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CST: 19/07/2019 08:25:53   

The Ensign Group Reports Fourth Quarter and Fiscal Year 2018 Results

162 Days ago

Conference Call and Webcast scheduled for tomorrow, February 7, 2019 at 10:00 am PT

MISSION VIEJO, Calif., Feb. 06, 2019 (GLOBE NEWSWIRE) -- The Ensign Group, Inc. (Nasdaq: ENSG), the parent company of the Ensign™ group of skilled nursing, rehabilitative care services, home health, home care, hospice care and assisted living companies, today announced its operating results for the fourth quarter and full year 2018, reporting record GAAP diluted earnings per share of $0.48 for the quarter and $1.70 for the year and record adjusted earnings per share of $0.54 for the quarter and $1.88 for the year (1).

Highlights Include :

  • GAAP earnings per share for the year was $1.70, an increase of 120.8% over the prior year, and adjusted earnings per share was $1.88, up 34.3% over the prior year(1)(2);

  • GAAP earnings per share for the fourth quarter was $0.48, an increase of 128.6% from the prior year quarter, and adjusted earnings per share was $0.54, an increase of 35.0% over the prior year quarter(1)(2);

  • Consolidated GAAP Net Income for the year was $92.4 million, an increase of 128.2% over the prior year, and consolidated adjusted Net Income for the year was $102.1 million, an increase of 38.3% over the prior year (1)(2);

  • Consolidated GAAP Net Income for the fourth quarter was $26.4 million, an increase of 135.2% from the prior year quarter, and adjusted Net Income was $29.4 million, an increase of 39.5% from the prior year quarter(1)(2);

  • Total Transitional and Skilled Services segment income was $190.9 million for the year, an increase of 36.1% over the prior year, and was  $55.2 million for the quarter, an increase of 38.2% over the prior year quarter and 19% sequentially over the third quarter;

  • Same store skilled services occupancy was 78.8%, an increase of 63 basis points over the prior year, and transitioning skilled services occupancy was 75.0%, an increase of 296 basis points over the prior year;

  • Total Home Health and Hospice Services segment revenue for the year was up 20.0% over the prior year to $170.9 million and segment income for the year was up 32.5% over the prior year to $26.1 million(3); and 

  • Total Assisted Living Services segment revenue for the year was up 11.1% over the prior year to $151.8 million and adjusted EBITDAR for the year was up 9.1% over the prior year to $52.8 million.
  1. See "Reconciliation of GAAP to Non-GAAP Financial Information".
  2. Adjusted earnings per share and Consolidated Adjusted Net Income increased by 15.3% and 18.8%, respectively, over the prior year if we applied a 25% tax rate to both periods. Adjusted earnings per share and Consolidated Adjusted Net Income increased by 17.4% and 20.0%, respectively, over the prior year quarter if we applied a 25% tax rate to both periods.
  3. Excludes the impact for the adoption of ASC 606.

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 President and Chief Executive Officer Christopher Christensen.  “The improvement we have been expecting in many of our operations, especially in Texas and Utah, is now materializing and making a meaningful contribution to our performance. However, we have many operations across all of our different buckets in all our geographies that still have tremendous organic upside, even in some of our most mature markets,” he added.  He credited the local operational and clinical leadership teams and all of their field-based and Service Center partners for continuing their relentless focus on clinical and financial performance while they continued to integrate 148 transitioning and newly acquired operations into the organization. 

“Our other lines of business continue to quietly create significant value,” Christensen stated.  He noted that Cornerstone Healthcare, Inc., Ensign’s home health and hospice portfolio subsidiary, grew its segment revenue and income by 20.0% and 32.5%, respectively, over the prior year.  Similarly, he said that Ensign’s assisted living and independent living portfolio company, which provides senior living services in 12 states, grew its segment revenue and adjusted EBITDAR by 11.1% and 9.1%, respectively, over the prior year.  Collectively, these two business segments now represent 15.7% of Ensign’s consolidated revenue. “We are making progress in our evaluation of a long-term strategic opportunity involving our new venture businesses.  Just as with our real estate transaction in 2014, our goal has been, and will be, to ensure that these businesses will benefit our shareholders over the long run,” he added.

Management also provided its 2019 annual guidance with earnings of between $2.17 and $2.26 per diluted share and annual revenue between $2.29 billion and $2.35 billion.  Overall, the midpoint of this guidance represents a 19%, or $0.36 per share, increase from the midpoint of management’s annual earnings guidance for 2018. “We are very excited about the coming year and our guidance demonstrates our optimism for the future,” he said.

Chief Financial Officer Suzanne Snapper reported that, “Our liquidity remains strong with approximately $307.1 million of availability on Ensign’s $450 million credit facility, which also has a built-in expansion option, and 52 unlevered real estate assets that add additional liquidity.”  She also reported that, even after some significant acquisition activity in the quarter, the Company’s lease-adjusted net-debt-to-adjusted EBITDAR ratio decreased again to 3.77x at year end, down from 4.2x at the end of the prior year.  She attributed this trend to the fact that EBITDAR from transitioning and newly acquired operations has continued to grow. She also indicated that cash generated from operations was $210.3 million for the year, which was primarily driven by an increase in operating results, stronger collections and lower taxes.

A discussion of the company's use of non-GAAP financial measures is set forth below. A reconciliation of net income to EBITDA, adjusted EBITDAR and adjusted EBITDA, as well as a reconciliation of GAAP earnings per share, net income to adjusted net earnings per share and adjusted net income, 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, 2018, 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 Highlights

During the quarter, the Company paid a quarterly cash dividend of $0.0475 per share of Ensign common stock. “We are pleased to announce our sixteenth consecutive annual dividend increase, which reflects our strong market position and continued commitment to return value to our shareholders,” Christensen commented.

In October, Ensign announced that its senior living portfolio company, acquired the real estate and operations of Villa Court Assisted Living and Memory Care, a 53-unit assisted living and 20-unit memory care facility located in Las Vegas, Nevada. “We are thrilled to expand our senior housing footprint in Las Vegas. It’s a market in which we anticipate growing as we rely on the talented leaders there that each seek to become the community of choice in their area,” Christensen added.

In November, Ensign announced that its affiliate acquired the real estate and operations of Rock Creek of Ottawa, a post-acute care retirement campus with 93 skilled nursing beds, 71 assisted living units and 24 independent living units located in Ottawa, Kansas. This acquisition represented the fourth transition from a non-profit seller in 2018, demonstrating Ensign’s continued success in working with non-profit operators that are looking to reposition their assets.

Also in November, Ensign acquired the real estate and operations of Creekside Transitional Care and Rehabilitation, a 139-bed skilled nursing and 21-unit assisted living facility located in Meridian, Idaho, and Bennett Hills Rehabilitation and Care Center, a 44-bed skilled nursing facility located in Gooding, Idaho.  These acquisitions bring the number of skilled nursing operations in Idaho to 10, further demonstrating Ensign’s strategy of developing strong clusters in each local healthcare market.

Ensign’s senior living portfolio company also acquired the operations of four assisted living facilities in the Dallas-Fort Worth area of Texas, including: Canyon Creek Memory Care, a 52-unit memory care facility located in Temple, Texas; Bridgewater Memory Care, a 52-unit memory care facility located in Granbury, Texas; Lakeshore Assisted Living and Memory Care, a 46-unit assisted living and 30-unit memory care community located in Rockwall, Texas; and Windsor Court Senior Living, a retirement community with 36 independent living units, 16 memory care units, and seven assisted living units located in Weatherford, Texas. 

Also during the quarter, Cornerstone Healthcare Inc., acquired the following: Alpha Nursing, a home health agency in Washington; Cornerstone Home Health and Hospice in Utah; and Sequoia Hospice in California.  “Each of these acquisitions are small agencies that we purchased from small business owners that were looking to exit the space.  We continue to see attractive growth opportunities like these and will opportunistically acquire when our leadership talent, geography and pricing align,” Christensen added.

Lastly, in January, the Company announced that it acquired the real estate and operations of Cedar Health and Rehabilitation, a skilled nursing facility with 120 skilled nursing beds located in Cedar City, Utah. “As is the case with all of our acquisition efforts, we pursued these operations because our local leaders see a pathway to meaningfully impact the quality of the healthcare services delivered to their residents and resulting occupancy improvements,” Christensen added. 

These additions bring Ensign's growing portfolio to 189 skilled nursing operations, 24 of which also include assisted living operations, 55 assisted and independent living operations, 23 hospice agencies, 24 home health agencies and seven home care businesses across sixteen states.  Ensign owns the real estate at 72 of its 244 healthcare facilities.  Mr. Christensen reaffirmed that Ensign continues to actively seek transactions to acquire real estate and to lease both well-performing and struggling skilled nursing, assisted living and other healthcare related businesses in new and existing markets.

2019 Guidance

Management provided guidance for 2019, with annual revenue guidance of $2.29 billion to $2.35 billion and annual earnings per share guidance of $2.17 to $2.26 per diluted share for 2019.  This guidance represents a 19%, or $0.36 per share, increase from the midpoint of management’s previous annual earnings guidance for 2018. Management’s guidance is based on diluted weighted average common shares outstanding of approximately 56.7 million and a 25% tax rate.  In addition, the guidance assumes, among other things, normalized health insurance costs, anticipated Medicare and Medicaid reimbursement rate increases, net of provider taxes and acquisitions closed in the first half of 2019. 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 7, 2019 at 10:00 a.m. Pacific time (1:00 p.m. Eastern time) to discuss Ensign’s fourth quarter and fiscal year 2018 financial results. To listen to the webcast, or to view any financial or statistical information required by SEC Regulation G, please visit the Investors Relations section of Ensign’s website at http://investor.ensigngroup.net. The webcast will be recorded, and will be available for replay via the website until 5:00 p.m. Pacific Time on Friday, March 1, 2019.

About Ensign

The Ensign Group, Inc.'s independent operating subsidiaries provide a broad spectrum of skilled nursing and assisted living services, physical, occupational and speech therapies, home health and hospice services and other rehabilitative and healthcare services at 244 healthcare facilities, 23 hospice agencies, 24 home health agencies and seven home care businesses in California, Arizona, Texas, Washington, Utah, Idaho, Colorado, Nevada, Iowa, Nebraska, Oregon, Wisconsin, Kansas, South Carolina, Oklahoma, and Wyoming. 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 terms, are not meant to imply that The Ensign Group, Inc. has direct operating assets, employees or revenue, or that any of the operations, the home health and hospice businesses, 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 ENSIGN GROUP, INC. 
CONSOLIDATED STATEMENTS OF INCOME 
(In thousands, except per share data)
               
  Three Months Ended December 31,   Year Ended December 31,
  2018   2018
adjusted to reflect
prior revenue
guidance
  2017   2018   2018
adjusted to reflect
prior revenue
guidance
  2017
Revenue                      
Service revenue $ 497,313     $ 504,387     $ 451,869     $ 1,888,862     $ 1,921,672     $ 1,712,670  
Assisted and independent living revenue   40,462       40,462       35,836       151,797       151,797       136,647  
Total revenue   537,775       544,849       487,705       2,040,659       2,073,469       1,849,317  
Expense                      
Cost of services   427,574       434,648       393,727       1,627,672       1,660,482       1,497,703  
(Return of unclaimed class action settlement)/charges related to class action lawsuit   -       -       -       (1,664 )     (1,664 )     11,000  
(Gains) losses related to divestitures   -       -       (410 )     -       -       2,321  
Rent—cost of services   35,339       35,339       33,652       138,512       138,512       131,919  
General and administrative expense   28,216       28,216       22,833       100,307       100,307       80,617  
Depreciation and amortization   12,199       12,199       11,760       47,344       47,344       44,472  
Total expenses   503,328       510,402       461,562       1,912,171       1,944,981       1,768,032  
Income from operations   34,447       34,447       26,143       128,488       128,488       81,285  
Other income (expense):                      
Interest expense   (3,711 )     (3,711 )     (3,599 )     (15,182 )     (15,182 )     (13,616 )
Interest income   586       586       636       2,063       2,063       1,609  
Other expense, net   (3,125 )     (3,125 )     (2,963 )     (13,119 )     (13,119 )     (12,007 )
Income before provision for income taxes   31,322       31,322       23,180       115,369       115,369       69,278  
Provision for income taxes   4,763       4,763       11,958       22,841       22,841       28,445  
Net income   26,559       26,559       11,222       92,528       92,528       40,833  
Less: net income attributable to noncontrolling interests   199       199       16       164       164       358  
Net income attributable to The Ensign Group, Inc. $ 26,360     $ 26,360     $ 11,206     $ 92,364     $ 92,364     $ 40,475  
                       
Net income per share attributable to The Ensign Group, Inc.:                      
Basic $ 0.50     $ 0.50     $ 0.22     $ 1.78     $ 1.78     $ 0.79  
Diluted $ 0.48     $ 0.48     $ 0.21     $ 1.70     $ 1.70     $ 0.77  
                       
Weighted average common shares outstanding:                      
Basic   52,449       52,449       51,250       52,016       52,016       50,932  
Diluted   54,967       54,967       53,176       54,397       54,397       52,829  
                       
                       

 

THE ENSIGN GROUP, INC.
CONSOLIDATED BALANCE SHEETS
  (In thousands)
       
  December 31,
  2018   2017
Assets      
Current assets:      
Cash and cash equivalents $ 31,083     $ 42,337  
Accounts receivable—less allowance for doubtful accounts of $2,886 and $43,961 at December 31, 2018 and  2017, respectively   276,099       265,068  
Investments—current   8,682       13,092  
Prepaid income taxes   6,219       19,447  
Prepaid expenses and other current assets   24,130       28,132  
Assets held for sale - current   1,859       -  
Total current assets   348,072       368,076  
Property and equipment, net   618,874       537,084  
Insurance subsidiary deposits and investments   36,168       28,685  
Escrow deposits   7,271       228  
Deferred tax assets   11,650       12,745  
Restricted and other assets   20,844       16,501  
Intangible assets, net   31,000       32,803  
Goodwill   80,477       81,062  
Other indefinite-lived intangibles   27,602       25,249  
Total assets $ 1,181,958     $ 1,102,433  
       
Liabilities and equity      
Current liabilities:      
Accounts payable $ 44,236     $ 39,043  
Accrued wages and related liabilities   119,656       90,508  
Accrued self-insurance liabilities—current   25,446       22,516  
Other accrued liabilities   69,784       63,815  
Current maturities of long-term debt   10,105       9,939  
Total current liabilities   269,227       225,821  
Long-term debt—less current maturities   233,135       302,990  
Accrued self-insurance liabilities—less current portion   54,605       50,220  
Deferred rent and other long-term liabilities   11,234       11,268  
Deferred gain related to sale-leaseback   11,417       12,075  
Total equity   602,340       500,059  
Total liabilities and equity $ 1,181,958     $ 1,102,433  
       
       
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,
  2018   2017
Net cash provided by operating activities $ 210,302     $ 72,952  
Net cash used in investing activities   (151,211 )     (106,593 )
Net cash (used in)/provided by financing activities   (70,345 )     18,272  
Net decrease in cash and cash equivalents   (11,254 )     (15,369 )
Cash and cash equivalents beginning of period   42,337       57,706  
Cash and cash equivalents end of period $ 31,083     $ 42,337  
       

 

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,
  2018 (As Reported)   2018
adjusted to reflect prior
revenue guidance
  2017
  2018 (As Reported)   2018
adjusted to reflect prior
revenue guidance
  2017
  $   %   $   %   $   %   $   %   $   %   $   %
                                               
                                               
                                               
                                               
                                               
                                               
                                               
  (Dollars in thousands)   (Dollars in thousands)
Transitional and skilled services $ 441,714   82.1 %   $ 448,518   82.3 %   $ 403,533   82.7 %   $ 1,679,012   82.3 %   $ 1,709,988   82.5 %   $ 1,545,210   83.6 %
Assisted and independent living services   40,462   7.5 %     40,462   7.4 %     35,836   7.4 %     151,797   7.4 %     151,797   7.3 %     136,646   7.4 %
Home health and hospice services:                                              
Home health   22,614   4.2 %     22,882   4.2 %     20,048   4.1 %     86,379   4.2 %     87,728   4.2 %     73,045   3.9 %
Hospice   21,579   4.0 %     21,581   4.0 %     19,636   4.0 %     82,658   4.1 %     83,143   4.0 %     69,358   3.8 %
Total home health and hospice services   44,193   8.2 %     44,463   8.2 %     39,684   8.1 %     169,037   8.3 %     170,871   8.2 %     142,403   7.7 %
All other (1)   11,406   2.2 %     11,406   2.1 %     8,652   1.8 %     40,813   2.0 %     40,813   2.0 %     25,058   1.3 %
Total revenue $ 537,775   100.0 %   $ 544,849   100.0 %   $ 487,705   100.0 %   $ 2,040,659   100.0 %   $ 2,073,469   100.0 %   $ 1,849,317   100.0 %
(1) Includes revenue from services generated in our other ancillary services.
                                               

 

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,        
               
  2018   2017        
               
  (Dollars in thousands)   Change   % Change
Total Facility Results:              
Transitional and skilled revenue (as reported) $ 441,714     $ 403,533     $ 38,181     9.5 %
Transitional and skilled revenue (adjusted to reflect prior revenue guidance)   448,518       403,533       44,985     11.1 %
Number of facilities at period end   164       160       4     2.5 %
Number of campuses at period end*   24       21       3     14.3 %
Actual patient days   1,393,783       1,315,247       78,536     6.0 %
Occupancy percentage — Operational beds   77.9 %     76.2 %       1.7 %
Skilled mix by nursing days   28.6 %     29.1 %       -0.5 %
Skilled mix by nursing revenue   48.1 %     49.3 %       -1.2 %
  Three Months Ended December 31,        
  2018   2017        
               
  (Dollars in thousands)   Change   % Change
Same Facility Results(1):              
Transitional and skilled revenue (as reported) $ 297,587     $ 281,245     $ 16,342     5.8 %
Transitional and skilled revenue (adjusted to reflect prior revenue guidance)   302,130       281,245       20,885     7.4 %
Number of facilities at period end   108       108       -     -  
Number of campuses at period end*   11       11       -     -  
Actual patient days   891,520       878,417       13,103     1.5 %
Occupancy percentage — Operational beds   79.3 %     78.4 %       0.9 %
Skilled mix by nursing days   30.4 %     30.0 %       0.4 %
Skilled mix by nursing revenue   50.3 %     50.4 %       -0.1 %
  Three Months Ended December 31,        
  2018   2017        
               
  (Dollars in thousands)   Change   % Change
Transitioning Facility Results(2):              
Transitional and skilled revenue (as reported) $ 102,084     $ 98,565     $ 3,519     3.6 %
Transitional and skilled revenue (adjusted to reflect prior revenue guidance)   103,746       98,565       5,181     5.3 %
Number of facilities at period end   40       40       -     -  
Number of campuses at period end*   9       9       -     -  
Actual patient days   361,477       352,451       9,026     2.6 %
Occupancy percentage — Operational beds   75.6 %     73.5 %       2.1 %
Skilled mix by nursing days   27.0 %     29.1 %       -2.1 %
Skilled mix by nursing revenue   46.0 %     49.4 %       -3.4 %
  Three Months Ended December 31,        
  2018   2017        
               
  (Dollars in thousands)   Change   % Change
Recently Acquired Facility Results(3):              
Transitional and skilled revenue (as reported) $ 42,043     $ 23,723     $ 18,320     NM
Transitional and skilled revenue (adjusted to reflect prior revenue guidance)   42,642       23,723       18,919     NM
Number of facilities at period end   16       12       4     NM
Number of campuses at period end*   4       1       3     NM
Actual patient days   140,786       84,379       56,407     NM
Occupancy percentage — Operational beds   75.0 %     67.4 %       NM
Skilled mix by nursing days   21.8 %     20.3 %       NM
Skilled mix by nursing revenue   37.0 %     36.1 %       NM
               
*  Campus represents a facility that offers both skilled nursing, assisted and/or independently living services. Revenue and expenses related to skilled nursing, assisted and independent living services have been allocated and recorded in the respective reportable segment.
(1)  Same Facility results represent all facilities purchased prior to January 1, 2015.
           
(2)  Transitioning Facility results represents all facilities purchased from January 1, 2015 to December 31, 2016.
   
(3)  Recently Acquired Facility (Acquisitions) results represent all facilities purchased on or subsequent to January 1, 2017.
   
               
  Year Ended December 31,        
  2018   2017   Change   % Change
               
  (Dollars in thousands)        
Total Facility Results:              
Transitional and skilled revenue (as reported) $ 1,679,012     $ 1,545,210     $ 133,802     8.7 %
Transitional and skilled revenue (adjusted to reflect prior revenue guidance)   1,709,988       1,545,210       164,778     10.7 %
Number of facilities at period end   164       160       4     2.5 %
Number of campuses at period end*   24       21       3     14.3 %
Actual patient days   5,405,952       5,050,140       355,812     7.0 %
Occupancy percentage — Operational beds   77.4 %     75.4 %       2.0 %
Skilled mix by nursing days   29.5 %     30.3 %       -0.8 %
Skilled mix by nursing revenue   49.6 %     51.1 %       -1.5 %
  Year Ended December 31,        
  2018   2017   Change   % Change
               
  (Dollars in thousands)        
Same Facility Results(1):              
Transitional and skilled revenue (as reported) $ 1,143,913     $ 1,108,822     $ 35,091     3.2 %
Transitional and skilled revenue (adjusted to reflect prior revenue guidance)   1,164,930       1,108,822       56,108     5.1 %
Number of facilities at period end   108       108       -     -  
Number of campuses at period end*   11       11       -     -  
Actual patient days   3,515,147       3,485,195       29,952     0.9 %
Occupancy percentage — Operational beds   78.8 %     78.2 %       0.6 %
Skilled mix by nursing days   30.9 %     30.8 %       0.1 %
Skilled mix by nursing revenue   51.3 %     51.5 %       -0.2 %
  Year Ended December 31,        
  2018   2017   Change   % Change
               
  (Dollars in thousands)        
Transitioning Facility Results(2):              
Transitional and skilled revenue (as reported) $ 399,747     $ 382,805     $ 16,942     4.4 %
Transitional and skilled revenue (adjusted to reflect prior revenue guidance)   407,351       382,805       24,546     6.4 %
Number of facilities at period end   40       40       -     -  
Number of campuses at period end*   9       9       -     -  
Actual patient days   1,424,563       1,371,769       52,794     3.8 %
Occupancy percentage — Operational beds   75.0 %     72.1 %       2.9 %
Skilled mix by nursing days   28.8 %     30.1 %       -1.3 %
Skilled mix by nursing revenue   48.4 %     51.5 %       -3.1 %
  Year Ended December 31,        
  2018   2017   Change   % Change
               
  (Dollars in thousands)        
Recently Acquired Facility Results(3):              
Transitional and skilled revenue (as reported) $ 135,352     $ 51,715     $ 83,637     NM
Transitional and skilled revenue (adjusted to reflect prior revenue guidance)   137,707       51,715       85,992     NM
Number of facilities at period end   16       12       4     NM
Number of campuses at period end*   4       1       3     NM
Actual patient days   466,242       187,601       278,641     NM
Occupancy percentage — Operational beds   74.3 %     58.1 %       NM
Skilled mix by nursing days   21.9 %     20.5 %       NM
Skilled mix by nursing revenue   38.0 %     37.3 %       NM
  Year Ended December 31,        
  2018   2017   Change   % Change
               
  (Dollars in thousands)        
Facility Closed Results(4):              
Skilled nursing revenue $ -     $ 1,868     $ (1,868 )   NM
Actual patient days   -       5,575       (5,575 )   NM
Occupancy percentage — Operational beds   0.0 %     34.3 %       NM
Skilled mix by nursing days   0.0 %     46.7 %       NM
Skilled mix by nursing revenue   0.0 %     71.5 %       NM
               
*  Campus represents a facility that offers both skilled nursing, assisted and/or independent living services. Revenue and expenses related to skilled nursing, assisted and independent living services have been allocated and recorded in the respective reportable segment.
(1)  Same Facility results represent all facilities purchased prior to January 1, 2015.
           
(2)  Transitioning Facility results represent all facilities purchased from January 1, 2015 to December 31, 2016.
   
(3)  Recently Acquired Facility (Acquisitions) results represent all facilities purchased on or subsequent to January 1, 2017.
   
(4)  Facility Closed results represent closed operations during the year ended December 31, 2017, which were excluded from Same Store and Transitioning results for the year ended December 31, 2017, 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
  2018   2017   2018   2017   2018   2017   2018   2017
Skilled Nursing Average Daily Revenue Rates:                              
Medicare $ 625.29   $ 612.89   $ 525.44   $ 514.34   $ 531.75   $ 517.26   $ 590.27   $ 576.93
Managed care   469.53     455.55     417.66     409.54     412.85     426.99     450.91     441.71
Other skilled   504.67     471.08     354.42     351.02     517.34     425.31     486.26     453.31
Total skilled revenue   539.91     520.39     461.99     455.88     481.67     478.03     516.35     501.22
Medicaid   234.66     221.23     201.70     191.97     231.08     215.32     225.68     213.31
Private and other payors   229.13     200.39     199.94     184.56     223.75     211.38     219.89     210.57
Total skilled nursing revenue $ 327.17   $ 307.86   $ 271.87   $ 267.20   $ 284.91   $ 267.93   $ 308.52   $ 297.12
                               
  Year   Ended December 31,
  Same Facility   Transitioning   Acquisitions   Total
  2018   2017   2018   2017   2018   2017   2018   2017
Skilled Nursing Average Daily Revenue Rates:                              
Medicare $ 615.47   $ 603.28   $ 518.33   $ 508.15   $ 528.92   $ 506.12   $ 580.96   $ 569.77
Managed care   464.89     451.28     412.42     414.44     415.49     416.25     447.34     440.55
Other skilled   493.63     465.72     354.34     364.65     489.66     470.51     475.59     451.16
Total skilled revenue   530.95     516.26     457.59     457.93     483.67     479.63     509.10     499.51
Medicaid   226.64     217.47     196.47     184.24     221.42     206.32     218.30     208.24
Private and other payors   225.89     202.22     201.03     191.92     226.71     210.28     218.42     209.72
Total skilled nursing revenue $ 320.96   $ 307.35   $ 272.34   $ 267.71   $ 279.86   $ 262.90   $ 304.57   $ 296.84
                               

 

                               
The following tables set forth our percentage of skilled nursing patient revenue and days by payor source for the three months ended and year ended December 31, 2018 and 2017:
                               
  Three Months Ended December 31,
  Same Facility   Transitioning   Acquisitions   Total
  2018
  2017
  2018
  2017
  2018
  2017
  2018
  2017
Percentage of Skilled Nursing Revenue:                              
Medicare 23.6 %   23.3 %   24.2 %   27.2 %   20.3 %   22.2 %   23.4 %   24.2 %
Managed care 16.8 %   18.1 %   18.6 %   19.0 %   13.0 %   10.4 %   16.9 %   17.8 %
Other skilled 9.9 %   9.0 %   3.2 %   3.2 %   3.7 %   3.5 %   7.8 %   7.3 %
Skilled mix 50.3 %   50.4 %   46.0 %   49.4 %   37.0 %   36.1 %   48.1 %   49.3 %
Private and other payors 7.6 %   7.8 %   9.8 %   10.9 %   10.7 %   12.3 %   8.4 %   8.9 %
Quality mix 57.9 %   58.2 %   55.8 %   60.3 %   47.7 %   48.4 %   56.5 %   58.2 %
Medicaid 42.1 %   41.8 %   44.2 %   39.7 %   52.3 %   51.6 %   43.5 %   41.8 %
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
  2018
  2017
  2018
  2017
  2018
  2017
  2018
  2017
Percentage of Skilled Nursing Days:                              
Medicare 12.3 %   11.8 %   12.5 %   14.2 %   10.8 %   11.5 %   12.2 %   12.4 %
Managed care 11.6 %   12.3 %   12.1 %   12.4 %   8.9 %   6.5 %   11.5 %   11.9 %
Other skilled 6.5 %   5.9 %   2.4 %   2.5 %   2.1 %   2.3 %   4.9 %   4.8 %
Skilled mix 30.4 %   30.0 %   27.0 %   29.1 %   21.8 %   20.3 %   28.6 %   29.1 %
Private and other payors 11.2 %   11.6 %   13.5 %   15.4 %   14.0 %   15.5 %   12.2 %   12.9 %
Quality mix 41.6 %   41.6 %   40.5 %   44.5 %   35.8 %   35.8 %   40.8 %   42.0 %
Medicaid 58.4 %   58.4 %   59.5 %   55.5 %   64.2 %   64.2 %   59.2 %   58.0 %
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
  2018
  2017
  2018
  2017
  2018
  2017
  2018
  2017
Percentage of Skilled Nursing Revenue:                              
Medicare 23.8 %   24.7 %   25.9 %   29.0 %   22.3 %   25.8 %   24.2 %   25.8 %
Managed care 17.8 %   18.2 %   19.4 %   19.1 %   11.9 %   8.5 %   17.7 %   18.1 %
Other skilled 9.7 %   8.6 %   3.1 %   3.4 %   3.8 %   3.0 %   7.7 %   7.2 %
Skilled mix 51.3 %   51.5 %   48.4 %   51.5 %   38.0 %   37.3 %   49.6 %   51.1 %
Private and other payors 7.7 %   7.9 %   10.1 %   10.5 %   11.3 %   13.2 %   8.5 %   8.6 %
Quality mix 59.0 %   59.4 %   58.5 %   62.0 %   49.3 %   50.5 %   58.1 %   59.7 %
Medicaid 41.0 %   40.6 %   41.5 %   38.0 %   50.7 %   49.5 %   41.9 %   40.3 %
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
  2018
  2017
  2018
  2017
  2018
  2017
  2018
  2017
Percentage of Skilled Nursing Days:                              
Medicare 12.3 %   12.6 %   13.6 %   15.3 %   11.7 %   13.4 %   12.6 %   13.4 %
Managed care 12.2 %   12.5 %   12.8 %   12.3 %   8.0 %   5.4 %   12.0 %   12.2 %
Other skilled 6.4 %   5.7 %   2.4 %   2.5 %   2.2 %   1.7 %   4.9 %   4.7 %
Skilled mix 30.9 %   30.8 %   28.8 %   30.1 %   21.9 %   20.5 %   29.5 %   30.3 %
Private and other payors 11.2 %   11.6 %   13.8 %   14.6 %   14.3 %   16.4 %   12.2 %   12.5 %
Quality mix 42.1 %   42.4 %   42.6 %   44.7 %   36.2 %   36.9 %   41.7 %   42.8 %
Medicaid 57.9 %   57.6 %   57.4 %   55.3 %   63.8 %   63.1 %   58.3 %   57.2 %
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 periods indicated:
               
  Three Months Ended December 31,        
  2018   2017   Change   % Change
               
  (Dollars in thousands)        
Revenue $ 40,462     $ 35,836     $ 4,626   12.9 %
Number of facilities at period end   56       49       7   14.3 %
Number of campuses at period end   24       21       3   14.3 %
Occupancy percentage (units)   75.9 %     75.8 %       0.1 %
Average monthly revenue per unit $ 2,866     $ 2,792     $ 74   2.7 %
               
  Year Ended December 31,        
  2018   2017   Change   % Change
               
  (Dollars in thousands)        
Resident fee revenue $ 151,797     $ 136,646     $ 15,151   11.1 %
Number of facilities at period end   56       49       7   14.3 %
Number of campuses at period end   24       21       3   14.3 %
Occupancy percentage (units)   75.7 %     76.4 %       -0.7 %
Average monthly revenue per unit $ 2,861     $ 2,800     $ 61   2.2 %
               

 

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 periods indicated:
               
  Three Months Ended December 31,        
  2018   2017   Change   % Change
               
  (Dollars in thousands)        
Home health and hospice revenue:              
Home health services $ 22,614   $ 20,048   $ 2,566     12.8 %
Hospice services   21,579     19,636     1,943     9.9 %
Total home health and hospice revenue $ 44,193   $ 39,684   $ 4,509     11.4 %
Adjusted to reflect prior revenue guidance              
Home health and hospice revenue              
Home health services $ 22,882   $ 20,048   $ 2,834     14.1 %
Hospice services   21,581     19,636     1,945     9.9 %
Total home health and hospice revenue $ 44,463   $ 39,684   $ 4,779     12.0 %
Home health services:              
Average medicare revenue per completed episode $ 3,027   $ 2,985   $ 42     1.4 %
Hospice services:              
Average daily census   1,386     1,229     157     12.8 %
Home health and hospice agencies   54     46     8     17.4 %
               
  Year Ended December 31,        
  2018   2017   Change   % Change
               
  (Dollars in thousands)        
Home health and hospice revenue              
Home health services $ 86,379   $ 73,045   $ 13,334     18.3 %
Hospice services   82,658     69,358     13,300     19.2 %
Total home health and hospice revenue $ 169,037   $ 142,403   $ 26,634     18.7 %
Adjusted to reflect prior revenue guidance              
Home health and hospice revenue              
Home health services $ 87,728   $ 73,045   $ 14,683     20.1 %
Hospice services   83,143     69,358     13,785     19.9 %
Total home health and hospice revenue $ 170,871   $ 142,403   $ 28,468     20.0 %
Home health services:              
Average medicare revenue per completed episode $ 2,982   $ 3,028   $ (46 )   -1.5 %
Hospice services:              
Average daily census   1,329     1,102     227     20.6 %
Home health and hospice agencies   54     46     8     17.4 %
               

 

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,
    2018 As Reported   2018 adjusted to reflect
prior revenue guidance
  2017
  2018 As Reported   2018 adjusted to reflect
prior revenue guidance
  2017
    $   %   $   %   $   %   $   %   $   %   $   %
                                                 
    (Dollars in thousands)   (Dollars in thousands)
Revenue:                                                
Medicaid   $ 198,030   36.8 %   $ 200,289   36.8 %   $ 174,795   35.8 %   $ 727,310   35.6 %   $ 738,179   35.6 %   $ 644,803   34.9 %
Medicare     142,896   26.6 %     143,081   26.3 %     130,465   26.8 %     552,577   27.1 %     556,159   26.8 %     515,884   27.9 %
Medicaid-skilled     31,662   5.9 %     32,073   5.8 %     27,208   5.6 %     117,686   5.8 %     119,667   5.8 %     102,875   5.6 %
Total     372,588   69.3 %     375,443   68.9 %     332,468   68.2 %     1,397,573   68.5 %     1,414,005   68.2 %     1,263,562   68.4 %
Managed Care     82,263   15.3 %     83,485   15.3 %     78,176   16.0 %     326,325   16.0 %     333,197   16.1 %     303,386   16.4 %
Private and Other(1)     82,924   15.4 %     85,921   15.8 %     77,061   15.8 %     316,761   15.5 %     326,267   15.7 %     282,369   15.2 %
Total revenue   $ 537,775   100.0 %   $ 544,849   100.0 %   $ 487,705   100.0 %   $ 2,040,659   100.0 %   $ 2,073,469   100.0 %   $ 1,849,317   100.0 %
(1) Private and other payors also includes revenue from all payors generated in our other ancillary services for the three months ended and year ended December 31, 2018 and 2017.
                                                 

 

               
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
               
  Three Months Ended
December 31,
  Year Ended
December 31,
  2018   2017   2018   2017
Net income attributable to The Ensign Group, Inc. $ 26,360     $ 11,206     $ 92,364     $ 40,475  
               
Non-GAAP adjustments              
Results related to facilities currently being constructed and other start-up operations(a)   492       2,374       3,840       13,378  
Charges related to the settlement/(return of unclaimed class action settlement) of the class action lawsuit   -       14       (1,664 )     11,177  
Share-based compensation expense(b)   2,697       2,941       10,337       9,695  
Results related to closed operations and operations not at full capacity, including continued obligations and closing expense(c)   222       4       933       5,602  
Bonus accrual as a result of the Tax Act(d)   -       3,100       -       3,100  
Losses/(business interruption gains) related to Hurricane Harvey and California fires(e)   -       741       (675 )     1,299  
Depreciation and amortization - patient base(f)   91       180       242       733  
General and administrative - transaction-related costs(g)   23       100       361       717  
COS - business interruption gains(h)   -       -           -  
COS - Goodwill and long-lived assets impairment(h)   4,632       -       7,809       -  
Professional service fees(i)   -       80       -       80  
Provision for income taxes on non-GAAP adjustments(j)   (5,107 )     344       (11,416 )     (12,399 )
Non-GAAP net income $ 29,410     $ 21,084     $ 102,131     $ 73,857  
               
Diluted Earnings Per Share As Reported              
Net income $ 0.48     $ 0.21     $ 1.70     $ 0.77  
Average number of shares outstanding   54,967       53,176       54,397       52,829  
               
Adjusted Diluted Earnings Per Share              
Net income   0.54       0.40       1.88       1.40  
Average number of shares outstanding   54,967       53,176       54,397       52,829  
               
Footnotes:              
(a) Represents operating results for facilities currently being constructed and other start-up operations.              
  Three Months Ended
December 31,
  Year Ended
December 31,
  2018   2017   2018   2017
Revenue $ (17,029 )   $ (17,480 )   $ (66,606 )   $ (62,686 )
Cost of services   13,661       15,726       55,106       59,424  
Rent   3,627       3,865       14,377       15,559  
Depreciation and amortization   233       263       963       1,081  
Total Non-GAAP adjustment $ 492     $ 2,374     $ 3,840     $ 13,378  
               
(b)  Represents share-based compensation expense incurred.              
  Three Months Ended
December 31,
  Year Ended
December 31,
  2018   2017   2018   2017
Cost of services $ 1,494     $ 1,219     $ 5,665     $ 4,988  
General and administrative   1,203       1722       4,672       4,707  
Total Non-GAAP adjustment $ 2,697     $ 2,941     $ 10,337     $ 9,695  
       
(c) Represents results at closed operations and operations not at full capacity, including the fair value of continued obligation under the lease agreement and related closing expenses of $4.0 million for the year ended December 31, 2017. Included in the three months and year ended December 31, 2017 results is the loss recovery of $1.3 million of certain losses related to a closed facility in the prior year.
  Three Months Ended
December 31,
  Year Ended
December 31,
  2018   2017   2018   2017
Revenue $ -     $ -     $ -     $ (2,805 )
(Gains)/Losses related to operational closures   -       (410 )     -       2,321  
Cost of services   137       321       601       5,115  
Rent   76       93       301       885  
Depreciation and amortization   9       -       31       86  
Total Non-GAAP adjustment $ 222     $ 4     $ 933     $ 5,602  
               
(d)  Represent bonus accrual as a result of the Tax Act.              
  Three Months Ended
December 31,
  Year Ended
December 31,
  2018   2017   2018   2017
Cost of services   -       600       -       600  
General and administrative   -       2,500       -       2,500  
Total Non-GAAP adjustment $ -     $ 3,100     $ -     $ 3,100  
               
(e) Losses and business interruption recoveries related to Hurricane Harvey and California fires.              
  Three Months Ended
December 31,
  Year Ended
December 31,
  2018   2017   2018   2017
Revenue $ -     $ 870     $ -     $ 638  
Cost of services   -       (129 )     (675 )     604  
Rent   -       -       -       50  
Depreciation and amortization   -       -       -       7  
Total Non-GAAP adjustment $ -     $ 741     $ (675 )   $ 1,299  
(f) Included in depreciation and amortization are amortization expenses related to patient base intangible assets at newly acquired skilled nursing and assisted living facilities.              
(g) Included in general and administrative expense are costs incurred to acquire an operation which are not capitalizable.            
(h) Impairment charges to goodwill and long-lived assets at one of our other ancillary operations and two assisted living facilities.        
  Three Months Ended
December 31,
  Year Ended
December 31,
  2018   2017   2018   2017
Cost of services   4,632       -       8,285       -  
Non-controlling interest   -       -       (476 )     -  
Total Non-GAAP adjustment $ 4,632     $ -     $ 7,809     $ -  
(i) Included in general and administrative expense are professional fees associated with income tax rate credits, tax reform impacts and adoption of the new revenue recognition standard.              
(j) Represents an adjustment to the provision for income tax to our historical year to date effective tax rate of 25.0%, resulting from the adoption of the Tax Cuts and Jobs Act, for the three months and year ended December 31, 2018 and 35.5% for the three months and year ended December 31, 2017.
               

 

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,
  2018   2017   2018   2017
Consolidated Statements of Income Data:              
Net income $ 26,559     $ 11,222     $ 92,528     $ 40,833  
Less: net income attributable to noncontrolling interests   199       16       164       358  
Interest expense, net   3,125       2,963       13,119       12,007  
Provision for income taxes   4,763       11,958       22,841       28,445  
Depreciation and amortization   12,199       11,760       47,344       44,472  
EBITDA $ 46,447     $ 37,887     $ 175,668     $ 125,399  
 
Adjustments to EBITDA:              
Earnings related to operations in the start-up phase   (3,368 )     (1,753 )     (11,500 )     (3,261 )
Charges related to the settlement/(return of unclaimed class action settlement) of the class action lawsuit and insurance claims   -       14       (1,664 )     11,177  
Share-based compensation expense   2,697       2,941       10,337       9,695  
Results related to closed operations and operations not at full capacity(a)   137       (88 )     601       4,632  
Bonus accrual as a result of the Tax Act   -       3,100       -       3,100  
Losses/(business insurance recoveries) related to Hurricane Harvey and California fires   -       741       (675 )     1,242  
Transaction-related costs(b)   23       100       361       717  
Professional service fee(c)   -       80       -       80  
Impairment of long-lived assets and goodwill(d)   4,632       -       7,809       -  
Rent related to items above   3,703       3,959       14,678       16,495  
Adjusted EBITDA $ 54,271     $ 46,981     $ 195,615     $ 169,276  
Rent—cost of services   35,339       33,652       138,512       131,919  
Less: rent related to items  above   (3,703 )     (3,959 )     (14,678 )     (16,495 )
Adjusted EBITDAR $ 85,907     $ 76,674     $ 319,449     $ 284,700  
               
               
(a)  Represents results at closed operations and operations not at full capacity during the years ended December 31, 2018 and 2017; including the fair value of continued obligation under the lease agreement and related closing expenses of $4.0 million for the year ended December 31, 2017. 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 2016.
(b)  Costs incurred to acquire operations which are not capitalizable.
(c)  Professional fees associated with income tax credits, tax reform impacts and adoption of the new revenue recognition standard.
(d)  Impairment charges of long-lived assets and goodwill during year ended December 31, 2018, excluding the impact of non-controlling interest of $0.5 million. Including the impact of noncontrolling interest, the impairment charge is $8.3 million.
               

 

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,   Year Ended December 31,
    Transitional and Skilled Services   Assisted and Independent Services   Home Health and
Hospice
  Transitional and Skilled Services   Assisted and Independent Services   Home Health and
Hospice
    2018   2017   2018   2017   2018   2017   2018   2017   2018   2017   2018   2017
                                                 
Statements of Income Data:                                                
Income from operations, excluding general and administrative expense(a)   $ 55,169     $ 39,910     $ 1,065     $ 4,298     $ 6,494     $ 5,805     $ 190,924     $ 140,272     $ 15,426     $ 16,736     $ 26,117     $ 19,717  
Less: net income attributable to noncontrolling interests     -       -       -       -       183       27       -       -       -       -       595       160  
Depreciation and amortization     8,360       7,890       1,920       1,647       256       245       31,931       29,928       7,282       6,334       1,045       945  
EBITDA   $ 63,529     $ 47,800     $ 2,985     $ 5,945     $ 6,567     $ 6,023     $ 222,855     $ 170,200     $ 22,708     $ 23,070     $ 26,567     $ 20,502  
                                                 
Adjustments to EBITDA:                                                
Results related to operations in the start-up phase     (3,455 )     (2,046 )     52       117       35       175       (11,924 )     (4,431 )     295       693       129       478  
Results related to closed operations and operations not at full capacity     137       (87 )     -       (2 )     -       -       601       3,801       -       -       -       728  
Losses/(business interruption recoveries) related to Hurricane Harvey and California fires     -       741       -       -       -       -       (675 )     1,242       -       -       -       -  
Share-based compensation expense     1,256       948       74       159       132       87       4,516       3,909       595       627       446       345  
Long-lived assets impairment(b)     -       -       4,632       -       -       -       -       -       4,632       -       -       -  
Bonus related to the Tax Act     -       575       -       25       -       -       -       575       -       25       -       -  
Rent related to item above     2,916       3,078       778       872       9       9       11,220       12,765       3,428       3,540       30       190  
Adjusted EBITDA     64,383       51,009       8,521       7,116       6,743       6,294       226,593       188,061       31,658       27,955       27,172       22,243  
Rent—cost of services     28,301       26,624       6,230       6,354       609       528       110,999       105,520       24,553       23,950       2281       1977  
Less: rent related to items above     (2,916 )     (3,078 )     (778 )     (872 )     (9 )     (9 )     (11,220 )     (12,765 )     (3,428 )     (3,540 )     (30 )     (190 )
Adjusted EBITDAR   $ 89,768     $ 74,555     $ 13,973     $ 12,598