Ensign Group(ENSG) - 2025 Q2 - Quarterly Results

Executive Summary & Highlights Second Quarter 2025 Financial Highlights The Ensign Group reported strong second quarter 2025 results, with significant year-over-year increases in GAAP and adjusted earnings per share, net income, and consolidated revenue. Operational metrics also showed robust growth, including higher occupancy rates and increased skilled services revenue across all facility types Second Quarter 2025 Key Financial & Operational Highlights (YoY Change) | Metric | Q2 2025 Value | YoY Change (%) | | :-------------------------------- | :---------------- | :------------- | | GAAP Diluted EPS | $1.44 | 18.0% | | Adjusted Diluted EPS | $1.59 | 20.5% | | GAAP Net Income | $84.4 million | 18.9% | | Adjusted Net Income | $93.3 million | 22.1% | | Same Facilities Occupancy | 82.1% | 2.0% | | Transitioning Facilities Occupancy | 84.0% | 4.6% | | Total Skilled Services Revenue | $1.17 billion | 18.4% | | Consolidated GAAP & Adjusted Revenue | $1.23 billion | 18.5% | | Standard Bearer Revenue | $31.5 million | 34.7% | | Standard Bearer FFO | $18.4 million | 26.6% | Annual Guidance Update Following a strong first half of 2025, The Ensign Group raised its annual earnings and revenue guidance for the year. The updated guidance reflects current quarter performance and anticipated acquisitions through the third quarter, with a new midpoint for earnings representing a significant increase over prior years Updated Annual 2025 Guidance | Metric | Previous Guidance | New Guidance | | :-------------------- | :------------------ | :------------- | | Diluted EPS | $6.22 to $6.38 | $6.34 to $6.46 | | Revenue | $4.89 billion to $4.94 billion | $4.99 billion to $5.02 billion | - The new midpoint of the increased 2025 earnings guidance represents an increase of more than 16% over 2024 results and 34% higher than 2023 results[5] - Guidance assumptions include diluted weighted average common shares outstanding of approximately 59.0 million, a 25.0% tax rate, normalized insurance costs, acquisitions expected to close through the third quarter, and current expectations regarding reimbursement rates. It excludes certain non-recurring charges, acquisition-related costs, and share-based compensation[6] Operational Review and Growth Strategy Management Commentary Management highlighted the outstanding performance of local teams, driving record second-quarter occupancy and skilled mix improvements. The company continues to pursue strategic acquisitions, adding 52 new operations since the beginning of 2024, many of which are exceeding expectations - Same store and transitioning occupancy increased to 82.1% and 84.0%, respectively, setting new second-quarter records[4] - Skilled daily census increased by 7.4% for same store operations and 13.5% for transitioning operations over the prior year quarter[4] - The company added eight new operations, including three real estate assets, during or since the quarter, bringing the total acquired operations since the beginning of 2024 to 52[6] - Liquidity remains strong with approximately $364.0 million of cash on hand and $592.6 million of available capacity under its line-of-credit[6] Growth and Real Estate Activities The company continues its acquisition strategy, expanding its presence in mature markets and deepening its commitment to healthcare communities. The overall portfolio now includes 348 healthcare operations across 17 states, with a balanced approach to leasing and acquiring real estate assets - Ensign's growing portfolio consists of 348 healthcare operations, 31 of which also include senior living operations, across 17 states[8] - Ensign now owns 146 real estate assets, 110 of which are operated by an Ensign affiliate[8] - The company's strategy includes both leasing and acquiring real estate, actively seeking performing and underperforming operations in several states[8] Recent Acquisitions Details The Ensign Group recently acquired several leased operations and real estate assets, expanding its footprint in California, Idaho, Washington, and Texas, primarily focusing on skilled nursing and senior living facilities - Recent leased operations acquisitions include: * Alamitos West Health and Rehabilitation (142-bed skilled nursing, Los Alamitos, CA) * Katella Senior Living Community (68-unit senior living, Los Alamitos, CA) * Toluca Lake Transitional Care (52-bed skilled nursing, North Hollywood, CA) * Ironwood Rehabilitation and Care Center (80-bed skilled nursing, Coeur d'Alene, ID) * Lakeside Rehabilitation and Care Center (100-bed skilled nursing, Coeur d'Alene, ID)[8][12] - Standard Bearer also acquired real estate assets operated by an Ensign-affiliate: * Pacific Haven Subacute and Healthcare Center (99-bed skilled nursing, Garden Grove, CA) * Marianwood Health and Rehabilitation (117-bed skilled nursing, Issaquah, WA) * Timber Springs Transitional Care (120-bed skilled nursing, Boise, ID)[8][12] - Three real estate assets were acquired and are operated by third-parties under triple net leases: * Mother Joseph Care Center (152-bed skilled nursing, Olympia, WA) * Emilie Court Assisted Living (60-unit senior living, Spokane, WA) * Duncanville Healthcare and Rehabilitation Center (107-bed skilled nursing, Duncanville, TX)[8][12] Standard Bearer Segment Overview The Standard Bearer segment comprises 140 owned properties, primarily leased under triple-net, long-term agreements to both Ensign-affiliated and third-party operators, generating significant rental revenue and FFO for the quarter - Standard Bearer is comprised of 140 owned properties, with 106 leased to Ensign-affiliated operators and 35 leased to third-party operators[9] Standard Bearer Q2 2025 Performance | Metric | Value | | :---------------- | :------------ | | Rental Revenue | $31.5 million | | FFO | $18.4 million | Dividend Policy The company paid a quarterly cash dividend of $0.0625 per share and plans to continue its long history of dividend payments, having increased the dividend for the 22nd consecutive year in December 2024 - Paid a quarterly cash dividend of $0.0625 per share of Ensign common stock[10] - Plans to continue its long history of paying dividends, having increased the dividend for the 22nd consecutive year in December 2024[10] Corporate Information About The Ensign Group The Ensign Group, Inc. operates through independent subsidiaries providing skilled nursing, senior living, and various rehabilitative and healthcare services across 17 states. The company also invests in healthcare real estate and offers other post-acute related services - Independent subsidiaries provide skilled nursing, senior living, physical, occupational, and speech therapies, and other rehabilitative and healthcare services at 348 facilities in 17 states[13] - Investment strategy includes acquiring, leasing, and owning healthcare real estate for the post-acute care continuum[13] - New business venture operating subsidiaries offer additional post-acute services such as mobile x-ray, transportation, long-term care pharmacy, and consulting services[13] Safe Harbor Statement The report contains forward-looking statements subject to various risks and uncertainties, including those related to reimbursement rates, acquisition capabilities, borrowing costs, competition, litigation, and regulatory changes, which could cause actual results to differ materially - Forward-looking statements are based on management's current expectations and are not guarantees of future results[14] - Risks and uncertainties include reduced prices and reimbursement rates, ability to acquire/manage operations, increasing borrowing costs, access to capital, operating margins, competition, litigation, and government regulations[15] - Readers are encouraged to review the Company's periodic SEC filings for a more complete discussion of risks[15] Consolidated Financial Statements Condensed Consolidated Statements of Income The condensed consolidated statements of income show significant revenue growth and increased net income for both the three and six months ended June 30, 2025, compared to the prior year, driven by higher service and rental revenues Condensed Consolidated Statements of Income (in thousands) | Metric | Three Months Ended June 30, 2025 | Three Months Ended June 30, 2024 | Six Months Ended June 30, 2025 | Six Months Ended June 30, 2024 | | :------------------------------------ | :------------------------------- | :------------------------------- | :----------------------------- | :----------------------------- | | Total Revenue | $1,227,769 | $1,036,285 | $2,400,810 | $2,046,457 | | Net Income | $84,466 | $71,181 | $164,819 | $140,141 | | Net Income Attributable to The Ensign Group, Inc. | $84,396 | $71,007 | $164,673 | $139,842 | | Diluted EPS | $1.44 | $1.22 | $2.81 | $2.41 | Condensed Consolidated Balance Sheets As of June 30, 2025, the company's total assets increased, primarily due to growth in property and equipment and right-of-use assets, while total equity also saw a substantial increase compared to December 31, 2024 Condensed Consolidated Balance Sheets (in thousands) | Metric | June 30, 2025 | December 31, 2024 | | :-------------------------------- | :-------------- | :---------------- | | Total Current Assets | $1,067,195 | $1,157,632 | | Property and equipment, net | $1,535,185 | $1,291,354 | | Right-of-use assets | $1,930,662 | $1,861,071 | | Total Assets | $4,930,291 | $4,669,356 | | Total Current Liabilities | $755,545 | $743,428 | | Total Equity | $2,020,983 | $1,840,428 | Condensed Consolidated Statements of Cash Flows For the six months ended June 30, 2025, operating activities generated significant cash, but substantial investing activities, primarily for acquisitions, led to a net decrease in cash and cash equivalents Condensed Consolidated Statements of Cash Flows (in thousands) - Six Months Ended June 30 | Activity | 2025 | 2024 | | :-------------------------------- | :--------- | :--------- | | Net Cash Provided by Operating Activities | $227,950 | $112,249 | | Net Cash Used in Investing Activities | $(311,924) | $(144,564) | | Net Cash Used in Financing Activities | $(16,655) | $25 | | Net Decrease in Cash and Cash Equivalents | $(100,629) | $(32,290) | | Cash and Cash Equivalents at End of Period | $363,969 | $477,336 | Non-GAAP Financial Measures & Reconciliations Reconciliation of GAAP to Non-GAAP Net Income and EPS The company provides reconciliations from GAAP net income and diluted EPS to adjusted non-GAAP figures, excluding items such as stock-based compensation, litigation, acquisition-related costs, and system implementation costs, to offer a clearer view of core operating performance Reconciliation of GAAP to Non-GAAP Net Income and EPS (in thousands, except per share data) | Metric | Three Months Ended June 30, 2025 | Three Months Ended June 30, 2024 | Six Months Ended June 30, 2025 | Six Months Ended June 30, 2024 | | :------------------------------------ | :------------------------------- | :------------------------------- | :----------------------------- | :----------------------------- | | Net Income Attributable to The Ensign Group, Inc. (GAAP) | $84,396 | $71,007 | $164,673 | $139,842 | | Non-GAAP Net Income | $93,320 | $76,409 | $182,292 | $151,793 | | Diluted Earnings Per Share (GAAP) | $1.44 | $1.22 | $2.81 | $2.41 | | Adjusted Diluted Earnings Per Share (Non-GAAP) | $1.59 | $1.32 | $3.11 | $2.62 | - Key non-GAAP adjustments include stock-based compensation expense, litigation, gain/loss on business interruption recoveries, acquisition related costs, costs incurred related to system implementations, and depreciation/amortization of patient base[24][25][26][27][28] Reconciliation of GAAP to Non-GAAP EBITDA, EBITDAR, and EBT The report provides reconciliations for EBITDA, Adjusted EBITDA, Adjusted EBITDAR, and Adjusted EBT, which are non-GAAP measures used by management and investors to evaluate operating performance by excluding various non-cash and non-recurring items Reconciliation of GAAP to Non-GAAP EBITDA, Adjusted EBITDA, Adjusted EBITDAR (in thousands) | Metric | Three Months Ended June 30, 2025 | Three Months Ended June 30, 2024 | Six Months Ended June 30, 2025 | Six Months Ended June 30, 2024 | | :-------------------- | :------------------------------- | :------------------------------- | :----------------------------- | :----------------------------- | | EBITDA | $134,858 | $107,334 | $260,704 | $211,968 | | Adjusted EBITDA | $146,611 | $117,207 | $283,996 | $232,882 | | Adjusted EBITDAR | $203,806 | N/A | $398,267 | N/A | Reconciliation of GAAP to Non-GAAP Adjusted EBT (in thousands) | Metric | Three Months Ended June 30, 2025 | Three Months Ended June 30, 2024 | Six Months Ended June 30, 2025 | Six Months Ended June 30, 2024 | | :-------------------- | :------------------------------- | :------------------------------- | :----------------------------- | :----------------------------- | | Income before provision for income taxes (GAAP) | $112,358 | $92,064 | $218,938 | $181,662 | | Adjusted EBT | $124,520 | $102,111 | $243,250 | $202,789 | Segment-Specific Non-GAAP Reconciliations The company provides non-GAAP reconciliations for its key segments, Skilled Services and Standard Bearer, to offer detailed insights into their individual operational profitability and performance, including segment income, EBITDA, Adjusted EBITDA, and FFO Skilled Services Segment The Skilled Services segment demonstrated strong performance with significant increases in segment income, EBITDA, and Adjusted EBITDA for both the three and six months ended June 30, 2025 Skilled Services Segment Performance (in thousands) | Metric | Three Months Ended June 30, 2025 | Three Months Ended June 30, 2024 | Six Months Ended June 30, 2025 | Six Months Ended June 30, 2024 | | :---------------- | :------------------------------- | :------------------------------- | :----------------------------- | :----------------------------- | | Segment Income | $150,004 | $122,185 | $293,935 | $248,994 | | EBITDA | $163,754 | $133,096 | $320,898 | $270,441 | | Adjusted EBITDA | $170,321 | $140,889 | $334,345 | $283,448 | Standard Bearer Segment The Standard Bearer segment reported increased rental revenue and Funds From Operations (FFO) for the three and six months ended June 30, 2025, reflecting growth in both third-party and Ensign-affiliated leases Standard Bearer Segment Performance (in thousands) | Metric | Three Months Ended June 30, 2025 | Three Months Ended June 30, 2024 | Six Months Ended June 30, 2025 | Six Months Ended June 30, 2024 | | :------------------------------------ | :------------------------------- | :------------------------------- | :----------------------------- | :----------------------------- | | Rental revenue generated from third-party tenants | $4,712 | $4,198 | $9,209 | $8,393 | | Rental revenue generated from Ensign's independent subsidiaries | $26,756 | $19,156 | $50,660 | $37,162 | | Total Rental Revenue | $31,468 | $23,354 | $59,869 | $45,555 | | Segment Income | $9,126 | $7,360 | $17,709 | $14,618 | | FFO | $18,391 | $14,526 | $35,450 | $28,613 | Discussion of Non-GAAP Financial Measures The company defines and explains its non-GAAP financial measures, including EBITDA, Adjusted EBITDA, Adjusted EBITDAR, and FFO, emphasizing their utility for evaluating operating performance by excluding infrequent or variable revenues and expenses, while also acknowledging their limitations compared to GAAP measures - EBITDA: Net income before interest income, provision for income taxes, depreciation and amortization, and interest expense[55] - Adjusted EBITDA: EBITDA adjusted for stock-based compensation, acquisition related costs, system implementation costs, litigation, and gain/loss on business interruption recoveries and long-lived assets[55] - Adjusted EBITDAR: Adjusted EBITDA further adjusted by adding back rent-cost of services[55] - FFO (Standard Bearer): Segment income, excluding real estate-related depreciation/amortization, gains/losses from real estate sales, insurance recoveries, and impairment of long-lived assets[55] - These non-GAAP measures provide supplemental information to evaluate operating performance, as excluded items are infrequent, variable, or do not represent current revenues/cash expenditures. However, they may not be comparable to other companies' calculations and should not replace GAAP measures[55] Operational Performance and Revenue Analysis Select Performance Indicators - Skilled Services The skilled services segment demonstrated strong operational growth across all facility categories (Total, Same, Transitioning, Recently Acquired) for Q2 and YTD 2025, with notable increases in skilled services revenue, patient days, and occupancy percentages Total Facility Results Overall, the total facility results for skilled services show robust growth in revenue, patient days, and occupancy, indicating strong demand and operational efficiency Total Facility Results - Skilled Services Segment (in thousands) | Metric | Q2 2025 | Q2 2024 | Change | % Change | | :-------------------------------- | :---------- | :---------- | :------- | :--------- | | Skilled services revenue | $1,173,576 | $991,285 | $182,291 | 18.4% | | Number of facilities at period end | 303 | 272 | 31 | 11.4% | | Actual patient days | 2,615,490 | 2,299,068 | 316,422 | 13.8% | | Occupancy percentage — Operational beds | 81.3% | 80.1% | 1.2% | 1.5% | | Skilled mix by nursing days | 30.8% | 29.9% | 0.9% | 3.0% | | Skilled mix by nursing revenue | 49.2% | 48.2% | 1.0% | 2.1% | Total Facility Results - Skilled Services Segment (in thousands) (Six Months Ended June 30) | Metric | 2025 | 2024 | Change | % Change | | :-------------------------------- | :---------- | :---------- | :------- | :--------- | | Skilled services revenue | $2,297,130 | $1,960,887 | $336,243 | 17.1% | | Number of facilities at period end | 303 | 272 | 31 | 11.4% | | Actual patient days | 5,153,626 | 4,554,599 | 599,027 | 13.2% | | Occupancy percentage — Operational beds | 81.6% | 80.1% | 1.5% | 1.9% | | Skilled mix by nursing days | 31.1% | 30.4% | 0.7% | 2.3% | | Skilled mix by nursing revenue | 49.7% | 49.0% | 0.7% | 1.4% | Same Facility Results Facilities acquired prior to January 1, 2022, demonstrated consistent growth, with increases in skilled services revenue, patient days, and occupancy, alongside an improved skilled mix Same Facility Results - Skilled Services Segment (in thousands) | Metric | Q2 2025 | Q2 2024 | Change | % Change | | :-------------------------------- | :---------- | :---------- | :------- | :--------- | | Skilled services revenue | $845,409 | $793,594 | $51,815 | 6.5% | | Actual patient days | 1,867,924 | 1,824,753 | 43,171 | 2.4% | | Occupancy percentage — Operational beds | 82.1% | 80.5% | 1.6% | 2.0% | | Skilled mix by nursing days | 32.4% | 30.9% | 1.5% | 4.9% | | Skilled mix by nursing revenue | 51.2% | 48.8% | 2.4% | 4.9% | Same Facility Results - Skilled Services Segment (in thousands) (Six Months Ended June 30) | Metric | 2025 | 2024 | Change | % Change | | :-------------------------------- | :---------- | :---------- | :------- | :--------- | | Skilled services revenue | $1,680,197 | $1,584,400 | $95,797 | 6.0% | | Actual patient days | 3,726,732 | 3,651,915 | 74,817 | 2.0% | | Occupancy percentage — Operational beds | 82.4% | 80.4% | 2.0% | 2.5% | | Skilled mix by nursing days | 32.8% | 31.3% | 1.5% | 4.8% | | Skilled mix by nursing revenue | 51.6% | 49.5% | 2.1% | 4.2% | Transitioning Facility Results Transitioning facilities (acquired between Jan 1, 2022, and Dec 31, 2023) showed strong improvements, with double-digit growth in skilled services revenue and significant increases in occupancy and skilled mix Transitioning Facility Results - Skilled Services Segment (in thousands) | Metric | Q2 2025 | Q2 2024 | Change | % Change | | :-------------------------------- | :---------- | :---------- | :------- | :--------- | | Skilled services revenue | $188,875 | $169,268 | $19,607 | 11.6% | | Actual patient days | 423,514 | 404,652 | 18,862 | 4.7% | | Occupancy percentage — Operational beds | 84.0% | 80.3% | 3.7% | 4.6% | | Skilled mix by nursing days | 29.5% | 27.2% | 2.3% | 8.5% | | Skilled mix by nursing revenue | 50.4% | 47.8% | 2.6% | 5.4% | Transitioning Facility Results - Skilled Services Segment (in thousands) (Six Months Ended June 30) | Metric | 2025 | 2024 | Change | % Change | | :-------------------------------- | :---------- | :---------- | :------- | :--------- | | Skilled services revenue | $373,055 | $338,622 | $34,433 | 10.2% | | Actual patient days | 840,252 | 805,595 | 34,657 | 4.3% | | Occupancy percentage — Operational beds | 83.8% | 79.9% | 3.9% | 4.9% | | Skilled mix by nursing days | 29.8% | 28.0% | 1.8% | 6.4% | | Skilled mix by nursing revenue | 50.9% | 48.8% | 2.1% | 4.3% | Recently Acquired Facility Results Recently acquired facilities (on or after Jan 1, 2024) significantly expanded the company's portfolio and contributed substantially to skilled services revenue and patient days, demonstrating strong initial performance Recently Acquired Facility Results - Skilled Services Segment (in thousands) | Metric | Q2 2025 | Q2 2024 | Change | % Change | | :-------------------------------- | :---------- | :---------- | :------- | :--------- | | Skilled services revenue | $139,292 | $28,389 | $110,903 | NM | | Number of facilities at period end | 45 | 13 | 32 | NM | | Actual patient days | 324,052 | 69,663 | 254,389 | NM | | Occupancy percentage — Operational beds | 74.3% | 70.8% | NM | NM | | Skilled mix by nursing days | 22.9% | 18.1% | NM | NM | | Skilled mix by nursing revenue | 35.6% | 30.4% | NM | NM | Recently Acquired Facility Results - Skilled Services Segment (in thousands) (Six Months Ended June 30) | Metric | 2025 | 2024 | Change | % Change | | :-------------------------------- | :---------- | :---------- | :------- | :--------- | | Skilled services revenue | $243,878 | $37,291 | $206,587 | NM | | Number of facilities at period end | 45 | 13 | 32 | NM | | Actual patient days | 586,642 | 95,007 | 491,635 | NM | | Occupancy percentage — Operational beds | 74.4% | 72.4% | NM | NM | | Skilled mix by nursing days | 22.0% | 17.8% | NM | NM | | Skilled mix by nursing revenue | 34.3% | 29.9% | NM | NM | Skilled Nursing Average Daily Revenue Rates by Payor Average daily revenue rates for skilled nursing services increased across all payor sources (Medicare, Managed Care, Other Skilled, Medicaid, Private) for Q2 and YTD 2025, with notable growth in Managed Care and Other Skilled categories, particularly in transitioning and recently acquired facilities Skilled Nursing Average Daily Revenue Rates (per day) (Q2 2025 vs. Q2 2024) | Payor | Same Facility 2025 | Same Facility 2024 | Transitioning 2025 | Transitioning 2024 | Acquisitions 2025 | Acquisitions 2024 | Total 2025 | Total 2024 | | :-------------------- | :----------------- | :----------------- | :----------------- | :----------------- | :---------------- | :---------------- | :--------- | :--------- | | Medicare | $786.82 | $748.36 | $850.63 | $819.42 | $686.08 | $615.16 | $789.43 | $760.63 | | Managed care | $578.99 | $548.81 | $603.30 | $556.52 | $533.47 | $456.07 | $578.40 | $548.28 | | Other skilled | $653.62 | $615.93 | $613.34 | $528.41 | $721.87 | $745.59 | $655.04 | $607.13 | | Total skilled revenue | $666.96 | $632.40 | $721.91 | $682.66 | $630.24 | $572.21 | $672.15 | $639.39 | | Medicaid | $306.87 | $299.94 | $296.03 | $277.59 | $336.14 | $296.25 | $308.87 | $295.73 | | Private and other payors | $292.90 | $277.47 | $310.80 | $285.25 | $353.84 | $266.30 | $305.96 | $278.32 | | Total skilled nursing revenue | $422.26 | $400.43 | $423.15 | $388.68 | $406.13 | $341.31 | $420.43 | $396.63 | Percentage of Skilled Nursing Revenue and Days by Payor The percentage of skilled nursing revenue and days by payor source shows a slight shift towards Medicare and Managed Care, and away from Medicaid, across all facility types for Q2 and YTD 2025, indicating a favorable payor mix trend Percentage of Skilled Nursing Revenue by Payor (Q2 2025 vs. Q2 2024) | Payor | Same Facility 2025 (%) | Same Facility 2024 (%) | Transitioning 2025 (%) | Transitioning 2024 (%) | Acquisitions 2025 (%) | Acquisitions 2024 (%) | Total 2025 (%) | Total 2024 (%) | | :-------------------- | :----------------- | :----------------- | :----------------- | :----------------- | :---------------- | :---------------- | :--------- | :--------- | | Medicare | 21.5% | 20.7% | 28.1% | 28.4% | 15.6% | 13.3% | 21.9% | 21.8% | | Managed care | 20.3% | 19.5% | 16.1% | 14.3% | 12.3% | 10.1% | 18.6% | 18.4% | | Other skilled | 9.4% | 8.6% | 6.2% | 5.1% | 7.7% | 7.0% | 8.7% | 8.0% | | Skilled mix | 51.2% | 48.8% | 50.4% | 47.8% | 35.6% | 30.4% | 49.2% | 48.2% | | Private and other payors | 6.8% | 7.2% | 6.8% | 7.8% | 12.4% | 13.0% | 7.5% | 7.4% | | Medicaid | 42.0% | 44.0% | 42.8% | 44.4% | 52.0% | 56.6% | 43.3% | 44.4% | | TOTAL SKILLED NURSING | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | Percentage of Skilled Nursing Days by Payor (Q2 2025 vs. Q2 2024) | Payor | Same Facility 2025 (%) | Same Facility 2024 (%) | Transitioning 2025 (%) | Transitioning 2024 (%) | Acquisitions 2025 (%) | Acquisitions 2024 (%) | Total 2025 (%) | Total 2024 (%) | | :-------------------- | :----------------- | :----------------- | :----------------- | :----------------- | :---------------- | :---------------- | :--------- | :--------- | | Medicare | 11.5% | 11.1% | 14.0% | 13.5% | 9.3% | 7.4% | 11.6% | 11.4% | | Managed care | 14.8% | 14.3% | 11.3% | 10.0% | 9.4% | 7.5% | 13.5% | 13.3% | | Other skilled | 6.1% | 5.5% | 4.2% | 3.7% | 4.2% | 3.2% | 5.7% | 5.2% | | Skilled mix | 32.4% | 30.9% | 29.5% | 27.2% | 22.9% | 18.1% | 30.8% | 29.9% | | Private and other payors | 9.8% | 10.3% | 9.4% | 10.6% | 14.3% | 16.7% | 10.2% | 10.5% | | Medicaid | 57.8% | 58.8% | 61.1% | 62.2% | 62.8% | 65.2% | 59.0% | 59.6% | | TOTAL SKILLED NURSING | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | Total Service Revenue by Payor Source Total service revenue increased significantly for Q2 and YTD 2025, with Managed Care and Private and other payors showing increased contributions to the overall revenue mix, while Medicaid and Medicare percentages remained relatively stable or slightly decreased Service Revenue by Payor Source (Three Months Ended June 30) | Payor | 2025 Revenue (in thousands) | 2025 % of Revenue | 2024 Revenue (in thousands) | 2024 % of Revenue | | :-------------------- | :-------------------------- | :---------------- | :-------------------------- | :---------------- | | Medicaid | $485,848 | 39.8% | $411,760 | 40.0% | | Medicare | $291,117 | 23.8% | $258,869 | 25.1% | | Medicaid — skilled | $75,207 | 6.2% | $62,969 | 6.1% | | Total Medicaid and Medicare | $852,172 | 69.8% | $733,598 | 71.2% | | Managed care | $229,495 | 18.8% | $191,022 | 18.5% | | Private and other | $139,747 | 11.4% | $105,954 | 10.3% | | SERVICE REVENUE | $1,221,414 | 100.0% | $1,030,574 | 100.0% | Service Revenue by Payor Source (Six Months Ended June 30) | Payor | 2025 Revenue (in thousands) | 2025 % of Revenue | 2024 Revenue (in thousands) | 2024 % of Revenue | | :-------------------- | :-------------------------- | :---------------- | :-------------------------- | :---------------- | | Medicaid | $939,688 | 39.3% | $801,923 | 39.4% | | Medicare | $578,868 | 24.2% | $524,452 | 25.8% | | Medicaid — skilled | $144,758 | 6.1% | $126,278 | 6.2% | | Total Medicaid and Medicare | $1,663,314 | 69.6% | $1,452,653 | 71.4% | | Managed care | $456,712 | 19.1% | $379,126 | 18.6% | | Private and other | $268,428 | 11.3% | $203,280 | 10.0% | | SERVICE REVENUE | $2,388,454 | 100.0% | $2,035,059 | 100.0% |