Genesis Healthcare (GENN) 10-Q 10 May 16 2016 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2016	May. 09, 2016
Document and Entity Information [Line Items]
Entity Registrant Name	Genesis Healthcare, Inc.
Entity Central Index Key	1,351,051
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Document Type	10-Q
Document Period End Date	Mar. 31, 2016
Document Fiscal Year Focus	2,016
Document Fiscal Period Focus	Q1
Amendment Flag	false
Entity Current Reporting Status	Yes
Class A Common Stock
Document and Entity Information [Line Items]
Entity Common Stock, Shares Outstanding		73,593,732
Class B Common Stock
Document and Entity Information [Line Items]
Entity Common Stock, Shares Outstanding		15,511,603
Class C Common Stock
Document and Entity Information [Line Items]
Entity Common Stock, Shares Outstanding		64,449,380

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2016	Dec. 31, 2015
Current assets:
Cash and cash equivalents	$ 52,204	$ 61,543
Restricted cash and investments in marketable securities	52,917	52,917
Accounts receivable, net of allowance for doubtful accounts of $204,296 and $189,739 at March 31, 2016 and December 31, 2015, respectively	821,199	789,387
Prepaid expenses	89,447	58,622
Other current assets	64,204	49,024
Total current assets	1,079,971	1,011,493
Property and equipment, net of accumulated depreciation of $638,768 and $502,176 at March 31, 2016 and December 31, 2015, respectively	3,981,879	4,085,247
Restricted cash and investments in marketable securities	137,934	145,210
Other long-term assets	125,666	130,869
Deferred income taxes	6,485	7,144
Identifiable intangible assets, less accumulated amortization of $73,458 and $66,570 at March 31, 2016 and December 31, 2015, respectively	203,080	209,967
Goodwill	470,735	470,019
Total assets	6,005,750	6,059,949
Current liabilities:
Current installments of long-term debt	8,113	12,477
Capital lease obligation	1,847	1,842
Financing obligations	1,230	989
Accounts payable	224,850	233,801
Accrued expenses	194,791	197,741
Accrued compensation	246,828	185,054
Self-insurance reserves	166,761	166,761
Total current liabilities	844,420	798,665
Long-term liabilities:
Long-term debt	1,105,022	1,186,159
Long-term capital lease obligation	1,056,884	1,053,816
Financing obligations	3,091,366	3,064,077
Deferred income taxes	18,696	14,939
Self-insurance reserves	443,816	428,569
Other long-term liabilities	$ 133,769	$ 133,111
Commitments and contingencies
Stockholders’ equity:
Additional paid-in-capital	$ 296,948	$ 295,359
Accumulated deficit	(774,641)	(731,602)
Accumulated other comprehensive (loss) income	272	(218)
Total stockholders’ deficit before noncontrolling interests	(477,267)	(436,307)
Noncontrolling interests	(210,956)	(183,080)
Total stockholders' deficit	(688,223)	(619,387)
Total liabilities and stockholders’ deficit	6,005,750	6,059,949
Class A Common Stock
Stockholders’ equity:
Common stock	74	74
Class B Common Stock
Stockholders’ equity:
Common stock	16	16
Class C Common Stock
Stockholders’ equity:
Common stock	$ 64	$ 64

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parentheticals) - USD ($) $ in Thousands	Mar. 31, 2016	Dec. 31, 2015
Current assets:
Allowance for doubtful accounts	$ 204,296	$ 189,739
Other assets:
Accumulated depreciation on property and equipment	693,086	638,768
Accumulated amortization on intangible assets	$ 73,458	$ 66,570
Class A Common Stock
Stockholders’ equity:
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, authorized (in shares)	1,000,000,000	1,000,000,000
Common stock, issued (in shares)	73,593,732	73,593,732
Common stock, shares, outstanding (in shares)	73,593,732	73,593,732
Class B Common Stock
Stockholders’ equity:
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, authorized (in shares)	20,000,000	20,000,000
Common stock, issued (in shares)	15,511,603	15,511,603
Common stock, shares, outstanding (in shares)	15,511,603	15,511,603
Class C Common Stock
Stockholders’ equity:
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, authorized (in shares)	150,000,000	150,000,000
Common stock, issued (in shares)	64,449,380	64,449,380
Common stock, shares, outstanding (in shares)	64,449,380	64,449,380

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2016	Mar. 31, 2015
CONSOLIDATED STATEMENTS OF OPERATIONS (UNAUDITED)
Net revenues	$ 1,472,218	$ 1,343,001
Salaries, wages and benefits	867,717	790,733
Other operating expenses	361,097	312,561
General and administrative	48,427	41,533
Provision for losses on accounts receivable	26,493	23,396
Lease expense	37,316	36,419
Depreciation and amortization expense	61,765	59,933
Interest expense	135,181	121,313
(Gain) loss on extinguishment of debt		3,234
Investment income	(481)	(416)
Other (income) loss	12	(7,611)
Transaction costs	1,754	86,069
Skilled Healthcare loss contingency expense	1,626
Equity in net (income) loss of unconsolidated affiliates	(763)	(153)
Loss before income tax expense (benefit)	(67,926)	(124,010)
Income tax (benefit) expense	3,064	(5,648)
Loss from continuing operations	(70,990)	(118,362)
(Loss) income from discontinued operations, net of taxes	(38)	112
Net loss	(71,028)	(118,250)
Less net loss (income) attributable to noncontrolling interests	27,989	5,684
Net loss attributable to Genesis Healthcare, Inc	$ (43,039)	$ (112,566)
Basic and diluted
Weighted-average shares outstanding for basic and diluted loss from continuing operations per share	89,198	75,234
Loss from continuing operations attributable to Genesis Healthcare, Inc.	$ (0.48)	$ (1.50)
(Loss) income from discontinued operations, net of taxes	0	0
Net loss attributable to Genesis Healthcare, Inc.	$ (0.48)	$ (1.50)

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2016	Mar. 31, 2015
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS)
Net loss	$ (71,028)	$ (118,250)
Net unrealized loss on marketable securities, net of tax	844	572
Comprehensive loss	(70,184)	(117,678)
Comprehensive (loss) income attributable to noncontrolling interests	27,635	5,382
Comprehensive loss attributable to Genesis Healthcare, Inc.	$ (42,549)	$ (112,296)

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2016	Mar. 31, 2015
Cash Flows from Operating Activities
Net loss	$ (71,028)	$ (118,250)
Adjustments to reconcile net loss to net cash provided by operating activities:
Non-cash interest and leasing arrangements, net	24,989	23,413
Other non-cash charges and gains, net	12	(7,587)
Share based compensation	1,590	25,373
Depreciation and amortization	61,765	60,077
Provision for losses on accounts receivable	26,493	23,392
Equity in net income of unconsolidated affiliates	(763)	(153)
Provision (benefit for deferred taxes, net	4,415	(9,493)
Changes in assets and liabilities:
Accounts receivable	(60,866)	(43,860)
Accounts payable and other accrued expenses and other	37,839	44,606
Net cash provided by operating activities	24,446	(2,482)
Cash Flows from Investing Activities
Capital expenditures	(26,243)	(16,721)
Purchases of marketable securities	(13,922)	(15,319)
Proceeds on maturity or sale of marketable securities	13,465	10,158
Net change in restricted cash and equivalents	8,578	(361)
Sale of investment in joint venture	1,010	26,358
Sales of inpatient assets	76,373	1,263
Purchases of inpatient assets, net of cash acquired	(778)
Other, net	(366)	912
Net cash used in investing activities	58,117	6,290
Cash Flows from Financing Activities
Borrowings under revolving credit facility	224,000	146,500
Repayments under revolving credit facility	(254,000)	(151,000)
Proceeds from issuance of long-term debt	67,872	360,000
Proceeds from tenant improvement draws under lease arrangements	499	95
Repayment of long-term debt	(127,717)	(330,627)
Debt issuance costs	(2,316)	(17,776)
Distributions to noncontrolling interests	(240)	(2,840)
Net cash provided by financing activities	(91,902)	4,352
Net (decrease) increase in cash and cash equivalents	(9,339)	8,160
Beginning of period	61,543	87,548
End of period	52,204	95,708
Supplemental disclosure of cash flow information
Interest paid	111,456	94,948
Net taxes (refunded) paid	(14,180)	5,917
Non-cash financing activities:
Financing obligations	$ 3,861	3,682
Assumptions of long-term debt		$ 326,610

General Information

General Information	3 Months Ended
	Mar. 31, 2016
General Information
Description of Business	(1) General Informatio n Description of Business Genesis Healthcare, Inc. is a healthcare services company that through its subsidiaries (collectively, the Company) owns and operates skilled nursing facilities, assisted/senior living facilities and a rehabilitation therapy business. The Company has an administrative services company that provides a full complement of administrative and consultative services that allows its affiliated operators and third-party operators with whom the Company contracts to better focus on delivery of healthcare services. The Company provides inpatient services through 512 skilled nursing, assisted/senior living and behavioral health centers located in 34 states. Revenues of the Company’s owned, leased and otherwise consolidated centers constitute approximately 84% of its revenues. The Company provides a range of rehabilitation therapy services, including speech pathology, physical therapy, occupational therapy and respiratory therapy. These services are provided by rehabilitation therapists and assistants employed or contracted at substantially all of the centers operated by the Company, as well as by contract to healthcare facilities operated by others. After the elimination of intercompany revenues, the rehabilitation therapy services business constitutes approximately 12% of the Company’s revenues. The Company provides an array of other specialty medical services, including management services, physician services, staffing services, hospice and home health services, and other healthcare related services, which comprise the balance of the Company’s revenues. Basis of Presentation The accompanying consolidated financial statements have been prepared in accordance with U.S. generally accepted accounting principles (U.S. GAAP). In the opinion of management, the consolidated financial statements include all necessary adjustments for a fair presentation of the financial position and results of operations for the periods presented. The consolidated financial statements of the Company include the accounts of the Company and its wholly-owned subsidiaries. All significant intercompany transactions have been eliminated in consolidation. The Company presents noncontrolling interests within the stockholders’ deficit section of its consolidated balance sheets. The Company presents the amount of net loss attributable to Genesis Healthcare, Inc. and net loss (income) attributable to noncontrolling interests in its consolidated statements of operations. The consolidated financial statements include the accounts of all entities controlled by the Company through its ownership of a majority voting interest and the accounts of any variable interest entities (VIEs) where the Company is subject to a majority of the risk of loss from the VIE's activities, or entitled to receive a majority of the entity's residual returns, or both. The Company assesses the requirements related to the consolidation of VIEs, including a qualitative assessment of power and economics that considers which entity has the power to direct the activities that “most significantly impact” the VIE's economic performance and has the obligation to absorb losses of, or the right to receive benefits that could be potentially significant to, the VIE. The Company's composition of variable interest entities was not material at March 31, 2016. The accompanying unaudited consolidated financial statements have been prepared in accordance with the instructions for Form 10-Q of Regulation S-X and do not include all of the disclosures normally required by U.S. GAAP or those normally required in annual reports on Form 10-K. Accordingly, these financial statements should be read in conjunction with the audited consolidated financial statements of the Company for the year ended December 31, 2015 filed with the U.S. Securities and Exchange Commission (the SEC) on Form 10-K on March 14, 2016. Certain prior year amounts have been reclassified to conform to current period presentation, the effect of which was not material. Upon adoption of new accounting guidance, debt issuance costs have been presented as a direct deduction from long-term debt rather than as an other long-term asset in all periods presented. The Company’s financial position at March 31, 2016 includes the impact of certain significant transactions and events, as disclosed within Note 3 – “ Significant Transactions and Events .” Recent Accounting Pronouncements In May 2014, the Financial Accounting Standards Board (the FASB) issued ASU No. 2014-09, Revenue from Contracts with Customers , (ASU 2014-09) which changes the requirements for recognizing revenue when entities enter into contracts with customers. Under ASU 2014-09, an entity will recognize revenue when it transfers promised goods or services to customers in an amount that reflects what it expects in exchange for the goods or services. It also requires more detailed disclosures to enable users of financial statements to understand the nature, amount, timing, and uncertainty of revenue and cash flows arising from contracts with customers. The adoption of ASU 2014-09 is effective for annual and interim periods beginning after December 15, 2017 and early adoption is not permitted. The Company is still evaluating the effect, if any, ASU 2014-09 will have on the Company’s consolidated financial condition and results of operations. In August 2014, the FASB issued ASU No. 2014-15, Presentation of Financial Statements – Going Concern, (ASU 2014-15) requiring management to evaluate whether there are conditions and events that raise substantial doubt about the entity’s ability to continue as a going concern and to provide disclosures in certain circumstances. ASU 2014-15 is effective for annual and interim periods ending after December 31, 2016. The Company is still evaluating the effect, if any, ASU 2014-15 will have on its consolidated financial condition and results of operations. In January 2016, the FASB issued ASU No. 2016-01, Financial Instruments – Overall (Subtopic 825-10): Recognition and Measurement of Financial Assets and Financial Liabilities, (ASU 2016-01), which is intended to improve the recognition and measurement of financial instruments. The new guidance is effective for annual and interim periods beginning after December 15, 2017, with early adoption permitted under certain circumstances. The Company is still evaluating the effect, if any, ASU 2016-01 will have on its consolidated financial condition and results of operations. In February 2016, the FASB issued amended authoritative guidance on accounting for leases. The new provisions require that a lessee of operating leases recognize a liability to make lease payments (the lease liability) and a right-of-use asset representing its right to use the underlying asset for the lease term. The lease liability will be equal to the present value of lease payments, with the right-of-use asset based upon the lease liability. The classification criteria for distinguishing between finance (or capital) leases and operating leases are substantially similar to the previous lease guidance, but with no explicit bright lines. As such, operating leases will result in straight-line rent expense similar to current practice. For short term leases (term of 12 months or less), a lessee is permitted to make an accounting election not to recognize lease assets and lease liabilities, which would generally result in lease expense being recognized on a straight-line basis over the lease term. The guidance is effective for annual and interim periods beginning after December 15, 2018, and will require application of the new guidance at the beginning of the earliest comparable period presented. Early adoption is permitted. The new standard must be adopted using a modified retrospective transition. The adoption of this standard is expected to have a material impact on the Company’s financial position. The Company is still evaluating the impact on its results of operations and does not expect the adoption of this standard to have an impact on liquidity. In March 2016, the FASB issued ASU No. 2016-09, Compensation - Stock Compensation (Topic 718): Improvements to Employee Share-Based Payment Accounting, (ASU 2016-09), which is intended to improve the accounting for employee share-based payments and affect all organizations that issue share-based payment awards to their employees. Several aspects of the accounting for share-based payment award transactions are simplified, including: (a) income tax consequences; (b) classification of awards as either equity or liabilities; and (c) classification on the statement of cash flows. The new guidance is effective for annual and interim periods beginning after December 15, 2016, with early adoption permitted. The Company is still evaluating the effect, if any, ASU 2016-09 will have on its consolidated financial condition and results of operations.

Certain Significant Risks and U

Certain Significant Risks and Uncertainties	3 Months Ended
	Mar. 31, 2016
Certain Significant Risks and Uncertainties
Certain Significant Risks and Uncertainties	(2) Certain Significant Risks and Uncertainties Revenue Sources The Company receives revenues from Medicare, Medicaid, private insurance, self-pay residents, other third-party payors and long-term care facilities that utilize its rehabilitation therapy and other services. The Company’s inpatient services segment derives approximately 79% of its revenue from Medicare and various state Medicaid programs. The following table depicts the Company’s inpatient services segment revenue by source for the three months ended March 31, 2016 and 2015. Three months ended March 31, 2016 2015 Medicare % % Medicaid % % Insurance % % Private and other % % Total % % The sources and amounts of the Company’s revenues are determined by a number of factors, including licensed bed capacity and occupancy rates of inpatient facilities, the mix of patients and the rates of reimbursement among payors. Likewise, payment for ancillary medical services, including services provided by the Company’s rehabilitation therapy services business, varies based upon the type of payor and payment methodologies. Changes in the case mix of the patients as well as payor mix among Medicare, Medicaid and private pay can significantly affect the Company’s profitability. It is not possible to quantify fully the effect of legislative changes, the interpretation or administration of such legislation or other governmental initiatives on the Company’s business and the business of the customers served by the Company’s rehabilitation therapy business. The potential impact of reforms to the United States healthcare system, including potential material changes to the delivery of healthcare services and the reimbursement paid for such services by the government or other third party payors, is uncertain at this time. Also, initiatives among managed care payors, conveners and referring acute care hospital systems to reduce lengths of stay and avoidable hospital admissions and to divert referrals to home health or other community-based care settings could have an adverse impact on the Company’s business. Accordingly, there can be no assurance that the impact of any future healthcare legislation, regulation or actions by participants in the health care continuum will not adversely affect the Company’s business. There can be no assurance that payments under governmental and private third-party payor programs will be timely, will remain at levels similar to present levels or will, in the future, be sufficient to cover the costs allocable to patients eligible for reimbursement pursuant to such programs. The Company’s financial condition and results of operations are and will continue to be affected by the reimbursement process, which in the healthcare industry is complex and can involve lengthy delays between the time that revenue is recognized and the time that reimbursement amounts are settled. Laws and regulations governing the Medicare and Medicaid programs, and the Company’s business generally, are complex and are often subject to a number of ambiguities in their application and interpretation. The Company believes that it is in substantial compliance with all applicable laws and regulations. However, from time to time the Company and its affiliates are subject to pending or threatened lawsuits and investigations involving allegations of potential wrongdoing, some of which may be material or involve significant costs to resolve and/or defend against, or may lead to other adverse effects on the Company and its affiliates including, but not limited to, fines, penalties and exclusion from participation in the Medicare and/or Medicaid programs. The Company’s business is subject to a number of other known and unknown risks and uncertainties, which are discussed in Item 1A (Risk Factors) of the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2015, which was filed with the SEC on March 14, 2016.

Significant Transactions and Ev

Significant Transactions and Events	3 Months Ended
	Mar. 31, 2016
Significant Transactions and Events
Significant Transactions and Events	(3) Significant Transactions and Events The Combination with Skilled On August 18, 2014, Skilled Healthcare Group, Inc., a Delaware corporation (Skilled) entered into a Purchase and Contribution Agreement with FC-GEN Operations Investment, LLC (FC-GEN) pursuant to which the businesses and operations of FC-GEN and Skilled were combined (the Combination). On February 2, 2015, the Combination was completed. Pro forma information The acquired business contributed net revenues of $152.7 million and net loss of $5.3 million to the Company for the period from February 1, 2015 to March 31, 2015 . The unaudited pro forma net effect of the Combination assuming the acquisition occurred as of January 1, 2015 is as follows (in thousands, except per share amounts): Pro forma three months ended March 31, 2015 Revenues $ Loss attributable to Genesis Healthcare, Inc. Loss per common share: Basic $ Diluted $ The unaudited pro forma financial data have been derived by combining the historical financial results of the Company and the operations acquired in the Combination for the periods presented. The unaudited results of operations includes transaction and financing costs totaling $84.7 million incurred by both the Company and Skilled in connection with the Combination. These costs have been eliminated from the results of operations for the three months ended March 31, 2015 for purposes of the pro forma financial presentation. Sale of Kansas ALFs On January 1, 2016, the Company sold 18 Kansas assisted/senior living facilities acquired in the Combination for $67.0 million. Of the proceeds received, $54.2 million were used to pay down partially the Real Estate Bridge Loans. See Note 7 – “ Long-Term Debt – Real Estate Bridge Loans.” Sale of Hospice and Home Health On March 9, 2016, the Company announced that it had signed an agreement with FC Compassus LLC, a nationwide network of community-based hospice and palliative care programs, to sell its hospice and home health operations for $84 million. Through the asset purchase agreement, the Company retained certain liabilities. See Note 11 – “ Commitments and Contingencies – Legal Proceedings - Creekside Hospice Litigation .” Certain members of the Company’s board of directors indirectly beneficially hold ownership interests in FC Compassus LLC totaling less than 10% in the aggregate. Effective May 1, 2016, the Company completed the sale and received $72 million in cash and a $12 million short-term note. The cash proceeds were used to pay down partially the Company’s Term Loan Facility. See Note 7 – “ Long-Term Debt – Term Loan Facility.” HUD Insured Loans On March 31, 2016, the Company closed on the HUD insured financing of ten skilled nursing facilities acquired in the Combination for $67.9 million. On April 28, 2016, the Company closed on the HUD insured financing of three additional skilled nursing facilities acquired in the Combination for $9.2 million. The $77.1 million in total proceeds from the financings were used to pay down partially the Real Estate Bridge Loans. See Note 7 – “ Long-Term Debt – Real Estate Bridge Loans.”

Earnings (Loss) Per Share

Earnings (Loss) Per Share	3 Months Ended
	Mar. 31, 2016
Earnings (Loss) Per Share
Earnings (Loss) Per Share	(4) Earnings (Loss) Per Share The Company has three classes of common stock. Classes A and B are identical in economic and voting interests. Class C has a 1 :1 voting ratio with the other two classes, representing the voting interests of the approximate 42% noncontrolling interest of the legacy FC-GEN owners. Class C common stock is a participating security; however, it shares in a de minimis economic interest and is therefore excluded from the denominator of the basic earnings (loss) per share (EPS) calculation. Basic EPS was computed by dividing net loss by the weighted-average number of outstanding common shares for the period. Diluted EPS is computed by dividing loss plus the effect of assumed conversions (if applicable) by the weighted-average number of outstanding shares after giving effect to all potential dilutive common stock, including options, warrants, common stock subject to repurchase and convertible preferred stock, if any. The computations of basic and diluted EPS are consistent with any potentially dilutive adjustments to the numerator or denominator being anti-dilutive and therefore excluded from the dilutive calculation. A reconciliation of the numerator and denominator used in the calculation of basic and diluted net income per common share follows (in thousands, except per share data): Three months ended March 31, 2016 2015 Numerator: Loss from continuing operations $ $ Less: Net loss attributable to noncontrolling interests Loss from continuing operations attributable to Genesis Healthcare, Inc. $ $ (Loss) income from discontinued operations, net of taxes Net loss attributable to Genesis Healthcare, Inc. $ $ Denominator: Weighted average shares outstanding for basic and diluted net loss per share Basic and diluted net loss per common share: Loss from continuing operations attributable to Genesis Healthcare, Inc. $ $ (Loss) income from discontinued operations, net of taxes Net loss attributable to Genesis Healthcare, Inc. $ $ The following were excluded from net loss attributable to Genesis Healthcare, Inc. and the weighted-average diluted shares computation for the three months ended March 31, 2016 and 2015 , as their inclusion would have been anti-dilutive (in thousands): Three months ended March 31, 2016 2015 Net loss Net loss attributable to attributable to Genesis Antidilutive Genesis Antidilutive Healthcare, Inc. shares Healthcare, Inc. shares Exchange of restricted stock units of noncontrolling interests $ $ Employee and director unvested restricted stock units — — — Because the Company is in a net loss position for the three months ended March 31, 2016 , the combined impact of the assumed conversion of the approximate 42% noncontrolling interest to common stock and the related tax implications are anti-dilutive to EPS. As of March 31, 2016 and 2015 , there were 64,449,380 units attributed to the noncontrolling interests outstanding. In addition to the outstanding units attributed to the noncontrolling interests, the conversion of all of those units will result in the issuance of an incremental 11,222 Class A common stock. On June 3, 2015, the shareholders approved the 2015 Omnibus Equity Incentive Plan, which authorized the grant of 4,116,870 restricted stock units to employees and 178,218 restricted stock units to non-employee directors. On October 26, 2015, an additional 653,130 restricted stock units were granted to employees. There were no grants in the three months ended March 31, 2016. Because the Company is in a net loss position for the three months ended March 31, 2016 , the combined impact of the grants under the 2015 Omnibus Equity Incentive Plan to common stock and the related tax implications are anti-dilutive to EPS.

Segment Information

Segment Information	3 Months Ended
	Mar. 31, 2016
Segment Information
Segment Information	(5) Segment Information The Company has three reportable operating segments: (i) inpatient services; (ii) rehabilitation therapy services; and (iii) other services. For additional information on these reportable segments see Note 1 – “General Informati on – Description of Business.” A summary of the Company’s segmented revenues follows: Three months ended March 31, 2016 2015 Increase / (Decrease) Revenue Revenue Revenue Revenue Dollars Percentage Dollars Percentage Dollars Percentage (in thousands, except percentages) Revenues: Inpatient services: Skilled nursing facilities $ % $ % $ % Assisted/Senior living facilities % % % Administration of third party facilities % % % Elimination of administrative services — % — % % Inpatient services, net % % % Rehabilitation therapy services: Total therapy services % % % Elimination intersegment rehabilitation therapy services % % % Third party rehabilitation therapy services % % % Other services: Total other services % % % Elimination intersegment other services % % % Third party other services % % % Net revenues $ % $ % $ % A summary of the Company’s unaudited condensed consolidated statement of operations follows: Three months ended March 31, 2016 Rehabilitation Inpatient Therapy Other Services Services Services Corporate Eliminations Consolidated (In thousands) Net revenues $ $ $ $ $ $ Salaries, wages and benefits — — Other operating expenses — General and administrative costs — — — — Provision for losses on accounts receivable — Lease expense — Depreciation and amortization expense — Interest expense — Investment income — — — Other loss — — — — Transaction costs — — — — Skilled Healthcare and other loss contingency expense — — — — Equity in net (income) loss of unconsolidated affiliates — — (Loss) income before income tax expense Income tax (benefit) expense — — — (Loss) income from continuing operations $ $ $ $ $ $ Three months ended March 31, 2015 Rehabilitation Inpatient Therapy Other Services Services Services Corporate Eliminations Consolidated (In thousands) Net revenues $ $ $ $ $ $ Salaries, wages and benefits — — Other operating expenses — General and administrative costs — — — — Provision for losses on accounts receivable — Lease expense — Depreciation and amortization expense — Interest expense Loss on extinguishment of debt — — — — Investment income — — Other income — — — — Transaction costs — — — Equity in net (income) loss of unconsolidated affiliates — — (Loss) income before income tax benefit Income tax benefit — — — — (Loss) income from continuing operations $ $ $ $ $ $ The following table presents the segment assets as of March 31, 2016 compared to December 31, 2015 (in thousands): March 31, 2016 December 31, 2015 Inpatient services $ $ Rehabilitation services Other services Corporate and eliminations Total assets $ $ The following table presents segment goodwill as of March 31, 2016 compared to December 31, 2015 (in thousands): March 31, 2016 December 31, 2015 Inpatient services $ $ Rehabilitation services Other services Total goodwill $ $

Property and Equipment

Property and Equipment	3 Months Ended
	Mar. 31, 2016
Property, Plant and Equipment [Abstract]
Property and Equipment	(6) Property and Equipment Property and equipment consisted of the following as of March 31, 2016 and December 31, 2015 (in thousands): March 31, 2016 December 31, 2015 Land, buildings and improvements $ $ Capital lease land, buildings and improvements Financing obligation land, buildings and improvements Equipment, furniture and fixtures Construction in progress Gross property and equipment Less: accumulated depreciation Net property and equipment $ $

Long-Term Debt

Long-Term Debt	3 Months Ended
	Mar. 31, 2016
Long-Term Debt Abstract
Long-Term Debt	(7) Long-Term Debt Long-term debt at March 31, 2016 and December 31, 2015 consisted of the following (in thousands): March 31, December 31, 2016 2015 Revolving credit facilities, net of debt issuance costs of $9,626 at March 31, 2016 and $10,254 at December 31, 2015 $ $ Term loan facility, net of original issue discount of $6,500 at March 31, 2016 and $7,475 at December 31, 2015, and net of debt issuance costs of $8,808 at March 31, 2016 and $10,129 at December 31, 2015 Real estate bridge loans, net of debt issuance costs of $7,628 at March 31, 2016 and $9,567 at December 31, 2015 HUD insured loans, net of debt issuance costs of $3,646 at March 31, 2016 and $1,395 at December 31, 2015 Mortgages and other secured debt (recourse) Mortgages and other secured debt (non-recourse), net of debt issuance costs of $165 at March 31, 2016 and $176 at December 31, 2015 Less: Current installments of long-term debt Long-term debt $ $ Revolving Credit Facilities The Company’s revolving credit facilities (the Revolving Credit Facilities) consist of a senior secured, asset-based revolving credit facility of up to $550 million under three separate tranches: Tranche A-1, Tranche A-2 and FILO Tranche. Interest accrues at a per annum rate equal to either (x) a base rate (calculated as the highest of the (i) prime rate, (ii) the federal funds rate plus 3.00% , or (iii) LIBOR plus the excess of the applicable margin between LIBOR loans and base rate loans) plus an applicable margin or (y) LIBOR plus an applicable margin. The applicable margin is based on the level of commitments for all three tranches, and in regards to LIBOR loans (i) for Tranche A-1 ranges from 3.25% to 2.75%; (ii) for Tranche A-2 ranges from 3.00% to 2.50%; and (iii) for FILO Tranche is 5.00% . The Revolving Credit Facilities mature on February 2, 2020, provided that if the Term Loan Facility (defined below), the Skilled Real Estate Bridge Loan (defined below) or the Revera Real Estate Bridge Loan (defined below) is not refinanced with longer term debt or their terms not extended prior to their extension option maturities of December 4, 2017, August 27, 2017 and May 29, 2018, respectively, the Revolving Credit Facilities will mature 90 days prior to such maturity date, as applicable. Borrowing levels under the Revolving Credit Facilities are limited to a borrowing base that is computed based upon the level of the Company’s eligible accounts receivable, as defined. In addition to paying interest on the outstanding principal borrowed under the Revolving Credit Facilities, the Company is required to pay a commitment fee to the lenders for any unutilized commitments. The commitment fee rate ranges from 0.375% per annum to 0.50% depending upon the level of unused commitment. Borrowings and interest rates under the three tranches were as follows at March 31, 2016 (dollars in thousands) : Weighted Average Revolving credit facility Borrowings Interest FILO tranche $ % Tranche A-1 % Tranche A-2 % $ % As of March 31, 2016 , the Company had a total borrowing base capacity of $544.1 million with outstanding borrowings under the Revolving Credit Facilities of $333.0 million and $68.2 million of drawn letters of credit securing insurance and lease obligations, leaving the Company with approximately $142.9 million of available borrowing capacity under the Revolving Credit Facilities. Term Loan Facility The five -year term loan facility (Term Loan Facility) is secured by a first priority lien on the membership interests in the Company and on substantially all of the Company’s and its subsidiaries’ assets other than collateral held on a first priority basis by the Revolving Credit Facilities lender. Borrowings under the Term Loan Facility bear interest at a rate per annum equal to the applicable margin plus, at the Company’s option, either (x) LIBOR or (y) a base rate determined by reference to the highest of (i) the lender defined prime rate, (ii) the federal funds rate effective plus one half of one percent and (iii) LIBOR described in subclause (x) plus 1.0% . LIBOR based loans are subject to an interest rate floor of 1.5% and base rate loans are subject to a floor of 2.5% . The Term Loan Facility matures on the earliest of (i) December 4, 2017 and (ii) 90 -days prior to the maturity of the Skilled Real Estate Bridge Loan, including extensions. As of March 31, 2016, the Term Loan Facility had an outstanding principal balance of $225.4 million. Base rate borrowings under the Term Loan Facility bore interest of approximately 11.0% at March 31, 2016 . One-month LIBOR borrowings under the Term Loan Facility bore interest of approximately 10.0% at March 31, 2016 . Principal payments for the three months ended March 31, 2016 were $3.0 million. The Term Loan Facility amortizes at a rate of 5% per annum. The lenders have the right to elect ratable principal payments or defer principal recoupment until the end of the term. In connection with the sale of the Company’s hospice and home health business effective May 1, 2016, the Company used the $72 million in cash proceeds to pay down partially the Company’s Term Loan Facility. See Note 3 – “Significant Transactions and Events – Sale of Hospice and Home Health.” Real Estate Bridge Loans In connection with the Combination on February 2, 2015, the Company entered into a $360.0 million real estate bridge loan (the Skilled Real Estate Bridge Loan), which is secured by a mortgage lien on the real property of 67 facilities and a second lien on certain receivables of the operators of such facilities. The Skilled Real Estate Bridge Loan is subject to a 24 -month term with two extension options of 90 -days each and accrues interest at a rate equal to LIBOR, plus 6.75% , plus an additional margin that ranges up to 7.00% based on the aggregate number of days the Skilled Real Estate Bridge Loan is outstanding. The interest rate is also subject to a LIBOR interest rate floor of 0.5% . The Skilled Real Estate Bridge Loan bore interest of 10.75% at March 31, 2016 . The Skilled Real Estate Bridge Loan is subject to payments of interest only during the term with a balloon payment due at maturity, provided, that to the extent the subsidiaries receive any net proceeds from the sale and / or refinance of the underlying facilities such net proceeds are required to be used to repay the outstanding principal balance of the Skilled Real Estate Bridge Loan. The proceeds of the Skilled Real Estate Bridge Loan were used to repay Skilled’s first lien senior secured term loan, repay Skilled’s mortgage loans and asset based revolving credit facility with MidCap Financial with excess proceeds used to fund direct costs of the Combination with the Company. The Skilled Real Estate Bridge Loan has an outstanding principal balance of $238.0 million at March 31, 2016 . In connection with the acquisition of 19 skilled nursing facilities on December 1, 2015 from Revera Assisted Living, Inc. (Revera), the Company entered into a $134.1 million real estate bridge loan (the Revera Real Estate Bridge Loan and, together with the Skilled Real Estate Bridge Loan, the Real Estate Bridge Loans), which is secured by a mortgage lien on the real property of 15 facilities and a second lien on certain receivables of the operators of such facilities. The Revera Real Estate Bridge Loan is subject to a 24 -month term with two extension options of 90 -days each and accrues interest at a rate equal to LIBOR, plus 6.75% , plus an additional margin that ranges up to 7.00% based on the aggregate number of days the Revera Real Estate Bridge Loan is outstanding, plus 0.25% multiplied by the result of dividing the number of percentage points by which the loan-to-value ratio, defined as the ratio, expressed as a percentage, of (i) the outstanding principal balance to (ii) the total appraised value of the facilities as of the closing date, exceeds 75% by five . The interest rate is also subject to a LIBOR interest rate floor of 0.5% . The Revera Real Estate Bridge Loan bore interest of 8.00% at March 31, 2016 . The Revera Real Estate Bridge Loan is subject to payments of interest only during the term with a balloon payment due at maturity, provided, that to the extent the subsidiaries receive any net proceeds from the sale and / or refinance of the underlying facilities such net proceeds are required to be used to repay the outstanding principal balance of the Revera Real Estate Bridge Loan. The proceeds of the Revera Real Estate Bridge Loan were used to finance the acquisition of 15 Revera facilities. The Revera Real Estate Bridge Loan has an outstanding principal balance of $134.1 million at March 31, 2016 . HUD Insured Loans As of March 31, 2016 , t he Company has 21 skilled nursing facility loans insured by the U.S. Department of Housing and Urban Development (HUD). The HUD insured loans have an original amortization term of 30 to 35 years. As of March 31, 2016, the Company has HUD insured loans with a combined aggregate principal balance of $175.0 million, including a $14.4 million debt premium on 10 skilled nursing facility loans established in purchase accounting in connection with the Combination. These loans have an average remaining term of 32 years with fixed interest rates ranging from 3.4% to 4.6% and a weighted average interest rate of 3.9% . Depending on the mortgage agreement, prepayments are generally allowed only after 12 months from the inception of the mortgage. Prepayments are subject to a penalty of 10% of the remaining principal balances in the first year and the prepayment penalty decreases each subsequent year by 1% until no penalty is required. Any further HUD insured loans will require additional HUD approval. All HUD insured loans are non-recourse loans to the Company. All loans are subject to HUD regulatory agreements that require escrow reserve funds to be deposited with the loan servicer for mortgage insurance premiums, property taxes, insurance and for capital replacement expenditures. As of March 31, 2016 , the Company has total escrow reserve funds of $9.8 million with the loan servicer that are reported within prepaid expenses. Other Debt Mortgages and other secured debt (recourse). The Company carries mortgage loans and notes payable on certain of its corporate office buildings and other acquired assets. The loans are secured by the underlying real property and have fixed or variable rates of interest ranging from 1.9% to 6.0% at March 31, 2016 , with maturity dates ranging from 2018 to 2020. Mortgages and other secured debt (non-recourse). Loans are carried by certain of the Company’s consolidated joint ventures. The loans consist principally of revenue bonds and secured bank loans. Loans are secured by the underlying real and personal property of individual facilities and have fixed or variable rates of interest ranging from 2.5% to 22.2% at March 31, 2016 , with maturity dates ranging from 2018 to 2034. Loans are labeled “ non-recourse” because neither the Company nor any of its wholly owned subsidiaries is obligated to perform under the respective loan agreements. Debt Covenants The Revolving Credit Facilities, the Term Loan Facility, the Skilled Real Estate Bridge Loan and the Revera Real Estate Bridge Loan (collectively, the Credit Facilities) each contain a number of restrictive covenants that, among other things, impose operating and financial restrictions on the Company and its subsidiaries. The Credit Facilities also require the Company to meet defined financial covenants, including interest coverage ratio, a maximum consolidated net leverage ratio and a minimum consolidated fixed charge coverage ratio, all as defined in the applicable agreements. The Credit Facilities also contain other customary covenants and events of default and cross default. At March 31, 2016, the Company was in compliance with its covenants. The Company’s ability to maintain compliance with its debt covenants depends in part on management’s ability to increase revenue and control costs. Due to continuing changes in the healthcare industry, as well as the uncertainty with respect to changing referral patterns, patient mix, and reimbursement rates, it is likely that future operating performance may not generate sufficient operating results to maintain compliance with its quarterly debt cov enant compliance requirements in the near term. Should the Company fail to comply with its debt covenants at a future measurement date, it would be in default under certain of its existing credit agreements. As of March 31, 2016, considering the combination of scheduled debt maturities or accelerated maturity features in other debt agreements, the Company has $581.1 million in debt obligations due in the next two years. The liquidity and financial condition of the Company will be adversely impacted in the event these obligations cannot be extended or refinanced prior to their scheduled or accelerated maturity dates. The maturity of total debt of $1,113.1 million at March 31, 2016 is as follows (in thousands): Twelve months ended March 31, 2017 $ 2018 2019 2020 2021 Thereafter Total debt maturity $

Leases and Lease Commitments

Leases and Lease Commitments	3 Months Ended
	Mar. 31, 2016
Leases and Lease Commitments
Leases and Lease Commitments	(8) Leases and Lease Commitments The Company leases certain facilities under capital and operating leases. Future minimum payments for the next five years and thereafter under such leases at March 31, 2016 are as follows (in thousands): Twelve months ended March 31, Capital Leases Operating Leases 2017 $ $ 2018 2019 2020 2021 Thereafter Total future minimum lease payments $ Less amount representing interest Capital lease obligation Less current portion Long-term capital lease obligation $ Capital Lease Obligations The capital lease obligations represent the present value of minimum lease payments under such capital lease and cease use arrangements and bear imputed interest at rates ranging from 3.5% to 12.8% at March 31, 2016 , and mature at dates ranging from 2016 to 2047. Deferred Lease Balances At March 31, 2016 and December 31, 2015 , the Company had $52.6 million and $54.7 million, respectively, of favorable leases net of accumulated amortization, included in identifiable intangible assets, and $33.9 million and $35.5 million, respectively, of unfavorable leases net of accumulated amortization included in other long-term liabilities on the consolidated balance sheet. Favorable and unfavorable lease assets and liabilities arise through the acquisition of leases in place that requires those contracts be recorded at their then fair value. The fair value of a lease is determined through a comparison of the actual rental rate with rental rates prevalent for similar assets in similar markets. A favorable lease asset to the Company represents a rental stream that is below market, and conversely an unfavorable lease is one with cost above market rates. These assets and liabilities amortize as lease expense over the remaining term of the respective leases on a straight-line basis. At March 31, 2016 and December 31, 2015 , the Company had $28.3 million and $27.3 million, respectively, of deferred straight-line rent balances included in other long-term liabilities on the consolidated balance sheet. Lease Covenants Certain lease agreements contain a number of restrictive covenants that, among other things and subject to certain exceptions, impose operating and financial restrictions on the Company and its subsidiaries. These leases also require the Company to meet defined financial covenants, including a minimum level of consolidated liquidity, a maximum consolidated net leverage ratio and a minimum consolidated fixed charge coverage. At March 31, 2016 , the Company was in compliance with its covenants under its lease arrangements. The Company’s ability to maintain compliance with its lease covenants depends in part on management’s ability to increase revenue and control costs. Due to continuing changes in the healthcare industry, as well as the uncertainty with respect to changing referral patterns, patient mix, and reimbursement rates, it is possible that future operating performance may not generate sufficient operating results to maintain compliance with its quarterly lease covenant compliance requirements. Should the Company fail to comply with its lease covenants at a future measurement date, it would be in default under certain of its existing lease agreements.

Financing Obligation

Financing Obligation	3 Months Ended
	Mar. 31, 2016
Financing Obligation
Financing Obligation	(9) Financing Obligation Future minimum payments for the next five years and thereafter under leases classified as financing obligations at March 31, 2016 are as follows (in thousands): Twelve months ended March 31, 2017 $ 2018 2019 2020 2021 Thereafter Total future minimum lease payments Less amount representing interest Financing obligations $ Less current portion Long-term financing obligations $

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2016
Income Tax Disclosure [Abstract]
Income Taxes	(10) Income Taxes The Company effectively owns 58% of FC-GEN, an entity taxed as a partnership for U.S. income tax purposes. This is the Company’s only source of taxable income. FC-GEN is subject to income taxes in several U.S. state and local jurisdictions. The income taxes assessed by these jurisdictions are included in the Company’s tax provision, but at its 58% ownership of FC-GEN. For the three months ended March 31, 2016 , the Company recorded an income tax expense of $3.1 million from continuing operations, representing an effective tax rate of (4.5)%, compared to an income tax benefit of $5.6 million from continuing operations, representing an effective tax rate of 4.6%, for the same period in 2015. The decrease in the effective tax rate is attributable to the full valuation allowance against the Company’s deferred tax assets, excluding the Company’s deferred tax asset on its Bermuda captive insurance company’s discounted unpaid loss reserve. On December 31, 2015, in assessing the requirement for, and amount of, a valuation allowance in accordance with the more likely than not standard, management determined that the Company would not realize its deferred tax assets and established a valuation allowance against the deferred tax assets. As of March 31, 2016, management has determined that the valuation allowance is still necessary. Beginning with the fourth quarter of 2014, the Company initiated rehabilitation therapy services within the People’s Republic of China. In this quarter ended March 31, 2016, the Company initiated rehabilitation therapy services within Hong Kong. At March 31, 2016, these business operations remain in their respective startup stage. Management does not anticipate these operations will generate taxable income in the near term. The operations currently do not have a material effect on the Company’s effective tax rate. Exchange Rights and Tax Receivable Agreement Following the Combination, the owners of FC-GEN will have the right to exchange their membership interests in FC-GEN for shares of Class A Common Stock of the Company or cash, at the Company’s option. As a result of such exchanges, the Company’s membership interest in FC-GEN will increase and its purchase price will be reflected in its share of the tax basis of FC-GEN’s tangible and intangible assets. Any resulting increases in tax basis are likely to increase tax depreciation and amortization deductions and, therefore, reduce the amount of income tax the Company would otherwise be required to pay in the future. Any such increase would also decrease gain (or increase loss) on future dispositions of the affected assets. There have been no exchanges for the quarters ended March 31, 2016 and 2015, respectively. Concurrent with the Combination, the Company entered into a tax receivable agreement (TRA) with the owners of FC-GEN. The agreement provides for the payment by the Company to the owners of FC-GEN of 90% of the cash savings, if any, in U.S. federal, state and local income tax that the Company actually realizes as a result of (i) the increases in tax basis attributable to the owners of FC-GEN and (ii) tax benefits related to imputed interest deemed to be paid by the Company as a result of the TRA. Under the TRA, the benefits deemed realized by the Company as a result of the increase in tax basis attributable to the owners of FC-GEN generally will be computed by comparing the actual income tax liability of the Company to the amount of such taxes that the Company would have been required to pay had there been no such increase in tax basis. Estimating the amount of payments that may be made under the TRA is by its nature imprecise, insofar as the calculation of amounts payable depends on a variety of factors. The actual increase in tax basis and deductions, as well as the amount and timing of any payments under the TRA, will vary depending upon a number of factors, including: · the timing of exchanges—for instance, the increase in any tax deductions will vary depending on the fair value of the depreciable or amortizable assets of FC-GEN and its subsidiaries at the time of each exchange, which fair value may fluctuate over time; · the price of shares of Company Class A Common Stock at the time of the exchange—the increase in any tax deductions, and the tax basis increase in other assets of FC-GEN and its subsidiaries is directly proportional to the price of shares of Company Class A Common Stock at the time of the exchange; · the amount and timing of the Company’s income—the Company is required to pay 90% of the deemed benefits as and when deemed realized. If FC-GEN does not have taxable income, the Company is generally not required (absent a change of control or circumstances requiring an early termination payment) to make payments under the TRA for that taxable year because no benefit will have been actually realized. However, any tax benefits that do not result in realized benefits in a given tax year likely will generate tax attributes that may be utilized to generate benefits in previous or future tax years. The utilization of such tax attributes will result in payments under the TRA; and · future tax rates of jurisdictions in which the Company has tax liability. The TRA also provides that upon certain mergers, asset sales, other forms of business combinations or other changes of control, FC-GEN (or its successor’s) obligations under the TRA would be based on certain assumptions defined in the TRA. As a result of these assumptions, FC-GEN could be required to make payments under the TRA that are greater or less than the specified percentage of the actual benefits realized by the Company that are subject to the TRA. In addition, if FC-GEN elects to terminate the TRA early, it would be required to make an early termination payment, which upfront payment may be made significantly in advance of the anticipated future tax benefits. Payments generally are due under the TRA within a specified period of time following the filing of FC-GEN’s U.S. federal and state income tax return for the taxable year with respect to which the payment obligation arises. Payments under the TRA generally will be based on the tax reporting positions that FC-GEN will determine. Although FC-GEN does not expect the Internal Revenue Service (IRS) to challenge the Company’s tax reporting positions, FC-GEN will not be reimbursed for any overpayments previously made under the TRA, but any overpayments will reduce future payments. As a result, in certain circumstances, payments could be made under the TRA in excess of the benefits that FC-GEN actually realizes in respect of the tax attributes subject to the TRA. The term of the TRA generally will continue until all applicable tax benefits have been utilized or expired, unless the Company exercises its right to terminate the TRA and make an early termination payment. In certain circumstances (such as certain changes in control, the election of the Company to exercise its right to terminate the agreement and make an early termination payment or an IRS challenge to a tax basis increase) it is possible that cash payments under the TRA may exceed actual cash savings.

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2016
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	(11) Commitments and Contingencies Loss Reserves For Certain Self-Insured Programs General and Professional Liability and Workers’ Compensation The Company self-insures for certain insurable risks, including general and professional liabilities and workers’ compensation liabilities through the use of self-insurance or retrospective and self-funded insurance policies and other hybrid policies, which vary among states in which the Company operates, including wholly owned captive insurance subsidiaries, to provide for potential liabilities for general and professional liability claims and workers’ compensation claims. Policies are typically written for a duration of twelve months and are measured on a “claims made” basis. Regarding workers’ compensation, the Company self-insures to its deductible and purchases statutorily required insurance coverage in excess of its deductible. There is a risk that amounts funded by the Company’s self-insurance programs may not be sufficient to respond to all claims asserted under those programs. Insurance reserves represent estimates of future claims payments. This liability includes an estimate of the development of reported losses and losses incurred but not reported. Provisions for changes in insurance reserves are made in the period of the related coverage. The Company also considers amounts that may be recovered from excess insurance carriers in estimating the ultimate net liability for such risks. The Company’s management employs its judgment and periodic independent actuarial analysis in determining the adequacy of certain self-insured workers’ compensation and general and professional liability obligations recorded as liabilities in the Company’s financial statements. The Company evaluates the adequacy of its self-insurance reserves on a semi-annual basis or more often when it is aware of changes to its incurred loss patterns that could impact the accuracy of those reserves. The methods of making such estimates and establishing the resulting reserves are reviewed periodically and are based on historical paid claims information and nationwide nursing home trends. The foundation for most of these methods is the Company’s actual historical reported and/or paid loss data. Any adjustments resulting therefrom are reflected in current earnings. Claims are paid over varying periods, and future payments may be different than the estimated reserves. The Company utilizes third-party administrators (TPAs) to process claims and to provide it with the data utilized in its assessments of reserve adequacy. The TPAs are under the oversight of the Company’s in-house risk management and legal functions. These functions ensure that the claims are properly administered so that the historical data is reliable for estimation purposes. Case reserves, which are approved by the Company’s legal and risk management departments, are determined based on an estimate of the ultimate settlement and/or ultimate loss exposure of individual claims. The reserves for loss for workers’ compensation risks are discounted based on actuarial estimates of claim payment patterns using a discount rate of approximately 1% for each policy period presented. The discount rate for the current policy year is 0.97% . The discount rates are based upon the risk-free rate for the appropriate duration for the respective policy year. The removal of discounting would have resulted in an increased reserve for workers’ compensation risks of $8.8 million and $8.6 million as of March 31, 2016 and December 31, 2015 , respectively. The reserves for general and professional liability are recorded on an undiscounted basis. For the three months ended March 31, 2016 and 2015 , the provision for general and professional liability risk totaled $34.9 million and $26.2 million, respectively. The reserves for general and professional liability were $381.7 million and $371.6 million as of March 31, 2016 and December 31, 2015 , respectively. For the three months ended March 31, 2016 and 2015 , the provision for workers’ compensation risk totaled $18.1 million and $18.0 million, respectively. The reserves for workers’ compensation risks were $228.9 million and $223.7 million as of March 31, 2016 and December 31, 2015 , respectively. Health Insurance The Company offers employees an option to participate in self-insured health plans. Health insurance claims are paid as they are submitted to the plans’ administrators. The Company maintains an accrual for claims that have been incurred but not yet reported to the plans’ administrators and therefore have not yet been paid. The liability for the self-insured health plan is recorded in accrued compensation in the consolidated balance sheets. Although management believes that the amounts provided in the Company’s consolidated financial statements are adequate and reasonable, there can be no assurances that the ultimate liability for such self-insured risks will not exceed management’s estimates. Legal Proceedings The Company and certain of its subsidiaries are involved in various litigation and regulatory investigations arising in the ordinary course of business. While there can be no assurance, based on the Company’s evaluation of information currently available, with the exception of the specific matters noted below, management does not believe the results of such litigation and regulatory investigations would have a material adverse effect on the results of operations, financial position or cash flows of the Company. However, the Company’s assessment of materiality may be affected by limited information (particularly in the early stages of government investigations). Accordingly, the Company’s assessment of materiality may change in the future based upon availability of discovery and further developments in the proceedings at issue. The results of legal proceedings are inherently uncertain, and material adverse outcomes are possible. From time to time the Company may enter into confidential discussions regarding the potential settlement of pending investigations or litigation. There are a variety of factors that influence the Company’s decisions to settle and the amount it may choose to pay, including the strength of the Company’s case, developments in the investigation or litigation, the behavior of other interested parties, the demand on management time and the possible distraction of the Company’s employees associated with the case and/or the possibility that the Company may be subject to an injunction or other equitable remedy. The settlement of any pending investigation, litigation or other proceedings could require the Company to make substantial settlement payments and result in its incurring substantial costs. Creekside Hospice Litigation On August 2, 2013, the United States Attorney for the District of Nevada and the Civil Division of the U.S. Department of Justice (the DOJ) informed the Company that its Civil Division was investigating Skilled, as well as its subsidiary, Creekside Hospice II, LLC, for possible violations of federal and state healthcare fraud and abuse laws and regulations (the Creekside Hospice Litigation). Those laws could have included the federal False Claims Act (FCA) and the Nevada False Claims Act (NFCA). The FCA provides for civil and administrative fines and penalties, plus treble damages. The NFCA provides for similar fines and penalties, including treble damages. Violations of those federal or state laws could also subject the Company and/or its subsidiaries to exclusion from participation in the Medicare and Medicaid programs. Any damages, fines, penalties, other sanctions and costs that the Company may incur as a result of any federal or state suit could be significant and could have a material and adverse effect on its results of operations and financial condition. On or about August 6, 2014, in relation to the investigation the DOJ filed a notice of intervention in two pending qui tam proceedings filed by private party relators under the FCA and the NFCA and advised that it intends to take over the actions. The DOJ filed its complaint in intervention on November 25, 2014, against Creekside, Skilled Healthcare Group, Inc., and Skilled Healthcare, LLC, asserting, among other things, that certain claims for hospice services provided by Creekside in the time period 2010 to 2013 did not meet Medicare requirements for reimbursement and are in violation of the civil False Claims Act. The DOJ is pursuing False Claims Act and federal common law claims remedies in an unspecified amount, with a request to treble provable damages and impose penalties per proved false claim in the amount ranging from $5,500 to $11,000 per claim, as applicable. The Company has had discussions with the DOJ regarding this matter and the Therapy Matters Investigation (defined below), the Staffing Matters Investigation (defined below) and the SunDance Part B Therapy Matter (defined below). While the Company denies the allegations and will vigorously defend this action, including any portion of the action that the private party relators may continue to pursue, the Company has accrued a combined $39.1 million as a contingent liability in connection with those four matters. However, it could ultimately cost more than that amount to settle or otherwise resolve the matter(s), including to satisfy any judgment that might be rendered against the Company or Creekside Hospice if the litigation defense were ultimately unsuccessful. Therapy Matters Investigation In February 2015, representatives of the DOJ informed the Company that they are investigating and may pursue legal action against the Company and certain of its subsidiaries including Hallmark Rehabilitation GP, LLC for alleged violations of the federal and state healthcare fraud and abuse laws and regulations related to the provision of therapy services at certain Skilled facilities from 2005 through 2013 (the Therapy Matters Investigation). These laws could include the FCA and similar state laws. As noted above, the FCA provides for civil and administrative fines and penalties, including civil fines ranging from $5,500 to $11,000 per claim plus treble damages. Applicable state laws provide for similar penalties. Violations of these federal or state laws could also subject the Company and/or its subsidiaries to exclusion from participation in the Medicare and Medicaid programs. Any damages, fines, penalties, other sanctions and costs that the Company may incur as a result of any federal and/or state suit could be significant and could have a material and adverse effect on its results of operations and financial condition. As noted above, the Company has had discussions with the DOJ regarding this matter, the Creekside Hospice Litigation, the Staffing Matters Investigation and the SunDance Part B Therapy Matter. The Company has accrued a combined $39.1 million as a contingent liability in connection with those four matters. However, it could ultimately cost more than that amount to settle or otherwise resolve the matter(s), including to satisfy any judgment that might be rendered against the Company if legal proceedings are commenced. At this time, the Company cannot predict what additional effect, if any, the investigation or any potential claims arising under applicable federal or state laws and regulations could have on the Company. While the Company will continue to cooperate with the government’s investigation of the matter, the Company intends to vigorously defend against any legal action that may be brought in the matter. Staffing Matters Investigation On February 10, 2015, the DOJ informed the Company that it intends to pursue legal action against the Company and certain of its subsidiaries related to staffing and certain quality of care allegations related to the issues adjudicated against the Company and those subsidiaries in a previously disclosed class action lawsuit that Skilled settled in 2010 (the Staffing Matters Investigation). The laws under which the DOJ could seek to pursue legal action could include the FCA and similar state laws. As noted above, violations of the FCA or similar state laws and regulations could subject the Company and/or its subsidiaries to severe monetary and other penalties and remedies. Any damages, fines, penalties, other sanctions and costs that the Company may incur as a result of any federal or state suit could be significant and could have a material and adverse effect on its results of operations and financial condition. As noted above, the Company has had discussions with the DOJ regarding this matter, the Creekside Hospice Litigation, the Therapy Matters Investigation, and the SunDance Part B Therapy Matter. The Company has accrued a combined $39.1 million as a contingent liability in connection with those four matters. However, it could ultimately cost more than that amount to settle or otherwise resolve the matter(s), including to satisfy any judgment that might be rendered against the Company if legal proceedings are commenced. At this time, the Company cannot predict what additional effect, if any, the investigation or any potential claims arising under applicable federal or state laws and regulations could have on the Company. While the Company will continue to cooperate with the government's evaluation of the matter, the Company intends to vigorously defend against any legal action that may be brought in the matter. SunDance Part B Therapy Matter SunDance Rehabilitation Corp. (SunDance) operates an outpatient agency licensed to provide Medicare Part B therapy services at assisted/senior living facilities in Georgia and is a party to a qui tam proceeding that was filed by a private party relator under the FCA. No SunDance agencies outside of Georgia are part of the qui tam proceeding. The Civil Division of the United States Attorney's Office for the District of Georgia has recently filed a notice of intervention in this matter. It is believed that when filed, the complaint in intervention may assert, among other things, that certain claims for therapy services provided by SunDance to certain Georgia facilities from the time period 2008 to 2012 did not meet Medicare requirements for reimbursement and are in violation of the FCA. As noted above, the Company has had discussions with the DOJ regarding this matter, the Creekside Hospice Litigation, the Therapy Matters Investigation, and the Staffing Matters Investigation. While the Company denies the allegations and will vigorously defend this action, including any portion of the action that the private party relators may continue to pursue, the Company has accrued a combined $39.l million as a contingent liability in connection with those four matters. However, it could ultimately cost more than that amount to settle or otherwise resolve the matter(s), including to satisfy any judgment that might be rendered against the Company or SunDance if the litigation defense were ultimately unsuccessful.

Fair Value of Financial Instrum

Fair Value of Financial Instruments	3 Months Ended
	Mar. 31, 2016
Fair Value of Financial Instruments
Fair Value Measurements	(12) Fair Value of Financial Instruments The Company’s financial instruments consist primarily of cash and equivalents, restricted cash, trade accounts receivable, investments in marketable securities, accounts payable, short and long-term debt and derivative financial instruments. The Company’s financial instruments, other than its trade accounts receivable and accounts payable, are spread across a number of large financial institutions whose credit ratings the Company monitors and believes do not currently carry a material risk of non-performance. Certain of the Company’s financial instruments, including its interest rate cap arrangements, contain an off-balance-sheet risk. Recurring Fair Value Measures Fair value is defined as an exit price (i.e., the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date). The fair value hierarchy prioritizes the inputs to valuation techniques used to measure fair value into three broad levels as shown below. An instrument’s classification within the fair value hierarchy is determined based on the lowest level input that is significant to the fair value measurement. Level 1 — Quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 — Inputs that are observable for the asset or liability, either directly or indirectly through market corroboration, for substantially the full term of the asset or liability. Level 3 — Inputs that are unobservable for the asset or liability based on the Company’s own assumptions (about the assumptions market participants would use in pricing the asset or liability). The tables below presents the Company’s assets and liabilities measured at fair value on a recurring basis as of March 31, 2016 and December 31, 2015 , aggregated by the level in the fair value hierarchy within which those measurements fall (in thousands): Fair Value Measurements at Reporting Date Using Quoted Prices in Significant Active Markets for Significant Other Unobservable March 31, Identical Assets Observable Inputs Inputs Assets: 2016 (Level 1) (Level 2) (Level 3) Cash and cash equivalents $ $ $ — $ — Restricted cash and equivalents — — Restricted investments in marketable securities — — Total $ $ $ — $ — Fair Value Measurements at Reporting Date Using Quoted Prices in Significant Active Markets for Significant Other Unobservable December 31, Identical Assets Observable Inputs Inputs Assets: 2015 (Level 1) (Level 2) (Level 3) Cash and cash equivalents $ $ $ — $ — Restricted cash and equivalents — — Restricted investments in marketable securities — — Total $ $ $ — $ — The Company places its cash and equivalents and restricted investments in marketable securities in quality financial instruments and limits the amount invested in any one institution or in any one type of instrument. The Company has not experienced any significant losses on such investments. Debt Instruments The table below shows the carrying amounts and estimated fair values of the Company’s primary long-term debt instruments: March 31, 2016 December 31, 2015 Carrying Value Fair Value Carrying Value Fair Value Revolving credit facilities $ $ $ $ Term loan facility Real estate bridge loans HUD insured loans Mortgages and other secured debt (recourse) Mortgages and other secured debt (non-recourse) $ $ $ $ The fair value of debt is based upon market prices or is computed using discounted cash flow analysis, based on the Company’s estimated borrowing rate at the end of each fiscal period presented. The Company believes that the inputs to the pricing models qualify as Level 2 measurements. Non-Recurring Fair Value Measures The Company recently applied the fair value measurement principles to certain of its non-recurring nonfinancial assets in connection with an impairment test . The following table presents the Company’s hierarchy for nonfinancial assets measured at fair value on a non-recurring basis (in thousands): Impairment Charges - Carrying Value Three months ended March 31, 2016 March 31, 2016 Assets: Property and equipment, net $ $ — Goodwill — Intangible assets — Impairment Charges - Carrying Value Three months ended December 31, 2015 March 31, 2015 Assets: Property and equipment, net $ $ — Goodwill — Intangible assets — The fair value of tangible and intangible assets is determined using a discounted cash flow approach, which is a significant unobservable input (Level 3). The Company estimates the fair value using the income approach (which is a discounted cash flow technique). These valuation methods required management to make various assumptions, including, but not limited to, future profitability, cash flows and discount rates. The Company’s estimates are based upon historical trends, management’s knowledge and experience and overall economic factors, including projections of future earnings potential. Developing discounted future cash flows in applying the income approach requires the Company to evaluate its intermediate to longer-term strategies, including, but not limited to, estimates of revenue growth, operating margins, capital requirements, inflation and working capital management. The development of appropriate rates to discount the estimated future cash flows requires the selection of risk premiums, which can materially impact the present value of future cash flows. The Company estimated the fair value of acquired tangible and intangible assets using discounted cash flow techniques that included an estimate of future cash flows, consistent with overall cash flow projections used to determine the purchase price paid to acquire the business, discounted at a rate of return that reflects the relative risk of the cash flows. The Company believes the estimates and assumptions used in the valuation methods are reasonable.

General Information (Policies)

General Information (Policies)	3 Months Ended
	Mar. 31, 2016
General Information
Description of Business	Description of Business Genesis Healthcare, Inc. is a healthcare services company that through its subsidiaries (collectively, the Company) owns and operates skilled nursing facilities, assisted/senior living facilities and a rehabilitation therapy business. The Company has an administrative services company that provides a full complement of administrative and consultative services that allows its affiliated operators and third-party operators with whom the Company contracts to better focus on delivery of healthcare services. The Company provides inpatient services through 512 skilled nursing, assisted/senior living and behavioral health centers located in 34 states. Revenues of the Company’s owned, leased and otherwise consolidated centers constitute approximately 84% of its revenues. The Company provides a range of rehabilitation therapy services, including speech pathology, physical therapy, occupational therapy and respiratory therapy. These services are provided by rehabilitation therapists and assistants employed or contracted at substantially all of the centers operated by the Company, as well as by contract to healthcare facilities operated by others. After the elimination of intercompany revenues, the rehabilitation therapy services business constitutes approximately 12% of the Company’s revenues. The Company provides an array of other specialty medical services, including management services, physician services, staffing services, hospice and home health services, and other healthcare related services, which comprise the balance of the Company’s revenues.
Basis of Presentation	Basis of Presentation The accompanying consolidated financial statements have been prepared in accordance with U.S. generally accepted accounting principles (U.S. GAAP). In the opinion of management, the consolidated financial statements include all necessary adjustments for a fair presentation of the financial position and results of operations for the periods presented. The consolidated financial statements of the Company include the accounts of the Company and its wholly-owned subsidiaries. All significant intercompany transactions have been eliminated in consolidation. The Company presents noncontrolling interests within the stockholders’ deficit section of its consolidated balance sheets. The Company presents the amount of net loss attributable to Genesis Healthcare, Inc. and net loss (income) attributable to noncontrolling interests in its consolidated statements of operations. The consolidated financial statements include the accounts of all entities controlled by the Company through its ownership of a majority voting interest and the accounts of any variable interest entities (VIEs) where the Company is subject to a majority of the risk of loss from the VIE's activities, or entitled to receive a majority of the entity's residual returns, or both. The Company assesses the requirements related to the consolidation of VIEs, including a qualitative assessment of power and economics that considers which entity has the power to direct the activities that “most significantly impact” the VIE's economic performance and has the obligation to absorb losses of, or the right to receive benefits that could be potentially significant to, the VIE. The Company's composition of variable interest entities was not material at March 31, 2016. The accompanying unaudited consolidated financial statements have been prepared in accordance with the instructions for Form 10-Q of Regulation S-X and do not include all of the disclosures normally required by U.S. GAAP or those normally required in annual reports on Form 10-K. Accordingly, these financial statements should be read in conjunction with the audited consolidated financial statements of the Company for the year ended December 31, 2015 filed with the U.S. Securities and Exchange Commission (the SEC) on Form 10-K on March 14, 2016. Certain prior year amounts have been reclassified to conform to current period presentation, the effect of which was not material. Upon adoption of new accounting guidance, debt issuance costs have been presented as a direct deduction from long-term debt rather than as an other long-term asset in all periods presented. The Company’s financial position at March 31, 2016 includes the impact of certain significant transactions and events, as disclosed within Note 3 – “ Significant Transactions and Events .”
Recent Accounting Pronouncements	Recent Accounting Pronouncements In May 2014, the Financial Accounting Standards Board (the FASB) issued ASU No. 2014-09, Revenue from Contracts with Customers , (ASU 2014-09) which changes the requirements for recognizing revenue when entities enter into contracts with customers. Under ASU 2014-09, an entity will recognize revenue when it transfers promised goods or services to customers in an amount that reflects what it expects in exchange for the goods or services. It also requires more detailed disclosures to enable users of financial statements to understand the nature, amount, timing, and uncertainty of revenue and cash flows arising from contracts with customers. The adoption of ASU 2014-09 is effective for annual and interim periods beginning after December 15, 2017 and early adoption is not permitted. The Company is still evaluating the effect, if any, ASU 2014-09 will have on the Company’s consolidated financial condition and results of operations. In August 2014, the FASB issued ASU No. 2014-15, Presentation of Financial Statements – Going Concern, (ASU 2014-15) requiring management to evaluate whether there are conditions and events that raise substantial doubt about the entity’s ability to continue as a going concern and to provide disclosures in certain circumstances. ASU 2014-15 is effective for annual and interim periods ending after December 31, 2016. The Company is still evaluating the effect, if any, ASU 2014-15 will have on its consolidated financial condition and results of operations. In January 2016, the FASB issued ASU No. 2016-01, Financial Instruments – Overall (Subtopic 825-10): Recognition and Measurement of Financial Assets and Financial Liabilities, (ASU 2016-01), which is intended to improve the recognition and measurement of financial instruments. The new guidance is effective for annual and interim periods beginning after December 15, 2017, with early adoption permitted under certain circumstances. The Company is still evaluating the effect, if any, ASU 2016-01 will have on its consolidated financial condition and results of operations. In February 2016, the FASB issued amended authoritative guidance on accounting for leases. The new provisions require that a lessee of operating leases recognize a liability to make lease payments (the lease liability) and a right-of-use asset representing its right to use the underlying asset for the lease term. The lease liability will be equal to the present value of lease payments, with the right-of-use asset based upon the lease liability. The classification criteria for distinguishing between finance (or capital) leases and operating leases are substantially similar to the previous lease guidance, but with no explicit bright lines. As such, operating leases will result in straight-line rent expense similar to current practice. For short term leases (term of 12 months or less), a lessee is permitted to make an accounting election not to recognize lease assets and lease liabilities, which would generally result in lease expense being recognized on a straight-line basis over the lease term. The guidance is effective for annual and interim periods beginning after December 15, 2018, and will require application of the new guidance at the beginning of the earliest comparable period presented. Early adoption is permitted. The new standard must be adopted using a modified retrospective transition. The adoption of this standard is expected to have a material impact on the Company’s financial position. The Company is still evaluating the impact on its results of operations and does not expect the adoption of this standard to have an impact on liquidity. In March 2016, the FASB issued ASU No. 2016-09, Compensation - Stock Compensation (Topic 718): Improvements to Employee Share-Based Payment Accounting, (ASU 2016-09), which is intended to improve the accounting for employee share-based payments and affect all organizations that issue share-based payment awards to their employees. Several aspects of the accounting for share-based payment award transactions are simplified, including: (a) income tax consequences; (b) classification of awards as either equity or liabilities; and (c) classification on the statement of cash flows. The new guidance is effective for annual and interim periods beginning after December 15, 2016, with early adoption permitted. The Company is still evaluating the effect, if any, ASU 2016-09 will have on its consolidated financial condition and results of operations.

Certain Significant Risks and20

Certain Significant Risks and Uncertainties (Tables)	3 Months Ended
	Mar. 31, 2016
Certain Significant Risks and Uncertainties
Schedule of Revenue by Source	Three months ended March 31, 2016 2015 Medicare % % Medicaid % % Insurance % % Private and other % % Total % %

Significant Transactions and 21

Significant Transactions and Events (Tables)	3 Months Ended
	Mar. 31, 2016
Significant Transactions and Events
Unaudited Pro Forma Net Effect of the Combination (in thousands, except per share amounts)	Pro forma three months ended March 31, 2015 Revenues $ Loss attributable to Genesis Healthcare, Inc. Loss per common share: Basic $ Diluted $

Earnings (Loss) Per Share (Tabl

Earnings (Loss) Per Share (Tables)	3 Months Ended
	Mar. 31, 2016
Earnings (Loss) Per Share
Reconciliation of the Numerator and Denominator Used in the Calculation of Net Income per Share (in thousands, except per share data)	Three months ended March 31, 2016 2015 Numerator: Loss from continuing operations $ $ Less: Net loss attributable to noncontrolling interests Loss from continuing operations attributable to Genesis Healthcare, Inc. $ $ (Loss) income from discontinued operations, net of taxes Net loss attributable to Genesis Healthcare, Inc. $ $ Denominator: Weighted average shares outstanding for basic and diluted net loss per share Basic and diluted net loss per common share: Loss from continuing operations attributable to Genesis Healthcare, Inc. $ $ (Loss) income from discontinued operations, net of taxes Net loss attributable to Genesis Healthcare, Inc. $ $
Schedule of Anti-dilutive Securities (in thousands)	Three months ended March 31, 2016 2015 Net loss Net loss attributable to attributable to Genesis Antidilutive Genesis Antidilutive Healthcare, Inc. shares Healthcare, Inc. shares Exchange of restricted stock units of noncontrolling interests $ $ Employee and director unvested restricted stock units — — —

Segment Information (Tables)

Segment Information (Tables)	3 Months Ended
	Mar. 31, 2016
Segment Information
Summary of Segmented Revenues	Three months ended March 31, 2016 2015 Increase / (Decrease) Revenue Revenue Revenue Revenue Dollars Percentage Dollars Percentage Dollars Percentage (in thousands, except percentages) Revenues: Inpatient services: Skilled nursing facilities $ % $ % $ % Assisted/Senior living facilities % % % Administration of third party facilities % % % Elimination of administrative services — % — % % Inpatient services, net % % % Rehabilitation therapy services: Total therapy services % % % Elimination intersegment rehabilitation therapy services % % % Third party rehabilitation therapy services % % % Other services: Total other services % % % Elimination intersegment other services % % % Third party other services % % % Net revenues $ % $ % $ %
Summaries of Condensed Consolidated Statements of Operations, Total Assets and Goodwill	Three months ended March 31, 2016 Rehabilitation Inpatient Therapy Other Services Services Services Corporate Eliminations Consolidated (In thousands) Net revenues $ $ $ $ $ $ Salaries, wages and benefits — — Other operating expenses — General and administrative costs — — — — Provision for losses on accounts receivable — Lease expense — Depreciation and amortization expense — Interest expense — Investment income — — — Other loss — — — — Transaction costs — — — — Skilled Healthcare and other loss contingency expense — — — — Equity in net (income) loss of unconsolidated affiliates — — (Loss) income before income tax expense Income tax (benefit) expense — — — (Loss) income from continuing operations $ $ $ $ $ $ Three months ended March 31, 2015 Rehabilitation Inpatient Therapy Other Services Services Services Corporate Eliminations Consolidated (In thousands) Net revenues $ $ $ $ $ $ Salaries, wages and benefits — — Other operating expenses — General and administrative costs — — — — Provision for losses on accounts receivable — Lease expense — Depreciation and amortization expense — Interest expense Loss on extinguishment of debt — — — — Investment income — — Other income — — — — Transaction costs — — — Equity in net (income) loss of unconsolidated affiliates — — (Loss) income before income tax benefit Income tax benefit — — — — (Loss) income from continuing operations $ $ $ $ $ $ The following table presents the segment assets as of March 31, 2016 compared to December 31, 2015 (in thousands): March 31, 2016 December 31, 2015 Inpatient services $ $ Rehabilitation services Other services Corporate and eliminations Total assets $ $ The following table presents segment goodwill as of March 31, 2016 compared to December 31, 2015 (in thousands): March 31, 2016 December 31, 2015 Inpatient services $ $ Rehabilitation services Other services Total goodwill $ $

Property and Equipment (Tables)

Property and Equipment (Tables)	3 Months Ended
	Mar. 31, 2016
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment (in thousands)	March 31, 2016 December 31, 2015 Land, buildings and improvements $ $ Capital lease land, buildings and improvements Financing obligation land, buildings and improvements Equipment, furniture and fixtures Construction in progress Gross property and equipment Less: accumulated depreciation Net property and equipment $ $

Long-term Debt (Tables)

Long-term Debt (Tables)	3 Months Ended
	Mar. 31, 2016
Long-Term Debt Abstract
Schedule of Long-term Debt (in thousands)	March 31, December 31, 2016 2015 Revolving credit facilities, net of debt issuance costs of $9,626 at March 31, 2016 and $10,254 at December 31, 2015 $ $ Term loan facility, net of original issue discount of $6,500 at March 31, 2016 and $7,475 at December 31, 2015, and net of debt issuance costs of $8,808 at March 31, 2016 and $10,129 at December 31, 2015 Real estate bridge loans, net of debt issuance costs of $7,628 at March 31, 2016 and $9,567 at December 31, 2015 HUD insured loans, net of debt issuance costs of $3,646 at March 31, 2016 and $1,395 at December 31, 2015 Mortgages and other secured debt (recourse) Mortgages and other secured debt (non-recourse), net of debt issuance costs of $165 at March 31, 2016 and $176 at December 31, 2015 Less: Current installments of long-term debt Long-term debt $ $
Schedule of Borrowings and Interest Rates (dollars in thousands)	Weighted Average Revolving credit facility Borrowings Interest FILO tranche $ % Tranche A-1 % Tranche A-2 % $ %
Schedule of Maturity of Total Debt (in thousands)	Twelve months ended March 31, 2017 $ 2018 2019 2020 2021 Thereafter Total debt maturity $

Leases and Lease Commitments (T

Leases and Lease Commitments (Tables)	3 Months Ended
	Mar. 31, 2016
Leases and Lease Commitments
Schedule of Future Minimum Capital and Operating Lease Payments (in thousands)	Twelve months ended March 31, Capital Leases Operating Leases 2017 $ $ 2018 2019 2020 2021 Thereafter Total future minimum lease payments $ Less amount representing interest Capital lease obligation Less current portion Long-term capital lease obligation $

Financing Obligation (Tables)

Financing Obligation (Tables)	3 Months Ended
	Mar. 31, 2016
Financing Obligation
Schedule of Future Minimum Financing Lease Payments (in thousands)	Twelve months ended March 31, 2017 $ 2018 2019 2020 2021 Thereafter Total future minimum lease payments Less amount representing interest Financing obligations $ Less current portion Long-term financing obligations $

Fair Value of Financial Instr28

Fair Value of Financial Instruments (Tables)	3 Months Ended
	Mar. 31, 2016
Fair Value of Financial Instruments
Schedule of Fair Value of Assets Measured on a Recurring Basis (in thousands)	Fair Value Measurements at Reporting Date Using Quoted Prices in Significant Active Markets for Significant Other Unobservable March 31, Identical Assets Observable Inputs Inputs Assets: 2016 (Level 1) (Level 2) (Level 3) Cash and cash equivalents $ $ $ — $ — Restricted cash and equivalents — — Restricted investments in marketable securities — — Total $ $ $ — $ — Fair Value Measurements at Reporting Date Using Quoted Prices in Significant Active Markets for Significant Other Unobservable December 31, Identical Assets Observable Inputs Inputs Assets: 2015 (Level 1) (Level 2) (Level 3) Cash and cash equivalents $ $ $ — $ — Restricted cash and equivalents — — Restricted investments in marketable securities — — Total $ $ $ — $ —
Schedule of Carrying Amounts and Estimated Fair Values of Long-term Debt Instruments	March 31, 2016 December 31, 2015 Carrying Value Fair Value Carrying Value Fair Value Revolving credit facilities $ $ $ $ Term loan facility Real estate bridge loans HUD insured loans Mortgages and other secured debt (recourse) Mortgages and other secured debt (non-recourse) $ $ $ $
Schedule of Hierarchy of Nonfinancial Assets Measured at Fair Value on a Nonrecurring Basis (in thousands)	Impairment Charges - Carrying Value Three months ended March 31, 2016 March 31, 2016 Assets: Property and equipment, net $ $ — Goodwill — Intangible assets — Impairment Charges - Carrying Value Three months ended December 31, 2015 March 31, 2015 Assets: Property and equipment, net $ $ — Goodwill — Intangible assets —

General Information (Details)

General Information (Details)	3 Months Ended
	Mar. 31, 2016statefacility
Inpatient Services
Facility Count
Number of skilled nursing and assisted living facilities | facility	512
Number of states with facilities | state	34
Inpatient Services | Revenue | Product Concentration Risk
Facility Count
Concentration risk (as a percent)	84.00%
Rehabilitation Therapy Services | Revenue | Product Concentration Risk
Facility Count
Concentration risk (as a percent)	12.00%

Certain Significant Risks and30

Certain Significant Risks and Uncertainties (Details) - Government contracts - Revenue - Inpatient Services	3 Months Ended
	Mar. 31, 2016	Mar. 31, 2015
Concentration Risk
Concentration risk (as a percent)	100.00%	100.00%
Medicare and Medicaid [Member]
Concentration Risk
Concentration risk (as a percent)	79.00%
Medicare
Concentration Risk
Concentration risk (as a percent)	26.00%	28.00%
Medicaid
Concentration Risk
Concentration risk (as a percent)	53.00%	51.00%
Insurance
Concentration Risk
Concentration risk (as a percent)	11.00%	11.00%
Private and Other
Concentration Risk
Concentration risk (as a percent)	10.00%	10.00%

Significant Transactions and 31

Significant Transactions and Events (Details) $ / shares in Units, $ in Thousands	May. 01, 2016USD ($)	Apr. 28, 2016USD ($)facility	Mar. 09, 2016USD ($)	Jan. 01, 2016USD ($)facility	Feb. 02, 2015facility	Mar. 31, 2015USD ($)	Mar. 31, 2016USD ($)facility	Mar. 31, 2015USD ($)$ / shares
Pro Forma Information
Revenues								$ 1,414,289
Loss attributable to Genesis Healthcare, Inc.								$ (16,317)
Net loss per share, Basic | $ / shares								$ (0.18)
Net loss per share, Diluted | $ / shares								$ (0.19)
Sale of facilities
Proceeds from Sale of Productive Assets							$ 76,373	$ 1,263
Partial pay down on loans							127,717	330,627
HUD Insured Loans
Proceeds from Issuance of Long-term Debt							$ 67,872	$ 360,000
HUD insured loans
HUD Insured Loans
Number of facilities pledged | facility							10
Real Estate Bridge Loan
Sale of facilities
Partial pay down on loans				$ 54,200
HUD Insured Loans
Number of facilities pledged | facility					67
Subsequent Event | HUD insured loans
HUD Insured Loans
Number of facilities pledged | facility		3
Subsequent Event | Real Estate Bridge Loan
Sale of facilities
Partial pay down on loans		$ 77,100
Assisted Senior Living Facilities | Kansas
Sale of facilities
Number of facilities sold | facility				18
Proceeds from Sale of Productive Assets				$ 67,000
Compassus
Sale of facilities
Aggregate ownership interest in counterparty indirectly held by certain board members, as a percent							10.00%
Compassus | Hospice And Home Health Operations
Sale of facilities
Proceeds from Sale of Productive Assets	$ 72,000
Sales price per agreement			$ 84,000
Short term note receivable	$ 12,000
The Combination
Pro Forma Information
Revenue of acquiree						$ 152,700
Net loss of acquiree						$ 5,300
Transaction costs in acquisition							$ 84,700
The Combination | HUD insured loans
HUD Insured Loans
Proceeds from Issuance of Long-term Debt							$ 67,900
The Combination | Subsequent Event | HUD insured loans
HUD Insured Loans
Proceeds from Issuance of Long-term Debt		$ 9,200

Earnings (Loss) Per Share (Deta

Earnings (Loss) Per Share (Details) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2016USD ($)class$ / sharesshares	Mar. 31, 2015USD ($)$ / sharesshares
Income Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Number of classes of common stock | class	3
Numerator:
Loss from continuing operations	$ (70,990)	$ (118,362)
Less: Net loss attributable to noncontrolling interests	(27,989)	(5,684)
Loss from continuing operations attributable to Genesis Healthcare, Inc.	(43,001)	(112,678)
(Loss) income from discontinued operations, net of taxes	(38)	112
Net loss attributable to Genesis Healthcare, Inc	$ (43,039)	$ (112,566)
Denominator:
Weighted-average shares outstanding for basic and diluted loss from continuing operations per share | shares	89,198	75,234
Loss from continuing operations attributable to Genesis Healthcare, Inc. | $ / shares	$ (0.48)	$ (1.50)
(Loss) income from discontinued operations, net of taxes | $ / shares	0	0
Net loss attributable to Genesis Healthcare, Inc. | $ / shares	$ (0.48)	$ (1.50)
Class C Common Stock
Income Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Voting ratio	1
Number of classes of stock that share voting ratio | class	2
Convertible noncontrolling interest (as a percent)	42.00%

Earnings (Loss) Per Share - Ant

Earnings (Loss) Per Share - Antidilutive Securities (Details) - USD ($) $ in Thousands	Oct. 26, 2015	Mar. 31, 2016	Mar. 31, 2015	Jun. 03, 2015
Restricted Stock Units (RSUs)
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive shares		(1,868,000)
Restricted Stock Units (RSUs) | Noncontrolling interests
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Net loss attributed to Genesis Healthcare, Inc.		$ (24,002)	$ (4,217)
Antidilutive shares		64,461,000	41,534,000
Class A Common Stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Incremental Class A stock attributable to conversion of noncontrolling interest		11,222
Class C Common Stock | Noncontrolling interests
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive shares		64,449,380
Convertible noncontrolling interest (as a percent)		42.00%
Restricted Stock Units (RSUs)
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Granted	653,130	0
2015 Omnibus Equity Incentive Plan | Restricted Stock Units (RSUs)
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares authorized (in shares)				4,116,870
2015 Omnibus Equity Incentive Plan | Restricted Stock Units (RSUs) | Director
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares authorized (in shares)				178,218

Segment Information - Segment R

Segment Information - Segment Reporting (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2016USD ($)segment	Mar. 31, 2015USD ($)
Segment Reporting Information
Number of Reportable Segments | segment	3
Net revenues	$ 1,472,218	$ 1,343,001
Increase (Decrease) in Net Revenue From Prior Period	$ 129,217
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	9.60%
Salaries, wages and benefits	$ 867,717	790,733
Other operating expenses	361,097	312,561
General and administrative	48,427	41,533
Provision for losses on accounts receivable	26,493	23,396
Lease expense	37,316	36,419
Depreciation and amortization expense	61,765	59,933
Interest expense	135,181	121,313
(Gain) loss on extinguishment of debt		3,234
Investment income	(481)	(416)
Other (income) loss	12	(7,611)
Amortization of Acquisition Costs	1,754	86,069
Skilled Healthcare loss contingency expense	1,626
Equity in net (income) loss of unconsolidated affiliates	(763)	(153)
(Loss) income before income tax benefit	(67,926)	(124,010)
Income tax (benefit) expense	3,064	(5,648)
(Loss) income from continuing operations	$ (70,990)	$ (118,362)
Product Concentration Risk | Sales Revenue, Net [Member]
Segment Reporting Information
Concentration Risk, Percentage	100.00%	100.00%
Inpatient Services
Segment Reporting Information
Net revenues	$ 1,242,056	$ 1,140,817
Increase (Decrease) in Net Revenue From Prior Period	$ 101,239
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	8.90%
Inpatient Services | Product Concentration Risk | Sales Revenue, Net [Member]
Segment Reporting Information
Concentration Risk, Percentage	84.30%	84.90%
Inpatient Services | Skilled Nursing Facilities
Segment Reporting Information
Net revenues	$ 1,208,433	$ 1,104,990
Increase (Decrease) in Net Revenue From Prior Period	$ 103,443
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	9.40%
Inpatient Services | Skilled Nursing Facilities | Product Concentration Risk | Sales Revenue, Net [Member]
Segment Reporting Information
Concentration Risk, Percentage	82.00%	82.30%
Inpatient Services | Assisted Senior Living Facilities
Segment Reporting Information
Net revenues	$ 30,919	$ 33,657
Increase (Decrease) in Net Revenue From Prior Period	$ (2,738)
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(8.10%)
Inpatient Services | Assisted Senior Living Facilities | Product Concentration Risk | Sales Revenue, Net [Member]
Segment Reporting Information
Concentration Risk, Percentage	2.10%	2.50%
Inpatient Services | Administration of third party facilities
Segment Reporting Information
Net revenues	$ 3,079	$ 2,671
Increase (Decrease) in Net Revenue From Prior Period	$ 408
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	15.30%
Inpatient Services | Administration of third party facilities | Product Concentration Risk | Sales Revenue, Net [Member]
Segment Reporting Information
Concentration Risk, Percentage	0.20%	0.20%
Rehabilitation Therapy Services
Segment Reporting Information
Net revenues	$ 178,680	$ 157,145
Increase (Decrease) in Net Revenue From Prior Period	$ 21,535
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	13.70%
Rehabilitation Therapy Services | Product Concentration Risk | Sales Revenue, Net [Member]
Segment Reporting Information
Concentration Risk, Percentage	12.20%	11.70%
Rehabilitation Therapy Services | Therapy Services
Segment Reporting Information
Net revenues	$ 285,112	$ 263,051
Increase (Decrease) in Net Revenue From Prior Period	$ 22,061
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	8.40%
Rehabilitation Therapy Services | Therapy Services | Product Concentration Risk | Sales Revenue, Net [Member]
Segment Reporting Information
Concentration Risk, Percentage	19.40%	19.60%
Other Services
Segment Reporting Information
Net revenues	$ 51,482	$ 45,039
Increase (Decrease) in Net Revenue From Prior Period	$ 6,443
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	14.30%
Other Services | Product Concentration Risk | Sales Revenue, Net [Member]
Segment Reporting Information
Concentration Risk, Percentage	3.50%	3.40%
Other Services | Other Services
Segment Reporting Information
Net revenues	$ 56,626	$ 52,546
Increase (Decrease) in Net Revenue From Prior Period	$ 4,080
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	7.80%
Other Services | Other Services | Product Concentration Risk | Sales Revenue, Net [Member]
Segment Reporting Information
Concentration Risk, Percentage	3.80%	3.90%
Operating Segments | Inpatient Services
Segment Reporting Information
Net revenues	$ 1,242,431	$ 1,141,318
Salaries, wages and benefits	588,902	542,692
Other operating expenses	438,699	396,542
Provision for losses on accounts receivable	23,345	19,073
Lease expense	36,296	35,528
Depreciation and amortization expense	53,839	48,225
Interest expense	108,989	103,654
Investment income	(458)	(358)
Other (income) loss	12
Amortization of Acquisition Costs		371
Equity in net (income) loss of unconsolidated affiliates	(476)	(309)
(Loss) income before income tax benefit	(6,717)	(4,100)
Income tax (benefit) expense	(2,162)
(Loss) income from continuing operations	(4,555)	(4,100)
Operating Segments | Rehabilitation Therapy Services
Segment Reporting Information
Net revenues	285,112	263,051
Salaries, wages and benefits	240,436	214,797
Other operating expenses	20,341	15,399
Provision for losses on accounts receivable	2,648	3,827
Lease expense	24	41
Depreciation and amortization expense	3,120	2,867
Interest expense	14	1
(Loss) income before income tax benefit	18,529	26,119
(Loss) income from continuing operations	18,529	26,119
Operating Segments | Other Services
Segment Reporting Information
Net revenues	56,524	52,336
Salaries, wages and benefits	38,379	33,244
Other operating expenses	14,008	14,533
Provision for losses on accounts receivable	546	541
Lease expense	530	459
Depreciation and amortization expense	314	362
Interest expense	16	10
(Loss) income before income tax benefit	2,731	3,187
(Loss) income from continuing operations	2,731	3,187
Corporate, Non-Segment
Segment Reporting Information
Net revenues	102	210
General and administrative	48,427	41,533
Provision for losses on accounts receivable	(46)	(45)
Lease expense	466	391
Depreciation and amortization expense	4,492	8,479
Interest expense	26,162	17,771
(Gain) loss on extinguishment of debt		3,234
Investment income	(23)	(181)
Other (income) loss		(7,611)
Amortization of Acquisition Costs	1,754	85,698
Skilled Healthcare loss contingency expense	1,626
Equity in net (income) loss of unconsolidated affiliates	(636)	(220)
(Loss) income before income tax benefit	(82,120)	(148,839)
Income tax (benefit) expense	5,226	(5,648)
(Loss) income from continuing operations	(87,346)	(143,191)
Elimination
Segment Reporting Information
Net revenues	(111,951)	(113,914)
Other operating expenses	(111,951)	(113,913)
Interest expense		(123)
Investment income		123
Equity in net (income) loss of unconsolidated affiliates	349	376
(Loss) income before income tax benefit	(349)	(377)
(Loss) income from continuing operations	(349)	(377)
Elimination | Inpatient Services
Segment Reporting Information
Net revenues	(375)	(501)
Increase (Decrease) in Net Revenue From Prior Period	$ 126
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(25.10%)
Elimination | Rehabilitation Therapy Services
Segment Reporting Information
Net revenues	$ (106,432)	$ (105,906)
Increase (Decrease) in Net Revenue From Prior Period	$ (526)
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	0.50%
Elimination | Rehabilitation Therapy Services | Product Concentration Risk | Sales Revenue, Net [Member]
Segment Reporting Information
Concentration Risk, Percentage	(7.20%)	(7.90%)
Elimination | Other Services
Segment Reporting Information
Net revenues	$ (5,144)	$ (7,507)
Increase (Decrease) in Net Revenue From Prior Period	$ 2,363
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(31.50%)
Elimination | Other Services | Product Concentration Risk | Sales Revenue, Net [Member]
Segment Reporting Information
Concentration Risk, Percentage	(0.30%)	(0.60%)

Segment Information - Assets by

Segment Information - Assets by Segment (Details) - USD ($) $ in Thousands	Mar. 31, 2016	Dec. 31, 2015
Segment Reporting, Asset Reconciling Item
Segment total assets	$ 6,005,750	$ 6,059,949
Goodwill included in total assets	470,735	470,019
Corporate and Eliminations
Segment Reporting, Asset Reconciling Item
Segment total assets	116,918	87,687
Inpatient Services
Segment Reporting, Asset Reconciling Item
Segment total assets	5,342,821	5,437,518
Goodwill included in total assets	357,649	357,649
Rehabilitation Therapy Services
Segment Reporting, Asset Reconciling Item
Segment total assets	452,814	442,969
Goodwill included in total assets	73,814	73,098
Other Services
Segment Reporting, Asset Reconciling Item
Segment total assets	93,197	91,775
Goodwill included in total assets	$ 39,272	$ 39,272

Property and Equipment (Details

Property and Equipment (Details) - USD ($) $ in Thousands	Mar. 31, 2016	Dec. 31, 2015
Property, Plant and Equipment [Abstract]
Land and land improvements	$ 649,581	$ 714,766
Capital lease land, buildings and improvements	905,855	903,977
Financing obligation land, buildings and improvements	2,654,835	2,644,307
Equipment, furniture and fixtures	438,366	436,300
Construction in progress	26,328	24,665
Gross property and equipment	4,674,965	4,724,015
Less accumulated depreciation	(693,086)	(638,768)
Net property and equipment	$ 3,981,879	$ 4,085,247

Long-Term Debt - Credit Facilit

Long-Term Debt - Credit Facility and Term Loans (Details) $ in Thousands	May. 01, 2016USD ($)	Apr. 28, 2016USD ($)	Jan. 01, 2016USD ($)	Feb. 02, 2015	Mar. 31, 2016USD ($)item	Mar. 31, 2015USD ($)	Dec. 31, 2015USD ($)
Debt Instrument
Total long-term debt					$ 1,113,135		$ 1,198,636
Current installments of long-term debt					(8,113)		(12,477)
Long-term debt					1,105,022		1,186,159
Revolving credit facility					$ 333,000
Weighted Average Interest Rate					4.01%
Term of debt					2 years
Partial pay down on loans					$ 127,717	$ 330,627
Revolving Credit Facility Tranche 1 [Member]
Debt Instrument
Revolving credit facility					$ 233,000
Weighted Average Interest Rate					3.94%
Revolving Credit Facility Tranche 1 [Member] | LIBOR | Minimum
Debt Instrument
Basis spread on variable rate					3.25%
Revolving Credit Facility Tranche 1 [Member] | LIBOR | Maximum
Debt Instrument
Basis spread on variable rate					2.75%
Revolving Credit Facility Tranche 2 [Member]
Debt Instrument
Revolving credit facility					$ 75,000
Weighted Average Interest Rate					3.62%
Revolving Credit Facility Tranche 2 [Member] | LIBOR | Minimum
Debt Instrument
Basis spread on variable rate					3.00%
Revolving Credit Facility Tranche 2 [Member] | LIBOR | Maximum
Debt Instrument
Basis spread on variable rate					2.50%
Revolving Credit Facility FILO Tranche [Member]
Debt Instrument
Revolving credit facility					$ 25,000
Weighted Average Interest Rate					5.87%
Revolving Credit Facility FILO Tranche [Member] | LIBOR
Debt Instrument
Basis spread on variable rate					5.00%
Term Loan Facility [Member]
Debt Instrument
Total long-term debt					$ 210,134		210,842
Original issue discount					6,500		7,475
Debt Issuance Cost					$ 8,808		10,129
Term of debt					5 years
Period prior to Skilled Real Estate Bridge Loan maturity the Term Loan Facility could mature					90 days
Outstanding principal balance under term loan facility					$ 225,400
Principal payments					$ 3,000
Debt Instrument Annual Amortization Rate (as a percent)					5.00%
Term Loan Facility [Member] | Subsequent Event
Debt Instrument
Partial pay down on loans	$ 72,000
Term Loan Facility [Member] | Base Rate
Debt Instrument
Debt Instrument Variable Interest Rate Floor					2.50%
Effective interest rate					11.00%
Term Loan Facility [Member] | LIBOR
Debt Instrument
Basis spread on variable rate					1.00%
Debt Instrument Variable Interest Rate Floor					1.50%
Effective interest rate					10.00%
Term Loan Facility [Member] | Federal Funds
Debt Instrument
Basis spread on variable rate					0.50%
Real Estate Bridge Loan
Debt Instrument
Total long-term debt					$ 364,433		484,533
Debt Issuance Cost					$ 7,628		9,567
Term of debt				24 months
Effective interest rate					10.75%
Partial pay down on loans			$ 54,200
Real Estate Bridge Loan | Subsequent Event
Debt Instrument
Partial pay down on loans		$ 77,100
Real Estate Bridge Loan | LIBOR
Debt Instrument
Basis spread on variable rate				6.75%
Debt Instrument Variable Interest Rate Floor				0.50%
HUD insured loans
Debt Instrument
Total long-term debt					$ 171,379		106,250
Debt Issuance Cost					$ 3,646		1,395
Weighted Average Interest Rate					3.90%
Mortgages and other secured debt (recourse)
Debt Instrument
Total long-term debt					$ 13,770		13,934
Mortgages and other secured debt (recourse) | Minimum
Debt Instrument
Effective interest rate					2.50%
Mortgages and other secured debt (recourse) | Maximum
Debt Instrument
Effective interest rate					22.20%
Mortgages and other secured debt (non-recourse)
Debt Instrument
Total long-term debt					$ 30,045		30,331
Debt Issuance Cost					$ 165		176
Mortgages and other secured debt (non-recourse) | Minimum
Debt Instrument
Effective interest rate					6.00%
Mortgages and other secured debt (non-recourse) | Maximum
Debt Instrument
Effective interest rate					1.90%
Revolving Credit Facilities
Debt Instrument
Total long-term debt					$ 323,374		352,746
Debt Issuance Cost					9,626		$ 10,254
Line of Credit Facility, Maximum Borrowing Capacity					550,000
Total borrowing base capacity					$ 544,100
Debt Instrument Number of Tranches | item					3
Debt instrument maturity period if not refinanced					90 days
Revolving credit facility					$ 333,000
Outstanding Letters of Credit					68,200
Available borrowing capacity under the revolving credit facilities					$ 142,900
Revolving Credit Facilities | Minimum
Debt Instrument
Commitment fee rate (as percentage)					0.375%
Revolving Credit Facilities | Maximum
Debt Instrument
Commitment fee rate (as percentage)					0.50%
Revolving Credit Facilities | Federal Funds
Debt Instrument
Basis spread on variable rate					3.00%

Long-Term Debt - Bridge HUD and

Long-Term Debt - Bridge HUD and Other (Details) $ in Millions	Dec. 01, 2015USD ($)facilityitem	Feb. 02, 2015USD ($)facilityitem	Mar. 31, 2016USD ($)facilityloan
Debt Instrument
Term of debt			2 years
Principal balance outstanding			$ 134.1
Weighted Average Interest Rate			4.01%
Real Estate Bridge Loan
Debt Instrument
Face amount of bridge loan		$ 360
Number of facilities pledged | facility		67
Term of debt		24 months
Debt instrument number of term extensions | item		2
Debt instrument term extension period (in days)		90 days
Principal balance outstanding			$ 238
Effective interest rate			10.75%
Revera Real Estate Bridge Loan [Member]
Debt Instrument
Number of facilities pledged | facility	15
Term of debt	24 months
Debt instrument number of term extensions | item	2
Debt instrument term extension period (in days)	90 days
Debt Instrument Threshold for Ratio	75.00%
Debt Instrument Additive to Threshold for Ratio	5.00%
Effective interest rate			8.00%
HUD insured loans
Debt Instrument
Number of facilities pledged | facility			10
Principal balance outstanding			$ 175
Number of debt instruments | loan			21
Debt premium			$ 14.4
Debt instrument average remaining term (in years)			32 years
Weighted Average Interest Rate			3.90%
Debt instrument period in which prepayment is not allowed (in months)			12 months
Prepayment penalty (as a percentage)			10.00%
Decrease in prepayment penalty (as a percentage)			1.00%
HUD insured loans | Prepaid Expenses and Other Current Assets [Member]
Debt Instrument
Escrow reserve funds			$ 9.8
Maximum | HUD insured loans
Debt Instrument
Debt instrument average remaining term (in years)		35 years
Fixed interest rate			4.60%
Maximum | Mortgages and other secured debt (non-recourse)
Debt Instrument
Effective interest rate			1.90%
Maximum | Mortgages and other secured debt (recourse)
Debt Instrument
Effective interest rate			22.20%
Minimum | HUD insured loans
Debt Instrument
Debt instrument average remaining term (in years)		30 years
Fixed interest rate			3.40%
Minimum | Mortgages and other secured debt (non-recourse)
Debt Instrument
Effective interest rate			6.00%
Minimum | Mortgages and other secured debt (recourse)
Debt Instrument
Effective interest rate			2.50%
LIBOR | Real Estate Bridge Loan
Debt Instrument
Basis spread on variable rate		6.75%
Debt Instrument Variable Interest Rate Floor		0.50%
LIBOR | Revera Real Estate Bridge Loan [Member]
Debt Instrument
Basis spread on variable rate	6.75%
Debt instrument additional margin based on ratio	0.25%
Debt Instrument Variable Interest Rate Floor	0.50%
LIBOR | Maximum | Real Estate Bridge Loan
Debt Instrument
Debt instrument additional margin based on days outstanding		7.00%
LIBOR | Maximum | Revera Real Estate Bridge Loan [Member]
Debt Instrument
Debt instrument additional margin based on days outstanding	7.00%
Revera Acquisition
Debt Instrument
Number of facilities acquired | facility	19
Revera Acquisition | Revera Real Estate Bridge Loan [Member]
Debt Instrument
Face amount of bridge loan	$ 134.1
Number of facilities acquired | facility	15

Long-Term Debt - Maturity (Deta

Long-Term Debt - Maturity (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2016	Dec. 31, 2015
Long-Term Debt Abstract
Debt obligations due in two years	$ 581,100
Debt Instrument, Term	2 years
Twelve months ended March 31,
2,017	$ 8,113
2,018	572,979
2,019	22,421
2,020	335,052
2,021	5,421
Thereafter	169,149
Long-term Debt, Fiscal Year Maturity [Abstract]
Total long-term debt	$ 1,113,135	$ 1,198,636

Lease and Lease Commitments - F

Lease and Lease Commitments - Future Minimum Capital and Operating Lease Payments (Details) - USD ($) $ in Thousands	Mar. 31, 2016	Dec. 31, 2015
Capital Leases, Future Minimum Payments Due, Rolling Maturity
2,017	$ 94,211
2,018	99,539
2,019	97,592
2,020	100,048
2,021	102,501
Thereafter	3,342,845
Total future minimum lease payments	3,836,736
Less amount representing interest	(2,778,005)
Capital lease obligation	1,058,731
Less current portion	(1,847)	$ (1,842)
Long-term capital lease obligation	1,056,884	$ 1,053,816
Operating Leases, Future Minimum Payments Due, Rolling Maturity
2,017	141,560
2,018	137,281
2,019	133,700
2,020	131,589
2,021	123,480
Thereafter	239,590
Total future minimum lease payments	$ 907,200

Lease and Lease Commitments - C

Lease and Lease Commitments - Capital Lease Rates and Deferred Balances (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2016	Dec. 31, 2015
Identifiable Intangible Assets [Member]
Net favorable leases	$ 52.6	$ 54.7
Other Noncurrent Liabilities [Member]
Net unfavorable leases	33.9	35.5
Deferred straight-line rent balances included in other long-term liabilities	$ 28.3	$ 27.3
Maximum
Capital lease imputed interest rate (as a percent)	12.80%
Minimum
Capital lease imputed interest rate (as a percent)	3.50%

Financing Obligation (Details)

Financing Obligation (Details) - USD ($) $ in Thousands	Mar. 31, 2016	Dec. 31, 2015
Present Value of Future Minimum Lease Payments, Sale Leaseback Transactions, Rolling Maturity
2,016	$ 277,805
2,017	285,744
2,018	293,908
2,019	302,310
2,020	310,945
Thereafter	9,841,789
Total future minimum lease payments	11,312,501
Less amount representing interest	(8,219,905)
Financing obligation	3,092,596
Less current portion	(1,230)	$ (989)
Long-term financing obligation	$ 3,091,366	$ 3,064,077

Income Taxes (Details)

Income Taxes (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2016	Mar. 31, 2015
(Expense) benefit from income taxes	$ (3,064)	$ 5,648
Effective tax rate	(4.50%)	4.60%
The Combination
Percentage of voting interests acquired	58.00%
Tax receivable agreement, potential payment as percentage of cash savings	90.00%

Commitments and Contingencies -

Commitments and Contingencies - Self Insurance Risks (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2016	Mar. 31, 2015	Dec. 31, 2015
Commitments and Contingencies Disclosure [Abstract]
Workers' compensation approximate discount rate (as a percentage)	1.00%
Workers' Compensation discount rate (as a percentage)	0.97%
Effect of discounting on reserve	$ 8.8		$ 8.6
Provision for general and professional liability	34.9	$ 26.2
Reserve for general and professional liability	381.7		371.6
Provision for workers' compensation	18.1	$ 18
Reserve for workers' compensation risks	$ 228.9		$ 223.7

Commitments and Contingencies45

Commitments and Contingencies - Litigation (Details)	Aug. 06, 2014USD ($)plaintiff	Feb. 28, 2015USD ($)	Mar. 31, 2016USD ($)claim
Creekside Hospice Investigation
Loss Contingencies
Number of Qui Tam proceedings | plaintiff	2
Loss contingency, range of possible penalty per claim, minimum	$ 5,500,000
Loss contingency, range of possible penalty per claim, maximum	$ 11,000,000
Therapy Matters Investigation [Member]
Loss Contingencies
Loss contingency, range of possible penalty per claim, minimum		$ 5,500,000
Loss contingency, range of possible penalty per claim, maximum		$ 11,000,000
Creekside Hospice Therapy Matters Investigation Staffing Matters Investigation And Sundance Part B Therapy Matter (Member) | Governmental Claims
Loss Contingencies
Number of pending proceedings | claim			4
Accrued contingent liability			$ 39,100,000

Fair Value Measurements (Detail

Fair Value Measurements (Details) - USD ($) $ in Thousands	Mar. 31, 2016	Dec. 31, 2015
Financial Liabilities Fair Value Disclosure [Abstract]
Revolving credit facility	$ 333,000
Carrying value	1,113,135	$ 1,198,636
Term Loan Facility [Member]
Financial Liabilities Fair Value Disclosure [Abstract]
Carrying value	210,134	210,842
Original issue discount	6,500	7,475
Real Estate Bridge Loan
Financial Liabilities Fair Value Disclosure [Abstract]
Carrying value	364,433	484,533
HUD insured loans
Financial Liabilities Fair Value Disclosure [Abstract]
Carrying value	171,379	106,250
Mortgages and other secured debt (recourse)
Financial Liabilities Fair Value Disclosure [Abstract]
Carrying value	13,770	13,934
Mortgages and other secured debt (non-recourse)
Financial Liabilities Fair Value Disclosure [Abstract]
Carrying value	30,045	30,331
Revolving Credit Facilities
Financial Liabilities Fair Value Disclosure [Abstract]
Revolving credit facility	333,000
Carrying value	323,374	352,746
Level 2
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	1,102,829	1,198,065
Level 2 | Term Loan Facility [Member]
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	203,370	210,271
Level 2 | Real Estate Bridge Loan
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	364,433	484,533
Level 2 | HUD insured loans
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	167,837	106,250
Level 2 | Mortgages and other secured debt (recourse)
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	13,770	13,934
Level 2 | Mortgages and other secured debt (non-recourse)
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	30,045	30,331
Level 2 | Revolving Credit Facilities
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	323,374	352,746
Fair Value, Measurements, Recurring
Assets, Fair Value Disclosure [Abstract]
Cash and equivalents	52,204	61,543
Restricted cash and equivalents	25,120	34,370
Restricted investments in marketable securities	165,731	163,757
Assets, Fair Value Disclosure, Total	243,055	259,670
Fair Value, Measurements, Recurring | Level 1
Assets, Fair Value Disclosure [Abstract]
Cash and equivalents	52,204	61,543
Restricted cash and equivalents	25,120	34,370
Restricted investments in marketable securities	165,731	163,757
Assets, Fair Value Disclosure, Total	243,055	259,670
Fair Value, Measurements, Nonrecurring [Member] | Level 3
Assets, Fair Value Disclosure [Abstract]
Property and equipment, net	3,981,879	4,085,247
Goodwill	470,735	470,019
Intangible assets	$ 203,080	$ 209,967