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8-K - CURRENT REPORT - ENSIGN GROUP, INCq32012form8-k.htm



The Ensign Group Reports Record Net Income, Adjusted Earnings of $0.62 per Share

Conference Call and Webcast Scheduled for November 8, 2012 at 10:00 am PT

MISSION VIEJO, California - November 7, 2012 - The Ensign Group, Inc. (Nasdaq: ENSG), the parent company of the Ensign™ group of skilled nursing, rehabilitative care services, assisted and independent living, home health, hospice care and urgent care companies, today reported operating results for the third quarter of 2012.

Financial highlights for the Third Quarter include:
Net income climbed 14.6% to a record $13.3 million;

Same-store skilled nursing occupancy grew by 40 basis points over the prior year quarter to 82.1%;

Same-store skilled mix days held steady at 28.7% despite reported soft hospital occupancy in many markets, while consolidated skilled days grew by 34 basis points to 25.2% of patient days;

Consolidated EBITDAR was a record $34.4 million, an increase of 3.0% over the prior year quarter, and the fourth consecutive sequential increase since the October 1, 2011 implementation of an 11.1% Medicare cut and changes to therapy regulations which increased therapy costs; and

Consolidated revenues were a record $207.2 million, up 5.5%.

Operating Results

Ensign matched its adjusted earnings per share for the same quarter of 2011, despite the effects of last October's unprecedented 11.1% reduction in Medicare rates to skilled nursing facilities and a simultaneous change in therapy regulations that increased the cost of delivering physical and other types of therapy to skilled nursing patients.

“We have now successfully navigated a full four quarters under the difficult circumstances posed by last years' cuts, and have posted improved operating results each quarter,” said Christopher Christensen, Ensign's President and Chief Executive Officer. He observed that, even though same-store revenues are tracking behind the prior year as a result of the cuts, the 14.6% earnings increase illustrates that Ensign's unique operating model has been able to adjust effectively on the expense side to the new reimbursement realities in skilled nursing care.
 
Mr. Christensen also highlighted the company's diversification into home health and hospice care, and into subacute care, as further evidence of the organization's agility and ability to quickly adjust in the face of operating headwinds. “As always, it is our empowered and motivated local leaders and their teams that have rallied to make up lost revenues, craft their own unique and innovative ways to get the job done, and again set Ensign apart from the crowd,” he said.
Mr. Christensen noted that the last four quarters “have been the perfect storm” for the skilled nursing industry, adding, “And we are grateful that - while we have increased revenue, earnings and occupancy more slowly than last year - we have nevertheless increased, and done so through a very difficult time.”






In other results, Chief Financial Officer Suzanne Snapper reported that EBITDA rose nearly $1.0 million to $31.1 million, notwithstanding the October 2011 Medicare cuts and therapy changes. She noted that Ensign, as a growing, dynamic company, had benefited from the contributions of recently-acquired and transitioning facilities, which posted revenue gains of 80% and 5.7% respectively, more than offsetting the 3.3% decline in same-store revenue resulting from the 2011 cuts.

She also reported that, while much of the industry appears to have suffered a decline in occupancy during the quarter, Ensign's same-store skilled nursing occupancy was actually up by 40 basis points to 82.1%, and same-store occupancy was up 35 basis points to 82.2%. “We believe that as the quality of our service offerings, our superior clinical outcomes and our connections to our individual markets continue to strengthen, we will increasingly draw market share across the portfolio,” she added, noting that the largest increases are expected “at the higher end of the acuity spectrum.”
Fully diluted GAAP earnings per share were $0.60 for the quarter, an 11.1% increase compared to $0.54 in the third quarter of 2011. Adjusted non-GAAP earnings for the quarter were $0.62 per fully diluted share, compared to $0.62 in the third quarter of 2011. A reconciliation of key GAAP and non-GAAP financial metrics appears in the financial data included with this release. More complete information is contained in the Company's 10-Q, which was filed with the SEC today and can be viewed on the Company's website at http://www.ensigngroup.net.

2012 Guidance Confirmed

Management confirmed its annual guidance, which was increased following the second quarter, projecting adjusted net income of $2.48 to $2.56 per diluted share on revenues of $830 million to $846 million. The guidance is based on diluted weighted average common shares outstanding of 22.1 million and assumes, among other things, no additional acquisitions or dispositions beyond those made to date, the effects of the announced Medicare market basket update, anticipated increases in overall net Medicaid reimbursement rates, a normalized tax rate of approximately 39%, and that tax rates do not materially increase. It also excludes expenses related to normalized rent from one operating lease for a not-yet opened facility and the costs associated with the settlement of the California class action, as well as expenses related to the DOJ investigation which can vary widely from quarter to quarter depending on the DOJ's activities and the required response by the Company.

Quarter Highlights
Dividend Declared
During the quarter, the company's Board of Directors declared a quarterly cash dividend of $0.06 per share of Ensign common stock. Ensign has been a dividend-paying company since 2002, and has increased its dividend every year.
Acquisition Growth
During the quarter, the company announced the acquisition of one skilled nursing and assisted living campus and one skilled nursing facility, both in the same transaction. In addition, the company exercised fixed-formula purchase options on three skilled nursing facilities it has operated for many years. The facilities were purchased with cash, and include:
In Idaho, Discovery Care Center, a 45-bed skilled nursing and 24-unit assisted living campus in Salmon.

Also in Idaho, Owyhee Health & Rehabilitation Center, a 49-bed skilled nursing facility located in Homedale, a suburb of the growing Boise market.

In Southern California, Ensign exercised a purchase option to acquire the underlying real estate of Palomar Vista Healthcare Center, a 74-bed skilled nursing facility located in Escondido. An Ensign subsidiary has operated Palomar Vista since 2003 under a lease from the family that founded the facility.

Also in Southern California, Ensign exercised purchase options to acquire the underlying real estate of Atlantic Memorial Healthcare Center, a 104-bed skilled nursing facility, and Shoreline Healthcare Center, a 75-bed





skilled nursing facility, both located in the City of Long Beach. Separate Ensign subsidiaries have operated the two facilities since 2002 under leases from the family that built and originally operated the two facilities.

The acquisitions brought Ensign's growing portfolio to 107 facilities, 85 of which are Ensign-owned, with Ensign affiliates holding purchase options on two of Ensign's 22 leased facilities, as well as four hospice companies and six home health businesses, spread over 11 states. Management reaffirmed that Ensign is actively seeking additional opportunities to acquire both well-performing and struggling long-term care, home health and hospice operations across the United States.

Conference Call

A live webcast will be held on Thursday, November 8, 2012 at 10:00 a.m. Pacific Time (1:00 p.m. Eastern Time) to discuss Ensign's third quarter 2012 financial results. To listen to the webcast, or to view any financial or statistical information required by SEC Regulation G, please visit the Investors section of the Ensign website at http://investor.ensigngroup.net. The webcast will be recorded, and will be available for replay via the website until 5:00 p.m. Pacific Time on Friday, November 23, 2012.
About Ensign
The Ensign Group, Inc.'s independent operating subsidiaries provide a broad spectrum of skilled nursing and assisted living services, physical, occupational and speech therapies, home health and hospice services, and other rehabilitative and healthcare services for both long-term residents and short-stay rehabilitation patients at 107 facilities, four hospice companies and six home health businesses in California, Arizona, Texas, Washington, Utah, Idaho, Colorado, Nevada, Iowa, Nebraska and Oregon. Each of these facilities and businesses 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 home health and hospice businesses, the urgent care joint venture, the Service Center 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. 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 facilities, its ability to manage its increasing borrowing costs as it incurs additional indebtedness to fund the acquisition and development of facilities; 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 facilities; competition from other companies in the acquisition, development and operation of facilities; 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 facilities if necessary. Readers should not place undue reliance on any forward-looking statements and are encouraged to review the company's periodic filings with the Securities and Exchange Commission, including its Form 10-Q, which was filed today, 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
Robert East, Westwicke Partners LLC, (443) 213-0500, bob.east@westwickepartners.com, or Gregory Stapley, Investor/Media Relations, The Ensign Group, Inc., (949) 487-9500, ir@ensigngroup.net.
SOURCE: The Ensign Group, Inc.






THE ENSIGN GROUP, INC.
GAAP and ADJUSTED CONDENSED CONSOLIDATED STATEMENT OF INCOME
(In thousands, except per share data)
 
 
Three Months Ended
September 30, 2012
 
Nine Months Ended
September 30, 2012
 
 
As Reported
 
Non-GAAP Adj.
 
As Adjusted
 
As Reported
 
Non-GAAP Adj.
 
As Adjusted
Revenue
$
207,150

 
 
 
$
207,150

 
$
613,618

 
 
 
$
613,618

Expense:
 
 
 
 
 
 
 
 
 
 
 
Cost of services (exclusive of facility rent, general and administrative and depreciation and amortization expense shown separately below)
164,877

 
(307)(1)(2)
 
164,570

 
488,305

 
(3,265)(1)(2)(3)
 
485,040

Facility rent—cost of services
3,374

 
(153)(4)
 
3,221

 
10,063

 
(445)(4)
 
9,618

General and administrative expense
8,099

 
(594)(5)
 
7,505

 
23,933

 
(1,442)(5)
 
22,491

Depreciation and amortization
7,179

 
(127)(6)
 
7,052

 
21,145

 
(433)(6)
 
20,712

Total expenses
183,529

 
(1,181)
 
182,348

 
543,446

 
(5,585)
 
537,861

Income from operations
23,621

 
1,181
 
24,802

 
70,172

 
5,585
 
75,757

Other income (expense):
 
 
 
 
 
 
 
 
 
 
 
Interest expense
(3,092
)
 
 
 
(3,092
)
 
(9,131
)
 
 
 
(9,131
)
Interest income
69

 
 
 
69

 
172

 
 
 
172

Other expense, net
(3,023
)
 
 
 
(3,023
)
 
(8,959
)
 
 
 
(8,959
)
Income before provision for income taxes
20,598

 
1,181
 
21,779

 
61,213

 
5,585
 
66,798

 
 
 
 
 
 
 
 
 
 
 
 
Tax Effect on Non-GAAP Adjustments
 
 
461(7)
 
 
 
 
 
2,178(7)
 
 
Tax True-up for Effective Tax Rate
 
 
471(8)
 
 
 
 
 
803(8)
 
 
Provision for income taxes
7,562

 
932
 
8,494

 
23,070

 
2,981
 
26,051

Net income
$
13,036

 
249
 
$
13,285

 
$
38,143

 
2,604
 
$
40,747

Less: net loss attributable to noncontrolling interests
(258
)
 
 
 
(258
)
 
(511
)
 
 
 
(511
)
Net income attributable to The Ensign Group, Inc.
$
13,294

 
249
 
$
13,543

 
$
38,654

 
2,604
 
$
41,258

Net income per share:
 
 
 
 
 
 
 
 
 
 
 
Basic
$
0.62

 
 
 
$
0.63

 
$
1.81

 
 
 
$
1.93

Diluted
$
0.60

 
 
 
$
0.62

 
$
1.77

 
 
 
$
1.88

Weighted average common shares outstanding:
 
 
 
 
 
 
 
 
 
 
 
Basic
21,488

 
 
 
21,488

 
21,369

 
 
 
21,369

Diluted
22,010

 
 
 
22,010

 
21,899

 
 
 
21,899

 
 
 
 
 
 
 
 
 
 
 
 
 
(1
)
Represents acquisition-related costs of $110 and $230 for the three and nine months ended September 30, 2012, respectively.
 

 
 
 
 
 
 
 
 
 
 
 
 
(2
)
Represents costs of $197 and $439 for the three and nine months ended September 30, 2012, respectively, incurred to recognize income tax credits which contributed to decrease in effective tax rate.
 
 
 
 
 
 
 
 
 
 
 
 
 
(3
)
Represents the settlement of a class action lawsuit regarding minimum staffing requirements in the state of California of $2,596 during the three months ended June 30, 2012.
 
 
 
 
 
 
 
 
 
 
 
 
 
(4
)
Represents straight-line rent amortization for a facility which the Company has begun construction activities, but has not commenced operations of a skilled nursing facility as of September 30, 2012.
 
 
 
 
 
 
 
 
 
 
 
 
 
(5
)
Represents legal costs incurred in connection with the ongoing investigation into the billing and reimbursement processes of some of our subsidiaries being conducted by the Department of Justice (DOJ).
 
 
 
 
 
 
 
 
 
 
 
 
 
(6
)
Represents amortization costs related to patient base intangible assets acquired. Patient base intangible assets are 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.
 

 
 
 
 
 
 
 
 
 
 
 
 
(7
)
Represents the tax impact of non-GAAP adjustments noted in (1) - (6) at a normalized tax rate of 39.0%.
 
 
 
 
 
 
 
 
 
 
 
 
 
(8
)
In FY 2011 and 2010, the Company's effective tax rates were a 38.3% and 39.3%, respectively. Therefore, this represents an adjustment to the provision for income taxes to normalize our current quarter effective tax rate to 39.0%.









THE ENSIGN GROUP, INC.
GAAP and ADJUSTED CONDENSED CONSOLIDATED STATEMENT OF INCOME
(In thousands, except per share data)
 
 
Three Months Ended
September 30, 2011
 
Nine Months Ended
September 30, 2011
 
 
As Reported
 
Non-GAAP Adj.
 
As Adjusted
 
As Reported
 
Non-GAAP Adj.
 
As Adjusted
Revenue
$
196,346

 
 
 
$
196,346

 
$
565,615

 
 
 
$
565,615

Expense:
 
 
 
 
 
 
 
 
 
 
 
Cost of services (exclusive of facility rent, general and administrative and depreciation and amortization expense shown separately below)
155,725

 
(158)(1)
 
155,567

 
444,517

 
(362)(1)
 
444,155

Facility rent—cost of services
3,331

 
 
 
3,331

 
10,380

 
 
 
10,380

General and administrative expense
7,195

 
 
 
7,195

 
22,188

 
 
 
22,188

Depreciation and amortization
6,179

 
(249)(2)
 
5,930

 
16,784

 
(808)(2)
 
15,976

Total expenses
172,430

 
(407)
 
172,023

 
493,869

 
(1,170)
 
492,699

Income from operations
23,916

 
407
 
24,323

 
71,746

 
1,170
 
72,916

Other income (expense):
 
 
 
 
 
 
 
 
 
 
 
Interest expense
(5,323
)
 
2,542(3)
 
(2,781
)
 
(10,789
)
 
2,542(3)
 
(8,247
)
Interest income
68

 
 
 
68

 
198

 
 
 
198

Other expense, net
(5,255
)
 
2,542
 
(2,713
)
 
(10,591
)
 
2,542
 
(8,049
)
Income before provision for income taxes
18,661

 
2,949
 
21,610

 
61,155

 
3,712
 
64,867

 
 
 
 
 
 
 
 
 
 
 
 
Provision for income taxes
7,063

 
1,116(4)
 
8,179

 
23,835

 
1,447(4)
 
25,282

Net income
$
11,598

 
1,833
 
$
13,431

 
$
37,320

 
2,265
 
$
39,585

Net income per share:
 
 
 
 
 
 
 
 
 
 
 
Basic
$
0.55

 
 
 
$
0.64

 
$
1.78

 
 
 
$
1.89

Diluted
$
0.54

 
 
 
$
0.62

 
$
1.73

 
 
 
$
1.84

Weighted average common shares outstanding:
 
 
 
 
 
 
 
 
 
 
 
Basic
20,995

 
 
 
20,995

 
20,920

 
 
 
20,920

Diluted
21,570

 
 
 
21,570

 
21,571

 
 
 
21,571

 
 
 
 
 
 
 
 
 
 
 
 
 
(1
)
Represents acquisition-related costs expenses.
 

 
 
 
 
 
 
 
 
 
 
 
 
(2
)
Represents amortization costs related to patient base intangible assets acquired. Patient base intangible assets are 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.
 
 
 
 
 
 
 
 
 
 
 
 
 
(3
)
Represents the loss on extinguishment and amortization of remaining deferred financing costs in connection with the Senior Credit Facility entered into by the Company on July 15, 2011.
 

 
 
 
 
 
 
 
 
 
 
 
 
(4
)
Represents the tax impact of non-GAAP adjustments noted in (1) - (3) at a normalized tax rate of 39.0%.






THE ENSIGN GROUP, INC.
RECONCILIATION OF NET INCOME TO EBITDA AND EBITDAR
(in thousands)
The table below reconciles net income to EBITDA and EBITDAR for the periods presented:
 
Three Months Ended
September 30,
 
Nine Months Ended
September 30,
 
2012
 
2011
 
2012
 
2011
 
(Dollars in thousands)
Consolidated Statements of Income Data:
 
 
 
 
 
 
 
Net income
$
13,036

 
$
11,598

 
$
38,143

 
$
37,320

Net loss attributable to noncontrolling interests
258

 

 
511

 

Interest expense, net
3,023

 
5,255

 
8,959

 
10,591

Provision for income taxes
7,562

 
7,063

 
23,070

 
23,835

Depreciation and amortization
7,179

 
6,179

 
21,145

 
16,784

EBITDA
$
31,058

 
$
30,095

 
$
91,828

 
$
88,530

Facility rent—cost of services
3,374

 
3,331

 
10,063

 
10,380

EBITDAR
$
34,432

 
$
33,426

 
$
101,891

 
$
98,910









THE ENSIGN GROUP, INC.
CONDENSED CONSOLIDATED BALANCE SHEETS
(In thousands)
 
September 30,
2012
 
December 31,
2011
Assets
 
 
 
Current assets:
 
 
 
Cash and cash equivalents
$
32,028

 
$
29,584

Accounts receivable—less allowance for doubtful accounts of $13,628 and $12,782 at September 30, 2012 and December 31, 2011, respectively
98,072

 
86,311

Investments—current
4,254

 

Prepaid income taxes
3,232

 
5,882

Prepaid expenses and other current assets
7,985

 
7,667

Deferred tax asset—current
10,178

 
11,195

Total current assets
155,749

 
140,639

Property and equipment, net
439,233

 
403,862

Insurance subsidiary deposits and investments
18,149

 
16,752

Escrow deposits

 
175

Deferred tax asset
4,787

 
3,514

Restricted and other assets
12,385

 
10,418

Intangible assets, net
4,867

 
2,321

Goodwill
22,180

 
17,177

Other indefinite-lived intangibles
10,598

 
1,481

Total assets
$
667,948

 
$
596,339

Liabilities and equity
 
 
 
Current liabilities:
 
 
 
Accounts payable
$
23,211

 
$
21,169

Accrued wages and related liabilities
34,868

 
41,958

Accrued self-insurance liabilities—current
15,897

 
12,369

Other accrued liabilities
22,615

 
18,577

Current maturities of long-term debt
7,133

 
6,314

Total current liabilities
103,724

 
100,387

Long-term debt—less current maturities
192,299

 
181,556

Accrued self-insurance liabilities—less current portion
34,928

 
31,904

Fair value of interest rate swap
3,116

 
2,143

Deferred rent and other long-term liabilities
3,306

 
2,864

Total liabilities
337,373

 
318,854

Temporary equity - redeemable noncontrolling interest
11,511

 

Total equity
319,064

 
277,485

Total liabilities and equity
$
667,948

 
$
596,339







THE ENSIGN GROUP, INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(In thousands)

The following table presents selected data from our condensed consolidated statement of cash flows for the periods presented:
 
Nine Months Ended
September 30,
 
2012
 
2011
 
(In thousands)
Net cash provided by operating activities
$
51,593

 
$
53,245

Net cash used in investing activities
(61,841
)
 
(126,870
)
Net cash provided by financing activities
12,692

 
27,187

Net increase (decrease) in cash and cash equivalents
2,444

 
(46,438
)
Cash and cash equivalents at beginning of period
29,584

 
72,088

Cash and cash equivalents at end of period
$
32,028

 
$
25,650








THE ENSIGN GROUP, INC.
SELECT PERFORMANCE INDICATORS
The following tables summarize our selected performance indicators, along with other statistics, for each of the dates or periods indicated:
 
Three Months Ended
September 30,
 
 
 
 
 
2012
 
2011
 
 
 
 
 
(Dollars in thousands)
 
Change
 
% Change
Total Facility Results:
 
 
 
 
 
 
 
Revenue
$
207,150

 
$
196,346

 
$
10,804

 
5.5
 %
Number of facilities at period end
107

 
99

 
8

 
8.1
 %
Actual patient days
872,701

 
812,627

 
60,074

 
7.4
 %
Occupancy percentage — Operational beds
78.7
%
 
78.7
%
 
 
 
 %
Skilled mix by nursing days
25.2
%
 
24.9
%
 
 
 
0.3
 %
Skilled mix by nursing revenue
49.3
%
 
51.3
%
 
 
 
(2.0
)%
 
Three Months Ended
September 30,
 
 
 
 
 
2012
 
2011
 
 
 
 
 
(Dollars in thousands)
 
Change
 
% Change
Same Facility Results(1):
 
 
 
 
 
 
 
Revenue
$
139,664

 
$
144,357

 
$
(4,693
)
 
(3.3
)%
Number of facilities at period end
62

 
62

 

 
 %
Actual patient days
537,256

 
536,500

 
756

 
0.1
 %
Occupancy percentage — Operational beds
82.2
%
 
81.8
%
 
 
 
0.4
 %
Skilled mix by nursing days
28.7
%
 
28.7
%
 
 
 
 %
Skilled mix by nursing revenue
53.3
%
 
55.7
%
 
 
 
(2.4
)%
 
Three Months Ended
September 30,
 
 
 
 
 
2012
 
2011
 
 
 
 
 
(Dollars in thousands)
 
Change
 
% Change
Transitioning Facility Results(2):
 
 
 
 
 
 
 
Revenue
$
37,163

 
$
35,147

 
$
2,016

 
5.7
%
Number of facilities at period end
20

 
20

 

 
%
Actual patient days
168,062

 
159,750

 
8,312

 
5.2
%
Occupancy percentage — Operational beds
75.7
%
 
71.9
%
 
 
 
3.8
%
Skilled mix by nursing days
18.8
%
 
16.8
%
 
 
 
2.0
%
Skilled mix by nursing revenue
40.0
%
 
38.6
%
 
 
 
1.4
%
 
Three Months Ended
September 30,
 
 
 
 
 
2012
 
2011
 
 
 
 
 
(Dollars in thousands)
 
Change
 
% Change
Recently Acquired Facility Results(3):
 
 
 
 
 
 
 
Revenue
$
30,323

 
$
16,842

 
$
13,481

 
NM
Number of facilities at period end
25

 
17

 
8

 
NM
Actual patient days
167,383

 
116,377

 
51,006

 
NM
Occupancy percentage — Operational beds
71.9
%
 
75.2
%
 
 
 
NM
Skilled mix by nursing days
16.8
%
 
11.0
%
 
 
 
NM
Skilled mix by nursing revenue
37.0
%
 
29.1
%
 
 
 
NM
______________________
(1)
Same Facility results represent all facilities purchased prior to January 1, 2009.
(2)
Transitioning Facility results represents all facilities purchased from January 1, 2009 to December 31, 2010.
(3)
Recently Acquired Facility (or “Acquisitions”) results represent all facilities purchased on or subsequent to January 1, 2011.





 
Nine Months Ended
September 30,
 
 
 
 
 
2012
 
2011
 
 
 
 
 
(Dollars in thousands)
 
Change
 
% Change
Total Facility Results:
 
 
 
 
 
 
 
Revenue
$
613,618

 
$
565,615

 
$
48,003

 
8.5
 %
Number of facilities at period end
107

 
99

 
8

 
8.1
 %
Actual patient days
2,580,026

 
2,291,107

 
288,919

 
12.6
 %
Occupancy percentage — Operational beds
79.2
%
 
79.5
%
 
 
 
(0.3
)%
Skilled mix by nursing days
25.8
%
 
25.8
%
 
 
 
 %
Skilled mix by nursing revenue
50.1
%
 
52.2
%
 
 
 
(2.1
)%
 
Nine Months Ended
September 30,
 
 
 
 
 
2012
 
2011
 
 
 
 
 
(Dollars in thousands)
 
Change
 
% Change
Same Facility Results(1):
 
 
 
 
 
 
 
Revenue
$
421,993

 
$
430,621

 
$
(8,628
)
 
(2.0
)%
Number of facilities at period end
62

 
62

 

 
 %
Actual patient days
1,614,554

 
1,601,360

 
13,194

 
0.8
 %
Occupancy percentage — Operational beds
82.9
%
 
82.3
%
 
 
 
0.6
 %
Skilled mix by nursing days
29.6
%
 
29.2
%
 
 
 
0.4
 %
Skilled mix by nursing revenue
54.3
%
 
56.2
%
 
 
 
(1.9
)%
 
Nine Months Ended
September 30,
 
 
 
 
 
2012
 
2011
 
 
 
 
 
(Dollars in thousands)
 
Change
 
% Change
Transitioning Facility Results(2):
 
 
 
 
 
 
 
Revenue
$
108,611

 
$
104,442

 
$
4,169

 
4.0
%
Number of facilities at period end
20

 
20

 

 
%
Actual patient days
493,258

 
481,277

 
11,981

 
2.5
%
Occupancy percentage — Operational beds
74.6
%
 
73.0
%
 
 
 
1.6
%
Skilled mix by nursing days
17.8
%
 
16.2
%
 
 
 
1.6
%
Skilled mix by nursing revenue
38.3
%
 
37.7
%
 
 
 
0.6
%
 
Nine Months Ended
September 30,
 
 
 
 
 
2012
 
2011
 
 
 
 
 
(Dollars in thousands)
 
Change
 
% Change
Recently Acquired Facility Results(3):
 
 
 
 
 
 
 
Revenue
$
83,014

 
$
30,552

 
$
52,462

 
NM
Number of facilities at period end
25

 
17

 
8

 
NM
Actual patient days
472,152

 
208,453

 
263,699

 
NM
Occupancy percentage — Operational beds
72.9
%
 
75.1
%
 
 
 
NM
Skilled mix by nursing days
17.4
%
 
13.2
%
 
 
 
NM
Skilled mix by nursing revenue
38.6
%
 
32.9
%
 
 
 
NM
______________________
(1)
Same Facility results represent all facilities purchased prior to January 1, 2009.
(2)
Transitioning Facility results represents all facilities purchased from January 1, 2009 to December 31, 2010.
(3)
Recently Acquired Facility (or “Acquisitions”) results represent all facilities purchased on or subsequent to January 1, 2011.







THE ENSIGN GROUP, INC.
SKILLED NURSING AVERAGE DAILY REVENUE RATES AND
PERCENT OF SKILLED NURSING REVENUE AND DAYS BY PAYOR
The following table reflects the change in the skilled nursing average daily revenue rates by payor source, excluding services that are not covered by the daily rate:
 
Three Months Ended September 30,
 
Same Facility
 
Transitioning
 
Acquisitions
 
Total
 
%
 
2012
 
2011
 
2012
 
2011
 
2012
 
2011
 
2012
 
2011
 
Change
Skilled Nursing Average Daily Revenue Rates:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicare
$
564.05

 
$
643.35

 
$
483.99

 
$
536.50

 
$
464.93

 
$
472.68

 
$
539.13

 
$
616.78

 
(12.6
)%
Managed care
380.35

 
369.63

 
399.24

 
415.53

 
398.82

 
490.71

 
383.29

 
375.05

 
2.2
 %
Other skilled
565.92

 
538.68

 
582.27

 
550.61

 

 

 
568.60

 
539.85

 
5.3
 %
Total skilled revenue
494.56

 
535.11

 
467.43

 
509.47

 
454.10

 
474.63

 
487.11

 
529.46

 
(8.0
)%
Medicaid
171.03

 
168.44

 
161.56

 
160.86

 
150.51

 
137.38

 
166.74

 
164.60

 
1.3
 %
Private and other payors
195.48

 
188.75

 
166.36

 
177.01

 
167.14

 
152.27

 
180.75

 
177.24

 
2.0
 %
Total skilled nursing revenue
$
266.15

 
$
275.75

 
$
219.68

 
$
221.55

 
$
206.73

 
$
180.37

 
$
249.38

 
$
257.06

 
(3.0
)%

 
Nine Months Ended September 30,
 
Same Facility
 
Transitioning
 
Acquisitions
 
Total
 
%
 
2012
 
2011
 
2012
 
2011
 
2012
 
2011
 
2012
 
2011
 
Change
Skilled Nursing Average Daily Revenue Rates:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicare
$
561.39

 
$
640.30

 
$
484.52

 
$
535.07

 
$
471.11

 
$
468.00

 
$
539.61

 
$
617.12

 
(12.6
)%
Managed care
371.90

 
368.52

 
405.64

 
424.72

 
405.85

 
489.89

 
376.64

 
373.99

 
0.7
 %
Other skilled
571.69

 
530.87

 
579.57

 
520.02

 

 

 
572.78

 
530.02

 
8.1
 %
Total skilled revenue
491.37

 
530.69

 
469.82

 
508.88

 
460.53

 
470.05

 
485.99

 
526.38

 
(7.7
)%
Medicaid
170.11

 
167.54

 
162.71

 
160.42

 
147.24

 
138.87

 
166.22

 
164.76

 
0.9
 %
Private and other payors
197.05

 
187.29

 
170.78

 
173.71

 
165.15

 
156.45

 
182.19

 
179.69

 
1.4
 %
Total skilled nursing revenue
$
267.72

 
$
275.62

 
$
218.53

 
$
218.57

 
$
207.64

 
$
189.26

 
$
250.98

 
$
259.85

 
(3.4
)%






The following tables set forth our percentage of skilled nursing patient revenue and days by payor source for the three and nine months ended September 30, 2012 and 2011:

 
Three Months Ended
September 30,
 
Same Facility
 
Transitioning
 
Acquisitions
 
Total
 
2012
 
2011
 
2012
 
2011
 
2012
 
2011
 
2012
 
2011
Percentage of Skilled Nursing Revenue:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicare
33.6
%
 
37.9
%
 
26.9
%
 
29.6
%
 
31.7
%
 
25.8
%
 
32.3
%
 
35.9
%
Managed care
15.5

 
14.3

 
9.5

 
7.2

 
5.3

 
3.3

 
13.4

 
12.5

Other skilled
4.2

 
3.5

 
3.6

 
1.8

 

 

 
3.6

 
2.9

Skilled mix
53.3

 
55.7

 
40.0

 
38.6

 
37.0

 
29.1

 
49.3

 
51.3

Private and other payors
7.0

 
7.0

 
10.7

 
10.7

 
24.8

 
32.6

 
9.5

 
9.2

Quality mix
60.3

 
62.7

 
50.7

 
49.3

 
61.8

 
61.7

 
58.8

 
60.5

Medicaid
39.7

 
37.3

 
49.3

 
50.7

 
38.2

 
38.3

 
41.2

 
39.5

Total skilled nursing
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%

 
Three Months Ended
September 30,
 
Same Facility
 
Transitioning
 
Acquisitions
 
Total
 
2012
 
2011
 
2012
 
2011
 
2012
 
2011
 
2012
 
2011
Percentage of Skilled Nursing Days:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicare
15.9
%
 
16.3
%
 
12.2
%
 
12.2
%
 
14.1
%
 
9.8
%
 
14.9
%
 
14.9
%
Managed care
10.9

 
10.7

 
5.2

 
3.9

 
2.7

 
1.2

 
8.7

 
8.6

Other skilled
1.9

 
1.7

 
1.4

 
0.7

 

 

 
1.6

 
1.4

Skilled mix
28.7

 
28.7

 
18.8

 
16.8

 
16.8

 
11.0

 
25.2

 
24.9

Private and other payors
9.5

 
10.2

 
14.2

 
13.3

 
30.8

 
38.7

 
13.2

 
13.3

Quality mix
38.2

 
38.9

 
33.0

 
30.1

 
47.6

 
49.7

 
38.4

 
38.2

Medicaid
61.8

 
61.1

 
67.0

 
69.9

 
52.4

 
50.3

 
61.6

 
61.8

Total skilled nursing
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%






 
Nine Months Ended
September 30,
 
Same Facility
 
Transitioning
 
Acquisitions
 
Total
 
2012
 
2011
 
2012
 
2011
 
2012
 
2011
 
2012
 
2011
Percentage of Skilled Nursing Revenue:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicare
34.8
%
 
38.1
%
 
26.6
%
 
29.1
%
 
33.1
%
 
29.7
%
 
33.3
%
 
36.3
%
Managed care
15.3

 
14.8

 
8.7

 
7.3

 
5.5

 
3.2

 
13.2

 
13.1

Other skilled
4.2

 
3.3

 
3.0

 
1.3

 

 

 
3.6

 
2.8

Skilled mix
54.3

 
56.2

 
38.3

 
37.7

 
38.6

 
32.9

 
50.1

 
52.2

Private and other payors
7.0

 
7.1

 
10.6

 
10.6

 
26.0

 
30.7

 
9.5

 
8.6

Quality mix
61.3

 
63.3

 
48.9

 
48.3

 
64.6

 
63.6

 
59.6

 
60.8

Medicaid
38.7

 
36.7

 
51.1

 
51.7

 
35.4

 
36.4

 
40.4

 
39.2

Total skilled nursing
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%

 
Nine Months Ended
September 30,
 
Same Facility
 
Transitioning
 
Acquisitions
 
Total
 
2012
 
2011
 
2012
 
2011
 
2012
 
2011
 
2012
 
2011
Percentage of Skilled Nursing Days:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicare
16.6
%
 
16.4
%
 
12.0
%
 
11.9
%
 
14.6
%
 
12.0
%
 
15.5
%
 
15.3
%
Managed care
11.0

 
11.1

 
4.7

 
3.8

 
2.8

 
1.2

 
8.8

 
9.1

Other skilled
2.0

 
1.7

 
1.1

 
0.5

 

 

 
1.5

 
1.4

Skilled mix
29.6

 
29.2

 
17.8

 
16.2

 
17.4

 
13.2

 
25.8

 
25.8

Private and other payors
9.6

 
10.4

 
13.6

 
13.4

 
32.7

 
37.2

 
13.2

 
12.4

Quality mix
39.2

 
39.6

 
31.4

 
29.6

 
50.1

 
50.4

 
39.0

 
38.2

Medicaid
60.8

 
60.4

 
68.6

 
70.4

 
49.9

 
49.6

 
61.0

 
61.8

Total skilled nursing
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%
 
100.0
%







THE ENSIGN GROUP, INC.
REVENUE BY PAYOR SOURCE
The following table sets forth our total revenue by payor source and as a percentage of total revenue for the periods indicated:
 
 
Three Months Ended
September 30,
 
Nine Months Ended
September 30,
 
 
2012
 
2011
 
2012
 
2011
 
 
$
 
%
 
$
 
%
 
$
 
%
 
$
 
%
 
 
(Dollars in thousands)
Revenue:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicaid
 
$
76,709

 
37.0
%
 
$
70,967

 
36.1
%
 
$
223,934

 
36.5
%
 
$
204,273

 
36.1
%
Medicare
 
69,526

 
33.6

 
71,293

 
36.3

 
209,715

 
34.2

 
207,897

 
36.8

Medicaid—skilled
 
6,316

 
3.0

 
5,024

 
2.6

 
18,590

 
3.0

 
13,730

 
2.4

Total
 
152,551

 
73.6

 
147,284

 
75.0

 
452,239

 
73.7

 
425,900

 
75.3

Managed Care
 
26,316

 
12.7

 
23,621

 
12.0

 
77,738

 
12.7

 
71,938

 
12.7

Private and Other
 
28,283

 
13.7

 
25,441

 
13.0

 
83,641

 
13.6

 
67,777

 
12.0

Total revenue
 
$
207,150

 
100.0
%
 
$
196,346

 
100.0
%
 
$
613,618

 
100.0
%
 
$
565,615

 
100.0
%

Discussion of Non-GAAP Financial Measures

EBITDA consists of net income, adjusted for net losses attributable to noncontrolling interest, before (a) interest expense, net, (b) provisions for income taxes, and (c) depreciation and amortization. EBITDAR consists of net income before (a) interest expense, net, (b) provisions for income taxes, (c) depreciation and amortization, and (d) facility rent-cost of services. The Company believes that the presentation of EBITDA and EBITDAR provides important supplemental information to management and investors to evaluate the Company's operating performance. The Company believes disclosure of adjusted non-GAAP net income and non-GAAP diluted earnings per share has economic substance because the excluded expenses are infrequent in nature and are variable in nature, or do not represent current 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 measure provides useful information to investors, the specific manner in which management uses this measure, and some of the limitations associated with the use of this measure, please refer to the Company's Report on Form 10-Q filed today with the SEC. The Form 10-Q is 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.