The Ensign Group, Inc. (ENSG) 10-Q 28 Oct 20 2020 Q3 Quarterly report Financial data

Cover Page

Cover Page - shares	9 Months Ended
	Sep. 30, 2020	Oct. 26, 2020
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2020
Document Transition Report	false
Entity File Number	001-33757
Entity Registrant Name	ENSIGN GROUP, INC
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	33-0861263
Entity Address, Address Line One	29222 Rancho Viejo Road, Suite 127
Entity Address, City or Town	San Juan Capistrano
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92675
City Area Code	949
Local Phone Number	487-9500
Title of 12(b) Security	Common Stock, par value $0.001 per share
Trading Symbol	ENSG
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		54,241,788
Entity Central Index Key	0001125376
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q3
Amendment Flag	false

UNAUDITED CONDENSED CONSOLIDATE

UNAUDITED CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 175,380	$ 59,175
Accounts receivable—less allowance for doubtful accounts of $6,053 and $2,472 at September 30, 2020 and December 31, 2019, respectively	294,151	308,985
Investments—current	17,577	17,754
Prepaid income taxes	13,550	739
Prepaid expenses and other current assets	25,969	24,428
Total current assets	526,627	411,081
Property and equipment, net	783,187	767,565
Right-of-use assets	1,027,434	1,046,901
Insurance subsidiary deposits and investments	31,768	30,571
Escrow deposits	35	14,050
Deferred tax assets	3,435	4,615
Restricted and other assets	31,777	26,207
Intangible assets, net	2,959	3,382
Goodwill	54,469	54,469
Other indefinite-lived intangibles	3,299	3,068
Total assets	2,464,990	2,361,909
Current liabilities:
Accounts payable	50,971	44,973
Accrued wages and related liabilities	177,115	151,009
Lease liabilities—current	47,342	44,964
Accrued self-insurance liabilities—current	33,022	29,252
CARES Act Provider Relief Fund and advance payment liabilities (Note 3)	123,988	0
Other accrued liabilities	89,625	70,273
Current maturities of long-term debt	3,139	2,702
Total current liabilities	525,202	343,173
Long-term debt—less current maturities	113,222	325,217
Long-term lease liabilities—less current portion	952,866	973,983
Accrued self-insurance liabilities—less current portion	62,016	58,114
Other long-term liabilities (Note 3)	46,140	5,278
Total liabilities	1,699,446	1,705,765
Commitments and contingencies (Notes 16, 18 and 19)
Ensign Group, Inc. stockholders' equity:
Common stock: $0.001 par value; 100,000 shares authorized; 56,926 and 54,135 shares issued and outstanding at September 30, 2020, respectively, and 56,176 and 53,487 shares issued and outstanding at December 31, 2019, respectively (Note 20)	57	56
Additional paid-in capital	328,347	307,914
Retained earnings	507,554	391,523
Common stock in treasury, at cost, 2,791 and 2,079 shares at September 30, 2020 and December 31, 2019, respectively (Note 20)	(71,203)	(45,296)
Total Ensign Group, Inc. stockholders' equity	764,755	654,197
Non-controlling interest	789	1,947
Total equity	765,544	656,144
Total liabilities and equity	$ 2,464,990	$ 2,361,909

UNAUDITED CONDENSED CONSOLIDA_2

UNAUDITED CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 6,053	$ 2,472
Common stock, par value (usd per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	100,000,000	100,000,000
Common stock, shares issued (in shares)	56,926,000	56,176,000
Common stock, shares outstanding (in shares)	54,135,000	53,487,000
Common stock in treasury, at cost (in shares)	2,791,000	2,079,000

UNAUDITED CONDENSED CONSOLIDA_3

UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF INCOME - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Income Statement [Abstract]
Revenue	$ 599,255	$ 512,109	$ 1,773,567	$ 1,476,333
Expense:
Cost of services	465,108	410,516	1,371,378	1,177,246
Rent—cost of services	32,504	31,875	97,318	93,278
General and administrative expense	32,817	25,514	96,493	78,622
Depreciation and amortization	13,757	13,405	41,082	37,700
Total expenses	544,186	481,310	1,606,271	1,386,846
Income from operations	55,069	30,799	167,296	89,487
Other income (expense):
Interest expense	(1,740)	(3,900)	(7,698)	(11,513)
Interest and other income	850	732	2,630	1,857
Other expense, net	(890)	(3,168)	(5,068)	(9,656)
Income before provision for income taxes	54,179	27,631	162,228	79,831
Provision for income taxes	10,866	5,093	37,026	14,944
Net income from continuing operations	43,313	22,538	125,202	64,887
Net income from discontinued operations, net of tax (Note 4)	0	5,290	0	19,473
Net income	43,313	27,828	125,202	84,360
Less:
Net income attributable to noncontrolling interests in continuing operations	253	390	1,045	591
Net income attributable to noncontrolling interests in discontinued operations (Note 4)	0	279	0	629
Net income attributable to noncontrolling interests	253	669	1,045	1,220
Net income attributable to The Ensign Group, Inc.	43,060	27,159	124,157	83,140
Amounts attributable to The Ensign Group, Inc.:
Income from continuing operations attributable to The Ensign Group, Inc.	43,060	22,148	124,157	64,296
Income from discontinued operations, net of income tax (Note 4)	0	5,011	0	18,844
Net income attributable to The Ensign Group, Inc.	$ 43,060	$ 27,159	$ 124,157	$ 83,140
Basic:
Continuing operations (in dollars per share)	$ 0.81	$ 0.41	$ 2.33	$ 1.20
Discontinued operations (in dollars per share)	0	0.09	0	0.35
Basic income per share attributable to The Ensign Group, Inc. (in dollars per share)	0.81	0.50	2.33	1.55
Diluted:
Continuing operations (in dollars per share)	0.77	0.39	2.23	1.15
Discontinued operations (in dollars per share)	0	0.09	0	0.33
Diluted income per share attributable to The Ensign Group, Inc.(in dollars per share)	$ 0.77	$ 0.48	$ 2.23	$ 1.48
Weighted average common shares outstanding:
Basic (in shares)	53,328	53,941	53,299	53,470
Diluted (in shares)	55,713	56,364	55,585	56,054

UNAUDITED CONDENSED CONSOLIDA_4

UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) shares in Thousands, $ in Thousands	Total	Cumulative Effect, Period of Adoption, Adjustment	Common Stock	Additional Paid-In Capital	Retained Earnings	Retained EarningsCumulative Effect, Period of Adoption, Adjustment	Treasury Stock	Non-Controlling Interest
Balance at beginning of period (in shares) at Dec. 31, 2018			52,584				1,932
Balance at beginning of period at Dec. 31, 2018	$ 602,340	$ 9,030	$ 55	$ 284,384	$ 344,901	$ 9,030	$ (38,405)	$ 11,405
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards (in shares)			371
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards	5,616			5,616
Dividends declared	(2,543)				(2,543)
Employee stock award compensation	2,612			2,612
Net income (loss) attributable to noncontrolling interest	235							235
Noncontrolling interest attributable to subsidiary equity plan (Note 17)	341				(317)			658
Net income attributable to the Ensign Group, Inc.	27,372				27,372
Balance at end of period (in shares) at Mar. 31, 2019			52,955				1,932
Balance at end of period at Mar. 31, 2019	645,003		$ 55	292,612	378,443		$ (38,405)	12,298
Balance at beginning of period (in shares) at Dec. 31, 2018			52,584				1,932
Balance at beginning of period at Dec. 31, 2018	602,340	9,030	$ 55	284,384	344,901	9,030	$ (38,405)	11,405
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss) attributable to noncontrolling interest	1,220
Net income attributable to the Ensign Group, Inc.	83,140
Balance at end of period (in shares) at Sep. 30, 2019			53,367				2,046
Balance at end of period at Sep. 30, 2019	701,806		$ 55	303,680	426,414		$ (43,890)	15,547
Balance at beginning of period (in shares) at Dec. 31, 2018			52,584				1,932
Balance at beginning of period at Dec. 31, 2018	602,340	$ 9,030	$ 55	284,384	344,901	$ 9,030	$ (38,405)	11,405
Balance at end of period (in shares) at Dec. 31, 2019			53,487				2,079
Balance at end of period at Dec. 31, 2019	656,144		$ 56	307,914	391,523		$ (45,296)	1,947
Balance at beginning of period (in shares) at Mar. 31, 2019			52,955				1,932
Balance at beginning of period at Mar. 31, 2019	645,003		$ 55	292,612	378,443		$ (38,405)	12,298
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards (in shares)			326
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards	3,213			3,213
Shares of common stock used to satisfy tax withholding obligations (in shares)			(9)				9
Shares of common stock used to satisfy tax withholding obligations	(485)						$ (485)
Dividends declared	(2,559)				(2,559)
Employee stock award compensation	3,066			3,066
Net income (loss) attributable to noncontrolling interest	316							316
Distribution to noncontrolling interest holder	(92)							(92)
Noncontrolling interest attributable to subsidiary equity plan (Note 17)	236				(2,497)			2,733
Net income attributable to the Ensign Group, Inc.	28,609				28,609
Balance at end of period (in shares) at Jun. 30, 2019			53,272				1,941
Balance at end of period at Jun. 30, 2019	677,307		$ 55	298,891	401,996		$ (38,890)	15,255
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards (in shares)			200
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards	1,828			1,828
Dividends declared	(2,564)				(2,564)
Employee stock award compensation	2,961			2,961
Stock repurchased during period, shares (in shares)			105				105
Repurchase of common stock (Note 20)	(5,000)						$ (5,000)
Net income (loss) attributable to noncontrolling interest	669							669
Distribution to noncontrolling interest holder	(177)							(177)
Repurchase of common stock attributable to subsidiary equity plan (Note 17)	(394)							(394)
Noncontrolling interest attributable to subsidiary equity plan (Note 17)	17				(177)			194
Net income attributable to the Ensign Group, Inc.	27,159				27,159
Balance at end of period (in shares) at Sep. 30, 2019			53,367				2,046
Balance at end of period at Sep. 30, 2019	701,806		$ 55	303,680	426,414		$ (43,890)	15,547
Balance at beginning of period (in shares) at Dec. 31, 2019			53,487				2,079
Balance at beginning of period at Dec. 31, 2019	656,144		$ 56	307,914	391,523		$ (45,296)	1,947
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards (in shares)			148
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards	1,552			1,552
Issuance of restricted stock (in shares)			723
Issuance of restricted stock	3,086		$ 1	3,085
Dividends declared	(2,683)				(2,683)
Employee stock award compensation	3,235			3,235
Stock repurchased during period, shares (in shares)			692				692
Repurchase of common stock (Note 20)	(25,000)						$ (25,000)
Net income (loss) attributable to noncontrolling interest	352							352
Distribution to noncontrolling interest holder	(720)							(720)
Net income attributable to the Ensign Group, Inc.	40,849				40,849
Balance at end of period (in shares) at Mar. 31, 2020			53,666				2,771
Balance at end of period at Mar. 31, 2020	676,815		$ 57	315,786	429,689		$ (70,296)	1,579
Balance at beginning of period (in shares) at Dec. 31, 2019			53,487				2,079
Balance at beginning of period at Dec. 31, 2019	656,144		$ 56	307,914	391,523		$ (45,296)	1,947
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss) attributable to noncontrolling interest	1,045
Net income attributable to the Ensign Group, Inc.	124,157
Balance at end of period (in shares) at Sep. 30, 2020			54,135				2,791
Balance at end of period at Sep. 30, 2020	765,544		$ 57	328,347	507,554		$ (71,203)	789
Balance at beginning of period (in shares) at Mar. 31, 2020			53,666				2,771
Balance at beginning of period at Mar. 31, 2020	676,815		$ 57	315,786	429,689		$ (70,296)	1,579
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards (in shares)			31
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards	456			456
Shares of common stock used to satisfy tax withholding obligations (in shares)			(17)				17
Shares of common stock used to satisfy tax withholding obligations	(753)						$ (753)
Issuance of restricted stock (in shares)			75
Issuance of restricted stock	0			0
Dividends declared	(2,718)				(2,718)
Employee stock award compensation	3,528			3,528
Net income (loss) attributable to noncontrolling interest	440							440
Distribution to noncontrolling interest holder	(240)							(240)
Net income attributable to the Ensign Group, Inc.	40,248				40,248
Balance at end of period (in shares) at Jun. 30, 2020			53,755				2,788
Balance at end of period at Jun. 30, 2020	717,776		$ 57	319,770	467,219		$ (71,049)	1,779
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards (in shares)			340
Issuance of common stock to employees and directors resulting from the exercise of stock options and grant of stock awards	4,404			4,404
Shares of common stock used to satisfy tax withholding obligations (in shares)			(3)				3
Shares of common stock used to satisfy tax withholding obligations	(154)						$ (154)
Issuance of restricted stock (in shares)			43
Issuance of restricted stock	0		$ 0	0
Dividends declared	(2,725)				(2,725)
Employee stock award compensation	4,173			4,173
Net income (loss) attributable to noncontrolling interest	253							253
Distribution to noncontrolling interest holder	(1,243)							(1,243)
Net income attributable to the Ensign Group, Inc.	43,060				43,060
Balance at end of period (in shares) at Sep. 30, 2020			54,135				2,791
Balance at end of period at Sep. 30, 2020	$ 765,544		$ 57	$ 328,347	$ 507,554		$ (71,203)	$ 789

UNAUDITED CONDENSED CONSOLIDA_5

UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (Parenthetical) - $ / shares	3 Months Ended
	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019
Statement of Stockholders' Equity [Abstract]
Dividends per share (in dollars per share)	$ 0.0500	$ 0.0500	$ 0.0500	$ 0.0475	$ 0.0475	$ 0.0475

UNAUDITED CONDENSED CONSOLIDA_6

UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Cash flows from operating activities:
Net income	$ 125,202	$ 84,360
Net income from discontinued operations, net of tax	0	(19,473)
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	41,082	37,700
Impairment of long-lived assets	2,681	1,471
Amortization of deferred financing fees	630	876
Non-cash leasing arrangement (Note 18)	337	134
Deferred income taxes	1,179	0
Provision for doubtful accounts	4,193	824
Stock-based compensation	10,936	8,215
Cash received from insurance proceeds related to replacement properties and business interruptions	282	803
Gain on insurance claims and disposal of assets	0	(3,026)
Change in operating assets and liabilities
Accounts receivable	11,441	(27,847)
Prepaid income taxes	(12,811)	3,677
Prepaid expenses and other assets	(7,468)	2,755
Operating lease obligations	(542)	(7,427)
Accounts payable	7,197	(4,623)
Accrued wages and related liabilities	29,194	14,493
Other accrued liabilities	19,333	8,487
Accrued self-insurance liabilities	8,433	4,686
Other long-term liabilities	40,862	2,992
Net cash provided by continuing operating activities	282,161	109,077
Net cash provided by discontinued operating activities (Note 4)	0	23,296
Net cash provided by operating activities	282,161	132,373
Cash flows from investing activities:
Purchase of property and equipment	(37,824)	(49,857)
Cash payments for business acquisitions (Note 9)	0	(6,455)
Cash payments for asset acquisitions (Note 9)	(23,077)	(75,305)
Escrow deposits	(35)	(50)
Escrow deposits used to fund acquisitions	14,050	7,271
Cash proceeds from the sale of assets and insurance proceeds	359	7,835
Purchases of investments	(14,648)	(11,042)
Maturities of investments	13,626	8,306
Other restricted assets	(936)	(1,886)
Net cash used in continuing investing activities	(48,485)	(121,183)
Net cash used in discontinued investing activities (Note 4)	0	(22,985)
Net cash used in investing activities	(48,485)	(144,168)
Cash flows from financing activities:
Proceeds from revolving credit facility and other debt (Note 16)	380,600	895,000
Payments on revolving credit facility and other debt (Note 16)	(592,255)	(863,494)
Issuance of common stock upon exercise of options	6,412	7,376
Repurchase of shares of common stock to satisfy tax withholding obligations	(907)	(485)
Repurchase of shares of common stock and subsidiary shares (Note 17)	0	(5,000)
Repurchase of shares of common stock (Note 20)	(25,000)	0
Dividends paid	(8,106)	(7,626)
Non-controlling interest distribution	(2,203)	(269)
Proceeds from CARES Act Provider Relief Fund and Medicare Advance Payment Program(Note 3)	235,976	0
Repayments of CARES Act Provider Relief Fund and Medicare Advance Payment Program(Note 3)	(111,988)	0
Net cash (used in)/provided by continuing financing activities	(117,471)	25,502
Net cash used in discontinued financing activities	0	(394)
Net cash (used in)/provided by financing activities	(117,471)	25,108
Net increase in cash and cash equivalents	116,205	13,313
Cash and cash equivalents beginning of period, including cash of discontinued operations	59,175	31,083
Cash and cash equivalents end of period, including cash of discontinued operations	175,380	44,396
Less cash of discontinued operations at end of period	0	47
Cash and cash equivalents end of period	175,380	44,349
Cash paid during the period for:
Interest	8,467	11,446
Income taxes	48,620	16,358
Lease liabilities	97,533	111,391
Non-cash financing and investing activity:
Accrued capital expenditures	2,900	3,500
Accrued dividends declared	2,725	2,564
Right-of-use assets obtained in exchange for new operating lease obligations	$ 14,669	$ 52,606

Description of Business

Description of Business	9 Months Ended
	Sep. 30, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
DESCRIPTION OF BUSINESS	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 of September 30, 2020, the Company operated 226 facilities and other ancillary operations located in Arizona, California, Colorado, Idaho, Iowa, Kansas, Massachusetts, Nebraska, Nevada, South Carolina, Texas, Utah, Washington and Wisconsin. The Company's operating subsidiaries, each of which strives to be the operation of choice in the community it serves, provide a broad spectrum of skilled nursing, senior living and other ancillary services. The Company's operating subsidiaries have a collective capacity of approximately 23,000 operational skilled nursing beds and 2,300 senior living units. As of September 30, 2020, the Company operated 163 facilities under long-term lease arrangements, and had options to purchase 11 of those 163 facilities. The Company owned an additional 93 real estate properties, which included 63 facilities operated and managed by the Company, 31 senior living operations leased to The Pennant Group, Inc. as part of the Spin-Off (defined below), and the Service Center location. Of those 31 senior living operations, two are located on the same real estate properties as the skilled nursing facilities. Certain of the Company’s wholly-owned independent subsidiaries, collectively referred to as the Service Center, provide specific 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 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. Spin-Off Transaction — On October 1, 2019, the Company completed the separation of its transitional and skilled nursing services, home health and hospice operations and substantially all of its senior living operations into two separate, publicly traded companies (the Spin-Off). Upon completion of the Spin-Off, the Company restructured its operations. The Company operates and reports one reportable operating segment: transitional and skilled services. The Company believes that this structure reflects its current operational and financial management, and provides the best structure for the Company to focus on growth opportunities while maintaining financial discipline. As a result of the Spin-Off, the condensed consolidated financial statements reflect the Spin-Off operations, assets and liabilities, and cash flows as discontinued operations for 2019 periods presented. Unless otherwise noted, amounts in the Notes to the Condensed Consolidated Financial Statements exclude amounts attributable to discontinued operations. Refer to Note 4, Spin-Off of Subsidiaries, for additional information regarding discontinued operations. Other Information — The accompanying condensed consolidated financial statements as of September 30, 2020 and for the three and nine months ended September 30, 2020 and 2019 (collectively, the Interim Financial Statements) are unaudited. Certain information and note disclosures normally included in annual consolidated financial statements have been condensed or omitted, as permitted under applicable rules and regulations. Readers of the Interim Financial Statements should refer to the Company’s audited consolidated financial statements and notes thereto for the year ended December 31, 2019 which are included in the Company’s Annual Report on Form 10-K, File No. 001-33757 (the Annual Report) filed with the Securities and Exchange Commission (SEC). Management believes that the Interim Financial Statements reflect all adjustments which are of a normal and recurring nature necessary to present fairly the Company’s financial position and results of operations in all material respects. The results of operations presented in the Interim Financial Statements are not necessarily representative of operations for the entire year.

Summary of Significant Accounti

Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2020
Accounting Policies [Abstract]
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Basis of Presentation — The accompanying Interim Financial Statements have been prepared in accordance with accounting principles generally accepted in the United States (GAAP). The Company is the sole member or stockholder of various consolidated limited liability companies and corporations established to operate various acquired skilled nursing operations, senior living operations and related ancillary services. All intercompany transactions and balances have been eliminated in consolidation. The condensed consolidated financial statements include the accounts of all entities controlled by the Company through its ownership of a majority voting interest. The Company presents noncontrolling interests within the equity section of its condensed consolidated balance sheets and the amount of consolidated net income that is attributable to The Ensign Group, Inc. and the noncontrolling interest in its condensed consolidated statements of income. The condensed consolidated financial statements include the accounts of all entities controlled by the Company through its ownership of a majority voting interest. Additionally, 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 are 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 three and nine months ended September 30, 2020 and 2019. During the first quarter of 2019, the Company completed the sale of one of its senior living operations for a sale price of $1,838. The sale transaction did not meet the criteria of discontinued operations as it did not represent a strategic shift that had, or will have, a major effect on the Company's operations and financial results. Estimates and Assumptions — The preparation of Interim 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 Interim Financial Statements and the reported amounts of revenue and expenses during the reporting periods. The most significant estimates in the Company’s Interim Financial Statements relate to revenue, acquired property and equipment, intangible assets and goodwill, right-of-use-assets, impairment of long-lived assets, lease liabilities, 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. Contracts insuring the lives of certain employees who are eligible to participate in non-qualified deferred compensation plans are held in a rabbi trust. Cash surrender value of the contracts is based on performance measurement funds that shadow the deferral investment allocations made by participants in the deferred compensation plan. The fair value of the pooled investment funds is derived using Level 2 inputs. Revenue Recognition — The Company recognizes revenue in accordance with Accounting Standards Codification Topic 606, Revenue from Contracts with Customers (ASC 606). See Note 5, Revenue and Accounts Receivable. 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, net of estimates for variable consideration. The allowance for doubtful accounts reflects the Company’s best estimate of probable losses inherent in the accounts receivable balance. The Company determines the allowance based on known troubled accounts and other currently available evidence. 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 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 determined there were impairment charges of $2,681 and $1,471 during the three and nine months ended September 30, 2020 and 2019, respectively. Leases and Leasehold Improvements - The Company leases skilled nursing facilities, senior living facilities and commercial office space. On January 1, 2019, the Company adopted Accounting Standards Codification Topic 842, Leases (ASC 842), electing the transition method that allows it to apply the standard as of the adoption date and record a cumulative adjustment in retained earnings. The Company determines if an arrangement is a lease at the inception of each lease. At the inception of each lease, the Company performs an evaluation to determine whether the lease should be classified as an operating or finance lease. As of September 30, 2020, the Company does not have any leases that are classified as finance leases. Rights and obligations of operating leases are included as right-of-use assets, current lease liabilities and long-term lease liabilities on the Company's condensed consolidated balance sheet. As the Company's leases do not provide an implicit rate, the Company uses its incremental borrowing rate based on the information available at lease commencement date in determining the present value of future lease payments. The Company utilized a third-party valuation specialist to assist in estimating the incremental borrowing rate. The Company records rent expense for operating leases 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. Renewals are not assumed in the determination of the lease term unless they are deemed to be reasonably assured at the inception of the lease. The lease term used for this evaluation also provides the basis for establishing depreciable lives for buildings subject to lease and leasehold improvements. The Company recognizes lease expense for leases with an initial term of 12 months or less on a straight-line basis over the lease term. These leases are not recorded on the condensed consolidated balance sheet. Certain of the Company's lease agreements include rental payments that are adjusted periodically for inflation. The lease agreements do not contain any material residual value guarantees or material restrictive covenants. The Company does not have material subleases. Intangible Assets and Goodwill — Definite-lived intangible assets consist primarily of patient base, facility trade names and customer relationships. Patient base is amortized over a period of four 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. The Company did not identify any goodwill or intangible asset impairment during the nine months ended September 30, 2020 and 2019. 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. The combined self-insured retention is $500 per claim, subject to an additional one-time deductible of $750 for California affiliated operations and a separate, one-time, deductible of $1,000 for non-California operations. For all affiliated operations, except those located in Colorado, the third-party coverage above these limits is $1,000 per claim, $3,000 per operation, with a $5,000 blanket aggregate limit and an additional state-specific aggregate where required by state law. In Colorado, the third-party coverage above these limits is $1,000 per claim and $3,000 per operation, which is independent of the aforementioned blanket aggregate limits that apply outside of Colorado. The self-insured retention and deductible limits for general and professional liability and workers' compensation for all states (except Texas and Washington for workers' compensation) are self-insured through the Captive, the related assets and liabilities of which are included in the accompanying condensed consolidated balance sheets. The Captive is subject to certain statutory requirements as an insurance provider. The Company’s policy is to accrue amounts equal to the actuarial 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 uses actuarial valuations to estimate the liability based on historical experience and industry information. Accrued general liability and professional malpractice liabilities on an undiscounted basis, net of anticipated insurance recoveries, were $53,759 and $46,984 as of September 30, 2020 and December 31, 2019, respectively. 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 the Company has purchased individual stop-loss coverage that insures individual claims that exceed $750 per occurrence. 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 benefit payments 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. Accrued workers’ compensation liabilities are recorded on an undiscounted basis, net of estimated recoveries, in the accompanying condensed consolidated balance sheets and were $25,230 and $25,419 as of September 30, 2020 and December 31, 2019, respectively. In addition, the Company has recorded an asset and equal liability of $7,239 and $7,999 at September 30, 2020 and December 31, 2019, respectively, in order to present the ultimate costs of malpractice and workers' compensation claims and the anticipated insurance recoveries on a gross basis. 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. The Company's policy does not include the additional one-time aggregate individual stop loss deductible of $75. The Company’s accrued liability under these plans recorded on an undiscounted basis in the accompanying condensed consolidated balance sheets was $8,810 and $6,964 as of September 30, 2020 and December 31, 2019, respectively. The Company believes that adequate provision has been made in the Interim Financial Statements for liabilities that may arise out of patient care, workers’ compensation, healthcare benefits and related services provided to date. The amount of the Company’s reserves was determined based on an estimation process that uses information obtained from both company-specific and industry data. This estimation process requires the Company to continuously monitor and evaluate the life cycle of the claims. Using data obtained from this monitoring and the Company’s assumptions about emerging trends, the Company, with the assistance of an independent actuary, develops information about the size of ultimate claims based on the Company’s historical experience and other available industry information. The most significant assumptions used in the estimation process include determining the trend in costs, the expected cost of claims incurred but not reported and the expected costs to settle or pay damage awards with respect to unpaid claims. The self-insured liabilities are based upon estimates, and while management believes that the estimates of loss are reasonable, the ultimate liability may be in excess of or less than the recorded amounts. Due to the inherent volatility of actuarially determined loss estimates, it is reasonably possible that the Company could experience changes in estimated losses that could be material to net income. If the Company’s actual liability exceeds its estimates of loss, its future earnings, cash flows and financial condition would be adversely affected. Income Taxes — Deferred tax assets and liabilities are established for temporary differences between the financial reporting basis and the tax basis of the Company’s assets and liabilities at tax rates in effect when such temporary differences are expected to reverse. The Company generally expects to fully utilize its deferred tax assets; however, when necessary, the Company records a valuation allowance to reduce its net deferred tax assets to the amount that is more likely than not to be realized. In determining the need for a valuation allowance or the need for and magnitude of liabilities for uncertain tax positions, the Company makes certain estimates and assumptions. These estimates and assumptions are based on, among other things, knowledge of operations, markets, historical trends and likely future changes and, when appropriate, the opinions of advisors with knowledge and expertise in certain fields. Due to certain risks associated with the Company’s estimates and assumptions, actual results could differ. 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 condensed consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to The Ensign Group, Inc. in its condensed consolidated statements of income. 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 stock-based payment awards made to employees and directors including employee stock options based on estimated fair values, ratably over the requisite service period of the award. Net income has been reduced as a result of the recognition of the fair value of all stock options and restricted stock awards issued, the amount of which is contingent upon the number of future grants and other variables. Recent Accounting Pronouncements — Except for rules and interpretive releases of the Securities and Exchange Commission (SEC) under authority of federal securities laws and a limited number of grandfathered standards, the Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) is the sole source of authoritative GAAP literature recognized by the FASB and applicable to the Company. For any new pronouncements announced, the Company considers whether the new pronouncements could alter previous generally accepted accounting principles and determines whether any new or modified principles will have a material impact on the Company's reported financial position or operations in the near term. The applicability of any standard is subject to the formal review of the Company's financial management and certain standards are under consideration. Recent Accounting Standards Adopted by the Company In August 2018, the FASB issued amended guidance to simplify fair value measurement disclosure requirements. The new provisions eliminate the requirements to disclose (1) transfers between Level 1 and Level 2 of the fair value hierarchy, (2) policies related to valuation processes and the timing of transfers between levels of the fair value hierarchy, and (3) net asset value disclosure of estimates of timing of future liquidity events. The FASB also modified disclosure requirements of Level 3 fair value measurements. The Company adopted this standard effective January 1, 2020 and determined there was no material impact on the Company's condensed consolidated financial statements. In January 2017, the FASB issued amended authoritative guidance to simplify and reduce the cost and complexity of the goodwill impairment test. The new provisions eliminate step 2 from the goodwill impairment test and shifts the concept of impairment from a measure of loss when comparing the implied fair value of goodwill to its carrying amount to comparing the fair value of a reporting unit with its carrying amount. The FASB also eliminated the requirements for any reporting unit with a zero or negative carrying amount to perform a qualitative assessment or step 2 of the goodwill impairment test. The new guidance does not amend the optional qualitative assessment of goodwill impairment. The Company adopted this standard effective January 1, 2020 and determined there was no material impact on the Company's condensed consolidated financial statements. In June 2016, the FASB issued Accounting Standards Update (ASU) 2016-13 “ Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments ”, which replaces the existing incurred loss impairment model with an expected credit loss model and requires a financial asset measured at amortized cost to be presented at the net amount expected to be collected. The Company adopted this standard effective January 1, 2020 and determined there was no material impact on the Company's condensed consolidated financial statements. Accounting Standards Recently Issued but Not Yet Adopted by the Company In December 2019, the FASB issued ASU 2019-12 "Simplifying the Accounting for Income Taxes (Topic 740)" as part of its simplification initiative to reduce the cost and complexity in accounting for income taxes. ASU 2019-12 removes certain exceptions related to the approach for intra-period tax allocation, the methodology for calculating income taxes in an interim period and the recognition of deferred tax liabilities for outside basis differences. ASU 2019-12 also amends other aspects of the guidance to help simplify and promote consistent application of GAAP. The guidance is effective for interim and annual periods beginning after December 15, 2020 and the Company has elected not to early adopt this ASU. The Company does not expect the adoption of ASU 2019-12 to have a material impact on its financial position, results of operations and liquidity. In February 2020, the FASB issued ASU 2020-04 "Reference Rate Reform (Topic 848)," which provides temporary, optional practical expedients and exceptions to enable a smoother transition to the new reference rates which will replace LIBOR and other reference rates expected to be discontinued. Adoption of the provisions of ASU 2020-04 is optional. The amendments are effective for all entities from the beginning of the interim period that includes the issuance date of the ASU. An entity may elect to apply the amendments prospectively through December 31, 2022. The Company is currently evaluating the impact of ASU 2020-04 on its financial position, results of operations and liquidity. In May 2020, the SEC issued Final Rule Release No. 33-10786 “ Amendments to Financial Disclosures about Acquired and Disposed Businesses ” (“SEC Rule 33-10786”), which amends the disclosure requirements applicable to acquisitions and dispositions of businesses. Amendments within SEC Rule 33-10786 primarily impact (1) the tests and thresholds used to determine the significance of acquisitions and dispositions; (2) the form and content of pro forma information required to be disclosed in connection with significant acquisitions and dispositions; (3) acquiree financial statement requirements; and (4) thresholds used to determine the significance of acquisitions and dispositions of real estate operations, and related financial statement requirements, among others. The amendments are effective for all SEC registrants beginning January 1, 2021, with early compliance permitted. The Company does not expect the amendments to have a material impact on its condensed consolidated financial statements.

COVID-19 UPDATE

COVID-19 UPDATE	9 Months Ended
	Sep. 30, 2020
Subsequent Events [Abstract]
COVID-19 UPDATE	COVID-19 UPDATE The outbreak of the 2019 coronavirus disease (COVID-19), which was declared a global pandemic by the World Health Organization (WHO) on March 11, 2020, and the related responses by public health and governmental authorities to contain and combat its outbreak and spread, continues to spread and impact healthcare operations across the United States, including the markets in which the Company operates. The Centers for Disease Control and Prevention (CDC) has stated that older adults are at a higher risk for serious illness from the coronavirus. As the COVID-19 pandemic continues, the impact on the Company's financial and operational results remain subject to change. The Company continues to monitor the impacts of the pandemic on its operations and financial condition. In response to the COVID-19 pandemic, Congress passed the Coronavirus Aid, Relief, and Economic Security Act of 2020 (the CARES Act), which was signed into law on March 27, 2020, and which authorized the cash distribution of relief funds to healthcare providers. On April 10, 2020, the Company began to receive CARES Act provider relief fund payments (Provider Relief Fund) from the U.S. Department of Health and Human Services (HHS). Through September 30, 2020, the Company's affiliated operations have directly or indirectly received in the aggregate approximately $132,052 in Provider Relief Funds. The Company returned $108,756 of the funds received to an agent of HHS in mid-July 2020. The Company received $23,296 of Provider Relief Funds in the third quarter as part of the $5.0 billion Nursing Home Infection Control distribution to be used to protect residents of nursing homes and long-term care facilities from the impact of COVID-19. The Company intends to repay the entire distribution received during the third quarter, but has not yet begun the repayment process. As of September 30, 2020, the Company recorded the Provider Relief Funds as a short-term liability on the condensed consolidated balance sheet. HHS has announced that it intends to issue another round of Provider Relief Funds to skilled nursing facilities that pass two gateway qualification tests based upon a facility’s COVID-19 infection and mortality rates. In order to qualify, facilities must demonstrate COVID-19 infection rates below the rate of infection in the counties they are located and demonstrate mortality rates below nationally established performance thresholds for nursing home residents infected with COVID-19. Facilities that qualify during each of the monthly performance periods, running from September 2020 through December 2020, will be eligible for additional funds based upon their aggregate performance on these infection and mortality measures. To date, the Company has not received additional funding related to this distribution. Additionally, the Company applied for and received $103,924 through the Medicare Accelerated and Advance Payment Program under the CARES Act for the nine months ended September 30, 2020. The purpose of the program is to assist in providing needed liquidity to care delivery providers. The Company repaid $3,232 of the funds in July 2020. In October 2020, the Centers for Medicare and Medicaid Services (CMS) released updated payment guidance to extend the repayment period beginning one year from the date the accelerated or advance payment was issued through lump sum payments or recoupment of future Medicare billings. Any unpaid funds will begin accruing interest 15 months after the repayment period. The Company's repayment period will start in March 2021. As of September 30, 2020, the Company has classified $100,692 the remaining cash receipts as a short-term liability. On March 18, 2020, the President signed into law The Family First Coronavirus Response Act, which provided a temporary 6.2% increase to the Federal Medical Assistance Percent (FMAP) effective January 1, 2020. The law permits states to retroactively change their state's Medicaid program rates effective as of January 1, 2020. The law provides discretion to each state and specifies that the funds are to be used to reimburse the recipient for healthcare related expenses that are attributable to COVID-19 associated with providing patient care. As of September 30, 2020, nine of the fourteen states in which the Company operates have approved a state-specific FMAP Medicaid program. Revenues from these additional payments are recognized in accordance with ASC 606, subject to variable consideration constraints. In certain operations where the Company received additional payments that exceeded expenses incurred related to COVID-19, the Company characterized such payments as variable revenue that required additional consideration and accordingly, the amount of FMAP-related revenue recognized is limited to the actual COVID-19 related expenses incurred. For the three months ended September 30, 2020, the Company received $17,344 in FMAP funding, of which, $11,691 was recognized as revenue. For the nine months ended September 30, 2020, the Company received $32,455 in FMAP funding, of which, $24,825 was recognized as revenue. The CARES Act also provides for deferred payment of the employer portion of social security taxes through the end of 2020, with 50% of the deferred amount due by December 31, 2021 with the remaining 50% due by December 31, 2022. The Company recorded $33,231 of deferred payment of social security taxes as a long-term liability, which is included in Other long-term liabilities in the condensed consolidated balance sheets as of September 30, 2020.

Spin-Off of Subsidiaries

Spin-Off of Subsidiaries	9 Months Ended
	Sep. 30, 2020
Equity [Abstract]
SPIN-OFF OF SUBSIDIARIES	SPIN-OFF OF SUBSIDIARIES On October 1, 2019, the Company completed the separation of its transitional and skilled nursing services, ancillary businesses, home health and hospice operations and substantially all of its senior living operations into two separate, publicly traded companies: • Ensign, which includes skilled nursing and senior living services, physical, occupational and speech therapies and other rehabilitative and healthcare services at 226 healthcare facilities and campuses, post-acute-related ancillary operations and real estate investments; and • The Pennant Group, Inc. (Pennant), which is a holding company of operating subsidiaries that provide home health, hospice and senior living services. The Company completed the separation through a tax-free distribution of substantially all of the outstanding shares of common stock of Pennant to Ensign stockholders on a pro rata basis. Ensign stockholders received one share of Pennant common stock for every two shares of Ensign common stock held at the close of business on September 20, 2019, the record date for the Spin-Off. The number of shares of Ensign common stock each stockholder owns and the related proportionate interest in Ensign did not change as a result of the Spin-Off. Each Ensign stockholder received only whole shares of Pennant common stock in the distribution, as well as cash in lieu of any fractional shares. The Spin-Off was effective October 1, 2019, with shares of Pennant common stock distributed on October 1, 2019. Pennant is listed on the NASDAQ Global Select Market (NASDAQ) and trades under the ticker symbol “PNTG”. Ensign and Pennant entered into several agreements in connection with the Spin-Off, including a transition services agreement (TSA), separation and distribution agreement, tax matters agreement and an employee matters agreement. Pursuant to the TSA, Ensign, Pennant and their respective subsidiaries are providing various services to each other on an interim, transitional basis. Services being provided by Ensign include, among others, certain finance, information technology, human resources, employee benefits and other administrative services. The TSA will terminate on or before September 30, 2021. Billings by Ensign under the TSA were not material during the three and nine months ended September 30, 2020. Immediately after the Spin-Off, Ensign ceased to consolidate the results of Pennant operations into its financial results. Pennant's operating results and cash flows for the three and nine months ended September 30, 2019 presented have been classified as discontinued operations within the Condensed Consolidated Financial Statements. The following table presents the financial results of Pennant for the indicated period and does not include corporate overhead allocations: Three Months Ended September 30, 2019 Nine Months Ended September 30, 2019 (In thousands) Revenue $ 88,398 $ 249,039 Expense: Cost of services 67,289 187,560 Rent—cost of services 5,853 17,295 General and administrative expense 6,196 16,672 Depreciation and amortization 914 2,402 Total expenses 80,252 223,929 Income from discontinued operations 8,146 25,110 Interest income 4 26 Provision for income taxes 2,860 5,663 Income from discontinued operations, net of tax 5,290 19,473 Net income attributable to discontinued noncontrolling interests 279 629 Net income attributable to The Ensign Group, Inc. $ 5,011 $ 18,844

Revenue and Accounts Receivable

Revenue and Accounts Receivable	9 Months Ended
	Sep. 30, 2020
Revenue from Contract with Customer [Abstract]
REVENUE AND ACCOUNTS RECEIVABLE	REVENUE AND ACCOUNTS RECEIVABLE The Company's revenue is derived primarily from providing healthcare services to its patients. Revenues are recognized when services are provided to the patients at the amount that reflects the consideration to which the Company expects to be entitled from patients and third-party payors, including Medicaid, Medicare and insurers (private and Medicare replacement plans), in exchange for providing patient care. The healthcare services in transitional and skilled patient contracts include routine services in exchange for a contractual agreed-upon amount or rate. Routine services are treated as a single performance obligation satisfied over time as services are rendered. As such, patient care services represent a bundle of services that are not capable of being distinct. Additionally, there may be ancillary services which are not included in the daily rates for routine services, but instead are treated as separate performance obligations satisfied at a point in time, if and when those services are rendered. Revenue recognized from healthcare services are adjusted for estimates of variable consideration to arrive at the transaction price. The Company determines the transaction price based on contractually agreed-upon amounts or rate on a per day basis, adjusted for estimates of variable consideration. The Company uses the expected value method in determining the variable component that should be used to arrive at the transaction price, using contractual agreements and historical reimbursement experience within each payor type. The amount of variable consideration which is included in the transaction price may be constrained, and is included in net revenue only to the extent that it is probable that a significant reversal in the amount of the cumulative revenue recognized will not occur in a future period. If actual amounts of consideration ultimately received differ from the Company’s estimates, the Company adjusts these estimates, which would affect net revenue in the period such variances become known. Revenue from the Medicare and Medicaid programs accounted for 75.1% and 73.5% for the three and nine months ended September 30, 2020, respectively, and 70.2% and 70.3% for the three and nine months ended September 30, 2019, respectively. Settlements with Medicare and Medicaid payors for retroactive adjustments due to audits and reviews are considered variable consideration and are included in the determination of the estimated transaction price. These settlements are estimated based on the terms of the payment agreement with the payor, correspondence from the payor and the Company’s historical settlement activity. Consistent with healthcare industry practices, any changes to these revenue estimates are recorded in the period the change or adjustment becomes known based on the final settlement. The Company recorded adjustments to revenue which were not material to the Company's condensed consolidated revenue for the three and nine months ended September 30, 2020 and 2019. Disaggregation of Revenue The Company disaggregates revenue from contracts with its patients by payors. The Company determines that disaggregating revenue into these categories achieves the disclosure objectives to depict how the nature, amount, timing and uncertainty of revenue and cash flows are affected by economic factors. Revenue by Payor 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 individual patients, adjusted for estimates for variable consideration. 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, adjusted for estimates for variable consideration, on a per patient, daily basis or as services are performed. Revenue for the three and nine months ended September 30, 2020 and 2019 is summarized in the following tables: Three Months Ended September 30, 2020 2019 Revenue % of Revenue Revenue % of Revenue Medicaid $ 222,192 37.1 % $ 205,945 40.2 % Medicare 189,237 31.6 119,633 23.4 Medicaid — skilled 38,232 6.4 34,080 6.6 Total Medicaid and Medicare 449,661 75.1 359,658 70.2 Managed care 87,648 14.6 88,542 17.3 Private and other (1) 61,946 10.3 63,909 12.5 Revenue $ 599,255 100.0 % $ 512,109 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services for the three months ended September 30, 2020 and 2019. During the three months ended September 30, 2020 and 2019, private and other payor s inclu des $4,065 and $660 of rental income, respectively . Nine Months Ended September 30, 2020 2019 Revenue % of Revenue Revenue % of Revenue Medicaid $ 672,506 37.9 % $ 586,222 39.7 % Medicare 519,865 29.3 355,141 24.1 Medicaid — skilled 110,626 6.3 96,323 6.5 Total Medicaid and Medicare 1,302,997 73.5 1,037,686 70.3 Managed care 271,993 15.3 258,205 17.5 Private and other (1) 198,577 11.2 180,442 12.2 Revenue $ 1,773,567 100.0 % $ 1,476,333 100.0 % (1) Private and other payors also includes revenue from all payors generated in other an cillary services for the nine months ended September 30, 2020 and 2019. During the nine months ended September 30, 2020 and 2019, private and other payors includes $12,295 and $2,085 of rental income, respectively. Balance Sheet Impact Included in the Company’s condensed consolidated balance sheets are contract balances, comprised of billed accounts receivable and unbilled receivables, which are the result of the timing of revenue recognition, billings and cash collections, as well as, contract liabilities, which primarily represent payments the Company receives in advance of services provided. The Company had no material contract liabilities and contract assets as of September 30, 2020 and December 31, 2019, or activity during the three and nine months ended September 30, 2020 and 2019. Accounts receivable as of September 30, 2020 and December 31, 2019, is summarized in the following table: September 30, 2020 December 31, 2019 Medicaid $ 114,925 $ 125,443 Managed care 57,249 70,015 Medicare 64,331 53,163 Private and other payors 63,699 62,836 300,204 311,457 Less: allowance for doubtful accounts (6,053) (2,472) Accounts receivable, net $ 294,151 $ 308,985 Practical Expedients and Exemptions As the Company’s contracts with its patients have an original duration of one year or less, the Company uses the practical expedient applicable to its contracts and does not consider the time value of money. Further, because of the short duration of these contracts, the Company has not disclosed the transaction price for the remaining performance obligations as of the end of each reporting period or when the Company expects to recognize this revenue. In addition, the Company has applied the practical expedient provided by ASC 340, Other Assets and Deferred Costs

Computation of Net Income Per C

Computation of Net Income Per Common Share	9 Months Ended
	Sep. 30, 2020
Earnings Per Share [Abstract]
COMPUTATION OF NET INCOME PER COMMON SHARE	COMPUTATION OF NET INCOME PER COMMON SHARE Basic net income per share is computed by dividing income from continuing operations attributable to stockholders of The Ensign Group, Inc. 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: Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Numerator: Net income from continuing operations $ 43,313 $ 22,538 $ 125,202 $ 64,887 Less: net income attributable to noncontrolling interests in continuing operations 253 390 1,045 591 Net income from continuing operations attributable to The Ensign Group, Inc. 43,060 22,148 124,157 64,296 Net income from discontinued operations, net of tax — 5,290 — 19,473 Less: net income attributable to noncontrolling interests in discontinued operations — 279 — 629 Net income from discontinued operations, net of tax — 5,011 — 18,844 Net income attributable to The Ensign Group, Inc. $ 43,060 $ 27,159 $ 124,157 $ 83,140 Denominator: Weighted average shares outstanding for basic net income per share 53,328 53,941 53,299 53,470 Basic net income per common share: Income from continuing operations $ 0.81 $ 0.41 $ 2.33 $ 1.20 Income from discontinued operations — 0.09 — 0.35 Net income attributable to The Ensign Group, Inc. $ 0.81 $ 0.50 $ 2.33 $ 1.55 A reconciliation of the numerator and denominator used in the calculation of diluted net income per common share follows: Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Numerator: Net income from continuing operations $ 43,313 $ 22,538 $ 125,202 $ 64,887 Less: net income attributable to noncontrolling interests in continuing operations 253 390 1,045 591 Net income from continuing operations attributable to The Ensign Group, Inc. 43,060 22,148 124,157 64,296 Net income from discontinued operations, net of tax — 5,290 — 19,473 Less: net income attributable to noncontrolling interests in discontinued operations — 279 — 629 Net income from discontinued operations, net of tax — 5,011 — 18,844 Net income attributable to The Ensign Group, Inc. $ 43,060 $ 27,159 $ 124,157 $ 83,140 Denominator: Weighted average common shares outstanding 53,328 53,941 53,299 53,470 Plus: incremental shares from assumed conversion (1) 2,385 2,423 2,286 2,584 Adjusted weighted average common shares outstanding 55,713 56,364 55,585 56,054 Diluted net income per common share: Income from continuing operations $ 0.77 $ 0.39 $ 2.23 $ 1.15 Income from discontinued operations — 0.09 — 0.33 Net income attributable to The Ensign Group, Inc. $ 0.77 $ 0.48 $ 2.23 $ 1.48 (1) Options outstanding which are anti-dilutive and therefore not factored into the weighted average common shares amount above were 1,144 and 979 for th e three and nine months ended September 30, 2020, respectively, and 421 and 143 for the three and nine months ended September 30, 2019, respectivel

Fair Value Measurements

Fair Value Measurements	9 Months Ended
	Sep. 30, 2020
Fair Value Disclosures [Abstract]
FAIR VALUE MEASUREMENTS	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 fair value of cash and cash equivalents of $175,380 and $59,175 as of September 30, 2020 and December 31, 2019, respectively, is derived using Level 1 inputs. The Company's other financial assets include contracts insuring the lives of certain employees who are eligible to participate in non-qualified deferred compensation plans which are held in a rabbi trust. The cash surrender value of these contracts is based on performance measurement funds that shadow the deferral investment allocations made by participants in the deferred compensation plan. As of September 30, 2020, the fair value of the pooled investment funds of $5,378 is derived using Level 2 inputs. The Company had no pooled investment funds as the cash surrender value of life insurance related to the deferred compensation plan was not implemented as of December 31, 2019. The Company's non-financial assets, which includes goodwill, intangible assets, property and equipment and right-of-use assets, 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, the Company assesses its long-lived assets for impairment. When impairment has occurred, such long-lived assets are written down to fair value. Debt Security Investments - Held to Maturity At September 30, 2020 and December 31, 2019, the Company had approximately $49,345 and $48,325, respectively, in debt security investments which were classified as held to maturity and carried at amortized cost. The carrying value of the debt securities approximates fair value based on Level 1 inputs. The Company has the intent and ability to hold these debt securities to maturity. Further, as of September 30, 2020, the debt security investments were held in AA, A and BBB r ated de bt securities. The Company believes its debt security investments that were in an unrealized loss position as of September 30, 2020 were not other-than-temporarily impaired, nor has any event occurred subsequent to that date, including the developments related to Coronavirus (COVID-19), that would indicate any other-than-temporary impairment.

Business Segments

Business Segments	9 Months Ended
	Sep. 30, 2020
Segment Reporting [Abstract]
BUSINESS SEGMENTS	BUSINESS SEGMENTS Prior to the Spin-Off, the Company had three reportable segments: (1) transitional and skilled services, (2) home health and hospice services and (3) senior living services. Upon completion of the Spin-Off, the Company has one reportable operating segment: transitional and skilled services, which includes the operation of skilled nursing facilities. The Company's Chief Executive Officer, who is its chief operating decision maker, or CODM, reviews financial information at the operating segment level. The Company also reports an “all other” category that includes results from its senior living operations, real estate properties leased to third-parties, mobile diagnostics, medical transportation and other ancillary operations. These operations are neither significant individually nor in the aggregate, and therefore do not constitute a reportable segment. The Company believes that this structure reflects its current operational and financial management, and provides the best structure for the Company to maximize the quality of care provided while maintaining financial discipline. As of September 30, 2020, transitional and skilled services included 193 wholly-owned affiliated skilled nursing operations and 24 campuses that provide skilled nursing and rehabilitative care services and senior living services. Included in the "all other" category are ancillary services the Company provided through ancillary operations and room and board and social services through nine wholly-owned affiliated senior living operations and 24 campuses. The Company evaluates performance and allocates capital resources to its operations 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 the Company's reportable 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 segment 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: Three Months Ended September 30, 2020 Transitional and Skilled Services All Other Total Revenue Revenue % Medicaid $ 218,840 $ 3,352 (1) $ 222,192 37.1 % Medicare 189,237 — 189,237 31.6 Medicaid-skilled 38,232 — 38,232 6.4 Subtotal 446,309 3,352 449,661 75.1 Managed care 87,648 — 87,648 14.6 Private and other 36,427 25,519 (2) 61,946 10.3 Total revenue $ 570,384 $ 28,871 $ 599,255 100.0 % (1) Medicaid payor includes revenue generated from senior living operations for the three months ended September 30, 2020. (2) Private and other payors also includes revenue from rental income, senior living operations and all payors generated in other ancillary services for the three months ended September 30, 2020. Three Months Ended September 30, 2019 Transitional and Skilled Services All Other Total Revenue Revenue % Medicaid $ 202,665 $ 3,280 (1) $ 205,945 40.2 % Medicare 119,633 — 119,633 23.4 Medicaid-skilled 34,080 — 34,080 6.6 Subtotal 356,378 3,280 359,658 70.2 Managed care 88,542 — 88,542 17.3 Private and other 41,053 22,856 (2) 63,909 12.5 Total revenue $ 485,973 $ 26,136 $ 512,109 100.0 % (1) Medicaid payor includes revenue generated from senior living operations for the three months ended September 30, 2019. (2) Private and other payors also includes revenue from rental income, senior living operations and all payors generated in other ancillary services for the three months ended September 30, 2019. Nine Months Ended September 30, 2020 Transitional and Skilled Services All Other Total Revenue Revenue % Medicaid $ 662,733 $ 9,773 (1) $ 672,506 37.9 % Medicare 519,865 — 519,865 29.3 Medicaid-skilled 110,626 — 110,626 6.3 Subtotal 1,293,224 9,773 1,302,997 73.5 Managed care 271,993 — 271,993 15.3 Private and other 120,351 78,226 (2) 198,577 11.2 Total revenue $ 1,685,568 $ 87,999 $ 1,773,567 100.0 % (1) Medicaid payor includes revenue generated from senior living operations for the nine months ended September 30, 2020. (2) Private and other payors also includes revenue from rental income, senior living operations and all payors generated in other ancillary services for the nine months ended September 30, 2020. Nine Months Ended September 30, 2019 Transitional and Skilled Services All Other Total Revenue Revenue % Medicaid $ 576,504 $ 9,718 (1) $ 586,222 39.7 % Medicare 355,141 — 355,141 24.1 Medicaid-skilled 96,323 — 96,323 6.5 Subtotal 1,027,968 9,718 1,037,686 70.3 Managed care 258,205 — 258,205 17.5 Private and other 118,296 62,146 (2) 180,442 12.2 Total revenue $ 1,404,469 $ 71,864 $ 1,476,333 100.0 % (1) Medicaid payor includes revenue generated from senior living operations for the nine months ended September 30, 2019. (2) Private and other payors also includes revenue from rental income, senior living operations and all payors generated in other ancillary services for the nine months ended September 30, 2019. The following tables set forth selected financial data consolidated by business segment: Three Months Ended September 30, 2020 Transitional and Skilled Services All Other (1) Total Revenue $ 570,384 $ 28,871 $ 599,255 Segment income (loss) 91,171 (36,102) 55,069 Interest expense, net of interest and other income (890) Income before provision for income taxes $ 54,179 Depreciation and amortization $ 10,225 $ 3,532 $ 13,757 (1) General and administrative expense are included in the "all other" category. Three Months Ended September 30, 2019 Transitional and Skilled Services All Other (1) Total Revenue $ 485,973 $ 26,136 $ 512,109 Segment income (loss) 56,838 (26,039) 30,799 Interest expense, net of interest and other income (3,168) Income before provision for income taxes $ 27,631 Depreciation and amortization $ 9,331 $ 4,074 $ 13,405 (1) General and administrative expense is included in the "all other" category. Nine Months Ended September 30, 2020 Transitional and Skilled Services All Other (1) Total Revenue $ 1,685,568 $ 87,999 $ 1,773,567 Segment income (loss) 263,253 (95,957) 167,296 Interest expense, net of interest and other income (5,068) Income before provision for income taxes $ 162,228 Depreciation and amortization $ 30,682 $ 10,400 $ 41,082 (1) General and administrative expense are included in the "all other" category. Nine Months Ended September 30, 2019 Transitional and Skilled Services All Other (1) Total Revenue $ 1,404,469 $ 71,864 $ 1,476,333 Segment income (loss) 172,254 (82,767) 89,487 Interest expense, net of interest and other income (9,656) Income before provision for income taxes $ 79,831 Depreciation and amortization $ 26,883 $ 10,817 $ 37,700

Acquisitions

Acquisitions	9 Months Ended
	Sep. 30, 2020
Business Combinations [Abstract]
ACQUISITIONS	ACQUISITIONS The Company's subsidiaries acquisition focus is to purchase or lease operations that are complementary to the current affiliated operations, accretive to the business or otherwise advance the Company's strategy. The results of all operating subsidiaries are included in the accompanying Interim Financial Statements subsequent to the date of acquisition. Acquisitions are accounted for using the acquisition method of accounting. The Company's affiliated operations also enter into long-term leases that may include options to purchase the facilities. As a result, from time to time, the affiliated operations will acquire the real estate of facilities that have been operating under third-party leases. 2020 Acquisitions During the nine months ended September 30, 2020, the Company expanded its operations through a combination of long-term leases and real estate purchases, with the addition of three stand-alone skilled nursing operations, one stand-alone independent living operation and one campus operation. These new operations added a total of 303 operational skilled nursing beds and 298 operational senior living units operated by the Company's affiliated operating subsidiaries. The aggregate purchase price for these acquisitions during the nine months ended September 30, 2020 was $23,077. For the acquisitions made through long-term leases, 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 entered into a separate operations transfer agreement with the prior operator as part of each transaction. The fair value of assets for all acquisitions was concentrated in property and equipment and, accordingly these transactions were classified as asset acquisitions. During the first quarter of 2020, the Company entered into a long-term lease agreement to transfer two senior living operations to Pennant. Ensign affiliates retained ownership of the real estate for these two senior living communities. 2019 Acquisitions During the nine months ended September 30, 2019, the Company expanded its operations through a combination of long-term leases and real estate purchases, with the addition of eleven stand-alone skilled nursing operations, two stand-alone senior living operations and three campus operations. For the acquisitions made through long-term leases, 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 addition of these operations added a total of 1,454 operational skilled nursing beds and 312 operational senior living units to be operated by the Company's affiliated operating subsidiaries. The Company also invested in new ancillary services that are complementary to its existing businesses. The Company entered into a separate operations transfer agreement with the prior operator as part of each transaction. In addition, the Company acquired real estate for an aggregate of $10,735. The aggregate purchase price for these acquisitions during the nine months ended September 30, 2019 was $82,684. The fair value of assets for seventeen of the acquisitions was concentrated in property and equipment and as such, these transactions were classified as asset acquisitions. The purchase price for the seventeen asset acquisitions was $75,305. The fair value of assets for the remaining one acquisition was concentrated in goodwill and as such, the transaction was classified as a business combination in accordance with ASC 805, Business Combinations . The purchase price for the business combination was $7,379. The Company also entered into a note payable with the seller of $924, which was subsequently paid off in the second quarter of 2019 and was included as payments of debt in the condensed consolidated statement of cash flows. In connection with the Spin-Off, the Company transferred the assets of two home health agencies, five hospice agencies, two home care agencies and the operations of one stand-alone senior living that were purchased for an aggregate price of $18,779. The Company’s acquisition strategy has been focused on identifying both opportunistic and strategic acquisitions within its target markets that offer strong opportunities for return. The operating subsidiaries acquired by the Company are frequently underperforming financially and can have regulatory and clinical challenges to overcome. Financial information, especially with underperforming operating subsidiaries, is often inadequate, inaccurate or unavailable. Consequently, the Company believes that prior operating results are not a meaningful representation of the Company’s current operating results or indicative of the integration potential of its newly acquired operating subsidiaries. The businesses acquired during the nine months ended September 30, 2020 were not material acquisitions to the Company individually or in the aggregate. Accordingly, pro forma financial information is not presented. These acquisitions have been included in the September 30, 2020 condensed consolidated balance sheets of the Company, and the operating results have been included in the condensed consolidated statements of operations of the Company since the dates the Company gained effective control. The table below presents the allocation of the purchase price for the operations acquired during the nine months ended September 30, 2020 and 2019, excluding assets that were contributed to Pennant that occurred during the Spin-Off. Nine Months Ended September 30, 2020 2019 Land $ 8,938 $ 23,940 Building and improvements 13,365 48,383 Equipment, furniture, and fixtures 454 3,770 Assembled occupancy 89 305 Definite-lived intangible assets — 440 Goodwill — 5,382 Favorable leases — 294 Other indefinite-lived intangible assets 231 170 Total acquisitions $ 23,077 $ 82,684

Property and Equipment _ Net

Property and Equipment — Net	9 Months Ended
	Sep. 30, 2020
Property, Plant and Equipment [Abstract]
PROPERTY AND EQUIPMENT— Net	PROPERTY AND EQUIPMENT— NET Property and equipment, net consists of the following: September 30, 2020 December 31, 2019 Land $ 100,678 $ 91,740 Buildings and improvements 552,217 531,538 Leasehold improvements 134,659 127,983 Equipment 231,813 212,808 Furniture and fixtures 4,525 4,453 Construction in progress 1,684 3,409 1,025,576 971,931 Less: accumulated depreciation (242,389) (204,366) Property and equipment, net $ 783,187 $ 767,565 See also Note 9, Acquisitions for information on acquisitions during the nine months ended September 30, 2020 and 2019.

Intangible Assets _ Net

Intangible Assets — Net	9 Months Ended
	Sep. 30, 2020
Intangible Assets, Net (Excluding Goodwill) [Abstract]
INTANGIBLE ASSETS — NET	INTANGIBLE ASSETS — NET September 30, 2020 December 31, 2019 Weighted Average Life (Years) Gross Carrying Amount Accumulated Amortization Gross Carrying Amount Accumulated Amortization Intangible Assets Net Net Lease acquisition costs 1.7 $ 360 $ (360) $ — $ 360 $ (349) $ 11 Favorable leases 2.1 534 (534) — 534 (448) 86 Assembled occupancy 0.4 3,071 (3,058) 13 2,982 (2,818) 164 Facility trade name 30.0 733 (360) 373 733 (342) 391 Customer relationships 18.2 4,640 (2,067) 2,573 4,640 (1,910) 2,730 Total $ 9,338 $ (6,379) $ 2,959 $ 9,249 $ (5,867) $ 3,382 During the three and nine months ended September 30, 2020, amortization expense was $354 and $1,445, respectively, of which $289 and $933 was related to the amortization of right-of-use assets, respectively. Amortization expense was $855 and $2,724, respectively, of which $495 and $1,485 was related to the amortization of right-of-use assets for the three and nine months ended September 30, 2019, respectively. Estimated amortization expense for each of the years ending December 31 is as follows: Year Amount 2020 (remainder) $ 69 2021 238 2022 234 2023 234 2024 234 2025 234 Thereafter 1,716 $ 2,959

Goodwill and Other Indefinite-L

Goodwill and Other Indefinite-Lived Intangible Assets	9 Months Ended
	Sep. 30, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
GOODWILL AND OTHER INDEFINITE-LIVED INTANGIBLE ASSETS	GOODWILL AND OTHER INDEFINITE-LIVED INTANGIBLE ASSETS The Company tests goodwill during the fourth quarter of each year or more often if events or circumstances indicate there may be impairment. The Company performs its analysis for each reporting unit that constitutes a business for which discrete financial information is produced and reviewed by operating segment management and provides services that are distinct from the other components of the operating segment, in accordance with the provisions of Accounting Standards Codification topic 350, Intangibles—Goodwill and Other (ASC 350). This guidance provides the option to first assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying value, a "Step 0" analysis. If, based on a review of qualitative factors, it is more likely than not that the fair value of a reporting unit is less than its carrying value, the Company performs "Step 1" of the traditional two-step goodwill impairment test by comparing the net assets of each reporting unit to their respective fair values. The Company determines the estimated fair value of each reporting unit using a discounted cash flow analysis. In the event a unit's net assets exceed its fair value, an implied fair value of goodwill must be determined by assigning the unit's fair value to each asset and liability of the unit. The excess of the fair value of the reporting unit over the amounts assigned to its assets and liabilities is the implied fair value of goodwill. An impairment loss is measured by the difference between the goodwill carrying value and the implied fair value. The Company anticipates that the majority of total goodwill recognized will be fully deductible for tax purposes as of September 30, 2020. The Company's acquisitions during the nine months ended September 30, 2020 were each classified as asset acquisitions and accordingly, no goodwill was recognized for these acquisitions. There were no other activities in goodwill during the nine months ended September 30, 2020. The following table represents the goodwill value by transitional and skilled service segment and "all other"category as of September 30, 2020: Goodwill Transitional and Skilled Services All Other Total September 30, 2020 $ 45,486 $ 8,983 $ 54,469 Other indefinite-lived intangible assets consists of the following: September 30, 2020 December 31, 2019 Trade name $ 889 $ 889 Medicare and Medicaid licenses 2,410 2,179 $ 3,299 $ 3,068

Restricted and Other Assets

Restricted and Other Assets	9 Months Ended
	Sep. 30, 2020
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
RESTRICTED AND OTHER ASSETS	RESTRICTED AND OTHER ASSETS Restricted and other assets consists of the following: September 30, 2020 December 31, 2019 Debt issuance costs, net $ 2,841 $ 3,374 Long-term insurance losses recoverable asset 7,239 7,999 Deposits with landlords 12,277 11,765 Capital improvement reserves with landlords and lenders 4,042 3,024 Cash surrender value of life insurance related to deferred compensation plan 5,378 — Other — 45 Restricted and other assets $ 31,777 $ 26,207 Included in restricted and other assets as of September 30, 2020 and December 31, 2019 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	9 Months Ended
	Sep. 30, 2020
Payables and Accruals [Abstract]
OTHER ACCRUED LIABILITIES	OTHER ACCRUED LIABILITIES Other accrued liabilities consists of the following: September 30, 2020 December 31, 2019 Quality assurance fee $ 6,452 $ 6,461 Refunds payable 35,636 29,412 Resident advances 9,720 8,870 Deferred FMAP revenue 7,629 — Cash held in trust for patients 5,596 3,038 Resident deposits 1,717 1,818 Dividends payable 2,725 2,705 Property taxes 10,933 8,055 Other 9,217 9,914 Other accrued liabilities $ 89,625 $ 70,273 Quality assurance fee represents the aggregate of amounts payable to Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, Utah, Washington and Wisconsin as a result of a mandated fee based on patient days or licensed beds. Refunds payable includes payables related to overpayments, duplicate payments and credit balances from various payor sources. Resident advances occur 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 condensed consolidated balance sheets.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2020
Income Tax Disclosure [Abstract]
INCOME TAXES	INCOME TAXES The Company recorded income tax expense of $37,026 and $14,944 during the nine months ended September 30, 2020 and 2019, respectively, or 22.8% of earnings before income taxes for the nine months ended September 30, 2020, compared to 18.7% for the nine months ended September 30, 2019. The effective tax rate for both nine month periods is driven by the impact of excess tax benefits from stock-based compensation, offset by non-deductible expenses including non-deductible compensation. In February 2020, the IRS sent notification to the Company that its 2017 tax return will be examined. In August 2020, the Company received notification from the IRS that it is no longer under examination. Th e Company is not currently under examination by any other major income tax jurisdiction. During 2020, the statutes of limitations will lapse on the Company's 2016 Federal tax year and certain 2015 and 2016 state tax years. The Company does not believe the Federal or state statute lapses or any other event will significantly impact the balance of unrecognized tax benefits in the next twelve months. The net balance of unrecognized tax benefits was not material to the Interim Financial Statements for the nine months ended September 30, 2020 and 2019.

Debt

Debt	9 Months Ended
	Sep. 30, 2020
Debt Disclosure [Abstract]
DEBT	DEBT Debt consists of the following: September 30, 2020 December 31, 2019 Revolving credit facility with Truist $ — $ 210,000 Mortgage loans and promissory notes 118,695 120,350 118,695 330,350 Less: current maturities (3,139) (2,702) Less: debt issuance costs, net (2,334) (2,431) $ 113,222 $ 325,217 Credit Facility with a Lending Consortium Arranged by Truist The Company maintains a revolving credit facility under the Third Amended and Restated Credit Agreements, dated as of October 1, 2019, between the Company and Truist Financial Corporation (Truist) (formerly known as SunTrust Bank, Inc.) (the Credit Facility). The Credit Facility includes a revolving line of credit of up to $350,000 in aggregate principal amount. The maturity date of the Credit Facility is October 1, 2024. Borrowings are supported by a lending consortium arranged by Truist. 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 0.50% to 1.50% per annum or LIBOR plus a margin range from 1.50% to 2.50% per annum, based on the Consolidated Total Net Debt to Consolidated EBITDA ratio (as defined in the agreement). In addition, the Company pays a commitment fee on the unused portion of the commitments that ranges from 0.25% to 0.45% per annum, depending on the Consolidated Total Net Debt to Consolidated EBITDA ratio. The Credit Facility is guaranteed, jointly and severally, by certain of the Company’s wholly owned subsidiaries, and is secured by a pledge of stock of the Company's material operating subsidiaries as well as a first lien on substantially all of its personal property. The Credit Facility contains customary covenants that, among other things, restrict, subject to certain exceptions, the ability of the Company and its operating subsidiaries to grant liens on their assets, incur indebtedness, sell assets, make investments, engage in acquisitions, mergers or consolidations, amend certain material agreements and pay certain dividends and other restricted payments. Under the Credit Facility, the Company must comply with financial maintenance covenants to be tested quarterly, consisting of (i) a maximum consolidated total net debt to consolidated EBITDA ratio (which shall not be greater than 3.00:1.00; provided that if the aggregate consideration for approved acquisitions in a six month period is greater than $50,000, then the ratio can be increased at the election of the Company with notice to the administrative agent to 3.50:1.00 for the first fiscal quarter and the immediately following three fiscal quarters), and (ii) a minimum interest/rent coverage ratio (which cannot be less than1.50:1.00). As of September 30, 2020, there was no outstanding debt under the Credit Facility. The Company was in compliance with all loan covenants as of September 30, 2020. As of October 26, 2020, there was no outstanding borrowings under the Credit Facility. Mortgage Loans and Promissory Notes As of September 30, 2020, 19 of the Company's subsidiaries are under mortgage loans insured with the Department of Housing and Urban Development (HUD) in the aggregate amount of $114,428, which subjects these subsidiaries to HUD oversight and periodic inspections. The mortgage loans bear fixed interest rates ranging from 2.6% to 3.5% per annum. Amounts borrowed under the mortgage loans may be prepaid, subject to prepayment fees of the principal balance on the date of prepayment. For the majority of the loans, during the first three years, the prepayment fee is 10% and is reduced by 3% in the fourth year of the loan, and reduced by 1.0% per year for years five ten ten In addition to the HUD mortgage loans above, the Company has two promissory notes. The notes bear fixed interest rates of 5.3% and 4.3% per annum and the term of the notes are 12 years and 10 months, respectively. The 12 year note which was used for an acquisition is secured by the real property comprising the facility and the rent, issues and profits thereof, as well as all personal property used in the operation of the facility. As of September 30, 2020, the Company's operating subsidiaries had $118,695 outstanding under the mortgage loans and notes, of which $3,139 is classified as short-term and the remaining $115,556 is classified as long-term. The Company was in compliance with all loan covenants as of September 30, 2020. 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. Off-Balance Sheet Arrangements During the three months ended September 30, 2020, the Company increased its outstanding letters of credit by $1,788 to $7,580. As of September 30, 2020, the Company had approximately $7,580 o

Options and Awards

Options and Awards	9 Months Ended
	Sep. 30, 2020
Share-based Payment Arrangement [Abstract]
OPTIONS AND AWARDS	OPTIONS AND AWARDS Stock-based compensation expense consists of stock-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 condensed consolidated statements of income for the three and nine months ended September 30, 2020 and 2019 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. 2017 Omnibus Incentive Plan - The Company has one active stock incentive plan, the 2017 Omnibus Incentive Plan (the 2017 Plan). The 2017 Plan provided for the issuance of 6,881 shares of common stock which are to be proportionally adjusted in the event of any Equity Restructuring. In connection with the Spin-Off, the number of shares available to be issued under the 2017 Plan were adjusted in the current year in order to reflect the proportional adjustments. The adjustment provides for a total issuance of 8,118 shares of common stock (the Spin-Off Conversion). The number of shares available to be issued under the 2017 Plan will be reduced by (i) one share for each share that relates to an option or stock appreciation right award and (ii) 2.5 shares for each share which relates to an award other than a stock option or stock appreciation right award (a full-value award). Granted non-employee director options vest and become exercisable in three equal annual installments, or the length of the term if less than three years, on the completion of each year of service measured from the grant date. All other options generally vest over 5 years at 20% per year on the anniversary of the grant date. Options expire 10 years from the date of grant. At September 30, 2020, there were approximately 3,334 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 stock option awards. Determining the appropriate fair-value model and calculating the fair value of stock option awards at the grant date requires considerable judgment, including estimating stock price volatility, expected option life, and forfeiture rates. The fair-value of the restricted stock awards at the grant date is based on the market price on the grant date, adjusted for forfeiture rates. The Company develops estimates based on historical data and market information, which can change significantly over time. Modifications of Equity Awards Effective at the time of the consummation of the Spin-Off, all holders of the Company's restricted stock awards on the date of record for the Spin-Off, received Pennant restricted stock awards consistent with the distribution ratio, with terms and conditions substantially similar to the terms and conditions applicable to the Company's restricted stock awards. For purposes of the vesting of these equity awards, continued employment or service with Ensign or with Pennant is treated as continued employment for purposes of both Ensign's and Pennant's equity awards and the vesting terms of each converted grant remained unchanged. Also, effective with the Spin-Off, the holders of the Company's stock options on the date of record received stock options consistent with a conversion ratio that was necessary to maintain the pre Spin-Off intrinsic value of the options. The stock options terms and conditions are based on the preexisting terms in the 2017 Plan, including nondiscretionary antidilution provisions. In order to preserve the aggregate intrinsic value of the Company's stock options held by such persons, the exercise prices of such awards were adjusted by using the proportion of the Pennant closing stock price to the total Company closing stock prices on the distribution date. All of these adjustments were designed to equalize the fair value of each award before and after Spin-Off. These adjustments were accounted for as modifications to the original awards. Due to the modification of the equity options as a result of the Spin-Off, the Company compared the fair value of the original equity awards immediately before and after the Spin-Off and no incremental fair value was recognized as a result of the above adjustments due to immateriality. Accordingly, the Company did not record any incremental compensation expense as a result of the modifications to the awards on the date of the Spin-Off. The Company's stock-based compensation expense was not significantly impacted by the equity award adjustments that occurred as a result of the Spin-Off. Deferred compensation costs as of the date of the Spin-Off reflected the unamortized balance of the original grant date fair value of the equity awards held by the employees of the Company's operating subsidiaries (regardless of whether those awards are linked to the Company's stock or Pennant's stock). Stock Options The Company granted 160 and 540 stock options during the three and nine months ended September 30, 2020, respectively. The Company used the following assumptions for stock options granted during the three months ended September 30, 2020 and 2019: Grant Year Options Granted (1) Weighted Average Risk-Free Rate Expected Life Weighted Average Volatility Weighted Average Dividend Yield 2020 160 0.4% 6.3 years 41.8% 0.3% 2019 154 1.5% 6.2 years 34.0% 0.4% (1) Options granted represents historical grant values prior to the Spin-Off for the three months ended September 30, 2019. The Company used the following assumptions for stock options granted during the nine months ended September 30, 2020 and 2019: Grant Year Options Granted (1 ) Weighted Average Risk-Free Rate Expected Life Weighted Average Volatility Weighted Average Dividend Yield 2020 540 0.7% 6.2 years 38.8% 0.4% 2019 553 2.0% 6.2 years 33.9% 0.4% (1) Options granted represents historical grant values prior to the Spin-Off for the nine months ended September 30, 2019. For the nine months ended September 30, 2020 and 2019, the following represents the exercise price and fair value displayed at grant date for stock option grants: Grant Year Granted (1) Weighted Average Exercise Price (2) Weighted Average Fair Value of Options (3) 2020 540 $ 50.46 $ 18.62 2019 553 $ 44.96 $ 16.01 (1) Options granted from January 1, 2019 through September 30, 2019 represent historical grant values prior to the impact of the Spin-Off. Options granted subsequent to October 1, 2019 represent grant values reflective of the Spin-Off. (2) Weighted average exercise price was calculated using exercise prices reflective of the Spin-Off Conversion for all periods presented. (3) Weighted average fair value of options was calculated using the fair values reflective of the Spin-Off Conversion for all periods presented. 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 September 30, 2020 and 2019 and therefore, the intrinsic value was $0 at the date of grant. The following table represents the employee stock option activity during the nine months ended September 30, 2020: Number of Weighted Number of Weighted Average January 1, 2020 4,428 $ 20.85 2,557 $ 12.82 Granted 540 50.46 Forfeited (52) 32.02 Exercised (519) 12.34 September 30, 2020 4,397 $ 25.36 2,501 $ 15.60 The following summary information reflects stock options outstanding, vested and related details as of September 30, 2020: Stock Options Outstanding Stock Options Vested Number Outstanding Black-Scholes Fair Value Remaining Contractual Life (Years) Vested and Exercisable Year of Grant Exercise Price 2010 $4.04 - $4.20 4 $ 9 0 4 2011 5.00 - 6.77 53 101 1 53 2012 5.56 - 6.75 155 482 2 155 2013 6.76 - 9.74 312 1,285 3 312 2014 8.94 - 16.05 826 3,960 4 826 2015 18.20 - 21.39 382 2,952 5 360 2016 15.93 - 16.86 341 2,016 6 250 2017 15.80 - 19.41 417 2,460 7 213 2018 22.49 - 32.71 631 6,492 8 208 2019 41.07 - 45.76 743 11,664 9 120 2020 44.84 - 58.06 533 6,294 10 — Total 4,397 $ 37,715 2,501 The aggregate intrinsic value of options outstanding, vested, expected to vest and exercised as of September 30, 2020 and December 31, 2019 is as follows: Options September 30, 2020 December 31, 2019 Outstanding $ 139,537 $ 108,623 Vested 103,551 83,243 Expected to vest 31,395 22,399 Exercisable 21,044 29,032 The intrinsic value is calculated as the difference between the market value of the underlying common stock and the exercise price of the options . Restricted Stock Awards The Company granted 48 and 242 restricted stock awards during the three and nine months ended September 30, 2020, respectively. The Company granted 58 and 252 restricted stock awards during the three and nine months ended September 30, 2019, respectively. All awards were granted at an issue price of $0 and generally vest over five years. The fair value per share of restricted awards granted during the nine months ended September 30, 2020 and 2019 ranged from $35.47 to $58.06 and $41.68 to $57.39, respectively. The fair value per share during the nine months ended September 30, 2019 is reflective of values prior to the Spin-Off, while the fair value per share during nine months ended September 30, 2020 is reflective of values subsequent to the Spin-Off. The fair value per share includes quarterly stock awards to non-employee directors. A summary of the status of the Company's non-vested restricted stock awards as of September 30, 2020 and changes during the nine months ended September 30, 2020 is presented below: Non-Vested Restricted Awards Weighted Average Grant Date Fair Value Nonvested at January 1, 2020 610 $ 31.35 Granted 242 47.02 Vested (245) 33.00 Forfeited (13) 30.20 Nonvested at September 30, 2020 594 $ 37.08 During the three and nine months ended September 30, 2020, respectively, the Company granted 6 and 16 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 $35.47 to $47.09 based on the market price on the grant date. Long-Term Incentive Plan On August 27, 2019, the Board approved the Long-Term Incentive Plan (the 2019 LTI Plan). The 2019 LTI Plan provides that certain employees of the Company and Pennant who assisted in the consummation of the Spin-Off are granted shares of restricted stock upon the successful completion of the Spin-Off. The 2019 LTI Plan provides for the issuance of 500 shares of Pennant restricted stock. The shares are vested over five years at 20% per year on the anniversary of the grant date. If a recipient is terminated or voluntarily leaves the Company, all shares subject to restriction or not yet vested shall be entirely forfeited. The total stock-based compensation related to the 2019 LTI Plan was approximately $286 and $675 for the three and nine months ended September 30, 2020, respectively. Stock-based compensation expense recognized for the Company's equity incentive plans and long-term incentive plan for the three and nine months ended September 30, 2020 and 2019 was as follows: Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 (1) 2020 2019 (1) Stock-based compensation expense related to stock options $ 1,692 $ 1,227 $ 4,656 $ 3,885 Stock-based compensation expense related to restricted stock awards 2,221 1,279 5,596 3,348 Stock-based compensation expense related to stock options and restricted stock awards to non-employee directors 260 323 684 982 Total $ 4,173 $ 2,829 $ 10,936 $ 8,215 (1) The amount of stock-based compensation expense that was classified as discontinued operations was $132 and $424, respectively, for the three and nine months ended September 30, 2019. In future periods, the Company expects to recognize approximately $23,699 and $25,155 in stock-based compensation expense for unvested options and unvested restricted stock awards, respectively, that were outstanding as of September 30, 2020. Future stock-based compensation expense will be recognized over 3.8 and 3.7 weighted average years for unvested options and restricted stock awards, respectively. There were 1,896 unvested and outstanding options at September 30, 2020, of which 1,769 shares are expected to vest. The weighted average contractual life for options outstanding, vested and expected to vest at September 30, 2020 was 6.0 years. Equity Instrument Denominated in the Shares of a Subsidiary On May 26, 2016, the Company granted stock options and restricted stock awards under the Subsidiary Equity Plan to employees and management of the subsidiary. During 2019, the Company contributed the net assets of the subsidiary to Pennant prior to the consummation of the Spin-Off on October 1, 2019. Effective upon the Spin-Off, all shares under the Plan were converted to Pennant shares and Pennant's Board of Directors hold full administrative authority of the Cornerstone Plan. No additional shares will be granted under this plan. The Company did not grant any new restricted shares nor did the Company grant any options during the nine months ended September 30, 2019. The awards granted generally vested over a period of three Prior to the Spin-Off, the grant-date fair value of the awards was recognized as compensation expense over the relevant vesting periods, with a corresponding adjustment to noncontrolling interests. As a result of the conversion of the Subsidiary Equity Plan, the Company's noncontrolling interest in the subsidiary was eliminated. The grant values were determined based on an independent valuation of the subsidiary shares. For the three and nine months ended September 30, 2019, the Company expensed $17 and $594, respectively, in stock-based compensation related to the Subsidiary Equity Plan. Further, during the three and nine months ended September 30, 2019, the Company repurchased 65 and 534 shares of common stock under the Subsidiary Equity Plan for $394 and $2,687, respectively. The Company subsequently sold the shares and received net proceeds of $2,293. Stock-based compensation expense related to the Subsidiary Equity Plan, payments from the repurchase of shares and the proceeds from the sale of the repurchased shares related to the Subsidiary Equity Plan are all included within the Company's condensed consolidated financial statements as discontinued operations.

Leases

Leases	9 Months Ended
	Sep. 30, 2020
Leases [Abstract]
LEASES	LEASES The Company leases from CareTrust REIT, Inc. (CareTrust) real property associated with 85 affiliated skilled nursing, senior living facilities used in the Company’s operations under eight “triple-net” master lease agreements (collectively, the Master Leases), which range in terms from 12 to 20 years. In connection with the Spin-Off, 11 of the original 94 properties under the CareTrust lease were transferred to Pennant. Of the 11 properties, two of the senior living operations are located on the same real estate properties as the skilled nursing facilities. At the Company’s option, the Master Leases may be extended for two or three five-year renewal terms beyond the initial term, on the same terms and conditions. The extension of the term of any of the Master Leases is subject to the following conditions: (1) no event of default under any of the Master Leases having occurred and being continuing; and (2) the tenants providing timely notice of their intent to renew. The term of the Master Leases is subject to termination prior to the expiration of the then current term upon default by the tenants in their obligations, if not cured within any applicable cure periods set forth in the Master Leases. If the Company elects to renew the term of a Master Lease, the renewal will be effective to all, but not less than all, of the leased property then subject to the Master Lease. The Company does not have the ability to terminate the obligations under a Master Lease prior to its expiration without CareTrust’s consent. If a Master Lease is terminated prior to its expiration other than with CareTrust’s consent, the Company may be liable for damages and incur charges such as continued payment of rent through the end of the lease term as well as maintenance and repair costs for the leased property. Commencing the third year, the rent structure under the Master Leases includes a fixed component, subject to annual escalation equal to the lesser of (1) the percentage change in the Consumer Price Index (but not less than zero) or (2) 2.5%. In addition to rent, the Company is required to pay the following: (1) all impositions and taxes levied on or with respect to the leased properties (other than taxes on the income of the lessor); (2) all utilities and other services necessary or appropriate for the leased properties and the business conducted on the leased properties; (3) all insurance required in connection with the leased properties and the business conducted on the leased properties; (4) all facility maintenance and repair costs; and (5) all fees in connection with any licenses or authorizations necessary or appropriate for the leased properties and the business conducted on the leased properties. Total rent expense under the Master Leases was approximately $13,139 and $39,394 for the three and nine months ended September 30, 2020, respectively, and $13,738 and $40,662 for the three and nine months ended September 30, 2019, respectively. Among other things, under the Master Leases, the Company must maintain compliance with specified financial covenants measured on a quarterly basis, including a portfolio coverage ratio and a minimum rent coverage ratio. The Master Leases also include certain reporting, legal and authorization requirements. The Company is not aware of any defaults as of September 30, 2020. In connection with the Spin-Off, the Company amended the Master Leases with CareTrust and other third-party lease agreements. These amendments terminated the leases related to Pennant and modified the rental payments and lease terms of the operations that remained with Ensign. In accordance with ASC 842, the amended lease agreements are considered to be modified and subject to lease modification guidance. The right-of-use (ROU) asset and lease liabilities related to these agreements were remeasured based on the change in the lease conditions such as rent payment and lease terms. The incremental borrowing rate was adjusted to reflect the revised lease terms which became effective at the date of the modification, which is the date of the Spin-Off. The net impact of the lease termination, for the 23 leases that transferred to Pennant and modification of lease agreements, is a reduction in ROU asset and lease liabilities of approximately $35,000. The annual rent expense transferred to Pennant was approximately $23,000. In connection with the Spin-Off, the Company also guaranteed certain leases of Pennant based on the underlying terms of the leases. The Company does not consider these guarantees to be probable and the likelihood of Pennant defaulting is remote, and therefore no liabilities have been accrued. 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 three Forty of the Company’s affiliated facilities, excluding the facilities that are operated under the Master Leases with CareTrust, are operated under eight 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. The components of operating lease expense are as follows: Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Rent - cost of services (1) $ 32,504 $ 31,875 $ 97,318 $ 93,278 General and administrative expense 16 55 48 360 Depreciation and amortization (2) 289 495 933 1,485 Variable lease costs (3) 3,229 3,106 9,692 9,169 $ 36,038 $ 35,531 $ 107,991 $ 104,292 (1) Rent- cost of services includes deferred rent expense adju stments of $101 and $337 for the three and nine months ended September 30, 2020, respectively. Rent- cost of services includes a reduction in deferred rent expense adjustments of $983 and increase in deferred rent expense adjustments of $134 for the three and nine months ended September 30, 2019, respectively. Additionally, rent- cost of services includes other variable lease costs such as CPI increases and short-term leases of $567 and $1,781 for the three and nine months ended September 30, 2020, respectively, and $628 and $1,056 for the three and nine months ended September 30, 2019, respectively. (2) Depreciation and amortization is related to the amortization of favorable and direct lease costs. (3) Variable lease costs, including property taxes and insurance, are classified in Cost of services in the Company's condensed consolidated statements of income. Future minimum lease payments for all leases as of September 30, 2020 are as follows: Year Amount 2020 (remainder) $ 31,940 2021 127,499 2022 127,130 2023 125,393 2024 124,412 2025 124,264 Thereafter 1,025,979 Total lease payments 1,686,617 Less: present value adjustment (686,409) Present value of total lease liabilities 1,000,208 Less: current lease liabilities (47,342) Long-term operating lease liabilities $ 952,866 Operating lease liabilities are based on the net present value of the remaining lease payments over the remaining lease term. In determining the present value of lease payments, the Company used its incremental borrowing rate based on the information available at the lease commencement date. As of September 30, 2020, the weighted average remaining lease term is 13.9 and the weighted average discount rate used to determine the operating lease liability is 8.3%. Subsequent to September 30, 2020, the Company entered into a new operating lease agreement at one of its facilities which will commence immediately upon the expiration of the current lease agreement at the facility, which is expiring on June 30, 2021. The new lease term is 24 years with the option to extend for an additional 10 years. The fair value of the related lease liability and ROU asset is estimated to be approximately $4,900. Lessor Activities In connection with the Spin-Off, Ensign affiliates retained ownership of the real estate at 29 senior living operations that were contributed to Pennant. During the first quarter of 2020, the Company transferred the operations of an additional two senior living operations to Pennant. Ensign affiliates retained ownership of the real estate for these 31 senior living communities. All of these properties are leased to Pennant on a triple-net basis, whereas the respective Pennant affiliates are responsible for all costs at the properties including: (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. The initial terms range between 14 to 16 years. Total annual rental income generated from the leases with Pennant is approximately $14,000, which includes variable rent such as property taxes. Total rental income from all third-party sources for the three and nine months ended September 30, 2020 and 2019 is as follows: Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Pennant (1) $ 3,443 $ — $ 10,272 $ — Other third-party 622 660 2,023 2,085 $ 4,065 $ 660 $ 12,295 $ 2,085 (1) Pennant rental income includes variable rent such as property taxes of $312 and $909 during the three and nine months ended September 30, 2020, respectively. Future annual rental income for all leases as of September 30, 2020 were as follows: Year Amount (1) 2020 (remainder) $ 4,104 2021 15,463 2022 14,918 2023 14,606 2024 14,073 2025 13,875 Thereafter 98,956 Total $ 175,995 (1) Annualized rental income includes base rents and variable rental income pursuant to existing leases as of September 30, 2020 . Subsequent to September 30, 2020, the Company amended a lease agreement at one of its properties, which is expiring on September 30, 2029, to extended the lease term an additional 5 years. The aggregate increase in rental income related to the amendment is estimated to be approximately $4,100.
LEASES	LEASES The Company leases from CareTrust REIT, Inc. (CareTrust) real property associated with 85 affiliated skilled nursing, senior living facilities used in the Company’s operations under eight “triple-net” master lease agreements (collectively, the Master Leases), which range in terms from 12 to 20 years. In connection with the Spin-Off, 11 of the original 94 properties under the CareTrust lease were transferred to Pennant. Of the 11 properties, two of the senior living operations are located on the same real estate properties as the skilled nursing facilities. At the Company’s option, the Master Leases may be extended for two or three five-year renewal terms beyond the initial term, on the same terms and conditions. The extension of the term of any of the Master Leases is subject to the following conditions: (1) no event of default under any of the Master Leases having occurred and being continuing; and (2) the tenants providing timely notice of their intent to renew. The term of the Master Leases is subject to termination prior to the expiration of the then current term upon default by the tenants in their obligations, if not cured within any applicable cure periods set forth in the Master Leases. If the Company elects to renew the term of a Master Lease, the renewal will be effective to all, but not less than all, of the leased property then subject to the Master Lease. The Company does not have the ability to terminate the obligations under a Master Lease prior to its expiration without CareTrust’s consent. If a Master Lease is terminated prior to its expiration other than with CareTrust’s consent, the Company may be liable for damages and incur charges such as continued payment of rent through the end of the lease term as well as maintenance and repair costs for the leased property. Commencing the third year, the rent structure under the Master Leases includes a fixed component, subject to annual escalation equal to the lesser of (1) the percentage change in the Consumer Price Index (but not less than zero) or (2) 2.5%. In addition to rent, the Company is required to pay the following: (1) all impositions and taxes levied on or with respect to the leased properties (other than taxes on the income of the lessor); (2) all utilities and other services necessary or appropriate for the leased properties and the business conducted on the leased properties; (3) all insurance required in connection with the leased properties and the business conducted on the leased properties; (4) all facility maintenance and repair costs; and (5) all fees in connection with any licenses or authorizations necessary or appropriate for the leased properties and the business conducted on the leased properties. Total rent expense under the Master Leases was approximately $13,139 and $39,394 for the three and nine months ended September 30, 2020, respectively, and $13,738 and $40,662 for the three and nine months ended September 30, 2019, respectively. Among other things, under the Master Leases, the Company must maintain compliance with specified financial covenants measured on a quarterly basis, including a portfolio coverage ratio and a minimum rent coverage ratio. The Master Leases also include certain reporting, legal and authorization requirements. The Company is not aware of any defaults as of September 30, 2020. In connection with the Spin-Off, the Company amended the Master Leases with CareTrust and other third-party lease agreements. These amendments terminated the leases related to Pennant and modified the rental payments and lease terms of the operations that remained with Ensign. In accordance with ASC 842, the amended lease agreements are considered to be modified and subject to lease modification guidance. The right-of-use (ROU) asset and lease liabilities related to these agreements were remeasured based on the change in the lease conditions such as rent payment and lease terms. The incremental borrowing rate was adjusted to reflect the revised lease terms which became effective at the date of the modification, which is the date of the Spin-Off. The net impact of the lease termination, for the 23 leases that transferred to Pennant and modification of lease agreements, is a reduction in ROU asset and lease liabilities of approximately $35,000. The annual rent expense transferred to Pennant was approximately $23,000. In connection with the Spin-Off, the Company also guaranteed certain leases of Pennant based on the underlying terms of the leases. The Company does not consider these guarantees to be probable and the likelihood of Pennant defaulting is remote, and therefore no liabilities have been accrued. 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 three Forty of the Company’s affiliated facilities, excluding the facilities that are operated under the Master Leases with CareTrust, are operated under eight 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. The components of operating lease expense are as follows: Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Rent - cost of services (1) $ 32,504 $ 31,875 $ 97,318 $ 93,278 General and administrative expense 16 55 48 360 Depreciation and amortization (2) 289 495 933 1,485 Variable lease costs (3) 3,229 3,106 9,692 9,169 $ 36,038 $ 35,531 $ 107,991 $ 104,292 (1) Rent- cost of services includes deferred rent expense adju stments of $101 and $337 for the three and nine months ended September 30, 2020, respectively. Rent- cost of services includes a reduction in deferred rent expense adjustments of $983 and increase in deferred rent expense adjustments of $134 for the three and nine months ended September 30, 2019, respectively. Additionally, rent- cost of services includes other variable lease costs such as CPI increases and short-term leases of $567 and $1,781 for the three and nine months ended September 30, 2020, respectively, and $628 and $1,056 for the three and nine months ended September 30, 2019, respectively. (2) Depreciation and amortization is related to the amortization of favorable and direct lease costs. (3) Variable lease costs, including property taxes and insurance, are classified in Cost of services in the Company's condensed consolidated statements of income. Future minimum lease payments for all leases as of September 30, 2020 are as follows: Year Amount 2020 (remainder) $ 31,940 2021 127,499 2022 127,130 2023 125,393 2024 124,412 2025 124,264 Thereafter 1,025,979 Total lease payments 1,686,617 Less: present value adjustment (686,409) Present value of total lease liabilities 1,000,208 Less: current lease liabilities (47,342) Long-term operating lease liabilities $ 952,866 Operating lease liabilities are based on the net present value of the remaining lease payments over the remaining lease term. In determining the present value of lease payments, the Company used its incremental borrowing rate based on the information available at the lease commencement date. As of September 30, 2020, the weighted average remaining lease term is 13.9 and the weighted average discount rate used to determine the operating lease liability is 8.3%. Subsequent to September 30, 2020, the Company entered into a new operating lease agreement at one of its facilities which will commence immediately upon the expiration of the current lease agreement at the facility, which is expiring on June 30, 2021. The new lease term is 24 years with the option to extend for an additional 10 years. The fair value of the related lease liability and ROU asset is estimated to be approximately $4,900. Lessor Activities In connection with the Spin-Off, Ensign affiliates retained ownership of the real estate at 29 senior living operations that were contributed to Pennant. During the first quarter of 2020, the Company transferred the operations of an additional two senior living operations to Pennant. Ensign affiliates retained ownership of the real estate for these 31 senior living communities. All of these properties are leased to Pennant on a triple-net basis, whereas the respective Pennant affiliates are responsible for all costs at the properties including: (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. The initial terms range between 14 to 16 years. Total annual rental income generated from the leases with Pennant is approximately $14,000, which includes variable rent such as property taxes. Total rental income from all third-party sources for the three and nine months ended September 30, 2020 and 2019 is as follows: Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Pennant (1) $ 3,443 $ — $ 10,272 $ — Other third-party 622 660 2,023 2,085 $ 4,065 $ 660 $ 12,295 $ 2,085 (1) Pennant rental income includes variable rent such as property taxes of $312 and $909 during the three and nine months ended September 30, 2020, respectively. Future annual rental income for all leases as of September 30, 2020 were as follows: Year Amount (1) 2020 (remainder) $ 4,104 2021 15,463 2022 14,918 2023 14,606 2024 14,073 2025 13,875 Thereafter 98,956 Total $ 175,995 (1) Annualized rental income includes base rents and variable rental income pursuant to existing leases as of September 30, 2020 . Subsequent to September 30, 2020, the Company amended a lease agreement at one of its properties, which is expiring on September 30, 2029, to extended the lease term an additional 5 years. The aggregate increase in rental income related to the amendment is estimated to be approximately $4,100.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2020
Commitments and Contingencies Disclosure [Abstract]
COMMITMENTS AND CONTINGENCIES	COMMITMENTS AND CONTINGENCIES Regulatory Matters — Laws and regulations governing Medicare and Medicaid programs are complex and subject to interpretation. Compliance with such laws and regulations can be subject to future governmental review and interpretation, as well as significant regulatory action including fines, penalties, and exclusion from certain governmental programs. Included in these laws and regulations is the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which requires healthcare providers (among other things) to safeguard the privacy and security of certain health information. 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 to the Company's independent operating subsidiary, (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 relationship or relationship to the Company. The terms of such obligations vary by contract and, in most instances, do not expressly state or include a specific or maximum dollar amount. 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 consolidated balance sheets for any of the periods presented. U.S. Department of Justice Civil Investigative Demand - On May 31, 2018, the Company received a Civil Investigative Demand (CID) from the U.S. Department of Justice stating that it was investigating whether there has been a violation of the False Claims Act and/or the Anti-Kickback Statute with respect to relationships between certain of the Company’s independently operated skilled nursing facilities and persons who serve or have served as medical directors, advisory board participants or other potential referral sources. The CID covered the period from October 3, 2013 through 2018, and was limited in scope to ten of the Company’s Southern California independent operating entities. In October 2018, the Department of Justice made an additional request for information covering the period of January 1, 2011 through 2018, relating to the same topic. As a general matter, the Company’s independent operating entities maintain policies and procedures to promote compliance with the False Claims Act, the Anti-Kickback Statute, and other applicable regulatory requirements. The Company has fully cooperated with the U.S. Department of Justice and promptly responded to the requests for information, and has been advised that the U.S. Department of Justice declined to intervene in any subsequent action filed by a relator in connection with the subject matter of this investigation. 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 independent operating subsidiaries. The Company, its independent 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. The U.S. House of Representatives Select Subcommittee on the Coronavirus Crisis has launched a nation-wide investigation into the coronavirus crisis in nursing homes. In June 2020, the Company received a document request from the House Select Subcommittee. The Company is cooperating in responding to this inquiry. However, it is not possible to predict the ultimate outcome of any such investigation or whether and what other investigations or regulatory responses may result from the investigation and could have a material adverse effect on our reputation, business, financial condition and results of operations. 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. Under the qui tam or "whistleblower" provisions of the False Claims Act, a private individual with knowledge of fraud may bring a claim on behalf of the federal government and receive a percentage of the federal government's recovery. Due to these whistleblower incentives, lawsuits have become more frequent. For example, and despite the decision of the U.S. Department of Justice to decline participation in litigation based on the subject matter of its previously issued Civil Investigative Demand, the qui tam relator may continue on with the lawsuit and pursue claims that the Company has allegedly violated the False Claims Act and/or the Anti-Kickback Statute. In addition to the Federal False Claims Act, some states, including California, Arizona and Texas, have enacted similar whistleblower and false claims laws and regulations. Further, 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 its independent operating subsidiaries do business. In May 2009, Congress passed the Fraud Enforcement and Recovery Act (FERA) which made significant changes to the Federal False Claims Act (FCA) and expanded 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 an 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, an employment relationship is generally not required 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's independent operating subsidiaries are routinely subjected to varying types of claims. One particular type of suit arises from alleged violations of minimum staffing requirements for skilled nursing facilities in those states which have enacted such requirements. The alleged failure to meet these requirements can, among other things, jeopardize a facility's compliance with the requirements of participation under certain state and federal healthcare programs; it may also subject the facility to a 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 may result in significant legal costs. The Company expects the plaintiffs' bar to continue to be aggressive in their pursuit of these staffing and similar claims. While the Company has been able to settle these claims without an ongoing material 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. The Company has been subjected to, and is currently involved in, class action litigation alleging violations (alone or in combination) of state and federal wage and hour laws as related to the alleged failure to pay wages, to timely provide and au thorize meal and rest breaks, and related causes action. The Company does not believe that the ultimate resolution of these actions will have an ongoing material adverse effect on the Company’s business, cash flows, financial condition or results of operations. The Company and its independent 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 filed by residents and responsible parties related to patient care and treatment (professional negligence claims), as well as employment related claims filed by current or former employees. A significant increase in the number of these claims, or an increase in the amounts owing should plaintiffs be successful in their prosecution of these claims, could materially adversely affect the Company’s business, financial condition, results of operations and cash flows. The Company cannot predict or provide any assurance as to the possible outcome of any inquiry, investigation or litigation. If any such litigation were to proceed, and the Company and its independent operating subsidiaries are subjected to, alleged to be liable for, or agree 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, or if the Company or its independent operating subsidiaries are alleged or found to be liable on theories of general or professional negligence or wage and hour violations, 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 violations, and may also include the assumption of specific procedural and financial obligations by the Company or its operating subsidiaries going forward under a corporate integrity agreement and/or other such arrangements. Medicare Revenue Recoupments — The Company's independent operating entities are subject to regulatory reviews relating to the provision of Medicare services, billings and potential overpayments as a result of Recovery Audit Contractors (RAC), Program Safeguard Contractors (PSC), and Medicaid Integrity Contractors (MIC) programs (collectively referred to as Reviews). For several months during the COVID-19 pandemic, CMS suspended its Targeted Probe and Educate (TPE) program. In July 2020, CMS announced that TPE program activity would resume in August 2020. As of September 30, 2020, none of the Company's independent operating subsidiaries had Reviews scheduled, on appeal, or in a dispute resolution process. The Company anticipates that these Reviews could increase in frequency in the future. If an operation fails a Review and/or subsequent Reviews, the operation could then be subject to extended review or an extrapolation of the identified error rate to billings in the same time period. As of September 30, 2020, the Company's independent operating subsidiaries have responded to the requests, and the related claims are currently under review, on appeal or in a dispute resolution process. U.S. Government Inquiry and Corporate Integrity Agreement — In October 2013, the Company and its independent operating entities 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 U.S. 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 and its independent operating entities have denied engaging in any illegal conduct and 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 and its independent operating entities entered into a five-year corporate integrity agreement (the CIA) with the Office of Inspector General-HHS. CMS acknowledged 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 required that the Company and its independent operating entities 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 Federally-funded health care programs. In the first quarter of 2019, the Company received notice from the OIG that the Company’s five-year CIA with the OIG had been completed. Upon receipt of the Company’s fifth and final annual report, the OIG confirmed that the term of the CIA is concluded. 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 59.7% and 57.3% of its total accounts receivable as of September 30, 2020 and December 31, 2019, respectively. Revenue from reimbursement under the Medicare and Medicaid programs accounted for 75.1% and 73.5% of the Company's revenue for the three and nine months ended September 30, 2020, respectively, and 70.2% and 70.3% for the three and nine months ended September 30, 2019, 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 October 26, 2020, the Company had approximately $998 in uninsured cash deposits. All uninsured bank deposits are held at high quality credit institutions.

Common Stock Repurchase Program

Common Stock Repurchase Program	9 Months Ended
	Sep. 30, 2020
Equity [Abstract]
COMMON STOCK REPURCHASE PROGRAM	COMMON STOCK REPURCHASE PROGRAMAs approved by the Board of Directors on March 4, 2020 and March 13, 2020, the Company entered into two stock repurchase programs pursuant to which the Company was authorized to repurchase up to $20,000 and $5,000, respectively, of its common stock under the programs for a period of approximately 12 months. Under these programs, the Company was 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 2020, the Company repurchased 503 and 189 shares of its common stock for $20,000 and $5,000, respectively. These repurchase programs expired upon the repurchase of the full authorized amount under the two plans.As approved by the Board of Directors on August 26, 2019, the Company entered into a stock repurchase program pursuant to which the Company may repurchase up to $20,000 of its common stock under the program for a period of approximately 12 months. Under this program, the Company is authorized to repurchase its issued and outstanding common shares from time to time in open-market and privately negotiated transactions and block trades in accordance with federal securities laws. The Company repurchased 138 shares of its common stock for a total of $6,406 in fiscal year 2019 before the repurchase program was cancelled in the first quarter of 2020.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2020
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation — The accompanying Interim Financial Statements have been prepared in accordance with accounting principles generally accepted in the United States (GAAP). The Company is the sole member or stockholder of various consolidated limited liability companies and corporations established to operate various acquired skilled nursing operations, senior living operations and related ancillary services. All intercompany transactions and balances have been eliminated in consolidation. The condensed consolidated financial statements include the accounts of all entities controlled by the Company through its ownership of a majority voting interest. The Company presents noncontrolling interests within the equity section of its condensed consolidated balance sheets and the amount of consolidated net income that is attributable to The Ensign Group, Inc. and the noncontrolling interest in its condensed consolidated statements of income. The condensed consolidated financial statements include the accounts of all entities controlled by the Company through its ownership of a majority voting interest. Additionally, 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 are 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 three and nine months ended September 30, 2020 and 2019.
Estimates and Assumptions	Estimates and Assumptions — The preparation of Interim 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 Interim Financial Statements and the reported amounts of revenue and expenses during the reporting periods. The most significant estimates in the Company’s Interim Financial Statements relate to revenue, acquired property and equipment, intangible assets and goodwill, right-of-use-assets, impairment of long-lived assets, lease liabilities, 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	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. Contracts insuring the lives of certain employees who are eligible to participate in non-qualified deferred compensation plans are held in a rabbi trust. Cash surrender value of the contracts is based on performance measurement funds that shadow the deferral investment allocations made by participants in the deferred compensation plan. The fair value of the pooled investment funds is derived using Level 2 inputs.
Revenue Recognition	Revenue Recognition — The Company recognizes revenue in accordance with Accounting Standards Codification Topic 606, Revenue from Contracts with Customers
Accounts Receivable and Allowance for Doubtful Accounts	Accounts Receivable and Allowance for Doubtful Accounts —
Property and Equipment	Property and Equipment — three
Impairment of Long-Lived Assets	Impairment of Long-Lived Assets —
Leases and Leasehold Improvements	Leases and Leasehold Improvements - The Company leases skilled nursing facilities, senior living facilities and commercial office space. On January 1, 2019, the Company adopted Accounting Standards Codification Topic 842, Leases (ASC 842), electing the transition method that allows it to apply the standard as of the adoption date and record a cumulative adjustment in retained earnings. The Company determines if an arrangement is a lease at the inception of each lease. At the inception of each lease, the Company performs an evaluation to determine whether the lease should be classified as an operating or finance lease. As of September 30, 2020, the Company does not have any leases that are classified as finance leases. Rights and obligations of operating leases are included as right-of-use assets, current lease liabilities and long-term lease liabilities on the Company's condensed consolidated balance sheet. As the Company's leases do not provide an implicit rate, the Company uses its incremental borrowing rate based on the information available at lease commencement date in determining the present value of future lease payments. The Company utilized a third-party valuation specialist to assist in estimating the incremental borrowing rate. The Company records rent expense for operating leases 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. Renewals are not assumed in the determination of the lease term unless they are deemed to be reasonably assured at the inception of the lease. The lease term used for this evaluation also provides the basis for establishing depreciable lives for buildings subject to lease and leasehold improvements.
Intangible Assets and Goodwill	Intangible Assets and Goodwill — Definite-lived intangible assets consist primarily of patient base, facility trade names and customer relationships. Patient base is amortized over a period of four 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. The Company did not identify any goodwill or intangible asset impairment during the nine months ended September 30, 2020 and 2019.
Self-Insurance	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. The combined self-insured retention is $500 per claim, subject to an additional one-time deductible of $750 for California affiliated operations and a separate, one-time, deductible of $1,000 for non-California operations. For all affiliated operations, except those located in Colorado, the third-party coverage above these limits is $1,000 per claim, $3,000 per operation, with a $5,000 blanket aggregate limit and an additional state-specific aggregate where required by state law. In Colorado, the third-party coverage above these limits is $1,000 per claim and $3,000 per operation, which is independent of the aforementioned blanket aggregate limits that apply outside of Colorado. The self-insured retention and deductible limits for general and professional liability and workers' compensation for all states (except Texas and Washington for workers' compensation) are self-insured through the Captive, the related assets and liabilities of which are included in the accompanying condensed consolidated balance sheets. The Captive is subject to certain statutory requirements as an insurance provider. The Company’s policy is to accrue amounts equal to the actuarial 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 uses actuarial valuations to estimate the liability based on historical experience and industry information. Accrued general liability and professional malpractice liabilities on an undiscounted basis, net of anticipated insurance recoveries, were $53,759 and $46,984 as of September 30, 2020 and December 31, 2019, respectively. 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 the Company has purchased individual stop-loss coverage that insures individual claims that exceed $750 per occurrence. 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 benefit payments 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. Accrued workers’ compensation liabilities are recorded on an undiscounted basis, net of estimated recoveries, in the accompanying condensed consolidated balance sheets and were $25,230 and $25,419 as of September 30, 2020 and December 31, 2019, respectively. In addition, the Company has recorded an asset and equal liability of $7,239 and $7,999 at September 30, 2020 and December 31, 2019, respectively, in order to present the ultimate costs of malpractice and workers' compensation claims and the anticipated insurance recoveries on a gross basis. 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. The Company's policy does not include the additional one-time aggregate individual stop loss deductible of $75. The Company’s accrued liability under these plans recorded on an undiscounted basis in the accompanying condensed consolidated balance sheets was $8,810 and $6,964 as of September 30, 2020 and December 31, 2019, respectively. The Company believes that adequate provision has been made in the Interim 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	Income Taxes — Deferred tax assets and liabilities are established for temporary differences between the financial reporting basis and the tax basis of the Company’s assets and liabilities at tax rates in effect when such temporary differences are expected to reverse. The Company generally expects to fully utilize its deferred tax assets; however, when necessary, the Company records a valuation allowance to reduce its net deferred tax assets to the amount that is more likely than not to be realized.
Noncontrolling Interest	Noncontrolling Interest —
Stock-Based Compensation	Stock-Based Compensation — The Company measures and recognizes compensation expense for all stock-based payment awards made to employees and directors including employee stock options based on estimated fair values, ratably over the requisite service period of the award. Net income has been reduced as a result of the recognition of the fair value of all stock options and restricted stock awards issued, the amount of which is contingent upon the number of future grants and other variables.
Recent Accounting Pronouncements	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 August 2018, the FASB issued amended guidance to simplify fair value measurement disclosure requirements. The new provisions eliminate the requirements to disclose (1) transfers between Level 1 and Level 2 of the fair value hierarchy, (2) policies related to valuation processes and the timing of transfers between levels of the fair value hierarchy, and (3) net asset value disclosure of estimates of timing of future liquidity events. The FASB also modified disclosure requirements of Level 3 fair value measurements. The Company adopted this standard effective January 1, 2020 and determined there was no material impact on the Company's condensed consolidated financial statements. In January 2017, the FASB issued amended authoritative guidance to simplify and reduce the cost and complexity of the goodwill impairment test. The new provisions eliminate step 2 from the goodwill impairment test and shifts the concept of impairment from a measure of loss when comparing the implied fair value of goodwill to its carrying amount to comparing the fair value of a reporting unit with its carrying amount. The FASB also eliminated the requirements for any reporting unit with a zero or negative carrying amount to perform a qualitative assessment or step 2 of the goodwill impairment test. The new guidance does not amend the optional qualitative assessment of goodwill impairment. The Company adopted this standard effective January 1, 2020 and determined there was no material impact on the Company's condensed consolidated financial statements. In June 2016, the FASB issued Accounting Standards Update (ASU) 2016-13 “ Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments ”, which replaces the existing incurred loss impairment model with an expected credit loss model and requires a financial asset measured at amortized cost to be presented at the net amount expected to be collected. The Company adopted this standard effective January 1, 2020 and determined there was no material impact on the Company's condensed consolidated financial statements. Accounting Standards Recently Issued but Not Yet Adopted by the Company In December 2019, the FASB issued ASU 2019-12 "Simplifying the Accounting for Income Taxes (Topic 740)" as part of its simplification initiative to reduce the cost and complexity in accounting for income taxes. ASU 2019-12 removes certain exceptions related to the approach for intra-period tax allocation, the methodology for calculating income taxes in an interim period and the recognition of deferred tax liabilities for outside basis differences. ASU 2019-12 also amends other aspects of the guidance to help simplify and promote consistent application of GAAP. The guidance is effective for interim and annual periods beginning after December 15, 2020 and the Company has elected not to early adopt this ASU. The Company does not expect the adoption of ASU 2019-12 to have a material impact on its financial position, results of operations and liquidity. In February 2020, the FASB issued ASU 2020-04 "Reference Rate Reform (Topic 848)," which provides temporary, optional practical expedients and exceptions to enable a smoother transition to the new reference rates which will replace LIBOR and other reference rates expected to be discontinued. Adoption of the provisions of ASU 2020-04 is optional. The amendments are effective for all entities from the beginning of the interim period that includes the issuance date of the ASU. An entity may elect to apply the amendments prospectively through December 31, 2022. The Company is currently evaluating the impact of ASU 2020-04 on its financial position, results of operations and liquidity. In May 2020, the SEC issued Final Rule Release No. 33-10786 “ Amendments to Financial Disclosures about Acquired and Disposed Businesses ” (“SEC Rule 33-10786”), which amends the disclosure requirements applicable to acquisitions and dispositions of businesses. Amendments within SEC Rule 33-10786 primarily impact (1) the tests and thresholds used to determine the significance of acquisitions and dispositions; (2) the form and content of pro forma information required to be disclosed in connection with significant acquisitions and dispositions; (3) acquiree financial statement requirements; and (4) thresholds used to determine the significance of acquisitions and dispositions of real estate operations, and related financial statement requirements, among others. The amendments are effective for all SEC registrants beginning January 1, 2021, with early compliance permitted. The Company does not expect the amendments to have a material impact on its condensed consolidated financial statements.

Spin-Off of Subsidiaries (Table

Spin-Off of Subsidiaries (Tables)	9 Months Ended
	Sep. 30, 2020
Equity [Abstract]
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed	The following table presents the financial results of Pennant for the indicated period and does not include corporate overhead allocations: Three Months Ended September 30, 2019 Nine Months Ended September 30, 2019 (In thousands) Revenue $ 88,398 $ 249,039 Expense: Cost of services 67,289 187,560 Rent—cost of services 5,853 17,295 General and administrative expense 6,196 16,672 Depreciation and amortization 914 2,402 Total expenses 80,252 223,929 Income from discontinued operations 8,146 25,110 Interest income 4 26 Provision for income taxes 2,860 5,663 Income from discontinued operations, net of tax 5,290 19,473 Net income attributable to discontinued noncontrolling interests 279 629 Net income attributable to The Ensign Group, Inc. $ 5,011 $ 18,844

Revenue and Accounts Receivab_2

Revenue and Accounts Receivable (Tables)	9 Months Ended
	Sep. 30, 2020
Revenue from Contract with Customer [Abstract]
Disaggregation of Revenue	Revenue for the three and nine months ended September 30, 2020 and 2019 is summarized in the following tables: Three Months Ended September 30, 2020 2019 Revenue % of Revenue Revenue % of Revenue Medicaid $ 222,192 37.1 % $ 205,945 40.2 % Medicare 189,237 31.6 119,633 23.4 Medicaid — skilled 38,232 6.4 34,080 6.6 Total Medicaid and Medicare 449,661 75.1 359,658 70.2 Managed care 87,648 14.6 88,542 17.3 Private and other (1) 61,946 10.3 63,909 12.5 Revenue $ 599,255 100.0 % $ 512,109 100.0 % (1) Private and other payors also includes revenue from all payors generated in other ancillary services for the three months ended September 30, 2020 and 2019. During the three months ended September 30, 2020 and 2019, private and other payor s inclu des $4,065 and $660 of rental income, respectively . Nine Months Ended September 30, 2020 2019 Revenue % of Revenue Revenue % of Revenue Medicaid $ 672,506 37.9 % $ 586,222 39.7 % Medicare 519,865 29.3 355,141 24.1 Medicaid — skilled 110,626 6.3 96,323 6.5 Total Medicaid and Medicare 1,302,997 73.5 1,037,686 70.3 Managed care 271,993 15.3 258,205 17.5 Private and other (1) 198,577 11.2 180,442 12.2 Revenue $ 1,773,567 100.0 % $ 1,476,333 100.0 % (1) Private and other payors also includes revenue from all payors generated in other an cillary services for the nine months ended September 30, 2020 and 2019. During the nine months ended September 30, 2020 and 2019, private and other payors includes $12,295 and $2,085 of rental income, respectively.
Schedule of Accounts, Notes, Loans and Financing Receivable	Accounts receivable as of September 30, 2020 and December 31, 2019, is summarized in the following table: September 30, 2020 December 31, 2019 Medicaid $ 114,925 $ 125,443 Managed care 57,249 70,015 Medicare 64,331 53,163 Private and other payors 63,699 62,836 300,204 311,457 Less: allowance for doubtful accounts (6,053) (2,472) Accounts receivable, net $ 294,151 $ 308,985

Computation of Net Income Per_2

Computation of Net Income Per Common Share (Tables)	9 Months Ended
	Sep. 30, 2020
Earnings Per Share [Abstract]
Schedule of Earnings Per Share, Basic, by Common Class, Including Two Class Method	A reconciliation of the numerator and denominator used in the calculation of basic net income per common share follows: Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Numerator: Net income from continuing operations $ 43,313 $ 22,538 $ 125,202 $ 64,887 Less: net income attributable to noncontrolling interests in continuing operations 253 390 1,045 591 Net income from continuing operations attributable to The Ensign Group, Inc. 43,060 22,148 124,157 64,296 Net income from discontinued operations, net of tax — 5,290 — 19,473 Less: net income attributable to noncontrolling interests in discontinued operations — 279 — 629 Net income from discontinued operations, net of tax — 5,011 — 18,844 Net income attributable to The Ensign Group, Inc. $ 43,060 $ 27,159 $ 124,157 $ 83,140 Denominator: Weighted average shares outstanding for basic net income per share 53,328 53,941 53,299 53,470 Basic net income per common share: Income from continuing operations $ 0.81 $ 0.41 $ 2.33 $ 1.20 Income from discontinued operations — 0.09 — 0.35 Net income attributable to The Ensign Group, Inc. $ 0.81 $ 0.50 $ 2.33 $ 1.55
Schedule of Earnings Per Share, Diluted, by Common Class, Including Two Class Method	A reconciliation of the numerator and denominator used in the calculation of diluted net income per common share follows: Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Numerator: Net income from continuing operations $ 43,313 $ 22,538 $ 125,202 $ 64,887 Less: net income attributable to noncontrolling interests in continuing operations 253 390 1,045 591 Net income from continuing operations attributable to The Ensign Group, Inc. 43,060 22,148 124,157 64,296 Net income from discontinued operations, net of tax — 5,290 — 19,473 Less: net income attributable to noncontrolling interests in discontinued operations — 279 — 629 Net income from discontinued operations, net of tax — 5,011 — 18,844 Net income attributable to The Ensign Group, Inc. $ 43,060 $ 27,159 $ 124,157 $ 83,140 Denominator: Weighted average common shares outstanding 53,328 53,941 53,299 53,470 Plus: incremental shares from assumed conversion (1) 2,385 2,423 2,286 2,584 Adjusted weighted average common shares outstanding 55,713 56,364 55,585 56,054 Diluted net income per common share: Income from continuing operations $ 0.77 $ 0.39 $ 2.23 $ 1.15 Income from discontinued operations — 0.09 — 0.33 Net income attributable to The Ensign Group, Inc. $ 0.77 $ 0.48 $ 2.23 $ 1.48 (1) Options outstanding which are anti-dilutive and therefore not factored into the weighted average common shares amount above were 1,144 and 979 for th e three and nine months ended September 30, 2020, respectively, and 421 and 143 for the three and nine months ended September 30, 2019, respectivel

Business Segments (Tables)

Business Segments (Tables)	9 Months Ended
	Sep. 30, 2020
Segment Reporting [Abstract]
Reconciliation of Revenue from Segments to Consolidated	Segment revenues by major payor source were as follows: Three Months Ended September 30, 2020 Transitional and Skilled Services All Other Total Revenue Revenue % Medicaid $ 218,840 $ 3,352 (1) $ 222,192 37.1 % Medicare 189,237 — 189,237 31.6 Medicaid-skilled 38,232 — 38,232 6.4 Subtotal 446,309 3,352 449,661 75.1 Managed care 87,648 — 87,648 14.6 Private and other 36,427 25,519 (2) 61,946 10.3 Total revenue $ 570,384 $ 28,871 $ 599,255 100.0 % (1) Medicaid payor includes revenue generated from senior living operations for the three months ended September 30, 2020. (2) Private and other payors also includes revenue from rental income, senior living operations and all payors generated in other ancillary services for the three months ended September 30, 2020. Three Months Ended September 30, 2019 Transitional and Skilled Services All Other Total Revenue Revenue % Medicaid $ 202,665 $ 3,280 (1) $ 205,945 40.2 % Medicare 119,633 — 119,633 23.4 Medicaid-skilled 34,080 — 34,080 6.6 Subtotal 356,378 3,280 359,658 70.2 Managed care 88,542 — 88,542 17.3 Private and other 41,053 22,856 (2) 63,909 12.5 Total revenue $ 485,973 $ 26,136 $ 512,109 100.0 % (1) Medicaid payor includes revenue generated from senior living operations for the three months ended September 30, 2019. (2) Private and other payors also includes revenue from rental income, senior living operations and all payors generated in other ancillary services for the three months ended September 30, 2019. Nine Months Ended September 30, 2020 Transitional and Skilled Services All Other Total Revenue Revenue % Medicaid $ 662,733 $ 9,773 (1) $ 672,506 37.9 % Medicare 519,865 — 519,865 29.3 Medicaid-skilled 110,626 — 110,626 6.3 Subtotal 1,293,224 9,773 1,302,997 73.5 Managed care 271,993 — 271,993 15.3 Private and other 120,351 78,226 (2) 198,577 11.2 Total revenue $ 1,685,568 $ 87,999 $ 1,773,567 100.0 % (1) Medicaid payor includes revenue generated from senior living operations for the nine months ended September 30, 2020. (2) Private and other payors also includes revenue from rental income, senior living operations and all payors generated in other ancillary services for the nine months ended September 30, 2020. Nine Months Ended September 30, 2019 Transitional and Skilled Services All Other Total Revenue Revenue % Medicaid $ 576,504 $ 9,718 (1) $ 586,222 39.7 % Medicare 355,141 — 355,141 24.1 Medicaid-skilled 96,323 — 96,323 6.5 Subtotal 1,027,968 9,718 1,037,686 70.3 Managed care 258,205 — 258,205 17.5 Private and other 118,296 62,146 (2) 180,442 12.2 Total revenue $ 1,404,469 $ 71,864 $ 1,476,333 100.0 % (1) Medicaid payor includes revenue generated from senior living operations for the nine months ended September 30, 2019.
Schedule of Segment Reporting Information, by Segment	The following tables set forth selected financial data consolidated by business segment: Three Months Ended September 30, 2020 Transitional and Skilled Services All Other (1) Total Revenue $ 570,384 $ 28,871 $ 599,255 Segment income (loss) 91,171 (36,102) 55,069 Interest expense, net of interest and other income (890) Income before provision for income taxes $ 54,179 Depreciation and amortization $ 10,225 $ 3,532 $ 13,757 (1) General and administrative expense are included in the "all other" category. Three Months Ended September 30, 2019 Transitional and Skilled Services All Other (1) Total Revenue $ 485,973 $ 26,136 $ 512,109 Segment income (loss) 56,838 (26,039) 30,799 Interest expense, net of interest and other income (3,168) Income before provision for income taxes $ 27,631 Depreciation and amortization $ 9,331 $ 4,074 $ 13,405 (1) General and administrative expense is included in the "all other" category. Nine Months Ended September 30, 2020 Transitional and Skilled Services All Other (1) Total Revenue $ 1,685,568 $ 87,999 $ 1,773,567 Segment income (loss) 263,253 (95,957) 167,296 Interest expense, net of interest and other income (5,068) Income before provision for income taxes $ 162,228 Depreciation and amortization $ 30,682 $ 10,400 $ 41,082 (1) General and administrative expense are included in the "all other" category. Nine Months Ended September 30, 2019 Transitional and Skilled Services All Other (1) Total Revenue $ 1,404,469 $ 71,864 $ 1,476,333 Segment income (loss) 172,254 (82,767) 89,487 Interest expense, net of interest and other income (9,656) Income before provision for income taxes $ 79,831 Depreciation and amortization $ 26,883 $ 10,817 $ 37,700

Acquisitions Acquisitions (Tabl

Acquisitions Acquisitions (Tables)	9 Months Ended
	Sep. 30, 2020
Business Combinations [Abstract]
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed	The table below presents the allocation of the purchase price for the operations acquired during the nine months ended September 30, 2020 and 2019, excluding assets that were contributed to Pennant that occurred during the Spin-Off. Nine Months Ended September 30, 2020 2019 Land $ 8,938 $ 23,940 Building and improvements 13,365 48,383 Equipment, furniture, and fixtures 454 3,770 Assembled occupancy 89 305 Definite-lived intangible assets — 440 Goodwill — 5,382 Favorable leases — 294 Other indefinite-lived intangible assets 231 170 Total acquisitions $ 23,077 $ 82,684

Property and Equipment _ Net (T

Property and Equipment — Net (Tables)	9 Months Ended
	Sep. 30, 2020
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment	Property and equipment, net consists of the following: September 30, 2020 December 31, 2019 Land $ 100,678 $ 91,740 Buildings and improvements 552,217 531,538 Leasehold improvements 134,659 127,983 Equipment 231,813 212,808 Furniture and fixtures 4,525 4,453 Construction in progress 1,684 3,409 1,025,576 971,931 Less: accumulated depreciation (242,389) (204,366) Property and equipment, net $ 783,187 $ 767,565

Intangible Assets _ Net (Tables

Intangible Assets — Net (Tables)	9 Months Ended
	Sep. 30, 2020
Intangible Assets, Net (Excluding Goodwill) [Abstract]
Schedule of Finite-Lived Intangible Assets	September 30, 2020 December 31, 2019 Weighted Average Life (Years) Gross Carrying Amount Accumulated Amortization Gross Carrying Amount Accumulated Amortization Intangible Assets Net Net Lease acquisition costs 1.7 $ 360 $ (360) $ — $ 360 $ (349) $ 11 Favorable leases 2.1 534 (534) — 534 (448) 86 Assembled occupancy 0.4 3,071 (3,058) 13 2,982 (2,818) 164 Facility trade name 30.0 733 (360) 373 733 (342) 391 Customer relationships 18.2 4,640 (2,067) 2,573 4,640 (1,910) 2,730 Total $ 9,338 $ (6,379) $ 2,959 $ 9,249 $ (5,867) $ 3,382
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense	Estimated amortization expense for each of the years ending December 31 is as follows: Year Amount 2020 (remainder) $ 69 2021 238 2022 234 2023 234 2024 234 2025 234 Thereafter 1,716 $ 2,959

Goodwill and Other Indefinite_2

Goodwill and Other Indefinite-Lived Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	The following table represents the goodwill value by transitional and skilled service segment and "all other"category as of September 30, 2020: Goodwill Transitional and Skilled Services All Other Total September 30, 2020 $ 45,486 $ 8,983 $ 54,469
Schedule of Other Indefinite-lived Intangible Assets by Major Class	Other indefinite-lived intangible assets consists of the following: September 30, 2020 December 31, 2019 Trade name $ 889 $ 889 Medicare and Medicaid licenses 2,410 2,179 $ 3,299 $ 3,068

Restricted and Other Assets (Ta

Restricted and Other Assets (Tables)	9 Months Ended
	Sep. 30, 2020
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Schedule of Restricted and Other Assets	Restricted and other assets consists of the following: September 30, 2020 December 31, 2019 Debt issuance costs, net $ 2,841 $ 3,374 Long-term insurance losses recoverable asset 7,239 7,999 Deposits with landlords 12,277 11,765 Capital improvement reserves with landlords and lenders 4,042 3,024 Cash surrender value of life insurance related to deferred compensation plan 5,378 — Other — 45 Restricted and other assets $ 31,777 $ 26,207

Other Accrued Liabilities (Tabl

Other Accrued Liabilities (Tables)	9 Months Ended
	Sep. 30, 2020
Payables and Accruals [Abstract]
Schedule of Other Accrued Liabilities	Other accrued liabilities consists of the following: September 30, 2020 December 31, 2019 Quality assurance fee $ 6,452 $ 6,461 Refunds payable 35,636 29,412 Resident advances 9,720 8,870 Deferred FMAP revenue 7,629 — Cash held in trust for patients 5,596 3,038 Resident deposits 1,717 1,818 Dividends payable 2,725 2,705 Property taxes 10,933 8,055 Other 9,217 9,914 Other accrued liabilities $ 89,625 $ 70,273

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2020
Debt Disclosure [Abstract]
Schedule of Long-term Debt	Debt consists of the following: September 30, 2020 December 31, 2019 Revolving credit facility with Truist $ — $ 210,000 Mortgage loans and promissory notes 118,695 120,350 118,695 330,350 Less: current maturities (3,139) (2,702) Less: debt issuance costs, net (2,334) (2,431) $ 113,222 $ 325,217

Options and Awards (Tables)

Options and Awards (Tables)	9 Months Ended
	Sep. 30, 2020
Share-based Payment Arrangement [Abstract]
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions	The Company used the following assumptions for stock options granted during the three months ended September 30, 2020 and 2019: Grant Year Options Granted (1) Weighted Average Risk-Free Rate Expected Life Weighted Average Volatility Weighted Average Dividend Yield 2020 160 0.4% 6.3 years 41.8% 0.3% 2019 154 1.5% 6.2 years 34.0% 0.4% (1) Options granted represents historical grant values prior to the Spin-Off for the three months ended September 30, 2019. The Company used the following assumptions for stock options granted during the nine months ended September 30, 2020 and 2019: Grant Year Options Granted (1 ) Weighted Average Risk-Free Rate Expected Life Weighted Average Volatility Weighted Average Dividend Yield 2020 540 0.7% 6.2 years 38.8% 0.4% 2019 553 2.0% 6.2 years 33.9% 0.4% (1) Options granted represents historical grant values prior to the Spin-Off for the nine months ended September 30, 2019.
Schedule of Weighted Average Grant Date Fair Value and Exercise Price of Options	For the nine months ended September 30, 2020 and 2019, the following represents the exercise price and fair value displayed at grant date for stock option grants: Grant Year Granted (1) Weighted Average Exercise Price (2) Weighted Average Fair Value of Options (3) 2020 540 $ 50.46 $ 18.62 2019 553 $ 44.96 $ 16.01 (1) Options granted from January 1, 2019 through September 30, 2019 represent historical grant values prior to the impact of the Spin-Off. Options granted subsequent to October 1, 2019 represent grant values reflective of the Spin-Off. (2) Weighted average exercise price was calculated using exercise prices reflective of the Spin-Off Conversion for all periods presented.
Schedule of Common Stock Outstanding Roll Forward	The following table represents the employee stock option activity during the nine months ended September 30, 2020: Number of Weighted Number of Weighted Average January 1, 2020 4,428 $ 20.85 2,557 $ 12.82 Granted 540 50.46 Forfeited (52) 32.02 Exercised (519) 12.34 September 30, 2020 4,397 $ 25.36 2,501 $ 15.60
Share-based Payment Arrangement, Option, Exercise Price Range	The following summary information reflects stock options outstanding, vested and related details as of September 30, 2020: Stock Options Outstanding Stock Options Vested Number Outstanding Black-Scholes Fair Value Remaining Contractual Life (Years) Vested and Exercisable Year of Grant Exercise Price 2010 $4.04 - $4.20 4 $ 9 0 4 2011 5.00 - 6.77 53 101 1 53 2012 5.56 - 6.75 155 482 2 155 2013 6.76 - 9.74 312 1,285 3 312 2014 8.94 - 16.05 826 3,960 4 826 2015 18.20 - 21.39 382 2,952 5 360 2016 15.93 - 16.86 341 2,016 6 250 2017 15.80 - 19.41 417 2,460 7 213 2018 22.49 - 32.71 631 6,492 8 208 2019 41.07 - 45.76 743 11,664 9 120 2020 44.84 - 58.06 533 6,294 10 — Total 4,397 $ 37,715 2,501
Schedule of Aggregate Intrinsic Value of Options	The aggregate intrinsic value of options outstanding, vested, expected to vest and exercised as of September 30, 2020 and December 31, 2019 is as follows: Options September 30, 2020 December 31, 2019 Outstanding $ 139,537 $ 108,623 Vested 103,551 83,243 Expected to vest 31,395 22,399 Exercisable 21,044 29,032
Schedule of Nonvested Restricted Stock Units Activity	A summary of the status of the Company's non-vested restricted stock awards as of September 30, 2020 and changes during the nine months ended September 30, 2020 is presented below: Non-Vested Restricted Awards Weighted Average Grant Date Fair Value Nonvested at January 1, 2020 610 $ 31.35 Granted 242 47.02 Vested (245) 33.00 Forfeited (13) 30.20 Nonvested at September 30, 2020 594 $ 37.08
Schedule of Stock-Based Compensation Expense	Stock-based compensation expense recognized for the Company's equity incentive plans and long-term incentive plan for the three and nine months ended September 30, 2020 and 2019 was as follows: Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 (1) 2020 2019 (1) Stock-based compensation expense related to stock options $ 1,692 $ 1,227 $ 4,656 $ 3,885 Stock-based compensation expense related to restricted stock awards 2,221 1,279 5,596 3,348 Stock-based compensation expense related to stock options and restricted stock awards to non-employee directors 260 323 684 982 Total $ 4,173 $ 2,829 $ 10,936 $ 8,215 (1) The amount of stock-based compensation expense that was classified as discontinued operations was $132 and $424, respectively, for the three and nine months ended September 30, 2019.

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 30, 2020
Leases [Abstract]
Lease, Cost	The components of operating lease expense are as follows: Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Rent - cost of services (1) $ 32,504 $ 31,875 $ 97,318 $ 93,278 General and administrative expense 16 55 48 360 Depreciation and amortization (2) 289 495 933 1,485 Variable lease costs (3) 3,229 3,106 9,692 9,169 $ 36,038 $ 35,531 $ 107,991 $ 104,292 (1) Rent- cost of services includes deferred rent expense adju stments of $101 and $337 for the three and nine months ended September 30, 2020, respectively. Rent- cost of services includes a reduction in deferred rent expense adjustments of $983 and increase in deferred rent expense adjustments of $134 for the three and nine months ended September 30, 2019, respectively. Additionally, rent- cost of services includes other variable lease costs such as CPI increases and short-term leases of $567 and $1,781 for the three and nine months ended September 30, 2020, respectively, and $628 and $1,056 for the three and nine months ended September 30, 2019, respectively. (2) Depreciation and amortization is related to the amortization of favorable and direct lease costs. (3) Variable lease costs, including property taxes and insurance, are classified in Cost of services in the Company's condensed consolidated statements of income.
Lessee, Operating Lease, Liability, Maturity	Future minimum lease payments for all leases as of September 30, 2020 are as follows: Year Amount 2020 (remainder) $ 31,940 2021 127,499 2022 127,130 2023 125,393 2024 124,412 2025 124,264 Thereafter 1,025,979 Total lease payments 1,686,617 Less: present value adjustment (686,409) Present value of total lease liabilities 1,000,208 Less: current lease liabilities (47,342) Long-term operating lease liabilities $ 952,866
Operating Lease, Lease Income	Total rental income from all third-party sources for the three and nine months ended September 30, 2020 and 2019 is as follows: Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Pennant (1) $ 3,443 $ — $ 10,272 $ — Other third-party 622 660 2,023 2,085 $ 4,065 $ 660 $ 12,295 $ 2,085 (1) Pennant rental income includes variable rent such as property taxes of $312 and $909 during the three and nine months ended September 30, 2020, respectively.
Lessor, Operating Lease, Payments to be Received, Maturity	Future annual rental income for all leases as of September 30, 2020 were as follows: Year Amount (1) 2020 (remainder) $ 4,104 2021 15,463 2022 14,918 2023 14,606 2024 14,073 2025 13,875 Thereafter 98,956 Total $ 175,995

Description of Business (Detail

Description of Business (Details)	9 Months Ended	12 Months Ended
	Sep. 30, 2020facilitybedsegment	Dec. 31, 2019segment	Oct. 01, 2019businessfacility	Sep. 30, 2019bed
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Health care facilities	226
Operational skilled nursing beds | bed	23,000
Operational senior living units | bed	2,300
Number of real estate properties leased	163
Number of real estate properties leased with an option to purchase	11
Restructuring Cost and Reserve [Line Items]
Number of real estate properties	93
Number of reportable segments | segment	1	3
Wholly Owned Properties
Restructuring Cost and Reserve [Line Items]
Number of real estate properties	63
Senior Living Facilities | The Pennant Group, Inc.
Restructuring Cost and Reserve [Line Items]
Number of real estate properties	2
Spinoff
Restructuring Cost and Reserve [Line Items]
Public companies created | business			2
Spinoff | Senior Living Facilities | The Pennant Group, Inc.
Restructuring Cost and Reserve [Line Items]
Number of real estate properties	31		29
Skilled Nursing Operations
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Operational skilled nursing beds | bed	303			1,454
Remaining Company | Skilled Nursing Operations | Spinoff
Restructuring Cost and Reserve [Line Items]
Number of real estate properties	2

Summary of Significant Accoun_3

Summary of Significant Accounting Policies - Divestiture (Details) - Disposal Group, Disposed of by Sale, Not Discontinued Operations $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)facility
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Senior living facility | facility	1
Sale price from divestiture of businesses | $	$ 1,838

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Property and Equipment (Details)	9 Months Ended
	Sep. 30, 2020
Minimum
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	3 years
Maximum
Property, Plant and Equipment [Line Items]
Property, plant and equipment, useful life	59 years

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Impairment of Long-Lived Assets (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Accounting Policies [Abstract]
Impairment of long-lived assets	$ 2,681	$ 1,471	$ 2,681	$ 1,471

Summary of Significant Accoun_6

Summary of Significant Accounting Policies - Intangible Assets and Goodwill (Details) - USD ($)	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Finite-Lived Intangible Assets [Line Items]
Goodwill impairment	$ 0	$ 0
Facility trade name
Finite-Lived Intangible Assets [Line Items]
Finite-lived intangible asset, useful life	30 years
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Finite-lived intangible asset, useful life	20 years
Minimum | Assembled occupancy
Finite-Lived Intangible Assets [Line Items]
Finite-lived intangible asset, useful life	4 months
Maximum | Assembled occupancy
Finite-Lived Intangible Assets [Line Items]
Finite-lived intangible asset, useful life	8 months

Summary of Significant Accoun_7

Summary of Significant Accounting Policies - Self-Insurance General and Professional (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
General and Professional Liability
Liability for Claims and Claims Adjustment Expense [Line Items]
Malpractice loss contingency, accrual, undiscounted	$ 53,759	$ 46,984
Self-Insurance Retention Per Claim | Parent Company | General Liability Insurance
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	500
Aggregate Deductible | Parent Company | California | General Liability Insurance
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	750
Aggregate Deductible | Parent Company | Non-California | General Liability Insurance
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	1,000
Blanket Aggregate | Third-Party Payor | All States Except Colorado | General Liability Insurance
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	5,000
Per Facility | Third-Party Payor | All States Except Colorado | General Liability Insurance
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	3,000
Per Facility | Third-Party Payor | Colorado | General Liability Insurance
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	3,000
Per Occurence | Third-Party Payor | All States Except Colorado | General Liability Insurance
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	1,000
Per Occurence | Third-Party Payor | Colorado | General Liability Insurance
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	$ 1,000

Summary of Significant Accoun_8

Summary of Significant Accounting Policies - Self-Insurance Workers' Compensation (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Workers' Compensation
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	$ 25,230	$ 25,419
Workers' Compensation
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	500
Workers' Compensation | TEXAS
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	750
Workers' Compensation | Loss-Sensitive Limit Per Claim | Other States, Except California, Texas and Washington
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	$ 350

Summary of Significant Accoun_9

Summary of Significant Accounting Policies - Self Insurance Recoveries (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Accounting Policies [Abstract]
Long-term insurance losses recoverable asset	$ 7,239	$ 7,999

Summary of Significant Accou_10

Summary of Significant Accounting Policies - Self-Insurance Health Insurance (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Health
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	$ 8,810	$ 6,964
Health Liability Insurance | Stop-Loss Insurance Limit Per Claim
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	300
Health Liability Insurance | Stop Loss Deductible
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	$ 75

COVID-19 UPDATE (Details)

COVID-19 UPDATE (Details) - USD ($) $ in Thousands	1 Months Ended	3 Months Ended	9 Months Ended
	Jul. 31, 2020	Sep. 30, 2020	Sep. 30, 2020	Sep. 30, 2019
Subsequent Events [Abstract]
Repayments of CARES Act Provider Relief Fund and Medicare Advance Payment Program(Note 3)	$ 108,756		$ 111,988	$ 0
Coronavirus Aid, Relief, and Economic Security (“CARES”) Funds Received		$ 23,296	132,052
Medicare Accelerated and Advance Payment			103,924
Repayment of Medicare Accelerated and Advance Payment Program	$ 3,232
Medicare Accelerated and Advance Payment, outstanding liability		100,692	100,692
FMAP payments received		17,344	32,455
Revenue, FMAP payments received		11,691	24,825
Deferred payment of social security taxes		$ 33,231	$ 33,231

Spin-Off of Subsidiaries - Narr

Spin-Off of Subsidiaries - Narrative (Details) $ in Thousands	Oct. 01, 2019business	Sep. 30, 2019USD ($)	Sep. 30, 2019USD ($)	Dec. 31, 2018USD ($)	Sep. 30, 2020facility
Restructuring Cost and Reserve [Line Items]
Health care facilities | facility					226
Spinoff
Restructuring Cost and Reserve [Line Items]
Public companies created | business	2
Expense related to spin-off transaction				$ 9,119
Restructuring charges		$ 3,261	$ 7,909
Spinoff | Common Stock
Restructuring Cost and Reserve [Line Items]
Stock split, conversion ratio	0.5

Spin-Off of Subsidiaries - Resu

Spin-Off of Subsidiaries - Results of Operations of Disposal Group (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Equity [Abstract]
Revenue		$ 88,398		$ 249,039
Expense:
Cost of services		67,289		187,560
Rent—cost of services		5,853		17,295
General and administrative expense		6,196		16,672
Depreciation and amortization		914		2,402
Total expenses		80,252		223,929
Income from discontinued operations		8,146		25,110
Interest income		4		26
Provision for income taxes		2,860		5,663
Income from discontinued operations, net of tax	$ 0	5,290	$ 0	19,473
Net income attributable to discontinued noncontrolling interests	0	279	0	629
Net income attributable to The Ensign Group, Inc.	$ 0	$ 5,011	$ 0	$ 18,844

Revenue and Accounts Receivab_3

Revenue and Accounts Receivable - Revenue from Medicare and Medicaid Programs (Details) - Customer Concentration Risk - Revenue Benchmark	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Disaggregation of Revenue [Line Items]
Concentration risk	100.00%	100.00%	100.00%	100.00%
Total Medicare and Medicaid
Disaggregation of Revenue [Line Items]
Concentration risk	75.10%	70.20%	73.50%	70.30%

Revenue and Accounts Receivab_4

Revenue and Accounts Receivable - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Disaggregation of Revenue [Line Items]
Revenue	$ 599,255	$ 512,109	$ 1,773,567	$ 1,476,333
Operating lease, lease income	$ 4,065	$ 660	$ 12,295	$ 2,085
Customer Concentration Risk | Revenue Benchmark
Disaggregation of Revenue [Line Items]
Concentration risk	100.00%	100.00%	100.00%	100.00%
Medicaid
Disaggregation of Revenue [Line Items]
Revenue	$ 222,192	$ 205,945	$ 672,506	$ 586,222
Medicaid | Customer Concentration Risk | Revenue Benchmark
Disaggregation of Revenue [Line Items]
Concentration risk	37.10%	40.20%	37.90%	39.70%
Medicare
Disaggregation of Revenue [Line Items]
Revenue	$ 189,237	$ 119,633	$ 519,865	$ 355,141
Medicare | Customer Concentration Risk | Revenue Benchmark
Disaggregation of Revenue [Line Items]
Concentration risk	31.60%	23.40%	29.30%	24.10%
Medicaid — skilled
Disaggregation of Revenue [Line Items]
Revenue	$ 38,232	$ 34,080	$ 110,626	$ 96,323
Medicaid — skilled | Customer Concentration Risk | Revenue Benchmark
Disaggregation of Revenue [Line Items]
Concentration risk	6.40%	6.60%	6.30%	6.50%
Total Medicaid and Medicare
Disaggregation of Revenue [Line Items]
Revenue	$ 449,661	$ 359,658	$ 1,302,997	$ 1,037,686
Total Medicaid and Medicare | Customer Concentration Risk | Revenue Benchmark
Disaggregation of Revenue [Line Items]
Concentration risk	75.10%	70.20%	73.50%	70.30%
Managed care
Disaggregation of Revenue [Line Items]
Revenue	$ 87,648	$ 88,542	$ 271,993	$ 258,205
Managed care | Customer Concentration Risk | Revenue Benchmark
Disaggregation of Revenue [Line Items]
Concentration risk	14.60%	17.30%	15.30%	17.50%
Private and other
Disaggregation of Revenue [Line Items]
Revenue	$ 61,946	$ 63,909	$ 198,577	$ 180,442
Private and other | Customer Concentration Risk | Revenue Benchmark
Disaggregation of Revenue [Line Items]
Concentration risk	10.30%	12.50%	11.20%	12.20%

Revenue and Accounts Receivab_5

Revenue and Accounts Receivable - Accounts Receivable (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts receivable	$ 300,204	$ 311,457
Less: allowance for doubtful accounts	(6,053)	(2,472)
Accounts receivable, net	294,151	308,985
Medicaid
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts receivable	114,925	125,443
Managed care
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts receivable	57,249	70,015
Medicare
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts receivable	64,331	53,163
Private and other payors
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts receivable	$ 63,699	$ 62,836

Computation of Net Income Per_3

Computation of Net Income Per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Sep. 30, 2020	Sep. 30, 2019
Numerator:
Net income from continuing operations	$ 43,313			$ 22,538			$ 125,202	$ 64,887
Less: net income attributable to noncontrolling interests in continuing operations	253			390			1,045	591
Net income from continuing operations attributable to The Ensign Group, Inc.	43,060			22,148			124,157	64,296
Net income from discontinued operations, net of tax	0			5,290			0	19,473
Net income attributable to noncontrolling interests in discontinued operations (Note 4)	0			279			0	629
Income from discontinued operations, net of income tax (Note 4)	0			5,011			0	18,844
Net income attributable to The Ensign Group, Inc.	$ 43,060	$ 40,248	$ 40,849	$ 27,159	$ 28,609	$ 27,372	$ 124,157	$ 83,140
Denominator:
Weighted average shares outstanding for basic net income per share (in shares)	53,328			53,941			53,299	53,470
Plus: incremental shares from assumed conversion (in shares)	2,385			2,423			2,286	2,584
Adjusted weighted average common shares outstanding (in shares)	55,713			56,364			55,585	56,054
Basic net income per common share:
Income from continuing operations (in dollars per share)	$ 0.81			$ 0.41			$ 2.33	$ 1.20
Income from discontinued operations (in dollars per share)	0			0.09			0	0.35
Basic income per share attributable to The Ensign Group, Inc. (in dollars per share)	0.81			0.50			2.33	1.55
Diluted net income per common share:
Income from continuing operations (in dollars per share)	0.77			0.39			2.23	1.15
Income from discontinued operations (in dollars per share)	0			0.09			0	0.33
Diluted income per share attributable to The Ensign Group, Inc.(in dollars per share)	$ 0.77			$ 0.48			$ 2.23	$ 1.48
Antidilutive securities excluded from computation of earnings per share, amount (in shares)	1,144			421			979	143

Fair Value Measurements - Sched

Fair Value Measurements - Schedule of Fair Value, of Assets and Liabilities Measured on Recurring Basis (Details) - USD ($)	Sep. 30, 2020	Dec. 31, 2019
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash surrender value of life insurance related to deferred compensation plan	$ 5,378,000	$ 0
Fair Value, Inputs, Level 1
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash and cash equivalents, fair value disclosure	175,380,000	59,175,000
Fair Value, Inputs, Level 2
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Cash surrender value of life insurance related to deferred compensation plan	$ 5,378,000	$ 0

Fair Value Measurements - Inves

Fair Value Measurements - Investments (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Debt Security, Corporate, US
Schedule of Held-to-maturity Securities [Line Items]
Debt securities, held-to-maturity	$ 49,345	$ 48,325

Business Segments - Narrative (

Business Segments - Narrative (Details)	9 Months Ended	12 Months Ended
	Sep. 30, 2020facilitysegment	Dec. 31, 2019segment
Segment Reporting [Abstract]
Number of reportable segments | segment	1	3
Transitional and skilled service facilities	193
Transitional and skilled services and senior living campuses	24
Senior living facilities	9

Business Segments - Revenue by

Business Segments - Revenue by Segment (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 599,255	$ 512,109	$ 1,773,567	$ 1,476,333
Revenue Benchmark | Customer Concentration Risk
Segment Reporting, Revenue Reconciling Item [Line Items]
Concentration risk	100.00%	100.00%	100.00%	100.00%
Medicaid
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 222,192	$ 205,945	$ 672,506	$ 586,222
Medicaid | Revenue Benchmark | Customer Concentration Risk
Segment Reporting, Revenue Reconciling Item [Line Items]
Concentration risk	37.10%	40.20%	37.90%	39.70%
Medicare
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 189,237	$ 119,633	$ 519,865	$ 355,141
Medicare | Revenue Benchmark | Customer Concentration Risk
Segment Reporting, Revenue Reconciling Item [Line Items]
Concentration risk	31.60%	23.40%	29.30%	24.10%
Medicaid — skilled
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 38,232	$ 34,080	$ 110,626	$ 96,323
Medicaid — skilled | Revenue Benchmark | Customer Concentration Risk
Segment Reporting, Revenue Reconciling Item [Line Items]
Concentration risk	6.40%	6.60%	6.30%	6.50%
Total Medicaid and Medicare
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 449,661	$ 359,658	$ 1,302,997	$ 1,037,686
Total Medicaid and Medicare | Revenue Benchmark | Customer Concentration Risk
Segment Reporting, Revenue Reconciling Item [Line Items]
Concentration risk	75.10%	70.20%	73.50%	70.30%
Managed care
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 87,648	$ 88,542	$ 271,993	$ 258,205
Managed care | Revenue Benchmark | Customer Concentration Risk
Segment Reporting, Revenue Reconciling Item [Line Items]
Concentration risk	14.60%	17.30%	15.30%	17.50%
Private and other
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 61,946	$ 63,909	$ 198,577	$ 180,442
Private and other | Revenue Benchmark | Customer Concentration Risk
Segment Reporting, Revenue Reconciling Item [Line Items]
Concentration risk	10.30%	12.50%	11.20%	12.20%
Operating Segments | Transitional and Skilled Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 570,384	$ 485,973	$ 1,685,568	$ 1,404,469
Operating Segments | Medicaid | Transitional and Skilled Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	218,840	202,665	662,733	576,504
Operating Segments | Medicare | Transitional and Skilled Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	189,237	119,633	519,865	355,141
Operating Segments | Medicaid — skilled | Transitional and Skilled Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	38,232	34,080	110,626	96,323
Operating Segments | Total Medicaid and Medicare | Transitional and Skilled Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	446,309	356,378	1,293,224	1,027,968
Operating Segments | Managed care | Transitional and Skilled Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	87,648	88,542	271,993	258,205
Operating Segments | Private and other | Transitional and Skilled Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	36,427	41,053	120,351	118,296
All Other
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	28,871	26,136	87,999	71,864
All Other | Medicaid
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	3,352	3,280	9,773	9,718
All Other | Medicare
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	0	0	0	0
All Other | Medicaid — skilled
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	0	0	0	0
All Other | Total Medicaid and Medicare
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	3,352	3,280	9,773	9,718
All Other | Managed care
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	0	0	0	0
All Other | Private and other
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 25,519	$ 22,856	$ 78,226	$ 62,146

Business Segments - Schedule of

Business Segments - Schedule of Segment Reporting Information, by Segment (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Segment Reporting Information [Line Items]
Revenue	$ 599,255	$ 512,109	$ 1,773,567	$ 1,476,333
Segment income (loss)	55,069	30,799	167,296	89,487
Interest expense, net of interest and other income	(890)	(3,168)	(5,068)	(9,656)
Income before provision for income taxes	54,179	27,631	162,228	79,831
Depreciation and amortization	13,757	13,405	41,082	37,700
Operating Segments | Transitional and Skilled Services
Segment Reporting Information [Line Items]
Revenue	570,384	485,973	1,685,568	1,404,469
Segment income (loss)	91,171	56,838	263,253	172,254
Depreciation and amortization	10,225	9,331	30,682	26,883
All Other
Segment Reporting Information [Line Items]
Revenue	28,871	26,136	87,999	71,864
Segment income (loss)	(36,102)	(26,039)	(95,957)	(82,767)
Depreciation and amortization	$ 3,532	$ 4,074	$ 10,400	$ 10,817

Acquisitions (Details)

Acquisitions (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2020USD ($)facilityoperationbed	Sep. 30, 2019USD ($)operationfacilitybed	Oct. 01, 2019facility
Business Acquisition [Line Items]
Operational skilled nursing beds | bed	23,000
Operational senior living units | bed	2,300
Total acquisitions | $	$ 23,077	$ 82,684
Number of real estate properties | facility	93
Payments to acquire real estate | $		10,735
Payments to acquire asset acquisitions | $	$ 23,077	75,305
Payments to acquire businesses, gross | $		7,379
Notes issued | $		$ 924
The Pennant Group, Inc. | Senior Living Facilities
Business Acquisition [Line Items]
Number of real estate properties | facility	2
Skilled Nursing Operations
Business Acquisition [Line Items]
Number of businesses acquired	3	11
Operational skilled nursing beds | bed	303	1,454
Transitional and Skilled Services and Senior Living Campuses
Business Acquisition [Line Items]
Number of businesses acquired	1	3
Senior Living Facilities
Business Acquisition [Line Items]
Number of businesses acquired	1	2
Operational senior living units | facility	298	312
Asset Acquisition
Business Acquisition [Line Items]
Number of businesses acquired		17
Business Combination
Business Acquisition [Line Items]
Number of businesses acquired		1
Spinoff
Business Acquisition [Line Items]
Total acquisitions | $		$ 18,779
Spinoff | The Pennant Group, Inc. | Senior Living Facilities
Business Acquisition [Line Items]
Number of real estate properties | facility	31		29
Spinoff | Senior Living Facilities
Business Acquisition [Line Items]
Number of businesses acquired		1
Spinoff | Home Health Agencies
Business Acquisition [Line Items]
Number of businesses acquired		2
Spinoff | Hospice Agencies
Business Acquisition [Line Items]
Number of businesses acquired		5
Spinoff | Home Care Agency
Business Acquisition [Line Items]
Number of businesses acquired		2

Acquisitions - Purchase Price A

Acquisitions - Purchase Price Allocation (Details) - Asset Acquisition - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Business Acquisition [Line Items]
Definite-lived intangible assets	$ 0	$ 440
Goodwill	0	5,382
Favorable leases	0	294
Other indefinite-lived intangible assets	231	170
Total acquisitions	23,077	82,684
Land
Business Acquisition [Line Items]
Property, plant and equipment	8,938	23,940
Buildings and improvements
Business Acquisition [Line Items]
Property, plant and equipment	13,365	48,383
Furniture and fixtures
Business Acquisition [Line Items]
Property, plant and equipment	454	3,770
Assembled occupancy
Business Acquisition [Line Items]
Property, plant and equipment	$ 89	$ 305

Property and Equipment _ Net (D

Property and Equipment — Net (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Property and equipment	$ 1,025,576	$ 971,931
Less: accumulated depreciation	(242,389)	(204,366)
Property and equipment, net	783,187	767,565
Land
Property, Plant and Equipment [Line Items]
Property and equipment	100,678	91,740
Buildings and improvements
Property, Plant and Equipment [Line Items]
Property and equipment	552,217	531,538
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment	134,659	127,983
Equipment
Property, Plant and Equipment [Line Items]
Property and equipment	231,813	212,808
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Property and equipment	4,525	4,453
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment	$ 1,684	$ 3,409

Intangible Assets _ Net - Sched

Intangible Assets — Net - Schedule of Finite Lived Intangible Assets (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Dec. 31, 2019
Acquired Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 9,338	$ 9,249
Accumulated Amortization	(6,379)	(5,867)
Net	$ 2,959	3,382
Lease acquisition costs
Acquired Finite-Lived Intangible Assets [Line Items]
Finite-lived intangible assets, weighted average useful life	1 year 8 months 12 days
Gross Carrying Amount	$ 360	360
Accumulated Amortization	(360)	(349)
Net	$ 0	11
Favorable leases
Acquired Finite-Lived Intangible Assets [Line Items]
Finite-lived intangible assets, weighted average useful life	2 years 1 month 6 days
Gross Carrying Amount	$ 534	534
Accumulated Amortization	(534)	(448)
Net	$ 0	86
Assembled occupancy
Acquired Finite-Lived Intangible Assets [Line Items]
Finite-lived intangible assets, weighted average useful life	4 months 24 days
Gross Carrying Amount	$ 3,071	2,982
Accumulated Amortization	(3,058)	(2,818)
Net	$ 13	164
Facility trade name
Acquired Finite-Lived Intangible Assets [Line Items]
Finite-lived intangible assets, weighted average useful life	30 years
Gross Carrying Amount	$ 733	733
Accumulated Amortization	(360)	(342)
Net	$ 373	391
Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Finite-lived intangible assets, weighted average useful life	18 years 2 months 12 days
Gross Carrying Amount	$ 4,640	4,640
Accumulated Amortization	(2,067)	(1,910)
Net	$ 2,573	$ 2,730

Intangible Assets _ Net - Narra

Intangible Assets — Net - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Finite-Lived Intangible Assets [Line Items]
Amortization of intangible assets	$ 354	$ 855	$ 1,445	$ 2,724
Right of use asset amortization	289		933
Operating lease expense	36,038	35,531	107,991	104,292
Depreciation and amortization
Finite-Lived Intangible Assets [Line Items]
Operating lease expense	$ 289	$ 495	$ 933	$ 1,485

Intangible Assets _ Net - Futur

Intangible Assets — Net - Future Amortization (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Year
2020 (remainder)	$ 69
2021	238
2022	234
2023	234
2024	234
2025	234
Thereafter	1,716
Net	$ 2,959	$ 3,382

Goodwill and Other Indefinite_3

Goodwill and Other Indefinite-Lived Intangible Assets - Goodwill Rollforward (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Goodwill [Line Items]
Goodwill	$ 54,469	$ 54,469
Operating Segments | Transitional and Skilled Services
Goodwill [Line Items]
Goodwill	45,486
All Other
Goodwill [Line Items]
Goodwill	$ 8,983

Goodwill and Other Indefinite_4

Goodwill and Other Indefinite-Lived Intangible Assets - Indefinite-Lived Intangible Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Indefinite-lived Intangible Assets [Line Items]
Medicare and Medicaid licenses	$ 3,299	$ 3,068
Trade name
Indefinite-lived Intangible Assets [Line Items]
Medicare and Medicaid licenses	889	889
Medicare and Medicaid licenses
Indefinite-lived Intangible Assets [Line Items]
Medicare and Medicaid licenses	$ 2,410	$ 2,179

Restricted and Other Assets - S

Restricted and Other Assets - Schedule of Restricted and Other Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Debt issuance costs, net	$ 2,841	$ 3,374
Long-term insurance losses recoverable asset	7,239	7,999
Deposits with landlords	12,277	11,765
Capital improvement reserves with landlords and lenders	4,042	3,024
Cash surrender value of life insurance related to deferred compensation plan	5,378	0
Other	0	45
Restricted and other assets	$ 31,777	$ 26,207

Restricted and Other Assets - N

Restricted and Other Assets - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2020
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Gain on deferral investment	$ 252	$ 710
Deferral investment expense	$ 268	$ 657

Other Accrued Liabilities (Deta

Other Accrued Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019	Sep. 30, 2019
Payables and Accruals [Abstract]
Quality assurance fee	$ 6,452	$ 6,461
Refunds payable	35,636	29,412
Resident advances	9,720	8,870
Deferred FMAP revenue	7,629	0
Cash held in trust for patients	5,596	3,038
Resident deposits	1,717	1,818
Dividends payable	2,725	2,705	$ 2,564
Property taxes	10,933	8,055
Other	9,217	9,914
Other accrued liabilities	$ 89,625	$ 70,273

Income Taxes Expense (Details)

Income Taxes Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Income Tax Disclosure [Abstract]
Provision for income taxes	$ 10,866	$ 5,093	$ 37,026	$ 14,944
Total income tax provision			22.80%	18.70%

Debt - Schedule of Long term de

Debt - Schedule of Long term debt (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Long-term debt, gross	$ 118,695	$ 330,350
Less: current maturities	(3,139)	(2,702)
Less: debt issuance costs, net	(2,334)	(2,431)
Long-term debt—less current maturities	113,222	325,217
Mortgage loans and promissory notes | Mortgage loans and promissory notes
Debt Instrument [Line Items]
Long-term debt, gross	118,695	120,350
Less: current maturities	(3,139)
Truist | Revolving Credit Facility
Debt Instrument [Line Items]
Long-term debt, gross	$ 0	$ 210,000

Debt - Credit Facility with a L

Debt - Credit Facility with a Lending Consortium Arranged by SunTrust (Details)	Oct. 01, 2019USD ($)	Oct. 26, 2020USD ($)	Sep. 30, 2020USD ($)	Dec. 31, 2019USD ($)
Debt Instrument [Line Items]
Long-term debt, gross			$ 118,695,000	$ 330,350,000
Truist | Revolving Credit Facility
Debt Instrument [Line Items]
Total net debt ratio, maximum	3
Long-term debt, threshold for EBITDA ratio increase election	$ 50,000,000
Total net debt ratio, maximum after increase election	3.50
Total net debt ratio, minimum	1.50
Long-term debt, gross			0	$ 210,000,000
Truist | Revolving Credit Facility | Minimum
Debt Instrument [Line Items]
Line of credit facility, unused capacity, commitment fee percentage	0.25%
Truist | Revolving Credit Facility | Maximum
Debt Instrument [Line Items]
Line of credit facility, unused capacity, commitment fee percentage	0.45%
Truist | Revolving Credit Facility | Third Amended Credit Facility
Debt Instrument [Line Items]
Line of credit facility, maximum borrowing capacity	$ 350,000,000
Long-term debt, gross			$ 0
Truist | Revolving Credit Facility | Third Amended Credit Facility | Subsequent Event
Debt Instrument [Line Items]
Long-term debt, gross		$ 0
Truist | Revolving Credit Facility | Base Rate | Minimum
Debt Instrument [Line Items]
Interest rate margin	0.50%
Truist | Revolving Credit Facility | Base Rate | Maximum
Debt Instrument [Line Items]
Interest rate margin	1.50%
Truist | Revolving Credit Facility | LIBOR | Minimum
Debt Instrument [Line Items]
Interest rate margin	1.50%
Truist | Revolving Credit Facility | LIBOR | Maximum
Debt Instrument [Line Items]
Interest rate margin	2.50%

Debt - Mortgage Loans and Promi

Debt - Mortgage Loans and Promissory Notes and Off-Balance Sheet Arrangements (Details) $ in Thousands	Jun. 01, 2020	May 01, 2015	Sep. 30, 2020USD ($)facility	Sep. 30, 2020USD ($)facility	Dec. 31, 2019USD ($)
Debt Instrument [Line Items]
Long-term debt, gross			$ 118,695	$ 118,695	$ 330,350
Amount outstanding, current			3,139	3,139	2,702
Letters of credit outstanding, pledged amount			7,580	7,580
Letter of Credit [Member]
Debt Instrument [Line Items]
Letter of credit increase			1,788
Line of credit facility, current borrowing capacity			$ 7,580	$ 7,580
Mortgage loans and promissory notes | Mortgages
Debt Instrument [Line Items]
Number of operating subsidiaries | facility			19	19
Notes payable			$ 114,428	$ 114,428
Prepayment penalty reduced rate during first three years			10.00%	10.00%
Prepayment penalty reduced rate during the fourth year			3.00%	3.00%
Prepayment penalty reduced rate for the fifth through tenth years			1.00%	1.00%
Mortgage loans and promissory notes | Mortgages | Minimum
Debt Instrument [Line Items]
Debt Instrument, pre-payment fee reduction, term				5 years
Debt instrument, term				25 years
Mortgage loans and promissory notes | Mortgages | Maximum
Debt Instrument [Line Items]
Debt Instrument, pre-payment fee reduction, term				10 years
Debt instrument, term				35 years
Mortgage loans and promissory notes | Notes Payable to Banks | Minimum
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage			2.60%	2.60%
Mortgage loans and promissory notes | Notes Payable to Banks | Maximum
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage			3.50%	3.50%
Mortgage loans and promissory notes | Promissory Note, 5.3%
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage		5.30%
Mortgage loans and promissory notes | Promissory Note, 5.3% | Minimum
Debt Instrument [Line Items]
Debt instrument, term		12 years
Mortgage loans and promissory notes | Promissory Note, 4.3%
Debt Instrument [Line Items]
Debt instrument, interest rate, stated percentage	4.30%
Mortgage loans and promissory notes | Promissory Note, 4.3% | Minimum
Debt Instrument [Line Items]
Debt instrument, term	10 months
Mortgage loans and promissory notes | Notes Payable Other Payables
Debt Instrument [Line Items]
Long-term debt, gross			$ 118,695	$ 118,695	$ 120,350
Amount outstanding, current			3,139	3,139
Long-term debt—less current maturities			$ 115,556	$ 115,556

Options and Awards - Stock Opti

Options and Awards - Stock Options Narrative (Details) shares in Thousands	May 25, 2017installmentshares	Sep. 30, 2020planshares	Sep. 30, 2019shares	Sep. 30, 2020plan$ / sharesshares	Sep. 30, 2019$ / sharesshares	Oct. 01, 2019shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of option plans | plan		1		1
Award vesting period				5 years
Options granted (in shares)		160	154	540	553
Grant date intrinsic value (in dollars per share) | $ / shares				$ 0	$ 0
2017 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized (in shares)	6,881
Conversion to reduce shares availability	1
Other than options, conversion to reduce shares availability	2.5
Award vesting period	5 years
Award vesting rights, percentage	20.00%
Expiration period	10 years
Number of shares available for grant (in shares)		3,334		3,334
2017 Plan | Non-employee directors
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of installments | installment	3
Award requisite service period	3 years
Spinoff | 2017 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized (in shares)						8,118

Options and Awards - Valuation

Options and Awards - Valuation Assumptions (Details) - shares shares in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Share-based Payment Arrangement [Abstract]
Options Granted (in shares)	160	154	540	553
Weighted Average Risk-Free Rate	0.40%	1.50%	0.70%	2.00%
Expected Life	6 years 3 months 18 days	6 years 2 months 12 days	6 years 2 months 12 days	6 years 2 months 12 days
Weighted Average Volatility	41.80%	34.00%	38.80%	33.90%
Weighted Average Dividend Yield	0.30%	0.40%	0.40%	0.40%

Options and Awards - Exercise P

Options and Awards - Exercise Price and Fair Value (Details) - $ / shares shares in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Share-based Payment Arrangement [Abstract]
Granted (in shares)	160	154	540	553
Weighted Average Exercise Price (in dollars per share)			$ 50.46	$ 44.96
Weighted Average Fair Value of Options (in dollars per share)			$ 18.62	$ 16.01

Options and Awards - Options Ou

Options and Awards - Options Outstanding Rollforward (Details) - $ / shares shares in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019
Number of Options Outstanding
Balance at beginning of period, (in shares)			4,428
Granted (in shares)	160	154	540	553
Forfeited (in shares)			(52)
Exercised (in shares)			(519)
Balance at end of period, (in shares)	4,397		4,397
Weighted Average Exercise Price
Balance at beginning of period, (in dollars per share)			$ 20.85
Granted (in dollars per share)			50.46	$ 44.96
Forfeited (in dollars per share)			32.02
Exercised (in dollars per share)			12.34
Balance at end of period, (in dollars per share)	$ 25.36		$ 25.36
Number of options vested (in shares)	2,501		2,501		2,557
Weighted average exercise price of options vested (in dollars per share)	$ 15.60		$ 15.60		$ 12.82

Options and Awards - Options _2

Options and Awards - Options Outstanding by Exercise Price (Details) $ / shares in Units, shares in Thousands, $ in Thousands	9 Months Ended
	Sep. 30, 2020USD ($)$ / sharesshares
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Number outstanding (in shares)	4,397
Black-Scholes Fair Value | $	$ 37,715
Stock options vested and exercisable (in shares)	2,501
2010
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Exercise price, lower range limit (in dollars per share) | $ / shares	$ 4.04
Exercise price, upper range limit (in dollars per share) | $ / shares	$ 4.20
Number outstanding (in shares)	4
Black-Scholes Fair Value | $	$ 9
Remaining Contractual Life (Years)	0 years
Stock options vested and exercisable (in shares)	4
2011
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Exercise price, lower range limit (in dollars per share) | $ / shares	$ 5
Exercise price, upper range limit (in dollars per share) | $ / shares	$ 6.77
Number outstanding (in shares)	53
Black-Scholes Fair Value | $	$ 101
Remaining Contractual Life (Years)	1 year
Stock options vested and exercisable (in shares)	53
2012
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Exercise price, lower range limit (in dollars per share) | $ / shares	$ 5.56
Exercise price, upper range limit (in dollars per share) | $ / shares	$ 6.75
Number outstanding (in shares)	155
Black-Scholes Fair Value | $	$ 482
Remaining Contractual Life (Years)	2 years
Stock options vested and exercisable (in shares)	155
2013
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Exercise price, lower range limit (in dollars per share) | $ / shares	$ 6.76
Exercise price, upper range limit (in dollars per share) | $ / shares	$ 9.74
Number outstanding (in shares)	312
Black-Scholes Fair Value | $	$ 1,285
Remaining Contractual Life (Years)	3 years
Stock options vested and exercisable (in shares)	312
2014
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Exercise price, lower range limit (in dollars per share) | $ / shares	$ 8.94
Exercise price, upper range limit (in dollars per share) | $ / shares	$ 16.05
Number outstanding (in shares)	826
Black-Scholes Fair Value | $	$ 3,960
Remaining Contractual Life (Years)	4 years
Stock options vested and exercisable (in shares)	826
2015
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Exercise price, lower range limit (in dollars per share) | $ / shares	$ 18.20
Exercise price, upper range limit (in dollars per share) | $ / shares	$ 21.39
Number outstanding (in shares)	382
Black-Scholes Fair Value | $	$ 2,952
Remaining Contractual Life (Years)	5 years
Stock options vested and exercisable (in shares)	360
2016
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Exercise price, lower range limit (in dollars per share) | $ / shares	$ 15.93
Exercise price, upper range limit (in dollars per share) | $ / shares	$ 16.86
Number outstanding (in shares)	341
Black-Scholes Fair Value | $	$ 2,016
Remaining Contractual Life (Years)	6 years
Stock options vested and exercisable (in shares)	250
2017
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Exercise price, lower range limit (in dollars per share) | $ / shares	$ 15.80
Exercise price, upper range limit (in dollars per share) | $ / shares	$ 19.41
Number outstanding (in shares)	417
Black-Scholes Fair Value | $	$ 2,460
Remaining Contractual Life (Years)	7 years
Stock options vested and exercisable (in shares)	213
2018
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Exercise price, lower range limit (in dollars per share) | $ / shares	$ 22.49
Exercise price, upper range limit (in dollars per share) | $ / shares	$ 32.71
Number outstanding (in shares)	631
Black-Scholes Fair Value | $	$ 6,492
Remaining Contractual Life (Years)	8 years
Stock options vested and exercisable (in shares)	208
2019
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Exercise price, lower range limit (in dollars per share) | $ / shares	$ 41.07
Exercise price, upper range limit (in dollars per share) | $ / shares	$ 45.76
Number outstanding (in shares)	743
Black-Scholes Fair Value | $	$ 11,664
Remaining Contractual Life (Years)	9 years
Stock options vested and exercisable (in shares)	120
2020
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Exercise price, lower range limit (in dollars per share) | $ / shares	$ 44.84
Exercise price, upper range limit (in dollars per share) | $ / shares	$ 58.06
Number outstanding (in shares)	533
Black-Scholes Fair Value | $	$ 6,294
Remaining Contractual Life (Years)	10 years
Stock options vested and exercisable (in shares)	0

Options and Awards - Intrinsic

Options and Awards - Intrinsic Values (Details) - Stock Options - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Outstanding	$ 139,537	$ 108,623
Vested	103,551	83,243
Expected to vest	31,395	22,399
Exercisable	$ 21,044	$ 29,032

Options and Awards - Restricted

Options and Awards - Restricted Stock Awards Narrative (Details) - $ / shares shares in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Nonvested restricted awards, granted (in shares)	48	58	242	252
Share-based compensation, restricted awards, exercise price (in dollars per share)			$ 0
Award vesting period			5 years
Granted (in dollars per share)			$ 47.02
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted (in dollars per share)			35.47	$ 41.68
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted (in dollars per share)			$ 58.06	$ 57.39
Non-employee directors
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted to non-employee directors (in shares)	6		16
Non-employee directors | Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted (in dollars per share)			$ 35.47
Non-employee directors | Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted (in dollars per share)			$ 47.09

Options and Awards - Restrict_2

Options and Awards - Restricted Award Rollforward (Details) - $ / shares shares in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Non-Vested Restricted Awards
Nonvested at beginning of period (in shares)			610
Granted (in shares)	48	58	242	252
Vested (in shares)			(245)
Forfeited (in shares)			(13)
Nonvested at end of period (in shares)	594		594
Weighted Average Grant Date Fair Value
Nonvested at beginning of period (in dollars per share)			$ 31.35
Granted (in dollars per share)			47.02
Vested (in dollars per share)			33
Forfeited (in dollars per share)			30.20
Nonvested at end of period (in dollars per share)	$ 37.08		$ 37.08

Options and Awards - Long-Term

Options and Awards - Long-Term Incentive Plan (Details) - USD ($) $ in Thousands	Aug. 27, 2019	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period				5 years
Share-based compensation expense		$ 4,173	$ 2,829	$ 10,936	$ 8,215
Spinoff | 2019 LTI Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized (in shares)	500,000
Award vesting period	5 years
Award vesting rights, percentage	20.00%
Share-based compensation expense		$ 286		$ 675

Options and Awards - Compensati

Options and Awards - Compensation Expense (Details) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense	$ 4,173	$ 2,829	$ 10,936	$ 8,215
Share-based compensation arrangement by share-based payment award, options, outstanding, weighted average remaining contractual term			6 years
Stock-based compensation expense related to stock options
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense	1,692	1,227	$ 4,656	3,885
Employee service share-based compensation, nonvested awards, total compensation cost not yet recognized	$ 23,699		$ 23,699
Employee service share-based compensation, nonvested awards, total compensation cost not yet recognized, period for recognition			3 years 9 months 18 days
Employee service share-based compensation, nonvested awards (in shares)	1,896		1,896
Share-based compensation arrangement by share-based payment award, options, expected to vest, number (in shares)	1,769		1,769
Stock-based compensation expense related to restricted stock awards
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense	$ 2,221	1,279	$ 5,596	3,348
Employee service share-based compensation, nonvested awards, total compensation cost not yet recognized	25,155		$ 25,155
Employee service share-based compensation, nonvested awards, total compensation cost not yet recognized, period for recognition			3 years 8 months 12 days
Stock-based compensation expense related to stock options and restricted stock awards to non-employee directors
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense	$ 260	323	$ 684	982
Spinoff | Stock-based compensation expense related to stock options
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense		$ 132		$ 424

Options and Awards - Equity Ins

Options and Awards - Equity Instrument Denominated in the Shares of a Subsidiary (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Nonvested restricted awards, granted (in shares)	48,000	58,000	242,000	252,000
Award vesting period			5 years
Vested in the period (in shares)			245,000
Share-based compensation expense	$ 4,173	$ 2,829	$ 10,936	$ 8,215
Repurchase of shares of common stock			$ 25,000	$ 0
Spinoff | Subsidiary Equity Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Nonvested restricted awards, granted (in shares)				0
Vested in the period (in shares)				976,000
Share-based compensation expense		$ 17		$ 594
Stock repurchased during period, shares (in shares)		65,000		534,000
Repurchase of shares of common stock		$ 394		$ 2,687
Proceeds from sale of equity		$ 2,293
Spinoff | Subsidiary Equity Plan | Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period				3 years
Spinoff | Subsidiary Equity Plan | Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period				5 years

Leases - Narrative (Details)

Leases - Narrative (Details) $ in Thousands	Oct. 28, 2020USD ($)	Oct. 01, 2019USD ($)facility	Sep. 30, 2020USD ($)agreementfacilityrenewal	Sep. 30, 2019USD ($)facility	Sep. 30, 2020USD ($)agreementfacilityrenewal	Sep. 30, 2019USD ($)facility	Dec. 31, 2019USD ($)
Lessee, Lease, Description [Line Items]
Master lease agreements | agreement			8		8
Number of real estate properties | facility			93		93
Senior living facilities | facility			9		9
Right-of-use assets		$ (35,000)	$ (1,027,434)		$ (1,027,434)		$ (1,046,901)
Lease liability			$ 1,000,208		$ 1,000,208
Facilities under master lease arrangement | facility			40		40
Operating lease, weighted average remaining lease term			13 years 10 months 24 days		13 years 10 months 24 days
Operating lease, weighted average discount rate, percent			8.30%		8.30%
Right-of-use assets obtained in exchange for new operating lease obligations					$ 14,669	$ 52,606
Subsequent Event
Lessee, Lease, Description [Line Items]
Lessee, operating lease, term of contract	24 years
Lessee, operating lease, renewal term	10 years
Right-of-use assets obtained in exchange for new operating lease obligations	$ 4,900
Spinoff
Lessee, Lease, Description [Line Items]
Rent expense		$ 23,000
Senior living facilities | facility		23
Lease liability		$ 35,000
Spinoff | Remaining Company | Skilled Nursing Operations
Lessee, Lease, Description [Line Items]
Number of real estate properties | facility			2		2
CareTrust REIT
Lessee, Lease, Description [Line Items]
Skilled nursing, assisted living and independent living facilities | facility			85	94	85	94
Master lease agreements | agreement			8		8
Lessee, operating lease, renewal term			5 years		5 years
Operating leases of lessee, contingent rentals, basis spread on variable rate			2.50%		2.50%
Rent expense			$ 13,139	$ 13,738	$ 39,394	$ 40,662
CareTrust REIT | Spinoff
Lessee, Lease, Description [Line Items]
Number of properties transferred to disposal group | facility		11
Various Landlords
Lessee, Lease, Description [Line Items]
Lessee, operating lease, term of contract			15 years		15 years
Lessee leasing arrangements, operating leases, number of renewal terms | renewal			2		2
Lessee, operating lease, renewal term			5 years		5 years
Minimum | Spinoff
Lessee, Lease, Description [Line Items]
Lessee, operating lease, term of contract		14 years
Minimum | CareTrust REIT
Lessee, Lease, Description [Line Items]
Lessee, operating lease, term of contract			12 years		12 years
Lessee leasing arrangements, operating leases, number of renewal terms | renewal			2		2
Minimum | Various Landlords
Lessee, Lease, Description [Line Items]
Lessee, operating lease, term of contract			5 years		5 years
Minimum | Various Landlords | Equipment
Lessee, Lease, Description [Line Items]
Lessee, operating lease, term of contract			3 years		3 years
Maximum | Spinoff
Lessee, Lease, Description [Line Items]
Lessee, operating lease, term of contract		16 years
Maximum | CareTrust REIT
Lessee, Lease, Description [Line Items]
Lessee, operating lease, term of contract			20 years		20 years
Lessee leasing arrangements, operating leases, number of renewal terms | renewal			3		3
Maximum | Various Landlords
Lessee, Lease, Description [Line Items]
Lessee, operating lease, term of contract			20 years		20 years
Maximum | Various Landlords | Equipment
Lessee, Lease, Description [Line Items]
Lessee, operating lease, term of contract			5 years		5 years
Cost of Sales and General and Administrative Expense
Lessee, Lease, Description [Line Items]
Rent expense			$ 32,520	$ 31,930	$ 97,366	$ 93,638

Leases - Lease Cost (Details)

Leases - Lease Cost (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Lessee, Lease, Description [Line Items]
Operating lease expense	$ 36,038	$ 35,531	$ 107,991	$ 104,292
Amortization of deferred rent	101	(983)	337	134
Rent - cost of services
Lessee, Lease, Description [Line Items]
Operating lease expense	32,504	31,875	97,318	93,278
Variable lease, cost	567	628	1,781	1,056
General and administrative expense
Lessee, Lease, Description [Line Items]
Operating lease expense	16	55	48	360
Depreciation and amortization
Lessee, Lease, Description [Line Items]
Operating lease expense	289	495	933	1,485
Cost of Services
Lessee, Lease, Description [Line Items]
Variable lease, cost	$ 3,229	$ 3,106	$ 9,692	$ 9,169

Leases - Future Minimum Lease P

Leases - Future Minimum Lease Payments (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Year
2020 (remainder)	$ 31,940
2021	127,499
2022	127,130
2023	125,393
2024	124,412
2025	124,264
Thereafter	1,025,979
Total lease payments	1,686,617
Less: present value adjustment	(686,409)
Present value of total lease liabilities	1,000,208
Less: current lease liabilities	(47,342)	$ (44,964)
Long-term operating lease liabilities	$ 952,866	$ 973,983

Lessor (Details)

Lessor (Details) $ in Thousands	Oct. 28, 2020USD ($)	Sep. 30, 2020USD ($)facility	Oct. 01, 2019facility
Lessor, Lease, Description [Line Items]
Number of real estate properties		93
Subsequent Event
Lessor, Lease, Description [Line Items]
Lessee, operating lease, term of contract	24 years
Lessor, operating lease, term of contract	5 years
Increase (decrease) in rental income receivable | $	$ 4,100
Spinoff
Lessor, Lease, Description [Line Items]
Sales-type lease, annual rental payments | $		$ 14,000
Spinoff | Minimum
Lessor, Lease, Description [Line Items]
Lessee, operating lease, term of contract			14 years
Spinoff | Maximum
Lessor, Lease, Description [Line Items]
Lessee, operating lease, term of contract			16 years
The Pennant Group, Inc. | Senior Living Facilities
Lessor, Lease, Description [Line Items]
Number of real estate properties		2
The Pennant Group, Inc. | Spinoff | Senior Living Facilities
Lessor, Lease, Description [Line Items]
Number of real estate properties		31	29

Lessor - Rental Income (Details

Lessor - Rental Income (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Lessor, Lease, Description [Line Items]
Operating lease, lease income	$ 4,065	$ 660	$ 12,295	$ 2,085
The Pennant Group, Inc.
Lessor, Lease, Description [Line Items]
Operating lease, variable lease income	312		909
The Pennant Group, Inc.
Lessor, Lease, Description [Line Items]
Operating lease, lease income	3,443	0	10,272	0
Third Party Tenants
Lessor, Lease, Description [Line Items]
Operating lease, lease income	$ 622	$ 660	$ 2,023	$ 2,085

Lessor - Future Minimum Lease P

Lessor - Future Minimum Lease Payments Receivable (Details) $ in Thousands	Sep. 30, 2020USD ($)
Leases [Abstract]
2020 (remainder)	$ 4,104
2021	15,463
2022	14,918
2023	14,606
2024	14,073
2025	13,875
Thereafter	98,956
Total	$ 175,995

Commitments and Contingencies (

Commitments and Contingencies (Details) $ in Thousands	Oct. 01, 2013	Oct. 31, 2013USD ($)	Sep. 30, 2020facility	Sep. 30, 2019	Sep. 30, 2020facility	Sep. 30, 2019	Dec. 31, 2019	Oct. 26, 2020USD ($)
Commitments and Contingencies Disclosure [Abstract]
Facilities under Medicare probe reviews | facility			0		0
Payments for legal settlements		$ 48,000
Agreement term	5 years
Subsequent Event
Concentration Risk [Line Items]
Cash, uninsured amount								$ 998
Customer Concentration Risk | Revenue Benchmark
Concentration Risk [Line Items]
Concentration risk			100.00%	100.00%	100.00%	100.00%
Customer Concentration Risk | Total Medicaid and Medicare | Accounts Receivable
Concentration Risk [Line Items]
Concentration risk					59.70%		57.30%
Customer Concentration Risk | Total Medicaid and Medicare | Revenue Benchmark
Concentration Risk [Line Items]
Concentration risk			75.10%	70.20%	73.50%	70.30%

Common Stock Repurchase Progr_2

Common Stock Repurchase Program (Details) shares in Thousands	Mar. 13, 2020USD ($)numberOfRepurchasePrograms	Mar. 04, 2020USD ($)	Aug. 26, 2019USD ($)	Mar. 31, 2020USD ($)shares	Sep. 30, 2019USD ($)	Dec. 31, 2019USD ($)shares
Equity, Class of Treasury Stock [Line Items]
Number of stock repurchase programs | numberOfRepurchasePrograms	2
Repurchase of common stock				$ 25,000,000	$ 5,000,000
March 4, 2020 Repurchase Program
Equity, Class of Treasury Stock [Line Items]
Stock repurchase program, authorized amount		$ 20,000,000
Stock repurchase program, period in force		12 months
Stock repurchased during period, shares (in shares) | shares				503
Repurchase of common stock				$ 20,000,000
March 13, 2020 Repurchase Program
Equity, Class of Treasury Stock [Line Items]
Stock repurchase program, authorized amount	$ 5,000,000
Stock repurchase program, period in force	12 months
Stock repurchased during period, shares (in shares) | shares				189
Repurchase of common stock				$ 5,000,000
August 26, 2019 Repurchase Program
Equity, Class of Treasury Stock [Line Items]
Stock repurchase program, authorized amount			$ 20,000,000
Stock repurchase program, period in force			12 months
Stock repurchased during period, shares (in shares) | shares						138
Repurchase of common stock						$ 6,406,000