DEI_Info_Cover_Page_Document
DEI Info Cover Page Document (USD $) | 12 Months Ended | ||
Dec. 31, 2013 | Feb. 10, 2014 | Jun. 30, 2013 | |
Entity Information [Abstract] | ' | ' | ' |
Entity Registrant Name | 'ENSIGN GROUP, INC | ' | ' |
Entity Central Index Key | '0001125376 | ' | ' |
Current Fiscal Year End Date | '--12-31 | ' | ' |
Entity Filer Category | 'Accelerated Filer | ' | ' |
Document Type | '10-K | ' | ' |
Document Period End Date | 31-Dec-13 | ' | ' |
Document Fiscal Year Focus | '2013 | ' | ' |
Document Fiscal Period Focus | 'FY | ' | ' |
Amendment Flag | 'false | ' | ' |
Entity Common Stock, Shares Outstanding | ' | 22,163,855 | ' |
Entity Well-known Seasoned Issuer | 'No | ' | ' |
Entity Voluntary Filers | 'No | ' | ' |
Entity Current Reporting Status | 'Yes | ' | ' |
Entity Public Float | ' | ' | $687,300,000 |
Consolidated_Balance_Sheets
Consolidated Balance Sheets (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Thousands, unless otherwise specified | ||
Current assets: | ' | ' |
Cash and cash equivalents | $65,755 | $40,685 |
Accounts receivable—less allowance for doubtful accounts of $16,540 and $13,811 at December 31, 2013 and 2012, respectively | 111,370 | 94,187 |
Investments—current | 5,511 | 5,195 |
Prepaid income taxes | 9,915 | 3,787 |
Prepaid expenses and other current assets | 9,213 | 8,606 |
Deferred tax asset—current | 9,232 | 14,871 |
Assets held for sale—current (Note 4) | 0 | 268 |
Total current assets | 210,996 | 167,599 |
Property and equipment, net | 479,770 | 447,855 |
Insurance subsidiary deposits and investments | 16,888 | 17,315 |
Escrow deposits | 1,000 | 4,635 |
Deferred tax asset | 4,464 | 2,234 |
Restricted and other assets | 9,804 | 8,640 |
Intangible assets, net | 5,718 | 6,115 |
Long-term assets held for sale (Note 4) | 0 | 11,324 |
Goodwill | 23,935 | 21,557 |
Other indefinite-lived intangibles | 7,740 | 3,588 |
Total assets | 760,315 | 690,862 |
Current liabilities: | ' | ' |
Accounts payable | 23,793 | 26,069 |
Accrued charge related to U.S. Government inquiry (Note 19) | 0 | 15,000 |
Accrued wages and related liabilities | 40,093 | 35,847 |
Accrued self-insurance liabilities—current | 15,461 | 16,034 |
Liabilities held for sale—current (Note 4) | 0 | 339 |
Other accrued liabilities | 25,698 | 20,871 |
Current maturities of long-term debt | 7,411 | 7,187 |
Total current liabilities | 112,456 | 121,347 |
Long-term debt—less current maturities | 251,895 | 200,505 |
Accrued self-insurance liabilities—less current portion | 33,642 | 34,849 |
Fair value of interest rate swap | 1,828 | 2,866 |
Long-term liabilities held for sale (Note 4) | 0 | 130 |
Deferred rent and other long-term liabilities | 3,237 | 3,281 |
Total liabilities | 403,058 | 362,978 |
Commitments and contingencies (Note 19) | ' | ' |
Equity: | ' | ' |
Common stock; $0.001 par value; 75,000 shares authorized; 22,580 and 22,113 shares issued and outstanding at December 31, 2013, respectively, and 22,244 and 21,719 shares issued and outstanding at December 31, 2012, respectively | 22 | 22 |
Additional paid-in capital | 101,364 | 90,949 |
Retained earnings | 257,502 | 239,344 |
Common stock in treasury, at cost, 237 and 301 shares at December 31, 2013 and 2012, respectively | -1,680 | -2,099 |
Accumulated other comprehensive loss | -1,112 | -1,745 |
Total Ensign Group, Inc. stockholders’ equity | 356,096 | 326,471 |
Non-controlling interest | 1,161 | 1,413 |
Total equity | 357,257 | 327,884 |
Total liabilities and equity | $760,315 | $690,862 |
Consolidated_Balance_Sheets_Ba
Consolidated Balance Sheets Balance Sheet Paranthetical (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Thousands, except Per Share data, unless otherwise specified | ||
Current assets: | ' | ' |
Allowance for doubtful accounts | $16,540 | $13,811 |
Equity: | ' | ' |
Common stock, par value | $0.00 | $0.00 |
Common stock, shares authorized | 75,000 | 75,000 |
Common stock, shares issued | 22,580 | 22,244 |
Common stock, shares outstanding | 22,113 | 21,719 |
Common stock in treasury, at cost | 237 | 301 |
Consolidated_Statements_of_Inc
Consolidated Statements of Income (USD $) | 12 Months Ended | ||
In Thousands, except Per Share data, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Revenue | $904,556 | $823,155 | $758,277 |
Expense: | ' | ' | ' |
Cost of services (exclusive of facility rent, general and administrative and depreciation and amortization expenses shown separately below) | 725,989 | 656,424 | 600,804 |
U.S. Government inquiry settlement (Note 19) | 33,000 | 15,000 | 0 |
Facility rent—cost of services | 13,613 | 13,281 | 13,725 |
General and administrative expense | 40,103 | 31,819 | 29,766 |
Depreciation and amortization | 33,909 | 28,358 | 23,286 |
Total expenses | 846,614 | 744,882 | 667,581 |
Income from operations | 57,942 | 78,273 | 90,696 |
Other income (expense): | ' | ' | ' |
Interest expense | -12,787 | -12,229 | -13,778 |
Interest income | 506 | 255 | 249 |
Other expense, net | -12,281 | -11,974 | -13,529 |
Income before provision for income taxes | 45,661 | 66,299 | 77,167 |
Provision for income taxes | 20,003 | 25,134 | 29,492 |
Income from continuing operations | 25,658 | 41,165 | 47,675 |
(Loss) income from discontinued operations, net of income tax benefit | -1,804 | -1,357 | 0 |
Net income | 23,854 | 39,808 | 47,675 |
Less: net income (loss) attributable to noncontrolling interests | -186 | -783 | 0 |
Net income attributable to The Ensign Group, Inc. | 24,040 | 40,591 | 47,675 |
Amounts attributable to The Ensign Group, Inc.: | ' | ' | ' |
Income from continuing operations attributable to The Ensign Group, Inc. | 25,844 | 41,948 | 47,675 |
(Loss) income from discontinued operations, net of income tax benefit | -1,804 | -1,357 | 0 |
Net income attributable to The Ensign Group, Inc. | $24,040 | $40,591 | $47,675 |
Basic: | ' | ' | ' |
Income from continuing operations attributable to The Ensign Group, Inc. | $1.18 | $1.96 | $2.27 |
Income (loss) from discontinued operations | ($0.08) | ($0.07) | $0 |
Net income attributable to The Ensign Group, Inc. | $1.10 | $1.89 | $2.27 |
Diluted: | ' | ' | ' |
Income from continuing operations attributable to The Ensign Group, Inc. | $1.16 | $1.91 | $2.21 |
Loss from discontinued operations | ($0.09) | ($0.06) | $0 |
Net income attributable to The Ensign Group, Inc. | $1.07 | $1.85 | $2.21 |
Weighted average common shares outstanding: | ' | ' | ' |
Dividends per share | $0.27 | $0.25 | $0.23 |
Common Class A [Member] | ' | ' | ' |
Weighted average common shares outstanding: | ' | ' | ' |
Basic | 21,900 | 21,429 | 20,967 |
Diluted | 22,364 | 21,942 | 21,583 |
Consolidated_Statements_of_Inc1
Consolidated Statements of Income Income Statement Paranthetical (USD $) | 12 Months Ended | ||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Income Statement parenthetical [Abstract] | ' | ' | ' |
Tax benefit | ($1,157) | ($869) | $0 |
Consolidated_Statement_of_Comp
Consolidated Statement of Comprehensive Income (USD $) | 12 Months Ended | ||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Net income | $23,854 | $39,808 | $47,675 |
Other comprehensive income (loss), net of tax: | ' | ' | ' |
Unrealized gain (loss) on interest rate swap, net of income tax provision (benefit) of ($405), $286, and $835 for the years ended December 31, 2013, 2012 and 2011, respectively. | 633 | -437 | -1,308 |
Comprehensive income | 24,487 | 39,371 | 46,367 |
Less: net income (loss) attributable to noncontrolling interests | -186 | -783 | 0 |
Comprehensive income attributable to The Ensign Group, Inc. | $24,673 | $40,154 | $46,367 |
Consolidated_Statement_of_Comp1
Consolidated Statement of Comprehensive Income Comprehensive Income Paranthetical (USD $) | 12 Months Ended | ||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Other Comprehensive Loss: | ' | ' | ' |
Income tax effect on unrealized gain (loss) on interest rate swap | ($405) | $286 | $835 |
Consolidated_Statements_of_Sto
Consolidated Statements of Stockholders' Equity Statement (USD $) | Total | Common Stock [Member] | Additional Paid-in Capital [Member] | Retained Earnings [Member] | Treasury Stock [Member] | Accumulated Other Comprehensive Income (Loss) [Member] | Noncontrolling Interest [Member] | Redeemable noncontrolling interest [Member] |
Share data in Thousands | ||||||||
Stockholders' Equity at Dec. 31, 2010 | $228,203,000 | $21,000 | $70,814,000 | $161,168,000 | ($3,800,000) | $0 | $0 | $0 |
Balance, Shares at Dec. 31, 2010 | ' | 20,815 | ' | ' | 582 | ' | ' | ' |
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards | ' | -344 | ' | ' | -186 | ' | ' | ' |
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards | 2,849,000 | 1,000 | 1,607,000 | 0 | 1,241,000 | 0 | 0 | 0 |
Issuance of restricted stock to employees | 143 | 20 | ' | ' | 0 | ' | ' | ' |
Issuance of restricted stock to employees | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Repurchase of shares of common stock | 0 | ' | ' | ' | ' | ' | ' | ' |
Dividends declared | -4,770,000 | 0 | 0 | -4,770,000 | 0 | 0 | 0 | 0 |
Share-based compensation | 3,356,000 | 0 | 3,356,000 | 0 | 0 | 0 | 0 | 0 |
Excess tax benefit from exercise of stock options | 1,480,000 | 0 | 1,480,000 | 0 | 0 | 0 | 0 | 0 |
Redeemable noncontrolling interest | 0 | ' | ' | ' | ' | ' | ' | ' |
Net loss attributable to noncontrolling interests | 0 | ' | ' | ' | ' | ' | ' | ' |
Net income | 47,675,000 | 0 | 0 | 47,675,000 | 0 | 0 | 0 | 0 |
Accumulated other comprehensive loss | -1,308,000 | 0 | 0 | 0 | 0 | -1,308,000 | 0 | 0 |
Stockholders' Equity at Dec. 31, 2011 | 277,485,000 | 22,000 | 77,257,000 | 204,073,000 | -2,559,000 | -1,308,000 | 0 | 0 |
Balance, Shares at Dec. 31, 2011 | ' | 21,179 | ' | ' | 396 | ' | ' | ' |
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards | ' | -488 | ' | ' | -102 | ' | ' | ' |
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards | 4,701,000 | 0 | 4,067,000 | 0 | 634,000 | 0 | 0 | 0 |
Issuance of restricted stock to employees | 71 | 52 | ' | ' | 0 | ' | ' | ' |
Issuance of restricted stock to employees | 1,360,000 | 0 | 1,360,000 | 0 | 0 | 0 | 0 | 0 |
Repurchase of common stock | ' | 0 | ' | ' | 7 | ' | ' | ' |
Repurchase of shares of common stock | -174,000 | 0 | 0 | 0 | -174,000 | 0 | 0 | 0 |
Dividends declared | -5,320,000 | 0 | 0 | -5,320,000 | 0 | 0 | 0 | 0 |
Share-based compensation | 3,379,000 | 0 | 3,379,000 | 0 | 0 | 0 | 0 | 0 |
Excess tax benefit from exercise of stock options | 1,868,000 | 0 | 1,868,000 | 0 | 0 | 0 | 0 | 0 |
Acquisition of redeemable noncontrolling interest | 13,378,000 | 0 | 0 | 0 | 0 | 0 | 1,778,000 | 11,600,000 |
Redeemable noncontrolling interest | 11,600,000 | ' | ' | ' | ' | ' | ' | ' |
Acquisition of noncontrolling interests, net of tax | -8,164,000 | 0 | 3,018,000 | 0 | 0 | 0 | 340,000 | -11,522,000 |
Net loss attributable to noncontrolling interests | -783,000 | 0 | 0 | 0 | 0 | 0 | -705,000 | -78,000 |
Net income | 40,591,000 | 0 | 0 | 40,591,000 | 0 | 0 | 0 | 0 |
Accumulated other comprehensive loss | -437,000 | 0 | 0 | 0 | 0 | -437,000 | 0 | 0 |
Stockholders' Equity, Including Portion Attributable to Noncontrolling Interest | 327,884,000 | 22,000 | 90,949,000 | 239,344,000 | -2,099,000 | -1,745,000 | 1,413,000 | 0 |
Stockholders' Equity at Dec. 31, 2012 | 326,471,000 | ' | ' | ' | ' | ' | ' | ' |
Balance, Shares at Dec. 31, 2012 | ' | 21,719 | ' | ' | 301 | ' | ' | ' |
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards | ' | -343 | ' | ' | -64 | ' | ' | ' |
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards | 3,582,000 | 0 | 3,163,000 | 0 | 419,000 | 0 | 0 | 0 |
Issuance of restricted stock to employees | 93 | 51 | ' | ' | 0 | ' | ' | ' |
Issuance of restricted stock to employees | 385,000 | 0 | 385,000 | 0 | 0 | 0 | 0 | 0 |
Repurchase of shares of common stock | 0 | ' | ' | ' | ' | ' | ' | ' |
Dividends declared | -5,882,000 | 0 | 0 | -5,882,000 | 0 | 0 | 0 | 0 |
Share-based compensation | 4,013,000 | 0 | 4,013,000 | 0 | 0 | 0 | 0 | 0 |
Excess tax benefit from exercise of stock options | 2,854,000 | 0 | 2,854,000 | 0 | 0 | 0 | 0 | 0 |
Redeemable noncontrolling interest | 0 | ' | ' | ' | ' | ' | ' | ' |
Net loss attributable to noncontrolling interests | -186,000 | 0 | 0 | 0 | 0 | 0 | -186,000 | 0 |
Net income | 24,040,000 | 0 | 0 | 24,040,000 | 0 | 0 | 0 | 0 |
Noncontrollng interest portion of adjustment to net working capital for prior year acquisition | -66,000 | 0 | 0 | 0 | 0 | 0 | -66,000 | 0 |
Accumulated other comprehensive loss | 633,000 | 0 | 0 | 0 | 0 | 633,000 | 0 | 0 |
Stockholders' Equity, Including Portion Attributable to Noncontrolling Interest | 357,257,000 | 22,000 | 101,364,000 | 257,502,000 | -1,680,000 | -1,112,000 | 1,161,000 | 0 |
Stockholders' Equity at Dec. 31, 2013 | $356,096,000 | ' | ' | ' | ' | ' | ' | ' |
Balance, Shares at Dec. 31, 2013 | ' | 22,113 | ' | ' | 237 | ' | ' | ' |
Consolidated_Statements_of_Cas
Consolidated Statements of Cash Flows (USD $) | 12 Months Ended | ||
Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | |
Cash flows from operating activities: | ' | ' | ' |
Net income | $23,854,000 | $39,808,000 | $47,675,000 |
Adjustments to reconcile net income to net cash provided by operating activities: | ' | ' | ' |
Loss from sale of discontinued operations (Note 4) | 2,837,000 | 0 | 0 |
Depreciation and amortization | 33,942,000 | 28,464,000 | 23,286,000 |
Goodwill impairment (Note 11) | 490,000 | 2,225,000 | 0 |
Amortization of deferred financing fees and debt discount | 821,000 | 826,000 | 717,000 |
Deferred income taxes | 3,006,000 | -2,111,000 | 1,090,000 |
Provision for doubtful accounts | 12,106,000 | 9,474,000 | 7,921,000 |
Share-based compensation | 4,399,000 | 4,739,000 | 3,356,000 |
Excess tax benefit from share-based compensation | -2,854,000 | -1,868,000 | -1,480,000 |
Deferred income tax effect of purchase of noncontrolling interest | 0 | -2,464,000 | 0 |
Loss on extinguishment of debt | 0 | 0 | 2,542,000 |
Gain on sale of equity method investment | -380,000 | 0 | 0 |
Loss (gain) on disposition of property and equipment | 1,379,000 | 412,000 | 190,000 |
Change in operating assets and liabilities | ' | ' | ' |
Accounts receivable | -27,290,000 | -16,150,000 | -24,795,000 |
Prepaid income taxes | -6,129,000 | 2,095,000 | -4,549,000 |
Prepaid expenses and other current assets | -501,000 | -944,000 | -491,000 |
Insurance subsidiary deposits and investments | 110,000 | -5,758,000 | -394,000 |
Accounts payable | -2,236,000 | 3,152,000 | 2,701,000 |
U.S. Government inquiry accrual (Note 19) | -15,000,000 | 15,000,000 | 0 |
Accrued wages and related liabilities | 4,246,000 | -6,360,000 | 4,581,000 |
Other accrued liabilities | 6,645,000 | 4,908,000 | 6,367,000 |
Accrued self-insurance | -1,842,000 | 6,205,000 | 4,059,000 |
Deferred rent liability | -179,000 | 397,000 | -89,000 |
Net cash provided by operating activities | 37,424,000 | 82,050,000 | 72,687,000 |
Cash flows from investing activities: | ' | ' | ' |
Purchase of property and equipment | -29,759,000 | -38,853,000 | -40,773,000 |
Cash payment for business acquisitions | -45,101,000 | -31,558,000 | -106,747,000 |
Cash payment for asset acquisitions | 0 | -11,261,000 | -23,385,000 |
Escrow deposits | -1,000,000 | -4,635,000 | -175,000 |
Escrow deposits used to fund business acquisitions | 4,635,000 | 175,000 | 14,422,000 |
Cash Proceeds on sale of urgent care franchising business, net of note receivable | 3,607,000 | 0 | 0 |
Cash proceeds on sale of equity method investment | 1,600,000 | 0 | 0 |
Cash proceeds from the sale of property and equipment | 929,000 | 155,000 | 766,000 |
Restricted and other assets | -146,000 | 1,481,000 | -160,000 |
Net cash used in investing activities | -65,235,000 | -84,496,000 | -156,052,000 |
Cash flows from financing activities: | ' | ' | ' |
Proceeds from issuance of debt | 58,700,000 | 36,525,000 | 90,000,000 |
Payments on long term debt | -7,207,000 | -16,825,000 | -46,259,000 |
Repurchase of shares of common stock | 0 | -174,000 | 0 |
Issuance of treasury stock upon exercise of options | 419,000 | 634,000 | 1,241,000 |
Issuance of common stock upon exercise of options | 3,163,000 | 4,067,000 | 1,607,000 |
Dividends paid | -4,318,000 | -6,604,000 | -4,637,000 |
Excess tax benefit from share-based compensation | 2,854,000 | 1,868,000 | 1,480,000 |
Purchase of noncontrolling interest | 0 | -5,700,000 | 0 |
Payments of deferred financing costs | -730,000 | -244,000 | -2,571,000 |
Net cash provided by financing activities | 52,881,000 | 13,547,000 | 40,861,000 |
Net increase in cash and cash equivalents | 25,070,000 | 11,101,000 | -42,504,000 |
Cash and cash equivalents beginning of period | 40,685,000 | 29,584,000 | 72,088,000 |
Cash and cash equivalents end of period | 65,755,000 | 40,685,000 | 29,584,000 |
Cash paid during the period for: | ' | ' | ' |
Interest | 12,809,000 | 12,394,000 | 13,871,000 |
Income taxes | 19,323,000 | 24,842,000 | 31,602,000 |
Non-cash financing and investing activity: | ' | ' | ' |
Redeemable noncontrolling interest | 0 | 11,600,000 | 0 |
Accrued capital expenditures | 1,693,000 | 1,734,000 | 571,000 |
Note receivable on sale of urgent care franchising business | $4,000,000 | $0 | $0 |
Description_of_Business
Description of Business | 12 Months Ended |
Dec. 31, 2013 | |
DESCRIPTION OF BUSINESS [Abstract] | ' |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block] | ' |
DESCRIPTION OF BUSINESS | |
The Company — The Ensign Group, Inc., through its subsidiaries (collectively, Ensign or the Company), provides skilled nursing and rehabilitative care services through the operation of 119 facilities, nine home health and seven hospice operations, seven urgent care centers and a mobile x-ray and diagnostic company as of December 31, 2013, located in Arizona, California, Colorado, Idaho, Iowa, Nebraska, Nevada, Oregon, Texas, Utah and Washington. The Company's operations, each of which strives to be the operation of choice in the community it serves, provide a broad spectrum of healthcare services including skilled nursing, assisted living, home health and hospice, mobile ancillary, and urgent care services. The Company's facilities have a collective capacity of approximately 13,200 operational skilled nursing, assisted living and independent living beds. As of December 31, 2013, the Company owned 96 of its 119 facilities and operated an additional 23 facilities through long-term lease arrangements, and had options to purchase two of those 23 facilities. | |
The Ensign Group, Inc. is a holding company with no direct operating assets, employees or revenue. All of the Company’s operations are operated by separate, independent subsidiaries, each of which has its own management, employees and assets. One of the Company’s wholly-owned subsidiaries, referred to as the Service Center, provides centralized 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. | |
Like the Company’s facilities, the Service Center and the Captive 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, as well as the use of the terms “we,” “us,” “our” and similar verbiage in this annual report is not meant to imply that The Ensign Group, Inc. has direct operating assets, employees or revenue, or that any of the facilities, the Service Center or the Captive are operated by the same entity. |
REIT_SpinOff
REIT Spin-Off | 12 Months Ended | |
Dec. 31, 2013 | ||
REIT Spin-Off [Abstract] | ' | |
Proposed Spin-Off of Real Estate Assets Through a Real Estate Investment Trust (REIT) [Text Block] | ' | |
PROPOSED SPIN-OFF OF REAL ESTATE ASSETS THROUGH A REAL ESTATE INVESTMENT TRUST (REIT) | ||
On November 7, 2013, the Company announced a plan to separate its healthcare business and its real estate business into two separate, publicly traded companies: | ||
• | Ensign, which will continue to provide healthcare services through its existing operations; and | |
• | CareTrust REIT, Inc. (CareTrust), which will own, acquire and lease real estate serving the healthcare industry. | |
The Company intends to accomplish the proposed separation by distributing all of the outstanding shares of CareTrust common stock to the Company’s stockholders on a pro rata basis (the Spin-Off). At the time of the Spin-Off, CareTrust, which is currently a wholly owned subsidiary of the Company, will hold substantially all of the real property owned by the Company, and will own and operate three independent living facilities. After the Spin-Off, all of these properties (except for three independent living facilities that CareTrust will operate) will be leased to the Company on a triple-net basis, under which the Company will be responsible for all costs at the properties, including property taxes, insurance and maintenance and repair costs. | ||
In accordance with Accounting Standards Codification (ASC) 505-60, Equity-Spinoffs and Reverse Spinoffs, the accounting for the separation of the Company follows its legal form, with Ensign as the legal and accounting spinnor and CareTrust as the legal and accounting spinnee, due to the relative significance of Ensign’s healthcare business, the relative fair values of the respective companies, the retention by Ensign of all senior management except Gregory K. Stapley by Ensign, and other relevant indicators. | ||
As part of the proposed Spin-Off, CareTrust intends to elect to be taxed and intends to qualify as a real estate investment trust (REIT) for U.S. federal income tax purposes commencing with its taxable year ending December 31, 2014. As a REIT, CareTrust will have to satisfy certain requirements relating to diversity of ownership, including a requirement that not more than 50% of its stock may be owned by five or fewer individuals. In order to help CareTrust satisfy the REIT requirements, its charter will include “excess share” provisions typical for REITs that will prohibit ownership of more than 9.8% of its outstanding shares. On November 7, 2013, the board of directors of the Company adopted a stockholder rights plan to discourage any of the Company's stockholders from exceeding this ownership level prior to the Spin-Off. In connection with the adoption of the stockholder rights plan, the board of directors declared a dividend of one right (a Right) for each share of Company common stock held by stockholders of record at the close of business on November 18, 2013. The Company will also issue one Right with each new share of the Company’s common stock that is subsequently issued while the stockholder rights plan is in place. The Rights are issued pursuant to a Rights Agreement, dated as of November 7, 2013 (the Rights Agreement). Initially, the Rights will not be exercisable and will trade with the shares of Company common stock. The Rights will generally be exercisable only if a person or group becomes an “acquiring person” by (i) acquiring beneficial ownership of 9.8% or more of the Company's common stock or, in the case of any person (including such person’s affiliates and associates) that beneficially owns 9.8% or more of the Company's common stock, upon the acquisition of additional shares by such person, or (ii) commencing a tender offer or exchange offer which, if consummated, could result in a person owning 9.8% or more of the Company's common stock. | ||
If a person or group becomes an acquiring person, the Rights will generally entitle each holder, other than the acquiring person, to acquire, for the exercise price of $200 per Right (subject to adjustment), shares of the Company's common stock (or, in certain circumstances, other consideration) having a market value equal to twice the exercise price. The Rights will expire at 5:00 P.M., New York City time, on the earlier of (i) the first business day after consummation of the proposed Spin-Off, or (ii) November 6, 2014, unless redeemed or exchanged earlier or unless the board of directors extends the expiration date. The Rights will not prevent a takeover of the Company, but may cause substantial dilution to a person that acquires 9.8% or more of the Company’s common stock. | ||
The proposed Spin-Off is conditioned on, among other things, final approval by the Board of Directors of the Company, the receipt of a ruling from the IRS that, among other things the Spin-Off will qualify as a tax-free transaction for U.S. federal income tax purposes, the receipt of an opinion of counsel as to the satisfaction of certain requirements for such tax-free treatment and, the receipt of an opinion of counsel that, commencing with CareTrust's taxable year ending on December 31, 2014, CareTrust has been organized in conformity with the requirements for qualification as a REIT under the Internal Revenue Code of 1986, as amended, and its proposed method of operation will enable it to meet the requirements for qualification and taxation as a REIT. |
Significant_Accounting_Policie
Significant Accounting Policies | 12 Months Ended |
Dec. 31, 2013 | |
SUMMARY OF SIGNIFICANT 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 of America (GAAP). The Company is the sole member or shareholder of various consolidated limited liability companies and corporations; each established to operate various acquired healthcare service operations. All intercompany transactions and balances have been eliminated in consolidation. 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 at December 31, 2013. | |
On March 25, 2013, the Company agreed to terms to sell Doctors Express (DRX), a national urgent care franchise system. The asset sale was effective on April 15, 2013. The results of operations for DRX have been classified as discontinued operations for all periods presented in the accompanying Financial Statements (see Note 4, Discontinued Operations). Certain assets and liabilities included in the sale of DRX have been presented as held for sale in the accompanying consolidated balance sheet as of December 31, 2012. In addition, the results of operations of DRX and the loss or impairment related to this divesture have been classified as discontinued operations in the accompanying consolidated statements of income for all periods presented. | |
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, worker’s compensation, and healthcare claims included in accrued self-insurance liabilities, other contingent liabilities, interest rate swaps, and income taxes. Actual results could differ from those estimates. | |
Business Segments — The Company has a single reportable segment — healthcare services, which includes providing skilled nursing, assisted living, home health and hospice, urgent care and related ancillary services. The Company’s single reportable segment is made up of several individual operating segments grouped together principally based on their geographical locations within the United States. Based on the similar economic and other characteristics of each of the operating segments, management believes the Company meets the criteria for aggregating its operating segments into a single reportable segment. | |
Fair Value of Financial Instruments — The Company’s financial instruments consist principally of cash and cash equivalents, debt security investments, interest rate swap agreements, 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. The interest rate swap is carried at fair value on the balance sheet. The Company’s fixed-rate debt instruments do not actively trade in an established market. The fair values of this debt are estimated by discounting the principal and interest payments at rates available to the Company for debt with similar terms and maturities. See further discussion of debt security investments in Note 6, Fair Value Measurements. | |
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 residents 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, daily basis. | |
Revenue from the Medicare and Medicaid programs accounted for 72.2%, 73.6% and 75.2% of the Company’s revenue for the years ended December 31, 2013, 2012 and 2011, 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 retroactive adjustments to revenue which were not material to the Company's consolidated revenue for the years ended December 31, 2013, 2012 and 2011. | |
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 residents and is recognized on the date services are provided at amounts billable to individual residents. For residents under 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, daily basis. The Company records revenue from private pay patients, at the agreed-upon rate, as services are performed. | |
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. Thereby, estimating revenue and recognizing it on a daily basis. | |
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 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 long-term assets. The majority of these deposits and investments are currently held in AA- and A- 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 6, Fair Value Measurements. | |
Equity Investment — As of December 31, 2012, one of the Company's subsidiaries had a non-marketable equity investment which was accounted for under the equity method. The investment was initially recorded at cost and the Company adjusted the carrying amount for its share of the earnings or losses of the investee after the date of investment. On April 23, 2013, the Company entered into a common unit redemption agreement with the investee where the non-marketable equity investment was repurchased. See further discussion at Note 12, Restricted and Other Assets. | |
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 57 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 operations 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 operations 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 has not identified any asset impairment during the years ended December 31, 2013, 2012 or 2011. | |
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, typically ranging from ten to 20 years. 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 facilities are amortized over 30 years and customer relationships are amortized over 20 years. | |
The Company's indefinite-lived intangible assets consist of trade names and home health and hospice Medicare 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. | |
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 defines reporting units as the individual operations. 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. For claims made after January 1, 2013, the self-insured retention was $500 per claim, subject to an additional one-time deductible of $1,000 for California facilities and a separate, one-time deductible of $750 for non-California facilities. For all facilities, except those located in Colorado, the third-party coverage above these amounts was $1,000 per claim, $3,000 per facility, with a $5,000 blanket aggregate available to both California and non-California operations, separately. In Colorado, the third-party coverage above these limits was $1,000 per claim and $3,000 per facility, which is independent of the aforementioned blanket aggregate applicable to its other 113 facilities. | |
The self-insured retention and deductible limits for general and professional liability and California 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, 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 liability in California. To protect itself against loss exposure in California with this policy, the Company has purchased individual stop-loss insurance coverage that insures individual claims that exceed $500 for each 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 for each occurrence. The Company’s operating subsidiaries in other states have third party guaranteed cost coverage. In California and Texas, 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 $3,280 and $3,219 at December 31, 2013 and December 31, 2012, 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 provides self-insured 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 per each covered member, subject to an additional one-time 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. | |
When the Company takes uncertain income tax positions that do not meet the recognition criteria, it records a liability for underpayment of income taxes and related interest and penalties, if any. In considering the need for and magnitude of a liability for such positions, the Company must consider the potential outcomes from a review of the positions by the taxing authorities. | |
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. | |
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. | |
Stock-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. | |
Derivatives and Hedging Activities — The Company evaluates variable and fixed interest rate risk exposure on a routine basis and to the extent the Company believes that it is appropriate, it will offset most of its variable risk exposure by entering into interest rate swap agreements. It is the Company's policy to only utilize derivative instruments for hedging purposes (i.e. not for speculation). The Company formally designates its interest rate swap agreements as hedges and documents all relationships between hedging instruments and hedged items. The Company formally assesses effectiveness of its hedging relationships, both at the hedge inception and on an ongoing basis, then measures and records ineffectiveness. The Company would discontinue hedge accounting prospectively (i) if it is determined that the derivative is no longer effective in offsetting change in the cash flows of a hedged item, (ii) when the derivative expires or is sold, terminated or exercised, (iii) if it is no longer probable that the forecasted transaction will occur, or (iv) if management determines that designation of the derivative as a hedge instrument is no longer appropriate. The Company’s derivative is recorded on the balance sheet at its fair value. | |
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 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. | |
Accumulated Other Comprehensive Loss and Total Comprehensive Income — Accumulated other comprehensive loss refers to revenue, expenses, gains, and losses that are recorded as an element of stockholders’ equity but are excluded from net income. The Company’s other comprehensive loss consists of net deferred gains and losses on certain derivative instruments accounted for as cash flow hedges. As of December 31, 2013 accumulated other comprehensive loss was $1,828, recorded net of tax of $716, or $1,112. As of December 31, 2012, accumulated other comprehensive loss was $2,866, recorded net of tax of $1,121, or $1,745. | |
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) ASC is the sole source of authoritative GAAP literature recognized by the FASB and applicable to the Company. The Company has reviewed the FASB issued Accounting Standards Update (ASU) accounting pronouncements and interpretations thereof that have effectiveness dates during the periods reported and in future periods. The Company has carefully considered the new pronouncements that alter previous generally accepted accounting principles and does not believe that 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. | |
Additionally, the FASB and the International Accounting Standards Board are working on joint convergence projects to address accounting differences between GAAP and International Financial Reporting Standards in order to support their commitment to achieve a single set of high-quality global accounting standards. One of the projects under deliberation includes accounting for leases. If enacted in its current draft form, the Company anticipates that the lease accounting proposal could impact its consolidated financial statements; however, the FASB's standard-setting process is ongoing and until new standards have been finalized and issued, the Company cannot quantify and determine the impact on its consolidated financial statements that may result from such future changes. |
Discontinued_Operations
Discontinued Operations | 12 Months Ended | ||||||||||||
Dec. 31, 2013 | |||||||||||||
Discontinued Operations [Abstract] | ' | ||||||||||||
Disposal Groups, Including Discontinued Operations, Disclosure [Text Block] | ' | ||||||||||||
DISCONTINUED OPERATIONS | |||||||||||||
On March 25, 2013, the Company agreed to terms to sell DRX, a national urgent care franchise system for approximately $8,000, adjusted for certain assets and liabilities. The asset sale was effective on April 15, 2013. The assets acquired at the initial purchase of DRX, including noncontrolling interest, were recorded at fair value. The initial fair value was greater than total cash paid to acquire all interests in DRX and the subsequent sale price. The sale of DRX has been accounted for as discontinued operations. Accordingly, the results of operations of this business for all periods presented and the loss related to this divesture have been classified as discontinued operations in the accompanying consolidated statements of income. As the sale was effective April 15, 2013, all assets and liabilities included in the sale were recorded as held for sale on the Company's consolidated balance sheets as of December 31, 2012. | |||||||||||||
A summary of discontinued operations follows: | |||||||||||||
Years Ended December 31, | |||||||||||||
2013 | 2012 | 2011 | |||||||||||
Revenue | $ | 728 | $ | 1,564 | $ | — | |||||||
Cost of services (exclusive of facility rent, general and administrative and depreciation and amortization expenses shown separately below) | (807 | ) | (3,646 | ) | — | ||||||||
Charges to discontinued operations for the excess carrying amount of goodwill and other indefinite-lived intangible assets | (2,837 | ) | — | — | |||||||||
Facility rent—cost of services | (12 | ) | (38 | ) | — | ||||||||
Depreciation and amortization | (33 | ) | (106 | ) | — | ||||||||
Loss from discontinued operations | (2,961 | ) | (2,226 | ) | — | ||||||||
Benefit from income taxes | (1,157 | ) | (869 | ) | — | ||||||||
Loss from discontinued operations, net of income tax benefit | $ | (1,804 | ) | $ | (1,357 | ) | $ | — | |||||
A summary of the net assets held for sale are as follows: | |||||||||||||
December 31, | |||||||||||||
2013 | 2012 | ||||||||||||
Current assets | $ | — | $ | 268 | |||||||||
Long-term assets: | |||||||||||||
Goodwill | — | 1,099 | |||||||||||
Other identifiable intangible assets, net | — | 10,200 | |||||||||||
Other long-term assets, net | — | 25 | |||||||||||
Total assets held for sale | — | 11,592 | |||||||||||
Current liabilities | — | (339 | ) | ||||||||||
Long-term liabilities | — | (130 | ) | ||||||||||
Total liabilities held for sale | — | (469 | ) | ||||||||||
Net assets held for sale | $ | — | $ | 11,123 | |||||||||
Computation_of_Net_Income_Per_
Computation of Net Income Per Common Share | 12 Months Ended | |||||||||||
Dec. 31, 2013 | ||||||||||||
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. | ||||||||||||
A reconciliation of the numerator and denominator used in the calculation of basic net income per common share follows: | ||||||||||||
Years Ended December 31, | ||||||||||||
2013 | 2012 | 2011 | ||||||||||
Numerator: | ||||||||||||
Income from continuing operations | $ | 25,658 | $ | 41,165 | $ | 47,675 | ||||||
Less: net loss attributable to noncontrolling interests | (186 | ) | (783 | ) | — | |||||||
Income from continuing operations attributable to The Ensign Group, Inc. | 25,844 | 41,948 | 47,675 | |||||||||
Plus: loss from discontinued operations, net of income tax | (1,804 | ) | (1,357 | ) | — | |||||||
Net income attributable to The Ensign Group, Inc. | $ | 24,040 | $ | 40,591 | $ | 47,675 | ||||||
Denominator: | ||||||||||||
Weighted average shares outstanding for basic net income per share | 21,900 | 21,429 | 20,967 | |||||||||
Basic net income (loss) per common share: | ||||||||||||
Income from continuing operations attributable to The Ensign Group, Inc. | $ | 1.18 | $ | 1.96 | $ | 2.27 | ||||||
Loss from discontinued operations | (0.08 | ) | (0.07 | ) | — | |||||||
Net income attributable to The Ensign Group, Inc. | $ | 1.1 | $ | 1.89 | $ | 2.27 | ||||||
A reconciliation of the numerator and denominator used in the calculation of diluted net income per common share follows: | ||||||||||||
Years Ended December 31, | ||||||||||||
2013 | 2012 | 2011 | ||||||||||
Numerator: | ||||||||||||
Income from continuing operations | $ | 25,658 | $ | 41,165 | $ | 47,675 | ||||||
Less: net loss attributable to the noncontrolling interests | (186 | ) | (783 | ) | — | |||||||
Income from continuing operations attributable to The Ensign Group, Inc. | 25,844 | 41,948 | 47,675 | |||||||||
Plus: loss from discontinued operations, net of income tax | (1,804 | ) | (1,357 | ) | — | |||||||
Net income attributable to The Ensign Group, Inc. | $ | 24,040 | $ | 40,591 | $ | 47,675 | ||||||
Denominator: | ||||||||||||
Weighted average common shares outstanding | 21,900 | 21,429 | 20,967 | |||||||||
Plus: incremental shares from assumed conversion (1) | 464 | 513 | 616 | |||||||||
Adjusted weighted average common shares outstanding | 22,364 | 21,942 | 21,583 | |||||||||
Diluted net income (loss) per common share: | ||||||||||||
Income from continuing operations attributable to The Ensign Group, Inc. | $ | 1.16 | $ | 1.91 | $ | 2.21 | ||||||
Loss from discontinued operations | (0.09 | ) | (0.06 | ) | — | |||||||
Net income attributable to The Ensign Group, Inc. | $ | 1.07 | $ | 1.85 | $ | 2.21 | ||||||
(1) Options outstanding which are anti-dilutive and therefore not factored into the weighted average common shares amount above were 402, 340 and 97 for the years ended December 31, 2013, 2012 and 2011, respectively. |
Fair_Value_Measurements
Fair Value Measurements | 12 Months Ended | ||||||||||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||||||||||
FAIR VALUE MEASUREMENTS [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 observable 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, 2013 and 2012: | |||||||||||||||||||||||||
December 31, | |||||||||||||||||||||||||
2013 | 2012 | ||||||||||||||||||||||||
Level 1 | Level 2 | Level 3 | Level 1 | Level 2 | Level 3 | ||||||||||||||||||||
Cash and cash equivalents | $ | 65,755 | $ | — | $ | — | $ | 40,685 | $ | — | $ | — | |||||||||||||
Fair value of interest rate swap | $ | — | $ | 1,828 | $ | — | $ | — | $ | 2,866 | $ | — | |||||||||||||
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 3, Summary of Significant Accounting Policies for further discussion. | |||||||||||||||||||||||||
Investments - Held to Maturity | |||||||||||||||||||||||||
At December 31, 2013 and 2012, the Company had approximately $22,399 and $22,510, respectively, in insurance subsidiary 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. The Company has the intent and ability to hold these debt securities to maturity. Further, at December 31, 2013, $4,066 is held in AA-rated debt securities backed by the Federal Deposit Insurance Corporation (FDIC) under the Temporary Liquidity Guarantee Program, and $18,333 is held in A-rated debt securities. These debt securities mature from February 2013 to October 2015. At December 31, 2012, $6,310 was held in AA-rated debt securities and $16,200 was held in A-rated debt securities. | |||||||||||||||||||||||||
Interest Rate Swap Agreement | |||||||||||||||||||||||||
In connection with the Senior Credit Facility with a lending consortium arranged by SunTrust and Wells Fargo (the Senior Credit Facility), in July 2011, the Company entered into an interest rate swap agreement in accordance with Company policy to reduce risk from volatility in the income statement due to changes in the LIBOR interest rate. The swap agreement, with a notional amount of $75,000, amortizing concurrently with the related term loan portion of the Senior Credit Facility, was five years in length and set to mature on July 15, 2016. The interest rate swap has been designated as a cash flow hedge and, as such, changes in fair value are reported in other comprehensive income in accordance with hedge accounting. Under the terms of this swap agreement, the net effect of the hedge was to record swap interest expense at a fixed rate of approximately 4.3%, exclusive of fees. Net interest paid under the swap was $1,047, $951 and $471 for the year ended December 31, 2013, 2012, and 2011, respectively. In addition, based on the December 31, 2013 interest rate swap valuation, the Company expects to record swap interest expense of approximately $1,100 during the year ended December 31, 2014. | |||||||||||||||||||||||||
The Company assesses hedge effectiveness at inception and on an ongoing basis by performing a regression analysis. The regression analysis compares the historical monthly changes in fair value of the interest rate swap to the historical monthly changes in the fair value of a hypothetically perfect interest rate swap over the trailing 30 months. The change in fair value of the hypothetical derivative is regarded as a proxy for the present value of the cumulative change in the expected future cash flows on the hedged transaction. The regression analysis serves as the Company's prospective and retrospective assessment of hedge effectiveness. Assuming the hedging relationship qualifies as highly effective, the actual swap will be recorded at fair value on the balance sheet and accumulated other comprehensive income (loss) will be adjusted to reflect the lesser of either the cumulative change in the fair value of the actual swap or the cumulative change in the fair value of the hypothetical derivative. | |||||||||||||||||||||||||
The interest rate swap agreement is recorded at fair value based upon valuation models which utilize relevant factors such as the contractual terms of the interest rate swap agreements, credit spreads for the contracting parties and interest rate curves. Based on this valuation method, the Company categorized the interest rate swap as Level 2 and recorded accumulated other comprehensive losses as of December 31, 2013 of $1,828, recorded net of tax of $716, or $1,112 in stockholders' equity, compared to $2,866, recorded net of tax of $1,121, or $1,745 as of December 31, 2012. There are no amounts attributable to hedge ineffectiveness that were required to be recognized in earnings. |
Revenue_and_Accounts_Receivabl
Revenue and Accounts Receivable | 12 Months Ended | ||||||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||||||
REVENUE AND ACCOUNTS RECEIVABLE [Abstract] | ' | ||||||||||||||||||||
Revenue and Accounts receivable [Text Block] | ' | ||||||||||||||||||||
REVENUE AND ACCOUNTS RECEIVABLE | |||||||||||||||||||||
Revenue for the years ended December 31, 2013, 2012 and 2011 is summarized in the following tables: | |||||||||||||||||||||
December 31, | |||||||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||||||
$ | % | $ | % | $ | % | ||||||||||||||||
Medicaid | $ | 323,803 | 35.8 | % | $ | 302,046 | 36.7 | % | $ | 277,736 | 36.6 | % | |||||||||
Medicare | 292,917 | 32.4 | 278,578 | 33.8 | 272,283 | 35.9 | |||||||||||||||
Medicaid — skilled | 36,085 | 4 | 25,418 | 3.1 | 20,290 | 2.7 | |||||||||||||||
Total Medicaid and Medicare | 652,805 | 72.2 | 606,042 | 73.6 | 570,309 | 75.2 | |||||||||||||||
Managed care | 118,168 | 13.1 | 106,268 | 12.9 | 94,266 | 12.4 | |||||||||||||||
Private and other payors(1) | 133,583 | 14.7 | 110,845 | 13.5 | 93,702 | 12.4 | |||||||||||||||
Revenue | $ | 904,556 | 100 | % | $ | 823,155 | 100 | % | $ | 758,277 | 100 | % | |||||||||
(1) Private and other payors includes revenue from urgent care centers and other ancillary businesses. | |||||||||||||||||||||
Accounts receivable as of December 31, 2013 and 2012 is summarized in the following table: | |||||||||||||||||||||
December 31, | |||||||||||||||||||||
2013 | 2012 | ||||||||||||||||||||
Medicaid | $ | 38,068 | $ | 28,534 | |||||||||||||||||
Managed care | 30,911 | 26,707 | |||||||||||||||||||
Medicare | 34,562 | 32,168 | |||||||||||||||||||
Private and other payors | 24,369 | 20,589 | |||||||||||||||||||
127,910 | 107,998 | ||||||||||||||||||||
Less: allowance for doubtful accounts | (16,540 | ) | (13,811 | ) | |||||||||||||||||
Accounts receivable | $ | 111,370 | $ | 94,187 | |||||||||||||||||
Acquisitions
Acquisitions | 12 Months Ended | |||||||
Dec. 31, 2013 | ||||||||
ACQUISITIONS [Abstract] | ' | |||||||
Business Combination Disclosure [Text Block] | ' | |||||||
ACQUISITIONS | ||||||||
The Company’s acquisition policy is generally to purchase or lease operations to complement the Company’s existing portfolio. The results of all the Company’s operations are included in the accompanying Financial Statements subsequent to the date of acquisition. Acquisitions are typically paid for in cash and are accounted for using the acquisition method of accounting. Where the Company enters into facility lease agreements, the Company typically does not pay any material amount to the prior facility operator nor does the Company acquire any assets or assume any liabilities, other than rights and obligations under the lease and operations transfer agreement, as part of the transaction. Some leases include options to purchase the facilities. As a result, from time to time, the Company will acquire facilities that the Company has been operating under third-party leases. | ||||||||
During the year ended December 31, 2013, the Company acquired seven stand-alone skilled nursing facilities, three stand-alone assisted living facilities, three home health operations, three hospice operations and one urgent care center. The aggregate purchase price of the 17 business acquisitions was approximately $45,364, which was paid in cash. The Company also entered into a separate operations transfer agreement with the prior tenant as part of each transaction. The operations acquired during the year ended December 31, 2013 are as follows: | ||||||||
• | On January 1, 2013, the Company acquired a home health operation in Washington for approximately $2,801, which was paid in cash. The acquisition did not have an impact on the Company's operational bed count. The Company recognized $1,966 and $815 in goodwill and other indefinite-lived intangible assets, respectively, as part of this transaction. | |||||||
• | On January 1, 2013, the Company acquired two hospice operations in Arizona and California, respectively, for approximately $1,825, which was paid in cash. The acquisition did not have an impact on the Company's operational bed count. The Company recognized $1,825 in other indefinite-lived intangible assets as part of these transactions. | |||||||
• | On February 16, 2013, the Company acquired a home health operation in Texas for approximately $375, which was paid in cash. This acquisition did not have an impact on the Company's operational bed count. The Company recognized $375 in other indefinite-lived intangible assets as part of this transaction. | |||||||
• | On March 1, 2013, the Company acquired a home health and hospice operation in Washington for approximately $1,137, which was paid in cash. This acquisition did not have an impact on the Company's operational bed count. The Company recognized $1,137 in other indefinite-lived intangible assets as part of this transaction. | |||||||
• | In addition, on March 1, 2013, the Company purchased a skilled nursing facility in Texas for approximately $4,508, which was paid in cash. This acquisition added 150 operational skilled nursing beds to the Company's operations. | |||||||
• | On April 1, 2013, the Company acquired three skilled nursing facilities in Texas for an aggregate purchase price of approximately $7,114, which was paid in cash. These acquisitions added 280 operational skilled nursing beds to the Company's operations. | |||||||
• | On May 1, 2013, the Company acquired a skilled nursing facility and an assisted living facility in Washington for an aggregate purchase price of $11,585, which was paid in cash. These acquisitions added 102 operational assisted living units and 110 operational skilled nursing beds to the Company's operations. | |||||||
• | In addition, on May 1, 2013, the Company acquired a skilled nursing facility in Nebraska for approximately $2,846, which was paid in cash. This acquisition added 70 operational skilled nursing beds to the Company's operations. | |||||||
• | On June 1, 2013, the Company acquired an assisted living facility in California for approximately $4,263, which was paid in cash. This acquisition added 110 operational assisted living units to the Company's operations. | |||||||
• | In addition, on June 1, 2013, the Company acquired an assisted living facility in Utah for approximately $2,856, which was paid in cash. This acquisition added 69 operational assisted living units to the Company's operations. | |||||||
• | On July 1, 2013 the Company acquired a skilled nursing facility in Washington for approximately $4,499, which was paid in cash. This acquisition added 82 operational skilled nursing beds to the Company's operations. | |||||||
• | In addition, on September 16, 2013, the Company acquired an existing leased urgent care center for approximately $1,555, which was paid in cash. The Company assumed the existing lease that was in place at the time of acquisition. The urgent care center acquisition did not have an impact on the Company's bed count. As part of this acquisition, the Company recognized $1,231 in goodwill. | |||||||
During the year ended December 31, 2012, the Company acquired five stand-alone skilled nursing facilities, one stand-alone assisted living facility, two home health operations and one hospice operation. The aggregate purchase price of the nine long-term care business acquisitions was approximately $31,558, which was paid in cash. The Company also entered into a separate operations transfer agreement with the prior tenant as part of each transaction. | ||||||||
In addition, during the year ended December 31, 2012, the Company purchased the underlying assets of three of its skilled nursing facilities in California which it previously operated under long-term lease agreements, which contained options to purchase, for $11,386, which was paid in cash. These acquisitions did not impact the Company's operational bed count. | ||||||||
In January 2012, the Company announced the formation of Immediate Clinic (IC) to develop and operate urgent care centers and related businesses. The first IC operated centers opened in the third quarter of 2012. As of the year ended December 31, 2013, the Company had seven IC operated centers open. On October 4, 2012, the Company invested an additional $6,000 to IC in exchange for senior preferred stock, which resulted in the Company holding approximately 96% of the outstanding interests in the joint venture on a fully-diluted basis. On December 20, 2012, the Company purchased the remaining outstanding interests in IC for approximately $400. | ||||||||
On March 1, 2012, DRX Urgent Care LLC (DRX), a newly formed subsidiary of IC, purchased substantially all of the | ||||||||
assets and assumed certain liabilities of Doctors Express Franchising LLC, a national urgent care franchise system for $2,000, adjusted for certain items at the time of close and redeemable noncontrolling interest. The redeemable noncontrolling interest was fair valued at the acquisition date at $11,600. The Company recognized intangible assets of $7,900 in trade name, $3,000 in franchise relationships and $2,724 in goodwill. See additional details in Note 11, Goodwill and Other Indefinite-Lived Intangible Assets - Net. On December 31, 2012, IC purchased the remaining ownership interest in DRX for approximately $5,300. | ||||||||
On December 31, 2012, the Company purchased 80% of the membership interest of a mobile x-ray and diagnostic company for $5,800, plus preliminary net working capital of approximately $1,300 for total consideration of approximately $7,100, which was paid in cash. The Company recognized intangible assets of approximately $900 in trade name, $4,200 in customer relationship and $2,100 in goodwill. The Company believes that goodwill will be deductible for tax purposes. See additional details in Note 11 Goodwill and Other Indefinite-Lived Intangible Assets-Net to the Financial Statements. | ||||||||
The table below presents the allocation of the purchase price for the operations acquired in business combinations during the years ended December 31, 2013 and 2012: | ||||||||
December 31, | ||||||||
2013 | 2012 | |||||||
Land | $ | 9,312 | $ | 1,012 | ||||
Building and improvements | 26,593 | 17,615 | ||||||
Equipment, furniture, and fixtures | 1,386 | 1,771 | ||||||
Assembled occupancy | 724 | 289 | ||||||
Goodwill | 3,197 | 7,105 | ||||||
Other indefinite-lived intangible assets | 4,152 | 10,007 | ||||||
Definite-lived intangible assets | — | 7,200 | ||||||
Other assets acquired, net of liabilities assumed | — | 651 | ||||||
Total acquisitions | $ | 45,364 | $ | 45,650 | ||||
Less: redeemable noncontrolling interest | — | (11,600 | ) | |||||
Less: noncontrolling interest in mobile diagnostic company acquired | — | (1,778 | ) | |||||
Less: cash received at acquisition | — | (714 | ) | |||||
Total cash paid for acquisitions | $ | 45,364 | $ | 31,558 | ||||
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 operations acquired by the Company are frequently underperforming financially and can have regulatory and clinical challenges to overcome. Financial information, especially with underperforming operations, is often inadequate, inaccurate or unavailable. Consequently, the Company believes that prior operating results are not meaningful, representative of the Company’s current operating results or indicative of the integration potential of its newly acquired operations. The businesses acquired in each of the years ending December 31, 2013, and 2012 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 consolidated balance sheet of the Company, and the operating results have been included in the consolidated statement of income of the Company since the dates the Company gained effective control. |
Property_and_Equipment
Property and Equipment | 12 Months Ended | |||||||
Dec. 31, 2013 | ||||||||
PROPERTY AND EQUIPMENT [Abstract] | ' | |||||||
Property, Plant and Equipment Disclosure [Text Block] | ' | |||||||
PROPERTY AND EQUIPMENT | ||||||||
Property and equipment consist of the following: | ||||||||
December 31, | ||||||||
2013 | 2012 | |||||||
Land | $ | 79,679 | $ | 70,487 | ||||
Buildings and improvements | 379,021 | 341,096 | ||||||
Equipment | 97,984 | 80,860 | ||||||
Furniture and fixtures | 8,851 | 8,790 | ||||||
Leasehold improvements | 44,123 | 32,570 | ||||||
Construction in progress | 2,081 | 14,185 | ||||||
611,739 | 547,988 | |||||||
Less: accumulated depreciation | (131,969 | ) | (100,133 | ) | ||||
Property and equipment, net | $ | 479,770 | $ | 447,855 | ||||
Intangible_Assets_Net
Intangible Assets - Net | 12 Months Ended | |||||||||||||||||||||||||||
Dec. 31, 2013 | ||||||||||||||||||||||||||||
INTANGIBLE ASSETS — Net [Abstract] | ' | |||||||||||||||||||||||||||
Intangible Assets Disclosure [Text Block] | ' | |||||||||||||||||||||||||||
INTANGIBLE ASSETS — Net | ||||||||||||||||||||||||||||
December 31, | ||||||||||||||||||||||||||||
Weighted Average Life (Years) | 2013 | 2012 | ||||||||||||||||||||||||||
Gross Carrying Amount | Accumulated Amortization | Gross Carrying Amount | Accumulated Amortization | |||||||||||||||||||||||||
Intangible Assets | Net | Net | ||||||||||||||||||||||||||
Lease acquisition costs | 15.5 | $ | 684 | $ | (589 | ) | $ | 95 | $ | 684 | $ | (545 | ) | $ | 139 | |||||||||||||
Favorable lease | 15 | 1,596 | (532 | ) | 1,064 | 1,596 | (426 | ) | 1,170 | |||||||||||||||||||
Assembled occupancy | 0.5 | 2,979 | (2,948 | ) | 31 | 2,255 | (2,211 | ) | 44 | |||||||||||||||||||
Facility trade name | 30 | 733 | (195 | ) | 538 | 733 | (171 | ) | 562 | |||||||||||||||||||
Customer relationships | 20 | 4,200 | (210 | ) | 3,990 | 4,200 | — | 4,200 | ||||||||||||||||||||
Total | $ | 10,192 | $ | (4,474 | ) | $ | 5,718 | $ | 9,468 | $ | (3,353 | ) | $ | 6,115 | ||||||||||||||
Amortization expense was $1,121, $571 and $1,329 for the years ended December 31, 2013, 2012 and 2011, respectively. Of the $1,121 in amortization expense incurred during the year ended December 31, 2013, approximately $737 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. | ||||||||||||||||||||||||||||
Estimated amortization expense for each of the years ending December 31 is as follows: | ||||||||||||||||||||||||||||
Year | Amount | |||||||||||||||||||||||||||
2014 | $ | 416 | ||||||||||||||||||||||||||
2015 | 365 | |||||||||||||||||||||||||||
2016 | 345 | |||||||||||||||||||||||||||
2017 | 345 | |||||||||||||||||||||||||||
2018 | 345 | |||||||||||||||||||||||||||
Thereafter | 3,902 | |||||||||||||||||||||||||||
$ | 5,718 | |||||||||||||||||||||||||||
Goodwill_and_Other_IndefiniteL
Goodwill and Other Indefinite-Lived Intangible Assets | 12 Months Ended | |||||||
Dec. 31, 2013 | ||||||||
GOODWILL AND OTHER INDEFINITE-LIVED INTANGIBLE ASSETS [Abstract] | ' | |||||||
Goodwill and Other Indefinite-Lived Intangibles [Text Block] | ' | |||||||
GOODWILL AND OTHER INDEFINITE-LIVED INTANGIBLE ASSETS | ||||||||
The Company performs its annual goodwill impairment analysis during the fourth quarter of each year 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. The Company tests for impairment 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. | ||||||||
On March 25, 2013, the Company agreed to terms to sell DRX, a national urgent care franchise system for approximately $8,000, adjusted for certain assets and liabilities. The asset sale was effective on April 15, 2013. The sale resulted in a pre-tax loss of $2,837 for the year ended December 31, 2013. The Company recognized charges to discontinued operations for the excess carrying amount of goodwill and other indefinite-lived intangible assets of $1,099 and $1,738, respectively, during the year ended December 31, 2013 as part of this transaction. See Note 4, Discontinued Operations for additional information. | ||||||||
The following table represents activity in goodwill as of and for the years ended December 31, 2013, 2012 and 2011: | ||||||||
Goodwill | ||||||||
1-Jan-11 | $ | 10,339 | ||||||
Additions | 6,838 | |||||||
Impairments | — | |||||||
31-Dec-11 | 17,177 | |||||||
Additions | 7,104 | |||||||
Impairments | (1,625 | ) | ||||||
31-Dec-12 | 22,656 | |||||||
Less: charge to discontinued operations for the excess carrying amount of goodwill | (1,099 | ) | ||||||
21,557 | ||||||||
Additions | 3,197 | |||||||
Impairment | (490 | ) | ||||||
Purchase price adjustment | (329 | ) | ||||||
31-Dec-13 | $ | 23,935 | ||||||
The Company recorded an impairment charge to goodwill on one facility of $490 for the year ended December 31, 2013. The facility experienced a significant reduction in admissions due to extensive renovations, which occurred over a year, which resulted in declines in related forecasted cash flows, resulting in the impairment to goodwill. Prior to this, the Company had not recorded a goodwill impairment charge related to a facility since the year ended December 31, 2010. Since 1999, the Company has recognized cumulative goodwill impairment losses of $3,399. The purchase price adjustment of $329 relates to the finalization of net working capital for the Company's acquisition in a mobile x-ray and diagnostic company in fiscal year 2012. | ||||||||
The initial fair value of DRX assets and liabilities incorporated the fair value analysis of the noncontrolling interest. Therefore, the original carrying value was based on the fair value of the noncontrolling interest and cash paid. In the course of performing its impairment analysis for the year ended December 31, 2012, the Company performed an impairment test over the assets of DRX. As part of the impairment test, the Company calculated the fair value of certain assets, including trade name and franchise agreements. To determine the implied value of goodwill, fair values were allocated to the assets and liabilities of DRX as of December 31, 2012. The implied fair value of goodwill was measured as the excess of the fair value of DRX over the amounts assigned to its assets and liabilities. The impairment loss for DRX was measured by the amount the carrying value of goodwill exceeded the implied fair value of the goodwill. Based on this assessment, the Company recorded a charge to goodwill and trade name at DRX of $1,625 and $600, respectively, in the year ended December 31, 2012, which the Company attributed to a decline in the estimated fair value of redeemable noncontrolling interest. See Note 4, Discontinued Operations. | ||||||||
As of December 31, 2013, the Company anticipates that total goodwill recognized will be fully deductible for tax purposes. | ||||||||
During the year ended December 31, 2013, the Company recorded $4,109 and $43 in home health and hospice Medicare license and trade name indefinite-lived intangible assets, respectively, as part of its acquisition of three home health and three hospice operations. | ||||||||
Other indefinite-lived intangible assets consists of the following: | ||||||||
December 31, | ||||||||
2013 | 2012 | |||||||
Trade name | $ | 1,033 | $ | 990 | ||||
Home health and hospice Medicare license | 6,707 | 2,598 | ||||||
$ | 7,740 | $ | 3,588 | |||||
Restricted_and_Other_Assets
Restricted and Other Assets | 12 Months Ended | |||||||
Dec. 31, 2013 | ||||||||
RESTRICTED AND OTHER ASSETS [Abstract] | ' | |||||||
Other Assets Disclosure [Text Block] | ' | |||||||
RESTRICTED AND OTHER ASSETS | ||||||||
Restricted and other assets consist of the following: | ||||||||
December 31, | ||||||||
2013 | 2012 | |||||||
Note receivable | $ | 2,000 | $ | — | ||||
Debt issuance costs, net | 2,801 | 2,769 | ||||||
Long-term insurance losses recoverable asset | 3,280 | 3,219 | ||||||
Deposits with landlords | 872 | 749 | ||||||
Capital improvement reserves with landlords and lenders | 706 | 683 | ||||||
Equity method investment | — | 1,220 | ||||||
Other long-term assets | 145 | — | ||||||
Restricted and other assets | $ | 9,804 | $ | 8,640 | ||||
Included in other assets as of December 31, 2013 and 2012, 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 an Accounting Standards Update issued by the FASB, capitalized debt issuance costs and the long-term portion of a note receivable from the sale of DRX. See Note 4, Discontinued Operations. Included in other assets as of December 31, 2012, was a non-marketable equity investment accounted for under the equity method. On April 23, 2013, the Company entered into a common unit redemption agreement with the investee where the non-marketable equity investment was repurchased for $1,600. The Company recognized a gain on the sale of its non-marketable equity investment of $380 in the second quarter of 2013. |
Other_Accrued_Liabilities
Other Accrued Liabilities | 12 Months Ended | |||||||
Dec. 31, 2013 | ||||||||
OTHER ACCRUED LIABILITIES [Abstract] | ' | |||||||
Other Liabilities Disclosure [Text Block] | ' | |||||||
OTHER ACCRUED LIABILITIES | ||||||||
Other accrued liabilities consist of the following: | ||||||||
December 31, | ||||||||
2013 | 2012 | |||||||
Quality assurance fee | $ | 3,933 | $ | 2,010 | ||||
Resident refunds payable | 5,238 | 4,564 | ||||||
Deferred revenue | 4,633 | 5,661 | ||||||
Cash held in trust for residents | 1,780 | 1,520 | ||||||
Resident deposits | 1,680 | 1,666 | ||||||
Dividends payable | 1,564 | — | ||||||
Property taxes | 2,894 | 2,264 | ||||||
Other | 3,976 | 3,186 | ||||||
Other accrued liabilities | $ | 25,698 | $ | 20,871 | ||||
Quality assurance fee represents amounts payable to California, Arizona, Utah, Idaho, Washington, Colorado, Iowa, and Nebraska in respect of a mandated fee based on resident days. Resident refunds payable includes amounts due to residents for overpayments and duplicate payments. Deferred revenue occurs when the Company receives payments in advance of services provided. Cash held in trust for residents reflects monies received from, or on behalf of, residents. Maintaining a trust account for residents is a regulatory requirement and, while the trust assets offset the liability, 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. |
Income_Taxes
Income Taxes | 12 Months Ended | |||||||||||
Dec. 31, 2013 | ||||||||||||
INCOME TAXES [Abstract] | ' | |||||||||||
Income Tax Disclosure [Text Block] | ' | |||||||||||
INCOME TAXES | ||||||||||||
The provision for income taxes for the years ended December 31, 2013, 2012 and 2011 is summarized as follows: | ||||||||||||
December 31, | ||||||||||||
2013 | 2012 | 2011 | ||||||||||
Current: | ||||||||||||
Federal | $ | 13,457 | $ | 24,434 | $ | 24,217 | ||||||
State | 2,766 | 4,445 | 4,185 | |||||||||
16,223 | 28,879 | 28,402 | ||||||||||
Deferred: | ||||||||||||
Federal | 3,777 | (2,433 | ) | 2,041 | ||||||||
State | 3 | (1,312 | ) | (951 | ) | |||||||
3,780 | (3,745 | ) | 1,090 | |||||||||
Total | $ | 20,003 | $ | 25,134 | $ | 29,492 | ||||||
A reconciliation of the federal statutory rate to the effective tax rate for the years ended December 31, 2013, 2012 and 2011, respectively, is comprised as follows: | ||||||||||||
December 31, | ||||||||||||
2013 | 2012 | 2011 | ||||||||||
Income tax expense at statutory rate | 35 | % | 35 | % | 35 | % | ||||||
State income taxes - net of federal benefit | 4 | 3 | 2.9 | |||||||||
Non-deductible settlement costs | 5 | — | — | |||||||||
Non-deductible expenses | 0.6 | 0.5 | 0.3 | |||||||||
Other adjustments | (0.8 | ) | (0.6 | ) | — | |||||||
Total income tax provision | 43.8 | % | 37.9 | % | 38.2 | % | ||||||
The Company's deferred tax assets and liabilities as of December 31, 2013 and 2012 are summarized as follows: | ||||||||||||
December 31, | ||||||||||||
2013 | 2012 | |||||||||||
Deferred tax assets (liabilities): | ||||||||||||
Accrued expenses | $ | 12,814 | $ | 16,916 | ||||||||
Allowance for doubtful accounts | 6,836 | 5,705 | ||||||||||
Tax credits | 2,898 | 2,400 | ||||||||||
Captive insurance | 8,979 | 7,360 | ||||||||||
Total deferred tax assets | 31,527 | 32,381 | ||||||||||
State taxes | (1,111 | ) | (327 | ) | ||||||||
Depreciation and amortization | (10,825 | ) | (11,828 | ) | ||||||||
Prepaid expenses | (5,895 | ) | (3,121 | ) | ||||||||
Total deferred tax liabilities | (17,831 | ) | (15,276 | ) | ||||||||
Net deferred tax assets | $ | 13,696 | $ | 17,105 | ||||||||
The Company had state credit carryforwards as of December 31, 2013 and 2012 of $2,898 and $2,400, respectively. These carryforwards almost entirely relate to state limitations on the application of Enterprise Zone employment-related tax credits. These Enterprise Zone credits are currently expected to carryforward until 2023 to offset future state income tax. The remainder of these carryforwards relate to credits against the Texas margin tax and is expected to carryforward until 2027. | ||||||||||||
The Company had Federal net operating loss carryforwards as of December 31, 2013 and 2012 of $1,243 and $932, respectively. These Federal net operating losses are expected to carry forward until 2032. The Company also had state net operating losses as of December 31, 2013 and 2012 of $559 and $1,134, respectively. These state net operating losses carry forward over various periods. | ||||||||||||
As of December 31, 2013, 2012 and 2011, the Company did not have any unrecognized tax benefits that would affect the Company's effective tax rate. | ||||||||||||
The Federal statutes of limitations on the Company's 2007, 2008, and 2009 income tax years lapsed during the third quarter of 2011, 2012 and 2013, respectively. During the fourth quarter of each year, various state statutes of limitations also lapsed. The lapses for the years ended December 31, 2013, 2012 and 2011 had no impact on the Company's unrecognized tax benefits. | ||||||||||||
During the first quarter of 2012, the State of California initiated an examination of the Company's income tax returns for the 2008 and 2009 income tax years. The examination was primarily focused on the Captive and the treatment of related insurance matters. To date, California has not proposed any adjustments. The Company is not currently under examination by any other major income tax jurisdiction. The Company does not believe the California examination or any other event will significantly impact the balance of unrecognized tax benefits in the next twelve months. | ||||||||||||
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. | ||||||||||||
The Company recorded total pre-tax charges related to the settlement with the U.S. Department of Justice (DOJ) and related expenses of $33,000 and $15,000 during the years ended December 31, 2013 and 2012, respectively, for a total charge of $48,000. The Company recorded estimated tax benefits of $10,383 and $5,865 during the year ended December 31, 2013 and three months ended December 31, 2012, respectively. See Note 19, Commitments and Contingencies. |
Leases_Notes
Leases (Notes) | 12 Months Ended | |||
Dec. 31, 2013 | ||||
Leases [Abstract] | ' | |||
Leases of Lessee Disclosure [Text Block] | ' | |||
LEASES | ||||
The Company leases certain facilities and its administrative offices under non-cancelable operating leases, most of which have initial lease terms ranging from five to 20 years. The Company also leases certain of its equipment under non-cancelable operating leases with initial terms ranging from three to five years. Most of these leases contain renewal options, certain of which involve rent increases. Total rent expense, inclusive of straight-line rent adjustments, was $14,073, $13,779 and $14,185 for the years ended December 31, 2013, 2012 and 2011, respectively. | ||||
Future minimum lease payments for all leases as of December 31, 2013 are as follows: | ||||
Year | Amount | |||
2014 | $ | 13,693 | ||
2015 | 13,677 | |||
2016 | 13,686 | |||
2017 | 13,722 | |||
2018 | 13,764 | |||
Thereafter | 71,093 | |||
$ | 139,635 | |||
Six of the Company's facilities are operated under two separate three-facility master lease arrangements and a breach at a single facility could subject multiple facilities covered by the same master lease to the same default risk. Under a master lease, the Company may lease a large number of geographically dispersed properties through an indivisible lease. Failure to comply with Medicare and Medicaid provider requirements is a default under several of the Company's 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 addition, a number of the Company's individual facility leases are held by the same or related landlords, and some of these leases include cross-default provisions that could cause a default at one facility to trigger a technical default with respect to others, potentially subjecting certain leases and facilities to the various remedies available to the landlords under separate but cross-defaulted leases. The Company is not aware of any defaults as of December 31, 2013. |
SelfInsurance_Reserves_Notes
Self-Insurance Reserves (Notes) | 12 Months Ended | |||||||||||||||
Dec. 31, 2013 | ||||||||||||||||
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, 2013 and 2012: | ||||||||||||||||
General and Professional Liability | ||||||||||||||||
Worker's Compensation | ||||||||||||||||
Health | Total | |||||||||||||||
Balance January 1, 2012 | $ | 32,010 | $ | 9,827 | $ | 2,436 | $ | 44,273 | ||||||||
Current year provisions | 13,226 | 7,186 | 14,302 | 34,714 | ||||||||||||
Claims paid and direct expenses | (9,207 | ) | (5,031 | ) | (14,271 | ) | (28,509 | ) | ||||||||
Long-term insurance losses recoverable | (921 | ) | 1,326 | — | 405 | |||||||||||
Balance December 31, 2012 | 35,108 | 13,308 | 2,467 | 50,883 | ||||||||||||
Current year provisions | 7,879 | 6,656 | 17,170 | 31,705 | ||||||||||||
Claims paid and direct expenses | (11,890 | ) | (4,755 | ) | (16,901 | ) | (33,546 | ) | ||||||||
Long-term insurance losses recoverable | (648 | ) | 709 | — | 61 | |||||||||||
Balance December 31, 2013 | $ | 30,449 | $ | 15,918 | $ | 2,736 | $ | 49,103 | ||||||||
Included in long-term insurance losses recoverable as of December 31, 2013 and 2012, 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. |
Debt
Debt | 12 Months Ended | |||||||
Dec. 31, 2013 | ||||||||
DEBT [Abstract] | ' | |||||||
Debt Disclosure [Text Block] | ' | |||||||
DEBT | ||||||||
Long-term debt consists of the following: | ||||||||
December 31, | ||||||||
2013 | 2012 | |||||||
Promissory note with RBS, principal and interest payable monthly and continuing through March 2019, interest at a fixed rate, collateralized by real property, assignment of rents and Company guaranty. | $ | 20,347 | $ | 21,032 | ||||
Senior Credit Facility with SunTrust and Wells Fargo, principal and interest payable quarterly, balance due at February 1, 2018, secured by substantially all of the Company’s personal property. | 144,325 | 89,375 | ||||||
Ten Project Note with GECC, principal and interest payable monthly; interest is fixed, balance due June 2016, collateralized by deeds of trust on real property, assignment of rents, security agreements and fixture financing statements. | 48,864 | 50,072 | ||||||
Promissory note with RBS, principal and interest payable monthly and continuing through January 2018, interest at a fixed rate, collateralized by real property, assignment of rents and Company guaranty. | 32,122 | 33,167 | ||||||
Promissory notes, principal, and interest payable monthly and continuing through October 2019, interest at fixed rate, collateralized by deed of trust on real property, assignment of rents and security agreement. | 8,919 | 9,203 | ||||||
Mortgage note, principal, and interest payable monthly and continuing through February 2027, interest at fixed rate, collateralized by deed of trust on real property, assignment of rents and security agreement. | 5,429 | 5,665 | ||||||
260,006 | 208,514 | |||||||
Less current maturities | (7,411 | ) | (7,187 | ) | ||||
Less debt discount | (700 | ) | (822 | ) | ||||
$ | 251,895 | $ | 200,505 | |||||
Senior Credit Facility with a Lending Consortium Arranged by SunTrust and Wells Fargo (the Senior Credit Facility) | ||||||||
On April 22, 2013, the Company entered into the fourth amendment to the Senior Credit Facility (the Fourth Amendment), which amended the Company's existing Senior Credit Facility Agreement, dated as of July 15, 2011, to amend certain covenants, representations and other key provisions in the credit agreement to, among other things, (i) allow for the settlement relating to the previously disclosed federal civil investigation that has been conducted by the U.S. Department of Justice and related federal agencies in an amount up to $50,000 and (ii) permit the Company to enter into a corporate integrity agreement with the Office of Inspector General-HHS. Except as set forth in the Fourth Amendment, all other terms and conditions of the Senior Credit Facility, as amended, remained in full force. | ||||||||
On February 1, 2013, the Company entered into the third amendment to the Senior Credit Facility (the Third Amendment), which amended the Company's existing Senior Credit Facility Agreement, dated as of July 15, 2011. The Third Amendment revised the Senior Credit Facility Agreement to, among other things, (i) increase the revolving credit portion of the Senior Credit Facility by $75,000 to an aggregate principal amount of $150,000, of which $78,700 was drawn as of December 31, 2013, and (ii) extend the maturity date of the Senior Credit Facility from July 15, 2016 to February 1, 2018. Except as set forth in the Third Amendment, all other terms and conditions of the Senior Credit Facility remained in full force and effect as described below. | ||||||||
On July 15, 2011, the Company entered into the Senior Credit Facility in an aggregate principal amount of up to $150,000 comprised of a $75,000 revolving credit facility and a $75,000 term loan advanced in one drawing on July 15, 2011. Borrowings under the term loan portion of the Senior Credit Facility amortize in equal quarterly installments commencing on September 30, 2011, in an aggregate annual amount equal to 5% per annum of the original principal amount. Interest rates per annum applicable to the Senior Credit Facility are, at the option of the Company, (i) LIBOR plus an initial margin of 2.5% or (ii) the Base Rate (as defined by the agreement) plus an initial margin of 1.5%. Under the terms of the Senior Credit Facility, the applicable margin adjusts based on the Company’s leverage ratio as set forth in further detail in the Senior Credit Facility agreement. Amounts borrowed pursuant to the Senior Credit Facility are guaranteed by certain of the Company’s wholly-owned subsidiaries and secured by substantially all of their personal property. To reduce the risk related to interest rate fluctuations, the Company, on behalf of the subsidiaries, entered into an interest rate swap agreement to effectively fix the interest rate on the term loan portion of the Senior Credit Facility. See further details of the interest rate swap at Note 6, Fair Value Measurements. | ||||||||
Among other things, under the Senior Credit Facility, the Company must maintain compliance with specified financial covenants measured on a quarterly basis, including a maximum net leverage ratio, minimum interest coverage ratio and minimum asset coverage ratio. The loan documents also include certain additional reporting, affirmative and negative covenants including limitations on the incurrence of additional indebtedness, liens, investments in other businesses, dividends declared in excess of 20% of consolidated net income and repurchases and capital expenditures. As of December 31, 2013, we were in compliance with all loan covenants. | ||||||||
Promissory Note with RBS Asset Finance, Inc. | ||||||||
On February 17, 2012, two of the Company's real estate holding subsidiaries as Borrowers executed a promissory note in favor of RBS Asset Finance, Inc. (RBS) as Lender for an aggregate of $21,525 (the 2012 RBS Loan). The 2012 RBS Loan was secured by Commercial Deed of Trust, Security Agreement, Assignment of Leases and Rents and Fixture Filings on the properties owned by the Borrowers, and other related instruments and agreements, including without limitation a promissory note and a Company guaranty. The 2012 RBS Loan bears interest at a fixed rate of 4.75%. Amounts borrowed under the 2012 RBS Loan may be prepaid starting after the second anniversary of the note subject to certain prepayment fees. The term of the RBS Loan is for seven years, with monthly principal and interest payments commencing on April 1, 2012 and the balance due on March 1, 2019. | ||||||||
Among other things, under the RBS Loan the Company must maintain compliance with specified financial covenants measured on a quarterly basis, including a minimum debt service coverage ratio, an average occupancy rate and a minimum project yield. The Loan Documents also include certain additional affirmative and negative covenants, including limitations on the disposition of the Borrowers and the collateral and minimum average cash balance requirements. As of December 31, 2013, the Company was in compliance with all loan covenants. | ||||||||
Promissory Notes with RBS Asset Finance, Inc. | ||||||||
On December 31, 2010, four of the Company's real estate holding subsidiaries executed a promissory note with RBS as Lender for an aggregate of $35,000 (RBS Loan). The RBS Loan was secured by Commercial Deeds of Trust, Security Agreements, Assignment of Leases and Rents and Fixture Fillings on the four properties and other related instruments and agreements, including without limitation a promissory note and a Company guaranty. The RBS Loan bears interest at a fixed rate of 6.04%. Amounts borrowed under the RBS Loan may be prepaid starting after the second anniversary of the note subject to prepayment fees of 5.0% of the principal balance on the date of prepayment. These prepayment fees are reduced by 1.0% a year for years three through seven of the loan. The term of the RBS Loan is for seven years, with monthly principal and interest payments commencing on February 1, 2011 and the balance due on January 1, 2018. | ||||||||
Among other things, under the RBS Loan, the Company must maintain compliance with specified financial covenants measured on a quarterly basis, including a minimum debt service coverage ratio, an average occupancy rate and a minimum project yield. The loan documents also include certain additional affirmative and negative covenants, including limitations on the disposition of the Borrowers and the collateral. As of December 31, 2013, the Company was in compliance with all loan covenants. | ||||||||
Term Loan with General Electric Capital Corporation | ||||||||
On December 29, 2006, a number of the Company's independent real estate holding subsidiaries jointly entered into the Third Amended and Restated Loan Agreement, with General Electric Capital Corporation (GECC), which consists of an approximately $55,700 multiple-advance term loan, further referred to as the Ten Project Note. The Ten Project Note matures in June 2016, and is currently secured by the real and personal property comprising the ten facilities owned by these subsidiaries. The Ten Project Note was funded in advances, with each advance bearing interest at a separate rate. The interest rates range from 6.95% to 7.50% per annum. | ||||||||
Under the Ten Project Note, the Company is subject to standard reporting requirements and other typical covenants for a loan of this type. Effective October 1, 2006 and continuing each calendar quarter thereafter, we are subject to restrictive financial covenants, including average occupancy, Debt Service (as defined in the agreement) and Project Yield (as defined in the agreement). As of December 31, 2013, the Company was in compliance with all loan covenants. | ||||||||
Promissory Notes with Johnson Land Enterprises, Inc. | ||||||||
On October 1, 2009, four subsidiaries of The Ensign Group, Inc. entered into four separate promissory notes with Johnson Land Enterprises, LLC, for an aggregate of $10,000, as a part of the Company’s acquisition of three skilled nursing facilities in Utah. The unpaid balance of principal and accrued interest from these notes is due on September 30, 2019. The notes bear interest at a rate of 6.0% per annum. As a part of this transaction, the Company recorded a discount to the debt balance in the form of imputed interest of $1,218. This amount will be amortized over the term of the promissory notes, or 10 years. | ||||||||
Mortgage Loan with Continental Wingate Associates, Inc. | ||||||||
Ensign Southland LLC, a subsidiary of The Ensign Group, Inc., entered into a mortgage loan on January 30, 2001 with Continental Wingate Associates, Inc. The mortgage loan is insured with the U.S. Department of Housing and Urban Development, or HUD, which subjects the Company's Southland facility to HUD oversight and periodic inspections. The unpaid balance of principal and accrued interest from this mortgage loan is due on February 1, 2027. The mortgage loan bears interest at the rate of 7.5% per annum. | ||||||||
This mortgage loan is secured by the real property comprising the Southland Care Center facility and the rents, issues and profits thereof, as well as all personal property used in the operation of the facility. | ||||||||
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 | |||||||
2014 | $ | 7,411 | ||||||
2015 | 7,672 | |||||||
2016 | 52,589 | |||||||
2017 | 6,584 | |||||||
2018 | 157,790 | |||||||
Thereafter | 27,960 | |||||||
$ | 260,006 | |||||||
Options_and_Awards
Options and Awards | 12 Months Ended | ||||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||||
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, 2013, 2012 and 2011 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. | |||||||||||||||||||
The Company has three option plans, 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), all of which have been approved by the stockholders. The total number of shares available under all of the Company’s stock incentive plans was 1,780 as of December 31, 2013. | |||||||||||||||||||
2001 Stock Option, Deferred Stock and Restricted Stock Plan - The 2001 Plan authorizes the sale of up to 1,980 shares of common stock to officers, employees, directors, and consultants of the Company. Granted non-employee director options vest and become exercisable immediately. Generally, all other granted options and restricted stock vest over five years at 20% per year on the anniversary of the grant date. Options expire ten years from the date of grant. The exercise price of the stock is determined by the board of directors, but shall not be less than 100% of the fair value on the date of grant. At December 31, 2013, 2012 and 2011, there were 319, 319 and 314, respectively, unissued shares of common stock available for issuance under this plan, including shares that have been forfeited and are available for reissue. | |||||||||||||||||||
2005 Stock Incentive Plan - The 2005 Plan authorizes the sale of up to 1,000 shares of treasury stock of which only 800 shares were repurchased and therefore eligible for reissuance. Options granted to non-employee directors vest and become exercisable immediately. All other granted options vest over five years at 20% per year on the anniversary of the grant date. Options expire 10 years from the date of grant. There were 147 unissued shares of common stock available for issuance under this plan for each of the years ending December 31, 2013, 2012 and 2011, including shares that have been forfeited and are available for reissue. | |||||||||||||||||||
2007 Omnibus Incentive Plan - The 2007 Plan authorizes the sale of up to 1,000 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 three years, on the completion of each year of service measured from the grant date. All other granted options vest over five years at 20% per year on the anniversary of the grant date. Options expire ten years from the date of grant. At December 31, 2013, 2012 and 2011, there were 1,314, 1,149 and 1,039 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 reflects the application of the simplified method set out in Staff Accounting Bulletin (SAB) No. 107 Share-Based Payment (SAB 107), which was issued in March 2005. In December 2007, the Securities and Exchange Commission (SEC) released Staff Accounting Bulletin No. 110 (SAB 110), which extends the use of the “simplified” method, under certain circumstances, in developing an estimate of the expected term of “plain vanilla” share options. Accordingly, the Company has utilized the average of the contractual term of the options and the weighted average vesting period for all options to calculate the expected option term. The Company will utilize its own experience to calculate the expected option term in the future when it has sufficient history. | ||||||||||||||||||
• | Estimated volatility also reflects the application of SAB 107 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 will utilize its own experience to calculate estimated volatility in the future when it has sufficient history. | ||||||||||||||||||
• | 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 8.45% per year is based on the Company's historical forfeiture activity of unvested stock options. | ||||||||||||||||||
The Company used the following assumptions for stock options granted during the years ended December 31, 2013, 2012 and 2011: | |||||||||||||||||||
Grant Year | Options Granted | Weighted Average Risk-Free Rate | Expected Life | Weighted Average Volatility | Weighted Average Dividend Yield | ||||||||||||||
2013 | 248 | 1.18 | % | - | 1.87% | 6.5 years | 55 | % | 0.64 | % | - | 0.93% | |||||||
2012 | 246 | 0.84 | % | - | 1.18% | 6.5 years | 55 | % | 0.93% | ||||||||||
2011 | 97 | 1.42 | % | - | 2.53% | 6.5 years | 55 | % | 0.93% | ||||||||||
For the years ended December 31, 2013, 2012 and 2011, 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 | ||||||||||||||||
2013 | 248 | $ | 35.47 | $ | 17.7 | ||||||||||||||
2012 | 246 | $ | 27.65 | $ | 13.47 | ||||||||||||||
2011 | 97 | $ | 24.79 | $ | 12.38 | ||||||||||||||
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, 2013, 2012 and 2011 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, 2013, 2012 and 2011: | |||||||||||||||||||
Number of | Weighted | Number of | Weighted | ||||||||||||||||
Options | Average | Options Vested | Average | ||||||||||||||||
Outstanding | Exercise Price | Exercise Price | |||||||||||||||||
of Options | |||||||||||||||||||
Vested | |||||||||||||||||||
January 1, 2011 | 1,904 | $ | 11.55 | 921 | $ | 9.07 | |||||||||||||
Granted | 97 | 24.79 | |||||||||||||||||
Forfeited | (54 | ) | 13.57 | ||||||||||||||||
Exercised | (314 | ) | 7.9 | ||||||||||||||||
31-Dec-11 | 1,633 | $ | 12.97 | 936 | $ | 10.65 | |||||||||||||
Granted | 246 | 27.65 | |||||||||||||||||
Forfeited | (63 | ) | 15.8 | ||||||||||||||||
Exercised | (429 | ) | 10.95 | ||||||||||||||||
31-Dec-12 | 1,387 | $ | 16.06 | 739 | $ | 11.88 | |||||||||||||
Granted | 248 | 35.47 | |||||||||||||||||
Forfeited | (66 | ) | 24.71 | ||||||||||||||||
Exercised | (320 | ) | 11.19 | ||||||||||||||||
December 31, 2013 | 1,249 | $ | 20.71 | 681 | $ | 14.23 | |||||||||||||
The following summary information reflects stock options outstanding, vested and related details as of December 31, 2013: | |||||||||||||||||||
Stock Options Vested | |||||||||||||||||||
Stock Options Outstanding | |||||||||||||||||||
Number Outstanding | Black-Scholes Fair Value | Remaining Contractual Life (Years) | Vested and Exercisable | ||||||||||||||||
Year of Grant | Exercise Price | ||||||||||||||||||
2005 | 4.99 | - | 5.75 | 20 | * | 2 | 20 | ||||||||||||
2006 | 7.05 | - | 7.5 | 96 | 923 | 3 | 96 | ||||||||||||
2008 | 9.38 | - | 14.87 | 254 | 1,409 | 5 | 254 | ||||||||||||
2009 | 14.88 | - | 16.7 | 280 | 2,221 | 6 | 208 | ||||||||||||
2010 | 17.47 | - | 18.16 | 73 | 653 | 7 | 35 | ||||||||||||
2011 | 21.61 | - | 29.3 | 80 | 993 | 8 | 29 | ||||||||||||
2012 | 24.04 | - | 29.16 | 215 | 2,890 | 9 | 39 | ||||||||||||
2013 | 29.25 | - | 42.13 | 231 | 4,116 | 10 | — | ||||||||||||
Total | 1,249 | $ | 13,205 | 681 | |||||||||||||||
* The Company will not recognize the Black-Scholes fair value for awards granted prior to January 1, 2006 unless such awards are modified. | |||||||||||||||||||
In addition to the above, during the years ended December 31, 2013, 2012 and 2011, the Company granted 93, 71 and 143 restricted stock awards, respectively. All awards were granted at an exercise price of $0 and vest over five years. The fair value per share of restricted awards granted in 2013, 2012 and 2011 ranged from $27.98 to $42.13, $24.04 to $29.16 and $21.61 to $29.30, respectively. | |||||||||||||||||||
A summary of the status of the Company's nonvested restricted stock awards as of December 31, 2013, and changes during the years ended December 31, 2013, 2012 and 2011 is presented below: | |||||||||||||||||||
Nonvested Restricted Awards | Weighted Average Grant Date Fair Value | ||||||||||||||||||
Nonvested at January 1, 2011 | 102 | $ | 18.05 | ||||||||||||||||
Granted | 143 | 25.52 | |||||||||||||||||
Vested | (31 | ) | 24.18 | ||||||||||||||||
Forfeited | (4 | ) | 19.16 | ||||||||||||||||
Nonvested at December 31, 2011 | 210 | $ | 22.32 | ||||||||||||||||
Granted | 71 | 27.78 | |||||||||||||||||
Vested | (44 | ) | 27.53 | ||||||||||||||||
Forfeited | (13 | ) | 21.98 | ||||||||||||||||
Nonvested at December 31, 2012 | 224 | $ | 23.04 | ||||||||||||||||
Granted | 93 | 35.27 | |||||||||||||||||
Vested | (51 | ) | 23.67 | ||||||||||||||||
Forfeited | (36 | ) | 24.7 | ||||||||||||||||
Nonvested at December 31, 2013 | 230 | $ | 28.68 | ||||||||||||||||
In addition, during the year ended December 31, 2013, the Company granted 10 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 $27.98 to $41.91 based on the market price on the grant date. The Company also granted 11 executive incentive awards at a fair value per share of $32.85 based on the market price on the grant date. | |||||||||||||||||||
Total share-based compensation expense recognized for the years ended December 31, 2013, 2012 and 2011 was as follows: | |||||||||||||||||||
Years Ended December 31, | |||||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||||
Share-based compensation expense related to stock options | $ | 2,217 | $ | 1,903 | $ | 2,265 | |||||||||||||
Share-based compensation expense related to restricted stock awards | 1,387 | 1,084 | 1,091 | ||||||||||||||||
Share-based compensation expense related to stock awards | 795 | 1,752 | — | ||||||||||||||||
Total | $ | 4,399 | $ | 4,739 | $ | 3,356 | |||||||||||||
For the year ended December 31, 2013, the Company expensed $410 in share-based compensation related to the quarterly stock awards to non-employee directors. | |||||||||||||||||||
The Company recognized tax benefits related to share-based compensation expense of $1,723, $1,740, and $1,285 during the years ended December 31, 2013, 2012 and 2011, respectively. In future periods, the Company expects to recognize approximately $7,089 and $5,867 in share-based compensation expense for unvested options and unvested restricted stock awards, respectively, that were outstanding as of December 31, 2013. Future share-based compensation expense will be recognized over 3.8 and 3.5 weighted average years for unvested options and restricted stock awards, respectively. There were 568 unvested and outstanding options at December 31, 2013, of which 530 are expected to vest. The weighted average contractual life for options vested at December 31, 2013 was 6.3 years. | |||||||||||||||||||
The aggregate intrinsic value of options outstanding, vested, expected to vest and exercised as of December 31, 2013, 2012, and 2011 is as follows: | |||||||||||||||||||
December 31, | |||||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||||
Outstanding | $ | 29,431 | $ | 15,703 | $ | 18,942 | |||||||||||||
Vested | 20,465 | 11,285 | 12,960 | ||||||||||||||||
Expected to vest | 7,873 | 4,088 | 5,374 | ||||||||||||||||
Exercised | 8,709 | 7,123 | 5,651 | ||||||||||||||||
The intrinsic value is calculated as the difference between the market value of the underlying common stock and the exercise price of the options. |
Commitments_and_Contingencies
Commitments and Contingencies | 12 Months Ended |
Dec. 31, 2013 | |
COMMITMENTS AND CONTINGENCIES [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. The Company believes that it is in compliance in all material respects with all applicable laws and regulations. | |
A significant portion of the Company’s revenue is derived from Medicaid and Medicare, for which reimbursement rates are subject to regulatory changes and government funding restrictions. Any significant future change to reimbursement rates or regulation on how services are provided could have a material effect on the Company’s operations. | |
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. | |
Income Tax Examinations — During the first quarter of 2012, the State of California initiated an examination of the Company's income tax returns for the 2008 and 2009 income tax years. The examination is primarily focused on the Captive and the treatment of related insurance matters. To date, California has not proposed any adjustments. The Company is not currently under examination by any other major income tax jurisdiction. See Note 14, Income Taxes. | |
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, (iv) agreements with certain lenders under which the Company may be required to indemnify such lenders against various claims and liabilities, and (v) 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 Company’s patients and residents and the services the Company provides. The Company and others in the industry are subject to an increasing number of claims and lawsuits, including professional liability claims, alleging that services 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. | |
In July 2010, Congress passed the Dodd-Frank Wall Street Reform and Consumer Protection Act (Dodd-Frank Act). The Dodd-Frank Act establishes rigorous standards and supervision to protect the economy and American consumers, investors and businesses. Included under Section 922 of the Dodd-Frank Act, the Securities and Exchange Commission (SEC) will be required to pay a reward to individuals who provide original information to the SEC resulting in monetary sanctions exceeding $1,000 in civil or criminal proceedings. The award will range from 10 to 30 percent of the amount recouped and the amount of the award shall be at the discretion of the SEC. The purpose of this reward program is to “motivate those with inside knowledge to come forward and assist the Government to identify and prosecute persons who have violated securities laws and recover money for victims of financial fraud.” | |
Healthcare litigation (including class action litigation) is common and is filed based upon a wide variety of claims and theories, and we are routinely subjected to varying types of claims. One particular type of suit arises from alleged violations of state-established minimum staffing requirements for skilled nursing facilities. 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, civil monetary penalty, or litigation. These class-action “staffing” suits have the potential to result in large jury verdicts and settlements, and have become more prevalent in the wake of a previous substantial jury award against one of the Company's competitors. The Company expects the plaintiff's bar to become increasingly aggressive in their pursuit of these staffing and similar claims. | |
A class action staffing suit was previously filed against the Company in the State of California, alleging, among other things, violations of certain Health and Safety Code provisions and a violation of the Consumer Legal Remedies Act at certain of the Company's California facilities. In 2007, the Company settled this class action suit, and the settlement was approved by the affected class and the Court. The Company has been defending a second such staffing class-action claim filed in Los Angeles Superior Court; however, a settlement was reached with class counsel and has received Court approval. The total costs associated with the settlement, including attorney's fees, estimated class payout, and related costs and expenses, are projected to be approximately $6,500, of which, approximately $1,500 of this amount was recorded during the year ended December 31, 2013, with the balance having been expensed in prior periods. The Company believes that the settlement will not have a material ongoing adverse effect on the Company’s business, financial condition or results of operations. | |
Other claims and suits, including class actions, continue to be filed against us and other companies in our 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 has been, and continues to be, subject to claims and legal actions that arise in the ordinary course of business, including potential claims related to care and treatment provided at its facilities as well as employment related claims. The Company does not believe that the ultimate resolution of these actions will have a material adverse effect on the Company’s business, cash flows, financial condition or results of operations. 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, could materially adversely affect the Company’s business, financial condition, results of operations and cash flows. | |
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 is 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, its 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 Company's assumption of specific procedural and financial obligations 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. The Company had one operation subject to probe review during the year ended December 31, 2013. The Company anticipates that these probe reviews will increase in frequency in the future. Further, the Company currently has no facilities on prepayment review; however, others may be placed on prepayment review in the future. If a facility fails prepayment review, the facility could then be subject to undergo targeted review, which is a review that targets perceived claims deficiencies. The Company has no facilities that are currently undergoing targeted review. | |
U.S. Government Inquiry — In late 2006, the Company learned that it might be the subject of an on-going criminal and civil investigation by the DOJ. This was confirmed in March 2007. The investigation was prompted by a whistleblower complaint, and related primarily to claims submitted to the Medicare program for rehabilitation services provided at skilled nursing facilities in Southern California. The Company, through its outside counsel and a special committee of independent directors established by its board, worked cooperatively with the U.S. Attorney's office to produce information requested by the government as part of an ongoing dialogue designed to resolve the issue. | |
In December 2011, the DOJ notified the Company that it had closed its criminal investigation without action although, as is typical, it reserved the right to reopen the criminal case if new facts came to light. This left only the civil investigation to resolve, and the Company continued to supply requested information to the DOJ and the Office of the Inspector General of the United States Department of Health and Human Services (HHS), including specific patient records and documents from 2007 to 2011 from six Southern California skilled nursing facilities that had been the subject of previous requests. | |
In early 2013, discussions between government representatives and the Company's special committee, its outside counsel and their experts had advanced sufficiently that the Company recorded an initial estimated liability in the amount of $15,000 in the fourth quarter of 2012 for the resolution of claims connected to the investigation. In April 2013, the Company and government representatives reached an agreement in principle to resolve the allegations and close the investigation. Based on these discussions, the Company recorded and announced an additional charge in the amount of $33,000 in the first quarter of 2013, increasing the total reserve to resolve the matter to $48,000 (the Reserve Amount). | |
In October 2013, the Company completed and executed a settlement agreement (the Settlement Agreement) with the Department of Justice and received the final approval of the Office of Inspector General-HHS and the United States District Court for the Central District of California. The settlement agreement fully and finally resolves the previously disclosed DOJ investigation and any ancillary claims which have been pending since 2006. 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 with the Office of Inspector General-HHS (the CIA). The CIA acknowledges the existence of the Company’s current compliance program, and requires that the Company continue during the term of the CIA to maintain a compliance 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 maintain several elements of its existing program during the term of the CIA, including maintaining a compliance officer, a compliance committee of the board of directors, and a code of conduct. The CIA requires that the Company conduct certain additional compliance-related activities during the term of the CIA, including various training and monitoring procedures, and maintaining a disciplinary process for compliance obligations. Pursuant to the CIA, the Company is 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 subject to periodic reporting and certification requirements attesting that the provisions of the CIA are being implemented and followed, as well as certain document and record retention mandates. | |
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 56.8% and 56.2% of its total accounts receivable as of December 31, 2013 and 2012, respectively. Revenue from reimbursement under the Medicare and Medicaid programs accounted for 72.2%, 73.6% and 75.2% of the Company’s revenue for the years ended December 31, 2013, 2012 and 2011, 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 11, 2014, the Company had approximately $1,001 in uninsured cash deposits. All uninsured bank deposits are held at high quality credit institutions. |
Defined_Contribution_Plan_Note
Defined Contribution Plan (Notes) | 12 Months Ended |
Dec. 31, 2013 | |
Defined Contributions 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 $487, $444 and $369 during the years ended December 31, 2013, 2012 and 2011, respectively. Beginning in 2007, the Company's plan allowed eligible employees to contribute up to 90% of their eligible compensation, subject to applicable annual Internal Revenue Code limits. |
Significant_Accounting_Policie1
Significant Accounting Policies Level 2 (Policies) | 12 Months Ended |
Dec. 31, 2013 | |
SUMMARY OF SIGNIFICANT 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 of America (GAAP). The Company is the sole member or shareholder of various consolidated limited liability companies and corporations; each established to operate various acquired healthcare service operations. All intercompany transactions and balances have been eliminated in consolidation. 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 at December 31, 2013. | |
On March 25, 2013, the Company agreed to terms to sell Doctors Express (DRX), a national urgent care franchise system. The asset sale was effective on April 15, 2013. The results of operations for DRX have been classified as discontinued operations for all periods presented in the accompanying Financial Statements (see Note 4, Discontinued Operations). Certain assets and liabilities included in the sale of DRX have been presented as held for sale in the accompanying consolidated balance sheet as of December 31, 2012. In addition, the results of operations of DRX and the loss or impairment related to this divesture have been classified as discontinued operations in the accompanying consolidated statements of income for all periods presented. | |
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, worker’s compensation, and healthcare claims included in accrued self-insurance liabilities, other contingent liabilities, interest rate swaps, and income taxes. Actual results could differ from those estimates. | |
Segment Reporting, Policy [Policy Text Block] | ' |
Business Segments — The Company has a single reportable segment — healthcare services, which includes providing skilled nursing, assisted living, home health and hospice, urgent care and related ancillary services. The Company’s single reportable segment is made up of several individual operating segments grouped together principally based on their geographical locations within the United States. Based on the similar economic and other characteristics of each of the operating segments, management believes the Company meets the criteria for aggregating its operating segments into a single reportable segment. | |
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, interest rate swap agreements, 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. The interest rate swap is carried at fair value on the balance sheet. The Company’s fixed-rate debt instruments do not actively trade in an established market. The fair values of this debt are estimated by discounting the principal and interest payments at rates available to the Company for debt with similar terms and maturities. See further discussion of debt security investments in Note 6, Fair Value Measurements. | |
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 residents 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, daily basis. | |
Revenue from the Medicare and Medicaid programs accounted for 72.2%, 73.6% and 75.2% of the Company’s revenue for the years ended December 31, 2013, 2012 and 2011, 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 retroactive adjustments to revenue which were not material to the Company's consolidated revenue for the years ended December 31, 2013, 2012 and 2011. | |
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 residents and is recognized on the date services are provided at amounts billable to individual residents. For residents under 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, daily basis. The Company records revenue from private pay patients, at the agreed-upon rate, as services are performed. | |
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. Thereby, estimating revenue and recognizing it on a daily basis. | |
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 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 long-term assets. The majority of these deposits and investments are currently held in AA- and A- 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 6, Fair Value Measurements. | |
Equity Method Investments, Policy [Policy Text Block] | ' |
Equity Investment — As of December 31, 2012, one of the Company's subsidiaries had a non-marketable equity investment which was accounted for under the equity method. The investment was initially recorded at cost and the Company adjusted the carrying amount for its share of the earnings or losses of the investee after the date of investment. On April 23, 2013, the Company entered into a common unit redemption agreement with the investee where the non-marketable equity investment was repurchased. See further discussion at Note 12, Restricted and Other Assets. | |
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 57 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 operations 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 operations 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 has not identified any asset impairment during the years ended December 31, 2013, 2012 or 2011. | |
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, typically ranging from ten to 20 years. 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 facilities are amortized over 30 years and customer relationships are amortized over 20 years. | |
The Company's indefinite-lived intangible assets consist of trade names and home health and hospice Medicare 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. | |
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 defines reporting units as the individual operations. 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 [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. For claims made after January 1, 2013, the self-insured retention was $500 per claim, subject to an additional one-time deductible of $1,000 for California facilities and a separate, one-time deductible of $750 for non-California facilities. For all facilities, except those located in Colorado, the third-party coverage above these amounts was $1,000 per claim, $3,000 per facility, with a $5,000 blanket aggregate available to both California and non-California operations, separately. In Colorado, the third-party coverage above these limits was $1,000 per claim and $3,000 per facility, which is independent of the aforementioned blanket aggregate applicable to its other 113 facilities. | |
The self-insured retention and deductible limits for general and professional liability and California 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, 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 liability in California. To protect itself against loss exposure in California with this policy, the Company has purchased individual stop-loss insurance coverage that insures individual claims that exceed $500 for each 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 for each occurrence. The Company’s operating subsidiaries in other states have third party guaranteed cost coverage. In California and Texas, 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 $3,280 and $3,219 at December 31, 2013 and December 31, 2012, 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 provides self-insured 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 per each covered member, subject to an additional one-time 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. | |
When the Company takes uncertain income tax positions that do not meet the recognition criteria, it records a liability for underpayment of income taxes and related interest and penalties, if any. In considering the need for and magnitude of a liability for such positions, the Company must consider the potential outcomes from a review of the positions by the taxing authorities. | |
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. | |
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] | ' |
Stock-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. | |
Derivatives, Policy [Policy Text Block] | ' |
Derivatives and Hedging Activities — The Company evaluates variable and fixed interest rate risk exposure on a routine basis and to the extent the Company believes that it is appropriate, it will offset most of its variable risk exposure by entering into interest rate swap agreements. It is the Company's policy to only utilize derivative instruments for hedging purposes (i.e. not for speculation). The Company formally designates its interest rate swap agreements as hedges and documents all relationships between hedging instruments and hedged items. The Company formally assesses effectiveness of its hedging relationships, both at the hedge inception and on an ongoing basis, then measures and records ineffectiveness. The Company would discontinue hedge accounting prospectively (i) if it is determined that the derivative is no longer effective in offsetting change in the cash flows of a hedged item, (ii) when the derivative expires or is sold, terminated or exercised, (iii) if it is no longer probable that the forecasted transaction will occur, or (iv) if management determines that designation of the derivative as a hedge instrument is no longer appropriate. The Company’s derivative is recorded on the balance sheet at its fair value. | |
Lease, Policy [Policy Text Block] | ' |
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 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. | |
Comprehensive Income, Policy [Policy Text Block] | ' |
Accumulated Other Comprehensive Loss and Total Comprehensive Income — Accumulated other comprehensive loss refers to revenue, expenses, gains, and losses that are recorded as an element of stockholders’ equity but are excluded from net income. The Company’s other comprehensive loss consists of net deferred gains and losses on certain derivative instruments accounted for as cash flow hedges. As of December 31, 2013 accumulated other comprehensive loss was $1,828, recorded net of tax of $716, or $1,112. As of December 31, 2012, accumulated other comprehensive loss was $2,866, recorded net of tax of $1,121, or $1,745. | |
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) ASC is the sole source of authoritative GAAP literature recognized by the FASB and applicable to the Company. The Company has reviewed the FASB issued Accounting Standards Update (ASU) accounting pronouncements and interpretations thereof that have effectiveness dates during the periods reported and in future periods. The Company has carefully considered the new pronouncements that alter previous generally accepted accounting principles and does not believe that 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. | |
Additionally, the FASB and the International Accounting Standards Board are working on joint convergence projects to address accounting differences between GAAP and International Financial Reporting Standards in order to support their commitment to achieve a single set of high-quality global accounting standards. One of the projects under deliberation includes accounting for leases. If enacted in its current draft form, the Company anticipates that the lease accounting proposal could impact its consolidated financial statements; however, the FASB's standard-setting process is ongoing and until new standards have been finalized and issued, the Company cannot quantify and determine the impact on its consolidated financial statements that may result from such future changes. |
Discontinued_Operations_Tables
Discontinued Operations (Tables) | 12 Months Ended | ||||||||||||
Dec. 31, 2013 | |||||||||||||
Discontinued Operations [Abstract] | ' | ||||||||||||
Schedule of Components of Discontinued Operations [Table Text Block] | ' | ||||||||||||
Years Ended December 31, | |||||||||||||
2013 | 2012 | 2011 | |||||||||||
Revenue | $ | 728 | $ | 1,564 | $ | — | |||||||
Cost of services (exclusive of facility rent, general and administrative and depreciation and amortization expenses shown separately below) | (807 | ) | (3,646 | ) | — | ||||||||
Charges to discontinued operations for the excess carrying amount of goodwill and other indefinite-lived intangible assets | (2,837 | ) | — | — | |||||||||
Facility rent—cost of services | (12 | ) | (38 | ) | — | ||||||||
Depreciation and amortization | (33 | ) | (106 | ) | — | ||||||||
Loss from discontinued operations | (2,961 | ) | (2,226 | ) | — | ||||||||
Benefit from income taxes | (1,157 | ) | (869 | ) | — | ||||||||
Loss from discontinued operations, net of income tax benefit | $ | (1,804 | ) | $ | (1,357 | ) | $ | — | |||||
Schedule of Assets and Liabilites Held For Sale [Table Text Block] | ' | ||||||||||||
December 31, | |||||||||||||
2013 | 2012 | ||||||||||||
Current assets | $ | — | $ | 268 | |||||||||
Long-term assets: | |||||||||||||
Goodwill | — | 1,099 | |||||||||||
Other identifiable intangible assets, net | — | 10,200 | |||||||||||
Other long-term assets, net | — | 25 | |||||||||||
Total assets held for sale | — | 11,592 | |||||||||||
Current liabilities | — | (339 | ) | ||||||||||
Long-term liabilities | — | (130 | ) | ||||||||||
Total liabilities held for sale | — | (469 | ) | ||||||||||
Net assets held for sale | $ | — | $ | 11,123 | |||||||||
Computation_of_Net_Income_Per_1
Computation of Net Income Per Common Share (Tables) | 12 Months Ended | |||||||||||
Dec. 31, 2013 | ||||||||||||
COMPUTATION OF NET INCOME PER COMMON SHARE [Abstract] | ' | |||||||||||
Schedule of Earnings Per Share, Basic, by Common Class, Including Two Class Method [Table Text Block] | ' | |||||||||||
Years Ended December 31, | ||||||||||||
2013 | 2012 | 2011 | ||||||||||
Numerator: | ||||||||||||
Income from continuing operations | $ | 25,658 | $ | 41,165 | $ | 47,675 | ||||||
Less: net loss attributable to noncontrolling interests | (186 | ) | (783 | ) | — | |||||||
Income from continuing operations attributable to The Ensign Group, Inc. | 25,844 | 41,948 | 47,675 | |||||||||
Plus: loss from discontinued operations, net of income tax | (1,804 | ) | (1,357 | ) | — | |||||||
Net income attributable to The Ensign Group, Inc. | $ | 24,040 | $ | 40,591 | $ | 47,675 | ||||||
Denominator: | ||||||||||||
Weighted average shares outstanding for basic net income per share | 21,900 | 21,429 | 20,967 | |||||||||
Basic net income (loss) per common share: | ||||||||||||
Income from continuing operations attributable to The Ensign Group, Inc. | $ | 1.18 | $ | 1.96 | $ | 2.27 | ||||||
Loss from discontinued operations | (0.08 | ) | (0.07 | ) | — | |||||||
Net income attributable to The Ensign Group, Inc. | $ | 1.1 | $ | 1.89 | $ | 2.27 | ||||||
Schedule of Earnings Per Share, Diluted, by Common Class, Including Two Class Method [Table Text Block] | ' | |||||||||||
Years Ended December 31, | ||||||||||||
2013 | 2012 | 2011 | ||||||||||
Numerator: | ||||||||||||
Income from continuing operations | $ | 25,658 | $ | 41,165 | $ | 47,675 | ||||||
Less: net loss attributable to the noncontrolling interests | (186 | ) | (783 | ) | — | |||||||
Income from continuing operations attributable to The Ensign Group, Inc. | 25,844 | 41,948 | 47,675 | |||||||||
Plus: loss from discontinued operations, net of income tax | (1,804 | ) | (1,357 | ) | — | |||||||
Net income attributable to The Ensign Group, Inc. | $ | 24,040 | $ | 40,591 | $ | 47,675 | ||||||
Denominator: | ||||||||||||
Weighted average common shares outstanding | 21,900 | 21,429 | 20,967 | |||||||||
Plus: incremental shares from assumed conversion (1) | 464 | 513 | 616 | |||||||||
Adjusted weighted average common shares outstanding | 22,364 | 21,942 | 21,583 | |||||||||
Diluted net income (loss) per common share: | ||||||||||||
Income from continuing operations attributable to The Ensign Group, Inc. | $ | 1.16 | $ | 1.91 | $ | 2.21 | ||||||
Loss from discontinued operations | (0.09 | ) | (0.06 | ) | — | |||||||
Net income attributable to The Ensign Group, Inc. | $ | 1.07 | $ | 1.85 | $ | 2.21 | ||||||
Fair_Value_Measurements_Tables
Fair Value Measurements (Tables) | 12 Months Ended | ||||||||||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||||||||||
FAIR VALUE MEASUREMENTS [Abstract] | ' | ||||||||||||||||||||||||
Fair Value, Assets Measured on Recurring Basis [Table Text Block] | ' | ||||||||||||||||||||||||
December 31, | |||||||||||||||||||||||||
2013 | 2012 | ||||||||||||||||||||||||
Level 1 | Level 2 | Level 3 | Level 1 | Level 2 | Level 3 | ||||||||||||||||||||
Cash and cash equivalents | $ | 65,755 | $ | — | $ | — | $ | 40,685 | $ | — | $ | — | |||||||||||||
Fair value of interest rate swap | $ | — | $ | 1,828 | $ | — | $ | — | $ | 2,866 | $ | — | |||||||||||||
Revenue_and_Accounts_Receivabl1
Revenue and Accounts Receivable (Tables) | 12 Months Ended | ||||||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||||||
REVENUE AND ACCOUNTS RECEIVABLE [Abstract] | ' | ||||||||||||||||||||
Schedule of Revenue Sources, Health Care Organization [Table Text Block] | ' | ||||||||||||||||||||
December 31, | |||||||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||||||
$ | % | $ | % | $ | % | ||||||||||||||||
Medicaid | $ | 323,803 | 35.8 | % | $ | 302,046 | 36.7 | % | $ | 277,736 | 36.6 | % | |||||||||
Medicare | 292,917 | 32.4 | 278,578 | 33.8 | 272,283 | 35.9 | |||||||||||||||
Medicaid — skilled | 36,085 | 4 | 25,418 | 3.1 | 20,290 | 2.7 | |||||||||||||||
Total Medicaid and Medicare | 652,805 | 72.2 | 606,042 | 73.6 | 570,309 | 75.2 | |||||||||||||||
Managed care | 118,168 | 13.1 | 106,268 | 12.9 | 94,266 | 12.4 | |||||||||||||||
Private and other payors(1) | 133,583 | 14.7 | 110,845 | 13.5 | 93,702 | 12.4 | |||||||||||||||
Revenue | $ | 904,556 | 100 | % | $ | 823,155 | 100 | % | $ | 758,277 | 100 | % | |||||||||
Schedule of Accounts, Notes, Loans and Financing Receivable [Table Text Block] | ' | ||||||||||||||||||||
December 31, | |||||||||||||||||||||
2013 | 2012 | ||||||||||||||||||||
Medicaid | $ | 38,068 | $ | 28,534 | |||||||||||||||||
Managed care | 30,911 | 26,707 | |||||||||||||||||||
Medicare | 34,562 | 32,168 | |||||||||||||||||||
Private and other payors | 24,369 | 20,589 | |||||||||||||||||||
127,910 | 107,998 | ||||||||||||||||||||
Less: allowance for doubtful accounts | (16,540 | ) | (13,811 | ) | |||||||||||||||||
Accounts receivable | $ | 111,370 | $ | 94,187 | |||||||||||||||||
Acquisitions_Tables
Acquisitions (Tables) | 12 Months Ended | |||||||
Dec. 31, 2013 | ||||||||
ACQUISITIONS [Abstract] | ' | |||||||
Schedule of Business Acquisitions, by Acquisition [Table Text Block] | ' | |||||||
The table below presents the allocation of the purchase price for the operations acquired in business combinations during the years ended December 31, 2013 and 2012: | ||||||||
December 31, | ||||||||
2013 | 2012 | |||||||
Land | $ | 9,312 | $ | 1,012 | ||||
Building and improvements | 26,593 | 17,615 | ||||||
Equipment, furniture, and fixtures | 1,386 | 1,771 | ||||||
Assembled occupancy | 724 | 289 | ||||||
Goodwill | 3,197 | 7,105 | ||||||
Other indefinite-lived intangible assets | 4,152 | 10,007 | ||||||
Definite-lived intangible assets | — | 7,200 | ||||||
Other assets acquired, net of liabilities assumed | — | 651 | ||||||
Total acquisitions | $ | 45,364 | $ | 45,650 | ||||
Less: redeemable noncontrolling interest | — | (11,600 | ) | |||||
Less: noncontrolling interest in mobile diagnostic company acquired | — | (1,778 | ) | |||||
Less: cash received at acquisition | — | (714 | ) | |||||
Total cash paid for acquisitions | $ | 45,364 | $ | 31,558 | ||||
Property_and_Equipment_Tables
Property and Equipment (Tables) | 12 Months Ended | |||||||
Dec. 31, 2013 | ||||||||
PROPERTY AND EQUIPMENT [Abstract] | ' | |||||||
Property, Plant and Equipment [Table Text Block] | ' | |||||||
December 31, | ||||||||
2013 | 2012 | |||||||
Land | $ | 79,679 | $ | 70,487 | ||||
Buildings and improvements | 379,021 | 341,096 | ||||||
Equipment | 97,984 | 80,860 | ||||||
Furniture and fixtures | 8,851 | 8,790 | ||||||
Leasehold improvements | 44,123 | 32,570 | ||||||
Construction in progress | 2,081 | 14,185 | ||||||
611,739 | 547,988 | |||||||
Less: accumulated depreciation | (131,969 | ) | (100,133 | ) | ||||
Property and equipment, net | $ | 479,770 | $ | 447,855 | ||||
Intangible_Assets_Net_Tables
Intangible Assets - Net (Tables) | 12 Months Ended | |||||||||||||||||||||||||||
Dec. 31, 2013 | ||||||||||||||||||||||||||||
INTANGIBLE ASSETS — Net [Abstract] | ' | |||||||||||||||||||||||||||
Schedule of Finite-Lived Intangible Assets [Table Text Block] | ' | |||||||||||||||||||||||||||
December 31, | ||||||||||||||||||||||||||||
Weighted Average Life (Years) | 2013 | 2012 | ||||||||||||||||||||||||||
Gross Carrying Amount | Accumulated Amortization | Gross Carrying Amount | Accumulated Amortization | |||||||||||||||||||||||||
Intangible Assets | Net | Net | ||||||||||||||||||||||||||
Lease acquisition costs | 15.5 | $ | 684 | $ | (589 | ) | $ | 95 | $ | 684 | $ | (545 | ) | $ | 139 | |||||||||||||
Favorable lease | 15 | 1,596 | (532 | ) | 1,064 | 1,596 | (426 | ) | 1,170 | |||||||||||||||||||
Assembled occupancy | 0.5 | 2,979 | (2,948 | ) | 31 | 2,255 | (2,211 | ) | 44 | |||||||||||||||||||
Facility trade name | 30 | 733 | (195 | ) | 538 | 733 | (171 | ) | 562 | |||||||||||||||||||
Customer relationships | 20 | 4,200 | (210 | ) | 3,990 | 4,200 | — | 4,200 | ||||||||||||||||||||
Total | $ | 10,192 | $ | (4,474 | ) | $ | 5,718 | $ | 9,468 | $ | (3,353 | ) | $ | 6,115 | ||||||||||||||
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense [Table Text Block] | ' | |||||||||||||||||||||||||||
Year | Amount | |||||||||||||||||||||||||||
2014 | $ | 416 | ||||||||||||||||||||||||||
2015 | 365 | |||||||||||||||||||||||||||
2016 | 345 | |||||||||||||||||||||||||||
2017 | 345 | |||||||||||||||||||||||||||
2018 | 345 | |||||||||||||||||||||||||||
Thereafter | 3,902 | |||||||||||||||||||||||||||
$ | 5,718 | |||||||||||||||||||||||||||
Goodwill_and_Other_IndefiniteL1
Goodwill and Other Indefinite-Lived Intangible Assets (Tables) | 12 Months Ended | |||||||
Dec. 31, 2013 | ||||||||
GOODWILL AND OTHER INDEFINITE-LIVED INTANGIBLE ASSETS [Abstract] | ' | |||||||
Schedule of Goodwill [Table Text Block] | ' | |||||||
Goodwill | ||||||||
1-Jan-11 | $ | 10,339 | ||||||
Additions | 6,838 | |||||||
Impairments | — | |||||||
31-Dec-11 | 17,177 | |||||||
Additions | 7,104 | |||||||
Impairments | (1,625 | ) | ||||||
31-Dec-12 | 22,656 | |||||||
Less: charge to discontinued operations for the excess carrying amount of goodwill | (1,099 | ) | ||||||
21,557 | ||||||||
Additions | 3,197 | |||||||
Impairment | (490 | ) | ||||||
Purchase price adjustment | (329 | ) | ||||||
31-Dec-13 | $ | 23,935 | ||||||
Schedule of Acquired Indefinite-lived Intangible Assets by Major Class [Table Text Block] | ' | |||||||
December 31, | ||||||||
2013 | 2012 | |||||||
Trade name | $ | 1,033 | $ | 990 | ||||
Home health and hospice Medicare license | 6,707 | 2,598 | ||||||
$ | 7,740 | $ | 3,588 | |||||
Restricted_and_Other_Assets_Ta
Restricted and Other Assets (Tables) | 12 Months Ended | |||||||
Dec. 31, 2013 | ||||||||
RESTRICTED AND OTHER ASSETS [Abstract] | ' | |||||||
Schedule of Other Assets [Table Text Block] | ' | |||||||
December 31, | ||||||||
2013 | 2012 | |||||||
Note receivable | $ | 2,000 | $ | — | ||||
Debt issuance costs, net | 2,801 | 2,769 | ||||||
Long-term insurance losses recoverable asset | 3,280 | 3,219 | ||||||
Deposits with landlords | 872 | 749 | ||||||
Capital improvement reserves with landlords and lenders | 706 | 683 | ||||||
Equity method investment | — | 1,220 | ||||||
Other long-term assets | 145 | — | ||||||
Restricted and other assets | $ | 9,804 | $ | 8,640 | ||||
Other_Accrued_Liabilities_Tabl
Other Accrued Liabilities (Tables) | 12 Months Ended | |||||||
Dec. 31, 2013 | ||||||||
OTHER ACCRUED LIABILITIES [Abstract] | ' | |||||||
Schedule of Accrued Liabilities [Table Text Block] | ' | |||||||
December 31, | ||||||||
2013 | 2012 | |||||||
Quality assurance fee | $ | 3,933 | $ | 2,010 | ||||
Resident refunds payable | 5,238 | 4,564 | ||||||
Deferred revenue | 4,633 | 5,661 | ||||||
Cash held in trust for residents | 1,780 | 1,520 | ||||||
Resident deposits | 1,680 | 1,666 | ||||||
Dividends payable | 1,564 | — | ||||||
Property taxes | 2,894 | 2,264 | ||||||
Other | 3,976 | 3,186 | ||||||
Other accrued liabilities | $ | 25,698 | $ | 20,871 | ||||
Income_Taxes_Income_Tax_Disclo
Income Taxes Income Tax Disclosure (Tables) | 12 Months Ended | |||||||||||
Dec. 31, 2013 | ||||||||||||
Income Tax Disclosure [Abstract] | ' | |||||||||||
Schedule of Components of Income Tax Expense (Benefit) [Table Text Block] | ' | |||||||||||
December 31, | ||||||||||||
2013 | 2012 | 2011 | ||||||||||
Current: | ||||||||||||
Federal | $ | 13,457 | $ | 24,434 | $ | 24,217 | ||||||
State | 2,766 | 4,445 | 4,185 | |||||||||
16,223 | 28,879 | 28,402 | ||||||||||
Deferred: | ||||||||||||
Federal | 3,777 | (2,433 | ) | 2,041 | ||||||||
State | 3 | (1,312 | ) | (951 | ) | |||||||
3,780 | (3,745 | ) | 1,090 | |||||||||
Total | $ | 20,003 | $ | 25,134 | $ | 29,492 | ||||||
Schedule of Effective Income Tax Rate Reconciliation [Table Text Block] | ' | |||||||||||
December 31, | ||||||||||||
2013 | 2012 | 2011 | ||||||||||
Income tax expense at statutory rate | 35 | % | 35 | % | 35 | % | ||||||
State income taxes - net of federal benefit | 4 | 3 | 2.9 | |||||||||
Non-deductible settlement costs | 5 | — | — | |||||||||
Non-deductible expenses | 0.6 | 0.5 | 0.3 | |||||||||
Other adjustments | (0.8 | ) | (0.6 | ) | — | |||||||
Total income tax provision | 43.8 | % | 37.9 | % | 38.2 | % | ||||||
Schedule of Deferred Tax Assets and Liabilities [Table Text Block] | ' | |||||||||||
December 31, | ||||||||||||
2013 | 2012 | |||||||||||
Deferred tax assets (liabilities): | ||||||||||||
Accrued expenses | $ | 12,814 | $ | 16,916 | ||||||||
Allowance for doubtful accounts | 6,836 | 5,705 | ||||||||||
Tax credits | 2,898 | 2,400 | ||||||||||
Captive insurance | 8,979 | 7,360 | ||||||||||
Total deferred tax assets | 31,527 | 32,381 | ||||||||||
State taxes | (1,111 | ) | (327 | ) | ||||||||
Depreciation and amortization | (10,825 | ) | (11,828 | ) | ||||||||
Prepaid expenses | (5,895 | ) | (3,121 | ) | ||||||||
Total deferred tax liabilities | (17,831 | ) | (15,276 | ) | ||||||||
Net deferred tax assets | $ | 13,696 | $ | 17,105 | ||||||||
Leases_Tables
Leases (Tables) | 12 Months Ended | |||
Dec. 31, 2013 | ||||
Leases [Abstract] | ' | |||
Schedule of Future Minimum Rental Payments for Operating Leases [Table Text Block] | ' | |||
Year | Amount | |||
2014 | $ | 13,693 | ||
2015 | 13,677 | |||
2016 | 13,686 | |||
2017 | 13,722 | |||
2018 | 13,764 | |||
Thereafter | 71,093 | |||
$ | 139,635 | |||
SelfInsurance_Reserves_Tables
Self-Insurance Reserves (Tables) | 12 Months Ended | |||||||||||||||
Dec. 31, 2013 | ||||||||||||||||
Self-Insurance Reserves [Abstract] | ' | |||||||||||||||
Rollforward of Self Insurance Reserves [Table Text Block] | ' | |||||||||||||||
General and Professional Liability | ||||||||||||||||
Worker's Compensation | ||||||||||||||||
Health | Total | |||||||||||||||
Balance January 1, 2012 | $ | 32,010 | $ | 9,827 | $ | 2,436 | $ | 44,273 | ||||||||
Current year provisions | 13,226 | 7,186 | 14,302 | 34,714 | ||||||||||||
Claims paid and direct expenses | (9,207 | ) | (5,031 | ) | (14,271 | ) | (28,509 | ) | ||||||||
Long-term insurance losses recoverable | (921 | ) | 1,326 | — | 405 | |||||||||||
Balance December 31, 2012 | 35,108 | 13,308 | 2,467 | 50,883 | ||||||||||||
Current year provisions | 7,879 | 6,656 | 17,170 | 31,705 | ||||||||||||
Claims paid and direct expenses | (11,890 | ) | (4,755 | ) | (16,901 | ) | (33,546 | ) | ||||||||
Long-term insurance losses recoverable | (648 | ) | 709 | — | 61 | |||||||||||
Balance December 31, 2013 | $ | 30,449 | $ | 15,918 | $ | 2,736 | $ | 49,103 | ||||||||
Debt_Tables
Debt (Tables) | 12 Months Ended | |||||||
Dec. 31, 2013 | ||||||||
DEBT [Abstract] | ' | |||||||
Schedule of Long-term Debt Instruments [Table Text Block] | ' | |||||||
December 31, | ||||||||
2013 | 2012 | |||||||
Promissory note with RBS, principal and interest payable monthly and continuing through March 2019, interest at a fixed rate, collateralized by real property, assignment of rents and Company guaranty. | $ | 20,347 | $ | 21,032 | ||||
Senior Credit Facility with SunTrust and Wells Fargo, principal and interest payable quarterly, balance due at February 1, 2018, secured by substantially all of the Company’s personal property. | 144,325 | 89,375 | ||||||
Ten Project Note with GECC, principal and interest payable monthly; interest is fixed, balance due June 2016, collateralized by deeds of trust on real property, assignment of rents, security agreements and fixture financing statements. | 48,864 | 50,072 | ||||||
Promissory note with RBS, principal and interest payable monthly and continuing through January 2018, interest at a fixed rate, collateralized by real property, assignment of rents and Company guaranty. | 32,122 | 33,167 | ||||||
Promissory notes, principal, and interest payable monthly and continuing through October 2019, interest at fixed rate, collateralized by deed of trust on real property, assignment of rents and security agreement. | 8,919 | 9,203 | ||||||
Mortgage note, principal, and interest payable monthly and continuing through February 2027, interest at fixed rate, collateralized by deed of trust on real property, assignment of rents and security agreement. | 5,429 | 5,665 | ||||||
260,006 | 208,514 | |||||||
Less current maturities | (7,411 | ) | (7,187 | ) | ||||
Less debt discount | (700 | ) | (822 | ) | ||||
$ | 251,895 | $ | 200,505 | |||||
Schedule of Maturities of Long-term Debt [Table Text Block] | ' | |||||||
Years Ending | ||||||||
December 31, | Amount | |||||||
2014 | $ | 7,411 | ||||||
2015 | 7,672 | |||||||
2016 | 52,589 | |||||||
2017 | 6,584 | |||||||
2018 | 157,790 | |||||||
Thereafter | 27,960 | |||||||
$ | 260,006 | |||||||
Options_and_Awards_Tables
Options and Awards (Tables) | 12 Months Ended | ||||||||||||||||||
Dec. 31, 2013 | |||||||||||||||||||
OPTIONS AND AWARDS [Abstract] | ' | ||||||||||||||||||
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions [Table Text Block] | ' | ||||||||||||||||||
Grant Year | Options Granted | Weighted Average Risk-Free Rate | Expected Life | Weighted Average Volatility | Weighted Average Dividend Yield | ||||||||||||||
2013 | 248 | 1.18 | % | - | 1.87% | 6.5 years | 55 | % | 0.64 | % | - | 0.93% | |||||||
2012 | 246 | 0.84 | % | - | 1.18% | 6.5 years | 55 | % | 0.93% | ||||||||||
2011 | 97 | 1.42 | % | - | 2.53% | 6.5 years | 55 | % | 0.93% | ||||||||||
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Weighted Average Grant Date Fair Value [Table Text Block] | ' | ||||||||||||||||||
Grant Year | Granted | Weighted Average Exercise Price | Weighted Average Fair Value of Options | ||||||||||||||||
2013 | 248 | $ | 35.47 | $ | 17.7 | ||||||||||||||
2012 | 246 | $ | 27.65 | $ | 13.47 | ||||||||||||||
2011 | 97 | $ | 24.79 | $ | 12.38 | ||||||||||||||
Schedule of Common Stock Outstanding Roll Forward [Table Text Block] | ' | ||||||||||||||||||
Number of | Weighted | Number of | Weighted | ||||||||||||||||
Options | Average | Options Vested | Average | ||||||||||||||||
Outstanding | Exercise Price | Exercise Price | |||||||||||||||||
of Options | |||||||||||||||||||
Vested | |||||||||||||||||||
January 1, 2011 | 1,904 | $ | 11.55 | 921 | $ | 9.07 | |||||||||||||
Granted | 97 | 24.79 | |||||||||||||||||
Forfeited | (54 | ) | 13.57 | ||||||||||||||||
Exercised | (314 | ) | 7.9 | ||||||||||||||||
31-Dec-11 | 1,633 | $ | 12.97 | 936 | $ | 10.65 | |||||||||||||
Granted | 246 | 27.65 | |||||||||||||||||
Forfeited | (63 | ) | 15.8 | ||||||||||||||||
Exercised | (429 | ) | 10.95 | ||||||||||||||||
31-Dec-12 | 1,387 | $ | 16.06 | 739 | $ | 11.88 | |||||||||||||
Granted | 248 | 35.47 | |||||||||||||||||
Forfeited | (66 | ) | 24.71 | ||||||||||||||||
Exercised | (320 | ) | 11.19 | ||||||||||||||||
December 31, 2013 | 1,249 | $ | 20.71 | 681 | $ | 14.23 | |||||||||||||
Schedule of Share-based Compensation, Shares Authorized under Stock Option Plans, by Exercise Price Range [Table Text Block] | ' | ||||||||||||||||||
Stock Options Vested | |||||||||||||||||||
Stock Options Outstanding | |||||||||||||||||||
Number Outstanding | Black-Scholes Fair Value | Remaining Contractual Life (Years) | Vested and Exercisable | ||||||||||||||||
Year of Grant | Exercise Price | ||||||||||||||||||
2005 | 4.99 | - | 5.75 | 20 | * | 2 | 20 | ||||||||||||
2006 | 7.05 | - | 7.5 | 96 | 923 | 3 | 96 | ||||||||||||
2008 | 9.38 | - | 14.87 | 254 | 1,409 | 5 | 254 | ||||||||||||
2009 | 14.88 | - | 16.7 | 280 | 2,221 | 6 | 208 | ||||||||||||
2010 | 17.47 | - | 18.16 | 73 | 653 | 7 | 35 | ||||||||||||
2011 | 21.61 | - | 29.3 | 80 | 993 | 8 | 29 | ||||||||||||
2012 | 24.04 | - | 29.16 | 215 | 2,890 | 9 | 39 | ||||||||||||
2013 | 29.25 | - | 42.13 | 231 | 4,116 | 10 | — | ||||||||||||
Total | 1,249 | $ | 13,205 | 681 | |||||||||||||||
Schedule of Nonvested Restricted Stock Units Activity [Table Text Block] | ' | ||||||||||||||||||
Nonvested Restricted Awards | Weighted Average Grant Date Fair Value | ||||||||||||||||||
Nonvested at January 1, 2011 | 102 | $ | 18.05 | ||||||||||||||||
Granted | 143 | 25.52 | |||||||||||||||||
Vested | (31 | ) | 24.18 | ||||||||||||||||
Forfeited | (4 | ) | 19.16 | ||||||||||||||||
Nonvested at December 31, 2011 | 210 | $ | 22.32 | ||||||||||||||||
Granted | 71 | 27.78 | |||||||||||||||||
Vested | (44 | ) | 27.53 | ||||||||||||||||
Forfeited | (13 | ) | 21.98 | ||||||||||||||||
Nonvested at December 31, 2012 | 224 | $ | 23.04 | ||||||||||||||||
Granted | 93 | 35.27 | |||||||||||||||||
Vested | (51 | ) | 23.67 | ||||||||||||||||
Forfeited | (36 | ) | 24.7 | ||||||||||||||||
Nonvested at December 31, 2013 | 230 | $ | 28.68 | ||||||||||||||||
Schedule of Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Table Text Block] | ' | ||||||||||||||||||
Years Ended December 31, | |||||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||||
Share-based compensation expense related to stock options | $ | 2,217 | $ | 1,903 | $ | 2,265 | |||||||||||||
Share-based compensation expense related to restricted stock awards | 1,387 | 1,084 | 1,091 | ||||||||||||||||
Share-based compensation expense related to stock awards | 795 | 1,752 | — | ||||||||||||||||
Total | $ | 4,399 | $ | 4,739 | $ | 3,356 | |||||||||||||
Share-based Compensation, Schedule of Intrisice Values by Option Category [Table Text Block] | ' | ||||||||||||||||||
December 31, | |||||||||||||||||||
2013 | 2012 | 2011 | |||||||||||||||||
Outstanding | $ | 29,431 | $ | 15,703 | $ | 18,942 | |||||||||||||
Vested | 20,465 | 11,285 | 12,960 | ||||||||||||||||
Expected to vest | 7,873 | 4,088 | 5,374 | ||||||||||||||||
Exercised | 8,709 | 7,123 | 5,651 | ||||||||||||||||
Description_of_Business_Detail
Description of Business (Details) | Dec. 31, 2013 |
Operations | |
facilities | |
Skilled nursing, assisted living and independent living facilities [Abstract] | ' |
Number of Real Estate Properties | 96 |
Number of Real Estate Properties Leased | 23 |
Number of Real Estate Properties Leased with an Option to Purchase | 2 |
Number of Real Estate Properties Operated | 119 |
Home Health Operations [Abstract] | ' |
Home Health Operations | 9 |
Hospice Operations [Abstract] | ' |
Hospice Operations | 7 |
Operational Skilled Nursing, Assisted Living and Independent Living Beds [Abstract] | ' |
Operational Skilled Nursing, Assisted Living and Independent Living Beds | 13,200 |
REIT_SpinOff_Details
REIT Spin-Off (Details) (Real Estate Investment Trust Spin-Off Transaction [Member], USD $) | 0 Months Ended | |
Feb. 13, 2014 | Nov. 07, 2013 | |
Rate | facilities | |
Public Companies Created | ' | 2 |
Subsequent Event [Member] | ' | ' |
Independent Living Facilities Operated by REIT | ' | 3 |
Ownership diversity requirement | 50.00% | ' |
Ownership provision in charter | 9.80% | ' |
Dividend right | 1 | ' |
Shareholder Right | 1 | ' |
Exercise Price for Acquiring Person | $200 | ' |
Significant_Accounting_Policie2
Significant Accounting Policies Revenue and Accounts Receivable (Details) | 12 Months Ended | ||
Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | |
Rate | Rate | Rate | |
% of Revenue | 100.00% | 100.00% | 100.00% |
Total Medicaid and Medicare | ' | ' | ' |
% of Revenue | 72.20% | 73.60% | 75.20% |
Significant_Accounting_Policie3
Significant Accounting Policies Self Insurance Liabilities (Details) (USD $) | Dec. 31, 2013 |
In Thousands, unless otherwise specified | |
Parent Company [Member] | Self-insurance retention per claim [Member] | General and Professional Liability Insurance [Member] | ' |
Self Insurance Limits | $500 |
CALIFORNIA | Parent Company [Member] | Aggregate Deductible [Member] | General and Professional Liability Insurance [Member] | ' |
Self Insurance Limits | 1,000 |
Non-California [Domain] | Parent Company [Member] | Aggregate Deductible [Member] | General and Professional Liability Insurance [Member] | ' |
Self Insurance Limits | 750 |
COLORADO | Third-Party Payor [Member] | Per Occurence [Member] | General and Professional Liability Insurance [Member] | ' |
Self Insurance Limits | 1,000 |
COLORADO | Third-Party Payor [Member] | Per Facility [Member] | General and Professional Liability Insurance [Member] | ' |
Self Insurance Limits | 3,000 |
All States Accept Colorado [Domain] | ' |
Skilled Nursing, Assisted Living and Independent Living Facilities | 113 |
All States Accept Colorado [Domain] | Third-Party Payor [Member] | Per Occurence [Member] | General and Professional Liability Insurance [Member] | ' |
Self Insurance Limits | 1,000 |
All States Accept Colorado [Domain] | Third-Party Payor [Member] | Per Facility [Member] | General and Professional Liability Insurance [Member] | ' |
Self Insurance Limits | 3,000 |
All states [Domain] | Third-Party Payor [Member] | Blanket Aggregate [Member] | General and Professional Liability Insurance [Member] | ' |
Self Insurance Limits | $5,000 |
Significant_Accounting_Policie4
Significant Accounting Policies Self-Insurance Workers' Compensation (Details) (Stop-Loss Insurance limit per claim [Member], Workers' Compensation [Member], USD $) | Dec. 31, 2013 |
In Thousands, unless otherwise specified | |
Self Insurance Limits | $500 |
TEXAS | ' |
Self Insurance Limits | $750 |
Significant_Accounting_Policie5
Significant Accounting Policies Self-Insurance Health Insurance (Details) (6321 Accident and Health Insurance [Member], USD $) | Dec. 31, 2013 |
In Thousands, unless otherwise specified | |
Stop-Loss Insurance limit per claim [Member] | ' |
Self Insurance Limits | $300 |
Stop Loss Deductible [Member] | ' |
Self Insurance Limits | $75 |
Significant_Accounting_Policie6
Significant Accounting Policies Self Insurance Recoveries (Details) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Thousands, unless otherwise specified | ||
Long-term insurance losses recoverable asset | $3,280 | $3,219 |
General and Professional Liability Insurance [Member] | ' | ' |
Long-term insurance losses recoverable asset | $3,280 | $3,219 |
Significant_Accounting_Policie7
Significant Accounting Policies Impairment (Details) (USD $) | 3 Months Ended | 12 Months Ended | |
In Thousands, unless otherwise specified | Dec. 31, 2013 | Sep. 30, 2012 | Dec. 31, 2013 |
Impairment of Long-Lived Assets, Held-for-use [Abstract] | ' | ' | ' |
Impairment of Long-Lived Assets Held-for-use | $0 | $0 | $0 |
Significant_Accounting_Policie8
Significant Accounting Policies Accumulated Other Comprehensive Income (Details) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Thousands, unless otherwise specified | ||
Fair value of interest rate swap | $1,828 | $2,866 |
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | ' | ' |
Interest Rate Cash Flow Hedging Instrument Liability, Tax Effect | 716 | 1,121 |
Interest Rate Cash Flow Hedge Derivative at Fair Value, Net | -1,112 | -1,745 |
Fair value of interest rate swap | $1,828 | $2,866 |
Significant_Accounting_Policie9
Significant Accounting Policies Property and Equipment (Details) | 12 Months Ended |
Dec. 31, 2013 | |
Property, Plant and Equipment [Abstract] | ' |
Property, Plant and Equipment, Useful Lives, Minimum | '3 years 0 months |
Property, Plant and Equipment, Useful Lives, Maximum | '57 years 0 months |
Discontinued_Operations_Detail
Discontinued Operations (Details) (USD $) | 12 Months Ended | ||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Discontinued Operations [Abstract] | ' | ' | ' |
Charges to discontinued operations for the excess carrying amount of goodwill and other indefinite-lived intangible assets | $2,837 | $0 | $0 |
Asset disposal, sale price | $8,000 | ' | ' |
Discontinued_Operations_Statem
Discontinued Operations Statement of Operations, Disposal Group (Details) (USD $) | 12 Months Ended | ||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | ' | ' | ' |
Revenue | $728 | $1,564 | $0 |
Cost of services (exclusive of facility rent, general and administrative and depreciation and amortization expense shown separately below) | -807 | -3,646 | 0 |
Charges to discontinued operations for the excess carrying amount of goodwill and other indefinite-lived intangible assets | -2,837 | 0 | 0 |
Facility rent - cost of services | -12 | -38 | 0 |
Depreciation and amortization | -33 | -106 | 0 |
Loss from discontinued operations | -2,961 | -2,226 | 0 |
Tax benefit | -1,157 | -869 | 0 |
Loss from discontinued operation, net of income tax benefit | ($1,804) | ($1,357) | $0 |
Discontinued_Operations_Assets
Discontinued Operations Assets and Liabilities Held For Sale (Details) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Thousands, unless otherwise specified | ||
Schedule of Assets and Liabilites Held For Sale [Line Items] | ' | ' |
Current assets | $0 | $268 |
Long-term assets: | ' | ' |
Goodwill, net | 0 | 1,099 |
Other identifiable intangible assets, net | 0 | 10,200 |
Other long-term assets, net | 0 | 25 |
Total assets held for sale | 0 | 11,592 |
Current liabilities | 0 | -339 |
Long-term liabilities | 0 | 130 |
Total liabilities held for sale | 0 | 469 |
Net assets held for sale | $0 | $11,123 |
Computation_of_Net_Income_Per_2
Computation of Net Income Per Common Share (Details) (USD $) | 12 Months Ended | ||
In Thousands, except Per Share data, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Numerator: | ' | ' | ' |
Income from continuing operations | $25,658 | $41,165 | $47,675 |
Less: net income (loss) attributable to noncontrolling interests | -186 | -783 | 0 |
Income from continuing operations attributable to The Ensign Group, Inc. | 25,844 | 41,948 | 47,675 |
(Loss) income from discontinued operations, net of income tax benefit | -1,804 | -1,357 | 0 |
Net income attributable to The Ensign Group, Inc. | $24,040 | $40,591 | $47,675 |
Basic net income (loss) per common share: | ' | ' | ' |
Income from continuing operations attributable to The Ensign Group, Inc. | $1.18 | $1.96 | $2.27 |
Income (loss) from discontinued operations | ($0.08) | ($0.07) | $0 |
Net income attributable to The Ensign Group, Inc. | $1.10 | $1.89 | $2.27 |
Common Class A [Member] | ' | ' | ' |
Denominator: | ' | ' | ' |
Weighted average common shares outstanding | 21,900 | 21,429 | 20,967 |
Computation_of_Net_Income_Per_3
Computation of Net Income Per Common Share Dilutive Table (Details) (USD $) | 12 Months Ended | |||||
In Thousands, except Per Share data, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | |||
Numerator: | ' | ' | ' | |||
Income from continuing operations | $25,658 | $41,165 | $47,675 | |||
Less: net income (loss) attributable to noncontrolling interests | -186 | -783 | 0 | |||
Income from continuing operations attributable to The Ensign Group, Inc. | 25,844 | 41,948 | 47,675 | |||
(Loss) income from discontinued operations, net of income tax benefit | -1,804 | -1,357 | 0 | |||
Net income attributable to The Ensign Group, Inc. | $24,040 | $40,591 | $47,675 | |||
Diluted net (loss) income per common share: | ' | ' | ' | |||
Income from continuing operations attributable to The Ensign Group, Inc. | $1.16 | $1.91 | $2.21 | |||
Loss from discontinued operations | ($0.09) | ($0.06) | $0 | |||
Net income attributable to The Ensign Group, Inc. | $1.07 | $1.85 | $2.21 | |||
Common Class A [Member] | ' | ' | ' | |||
Denominator: | ' | ' | ' | |||
Weighted average common shares outstanding | 21,900 | 21,429 | 20,967 | |||
Plus: incremental shares from assumed conversion (1) | 464 | [1] | 513 | [1] | 616 | [1] |
Adjusted weighted average common shares outstanding | 22,364 | 21,942 | 21,583 | |||
[1] | (1) Options outstanding which are anti-dilutive and therefore not factored into the weighted average common shares amount above were 402, 340 and 97 for the years ended December 31, 2013, 2012 and 2011, respectively. |
Computation_of_Net_Income_Per_4
Computation of Net Income Per Common Share Antidilutive Shares (Details) | 12 Months Ended | ||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Earnings Per Share, Diluted, Other Disclosures [Abstract] | ' | ' | ' |
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount | 402 | 340 | 97 |
Fair_Value_Measurements_Detail
Fair Value Measurements (Details) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 | Sep. 30, 2012 | Dec. 31, 2011 | Dec. 31, 2010 |
In Thousands, unless otherwise specified | |||||
Cash and cash equivalents | $65,755 | $40,685 | $40,685 | $29,584 | $72,088 |
Fair value of interest rate swap | 1,828 | 2,866 | ' | ' | ' |
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | ' | ' | ' | ' | ' |
Cash and cash equivalents | 65,755 | 40,685 | ' | ' | ' |
Fair value of interest rate swap | 0 | 0 | ' | ' | ' |
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | ' | ' | ' | ' | ' |
Cash and cash equivalents | 0 | 0 | ' | ' | ' |
Fair value of interest rate swap | 1,828 | 2,866 | ' | ' | ' |
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member] | ' | ' | ' | ' | ' |
Cash and cash equivalents | 0 | 0 | ' | ' | ' |
Fair value of interest rate swap | $0 | $0 | ' | ' | ' |
Fair_Value_Measurements_Invest
Fair Value Measurements Investments (Details) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Thousands, unless otherwise specified | ||
Schedule of Held-to-maturity Securities [Line Items] | ' | ' |
Fair value of interest rate swap | $1,828 | $2,866 |
Held-to-maturity Securities | 22,399 | 22,510 |
Moody's, Aa2 Rating [Member] | ' | ' |
Schedule of Held-to-maturity Securities [Line Items] | ' | ' |
Held-to-maturity Securities | 4,066 | 6,310 |
Moody's, A1 Rating [Member] | ' | ' |
Schedule of Held-to-maturity Securities [Line Items] | ' | ' |
Held-to-maturity Securities | 18,333 | 16,200 |
Fair Value, Inputs, Level 2 [Member] | Fair Value, Measurements, Recurring [Member] | ' | ' |
Schedule of Held-to-maturity Securities [Line Items] | ' | ' |
Fair value of interest rate swap | 1,828 | 2,866 |
Interest Rate Cash Flow Hedging Instrument Liability, Tax Effect | 716 | 1,121 |
Interest Rate Cash Flow Hedge Derivative at Fair Value, Net | ($1,112) | ($1,745) |
Fair_Value_Measurements_SWAP_D
Fair Value Measurements SWAP (Details) (USD $) | 12 Months Ended | ||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Rate | |||
Derivative, Notional Amount | $75,000 | ' | ' |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | ' | ' | ' |
Maximum Length of Time Hedged in Cash Flow Hedge | '5 years 0 months | ' | ' |
Derivative, Fixed Interest Rate | 4.30% | ' | ' |
Interest Paid, Net | 1,047 | 951 | 471 |
Interest Expected to be Paid for the Year | 1,100 | ' | ' |
Fair Value, Inputs, Level 2 [Member] | Fair Value, Measurements, Recurring [Member] | ' | ' | ' |
Interest Rate Cash Flow Hedging Instrument Liability, Tax Effect | $716 | $1,121 | ' |
Months [Member] | Fair Value, Inputs, Level 2 [Member] | Fair Value, Measurements, Recurring [Member] | Regression Analysis [Member] | ' | ' | ' |
Discussion of Cash Flow Hedge Effectiveness Assessment and Measurement | '30 months | ' | ' |
Fair_Value_Measurements_Accumu
Fair Value Measurements Accumulated Other Comprehensive Loss (Details) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Thousands, unless otherwise specified | ||
Fair value of interest rate swap | $1,828 | $2,866 |
Fair Value, Inputs, Level 2 [Member] | Fair Value, Measurements, Recurring [Member] | ' | ' |
Fair value of interest rate swap | 1,828 | 2,866 |
Interest Rate Cash Flow Hedging Instrument Liability, Tax Effect | 716 | 1,121 |
Interest Rate Cash Flow Hedge Derivative at Fair Value, Net | ($1,112) | ($1,745) |
Revenue_and_Accounts_Receivabl2
Revenue and Accounts Receivable Revenue YTD (Details) (USD $) | 12 Months Ended | |||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | |
Rate | Rate | Rate | ||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | ' | ' | ' | |
Revenue | $904,556 | $823,155 | $758,277 | |
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 | 323,803 | 302,046 | 277,736 | |
Revenue by payor as a percent of total revenue | 35.80% | 36.70% | 36.60% | |
Medicare | ' | ' | ' | |
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | ' | ' | ' | |
Revenue | 292,917 | 278,578 | 272,283 | |
Revenue by payor as a percent of total revenue | 32.40% | 33.80% | 35.90% | |
Medicaid — skilled | ' | ' | ' | |
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | ' | ' | ' | |
Revenue | 36,085 | 25,418 | 20,290 | |
Revenue by payor as a percent of total revenue | 4.00% | 3.10% | 2.70% | |
Total Medicaid and Medicare | ' | ' | ' | |
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | ' | ' | ' | |
Revenue | 652,805 | 606,042 | 570,309 | |
Revenue by payor as a percent of total revenue | 72.20% | 73.60% | 75.20% | |
Managed care | ' | ' | ' | |
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | ' | ' | ' | |
Revenue | 118,168 | 106,268 | 94,266 | |
Revenue by payor as a percent of total revenue | 13.10% | 12.90% | 12.40% | |
Private and other payors | ' | ' | ' | |
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | ' | ' | ' | |
Revenue | $133,583 | [1] | $110,845 | $93,702 |
Revenue by payor as a percent of total revenue | 14.70% | [1] | 13.50% | 12.40% |
[1] | (1) Private and other payors includes revenue from urgent care centers and other ancillary businesses. |
Revenue_and_Accounts_Receivabl3
Revenue and Accounts Receivable Accounts Receivable (Details) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Thousands, unless otherwise specified | ||
Accounts, Notes, Loans and Financing Receivable [Line Items] | ' | ' |
Accounts Receivable, Gross | $127,910 | $107,998 |
Less: allowance for doubtful accounts | -16,540 | -13,811 |
Accounts receivable | 111,370 | 94,187 |
Medicaid | ' | ' |
Accounts, Notes, Loans and Financing Receivable [Line Items] | ' | ' |
Accounts Receivable, Gross | 38,068 | 28,534 |
Managed care | ' | ' |
Accounts, Notes, Loans and Financing Receivable [Line Items] | ' | ' |
Accounts Receivable, Gross | 30,911 | 26,707 |
Medicare | ' | ' |
Accounts, Notes, Loans and Financing Receivable [Line Items] | ' | ' |
Accounts Receivable, Gross | 34,562 | 32,168 |
Private other payors | ' | ' |
Accounts, Notes, Loans and Financing Receivable [Line Items] | ' | ' |
Accounts Receivable, Gross | $24,369 | $20,589 |
Acquisitions_Acquisition_Summa
Acquisitions Acquisition Summary (Details) | 12 Months Ended | 0 Months Ended | 12 Months Ended | 0 Months Ended | 12 Months Ended | |||||||
Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2012 | Apr. 02, 2013 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2012 | Jan. 02, 2013 | Dec. 31, 2013 | |
Businesses | Skilled nursing facility | Skilled nursing facility | Skilled nursing facility | Assisted Living Facility | Assisted Living Facility | Home Health Operation | Home Health Operation | Hospice Operation | Hospice Operation | Hospice Operation | Urgent Care Centers [Member] | |
facilities | facilities | TEXAS | facilities | facilities | Operations | Operations | Operations | Operations | Arizona and California | facilities | ||
facilities | Operations | |||||||||||
Business Acquisition [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Number of Businesses Acquired | 17 | 7 | 5 | 3 | 3 | 1 | 3 | 2 | 3 | 1 | 2 | 1 |
Acquisitions_Acquisitions_by_d
Acquisitions Acquisitions by date (Details) (USD $) | 12 Months Ended | 12 Months Ended | 0 Months Ended | 12 Months Ended | 0 Months Ended | 12 Months Ended | 0 Months Ended | 12 Months Ended | 0 Months Ended | 12 Months Ended | 0 Months Ended | |||||||||||||||||||||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 30, 2012 | Dec. 20, 2012 | Oct. 04, 2012 | Dec. 31, 2011 | Jan. 02, 2011 | Dec. 31, 2013 | Dec. 31, 2012 | Mar. 02, 2013 | Dec. 31, 2013 | Dec. 31, 2012 | Jan. 02, 2013 | Feb. 02, 2013 | Dec. 31, 2013 | Dec. 31, 2012 | Jan. 02, 2013 | Dec. 31, 2013 | Dec. 31, 2012 | Jul. 02, 2013 | Apr. 02, 2013 | Mar. 02, 2013 | 2-May-13 | Mar. 02, 2013 | 2-May-13 | Dec. 31, 2013 | Dec. 31, 2012 | Jun. 02, 2013 | Jun. 02, 2013 | Dec. 31, 2013 | Sep. 17, 2013 | Dec. 31, 2012 |
Businesses | facilities | Rate | Operations acquired in business combinations | Operations acquired in business combinations | urgent care franchising business [Member] | Home Health Operation | Home Health Operation | Home Health Operation | Home Health Operation | Hospice Operation | Hospice Operation | Hospice Operation | Skilled nursing facility | Skilled nursing facility | Skilled nursing facility | Skilled nursing facility | Skilled nursing facility | Skilled nursing facility | Home health and hospice operation | Skilled Nursing and Assisted Living Facilities [Member] | Assisted Living Facility | Assisted Living Facility | Assisted Living Facility | Assisted Living Facility | Urgent Care Centers [Member] | Urgent Care Centers [Member] | Mobile xray and diagnostic company [Member] | |||||
Centers | Operations | Operations | WASHINGTON | TEXAS | Operations | Operations | Arizona and California | facilities | facilities | WASHINGTON | TEXAS | TEXAS | NEBRASKA | WASHINGTON | WASHINGTON | facilities | facilities | CALIFORNIA | UTAH | facilities | WASHINGTON | Rate | ||||||||||
Operations | facilities | Beds | Beds | Beds | Beds | |||||||||||||||||||||||||||
Beds | ||||||||||||||||||||||||||||||||
Business Acquisition [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Number of Businesses Acquired | 17 | ' | ' | ' | ' | ' | ' | ' | ' | ' | 3 | 2 | ' | ' | 3 | 1 | 2 | 7 | 5 | ' | 3 | ' | ' | ' | ' | 3 | 1 | ' | ' | 1 | ' | ' |
Business acquisitions | ' | ' | ' | ' | ' | ' | ' | $45,364 | $31,558 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Cash payment to acquire businesses | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 2,801 | 375 | ' | ' | 1,825 | ' | ' | 4,499 | 7,114 | 4,508 | 2,846 | 1,137 | 11,585 | ' | ' | 4,263 | 2,856 | ' | 1,555 | ' |
Goodwill | 23,935 | 21,557 | 22,656 | ' | ' | 17,177 | 10,339 | 3,197 | 7,105 | 2,724 | ' | ' | 1,966 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,231 | 2,100 |
Subsidiary purchase of remaining ownership interest in urgent care franchising business | ' | ' | ' | ' | ' | ' | ' | ' | ' | 5,300 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Other intangible assets | ' | ' | ' | ' | ' | ' | ' | 4,152 | 10,007 | ' | ' | ' | 815 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Operational Assisted Living Units | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 102 | ' | ' | 110 | 69 | ' | ' | ' |
Operational Skilled Nursing Beds | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 82 | 280 | 150 | 70 | ' | 110 | ' | ' | ' | ' | ' | ' | ' |
Asset Acquisitions | ' | 3 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Asset Acquisitions | ' | 11,386 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Urgent Care Centers Operated | 7 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Additional investment in urgent care subsidiary | ' | ' | ' | ' | 6,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Fully diluted ownership interest in joint venture | ' | ' | ' | ' | 96.00% | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Purchase of remaining outstanding interests in joint venture | ' | ' | ' | 400 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Business Acquisition, purchase price, urgent care franchise operations | ' | ' | ' | ' | ' | ' | ' | ' | ' | 2,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Temporary Equity, Redemption Value | ' | ' | ' | ' | ' | ' | ' | ' | ' | 11,600 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Noncontrolling Interest, Ownership Percentage by Parent | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 80.00% |
Membership interest in entity acquired | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 5,800 |
Business Acquisition, net working capital acquired | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1,300 |
Business acquisition, cost of acquired entity | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 7,100 |
Indefinite-Lived Trade Names | 43 | ' | ' | ' | ' | ' | ' | ' | ' | 7,900 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 900 |
Finite-Lived Customer Relationships, Gross | ' | ' | ' | ' | ' | ' | ' | ' | ' | $3,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | $4,200 |
Acquisitions_Details
Acquisitions (Details) (USD $) | 12 Months Ended | ||||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 30, 2012 | Dec. 31, 2011 | Jan. 02, 2011 |
Allocation of purchase price: | ' | ' | ' | ' | ' |
Goodwill | $23,935 | $21,557 | $22,656 | $17,177 | $10,339 |
Definite-lived intangible assets | 0 | 7,200 | ' | ' | ' |
Other assets acquired, net of liabilities assumed | 0 | 651 | ' | ' | ' |
Less: redeemable noncontrolling interest | 0 | -11,600 | ' | ' | ' |
Less: noncontrolling interest in mobile diagnostic company | ' | -8,164 | ' | ' | ' |
Operations acquired in business combinations | ' | ' | ' | ' | ' |
Allocation of purchase price: | ' | ' | ' | ' | ' |
Land | 9,312 | 1,012 | ' | ' | ' |
Building and improvements | 26,593 | 17,615 | ' | ' | ' |
Equipment, furniture and fixtures | 1,386 | 1,771 | ' | ' | ' |
Assembled occupancy | 724 | 289 | ' | ' | ' |
Goodwill | 3,197 | 7,105 | ' | ' | ' |
Other intangible assets | 4,152 | 10,007 | ' | ' | ' |
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Assets | 45,364 | 45,650 | ' | ' | ' |
Business acquisitions | 45,364 | 31,558 | ' | ' | ' |
Mobile xray and diagnostic company [Member] | ' | ' | ' | ' | ' |
Allocation of purchase price: | ' | ' | ' | ' | ' |
Goodwill | ' | 2,100 | ' | ' | ' |
Less: noncontrolling interest in mobile diagnostic company | 0 | -1,778 | ' | ' | ' |
Less: cash received at acquisition | $0 | ($714) | ' | ' | ' |
Property_and_Equipment_Details
Property and Equipment (Details) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Thousands, unless otherwise specified | ||
Property, Plant and Equipment [Line Items] | ' | ' |
Property and equipment | $611,739 | $547,988 |
Less: accumulated depreciation | -131,969 | -100,133 |
Property and equipment, net | 479,770 | 447,855 |
Land | ' | ' |
Property, Plant and Equipment [Line Items] | ' | ' |
Property and equipment | 79,679 | 70,487 |
Building and improvements | ' | ' |
Property, Plant and Equipment [Line Items] | ' | ' |
Property and equipment | 379,021 | 341,096 |
Equipment | ' | ' |
Property, Plant and Equipment [Line Items] | ' | ' |
Property and equipment | 97,984 | 80,860 |
Furniture and fixtures | ' | ' |
Property, Plant and Equipment [Line Items] | ' | ' |
Property and equipment | 8,851 | 8,790 |
Leasehold improvements | ' | ' |
Property, Plant and Equipment [Line Items] | ' | ' |
Property and equipment | 44,123 | 32,570 |
Construction in progress | ' | ' |
Property, Plant and Equipment [Line Items] | ' | ' |
Property and equipment | $2,081 | $14,185 |
Intangible_Assets_Net_Details
Intangible Assets - Net (Details) (USD $) | 3 Months Ended | 12 Months Ended | 3 Months Ended | 3 Months Ended | 3 Months Ended | 12 Months Ended | 3 Months Ended | ||||||||||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2012 | Mar. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2012 | Mar. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2012 | Mar. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2012 | Mar. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2012 |
Lease acquisition costs | Lease acquisition costs | Lease acquisition costs | Off-Market Favorable Lease [Member] | Off-Market Favorable Lease [Member] | Off-Market Favorable Lease [Member] | Assembled occupancy | Assembled occupancy | Assembled occupancy | Facility trade names | Facility trade names | Facility trade names | Customer Relationships [Member] | Customer Relationships [Member] | ||||
Acquired Finite-Lived Intangible Assets [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Weighted Average Life (Years) | ' | ' | ' | '15 years 6 months | ' | ' | '15 years 0 months | ' | ' | '0 years 6 months | ' | ' | '30 years 0 months | ' | ' | ' | ' |
Gross Carrying Amount | $10,192 | $10,192 | $9,468 | ' | $684 | $684 | ' | $1,596 | $1,596 | ' | $2,979 | $2,255 | ' | $733 | $733 | $4,200 | $4,200 |
Accumulated Amortization | -4,474 | -4,474 | -3,353 | ' | -589 | -545 | ' | -532 | -426 | ' | -2,948 | -2,211 | ' | -195 | -171 | -210 | 0 |
Net | 5,718 | 5,718 | 6,115 | ' | 95 | 139 | ' | 1,064 | 1,170 | ' | 31 | 44 | ' | 538 | 562 | 3,990 | 4,200 |
Amortization [Abstract] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Amortization of Intangible Assets | $1,329 | $1,121 | $571 | ' | ' | ' | ' | ' | ' | ' | $737 | ' | ' | ' | ' | ' | ' |
Intangible_Assets_Net_Future_A
Intangible Assets - Net Future Amortization (Details) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Thousands, unless otherwise specified | ||
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract] | ' | ' |
2014 | $416 | ' |
2015 | 365 | ' |
2016 | 345 | ' |
2017 | 345 | ' |
2018 | 345 | ' |
Thereafter | 3,902 | ' |
Finite-Lived Intangible Assets, Net | $5,718 | $6,115 |
Goodwill_and_Other_IndefiniteL2
Goodwill and Other Indefinite-Lived Intangible Assets Goodwill (Details) (USD $) | 12 Months Ended | ||||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Dec. 30, 2012 | Jan. 02, 2011 |
Discontinued Operations [Abstract] | ' | ' | ' | ' | ' |
Asset disposal, sale price | $8,000 | ' | ' | ' | ' |
Charges to discontinued operations for the excess carrying amount of goodwill and other indefinite-lived intangible assets | 2,837 | 0 | 0 | ' | ' |
Less: charges to discontinued operations for the excess carrying amount of goodwill | -1,099 | ' | ' | ' | ' |
Disposal Group, Including Discontinued Operations, reduction in carrying amount of indefinite-lived intangible assets | 1,738 | ' | ' | ' | ' |
Goodwill [Roll Forward] | ' | ' | ' | ' | ' |
December 31, | 21,557 | 17,177 | ' | 22,656 | 10,339 |
Less: charges to discontinued operations for the excess carrying amount of goodwill | -1,099 | ' | ' | ' | ' |
Additions | 3,197 | 7,104 | 6,838 | ' | ' |
Goodwill Impairment | -490 | -1,625 | 0 | ' | ' |
Adjustment to net working capital for prior year acquisition | -329 | ' | ' | ' | ' |
December 31, | 23,935 | 21,557 | 17,177 | 22,656 | 10,339 |
Goodwill, Impaired, Accumulated Impairment Loss | 3,399 | ' | ' | ' | ' |
Impairment of Intangible Assets, Indefinite-lived (Excluding Goodwill) | ' | $600 | ' | ' | ' |
Goodwill_and_Other_IndefiniteL3
Goodwill and Other Indefinite-Lived Intangible Assets Other Indefinite-Lived Intangibles (Details) (USD $) | 12 Months Ended |
In Thousands, unless otherwise specified | Dec. 31, 2013 |
Operations | |
Indefinite-Lived Intangible Assets Acquired [Abstract] | ' |
Indefinite-Lived Trade Names | $43 |
Acquired Indefinite-lived intangible assets, Home Health Medicare License | $4,109 |
Home Health Operations Acquired | 3 |
Hospice Operations Acquired | 3 |
Goodwill_and_Other_IndefiniteL4
Goodwill and Other Indefinite-Lived Intangible Assets Indefinite-lived intangble assets (Details) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Thousands, unless otherwise specified | ||
Indefinite-lived Intangible Assets [Line Items] | ' | ' |
Other indefinite-lived intangibles | $7,740 | $3,588 |
Trade Names [Member] | ' | ' |
Indefinite-lived Intangible Assets [Line Items] | ' | ' |
Other indefinite-lived intangibles | 1,033 | 990 |
Home Health and Hospice Medicare License [Member] | ' | ' |
Indefinite-lived Intangible Assets [Line Items] | ' | ' |
Other indefinite-lived intangibles | $6,707 | $2,598 |
Restricted_and_Other_Assets_De
Restricted and Other Assets (Details) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Thousands, unless otherwise specified | ||
RESTRICTED AND OTHER ASSETS [Abstract] | ' | ' |
Notes receivable non current | $2,000 | $0 |
Debt issuance costs, net | 2,801 | 2,769 |
Long-term insurance losses recoverable asset | 3,280 | 3,219 |
Deposits with landlords | 872 | 749 |
Capital improvement reserves with landlords and lenders | 706 | 683 |
Equity method investments | 0 | 1,220 |
Other long-term assets | 145 | 0 |
Restricted and other assets | $9,804 | $8,640 |
Restricted_and_Other_Assets_Su
Restricted and Other Assets Subsequent Event (Details) (USD $) | 3 Months Ended | 12 Months Ended | ||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Subsequent Event - Sale of Investment [Abstract] | ' | ' | ' | ' |
Cash proceeds on sale of equity method investment | $1,600 | $1,600 | $0 | $0 |
Gain (Loss) on Sale of Equity Investments | $380 | ' | ' | ' |
Other_Accrued_Liabilities_Deta
Other Accrued Liabilities (Details) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Thousands, unless otherwise specified | ||
OTHER ACCRUED LIABILITIES [Abstract] | ' | ' |
Quality assurance fee | $3,933 | $2,010 |
Resident refunds payable | 5,238 | 4,564 |
Deferred revenue | 4,633 | 5,661 |
Cash held in trust for residents | 1,780 | 1,520 |
Resident deposits | 1,680 | 1,666 |
Dividends payable | 1,564 | 0 |
Property taxes | 2,894 | 2,264 |
Other | 3,976 | 3,186 |
Other accrued liabilities | $25,698 | $20,871 |
Income_Taxes_US_Goverment_Inqu
Income Taxes U.S. Goverment Inquiry Settlement (Details) (USD $) | 3 Months Ended | 12 Months Ended | |||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
U.S. Government Inquiry Settlement [Abstract] | ' | ' | ' | ' | ' |
U.S. Government inquiry settlement (Note 19) | ' | $15,000 | $33,000 | $15,000 | $0 |
Tax Benefit Recognized on Settlement with the U.S. Government | 10,383 | 5,865 | ' | ' | ' |
U.S. Government inquiry settlement | ' | ' | $48,000 | ' | ' |
Income_Taxes_Income_Tax_Expens
Income Taxes Income Tax Expense (Details) (USD $) | 12 Months Ended | ||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Current: | ' | ' | ' |
Current Federal Tax Expense (Benefit) | $13,457 | $24,434 | $24,217 |
Current State and Local Tax Expense (Benefit) | 2,766 | 4,445 | 4,185 |
Current Income Tax Expense (Benefit) | 16,223 | 28,879 | 28,402 |
Deferred: | ' | ' | ' |
Deferred Federal Income Tax Expense (Benefit) | 3,777 | -2,433 | 2,041 |
Deferred State and Local Income Tax Expense (Benefit) | 3 | -1,312 | -951 |
Deferred Income Tax Expense (Benefit) | 3,780 | -3,745 | 1,090 |
Income Tax Expense (Benefit) | $20,003 | $25,134 | $29,492 |
Income_Taxes_Rate_Reconciliati
Income Taxes Rate Reconciliation (Details) | 12 Months Ended | ||
Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | |
Rate | Rate | Rate | |
Effective Income Tax Rate Reconciliation, Percent [Abstract] | ' | ' | ' |
Income tax expense at statutory rate | 35.00% | 35.00% | 35.00% |
State income taxes - net of federal benefit | 4.00% | 3.00% | 2.90% |
Effective Income Tax Rate Reconciliation, Non-deductible expense, U.S. Government settlement | 5.00% | 0.00% | 0.00% |
Non-deductible expenses | 0.60% | 0.50% | 0.30% |
Other adjustments | -0.80% | -0.60% | 0.00% |
Total income tax provision | 43.80% | 37.90% | 38.20% |
Income_Taxes_Deferred_Tax_Asse
Income Taxes Deferred Tax Assets and Liabilities (Details) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Thousands, unless otherwise specified | ||
Components of Deferred Tax Assets and Liabilities [Abstract] | ' | ' |
Accrued Expenses | $12,814 | $16,916 |
Allowance for doubtful accounts | 6,836 | 5,705 |
Tax credits | 2,898 | 2,400 |
Captive insurance | 8,979 | 7,360 |
Total deferred tax assets | 31,527 | 32,381 |
State taxes | -1,111 | -327 |
Depreciation and amortization | -10,825 | -11,828 |
Prepaid expenses | -5,895 | -3,121 |
Total deferred tax liabilities | -17,831 | -15,276 |
Net deferred tax assets | $13,696 | $17,105 |
Income_Taxes_Additional_Tax_In
Income Taxes Additional Tax Information (Details) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Additional Income Tax Disclosures [Abstract] | ' | ' | ' |
Tax credits | $2,898,000 | $2,400,000 | ' |
Deferred Tax Assets, Operating Loss Carryforwards, Subject to Expiration | 1,243,000 | 932,000 | ' |
Deferred Tax Assets, Operating Loss Carryforwards, State and Local | 559,000 | 1,134,000 | ' |
Unrecognized Tax Benefits | $0 | $0 | $0 |
Leases_Details
Leases (Details) (USD $) | Dec. 31, 2013 |
In Thousands, unless otherwise specified | |
Leases [Abstract] | ' |
2014 | $13,693 |
2015 | 13,677 |
2016 | 13,686 |
2017 | 13,722 |
2018 | 13,764 |
Thereafter | 71,093 |
Operating Leases, Future Minimum Payments Due | $139,635 |
Leases_Lease_Description_Detai
Leases Lease Description (Details) (USD $) | 12 Months Ended | ||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Agreements | |||
facilities | |||
Lease Description [Abstract] | ' | ' | ' |
Average operating lease minimum term | '5 years 0 months | ' | ' |
Average operating lease maximum term | '20 years 0 months | ' | ' |
Average non-cancellable equipment leases minimum term | '3 years 0 months | ' | ' |
Average non-cancellable equipment lease maximum term | '5 years 0 months | ' | ' |
Operating Leases, Rent Expense, Net | $14,073 | $13,779 | $14,185 |
Facilities under master lease arrangement | 6 | ' | ' |
Master Lease Agreements | 2 | ' | ' |
SelfInsurance_Reserves_Details
Self-Insurance Reserves (Details) (USD $) | 12 Months Ended | |
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 |
Liability for Future Policy Benefit, by Product Segment [Line Items] | ' | ' |
Balance | $50,883 | $44,273 |
Current year provisions | 31,705 | 34,714 |
Claims paid and direct expenses | -33,546 | -28,509 |
Long-term insurance losses recoverable | 61 | 405 |
Balance | 49,103 | 50,883 |
Professional Malpractice Liability Insurance [Member] | ' | ' |
Liability for Future Policy Benefit, by Product Segment [Line Items] | ' | ' |
Balance | 35,108 | 32,010 |
Current year provisions | 7,879 | 13,226 |
Claims paid and direct expenses | -11,890 | -9,207 |
Long-term insurance losses recoverable | -648 | -921 |
Balance | 30,449 | 35,108 |
Workers' Compensation [Member] | ' | ' |
Liability for Future Policy Benefit, by Product Segment [Line Items] | ' | ' |
Balance | 13,308 | 9,827 |
Current year provisions | 6,656 | 7,186 |
Claims paid and direct expenses | -4,755 | -5,031 |
Long-term insurance losses recoverable | 709 | 1,326 |
Balance | 15,918 | 13,308 |
Health Insurance Product Line [Member] | ' | ' |
Liability for Future Policy Benefit, by Product Segment [Line Items] | ' | ' |
Balance | 2,467 | 2,436 |
Current year provisions | 17,170 | 14,302 |
Claims paid and direct expenses | -16,901 | -14,271 |
Long-term insurance losses recoverable | 0 | 0 |
Balance | $2,736 | $2,467 |
Debt_Details
Debt (Details) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 |
In Thousands, unless otherwise specified | ||
Debt Instrument [Line Items] | ' | ' |
Long-term Debt, Gross | $260,006 | $208,514 |
Current maturities of long-term debt | -7,411 | -7,187 |
Debt Instrument, Unamortized Discount | -700 | -822 |
Long Term Debt, net of Current Maturities and Debt Discount | 251,895 | 200,505 |
Collateralized Debt Obligations [Member] | ' | ' |
Debt Instrument [Line Items] | ' | ' |
Mortgage Loans on Real Estate | 5,429 | 5,665 |
Collateralized Debt Obligations [Member] | Notes Payable, Other Payables [Member] | ' | ' |
Debt Instrument [Line Items] | ' | ' |
Notes Payable | 8,919 | 9,203 |
Debt Instrument, Unamortized Discount | -1,218 | ' |
RBS Feb 2012 [Member] | Collateralized Debt Obligations [Member] | Notes Payable to Banks [Member] | ' | ' |
Debt Instrument [Line Items] | ' | ' |
Notes Payable | 20,347 | 21,032 |
Six-Bank Lending Consortium Arranged by SunTrust and Wells Fargo [Member] | Secured Debt [Member] | Senior Debt Obligations [Member] | ' | ' |
Debt Instrument [Line Items] | ' | ' |
Senior Notes | 144,325 | 89,375 |
General Electric Capital Corporation (GECC) [Member] | Collateralized Debt Obligations [Member] | Notes Payable to Banks [Member] | ' | ' |
Debt Instrument [Line Items] | ' | ' |
Notes Payable | 48,864 | 50,072 |
RBS [Member] | Collateralized Debt Obligations [Member] | Notes Payable to Banks [Member] | ' | ' |
Debt Instrument [Line Items] | ' | ' |
Notes Payable | $32,122 | $33,167 |
Debt_New_Loan_Description_Deta
Debt New Loan Description (Details) (USD $) | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 | Dec. 31, 2013 |
In Thousands, unless otherwise specified | Senior Notes [Member] | Senior Notes [Member] | Senior Notes [Member] | Senior Notes [Member] | Senior Debt Obligations [Member] | Collateralized Debt Obligations [Member] | Collateralized Debt Obligations [Member] | Collateralized Debt Obligations [Member] | Collateralized Debt Obligations [Member] | Collateralized Debt Obligations [Member] | ||
Six-Bank Lending Consortium Arranged by SunTrust and Wells Fargo [Member] | Six-Bank Lending Consortium Arranged by SunTrust and Wells Fargo [Member] | Six-Bank Lending Consortium Arranged by SunTrust and Wells Fargo [Member] | Six-Bank Lending Consortium Arranged by SunTrust and Wells Fargo [Member] | Six-Bank Lending Consortium Arranged by SunTrust and Wells Fargo [Member] | Rate | Notes Payable, Other Payables [Member] | RBS [Member] | General Electric Capital Corporation (GECC) [Member] | RBS Feb 2012 [Member] | |||
Revolving Credit Facility [Member] | Senior Debt Obligations [Member] | Senior Debt Obligations [Member] | Notes Payable to Banks [Member] | Inerest Rate Option Two [Member] | Rate | Notes Payable to Banks [Member] | Notes Payable to Banks [Member] | Notes Payable to Banks [Member] | ||||
Rate | Interest Rate Option One [Member] | Rate | Rate | Rate | Rate | |||||||
Rate | ||||||||||||
Covenant on Maximum Settlement Amount for U.S. Government Inquiry | ' | ' | $50,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' |
LIne of Credit Facility Extention | ' | ' | 75,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Debt Instrument, Interest Rate, Stated Percentage | ' | ' | ' | ' | 2.50% | ' | 1.50% | 7.50% | 6.00% | 6.04% | ' | 4.75% |
Line of Credit Facility, Maximum Borrowing Capacity | ' | ' | 150,000 | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Line of Credit Facility, Amount Outstanding | ' | ' | 78,700 | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Original maximum borrowing capacity | ' | ' | 75,000 | 150,000 | ' | 75,000 | ' | ' | ' | ' | ' | ' |
Debt Instrument, Interest Rate, Effective Percentage | ' | ' | ' | 5.00% | ' | ' | ' | ' | ' | ' | ' | ' |
Debt Covenant - Maximum dividends declared | ' | ' | ' | 20.00% | ' | ' | ' | ' | ' | ' | ' | ' |
Debt Instrument, Face Amount | ' | ' | ' | ' | ' | ' | ' | ' | 10,000 | 35,000 | 55,700 | 21,525 |
Debt Instrument, Term | ' | ' | ' | ' | ' | ' | ' | ' | '10 years 0 months | '7 years 0 months | ' | '7 years 0 months |
Debt instrument, prepayment fee, percent | ' | ' | ' | ' | ' | ' | ' | ' | ' | 5.00% | ' | ' |
Debt instrument, prepayment penalty annual reduction, percent | ' | ' | ' | ' | ' | ' | ' | ' | ' | 1.00% | ' | ' |
Debt Instrument, Interest Rate, Stated Percentage Rate Range, Minimum | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 6.95% | ' |
Debt Instrument, Interest Rate, Stated Percentage Rate Range, Maximum | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | 7.50% | ' |
Debt Instrument, Unamortized Discount | $700 | $822 | ' | ' | ' | ' | ' | ' | $1,218 | ' | ' | ' |
Debt_Maturities_Details
Debt Maturities (Details) (USD $) | Dec. 31, 2013 |
In Thousands, unless otherwise specified | |
Long-term debt maturities [Abstract] | ' |
Long-term Debt, Maturities, Repayments of Principal in Next Twelve Months | $7,411 |
Long-term Debt, Maturities, Repayments of Principal in Year Two | 7,672 |
Long-term Debt, Maturities, Repayments of Principal in Year Three | 52,589 |
Long-term Debt, Maturities, Repayments of Principal in Year Four | 6,584 |
Long-term Debt, Maturities, Repayments of Principal in Year Five | 157,790 |
Long-term Debt, Maturities, Repayments of Principal after Year Five | 27,960 |
Long-term Debt | $260,006 |
Options_and_Awards_Lead_Paragr
Options and Awards Lead Paragraphs (Details) | 12 Months Ended | ||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Rate | |||
Share-based Compensation Arrangement by Share-based Payment Award, Options, Additional Disclosures [Abstract] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions, Estimated Forfeiture Rate | 8.45% | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant | 1,780 | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period | '5 years 0 months | ' | ' |
Issuance of restricted stock to employees | 93 | 71 | 143 |
Options Granted | 248 | 246 | 97 |
Treasury Stock [Member] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Options, Additional Disclosures [Abstract] | ' | ' | ' |
Issuance of restricted stock to employees | 0 | 0 | 0 |
2001 Stock Option Plan [Member] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Options, Additional Disclosures [Abstract] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant | 319 | 319 | 314 |
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period | '5 years 0 months | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Rights, Percentage | 20.00% | ' | ' |
2005 Stock Incentive Plan [Member] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Options, Additional Disclosures [Abstract] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant | 147 | 147 | 147 |
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period | '5 years 0 months | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Rights, Percentage | 20.00% | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Authorized | 1,000 | ' | ' |
2005 Stock Incentive Plan [Member] | Treasury Stock [Member] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Options, Additional Disclosures [Abstract] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant | 800 | ' | ' |
2007 Omnibus Incentive Plan [Member] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Options, Additional Disclosures [Abstract] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant | 1,314 | 1,149 | 1,039 |
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period | '5 years 0 months | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Rights, Percentage | 20.00% | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Expiration Period | '10 years 0 months | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Authorized | 1,000 | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Annual Increase in Number of Shares Authorized | 1,000 | ' | ' |
Options_and_Awards_Valuation_A
Options and Awards Valuation Assumptions QTD (Details) | 12 Months Ended | ||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Rate | Rate | Rate | |
Fair Value Assumptions and Methodology | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions, Estimated Forfeiture Rate | 8.45% | ' | ' |
Options Granted | 248 | 246 | 97 |
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions, Risk Free Interest Rate, Minimum | 1.18% | 0.84% | 1.42% |
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions, Risk Free Interest Rate, Maximum | 1.87% | 1.18% | 2.53% |
Expected Life | '6 years 6 months | '6 years 6 months | '6 years 6 months |
Weighted Average Volatility | 55.00% | 55.00% | 55.00% |
Weighted Average Dividend Yield | 0.64% | 0.93% | 0.93% |
Options_and_Awards_Exercise_Pr
Options and Awards Exercise Price and Fair Value (Details) (USD $) | 12 Months Ended | ||
In Thousands, except Per Share data, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Net of Forfeitures [Abstract] | ' | ' | ' |
Options Granted | 248 | 246 | 97 |
Weighted Average Exercise Price | $35.47 | $27.65 | $24.79 |
Weighted Average Fair Value of Options | $17.70 | $13.47 | $12.38 |
Intrinsic Value of Options Granted on Grant Date [Abstract] | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Grant Date Intrinsic Value | $0 | ' | ' |
Options_and_Awards_Options_Out
Options and Awards Options Outstanding Rollforward (Details) (USD $) | 12 Months Ended | |||
In Thousands, except Per Share data, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Jan. 02, 2011 |
Options Granted | 248 | 246 | 97 | ' |
Weighted Average Exercise Price, Options Granted | $35.47 | $27.65 | $24.79 | ' |
Weighted Average Exercise Price, Options Forfeited in Period | $24.70 | $21.98 | $19.16 | ' |
Common Class A [Member] | ' | ' | ' | ' |
Options outstanding January 1, 2013 | 1,387 | 1,633 | ' | 1,904 |
Weighted average exercise price January 1, 2013 | $16.06 | $12.97 | ' | $11.55 |
Options vested January 1, 2013 | 739 | 936 | ' | 921 |
Weighted Average Exercise Price of Options Vested January 1, 2013 | $11.88 | $10.65 | ' | $9.07 |
Options Granted | 248 | 246 | 97 | ' |
Options Forfeited in Period | -66 | -63 | -54 | ' |
Weighted Average Exercise Price, Options Forfeited in Period | $24.71 | $15.80 | $13.57 | ' |
Options Exercised in Period | -320 | -429 | -314 | ' |
Weighted Average Exercise Price, Options Exercised in Period | $11.19 | $10.95 | $7.90 | ' |
Options outstanding September 30, 2013 | 1,249 | 1,387 | 1,633 | 1,904 |
Weighted average exercise price September 30, 2013 | $20.71 | $16.06 | $12.97 | $11.55 |
Options vested September 30, 2013 | 681 | 739 | 936 | 921 |
Weighted Average Exercise Price of Options Vested September 30, 2013 | $14.23 | $11.88 | $10.65 | $9.07 |
Options_and_Awards_Options_Out1
Options and Awards Options Outstanding by Exercise Price (Details) (USD $) | 12 Months Ended | |
In Thousands, except Per Share data, unless otherwise specified | Dec. 31, 2013 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Number of Outstanding Options | 1,249 | |
Black-Scholes Fair Value | $13,205 | |
Stock Options Vested and Exercisable | 681 | |
2005 | ' | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Exercise Price, Lower Range Limit | $4.99 | |
Exercise Price, Upper Range Limit | $5.75 | |
Black-Scholes Fair Value | 0 | [1] |
Remaining Contractual Life (Years) | '2 years 0 months | |
2006 | ' | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Exercise Price, Lower Range Limit | $7.05 | |
Exercise Price, Upper Range Limit | $7.50 | |
Black-Scholes Fair Value | 923 | |
Remaining Contractual Life (Years) | '3 years 0 months | |
2008 | ' | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Exercise Price, Lower Range Limit | $9.38 | |
Exercise Price, Upper Range Limit | $14.87 | |
Black-Scholes Fair Value | 1,409 | |
Remaining Contractual Life (Years) | '5 years 0 months | |
2009 | ' | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Exercise Price, Lower Range Limit | $14.88 | |
Exercise Price, Upper Range Limit | $16.70 | |
Black-Scholes Fair Value | 2,221 | |
Remaining Contractual Life (Years) | '6 years 0 months | |
2010 | ' | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Exercise Price, Lower Range Limit | $17.47 | |
Exercise Price, Upper Range Limit | $18.16 | |
Black-Scholes Fair Value | 653 | |
Remaining Contractual Life (Years) | '7 years 0 months | |
2011 | ' | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Exercise Price, Lower Range Limit | $21.61 | |
Exercise Price, Upper Range Limit | $29.30 | |
Black-Scholes Fair Value | 993 | |
Remaining Contractual Life (Years) | '8 years 0 months | |
2012 | ' | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Exercise Price, Lower Range Limit | $24.04 | |
Exercise Price, Upper Range Limit | $29.16 | |
Black-Scholes Fair Value | 2,890 | |
Remaining Contractual Life (Years) | '9 years 0 months | |
2013 | ' | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Exercise Price, Lower Range Limit | $29.25 | |
Exercise Price, Upper Range Limit | $42.13 | |
Black-Scholes Fair Value | $4,116 | |
Remaining Contractual Life (Years) | '10 years 0 months | |
Common Class A [Member] | 2005 | ' | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Number of Outstanding Options | 20 | |
Stock Options Vested and Exercisable | 20 | |
Common Class A [Member] | 2006 | ' | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Number of Outstanding Options | 96 | |
Stock Options Vested and Exercisable | 96 | |
Common Class A [Member] | 2008 | ' | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Number of Outstanding Options | 254 | |
Stock Options Vested and Exercisable | 254 | |
Common Class A [Member] | 2009 | ' | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Number of Outstanding Options | 280 | |
Stock Options Vested and Exercisable | 208 | |
Common Class A [Member] | 2010 | ' | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Number of Outstanding Options | 73 | |
Stock Options Vested and Exercisable | 35 | |
Common Class A [Member] | 2011 | ' | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Number of Outstanding Options | 80 | |
Stock Options Vested and Exercisable | 29 | |
Common Class A [Member] | 2012 | ' | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Number of Outstanding Options | 215 | |
Stock Options Vested and Exercisable | 39 | |
Common Class A [Member] | 2013 | ' | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | ' | |
Number of Outstanding Options | 231 | |
Stock Options Vested and Exercisable | 0 | |
[1] | * The Company will not recognize the Black-Scholes fair value for awards granted prior to January 1, 2006 unless such awards are modified. |
Options_and_Awards_Restricted_
Options and Awards Restricted Awards Granted (Details) (USD $) | 12 Months Ended | ||
In Thousands, except Per Share data, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
OPTIONS AND AWARDS [Abstract] | ' | ' | ' |
Issuance of restricted stock to employees | 93 | 71 | 143 |
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period | '5 years 0 months | ' | ' |
Share-based Compensation, Restricted Awards, Exercise Price | $0 | ' | ' |
Share-based compensation, restricted awards, fair value at grant date, minimum during period | $27.98 | $24.04 | $21.61 |
Share-based compensation, restricted awards, grant date fair value, maximum during the period | $42.13 | $29.16 | $29.30 |
Options_and_Awards_Restricted_1
Options and Awards Restricted Award Rollforward (Details) (USD $) | 12 Months Ended | |||
In Thousands, except Per Share data, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Jan. 02, 2011 |
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Rollforward [Roll Forward] | ' | ' | ' | ' |
Nonvested Restricted Awards, Nonvested at January 1, | 224 | 210 | ' | 102 |
Weighted Average Grant Date Fair Value, Nonvested at January 1, | $23.04 | $22.32 | ' | $18.05 |
Issuance of restricted stock to employees | 93 | 71 | 143 | ' |
Weighted Average Grant Date Fair Value, Restricted Awards Granted in the Period | $35.27 | $27.78 | $25.52 | ' |
Nonvested Restricted Awards, Vested in the Period | -51 | -44 | -31 | ' |
Weighted Average Grant Date Fair Value, Restricted Awards Vested in the Period | $23.67 | $27.53 | $24.18 | ' |
Nonvested Restricted Awards, Forfeited in the Period | -36 | -13 | -4 | ' |
Weighted Average Grant Date Fair Value, Restricted Awards Forfeited in the Period | $24.70 | $21.98 | $19.16 | ' |
Nonvested Restricted Awards, Nonvested at December 31, | 230 | 224 | 210 | 102 |
Weighted Average Grant Date Fair Value, Nonvested at December 31, 2013 | $28.68 | $23.04 | $22.32 | $18.05 |
Options_and_Awards_Stock_Award
Options and Awards Stock Awards to Board (Details) (USD $) | 12 Months Ended | ||
Share data in Thousands, except Per Share data, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Share-based compensation, restricted awards, fair value at grant date, minimum during period | $27.98 | $24.04 | $21.61 |
Share-based compensation, restricted awards, grant date fair value, maximum during the period | $42.13 | $29.16 | $29.30 |
Stock Issued During Period, Shares, Restricted Stock Award, Gross | 93 | 71 | 143 |
Director [Member] | ' | ' | ' |
Share-based compensation, restricted awards, fair value at grant date, minimum during period | $27.98 | ' | ' |
Share-based compensation, restricted awards, grant date fair value, maximum during the period | $41.91 | ' | ' |
Stock Issued During Period, Shares, Restricted Stock Award, Gross | 10 | ' | ' |
Executive Officer [Member] | ' | ' | ' |
Stock Issued During Period, Shares, Restricted Stock Award, Gross | 11 | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Vested in Period, Fair Value | $32.85 | ' | ' |
Options_and_Awards_Compensatio
Options and Awards Compensation Expense (Details) (USD $) | 12 Months Ended | 3 Months Ended | |||||||||||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | Dec. 31, 2013 |
Stock Options | Stock Options | Stock Options | Restricted Stock Awards | Restricted Stock Awards | Restricted Stock Awards | Stock awards | Stock awards | Stock awards | Director [Member] | ||||
Stock awards | |||||||||||||
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items] | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Share-based compensation | $4,013 | $3,379 | $3,356 | $2,217 | $1,903 | $2,265 | $1,387 | $1,084 | $1,091 | $795 | $1,752 | $0 | $410 |
Employee Service Share-based Compensation, Tax Benefit Realized from Exercise of Stock Options | 1,723 | 1,740 | 1,285 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized | ' | ' | ' | 7,089 | ' | ' | 5,867 | ' | ' | ' | ' | ' | ' |
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized, Period for Recognition | ' | ' | ' | '3 years 9 months | ' | ' | '3 years 6 months | ' | ' | ' | ' | ' | ' |
Employee Service Share-based Compensation, Nonvested Awards | ' | ' | ' | 568 | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Options, Expected to Vest, Number | ' | ' | ' | 530 | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Remaining Contractual Term | '6 years 3 months | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Share-based compensation | $4,399 | $4,739 | $3,356 | ' | ' | ' | ' | ' | ' | ' | ' | ' | ' |
Options_and_Awards_Intrinsic_V
Options and Awards Intrinsic Values (Details) (Stock Options, USD $) | 12 Months Ended | ||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Stock Options | ' | ' | ' |
Outstanding | $29,431 | $15,703 | $18,942 |
Vested | 20,465 | 11,285 | 12,960 |
Expected to Vest | 7,873 | 4,088 | 5,374 |
Exercised | $8,709 | $7,123 | $5,651 |
Commitments_and_Contingencies_
Commitments and Contingencies Litigation (Details) (USD $) | 3 Months Ended | 12 Months Ended | ||
In Thousands, unless otherwise specified | Dec. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Accrued charge related to U.S. Government inquiry | $15,000 | $0 | $15,000 | ' |
U.S. Government inquiry settlement (Note 19) | 15,000 | 33,000 | 15,000 | 0 |
U.S. Government inquiry settlement | ' | 48,000 | ' | ' |
Staffing Class Action [Member] | ' | ' | ' | ' |
Loss Contingency, Settlement Agreement, Consideration | ' | 6,500 | ' | ' |
Loss Contingency, Loss in Period | ' | $1,500 | ' | ' |
Commitments_and_Contingencies_1
Commitments and Contingencies Medicare Revenue Recoupments (Details) | 12 Months Ended |
Dec. 31, 2013 | |
facilities | |
Medicare Probe Reviews [Abstract] | ' |
Facilities under Medicare Probe Reviews | 1 |
Commitments_and_Contingencies_2
Commitments and Contingencies Other Matters (Details) (USD $) | 3 Months Ended | 12 Months Ended | ||
In Thousands, unless otherwise specified | Dec. 31, 2012 | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Rate | Rate | Rate | ||
U.S. Government inquiry settlement (Note 19) | $15,000 | $33,000 | $15,000 | $0 |
Revenue by payor as a percent of total revenue | ' | 100.00% | 100.00% | 100.00% |
CALIFORNIA | ' | ' | ' | ' |
Facilities Identified by Investigation | ' | 6 | ' | ' |
Commitments_and_Contingencies_3
Commitments and Contingencies Concentrations (Details) | 12 Months Ended | ||
Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 | |
Rate | Rate | Rate | |
% of Revenue | 100.00% | 100.00% | 100.00% |
Total Medicaid and Medicare | ' | ' | ' |
Accounts receivable by payor as a percent of total accounts receivable | 56.80% | 56.20% | ' |
% of Revenue | 72.20% | 73.60% | 75.20% |
Commitments_and_Contingencies_4
Commitments and Contingencies Cash in Excess of FDIC Limits (Details) (USD $) | Feb. 11, 2014 | Dec. 31, 2013 |
In Thousands, unless otherwise specified | ||
Cash, Insured and Uninsured [Abstract] | ' | ' |
Cash, FDIC Insured Amount | ' | $250 |
Cash, Uninsured Amount | $1,001 | ' |
Defined_Contribution_Plan_Deta
Defined Contribution Plan (Details) (USD $) | 12 Months Ended | ||
In Thousands, unless otherwise specified | Dec. 31, 2013 | Dec. 31, 2012 | Dec. 31, 2011 |
Rate | |||
Defined Contributions Plan [Abstract] | ' | ' | ' |
Defined Benefit Plan, Contributions by Employer | $487 | $444 | $369 |
Defined Contribution Plan, Employer Matching Contribution, Percent of Employees' Gross Pay | 90.00% | ' | ' |