensation expense | 6,039 | 4,909 | 22,720 | 18,678 | |||||||||||
Real estate transactions and other related costs(a) | — | 5,232 | — | 5,689 | |||||||||||
Legal finding(b) | 68 | — | 4,280 | — | |||||||||||
Gain on sale of assets and business interruptions recoveries | (913 | ) | (1,825 | ) | (4,380 | ) | (2,365 | ) | |||||||
Results related to operations not at full capacity | — | — | — | 585 | |||||||||||
Acquisition related costs(c) | 253 | 50 | 669 | 384 | |||||||||||
Costs incurred related to new systems implementation | 682 | 69 | 1,072 | 186 | |||||||||||
Rent related to items above | — | — | — | 38 | |||||||||||
Adjusted EBITDA | $ | 98,157 | $ | 88,430 | $ | 383,570 | $ | 336,572 | |||||||
Rent—cost of services | 41,152 | 35,837 | 153,049 | 139,371 | |||||||||||
Less: rent related to items above | — | — | — | (38 | ) | ||||||||||
Adjusted rent | 41,152 | 35,837 | 153,049 | 139,333 | |||||||||||
Adjusted EBITDAR | $ | 139,309 | $ | 536,619 | |||||||||||
(a) Real estate transactions and other related costs include costs incurred related to the formation of Standard Bearer and other real estate related activities.
(b) Legal finding against our non-emergent transportation subsidiary.
(c) Costs incurred to acquire operations that are not capitalizable.
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 indicated:
Three Months Ended |
|||||||||||||
2022 | 2021 | Change | % Change | ||||||||||
TOTAL FACILITY RESULTS: | (Dollars in thousands) | ||||||||||||
Skilled services revenue | $ | 777,648 | $ | 667,241 | $ | 110,407 | 16.5 | % | |||||
Number of facilities at period end | 234 | 211 | 23 | 10.9 | % | ||||||||
Number of campuses at period end* | 26 | 25 | 1 | 4.0 | % | ||||||||
Actual patient days | 1,956,091 | 1,703,536 | 252,555 | 14.8 | % | ||||||||
Occupancy percentage — Operational beds | 76.2 | % | 73.9 | % | 2.3 | % | |||||||
Skilled mix by nursing days | 30.9 | % | 31.2 | % | (0.3 | )% | |||||||
Skilled mix by nursing revenue | 51.1 | % | 51.9 | % | (0.8 | )% |
Three Months Ended |
|||||||||||||
2022 | 2021 | Change | % Change | ||||||||||
SAME FACILITY RESULTS:(1) | (Dollars in thousands) | ||||||||||||
Skilled services revenue | $ | 574,790 | $ | 538,069 | $ | 36,721 | 6.8 | % | |||||
Number of facilities at period end | 167 | 167 | — | — | % | ||||||||
Number of campuses at period end* | 20 | 20 | — | — | % | ||||||||
Actual patient days | 1,399,834 | 1,346,560 | 53,274 | 4.0 | % | ||||||||
Occupancy percentage — Operational beds | 77.8 | % | 74.9 | % | 2.9 | % | |||||||
Skilled mix by nursing days | 33.6 | % | 33.0 | % | 0.6 | % | |||||||
Skilled mix by nursing revenue | 53.8 | % | 53.7 | % | 0.1 | % |
Three Months Ended |
|||||||||||||
2022 | 2021 | Change | % Change | ||||||||||
TRANSITIONING FACILITY RESULTS:(2) | (Dollars in thousands) | ||||||||||||
Skilled services revenue | $ | 97,615 | $ | 88,852 | $ | 8,763 | 9.9 | % | |||||
Number of facilities at period end | 27 | 27 | — | — | % | ||||||||
Number of campuses at period end* | 5 | 5 | — | — | % | ||||||||
Actual patient days | 258,891 | 244,892 | 13,999 | 5.7 | % | ||||||||
Occupancy percentage — Operational beds | 76.8 | % | 72.5 | % | 4.3 | % | |||||||
Skilled mix by nursing days | 26.9 | % | 26.0 | % | 0.9 | % | |||||||
Skilled mix by nursing revenue | 46.5 | % | 46.2 | % | 0.3 | % |
Three Months Ended |
||||||||||||
2022 | 2021 | Change | % Change | |||||||||
RECENTLY ACQUIRED FACILITY RESULTS:(3) | (Dollars in thousands) | |||||||||||
Skilled services revenue | $ | 105,243 | $ | 40,320 | $ | 64,923 | NM | |||||
Number of facilities at period end | 40 | 17 | 23 | NM | ||||||||
Number of campuses at period end* | 1 | — | 1 | NM | ||||||||
Actual patient days | 297,366 | 112,084 | 185,282 | NM | ||||||||
Occupancy percentage — Operational beds | 69.2 | % | 66.5 | % | NM | |||||||
Skilled mix by nursing days | 21.5 | % | 20.5 | % | NM | |||||||
Skilled mix by nursing revenue | 40.3 | % | 39.4 | % | NM |
* 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. In 2022, we converted three skilled nursing facilities into campuses.
(1) Same Facility results represent all facilities purchased prior to
(2) Transitioning Facility results represent all facilities purchased from
(3) Recently Acquired Facility (Acquisitions) results represent all facilities purchased on or subsequent to
Year Ended |
|||||||||||||
2022 | 2021 | Change | % Change | ||||||||||
TOTAL FACILITY RESULTS: | (Dollars in thousands) | ||||||||||||
Skilled services revenue | $ | 2,906,215 | $ | 2,523,234 | $ | 382,981 | 15.2 | % | |||||
Number of facilities at period end | 234 | 211 | 23 | 10.9 | % | ||||||||
Number of campuses at period end* | 26 | 25 | 1 | 4.0 | % | ||||||||
Actual patient days | 7,243,781 | 6,478,810 | 764,971 | 11.8 | % | ||||||||
Occupancy percentage — Operational beds | 75.3 | % | 72.8 | % | 2.5 | % | |||||||
Skilled mix by nursing days | 31.8 | % | 31.7 | % | 0.1 | % | |||||||
Skilled mix by nursing revenue | 52.0 | % | 52.3 | % | (0.3 | )% |
Year Ended |
|||||||||||||
2022 | 2021 | Change | % Change | ||||||||||
SAME FACILITY RESULTS:(1) | (Dollars in thousands) | ||||||||||||
Skilled services revenue | $ | 2,237,100 | $ | 2,084,537 | $ | 152,563 | 7.3 | % | |||||
Number of facilities at period end | 167 | 167 | — | — | % | ||||||||
Number of campuses at period end* | 20 | 20 | — | — | % | ||||||||
Actual patient days | 5,450,136 | 5,269,464 | 180,672 | 3.4 | % | ||||||||
Occupancy percentage — Operational beds | 76.4 | % | 73.9 | % | 2.5 | % | |||||||
Skilled mix by nursing days | 33.7 | % | 33.1 | % | 0.6 | % | |||||||
Skilled mix by nursing revenue | 53.9 | % | 53.8 | % | 0.1 | % |
Year Ended |
|||||||||||||
2022 | 2021 | Change | % Change | ||||||||||
TRANSITIONING FACILITY RESULTS:(2) | (Dollars in thousands) | ||||||||||||
Skilled services revenue | $ | 381,003 | $ | 336,338 | $ | 44,665 | 13.3 | % | |||||
Number of facilities at period end | 27 | 27 | — | — | % | ||||||||
Number of campuses at period end* | 5 | 5 | — | — | % | ||||||||
Actual patient days | 1,002,904 | 929,058 | 73,846 | 7.9 | % | ||||||||
Occupancy percentage — Operational beds | 74.9 | % | 69.4 | % | 5.5 | % | |||||||
Skilled mix by nursing days | 27.5 | % | 26.1 | % | 1.4 | % | |||||||
Skilled mix by nursing revenue | 47.4 | % | 46.3 | % | 1.1 | % |
Year Ended |
||||||||||||
2022 | 2021 | Change | % Change | |||||||||
RECENTLY ACQUIRED FACILITY RESULTS:(3) | (Dollars in thousands) | |||||||||||
Skilled services revenue | $ | 288,112 | $ | 102,359 | $ | 185,753 | NM | |||||
Number of facilities at period end | 40 | 17 | 23 | NM | ||||||||
Number of campuses at period end* | 1 | — | 1 | NM | ||||||||
Actual patient days | 790,741 | 280,288 | 510,453 | NM | ||||||||
Occupancy percentage — Operational beds | 69.4 | % | 66.2 | % | NM | |||||||
Skilled mix by nursing days | 23.5 | % | 22.4 | % | NM | |||||||
Skilled mix by nursing revenue | 42.3 | % | 42.3 | % | NM |
* 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. In 2022, we converted three skilled nursing facilities into campuses.
(1) Same Facility results represent all facilities purchased prior to
(2) Transitioning Facility results represent all facilities purchased from
(3) Recently Acquired Facility (Acquisitions) results represent all facilities purchased on or subsequent to
SKILLED NURSING AVERAGE DAILY REVENUE RATES AND
PERCENT OF SKILLED NURSING REVENUE AND DAYS BY PAYOR
(Unaudited)
The following table reflects 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 |
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Same Facility | Transitioning | Acquisitions | Total | ||||||||||||||||||||
2022 | 2021 | 2022 | 2021 | 2022 | 2021 | 2022 | 2021 | ||||||||||||||||
SKILLED NURSING AVERAGE DAILY REVENUE RATES | |||||||||||||||||||||||
Medicare | $ | 706.25 | $ | 692.56 | $ | 705.50 | $ | 687.81 | $ | 662.73 | $ | 680.84 | $ | 700.23 | $ | 691.26 | |||||||
Managed care | 516.68 | 502.20 | 482.23 | 462.66 | 512.28 | 510.38 | 511.90 | 497.67 | |||||||||||||||
Other skilled | 599.60 | 552.98 | 477.90 | 410.46 | 466.51 | 584.02 | 578.36 | 543.79 | |||||||||||||||
Total skilled revenue | 607.32 | 587.87 | 581.83 | 564.77 | 586.96 | 613.80 | 602.22 | 586.23 | |||||||||||||||
Medicaid | 265.52 | 252.94 | 248.79 | 232.41 | 240.97 | 243.48 | 258.91 | 249.01 | |||||||||||||||
Private and other payors | 256.69 | 236.69 | 232.51 | 221.20 | 226.64 | 239.19 | 248.24 | 234.43 | |||||||||||||||
Total skilled nursing revenue | $ | 379.38 | $ | 361.89 | $ | 336.38 | $ | 317.38 | $ | 313.89 | $ | 318.92 | $ | 363.73 | $ | 352.66 |
(1) These rates exclude additional Federal Medical Assistance Percentage (FMAP) and other state relief funding and include sequestration reversal of 2% in 2021.
Year Ended |
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Same Facility | Transitioning | Acquisitions | Total | ||||||||||||||||||||
2022 | 2021 | 2022 | 2021 | 2022 | 2021 | 2022 | 2021 | ||||||||||||||||
SKILLED NURSING AVERAGE DAILY REVENUE RATES | |||||||||||||||||||||||
Medicare | $ | 693.31 | $ | 687.26 | $ | 690.20 | $ | 681.34 | $ | 675.96 | $ | 707.03 | $ | 691.25 | $ | 687.18 | |||||||
Managed care | 513.80 | 503.36 | 476.71 | 463.89 | 502.48 | 510.88 | 508.53 | 498.97 | |||||||||||||||
Other skilled | 582.84 | 543.06 | 461.46 | 411.41 | 477.86 | 558.26 | 563.56 | 534.40 | |||||||||||||||
Total skilled revenue | 599.02 | 585.58 | 578.03 | 568.30 | 583.74 | 624.26 | 595.26 | 584.72 | |||||||||||||||
Medicaid | 262.11 | 251.35 | 245.74 | 234.38 | 245.87 | 245.52 | 257.67 | 248.41 | |||||||||||||||
Private and other payors | 254.06 | 238.33 | 230.40 | 227.98 | 235.50 | 251.92 | 248.54 | 237.21 | |||||||||||||||
Total skilled nursing revenue | $ | 374.97 | $ | 360.80 | $ | 335.41 | $ | 320.95 | $ | 324.40 | $ | 330.88 | $ | 363.97 | $ | 353.79 |
(1) These rates exclude additional FMAP and other state relief funding and include sequestration reversal of 1% for the second quarter in 2022 and 2% for the first quarter of 2022 and the year ended
The following tables set forth our percentage of skilled nursing patient revenue and days by payor source for the quarter and years ended
Three Months Ended |
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Same Facility | Transitioning | Acquisitions | Total | ||||||||||||||||||||
2022 | 2021 | 2022 | 2021 | 2022 | 2021 | 2022 | 2021 | ||||||||||||||||
PERCENTAGE OF SKILLED NURSING REVENUE | |||||||||||||||||||||||
Medicare | 25.2 | % | 25.6 | % | 25.3 | % | 26.8 | % | 24.7 | % | 23.7 | % | 25.1 | % | 25.6 | % | |||||||
Managed care | 19.4 | 19.5 | 18.0 | 16.1 | 10.6 | 10.1 | 18.1 | 18.5 | |||||||||||||||
Other skilled | 9.2 | 8.6 | 3.2 | 3.3 | 5.0 | 5.6 | 7.9 | 7.8 | |||||||||||||||
Skilled mix | 53.8 | 53.7 | 46.5 | 46.2 | 40.3 | 39.4 | 51.1 | 51.9 | |||||||||||||||
Private and other payors | 6.8 | 6.9 | 8.5 | 8.0 | 7.9 | 7.0 | 7.2 | 7.1 | |||||||||||||||
Medicaid | 39.4 | 39.4 | 45.0 | 45.8 | 51.8 | 53.6 | 41.7 | 41.0 | |||||||||||||||
TOTAL SKILLED NURSING | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % |
Three Months Ended |
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Same Facility | Transitioning | Acquisitions | Total | ||||||||||||||||||||
2022 | 2021 | 2022 | 2021 | 2022 | 2021 | 2022 | 2021 | ||||||||||||||||
PERCENTAGE OF SKILLED |
|||||||||||||||||||||||
Medicare | 13.5 | % | 13.4 | % | 12.0 | % | 12.4 | % | 11.7 | % | 11.1 | % | 13.1 | % | 13.1 | % | |||||||
Managed care | 14.3 | 14.1 | 12.5 | 11.0 | 6.5 | 6.3 | 12.9 | 13.1 | |||||||||||||||
Other skilled | 5.8 | 5.5 | 2.4 | 2.6 | 3.3 | 3.1 | 4.9 | 5.0 | |||||||||||||||
Skilled mix | 33.6 | 33.0 | 26.9 | 26.0 | 21.5 | 20.5 | 30.9 | 31.2 | |||||||||||||||
Private and other payors | 10.2 | 10.7 | 12.2 | 11.5 | 11.0 | 9.2 | 10.5 | 10.7 | |||||||||||||||
Medicaid | 56.2 | 56.3 | 60.9 | 62.5 | 67.5 | 70.3 | 58.6 | 58.1 | |||||||||||||||
TOTAL SKILLED NURSING | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % |
Year Ended |
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Same Facility | Transitioning | Acquisitions | Total | ||||||||||||||||||||
2022 | 2021 | 2022 | 2021 | 2022 | 2021 | 2022 | 2021 | ||||||||||||||||
PERCENTAGE OF SKILLED NURSING REVENUE | |||||||||||||||||||||||
Medicare | 25.6 | % | 25.9 | % | 27.2 | % | 27.9 | % | 24.4 | % | 25.2 | % | 25.7 | % | 26.1 | % | |||||||
Managed care | 19.6 | 19.4 | 16.8 | 15.1 | 10.6 | 9.0 | 18.3 | 18.4 | |||||||||||||||
Other skilled | 8.7 | 8.5 | 3.4 | 3.3 | 7.3 | 8.1 | 8.0 | 7.8 | |||||||||||||||
Skilled mix | 53.9 | 53.8 | 47.4 | 46.3 | 42.3 | 42.3 | 52.0 | 52.3 | |||||||||||||||
Private and other payors | 7.0 | 6.8 | 8.0 | 7.7 | 6.9 | 6.1 | 7.0 | 6.9 | |||||||||||||||
Medicaid | 39.1 | 39.4 | 44.6 | 46.0 | 50.8 | 51.6 | 41.0 | 40.8 | |||||||||||||||
TOTAL SKILLED NURSING | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % |
Year Ended |
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Same Facility | Transitioning | Acquisitions | Total | ||||||||||||||||||||
2022 | 2021 | 2022 | 2021 | 2022 | 2021 | 2022 | 2021 | ||||||||||||||||
PERCENTAGE OF SKILLED |
|||||||||||||||||||||||
Medicare | 13.9 | % | 13.6 | % | 13.2 | % | 13.2 | % | 11.7 | % | 11.8 | % | 13.5 | % | 13.5 | % | |||||||
Managed care | 14.3 | 13.9 | 11.8 | 10.4 | 6.9 | 5.8 | 13.1 | 13.0 | |||||||||||||||
Other skilled | 5.5 | 5.6 | 2.5 | 2.5 | 4.9 | 4.8 | 5.2 | 5.2 | |||||||||||||||
Skilled mix | 33.7 | 33.1 | 27.5 | 26.1 | 23.5 | 22.4 | 31.8 | 31.7 | |||||||||||||||
Private and other payors | 10.3 | 10.3 | 11.6 | 11.0 | 9.5 | 8.1 | 10.3 | 10.2 | |||||||||||||||
Medicaid | 56.0 | 56.6 | 60.9 | 62.9 | 67.0 | 69.5 | 57.9 | 58.1 | |||||||||||||||
TOTAL SKILLED NURSING | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % |
UNAUDITED REVENUE BY PAYOR SOURCE
The following table sets forth our service revenue by payor source and as a percentage of total service revenue for the periods indicated:
Three Months Ended |
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2022 | 2021 | ||||||||||
Revenue | % of Revenue | Revenue | % of Revenue | ||||||||
Medicaid(1) | $ | 320,065 | 39.7 | % | $ | 272,639 | 39.6 | % | |||
Medicare | 222,151 | 27.6 | 190,132 | 27.6 | |||||||
Medicaid — skilled | 54,523 | 6.8 | 44,729 | 6.5 | |||||||
Total Medicaid and Medicare | 596,739 | 74.1 | 507,500 | 73.7 | |||||||
Managed care | 136,674 | 17.0 | 120,503 | 17.5 | |||||||
Private and other(2) | 71,912 | 8.9 | 60,991 | 8.8 | |||||||
SERVICE REVENUE | $ | 805,325 | 100.0 | % | $ | 688,994 | 100.0 | % |
(1) Medicaid payor includes revenue generated from senior living operations and revenue related to FMAP and other COVID-19 related state funding.
(2) Private and other payors also includes revenue from senior living operations and all payors generated in other ancillary services.
Year Ended |
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2022 | 2021 | ||||||||||
Revenue | % of Revenue | Revenue | % of Revenue | ||||||||
Medicaid(1) | $ | 1,183,156 | 39.3 | % | $ | 1,022,460 | 39.2 | % | |||
Medicare | 832,160 | 27.7 | 727,103 | 27.8 | |||||||
Medicaid — skilled | 200,878 | 6.7 | 172,770 | 6.6 | |||||||
Total Medicaid and Medicare | 2,216,194 | 73.7 | 1,922,333 | 73.6 | |||||||
Managed care | 525,710 | 17.5 | 456,728 | 17.5 | |||||||
Private and other(2) | 266,807 | 8.8 | 232,415 | 8.9 | |||||||
SERVICE REVENUE | $ | 3,008,711 | 100.0 | % | $ | 2,611,476 | 100.0 | % |
(1) Medicaid payor includes revenue generated from senior living operations and revenue related to FMAP and other COVID-19 related state funding.
(2) Private and other payors also includes revenue from senior living operations and all payors generated in other ancillary services.
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 |
Year Ended |
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2022 | 2021 | 2022 | 2021 | ||||||||||||
Statements of Income Data: | |||||||||||||||
Segment income(a) | $ | 106,460 | $ | 100,234 | $ | 408,732 | $ | 373,603 | |||||||
Depreciation and amortization | 8,813 | 7,788 | 33,224 | 30,681 | |||||||||||
EBITDA | $ | 115,273 | $ | 108,022 | $ | 441,956 | $ | 404,284 | |||||||
Adjustments to EBITDA: | |||||||||||||||
Business interruption recoveries | (913 | ) | (1,825 | ) | (913 | ) | (1,825 | ) | |||||||
Stock-based compensation expense | 3,823 | 3,102 | 14,394 | 11,401 | |||||||||||
ADJUSTED EBITDA | $ | 118,183 | $ | 109,299 | $ | 455,437 | $ | 413,860 | |||||||
(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.
Standard Bearer
In conjunction with the formation
The following table sets forth details of operating results for our revenue and earnings, and their respective components, by Standard Bearer for the periods indicated:
Three Months Ended |
Year Ended |
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2022 | 2021 | 2022 | 2021 | ||||||||
Rental revenue generated from third-party tenants | $ | 3,790 | $ | 3,633 | $ | 14,970 | $ | 13,962 | |||
Rental revenue generated from Ensign affiliated operations | 15,624 | 11,780 | 57,967 | 44,165 | |||||||
TOTAL RENTAL REVENUE | $ | 19,414 | $ | 15,413 | $ | 72,937 | $ | 58,127 | |||
Segment income(a) | 7,192 | 8,317 | 27,871 | 31,876 | |||||||
Depreciation and amortization | 5,815 | 4,766 | 21,613 | 17,558 | |||||||
FFO(b) | $ | 13,007 | $ | 13,083 | $ | 49,484 | $ | 49,434 | |||
(a) Segment income reflects profit or loss from operations before provision for income taxes, excluding gain or loss from sale of real estate and insurance recoveries and charges from real estate. Included in Standard Bearer expenses for the quarter and year ended
(b) FFO, in accordance with the definition used by the
Discussion of Non-GAAP Financial Measures
EBITDA consists of net income before (a) other expense, net, (b) provisions for income taxes and (c) depreciation and amortization. Adjusted EBITDA consists of net income before (a) other expense, net, (b) provisions for income taxes, (c) depreciation and amortization, (d) stock-based compensation expense; (e) results of operations not at full capacity, excluding depreciation, interest and income taxes, (f) acquisition related costs, (g) legal finding, (h) gain on sale of assets and business interruptions recoveries, (i) costs incurred related to new systems implementation and (j) real estate transactions and other related costs. Adjusted EBITDAR consists of net income before (a) other expense, net, (b) provisions for income taxes, (c) depreciation and amortization, (d) rent-cost of services, (e) stock-based compensation expense; (f) results of operations not at full capacity, excluding rent, depreciation, interest and income taxes, (g) acquisition related costs, (h) legal finding, (i) gain on sale of assets and business interruptions recoveries, (j) costs incurred related to new systems implementation and (k) real estate transactions and other related costs. Funds from Operations (FFO) for our real estate segment consists of segment income, excluding depreciation and amortization related to real estate, gains or losses from sales of real estate, insurance recoveries related to real estate and impairment of depreciable real estate assets. The company believes that the presentation of EBITDA, adjusted EBITDA, FFO, adjusted net income and adjusted earnings per share 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, FFO, EBITDA, adjusted EBITDA and adjusted EBITDAR 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

Source: The Ensign Group, Inc.