DEI Info Cover Page Document
DEI Info Cover Page Document - USD ($) | 12 Months Ended | ||
Dec. 31, 2016 | Feb. 03, 2017 | Jun. 30, 2016 | |
Entity Information [Abstract] | |||
Entity Registrant Name | ENSIGN GROUP, INC | ||
Entity Central Index Key | 1,125,376 | ||
Current Fiscal Year End Date | --12-31 | ||
Entity Filer Category | Large Accelerated Filer | ||
Document Type | 10-K | ||
Current Reporting Status | Yes | ||
Document Period End Date | Dec. 31, 2016 | ||
Document Fiscal Year Focus | 2,016 | ||
Document Fiscal Period Focus | FY | ||
Amendment Flag | false | ||
Entity Well-known Seasoned Issuer | Yes | ||
Entity Voluntary Filers | No | ||
Entity Common Stock, Shares Outstanding | 50,898,387 | ||
Entity Public Float | $ 884,000,000 |
Consolidated Balance Sheets
Consolidated Balance Sheets - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Current assets: | ||
Cash and cash equivalents | $ 57,706 | $ 41,569 |
Accounts receivable—less allowance for doubtful accounts of $39,791 and $30,308 at December 31, 2016 and December 31, 2015, respectively | 244,433 | 209,026 |
Investments—current | 11,550 | 2,004 |
Prepaid income taxes | 302 | 8,141 |
Prepaid expenses and other current assets | 19,871 | 18,827 |
Total current assets | 333,862 | 279,567 |
Property and equipment, net | 484,498 | 299,633 |
Insurance subsidiary deposits and investments | 23,634 | 32,713 |
Escrow deposits | 1,582 | 400 |
Deferred tax asset | 23,073 | 20,852 |
Restricted and other assets | 12,614 | 9,631 |
Intangible assets, net | 35,076 | 45,431 |
Goodwill | 67,100 | 40,886 |
Other indefinite-lived intangibles | 19,586 | 18,646 |
Total assets | 1,001,025 | 747,759 |
Current liabilities: | ||
Accounts payable | 38,991 | 36,029 |
Accrued wages and related liabilities | 84,686 | 78,890 |
Accrued self-insurance liabilities—current | 21,359 | 18,122 |
Other accrued liabilities | 58,763 | 46,205 |
Current maturities of long-term debt | 8,129 | 620 |
Total current liabilities | 211,928 | 179,866 |
Long-term debt—less current maturities | 275,486 | 99,051 |
Accrued self-insurance liabilities—less current portion | 43,992 | 37,881 |
Deferred rent and other long-term liabilities | 9,124 | 3,976 |
Total liabilities | 540,530 | 320,774 |
Commitments and contingencies (Notes 16, 18 and 20) | ||
Equity: | ||
Common stock; $0.001 par value; 75,000 shares authorized; 52,787 and 50,838 shares issued and outstanding at December 31, 2016, respectively, and 51,918 and 51,370 shares issued and outstanding at December 31, 2015, respectively (Note 3) | 52 | 51 |
Additional paid-in capital (Note 3) | 252,493 | 235,076 |
Retained earnings | 235,021 | 193,420 |
Common stock in treasury, at cost, 1,520 and 123 shares at December 31, 2016 and December 31, 2015, respectively (Note 3) | (31,117) | (1,223) |
Total Ensign Group, Inc. stockholders' equity | 456,449 | 427,324 |
Non-controlling interest | 4,046 | (339) |
Total equity | 460,495 | 426,985 |
Total liabilities and equity | $ 1,001,025 | $ 747,759 |
Consolidated Balance Sheets Bal
Consolidated Balance Sheets Balance Sheet (Paranthetical) - USD ($) shares in Thousands, $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Current assets: | ||
Allowance for doubtful accounts | $ 39,791 | $ 30,308 |
Equity: | ||
Common stock, par value | $ 0.001 | $ 0.001 |
Common stock, shares authorized | 75,000 | 75,000 |
Common stock, shares issued | 52,787 | 51,918 |
Common stock, shares outstanding | 50,838 | 51,370 |
Common stock in treasury, at cost | 1,520 | 123 |
Consolidated Statements of Inco
Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Revenue | $ 1,654,864 | $ 1,341,826 | $ 1,027,406 |
Expense: | |||
Cost of services | 1,341,814 | 1,067,694 | 822,669 |
Gain related to divestitures (Note 18 and 19) | (11,225) | 0 | 0 |
Rent—cost of services (Note 18) | 124,581 | 88,776 | 48,488 |
General and administrative expense | 69,165 | 64,163 | 56,895 |
Depreciation and amortization | 38,682 | 28,111 | 26,430 |
Total expenses | 1,563,017 | 1,248,744 | 954,482 |
Income from operations | 91,847 | 93,082 | 72,924 |
Other income (expense): | |||
Interest expense | (7,136) | (2,828) | (12,976) |
Interest income | 1,107 | 845 | 594 |
Other expense, net | (6,029) | (1,983) | (12,382) |
Income before provision for income taxes | 85,818 | 91,099 | 60,542 |
Provision for income taxes | 32,975 | 35,182 | 26,801 |
Net income | 52,843 | 55,917 | 33,741 |
Less: net income (loss) attributable to noncontrolling interests | 2,853 | 485 | (2,209) |
Net income attributable to The Ensign Group, Inc. | 49,990 | 55,432 | 35,950 |
Amounts attributable to The Ensign Group, Inc.: | |||
Net income attributable to The Ensign Group, Inc. | $ 49,990 | $ 55,432 | $ 35,950 |
Basic: | |||
Basic net income per common share attributable to The Ensign Group, Inc. | $ 0.99 | $ 1.10 | $ 0.80 |
Diluted: | |||
Diluted net income per common share attributable to The Ensign Group, Inc. | $ 0.96 | $ 1.06 | $ 0.78 |
Weighted average common shares outstanding: | |||
Basic | 50,555 | 50,316 | 44,682 |
Diluted | 52,133 | 52,210 | 46,190 |
Dividends per share | $ 0.1625 | $ 0.1525 | $ 0.1425 |
Consolidated Statement of Compr
Consolidated Statement of Comprehensive Income - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Net income | $ 52,843 | $ 55,917 | $ 33,741 |
Other comprehensive income, net of tax: | |||
Unrealized gain on interest rate swap, net of income tax provision of $78 for the years ended December 31, 2014. | 0 | 0 | 89 |
Reclassification of derivative loss to income, net of income tax benefit of $638 for the year ended December 31, 2014. | 0 | 0 | 1,023 |
Comprehensive income | 52,843 | 55,917 | 34,853 |
Less: net income (Loss) attributable to noncontrolling interest | 2,853 | 485 | (2,209) |
Comprehensive income attributable to The Ensign Group, Inc. | $ 49,990 | $ 55,432 | $ 37,062 |
Consolidated Statement of Comp6
Consolidated Statement of Comprehensive Income Comprehensive Income Paranthetical $ in Thousands | 12 Months Ended |
Dec. 31, 2014USD ($) | |
Other Comprehensive Income: | |
Income tax effect on realized loss on interest rate swap | $ (78) |
Income tax effect on unrealized gain on interest rate swap | $ 638 |
Consolidated Statement of Stock
Consolidated Statement of Stockholders' Equity Statement - USD ($) shares in Thousands, $ in Thousands | Total | Common Stock [Member] | Additional Paid-in Capital [Member] | Retained Earnings [Member] | Treasury Stock [Member] | AOCI Attributable to Parent [Member] | Noncontrolling Interest [Member] |
Shares, Outstanding | 22,113 | 237 | |||||
Stockholders' Equity, Including Portion Attributable to Noncontrolling Interest | $ 357,257 | $ 22 | $ 101,364 | $ 257,502 | $ (1,680) | $ (1,112) | $ 1,161 |
Stock Issued During Period, Shares, Other | 415 | (87) | |||||
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards | $ 3,845 | 3,475 | $ 370 | ||||
Issuance of restricted stock to employees | 56 | 63 | |||||
Stock Issued During Period, Value, Restricted Stock Award, Gross | $ 0 | ||||||
Repurchase of common stock (Note 3) | 0 | ||||||
Dividends declared | (6,441) | (6,441) | |||||
Employee stock award compensation | 5,190 | 5,190 | |||||
Excess tax benefit from share-based compensation | 4,264 | 4,264 | |||||
Less: net income (loss) attributable to noncontrolling interests | (2,209) | (2,209) | |||||
Distribution of net assets to CareTrust (Note 23) | (141,165) | (141,165) | |||||
Net Income attributable to the Ensign Group, Inc. | 35,950 | 35,950 | |||||
Termination of swap and other comprehensive income | 1,112 | 1,112 | |||||
Shares, Outstanding | 22,591 | 150 | |||||
Stockholders' Equity, Including Portion Attributable to Noncontrolling Interest | 257,803 | $ 22 | 114,293 | 145,846 | $ (1,310) | 0 | (1,048) |
Stock Issued During Period, Shares, Other | 255 | (27) | |||||
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards | $ 2,530 | 2,443 | $ 87 | ||||
Issuance of restricted stock to employees | 323 | 105 | |||||
Stock Issued During Period, Value, Restricted Stock Award, Gross | $ 1,892 | 1,892 | |||||
Stock Issued During Period, Shares, New Issues | 2,734 | ||||||
Issuance of common stock through public offering, net of issuance costs | 106,120 | $ 3 | 106,117 | ||||
Repurchase of common stock (Note 3) | 0 | ||||||
Dividends declared | (7,858) | (7,858) | |||||
Employee stock award compensation | 6,677 | 6,677 | |||||
Excess tax benefit from share-based compensation | 3,680 | 3,680 | |||||
Stock Issued During Period, Shares, Stock Splits | 25,685 | ||||||
Stock issued to effect stock split | 0 | $ 26 | (26) | ||||
Noncontrolling interest assumed related to acquisition | 224 | 224 | |||||
Less: net income (loss) attributable to noncontrolling interests | 485 | 485 | |||||
Net Income attributable to the Ensign Group, Inc. | 55,432 | 55,432 | |||||
Shares, Outstanding | 51,370 | 123 | |||||
Stockholders' Equity, Including Portion Attributable to Noncontrolling Interest | 426,985 | $ 51 | 235,076 | 193,420 | $ (1,223) | 0 | (339) |
Stock Issued During Period, Shares, Other | 668 | (55) | |||||
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards | $ 4,152 | $ 1 | 4,045 | $ 106 | |||
Issuance of restricted stock to employees | 299 | 252 | |||||
Stock Issued During Period, Value, Restricted Stock Award, Gross | $ 2,517 | 2,517 | |||||
Stock Repurchased During Period, Shares | (1,452) | 1,452 | |||||
Repurchase of common stock (Note 3) | 30,000 | $ (30,000) | |||||
Dividends declared | (8,282) | (8,282) | |||||
Employee stock award compensation | 7,776 | 7,776 | |||||
Excess tax benefit from share-based compensation | 3,079 | 3,079 | |||||
Equity, Fair Value Adjustment | 1,325 | (107) | 1,432 | ||||
Noncontrolling interest assumed related to acquisition | 100 | 100 | |||||
Less: net income (loss) attributable to noncontrolling interests | 2,853 | 2,853 | |||||
Net Income attributable to the Ensign Group, Inc. | 49,990 | 49,990 | |||||
Shares, Outstanding | 50,838 | 1,520 | |||||
Stockholders' Equity, Including Portion Attributable to Noncontrolling Interest | $ 460,495 | $ 52 | $ 252,493 | $ 235,021 | $ (31,117) | $ 0 | $ 4,046 |
Consolidated Statements of Cash
Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Cash flows from operating activities: | |||
Net income | $ 52,843 | $ 55,917 | $ 33,741 |
Adjustments to reconcile net income to net cash provided by operating activities: | |||
Depreciation and amortization | 38,682 | 28,111 | 26,430 |
Amortization of deferred financing fees | 825 | 591 | 687 |
Fixed assets impairment | 137 | 0 | 0 |
Write-off of deferred financing fees | 321 | 0 | 0 |
Deferred income taxes | (2,208) | 1,251 | (3,110) |
Provision for doubtful accounts | 28,512 | 19,802 | 13,179 |
Share-based compensation | 9,101 | 6,677 | 5,190 |
Excess tax benefit from share-based compensation | (3,079) | (3,680) | (4,264) |
Loss on extinguishment of debt | 0 | 0 | 4,067 |
Loss on termination of interest rate swap | 0 | 0 | 1,661 |
(Gain)/loss on disposition of property and equipment | 164 | 205 | 100 |
Gain on sale of urgent care centers | (19,160) | 0 | 0 |
Change in operating assets and liabilities | |||
Accounts receivable | (63,617) | (100,324) | (31,867) |
Prepaid income taxes | 7,839 | (5,149) | 6,897 |
Prepaid expenses and other assets | (1,465) | (10,340) | 864 |
Insurance subsidiary deposits and investments | (467) | (10,785) | (1,533) |
Losses related to operational closures (Note 18) | 7,205 | 0 | 0 |
Accounts payable | 577 | 1,780 | 7,978 |
Accrued wages and related liabilities | (4,978) | 22,178 | 16,644 |
Income taxes payable | 987 | 0 | 0 |
Other accrued liabilities | 12,588 | 21,403 | 6,337 |
Accrued self-insurance liabilities | 8,125 | 5,418 | 1,881 |
Deferred rent liability | 956 | 314 | (2) |
Net cash provided by operating activities | 73,888 | 33,369 | 84,880 |
Cash flows from investing activities: | |||
Purchase of property and equipment | (65,699) | (60,018) | (53,693) |
Cash payment for business acquisitions | (64,310) | (110,802) | (92,669) |
Cash payment for asset acquisitions | (120,935) | (17,750) | (7,938) |
Escrow deposits | (1,582) | (400) | (16,153) |
Escrow deposits used to fund business acquisitions | 400 | 16,153 | 1,000 |
Increase in restricted cash | 0 | 0 | (8,219) |
Use of restricted cash | 0 | 5,082 | 3,137 |
Cash received from sale of urgent care centers and franchising businesses, net of note receivable | 40,734 | 2,000 | 2,000 |
Cash proceeds from the sale of property and equipment and insurance proceeds | 391 | 10 | 24 |
Restricted and other assets | 365 | (2,813) | (340) |
Net cash used in investing activities | (210,636) | (168,538) | (172,851) |
Cash flows from financing activities: | |||
Proceeds from revolving credit facility (Note 16) | 844,000 | 334,000 | 495,677 |
Payments on revolving credit facility and other debt (Note 16 and Note 3) | (659,514) | (314,417) | (331,198) |
Proceeds from common stock offering (Note 3) | 0 | 112,078 | 0 |
Issuance costs in connection with common stock offering (Note 3) | 0 | (5,961) | 0 |
Issuance of treasury stock upon exercise of options | 106 | 87 | 370 |
Cash retained by CareTrust at separation (Note 4) | 0 | 0 | (78,731) |
Issuance of common stock upon exercise of options | 6,563 | 4,337 | 3,475 |
Repurchase of shares of common stock (Note 3) | (30,000) | 0 | 0 |
Dividends paid | (8,173) | (7,494) | (6,297) |
Excess tax benefit from share-based compensation | 3,181 | 3,700 | 4,280 |
Prepayment penalty on early retirement of debt | 0 | 0 | (2,069) |
Payments of deferred financing costs | (3,278) | 0 | (12,883) |
Net cash provided by financing activities | 152,885 | 126,330 | 72,624 |
Net increase (decrease) in cash and cash equivalents | 16,137 | (8,839) | (15,347) |
Cash and cash equivalents beginning of period | 41,569 | 50,408 | 65,755 |
Cash and cash equivalents end of period | 57,706 | 41,569 | 50,408 |
Cash paid during the period for: | |||
Interest | 6,428 | 2,773 | 13,511 |
Income taxes | 23,163 | 35,490 | 22,029 |
Non-cash financing and investing activity: | |||
Accrued capital expenditures | 6,828 | 4,171 | 3,109 |
Note receivable from sale of urgent care centers and franchising business | 700 | 0 | 2,000 |
Favorable lease included in the fair value of assets acquisitions | 7,190 | 0 | 0 |
Refundable deposits assumed as part of business acquisition | 0 | 3,488 | 0 |
Debt assumed as part of asset acquisition | $ 0 | $ 11,699 | $ 3,417 |
Description of Business
Description of Business | 12 Months Ended |
Dec. 31, 2016 | |
DESCRIPTION OF BUSINESS [Abstract] | |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block] | DESCRIPTION OF BUSINESS The Company - The Ensign Group, Inc. (collectively, Ensign or the Company), is a holding company with no direct operating assets, employees or revenue. The Company, through its operating subsidiaries, is a provider of health care services across the post-acute care continuum, as well as, other ancillary businesses. As of December 31, 2016 , the Company operated 210 facilities, 39 home health, hospice and home care agencies and other ancillary operations located in Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, Oregon, South Carolina, Texas, Utah, Washington and Wisconsin. The Company historically operated urgent care clinics in Colorado and Washington. The Company completed the sale of its urgent care centers in 2016. The Company's operating subsidiaries, each of which strives to be the operation of choice in the community it serves, provide a broad spectrum of skilled nursing, assisted living, home health, home care, hospice, urgent care and other ancillary services. The Company's operating subsidiaries have a collective capacity of approximately 17,700 operational skilled nursing beds and 4,450 assisted living and independent living units. As of December 31, 2016 , the Company owned 50 of its 210 affiliated facilities and leased an additional 160 facilities through long-term lease arrangements and had options to purchase 9 of those 160 facilities. As of December 31, 2015 , the Company owned 32 of its 186 affiliated facilities and leased an additional 154 facilities through long-term lease arrangements, and had options to purchase 20 of those 154 facilities. Certain of the Company’s wholly-owned independent subsidiaries, collectively referred to as the Service Center, provide certain accounting, payroll, human resources, information technology, legal, risk management and other centralized services to the other operating subsidiaries through contractual relationships with such subsidiaries. The Company also has a wholly-owned captive insurance subsidiary (the Captive) that provides some claims-made coverage to the Company’s operating subsidiaries for general and professional liability, as well as coverage for certain workers’ compensation insurance liabilities. Each of the Company's affiliated operations are operated by separate, wholly-owned, independent subsidiaries that have their own management, employees and assets. References herein to the consolidated “Company” and “its” assets and activities in this Annual Report is not meant to imply, nor should it be construed as meaning, that The Ensign Group, Inc. has direct operating assets, employees or revenue, or that any of the subsidiaries, are operated by The Ensign Group, Inc. |
Significant Accounting Policies
Significant Accounting Policies | 12 Months Ended |
Dec. 31, 2016 | |
Accounting Policies [Abstract] | |
Basis of Presentation and Significant Accounting Policies [Text Block] | SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Basis of Presentation — The accompanying consolidated financial statements (Financial Statements) have been prepared in accordance with accounting principles generally accepted in the United States (GAAP). The Company is the sole member or shareholder of various consolidated limited liability companies and corporations established to operate various acquired skilled nursing and assisted living operations, home health, hospice and home care operations, urgent care centers and related ancillary services. 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 during the year ended December 31, 2016 . The Company completed the sale of its urgent care centers for an aggregate purchase price of $41,492 . The sale transactions do not meet the criteria of discontinued operations as they do not represent a strategic shift that has, or will have, a major effect on the Company’s operations and financial results. Reclassifications - Prior period results reflect reclassifications, for comparative purposes, related to the early adoption of authoritative guidance for the presentation of deferred taxes. Deferred tax assets have been presented on the balance sheets as a non-current asset for all periods presented. Historically, these assets were classified as either current or non-current assets, as applicable. Estimates and Assumptions — The preparation of Financial Statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting periods. The most significant estimates in the Company’s Financial Statements relate to revenue, allowance for doubtful accounts, intangible assets and goodwill, impairment of long-lived assets, general and professional liability, workers' compensation and healthcare claims included in accrued self-insurance liabilities and income taxes. Actual results could differ from those estimates. Fair Value of Financial Instruments — The Company’s financial instruments consist principally of cash and cash equivalents, debt security investments, accounts receivable, insurance subsidiary deposits, accounts payable and borrowings. The Company believes all of the financial instruments’ recorded values approximate fair values because of their nature or respective short durations. Revenue Recognition — The Company recognizes revenue when the following four conditions have been met: (i) there is persuasive evidence that an arrangement exists; (ii) delivery has occurred or service has been rendered; (iii) the price is fixed or determinable; and (iv) collection is reasonably assured. The Company's revenue is derived primarily from providing healthcare services to patients and is recognized on the date services are provided at amounts billable to the individual. For reimbursement arrangements with third-party payors, including Medicaid, Medicare and private insurers, revenue is recorded based on contractually agreed-upon amounts on a per patient basis. Revenue from the Medicare and Medicaid programs accounted for 67.8% , 69.1% and 71.4% of the Company's revenue for the years ended December 31, 2016, 2015 and 2014 , respectively. The Company records revenue from these governmental and managed care programs as services are performed at their expected net realizable amounts under these programs. The Company’s revenue from governmental and managed care programs is subject to audit and retroactive adjustment by governmental and third-party agencies. Consistent with healthcare industry accounting practices, any changes to these governmental revenue estimates are recorded in the period the change or adjustment becomes known based on final settlement. The Company recorded adjustments to revenue which were not material to the Company's consolidated revenue for the years ended December 31, 2016, 2015 and 2014 . The Company’s service specific revenue recognition policies are as follows: Skilled Nursing Revenue The Company’s revenue is derived primarily from providing long-term healthcare services to patients and is recognized on the date services are provided at amounts billable to individual patients. For patients under reimbursement arrangements with third-party payors, including Medicaid, Medicare and private insurers, revenue is recorded based on contractually agreed-upon amounts or rate on a per patient, daily basis or as services are performed. Assisted and Independent Living Revenue The Company's revenue is recorded when services are rendered on the date services are provided at amounts billable to individual residents and consists of fees for basic housing and assisted living care. Residency agreements are generally for a term of 30 days, with resident fees billed monthly in advance. For patients under reimbursement arrangements with Medicaid, revenue is recorded based on contractually agreed-upon amounts or rate on a per resident, daily basis or as services. Revenue for certain ancillary charges is recognized as services are provided, and such fees are billed monthly in arrears. Home Health Revenue Medicare Revenue Net service revenue is recorded under the Medicare prospective payment system based on a 60-day episode payment rate that is subject to adjustment based on certain variables including, but not limited to: (a) an outlier payment if patient care was unusually costly; (b) a low utilization payment adjustment if the number of visits was fewer than five; (c) a partial payment if the patient transferred to another provider or the Company received a patient from another provider before completing the episode; (d) a payment adjustment based upon the level of therapy services required; (e) the number of episodes of care provided to a patient, regardless of whether the same home health provider provided care for the entire series of episodes; (f) changes in the base episode payments established by the Medicare program; (g) adjustments to the base episode payments for case mix and geographic wages; and (h) recoveries of overpayments. The Company makes adjustments to Medicare revenue on completed episodes to reflect differences between estimated and actual payment amounts, an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. Therefore, the Company believes that its reported net service revenue and patient accounts receivable will be the net amounts to be realized from Medicare for services rendered. In addition to revenue recognized on completed episodes, the Company also recognizes a portion of revenue associated with episodes in progress. Episodes in progress are 60-day episodes of care that begin during the reporting period, but were not completed as of the end of the period. As such, the Company estimates revenue and recognizes it on a daily basis. The primary factors underlying this estimate are the number of episodes in progress at the end of the reporting period, expected Medicare revenue per episode and its estimate of the average percentage complete based on visits performed. Non-Medicare Revenue Episodic Based Revenue - The Company recognizes revenue in a similar manner as it recognizes Medicare revenue for episodic-based rates that are paid by other insurance carriers, including Medicare Advantage programs; however, these rates can vary based upon the negotiated terms. Non-episodic Based Revenue - Revenue is recorded on an accrual basis based upon the date of service at amounts equal to its established or estimated per-visit rates, as applicable. Hospice Revenue Revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are daily rates for each of the levels of care the Company delivers. The Company makes adjustments to revenue for an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. Additionally, as Medicare hospice revenue is subject to an inpatient cap limit and an overall payment cap, the Company monitors its provider numbers and estimates amounts due back to Medicare if a cap has been exceeded. The Company records these adjustments as a reduction to revenue and increases other accrued liabilities. Accounts Receivable and Allowance for Doubtful Accounts — Accounts receivable consist primarily of amounts due from Medicare and Medicaid programs, other government programs, managed care health plans and private payor sources. Estimated provisions for doubtful accounts are recorded to the extent it is probable that a portion or all of a particular account will not be collected. In evaluating the collectability of accounts receivable, the Company considers a number of factors, including the age of the accounts, changes in collection patterns, the composition of patient accounts by payor type and the status of ongoing disputes with third-party payors. On an annual basis, the historical collection percentages are reviewed by payor and by state and are updated to reflect the recent collection experience of the Company. In order to determine the appropriate reserve rate percentages which ultimately establish the allowance, the Company analyzes historical cash collection patterns by payor and by state. The percentages applied to the aged receivable balances are based on the Company’s historical experience and time limits, if any, for managed care, Medicare, Medicaid and other payors. The Company periodically refines its estimates of the allowance for doubtful accounts based on experience with the estimation process and changes in circumstances. Cash and Cash Equivalents — Cash and cash equivalents consist of bank term deposits, money market funds and treasury bill related investments with original maturities of three months or less at time of purchase and therefore approximate fair value. The fair value of money market funds is determined based on “Level 1” inputs, which consist of unadjusted quoted prices in active markets that are accessible at the measurement date for identical, unrestricted assets. The Company places its cash and short-term investments with high credit quality financial institutions. Insurance Subsidiary Deposits and Investments — The Company's captive insurance subsidiary cash and cash equivalents, deposits and investments are designated to support long-term insurance subsidiary liabilities and have been classified as short-term and long-term assets based on the expected future payments of the Company's captive insurance liabilities. The majority of these deposits and investments are currently held in AA, A and BBB+ rated debt security investments and the remainder is held in a bank account with a high credit quality financial institution. See further discussion at Note 5, Fair Value Measurements. Property and Equipment — Property and equipment are initially recorded at their historical cost. Repairs and maintenance are expensed as incurred. Depreciation is computed using the straight-line method over the estimated useful lives of the depreciable assets (ranging from three to 59 years). Leasehold improvements are amortized on a straight-line basis over the shorter of their estimated useful lives or the remaining lease term. Impairment of Long-Lived Assets — The Company reviews the carrying value of long-lived assets that are held and used in the Company’s operating subsidiaries for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of these assets is determined based upon expected undiscounted future net cash flows from the operating subsidiaries to which the assets relate, utilizing management’s best estimate, appropriate assumptions, and projections at the time. If the carrying value is determined to be unrecoverable from future operating cash flows, the asset is deemed impaired and an impairment loss would be recognized to the extent the carrying value exceeded the estimated fair value of the asset. The Company estimates the fair value of assets based on the estimated future discounted cash flows of the asset. Management has evaluated its long-lived assets and recorded an impairment charge of $137 related to the closure of one facility during the first quarter of 2016. The Company did not record impairment charges during the years ended December 31, 2015 and 2014 . Intangible Assets and Goodwill — Definite-lived intangible assets consist primarily of favorable leases, lease acquisition costs, patient base, facility trade names and customer relationships. Favorable leases and lease acquisition costs are amortized over the life of the lease of the facility. Patient base is amortized over a period of four to eight months, depending on the classification of the patients and the level of occupancy in a new acquisition on the acquisition date. Trade names at affiliated facilities are amortized over 30 years and customer relationships are amortized over a period of up to 20 years. The Company's indefinite-lived intangible assets consist of trade names and Medicare and Medicaid licenses. The Company tests indefinite-lived intangible assets for impairment on an annual basis or more frequently if events or changes in circumstances indicate that the carrying amount of the intangible asset may not be recoverable. Goodwill represents the excess of the purchase price over the fair value of identifiable net assets acquired in business combinations. Goodwill is subject to annual testing for impairment. In addition, goodwill is tested for impairment if events occur or circumstances change that would reduce the fair value of a reporting unit below its carrying amount. The Company performs its annual test for impairment during the fourth quarter of each year. See further discussion at Note 12, 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 combined self-insured retention was $500 per claim, subject to an additional one-time deductible of $1,000 for California affiliated facilities and a separate, one-time, deductible of $750 for non-California facilities. For all California affiliated facilities, the third-party coverage above these limits was $1,000 per claim, $3,000 per facility, with a $5,000 blanket aggregate limit. For all facilities outside of California, except those located in Colorado, the third-party coverage above these limits was $1,000 per claim, $3,000 per facility, with a $5,000 blanket aggregate and an additional state-specific aggregate where required by state law. In Colorado, the third-party coverage above these limits was $1,000 per claim and $3,000 per facility for skilled nursing facilities, which is independent of the aforementioned blanket aggregate limits that apply outside of Colorado. Beginning on January 1, 2017, the combined self-insured retention will be $500 per claim, subject to an additional one-time deductible of $750 for California affiliated facilities and a separate, one-time, deductible of $1,000 for non-California facilities. The self-insured retention and deductible limits for general and professional liability and workers' compensation for all states (except Texas and Washington for workers' compensation) are self-insured through the Captive, the related assets and liabilities of which are included in the accompanying consolidated balance sheets. The Captive is subject to certain statutory requirements as an insurance provider. These requirements include, but are not limited to, maintaining statutory capital. The Company’s policy is to accrue amounts equal to the actuarially estimated costs to settle open claims of insureds, as well as an estimate of the cost of insured claims that have been incurred but not reported. The Company develops information about the size of the ultimate claims based on historical experience, current industry information and actuarial analysis, and evaluates the estimates for claim loss exposure on a quarterly basis. The Company’s operating subsidiaries are self-insured for workers’ compensation in California. To protect itself against loss exposure in California with this policy, the Company has purchased individual specific excess insurance coverage that insures individual claims that exceed $500 per occurrence. In Texas, the operating subsidiaries have elected non-subscriber status for workers’ compensation claims and, effective February 1, 2011, the Company has purchased individual stop-loss coverage that insures individual claims that exceed $750 per occurrence. As of July 1, 2014, the Company’s operating subsidiaries in all other states, with the exception of Washington, are under a loss sensitive plan that insures individual claims that exceed $350 per occurrence. In Washington, the operating subsidiaries' coverage is financed through premiums paid by the employers and employees. The claims and pay benefits are managed through a state insurance pool. Outside of California, Texas and Washington, the Company has purchased insurance coverage that insures individual claims that exceed $350 per accident. In all states except Washington, the Company accrues amounts equal to the estimated costs to settle open claims, as well as an estimate of the cost of claims that have been incurred but not reported. The Company uses actuarial valuations to estimate the liability based on historical experience and industry information. In addition, the Company has recorded an asset and equal liability of $4,104 and $2,881 at December 31, 2016 and 2015 , 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 13, Restricted and Other Assets. The Company self-funds medical (including prescription drugs) and dental healthcare benefits to the majority of its employees. The Company is fully liable for all financial and legal aspects of these benefit plans. To protect itself against loss exposure with this policy, the Company has purchased individual stop-loss insurance coverage that insures individual claims that exceed $300 for each covered person with an additional one-time aggregate individual stop loss deductible of $75 . Beginning 2016, the Company's policy does not include the additional one-time aggregate individual stop loss deductible of $75 . The Company believes that adequate provision has been made in the Financial Statements for liabilities that may arise out of patient care, workers’ compensation, healthcare benefits and related services provided to date. The amount of the Company’s reserves was determined based on an estimation process that uses information obtained from both company-specific and industry data. This estimation process requires the Company to continuously monitor and evaluate the life cycle of the claims. Using data obtained from this monitoring and the Company’s assumptions about emerging trends, the Company, with the assistance of an independent actuary, develops information about the size of ultimate claims based on the Company’s historical experience and other available industry information. The most significant assumptions used in the estimation process include determining the trend in costs, the expected cost of claims incurred but not reported and the expected costs to settle or pay damage awards with respect to unpaid claims. The self-insured liabilities are based upon estimates, and while management believes that the estimates of loss are reasonable, the ultimate liability may be in excess of or less than the recorded amounts. Due to the inherent volatility of actuarially determined loss estimates, it is reasonably possible that the Company could experience changes in estimated losses that could be material to net income. If the Company’s actual liability exceeds its estimates of loss, its future earnings, cash flows and financial condition would be adversely affected. Income Taxes — Deferred tax assets have been presented on the balance sheet as a non-current asset for all periods presented related to the early adoption of authoritative guidance for the presentation of deferred taxes. Historically, these assets were classified as either current or non-current assets, as applicable. There is no effect on the consolidated statements of income or consolidated statements of cash flow. Deferred tax assets and liabilities are established for temporary differences between the financial reporting basis and the tax basis of the Company’s assets and liabilities at tax rates in effect when such temporary differences are expected to reverse. The Company generally expects to fully utilize its deferred tax assets; however, when necessary, the Company records a valuation allowance to reduce its net deferred tax assets to the amount that is more likely than not to be realized. In determining the need for a valuation allowance or the need for and magnitude of liabilities for uncertain tax positions, the Company makes certain estimates and assumptions. These estimates and assumptions are based on, among other things, knowledge of operations, markets, historical trends and likely future changes and, when appropriate, the opinions of advisors with knowledge and expertise in certain fields. Due to certain risks associated with the Company’s estimates and assumptions, actual results could differ. 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. Leases and Leasehold Improvements - At the inception of each lease, the Company performs an evaluation to determine whether the lease should be classified as an operating or capital lease. The Company records rent expense for operating leases that contain scheduled rent increases on a straight-line basis over the term of the lease. The lease term used for straight-line rent expense is calculated from the date the Company is given control of the leased premises through the end of the lease term. The lease term used for this evaluation also provides the basis for establishing depreciable lives for buildings subject to lease and leasehold improvements, as well as the period over which the Company records straight-line rent expense. Recent Accounting Pronouncements — Except for rules and interpretive releases of the Securities and Exchange Commission (SEC) under authority of federal securities laws and a limited number of grandfathered standards, the Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) is the sole source of authoritative GAAP literature recognized by the FASB and applicable to the Company. For any new pronouncements announced, the Company considers whether the new pronouncements could alter previous generally accepted accounting principles and determines whether any new or modified principles will have a material impact on the Company's reported financial position or operations in the near term. The applicability of any standard is subject to the formal review of the Company's financial management and certain standards are under consideration. Recent Accounting Standards Adopted by the Company: In November 2015, the FASB issued updated guidance requiring all deferred tax assets and liabilities be presented as non-current. The Company early adopted this guidance in the first quarter of fiscal year 2016, retrospectively. The Company has classified deferred tax amounts as non-current assets in the consolidated balance sheet for all periods presented. There was no effect on the consolidated statements of income or statement of cash flows. See the Consolidated Balance Sheets. In April 2015, the FASB issued updated guidance requiring debt issuance costs related to a recognized debt liability to be presented in the consolidated balance sheet as a direct reduction from the carrying amount of the debt liability. The new standard was effective for the Company in the first quarter of fiscal year 2016. The Company adopted this amendment during the first quarter of 2016. See Note 16, Debt to the Consolidated Financial Statements. In August 2014, the FASB issued authoritative guidance requiring management to evaluate whether there are conditions and events that raise substantial doubt about the entity’s ability to continue as a going concern and to provide disclosures in certain circumstances. The new standard was effective for the Company in the first quarter of fiscal year 2016. The adoption of this standard did not have a material effect on the Company's financial statements. Accounting Standards Recently Issued But Not Yet Adopted by the Company: In August 2016, the FASB issued amended authoritative guidance to reduce the diversity in practice related to the presentation and classification of certain cash receipts and cash payments in the statement of cash flows. The new provisions target cash flow issues related to (i) debt prepayment or debt extinguishment costs, (ii) settlement of debt instruments with coupon rates that are insignificant relative to effective interest rates, (iii) contingent consideration payments made after a business combination, (iv) proceeds from settlement of insurance claims, (v) proceeds from the settlement of corporate-owned life insurance and bank-owned life insurance policies, (vi) distributions received from equity method investees, (vii) beneficial interests in securitization transactions and (viii) separately identifiable cash flows and application of the predominance principle. This guidance will be effective for fiscal years beginning after December 15, 2017, which will be the Company's fiscal year 2018, with early adoption permitted. The adoption of this standard is not expected to have a material impact on the Company’s consolidated financial statements. In April 2016, the FASB issued its standard to simplify several aspects the accounting for employee share-based payment transactions, which includes the accounting for income taxes, forfeitures, and statutory tax withholding requirements, as well as classification in the statement of cash flows. This guidance will be effective for annual periods beginning after December 15, 2016, which will be the Company's fiscal year 2017, with early adoption permitted. The adoption of the guidance will result in a decrease in income tax expense and an increase in diluted share counts and net cash provided by operating activities. In March 2016, the FASB issued its standard to amend the principal-versus-agent implementation guidance and illustrations in the Board’s new revenue standard, which includes accounting implication related to (1) determining the appropriate unit of account under the revenue standard’s principal-versus-agent guidance and (2) applying the indicators of whether an entity is a principal or an agent in accordance with the revenue standard’s control principle. The guidance will be effective for fiscal years beginning after December 15, 2017, which will be the Company's fiscal year 2018. The guidance has the same effective date as the new revenue standard and the Company is required to adopt the guidance by using the same transition method it would use to adopt the new revenue standard. The Company's evaluation of the adoption method and impact to the consolidated financial statements is ongoing and being performed concurrently with the new revenue standard. In February 2016, the FASB issued amended authoritative guidance on accounting for leases. The new provisions require that a lessee of operating leases recognize in the statement of financial position a liability to make lease payments (the lease liability) and a right-of-use asset representing its right to use the underlying asset for the lease term. The lease liability will be equal to the present value of lease payments, with the right-of-use asset based upon the lease liability. The classification criteria for distinguishing between finance (or capital) leases and operating leases are substantially similar to the previous lease guidance, but with no explicit bright lines. As such, operating leases will result in straight-line rent expense similar to current practice. For short term leases (term of 12 months or less), a lessee is permitted to make an accounting election not to recognize lease assets and lease liabilities, which would generally result in lease expense being recognized on a straight-line basis over the lease term. This guidance applies to all entities and is effective for annual periods beginning after December 15, 2018, which will be the Company's fiscal year 2019, with early adoption permitted. The Company is currently evaluating the impact this guidance will have on its consolidated financial statements but expect this adoption will result in a significant increase in the assets and liabilities on its consolidated balance sheet. In January 2016, the FASB issued amended authoritative guidance which makes targeted improvements for financial instruments. The new provisions impact certain aspects of recognition, measurement, presentation and disclosure requirements of financial instruments. Specifically, the guidance will (1) require equity investments to be measured at fair value with changes in fair value recognized in net income, (2) simplify the impairment assessment of equity investments without readily determinable fair values, (3) eliminate the requirement to disclose the method and assumptions used to estimate fair value for financial instruments measured at amortized cost, and (4) require separate presentation of financial assets and financial liabilities by measurement category. The guidance is effective for annual and interim periods beginning after December 15, 2017, which will be the Company's |
Common Stock
Common Stock | 12 Months Ended |
Dec. 31, 2016 | |
Common Stock [Abstract] | |
Common stock offering [Text Block] | COMMON STOCK Common Stock Repurchase Program On November 4, 2015 and February 9, 2016, the Company announced that its Board of Directors authorized two stock repurchase programs, under which the Company may repurchase up to $15,000 of its common stock under each program for a period of 12 months. Under these programs, the Company is authorized to repurchase its issued and outstanding common shares from time to time in open-market and privately negotiated transactions and block trades in accordance with federal securities laws. During the first quarter of 2016, the Company repurchased 1,452 shares of its common stock for a total of $30,000 and the repurchase programs expired upon the repurchase of the full authorized amount under the plans. The Company did not have stock repurchase programs in place during the the year ended December 31, 2014. Common Stock Offering On February 9, 2015, the Company entered into an underwriting agreement with Wells Fargo Securities, LLC as representative of the underwriters named therein (collectively, the Underwriters), pursuant to which the Company agreed to issue and sell to the Underwriters 5,000 shares of its common stock and also agreed to issue and sell to the Underwriters, at the option of the Underwriters, an aggregate of up to 750 additional shares of common stock (the Common Stock Offering). Subsequently, the Company completed a common stock offering, issuing 5,467 shares at approximately $20.50 per share. After deducting underwriting discounts and commissions of $5,604 , excluding other issuance costs of $357 , the Company received net proceeds of $106,474 . The Company then used $94,000 of the net proceeds to pay off outstanding amounts under its credit facility. |
Computation of Net Income Per C
Computation of Net Income Per Common Share | 12 Months Ended |
Dec. 31, 2016 | |
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: Year Ended December 31, 2016 2015 2014 Numerator: Net income $ 52,843 $ 55,917 $ 33,741 Less: net income (loss) attributable to noncontrolling interests 2,853 485 (2,209 ) Net income attributable to The Ensign Group, Inc. $ 49,990 $ 55,432 $ 35,950 Denominator: Weighted average shares outstanding for basic net income per share 50,555 50,316 44,682 Basic net income per common share attributable to The Ensign Group, Inc. $ 0.99 $ 1.10 $ 0.80 A reconciliation of the numerator and denominator used in the calculation of diluted net income per common share follows: Year Ended December 31, 2016 2015 2014 Numerator: Net income $ 52,843 $ 55,917 $ 33,741 Less: net income (loss) attributable to noncontrolling interests 2,853 485 (2,209 ) Net income attributable to The Ensign Group, Inc. $ 49,990 $ 55,432 $ 35,950 Denominator: Weighted average common shares outstanding 50,555 50,316 44,682 Plus: incremental shares from assumed conversion (1) 1,578 1,894 1,508 Adjusted weighted average common shares outstanding 52,133 52,210 46,190 Diluted net income per common share attributable to The Ensign Group, Inc. $ 0.96 $ 1.06 $ 0.78 (1) Options outstanding which are anti-dilutive and therefore not factored into the weighted average common shares amount above were 838 , 258 , and 1,084 for the years ended December 31, 2016, 2015 and 2014 , respectively. |
Fair Value Measurements
Fair Value Measurements | 12 Months Ended |
Dec. 31, 2016 | |
Fair Value Disclosures [Abstract] | |
Fair Value Disclosures [Text Block] | FAIR VALUE MEASUREMENTS Fair value measurements are based on a three-tier hierarchy that prioritizes the inputs used to measure fair value. These tiers include: Level 1, defined as observable inputs such as quoted market prices in active markets; Level 2, defined as inputs other than quoted prices included within Level 1 that are observable for the asset or liability, either directly or indirectly; and Level 3, defined as unobservable inputs for which little or no market data exists, therefore requiring an entity to develop its own assumptions. The following table summarizes the financial assets and liabilities measured at fair value on a recurring basis as of December 31, 2016 and 2015 : December 31, 2016 2015 Level 1 Level 2 Level 3 Level 1 Level 2 Level 3 Cash and cash equivalents $ 57,706 $ — $ — $ 41,569 $ — $ — Our non-financial assets, which include long-lived assets, including goodwill, intangible assets and property and equipment, are not required to be measured at fair value on a recurring basis. However, on a periodic basis, or whenever events or changes in circumstances indicate that their carrying value may not be recoverable, we assess our long-lived assets for impairment. When impairment has occurred, such long-lived assets are written down to fair value. See Note 2, Summary of Significant Accounting Policies for further discussion of the Company's significant accounting policies. Debt Security Investments - Held to Maturity At December 31, 2016 and 2015 , the Company had approximately $35,184 and $34,717 , respectively, in debt security investments which were classified as held to maturity and carried at amortized cost. The carrying value of the debt securities approximates fair value. The Company has the intent and ability to hold these debt securities to maturity. Further, as of December 31, 2016 , the debt security investments were held in AA, A and BBB+ rated debt securities. |
Revenue and Accounts Receivable
Revenue and Accounts Receivable | 12 Months Ended |
Dec. 31, 2016 | |
REVENUE AND ACCOUNTS RECEIVABLE [Abstract] | |
Revenue and Accounts receivable [Text Block] | REVENUE AND ACCOUNTS RECEIVABLE Revenue for the years ended December 31, 2016, 2015 and 2014 is summarized in the following tables: Year Ended December 31, 2016 2015 2014 Revenue % of Revenue Revenue % of Revenue Revenue % of Revenue Medicaid $ 557,958 33.7 % $ 458,956 34.2 % $ 369,106 35.9 % Medicare 477,019 28.8 395,503 29.5 313,144 30.5 Medicaid — skilled 87,517 5.3 71,905 5.4 51,157 5.0 Total Medicaid and Medicare 1,122,494 67.8 926,364 69.1 733,407 71.4 Managed care 265,508 16.0 206,770 15.4 145,796 14.2 % Private and other payors (1) 266,862 16.2 208,692 15.5 148,203 14.4 % Revenue $ 1,654,864 100.0 % $ 1,341,826 100.0 % $ 1,027,406 100.0 % (1) Private and other payors also includes revenue from all payors generated in urgent care centers and other ancillary services. Accounts receivable as of December 31, 2016 and 2015 is summarized in the following table: December 31, 2016 2015 Medicaid $ 111,031 $ 90,677 Managed care 66,346 56,411 Medicare 55,500 49,970 Private and other payors 51,347 42,276 284,224 239,334 Less: allowance for doubtful accounts (39,791 ) (30,308 ) Accounts receivable, net $ 244,433 $ 209,026 |
Business Segments
Business Segments | 12 Months Ended |
Dec. 31, 2016 | |
Segment Reporting [Abstract] | |
Segment Reporting Disclosure [Text Block] | BUSINESS SEGMENTS The Company has three reportable operating segments: (1) transitional and skilled services, which includes the operation of skilled nursing facilities; (2) assisted and independent living services, which includes the operation of assisted and independent living facilities; and (3) home health and hospice services, which includes the Company's home health, home care and hospice businesses. The Company's Chief Executive Officer, who is our chief operating decision maker, or CODM, reviews financial information at the operating segment level. The Company also reports an “all other” category that includes revenue from its urgent care centers, mobile diagnostics and other ancillary operations. These operations are neither significant individually nor in aggregate and therefore do not constitute a reportable segment. In 2016, the Company completed the sale of its urgent care centers for an aggregate purchase price of $41,492 . The reporting segments are business units that offer different services and that are managed separately to provide greater visibility into those operations. The expansion of the Company's assisted and independent living services led it to separate the assisted and independent living services into a distinct reportable segment in the fourth quarter of 2016. Previously, the Company had two reportable segments, transitional, skilled and assisted living services (TSA services), which includes the operation of skilled nursing facilities and assisted living facilities; and (2) home health and hospice services. The Company has presented 2015 and 2014 financial information on a comparative basis to conform with the current year segment presentation. Certain revenues by payor source were reclassified between Medicaid and private and other to conform with the current year segment presentation. See also Note 12, Goodwill and Other Indefinite-Lived Intangible Assets for comparative information on changes in the carrying amount of goodwill by segment. As of December 31, 2016 , transitional and skilled services included 149 wholly-owned affiliated skilled nursing facilities and 21 campuses that provide skilled nursing and rehabilitative care services. The Company provided room and board and social services through 40 wholly-owned affiliated assisted and independent living facilities and 21 campuses. Home health, home care and hospice services were provided to patients through the Company's 39 agencies. The Company's urgent care services, which is included in the "all other" category, were provided to patients by the Company's wholly owned urgent care operating subsidiaries. See also Note 19, Divestitures for further information relating to the sale of urgent care centers. As of December 31, 2016 , the Company held majority membership interests in other ancillary operations, which operating results are included in the "all other" category. The Company evaluates performance and allocates capital resources to each segment based on an operating model that is designed to maximize the quality of care provided and profitability. General and administrative expenses are not allocated to any segment for purposes of determining segment profit or loss, and are included in the "all other" category in the selected segment financial data that follows. The accounting policies of the reporting segments are the same as those described in Note 2 , Summary of Significant Accounting Policies. The Company's CODM does not review assets by segment in his resource allocation and therefore assets by segment are not disclosed below. Segment revenues by major payor source were as follows: Year Ended December 31, 2016 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 521,063 $ 26,397 $ 10,498 $ — $ 557,958 33.7 % Medicare 396,519 — 80,500 — 477,019 28.8 Medicaid-skilled 87,517 — — — 87,517 5.3 Subtotal 1,005,099 26,397 90,998 — 1,122,494 67.8 Managed care 247,844 — 17,664 — 265,508 16.0 Private and other 121,860 97,239 7,151 40,612 (1) 266,862 16.2 Total revenue $ 1,374,803 $ 123,636 $ 115,813 $ 40,612 $ 1,654,864 100.0 % (1) Private and other payors in our "All Other" category includes revenue from all payors generated in the Company's urgent care centers and other ancillary operations. Year Ended December 31, 2015 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 430,368 $ 19,642 $ 8,946 $ — $ 458,956 34.2 % Medicare 332,429 — 63,074 — 395,503 29.5 Medicaid-skilled 71,905 — — — 71,905 5.4 Subtotal 834,702 19,642 72,020 — 926,364 69.1 Managed care 194,743 — 12,027 — 206,770 15.4 Private and other 96,943 68,487 6,309 36,953 (1) 208,692 15.5 Total revenue $ 1,126,388 $ 88,129 $ 90,356 $ 36,953 $ 1,341,826 100.0 % (1) Private and other payors in our "All Other" category includes revenue from all payors generated in the Company's urgent care centers and other ancillary operations. Year ended December 31, 2014 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 352,271 $ 11,590 $ 5,245 $ — $ 369,106 35.9 % Medicare 274,723 — 38,421 — 313,144 30.5 Medicaid-skilled 51,157 — — — 51,157 5.0 Subtotal 678,151 11,590 43,666 — 733,407 71.4 Managed care 138,215 — 7,581 — 145,796 14.2 Private and other 85,104 37,258 3,269 22,572 (1) 148,203 14.4 Total revenue $ 901,470 $ 48,848 $ 54,516 $ 22,572 $ 1,027,406 100.0 % (1) Private and other payors in our "All Other" category includes revenue from all payors generated in the Company's urgent care centers and other ancillary operations. The following table sets forth selected financial data consolidated by business segment: Year Ended December 31, 2016 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Elimination Total Revenue from external customers $ 1,374,803 $ 123,636 $ 115,813 $ 40,612 $ 1,654,864 Intersegment revenue (1) 2,929 — — 2,184 (5,113 ) — Total revenue $ 1,377,732 $ 123,636 $ 115,813 $ 42,796 $ (5,113 ) $ 1,654,864 Segment income (loss) (2) $ 118,118 $ 11,701 $ 16,571 $ (54,543 ) $ — $ 91,847 Interest expense, net of interest income (6,029 ) Income before provision for income taxes $ 85,818 Depreciation and amortization $ 26,298 $ 4,157 $ 924 $ 7,303 $ — $ 38,682 (1) Intersegment revenue represents services provided at the Company's skilled nursing facilities, urgent care centers and other ancillary operations to the Company's other operating subsidiaries. (2) Segment income excludes general and administrative expense for transitional and skilled services, assisted and independent living services and home health and hospice businesses. General and administrative expense is included in "All Other" category. The Company's transitional and skilled services segment income for the year ended December 31, 2016 included the continued obligation under the lease and related closing expenses of $7,935 , including the present value of rental payments of approximately $6,512 , which was recognized for the closure of one skilled nursing facility in the first quarter of 2016. See Note 18, Leases for further detail. Year Ended December 31, 2015 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Elimination Total Revenue from external customers $ 1,126,388 $ 88,129 $ 90,356 $ 36,953 $ 1,341,826 Intersegment revenue (1) 2,447 — 881 (3,328 ) — Total revenue $ 1,128,835 $ 88,129 $ 90,356 $ 37,834 $ (3,328 ) $ 1,341,826 Segment income (loss) (2) $ 136,744 $ 11,463 $ 13,584 $ (68,709 ) $ — $ 93,082 Interest expense, net of interest income $ (1,983 ) Income before provision for income taxes $ 91,099 Depreciation and amortization $ 18,008 $ 3,338 $ 980 $ 5,785 $ — $ 28,111 (1) Intersegment revenue represents services provided at the Company's skilled nursing facilities, urgent care centers and other ancillary operations to the Company's other operating subsidiaries. (2) Segment income excludes general and administrative expense for transitional and skilled services, assisted and independent living services and home health and hospice businesses. General and administrative expense is included in "All Other" category. Year Ended December 31, 2014 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Elimination Total Revenue from external customers $ 901,470 $ 48,848 $ 54,516 $ 22,572 $ 1,027,406 Intersegment revenue (1) 2,066 — 735 (2,801 ) — Total revenue $ 903,536 $ 48,848 $ 54,516 $ 23,307 $ (2,801 ) $ 1,027,406 Segment income (loss) (2) $ 117,816 $ 8,195 $ 9,701 $ (62,788 ) $ — $ 72,924 Interest expense, net of interest income $ (12,382 ) Income before provision for income taxes $ 60,542 Depreciation and amortization $ 19,673 $ 1,996 $ 539 $ 4,222 $ — $ 26,430 (1) Intersegment revenue represents services provided at the Company's skilled nursing facilities, urgent care centers and other ancillary operations to the Company's other operating subsidiaries. (2) Segment income excludes general and administrative expense for transitional and skilled services, assisted and independent living services and home health and hospice businesses. General and administrative expense is included in "All Other" category. |
Acquisitions
Acquisitions | 12 Months Ended |
Dec. 31, 2016 | |
Business Combinations [Abstract] | |
Business Combination Disclosure [Text Block] | ACQUISITIONS The Company’s acquisition focus is to purchase or lease operating subsidiaries that are complementary to the Company’s current affiliated operations, accretive to the Company's business or otherwise advance the Company's strategy. The results of all the Company’s operating subsidiaries are included in the accompanying Financial Statements subsequent to the date of acquisition. Acquisitions are accounted for using the acquisition method of accounting. The Company also enters into long-term leases that may include options to purchase the affiliated facilities. As a result, from time to time, the Company will acquire affiliated facilities that the Company has been operating under third-party leases. During the year ended December 31, 2016 , the Company expanded its operations with the addition of two home health agencies and five hospice agencies. In addition, the Company acquired eighteen stand-alone skilled nursing operations and one post-acute care campus through a combination of long-term leases and purchases. As part of these acquisitions, the Company acquired the real estate at two of the skilled nursing operations and one post-acute care campus and entered into long term leases for sixteen skilled nursing operations. The Company did not acquire any material assets or assume any liabilities other than the tenant's post-assumption rights and obligations under the long-term lease. The Company also invested in new ancillary services that are complementary to its existing transitional and skilled services; assisted and independent living services and home health and hospice businesses. The aggregate purchase price for these acquisitions for the year ended December 31, 2016 was $64,521 . The expansion of skilled nursing operations added 2,336 operational skilled nursing beds and ten assisted living units operated by the Company's operating subsidiaries. The Company entered into a separate operations transfer agreement with the prior operator as part of each transaction. The Company's operating subsidiaries opened six newly constructed post-acute care campuses under long-term lease agreements, which added 463 operational skilled nursing beds and 142 assisted living units. During the year ended December 31, 2015, the Company continued to expand its operations with the addition of 50 stand-alone skilled nursing and assisted living operations, seven home health, hospice and home care agencies and three urgent care centers to its operations through a combination of long-term leases and purchases. The Company did not acquire any material assets or assume any liabilities other than the tenant's post-assumption rights and obligations under the long-term leases. As part of these transactions, we acquired the real estate at 18 of the skilled nursing and assisted and independent living operations. In addition, the Company has invested in new business lines that are complementary to its existing transitional and skilled services; assisted and independent living services and home health and hospice businesses. The aggregate purchase price conveyed in all acquisitions was $119,965 , including the assumption of liabilities of $8,939 . The expansion of skilled nursing and assisted and independent living operations added 2,580 and 2,013 operational skilled nursing beds and assisted and independent living units, respectively, operated by the Company's operating subsidiaries. The Company also entered into a separate operations transfer agreement with the prior operator as part of each transaction. During the year ended December 31, 2014, the Company expanded its operations with the addition of 21 stand-alone skilled nursing and assisted living operations and nine home health, home care and hospice agencies to its operations through a combination of long-term leases and purchases. The aggregate purchase price was approximately $96,085 , including the assumption of an existing HUD-insured loan of $3,417 . The Company also entered into a separate operations transfer agreement with the prior operator as part of each transaction. The table below presents the allocation of the purchase price for the operations acquired in business combinations during the year ended December 31, 2016 , 2015 and 2014 : December 31, 2016 2015 2014 Land $ 1,054 $ 12,811 $ 10,314 Building and improvements 21,057 73,502 41,995 Equipment, furniture, and fixtures 8,265 4,612 2,933 Assembled occupancy 1,299 895 905 Definite-lived intangible assets 363 360 729 Goodwill 30,343 10,617 6,334 Favorable leases 393 10,901 28,680 Other indefinite-lived intangible assets 1,741 6,285 4,195 Other assets acquired, net of liabilities assumed 6 (18 ) — Total acquisitions $ 64,521 $ 119,965 $ 96,085 In addition to the business combinations above, in 2016, the Company acquired the underlying real estate of fifteen assisted living operation, which the Company previously operated under a long-term lease agreement for an aggregate purchase price of $127,348 . For year ended December 31, 2015, the Company acquired the underlying real estate and assets of three skilled nursing operations, which the Company previously operated under long-term lease agreements for an aggregate purchase price of $ $23,998 , which included a promissory note of $ $6,248 . These asset acquisitions did not impact the Company's operational bed or unit counts. Subsequent to December 31, 2016 , the Company acquired one skilled nursing and assisted living operation for a purchase price of $5,750 , which included real estate. The addition of this operation added 124 operational skilled nursing beds and nine assisted living units operated by the Company's operating subsidiaries. |
Acquisitions - Pro Forma
Acquisitions - Pro Forma | 12 Months Ended |
Dec. 31, 2016 | |
Business Acquisition, Pro Forma Information [Abstract] | |
Business Acquisitions, Pro Forma Information [Text Block] | ACQUISITIONS - PRO FORMA FINANCIAL INFORMATION The Company has established an acquisition strategy that is focused on identifying acquisitions within its target markets that offer the greatest opportunity for investment return at attractive prices. The facilities acquired by the Company are frequently underperforming financially and can have regulatory and clinical challenges to overcome. Financial information, especially with underperforming facilities, is often inadequate, inaccurate or unavailable. As a result, the Company has developed an acquisition assessment program that is based on existing and potential resident mix, the local available market, referral sources and operating expectations based on the Company's experience with its existing facilities. Following an acquisition, the Company implements a well-developed integration program to provide a plan for transition and generation of profits from facilities that have a history of significant operating losses. Consequently, the Company believes that prior operating results are not meaningful as the information is not generally representative of the Company's current operating results or indicative of the integration potential of its newly acquired facilities. The following table represents pro forma results of consolidated operations as if the acquisitions acquired from January 1, 2016 through the issuance date of the financial statements had occurred at the beginning of 2015, after giving effect to certain adjustments. December 31, 2016 2015 (Unaudited) Revenue $ 1,725,063 $ 1,524,371 Net income attributable to The Ensign Group, Inc. 48,992 54,790 Diluted net income per common share $ 0.94 $ 1.05 Our pro forma assumptions are as follows: • Revenues and operating costs were based on actual results from the prior operator or from regulatory filings where available. If actual results were not available, revenues and operating costs were estimated based on available partial operating results of the prior operator of the facility, or if no information was available, estimates were derived from the Company’s post-acquisition operating results for that particular facility. Prior year results for the 2016 acquisitions were obtained from available financial information provided by prior operators or available cost reports filed by the prior operators. • Interest expense is based upon the purchase price and average cost of debt borrowed during each respective year when applicable, and depreciation is calculated using the purchase price allocated to the related assets through acquisition accounting. The foregoing unaudited pro forma information is not indicative of what the results of operations would have been if the acquisitions had actually occurred at the beginning of the periods presented, and is not intended as a projection of future results or trends. Included in the table above are pro forma revenue and loss generated during the year ended December 31, 2016 , by individually immaterial business acquisitions completed through the issuance date of the Financial Statements of $ 70,199 and $997 , respectively. Included in the table above are pro forma revenue and loss generated during the year ended December 31, 2015 , by individually immaterial business acquisitions completed through the issuance date of the financial statements of $182,546 and $642 , respectively. |
Property and Equipment
Property and Equipment | 12 Months Ended |
Dec. 31, 2016 | |
Property, Plant and Equipment [Abstract] | |
Property, Plant and Equipment Disclosure [Text Block] | PROPERTY AND EQUIPMENT— Net Property and equipment, net consist of the following: December 31, 2016 2015 Land $ 47,565 $ 41,451 Buildings and improvements 304,263 151,434 Equipment 153,170 114,752 Furniture and fixtures 6,931 5,504 Leasehold improvements 80,164 68,405 Construction in progress 2,441 781 594,534 382,327 Less: accumulated depreciation (110,036 ) (82,694 ) Property and equipment, net $ 484,498 $ 299,633 See Note 8, Acquisitions for information on acquisitions during the year ended December 31, 2016 . |
Intangible Assets - Net
Intangible Assets - Net | 12 Months Ended |
Dec. 31, 2016 | |
Intangible Assets, Net (Excluding Goodwill) [Abstract] | |
Intangible Assets Disclosure [Text Block] | INTANGIBLE ASSETS — Net Weighted Average Life (Years) December 31, 2016 2015 Gross Carrying Amount Accumulated Amortization Gross Carrying Amount Accumulated Amortization Intangible Assets Net Net Lease acquisition costs 24.7 $ 483 $ (78 ) $ 405 $ 604 $ (577 ) $ 27 Favorable leases 32.1 35,116 (4,589 ) 30,527 43,248 (2,923 ) 40,325 Assembled occupancy 0.0 1,897 (1,897 ) — 4,779 (4,476 ) 303 Facility trade name 30.0 733 (269 ) 464 733 (244 ) 489 Customer relationships 18.5 4,933 (1,253 ) 3,680 5,300 (1,013 ) 4,287 Total $ 43,162 $ (8,086 ) $ 35,076 $ 54,664 $ (9,233 ) $ 45,431 Amortization expense was $4,634 , $3,824 and $1,089 for the years ended December 31, 2016, 2015 and 2014 , respectively. Of the $4,634 in amortization expense incurred during the year ended December 31, 2016 , approximately $1,602 related to the amortization of patient base intangible assets at recently acquired facilities, which is typically amortized over a period of four to eight months, depending on the classification of the patients and the level of occupancy in a new acquisition on the acquisition date. As of December 31, 2016 , the Company removed $582 in customer relationships as part of the sale of urgent care center and $7,190 of favorable leases as part of the acquisition of the real estate of fifteen assisted living operations. In addition, the Company identified intangible assets that have become fully amortized during the year and removed the fully amortized balances from the gross asset and accumulated amortization amounts. Estimated amortization expense for each of the years ending December 31 is as follows: Year Amount 2017 2,282 2018 2,282 2019 2,282 2020 1,573 2021 1,475 Thereafter 25,182 $ 35,076 |
Goodwill and Other Indefinite-L
Goodwill and Other Indefinite-Lived Intangible Assets | 12 Months Ended |
Dec. 31, 2016 | |
Indefinite-Lived Intangible Assets (Including Goodwill) [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, in accordance with the provisions of Accounting Standards Codification topic 350, Intangibles—Goodwill and Other (ASC 350). This guidance provides the option to first assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying value, a "Step 0" analysis. If, based on a review of qualitative factors, it is more likely than not that the fair value of a reporting unit is less than its carrying value, the Company performs "Step 1" of the traditional two-step goodwill impairment test by comparing the net assets of each reporting unit to their respective fair values. The Company determines the estimated fair value of each reporting unit using a discounted cash flow analysis. In the event a unit's net assets exceed its fair value, an implied fair value of goodwill must be determined by assigning the unit's fair value to each asset and liability of the unit. The excess of the fair value of the reporting unit over the amounts assigned to its assets and liabilities is the implied fair value of goodwill. An impairment loss is measured by the difference between the goodwill carrying value and the implied fair value. The Company performs its goodwill impairment test annually and evaluates goodwill when events or changes in circumstances indicate that its carrying value may not be recoverable. The Company performs the annual impairment testing of goodwill using October 1 as the measurement date. The Company completed its goodwill impairment test as of October 1, 2016 and no impairments were identified. In the fourth quarter of 2016, the Company separated the assisted and independent living services into a distinct reportable segment. The Company re-tested for goodwill impairment based on the new reporting units and no impairments were identified. As of December 31, 2016 , the Company removed $4,103 in goodwill as part of the sale of urgent care centers. The following table represents activity in goodwill by segment as of and for the year ended December 31, 2016 : Goodwill Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total January 1, 2014 $ 13,338 $ 316 $ 7,278 $ 3,003 $ 23,935 Impairments — — — $ — $ — Additions 883 1,440 3,651 $ 360 6,334 December 31, 2014 $ 14,221 $ 1,756 $ 10,929 $ 3,363 $ 30,269 Impairments — — — $ — $ — Additions — 1,782 5,173 $ 3,662 10,617 December 31, 2015 $ 14,221 $ 3,538 $ 16,102 $ 7,025 $ 40,886 Less: Dispositions — — — $ (4,103 ) $ (4,103 ) Purchase price adjustment — — — (26 ) (26 ) Additions 26,415 — 1,799 2,129 30,343 December 31, 2016 $ 40,636 $ 3,538 $ 17,901 $ 5,025 $ 67,100 There was no impairment charge to goodwill for the years ended December 31, 2016, 2015, and 2014. The Company anticipates that total goodwill recognized will be fully deductible for tax purposes as of December 31, 2016 . See further discussion of goodwill acquired at Note 8, Acquisitions . During the year ended December 31, 2016 , the Company recorded $1,709 in home health and hospice Medicare license and $31 in trade name indefinite-lived intangible assets as part of its acquisitions. In addition, the Company removed $800 in trade name as part of the sale of urgent care centers in 2016. Other indefinite-lived intangible assets consists of the following: December 31, 2016 December 31, 2015 Trade name $ 1,146 $ 1,915 Medicare and Medicaid licenses 18,440 16,731 $ 19,586 $ 18,646 |
Restricted and Other Assets
Restricted and Other Assets | 12 Months Ended |
Dec. 31, 2016 | |
Other Assets [Abstract] | |
Other Assets Disclosure [Text Block] | RESTRICTED AND OTHER ASSETS Restricted and other assets consist of the following: December 31, 2016 2015 Debt issuance costs, net $ 3,611 $ 2,021 Long-term insurance losses recoverable asset 4,104 2,881 Deposits with landlords 3,526 3,969 Capital improvement reserves with landlords and lenders 673 760 Note receivable from sale of urgent care centers 700 — Restricted and other assets $ 12,614 $ 9,631 Included in restricted and other assets as of December 31, 2016 and 2015, are anticipated insurance recoveries related to the Company's workers' compensation, general and professional liability claims that are recorded on a gross rather than net basis in accordance with an Accounting Standards Update issued by the FASB. |
Other Accrued Liabilities
Other Accrued Liabilities | 12 Months Ended |
Dec. 31, 2016 | |
Accrued Liabilities [Abstract] | |
Other Liabilities Disclosure [Text Block] | OTHER ACCRUED LIABILITIES Other accrued liabilities consist of the following: December 31, 2016 2015 Quality assurance fee $ 4,604 $ 6,120 Refunds payable 18,368 13,252 Deferred revenue 6,994 6,696 Cash held in trust for patients 2,373 3,016 Resident deposits 6,099 5,884 Dividends payable 2,186 2,072 Property taxes 9,130 4,230 Charges related to operational closure 1,972 — Other 7,037 4,935 Other accrued liabilities $ 58,763 $ 46,205 Quality assurance fee represents amounts payable to Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, Utah, Washington and Wisconsin as a result of a mandated fee based on patient days or licensed beds. Refunds payable includes payables related to overpayments and duplicate payments from various payor sources. Deferred revenue occurs when the Company receives payments in advance of services provided. Resident deposits include refundable deposits to patients. Cash held in trust for patients reflects monies received from, or on behalf of, patients. Maintaining a trust account for patients is a regulatory requirement and, while the trust assets offset the liabilities, the Company assumes a fiduciary responsibility for these funds. The cash balance related to this liability is included in other current assets in the accompanying consolidated balance sheets. |
Income Taxes
Income Taxes | 12 Months Ended |
Dec. 31, 2016 | |
Income Tax Disclosure [Abstract] | |
Income Tax Disclosure [Text Block] | INCOME TAXES The provision for income taxes on continuing operations for the years ended December 31, 2016, 2015 and 2014 is summarized as follows: Year Ended December 31, 2016 2015 2014 Current: Federal $ 30,043 $ 28,149 $ 25,490 State 5,183 5,761 4,405 35,226 33,910 29,895 Deferred: Federal (1,034 ) 2,026 (2,438 ) State (1,217 ) (754 ) (656 ) (2,251 ) 1,272 (3,094 ) Total $ 32,975 $ 35,182 $ 26,801 A reconciliation of the federal statutory rate to the effective tax rate for income from operations for the years ended December 31, 2016, 2015 and 2014, respectively, is comprised as follows: December 31, 2016 2015 2014 Income tax expense at statutory rate 35.0 % 35.0 % 35.0 % State income taxes - net of federal benefit 3.0 3.6 4.0 Non-deductible expenses 0.9 0.6 0.6 Non-deductible transaction costs — — 5.2 Other adjustments (0.5 ) (0.6 ) (0.4 ) Total income tax provision 38.4 % 38.6 % 44.4 % The Company's deferred tax assets and liabilities as of December 31, 2016 and 2015 are summarized as follows: December 31, 2016 2015 Deferred tax assets (liabilities): Accrued expenses $ 21,732 $ 18,957 Allowance for doubtful accounts 15,956 12,313 Tax credits 3,461 3,439 Insurance 7,333 5,814 Total deferred tax assets 48,482 40,523 State taxes (1,023 ) (420 ) Depreciation and amortization (20,643 ) (14,773 ) Prepaid expenses (3,743 ) (4,478 ) Total deferred tax liabilities (25,409 ) (19,671 ) Net deferred tax assets $ 23,073 $ 20,852 The Company had state credit carryforwards as of December 31, 2016 and 2015 of $3,430 and $3,439 , respectively. These carryforwards almost entirely relate to state limitations on the application of Enterprise Zone employment-related tax credits. Unless the Company uses the Enterprise Zone credits beforehand, the carryforward will begin to expire in 2023. The remainder of these carryforwards relates to credits against the Texas margin tax and is expected to carryforward until 2027. The Company did not have federal net operating loss carryforward as of December 31, 2016. The Company had federal net operating loss carryforwards as of December 31, 2015 of $4,389 . The Company also had state net operating losses as of December 31, 2016 and 2015 of $67 and $84 , respectively. These state net operating losses will begin to expire in 2032. The Federal statutes of limitations on the Company's 2010, 2011, and 2012 income tax years lapsed during the third quarter of 2014, 2015, and 2016, respectively. During the fourth quarter of each year, various state statutes of limitations also lapsed. The lapses for the years ended December 31, 2016, 2015, and 2014 had no impact on the Company's unrecognized tax benefits. As of December 31, 2016, 2015 and 2014, the Company did not have any unrecognized tax benefits, net of their state benefits, that would affect the Company's effective tax rate. The Company classifies interest and/or penalties on income tax liabilities or refunds as additional income tax expense or income. Such amounts are not material. |
Debt
Debt | 12 Months Ended |
Dec. 31, 2016 | |
Debt Disclosure [Abstract] | |
Debt Disclosure [Text Block] | DEBT Long-term debt consists of the following: December 31, 2016 2015 Term loan with SunTrust, interest payable quarterly $ 148,125 $ — Credit facility with SunTrust 122,000 85,000 Mortgage loans and promissory note, principal and interest payable monthly, interest at fixed rate 14,032 14,671 284,157 99,671 Less current maturities (8,129 ) (620 ) Less debt issuance costs (542 ) — $ 275,486 $ 99,051 Credit Facility with a Lending Consortium Arranged by SunTrust The Company maintains a credit facility with a lending consortium arranged by SunTrust (as amended to date, the Credit Facility). On July 19, 2016, the Company entered into the second amendment to the credit facility (Second Amended Credit Facility), which amended the existing credit agreement to increase the aggregate principal amount up to $450,000 . The Second Amended Credit Facility comprised of a $300,000 revolving credit facility and a $150,000 term loan. Borrowings under the term loan portion of the Second Amended Credit Facility mature on February 5, 2021 and amortizes in equal quarterly installments, in an aggregate annual amount equal to 5.0% per annum of the original principal amount. The interest rates and commitment fee applicable to the Second Amended Credit Facility are similar to the Amended Credit Facility discussed below. Except as set forth in the Second Amended Credit Facility, all other terms and conditions of the Amended Credit Facility remained in full force and effect as described below. On February 5, 2016, the Company amended its existing revolving credit facility to increase its aggregate principal amount available to $250,000 (the Amended Credit Facility). Under the credit facility, the Company may seek to obtain incremental revolving or term loans in an aggregate amount not to exceed $150,000 . The interest rates applicable to loans under the credit facility are, at the Company's option, equal to either a base rate plus a margin ranging from 0.75% to 1.75% per annum or LIBOR plus a margin ranging from 1.75% to 2.75% per annum, based on the Consolidated Total Net Debt to Consolidated EBITDA ratio (as defined in the agreement). In addition, the Company will pay a commitment fee on the unused portion of the commitments under the credit facility that will range from 0.30% to 0.50% per annum, depending on the Consolidated Total Net Debt to Consolidated EBITDA ratio of the Company and its subsidiaries. The Company is permitted to prepay all or any portion of the loans under the credit facility prior to maturity without premium or penalty, subject to reimbursement of any LIBOR breakage costs of the lenders. The Credit Facility is secured by a pledge of stock of the Company's material operating subsidiaries as well as a first lien on substantially all of its personal property. The credit facility contains customary covenants that, among other things, restrict, subject to certain exceptions, the ability of the Company and its operating subsidiaries to grant liens on their assets, incur indebtedness, sell assets, make investments, engage in acquisitions, mergers or consolidations, amend certain material agreements and pay certain dividends and other restricted payments. Under the Credit Facility, the Company must comply with financial maintenance covenants to be tested quarterly, consisting of a maximum Consolidated Total Net Debt to consolidated EBITDA ratio (which shall be increased to 3.50 : 1.00 for the current fiscal quarter and the immediate following three fiscal quarters), and a minimum interest/rent coverage ratio (which cannot be below 1.50 : 1.00 ). The majority of lenders can require that the Company and its operating subsidiaries mortgage certain of its real property assets to secure the Amended Credit Facility if an event of default occurs, the Consolidated Total Net Debt to consolidated EBITDA ratio is above 2.75 : 1.00 for two consecutive fiscal quarters, or its liquidity is equal or less than 10% of the Aggregate Revolving Commitment Amount (as defined in the agreement) for ten consecutive business days, provided that such mortgages will no longer be required if the event of default is cured, the Consolidated Total Net Debt to consolidated EBITDA ratio is below 2.75 : 1.00 for two consecutive fiscal quarters, or its liquidity is above 10% of the Aggregate Revolving Commitment Amount (as defined in the agreement) or ninety consecutive days, as applicable. As of December 31, 2016 , the Company's operating subsidiaries had $270,125 outstanding under the Credit Facility. The outstanding balance on the on the term loan was $148,125 , of which $7,500 is classified as short-term and the remaining $140,625 is classified as long-term. The outstanding balance on the revolving Credit Facility was $122,000 , which is classified as long-term. The Company was in compliance with all loan covenants as of December 31, 2016 . On May 30, 2014, the Company entered into the Credit Facility in an aggregate principal amount of $150,000 from a syndicate of banks and other financial institutions. Under the Credit Facility, the Company may seek to obtain incremental revolving or term loans in an aggregate amount not to exceed $75,000 . The interest rates applicable to loans under the Credit Facility are, at the Company’s option, equal to either a base rate plus a margin ranging from 1.25% to 2.25% per annum or LIBOR plus a margin ranging from 2.25% to 3.25% per annum, based on the debt to Consolidated EBITDA ratio of the Company and its operating subsidiaries as defined in the agreement. In addition, the Company will pay a commitment fee on the unused portion of the commitments under the Credit Facility that will range from 0.30% to 0.50% per annum, depending on the debt to Consolidated EBITDA ratio of the Company and its operating subsidiaries. Loans made under the Credit Facility are not subject to interim amortization. The Company is not required to repay any loans under the Credit Facility prior to maturity, other than to the extent the outstanding borrowings exceed the aggregate commitments under the Credit Facility. The Credit Facility is guaranteed, jointly and severally, by certain of the Company’s wholly owned subsidiaries, and is secured by substantially all of the Company's personal property. Under the Credit Facility, the Company must comply with financial maintenance covenants to be tested quarterly, consisting of a maximum debt to consolidated EBITDA ratio, and a minimum interest/rent coverage ratio. The majority of lenders can require that the Company and its operating subsidiaries mortgage certain of their real property assets to secure the Credit Facility if an event of default occurs, the debt to consolidated EBITDA ratio is above 2.50 : 1.00 for two consecutive fiscal quarters, or the Company’s liquidity is equal or less than 10% of the Aggregate Revolving Commitment Amount (as defined in the agreement) for ten consecutive business days, provided that such mortgages will no longer be required if the event of default is cured, the debt to consolidated EBITDA ratio is below 2.50 : 1.00 for two consecutive fiscal quarters, or the Company’s liquidity is above 10% of the Aggregate Revolving Commitment Amount (as defined in the agreement) or ninety consecutive days, as applicable. As of February 6, 2017 , there was approximately $300,000 outstanding under the Credit Facility. Mortgage Loans and Promissory Note The Company had outstanding indebtedness under mortgage loans and promissory note issued in connection with various acquisitions. The mortgage loans are insured with the U.S. Department of Housing and Urban Development (HUD), which subjects the Company's operating subsidiaries to HUD oversight and periodic inspections. The mortgage loans and note bear fixed interest rates between 2.6% and 5.3% per annum. Amounts borrowed under the mortgage loans may be prepaid starting after the second anniversary of the notes subject to prepayment fees of the principal balance on the date of prepayment. These prepayment fees are reduced by 1.0% per year for years three through eleven of the loan. There is no prepayment penalty after year eleven . The term of the mortgage loans and note is between 12 and 33 years . The mortgage loans and note are secured by the real property comprising the facilities and the rents, issues and profits thereof, as well as all personal property used in the operation of the facilities. As of December 31, 2016 , the Company's operating subsidiaries had $14,032 outstanding under the mortgage loans and note, of which $629 is classified as short-term and the remaining $13,403 is classified as long-term. The Company was in compliance with all loan covenants as of December 31, 2016 . 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 2017 $ 8,129 2018 8,178 2019 8,208 2020 8,241 2021 240,900 Thereafter 10,501 $ 284,157 Off-Balance Sheet Arrangements As of December 31, 2016 , the Company had approximately $2,310 on the credit facility of borrowing capacity pledged as collateral to secure outstanding letters of credit. |
Options and Awards
Options and Awards | 12 Months Ended |
Dec. 31, 2016 | |
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, 2016, 2015 and 2014 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 Company's stockholders. The total number of shares available under all of the Company’s stock incentive plans was 3,042 as of December 31, 2016 . 2001 Stock Option, Deferred Stock and Restricted Stock Plan - The 2001 Plan authorizes the sale of up to 3,960 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. There were 643 , 638 and 638 unissued shares of common stock available for issuance under this plan for each of the years ending December 31, 2016, 2015 and 2014, 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 1,000 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 ten years from the date of grant. There were 294 unissued shares of common stock available for issuance under this plan for each of the years ending December 31, 2016, 2015 and 2014, including shares that have been forfeited and are available for reissue. 2007 Omnibus Incentive Plan - The 2007 Plan authorizes the sale of up to 2,000 shares of common stock to officers, employees, directors and consultants of the Company. In addition, the number of shares of common stock reserved under the 2007 Plan will automatically increase on the first day of each fiscal year, beginning on January 1, 2008, in an amount equal to the lesser of (i) 1,000 shares of common stock, or (ii) 2% of the number of shares outstanding as of the last day of the immediately preceding fiscal year, or (iii) such lesser number as determined by the Company's board of directors. Granted non-employee director options vest and become exercisable in three equal annual installments, or the length of the term if less than 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 10 years from the date of grant. At December 31, 2016, 2015 and 2014, there were 2,105 , 1,740 , and 1,534 unissued shares of common stock available for issuance under this plan. The Company uses the Black-Scholes option-pricing model to recognize the value of stock-based compensation expense for all share-based payment awards. Determining the appropriate fair-value model and calculating the fair value of stock-based awards at the grant date requires considerable judgment, including estimating stock price volatility, expected option life and forfeiture rates. The Company develops estimates based on historical data and market information, which can change significantly over time. The Black-Scholes model required the Company to make several key judgments including: • The expected option term is calculated by the average of the contractual term of the options and the weighted average vesting period for all options. The calculation of the expected option term is based on the Company's experience due to sufficient history. • Estimated volatility also reflects the application of 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 utilized its own experience to calculate estimated volatility for options granted in the year 2016 and 2015. • 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 8.75% per year is based on the Company's historical forfeiture activity of unvested stock options. Stock Options The Company granted 497 options and 299 restricted stock awards from the 2007 Plan during the year ended December 31, 2016 . The Company used the following assumptions for stock options granted during the years ended December 31, 2016, 2015 and 2014 : Grant Year Options Granted Weighted Average Risk-Free Rate Expected Life Weighted Average Volatility Weighted Average Dividend Yield 2016 497 1.38% 6.3 years 38% 0.80% 2015 637 1.69% 6.5 years 39% 0.63% 2014 2,058 1.82% 6.5 years 46% 0.62% For the years ended December 31, 2016, 2015 and 2014 , 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 2016 497 $ 19.43 $ 7.00 2015 637 $ 23.27 $ 9.08 2014 2,058 $ 12.68 $ 5.66 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, 2016, 2015 and 2014 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, 2016, 2015 and 2014 : Number of Options Outstanding Weighted Average Exercise Price Number of Options Vested Weighted Average Exercise Price of Options Vested January 1, 2014 4,580 $ 5.65 2,498 $ 3.88 Granted 2,058 12.68 Forfeited (128 ) 8.14 Exercised (978 ) 3.93 December 31, 2014 5,532 $ 8.51 2,218 $ 4.70 Granted 637 23.27 Forfeited (233 ) 12.55 Exercised (488 ) 5.20 December 31, 2015 5,448 $ 10.36 2,526 $ 6.35 Granted 497 19.43 Forfeited (127 ) 14.46 Exercised (642 ) 6.47 December 31, 2016 5,176 $ 11.62 2,704 $ 8.18 The following summary information reflects stock options outstanding, vested and related details as of December 31, 2016 : Stock Options Vested Stock Options Outstanding Number Outstanding Black-Scholes Fair Value Remaining Contractual Life (Years) Vested and Exercisable Year of Grant Exercise Price 2008 2.56 - 4.06 415 $ 618 2 415 2009 4.06 - 4.56 542 1,162 3 542 2010 4.77 - 4.96 143 347 4 143 2011 5.90 - 7.99 167 567 5 167 2012 6.56 - 7.96 528 1,952 6 390 2013 7.98 - 11.49 617 2,996 7 331 2014 10.55 - 18.94 1,688 9,547 8 597 2015 21.47 - 25.24 590 5,357 9 119 2016 18.79 - 19.89 486 3,396 10 — Total 5,176 $ 25,942 2,704 Restricted Stock Awards The Company granted 299 , 323 and 56 restricted stock awards during the years ended December 31, 2016, 2015 and 2014 , respectively. All awards were granted at an exercise price of $0 and generally vest over five years . The fair value per share of restricted awards granted during 2016 , 2015 and 2014 ranged from $18.79 to $23.23 , $21.00 to $26.55 , and $15.38 to $22.36 , respectively. A summary of the status of the Company's non-vested restricted stock awards as of December 31, 2016 and changes during the years ended December 31, 2016, 2015 and 2014 is presented below: Non-Vested Restricted Awards Weighted Average Grant Date Fair Value Nonvested at January 1, 2014 460 $ 14.34 Granted 56 17.75 Vested (130 ) 13.38 Forfeited (20 ) 15.12 Nonvested at December 31, 2014 366 $ 15.15 Granted 323 22.99 Vested (234 ) 17.36 Forfeited (30 ) 16.81 Nonvested at December 31, 2015 425 $ 19.79 Granted 299 20.55 Vested (279 ) 19.58 Forfeited (16 ) 20.85 Nonvested at December 31, 2016 429 $ 20.42 During the year ended December 31, 2016 , the Company granted 32 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 $19.61 to $23.23 based on the market price on the grant date. Total share-based compensation expense recognized for the years ended December 31, 2016, 2015 and 2014 was as follows: Year Ended December 31, 2016 2015 2014 Share-based compensation expense related to stock options $ 4,793 $ 4,164 $ 3,134 Share-based compensation expense related to restricted stock awards 2,371 1,931 1,657 Share-based compensation expense related to stock awards to non-employee directors 612 582 399 Total $ 7,776 $ 6,677 $ 5,190 For the year ended December 31, 2016, 2015 and 2014, the Company expensed $612 , $582 and $399 , respectively, in share-based compensation related to the quarterly stock awards to non-employee directors. In future periods, the Company expects to recognize approximately $13,457 and $7,594 in share-based compensation expense for unvested options and unvested restricted stock awards, respectively, that were outstanding as of December 31, 2016 . Future share-based compensation expense will be recognized over 3.1 and 3.4 weighted average years for unvested options and restricted stock awards, respectively. There were 2,472 unvested and outstanding options at December 31, 2016 , of which 2,333 are expected to vest. The weighted average contractual life for options outstanding, vested and expected to vest at December 31, 2016 was 6.1 years. The aggregate intrinsic value of options outstanding, vested, expected to vest and exercised as of and for the years ended December 31, 2016, 2015 and 2014 is as follows: December 31, Options 2016 2015 2014 Outstanding $ 55,610 $ 67,508 $ 75,689 Vested 38,101 41,128 38,811 Expected to vest 15,983 23,508 31,160 Exercisable 9,199 8,709 10,496 The intrinsic value is calculated as the difference between the market value of the underlying common stock and the exercise price of the options. Equity Instrument Denominated in the Shares of a Subsidiary On May 26, 2016, the Company implemented a management equity plan and granted stock options and restricted stock awards of a subsidiary of the Company to employees and management of that subsidiary (Subsidiary Equity Plan). These awards generally vest over a period of five years or upon the occurrence of certain prescribed events. The value of the stock options and restricted stock awards is tied to the value of the common stock of the subsidiary. The awards can be put to the Company at various prescribed dates, which in no event is earlier than six months after vesting of the restricted awards or exercise of the stock options. The Company can also call the awards, generally upon employee termination. The grant-date fair value of the 2016 awards is $4,623 , which will be recognized as compensation expense over the relevant vesting periods, with a corresponding adjustment to noncontrolling interests. The grant value was determined based on an independent valuation of the subsidiary shares. For the year ended December 31, 2016 , the Company expensed $1,325 in share-based compensation related to the Subsidiary Equity Plan. There was no expense incurred for the year ended December 31, 2015 and 2014 as the plan was implemented in the second quarter of 2016. The aggregate number of the Company's common shares that would be required to settle these awards at current estimated fair values, including vested and unvested awards, at December 31, 2016 is 212 . There was no comparable amount at December 31, 2015 and 2014 as the plan was implemented in the second quarter of 2016. |
Leases
Leases | 12 Months Ended |
Dec. 31, 2016 | |
Leases [Abstract] | |
Leases of Lessee Disclosure [Text Block] | LEASES The Company leases from CareTrust REIT, Inc. (CareTrust) real property associated with 93 affiliated skilled nursing, assisted living and independent living facilities used in the Company’s operations under eight “triple-net” master lease agreements (collectively, the Master Leases), which ranges from 12 to 19 years. At the Company’s option, the Master Leases may be extended for two or three five-year renewal terms beyond the initial term, on the same terms and conditions. The extension of the term of any of the Master Leases is subject to the following conditions: (1) no event of default under any of the Master Leases having occurred and being continuing; and (2) the tenants providing timely notice of their intent to renew. The term of the Master Leases is subject to termination prior to the expiration of the then current term upon default by the tenants in their obligations, if not cured within any applicable cure periods set forth in the Master Leases. The Company does not have the ability to terminate the obligations under a Master Lease prior to its expiration without CareTrust’s consent. If a Master Lease is terminated prior to its expiration other than with CareTrust’s consent, the Company may be liable for damages and incur charges such as continued payment of rent through the end of the lease term and maintenance and repair costs for the leased property. Commencing the third year, the rent structure under the Master Leases includes a fixed component, subject to annual escalation equal to the lesser of (1) the percentage change in the Consumer Price Index (but not less than zero) or (2) 2.5% . In addition to rent, the Company is required to pay the following: (1) all impositions and taxes levied on or with respect to the leased properties (other than taxes on the income of the lessor); (2) all utilities and other services necessary or appropriate for the leased properties and the business conducted on the leased properties; (3) all insurance required in connection with the leased properties and the business conducted on the leased properties; (4) all facility maintenance and repair costs; and (5) all fees in connection with any licenses or authorizations necessary or appropriate for the leased properties and the business conducted on the leased properties. Total rent expense under the Master Leases was approximately $56,271 , $56,000 and $32,700 for the years ended December 31, 2016, 2015 and 2014 , respectively. At the Company's option, the Master Leases may be extended for two or three five-year renewal terms beyond the initial term, on the same terms and conditions. If the Company elects to renew the term of a Master Lease, the renewal will be effective as to all, but not less than all, of the leased property then subject to the Master Lease. Among other things, under the Master Leases, the Company must maintain compliance with specified financial covenants measured on a quarterly basis, including a portfolio coverage ratio and a minimum rent coverage ratio. The Master Leases also include certain reporting, legal and authorization requirements. The Company is not aware of any defaults as of December 31, 2016 . During the first quarter of 2016, the Company voluntarily discontinued operations in one of its skilled nursing facilities in order to preserve the overall ability to serve the residents in surrounding counties after careful consideration and some clinical survey challenges. As part of this closure, the Company entered into an agreement with its landlord allowing for the closure of the property as well as other provisions to allow its landlord to transfer the property and the licenses free and clear of the applicable master lease. This arrangement will not impact the rent expense to be paid in 2016, or expected to be paid in future periods, and will have no material impact on the Company's lease coverage ratios under the Master Leases. The Company recorded a continued obligation liability under the lease and related closing expenses of $7,935 , including the present value of rental payments of approximately $6,512 , which was recognized in the first quarter of 2016. Residents of the affected facility were transferred to other local skilled nursing facilities. The Company also leases certain affiliated operations and its administrative offices under non-cancelable operating leases, most of which have initial lease terms ranging from five to 20 years . The Company has entered into multiple lease agreements with various landlords to operate newly constructed state-of-the-art, full-service healthcare resorts upon completion of construction. The term of each lease is 15 years with two five -year renewal options and is subject to annual escalation equal to the percentage change in the Consumer Price Index with a stated cap percentage. In addition, the Company leases certain of its equipment under non-cancelable operating leases with initial terms ranging from three to five years . Most of these leases contain renewal options, certain of which involve rent increases. Total rent expense, inclusive of straight-line rent adjustments and rent associated with the Master Leases noted above, was $125,221 , $89,264 and $48,947 for the years ended December 31, 2016, 2015 and 2014 , respectively. Future minimum lease payments for all leases as of December 31, 2016 are as follows: Year Amount 2017 137,247 2018 140,211 2019 139,851 2020 139,191 2021 138,498 Thereafter 1,145,188 $ 1,840,186 Twenty-two of the Company’s affiliated facilities, excluding the facilities that are operated under the Master Leases with CareTrust, are operated under five separate master lease arrangements. Under these master leases, a breach at a single facility could subject one or more of the other facilities covered by the same master lease to the same default risk. Failure to comply with Medicare and Medicaid provider requirements is a default under several of the Company’s leases, master lease agreements and debt financing instruments. In addition, other potential defaults related to an individual facility may cause a default of an entire master lease portfolio and could trigger cross-default provisions in the Company’s outstanding debt arrangements and other leases. With an indivisible lease, it is difficult to restructure the composition of the portfolio or economic terms of the lease without the consent of the landlord. In November 2016, the Company entered into an agreement with its landlord to terminate the lease effective as of November 16, 2016. The lease of the facility was scheduled to expire on May 31, 2031. The lease terminates effective as of November 16, 2016. 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, 2016 . |
Divestitures
Divestitures | 12 Months Ended |
Dec. 31, 2016 | |
Divestitures [Abstract] | |
Disposal Groups, Including Discontinued Operations, Disclosure [Text Block] | DIVESTITURES In 2016, the Company completed the sale of seventeen urgent care centers for an aggregate sale price of $41,492 . As a result of the sale, the Company recognized a pretax gain of $19,160 , which is included in operating income. Due to the disposition of the clinics, the Company is no longer the primary beneficiary and the variable interest entities associated with the urgent care operations was deconsolidated from the Company's consolidated financial statements as of December 31, 2016 . At deconsolidation, the Company eliminated intercompany balances that previously existed. The sale of this investment supports the Company's increased focus on growth opportunities in its business lines that are complementary to its existing transitional and skilled services. The sale transactions did not meet the criteria of a discontinued operation as they do not represent a strategic shift that has or will have a major effect on the Company’s operations and financial results. |
Commitments and Contingencies
Commitments and Contingencies | 12 Months Ended |
Dec. 31, 2016 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies Disclosure [Text Block] | COMMITMENTS AND CONTINGENCIES Regulatory Matters — Laws and regulations governing Medicare and Medicaid programs are complex and subject to interpretation. Compliance with such laws and regulations can be subject to future governmental review and interpretation, as well as significant regulatory action including fines, penalties, and exclusion from certain governmental programs. The Company believes that it is in compliance in all material respects with all applicable laws and regulations. Cost-Containment Measures — Both government and private pay sources have instituted cost-containment measures designed to limit payments made to providers of healthcare services, and there can be no assurance that future measures designed to limit payments made to providers will not adversely affect the Company. Indemnities — From time to time, the Company enters into certain types of contracts that contingently require the Company to indemnify parties against third-party claims. These contracts primarily include (i) certain real estate leases, under which the Company may be required to indemnify property owners or prior facility operators for post-transfer environmental or other liabilities and other claims arising from the Company’s use of the applicable premises, (ii) operations transfer agreements, in which the Company agrees to indemnify past operators of facilities the Company acquires against certain liabilities arising from the transfer of the operation and/or the operation thereof after the transfer, (iii) certain lending agreements, under which the Company may be required to indemnify the lender against various claims and liabilities, and (iv) certain agreements with the Company’s officers, directors and employees, under which the Company may be required to indemnify such persons for liabilities arising out of their employment relationships. The terms of such obligations vary by contract and, in most instances, a specific or maximum dollar amount is not explicitly stated therein. Generally, amounts under these contracts cannot be reasonably estimated until a specific claim is asserted. Consequently, because no claims have been asserted, no liabilities have been recorded for these obligations on the Company’s balance sheets for any of the periods presented. Litigation — The skilled nursing business involves a significant risk of liability given the age and health of the patients and residents served by the Company's operating subsidiaries. The Company, its operating subsidiaries, and others in the industry are subject to an increasing number of claims and lawsuits, including professional liability claims, alleging that services provided have resulted in personal injury, elder abuse, wrongful death or other related claims. The defense of these lawsuits may result in significant legal costs, regardless of the outcome, and can result in large settlement amounts or damage awards. In addition to the potential lawsuits and claims described above, the Company is also subject to potential lawsuits under the Federal False Claims Act and comparable state laws alleging submission of fraudulent claims for services to any healthcare program (such as Medicare) or payor. A violation may provide the basis for exclusion from federally-funded healthcare programs. Such exclusions could have a correlative negative impact on the Company’s financial performance. Some states, including California, Arizona and Texas, have enacted similar whistleblower and false claims laws and regulations. In addition, the Deficit Reduction Act of 2005 created incentives for states to enact anti-fraud legislation modeled on the Federal False Claims Act. As such, the Company could face increased scrutiny, potential liability and legal expenses and costs based on claims under state false claims acts in markets in which it does business. In May 2009, Congress passed the Fraud Enforcement and Recovery Act (FERA) of 2009 which made significant changes to the Federal False Claims Act (FCA), expanding the types of activities subject to prosecution and whistleblower liability. Following changes by FERA, health care providers face significant penalties for the knowing retention of government overpayments, even if no false claim was involved. Health care providers can now be liable for knowingly and improperly avoiding or decreasing an obligation to pay money or property to the government. This includes the retention of any government overpayment. The government can argue, therefore, that a FCA violation can occur without any affirmative fraudulent action or statement, as long as it is knowingly improper. In addition, FERA extended protections against retaliation for whistleblowers, including protections not only for employees, but also contractors and agents. Thus, there is generally no need for an employment relationship in order to qualify for protection against retaliation for whistleblowing. Healthcare litigation (including class action litigation) is common and is filed based upon a wide variety of claims and theories, and the Company is routinely subjected to varying types of claims. One particular type of suit arises from alleged violations of 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, a civil money 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 continue to be aggressive in their pursuit of these staffing and similar claims. The Company has in the past been subject to class action litigation involving claims of alleged violations of regulatory requirements related to staffing. While the Company has been able to settle these claims without a material ongoing adverse effect on its business, future claims could be brought that may materially affect its business, financial condition and results of operations. Other claims and suits, including class actions, continue to be filed against the Company and other companies in its industry. If there were a significant increase in the number of these claims or an increase in amounts owing should plaintiffs be successful in their prosecution of these claims, this could materially adversely affect the Company’s business, financial condition, results of operations and cash flows. The Company and its operating subsidiaries have been, and continue to be, subject to claims and legal actions that arise in the ordinary course of business, including potential claims related to patient care and treatment as well as employment related claims. For example, the Company has been subjected to, and is currently involved in, class action litigation alleging violations of state and federal wage and hour law. 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. Other claims and suits continue to be filed against the Company and other companies in its industry. By way of recent example, a general/premises liability lawsuit was filed against one of the Company’s independent operating entities in San Luis Obispo, California, in connection with an alleged injury to a non-employee/contractor. The Company estimates that the cost of resolving this case will be approximately $2,100 , which was recorded in the consolidated financial statements during the year ended December 31, 2016 . Further, another one of the Company’s independent operating entities was sued on allegations of professional negligence, which the claim was recently settled. The Company estimated that the costs associated with the settlement of this second matter will be approximately $2,800 , which was recorded in the consolidated financial statements during the year ended December 31, 2016 . The Company does not expect that there will be any material ongoing adverse effect on the Company's business, financial condition or results of operations in connection with the resolution of these matters. The Company cannot predict or provide any assurance as to the possible outcome of any litigation. If any litigation were to proceed, and the Company and its operating subsidiaries are subjected to, alleged to be liable for, or agrees to a settlement of, claims or obligations under Federal Medicare statutes, the Federal False Claims Act, or similar State and Federal statutes and related regulations, the Company's business, financial condition and results of operations and cash flows could be materially and adversely affected and its stock price could be adversely impacted. Among other things, any settlement or litigation could involve the payment of substantial sums to settle any alleged civil violations, and may also include the assumption of specific procedural and financial obligations by the Company or its subsidiaries going forward under a corporate integrity agreement and/or other arrangement with the government. Medicare Revenue Recoupments — The Company is subject to reviews relating to Medicare services, billings and potential overpayments. During the year ended December 31, 2016 , eighteen of the Company's operating subsidiaries have been subject to probe reviews, both pre- and post-payment. Twelve of these reviews have successfully closed as of December 31, 2016 . The Company anticipates that these probe reviews will increase in frequency in the future. If a facility fails a probe review and subsequent re-probes, the facility could then be subject to extended pre-pay review or extrapolation of the identified error rate to all billing in the same time period. None of the Company's operating subsidiaries are currently on extended prepayment review or subject to extrapolation, although that may occur in the future. As of December 31, 2016 , the Company has six operating subsidiaries under probe review. U.S. Government Inquiry — In October 2013, the Company completed and executed a settlement agreement (the Settlement Agreement) with the DOJ, which received the final approval of the Office of Inspector General-HHS and the United States District Court for the Central District of California. Pursuant to the Settlement Agreement, the Company made a single lump-sum remittance to the government in the amount of $48,000 in October 2013. The Company has denied engaging in any illegal conduct and has agreed to the settlement amount without any admission of wrongdoing in order to resolve the allegations and to avoid the uncertainty and expense of protracted litigation. In connection with the settlement and effective as of October 1, 2013, the Company entered into a five-year corporate integrity agreement (the CIA) with the Office of Inspector General-HHS. The CIA acknowledges the existence of the Company’s current compliance program, which is in accord with the Office of the Inspector General (OIG)’s guidance related to an effective compliance program, and requires that the Company continue during the term of the CIA to maintain a program designed to promote compliance with the statutes, regulations, and written directives of Medicare, Medicaid, and all other Federal health care programs. The Company is also required to notify the Office of Inspector General-HHS in writing, of, among other things: (i) any ongoing government investigation or legal proceeding involving an allegation that the Company has committed a crime or has engaged in fraudulent activities; (ii) any other matter that a reasonable person would consider a probable violation of applicable criminal, civil, or administrative laws related to compliance with federal healthcare programs; and (iii) any change in location, sale, closing, purchase, or establishment of a new business unit or location related to items or services that may be reimbursed by federal health care programs. The Company is also required to retain an Independent Review Organization (IRO) to review certain clinical documentation annually for the term of the CIA. The Company has met the requirements of its third year under the Settlement Agreement and passed its IRO audits. Participation in federal healthcare programs by the Company is not affected by the Settlement Agreement or the CIA. In the event of an uncured material breach of the CIA, the Company could be excluded from participation in federal healthcare programs and/or subject to prosecution. Concentrations Credit Risk — The Company has significant accounts receivable balances, the collectability of which is dependent on the availability of funds from certain governmental programs, primarily Medicare and Medicaid. These receivables represent the only significant concentration of credit risk for the Company. The Company does not believe there are significant credit risks associated with these governmental programs. The Company believes that an appropriate allowance has been recorded for the possibility of these receivables proving uncollectible, and continually monitors and adjusts these allowances as necessary. The Company’s receivables from Medicare and Medicaid payor programs accounted for approximately 58.6% and 58.8% of its total accounts receivable as of December 31, 2016 and 2015, respectively. Revenue from reimbursement under the Medicare and Medicaid programs accounted for 67.8% , 69.1% and 71.4% of the Company's revenue for the years ended December 31, 2016, 2015 and 2014 , 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 6, 2017 , the Company had approximately $2,500 in uninsured cash deposits. All uninsured bank deposits are held at high quality credit institutions. |
Self-Insurance Reserves
Self-Insurance Reserves | 12 Months Ended |
Dec. 31, 2016 | |
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, 2016 and 2015: General and Professional Liability Workers' Compensation Health Total Balance January 1, 2015 30,401 15,758 3,801 $ 49,960 Current year provisions 12,528 12,508 15,921 40,957 Claims paid and direct expenses (11,911 ) (8,822 ) (14,648 ) (35,381 ) Change in long-term insurance losses recoverable (308 ) 775 — 467 Balance December 31, 2015 30,710 20,219 5,074 56,003 Current year provisions 23,149 12,887 38,151 74,187 Claims paid and direct expenses (18,186 ) (10,290 ) (37,586 ) (66,062 ) Change in long-term insurance losses recoverable 637 586 — 1,223 Balance December 31, 2016 $ 36,310 $ 23,402 $ 5,639 $ 65,351 Included in long-term insurance losses recoverable as of December 31, 2016 and 2015, 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. |
Defined Contribution Plan
Defined Contribution Plan | 12 Months Ended |
Dec. 31, 2016 | |
Defined Contribution Plan [Abstract] | |
Defined Contribution Plan Disclosures [Table 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 $862 , $682 and $565 during the years ended December 31, 2016, 2015 and 2014, respectively. Beginning in 2007, the 401(k) Plan allowed eligible employees to contribute up to 90% of their eligible compensation, subject to applicable annual Internal Revenue Code limits. |
REIT Spin-Off
REIT Spin-Off | 12 Months Ended |
Dec. 31, 2015 | |
REIT Spin-Off [Abstract] | |
Proposed Spin-Off of Real Estate Assets Through a Real Estate Investment Trust (REIT) [Text Block] | SPIN-OFF OF REAL ESTATE ASSETS THROUGH A REAL ESTATE INVESTMENT TRUST On June 1, 2014, the Company completed its plan to separate into two separate publicly traded companies by creating a newly formed, publicly traded real estate investment trust (REIT), known as CareTrust REIT, Inc. (CareTrust), through a tax free spin-off (the Spin-Off). The Company effected the Spin-Off by distributing to its stockholders one share of CareTrust common stock for each share of Ensign common stock held at the close of business on May 22, 2014, the record date for the Spin-Off. The Company received a private letter ruling from the Internal Revenue Service (IRS) substantially to the effect that the Spin-Off will qualify as a tax-free transaction for U.S. federal income tax purposes. The private letter ruling relies on certain facts, representations, assumptions and undertakings. Prior to the Spin-Off, the Company entered into a Separation and Distribution Agreement with CareTrust, setting forth the mechanics of the Spin-Off, certain organizational matters and other ongoing obligations of the Company and CareTrust. The Company and CareTrust or their respective subsidiaries, as applicable, also entered into a number of other agreements to govern the relationship between CareTrust and the Company. Immediately before the Spin-Off, on May 30, 2014, while CareTrust was a wholly-owned subsidiary of the Company, CareTrust raised $260,000 of debt financing (the Bond). CareTrust also entered into the Fifth Amended and Restated Loan Agreement, with General Electric Capital Corporation (GECC), which consisted of an additional loan of $50,676 to an aggregate principal amount of $99,000 (the Ten Project Note). The Ten Project Note and the Bond were assumed by CareTrust in connection with the Spin-Off. CareTrust transferred $220,752 to the Company, a portion of which the Company used to retire $208,635 of long-term debt prior to maturity. The remaining portion was used to pay prepayment penalties and other third party fees relating to the early retirement of outstanding debt. The amount retained by the Company of $8,219 was recorded as restricted cash, of which $6,400 was classified as current assets and $1,819 was classified as non-current assets as of June 1, 2014. The amount represented a portion of the proceeds received from CareTrust in connection with the Spin-Off that the Company intended to use to pay up to eight regular quarterly dividend payments. During the year ended December 31, 2015 and 2014, the Company utilized $3,137 and $5,082 , respectively, to pay the quarterly dividend payments. The remaining cash of $78,731 that CareTrust retained on the Spin-Off date was transferred to CareTrust as part of the assets and liabilities contributed to CareTrust in connection with the Spin-Off. As of March 31, 2014, the Company operated 120 affiliated facilities. Prior to the Spin-Off, the Company separated the healthcare operations from the independent living operations at two locations, resulting in a total of 122 affiliated facilities. In connection with the Spin-Off, the Company contributed to CareTrust the assets and liabilities associated with 94 real property and three independent living facilities that CareTrust now operates and that were previously owned by the Company. The results of the three independent living facilities that were transferred to CareTrust in connection with the Spin-Off were not material to the Company's results of operations for the years ended December 31, 2014 and 2013. The assets and liabilities were contributed to CareTrust based on their historical carrying values, which were as follows: Cash and cash equivalents $ 78,731 Other current assets 34 Property and equipment, net 421,846 Deferred financing costs 11,088 Accounts payable and accrued expenses (4,971 ) Current deferred tax liability (125 ) Deferred tax liability (5,925 ) Current maturities of long-term debt (2,342 ) Long-term debt—less current maturities (357,171 ) Net contribution $ 141,165 As a result of the Spin-Off, CareTrust owns all of the 94 real property and three independent living facilities that were transferred in connection with the Spin-Off. The Company leases the 94 real property facilities from CareTrust under eight “triple-net” master lease agreements (collectively, the Master Leases). The Company continues to operate the affiliated skilled nursing, assisted living and independent living facilities that are leased from CareTrust pursuant to the Master Leases. See Note 18, Leases for detail of the Master Leases arrangement. In addition, Christopher Christensen, the Company's Chief Executive Officer, served as a board member of CareTrust subsequent to the Spin-Off through April 15, 2015. The Company did not incur transactions costs related to the Spin-Off for the year ended December 31, 2016 and 2015. The Company incurred transaction costs associated with the Spin-Off of $9,026 for years ended December 31, 2014, which is included in general and administrative expenses within the consolidated statements of income. |
Significant Accounting Polici32
Significant Accounting Policies Level 2 (Policies) | 12 Months Ended |
Dec. 31, 2016 | |
Accounting Policies [Abstract] | |
Basis of Accounting, Policy [Policy Text Block] | Basis of Presentation — The accompanying consolidated financial statements (Financial Statements) have been prepared in accordance with accounting principles generally accepted in the United States (GAAP). The Company is the sole member or shareholder of various consolidated limited liability companies and corporations established to operate various acquired skilled nursing and assisted living operations, home health, hospice and home care operations, urgent care centers and related ancillary services. 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 during the year ended December 31, 2016 . The Company completed the sale of its urgent care centers for an aggregate purchase price of $41,492 . The sale transactions do not meet the criteria of discontinued operations as they do not represent a strategic shift that has, or will have, a major effect on the Company’s operations and financial results. |
Reclassifications [Text Block] | Reclassifications - Prior period results reflect reclassifications, for comparative purposes, related to the early adoption of authoritative guidance for the presentation of deferred taxes. Deferred tax assets have been presented on the balance sheets as a non-current asset for all periods presented. Historically, these assets were classified as either current or non-current assets, as applicable. |
Use of Estimates, Policy [Policy Text Block] | Estimates and Assumptions — The preparation of Financial Statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting periods. The most significant estimates in the Company’s Financial Statements relate to revenue, allowance for doubtful accounts, intangible assets and goodwill, impairment of long-lived assets, general and professional liability, workers' compensation and healthcare claims included in accrued self-insurance liabilities and income taxes. Actual results could differ from those estimates. |
Fair Value of Financial Instruments, Policy [Policy Text Block] | Fair Value of Financial Instruments — The Company’s financial instruments consist principally of cash and cash equivalents, debt security investments, accounts receivable, insurance subsidiary deposits, accounts payable and borrowings. The Company believes all of the financial instruments’ recorded values approximate fair values because of their nature or respective short durations. |
Revenue Recognition, Sales of Services [Policy Text Block] | Revenue Recognition — The Company recognizes revenue when the following four conditions have been met: (i) there is persuasive evidence that an arrangement exists; (ii) delivery has occurred or service has been rendered; (iii) the price is fixed or determinable; and (iv) collection is reasonably assured. The Company's revenue is derived primarily from providing healthcare services to patients and is recognized on the date services are provided at amounts billable to the individual. For reimbursement arrangements with third-party payors, including Medicaid, Medicare and private insurers, revenue is recorded based on contractually agreed-upon amounts on a per patient basis. Revenue from the Medicare and Medicaid programs accounted for 67.8% , 69.1% and 71.4% of the Company's revenue for the years ended December 31, 2016, 2015 and 2014 , respectively. The Company records revenue from these governmental and managed care programs as services are performed at their expected net realizable amounts under these programs. The Company’s revenue from governmental and managed care programs is subject to audit and retroactive adjustment by governmental and third-party agencies. Consistent with healthcare industry accounting practices, any changes to these governmental revenue estimates are recorded in the period the change or adjustment becomes known based on final settlement. The Company recorded adjustments to revenue which were not material to the Company's consolidated revenue for the years ended December 31, 2016, 2015 and 2014 . The Company’s service specific revenue recognition policies are as follows: Skilled Nursing Revenue The Company’s revenue is derived primarily from providing long-term healthcare services to patients and is recognized on the date services are provided at amounts billable to individual patients. For patients under reimbursement arrangements with third-party payors, including Medicaid, Medicare and private insurers, revenue is recorded based on contractually agreed-upon amounts or rate on a per patient, daily basis or as services are performed. Assisted and Independent Living Revenue The Company's revenue is recorded when services are rendered on the date services are provided at amounts billable to individual residents and consists of fees for basic housing and assisted living care. Residency agreements are generally for a term of 30 days, with resident fees billed monthly in advance. For patients under reimbursement arrangements with Medicaid, revenue is recorded based on contractually agreed-upon amounts or rate on a per resident, daily basis or as services. Revenue for certain ancillary charges is recognized as services are provided, and such fees are billed monthly in arrears. Home Health Revenue Medicare Revenue Net service revenue is recorded under the Medicare prospective payment system based on a 60-day episode payment rate that is subject to adjustment based on certain variables including, but not limited to: (a) an outlier payment if patient care was unusually costly; (b) a low utilization payment adjustment if the number of visits was fewer than five; (c) a partial payment if the patient transferred to another provider or the Company received a patient from another provider before completing the episode; (d) a payment adjustment based upon the level of therapy services required; (e) the number of episodes of care provided to a patient, regardless of whether the same home health provider provided care for the entire series of episodes; (f) changes in the base episode payments established by the Medicare program; (g) adjustments to the base episode payments for case mix and geographic wages; and (h) recoveries of overpayments. The Company makes adjustments to Medicare revenue on completed episodes to reflect differences between estimated and actual payment amounts, an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. Therefore, the Company believes that its reported net service revenue and patient accounts receivable will be the net amounts to be realized from Medicare for services rendered. In addition to revenue recognized on completed episodes, the Company also recognizes a portion of revenue associated with episodes in progress. Episodes in progress are 60-day episodes of care that begin during the reporting period, but were not completed as of the end of the period. As such, the Company estimates revenue and recognizes it on a daily basis. The primary factors underlying this estimate are the number of episodes in progress at the end of the reporting period, expected Medicare revenue per episode and its estimate of the average percentage complete based on visits performed. Non-Medicare Revenue Episodic Based Revenue - The Company recognizes revenue in a similar manner as it recognizes Medicare revenue for episodic-based rates that are paid by other insurance carriers, including Medicare Advantage programs; however, these rates can vary based upon the negotiated terms. Non-episodic Based Revenue - Revenue is recorded on an accrual basis based upon the date of service at amounts equal to its established or estimated per-visit rates, as applicable. Hospice Revenue Revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are daily rates for each of the levels of care the Company delivers. The Company makes adjustments to revenue for an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. Additionally, as Medicare hospice revenue is subject to an inpatient cap limit and an overall payment cap, the Company monitors its provider numbers and estimates amounts due back to Medicare if a cap has been exceeded. The Company records these adjustments as a reduction to revenue and increases other accrued liabilities. |
Trade and Other Accounts Receivable, Policy [Policy Text Block] | Accounts Receivable and Allowance for Doubtful Accounts — Accounts receivable consist primarily of amounts due from Medicare and Medicaid programs, other government programs, managed care health plans and private payor sources. Estimated provisions for doubtful accounts are recorded to the extent it is probable that a portion or all of a particular account will not be collected. In evaluating the collectability of accounts receivable, the Company considers a number of factors, including the age of the accounts, changes in collection patterns, the composition of patient accounts by payor type and the status of ongoing disputes with third-party payors. On an annual basis, the historical collection percentages are reviewed by payor and by state and are updated to reflect the recent collection experience of the Company. In order to determine the appropriate reserve rate percentages which ultimately establish the allowance, the Company analyzes historical cash collection patterns by payor and by state. The percentages applied to the aged receivable balances are based on the Company’s historical experience and time limits, if any, for managed care, Medicare, Medicaid and other payors. The Company periodically refines its estimates of the allowance for doubtful accounts based on experience with the estimation process and changes in circumstances. |
Cash and Cash Equivalents, Policy [Policy Text Block] | Cash and Cash Equivalents — Cash and cash equivalents consist of bank term deposits, money market funds and treasury bill related investments with original maturities of three months or less at time of purchase and therefore approximate fair value. The fair value of money market funds is determined based on “Level 1” inputs, which consist of unadjusted quoted prices in active markets that are accessible at the measurement date for identical, unrestricted assets. The Company places its cash and short-term investments with high credit quality financial institutions. |
Insurance Subsidiary Deposits and Investments [Policy Text Block] | Insurance Subsidiary Deposits and Investments — The Company's captive insurance subsidiary cash and cash equivalents, deposits and investments are designated to support long-term insurance subsidiary liabilities and have been classified as short-term and long-term assets based on the expected future payments of the Company's captive insurance liabilities. The majority of these deposits and investments are currently held in AA, A and BBB+ rated debt security investments and the remainder is held in a bank account with a high credit quality financial institution. See further discussion at Note 5, Fair Value Measurements. |
Property, Plant and Equipment, Policy [Policy Text Block] | Property and Equipment — Property and equipment are initially recorded at their historical cost. Repairs and maintenance are expensed as incurred. Depreciation is computed using the straight-line method over the estimated useful lives of the depreciable assets (ranging from three to 59 years). Leasehold improvements are amortized on a straight-line basis over the shorter of their estimated useful lives or the remaining lease term. |
Impairment or Disposal of Long-Lived Assets, Policy [Policy Text Block] | Impairment of Long-Lived Assets — The Company reviews the carrying value of long-lived assets that are held and used in the Company’s operating subsidiaries for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of these assets is determined based upon expected undiscounted future net cash flows from the operating subsidiaries to which the assets relate, utilizing management’s best estimate, appropriate assumptions, and projections at the time. If the carrying value is determined to be unrecoverable from future operating cash flows, the asset is deemed impaired and an impairment loss would be recognized to the extent the carrying value exceeded the estimated fair value of the asset. The Company estimates the fair value of assets based on the estimated future discounted cash flows of the asset. Management has evaluated its long-lived assets and recorded an impairment charge of $137 related to the closure of one facility during the first quarter of 2016. The Company did not record impairment charges during the years ended December 31, 2015 and 2014 . |
Goodwill and Intangible Assets, Policy [Policy Text Block] | Intangible Assets and Goodwill — Definite-lived intangible assets consist primarily of favorable leases, lease acquisition costs, patient base, facility trade names and customer relationships. Favorable leases and lease acquisition costs are amortized over the life of the lease of the facility. Patient base is amortized over a period of four to eight months, depending on the classification of the patients and the level of occupancy in a new acquisition on the acquisition date. Trade names at affiliated facilities are amortized over 30 years and customer relationships are amortized over a period of up to 20 years. The Company's indefinite-lived intangible assets consist of trade names and Medicare and Medicaid licenses. The Company tests indefinite-lived intangible assets for impairment on an annual basis or more frequently if events or changes in circumstances indicate that the carrying amount of the intangible asset may not be recoverable. Goodwill represents the excess of the purchase price over the fair value of identifiable net assets acquired in business combinations. Goodwill is subject to annual testing for impairment. In addition, goodwill is tested for impairment if events occur or circumstances change that would reduce the fair value of a reporting unit below its carrying amount. The Company performs its annual test for impairment during the fourth quarter of each year. See further discussion at Note 12, Goodwill and Other Indefinite-Lived Intangible Assets . |
Deferred Rent [Policy Text Block] | Deferred Rent - Deferred rent represents rental expense, determined on a straight-line basis over the life of the related lease, in excess of actual rent payments. |
Liability Reserve Estimate, Policy [Policy Text Block] | Self-Insurance — The Company is partially self-insured for general and professional liability up to a base amount per claim (the self-insured retention) with an aggregate, one-time deductible above this limit. Losses beyond these amounts are insured through third-party policies with coverage limits per claim, per location and on an aggregate basis for the Company. For claims made after January 1, 2013, the combined self-insured retention was $500 per claim, subject to an additional one-time deductible of $1,000 for California affiliated facilities and a separate, one-time, deductible of $750 for non-California facilities. For all California affiliated facilities, the third-party coverage above these limits was $1,000 per claim, $3,000 per facility, with a $5,000 blanket aggregate limit. For all facilities outside of California, except those located in Colorado, the third-party coverage above these limits was $1,000 per claim, $3,000 per facility, with a $5,000 blanket aggregate and an additional state-specific aggregate where required by state law. In Colorado, the third-party coverage above these limits was $1,000 per claim and $3,000 per facility for skilled nursing facilities, which is independent of the aforementioned blanket aggregate limits that apply outside of Colorado. Beginning on January 1, 2017, the combined self-insured retention will be $500 per claim, subject to an additional one-time deductible of $750 for California affiliated facilities and a separate, one-time, deductible of $1,000 for non-California facilities. The self-insured retention and deductible limits for general and professional liability and workers' compensation for all states (except Texas and Washington for workers' compensation) are self-insured through the Captive, the related assets and liabilities of which are included in the accompanying consolidated balance sheets. The Captive is subject to certain statutory requirements as an insurance provider. These requirements include, but are not limited to, maintaining statutory capital. The Company’s policy is to accrue amounts equal to the actuarially estimated costs to settle open claims of insureds, as well as an estimate of the cost of insured claims that have been incurred but not reported. The Company develops information about the size of the ultimate claims based on historical experience, current industry information and actuarial analysis, and evaluates the estimates for claim loss exposure on a quarterly basis. The Company’s operating subsidiaries are self-insured for workers’ compensation in California. To protect itself against loss exposure in California with this policy, the Company has purchased individual specific excess insurance coverage that insures individual claims that exceed $500 per occurrence. In Texas, the operating subsidiaries have elected non-subscriber status for workers’ compensation claims and, effective February 1, 2011, the Company has purchased individual stop-loss coverage that insures individual claims that exceed $750 per occurrence. As of July 1, 2014, the Company’s operating subsidiaries in all other states, with the exception of Washington, are under a loss sensitive plan that insures individual claims that exceed $350 per occurrence. In Washington, the operating subsidiaries' coverage is financed through premiums paid by the employers and employees. The claims and pay benefits are managed through a state insurance pool. Outside of California, Texas and Washington, the Company has purchased insurance coverage that insures individual claims that exceed $350 per accident. In all states except Washington, the Company accrues amounts equal to the estimated costs to settle open claims, as well as an estimate of the cost of claims that have been incurred but not reported. The Company uses actuarial valuations to estimate the liability based on historical experience and industry information. In addition, the Company has recorded an asset and equal liability of $4,104 and $2,881 at December 31, 2016 and 2015 , 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 13, Restricted and Other Assets. The Company self-funds medical (including prescription drugs) and dental healthcare benefits to the majority of its employees. The Company is fully liable for all financial and legal aspects of these benefit plans. To protect itself against loss exposure with this policy, the Company has purchased individual stop-loss insurance coverage that insures individual claims that exceed $300 for each covered person with an additional one-time aggregate individual stop loss deductible of $75 . Beginning 2016, the Company's policy does not include the additional one-time aggregate individual stop loss deductible of $75 . The Company believes that adequate provision has been made in the Financial Statements for liabilities that may arise out of patient care, workers’ compensation, healthcare benefits and related services provided to date. The amount of the Company’s reserves was determined based on an estimation process that uses information obtained from both company-specific and industry data. This estimation process requires the Company to continuously monitor and evaluate the life cycle of the claims. Using data obtained from this monitoring and the Company’s assumptions about emerging trends, the Company, with the assistance of an independent actuary, develops information about the size of ultimate claims based on the Company’s historical experience and other available industry information. The most significant assumptions used in the estimation process include determining the trend in costs, the expected cost of claims incurred but not reported and the expected costs to settle or pay damage awards with respect to unpaid claims. The self-insured liabilities are based upon estimates, and while management believes that the estimates of loss are reasonable, the ultimate liability may be in excess of or less than the recorded amounts. Due to the inherent volatility of actuarially determined loss estimates, it is reasonably possible that the Company could experience changes in estimated losses that could be material to net income. If the Company’s actual liability exceeds its estimates of loss, its future earnings, cash flows and financial condition would be adversely affected. |
Income Tax, Policy [Policy Text Block] | Income Taxes — Deferred tax assets have been presented on the balance sheet as a non-current asset for all periods presented related to the early adoption of authoritative guidance for the presentation of deferred taxes. Historically, these assets were classified as either current or non-current assets, as applicable. There is no effect on the consolidated statements of income or consolidated statements of cash flow. Deferred tax assets and liabilities are established for temporary differences between the financial reporting basis and the tax basis of the Company’s assets and liabilities at tax rates in effect when such temporary differences are expected to reverse. The Company generally expects to fully utilize its deferred tax assets; however, when necessary, the Company records a valuation allowance to reduce its net deferred tax assets to the amount that is more likely than not to be realized. In determining the need for a valuation allowance or the need for and magnitude of liabilities for uncertain tax positions, the Company makes certain estimates and assumptions. These estimates and assumptions are based on, among other things, knowledge of operations, markets, historical trends and likely future changes and, when appropriate, the opinions of advisors with knowledge and expertise in certain fields. Due to certain risks associated with the Company’s estimates and assumptions, actual results could differ. |
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. |
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 operating leases that contain scheduled rent increases on a straight-line basis over the term of the lease. The lease term used for straight-line rent expense is calculated from the date the Company is given control of the leased premises through the end of the lease term. The lease term used for this evaluation also provides the basis for establishing depreciable lives for buildings subject to lease and leasehold improvements, as well as the period over which the Company records straight-line rent expense. |
New Accounting Pronouncements, Policy [Policy Text Block] | Recent Accounting Pronouncements — Except for rules and interpretive releases of the Securities and Exchange Commission (SEC) under authority of federal securities laws and a limited number of grandfathered standards, the Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) is the sole source of authoritative GAAP literature recognized by the FASB and applicable to the Company. For any new pronouncements announced, the Company considers whether the new pronouncements could alter previous generally accepted accounting principles and determines whether any new or modified principles will have a material impact on the Company's reported financial position or operations in the near term. The applicability of any standard is subject to the formal review of the Company's financial management and certain standards are under consideration. Recent Accounting Standards Adopted by the Company: In November 2015, the FASB issued updated guidance requiring all deferred tax assets and liabilities be presented as non-current. The Company early adopted this guidance in the first quarter of fiscal year 2016, retrospectively. The Company has classified deferred tax amounts as non-current assets in the consolidated balance sheet for all periods presented. There was no effect on the consolidated statements of income or statement of cash flows. See the Consolidated Balance Sheets. In April 2015, the FASB issued updated guidance requiring debt issuance costs related to a recognized debt liability to be presented in the consolidated balance sheet as a direct reduction from the carrying amount of the debt liability. The new standard was effective for the Company in the first quarter of fiscal year 2016. The Company adopted this amendment during the first quarter of 2016. See Note 16, Debt to the Consolidated Financial Statements. In August 2014, the FASB issued authoritative guidance requiring management to evaluate whether there are conditions and events that raise substantial doubt about the entity’s ability to continue as a going concern and to provide disclosures in certain circumstances. The new standard was effective for the Company in the first quarter of fiscal year 2016. The adoption of this standard did not have a material effect on the Company's financial statements. Accounting Standards Recently Issued But Not Yet Adopted by the Company: In August 2016, the FASB issued amended authoritative guidance to reduce the diversity in practice related to the presentation and classification of certain cash receipts and cash payments in the statement of cash flows. The new provisions target cash flow issues related to (i) debt prepayment or debt extinguishment costs, (ii) settlement of debt instruments with coupon rates that are insignificant relative to effective interest rates, (iii) contingent consideration payments made after a business combination, (iv) proceeds from settlement of insurance claims, (v) proceeds from the settlement of corporate-owned life insurance and bank-owned life insurance policies, (vi) distributions received from equity method investees, (vii) beneficial interests in securitization transactions and (viii) separately identifiable cash flows and application of the predominance principle. This guidance will be effective for fiscal years beginning after December 15, 2017, which will be the Company's fiscal year 2018, with early adoption permitted. The adoption of this standard is not expected to have a material impact on the Company’s consolidated financial statements. In April 2016, the FASB issued its standard to simplify several aspects the accounting for employee share-based payment transactions, which includes the accounting for income taxes, forfeitures, and statutory tax withholding requirements, as well as classification in the statement of cash flows. This guidance will be effective for annual periods beginning after December 15, 2016, which will be the Company's fiscal year 2017, with early adoption permitted. The adoption of the guidance will result in a decrease in income tax expense and an increase in diluted share counts and net cash provided by operating activities. In March 2016, the FASB issued its standard to amend the principal-versus-agent implementation guidance and illustrations in the Board’s new revenue standard, which includes accounting implication related to (1) determining the appropriate unit of account under the revenue standard’s principal-versus-agent guidance and (2) applying the indicators of whether an entity is a principal or an agent in accordance with the revenue standard’s control principle. The guidance will be effective for fiscal years beginning after December 15, 2017, which will be the Company's fiscal year 2018. The guidance has the same effective date as the new revenue standard and the Company is required to adopt the guidance by using the same transition method it would use to adopt the new revenue standard. The Company's evaluation of the adoption method and impact to the consolidated financial statements is ongoing and being performed concurrently with the new revenue standard. In February 2016, the FASB issued amended authoritative guidance on accounting for leases. The new provisions require that a lessee of operating leases recognize in the statement of financial position a liability to make lease payments (the lease liability) and a right-of-use asset representing its right to use the underlying asset for the lease term. The lease liability will be equal to the present value of lease payments, with the right-of-use asset based upon the lease liability. The classification criteria for distinguishing between finance (or capital) leases and operating leases are substantially similar to the previous lease guidance, but with no explicit bright lines. As such, operating leases will result in straight-line rent expense similar to current practice. For short term leases (term of 12 months or less), a lessee is permitted to make an accounting election not to recognize lease assets and lease liabilities, which would generally result in lease expense being recognized on a straight-line basis over the lease term. This guidance applies to all entities and is effective for annual periods beginning after December 15, 2018, which will be the Company's fiscal year 2019, with early adoption permitted. The Company is currently evaluating the impact this guidance will have on its consolidated financial statements but expect this adoption will result in a significant increase in the assets and liabilities on its consolidated balance sheet. In January 2016, the FASB issued amended authoritative guidance which makes targeted improvements for financial instruments. The new provisions impact certain aspects of recognition, measurement, presentation and disclosure requirements of financial instruments. Specifically, the guidance will (1) require equity investments to be measured at fair value with changes in fair value recognized in net income, (2) simplify the impairment assessment of equity investments without readily determinable fair values, (3) eliminate the requirement to disclose the method and assumptions used to estimate fair value for financial instruments measured at amortized cost, and (4) require separate presentation of financial assets and financial liabilities by measurement category. The guidance is effective for annual and interim periods beginning after December 15, 2017, which will be the Company's fiscal year 2018. Early adoption is not permitted. The adoption of this standard is not expected to have a material impact on the Company’s consolidated financial statements. In May 2014, the FASB and International Accounting Standards Board issued their final standard on revenue from contracts with customers that outlines a single comprehensive model for entities to use in accounting for revenue arising from contracts with customers. The new standard supersedes most current revenue recognition guidance, including industry-specific guidance, and may be applied retrospectively to each period presented (full retrospective method) or retrospectively with the cumulative effect recognized in beginning retained earnings as of the date of adoption (modified retrospective method). In July 2015, the FASB formally deferred for one year the effective date of the new revenue standard and decided to permit entities to early adopt the standard. The guidance will be effective for fiscal years beginning after December 15, 2017, which will be the Company's fiscal year 2018. The Company has initiated an adoption plan in fiscal year 2015, beginning with preliminary evaluation of the standard, and will continue by performing additional analysis of revenue streams and transactions for which the accounting may change under the new standard. The adoption plan, which also includes evaluation of the adoption method and the impact to the consolidated financial statements, is ongoing and will be completed by the end of fiscal year 2017. The new guidance requires enhanced disclosures, including revenue recognition policies to identify performance obligations and significant judgments in measurement and recognition. The FASB has issued and may issue in the future, interpretive guidance, which may impact its evaluation, however the Company currently anticipates adopting the standard as of January 1, 2018, using the modified retrospective method. |
Computation of Net Income Per33
Computation of Net Income Per Common Share (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
COMPUTATION OF NET INCOME PER COMMON SHARE [Abstract] | |
Schedule of Earnings Per Share, Basic, by Common Class, Including Two Class Method [Table Text Block] | Year Ended December 31, 2016 2015 2014 Numerator: Net income $ 52,843 $ 55,917 $ 33,741 Less: net income (loss) attributable to noncontrolling interests 2,853 485 (2,209 ) Net income attributable to The Ensign Group, Inc. $ 49,990 $ 55,432 $ 35,950 Denominator: Weighted average shares outstanding for basic net income per share 50,555 50,316 44,682 Basic net income per common share attributable to The Ensign Group, Inc. $ 0.99 $ 1.10 $ 0.80 |
Schedule of Earnings Per Share, Diluted, by Common Class, Including Two Class Method [Table Text Block] | Year Ended December 31, 2016 2015 2014 Numerator: Net income $ 52,843 $ 55,917 $ 33,741 Less: net income (loss) attributable to noncontrolling interests 2,853 485 (2,209 ) Net income attributable to The Ensign Group, Inc. $ 49,990 $ 55,432 $ 35,950 Denominator: Weighted average common shares outstanding 50,555 50,316 44,682 Plus: incremental shares from assumed conversion (1) 1,578 1,894 1,508 Adjusted weighted average common shares outstanding 52,133 52,210 46,190 Diluted net income per common share attributable to The Ensign Group, Inc. $ 0.96 $ 1.06 $ 0.78 (1) Options outstanding which are anti-dilutive and therefore not factored into the weighted average common shares amount above were 838 , 258 , and 1,084 for the years ended December 31, 2016, 2015 and 2014 , respectively. |
Fair Value Measurements (Tables
Fair Value Measurements (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Fair Value Disclosures [Abstract] | |
Fair Value, Assets Measured on Recurring Basis [Table Text Block] | December 31, 2016 2015 Level 1 Level 2 Level 3 Level 1 Level 2 Level 3 Cash and cash equivalents $ 57,706 $ — $ — $ 41,569 $ — $ — |
Revenue and Accounts Receivab35
Revenue and Accounts Receivable (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
REVENUE AND ACCOUNTS RECEIVABLE [Abstract] | |
Schedule of Revenue Sources, Health Care Organization [Table Text Block] | Year Ended December 31, 2016 2015 2014 Revenue % of Revenue Revenue % of Revenue Revenue % of Revenue Medicaid $ 557,958 33.7 % $ 458,956 34.2 % $ 369,106 35.9 % Medicare 477,019 28.8 395,503 29.5 313,144 30.5 Medicaid — skilled 87,517 5.3 71,905 5.4 51,157 5.0 Total Medicaid and Medicare 1,122,494 67.8 926,364 69.1 733,407 71.4 Managed care 265,508 16.0 206,770 15.4 145,796 14.2 % Private and other payors (1) 266,862 16.2 208,692 15.5 148,203 14.4 % Revenue $ 1,654,864 100.0 % $ 1,341,826 100.0 % $ 1,027,406 100.0 % (1) Private and other payors also includes revenue from all payors generated in urgent care centers and other ancillary services. |
Schedule of Accounts, Notes, Loans and Financing Receivable [Table Text Block] | December 31, 2016 2015 Medicaid $ 111,031 $ 90,677 Managed care 66,346 56,411 Medicare 55,500 49,970 Private and other payors 51,347 42,276 284,224 239,334 Less: allowance for doubtful accounts (39,791 ) (30,308 ) Accounts receivable, net $ 244,433 $ 209,026 |
Business Segments (Tables)
Business Segments (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Segment Reporting [Abstract] | |
Reconciliation of Revenue from Segments to Consolidated [Table Text Block] | Year Ended December 31, 2016 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 521,063 $ 26,397 $ 10,498 $ — $ 557,958 33.7 % Medicare 396,519 — 80,500 — 477,019 28.8 Medicaid-skilled 87,517 — — — 87,517 5.3 Subtotal 1,005,099 26,397 90,998 — 1,122,494 67.8 Managed care 247,844 — 17,664 — 265,508 16.0 Private and other 121,860 97,239 7,151 40,612 (1) 266,862 16.2 Total revenue $ 1,374,803 $ 123,636 $ 115,813 $ 40,612 $ 1,654,864 100.0 % (1) Private and other payors in our "All Other" category includes revenue from all payors generated in the Company's urgent care centers and other ancillary operations. Year Ended December 31, 2015 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 430,368 $ 19,642 $ 8,946 $ — $ 458,956 34.2 % Medicare 332,429 — 63,074 — 395,503 29.5 Medicaid-skilled 71,905 — — — 71,905 5.4 Subtotal 834,702 19,642 72,020 — 926,364 69.1 Managed care 194,743 — 12,027 — 206,770 15.4 Private and other 96,943 68,487 6,309 36,953 (1) 208,692 15.5 Total revenue $ 1,126,388 $ 88,129 $ 90,356 $ 36,953 $ 1,341,826 100.0 % (1) Private and other payors in our "All Other" category includes revenue from all payors generated in the Company's urgent care centers and other ancillary operations. Year ended December 31, 2014 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total Revenue Revenue % Medicaid $ 352,271 $ 11,590 $ 5,245 $ — $ 369,106 35.9 % Medicare 274,723 — 38,421 — 313,144 30.5 Medicaid-skilled 51,157 — — — 51,157 5.0 Subtotal 678,151 11,590 43,666 — 733,407 71.4 Managed care 138,215 — 7,581 — 145,796 14.2 Private and other 85,104 37,258 3,269 22,572 (1) 148,203 14.4 Total revenue $ 901,470 $ 48,848 $ 54,516 $ 22,572 $ 1,027,406 100.0 % (1) Private and other payors in our "All Other" category includes revenue from all payors generated in the Company's urgent care centers and other ancillary operations. |
Schedule of Segment Reporting Information, by Segment [Table Text Block] | The following table sets forth selected financial data consolidated by business segment: Year Ended December 31, 2016 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Elimination Total Revenue from external customers $ 1,374,803 $ 123,636 $ 115,813 $ 40,612 $ 1,654,864 Intersegment revenue (1) 2,929 — — 2,184 (5,113 ) — Total revenue $ 1,377,732 $ 123,636 $ 115,813 $ 42,796 $ (5,113 ) $ 1,654,864 Segment income (loss) (2) $ 118,118 $ 11,701 $ 16,571 $ (54,543 ) $ — $ 91,847 Interest expense, net of interest income (6,029 ) Income before provision for income taxes $ 85,818 Depreciation and amortization $ 26,298 $ 4,157 $ 924 $ 7,303 $ — $ 38,682 (1) Intersegment revenue represents services provided at the Company's skilled nursing facilities, urgent care centers and other ancillary operations to the Company's other operating subsidiaries. (2) Segment income excludes general and administrative expense for transitional and skilled services, assisted and independent living services and home health and hospice businesses. General and administrative expense is included in "All Other" category. The Company's transitional and skilled services segment income for the year ended December 31, 2016 included the continued obligation under the lease and related closing expenses of $7,935 , including the present value of rental payments of approximately $6,512 , which was recognized for the closure of one skilled nursing facility in the first quarter of 2016. See Note 18, Leases for further detail. Year Ended December 31, 2015 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Elimination Total Revenue from external customers $ 1,126,388 $ 88,129 $ 90,356 $ 36,953 $ 1,341,826 Intersegment revenue (1) 2,447 — 881 (3,328 ) — Total revenue $ 1,128,835 $ 88,129 $ 90,356 $ 37,834 $ (3,328 ) $ 1,341,826 Segment income (loss) (2) $ 136,744 $ 11,463 $ 13,584 $ (68,709 ) $ — $ 93,082 Interest expense, net of interest income $ (1,983 ) Income before provision for income taxes $ 91,099 Depreciation and amortization $ 18,008 $ 3,338 $ 980 $ 5,785 $ — $ 28,111 (1) Intersegment revenue represents services provided at the Company's skilled nursing facilities, urgent care centers and other ancillary operations to the Company's other operating subsidiaries. (2) Segment income excludes general and administrative expense for transitional and skilled services, assisted and independent living services and home health and hospice businesses. General and administrative expense is included in "All Other" category. Year Ended December 31, 2014 Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Elimination Total Revenue from external customers $ 901,470 $ 48,848 $ 54,516 $ 22,572 $ 1,027,406 Intersegment revenue (1) 2,066 — 735 (2,801 ) — Total revenue $ 903,536 $ 48,848 $ 54,516 $ 23,307 $ (2,801 ) $ 1,027,406 Segment income (loss) (2) $ 117,816 $ 8,195 $ 9,701 $ (62,788 ) $ — $ 72,924 Interest expense, net of interest income $ (12,382 ) Income before provision for income taxes $ 60,542 Depreciation and amortization $ 19,673 $ 1,996 $ 539 $ 4,222 $ — $ 26,430 (1) Intersegment revenue represents services provided at the Company's skilled nursing facilities, urgent care centers and other ancillary operations to the Company's other operating subsidiaries. (2) Segment income excludes general and administrative expense for transitional and skilled services, assisted and independent living services and home health and hospice businesses. General and administrative expense is included in "All Other" category. |
Acquisitions (Tables)
Acquisitions (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Business Combinations [Abstract] | |
Schedule of Business Acquisitions, by Acquisition [Table Text Block] | December 31, 2016 2015 2014 Land $ 1,054 $ 12,811 $ 10,314 Building and improvements 21,057 73,502 41,995 Equipment, furniture, and fixtures 8,265 4,612 2,933 Assembled occupancy 1,299 895 905 Definite-lived intangible assets 363 360 729 Goodwill 30,343 10,617 6,334 Favorable leases 393 10,901 28,680 Other indefinite-lived intangible assets 1,741 6,285 4,195 Other assets acquired, net of liabilities assumed 6 (18 ) — Total acquisitions $ 64,521 $ 119,965 $ 96,085 |
Acquisitions - Pro Forma (Table
Acquisitions - Pro Forma (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Business Acquisition, Pro Forma Information [Abstract] | |
Business Acquisition, Pro Forma Information [Table Text Block] | December 31, 2016 2015 (Unaudited) Revenue $ 1,725,063 $ 1,524,371 Net income attributable to The Ensign Group, Inc. 48,992 54,790 Diluted net income per common share $ 0.94 $ 1.05 |
Property and Equipment (Tables)
Property and Equipment (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Property, Plant and Equipment [Abstract] | |
Property, Plant and Equipment [Table Text Block] | December 31, 2016 2015 Land $ 47,565 $ 41,451 Buildings and improvements 304,263 151,434 Equipment 153,170 114,752 Furniture and fixtures 6,931 5,504 Leasehold improvements 80,164 68,405 Construction in progress 2,441 781 594,534 382,327 Less: accumulated depreciation (110,036 ) (82,694 ) Property and equipment, net $ 484,498 $ 299,633 |
Intangible Assets - Net (Tables
Intangible Assets - Net (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Intangible Assets, Net (Excluding Goodwill) [Abstract] | |
Schedule of Finite-Lived Intangible Assets [Table Text Block] | Weighted Average Life (Years) December 31, 2016 2015 Gross Carrying Amount Accumulated Amortization Gross Carrying Amount Accumulated Amortization Intangible Assets Net Net Lease acquisition costs 24.7 $ 483 $ (78 ) $ 405 $ 604 $ (577 ) $ 27 Favorable leases 32.1 35,116 (4,589 ) 30,527 43,248 (2,923 ) 40,325 Assembled occupancy 0.0 1,897 (1,897 ) — 4,779 (4,476 ) 303 Facility trade name 30.0 733 (269 ) 464 733 (244 ) 489 Customer relationships 18.5 4,933 (1,253 ) 3,680 5,300 (1,013 ) 4,287 Total $ 43,162 $ (8,086 ) $ 35,076 $ 54,664 $ (9,233 ) $ 45,431 |
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense [Table Text Block] | Year Amount 2017 2,282 2018 2,282 2019 2,282 2020 1,573 2021 1,475 Thereafter 25,182 $ 35,076 |
Goodwill and Other Indefinite41
Goodwill and Other Indefinite-Lived Intangible Assets (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Indefinite-Lived Intangible Assets (Including Goodwill) [Abstract] | |
Schedule of Goodwill [Table Text Block] | Goodwill Transitional and Skilled Services Assisted and Independent Living Services Home Health and Hospice Services All Other Total January 1, 2014 $ 13,338 $ 316 $ 7,278 $ 3,003 $ 23,935 Impairments — — — $ — $ — Additions 883 1,440 3,651 $ 360 6,334 December 31, 2014 $ 14,221 $ 1,756 $ 10,929 $ 3,363 $ 30,269 Impairments — — — $ — $ — Additions — 1,782 5,173 $ 3,662 10,617 December 31, 2015 $ 14,221 $ 3,538 $ 16,102 $ 7,025 $ 40,886 Less: Dispositions — — — $ (4,103 ) $ (4,103 ) Purchase price adjustment — — — (26 ) (26 ) Additions 26,415 — 1,799 2,129 30,343 December 31, 2016 $ 40,636 $ 3,538 $ 17,901 $ 5,025 $ 67,100 |
Schedule of Acquired Indefinite-lived Intangible Assets by Major Class [Table Text Block] | December 31, 2016 December 31, 2015 Trade name $ 1,146 $ 1,915 Medicare and Medicaid licenses 18,440 16,731 $ 19,586 $ 18,646 |
Restricted and Other Assets (Ta
Restricted and Other Assets (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Other Assets [Abstract] | |
Schedule of Other Assets [Table Text Block] | December 31, 2016 2015 Debt issuance costs, net $ 3,611 $ 2,021 Long-term insurance losses recoverable asset 4,104 2,881 Deposits with landlords 3,526 3,969 Capital improvement reserves with landlords and lenders 673 760 Note receivable from sale of urgent care centers 700 — Restricted and other assets $ 12,614 $ 9,631 |
Other Accrued Liabilities (Tabl
Other Accrued Liabilities (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Accrued Liabilities [Abstract] | |
Schedule of Accrued Liabilities [Table Text Block] | December 31, 2016 2015 Quality assurance fee $ 4,604 $ 6,120 Refunds payable 18,368 13,252 Deferred revenue 6,994 6,696 Cash held in trust for patients 2,373 3,016 Resident deposits 6,099 5,884 Dividends payable 2,186 2,072 Property taxes 9,130 4,230 Charges related to operational closure 1,972 — Other 7,037 4,935 Other accrued liabilities $ 58,763 $ 46,205 |
Income Taxes Income Taxes (Tabl
Income Taxes Income Taxes (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Income Tax Disclosure [Abstract] | |
Schedule of Components of Income Tax Expense (Benefit) [Table Text Block] | Year Ended December 31, 2016 2015 2014 Current: Federal $ 30,043 $ 28,149 $ 25,490 State 5,183 5,761 4,405 35,226 33,910 29,895 Deferred: Federal (1,034 ) 2,026 (2,438 ) State (1,217 ) (754 ) (656 ) (2,251 ) 1,272 (3,094 ) Total $ 32,975 $ 35,182 $ 26,801 |
Schedule of Effective Income Tax Rate Reconciliation [Table Text Block] | December 31, 2016 2015 2014 Income tax expense at statutory rate 35.0 % 35.0 % 35.0 % State income taxes - net of federal benefit 3.0 3.6 4.0 Non-deductible expenses 0.9 0.6 0.6 Non-deductible transaction costs — — 5.2 Other adjustments (0.5 ) (0.6 ) (0.4 ) Total income tax provision 38.4 % 38.6 % 44.4 % |
Schedule of Deferred Tax Assets and Liabilities [Table Text Block] | December 31, 2016 2015 Deferred tax assets (liabilities): Accrued expenses $ 21,732 $ 18,957 Allowance for doubtful accounts 15,956 12,313 Tax credits 3,461 3,439 Insurance 7,333 5,814 Total deferred tax assets 48,482 40,523 State taxes (1,023 ) (420 ) Depreciation and amortization (20,643 ) (14,773 ) Prepaid expenses (3,743 ) (4,478 ) Total deferred tax liabilities (25,409 ) (19,671 ) Net deferred tax assets $ 23,073 $ 20,852 |
Debt (Tables)
Debt (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Debt Disclosure [Abstract] | |
Schedule of Long-term Debt Instruments [Table Text Block] | December 31, 2016 2015 Term loan with SunTrust, interest payable quarterly $ 148,125 $ — Credit facility with SunTrust 122,000 85,000 Mortgage loans and promissory note, principal and interest payable monthly, interest at fixed rate 14,032 14,671 284,157 99,671 Less current maturities (8,129 ) (620 ) Less debt issuance costs (542 ) — $ 275,486 $ 99,051 |
Options and Awards (Tables)
Options and Awards (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Options and Awards [Abstract] | |
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions [Table Text Block] | The Company used the following assumptions for stock options granted during the years ended December 31, 2016, 2015 and 2014 : Grant Year Options Granted Weighted Average Risk-Free Rate Expected Life Weighted Average Volatility Weighted Average Dividend Yield 2016 497 1.38% 6.3 years 38% 0.80% 2015 637 1.69% 6.5 years 39% 0.63% 2014 2,058 1.82% 6.5 years 46% 0.62% |
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 2016 497 $ 19.43 $ 7.00 2015 637 $ 23.27 $ 9.08 2014 2,058 $ 12.68 $ 5.66 |
Schedule of Common Stock Outstanding Roll Forward [Table Text Block] | Number of Options Outstanding Weighted Average Exercise Price Number of Options Vested Weighted Average Exercise Price of Options Vested January 1, 2014 4,580 $ 5.65 2,498 $ 3.88 Granted 2,058 12.68 Forfeited (128 ) 8.14 Exercised (978 ) 3.93 December 31, 2014 5,532 $ 8.51 2,218 $ 4.70 Granted 637 23.27 Forfeited (233 ) 12.55 Exercised (488 ) 5.20 December 31, 2015 5,448 $ 10.36 2,526 $ 6.35 Granted 497 19.43 Forfeited (127 ) 14.46 Exercised (642 ) 6.47 December 31, 2016 5,176 $ 11.62 2,704 $ 8.18 |
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 2008 2.56 - 4.06 415 $ 618 2 415 2009 4.06 - 4.56 542 1,162 3 542 2010 4.77 - 4.96 143 347 4 143 2011 5.90 - 7.99 167 567 5 167 2012 6.56 - 7.96 528 1,952 6 390 2013 7.98 - 11.49 617 2,996 7 331 2014 10.55 - 18.94 1,688 9,547 8 597 2015 21.47 - 25.24 590 5,357 9 119 2016 18.79 - 19.89 486 3,396 10 — Total 5,176 $ 25,942 2,704 |
Schedule of Nonvested Restricted Stock Units Activity [Table Text Block] | Non-Vested Restricted Awards Weighted Average Grant Date Fair Value Nonvested at January 1, 2014 460 $ 14.34 Granted 56 17.75 Vested (130 ) 13.38 Forfeited (20 ) 15.12 Nonvested at December 31, 2014 366 $ 15.15 Granted 323 22.99 Vested (234 ) 17.36 Forfeited (30 ) 16.81 Nonvested at December 31, 2015 425 $ 19.79 Granted 299 20.55 Vested (279 ) 19.58 Forfeited (16 ) 20.85 Nonvested at December 31, 2016 429 $ 20.42 |
Schedule of Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Table Text Block] | Year Ended December 31, 2016 2015 2014 Share-based compensation expense related to stock options $ 4,793 $ 4,164 $ 3,134 Share-based compensation expense related to restricted stock awards 2,371 1,931 1,657 Share-based compensation expense related to stock awards to non-employee directors 612 582 399 Total $ 7,776 $ 6,677 $ 5,190 |
Share-based Compensation, Schedule of Intrisice Values by Option Category [Table Text Block] | December 31, Options 2016 2015 2014 Outstanding $ 55,610 $ 67,508 $ 75,689 Vested 38,101 41,128 38,811 Expected to vest 15,983 23,508 31,160 Exercisable 9,199 8,709 10,496 |
Leases (Tables)
Leases (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Leases [Abstract] | |
Schedule of Future Minimum Rental Payments for Operating Leases [Table Text Block] | Year Amount 2017 137,247 2018 140,211 2019 139,851 2020 139,191 2021 138,498 Thereafter 1,145,188 $ 1,840,186 |
Self-Insurance Reserves (Tables
Self-Insurance Reserves (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Self-Insurance Reserves [Abstract] | |
Self-Insurance Reserves [Table Text Block] | General and Professional Liability Workers' Compensation Health Total Balance January 1, 2015 30,401 15,758 3,801 $ 49,960 Current year provisions 12,528 12,508 15,921 40,957 Claims paid and direct expenses (11,911 ) (8,822 ) (14,648 ) (35,381 ) Change in long-term insurance losses recoverable (308 ) 775 — 467 Balance December 31, 2015 30,710 20,219 5,074 56,003 Current year provisions 23,149 12,887 38,151 74,187 Claims paid and direct expenses (18,186 ) (10,290 ) (37,586 ) (66,062 ) Change in long-term insurance losses recoverable 637 586 — 1,223 Balance December 31, 2016 $ 36,310 $ 23,402 $ 5,639 $ 65,351 |
REIT Spin-Off (Tables)
REIT Spin-Off (Tables) | 12 Months Ended |
Dec. 31, 2015 | |
REIT Spin-Off [Abstract] | |
REIT Spin-Off Transaction Summary [Table Text Block] | Cash and cash equivalents $ 78,731 Other current assets 34 Property and equipment, net 421,846 Deferred financing costs 11,088 Accounts payable and accrued expenses (4,971 ) Current deferred tax liability (125 ) Deferred tax liability (5,925 ) Current maturities of long-term debt (2,342 ) Long-term debt—less current maturities (357,171 ) Net contribution $ 141,165 |
Description of Business (Detail
Description of Business (Details) | Dec. 31, 2016businessBedsfacilities | Dec. 31, 2015facilities |
Skilled nursing, assisted living and independent living facilities [Abstract] | ||
Number of Real Estate Properties | 50 | 32 |
Number of Real Estate Properties Leased | 160 | 154 |
Number of Real Estate Properties Leased with an Option to Purchase | 9 | 20 |
Number of Real Estate Properties Operated | 210 | 186 |
Home Health, Hospice and Home Care Operations | business | 39 | |
Operational Skilled Nursing Beds | Beds | 17,700 | |
Operational Skilled Nursing, Assisted Living and Independent Living Beds [Abstract] | ||
Operational Skilled Nursing, Assisted Living and Independent Living Beds | Beds | 4,450 |
Significant Accounting Polici51
Significant Accounting Policies Divestiture (Details) $ in Thousands | 12 Months Ended |
Dec. 31, 2016USD ($) | |
Disposal Group, Disposed of by Sale, Not Discontinued Operations [Member] | |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | |
Sale Price from Divestiture of Businesses | $ 41,492 |
Significant Accounting Polici52
Significant Accounting Policies Revenue and Accounts Receivable (Details) | 12 Months Ended | ||
Dec. 31, 2016Rate | Dec. 31, 2015Rate | Dec. 31, 2014Rate | |
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | |||
% of Revenue | 100.00% | 100.00% | 100.00% |
Total Medicaid and Medicare | |||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | |||
% of Revenue | 67.80% | 69.10% | 71.40% |
Significant Accounting Polici53
Significant Accounting Policies Impairment (Details) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2016 | Dec. 31, 2015 | |
Impairment of Long-Lived Assets, Held-for-use [Abstract] | ||
Impairment of Long-Lived Assets Held-for-use | $ 137 | $ 0 |
Significant Accounting Polici54
Significant Accounting Policies Self Insurance Liabilities (Details) - General and Professional Liability Insurance [Member] - USD ($) $ in Thousands | Jan. 01, 2017 | Dec. 31, 2016 |
Self-insurance retention per claim [Member] | Parent Company [Member] | ||
Liability for Claims and Claims Adjustment Expense [Line Items] | ||
Self Insurance Reserve | $ 500 | |
Aggregate Deductible [Member] | Parent Company [Member] | CALIFORNIA | ||
Liability for Claims and Claims Adjustment Expense [Line Items] | ||
Self Insurance Reserve | $ 1,000 | |
Aggregate Deductible [Member] | Parent Company [Member] | Non-California [Domain] | ||
Liability for Claims and Claims Adjustment Expense [Line Items] | ||
Self Insurance Reserve | 1,000 | 750 |
Per Occurence [Member] | Third-Party Payor [Member] | CALIFORNIA | ||
Liability for Claims and Claims Adjustment Expense [Line Items] | ||
Self Insurance Reserve | 1,000 | |
Per Occurence [Member] | Third-Party Payor [Member] | COLORADO | ||
Liability for Claims and Claims Adjustment Expense [Line Items] | ||
Self Insurance Reserve | 1,000 | |
Per Occurence [Member] | Third-Party Payor [Member] | All States Accept Colorado [Domain] | ||
Liability for Claims and Claims Adjustment Expense [Line Items] | ||
Self Insurance Reserve | 1,000 | |
Per Facility [Member] | Third-Party Payor [Member] | CALIFORNIA | ||
Liability for Claims and Claims Adjustment Expense [Line Items] | ||
Self Insurance Reserve | 3,000 | |
Per Facility [Member] | Third-Party Payor [Member] | COLORADO | ||
Liability for Claims and Claims Adjustment Expense [Line Items] | ||
Self Insurance Reserve | 3,000 | |
Per Facility [Member] | Third-Party Payor [Member] | All States Accept Colorado [Domain] | ||
Liability for Claims and Claims Adjustment Expense [Line Items] | ||
Self Insurance Reserve | 3,000 | |
Blanket Aggregate [Member] | Third-Party Payor [Member] | CALIFORNIA | ||
Liability for Claims and Claims Adjustment Expense [Line Items] | ||
Self Insurance Reserve | 5,000 | |
Blanket Aggregate [Member] | Third-Party Payor [Member] | All States Accept Colorado [Domain] | ||
Liability for Claims and Claims Adjustment Expense [Line Items] | ||
Self Insurance Reserve | $ 5,000 | |
Subsequent Event [Member] | Aggregate Deductible [Member] | Parent Company [Member] | CALIFORNIA | ||
Liability for Claims and Claims Adjustment Expense [Line Items] | ||
Self Insurance Reserve | $ 750 |
Significant Accounting Polici55
Significant Accounting Policies Self-Insurance General and Professional (Details) - Third-Party Payor [Member] - All States Accept Colorado [Domain] - General and Professional Liability Insurance [Member] $ in Thousands | Dec. 31, 2016USD ($) |
Blanket Aggregate [Member] | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | $ 5,000 |
Per Facility [Member] | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | 3,000 |
Per Occurence [Member] | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | $ 1,000 |
Significant Accounting Polici56
Significant Accounting Policies Self-Insurance Workers' Compensation (Details) - Workers' Compensation [Member] $ in Thousands | Dec. 31, 2016USD ($) |
Stop-Loss Insurance limit per claim [Member] | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | $ 500 |
Stop-Loss Insurance limit per claim [Member] | TEXAS | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | 750 |
Loss-Sensitive limit per claim [Member] [Member] | Other states, except California, Texas and Washington [Domain] | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | $ 350 |
Significant Accounting Polici57
Significant Accounting Policies Self Insurance Recoveries (Details) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Liability for Claims and Claims Adjustment Expense [Line Items] | ||
Long-term insurance losses recoverable asset | $ 4,104 | $ 2,881 |
General and Professional Liability Insurance [Member] | ||
Liability for Claims and Claims Adjustment Expense [Line Items] | ||
Long-term insurance losses recoverable asset | $ 4,104 | $ 2,881 |
Significant Accounting Polici58
Significant Accounting Policies Self-Insurance Health Insurance (Details) - Health Liability Insurance [Member] $ in Thousands | Dec. 31, 2016USD ($) |
Stop-Loss Insurance limit per claim [Member] | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | $ 300 |
Stop Loss Deductible [Member] | |
Liability for Claims and Claims Adjustment Expense [Line Items] | |
Self Insurance Reserve | $ 75 |
Common Stock (Details)
Common Stock (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands | Feb. 24, 2015 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | Nov. 04, 2015 | Feb. 18, 2015 | Feb. 09, 2015 |
Common Stock Transactions [Line Items] | |||||||
Payments of underwriter discounts and commissions | $ 0 | $ (5,961) | $ 0 | ||||
Proceeds from Issuance of Common Stock | 0 | 112,078 | 0 | ||||
Repurchase of shares of common stock (Note 3) | $ (30,000) | $ 0 | $ 0 | ||||
Common stock, shares issued | 52,787 | 51,918 | |||||
Common Stock [Member] | |||||||
Common Stock Transactions [Line Items] | |||||||
Shares Issued, Price Per Share | $ 20.50 | ||||||
Payments of underwriter discounts and commissions | $ 5,604 | ||||||
Common stock issued in an offering | 5,467 | ||||||
Proceeds from Issuance of Common Stock | $ 106,474 | ||||||
Other issuance costs in an offering | $ 357 | ||||||
Proceeds from stock issuance used to pay debt | $ 94,000 | ||||||
Common stock, shares issued | 5,000 | ||||||
Additional Common Stock to be Issued in an Offering | 750 | ||||||
Common Stock [Member] | |||||||
Common Stock Transactions [Line Items] | |||||||
Stock Repurchase Program, Authorized Amount | $ 15,000 | ||||||
Stock Repurchased During Period, Shares | 1,452 | ||||||
Repurchase of shares of common stock (Note 3) | $ (30,000) |
Computation of Net Income Per60
Computation of Net Income Per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Numerator: | |||
Net income | $ 52,843 | $ 55,917 | $ 33,741 |
Less: net income (loss) attributable to noncontrolling interests | 2,853 | 485 | (2,209) |
Net income attributable to The Ensign Group, Inc. | $ 49,990 | $ 55,432 | $ 35,950 |
Denominator: | |||
Weighted average shares outstanding for basic net income per share | 50,555 | 50,316 | 44,682 |
Basic net income (loss) per common share: | |||
Basic net income per common share attributable to The Ensign Group, Inc. | $ 0.99 | $ 1.10 | $ 0.80 |
Common Class A [Member] | |||
Denominator: | |||
Weighted average shares outstanding for basic net income per share | 50,555 | 50,316 | 44,682 |
Computation of Net Income Per61
Computation of Net Income Per Common Share Dilutive Table (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands | 12 Months Ended | |||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | ||
Numerator: | ||||
Net income | $ 52,843 | $ 55,917 | $ 33,741 | |
Less: net income (loss) attributable to noncontrolling interests | 2,853 | 485 | (2,209) | |
Net income attributable to The Ensign Group, Inc. | $ 49,990 | $ 55,432 | $ 35,950 | |
Denominator: | ||||
Basic | 50,555 | 50,316 | 44,682 | |
Adjusted weighted average common shares outstanding | 52,133 | 52,210 | 46,190 | |
Diluted net (loss) income per common share: | ||||
Diluted net income per common share attributable to The Ensign Group, Inc. | $ 0.96 | $ 1.06 | $ 0.78 | |
Common Class A [Member] | ||||
Denominator: | ||||
Basic | 50,555 | 50,316 | 44,682 | |
Plus: incremental shares from assumed conversion (1) | [1] | 1,578 | 1,894 | 1,508 |
[1] | (1) Options outstanding which are anti-dilutive and therefore not factored into the weighted average common shares amount above were 838, 258, and 1,084 for the years ended December 31, 2016, 2015 and 2014, respectively. |
Computation of Net Income Per62
Computation of Net Income Per Common Share Antidilutive Shares (Details) - shares shares in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Earnings Per Share, Diluted, Other Disclosures [Abstract] | |||
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount | 838 | 258 | 1,084 |
Fair Value Measurements (Detail
Fair Value Measurements (Details) - Cash and cash equivalents - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Level 1 | ||
Cash and cash equivalents | $ 57,706 | $ 41,569 |
Level 2 | ||
Cash and cash equivalents | 0 | 0 |
Level 3 | ||
Cash and cash equivalents | $ 0 | $ 0 |
Fair Value Measurements Investm
Fair Value Measurements Investments (Details) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Domestic Corporate Debt Securities [Member] | ||
Schedule of Held-to-maturity Securities [Line Items] | ||
Held-to-maturity Securities | $ 35,184 | $ 34,717 |
Revenue and Accounts Receivab65
Revenue and Accounts Receivable Revenue YTD (Details) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | ||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | ||||
Revenue | $ 1,654,864 | $ 1,341,826 | $ 1,027,406 | |
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 | $ 557,958 | $ 458,956 | $ 369,106 | |
Revenue by payor as a percent of total revenue | 33.70% | 34.20% | 35.90% | |
Medicare | ||||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | ||||
Revenue | $ 477,019 | $ 395,503 | $ 313,144 | |
Revenue by payor as a percent of total revenue | 28.80% | 29.50% | 30.50% | |
Medicaid — skilled | ||||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | ||||
Revenue | $ 87,517 | $ 71,905 | $ 51,157 | |
Revenue by payor as a percent of total revenue | 5.30% | 5.40% | 5.00% | |
Total Medicaid and Medicare | ||||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | ||||
Revenue | $ 1,122,494 | $ 926,364 | $ 733,407 | |
Revenue by payor as a percent of total revenue | 67.80% | 69.10% | 71.40% | |
Managed care | ||||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | ||||
Revenue | $ 265,508 | $ 206,770 | $ 145,796 | |
Revenue by payor as a percent of total revenue | 16.00% | 15.40% | 14.20% | |
Private and other payors(1) | ||||
Health Care Organization, Receivable and Revenue Disclosures [Line Items] | ||||
Revenue | [1] | $ 266,862 | $ 208,692 | $ 148,203 |
Revenue by payor as a percent of total revenue | 16.20% | 15.50% | 14.40% | |
[1] | (1) Private and other payors also includes revenue from all payors generated in urgent care centers and other ancillary services. |
Revenue and Accounts Receivab66
Revenue and Accounts Receivable Accounts Receivable (Details) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Accounts, Notes, Loans and Financing Receivable [Line Items] | ||
Accounts Receivable, Gross | $ 284,224 | $ 239,334 |
Less: allowance for doubtful accounts | (39,791) | (30,308) |
Accounts receivable, net | 244,433 | 209,026 |
Medicaid | ||
Accounts, Notes, Loans and Financing Receivable [Line Items] | ||
Accounts Receivable, Gross | 111,031 | 90,677 |
Managed care | ||
Accounts, Notes, Loans and Financing Receivable [Line Items] | ||
Accounts Receivable, Gross | 66,346 | 56,411 |
Medicare | ||
Accounts, Notes, Loans and Financing Receivable [Line Items] | ||
Accounts Receivable, Gross | 55,500 | 49,970 |
Private and other payors | ||
Accounts, Notes, Loans and Financing Receivable [Line Items] | ||
Accounts Receivable, Gross | $ 51,347 | $ 42,276 |
Business Segments (Details)
Business Segments (Details) $ in Thousands | 12 Months Ended |
Dec. 31, 2016USD ($)Segmentsbusinessfacilities | |
Segment Reporting Information [Line Items] | |
Number of Reportable Segments | Segments | 3 |
Traditional and Skilled Service Facilities | facilities | 149 |
Traditional and Skilled Services and Assistant and Independent Living Campuses | facilities | 21 |
Home Health, Hospice and Home Care Operations | business | 39 |
Business Exit Costs | $ | $ 7,935 |
Gain (Loss) on Contract Termination | $ | 6,512 |
Disposal Group, Disposed of by Sale, Not Discontinued Operations [Member] | |
Segment Reporting Information [Line Items] | |
Sale Price from Divestiture of Businesses | $ | $ 41,492 |
Assisted Living and Independent Living Facility [Member] [Member] | |
Segment Reporting Information [Line Items] | |
Number of Units in Real Estate Property | facilities | 40 |
Business Segments Revenue by Se
Business Segments Revenue by Segment (Details) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | ||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | $ 1,654,864 | $ 1,341,826 | $ 1,027,406 | |
Revenue by payor as a percent of total revenue | 100.00% | 100.00% | 100.00% | |
TSA Services | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | $ 1,374,803 | $ 1,126,388 | $ 901,470 | |
Assisted and Independent Living Services Segment [Member] | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 123,636 | 88,129 | 48,848 | |
Home Health and Hospice Services | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 115,813 | 90,356 | 54,516 | |
Other Segments [Member] | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 40,612 | 36,953 | 22,572 | |
Medicaid | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | $ 557,958 | $ 458,956 | $ 369,106 | |
Revenue by payor as a percent of total revenue | 33.70% | 34.20% | 35.90% | |
Medicaid | TSA Services | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | $ 521,063 | $ 430,368 | $ 352,271 | |
Medicaid | Assisted and Independent Living Services Segment [Member] | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 26,397 | 19,642 | 11,590 | |
Medicaid | Home Health and Hospice Services | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 10,498 | 8,946 | 5,245 | |
Medicaid | Other Segments [Member] | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 0 | 0 | 0 | |
Medicare | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | $ 477,019 | $ 395,503 | $ 313,144 | |
Revenue by payor as a percent of total revenue | 28.80% | 29.50% | 30.50% | |
Medicare | TSA Services | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | $ 396,519 | $ 332,429 | $ 274,723 | |
Medicare | Assisted and Independent Living Services Segment [Member] | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 0 | 0 | 0 | |
Medicare | Home Health and Hospice Services | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 80,500 | 63,074 | 38,421 | |
Medicare | Other Segments [Member] | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 0 | 0 | 0 | |
Medicaid — skilled | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | $ 87,517 | $ 71,905 | $ 51,157 | |
Revenue by payor as a percent of total revenue | 5.30% | 5.40% | 5.00% | |
Medicaid — skilled | TSA Services | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | $ 87,517 | $ 71,905 | $ 51,157 | |
Medicaid — skilled | Assisted and Independent Living Services Segment [Member] | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 0 | 0 | 0 | |
Medicaid — skilled | Home Health and Hospice Services | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 0 | 0 | 0 | |
Medicaid — skilled | Other Segments [Member] | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 0 | 0 | 0 | |
Total Medicaid and Medicare | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | $ 1,122,494 | $ 926,364 | $ 733,407 | |
Revenue by payor as a percent of total revenue | 67.80% | 69.10% | 71.40% | |
Total Medicaid and Medicare | TSA Services | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | $ 1,005,099 | $ 834,702 | $ 678,151 | |
Total Medicaid and Medicare | Assisted and Independent Living Services Segment [Member] | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 26,397 | 19,642 | 11,590 | |
Total Medicaid and Medicare | Home Health and Hospice Services | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 90,998 | 72,020 | 43,666 | |
Total Medicaid and Medicare | Other Segments [Member] | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 0 | 0 | 0 | |
Managed care | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | $ 265,508 | $ 206,770 | $ 145,796 | |
Revenue by payor as a percent of total revenue | 16.00% | 15.40% | 14.20% | |
Managed care | TSA Services | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | $ 247,844 | $ 194,743 | $ 138,215 | |
Managed care | Assisted and Independent Living Services Segment [Member] | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 0 | 0 | 0 | |
Managed care | Home Health and Hospice Services | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 17,664 | 12,027 | 7,581 | |
Managed care | Other Segments [Member] | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 0 | 0 | 0 | |
Private and other payors | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | [1] | $ 266,862 | $ 208,692 | $ 148,203 |
Revenue by payor as a percent of total revenue | 16.20% | 15.50% | 14.40% | |
Private and other payors | TSA Services | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | $ 121,860 | $ 96,943 | $ 85,104 | |
Private and other payors | Assisted and Independent Living Services Segment [Member] | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 97,239 | 68,487 | 37,258 | |
Private and other payors | Home Health and Hospice Services | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | 7,151 | 6,309 | 3,269 | |
Private and other payors | Other Segments [Member] | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenue | $ 40,612 | $ 36,953 | $ 22,572 | |
[1] | (1) Private and other payors also includes revenue from all payors generated in urgent care centers and other ancillary services. |
Business Segments Schedule of S
Business Segments Schedule of Segment Reporting Information, by Segment (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Segment Reporting Information [Line Items] | |||
Revenue | $ 1,654,864 | $ 1,341,826 | $ 1,027,406 |
Intersegment revenue (1) | 0 | 0 | 0 |
Revenue including intersegment revenue | 1,654,864 | 1,341,826 | 1,027,406 |
Segment income (loss) (2) | 91,847 | 93,082 | 72,924 |
Interest expense, net of interest income | (6,029) | (1,983) | (12,382) |
Income before provision for income taxes | 85,818 | 91,099 | 60,542 |
Depreciation and amortization | 38,682 | 28,111 | 26,430 |
TSA Services | |||
Segment Reporting Information [Line Items] | |||
Revenue | 1,374,803 | 1,126,388 | 901,470 |
Intersegment revenue (1) | 2,929 | 2,447 | 2,066 |
Revenue including intersegment revenue | 1,377,732 | 1,128,835 | 903,536 |
Segment income (loss) (2) | 118,118 | 136,744 | 117,816 |
Depreciation and amortization | 26,298 | 18,008 | 19,673 |
Assisted and Independent Living Services Segment [Member] | |||
Segment Reporting Information [Line Items] | |||
Revenue | 123,636 | 88,129 | 48,848 |
Intersegment revenue (1) | 0 | ||
Revenue including intersegment revenue | 123,636 | 88,129 | 48,848 |
Segment income (loss) (2) | 11,701 | 11,463 | 8,195 |
Depreciation and amortization | 4,157 | 3,338 | 1,996 |
Home Health and Hospice Services | |||
Segment Reporting Information [Line Items] | |||
Revenue | 115,813 | 90,356 | 54,516 |
Intersegment revenue (1) | 0 | 0 | 0 |
Revenue including intersegment revenue | 115,813 | 90,356 | 54,516 |
Segment income (loss) (2) | 16,571 | 13,584 | 9,701 |
Depreciation and amortization | 924 | 980 | 539 |
Other Segments [Member] | |||
Segment Reporting Information [Line Items] | |||
Revenue | 40,612 | 36,953 | 22,572 |
Intersegment revenue (1) | 2,184 | 881 | 735 |
Revenue including intersegment revenue | 42,796 | 37,834 | 23,307 |
Segment income (loss) (2) | (54,543) | (68,709) | (62,788) |
Depreciation and amortization | 7,303 | 5,785 | 4,222 |
Elimination | |||
Segment Reporting Information [Line Items] | |||
Intersegment revenue (1) | (5,113) | (3,328) | (2,801) |
Revenue including intersegment revenue | (5,113) | (3,328) | (2,801) |
Segment income (loss) (2) | 0 | 0 | 0 |
Depreciation and amortization | $ 0 | $ 0 | $ 0 |
Acquisitions Acquisition Summar
Acquisitions Acquisition Summary (Details) $ in Thousands | Feb. 01, 2017USD ($)BedsOperations | Dec. 31, 2016USD ($)BedsfacilitiesOperations | Dec. 31, 2015USD ($)BedsfacilitiesOperations | Dec. 31, 2014USD ($)Operations |
Business Acquisition [Line Items] | ||||
Payments to acquire leased assets | $ | $ 120,935 | $ 17,750 | $ 7,938 | |
Payments to Acquire Businesses, Net of Cash Acquired | $ | $ 64,310 | $ 110,802 | $ 92,669 | |
Operational Skilled Nursing Beds | Beds | 17,700 | |||
Operational Assisted Living Units | Beds | 4,450 | |||
Skilled Nursing Care Facilities and Assisted Living Operations [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 50 | 21 | ||
Skilled nursing, assisted living and independent living facilities [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 1 | |||
621610 Home Health Care Services [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 2 | |||
Hospice Agency [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 5 | |||
Assisted Living Facility [Member] | ||||
Business Acquisition [Line Items] | ||||
Operational Assisted Living Units | Beds | 142 | |||
8051 Services, Skilled Nursing Care Facilities [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 18 | |||
Payments to acquire leased assets | $ | $ 23,998 | |||
Operational Skilled Nursing Beds | Beds | 463 | 2,580 | ||
Home Health Care Services and Hospice Agencies [Member] | ||||
Business Acquisition [Line Items] | ||||
Payments to Acquire Businesses, Net of Cash Acquired | $ | $ 64,521 | |||
Skilled nursing, assisted living and independent living facilities [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | facilities | 1 | 18 | ||
8051 Services, Skilled Nursing Care Facilities [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | facilities | 2 | |||
Assisted Living Facility [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 15 | |||
Payments to acquire leased assets | $ | $ 127,348 | |||
8051 Services, Skilled Nursing Care Facilities [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 3 | |||
Assisted Living Facility [Member] | ||||
Business Acquisition [Line Items] | ||||
Operational Assisted Living Units | Beds | 10 | |||
8051 Services, Skilled Nursing Care Facilities [Member] | ||||
Business Acquisition [Line Items] | ||||
Operational Skilled Nursing Beds | Beds | 2,336 | |||
8051 Services, Skilled Nursing Care Facilities [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | facilities | 16 | |||
8051 Services, Skilled Nursing Care Facilities [Member] | 8051 Services, Skilled Nursing Care Facilities [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 6 | |||
Subsequent Event [Member] | Skilled Nursing Care Facilities and Assisted Living Operations [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of Businesses Acquired | 1 | |||
Payments to Acquire Businesses, Net of Cash Acquired | $ | $ 5,750 | |||
Subsequent Event [Member] | Assisted Living Facility [Member] | ||||
Business Acquisition [Line Items] | ||||
Operational Assisted Living Units | Beds | 9 | |||
Subsequent Event [Member] | 8051 Services, Skilled Nursing Care Facilities [Member] | ||||
Business Acquisition [Line Items] | ||||
Operational Skilled Nursing Beds | Beds | 124 |
Acquisitions Prior Period Acqui
Acquisitions Prior Period Acquisitions (Details) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016USD ($)BedsfacilitiesOperations | Dec. 31, 2015USD ($)BedsfacilitiesOperations | Dec. 31, 2014USD ($)Operations | |
Business Acquisition [Line Items] | |||
Payments to acquire leased assets | $ 120,935 | $ 17,750 | $ 7,938 |
Payments to Acquire Businesses, Net of Cash Acquired | $ 64,310 | $ 110,802 | $ 92,669 |
Operational Skilled Nursing Beds | Beds | 17,700 | ||
Skilled Nursing Care Facilities and Assisted Living Operations [Member] | |||
Business Acquisition [Line Items] | |||
Number of Businesses Acquired | Operations | 50 | 21 | |
8051 Services, Skilled Nursing Care Facilities [Member] | |||
Business Acquisition [Line Items] | |||
Payments to acquire leased assets | $ 23,998 | ||
Number of Businesses Acquired | Operations | 18 | ||
Operational Skilled Nursing Beds | Beds | 463 | 2,580 | |
Notes Issued | $ 6,248 | ||
Home Health, Hospice Agencies and Home Care Services [Member] | |||
Business Acquisition [Line Items] | |||
Number of Businesses Acquired | Operations | 7 | 9 | |
Urgent Care Centers [Member] | |||
Business Acquisition [Line Items] | |||
Number of Businesses Acquired | Operations | 3 | ||
Skilled nursing, assisted living, home health, home care, hospice and urgent care [Member] | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Net of Cash Acquired | $ 119,965 | $ 96,085 | |
Liability Assumed, Refundable Deposits | $ 8,939 | ||
Assisted Living and Independent Living Facility [Member] [Member] | |||
Business Acquisition [Line Items] | |||
Operational Assisted and Independent Living Beds | Beds | 2,013 | ||
Notes Payable to Banks [Member] | Collateralized Debt Obligations [Member] | |||
Business Acquisition [Line Items] | |||
Debt Instrument, Face Amount | $ 3,417 | ||
Skilled nursing, assisted living and independent living facilities [Member] | |||
Business Acquisition [Line Items] | |||
Number of Businesses Acquired | facilities | 1 | 18 | |
Assisted Living Facility [Member] | |||
Business Acquisition [Line Items] | |||
Payments to acquire leased assets | $ 127,348 | ||
Number of Businesses Acquired | Operations | 15 | ||
8051 Services, Skilled Nursing Care Facilities [Member] | |||
Business Acquisition [Line Items] | |||
Number of Businesses Acquired | Operations | 3 |
Acquisitions (Details)
Acquisitions (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | $ 64,521 | $ 119,965 | $ 96,085 |
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net | 6 | (18) | 0 |
Land | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | 1,054 | 12,811 | 10,314 |
Building and improvements | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | 21,057 | 73,502 | 41,995 |
Equipment, furniture, and fixtures | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | 8,265 | 4,612 | 2,933 |
Assembled occupancy | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | 1,299 | 895 | 905 |
Definite-lived intangible assets | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | 363 | 360 | 729 |
Favorable leases | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | 393 | 10,901 | 28,680 |
Goodwill | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | 30,343 | 10,617 | 6,334 |
Other indefinite-lived intangible assets | |||
Business Acquisition [Line Items] | |||
Payments to Acquire Businesses, Gross | $ 1,741 | $ 6,285 | $ 4,195 |
Acquisitions - Pro Forma (Detai
Acquisitions - Pro Forma (Details) - USD ($) $ / shares in Units, $ in Thousands | 12 Months Ended | |
Dec. 31, 2016 | Dec. 31, 2015 | |
Business Acquisition, Pro Forma Information [Abstract] | ||
Revenue | $ 1,725,063 | $ 1,524,371 |
Net income attributable to The Ensign Group, Inc. | $ 48,992 | $ 54,790 |
Diluted net income per common share | $ 0.94 | $ 1.05 |
Business Acquisition, Pro Forma Revenue | $ 70,199 | $ 182,546 |
Business Combination, Pro Forma Information, Earnings or Loss of Acquiree since Acquisition Date, Actual | $ 997 | $ 642 |
Property and Equipment (Details
Property and Equipment (Details) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Property, Plant and Equipment [Line Items] | ||
Property and equipment | $ 594,534 | $ 382,327 |
Less: accumulated depreciation | (110,036) | (82,694) |
Property and equipment, net | 484,498 | 299,633 |
Land | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment | 47,565 | 41,451 |
Building and improvements | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment | 304,263 | 151,434 |
Equipment | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment | 153,170 | 114,752 |
Furniture and fixtures | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment | 6,931 | 5,504 |
Leasehold improvements | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment | 80,164 | 68,405 |
Construction in progress | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment | $ 2,441 | $ 781 |
Intangible Assets - Net (Detail
Intangible Assets - Net (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Acquired Finite-Lived Intangible Assets [Line Items] | |||
Gross Carrying Amount | $ 43,162 | $ 54,664 | |
Accumulated Amortization | (8,086) | (9,233) | |
Net | 35,076 | 45,431 | |
Amortization [Abstract] | |||
Amortization of Intangible Assets | $ 4,634 | 3,824 | $ 1,089 |
Lease acquisition costs | |||
Acquired Finite-Lived Intangible Assets [Line Items] | |||
Weighted Average Life (Years) | 24 years 8 months | ||
Gross Carrying Amount | $ 483 | 604 | |
Accumulated Amortization | (78) | (577) | |
Net | $ 405 | 27 | |
Favorable leases | |||
Acquired Finite-Lived Intangible Assets [Line Items] | |||
Weighted Average Life (Years) | 32 years 1 month | ||
Gross Carrying Amount | $ 35,116 | 43,248 | |
Accumulated Amortization | (4,589) | (2,923) | |
Net | $ 30,527 | 40,325 | |
Assembled occupancy | |||
Acquired Finite-Lived Intangible Assets [Line Items] | |||
Weighted Average Life (Years) | 0 years | ||
Gross Carrying Amount | $ 1,897 | 4,779 | |
Accumulated Amortization | (1,897) | (4,476) | |
Net | 0 | 303 | |
Amortization [Abstract] | |||
Amortization of Intangible Assets | $ 1,602 | ||
Trade name | |||
Acquired Finite-Lived Intangible Assets [Line Items] | |||
Weighted Average Life (Years) | 30 years | ||
Gross Carrying Amount | $ 733 | 733 | |
Accumulated Amortization | (269) | (244) | |
Net | $ 464 | 489 | |
Customer relationships | |||
Acquired Finite-Lived Intangible Assets [Line Items] | |||
Weighted Average Life (Years) | 18 years 6 months | ||
Gross Carrying Amount | $ 4,933 | 5,300 | |
Accumulated Amortization | (1,253) | (1,013) | |
Net | 3,680 | $ 4,287 | |
Customer relationships | Disposal Group, Disposed of by Sale, Not Discontinued Operations [Member] | Urgent Care Centers [Member] | |||
Acquired Finite-Lived Intangible Assets [Line Items] | |||
Gross Carrying Amount | 582 | ||
Favorable leases | Assisted Living Facility [Member] | |||
Acquired Finite-Lived Intangible Assets [Line Items] | |||
Gross Carrying Amount | $ 7,190 |
Intangible Assets - Net Future
Intangible Assets - Net Future Amortization (Details) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract] | ||
2,017 | $ 2,282 | |
2,018 | 2,282 | |
2,019 | 2,282 | |
2,020 | 1,573 | |
2,021 | 1,475 | |
Thereafter | 25,182 | |
Finite-Lived Intangible Assets, Net | $ 35,076 | $ 45,431 |
Goodwill and Other Indefinite77
Goodwill and Other Indefinite-Lived Intangible Assets Goodwill Rollforward (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Goodwill [Line Items] | |||
January 1 | $ 40,886 | $ 30,269 | $ 23,935 |
Goodwill, Impairment Loss | 0 | 0 | 0 |
Less: Dispositions | (4,103) | ||
Purchase price adjustment | (26) | ||
Additions | 30,343 | 10,617 | 6,334 |
December 31 | 67,100 | 40,886 | 30,269 |
Transitional and Skilled Services Segment [Member] | |||
Goodwill [Line Items] | |||
January 1 | 14,221 | 14,221 | 13,338 |
Goodwill, Impairment Loss | 0 | 0 | |
Less: Dispositions | 0 | ||
Purchase price adjustment | 0 | ||
Additions | 26,415 | 0 | 883 |
December 31 | 40,636 | 14,221 | 14,221 |
Assisted and Independent Living Services Segment [Member] | |||
Goodwill [Line Items] | |||
January 1 | 3,538 | 1,756 | 316 |
Goodwill, Impairment Loss | 0 | 0 | |
Less: Dispositions | 0 | ||
Purchase price adjustment | 0 | ||
Additions | 0 | 1,782 | 1,440 |
December 31 | 3,538 | 3,538 | 1,756 |
Home Health and Hospice Services | |||
Goodwill [Line Items] | |||
January 1 | 16,102 | 10,929 | 7,278 |
Goodwill, Impairment Loss | 0 | 0 | |
Less: Dispositions | 0 | ||
Purchase price adjustment | 0 | ||
Additions | 1,799 | 5,173 | 3,651 |
December 31 | 17,901 | 16,102 | 10,929 |
Other Segments [Member] | |||
Goodwill [Line Items] | |||
January 1 | 7,025 | 3,363 | 3,003 |
Goodwill, Impairment Loss | 0 | 0 | |
Less: Dispositions | (4,103) | ||
Purchase price adjustment | (26) | ||
Additions | 2,129 | 3,662 | 360 |
December 31 | 5,025 | 7,025 | 3,363 |
Disposal Group, Disposed of by Sale, Not Discontinued Operations [Member] | All Other [Member] | |||
Goodwill [Line Items] | |||
Goodwill, Impairment Loss | 0 | $ 0 | $ 0 |
Disposal Group, Disposed of by Sale, Not Discontinued Operations [Member] | Other Segments [Member] | |||
Goodwill [Line Items] | |||
Less: Dispositions | $ 4,103 |
Goodwill and Other Indefinite78
Goodwill and Other Indefinite-Lived Intangible Assets Indefinite-lived intangble assets (Details) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2016 | Dec. 31, 2015 | |
Indefinite-lived Intangible Assets [Line Items] | ||
Other indefinite-lived intangibles | $ 19,586 | $ 18,646 |
Home Health and Hospice Services | Trade name | ||
Indefinite-lived Intangible Assets [Line Items] | ||
Other indefinite-lived intangibles | 1,146 | 1,915 |
Home Health and Hospice Services | Medicare and Medicaid licenses | ||
Indefinite-lived Intangible Assets [Line Items] | ||
Other indefinite-lived intangibles | 18,440 | $ 16,731 |
Indefinite-lived Intangible Assets Acquired | 1,709 | |
Trade name | Medicare and Medicaid licenses | ||
Indefinite-lived Intangible Assets [Line Items] | ||
Indefinite-lived Intangible Assets Acquired | 31 | |
Disposal Group, Disposed of by Sale, Not Discontinued Operations [Member] | Trade name | Urgent Care Centers [Member] | ||
Indefinite-lived Intangible Assets [Line Items] | ||
Indefinite-lived Intangible Assets Acquired | $ 800 |
Restricted and Other Assets (De
Restricted and Other Assets (Details) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Other Assets [Abstract] | ||
Debt issuance costs, net | $ 3,611 | $ 2,021 |
Long-term insurance losses recoverable asset | 4,104 | 2,881 |
Deposits with landlords | 3,526 | 3,969 |
Capital improvement reserves with landlords and lenders | 673 | 760 |
Note receivable from sale of urgent care centers | 700 | 0 |
Restricted and other assets | $ 12,614 | $ 9,631 |
Other Accrued Liabilities (Deta
Other Accrued Liabilities (Details) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Accrued Liabilities [Abstract] | ||
Quality assurance fee | $ 4,604 | $ 6,120 |
Refunds payable | 18,368 | 13,252 |
Deferred revenue | 6,994 | 6,696 |
Cash held in trust for patients | 2,373 | 3,016 |
Resident deposits | 6,099 | 5,884 |
Dividends payable | 2,186 | 2,072 |
Property taxes | 9,130 | 4,230 |
Charges related to operational closure | 1,972 | 0 |
Other | 7,037 | 4,935 |
Other accrued liabilities | $ 58,763 | $ 46,205 |
Income Taxes Income Tax Expense
Income Taxes Income Tax Expense (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Income Tax Disclosure [Abstract] | |||
Currend Federal | $ 30,043 | $ 28,149 | $ 25,490 |
Current State | 5,183 | 5,761 | 4,405 |
Current Income Tax Expense | 35,226 | 33,910 | 29,895 |
Deferred Federal | (1,034) | 2,026 | (2,438) |
Deferred State | (1,217) | (754) | (656) |
Deferred Income Tax Expense | (2,251) | 1,272 | (3,094) |
Provision for Income Taxes | $ 32,975 | $ 35,182 | $ 26,801 |
Income Taxes Income Tax Rate Re
Income Taxes Income Tax Rate Reconciliation (Details) | 12 Months Ended | ||
Dec. 31, 2016Rate | Dec. 31, 2015Rate | Dec. 31, 2014Rate | |
Income tax expense at statutory rate | 35.00% | 35.00% | 35.00% |
State income taxes - net of federal benefit | 3.00% | 3.60% | 4.00% |
Non-deductible settlement costs | 0.90% | 0.60% | 0.60% |
Other adjustments | (0.50%) | (0.60%) | (0.40%) |
Total income tax provision | 38.40% | 38.60% | 44.40% |
Real Estate Investment Trust Spin-Off Transaction [Member] | |||
Non-deductible settlement costs | 0.00% | 0.00% | 5.20% |
Income Taxes Deferred Income Ta
Income Taxes Deferred Income Taxes (Details) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Income Tax Disclosure [Abstract] | ||
Accrued expenses | $ 21,732 | $ 18,957 |
Allowance for doubtful accounts | 15,956 | 12,313 |
Tax credits | 3,461 | 3,439 |
Insurance | 7,333 | 5,814 |
Total deferred tax assets | 48,482 | 40,523 |
State taxes | (1,023) | (420) |
Depreciation and amortization | (20,643) | (14,773) |
Prepaid expenses | (3,743) | (4,478) |
Total deferred tax liabilities | 25,409 | 19,671 |
Net deferred tax assets | $ 23,073 | $ 20,852 |
Income Taxes Income Tax Other D
Income Taxes Income Tax Other Disclosures (Details) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Operating Loss Carryforwards [Line Items] | ||
Deferred Tax Assets, Tax Credit Carryforwards, General Business | $ 3,430 | $ 3,439 |
Domestic Tax Authority [Member] | ||
Operating Loss Carryforwards [Line Items] | ||
Operating Loss Carryforwards | 0 | 4,389 |
State and Local Jurisdiction [Member] | ||
Operating Loss Carryforwards [Line Items] | ||
Operating Loss Carryforwards | $ 67 | $ 84 |
Debt (Details)
Debt (Details) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Debt Instrument [Line Items] | ||
Long-term Debt, Gross | $ 284,157 | $ 99,671 |
Current maturities of long-term debt | (8,129) | (620) |
Long Term Debt, net of Current Maturities and Debt Discount | 275,486 | 99,051 |
SunTrust Bank [Member] | Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Credit facility with SunTrust | 122,000 | 85,000 |
Second Amended Credit Facility [Member] | SunTrust Bank [Member] | Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Term loan with SunTrust, interest payable quarterly | 148,125 | 0 |
Less debt issuance costs | (542) | 0 |
Collateralized Debt Obligations [Member] | Notes Payable, Other Payables [Member] | ||
Debt Instrument [Line Items] | ||
Mortgage loans and promissory note, principal and interest payable monthly, interest at fixed rate | $ 14,032 | $ 14,671 |
Debt Additional Disclosures (De
Debt Additional Disclosures (Details) $ in Thousands | Feb. 05, 2016USD ($)Rate | May 30, 2014USD ($)Rate | Dec. 31, 2016USD ($) | Feb. 06, 2017USD ($) | Jul. 19, 2016USD ($)Rate | Dec. 31, 2015USD ($)Rate | Jul. 01, 2015Rate | Apr. 02, 2015Rate |
Collateralized Debt Obligations [Member] | Notes Payable to Banks [Member] | ||||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||||
Debt Instrument, Interest Rate, Stated Percentage | Rate | 2.60% | 5.30% | ||||||
Collateralized Debt Obligations [Member] | Notes Payable, Other Payables [Member] | ||||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||||
Notes Payable | $ 14,032 | $ 14,671 | ||||||
Notes Payable, Current | 629 | |||||||
Notes Payable, Noncurrent | 13,403 | |||||||
Collateralized Debt Obligations [Member] | Mortgage Loans on Real Estate [Member] | ||||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||||
Prepayment penalty reduced rate | Rate | 1.00% | |||||||
Secured Debt [Member] | Senior Debt Obligations [Member] | ||||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||||
Pledged Financial Instruments, Not Separately Reported, Securities for Letter of Credit Facilities | $ 2,310 | |||||||
Minimum [Member] | Collateralized Debt Obligations [Member] | Mortgage Loans on Real Estate [Member] | ||||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||||
Debt Instrument, pre-payment fee reduction, term | 3 years | |||||||
Debt Instrument, Term | 12 years | |||||||
Maximum [Member] | Collateralized Debt Obligations [Member] | Mortgage Loans on Real Estate [Member] | ||||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||||
Debt Instrument, pre-payment fee reduction, term | 11 years | |||||||
Debt Instrument, Term | 33 years | |||||||
SunTrust Bank [Member] | Revolving Credit Facility [Member] | ||||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||||
Line of Credit Facility, Current Borrowing Capacity | $ 250,000 | $ 150,000 | ||||||
Line of Credit Facility, Maximum Borrowing Capacity | $ 150,000 | $ 75,000 | ||||||
Total Net Debt Ratio, Maximum | 3.50 | |||||||
EBITDA Ratio, Maximum | 1 | |||||||
Total Net Debt Ratio, Minimum | 1.50 | |||||||
EBITDA Ratio, Minimum | 1 | |||||||
Total Net Debt Ratio, Default | 2.75 | 2.50 | ||||||
EBITDA Ratio, Default | 1 | 1 | ||||||
Aggregate Revolving Commitment Percentage | Rate | 10.00% | 10.00% | ||||||
Total Net Debt Ratio, Cured | 2.75 | 2.50 | ||||||
EBITDA Ratio, Cured | 1 | 1 | ||||||
SunTrust Bank [Member] | Revolving Credit Facility [Member] | Second Amended Credit Facility [Member] | ||||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||||
Term Loan, Amount Outstanding, Current | $ 7,500 | |||||||
Term Loan, Amount Outstanding, Noncurrent | 140,625 | |||||||
Line of Credit Facility, Current Borrowing Capacity | $ 450,000 | |||||||
Long-term Line of Credit | 300,000 | |||||||
Term Loan, Borrowing Capacity | $ 150,000 | |||||||
Line of Credit Facility, Interest Rate at Period End | Rate | 5.00% | |||||||
Term Loan and Line of Credit Facility, Amount Outstanding | $ 270,125 | |||||||
SunTrust Bank [Member] | Revolving Credit Facility [Member] | Subsequent Event [Member] | Second Amended Credit Facility [Member] | ||||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||||
Term Loan and Line of Credit Facility, Amount Outstanding | $ 300,000 | |||||||
SunTrust Bank [Member] | Revolving Credit Facility [Member] | Minimum [Member] | ||||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||||
Line of Credit Facility, Interest Rate, Additional Margin | Rate | 0.75% | 1.25% | ||||||
Line of Credit Facility, Interest Rate, LIBOR | Rate | 1.75% | 2.25% | ||||||
Line of Credit Facility, Unused Capacity, Commitment Fee Percentage | Rate | 0.30% | 0.30% | ||||||
SunTrust Bank [Member] | Revolving Credit Facility [Member] | Maximum [Member] | ||||||||
Long-Term Debt Additional Disclosures [Line Items] | ||||||||
Line of Credit Facility, Interest Rate, Additional Margin | Rate | 1.75% | 2.25% | ||||||
Line of Credit Facility, Interest Rate, LIBOR | Rate | 2.75% | 3.25% | ||||||
Line of Credit Facility, Unused Capacity, Commitment Fee Percentage | Rate | 0.50% | 0.50% |
Debt Future Principal Obligatio
Debt Future Principal Obligations (Details) $ in Thousands | Dec. 31, 2016USD ($) |
Debt Disclosure [Abstract] | |
Long-term Debt, Maturities, Repayments of Principal in Next Twelve Months | $ 8,129 |
Long-term Debt, Maturities, Repayments of Principal in Year Two | 8,178 |
Long-term Debt, Maturities, Repayments of Principal in Year Three | 8,208 |
Long-term Debt, Maturities, Repayments of Principal in Year Four | 8,241 |
Long-term Debt, Maturities, Repayments of Principal in Year Five | 240,900 |
Long-term Debt, Maturities, Repayments of Principal for Thereafter Five Years | 10,501 |
Long-term Debt | $ 284,157 |
Options and Awards Lead Paragra
Options and Awards Lead Paragraphs (Details) - shares shares in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Stock Issued or Granted During Period, Share-based Compensation [Abstract] | |||
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant | 3,042 | ||
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Fair Value Assumptions, Forfeiture Rate | 8.75% | ||
2001 Plan [Member] | |||
Stock Issued or Granted During Period, Share-based Compensation [Abstract] | |||
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant | 643 | 638 | 638 |
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Authorized | 3,960 | ||
2005 Plan [Member] | |||
Stock Issued or Granted During Period, Share-based Compensation [Abstract] | |||
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant | 294 | 294 | 294 |
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Authorized | 1,000 | ||
Share-Based Compensation Arrangement by Shared-Based Payment Award, Repurchased | 1,000 | ||
2007 Plan [Member] | |||
Stock Issued or Granted During Period, Share-based Compensation [Abstract] | |||
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant | 2,105 | 1,740 | 1,534 |
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Authorized | 2,000 |
Options and Awards Valuation As
Options and Awards Valuation Assumptions (Details) - shares shares in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Fair Value Assumptions and Methodology | |||
Issuance of restricted stock to employees | 299 | 323 | 56 |
Options Granted | 497 | 637 | 2,058 |
Weighted Average Risk-Free Rate | 1.38% | 1.69% | 1.82% |
Expected Life | 6 years 4 months | 6 years 6 months | 6 years 6 months |
Weighted Average Volatility | 38.00% | 39.00% | 46.00% |
Weighted Average Dividend Yield | 0.80% | 0.63% | 0.62% |
Options and Awards Exercise Pri
Options and Awards Exercise Price and Fair Value (Details) - $ / shares shares in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Net of Forfeitures [Abstract] | |||
Options Granted | 497 | 637 | 2,058 |
Weighted Average Exercise Price | $ 19.43 | $ 23.27 | $ 12.68 |
Weighted Average Fair Value of Options | 7 | 9.08 | 5.66 |
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 | $ 0 | $ 0 |
Options and Awards Options Outs
Options and Awards Options Outstanding Rollforward (Details) - $ / shares shares in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Options outstanding January 1 | 5,448 | 5,532 | 4,580 |
Weighted average exercise price January 1 | $ 10.36 | $ 8.51 | $ 5.65 |
Options vested January 1 | 2,526 | 2,218 | 2,498 |
Weighted Average Exercise Price of Options Vested January 1 | $ 6.35 | $ 4.70 | $ 3.88 |
Options Granted | 497 | 637 | 2,058 |
Weighted Average Exercise Price, Options Granted | $ 19.43 | $ 23.27 | $ 12.68 |
Options Forfeited in Period | (127) | (233) | (128) |
Weighted Average Exercise Price, Options Forfeited in Period | $ 14.46 | $ 12.55 | $ 8.14 |
Options Exercised in Period | (642) | (488) | (978) |
Weighted Average Exercise Price, Options Exercised in Period | $ 6.47 | $ 5.20 | $ 3.93 |
Options outstanding December 31 | 5,176 | 5,448 | 5,532 |
Weighted average exercise price December 31 | $ 11.62 | $ 10.36 | $ 8.51 |
Options vested December 31 | 2,704 | 2,526 | 2,218 |
Weighted Average Exercise Price of Options Vested December 31 | $ 8.18 | $ 6.35 | $ 4.70 |
Options and Awards Options Ou92
Options and Awards Options Outstanding by Exercise Price (Details) $ / shares in Units, shares in Thousands, $ in Thousands | 12 Months Ended |
Dec. 31, 2016USD ($)$ / sharesshares | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Number of Outstanding Options | 5,176 |
Black-Scholes Fair Value | $ | $ 25,942 |
Stock Options Vested and Exercisable | 2,704 |
2,008 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 2.56 |
Exercise Price, Upper Range Limit | $ / shares | $ 4.06 |
Number of Outstanding Options | 415 |
Black-Scholes Fair Value | $ | $ 618 |
Remaining Contractual Life (Years) | 2 years |
Stock Options Vested and Exercisable | 415 |
2,009 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 4.06 |
Exercise Price, Upper Range Limit | $ / shares | $ 4.56 |
Number of Outstanding Options | 542 |
Black-Scholes Fair Value | $ | $ 1,162 |
Remaining Contractual Life (Years) | 3 years |
Stock Options Vested and Exercisable | 542 |
2,010 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 4.77 |
Exercise Price, Upper Range Limit | $ / shares | $ 4.96 |
Number of Outstanding Options | 143 |
Black-Scholes Fair Value | $ | $ 347 |
Remaining Contractual Life (Years) | 4 years |
Stock Options Vested and Exercisable | 143 |
2,011 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 5.90 |
Exercise Price, Upper Range Limit | $ / shares | $ 7.99 |
Number of Outstanding Options | 167 |
Black-Scholes Fair Value | $ | $ 567 |
Remaining Contractual Life (Years) | 5 years |
Stock Options Vested and Exercisable | 167 |
2,012 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 6.56 |
Exercise Price, Upper Range Limit | $ / shares | $ 7.96 |
Number of Outstanding Options | 528 |
Black-Scholes Fair Value | $ | $ 1,952 |
Remaining Contractual Life (Years) | 6 years |
Stock Options Vested and Exercisable | 390 |
2,013 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 7.98 |
Exercise Price, Upper Range Limit | $ / shares | $ 11.49 |
Number of Outstanding Options | 617 |
Black-Scholes Fair Value | $ | $ 2,996 |
Remaining Contractual Life (Years) | 7 years |
Stock Options Vested and Exercisable | 331 |
2,014 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 10.55 |
Exercise Price, Upper Range Limit | $ / shares | $ 18.94 |
Number of Outstanding Options | 1,688 |
Black-Scholes Fair Value | $ | $ 9,547 |
Remaining Contractual Life (Years) | 8 years |
Stock Options Vested and Exercisable | 597 |
2,015 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 21.47 |
Exercise Price, Upper Range Limit | $ / shares | $ 25.24 |
Number of Outstanding Options | 590 |
Black-Scholes Fair Value | $ | $ 5,357 |
Remaining Contractual Life (Years) | 9 years |
Stock Options Vested and Exercisable | 119 |
2,016 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Exercise Price, Lower Range Limit | $ / shares | $ 18.79 |
Exercise Price, Upper Range Limit | $ / shares | $ 19.89 |
Number of Outstanding Options | 486 |
Black-Scholes Fair Value | $ | $ 3,396 |
Remaining Contractual Life (Years) | 10 years |
Stock Options Vested and Exercisable | 0 |
Options and Awards Restricted A
Options and Awards Restricted Awards Granted (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Restricted awards granted [Line Items] | |||
Restricted Awards Grant Date Fair Value Range, Minimum | $ 18.79 | $ 21 | $ 15.38 |
Restricted Awards Grant Date Fair Value Range, Maximum | $ 23.23 | $ 26.55 | $ 22.36 |
Share-based Compensation, Restricted Awards, Exercise Price | $ 0 | ||
Issuance of restricted stock to employees | 299 | 323 | 56 |
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period | 5 years | ||
Director [Member] | |||
Restricted awards granted [Line Items] | |||
Restricted Awards Grant Date Fair Value Range, Minimum | $ 19.61 | ||
Restricted Awards Grant Date Fair Value Range, Maximum | $ 23.23 | ||
Options Granted to Non-employee Directors | 32 |
Options and Awards Restricted94
Options and Awards Restricted Award Rollforward (Details) - $ / shares shares in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Restricted Stock Rollforward [Line Items] | |||
Nonvested Restricted Awards, Nonvested at January 1 | 425 | 366 | 460 |
Weighted Average Grant Date Fair Value, Nonvested at January 1 | $ 19.79 | $ 15.15 | $ 14.34 |
Issuance of restricted stock to employees | 299 | 323 | 56 |
Weighted Average Grant Date Fair Value, Restricted Awards Granted in the Period | $ 20.55 | $ 22.99 | $ 17.75 |
Nonvested Restricted Awards, Vested in the Period | (279) | (234) | (130) |
Weighted Average Grant Date Fair Value, Restricted Awards Vested in the Period | $ 19.58 | $ 17.36 | $ 13.38 |
Nonvested Restricted Awards, Forfeited in the Period | (16) | (30) | (20) |
Weighted Average Grant Date Fair Value, Restricted Awards Forfeited in the Period | $ 20.85 | $ 16.81 | $ 15.12 |
Nonvested Restricted Awards, Nonvested at December 31 | 429 | 425 | 366 |
Weighted Average Grant Date Fair Value, Nonvested at December 31 | $ 20.42 | $ 19.79 | $ 15.15 |
Options and Awards Compensation
Options and Awards Compensation Expense (Details) - USD ($) shares in Thousands, $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items] | |||
Share-based compensation expense | $ 7,776 | $ 6,677 | $ 5,190 |
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized [Abstract] | |||
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Remaining Contractual Term | 6 years 1 month | ||
Stock Options | |||
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items] | |||
Share-based compensation expense | $ 4,793 | 4,164 | 3,134 |
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized [Abstract] | |||
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized | $ 13,457 | ||
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized, Period for Recognition | 3 years 1 month | ||
Employee Service Share-based Compensation, Nonvested Awards | 2,472 | ||
Share-based Compensation Arrangement by Share-based Payment Award, Options, Expected to Vest, Number | 2,333 | ||
Restricted Stock Awards | |||
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items] | |||
Share-based compensation expense | $ 2,371 | 1,931 | 1,657 |
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized [Abstract] | |||
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized | $ 7,594 | ||
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized, Period for Recognition | 3 years 5 months | ||
Stock awards | |||
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items] | |||
Share-based compensation expense | $ 612 | $ 582 | $ 399 |
Options and Awards Intrinsic Va
Options and Awards Intrinsic Values (Details) - Stock Options - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Outstanding | $ 55,610 | $ 67,508 | $ 75,689 |
Vested | 38,101 | 41,128 | 38,811 |
Expected to Vest | 15,983 | 23,508 | 31,160 |
Exercised | $ 9,199 | $ 8,709 | $ 10,496 |
Options and Awards Subsidiary E
Options and Awards Subsidiary Equity Plan (Details) - USD ($) shares in Thousands, $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Employee stock award compensation | $ 7,776 | $ 6,677 | $ 5,190 |
Stock awards [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Employee stock award compensation | 612 | 582 | 399 |
Subsidiaries [Member] | Stock awards [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Stock Granted, Value, Share-based Compensation, Gross | 4,623 | ||
Employee stock award compensation | $ 1,325 | $ 0 | $ 0 |
Common Stock Required to Settle Subsidiary Shares | 212 | 0 | 0 |
Leases (Details)
Leases (Details) $ in Thousands | Jun. 03, 2014 | Dec. 31, 2016USD ($)facilitiesRenewals | Dec. 31, 2015USD ($) | Dec. 31, 2014USD ($) | Jun. 01, 2014facilities | Jun. 01, 2014Agreements |
Operating Leased Assets [Line Items] | ||||||
Master Lease agreements | facilities | 5 | |||||
Business Exit Costs | $ 7,935 | |||||
Operating Leases, Rent Expense | $ 125,221 | $ 89,264 | $ 48,947 | |||
Average operating lease minimum term | 5 years | |||||
Average operating lease maximum term | 20 years | |||||
Average non-cancellable equipment leases minimum term | 3 years | |||||
Average non-cancellable equipment lease maximum term | 5 years | |||||
Facilities under master lease arrangement | facilities | 22 | |||||
Gain (Loss) on Contract Termination | $ 6,512 | |||||
Various Landlords[Member] [Member] | ||||||
Operating Leased Assets [Line Items] | ||||||
Lessee Leasing Arrangements, Operating Leases, Term of Contract | 15 years | |||||
Lessee Leasing Arrangements, Operating Leases, Number of Renewal Terms, Minimum | Renewals | 2 | |||||
Lessee Leasing Arrangements, Operating Leases, Renewal Term | 5 years | |||||
CareTrust REIT [Member] | ||||||
Operating Leased Assets [Line Items] | ||||||
Payments for Rent | $ 56,271 | $ 56,000 | $ 32,700 | |||
Average operating lease minimum term | 12 years | |||||
Average operating lease maximum term | 19 years | |||||
Operating Leases of Lessee, Contingent Rentals, Description of Variable Rate Basis | 0.025 | |||||
Real Estate Investment Trust Spin-Off Transaction [Member] | CareTrust REIT [Member] | ||||||
Operating Leased Assets [Line Items] | ||||||
Skilled Nursing, Assisted Living and Independent Living Facilities | facilities | 93 | |||||
Master Lease agreements | 8 | 8 |
Leases Future minimum lease pay
Leases Future minimum lease payments (Details) $ in Thousands | Dec. 31, 2016USD ($) |
Leases [Abstract] | |
2,017 | $ 137,247 |
2,018 | 140,211 |
2,019 | 139,851 |
2,020 | 139,191 |
2,021 | 138,498 |
Thereafter | 1,145,188 |
Operating Leases, Future Minimum Payments Due | $ 1,840,186 |
Divestitures (Details)
Divestitures (Details) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016USD ($)facilities | Dec. 31, 2015USD ($) | Dec. 31, 2014USD ($) | |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | |||
Gain (Loss) on Disposition of Business | $ 19,160 | $ 0 | $ 0 |
Disposal Group, Disposed of by Sale, Not Discontinued Operations [Member] | |||
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | |||
Urgent Care Centers Operated | facilities | 17 | ||
Sale Price from Divestiture of Businesses | $ 41,492 | ||
Gain (Loss) on Disposition of Business | $ 19,160 |
Commitments and Contingencies L
Commitments and Contingencies Litigation (Details) $ in Thousands | 12 Months Ended |
Dec. 31, 2016USD ($) | |
General Liability [Member] | |
Litigation [Line Items] | |
Litigation Settlement, Amount | $ 2,100 |
Professional Malpractice Liability Insurance [Member] | |
Litigation [Line Items] | |
Litigation Settlement, Amount | $ 2,800 |
Commitments and Contingencies M
Commitments and Contingencies Medicare Revenue Recoupments (Details) | 12 Months Ended |
Dec. 31, 2016facilities | |
Medicare Probe Reviews [Abstract] | |
Facilities under Medicare Probe Reviews | 18 |
Facilities under Medicare Probe Reviews Closed | 12 |
Facilities under Medicare Probe Reviews in Process | 6 |
Commitments and Contingencies O
Commitments and Contingencies Other Matters (Details) $ in Thousands | 12 Months Ended |
Dec. 31, 2014USD ($) | |
Other Commitments [Line Items] | |
Litigation Settlement Paid to U.S. Government | $ 48,000 |
Commitments and Contingencies C
Commitments and Contingencies Concentrations (Details) | 12 Months Ended | ||
Dec. 31, 2016Rate | Dec. 31, 2015Rate | Dec. 31, 2014Rate | |
Concentration Risk [Line Items] | |||
% of Revenue | 100.00% | 100.00% | 100.00% |
Total Medicaid and Medicare | |||
Concentration Risk [Line Items] | |||
Accounts receivable by payor as a percent of total accounts receivable | 58.60% | 58.80% | |
% of Revenue | 67.80% | 69.10% | 71.40% |
Commitments and Contingencie105
Commitments and Contingencies Cash in Excess of FDIC Limits (Details) - USD ($) $ in Thousands | Feb. 06, 2017 | Dec. 31, 2016 |
Cash in Excess of FDIC limits [Line Items] | ||
Cash, FDIC Insured Amount | $ 250 | |
Subsequent Event [Member] | ||
Cash in Excess of FDIC limits [Line Items] | ||
Cash, Uninsured Amount | $ 2,500 |
Self-Insurance Reserves (Detail
Self-Insurance Reserves (Details) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2016 | Dec. 31, 2015 | |
Schedule of Self-Insurance Reserves [Line Items] | ||
Balance January 1 | $ 56,003 | $ 49,960 |
Current year provisions | 74,187 | 40,957 |
Claims paid and direct expenses | (66,062) | (35,381) |
Change in long-term insurance losses recoverable | (1,223) | (467) |
Balance December 31 | 65,351 | 56,003 |
Professional Malpractice Liability Insurance [Member] | ||
Schedule of Self-Insurance Reserves [Line Items] | ||
Balance January 1 | 30,710 | 30,401 |
Current year provisions | 23,149 | 12,528 |
Claims paid and direct expenses | (18,186) | (11,911) |
Change in long-term insurance losses recoverable | (637) | (308) |
Balance December 31 | 36,310 | 30,710 |
Workers' Compensation [Member] | ||
Schedule of Self-Insurance Reserves [Line Items] | ||
Balance January 1 | 20,219 | 15,758 |
Current year provisions | 12,887 | 12,508 |
Claims paid and direct expenses | (10,290) | (8,822) |
Change in long-term insurance losses recoverable | (586) | (775) |
Balance December 31 | 23,402 | 20,219 |
Health Insurance Product Line [Member] | ||
Schedule of Self-Insurance Reserves [Line Items] | ||
Balance January 1 | 5,074 | 3,801 |
Current year provisions | 38,151 | 15,921 |
Claims paid and direct expenses | (37,586) | (14,648) |
Change in long-term insurance losses recoverable | 0 | 0 |
Balance December 31 | $ 5,639 | $ 5,074 |
Defined Contribution Plan (Deta
Defined Contribution Plan (Details) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | Dec. 31, 2006 | |
Defined Contribution Plan [Abstract] | ||||
Defined Contribution Plan, Employer Discretionary Contribution Amount | $ 862 | $ 682 | $ 565 | |
Defined Contribution Plan, Maximum Annual Contributions Per Employee, Percent | 90.00% | 15.00% |
REIT Spin-Off (Details)
REIT Spin-Off (Details) $ in Thousands | Jun. 03, 2014USD ($) | Dec. 31, 2016USD ($) | Jun. 30, 2016USD ($) | Dec. 31, 2015USD ($) | Dec. 31, 2014USD ($) | Sep. 30, 2014USD ($) | Jun. 01, 2014USD ($)facilitiesCompanies | Mar. 31, 2014facilities | Dec. 31, 2013USD ($) |
Cash and cash equivalents | $ 57,706 | $ 41,569 | $ 41,569 | $ 50,408 | $ 65,755 | ||||
Real Estate Investment Trust Spin-Off Transaction [Member] | |||||||||
Public Companies Created | Companies | 2 | ||||||||
Parent Company [Member] | |||||||||
Skilled Nursing, Assisted Living and Independent Living Facilities | facilities | 120 | ||||||||
Parent Company [Member] | Real Estate Investment Trust Spin-Off Transaction [Member] | |||||||||
Payments for Deposits Applied to Debt Retirements | $ 208,635 | ||||||||
Restricted Cash and Investments | $ 8,219 | ||||||||
Restricted Cash and Investments, Current | $ 5,082 | 6,400 | |||||||
Restricted Cash and Investments, Noncurrent | 1,819 | ||||||||
Dividend Payments Restrictions Schedule, Statutory Capital and Surplus | $ 3,137 | ||||||||
Cash and cash equivalents | $ 78,731 | ||||||||
Skilled Nursing, Assisted Living and Independent Living Facilities after the Spin-Off | facilities | 122 | ||||||||
Facilities Leased Under Master Lease Agreements with CareTrust | facilities | 94 | ||||||||
CareTrust REIT [Member] | Real Estate Investment Trust Spin-Off Transaction [Member] | |||||||||
Cash Transferred from Subsidiary | $ 220,752 | ||||||||
Cash and cash equivalents | $ 78,731 | ||||||||
Skilled Nursing, Assisted Living and Independent Living Facilities | facilities | 93 | ||||||||
Private Placement [Member] | CareTrust REIT [Member] | Real Estate Investment Trust Spin-Off Transaction [Member] | |||||||||
Senior Notes, Noncurrent | $ 260,000 | ||||||||
General Electric Capital Corporation (GECC) [Member] | Senior Subordinated Notes [Member] | CareTrust REIT [Member] | Real Estate Investment Trust Spin-Off Transaction [Member] | |||||||||
Senior Notes | 99,000 | ||||||||
General Electric Capital Corporation (GECC) [Member] | Private Placement [Member] | CareTrust REIT [Member] | Real Estate Investment Trust Spin-Off Transaction [Member] | |||||||||
Increase in Loan Principal | $ 50,676 |
REIT Spin-Off REIT Spin-Off Net
REIT Spin-Off REIT Spin-Off Net Contribution Summary (Details) - USD ($) $ in Thousands | Dec. 31, 2016 | Jun. 30, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | Dec. 31, 2013 |
REIT Spin-Off Transaction Summary [Line Items] | |||||
Cash and cash equivalents | $ 57,706 | $ 41,569 | $ 41,569 | $ 50,408 | $ 65,755 |
Property and equipment, net | 484,498 | 299,633 | |||
Current maturities of long-term debt | (8,129) | (620) | |||
Long-term debt—less current maturities | $ (275,486) | $ (99,051) | |||
Real Estate Investment Trust Spin-Off Transaction [Member] | CareTrust REIT [Member] | |||||
REIT Spin-Off Transaction Summary [Line Items] | |||||
Cash and cash equivalents | 78,731 | ||||
Other Assets, Current | 34 | ||||
Property and equipment, net | 421,846 | ||||
Debt Issuance Costs, Current, Net | 11,088 | ||||
Accounts Payable and Accrued Liabilities, Current | (4,971) | ||||
Deferred Tax Liabilities, Net, Current | (125) | ||||
Deferred Tax Liabilities, Net, Noncurrent | (5,925) | ||||
Current maturities of long-term debt | (2,342) | ||||
Long-term debt—less current maturities | (357,171) | ||||
Net Assets and Liabilities Contributed to Real Estate Investment Trust (REIT) | $ 141,165 |
REIT Spin-Off REIT Spin-Off Tra
REIT Spin-Off REIT Spin-Off Transaction Additional Disclosures (Details) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2016USD ($)facilities | Dec. 31, 2015USD ($) | Dec. 31, 2014USD ($) | Jun. 01, 2014facilities | |
REIT Spin-Off Transaction Additional Disclosures [Line Items] | ||||
Costs Incurred to Execute Real Estate Investment Trust Spin-Off Transaction | $ | $ 0 | $ 0 | $ 9,026 | |
Master Lease agreements | 5 | |||
Parent Company [Member] | Real Estate Investment Trust Spin-Off Transaction [Member] | ||||
REIT Spin-Off Transaction Additional Disclosures [Line Items] | ||||
Facilities Leased Under Master Lease Agreements with CareTrust | 94 |