Delaware | 001-33757 | 33-0861263 | ||||
(State or other jurisdiction of incorporation) | (Commission File Number) | (IRS Employer Identification No.) | ||||
27101 Puerta Real, Suite 450, Mission Viejo, CA | 92691 | |||||
(Address of principal executive offices) | (Zip Code) |
o | Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425) | |
o | Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12) | |
o | Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b)) | |
o | Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c)) |
Exhibit No. | Description | |
Press Release of the Company dated February 8, 2018 |
Dated: February 9, 2018 | THE ENSIGN GROUP, INC. | |||
By: | /s/ Suzanne D. Snapper | |||
Suzanne D. Snapper | ||||
Chief Financial Officer | ||||
Exhibit No. | Description | |
Press Release of the Company dated February 8, 2018 |
• | GAAP earnings for the quarter was $0.21 per diluted share, and adjusted earnings per share was up 33.3% over the prior year quarter to a record $0.40 per diluted share(1); |
• | Consolidated GAAP Net Income for the quarter was $11.2 million, and consolidated adjusted Net Income was $21.1 million, an increase of 35.4% over the prior year quarter(1); |
• | Transitioning skilled occupancy was 74.7%, an increase of 289 basis points over the prior year quarter and same-store occupancy was 78.7%, an increase of 109 basis points over the prior year quarter; |
• | Total Transitional and Skilled Services segment income was $39.9 million for the quarter, an increase of 40.2% over the prior year quarter and an increase of 8.3% sequentially over the third quarter; |
• | Total Assisted and Independent Living Services segment revenue was up 13.7% to $35.8 million and segment income was up 66.3% to $4.3 million, both over the prior year quarter; and |
• | Total Home Health and Hospice Services segment revenue was up 27.5% to $39.7 million and segment income was up 27.7% to $5.8 million, both over the prior year quarter. |
Three Months Ended December 31, | Year Ended December 31, | ||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||
Revenue | $ | 487,705 | $ | 433,048 | $ | 1,849,317 | $ | 1,654,864 | |||||||
Expense: | |||||||||||||||
Cost of services | 393,727 | 355,997 | 1,497,703 | 1,341,814 | |||||||||||
Charge related to class action lawsuit | — | — | 11,000 | — | |||||||||||
(Gains)/losses related to operational closures | (410 | ) | (16,655 | ) | 2,321 | (11,225 | ) | ||||||||
Rent—cost of services | 33,652 | 33,507 | 131,919 | 124,581 | |||||||||||
General and administrative expense | 22,833 | 14,815 | 80,617 | 69,165 | |||||||||||
Depreciation and amortization | 11,760 | 9,701 | 44,472 | 38,682 | |||||||||||
Total expenses | 461,562 | 397,365 | 1,768,032 | 1,563,017 | |||||||||||
Income from operations | 26,143 | 35,683 | 81,285 | 91,847 | |||||||||||
Other income (expense): | |||||||||||||||
Interest expense | (3,599 | ) | (2,184 | ) | (13,616 | ) | (7,136 | ) | |||||||
Interest income | 636 | 358 | 1,609 | 1,107 | |||||||||||
Other expense, net | (2,963 | ) | (1,826 | ) | (12,007 | ) | (6,029 | ) | |||||||
Income before provision for income taxes | 23,180 | 33,857 | 69,278 | 85,818 | |||||||||||
Provision for income taxes | 11,958 | 12,851 | 28,445 | 32,975 | |||||||||||
Net income | 11,222 | 21,006 | 40,833 | 52,843 | |||||||||||
Less: net income attributable to noncontrolling interests | 16 | 2,669 | 358 | 2,853 | |||||||||||
Net income attributable to The Ensign Group, Inc. | $ | 11,206 | $ | 18,337 | $ | 40,475 | $ | 49,990 | |||||||
Net income per share | |||||||||||||||
Basic: | $ | 0.22 | $ | 0.36 | $ | 0.79 | $ | 0.99 | |||||||
Diluted: | $ | 0.21 | $ | 0.35 | $ | 0.77 | $ | 0.96 | |||||||
Weighted average common shares outstanding: | |||||||||||||||
Basic | 51,250 | 50,724 | 50,932 | 50,555 | |||||||||||
Diluted | 53,176 | 52,231 | 52,829 | 52,133 | |||||||||||
Dividends per share | $ | 0.0450 | $ | 0.0425 | $ | 0.1725 | $ | 0.1625 | |||||||
December 31, | |||||||
2017 | 2016 | ||||||
Assets | |||||||
Current assets: | |||||||
Cash and cash equivalents | $ | 42,337 | $ | 57,706 | |||
Accounts receivable—less allowance for doubtful accounts of $43,961 and $39,791 at December 31, 2017 and 2016, respectively | 265,068 | 244,433 | |||||
Investments—current | 13,092 | 11,550 | |||||
Prepaid income taxes | 19,447 | 302 | |||||
Prepaid expenses and other current assets | 28,132 | 19,871 | |||||
Total current assets | 368,076 | 333,862 | |||||
Property and equipment, net | 537,084 | 484,498 | |||||
Insurance subsidiary deposits and investments | 28,685 | 23,634 | |||||
Escrow deposits | 228 | 1,582 | |||||
Deferred tax assets | 12,745 | 23,073 | |||||
Restricted and other assets | 16,501 | 12,614 | |||||
Intangible assets, net | 32,803 | 35,076 | |||||
Goodwill | 81,062 | 67,100 | |||||
Other indefinite-lived intangibles | 25,249 | 19,586 | |||||
Total assets | $ | 1,102,433 | $ | 1,001,025 | |||
Liabilities and equity | |||||||
Current liabilities: | |||||||
Accounts payable | $ | 39,043 | $ | 38,991 | |||
Accrued wages and related liabilities | 90,508 | 84,686 | |||||
Accrued self-insurance liabilities—current | 22,516 | 21,359 | |||||
Other accrued liabilities | 63,815 | 58,763 | |||||
Current maturities of long-term debt | 9,939 | 8,129 | |||||
Total current liabilities | 225,821 | 211,928 | |||||
Long-term debt—less current maturities | 302,990 | 275,486 | |||||
Accrued self-insurance liabilities—less current portion | 50,220 | 43,992 | |||||
Deferred rent and other long-term liabilities | 11,268 | 9,124 | |||||
Deferred gain related to sale-leaseback | 12,075 | — | |||||
Total equity | 500,059 | 460,495 | |||||
Total liabilities and equity | $ | 1,102,433 | $ | 1,001,025 |
December 31, | |||||||
2017 | 2016 | ||||||
Net cash provided by operating activities | 72,952 | 73,888 | |||||
Net cash used in investing activities | (106,593 | ) | (210,636 | ) | |||
Net cash provided by financing activities | 18,272 | 152,885 | |||||
Net (decrease)/increase in cash and cash equivalents | (15,369 | ) | 16,137 | ||||
Cash and cash equivalents at beginning of period | 57,706 | 41,569 | |||||
Cash and cash equivalents at end of period | $ | 42,337 | $ | 57,706 |
THE ENSIGN GROUP, INC. | |||||||||||||||||||||||||||||
REVENUE BY SEGMENT | |||||||||||||||||||||||||||||
The following table sets forth our total revenue by segment and as a percentage of total revenue for the periods indicated: | |||||||||||||||||||||||||||||
Three Months Ended December 31, | Year Ended December 31, | ||||||||||||||||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||||||||||||||||
$ | % | $ | % | $ | % | $ | % | ||||||||||||||||||||||
(Dollars in thousands) | (Dollars in thousands) | ||||||||||||||||||||||||||||
Transitional and skilled services | $ | 403,533 | 82.7 | % | $ | 361,857 | 83.5 | % | $ | 1,545,210 | 83.6 | % | $ | 1,374,803 | 83.1 | % | |||||||||||||
Assisted and independent living facilities | 35,836 | 7.4 | 31,512 | 7.3 | 136,646 | 7.4 | 123,636 | 7.5 | |||||||||||||||||||||
Home health and hospice services: | |||||||||||||||||||||||||||||
Home health | 20,048 | 4.1 | 16,474 | 3.8 | 73,045 | 3.9 | 60,326 | 3.6 | |||||||||||||||||||||
Hospice | 19,636 | 4.0 | 14,660 | 3.4 | 69,358 | 3.8 | 55,487 | 3.4 | |||||||||||||||||||||
Total home health and hospice services | 39,684 | 8.1 | 31,134 | 7.2 | 142,403 | 7.7 | 115,813 | 7.0 | |||||||||||||||||||||
All other (1) | 8,652 | 1.8 | 8,545 | 2.0 | 25,058 | 1.3 | 40,612 | 2.4 | |||||||||||||||||||||
Total revenue | $ | 487,705 | 100.0 | % | $ | 433,048 | 100.0 | % | $ | 1,849,317 | 100.0 | % | $ | 1,654,864 | 100.0 | % | |||||||||||||
(1) Includes revenue from services generated in our other ancillary services for the three months and year ended December 31, 2017 and 2016 and urgent care centers for the three months and year ended December 31, 2016. | |||||||||||||||||||||||||||||
THE ENSIGN GROUP, INC. | ||||||||||
SELECT PERFORMANCE INDICATORS | ||||||||||
(Unaudited) |
Three Months Ended December 31, | ||||||||||||||
2017 | 2016 | |||||||||||||
(Dollars in thousands) | Change | % Change | ||||||||||||
Total Facility Results: | ||||||||||||||
Transitional and skilled revenue | $ | 403,533 | $ | 361,857 | $ | 41,676 | 11.5 | % | ||||||
Number of facilities at period end | 160 | 149 | 11 | 7.4 | % | |||||||||
Number of campuses at period end* | 21 | 21 | — | —% | ||||||||||
Actual patient days | 1,315,247 | 1,217,216 | 98,031 | 8.1 | % | |||||||||
Occupancy percentage — Operational beds | 76.2 | % | 74.6 | % | 1.6 | % | ||||||||
Skilled mix by nursing days | 29.1 | % | 30.1 | % | (1.0 | )% | ||||||||
Skilled mix by nursing revenue | 49.3 | % | 51.8 | % | (2.5 | )% |
Three Months Ended December 31, | ||||||||||||||
2017 | 2016 | |||||||||||||
(Dollars in thousands) | Change | % Change | ||||||||||||
Same Facility Results(1): | ||||||||||||||
Transitional and skilled revenue | $ | 248,396 | $ | 235,893 | $ | 12,503 | 5.3 | % | ||||||
Number of facilities at period end | 93 | 93 | — | —% | ||||||||||
Number of campuses at period end* | 11 | 11 | — | —% | ||||||||||
Actual patient days | 777,331 | 772,750 | 4,581 | 0.6 | % | |||||||||
Occupancy percentage — Operational beds | 78.7 | % | 77.6 | % | 1.1 | % | ||||||||
Skilled mix by nursing days | 29.2 | % | 29.1 | % | 0.1 | % | ||||||||
Skilled mix by nursing revenue | 49.5 | % | 50.4 | % | (0.9 | )% |
Three Months Ended December 31, | ||||||||||||||
2017 | 2016 | |||||||||||||
(Dollars in thousands) | Change | % Change | ||||||||||||
Transitioning Facility Results(2): | ||||||||||||||
Transitional and skilled revenue | $ | 77,870 | $ | 75,081 | $ | 2,789 | 3.7 | % | ||||||
Number of facilities at period end | 37 | 37 | — | —% | ||||||||||
Number of campuses at period end* | 3 | 3 | — | —% | ||||||||||
Actual patient days | 250,814 | 243,300 | 7,514 | 3.1 | % | |||||||||
Occupancy percentage — Operational beds | 74.7 | % | 71.8 | % | 2.9 | % | ||||||||
Skilled mix by nursing days | 33.8 | % | 36.0 | % | (2.2 | )% | ||||||||
Skilled mix by nursing revenue | 52.6 | % | 56.0 | % | (3.4 | )% |
Three Months Ended December 31, | |||||||||||||
2017 | 2016 | ||||||||||||
(Dollars in thousands) | Change | % Change | |||||||||||
Recently Acquired Facility Results(3): | |||||||||||||
Transitional and skilled revenue | $ | 77,267 | $ | 49,310 | $ | 27,957 | NM | ||||||
Number of facilities at period end | 30 | 18 | 12 | NM | |||||||||
Number of campuses at period end* | 7 | 6 | 1 | NM | |||||||||
Actual patient days | 287,102 | 196,089 | 91,013 | NM | |||||||||
Occupancy percentage — Operational beds | 71.5 | % | 70.1 | % | NM | ||||||||
Skilled mix by nursing days | 24.6 | % | 26.3 | % | NM | ||||||||
Skilled mix by nursing revenue | 45.2 | % | 51.1 | % | NM |
Three Months Ended December 31, | |||||||||||||
2017 | 2016 | ||||||||||||
(Dollars in thousands) | Change | % Change | |||||||||||
Facility Closed Results(4): | |||||||||||||
Skilled nursing revenue | $ | — | $ | 1,573 | $ | (1,573 | ) | NM | |||||
Actual patient days | — | 5,077 | (5,077 | ) | NM | ||||||||
Occupancy percentage — Operational beds | — | % | 30.5 | % | NM | ||||||||
Skilled mix by nursing days | — | % | 41.6 | % | NM | ||||||||
Skilled mix by nursing revenue | — | % | 67.3 | % | NM |
(1) | Same Facility results represent all facilities purchased prior to January 1, 2014. |
(2) | Transitioning Facility results represents all facilities purchased from January 1, 2014 to December 31, 2015. |
(3) | Recently Acquired Facility (Acquisitions) results represent all facilities purchased on or subsequent to January 1, 2016. |
(4) | Facility Closed results represents closed operations during 2017 and 2016, which were excluded from Same Store and Recently Acquired results for the three months ended December 31, 2016, for comparison purposes. |
Year Ended December 31, | ||||||||||||||
2017 | 2016 | |||||||||||||
(Dollars in thousands) | Change | % Change | ||||||||||||
Total Facility Results: | ||||||||||||||
Transitional and skilled revenue | $ | 1,545,210 | $ | 1,374,803 | $ | 170,407 | 12.4 | % | ||||||
Number of facilities at period end | 160 | 149 | 11 | 7.4 | % | |||||||||
Number of campuses at period end* | 21 | 21 | — | — | % | |||||||||
Actual patient days | 5,050,140 | 4,620,735 | 429,405 | 9.3 | % | |||||||||
Occupancy percentage — Operational beds | 75.4 | % | 75.4 | % | — | % | ||||||||
Skilled mix by nursing days | 30.3 | % | 30.9 | % | (0.6 | )% | ||||||||
Skilled mix by nursing revenue | 51.1 | % | 52.5 | % | (1.4 | )% |
Year Ended December 31, | ||||||||||||||
2017 | 2016 | |||||||||||||
(Dollars in thousands) | Change | % Change | ||||||||||||
Same Facility Results(1): | ||||||||||||||
Transitional and skilled revenue | $ | 975,203 | $ | 942,854 | $ | 32,349 | 3.4 | % | ||||||
Number of facilities at period end | 93 | 93 | — | — | % | |||||||||
Number of campuses at period end* | 11 | 11 | — | — | % | |||||||||
Actual patient days | 3,083,292 | 3,099,764 | (16,472 | ) | (0.5 | )% | ||||||||
Occupancy percentage — Operational beds | 78.4 | % | 78.1 | % | 0.3 | % | ||||||||
Skilled mix by nursing days | 30.0 | % | 29.8 | % | 0.2 | % | ||||||||
Skilled mix by nursing revenue | 50.8 | % | 51.3 | % | (0.5 | )% |
Year Ended December 31, | ||||||||||||||
2017 | 2016 | |||||||||||||
(Dollars in thousands) | Change | % Change | ||||||||||||
Transitioning Facility Results(2): | ||||||||||||||
Transitional and skilled revenue | $ | 310,545 | $ | 292,360 | $ | 18,185 | 6.2 | % | ||||||
Number of facilities at period end | 37 | 37 | — | — | % | |||||||||
Number of campuses at period end* | 3 | 3 | — | — | % | |||||||||
Actual patient days | 988,246 | 963,760 | 24,486 | 2.5 | % | |||||||||
Occupancy percentage — Operational beds | 74.2 | % | 71.4 | % | 2.8 | % | ||||||||
Skilled mix by nursing days | 35.5 | % | 36.5 | % | (1.0 | )% | ||||||||
Skilled mix by nursing revenue | 54.3 | % | 56.8 | % | (2.5 | )% |
Year Ended December 31, | |||||||||||||
2017 | 2016 | ||||||||||||
(Dollars in thousands) | Change | % Change | |||||||||||
Recently Acquired Facility Results(3): | |||||||||||||
Transitional and skilled revenue | $ | 257,594 | $ | 134,828 | $ | 122,766 | NM | ||||||
Number of facilities at period end | 30 | 18 | 12 | NM | |||||||||
Number of campuses at period end* | 7 | 6 | 1 | NM | |||||||||
Actual patient days | 973,027 | 536,495 | 436,532 | NM | |||||||||
Occupancy percentage — Operational beds | 68.5 | % | 71.4 | % | NM | ||||||||
Skilled mix by nursing days | 25.8 | % | 27.5 | % | NM | ||||||||
Skilled mix by nursing revenue | 48.0 | % | 52.4 | % | NM |
Year Ended December 31, | |||||||||||||
2017 | 2016 | ||||||||||||
(Dollars in thousands) | Change | % Change | |||||||||||
Facility Closed Results(4): | |||||||||||||
Skilled nursing revenue | $ | 1,868 | $ | 4,761 | $ | (2,893 | ) | NM | |||||
Actual patient days | 5,575 | 20,716 | (15,141 | ) | NM | ||||||||
Occupancy percentage — Operational beds | 34.3 | % | 37.5 | % | NM | ||||||||
Skilled mix by nursing days | 46.7 | % | 20.1 | % | NM | ||||||||
Skilled mix by nursing revenue | 71.5 | % | 42.0 | % | NM |
(1) | Same Facility results represent all facilities purchased prior to January 1, 2014. |
(2) | Transitioning Facility results represents all facilities purchased from January 1, 2014 to December 31, 2015. |
(3) | Recently Acquired Facility (Acquisitions) results represent all facilities purchased on or subsequent to January 1, 2016. |
(4) | Facility Closed results represents closed operations during 2017 and 2016, which were excluded from Same Store and Recently Acquired results for the years ended December 31, 2017 and 2016, for comparison purposes. |
Three Months Ended December 31, | |||||||||||||||||||||||||||||||
Same Facility | Transitioning | Acquisitions | Total | ||||||||||||||||||||||||||||
2017 | 2016 | 2017 | 2016 | 2017 | 2016 | 2017 | 2016 | ||||||||||||||||||||||||
Skilled Nursing Average Daily Revenue Rates: | |||||||||||||||||||||||||||||||
Medicare | $ | 611.62 | $ | 599.29 | $ | 555.06 | $ | 540.19 | $ | 513.42 | $ | 494.50 | $ | 576.93 | $ | 565.24 | |||||||||||||||
Managed care | 450.58 | 431.18 | 442.50 | 447.67 | 413.12 | 408.55 | 441.71 | 432.87 | |||||||||||||||||||||||
Other skilled | 485.60 | 466.61 | 375.63 | 366.02 | 418.98 | — | 453.31 | 439.11 | |||||||||||||||||||||||
Total skilled revenue | 522.53 | 512.97 | 471.00 | 469.77 | 469.08 | 464.59 | 501.22 | 495.55 | |||||||||||||||||||||||
Medicaid | 222.65 | 206.77 | 214.40 | 211.09 | 186.49 | 155.51 | 213.31 | 199.63 | |||||||||||||||||||||||
Private and other payors | 215.16 | 204.54 | 239.76 | 184.90 | 188.51 | 167.94 | 210.57 | 192.72 | |||||||||||||||||||||||
Total skilled nursing revenue | $ | 309.89 | $ | 295.47 | $ | 303.87 | $ | 301.89 | $ | 256.70 | $ | 239.40 | $ | 297.12 | $ | 287.70 |
Year Ended December 31, | |||||||||||||||||||||||||||||||
Same Facility | Transitioning | Acquisitions | Total | ||||||||||||||||||||||||||||
2017 | 2016 | 2017 | 2016 | 2017 | 2016 | 2017 | 2016 | ||||||||||||||||||||||||
Skilled Nursing Average Daily Revenue Rates: | |||||||||||||||||||||||||||||||
Medicare | $ | 601.53 | $ | 583.21 | $ | 548.09 | $ | 528.65 | $ | 506.27 | $ | 486.45 | $ | 569.77 | $ | 556.89 | |||||||||||||||
Managed care | 445.73 | 428.13 | 445.45 | 438.21 | 414.34 | 401.22 | 440.55 | 428.53 | |||||||||||||||||||||||
Other skilled | 483.23 | 468.59 | 369.82 | 369.59 | 449.89 | — | 451.16 | 441.86 | |||||||||||||||||||||||
Total skilled revenue | 518.82 | 505.95 | 470.65 | 462.84 | 468.89 | 457.58 | 499.51 | 490.18 | |||||||||||||||||||||||
Medicaid | 217.22 | 205.82 | 215.49 | 201.24 | 172.02 | 154.73 | 208.24 | 198.92 | |||||||||||||||||||||||
Private and other payors | 212.72 | 197.11 | 233.26 | 208.11 | 191.16 | 167.15 | 209.72 | 197.87 | |||||||||||||||||||||||
Total skilled nursing revenue | $ | 307.47 | $ | 294.12 | $ | 307.77 | $ | 297.20 | $ | 252.02 | $ | 240.27 | $ | 296.84 | $ | 288.93 |
Three Months Ended December 31, | |||||||||||||||||||||||
Same Facility | Transitioning | Acquisitions | Total | ||||||||||||||||||||
2017 | 2016 | 2017 | 2016 | 2017 | 2016 | 2017 | 2016 | ||||||||||||||||
Percentage of Skilled Nursing Revenue: | |||||||||||||||||||||||
Medicare | 23.5 | % | 26.5 | % | 23.1 | % | 25.0 | % | 27.5 | % | 35.5 | % | 24.2 | % | 27.6 | % | |||||||
Managed care | 17.2 | 15.9 | 20.9 | 23.6 | 16.6 | 15.6 | 17.8 | 17.4 | |||||||||||||||
Other skilled | 8.8 | 8.0 | 8.6 | 7.4 | 1.1 | — | 7.3 | 6.8 | |||||||||||||||
Skilled mix | 49.5 | 50.4 | 52.6 | 56.0 | 45.2 | 51.1 | 49.3 | 51.8 | |||||||||||||||
Private and other payors | 8.0 | 8.7 | 7.6 | 5.5 | 12.9 | 13.9 | 8.9 | 8.7 | |||||||||||||||
Quality mix | 57.5 | 59.1 | 60.2 | 61.5 | 58.1 | 65.0 | 58.2 | 60.5 | |||||||||||||||
Medicaid | 42.5 | 40.9 | 39.8 | 38.5 | 41.9 | 35.0 | 41.8 | 39.5 | |||||||||||||||
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 | ||||||||||||||||||||
2017 | 2016 | 2017 | 2016 | 2017 | 2016 | 2017 | 2016 | ||||||||||||||||
Percentage of Skilled Nursing Days: | |||||||||||||||||||||||
Medicare | 11.8 | % | 13.1 | % | 12.6 | % | 14.0 | % | 13.7 | % | 17.2 | % | 12.4 | % | 14.0 | % | |||||||
Managed care | 11.8 | 10.9 | 14.3 | 15.9 | 10.3 | 9.1 | 11.9 | 11.6 | |||||||||||||||
Other skilled | 5.6 | 5.1 | 6.9 | 6.1 | 0.6 | — | 4.8 | 4.5 | |||||||||||||||
Skilled mix | 29.2 | 29.1 | 33.8 | 36.0 | 24.6 | 26.3 | 29.1 | 30.1 | |||||||||||||||
Private and other payors | 12.0 | 12.5 | 9.9 | 9.0 | 18.0 | 19.9 | 12.9 | 13.0 | |||||||||||||||
Quality mix | 41.2 | 41.6 | 43.7 | 45.0 | 42.6 | 46.2 | 42.0 | 43.1 | |||||||||||||||
Medicaid | 58.8 | 58.4 | 56.3 | 55.0 | 57.4 | 53.8 | 58.0 | 56.9 | |||||||||||||||
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 | ||||||||||||||||||||
2017 | 2016 | 2017 | 2016 | 2017 | 2016 | 2017 | 2016 | ||||||||||||||||
Percentage of Skilled Nursing Revenue: | |||||||||||||||||||||||
Medicare | 25.1 | % | 27.2 | % | 24.3 | % | 25.5 | % | 30.5 | % | 36.8 | % | 25.8 | % | 27.8 | % | |||||||
Managed care | 17.2 | 16.4 | 22.0 | 24.1 | 16.9 | 15.6 | 18.1 | 17.9 | |||||||||||||||
Other skilled | 8.5 | 7.7 | 8.0 | 7.2 | 0.6 | — | 7.2 | 6.8 | |||||||||||||||
Skilled mix | 50.8 | 51.3 | 54.3 | 56.8 | 48.0 | 52.4 | 51.1 | 52.5 | |||||||||||||||
Private and other payors | 8.0 | 8.5 | 7.0 | 6.2 | 13.4 | 12.7 | 8.6 | 8.5 | |||||||||||||||
Quality mix | 58.8 | 59.8 | 61.3 | 63.0 | 61.4 | 65.1 | 59.7 | 61.0 | |||||||||||||||
Medicaid | 41.2 | 40.2 | 38.7 | 37.0 | 38.6 | 34.9 | 40.3 | 39.0 | |||||||||||||||
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 | ||||||||||||||||||||
2017 | 2016 | 2017 | 2016 | 2017 | 2016 | 2017 | 2016 | ||||||||||||||||
Percentage of Skilled Nursing Days: | |||||||||||||||||||||||
Medicare | 12.8 | % | 13.7 | % | 13.6 | % | 14.3 | % | 15.2 | % | 18.2 | % | 13.4 | % | 14.4 | % | |||||||
Managed care | 11.8 | 11.3 | 15.2 | 16.3 | 10.3 | 9.3 | 12.2 | 12.0 | |||||||||||||||
Other skilled | 5.4 | 4.8 | 6.7 | 5.9 | 0.3 | — | 4.7 | 4.5 | |||||||||||||||
Skilled mix | 30.0 | 29.8 | 35.5 | 36.5 | 25.8 | 27.5 | 30.3 | 30.9 | |||||||||||||||
Private and other payors | 11.9 | 12.6 | 9.3 | 8.9 | 17.7 | 18.4 | 12.5 | 12.5 | |||||||||||||||
Quality mix | 41.9 | 42.4 | 44.8 | 45.4 | 43.5 | 45.9 | 42.8 | 43.4 | |||||||||||||||
Medicaid | 58.1 | 57.6 | 55.2 | 54.6 | 56.5 | 54.1 | 57.2 | 56.6 | |||||||||||||||
Total skilled nursing | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % |
THE ENSIGN GROUP, INC. | ||||||||||
SELECT PERFORMANCE INDICATORS | ||||||||||
(Unaudited) | ||||||||||
The following tables summarize our selected performance indicators for our assisted and independent living segment along with other statistics, for each of the date or periods indicated: | ||||||||||
Three Months Ended December 31, | ||||||||||||||
2017 | 2016 | |||||||||||||
(Dollars in thousands) | Change | % Change | ||||||||||||
Revenue | $ | 35,836 | $ | 31,512 | $ | 4,324 | 13.7 | % | ||||||
Number of facilities at period end | 49 | 40 | 9 | 22.5 | % | |||||||||
Number of campuses at period end | 21 | 21 | — | —% | ||||||||||
Occupancy percentage (units) | 75.8 | % | 76.3 | % | (0.5 | )% | ||||||||
Average monthly revenue per unit | $ | 2,792 | $ | 2,748 | $ | 44 | 1.6 | % |
Year Ended December 31, | ||||||||||||||
2017 | 2016 | Change | % Change | |||||||||||
(Dollars in thousands) | ||||||||||||||
Revenue | $ | 136,646 | $ | 123,636 | $ | 13,010 | 10.5 | % | ||||||
Number of facilities at period end | 49 | 40 | 9 | 22.5 | % | |||||||||
Number of campuses at period end | 21 | 21 | — | — | % | |||||||||
Occupancy percentage (units) | 76.4 | % | 76.0 | % | 0.4 | % | ||||||||
Average monthly revenue per unit | $ | 2,800 | $ | 2,746 | $ | 54 | 2.0 | % |
THE ENSIGN GROUP, INC. | ||||||||||
SELECT PERFORMANCE INDICATORS | ||||||||||
(Unaudited) | ||||||||||
The following tables summarize our selected performance indicators for our home health and hospice segment along with other statistics, for each of the date or periods indicated: | ||||||||||
Three Months Ended December 31, | ||||||||||||||
2017 | 2016 | Change | % Change | |||||||||||
(Dollars in thousands) | ||||||||||||||
Home health and hospice revenue | ||||||||||||||
Home health services | $ | 20,048 | $ | 16,474 | $ | 3,574 | 21.7 | % | ||||||
Hospice services | 19,636 | 14,660 | 4,976 | 33.9 | ||||||||||
Total home health and hospice revenue | $ | 39,684 | $ | 31,134 | $ | 8,550 | 27.5 | % | ||||||
Home health services: | ||||||||||||||
Average Medicare Revenue per Completed Episode | $ | 2,985 | $ | 3,085 | $ | (100 | ) | (3.2 | )% | |||||
Hospice services: | ||||||||||||||
Average Daily Census | 1,229 | 975 | 254 | 26.1 | % |
Year Ended December 31, | ||||||||||||||
2017 | 2016 | Change | % Change | |||||||||||
(Dollars in thousands) | ||||||||||||||
Home health and hospice revenue: | ||||||||||||||
Home health services | $ | 73,045 | $ | 60,326 | $ | 12,719 | 21.1 | % | ||||||
Hospice services | 69,358 | 55,487 | 13,871 | 25.0 | ||||||||||
Total home health and hospice revenue | $ | 142,403 | $ | 115,813 | $ | 26,590 | 23.0 | % | ||||||
Home health services: | ||||||||||||||
Average Medicare Revenue per Completed Episode | $ | 3,028 | $ | 2,986 | $ | 42 | 1.4 | % | ||||||
Hospice services: | ||||||||||||||
Average Daily Census | 1,102 | 905 | 197 | 21.8 | % |
Three Months Ended December 31, | Year Ended December 31, | |||||||||||||||||||||||||||
2017 | 2016 | 2017 | 2016 | |||||||||||||||||||||||||
$ | % | $ | % | $ | % | $ | % | |||||||||||||||||||||
(Dollars in thousands) | (Dollars in thousands) | |||||||||||||||||||||||||||
Revenue: | ||||||||||||||||||||||||||||
Medicaid | $ | 174,795 | 35.8 | % | $ | 148,127 | 34.2 | % | $ | 644,803 | 34.9 | % | $ | 557,958 | 33.7 | % | ||||||||||||
Medicare | 130,465 | 26.8 | 125,006 | 28.9 | 515,884 | 27.9 | 477,019 | 28.8 | ||||||||||||||||||||
Medicaid-skilled | 27,208 | 5.6 | 23,018 | 5.3 | 102,875 | 5.6 | 87,517 | 5.3 | ||||||||||||||||||||
Total | 332,468 | 68.2 | 296,151 | 68.4 | 1,263,562 | 68.4 | 1,122,494 | 67.8 | ||||||||||||||||||||
Managed Care | 78,176 | 16.0 | 68,406 | 15.8 | 303,386 | 16.4 | 265,508 | 16.0 | ||||||||||||||||||||
Private and Other(1) | 77,061 | 15.8 | 68,491 | 15.8 | 282,369 | 15.2 | 266,862 | 16.2 | ||||||||||||||||||||
Total revenue | $ | 487,705 | 100.0 | % | $ | 433,048 | 100.0 | % | $ | 1,849,317 | 100.0 | % | $ | 1,654,864 | 100.0 | % | ||||||||||||
(1) Private and other payors also includes revenue from all payors generated in our other ancillary services. |
Three Months Ended December 31, | Year Ended December 31, | ||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||
Net income attributable to The Ensign Group, Inc. | $ | 11,206 | $ | 18,337 | $ | 40,475 | $ | 49,990 | |||||||
Non-GAAP adjustments | |||||||||||||||
Costs incurred for facilities currently being constructed and other start-up operations(a) | 2,374 | 4,661 | 13,378 | 15,006 | |||||||||||
Legal costs and charges related to the settlement of the class action lawsuit and insurance claims(b) | 14 | 223 | 11,177 | 4,924 | |||||||||||
Share-based compensation expense(c) | 2,941 | 2,194 | 9,695 | 9,101 | |||||||||||
Results related to closed operations and operations not at full capacity, including continued obligations and closing expense(d) | 4 | 307 | 5,602 | 8,845 | |||||||||||
Bonus accrual as a result of the Tax Act(e) | 3,100 | — | 3,100 | — | |||||||||||
Losses related to Hurricane Harvey and California fires on impacted operations(f) | 741 | — | 1,299 | — | |||||||||||
Depreciation and amortization - Patient base(g) | 180 | 20 | 733 | 1,678 | |||||||||||
General and administrative - Transaction-related costs(h) | 100 | 164 | 717 | 1,102 | |||||||||||
General and administrative - Costs incurred related to new systems implementation and professional service fees(i) | 80 | 76 | 80 | 1,148 | |||||||||||
Results at urgent care centers, including noncontrolling interests(j) | — | 3,174 | — | 3,149 | |||||||||||
Gain on sale of urgent care centers (k) | — | (16,655 | ) | — | (19,160 | ) | |||||||||
Interest expense - Write off of deferred financing fees(l) | — | — | — | 349 | |||||||||||
Provision for income taxes on Non-GAAP adjustments(m) | 344 | 3,069 | (12,399 | ) | (9,126 | ) | |||||||||
Non-GAAP Net Income | $ | 21,084 | $ | 15,570 | $ | 73,857 | $ | 67,006 | |||||||
Diluted Earnings Per Share As Reported | |||||||||||||||
Net Income | $ | 0.21 | $ | 0.35 | $ | 0.77 | $ | 0.96 | |||||||
Average number of shares outstanding | 53,176 | 52,231 | 52,829 | 52,133 | |||||||||||
Adjusted Diluted Earnings Per Share | |||||||||||||||
Net Income | $ | 0.40 | $ | 0.30 | $ | 1.40 | $ | 1.29 | |||||||
Average number of shares outstanding | 53,176 | 52,231 | 52,829 | 52,133 | |||||||||||
Footnote: | |||||||||||||||
(a) Represent operating results for facilities currently being constructed and other start-up operations. | |||||||||||||||
Three Months Ended December 31, | Year Ended December 31, | ||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||
Revenue | $ | (17,480 | ) | $ | (13,579 | ) | $ | (62,686 | ) | $ | (35,140 | ) | |||
Cost of services | 15,726 | 14,278 | 59,424 | 38,990 | |||||||||||
Rent | 3,865 | 3,674 | 15,559 | 10,346 | |||||||||||
Depreciation and amortization | 263 | 288 | 1,081 | 810 | |||||||||||
Total Non-GAAP adjustment | $ | 2,374 | $ | 4,661 | $ | 13,378 | $ | 15,006 | |||||||
(b) Legal costs and charges incurred in connection with the settlement of the class action lawsuit in 2017 and insurance claims in 2016. | |||||||||||||||
(c) Represent share-based compensation expense incurred. | |||||||||||||||
Three Months Ended December 31, | Year Ended December 31, | ||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||
Cost of services | $ | 1,219 | $ | 1,211 | $ | 4,988 | $ | 4,956 | |||||||
General and administrative | 1,722 | 983 | 4,707 | 4,145 | |||||||||||
Total Non-GAAP adjustment | $ | 2,941 | $ | 2,194 | $ | 9,695 | $ | 9,101 | |||||||
(d) Represent results at closed operations and operations not at full capacity. | |||||||||||||||
Three Months Ended December 31, | Year Ended December 31, | ||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||
Revenue | $ | — | $ | (499 | ) | $ | (2,805 | ) | $ | (603 | ) | ||||
(Gains)/Losses related to operational closures | (410 | ) | — | 2,321 | — | ||||||||||
Cost of services | 321 | 743 | 5,115 | 9,309 | |||||||||||
Rent | 93 | 55 | 885 | 118 | |||||||||||
Depreciation and amortization | — | 8 | 86 | 21 | |||||||||||
Total Non-GAAP adjustment | $ | 4 | $ | 307 | $ | 5,602 | $ | 8,845 | |||||||
(e) Represent bonus accrual as a result of the Tax Act. | |||||||||||||||
Three Months Ended December 31, | Year Ended December 31, | ||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||
Cost of services | 600 | — | 600 | — | |||||||||||
General and administrative | 2,500 | — | 2,500 | — | |||||||||||
Total Non-GAAP adjustment | $ | 3,100 | $ | — | $ | 3,100 | $ | — | |||||||
(f) Losses related to Hurricane Harvey and California fires on impacted operations. | |||||||||||||||
Three Months Ended December 31, | Year Ended December 31, | ||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||
Revenue | $ | 870 | $ | — | $ | 638 | $ | — | |||||||
Cost of services | (129 | ) | — | 604 | — | ||||||||||
Rent | — | — | 50 | — | |||||||||||
Depreciation and amortization | — | — | 7 | — | |||||||||||
Total Non-GAAP adjustment | $ | 741 | $ | — | $ | 1,299 | $ | — | |||||||
(g) Included in depreciation and amortization are amortization expenses related to patient base intangible assets at newly acquired skilled nursing and assisted living facilities. | |||||||||||||||
(h) Included in general and administrative expense are costs incurred to acquire an operation which are not capitalizable. | |||||||||||||||
(i) Included in general and administrative expense are costs incurred related to new systems implementation and professional fees associated with income tax rate credits, tax reform impacts and adoption of the new revenue recognition standard. | |||||||||||||||
(j) Represent operating results at urgent care centers, including noncontrolling interest. | |||||||||||||||
Three Months Ended December 31, | Year Ended December 31, | ||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||
Revenue | $ | — | $ | (4,186 | ) | $ | — | $ | (24,759 | ) | |||||
Cost of services | — | 4,342 | — | 22,420 | |||||||||||
Rent | — | 406 | — | 2,021 | |||||||||||
Depreciation and amortization | — | — | — | 861 | |||||||||||
Non-controlling interest | — | 2,612 | — | 2,606 |
Total Non-GAAP adjustment | $ | — | $ | 3,174 | $ | — | $ | 3,149 | |||||||
(k) Included in (gain)/loss related to divestitures is gain on sale of urgent care centers. | |||||||||||||||
(l) Included in interest expense are write-offs of deferred financing fees associated with the amendment of credit facility for the year ended December 31, 2016. | |||||||||||||||
(m) Represents an adjustment to provision for income tax to our historical year to date effective tax rate of 35.5%, resulting from adoption of ASU 2016-09, for the three months ended and year ended December 31, 2017 and 38.5% for the three months ended and year ended December 31, 2016. |
Three Months Ended December 31, | Year Ended December 31, | ||||||||||||||
2017 | 2016 | 2017 | 2016 | ||||||||||||
Consolidated Statements of Income Data: | |||||||||||||||
Net income | $ | 11,222 | $ | 21,006 | $ | 40,833 | $ | 52,843 | |||||||
Less: net income attributable to noncontrolling interests | 16 | 2,669 | 358 | 2,853 | |||||||||||
Interest expense, net | 2,963 | 1,826 | 12,007 | 6,029 | |||||||||||
Provision for income taxes | 11,958 | 12,851 | 28,445 | 32,975 | |||||||||||
Depreciation and amortization | 11,760 | 9,701 | 44,472 | 38,682 | |||||||||||
EBITDA | $ | 37,887 | $ | 42,715 | $ | 125,399 | $ | 127,676 | |||||||
Adjustments to EBITDA: | |||||||||||||||
Legal costs and charges related to the settlement of the class action lawsuit and insurance claims(a) | 14 | 223 | 11,177 | 4,924 | |||||||||||
Share-based compensation expense(b) | 2,941 | 2,194 | 9,695 | 9,101 | |||||||||||
Results related to closed operations and operations not at full capacity, including continued obligations and closing expenses(c) | (88 | ) | 244 | 4,632 | 8,705 | ||||||||||
(Earnings)/losses related to facilities currently being constructed and other start-up operations(d) | (1,753 | ) | 699 | (3,261 | ) | 3,850 | |||||||||
Bonus accrual as result of the Tax Act(e) | 3,100 | — | 3,100 | — | |||||||||||
Losses related to Hurricane Harvey and California fires on impacted operations (f) | 741 | — | 1,242 | — | |||||||||||
Transaction-related costs(g) | 100 | 164 | 717 | 1,102 | |||||||||||
Costs incurred related to new systems implementation and professional service fee(h) | 80 | 76 | 80 | 1,148 | |||||||||||
Operating results and gain on sale of urgent care centers(i) | — | (13,887 | ) | — | (18,893 | ) | |||||||||
Rent related to items(c),(d),(f) and (i) above | 3,959 | 4,135 | 16,495 | 12,485 | |||||||||||
Adjusted EBITDA | $ | 46,981 | $ | 36,563 | $ | 169,276 | $ | 150,098 | |||||||
Rent—cost of services | 33,652 | 33,507 | 131,919 | 124,581 | |||||||||||
Less: rent related to items(c),(d),(f), and (i) above | (3,959 | ) | (4,135 | ) | (16,495 | ) | (12,485 | ) | |||||||
Adjusted EBITDAR | $ | 76,674 | $ | 65,935 | $ | 284,700 | $ | 262,194 | |||||||
(b) | Share-based compensation expense incurred. |
(c) | Represent results at closed operations and operations not at full capacity during the three months and the years ended December 31, 2017 and 2016, including the fair value of continued obligation under the lease agreement and related closing expenses of $4.0 million and $7.9 million for the years ended December 31, 2017 and 2016, respectively. Included in the year ended December 31, 2017 results is the loss recovery of $1.3 million of certain losses related to a closed facility in prior year. This amount excludes rent, depreciation and interest expense. |
(d) | Represents results related to facilities currently being constructed and other start-up operations. This amount excludes rent, depreciation and interest expense. |
(e) | Bonus accrual as a result of the Tax Act. |
(f) | Losses related to Hurricane Harvey and California fires on impacted operations. This amount excludes rent, depreciation and interest expense. |
(g) | Costs incurred to acquire operations which are not capitalizable. |
(h) | Costs incurred related to new systems implementation and professional fees associated with income tax rate credits, tax reform impacts and adoption of the new revenue recognition standard. |
(i) | Operating results and gain on sale of urgent care centers. This amount excludes rent, depreciation, interest expense and the net loss attributable to the variable interest entity associated with our urgent care business. |
THE ENSIGN GROUP, INC. | |||||||||||||||||||||||||
RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION | |||||||||||||||||||||||||
(In thousands) | |||||||||||||||||||||||||
(Unaudited) | |||||||||||||||||||||||||
The table below reconciles net income from operations to EBITDA, Adjusted EBITDA and Adjusted EBITDAR for each reportable segment for the periods presented: | |||||||||||||||||||||||||
Three Months Ended December 31, | |||||||||||||||||||||||||
Transitional and Skilled Services | Assisted and Independent Services | Home Health and Hospice | |||||||||||||||||||||||
2017 | 2016 | 2017 | 2016 | 2017 | 2016 | ||||||||||||||||||||
Statements of Income Data: | |||||||||||||||||||||||||
Income from operations, excluding general and administrative expense(a) | $ | 39,910 | $ | 28,473 | $ | 4,298 | $ | 2,585 | $ | 5,805 | $ | 4,547 | |||||||||||||
Less: net income attributable to noncontrolling interests | — | — | — | — | 27 | — | |||||||||||||||||||
Depreciation and amortization | 7,890 | 6,661 | 1,647 | 1,036 | 245 | 215 | |||||||||||||||||||
EBITDA | $ | 47,800 | $ | 35,134 | $ | 5,945 | $ | 3,621 | $ | 6,023 | $ | 4,762 | |||||||||||||
Adjustments to EBITDA: | |||||||||||||||||||||||||
Costs at facilities currently being constructed and other start-up operations(b) | (2,046 | ) | 688 | 117 | (66 | ) | 175 | 77 | |||||||||||||||||
Results related to closed operations and operations not at full capacity, including continued obligations and closing expenses(c) | (87 | ) | 244 | (2 | ) | — | — | — | |||||||||||||||||
Impact of Hurricane Harvey and California fires to operations (d) | 741 | — | — | — | — | ||||||||||||||||||||
Share-based compensation expense(e) | 948 | 1,009 | 159 | 88 | 87 | 83 | |||||||||||||||||||
Bonus related to the Tax Act(f) | 575 | — | 25 | — | — | — | |||||||||||||||||||
Insurance reserve in connection with the settlement of claims(g) | — | 223 | — | — | — | — | |||||||||||||||||||
Less: rent related to item(b),(c) and (d) above | $ | 3,078 | $ | 2,500 | $ | 872 | $ | 1,283 | $ | 9 | $ | 9 | |||||||||||||
Adjusted EBITDA | 51,009 | 39,798 | 7,116 | 4,926 | 6,294 | 4,931 | |||||||||||||||||||
Rent—cost of services | 26,624 | 25,314 | 6,354 | 7,283 | 528 | 404 | |||||||||||||||||||
Less: rent related to items(b),(c) and(d) above | $ | (3,078 | ) | $ | (2,500 | ) | $ | (872 | ) | $ | (1,283 | ) | $ | (9 | ) | $ | (9 | ) | |||||||
Adjusted EBITDAR | $ | 74,555 | $ | 62,612 | $ | 12,598 | $ | 10,926 | $ | 6,813 | $ | 5,326 |
Year Ended December 31, | |||||||||||||||||||||||||
Transitional and Skilled Services | Assisted and Independent Services | Home Health and Hospice | |||||||||||||||||||||||
2017 | 2016 | 2017 | 2016 | 2017 | 2016 | ||||||||||||||||||||
Statements of Income Data: | |||||||||||||||||||||||||
Income from operations, excluding general and administrative expense(a) | $ | 140,272 | $ | 118,118 | $ | 16,736 | $ | 11,701 | $ | 19,717 | $ | 16,571 | |||||||||||||
Less: net income attributable to noncontrolling interests | — | — | — | — | 160 | — | |||||||||||||||||||
Depreciation and amortization | 29,928 | $ | 26,298 | $ | 6,334 | $ | 4,157 | $ | 945 | $ | 924 | ||||||||||||||
EBITDA | $ | 170,200 | $ | 144,416 | $ | 23,070 | $ | 15,858 | $ | 20,502 | $ | 17,495 | |||||||||||||
Adjustments to EBITDA: | |||||||||||||||||||||||||
Costs at facilities currently being constructed and other start-up operations(b) | (4,431 | ) | 2,968 | 693 | 727 | 478 | 155 | ||||||||||||||||||
Results related to closed operations and operations not at full capacity, including continued obligations and closing expenses(c) | 3,801 | 8,705 | — | — | 728 | — | |||||||||||||||||||
Impact of Hurricane Harvey and California fires to operations (d) | 1,242 | — | — | — | — | — | |||||||||||||||||||
Share-based compensation expense(e) | 3,909 | 4,192 | 627 | 365 | 345 | 287 | |||||||||||||||||||
Bonus related to the Tax Act(f) | 575 | — | 25 | — | — | — | |||||||||||||||||||
Insurance reserve in connection with the settlement of claims(g) | — | 4,924 | — | — | — | — | |||||||||||||||||||
Less: rent related to item(b),(c) and (d) above | 12,765 | 7,032 | 3,540 | 3,396 | 190 | 36 | |||||||||||||||||||
Adjusted EBITDA | $ | 188,061 | $ | 172,237 | $ | 27,955 | $ | 20,346 | $ | 22,243 | $ | 17,973 | |||||||||||||
Rent—cost of services | 105,520 | 91,761 | 23,950 | 28,906 | 1,977 | 1,151 | |||||||||||||||||||
Less: rent related to items(b),(c) and(d) above | (12,765 | ) | (7,032 | ) | (3,540 | ) | (3,396 | ) | (190 | ) | (36 | ) | |||||||||||||
Adjusted EBITDAR | $ | 280,816 | $ | 256,966 | $ | 48,365 | $ | 45,856 | $ | 24,030 | $ | 19,088 | |||||||||||||