The Ensign Group, Inc. (ENSG) 10-K5 Feb 252024 FY Annual reportFinancial data

Company Profile

Cover

Cover - USD ($) $ in Thousands	12 Months Ended
Cover - USD ($) $ in Thousands	Dec. 31, 2024	Jan. 31, 2025	Jun. 30, 2024
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2024
Current Fiscal Year End Date	--12-31
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 Well-known Seasoned Issuer	Yes
Entity Voluntary Filers	No
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
ICFR Auditor Attestation Flag	true
Document Financial Statement Restatement Recovery Analysis	false
Entity Shell Company	false
Entity Public Float			$ 4,196,977
Entity Common Stock, Shares Outstanding		57,455,374
Documents Incorporated by Reference	Part III of this Form 10-K incorporates information by reference from the Registrant's definitive proxy statement for the Registrant's 2025 Annual Meeting of Stockholders to be filed within 120 days after the close of the fiscal year covered by this annual report.
Entity Central Index Key	0001125376
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	FY
Amendment Flag	false

Audit Information

Audit Information	12 Months Ended
Audit Information	Dec. 31, 2024
Audit Information [Abstract]
Auditor Name	DELOITTE & TOUCHE LLP
Auditor Location	Costa Mesa, California
Auditor Firm ID	34

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Current assets:
Cash and cash equivalents	$ 464,598	$ 509,626
Accounts receivable—less allowance for doubtful accounts of $8,435 and $9,348 at December 31, 2024 and 2023, respectively	569,897	485,039
Investments—current	62,255	17,229
Prepaid expenses and other current assets	60,882	35,036
Total current assets	1,157,632	1,046,930
Property and equipment, net	1,291,354	1,090,771
Right-of-use assets	1,861,071	1,756,430
Insurance subsidiary deposits and investments	141,246	92,687
Deferred tax assets	66,281	67,124
Restricted and other assets	46,499	40,205
Intangible assets, net	7,292	6,525
Goodwill	97,981	76,869
TOTAL ASSETS	4,669,356	4,177,541
Current liabilities:
Accounts payable	98,947	92,811
Accrued wages and related liabilities	347,532	332,568
Lease liabilities—current	93,475	82,526
Accrued self-insurance liabilities—current	67,331	54,664
Other accrued liabilities	132,057	168,228
Current maturities of long-term debt	4,086	3,950
Total current liabilities	743,428	734,747
Long-term debt—less current maturities	141,585	145,497
Long-term lease liabilities—less current portion	1,735,325	1,639,326
Accrued self-insurance liabilities—less current portion	144,421	111,246
Other long-term liabilities	64,169	49,408
TOTAL LIABILITIES	2,828,928	2,680,224
Commitments and contingencies (Notes 14 and 19)
Ensign Group, Inc. stockholders' equity:
Common stock: $0.001 par value; 150,000 shares authorized; 60,838 and 57,438 shares issued and shares outstanding at December 31, 2024, respectively, and 59,987 and 56,597 shares issued and shares outstanding at December 31, 2023, respectively	61	60
Additional paid-in capital	528,052	465,707
Retained earnings	1,426,762	1,142,653
Common stock in treasury, at cost, 3,400 and 3,390 shares at December 31, 2024 and 2023, respectively	(117,764)	(116,555)
Total Ensign Group, Inc. stockholders' equity	1,837,111	1,491,865
Non-controlling interest	3,317	5,452
Total equity	1,840,428	1,497,317
TOTAL LIABILITIES AND EQUITY	$ 4,669,356	$ 4,177,541

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) shares in Thousands, $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Allowance for doubtful accounts on accounts receivable	$ 8,435	$ 9,348
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common shares authorized (in shares)	150,000	150,000
Common shares issued (in shares)	60,838	59,987
Common shares outstanding (in shares)	57,438	56,597
Common shares in treasury, at cost (in shares)	3,400	3,390

CONSOLIDATED STATEMENTS OF INCO

CONSOLIDATED STATEMENTS OF INCOME - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
TOTAL REVENUE	$ 4,260,485	$ 3,729,355	$ 3,025,468
Expense:
Cost of services	3,376,884	2,941,238	2,354,434
Rent—cost of services	216,016	197,358	153,049
General and administrative expense	225,143	263,005	158,805
Depreciation and amortization	84,138	72,387	62,355
TOTAL EXPENSES	3,902,181	3,473,988	2,728,643
Income from operations	358,304	255,367	296,825
Other income (expense):
Interest expense	(8,286)	(8,087)	(8,931)
Interest income	28,749	19,216	5,035
Other income (expense)	7,327	6,266	(3,840)
OTHER INCOME (EXPENSE), NET	27,790	17,395	(7,736)
Income before provision for income taxes	386,094	272,762	289,089
Provision for income taxes	87,636	62,912	64,437
NET INCOME	298,458	209,850	224,652
Less:
Net income (loss) attributable to noncontrolling interests	485	451	(29)
NET INCOME ATTRIBUTABLE TO THE ENSIGN GROUP, INC.	$ 297,973	$ 209,399	$ 224,681
NET INCOME PER SHARE ATTRIBUTABLE TO THE ENSIGN GROUP INC.
Basic (in dollars per share)	$ 5.26	$ 3.76	$ 4.09
Diluted (in dollars per share)	$ 5.12	$ 3.65	$ 3.95
WEIGHTED AVERAGE COMMON SHARES OUTSTANDING
Basic (in shares)	56,655	55,708	54,887
Diluted (in shares)	58,240	57,323	56,871
Service revenue
TOTAL REVENUE	$ 4,237,525	$ 3,708,071	$ 3,008,711
Rental revenue
TOTAL REVENUE	$ 22,960	$ 21,284	$ 16,757

CONSOLIDATED STATEMENTS OF STOC

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock	Additional Paid-In Capital	Retained Earnings	Treasury Stock	Non-Controlling Interest
Common stock, balance at beginning of period (in shares) at Dec. 31, 2021		55,190
Balance at beginning of period at Dec. 31, 2021	$ 1,021,714	$ 58	$ 369,760	$ 733,992	$ (83,042)	$ 946
Treasury stock, balance at beginning of period (in shares) at Dec. 31, 2021					2,944
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock to employees and directors resulting from the exercise of stock options (in shares)	688	688
Issuance of common stock to employees and directors resulting from the exercise of stock options	$ 12,677	$ 1	12,676
Issuance of restricted stock, net of forfeitures (in shares)		207
Issuance of restricted stock, net of forfeitures	5,241		5,241
Shares of common stock used to satisfy tax withholding obligations (in shares)		20			20
Shares of common stock used to satisfy tax withholding obligations	(1,702)				$ (1,702)
Dividends declared	(12,334)			(12,334)
Employee stock award compensation	$ 22,720		22,720
Repurchase of common stock (in shares)	(404)	(404)			(404)
Repurchase of common stock	$ (29,882)				$ (29,882)
Acquisition of noncontrolling interest shares	(704)		(1,539)			835
Issuance of noncontrolling interests through subsidiary equity plan	6,693		6,693
Net income (loss) attributable to noncontrolling interests	(29)					(29)
Noncontrolling interests attributable to subsidiary equity plan	(275)		9			(284)
Net income attributable to the Ensign Group, Inc.	224,681			224,681
Common stock, balance at end of period (in shares) at Dec. 31, 2022		55,661
Balance at end of period at Dec. 31, 2022	$ 1,248,800	$ 59	415,560	946,339	$ (114,626)	1,468
Treasury stock, balance at end of period (in shares) at Dec. 31, 2022					3,368
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock to employees and directors resulting from the exercise of stock options (in shares)	759	759
Issuance of common stock to employees and directors resulting from the exercise of stock options	$ 18,369	$ 1	18,368
Issuance of restricted stock, net of forfeitures (in shares)		199
Issuance of restricted stock, net of forfeitures	5,068		5,068
Shares of common stock used to satisfy tax withholding obligations (in shares)		22			22
Shares of common stock used to satisfy tax withholding obligations	(1,929)				$ (1,929)
Dividends declared	(13,085)			(13,085)
Employee stock award compensation	30,754		30,754
Acquisition of noncontrolling interest shares	(256)		(256)
Net income (loss) attributable to noncontrolling interests	451					451
Noncontrolling interests attributable to subsidiary equity plan	(254)		(3,787)			3,533
Net income attributable to the Ensign Group, Inc.	$ 209,399			209,399
Common stock, balance at end of period (in shares) at Dec. 31, 2023	56,597	56,597
Balance at end of period at Dec. 31, 2023	$ 1,497,317	$ 60	465,707	1,142,653	$ (116,555)	5,452
Treasury stock, balance at end of period (in shares) at Dec. 31, 2023	3,390				3,390
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock to employees and directors resulting from the exercise of stock options (in shares)	632	632
Issuance of common stock to employees and directors resulting from the exercise of stock options	$ 22,286	$ 1	22,285
Issuance of restricted stock, net of forfeitures (in shares)		219
Issuance of restricted stock, net of forfeitures	6,165		6,165
Shares of common stock used to satisfy tax withholding obligations (in shares)		10			10
Shares of common stock used to satisfy tax withholding obligations	(1,209)				$ (1,209)
Dividends declared	(13,864)			(13,864)
Employee stock award compensation	36,183		36,183
Acquisition of noncontrolling interest shares	(4,450)		(2,426)			(2,024)
Net income (loss) attributable to noncontrolling interests	485					485
Noncontrolling interests attributable to subsidiary equity plan	(458)		138			(596)
Net income attributable to the Ensign Group, Inc.	$ 297,973			297,973
Common stock, balance at end of period (in shares) at Dec. 31, 2024	57,438	57,438
Balance at end of period at Dec. 31, 2024	$ 1,840,428	$ 61	$ 528,052	$ 1,426,762	$ (117,764)	$ 3,317
Treasury stock, balance at end of period (in shares) at Dec. 31, 2024	3,400				3,400

CONSOLIDATED STATEMENTS OF ST_2

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (Parenthetical) - $ / shares	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Statement of Stockholders' Equity [Abstract]
Dividends declared (in dollars per share)	$ 0.2425	$ 0.2325	$ 0.2225

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Cash flows from operating activities:
Net income	$ 298,458	$ 209,850	$ 224,652
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	84,138	72,387	62,355
Amortization of deferred financing fees	1,061	1,067	1,036
Non-cash leasing arrangement	808	870	493
Impairment of long-lived assets	1,849	0	0
Write-off of deferred financing fees	200	0	566
Deferred income taxes	635	(27,481)	(6,496)
Provision for doubtful accounts	1,739	3,408	2,390
Stock-based compensation	36,226	30,767	22,720
Cash received from insurance proceeds	199	1,396	1,282
Loss (gain) on sale of assets	486	(123)	(3,467)
Loss (gain) on insurance claims and asset disposals	833	(550)	(627)
Litigation	(4,289)	47,182	4,553
Change in operating assets and liabilities
Accounts receivable	(84,397)	(79,818)	(82,426)
Prepaid income taxes	(9,227)	814	809
Prepaid expenses and other assets	(19,055)	6,993	(9,141)
Deferred employer portion of social security taxes	0	0	(24,155)
Cash surrender value of life insurance policy premiums	(14,833)	(16,072)	(7,614)
Deferred compensation liability	14,986	16,044	7,637
Operating lease obligations	287	(6,564)	345
Accounts payable	2,835	15,924	17,870
Accrued wages and related liabilities	19,992	47,967	38,982
Other accrued liabilities	(30,670)	23,828	3,010
Accrued self-insurance liabilities	44,014	28,827	17,785
Other long-term liabilities	911	(50)	(46)
NET CASH PROVIDED BY OPERATING ACTIVITIES	347,186	376,666	272,513
Cash flows from investing activities:
Purchase of property and equipment	(158,240)	(106,180)	(87,545)
Cash payments for acquisitions	(156,547)	(69,014)	(101,136)
Cash from insurance proceeds	3,334	2,029	1,339
Cash proceeds from the sale of assets	2,818	248	8,630
Purchases of investments	(105,149)	(29,603)	(21,975)
Maturities of investments	26,397	18,852	14,356
Other restricted assets	(2,665)	970	149
NET CASH USED IN INVESTING ACTIVITIES	(390,052)	(182,698)	(186,182)
Cash flows from financing activities:
Proceeds from debt	400	150	411
Payments on debt	(4,350)	(4,033)	(4,106)
Issuance of common stock upon exercise of options	22,286	18,369	12,677
Repurchase of shares of common stock to satisfy tax withholding obligations	(1,209)	(1,929)	(1,702)
Repurchase of shares of common stock	0	0	(29,882)
Dividends paid	(13,671)	(12,890)	(12,168)
Proceeds from sale of subsidiary shares	0	0	6,693
Non-controlling interest distribution	(543)	(4)	(284)
Purchase of non-controlling interest	(4,450)	(256)	(704)
Payment of contingent consideration	(625)	0	0
Payments of deferred financing costs	0	(19)	(3,197)
NET CASH USED IN FINANCING ACTIVITIES	(2,162)	(612)	(32,262)
Net (decrease) increase in cash and cash equivalents	(45,028)	193,356	54,069
Cash and cash equivalents beginning of period	509,626	316,270	262,201
Cash and cash equivalents end of period	464,598	509,626	316,270
Cash paid during the period for:
Interest	7,063	7,025	7,604
Income taxes	96,337	89,730	70,055
Lease liabilities	215,677	196,942	151,870
Non-cash financing and investing activity
Accrued capital expenditures	7,900	4,600	4,800
Accrued dividends declared	3,589	3,396	3,201
Right-of-use assets obtained in exchange for new and modified operating lease obligations	$ 232,918	$ 376,550	$ 370,753

DESCRIPTION OF BUSINESS

DESCRIPTION OF BUSINESS	12 Months Ended
DESCRIPTION OF BUSINESS	Dec. 31, 2024
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's independent subsidiaries provide health care services across the post-acute care continuum and engage in the ownership, acquisition, development and leasing of skilled nursing, senior living and other healthcare-related properties and ancillary businesses. As of December 31, 2024, the Company's independent subsidiaries operated 327 facilities and other ancillary operations located in Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, South Carolina, Tennessee, Texas, Utah, Washington and Wisconsin. The Company's independent subsidiaries have a collective capacity of approximately 33,500 operational skilled nursing beds and 3,100 senior living units. As of December 31, 2024, the Company's independent subsidiaries operated 231 facilities under long-term lease arrangements and had options to purchase 12 of those 231 facilities. The Company's real estate portfolio consists of 129 owned real estate properties, which includes 96 facilities operated and managed by the Company's independent subsidiaries, 33 operations leased to and operated by third-party operators and the Service Center (defined below) location. Of those 33 third-party operations, one senior living operation is located on the same real estate property as a skilled nursing operation that an independent subsidiary operates. 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 independent subsidiaries. The Company also has a wholly-owned captive insurance subsidiary that provides some claims-made coverage to the Company’s independent subsidiaries for general and professional liabilities, as well as coverage for certain workers’ compensation insurance liabilities. The Company's captive real estate investment trust (REIT), Standard Bearer Healthcare REIT, Inc. (Standard Bearer), owns and manages its real estate business. The REIT structure provides the Company with an efficient vehicle for future acquisitions of properties that could be operated by Ensign's independent subsidiaries or other third parties. Standard Bearer has elected to be taxed as a REIT for U.S. federal income tax purposes. Refer to Note 6, Standard Bearer for additional information on Standard Bearer. Each of the Company's independent subsidiaries are operated by wholly-owned subsidiaries that have their own management, employees and assets. References herein to the consolidated “Company” and “its” assets and activities in this Annual Report are 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.

SUMMARY OF SIGNIFICANT ACCOUNTI

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	12 Months Ended
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	Dec. 31, 2024
Accounting Policies [Abstract]
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Basis of Presentation — The accompanying consolidated financial statements (the 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 Company presents noncontrolling interests within the equity section of its consolidated balance sheets and the amount of consolidated net income that is attributable to The Ensign Group, Inc. and the noncontrolling interests in its consolidated statements of income. The Financial Statements include the accounts of all independent subsidiaries controlled by the Company through its ownership of a majority voting interest. Reclassifications — Certain amounts in the prior period statements of income and statements of cash flows have been reclassified to conform to the presentation of the current period financial statements. These reclassifications had no effect on the previously reported net income. Estimates and Assumptions — The preparation of the Financial Statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the Financial Statements and the reported amounts of revenue and expenses during the reporting periods. The most significant estimates in the Company’s Financial Statements relate to revenue, acquired property and equipment, intangible assets and goodwill, right-of-use assets and lease liabilities, impairment of long-lived assets, as well as general and professional liabilities, workers' compensation and healthcare claims included in accrued self-insurance liabilities. Actual results could differ from those estimates. Fair Value Considerations — The Company’s financial instruments consist principally of cash and cash equivalents, debt security investments, accounts receivable, insurance subsidiary deposits, deferred compensation investment funds, equity investments, 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. 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. See Note 5, Fair Value Measurements for additional information. 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. Service Revenue Recognition — The Company recognizes revenue in accordance with Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) Topic 606, Revenue from Contracts with Customers (ASC 606). The Company's service revenue is derived primarily from providing healthcare services to its patients. Revenue is recognized when services are provided to patients at the amount that reflects the consideration that 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 provided pursuant to 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 that 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 rates 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 that 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. 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 FASB ASC Topic 340, Other Assets and Deferred Costs , and all incremental customer contract acquisition costs are expensed as they are incurred because the amortization period would have been one year or less. Rental Revenue Recognition — The Company's rental revenues are primarily generated by leasing healthcare-related properties through triple-net lease arrangements, under which the tenant is solely responsible for the costs related to the property. Revenue for operating leases is recognized on a straight-line basis over the lease term when collectability of all minimum lease payments is probable in accordance with FASB ASC Topic 842, Leases (ASC 842). The Company has elected the single component practical expedient, which allows a lessor, by class of underlying asset, not to allocate the total consideration to the lease and non-lease components based on their relative stand-alone selling prices where certain criteria are met. Tenant reimbursements related to property taxes and insurance are neither considered lease nor non-lease components under ASC 842. Lessee payments for taxes and insurance paid directly to a third party, on behalf of the Company, are excluded from variable lease payments and rental revenue in the Company’s consolidated statements of income. Otherwise, tenant reimbursements for taxes and insurance that are paid by the Company directly to a third party are classified as additional rental revenue and expense and recognized by the Company on a gross basis. Accounts Receivable — 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. Cash and Cash Equivalents — Cash and cash equivalents consist of bank term deposits, money market funds and treasury bill related investments with original maturities of three months or less at time of purchase and therefore approximate fair value. The fair value of money market funds is determined based on “Level 1” inputs, which consist of unadjusted quoted prices in active markets that are accessible at the measurement date for identical, unrestricted assets. The Company places its cash and short-term investments with high credit quality financial institutions. Insurance Subsidiary Deposits and Other Investments — The Company's captive insurance subsidiary cash and cash equivalents, deposits and investments are designated to support long-term insurance subsidiary liabilities and have been classified as short-term and long-term assets based on the timing of expected future payments of the Company's captive insurance liabilities. The majority of these deposits and investments are currently held in AA, A and BBB rated debt security investments and the remainder is held in a bank account with a high credit quality financial institution. Investments classified as held-to-maturity are financial instruments that the Company has the intent and ability to hold to maturity and are reported net of any related amortization and are not remeasured to fair value on a recurring basis. The Company's non-qualified deferred compensation plan's (the DCP) contracts insuring the lives of certain employees who are eligible to participate in the DCP are held in a rabbi trust. Cash surrender value of the contracts is based on funds that shadow the investment allocations specified by participants in the deferred compensation plan. When evaluating an investment for its current expected credit losses, the Company reviews factors such as historical experience with defaults, losses, credit ratings, term, market sector and macroeconomic trends, including current conditions and forecasts to the extent they are reasonable and supportable. 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 Leases — The Company leases skilled nursing facilities, senior living facilities and commercial office space. The Company determines if an arrangement is a lease and performs an evaluation to determine whether the lease should be classified as an operating or finance lease at the inception of the lease. As of December 31, 2024, the Company has three financing lease that are not material to the consolidated balance sheet. Rights and obligations of the operating leases are included as right-of-use assets and current and long-term lease liabilities on the Company's consolidated balance sheets. 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 utilizes a third-party credit 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's real estate leases generally have initial lease terms of ten years or more and typically include one or more options to renew, with renewal terms that generally extend the lease term for an additional ten The Company subleases skilled nursing facilities to third-party operators and considers the subleases to be separate contracts as the Company is not relieved of its primary obligation under its operating lease. The rental income from third-parties related to these subleases is presented on a gross basis from the rent expense associated with the Company's lease obligations and is not material to the consolidated statements of income. Impairment of Long-Lived Assets — The Company reviews the carrying value of long-lived assets that are held and used in the Company’s independent 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 independent 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. 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. 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 FASB ASC 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. 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 a goodwill impairment test by comparing the carrying value of each reporting unit to its respective fair value. The Company determines the estimated fair value of each reporting unit using a discounted cash flow analysis. The fair value of the reporting unit is the implied fair value of goodwill. In the event a reporting unit's carrying value exceeds its fair value, an impairment loss will be recognized. An impairment loss is measured by the difference between the carrying value of the reporting unit and its fair value. The Company anticipates that the majority of goodwill recognized will be fully deductible for tax purposes as of December 31, 2024. Self-Insurance — The Company is partially self-insured for general and professional liability claims 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 $750 per claim, subject to an additional one-time deductible of $1,500 for the Company's independent subsidiaries in California. For the independent subsidiaries not in California, the self-insured claim is $650 per claim, subject to an additional one-time, deductible of $1,400. For all independent subsidiaries, except those located in Colorado, the third-party coverage above these limits is $1,000 per claim, $3,000 per operation, with a $10,000 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 aggregate limits that apply outside of Colorado. Subsequent to December 31, 2024, the combined self-insured retention is $1,000 per claim ($750 if an enforceable arbitration agreement applies), subject to an additional one-time deductible of $2,950 for the Company's independent subsidiaries in California. For the independent subsidiaries not in California, the self-insured claim is $750 per claim ($650 if an enforceable arbitration agreement applies), subject to an additional one-time, deductible of $4,500. The majority of the self-insured retention and deductible limits for general and professional liabilities and workers' compensation liabilities are self-insured through the captive insurance subsidiary, the related assets and liabilities of which are included in the accompanying consolidated balance sheets. The captive insurance subsidiary 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. The Company’s independent subsidiaries are self-insured for workers’ compensation liabilities 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 $625 per occurrence. In Texas, the independent 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 independent 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 the state of Washington, the Company is self-insured and has purchased individual specific excess insurance coverage that insures individual claims that exceed $500 per occurrence. For all of the self-insured plans and retention, 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. 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 $525 for each covered person. The Company believes that adequate provision has been made in the Financial Statements for liabilities that may arise out of patient care, workers’ compensation, healthcare benefits and related services provided to date. The amount of the Company’s reserves was determined based on an estimation process that uses information obtained from both company-specific and industry data. This estimation process requires the Company to continuously monitor and evaluate the life cycle of the claims. Using data obtained from this monitoring and the Company’s assumptions about emerging trends, the Company, with the assistance of an independent actuary, develops information about the size of ultimate claims based on the Company’s historical experience and other available industry information. The most significant assumptions used in the estimation process include determining the trend in costs, the expected cost of claims incurred but not reported and the expected costs to settle or pay damage awards with respect to unpaid claims. The self-insured liabilities are based upon estimates, and while management believes that the estimates of loss are reasonable, the ultimate liability may be in excess of or less than the recorded amounts. Due to the inherent volatility of actuarially determined loss estimates, it is reasonably possible that the Company could experience changes in estimated losses that could be material to net income. If the Company’s actual liabilities exceed its estimates of losses, 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. Standard Bearer was organized, has operated and intends to continue to operate in a manner to qualify for taxation as a REIT. In order to qualify as a REIT, Standard Bearer must meet certain organizational and operational requirements, including a requirement to distribute to its shareholders, which in this case is the Company, at least 90% of its annual taxable income. As a REIT, Standard Bearer generally will not be subject to federal income tax to the extent it distributes as qualifying dividends, all of its REIT taxable income to its shareholders. If Standard Bearer fails to qualify as a REIT in any taxable year, it will be subject to federal income tax on its taxable income at regular corporate income tax rates and generally will not be permitted to qualify for treatment as a REIT for federal income tax purposes for the four taxable years following the year during which qualification is lost unless the Internal Revenue Service grants the Company relief under certain statutory provisions. Noncontrolling Interest — The noncontrolling interest in a subsidiary is initially recognized at estimated fair value on the acquisition date and is presented within total equity in the Company's consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to The Ensign Group, Inc. in its consolidated statements of income. 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 and restricted stock awards 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 based upon the number of grants and other variables. As stock-based compensation expense recognized in the Company’s consolidated statements of income was based on awards 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. Comprehensive Income — The Company does not have any components of other comprehensive income recorded within its Financial Statements and, therefore, does not separately present a statement of comprehensive income in its Financial Statements. 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 FASB ASC is the sole source of authoritative GAAP literature recognized by the FASB and applicable to the Company. For any new pronouncements announced, the Company considers whether the new pronouncements could alter previous generally accepted accounting principles and determines whether any new or modified principles will have a material impact on the Company's reported financial position or operations in the near term. The applicability of any standard is subject to the formal review of the Company's financial management and certain standards are under consideration. Recent Accounting Standards Adopted by the Company — In November 2023, the FASB issued Accounting Standards Update (ASU) 2023-07 " Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, " which requires the Company to expand the breadth and frequency of segment disclosures to include additional information about significant segment expenses, the chief operating decision maker (CODM) and other items, and also require the annual disclosures on an interim basis. This guidance was effective for annual periods beginning with the Company's fiscal year 2024, and in interim periods within the Company's fiscal year 2025. The Company adopted the requirements of this ASU in Note 8, Business Segments of this Annual Report. Recently Issued Accounting Pronouncements Not Yet Adopted — In October 2023, the FASB issued ASU 2023-06 "Codification Amendments in Response to the SEC’s Disclosure Update and Simplification Initiative," which amends U.S. GAAP to include 14 disclosure requirements that are currently required under SEC Regulation S-X or Regulation S-K. Each amendment will be effective on the date on which the SEC removes the related disclosure requirement from SEC Regulation S-X or Regulation S-K. The adoption is not expected to have a material impact on the Company's Financial Statements as these requirements were previously incorporated under the SEC Regulations. In December 2023, the FASB issued ASU 2023-09 " Income Taxes (Topic 740): Improvements to Income Tax Disclosures, " which requires the Company to disclose disaggregated jurisdictional and categorical information for the tax rate reconciliation, income taxes paid and other income tax related amounts. ASU 2023-09 is effective for annual periods beginning with the Company's fiscal year 2025, with early adoption permitted. The Company is currently evaluating the impact of this ASU on its Notes to the Consolidated Financial Statements. In November 2024, the FASB issued ASU 2024-03 " Disaggregation of Income Statement Expenses, " which requires the Company to disaggregate key expense categories such as employee compensation, depreciation and intangible asset amortization within its financial statements. ASU 2024-03 is effective for annuals periods beginning with the Company's fiscal year 2027, and interim periods within the Company's fiscal year 2028, with early adoption permitted. The Company is currently evaluating the impact of this ASU on its Notes to the Consolidated Financial Statements.

REVENUE AND ACCOUNTS RECEIVABLE

REVENUE AND ACCOUNTS RECEIVABLE	12 Months Ended
REVENUE AND ACCOUNTS RECEIVABLE	Dec. 31, 2024
Revenue from Contract with Customer [Abstract]
REVENUE AND ACCOUNTS RECEIVABLE	REVENUE AND ACCOUNTS RECEIVABLE The Company's service revenue is derived primarily from providing healthcare services to its patients. Revenue is recognized when services are provided to patients at the amount that reflects the consideration that 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. Disaggregation of Revenue The Company disaggregates revenue from contracts with its patients by payors. The Company has determined 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 rates, adjusted for estimates for variable consideration, on a per patient, daily basis or as services are performed. Revenue from the Medicare and Medicaid programs accounted for 70.9%, 72.6% and 73.7% for the years ended December 31, 2024, 2023 and 2022, 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 revenue for the years ended December 31, 2024, 2023 and 2022. Service revenue for the years ended December 31, 2024, 2023 and 2022 is summarized in the following tables: Year Ended December 31, 2024 2023 2022 Revenue % of Revenue Revenue % of Revenue Revenue % of Revenue Medicaid (1)(2) $ 1,682,344 39.7 % $ 1,459,449 39.4 % $ 1,183,156 39.3 % Medicare 1,055,226 24.9 985,749 26.6 832,160 27.7 Medicaid — skilled 266,738 6.3 245,663 6.6 200,878 6.7 Total Medicaid and Medicare $ 3,004,308 70.9 % $ 2,690,861 72.6 % $ 2,216,194 73.7 % Managed care 789,643 18.6 666,129 18.0 525,710 17.5 Private and other (3) 443,574 10.5 351,081 9.4 266,807 8.8 SERVICE REVENUE $ 4,237,525 100.0 % $ 3,708,071 100.0 % $ 3,008,711 100.0 % (1) Medicaid payor includes revenue for senior living operations. (2) Medicaid payor includes revenue related to state relief funding during the year ended December 31, 2023 and 2022. (3) Private and other also includes revenue from senior living operations and all revenue generated in other an cillary services. In addition to the service revenue above, the Company's rental revenue derived from triple-net lease arrangements with third parties is $22,960, $21,284 and $16,757 for the years ended December 31, 2024, 2023 and 2022. State relief funding The Company received state relief funding through Medicaid programs from various states, including healthcare relief funding under the American Rescue Plan Act (ARPA), increases in the Federal Medical Assistance Percentage (FMAP) under the Families First Coronavirus Response Act (FFCRA) and other state specific relief programs. The funding generally incorporates specific use requirements primarily for direct patient care including labor related expenses that are attributable to the COVID-19 pandemic or are associated with providing patient care. Due to the expiration of the COVID-19 Public Health Emergency in May 2023, the Company did not receive additional funding during the year ended December 31, 2024. 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 specific qualifiers, the Company recorded deferred revenue for the excess amount until additional expenses are incurred for recognition. Accordingly, the amount of state relief revenue recognized is limited to the actual related expenses incurred. As of years ended December 31, 2023 and 2022, the Company had $486 and $1,001 in unapplied state relief funds, respectively. During the years ended December 31, 2023 and 2022, the Company received an additional $64,238, and $81,057 in state relief funding and recognized $64,753, and $81,837, respectively, as revenue. Federal relief funding As part of the Coronavirus Aid, Relief, and Economic Security Act of 2020 (CARES Act), the Company deferred payment of the employer portion of social security taxes related to 2020. For the year ended December 31, 2022, the Company paid $24,155, which was the second and final payment associated with the deferred amount from 2020. Balance Sheet Impact Included in the Company’s 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 December 31, 2024 and 2023, or activity during the years ended December 31, 2024, 2023 and 2022. 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 and doubtful accounts. Accounts receivable as of December 31, 2024 and 2023, is summarized in the following table: December 31, 2024 2023 Medicaid $ 228,872 $ 178,285 Managed care 139,711 125,907 Medicare 77,056 85,512 Private and other payors 132,693 104,683 $ 578,332 $ 494,387 Less: allowance for doubtful accounts (8,435) (9,348) ACCOUNTS RECEIVABLE, NET $ 569,897 $ 485,039

COMPUTATION OF NET INCOME PER C

COMPUTATION OF NET INCOME PER COMMON SHARE	12 Months Ended
COMPUTATION OF NET INCOME PER COMMON SHARE	Dec. 31, 2024
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 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: Year Ended December 31, 2024 2023 2022 NUMERATOR: Net income $ 298,458 $ 209,850 $ 224,652 Less: net income (loss) attributable to noncontrolling interests 485 451 (29) Net income attributable to The Ensign Group, Inc. $ 297,973 $ 209,399 $ 224,681 DENOMINATOR: Weighted average shares outstanding for basic net income per share 56,655 55,708 54,887 Basic net income per common share: $ 5.26 $ 3.76 $ 4.09 A reconciliation of the numerator and denominator used in the calculation of diluted net income per common share follows: Year Ended December 31, 2024 2023 2022 NUMERATOR: Net income $ 298,458 $ 209,850 $ 224,652 Less: net income (loss) attributable to noncontrolling interests 485 451 (29) Net income attributable to The Ensign Group, Inc. $ 297,973 $ 209,399 $ 224,681 DENOMINATOR: Weighted average common shares outstanding 56,655 55,708 54,887 Plus: incremental shares from assumed conversion (1) 1,585 1,615 1,984 Adjusted weighted average common shares outstanding 58,240 57,323 56,871 Diluted net income per common share: $ 5.12 $ 3.65 $ 3.95 (1) Options outstanding which are anti-dilutive and therefore not factored into the weighted average common shares amount above were 914, 1,429 and 780 for the years ended December 31, 2024, 2023 and 2022, respectively.

FAIR VALUE MEASUREMENTS

FAIR VALUE MEASUREMENTS	12 Months Ended
FAIR VALUE MEASUREMENTS	Dec. 31, 2024
Fair Value Disclosures [Abstract]
FAIR VALUE MEASUREMENTS	FAIR VALUE MEASUREMENTS The Company's financial assets include held-to-maturity investments carried at amortized cost basis of $138,600 and $59,530, of which $65,831 and $59,530 are designated to support long-term insurance subsidiary liabilities, both as of December 31, 2024 and 2023, respectively. As of December 31, 2024 and 2023, the amortized cost basis of these financial assets are considered to approximate fair value and are derived using Level 2 inputs. The Company believes its amortized cost basis investments that were in an unrealized loss position as of December 31, 2024 and 2023 do not require an allowance for expected credit losses, nor has any event occurred through the filing date of this report that would indicate differently. The Company's financial assets also include the contracts insuring the lives of certain employees who are eligible to participate in non-qualified deferred compensation plans that are held in a rabbi trust. The cash surrender value of these contracts is based on funds that shadow the investment allocations specified by participants in the deferred compensation plan and are held at fair value. As of December 31, 2024 and 2023, the fair value of the investment funds was $56,049 and $41,216, respectively, which are derived using Level 2 inputs.

STANDARD BEARER

STANDARD BEARER	12 Months Ended
STANDARD BEARER	Dec. 31, 2024
Segment Reporting [Abstract]
STANDARD BEARER	STANDARD BEARER Standard Bearer's real estate portfolio consists of 124 of the Company's 129 owned real estate properties, of which 92 are operated and managed by the Company's independent subsidiaries and 33 are leased to and operated by third-party operators. Of those 33 operations, one senior living operation is located on the same real estate property as a skilled nursing operation that an independent subsidiary operates. During the year ended December 31, 2024, Standard Bearer added $131,927 of real estate assets associated with 11 stand-alone skilled nursing operations, three stand-alone senior living operations and three campus operations . These new additions for the stand-alone skilled nursing and campus operations are operated by 14 of the Company's independent subsidiaries and the three stand-alone senior living operations are leased to a third-party operator. Refer to Note 7, Operation Expansions , for additional information. Subsequent to December 31, 2024, Standard Bearer added $50,853 of real estate assets associated with four stand-alone skilled nursing operations and one campus operation. Four of the acquisitions were related to exercising purchase options under an existing lease arrangement from CareTrust REIT, Inc. (CareTrust). These locations are currently operated by the Company's independent subsidiaries. The remaining one real estate acquisition was leased back to the Company's independent subsidiaries. Refer to Note 7, Operation Expansions , for additional information. During the year ended December 31, 2023, Standard Bearer added $65,899 of real estate assets associated with three stand-alone skilled nursing facilities and two campus operations. Of these additions, the three skilled nursing facilities and one campus operation acquired are operated by the Company's independent subsidiaries and the other campus operation is leased to a third-party operator. During the year ended December 31, 2022, Standard Bearer added $84,656 of real estate assets associated with ten skilled nursing facilities, three of which were previously operated and managed by the Company's independent subsidiaries. Refer to Note 7, Operation Expansions , for additional information. As part of the formation of Standard Bearer, certain of the Company's independent subsidiaries , Standard Bearer and Standard Bearer's independent real estate subsidiaries entered into several agreements that include leasing, management services and debt arrangements between the operations . All intercompany transactions have been eliminated in consolidation. Refer to Note 8, Business Segments , for additional information related to these intercompany eliminations as well as Standard Bearer as a reportable segment. Intercompany master lease agreements Certain of the Company's independent subsidiaries and 92 Standard Bearer independent real estate subsidiaries have entered into six triple-net master lease agreements (collectively, the Standard Bearer Master Leases). The lease periods range from 15 to 19 years with three five-year renewal options beyond the initial term, on the same terms and conditions. The rent structure under the Standard Bearer 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 independent subsidiaries are required to pay the following: (1) all impositions and taxes levied on or with respect to the leased properties; (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. Intercompany rental revenue generated from Ensign affiliated operations was $78,110, $66,712, and $57,967 for the years ended December 31, 2024, 2023 and 2022, respectively, which has been eliminated in consolidation. Intercompany management agreement Standard Bearer has no employees. The Service Center provides personnel and services to Standard Bearer pursuant to the management agreement between Standard Bearer and the Service Center. The management agreement provides for a base management fee that is equal to 5.0% of total rental revenue and an incentive management fee that is equal to 5.0% of funds from operations (FFO) and is capped at 1.0% of total rental revenue, for a total of 6.0%. Management fee generated between Standard Bearer and the Service Center for the years ended December 31, 2024, 2023 and 2022 was $5,707, $4,948 and $4,367, respectively, which has been eliminated in consolidation. Intercompany debt arrangements Standard Bearer obtains its funding through various sources including operating cash flows, access to debt arrangements and intercompany loans. The intercompany debt arrangements include mortgage loans and a credit facility to fund acquisitions and working capital needs. The interest rate under the credit facility is a base rate plus a margin ranging from 0.25% to 1.25% per annum or SOFR plus a margin ranging from 1.25% to 2.25% per annum. In addition, as the Department of Housing and Urban Development (HUD) mortgage loans and promissory note are entered into by real estate subsidiaries of Standard Bearer, the interest expense incurred from these debts are included in Standard Bearer's segment income. Refer to Note 14, Debt , for additional information related to these debts. Equity Instrument Denominated in the Shares of a Subsidiary As part of the formation of Standard Bearer in 2022, the Company established the Standard Bearer Healthcare REIT, Inc. 2022 Omnibus Incentive Plan (Standard Bearer Equity Plan). The Company may grant stock options and restricted stock awards under the Standard Bearer Equity Plan to employees and management of Ensign's independent subsidiaries. These awards generally vest over a period of five years or upon the occurrence of certain prescribed events. The value of the stock options and restricted stock awards is tied to the value of the common stock of Standard Bearer, which is determined based on an independent valuation of Standard Bearer. The Company can also call the awards, generally upon employee termination. The Company granted 39 restricted stock awards during the year ended December 31, 2024. During the years ended December 31, 2023 and 2022, the Company did not grant any stock options or restricted shares under the Standard Bearer Equity Plan. During the years ended December 31, 2024, 2023 and 2022, there were no restricted stock awards vested for the periods. The grant-date fair value of the awards is recognized as compensation expense over the relevant vesting periods, with a corresponding adjustment to noncontrolling interests. The grant value was determined based on an independent valuation of the subsidiary shares. For the year ended December 31, 2024, the Standard Bearer Equity Plan's share-based compensation expense was not material. There was no expense during the years ended December 31, 2023 and 2022. During the year ended December 31, 2022, Standard Bearer sold fully vested common shares from the Standard Bearer Equity Plan to shareholders for cash of $6,544. Also, during the year ended December 31, 2022, Standard Bearer established shareholders of its preferred shares through contributions of cash of $149. These preferred shares were fully vested at the time of the contributions by the shareholders. The value of Standard Bearer common and preferred shares held by the Company are eliminated in consolidation and the value held by other shareholders are classified as noncontrolling interests on the Company's consolidated balance sheets.

OPERATION EXPANSIONS

OPERATION EXPANSIONS	12 Months Ended
OPERATION EXPANSIONS	Dec. 31, 2024
Business Combination, Asset Acquisition, and Joint Venture Formation [Abstract]
OPERATION EXPANSIONS	OPERATION EXPANSIONS The expansion focus of the Company's independent subsidiaries is to purchase or lease operations that are complementary to the current operations, accretive to the business, or otherwise advance the Company's strategy. The results of all independent subsidiaries are included in the Financial Statements subsequent to the date of acquisition. Acquisitions are accounted for using the acquisition method of accounting. In connection with the new operations obtained 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 also entered into a separate operations transfer agreement with each prior operator as part of each transaction. The Company's independent subsidiaries also enter into long-term leases that may include options to purchase the facilities. As a result, from time to time, an independent real estate subsidiary may acquire the property of facilities that have previously been operated under third-party leases. 2024 Expansions During the year ended December 31, 2024, the Company expanded its operations through a combination of long-term leases and real estate purchases , with the addition of 28 stand-alone skilled nursing operations, including a long-term acute care hospital and three campus operations. Of these additions, Standard Bearer acquired the real estate of 14 of these operations, all of which were leased back to the Company's independent subsidiaries. Refer to Note 6, Standard Bearer, for additional information on the purchase of real estate properties. These new operations added a total of 3,030 operational skilled nursing beds, including 43 long-term acute care beds and 218 operational senior living units to be operated by the Company's independent subsidiaries. The Company also invested in new ancillary services that are complementary to its existing businesses. Subsequent to December 31, 2024, the Company expanded its operations with the addition of seven stand-alone skilled nursing operations. Of these additions, Standard Bearer acquired the real estate of one of these operations, which was leased back to the Company's independent subsidiary. Refer to Note 6, Standard Bearer, for additional information on the purchase of the real estate property. The new operations added 682 operational skilled nursing beds to be operated by the Company's independent subsidiaries. 2023 Expansions During the year ended December 31, 2023, the Company expanded its operations through a combination of long-term leases and real estate purchases , with the addition of 25 stand-alone skilled nursing operations and one campus operation. Of these additions, Standard Bearer acquired the real estate of three of the stand-alone skilled nursing operations and one campus operation, which were leased back to the Company's independent subsidiaries. Refer to Note 6, Standard Bearer, for additional information on the purchase of real estate properties. These new operations added a total of 2,483 operational skilled nursing beds and 94 operational senior living units to be operated by the Company's independent subsidiaries. 2022 Expansions During the year ended December 31, 2022, the Company expanded its operations and real estate portfolio through a combination of long-term leases and real estate purchases , with the addition of 23 stand-alone skilled nursing operations and one campus operation. Of these additions, Standard Bearer acquired the real estate of seven of the stand-alone skilled nursing operations, which were leased back to Ensign's independent subsidiaries. Refer to Note 6, Standard Bearer , for additional information on the purchases of real estate properties. In addition, the Company added five senior living operations that were transferred from The Pennant Group, Inc. (Pennant), three of which are part of campuses operated by the Company's independent subsidiaries. These new operations added a total of 3,058 operational skilled nursing beds and 674 operational senior living units to be operated by the Company's independent subsidiaries. The Company also invested in new ancillary services that are complementary to its existing businesses. The table below presents the allocation of the purchase price for the operations acquired during the years ended December 31, 2024, 2023 and 2022: Year Ended December 31, 2024 2023 2022 Land $ 20,547 $ 7,794 $ 15,527 Building and improvements 108,709 57,488 65,070 Equipment, furniture, and fixtures 2,937 1,840 1,618 Assembled occupancy 1,210 346 367 Goodwill 21,112 — 16,400 Leased asset — — 1,909 Other indefinite-lived intangible assets 364 330 245 TOTAL ACQUISITIONS $ 154,879 $ 67,798 $ 101,136 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 operations added by the Company are frequently underperforming financially and can have regulatory and clinical challenges to overcome. Financial information, especially with underperforming operations, is often inadequate, inaccurate or unavailable. Consequently, the Company believes that prior operating results are not a meaningful representation of the Company’s current operating results or indicative of the integration potential of its newly acquired independent subsidiaries . The operations added during the year ended December 31, 2024 were not material to the Company individually or in the aggregate. Accordingly, pro forma financial information is not presented. These additions have been included in the consolidated balance sheets of the Company, and the operating results have been included in the consolidated statements of income of the Company since the date the Company gained effective control.

BUSINESS SEGMENTS

BUSINESS SEGMENTS	12 Months Ended
BUSINESS SEGMENTS	Dec. 31, 2024
Segment Reporting [Abstract]
BUSINESS SEGMENTS	BUSINESS SEGMENTS The Company has two reportable segments: (1) skilled services, which includes the operation of skilled nursing facilities and rehabilitation therapy services and (2) Standard Bearer, which is comprised of selected real estate properties owned by Standard Bearer and leased to skilled nursing and senior living operators. As of December 31, 2024, the skilled services segment includes 286 skilled nursing and 30 campus operations that provide both skilled nursing and rehabilitative care services and senior living services. The Company's Standard Bearer segment consists of 124 owned real estate properties. The Company also reports an “All Other” category that includes results from its senior living operations, which includes 11 stand-alone senior living operations and the senior living operations at 30 campus operations that provide both skilled nursing and rehabilitative care services and senior living services. In addition, the "All Other" category includes mobile diagnostics, medical transportation, other real estate, other ancillary operations and the Service Center. Services included in the “All Other” category are insignificant individually, and therefore do not constitute a reportable segment. The Company’s reportable segments are significant operating segments that offer differentiated services. The segment structure reflects the Company's current operational and financial management and provides the best structure to maximize the quality of care and investment strategy provided, while maintaining financial discipline. Segment income (loss) is defined as income or loss before provision for income taxes, excluding gain or loss from sale of real estate, real estate insurance recoveries and impairment of long-lived assets. The Company's CODM, who is the Chief Executive Officer, reviews segment income or loss for each operating segment to evaluate performance and allocate capital resources. The CODM uses segment income or loss to analyze actual results as part of operational planning and to decide whether to reinvest profits into the segments or into other parts of the Company, such as through acquisitions, to pay dividends or to recommend a stock repurchase program. The Company's CODM does not review assets by segment in his resource allocation and therefore assets by segment are not disclosed below. Intercompany revenue is eliminated in consolidation, along with corresponding intercompany expenses. Included in segment income for Standard Bearer is expense for intercompany services provided by the Service Center as described in Note 6, Standard Bearer , as it is part of the CODM financial information. The following tables set forth financial information for the segments: Year Ended December 31, 2024 Skilled Services Standard Bearer Total Service revenue (1) $ 4,076,825 $ — $ 4,076,825 Rental revenue — 95,086 95,086 Segment revenue $ 4,076,825 $ 95,086 $ 4,171,911 Reconciliation of revenue: All other revenue (2) 192,881 Elimination of intercompany revenue (3) (104,307) TOTAL CONSOLIDATED REVENUE $ 4,260,485 Less: Other segment items (4) 3,513,167 9,152 Depreciation and amortization 45,195 29,297 Interest expense (5) — 27,302 Segment income $ 518,463 $ 29,335 $ 547,798 Reconciliation of profit or loss: All other loss (161,704) INCOME BEFORE PROVISION FOR INCOME TAXES $ 386,094 (1) Skilled services service revenue does not include intercompany service revenue generated by ancillary operations provided to the Company's independent subsidiaries and management service revenue generated by the Service Center with Standard Bearer. Intercompany service revenue is eliminated in "Elimination of intercompany revenue". (2) All other revenue includes $181,066 of service revenue and $11,815 of rental revenue for the year ended December 31, 2024, both of which include intercompany revenue that is eliminated in "Elimination of intercompany revenue". (3) Elimination of intercompany revenue includes the elimination of intercompany rental revenue of $83,941 and intercompany service revenue of $20,366 for the year ended December 31, 2024. (4) Other segment items includes cost of services and rent expense for the skilled services segment and cost of services, rent expense and general and administrative expenses for the Standard Bearer segment. Additionally, there are intercompany expenses of $104,307 during the year ended December 31, 2024, which are eliminated in consolidation. (5) Included in interest expense in Standard Bearer is interest from intercompany debt arrangements between Standard Bearer and The Ensign Group, Inc. of $20,285 during the year ended December 31, 2024, which is eliminated in consolidation. Year Ended December 31, 2023 Skilled Services Standard Bearer Total Service revenue (1) $ 3,578,855 $ — $ 3,578,855 Rental revenue — 82,486 82,486 Segment revenue $ 3,578,855 $ 82,486 $ 3,661,341 Reconciliation of revenue: All other revenue (2) 155,804 Elimination of intercompany revenue (3) (87,790) TOTAL CONSOLIDATED REVENUE $ 3,729,355 Less: Other segment items (4) 3,075,164 8,455 Depreciation and amortization 38,766 25,205 Interest expense (5) — 19,761 Segment income $ 464,925 $ 29,065 $ 493,990 Reconciliation of profit or loss: All other loss (221,228) INCOME BEFORE PROVISION FOR INCOME TAXES $ 272,762 (1) Skilled services service revenue does not include intercompany service revenue generated by ancillary operations provided to the Company's independent subsidiaries and management service revenue generated by the Service Center with Standard Bearer. Intercompany service revenue is eliminated in "Elimination of intercompany revenue". (2) All Other revenue includes $144,667 of service revenue and $11,137 of rental revenue for the year ended December 31, 2023, both of which include intercompany revenue that is eliminated in "Elimination of intercompany revenue". (3) Elimination of intercompany revenue includes the elimination intercompany rental revenue of $72,339 and intercompany service revenue of $15,451 for the year ended December 31, 2023. (4) Other segment items includes cost of services and rent expense for the skilled services segment and cost of services, rent expense and general and administrative expenses for the Standard Bearer segment. Additionally, there are intercompany expenses of $87,790 during the year ended December 31, 2023, which is eliminated in consolidation. (5) Included in interest expense in Standard Bearer is interest from intercompany debt arrangements between Standard Bearer and The Ensign Group, Inc. of $12,902 during the year ended December 31, 2023, which is eliminated in consolidation. Year Ended December 31, 2022 Skilled Services Standard Bearer Total Service revenue (1) $ 2,906,215 $ — $ 2,906,215 Rental revenue — 72,937 72,937 Segment revenue $ 2,906,215 $ 72,937 $ 2,979,152 Reconciliation of revenue: All other revenue (2) 122,610 Elimination of intercompany revenue (3) (76,294) TOTAL CONSOLIDATED REVENUE $ 3,025,468 Less: Other segment items (4) 2,464,259 7,746 Depreciation and amortization 33,224 21,613 Interest expense (5) — 15,707 Segment income $ 408,732 $ 27,871 $ 436,603 Reconciliation of profit or loss: All other loss (147,514) INCOME BEFORE PROVISION FOR INCOME TAXES $ 289,089 (1) Skilled services service revenue does not include intercompany service revenue generated by ancillary operations provided to the Company's independent subsidiaries and management service revenue generated by the Service Center with Standard Bearer. Intercompany service revenue is eliminated in "Elimination of intercompany revenue". (2) All Other revenue includes $115,214 of service revenue and $7,396 of rental revenue for the year ended December 31, 2022, both of which include intercompany revenue that is eliminated in "Elimination of intercompany revenue". (3) Elimination of intercompany revenue includes the elimination of intercompany rental revenue of $63,576 and intercompany service revenue of $12,718 for the year ended December 31, 2022. (4) Other segment items includes cost of services and rent expense for the skilled services segment and cost of services, rent expense and general and administrative expenses for the Standard Bearer segment. Additionally, there are intercompany expenses of $76,294 during the year ended December 31, 2022, which is eliminated in consolidation. (5) Included in interest expense in Standard Bearer is interest from intercompany debt arrangements between Standard Bearer and The Ensign Group, Inc. of $8,646 during the year ended December 31, 2022, which is eliminated in consolidation. Service revenue by major payor source were as follows: Year Ended December 31, 2024 Skilled Services All Other (3) Total Service Revenue Revenue % Medicaid (1) $ 1,646,422 $ 35,922 $ 1,682,344 39.7 % Medicare 1,055,226 — 1,055,226 24.9 Medicaid-skilled 266,738 — 266,738 6.3 Subtotal $ 2,968,386 $ 35,922 $ 3,004,308 70.9 % Managed care 789,643 — 789,643 18.6 Private and other (2) 318,796 124,778 443,574 10.5 TOTAL SERVICE REVENUE $ 4,076,825 $ 160,700 $ 4,237,525 100.0 % (1) Medicaid payor includes revenue generated from senior living operations. (2) Private and other payors also includes revenue from senior living operations and all revenue generated in other ancillary services. (3) All Other incorporates intercompany eliminations. Year Ended December 31, 2023 Skilled Services All Other (3) Total Service Revenue Revenue % Medicaid (1) $ 1,429,473 $ 29,976 $ 1,459,449 39.4 % Medicare 985,749 — 985,749 26.6 Medicaid-skilled 245,663 — 245,663 6.6 Subtotal $ 2,660,885 $ 29,976 $ 2,690,861 72.6 % Managed care 666,129 — 666,129 18.0 Private and other (2) 251,841 99,240 351,081 9.4 TOTAL SERVICE REVENUE $ 3,578,855 $ 129,216 $ 3,708,071 100.0 % (1) Medicaid payor includes revenue generated from senior living operations and revenue related to state relief funding. (2) Private and other payors also includes revenue from senior living operations and all revenue generated in other ancillary services. (3) All Other incorporates intercompany eliminations. Year Ended December 31, 2022 Skilled Services All Other (3) Total Service Revenue Revenue % Medicaid (1) $ 1,158,309 $ 24,847 $ 1,183,156 39.3 % Medicare 832,160 — 832,160 27.7 Medicaid-skilled 200,878 — 200,878 6.7 Subtotal 2,191,347 24,847 2,216,194 73.7 Managed care 525,710 — 525,710 17.5 Private and other (2) 189,158 77,649 266,807 8.8 TOTAL SERVICE REVENUE $ 2,906,215 $ 102,496 $ 3,008,711 100.0 % (1) Medicaid payor includes revenue generated from senior living operations and revenue related to state relief funding. (2) Private and other payors also includes revenue from senior living operations and all payors generated in other ancillary services. (3) All Other incorporates intercompany eliminations.

PROPERTY AND EQUIPMENT_ NET

PROPERTY AND EQUIPMENT— NET	12 Months Ended
PROPERTY AND EQUIPMENT— NET	Dec. 31, 2024
Property, Plant and Equipment [Abstract]
PROPERTY AND EQUIPMENT— NET	PROPERTY AND EQUIPMENT - NET Property and equipment, net consists of the following: December 31, 2024 2023 Land $ 162,873 $ 142,656 Buildings and improvements 933,790 803,155 Leasehold improvements 212,603 172,064 Equipment 396,018 339,383 Furniture and fixtures 4,349 4,192 Construction in progress 41,209 25,563 $ 1,750,842 $ 1,487,013 Less: accumulated depreciation (459,488) (396,242) PROPERTY AND EQUIPMENT, NET $ 1,291,354 $ 1,090,771 The Company completed the sale of assets for a sale price of $8,607 and recorded a gain of $3,467 within the Company's consolidated statement of income as cost of services during the year ended December 31, 2022. The Company recorded gain and losses related to sale of assets, which were not material during the years ended December 31, 2024 and 2023. Management evaluated its long-lived assets and recorded an impairment charge of $1,849 within the Company's consolidated statement of income as cost of services

INTANGIBLE ASSETS _ NET

INTANGIBLE ASSETS — NET	12 Months Ended
INTANGIBLE ASSETS — NET	Dec. 31, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
INTANGIBLE ASSETS — NET	INTANGIBLE ASSETS - NET Weighted Average Life (Years) December 31, 2024 2023 Gross Carrying Amount Accumulated Amortization Gross Carrying Amount Accumulated Amortization Intangible Assets Net Net Assembled occupancy 0.4 $ 1,991 $ (1,316) $ 675 $ 781 $ (742) $ 39 Facility trade name 30.0 733 (462) 271 733 (439) 294 Customer relationships 18.4 4,582 (2,902) 1,680 4,582 (2,692) 1,890 TOTAL $ 7,306 $ (4,680) $ 2,626 $ 6,096 $ (3,873) $ 2,223 During the years ended December 31, 2024, 2023 and 2022, amortization expense was $2,019, $1,790 and $1,714, respectively, of which $1,212, $1,202, and $1,160 was related to the amortization of right-of-use assets, respectively. The Company did not record any impairment charge to intangible assets during the years ended December 31, 2024, 2023 and 2022. Estimated amortization expense for each of the years ending December 31 is as follows: Year Amount 2025 911 2026 234 2027 234 2028 234 2029 234 Thereafter 779 $ 2,626 Other indefinite-lived intangible assets consist of the following: December 31, 2024 2023 Trade name $ 889 $ 889 Medicare and Medicaid licenses 3,777 3,413 TOTAL $ 4,666 $ 4,302

GOODWILL

GOODWILL	12 Months Ended
GOODWILL	Dec. 31, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
GOODWILL	GOODWILL Provided that goodwill corresponds to the acquisition of a business and not merely the acquisition of real estate property, the Company's Standard Bearer segment appropriately does not carry a goodwill balance. The following table represents activity in goodwill by skilled service segment and "all other" category as of December 31, 2024, 2023 and 2022: Goodwill Skilled Services All Other Total January 1, 2022 $ 51,486 $ 8,983 $ 60,469 Additions 16,400 — 16,400 December 31, 2022 $ 67,886 $ 8,983 $ 76,869 December 31, 2023 $ 67,886 $ 8,983 $ 76,869 Additions 20,740 372 21,112 December 31, 2024 $ 88,626 $ 9,355 $ 97,981 Management has evaluated its goodwill and intangible assets and determined there was no impairment during the years ended December 31, 2024, 2023 and 2022. The Company has recognized cumulative goodwill impairment losses of $7,410, since inception in 1999.

OTHER ACCRUED LIABILITIES

OTHER ACCRUED LIABILITIES	12 Months Ended
OTHER ACCRUED LIABILITIES	Dec. 31, 2024
Payables and Accruals [Abstract]
OTHER ACCRUED LIABILITIES	OTHER ACCRUED LIABILITIES Other accrued liabilities consist of the following: December 31, 2024 2023 Quality assurance fee $ 12,667 $ 14,035 Refunds payable 56,755 51,248 Resident advances 18,818 10,834 Cash held in trust for patients 6,370 6,215 Dividends payable 3,589 3,396 Property taxes 15,400 12,875 Accrued litigation (Note 19) — 51,734 Other 18,458 17,891 OTHER ACCRUED LIABILITIES $ 132,057 $ 168,228 Quality assurance fee represents the aggregate of amounts payable to Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, Tennessee, 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. 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 consolidated balance sheets.

INCOME TAXES

INCOME TAXES	12 Months Ended
INCOME TAXES	Dec. 31, 2024
Income Tax Disclosure [Abstract]
INCOME TAXES	INCOME TAXES The provision for income taxes for the years ended December 31, 2024, 2023 and 2022 is summarized as follows: Year Ended December 31, 2024 2023 2022 Current: Federal $ 70,144 $ 73,092 $ 56,717 State 16,857 17,301 14,216 $ 87,001 $ 90,393 $ 70,933 Deferred: Federal 582 (22,280) (5,158) State 53 (5,201) (1,338) $ 635 $ (27,481) $ (6,496) TOTAL $ 87,636 $ 62,912 $ 64,437 A reconciliation of the federal statutory rate to the effective tax rate for net income for the years ended December 31, 2024, 2023 and 2022, respectively, is comprised as follows: December 31, 2024 2023 2022 Income tax expense at statutory rate 21.0 % 21.0 % 21.0 % State income taxes - net of federal benefit 3.5 3.5 3.5 Non-deductible expenses 1.8 3.4 2.0 Equity compensation (3.3) (4.2) (3.6) Other adjustments (0.3) (0.6) (0.6) TOTAL INCOME TAX PROVISION 22.7 % 23.1 % 22.3 % The Company's effective tax rate was 22.7% for the year ended December 31, 2024, compared to 23.1% for the same period in 2023 and 22.3% in 2022. The lower effective tax rate is due to lower non-deductible expenses included but not limited to tax benefits from stock based compensation. The Company's deferred tax assets and liabilities as of December 31, 2024 and 2023 are summarized below. December 31, 2024 2023 Deferred tax assets (liabilities): Accrued expenses $ 76,419 $ 81,502 Revenue related reserves 27,023 23,714 Tax credits 597 1,192 Insurance 24,817 16,864 Lease liability 470,313 444,590 $ 599,169 $ 567,862 Valuation allowance (93) (789) TOTAL DEFERRED TAX ASSETS $ 599,076 $ 567,073 State taxes (197) (280) Depreciation and amortization (57,253) (52,334) Prepaid expenses (6,390) (4,113) Right-of-use asset (468,955) (443,222) TOTAL DEFERRED TAX LIABILITIES $ (532,795) $ (499,949) NET DEFERRED TAX ASSETS $ 66,281 $ 67,124 The Company had state credit carryforwards as of December 31, 2024 and 2023 of $597 and $1,192, respectively. These carryforwards almost entirely relate to state limitations on the application of Enterprise Zone employment-related tax credits. Unless the Company uses the Enterprise Zone credits beforehand, the carryforward began to expire in 2023. The remainder of these carryforwards relate to credits against the Texas margin tax and is expected to carryforward until 2027. As of December 31, 2024 and 2023, the valuation allowance of $93 and $789, respectively, was primarily recorded against the Enterprise Zone credits as the Company believes it is more likely than not that some of the benefit of the credits will not be realized. The Company's operating loss carry forwards for states were not material during the years ended December 31, 2024 and 2023. As of December 31, 2024, 2023 and 2022, the Company did not have any unrecognized tax benefits, net of its state benefits that would affect the Company's effective tax rate. The Company classifies interest and/or penalties on income tax liabilities or refunds as additional income tax expense or income. Such amounts are not material. The federal statutes of limitations on the Company's 2020, 2019, and 2018 income tax years lapsed during the third quarter of 2024, 2023, and 2022, respectively. During the fourth quarter of each year, various state statutes of limitations also lapsed. The lapses during the years ended December 31, 2024 and 2023 had no impact on the Company's unrecognized tax benefits.

DEBT

DEBT	12 Months Ended
DEBT	Dec. 31, 2024
Debt Disclosure [Abstract]
DEBT	DEBT Debt consists of the following: December 31, 2024 2023 Mortgage loans and promissory note $ 148,438 $ 152,388 Less: current maturities (4,086) (3,950) Less: debt issuance costs, net (2,767) (2,941) LONG-TERM DEBT LESS CURRENT MATURITIES $ 141,585 $ 145,497 Credit Facility with a Lending Consortium Arranged by Truist The Company maintains a revolving credit facility between the Company and its independent subsidiaries, including Standard Bearer as co-borrowers, and Truist Securities (Truist) (the Credit Facility) with a revolving line of credit of up to $600,000 in aggregate principal amount with a maturity date of April 8, 2027. 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 0.25% to 1.25% per annum or SOFR plus a margin ranging from 1.25% to 2.25% per annum, based on the Consolidated Total Net Debt to Consolidated EBITDA ratio (as defined in the Credit Facility). In addition, there is a commitment fee on the unused portion of the commitments that ranges from 0.20% to 0.40% per annum, depending on the Consolidated Total Net Debt to Consolidated EBITDA ratio. Borrowings made under the Credit Facility are guaranteed, jointly and severally, by certain of the Company’s wholly-owned subsidiaries, and are secured by a pledge of stock of the Company's material independent subsidiaries as well as a first lien on substantially all of such independent subsidiaries' personal property. The Credit Facility contains customary covenants that, among other things, restrict, subject to certain exceptions, the ability of the Company and its independent 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 terms of 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 3.75:1.00; 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 4.25:1.00 for the first fiscal quarter and the immediately following three fiscal quarters), and (ii) a minimum interest/rent coverage ratio (which cannot be less than 1.50:1.00). As of December 31, 2024, there was no outstanding debt under the Credit Facility. The Company was in compliance with all loan covenants as of December 31, 2024. Mortgage Loans and Promissory Note As of December 31, 2024, the Company has 23 subsidiaries that have mortgage loans insured with HUD in the aggregate amount of $146,898, which subjects these subsidiaries to HUD oversight and periodic inspections. The mortgage loans bear effective interest rates in a range of 3.1% to 4.2%, including fixed interest rates in a range of 2.4% to 3.3% per annum. In addition to the interest rate, the Company incurs other fees for HUD placement, including, but not limited to audit fees. Amounts borrowed under the mortgage loans may be prepaid, subject to prepayment fees based on the principal balance on the date of prepayment. For the majority of the loans, during the first three years, the prepayment fee is 10.0% and is reduced by 3.0% in the fourth year of the loan and reduced by 1.0% per year for years five through ten of the loan. There is no prepayment penalty after year ten. The terms for all the mortgage loans are 25 to 35 years. In addition to the HUD mortgage loans above, the Company has a promissory note of $1,540 that bears a fixed interest rate of 5.3% per annum and has a term of 12 years. The note, which was assumed as part of 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. Future principal payments due under the long-term debt arrangements discussed above are as follows: Years Ending December 31, Amount 2025 $ 4,086 2026 4,227 2027 3,897 2028 3,779 2029 3,896 Thereafter 128,553 $ 148,438 Based on Level 2 inputs, 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 As of December 31, 2024, the Company had approximately $27,893 of borrowing capacity under the Credit Facility pledged as collateral to secure outstanding letters of credit, which increased by $21,638 from December 31, 2023. The Company believes that its outstanding letters of credit as of December 31, 2024 do not require an allowance for expected credit losses, nor has any event occurred through the filing date of this report that would indicate differently.

OPTIONS AND AWARDS

OPTIONS AND AWARDS	12 Months Ended
OPTIONS AND AWARDS	Dec. 31, 2024
Share-Based Payment Arrangement [Abstract]
OPTIONS AND AWARDS	OPTIONS AND AWARDS 2022 Omnibus Incentive Plan (2022 Plan) — The Company has one stock incentive plan, the 2022 Omnibus Incentive Plan (the 2022 Plan), pursuant to which grants of the Company's securities may currently be made. Including the shares rolled over from the 2017 Omnibus Incentive Plan, the 2022 Plan provides for the issuance of 3,452 shares of common stock. The number of shares available to be issued under the 2022 Plan will be reduced by (i) one share for each share that relates to an option or stock appreciation right award and (ii) two shares for each share which relates to an award other than a stock option or stock appreciation right award (a full-value award). Non-employee director options, to the extent granted, will 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 five years at 20% per year on the anniversary of the grant date. Options expire ten years from the date of grant. At December 31, 2024, the total number of shares available for issuance under the 2022 Plan was 346. 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 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. The Black-Scholes model required the Company to make several key judgments including: • The expected option term is calculated by the average of the contractual term of the options and the weighted average vesting period for all options. The calculation of the expected option term is based on the Company's experience due to sufficient history. • The Company utilizes its own experience to calculate estimated volatility for options granted. • The dividend yield is based on the Company's historical pattern of dividends as well as expected dividend patterns. • The risk-free rate is based on the implied yield of U.S. Treasury notes as of the grant date with a remaining term approximately equal to the expected term. • Estimated forfeiture rate of approximately 4.86% per year is based on the Company's historical forfeiture activity of unvested stock options. Stock Options The Company granted 704, 1,008 and 581 stock options during the years ended December 31, 2024, 2023 and 2022, respectively. The Company used the following assumptions for stock options granted during the years ended December 31, 2024, 2023 and 2022: Grant Year Options Granted Weighted Average Risk-Free Rate Expected Life Weighted Average Volatility Weighted Average Dividend Yield 2024 704 4.3% 6.2 years 40.5% 0.2% 2023 1,008 4.3% 6.2 years 41.3% 0.2% 2022 581 2.8% 6.2 years 42.1% 0.3% For the years ended December 31, 2024, 2023 and 2022, the following represents the exercise price and fair value displayed at grant date for stock option grants: Grant Year Granted Weighted Average Exercise Price Weighted Average Fair Value of Options 2024 704 $ 132.46 $ 60.37 2023 1,008 $ 95.05 $ 43.85 2022 581 $ 85.74 $ 37.83 The weighted average exercise price equaled the weighted average fair value of common stock on the grant date for all options granted during the periods ended December 31, 2024, 2023 and 2022 and therefore, the intrinsic value was $0 at the date of grant. The following table represents the employee stock option activity during the years ended December 31, 2024, 2023 and 2022: Number of Options Outstanding Weighted Average Number of Weighted Average Exercise Price of Options Vested January 1, 2022 4,038 $ 36.60 2,183 $ 21.02 Granted 581 85.74 Forfeited (98) 59.52 Exercised (688) 18.43 December 31, 2022 3,833 $ 46.72 2,069 $ 28.87 Granted 1,008 95.05 Forfeited (91) 71.44 Exercised (759) 24.21 December 31. 2023 3,991 $ 62.65 1,887 $ 39.58 Granted 704 132.46 Forfeited (76) 86.92 Exercised (632) 35.28 December 31, 2024 3,987 $ 78.84 1,895 $ 52.64 The following table represents the employee stock option activity during the year ended December 31, 2024: Stock Options Outstanding Stock Options Vested Number Outstanding Black-Scholes Fair Value Remaining Contractual Life (Years) Vested and Exercisable Year of Grant Exercise Price 2015 $18.20 - $21.39 69 $ 537 1 69 2016 15.93 - 16.86 112 667 2 112 2017 15.80 - 19.41 148 867 3 148 2018 22.49 - 32.71 241 2,557 4 241 2019 41.07 - 45.76 417 6,557 5 417 2020 44.84 - 59.49 406 8,020 6 301 2021 73.47 - 83.64 458 15,041 7 251 2022 79.79 - 94.88 489 18,601 8 176 2023 89.83 - 98.83 951 41,753 9 180 2024 $119.19 - $146.37 696 42,024 10 — TOTAL 3,987 $ 136,624 1,895 The aggregate intrinsic value of options outstanding, vested and expected to vest as of December 31, 2024, 2023 and 2022 is as follows: December 31, Options 2024 2023 2022 Outstanding $ 219,309 $ 197,819 $ 183,593 Vested 152,011 137,048 136,000 Expected to vest 63,243 56,759 43,232 The intrinsic value is calculated as the difference between the market value of the underlying common stock and the exercise price of the options . At December 31, 2024, 2023 and 2022, t he aggregate intrinsic value of options that vested during the years ended December 31, 2024, 2023 and 2022 was $37,700, $31,658, and $27,955, respectively. The total intrinsic value of options exercised during the years ended December 31, 2024, 2023 and 2022 was $60,358, $56,186, and $47,441, respectively. Restricted Stock Awards The Company granted 232, 219 and 233 restricted stock awards during the years ended December 31, 2024 , 2023 and 2022, 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 years ended December 31, 2024 , 2023 and 2022 ranged from $116.65 to $149.12, $89.83 to $98.31 and $73.17 to $94.88, respectively. The fair value per share includes quarterly stock awards to non-employee directors. Included in the restricted stock award grants are $6,165 and $5,068 of annual bonuses that were settled in vested restricted stock awards during the years ended December 31, 2024 and 2023, respectively. A summary of the status of the Company's non-vested restricted stock awards as of December 31, 2024 and changes during the years ended December 31, 2024, 2023 and 2022 is presented below: Non-Vested Restricted Awards Weighted Average Grant Date Fair Value Nonvested at January 1, 2022 549 $ 52.16 Granted 233 81.57 Vested (269) 54.06 Forfeited (26) 57.29 Nonvested at December 31, 2022 487 $ 64.92 Granted 219 92.04 Vested (255) 64.21 Forfeited (20) 71.53 Nonvested at December 31, 2023 431 $ 78.91 Granted 232 131.26 Vested (215) 86.97 Forfeited (13) 83.12 Nonvested at December 31, 2024 435 $ 102.71 During the year ended December 31, 2024, the Company granted 16 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 $116.65 to $149.12 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 who assisted in the consummation of the spin-off of Pennant from the Company in 2019 were granted shares of restricted stock upon successful completion of the spin-off. The 2019 LTI Plan provides for the issuance of 500 shares of Pennant restricted stock. As of December 31, 2024, the 2019 LTI Plan was fully vested. The total stock-based compensation related to the 2019 LTI Plan was $546, $827, and $836 for the years ended December 31, 2024, 2023 and 2022, respectively. Stock-based compensation expense Stock-based compensation expense recognized for the Company's equity incentive plans and long-term incentive plan for the years ended December 31, 2024 , 2023 and 2022 was as follows: Year Ended December 31, 2024 2023 2022 Stock-based compensation expense related to stock options $ 22,439 $ 17,221 $ 11,361 Stock-based compensation expense related to restricted stock awards 11,662 11,845 9,920 Stock-based compensation expense related to restricted stock awards to non-employee directors 2,082 1,688 1,439 TOTAL $ 36,183 $ 30,754 $ 22,720 In future periods, the Company expects to recognize approximately $84,914 and $38,434 in stock-based compensation expense for unvested options and unvested restricted stock awards, respectively, that were outstanding as of December 31, 2024. 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 2,092 unvested and outstanding options as of December 31, 2024, of which 1,925 shares are expected to vest. The weighted average contractual life for options outstanding, vested and expected to vest as of December 31, 2024 was 6.7 years.

LEASES

LEASES	12 Months Ended
LEASES	Dec. 31, 2024
Leases [Abstract]
LEASES	LEASES The Company leases from CareTrust REIT, Inc. (CareTrust) real property associated with 100 independent skilled nursing and senior living facilities used in the Company’s operations, 99 of which are under nine “triple-net” master lease agreements (collectively, the Master Leases), which range in terms from 13 to 20 years. At the Company’s option, the Master Leases may be extended for two or three five-year renewal terms beyond the initial term, on the same terms and conditions. The extension of the term of any of the Master Leases is subject to the following conditions: (1) no event of default under any of the Master Leases having occurred and 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 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. During the year ended December 31, 2024, the Company amended two of the Master Leases by adding three operations and extending the terms to 15 and 20 years, respectively. These amendments increased the lease liabilities and right-of-use assets by $72,503 to reflect the new lease obligations. Additionally, four of the 100 facilities leased from CareTrust include an option to purchase that the Company can exercise starting on December 1, 2024. Subsequent to December 31, 2024, the Company purchased the real estate of the four facilities from CareTrust for $44,575. 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. 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. The terms and conditions of the one stand-alone lease are substantially the same as those for the master leases described above. Total rent expense under the Master Leases was approximately $69,399, $66,439 and $64,178 for the years ended December 31, 2024, 2023 and 2022, 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 in compliance with requirements of the Master Leases as of December 31, 2024. The Company leases facilities where its independent subsidiaries operate and certain administrative offices under non-cancelable operating leases, most of which have initial lease terms ranging from 15 to 20 years. In addition, the Company leases certain of its equipment under non-cancelable operating leases with initial terms ranging from three Ninety of the Company’s independent subsidiaries, excluding the subsidiaries that are operated under the Master Leases with CareTrust, are operated under 14 separate master lease arrangements. During the year ended December 31, 2024, the Company amended one of the separate master lease arrangements to add two stand-alone skilled nursing operations operated by the Company's independent subsidiaries and extended the term to 20 years. In addition, the Company entered into one new master lease arrangement to add six stand-alone skilled nursing operations operated by the Company's independent subsidiaries with an initial term of 15 years. The amended and new master lease arrangements increased the lease liabilities and right-of-use assets by $71,616 to reflect the new lease obligations. Under the master leases, a default 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: Year Ended December 31, 2024 2023 2022 Rent - cost of services (1) $ 216,016 $ 197,358 $ 153,049 Cost of services (2) 24,297 20,454 16,938 General and administrative expense 700 498 125 Depreciation and amortization (3) 1,212 1,202 1,160 $ 242,225 $ 219,512 $ 171,272 (1) Rent- cost of services includes accrued rent expense adju stments of $808, $870 and $493 for the years ended December 31, 2024, 2023 and 2022, respectively. Additionally, rent- cost of services includes other variable lease costs such as consumer price index increases and short-term leases of $14,013, $10,259, $5,878 for the years ended December 31, 2024, 2023, and 2022 respectively. (2) Cost of services includes variable lease costs, which consists of property taxes and insurance. (3) Depreciation and amortization is related to the amortization of favorable and direct lease costs. Future minimum lease payments for all third-party leases as of December 31, 2024 are as follows: Year Amount 2025 $ 204,909 2026 204,696 2027 204,002 2028 202,994 2029 199,144 Thereafter 1,776,571 TOTAL LEASE PAYMENTS $ 2,792,316 Less: present value adjustment (963,516) PRESENT VALUE OF TOTAL LEASE LIABILITIES $ 1,828,800 Less: current lease liabilities (93,475) LONG-TERM OPERATING LEASE LIABILITIES $ 1,735,325 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 December 31, 2024 and 2023, the weighted average remaining lease term is 14.5 years and 14.9 years, respectively, and the weighted average discount rate used to determine the operating lease liabilities is 6.3% and 6.5%, respectively. Subsequent to December 31, 2024, the Company expanded its operations through a new master lease with the addition of six standalone skilled nursing operations. The aggregate impact to the carrying value of lease liabilities and right-of-use assets related to the long-term leases is estimated to be approximately $67,572. Lessor Activities The Company leases its owned real estate properties to third-party operators, of which 32 senior living operations are operated by Pennant. All of these properties are triple-net leases, whereby the respective tenants 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 from 14 to 16 years. During 2024, the Company expanded its operations through a separate master lease arrangement for three stand-alone senior living operations with a third-party operator for an initial lease term of 15 years. During 2023, the Company entered into a sublease agreement for three stand-alone skilled nursing operations with a third-party operator with an initial lease term of 18 years. Additionally, during the year, the Company entered into a lease agreement with a third-party operator for one campus operation with an initial lease term of 15 years. Total rental income from all third-party sources for the years ended December 31, 2024, 2023 and 2022 is as follows: Year Ended December 31, 2024 2023 2022 Pennant (1) $ 15,480 $ 15,048 $ 14,915 Other third-party (2) 7,480 6,236 1,842 TOTAL $ 22,960 $ 21,284 $ 16,757 (1) Pennant rental income includes variable rent such as property taxes of $1,235, $1,296, and $1,318 during the year ended December 31, 2024, 2023, and 2022. (2) Other third-party includes rental revenue associated with the Company's subleases to third parties of $4,347 and $3,897 for the years ended December 31, 2024 and 2023. There was no sublease rental revenue for the year ended December 31, 2022. Future annual rental income for all third-party leases as of December 31, 2024 were as follows: Year Amount (1) 2025 $ 23,664 2026 23,179 2027 22,736 2028 22,535 2029 22,511 Thereafter 119,811 TOTAL $ 234,436
LEASES	LEASES The Company leases from CareTrust REIT, Inc. (CareTrust) real property associated with 100 independent skilled nursing and senior living facilities used in the Company’s operations, 99 of which are under nine “triple-net” master lease agreements (collectively, the Master Leases), which range in terms from 13 to 20 years. At the Company’s option, the Master Leases may be extended for two or three five-year renewal terms beyond the initial term, on the same terms and conditions. The extension of the term of any of the Master Leases is subject to the following conditions: (1) no event of default under any of the Master Leases having occurred and 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 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. During the year ended December 31, 2024, the Company amended two of the Master Leases by adding three operations and extending the terms to 15 and 20 years, respectively. These amendments increased the lease liabilities and right-of-use assets by $72,503 to reflect the new lease obligations. Additionally, four of the 100 facilities leased from CareTrust include an option to purchase that the Company can exercise starting on December 1, 2024. Subsequent to December 31, 2024, the Company purchased the real estate of the four facilities from CareTrust for $44,575. 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. 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. The terms and conditions of the one stand-alone lease are substantially the same as those for the master leases described above. Total rent expense under the Master Leases was approximately $69,399, $66,439 and $64,178 for the years ended December 31, 2024, 2023 and 2022, 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 in compliance with requirements of the Master Leases as of December 31, 2024. The Company leases facilities where its independent subsidiaries operate and certain administrative offices under non-cancelable operating leases, most of which have initial lease terms ranging from 15 to 20 years. In addition, the Company leases certain of its equipment under non-cancelable operating leases with initial terms ranging from three Ninety of the Company’s independent subsidiaries, excluding the subsidiaries that are operated under the Master Leases with CareTrust, are operated under 14 separate master lease arrangements. During the year ended December 31, 2024, the Company amended one of the separate master lease arrangements to add two stand-alone skilled nursing operations operated by the Company's independent subsidiaries and extended the term to 20 years. In addition, the Company entered into one new master lease arrangement to add six stand-alone skilled nursing operations operated by the Company's independent subsidiaries with an initial term of 15 years. The amended and new master lease arrangements increased the lease liabilities and right-of-use assets by $71,616 to reflect the new lease obligations. Under the master leases, a default 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: Year Ended December 31, 2024 2023 2022 Rent - cost of services (1) $ 216,016 $ 197,358 $ 153,049 Cost of services (2) 24,297 20,454 16,938 General and administrative expense 700 498 125 Depreciation and amortization (3) 1,212 1,202 1,160 $ 242,225 $ 219,512 $ 171,272 (1) Rent- cost of services includes accrued rent expense adju stments of $808, $870 and $493 for the years ended December 31, 2024, 2023 and 2022, respectively. Additionally, rent- cost of services includes other variable lease costs such as consumer price index increases and short-term leases of $14,013, $10,259, $5,878 for the years ended December 31, 2024, 2023, and 2022 respectively. (2) Cost of services includes variable lease costs, which consists of property taxes and insurance. (3) Depreciation and amortization is related to the amortization of favorable and direct lease costs. Future minimum lease payments for all third-party leases as of December 31, 2024 are as follows: Year Amount 2025 $ 204,909 2026 204,696 2027 204,002 2028 202,994 2029 199,144 Thereafter 1,776,571 TOTAL LEASE PAYMENTS $ 2,792,316 Less: present value adjustment (963,516) PRESENT VALUE OF TOTAL LEASE LIABILITIES $ 1,828,800 Less: current lease liabilities (93,475) LONG-TERM OPERATING LEASE LIABILITIES $ 1,735,325 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 December 31, 2024 and 2023, the weighted average remaining lease term is 14.5 years and 14.9 years, respectively, and the weighted average discount rate used to determine the operating lease liabilities is 6.3% and 6.5%, respectively. Subsequent to December 31, 2024, the Company expanded its operations through a new master lease with the addition of six standalone skilled nursing operations. The aggregate impact to the carrying value of lease liabilities and right-of-use assets related to the long-term leases is estimated to be approximately $67,572. Lessor Activities The Company leases its owned real estate properties to third-party operators, of which 32 senior living operations are operated by Pennant. All of these properties are triple-net leases, whereby the respective tenants 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 from 14 to 16 years. During 2024, the Company expanded its operations through a separate master lease arrangement for three stand-alone senior living operations with a third-party operator for an initial lease term of 15 years. During 2023, the Company entered into a sublease agreement for three stand-alone skilled nursing operations with a third-party operator with an initial lease term of 18 years. Additionally, during the year, the Company entered into a lease agreement with a third-party operator for one campus operation with an initial lease term of 15 years. Total rental income from all third-party sources for the years ended December 31, 2024, 2023 and 2022 is as follows: Year Ended December 31, 2024 2023 2022 Pennant (1) $ 15,480 $ 15,048 $ 14,915 Other third-party (2) 7,480 6,236 1,842 TOTAL $ 22,960 $ 21,284 $ 16,757 (1) Pennant rental income includes variable rent such as property taxes of $1,235, $1,296, and $1,318 during the year ended December 31, 2024, 2023, and 2022. (2) Other third-party includes rental revenue associated with the Company's subleases to third parties of $4,347 and $3,897 for the years ended December 31, 2024 and 2023. There was no sublease rental revenue for the year ended December 31, 2022. Future annual rental income for all third-party leases as of December 31, 2024 were as follows: Year Amount (1) 2025 $ 23,664 2026 23,179 2027 22,736 2028 22,535 2029 22,511 Thereafter 119,811 TOTAL $ 234,436

DEFINED CONTRIBUTION PLANS

DEFINED CONTRIBUTION PLANS	12 Months Ended
DEFINED CONTRIBUTION PLANS	Dec. 31, 2024
Retirement Benefits [Abstract]
DEFINED CONTRIBUTION PLANS	DEFINED CONTRIBUTION PLANS The Company has a 401(k) defined contribution plan (the 401(k) Plan), whereby eligible employees may contribute up to 90% of their annual basic earnings, subject to applicable annual Internal Revenue Code limits. Additionally, the 401(k) Plan provides for discretionary matching contributions (as defined in the 401(k) Plan) by the Company. The Company expensed matching contributions to the 401(k) Plan of $3,532, $2,836, and $2,418 during the years ended December 31, 2024, 2023 and 2022, respectively. The Company has a non-qualified deferred compensation plan (DCP), whereby certain highly compensated employees who are otherwise ineligible to participate in the Company's 401(k) plan, may defer the receipt of a portion of their base compensation and, for certain employees, up to 100% of their eligible bonuses. Additionally, the DCP allows for the employee deferrals to be deposited into a rabbi trust and the funds are generally invested in individual variable life insurance contracts owned by the Company that are specifically designed to fund savings plans of this nature. As of December 31, 2024 and 2023, the Company accrued $63,051 and $49,201, respectively, as long term deferred compensation in other long term liabilities on the consolidated balance sheets. Cash surrender value of the contracts is based on investment funds that shadow the investment allocations specified by participants in the deferred compensation plan. Refer to Note 5, Fair Value Measurements for more information on the funds. For the years ended December 31, 2024 and 2023, the Company recorded gains related to its DCP of $5,157 and $4,634, respectively, which are included in other income (expense), and recorded offsetting expenses of $5,559 and $4,887, which are allocated between cost of services and general and administrative expenses. For the year ended December 31, 2022, the Company recorded a loss related to its DCP of $4,188, which is included in other income (expense), and recorded an offsetting reduction in expense of $4,051, which is allocated between cost of services and general and administrative expenses.

SELF INSURANCE LIABILITIES

SELF INSURANCE LIABILITIES	12 Months Ended
SELF INSURANCE LIABILITIES	Dec. 31, 2024
Insurance [Abstract]
SELF INSURANCE LIABILITIES	SELF INSURANCE LIABILITIES The following table represents the Company's self-insurance insurance liabilities, on an undiscounted basis, inclusive of anticipated insurance recoveries, as of December 31, 2024 and 2023: December 31, 2024 2023 Accrued general liability and professional malpractice liabilities $ 160,149 $ 117,744 Accrued workers’ compensation liabilities 37,291 33,352 Accrued health benefits 14,312 14,814 TOTAL SELF-INSURANCE LIABILITIES $ 211,752 $ 165,910 Less: current self-insurance liabilities 67,331 54,664 LONG-TERM SELF-INSURANCE LIABILITIES $ 144,421 $ 111,246 The following table represents activity in the Company's self-insurance liabilities as of and for the years ended December 31, 2024 and 2023: Amount Balance January 1, 2023 $ 131,682 Current year provisions 164,627 Claims paid and direct expenses (135,799) Change in long-term insurance losses recoverable 5,400 Balance December 31, 2023 $ 165,910 Current year provisions 217,631 Claims paid and direct expenses (173,617) Change in long-term insurance losses recoverable 1,828 Balance December 31, 2024 $ 211,752 The anticipated insurance recoveries included in the self-insurance liabilities are presented gross rather than net with the corresponding asset of $17,741 and $15,913 as of December 31, 2024 and 2023, respectively, included in Restricted and other assets on the consolidated balance sheets.

COMMITMENTS AND CONTINGENCIES

COMMITMENTS AND CONTINGENCIES	12 Months Ended
COMMITMENTS AND CONTINGENCIES	Dec. 31, 2024
Commitments and Contingencies Disclosure [Abstract]
COMMITMENTS AND CONTINGENCIES	COMMITMENTS AND CONTINGENCIES 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. 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. Litigation and Regulatory Matters — The Company and its independent subsidiaries are party to various legal actions and administrative proceedings and are subject to various claims arising in the ordinary course of business. Such claims may be related to, but are not limited to, the Health Insurance Portability and Accountability Act of 1996, alleged Medicare or Medicaid false claims, qui tam or "whistleblower" provisions of the False Claims Act and/or the Anti-Kickback Statute, alleged violations of state and federal wage and hour laws, environmental matters, investigations, examinations, audits, site visits and surveys or other claims in connection with the delivery of healthcare and non-healthcare services. Refer to Part I. Item 3. Legal Proceedings for additional information on litigation and regulatory matters. In 2024, the Company, on behalf of its independent subsidiaries, received a Civil Investigative Demand (CID) from the U.S. Department of Justice (DOJ) indicating that the DOJ is investigating the Company to determine whether claims have been submitted to Medicare and Texas Medicaid for services which were unnecessary or otherwise not consistent with existing reimbursement requirements. The CID covers the period from January 1, 2016, to the present. As a general matter, the Company's independent subsidiaries maintain policies and procedures to promote compliance with all applicable Medicare and Medicaid requirements, including but not limited to those relating to the presentation of claims for reimbursement for services provided . The Company is fully cooperating with the DOJ in response to the CID. However, the Company cannot predict the outcome of the investigation or its potential impact on the consolidated financial statements. In 2023, in a four-week medical negligence trial in the State of Arizona, the jury returned a verdict against one of the Company’s independent subsidiaries. The Company is in the process of appealing the jury verdict. The Company has in the past appealed similar decisions and has, in some circumstances, received decisions in its favor. Although the Company intends to vigorously defend against these claims and in general these types of claims and cases, there can be no assurance that the outcomes of these matters will not have a material adverse effect on operational results and financial condition. In 2018, the Company, on behalf of its independent subsidiaries, received a CID from the DOJ stating that it was investigating to determine whether there had been a violation of the False Claims Act (FCA) and/or the Anti-Kickback Statute (AKS) with respect to the relationships between certain of the Company’s independent subsidiaries and persons who serve or have served as medical directors. In 2020, the Company was advised that the DOJ declined to intervene in any subsequent action filed in connection with the subject matter of this investigation. Despite the decision of the DOJ to decline to participate in litigation based on the subject matter of its previously issued CID, the involved qui tam relator moved forward with the complaint in 2020. In 2024, the Company mediated with the involved parties and agreed to settle the civil case for $48,000 and recorded the accrual as of December 31, 2023. Following the finalization of the settlement documents and payment of the settlement funds during the year ended December 31, 2024, the qui tam complaint was dismissed and the matter was resolved. Medicare Revenue Recoupments — The Company's independent subsidiaries are subject to regulatory reviews relating to the provision of Medicare services, billings and potential overpayments as a result of Recovery Audit Contractors (RAC), various Program Safeguard Contractors, and Medicaid Integrity Contractor programs (collectively referred to as Reviews). Reviews vary in claim selection size and processes, ranging from a single episode/claim month to larger, multi-claim batches; and from single rounds of review to reviews of multiple rounds with pass/fail criteria. If an operation has a significant error rate or 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. The Company anticipates that these Reviews could increase in frequency in the future. As of December 31, 2024 and through the filing date of this report, 18 of the Company's independent subsidiaries had multi-claim Reviews scheduled or in process. 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 52.9% and 53.4% of its total accounts receivable as of December 31, 2024 and 2023, respectively. Revenue from reimbursement under the Medicare and Medicaid programs accounted for 70.9%, 72.6% and 73.7% of the Company's revenue for the years ended December 31, 2024, 2023 and 2022, respectively.

COMMON STOCK REPURCHASE PROGRAM

COMMON STOCK REPURCHASE PROGRAM	12 Months Ended
COMMON STOCK REPURCHASE PROGRAM	Dec. 31, 2024
Equity [Abstract]
COMMON STOCK REPURCHASE PROGRAM	COMMON STOCK REPURCHASE PROGRAM On May 16, 2024, the Board of Directors approved 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 from September 1, 2024. The Company did not purchase any shares pursuant to this stock repurchase program during the year ended December 31, 2024. On August 29, 2023, the Board of Directors approved a stock repurchase program pursuant to which the Company could repurchase up to $20,000 of its common stock under the program for a period of approximately 12 months from September 1, 2023. The stock repurchase program expired on August 31, 2024 and is no longer in effect. The Company did not purchase any shares pursuant to this stock repurchase program. On July 28, 2022, the Board of Directors approved a stock repurchase program pursuant to which the Company could repurchase up to $20,000 of its common stock under the program for a period of approximately 12 months from August 2, 2022. The stock repurchase program expired on August 2, 2023 and is no longer in effect. The Company did not purchase any shares pursuant to this stock repurchase program. In addition, the Company repurchased 404 shares of its common stock for $29,882 during the year ended December 31, 2022, related to two separate stock repurchase programs that are no longer in effect. Under these repurchase programs, the Company is authorized to repurchase its issued and outstanding common shares from time to time in open-market and privately negotiated transactions, tender offers, pursuant to contractual provisions, and block trades, or otherwise in accordance with federal securities laws. The share repurchase program does not obligate the Company to acquire any specific number of shares. Any such repurchases will depend on the Company's business strategy, prevailing market conditions, the Company's liquidity requirements, contractual restrictions or covenants, compliance with securities laws, and other factors. The amounts involved in any such transaction may be material.

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	12 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Pay vs Performance Disclosure
Net Income (Loss)	$ 297,973	$ 209,399	$ 224,681

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended	12 Months Ended
Insider Trading Arrangements	Dec. 31, 2024 shares	Dec. 31, 2024 shares
Trading Arrangements, by Individual
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false
Dr. Ann S. Blouin [Member]
Trading Arrangements, by Individual
Material Terms of Trading Arrangement		Dr. Ann S. Blouin, a member of our Board of Directors, entered into a Rule 10b5-1 trading arrangement on November 12, 2024. Dr. Blouin's 10b5-1 Plan provides for the sale of up to 450 shares of the Company's common stock between February 11, 2025 and November 11, 2025.
Name	Dr. Ann S. Blouin
Title	a member of our Board of Directors
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	November 12, 2024
Expiration Date	November 11, 2025
Arrangement Duration	273 days
Aggregate Available	450	450
Suzanne D. Snapper [Member]
Trading Arrangements, by Individual
Material Terms of Trading Arrangement		Suzanne D. Snapper, Chief Financial Officer, Executive Vice President, and Director, entered into a Rule 10b5-1 trading arrangement on November 15, 2024. Ms. Snapper's 10b5-1 Plan provides for the potential exercise of vested stock options and the associated sale of up to 10,618 shares of the Company's common stock between February 18, 2025 and July 28, 2025.
Name	Suzanne D. Snapper
Title	Chief Financial Officer, Executive Vice President, and Director
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	November 15, 2024
Expiration Date	July 28, 2025
Arrangement Duration	160 days
Aggregate Available	10,618	10,618

Insider Trading Policies and Pr

Insider Trading Policies and Procedures	12 Months Ended
Insider Trading Policies and Procedures	Dec. 31, 2024
Insider Trading Policies and Procedures [Line Items]
Insider Trading Policies and Procedures Adopted	true

Cybersecurity Risk Management a

Cybersecurity Risk Management and Strategy Disclosure	12 Months Ended
Cybersecurity Risk Management and Strategy Disclosure	Dec. 31, 2024
Cybersecurity Risk Management, Strategy, and Governance [Line Items]
Cybersecurity Risk Management Processes for Assessing, Identifying, and Managing Threats [Text Block]	We utilize information technology that enables our operational leaders to access and share with their peers, both clinical and financial performance data in real time. Armed with relevant and current information, our operation leaders and their management teams can share best practices and the latest information, adjust to challenges and opportunities on a timely basis, improve quality of care, mitigate risk and improve both clinical outcomes and financial performance. We have also invested in specialized healthcare technology systems to assist our nursing and support staff. We have installed software and touch-screen interface systems in each operation to enable our clinical staff to monitor and deliver patient care and record patient information more efficiently. We believe these systems have improved the quality of our medical and billing records, while improving the productivity of our staff. Such uses of information systems give rise to cybersecurity risks, including system disruption, security breach, ransomware, theft, espionage and inadvertent release of information. RISK MANAGEMENT AND STRATEGY Risk Management We assess and identify security risk to the organization by: • conducting risk assessments to determine the likelihood and magnitude of an attack from unauthorized access, use, disclosure, disruption, modification or destruction of information systems and the related information processes, stored, or transmitted; • performing penetration testing assessments annually and producing security assessment reports that document the results of the assessment for use and review by information technology (IT) senior leadership, including the Service Center's Chief Information Officer; • ensuring security controls are assessed for effectiveness, are implemented correctly, operating as intended and producing the desired outcome; • continuously scanning for vulnerabilities and remediating vulnerabilities within their service level agreements in accordance with the associated risk level; and • reviewing third party and vendor risks to our organization through an internal interdisciplinary Technology Advisory Committee that includes members from our IT, Information Security Office (ISO), legal, compliance, clinical, finance and billing departments. Monitoring We have established a continuous monitoring strategy and program, which includes: • a set of defined security metrics to be monitored; • performance of security control assessments on an ongoing basis; • addressing results of analysis and reporting security status to the executive team; • monitoring information systems to detect attacks and indicators of potential attacks or compromises; • identification of unauthorized use of the information system resources; • deployment of monitoring systems and agents strategically within the information system environment; and • require that third party service providers who store, process or transmit data with access to electronic Protected Health Information (ePHI) undergo an independent third-party audit to achieve system organization controls certification annually. Data Protection We have implemented an Information Security Management System Program to secure sensitive data protected by us. This program includes: • establishing policies governing data security; • monitoring data access throughout the organization’s independent subsidiaries; • providing continuous security training and awareness; • establishing controls over devices on the network which are actively tracked, monitored and evaluated for new, missing, or updated software needed to strengthen security on the device, patch known vulnerabilities, or stabilize software or operating system issues; • protecting sensitive data through encryption techniques; and • designing and implementing systems to include backup and recoverability principles, such as periodic data backups and safeguards in the case of a disaster. Incident Management Plan Our cybersecurity incident management plan comprises the following six-step process: • The Service Center's Chief Information Officer and Director of Information Security lead its ISO team in the development, documentation, review and testing of security procedures and incident management procedures. Beyond initial creation, procedures are continually re-assessed, updated and tested on an ongoing basis. • The ISO team works with the Executive Team on the identification, assessment, verification and classification of incidents to determine affected stakeholders and appropriate parties for contact. • The Service Center's Chief Information Officer and Director of Information Security are responsible for launching the Incident Response Team (IRT) if necessary and for notification to the Executive Team, who in turn will contact the Board of Directors and the Audit Committee to validate that the response is being addressed appropriately. • The IRT, in consultation with outside experts if needed, is responsible for the following: • Initial containment by making tactical changes to the computing environment to mitigate active threats based on currently known information. • Analysis to establish the root cause of incidents, identification and evidence collection from all affected machines and log sources, threat intelligence and other information sources. Once all appropriate information has been collected, we perform a careful analysis using forensically-sound tools and methods to prevent any contamination of evidence. • Incident containment by further analyzing additional information and further identifying any additional compromised machines or resources not previously identified. • Incident eradication by re-assessing the root cause of incidents where solutions are then implemented to solve underlying problems and prevent re-occurrence. • Recovery and restoring normal business functionality, which includes the reversal of any damage caused by the incident and responding as necessary. • Review after closure of each incident and conducting a lessons learned analysis to improve prevention and help to make incident response processes more efficient and effective. Also, the IRT evaluates competency and any additional training requirements needed. A final incident report will then be provided to key stakeholders and IRT members, which includes, but is not limited to the summary of the incident and its impact, a timeline of events, a detailed description of the incident, an evaluation of the organizational response and an assessment of the damages. We have not experienced a material cybersecurity breach in the past five years and, as a result, there have been no charges related to a breach in the past five years. Moreover, risks from cybersecurity threats have not materially affected our business strategy, results of operations, or financial condition. While we have implemented processes and procedures that we believe are tailored to address and mitigate the cybersecurity threats that our company faces, there can be no assurances that such an incident will not occur despite our efforts, as more fully described in Item 1A. Risk Factors
Cybersecurity Risk Management Processes Integrated [Flag]	true
Cybersecurity Risk Management Processes Integrated [Text Block]	We utilize information technology that enables our operational leaders to access and share with their peers, both clinical and financial performance data in real time. Armed with relevant and current information, our operation leaders and their management teams can share best practices and the latest information, adjust to challenges and opportunities on a timely basis, improve quality of care, mitigate risk and improve both clinical outcomes and financial performance. We have also invested in specialized healthcare technology systems to assist our nursing and support staff. We have installed software and touch-screen interface systems in each operation to enable our clinical staff to monitor and deliver patient care and record patient information more efficiently. We believe these systems have improved the quality of our medical and billing records, while improving the productivity of our staff. Such uses of information systems give rise to cybersecurity risks, including system disruption, security breach, ransomware, theft, espionage and inadvertent release of information.
Cybersecurity Risk Management Third Party Engaged [Flag]	true
Cybersecurity Risk Third Party Oversight and Identification Processes [Flag]	true
Cybersecurity Risk Materially Affected or Reasonably Likely to Materially Affect Registrant [Flag]	false
Cybersecurity Risk Board of Directors Oversight [Text Block]	Our Audit Committee receives quarterly reports on our information security and cyber fraud prevention programs from the Service Center's Chief Information Officer and Director of Information Security, who each have over 24 years of experience in IT, including various leadership roles at other large corporations. One of the three members of our Audit Committee is a cybersecurity expert.
Cybersecurity Risk Board Committee or Subcommittee Responsible for Oversight [Text Block]	Our Audit Committee receives quarterly reports on our information security and cyber fraud prevention programs from the Service Center's Chief Information Officer and Director of Information Security, who each have over 24 years of experience in IT, including various leadership roles at other large corporations. One of the three members of our Audit Committee is a cybersecurity expert.
Cybersecurity Risk Process for Informing Board Committee or Subcommittee Responsible for Oversight [Text Block]	The Service Center's Chief Information Officer and Director of Information Security are responsible for launching the Incident Response Team (IRT) if necessary and for notification to the Executive Team, who in turn will contact the Board of Directors and the Audit Committee to validate that the response is being addressed appropriately.
Cybersecurity Risk Role of Management [Text Block]	Our cybersecurity incident management plan comprises the following six-step process: • The Service Center's Chief Information Officer and Director of Information Security lead its ISO team in the development, documentation, review and testing of security procedures and incident management procedures. Beyond initial creation, procedures are continually re-assessed, updated and tested on an ongoing basis. • The ISO team works with the Executive Team on the identification, assessment, verification and classification of incidents to determine affected stakeholders and appropriate parties for contact. • The Service Center's Chief Information Officer and Director of Information Security are responsible for launching the Incident Response Team (IRT) if necessary and for notification to the Executive Team, who in turn will contact the Board of Directors and the Audit Committee to validate that the response is being addressed appropriately. • The IRT, in consultation with outside experts if needed, is responsible for the following: • Initial containment by making tactical changes to the computing environment to mitigate active threats based on currently known information. • Analysis to establish the root cause of incidents, identification and evidence collection from all affected machines and log sources, threat intelligence and other information sources. Once all appropriate information has been collected, we perform a careful analysis using forensically-sound tools and methods to prevent any contamination of evidence. • Incident containment by further analyzing additional information and further identifying any additional compromised machines or resources not previously identified. • Incident eradication by re-assessing the root cause of incidents where solutions are then implemented to solve underlying problems and prevent re-occurrence. • Recovery and restoring normal business functionality, which includes the reversal of any damage caused by the incident and responding as necessary. • Review after closure of each incident and conducting a lessons learned analysis to improve prevention and help to make incident response processes more efficient and effective. Also, the IRT evaluates competency and any additional training requirements needed. A final incident report will then be provided to key stakeholders and IRT members, which includes, but is not limited to the summary of the incident and its impact, a timeline of events, a detailed description of the incident, an evaluation of the organizational response and an assessment of the damages. We have not experienced a material cybersecurity breach in the past five years and, as a result, there have been no charges related to a breach in the past five years. Moreover, risks from cybersecurity threats have not materially affected our business strategy, results of operations, or financial condition. While we have implemented processes and procedures that we believe are tailored to address and mitigate the cybersecurity threats that our company faces, there can be no assurances that such an incident will not occur despite our efforts, as more fully described in Item 1A. Risk Factors
Cybersecurity Risk Management Positions or Committees Responsible [Flag]	true
Cybersecurity Risk Management Positions or Committees Responsible [Text Block]	Service Center's Chief Information Officer and Director of Information Security
Cybersecurity Risk Management Expertise of Management Responsible [Text Block]	Service Center's Chief Information Officer and Director of Information Security, who each have over 24 years of experience in IT, including various leadership roles at other large corporations.
Cybersecurity Risk Process for Informing Management or Committees Responsible [Text Block]	The ISO has been established by the Service Center's Chief Information Officer, with dedicated cyber security staff focusing on security monitoring, vulnerability management, incident response, risk assessments, employee training, security engineering and management of cyber security policies, standards and regulatory compliance. Like many organizations, we align to a Cyber Security Framework and take a risk-based approach during control assessment and implementation. We align to the National Institute of Standards and Technology (NIST) Special Publication 800-53 Revision 4, a globally recognized cyber security framework of Policies, Standards and Controls is comprised of five categories of defense – Identify, Protect, Detect, Respond and Recover. We are committed to the protection of our data, systems, network and continually invest in enhancements to mitigate or reduce the impact from a cyber security threat. We conduct periodic tests to maintain readiness and resiliency while regularly reviewing policies in the interest of protecting data security. External companies or agencies may be called upon to provide consulting, guidance, assistance, or some other form of support in response to a cybersecurity incident. The regular training of employees, at least annually, on the ever-present threat of cybersecurity helps maintain data security.
Cybersecurity Risk Management Positions or Committees Responsible Report to Board [Flag]	true

SUMMARY OF SIGNIFICANT ACCOUN_2

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)	12 Months Ended
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)	Dec. 31, 2024
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation —
Reclassifications	Reclassifications — Certain amounts in the prior period statements of income and statements of cash flows have been reclassified to conform to the presentation of the current period financial statements. These reclassifications had no effect on the previously reported net income.
Estimates and Assumptions	Estimates and Assumptions —
Fair Value Considerations	Fair Value Considerations — The Company’s financial instruments consist principally of cash and cash equivalents, debt security investments, accounts receivable, insurance subsidiary deposits, deferred compensation investment funds, equity investments, 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. 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. See Note 5, Fair Value Measurements for additional information.
Service Revenue Recognition, Rental Revenue Recognition	Service Revenue Recognition — The Company recognizes revenue in accordance with Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) Topic 606, Revenue from Contracts with Customers (ASC 606). The Company's service revenue is derived primarily from providing healthcare services to its patients. Revenue is recognized when services are provided to patients at the amount that reflects the consideration that 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 provided pursuant to 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 that 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 rates 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 that 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. 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 FASB ASC Topic 340, Other Assets and Deferred Costs , and all incremental customer contract acquisition costs are expensed as they are incurred because the amortization period would have been one year or less. Rental Revenue Recognition — The Company's rental revenues are primarily generated by leasing healthcare-related properties through triple-net lease arrangements, under which the tenant is solely responsible for the costs related to the property. Revenue for operating leases is recognized on a straight-line basis over the lease term when collectability of all minimum lease payments is probable in accordance with FASB ASC Topic 842, Leases (ASC 842). The Company has elected the single component practical expedient, which allows a lessor, by class of underlying asset, not to allocate the total consideration to the lease and non-lease components based on their relative stand-alone selling prices where certain criteria are met.
Accounts Receivable	Accounts Receivable — 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.
Cash and Cash Equivalents	Cash and Cash Equivalents — Cash and cash equivalents consist of bank term deposits, money market funds and treasury bill related investments with original maturities of three months or less at time of purchase and therefore approximate fair value. The fair value of money market funds is determined based on “Level 1” inputs, which consist of unadjusted quoted prices in active markets that are accessible at the measurement date for identical, unrestricted assets. The Company places its cash and short-term investments with high credit quality financial institutions.
Insurance Subsidiary Deposits and Other Investments	Insurance Subsidiary Deposits and Other Investments — The Company's captive insurance subsidiary cash and cash equivalents, deposits and investments are designated to support long-term insurance subsidiary liabilities and have been classified as short-term and long-term assets based on the timing of expected future payments of the Company's captive insurance liabilities. The majority of these deposits and investments are currently held in AA, A and BBB rated debt security investments and the remainder is held in a bank account with a high credit quality financial institution. Investments classified as held-to-maturity are financial instruments that the Company has the intent and ability to hold to maturity and are reported net of any related amortization and are not remeasured to fair value on a recurring basis. The Company's non-qualified deferred compensation plan's (the DCP) contracts insuring the lives of certain employees who are eligible to participate in the DCP are held in a rabbi trust. Cash surrender value of the contracts is based on funds that shadow the investment allocations specified by participants in the deferred compensation plan. When evaluating an investment for its current expected credit losses, the Company reviews factors such as historical experience with defaults, losses, credit ratings, term, market sector and macroeconomic trends, including current conditions and forecasts to the extent they are reasonable and supportable.
Property and Equipment	Property and Equipment — three
Leases	Leases — The Company leases skilled nursing facilities, senior living facilities and commercial office space. The Company determines if an arrangement is a lease and performs an evaluation to determine whether the lease should be classified as an operating or finance lease at the inception of the lease. As of December 31, 2024, the Company has three financing lease that are not material to the consolidated balance sheet. Rights and obligations of the operating leases are included as right-of-use assets and current and long-term lease liabilities on the Company's consolidated balance sheets. 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 utilizes a third-party credit 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's real estate leases generally have initial lease terms of ten years or more and typically include one or more options to renew, with renewal terms that generally extend the lease term for an additional ten
Impairment of Long-Lived Assets	Impairment of Long-Lived Assets —
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. 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 FASB ASC Topic 350, Intangibles—Goodwill and Other
Self-Insurance	Self-Insurance — The Company is partially self-insured for general and professional liability claims 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 $750 per claim, subject to an additional one-time deductible of $1,500 for the Company's independent subsidiaries in California. For the independent subsidiaries not in California, the self-insured claim is $650 per claim, subject to an additional one-time, deductible of $1,400. For all independent subsidiaries, except those located in Colorado, the third-party coverage above these limits is $1,000 per claim, $3,000 per operation, with a $10,000 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 aggregate limits that apply outside of Colorado. Subsequent to December 31, 2024, the combined self-insured retention is $1,000 per claim ($750 if an enforceable arbitration agreement applies), subject to an additional one-time deductible of $2,950 for the Company's independent subsidiaries in California. For the independent subsidiaries not in California, the self-insured claim is $750 per claim ($650 if an enforceable arbitration agreement applies), subject to an additional one-time, deductible of $4,500. The majority of the self-insured retention and deductible limits for general and professional liabilities and workers' compensation liabilities are self-insured through the captive insurance subsidiary, the related assets and liabilities of which are included in the accompanying consolidated balance sheets. The captive insurance subsidiary 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. The Company’s independent subsidiaries are self-insured for workers’ compensation liabilities 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 $625 per occurrence. In Texas, the independent 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 independent 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 the state of Washington, the Company is self-insured and has purchased individual specific excess insurance coverage that insures individual claims that exceed $500 per occurrence. For all of the self-insured plans and retention, 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. 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 $525 for each covered person. The Company believes that adequate provision has been made in the Financial Statements for liabilities that may arise out of patient care, workers’ compensation, healthcare benefits and related services provided to date. The amount of the Company’s reserves was determined based on an estimation process that uses information obtained from both company-specific and industry data. This estimation process requires the Company to continuously monitor and evaluate the life cycle of the claims. Using data obtained from this monitoring and the Company’s assumptions about emerging trends, the Company, with the assistance of an independent actuary, develops information about the size of ultimate claims based on the Company’s historical experience and other available industry information. The most significant assumptions used in the estimation process include determining the trend in costs, the expected cost of claims incurred but not reported and the expected costs to settle or pay damage awards with respect to unpaid claims. The self-insured liabilities are based upon estimates, and while management believes that the estimates of loss are reasonable, the ultimate liability may be in excess of or less than the recorded amounts. Due to the inherent volatility of actuarially determined loss estimates, it is reasonably possible that the Company could experience changes in estimated losses that could be material to net income. If the Company’s actual liabilities exceed its estimates of losses, 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. 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	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 and restricted stock awards 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 based upon the number of grants and other variables. As stock-based compensation expense recognized in the Company’s consolidated statements of income was based on awards 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.
Comprehensive Income	Comprehensive Income —
Recently 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 FASB ASC is the sole source of authoritative GAAP literature recognized by the FASB and applicable to the Company. For any new pronouncements announced, the Company considers whether the new pronouncements could alter previous generally accepted accounting principles and determines whether any new or modified principles will have a material impact on the Company's reported financial position or operations in the near term. The applicability of any standard is subject to the formal review of the Company's financial management and certain standards are under consideration. Recent Accounting Standards Adopted by the Company — In November 2023, the FASB issued Accounting Standards Update (ASU) 2023-07 " Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, " which requires the Company to expand the breadth and frequency of segment disclosures to include additional information about significant segment expenses, the chief operating decision maker (CODM) and other items, and also require the annual disclosures on an interim basis. This guidance was effective for annual periods beginning with the Company's fiscal year 2024, and in interim periods within the Company's fiscal year 2025. The Company adopted the requirements of this ASU in Note 8, Business Segments of this Annual Report. Recently Issued Accounting Pronouncements Not Yet Adopted — In October 2023, the FASB issued ASU 2023-06 "Codification Amendments in Response to the SEC’s Disclosure Update and Simplification Initiative," which amends U.S. GAAP to include 14 disclosure requirements that are currently required under SEC Regulation S-X or Regulation S-K. Each amendment will be effective on the date on which the SEC removes the related disclosure requirement from SEC Regulation S-X or Regulation S-K. The adoption is not expected to have a material impact on the Company's Financial Statements as these requirements were previously incorporated under the SEC Regulations. In December 2023, the FASB issued ASU 2023-09 " Income Taxes (Topic 740): Improvements to Income Tax Disclosures, " which requires the Company to disclose disaggregated jurisdictional and categorical information for the tax rate reconciliation, income taxes paid and other income tax related amounts. ASU 2023-09 is effective for annual periods beginning with the Company's fiscal year 2025, with early adoption permitted. The Company is currently evaluating the impact of this ASU on its Notes to the Consolidated Financial Statements. In November 2024, the FASB issued ASU 2024-03 " Disaggregation of Income Statement Expenses, " which requires the Company to disaggregate key expense categories such as employee compensation, depreciation and intangible asset amortization within its financial statements. ASU 2024-03 is effective for annuals periods beginning with the Company's fiscal year 2027, and interim periods within the Company's fiscal year 2028, with early adoption permitted. The Company is currently evaluating the impact of this ASU on its Notes to the Consolidated Financial Statements.

REVENUE AND ACCOUNTS RECEIVAB_2

REVENUE AND ACCOUNTS RECEIVABLE (Tables)	12 Months Ended
REVENUE AND ACCOUNTS RECEIVABLE (Tables)	Dec. 31, 2024
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregation of Revenue	Service revenue for the years ended December 31, 2024, 2023 and 2022 is summarized in the following tables: Year Ended December 31, 2024 2023 2022 Revenue % of Revenue Revenue % of Revenue Revenue % of Revenue Medicaid (1)(2) $ 1,682,344 39.7 % $ 1,459,449 39.4 % $ 1,183,156 39.3 % Medicare 1,055,226 24.9 985,749 26.6 832,160 27.7 Medicaid — skilled 266,738 6.3 245,663 6.6 200,878 6.7 Total Medicaid and Medicare $ 3,004,308 70.9 % $ 2,690,861 72.6 % $ 2,216,194 73.7 % Managed care 789,643 18.6 666,129 18.0 525,710 17.5 Private and other (3) 443,574 10.5 351,081 9.4 266,807 8.8 SERVICE REVENUE $ 4,237,525 100.0 % $ 3,708,071 100.0 % $ 3,008,711 100.0 % (1) Medicaid payor includes revenue for senior living operations. (2) Medicaid payor includes revenue related to state relief funding during the year ended December 31, 2023 and 2022. (3) Private and other also includes revenue from senior living operations and all revenue generated in other an cillary services.
Schedule of Accounts Receivable	Accounts receivable as of December 31, 2024 and 2023, is summarized in the following table: December 31, 2024 2023 Medicaid $ 228,872 $ 178,285 Managed care 139,711 125,907 Medicare 77,056 85,512 Private and other payors 132,693 104,683 $ 578,332 $ 494,387 Less: allowance for doubtful accounts (8,435) (9,348) ACCOUNTS RECEIVABLE, NET $ 569,897 $ 485,039

COMPUTATION OF NET INCOME PER_2

COMPUTATION OF NET INCOME PER COMMON SHARE (Tables)	12 Months Ended
COMPUTATION OF NET INCOME PER COMMON SHARE (Tables)	Dec. 31, 2024
Earnings Per Share [Abstract]
Schedule of Reconciliation of the Numerator and Denominator Used in the Calculation of Basic Net Income Per Common Share	A reconciliation of the numerator and denominator used in the calculation of basic net income per common share follows: Year Ended December 31, 2024 2023 2022 NUMERATOR: Net income $ 298,458 $ 209,850 $ 224,652 Less: net income (loss) attributable to noncontrolling interests 485 451 (29) Net income attributable to The Ensign Group, Inc. $ 297,973 $ 209,399 $ 224,681 DENOMINATOR: Weighted average shares outstanding for basic net income per share 56,655 55,708 54,887 Basic net income per common share: $ 5.26 $ 3.76 $ 4.09
Schedule of Reconciliation of the Numerator and Denominator Used in the Calculation of Diluted Net Income Per Common Share	A reconciliation of the numerator and denominator used in the calculation of diluted net income per common share follows: Year Ended December 31, 2024 2023 2022 NUMERATOR: Net income $ 298,458 $ 209,850 $ 224,652 Less: net income (loss) attributable to noncontrolling interests 485 451 (29) Net income attributable to The Ensign Group, Inc. $ 297,973 $ 209,399 $ 224,681 DENOMINATOR: Weighted average common shares outstanding 56,655 55,708 54,887 Plus: incremental shares from assumed conversion (1) 1,585 1,615 1,984 Adjusted weighted average common shares outstanding 58,240 57,323 56,871 Diluted net income per common share: $ 5.12 $ 3.65 $ 3.95 (1) Options outstanding which are anti-dilutive and therefore not factored into the weighted average common shares amount above were 914, 1,429 and 780 for the years ended December 31, 2024, 2023 and 2022, respectively.

OPERATION EXPANSIONS (Tables)

OPERATION EXPANSIONS (Tables)	12 Months Ended
OPERATION EXPANSIONS (Tables)	Dec. 31, 2024
Business Combination, Asset Acquisition, and Joint Venture Formation [Abstract]
Schedule of Purchase Price Allocation	The table below presents the allocation of the purchase price for the operations acquired during the years ended December 31, 2024, 2023 and 2022: Year Ended December 31, 2024 2023 2022 Land $ 20,547 $ 7,794 $ 15,527 Building and improvements 108,709 57,488 65,070 Equipment, furniture, and fixtures 2,937 1,840 1,618 Assembled occupancy 1,210 346 367 Goodwill 21,112 — 16,400 Leased asset — — 1,909 Other indefinite-lived intangible assets 364 330 245 TOTAL ACQUISITIONS $ 154,879 $ 67,798 $ 101,136

BUSINESS SEGMENTS (Tables)

BUSINESS SEGMENTS (Tables)	12 Months Ended
BUSINESS SEGMENTS (Tables)	Dec. 31, 2024
Segment Reporting [Abstract]
Schedule of Segment Financial Information	The following tables set forth financial information for the segments: Year Ended December 31, 2024 Skilled Services Standard Bearer Total Service revenue (1) $ 4,076,825 $ — $ 4,076,825 Rental revenue — 95,086 95,086 Segment revenue $ 4,076,825 $ 95,086 $ 4,171,911 Reconciliation of revenue: All other revenue (2) 192,881 Elimination of intercompany revenue (3) (104,307) TOTAL CONSOLIDATED REVENUE $ 4,260,485 Less: Other segment items (4) 3,513,167 9,152 Depreciation and amortization 45,195 29,297 Interest expense (5) — 27,302 Segment income $ 518,463 $ 29,335 $ 547,798 Reconciliation of profit or loss: All other loss (161,704) INCOME BEFORE PROVISION FOR INCOME TAXES $ 386,094 (1) Skilled services service revenue does not include intercompany service revenue generated by ancillary operations provided to the Company's independent subsidiaries and management service revenue generated by the Service Center with Standard Bearer. Intercompany service revenue is eliminated in "Elimination of intercompany revenue". (2) All other revenue includes $181,066 of service revenue and $11,815 of rental revenue for the year ended December 31, 2024, both of which include intercompany revenue that is eliminated in "Elimination of intercompany revenue". (3) Elimination of intercompany revenue includes the elimination of intercompany rental revenue of $83,941 and intercompany service revenue of $20,366 for the year ended December 31, 2024. (4) Other segment items includes cost of services and rent expense for the skilled services segment and cost of services, rent expense and general and administrative expenses for the Standard Bearer segment. Additionally, there are intercompany expenses of $104,307 during the year ended December 31, 2024, which are eliminated in consolidation. (5) Included in interest expense in Standard Bearer is interest from intercompany debt arrangements between Standard Bearer and The Ensign Group, Inc. of $20,285 during the year ended December 31, 2024, which is eliminated in consolidation. Year Ended December 31, 2023 Skilled Services Standard Bearer Total Service revenue (1) $ 3,578,855 $ — $ 3,578,855 Rental revenue — 82,486 82,486 Segment revenue $ 3,578,855 $ 82,486 $ 3,661,341 Reconciliation of revenue: All other revenue (2) 155,804 Elimination of intercompany revenue (3) (87,790) TOTAL CONSOLIDATED REVENUE $ 3,729,355 Less: Other segment items (4) 3,075,164 8,455 Depreciation and amortization 38,766 25,205 Interest expense (5) — 19,761 Segment income $ 464,925 $ 29,065 $ 493,990 Reconciliation of profit or loss: All other loss (221,228) INCOME BEFORE PROVISION FOR INCOME TAXES $ 272,762 (1) Skilled services service revenue does not include intercompany service revenue generated by ancillary operations provided to the Company's independent subsidiaries and management service revenue generated by the Service Center with Standard Bearer. Intercompany service revenue is eliminated in "Elimination of intercompany revenue". (2) All Other revenue includes $144,667 of service revenue and $11,137 of rental revenue for the year ended December 31, 2023, both of which include intercompany revenue that is eliminated in "Elimination of intercompany revenue". (3) Elimination of intercompany revenue includes the elimination intercompany rental revenue of $72,339 and intercompany service revenue of $15,451 for the year ended December 31, 2023. (4) Other segment items includes cost of services and rent expense for the skilled services segment and cost of services, rent expense and general and administrative expenses for the Standard Bearer segment. Additionally, there are intercompany expenses of $87,790 during the year ended December 31, 2023, which is eliminated in consolidation. (5) Included in interest expense in Standard Bearer is interest from intercompany debt arrangements between Standard Bearer and The Ensign Group, Inc. of $12,902 during the year ended December 31, 2023, which is eliminated in consolidation. Year Ended December 31, 2022 Skilled Services Standard Bearer Total Service revenue (1) $ 2,906,215 $ — $ 2,906,215 Rental revenue — 72,937 72,937 Segment revenue $ 2,906,215 $ 72,937 $ 2,979,152 Reconciliation of revenue: All other revenue (2) 122,610 Elimination of intercompany revenue (3) (76,294) TOTAL CONSOLIDATED REVENUE $ 3,025,468 Less: Other segment items (4) 2,464,259 7,746 Depreciation and amortization 33,224 21,613 Interest expense (5) — 15,707 Segment income $ 408,732 $ 27,871 $ 436,603 Reconciliation of profit or loss: All other loss (147,514) INCOME BEFORE PROVISION FOR INCOME TAXES $ 289,089 (1) Skilled services service revenue does not include intercompany service revenue generated by ancillary operations provided to the Company's independent subsidiaries and management service revenue generated by the Service Center with Standard Bearer. Intercompany service revenue is eliminated in "Elimination of intercompany revenue". (2) All Other revenue includes $115,214 of service revenue and $7,396 of rental revenue for the year ended December 31, 2022, both of which include intercompany revenue that is eliminated in "Elimination of intercompany revenue". (3) Elimination of intercompany revenue includes the elimination of intercompany rental revenue of $63,576 and intercompany service revenue of $12,718 for the year ended December 31, 2022. (4) Other segment items includes cost of services and rent expense for the skilled services segment and cost of services, rent expense and general and administrative expenses for the Standard Bearer segment. Additionally, there are intercompany expenses of $76,294 during the year ended December 31, 2022, which is eliminated in consolidation.
Schedule of Service Revenue by Major Payor Source	Service revenue by major payor source were as follows: Year Ended December 31, 2024 Skilled Services All Other (3) Total Service Revenue Revenue % Medicaid (1) $ 1,646,422 $ 35,922 $ 1,682,344 39.7 % Medicare 1,055,226 — 1,055,226 24.9 Medicaid-skilled 266,738 — 266,738 6.3 Subtotal $ 2,968,386 $ 35,922 $ 3,004,308 70.9 % Managed care 789,643 — 789,643 18.6 Private and other (2) 318,796 124,778 443,574 10.5 TOTAL SERVICE REVENUE $ 4,076,825 $ 160,700 $ 4,237,525 100.0 % (1) Medicaid payor includes revenue generated from senior living operations. (2) Private and other payors also includes revenue from senior living operations and all revenue generated in other ancillary services. (3) All Other incorporates intercompany eliminations. Year Ended December 31, 2023 Skilled Services All Other (3) Total Service Revenue Revenue % Medicaid (1) $ 1,429,473 $ 29,976 $ 1,459,449 39.4 % Medicare 985,749 — 985,749 26.6 Medicaid-skilled 245,663 — 245,663 6.6 Subtotal $ 2,660,885 $ 29,976 $ 2,690,861 72.6 % Managed care 666,129 — 666,129 18.0 Private and other (2) 251,841 99,240 351,081 9.4 TOTAL SERVICE REVENUE $ 3,578,855 $ 129,216 $ 3,708,071 100.0 % (1) Medicaid payor includes revenue generated from senior living operations and revenue related to state relief funding. (2) Private and other payors also includes revenue from senior living operations and all revenue generated in other ancillary services. (3) All Other incorporates intercompany eliminations. Year Ended December 31, 2022 Skilled Services All Other (3) Total Service Revenue Revenue % Medicaid (1) $ 1,158,309 $ 24,847 $ 1,183,156 39.3 % Medicare 832,160 — 832,160 27.7 Medicaid-skilled 200,878 — 200,878 6.7 Subtotal 2,191,347 24,847 2,216,194 73.7 Managed care 525,710 — 525,710 17.5 Private and other (2) 189,158 77,649 266,807 8.8 TOTAL SERVICE REVENUE $ 2,906,215 $ 102,496 $ 3,008,711 100.0 % (1) Medicaid payor includes revenue generated from senior living operations and revenue related to state relief funding. (2) Private and other payors also includes revenue from senior living operations and all payors generated in other ancillary services. (3) All Other incorporates intercompany eliminations.

PROPERTY AND EQUIPMENT_ NET (Ta

PROPERTY AND EQUIPMENT— NET (Tables)	12 Months Ended
PROPERTY AND EQUIPMENT— NET (Tables)	Dec. 31, 2024
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment, Net	Property and equipment, net consists of the following: December 31, 2024 2023 Land $ 162,873 $ 142,656 Buildings and improvements 933,790 803,155 Leasehold improvements 212,603 172,064 Equipment 396,018 339,383 Furniture and fixtures 4,349 4,192 Construction in progress 41,209 25,563 $ 1,750,842 $ 1,487,013 Less: accumulated depreciation (459,488) (396,242) PROPERTY AND EQUIPMENT, NET $ 1,291,354 $ 1,090,771

INTANGIBLE ASSETS _ NET (Tables

INTANGIBLE ASSETS — NET (Tables)	12 Months Ended
INTANGIBLE ASSETS — NET (Tables)	Dec. 31, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Finite-Lived Intangible Assets	Weighted Average Life (Years) December 31, 2024 2023 Gross Carrying Amount Accumulated Amortization Gross Carrying Amount Accumulated Amortization Intangible Assets Net Net Assembled occupancy 0.4 $ 1,991 $ (1,316) $ 675 $ 781 $ (742) $ 39 Facility trade name 30.0 733 (462) 271 733 (439) 294 Customer relationships 18.4 4,582 (2,902) 1,680 4,582 (2,692) 1,890 TOTAL $ 7,306 $ (4,680) $ 2,626 $ 6,096 $ (3,873) $ 2,223
Schedule of Estimated Amortization Expense	Estimated amortization expense for each of the years ending December 31 is as follows: Year Amount 2025 911 2026 234 2027 234 2028 234 2029 234 Thereafter 779 $ 2,626
Schedule of Indefinite-lived Intangible Assets	Other indefinite-lived intangible assets consist of the following: December 31, 2024 2023 Trade name $ 889 $ 889 Medicare and Medicaid licenses 3,777 3,413 TOTAL $ 4,666 $ 4,302

GOODWILL (Tables)

GOODWILL (Tables)	12 Months Ended
GOODWILL (Tables)	Dec. 31, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	The following table represents activity in goodwill by skilled service segment and "all other" category as of December 31, 2024, 2023 and 2022: Goodwill Skilled Services All Other Total January 1, 2022 $ 51,486 $ 8,983 $ 60,469 Additions 16,400 — 16,400 December 31, 2022 $ 67,886 $ 8,983 $ 76,869 December 31, 2023 $ 67,886 $ 8,983 $ 76,869 Additions 20,740 372 21,112 December 31, 2024 $ 88,626 $ 9,355 $ 97,981

OTHER ACCRUED LIABILITIES (Tabl

OTHER ACCRUED LIABILITIES (Tables)	12 Months Ended
OTHER ACCRUED LIABILITIES (Tables)	Dec. 31, 2024
Payables and Accruals [Abstract]
Schedule of Other Accrued Liabilities	Other accrued liabilities consist of the following: December 31, 2024 2023 Quality assurance fee $ 12,667 $ 14,035 Refunds payable 56,755 51,248 Resident advances 18,818 10,834 Cash held in trust for patients 6,370 6,215 Dividends payable 3,589 3,396 Property taxes 15,400 12,875 Accrued litigation (Note 19) — 51,734 Other 18,458 17,891 OTHER ACCRUED LIABILITIES $ 132,057 $ 168,228

INCOME TAXES (Tables)

INCOME TAXES (Tables)	12 Months Ended
INCOME TAXES (Tables)	Dec. 31, 2024
Income Tax Disclosure [Abstract]
Schedule of Components of Income Tax Expense (Benefit)	The provision for income taxes for the years ended December 31, 2024, 2023 and 2022 is summarized as follows: Year Ended December 31, 2024 2023 2022 Current: Federal $ 70,144 $ 73,092 $ 56,717 State 16,857 17,301 14,216 $ 87,001 $ 90,393 $ 70,933 Deferred: Federal 582 (22,280) (5,158) State 53 (5,201) (1,338) $ 635 $ (27,481) $ (6,496) TOTAL $ 87,636 $ 62,912 $ 64,437
Schedule of Effective Income Tax Rate Reconciliation	A reconciliation of the federal statutory rate to the effective tax rate for net income for the years ended December 31, 2024, 2023 and 2022, respectively, is comprised as follows: December 31, 2024 2023 2022 Income tax expense at statutory rate 21.0 % 21.0 % 21.0 % State income taxes - net of federal benefit 3.5 3.5 3.5 Non-deductible expenses 1.8 3.4 2.0 Equity compensation (3.3) (4.2) (3.6) Other adjustments (0.3) (0.6) (0.6) TOTAL INCOME TAX PROVISION 22.7 % 23.1 % 22.3 %
Schedule of Deferred Tax Assets and Liabilities	The Company's deferred tax assets and liabilities as of December 31, 2024 and 2023 are summarized below. December 31, 2024 2023 Deferred tax assets (liabilities): Accrued expenses $ 76,419 $ 81,502 Revenue related reserves 27,023 23,714 Tax credits 597 1,192 Insurance 24,817 16,864 Lease liability 470,313 444,590 $ 599,169 $ 567,862 Valuation allowance (93) (789) TOTAL DEFERRED TAX ASSETS $ 599,076 $ 567,073 State taxes (197) (280) Depreciation and amortization (57,253) (52,334) Prepaid expenses (6,390) (4,113) Right-of-use asset (468,955) (443,222) TOTAL DEFERRED TAX LIABILITIES $ (532,795) $ (499,949) NET DEFERRED TAX ASSETS $ 66,281 $ 67,124

DEBT (Tables)

DEBT (Tables)	12 Months Ended
DEBT (Tables)	Dec. 31, 2024
Debt Disclosure [Abstract]
Schedule of Debt	Debt consists of the following: December 31, 2024 2023 Mortgage loans and promissory note $ 148,438 $ 152,388 Less: current maturities (4,086) (3,950) Less: debt issuance costs, net (2,767) (2,941) LONG-TERM DEBT LESS CURRENT MATURITIES $ 141,585 $ 145,497
Schedule of Maturities of Long-term Debt	Future principal payments due under the long-term debt arrangements discussed above are as follows: Years Ending December 31, Amount 2025 $ 4,086 2026 4,227 2027 3,897 2028 3,779 2029 3,896 Thereafter 128,553 $ 148,438

OPTIONS AND AWARDS (Tables)

OPTIONS AND AWARDS (Tables)	12 Months Ended
OPTIONS AND AWARDS (Tables)	Dec. 31, 2024
Share-Based Payment Arrangement [Abstract]
Schedule of Assumptions for Stock Options Granted	The Company granted 704, 1,008 and 581 stock options during the years ended December 31, 2024, 2023 and 2022, respectively. The Company used the following assumptions for stock options granted during the years ended December 31, 2024, 2023 and 2022: Grant Year Options Granted Weighted Average Risk-Free Rate Expected Life Weighted Average Volatility Weighted Average Dividend Yield 2024 704 4.3% 6.2 years 40.5% 0.2% 2023 1,008 4.3% 6.2 years 41.3% 0.2% 2022 581 2.8% 6.2 years 42.1% 0.3%
Schedule of Exercise Price and Fair Value Displayed at Grant Date for Stock Option Grants	For the years ended December 31, 2024, 2023 and 2022, the following represents the exercise price and fair value displayed at grant date for stock option grants: Grant Year Granted Weighted Average Exercise Price Weighted Average Fair Value of Options 2024 704 $ 132.46 $ 60.37 2023 1,008 $ 95.05 $ 43.85 2022 581 $ 85.74 $ 37.83
Schedule of Employee Stock Option Roll Forward	The following table represents the employee stock option activity during the years ended December 31, 2024, 2023 and 2022: Number of Options Outstanding Weighted Average Number of Weighted Average Exercise Price of Options Vested January 1, 2022 4,038 $ 36.60 2,183 $ 21.02 Granted 581 85.74 Forfeited (98) 59.52 Exercised (688) 18.43 December 31, 2022 3,833 $ 46.72 2,069 $ 28.87 Granted 1,008 95.05 Forfeited (91) 71.44 Exercised (759) 24.21 December 31. 2023 3,991 $ 62.65 1,887 $ 39.58 Granted 704 132.46 Forfeited (76) 86.92 Exercised (632) 35.28 December 31, 2024 3,987 $ 78.84 1,895 $ 52.64
Stock Options Outstanding, Vested and Related Details	The following table represents the employee stock option activity during the year ended December 31, 2024: Stock Options Outstanding Stock Options Vested Number Outstanding Black-Scholes Fair Value Remaining Contractual Life (Years) Vested and Exercisable Year of Grant Exercise Price 2015 $18.20 - $21.39 69 $ 537 1 69 2016 15.93 - 16.86 112 667 2 112 2017 15.80 - 19.41 148 867 3 148 2018 22.49 - 32.71 241 2,557 4 241 2019 41.07 - 45.76 417 6,557 5 417 2020 44.84 - 59.49 406 8,020 6 301 2021 73.47 - 83.64 458 15,041 7 251 2022 79.79 - 94.88 489 18,601 8 176 2023 89.83 - 98.83 951 41,753 9 180 2024 $119.19 - $146.37 696 42,024 10 — TOTAL 3,987 $ 136,624 1,895
Schedule of Aggregate Intrinsic Value of Options	The aggregate intrinsic value of options outstanding, vested and expected to vest as of December 31, 2024, 2023 and 2022 is as follows: December 31, Options 2024 2023 2022 Outstanding $ 219,309 $ 197,819 $ 183,593 Vested 152,011 137,048 136,000 Expected to vest 63,243 56,759 43,232
Schedule of Nonvested Restricted Stock Awards	A summary of the status of the Company's non-vested restricted stock awards as of December 31, 2024 and changes during the years ended December 31, 2024, 2023 and 2022 is presented below: Non-Vested Restricted Awards Weighted Average Grant Date Fair Value Nonvested at January 1, 2022 549 $ 52.16 Granted 233 81.57 Vested (269) 54.06 Forfeited (26) 57.29 Nonvested at December 31, 2022 487 $ 64.92 Granted 219 92.04 Vested (255) 64.21 Forfeited (20) 71.53 Nonvested at December 31, 2023 431 $ 78.91 Granted 232 131.26 Vested (215) 86.97 Forfeited (13) 83.12 Nonvested at December 31, 2024 435 $ 102.71
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 years ended December 31, 2024 , 2023 and 2022 was as follows: Year Ended December 31, 2024 2023 2022 Stock-based compensation expense related to stock options $ 22,439 $ 17,221 $ 11,361 Stock-based compensation expense related to restricted stock awards 11,662 11,845 9,920 Stock-based compensation expense related to restricted stock awards to non-employee directors 2,082 1,688 1,439 TOTAL $ 36,183 $ 30,754 $ 22,720

LEASES (Tables)

LEASES (Tables)	12 Months Ended
LEASES (Tables)	Dec. 31, 2024
Leases [Abstract]
Schedule of Operating Lease Expenses	The components of operating lease expense are as follows: Year Ended December 31, 2024 2023 2022 Rent - cost of services (1) $ 216,016 $ 197,358 $ 153,049 Cost of services (2) 24,297 20,454 16,938 General and administrative expense 700 498 125 Depreciation and amortization (3) 1,212 1,202 1,160 $ 242,225 $ 219,512 $ 171,272 (1) Rent- cost of services includes accrued rent expense adju stments of $808, $870 and $493 for the years ended December 31, 2024, 2023 and 2022, respectively. Additionally, rent- cost of services includes other variable lease costs such as consumer price index increases and short-term leases of $14,013, $10,259, $5,878 for the years ended December 31, 2024, 2023, and 2022 respectively. (2) Cost of services includes variable lease costs, which consists of property taxes and insurance. (3) Depreciation and amortization is related to the amortization of favorable and direct lease costs.
Schedule of Future Minimum Lease Payments	Future minimum lease payments for all third-party leases as of December 31, 2024 are as follows: Year Amount 2025 $ 204,909 2026 204,696 2027 204,002 2028 202,994 2029 199,144 Thereafter 1,776,571 TOTAL LEASE PAYMENTS $ 2,792,316 Less: present value adjustment (963,516) PRESENT VALUE OF TOTAL LEASE LIABILITIES $ 1,828,800 Less: current lease liabilities (93,475) LONG-TERM OPERATING LEASE LIABILITIES $ 1,735,325
Schedule of Rental Income from Third-Party Sources	Total rental income from all third-party sources for the years ended December 31, 2024, 2023 and 2022 is as follows: Year Ended December 31, 2024 2023 2022 Pennant (1) $ 15,480 $ 15,048 $ 14,915 Other third-party (2) 7,480 6,236 1,842 TOTAL $ 22,960 $ 21,284 $ 16,757 (1) Pennant rental income includes variable rent such as property taxes of $1,235, $1,296, and $1,318 during the year ended December 31, 2024, 2023, and 2022. (2) Other third-party includes rental revenue associated with the Company's subleases to third parties of $4,347 and $3,897 for the years ended December 31, 2024 and 2023. There was no sublease rental revenue for the year ended December 31, 2022.
Schedule of Annual Rental Income	Future annual rental income for all third-party leases as of December 31, 2024 were as follows: Year Amount (1) 2025 $ 23,664 2026 23,179 2027 22,736 2028 22,535 2029 22,511 Thereafter 119,811 TOTAL $ 234,436

SELF INSURANCE LIABILITIES (Tab

SELF INSURANCE LIABILITIES (Tables)	12 Months Ended
SELF INSURANCE LIABILITIES (Tables)	Dec. 31, 2024
Insurance [Abstract]
Schedule of Self-Insurance Insurance Liabilities	The following table represents the Company's self-insurance insurance liabilities, on an undiscounted basis, inclusive of anticipated insurance recoveries, as of December 31, 2024 and 2023: December 31, 2024 2023 Accrued general liability and professional malpractice liabilities $ 160,149 $ 117,744 Accrued workers’ compensation liabilities 37,291 33,352 Accrued health benefits 14,312 14,814 TOTAL SELF-INSURANCE LIABILITIES $ 211,752 $ 165,910 Less: current self-insurance liabilities 67,331 54,664 LONG-TERM SELF-INSURANCE LIABILITIES $ 144,421 $ 111,246
Schedule of Insurance Liabilities	The following table represents activity in the Company's self-insurance liabilities as of and for the years ended December 31, 2024 and 2023: Amount Balance January 1, 2023 $ 131,682 Current year provisions 164,627 Claims paid and direct expenses (135,799) Change in long-term insurance losses recoverable 5,400 Balance December 31, 2023 $ 165,910 Current year provisions 217,631 Claims paid and direct expenses (173,617) Change in long-term insurance losses recoverable 1,828 Balance December 31, 2024 $ 211,752

DESCRIPTION OF BUSINESS (Detail

DESCRIPTION OF BUSINESS (Details)	Dec. 31, 2024 property facility bed unit
Real Estate Properties [Line Items]
Number of real estate properties	129
Standard Bearer Healthcare REIT, Inc.
Real Estate Properties [Line Items]
Number of real estate properties	124
Subsidiaries
Real Estate Properties [Line Items]
Number of real estate properties	96
Number of operational skilled nursing beds \| bed	33,500
Number of senior living units \| unit	3,100
Number of facilities under long-term lease arrangements \| facility	231
Options to purchase under long-term lease arrangements \| facility	12
Subsidiaries \| Standard Bearer Healthcare REIT, Inc.
Real Estate Properties [Line Items]
Number of real estate properties	92
Third Party Operators \| Standard Bearer Healthcare REIT, Inc.
Real Estate Properties [Line Items]
Number of real estate properties	33
Third Party Operators \| Standard Bearer Healthcare REIT, Inc. \| Senior Living Operations
Real Estate Properties [Line Items]
Number of senior living operations sharing property with skilled nursing operations	1
Combined Real Estate And Leases \| Subsidiaries
Real Estate Properties [Line Items]
Number of real estate properties \| facility	327

SUMMARY OF SIGNIFICANT ACCOUN_3

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Property and Equipment (Details)	Dec. 31, 2024
Minimum
Property, Plant and Equipment [Line Items]
Property and equipment useful life	3 years
Maximum
Property, Plant and Equipment [Line Items]
Property and equipment useful life	59 years

SUMMARY OF SIGNIFICANT ACCOUN_4

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Leases (Details)	12 Months Ended
	Dec. 31, 2024 lease option
Real Estate Properties [Line Items]
Number of financing lease \| lease	3
Number of options to renew lease \| option	1
Minimum
Real Estate Properties [Line Items]
Lease term	10 years
Extended lease term	10 years
Maximum
Real Estate Properties [Line Items]
Extended lease term	15 years

SUMMARY OF SIGNIFICANT ACCOUN_5

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Intangible Assets and Goodwill (Details)	Dec. 31, 2024
Assembled occupancy \| Minimum
Finite-Lived Intangible Assets [Line Items]
Definite-lived intangible asset useful life	4 months
Assembled occupancy \| Maximum
Finite-Lived Intangible Assets [Line Items]
Definite-lived intangible asset useful life	8 months
Trade name
Finite-Lived Intangible Assets [Line Items]
Definite-lived intangible asset useful life	30 years
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Definite-lived intangible asset useful life	20 years

SUMMARY OF SIGNIFICANT ACCOUN_6

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Self-Insurance (Details) - USD ($) $ in Thousands	Feb. 05, 2025	Dec. 31, 2024	Dec. 31, 2023
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve		$ 211,752	$ 165,910
Workers' Compensation
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve		37,291	$ 33,352
Workers' Compensation \| California
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve		625
Workers' Compensation \| Texas
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve		750
Self-Insurance Retention Per Claim \| General Liability \| WASHINGTON
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve		500
Self-Insurance Retention Per Claim \| Parent Company \| General Liability \| California
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve		750
Self-Insurance Retention Per Claim \| Parent Company \| General Liability \| California \| Subsequent Event
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	$ 1,000
Self-Insurance Retention Per Claim \| Parent Company \| General Liability \| Non-california
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve		650
Self-Insurance Retention Per Claim \| Parent Company \| General Liability \| Non-california \| Subsequent Event
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	750
Enforceable Arbitration Agreement \| Parent Company \| General Liability \| California \| Subsequent Event
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	750
Enforceable Arbitration Agreement \| Parent Company \| General Liability \| Non-california \| Subsequent Event
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	650
Aggregate Deductible \| Parent Company \| General Liability \| California
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve		1,500
Aggregate Deductible \| Parent Company \| General Liability \| California \| Subsequent Event
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	2,950
Aggregate Deductible \| Parent Company \| General Liability \| Non-california
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve		1,400
Aggregate Deductible \| Parent Company \| General Liability \| Non-california \| Subsequent Event
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve	$ 4,500
Per Occurence \| Third-Party Payor \| General Liability \| All States Except Colorado
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve		1,000
Per Occurence \| Third-Party Payor \| General Liability \| Colorado
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve		1,000
Per Facility \| Third-Party Payor \| General Liability \| All States Except Colorado
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve		3,000
Per Facility \| Third-Party Payor \| General Liability \| Colorado
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve		3,000
Aggregate \| Third-Party Payor \| General Liability \| All States Except Colorado
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve		10,000
Loss-Sensitive Limit Per Claim \| Workers' Compensation \| Other States, Except California, Texas and Washington
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve		350
Stop-Loss Insurance Limit Per Claim \| Health Liability Insurance
Liability for Claims and Claims Adjustment Expense [Line Items]
Self insurance reserve		$ 525

REVENUE AND ACCOUNTS RECEIVAB_3

REVENUE AND ACCOUNTS RECEIVABLE - Narrative (Details) - USD ($)	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Disaggregation of Revenue [Line Items]
Revenue	$ 4,260,485,000	$ 3,729,355,000	$ 3,025,468,000
Stat relief funding received	0	64,238,000	81,057,000
Unapplied state relief funds		486,000	1,001,000
Stat relief funding recognized as revenue		64,753,000	81,837,000
Payment associated with deferred amount			24,155,000
Service revenue
Disaggregation of Revenue [Line Items]
Revenue	4,237,525,000	3,708,071,000	3,008,711,000
Service revenue \| Total Medicare and Medicaid
Disaggregation of Revenue [Line Items]
Revenue	$ 3,004,308,000	$ 2,690,861,000	$ 2,216,194,000
Service revenue \| Revenue \| Customer Concentration Risk
Disaggregation of Revenue [Line Items]
% of Revenue	100%	100%	100%
Service revenue \| Revenue \| Customer Concentration Risk \| Total Medicare and Medicaid
Disaggregation of Revenue [Line Items]
% of Revenue	70.90%	72.60%	73.70%
Rental revenue
Disaggregation of Revenue [Line Items]
Revenue	$ 22,960,000	$ 21,284,000	$ 16,757,000

REVENUE AND ACCOUNTS RECEIVAB_4

REVENUE AND ACCOUNTS RECEIVABLE - Schedule of Disaggregation of Revenue (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Disaggregation of Revenue [Line Items]
Revenue	$ 4,260,485	$ 3,729,355	$ 3,025,468
Service revenue
Disaggregation of Revenue [Line Items]
Revenue	4,237,525	3,708,071	3,008,711
Service revenue \| Total Medicaid and Medicare
Disaggregation of Revenue [Line Items]
Revenue	3,004,308	2,690,861	2,216,194
Service revenue \| Medicaid
Disaggregation of Revenue [Line Items]
Revenue	1,682,344	1,459,449	1,183,156
Service revenue \| Medicare
Disaggregation of Revenue [Line Items]
Revenue	1,055,226	985,749	832,160
Service revenue \| Medicaid — skilled
Disaggregation of Revenue [Line Items]
Revenue	266,738	245,663	200,878
Service revenue \| Managed care
Disaggregation of Revenue [Line Items]
Revenue	789,643	666,129	525,710
Service revenue \| Private and other
Disaggregation of Revenue [Line Items]
Revenue	$ 443,574	$ 351,081	$ 266,807
Service revenue \| Revenue \| Customer Concentration Risk
Disaggregation of Revenue [Line Items]
% of Revenue	100%	100%	100%
Service revenue \| Revenue \| Customer Concentration Risk \| Total Medicaid and Medicare
Disaggregation of Revenue [Line Items]
% of Revenue	70.90%	72.60%	73.70%
Service revenue \| Revenue \| Customer Concentration Risk \| Medicaid
Disaggregation of Revenue [Line Items]
% of Revenue	39.70%	39.40%	39.30%
Service revenue \| Revenue \| Customer Concentration Risk \| Medicare
Disaggregation of Revenue [Line Items]
% of Revenue	24.90%	26.60%	27.70%
Service revenue \| Revenue \| Customer Concentration Risk \| Medicaid — skilled
Disaggregation of Revenue [Line Items]
% of Revenue	6.30%	6.60%	6.70%
Service revenue \| Revenue \| Customer Concentration Risk \| Managed care
Disaggregation of Revenue [Line Items]
% of Revenue	18.60%	18%	17.50%
Service revenue \| Revenue \| Customer Concentration Risk \| Private and other
Disaggregation of Revenue [Line Items]
% of Revenue	10.50%	9.40%	8.80%

REVENUE AND ACCOUNTS RECEIVAB_5

REVENUE AND ACCOUNTS RECEIVABLE - Schedule of Accounts Receivable (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts receivable, gross	$ 578,332	$ 494,387
Less: allowance for doubtful accounts	(8,435)	(9,348)
ACCOUNTS RECEIVABLE, NET	569,897	485,039
Medicaid
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts receivable, gross	228,872	178,285
Managed care
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts receivable, gross	139,711	125,907
Medicare
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts receivable, gross	77,056	85,512
Private and other payors
Accounts, Notes, Loans and Financing Receivable [Line Items]
Accounts receivable, gross	$ 132,693	$ 104,683

COMPUTATION OF NET INCOME PER_3

COMPUTATION OF NET INCOME PER COMMON SHARE (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
NUMERATOR:
Net income	$ 298,458	$ 209,850	$ 224,652
Less: net income (loss) attributable to noncontrolling interests	485	451	(29)
NET INCOME ATTRIBUTABLE TO THE ENSIGN GROUP, INC.	$ 297,973	$ 209,399	$ 224,681
DENOMINATOR:
Weighted average shares outstanding for basic net income per share (in shares)	56,655	55,708	54,887
Plus: incremental shares from assumed conversion (in shares)	1,585	1,615	1,984
Adjusted weighted average common shares outstanding (in shares)	58,240	57,323	56,871
Basic net income per common share (in dollars per share)	$ 5.26	$ 3.76	$ 4.09
Diluted net income per common share (in dollars per share)	$ 5.12	$ 3.65	$ 3.95
Antidilutive securities excluded from computation of earnings per share, amount (in shares)	914	1,429	780

FAIR VALUE MEASUREMENTS (Detail

FAIR VALUE MEASUREMENTS (Details) - Fair Value, Inputs, Level 2 - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Amortized cost basis of held-to-maturity investments	$ 138,600	$ 59,530
Financial assets, investment funds	56,049	41,216
Long-Term Insurance Subsidiary Liabilities
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Amortized cost basis of held-to-maturity investments	$ 65,831	$ 59,530

STANDARD BEARER (Details)

STANDARD BEARER (Details)	1 Months Ended	3 Months Ended	12 Months Ended
STANDARD BEARER (Details)	Feb. 05, 2025 USD ($) property	Mar. 31, 2023	Dec. 31, 2024 USD ($) property lease renewal subsidiary shares	Dec. 31, 2023 USD ($) property shares	Dec. 31, 2022 USD ($) property shares
Segment Reporting Information [Line Items]
Number of real estate properties acquired			129
Number of master lease arrangements \| lease			6
Options granted (in shares) \| shares			704,000	1,008,000	581,000
Share-based compensation \| $			$ 36,183,000	$ 30,754,000	$ 22,720,000
Restricted Stock Awards
Segment Reporting Information [Line Items]
Award vesting period			5 years
Restricted stock awards granted (in shares) \| shares			232,000	219,000	233,000
Vested in the period (in shares) \| shares			215,000	255,000	269,000
Share-based compensation \| $			$ 11,662,000	$ 11,845,000	$ 9,920,000
Standard Bearer Equity Plan
Segment Reporting Information [Line Items]
Award vesting period		5 years
Options granted (in shares) \| shares				0	0
Share-based compensation \| $				$ 0	$ 0
Proceeds from issuance of common stock \| $					6,544,000
Proceeds from issuance of preferred shares \| $					$ 149,000
Standard Bearer Equity Plan \| Restricted Stock Awards
Segment Reporting Information [Line Items]
Restricted stock awards granted (in shares) \| shares			39,000	0	0
Vested in the period (in shares) \| shares			0	0	0
Minimum
Segment Reporting Information [Line Items]
Lease term			10 years
Extended lease term			10 years
Minimum \| Revolving credit facility with Truist \| Truist \| Base Rate
Segment Reporting Information [Line Items]
Interest rate margin			0.25%
Minimum \| Revolving credit facility with Truist \| Truist \| Secured Overnight Financing Rate (SOFR)
Segment Reporting Information [Line Items]
Interest rate margin			1.25%
Maximum
Segment Reporting Information [Line Items]
Extended lease term			15 years
Maximum \| Revolving credit facility with Truist \| Truist \| Base Rate
Segment Reporting Information [Line Items]
Interest rate margin			1.25%
Maximum \| Revolving credit facility with Truist \| Truist \| Secured Overnight Financing Rate (SOFR)
Segment Reporting Information [Line Items]
Interest rate margin			2.25%
Standard Bearer Master Leases
Segment Reporting Information [Line Items]
Lessee leasing arrangements, operating leases, number of renewal terms \| renewal			3
Extended lease term			5 years
Operating leases of lessee, contingent rentals, basis spread on variable rate			2.50%
Rental revenue \| $			$ 78,110,000	$ 66,712,000	$ 57,967,000
Standard Bearer Master Leases \| Base Management Fee
Segment Reporting Information [Line Items]
Management fees, as a percentage of total revenues			5%
Management fees \| $			$ 5,707,000	4,948,000	$ 4,367,000
Standard Bearer Master Leases \| Incentive Management Fee
Segment Reporting Information [Line Items]
Management fees, as a percentage of total revenues			1%
Management fees, as a percentage of funds from operations			5%
Standard Bearer Master Leases \| Total Management Fee
Segment Reporting Information [Line Items]
Management fees, as a percentage of total revenues			6%
Standard Bearer Master Leases \| Minimum
Segment Reporting Information [Line Items]
Lease term			15 years
Operating leases of lessee, contingent rentals, basis spread on variable rate			0%
Standard Bearer Master Leases \| Maximum
Segment Reporting Information [Line Items]
Lease term			19 years
CareTrust REIT
Segment Reporting Information [Line Items]
Operating leases of lessee, contingent rentals, basis spread on variable rate			2.50%
Senior Living Operations \| 2022 Acquired Properties
Segment Reporting Information [Line Items]
Number of real estate properties acquired					5
Subsidiaries
Segment Reporting Information [Line Items]
Number of real estate properties acquired			96
Subsidiaries \| Senior Living Operations \| 2022 Acquired Properties
Segment Reporting Information [Line Items]
Number of real estate properties acquired					3
Standard Bearer Healthcare REIT, Inc.
Segment Reporting Information [Line Items]
Number of real estate properties acquired			124
Standard Bearer Healthcare REIT, Inc. \| 2024 Acquired Properties
Segment Reporting Information [Line Items]
Asset acquisition, purchase price \| $			$ 131,927,000
Number of operating subsidiaries \| subsidiary			14
Standard Bearer Healthcare REIT, Inc. \| 2025 Acquired Properties \| Subsequent Event
Segment Reporting Information [Line Items]
Asset acquisition, purchase price \| $	$ 50,853,000
Standard Bearer Healthcare REIT, Inc. \| 2023 Acquired Properties
Segment Reporting Information [Line Items]
Asset acquisition, purchase price \| $				$ 65,899,000
Standard Bearer Healthcare REIT, Inc. \| 2022 Acquired Properties
Segment Reporting Information [Line Items]
Asset acquisition, purchase price \| $					$ 84,656,000
Standard Bearer Healthcare REIT, Inc. \| Skilled Nursing Operations \| 2024 Acquired Properties
Segment Reporting Information [Line Items]
Number of real estate properties acquired			11
Standard Bearer Healthcare REIT, Inc. \| Skilled Nursing Operations \| 2025 Acquired Properties \| Subsequent Event
Segment Reporting Information [Line Items]
Number of real estate properties acquired	4
Standard Bearer Healthcare REIT, Inc. \| Skilled Nursing Operations \| 2023 Acquired Properties
Segment Reporting Information [Line Items]
Number of real estate properties acquired				3
Standard Bearer Healthcare REIT, Inc. \| Skilled Nursing Operations \| 2022 Acquired Properties
Segment Reporting Information [Line Items]
Number of real estate properties acquired					10
Standard Bearer Healthcare REIT, Inc. \| Campus Operations \| 2024 Acquired Properties
Segment Reporting Information [Line Items]
Number of real estate properties acquired			3
Standard Bearer Healthcare REIT, Inc. \| Campus Operations \| 2025 Acquired Properties \| Subsequent Event
Segment Reporting Information [Line Items]
Number of real estate properties acquired	1
Standard Bearer Healthcare REIT, Inc. \| Campus Operations \| 2023 Acquired Properties
Segment Reporting Information [Line Items]
Number of real estate properties acquired				2
Standard Bearer Healthcare REIT, Inc. \| Subsidiaries
Segment Reporting Information [Line Items]
Number of real estate properties acquired			92
Standard Bearer Healthcare REIT, Inc. \| Subsidiaries \| 2025 Acquired Properties \| Subsequent Event
Segment Reporting Information [Line Items]
Number of real estate properties acquired	1
Standard Bearer Healthcare REIT, Inc. \| Subsidiaries \| 2025 Acquired Properties \| Subsequent Event \| CareTrust REIT
Segment Reporting Information [Line Items]
Number of real estate properties acquired	4
Standard Bearer Healthcare REIT, Inc. \| Subsidiaries \| Skilled Nursing Operations \| 2024 Acquired Properties
Segment Reporting Information [Line Items]
Number of real estate properties acquired			14
Standard Bearer Healthcare REIT, Inc. \| Subsidiaries \| Skilled Nursing Operations \| 2025 Acquired Properties \| Subsequent Event
Segment Reporting Information [Line Items]
Number of real estate properties acquired	1
Standard Bearer Healthcare REIT, Inc. \| Subsidiaries \| Skilled Nursing Operations \| 2023 Acquired Properties
Segment Reporting Information [Line Items]
Number of real estate properties acquired				3
Standard Bearer Healthcare REIT, Inc. \| Subsidiaries \| Skilled Nursing Operations \| 2022 Acquired Properties
Segment Reporting Information [Line Items]
Number of real estate properties acquired					7
Standard Bearer Healthcare REIT, Inc. \| Subsidiaries \| Campus Operations \| 2023 Acquired Properties
Segment Reporting Information [Line Items]
Number of real estate properties acquired				1
Standard Bearer Healthcare REIT, Inc. \| Third Party Operators
Segment Reporting Information [Line Items]
Number of real estate properties acquired			33
Standard Bearer Healthcare REIT, Inc. \| Third Party Operators \| Senior Living Operations
Segment Reporting Information [Line Items]
Number of senior living operations sharing property with skilled nursing operations			1
Standard Bearer Healthcare REIT, Inc. \| Third Party Operators \| Senior Living Operations \| 2024 Acquired Properties
Segment Reporting Information [Line Items]
Number of real estate properties acquired			3
Standard Bearer Healthcare REIT, Inc. \| Previous Subsidiaries \| Skilled Nursing Operations \| 2022 Acquired Properties
Segment Reporting Information [Line Items]
Number of real estate properties acquired					3

OPERATION EXPANSIONS - Narrativ

OPERATION EXPANSIONS - Narrative (Details)	Feb. 05, 2025 property bed	Dec. 31, 2024 property unit bed	Dec. 31, 2023 property unit bed	Dec. 31, 2022 property unit bed
Business Acquisition [Line Items]
Number of real estate properties acquired		129
Subsidiaries
Business Acquisition [Line Items]
Number of real estate properties acquired		96
Number of operational skilled nursing beds \| bed		33,500
Number of senior living units \| unit		3,100
Standard Bearer Healthcare REIT, Inc.
Business Acquisition [Line Items]
Number of real estate properties acquired		124
Standard Bearer Healthcare REIT, Inc. \| Subsidiaries
Business Acquisition [Line Items]
Number of real estate properties acquired		92
2024 Acquired Properties \| Subsidiaries
Business Acquisition [Line Items]
Number of operational skilled nursing beds \| bed		3,030
Long-term acute care beds included within operational skilled nursing beds \| bed		43
Number of senior living units \| unit		218
2024 Acquired Properties \| Skilled Nursing Operations \| Standard Bearer Healthcare REIT, Inc.
Business Acquisition [Line Items]
Number of real estate properties acquired		11
2024 Acquired Properties \| Skilled Nursing Operations \| Standard Bearer Healthcare REIT, Inc. \| Subsidiaries
Business Acquisition [Line Items]
Number of real estate properties acquired		14
2024 Acquired Properties \| Campus Operations \| Standard Bearer Healthcare REIT, Inc.
Business Acquisition [Line Items]
Number of real estate properties acquired		3
2024 Acquired Properties \| Skilled Nursing Operations
Business Acquisition [Line Items]
Number of real estate properties acquired		28
2024 Acquired Properties \| Campus Operations
Business Acquisition [Line Items]
Number of real estate properties acquired		3
2025 Acquired Properties \| Standard Bearer Healthcare REIT, Inc. \| Subsidiaries \| Subsequent Event
Business Acquisition [Line Items]
Number of real estate properties acquired	1
Number of operational skilled nursing beds \| bed	682
2025 Acquired Properties \| Skilled Nursing Operations \| Standard Bearer Healthcare REIT, Inc. \| Subsequent Event
Business Acquisition [Line Items]
Number of real estate properties acquired	4
2025 Acquired Properties \| Skilled Nursing Operations \| Standard Bearer Healthcare REIT, Inc. \| Subsidiaries \| Subsequent Event
Business Acquisition [Line Items]
Number of real estate properties acquired	1
2025 Acquired Properties \| Campus Operations \| Standard Bearer Healthcare REIT, Inc. \| Subsequent Event
Business Acquisition [Line Items]
Number of real estate properties acquired	1
2025 Acquired Properties \| Skilled Nursing Operations \| Subsequent Event
Business Acquisition [Line Items]
Number of real estate properties acquired	7
2023 Acquired Properties \| Subsidiaries
Business Acquisition [Line Items]
Number of operational skilled nursing beds \| bed			2,483
Number of senior living units \| unit			94
2023 Acquired Properties \| Skilled Nursing Operations \| Standard Bearer Healthcare REIT, Inc.
Business Acquisition [Line Items]
Number of real estate properties acquired			3
2023 Acquired Properties \| Skilled Nursing Operations \| Standard Bearer Healthcare REIT, Inc. \| Subsidiaries
Business Acquisition [Line Items]
Number of real estate properties acquired			3
2023 Acquired Properties \| Campus Operations \| Standard Bearer Healthcare REIT, Inc.
Business Acquisition [Line Items]
Number of real estate properties acquired			2
2023 Acquired Properties \| Campus Operations \| Standard Bearer Healthcare REIT, Inc. \| Subsidiaries
Business Acquisition [Line Items]
Number of real estate properties acquired			1
2023 Acquired Properties \| Skilled Nursing Operations
Business Acquisition [Line Items]
Number of real estate properties acquired			25
2023 Acquired Properties \| Campus Operations
Business Acquisition [Line Items]
Number of real estate properties acquired			1
2022 Acquired Properties \| Subsidiaries
Business Acquisition [Line Items]
Number of operational skilled nursing beds \| bed				3,058
Number of senior living units \| unit				674
2022 Acquired Properties \| Skilled Nursing Operations \| Standard Bearer Healthcare REIT, Inc.
Business Acquisition [Line Items]
Number of real estate properties acquired				10
2022 Acquired Properties \| Skilled Nursing Operations \| Standard Bearer Healthcare REIT, Inc. \| Subsidiaries
Business Acquisition [Line Items]
Number of real estate properties acquired				7
2022 Acquired Properties \| Senior Living Operations
Business Acquisition [Line Items]
Number of real estate properties acquired				5
2022 Acquired Properties \| Senior Living Operations \| Subsidiaries
Business Acquisition [Line Items]
Number of real estate properties acquired				3
2022 Acquired Properties \| Skilled Nursing Operations
Business Acquisition [Line Items]
Number of real estate properties acquired				23
2022 Acquired Properties \| Campus Operations
Business Acquisition [Line Items]
Number of real estate properties acquired				1

OPERATION EXPANSIONS - Purchase

OPERATION EXPANSIONS - Purchase Price Allocation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Business Acquisition [Line Items]
Goodwill	$ 21,112		$ 16,400
Acquired Properties
Business Acquisition [Line Items]
Goodwill	21,112	$ 0	16,400
Leased asset	0	0	1,909
Other indefinite-lived intangible assets	364	330	245
TOTAL ACQUISITIONS	154,879	67,798	101,136
Acquired Properties \| Land
Business Acquisition [Line Items]
Property, plant and equipment	20,547	7,794	15,527
Acquired Properties \| Building and improvements
Business Acquisition [Line Items]
Property, plant and equipment	108,709	57,488	65,070
Acquired Properties \| Equipment, furniture, and fixtures
Business Acquisition [Line Items]
Property, plant and equipment	2,937	1,840	1,618
Acquired Properties \| Assembled occupancy
Business Acquisition [Line Items]
Property, plant and equipment	$ 1,210	$ 346	$ 367

BUSINESS SEGMENTS - Narrative (

BUSINESS SEGMENTS - Narrative (Details)	12 Months Ended
BUSINESS SEGMENTS - Narrative (Details)	Dec. 31, 2024 segment property
Segment Reporting Information [Line Items]
Number of reportable segments \| segment	2
Number of real estate properties	129
Skilled Services \| Skilled Nursing Operations
Segment Reporting Information [Line Items]
Number of real estate properties	286
Skilled Services \| Campus Operations
Segment Reporting Information [Line Items]
Number of real estate properties	30
Standard Bearer
Segment Reporting Information [Line Items]
Number of real estate properties	124
All Other \| Campus Operations
Segment Reporting Information [Line Items]
Number of real estate properties	30
All Other \| Senior Living Operations
Segment Reporting Information [Line Items]
Number of real estate properties	11

BUSINESS SEGMENTS - Schedule of

BUSINESS SEGMENTS - Schedule of Segment Financial Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Segment Reporting Information [Line Items]
TOTAL REVENUE	$ 4,260,485	$ 3,729,355	$ 3,025,468
Depreciation and amortization	84,138	72,387	62,355
Interest expense	8,286	8,087	8,931
Income before provision for income taxes	386,094	272,762	289,089
Service revenue
Segment Reporting Information [Line Items]
TOTAL REVENUE	4,237,525	3,708,071	3,008,711
Rental revenue
Segment Reporting Information [Line Items]
TOTAL REVENUE	22,960	21,284	16,757
Operating Segments
Segment Reporting Information [Line Items]
TOTAL REVENUE	4,171,911	3,661,341	2,979,152
Segment income (loss)	547,798	493,990	436,603
Operating Segments \| Service revenue
Segment Reporting Information [Line Items]
TOTAL REVENUE	4,076,825	3,578,855	2,906,215
Operating Segments \| Rental revenue
Segment Reporting Information [Line Items]
TOTAL REVENUE	95,086	82,486	72,937
Operating Segments \| Skilled Services
Segment Reporting Information [Line Items]
TOTAL REVENUE	4,076,825	3,578,855	2,906,215
Other segment items	3,513,167	3,075,164	2,464,259
Depreciation and amortization	45,195	38,766	33,224
Interest expense	0	0	0
Segment income (loss)	518,463	464,925	408,732
Operating Segments \| Skilled Services \| Service revenue
Segment Reporting Information [Line Items]
TOTAL REVENUE	4,076,825	3,578,855	2,906,215
Operating Segments \| Skilled Services \| Rental revenue
Segment Reporting Information [Line Items]
TOTAL REVENUE	0	0	0
Operating Segments \| Standard Bearer
Segment Reporting Information [Line Items]
TOTAL REVENUE	95,086	82,486	72,937
Other segment items	9,152	8,455	7,746
Depreciation and amortization	29,297	25,205	21,613
Interest expense	27,302	19,761	15,707
Segment income (loss)	29,335	29,065	27,871
Operating Segments \| Standard Bearer \| Service revenue
Segment Reporting Information [Line Items]
TOTAL REVENUE	0	0	0
Operating Segments \| Standard Bearer \| Rental revenue
Segment Reporting Information [Line Items]
TOTAL REVENUE	95,086	82,486	72,937
Intercompany Elimination
Segment Reporting Information [Line Items]
TOTAL REVENUE	(104,307)	(87,790)	(76,294)
Other segment items	(104,307)	(87,790)	(76,294)
Interest expense	(20,285)	(12,902)	(8,646)
Intercompany Elimination \| Service revenue
Segment Reporting Information [Line Items]
TOTAL REVENUE	(20,366)	(15,451)	(12,718)
Intercompany Elimination \| Rental revenue
Segment Reporting Information [Line Items]
TOTAL REVENUE	(83,941)	(72,339)	(63,576)
Other
Segment Reporting Information [Line Items]
TOTAL REVENUE	192,881	155,804	122,610
Segment income (loss)	(161,704)	(221,228)	(147,514)
Other \| Service revenue
Segment Reporting Information [Line Items]
TOTAL REVENUE	181,066	144,667	115,214
Other \| Rental revenue
Segment Reporting Information [Line Items]
TOTAL REVENUE	$ 11,815	$ 11,137	$ 7,396

BUSINESS SEGMENTS - Schedule _2

BUSINESS SEGMENTS - Schedule of Service Revenue by Major Payor Source (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	$ 4,260,485	$ 3,729,355	$ 3,025,468
Operating Segments
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	4,171,911	3,661,341	2,979,152
Operating Segments \| Skilled Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	4,076,825	3,578,855	2,906,215
Service revenue
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	4,237,525	3,708,071	3,008,711
Service revenue \| Total Medicaid and Medicare
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	3,004,308	2,690,861	2,216,194
Service revenue \| Medicaid
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	1,682,344	1,459,449	1,183,156
Service revenue \| Medicare
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	1,055,226	985,749	832,160
Service revenue \| Medicaid-skilled
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	266,738	245,663	200,878
Service revenue \| Managed care
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	789,643	666,129	525,710
Service revenue \| Private and other
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	$ 443,574	$ 351,081	$ 266,807
Service revenue \| Revenue \| Customer Concentration Risk
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue %	100%	100%	100%
Service revenue \| Revenue \| Customer Concentration Risk \| Total Medicaid and Medicare
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue %	70.90%	72.60%	73.70%
Service revenue \| Revenue \| Customer Concentration Risk \| Medicaid
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue %	39.70%	39.40%	39.30%
Service revenue \| Revenue \| Customer Concentration Risk \| Medicare
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue %	24.90%	26.60%	27.70%
Service revenue \| Revenue \| Customer Concentration Risk \| Medicaid-skilled
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue %	6.30%	6.60%	6.70%
Service revenue \| Revenue \| Customer Concentration Risk \| Managed care
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue %	18.60%	18%	17.50%
Service revenue \| Revenue \| Customer Concentration Risk \| Private and other
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue %	10.50%	9.40%	8.80%
Service revenue \| Operating Segments
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	$ 4,076,825	$ 3,578,855	$ 2,906,215
Service revenue \| Operating Segments \| Skilled Services
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	4,076,825	3,578,855	2,906,215
Service revenue \| Operating Segments \| Skilled Services \| Total Medicaid and Medicare
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	2,968,386	2,660,885	2,191,347
Service revenue \| Operating Segments \| Skilled Services \| Medicaid
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	1,646,422	1,429,473	1,158,309
Service revenue \| Operating Segments \| Skilled Services \| Medicare
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	1,055,226	985,749	832,160
Service revenue \| Operating Segments \| Skilled Services \| Medicaid-skilled
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	266,738	245,663	200,878
Service revenue \| Operating Segments \| Skilled Services \| Managed care
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	789,643	666,129	525,710
Service revenue \| Operating Segments \| Skilled Services \| Private and other
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	318,796	251,841	189,158
Service revenue \| All Other
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	160,700	129,216	102,496
Service revenue \| All Other \| Total Medicaid and Medicare
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	35,922	29,976	24,847
Service revenue \| All Other \| Medicaid
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	35,922	29,976	24,847
Service revenue \| All Other \| Medicare
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	0	0	0
Service revenue \| All Other \| Medicaid-skilled
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	0	0	0
Service revenue \| All Other \| Managed care
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	0	0	0
Service revenue \| All Other \| Private and other
Segment Reporting, Revenue Reconciling Item [Line Items]
Total Service Revenue	$ 124,778	$ 99,240	$ 77,649

PROPERTY AND EQUIPMENT_ NET - S

PROPERTY AND EQUIPMENT— NET - Schedule of Property and Equipment, Net (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Property, Plant and Equipment [Line Items]
Property and equipment	$ 1,750,842	$ 1,487,013
Less: accumulated depreciation	(459,488)	(396,242)
PROPERTY AND EQUIPMENT, NET	1,291,354	1,090,771
Land
Property, Plant and Equipment [Line Items]
Property and equipment	162,873	142,656
Buildings and improvements
Property, Plant and Equipment [Line Items]
Property and equipment	933,790	803,155
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment	212,603	172,064
Equipment
Property, Plant and Equipment [Line Items]
Property and equipment	396,018	339,383
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Property and equipment	4,349	4,192
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment	$ 41,209	$ 25,563

PROPERTY AND EQUIPMENT_ NET - N

PROPERTY AND EQUIPMENT— NET - Narrative (Details) - USD ($)	12 Months Ended
PROPERTY AND EQUIPMENT— NET - Narrative (Details) - USD ($)	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Property, Plant and Equipment [Abstract]
Sales price on sale of assets			$ 8,607,000
Gain on sale of assets			3,467,000
Impairment of long lived assets	$ 1,849,000	$ 0	$ 0
Impairment, Long-Lived Asset, Held-for-Use, Statement of Income or Comprehensive Income [Extensible Enumeration]	Cost of services

INTANGIBLE ASSETS _ NET - Sched

INTANGIBLE ASSETS — NET - Schedule of Finite Lived Intangible Assets (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 7,306	$ 6,096
Accumulated Amortization	(4,680)	(3,873)
Net	$ 2,626	2,223
Assembled occupancy
Finite-Lived Intangible Assets [Line Items]
Weighted Average Life (Years)	4 months 24 days
Gross Carrying Amount	$ 1,991	781
Accumulated Amortization	(1,316)	(742)
Net	$ 675	39
Facility trade name
Finite-Lived Intangible Assets [Line Items]
Weighted Average Life (Years)	30 years
Gross Carrying Amount	$ 733	733
Accumulated Amortization	(462)	(439)
Net	$ 271	294
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Weighted Average Life (Years)	18 years 4 months 24 days
Gross Carrying Amount	$ 4,582	4,582
Accumulated Amortization	(2,902)	(2,692)
Net	$ 1,680	$ 1,890

INTANGIBLE ASSETS _ NET - Narra

INTANGIBLE ASSETS — NET - Narrative (Details) - USD ($)	12 Months Ended
INTANGIBLE ASSETS — NET - Narrative (Details) - USD ($)	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Amortization of intangible assets	$ 2,019,000	$ 1,790,000	$ 1,714,000
Impairment charge to intangible assets	0	0	0
Medicare and Medicaid licenses
Finite-Lived Intangible Assets [Line Items]
Indefinite-lived intangible assets acquired	364,000	330,000	245,000
Depreciation and Amortization
Finite-Lived Intangible Assets [Line Items]
Operating lease expense	$ 1,212,000	$ 1,202,000	$ 1,160,000

INTANGIBLE ASSETS _ NET - Sch_2

INTANGIBLE ASSETS — NET - Schedule of Estimated Amortization Expense (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
2025	$ 911
2026	234
2027	234
2028	234
2029	234
Thereafter	779
Net	$ 2,626	$ 2,223

INTANGIBLE ASSETS _ NET - Sch_3

INTANGIBLE ASSETS — NET - Schedule of Indefinite-lived Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Indefinite-lived Intangible Assets [Line Items]
Other indefinite-lived intangibles	$ 4,666	$ 4,302
Trade name
Indefinite-lived Intangible Assets [Line Items]
Other indefinite-lived intangibles	889	889
Medicare and Medicaid licenses
Indefinite-lived Intangible Assets [Line Items]
Other indefinite-lived intangibles	$ 3,777	$ 3,413

GOODWILL - Schedule of Goodwill

GOODWILL - Schedule of Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Goodwill [Roll Forward]
Goodwill, beginning balance	$ 76,869	$ 76,869	$ 60,469
Additions	21,112		16,400
Goodwill, ending balance	97,981	76,869	76,869
Operating Segments \| Skilled Services
Goodwill [Roll Forward]
Goodwill, beginning balance	67,886	67,886	51,486
Additions	20,740		16,400
Goodwill, ending balance	88,626	67,886	67,886
All Other
Goodwill [Roll Forward]
Goodwill, beginning balance	8,983	8,983	8,983
Additions	372		0
Goodwill, ending balance	$ 9,355	$ 8,983	$ 8,983

GOODWILL - Narrative (Details)

GOODWILL - Narrative (Details) - USD ($)	12 Months Ended
GOODWILL - Narrative (Details) - USD ($)	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and intangible asset impairment	$ 0	$ 0	$ 0
Cumulative goodwill impairment losses	$ 7,410,000

OTHER ACCRUED LIABILITIES (Deta

OTHER ACCRUED LIABILITIES (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Payables and Accruals [Abstract]
Quality assurance fee	$ 12,667	$ 14,035
Refunds payable	56,755	51,248
Resident advances	18,818	10,834
Cash held in trust for patients	6,370	6,215
Dividends payable	3,589	3,396	$ 3,201
Property taxes	15,400	12,875
Accrued litigation	0	51,734
Other	18,458	17,891
OTHER ACCRUED LIABILITIES	$ 132,057	$ 168,228

INCOME TAXES - Expense (Details

INCOME TAXES - Expense (Details) - USD ($) $ in Thousands	12 Months Ended
INCOME TAXES - Expense (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Current:
Federal	$ 70,144	$ 73,092	$ 56,717
State	16,857	17,301	14,216
Total current income tax expense (benefit)	87,001	90,393	70,933
Deferred:
Federal	582	(22,280)	(5,158)
State	53	(5,201)	(1,338)
Total deferred income tax expense (benefit)	635	(27,481)	(6,496)
Provision for income taxes	$ 87,636	$ 62,912	$ 64,437

INCOME TAXES - Tax Rate (Detail

INCOME TAXES - Tax Rate (Details)	12 Months Ended
INCOME TAXES - Tax Rate (Details)	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Income tax expense at statutory rate	21%	21%	21%
State income taxes - net of federal benefit	3.50%	3.50%	3.50%
Non-deductible expenses	1.80%	3.40%	2%
Equity compensation	(3.30%)	(4.20%)	(3.60%)
Other adjustments	(0.30%)	(0.60%)	(0.60%)
TOTAL INCOME TAX PROVISION	22.70%	23.10%	22.30%

INCOME TAXES - Narrative (Detai

INCOME TAXES - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
INCOME TAXES - Narrative (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Effective income tax rate	22.70%	23.10%	22.30%
Tax credits	$ 597	$ 1,192
Valuation allowance	$ 93	$ 789

INCOME TAXES - Deferred Tax Ass

INCOME TAXES - Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Accrued expenses	$ 76,419	$ 81,502
Revenue related reserves	27,023	23,714
Tax credits	597	1,192
Insurance	24,817	16,864
Lease liability	470,313	444,590
Total deferred tax assets	599,169	567,862
Valuation allowance	(93)	(789)
TOTAL DEFERRED TAX ASSETS	599,076	567,073
State taxes	(197)	(280)
Depreciation and amortization	(57,253)	(52,334)
Prepaid expenses	(6,390)	(4,113)
Right-of-use asset	(468,955)	(443,222)
TOTAL DEFERRED TAX LIABILITIES	(532,795)	(499,949)
NET DEFERRED TAX ASSETS	$ 66,281	$ 67,124

DEBT - Schedule of Long-term De

DEBT - Schedule of Long-term Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Less: current maturities	$ (4,086)	$ (3,950)
Less: debt issuance costs, net	(2,767)	(2,941)
LONG-TERM DEBT LESS CURRENT MATURITIES	141,585	145,497
Mortgage loans and promissory note
Debt Instrument [Line Items]
Mortgage loans and promissory note	$ 148,438	$ 152,388

DEBT - Credit Facility with a L

DEBT - Credit Facility with a Lending Consortium Arranged by Truist (Details) - Revolving credit facility with Truist - Truist	12 Months Ended
	Dec. 31, 2024 USD ($)
Debt Instrument [Line Items]
Line of credit facility, maximum borrowing capacity	$ 600,000,000
Total net debt ratio, maximum	3.75
Long-term debt threshold for EBITDA ratio increase election period	6 months
Long-term debt, threshold for EBITDA ratio increase election	$ 50,000,000
Total net debt ratio, maximum after increase election	4.25
Total net debt ratio, minimum	1.50
Outstanding debt	$ 0
Minimum
Debt Instrument [Line Items]
Line of credit facility, unused capacity, commitment fee percentage	0.20%
Maximum
Debt Instrument [Line Items]
Line of credit facility, unused capacity, commitment fee percentage	0.40%
Base Rate \| Minimum
Debt Instrument [Line Items]
Interest rate margin	0.25%
Base Rate \| Maximum
Debt Instrument [Line Items]
Interest rate margin	1.25%
Secured Overnight Financing Rate (SOFR) \| Minimum
Debt Instrument [Line Items]
Interest rate margin	1.25%
Secured Overnight Financing Rate (SOFR) \| Maximum
Debt Instrument [Line Items]
Interest rate margin	2.25%

DEBT - Mortgage Loans and Promi

DEBT - Mortgage Loans and Promissory Notes and Off-Balance Sheet Arrangements (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2024 USD ($) subsidiary	Dec. 31, 2023 USD ($)
Debt Instrument [Line Items]
Letters of credit outstanding, pledged amount	$ 27,893
Letter of Credit
Debt Instrument [Line Items]
Letter of credit increase	21,638
Mortgage loans and promissory note
Debt Instrument [Line Items]
Outstanding debt	$ 148,438	$ 152,388
Mortgage loans and promissory note \| HUD Insured Mortgages \| First Three Years
Debt Instrument [Line Items]
Prepayment penalty	10%
Mortgage loans and promissory note \| HUD Insured Mortgages \| In The Fourth Year
Debt Instrument [Line Items]
Reduction in prepayment penalty	3%
Mortgage loans and promissory note \| HUD Insured Mortgages \| Years Five Through Ten
Debt Instrument [Line Items]
Reduction in prepayment penalty	1%
Mortgage loans and promissory note \| HUD Insured Mortgages \| After Year Ten
Debt Instrument [Line Items]
Prepayment penalty	0%
Mortgage loans and promissory note \| HUD Insured Mortgages \| Minimum
Debt Instrument [Line Items]
Debt instrument, interest rate, effective percentage	3.10%
Debt instrument, interest rate, stated percentage	2.40%
Debt instrument, term	25 years
Mortgage loans and promissory note \| HUD Insured Mortgages \| Maximum
Debt Instrument [Line Items]
Debt instrument, interest rate, effective percentage	4.20%
Debt instrument, interest rate, stated percentage	3.30%
Debt instrument, term	35 years
Mortgage loans and promissory note \| HUD Insured Mortgages \| Twenty Three Subsidiaries
Debt Instrument [Line Items]
Number of operating subsidiaries \| subsidiary	23
Outstanding debt	$ 146,898
Mortgage loans and promissory note \| 5.3% Promissory Note
Debt Instrument [Line Items]
Outstanding debt	$ 1,540
Debt instrument, interest rate, stated percentage	5.30%
Debt instrument, term	12 years

DEBT - Long-term Debt Arrangeme

DEBT - Long-term Debt Arrangements (Details) $ in Thousands	Dec. 31, 2024 USD ($)
Debt Disclosure [Abstract]
2025	$ 4,086
2026	4,227
2027	3,897
2028	3,779
2029	3,896
Thereafter	128,553
Total long-term debt	$ 148,438

OPTIONS AND AWARDS - Stock Opti

OPTIONS AND AWARDS - Stock Options, Narrative (Details) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2024 USD ($) plan installment $ / shares shares	Dec. 31, 2023 USD ($) $ / shares	Dec. 31, 2022 USD ($) $ / shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of stock incentive plans \| plan	1
Forfeiture rate	4.86%
Grant date intrinsic value (in dollars per share) \| $ / shares	$ 0	$ 0	$ 0
Intrinsic value of options exercised in period \| $	$ 60,358	$ 56,186	$ 47,441
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Aggregate intrinsic value of options that vested in period \| $	$ 37,700	$ 31,658	$ 27,955
2022 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized (in shares) \| shares	3,452
Conversion to reduce shares availability	1
Other than options, conversion to reduce shares availability	2
Award vesting period	5 years
Award vesting rights, percentage	20%
Expiration period	10 years
Number of shares available for grant (in shares) \| shares	346
2022 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

OPTIONS AND AWARDS - Schedule o

OPTIONS AND AWARDS - Schedule of Assumptions for Stock Options Granted (Details) - shares shares in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Share-Based Payment Arrangement [Abstract]
Options granted (in shares)	704	1,008	581
Weighted Average Risk-Free Rate	4.30%	4.30%	2.80%
Expected Life	6 years 2 months 12 days	6 years 2 months 12 days	6 years 2 months 12 days
Weighted Average Volatility	40.50%	41.30%	42.10%
Weighted Average Dividend Yield	0.20%	0.20%	0.30%

OPTIONS AND AWARDS - Schedule_2

OPTIONS AND AWARDS - Schedule of Exercise Price and Fair Value Displayed at Grant Date for Stock Option Grants (Details) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Share-Based Payment Arrangement [Abstract]
Granted (in shares)	704	1,008	581
Weighted Average Exercise Price (in dollars per share)	$ 132.46	$ 95.05	$ 85.74
Weighted Average Fair Value of Options (in dollars per share)	$ 60.37	$ 43.85	$ 37.83

OPTIONS AND AWARDS - Schedule_3

OPTIONS AND AWARDS - Schedule of Employee Stock Option Roll Forward (Details) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Number of Options Outstanding
Balance at beginning of period, (in shares)	3,991	3,833	4,038
Granted (in shares)	704	1,008	581
Forfeited (in shares)	(76)	(91)	(98)
Exercised (in shares)	(632)	(759)	(688)
Balance at end of period, (in shares)	3,987	3,991	3,833
Weighted Average Exercise Price
Balance at beginning of period (in dollars per share)	$ 62.65	$ 46.72	$ 36.60
Granted (in dollars per share)	132.46	95.05	85.74
Forfeited (in dollars per share)	86.92	71.44	59.52
Exercised (in dollars per share)	35.28	24.21	18.43
Balance at end of period (in dollars per share)	$ 78.84	$ 62.65	$ 46.72
Number of Options Vested (in shares)	1,895	1,887	2,069	2,183
Weighted Average Exercise Price of Options Vested (in dollars per share)	$ 52.64	$ 39.58	$ 28.87	$ 21.02

OPTIONS AND AWARDS - Options Ou

OPTIONS AND AWARDS - Options Outstanding by Exercise Price (Details) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2024 USD ($) $ / shares shares
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Number outstanding (in shares)	3,987
Black-Scholes Fair Value \| $	$ 136,624
Stock options vested and exercisable (in shares)	1,895
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)	69
Black-Scholes Fair Value \| $	$ 537
Remaining Contractual Life (Years)	1 year
Stock options vested and exercisable (in shares)	69
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)	112
Black-Scholes Fair Value \| $	$ 667
Remaining Contractual Life (Years)	2 years
Stock options vested and exercisable (in shares)	112
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)	148
Black-Scholes Fair Value \| $	$ 867
Remaining Contractual Life (Years)	3 years
Stock options vested and exercisable (in shares)	148
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)	241
Black-Scholes Fair Value \| $	$ 2,557
Remaining Contractual Life (Years)	4 years
Stock options vested and exercisable (in shares)	241
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)	417
Black-Scholes Fair Value \| $	$ 6,557
Remaining Contractual Life (Years)	5 years
Stock options vested and exercisable (in shares)	417
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	$ 59.49
Number outstanding (in shares)	406
Black-Scholes Fair Value \| $	$ 8,020
Remaining Contractual Life (Years)	6 years
Stock options vested and exercisable (in shares)	301
2021
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Exercise price, lower range limit (in dollars per share) \| $ / shares	$ 73.47
Exercise price, upper range limit (in dollars per share) \| $ / shares	$ 83.64
Number outstanding (in shares)	458
Black-Scholes Fair Value \| $	$ 15,041
Remaining Contractual Life (Years)	7 years
Stock options vested and exercisable (in shares)	251
2022
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Exercise price, lower range limit (in dollars per share) \| $ / shares	$ 79.79
Exercise price, upper range limit (in dollars per share) \| $ / shares	$ 94.88
Number outstanding (in shares)	489
Black-Scholes Fair Value \| $	$ 18,601
Remaining Contractual Life (Years)	8 years
Stock options vested and exercisable (in shares)	176
2023
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Exercise price, lower range limit (in dollars per share) \| $ / shares	$ 89.83
Exercise price, upper range limit (in dollars per share) \| $ / shares	$ 98.83
Number outstanding (in shares)	951
Black-Scholes Fair Value \| $	$ 41,753
Remaining Contractual Life (Years)	9 years
Stock options vested and exercisable (in shares)	180
2024
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items]
Exercise price, lower range limit (in dollars per share) \| $ / shares	$ 119.19
Exercise price, upper range limit (in dollars per share) \| $ / shares	$ 146.37
Number outstanding (in shares)	696
Black-Scholes Fair Value \| $	$ 42,024
Remaining Contractual Life (Years)	10 years
Stock options vested and exercisable (in shares)	0

OPTIONS AND AWARDS - Schedule_4

OPTIONS AND AWARDS - Schedule of Aggregate Intrinsic Value of Options (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Share-Based Payment Arrangement [Abstract]
Outstanding	$ 219,309	$ 197,819	$ 183,593
Vested	152,011	137,048	136,000
Expected to vest	$ 63,243	$ 56,759	$ 43,232

OPTIONS AND AWARDS - Restricted

OPTIONS AND AWARDS - Restricted Stock Awards, Narrative (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation, restricted awards, exercise price (in dollars per share)	$ 0
Restricted Stock Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted (in shares)	232	219	233
Award vesting period	5 years
Granted (in dollars per share)	$ 131.26	$ 92.04	$ 81.57
Annual bonuses settled in vested awards	$ 6,165	$ 5,068
Restricted Stock Awards \| Non-employee Directors
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted (in shares)	16
Restricted Stock Awards \| Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted (in dollars per share)	$ 116.65	$ 89.83	73.17
Restricted Stock Awards \| Minimum \| Non-employee Directors
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted (in dollars per share)	116.65
Restricted Stock Awards \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted (in dollars per share)	149.12	$ 98.31	$ 94.88
Restricted Stock Awards \| Maximum \| Non-employee Directors
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted (in dollars per share)	$ 149.12

OPTIONS AND AWARDS - Schedule_5

OPTIONS AND AWARDS - Schedule of Nonvested Restricted Stock Awards (Details) - Restricted Stock Awards - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Non-Vested Restricted Awards
Nonvested at beginning of period (in shares)	431	487	549
Granted (in shares)	232	219	233
Vested (in shares)	(215)	(255)	(269)
Forfeited (in shares)	(13)	(20)	(26)
Nonvested at end of period (in shares)	435	431	487
Weighted Average Grant Date Fair Value
Nonvested at beginning of period (in dollars per share)	$ 78.91	$ 64.92	$ 52.16
Granted (in dollars per share)	131.26	92.04	81.57
Vested (in dollars per share)	86.97	64.21	54.06
Forfeited (in dollars per share)	83.12	71.53	57.29
Nonvested at end of period (in dollars per share)	$ 102.71	$ 78.91	$ 64.92

OPTIONS AND AWARDS - Long-Term

OPTIONS AND AWARDS - Long-Term Incentive Plan, Narrative (Details) - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022	Aug. 27, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation	$ 36,183	$ 30,754	$ 22,720
Spinoff \| 2019 LTI Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized (in shares)				500
Share-based compensation	$ 546	$ 827	$ 836

OPTIONS AND AWARDS - Schedule_6

OPTIONS AND AWARDS - Schedule of Stock-Based Compensation Expense (Details) - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Stock-based compensation expense related to stock options	$ 36,183	$ 30,754	$ 22,720
Share-based compensation, options outstanding, weighted average remaining contractual term	6 years 8 months 12 days
Stock-based compensation expense related to stock options
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Stock-based compensation expense related to stock options	$ 22,439	17,221	11,361
Share-based compensation, nonvested awards, cost not yet recognized	$ 84,914
Share-based compensation, nonvested awards, cost not yet recognized, period for recognition	3 years 9 months 18 days
Share-based compensation, nonvested awards (in shares)	2,092
Share-based compensation, options expected to vest, number (in shares)	1,925
Stock-based compensation expense related to restricted stock awards
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Stock-based compensation expense related to stock options	$ 11,662	11,845	9,920
Share-based compensation, nonvested awards, cost not yet recognized	$ 38,434
Share-based compensation, nonvested awards, cost not yet recognized, period for recognition	3 years 8 months 12 days
Stock-based compensation expense related to restricted stock awards to non-employee directors
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Stock-based compensation expense related to stock options	$ 2,082	$ 1,688	$ 1,439

LEASES - Lessee Narrative (Deta

LEASES - Lessee Narrative (Details) $ in Thousands	1 Months Ended	12 Months Ended
LEASES - Lessee Narrative (Details) $ in Thousands	Feb. 05, 2025 USD ($) property	Dec. 31, 2024 USD ($) property agreement renewal subsidiary lease	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired		129
Increase (decrease) in lease liability \| $		$ 287	$ (6,564)	$ 345
Operating lease, weighted average remaining lease term		14 years 6 months	14 years 10 months 24 days
Operating lease, weighted average discount rate, percent		6.30%	6.50%
Subsidiaries
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired		96
Cost of Sales and General and Administrative Expense
Lessee, Lease, Description [Line Items]
Rent expense \| $		$ 216,716	$ 197,856	153,174
Standard Bearer Healthcare REIT, Inc.
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired		124
Standard Bearer Healthcare REIT, Inc. \| Subsidiaries
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired		92
2024 Acquired Properties \| Standard Bearer Healthcare REIT, Inc.
Lessee, Lease, Description [Line Items]
Asset acquisition, purchase price \| $		$ 131,927
2025 Acquired Properties \| Standard Bearer Healthcare REIT, Inc. \| Subsequent Event
Lessee, Lease, Description [Line Items]
Asset acquisition, purchase price \| $	$ 50,853
2025 Acquired Properties \| Standard Bearer Healthcare REIT, Inc. \| Subsequent Event \| Subsidiaries
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired	1
Minimum
Lessee, Lease, Description [Line Items]
Lease term		10 years
Extended lease term		10 years
Maximum
Lessee, Lease, Description [Line Items]
Extended lease term		15 years
Skilled Nursing Operations \| 2024 Acquired Properties \| Standard Bearer Healthcare REIT, Inc.
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired		11
Skilled Nursing Operations \| 2024 Acquired Properties \| Standard Bearer Healthcare REIT, Inc. \| Subsidiaries
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired		14
Skilled Nursing Operations \| 2025 Acquired Properties \| Standard Bearer Healthcare REIT, Inc. \| Subsequent Event
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired	4
Skilled Nursing Operations \| 2025 Acquired Properties \| Standard Bearer Healthcare REIT, Inc. \| Subsequent Event \| Subsidiaries
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired	1
CareTrust REIT
Lessee, Lease, Description [Line Items]
Consumer price index		0%
Operating leases of lessee, contingent rentals, basis spread on variable rate		2.50%
Number of stand-alone leases \| lease		1
Rent expense \| $		$ 69,399	$ 66,439	$ 64,178
CareTrust REIT \| 2025 Acquired Properties \| Standard Bearer Healthcare REIT, Inc. \| Subsequent Event \| Subsidiaries
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired	4
CareTrust REIT \| Skilled Nursing Operations And Senior Living Facilities \| 2025 Acquired Properties \| Standard Bearer Healthcare REIT, Inc. \| Subsequent Event
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired	4
Asset acquisition, purchase price \| $	$ 44,575
Various Landlords
Lessee, Lease, Description [Line Items]
Number of master lease agreements \| agreement		14
Subsidiaries under master lease arrangement \| subsidiary		90
Various Landlords \| Minimum
Lessee, Lease, Description [Line Items]
Lease term		15 years
Various Landlords \| Minimum \| Equipment
Lessee, Lease, Description [Line Items]
Lease term		3 years
Various Landlords \| Maximum
Lessee, Lease, Description [Line Items]
Lease term		20 years
Various Landlords \| Maximum \| Equipment
Lessee, Lease, Description [Line Items]
Lease term		5 years
Master Lease Agreements \| CareTrust REIT \| Skilled Nursing Operations And Senior Living Facilities
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired		100
New And Amended Master Lease Agreement \| Various Landlords
Lessee, Lease, Description [Line Items]
Increase in right-of-use asset \| $		$ 71,616
Increase (decrease) in lease liability \| $		$ 71,616
Amended Master Lease Agreement
Lessee, Lease, Description [Line Items]
Number of master lease agreements \| agreement		2
Increase in right-of-use asset \| $		$ 72,503
Increase (decrease) in lease liability \| $		$ 72,503
Amended Master Lease Agreement \| Operation \| 2024 Acquired Properties
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired		3
Amended Master Lease Agreement \| Skilled Nursing Operations \| 2024 Acquired Properties \| Subsidiaries
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired		2
Amended Master Lease Agreement \| Various Landlords
Lessee, Lease, Description [Line Items]
Number of master lease agreements \| agreement		1
Term of operating lease		20 years
Amended Master Lease Agreement, One
Lessee, Lease, Description [Line Items]
Lessee, operating lease, term extension		15 years
Amended Master Lease Agreement, Two
Lessee, Lease, Description [Line Items]
Lessee, operating lease, term extension		20 years
New Master Lease Agreeement \| Subsequent Event
Lessee, Lease, Description [Line Items]
Increase in right-of-use asset \| $	67,572
Increase (decrease) in lease liability \| $	$ 67,572
New Master Lease Agreeement \| Skilled Nursing Operations \| 2024 Acquired Properties \| Subsidiaries
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired		6
New Master Lease Agreeement \| Skilled Nursing Operations \| 2025 Acquired Properties \| Subsequent Event
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired	6
New Master Lease Agreeement \| Various Landlords
Lessee, Lease, Description [Line Items]
Number of master lease agreements \| agreement		1
Term of operating lease		15 years
Triple Net Lease Arrangements \| CareTrust REIT
Lessee, Lease, Description [Line Items]
Number of master lease agreements \| agreement		9
Extended lease term		5 years
Triple Net Lease Arrangements \| CareTrust REIT \| Minimum
Lessee, Lease, Description [Line Items]
Lease term		13 years
Lessee leasing arrangements, operating leases, number of renewal terms \| renewal		2
Triple Net Lease Arrangements \| CareTrust REIT \| Maximum
Lessee, Lease, Description [Line Items]
Lease term		20 years
Lessee leasing arrangements, operating leases, number of renewal terms \| renewal		3
Triple Net Lease Arrangements \| CareTrust REIT \| Skilled Nursing Operations And Senior Living Facilities
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired		99
Purchase Option \| CareTrust REIT \| Skilled Nursing Operations And Senior Living Facilities
Lessee, Lease, Description [Line Items]
Number of real estate properties acquired		4

LEASES - Schedule of Operating

LEASES - Schedule of Operating Lease Expenses (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Lessee, Lease, Description [Line Items]
Cost of service	$ 24,297	$ 20,454	$ 16,938
Lease, cost	242,225	219,512	171,272
Accrued rent expense adjustments	808	870	493
Rent - cost of services
Lessee, Lease, Description [Line Items]
Operating lease expense	216,016	197,358	153,049
CPI increases and short term-lease cost	14,013	10,259	5,878
General and administrative expense
Lessee, Lease, Description [Line Items]
Operating lease expense	700	498	125
Depreciation and amortization
Lessee, Lease, Description [Line Items]
Operating lease expense	$ 1,212	$ 1,202	$ 1,160

LEASES - Schedule of Future Min

LEASES - Schedule of Future Minimum Lease Payments (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Year
2025	$ 204,909
2026	204,696
2027	204,002
2028	202,994
2029	199,144
Thereafter	1,776,571
TOTAL LEASE PAYMENTS	2,792,316
Less: present value adjustment	(963,516)
PRESENT VALUE OF TOTAL LEASE LIABILITIES	1,828,800
Less: current lease liabilities	(93,475)	$ (82,526)
LONG-TERM OPERATING LEASE LIABILITIES	$ 1,735,325	$ 1,639,326

LEASES - Lessor Narrative (Deta

LEASES - Lessor Narrative (Details) - property	Dec. 31, 2024	Dec. 31, 2023
Lessor, Lease, Description [Line Items]
Number of real estate properties	129
Leases To Third Party Operators
Lessor, Lease, Description [Line Items]
Term of operating lease	15 years	15 years
Leases To Third Party Operators \| Senior Living Operations \| 2024 Acquired Properties
Lessor, Lease, Description [Line Items]
Number of real estate properties	3
Leases To Third Party Operators \| Campus Operations \| 2023 Acquired Properties
Lessor, Lease, Description [Line Items]
Number of real estate properties		1
Leases To Third Party Operators \| Minimum
Lessor, Lease, Description [Line Items]
Term of operating lease	14 years
Leases To Third Party Operators \| Maximum
Lessor, Lease, Description [Line Items]
Term of operating lease	16 years
Leases To Third Party Operators \| The Pennant Group, Inc. \| Senior Living Operations
Lessor, Lease, Description [Line Items]
Number of real estate properties	32
Sublease To Third Party Operators
Lessor, Lease, Description [Line Items]
Term of operating lease		18 years
Sublease To Third Party Operators \| Skilled Nursing Operations \| 2023 Acquired Properties
Lessor, Lease, Description [Line Items]
Number of real estate properties		3

LEASES - Schedule of Rental Inc

LEASES - Schedule of Rental Income from Third-Party Sources (Details) - USD ($)	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Lessor, Lease, Description [Line Items]
Operating Lease, Lease Income, Statement of Income or Comprehensive Income [Extensible Enumeration]	TOTAL REVENUE	TOTAL REVENUE	TOTAL REVENUE
Operating Segments \| Rental revenue \| All Other
Lessor, Lease, Description [Line Items]
Sublease income	$ 4,347,000	$ 3,897,000	$ 0
Leases To Third Party Operators
Lessor, Lease, Description [Line Items]
Rental revenue	22,960,000	21,284,000	16,757,000
Leases To Third Party Operators \| Pennant
Lessor, Lease, Description [Line Items]
Rental revenue	15,480,000	15,048,000	14,915,000
Operating lease, variable lease income	1,235,000	1,296,000	1,318,000
Leases To Third Party Operators \| Other third-party
Lessor, Lease, Description [Line Items]
Rental revenue	$ 7,480,000	$ 6,236,000	$ 1,842,000

LEASES - Schedule of Annual Ren

LEASES - Schedule of Annual Rental Income (Details) $ in Thousands	Dec. 31, 2024 USD ($)
Leases [Abstract]
2025	$ 23,664
2026	23,179
2027	22,736
2028	22,535
2029	22,511
Thereafter	119,811
TOTAL	$ 234,436

DEFINED CONTRIBUTION PLANS (Det

DEFINED CONTRIBUTION PLANS (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Defined Contribution Plan Disclosure [Line Items]
Deferred compensation liability, noncurrent	$ 63,051	$ 49,201
Loss (gain) on deferral investment	(5,157)	(4,634)	$ 4,188
Offsetting expense (income)	$ 5,559	4,887	(4,051)
Qualified Plan
Defined Contribution Plan Disclosure [Line Items]
Maximum annual contributions per employee	90%
Expensed matching contributions	$ 3,532	$ 2,836	$ 2,418
Nonqualified Plan
Defined Contribution Plan Disclosure [Line Items]
Maximum annual contributions per employee	100%

SELF INSURANCE LIABILITIES - Sc

SELF INSURANCE LIABILITIES - Schedule of Future Self Insurance Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Liabilities for Guarantees on Long-Duration Contracts [Line Items]
TOTAL SELF-INSURANCE LIABILITIES	$ 211,752	$ 165,910
Less: current self-insurance liabilities	67,331	54,664
LONG-TERM SELF-INSURANCE LIABILITIES	144,421	111,246
Accrued general liability and professional malpractice liabilities
Liabilities for Guarantees on Long-Duration Contracts [Line Items]
TOTAL SELF-INSURANCE LIABILITIES	160,149	117,744
Accrued workers’ compensation liabilities
Liabilities for Guarantees on Long-Duration Contracts [Line Items]
TOTAL SELF-INSURANCE LIABILITIES	37,291	33,352
Accrued health benefits
Liabilities for Guarantees on Long-Duration Contracts [Line Items]
TOTAL SELF-INSURANCE LIABILITIES	$ 14,312	$ 14,814

SELF INSURANCE LIABILITIES - _2

SELF INSURANCE LIABILITIES - Schedule of Insurance Liabilities (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023
Movement in Liability for Future Policy Benefits [Roll Forward]
Beginning balance	$ 165,910	$ 131,682
Current year provisions	217,631	164,627
Claims paid and direct expenses	(173,617)	(135,799)
Change in long-term insurance losses recoverable	1,828	5,400
Ending balance	$ 211,752	$ 165,910

SELF INSURANCE LIABILITIES - Na

SELF INSURANCE LIABILITIES - Narrative (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Insurance [Abstract]
Gross insurance recoveries	$ 17,741	$ 15,913

COMMITMENTS AND CONTINGENCIES (

COMMITMENTS AND CONTINGENCIES (Details) $ in Millions	12 Months Ended
COMMITMENTS AND CONTINGENCIES (Details) $ in Millions	Dec. 31, 2024 USD ($) subsidiary	Dec. 31, 2023	Dec. 31, 2022
Concentration Risk [Line Items]
Litigation settlement, amount awarded to other party \| $	$ 48
Independent subsidiaries with multi-claim reviews scheduled or in process \| subsidiary	18
Accounts Receivable \| Customer Concentration Risk \| Total Medicaid and Medicare
Concentration Risk [Line Items]
Concentration percentage	52.90%	53.40%
Revenue \| Customer Concentration Risk \| Service revenue
Concentration Risk [Line Items]
Concentration percentage	100%	100%	100%
Revenue \| Customer Concentration Risk \| Total Medicaid and Medicare \| Service revenue
Concentration Risk [Line Items]
Concentration percentage	70.90%	72.60%	73.70%

COMMON STOCK REPURCHASE PROGR_2

COMMON STOCK REPURCHASE PROGRAM (Details) - USD ($)				12 Months Ended
COMMON STOCK REPURCHASE PROGRAM (Details) - USD ($)	May 16, 2024	Aug. 29, 2023	Jul. 28, 2022	Dec. 31, 2024	Dec. 31, 2022
Equity, Class of Treasury Stock [Line Items]
Repurchase of common stock (in shares)					404,000
Amount of common stock repurchased					$ 29,882,000
May 2024 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
Repurchase of common stock (in shares)				0
August 2023 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
Repurchase of common stock (in shares)				0
July 2022 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
Repurchase of common stock (in shares)			0