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8-K - 8-K - ENSIGN GROUP, INCq42019form8-k.htm


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The Ensign Group Reports Fourth Quarter and Fiscal Year 2019 Results

Conference Call and Webcast scheduled for tomorrow, February 6, 2020 at 10:00 am PT
SAN JUAN CAPISTRANO, California - February 5, 2020 - The Ensign Group, Inc. (Nasdaq: ENSG), the parent company of the Ensign(TM) group of companies, which provide skilled nursing, senior living services, rehabilitative care services and other healthcare services, announced its operating results for the fourth quarter and full year 2019, reporting record GAAP diluted earnings per share of $0.49 and $1.97 for the quarter and year ended December 31, 2019, respectively. Ensign also reported a record adjusted earnings per share of $0.60 for the quarter and $2.24 for the year(2).
Highlights Include:

GAAP diluted earnings per share for the quarter was $0.49, representing a 48.5%(1) increase over the prior year quarter; and spin-adjusted diluted earnings per share for the fourth quarter was $0.60(2), an increase of 39.5%(3) from prior year quarter and an increase of 33.3%(3) sequentially over the third quarter.

GAAP diluted earnings per share for the year was $1.97 and adjusted diluted earnings per share for the year was $2.24(2), an increase of 29.5%(4) over the prior year.

Consolidated GAAP revenues for the year were $2.29 billion and consolidated adjusted revenues for the year were $2.28 billion(2), an increase of 19.9%(4) over the prior year.

Total skilled services revenue was $1.9 billion for the year, an increase of 15.2% over the prior year, and was $530.2 million for the quarter, an increase of 20.0% over the prior year quarter and 9.1% sequentially over the third quarter(5).

Same store occupancy was 80.3%, an increase of 216 basis points over the prior year; and same store skilled managed care and Medicare revenue was up 8.4% and 4.9%, respectively.

Transitioning occupancy was 78.1%, an increase of 279 basis points over the prior year; and transitioning skilled managed care revenue was up 15.7%.

Same store skilled days increased by 3.0% and transitioning skilled days increased by 4.9%, both for the year.

Same store skilled days increased by 8.8% and total same store skilled days increased by 3.1% basis points, both sequentially over the third quarter;

GAAP net income was $91.7 million(1), an increase of 54.1%(1) over the prior year, and spin-adjusted net income for the year was $109.0 million(3), an increase of 40.5%(3) over the prior year.

(1) Represents GAAP continued operations which excluding operating results for the recently spun-out The Pennant Group, Inc. ("Spin-Off") in accordance with the discontinued operation guidance in GAAP
(2) See "Reconciliation of GAAP to Non-GAAP Financial Information".
(3) Unaudited pro forma Non-GAAP results include adjustments of rental income, savings of general and administrative expense and interest as if the Spin-Off has occurred at the beginning of the period reported.
(4) Unaudited pro forma Non-GAAP results include results of continuing operations for four quarters and three quarters of discontinuing operations to be comparable to 2019 Non-GAAP results.
(5) Our Transitional and Skilled Services Segment is defined and outlined in Note 7 on Form 10-K. 










Operating Results

“We are thrilled to report a record quarter as we achieved our highest adjusted earnings per share in our history,” said Ensign’s Chief Executive Officer Barry Port. He credited the local operational and clinical leadership teams and all of their field-based and Service Center partners for achieving these impressive clinical and financial results even in the midst of completing a transformative spin-off transaction and implementing a brand new reimbursement system. “We are proud that our amazing operators were able to achieve these record results in the midst of potential distractions. We also want to remind you that we can see tremendous organic growth potential in our 73 transitioning and newly acquired operations and in same store operations. We are very excited about our continued operational momentum and expect it to continue into 2020,” he added.
Port noted that much of the improvement came from strong quarter over quarter improvements in occupancy and both skilled mix days and revenue across same store, transitioning and newly acquired operations. He added, “We are excited about the positive trends we continue to see in occupancy, as this is the fourth quarter in a row where we have experienced an increase of over 150 basis points in occupancy in both same store and transitioning operations, quarter over quarter.”
Mr. Port also commented on the organization’s experience in its first quarter of operations under CMS’s Patient Driven Payment Model (“PDPM”). Complimenting CMS on the new system, he said, “We believe PDPM is an excellent long-term, patient-centered program that rewards operators that achieve high quality outcomes.” Port noted “After adjusting for the recent market basket increase, we experienced a range of rate growth from approximately 3% for our transitioning operations to approximately 6% for our same store operations, which generally serve a higher acuity patient as they mature into clinically complex operations. Our locally-driven model of improving our clinical capabilities has always been focused on increasing our acuity, which has resulted in consistent improvement in earnings, independent of the current rate environment. While we experienced a modest rate improvement in our first quarter under the new system, the lion’s share of our performance during the quarter is totally unrelated to the PDPM impact.”
Ensign also announced a 12.4% increase from its initial 2020 annual earnings guidance. “Given the strength of the quarter and our expectations for continued improvement over the next few quarters, we are raising our 2020 annual earnings guidance to $2.50 to $2.58 per diluted share and annual revenue guidance to $2.42 billion to $2.45 billion. “We are very optimistic that with the continued upside that is inherent in our portfolio and the attractive acquisitions on the horizon, that we will be able to continue to meet or exceed our historic growth rates. To underline this confidence, the midpoint of our 2020 guidance represents an increase of 30.3% over our 2019 spin adjusted results, which was $1.95(3) per diluted share when adjusting for the full-year impact of the Pennant spin-off. In addition, this guidance represents an increase of 13.4% over our adjusted diluted 2019 results of $2.24(2), which includes Pennant results for the first nine months of 2019,” Port said.
“We are very excited about our performance this year and are confident that as our local leaders continue to stay true to our operating model, our operational strength will continue into 2020 and beyond,” he added. “In the fourth quarter, we more than replaced Pennant’s historical earnings, much sooner than anticipated, and we expect that trend to accelerate into 2020. We have not even come close to reaching our full potential, and to do so it will take a relentless commitment to our culture and the repetitious adherence to sound fundamentals,” Port said.
Chief Financial Officer, Suzanne Snapper reported that the company’s liquidity remains strong with approximately $135 million of availability on its new $350 million credit facility, which also has a built-in expansion option, and 72 unlevered real estate assets that add additional liquidity. Snapper also indicated that the company maintained a lease-adjusted net-debt-to-adjusted EBITDAR ratio of 3.95x at quarter end a decrease from 4.14x(1) (when adjusting for the Spin-off), even after heavy acquisitions during the fourth quarter, which tend to temporarily raise the ratio while EBITDAR from new acquisitions catches up.
A discussion of the company's use of non-GAAP and proforma financial measures is set forth below. A reconciliation of net income to EBITDA, adjusted EBITDAR, adjusted EBITDA, as well as a reconciliation of GAAP earnings per share, net income to adjusted net income and adjusted net earnings per share, and proforma metrics 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 year ended December 31, 2019, which is expected to be filed with the SEC today and can be viewed on the company’s website at http://www.ensigngroup.net.
Quarter Growth
During the quarter, the Company paid a quarterly cash dividend of $0.05 per share of Ensign common stock. “We are pleased to announce our seventeenth consecutive annual dividend increase, which reflects our strong market position and continued commitment to return value to our shareholders,” said Chad Keetch, Ensign’s Chief Investment Officer.
Also during the quarter and since, Ensign’s affiliates acquired the following skilled nursing and healthcare campus operations:
St. Joseph’s Villa Independent Living, a 58-unit independent living operation in Salt Lake City, Utah
Treasure Hills Healthcare and Rehabilitation Center, a skilled nursing facility with 110 skilled nursing beds, located in Harlingen, Texas; 





Keller Oaks Healthcare Center, a skilled nursing facility with 146 skilled nursing beds, located in Keller, Texas;
Kirkwood Manor, a skilled nursing facility with 162 skilled nursing beds, located in New Braunfels, Texas;
Hunters Pond Rehabilitation and Healthcare, a skilled nursing facility with 128 skilled nursing beds, located in San Antonio, Texas; 
Pecan Valley Rehabilitation and Healthcare, a skilled nursing facility with 124 skilled nursing beds, located in San Antonio, Texas;
Westover Hills Rehabilitation and Healthcare, a skilled nursing facility with 124 skilled nursing beds, located in San Antonio, Texas;
Crestwood Health and Rehabilitation Center, a skilled nursing facility with 112 skilled nursing beds and an assisted living center with 36 assisted living units, located in Willis Point, Texas;
Beacon Harbor Healthcare and Rehabilitation, a skilled nursing facility with 190 skilled nursing beds, located in Rockwall, Texas;
Rowlett Health and Rehabilitation Center, a skilled nursing facility with 150 skilled nursing beds, located in Rowlett, Texas;
Pleasant Manor Healthcare and Rehabilitation, a skilled nursing facility with 126 skilled nursing beds, located in Waxahachie, Texas;
Mission Palms Post Acute, a skilled nursing facility with 160 skilled nursing beds located in Mesa, Arizona; and
The Healthcare Center at Patriot Heights, a healthcare campus with 59 skilled nursing beds and 158 independent living units located in San Antonio, Texas.  
“As we saw last quarter, the pipeline for our typical turnaround opportunities and well-priced strategic deals remains strong. We are still being very selective and are keeping plenty of dry powder on hand for what we believe will continue to be an attractive buyer’s market,” said Keetch. “We look forward to growing within our existing geographical footprint and will do so as we see significant advantages to adding strength in markets we know well, including some of our newer emerging markets as they continue to mature and prepare for growth. We remain confident that there are and will be many, many opportunities to be had at the right prices,” he added.
These additions bring Ensign's growing portfolio to 225 skilled nursing operations, 23 of which also include senior living operations across fourteen states.  Ensign now owns 92 real estate assets, 62 of which it operates.  Keetch reaffirmed that Ensign continues to actively seek transactions to acquire real estate and to lease both well-performing and struggling skilled nursing, senior living and other healthcare related businesses in new and existing markets.
Increased 2020 Guidance
Management raised guidance for 2020, with annual earnings per share guidance to $2.50 to 2.58 per diluted share and annual revenue guidance to $2.42 billion to $2.45 billion. The midpoint of this 2020 guidance represents an increase of 30.3% over 2019 spin adjusted results, which was $1.95 per diluted share when adjusting for the full-year impact of the Pennant spin-off. Management’s guidance is based on diluted weighted average common shares outstanding of approximately 57.6 million and a 25% tax rate. In addition, the guidance assumes, among other things, normalized health insurance costs, normal anticipated Medicare and Medicaid reimbursement rate increases, net of provider taxes, and acquisitions closed in the first half of 2020. It also excludes acquisition-related costs and amortization costs related to intangible assets acquired, share-based compensation and start-up losses.
Conference Call
A live webcast will be held Thursday, February 6, 2020 at 10:00 a.m. Pacific time (1:00 p.m. Eastern time) to discuss Ensign’s fourth quarter and fiscal year 2019 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, February 28, 2020.

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 and other rehabilitative and healthcare services at 225 healthcare facilities in Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, South Carolina, Texas, Utah, Washington and Wisconsin.   Ensign’s new business venture operating subsidiaries also offer several other post-acute-related services, including mobile x-ray, lab, 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 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. 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 following tables have been adjusted to reflect the operations transferred to The Pennant Group, Inc. as part of the Spin-Off as discontinued operations. Accordingly, the results are displayed using continuing and discontinued operations format. Supplemental data that outlines the impact of continuing and discontinued operations has been provided.

THE ENSIGN GROUP, INC.
CONSOLIDATED STATEMENT OF INCOME
(In thousands, except per share data)

Three Months Ended December 31,
 
Year Ended December 31,

2019
 
2018
 
2019
 
2018
Revenue from continuing operations
$
560,191

 
$
462,439

 
$
2,036,524

 
$
1,754,601

Expense from continuing operations
 
 
 
 
 
 
 
Cost of services
443,382

 
372,066

 
1,620,628

 
1,418,249

Return of unclaimed class action settlement

 

 

 
(1,664
)
Rent—cost of services
31,511

 
29,898

 
124,789

 
117,676

General and administrative expense
32,251

 
25,013

 
110,873

 
90,563

Depreciation and amortization
13,354

 
11,544

 
51,054

 
44,864

Total expenses
520,498

 
438,521

 
1,907,344

 
1,669,688

Income from operations from continuing operations
39,693

 
23,918

 
129,180

 
84,913

Other income (expense):
 
 
 
 
 
 
 
Interest expense
(4,149
)
 
(3,711
)
 
(15,662
)
 
(15,182
)
Interest income
792

 
549

 
2,649

 
2,016

Other expense, net
(3,357
)
 
(3,162
)
 
(13,013
)
 
(13,166
)
Income before provision for income taxes
36,336

 
20,756

 
116,167

 
71,747

Provision for income taxes
9,010

 
2,653

 
23,954

 
12,685

Net income from continuing operations, net of tax
27,326

 
18,103

 
92,213

 
59,062

Net income from discontinued operations, net of tax

 
8,456

 
19,473

 
33,466

Net income
27,326

 
26,559

 
111,686

 
92,528

Less:
 
 
 
 
 
 
 
Net (loss)/income attributable to noncontrolling interests
(68
)
 
16

 
523

 
(431
)
Net income attributable to discontinued noncontrolling interests

 
183

 
629

 
595

Net (loss)/income attributable to noncontrolling interests
(68
)
 
199

 
1,152

 
164

Net income attributable to The Ensign Group, Inc.
$
27,394

 
$
26,360

 
$
110,534

 
$
92,364

Amounts attributable to the The Ensign Group, Inc.
 
 
 
 
 
 
 
Income from continuing operations attributable to The Ensign Group, Inc.
27,394

 
18,087

 
91,690

 
59,493

Income from discontinued operations, net of income tax

 
8,273

 
18,844

 
32,871

Net income attributable to The Ensign Group, Inc.
$
27,394

 
$
26,360

 
$
110,534

 
$
92,364

Net income per share attributable to The Ensign Group, Inc.:
 
 
 
 
 
 
 
Basic:
 
 
 
 
 
 
 
Continuing operations
$
0.51

 
$
0.34

 
$
1.72

 
$
1.14

Discontinued operations
$

 
$
0.16

 
$
0.35

 
$
0.64

Basic income per share attributable to The Ensign Group, Inc.
$
0.51

 
$
0.50

 
$
2.07

 
$
1.78

Diluted:
 
 
 
 
 
 
 
Continuing operations
$
0.49

 
$
0.33

 
$
1.64

 
$
1.09

Discontinued operations
$

 
$
0.15

 
$
0.33

 
$
0.61

Diluted income per share attributable to The Ensign Group, Inc.
$
0.49

 
$
0.48

 
$
1.97

 
$
1.70

Weighted average common shares outstanding:
 
 
 
 
 
 
 
Basic
53,397

 
52,449

 
53,452

 
52,016

Diluted
55,760

 
54,967

 
55,981

 
54,397







THE ENSIGN GROUP, INC.
GAAP, NON-GAAP AND PRO FORMA INFORMATION
(In thousands, except per share data)
(Unaudited)

The following table sets forth GAAP, Non-GAAP and pro forma results for our revenue, net income, diluted EPS, EBITDA and EBITDAR for the periods indicated:

 
 
Three Months Ended December 31, 2019
 
 
 GAAP
 
Non-GAAP(1)
 
Pro Forma Non-GAAP Adjustments(2)
Net revenue - continuing operations
 
$
560,191

 
$
555,979

 
$
555,979

Net revenue - discontinued operations
 

 

 
 
Net revenue
 
$
560,191

 
$
555,979

 
 
 
 
 
 
 
 
 
Net income - continuing operations
 
$
27,394

 
$
33,529

 
$
33,529

Net income - discontinued operations
 

 

 
 
Net income
 
$
27,394

 
$
33,529

 
 
 
 
 
 
 
 
 
Fully diluted EPS - continuing operations
 
$
0.49

 
$
0.60

 
$
0.60

Fully diluted EPS - discontinued operations
 
$

 
$

 
 
Fully diluted EPS
 
$
0.49

 
$
0.60

 
 
 
 
 
 
 
 
 
EBITDA - continuing operations
 
$
53,115

 
$
60,430

 
$
60,430

EBITDA - discontinued operations
 

 

 
 
EBITDA
 
$
53,115

 
$
60,430

 
 
 
 
 
 
 
 
 
EBITDAR - continuing operations
 
 
 
$
91,498

 
$
91,498

EBITDAR - discontinued operations
 
 
 

 
 
EBITDAR
 
 
 
$
91,498

 
 
 
 
 
 
 
 
 
 
 
Three Months Ended December 31, 2018
 
 
 GAAP
 
Non-GAAP(1)
 
Pro Forma Non-GAAP Adjustments(2)
Net revenue - continuing operations
 
$
462,439

 
$
445,455

 
$
448,293

Net revenue - discontinued operations
 
75,336

 
75,291

 
 
Net revenue
 
$
537,775

 
$
520,746

 
 
 
 
 
 
 
 
 
Net income - continuing operations
 
$
18,087

 
$
21,254

 
$
23,569

Net income - discontinued operations
 
8,273

 
8,156

 
 
Net income
 
$
26,360

 
$
29,410

 
 
 
 
 
 
 
 
 
Fully diluted EPS - continuing operations
 
$
0.33

 
$
0.39

 
$
0.43

Fully diluted EPS - discontinued operations
 
$
0.15

 
$
0.15

 
 
Fully diluted EPS
 
$
0.48

 
$
0.54

 
 
 
 
 
 
 
 
 
EBITDA - continuing operations
 
$
35,446

 
$
42,728

 
$
45,973

EBITDA - discontinued operations
 
11,001

 
11,543

 
 
EBITDA
 
$
46,447

 
$
54,271

 
 
 





 
 
Three Months Ended September 30, 2019
 
 
 GAAP
 
Non-GAAP(1)
 
Pro Forma Non-GAAP Adjustments(2)
Net revenue - continuing operations
 
$
512,109

 
$
509,541

 
$
512,582

Net revenue - discontinued operations
 
88,398

 
88,325

 
 
Net revenue
 
$
600,507

 
$
597,866

 
 
 
 
 
 
 
 
 
Net income - continuing operations
 
$
22,148

 
$
22,447

 
$
25,487

Net income - discontinued operations
 
5,011

 
8,496

 
 
Net income
 
$
27,159

 
$
30,943

 
 
 
 
 
 
 
 
 
Fully diluted EPS - continuing operations
 
$
0.39

 
$
0.40

 
$
0.45

Fully diluted EPS - discontinued operations
 
$
0.09

 
$
0.15

 
 
Fully diluted EPS
 
$
0.48

 
$
0.55

 
 
 
 
 
 
 
 
 
EBITDA - continuing operations
 
$
43,814

 
$
46,160

 
$
50,286

EBITDA - discontinued operations
 
8,781

 
12,324

 
 
EBITDA
 
$
52,595

 
$
58,484

 
 
 
 
 
 
 
 
 
EBITDAR - continuing operations
 
 
 
$
77,740

 
$
81,866

EBITDAR - discontinued operations
 
 
 
18,173

 
 
EBITDAR
 
 
 
$
95,913

 
 

 
 
Year Ended December 31, 2019
 
 
 GAAP
 
Non-GAAP(1)
 
Pro Forma Non-GAAP Adjustments(2)
Net revenue - continuing operations
 
$
2,036,524

 
$
2,027,915

 
$
2,037,010

Net revenue - discontinued operations
 
249,039

 
248,713

 
 
Net revenue
 
$
2,285,563

 
$
2,276,628

 

 
 
 
 
 
 
 
Net income - continuing operations
 
$
91,690

 
$
99,869

 
$
108,990

Net income - discontinued operations
 
18,844

 
25,688

 
 
Net income
 
$
110,534

 
$
125,557

 

 
 
 
 
 
 
 
Fully diluted EPS - continuing operations
 
$
1.64

 
$
1.78

 
$
1.95

Fully diluted EPS - discontinued operations
 
$
0.33

 
$
0.46

 
 
Fully diluted EPS
 
$
1.97

 
$
2.24

 

 
 
 
 
 
 
 
EBITDA - continuing operations
 
$
179,711

 
$
195,645

 
$
207,805

EBITDA - discontinued operations
 
26,883

 
36,801

 
 
EBITDA
 
$
206,594

 
$
232,446

 

 
 
 
 
 
 
 
EBITDAR - continuing operations
 
 
 
$
319,513

 
$
331,674

EBITDAR - discontinued operations
 
 
 
54,084

 
 
EBITDAR
 
 
 
$
373,597

 

 





 
 
Year Ended December 31, 2018
 
 
 GAAP
 
Non-GAAP(1)
 
Pro Forma Non-GAAP Adjustments(2)
 
Pro Forma Non-GAAP Adjustments(3)
Net revenue - continuing operations
 
$
1,754,601

 
$
1,688,214

 
$
1,699,568

 
$
1,688,214

Net revenue - discontinued operations
 
286,058

 
285,838

 
 
 
210,546

Net revenue
 
$
2,040,659

 
$
1,974,052

 
 
 
$
1,898,760

 
 
 
 
 
 
 
 
 
Net income - continuing operations
 
$
59,493

 
$
68,319

 
$
77,584

 
$
68,319

Net income - discontinued operations
 
32,871

 
33,812

 
 
 
$
25,654

Net income
 
$
92,364

 
$
102,131

 
 
 
$
93,973

 
 
 
 
 
 
 
 
 
Fully diluted EPS - continuing operations
 
$
1.09

 
$
1.26

 
$
1.43

 
$
1.26

Fully diluted EPS - discontinued operations
 
$
0.61

 
$
0.62

 
 
 
0.47

Fully diluted EPS
 
$
1.70

 
$
1.88

 
 
 
$
1.73

 
 
 
 
 
 
 
 
 
EBITDA - continuing operations
 
$
130,208

 
$
147,988

 
$
160,968

 
$
147,988

EBITDA - discontinued operations
 
45,460

 
47,627

 
 
 
36,083

EBITDA
 
$
175,668

 
$
195,615

 
 
 
$
184,071

 
 
 
(1) Refer to our reconciliation of GAAP to Non-GAAP financial information.
 
 
(2) Unaudited pro forma Non-GAAP results include adjustments of rental income, savings of general and administrative and interest expense as if the Spin-Off had occurred at the beginning of the period reported.
(3) Unaudited pro forma Non-GAAP results include results of continuing operations for four quarters and three quarters of discontinued operations to be comparable to 2019 Non-GAAP results.






THE ENSIGN GROUP, INC.
CONSOLIDATED BALANCE SHEETS
(In thousands)

December 31,
 
2019

2018
Assets
 
 
 
Current assets:
 

 
Cash and cash equivalents
$
59,175


$
31,042

Accounts receivable—less allowance for doubtful accounts of $2,472 and $2,270 at December 31, 2019 and 2018, respectively
308,985


251,915

Investments—current
17,754


8,682

Prepaid income taxes
739


6,219

Prepaid expenses and other current assets
24,428


19,576

Assets held for sale - current

 
1,859

Current assets of discontinued operations

 
28,779

Total current assets
411,081


348,072

Property and equipment, net
767,565


608,416

Right-of-use assets
1,046,901

 

Insurance subsidiary deposits and investments
30,571


36,168

Escrow deposits
14,050


7,271

Deferred tax assets
4,615


11,749

Restricted and other assets
26,207


18,459

Intangible assets, net
3,382


30,922

Goodwill
54,469


49,585

Other indefinite-lived intangibles
3,068


2,466

Long-term assets of discontinued operations
$

 
$
68,850

Total assets
$
2,361,909


$
1,181,958

 



Liabilities and equity
 

 
Current liabilities:
 

 
Accounts payable
$
44,973


$
39,846

Accrued wages and related liabilities
151,009


106,870

Lease liabilities—current
44,964

 

Accrued self-insurance liabilities—current
29,252


25,446

Other accrued liabilities
70,273


56,711

Current maturities of long-term debt
2,702


10,105

Current liabilities of discontinued operations

 
30,249

Total current liabilities
343,173


269,227

Long-term debt—less current maturities
325,217


233,135

Long-term lease liabilities—less current portion
973,983

 

Accrued self-insurance liabilities—less current portion
58,114


54,605

Other long-term liabilities
5,278


7,918

Deferred gain related to sale-leaseback


11,417

Long-term liabilities of discontinued operations

 
3,316

Total equity
656,144


602,340

Total liabilities and equity
$
2,361,909


$
1,181,958











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

The following table presents selected data from our consolidated statements of cash flows for the periods presented:

Year Ended December 31,

2019

2018
Net cash provided by (used in):
 
 
 
Continuing operating activities
$
168,927

 
$
170,152

Continuing investing activities
(224,030
)
 
(141,340
)
Continuing financing activities
83,278

 
(70,345
)
Net (decrease) increase in cash from discontinued operations
(83
)
 
30,279

Net increase (decrease) in cash and cash equivalents
28,092


(11,254
)
Cash and cash equivalents beginning of period, including cash of discontinued operations
31,083


42,337

Cash and cash equivalents end of period, including cash of discontinued operations
$
59,175


$
31,083

Less cash of discontinued operations at end of period

 
41

Cash and cash equivalents at end of period
$
59,175

 
$
31,042


THE ENSIGN GROUP, INC.
RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION
(In thousands, except per share data)
(Unaudited)

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,
 
2019
 
2018
 
2019
 
2018
Net income from continuing operations
$
27,394


$
18,087

 
$
91,690


$
59,493

Net income from discontinued operations, net of tax


8,273

 
18,844


32,871

Net income attributable to The Ensign Group, Inc.
$
27,394

 
$
26,360


$
110,534


$
92,364

 







Non-GAAP adjustments







Results related to operations in the start-up phase(a)

 
449

 

 
3,682

Return of unclaimed class action settlement

 

 

 
(1,664
)
Share-based compensation expense(b)
3,107

 
2,211

 
11,322

 
8,367

Results related to closed operations and operations not at full capacity(c)
1,311

 
222

 
3,505

 
933

Acquisition related costs(d)
132

 
10

 
277

 
322

Depreciation and amortization - patient base(e)
260

 
79

 
521

 
154

General and administrative - Spin-Off transaction costs(f)
464

 

 
464

 

COS - Impairment charges to fixed assets, net of gain on sale(g)
1,732

 
4,632

 
329

 
4,632

COS - business interruption gains(h)

 

 

 
(675
)
COS - impairment of goodwill and intangibles(i)
941

 

 
941

 
3,177

Interest expense - write off of deferred financing fees(j)
329

 

 
329

 

Provision for income taxes on Non-GAAP adjustments(k)
(2,141
)
 
(4,436
)
 
(9,509
)
 
(10,102
)
Non-GAAP income from continuing operations
$
33,529

 
$
21,254

 
$
99,869

 
$
68,319

Non-GAAP income from discontinued operations(l)

 
8,156

 
25,688

 
33,812

Non-GAAP net income
$
33,529


$
29,410


$
125,557


$
102,131

 
 
 
 

 
 
 





Average number of shares outstanding
55,760

 
54,967

 
55,981

 
54,397

 
 
 
 
 
 
 
 
Diluted Earnings Per Share As Reported
 
 
 

 
 
 
Continuing operations
$
0.49

 
$
0.33

 
$
1.64

 
$
1.09

Discontinued operations
$

 
$
0.15

 
$
0.33

 
$
0.61

Diluted income per share attributable to The Ensign Group, Inc.
$
0.49

 
$
0.48


$
1.97

 
$
1.70

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Adjusted Diluted Earnings Per Share
 
 
 
 
 
 
 
Continuing operations
$
0.60

 
$
0.39

 
$
1.78

 
$
1.26

Discontinued operations
$

 
$
0.15

 
$
0.46

 
$
0.62

Diluted income per share attributable to The Ensign Group, Inc.
$
0.60

 
$
0.54


$
2.24


$
1.88

 
 
 
 
 
 
 
 
Footnotes:







(a) Represents operating results for start-up operations.
 
Three Months Ended
December 31,

Year Ended December 31,
 
2019
 
2018
 
2019
 
2018
Revenue
$

 
$
(16,984
)
 
$

 
$
(66,386
)
Cost of services

 
13,581

 

 
54,758

Rent

 
3,619

 

 
14,347

Depreciation and amortization

 
233

 

 
963

Total Non-GAAP adjustment
$

 
$
449


$


$
3,682

 
 
 
 
 
 
 
 
(b) Represents share-based compensation expense incurred.
 
Three Months Ended December 31,

Year Ended December 31,
 
2019
 
2018
 
2019
 
2018
Cost of services
$
2,001

 
$
1,379

 
$
7,036

 
$
5,183

General and administrative
1,106

 
832

 
4,286

 
3,184

Total Non-GAAP adjustment
$
3,107

 
$
2,211


$
11,322


$
8,367













(c) Represents results at closed operations and operations not at full capacity
 
Three Months Ended December 31,

Year Ended December 31,
 
2019
 
2018
 
2019
 
2018
Revenue
$
(4,212
)
 
$

 
$
(8,609
)
 
$

Cost of services
4,708

 
137

 
10,289

 
601

Rent
443

 
76

 
921

 
301

Depreciation and amortization
372

 
9

 
904

 
31

Total Non-GAAP adjustment
$
1,311

 
$
222


$
3,505


$
933

 
 
 
 
 
 
 
 
(d) Represents costs incurred to acquire an operation which are not capitalizable.
(e) Included in depreciation and amortization are expenses related to patient base intangible assets at newly acquired skilled nursing and senior living facilities.
(f) Included in general and administrative expense are costs incurred in connection with the completed Spin-Off of our home health and hospice operations and substantially all of our senior living operations to a newly formed publicly traded company subsequent to the Spin-Off date. Expenses incurred prior to Spin-Off date are included in discontinued operations as an adjustment.
(g) Impairment charges to fixed assets includes impairment charges of $1.7 million at one of our skilled nursing operations during the three months ended December 31, 2019. Additionally, included in the year ended December 31, 2019, impairment charges of $1.5 million at two of our senior living operations and at the skilled nursing operation mentioned, offset by the gain recognized for the sale of real estate of $2.9 million.





(h) Business interruption recoveries related to insurance claims of the California fires that occurred in the fourth quarter of 2017.
(i) Impairment charges to goodwill and intangible assets at our other ancillary operations and a skilled nursing operation.
(j) Represents the write off of deferred financing fees associated with the amendment of the credit facility.
(k) Represents an adjustment to the provision for income tax to our historical year to date effective tax rate of 25.0% for the three months and years ended December 31, 2019 and 2018.
(l) Represents results of the home health, hospice and senior living operations we transferred to the Pennant Group, Inc. as a result of the Spin-Off.
 
Three Months Ended December 31,
 
Year Ended December 31,
 
2019
 
2018
 
2019
 
2018
Revenue
$

 
$
75,291

 
$
248,713

 
$
285,838

Cost of services

 
(55,314
)
 
(185,963
)
 
(208,585
)
General and administrative expenses

 
(2,819
)
 
(8,037
)
 
(8,225
)
Rent

 
(5,432
)
 
(17,283
)
 
(20,805
)
Depreciation and amortization

 
(643
)
 
(2,367
)
 
(2,392
)
Interest income, net

 
36

 
26

 
47

Provision for income taxes

 
(2,780
)
 
(8,772
)
 
(11,471
)
Non-controlling interest

 
(183
)
 
(629
)
 
(595
)
Non-GAAP net income from discontinued operations
$

 
$
8,156

 
$
25,688

 
$
33,812







THE ENSIGN GROUP, INC.
RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION
(In thousands)
(Unaudited)

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,
 
 
2019
 
2018
 
2019
 
2018
Consolidated Statements of Income Data:
 
 
 
 
 
 
 
 
Net income attributable to The Ensign Group, Inc.
 
$
27,326

 
$
26,559

 
$
111,686

 
$
92,528

Less: net (loss)/income attributable to noncontrolling interests in continuing operations
 
(68
)
 
16

 
523

 
(431
)
Less: net income from discontinued operations, net of tax
 

 
8,456

 
19,473

 
33,466

Add: Interest expense, net
 
3,357

 
3,162

 
13,013

 
13,166

 Provision for income taxes
 
9,010

 
2,653

 
23,954

 
12,685

 Depreciation and amortization
 
13,354

 
11,544

 
51,054

 
44,864

EBITDA from continuing operations
 
53,115

 
35,446

 
179,711

 
130,208

EBITDA from discontinued operations(g)
 

 
11,001

 
26,883

 
45,460

EBITDA
 
$
53,115

 
$
46,447

 
$
206,594

 
$
175,668

Adjustments to EBITDA:
 
 
 
 
 
 
 
 
Earnings related to operations in the start-up phase (a)
 

 
(3,403
)
 

 
(11,628
)
Return of unclaimed class action settlement
 

 

 

 
(1,664
)
Share-based compensation expense
 
3,107

 
2,211

 
11,322

 
8,367

Results related to closed operations and operations not at full capacity(b)
 
496

 
137

 
1,680

 
601

Acquisition related costs(c)
 
132

 
10

 
277

 
322

Spin-Off transaction costs(d)
 
464

 

 
464

 

Impairment charges to fixed assets, net of gain on sale(e)
 
1,732

 
4,632

 
329

 
4,632

Business interruption recoveries related to Hurricane Harvey and California fires
 

 

 

 
(675
)
Impairment of goodwill and intangible assets(f)
 
941

 

 
941

 
3,177

Rent related to items above
 
443

 
3,695

 
921

 
14,648

Adjusted EBITDA from continuing operations
 
60,430

 
42,728

 
195,645

 
147,988

Adjusted EBITDA from discontinued operations(g)
 

 
11,543

 
36,801

 
47,627

Adjusted EBITDA
 
$
60,430

 
$
54,271

 
$
232,446

 
$
195,615

Rent—cost of services
 
31,511

 
29,898

 
124,789

 
117,676

Less: rent related to items above
 
(443
)
 
(3,695
)
 
(921
)
 
(14,648
)
Adjusted rent - cost of services
 
31,068

 
26,203

 
123,868

 
103,028

Adjusted rent included in discontinued operations
 
$

 
$
5,432

 
$
17,283

 
$
20,805

Adjusted EBITDAR from continuing operations
 
$
91,498

 
 
 
$
356,314

 
 
Adjusted EBITDAR
 
$
91,498

 
 
 
$
373,597

 
 
 
 
 
 
 
 
 
 
 
(a)
Represents results related to facilities currently in the start-up phase after construction was completed. This amount excludes rent, depreciation and interest expense.
(b)
Results at closed operations and operations not at full capacity during the periods presented.
(c)
Costs incurred to acquire operations which are not capitalizable.
(d)
Costs incurred in connection with the completed Spin-Off transaction of our home health and hospice operations and substantially all of our senior living operations to a newly formed publicly traded company. Transaction costs incurred prior to Spin-Off date are included in discontinued operations as an adjustment.
(e)
Impairment charges to fixed assets includes impairment charges of $1.7 million at one of our skilled nursing operations during the three months ended December 31, 2019. Included in the year ended December 31, 2019, impairment charges of $1.5 million at two of our senior living operations and at the skilled nursing operation mentioned, offset by the gain recognized for the sale of real estate of $2.9 million.
(f)
Impairment charges to goodwill and intangible assets at our other ancillary operations and a skilled nursing operation.





(g)
All adjustments included in the table below are presented within net income from discontinued operations, net of tax within the consolidated statements of income for the periods presented.
    
 
Three Months Ended December 31,
 
Year Ended December 31,
 
2019
2018
 
2019
2018
Consolidated Statements of Income Data:
 
 
 
 
 
Net income from discontinued operations, net of tax
$

$
8,456

 
$
19,473

$
33,466

Less: net income attributable to noncontrolling interests in discontinued operations

183

 
629

595

Add: Interest income, net

$
(37
)
 
$
(26
)
$
(47
)
Provision for income taxes

2,110

 
5,663

10,156

Depreciation and amortization

655

 
2,402

2,480

EBITDA from discontinued operations
$

$
11,001

 
$
26,883

$
45,460

 
 
 
 
 
 
Adjustments to EBITDA from discontinued operations:
 
 
 
 
 
Earnings related to operations in the start-up phase

35

 
377

128

Share-based compensation expense

486

 
1,018

1,970

Spin-off transaction costs

13

 
7,909


Acquisition related costs


 
603

39

Rent related to items above

8

 
11

30

Adjusted EBITDA from discontinued operations
$

$
11,543

 
$
36,801

$
47,627


 
THE ENSIGN GROUP, INC.
 
 
SELECT PERFORMANCE INDICATORS
 
 
(Unaudited)
 

The following tables summarize our selected performance indicators for our transitional and skilled services segment along with other statistics, for each of the dates or periods indicated:
 
Three Months Ended December 31,
 
 
 
 
 
2019
 
2018
 
Change
 
% Change
 
 
 
 
 
 
 
 
 
(Dollars in thousands)
 
 
 
 
Total Facility Results:
 
 
 
 
 
 
 
Transitional and skilled revenue
$
530,171

 
$
441,714

 
$
88,457

 
20.0
%
Number of facilities at period end
190

 
168

 
22

 
13.1
%
Number of campuses at period end*
23

 
19

 
4

 
21.1
%
Actual patient days
1,591,163

 
1,393,783

 
197,380

 
14.2
%
Occupancy percentage — Operational beds
79.1
%
 
77.9
%
 
 
 
1.2
%
Skilled mix by nursing days
28.7
%
 
28.6
%
 
 
 
0.1
%
Skilled mix by nursing revenue
49.2
%
 
48.1
%
 
 
 
1.1
%





 
Three Months Ended December 31,
 
 
 
 
 
2019
 
2018
 
Change
 
% Change
 
 
 
 
 
 
 
 
 
(Dollars in thousands)
 
 
 
 
Same Facility Results(1):
 
 
 
 
 
 
 
Transitional and skilled revenue
$
372,507

 
$
339,210

 
$
33,297

 
9.8
%
Number of facilities at period end
131

 
131

 

 
%
Number of campuses at period end*
9

 
9

 

 
%
Actual patient days
1,065,825

 
1,032,926

 
32,899

 
3.2
%
Occupancy percentage — Operational beds
80.6
%
 
78.7
%
 
 
 
1.9
%
Skilled mix by nursing days
31.2
%
 
30.4
%
 
 
 
0.8
%
Skilled mix by nursing revenue
52.0
%
 
49.9
%
 
 
 
2.1
%
 
Three Months Ended December 31,
 
 
 
 
 
2019
 
2018
 
Change
 
% Change
 
 
 
 
 
 
 
 
 
(Dollars in thousands)
 
 
 
 
Transitioning Facility Results(2):
 
 
 
 
 
 
 
Transitional and skilled revenue
$
94,778

 
$
86,516

 
$
8,262

 
9.5
%
Number of facilities at period end
33

 
33

 

 

Number of campuses at period end*
7

 
7

 

 

Actual patient days
313,281

 
307,367

 
5,914

 
1.9
%
Occupancy percentage — Operational beds
77.7
%
 
76.2
%
 
 
 
1.5
%
Skilled mix by nursing days
25.4
%
 
24.4
%
 
 
 
1.0
%
Skilled mix by nursing revenue
45.5
%
 
43.8
%
 
 
 
1.7
%
 
Three Months Ended December 31,
 
 
 
 
 
2019
 
2018
 
Change
 
% Change
 
 
 
 
 
 
 
 
 
(Dollars in thousands)
 
 
 
 
Recently Acquired Facility Results(3):
 
 
 
 
 
 
 
Transitional and skilled revenue
$
62,010

 
$
13,017

 
$
48,993

 
NM
Number of facilities at period end
26

 
4

 
22

 
NM
Number of campuses at period end*
7

 
3

 
4

 
NM
Actual patient days
209,255

 
43,387

 
165,868

 
NM
Occupancy percentage — Operational beds
74.2
%
 
72.4
%
 
 
 
NM
Skilled mix by nursing days
20.9
%
 
19.8
%
 
 

 
NM
Skilled mix by nursing revenue
38.1
%
 
32.2
%
 
 

 
NM
 
Three Months Ended December 31,
 
 
 
 
 
2019
 
2018
 
Change
 
% Change
 
 
 
 
 
 
 
 
 
(Dollars in thousands)
 
 
 
 
Facility Closed Results(4):
 
 
 
 
 
 
 
Transitional and skilled revenue
$
876

 
$
2,971

 
$
(2,095
)
 
NM
Actual patient days
2,802

 
10,103

 
(7,301
)
 
NM
Occupancy percentage — Operational beds
60.7
%
 
73.7
%
 
 
 
NM
Skilled mix by nursing days
13.7
%
 
15.1
%
 
 

 
NM
Skilled mix by nursing revenue
27.8
%
 
29.9
%
 
 

 
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 reportable segment.
(1)
Same Facility results represent all facilities purchased prior to January 1, 2016.
(2)
Transitioning Facility results represent all facilities purchased from January 1, 2016 to December 31, 2017.
(3)
Recently Acquired Facility (Acquisitions) results represent all facilities purchased on or subsequent to January 1, 2018.
(4)
Facility Closed results represents closed operations during the three months ended December 31, 2019, which were excluded from Same Facilities results for the three months ended December 31, 2019 and 2018 for comparison purposes.






 
Year Ended December 31,
 
 
 
 
 
2019
 
2018
 
Change
 
% Change
 
 
 
 
 
 
 
 
 
(Dollars in thousands)
 
 
 
 
Total Facility Results:
 
 
 
 
 
 
 
Transitional and skilled revenue
$
1,934,640

 
$
1,679,012

 
$
255,628

 
15.2
 %
Number of facilities at period end
190

 
168

 
22

 
13.1
 %
Number of campuses at period end*
23

 
19

 
4

 
21.1
 %
Actual patient days
5,987,027

 
5,405,952

 
581,075

 
10.7
 %
Occupancy percentage — Operational beds
79.2
%
 
77.4
%
 
 
 
1.8
 %
Skilled mix by nursing days
29.0
%
 
29.5
%
 
 
 
(0.5
)%
Skilled mix by nursing revenue
48.8
%
 
49.6
%
 
 
 
(0.8
)%
 
Year Ended December 31,
 
 
 
 
 
2019
 
2018
 
Change
 
% Change
 
 
 
 
 
 
 
 
 
(Dollars in thousands)
 
 
 
 
Same Facility Results(1):
 
 
 
 
 
 
 
Transitional and skilled revenue
$
1,410,718

 
$
1,307,882

 
$
102,836

 
7.9
 %
Number of facilities at period end
131

 
131

 

 
 %
Number of campuses at period end*
9

 
9

 

 
 %
Actual patient days
4,199,374

 
4,070,122

 
129,252

 
3.2
 %
Occupancy percentage — Operational beds
80.3
%
 
78.2
%
 
 
 
2.1
 %
Skilled mix by nursing days
31.1
%
 
31.2
%
 
 
 
(0.1
)%
Skilled mix by nursing revenue
51.2
%
 
51.1
%
 
 
 
0.1
 %
 
Year Ended December 31,
 
 
 
 
 
2019
 
2018
 
Change
 
% Change
 
 
 
 
 
 
 
 
 
(Dollars in thousands)
 
 
 
 
Transitioning Facility Results(2):
 
 
 
 
 
 
 
Transitional and skilled revenue
$
364,337

 
$
330,795

 
$
33,542

 
10.1
 %
Number of facilities at period end
33

 
33

 

 

Number of campuses at period end*
7

 
7

 

 

Actual patient days
1,247,573

 
1,201,138

 
46,435

 
3.9
 %
Occupancy percentage — Operational beds
78.1
%
 
75.3
%
 
 
 
2.8
 %
Skilled mix by nursing days
25.5
%
 
25.2
%
 
 
 
0.3
 %
Skilled mix by nursing revenue
44.9
%
 
45.2
%
 
 
 
(0.3
)%
 
Year Ended December 31,
 
 
 
 
 
2019
 
2018
 
Change
 
% Change
 
 
 
 
 
 
 
 
 
(Dollars in thousands)
 
 
 
 
Recently Acquired Facility Results(3):
 
 
 
 
 
 
 
Transitional and skilled revenue
$
149,995

 
$
28,580

 
$
121,415

 
NM
Number of facilities at period end
26

 
4

 
22

 
NM
Number of campuses at period end*
7

 
3

 
4

 
NM
Actual patient days
510,541

 
95,034

 
415,507

 
NM
Occupancy percentage — Operational beds
74.0
%
 
73.9
%
 
 
 
NM
Skilled mix by nursing days
20.9
%
 
20.5
%
 
 

 
NM
Skilled mix by nursing revenue
36.4
%
 
33.4
%
 
 

 
NM






 
Year Ended December 31,
 
 
 
 
 
2019
 
2018
 
Change
 
% Change
 
 
 
 
 
 
 
 
 
(Dollars in thousands)
 
 
 
 
Facility Closed Results(4):
 
 
 
 
 
 
 
Transitional and skilled revenue
$
9,590

 
$
11,755

 
$
(2,165
)
 
NM
Actual patient days
29,539

 
39,658

 
(10,119
)
 
NM
Occupancy percentage — Operational beds
65.2
%
 
72.9
%
 
 
 
NM
Skilled mix by nursing days
17.0
%
 
16.1
%
 
 

 
NM
Skilled mix by nursing revenue
34.4
%
 
33.4
%
 
 

 
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 reportable segment.
(1)
Same Facility results represent all facilities purchased prior to January 1, 2016.
(2)
Transitioning Facility results represent all facilities purchased from January 1, 2016 to December 31, 2017.
(3)
Recently Acquired Facility (Acquisitions) results represent all facilities purchased on or subsequent to January 1, 2018.
(4)
Facility Closed results represents closed operations during the year ended December 31, 2019, which were excluded from Same Facilities results for the year ended December 31, 2019 and 2018 for comparison purposes.

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 skilled nursing average daily revenue rates by payor source, excluding services that are not covered by the daily rate:
 
Three Months Ended December 31,
 
Same Facility
 
Transitioning
 
Acquisitions
 
Total
 
2019
 
2018
 
2019
 
2018
 
2019
 
2018
 
2019
 
2018
Skilled Nursing Average Daily Revenue Rates:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicare
$
669.99

 
$
611.29

 
$
566.96

 
$
529.04

 
$
615.07

 
$
520.12

 
$
642.11

 
$
590.27

Managed care
486.07

 
461.46

 
429.96

 
415.66

 
439.18

 
424.28

 
470.83

 
450.91

Other skilled
511.16

 
485.01

 
495.11

 
581.69

 
323.27

 
249.05

 
501.46

 
486.26

Total skilled revenue
563.23

 
526.39

 
502.37

 
480.00

 
518.43

 
458.20

 
548.33

 
516.35

Medicaid
237.78

 
232.72

 
208.42

 
200.45

 
224.69

 
240.55

 
230.12

 
225.68

Private and other payors
226.89

 
228.35

 
195.88

 
194.95

 
211.72

 
237.21

 
216.97

 
219.89

Total skilled nursing revenue
$
338.08

 
$
321.86

 
$
281.18

 
$
268.05

 
$
284.27

 
$
283.32

 
$
319.72

 
$
308.52

 
Year Ended December 31,
 
Same Facility
 
Transitioning
 
Acquisitions
 
Total
 
2019
 
2018
 
2019
 
2018
 
2019
 
2018
 
2019
 
2018
Skilled Nursing Average Daily Revenue Rates:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicare
$
628.20

 
$
600.65

 
$
542.67

 
$
520.85

 
$
594.74

 
$
528.11

 
$
607.24

 
$
580.96

Managed care
470.85

 
457.09

 
420.48

 
410.87

 
432.41

 
423.94

 
458.26

 
447.34

Other skilled
496.37

 
475.12

 
491.15

 
522.24

 
327.22

 
246.85

 
490.93

 
475.59

Total skilled revenue
537.00

 
517.86

 
484.13

 
473.60

 
501.13

 
460.52

 
525.41

 
509.10

Medicaid
232.41

 
225.48

 
203.99

 
193.18

 
231.46

 
235.70

 
226.43

 
218.30

Private and other payors
231.87

 
225.31

 
202.19

 
198.33

 
229.17

 
237.61

 
223.97

 
218.42

Total skilled nursing revenue
$
327.48

 
$
317.01

 
$
275.25

 
$
264.81

 
$
287.52

 
$
282.07

 
$
313.11

 
$
304.57











The following tables set forth our percentage of skilled nursing patient revenue and days by payor source for the three months and years ended December 31, 2019 and 2018:
 
Three Months Ended December 31,
 
Same Facility
 
Transitioning
 
Acquisitions
 
Total
 
2019
 
2018
 
2019
 
2018
 
2019
 
2018
 
2019
 
2018
Percentage of Skilled Nursing Revenue:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicare
24.2
%
 
23.2
%
 
26.0
%
 
25.2
%
 
22.8
%
 
17.4
%
 
24.3
%
 
23.4
%
Managed care
17.9

 
17.0

 
17.4

 
17.0

 
13.2

 
13.6

 
17.3

 
16.9

Other skilled
9.9

 
9.7

 
2.1

 
1.6

 
2.1

 
1.2

 
7.6

 
7.8

Skilled mix
52.0

 
49.9

 
45.5

 
43.8

 
38.1

 
32.2

 
49.2

 
48.1

Private and other payors
7.4

 
7.5

 
11.1

 
11.0

 
9.8

 
13.1

 
8.4

 
8.4

Medicaid
40.6

 
42.6

 
43.4

 
45.2

 
52.1

 
54.7

 
42.4

 
43.5

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
 
2019
 
2018
 
2019
 
2018
 
2019
 
2018
 
2019
 
2018
Percentage of Skilled Nursing Days:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicare
12.2
%
 
12.2
%
 
12.9
%
 
12.8
%
 
10.6
%
 
9.5
%
 
12.1
%
 
12.2
%
Managed care
12.5

 
11.8

 
11.4

 
10.9

 
8.6

 
9.0

 
11.7

 
11.5

Other skilled
6.5

 
6.4

 
1.1

 
0.7

 
1.7

 
1.3

 
4.9

 
4.9

Skilled mix
31.2

 
30.4

 
25.4

 
24.4

 
20.9

 
19.8

 
28.7

 
28.6

Private and other payors
11.1

 
11.0

 
16.1

 
15.2

 
13.2

 
16.0

 
12.3

 
12.2

Medicaid
57.7

 
58.6

 
58.5

 
60.4

 
65.9

 
64.2

 
59.0

 
59.2

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
 
2019
 
2018
 
2019
 
2018
 
2019
 
2018
 
2019
 
2018
Percentage of Skilled Nursing Revenue:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicare
23.2
%
 
23.6
%
 
25.1
%
 
26.8
%
 
20.6
%
 
17.9
%
 
23.4
%
 
24.2
%
Managed care
18.4

 
18.1

 
18.1

 
16.9

 
13.8

 
14.4

 
17.9

 
17.7

Other skilled
9.6

 
9.4

 
1.7

 
1.5

 
2.0

 
1.1

 
7.5

 
7.7

Skilled mix
51.2

 
51.1

 
44.9

 
45.2

 
36.4

 
33.4

 
48.8

 
49.6

Private and other payors
7.5

 
7.6

 
11.3

 
11.5

 
11.0

 
14.1

 
8.5

 
8.5

Medicaid
41.3

 
41.3

 
43.8

 
43.3

 
52.6

 
52.5

 
42.7

 
41.9

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
 
2019
 
2018
 
2019
 
2018
 
2019
 
2018
 
2019
 
2018
Percentage of Skilled Nursing Days:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medicare
12.1
%
 
12.4
%
 
12.7
%
 
13.6
%
 
10.0
%
 
9.5
%
 
12.0
%
 
12.6
%
Managed care
12.7

 
12.5

 
11.8

 
10.8

 
9.2

 
9.6

 
12.2

 
12.0

Other skilled
6.3

 
6.3

 
1.0

 
0.8

 
1.7

 
1.4

 
4.8

 
4.9

Skilled mix
31.1

 
31.2

 
25.5

 
25.2

 
20.9

 
20.5

 
29.0

 
29.5

Private and other payors
10.8

 
11.0

 
15.6

 
15.6

 
13.9

 
16.8

 
12.1

 
12.2

Medicaid
58.1

 
57.8

 
58.9

 
59.2

 
65.2

 
62.7

 
58.9

 
58.3

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 December 31,
 
Year Ended December 31,
 
 
2019
 
2018
 
2019

2018
 
 
$
 
%
 
$
 
%
 
$
 
%
 
$
 
%
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
(Dollars in thousands)
 
(Dollars in thousands)
Revenue:
 
 
 
 
 
 
 
 
 
 

 

 

 
Medicaid
 
$
216,729

 
38.7
%
 
$
188,058

 
40.7
%
 
$
802,952

 
39.4
%
 
$
691,276

 
39.4
%
Medicare
 
144,213

 
25.7

 
112,884

 
24.4

 
499,353

 
24.5

 
436,580

 
24.9

Medicaid-skilled
 
36,567

 
6.5

 
31,662

 
6.9

 
132,889

 
6.5

 
117,686

 
6.7

Total Medicaid and Medicare
 
397,509

 
70.9

 
332,604

 
72.0

 
1,435,194

 
70.4

 
1,245,542

 
71.0

Managed Care
 
92,849

 
16.6

 
76,002

 
16.4

 
351,054

 
17.2

 
301,866

 
17.2

Private and Other(1)
 
69,833

 
12.5

 
53,833

 
11.6

 
250,276

 
12.4

 
207,193

 
11.8

Revenue
 
$
560,191

 
100.0
%
 
$
462,439

 
100.0
%
 
$
2,036,524

 
100.0
%
 
$
1,754,601

 
100.0
%
(1) Private and other payors also includes revenue from all payors generated in our other ancillary services for the three months and years ended December 31, 2019 and 2018. During the fiscal year 2019, private and other payors includes $5,812 of rental income.






THE ENSIGN GROUP, INC.
SUPPLEMENTAL RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION BY QUARTER
(In thousands, except per share data)
(Unaudited)

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
 
3/31/2019
 
6/30/2019
 
9/30/2019
 
12/31/2019
Net income from continuing operations
$
21,480

 
$
20,668

 
$
22,148

 
$
27,394

Net income from discontinued operations, net of tax
5,892

 
7,941

 
5,011

 

Net income attributable to The Ensign Group, Inc.
$
27,372

 
$
28,609

 
$
27,159

 
$
27,394

 
 
 
 
 
 
 
 
Non-GAAP adjustments
 
 
 
 
 
 
 
Share-based compensation expense(a)
2,456

 
2,930

 
2,829

 
3,107

Results related to closed operations and operations not at full capacity(b)
349

 
626

 
1,219

 
1,311

Acquisition related costs(c)
26

 
49

 
69

 
132

Depreciation and amortization - patient base(d)
70

 
87

 
104

 
260

General and administrative - Spin-Off transaction costs(e)

 

 

 
464

COS - (gain on sale)/impairment charges to fixed assets(f)

 

 
(1,402
)
 
1,732

COS - impairment of goodwill and intangibles(g)

 

 

 
941

Interest expense - write off of deferred financing fee(h)

 

 

 
329

Provision for income taxes on Non-GAAP adjustments(i)
(2,161
)
 
(2,687
)
 
(2,520
)
 
(2,141
)
Non-GAAP income from continuing operations
$
22,220

 
$
21,673

 
$
22,447

 
$
33,529

Non-GAAP income from discontinued operations
8,583

 
8,609

 
8,496

 

Non-GAAP net income
$
30,803

 
$
30,282

 
$
30,943

 
$
33,529

 
 
 
 
 
 
 
 
Average number of shares outstanding
55,698

 
56,078

 
56,364

 
55,760

 
 
 
 
 
 
 
 
Diluted Earnings Per Share As Reported
 
 
 
 
 
 
 
Continuing operations
$
0.39

 
$
0.37

 
$
0.39

 
$
0.49

Discontinued operations
$
0.10

 
$
0.14

 
$
0.09

 
$

Diluted income per share attributable to The Ensign Group, Inc.
$
0.49

 
$
0.51

 
$
0.48

 
$
0.49

 
 
 
 
 
 
 
 
Adjusted Diluted Earnings Per Share
 
 
 
 
 
 
 
Continuing operations
$
0.40

 
$
0.39

 
$
0.40

 
$
0.60

Discontinued operations
$
0.15

 
$
0.15

 
$
0.15

 
$

Diluted income per share attributable to The Ensign Group, Inc.
$
0.55

 
$
0.54

 
$
0.55

 
$
0.60

 
 
 
 
 
 
 
 
Footnotes:
 
 
 
 
 
 
 
(a) Represents share-based compensation expense incurred.
 
Three Months Ended
 
3/31/2019
 
6/30/2019
 
9/30/2019
 
12/31/2019
Cost of services
$
1,516

 
$
1,779

 
$
1,740

 
$
2,001

General and administrative
940

 
1,151

 
1,089

 
1,106

Total Non-GAAP adjustment
$
2,456

 
$
2,930

 
$
2,829

 
$
3,107

 
 
 
 
 
 
 
 
(b) Represents results at closed operations and operations not at full capacity
 
Three Months Ended





 
3/31/2019
 
6/30/2019
 
9/30/2019
 
12/31/2019
Revenue
$

 
$
(1,830
)
 
$
(2,567
)
 
$
(4,212
)
Cost of services
264

 
2,195

 
3,122

 
4,708

Rent
76

 
107

 
295

 
443

Depreciation and amortization
9

 
154

 
369

 
372

Total Non-GAAP adjustment
$
349

 
$
626

 
$
1,219

 
$
1,311

 
 
 
 
 
 
 
 
(c) Represents costs incurred to acquire an operation which are not capitalizable.
(d) Included in depreciation and amortization are expenses related to patient base intangible assets at newly acquired skilled nursing and senior living facilities.
(e) Included in general and administrative expense are costs incurred in connection with the completed Spin-Off of our home health and hospice operations and substantially all of our senior living operations to a newly formed publicly traded company subsequent to the Spin-Off date.
(f) Impairment charges to fixed assets includes impairment charges of $1.7 million at a leased skilled nursing operations during the three months ended December 31, 2019. Included in the three months ended September 30, 2019, impairment charges of $1.5 million at two of our senior living operations, offset by the gain recognized for the sale of real estate of $2.9 million.
(g) Impairment charges to goodwill and intangible assets at our other ancillary operations and a skilled nursing operation.
(h) Represents the write off of deferred financing fees associated with the amendment of the credit facility.
(i) Represents an adjustment to the provision for income tax to our historical year to date effective tax rate of 25.0% for the periods presented.
(j) Represents results of the home health, hospice and senior living operations we transferred to the Pennant Group, Inc. as a result of the Spin-Off.
 
Three Months Ended
 
3/31/2019
 
6/30/2019
 
9/30/2019
 
12/31/2019
Revenue
$
77,730

 
$
82,658

 
$
88,325

 
$

Cost of services
(57,448
)
 
(61,534
)
 
(66,981
)
 

General and administrative expenses
(2,393
)
 
(2,752
)
 
(2,892
)
 

Rent
(5,598
)
 
(5,836
)
 
(5,849
)
 

Depreciation and amortization
(658
)
 
(800
)
 
(909
)
 

Interest income, net
11

 
9

 
6

 

Provision for income taxes
(2,911
)
 
(2,936
)
 
(2,925
)
 

Non-controlling interest
(150
)
 
(200
)
 
(279
)
 

Non-GAAP net income from discontinued operations
$
8,583

 
$
8,609

 
$
8,496

 
$







THE ENSIGN GROUP, INC.
SUPPLEMENTAL RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION BY QUARTER
(In thousands)
(Unaudited)

The table below reconciles net income to EBITDA, Adjusted EBITDA and Adjusted EBITDAR for the periods presented:
 
 
Three Months Ended
 
 
3/31/2019
 
6/30/2019
 
9/30/2019
 
12/31/2019
Consolidated Statements of Income Data:
 
 
 
 
 
 
 
 
Net income attributable to The Ensign Group, Inc.
 
$
27,607

 
$
28,925

 
$
27,828

 
$
27,326

Less: net income/(loss) attributable to noncontrolling interests in continuing operations
 
85

 
116

 
390

 
(68
)
Less: net income from discontinued operations, net of tax
 
6,042

 
8,141

 
5,290

 

Add: Interest expense, net
 
3,109

 
3,379

 
3,168

 
3,357

Provision for income taxes
 
5,275

 
4,576

 
5,093

 
9,010

Depreciation and amortization
 
11,929

 
12,366

 
13,405

 
13,354

EBITDA from continuing operations
 
41,793

 
40,989

 
43,814

 
53,115

EBITDA from discontinued operations
 
8,374

 
9,725

 
8,781

 

EBITDA
 
$
50,167

 
$
50,714

 
$
52,595

 
$
53,115

Adjustments to EBITDA:
 
 
 
 
 
 
 
 
Share-based compensation expense
 
2,456

 
2,930

 
2,829

 
3,107

Results related to closed operations and operations not at full capacity(a)
 
264

 
365

 
555

 
496

Acquisition related costs(b)
 
26

 
49

 
69

 
132

Spin-Off transaction costs(c)
 

 

 

 
464

(Gain on sale)/impairment charges to fixed assets(d)
 

 

 
(1,402
)
 
1,732

Impairment of goodwill and intangible assets(e)
 

 

 

 
941

Rent related to items above
 
76

 
107

 
295

 
443

Adjusted EBITDA from continuing operations
 
44,615

 
44,440

 
46,160

 
60,430

Adjusted EBITDA from discontinued operations(f)
 
12,141

 
12,336

 
12,324

 

Adjusted EBITDA
 
$
56,756

 
$
56,776

 
$
58,484

 
$
60,430

Rent—cost of services
 
30,181

 
31,222

 
31,875

 
31,511

Less: rent related to items above
 
(76
)
 
(107
)
 
(295
)
 
(443
)
Adjusted rent - cost of services
 
$
30,105

 
$
31,115

 
31,580

 
31,068

Adjusted rent included in discontinued operations
 
$
5,598

 
$
5,836

 
$
5,849

 
$

Adjusted EBITDAR from continuing operations
 
74,720

 
75,555

 
77,740

 
91,498

Adjusted EBITDAR
 
$
92,459

 
$
93,727

 
$
95,913

 
$
91,498

 
 
 
 
 
 
 
 
 
(a)
Results at closed operations and operations not at full capacity during the periods presented.
(b)
Costs incurred to acquire operations which are not capitalizable.
(c) Costs incurred in connection with the completed Spin-Off transaction of our home health and hospice operations and substantially all of our senior living operations to a newly formed publicly traded company.
(d)
Impairment charges to fixed assets includes impairment charges of $1.7 million at one of our skilled nursing operations during the three months ended December 31, 2019. Included in the three months ended September 30, 2019, impairment charges of $1.5 million at two of our senior living operations, offset by the gain recognized for the sale of real estate of $2.9 million.
(e) Impairment charges to goodwill and intangible assets at our other ancillary operations and a skilled nursing operation.
(f) All adjustments included in the table below are presented within net income from discontinued operations, net of tax within the consolidated statements of income for the periods presented.






    
 
Three Months Ended December 31,
 
3/31/2019
 
6/30/2019
 
9/30/2019
 
12/31/2019
Consolidated Statements of Income Data:
 
 
 
 
 
 
 
Net income from discontinued operations, net of tax
$
6,042

 
$
8,141

 
$
5,290

 
$

Less: net income attributable to noncontrolling interests in discontinued operations
150

 
200

 
279

 

Add: Interest income, net
(12
)
 
(10
)
 
(4
)
 

 Provision for income taxes
1,825

 
976

 
2,860

 

 Depreciation and amortization
669

 
818

 
914

 

EBITDA from discontinued operations
$
8,374

 
$
9,725

 
$
8,781

 
$

 
 
 
 
 
 
 
 
Adjustments to EBITDA from discontinued operations:
 
 
 
 
 
 
 
Earnings related to operations in the start-up phase
236

 
82

 
59

 

Share-based compensation expense
497

 
372

 
149

 

Spin-Off transaction costs
2,990

 
1,658

 
3,261

 

Acquisition related costs
36

 
497

 
70

 

Rent related to items above
8

 
2

 
4

 

Adjusted EBITDA from discontinued operations
$
12,141

 
$
12,336

 
$
12,324

 
$


Discussion of Non-GAAP Financial Measures

EBITDA consists of net income before (a) interest expense, net, (b) provisions for income taxes and (c) depreciation and amortization. Adjusted EBITDA consists of net income before (a) interest expense, net, (b) provisions for income taxes, (c) depreciation and amortization, (d) costs incurred for operations currently in start-up phase, excluding depreciation, interest and income taxes, (e) return of unclaimed class action settlement; (f) share-based compensation expense; (g) results of operations not at full capacity, excluding depreciation, interest and income taxes, (h) acquisition related costs; (i) spin-off transaction costs, (j) impairment charges to fixed assets, net of gain on sale of assets; (k) business interruption recoveries; and (l) impairment of intangible assets and goodwill. Adjusted EBITDAR consists of net income before (a) interest expense, net, (b) provisions for income taxes, (c) depreciation and amortization, (d) rent-cost of services, (e) costs incurred for facilities currently in start-up phase, excluding rent, depreciation, interest and income taxes, (f) return of unclaimed class action settlement; (g) share-based compensation expense; (h) results of operations not at full capacity, excluding rent, depreciation, interest and income taxes, (i) return of unclaimed class action settlement; (j) spin-off transaction costs, (k) impairment charges to fixed assets, net of gain on sale of assets; (l) business interruption recoveries; and (m) impairment of intangible assets and goodwill. The company believes that the presentation of EBITDA, adjusted EBITDA, 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, 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.
We have included unaudited pro forma financials. The unaudited pro forma consolidated financial information were not prepared in accordance with Article 11 of Regulation S-X. The historical financial data has also been adjusted to give pro forma effect to events that are directly attributable to the Spin-Off transaction and have an ongoing effect on Ensign’s statement of operations. The unaudited pro forma consolidated financial statements include: (1) rental income generated from a master lease with Pennant; (2) reduction in estimated historical general and administrative expenses related to Pennant; (3) amendment of the credit facility in connection with the spin-off; and (4) the discontinued operation effect of the spin-off. For further information regarding why the company believes that this non-GAAP and pro forma 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.