DEI Info Cover Page Document	6 Months Ended
DEI Info Cover Page Document	Jun. 30, 2013	Aug. 05, 2013
Entity Information [Abstract]
Entity Registrant Name	ENSIGN GROUP, INC
Entity Central Index Key	0001125376
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Document Type	10-Q
Document Period End Date	Jun. 30, 2013
Document Fiscal Year Focus	2013
Document Fiscal Period Focus	Q2
Amendment Flag	false
Entity Common Stock, Shares Outstanding		21,934,900

Condensed Consolidated Balance Sheets (USD $) In Thousands, unless otherwise specified	6 Months Ended
	Jun. 30, 2013	Dec. 31, 2012
Entity Registrant Name	ENSIGN GROUP, INC
Current assets:
Cash and cash equivalents	$ 27,499	$ 40,685
Accounts receivable—less allowance for doubtful accounts of $14,014 and $13,811 at June 30, 2013 and December 31, 2012, respectively	107,436	94,187
Investments—current	3,279	5,195
Prepaid income taxes	10,729	3,787
Prepaid expenses and other current assets	7,086	8,606
Deferred tax asset—current	13,351	14,871
Assets held for sale—current (Note 3)	0	268
Total current assets	169,380	167,599
Property and equipment, net	476,671	447,855
Insurance subsidiary deposits and investments	19,384	17,315
Escrow deposits	4,506	4,635
Deferred tax asset	3,490	2,234
Restricted and other assets	12,596	8,640
Intangible assets, net	6,302	6,115
Long-term assets held for sale (Note 3)	0	11,324
Goodwill	23,523	21,557
Other indefinite-lived intangibles	7,740	3,588
Total assets	723,592	690,862
Current liabilities:
Accounts payable	21,315	26,069
Accrued charge related to U.S. Government inquiry (Note 16)	48,000	15,000
Accrued wages and related liabilities	34,511	35,847
Accrued self-insurance liabilities—current	14,662	16,034
Liabilities held for sale—current (Note 3)	0	339
Other accrued liabilities	19,216	20,871
Current maturities of long-term debt	7,297	7,187
Total current liabilities	145,001	121,347
Long-term debt—less current maturities	206,874	200,505
Accrued self-insurance liabilities—less current portion	36,376	34,849
Fair value of interest rate swap	1,948	2,866
Long-term liabilities held for sale (Note 3)	0	130
Deferred rent and other long-term liabilities	3,142	3,281
Total liabilities	393,341	362,978
Commitments and contingencies (Note 16)
Equity:
Common stock; $0.001 par value; 75,000 shares authorized; 22,426 and 21,898 shares issued and outstanding at June 30, 2013, respectively, and 22,244 and 21,719 shares issued and outstanding at December 31, 2012, respectively	22	22
Additional paid-in capital	95,703	90,949
Retained earnings	236,689	239,344
Common stock in treasury, at cost, 296 and 301 shares at June 30, 2013 and December 31, 2012, respectively	(2,063)	(2,099)
Accumulated other comprehensive income	(1,186)	(1,745)
Total Ensign Group, Inc. stockholders’ equity	329,165	326,471
Non-controlling interest	1,086	1,413
Total equity	330,251	327,884
Total liabilities and equity	$ 723,592	$ 690,862

Condensed Consolidated Balance Sheets Balance Sheet Paranthetical (USD $) In Thousands, except Per Share data, unless otherwise specified	Jun. 30, 2013	Dec. 31, 2012
Current assets:
Allowance for doubtful accounts	$ 14,014	$ 13,811
Equity:
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	75,000	75,000
Common stock, shares issued	22,426	22,244
Common stock, shares outstanding	21,898	21,719
Common stock in treasury, at cost	296	301

Condensed Consolidated Statements of Income (USD $) In Thousands, except Per Share data, unless otherwise specified	3 Months Ended		6 Months Ended
	Jun. 30, 2013	Jun. 30, 2012	Jun. 30, 2013	Jun. 30, 2012
Revenue	$ 220,086	$ 203,919	$ 438,287	$ 405,959
Expense:
Cost of services (exclusive of facility rent, general and administrative and depreciation and amortization expenses shown separately below)	175,913	162,085	351,974	322,712
U.S. Government inquiry settlement (Note 16)	0	0	33,000	0
Facility rent—cost of services	3,338	3,355	6,652	6,675
General and administrative expense	8,872	8,137	17,720	15,834
Depreciation and amortization	8,671	7,010	16,403	13,924
Total expenses	196,794	180,587	425,749	359,145
Income from operations	23,292	23,332	12,538	46,814
Other income (expense):
Interest expense	(3,145)	(3,114)	(6,260)	(6,039)
Interest income	129	52	222	103
Other expense, net	(3,016)	(3,062)	(6,038)	(5,936)
Income before provision for income taxes	20,276	20,270	6,500	40,878
Provision for income taxes	7,846	7,872	4,833	15,586
Income from continuing operations	12,430	12,398	1,667	25,292
Loss from discontinued operations, net of income tax benefit	(26)	(119)	(1,774)	(185)
Net income (loss)	12,404	12,279	(107)	25,107
Less: net income (loss) attributable to noncontrolling interests	37	(177)	(327)	(253)
Net income attributable to The Ensign Group, Inc.	12,367	12,456	220	25,360
Amounts attributable to The Ensign Group, Inc.:
Income from continuing operations attributable to The Ensign Group, Inc.	12,393	12,575	1,994	25,545
Loss from discontinued operations, net of income tax benefit	(26)	(119)	(1,774)	(185)
Net income attributable to The Ensign Group, Inc.	$ 12,367	$ 12,456	$ 220	$ 25,360
Basic:
Income from continuing operations attributable to The Ensign Group, Inc.	$ 0.57	$ 0.59	$ 0.09	$ 1.20
Loss from discontinued operations	$ 0.00	$ (0.01)	$ (0.08)	$ (0.01)
Net income attributable to The Ensign Group, Inc.	$ 0.57	$ 0.58	$ 0.01	$ 1.19
Diluted:
Income from continuing operations attributable to The Ensign Group, Inc.	$ 0.55	$ 0.57	$ 0.09	$ 1.17
Loss from discontinued operations	$ 0.00	$ 0.00	$ (0.08)	$ (0.01)
Net income attributable to The Ensign Group, Inc.	$ 0.55	$ 0.57	$ 0.01	$ 1.16
Common Class A [Member]
Weighted average common shares outstanding:
Basic	21,859	21,368	21,814	21,309
Diluted	22,321	21,886	22,267	21,841

Condensed Consolidated Statement of Comprehensive Income (USD $) In Thousands, unless otherwise specified	3 Months Ended		6 Months Ended
	Jun. 30, 2013	Jun. 30, 2012	Jun. 30, 2013	Jun. 30, 2012
Net income (loss)	$ 12,404	$ 12,279	$ (107)	$ 25,107
Other comprehensive loss, net of tax:
Unrealized gain (loss) on interest rate swap, net of income tax (benefit) expense of ($225) and ($359) for the three and six months ended June 30, 2013, respectively, and $224 and $226 for the three and six months ended June 30, 2012, respectively	394	(349)	559	(354)
Comprehensive income	12,798	11,930	452	24,753
Less: net income (loss) attributable to noncontrolling interests	37	(177)	(327)	(253)
Comprehensive income attributable to The Ensign Group, Inc.	$ 12,761	$ 12,107	$ 779	$ 25,006

Condensed Consolidated Statement of Comprehensive Income Comprehensive Income Paranthetical (USD $) In Thousands, unless otherwise specified	3 Months Ended		6 Months Ended
	Jun. 30, 2013	Jun. 30, 2012	Jun. 30, 2013	Jun. 30, 2012
Other Comprehensive Loss:
Income tax effect on unrealized gain (loss) on interest rate swap	$ (255)	$ 224	$ (359)	$ 226

Condensed Consolidated Statements of Cash Flows (USD $) In Thousands, unless otherwise specified	6 Months Ended
	Jun. 30, 2013	Jun. 30, 2012
Cash flows from operating activities:
Net income (loss)	$ (107)	$ 25,107
Adjustments to reconcile net income to net cash provided by operating activities:
Loss from sale of discontinued operations (Note 3)	2,837	0
U.S. Government inquiry settlement (Note 16)	33,000	0
Depreciation and amortization	16,432	13,966
Amortization of deferred financing fees and debt discount	411	411
Deferred income taxes	(95)	(597)
Provision for doubtful accounts	5,527	3,939
Share-based compensation	1,945	1,615
Excess tax benefit from share-based compensation	(908)	(618)
Gain on sale of equity method investment	(380)	0
Loss (gain) on disposition of property and equipment	1,129	203
Change in operating assets and liabilities
Accounts receivable	(18,776)	(14,063)
Prepaid income taxes	(6,942)	3,266
Prepaid expenses and other current assets	1,577	767
Insurance subsidiary deposits and investments	(153)	(5,825)
Accounts payable	(5,331)	(901)
Accrued wages and related liabilities	(1,336)	(8,032)
Other accrued liabilities	(1,658)	255
Accrued self-insurance	(291)	5,250
Deferred rent liability	(274)	317
Net cash provided by operating activities	26,607	25,060
Cash flows from investing activities:
Purchase of property and equipment	(13,405)	(16,382)
Cash payment for business acquisitions	(39,310)	(18,045)
Escrow deposits	(4,506)	(210)
Escrow deposits used to fund business acquisitions	4,635	175
Cash Proceeds on sale of urgent care franchising business, net of note receivable	3,610	0
Cash proceeds on sale of equity method investment	1,600	0
Cash proceeds from the sale of fixed assets	641	30
Restricted and other assets	(156)	(1,398)
Net cash used in investing activities	(46,891)	(35,830)
Cash flows from financing activities:
Proceeds from issuance of debt	10,000	21,525
Payments on long term debt	(3,581)	(8,306)
Repurchase of shares of common stock	0	(174)
Issuance of treasury stock upon exercise of options	36	147
Issuance of common stock upon exercise of options	1,901	2,995
Dividends paid	(1,436)	(2,576)
Excess tax benefit from share-based compensation	908	618
Payments of deferred financing costs	(730)	(258)
Net cash provided by (used in) financing activities	7,098	13,971
Net increase (decrease) in cash and cash equivalents	(13,186)	3,201
Cash and cash equivalents beginning of period	40,685	29,584
Cash and cash equivalents end of period	27,499	32,785
Cash paid during the period for:
Interest	6,267	6,129
Income taxes	9,890	12,215
Non-cash financing and investing activity:
Acquisition of redeemable noncontrolling interest	0	11,600
Accrued capital expenditures	577	809
Note receivable on sale of urgent care franchising business	$ 4,000	$ 0

Description of Business	6 Months Ended
Description of Business	Jun. 30, 2013
DESCRIPTION OF BUSINESS [Abstract]
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block]	DESCRIPTION OF BUSINESS The Company - The Ensign Group, Inc., through its subsidiaries (collectively, Ensign or the Company), provides skilled nursing and rehabilitative care services through the operation of 118 facilities, nine home health and seven hospice operations as of June 30, 2013, located in Arizona, California, Colorado, Idaho, Iowa, Nebraska, Nevada, Oregon, Texas, Utah and Washington. The Company's operations, each of which strives to be the operation of choice in the community it serves, provide a broad spectrum of skilled nursing, assisted living, home health and hospice services, including physical, occupational and speech therapies, and other rehabilitative and healthcare services, for both long-term residents and short-stay rehabilitation patients. In the first quarter of 2012, the Company entered into a business to develop and operate urgent care centers. These walk-in clinics offer daily access to healthcare for minor injuries and illnesses, including x-ray and lab services, all from convenient neighborhood locations with no appointments. In the fourth quarter of 2012, the Company acquired an 80% membership interest in a mobile x-ray and diagnostic company. The mobile x-ray and diagnostic company is a leader in providing mobile diagnostic services, including digital x-ray, ultrasound, electrocardiograms, ankle-brachial index, and phlebotomy services to people in their homes or at long-term care facilities. The Company's facilities have a collective capacity of approximately 13,000 operational skilled nursing, assisted living and independent living beds. As of June 30, 2013, the Company owned 95 of its 118 facilities and operated an additional 23 facilities through long-term lease arrangements, and had options to purchase two of those 23 facilities. The Ensign Group, Inc. is a holding company with no direct operating assets, employees or revenue. All of the Company’s operations are operated by separate, independent subsidiaries, each of which has its own management, employees and assets. One of the Company’s wholly-owned subsidiaries, referred to as the Service Center, provides centralized accounting, payroll, human resources, information technology, legal, risk management and other centralized services to the other operating subsidiaries through contractual relationships with such subsidiaries. The Company also has a wholly-owned captive insurance subsidiary (the Captive) that provides some claims-made coverage to the Company’s operating subsidiaries for general and professional liability, as well as coverage for certain workers’ compensation insurance liabilities. Like the Company’s facilities, the Service Center and the Captive are operated by separate, wholly-owned, independent subsidiaries that have their 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,” “our” and similar verbiage in this quarterly report is 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 or the Captive are operated by the same entity. Other Information — The accompanying condensed consolidated financial statements as of June 30, 2013 and for the three and six months ended June 30, 2013 and 2012 (collectively, the Interim Financial Statements), are unaudited. Certain information and note disclosures normally included in annual consolidated financial statements have been condensed or omitted, as permitted under applicable rules and regulations. Readers of the Interim Financial Statements should refer to the Company’s audited consolidated financial statements and notes thereto for the year ended December 31, 2012 which are included in the Company’s annual report on Form 10-K, File No. 001-33757 (the Annual Report) filed with the Securities and Exchange Commission (the SEC). Management believes that the Interim Financial Statements reflect all adjustments which are of a normal and recurring nature necessary to present fairly the Company’s financial position and results of operations in all material respects. The results of operations presented in the Interim Financial Statements are not necessarily representative of operations for the entire year.

Significant Accounting Policies	6 Months Ended
Significant Accounting Policies	Jun. 30, 2013
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES [Abstract]
Basis of Presentation and Significant Accounting Policies [Text Block]	SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Basis of Presentation - The accompanying Interim Financial Statements have been prepared in accordance with accounting principles generally accepted in the United States of America. The Company is the sole member or shareholder of various consolidated limited liability companies and corporations; each established to operate various acquired skilled nursing and assisted living facilities, home health and hospice operations, urgent care centers and related ancillary services. All intercompany transactions and balances have been eliminated in consolidation. The Company presents noncontrolling interest within the equity section of its consolidated balance sheets. The Company presents the amount of consolidated net income (loss) that is attributable to The Ensign Group, Inc. and the noncontrolling interest in its consolidated statements of operations. The consolidated financial statements include the accounts of all entities controlled by the Company through its ownership of a majority voting interest and the accounts of any variable interest entities (VIEs) where the Company is subject to a majority of the risk of loss from the VIE's activities, or entitled to receive a majority of the entity's residual returns, or both. The Company assesses the requirements related to the consolidation of VIEs, including a qualitative assessment of power and economics that considers which entity has the power to direct the activities that "most significantly impact" the VIE's economic performance and has the obligation to absorb losses of, or the right to receive benefits that could be potentially significant to, the VIE. The Company's relationship with variable interest entities was not material at June 30, 2013. On March 25, 2013, the Company agreed to terms to sell Doctors Express (DRX), a national urgent care franchise system. The asset sale was effective on April 15, 2013. The results of operations for DRX have been classified as discontinued operations for all periods presented (see Note 3, Discontinued Operations) in the accompanying Interim Financial Statements. Certain assets and liabilities included in the sale of DRX have been presented as held for sale in the accompanying condensed consolidated balance sheet as of December 31, 2012. In addition, the results of operations of DRX and the loss or impairment related to this divesture have been classified as discontinued operations in the accompanying condensed consolidated statements of operations for all periods presented. Estimates and Assumptions — The preparation of Interim Financial Statements in conformity with U.S. generally accepted accounting principles (GAAP) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting periods. The most significant estimates in the Company’s Financial Statements relate to revenue, allowance for doubtful accounts, intangible assets and goodwill, impairment of long-lived assets, general and professional liability, worker’s compensation, and healthcare claims included in accrued self-insurance liabilities, other contingent liabilities, interest rate swaps, and income taxes. Actual results could differ from those estimates. Business Segments — The Company has a single reportable segment — long-term care services, which includes the operation of skilled nursing and assisted living facilities, home health and hospice operations, urgent care centers and related ancillary services. The Company’s single reportable segment is made up of several individual operating segments grouped together principally based on their geographical locations within the United States. Based on the similar economic and other characteristics of each of the operating segments, management believes the Company meets the criteria for aggregating its operating segments into a single reportable segment. Fair Value of Financial Instruments — The Company’s financial instruments consist principally of cash and cash equivalents, debt security investments, interest rate swap agreements, accounts receivable, insurance subsidiary deposits, accounts payable and borrowings. The Company believes all of the financial instruments’ recorded values approximate fair values because of their nature or respective short durations. The interest rate swap is carried at fair value on the balance sheet. The Company’s fixed-rate debt instruments do not actively trade in an established market. The fair values of this debt are estimated by discounting the principal and interest payments at rates available to the Company for debt with similar terms and maturities. See further discussion of debt security investments in Note 5, Fair Value Measurements. Revenue Recognition — The Company recognizes revenue when the following four conditions have been met: (i) there is persuasive evidence that an arrangement exists; (ii) delivery has occurred or service has been rendered; (iii) the price is fixed or determinable; and (iv) collection is reasonably assured. The Company's revenue is derived primarily from providing healthcare services to residents and is recognized on the date services are provided at amounts billable to individual residents. For residents under reimbursement arrangements with third-party payors, including Medicaid, Medicare and private insurers, revenue is recorded based on contractually agreed-upon amounts on a per patient, daily basis. Revenue from the Medicare and Medicaid programs accounted for 72.7% and 72.8% of the Company’s revenue during the three and six months ended June 30, 2013, respectively, and 73.8% for both periods during the three and six months ended June 30, 2012. The Company records revenue from these governmental and managed care programs as services are performed at their expected net realizable amounts under these programs. The Company’s revenue from governmental and managed care programs is subject to audit and retroactive adjustment by governmental and third-party agencies. Consistent with healthcare industry accounting practices, any changes to these governmental revenue estimates are recorded in the period the change or adjustment becomes known based on final settlement. The Company recorded retroactive adjustments to revenue which were not material to the Company's consolidated revenue for the three and six months ended June 30, 2013 and 2012. The Company’s service specific revenue recognition policies are as follows: Skilled Nursing Revenue The Company’s revenue is derived primarily from providing long-term healthcare services to residents and is recognized on the date services are provided at amounts billable to individual residents. For residents under reimbursement arrangements with third-party payors, including Medicaid, Medicare and private insurers, revenue is recorded based on contractually agreed-upon amounts on a per patient, daily basis. The Company records revenue from private pay patients, at the agreed-upon rate, as services are performed. Home Health Revenue Medicare Revenue Net service revenue is recorded under the Medicare prospective payment system (PPS) based on a 60-day episode payment rate that is subject to adjustment based on certain variables including, but not limited to: (a) an outlier payment if patient care was unusually costly; (b) a low utilization payment adjustment (LUPA) if the number of visits was fewer than five; (c) a partial payment if the patient transferred to another provider or the Company received a patient from another provider before completing the episode; (d) a payment adjustment based upon the level of therapy services required; (e) the number of episodes of care provided to a patient, regardless of whether the same home health provider provided care for the entire series of episodes; (f) changes in the base episode payments established by the Medicare Program; (g) adjustments to the base episode payments for case mix and geographic wages; and (h) recoveries of overpayments. The Centers for Medicare and Medicaid Services (CMS) added two regulations to PPS that became effective April 1, 2011: (1) a face-to-face encounter requirement and (2) changes to the therapy assessment schedule, which require additional patient evaluations and certifications. As a condition for Medicare payment, the first regulation mandates that prior to certifying a patient's eligibility for the home health benefit, the certifying physician must document that they have had a face-to-face encounter with the patient. The second regulation mandates that periodic assessments be made by a professional qualified therapist at designated intervals, including at least once every 30 days during a therapy patient's course of treatment. Management evaluates the potential for revenue adjustments as a result of these regulations. We make adjustments to Medicare revenue on completed episodes to reflect differences between estimated and actual payment amounts, an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. Therefore, we believe that our reported net service revenue and patient accounts receivable will be the net amounts to be realized from Medicare for services rendered. In addition to revenue recognized on completed episodes, we also recognize a portion of revenue associated with episodes in progress. Episodes in progress are 60-day episodes of care that begin during the reporting period, but were not completed as of the end of the period. Non-Medicare Revenue Episodic Based Revenue — The Company recognizes revenue in a similar manner as we recognize Medicare revenue for episodic-based rates that are paid by other insurance carriers, including Medicare Advantage programs; however, these rates can vary based upon the negotiated terms. Non-episodic Based Revenue — Revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established or estimated per-visit rates, as applicable. Hospice Revenue Revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are daily rates for each of the levels of care we deliver. The Company makes adjustments to revenue for an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. Additionally, as Medicare hospice revenue is subject to an inpatient cap limit and an overall payment cap, the Company monitors its provider numbers and estimates amounts due back to Medicare if a cap has been exceeded. The Company records these adjustments as a reduction to revenue and increases other accrued liabilities. Accounts Receivable and Allowance for Doubtful Accounts Accounts receivable consist primarily of amounts due from Medicare and Medicaid programs, other government programs, managed care health plans and private payor sources. Estimated provisions for doubtful accounts are recorded to the extent it is probable that a portion or all of a particular account will not be collected. In evaluating the collectability of accounts receivable, the Company considers a number of factors, including the age of the accounts, changes in collection patterns, the composition of patient accounts by payor type and the status of ongoing disputes with third-party payors. On an annual basis, the historical collection percentages are reviewed by payor and by state and are updated to reflect the recent collection experience of the Company. In order to determine the appropriate reserve rate percentages which ultimately establish the allowance, the Company analyzes historical cash collection patterns by payor and by state. The percentages applied to the aged receivable balances are based on the Company’s historical experience and time limits, if any, for managed care, Medicare, Medicaid and other payors. The Company periodically refines its estimates of the allowance for doubtful accounts based on experience with the estimation process and changes in circumstances. Equity Investment — As of December 31, 2012, one of the Company's subsidiaries had a non-marketable equity investment which was accounted for under the equity method. The investment was initially recorded at cost and the Company adjusted the carrying amount for its share of the earnings or losses of the investee after the date of investment. On April 23, 2013, the Company entered into a common unit redemption agreement with the investee where the non-marketable equity investment was repurchased. See further discussion at Note 11, Restricted and Other Assets. Property and Equipment — Property and equipment are initially recorded at their historical cost. Repairs and maintenance are expensed as incurred. Depreciation is computed using the straight-line method over the estimated useful lives of the depreciable assets (generally ranging from three to 30 years). Leasehold improvements are amortized on a straight-line basis over the shorter of their estimated useful lives or the remaining lease term. Impairment of Long-Lived Assets — The Company reviews the carrying value of long-lived assets that are held and used in the Company’s operations for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of these assets is determined based upon expected undiscounted future net cash flows from the operations to which the assets relate, utilizing management’s best estimate, appropriate assumptions, and projections at the time. If the carrying value is determined to be unrecoverable from future operating cash flows, the asset is deemed impaired and an impairment loss would be recognized to the extent the carrying value exceeded the estimated fair value of the asset. The Company estimates the fair value of assets based on the estimated future discounted cash flows of the asset. Management has evaluated its long-lived assets and has not identified any asset impairment during the three and six months ended June 30, 2013 or 2012. Intangible Assets and Goodwill — Definite-lived intangible assets consist primarily of favorable leases, lease acquisition costs, patient base, facility trade names and customer relationships. Favorable leases and lease acquisition costs are amortized over the life of the lease of the facility, typically ranging from ten to 20 years. Patient base is amortized over a period of four to eight months, depending on the classification of the patients and the level of occupancy in a new acquisition on the acquisition date. Trade names at facilities are amortized over 30 years and customer relationships are amortized over 20 years. The Company's indefinite-lived intangible assets consist of trade names and home health and hospice Medicare licenses. The Company tests indefinite-lived intangible assets for impairment on an annual basis or more frequently if events or changes in circumstances indicate that the carrying amount of the intangible asset may not be recoverable. Goodwill represents the excess of the purchase price over the fair value of identifiable net assets acquired in business combinations. Goodwill is subject to annual testing for impairment. In addition, goodwill is tested for impairment if events occur or circumstances change that would reduce the fair value of a reporting unit below its carrying amount. The Company defines reporting units as the individual operations. The Company performs its annual test for impairment during the fourth quarter of each year. See further discussion at Note 10, Goodwill and Other Indefinite-Lived Intangible Assets. Self-Insurance — The Company is partially self-insured for general and professional liability up to a base amount per claim (the self-insured retention) with an aggregate, one-time deductible above this limit. Losses beyond these amounts are insured through third-party policies with coverage limits per occurrence, per location and on an aggregate basis for the Company. For claims made after April 1, 2013, the combined self-insured retention was $500 per claim with an aggregate $1,750 deductible limit. For all facilities, except those located in Colorado, the third-party coverage above these limits was $1,000 per occurrence, $3,000 per facility, with a $10,000 blanket aggregate and an additional state-specific aggregate where required by state law. In Colorado, the third-party coverage above these limits was $1,000 per occurrence and $3,000 per facility, which is independent of the $10,000 blanket aggregate applicable to our other 112 facilities. The self-insured retention and deductible limits for general and professional liability and workers' compensation are self-insured through the Captive, the related assets and liabilities of which are included in the accompanying condensed consolidated balance sheets. The Captive is subject to certain statutory requirements as an insurance provider. These requirements include, but are not limited to, maintaining statutory capital. The Company’s policy is to accrue amounts equal to the actuarially estimated costs to settle open claims of insureds, as well as an estimate of the cost of insured claims that have been incurred but not reported. The Company develops information about the size of the ultimate claims based on historical experience, current industry information and actuarial analysis, and evaluates the estimates for claim loss exposure on a quarterly basis. Accrued general liability and professional malpractice liabilities recorded on an undiscounted basis, net of anticipated insurance recoveries, in the accompanying condensed consolidated balance sheets were $30,985 and $33,215 as of June 30, 2013 and December 31, 2012, respectively. The Company’s operating subsidiaries are self-insured for workers’ compensation liability in California. To protect itself against loss exposure in California with this policy, the Company has purchased individual stop-loss insurance coverage that insures individual claims that exceed $500 for each claim. In Texas, the operating subsidiaries have elected non-subscriber status for workers’ compensation claims and, effective February 1, 2011, the Company has purchased individual stop-loss coverage that insures individual claims that exceed $750 for each claim. The Company’s operating subsidiaries in other states have third party guaranteed cost coverage. In California and Texas, the Company accrues amounts equal to the estimated costs to settle open claims, as well as an estimate of the cost of claims that have been incurred but not reported. The Company uses actuarial valuations to estimate the liability based on historical experience and industry information. Accrued workers’ compensation liabilities are recorded on an undiscounted basis in the accompanying condensed consolidated balance sheets and were $13,771 and $11,983 as of June 30, 2013 and December 31, 2012, respectively. In addition, the Company has recorded an asset and equal liability of $3,665 and $3,219 at June 30, 2013 and December 31, 2012, respectively, in order to present the ultimate costs of malpractice and workers' compensation claims and the anticipated insurance recoveries on a gross basis. The Company provides self-insured medical (including prescription drugs) and dental healthcare benefits to the majority of its employees. The Company is fully liable for all financial and legal aspects of these benefit plans. To protect itself against loss exposure with this policy, the Company has purchased individual stop-loss insurance coverage that insures individual claims that exceed $300 for each covered person with an aggregate individual stop loss deductible of $75. The Company’s accrued liability under these plans recorded on an undiscounted basis in the accompanying condensed consolidated balance sheets was $2,617 and $2,467 at June 30, 2013 and December 31, 2012, respectively. The Company believes that adequate provision has been made in the Financial Statements for liabilities that may arise out of patient care, workers’ compensation, healthcare benefits and related services provided to date. The amount of the Company’s reserves was determined based on an estimation process that uses information obtained from both company-specific and industry data. This estimation process requires the Company to continuously monitor and evaluate the life cycle of the claims. Using data obtained from this monitoring and the Company’s assumptions about emerging trends, the Company, with the assistance of an independent actuary, develops information about the size of ultimate claims based on the Company’s historical experience and other available industry information. The most significant assumptions used in the estimation process include determining the trend in costs, the expected cost of claims incurred but not reported and the expected costs to settle or pay damage awards with respect to unpaid claims. The self-insured liabilities are based upon estimates, and while management believes that the estimates of loss are reasonable, the ultimate liability may be in excess of or less than the recorded amounts. Due to the inherent volatility of actuarially determined loss estimates, it is reasonably possible that the Company could experience changes in estimated losses that could be material to net income. If the Company’s actual liability exceeds its estimates of loss, its future earnings, cash flows and financial condition would be adversely affected. Income Taxes —Deferred tax assets and liabilities are established for temporary differences between the financial reporting basis and the tax basis of the Company’s assets and liabilities at tax rates in effect when such temporary differences are expected to reverse. The Company generally expects to fully utilize its deferred tax assets; however, when necessary, the Company records a valuation allowance to reduce its net deferred tax assets to the amount that is more likely than not to be realized. For interim reporting purposes, the provision for income taxes is determined based on the estimated annual effective income tax rate applied to pre-tax income, adjusted for certain discrete items occurring during the period. In determining the effective income tax rate for interim financial statements, the Company must consider expected annual income, permanent differences between financial reporting and tax recognition of income or expense and other factors. When the Company takes uncertain income tax positions that do not meet the recognition criteria, it records a liability for underpayment of income taxes and related interest and penalties, if any. In considering the need for and magnitude of a liability for such positions, the Company must consider the potential outcomes from a review of the positions by the taxing authorities. In determining the need for a valuation allowance, the annual income tax rate for interim periods, or the need for and magnitude of liabilities for uncertain tax positions, the Company makes certain estimates and assumptions. These estimates and assumptions are based on, among other things, knowledge of operations, markets, historical trends and likely future changes and, when appropriate, the opinions of advisors with knowledge and expertise in certain fields. Due to certain risks associated with the Company’s estimates and assumptions, actual results could differ. Noncontrolling Interest — The noncontrolling interest in a subsidiary is initially recognized at estimated fair value on the acquisition date and is presented within total equity in the Company's condensed consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income (loss) attributable to The Ensign Group, Inc. in its condensed consolidated statements of operations and net income (loss) per share is calculated based on net income (loss) attributable to The Ensign Group, Inc.'s stockholders. The carrying amount of the noncontrolling interest is adjusted based on an allocation of subsidiary earnings based on ownership interest. Stock-Based Compensation — The Company measures and recognizes compensation expense for all share-based payment awards made to employees and directors including employee stock options based on estimated fair values, ratably over the requisite service period of the award. Net income has been reduced as a result of the recognition of the fair value of all stock options and restricted stock awards issued, the amount of which is contingent upon the number of future grants and other variables. Derivatives and Hedging Activities — The Company evaluates variable and fixed interest rate risk exposure on a routine basis and to the extent the Company believes that it is appropriate, it will offset most of its variable risk exposure by entering into interest rate swap agreements. It is the Company's policy to only utilize derivative instruments for hedging purposes (i.e. not for speculation). The Company formally designates its interest rate swap agreements as hedges and documents all relationships between hedging instruments and hedged items. The Company formally assesses effectiveness of its hedging relationships, both at the hedge inception and on an ongoing basis, then measures and records ineffectiveness. The Company would discontinue hedge accounting prospectively (i) if it is determined that the derivative is no longer effective in offsetting change in the cash flows of a hedged item, (ii) when the derivative expires or is sold, terminated or exercised, (iii) if it is no longer probable that the forecasted transaction will occur, or (iv) if management determines that designation of the derivative as a hedge instrument is no longer appropriate. The Company’s derivative is recorded on the balance sheet at its fair value. Accumulated Other Comprehensive Loss and Total Comprehensive Income (Loss) — Accumulated other comprehensive loss refers to revenue, expenses, gains, and losses that are recorded as an element of stockholders’ equity but are excluded from net income. The Company’s other comprehensive loss consists of net deferred gains and losses on certain derivative instruments accounted for as cash flow hedges. As of June 30, 2013, accumulated other comprehensive losses were $1,948, recorded net of tax of $762 or $1,186, in stockholders' equity. As of December 31, 2012, accumulated other comprehensive losses were $2,866, net of tax of $1,121 or $1,745. Recent Accounting Pronouncements — Except for rules and interpretive releases of the SEC under authority of federal securities laws and a limited number of grandfathered standards, the FASB Accounting Standards Codification™ (ASC) is the sole source of authoritative GAAP literature recognized by the FASB and applicable to the Company. The Company has reviewed the FASB issued Accounting Standards Update (ASU) accounting pronouncements and interpretations thereof that have effectiveness dates during the periods reported and in future periods. The Company has carefully considered the new pronouncements that alter previous generally accepted accounting principles and does not believe that any new or modified principles will have a material impact on the Company's reported financial position or operations in the near term. The applicability of any standard is subject to the formal review of the Company's financial management and certain standards are under consideration.

Discontinued Operations (Notes)

6 Months Ended

Jun. 30, 2013

Discontinued Operations [Abstract]

Disposal Groups, Including Discontinued Operations, Disclosure [Text Block]

DISCONTINUED OPERATIONS

On March 25, 2013, the Company agreed to terms to sell DRX, a national urgent care franchise system for approximately $8,000, adjusted for certain assets and liabilities. The asset sale was effective on April 15, 2013. The sale resulted in a pre-tax loss of $2,837 for the six months ended June 30, 2013. The assets acquired at the initial purchase of DRX, including noncontrolling interest, were recorded at fair value. The initial fair value was greater than total cash paid to acquire all interests in DRX and the subsequent sale price. The sale of DRX has been accounted for as discontinued operations. Accordingly, the results of operations of this business for all periods presented and the loss related to this divesture have been classified as discontinued operations in the accompanying condensed consolidated statements of operations. As the sale was effective April 15, 2013, all assets and liabilities included in the sale were recorded as held for sale on the Company's condensed consolidated balance sheets as of December 31, 2012.

A summary of discontinued operations follows (in thousands):



	Three Months Ended June 30, 2013						Six Months Ended June 30,
	2013			2012			2013			2012
Revenue	$	104		$	389		$	728		$	509
Cost of services (exclusive of facility rent, general and administrative and depreciation and amortization expenses shown separately below)	(118		)	(514		)	(739		)	(716		)
Charges to discontinued operations for the excess carrying amount of goodwill and other indefinite-lived intangible assets	(13		)	—			(2,837		)	—
Facility rent—cost of services	(5		)	(13		)	(12		)	(14		)
Depreciation and amortization	(1		)	(32		)	(33		)	(42		)
Loss from discontinued operations	(33		)	(170		)	(2,893		)	(263		)
Benefit from income taxes	(7		)	(51		)	(1,119		)	(78		)
Loss from discontinued operations, net of income tax benefit	$	(26	)	$	(119	)	$	(1,774	)	$	(185	)

A summary of the net assets held for sale are as follows (in thousands):



	June 30, 2013		December 31, 2012
Current assets	$	—	$	268
Long-term assets:
Goodwill, net	—		1,099
Other identifiable intangible assets, net	—		10,200
Other long-term assets, net	—		25
Total assets held for sale	—		11,592

Current liabilities	—		(339		)
Long-term liabilities	—		(130		)
Total liabilities held for sale	—		(469		)
Net assets held for sale	$	—	$	11,123

Computation of Net Income Per Common Share

6 Months Ended

Jun. 30, 2013

COMPUTATION OF NET INCOME PER COMMON SHARE [Abstract]

Earnings Per Share [Text Block]

COMPUTATION OF NET INCOME PER COMMON SHARE

Basic net income (loss) per share is computed by dividing income from continuing operations attributable to Ensign Group, Inc. stockholders by the weighted average number of outstanding common shares for the period. The computation of diluted net income per share is similar to the computation of basic net income per share except that the denominator is increased to include contingently returnable shares and the number of additional common shares that would have been outstanding if the dilutive potential common shares had been issued.

A reconciliation of the numerator and denominator used in the calculation of basic net income per common share follows:



	Three Months Ended June 30,						Six Months Ended June 30,
	2013			2012			2013			2012
Numerator:
Income from continuing operations	$	12,430		$	12,398		$	1,667		$	25,292
Less: net income (loss) attributable to noncontrolling interests	37			(177		)	(327		)	(253		)
Income from continuing operations attributable to The Ensign Group, Inc.	12,393			12,575			1,994			25,545
Loss from discontinued operations, net of income tax benefit	(26		)	(119		)	(1,774		)	(185		)
Net income attributable to The Ensign Group, Inc.	$	12,367		$	12,456		$	220		$	25,360

Denominator:
Weighted average shares outstanding for basic net income per share	21,859			21,368			21,814			21,309

Basic net income (loss) per common share:
Income from continuing operations attributable to The Ensign Group, Inc.	$	0.57		$	0.59		$	0.09		$	1.20
Loss from discontinued operations	$	—		$	(0.01	)	$	(0.08	)	$	(0.01	)
Net income attributable to The Ensign Group, Inc.	$	0.57		$	0.58		$	0.01		$	1.19

A reconciliation of the numerator and denominator used in the calculation of diluted net income per common share follows:



	Three Months Ended June 30,						Six Months Ended June 30,
	2013			2012			2013			2012
Numerator:
Income from continuing operations	$	12,430		$	12,398		$	1,667		$	25,292
Less: net income (loss) attributable to the noncontrolling interests	37			(177		)	(327		)	(253		)
Income from continuing operations attributable to The Ensign Group, Inc.	12,393			12,575			1,994			25,545
Loss from discontinued operations, net of income tax benefit	(26		)	(119		)	(1,774		)	(185		)
Net income attributable to The Ensign Group, Inc.	$	12,367		$	12,456		$	220		$	25,360
Denominator:
Weighted average common shares outstanding	21,859			21,368			21,814			21,309
Plus: incremental shares from assumed conversion (1)	462			518			453			532
Adjusted weighted average common shares outstanding	22,321			21,886			22,267			21,841
Diluted net income (loss) per common share:
Income from continuing operations attributable to The Ensign Group, Inc.	$	0.55		$	0.57		$	0.09		$	1.17
Loss from discontinued operations	$	—		$	—		$	(0.08	)	$	(0.01	)
Net income attributable to The Ensign Group, Inc.	$	0.55		$	0.57		$	0.01		$	1.16

(1) Options outstanding which are anti-dilutive and therefore not factored into the weighted average common shares amount above were 341 and 377 for the three and six months ended June 30, 2013 and 188 and 187 for the three and six months ended June 30, 2012, respectively.

Fair Value Measurements

6 Months Ended

Jun. 30, 2013

FAIR VALUE MEASUREMENTS [Abstract]

Fair Value Disclosures [Text Block]

FAIR VALUE MEASUREMENTS

Fair value measurements are based on a three-tier hierarchy that prioritizes the inputs used to measure fair value. These tiers include: Level 1, defined as observable inputs such as quoted market prices in active markets; Level 2, defined as inputs other than quoted prices included within Level 1 that are observable for the asset or liability, either directly or indirectly; and Level 3, defined as observable inputs for which little or no market data exists, therefore requiring an entity to develop its own assumptions.

The following table summarizes the financial assets and liabilities measured at fair value on a recurring basis as of June 30, 2013 and December 31, 2012:



	June 30, 2013						December 31, 2012
	Level 1		Level 2		Level 3		Level 1		Level 2		Level 3
Cash and cash equivalents	$	27,499	$	—	$	—	$	40,685	$	—	$	—
Fair value of interest rate swap	$	—	$	1,948	$	—	$	—	$	2,866	$	—

Our non-financial assets, which include long-lived assets, including goodwill, intangible assets and property and equipment, are not required to be measured at fair value on a recurring basis. However, on a periodic basis, or whenever events or changes in circumstances indicate that their carrying value may not be recoverable, we assess our long-lived assets for impairment. When impairment has occurred, such long-lived assets are written down to fair value. See Note 2 for further discussion of our significant accounting policies.

Debt Security Investments - Held to Maturity

At June 30, 2013 and December 31, 2012, the Company had approximately $22,663 and $22,510, respectively, in debt security investments which were classified as held to maturity and carried at amortized cost. The carrying value of the debt securities approximates fair value. The Company has the intent and ability to hold these debt securities to maturity. Further, at June 30, 2013, $6,181 is held in AA-rated debt securities backed by the Federal Deposit Insurance Corporation (FDIC) under the Temporary Liquidity Guarantee Program, and $16,482 is held in A-rated debt securities.

Interest Rate Swap Agreement

In connection with the Senior Credit Facility with a six-bank lending consortium arranged by SunTrust and Wells Fargo (the Senior Credit Facility), in July 2011, the Company entered into an interest rate swap agreement in accordance with Company policy to reduce risk from volatility in the income statement due to changes in the LIBOR interest rate. The swap agreement, with a notional amount of $75,000, amortizing concurrently with the related term loan portion of the Facility, was five years in length and set to mature on July 15, 2016. The interest rate swap has been designated as a cash flow hedge and, as such, changes in fair value are reported in other comprehensive income (loss) in accordance with hedge accounting. Under the terms of this swap agreement, the net effect of the hedge was to record swap interest expense at a fixed rate of approximately 4.3%, exclusive of fees. Net interest paid under the swap was $262 and $514 for the three and six months ended June 30, 2013 and $244 and $470 for the three and six months ended June 30, 2012, respectively. In addition, based on the June 30, 2013 interest rate swap valuation, the Company expects to record swap interest expense of approximately $1,000 during the year ended December 31, 2013.

The Company assesses hedge effectiveness at inception and on an ongoing basis by performing a regression analysis. The regression analysis compares to the historical monthly changes in fair value of the interest rate swap to the historical monthly changes in the fair value of a hypothetically perfect interest rate swap over the trailing 30 months. The change in fair value of the hypothetical derivative is regarded as a proxy for the present value of the cumulative change in the expected future cash flows on the hedged transaction. The regression analysis serves as the Company's prospective and retrospective assessment of hedge effectiveness. Assuming the hedging relationship qualifies as highly effective, the actual swap will be recorded at fair value on the balance sheet and accumulated other comprehensive income (loss) will be adjusted to reflect the lesser of either the cumulative change in the fair value of the actual swap or the cumulative change in the fair value of the hypothetical derivative.

The interest rate swap agreement is recorded at fair value based upon valuation models which utilize relevant factors such as the contractual terms of the interest rate swap agreements, credit spreads for the contracting parties and interest rate curves. Based on this valuation method, the Company categorized the interest rate swap as Level 2 and recorded accumulated other comprehensive losses as of June 30, 2013 of $1,948, net of tax of $762, or $1,186, in stockholders' equity, compared to $2,866 net of tax of $1,121, or $1,745 as of December 31, 2012. There are no amounts attributable to hedge ineffectiveness that were required to be recognized in earnings.

Revenue and Accounts Receivable

6 Months Ended

Jun. 30, 2013

REVENUE AND ACCOUNTS RECEIVABLE [Abstract]

Revenue and Accounts receivable [Text Block]

REVENUE AND ACCOUNTS RECEIVABLE

Revenue for the three and six months ended June 30, 2013 and 2012 is summarized in the following tables:



	Three Months Ended June 30,
	2013				2012
	Revenue		% of Revenue		Revenue		% of Revenue
Medicaid	$	78,989	35.9	%	$	73,641	36.2	%
Medicare	72,148		32.8		70,396		34.5
Medicaid — skilled	8,939		4.0		6,413		3.1
Total Medicaid and Medicare	160,076		72.7		150,450		73.8
Managed care	27,375		12.5		25,730		12.6
Private and other payors	32,635		14.8		27,739		13.6
Revenue	$	220,086	100.0	%	$	203,919	100.0	%



	Six Months Ended June 30,
	2013				2012
	Revenue		% of Revenue		Revenue		% of Revenue
Medicaid	$	155,499	35.5	%	$	147,224	36.3	%
Medicare	146,075		33.3		140,190		34.5
Medicaid — skilled	17,412		4.0		12,274		3.0
Total Medicaid and Medicare	318,986		72.8		299,688		73.8
Managed care	56,560		12.9		51,422		12.7
Private and other payors	62,741		14.3		54,849		13.5
Revenue	$	438,287	100.0	%	$	405,959	100.0	%

Accounts receivable as of June 30, 2013 and December 31, 2012 is summarized in the following table:



	June 30, 2013			December 31, 2012
Medicaid	$	35,887		$	28,534
Managed care	29,274			26,707
Medicare	32,505			32,168
Private and other payors	23,784			20,589
	121,450			107,998
Less: allowance for doubtful accounts	(14,014		)	(13,811		)
Accounts receivable	$	107,436		$	94,187

Acquisitions

6 Months Ended

Jun. 30, 2013

ACQUISITIONS [Abstract]

Business Combination Disclosure [Text Block]

ACQUISITIONS

The Company’s acquisition policy is generally to purchase or lease operations to complement the Company’s existing portfolio. The results of all the Company’s operations are included in the accompanying Interim Financial Statements subsequent to the date of acquisition. Acquisitions are typically paid for in cash and are accounted for using the acquisition method of accounting. Where the Company enters into facility lease agreements, the Company typically does not pay any material amount to the prior facility operator nor does the Company acquire any assets or assume any liabilities, other than rights and obligations under the lease and operations transfer agreement, as part of the transaction. Some leases include options to purchase the facilities. As a result, from time to time, the Company will acquire facilities that the Company has been operating under third-party leases.

During the six months ended June 30, 2013, the Company acquired seven stand-alone skilled nursing facilities, three stand-alone assisted living facilities, three home health operations and three hospice operations. The aggregate purchase price of the 16 business acquisitions was approximately $39,310, which was paid in cash. The Company also entered into a separate operations transfer agreement with the prior tenant as part of each transaction. The operations acquired during the six months ended June 30, 2013 are as follows:


•	On January 1, 2013, the Company acquired a home health operation in Washington for approximately $2,801, which was paid in cash. The acquisition did not have an impact on the Company's operational bed count. The Company recognized $1,966 and $815 in goodwill and other indefinite-lived intangible assets, respectively, as part of this transaction.


•	On January 1, 2013, the Company acquired two hospice operations in Arizona and California, respectively, for approximately $1,825, which was paid in cash. The acquisition did not have an impact on the Company's operational bed count. The Company recognized $1,825 in other indefinite-lived intangible assets as part of these transactions.


•	On February 16, 2013, the Company acquired a home health operation in Texas for approximately $375, which was paid in cash. This acquisition did not have an impact on the Company's operational bed count. The Company recognized $375 in other indefinite-lived intangible assets as part of this transaction.


•	On March 1, 2013, the Company acquired a home health and hospice operation in Washington for approximately $1,137, which was paid in cash. This acquisition did not have an impact on the Company's operational bed count. The Company recognized $1,137 in other indefinite-lived intangible assets as part of this transaction.


•	In addition, on March 1, 2013, the Company purchased a skilled nursing facility in Texas for approximately $4,508, which was paid in cash. This acquisition added 150 operational skilled nursing beds to the Company's operations.


•	On April 1, 2013, the Company acquired three skilled nursing facilities in Texas for an aggregate purchase price of approximately $7,114, which was paid in cash. These acquisitions added 280 operational skilled nursing beds to the Company's operations.


•	On May 1, 2013, the Company acquired a skilled nursing facility and an assisted living facility in Washington for an aggregate purchase price of $11,585, which was paid in cash. These acquisitions added 102 operational assisted living units and 110 operational skilled nursing beds to the Company's operations.


•	In addition, on May 1, 2013, the Company acquired a skilled nursing facility in Nebraska for approximately $2,846, which was paid in cash. This acquisition added 70 operational skilled nursing beds to the Company's operations.


•	On June 1, 2013, the Company acquired an assisted living facility in California for approximately $4,263, which was paid in cash. This acquisition added 110 operational assisted living units to the Company's operations.


•	In addition, on June 1, 2013, the Company acquired an assisted living facility in Utah for approximately $2,856, which was paid in cash. This acquisition added 69 operational assisted living units to the Company's operations.

The table below presents the allocation of the purchase price for the operations acquired in business combinations during the six months ended June 30, 2013 and 2012:



	June 30,
	2013		2012
Land	$	7,591	$	676
Building and improvements	23,702		11,253
Equipment, furniture, and fixtures	1,204		802
Assembled occupancy	695		196
Goodwill	1,966		2,279
Other indefinite-lived intangible assets	4,152		1,217
	$	39,310	$	16,423

On July 1, 2013 the Company acquired a skilled nursing facility in Washington for approximately $4,425, which was paid in cash. This acquisition added 82 operational skilled nursing beds to the Company's operations. The Company also entered into a separate operations transfer agreement with the prior tenant as part of each transaction. The preliminary allocation of the purchase price was not completed as necessary valuation information was not yet available.

The Company’s acquisition strategy has been focused on identifying both opportunistic and strategic acquisitions within its target markets that offer strong opportunities for return on invested capital. The operations acquired by the Company are frequently underperforming financially and can have regulatory and clinical challenges to overcome. Financial information, especially with underperforming operations, is often inadequate, inaccurate or unavailable. Consequently, the Company believes that prior operating results are not meaningful, representative of the Company’s current operating results or indicative of the integration potential of its newly acquired operations. The businesses acquired during the six months ended June 30, 2013 were not material acquisitions to the Company individually or in the aggregate. Accordingly, pro forma financial information is not presented. These acquisitions have been included in the June 30, 2013 condensed consolidated balance sheet of the Company, and the operating results have been included in the condensed consolidated statement of income of the Company since the dates the Company gained effective control.

Property and Equipment

6 Months Ended

Jun. 30, 2013

PROPERTY AND EQUIPMENT [Abstract]

Property, Plant and Equipment Disclosure [Text Block]

PROPERTY AND EQUIPMENT

Property and equipment consist of the following:



	June 30, 2013			December 31, 2012
Land	$	78,077		$	70,487
Buildings and improvements	369,982			341,096
Equipment	92,037			80,860
Furniture and fixtures	8,825			8,790
Leasehold improvements	42,657			32,570
Construction in progress	979			14,185
	592,557			547,988
Less: accumulated depreciation	(115,886		)	(100,133		)
Property and equipment, net	$	476,671		$	447,855

Intangible Assets - Net

6 Months Ended

Jun. 30, 2013

INTANGIBLE ASSETS — Net [Abstract]

Intangible Assets Disclosure [Text Block]

INTANGIBLE ASSETS — Net



	Weighted Average Life (Years)	June 30, 2013							December 31, 2012
		Gross Carrying Amount		Accumulated Amortization					Gross Carrying Amount		Accumulated Amortization
Intangible Assets		Gross Carrying Amount		Accumulated Amortization			Net		Gross Carrying Amount		Accumulated Amortization			Net
Lease acquisition costs	15.5	$	684	$	(567	)	$	117	$	684	$	(545	)	$	139
Favorable lease	15.0	1,596		(479		)	1,117		1,596		(426		)	1,170
Assembled occupancy	0.5	2,949		(2,526		)	423		2,255		(2,211		)	44
Facility trade name	30.0	733		(183		)	550		733		(171		)	562
Customer relationships	20.0	4,200		(105		)	4,095		4,200		—			4,200
Total		$	10,162	$	(3,860	)	$	6,302	$	9,468	$	(3,353	)	$	6,115

Amortization expense was $325 and $507 for the three and six months ended June 30, 2013 and $200 and $439 for the three and six months ended June 30, 2012, respectively. Of the $507 in amortization expense incurred during the six months ended June 30, 2013, approximately $315 related to the amortization of patient base intangible assets at recently acquired facilities, which is typically amortized over a period of four to eight months, depending on the classification of the patients and the level of occupancy in a new acquisition on the acquisition date.

Estimated amortization expense for each of the years ending December 31 is as follows:



Year	Amount
2013 (remainder)	$	600
2014	416
2015	365
2016	345
2017	345
2018	345
Thereafter	3,886
	$	6,302

Goodwill and Other Indefinite-Lived Intangible Assets

6 Months Ended

Jun. 30, 2013

GOODWILL AND OTHER INDEFINITE-LIVED INTANGIBLE ASSETS [Abstract]

Goodwill and Other Indefinite-Lived Intangibles [Text Block]

GOODWILL AND OTHER INDEFINITE-LIVED INTANGIBLE ASSETS

The Company performs its annual goodwill impairment analysis during the fourth quarter of each year for each reporting unit that constitutes a business for which discrete financial information is produced and reviewed by operating segment management and provides services that are distinct from the other components of the operating segment. The Company tests for impairment by comparing the net assets of each reporting unit to their respective fair values. The Company determines the estimated fair value of each reporting unit using a discounted cash flow analysis. In the event a unit's net assets exceed its fair value, an implied fair value of goodwill must be determined by assigning the unit's fair value to each asset and liability of the unit. The excess of the fair value of the reporting unit over the amounts assigned to its assets and liabilities is the implied fair value of goodwill. An impairment loss is measured by the difference between the goodwill carrying value and the implied fair value.

The following table represents activity in goodwill as of and for the six months ended June 30, 2013:



	Goodwill
December 31, 2012	$	22,656
Less: charges to discontinued operations for the excess carrying amount of goodwill	(1,099		)
	21,557
Additions	1,966
June 30, 2013	$	23,523

As of June 30, 2013, the Company anticipates that total goodwill recognized will be fully deductible for tax purposes.

During the six months ended June 30, 2013, the Company recorded $4,109 and $43 in home health and hospice Medicare license and trade name indefinite-lived intangible assets, respectively, as part of its acquisition of three home health and three hospice operations.

Other indefinite-lived intangible assets consists of the following:



	June 30,		December 31,
	2013		2012
Trade name	$	1,033	$	990
Home health and hospice Medicare license	6,707		2,598
	$	7,740	$	3,588

Restricted and Other Assets

6 Months Ended

Jun. 30, 2013

RESTRICTED AND OTHER ASSETS [Abstract]

Other Assets Disclosure [Text Block]

RESTRICTED AND OTHER ASSETS

Restricted and other assets consist of the following:



	June 30, 2013		December 31, 2012
Note receivable	$	4,000	$	—
Debt issuance costs, net	3,150		2,769
Long-term insurance losses recoverable asset	3,665		3,219
Deposits with landlords	812		749
Capital improvement reserves with landlords and lenders	775		683
Equity method investment	—		1,220
Other long-term assets	194		—
Restricted and other assets	$	12,596	$	8,640

Included in other assets as of June 30, 2013, are anticipated insurance recoveries related to the Company's general and professional liability claims that are recorded on a gross rather than net basis in accordance with an Accounting Standards Update issued by the FASB, capitalized debt issuance costs and a note receivable from the sale of DRX effective April 15, 2013. Included in other assets, as of December 31, 2012, was a non-marketable equity investment accounted for under the equity method. On April 23, 2013, the Company entered into a common unit redemption agreement with the investee where the non-marketable equity investment was repurchased for $1,600. The Company recognized a gain on the sale of its non-marketable equity investment of $380 in the second quarter of 2013.