DEI Info Cover Page Document
DEI Info Cover Page Document - USD ($) | 12 Months Ended | ||
Dec. 31, 2017 | Feb. 05, 2018 | Jun. 30, 2017 | |
Entity Information [Abstract] | |||
Entity Registrant Name | ENSIGN GROUP, INC | ||
Entity Central Index Key | 1,125,376 | ||
Current Fiscal Year End Date | --12-31 | ||
Entity Filer Category | Large Accelerated Filer | ||
Document Type | 10-K | ||
Current Reporting Status | Yes | ||
Document Period End Date | Dec. 31, 2017 | ||
Document Fiscal Year Focus | 2,017 | ||
Document Fiscal Period Focus | FY | ||
Amendment Flag | false | ||
Entity Well-known Seasoned Issuer | Yes | ||
Entity Voluntary Filers | No | ||
Entity Common Stock, Shares Outstanding | 51,484,963 | ||
Entity Public Float | $ 780,000,000 |
Consolidated Balance Sheets
Consolidated Balance Sheets - USD ($) $ in Thousands | Dec. 31, 2017 | Dec. 31, 2016 |
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 asset | 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 |
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 (Note 17) | 12,075 | 0 |
Total liabilities | 602,374 | 540,530 |
Commitments and contingencies (Notes 15, 17 and 19) | ||
Equity: | ||
Common stock; $0.001 par value; 75,000 shares authorized; 53,675 and 51,360 shares issued and outstanding at December 31, 2017, respectively, and 52,787 and 50,838 shares issued and outstanding at December 31, 2016, respectively (Note 3) | 53 | 52 |
Additional paid-in capital (Note 3) | 266,058 | 252,493 |
Retained earnings | 264,691 | 235,021 |
Common stock in treasury, at cost, 1,932 and 1,520 shares at December 31, 2017 and 2016, respectively (Note 3) | (38,405) | (31,117) |
Total Ensign Group, Inc. stockholders' equity | 492,397 | 456,449 |
Non-controlling interest | 7,662 | 4,046 |
Total equity | 500,059 | 460,495 |
Total liabilities and equity | $ 1,102,433 | $ 1,001,025 |
Consolidated Balance Sheets Bal
Consolidated Balance Sheets Balance Sheet (Paranthetical) - USD ($) shares in Thousands, $ in Thousands | Dec. 31, 2017 | Dec. 31, 2016 |
Current assets: | ||
Allowance for doubtful accounts | $ 43,961 | $ 39,791 |
Equity: | ||
Common stock, par value | $ 0.001 | $ 0.001 |
Common stock, shares authorized | 75,000 | 75,000 |
Common stock, shares issued | 53,675 | 52,787 |
Common stock, shares outstanding | 51,360 | 50,838 |
Common stock in treasury, at cost | 1,932 | 1,520 |
Consolidated Statements of Inco
Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Revenue | $ 1,849,317 | $ 1,654,864 | $ 1,341,826 |
Expense: | |||
Cost of services | 1,497,703 | 1,341,814 | 1,067,694 |
Charge related to class action lawsuit (Note 19) | 11,000 | 0 | 0 |
(Gains)/losses related to divestitures (Note 7 and 17) | 2,321 | (11,225) | 0 |
Rent—cost of services (Note 17) | 131,919 | 124,581 | 88,776 |
General and administrative expense | 80,617 | 69,165 | 64,163 |
Depreciation and amortization | 44,472 | 38,682 | 28,111 |
Total expenses | 1,768,032 | 1,563,017 | 1,248,744 |
Income from operations | 81,285 | 91,847 | 93,082 |
Other income (expense): | |||
Interest expense | (13,616) | (7,136) | (2,828) |
Interest income | 1,609 | 1,107 | 845 |
Other expense, net | (12,007) | (6,029) | (1,983) |
Income before provision for income taxes | 69,278 | 85,818 | 91,099 |
Provision for income taxes | 28,445 | 32,975 | 35,182 |
Net income | 40,833 | 52,843 | 55,917 |
Less: net income attributable to noncontrolling interests | 358 | 2,853 | 485 |
Net income attributable to The Ensign Group, Inc. | $ 40,475 | $ 49,990 | $ 55,432 |
Basic: | |||
Basic net income per common share attributable to The Ensign Group, Inc. | $ 0.79 | $ 0.99 | $ 1.10 |
Diluted: | |||
Diluted net income per common share attributable to The Ensign Group, Inc. | $ 0.77 | $ 0.96 | $ 1.06 |
Weighted average common shares outstanding: | |||
Basic | 50,932 | 50,555 | 50,316 |
Adjusted weighted average common shares outstanding | 52,829 | 52,133 | 52,210 |
Dividends per share | $ 0.1725 | $ 0.1625 | $ 0.1525 |
Consolidated Statement of Stock
Consolidated Statement of Stockholders' Equity Statement - USD ($) shares in Thousands, $ in Thousands | Total | Common Stock [Member] | Additional Paid-in Capital [Member] | Retained Earnings [Member] | Treasury Stock [Member] | Noncontrolling Interest [Member] |
Balance - January 1 at Dec. 31, 2014 | $ 257,803 | $ 22 | $ 114,293 | $ 145,846 | $ (1,310) | $ (1,048) |
Balance - January 1 (in shares) at Dec. 31, 2014 | 22,591 | |||||
Balance - January 1 (in treasury shares) at Dec. 31, 2014 | 150 | |||||
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards (in shares) | 255 | (27) | ||||
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards | 2,530 | $ 0 | 2,443 | $ 87 | ||
Issuance of restricted stock to employees (in shares) | 105 | |||||
Issuance of restricted stock to employees | 1,892 | 1,892 | ||||
Issuance of common stock through public offering, net of issuance costs (in shares) | 2,734 | |||||
Issuance of common stock through public offering, net of issuance costs | 106,120 | $ 3 | 106,117 | |||
Repurchase of common stock (Note 3) | 0 | |||||
Dividends declared | (7,858) | (7,858) | ||||
Employee stock award compensation | 6,677 | 6,677 | ||||
Excess tax benefit from share-based compensation | 3,680 | 3,680 | ||||
Stock issued to effect stock split (in shares) | 25,685 | |||||
Stock issued to effect stock split | 0 | $ 26 | (26) | |||
Noncontrolling interest assumed related to acquisition | 224 | 224 | ||||
Less: net income attributable to noncontrolling interests | 485 | 485 | ||||
Net income attributable to The Ensign Group, Inc. | 55,432 | 55,432 | ||||
Balance - December 31 at Dec. 31, 2015 | 426,985 | $ 51 | 235,076 | 193,420 | $ (1,223) | (339) |
Balance - December 31 (in shares) at Dec. 31, 2015 | 51,370 | |||||
Balance - December 31 (in treasury shares) at Dec. 31, 2015 | 123 | |||||
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards (in shares) | 668 | (55) | ||||
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards | 4,152 | $ 1 | 4,045 | $ 106 | ||
Issuance of restricted stock to employees (in shares) | 252 | |||||
Issuance of restricted stock to employees | 2,517 | 2,517 | ||||
Repurchase of common stock (Note 3) (in shares) | (1,452) | 1,452 | ||||
Repurchase of common stock (Note 3) | (30,000) | $ (30,000) | ||||
Dividends declared | (8,282) | (8,282) | ||||
Employee stock award compensation | 7,776 | 7,776 | ||||
Excess tax benefit from share-based compensation | 3,079 | 3,079 | ||||
Noncontrolling interest attributable to subsidiary equity plan (Note 16) | 1,325 | (107) | 1,432 | |||
Noncontrolling interest assumed related to acquisition | 100 | 100 | ||||
Less: net income attributable to noncontrolling interests | 2,853 | 2,853 | ||||
Net income attributable to The Ensign Group, Inc. | 49,990 | 49,990 | ||||
Balance - December 31 at Dec. 31, 2016 | $ 460,495 | $ 52 | 252,493 | 235,021 | $ (31,117) | 4,046 |
Balance - December 31 (in shares) at Dec. 31, 2016 | 50,838 | 50,838 | ||||
Balance - December 31 (in treasury shares) at Dec. 31, 2016 | 1,520 | |||||
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards (in shares) | 807 | 0 | ||||
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards | $ 5,128 | $ 1 | 5,127 | $ 0 | ||
Issuance of restricted stock to employees (in shares) | 127 | |||||
Issuance of restricted stock to employees | 146 | 146 | ||||
Repurchase of common stock (Note 3) (in shares) | (412) | 412 | ||||
Repurchase of common stock (Note 3) | (7,288) | $ (7,288) | ||||
Dividends declared | (8,867) | (8,867) | ||||
Employee stock award compensation | 8,331 | 8,331 | ||||
Acquisition of noncontrolling interest, net of tax | (83) | (39) | (44) | |||
Noncontrolling interest attributable to subsidiary equity plan (Note 16) | 1,364 | (1,938) | 3,302 | |||
Less: net income attributable to noncontrolling interests | 358 | 358 | ||||
Net income attributable to The Ensign Group, Inc. | 40,475 | 40,475 | ||||
Balance - December 31 at Dec. 31, 2017 | $ 500,059 | $ 53 | $ 266,058 | $ 264,691 | $ (38,405) | $ 7,662 |
Balance - December 31 (in shares) at Dec. 31, 2017 | 51,360 | 51,360 | ||||
Balance - December 31 (in treasury shares) at Dec. 31, 2017 | 1,932 |
Consolidated Statements of Cash
Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Cash flows from operating activities: | |||
Net income | $ 40,833 | $ 52,843 | $ 55,917 |
Adjustments to reconcile net income to net cash provided by operating activities: | |||
Depreciation and amortization | 44,472 | 38,682 | 28,111 |
Amortization of deferred financing fees | 1,039 | 825 | 591 |
Amortization of deferred gain on sale-leaseback | (421) | 0 | 0 |
Impairment of long-lived assets | 111 | 137 | 0 |
Write-off of deferred financing fees | 0 | 321 | 0 |
Deferred income taxes | 10,329 | (2,208) | 1,251 |
Provision for doubtful accounts | 31,023 | 28,512 | 19,802 |
Share-based compensation | 9,695 | 9,101 | 6,677 |
Excess tax benefit from share-based compensation (Note 2) | 0 | (3,079) | (3,680) |
Insurance proceeds received for damage to property | 477 | 0 | 0 |
Gain on disposition of intangibles, property and equipment | 278 | 164 | 205 |
Gain on sale of urgent care centers | 0 | (19,160) | 0 |
Change in operating assets and liabilities | |||
Accounts receivable | (52,301) | (63,617) | (100,324) |
Prepaid income taxes | (19,145) | 7,839 | (5,149) |
Prepaid expenses and other assets | (9,380) | (1,465) | (10,340) |
Insurance subsidiary deposits and investments | (6,592) | (467) | (10,785) |
Liabilities related to operational closures (Note 7 and 17) | 2,210 | 7,205 | 0 |
Accounts payable | 3,329 | 577 | 1,780 |
Accrued wages and related liabilities | 5,822 | (4,978) | 22,178 |
Income taxes payable | (1,182) | 987 | 0 |
Other accrued liabilities | 5,777 | 12,588 | 21,403 |
Accrued self-insurance liabilities | 6,095 | 8,125 | 5,418 |
Deferred rent liability | 483 | 956 | 314 |
Net cash provided by operating activities | 72,952 | 73,888 | 33,369 |
Cash flows from investing activities: | |||
Purchase of property and equipment | (57,166) | (65,699) | (60,018) |
Cash payments for business acquisitions | (89,565) | (64,310) | (110,802) |
Cash payments for asset acquisitions | (195) | (120,935) | (17,750) |
Escrow deposits | (228) | (1,582) | (400) |
Escrow deposits used to fund business acquisitions | 1,582 | 400 | 16,153 |
Use of restricted cash | 0 | 0 | 5,082 |
Cash received from sale of urgent care centers and franchising businesses, net of note receivable | 0 | 40,734 | 2,000 |
Cash proceeds from sale-leaseback | 38,000 | 0 | 0 |
Cash proceeds from the sale of fixed assets and insurance proceeds | 3,215 | 391 | 10 |
Restricted and other assets | (2,236) | 365 | (2,813) |
Net cash used in investing activities | (106,593) | (210,636) | (168,538) |
Cash flows from financing activities: | |||
Proceeds from revolving credit facility and other debt (Note 15) | 1,022,015 | 844,000 | 334,000 |
Payments on revolving credit facility and other debt (Note 15) | (990,154) | (659,514) | (314,417) |
Proceeds from common stock offering (Note 3) | 0 | 0 | 112,078 |
Issuance costs in connection with common stock offering (Note 3) | 0 | 0 | (5,961) |
Issuance of treasury stock upon exercise of options | 0 | 106 | 87 |
Issuance of common stock upon exercise of options | 5,274 | 6,563 | 4,337 |
Repurchase of common stock (Note 3) | (7,288) | (30,000) | 0 |
Dividends paid | (8,717) | (8,173) | (7,494) |
Excess tax benefit from share-based compensation (Note 2) | 0 | 3,181 | 3,700 |
Purchase of non-controlling interest | (83) | 0 | 0 |
Payments of deferred financing costs | (2,775) | (3,278) | 0 |
Net cash provided by financing activities | 18,272 | 152,885 | 126,330 |
Net (decrease)/increase in cash and cash equivalents | (15,369) | 16,137 | (8,839) |
Cash and cash equivalents beginning of period | 57,706 | 41,569 | 50,408 |
Cash and cash equivalents end of period | 42,337 | 57,706 | 41,569 |
Cash paid during the period for: | |||
Interest | 13,284 | 6,428 | 2,773 |
Income taxes | 38,382 | 23,163 | 35,490 |
Non-cash financing and investing activity: | |||
Accrued capital expenditures | 3,550 | 6,828 | 4,171 |
Note receivable from sale of urgent care centers and franchising business | 0 | 700 | 0 |
Favorable lease included in the fair value of assets acquisitions | 0 | 7,190 | 0 |
Refundable deposits assumed as part of business acquisition | 0 | 0 | 3,488 |
Debt assumed as part of asset acquisition | $ 0 | $ 0 | $ 11,699 |
Description of Business
Description of Business | 12 Months Ended |
Dec. 31, 2017 | |
DESCRIPTION OF BUSINESS [Abstract] | |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block] | DESCRIPTION OF BUSINESS The Company - The Ensign Group, Inc. (collectively, Ensign or the Company), is a holding company with no direct operating assets, employees or revenue. The Company, through its operating subsidiaries, is a provider of health care services across the post-acute care continuum, as well as other ancillary businesses. As of December 31, 2017 , the Company operated 230 facilities, 46 home health, hospice and home care agencies and other ancillary operations located in Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, Oklahoma, Oregon, South Carolina, Texas, Utah, Washington and Wisconsin. The Company's operating subsidiaries, each of which strives to be the operation of choice in the community it serves, provide a broad spectrum of skilled nursing, assisted living, home health, home care, hospice and other ancillary services. The Company's operating subsidiaries have a collective capacity of approximately 18,900 operational skilled nursing beds and 5,000 assisted living and independent living units. As of December 31, 2017 , the Company owned 63 of its 230 affiliated facilities and leased an additional 167 facilities through long-term lease arrangements and had options to purchase 11 of those 167 facilities. As of December 31, 2016 , the Company owned 50 of its 210 affiliated facilities and leased an additional 160 facilities through long-term lease arrangements, and had options to purchase nine of those 160 facilities. Certain of the Company’s wholly-owned independent subsidiaries, collectively referred to as the Service Center, provide certain accounting, payroll, human resources, information technology, legal, risk management and other centralized services to the other operating subsidiaries through contractual relationships with such subsidiaries. The Company also has a wholly-owned captive insurance subsidiary (the Captive) that provides some claims-made coverage to the Company’s operating subsidiaries for general and professional liability, as well as coverage for certain workers’ compensation insurance liabilities. Each of the Company's affiliated operations are operated by separate, wholly-owned, independent subsidiaries that have their own management, employees and assets. References herein to the consolidated “Company” and “its” assets and activities in this Annual Report is not meant to imply, nor should it be construed as meaning, that The Ensign Group, Inc. has direct operating assets, employees or revenue, or that any of the subsidiaries, are operated by The Ensign Group, Inc. |
Significant Accounting Policies
Significant Accounting Policies | 12 Months Ended |
Dec. 31, 2017 | |
Accounting Policies [Abstract] | |
Basis of Presentation and Significant Accounting Policies [Text Block] | SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Basis of Presentation — The accompanying consolidated financial statements (Financial Statements) have been prepared in accordance with accounting principles generally accepted in the United States (GAAP). The Company is the sole member or shareholder of various consolidated limited liability companies and corporations established to operate various acquired skilled nursing and assisted living operations, home health, hospice and home care operations, and related ancillary services. All intercompany transactions and balances have been eliminated in consolidation. The consolidated financial statements include the accounts of all entities controlled by the Company through its ownership of a majority voting interest. The Company presents noncontrolling interest within the equity section of its consolidated balance sheets. The Company presents the amount of consolidated net income that is attributable to The Ensign Group, Inc. and the noncontrolling interest in its consolidated statements of income. The consolidated financial statements include the accounts of all entities controlled by the Company through its ownership of a majority voting interest and the accounts of any variable interest entities (VIEs) where the Company is subject to a majority of the risk of loss from the VIE's activities, or entitled to receive a majority of the entity's residual returns, or both. The Company assesses the requirements related to the consolidation of VIEs, including a qualitative assessment of power and economics that considers which entity has the power to direct the activities that "most significantly impact" the VIE's economic performance and has the obligation to absorb losses of, or the right to receive benefits that could be potentially significant to, the VIE. The Company's relationship with variable interest entities was not material during the year ended December 31, 2017. In 2016, the Company completed the sale of its urgent care centers for an aggregate purchase price of $41,492 . The sale transactions do not meet the criteria of discontinued operations as they do not represent a strategic shift that has, or will have, a major effect on the Company’s operations and financial results. Estimates and Assumptions — The preparation of Financial Statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the Financial Statements and the reported amounts of revenue and expenses during the reporting periods. The most significant estimates in the Company’s Financial Statements relate to revenue, allowance for doubtful accounts, intangible assets and goodwill, impairment of long-lived assets, general and professional liability, workers' compensation and healthcare claims included in accrued self-insurance liabilities, and income taxes. Actual results could differ from those estimates. Fair Value of Financial Instruments — The Company’s financial instruments consist principally of cash and cash equivalents, debt security investments, accounts receivable, insurance subsidiary deposits, accounts payable and borrowings. The Company believes all of the financial instruments’ recorded values approximate fair values because of their nature or respective short durations. Revenue Recognition — The Company recognizes revenue when the following four conditions have been met: (i) there is persuasive evidence that an arrangement exists; (ii) delivery has occurred or service has been rendered; (iii) the price is fixed or determinable; and (iv) collection is reasonably assured. The Company's revenue is derived primarily from providing healthcare services to patients and is recognized on the date services are provided at amounts billable to the individual. For reimbursement arrangements with third-party payors, including Medicaid, Medicare and private insurers, revenue is recorded based on contractually agreed-upon amounts on a per patient basis. Revenue from the Medicare and Medicaid programs accounted for 68.4% , 67.8% and 69.1% of the Company's revenue for the years ended December 31, 2017, 2016 and 2015 , respectively. The Company records revenue from these governmental and managed care programs as services are performed at their expected net realizable amounts under these programs. The Company’s revenue from governmental and managed care programs is subject to audit and retroactive adjustment by governmental and third-party agencies. Consistent with healthcare industry accounting practices, any changes to these governmental revenue estimates are recorded in the period the change or adjustment becomes known based on final settlement. The Company recorded adjustments to revenue which were not material to the Company's consolidated revenue or Financial Statements for the years ended December 31, 2017, 2016 and 2015 . The Company’s service specific revenue recognition policies are as follows: Skilled Nursing Revenue The Company’s revenue is derived primarily from providing long-term healthcare services to patients and is recognized on the date services are provided at amounts billable to individual patients. For patients under reimbursement arrangements with third-party payors, including Medicaid, Medicare and private insurers, revenue is recorded based on contractually agreed-upon amounts or rate on a per patient, daily basis or as services are performed. Assisted and Independent Living Revenue The Company's revenue is recorded when services are rendered on the date services are provided at amounts billable to individual residents and consists of fees for basic housing and assisted living care. Residency agreements are generally for a term of 30 days, with resident fees billed monthly in advance. For patients under reimbursement arrangements with Medicaid, revenue is recorded based on contractually agreed-upon amounts or rate on a per resident, daily basis or as services rendered. Revenue for certain ancillary charges is recognized as services are provided, and such fees are billed monthly in arrears. Home Health Revenue Medicare Revenue Net service revenue is recorded under the Medicare prospective payment system based on a 60-day episode payment rate that is subject to adjustment based on certain variables including, but not limited to: (a) an outlier payment if patient care was unusually costly; (b) a low utilization payment adjustment if the number of visits was fewer than five; (c) a partial payment if the patient transferred to another provider or the Company received a patient from another provider before completing the episode; (d) a payment adjustment based upon the level of therapy services required; (e) the number of episodes of care provided to a patient, regardless of whether the same home health provider provided care for the entire series of episodes; (f) changes in the base episode payments established by the Medicare program; (g) adjustments to the base episode payments for case mix and geographic wages; and (h) recoveries of overpayments. The Company makes adjustments to Medicare revenue on completed episodes to reflect differences between estimated and actual payment amounts, an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. Therefore, the Company believes that its reported net service revenue and patient accounts receivable will be the net amounts to be realized from Medicare for services rendered. In addition to revenue recognized on completed episodes, the Company also recognizes a portion of revenue associated with episodes in progress. Episodes in progress are 60-day episodes of care that begin during the reporting period, but were not completed as of the end of the period. As such, the Company estimates revenue and recognizes it on a daily basis. The primary factors underlying this estimate are the number of episodes in progress at the end of the reporting period, expected Medicare revenue per episode and its estimate of the average percentage complete based on visits performed. Non-Medicare Revenue Episodic Based Revenue - The Company recognizes revenue in a similar manner as it recognizes Medicare revenue for episodic-based rates that are paid by other insurance carriers, including Medicare Advantage programs; however, these rates can vary based upon the negotiated terms. Non-episodic Based Revenue - Revenue is recorded on an accrual basis based upon the date of service at amounts equal to its established or estimated per-visit rates, as applicable. Hospice Revenue Revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are daily rates for each of the levels of care the Company delivers. The Company makes adjustments to revenue for an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. Additionally, as Medicare hospice revenue is subject to an inpatient cap limit and an overall payment cap, the Company monitors its provider numbers and estimates amounts due back to Medicare if a cap has been exceeded. The Company records these adjustments as a reduction to revenue and increases to other accrued liabilities. Accounts Receivable and Allowance for Doubtful Accounts — Accounts receivable consist primarily of amounts due from Medicare and Medicaid programs, other government programs, managed care health plans and private payor sources. Estimated provisions for doubtful accounts are recorded to the extent it is probable that a portion or all of a particular account will not be collected. In evaluating the collectability of accounts receivable, the Company considers a number of factors, including the age of the accounts, changes in collection patterns, the composition of patient accounts by payor type and the status of ongoing disputes with third-party payors. On an annual basis, the historical collection percentages are reviewed by payor and by state and are updated to reflect the recent collection experience of the Company. In order to determine the appropriate reserve rate percentages which ultimately establish the allowance, the Company analyzes historical cash collection patterns by payor and by state. The percentages applied to the aged receivable balances are based on the Company’s historical experience and time limits, if any, for managed care, Medicare, Medicaid and other payors. The Company periodically refines its estimates of the allowance for doubtful accounts based on experience with the estimation process and changes in circumstances. Cash and Cash Equivalents — Cash and cash equivalents consist of bank term deposits, money market funds and treasury bill related investments with original maturities of three months or less at time of purchase and therefore approximate fair value. The fair value of money market funds is determined based on “Level 1” inputs, which consist of unadjusted quoted prices in active markets that are accessible at the measurement date for identical, unrestricted assets. The Company places its cash and short-term investments with high credit quality financial institutions. Insurance Subsidiary Deposits and Investments — The Company's captive insurance subsidiary cash and cash equivalents, deposits and investments are designated to support long-term insurance subsidiary liabilities and have been classified as short-term and long-term assets based on the timing of expected future payments of the Company's captive insurance liabilities. The majority of these deposits and investments are currently held in AA, A and BBB+ rated debt security investments and the remainder is held in a bank account with a high credit quality financial institution. See further discussion at Note 5, Fair Value Measurements. The Company evaluates securities for other-than-temporary impairment (“OTTI”) on at least a quarterly basis, and more frequently when economic or market conditions warrant such an evaluation. If securities are in an unrealized loss position, the Company considers the extent and duration of the unrealized loss, and the financial condition and near-term prospects of the issuer. The Company also assesses whether it intends to sell, or it is more likely than not that it will be required to sell, a security in an unrealized loss position before recovery of its amortized cost basis. If either of the criteria regarding intent or requirement to sell is met, the entire difference between amortized cost and fair value is recognized as impairment through earnings. For the years ended December 31, 2016 and 2017, the Company did not recognize any OTTI for its investments. Property and Equipment — Property and equipment are initially recorded at their historical cost. Repairs and maintenance are expensed as incurred. Depreciation is computed using the straight-line method over the estimated useful lives of the depreciable assets (ranging from three to 59 years ). Leasehold improvements are amortized on a straight-line basis over the shorter of their estimated useful lives or the remaining lease term. Impairment of Long-Lived Assets — The Company reviews the carrying value of long-lived assets that are held and used in the Company’s operating subsidiaries for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of these assets is determined based upon expected undiscounted future net cash flows from the operating subsidiaries to which the assets relate, utilizing management’s best estimate, appropriate assumptions, and projections at the time. If the carrying value is determined to be unrecoverable from future operating cash flows, the asset is deemed impaired and an impairment loss would be recognized to the extent the carrying value exceeded the estimated fair value of the asset. The Company estimates the fair value of assets based on the estimated future discounted cash flows of the asset. Management has evaluated its long-lived assets and recorded an impairment charge of $111 and $137 related to the closure of facilities during the years ended December 31, 2017 and 2016 , respectively. The Company did not identify any asset impairment during the year ended December 31, 2015. Leases and Leasehold Improvements - At the inception of each lease, the Company performs an evaluation to determine whether the lease should be classified as an operating or capital lease. The Company records rent expense for operating leases that contain scheduled rent increases on a straight-line basis over the term of the lease. The lease term used for straight-line rent expense is calculated from the date the Company is given control of the leased premises through the end of the lease term. The lease term used for this evaluation also provides the basis for establishing depreciable lives for buildings subject to lease and leasehold improvements, as well as the period over which the Company records straight-line rent expense. Intangible Assets and Goodwill — Definite-lived intangible assets consist primarily of favorable leases, lease acquisition costs, patient base, facility trade names and customer relationships. Favorable leases and lease acquisition costs are amortized over the life of the lease of the facility. Patient base is amortized over a period of four to eight months, depending on the classification of the patients and the level of occupancy in a new acquisition on the acquisition date. Trade names at affiliated facilities are amortized over 30 years and customer relationships are amortized over a period of up to 20 years . The Company's indefinite-lived intangible assets consist of trade names and Medicare and Medicaid licenses. The Company tests indefinite-lived intangible assets for impairment on an annual basis or more frequently if events or changes in circumstances indicate that the carrying amount of the intangible asset may not be recoverable. The Company did not identify any asset impairment during the years ended December 31, 2017, 2016 and 2015. Goodwill represents the excess of the purchase price over the fair value of identifiable net assets acquired in business combinations. Goodwill is subject to annual testing for impairment. In addition, goodwill is tested for impairment if events occur or circumstances change that would reduce the fair value of a reporting unit below its carrying amount. The Company performs its annual test for impairment during the fourth quarter of each year. See further discussion at Note 11, Goodwill and Other Indefinite-Lived Intangible Assets . Deferred Rent - Deferred rent represents rental expense, determined on a straight-line basis over the life of the related lease, in excess of actual rent payments. Self-Insurance — The Company is partially self-insured for general and professional liability up to a base amount per claim (the self-insured retention) with an aggregate, one-time deductible above this limit. Losses beyond these amounts are insured through third-party policies with coverage limits per claim, per location and on an aggregate basis for the Company. Starting on January 1, 2017, the combined self-insured retention was $500 per claim, subject to an additional one-time deductible of $750 for California affiliated operations and a separate, one-time, deductible of $1,000 for non-California operations. For all affiliated operations, except those located in Colorado, the third-party coverage above these limits was $1,000 per claim, $3,000 per operation, with a $5,000 blanket aggregate limit and an additional state-specific aggregate where required by state law. In Colorado, the third-party coverage above these limits was $1,000 per claim and $3,000 per operation, which is independent of the aforementioned blanket aggregate limits that apply outside of Colorado. The self-insured retention and deductible limits for general and professional liability and workers' compensation for all states (except Texas and Washington for workers' compensation) are self-insured through the Captive, the related assets and liabilities of which are included in the accompanying consolidated balance sheets. The Captive is subject to certain statutory requirements as an insurance provider. These requirements include, but are not limited to, maintaining statutory capital. The Company’s policy is to accrue amounts equal to the actuarially estimated costs to settle open claims of insureds, as well as an estimate of the cost of insured claims that have been incurred but not reported. The Company develops information about the size of the ultimate claims based on historical experience, current industry information and actuarial analysis, and evaluates the estimates for claim loss exposure on a quarterly basis. The Company’s operating subsidiaries are self-insured for workers’ compensation in California. To protect itself against loss exposure in California with this policy, the Company has purchased individual specific excess insurance coverage that insures individual claims that exceed $500 per occurrence. In Texas, the operating subsidiaries have elected non-subscriber status for workers’ compensation claims and, effective February 1, 2011, the Company has purchased individual stop-loss coverage that insures individual claims that exceed $750 per occurrence. As of July 1, 2014, the Company’s operating subsidiaries in all other states, with the exception of Washington, are under a loss sensitive plan that insures individual claims that exceed $350 per occurrence. In Washington, the operating subsidiaries' coverage is financed through premiums paid by the employers and employees. The claims and pay benefits are managed through a state insurance pool. Outside of California, Texas and Washington, the Company has purchased insurance coverage that insures individual claims that exceed $350 per accident. In all states except Washington, the Company accrues amounts equal to the estimated costs to settle open claims, as well as an estimate of the cost of claims that have been incurred but not reported. The Company uses actuarial valuations to estimate the liability based on historical experience and industry information. In addition, the Company has recorded an asset and equal liability of $5,394 and $4,104 at December 31, 2017 and 2016, respectively, in order to present the ultimate costs of malpractice and workers' compensation claims and the anticipated insurance recoveries on a gross basis. See Note 12, Restricted and Other Assets. The Company self-funds medical (including prescription drugs) and dental healthcare benefits to the majority of its employees. The Company is fully liable for all financial and legal aspects of these benefit plans. To protect itself against loss exposure with this policy, the Company has purchased individual stop-loss insurance coverage that insures individual claims that exceed $300 for each covered person with an additional one-time aggregate individual stop loss deductible of $75 . Beginning 2016, the Company's policy does not include the additional one-time aggregate individual stop loss deductible of $75 . The Company believes that adequate provision has been made in the Financial Statements for liabilities that may arise out of patient care, workers’ compensation, healthcare benefits and related services provided to date. The amount of the Company’s reserves was determined based on an estimation process that uses information obtained from both company-specific and industry data. This estimation process requires the Company to continuously monitor and evaluate the life cycle of the claims. Using data obtained from this monitoring and the Company’s assumptions about emerging trends, the Company, with the assistance of an independent actuary, develops information about the size of ultimate claims based on the Company’s historical experience and other available industry information. The most significant assumptions used in the estimation process include determining the trend in costs, the expected cost of claims incurred but not reported and the expected costs to settle or pay damage awards with respect to unpaid claims. The self-insured liabilities are based upon estimates, and while management believes that the estimates of loss are reasonable, the ultimate liability may be in excess of or less than the recorded amounts. Due to the inherent volatility of actuarially determined loss estimates, it is reasonably possible that the Company could experience changes in estimated losses that could be material to net income. If the Company’s actual liability exceeds its estimates of loss, its future earnings, cash flows and financial condition would be adversely affected. Income Taxes — Deferred tax assets and liabilities are established for temporary differences between the financial reporting basis and the tax basis of the Company’s assets and liabilities at tax rates in effect when such temporary differences are expected to reverse. The Company generally expects to fully utilize its deferred tax assets; however, when necessary, the Company records a valuation allowance to reduce its net deferred tax assets to the amount that is more likely than not to be realized. In determining the need for a valuation allowance or the need for and magnitude of liabilities for uncertain tax positions, the Company makes certain estimates and assumptions. These estimates and assumptions are based on, among other things, knowledge of operations, markets, historical trends and likely future changes and, when appropriate, the opinions of advisors with knowledge and expertise in certain fields. Due to certain risks associated with the Company’s estimates and assumptions, actual results could differ. The Tax Cuts and Jobs Act (the Tax Act), which was enacted in December 2017, increased the Company's income tax expense by $3,915 for the year ended December 31, 2017. The Tax Act will decrease the corporate income tax rate from 35.0% to 21.0% beginning on January 1, 2018. The Company expects meaningful benefits from this reduction to continue from its enactment in future periods. See Note 14, Income Taxes for further detail. Noncontrolling Interest — The noncontrolling interest in a subsidiary is initially recognized at estimated fair value on the acquisition date and is presented within total equity in the Company's consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to The Ensign Group, Inc. in its consolidated statements of income and net income per share is calculated based on net income attributable to The Ensign Group, Inc.'s stockholders. The carrying amount of the noncontrolling interest is adjusted based on an allocation of subsidiary earnings based on ownership interest. Share-Based Compensation — The Company measures and recognizes compensation expense for all share-based payment awards made to employees and directors including employee stock options based on estimated fair values, ratably over the requisite service period of the award. Net income has been reduced as a result of the recognition of the fair value of all stock options and restricted stock awards issued, the amount of which is contingent upon the number of future grants and other variables. Recent Accounting Pronouncements — Except for rules and interpretive releases of the Securities and Exchange Commission (SEC) under authority of federal securities laws and a limited number of grandfathered standards, the Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) is the sole source of authoritative GAAP literature recognized by the FASB and applicable to the Company. For any new pronouncements announced, the Company considers whether the new pronouncements could alter previous generally accepted accounting principles and determines whether any new or modified principles will have a material impact on the Company's reported financial position or operations in the near term. The applicability of any standard is subject to the formal review of the Company's financial management and certain standards are under consideration. Recent Accounting Standards Adopted by the Company In March 2016, the FASB issued a new standard to simplify several aspects of the accounting for employee share-based payment transactions, which includes the accounting for income taxes, forfeitures, and statutory tax withholding requirements, as well as classification in the statement of cash flows. The new standard was effective for the Company in the first quarter of fiscal year 2017. Under the previous guidance, excess tax benefits and deficiencies from share-based compensation arrangements were recorded in equity when the awards vested or were settled. The new guidance requires prospective recognition of excess tax benefits and deficiencies in the income statement, resulting in the recognition of excess tax benefits in income tax expense, of $3,423 , rather than in paid-in-capital, for the year ended December 31, 2017 . In addition, under the new guidance, excess income tax benefits from share-based compensation arrangements are classified as cash flow from operations, rather than as cash flow from financing activities. The Company has elected to apply the cash flow classification guidance prospectively, resulting in an increase to operating cash flow for the year ended December 31, 2017 and the prior year period has not been adjusted. The Company has also elected to continue to estimate the expected forfeitures rather than electing to account for forfeitures as they occur. Finally, the adoption of the guidance requires excess tax benefits and deficiencies to be prospectively excluded from assumed future proceeds in the calculation of diluted shares, resulting in an increase in diluted weighted average shares outstanding. Accounting Standards Recently Issued But Not Yet Adopted by the Company In May 2017, the FASB issued amended authoritative guidance to provide guidance on types of changes to the terms or conditions of share-based payments awards to which an entity would be required to apply modification accounting under ASC 718. This guidance is effective for annual and interim periods beginning after December 15, 2017, which will be the Company's fiscal year 2018, with early adoption permitted in certain cases. The adoption of this standard is not expected to have a material impact on the Company's consolidated financial statements. In January 2017, the FASB issued amended authoritative guidance to clarify the definition of a business and reduce diversity in practice related to the evaluation of whether transactions should be accounted for as acquisitions (or disposals) of assets or businesses. The new provisions provide the requirements needed for an integrated set of assets and activities (the set) to be a business and also establish a practical way to determine when a set is not a business. The ASU provides a screen to determine when an integrated set of assets and activities is not a business. The more robust framework helps entities to narrow the definition of outputs created by the set and align it with how outputs are described in the new revenue standard. This guidance is effective for annual and interim periods beginning after December 15, 2017, which will be the Company's fiscal year 2018, with early adoption permitted in certain cases. The new guidance is required to be applied on a prospective basis. The effect of the implementation will depend upon the nature of the Company's future acquisitions. In January 2017, the FASB issued amended authoritative guidance to simplify and reduce the cost and complexity of the goodwill impairment test. The new provisions eliminate step 2 from the goodwill impairment test and shifts the concept of impairment from a measure of loss when comparing the implied fair value of goodwill to its carrying amount to comparing the fair value of a reporting unit with its carrying amount. The Board also eliminated the requirements for any reporting unit with a zero or negative carrying amount to perform a qualitative assessment or step 2 of the goodwill impairment test. The new guidance does not amend the optional qualitative assessment of goodwill impairment. This guidance is effective for annual periods beginning after December 15, 2019, which will be the Company's fiscal year 2020, with early adoption permitted. The adoption of this standard is not expected to have a material impact on the Company's consolidated financial statements. In October 2016, the FASB issued amended authoritative guidance to require companies to recognize the income tax consequences of an intra-entity transfer of an asset, other than inventory, when the transfer occurs. The amendments will be effective for the Company’s fiscal year beginning January 1, 2018. The new guidance is required to be applied on a modified retrospective basis through a cumulative-effect adjustment directly to retained earnings as of the beginning of the period of adoption. The adoption of this standard is not expected to have a material impact on the Company's consolidated financial statements based on the Company's historical activity. Furthermore, the actual impact of implementation will largely depend on future intra-entity asset transfers, if any. In August 2016, the FASB issued amended authoritative guidance to reduce the diversity in practice related to the presentation and classification of certain cash receipts and cash payments in the statement of cash flows. The new provisions target cash flow issues related to (i) debt prepayment or debt extinguishment costs, (ii) settlement of debt instruments with coupon rates that are insignificant relative to effective interest rates, (iii) contingent consideration payments made after a business combination, (iv) proceeds from settlement of insurance claims, (v) proceeds from the settlement of corporate-owned life insurance and bank-owned life insurance policies, (vi) distributions received from equity method investees, (vii) beneficial interests in securitization transactions and (viii) separately identifiable cash flows and application of the predominance principle. This guidance will be effective for fiscal years beginning after December 15, 2017, which will be the Company's fiscal year 2018, with early adoption permitted. The adoption of this standard is not expected to have a |
Common Stock
Common Stock | 12 Months Ended |
Dec. 31, 2017 | |
Common Stock [Abstract] | |
Common stock offering [Text Block] | COMMON STOCK On February 8, 2017, the Company announced that its Board of Directors authorized a stock repurchase program, under which the Company may repurchase up to $30,000 of its common stock under the program for a period of 12 months . Under this program, the Company is authorized to repurchase its issued and outstanding common shares from time to time in open-market and privately negotiated transactions and block trades in accordance with federal securities laws. The stock repurchase program expired on February 8, 2018 . During the year ended December 31, 2017, the Company repurchased 412 shares of its common stock for a total of $7,288 . On November 4, 2015 and February 9, 2016, the Company announced that its Board of Directors authorized two stock repurchase programs, under which the Company could repurchase up to $15,000 of its common stock under each program for a period of 12 months . During the first quarter of 2016, the Company repurchased 1,452 shares of its common stock for a total of $30,000 and these repurchase programs expired upon the repurchase of the full authorized amount under such plans. |
Computation of Net Income Per C
Computation of Net Income Per Common Share | 12 Months Ended |
Dec. 31, 2017 | |
COMPUTATION OF NET INCOME PER COMMON SHARE [Abstract] | |
Earnings Per Share [Text Block] | COMPUTATION OF NET INCOME PER COMMON SHARE Basic net income per share is computed by dividing income from continuing operations attributable to The Ensign Group, Inc. stockholders by the weighted average number of outstanding common shares for the period. The computation of diluted net income per share is similar to the computation of basic net income per share except that the denominator is increased to include the number of additional common shares that would have been outstanding if the dilutive potential common shares had been issued. The adoption of ASU No. 2016-09, Improvements to Employee Share-Based Payment Accounting: Topic 718 requires excess tax benefits and deficiencies to be prospectively excluded from assumed future proceeds in the calculation of diluted shares, resulting in an increase in diluted weighted average shares outstanding. A reconciliation of the numerator and denominator used in the calculation of basic net income per common share follows: Year Ended December 31, 2017 2016 2015 Numerator: Net income $ 40,833 $ 52,843 $ 55,917 Less: net income attributable to noncontrolling interests 358 2,853 485 Net income attributable to The Ensign Group, Inc. $ 40,475 $ 49,990 $ 55,432 Denominator: Weighted average shares outstanding for basic net income per share 50,932 50,555 50,316 Basic net income per common share attributable to The Ensign Group, Inc. $ 0.79 $ 0.99 $ 1.10 A reconciliation of the numerator and denominator used in the calculation of diluted net income per common share follows: Year Ended December 31, 2017 2016 2017 Numerator: Net income $ 40,833 $ 52,843 $ 55,917 Less: net income attributable to noncontrolling interests 358 2,853 485 Net income attributable to The Ensign Group, Inc. $ 40,475 $ 49,990 $ 55,432 Denominator: Weighted average common shares outstanding 50,932 50,555 50,316 Plus: incremental shares from assumed conversion (1) 1,897 1,578 1,894 Adjusted weighted average common shares outstanding 52,829 52,133 52,210 Diluted net income per common share attributable to The Ensign Group, Inc. $ 0.77 $ 0.96 $ 1.06 (1) Options outstanding which are anti-dilutive and therefore not factored into the weighted average common shares amount above were 1,252 , 838 and 258 for the years ended December 31, 2017, 2016 and 2015 , respectively. |
Fair Value Measurements
Fair Value Measurements | 12 Months Ended |
Dec. 31, 2017 | |
Fair Value Disclosures [Abstract] | |
Fair Value Disclosures [Text Block] | FAIR VALUE MEASUREMENTS Fair value measurements are based on a three-tier hierarchy that prioritizes the inputs used to measure fair value. These tiers include: Level 1, defined as observable inputs such as quoted market prices in active markets; Level 2, defined as inputs other than quoted prices included within Level 1 that are observable for the asset or liability, either directly or indirectly; and Level 3, defined as unobservable inputs for which little or no market data exists, therefore requiring an entity to develop its own assumptions. The following table summarizes the financial assets and liabilities measured at fair value on a recurring basis as of December 31, 2017 and 2016: December 31, 2017 2016 Level 1 Level 2 Level 3 Level 1 Level 2 Level 3 Cash and cash equivalents $ 42,337 $ — $ — $ 57,706 $ — $ — Our non-financial assets, which include long-lived assets, including goodwill, intangible assets and property and equipment, are not required to be measured at fair value on a recurring basis. However, on a periodic basis, or whenever events or changes in circumstances indicate that their carrying value may not be recoverable, we assess our long-lived assets for impairment. When impairment has occurred, such long-lived assets are written down to fair value. See Note 2, Summary of Significant Accounting Policies for further discussion of the Company's significant accounting policies. Debt Security Investments - Held to Maturity At December 31, 2017 and 2016, the Company had approximately $41,777 and $35,184 , respectively, in debt security investments which were classified as held to maturity and carried at amortized cost. The carrying value of the debt securities approximates fair value based on Level 1. The Company has the intent and ability to hold these debt securities to maturity. Further, as of December 31, 2017 , the debt security investments were held in AA, A and BBB+ rated debt securities. |
Revenue and Accounts Receivable
Revenue and Accounts Receivable | 12 Months Ended |
Dec. 31, 2017 | |
REVENUE AND ACCOUNTS RECEIVABLE [Abstract] | |
Revenue and Accounts receivable [Text Block] | REVENUE AND ACCOUNTS RECEIVABLE Revenue for the years ended December 31, 2017, 2016 and 2015 is summarized in the following tables: Year Ended December 31, 2017 2016 2015 Revenue % of Revenue Revenue % of Revenue Revenue % of Revenue Medicaid $ 644,803 34.9 % $ 557,958 33.7 % $ 458,956 34.2 % Medicare 515,884 27.9 477,019 28.8 395,503 29.5 Medicaid — skilled 102,875 5.6 87,517 5.3 71,905 5.4 Total Medicaid and Medicare 1,263,562 68.4 1,122,494 67.8 926,364 69.1 Managed care 303,386 16.4 265,508 16.0 206,770 15.4 Private and other payors (1) 282,369 15.2 266,862 16.2 208,692 15.5 Revenue $ 1,849,317 100.0 % $ 1,654,864 100.0 % $ 1,341,826 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services for the years ended December 31, 2017, 2016 and 2015 and urgent care centers for the years ended December 31, 2016 and 2015. Accounts receivable as of December 31, 2017 and 2016 is summarized in the following table: December 31, 2017 2016 Medicaid $ 119,441 $ 111,031 Managed care 68,930 66,346 Medicare 55,667 55,500 Private and other payors 64,991 51,347 309,029 284,224 Less: allowance for doubtful accounts (43,961 ) (39,791 ) Accounts receivable, net $ 265,068 $ 244,433 |
Business Segments
Business Segments | 12 Months Ended |
Dec. 31, 2017 | |
Segment Reporting [Abstract] | |
Segment Reporting Disclosure [Text Block] | BUSINESS SEGMENTS The Company has three reportable operating segments: (1) transitional and skilled services, which includes the operation of skilled nursing facilities; (2) assisted and independent living services, which includes the operation of assisted and independent living facilities; and (3) home health and hospice services, which includes the Company's home health, home care and hospice businesses. The Company's Chief Executive Officer, who is its chief operating decision maker, or CODM, reviews financial information at the operating segment level. The Company also reports an “all other” category that includes results from its mobile diagnostics and other ancillary operations for the years ended December 31, 2017, 2016 and 2015 and urgent care centers for the years ended December 31, 2016 and 2015. The Company completed the sale of its urgent care centers in 2016 and recognized a pretax gain of $41,492 . These operations are neither significant individually nor in aggregate and therefore do not constitute a reportable segment. The reporting segments are business units that offer different services and are managed separately to provide greater visibility into those operations. As of December 31, 2017 , transitional and skilled services included 160 wholly-owned affiliated skilled nursing facilities and 21 campuses that provide skilled nursing and rehabilitative care services. The Company provided room and board and social services through 49 wholly-owned affiliated assisted and independent living facilities and 21 campuses. Home health, home care and hospice services were provided to patients through 46 affiliated agencies. As of December 31, 2017 , the Company held majority membership interests in other ancillary operations, which operating results are included in the "all other" category. The Company evaluates performance and allocates capital resources to each segment based on an operating model that is designed to maximize the quality of care provided and profitability. General and administrative expenses are not allocated to any segment for purposes of determining segment profit or loss, and are included in the "all other" category in the selected segment financial data that follows. The accounting policies of the reporting segments are the same as those described in Note 2 , Summary of Significant Accounting Policies. The Company's CODM does not review assets by segment in his resource allocation and therefore assets by segment are not disclosed below. Segment revenues by major payor source were as follows: Year Ended December 31, 2017 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 603,104 $ 30,469 $ 11,230 $ — $ 644,803 34.9 % Medicare 417,870 — 98,014 — 515,884 27.9 Medicaid-skilled 102,875 — — — 102,875 5.6 Subtotal 1,123,849 30,469 109,244 — 1,263,562 68.4 Managed care 281,563 — 21,823 — 303,386 16.4 Private and other 139,798 106,177 11,336 25,058 (1) 282,369 15.2 Total revenue $ 1,545,210 $ 136,646 $ 142,403 $ 25,058 $ 1,849,317 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services for the year ended December 31, 2017. Year Ended December 31, 2016 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 521,063 $ 26,397 $ 10,498 $ — $ 557,958 33.7 % Medicare 396,519 — 80,500 — 477,019 28.8 Medicaid-skilled 87,517 — — — 87,517 5.3 Subtotal 1,005,099 26,397 90,998 — 1,122,494 67.8 Managed care 247,844 — 17,664 — 265,508 16.0 Private and other 121,860 97,239 7,151 40,612 (1) 266,862 16.2 Total revenue $ 1,374,803 $ 123,636 $ 115,813 $ 40,612 $ 1,654,864 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services and urgent care centers for the year ended December 31, 2016. Year Ended December 31, 2015 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 430,368 $ 19,642 $ 8,946 $ — $ 458,956 34.2 % Medicare 332,429 — 63,074 — 395,503 29.5 Medicaid-skilled 71,905 — — — 71,905 5.4 Subtotal 834,702 19,642 72,020 — 926,364 69.1 Managed care 194,743 — 12,027 — 206,770 15.4 Private and other 96,943 68,487 6,309 36,953 (1) 208,692 15.5 Total revenue $ 1,126,388 $ 88,129 $ 90,356 $ 36,953 $ 1,341,826 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services and urgent care centers for the year ended December 31, 2015. The following table sets forth selected financial data consolidated by business segment: Year Ended December 31, 2017 Transitional and Skilled Services (3) Assisted and Independent Living Services (3) Home Health and Hospice Services All Other Elimination Total Revenue from external customers $ 1,545,210 $ 136,646 $ 142,403 $ 25,058 $ — $ 1,849,317 Intersegment revenue (1) 3,023 — — 3,035 (6,058 ) — Total revenue $ 1,548,233 $ 136,646 $ 142,403 $ 28,093 $ (6,058 ) $ 1,849,317 Segment income (loss) (2) $ 140,272 $ 16,736 $ 19,717 $ (95,440 ) $ — $ 81,285 Interest expense, net of interest income $ (12,007 ) Income before provision for income taxes $ 69,278 Depreciation and amortization $ 29,928 $ 6,334 $ 945 $ 7,265 $ — $ 44,472 (1) Intersegment revenue represents services provided at the Company's operating subsidiaries to the Company's other business lines. (2) Segment income (loss) includes depreciation and amortization expense and excludes general and administrative expense and interest expense for transitional and skilled services, assisted and independent living services and home health and hospice businesses. General and administrative expense is included in the "All Other" category. (3) The Company's campuses represent facilities that offer 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. Year Ended December 31, 2016 Transitional and Skilled Services (3) Assisted and Independent Living Services (3) Home Health and Hospice Services All Other Elimination Total Revenue from external customers $ 1,374,803 $ 123,636 $ 115,813 $ 40,612 $ — $ 1,654,864 Intersegment revenue (1) 2,929 — — 2,184 (5,113 ) — Total revenue $ 1,377,732 $ 123,636 $ 115,813 $ 42,796 $ (5,113 ) $ 1,654,864 Segment income (loss) (2) $ 118,118 $ 11,701 $ 16,571 $ (54,543 ) $ — $ 91,847 Interest expense, net of interest income $ (6,029 ) Income before provision for income taxes $ 85,818 Depreciation and amortization $ 26,298 $ 4,157 $ 924 $ 7,303 $ — $ 38,682 (1) Intersegment revenue represents services provided at the Company's operating subsidiaries to the Company's other business lines. (2) Segment income (loss) includes depreciation and amortization expense and excludes general and administrative expense and interest expense for transitional and skilled services, assisted and independent living services and home health and hospice businesses. General and administrative expense is included in the "All Other" category. (3) The Company's campuses represent facilities that offer 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. Year Ended December 31, 2015 Transitional and Skilled Services (3) Assisted and Independent Living Services (3) Home Health and Hospice Services All Other Elimination Total Revenue from external customers $ 1,126,388 $ 88,129 $ 90,356 $ 36,953 $ — $ 1,341,826 Intersegment revenue (1) 2,447 — — 881 (3,328 ) — Total revenue $ 1,128,835 $ 88,129 $ 90,356 $ 37,834 $ (3,328 ) $ 1,341,826 Segment income (loss) (2) $ 136,744 $ 11,463 $ 13,584 $ (68,709 ) $ — $ 93,082 Interest expense, net of interest income $ (1,983 ) Income before provision for income taxes $ 91,099 Depreciation and amortization $ 18,008 $ 3,338 $ 980 $ 5,785 $ — $ 28,111 (1) Intersegment revenue represents services provided at the Company's operating subsidiaries to the Company's other business lines. (2) Segment income (loss) includes depreciation and amortization expense and excludes general and administrative expense and interest expense for transitional and skilled services, assisted and independent living services and home health and hospice businesses. General and administrative expense is included in the "All Other" category. (3) The Company's campuses represent facilities that offer 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. The Company's transitional and skilled services segment income for the years ended December 31, 2017 and 2016 included continued obligations under the lease related to closed operations, lease termination costs and related closing expenses of $4,017 and $7,935 , respectively. These amounts included the present value of future rental payments of approximately $2,715 and $6,512 and long-lived assets impairment of $111 and $137 for the years ended December 31, 2017 and 2016 , respectively. These costs were not incurred for the year ended December 31, 2015. See Note 17, Leases for further detail. Included in the year ended December 31, 2017 is the loss recovery of $1,286 related to a facility that was closed in the prior year. |
Acquisitions
Acquisitions | 12 Months Ended |
Dec. 31, 2017 | |
Business Combinations [Abstract] | |
Business Combination Disclosure [Text Block] | ACQUISITIONS The Company’s acquisition focus is to purchase or lease operating subsidiaries that are complementary to the Company’s current affiliated operations, accretive to the Company's business or otherwise advance the Company's strategy. The results of all the Company’s operating subsidiaries are included in the accompanying Financial Statements subsequent to the date of acquisition. Acquisitions are accounted for using the acquisition method of accounting. The Company also enters into long-term leases that may include options to purchase the affiliated facilities. As a result, from time to time, the Company will acquire affiliated facilities that the Company has been operating under third-party leases. During the year ended December 31, 2017 , the Company expanded its operations through a combination of long-term leases and purchases, with the addition of eight stand-alone skilled nursing operations, nine stand-alone assisted and independent living operations, one campus operation, three home health agencies, three hospice agencies and one home care agency. The Company did not acquire any material assets or assume any liabilities other than the tenant's post-assumption rights and obligations under the long-term leases. The Company has also invested in ancillary services that are complementary to its existing transitional and skilled services, assisted and independent living services, and home health and hospice businesses. The aggregate purchase price for these acquisitions for the year ended December 31, 2017 was $89,683 . The addition of these operations added 905 operational skilled nursing beds and 594 assisted living units operated by the Company's operating subsidiaries. The Company entered into a separate operations transfer agreement with the prior operator as part of each transaction. Additionally, the Company's operating subsidiaries also opened four newly constructed stand-alone skilled nursing operations under long-term lease agreements, which added 455 operational skilled nursing beds. During the year ended December 31, 2016 , the Company expanded its operations with the addition of two home health agencies and five hospice agencies. In addition, the Company acquired eighteen stand-alone skilled nursing operations and one post-acute care campus through a combination of long-term leases and purchases. As part of these acquisitions, the Company acquired the real estate at two of the skilled nursing operations and one post-acute care campus and entered into long term leases for sixteen skilled nursing operations. The Company did not acquire any material assets or assume any liabilities other than the tenant's post-assumption rights and obligations under the long-term lease. The Company also invested in new ancillary services that are complementary to its existing transitional and skilled services; assisted and independent living services and home health and hospice businesses. The aggregate purchase price for these acquisitions for the year ended December 31, 2016 was $64,521 . The expansion of skilled nursing operations added 2,336 operational skilled nursing beds and ten assisted living units operated by the Company's operating subsidiaries. The Company entered into a separate operations transfer agreement with the prior operator as part of each transaction. Additionally, the Company's operating subsidiaries opened six newly constructed post-acute care campuses under long-term lease agreements, which added 463 operational skilled nursing beds and 142 assisted living units. During the year ended December 31, 2015, the Company continued to expand its operations with the addition of 50 stand-alone skilled nursing and assisted living operations, seven home health, hospice and home care agencies and three urgent care centers to its operations through a combination of long-term leases and purchases. The Company did not acquire any material assets or assume any liabilities other than the tenant's post-assumption rights and obligations under the long-term leases. As part of these transactions, we acquired the real estate at 18 of the skilled nursing and assisted and independent living operations. In addition, the Company has invested in new business lines that are complementary to its existing transitional and skilled services; assisted and independent living services and home health and hospice businesses. The aggregate purchase price conveyed in all acquisitions was $119,965 , including the assumption of liabilities of $8,939 . The expansion of skilled nursing and assisted and independent living operations added 2,580 and 2,013 operational skilled nursing beds and assisted and independent living units, respectively, operated by the Company's operating subsidiaries. The Company also entered into a separate operations transfer agreement with the prior operator as part of each transaction. The table below presents the allocation of the purchase price for the operations acquired in business combinations during the year ended December 31, 2017 , 2016 and 2015. As of the date of this filing, the preliminary allocation of the purchase price for certain acquisitions in the fourth quarter was not completed as necessary valuation information was not yet available. December 31, 2017 2016 2015 Land $ 9,732 $ 1,054 $ 12,811 Building and improvements 53,735 21,057 73,502 Equipment, furniture, and fixtures 4,382 8,265 4,612 Assembled occupancy 762 1,299 895 Definite-lived intangible assets — 363 360 Goodwill 13,962 30,343 10,617 Favorable leases — 393 10,901 Other indefinite-lived intangible assets 7,018 1,741 6,285 Other assets acquired, net of liabilities assumed 92 6 (18 ) Total acquisitions $ 89,683 $ 64,521 $ 119,965 In addition to the business combinations above, during the year ended December 31, 2017, the Company acquired Medicare and Medicaid licenses to add to its existing operations for an aggregate purchase price of $195 . For year ended December 31, 2016, the Company acquired the underlying real estate of fifteen assisted living operations, which the Company previously operated under a long-term lease agreement for an aggregate purchase price of $127,348 . For year ended December 31, 2015, the Company acquired the underlying real estate and assets of three skilled nursing operations that the Company previously operated under long-term lease agreements for an aggregate purchase price of $23,998 , which included a promissory note of $6,248 . These asset acquisitions did not impact the Company's operational bed or unit counts. Subsequent to December 31, 2017 , the Company acquired two stand-alone assisted and independent living operations for an aggregate purchase price of $4,298 . The addition of these operations added 74 assisted living units operated by the Company's operating subsidiaries. The Company’s acquisition strategy has been focused on identifying both opportunistic and strategic acquisitions within its target markets that offer strong opportunities for return on invested capital. The operating subsidiaries acquired by the Company are frequently underperforming financially and can have regulatory and clinical challenges to overcome. Financial information, especially with underperforming operating subsidiaries, is often inadequate, inaccurate or unavailable. Consequently, the Company believes that prior operating results are not a meaningful representation of the Company’s current operating results or indicative of the integration potential of its newly acquired operating subsidiaries. The businesses acquired during the year ended December 31, 2017 were not material acquisitions to the Company individually or in the aggregate. Accordingly, pro forma financial information is not presented. These acquisitions have been included in the December 31, 2017 consolidated balance sheets of the Company, and the operating results have been included in the consolidated statements of operations of the Company since the dates the Company gained effective control. |
Property and Equipment
Property and Equipment | 12 Months Ended |
Dec. 31, 2017 | |
Property, Plant and Equipment [Abstract] | |
Property, Plant and Equipment Disclosure [Text Block] | PROPERTY AND EQUIPMENT— Net Property and equipment, net consist of the following: December 31, 2017 2016 Land $ 49,081 $ 47,565 Buildings and improvements 342,641 304,263 Equipment 181,530 153,170 Furniture and fixtures 5,244 6,931 Leasehold improvements 97,221 80,164 Construction in progress 5,460 2,441 681,177 594,534 Less: accumulated depreciation (144,093 ) (110,036 ) Property and equipment, net $ 537,084 $ 484,498 The Company disposed of $24,847 of land, building and equipment as part of the sale-leaseback transaction during the year ended December 31, 2017. See Note 17, Leases for information on the sale-leaseback transaction. See also Note 8, Acquisitions for information on acquisitions during the year ended December 31, 2017. |
Intangible Assets - Net
Intangible Assets - Net | 12 Months Ended |
Dec. 31, 2017 | |
Intangible Assets, Net (Excluding Goodwill) [Abstract] | |
Intangible Assets Disclosure [Text Block] | INTANGIBLE ASSETS — Net Weighted Average Life (Years) December 31, 2017 2016 Gross Carrying Amount Accumulated Amortization Gross Carrying Amount Accumulated Amortization Intangible Assets Net Net Lease acquisition costs 24.8 $ 483 $ (99 ) $ 384 $ 483 $ (78 ) $ 405 Favorable leases 33.0 35,116 (6,568 ) 28,548 35,116 (4,589 ) 30,527 Assembled occupancy 0.7 2,659 (2,631 ) 28 1,897 (1,897 ) — Facility trade name 30.0 733 (293 ) 440 733 (269 ) 464 Customer relationships 18.7 4,933 (1,530 ) 3,403 4,933 (1,253 ) 3,680 Total $ 43,924 $ (11,121 ) $ 32,803 $ 43,162 $ (8,086 ) $ 35,076 Amortization expense was $3,035 , $4,634 and $3,824 for the years ended December 31, 2017, 2016 and 2015, respectively. Of the $3,035 in amortization expense incurred during the year ended December 31, 2017, approximately $734 related to the amortization of patient base intangible assets at recently acquired facilities, which is typically amortized over a period of four to eight months, depending on the classification of the patients and the level of occupancy in a new acquisition on the acquisition date. As of December 31, 2016 , the Company removed $582 in customer relationships as part of the sale of urgent care centers and $7,190 of favorable leases as part of the acquisition of the real estate of fifteen assisted living operations. Estimated amortization expense for each of the years ending December 31 is as follows: Year Amount 2018 2,329 2019 2,301 2020 1,593 2021 1,497 2022 1,471 Thereafter 23,612 $ 32,803 |
Goodwill and Other Indefinite-L
Goodwill and Other Indefinite-Lived Intangible Assets | 12 Months Ended |
Dec. 31, 2017 | |
Indefinite-Lived Intangible Assets (Including Goodwill) [Abstract] | |
Goodwill and Other Indefinite-Lived Intangibles [Text Block] | GOODWILL AND OTHER INDEFINITE-LIVED INTANGIBLE ASSETS The Company tests goodwill during the fourth quarter of each year or more often if events or circumstances indicate there may be impairment. The Company performs its analysis for each reporting unit that constitutes a business for which discrete financial information is produced and reviewed by operating segment management and provides services that are distinct from the other components of the operating segment, in accordance with the provisions of Accounting Standards Codification topic 350, Intangibles—Goodwill and Other (ASC 350). This guidance provides the option to first assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying value, a "Step 0" analysis. If, based on a review of qualitative factors, it is more likely than not that the fair value of a reporting unit is less than its carrying value, the Company performs "Step 1" of the traditional two-step goodwill impairment test by comparing the net assets of each reporting unit to their respective fair values. The Company determines the estimated fair value of each reporting unit using a discounted cash flow analysis. In the event a unit's net assets exceed its fair value, an implied fair value of goodwill must be determined by assigning the unit's fair value to each asset and liability of the unit. The excess of the fair value of the reporting unit over the amounts assigned to its assets and liabilities is the implied fair value of goodwill. An impairment loss is measured by the difference between the goodwill carrying value and the implied fair value. The Company performs its goodwill impairment test annually and evaluates goodwill when events or changes in circumstances indicate that its carrying value may not be recoverable. The Company performs the annual impairment testing of goodwill using October 1 as the measurement date. The Company completed its goodwill impairment test as of October 1, 2017 and no impairments were identified. As of December 31, 2016 , the Company removed $4,103 in goodwill as part of the sale of urgent care centers. The following table represents activity in goodwill by segment as of and for the year ended December 31, : Goodwill Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total January 1, 2015 $ 14,221 $ 1,756 $ 10,929 $ 3,363 $ 30,269 Additions — 1,782 5,173 3,662 10,617 December 31, 2015 $ 14,221 $ 3,538 $ 16,102 $ 7,025 $ 40,886 Less: Dispositions — — — (4,103 ) (4,103 ) Purchase price adjustment — — — (26 ) (26 ) Additions 26,415 — 1,799 2,129 30,343 December 31, 2016 $ 40,636 $ 3,538 $ 17,901 $ 5,025 $ 67,100 Additions 4,850 420 6,421 2,271 13,962 December 31, 2017 $ 45,486 $ 3,958 $ 24,322 $ 7,296 $ 81,062 There was no impairment charge to goodwill for the years ended December 31, 2017, 2016 and 2015. The Company anticipates that the majority of total goodwill recognized will be fully deductible for tax purposes as of December 31, 2017 . See further discussion of goodwill acquired at Note 8, Acquisitions . During the year ended December 31, 2017, the Company recorded $7,178 in Medicare and Medicaid licenses and $35 in trade name indefinite-lived intangible assets as part of its acquisitions. In addition, the Company disposed of $500 in Medicare license in fiscal year 2017. Other indefinite-lived intangible assets consists of the following: December 31, 2017 December 31, 2016 Trade name $ 1,181 $ 1,146 Medicare and Medicaid licenses 24,068 18,440 $ 25,249 $ 19,586 |
Restricted and Other Assets
Restricted and Other Assets | 12 Months Ended |
Dec. 31, 2017 | |
Other Assets [Abstract] | |
Other Assets Disclosure [Text Block] | RESTRICTED AND OTHER ASSETS Restricted and other assets consist of the following: December 31, 2017 2016 Debt issuance costs, net $ 2,799 $ 3,611 Long-term insurance losses recoverable asset 5,394 4,104 Deposits with landlords 5,981 3,526 Capital improvement reserves with landlords and lenders 2,327 673 Note receivable from sale of urgent care centers — 700 Restricted and other assets $ 16,501 $ 12,614 Included in restricted and other assets as of December 31, 2017 and 2016, are anticipated insurance recoveries related to the Company's workers' compensation, general and professional liability claims that are recorded on a gross rather than net basis in accordance with an Accounting Standards Update issued by the FASB. Note receivable from sale of urgent centers was reclassified to current assets. The Company collected the receivable in January 2018. |
Other Accrued Liabilities
Other Accrued Liabilities | 12 Months Ended |
Dec. 31, 2017 | |
Accrued Liabilities [Abstract] | |
Other Liabilities Disclosure [Text Block] | OTHER ACCRUED LIABILITIES Other accrued liabilities consist of the following: December 31, 2017 2016 Quality assurance fee $ 4,864 $ 4,604 Refunds payable 21,661 18,368 Deferred revenue 7,066 6,994 Cash held in trust for patients 2,609 2,373 Resident deposits 6,574 6,099 Dividends payable 2,328 2,186 Property taxes 10,088 9,130 Income tax payable — 1,182 Operational closure liability 910 1,972 Other 7,715 5,855 Other accrued liabilities $ 63,815 $ 58,763 Quality assurance fee represents amounts payable to Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, Utah, Washington and Wisconsin as a result of a mandated fee based on patient days or licensed beds. Refunds payable includes payables related to overpayments, duplicate payments and credit balances from various payor sources. Deferred revenue occurs when the Company receives payments in advance of services provided. Resident deposits include refundable deposits to patients. Cash held in trust for patients reflects monies received from, or on behalf of, patients. Maintaining a trust account for patients is a regulatory requirement and, while the trust assets offset the liabilities, the Company assumes a fiduciary responsibility for these funds. The cash balance related to this liability is included in other current assets in the accompanying consolidated balance sheets. Operational closure liability includes the short-term portion of the closing costs that are payable within the next 12 months. The remaining long-term portion is included in other long-term liabilities in the accompanying consolidated balance sheets. |
Income Taxes
Income Taxes | 12 Months Ended |
Dec. 31, 2017 | |
Income Tax Disclosure [Abstract] | |
Income Tax Disclosure [Text Block] | INCOME TAXES The Tax Act was enacted on December 22, 2017. Effective January 1, 2018 the Tax Act reduces the corporate rate from 35.0% to 21.0%. As of December 31, 2017, the Company has not completed its accounting for the tax effects of the enactment of the Act; however, the Company has made a reasonable estimate of the effects on its existing deferred tax balances. The Company recognized an income tax expense of $3,915 in the year ended December 31, 2017 to reflect the revaluation of the Company's net deferred tax assets based on the U.S. federal tax rate of 21.0%. The Company is currently analyzing the Tax Act and refining its calculations, which could potentially impact the measurement of the Company's tax balances. The expected impact of the enactment of the Tax Act for fiscal year 2017 is reflected in the table below. The provision for income taxes on continuing operations for the years ended December 31, 2017, 2016 and 2015 is summarized as follows: Year Ended December 31, 2017 2016 2015 Current: Federal $ 15,141 $ 30,043 $ 28,149 State 2,975 5,183 5,761 18,116 35,226 33,910 Deferred: Federal 5,428 (1,034 ) 2,026 State 986 (1,217 ) (754 ) 6,414 (2,251 ) 1,272 Adjustment to deferred taxes for tax rate change 3,915 — — Total $ 28,445 $ 32,975 $ 35,182 A reconciliation of the federal statutory rate to the effective tax rate for income from continuing operations for the years ended December 31, 2017, 2016 and 2015, respectively, is comprised as follows: December 31, 2017 2016 2015 Income tax expense at statutory rate 35.0 % 35.0 % 35.0 % State income taxes - net of federal benefit 3.1 3.0 3.6 Non-deductible expenses 1.7 0.9 0.6 Equity compensation (4.5 ) — — Revaluation of deferred 5.7 — — Other adjustments 0.1 (0.5 ) (0.6 ) Total income tax provision 41.1 % 38.4 % 38.6 % The Company's deferred tax assets and liabilities as of December 31, 2017 and 2016 are summarized below. The deferred taxes in 2017 reflect the federal tax rate of 21.0%, whereas 2016 reflect a federal tax rate of 35.0%. December 31, 2017 2016 Deferred tax assets (liabilities): Accrued expenses $ 16,500 $ 21,732 Allowance for doubtful accounts 11,090 15,956 Tax credits 3,334 3,461 Insurance 5,135 7,333 36,059 48,482 Valuation allowance (530 ) — Total deferred tax assets 35,529 48,482 State taxes (911 ) (1,023 ) Depreciation and amortization (18,248 ) (20,643 ) Prepaid expenses (3,625 ) (3,743 ) Total deferred tax liabilities (22,784 ) (25,409 ) Net deferred tax assets $ 12,745 $ 23,073 The Company has recorded a decrease related to deferred tax assets and deferred tax liabilities of $17,995 and $14,080 , respectively, with a net adjustment to deferred income tax expense of $3,915 for the year ended December 31, 2017 as a result of the Tax Act. The Company had state credit carryforwards as of December 31, 2017 and 2016 of $3,302 and $3,430 , respectively. These carryforwards almost entirely relate to state limitations on the application of Enterprise Zone employment-related tax credits. Unless the Company uses the Enterprise Zone credits before hand, the carryforward will begin to expire in 2023. The remainder of these carryforwards relates to credits against the Texas margin tax and is expected to carry forward until 2027. As of December 31, 2017 a valuation allowance of $530 was recorded against the Enterprise Zone credits as the Company believes it is more likely than not that some of the benefit of the credits will not be realized. The Company's operating loss carry forwards for both federal and states were not material during the year ended December 31, 2017 and 2016. The Federal statutes of limitations on the Company's 2011, 2012, and 2013 income tax years lapsed during the third quarter of 2015, 2016, and 2017, respectively. During the fourth quarter of each year, various state statutes of limitations also lapsed. The lapses for the years ended December 31, 2017, 2016, and 2015 had no impact on the Company's unrecognized tax benefits. As of December 31, 2017, 2016 and 2015, the Company did not have any unrecognized tax benefits, net of their state benefits, that would affect the Company's effective tax rate. The Company classifies interest and/or penalties on income tax liabilities or refunds as additional income tax expense or income. Such amounts are not material. |
Debt
Debt | 12 Months Ended |
Dec. 31, 2017 | |
Debt Disclosure [Abstract] | |
Debt Disclosure [Text Block] | DEBT Long-term debt consists of the following: December 31, 2017 2016 Term loan with SunTrust, interest payable quarterly $ 140,625 $ 148,125 Credit facility with SunTrust 50,000 122,000 Mortgage loans and promissory note, principal and interest payable monthly, interest at fixed rate 125,394 14,032 316,019 284,157 Less: current maturities (9,939 ) (8,129 ) Less: debt issuance costs (3,090 ) (542 ) $ 302,990 $ 275,486 Credit Facility with a Lending Consortium Arranged by SunTrust The Company maintains a credit facility with a lending consortium arranged by SunTrust (as amended to date, the Credit Facility). The Company originally entered into the Credit Facility in an aggregate principal amount of $150,000 in May 2014. Under the Credit Facility, the Company could seek to obtain incremental revolving or term loans in an aggregate amount not to exceed $75,000 . The interest rates applicable to loans under the Credit Facility are, at the Company’s option, equal to either a base rate plus a margin ranging from 1.25% to 2.25% per annum or LIBOR plus a margin ranging from 2.25% to 3.25% per annum, based on the debt to Consolidated EBITDA ratio of the Company and its operating subsidiaries as defined in the agreement. In addition, the Company will pay a commitment fee on the unused portion of the commitments under the Credit Facility that will range from 0.30% to 0.50% per annum, depending on the debt to Consolidated EBITDA ratio of the Company and its operating subsidiaries. Loans made under the Credit Facility are not subject to interim amortization. The Company is not required to repay any loans under the Credit Facility prior to maturity, other than to the extent the outstanding borrowings exceed the aggregate commitments under the Credit Facility. On February 5, 2016, the Company amended its existing revolving credit facility to increase its aggregate principal amount available to $250,000 (the Amended Credit Facility). Under the credit facility, the Company may seek to obtain incremental revolving or term loans in an aggregate amount not to exceed $150,000 . The interest rates applicable to loans under the credit facility are, at the Company's option, equal to either a base rate plus a margin ranging from 0.75% to 1.75% per annum or LIBOR plus a margin ranging from 1.75% to 2.75% per annum, based on the Consolidated Total Net Debt to Consolidated EBITDA ratio (as defined in the agreement). In addition, the Company will pay a commitment fee on the unused portion of the commitments under the credit facility that will range from 0.30% to 0.50% per annum, depending on the Consolidated Total Net Debt to Consolidated EBITDA ratio of the Company and its subsidiaries. The Company is permitted to prepay all or any portion of the loans under the credit facility prior to maturity without premium or penalty, subject to reimbursement of any LIBOR breakage costs of the lenders. On July 19, 2016, the Company entered into the second amendment to the credit facility (Second Amended Credit Facility), which amended the existing credit agreement to increase the aggregate principal amount up to $450,000 . The Second Amended Credit Facility is comprised of a $300,000 revolving credit facility and a $150,000 term loan. Borrowings under the term loan portion of the Second Amended Credit Facility mature on February 5, 2021 and amortize in equal quarterly installments, in an aggregate annual amount equal to 5.0% per annum of the original principal amount. The interest rates and commitment fee applicable to the Second Amended Credit Facility are similar to the Amended Credit Facility discussed below. Except as set forth in the Second Amended Credit Facility, all other terms and conditions of the Amended Credit Facility remained in full force and effect as described below. The Credit Facility is guaranteed, jointly and severally, by certain of the Company’s wholly owned subsidiaries, and is secured by a pledge of stock of the Company's material operating subsidiaries as well as a first lien on substantially all of its personal property. The credit facility contains customary covenants that, among other things, restrict, subject to certain exceptions, the ability of the Company and its operating subsidiaries to grant liens on their assets, incur indebtedness, sell assets, make investments, engage in acquisitions, mergers or consolidations, amend certain material agreements and pay certain dividends and other restricted payments. Under the Credit Facility, the Company must comply with financial maintenance covenants to be tested quarterly, consisting of a maximum Consolidated Total Net Debt to consolidated EBITDA ratio (which shall be increased to 3.50 : 1.00 for the first fiscal quarter and the immediate following three fiscal quarters), and a minimum interest/rent coverage ratio (which cannot be below 1.50 : 1.00 ). The majority of lenders can require that the Company and its operating subsidiaries mortgage certain of its real property assets to secure the Amended Credit Facility if an event of default occurs, the Consolidated Total Net Debt to consolidated EBITDA ratio is above 2.75 : 1.00 for two consecutive fiscal quarters, or its liquidity is equal or less than 10% of the Aggregate Revolving Commitment Amount (as defined in the agreement) for ten consecutive business days, provided that such mortgages will no longer be required if the event of default is cured, the Consolidated Total Net Debt to consolidated EBITDA ratio is below 2.75 : 1.00 for two consecutive fiscal quarters, or its liquidity is above 10% of the Aggregate Revolving Commitment Amount (as defined in the agreement) or ninety consecutive days, as applicable. As of December 31, 2017 , the Company's operating subsidiaries had $190,625 outstanding under the Credit Facility. The outstanding balance on the term loan was $140,625 , of which $7,500 is classified as short-term and the remaining $133,125 is classified as long-term. The outstanding balance on the revolving Credit Facility was $50,000 , which is classified as long-term. The Company was in compliance with all loan covenants as of December 31, 2017 . As of February 2, 2018 , there was approximately $195,625 outstanding under the Credit Facility. Mortgage Loans and Promissory Note In December 2017, seventeen of the Company's subsidiaries entered into mortgage loans in the aggregate amount of $112,000 . The mortgage loans are insured with Department of Housing and Urban Development (HUD), which subjects these subsidiaries to HUD oversight and periodic inspections. The mortgage loans and note bear fixed interest rates of 3.3% per annum. Amounts borrowed under the mortgage loans may be prepaid, subject to prepayment fees of the principal balance on the date of prepayment. During the first three years, the prepayment fee is 10% and is reduced by 3% in the fourth year of the loan, and reduced by 1.0% per year for years five through ten of the loan. There is no prepayment penalty after year ten . The terms of the mortgage loans are 30 to 35 -years. The borrowings were arranged by Lancaster Pollard Mortgage Company, LLC, and insured by HUD. Loan proceeds were used to pay down previously drawn amounts on Ensign's revolving line of credit. In addition to refinancing existing borrowings, the proceeds of the HUD-insured debt helped fund acquisitions, to renovate and upgrade existing and future facilities, to cover working capital needs and for other business purposes. In addition to the HUD mortgage loans above, the Company had outstanding indebtedness under mortgage loans insured with HUD and a promissory note issued in connection with various acquisitions. These mortgage loans and note bear fixed interest rates between 2.6% and 5.3% per annum. Amounts borrowed under the mortgage loans may be prepaid starting after the second anniversary of the notes subject to prepayment fees of the principal balance on the date of prepayment. These prepayment fees are reduced by 1.0% per year for years three through eleven of the loan. There is no prepayment penalty after year eleven . The term of the mortgage loans and the note is between 12 and 33 years. The mortgage loans and note are secured by the real property comprising the facilities and the rents, issues and profits thereof, as well as all personal property used in the operation of the facilities. As of December 31, 2017 , the Company's operating subsidiaries had $125,394 outstanding under the mortgage loans and note, of which $2,439 is classified as short-term and the remaining $122,955 is classified as long-term. The Company was in compliance with all loan covenants as of December 31, 2017 . Based on Level 2, the carrying value of the Company's long-term debt is considered to approximate the fair value of such debt for all periods presented based upon the interest rates that the Company believes it can currently obtain for similar debt. Future principal payments due under the long-term debt arrangements discussed above are as follows: Years Ending December 31, Amount 2018 9,939 2019 10,106 2020 10,203 2021 170,926 2022 2,904 Thereafter 111,941 $ 316,019 Off-Balance Sheet Arrangements During the year ended December 31, 2017, the Company increased the letters of credit by $3,994 . As of December 31, 2017 , the Company had approximately $6,304 on the credit facility of borrowing capacity pledged as collateral to secure outstanding letters of credit. |
Options and Awards
Options and Awards | 12 Months Ended |
Dec. 31, 2017 | |
Options and Awards [Abstract] | |
Disclosure of Compensation Related Costs, Share-based Payments [Text Block] | OPTIONS AND AWARDS Stock-based compensation expense consists of share-based payment awards made to employees and directors, including employee stock options and restricted stock awards, based on estimated fair values. As stock-based compensation expense recognized in the Company’s consolidated statements of income for the years ended December 31, 2017, 2016 and 2015 was based on awards ultimately expected to vest, it has been reduced for estimated forfeitures. The Company estimates forfeitures at the time of grant and, if necessary, revises the estimate in subsequent periods if actual forfeitures differ. During the second quarter of 2017, the Company's shareholders approved the 2017 Omnibus Incentive Plan (the 2017 Plan). The total number of shares available under all of the Company’s stock incentive plans was 6,277 as of December 31, 2017. The Company retired the 2001 Stock Option, Deferred Stock and Restricted Stock Plan (2001 Plan), the 2005 Stock Incentive Plan (2005 Plan), and the 2007 Omnibus Incentive Plan (2007 Plan) as a result of the approval of the 2017 Plan. 2007 Omnibus Incentive Plan - The 2007 Plan authorizes the sale of up to 2,000 shares of common stock to officers, employees, directors and consultants of the Company. In addition, the number of shares of common stock reserved under the 2007 Plan will automatically increase on the first day of each fiscal year, beginning on January 1, 2008, in an amount equal to the lesser of (i) 1,000 shares of common stock, or (ii) 2% of the number of shares outstanding as of the last day of the immediately preceding fiscal year, or (iii) such lesser number as determined by the Company's board of directors. Granted non-employee director options vest and become exercisable in three equal annual installments, or the length of the term if less than 3 years , on the completion of each year of service measured from the grant date. All other granted options vest over 5 years at 20% per year on the anniversary of the grant date. Options expire 10 years from the date of grant. The Company granted 156 options and 61 restricted stock awards from the 2007 Plan in the first half of 2017 prior to the retirement of the 2007 Plan. 2017 Omnibus Incentive Plan - The 2017 Plan provides for the issuance of 6,881 shares of common stock. The number of shares available to be issued under the 2017 Plan will be reduced by (i) one share for each share that relates to an option or stock appreciation right award and (ii) 2.5 shares for each share which relates to an award other than a stock option or stock appreciation right award (a full-value award). Granted non-employee director options vest and become exercisable in three equal annual installments, or the length of the term if less than 3 years , on the completion of each year of service measured from the grant date. All other options generally vest over 5 years at 20% per year on the anniversary of the grant date. Options expire 10 years from the date of grant. At December 31, 2017 , there were 6,277 unissued shares of common stock available for issuance under this plan. The Company uses the Black-Scholes option-pricing model to recognize the value of stock-based compensation expense for all share-based payment awards. Determining the appropriate fair-value model and calculating the fair value of stock-based awards at the grant date requires considerable judgment, including estimating stock price volatility, expected option life and forfeiture rates. The Company develops estimates based on historical data and market information, which can change significantly over time. The Black-Scholes model required the Company to make several key judgments including: • The expected option term is calculated by the average of the contractual term of the options and the weighted average vesting period for all options. The calculation of the expected option term is based on the Company's experience due to sufficient history. • Estimated volatility also reflects the application of ASC 718 interpretive guidance and, accordingly, incorporates historical volatility of similar public entities until sufficient information regarding the volatility of the Company's share price becomes available. The Company has utilized its own experience to calculate estimated volatility for options granted. • The dividend yield is based on the Company's historical pattern of dividends as well as expected dividend patterns. • The risk-free rate is based on the implied yield of U.S. Treasury notes as of the grant date with a remaining term approximately equal to the expected term. • Estimated forfeiture rate of approximately 9.73% per year is based on the Company's historical forfeiture activity of unvested stock options. Stock Options The Company granted 481 options and 173 restricted stock awards from the 2007 and 2017 Plans during the year ended December 31, 2017. The Company used the following assumptions for stock options granted during the years ended December 31, 2017, 2016 and 2015 : Grant Year Options Granted Weighted Average Risk-Free Rate Expected Life Weighted Average Volatility Weighted Average Dividend Yield 2017 481 2.0% 6.2 years 35.2% 0.8% 2016 497 1.4% 6.3 years 37.8% 0.8% 2015 637 1.7% 6.5 years 39.5% 0.6% For the years ended December 31, 2017, 2016 and 2015 , the following represents the exercise price and fair value displayed at grant date for stock option grants: Grant Year Granted Weighted Average Exercise Price Weighted Average Fair Value of Options 2017 481 $ 20.31 $ 7.00 2016 497 $ 19.43 $ 7.00 2015 637 $ 23.27 $ 9.08 The weighted average exercise price equaled the weighted average fair value of common stock on the grant date for all options granted during the periods ended December 31, 2017, 2016 and 2015 and therefore, the intrinsic value was $0 at date of grant. The following table represents the employee stock option activity during the years ended December 31, 2017, 2016 and 2015 : Number of Options Outstanding Weighted Average Exercise Price Number of Options Vested Weighted Average Exercise Price of Options Vested January 1, 2015 5,532 $ 8.51 2,218 $ 4.70 Granted 637 23.27 Forfeited (233 ) 12.55 Exercised (488 ) 5.20 December 31, 2015 5,448 $ 10.36 2,526 $ 6.35 Granted 497 19.43 Forfeited (127 ) 14.46 Exercised (642 ) 6.47 December 31, 2016 5,176 $ 11.62 2,704 $ 8.18 Granted 481 20.31 Forfeited (178 ) 15.82 Exercised (740 ) 6.93 December 31, 2017 4,739 $ 13.08 2,776 $ 10.07 The following summary information reflects stock options outstanding, vested and related details as of December 31, 2017 : Stock Options Vested Stock Options Outstanding Number Outstanding Black-Scholes Fair Value Remaining Contractual Life (Years) Vested and Exercisable Year of Grant Exercise Price 2008 2.56 - 4.06 185 $ 292 1 185 2009 4.06 - 4.56 420 907 2 420 2010 4.77 - 4.96 116 281 3 116 2011 5.90 - 7.99 134 454 4 134 2012 6.56 - 7.96 435 1,603 5 435 2013 7.98 - 11.49 522 2,539 6 390 2014 10.55 - 18.94 1,458 8,272 7 789 2015 21.47 - 25.24 549 5,000 8 219 2016 18.79 - 19.89 450 3,140 9 88 2017 18.64 - 22.90 470 3,291 10 — Total 4,739 $ 25,779 2,776 Restricted Stock Awards The Company granted 173 , 299 and 323 restricted stock awards during the years ended December 31, 2017, 2016 and 2015 , respectively. All awards were granted at an exercise price of $0 and generally vest over five years . The fair value per share of restricted awards granted during the 2017, 2016 and 2015 ranged from $18.47 to $22.90 , $18.79 to $23.23 and $21.00 to $26.55 , respectively. The fair value per share includes quarterly stock awards to non-employee directors. A summary of the status of the Company's non-vested restricted stock awards as of December 31, 2017 and changes during the years ended December 31, 2017, 2016 and 2015 is presented below: Non-Vested Restricted Awards Weighted Average Grant Date Fair Value Nonvested at January 1, 2015 366 $ 15.15 Granted 323 22.99 Vested (234 ) 17.36 Forfeited (30 ) 16.81 Nonvested at December 31, 2015 425 $ 19.79 Granted 299 20.55 Vested (279 ) 19.58 Forfeited (16 ) 20.85 Nonvested at December 31, 2016 429 $ 20.42 Granted 173 20.21 Vested (195 ) 19.79 Forfeited (24 ) 20.34 Nonvested at December 31, 2017 383 $ 20.65 During the year ended December 31, 2017 , the Company granted 30 automatic quarterly stock awards to non-employee directors for their service on the Company's board of directors. The fair value per share of these stock awards ranged from $18.47 to $21.96 based on the market price on the grant date. Share-based compensation expense recognized for the Company's equity incentive plans for the years ended December 31, 2017, 2016 and 2015 was as follows: Year Ended December 31, 2017 2016 2015 Share-based compensation expense related to stock options $ 4,773 $ 4,793 4,164 Share-based compensation expense related to restricted stock awards 2,322 2,371 1,931 Share-based compensation expense related to stock options and restricted stock awards to non-employee directors 1,236 612 582 Total $ 8,331 $ 7,776 $ 6,677 In future periods, the Company expects to recognize approximately $11,063 and $6,916 in share-based compensation expense for unvested options and unvested restricted stock awards, respectively, that were outstanding as of December 31, 2017 . Future share-based compensation expense will be recognized over 2.9 and 3.4 weighted average years for unvested options and restricted stock awards, respectively. There were 1,963 unvested and outstanding options at December 31, 2017 , of which 1,864 are expected to vest. The weighted average contractual life for options outstanding, vested and expected to vest at December 31, 2017 was 5.7 years. The aggregate intrinsic value of options outstanding, vested, expected to vest and exercised as of and for the years ended December 31, 2017, 2016 and 2015 is as follows: December 31, Options 2017 2016 2015 Outstanding $ 44,060 $ 55,610 $ 67,508 Vested 33,976 38,101 41,128 Expected to vest 9,311 15,983 23,508 Exercisable 10,481 9,199 8,709 The intrinsic value is calculated as the difference between the market value of the underlying common stock and the exercise price of the options. Equity Instrument Denominated in the Shares of a Subsidiary On May 26, 2016, the Company implemented a management equity plan and granted stock options and restricted stock awards of a subsidiary of the Company to employees and management of that subsidiary (Subsidiary Equity Plan). These awards generally vest over a period of five years or upon the occurrence of certain prescribed events. The value of the stock options and restricted stock awards is tied to the value of the common stock of the subsidiary. The awards can be put to the Company at various prescribed dates, which in no event is earlier than six months after vesting of the restricted awards or exercise of the stock options. The Company can also call the awards, generally upon employee termination. The grant-date fair value of the awards is recognized as compensation expense over the relevant vesting periods, with a corresponding adjustment to noncontrolling interests. The grant value was determined based on an independent valuation of the subsidiary shares. For the years ended December 31, 2017 and 2016 , the Company expensed $1,364 and $1,325 , respectively, in share-based compensation related to the Subsidiary Equity Plan. There was no expense incurred for the year ended December 31, 2015 as the plan was implemented in the second quarter of 2016. The aggregate number of the Company's common shares that would be required to settle these awards at current estimated fair values, including vested and unvested awards, at December 31, 2017 and 2016 is 264 and 212 , respectively. There was no comparable amount at December 31, 2015 as the plan was implemented in the second quarter of 2016. |
Leases
Leases | 12 Months Ended |
Dec. 31, 2017 | |
Leases [Abstract] | |
Leases of Lessee Disclosure [Text Block] | LEASES The Company leases from CareTrust REIT, Inc. (CareTrust) real property associated with 92 affiliated skilled nursing, assisted living and independent living facilities used in the Company’s operations under eight “triple-net” master lease agreements (collectively, the Master Leases), which range in terms from 12 to 19 years. At the Company’s option, the Master Leases may be extended for two or three five -year renewal terms beyond the initial term, on the same terms and conditions. The extension of the term of any of the Master Leases is subject to the following conditions: (1) no event of default under any of the Master Leases having occurred and being continuing; and (2) the tenants providing timely notice of their intent to renew. The term of the Master Leases is subject to termination prior to the expiration of the then current term upon default by the tenants in their obligations, if not cured within any applicable cure periods set forth in the Master Leases. If the Company elects to renew the term of a Master Lease, the renewal will be effective to all, but not less than all, of the leased property then subject to the Master Lease. The Company does not have the ability to terminate the obligations under a Master Lease prior to its expiration without CareTrust’s consent. If a Master Lease is terminated prior to its expiration other than with CareTrust’s consent, the Company may be liable for damages and incur charges such as continued payment of rent through the end of the lease term as well as maintenance and repair costs for the leased property. Commencing the third year, the rent structure under the Master Leases includes a fixed component, subject to annual escalation equal to the lesser of (1) the percentage change in the Consumer Price Index (but not less than zero) or (2) 2.5% . In addition to rent, the Company is required to pay the following: (1) all impositions and taxes levied on or with respect to the leased properties (other than taxes on the income of the lessor); (2) all utilities and other services necessary or appropriate for the leased properties and the business conducted on the leased properties; (3) all insurance required in connection with the leased properties and the business conducted on the leased properties; (4) all facility maintenance and repair costs; and (5) all fees in connection with any licenses or authorizations necessary or appropriate for the leased properties and the business conducted on the leased properties. Total rent expense under the Master Leases was approximately $57,169 , $56,271 and $56,000 for the years ended December 31, 2017, 2016 and 2015 , respectively. Among other things, under the Master Leases, the Company must maintain compliance with specified financial covenants measured on a quarterly basis, including a portfolio coverage ratio and a minimum rent coverage ratio. The Master Leases also include certain reporting, legal and authorization requirements. The Company is not aware of any defaults as of December 31, 2017 . The Company also leases certain affiliated operations and its administrative offices under non-cancelable operating leases, most of which have initial lease terms ranging from five to 20 years . The Company has entered into multiple lease agreements with various landlords to operate newly constructed state-of-the-art, full-service healthcare resorts upon completion of construction. The term of each lease is 15 years with two five -year renewal options and is subject to annual escalation equal to the percentage change in the Consumer Price Index with a stated cap percentage. In addition, the Company leases certain of its equipment under non-cancelable operating leases with initial terms ranging from three to five years years. Most of these leases contain renewal options, certain of which involve rent increases. Total rent expense, inclusive of straight-line rent adjustments and rent associated with the Master Leases noted above, was $132,932 , $125,221 and $89,264 for the years ended December 31, 2017, 2016 and 2015 , respectively. Twenty-five of the Company’s affiliated facilities, excluding the facilities that are operated under the Master Leases with CareTrust, are operated under six separate master lease arrangements. Under these master leases, a breach at a single facility could subject one or more of the other facilities covered by the same master lease to the same default risk. Failure to comply with Medicare and Medicaid provider requirements is a default under several of the Company’s leases, master lease agreements and debt financing instruments. In addition, other potential defaults related to an individual facility may cause a default of an entire master lease portfolio and could trigger cross-default provisions in the Company’s outstanding debt arrangements and other leases. With an indivisible lease, it is difficult to restructure the composition of the portfolio or economic terms of the lease without the consent of the landlord. In March 2017, the Company voluntarily discontinued operations at one of its skilled nursing facilities after determining that the facility could not competitively operate in the marketplace without substantial investment renovating the building. After careful consideration, the Company determined that the costs to renovate the facility could outweigh the future returns from the operation. As part of this closure, the Company entered into an agreement with its landlord allowing for the closure of the property, as well as other provisions, to allow its landlord to transfer the property and the licenses free and clear of the applicable master lease. This arrangement does not impact the rent expense paid in 2017, or expected to be paid in future periods, and has no material impact on the Company's lease coverage ratios under the Master Leases. The Company recorded a continued obligation liability under the lease and related closing expenses of $2,830 , including the present value of rental payments of approximately $2,715 , in 2017. Residents of the affected facility were transferred to local skilled nursing facilities. During the first quarter of 2016, the Company voluntarily discontinued operations at one of its skilled nursing facilities in order to preserve the overall ability to serve the residents in surrounding counties after careful consideration and some clinical survey challenges. As part of this closure, the Company entered into an agreement with its landlord allowing for the closure of the property as well as other provisions to allow its landlord to transfer the property and the licenses free and clear of the applicable master lease. This arrangement does not impact the rental payments and has no material impact on the Company's lease coverage ratios under the Master Leases. The Company recorded a continued obligation liability under the lease and related closing expenses of $7,935 , including the present value of rental payments of approximately $6,512 , in 2016. Residents of the affected facility were transferred to local skilled nursing facilities. In 2017, the Company recovered $1,286 of certain losses that were recorded in 2016 related to the closure of the operation. The loss recovery was recorded as a gain in 2017. In March 2017, the Company entered into definitive agreements to sell the properties of two skilled nursing facilities and one assisted living community. The transaction closed in the second quarter of 2017. Upon closing the transaction, the Company leased the properties under a triple-net master lease with an initial 20 -year term, with three 5 -year optional extensions, at CPI-based annual escalators. The Company received $38,000 in proceeds. The carrying value for the sale was $24,847 . Under applicable accounting guidance, the master lease was classified as an operating lease. The Company recognized a deferred gain on the transaction of $13,153 in 2017 that is amortized over the life of the lease. During the first quarter of 2017, the Company terminated its lease obligations on four transitional care facilities that are currently under development and one newly constructed stand-alone skilled nursing operation. The Company recorded $1,187 in lease termination costs and long-lived asset impairment. Future minimum lease payments for all leases as of December 31, 2017 are as follows: Year Amount 2018 135,841 2019 135,395 2020 135,149 2021 134,942 2022 133,446 Thereafter 1,080,348 $ 1,755,121 |
Self-Insurance Reserves
Self-Insurance Reserves | 12 Months Ended |
Dec. 31, 2017 | |
Self-Insurance Reserves [Abstract] | |
Insurance Disclosure [Text Block] | SELF INSURANCE RESERVES The following table represents activity in our insurance reserves as of and for the years ended December 31, 2017 and 2016: General and Professional Liability Workers' Compensation Health Total Balance January 1, 2016 30,710 20,219 5,074 $ 56,003 Current year provisions 23,149 12,887 38,151 74,187 Claims paid and direct expenses (18,186 ) (10,290 ) (37,586 ) (66,062 ) Change in long-term insurance losses recoverable 637 586 — 1,223 Balance December 31, 2016 36,310 23,402 5,639 65,351 Current year provisions 20,396 15,202 53,796 89,394 Claims paid and direct expenses (16,133 ) (12,455 ) (54,712 ) (83,300 ) Change in long-term insurance losses recoverable 361 930 — 1,291 Balance December 31, 2017 $ 40,934 $ 27,079 $ 4,723 $ 72,736 Included in long-term insurance losses recoverable as of December 31, 2017 and 2016, are anticipated insurance recoveries related to the Company's general and professional liability claims that are recorded on a gross rather than net basis in accordance with GAAP. |
Commitments and Contingencies
Commitments and Contingencies | 12 Months Ended |
Dec. 31, 2017 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies Disclosure [Text Block] | COMMITMENTS AND CONTINGENCIES Regulatory Matters — Laws and regulations governing Medicare and Medicaid programs are complex and subject to interpretation. Compliance with such laws and regulations can be subject to future governmental review and interpretation, as well as significant regulatory action including fines, penalties, and exclusion from certain governmental programs. Included in these laws and regulations is the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which requires healthcare providers (among other things) to safeguard and keep confidential protected health information. In late December 2016, the Company learned of a potential issue at one of its independent operating entities in Arizona which involved the limited and inadvertent disclosure of certain confidential information. The issue has been internally investigated, addressed and disclosed as per the HIPAA obligations. The Company believes that it is presently in compliance in all material respects with all applicable laws and regulations. Cost-Containment Measures — Both government and private pay sources have instituted cost-containment measures designed to limit payments made to providers of healthcare services, and there can be no assurance that future measures designed to limit payments made to providers will not adversely affect the Company. Indemnities — From time to time, the Company enters into certain types of contracts that contingently require the Company to indemnify parties against third-party claims. These contracts primarily include (i) certain real estate leases, under which the Company may be required to indemnify property owners or prior facility operators for post-transfer environmental or other liabilities and other claims arising from the Company’s use of the applicable premises, (ii) operations transfer agreements, in which the Company agrees to indemnify past operators of facilities the Company acquires against certain liabilities arising from the transfer of the operation and/or the operation thereof after the transfer, (iii) certain lending agreements, under which the Company may be required to indemnify the lender against various claims and liabilities, and (iv) certain agreements with the Company’s officers, directors and employees, under which the Company may be required to indemnify such persons for liabilities arising out of their employment relationships. The terms of such obligations vary by contract and, in most instances, a specific or maximum dollar amount is not explicitly stated therein. Generally, amounts under these contracts cannot be reasonably estimated until a specific claim is asserted. Consequently, because no claims have been asserted, no liabilities have been recorded for these obligations on the Company’s balance sheets for any of the periods presented. Litigation — The skilled nursing business involves a significant risk of liability given the age and health of the patients and residents served by the Company's operating subsidiaries. The Company, its operating subsidiaries, and others in the industry are subject to an increasing number of claims and lawsuits, including professional liability claims, alleging that services provided have resulted in personal injury, elder abuse, wrongful death or other related claims. The defense of these lawsuits may result in significant legal costs, regardless of the outcome, and can result in large settlement amounts or damage awards. In addition to the potential lawsuits and claims described above, the Company is also subject to potential lawsuits under the Federal False Claims Act and comparable state laws alleging submission of fraudulent claims for services to any healthcare program (such as Medicare) or payor. A violation may provide the basis for exclusion from federally-funded healthcare programs. Such exclusions could have a correlative negative impact on the Company’s financial performance. Some states, including California, Arizona and Texas, have enacted similar whistleblower and false claims laws and regulations. In addition, the Deficit Reduction Act of 2005 created incentives for states to enact anti-fraud legislation modeled on the Federal False Claims Act. As such, the Company could face increased scrutiny, potential liability and legal expenses and costs based on claims under state false claims acts in markets in which it does business. In May 2009, Congress passed the Fraud Enforcement and Recovery Act (FERA) of 2009 which made significant changes to the Federal False Claims Act (FCA), expanding the types of activities subject to prosecution and whistleblower liability. Following changes by FERA, health care providers face significant penalties for the knowing retention of government overpayments, even if no false claim was involved. Health care providers can now be liable for knowingly and improperly avoiding or decreasing an obligation to pay money or property to the government. This includes the retention of any government overpayment. The government can argue, therefore, that a FCA violation can occur without any affirmative fraudulent action or statement, as long as it is knowingly improper. In addition, FERA extended protections against retaliation for whistleblowers, including protections not only for employees, but also contractors and agents. Thus, there is generally no need for an employment relationship in order to qualify for protection against retaliation for whistleblowing. Healthcare litigation (including class action litigation) is common and is filed based upon a wide variety of claims and theories, and the Company is routinely subjected to varying types of claims. One particular type of suit arises from alleged violations of minimum staffing requirements for skilled nursing facilities in those states which have enacted such requirements. Failure to meet these requirements can, among other things, jeopardize a facility's compliance with conditions of participation under certain state and federal healthcare programs; it may also subject the facility to a notice of deficiency, a citation, a civil money penalty, or litigation. These class-action “staffing” suits have the potential to result in large jury verdicts and settlements. The Company expects the plaintiff's bar to continue to be aggressive in their pursuit of these staffing and similar claims. The Company has in the past been subject to class action litigation involving claims of alleged violations of regulatory requirements related to staffing. While the Company has been able to settle these claims without a material ongoing adverse effect on its business, future claims could be brought that may materially affect its business, financial condition and results of operations. Other claims and suits, including class actions, continue to be filed against the Company and other companies in its industry. If there were a significant increase in the number of these claims or an increase in amounts owing should plaintiffs be successful in their prosecution of these claims, this could materially adversely affect the Company’s business, financial condition, results of operations and cash flows. The Company and its operating subsidiaries have been, and continue to be, subject to claims and legal actions that arise in the ordinary course of business, including potential claims related to patient care and treatment as well as employment related claims. Since 2011, the Company has been involved in a class action litigation claim alleging violations of state and federal wage and hour laws. In January 2017, the Company participated in an initial mediation session with plaintiffs' counsel. As a result of this discussion and due to (i) the fact no class had been certified (ii) the lack of specificity as to legal theories put forth by the plaintiffs, (iii) the nature of the remedies sought and (iv) the lack of any basis on which to compute estimated compensatory and/or exemplary damages, the Company could not predict what the outcome of the pending purported class action lawsuit would be, what the timing of the ultimate resolution of this lawsuit would be, or an estimate and/or range of possible loss related to it. In light of the inherent uncertainties involved in the pending class action lawsuit, the Company determined that we were not able to estimate the related costs or range of costs for the year ended December 31, 2016. In March 2017, the Company was invited to engage in further mediation discussions to determine whether settlement in advance of a decision on class certification was possible. In April 2017, the Company reached an agreement in principle to settle the subject class action litigation, without any admission of liability and subject to approval by the California Superior Court. Based upon the recent change in case status, the Company recorded an accrual for estimated probable losses of $11,000 , exclusive of legal fees, in the first quarter of 2017. The Company funded the settlement amount of $11,000 in December 2017, and it will be distributed to the class members in Q1 of 2018. Other claims and suits continue to be filed against the Company and other companies in its industry. By way of recent example, a general/premises liability lawsuit was filed against one of the Company’s independent operating entities in San Luis Obispo, California, in connection with an alleged injury to a non-employee/contractor. Further, another one of the Company’s independent operating entities was sued on allegations of professional negligence, which claim was recently settled. The Company does not expect that there will be any material ongoing adverse effect on the Company's business, financial condition or results of operations in connection with the resolution of these matters. The Company cannot predict or provide any assurance as to the possible outcome of any litigation. If any litigation were to proceed, and the Company and its operating subsidiaries are subjected to, alleged to be liable for, or agrees to a settlement of, claims or obligations under Federal Medicare statutes, the Federal False Claims Act, or similar State and Federal statutes and related regulations, the Company's business, financial condition and results of operations and cash flows could be materially and adversely affected and its stock price could be adversely impacted. Among other things, any settlement or litigation could involve the payment of substantial sums to settle any alleged civil violations, and may also include the assumption of specific procedural and financial obligations by the Company or its subsidiaries going forward under a corporate integrity agreement and/or other arrangement with the government. Medicare Revenue Recoupments — The Company is subject to reviews relating to Medicare services, billings and potential overpayments as a result of Recovery Audit Contractors (RAC), Zone Program Integrity Contractors (ZPIC), Program Safeguard Contractors (PSC) and Medicaid Integrity Contributors (MIC) programs. As of December 31, 2017 , seven of the Company's operating subsidiaries had probes scheduled and in process, both pre- and post-payment. The Company anticipates that these probe reviews will increase in frequency in the future. If a facility fails a probe review and subsequent re-probes, the facility could then be subject to extended pre-pay review or extrapolation of the identified error rate to all billing in the same time period. None of the Company's operating subsidiaries are currently on extended prepayment review, although that may occur in the future. U.S. Government Inquiry — In October 2013, the Company completed and executed a settlement agreement (the Settlement Agreement) with the DOJ, which received the final approval of the Office of Inspector General-HHS and the United States District Court for the Central District of California. Pursuant to the Settlement Agreement, the Company made a single lump-sum remittance to the government in the amount of $48,000 in October 2013. The Company has denied engaging in any illegal conduct and has agreed to the settlement amount without any admission of wrongdoing in order to resolve the allegations and to avoid the uncertainty and expense of protracted litigation. In connection with the settlement and effective as of October 1, 2013, the Company entered into a five-year corporate integrity agreement (the CIA) with the Office of Inspector General-HHS. The CIA acknowledges the existence of the Company’s current compliance program, which is in accord with the Office of the Inspector General (OIG)’s guidance related to an effective compliance program, and requires that the Company continue during the term of the CIA to maintain a program designed to promote compliance with the statutes, regulations, and written directives of Medicare, Medicaid, and all other Federal health care programs. The Company is also required to notify the Office of Inspector General-HHS in writing, of, among other things: (i) any ongoing government investigation or legal proceeding involving an allegation that the Company has committed a crime or has engaged in fraudulent activities; (ii) any other matter that a reasonable person would consider a probable violation of applicable criminal, civil, or administrative laws related to compliance with federal healthcare programs; and (iii) any change in location, sale, closing, purchase, or establishment of a new business unit or location related to items or services that may be reimbursed by federal health care programs. The Company is also required to retain an Independent Review Organization (IRO) to review certain clinical documentation annually for the term of the CIA. The Company has continued to meet the requirements under the Settlement Agreement and pass its IRO audits. Participation in federal healthcare programs by the Company is not affected by the Settlement Agreement or the CIA. In the event of an uncured material breach of the CIA, the Company could be excluded from participation in federal healthcare programs and/or subject to prosecution. Concentrations Credit Risk — The Company has significant accounts receivable balances, the collectability of which is dependent on the availability of funds from certain governmental programs, primarily Medicare and Medicaid. These receivables represent the only significant concentration of credit risk for the Company. The Company does not believe there are significant credit risks associated with these governmental programs. The Company believes that an appropriate allowance has been recorded for the possibility of these receivables proving uncollectible, and continually monitors and adjusts these allowances as necessary. The Company’s receivables from Medicare and Medicaid payor programs accounted for approximately 56.7% and 58.6% of its total accounts receivable as of December 31, 2017 and 2016, respectively. Revenue from reimbursement under the Medicare and Medicaid programs accounted for 68.4% , 67.8% and 69.1% of the Company's revenue for the years ended December 31, 2017, 2016 and 2015 , respectively. Cash in Excess of FDIC Limits — The Company currently has bank deposits with financial institutions in the U.S. that exceed FDIC insurance limits. FDIC insurance provides protection for bank deposits up to $250 . In addition, the Company has uninsured bank deposits with a financial institution outside the U.S. As of February 2, 2018 , the Company had approximately $965 in uninsured cash deposits. All uninsured bank deposits are held at high quality credit institutions. |
Divestitures
Divestitures | 12 Months Ended |
Dec. 31, 2017 | |
Divestitures [Abstract] | |
Disposal Groups, Including Discontinued Operations, Disclosure [Text Block] | DIVESTITURES In 2016, the Company completed the sale of seventeen urgent care centers for an aggregate sale price of $41,492 . As a result of the sale, the Company recognized a pretax gain of $19,160 , which is included in operating income. Due to the disposition of the clinics, the Company is no longer the primary beneficiary and the variable interest entities associated with the urgent care operations was deconsolidated from the Company's consolidated financial statements as of December 31, 2016 . At deconsolidation, the Company eliminated intercompany balances that previously existed. The sale of this investment supports the Company's increased focus on growth opportunities in its business lines that are complementary to its existing transitional and skilled services. The sale transactions did not meet the criteria of a discontinued operation as they do not represent a strategic shift that has or will have a major effect on the Company’s operations and financial results. |
Defined Contribution Plan
Defined Contribution Plan | 12 Months Ended |
Dec. 31, 2017 | |
Defined Contribution Plan [Abstract] | |
Compensation and Employee Benefit Plans [Text Block] | DEFINED CONTRIBUTION PLAN The Company has a 401(k) defined contribution plan (the 401(k) Plan), whereby eligible employees may contribute up to 15% of their annual basic earnings. Additionally, the 401(k) Plan provides for discretionary matching contributions (as defined in the 401(k) Plan) by the Company. The Company expensed matching contributions to the 401(k) Plan of $1,028 , $862 and $682 during the years ended December 31, 2017, 2016 and 2015, respectively. Beginning in 2007, the 401(k) Plan allowed eligible employees to contribute up to 90% of their eligible compensation, subject to applicable annual Internal Revenue Code limits |
Significant Accounting Polici28
Significant Accounting Policies Level 2 (Policies) | 12 Months Ended |
Dec. 31, 2017 | |
Accounting Policies [Abstract] | |
Basis of Accounting, Policy [Policy Text Block] | Basis of Presentation — The accompanying consolidated financial statements (Financial Statements) have been prepared in accordance with accounting principles generally accepted in the United States (GAAP). The Company is the sole member or shareholder of various consolidated limited liability companies and corporations established to operate various acquired skilled nursing and assisted living operations, home health, hospice and home care operations, and related ancillary services. All intercompany transactions and balances have been eliminated in consolidation. The consolidated financial statements include the accounts of all entities controlled by the Company through its ownership of a majority voting interest. The Company presents noncontrolling interest within the equity section of its consolidated balance sheets. The Company presents the amount of consolidated net income that is attributable to The Ensign Group, Inc. and the noncontrolling interest in its consolidated statements of income. The consolidated financial statements include the accounts of all entities controlled by the Company through its ownership of a majority voting interest and the accounts of any variable interest entities (VIEs) where the Company is subject to a majority of the risk of loss from the VIE's activities, or entitled to receive a majority of the entity's residual returns, or both. The Company assesses the requirements related to the consolidation of VIEs, including a qualitative assessment of power and economics that considers which entity has the power to direct the activities that "most significantly impact" the VIE's economic performance and has the obligation to absorb losses of, or the right to receive benefits that could be potentially significant to, the VIE. The Company's relationship with variable interest entities was not material during the year ended December 31, 2017. In 2016, the Company completed the sale of its urgent care centers for an aggregate purchase price of $41,492 . The sale transactions do not meet the criteria of discontinued operations as they do not represent a strategic shift that has, or will have, a major effect on the Company’s operations and financial results. |
Use of Estimates, Policy [Policy Text Block] | Estimates and Assumptions — The preparation of Financial Statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the Financial Statements and the reported amounts of revenue and expenses during the reporting periods. The most significant estimates in the Company’s Financial Statements relate to revenue, allowance for doubtful accounts, intangible assets and goodwill, impairment of long-lived assets, general and professional liability, workers' compensation and healthcare claims included in accrued self-insurance liabilities, and income taxes. Actual results could differ from those estimates. |
Fair Value of Financial Instruments, Policy [Policy Text Block] | Fair Value of Financial Instruments — The Company’s financial instruments consist principally of cash and cash equivalents, debt security investments, accounts receivable, insurance subsidiary deposits, accounts payable and borrowings. The Company believes all of the financial instruments’ recorded values approximate fair values because of their nature or respective short durations. |
Revenue Recognition, Sales of Services [Policy Text Block] | Revenue Recognition — The Company recognizes revenue when the following four conditions have been met: (i) there is persuasive evidence that an arrangement exists; (ii) delivery has occurred or service has been rendered; (iii) the price is fixed or determinable; and (iv) collection is reasonably assured. The Company's revenue is derived primarily from providing healthcare services to patients and is recognized on the date services are provided at amounts billable to the individual. For reimbursement arrangements with third-party payors, including Medicaid, Medicare and private insurers, revenue is recorded based on contractually agreed-upon amounts on a per patient basis. Revenue from the Medicare and Medicaid programs accounted for 68.4% , 67.8% and 69.1% of the Company's revenue for the years ended December 31, 2017, 2016 and 2015 , respectively. The Company records revenue from these governmental and managed care programs as services are performed at their expected net realizable amounts under these programs. The Company’s revenue from governmental and managed care programs is subject to audit and retroactive adjustment by governmental and third-party agencies. Consistent with healthcare industry accounting practices, any changes to these governmental revenue estimates are recorded in the period the change or adjustment becomes known based on final settlement. The Company recorded adjustments to revenue which were not material to the Company's consolidated revenue or Financial Statements for the years ended December 31, 2017, 2016 and 2015 . The Company’s service specific revenue recognition policies are as follows: Skilled Nursing Revenue The Company’s revenue is derived primarily from providing long-term healthcare services to patients and is recognized on the date services are provided at amounts billable to individual patients. For patients under reimbursement arrangements with third-party payors, including Medicaid, Medicare and private insurers, revenue is recorded based on contractually agreed-upon amounts or rate on a per patient, daily basis or as services are performed. Assisted and Independent Living Revenue The Company's revenue is recorded when services are rendered on the date services are provided at amounts billable to individual residents and consists of fees for basic housing and assisted living care. Residency agreements are generally for a term of 30 days, with resident fees billed monthly in advance. For patients under reimbursement arrangements with Medicaid, revenue is recorded based on contractually agreed-upon amounts or rate on a per resident, daily basis or as services rendered. Revenue for certain ancillary charges is recognized as services are provided, and such fees are billed monthly in arrears. Home Health Revenue Medicare Revenue Net service revenue is recorded under the Medicare prospective payment system based on a 60-day episode payment rate that is subject to adjustment based on certain variables including, but not limited to: (a) an outlier payment if patient care was unusually costly; (b) a low utilization payment adjustment if the number of visits was fewer than five; (c) a partial payment if the patient transferred to another provider or the Company received a patient from another provider before completing the episode; (d) a payment adjustment based upon the level of therapy services required; (e) the number of episodes of care provided to a patient, regardless of whether the same home health provider provided care for the entire series of episodes; (f) changes in the base episode payments established by the Medicare program; (g) adjustments to the base episode payments for case mix and geographic wages; and (h) recoveries of overpayments. The Company makes adjustments to Medicare revenue on completed episodes to reflect differences between estimated and actual payment amounts, an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. Therefore, the Company believes that its reported net service revenue and patient accounts receivable will be the net amounts to be realized from Medicare for services rendered. In addition to revenue recognized on completed episodes, the Company also recognizes a portion of revenue associated with episodes in progress. Episodes in progress are 60-day episodes of care that begin during the reporting period, but were not completed as of the end of the period. As such, the Company estimates revenue and recognizes it on a daily basis. The primary factors underlying this estimate are the number of episodes in progress at the end of the reporting period, expected Medicare revenue per episode and its estimate of the average percentage complete based on visits performed. Non-Medicare Revenue Episodic Based Revenue - The Company recognizes revenue in a similar manner as it recognizes Medicare revenue for episodic-based rates that are paid by other insurance carriers, including Medicare Advantage programs; however, these rates can vary based upon the negotiated terms. Non-episodic Based Revenue - Revenue is recorded on an accrual basis based upon the date of service at amounts equal to its established or estimated per-visit rates, as applicable. Hospice Revenue Revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are daily rates for each of the levels of care the Company delivers. The Company makes adjustments to revenue for an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. Additionally, as Medicare hospice revenue is subject to an inpatient cap limit and an overall payment cap, the Company monitors its provider numbers and estimates amounts due back to Medicare if a cap has been exceeded. The Company records these adjustments as a reduction to revenue and increases to other accrued liabilities. |
Trade and Other Accounts Receivable, Policy [Policy Text Block] | Accounts Receivable and Allowance for Doubtful Accounts — Accounts receivable consist primarily of amounts due from Medicare and Medicaid programs, other government programs, managed care health plans and private payor sources. Estimated provisions for doubtful accounts are recorded to the extent it is probable that a portion or all of a particular account will not be collected. In evaluating the collectability of accounts receivable, the Company considers a number of factors, including the age of the accounts, changes in collection patterns, the composition of patient accounts by payor type and the status of ongoing disputes with third-party payors. On an annual basis, the historical collection percentages are reviewed by payor and by state and are updated to reflect the recent collection experience of the Company. In order to determine the appropriate reserve rate percentages which ultimately establish the allowance, the Company analyzes historical cash collection patterns by payor and by state. The percentages applied to the aged receivable balances are based on the Company’s historical experience and time limits, if any, for managed care, Medicare, Medicaid and other payors. The Company periodically refines its estimates of the allowance for doubtful accounts based on experience with the estimation process and changes in circumstances. |
Cash and Cash Equivalents, Policy [Policy Text Block] | Cash and Cash Equivalents — Cash and cash equivalents consist of bank term deposits, money market funds and treasury bill related investments with original maturities of three months or less at time of purchase and therefore approximate fair value. The fair value of money market funds is determined based on “Level 1” inputs, which consist of unadjusted quoted prices in active markets that are accessible at the measurement date for identical, unrestricted assets. The Company places its cash and short-term investments with high credit quality financial institutions. |
Insurance Subsidiary Deposits and Investments [Policy Text Block] | Insurance Subsidiary Deposits and Investments — The Company's captive insurance subsidiary cash and cash equivalents, deposits and investments are designated to support long-term insurance subsidiary liabilities and have been classified as short-term and long-term assets based on the timing of expected future payments of the Company's captive insurance liabilities. The majority of these deposits and investments are currently held in AA, A and BBB+ rated debt security investments and the remainder is held in a bank account with a high credit quality financial institution. See further discussion at Note 5, Fair Value Measurements. The Company evaluates securities for other-than-temporary impairment (“OTTI”) on at least a quarterly basis, and more frequently when economic or market conditions warrant such an evaluation. If securities are in an unrealized loss position, the Company considers the extent and duration of the unrealized loss, and the financial condition and near-term prospects of the issuer. The Company also assesses whether it intends to sell, or it is more likely than not that it will be required to sell, a security in an unrealized loss position before recovery of its amortized cost basis. If either of the criteria regarding intent or requirement to sell is met, the entire difference between amortized cost and fair value is recognized as impairment through earnings. For the years ended December 31, 2016 and 2017, the Company did not recognize any OTTI for its investments. |
Property, Plant and Equipment, Policy [Policy Text Block] | Property and Equipment — Property and equipment are initially recorded at their historical cost. Repairs and maintenance are expensed as incurred. Depreciation is computed using the straight-line method over the estimated useful lives of the depreciable assets (ranging from three to 59 years ). Leasehold improvements are amortized on a straight-line basis over the shorter of their estimated useful lives or the remaining lease term. |
Impairment or Disposal of Long-Lived Assets, Policy [Policy Text Block] | Impairment of Long-Lived Assets — The Company reviews the carrying value of long-lived assets that are held and used in the Company’s operating subsidiaries for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of these assets is determined based upon expected undiscounted future net cash flows from the operating subsidiaries to which the assets relate, utilizing management’s best estimate, appropriate assumptions, and projections at the time. If the carrying value is determined to be unrecoverable from future operating cash flows, the asset is deemed impaired and an impairment loss would be recognized to the extent the carrying value exceeded the estimated fair value of the asset. The Company estimates the fair value of assets based on the estimated future discounted cash flows of the asset. Management has evaluated its long-lived assets and recorded an impairment charge of $111 and $137 related to the closure of facilities during the years ended December 31, 2017 and 2016 , respectively. The Company did not identify any asset impairment during the year ended December 31, 2015. |
Lease, Policy [Policy Text Block] (Deprecated 2017-01-31) | Leases and Leasehold Improvements - At the inception of each lease, the Company performs an evaluation to determine whether the lease should be classified as an operating or capital lease. The Company records rent expense for operating leases that contain scheduled rent increases on a straight-line basis over the term of the lease. The lease term used for straight-line rent expense is calculated from the date the Company is given control of the leased premises through the end of the lease term. The lease term used for this evaluation also provides the basis for establishing depreciable lives for buildings subject to lease and leasehold improvements, as well as the period over which the Company records straight-line rent expense. |
Goodwill and Intangible Assets, Policy [Policy Text Block] | Intangible Assets and Goodwill — Definite-lived intangible assets consist primarily of favorable leases, lease acquisition costs, patient base, facility trade names and customer relationships. Favorable leases and lease acquisition costs are amortized over the life of the lease of the facility. Patient base is amortized over a period of four to eight months, depending on the classification of the patients and the level of occupancy in a new acquisition on the acquisition date. Trade names at affiliated facilities are amortized over 30 years and customer relationships are amortized over a period of up to 20 years . The Company's indefinite-lived intangible assets consist of trade names and Medicare and Medicaid licenses. The Company tests indefinite-lived intangible assets for impairment on an annual basis or more frequently if events or changes in circumstances indicate that the carrying amount of the intangible asset may not be recoverable. The Company did not identify any asset impairment during the years ended December 31, 2017, 2016 and 2015. Goodwill represents the excess of the purchase price over the fair value of identifiable net assets acquired in business combinations. Goodwill is subject to annual testing for impairment. In addition, goodwill is tested for impairment if events occur or circumstances change that would reduce the fair value of a reporting unit below its carrying amount. The Company performs its annual test for impairment during the fourth quarter of each year. See further discussion at Note 11, Goodwill and Other Indefinite-Lived Intangible Assets . |
Deferred Rent [Policy Text Block] | Deferred Rent - Deferred rent represents rental expense, determined on a straight-line basis over the life of the related lease, in excess of actual rent payments. |
Liability Reserve Estimate, Policy [Policy Text Block] | Self-Insurance — The Company is partially self-insured for general and professional liability up to a base amount per claim (the self-insured retention) with an aggregate, one-time deductible above this limit. Losses beyond these amounts are insured through third-party policies with coverage limits per claim, per location and on an aggregate basis for the Company. Starting on January 1, 2017, the combined self-insured retention was $500 per claim, subject to an additional one-time deductible of $750 for California affiliated operations and a separate, one-time, deductible of $1,000 for non-California operations. For all affiliated operations, except those located in Colorado, the third-party coverage above these limits was $1,000 per claim, $3,000 per operation, with a $5,000 blanket aggregate limit and an additional state-specific aggregate where required by state law. In Colorado, the third-party coverage above these limits was $1,000 per claim and $3,000 per operation, which is independent of the aforementioned blanket aggregate limits that apply outside of Colorado. The self-insured retention and deductible limits for general and professional liability and workers' compensation for all states (except Texas and Washington for workers' compensation) are self-insured through the Captive, the related assets and liabilities of which are included in the accompanying consolidated balance sheets. The Captive is subject to certain statutory requirements as an insurance provider. These requirements include, but are not limited to, maintaining statutory capital. The Company’s policy is to accrue amounts equal to the actuarially estimated costs to settle open claims of insureds, as well as an estimate of the cost of insured claims that have been incurred but not reported. The Company develops information about the size of the ultimate claims based on historical experience, current industry information and actuarial analysis, and evaluates the estimates for claim loss exposure on a quarterly basis. The Company’s operating subsidiaries are self-insured for workers’ compensation in California. To protect itself against loss exposure in California with this policy, the Company has purchased individual specific excess insurance coverage that insures individual claims that exceed $500 per occurrence. In Texas, the operating subsidiaries have elected non-subscriber status for workers’ compensation claims and, effective February 1, 2011, the Company has purchased individual stop-loss coverage that insures individual claims that exceed $750 per occurrence. As of July 1, 2014, the Company’s operating subsidiaries in all other states, with the exception of Washington, are under a loss sensitive plan that insures individual claims that exceed $350 per occurrence. In Washington, the operating subsidiaries' coverage is financed through premiums paid by the employers and employees. The claims and pay benefits are managed through a state insurance pool. Outside of California, Texas and Washington, the Company has purchased insurance coverage that insures individual claims that exceed $350 per accident. In all states except Washington, the Company accrues amounts equal to the estimated costs to settle open claims, as well as an estimate of the cost of claims that have been incurred but not reported. The Company uses actuarial valuations to estimate the liability based on historical experience and industry information. In addition, the Company has recorded an asset and equal liability of $5,394 and $4,104 at December 31, 2017 and 2016, respectively, in order to present the ultimate costs of malpractice and workers' compensation claims and the anticipated insurance recoveries on a gross basis. See Note 12, Restricted and Other Assets. The Company self-funds medical (including prescription drugs) and dental healthcare benefits to the majority of its employees. The Company is fully liable for all financial and legal aspects of these benefit plans. To protect itself against loss exposure with this policy, the Company has purchased individual stop-loss insurance coverage that insures individual claims that exceed $300 for each covered person with an additional one-time aggregate individual stop loss deductible of $75 . Beginning 2016, the Company's policy does not include the additional one-time aggregate individual stop loss deductible of $75 . The Company believes that adequate provision has been made in the Financial Statements for liabilities that may arise out of patient care, workers’ compensation, healthcare benefits and related services provided to date. The amount of the Company’s reserves was determined based on an estimation process that uses information obtained from both company-specific and industry data. This estimation process requires the Company to continuously monitor and evaluate the life cycle of the claims. Using data obtained from this monitoring and the Company’s assumptions about emerging trends, the Company, with the assistance of an independent actuary, develops information about the size of ultimate claims based on the Company’s historical experience and other available industry information. The most significant assumptions used in the estimation process include determining the trend in costs, the expected cost of claims incurred but not reported and the expected costs to settle or pay damage awards with respect to unpaid claims. The self-insured liabilities are based upon estimates, and while management believes that the estimates of loss are reasonable, the ultimate liability may be in excess of or less than the recorded amounts. Due to the inherent volatility of actuarially determined loss estimates, it is reasonably possible that the Company could experience changes in estimated losses that could be material to net income. If the Company’s actual liability exceeds its estimates of loss, its future earnings, cash flows and financial condition would be adversely affected. |
Income Tax, Policy [Policy Text Block] | Income Taxes — Deferred tax assets and liabilities are established for temporary differences between the financial reporting basis and the tax basis of the Company’s assets and liabilities at tax rates in effect when such temporary differences are expected to reverse. The Company generally expects to fully utilize its deferred tax assets; however, when necessary, the Company records a valuation allowance to reduce its net deferred tax assets to the amount that is more likely than not to be realized. In determining the need for a valuation allowance or the need for and magnitude of liabilities for uncertain tax positions, the Company makes certain estimates and assumptions. These estimates and assumptions are based on, among other things, knowledge of operations, markets, historical trends and likely future changes and, when appropriate, the opinions of advisors with knowledge and expertise in certain fields. Due to certain risks associated with the Company’s estimates and assumptions, actual results could differ. The Tax Cuts and Jobs Act (the Tax Act), which was enacted in December 2017, increased the Company's income tax expense by $3,915 for the year ended December 31, 2017. The Tax Act will decrease the corporate income tax rate from 35.0% to 21.0% beginning on January 1, 2018. The Company expects meaningful benefits from this reduction to continue from its enactment in future periods. See Note 14, Income Taxes for further detail. |
Noncontrolling Interest [Policy Text Block] | Noncontrolling Interest — The noncontrolling interest in a subsidiary is initially recognized at estimated fair value on the acquisition date and is presented within total equity in the Company's consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to The Ensign Group, Inc. in its consolidated statements of income and net income per share is calculated based on net income attributable to The Ensign Group, Inc.'s stockholders. The carrying amount of the noncontrolling interest is adjusted based on an allocation of subsidiary earnings based on ownership interest. |
Share-based Compensation, Option and Incentive Plans Policy [Policy Text Block] | Share-Based Compensation — The Company measures and recognizes compensation expense for all share-based payment awards made to employees and directors including employee stock options based on estimated fair values, ratably over the requisite service period of the award. Net income has been reduced as a result of the recognition of the fair value of all stock options and restricted stock awards issued, the amount of which is contingent upon the number of future grants and other variables. |
New Accounting Pronouncements, Policy [Policy Text Block] | Recent Accounting Pronouncements — Except for rules and interpretive releases of the Securities and Exchange Commission (SEC) under authority of federal securities laws and a limited number of grandfathered standards, the Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) is the sole source of authoritative GAAP literature recognized by the FASB and applicable to the Company. For any new pronouncements announced, the Company considers whether the new pronouncements could alter previous generally accepted accounting principles and determines whether any new or modified principles will have a material impact on the Company's reported financial position or operations in the near term. The applicability of any standard is subject to the formal review of the Company's financial management and certain standards are under consideration. Recent Accounting Standards Adopted by the Company In March 2016, the FASB issued a new standard to simplify several aspects of the accounting for employee share-based payment transactions, which includes the accounting for income taxes, forfeitures, and statutory tax withholding requirements, as well as classification in the statement of cash flows. The new standard was effective for the Company in the first quarter of fiscal year 2017. Under the previous guidance, excess tax benefits and deficiencies from share-based compensation arrangements were recorded in equity when the awards vested or were settled. The new guidance requires prospective recognition of excess tax benefits and deficiencies in the income statement, resulting in the recognition of excess tax benefits in income tax expense, of $3,423 , rather than in paid-in-capital, for the year ended December 31, 2017 . In addition, under the new guidance, excess income tax benefits from share-based compensation arrangements are classified as cash flow from operations, rather than as cash flow from financing activities. The Company has elected to apply the cash flow classification guidance prospectively, resulting in an increase to operating cash flow for the year ended December 31, 2017 and the prior year period has not been adjusted. The Company has also elected to continue to estimate the expected forfeitures rather than electing to account for forfeitures as they occur. Finally, the adoption of the guidance requires excess tax benefits and deficiencies to be prospectively excluded from assumed future proceeds in the calculation of diluted shares, resulting in an increase in diluted weighted average shares outstanding. Accounting Standards Recently Issued But Not Yet Adopted by the Company In May 2017, the FASB issued amended authoritative guidance to provide guidance on types of changes to the terms or conditions of share-based payments awards to which an entity would be required to apply modification accounting under ASC 718. This guidance is effective for annual and interim periods beginning after December 15, 2017, which will be the Company's fiscal year 2018, with early adoption permitted in certain cases. The adoption of this standard is not expected to have a material impact on the Company's consolidated financial statements. In January 2017, the FASB issued amended authoritative guidance to clarify the definition of a business and reduce diversity in practice related to the evaluation of whether transactions should be accounted for as acquisitions (or disposals) of assets or businesses. The new provisions provide the requirements needed for an integrated set of assets and activities (the set) to be a business and also establish a practical way to determine when a set is not a business. The ASU provides a screen to determine when an integrated set of assets and activities is not a business. The more robust framework helps entities to narrow the definition of outputs created by the set and align it with how outputs are described in the new revenue standard. This guidance is effective for annual and interim periods beginning after December 15, 2017, which will be the Company's fiscal year 2018, with early adoption permitted in certain cases. The new guidance is required to be applied on a prospective basis. The effect of the implementation will depend upon the nature of the Company's future acquisitions. In January 2017, the FASB issued amended authoritative guidance to simplify and reduce the cost and complexity of the goodwill impairment test. The new provisions eliminate step 2 from the goodwill impairment test and shifts the concept of impairment from a measure of loss when comparing the implied fair value of goodwill to its carrying amount to comparing the fair value of a reporting unit with its carrying amount. The Board also eliminated the requirements for any reporting unit with a zero or negative carrying amount to perform a qualitative assessment or step 2 of the goodwill impairment test. The new guidance does not amend the optional qualitative assessment of goodwill impairment. This guidance is effective for annual periods beginning after December 15, 2019, which will be the Company's fiscal year 2020, with early adoption permitted. The adoption of this standard is not expected to have a material impact on the Company's consolidated financial statements. In October 2016, the FASB issued amended authoritative guidance to require companies to recognize the income tax consequences of an intra-entity transfer of an asset, other than inventory, when the transfer occurs. The amendments will be effective for the Company’s fiscal year beginning January 1, 2018. The new guidance is required to be applied on a modified retrospective basis through a cumulative-effect adjustment directly to retained earnings as of the beginning of the period of adoption. The adoption of this standard is not expected to have a material impact on the Company's consolidated financial statements based on the Company's historical activity. Furthermore, the actual impact of implementation will largely depend on future intra-entity asset transfers, if any. In August 2016, the FASB issued amended authoritative guidance to reduce the diversity in practice related to the presentation and classification of certain cash receipts and cash payments in the statement of cash flows. The new provisions target cash flow issues related to (i) debt prepayment or debt extinguishment costs, (ii) settlement of debt instruments with coupon rates that are insignificant relative to effective interest rates, (iii) contingent consideration payments made after a business combination, (iv) proceeds from settlement of insurance claims, (v) proceeds from the settlement of corporate-owned life insurance and bank-owned life insurance policies, (vi) distributions received from equity method investees, (vii) beneficial interests in securitization transactions and (viii) separately identifiable cash flows and application of the predominance principle. This guidance will be effective for fiscal years beginning after December 15, 2017, which will be the Company's fiscal year 2018, with early adoption permitted. The adoption of this standard is not expected to have a material impact on the Company’s consolidated financial statements. In February 2016, the FASB issued amended authoritative guidance on accounting for leases. The new provisions require that a lessee of operating leases recognize in the statement of financial position a liability to make lease payments (the lease liability) and a right-of-use asset representing its right to use the underlying asset for the lease term. The lease liability will be equal to the present value of lease payments, with the right-of-use asset based upon the lease liability. The classification criteria for distinguishing between finance (or capital) leases and operating leases are substantially similar to the previous lease guidance, but with no explicit bright lines. As such, operating leases will result in straight-line rent expense similar to current practice. For short term leases (term of 12 months or less), a lessee is permitted to make an accounting election not to recognize lease assets and lease liabilities, which would generally result in lease expense being recognized on a straight-line basis over the lease term. This guidance applies to all entities and is effective for annual periods beginning after December 15, 2018, which will be the Company's fiscal year 2019, with early adoption permitted. The Company is currently evaluating the impact this guidance will have on its consolidated financial statements but expects this adoption will result in a significant increase in the assets and liabilities on its consolidated balance sheets. In January 2016, the FASB issued amended authoritative guidance which makes targeted improvements for financial instruments. The new provisions impact certain aspects of recognition, measurement, presentation and disclosure requirements of financial instruments. Specifically, the guidance will (1) require equity investments to be measured at fair value with changes in fair value recognized in net income, (2) simplify the impairment assessment of equity investments without readily determinable fair values, (3) eliminate the requirement to disclose the method and assumptions used to estimate fair value for financial instruments measured at amortized cost, and (4) require separate presentation of financial assets and financial liabilities by measurement category. The guidance is effective for annual and interim periods beginning after December 15, 2017, which will be the Company's fiscal year 2018. Early adoption is not permitted. The adoption of this standard is not expected to have a material impact on the Company’s consolidated financial statements. In March 2016, the FASB issued its standard to amend the principal-versus-agent implementation guidance and illustrations in the Board’s new revenue standard, which includes accounting implication related to (1) determining the appropriate unit of account under the revenue standard’s principal-versus-agent guidance and (2) applying the indicators of whether an entity is a principal or an agent in accordance with the revenue standard’s control principle. The guidance will be effective for fiscal years beginning after December 15, 2017, which will be the Company's fiscal year 2018. The guidance has the same effective date as the new revenue standard and the Company is required to adopt the guidance by using the same transition method it would use to adopt the new revenue standard. The Company's evaluation of the adoption method and impact to the consolidated financial statements is performed concurrently with the new revenue standard below. In May 2014, the FASB and International Accounting Standards Board issued their final standard on revenue from contracts with customers that outlines a single comprehensive model for entities to use in accounting for revenue arising from contracts with customers. The new standard supersedes most current revenue recognition guidance, including industry-specific guidance, and may be applied retrospectively to each period presented (full retrospective method) or retrospectively with the cumulative effect recognized in beginning retained earnings as of the date of adoption (modified retrospective method). In July 2015, the FASB formally deferred for one year the effective date of the new revenue standard and decided to permit entities to early adopt the standard. In December 2016, the FASB made certain technical corrections to further clarify the core revenue recognition principles, primarily in response to feedback from several sources, including the FASB/IASB Transition Resource Group. The guidance will be effective for fiscal years beginning after December 15, 2017, which will be the Company's fiscal year 2018. The Company initiated an adoption plan in fiscal year 2015, beginning with preliminary evaluation of the standard, and subsequently performed additional analysis of revenue streams and transactions under the new standard. In particular, the Company performed analysis into the application of the portfolio approach as a practical expedient to group patient contracts with similar characteristics, such that revenue for a given portfolio would not be materially different than if it were evaluated on a contract-by-contract basis. The adoption plan has been completed and the impact to the consolidated financial statements for periods subsequent to adoption is not material. As part of the impact assessment, the Company evaluated any variable consideration, potential constraints on the estimate of variable consideration, and significant financing components, in particular as it related to third party settlements. The Company anticipates that for periods subsequent to adoption, the majority of what is currently classified as bad debt expense under operating expenses will be treated as an implicit price concession factored into net revenue, consistent with the intent of the standard. The new standard also requires enhanced disclosures related to the disaggregation of revenue, information about contract balances, and other disclosures about contracts with customers, including revenue recognition policies to identify performance obligations and significant judgments in measurement and recognition. The Company adopted the new revenue standard as of January 1, 2018 using the modified retrospective method and the adoption did not have a material impact. |
Computation of Net Income Per29
Computation of Net Income Per Common Share (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
COMPUTATION OF NET INCOME PER COMMON SHARE [Abstract] | |
Schedule of Earnings Per Share, Basic, by Common Class, Including Two Class Method [Table Text Block] | Year Ended December 31, 2017 2016 2015 Numerator: Net income $ 40,833 $ 52,843 $ 55,917 Less: net income attributable to noncontrolling interests 358 2,853 485 Net income attributable to The Ensign Group, Inc. $ 40,475 $ 49,990 $ 55,432 Denominator: Weighted average shares outstanding for basic net income per share 50,932 50,555 50,316 Basic net income per common share attributable to The Ensign Group, Inc. $ 0.79 $ 0.99 $ 1.10 |
Schedule of Earnings Per Share, Diluted, by Common Class, Including Two Class Method [Table Text Block] | A reconciliation of the numerator and denominator used in the calculation of diluted net income per common share follows: Year Ended December 31, 2017 2016 2017 Numerator: Net income $ 40,833 $ 52,843 $ 55,917 Less: net income attributable to noncontrolling interests 358 2,853 485 Net income attributable to The Ensign Group, Inc. $ 40,475 $ 49,990 $ 55,432 Denominator: Weighted average common shares outstanding 50,932 50,555 50,316 Plus: incremental shares from assumed conversion (1) 1,897 1,578 1,894 Adjusted weighted average common shares outstanding 52,829 52,133 52,210 Diluted net income per common share attributable to The Ensign Group, Inc. $ 0.77 $ 0.96 $ 1.06 (1) Options outstanding which are anti-dilutive and therefore not factored into the weighted average common shares amount above were 1,252 , 838 and 258 for the years ended December 31, 2017, 2016 and 2015 , respectively. |
Fair Value Measurements (Tables
Fair Value Measurements (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Fair Value Disclosures [Abstract] | |
Fair Value, Assets Measured on Recurring Basis [Table Text Block] | The following table summarizes the financial assets and liabilities measured at fair value on a recurring basis as of December 31, 2017 and 2016: December 31, 2017 2016 Level 1 Level 2 Level 3 Level 1 Level 2 Level 3 Cash and cash equivalents $ 42,337 $ — $ — $ 57,706 $ — $ — |
Revenue and Accounts Receivab31
Revenue and Accounts Receivable (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
REVENUE AND ACCOUNTS RECEIVABLE [Abstract] | |
Schedule of Revenue Sources, Health Care Organization [Table Text Block] | Revenue for the years ended December 31, 2017, 2016 and 2015 is summarized in the following tables: Year Ended December 31, 2017 2016 2015 Revenue % of Revenue Revenue % of Revenue Revenue % of Revenue Medicaid $ 644,803 34.9 % $ 557,958 33.7 % $ 458,956 34.2 % Medicare 515,884 27.9 477,019 28.8 395,503 29.5 Medicaid — skilled 102,875 5.6 87,517 5.3 71,905 5.4 Total Medicaid and Medicare 1,263,562 68.4 1,122,494 67.8 926,364 69.1 Managed care 303,386 16.4 265,508 16.0 206,770 15.4 Private and other payors (1) 282,369 15.2 266,862 16.2 208,692 15.5 Revenue $ 1,849,317 100.0 % $ 1,654,864 100.0 % $ 1,341,826 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services for the years ended December 31, 2017, 2016 and 2015 and urgent care centers for the years ended December 31, 2016 and 2015. |
Schedule of Accounts, Notes, Loans and Financing Receivable [Table Text Block] | Accounts receivable as of December 31, 2017 and 2016 is summarized in the following table: December 31, 2017 2016 Medicaid $ 119,441 $ 111,031 Managed care 68,930 66,346 Medicare 55,667 55,500 Private and other payors 64,991 51,347 309,029 284,224 Less: allowance for doubtful accounts (43,961 ) (39,791 ) Accounts receivable, net $ 265,068 $ 244,433 |
Business Segments (Tables)
Business Segments (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Segment Reporting [Abstract] | |
Reconciliation of Revenue from Segments to Consolidated [Table Text Block] | Segment revenues by major payor source were as follows: Year Ended December 31, 2017 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 603,104 $ 30,469 $ 11,230 $ — $ 644,803 34.9 % Medicare 417,870 — 98,014 — 515,884 27.9 Medicaid-skilled 102,875 — — — 102,875 5.6 Subtotal 1,123,849 30,469 109,244 — 1,263,562 68.4 Managed care 281,563 — 21,823 — 303,386 16.4 Private and other 139,798 106,177 11,336 25,058 (1) 282,369 15.2 Total revenue $ 1,545,210 $ 136,646 $ 142,403 $ 25,058 $ 1,849,317 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services for the year ended December 31, 2017. Year Ended December 31, 2016 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 521,063 $ 26,397 $ 10,498 $ — $ 557,958 33.7 % Medicare 396,519 — 80,500 — 477,019 28.8 Medicaid-skilled 87,517 — — — 87,517 5.3 Subtotal 1,005,099 26,397 90,998 — 1,122,494 67.8 Managed care 247,844 — 17,664 — 265,508 16.0 Private and other 121,860 97,239 7,151 40,612 (1) 266,862 16.2 Total revenue $ 1,374,803 $ 123,636 $ 115,813 $ 40,612 $ 1,654,864 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services and urgent care centers for the year ended December 31, 2016. Year Ended December 31, 2015 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 430,368 $ 19,642 $ 8,946 $ — $ 458,956 34.2 % Medicare 332,429 — 63,074 — 395,503 29.5 Medicaid-skilled 71,905 — — — 71,905 5.4 Subtotal 834,702 19,642 72,020 — 926,364 69.1 Managed care 194,743 — 12,027 — 206,770 15.4 Private and other 96,943 68,487 6,309 36,953 (1) 208,692 15.5 Total revenue $ 1,126,388 $ 88,129 $ 90,356 $ 36,953 $ 1,341,826 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services and urgent care centers for the year ended December 31, 2015. |
Schedule of Segment Reporting Information, by Segment [Table Text Block] | The following table sets forth selected financial data consolidated by business segment: Year Ended December 31, 2017 Transitional and Skilled Services (3) Assisted and Independent Living Services (3) Home Health and Hospice Services All Other Elimination Total Revenue from external customers $ 1,545,210 $ 136,646 $ 142,403 $ 25,058 $ — $ 1,849,317 Intersegment revenue (1) 3,023 — — 3,035 (6,058 ) — Total revenue $ 1,548,233 $ 136,646 $ 142,403 $ 28,093 $ (6,058 ) $ 1,849,317 Segment income (loss) (2) $ 140,272 $ 16,736 $ 19,717 $ (95,440 ) $ — $ 81,285 Interest expense, net of interest income $ (12,007 ) Income before provision for income taxes $ 69,278 Depreciation and amortization $ 29,928 $ 6,334 $ 945 $ 7,265 $ — $ 44,472 (1) Intersegment revenue represents services provided at the Company's operating subsidiaries to the Company's other business lines. (2) Segment income (loss) includes depreciation and amortization expense and excludes general and administrative expense and interest expense for transitional and skilled services, assisted and independent living services and home health and hospice businesses. General and administrative expense is included in the "All Other" category. (3) The Company's campuses represent facilities that offer 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. Year Ended December 31, 2016 Transitional and Skilled Services (3) Assisted and Independent Living Services (3) Home Health and Hospice Services All Other Elimination Total Revenue from external customers $ 1,374,803 $ 123,636 $ 115,813 $ 40,612 $ — $ 1,654,864 Intersegment revenue (1) 2,929 — — 2,184 (5,113 ) — Total revenue $ 1,377,732 $ 123,636 $ 115,813 $ 42,796 $ (5,113 ) $ 1,654,864 Segment income (loss) (2) $ 118,118 $ 11,701 $ 16,571 $ (54,543 ) $ — $ 91,847 Interest expense, net of interest income $ (6,029 ) Income before provision for income taxes $ 85,818 Depreciation and amortization $ 26,298 $ 4,157 $ 924 $ 7,303 $ — $ 38,682 (1) Intersegment revenue represents services provided at the Company's operating subsidiaries to the Company's other business lines. (2) Segment income (loss) includes depreciation and amortization expense and excludes general and administrative expense and interest expense for transitional and skilled services, assisted and independent living services and home health and hospice businesses. General and administrative expense is included in the "All Other" category. (3) The Company's campuses represent facilities that offer 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. Year Ended December 31, 2015 Transitional and Skilled Services (3) Assisted and Independent Living Services (3) Home Health and Hospice Services All Other Elimination Total Revenue from external customers $ 1,126,388 $ 88,129 $ 90,356 $ 36,953 $ — $ 1,341,826 Intersegment revenue (1) 2,447 — — 881 (3,328 ) — Total revenue $ 1,128,835 $ 88,129 $ 90,356 $ 37,834 $ (3,328 ) $ 1,341,826 Segment income (loss) (2) $ 136,744 $ 11,463 $ 13,584 $ (68,709 ) $ — $ 93,082 Interest expense, net of interest income $ (1,983 ) Income before provision for income taxes $ 91,099 Depreciation and amortization $ 18,008 $ 3,338 $ 980 $ 5,785 $ — $ 28,111 (1) Intersegment revenue represents services provided at the Company's operating subsidiaries to the Company's other business lines. (2) Segment income (loss) includes depreciation and amortization expense and excludes general and administrative expense and interest expense for transitional and skilled services, assisted and independent living services and home health and hospice businesses. General and administrative expense is included in the "All Other" category. (3) The Company's campuses represent facilities that offer 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. |
Acquisitions (Tables)
Acquisitions (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Business Combinations [Abstract] | |
Schedule of Business Acquisitions, by Acquisition [Table Text Block] | December 31, 2017 2016 2015 Land $ 9,732 $ 1,054 $ 12,811 Building and improvements 53,735 21,057 73,502 Equipment, furniture, and fixtures 4,382 8,265 4,612 Assembled occupancy 762 1,299 895 Definite-lived intangible assets — 363 360 Goodwill 13,962 30,343 10,617 Favorable leases — 393 10,901 Other indefinite-lived intangible assets 7,018 1,741 6,285 Other assets acquired, net of liabilities assumed 92 6 (18 ) Total acquisitions $ 89,683 $ 64,521 $ 119,965 |
Property and Equipment (Tables)
Property and Equipment (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Property, Plant and Equipment [Abstract] | |
Property, Plant and Equipment [Table Text Block] | Property and equipment, net consist of the following: December 31, 2017 2016 Land $ 49,081 $ 47,565 Buildings and improvements 342,641 304,263 Equipment 181,530 153,170 Furniture and fixtures 5,244 6,931 Leasehold improvements 97,221 80,164 Construction in progress 5,460 2,441 681,177 594,534 Less: accumulated depreciation (144,093 ) (110,036 ) Property and equipment, net $ 537,084 $ 484,498 |
Intangible Assets - Net (Tables
Intangible Assets - Net (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Intangible Assets, Net (Excluding Goodwill) [Abstract] | |
Schedule of Finite-Lived Intangible Assets [Table Text Block] | Weighted Average Life (Years) December 31, 2017 2016 Gross Carrying Amount Accumulated Amortization Gross Carrying Amount Accumulated Amortization Intangible Assets Net Net Lease acquisition costs 24.8 $ 483 $ (99 ) $ 384 $ 483 $ (78 ) $ 405 Favorable leases 33.0 35,116 (6,568 ) 28,548 35,116 (4,589 ) 30,527 Assembled occupancy 0.7 2,659 (2,631 ) 28 1,897 (1,897 ) — Facility trade name 30.0 733 (293 ) 440 733 (269 ) 464 Customer relationships 18.7 4,933 (1,530 ) 3,403 4,933 (1,253 ) 3,680 Total $ 43,924 $ (11,121 ) $ 32,803 $ 43,162 $ (8,086 ) $ 35,076 |
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense [Table Text Block] | Estimated amortization expense for each of the years ending December 31 is as follows: Year Amount 2018 2,329 2019 2,301 2020 1,593 2021 1,497 2022 1,471 Thereafter 23,612 $ 32,803 |
Goodwill and Other Indefinite36
Goodwill and Other Indefinite-Lived Intangible Assets (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Indefinite-Lived Intangible Assets (Including Goodwill) [Abstract] | |
Schedule of Goodwill [Table Text Block] | The following table represents activity in goodwill by segment as of and for the year ended December 31, : Goodwill Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total January 1, 2015 $ 14,221 $ 1,756 $ 10,929 $ 3,363 $ 30,269 Additions — 1,782 5,173 3,662 10,617 December 31, 2015 $ 14,221 $ 3,538 $ 16,102 $ 7,025 $ 40,886 Less: Dispositions — — — (4,103 ) (4,103 ) Purchase price adjustment — — — (26 ) (26 ) Additions 26,415 — 1,799 2,129 30,343 December 31, 2016 $ 40,636 $ 3,538 $ 17,901 $ 5,025 $ 67,100 Additions 4,850 420 6,421 2,271 13,962 December 31, 2017 $ 45,486 $ 3,958 $ 24,322 $ 7,296 $ 81,062 |
Schedule of Acquired Indefinite-lived Intangible Assets by Major Class [Table Text Block] | Other indefinite-lived intangible assets consists of the following: December 31, 2017 December 31, 2016 Trade name $ 1,181 $ 1,146 Medicare and Medicaid licenses 24,068 18,440 $ 25,249 $ 19,586 |
Restricted and Other Assets (Ta
Restricted and Other Assets (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Other Assets [Abstract] | |
Schedule of Other Assets [Table Text Block] | Restricted and other assets consist of the following: December 31, 2017 2016 Debt issuance costs, net $ 2,799 $ 3,611 Long-term insurance losses recoverable asset 5,394 4,104 Deposits with landlords 5,981 3,526 Capital improvement reserves with landlords and lenders 2,327 673 Note receivable from sale of urgent care centers — 700 Restricted and other assets $ 16,501 $ 12,614 |
Other Accrued Liabilities (Tabl
Other Accrued Liabilities (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Accrued Liabilities [Abstract] | |
Schedule of Accrued Liabilities [Table Text Block] | Other accrued liabilities consist of the following: December 31, 2017 2016 Quality assurance fee $ 4,864 $ 4,604 Refunds payable 21,661 18,368 Deferred revenue 7,066 6,994 Cash held in trust for patients 2,609 2,373 Resident deposits 6,574 6,099 Dividends payable 2,328 2,186 Property taxes 10,088 9,130 Income tax payable — 1,182 Operational closure liability 910 1,972 Other 7,715 5,855 Other accrued liabilities $ 63,815 $ 58,763 |
Income Taxes (Tables)
Income Taxes (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Income Tax Disclosure [Abstract] | |
Schedule of Components of Income Tax Expense (Benefit) [Table Text Block] | The provision for income taxes on continuing operations for the years ended December 31, 2017, 2016 and 2015 is summarized as follows: Year Ended December 31, 2017 2016 2015 Current: Federal $ 15,141 $ 30,043 $ 28,149 State 2,975 5,183 5,761 18,116 35,226 33,910 Deferred: Federal 5,428 (1,034 ) 2,026 State 986 (1,217 ) (754 ) 6,414 (2,251 ) 1,272 Adjustment to deferred taxes for tax rate change 3,915 — — Total $ 28,445 $ 32,975 $ 35,182 |
Schedule of Effective Income Tax Rate Reconciliation [Table Text Block] | A reconciliation of the federal statutory rate to the effective tax rate for income from continuing operations for the years ended December 31, 2017, 2016 and 2015, respectively, is comprised as follows: December 31, 2017 2016 2015 Income tax expense at statutory rate 35.0 % 35.0 % 35.0 % State income taxes - net of federal benefit 3.1 3.0 3.6 Non-deductible expenses 1.7 0.9 0.6 Equity compensation (4.5 ) — — Revaluation of deferred 5.7 — — Other adjustments 0.1 (0.5 ) (0.6 ) Total income tax provision 41.1 % 38.4 % 38.6 % |
Schedule of Deferred Tax Assets and Liabilities [Table Text Block] | The Company's deferred tax assets and liabilities as of December 31, 2017 and 2016 are summarized below. The deferred taxes in 2017 reflect the federal tax rate of 21.0%, whereas 2016 reflect a federal tax rate of 35.0%. December 31, 2017 2016 Deferred tax assets (liabilities): Accrued expenses $ 16,500 $ 21,732 Allowance for doubtful accounts 11,090 15,956 Tax credits 3,334 3,461 Insurance 5,135 7,333 36,059 48,482 Valuation allowance (530 ) — Total deferred tax assets 35,529 48,482 State taxes (911 ) (1,023 ) Depreciation and amortization (18,248 ) (20,643 ) Prepaid expenses (3,625 ) (3,743 ) Total deferred tax liabilities (22,784 ) (25,409 ) Net deferred tax assets $ 12,745 $ 23,073 |
Debt (Tables)
Debt (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Debt Disclosure [Abstract] | |
Schedule of Long-term Debt Instruments [Table Text Block] | Long-term debt consists of the following: December 31, 2017 2016 Term loan with SunTrust, interest payable quarterly $ 140,625 $ 148,125 Credit facility with SunTrust 50,000 122,000 Mortgage loans and promissory note, principal and interest payable monthly, interest at fixed rate 125,394 14,032 316,019 284,157 Less: current maturities (9,939 ) (8,129 ) Less: debt issuance costs (3,090 ) (542 ) $ 302,990 $ 275,486 |
Options and Awards (Tables)
Options and Awards (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Options and Awards [Abstract] | |
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions [Table Text Block] | The Company used the following assumptions for stock options granted during the years ended December 31, 2017, 2016 and 2015 : Grant Year Options Granted Weighted Average Risk-Free Rate Expected Life Weighted Average Volatility Weighted Average Dividend Yield 2017 481 2.0% 6.2 years 35.2% 0.8% 2016 497 1.4% 6.3 years 37.8% 0.8% 2015 637 1.7% 6.5 years 39.5% 0.6% |
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Weighted Average Grant Date Fair Value [Table Text Block] | For the years ended December 31, 2017, 2016 and 2015 , the following represents the exercise price and fair value displayed at grant date for stock option grants: Grant Year Granted Weighted Average Exercise Price Weighted Average Fair Value of Options 2017 481 $ 20.31 $ 7.00 2016 497 $ 19.43 $ 7.00 2015 637 $ 23.27 $ 9.08 |
Schedule of Common Stock Outstanding Roll Forward [Table Text Block] | The following table represents the employee stock option activity during the years ended December 31, 2017, 2016 and 2015 : Number of Options Outstanding Weighted Average Exercise Price Number of Options Vested Weighted Average Exercise Price of Options Vested January 1, 2015 5,532 $ 8.51 2,218 $ 4.70 Granted 637 23.27 Forfeited (233 ) 12.55 Exercised (488 ) 5.20 December 31, 2015 5,448 $ 10.36 2,526 $ 6.35 Granted 497 19.43 Forfeited (127 ) 14.46 Exercised (642 ) 6.47 December 31, 2016 5,176 $ 11.62 2,704 $ 8.18 Granted 481 20.31 Forfeited (178 ) 15.82 Exercised (740 ) 6.93 December 31, 2017 4,739 $ 13.08 2,776 $ 10.07 |
Schedule of Share-based Compensation, Shares Authorized under Stock Option Plans, by Exercise Price Range [Table Text Block] | The following summary information reflects stock options outstanding, vested and related details as of December 31, 2017 : Stock Options Vested Stock Options Outstanding Number Outstanding Black-Scholes Fair Value Remaining Contractual Life (Years) Vested and Exercisable Year of Grant Exercise Price 2008 2.56 - 4.06 185 $ 292 1 185 2009 4.06 - 4.56 420 907 2 420 2010 4.77 - 4.96 116 281 3 116 2011 5.90 - 7.99 134 454 4 134 2012 6.56 - 7.96 435 1,603 5 435 2013 7.98 - 11.49 522 2,539 6 390 2014 10.55 - 18.94 1,458 8,272 7 789 2015 21.47 - 25.24 549 5,000 8 219 2016 18.79 - 19.89 450 3,140 9 88 2017 18.64 - 22.90 470 3,291 10 — Total 4,739 $ 25,779 2,776 |
Schedule of Nonvested Restricted Stock Units Activity [Table Text Block] | A summary of the status of the Company's non-vested restricted stock awards as of December 31, 2017 and changes during the years ended December 31, 2017, 2016 and 2015 is presented below: Non-Vested Restricted Awards Weighted Average Grant Date Fair Value Nonvested at January 1, 2015 366 $ 15.15 Granted 323 22.99 Vested (234 ) 17.36 Forfeited (30 ) 16.81 Nonvested at December 31, 2015 425 $ 19.79 Granted 299 20.55 Vested (279 ) 19.58 Forfeited (16 ) 20.85 Nonvested at December 31, 2016 429 $ 20.42 Granted 173 20.21 Vested (195 ) 19.79 Forfeited (24 ) 20.34 Nonvested at December 31, 2017 383 $ 20.65 |
Schedule of Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Table Text Block] | Share-based compensation expense recognized for the Company's equity incentive plans for the years ended December 31, 2017, 2016 and 2015 was as follows: Year Ended December 31, 2017 2016 2015 Share-based compensation expense related to stock options $ 4,773 $ 4,793 4,164 Share-based compensation expense related to restricted stock awards 2,322 2,371 1,931 Share-based compensation expense related to stock options and restricted stock awards to non-employee directors 1,236 612 582 Total $ 8,331 $ 7,776 $ 6,677 |
Share-based Compensation, Schedule of Intrisice Values by Option Category [Table Text Block] | The aggregate intrinsic value of options outstanding, vested, expected to vest and exercised as of and for the years ended December 31, 2017, 2016 and 2015 is as follows: December 31, Options 2017 2016 2015 Outstanding $ 44,060 $ 55,610 $ 67,508 Vested 33,976 38,101 41,128 Expected to vest 9,311 15,983 23,508 Exercisable 10,481 9,199 8,709 |
Leases (Tables)
Leases (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Leases [Abstract] | |
Schedule of Future Minimum Rental Payments for Operating Leases [Table Text Block] | Future minimum lease payments for all leases as of December 31, 2017 are as follows: Year Amount 2018 135,841 2019 135,395 2020 135,149 2021 134,942 2022 133,446 Thereafter 1,080,348 $ 1,755,121 |
Self-Insurance Reserves (Tables
Self-Insurance Reserves (Tables) | 12 Months Ended |
Dec. 31, 2017 | |
Self-Insurance Reserves [Abstract] | |
Self-Insurance Reserves [Table Text Block] | The following table represents activity in our insurance reserves as of and for the years ended December 31, 2017 and 2016: General and Professional Liability Workers' Compensation Health Total Balance January 1, 2016 30,710 20,219 5,074 $ 56,003 Current year provisions 23,149 12,887 38,151 74,187 Claims paid and direct expenses (18,186 ) (10,290 ) (37,586 ) (66,062 ) Change in long-term insurance losses recoverable 637 586 — 1,223 Balance December 31, 2016 36,310 23,402 5,639 65,351 Current year provisions 20,396 15,202 53,796 89,394 Claims paid and direct expenses (16,133 ) (12,455 ) (54,712 ) (83,300 ) Change in long-term insurance losses recoverable 361 930 — 1,291 Balance December 31, 2017 $ 40,934 $ 27,079 $ 4,723 $ 72,736 |
Description of Business (Detail
Description of Business (Details) | Dec. 31, 2017businessBedsfacilities | Dec. 31, 2016facilities |
Skilled nursing, assisted living and independent living facilities [Abstract] | ||
Number of Real Estate Properties | 63 | 50 |
Number of Real Estate Properties Leased | 167 | 160 |
Number of Real Estate Properties Leased with an Option to Purchase | 11 | 9 |
Number of Real Estate Properties Operated | 230 | 210 |
Home Health, Hospice and Home Care Operations | business | 46 | |
Operational Skilled Nursing Beds | Beds | 18,900 | |
Operational Skilled Nursing, Assisted Living and Independent Living Beds [Abstract] | ||
Operational Skilled Nursing, Assisted Living and Independent Living Beds | Beds | 5,000 |
Significant Accounting Polici45
Significant Accounting Policies Divestiture (Details) $ in Thousands | 12 Months Ended |
Dec. 31, 2016USD ($) | |
Disposal Group, Disposed of by Sale, Not Discontinued Operations [Member] | |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | |
Sale Price from Divestiture of Businesses | $ 41,492 |
Significant Accounting Polici46
Significant Accounting Policies Revenue and Accounts Receivable (Details) | 12 Months Ended | ||
Dec. 31, 2017Rate | Dec. 31, 2016Rate | Dec. 31, 2015Rate | |
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | |||
% of Revenue | 100.00% | 100.00% | 100.00% |
Total Medicaid and Medicare | |||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | |||
% of Revenue | 68.40% | 67.80% | 69.10% |
Significant Accounting Polici47
Significant Accounting Policies Property and Equipment (Details) | 12 Months Ended |
Dec. 31, 2017 | |
Minimum [Member] | |
Property, Plant and Equipment [Line Items] | |
Property, Plant and Equipment, Useful Life | 3 years |
Maximum [Member] | |
Property, Plant and Equipment [Line Items] | |
Property, Plant and Equipment, Useful Life | 59 years |
Significant Accounting Polici48
Significant Accounting Policies Impairment (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Accounting Policies [Abstract] | |||
Impairment of Long-Lived Assets to be Disposed of | $ 111 | $ 137 | $ 0 |
Impairment of Intangible Assets, Indefinite-lived (Excluding Goodwill) | $ 0 | $ 0 | $ 0 |
Significant Accounting Polici49
Significant Accounting Policies Intangible Assets and Goodwill (Details) | 12 Months Ended |
Dec. 31, 2017 | |
Assembled occupancy | Minimum [Member] | |
Finite-Lived Intangible Assets [Line Items] | |
Finite-Lived Intangible Asset, Useful Life | 4 months |
Assembled occupancy | Maximum [Member] | |
Finite-Lived Intangible Assets [Line Items] | |
Finite-Lived Intangible Asset, Useful Life | 8 months |
Trade name | |
Finite-Lived Intangible Assets [Line Items] | |
Finite-Lived Intangible Asset, Useful Life | 30 years |
Customer relationships | |
Finite-Lived Intangible Assets [Line Items] | |
Finite-Lived Intangible Asset, Useful Life | 20 years |
Significant Accounting Polici50
Significant Accounting Policies Self-Insurance General and Professional (Details) - General and Professional Liability Insurance [Member] $ in Thousands | Dec. 31, 2017USD ($) |
Self-insurance retention per claim [Member] | Parent Company [Member] | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | $ 500 |
Aggregate Deductible [Member] | Parent Company [Member] | CALIFORNIA | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | 750 |
Aggregate Deductible [Member] | Parent Company [Member] | Non-California [Domain] | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | 1,000 |
Blanket Aggregate [Member] | Third-Party Payor [Member] | All States Except Colorado [Domain] | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | 5,000 |
Per Facility [Member] | Third-Party Payor [Member] | All States Except Colorado [Domain] | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | 3,000 |
Per Facility [Member] | Third-Party Payor [Member] | COLORADO | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | 3,000 |
Per Occurence [Member] | Third-Party Payor [Member] | All States Except Colorado [Domain] | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | 1,000 |
Per Occurence [Member] | Third-Party Payor [Member] | COLORADO | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | $ 1,000 |
Significant Accounting Polici51
Significant Accounting Policies Self-Insurance Workers' Compensation (Details) - Workers' Compensation [Member] $ in Thousands | Dec. 31, 2017USD ($) |
Stop-Loss Insurance limit per claim [Member] | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | $ 500 |
Stop-Loss Insurance limit per claim [Member] | TEXAS | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | 750 |
Loss-Sensitive limit per claim [Member] [Member] | Other states, except California, Texas and Washington [Domain] | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | $ 350 |
Significant Accounting Polici52
Significant Accounting Policies Self Insurance Recoveries (Details) - USD ($) $ in Thousands | Dec. 31, 2017 | Dec. 31, 2016 |
Accounting Policies [Abstract] | ||
Long-term insurance losses recoverable asset | $ 5,394 | $ 4,104 |
Significant Accounting Polici53
Significant Accounting Policies Self-Insurance Health Insurance (Details) - Health Liability Insurance [Member] $ in Thousands | Dec. 31, 2017USD ($) |
Stop-Loss Insurance limit per claim [Member] | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | $ 300 |
Stop Loss Deductible [Member] | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | $ 75 |
Significant Accounting Polici54
Significant Accounting Policies Income Taxes (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Accounting Policies [Abstract] | |||
Adjustment to deferred taxes for tax rate change | $ 3,915 | $ 0 | $ 0 |
Significant Accounting Polici55
Significant Accounting Policies Recent Accounting Standards Adopted (Details) $ in Thousands | 12 Months Ended |
Dec. 31, 2017USD ($) | |
Accounting Policies [Abstract] | |
Income Tax Effects Allocated Directly to Equity, Employee Stock Options | $ 3,423 |
Common Stock (Details)
Common Stock (Details) shares in Thousands, $ in Thousands | Feb. 08, 2017USD ($) | Nov. 04, 2015USD ($)Agreements | Dec. 31, 2017USD ($)shares | Dec. 31, 2016USD ($)shares | Dec. 31, 2015USD ($) |
Common Stock Transactions [Line Items] | |||||
Stock Repurchase Program, Period in Force | 12 months | 12 months | |||
Stock Repurchase Program Expiration Date | Feb. 8, 2018 | ||||
Repurchase of common stock (Note 3) | $ (7,288) | $ (30,000) | $ 0 | ||
Number of Stock Repurchase Programs | Agreements | 2 | ||||
Common Stock [Member] | |||||
Common Stock Transactions [Line Items] | |||||
Stock Repurchase Program, Authorized Amount | $ 30,000 | $ 15,000 | |||
Stock Repurchased During Period, Shares | shares | 412 | 1,452 | |||
Repurchase of common stock (Note 3) | $ (7,288) | $ (30,000) |
Computation of Net Income Per57
Computation of Net Income Per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands | 12 Months Ended | |||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | ||
Numerator: | ||||
Net income | $ 40,833 | $ 52,843 | $ 55,917 | |
Less: net income attributable to noncontrolling interests | 358 | 2,853 | 485 | |
Net income attributable to The Ensign Group, Inc. | $ 40,475 | $ 49,990 | $ 55,432 | |
Denominator: | ||||
Weighted average shares outstanding for basic net income per share | 50,932 | 50,555 | 50,316 | |
Adjusted weighted average common shares outstanding | 52,829 | 52,133 | 52,210 | |
Basic net income (loss) per common share: | ||||
Basic net income per common share attributable to The Ensign Group, Inc. | $ 0.79 | $ 0.99 | $ 1.10 | |
Diluted net (loss) income per common share: | ||||
Diluted net income per common share attributable to The Ensign Group, Inc. | $ 0.77 | $ 0.96 | $ 1.06 | |
Common Class A [Member] | ||||
Denominator: | ||||
Weighted average shares outstanding for basic net income per share | 50,932 | 50,555 | 50,316 | |
Plus: incremental shares from assumed conversion (1) | [1] | 1,897 | 1,578 | 1,894 |
[1] | (1) Options outstanding which are anti-dilutive and therefore not factored into the weighted average common shares amount above were 1,252, 838 and 258 for the years ended December 31, 2017, 2016 and 2015, respectively. |
Computation of Net Income Per58
Computation of Net Income Per Common Share Antidilutive Shares (Details) - shares shares in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Earnings Per Share, Diluted, Other Disclosures [Abstract] | |||
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount | 1,252 | 838 | 258 |
Fair Value Measurements (Detail
Fair Value Measurements (Details) - Cash and cash equivalents - USD ($) $ in Thousands | Dec. 31, 2017 | Dec. 31, 2016 |
Level 1 | ||
Cash and cash equivalents | $ 42,337 | $ 57,706 |
Level 2 | ||
Cash and cash equivalents | 0 | 0 |
Level 3 | ||
Cash and cash equivalents | $ 0 | $ 0 |
Fair Value Measurements Investm
Fair Value Measurements Investments (Details) - USD ($) $ in Thousands | Dec. 31, 2017 | Dec. 31, 2016 |
Domestic Corporate Debt Securities [Member] | ||
Schedule of Held-to-maturity Securities [Line Items] | ||
Held-to-maturity Securities | $ 41,777 | $ 35,184 |
Revenue and Accounts Receivab61
Revenue and Accounts Receivable Revenue (Details) - USD ($) $ in Thousands | 12 Months Ended | ||||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | |||||
Revenue | $ 1,849,317 | $ 1,654,864 | $ 1,341,826 | ||
Revenue by payor as a percent of total revenue | 100.00% | 100.00% | 100.00% | ||
Medicaid | |||||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | |||||
Revenue | $ 644,803 | $ 557,958 | $ 458,956 | ||
Revenue by payor as a percent of total revenue | 34.90% | 33.70% | 34.20% | ||
Medicare | |||||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | |||||
Revenue | $ 515,884 | $ 477,019 | $ 395,503 | ||
Revenue by payor as a percent of total revenue | 27.90% | 28.80% | 29.50% | ||
Medicaid — skilled | |||||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | |||||
Revenue | $ 102,875 | $ 87,517 | $ 71,905 | ||
Revenue by payor as a percent of total revenue | 5.60% | 5.30% | 5.40% | ||
Total Medicaid and Medicare | |||||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | |||||
Revenue | $ 1,263,562 | $ 1,122,494 | $ 926,364 | ||
Revenue by payor as a percent of total revenue | 68.40% | 67.80% | 69.10% | ||
Managed care | |||||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | |||||
Revenue | $ 303,386 | $ 265,508 | $ 206,770 | ||
Revenue by payor as a percent of total revenue | 16.40% | 16.00% | 15.40% | ||
Private and other payors(1) | |||||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | |||||
Revenue | $ 282,369 | [1] | $ 266,862 | [1] | $ 208,692 |
Revenue by payor as a percent of total revenue | 15.20% | 16.20% | 15.50% | ||
[1] | (1) Private and other payors also includes revenue from all payors generated in other ancillary services for the years ended December 31, 2017, 2016 and 2015 and urgent care centers for the years ended December 31, 2016 and 2015. |
Revenue and Accounts Receivab62
Revenue and Accounts Receivable Accounts Receivable (Details) - USD ($) $ in Thousands | Dec. 31, 2017 | Dec. 31, 2016 |
Accounts, Notes, Loans and Financing Receivable [Line Items] | ||
Accounts Receivable, Gross | $ 309,029 | $ 284,224 |
Less: allowance for doubtful accounts | (43,961) | (39,791) |
Accounts receivable, net | 265,068 | 244,433 |
Medicaid | ||
Accounts, Notes, Loans and Financing Receivable [Line Items] | ||
Accounts Receivable, Gross | 119,441 | 111,031 |
Managed care | ||
Accounts, Notes, Loans and Financing Receivable [Line Items] | ||
Accounts Receivable, Gross | 68,930 | 66,346 |
Medicare | ||
Accounts, Notes, Loans and Financing Receivable [Line Items] | ||
Accounts Receivable, Gross | 55,667 | 55,500 |
Private and other payors | ||
Accounts, Notes, Loans and Financing Receivable [Line Items] | ||
Accounts Receivable, Gross | $ 64,991 | $ 51,347 |
Business Segments (Details)
Business Segments (Details) $ in Thousands | 3 Months Ended | 12 Months Ended | ||
Jun. 30, 2017USD ($) | Dec. 31, 2017USD ($)businessfacilitiesSegments | Dec. 31, 2016USD ($) | Dec. 31, 2015USD ($) | |
Segment Reporting Information [Line Items] | ||||
Number of Reportable Segments | Segments | 3 | |||
Transitional and Skilled Service Facilities | facilities | 160 | |||
Transitional and Skilled Services and Assistant and Independent Living Campuses | facilities | 21 | |||
Assisted and Independent Living Facilities | facilities | 49 | |||
Home Health, Hospice and Home Care Operations | business | 46 | |||
Business Exit Costs | $ 2,321 | $ (11,225) | $ 0 | |
Gain (Loss) on Contract Termination | 2,715 | 6,512 | 0 | |
Impairment of Long-Lived Assets to be Disposed of | 111 | 137 | 0 | |
Disposal Group, Disposed of by Sale, Not Discontinued Operations [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Sale Price from Divestiture of Businesses | 41,492 | |||
Contract Termination and Facility Closing [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Business Exit Costs | 4,017 | 0 | 0 | |
Facility Closing [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Business Exit Costs | $ (1,286) | $ 2,830 | $ 7,935 | $ 0 |
Business Segments Revenue by Se
Business Segments Revenue by Segment (Details) - USD ($) $ in Thousands | 12 Months Ended | ||||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | $ 1,849,317 | $ 1,654,864 | $ 1,341,826 | ||
Revenue by payor as a percent of total revenue | 100.00% | 100.00% | 100.00% | ||
Transitional and Skilled Services Segment | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | $ 1,545,210 | $ 1,374,803 | $ 1,126,388 | ||
Assisted and Independent Living Services Segment | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 136,646 | 123,636 | 88,129 | ||
Home Health and Hospice Services | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 142,403 | 115,813 | 90,356 | ||
All Other | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 25,058 | 40,612 | 36,953 | ||
Medicaid | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | $ 644,803 | $ 557,958 | $ 458,956 | ||
Revenue by payor as a percent of total revenue | 34.90% | 33.70% | 34.20% | ||
Medicaid | Transitional and Skilled Services Segment | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | $ 603,104 | $ 521,063 | $ 430,368 | ||
Medicaid | Assisted and Independent Living Services Segment | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 30,469 | 26,397 | 19,642 | ||
Medicaid | Home Health and Hospice Services | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 11,230 | 10,498 | 8,946 | ||
Medicaid | All Other | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 0 | 0 | 0 | ||
Medicare | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | $ 515,884 | $ 477,019 | $ 395,503 | ||
Revenue by payor as a percent of total revenue | 27.90% | 28.80% | 29.50% | ||
Medicare | Transitional and Skilled Services Segment | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | $ 417,870 | $ 396,519 | $ 332,429 | ||
Medicare | Assisted and Independent Living Services Segment | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 0 | 0 | 0 | ||
Medicare | Home Health and Hospice Services | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 98,014 | 80,500 | 63,074 | ||
Medicare | All Other | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 0 | 0 | 0 | ||
Medicaid — skilled | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | $ 102,875 | $ 87,517 | $ 71,905 | ||
Revenue by payor as a percent of total revenue | 5.60% | 5.30% | 5.40% | ||
Medicaid — skilled | Transitional and Skilled Services Segment | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | $ 102,875 | $ 87,517 | $ 71,905 | ||
Medicaid — skilled | Assisted and Independent Living Services Segment | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 0 | 0 | 0 | ||
Medicaid — skilled | Home Health and Hospice Services | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 0 | 0 | 0 | ||
Medicaid — skilled | All Other | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 0 | 0 | 0 | ||
Total Medicaid and Medicare | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | $ 1,263,562 | $ 1,122,494 | $ 926,364 | ||
Revenue by payor as a percent of total revenue | 68.40% | 67.80% | 69.10% | ||
Total Medicaid and Medicare | Transitional and Skilled Services Segment | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | $ 1,123,849 | $ 1,005,099 | $ 834,702 | ||
Total Medicaid and Medicare | Assisted and Independent Living Services Segment | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 30,469 | 26,397 | 19,642 | ||
Total Medicaid and Medicare | Home Health and Hospice Services | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 109,244 | 90,998 | 72,020 | ||
Total Medicaid and Medicare | All Other | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 0 | 0 | 0 | ||
Managed care | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | $ 303,386 | $ 265,508 | $ 206,770 | ||
Revenue by payor as a percent of total revenue | 16.40% | 16.00% | 15.40% | ||
Managed care | Transitional and Skilled Services Segment | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | $ 281,563 | $ 247,844 | $ 194,743 | ||
Managed care | Assisted and Independent Living Services Segment | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 0 | 0 | 0 | ||
Managed care | Home Health and Hospice Services | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 21,823 | 17,664 | 12,027 | ||
Managed care | All Other | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 0 | 0 | 0 | ||
Private and other payors | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | $ 282,369 | [1] | $ 266,862 | [1] | $ 208,692 |
Revenue by payor as a percent of total revenue | 15.20% | 16.20% | 15.50% | ||
Private and other payors | Transitional and Skilled Services Segment | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | $ 139,798 | $ 121,860 | $ 96,943 | ||
Private and other payors | Assisted and Independent Living Services Segment | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 106,177 | 97,239 | 68,487 | ||
Private and other payors | Home Health and Hospice Services | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | 11,336 | 7,151 | 6,309 | ||
Private and other payors | All Other | |||||
Segment Reporting, Revenue Reconciling Item [Line Items] | |||||
Revenue | $ 25,058 | $ 40,612 | $ 36,953 | ||
[1] | (1) Private and other payors also includes revenue from all payors generated in other ancillary services for the years ended December 31, 2017, 2016 and 2015 and urgent care centers for the years ended December 31, 2016 and 2015. |
Business Segments Schedule of S
Business Segments Schedule of Segment Reporting Information, by Segment (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Segment Reporting Information [Line Items] | |||
Revenue | $ 1,849,317 | $ 1,654,864 | $ 1,341,826 |
Intersegment revenue (1) | 0 | 0 | 0 |
Revenue including intersegment revenue | 1,849,317 | 1,654,864 | 1,341,826 |
Segment income (loss) (2) | 81,285 | 91,847 | 93,082 |
Interest expense, net of interest income | (12,007) | (6,029) | (1,983) |
Income before provision for income taxes | 69,278 | 85,818 | 91,099 |
Depreciation and amortization | 44,472 | 38,682 | 28,111 |
Transitional and Skilled Services Segment | |||
Segment Reporting Information [Line Items] | |||
Revenue | 1,545,210 | 1,374,803 | 1,126,388 |
Intersegment revenue (1) | 3,023 | 2,929 | 2,447 |
Revenue including intersegment revenue | 1,548,233 | 1,377,732 | 1,128,835 |
Segment income (loss) (2) | 140,272 | 118,118 | 136,744 |
Depreciation and amortization | 29,928 | 26,298 | 18,008 |
Assisted and Independent Living Services Segment | |||
Segment Reporting Information [Line Items] | |||
Revenue | 136,646 | 123,636 | 88,129 |
Intersegment revenue (1) | 0 | 0 | 0 |
Revenue including intersegment revenue | 136,646 | 123,636 | 88,129 |
Segment income (loss) (2) | 16,736 | 11,701 | 11,463 |
Depreciation and amortization | 6,334 | 4,157 | 3,338 |
Home Health and Hospice Services | |||
Segment Reporting Information [Line Items] | |||
Revenue | 142,403 | 115,813 | 90,356 |
Intersegment revenue (1) | 0 | 0 | 0 |
Revenue including intersegment revenue | 142,403 | 115,813 | 90,356 |
Segment income (loss) (2) | 19,717 | 16,571 | 13,584 |
Depreciation and amortization | 945 | 924 | 980 |
All Other | |||
Segment Reporting Information [Line Items] | |||
Revenue | 25,058 | 40,612 | 36,953 |
Intersegment revenue (1) | 3,035 | 2,184 | 881 |
Revenue including intersegment revenue | 28,093 | 42,796 | 37,834 |
Segment income (loss) (2) | (95,440) | (54,543) | (68,709) |
Depreciation and amortization | 7,265 | 7,303 | 5,785 |
Elimination | |||
Segment Reporting Information [Line Items] | |||
Intersegment revenue (1) | (6,058) | (5,113) | (3,328) |
Revenue including intersegment revenue | (6,058) | (5,113) | (3,328) |
Segment income (loss) (2) | 0 | 0 | 0 |
Depreciation and amortization | $ 0 | $ 0 | $ 0 |
Acquisitions Acquisition Summar
Acquisitions Acquisition Summary (Details) $ in Thousands | Feb. 01, 2018USD ($)BedsOperations | Dec. 31, 2017USD ($)BedsOperations | Dec. 31, 2016USD ($)BedsOperations | Dec. 31, 2015USD ($)BedsOperations |
Business Acquisition [Line Items] | ||||
Payments to acquire leased assets | $ | $ 195 | $ 120,935 | $ 17,750 | |
Payments to Acquire Businesses, Gross | $ | $ 89,683 | 64,521 | 119,965 | |
Operational Skilled Nursing Beds | Beds | 18,900 | |||
Operational Assisted Living Units | Beds | 5,000 | |||
Payments to Acquire Businesses, Net of Cash Acquired | $ | $ 89,565 | $ 64,310 | $ 110,802 | |
8051 Services, Skilled Nursing Care Facilities [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 8 | 18 | 50 | |
Payments to acquire leased assets | $ | $ 23,998 | |||
Notes Issued | $ | $ 6,248 | |||
Operational Skilled Nursing Beds | Beds | 905 | 2,336 | 2,580 | |
Home Health, Hospice and Home Care Agency [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 7 | |||
Assisted Living and Independent Living Facility [Member] [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 9 | |||
Operational Assisted Living and Independent Living Units | Beds | 2,013 | |||
Transitional and Skilled Services and Assisted and Independent Campuses [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 1 | 1 | ||
8082 Services, Home Health Care Services [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 3 | 2 | ||
Hospice Agency [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 3 | 5 | ||
Home Care Agency [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 1 | |||
Urgent Care Centers [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 3 | |||
Assisted Living Facility [Member] | ||||
Business Acquisition [Line Items] | ||||
Operational Assisted Living Units | Beds | 594 | 10 | ||
Skilled Nursing, Assisted Living, Home Health, Home Care, Hospice and Urgent Care [Member] | ||||
Business Acquisition [Line Items] | ||||
Payments to Acquire Businesses, Net of Cash Acquired | $ | $ 119,965 | |||
Liability Assumed, Refundable Deposits | $ | $ 8,939 | |||
Transitional and Skilled Services and Assisted and Independent Campuses [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 1 | |||
Skilled Nursing, Assisted Living and Independent Living Facilities [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 18 | |||
8051 Services, Skilled Nursing Care Facilities [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 2 | |||
Assisted Living Facility [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 15 | |||
Payments to acquire leased assets | $ | $ 127,348 | |||
8051 Services, Skilled Nursing Care Facilities [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 3 | |||
Assisted Living Facility [Member] | Assisted Living Facility [Member] | ||||
Business Acquisition [Line Items] | ||||
Operational Skilled Nursing Beds | Beds | 142 | |||
Assisted Living and Independent Living Facility [Member] [Member] | Assisted Living and Independent Living Facility [Member] [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 6 | |||
8051 Services, Skilled Nursing Care Facilities [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 16 | |||
8051 Services, Skilled Nursing Care Facilities [Member] | 8051 Services, Skilled Nursing Care Facilities [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 4 | |||
Operational Skilled Nursing Beds | Beds | 455 | 463 | ||
Subsequent Event [Member] | Assisted Living and Independent Living Facility [Member] [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 2 | |||
Payments to Acquire Businesses, Gross | $ | $ 4,298 | |||
Operational Assisted Living Units | Beds | 74 |
Acquisitions (Details)
Acquisitions (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | $ 89,683 | $ 64,521 | $ 119,965 |
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net | 92 | 6 | (18) |
Land | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | 9,732 | 1,054 | 12,811 |
Building and improvements | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | 53,735 | 21,057 | 73,502 |
Equipment, furniture, and fixtures | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | 4,382 | 8,265 | 4,612 |
Assembled occupancy | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | 762 | 1,299 | 895 |
Definite-lived intangible assets | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | 0 | 363 | 360 |
Favorable leases | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | 0 | 393 | 10,901 |
Goodwill | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | 13,962 | 30,343 | 10,617 |
Other indefinite-lived intangible assets | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | $ 7,018 | $ 1,741 | $ 6,285 |
Property and Equipment (Details
Property and Equipment (Details) - USD ($) $ in Thousands | Dec. 31, 2017 | Dec. 31, 2016 |
Property, Plant and Equipment [Line Items] | ||
Property and equipment | $ 681,177 | $ 594,534 |
Less: accumulated depreciation | (144,093) | (110,036) |
Property and equipment, net | 537,084 | 484,498 |
Land | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment | 49,081 | 47,565 |
Building and improvements | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment | 342,641 | 304,263 |
Equipment | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment | 181,530 | 153,170 |
Furniture and fixtures | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment | 5,244 | 6,931 |
Leasehold improvements | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment | 97,221 | 80,164 |
Construction in progress | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment | $ 5,460 | $ 2,441 |
Property and Equipment Addition
Property and Equipment Additional Disclosures (Details) $ in Thousands | Jun. 01, 2017USD ($) |
Property, Plant and Equipment, Type [Abstract] | |
Sale Leaseback Transaction, Historical Cost | $ 24,847 |
Intangible Assets - Net (Detail
Intangible Assets - Net (Details) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2017 | Dec. 31, 2016 | |
Acquired Finite-Lived Intangible Assets [Line Items] | ||
Finite-Lived Intangible Assets, Gross | $ 43,924 | $ 43,162 |
Accumulated Amortization | (11,121) | (8,086) |
Intangible assets, net | $ 32,803 | 35,076 |
Lease acquisition costs | ||
Acquired Finite-Lived Intangible Assets [Line Items] | ||
Weighted Average Life (Years) | 24 years 8 months 31 days | |
Finite-Lived Intangible Assets, Gross | $ 483 | 483 |
Accumulated Amortization | (99) | (78) |
Intangible assets, net | $ 384 | 405 |
Favorable leases | ||
Acquired Finite-Lived Intangible Assets [Line Items] | ||
Weighted Average Life (Years) | 33 years | |
Finite-Lived Intangible Assets, Gross | $ 35,116 | 35,116 |
Accumulated Amortization | (6,568) | (4,589) |
Intangible assets, net | $ 28,548 | 30,527 |
Assembled occupancy | ||
Acquired Finite-Lived Intangible Assets [Line Items] | ||
Weighted Average Life (Years) | 7 months 30 days | |
Finite-Lived Intangible Assets, Gross | $ 2,659 | 1,897 |
Accumulated Amortization | (2,631) | (1,897) |
Intangible assets, net | $ 28 | 0 |
Trade name | ||
Acquired Finite-Lived Intangible Assets [Line Items] | ||
Weighted Average Life (Years) | 30 years | |
Finite-Lived Intangible Assets, Gross | $ 733 | 733 |
Accumulated Amortization | (293) | (269) |
Intangible assets, net | $ 440 | 464 |
Customer relationships | ||
Acquired Finite-Lived Intangible Assets [Line Items] | ||
Weighted Average Life (Years) | 18 years 7 months 30 days | |
Finite-Lived Intangible Assets, Gross | $ 4,933 | 4,933 |
Accumulated Amortization | (1,530) | (1,253) |
Intangible assets, net | $ 3,403 | $ 3,680 |
Intangible Assets - Net Additio
Intangible Assets - Net Additional Disclosures (Details) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2017USD ($) | Dec. 31, 2016USD ($)Operations | Dec. 31, 2015USD ($) | |
Finite-Lived Intangible Assets [Line Items] | |||
Amortization of Intangible Assets | $ 3,035 | $ 4,634 | $ 3,824 |
Finite-Lived Intangible Assets, Gross | 43,924 | 43,162 | |
Assembled occupancy | |||
Finite-Lived Intangible Assets [Line Items] | |||
Amortization of Intangible Assets | 734 | ||
Finite-Lived Intangible Assets, Gross | $ 2,659 | 1,897 | |
Assembled occupancy | Minimum [Member] | |||
Finite-Lived Intangible Assets [Line Items] | |||
Finite-Lived Intangible Asset, Useful Life | 4 months | ||
Assembled occupancy | Maximum [Member] | |||
Finite-Lived Intangible Assets [Line Items] | |||
Finite-Lived Intangible Asset, Useful Life | 8 months | ||
Assisted Living Facility [Member] | Favorable leases | |||
Finite-Lived Intangible Assets [Line Items] | |||
Finite-Lived Intangible Assets, Gross | 7,190 | ||
Disposal Group, Disposed of by Sale, Not Discontinued Operations [Member] | Urgent Care Centers [Member] | Customer relationships | |||
Finite-Lived Intangible Assets [Line Items] | |||
Finite-Lived Intangible Assets, Gross | $ 582 | ||
Assisted Living Facility [Member] | |||
Finite-Lived Intangible Assets [Line Items] | |||
Number of Businesses Acquired | Operations | 15 |
Intangible Assets - Net Future
Intangible Assets - Net Future Amortization (Details) - USD ($) $ in Thousands | Dec. 31, 2017 | Dec. 31, 2016 |
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract] | ||
2,018 | $ 2,329 | |
2,019 | 2,301 | |
2,020 | 1,593 | |
2,021 | 1,497 | |
2,022 | 1,471 | |
Thereafter | 23,612 | |
Intangible assets, net | $ 32,803 | $ 35,076 |
Goodwill and Other Indefinite73
Goodwill and Other Indefinite-Lived Intangible Assets Goodwill Rollforward (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Goodwill [Line Items] | |||
January 1 | $ 67,100 | $ 40,886 | $ 30,269 |
Less: Dispositions | (4,103) | ||
Purchase price adjustment | (26) | ||
Additions | 13,962 | 30,343 | 10,617 |
December 31 | 81,062 | 67,100 | 40,886 |
Goodwill, Impairment Loss | 0 | 0 | 0 |
Transitional and Skilled Services Segment | |||
Goodwill [Line Items] | |||
January 1 | 40,636 | 14,221 | 14,221 |
Less: Dispositions | 0 | ||
Purchase price adjustment | 0 | ||
Additions | 4,850 | 26,415 | 0 |
December 31 | 45,486 | 40,636 | 14,221 |
Assisted and Independent Living Services Segment | |||
Goodwill [Line Items] | |||
January 1 | 3,538 | 3,538 | 1,756 |
Less: Dispositions | 0 | ||
Purchase price adjustment | 0 | ||
Additions | 420 | 0 | 1,782 |
December 31 | 3,958 | 3,538 | 3,538 |
Home Health and Hospice Services | |||
Goodwill [Line Items] | |||
January 1 | 17,901 | 16,102 | 10,929 |
Less: Dispositions | 0 | ||
Purchase price adjustment | 0 | ||
Additions | 6,421 | 1,799 | 5,173 |
December 31 | 24,322 | 17,901 | 16,102 |
All Other | |||
Goodwill [Line Items] | |||
January 1 | 5,025 | 7,025 | 3,363 |
Less: Dispositions | (4,103) | ||
Purchase price adjustment | (26) | ||
Additions | 2,271 | 2,129 | 3,662 |
December 31 | $ 7,296 | 5,025 | $ 7,025 |
Disposal Group, Disposed of by Sale, Not Discontinued Operations [Member] | All Other | |||
Goodwill [Line Items] | |||
Less: Dispositions | $ (4,103) |
Goodwill and Other Indefinite74
Goodwill and Other Indefinite-Lived Intangible Assets Indefinite-lived intangble assets (Details) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2017 | Dec. 31, 2016 | |
Indefinite-lived Intangible Assets [Line Items] | ||
Other indefinite-lived intangibles | $ 25,249 | $ 19,586 |
Home Health and Hospice Services | Trade name | ||
Indefinite-lived Intangible Assets [Line Items] | ||
Other indefinite-lived intangibles | 1,181 | 1,146 |
Indefinite-lived Intangible Assets Acquired | 35 | |
Home Health and Hospice Services | Medicare and Medicaid licenses | ||
Indefinite-lived Intangible Assets [Line Items] | ||
Other indefinite-lived intangibles | 24,068 | $ 18,440 |
Indefinite-lived Intangible Assets Acquired | 7,178 | |
Indefinite-lived Intangible Assets, Period Increase (Decrease) | $ 500 |
Restricted and Other Assets (De
Restricted and Other Assets (Details) - USD ($) $ in Thousands | Dec. 31, 2017 | Dec. 31, 2016 |
Other Assets [Abstract] | ||
Debt issuance costs, net | $ 2,799 | $ 3,611 |
Long-term insurance losses recoverable asset | 5,394 | 4,104 |
Deposits with landlords | 5,981 | 3,526 |
Capital improvement reserves with landlords and lenders | 2,327 | 673 |
Note receivable from sale of urgent care centers | 0 | 700 |
Restricted and other assets | $ 16,501 | $ 12,614 |
Other Accrued Liabilities (Deta
Other Accrued Liabilities (Details) - USD ($) $ in Thousands | Dec. 31, 2017 | Dec. 31, 2016 |
Accrued Liabilities [Abstract] | ||
Quality assurance fee | $ 4,864 | $ 4,604 |
Refunds payable | 21,661 | 18,368 |
Deferred revenue | 7,066 | 6,994 |
Cash held in trust for patients | 2,609 | 2,373 |
Resident deposits | 6,574 | 6,099 |
Dividends payable | 2,328 | 2,186 |
Property taxes | 10,088 | 9,130 |
Income tax payable | 0 | 1,182 |
Operational closure liability | 910 | 1,972 |
Other | 7,715 | 5,855 |
Other accrued liabilities | $ 63,815 | $ 58,763 |
Income Taxes Expense (Details)
Income Taxes Expense (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Income Tax Disclosure [Abstract] | |||
Current Federal | $ 15,141 | $ 30,043 | $ 28,149 |
Current State | 2,975 | 5,183 | 5,761 |
Current Income Tax Expense | 18,116 | 35,226 | 33,910 |
Deferred Federal | 5,428 | (1,034) | 2,026 |
Deferred State | 986 | (1,217) | (754) |
Deferred income taxes | 6,414 | (2,251) | 1,272 |
Adjustment to deferred taxes for tax rate change | 3,915 | 0 | 0 |
Provision for income taxes | $ 28,445 | $ 32,975 | $ 35,182 |
Income Taxes Rate Reconciliatio
Income Taxes Rate Reconciliation (Details) | 12 Months Ended | ||
Dec. 31, 2017Rate | Dec. 31, 2016Rate | Dec. 31, 2015Rate | |
Income tax expense at statutory rate | 35.00% | 35.00% | 35.00% |
State income taxes - net of federal benefit | 3.10% | 3.00% | 3.60% |
Non-deductible expenses | 1.70% | 0.90% | 0.60% |
Equity compensation | (4.50%) | 0.00% | 0.00% |
Revaluation of deferred | 5.70% | 0.00% | 0.00% |
Other adjustments | 0.10% | (0.50%) | (0.60%) |
Total income tax provision | 41.10% | 38.40% | 38.60% |
Income Taxes Deferred (Details)
Income Taxes Deferred (Details) - USD ($) $ in Thousands | Dec. 31, 2017 | Dec. 31, 2016 |
Income Tax Disclosure [Abstract] | ||
Accrued expenses | $ 16,500 | $ 21,732 |
Allowance for doubtful accounts | 11,090 | 15,956 |
Tax credits | 3,334 | 3,461 |
Insurance | 5,135 | 7,333 |
Deferred tax assets | 36,059 | 48,482 |
Valuation allowance | (530) | 0 |
Deferred Tax Assets, Net of Valuation Allowance | 35,529 | 48,482 |
State taxes | (911) | (1,023) |
Depreciation and amortization | (18,248) | (20,643) |
Prepaid expenses | (3,625) | (3,743) |
Total deferred tax liabilities | (22,784) | (25,409) |
Net deferred tax assets | $ 12,745 | $ 23,073 |
Income Taxes Other Disclosures
Income Taxes Other Disclosures (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Operating Loss Carryforwards [Line Items] | |||
Increase (Decrease) in Deferred Tax Asset | $ 17,995 | ||
Increase (Decrease) in Deferred Tax Liability | 14,080 | ||
Adjustment to deferred taxes for tax rate change | 3,915 | $ 0 | $ 0 |
Deferred Tax Assets, Tax Credit Carryforwards, General Business | 3,302 | 3,430 | |
Valuation Allowance, Deferred Tax Asset, Increase (Decrease), Amount | 530 | ||
Unrecognized Tax Benefits that Would Impact Effective Tax Rate | $ 0 | $ 0 | $ 0 |
Debt (Details)
Debt (Details) - USD ($) $ in Thousands | Dec. 31, 2017 | Dec. 31, 2016 |
Debt Instrument [Line Items] | ||
Long-term Debt, Gross | $ 316,019 | $ 284,157 |
Current maturities of long-term debt | (9,939) | (8,129) |
Long Term Debt, net of Current Maturities and Debt Discount | 302,990 | 275,486 |
SunTrust Bank [Member] | Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Credit facility with SunTrust | 50,000 | 122,000 |
Second Amended Credit Facility [Member] | SunTrust Bank [Member] | Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Term loan with SunTrust, interest payable quarterly | 140,625 | 148,125 |
Less: debt issuance costs | (3,090) | (542) |
Collateralized Debt Obligations [Member] | Notes Payable, Other Payables [Member] | ||
Debt Instrument [Line Items] | ||
Mortgage loans and promissory note, principal and interest payable monthly, interest at fixed rate | $ 125,394 | $ 14,032 |
Debt Additional Disclosures (De
Debt Additional Disclosures (Details) $ in Thousands | Feb. 05, 2016USD ($)Rate | May 30, 2014USD ($)Rate | Feb. 02, 2018USD ($) | Dec. 31, 2017USD ($) | Dec. 31, 2016USD ($) | Jul. 19, 2016USD ($)Rate |
Secured Debt [Member] | Senior Debt Obligations [Member] | ||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||
Increase in Letters of Credit | $ 3,994 | |||||
Pledged Financial Instruments, Not Separately Reported, Securities for Letter of Credit Facilities | 6,304 | |||||
SunTrust Bank [Member] | Revolving Credit Facility [Member] | ||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||
Credit facility with SunTrust | 50,000 | $ 122,000 | ||||
Line of Credit Facility, Current Borrowing Capacity | $ 250,000 | $ 150,000 | ||||
Line of Credit Facility, Maximum Borrowing Capacity | $ 150,000 | $ 75,000 | ||||
Total Net Debt Ratio, Maximum | 3.50 | |||||
Total Net Debt Ratio, Minimum | 1.50 | |||||
EBITDA Ratio, Maximum | 1 | |||||
EBITDA Ratio, Minimum | 1 | |||||
Total Net Debt Ratio, Default | 2.75 | |||||
EBITDA Ratio, Default | 1 | |||||
Aggregate Revolving Commitment Percentage | Rate | 10.00% | |||||
Total Net Debt Ratio, Cured | 2.75 | |||||
EBITDA Ratio, Cured | 1 | |||||
SunTrust Bank [Member] | Revolving Credit Facility [Member] | Second Amended Credit Facility [Member] | ||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||
Term Loan, Amount Outstanding, Current | 7,500 | |||||
Term Loan, Amount Outstanding, Noncurrent | 133,125 | |||||
Line of Credit Facility, Current Borrowing Capacity | $ 450,000 | |||||
Long-term Line of Credit | 300,000 | |||||
Term Loan, Borrowing Capacity | $ 150,000 | |||||
Line of Credit Facility, Interest Rate at Period End | Rate | 5.00% | |||||
Term loan with SunTrust, interest payable quarterly | 140,625 | $ 148,125 | ||||
Term Loan and Line of Credit Facility, Amount Outstanding | $ 190,625 | |||||
SunTrust Bank [Member] | Revolving Credit Facility [Member] | Subsequent Event [Member] | Second Amended Credit Facility [Member] | ||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||
Term Loan and Line of Credit Facility, Amount Outstanding | $ 195,625 | |||||
SunTrust Bank [Member] | Revolving Credit Facility [Member] | Minimum [Member] | ||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||
Line of Credit Facility, Interest Rate, Additional Margin | Rate | 0.75% | 1.25% | ||||
Line of Credit Facility, Interest Rate, LIBOR | Rate | 1.75% | 2.25% | ||||
Line of Credit Facility, Unused Capacity, Commitment Fee Percentage | Rate | 0.30% | 0.30% | ||||
SunTrust Bank [Member] | Revolving Credit Facility [Member] | Maximum [Member] | ||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||
Line of Credit Facility, Interest Rate, Additional Margin | Rate | 1.75% | 2.25% | ||||
Line of Credit Facility, Interest Rate, LIBOR | Rate | 2.75% | 3.25% | ||||
Line of Credit Facility, Unused Capacity, Commitment Fee Percentage | Rate | 0.50% | 0.50% |
Debt Other Additional Disclosur
Debt Other Additional Disclosures (Details) - Collateralized Debt Obligations [Member] $ in Thousands | Dec. 31, 2014 | Dec. 27, 2017USD ($)facilitiesRate | Dec. 31, 2017USD ($) | Dec. 31, 2016USD ($) | Dec. 31, 2015Rate |
Mortgages [Member] | |||||
Debt Instrument [Line Items] | |||||
Number of Operating Subsidiaries | facilities | 17 | ||||
Prepayment Penalty Reduced Rate During First Three Years | 10.00% | ||||
Prepayment Penalty Reduced Rate During the Fourth Year | 3.00% | ||||
Prepayment Penalty Reduced Rate for the Fifth through Tenth Years | 1.00% | ||||
Prepayment penalty reduced rate | 1.00% | ||||
Notes Payable | $ | $ 112,000 | ||||
Mortgages [Member] | Minimum [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt Instrument, pre-payment fee reduction, term | 3 years | 5 years | |||
Debt Instrument, Term | 12 years | 30 years | |||
Mortgages [Member] | Maximum [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt Instrument, pre-payment fee reduction, term | 11 years | 10 years | |||
Debt Instrument, Term | 33 years | 35 years | |||
Notes Payable, Other Payables [Member] | |||||
Debt Instrument [Line Items] | |||||
Notes Payable | $ | $ 125,394 | $ 14,032 | |||
Notes Payable, Current | $ | 2,439 | ||||
Notes Payable, Noncurrent | $ | $ 122,955 | ||||
Notes Payable to Banks [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt Instrument, Interest Rate, Stated Percentage | 3.30% | ||||
Notes Payable to Banks [Member] | Minimum [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt Instrument, Interest Rate, Stated Percentage | 2.60% | ||||
Notes Payable to Banks [Member] | Maximum [Member] | |||||
Debt Instrument [Line Items] | |||||
Debt Instrument, Interest Rate, Stated Percentage | 5.30% |
Debt Future Principal Obligatio
Debt Future Principal Obligations (Details) $ in Thousands | Dec. 31, 2017USD ($) |
Debt Disclosure [Abstract] | |
2,018 | $ 9,939 |
2,019 | 10,106 |
2,020 | 10,203 |
2,021 | 170,926 |
2,022 | 2,904 |
Thereafter | 111,941 |
Long-term Debt | $ 316,019 |
Options and Awards Lead Paragra
Options and Awards Lead Paragraphs (Details) | May 25, 2017shares | Nov. 08, 2007Rateshares | Dec. 31, 2017Rateshares | Dec. 31, 2016shares | Dec. 31, 2015shares |
Stock Issued or Granted During Period, Share-based Compensation [Abstract] | |||||
Award Vesting Period | 5 years | ||||
Estimated Forfeiture Rate | Rate | 9.73% | ||||
Options Granted | 481,000 | 497,000 | 637,000 | ||
Nonvested Restricted Awards, Granted | 173,000 | 299,000 | 323,000 | ||
2017 Plan [Member] [Member] | |||||
Stock Issued or Granted During Period, Share-based Compensation [Abstract] | |||||
Number of Shares Available for Grant | 6,277,000 | ||||
Number of Shares Authorized | 6,881,000 | ||||
Conversion to Reduce Shares Availability | 1 | ||||
Other than Options, Conversion to Reduce Shares Availability | 2.5 | ||||
Award Vesting Period | 5 years | ||||
Award Vesting Rights, Percentage | 20.00% | ||||
Expiration Period | 10 years | ||||
2007 Plan [Member] | |||||
Stock Issued or Granted During Period, Share-based Compensation [Abstract] | |||||
Number of Shares Authorized | 2,000,000 | ||||
Share-based Compensation Arrangement by Share-based Payment Award, Number of Additional Shares Authorized | 1,000 | ||||
Share-based Compensation Arrangement by Share-based Payment Award, Percentage of Additional Shares Authorized | Rate | 2.00% | ||||
Award Vesting Period | 5 years | ||||
Award Vesting Rights, Percentage | 20.00% | ||||
Expiration Period | 10 years | ||||
Options Granted | 156,000 | ||||
Nonvested Restricted Awards, Granted | 61,000 | ||||
Director [Member] | 2017 Plan [Member] [Member] | |||||
Stock Issued or Granted During Period, Share-based Compensation [Abstract] | |||||
Award Vesting Period | 3 years | ||||
Award Requisite Service Period | 3 years | ||||
Director [Member] | 2007 Plan [Member] | |||||
Stock Issued or Granted During Period, Share-based Compensation [Abstract] | |||||
Award Vesting Period | 3 years | ||||
Award Requisite Service Period | 3 years |
Options and Awards Valuation As
Options and Awards Valuation Assumptions (Details) - shares shares in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Fair Value Assumptions and Methodology | |||
Options Granted | 481 | 497 | 637 |
Weighted Average Risk-Free Rate | 2.00% | 1.40% | 1.70% |
Expected Life | 6 years 2 months | 6 years 4 months | 6 years 6 months |
Weighted Average Volatility | 35.20% | 37.80% | 39.50% |
Weighted Average Dividend Yield | 0.80% | 0.80% | 0.60% |
Options and Awards Exercise Pri
Options and Awards Exercise Price and Fair Value (Details) - $ / shares shares in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Net of Forfeitures [Abstract] | |||
Options Granted | 481 | 497 | 637 |
Weighted Average Exercise Price | $ 20.31 | $ 19.43 | $ 23.27 |
Weighted Average Fair Value of Options | 7 | 7 | 9.08 |
Intrinsic Value of Options Granted on Grant Date [Abstract] | |||
Grant Date Intrinsic Value | $ 0 | $ 0 | $ 0 |
Options and Awards Options Outs
Options and Awards Options Outstanding Rollforward (Details) - $ / shares shares in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Options outstanding January 1, | 5,176 | 5,448 | 5,532 |
Weighted average exercise price January 1, | $ 11.62 | $ 10.36 | $ 8.51 |
Options vested January 1, | 2,704 | 2,526 | 2,218 |
Weighted Average Exercise Price of Options Vested January 1, | $ 8.18 | $ 6.35 | $ 4.70 |
Options Granted | 481 | 497 | 637 |
Weighted Average Exercise Price, Options Granted | $ 20.31 | $ 19.43 | $ 23.27 |
Options Forfeited in Period | (178) | (127) | (233) |
Weighted Average Exercise Price, Options Forfeited in Period | $ 15.82 | $ 14.46 | $ 12.55 |
Options Exercised in Period | (740) | (642) | (488) |
Weighted Average Exercise Price, Options Exercised in Period | $ 6.93 | $ 6.47 | $ 5.20 |
Options outstanding December 31, | 4,739 | 5,176 | 5,448 |
Weighted average exercise price December 31, | $ 13.08 | $ 11.62 | $ 10.36 |
Options vested December 31, | 2,776 | 2,704 | 2,526 |
Weighted Average Exercise Price of Options Vested December 31, | $ 10.07 | $ 8.18 | $ 6.35 |
Options and Awards Options Ou89
Options and Awards Options Outstanding by Exercise Price (Details) $ / shares in Units, shares in Thousands, $ in Thousands | 12 Months Ended |
Dec. 31, 2017USD ($)$ / sharesshares | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Number of Outstanding Options | 4,739 |
Black-Scholes Fair Value | $ | $ 25,779 |
Stock Options Vested and Exercisable | 2,776 |
2,008 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 2.56 |
Exercise Price, Upper Range Limit | $ / shares | $ 4.06 |
Number of Outstanding Options | 185 |
Black-Scholes Fair Value | $ | $ 292 |
Remaining Contractual Life (Years) | 1 year |
Stock Options Vested and Exercisable | 185 |
2,009 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 4.06 |
Exercise Price, Upper Range Limit | $ / shares | $ 4.56 |
Number of Outstanding Options | 420 |
Black-Scholes Fair Value | $ | $ 907 |
Remaining Contractual Life (Years) | 2 years |
Stock Options Vested and Exercisable | 420 |
2,010 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 4.77 |
Exercise Price, Upper Range Limit | $ / shares | $ 4.96 |
Number of Outstanding Options | 116 |
Black-Scholes Fair Value | $ | $ 281 |
Remaining Contractual Life (Years) | 3 years |
Stock Options Vested and Exercisable | 116 |
2,011 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 5.90 |
Exercise Price, Upper Range Limit | $ / shares | $ 7.99 |
Number of Outstanding Options | 134 |
Black-Scholes Fair Value | $ | $ 454 |
Remaining Contractual Life (Years) | 4 years |
Stock Options Vested and Exercisable | 134 |
2,012 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 6.56 |
Exercise Price, Upper Range Limit | $ / shares | $ 7.96 |
Number of Outstanding Options | 435 |
Black-Scholes Fair Value | $ | $ 1,603 |
Remaining Contractual Life (Years) | 5 years |
Stock Options Vested and Exercisable | 435 |
2,013 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 7.98 |
Exercise Price, Upper Range Limit | $ / shares | $ 11.49 |
Number of Outstanding Options | 522 |
Black-Scholes Fair Value | $ | $ 2,539 |
Remaining Contractual Life (Years) | 6 years |
Stock Options Vested and Exercisable | 390 |
2,014 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 10.55 |
Exercise Price, Upper Range Limit | $ / shares | $ 18.94 |
Number of Outstanding Options | 1,458 |
Black-Scholes Fair Value | $ | $ 8,272 |
Remaining Contractual Life (Years) | 7 years |
Stock Options Vested and Exercisable | 789 |
2,015 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 21.47 |
Exercise Price, Upper Range Limit | $ / shares | $ 25.24 |
Number of Outstanding Options | 549 |
Black-Scholes Fair Value | $ | $ 5,000 |
Remaining Contractual Life (Years) | 8 years |
Stock Options Vested and Exercisable | 219 |
2,016 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 18.79 |
Exercise Price, Upper Range Limit | $ / shares | $ 19.89 |
Number of Outstanding Options | 450 |
Black-Scholes Fair Value | $ | $ 3,140 |
Remaining Contractual Life (Years) | 9 years |
Stock Options Vested and Exercisable | 88 |
2,017 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 18.64 |
Exercise Price, Upper Range Limit | $ / shares | $ 22.90 |
Number of Outstanding Options | 470 |
Black-Scholes Fair Value | $ | $ 3,291 |
Remaining Contractual Life (Years) | 10 years |
Stock Options Vested and Exercisable | 0 |
Options and Awards Restricted A
Options and Awards Restricted Awards Granted (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Restricted awards granted [Line Items] | |||
Restricted Awards Grant Date Fair Value Range, Minimum | $ 18.47 | $ 18.79 | $ 21 |
Restricted Awards Grant Date Fair Value Range, Maximum | $ 22.90 | $ 23.23 | $ 26.55 |
Share-based Compensation, Restricted Awards, Exercise Price | $ 0 | ||
Issuance of restricted stock to employees (in shares) | 173 | 299 | 323 |
Award Vesting Period | 5 years | ||
Director [Member] | |||
Restricted awards granted [Line Items] | |||
Restricted Awards Grant Date Fair Value Range, Minimum | $ 18.47 | ||
Restricted Awards Grant Date Fair Value Range, Maximum | $ 21.96 | ||
Options Granted to Non-employee Directors | 30 |
Options and Awards Restricted91
Options and Awards Restricted Award Rollforward (Details) - $ / shares shares in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Restricted Stock Rollforward [Line Items] | |||
Nonvested Restricted Awards, Nonvested at January 1, | 429 | 425 | 366 |
Weighted Average Grant Date Fair Value, Nonvested at January 1, | $ 20.42 | $ 19.79 | $ 15.15 |
Nonvested Restricted Awards, Granted | 173 | 299 | 323 |
Weighted Average Grant Date Fair Value, Restricted Awards Granted in the Period | $ 20.21 | $ 20.55 | $ 22.99 |
Nonvested Restricted Awards, Vested in the Period | (195) | (279) | (234) |
Weighted Average Grant Date Fair Value, Restricted Awards Vested in the Period | $ 19.79 | $ 19.58 | $ 17.36 |
Nonvested Restricted Awards, Forfeited in the Period | (24) | (16) | (30) |
Weighted Average Grant Date Fair Value, Restricted Awards Forfeited in the Period | $ 20.34 | $ 20.85 | $ 16.81 |
Nonvested Restricted Awards, Nonvested at December 31, | 383 | 429 | 425 |
Weighted Average Grant Date Fair Value, Nonvested at December 31, | $ 20.65 | $ 20.42 | $ 19.79 |
Options and Awards Compensation
Options and Awards Compensation Expense (Details) - USD ($) shares in Thousands, $ in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items] | |||
Share-based compensation expense | $ 8,331 | $ 7,776 | $ 6,677 |
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized [Abstract] | |||
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Remaining Contractual Term | 5 years 8 months | ||
Stock Options | |||
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items] | |||
Share-based compensation expense | $ 4,773 | 4,793 | 4,164 |
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized [Abstract] | |||
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized | $ 11,063 | ||
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized, Period for Recognition | 2 years 9 months 40 days | ||
Employee Service Share-based Compensation, Nonvested Awards | 1,963 | ||
Share-based Compensation Arrangement by Share-based Payment Award, Options, Expected to Vest, Number | 1,864 | ||
Restricted Stock Awards | |||
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items] | |||
Share-based compensation expense | $ 2,322 | 2,371 | 1,931 |
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized [Abstract] | |||
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized | $ 6,916 | ||
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized, Period for Recognition | 3 years 4 months 15 days | ||
Stock awards | |||
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items] | |||
Share-based compensation expense | $ 1,236 | $ 612 | $ 582 |
Options and Awards Intrinsic Va
Options and Awards Intrinsic Values (Details) - Stock Options - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Outstanding | $ 44,060 | $ 55,610 | $ 67,508 |
Vested | 33,976 | 38,101 | 41,128 |
Expected to Vest | 9,311 | 15,983 | 23,508 |
Exercised | $ 10,481 | $ 9,199 | $ 8,709 |
Options and Awards Subsidiary E
Options and Awards Subsidiary Equity Plan (Details) - USD ($) shares in Thousands, $ in Thousands | 12 Months Ended | ||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Award Vesting Period | 5 years | ||
Employee stock award compensation | $ 8,331 | $ 7,776 | $ 6,677 |
Subsidiaries [Member] | Subsidiaries Stock awards [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Award Vesting Period | 5 years | ||
Employee stock award compensation | $ 1,364 | $ 1,325 | $ 0 |
Common Stock Required to Settle Subsidiary Shares | 264 | 212 | 0 |
Leases (Details)
Leases (Details) $ in Thousands | Jun. 01, 2014facilitiesRenewals | Dec. 31, 2017USD ($)facilitiesRenewals | Dec. 31, 2016USD ($) | Dec. 31, 2015USD ($) |
Operating Leased Assets [Line Items] | ||||
Operating Leases, Rent Expense | $ | $ 132,932 | $ 125,221 | $ 89,264 | |
Facilities under Master Lease Arrangement | 25 | |||
Master Lease Agreements | 6 | |||
Various Landlords [Member] [Member] | ||||
Operating Leased Assets [Line Items] | ||||
Lessee, Operating Lease, Term of Contract | 15 years | |||
Lessee Leasing Arrangements, Operating Leases, Number of Renewal Terms | Renewals | 2 | |||
Lessee, Operating Lease, Renewal Term | 5 years | |||
CareTrust REIT [Member] | ||||
Operating Leased Assets [Line Items] | ||||
Skilled Nursing, Assisted Living and Independent Living Facilities | 92 | |||
Operating Leases of Lessee, Contingent Rentals, Description of Variable Rate Basis | 0.025 | |||
Payments for Rent | $ | $ 57,169 | $ 56,271 | $ 56,000 | |
Lessee, Operating Lease, Renewal Term | 5 years | |||
Master Lease Agreements | 8 | |||
Minimum [Member] | Various Landlords [Member] [Member] | ||||
Operating Leased Assets [Line Items] | ||||
Lessee, Operating Lease, Term of Contract | 5 years | |||
Average Term of Non-Cancellable Equipment Leases | 3 years | |||
Minimum [Member] | CareTrust REIT [Member] | ||||
Operating Leased Assets [Line Items] | ||||
Lessee, Operating Lease, Term of Contract | 12 years | |||
Lessee Leasing Arrangements, Operating Leases, Number of Renewal Terms | Renewals | 2 | |||
Maximum [Member] | Various Landlords [Member] [Member] | ||||
Operating Leased Assets [Line Items] | ||||
Lessee, Operating Lease, Term of Contract | 20 years | |||
Average Term of Non-Cancellable Equipment Leases | 5 years | |||
Maximum [Member] | CareTrust REIT [Member] | ||||
Operating Leased Assets [Line Items] | ||||
Lessee, Operating Lease, Term of Contract | 19 years | |||
Lessee Leasing Arrangements, Operating Leases, Number of Renewal Terms | Renewals | 3 |
Leases Additional Disclosures (
Leases Additional Disclosures (Details) $ in Thousands | 3 Months Ended | 12 Months Ended | ||
Jun. 30, 2017USD ($) | Dec. 31, 2017USD ($)facilities | Dec. 31, 2016USD ($)facilities | Dec. 31, 2015USD ($) | |
Operating Leased Assets [Line Items] | ||||
Gain (Loss) on Contract Termination | $ 2,715 | $ 6,512 | $ 0 | |
Business Exit Costs | $ 2,321 | $ (11,225) | 0 | |
Skilled Nursing, Assisted Living and Independent Living Facilities [Member] | ||||
Operating Leased Assets [Line Items] | ||||
Number of Businesses with Lease Terminations | facilities | 4 | |||
8051 Services, Skilled Nursing Care Facilities [Member] | ||||
Operating Leased Assets [Line Items] | ||||
Number of Businesses with Lease Terminations | facilities | 1 | |||
Disposal Group, Disposed of by Means Other than Sale, Not Discontinued Operations [Member] | 8051 Services, Skilled Nursing Care Facilities [Member] | ||||
Operating Leased Assets [Line Items] | ||||
Number of Businesses Closed | facilities | 1 | 1 | ||
Facility Closing [Member] | ||||
Operating Leased Assets [Line Items] | ||||
Business Exit Costs | $ (1,286) | $ 2,830 | $ 7,935 | $ 0 |
Contract Termination [Member] | ||||
Operating Leased Assets [Line Items] | ||||
Business Exit Costs | $ 1,187 |
Leases Sale Leaseback Transacti
Leases Sale Leaseback Transactions (Details) $ in Thousands | Jun. 01, 2017USD ($) |
Sale Leaseback Transaction [Line Items] | |
Sale Leaseback Transaction, Lease Terms | 20 |
Sale Leaseback Transaction, Gross Proceeds, Investing Activities | $ 38,000 |
Sale Leaseback Transaction, Historical Cost | 24,847 |
Sale Leaseback Transaction, Current Period Gain Recognized | $ 13,153 |
Number of Optional Lease Extension [Member] [Member] | |
Sale Leaseback Transaction [Line Items] | |
Sale Leaseback Transaction, Lease Terms | 3 |
Optional Lease Extension [Member] | |
Sale Leaseback Transaction [Line Items] | |
Sale Leaseback Transaction, Lease Terms | 5 |
8051 Services, Skilled Nursing Care Facilities [Member] | |
Sale Leaseback Transaction [Line Items] | |
Sale Leaseback Transaction, Description of Asset(s) | 2 |
Assisted Living Facility [Member] | |
Sale Leaseback Transaction [Line Items] | |
Sale Leaseback Transaction, Description of Asset(s) | 1 |
Leases Future minimum lease pay
Leases Future minimum lease payments (Details) $ in Thousands | Dec. 31, 2017USD ($) |
Leases [Abstract] | |
2,018 | $ 135,841 |
2,019 | 135,395 |
2,020 | 135,149 |
2,021 | 134,942 |
2,022 | 133,446 |
Thereafter | 1,080,348 |
Operating Leases, Future Minimum Payments Due | $ 1,755,121 |
Self-Insurance Reserves (Detail
Self-Insurance Reserves (Details) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2017 | Dec. 31, 2016 | |
Schedule of Self-Insurance Reserves [Line Items] | ||
Balance January 1, | $ 65,351 | $ 56,003 |
Current year provisions | 89,394 | 74,187 |
Claims paid and direct expenses | (83,300) | (66,062) |
Change in long-term insurance losses recoverable | 1,291 | 1,223 |
Balance December 31, | 72,736 | 65,351 |
Professional Malpractice Liability Insurance [Member] | ||
Schedule of Self-Insurance Reserves [Line Items] | ||
Balance January 1, | 36,310 | 30,710 |
Current year provisions | 20,396 | 23,149 |
Claims paid and direct expenses | (16,133) | (18,186) |
Change in long-term insurance losses recoverable | 361 | 637 |
Balance December 31, | 40,934 | 36,310 |
Workers' Compensation [Member] | ||
Schedule of Self-Insurance Reserves [Line Items] | ||
Balance January 1, | 23,402 | 20,219 |
Current year provisions | 15,202 | 12,887 |
Claims paid and direct expenses | (12,455) | (10,290) |
Change in long-term insurance losses recoverable | 930 | 586 |
Balance December 31, | 27,079 | 23,402 |
Health Insurance Product Line [Member] | ||
Schedule of Self-Insurance Reserves [Line Items] | ||
Balance January 1, | 5,639 | 5,074 |
Current year provisions | 53,796 | 38,151 |
Claims paid and direct expenses | (54,712) | (37,586) |
Change in long-term insurance losses recoverable | 0 | 0 |
Balance December 31, | $ 4,723 | $ 5,639 |
Commitments and Contingencies L
Commitments and Contingencies Litigation (Details) $ in Thousands | 12 Months Ended |
Dec. 31, 2017USD ($) | |
Litigation [Line Items] | |
Litigation Settlement, Amount Awarded to Other Party | $ 11,000 |
Commitments and Contingencies M
Commitments and Contingencies Medicare Revenue Recoupments (Details) | 12 Months Ended |
Dec. 31, 2017facilities | |
Medicare Probe Reviews [Abstract] | |
Facilities under Medicare Probe Reviews | 7 |
Commitments and Contingencies O
Commitments and Contingencies Other Matters (Details) $ in Thousands | 12 Months Ended |
Dec. 31, 2013USD ($) | |
Other Commitments [Line Items] | |
Litigation Settlement Paid to U.S. Government | $ 48,000 |
Commitments and Contingencies C
Commitments and Contingencies Concentrations (Details) | 12 Months Ended | ||
Dec. 31, 2017Rate | Dec. 31, 2016Rate | Dec. 31, 2015Rate | |
Concentration Risk [Line Items] | |||
% of Revenue | 100.00% | 100.00% | 100.00% |
Total Medicaid and Medicare | |||
Concentration Risk [Line Items] | |||
Accounts receivable by payor as a percent of total accounts receivable | 56.70% | 58.60% | |
% of Revenue | 68.40% | 67.80% | 69.10% |
Commitments and Contingencie104
Commitments and Contingencies Cash in Excess of FDIC Limits (Details) - USD ($) $ in Thousands | Feb. 02, 2018 | Dec. 31, 2017 |
Cash in Excess of FDIC limits [Line Items] | ||
Cash, FDIC Insured Amount | $ 250 | |
Subsequent Event [Member] | ||
Cash in Excess of FDIC limits [Line Items] | ||
Cash, Uninsured Amount | $ 965 |
Divestitures (Details)
Divestitures (Details) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2017USD ($) | Dec. 31, 2016USD ($)Centers | Dec. 31, 2015USD ($) | |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | |||
Gain (Loss) on Disposition of Business | $ 0 | $ 19,160 | $ 0 |
Disposal Group, Disposed of by Sale, Not Discontinued Operations [Member] | |||
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | |||
Urgent Care Centers Operated | Centers | 17 | ||
Sale Price from Divestiture of Businesses | $ 41,492 | ||
Gain (Loss) on Disposition of Business | $ 19,160 |
Defined Contribution Plan (Deta
Defined Contribution Plan (Details) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2006 | |
Defined Contribution Plan [Abstract] | ||||
Defined Contribution Plan, Maximum Annual Contributions Per Employee, Percent | 15.00% | 90.00% | ||
Defined Contribution Plan, Employer Discretionary Contribution Amount | $ 1,028 | $ 862 | $ 682 |