The Ensign Group Reports Fourth Quarter and Fiscal Year 2022 Results; Issues 2023 Guidance
Conference Call and Webcast scheduled for tomorrow, February 3, 2023 at 10:00 am PT
SAN JUAN CAPISTRANO, Calif., Feb. 02, 2023 (GLOBE NEWSWIRE) -- The Ensign Group, Inc. (Nasdaq: ENSG), the parent company of the Ensign^ (TM) group of companies, which provide post-acute healthcare services and invest in the long-term healthcare industry, primarily in skilled nursing and senior living facilities, announced record operating results for the quarter and year ended December 31, 2022, reporting GAAP diluted earnings per share of $1.06 and $3.95 for the quarter and year, respectively. Ensign also reported adjusted earnings per share^2 of $1.10 for the quarter and $4.14 for the year.*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 Barry Port, Ensign’s Chief Executive Officer. “Remarkably, we saw continued improvement in occupancies, skilled revenue and managed care revenues. We were particularly pleased that we achieved sequential growth in overall occupancy for the eighth consecutive quarter, with same store and transitioning operations increasing by 2.9% and 4.3%, respectively, over the prior year quarter. As of the end of the quarter, our same store occupancy reached 77.8% and we continue to get closer and closer to our pre-Covid occupancy levels, which was at 80.1% in March 2020. We are amazed by the commitment of our caregivers and their continued endurance and strength,” Port added.
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.
Chad Keetch, Ensign’s Chief Investment Officer and Executive Vice President pointed to the Company’s recent acquisitions, noting that the organization remains poised to continue to take advantage of an attractive acquisition environment. “As we expected, we continued to add to our growing portfolio and are very excited about the 12 new operations we added during the quarter. In addition, we also completed the previously announced acquisition of 20 skilled nursing operations in the state of California, 17 of which we will operate, that were previously operated by North American Healthcare. The real estate for these California operations is all owned by Sabra Health Care REIT, Inc. and have been added to our long-term triple net master lease with them. As we said when we announced this transaction last November, we are honored that Sabra will be entrusting us with this portfolio and are very excited to expand our growing relationship with them. Each operation is a perfect fit with our existing footprint in some of our strongest and most mature markets, while also allowing us to move into the Bay Area. These operations are coming to us with a solid foundation of clinical and operational strength, and when combined with an infusion of Ensign’s cultural and operational principles, we are confident that these operations will thrive and become solid contributors to each of their markets and clusters over time,” Keetch said.
Mr. Port, stated, “We are very humbled by what we were able to accomplish in 2022 while dealing with so many unusual challenges, but we also know we can still be so much better and are excited about the enormous potential within our portfolio as we continue to apply our proven locally-driven healthcare model. We are issuing our annual 2023 earnings guidance of $4.60 to $4.74 per diluted share and annual revenue guidance of $3.55 billion to $3.62 billion. The midpoint of this 2023 earnings guidance represents an increase of 12.8% over our 2022 results and is 28.3% higher than our 2021 results.”
Speaking to the Company’s financial health, Ms. Snapper, Ensign’s Executive Vice President and Chief Financial Officer reported that the company’s liquidity remains strong with approximately $316.3 million of cash on hand and $593.3 million of available capacity under its line-of-credit. Ms. Snapper also indicated that, “Management’s guidance is based on diluted weighted average common shares outstanding of approximately 57.7 million and a 25% tax rate. In addition, the guidance assumes, among other things, normalized health insurance costs, management’s current expectations regarding reimbursement rates and recovery of the COVID-19 pandemic. It also excludes one-time charges, acquisition-related costs and amortization costs related to intangible assets acquired and share-based compensation.”
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 December 31, 2022 which is expected to be filed with the SEC today and can be viewed on the company’s website at http://www.ensigngroup.net.
*Growth and Real Estate Highlights *
Mr. Keetch added additional commentary on the Company’s continued acquisition activity, noting that the growth took place in some of the Company’s most mature markets. He noted that during the quarter the Company added three skilled nursing operations in South Carolina, one skilled nursing operation in Arizona, six skilled nursing operations in Texas and two skilled nursing operations in Colorado, totaling an additional 1,505 new operational beds. In addition, on February 1, 2023, Ensign-affiliates added 17 new operations, adding 1,462 operational beds to Ensign’s portfolio. “As we evaluate growth from last year and since, including the recent California acquisition, totaled 46 new operations, we can see that our discipline is paying off. While we expect the pace of closings to slow for the coming months, we continue to see a wide range of large, medium-sized and small portfolios and expect to continue to see attractive opportunities in 2023, but as we’ve said before, we will continue to stay true to our strategy of disciplined growth,” he added.
The recent acquisitions include the following operations:
· Brodie Ranch Nursing and Rehabilitation, a 120-bed skilled nursing facility in Austin, Texas;
· Onion Creek Nursing and Rehabilitation Center, a 125-bed skilled nursing facility in Austin, Texas;
· Riverside Nursing and Rehabilitation Center, a 122-bed skilled nursing facility in Austin, Texas;
· West Oaks Nursing and Rehabilitation Center, a 125-bed skilled nursing facility in Austin, Texas;
· Lakeside Nursing and Rehabilitation Center, a 118-bed skilled nursing facility in San Antonio, Texas;
· Mystic Park Nursing and Rehabilitation Center, a 119-bed skilled nursing facility in San Antonio, Texas;
· Brighton Care Center, a 108-bed skilled nursing facility located in Brighton, Colorado;
· Malley Transitional Care Center, a 162-bed skilled nursing facility located in Northglenn, Colorado
· Oak Harbor Healthcare, a 132-bed skilled nursing facility in Mount Pleasant, South Carolina;
· Oak View Health and Rehabilitation, a 190-bed skilled nursing facility in Conway, 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 in Long 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 in Long Beach, California;
· Chatsworth Park Health Care Center, a 128-bed skilled nursing facility located in Chatsworth, California;
· Coventry Court Health Center, a 95-bed skilled nursing facility located in Anaheim, 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 in Lodi, 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 in Grand Terrace, California;
· Lake Balboa Care Center, a 50-bed skilled nursing facility located in Van Nuys, California;
· Lomita Post Acute Care Center, a 68-bed skilled nursing facility located in Lomita, California;
· New Orange Hills, a 143-bed skilled nursing facility located in Orange, California;
· Pacifica Nursing and Rehabilitation Center, a 68-bed skilled nursing facility located in Pacifica, California;
· Palm Terrace Care Center, a 70-bed skilled nursing facility located in Riverside, California; and
· Ramona Nursing and Rehabilitation Center, a 148-bed skilled nursing facility located in Danville, 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 Pennant Group, Inc. Keetch noted that each of these properties are subject to triple-net, long-term leases and generated rental revenue of $19.4 million for the quarter, of which $15.6 million was derived from Ensign affiliated operations. Also, for the quarter, Standard Bearer reported $13.0 million in FFO.
The Company paid a quarterly cash dividend of $0.0575 per share of Ensign common stock. Keetch noted that the Company’s liquidity remains strong and that the Company plans to continue its 20-year history of paying dividends into the future.
*Conference Call *
A live webcast will be held Friday, February 3, 2023 at 10:00 a.m. Pacific time (1:00 p.m. Eastern time) to discuss Ensign’s fourth quarter of 2022 financial results. To listen to the webcast, or to view any financial or statistical information required by SEC Regulation G, please visit the Investors Relations section of Ensign’s website at http://investor.ensigngroup.net. The webcast will be recorded, and will be available for replay via the website until 5:00 p.m. Pacific time on Friday, March 3, 2023.
*About Ensign™*
The Ensign Group, Inc.'s independent operating subsidiaries provide a broad spectrum of skilled nursing and senior living services, physical, occupational and speech therapies and other rehabilitative and healthcare services at 288 healthcare facilities in Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, South Carolina, Texas, Utah, Washington and Wisconsin. As part of its investment strategy, the Company also acquire, lease and own healthcare real estate to service the post-acute care continuum through acquisition and investment opportunities in healthcare properties. Ensign’s new business venture operating subsidiaries also offer several other post-acute-related services, including mobile x-ray, non-emergency transportation services and other consulting services also across several states. Each of these operations is operated by a separate, independent operating subsidiary that has its own management, employees and assets. References herein to the consolidated "company" and "its" assets and activities, as well as the use of the terms "we," "us," "its" and similar verbiage, are not meant to imply that The Ensign Group, Inc. has direct operating assets, employees or revenue, or that any of the facilities, the Service Center, Standard Bearer or the captive insurance subsidiary are operated by the same entity. More information about Ensign is available at http://www.ensigngroup.net.
*Safe Harbor Statement under the Private Securities Litigation Reform Act of 1995:*
This press release contains, and the related conference call and webcast will include, forward-looking statements that are based on management’s current expectations, assumptions and beliefs about its business, financial performance, operating results, the industry in which it operates and other future events. Forward-looking statements can often be identified by words such as "anticipates," "expects," "intends," "plans," "predicts," "believes," "seeks," "estimates," "may," "will," "should," "would," "could," "potential," "continue," "ongoing," similar expressions, and variations or negatives of these words. These forward-looking statements include, but are not limited to, statements regarding growth prospects, future operating and financial performance, and acquisition activities. They are not guarantees of future results and are subject to risks, uncertainties and assumptions that could cause actual results to materially and adversely differ from those expressed in any forward-looking statement.
These risks and uncertainties relate to the company’s business, its industry and its common stock and include: reduced prices and reimbursement rates for its services; its ability to acquire, develop, manage or improve operations, its ability to manage its increasing borrowing costs as it incurs additional indebtedness to fund the acquisition and development of operations; its ability to access capital on a cost-effective basis to continue to successfully implement its growth strategy; its operating margins and profitability could suffer if it is unable to grow and manage effectively its increasing number of operations; competition from other companies in the acquisition, development and operation of facilities; its ability to defend claims and lawsuits, including professional liability claims alleging that our services resulted in personal injury, and other regulatory-related claims; and the application of existing or proposed government regulations, or the adoption of new laws and regulations, that could limit its business operations, require it to incur significant expenditures or limit its ability to relocate its operations if necessary. Additionally, our business and operations 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 Securities and Exchange Commission, including its Form 10-K, for a more complete discussion of the risks and other factors that could affect Ensign’s business, prospects and any forward-looking statements. Except as required by the federal securities laws, Ensign does not undertake any obligation to publicly update or revise any forward-looking statements, whether as a result of new information, future events, changing circumstances or any other reason after the date of this press release.
*Contact Information*
Investor/Media Relations, The Ensign Group, Inc., (949) 487-9500, ir@ensigngroup.net.
SOURCE: The Ensign Group, Inc.
*
THE ENSIGN GROUP, INC.*
CONSOLIDATED STATEMENTS OF INCOME
*Three Months Ended December 31,* *Year Ended December 31,* *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 *$* *2,627,461*
Expense:
Cost of services 633,529 535,063 2,354,434 2,019,879
Rent—cost of services 41,152 35,837 153,049 139,371
General and administrative expense 42,775 42,026 158,805 151,761
Depreciation and amortization 16,880 14,602 62,355 55,985
*TOTAL EXPENSES* *734,336* *627,528* *2,728,643* *2,366,996*
Income from operations 75,196 65,614 296,825 260,465
Other (expense) income:
Interest expense (2,067 ) (1,865 ) (8,931 ) (6,849 )
Other income 4,322 2,271 1,195 4,388
*Other income (expense), net* 2,255 406 (7,736 ) (2,461 )
Income before provision for income taxes 77,451 66,020 289,089 258,004
Provision for income taxes 16,932 17,059 64,437 60,279
*NET INCOME* *60,519* *48,961* *224,652* *197,725*
Less: net income (loss) attributable to noncontrolling interests 48 221 (29 ) 3,073
*Net income attributable to The Ensign Group, Inc.* *$* *60,471* *$* *48,740* *$* *224,681* *$* *194,652*
*NET INCOME PER SHARE ATTRIBUTABLE TO THE ENSIGN GROUP INC.*
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 *THE ENSIGN GROUP, INC.*
CONSOLIDATED BALANCE SHEETS
*December 31,* *2022* *2021* (In thousands)
*ASSETS*
Current assets:
Cash and cash equivalents $ 316,270 $ 262,201
Accounts receivable—less allowance for doubtful accounts of $7,802 and $11,213 at December 31, 2022 and 2021, respectively 408,432 328,731
Investments—current 15,441 13,763
Prepaid income taxes 4,643 5,452
Prepaid expenses and other current assets 36,339 29,562
*Total current assets* *781,125* *639,709*
Property and equipment, net 992,010 888,434
Right-of-use assets 1,450,995 1,138,872
Insurance subsidiary deposits and investments 67,652 54,097
Deferred tax assets 39,643 33,147
Restricted and other assets 37,291 29,516
Intangible assets, net 2,465 2,652
Goodwill 76,869 60,469
Other indefinite-lived intangibles 3,972 3,727
*TOTAL ASSETS* *$* *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*
*
THE ENSIGN GROUP, INC.*
CONSOLIDATED STATEMENTS OF CASH FLOWS
The following table presents selected data from our consolidated statements of cash flows for the periods presented:
*Year Ended December 31,* *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* * THE ENSIGN GROUP, INC.*
UNAUDITED RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION
*(In thousands, except per share data)*
*RECONCILIATION OF GAAP TO NON-GAAP NET INCOME *
The following table reconciles net income to Non-GAAP net income for the periods presented:
*Three Months Ended December 31,* *Year Ended December 31,* *2022* *2021* *2022* *2021*
Net income attributable to The Ensign Group, Inc. $ 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 December 31,* *Year Ended December 31,* *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 December 31,* *Year Ended December 31,* *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%.*THE ENSIGN GROUP, INC.*
UNAUDITED RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION
*(In thousands)*
The table below reconciles net income to EBITDA, Adjusted EBITDA and Adjusted EBITDAR for the periods presented:
*Three Months Ended December 31,* *Year Ended December 31,* *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.
*THE ENSIGN GROUP, INC.*
UNAUDITED SELECT PERFORMANCE INDICATORS
The following tables summarize our selected performance indicators for our skilled services segment along with other statistics, for each of the dates or periods indicated:
*Three Months Ended December 31,* *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 December 31,* *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 December 31,* *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 December 31,* *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 January 1, 2019.
(2) Transitioning Facility results represent all facilities purchased from January 1, 2019 to December 31, 2020.
(3) Recently Acquired Facility (Acquisitions) results represent all facilities purchased on or subsequent to January 1, 2021.
*Year Ended December 31,* *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 December 31,* *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 December 31,* *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 December 31,* *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 January 1, 2019.
(2) Transitioning Facility results represent all facilities purchased from January 1, 2019 to December 31, 2020.
(3) Recently Acquired Facility (Acquisitions) results represent all facilities purchased on or subsequent to January 1, 2021.
*THE ENSIGN GROUP, INC.*
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 December 31,* *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 December 31,* *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 December 31, 2021.
The following tables set forth our percentage of skilled nursing patient revenue and days by payor source for the quarter and years ended December 31, 2022 and 2021:
*Three Months Ended December 31,* *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 December 31,* *Same Facility* *Transitioning* *Acquisitions* *Total* *2022* *2021* *2022* *2021* *2022* *2021* *2022* *2021*
*PERCENTAGE OF SKILLED NURSING DAYS*
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 December 31,* *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 December 31,* *Same Facility* *Transitioning* *Acquisitions* *Total* *2022* *2021* *2022* *2021* *2022* *2021* *2022* *2021*
*PERCENTAGE OF SKILLED NURSING DAYS*
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* *%**THE ENSIGN GROUP, INC.*
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 December 31,* *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 December 31,* *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.
*THE ENSIGN GROUP, INC.*
UNAUDITED RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION BY SEGMENT
*(In thousands)*
*Skilled Services*
The table below reconciles net income to EBITDA and Adjusted EBITDA for the skilled services reportable segment for the periods presented:
*Three Months Ended December 31,* *Year Ended December 31,* *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 Standard Bearer Healthcare REIT, Inc. (Standard Bearer) in January 2022, we revised our former real estate segment to include only real estate properties that are part of Standard Bearer. Segment information for the prior period has been recast to reflect the change of our segment structure. In addition, included in the results during the year ended December 31, 2022 are expenses incurred related to intercompany arrangements between Standard Bearer and its subsidiaries and certain subsidiaries of the Company that were entered into in 2022 and therefore are not reflected in the 2021 amounts.
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 December 31,* *Year Ended December 31,* *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 December 31, 2022 is management fee of $1.2 million and $4.4 million, respectively, and interest of $2.5 million and $8.6 million, respectively, from intercompany agreements between Standard Bearer and The Ensign Group, Inc. and other affiliated entities, including the Service Center, that were entered into in January 2022. These agreements were not in place in 2021, therefore no expense was recognized in 2021.
(b) FFO, in accordance with the definition used by the National Association of Real Estate Investment Trusts, means net income attributable to common stockholders, computed in accordance with U.S. GAAP, excluding gains (or losses) from sales of real estate and impairment of depreciable real estate assets, while including depreciation and amortization related to real estate to earnings.
*Discussion of Non-GAAP Financial Measures*
EBITDA consists of net income before (a) 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 Securities and Exchange Commission, including its Annual Report on Form 10-K and Quarterly Report on Form 10-Q. The company’s periodic filings are available on the SEC's website at www.sec.gov or under the "Financial Information" link of the Investor Relations section on Ensign’s website at http://www.ensigngroup.net.