Genesis Healthcare (GENN) 10-K 16 Mar 20 2019 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2019	Mar. 13, 2020	Jun. 30, 2019
Document Information [Line Items]
Entity Central Index Key	0001351051
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2019
Document Transition Report	false
Entity File Number	001-33459
Entity Registrant Name	Genesis Healthcare, Inc.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	20-3934755
Entity Address, Address Line One	101 East State Street
Entity Address, City or Town	Kennett Square
Entity Address, State or Province	PA
Entity Address, Postal Zip Code	19348
City Area Code	610
Local Phone Number	444-6350
Title of 12(b) Security	Class A Common Stock, $0.001 par value per share
Trading Symbol	GEN
Security Exchange Name	NYSE
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Public Float			$ 115.6
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	FY
Amendment Flag	false
Class A Common Stock
Document Information [Line Items]
Entity Listing, Par Value Per Share	$ 0.001
Entity Common Stock, Shares Outstanding		108,163,948
Class B Common Stock
Document Information [Line Items]
Entity Listing, Par Value Per Share	0.001
Entity Common Stock, Shares Outstanding		744,396
Class C Common Stock
Document Information [Line Items]
Entity Listing, Par Value Per Share	$ 0.001
Entity Common Stock, Shares Outstanding		55,902,144

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 12,097	$ 20,865
Restricted cash and equivalents	63,101	73,762
Restricted investments in marketable securities	31,855	35,631
Accounts receivable	567,636	622,717
Prepaid expenses	108,908	82,747
Other current assets	44,079	36,528
Assets held for sale	1,171	3,375
Total current assets	828,847	875,625
Property and equipment, net of accumulated depreciation of $431,361 and $976,802 at December 31, 2019 and December 31, 2018, respectively	962,105	2,887,554
Finance lease right-of-use assets, net of accumulated amortization of $23,401 at December 31, 2019	37,097
Operating lease right-of-use assets	2,399,505
Restricted cash and equivalents	50,608	47,649
Restricted investments in marketable securities	105,087	100,522
Other long-term assets	85,725	125,595
Deferred income taxes	3,772	5,867
Identifiable intangible assets, net of accumulated amortization of $76,243 and $99,160 at December 31, 2019 and December 31, 2018, respectively	87,446	119,082
Goodwill	85,642	85,642
Assets held for sale	16,306	16,087
Total assets	4,662,140	4,263,623
Current liabilities:
Current installments of long-term debt	162,426	122,531
Current installments of finance lease obligations	2,839
Current installments of finance lease obligations under Topic 840		2,171
Current installments of operating lease obligations	140,887
Current installments of financing obligations under Topic 840		2,001
Accounts payable	238,384	234,786
Accrued expenses	226,092	227,813
Accrued compensation	153,698	172,726
Self-insurance reserves	146,476	149,545
Current portion of liabilities held for sale	368	639
Total current liabilities	1,071,170	912,212
Long-term liabilities:
Long-term debt	1,450,994	1,082,933
Finance lease obligations	39,335	967,942
Operating lease obligations	2,681,403
Financing obligations		2,732,939
Deferred income taxes	5,245	6,281
Self-insurance reserves	406,864	453,993
Liabilities held for sale	19,789	25,942
Other long-term liabilities	69,905	126,247
Commitments and contingencies
Stockholders’ deficit:
Additional paid-in-capital	248,594	270,408
Accumulated deficit	(1,010,296)	(1,609,828)
Accumulated other comprehensive income (loss)	602	(262)
Total stockholders’ deficit before noncontrolling interests	(760,935)	(1,339,520)
Noncontrolling interests	(321,630)	(705,346)
Total stockholders' deficit	(1,082,565)	(2,044,866)
Total liabilities and stockholders’ deficit	4,662,140	4,263,623
Class A Common Stock
Stockholders’ deficit:
Common stock	108	101
Class B Common Stock
Stockholders’ deficit:
Common stock	1	1
Class C Common Stock
Stockholders’ deficit:
Common stock	$ 56	$ 60

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parentheticals) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2019
Other assets:
Accumulated depreciation on property and equipment	$ 976,802	$ 431,361
Accumulated amortization on finance lease ROU asset		23,401
Accumulated amortization on intangible assets	99,160	$ 76,243
Stockholders’ deficit:
Capital Lease Obligations Incurred	$ 69,255
Class A Common Stock
Stockholders’ deficit:
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)	101,235,935	107,888,854
Common stock, shares, outstanding (in shares)	101,235,935	107,888,854
Class B Common Stock
Stockholders’ deficit:
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)	744,396	744,396
Common stock, shares, outstanding (in shares)	744,396	744,396
Class C Common Stock
Stockholders’ deficit:
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)	59,700,801	56,172,193
Common stock, shares, outstanding (in shares)	59,700,801	56,172,193

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
CONSOLIDATED STATEMENTS OF OPERATIONS (UNAUDITED)
Net revenues	$ 4,565,834	$ 4,976,650
Salaries, wages and benefits	2,485,010	2,786,908
Other operating expenses	1,374,847	1,479,880
General and administrative costs	144,471	149,182
Lease expense	387,063
Lease expense under Topic 840		129,859
Depreciation and amortization expense	123,159	220,896
Interest expense	180,392	463,738
(Gain) loss on early extinguishment of debt	(122)	391
Investment income	(7,296)	(6,832)
Other income	(173,505)	(12,920)
Transaction costs	26,362	31,953
Long-lived asset impairments	16,937	104,997
Goodwill and identifiable intangible asset impairments		3,538
Equity in net income of unconsolidated affiliates	(712)	(100)
Income (loss) before income tax expense (benefit)	9,228	(374,840)
Income tax expense (benefit)	1,754	(2,423)
Net income (loss)	7,474	(372,417)
Less net loss attributable to noncontrolling interests	7,145	137,186
Net income (loss) attributable to Genesis Healthcare, Inc.	$ 14,619	$ (235,231)
Basic:
Weighted-average shares outstanding for basic net income (loss) per share	107,286	101,007
Basic net income (loss) per common share attributable to Genesis Healthcare, Inc.	$ 0.14	$ (2.33)
Diluted:
Weighted-average shares outstanding for diluted net income (loss) per share	165,314	101,007
Diluted net income (loss) per common share attributable to Genesis Healthcare, Inc.	$ 0.10	$ (2.33)

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Income (Loss) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS)
Net income (loss)	$ 7,474	$ (372,417)
Net unrealized gain (loss) on marketable securities, net of tax	1,198	(48)
Comprehensive income (loss)	8,672	(372,465)
Less: comprehensive loss attributable to noncontrolling interests	6,811	137,334
Comprehensive income (loss) attributable to Genesis Healthcare, Inc.	$ 15,483	$ (235,131)

Consolidated Statements of Stoc

Consolidated Statements of Stockholders' Deficit - USD ($) $ in Thousands	Common StockClass A Common Stock	Common StockClass B Common Stock	Common StockClass C Common Stock	Additional Paid-In Capital	Accumulated Deficit	Accumulated Other Comprehensive (Loss) Income	Stockholders' Deficit	Noncontrolling Interests	Total
Balance, beginning of period at Dec. 31, 2017	$ 97	$ 1	$ 61	$ 290,573	$ (1,374,597)	$ (362)	$ (1,084,227)	$ (595,905)	$ (1,680,132)
Balance, beginning of period (in shares) at Dec. 31, 2017	97,101	744	61,561
Increase (decrease) in stockholders' deficit
Net loss					(235,231)		(235,231)	(137,186)	(372,417)
Net unrealized gain (loss) on marketable securities, net of tax						100	100	(148)	(48)
Share-based compensation				8,820			8,820		8,820
Issuance of common stock	$ 2			(2)
Issuance of common stock, shares	2,275
Conversion of common stock among classes	$ 2		$ (1)	(29,855)			(29,854)	29,854
Conversion of common stock among classes (in shares)	1,860		(1,860)
Distributions to noncontrolling interests				(64)			(64)	(1,961)	(2,025)
Issuance of stock warrants				936			936		936
Balance, end of period at Dec. 31, 2018	$ 101	$ 1	$ 60	270,408	(1,609,828)	(262)	(1,339,520)	(705,346)	(2,044,866)
Balance, end of period (in shares) at Dec. 31, 2018	101,236	744	59,701
Increase (decrease) in stockholders' deficit
Net loss					14,619		14,619	(7,145)	7,474
Net unrealized gain (loss) on marketable securities, net of tax						864	864	334	1,198
Share-based compensation				7,309			7,309		7,309
Issuance of common stock	$ 3			(3)
Issuance of common stock, shares	3,124
Conversion of common stock among classes	$ 4		$ (4)	(29,184)			(29,184)	29,184
Conversion of common stock among classes (in shares)	3,529		(3,529)
Distributions to noncontrolling interests				64			64	(5,817)	(5,753)
Contributions from noncontrolling interests								27,031	27,031
Cumulative effect of accounting change					584,913		584,913	340,129	925,042
Balance, end of period at Dec. 31, 2019	$ 108	$ 1	$ 56	$ 248,594	$ (1,010,296)	$ 602	$ (760,935)	$ (321,630)	$ (1,082,565)
Balance, end of period (in shares) at Dec. 31, 2019	107,889	744	56,172

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Cash flows from operating activities
Net income (loss)	$ 7,474	$ (372,417)
Adjustments to reconcile net income (loss) to net cash provided by operating activities:
Non-cash interest and leasing arrangements, net	27,311	72,193
Other non-cash gain, net	(173,505)	(12,920)
Share based compensation	7,309	8,820
Depreciation and amortization expense	123,159	220,896
Reduction in the carrying amount of operating lease right-of-use assets	117,127
(Recovery) provision for losses on accounts receivable	(4,469)	2,554
Equity in net income of unconsolidated affiliates	(712)	(100)
Benefit for deferred taxes	(179)	(3,475)
Long-lived asset impairments	16,937	104,997
Goodwill and identifiable intangible asset impairments		3,538
Gain on early extinguishment of debt	(2,822)	(94)
Changes in assets and liabilities:
Accounts receivable	45,745	66,508
Accounts payable and other accrued expenses and other	(76,911)	(71,916)
Operating lease obligations	(93,630)
Net cash (used in) provided by operating activities	(7,166)	18,584
Cash flows from investing activities:
Capital expenditures	62,727	51,152
Purchases of marketable securities	(70,316)	(79,650)
Proceeds on maturity or sale of marketable securities	71,174	69,180
Purchases of assets	(591,660)
Sales of assets	257,806	74,375
Restricted deposits	(3,820)	(873)
Notes receivable and other investment reductions	12,590	396
Other, net	(50)	(400)
Net cash (used in) provided by investing activities	(387,003)	11,876
Cash flows from financing activities:
Borrowings under revolving credit facilities	4,661,000	4,591,439
Repayments under revolving credit facilities	(4,630,664)	(4,548,815)
Proceeds from issuance of long-term debt	538,538	574,171
Repayment of long-term debt	(199,626)	(544,077)
Repayment of finance lease obligations	(2,645)
Debt issuance costs	(10,182)	(17,030)
Debt settlement costs		(485)
Contributions from noncontrolling interests	27,031
Distributions to noncontrolling interests and stockholders	(5,753)	(2,025)
Net cash provided by financing activities	377,699	53,178
Net (decrease) increase in cash, cash equivalents and restricted cash and equivalents	(16,470)	83,638
Cash, cash equivalents and restricted cash and equivalents:
Beginning of period	142,276	58,638
End of period	125,806	142,276
Supplemental cash flow information:
Interest paid	153,589	393,632
Net taxes paid	1,496	4,427
Non-cash investing and financing activities:
Finance lease obligations, net write-down due to lease activity		(69,255)
Finance lease obligations, net write-down due to lease activity	(930,110)
Assets subject to finance lease obligations, net (gross-up) write-down due to lease activity	(53,588)
Assets subject to capital lease obligations, net (gross-up) write-down due to lease activity, under ASC 840		50,321
Operating lease obligations, net gross-up due to lease activity	2,916,017
Assets subject to operating leases, net (gross-up) due to lease activity	(2,523,708)
Financing obligations, net write-down due to lease activity	(2,734,940)	(168,993)
Assets subject to financing obligations, net write-down due to lease activity	$ 1,718,507	$ 131,048

General Information

General Information	12 Months Ended
	Dec. 31, 2019
General Information
General Information	(1) Description of Business Genesis Healthcare, Inc. is a healthcare services holding company that through its subsidiaries (collectively, the Company or Genesis), 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. At December 31, 2019, the Company provides inpatient services through 381 skilled nursing, assisted/senior living and behavioral health centers located in 26 states. Revenues of the Company’s owned, leased and otherwise consolidated inpatient businesses constitute approximately 87% 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. The Company has expanded its delivery model for providing rehabilitation services to community-based and at-home settings, as well as internationally in China. After the elimination of intercompany revenues, the rehabilitation therapy services business constitutes approximately 10% of the Company’s revenues. The Company provides an array of other specialty medical services, including management services, physician services, staffing 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 income (loss) attributable to Genesis Healthcare, Inc. and net loss 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 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 control and economics that considers whether the Company 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. During 2019, the Company entered into two partnerships that acquired the real property of 33 skilled nursing facilities that are leased to the Company. Management has concluded that these entities are VIEs, of which the Company is the primary beneficiary. As a result, it has included the assets, liabilities, and operating results of these entities in its consolidated financial statements. See Note 4 – “ Significant Transactions and Events – Strategic Partnership .” Certain prior year disclosure amounts have been reclassified to conform to current period presentation. Financial Condition and Liquidity Considerations The accompanying consolidated financial statements have been prepared on the basis that the Company will continue as a going concern, which contemplates the realization of assets and the satisfaction of liabilities in the normal course of business. In evaluating the Company’s ability to continue as a going concern, management considered the conditions and events that could raise substantial doubt about the Company’s ability to continue as a going concern for 12 months following the date the Company’s financial statements were issued (March 16, 2020). Management considered the recent results of operations as well as the Company’s current financial condition and liquidity sources, including current funds available, forecasted future cash flows and the Company’s conditional and unconditional obligations due before March 16, 2021. Based upon such considerations, management determined that there are no known or knowable conditions or events that raise substantial doubt about the Company’s ability to continue as a going concern for 12 months following the date of issuance of these financial statements (March 16, 2020). The Company’s results of operations continue to be negatively impacted by the persistent pressure of healthcare reforms enacted in recent years. This challenging operating environment has been most acute in the Company’s inpatient segment, but also has had a detrimental effect on the Company’s rehabilitation therapy segment and its customers. In recent years, the Company has implemented a number of cost mitigation strategies to offset the negative financial implications of this challenging operating environment. The Company expects to continue to pursue cost mitigation and other strategies in response to the operating environment and liquidity requirements. During the year ended December 31, 2019, the Company amended, or obtained waivers related to, the financial covenants of all of its material debt and lease agreements to account for these ongoing changes in its capital structure and business conditions. Although the Company is and projects to be in compliance with all of its material debt and lease covenants through March 16, 2021, the ongoing uncertainty related to the impact of healthcare reform initiatives may have an adverse impact on the Company’s ability to remain in compliance with the covenants. Should the Company fail to comply with its debt and lease covenants at a future measurement date it could, absent necessary and timely waivers and/or amendments, be in default under certain of its existing debt and lease agreements. To the extent any cross-default provisions apply, the default could have a more significant impact on the Company’s financial position.

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2019
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	(2) Estimates and Assumptions The consolidated financial statements have been prepared in conformity with U.S. GAAP, which requires management to consolidate company financial information and make informed estimates and assumptions that affect the reported amounts of assets and liabi lities, disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. The most significant estimates in the Company’s consolidated financial statements relate to revenues, valuation of accounts receivable, self-insured liabilities, income taxes, impairment of long-lived assets, and other contingencies. Actual results could differ from those estimates. Revenue Recognition The Company adopted Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) Topic 606, Revenue from Contracts with Customers (Topic 606), effective January 1, 2018. The Company’s adoption of Topic 606 primarily impacted the presentation of revenues due to the inclusion of variable consideration in the form of implicit price concessions contained in certain of its contracts with customers. Under Topic 606, amounts estimated to be uncollectable are generally considered implicit price concessions that are a direct reduction to net revenues. To the extent there are material subsequent events that affect the payor's ability to pay, such amounts are recorded within operating expenses. The Company generates revenues, primarily by providing healthcare services to its customers. Revenues are recognized when control of the promised good or service is transferred to our customers, in an amount that reflects the consideration to which the Company expects to be entitled from patients, third-party payors (including government programs and insurers) and others, in exchange for those goods and services. Performance obligations are determined based on the nature of the services provided. The majority of the Company’s healthcare services represent a bundle of services that are not capable of being distinct and as such, are treated as a single performance obligation satisfied over time as services are rendered. The Company also provides certain ancillary services which are not included in the bundle of services, and as such, are treated as separate performance obligations satisfied at a point in time, if and when those services are rendered. The Company determines the transaction price based on contractually agreed-upon amounts or rates, adjusted for estimates of variable consideration, such as implicit price concessions. The Company utilizes the expected value method to determine the amount of variable consideration that should be included to arrive at the transaction price, using contractual agreements and historical reimbursement experience within each payor type. Variable consideration also exists in the form of settlements with Medicare and Medicaid as a result of retroactive adjustments due to audits and reviews. The Company applies constraint to the transaction price, such that net revenues are recorded only to the extent that it is probable that a significant reversal in the amount of the cumulative revenue recognized will not occur in the future. If actual amounts of consideration ultimately received differ from the Company’s estimates, the Company adjusts these estimates, which would affect net revenues in the period such variances become known. Adjustments arising from a change in the transaction price were not significant for the years ended December 31, 2019 and 2018. The Company does not adjust the promised amount of consideration for the effects of a significant financing component due to its expectation that the period between the time the service is provided and the time payment is received will be one year or less. The Company recognizes revenue in the statements of operations and contract assets on the consolidated balance sheets only when services have been provided. Since the Company has performed its obligation under the contract, it has unconditional rights to the consideration recorded as contract assets and therefore classifies those billed and unbilled contract assets as accounts receivable. Payments that the Company receives from customers in advance of providing services represent contract liabilities. Such payments primarily relate to private pay patients, which are billed monthly in advance. See Note 5 – “ Net Revenues and Accounts Receivable. ” Accounts Receivable The Company’s accounts receivable are primarily comprised of amounts due from Medicare, Medicaid, private insurance, self-pay residents, other third-party payors and long-term care providers that utilize its rehabilitation therapy and other services. The Company evaluates the valuation of accounts receivable based on analysis of historical collection trends, as well as its understanding of the nature and collectibility of accounts based on their age and other factors. Cash and Cash Equivalents Cash and cash equivalents consist of cash and short-term investments with original maturities of three months or less when purchased and therefore, approximate fair value. The Company’s available cash is held in accounts at commercial banking institutions. The Company currently has bank deposits with commercial banking institutions that exceed Federal Deposit Insurance Corporation insurance limits. Restricted Cash and Equivalents Restricted cash and equivalents includes cash and money market funds held by the Company’s wholly-owned captive insurance subsidiary, which are substantially restricted to securing outstanding claims losses. Further, restricted cash and equivalents includes cash proceeds received under the ABL Credit Facilities that are pledged to cash collateralize letters of credit previously issued under the retired revolving credit facilities, as well as cash account balances subject to deposit account control agreements that were sprung under the ABL Credit Facilities resulting in the majority of the Company’s cash accounts being classified as restricted. See Note 12 – “ Long-Term Debt – Asset Based Lending Facilities.” The restricted cash and equivalents balances at December 31, 2019 and 2018 were $113.7 million and $121.4 million, respectively. Restricted Investments in Marketable Securities Restricted investments in marketable securities primarily consist of fixed interest rate securities that are considered to be available-for-sale and accordingly are reported at fair value with unrealized gains and losses, net of related tax effects, included within accumulated other comprehensive income (loss), a separate component of stockholders’ deficit. Fair values for fixed interest rate securities are based on quoted market prices. A decline in the market value of any security below cost that is deemed other-than-temporary is charged to income, resulting in the establishment of a new cost basis for the security. Realized gains and losses for securities classified as available-for-sale are derived using the specific identification method for determining the cost of securities sold. The restricted investments in marketable securities balances at December 31, 2019 and 2018 were $136.9 million and $136.2 million, respectively. Property and Equipment Property and equipment are carried at cost less accumulated depreciation. Depreciation expense is calculated using the straight-line method over the estimated useful lives of the depreciable assets, which generally range from 20-35 years for buildings, building improvements and land improvements, and 3-15 years for equipment, furniture and fixtures. Depreciation expense on leasehold improvements is calculated using the straight-line method over the lesser of the lease term or the estimated useful life of the asset. Expenditures for maintenance and repairs necessary to maintain property and equipment in efficient operating condition are expensed as incurred. Costs of additions and improvements are capitalized. Total depreciation expense for the years ended December 31, 2019 and 2018 was $96.1 million and $210.0 million, respectively. Impairment of Long-Lived Assets The Company’s long-lived assets are reviewed for impairment whenever events or changes in circumstances indicate the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by comparison of the carrying amount of an asset to the future cash flows expected to be generated by the asset. If the carrying amount of an asset exceeds its estimated future undiscounted cash flows, an impairment charge is recognized to the extent the carrying amount of the asset exceeds the fair value of the asset. Assets to be disposed of are reported at the lower of the carrying amount or the fair value, less costs to sell. See Note 19 – “ Asset Impairment Charges .” Goodwill and Identifiable Intangible Assets Goodwill represents the excess of the purchase price over the fair value of identifiable net assets acquired in business combinations. The Company tests goodwill on an annual basis and between annual tests if events occur or circumstances exist that would reduce the fair value of a reporting unit below its carrying amount. The Company performs its annual goodwill impairment assessment for its reporting units as of September 30 of each year. The Company first assesses qualitative factors to determine whether it is necessary to perform quantitative goodwill impairment testing. If determined necessary, the Company applies the quantitative impairment test to identify and measure the amount of impairment, if any. Definite-lived intangible assets consist of management contracts, customer relationships and favorable leases. These assets are amortized in accordance with the authoritative guidance for intangible assets using the straight-line method over their estimated useful lives. These assets are tested for impairment consistent with the Company’s long-lived assets. Indefinite-lived intangible assets consist of trade names. The Company tests indefinite-lived intangible assets for impairment on an annual basis or more frequently if events occur or circumstances exist that would indicate that the carrying amount of the intangible asset may not be recoverable. See Note 11 – “ Goodwill and Identifiable Intangible Assets ” and Note 19 – “ Asset Impairment Charges .” Self-Insurance Reserves The Company provides for self-insurance reserves for both general and professional liability and workers’ compensation claims based on estimates of the ultimate costs for both reported claims and claims incurred but not reported. Estimated losses from asserted and incurred but not reported claims are accrued based on the Company’s estimates of the ultimate costs of the claims, which include costs associated with litigating or settling claims, and the relationship of past reported incidents to eventual claims payments. All relevant information, including the Company’s own historical experience, the nature and extent of existing asserted claims and reported incidents, and independent actuarial analyses of this information is used in estimating the expected amount of claims. The reserves for loss for workers’ compensation risks are discounted based on actuarial estimates of claim payment patterns whereas the reserves for general and professional liability are recorded on an undiscounted basis. The Company also considers amounts that may be recovered from excess insurance carriers in estimating the ultimate net liability for such risks. See Note 21 – “ Commitments and Contingencies – Loss Reserves For Certain Self-Insured Programs – General and Professional Liability and Workers’ Compensation .” Income Taxes The Company’s effective tax rate is based on pretax income, statutory tax rates and tax planning opportunities available in the various jurisdictions in which it operates. The Company accounts for income taxes in accordance with applicable guidance on accounting for income taxes, which requires that deferred tax assets and liabilities be recognized using enacted tax rates for the effect of temporary differences between book and tax bases on recorded assets and liabilities. Accounting guidance also requires that deferred tax assets be reduced by a valuation allowance, when it is more likely than not that a tax benefit will not be realized. The recognition and measurement of a tax position is based on management’s best judgment given the facts, circumstances and information available at the reporting date. The Company evaluates tax positions to determine whether the benefits of tax positions are more likely than not of being sustained upon audit based on the technical merits of the tax position. For tax positions that are more likely than not of being sustained upon audit, the Company recognizes the largest amount of the benefit that is greater than 50% likely of being realized upon ultimate settlement in the financial statements. For tax positions that are not more likely than not of being sustained upon audit, the Company does not recognize any portion of the benefit in the financial statements. If the more likely than not threshold is not met in the period for which a tax position is taken, the Company may subsequently recognize the benefit of that tax position if the tax matter is effectively settled, the statute of limitations expires, or if the more likely than not threshold is met in a subsequent period. The Company evaluates, on a quarterly basis, its ability to realize deferred tax assets by assessing its valuation allowance and by adjusting the amount of such allowance, if necessary. The factors used to assess the likelihood of realization are its forecast of pre-tax earnings, its forecast of future taxable income and available tax planning strategies that could be implemented to realize the net deferred tax assets. To the extent the Company prevails in matters for which reserves have been established, or is required to pay amounts in excess of its reserves, its effective tax rate in a given financial statement period could be materially affected. An unfavorable tax settlement would require use of cash and result in an increase in the effective tax rate in the year of resolution. A favorable tax settlement would be recognized as a reduction in the Company’s effective tax rate in the year of resolution. The Company records accrued interest and penalties associated with uncertain tax positions as income tax expense in the consolidated statement of operations. Leases The Company adopted a new leasing standard, FASB ASC Topic 842, Leases (Topic 842), on January 1, 2019 and elected the option to apply the transition requirements thereof at the effective date with the effects of initially applying the new standard recognized as a cumulative-effect adjustment to accumulated deficit on the adoption date. Consequently, financial information has not been updated for periods prior to January 1, 2019 . See Recently Adopted Accounting Pronouncements below. The Company leases skilled nursing facilities and assisted/senior living facilities, as well as certain office space, land, and equipment. Under Topic 842, the Company evaluates at contract inception whether a lease exists and recognizes a lease liability and right-of-use (ROU) asset for all leases with a term greater than 12 months. Leases are classified as either finance or operating. While many of the Company’s facilities are subject to master lease agreements, leases are assessed, classified, and measured at the facility level. All lease liabilities are measured as the present value of the future lease payments using a discount rate, which is generally the Company’s incremental borrowing rate for collateralized borrowings. The future lease payments used to measure the lease liability include both fixed and variable payments that depend on a rate or index, as well as the exercise price of any options to purchase the underlying asset that have been deemed reasonably certain of being exercised. Future lease payments for optional renewal periods that are not reasonably certain of being exercised are excluded from the measurement of the lease liability. Regarding variable payments that depend on a rate or index, the lease liability is measured using the applicable rate or index as of lease commencement and is only remeasured under certain circumstances, such as a change in the lease term. Lease incentives serve to reduce the amount of future lease payments included in the measurement of the lease liability. For all leases, the ROU asset is initially derived from the measurement of the lease liability and adjusted for certain items, such as initial direct costs and lease incentives received. ROU assets are subject to impairment testing. Amortization of finance lease ROU assets, which is generally recognized on a straight-line basis over the lesser of the lease term and the estimated useful life of the asset, is included within depreciation and amortization expense in the consolidated statements of operations. Interest expense associated with finance lease liabilities is included within interest expense in the consolidated statements of operations. Operating lease expense is recognized on a straight-line basis over the lease term and included within lease expense in the consolidation statements of operations. The lease term is determined based on the date the Company acquires control of the leased premises through the end of the lease term. Optional renewals periods are not initially included in the lease term unless they are deemed to be reasonably certain of being exercised at lease commencement. For further discussion, see Note 10 – “Leases.” Earnings (Loss) Per Share The Company follows the Financial Accounting Standards Board’s (FASB) authoritative guidance for the financial reporting of earnings (loss) per share. Earnings (loss) per share excludes dilution and is based upon the weighted average number of common shares outstanding during the respective periods. Diluted earnings (loss) per share reflects the potential dilution that could occur if securities or other contracts to issue common stock were exercised or converted into common stock or otherwise resulted in the issuance of common stock that then shared in the earnings of the Company. See Note 6 – “Earnings (Loss) Per Share .” Business Combinations The Company’s acquisition strategy is to identify facilities for purchase or lease that are complementary to its current affiliated facilities, accretive to its business or otherwise advance its strategy. The results of all of the Company’s operating subsidiaries are included in the accompanying financial statements subsequent to the date of acquisition. Acquisitions are accounted for using the acquisition method of accounting and include leasing and other financing arrangements as well as cash transactions. Assets and liabilities of the acquired entities are recorded at their estimated fair values at the acquisition date. Goodwill represents the excess of the purchase price over the fair value of net assets, including the amount assigned to identifiable intangible assets. Given the time it takes to obtain pertinent information to finalize the acquired company’s balance sheet, the initial fair value might not be finalized up to one year after the date of acquisition. In developing estimates of fair values for long-lived assets, the Company utilizes a variety of factors including market data, cash flows, growth rates, and replacement costs. Determining the fair value for specifically identified intangible assets involves significant judgment, estimates and projections related to the valuation to be applied to intangible assets such as favorable leases, customer relationships, management contracts and trade names. The subjective nature of management’s assumptions increases the risk associated with estimates surrounding the projected performance of the acquired entity. In transactions where significant judgment or other assumptions could have a material impact on the conclusion, the Company may engage third party specialists to assist in the valuation of the acquired assets and liabilities. Additionally, as the Company amortizes definite-lived acquired intangible assets over time, the purchase accounting allocation directly impacts the amortization expense recorded on the financial statements. Recently Adopted Accounting Pronouncements In February 2016, the FASB established Topic 842 by issuing Accounting Standards Update (ASU) No. 2016-02, which requires lessees to recognize leases on-balance sheet and disclose key information about leasing arrangements. Topic 842 was subsequently amended by ASU No. 2018-01, Land Easement Practical Expedient for Transition to Topic 842 ; ASU No. 2018-10, Codification Improvements to Topic 842, Leases ; and ASU No. 2018-11, Targeted Improvements . The new standard establishes a right-of-use (ROU) model that requires a lessee to recognize a ROU asset and lease liability on the balance sheet for all leases with a term longer than 12 months. Leases will be classified as finance or operating, with classification affecting the pattern and classification of expense recognition in the statement of operations. The Company adopted the new standard on January 1, 2019. The Company elected the option to apply the transition requirements in Topic 842 at the effective date of January 1, 2019 with the effects of initially applying Topic 842 recognized as a cumulative-effect adjustment to accumulated deficit in the period of adoption. Consequently, financial information has not been updated and the disclosures required under the new standard have not been provided for dates and periods before January 1, 2019. The new standard provides a number of optional practical expedients in transition. The Company has elected the ‘package of practical expedients’, which permit it to not reassess its prior conclusions about lease identification, lease classification and initial direct costs. The Company did not elect the use-of-hindsight or the practical expedient pertaining to land easements; the latter is not applicable to the Company. The adoption of the new standard had a material effect on the Company’s financial statements. The most significant effects relate to (1) the recognition of new ROU assets and lease liabilities on its balance sheet for real estate operating leases; (2) the derecognition of existing assets and liabilities for sale-leaseback transactions (including those arising from build-to-suit lease arrangements for which construction is complete and the Company is leasing the constructed asset) that historically did not qualify for sale accounting; and (3) providing significant new disclosures about its leasing activities. Upon adoption, the Company: · Recognized operating lease liabilities of $0.6 billion based on the present value of the remaining minimum rental payments as determined in accordance with Topic 842 for leases that had historically been accounted for as operating leases under the previous leasing standards. The Company recognized corresponding ROU assets of approximately $0.5 billion based on the operating lease liabilities, adjusted for existing straight-line lease liabilities, existing assets and liabilities related to favorable and unfavorable terms of operating leases previously recognized in respect of business combinations, and the impairment of the ROU assets. The resulting net impact of $0.1 billion associated with this change in accounting was recognized as an increase to opening accumulated deficit as of January 1, 2019. · Derecognized existing financing obligations of $2.7 billion and existing property and equipment of $1.7 billion. The Company recognized new operating lease liabilities and corresponding ROU assets of $1.9 billion on its balance sheet for the associated leases. The resulting net impact of $1.0 billion associated with this change in accounting was recognized as a reduction to opening accumulated deficit as of January 1, 2019. The new standard also provides practical expedients for an entity’s ongoing accounting. The Company elected the short-term lease recognition exemption for all leases that qualify. See Note 10 – “ Leases. ” In February 2018, the FASB issued ASU 2018-02, Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income , which permits entities to reclassify the disproportionate income tax effects of the Tax Cuts and Jobs Act (Tax Reform Act) on items within accumulated other comprehensive income (loss) to retained earnings. These disproportionate income tax effect items are referred to as "stranded tax effects." Amendments in this update only relate to the reclassification of the income tax effects of the Tax Reform Act. Other accounting guidance that requires the effect of changes in tax laws or rates to be included in net income is not affected by this update. The Company adopted the new standard on January 1, 2019. The adoption of ASU 2018-02 did not have a material impact on the Company’s consolidated financial statements. Recently Issued Accounting Pronouncements In August 2018, the FASB issued ASU 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework – Changes to the Disclosure Requirements for Fair Value Measurement , which simplifies the fair value measurement disclosure requirements. The Company adopted the new standard on January 1, 2020. The adoption of ASU 2018-13 did not have a material impact on the Company’s consolidated financial statements and related disclosures. In June 2016, the FASB issued ASU 2016-13, Financial Instruments - Credit Losses: Measurement of Credit Losses on Financial Instruments , which is intended to improve financial reporting by requiring earlier recognition of credit losses on certain financial assets, such as available-for-sale debt securities. The standard replaces the current incurred loss impairment model that recognizes losses when a probable threshold is met with a requirement to recognize lifetime expected credit losses immediately when a financial asset is originated or purchased. The standard has been further refined through subsequent releases by the FASB, including the extension of the effective date. As a smaller reporting company, the standard is effective for the Company for fiscal years beginning after December 15, 2022, including interim periods within those annual periods, with early adoption permitted. The Company is currently evaluating the effect that the standard will have on its consolidated financial statements and related disclosures. In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes, which serves to remove or amend certain requirements associated with the accounting for income taxes. The standard is effective for fiscal years beginning after December 15, 2020, including interim periods within those annual periods, with early adoption permitted. The Company is currently evaluating the effect, if any, that the standard will have on its consolidated financial statements and related disclosures.

Certain Significant Risks and U

Certain Significant Risks and Uncertainties	12 Months Ended
	Dec. 31, 2019
Certain Significant Risks and Uncertainties
Certain Significant Risks and Uncertainties	(3) 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 78% 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 years ended December 31, 2019 and 2018: Year ended December 31, 2019 2018 Medicare 20 % 21 % Medicaid 58 % 57 % Insurance 12 % 12 % Private 7 % 8 % Other 3 % 2 % Total 100 % 100 % 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, 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. Concentration of Credit Risk The Company is exposed to the credit risk of its third-party customers, many of whom are in similar lines of business as the Company and are exposed to the same systemic industry risks of operations as the Company, resulting in a concentration of risk. These include organizations that utilize the Company’s rehabilitation services, staffing services and physician service offerings, engaged in similar business activities or having economic features that would cause their ability to meet contractual obligations, including those to the Company, to be similarly affected by changes in regulatory and systemic industry conditions. Management assesses its exposure to loss on accounts at the customer level. The greatest concentration of risk exists in the Company’s rehabilitation therapy services business where it has over 140 distinct customers, many being chain operators with more than one location. One of the Company’s customers, a related party, comprises $28.9 million, approximately 34%, of the gross outstanding contract receivables in the rehabilitation services business at December 31, 2019. See Note 16 – “Related Party Transactions.” Additionally, one former customer comprises $7.0 million, approximately 8%, of the gross outstanding contract receivables in the rehabilitation therapy services business at December 31, 2019. A future adverse event impacting the solvency of these large customers resulting in their insolvency or other economic distress would have a material impact on the Company. Covenant Compliance Should the Company fail to comply with its debt and lease covenants at a future measurement date, it could, absent necessary and timely waivers and/or amendments, be in default under certain of its existing debt and lease agreements. To the extent any cross-default provisions may apply, the default could have an even more significant impact on the Company’s financial position. Although the Company is in compliance, and projects to remain in compliance, with the covenants required by its material debt and lease agreements, the ongoing uncertainty related to the impact of healthcare reform initiatives may have an adverse impact on the Company’s ability to remain in compliance with its financial covenants through March 16, 2021. The Company’s ability to maintain compliance with financial covenants required by its debt and lease agreements depends in part on management’s ability to increase revenues 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 debt and lease covenant requirements. There can be no assurance that the confluence of these and other factors will not impede the Company’s ability to meet covenants required by its debt and lease agreements in the future.

Significant Transactions and Ev

Significant Transactions and Events	12 Months Ended
	Dec. 31, 2019
Significant Transactions and Events
Significant Transactions and Events	(4) Strategic Partnerships Next Partnership On January 31, 2019, Welltower Inc. (Welltower) sold the real estate of 15 facilities to a real estate partnership (Next Partnership), of which the Company acquired a 46% membership interest for $16.0 million. The remaining interest is held by Next Healthcare (Next), a related party. See Note 16 – “ Related Party Transactions .” In conjunction with the facility sales, the Company received aggregate annual rent credits of $17.2 million. The Company will continue to operate these facilities pursuant to a master lease with the Next Partnership. The term of the master lease is 15 years with two five-year renewal options available. The Company will pay annual rent of $19.5 million, with no rent escalators for the first five years and an escalator of 2% beginning in the sixth lease year and thereafter. The Company also obtained a fixed price purchase option to acquire all of the real property of the facilities. The purchase option is exercisable between lease years five and seven, reducing in price each successive year down to a 10% premium over the net price paid by the partnership to acquire the facilities from Welltower. The Company has concluded the Next Partnership qualifies as a VIE and the Company is the primary beneficiary. As such, the Company has consolidated all of the accounts of the Next Partnership in the accompanying consolidated financial statements. The ROU assets and lease obligations related to the Next Partnership lease agreement have been fully eliminated in the Company’s consolidated financial statements. The Next Partnership acquired 22 skilled nursing facilities for a purchase price of $252.5 million but immediately sold seven of these facilities for $79.0 million. The initial consolidation of the remaining 15 facilities resulted in property and equipment of $173.5 million, non-recourse debt of $165.7 million, net of debt issuance costs, and non-controlling interest of $18.5 million. The impact of consolidation on the accompanying consolidated statement of operations was not material for the year ended December 31, 2019 apart from transaction costs of $5.3 million. Vantage Point Partnership On September 12, 2019, Welltower and Second Spring Healthcare Investments (Second Spring) sold the real estate of four and 14 facilities, respectively, to a real estate partnership (Vantage Point Partnership), in which the Company invested $37.5 million for an approximate 30% membership interest. The remaining membership interest is held by Vantage Point Capital, LLC (Vantage Point) for an investment of $85.3 million consisting of an equity investment of $8.5 million and a formation loan of $76.8 million. In conjunction with the facility sales, the Company received aggregate annual rent credits of $30.3 million. The Company will continue to operate these facilities pursuant to a new master lease with the Vantage Point Partnership. The term of the master lease is 15 years with two five-year renewal options available. The Company will pay annual rent of approximately $33.1 million, with no rent escalators for the first four years and an escalator of 2% beginning in the fifth lease year and thereafter. The Company also obtained a fixed price purchase option to acquire all of the real property of the facilities. The purchase option is exercisable during certain periods in fiscal years 2024 and 2025 for a 10% premium over the purchase price paid by the partnership. Further, Vantage Point holds a put option that would require the Company to acquire its membership interests in the Vantage Point Partnership. The put option becomes exercisable if the Company opts not to purchase the facilities or upon the occurrence of certain events of default. The Company has concluded the Vantage Point Partnership qualifies as a VIE and the Company is the primary beneficiary. As such, the Company has consolidated all of the accounts of the Vantage Point Partnership in the accompanying financial statements. The ROU assets and lease obligations related to the Vantage Point Partnership lease agreement have been fully eliminated in the Company’s consolidated financial statements. The Vantage Point Partnership acquired all 18 skilled nursing facilities for a purchase price of $339.2 million. The initial consolidation primarily resulted in property and equipment of $339.2 million, non-recourse debt of $306.1 million, net of debt issuance costs, and non-controlling interest of $8.5 million. The Company has not finalized the analysis of the consideration and purchase price allocation and will continue to review this during the measurement period. Other than transaction costs of $11.0 million, the impact of consolidation on the accompanying consolidated statement of operations was not material for the year ended December 31, 2019. During the third quarter of 2019, the Company sold the real property of seven skilled nursing facilities and one assisted/senior living facility located in Georgia, New Jersey, Virginia, and Maryland to affiliates of Vantage Point for an aggregate purchase price of $91.8 million, using the majority of the proceeds to acquire its interest in the Vantage Point Partnership and repay indebtedness. The operations of seven of these facilities were also divested. Three of the facilities were subject to real estate loans and two were subject to loans insured by the U.S. Department of Housing and Urban Development (HUD). See Note 9 – “Property and Equipment” and Note 12 – “Long-Term Debt – Real Estate Loans” and “Long-Term Debt – HUD Insured Loans.” The Company also divested the operations of an additional leased skilled nursing facility located in Georgia, marking an exit from the inpatient business in this state. The divested facilities had aggregate annual revenues of $84.1 million and annual pre-tax net income of $2.6 million. The divestitures resulted in an aggregate gain of $57.8 million. Divestiture of Non-Strategic Facilities 2019 Divestitures California Divestitures During the second quarter of 2019, the Company sold the real property and divested the operations of five skilled nursing facilities in California for a sale price of $56.5 million. Loan repayments of $41.8 million were paid on the facilities at closing. See Note 9 – “Property and Equipment” and Note 12 – “Long-Term Debt – Real Estate Loans” and “Long-Term Debt – HUD Insured Loans.” The Company incurred prepayment penalties and other closing costs of $2.4 million at settlement. The facilities generated annual revenues of $53.0 million and pre-tax net income of $1.6 million. The divestiture resulted in a gain of $25.0 million. The Company also divested the operations of one behavioral health center located in California upon the lease’s expiration in the second quarter of 2019. The center generated annual revenues of $3.1 million and pre-tax net loss of $0.3 million. The divestiture resulted in a loss of $0.1 million. During the third quarter of 2019, the Company sold the real property and divested the operations of one additional skilled nursing facility and one assisted/senior living facility in California for an aggregate sale price of $11.5 million. Loan repayments of $9.6 million were paid on the facilities at closing. See Note 9 – “Property and Equipment” and Note 12 – “Long-Term Debt – HUD Insured Loans.” The facilities generated annual revenues of $10.4 million and pre-tax net income of less than $0.1 million. The divestiture resulted in an aggregate gain of $0.6 million. Texas Divestitures During the fourth quarter of 2019, the Company sold the real property of seven facilities in Texas for a sales price of $20.1 million. The net proceeds were used principally to repay the indebtedness of the facilities. The Company recognized a net gain of $3.3 million associated with the sale of the facilities. The Company recognized a gain on early extinguishment of debt of $2.6 million associated with the write off of the debt premiums and issuance costs on the underlying HUD loans. These seven facilities had been classified as held for sale as of December 31, 2018. See Note 20 – “Assets Held for Sale.” Other Divestitures During the first quarter of 2019, the Company divested the operations of nine facilities located in New Jersey and Ohio that were subject to the master lease with Welltower (the Welltower Master Lease). The nine divested facilities had aggregate annual revenues of $90.2 million and annual pre-tax net loss of $6.0 million. The Company recognized a loss on exit reserves of $3.5 million. The Company also completed the closure of one facility located in Ohio. The facility generated annual revenues of $7.7 million and pre-tax net loss of $1.6 million. The closure resulted in a loss of $0.2 million. During the second quarter of 2019, the Company divested the operations of three leased skilled nursing facilities. Two of the facilities were located in Connecticut and subject to the Welltower Master Lease, while the third was located in Ohio. The facilities generated annual revenues of $24.7 million and pre-tax net loss of $2.9 million. The divestitures resulted in a loss of $1.1 million. During the third quarter of 2019, the Company divested the operations of 11 leased skilled nursing facilities and completed the closure of a twelfth facility. Nine of the facilities were located in Ohio, marking an exit from the inpatient business in this state, while the remaining three were located in Massachusetts, Utah, and Idaho. Four of the facilities were subject to a master lease with Omega Healthcare Investors, Inc. (Omega), three of which were removed from the lease, resulting in an annual rent credit of $1.9 million, with the fourth, the closed facility, remaining subject to the lease. The twelve facilities generated annual revenues of $75.6 million and pre-tax loss of $4.6 million. The divestitures resulted in a loss of $3.5 million. During the fourth quarter of 2019, the Company divested the operations of one leased skilled nursing facility in New Jersey. The facility generated annual revenues of $19.0 million and pre-tax net loss of $1.2 million. The divestiture resulted in a loss of $0.9 million, which was primarily attributable to exit costs. 2018 Divestitures During the year ended December 31, 2018, the Company divested the operations of 54 skilled nursing facilities and one assisted/senior living facility. These divestitures resulted in net gains of $34.8 million, which are included in other income on the consolidated statements of operations. See Note 18 – “ Other Income .” Texas Divestitures During the fourth quarter of 2018, the Company divested the operations of 23 skilled nursing facilities located in Texas, consisting of 22 owned facilities and one leased facility. The Company sold the real property associated with 15 of the owned facilities, with the real property of the remaining seven owned facilities being classified as held for sale at December 31, 2018. Sale proceeds of approximately $89.4 million, net of transaction costs, were used principally to repay the indebtedness of the facilities. The Company recognized a gain of $3.4 million primarily attributable to the derecognition of financing lease assets and obligations offset by a loss of $4.6 million for exit costs. Debt premiums and issuance costs of $9.4 million associated with underlying HUD loans were written off as a gain on early extinguishment of debt. Other Divestitures During the first quarter of 2018, the Company closed one leased skilled nursing facility located in Massachusetts. The facility remained subject to a master lease with Welltower until its sale in the second quarter of 2019. The facility generated annual revenues of $9.0 million and pre-tax net loss of $2.7 million. The closure resulted in a loss of $0.3 million. During the second quarter of 2018, the Company divested 19 leased skilled nursing facilities, one of which had previously been closed during 2017. The facilities were located across the states of California, Kentucky, Massachusetts, New Jersey, and Pennsylvania. Twelve of the facilities were subject to a master lease with Second Spring and six were subject to a master lease with Sabra Health Care REIT, Inc. (Sabra). The facilities generated annual revenues of $182.7 million and pre-tax loss of $23.8 million. The Company recorded a gain of $22.5 million on the divestitures, offset by a loss on exit costs of $8.4 million. Additionally, the Company recognized a capital lease net asset and obligation write-down of $16.8 million, a financing obligation net asset write-down of $113.3 million and a financing obligation write-down of $134.5 million associated with 12 of the facilities. The Company recorded accelerated depreciation expense of $5.3 million associated with the divestitures. During the third quarter of 2018, the Company divested seven leased facilities, consisting of six skilled nursing facilities and one behavioral health clinic. The facilities were located across the states of California, Indiana, Maryland, Pennsylvania, Ohio, and Texas. Three of the facilities were subject to a master lease with Welltower, while two others were subject to master leases with Second Spring and Sabra. The facilities generated annual revenues of $71.7 million and pre-tax loss of $9.7 million. The Company recorded a gain of $27.9 million on the divestitures, offset by a loss on exit costs of $3.1 million. Additionally, the Company recognized capital lease and financing obligation net asset write-downs of $44.5 million and capital lease and financing obligation write-downs of $77.0 million associated with four of the facilities. The Company recorded accelerated depreciation expense of $7.3 million associated with the divestitures. The Company received an annual rent credit of $0.6 million associated with the divestiture of one of the facilities. During the fourth quarter of 2018, the Company divested six facilities, consisting of five leased skilled nursing facilities and one owned assisted/senior living facility. The facilities were located across the states of Georgia, Idaho, Montana, and Nevada. Four of the facilities were subject to a master lease with Sabra. The facilities generated annual revenues of $36.8 million and pre-tax income of $3.1 million. The Company recorded a gain of $0.4 million on the divestitures, offset by a loss on exit costs of $1.1 million. The Company received an annual rent credit of $0.3 million associated with the divestiture of one of the leased facilities. The owned facility was sold for $2.2 million with net proceeds of $1.9 million being primarily used to pay down indebtedness. Additionally, the Company recorded a loss of $1.9 million for exit costs associated with the pending closure of certain clinics associated with the Company’s rehabilitation services business. Acquisitions On June 1, 2019, the Company acquired the operations of one skilled nursing facility in New Mexico. The new facility has 80 licensed beds and generates approximate annual net revenue of $3.4 million. The facility is leased from Omega and is classified as an operating lease. The facility’s 2019 pre-tax net income was de minimis. On November 1, 2018, the Company acquired the operations of eight skilled nursing facilities and one assisted/senior living facility in New Mexico and Arizona. The nine new facilities have approximately 1,000 beds and generate approximate annual net revenue of $60.0 million. The facilities are leased from Omega. Four of the facilities were classified as capital leases and resulted in an initial capital lease asset and obligation gross up of $14.6 million. The remaining five facilities were initially classified as operating leases. Lease Transactions Gains, losses and termination charges associated with master lease terminations and amendments are recorded as non-recurring charges. These amendments and terminations resulted in net gains of $93.8 million and net losses of $21.9 million for the years ended December 31, 2019 and 2018, respectively. These gains and losses are included in other income on the consolidated statements of operations. Welltower During the year ended December 31, 2019, the Company amended the Welltower Master Lease several times to reflect the lease termination of 30 facilities, including the 15 facilities sold to and now leased from the Next Partnership. As a result of the lease termination on the 30 facilities, the Company received annual rent credits of approximately $25.9 million. For those facilities remaining under the Welltower Master Lease, the Company reassessed the likelihood of exercising its renewal options and concluded that it no longer met the reasonably certain threshold. Lease modification analyses were performed at each amendment date and as of December 31, 2019 all 43 facilities subject to the Welltower Master Lease are classified as operating leases. In total, the amendments resulted in a net reduction to finance lease ROU assets and obligations of $11.7 million and $22.4 million, respectively, a net reduction to operating lease ROU assets and obligations of $112.8 million and $150.4 million, respectively and a gain of $48.3 million. Omega During the third quarter of 2019, the Company amended its master lease with Omega to reflect the lease termination of three facilities subject to the lease and received annual rent credits of $1.9 million. In conjunction with the lease termination, finance lease ROU assets and lease obligations of $10.1 million and $16.8 million, respectively, were written off. Additionally, for those facilities remaining under the master lease, the Company reassessed the likelihood of exercising its renewal options and concluded that it no longer met the reasonably certain threshold. Consequently, the remaining facilities subject to the master lease were reclassified from finance leases to operating leases and the corresponding ROU assets and liabilities were reduced by $164.6 million and $181.3 million, respectively. The lease termination and remeasurement resulted in an aggregate gain of $23.4 million. During the fourth quarter of 2019, the Company amended its master lease with Omega to reflect the inclusion of nine skilled nursing facilities and one assisted living facility in New Mexico and Arizona. These facilities were previously leased from Omega, following the terms of a separate lease agreement, and all facilities were classified as operating leases. There was no change in base rent for the 10 facilities upon addition to the master lease. The lease assessment and measurement resulted in operating lease classification with a $10.6 million ROU asset and lease liability gross up. In addition, the Company received $15.0 million as a short-term note payable in full to Omega by April 30, 2020. See Note 12 – “ Long-Term Debt – Notes Payable.” Second Spring During the third quarter of 2019, the Company amended its master lease with Second Spring to reflect the lease termination of 14 facilities subject to the lease and received annual rent credits of $28.4 million. In conjunction with the lease termination, finance lease ROU assets and lease obligations of $5.9 million and $8.8 million, respectively, were written off and operating lease ROU assets and lease obligations of $202.7 million and $205.4 million, respectively, were written off. Additionally, for those facilities remaining under the master lease, the Company reassessed the likelihood of exercising its renewal options and concluded that it no longer met the reasonably certain threshold. Consequently, the remaining facilities subject to the master lease were reclassified from finance leases to operating leases and the corresponding ROU assets and liabilities were increased by $54.4 million and $33.3 million, respectively. The lease termination and remeasurement resulted in an aggregate gain of $26.9 million. Sabra The Company is party to an agreement with Sabra resulting in permanent and unconditional annual cash rent savings of $19 million effective January 1, 2018. Sabra has pursued and the Company has supported Sabra’s previously announced sale of the Company’s leased assets. At the closing of such sales, the Company has entered into lease agreements with new landlords for a majority of the assets currently leased with Sabra. During the year ended December 31, 2018, Sabra completed the sale of 34 facilities to third party landlords with whom the Company has entered into new lease agreements. Those transactions are summarized below. During the second quarter of 2018, Sabra completed the sale and lease termination of 21 facilities, consisting of 20 skilled nursing facilities and one assisted/senior living facility. The facilities were located across nine states. As a result of the sales, the Company will receive an annual rent credit of $19.4 million for the remaining lease term. The Company continues to operate 12 of the facilities under a new lease with a new landlord, Next Healthcare Capital (Next), as described in Note 16 - "Related Party Transactions." The Company continues to operate the other nine facilities under a separate lease with a new landlord. The new lease has a ten-year initial term, one five-year renewal option and initial annual rent of $7.4 million. The Company recognized accelerated depreciation expense of $9.6 million associated with the property and equipment sold and a gain on the write off of certain lease liabilities of $9.9 million. During the fourth quarter of 2018, Sabra completed the sale and lease termination of 13 skilled nursing facilities located in California, Colorado, Connecticut, and New Mexico. As a result of the sales, the Company will receive an annual rent credit of $6.7 million for the remaining lease term. The Company continues to operate four of the facilities under a lease agreement with a new landlord. The new lease has a 9.5 year initial term, one five-year renewal option and initial annual rent of $3.4 million. The Company continues to operate the other nine facilities under a lease agreement with a new landlord. The new lease has a ten-year initial term, one five-year renewal option, and initial annual rent of $3.3 million. The Company recognized accelerated depreciation expense of $7.4 million associated with the property and equipment sold and a gain on the write off of certain lease liabilities of $6.2 million. As a result of the amendments and lease terminations noted above, the Company recorded a lease termination charge of $34.1 million in the year ended December 31, 2018, with an offsetting obligation recorded in other long-term liabilities. The charge represents the discounted residual rents the Company will continue to pay Sabra on the facilities that have been terminated due to either divestiture or sale to a new landlord. On an undiscounted basis, the Company was obligated to pay Sabra approximately $41.0 million as of December 31, 2018. This obligation will be repaid over a period of approximately four years ending in 2023. Other During the first quarter of 2019, the Company amended a master lease agreement for 19 skilled nursing facilities. The amendment extended the lease term by five years through October 31, 2026, removed the Company’s option to purchase certain facilities under the lease and adjusted certain financial covenants. The Company had previously determined that the renewal option period was not reasonably certain of exercise. Upon execution of the amendment, the operating lease ROU assets and obligations were remeasured, resulting in an increase of $77.2 million to both operating lease ROU assets and obligations. During the third quarter of 2019, the Company amended a master lease agreement to reflect the lease termination of six facilities subject to the lease. In conjunction with the lease termination, operating lease ROU assets of $4.9 million were written off, resulting in a loss of $4.9 million. During the second quarter of 2018, the Company negotiated the extensions of four separate lease agreements resulting in the derecognition of certain lease assets totaling $1.9 million. During the year ended December 31, 2018, the cease to use asset associated with a leased facility divestiture initially recorded during 2017 was further adjusted to reflect changes in the sublease assumption, resulting in a loss of $2.0 million. Restructuring Transactions Overview During the first quarter of 2018, the Company entered into a number of agreements, amendments and new financing facilities further described below in an effort to strengthen significantly its capital structure. In total, the Restructuring Transactions reduced the Company’s annual cash fixed charges by approximately $62.0 million beginning in 2018 and also provided $70.0 million of additional cash and borrowing availability, increasing the Company’s liquidity and financial flexibility. In connection with the Restructuring Transactions, the Company entered into a new asset based lending facility agreement, replacing its prior revolving credit facilities, expanding its term loan borrowings, amending its real estate loans with Welltower while refinancing some of those loan amounts through new real estate loans. The new asset based lending facility agreement and real estate loans are financed through MidCap Funding IV Trust and MidCap Financial Trust (collectively, MidCap), respectively. See Note 12 – “ Long-Term Debt .” The Company also amended the financial covenants in all of its material loan agreements and all but two of its material master leases. Financial covenants were amended to account for changes in the Company’s capital structure as a result of the Restructuring Transactions and to account for the current business climate. Welltower Master Lease Amendment During the first quarter of 2018, the Company entered into a definitive agreement with Welltower to amend the Welltower Master Lease (the Welltower Master Lease Amendment). The Welltower Master Lease Amendment reduced the Company’s annual base rent payment by $35.0 million effective as of January 1, 2018, reduced the annual rent escalator from approximately 2.9% to 2.5% effective on April 1, 2018 and further reduced the annual rent escalator to 2.0% beginning January 1, 2019. In addition, the Welltower Master Lease Amendment extended the initial term of the master lease by five years to January 31, 2037 and extended the optional renewal term of the master lease by five years to December 31, 2048. The Welltower Master Lease Amendment also provides a potential upward rent reset, conditioned upon achievement of certain upside operating metrics, effective January 1, 2023. If triggered, the incremental rent from the reset is capped at $35.0 million. Omnibus Agreement During the first quarter of 2018, the Company entered into an Omnibus Agreement with Welltower and Omega, pursuant to which Welltower and Omega committed to provide up to $40.0 million in new term loans and amend the current term loan agreement to, among other things, accommodate a refinancing of the Company’s existing asset based credit facility, in each case subject to certain conditions, including the completion of a restructuring of certain of the Company’s other material debt and lease obligations. The Omnibus Agreement also provided that upon satisfying certain conditions, including raising new capital that is used to pay down certain indebtedness owed to Welltower and Omega, (a) $50.0 million of outstanding indebtedness owed to Welltower would be written off and (b) the Company may request conversion of not more than $50.0 million of the outstanding balance of the Company’s Welltower Real Estate Loans into equity. If the proposed equity conversion would result in any adverse REIT qualification, status or compliance consequences to Welltower, then the debt that would otherwise be converted to equity shall instead be converted into a loan incurring paid in kind interest at 2% per annum compounded quarterly, with a term of ten years commencing on the date the applicable conditions precedent to the equity conversion have been satisfied. Moreover, the Company agreed to support Welltower in connection with the sale of certain of Welltower’s interests in facilities covered by the Welltower Master Lease, including negotiating and entering into definitive new master lease agreements with third party buyers. The conditions described above have not been satisfied as of December 31, 2019. In connection with the Omnibus Agreement, the Company agreed to issue warrants to Welltower and Omega to purchase 900,000 shares and 600,000 shares, respectively, of the Company’s Class A Common Stock at an exercise price equal to $1.33 per share. Issuance of the warrant to Welltower is subject to the satisfaction of certain conditions, which had not occurred as of December 31, 2019. The warrants may be exercised at any time during the period commencing six months from the date of issuance and ending five years from the date of issuance.

Net Revenues and Accounts Recei

Net Revenues and Accounts Receivable	12 Months Ended
	Dec. 31, 2019
Net Revenues and Accounts Receivable
Net Revenues and Accounts Receivable	(5) Net Revenues and Accounts Receivable Revenue Streams Inpatient Services The Company generates revenues primarily by providing services to patients within its facilities. The Company uses interdisciplinary teams of experienced medical professionals to provide services prescribed by physicians. These teams include registered nurses, licensed practical nurses, certified nursing assistants and other professionals who provide individualized comprehensive nursing care. Many of the Company’s facilities are equipped to provide specialty care, such as on-site dialysis, ventilator care, cardiac and pulmonary management, as well as standard services, such as room and board, special nutritional programs, social services, recreational activities and related healthcare and other services. The Company assesses collectibility on all accounts prior to providing services. Rehabilitation Therapy Services The Company generates revenues by providing rehabilitation therapy services, including speech-language pathology, physical therapy, occupational therapy and respiratory therapy at its skilled nursing facilities and assisted/senior living facilities, as well as facilities of third-party skilled nursing operators and other outpatient settings. The majority of revenues generated by rehabilitation therapy services rendered are billed to contracted third party providers. Other Services The Company generates revenues by providing an array of other specialty medical services, including physician services, staffing services, and other healthcare related services. Disaggregation of Revenues The Company disaggregates revenue from contracts with customers by reportable operating segments and payor type. The Company notes that disaggregation of revenue into these categories achieves the disclosure objectives to depict how the nature, amount, timing and uncertainty of revenue and cash flows are affected by economic factors. The payment terms and conditions within the Company's revenue-generating contracts vary by contract type and payor source. Payments are generally received within 30 to 60 days after billing. See Note 7 – “ Segment Information .” The composition of net revenues by payor type and operating segment for the years ended December 31, 2019 and 2018 are as follows (in thousands): Year ended December 31, 2019 Rehabilitation Inpatient Therapy Other Services Services Services Total Medicare $ 800,253 $ 90,811 $ — $ 891,064 Medicaid 2,313,479 2,144 — 2,315,623 Insurance 463,135 22,273 — 485,408 Private 310,022 296 — 310,318 Third party providers — 336,509 78,709 415,218 Other 69,143 10,513 68,547 148,203 Total net revenues $ 3,956,032 $ 462,546 $ 147,256 $ 4,565,834 Year ended December 31, 2018 Rehabilitation Inpatient Therapy Other Services Services Services Total Medicare $ 913,615 $ 89,514 $ — $ 1,003,129 Medicaid 2,461,228 2,096 — 2,463,324 Insurance 517,512 23,071 — 540,583 Private 339,680 438 — 340,118 Third party providers — 415,541 83,952 499,493 Other 64,838 17,254 47,911 130,003 Total net revenues $ 4,296,873 $ 547,914 $ 131,863 $ 4,976,650 (1) Includes Assisted/Senior living revenue of $93.1 million and $96.1 million for the years ended December 31, 2019 and 2018, respectively. Such amounts do not represent contracts with customers under Topic 606. (2) Primarily consists of revenue from Veteran Affairs and administration of third party facilities. (3) Includes net revenues from all payors generated by the other services, excluding third party providers.

Earnings (Loss) Per Share

Earnings (Loss) Per Share	12 Months Ended
	Dec. 31, 2019
Earnings (Loss) Per Share
Earnings (Loss) Per Share	(6) 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 each of the other two classes, representing the voting interests of the legacy FC-GEN Operations Investment, LLC (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 income (loss) attributable to Genesis Healthcare, Inc. by the weighted-average number of outstanding common shares for the period. Diluted EPS is computed by dividing net income (loss) attributable to Genesis Healthcare, Inc. plus the effect of any assumed conversions of noncontrolling interests by the weighted-average number of outstanding common shares after giving effect to all potential dilutive common stock. A reconciliation of the numerator and denominator used in the calculation of basic net income (loss) per common share follows (in thousands, except per share data): Year ended December 31, 2019 2018 Numerator: Net income (loss) $ 7,474 $ (372,417) Less: Net loss attributable to noncontrolling interests 7,145 137,186 Net income (loss) attributable to Genesis Healthcare, Inc. $ 14,619 $ (235,231) Denominator: Weighted-average shares outstanding for basic net income (loss) per share 107,286 101,007 Basic net income (loss) per common share attributable to Genesis Healthcare, Inc. $ 0.14 $ (2.33) A reconciliation of the numerator and denominator used in the calculation of diluted net income (loss) per common share follows (in thousands, except per share data): Year ended December 31, 2019 2018 Numerator: Net income (loss) $ 7,474 $ (372,417) Less: Net loss attributable to noncontrolling interests 7,145 137,186 Net income (loss) attributable to Genesis Healthcare, Inc. $ 14,619 $ (235,231) Plus: Assumed conversion of noncontrolling interests 1,868 — Net income (loss) available to common stockholders after assumed conversions $ 16,487 $ (235,231) Denominator: Weighted-average common shares outstanding 107,286 101,007 Plus: Assumed conversion of noncontrolling interests 57,074 — Plus: Unvested restricted stock units and stock warrants 954 — Adjusted weighted-average common shares outstanding, diluted 165,314 101,007 Diluted net income (loss) per common share attributable to Genesis Healthcare, Inc. $ 0.10 $ (2.33) As the Company was in a net loss position for the year ended December 31, 2018, the computation of diluted net loss per common share for this period excludes the effects of 61.5 million anti-dilutive shares attributable to the assumed conversion of noncontrolling interests, unvested restricted stock units, and stock warrants. As of December 31, 2018, there were 59.7 million units attributable to the noncontrolling interests outstanding. In the year ended December 31, 2018, the Company issued a warrant to purchase 600,000 shares of its Class A common stock at an exercise price of $1.33 per share, exercisable beginning on September 6, 2018 and ending on March 6, 2023. See Note 4 – “ Significant Transactions and Events – Restructuring Transactions – Omnibus Agreement.” In the year ended December 31, 2017, the Company issued a warrant to purchase 900,000 shares of its Class A common stock at an exercise price of $1.00 per share, exercisable through December 30, 2022.

Segment Information

Segment Information	12 Months Ended
	Dec. 31, 2019
Segment Information
Segment Information	(7) 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 Information – Description of Business .” A summary of the Company’s segmented revenues follows (in thousands, except percentages): Year ended December 31, 2019 2018 Increase / (Decrease) Revenue Revenue Revenue Revenue Dollars Percentage Dollars Percentage Dollars Percentage Revenues: Inpatient services: Skilled nursing facilities $ 3,857,793 84.4 % $ 4,195,596 84.3 % $ (337,803) (8.1) % Assisted/Senior living facilities 93,054 2.0 % 95,571 1.9 % (2,517) (2.6) % Administration of third party facilities 8,310 0.2 % 8,733 0.2 % (423) (4.8) % Elimination of administrative services (3,125) (0.1) % (3,027) — % (98) (3.2) % Inpatient services, net 3,956,032 86.5 % 4,296,873 86.4 % (340,841) (7.9) % Rehabilitation therapy services: Total therapy services 738,124 16.2 % 889,069 17.9 % (150,945) (17.0) % Elimination of intersegment rehabilitation therapy services (275,578) (6.0) % (341,155) (6.9) % 65,577 19.2 % Third party rehabilitation therapy services, net 462,546 10.2 % 547,914 11.0 % (85,368) (15.6) % Other services: Total other services 198,920 4.4 % 161,038 3.2 % 37,882 23.5 % Elimination of intersegment other services (51,664) (1.1) % (29,175) (0.6) % (22,489) (77.1) % Third party other services, net 147,256 3.3 % 131,863 2.6 % 15,393 11.7 % Net revenues $ 4,565,834 100.0 % $ 4,976,650 100.0 % $ (410,816) (8.3) % A summary of the Company’s condensed consolidated statement of operations follows (in thousands): Year ended December 31, 2019 Rehabilitation Inpatient Therapy Other Services Services Services Corporate Eliminations Consolidated Net revenues $ 3,959,157 $ 738,124 $ 198,676 $ 244 $ (330,367) $ 4,565,834 Salaries, wages and benefits 1,761,273 601,196 122,541 — — 2,485,010 Other operating expenses 1,599,549 44,088 62,104 — (330,894) 1,374,847 General and administrative costs — — — 144,471 — 144,471 Lease expense 382,897 1,297 1,463 1,406 — 387,063 Depreciation and amortization expense 99,529 12,230 720 10,775 (95) 123,159 Interest expense 83,887 55 35 97,831 (1,416) 180,392 Gain on early extinguishment of debt — — — (122) — (122) Investment income — — — (8,712) 1,416 (7,296) Other (income) loss (172,709) (926) 112 18 — (173,505) Transaction costs — — — 26,362 — 26,362 Long-lived asset impairments 16,937 — — — — 16,937 Equity in net loss (income) of unconsolidated affiliates — — — 4,091 (4,803) (712) Income (loss) before income tax expense 187,794 80,184 11,701 (275,876) 5,425 9,228 Income tax expense — — — 1,754 — 1,754 Net income (loss) $ 187,794 $ 80,184 $ 11,701 $ (277,630) $ 5,425 $ 7,474 Year ended December 31, 2018 Rehabilitation Inpatient Therapy Other Services Services Services Corporate Eliminations Consolidated Net revenues $ 4,299,900 $ 889,069 $ 160,913 $ 125 $ (373,357) $ 4,976,650 Salaries, wages and benefits 1,944,091 733,763 109,054 — — 2,786,908 Other operating expenses 1,740,537 51,590 61,110 — (373,357) 1,479,880 General and administrative costs — — — 149,182 — 149,182 Lease expense 127,323 — 1,289 1,247 — 129,859 Depreciation and amortization expense 193,930 12,779 684 13,503 — 220,896 Interest expense 367,562 55 36 96,085 — 463,738 Loss on early extinguishment of debt — — — 391 — 391 Investment income — — — (6,832) — (6,832) Other (income) loss (14,872) 1,942 78 (68) — (12,920) Transaction costs — — — 31,953 — 31,953 Long-lived asset impairments 104,997 — — — — 104,997 Goodwill and identifiable intangible asset impairments 3,538 — — — — 3,538 Equity in net (income) loss of unconsolidated affiliates — — — (1,608) 1,508 (100) (Loss) income before income tax benefit (167,206) 88,940 (11,338) (283,728) (1,508) (374,840) Income tax benefit — — — (2,423) — (2,423) Net (loss) income $ (167,206) $ 88,940 $ (11,338) $ (281,305) $ (1,508) $ (372,417) The following table presents the segment assets as of December 31, 2019 compared to December 31, 2018 (in thousands): December 31, 2019 December 31, 2018 Inpatient services $ 4,221,579 $ 3,735,778 Rehabilitation therapy services 281,978 329,687 Other services 49,877 36,240 Corporate and eliminations 108,706 161,918 Total assets $ 4,662,140 $ 4,263,623

Restricted Investments in Marke

Restricted Investments in Marketable Securities	12 Months Ended
	Dec. 31, 2019
Restricted Investments in Marketable Securities
Restricted Investments in Marketable Securities	(8) The current portion of restricted investments in marketable securities principally represents an estimate of the level of outstanding self-insured losses the Company expects to pay in the succeeding year through its wholly-owned captive insurance company. See Note 21 – “ Commitments and Contingencies – Loss Reserves For Certain Self-Insured Programs .” Restricted investments in marketable securities at December 31, 2019 consist of the following (in thousands): Unrealized losses Amortized Unrealized Less than Greater than cost gains 12 months 12 months Fair value Restricted investments in marketable securities: Mortgage/government backed securities $ 20,957 $ 90 $ (17) $ (7) $ 21,023 Corporate bonds 48,362 566 — (2) 48,926 Government bonds 66,734 286 (22) (5) 66,993 $ 136,053 $ 942 $ (39) $ (14) 136,942 Less: Current portion of restricted investments (31,855) Long-term restricted investments $ 105,087 Restricted investments in marketable securities at December 31, 2018 consist of the following (in thousands): Unrealized losses Amortized Unrealized Less than Greater than cost gains 12 months 12 months Fair value Restricted investments in marketable securities: Mortgage/government backed securities $ 11,945 $ 4 $ — $ (130) $ 11,819 Corporate bonds 56,199 49 (42) (387) 55,819 Government bonds 68,767 76 (2) (326) 68,515 $ 136,911 $ 129 $ (44) $ (843) 136,153 Less: Current portion of restricted investments (35,631) Long-term restricted investments $ 100,522 Maturities of restricted investments yielded proceeds of $69.2 million and $65.7 million for the years ended December 31, 2019 and 2018, respectively. Sales of investments yielded proceeds of $2.0 million and $3.5 million for the years ended December 31, 2019 and 2018, respectively. Associated gross realized gain and loss for the years ended December 31, 2019 and 2018 were de minimis. The majority of the Company’s investments are investment grade government and corporate debt securities that have maturities of five years or less. The Company generally holds the investments until maturity. Restricted investments in marketable securities held at December 31, 2019 mature as follows (in thousands): Amortized Fair cost value Due in one year or less $ 46,681 $ 46,766 Due after 1 year through 5 years 86,372 87,165 Due after 5 years through 10 years — — Due after 10 years 3,000 3,011 $ 136,053 $ 136,942 Actual maturities may differ from stated maturities because borrowers may have the right to call or prepay certain obligations and may exercise that right with or without prepayment penalties. The Company has issued letters of credit totaling $125.0 million at December 31, 2019 to its third party administrators and excess insurance carriers. Restricted cash of $0.7 million and restricted investments with an amortized cost of $136.1 million and a fair value of $136.9 million are pledged as security for these letters of credit as of December 31, 2019.

Property and Equipment

Property and Equipment	12 Months Ended
	Dec. 31, 2019
Property and Equipment
Property and Equipment	(9) Property and equipment consisted of the following as of December 31, 2019 and 2018 (in thousands): December 31, 2019 December 31, 2018 Land, buildings and improvements $ 1,004,447 $ 469,575 Finance lease land, buildings and improvements — 693,546 Financing obligation land, buildings and improvements — 2,274,211 Equipment, furniture and fixtures 386,248 417,684 Construction in progress 2,771 9,340 Gross property and equipment 1,393,466 3,864,356 Less: accumulated depreciation (431,361) (976,802) Net property and equipment $ 962,105 $ 2,887,554 On January 1, 2019, the Company derecognized net financing obligation land and buildings of $1.7 billion and reclassified net finance lease land and buildings of $0.6 billion to finance lease ROU assets within the consolidated balance sheets due to the adoption of Topic 842. See Note 2 – “Summary of Significant Accounting Policies – Recently Adopted Accounting Pronouncements” and Note 10 – “Leases.” Additionally, improvements of approximately $12.7 million and $73.6 million, which were historically associated with finance leases (referred to as “capital leases” prior to the adoption of Topic 842) and financing obligations, respectively, have been reclassified to “Land, buildings and improvements.” During 2019, the Company identified a buyer for eight facilities located in California. Seven of these facilities were sold in 2019, resulting in a net reduction of property and equipment of $36.9 million, and closure of the eighth is pending regulatory approval. At December 31, 2019, net property and equipment of $16.3 million attributable to one California skilled nursing facility remains classified as held for sale. The property and equipment of these facilities was primarily classified in the “Land, buildings and improvements” line item as of December 31, 2018. See Note 4 – “Significant Transactions and Events – Divestiture of Non-Strategic Facilities – 2019 Divestitures – California Divestitures ” and Note 20 – “Assets Held for Sale.” During the year ended December 31, 2019, the Company sold the real property of eight facilities and consolidated the property and equipment of the Next Partnership and the Vantage Point Partnership. See Note 4 – “ Significant Transactions and Events – Strategic Partnerships .” The sales resulted in a net reduction of property and equipment of $29.4 million, while the consolidation of the partnerships resulted in an increase of $512.7 million, both of which were primarily classified in the “Land, buildings and improvements” line item. During the year ended December 31, 2019, the Company recognized long-lived asset impairment charges resulting in the reduction of net property and equipment of $10.7 million. See Note 19 – “ Asset Impairment Charges – Long-Lived Assets with a Definite Useful Life.”

Leases

Leases	12 Months Ended
	Dec. 31, 2019
Leases
Lessee operating and finance leases	(10) The Company leases the majority of the skilled nursing facilities and assisted/senior living facilities used in its operations, most of which are subject to triple-net leases, meaning that in addition to rent, the Company is responsible for paying property taxes, insurance, and maintenance and repair costs. As of December 31, 2019, the Company leased approximately 78% of its centers; 45% were leased pursuant to master lease agreements with four landlords. The Company also leases certain office space, land, and equipment. The Company’s real estate leases generally have initial lease terms of 10 to 15 years or more and typically include one or more options to renew, with renewal terms that generally extend the lease term for an additional five to ten years or more. Exercise of the renewal options is generally subject to the satisfaction of certain conditions which vary by contract and generally follow payment terms that are consistent with those in place during the initial term. The Company assesses renewal options using a “reasonably certain” threshold, which is understood to be a high threshold and, therefore, the majority of its leases’ terms do not include renewal periods when measuring the lease liability. For leases where the Company is reasonably certain to exercise its renewal option, the option periods are included within the lease term and, therefore, the measurement of the ROU asset and lease liability. The payment structure of the Company’s leases generally contain annual escalation clauses that are either fixed or variable in nature, some of which are dependent upon published indices. Leases with an initial term of 12 months or less are not recorded on the balance sheet; expense for these leases is recognized on a straight-line basis over the lease term as an other operating expense. Certain leases include options for the Company to purchase the leased asset. For such leases, the Company assesses the likelihood of exercising the purchase option using a “reasonably certain” threshold, which is understood to be a high threshold and, therefore, purchase options are generally assumed to be exercised when a compelling economic reason to exercise the option exists. Certain leases include options to terminate the lease, the terms and conditions of which vary by contract. Such options allow the contract parties to terminate their obligations under the lease contract, typically in return for an agreed financial consideration. The Company’s lease agreements do not contain any material residual value guarantees. The Company leases certain facilities from affiliates of related parties. See Note 16 – “Related Party Transactions.” The Company makes certain assumptions in determining the discount rate. As most of the Company’s leases do not provide an implicit rate, the Company uses its incremental borrowing rate for collateralized borrowings, based on the information available at commencement date, in determining the present value of lease payments. In order to apply the incremental borrowing rate, a portfolio approach was utilized to group assets based on similar lease terms in a manner whereby the Company reasonably expects that the application does not differ materially from application to individual leases. Subsequent to lease commencement date, the Company reassesses lease classification when there is a contract modification that is not accounted for as a separate contract, a change in lease term, or a change in the assessment of whether the lessee is reasonably certain to exercise an option to purchase the underlying asset. This reassessment is made using current facts, circumstances and conditions. As a result of a lease’s modification, the remaining consideration in the contract is reallocated to lease and non-lease components, as applicable, and the lease liability is remeasured using the applicable discount rate at the effective date of the modification. The remeasurement of the lease liability will result in adjustment to the corresponding ROU asset, unless the lease is fully or partially terminated, in which case, a gain or loss will be recognized. Lease Transactions During the year ended December 31, 2019, the Company amended, extended and terminated the leases with respect to numerous facilities subject to material lease agreements, resulting in ROU asset and liability adjustments. See Note 4 – “Significant Transactions and Events – Lease Transactions.” During the year ended December 31, 2019, the Company recognized impairment charges resulting in the reduction of Asset Impairment Charges – Long-Lived Assets with a Definite Useful Life.” The maturity of total operating and finance lease obligations at December 31, 2019 is as follows (in thousands): Year ending December 31, Operating Leases Finance Leases (1) 2020 $ 382,926 $ 7,659 2021 386,440 7,468 2022 384,450 7,264 2023 382,649 7,032 2024 388,091 6,812 Thereafter 3,045,668 35,886 Total lease payments 4,970,224 72,121 Less interest (2,147,934) (29,947) Total lease obligations 2,822,290 42,174 Less current portion (140,887) (2,839) Long-term lease obligations $ 2,681,403 $ 39,335 (1) Finance lease payments include $37.2 million related to options to renew lease terms that are reasonably certain of being exercised. The Company’s future minimum commitments under finance leases (formerly capital leases), financing obligations, and operating leases as of December 31, 2018 were as follows (in thousands): Year ending December 31, Finance Leases Financing Obligations Operating Leases 2019 $ 88,793 $ 237,335 $ 110,755 2020 89,397 242,052 109,391 2021 91,292 245,311 106,031 2022 93,281 242,214 84,003 2023 95,376 247,852 76,701 Thereafter 3,325,042 6,661,624 373,753 Total future minimum lease payments 3,783,181 7,876,388 $ 860,634 Less amount representing interest (2,813,068) (5,141,448) Total lease obligation 970,113 2,734,940 Less current portion (2,171) (2,001) Long-term obligation $ 967,942 $ 2,732,939 The following table provides lease costs by expense line item on the consolidated statements of operations for the year ended December 31, 2019: Year ended Lease Cost Classification December 31, 2019 Operating lease cost Lease expense $ 387,063 Finance lease cost: Amortization of finance lease right-of-use assets Depreciation and amortization expense 16,224 Interest on finance lease obligations Interest expense 50,162 Total finance lease expense 66,386 Variable lease cost Other operating expenses 37,841 Short-term leases Other operating expenses 24,297 Total lease cost $ 515,587 The following table provides remaining lease term and discount rates by lease classification as of December 31, 2019: Lease Term and Discount Rate December 31, 2019 Weighted-average remaining lease term (years) Operating leases 12.6 Finance leases 10.2 Weighted-average discount rate Operating leases Finance leases The following table includes supplemental lease information for the year ended December 31, 2019 (in thousands): Year ended Other information December 31, 2019 Cash paid for amounts included in the measurement of lease obligations Operating cash flows from operating leases $ 364,334 Operating cash flows from finance leases 47,188 Financing cash flows from finance leases 2,645 Right-of-use assets obtained in exchange for new lease obligations Operating leases 96,718 Finance leases 1,160 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. These leases include cross-default provisions with each other and certain material debt instruments. The Company has master lease agreements with Welltower, Sabra, Omega and Second Spring (collectively, the Master Lease Agreements). The Master Lease Agreements each contain a number of financial, affirmative and negative covenants, including a maximum leverage ratio, a minimum fixed charge coverage ratio, and minimum liquidity. At December 31, 2019, the Company is in compliance with the financial covenants contained in the Master Lease Agreements. The Company has two master lease agreements with Cindat Best Years Welltower JV LLC (CBYW) involving 28 of its facilities. The Company did not meet certain financial covenants contained in one of the master lease agreements involving two of its facilities at December 31, 2019. On March 9, 2020, the Company received a waiver for these covenant breaches through April 1, 2021. At December 31, 2019, the Company is in compliance with the financial covenants contained in the other master lease agreement. At December 31, 2019, the Company did not meet certain financial covenants contained in one lease related to two of its facilities. The Company is, and expects to continue to be, current in the timely payment of its obligations under this lease. The lease does not have cross default provisions, nor does it trigger cross default provisions in any of the Company’s other loan or lease agreements. The Company will continue to work with the related credit party to amend the lease and the related financial covenants. The Company does not believe the breach of such financial covenants at December 31, 2019 will have a material adverse impact on its financial condition or results of operations. The Company has been afforded certain cure rights to such defaults by posting collateral in the form of additional letters of credit or security deposit. 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, absent necessary and timely waivers and/or amendments, be in default under certain of its existing lease agreements. To the extent any cross-default provisions may apply, the default would have an even more significant impact on the Company’s financial position.

Goodwill and Identifiable Intan

Goodwill and Identifiable Intangible Assets	12 Months Ended
	Dec. 31, 2019
Goodwill and Identifiable Intangible Assets
Goodwill and Identifiable Intangible Assets	(11) Goodwill is an asset representing the future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized. The changes in the carrying value of goodwill are as follows (in thousands): Rehabilitation Therapy Services Other Services Consolidated Balance at December 31, 2018 Goodwill 73,814 11,828 85,642 Accumulated impairment losses — — — $ 73,814 $ 11,828 $ 85,642 Balance at December 31, 2019 Goodwill 73,814 11,828 85,642 Accumulated impairment losses — — — $ 73,814 $ 11,828 $ 85,642 During the year ended December 31, 2017, as a result of changes in the regulatory and reimbursement environment, the Company performed a quantitative impairment test for all reporting units, the results of which indicated that the carrying value of the inpatient reporting unit exceeded its fair value. Consequently, the Company recorded an impairment of $351.5 million, representing the entire balance of goodwill associated with the inpatient reporting unit. Identifiable intangible assets consist of the following at December 31, 2019 and 2018 (in thousands): December 31, 2019 Weighted Average Remaining Life (Years) Customer relationship assets, net of accumulated amortization of $76,243 $ 36,891 8 Trade names 50,555 Indefinite Identifiable intangible assets $ 87,446 December 31, 2018 Weighted Average Remaining Life (Years) Customer relationship assets, net of accumulated amortization of $65,756 $ 47,077 8 Favorable leases, net of accumulated amortization of $33,404 21,449 10 Trade names 50,556 Indefinite Identifiable intangible assets $ 119,082 Identifiable intangible assets consist of customer relationship assets, favorable lease contracts and trade names.  Customer relationship assets exist in the Company’s rehabilitation services, respiratory services, management services and medical staffing businesses. These assets are amortized on a straight-line basis over the expected period of benefit.  Favorable lease contracts represented the estimated value of future cash outflows of operating lease contracts compared to lease rates that could be negotiated in an arms-length transaction at the time of measurement. Favorable lease contracts were amortized on a straight-line basis over the lease terms. Upon the Company’s adoption of Topic 842, the existing favorable lease balances were included in the measurement of the new operating lease ROU assets. See Note 2 – “Summary of Significant Accounting Policies – Recently Adopted Accounting Pronouncements.”  The Company’s trade names have value, in particular in the rehabilitation business which markets its services to other providers of skilled nursing and assisted/senior living services. The trade name asset has an indefinite life and is measured no less than annually or if indicators of potential impairment become apparent. Amortization expense related to customer relationship assets, which is included in depreciation and amortization expense, for the years ended December 31, 2019 and 2018 was $10.5 million and $10.5 million, respectively. Amortization expense related to favorable leases, which was included in lease expense, for the year ended December 31, 2018 was $6.5 million. Based upon amounts recorded at December 31, 2019, amortization expense related to identifiable intangible assets is estimated to be $5.2 million in 2020, $5.1 million in 2021, $5.0 million in 2022, $4.6 million in 2023, and $4.6 million in 2024 and $12.4 million, thereafter. The Company recorded no asset impairment charges related to identifiable intangible assets during the year ended December 31, 2019. During the year ended December 31, 2018, the Company recorded a $3.5 million impairment of favorable lease assets associated with underperforming properties, which is included in goodwill and identifiable asset impairments on the consolidated statements of operations. See Note 19 – “ Asset Impairment Charges – Identifiable Intangible Assets with a Definite Useful Life .”

Long-Term Debt

Long-Term Debt	12 Months Ended
	Dec. 31, 2019
Long-Term Debt.
Long-Term Debt	(12) Long-term debt at December 31, 2019 and 2018 consisted of the following (in thousands): December 31, 2019 December 31, 2018 Asset based lending facilities, net of debt issuance costs of $8,615 and $11,335 at December 31, 2019 and December 31, 2018, respectively $ 412,346 $ 419,289 Term loan agreements, net of debt issuance costs of $1,084 and $1,851 and debt premium balance of $4,816 and $8,446 at December 31, 2019 and December 31, 2018, respectively 196,714 184,652 Real estate loans, net of debt issuance costs of $3,846 and $5,360 and debt premium balance of $19,328 and $28,992 at December 31, 2019 and December 31, 2018, respectively 265,700 307,690 HUD insured loans, net of debt issuance costs of $2,909 and $5,247 and debt premium balance of $0 and $860 at December 31, 2019 and December 31, 2018, respectively 117,117 181,762 Notes payable 116,952 81,398 Mortgages and other secured debt (recourse) 6,369 4,190 Mortgages and other secured debt (non-recourse), net of debt issuance costs of $9,349 and $187 and debt premium balance of $1,422 and $1,520 at December 31, 2019 and December 31, 2018, respectively 498,222 26,483 1,613,420 1,205,464 Less: Current installments of long-term debt (162,426) (122,531) Long-term debt $ 1,450,994 $ 1,082,933 Asset Based Lending Facilities On March 6, 2018, the Company entered into a new asset based lending facility agreement with MidCap. The agreement initially provided for a $555.0 million asset based lending facility comprised of (a) a $325.0 million first lien term loan facility, (b) a $200.0 million first lien revolving credit facility and (c) a $30.0 million delayed draw term loan facility (collectively, the ABL Credit Facilities). The commitments under the delayed draw term loan facility will be reduced to $27.5 million on March 31, 2020, $25.0 million on June 30, 2020, $22.5 million on September 30, 2020, and $20.0 million on December 31, 2020 and thereafter. On June 5, 2019, the ABL Credit Facilities were amended to simultaneously increase the aggregate revolving credit facility commitment by $40.0 million and partially prepay the first lien term loan facility by $40.0 million. The resulting commitment levels of the revolving credit facility and first lien term loan facility were $240.0 million and $285.0 million, respectively. The ABL Credit Facilities have a five-year term set to mature on March 6, 2023. The ABL Credit Facilities include a springing maturity clause that would accelerate its maturity 90 days prior to the maturity of the Term Loan Agreements, Welltower Real Estate Loans or MidCap Real Estate Loans (as defined below), in the event those agreements are not extended or refinanced. The revolving credit facility includes a swinging lockbox arrangement whereby the Company transfers all funds deposited within its designated lockboxes to MidCap on a daily basis and then draws from the revolving credit facility as needed. The Company has presented the entire revolving credit facility borrowings balance of $136.0 million in current installments of long-term debt at December 31, 2019. Despite this classification, the Company expects that it will have the ability to borrow and repay on the revolving credit facility through its maturity date. Cash proceeds of $50.6 million received under the ABL Credit Facilities remain in a restricted account. This amount is pledged to cash collateralize letters of credit previously issued under the retired revolving credit facilities. The Company has classified this deposit and all cash account balances subject to deposit account control agreements that were sprung under the ABL Credit Facilities as restricted cash and equivalents within the consolidated balance sheets at December 31, 2019 and 2018. Borrowings under the term loan and revolving credit facility components of the ABL Credit Facilities bear interest at a 90-day LIBOR rate (subject to a floor of 0.5%) plus an applicable margin of 6%. Borrowings under the delayed draw component bear interest at a 90-day LIBOR rate (subject to a floor of 1%) plus an applicable margin of 11%. Borrowing levels under the term loan and revolving credit facility components of the ABL Credit Facilities are limited to a borrowing base that is computed based upon the level of eligible accounts receivable. In addition to paying interest on the outstanding principal borrowed under the revolving credit facility, the Company is required to pay a commitment fee to the lenders for any unutilized commitments. The commitment fee rate equals 0.5% per annum on the revolving credit facility and 2% on the delayed draw term loan facility. The term loan facility and revolving credit facility include a termination fee equal to 2% if the loans are prepaid within the first two years and 1.5% thereafter. The term loan facility and revolving credit facility include an exit fee equal to $1.6 million and $1.0 million, respectively, due and payable on the earlier of the loan’s retirement or on the maturity date. The ABL Credit Facilities contain representations and warranties, affirmative covenants, negative covenants, financial covenants and events of default and security interests that are customarily required for similar financings. Financial covenants include a minimum consolidated fixed charge coverage ratio, a maximum leverage ratio and minimum liquidity. Borrowings and interest rates under the ABL Credit Facilities were as follows at December 31, 2019 (dollars in thousands): Weighted Average ABL Credit Facilities Commitment Borrowings Interest Term loan facility $ 285,000 $ 285,000 7.91 % Revolving credit facility (Non-HUD) 168,000 78,860 7.91 % Revolving credit facility (HUD) 72,000 27,101 7.91 % Delayed draw term loan facility 30,000 30,000 12.91 % $ 555,000 $ 420,961 8.26 % As of December 31, 2019, the Company had a total borrowing base capacity of $436.5 million with outstanding borrowings under the ABL Credit Facilities of $421.0 million, leaving the Company with approximately $15.5 million of available borrowing capacity under the ABL Credit Facilities. Term Loan Agreements The Company and certain of its affiliates, including FC-GEN (the Borrower) are party to a term loan agreement, as amended (the Term Loan Agreement) with an affiliate of Welltower and an affiliate of Omega. The Term Loan Agreement originally provided for term loans (the Term Loans) in the aggregate principal amount of $120.0 million and later expanded to $160.0 million. The Term Loan Agreement was amended on May 9, 2019 to extend the maturity date from July 29, 2020 to November 30, 2021. The original Term Loan for $120.0 million bears interest at a rate equal to 14.0% per annum, with up to 9.0% per annum to be paid in kind. The additional Term Loan for $40.0 million bears interest at a rate equal to 10.0% per annum, with up to 5.0% per annum to be paid in kind. The Term Loans had an outstanding accreted principal balance of $193.0 million and $178.1 million at December 31, 2019 and 2018, respectively. The Term Loan Agreement is secured by a first priority lien on the equity interests of the subsidiaries of the Company and the Borrower as well as certain other assets of the Company, the Borrower and their subsidiaries, subject to certain exceptions. The Term Loan Agreement is also secured by a junior lien on the assets that secure the ABL Credit Facilities on a first priority basis. Welltower and Omega, or their respective affiliates, are each currently landlords under certain master lease agreements to which the Company and/or its affiliates are tenants. The Term Loan Agreement contains financial, affirmative and negative covenants, and events of default that are customary for debt securities of this type. Financial covenants include maintenance covenants which require the Company to maintain a maximum leverage ratio, a minimum interest coverage ratio and a minimum fixed charge coverage ratio. The most restrictive financial covenant is the minimum interest coverage ratio which requires the Company to maintain a coverage ratio, as defined therein, of no less than 1.70 to 1.0 through December 31, 2020 and increasing to 1.80 to 1.0 thereafter. Real Estate Loans On March 30, 2018, the Company entered into two real estate loans with MidCap (MidCap Real Estate Loans) with combined available proceeds of $75.0 million. The MidCap Real Estate Loans are secured by 12 skilled nursing facilities and are subject to a five-year term maturing on March 30, 2023. The maturity of the MidCap Real Estate Loans will accelerate in the event the ABL Credit Facilities are repaid in full and terminated. The loans, which were interest only in the first year, are subject to an annual interest rate equal to 30-day LIBOR (subject to a floor of 1.5%) plus an applicable margin of 5.85%. Beginning April 1, 2019, mandatory principal payments commenced with the balance of the loans to be repaid at maturity. Proceeds from the MidCap Real Estate Loans were used to repay partially the Welltower Real Estate Loans (defined below). On November 8, 2018, one of the MidCap Real Estate Loans was amended with an additional borrowing of $10.0 million. The proceeds were used to retire a maturing mortgage loan on a corporate office building. The office building has been added as collateral and the loan maturity remains March 30, 2023. The $10.0 million additional loan is subject to an annual interest rate equal to 30-day LIBOR (subject to a floor of 2.0%) plus an applicable margin of 6.25% with principal amortizing immediately and the balance due at maturity. On May 1, 2019, the Company divested the real property and operations of five skilled nursing facilities in California, three of which were subject to the MidCap Real Estate Loans. The Company used the sale proceeds to repay $27.7 million on the MidCap Real Estate Loans. During the third quarter of 2019, the Company divested the real property of two skilled nursing facilities in New Jersey and one skilled nursing facility in Maryland that were subject to the MidCap Real Estate Loans and used the sale proceeds to repay $12.1 million on the loans. See Note 4 – “Significant Transactions and Events – Strategic Partnerships – Vantage Point Partnership.” The MidCap Real Estate Loans had an outstanding principal balance of $42.2 million and $83.0 million at December 31, 2019 and 2018, respectively. The Company is subject to multiple real estate loan agreements with Welltower (Welltower Real Estate Loans). The Welltower Real Estate Loans are 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 Welltower Real Estate Loans. Each Welltower Real Estate Loan has a maturity date of January 1, 2022 and an annual interest rate of 12.0%, of which 7.0% will be paid in cash and 5.0% will be paid in kind. The Company has agreed to make commercially reasonable efforts to secure commitments to repay no less than $105.0 million of the Welltower Real Estate Loan obligations. As of December 31, 2019, the Company has not yet secured the total required repayments or commitments. As a result, the annual cash component of the interest payments was increased by approximately $2.0 million with a corresponding decrease in the paid in kind component of interest. At December 31, 2019, the Welltower Real Estate Loans are secured by a mortgage lien on the real property and a second lien on certain receivables of the operator of the one remaining facility subject to the Welltower Real Estate Loans. The Welltower Real Estate Loans contain a conversion option, whereby up to $50.0 million of the balance can be converted into Class A common stock of the Company or a 10-year note bearing 2% paid in kind interest. The conversion option is available to the Company upon the satisfaction of certain conditions, the most significant include: the raise of new capital and application thereof to existing Welltower debt instruments, the repayment of $105.0 million to Welltower, as described above, the partial repayment of the Term Loans, and the partial repayment of the Welltower Real Estate Loans, such that the remaining outstanding principal balance does not exceed $50.0 million. The Welltower Real Estate Loans had an outstanding accreted principal balance of $208.0 million and $201.1 million at December 31, 2019 and 2018, respectively. HUD Insured Loans As of December 31, 2019, the Company has 16 owned skilled nursing facility loans insured by HUD. The HUD insured loans have an original amortization term ranging from 30 to 35 years and an average remaining term of 29 years with fixed interest rates ranging from 3.0% to 3.5% and a weighted average interest rate of 3.3%. 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 thereafter. Any further HUD insured loans will require additional HUD approval. The HUD insured loans for owned facilities had an aggregate principal balance of $140.6 million and $210.0 million at December 31, 2019 and 2018, respectively. The loan of one facility in California was classified as held for sale at December 31, 2019. This loan had an outstanding balance of $20.2 million, net of debt issuances costs, and escrow reserve funds of $1.1 million. The loans of three facilities in Texas were classified as held for sale at December 31, 2018. These loans had an outstanding balance of $26.6 million, net of debt issuance costs and debt premiums, and aggregate escrow reserve funds of $3.4 million. See Note 20 – “Assets Held for Sale.” 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 December 31, 2019, the Company has total escrow reserve funds of $11.7 million with the loan servicer that are reported within prepaid expenses in the consolidated balance sheets. During the year ended December 31, 2019, the Company sold the real property of three skilled nursing facilities and one assisted/senior living facility in California subject to HUD financing, the proceeds of which were used to retire HUD insured loans totaling $23.8 million. See Note 4 – “Significant Transactions and Events – Divestiture of Non-Strategic Facilities – 2019 Divestitures – California Divestitures.” In addition, the Company sold the real property of one skilled nursing facility in New Jersey and one skilled nursing facility in Virginia. The proceeds of these two sales were used to retire HUD insured loans totaling $18.4 million. See Note 4 – “Significant Transactions and Events – Strategic Partnerships – Vantage Point Partnership.” Finally, the Company sold the real property of three skilled nursing facilities in Texas that were subject to HUD insured loans and had been classified as held for sale in the consolidated balance sheets as of December 31, 2018. The proceeds from the sale were used to retire HUD insured loans totaling $23.4 million. See Note 4 – “Significant Transactions and Events – Divestiture of Non-Strategic Facilities – 2019 Divestitures – Texas Divestitures.” Notes Payable On January 17, 2018, the Company converted $19.6 million of its trade payables into a note payable. The note, as amended, was repaid in equal monthly installments through December 2019 at an annual interest rate of 5.75%. The loan was repaid in full at December 31, 2019 and had an outstanding balance of $7.8 million at December 31, 2018. In November 2016, the Company issued a note totaling $51.2 million to Welltower. The note accrues cash interest at 3.0% and paid-in-kind interest at 7.0%. Cash interest is paid and paid-in-kind interest accretes the principal amount semi-annually every May 1 and November 1. The note was amended on May 9, 2019 to extend the maturity date from October 30, 2020 to December 15, 2021. Upon the satisfaction of certain conditions, including the repayment of the Term Loans, repayment of the other note payable, noted below, to Welltower, and partial repayment of the Welltower Real Estate Loans, the outstanding note balance in excess of $6.0 million will be forgiven by Welltower. The note had an outstanding accreted balance of $64.2 million and $60.0 million at December 31, 2019 and 2018, respectively. In December 2016, the Company issued a second note for $11.7 million to Welltower, which accrues cash interest at 3.0% and paid-in-kind interest at 7.0%. Cash interest is paid and paid-in-kind interest accretes the principal amount semi-annually every June 15 and December 15. The note matures on December 15, 2021, and had an outstanding accreted principal balance of $14.6 million and $13.6 million at December 31, 2019 and 2018, respectively. In October 2019, the Company converted $23.2 million of its trade payables into a note payable. The note requires monthly interest payments based on an annual interest rate of 3.5%. The balance of the note is due on the maturity date, September 30, 2022. In November 2019, the Company issued a short-term note payable for $15.0 million, the entire balance of which was outstanding at December 31, 2019. The balance of the note is due no later than April 30, 2020. 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 with a weighted average interest of 1.5% at December 31, 2019, and maturity dates ranging from 2020 to 2024. On November 8, 2018, the mortgage loan of $10.0 million on one of the Company’s corporate office buildings matured and was refinanced through a MidCap Real Estate Loan. Mortgages and other secured debt (non-recourse). Loans are carried by certain of the Company’s consolidated joint ventures and VIEs. 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 with a weighted average interest rate of 7.2% at December 31, 2019. Maturity dates range from 2022 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. The aggregate principal balance of these loans includes a $1.4 million debt premium on one debt instrument. In the year ended December 31, 2019, the Company consolidated the financial statements of the Next Partnership and the Vantage Point Partnership. See Note 4 – “ Significant Transactions and Events – Strategic Partnerships – Next Partnership ” and Note 4 – “ Significant Transactions and Events – Strategic Partnerships – Vantage Point Partnership. ” The Next Partnership’s debt consists of a three-year term loan in an initial amount of $142.1 million and a 10-year mezzanine loan in the amount of $27.0 million. In December 2019, the Next Partnership term loan was partially refinanced via three new HUD insured loans. Proceeds from the new HUD insured loans were principally used to pay down $38.7 million on the Next Partnership term loan, such that the outstanding principal balance was $103.4 million at December 31, 2019. The new loans had an aggregate initial principal balance of $41.7 million, all of which remained outstanding as of December 31, 2019. The loans have an original amortization term of 35 years and a fixed interest rate of 3.15%. Proceeds were principally used to repay a portion of the term loan associated with the Next Partnership and fees. The HUD insured loans are non-recourse loans to the Company and 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 December 31, 2019, the Company has total escrow reserve funds of $3.9 million with the loan servicer that are reported within prepaid expenses in the consolidated balance sheets. The Vantage Point Partnership’s debt consists of a 7-year term loan with available proceeds of $240.9 million, $233.6 million of which was drawn as of December 31, 2019, as well as a promissory note due to Vantage Point in the amount of $76.8 million, due on September 12, 2028. On January 10, 2020, the Vantage Point Partnership acquired its nineteenth facility. In conjunction with the acquisition, the remaining available proceeds on the term loan, $7.3 million, were drawn. Debt Covenants The ABL Credit Facilities, the Term Loan Agreement and the Welltower Real Estate Loans (collectively, the Credit Facilities) each contain a number of financial, affirmative and negative covenants, including a maximum leverage ratio, a minimum interest coverage ratio, a minimum fixed charge coverage ratio and minimum liquidity. The Credit Facilities include cross-default provisions with each other and certain material lease agreements. At December 31, 2019, the Company was in compliance with its financial covenants contained in the Credit Facilities. 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 possible that future operating performance may not generate sufficient operating results to maintain compliance with its quarterly debt covenant compliance requirements. Should the Company fail to comply with its debt covenants at a future measurement date, it would, absent necessary and timely waivers and/or amendments, be in default under certain of its existing credit agreements. To the extent any cross-default provisions may apply, the default would have an even more significant impact on the Company’s financial position. The maturity of total debt of $1.6 billion, excluding debt issuance costs and other non-cash debt discounts and premiums, at December 31, 2019 is as follows (in thousands): Twelve months ended December 31, 2020 $ 162,482 2021 278,941 2022 346,155 2023 344,985 2024 11,171 Thereafter 469,923 Total debt maturity $ 1,613,657

Stockholders' Deficit

Stockholders' Deficit	12 Months Ended
	Dec. 31, 2019
Stockholders’ Deficit.
Stockholders' Deficit	(13) The total number of shares of all classes of stock that the Company shall have authority to issue is 1,200,000,000 consisting of: · 1,000,000,000 shares of Class A common stock, par value $0.001 per share, of which 107,888,854 shares and 101,235,935 shares were issued at December 31, 2019 and 2018, respectively; · 20,000,000 shares of Class B common stock, par value $0.001 per share, of which 744,396 shares and 744,396 shares were issued at December 31, 2019 and 2018, respectively; · 150,000,000 shares of Class C common stock, par value $0.001 per share, of which 56,172,193 shares and 59,700,801 shares were issued at December 31, 2019 and 2018, respectively; and · 30,000,000 shares of Preferred Stock, par value $0.001 per share, of which no shares were issued at December 31, 2019 and 2018.

Stock-Based Compensation

Stock-Based Compensation	12 Months Ended
	Dec. 31, 2019
Stock-Based Compensation
Stock-Based Compensation	(14) The Company provides stock-based compensation to attract and retain employees while also aligning employees’ interests with the interests of its shareholders. The 2015 Plan, which is shareholder-approved, permits the grant of various cash-based and equity-based awards to selected employees, directors, independent contractors and consultants of the Company. The 2015 Plan permits the grant of up to 24.4 million shares of Class A common stock, subject to certain adjustments and limitations. Stock-based compensation expense is comprised of restricted stock units, which are based on estimated fair value, made to certain employees and directors. The Company accounts for forfeitures when they occur. Restricted Stock Units The Company grants restricted stock units under the 2015 Plan. Each unit represents an obligation to deliver to the holder one share of the Company’s Class A common stock upon vesting. Restricted stock units are subject to some combination of service-based, performance-based, and market-based vesting conditions. Units subject to only service-based vesting conditions generally vest in equal installments over three years on the anniversary of the grant date with expense being recognized over the requisite service period. The fair value of such units is measured at the market price of the Company’s stock on the date of the grant. Units subject to performance-based or market-based vesting conditions are generally subject to a service-based vesting condition (i.e. cliff vest). Consequently, expense of such awards is recognized over the requisite service period. Units subject to performance-based vesting conditions generally cliff vest upon satisfaction of performance targets. The fair value of such units is measured at the market price of the Company’s stock on the date of the grant. Units subject to market-based vesting conditions generally cliff vest upon the Company’s share price meeting specified target prices. The fair value of such units is measured using the Monte-Carlo simulation model, which incorporates into the fair value determination the possibility that the target share prices may not be met. Further, expense related to these units is recognized regardless of whether the market-based vesting condition is satisfied, provided that the requisite service has been provided. A summary of the Company’s non-vested restricted stock units as of and for the year ended December 31, 2019 is shown below (number of units in thousands): Number of Restricted Stock Units Weighted-Average Grant Date Fair Value Non-vested balance at January 1, 2019 10,192 $ 1.89 Granted 4,778 1.30 Vested (3,375) 1.82 Forfeited (1,636) 1.24 Non-vested balance at December 31, 2019 9,959 $ 1.74 For the year ended December 31, 2018, the weighted-average grant date fair value of restricted stock units granted was $2.43. As of December 31, 2019, there was approximately $12.3 million of unrecognized expense related to non-vested restricted stock units, which is expected to be recognized over a weighted-average term of 1.6 years. During the years ended December 31, 2019 and 2018, the fair value of restricted stock units that vested was $4.4 million and $5.8 million, respectively. At December 31, 2019, 5.3 million shares of the Company’s Class A common stock are available for delivery under the 2015 Plan. Stock-based compensation expense related to restricted stock units included in general and administrative costs was $7.3 million and $8.8 million for the years ended December 31, 2019 and 2018, respectively. The income tax benefit for stock-based compensation expense was $4.4 million and $4.8 million for the years ended December 31, 2019 and 2018, respectively.

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2019
Income Taxes
Income Taxes	(15) The Company’s provision for income taxes was based upon management’s estimate of taxable income or loss for each respective accounting period. The Company recognizes an asset or liability for the deferred tax consequences of temporary differences between the tax bases of assets, including net operating loss and credit carryforwards, and liabilities and the amounts reported in the financial statements. These temporary differences would result in taxable or deductible amounts in future years when the reported amounts of the assets are recovered or liabilities are settled. The Company effectively owns 66.1% 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. The taxable income of the partnership is subject to the income allocation rules of IRC Sec. 704. Management believes the mechanics of IRC Sec. 704 will cause a greater portion of the temporary tax deductions to be allocated to the Company. This allocation reduced the Company’s taxable income for the years ended December 31, 2019 and 2018, respectively. Income Tax Provision Total income tax expense (benefit) was as follows (in thousands): Year ended December 31, 2019 2018 Continuing operations $ 1,754 $ (2,423) Stockholder's deficit 346 (115) Total $ 2,100 $ (2,538) The components of the provision for income taxes on income (loss) for the years ended December 31, 2019 and 2018 were as follows (in thousands): Year ended December 31, 2019 2018 Current: Federal $ 1,014 $ 1,064 State 28 (12) 1,042 1,052 Deferred: Federal 29 (521) State 683 (2,954) 712 (3,475) Total $ 1,754 $ (2,423) At December 31, 2019 and 2018, the current income taxes were primarily generated on the taxable income of the Company’s Bermuda captive insurance company. Reasonable estimates for the Company’s state and local provision were made based on the Company’s analysis of the state’s enacted response to U.S. federal tax reform. During the years ended December 31, 2019 and 2018, the Company’s rehabilitation therapy services business operations within the People’s Republic of China and Hong Kong generated both U.S. federal and foreign taxable losses. The deferred tax assets generated by the foreign operations were fully valued at December 31, 2019 and 2018. Management does not anticipate these operations will generate significant taxable income in the near term. The operations currently do not have a material effect on the Company’s effective tax rate. Under the U.S. Tax Cuts and Jobs Act, the Company's federal net operating losses that have been incurred prior to January 1, 2018 will continue to have a 20-year carryforward limitation applied and will need to be evaluated for recoverability in the future as such. For net operating losses created after December 31, 2017, the net operating losses will have an indefinite life, but usage will be limited to 80% of taxable income in any given year. Further, the Company has recorded a deferred tax asset for the deferred interest that it estimates will not be deducted in tax years 2019 and 2018. The deferred interest can be carried forward indefinitely, such that it may be deductible in future tax years based upon certain limitations. The Company has estimated the impact of the U.S. Tax Cuts and Jobs Act on state income taxes reflected in its income tax benefit for the years ended December 31, 2019 and 2018. In assessing the requirement for, and amount of, a valuation allowance in accordance with the more likely than not standard for all periods, the Company gives appropriate consideration to all positive and negative evidence related to the realization of its deferred tax assets. The assessment considers the nature, frequency and severity of current and cumulative losses, forecasts of future profitability, the duration of statutory carryforward periods and the Company’s experience with operating loss and tax credit expirations. A history of cumulative losses is a significant piece of negative evidence used in the assessment. At December 31, 2019 and 2018, the Company has established a full valuation allowance against the majority of its net deferred tax assets in the amount of $386.2 million and $342.6 million, respectively, based on management’s assessment that the Company will not realize its deferred tax assets. The valuation allowance does not include the discounted unpaid loss reserve deferred tax asset of the Company’s captive insurance company, which continues to have taxable income that will allow the Company to utilize its deferred tax assets. Total income tax expense (benefit) for the periods presented was as follows (in thousands): Year ended December 31, 2019 2018 Computed “expected” expense (benefit) $ 1,939 $ (78,716) (Reduction) increase in income taxes resulting from: State and local income taxes, net of federal tax benefit 107 113 Income tax credits (2,088) (2,397) Non-controlling interest 4,038 28,366 Adjustment to deferred taxes, including credits and valuation allowance (2,977) 50,302 FIN 48 — (38) Other, net 735 (53) Total income tax expense (benefit) $ 1,754 $ (2,423) The Company’s effective income tax rates were 19.0% and 0.6% in the years ended December 31, 2019 and 2018, respectively. The 19.0% effective rate is primarily attributable to the current income tax expense of the Company’s captive insurance company. The tax effects of temporary differences that give rise to significant portions of the deferred tax assets and deferred tax liabilities at December 31, 2019 and 2018 are presented below (in thousands): 2019 2018 Deferred tax assets: Investment in partnership $ 224,215 $ 195,095 Net operating loss carryforwards 133,611 121,111 Discounted unpaid loss reserve 2,156 3,567 General business credits 30,006 28,729 Total deferred tax assets 389,988 348,502 Valuation allowance (386,216) (342,635) Deferred tax assets, net of valuation allowance $ 3,772 $ 5,867 Deferred tax liabilities: Long-lived assets: intangible property (5,245) (6,281) Total deferred tax liabilities (5,245) (6,281) Net deferred tax liabilities $ (1,473) $ (414) Uncertain Tax Positions The Company follows ASC 740 guidance for recognizing and measuring tax positions taken or expected to be taken in a tax return that directly or indirectly affect amounts reported in financial statements, and accounting for the related income tax effects of individual tax positions that do not meet the recognition thresholds required in order for any part of the benefit of that tax position to be recognized in an entity’s financial statements. The Company, excluding its corporate groups, is only subject to state and local income tax in certain jurisdictions. The Company’s corporate groups are subject to federal, state and local income taxes. The Company is also subject to income based taxes in the People’s Republic of China and Hong Kong. However, these business operations have generated current taxable losses since their inception. Significant judgment is required in evaluating its uncertain tax positions and determining its provision for income taxes. The Company utilizes a two-step approach to recognizing and measuring uncertain tax positions. The first step is to evaluate the technical merits of a tax position for recognition by determining if the weight of available evidence indicates that it is more likely than not that the position will be sustained on audit, including resolution of related appeals or litigation processes. The second step is to measure the tax benefit as the largest amount that is more than 50% likely of being realized upon settlement. The Company is subject to various federal and state income tax audits in the ordinary course of business. Such audits could result in increased tax payments, interest and penalties. While the Company believes its tax positions are appropriate, it cannot assure that the various authorities engaged in the examination of its income tax returns will not challenge the Company’s positions. The Company believes it has adequately reserved, if necessary, for its potential audit exposures of uncertain tax positions, though no assurance can be given that the final tax outcome of these matters will not be different. The Company adjusts these reserves through closely monitoring and continuously evaluating, if any, the changes of facts and circumstances and tax legislative development, such as the closing of a tax audit or the expiration of the statute of limitations. To the extent that the final tax outcome of these matters is different than the amounts recorded, such differences will impact the provision for income taxes in the period in which such determination is made. The provision for income taxes includes the impact of reserve provisions and changes to reserves that are considered appropriate, as well as the related net interest. A reconciliation of unrecognized tax benefits follows (in thousands): Balance, December 31, 2017 $ 115 Reductions due to lapses of applicable statute of limitations (38) Balance, December 31, 2018 $ 77 Reductions due to lapses of applicable statute of limitations — Balance, December 31, 2019 $ 77 The Company’s unrecognized tax benefits reserve for uncertain tax positions primarily related to the accrual of penalty on underpayment of quarterly estimated tax. All of the gross unrecognized tax benefits would affect the effective tax rate if recognized. Unrecognized tax benefits are adjusted in the period in which new information about a tax position becomes available or the final outcome differs from the amount recorded. Unrecognized tax benefits are not expected to change significantly over the next twelve months. The Company recognizes potential accrued interest related to unrecognized tax benefits in income tax expense. Penalties, if incurred, would also be recognized as a component of income tax expense. The amount of accrued interest related to unrecognized tax benefits was less than $0.1 million as of both December 31, 2019 and 2018. Generally, the Company has open tax years for state purposes subject to tax audit on average of between three years to six years. The Company’s U.S. income tax returns from 2013 through 2018 are open and could be subject to examination. Exchange Rights and Tax Receivable Agreement The owners of FC-GEN have the right to exchange their membership units in FC-GEN , along with an equivalent number of Class C shares, 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 were exchanges of 3.5 million FC-GEN units and Class C shares during the year ended December 31, 2019, equating to 3.5 million Class A shares. The exchanges during the year ended December 31, 2019, resulted in a $16.9 million IRC Section 754 tax basis step-up in the tax deductible goodwill of FC-GEN. There were exchanges of 1.9 million FC-GEN units and Class C shares during the year ended December 31, 2018, equating to 1.9 million Class A shares. The exchanges during the year ended December 31, 2018 resulted in a $9.6 million IRC Section 754 tax basis step-up in the tax deductible goodwill of FC-GEN. The Company is party to 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 returns 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.

Related Party Transactions

Related Party Transactions	12 Months Ended
	Dec. 31, 2019
Related Party Transactions
Related Party Transactions	(16) The Company provides rehabilitation services to certain facilities owned and operated by two customers in which certain members of the Company’s board of directors, board observers, and shareholders with greater than 5% of the Company’s Class A common stock beneficially own an ownership interest. In the case of one significant customer, these services resulted in net revenues of $114.3 million and $126.4 million in the years ended December 31, 2019 and 2018, respectively. The services resulted in net accounts receivable balances of $28.9 million and $32.3 million at December 31, 2019 and 2018, respectively. Further, the Company holds a note receivable from this customer, which was derived from past due accounts receivable, in the amount of $56.3 million. The Company has reserved $55.0 million on the note receivable balance. The reserve represents the judgment of management and does not indicate a forgiveness of any amount owed by this related party customer. The Company is monitoring the financial condition of this customer and will adjust the reserve levels accordingly as new information about their outlook is available. In the case of the other customer, services began in the third quarter of 2018. The Company recorded net revenues of $6.6 million and $1.9 million in the years ended December 31, 2019 and 2018, respectively, resulting in net accounts receivable balances of $1.4 million and $1.1 million at December 31, 2019 and 2018, respectively. Prior to December 31, 2019, certain members of the Company’s board of directors, board observers, and shareholders with greater than 5% of the Company’s Class A common stock indirectly beneficially held ownership interests in FC Compassus LLC (Compassus) totaling less than 10% in the aggregate. Effective December 31, 2019, no members indirectly beneficially hold ownership interests in Compassus. The Company is party to certain immaterial preferred provider and affiliation agreements with Compassus. Separately, the Company had a note receivable balance of $23.2 million from Compassus. The note was comprised of principal of $12.0 million and accrued interest, and was associated with the Company’s sale of its hospice and home health operations to Compassus, which was completed during 2016. The note balance was paid in full during December 2019. Prior to September 20, 2019, certain members of the Company’s board of directors, board observers, and shareholders with greater than 5% of the Company’s Class A common stock indirectly beneficially held ownership interests in Trident USA totaling less than 10% in the aggregate. Effective September 20, 2019, no members indirectly beneficially hold ownership interests in Trident USA. However, the Company remains party to mobile radiology and laboratory/diagnostic services agreements with Trident USA. Fees for these services were $8.4 million and $12.6 million in the years ended December 31, 2019 and 2018, respectively. Certain subsidiaries of the Company are subject to a lease of 12 centers in New Hampshire and Florida from 12 separate limited liability companies affiliated with Next (the Next Landlord Entities). The lease was effective June 1, 2018 and the initial annualized rent to be paid is $13.0 million. The lease includes a purchase option that is exercisable in 2022. In addition, certain subsidiaries of the Company are subject to a lease of 15 centers from 15 separate limited liability companies affiliated with the Next Landlord Entities. The Company owns a 46% membership interest in the Next Partnership. The lease was effective February 1, 2019 and the initial annualized rent to be paid is $19.5 million. The lease includes a purchase option that is exercisable during 2024 through 2026. See Note 4 – “ Significant Transactions and Events – Strategic Partnerships – Next Partnership .” Certain members of the Company’s board of directors each directly or indirectly hold an ownership interest in the Next Landlord Entities totaling approximately 4% in the aggregate. These members have earned acquisition fees, and may earn asset management fees and other fees paid from the Next Landlord Entities. As of December 31, 2019, Welltower held approximately 8.9% of the shares of the Company’s Class A Common Stock, representing approximately 5.8% of the voting power of the Company’s voting securities. The Company is party to a master lease with an affiliate of Welltower. The initial term of the master lease expires on January 31, 2037 and the Company has one eleven-year renewal option. Beginning January 1, 2019, annual rent escalators under the master lease were 2.0%. During the year ended December 31, 2019, the Company paid rent of approximately $73.7 million to Welltower. The Company holds options to purchase certain facilities subject to the master lease. At December 31, 2019, the Company leased 43 facilities from Welltower. The Company and certain of its affiliates are also party to certain debt instruments with Welltower. See Note 12 – “ Long-Term Debt – Term Loan Agreements, ” “ Long-Term Debt – Real Estate Loans, ” and “ Long-Term Debt – Notes Payable .” During the third quarter of 2019, the Company entered into a consulting agreement with one of the Company’s board observers. The consulting agreement has a term of one year and compensation of approximately $0.6 million. Services provided include sourcing, negotiating and assisting with closing of transactions and financing. On March 5, 2020, the consulting agreement was terminated.

Defined Contribution Plan

Defined Contribution Plan	12 Months Ended
	Dec. 31, 2019
Defined Contribution Plan
Defined Contribution Plan	(17) The Company sponsors a defined contribution plan covering substantially all employees who meet certain eligibility requirements. The Company did not match employee contributions for the defined contribution plan in 2019 and 2018.

Other Income

Other Income	12 Months Ended
	Dec. 31, 2019
Other Income
Other Income	(18) In the years ended December 31, 2019 and 2018, the Company completed multiple transactions, including the divestitures of numerous owned assets and the termination and refinancing of certain facilities subject to lease agreements. See Note 4 – “ Significant Transactions and Events .” These transactions resulted in a net gain recorded as other income in the consolidated statements of operations. The following table summarizes those net gains (in thousands): Year ended December 31, 2019 2018 Gain on sale of owned assets (1) $ (90,723) $ — Loss recognized for exit costs associated with divestiture of operations (2) 12,997 21,459 Gain on lease termination or modification (3) (95,779) (34,379) Total other income $ (173,505) $ (12,920) (1) The Company sold 13 owned skilled nursing facilities and two assisted/senior living facilities in 2019. The gain represents sale proceeds in excess of the carrying value of the assets sold. The Company sold 22 skilled nursing facilities and one assisted/senior living facility in 2018. The sale price approximated the carrying value of those assets sold. (2) The Company divested operations of 44 facilities and 55 facilities in 2019 and 2018, respectively. Upon divestiture, the Company recognizes exit costs for uncollectible accounts receivable resulting from a sale, the write-off of inventory balances assumed by the new operator, and other costs associated with the transition of operations. (3) The Company has amended numerous lease agreements in 2019 and 2018 in conjunction with its efforts detailed in Note 4 – “ Significant Transactions and Events .” These transactions resulted in a combination of base rent reductions, annual escalator reductions, lease term extensions or reductions and facility terminations. Each lease amendment triggers a lease reassessment of the respective ROU asset and lease liability with an offsetting adjustment recorded to the consolidated statements of operations as other income or loss.

Asset Impairment Charges

Asset Impairment Charges	12 Months Ended
	Dec. 31, 2019
Goodwill and Identifiable Intangible Assets
Asset Impairment Charges	( 19) Long-Lived Assets with a Definite Useful Life In each quarter, the Company’s long-lived assets with a definite useful life are tested for impairment at the lowest levels for which there are identifiable cash flows. The Company estimated the future net undiscounted cash flows expected to be generated from the use of the long-lived assets and then compared the estimated undiscounted cash flows to the carrying amount of the long-lived assets. The cash flow period was based on the remaining useful lives of the primary asset in each long-lived asset group, principally a building or ROU asset in the inpatient segment and customer relationship assets in the rehabilitation therapy services segment. During the years ended December 31, 2019 and 2018, the Company recognized impairment charges in the inpatient segment totaling $16.9 m illion and $105.0 million, respectively. Identifiable Intangible Assets with a Definite Useful Life Favorable lease contracts represent the estimated value of future cash outflows of operating lease contracts compared to lease rates that could be negotiated in an arms-length transaction at the time of measurement. Favorable lease contracts are amortized on a straight-line basis over the lease terms. These favorable lease contracts are measured for impairment using estimated future net undiscounted cash flows expected to be generated from the use of the leased assets compared to the carrying amount of the favorable lease. The cash flow period was based on the remaining useful lives of the asset, which for favorable lease assets is the lease term. During the year ended December 31, 2018, the Company recognized impairment charges on its favorable lease intangible assets with a definite useful life of $3.5 million. This charge is presented in goodwill and identifiable intangible asset impairments on the consolidated statements of operations. Goodwill and Identifiable Intangible Assets with an Indefinite Useful Life The Company performed its annual goodwill impairment test as of September 30, 2019 and 2018. For the years ended December 31, 2019 and 2018, the Company performed a qualitative impairment test, which indicated that no impairment existed. The Company conducts the test at the reporting unit level that management has determined aligns with the Company’s segment reporting. See Note 7 – “Segment Information.” Indefinite-lived intangible assets consist of trade names. In conjunction with the annual goodwill impairment test, the Company performed an assessment of its indefinite-lived intangible assets, noting no impairment existed for the years ended December 31, 2019 and 2018.

Assets Held for Sale

Assets Held for Sale	12 Months Ended
	Dec. 31, 2019
Assets Held for Sale
Assets Held for Sale	(20) In the normal course of business, the Company continually evaluates the performance of its operating units, with an emphasis on selling or closing underperforming or non-strategic assets. These assets are evaluated to determine whether they qualify as assets held for sale or discontinued operations. The assets and liabilities of a disposal group classified as held for sale shall be presented separately in the asset and liability sections, respectively, of the statement of financial position in the period in which they are identified only. Assets held for sale that qualify as discontinued operations are removed from the results of continuing operations. The results of operations in the current and prior year periods, along with any cost to exit such businesses in the year of discontinuation, are classified as discontinued operations in the consolidated statements of operations. During the year ended December 31, 2019, the Company identified a disposal group of seven skilled nursing facilities and one assisted/senior living facility operated by the Company in the state of California that qualified as assets held for sale, but did not meet the criteria as a discontinued operation. The Company is party to a purchase and sale agreement, as amended, to sell the facilities for $88.8 million. During the year ended December 31, 2019, the sale of seven of the eight facilities was completed. See Note 4 – “ Significant Transactions and Events – Divestiture of Non-Strategic Facilities – 2019 Divestitures – California Divestitures.” The sale of the remaining HUD-insured facility occurred on February 26, 2020. See Note 23 – “ Subsequent Events - Divestitures .” During the year ended December 31, 2018, the Company identified a disposal group of 23 skilled nursing facilities operated by the Company in the state of Texas that qualified as assets held for sale, but did not meet the criteria as a discontinued operation. The Company completed the sale of the operations of all 23 skilled nursing facilities and the real estate of 16 skilled nursing facilities during the fourth quarter of 2018. The Company was party to a purchase and sale agreement, as amended, to sell the remaining seven facilities for $20.1 million. Four of the facilities were subject to Welltower Real Estate Loans and three of the facilities were subject to HUD-insured loans. The Company classified as assets held for sale in its consolidated balance sheets as of December 31, 2018, the real property and other balances associated with the remaining seven facilities. In the fourth quarter of 2019, the Company completed the sale of the remaining seven facilities, marking an exit from the inpatient business in Texas. See Note 4 – “ Significant Transactions and Events – Divestiture of Non-Strategic Facilities – 2019 Divestitures – Texas Divestitures.” In total, the Company classified as assets held for sale in its consolidated balance sheets as of December 31, 2019 and 2018, the real property and other balances associated with one facility and seven facilities, respectively. The following table sets forth the major classes of assets and liabilities included as part of the disposal groups as of December 31, 2019 and 2018 (in thousands): December 31, 2019 December 31, 2018 Current assets: Prepaid expenses $ 1,171 $ 3,375 Long-term assets: Property and equipment, net of accumulated depreciation of $2,201 and $3,640 at December 31, 2019 and December 31, 2018, respectively 16,306 16,087 Total assets $ 17,477 $ 19,462 Current liabilities: Current installments of long-term debt $ 368 $ 639 Long-term liabilities: Long-term debt 19,789 25,942 Total liabilities $ 20,157 $ 26,581

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2019
Commitments and Contingencies
Commitments and Contingencies	(21) 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. General and professional liability policies are typically written for a duration of 12 months or less 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. Excess insurance policies are typically written for a duration of 12 months or less and are measured on an “occurrence” basis. 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 frequently 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 a combination of third-party administrators (TPAs), in-house adjusters, and legal counsel, along with systems designed to maintain and process claims to provide it with the data utilized in its assessments of reserve adequacy. Where TPAs are utilized, they operate under the oversight of the Company’s in-house risk management and legal functions. These functions and systems 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 provision for general and professional liability risks totaled $70.1 million and $102.5 million for the years ended December 31, 2019 and 2018, respectively. The reduction in the provision for general and professional liability for the year ended December 31, 2019 is the result of favorable prior year claim development and lower current year loss exposures. The favorable development is due to the combination of the ongoing impact of tort reform, claim settlements, and other risk management activities. The reserves for general and professional liability, which are recorded on an undiscounted basis, were $392.8 million and $435.3 million as of December 31, 2019 and 2018, respectively. The provision for workers’ compensation risks totaled $47.6 million and $49.9 million for the years ended December 31, 2019 and 2018, respectively. The reserves for workers’ compensation risks were $160.5 million and $168.3 million as of December 31, 2019 and 2018, respectively. These reserves are discounted based on actuarial estimates of claim payment patterns using a discount rate for the current policy year of 1.6%. 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 $12.0 million and $8.3 million as of December 31, 2019 and 2018, 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. This accrual for incurred but not yet reported claims was $15.1 million and $16.6 million as of December 31, 2019 and 2018, respectively. 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. Settlement Agreement In 2017, the Company and the U.S. Department of Justice (the DOJ) entered into a settlement agreement regarding four matters arising out of the activities of Skilled Healthcare Group, Inc. (Skilled) or Sun Healthcare Group, Inc. prior to their operations becoming part of the Company’s operations (collectively, the Successor Matters). The Company agreed to the settlement in order to resolve the allegations underlying the Successor Matters and to avoid the uncertainty and expense of litigation. The settlement agreement called for payment of a collective settlement amount of $52.7 million (the Settlement Amount), including separate Medicaid repayment agreements with each affected state Medicaid program. The Company will continue to remit the Settlement Amount through January 1, 2022. The remaining outstanding Settlement Amount at December 31, 2019 was $25.7 million, of which $12.1 million is recorded in accrued expenses and $13.6 million is recorded in other long-term liabilities. Conditional Asset Retirement Obligations Certain of the Company’s leased and owned real estate assets contain asbestos, which is believed to be appropriately contained in accordance with environmental regulations. If these properties were demolished or subject to renovation activities that disturb the asbestos, certain environmental regulations are in place, which specify the manner in which the asbestos must be handled and disposed. At December 31, 2019 and 2018, the Company has a liability for the asset retirement obligation associated primarily with the cost of asbestos removal aggregating approximately $6.6 million and $9.0 million, respectively, which is included in other long-term liabilities. The liability for each facility will be accreted to its settlement value, which is estimated to approximate $16.9 million through the estimated settlement dates extending from 2020 through 2042. Due to the time over which these obligations could be settled and the judgment used to determine the liability, the ultimate obligation may differ from the estimate. Upon settlement, any difference between actual cost and the estimate is recognized as a gain or loss in that period. Annual accretion of the liability is recorded each year for the impacted assets until the obligation year is reached, either by sale of the property, demolition or some other future event such as a government action. Employment Agreements The Company has employment agreements and arrangements with its executive officers and certain members of management. The agreements generally continue until terminated by the executive or management, and provide for severance payments under certain circumstances.

Fair Value of Financial Instrum

Fair Value of Financial Instruments	12 Months Ended
	Dec. 31, 2019
Fair Value of Financial Instruments
Fair Value of Financial Instruments	(22) The Company’s financial instruments consist primarily of cash and cash equivalents, restricted cash and equivalents, restricted investments in marketable securities, accounts receivable, accounts payable and current and long-term debt. The Company’s financial instruments, other than its 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. 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 present the Company’s assets measured at fair value on a recurring basis as of December 31, 2019 and 2018, 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 December 31, Identical Assets Observable Inputs Inputs Assets: 2019 (Level 1) (Level 2) (Level 3) Cash and cash equivalents $ 12,097 $ 12,097 $ — $ — Restricted cash and equivalents 113,709 113,709 — — Restricted investments in marketable securities: Mortgage/government backed securities 21,023 — 21,023 — Corporate bonds 48,926 — 48,926 — Government bonds 66,993 45,903 21,090 — Total $ 262,748 $ 171,709 $ 91,039 $ — 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: 2018 (Level 1) (Level 2) (Level 3) Cash and cash equivalents $ 20,865 $ 20,865 $ — $ — Restricted cash and equivalents 121,411 121,411 — — Restricted investments in marketable securities: Mortgage/government backed securities 11,819 — 11,819 — Corporate bonds 55,819 — 55,819 — Government bonds 68,515 40,699 27,816 — Total $ 278,429 $ 182,975 $ 95,454 $ — The Company places its cash and cash equivalents, restricted 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. Many of the Company’s financial instruments have quoted prices but are traded less frequently, instruments whose fair value has been derived using a model where inputs to the model are directly observable in the market, or can be derived principally from or corroborated by observable market data, and instruments that are fairly valued using other financial instruments, the parameters of which can be directly observed. These financial instruments have been reported as Level 2 measurements. Debt Instruments The table below shows the carrying amounts and estimated fair values, net of debt issuance costs and other non-cash debt discounts and premiums, of the Company’s primary long-term debt instruments: December 31, 2019 December 31, 2018 Carrying Value Fair Value Carrying Value Fair Value Asset based lending facilities $ 412,346 $ 412,346 $ 419,289 $ 419,289 Term loan agreements 196,714 196,714 184,652 184,652 Real estate loans 265,700 265,700 307,690 307,690 HUD insured loans 117,117 117,117 181,762 180,950 Notes payable 116,952 116,952 81,398 81,398 Mortgages and other secured debt (recourse) 6,369 6,369 4,190 4,190 Mortgages and other secured debt (non-recourse) 498,222 498,222 26,483 26,483 $ 1,613,420 $ 1,613,420 $ 1,205,464 $ 1,204,652 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 majority of the Company’s debt instruments contain variable rates that are based upon current market prices, or have been refinanced within the recent past. Consequently, management believes the carrying value of these debt instruments approximates fair value. The Company believes this approach approximates the exit price notion of fair value measurement and 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 tables present the Company’s hierarchy for nonfinancial assets measured at fair value on a non-recurring basis (in thousands): Impairment Charges - Carrying Value Year ended December 31, 2019 December 31, 2019 Assets: Property and equipment, net $ 962,105 $ 10,696 Finance lease right-of-use assets, net 37,097 — Operating lease right-of-use assets 2,399,505 6,241 Intangible assets, net 87,446 — Goodwill 85,642 — Impairment Charges - Carrying Value Year ended December 31, 2018 December 31, 2018 Assets: Property and equipment, net $ 2,887,554 $ 104,997 Intangible assets, net 119,082 3,538 Goodwill 85,642 — The fair value allocation related to the Company’s acquisitions and the fair value of tangible and intangible assets related to the Company’s impairment analysis are 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.

Subsequent Events

Subsequent Events	12 Months Ended
	Dec. 31, 2019
Subsequent Events
Subsequent Events	(23) Strategic Partnerships Vantage Point Partnership On January 10, 2020, Welltower sold the real estate of one skilled nursing facility located in Massachusetts to Vantage Point Partnership. The sale represents the final component of the transaction that was initiated on September 12, 2019. The Company will receive an annual rent credit of $0.7 million from Welltower as a result of the lease termination. The Vantage Point Partnership acquired this skilled nursing facility for a purchase price of $9.1 million. The initial consolidation of this skilled nursing facility primarily resulted in property and equipment of $9.1 million, non-recourse debt of $7.3 million with the balance of the purchase price settled primarily with proceeds held in escrow from the September 12, 2019 closing. The Company will continue to operate the facility under the master lease agreement with Vantage Point Partnership along with the other 18 facilities. The addition of this one skilled nursing facility resulted in an increase of annual rent of $0.9 million. See Note 4 - “ Significant Transactions and Events – Strategic Partnerships - Vantage Point Partnership .” NewGen Partnership On February 1, 2020, the Company transitioned operational responsibility for 19 facilities in the states of California, Washington and Nevada to New Generation Health, LLC (NewGen). The Company sold the real estate and operations of six skilled nursing facilities and transferred the leasehold rights to 13 skilled nursing, behavioral health and assisted living facilities for $78.9 million. The Company will retain a 50% interest in the facilities. Net transaction proceeds were used by the Company to repay indebtedness, including prepayment fees, of $33.7 million, fund its initial equity contribution and working capital requirement of approximately $15.0 million, and provide financing to the partnership of $9.0 million. Concurrently, the facilities have entered, or will enter upon regulatory approval, into management services agreements with NewGen for the day-to-day operations of the facilities. The Company will continue to provide administrative and back office services to the facilities pursuant to administrative support agreements, as well as therapy services pursuant to therapy services agreements. The Company is currently assessing whether it will continue to consolidate the financial statements of these facilities for financial reporting purposes. Divestitures On January 31, 2020, Omega sold the real estate of one skilled nursing facility located in Massachusetts. The Company leased the facility under a master lease agreement, but closed the facility on July 1, 2019. The sale resulted in the lease termination of the facility and an annual rent credit of $0.4 million. On February 1, 2020, the Company sold two owned skilled nursing facilities in North Carolina and one owned skilled nursing facility in Maryland for $61.8 million. Proceeds were used to retire $29.1 million of HUD financed debt. The three facilities generated revenues of $38.7 million and pre-tax income of $0.5 million. On February 26, 2020, the Company completed the sale of one owned HUD-insured skilled nursing facility in California for $20.8 million. The facility had been classified as an asset held for sale as of December 31, 2019. Proceeds were used to retire $20.5 million of HUD financed debt. The facility generated revenues of $14.0 million and pre-tax loss of $0.1 million. See Note 20 – “ Assets Held for Sale .” On March 4, 2020, the Company divested the operations of one leased assisted/senior living facility in Montana. The lease termination resulted in an annual rent credit of $0.7 million. The facility generated revenues of $2.5 million and pre-tax income of $0.1 million. The Company is currently assessing the impact these divestitures and lease amendments will have on its consolidated financial statements.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2019
Accounting Policies [Abstract]
Description of Business	Description of Business Genesis Healthcare, Inc. is a healthcare services holding company that through its subsidiaries (collectively, the Company or Genesis), 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. At December 31, 2019, the Company provides inpatient services through 381 skilled nursing, assisted/senior living and behavioral health centers located in 26 states. Revenues of the Company’s owned, leased and otherwise consolidated inpatient businesses constitute approximately 87% 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. The Company has expanded its delivery model for providing rehabilitation services to community-based and at-home settings, as well as internationally in China. After the elimination of intercompany revenues, the rehabilitation therapy services business constitutes approximately 10% of the Company’s revenues. The Company provides an array of other specialty medical services, including management services, physician services, staffing 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 income (loss) attributable to Genesis Healthcare, Inc. and net loss 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 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 control and economics that considers whether the Company 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. During 2019, the Company entered into two partnerships that acquired the real property of 33 skilled nursing facilities that are leased to the Company. Management has concluded that these entities are VIEs, of which the Company is the primary beneficiary. As a result, it has included the assets, liabilities, and operating results of these entities in its consolidated financial statements. See Note 4 – “ Significant Transactions and Events – Strategic Partnership .” Certain prior year disclosure amounts have been reclassified to conform to current period presentation.
Financial Condition and Liquidity Considerations	Financial Condition and Liquidity Considerations The accompanying consolidated financial statements have been prepared on the basis that the Company will continue as a going concern, which contemplates the realization of assets and the satisfaction of liabilities in the normal course of business. In evaluating the Company’s ability to continue as a going concern, management considered the conditions and events that could raise substantial doubt about the Company’s ability to continue as a going concern for 12 months following the date the Company’s financial statements were issued (March 16, 2020). Management considered the recent results of operations as well as the Company’s current financial condition and liquidity sources, including current funds available, forecasted future cash flows and the Company’s conditional and unconditional obligations due before March 16, 2021. Based upon such considerations, management determined that there are no known or knowable conditions or events that raise substantial doubt about the Company’s ability to continue as a going concern for 12 months following the date of issuance of these financial statements (March 16, 2020). The Company’s results of operations continue to be negatively impacted by the persistent pressure of healthcare reforms enacted in recent years. This challenging operating environment has been most acute in the Company’s inpatient segment, but also has had a detrimental effect on the Company’s rehabilitation therapy segment and its customers. In recent years, the Company has implemented a number of cost mitigation strategies to offset the negative financial implications of this challenging operating environment. The Company expects to continue to pursue cost mitigation and other strategies in response to the operating environment and liquidity requirements. During the year ended December 31, 2019, the Company amended, or obtained waivers related to, the financial covenants of all of its material debt and lease agreements to account for these ongoing changes in its capital structure and business conditions. Although the Company is and projects to be in compliance with all of its material debt and lease covenants through March 16, 2021, the ongoing uncertainty related to the impact of healthcare reform initiatives may have an adverse impact on the Company’s ability to remain in compliance with the covenants. Should the Company fail to comply with its debt and lease covenants at a future measurement date it could, absent necessary and timely waivers and/or amendments, be in default under certain of its existing debt and lease agreements. To the extent any cross-default provisions apply, the default could have a more significant impact on the Company’s financial position.
Estimates and Assumptions	Estimates and Assumptions The consolidated financial statements have been prepared in conformity with U.S. GAAP, which requires management to consolidate company financial information and make informed estimates and assumptions that affect the reported amounts of assets and liabi lities, disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. The most significant estimates in the Company’s consolidated financial statements relate to revenues, valuation of accounts receivable, self-insured liabilities, income taxes, impairment of long-lived assets, and other contingencies. Actual results could differ from those estimates.
Revenue Recognition	Revenue Recognition The Company adopted Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) Topic 606, Revenue from Contracts with Customers (Topic 606), effective January 1, 2018. The Company’s adoption of Topic 606 primarily impacted the presentation of revenues due to the inclusion of variable consideration in the form of implicit price concessions contained in certain of its contracts with customers. Under Topic 606, amounts estimated to be uncollectable are generally considered implicit price concessions that are a direct reduction to net revenues. To the extent there are material subsequent events that affect the payor's ability to pay, such amounts are recorded within operating expenses. The Company generates revenues, primarily by providing healthcare services to its customers. Revenues are recognized when control of the promised good or service is transferred to our customers, in an amount that reflects the consideration to which the Company expects to be entitled from patients, third-party payors (including government programs and insurers) and others, in exchange for those goods and services. Performance obligations are determined based on the nature of the services provided. The majority of the Company’s healthcare services represent a bundle of services that are not capable of being distinct and as such, are treated as a single performance obligation satisfied over time as services are rendered. The Company also provides certain ancillary services which are not included in the bundle of services, and as such, are treated as separate performance obligations satisfied at a point in time, if and when those services are rendered. The Company determines the transaction price based on contractually agreed-upon amounts or rates, adjusted for estimates of variable consideration, such as implicit price concessions. The Company utilizes the expected value method to determine the amount of variable consideration that should be included to arrive at the transaction price, using contractual agreements and historical reimbursement experience within each payor type. Variable consideration also exists in the form of settlements with Medicare and Medicaid as a result of retroactive adjustments due to audits and reviews. The Company applies constraint to the transaction price, such that net revenues are recorded only to the extent that it is probable that a significant reversal in the amount of the cumulative revenue recognized will not occur in the future. If actual amounts of consideration ultimately received differ from the Company’s estimates, the Company adjusts these estimates, which would affect net revenues in the period such variances become known. Adjustments arising from a change in the transaction price were not significant for the years ended December 31, 2019 and 2018. The Company does not adjust the promised amount of consideration for the effects of a significant financing component due to its expectation that the period between the time the service is provided and the time payment is received will be one year or less. The Company recognizes revenue in the statements of operations and contract assets on the consolidated balance sheets only when services have been provided. Since the Company has performed its obligation under the contract, it has unconditional rights to the consideration recorded as contract assets and therefore classifies those billed and unbilled contract assets as accounts receivable. Payments that the Company receives from customers in advance of providing services represent contract liabilities. Such payments primarily relate to private pay patients, which are billed monthly in advance. See Note 5 – “ Net Revenues and Accounts Receivable. ”
Accounts Receivable	Accounts Receivable The Company’s accounts receivable are primarily comprised of amounts due from Medicare, Medicaid, private insurance, self-pay residents, other third-party payors and long-term care providers that utilize its rehabilitation therapy and other services. The Company evaluates the valuation of accounts receivable based on analysis of historical collection trends, as well as its understanding of the nature and collectibility of accounts based on their age and other factors.
Cash and Cash Equivalents	Cash and Cash Equivalents Cash and cash equivalents consist of cash and short-term investments with original maturities of three months or less when purchased and therefore, approximate fair value. The Company’s available cash is held in accounts at commercial banking institutions. The Company currently has bank deposits with commercial banking institutions that exceed Federal Deposit Insurance Corporation insurance limits.
Restricted Cash and Equivalents	Restricted Cash and Equivalents Restricted cash and equivalents includes cash and money market funds held by the Company’s wholly-owned captive insurance subsidiary, which are substantially restricted to securing outstanding claims losses. Further, restricted cash and equivalents includes cash proceeds received under the ABL Credit Facilities that are pledged to cash collateralize letters of credit previously issued under the retired revolving credit facilities, as well as cash account balances subject to deposit account control agreements that were sprung under the ABL Credit Facilities resulting in the majority of the Company’s cash accounts being classified as restricted. See Note 12 – “ Long-Term Debt – Asset Based Lending Facilities.” The restricted cash and equivalents balances at December 31, 2019 and 2018 were $113.7 million and $121.4 million, respectively.
Restricted Investments in Marketable Securities	Restricted Investments in Marketable Securities Restricted investments in marketable securities primarily consist of fixed interest rate securities that are considered to be available-for-sale and accordingly are reported at fair value with unrealized gains and losses, net of related tax effects, included within accumulated other comprehensive income (loss), a separate component of stockholders’ deficit. Fair values for fixed interest rate securities are based on quoted market prices. A decline in the market value of any security below cost that is deemed other-than-temporary is charged to income, resulting in the establishment of a new cost basis for the security. Realized gains and losses for securities classified as available-for-sale are derived using the specific identification method for determining the cost of securities sold. The restricted investments in marketable securities balances at December 31, 2019 and 2018 were $136.9 million and $136.2 million, respectively.
Property and Equipment	Property and Equipment Property and equipment are carried at cost less accumulated depreciation. Depreciation expense is calculated using the straight-line method over the estimated useful lives of the depreciable assets, which generally range from 20-35 years for buildings, building improvements and land improvements, and 3-15 years for equipment, furniture and fixtures. Depreciation expense on leasehold improvements is calculated using the straight-line method over the lesser of the lease term or the estimated useful life of the asset. Expenditures for maintenance and repairs necessary to maintain property and equipment in efficient operating condition are expensed as incurred. Costs of additions and improvements are capitalized. Total depreciation expense for the years ended December 31, 2019 and 2018 was $96.1 million and $210.0 million, respectively.
Impairment of Long-Lived Assets	Impairment of Long-Lived Assets The Company’s long-lived assets are reviewed for impairment whenever events or changes in circumstances indicate the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by comparison of the carrying amount of an asset to the future cash flows expected to be generated by the asset. If the carrying amount of an asset exceeds its estimated future undiscounted cash flows, an impairment charge is recognized to the extent the carrying amount of the asset exceeds the fair value of the asset. Assets to be disposed of are reported at the lower of the carrying amount or the fair value, less costs to sell. See Note 19 – “ Asset Impairment Charges .”
Goodwill and Identifiable Intangible Assets	Goodwill and Identifiable Intangible Assets Goodwill represents the excess of the purchase price over the fair value of identifiable net assets acquired in business combinations. The Company tests goodwill on an annual basis and between annual tests if events occur or circumstances exist that would reduce the fair value of a reporting unit below its carrying amount. The Company performs its annual goodwill impairment assessment for its reporting units as of September 30 of each year. The Company first assesses qualitative factors to determine whether it is necessary to perform quantitative goodwill impairment testing. If determined necessary, the Company applies the quantitative impairment test to identify and measure the amount of impairment, if any. Definite-lived intangible assets consist of management contracts, customer relationships and favorable leases. These assets are amortized in accordance with the authoritative guidance for intangible assets using the straight-line method over their estimated useful lives. These assets are tested for impairment consistent with the Company’s long-lived assets. Indefinite-lived intangible assets consist of trade names. The Company tests indefinite-lived intangible assets for impairment on an annual basis or more frequently if events occur or circumstances exist that would indicate that the carrying amount of the intangible asset may not be recoverable. See Note 11 – “ Goodwill and Identifiable Intangible Assets ” and Note 19 – “ Asset Impairment Charges .”
Self-Insurance Reserves	Self-Insurance Reserves The Company provides for self-insurance reserves for both general and professional liability and workers’ compensation claims based on estimates of the ultimate costs for both reported claims and claims incurred but not reported. Estimated losses from asserted and incurred but not reported claims are accrued based on the Company’s estimates of the ultimate costs of the claims, which include costs associated with litigating or settling claims, and the relationship of past reported incidents to eventual claims payments. All relevant information, including the Company’s own historical experience, the nature and extent of existing asserted claims and reported incidents, and independent actuarial analyses of this information is used in estimating the expected amount of claims. The reserves for loss for workers’ compensation risks are discounted based on actuarial estimates of claim payment patterns whereas the reserves for general and professional liability are recorded on an undiscounted basis. The Company also considers amounts that may be recovered from excess insurance carriers in estimating the ultimate net liability for such risks. See Note 21 – “ Commitments and Contingencies – Loss Reserves For Certain Self-Insured Programs – General and Professional Liability and Workers’ Compensation .”
Income Taxes	Income Taxes The Company’s effective tax rate is based on pretax income, statutory tax rates and tax planning opportunities available in the various jurisdictions in which it operates. The Company accounts for income taxes in accordance with applicable guidance on accounting for income taxes, which requires that deferred tax assets and liabilities be recognized using enacted tax rates for the effect of temporary differences between book and tax bases on recorded assets and liabilities. Accounting guidance also requires that deferred tax assets be reduced by a valuation allowance, when it is more likely than not that a tax benefit will not be realized. The recognition and measurement of a tax position is based on management’s best judgment given the facts, circumstances and information available at the reporting date. The Company evaluates tax positions to determine whether the benefits of tax positions are more likely than not of being sustained upon audit based on the technical merits of the tax position. For tax positions that are more likely than not of being sustained upon audit, the Company recognizes the largest amount of the benefit that is greater than 50% likely of being realized upon ultimate settlement in the financial statements. For tax positions that are not more likely than not of being sustained upon audit, the Company does not recognize any portion of the benefit in the financial statements. If the more likely than not threshold is not met in the period for which a tax position is taken, the Company may subsequently recognize the benefit of that tax position if the tax matter is effectively settled, the statute of limitations expires, or if the more likely than not threshold is met in a subsequent period. The Company evaluates, on a quarterly basis, its ability to realize deferred tax assets by assessing its valuation allowance and by adjusting the amount of such allowance, if necessary. The factors used to assess the likelihood of realization are its forecast of pre-tax earnings, its forecast of future taxable income and available tax planning strategies that could be implemented to realize the net deferred tax assets. To the extent the Company prevails in matters for which reserves have been established, or is required to pay amounts in excess of its reserves, its effective tax rate in a given financial statement period could be materially affected. An unfavorable tax settlement would require use of cash and result in an increase in the effective tax rate in the year of resolution. A favorable tax settlement would be recognized as a reduction in the Company’s effective tax rate in the year of resolution. The Company records accrued interest and penalties associated with uncertain tax positions as income tax expense in the consolidated statement of operations.
Leases	Leases The Company adopted a new leasing standard, FASB ASC Topic 842, Leases (Topic 842), on January 1, 2019 and elected the option to apply the transition requirements thereof at the effective date with the effects of initially applying the new standard recognized as a cumulative-effect adjustment to accumulated deficit on the adoption date. Consequently, financial information has not been updated for periods prior to January 1, 2019 . See Recently Adopted Accounting Pronouncements below. The Company leases skilled nursing facilities and assisted/senior living facilities, as well as certain office space, land, and equipment. Under Topic 842, the Company evaluates at contract inception whether a lease exists and recognizes a lease liability and right-of-use (ROU) asset for all leases with a term greater than 12 months. Leases are classified as either finance or operating. While many of the Company’s facilities are subject to master lease agreements, leases are assessed, classified, and measured at the facility level. All lease liabilities are measured as the present value of the future lease payments using a discount rate, which is generally the Company’s incremental borrowing rate for collateralized borrowings. The future lease payments used to measure the lease liability include both fixed and variable payments that depend on a rate or index, as well as the exercise price of any options to purchase the underlying asset that have been deemed reasonably certain of being exercised. Future lease payments for optional renewal periods that are not reasonably certain of being exercised are excluded from the measurement of the lease liability. Regarding variable payments that depend on a rate or index, the lease liability is measured using the applicable rate or index as of lease commencement and is only remeasured under certain circumstances, such as a change in the lease term. Lease incentives serve to reduce the amount of future lease payments included in the measurement of the lease liability. For all leases, the ROU asset is initially derived from the measurement of the lease liability and adjusted for certain items, such as initial direct costs and lease incentives received. ROU assets are subject to impairment testing. Amortization of finance lease ROU assets, which is generally recognized on a straight-line basis over the lesser of the lease term and the estimated useful life of the asset, is included within depreciation and amortization expense in the consolidated statements of operations. Interest expense associated with finance lease liabilities is included within interest expense in the consolidated statements of operations. Operating lease expense is recognized on a straight-line basis over the lease term and included within lease expense in the consolidation statements of operations. The lease term is determined based on the date the Company acquires control of the leased premises through the end of the lease term. Optional renewals periods are not initially included in the lease term unless they are deemed to be reasonably certain of being exercised at lease commencement. For further discussion, see Note 10 – “Leases.”
Earnings (Loss) Per Share	Earnings (Loss) Per Share The Company follows the Financial Accounting Standards Board’s (FASB) authoritative guidance for the financial reporting of earnings (loss) per share. Earnings (loss) per share excludes dilution and is based upon the weighted average number of common shares outstanding during the respective periods. Diluted earnings (loss) per share reflects the potential dilution that could occur if securities or other contracts to issue common stock were exercised or converted into common stock or otherwise resulted in the issuance of common stock that then shared in the earnings of the Company. See Note 6 – “Earnings (Loss) Per Share .”
Business Combinations	Business Combinations The Company’s acquisition strategy is to identify facilities for purchase or lease that are complementary to its current affiliated facilities, accretive to its business or otherwise advance its strategy. The results of all of the Company’s operating subsidiaries are included in the accompanying financial statements subsequent to the date of acquisition. Acquisitions are accounted for using the acquisition method of accounting and include leasing and other financing arrangements as well as cash transactions. Assets and liabilities of the acquired entities are recorded at their estimated fair values at the acquisition date. Goodwill represents the excess of the purchase price over the fair value of net assets, including the amount assigned to identifiable intangible assets. Given the time it takes to obtain pertinent information to finalize the acquired company’s balance sheet, the initial fair value might not be finalized up to one year after the date of acquisition. In developing estimates of fair values for long-lived assets, the Company utilizes a variety of factors including market data, cash flows, growth rates, and replacement costs. Determining the fair value for specifically identified intangible assets involves significant judgment, estimates and projections related to the valuation to be applied to intangible assets such as favorable leases, customer relationships, management contracts and trade names. The subjective nature of management’s assumptions increases the risk associated with estimates surrounding the projected performance of the acquired entity. In transactions where significant judgment or other assumptions could have a material impact on the conclusion, the Company may engage third party specialists to assist in the valuation of the acquired assets and liabilities. Additionally, as the Company amortizes definite-lived acquired intangible assets over time, the purchase accounting allocation directly impacts the amortization expense recorded on the financial statements.
Recently Adopted Accounting Pronouncements	Recently Adopted Accounting Pronouncements In February 2016, the FASB established Topic 842 by issuing Accounting Standards Update (ASU) No. 2016-02, which requires lessees to recognize leases on-balance sheet and disclose key information about leasing arrangements. Topic 842 was subsequently amended by ASU No. 2018-01, Land Easement Practical Expedient for Transition to Topic 842 ; ASU No. 2018-10, Codification Improvements to Topic 842, Leases ; and ASU No. 2018-11, Targeted Improvements . The new standard establishes a right-of-use (ROU) model that requires a lessee to recognize a ROU asset and lease liability on the balance sheet for all leases with a term longer than 12 months. Leases will be classified as finance or operating, with classification affecting the pattern and classification of expense recognition in the statement of operations. The Company adopted the new standard on January 1, 2019. The Company elected the option to apply the transition requirements in Topic 842 at the effective date of January 1, 2019 with the effects of initially applying Topic 842 recognized as a cumulative-effect adjustment to accumulated deficit in the period of adoption. Consequently, financial information has not been updated and the disclosures required under the new standard have not been provided for dates and periods before January 1, 2019. The new standard provides a number of optional practical expedients in transition. The Company has elected the ‘package of practical expedients’, which permit it to not reassess its prior conclusions about lease identification, lease classification and initial direct costs. The Company did not elect the use-of-hindsight or the practical expedient pertaining to land easements; the latter is not applicable to the Company. The adoption of the new standard had a material effect on the Company’s financial statements. The most significant effects relate to (1) the recognition of new ROU assets and lease liabilities on its balance sheet for real estate operating leases; (2) the derecognition of existing assets and liabilities for sale-leaseback transactions (including those arising from build-to-suit lease arrangements for which construction is complete and the Company is leasing the constructed asset) that historically did not qualify for sale accounting; and (3) providing significant new disclosures about its leasing activities. Upon adoption, the Company: · Recognized operating lease liabilities of $0.6 billion based on the present value of the remaining minimum rental payments as determined in accordance with Topic 842 for leases that had historically been accounted for as operating leases under the previous leasing standards. The Company recognized corresponding ROU assets of approximately $0.5 billion based on the operating lease liabilities, adjusted for existing straight-line lease liabilities, existing assets and liabilities related to favorable and unfavorable terms of operating leases previously recognized in respect of business combinations, and the impairment of the ROU assets. The resulting net impact of $0.1 billion associated with this change in accounting was recognized as an increase to opening accumulated deficit as of January 1, 2019. · Derecognized existing financing obligations of $2.7 billion and existing property and equipment of $1.7 billion. The Company recognized new operating lease liabilities and corresponding ROU assets of $1.9 billion on its balance sheet for the associated leases. The resulting net impact of $1.0 billion associated with this change in accounting was recognized as a reduction to opening accumulated deficit as of January 1, 2019. The new standard also provides practical expedients for an entity’s ongoing accounting. The Company elected the short-term lease recognition exemption for all leases that qualify. See Note 10 – “ Leases. ” In February 2018, the FASB issued ASU 2018-02, Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income , which permits entities to reclassify the disproportionate income tax effects of the Tax Cuts and Jobs Act (Tax Reform Act) on items within accumulated other comprehensive income (loss) to retained earnings. These disproportionate income tax effect items are referred to as "stranded tax effects." Amendments in this update only relate to the reclassification of the income tax effects of the Tax Reform Act. Other accounting guidance that requires the effect of changes in tax laws or rates to be included in net income is not affected by this update. The Company adopted the new standard on January 1, 2019. The adoption of ASU 2018-02 did not have a material impact on the Company’s consolidated financial statements. Recently Issued Accounting Pronouncements In August 2018, the FASB issued ASU 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework – Changes to the Disclosure Requirements for Fair Value Measurement , which simplifies the fair value measurement disclosure requirements. The Company adopted the new standard on January 1, 2020. The adoption of ASU 2018-13 did not have a material impact on the Company’s consolidated financial statements and related disclosures. In June 2016, the FASB issued ASU 2016-13, Financial Instruments - Credit Losses: Measurement of Credit Losses on Financial Instruments , which is intended to improve financial reporting by requiring earlier recognition of credit losses on certain financial assets, such as available-for-sale debt securities. The standard replaces the current incurred loss impairment model that recognizes losses when a probable threshold is met with a requirement to recognize lifetime expected credit losses immediately when a financial asset is originated or purchased. The standard has been further refined through subsequent releases by the FASB, including the extension of the effective date. As a smaller reporting company, the standard is effective for the Company for fiscal years beginning after December 15, 2022, including interim periods within those annual periods, with early adoption permitted. The Company is currently evaluating the effect that the standard will have on its consolidated financial statements and related disclosures. In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes, which serves to remove or amend certain requirements associated with the accounting for income taxes. The standard is effective for fiscal years beginning after December 15, 2020, including interim periods within those annual periods, with early adoption permitted. The Company is currently evaluating the effect, if any, that the standard will have on its consolidated financial statements and related disclosures.

Certain Significant Risks and_2

Certain Significant Risks and Uncertainties (Tables)	12 Months Ended
	Dec. 31, 2019
Certain Significant Risks and Uncertainties
Schedule of revenue by major source (in thousands)	Year ended December 31, 2019 2018 Medicare 20 % 21 % Medicaid 58 % 57 % Insurance 12 % 12 % Private 7 % 8 % Other 3 % 2 % Total 100 % 100 %

Net Revenues and Accounts Rec_2

Net Revenues and Accounts Receivable (Tables)	12 Months Ended
	Dec. 31, 2019
Net Revenues and Accounts Receivable
Schedule of revenues by revenue source	The composition of net revenues by payor type and operating segment for the years ended December 31, 2019 and 2018 are as follows (in thousands): Year ended December 31, 2019 Rehabilitation Inpatient Therapy Other Services Services Services Total Medicare $ 800,253 $ 90,811 $ — $ 891,064 Medicaid 2,313,479 2,144 — 2,315,623 Insurance 463,135 22,273 — 485,408 Private 310,022 296 — 310,318 Third party providers — 336,509 78,709 415,218 Other 69,143 10,513 68,547 148,203 Total net revenues $ 3,956,032 $ 462,546 $ 147,256 $ 4,565,834 Year ended December 31, 2018 Rehabilitation Inpatient Therapy Other Services Services Services Total Medicare $ 913,615 $ 89,514 $ — $ 1,003,129 Medicaid 2,461,228 2,096 — 2,463,324 Insurance 517,512 23,071 — 540,583 Private 339,680 438 — 340,118 Third party providers — 415,541 83,952 499,493 Other 64,838 17,254 47,911 130,003 Total net revenues $ 4,296,873 $ 547,914 $ 131,863 $ 4,976,650 (1) Includes Assisted/Senior living revenue of $93.1 million and $96.1 million for the years ended December 31, 2019 and 2018, respectively. Such amounts do not represent contracts with customers under Topic 606. (2) Primarily consists of revenue from Veteran Affairs and administration of third party facilities. (3) Includes net revenues from all payors generated by the other services, excluding third party providers.

Earnings (Loss) Per Share (Tabl

Earnings (Loss) Per Share (Tables)	12 Months Ended
	Dec. 31, 2019
Earnings (Loss) Per Share
Schedule of reconciliation of the numerator and denominator used in the calculation of basic net income (loss) per common share	A reconciliation of the numerator and denominator used in the calculation of basic net income (loss) per common share follows (in thousands, except per share data): Year ended December 31, 2019 2018 Numerator: Net income (loss) $ 7,474 $ (372,417) Less: Net loss attributable to noncontrolling interests 7,145 137,186 Net income (loss) attributable to Genesis Healthcare, Inc. $ 14,619 $ (235,231) Denominator: Weighted-average shares outstanding for basic net income (loss) per share 107,286 101,007 Basic net income (loss) per common share attributable to Genesis Healthcare, Inc. $ 0.14 $ (2.33)
Schedule of reconciliation of the numerator and denominator used in the calculation of diluted net loss per common share	A reconciliation of the numerator and denominator used in the calculation of diluted net income (loss) per common share follows (in thousands, except per share data): Year ended December 31, 2019 2018 Numerator: Net income (loss) $ 7,474 $ (372,417) Less: Net loss attributable to noncontrolling interests 7,145 137,186 Net income (loss) attributable to Genesis Healthcare, Inc. $ 14,619 $ (235,231) Plus: Assumed conversion of noncontrolling interests 1,868 — Net income (loss) available to common stockholders after assumed conversions $ 16,487 $ (235,231) Denominator: Weighted-average common shares outstanding 107,286 101,007 Plus: Assumed conversion of noncontrolling interests 57,074 — Plus: Unvested restricted stock units and stock warrants 954 — Adjusted weighted-average common shares outstanding, diluted 165,314 101,007 Diluted net income (loss) per common share attributable to Genesis Healthcare, Inc. $ 0.10 $ (2.33)

Segment Information (Tables)

Segment Information (Tables)	12 Months Ended
	Dec. 31, 2019
Segment Information
Summary of segmented revenues	A summary of the Company’s segmented revenues follows (in thousands, except percentages): Year ended December 31, 2019 2018 Increase / (Decrease) Revenue Revenue Revenue Revenue Dollars Percentage Dollars Percentage Dollars Percentage Revenues: Inpatient services: Skilled nursing facilities $ 3,857,793 84.4 % $ 4,195,596 84.3 % $ (337,803) (8.1) % Assisted/Senior living facilities 93,054 2.0 % 95,571 1.9 % (2,517) (2.6) % Administration of third party facilities 8,310 0.2 % 8,733 0.2 % (423) (4.8) % Elimination of administrative services (3,125) (0.1) % (3,027) — % (98) (3.2) % Inpatient services, net 3,956,032 86.5 % 4,296,873 86.4 % (340,841) (7.9) % Rehabilitation therapy services: Total therapy services 738,124 16.2 % 889,069 17.9 % (150,945) (17.0) % Elimination of intersegment rehabilitation therapy services (275,578) (6.0) % (341,155) (6.9) % 65,577 19.2 % Third party rehabilitation therapy services, net 462,546 10.2 % 547,914 11.0 % (85,368) (15.6) % Other services: Total other services 198,920 4.4 % 161,038 3.2 % 37,882 23.5 % Elimination of intersegment other services (51,664) (1.1) % (29,175) (0.6) % (22,489) (77.1) % Third party other services, net 147,256 3.3 % 131,863 2.6 % 15,393 11.7 % Net revenues $ 4,565,834 100.0 % $ 4,976,650 100.0 % $ (410,816) (8.3) %
Summary of condensed consolidated statements of operations and Total assets	A summary of the Company’s condensed consolidated statement of operations follows (in thousands): Year ended December 31, 2019 Rehabilitation Inpatient Therapy Other Services Services Services Corporate Eliminations Consolidated Net revenues $ 3,959,157 $ 738,124 $ 198,676 $ 244 $ (330,367) $ 4,565,834 Salaries, wages and benefits 1,761,273 601,196 122,541 — — 2,485,010 Other operating expenses 1,599,549 44,088 62,104 — (330,894) 1,374,847 General and administrative costs — — — 144,471 — 144,471 Lease expense 382,897 1,297 1,463 1,406 — 387,063 Depreciation and amortization expense 99,529 12,230 720 10,775 (95) 123,159 Interest expense 83,887 55 35 97,831 (1,416) 180,392 Gain on early extinguishment of debt — — — (122) — (122) Investment income — — — (8,712) 1,416 (7,296) Other (income) loss (172,709) (926) 112 18 — (173,505) Transaction costs — — — 26,362 — 26,362 Long-lived asset impairments 16,937 — — — — 16,937 Equity in net loss (income) of unconsolidated affiliates — — — 4,091 (4,803) (712) Income (loss) before income tax expense 187,794 80,184 11,701 (275,876) 5,425 9,228 Income tax expense — — — 1,754 — 1,754 Net income (loss) $ 187,794 $ 80,184 $ 11,701 $ (277,630) $ 5,425 $ 7,474 Year ended December 31, 2018 Rehabilitation Inpatient Therapy Other Services Services Services Corporate Eliminations Consolidated Net revenues $ 4,299,900 $ 889,069 $ 160,913 $ 125 $ (373,357) $ 4,976,650 Salaries, wages and benefits 1,944,091 733,763 109,054 — — 2,786,908 Other operating expenses 1,740,537 51,590 61,110 — (373,357) 1,479,880 General and administrative costs — — — 149,182 — 149,182 Lease expense 127,323 — 1,289 1,247 — 129,859 Depreciation and amortization expense 193,930 12,779 684 13,503 — 220,896 Interest expense 367,562 55 36 96,085 — 463,738 Loss on early extinguishment of debt — — — 391 — 391 Investment income — — — (6,832) — (6,832) Other (income) loss (14,872) 1,942 78 (68) — (12,920) Transaction costs — — — 31,953 — 31,953 Long-lived asset impairments 104,997 — — — — 104,997 Goodwill and identifiable intangible asset impairments 3,538 — — — — 3,538 Equity in net (income) loss of unconsolidated affiliates — — — (1,608) 1,508 (100) (Loss) income before income tax benefit (167,206) 88,940 (11,338) (283,728) (1,508) (374,840) Income tax benefit — — — (2,423) — (2,423) Net (loss) income $ (167,206) $ 88,940 $ (11,338) $ (281,305) $ (1,508) $ (372,417) The following table presents the segment assets as of December 31, 2019 compared to December 31, 2018 (in thousands): December 31, 2019 December 31, 2018 Inpatient services $ 4,221,579 $ 3,735,778 Rehabilitation therapy services 281,978 329,687 Other services 49,877 36,240 Corporate and eliminations 108,706 161,918 Total assets $ 4,662,140 $ 4,263,623

Restricted Investments in Mar_2

Restricted Investments in Marketable Securities (Tables)	12 Months Ended
	Dec. 31, 2019
Restricted Investments in Marketable Securities
Schedule of Restricted Investments in Marketable Securities	Restricted investments in marketable securities at December 31, 2019 consist of the following (in thousands): Unrealized losses Amortized Unrealized Less than Greater than cost gains 12 months 12 months Fair value Restricted investments in marketable securities: Mortgage/government backed securities $ 20,957 $ 90 $ (17) $ (7) $ 21,023 Corporate bonds 48,362 566 — (2) 48,926 Government bonds 66,734 286 (22) (5) 66,993 $ 136,053 $ 942 $ (39) $ (14) 136,942 Less: Current portion of restricted investments (31,855) Long-term restricted investments $ 105,087 Restricted investments in marketable securities at December 31, 2018 consist of the following (in thousands): Unrealized losses Amortized Unrealized Less than Greater than cost gains 12 months 12 months Fair value Restricted investments in marketable securities: Mortgage/government backed securities $ 11,945 $ 4 $ — $ (130) $ 11,819 Corporate bonds 56,199 49 (42) (387) 55,819 Government bonds 68,767 76 (2) (326) 68,515 $ 136,911 $ 129 $ (44) $ (843) 136,153 Less: Current portion of restricted investments (35,631) Long-term restricted investments $ 100,522
Schedule of Maturities of Restricted Investments in Marketable Securities	Restricted investments in marketable securities held at December 31, 2019 mature as follows (in thousands): Amortized Fair cost value Due in one year or less $ 46,681 $ 46,766 Due after 1 year through 5 years 86,372 87,165 Due after 5 years through 10 years — — Due after 10 years 3,000 3,011 $ 136,053 $ 136,942

Property and Equipment (Tables)

Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2019
Property and Equipment
Schedule of property and equipment	Property and equipment consisted of the following as of December 31, 2019 and 2018 (in thousands): December 31, 2019 December 31, 2018 Land, buildings and improvements $ 1,004,447 $ 469,575 Finance lease land, buildings and improvements — 693,546 Financing obligation land, buildings and improvements — 2,274,211 Equipment, furniture and fixtures 386,248 417,684 Construction in progress 2,771 9,340 Gross property and equipment 1,393,466 3,864,356 Less: accumulated depreciation (431,361) (976,802) Net property and equipment $ 962,105 $ 2,887,554

Leases (Tables)

Leases (Tables)	12 Months Ended
	Dec. 31, 2019
Leases
Schedule of operating lease liability maturities - ASC 842	The maturity of total operating and finance lease obligations at December 31, 2019 is as follows (in thousands): Year ending December 31, Operating Leases Finance Leases (1) 2020 $ 382,926 $ 7,659 2021 386,440 7,468 2022 384,450 7,264 2023 382,649 7,032 2024 388,091 6,812 Thereafter 3,045,668 35,886 Total lease payments 4,970,224 72,121 Less interest (2,147,934) (29,947) Total lease obligations 2,822,290 42,174 Less current portion (140,887) (2,839) Long-term lease obligations $ 2,681,403 $ 39,335 (1) Finance lease payments include $37.2 million related to options to renew lease terms that are reasonably certain of being exercised.
Schedule of finance lease liability maturities - ASC 842	Year ending December 31, Operating Leases Finance Leases (1) 2020 $ 382,926 $ 7,659 2021 386,440 7,468 2022 384,450 7,264 2023 382,649 7,032 2024 388,091 6,812 Thereafter 3,045,668 35,886 Total lease payments 4,970,224 72,121 Less interest (2,147,934) (29,947) Total lease obligations 2,822,290 42,174 Less current portion (140,887) (2,839) Long-term lease obligations $ 2,681,403 $ 39,335 (1) Finance lease payments include $37.2 million related to options to renew lease terms that are reasonably certain of being exercised.
Schedule of future minimum lease commitments under ASC 840	The Company’s future minimum commitments under finance leases (formerly capital leases), financing obligations, and operating leases as of December 31, 2018 were as follows (in thousands): Year ending December 31, Finance Leases Financing Obligations Operating Leases 2019 $ 88,793 $ 237,335 $ 110,755 2020 89,397 242,052 109,391 2021 91,292 245,311 106,031 2022 93,281 242,214 84,003 2023 95,376 247,852 76,701 Thereafter 3,325,042 6,661,624 373,753 Total future minimum lease payments 3,783,181 7,876,388 $ 860,634 Less amount representing interest (2,813,068) (5,141,448) Total lease obligation 970,113 2,734,940 Less current portion (2,171) (2,001) Long-term obligation $ 967,942 $ 2,732,939
Schedule of leases	Year ended Lease Cost Classification December 31, 2019 Operating lease cost Lease expense $ 387,063 Finance lease cost: Amortization of finance lease right-of-use assets Depreciation and amortization expense 16,224 Interest on finance lease obligations Interest expense 50,162 Total finance lease expense 66,386 Variable lease cost Other operating expenses 37,841 Short-term leases Other operating expenses 24,297 Total lease cost $ 515,587
Schedule of quantitative information associated with operating and finance leases	Lease Term and Discount Rate December 31, 2019 Weighted-average remaining lease term (years) Operating leases 12.6 Finance leases 10.2 Weighted-average discount rate Operating leases Finance leases The following table includes supplemental lease information for the year ended December 31, 2019 (in thousands): Year ended Other information December 31, 2019 Cash paid for amounts included in the measurement of lease obligations Operating cash flows from operating leases $ 364,334 Operating cash flows from finance leases 47,188 Financing cash flows from finance leases 2,645 Right-of-use assets obtained in exchange for new lease obligations Operating leases 96,718 Finance leases 1,160

Goodwill and Identifiable Int_2

Goodwill and Identifiable Intangible Assets (Tables)	12 Months Ended
	Dec. 31, 2019
Goodwill and Identifiable Intangible Assets
Schedule of Changes in Carrying Value of Goodwill (in thousands)	The changes in the carrying value of goodwill are as follows (in thousands): Rehabilitation Therapy Services Other Services Consolidated Balance at December 31, 2018 Goodwill 73,814 11,828 85,642 Accumulated impairment losses — — — $ 73,814 $ 11,828 $ 85,642 Balance at December 31, 2019 Goodwill 73,814 11,828 85,642 Accumulated impairment losses — — — $ 73,814 $ 11,828 $ 85,642
Schedule of identifiable intangible assets (in thousands)	Identifiable intangible assets consist of the following at December 31, 2019 and 2018 (in thousands): December 31, 2019 Weighted Average Remaining Life (Years) Customer relationship assets, net of accumulated amortization of $76,243 $ 36,891 8 Trade names 50,555 Indefinite Identifiable intangible assets $ 87,446 December 31, 2018 Weighted Average Remaining Life (Years) Customer relationship assets, net of accumulated amortization of $65,756 $ 47,077 8 Favorable leases, net of accumulated amortization of $33,404 21,449 10 Trade names 50,556 Indefinite Identifiable intangible assets $ 119,082

Long-term Debt (Tables)

Long-term Debt (Tables)	12 Months Ended
	Dec. 31, 2019
Long-Term Debt.
Schedule of long-term debt	Long-term debt at December 31, 2019 and 2018 consisted of the following (in thousands): December 31, 2019 December 31, 2018 Asset based lending facilities, net of debt issuance costs of $8,615 and $11,335 at December 31, 2019 and December 31, 2018, respectively $ 412,346 $ 419,289 Term loan agreements, net of debt issuance costs of $1,084 and $1,851 and debt premium balance of $4,816 and $8,446 at December 31, 2019 and December 31, 2018, respectively 196,714 184,652 Real estate loans, net of debt issuance costs of $3,846 and $5,360 and debt premium balance of $19,328 and $28,992 at December 31, 2019 and December 31, 2018, respectively 265,700 307,690 HUD insured loans, net of debt issuance costs of $2,909 and $5,247 and debt premium balance of $0 and $860 at December 31, 2019 and December 31, 2018, respectively 117,117 181,762 Notes payable 116,952 81,398 Mortgages and other secured debt (recourse) 6,369 4,190 Mortgages and other secured debt (non-recourse), net of debt issuance costs of $9,349 and $187 and debt premium balance of $1,422 and $1,520 at December 31, 2019 and December 31, 2018, respectively 498,222 26,483 1,613,420 1,205,464 Less: Current installments of long-term debt (162,426) (122,531) Long-term debt $ 1,450,994 $ 1,082,933
Schedule of borrowings and interest rates under ABL Credit Facility	Borrowings and interest rates under the ABL Credit Facilities were as follows at December 31, 2019 (dollars in thousands): Weighted Average ABL Credit Facilities Commitment Borrowings Interest Term loan facility $ 285,000 $ 285,000 7.91 % Revolving credit facility (Non-HUD) 168,000 78,860 7.91 % Revolving credit facility (HUD) 72,000 27,101 7.91 % Delayed draw term loan facility 30,000 30,000 12.91 % $ 555,000 $ 420,961 8.26 %
Schedule of maturity of total debt	The maturity of total debt of $1.6 billion, excluding debt issuance costs and other non-cash debt discounts and premiums, at December 31, 2019 is as follows (in thousands): Twelve months ended December 31, 2020 $ 162,482 2021 278,941 2022 346,155 2023 344,985 2024 11,171 Thereafter 469,923 Total debt maturity $ 1,613,657

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	12 Months Ended
	Dec. 31, 2019
Stock-Based Compensation
Schedule of Nonvested Share Activity	A summary of the Company’s non-vested restricted stock units as of and for the year ended December 31, 2019 is shown below (number of units in thousands): Number of Restricted Stock Units Weighted-Average Grant Date Fair Value Non-vested balance at January 1, 2019 10,192 $ 1.89 Granted 4,778 1.30 Vested (3,375) 1.82 Forfeited (1,636) 1.24 Non-vested balance at December 31, 2019 9,959 $ 1.74

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2019
Income Taxes
Schedule of total income tax (benefit) expense by income category	Total income tax expense (benefit) was as follows (in thousands): Year ended December 31, 2019 2018 Continuing operations $ 1,754 $ (2,423) Stockholder's deficit 346 (115) Total $ 2,100 $ (2,538)
Schedule of Components of Income Tax Expense (Benefit)	The components of the provision for income taxes on income (loss) for the years ended December 31, 2019 and 2018 were as follows (in thousands): Year ended December 31, 2019 2018 Current: Federal $ 1,014 $ 1,064 State 28 (12) 1,042 1,052 Deferred: Federal 29 (521) State 683 (2,954) 712 (3,475) Total $ 1,754 $ (2,423)
Schedule of Effective Income Tax Rate Reconciliation	Total income tax expense (benefit) for the periods presented was as follows (in thousands): Year ended December 31, 2019 2018 Computed “expected” expense (benefit) $ 1,939 $ (78,716) (Reduction) increase in income taxes resulting from: State and local income taxes, net of federal tax benefit 107 113 Income tax credits (2,088) (2,397) Non-controlling interest 4,038 28,366 Adjustment to deferred taxes, including credits and valuation allowance (2,977) 50,302 FIN 48 — (38) Other, net 735 (53) Total income tax expense (benefit) $ 1,754 $ (2,423)
Schedule of Deferred Tax Assets and Liabilities	The tax effects of temporary differences that give rise to significant portions of the deferred tax assets and deferred tax liabilities at December 31, 2019 and 2018 are presented below (in thousands): 2019 2018 Deferred tax assets: Investment in partnership $ 224,215 $ 195,095 Net operating loss carryforwards 133,611 121,111 Discounted unpaid loss reserve 2,156 3,567 General business credits 30,006 28,729 Total deferred tax assets 389,988 348,502 Valuation allowance (386,216) (342,635) Deferred tax assets, net of valuation allowance $ 3,772 $ 5,867 Deferred tax liabilities: Long-lived assets: intangible property (5,245) (6,281) Total deferred tax liabilities (5,245) (6,281) Net deferred tax liabilities $ (1,473) $ (414)
Schedule of Unrecognized Tax Benefits Roll Forward	A reconciliation of unrecognized tax benefits follows (in thousands): Balance, December 31, 2017 $ 115 Reductions due to lapses of applicable statute of limitations (38) Balance, December 31, 2018 $ 77 Reductions due to lapses of applicable statute of limitations — Balance, December 31, 2019 $ 77

Other Income (Tables)

Other Income (Tables)	12 Months Ended
	Dec. 31, 2019
Other Income
Summary of Net (Gain) Loss Recorded as Other Income	The following table summarizes those net gains (in thousands): Year ended December 31, 2019 2018 Gain on sale of owned assets (1) $ (90,723) $ — Loss recognized for exit costs associated with divestiture of operations (2) 12,997 21,459 Gain on lease termination or modification (3) (95,779) (34,379) Total other income $ (173,505) $ (12,920) (1) The Company sold 13 owned skilled nursing facilities and two assisted/senior living facilities in 2019. The gain represents sale proceeds in excess of the carrying value of the assets sold. The Company sold 22 skilled nursing facilities and one assisted/senior living facility in 2018. The sale price approximated the carrying value of those assets sold. (2) The Company divested operations of 44 facilities and 55 facilities in 2019 and 2018, respectively. Upon divestiture, the Company recognizes exit costs for uncollectible accounts receivable resulting from a sale, the write-off of inventory balances assumed by the new operator, and other costs associated with the transition of operations. (3) The Company has amended numerous lease agreements in 2019 and 2018 in conjunction with its efforts detailed in Note 4 – “ Significant Transactions and Events .” These transactions resulted in a combination of base rent reductions, annual escalator reductions, lease term extensions or reductions and facility terminations. Each lease amendment triggers a lease reassessment of the respective ROU asset and lease liability with an offsetting adjustment recorded to the consolidated statements of operations as other income or loss.

Assets Held for Sale (Tables)

Assets Held for Sale (Tables)	12 Months Ended
	Dec. 31, 2019
Assets Held for Sale
Schedule of major classes of assets and liabilities included as part of the disposal groups	The following table sets forth the major classes of assets and liabilities included as part of the disposal groups as of December 31, 2019 and 2018 (in thousands): December 31, 2019 December 31, 2018 Current assets: Prepaid expenses $ 1,171 $ 3,375 Long-term assets: Property and equipment, net of accumulated depreciation of $2,201 and $3,640 at December 31, 2019 and December 31, 2018, respectively 16,306 16,087 Total assets $ 17,477 $ 19,462 Current liabilities: Current installments of long-term debt $ 368 $ 639 Long-term liabilities: Long-term debt 19,789 25,942 Total liabilities $ 20,157 $ 26,581

Fair Value of Financial Instr_2

Fair Value of Financial Instruments (Tables)	12 Months Ended
	Dec. 31, 2019
Fair Value of Financial Instruments
Schedule of fair value of assets measured on a recurring basis	The tables below present the Company’s assets measured at fair value on a recurring basis as of December 31, 2019 and 2018, 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 December 31, Identical Assets Observable Inputs Inputs Assets: 2019 (Level 1) (Level 2) (Level 3) Cash and cash equivalents $ 12,097 $ 12,097 $ — $ — Restricted cash and equivalents 113,709 113,709 — — Restricted investments in marketable securities: Mortgage/government backed securities 21,023 — 21,023 — Corporate bonds 48,926 — 48,926 — Government bonds 66,993 45,903 21,090 — Total $ 262,748 $ 171,709 $ 91,039 $ — 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: 2018 (Level 1) (Level 2) (Level 3) Cash and cash equivalents $ 20,865 $ 20,865 $ — $ — Restricted cash and equivalents 121,411 121,411 — — Restricted investments in marketable securities: Mortgage/government backed securities 11,819 — 11,819 — Corporate bonds 55,819 — 55,819 — Government bonds 68,515 40,699 27,816 — Total $ 278,429 $ 182,975 $ 95,454 $ —
Schedule of carrying amounts and estimated fair values of long-term debt, net of issuance costs and other non-cash debt discounts and premiums	December 31, 2019 December 31, 2018 Carrying Value Fair Value Carrying Value Fair Value Asset based lending facilities $ 412,346 $ 412,346 $ 419,289 $ 419,289 Term loan agreements 196,714 196,714 184,652 184,652 Real estate loans 265,700 265,700 307,690 307,690 HUD insured loans 117,117 117,117 181,762 180,950 Notes payable 116,952 116,952 81,398 81,398 Mortgages and other secured debt (recourse) 6,369 6,369 4,190 4,190 Mortgages and other secured debt (non-recourse) 498,222 498,222 26,483 26,483 $ 1,613,420 $ 1,613,420 $ 1,205,464 $ 1,204,652
Schedule of hierarchy of nonfinancial assets measured at fair value on a nonrecurring basis	The following tables present the Company’s hierarchy for nonfinancial assets measured at fair value on a non-recurring basis (in thousands): Impairment Charges - Carrying Value Year ended December 31, 2019 December 31, 2019 Assets: Property and equipment, net $ 962,105 $ 10,696 Finance lease right-of-use assets, net 37,097 — Operating lease right-of-use assets 2,399,505 6,241 Intangible assets, net 87,446 — Goodwill 85,642 — Impairment Charges - Carrying Value Year ended December 31, 2018 December 31, 2018 Assets: Property and equipment, net $ 2,887,554 $ 104,997 Intangible assets, net 119,082 3,538 Goodwill 85,642 —

General Information (Details)

General Information (Details)	12 Months Ended
	Dec. 31, 2019statefacility	Dec. 31, 2018
Product Concentration Risk
Concentration risk
Concentration risk (as a percent)	100.00%	100.00%
Rehabilitation therapy service | Product Concentration Risk
Concentration risk
Concentration risk (as a percent)	10.20%	11.00%
Rehabilitation therapy service | Revenue | Product Concentration Risk
Concentration risk
Concentration risk (as a percent)	10.00%
Inpatient Services
Description of business
Number of skilled nursing, assisted/senior living and behavioral health centers through which inpatient services are provided	381
Number of states with facilities | state	26
Inpatient Services | Product Concentration Risk
Concentration risk
Concentration risk (as a percent)	86.50%	86.40%
Inpatient Services | Revenue | Product Concentration Risk
Concentration risk
Concentration risk (as a percent)	87.00%
Skilled Nursing Facility
Concentration risk
Number of facilities leased from VIE in partnership	33

Summary of Significant Accoun_3

Summary of Significant Accounting Policies - Revenue recognition through Restricted Investments (Details) - USD ($) $ in Millions	Dec. 31, 2019	Dec. 31, 2018
Restricted Cash and Investments in Marketable Securities
Restricted cash and equivalents	$ 113.7	$ 121.4
Restricted investments in marketable securities	$ 136.9	$ 136.2

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - PP&E (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Property, Plant and Equipment
Depreciation expense	$ 96.1	$ 210
Buildings Building Improvements And Land Improvements [Member] | Minimum
Property, Plant and Equipment
Property and equipment, useful life	20 years
Buildings Building Improvements And Land Improvements [Member] | Maximum
Property, Plant and Equipment
Property and equipment, useful life	35 years
Equipment, furniture and fixtures | Minimum
Property, Plant and Equipment
Property and equipment, useful life	3 years
Equipment, furniture and fixtures | Maximum
Property, Plant and Equipment
Property and equipment, useful life	15 years

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - New accounting pronouncements (Details) - USD ($) $ in Thousands	Jan. 01, 2019	Dec. 31, 2019
Lease amendments
Operating lease liability	$ 600,000	$ 2,822,290
Operating lease right-of-use assets	500,000	$ 2,399,505
Increase in Accumulated Deficit	100,000
Net Financing Obligation Derecognized	2,700,000
Property and equipment derecognized from PP&E due to adoption of Topic 842	1,700,000
New Operating Lease, Right-of-Use Asset	1,900,000
Decrease In Accumulated Deficit	$ 1,000
ASU 2016-02
Lease amendments
Practical expedients package adoption	true
New Accounting Pronouncement or Change in Accounting Principle, Prior Period Not Restated [true false]	true
New Operating Lease, Liability	$ 1,900
New Operating Lease, Right-of-Use Asset	$ 1,900
Use-of-hindsight practical expedient election	false
Land easement practical expedient election	false

Certain Significant Risks and_3

Certain Significant Risks and Uncertainties - Revenue Sources (Details) - Government contracts - Inpatient Services	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Revenue Sources
Concentration Risk, Percentage	100.00%	100.00%
Medicare
Revenue Sources
Concentration Risk, Percentage	20.00%	21.00%
Medicaid
Revenue Sources
Concentration Risk, Percentage	58.00%	57.00%
Insurance
Revenue Sources
Concentration Risk, Percentage	12.00%	12.00%
Private
Revenue Sources
Concentration Risk, Percentage	7.00%	8.00%
Other
Revenue Sources
Concentration Risk, Percentage	3.00%	2.00%
Revenue | Medicare and Medicaid
Revenue Sources
Concentration Risk, Percentage	78.00%

Certain Significant Risks and_4

Certain Significant Risks and Uncertainties - Concentration of Credit Risk (Details) - Credit Concentration Risk [Member] - Accounts Receivable - Rehabilitation Services $ in Millions	12 Months Ended
	Dec. 31, 2019USD ($)customer
Minimum
Concentration Risk
Number of distinct customers	140
Group Of Largest Customers
Concentration Risk
Concentration risk (as a percent)	8.00%
Number of large customers comprising over 34% of the net outstanding contract receivables	1
Number of former customers representing approximately 8% of gross outstanding contract receivables	1
Contract receivables, net | $	$ 7
Related Party Customer
Concentration Risk
Concentration risk (as a percent)	34.00%
Gross contract receivables | $	$ 28.9

Significant Transactions and _2

Significant Transactions and Events - Next Partnership (Details) $ in Thousands	Sep. 12, 2019USD ($)facilityitem	Jan. 31, 2019USD ($)facilityitem	Mar. 31, 2020USD ($)	Dec. 31, 2019facility	Sep. 30, 2019USD ($)facility	Mar. 31, 2019facility	Dec. 31, 2019USD ($)facility	Dec. 31, 2018facility
Acquisitions, Lease Amendments and Terminations
Number of facilities sold | facility				7
Annual rent							$ 387,063
Variable Interest Entity [Abstract]
Number Of Facilities Divested Or Closed | facility							44	55
Next Joint Venture
Acquisitions, Lease Amendments and Terminations
Ownership interest in joint venture properties		46.00%
Payment for investment in joint venture		$ 16,000
Variable Interest Entity [Abstract]
Payment for investment in joint venture		16,000
Next Partnership
Variable Interest Entity [Abstract]
Purchase price of facilities acquired		252,500
Proceeds from sale of facilities		79,000
Non-recourse debt		165,700
Non-controlling interest		$ 18,500
Transaction costs							$ 5,300
Next Partnership | Skilled Nursing Facilities
Acquisitions, Lease Amendments and Terminations
Number of facilities sold | facility		7
Variable Interest Entity [Abstract]
Number of facilities acquired | facility		22
Number of facilities included in consolidation of VIE | facility		15
Next Partnership | Land, Buildings and Improvements
Variable Interest Entity [Abstract]
Property, plant and equipment, net, increase due to consolidation		$ 173,500
Vantage Point Partnership
Acquisitions, Lease Amendments and Terminations
Annual rent credits	$ 30,300
Fixed price purchase option premium percentage	10.00%
Variable Interest Entity [Abstract]
Non-recourse debt	$ 306,100
Non-controlling interest	$ 8,500
Ownership interest	30.00%
Other Transaction costs			$ 11,000
Annual revenues	$ 84,100
Pre-tax net income (loss)	2,600
Gain (loss) recognized in disposal group	$ 57,800
Vantage Point Partnership | Skilled Nursing Facilities
Acquisitions, Lease Amendments and Terminations
Number of facilities sold | facility	18
Variable Interest Entity [Abstract]
Purchase price of facilities acquired	$ 339,200
Vantage Point Partnership | Land, Buildings and Improvements
Variable Interest Entity [Abstract]
Purchase price of facilities acquired	$ 339,200
Property, plant and equipment, net, increase due to consolidation							$ 512,700
Vantage Point Partnership | Georgia New Jersey Virginia and Maryland | Skilled Nursing Facilities
Variable Interest Entity [Abstract]
Purchase price of facilities acquired					$ 91,800
Vantage Point Partnership | Georgia New Jersey Virginia and Maryland | Skilled Nursing Facility
Acquisitions, Lease Amendments and Terminations
Number of facilities sold | facility					7
Vantage Point Partnership | Georgia New Jersey Virginia and Maryland | Assisted Or Senior Living Facility
Acquisitions, Lease Amendments and Terminations
Number of facilities sold | facility					1
Real estate loans | Vantage Point Partnership
Variable Interest Entity [Abstract]
Number of facilities divested or closed subjected to loans | facility	3
HUD insured loans | Vantage Point Partnership
Variable Interest Entity [Abstract]
Number of facilities divested or closed subjected to loans | facility	2
Next Joint Venture
Acquisitions, Lease Amendments and Terminations
Annual rent credits		$ 17,200
Number of years after the start of lease the fixed price purchase option becomes exercisable		5 years
Latest number of years after start of lease the fixed price purchase option may be exercised		7 years
Fixed price purchase option premium percentage		10.00%
Next Joint Venture | Vantage Point Partnership
Acquisitions, Lease Amendments and Terminations
Payment for investment in joint venture	$ 37,500
Variable Interest Entity [Abstract]
Payment for investment in joint venture	$ 37,500
Next master lease agreement | Skilled Nursing Facilities
Acquisitions, Lease Amendments and Terminations
Number of facilities sold | facility						19
Operating lease renewal term						5 years
Next master lease agreement | Next Joint Venture
Acquisitions, Lease Amendments and Terminations
Annual Escalators (as a percent)		2.00%
Next master lease agreement | Vantage Point Partnership
Acquisitions, Lease Amendments and Terminations
Term of operating lease	15 years
Number of renewal options | item	2
Operating lease renewal term	5 years
Annual rent	$ 33,100
Annual Escalators (as a percent)	2.00%
Next master lease agreement | Next Joint Venture
Acquisitions, Lease Amendments and Terminations
Term of operating lease		15 years
Number of renewal options | item		2
Operating lease renewal term		5 years
Annual rent		$ 19,500
Welltower
Acquisitions, Lease Amendments and Terminations
Number of facilities sold | facility		15
Welltower | Vantage Point Partnership
Acquisitions, Lease Amendments and Terminations
Number of facilities sold | item	4
Second Spring Healthcare Investment | Vantage Point Partnership
Acquisitions, Lease Amendments and Terminations
Number of facilities sold | facility	14
Vantage Point Capital, LLC [Member]
Acquisitions, Lease Amendments and Terminations
Payment for investment in joint venture	$ 85,300
Variable Interest Entity [Abstract]
Investment in unconsolidated joint venture	8,500
Loans and Leases Receivable, Related Parties	76,800
Payment for investment in joint venture	$ 85,300

Significant Transactions and _3

Significant Transactions and Events - Divestiture of Non-Strategic Facilities (Details)

Jun. 01, 2019USD ($)item

Jan. 31, 2019facility

Jan. 01, 2019USD ($)

Dec. 31, 2018USD ($)facility

Dec. 31, 2019USD ($)facility

Sep. 30, 2019USD ($)facilityitem

Jun. 30, 2019USD ($)facility

Mar. 31, 2019USD ($)facility

Dec. 31, 2018USD ($)facility

Sep. 30, 2018USD ($)facility

Jun. 30, 2018USD ($)agreementfacility

Mar. 31, 2018USD ($)facility

Dec. 31, 2019USD ($)facility

Dec. 31, 2018USD ($)facility

Dec. 31, 2017facility

Nov. 30, 2019USD ($)

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

44

55

Disposal Group, Not Discontinued Operation, Loss (Gain) on Write-down

$ 1,900,000

Write-off of finance lease ROU assets

$ 54,400,000

Write-off of operating lease liabilities

33,300,000

Gain on partial lease termination

$ 95,779,000

$ 34,379,000

Number Of Facilities Sold | facility

7

Other Nonoperating Income (Expense)

173,505,000

12,920,000

Increase in Operating lease obligations

(93,630,000)

Divestiture exit costs

$ 1,900,000

Gain on early extinguishment of debt

$ 122,000

$ (391,000)

Losses recorded from leased facility divestiture

$ (2,000,000)

Number of facilities sold to third party landlords | facility

34

Number of lease agreements negotiated for extensions | agreement

4

Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities presented as assets held for sale | facility

8

8

Assisted Senior Living Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

1

Divestiture | Skilled Nursing Facilities And Assisted Senior Living Facilities

Skilled Nursing Facility Divestitures

Gain (loss) recognized in disposal group

400,000

Divestiture exit costs

$ 1,100,000

Divestiture | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

1

Number Of Facilities Sold | facility

3

Annual revenues

75,600,000

Pre-tax net income (loss)

4,600,000

Gain (loss) recognized in disposal group

$ 3,500,000

Annual rent credit

$ 300,000

Divestiture | Assisted Senior Living Facilities

Skilled Nursing Facility Divestitures

Sales price

$ 2,200,000

2,200,000

$ 2,200,000

Repayments of loans

$ 1,900,000

Divestiture | Behavioral Health Center

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

1

Divestiture of real property and operations | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

11

Number of facilities closed | facility

12

Annual rent credit granted on termination

$ 1,900,000

Disposed by sale | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

54

Number Of Facilities Sold | facility

13

22

Maryland | Divestiture of real property and operations

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | item

1

California | Divestiture of real and personal property | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Annual revenues

$ 10,400,000

Sales price

11,500,000

Repayments of loans

$ 9,600,000

California | Divestiture of real property and operations | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

1

5

Annual revenues

$ 53,000,000

Pre-tax net income (loss)

$ 100,000

1,600,000

Gain (loss) recognized in disposal group

$ 600,000

25,000,000

Sales price

56,500,000

Repayments of loans

41,800,000

Prepayment penalties and other closing costs at extinguishment

$ 2,400,000

California | Divestiture of real property and operations | Assisted Senior Living Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

1

California | Lease termination | Behavioral Health Center

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

1

Annual revenues

$ 3,100,000

Pre-tax net income (loss)

300,000

Gain (loss) recognized in disposal group

$ 100,000

Massachusetts Utah and Idaho | Divestiture of real property and operations | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

3

New Jersey | Divestiture | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

1

Annual revenues

$ 19,000,000

Pre-tax net income (loss)

1,200,000

Gain (loss) recognized in disposal group

900,000

New Jersey | Divestiture of real property and operations

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | item

2

New Jersey | Divestiture of real property and operations | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number Of Facilities Sold | facility

1

Texas

Skilled Nursing Facility Divestitures

Number of facilities presented as assets held for sale | facility

7

7

7

Gain on early extinguishment of debt

$ 2,600,000

Texas | Divestiture of real property and operations | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number Of Facilities Sold | facility

23

Gain (loss) recognized in disposal group

$ 3,400,000

Divestiture exit costs

$ 4,600,000

Number of owned facilities | facility

22

Number Of Leased Facilities

$ 1

Cash proceeds

89,400,000

Gain on early extinguishment of debt

$ 9,400,000

Texas | Disposed by sale | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

15

Number Of Facilities Sold | facility

7

23

Texas | Assets held for sale | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

7

Gain (loss) recognized in disposal group

$ 3,300,000

Sales price

20,100,000

$ 20,100,000

$ 20,100,000

Georgia, Idaho, Montana And Nevada | Skilled Nursing Facilities And Assisted Senior Living Facilities

Skilled Nursing Facility Divestitures

Annual revenues

$ 36,800,000

Pre-tax net income (loss)

$ 3,100,000

Georgia, Idaho, Montana And Nevada | Divestiture | Skilled Nursing Facilities And Assisted Senior Living Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

6

Georgia, Idaho, Montana And Nevada | Divestiture | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

5

Georgia, Idaho, Montana And Nevada | Divestiture | Assisted Senior Living Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

1

California, Indiana, Maryland, Pennsylvania, Ohio, and Texas | Divestiture | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

6

Accelerated depreciation expense on property and equipment released at lease termination

$ 7,300,000

California, Indiana, Maryland, Pennsylvania, Ohio, and Texas | Divestiture | Skilled Nursing Facilities And Behavioral Health Clinic

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

7

Annual revenues

$ 71,700,000

Pre-tax net income (loss)

9,700,000

Gain (loss) recognized in disposal group

27,900,000

Annual rent credit

600,000

Amount of capital lease and financing obligation net asset write-down

44,500,000

Amount of capital lease obligation and financing obligation write-down

77,000,000

Divestiture exit costs

$ 3,100,000

California, Kentucky, Massachusetts, New Jersey, and Pennsylvania | Divestiture

Skilled Nursing Facility Divestitures

Pre-tax net income (loss)

$ 23,800,000

California, Kentucky, Massachusetts, New Jersey, and Pennsylvania | Divestiture | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

19

Number of facilities closed | facility

1

Annual revenues

$ 182,700,000

Gain (loss) recognized in disposal group

22,500,000

Accelerated depreciation expense on property and equipment released at lease termination

5,300,000

Amount of capital lease asset write-down due to divestiture

16,800,000

Amount of net financing obligation asset write-down due to divestiture

113,300,000

Amount of financing obligation write-down

134,500,000

Divestiture exit costs

$ 8,400,000

California, Colorado, Connecticut And New Mexico

Skilled Nursing Facility Divestitures

Accelerated depreciation expense on property and equipment released at lease termination

$ 7,400,000

Gain (loss) on contract termination

6,200,000

California, Colorado, Connecticut And New Mexico | Skilled Nursing Facilities And Assisted Senior Living Facilities

Skilled Nursing Facility Divestitures

Annual rent credit

$ 6,700,000

California, Colorado, Connecticut And New Mexico | Sale and lease termination | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number Of Facilities Sold | facility

13

New Jersey And Ohio | Divestiture

Skilled Nursing Facility Divestitures

Annual revenues

$ 90,200,000

Pre-tax net income (loss)

6,000,000

Gain (loss) recognized in disposal group

3,500,000

Ohio | Divestiture

Skilled Nursing Facility Divestitures

Annual revenues

7,700,000

Pre-tax net income (loss)

1,600,000

Gain (loss) recognized in disposal group

$ 200,000

Ohio | Divestiture | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

1

Ohio | Divestiture of real property and operations | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

9

Other income (loss)

Skilled Nursing Facility Divestitures

Gain on partial lease termination

$ 93,800,000

Gain (loss) on partial lease termination

$ 21,900,000

Other income (loss) | Disposed by sale | Assisted Senior Living Facilities

Skilled Nursing Facility Divestitures

Gain (loss) recognized in disposal group

34,800,000

Sabra Master Leases

Skilled Nursing Facility Divestitures

Number of facilities under lease | facility

4

Permanent and unconditional annual cash rent savings

$ 19,000,000

Sabra Master Leases | Sale and lease termination

Skilled Nursing Facility Divestitures

Number of states facilities sold located in | facility

9

Sabra Master Leases | Lease termination | Skilled Nursing Facilities And Assisted Senior Living Facilities

Skilled Nursing Facility Divestitures

Annual rent credit

$ 7,400,000

Sabra Master Leases | Lease termination | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Gain (Loss) on Write Off Of Lease Liabilities

9,900,000

Sabra Master Leases | Florida And New Hampshire | Lease termination | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Accelerated depreciation expense on property and equipment released at lease termination

9,600,000

Annual rent credit

$ 19,400,000

Sabra Master Leases | California, Kentucky, Massachusetts, New Jersey, and Pennsylvania | Divestiture | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities under lease | facility

6

Sabra Master Leases | Kentucky, Ohio and Indiana

Skilled Nursing Facility Divestitures

Number Of Facilities Sold | facility

20

Sabra Master Leases | Other long-term liabilities

Skilled Nursing Facility Divestitures

Lease termination obligation

$ 34,100,000

$ 34,100,000

34,100,000

Welltower Master Lease

Skilled Nursing Facility Divestitures

Number of facilities terminated from master lease agreement | facility

30

Annual rent credit granted on termination

$ 25,900,000

Gain on partial lease termination

$ 48,300,000

Number Of Facilities Sold | facility

15

Welltower Master Lease | Disposal Group Not Discontinued Operations Divestiture And Lease Termination | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Write-off of finance lease ROU assets

$ 11,700,000

Write-off of finance lease liabilities

22,400,000

Write-off of operating lease ROU assets

112,800,000

Write-off of operating lease liabilities

$ 150,400,000

Welltower Master Lease | Massachusetts | Disposed by sale | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

1

Annual revenues

$ 9,000,000

Pre-tax net income (loss)

2,700,000

Gain (loss) recognized in disposal group

$ 300,000

Welltower Master Lease | California, Indiana, Maryland, Pennsylvania, Ohio, and Texas | Divestiture

Skilled Nursing Facility Divestitures

Number of facilities under lease | facility

3

Welltower Master Lease | Connecticut | Disposal Group Not Discontinued Operations Divestiture And Lease Termination | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

2

Annual revenues

$ 24,700,000

Pre-tax net income (loss)

2,900,000

Gain (loss) recognized in disposal group

$ 1,100,000

Welltower Master Lease | New Jersey And Ohio | Divestiture

Skilled Nursing Facility Divestitures

Number of facilities divested or closed | facility

9

Omega

Skilled Nursing Facility Divestitures

Number of facilities terminated from master lease agreement | facility

3

Annual rent credit granted on termination

$ 1,900,000

Write-off of finance lease ROU assets

10,100,000

Write-off of finance lease liabilities

16,800,000

Write-off of operating lease ROU assets

164,600,000

Write-off of operating lease liabilities

181,300,000

Gain on partial lease termination

$ 23,400,000

Omega | Divestiture of real property and operations | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities closed | facility

3

Number of skilled nursing facilities leased to third party operator | facility

4

Omega | New Mexico And Arizona

Skilled Nursing Facility Divestitures

Write-off of operating lease ROU assets

$ 10,600,000

Omega | New Mexico And Arizona | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities under lease | facility

9

Omega | New Mexico And Arizona | Assisted Senior Living Facilities

Skilled Nursing Facility Divestitures

Number of facilities terminated from master lease agreement | facility

1

Omega | New Mexico | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities acquired | item

1

Number of beds in facilities | item

80

Annual net revenue from acquired operations

$ 3,400,000

Second Spring Master Lease

Skilled Nursing Facility Divestitures

Number of facilities terminated from master lease agreement

14

Write-off of finance lease ROU assets

$ 5,900,000

Write-off of finance lease liabilities

8,800,000

Write-off of operating lease ROU assets

202,700,000

Write-off of operating lease liabilities

205,400,000

Gain on partial lease termination

$ 26,900,000

Second Spring Master Lease | California, Kentucky, Massachusetts, New Jersey, and Pennsylvania | Divestiture | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number of facilities under lease | facility

12

Second Spring And Sabra Master Lease [Member] | California, Indiana, Maryland, Pennsylvania, Ohio, and Texas | Divestiture

Skilled Nursing Facility Divestitures

Number of facilities under lease | facility

2

New Landlord Lease Agreement

Skilled Nursing Facility Divestitures

Number of lease renewal options | facility

1

New Landlord Lease Agreement | California, Colorado, Connecticut And New Mexico | Skilled Nursing Facilities With Nine And Half Year Term

Skilled Nursing Facility Divestitures

Number Of Facilities Sold | facility

4

Initial lease term

9 years 6 months

Period of extension of the renewal term of the master lease

5 years

Initial annual rent

$ 3,400,000

New Landlord Lease Agreement | California, Colorado, Connecticut And New Mexico | Skilled Nursing Facilities With Ten Year Term

Skilled Nursing Facility Divestitures

Number Of Facilities Sold | facility

9

Initial lease term

10 years

Period of extension of the renewal term of the master lease

5 years

Initial annual rent

$ 3,300,000

Next master lease agreement

Skilled Nursing Facility Divestitures

Number of facilities terminated from master lease agreement | facility

6

Next master lease agreement | Skilled Nursing Facilities

Skilled Nursing Facility Divestitures

Number Of Facilities Sold | facility

19

Increase in operating ROU assets

$ 77,200,000

Extend term (in years)

5 years

Next master lease agreement | Lease termination

Skilled Nursing Facility Divestitures

Write-off of operating lease ROU assets

$ 4,900,000

Gain on partial lease termination

$ (4,900,000)

Welltower

Skilled Nursing Facility Divestitures

Number Of Facilities Sold | facility

15

Welltower | Welltower Master Lease

Skilled Nursing Facility Divestitures

Number of facilities subject to welltower master lease classified as operating leases | facility

43

Sabra | Sabra Master Leases

Skilled Nursing Facility Divestitures

Undiscounted lease termination obligation

$ 41,000,000

$ 41,000,000

$ 41,000,000

Lease termination obligation repayment period

4 years

Sabra | Sabra Master Leases | Sale and lease termination

Skilled Nursing Facility Divestitures

Number Of Facilities Sold | facility

1

Sabra | Sabra Master Leases | Sale and lease termination | Skilled Nursing Facilities And Assisted Senior Living Facilities

Skilled Nursing Facility Divestitures

Number Of Facilities Sold | facility

21

Sabra | New Landlord Lease Agreement

Skilled Nursing Facility Divestitures

Initial lease term

10 years

Period of extension of the renewal term of the master lease

5 years

Note Payable Due April 30, 2020 [Member]

Skilled Nursing Facility Divestitures

Short-term note payable

$ 15,000,000

Note Payable Due April 30, 2020 [Member] | Omega | New Mexico And Arizona

Skilled Nursing Facility Divestitures

Short-term note payable

$ 15,000,000

$ 15,000,000

Significant Transactions and _4

Significant Transactions and Events - Acquisitions (Details) $ in Millions	Nov. 01, 2018USD ($)facilityitem
New Mexico And Arizona
Acquisitions
Number of facilities classified as capital leases	4
Number of facilities classified as operating leases	5
Capital lease assets and obligation | $	$ 14.6
Omega | Skilled Nursing Facilities And Assisted Senior Living Facilities | New Mexico And Arizona
Acquisitions
Number of operations acquired	9
Number of beds in facilities | item	1,000
Annual net revenue from acquired operations | $	$ 60
Omega | Skilled Nursing Facility | New Mexico
Acquisitions
Number of operations acquired	8
Omega | Assisted Senior Living Facilities | Arizona
Acquisitions
Number of operations acquired	1

Significant Transactions and _5

Significant Transactions and Events - Lease Amendments and Terminations (Details)	Dec. 31, 2019
FC-GEN Operations Investment, LLC
Business Acquisition [Line Items]
Ownership interest in combined entity (as a percent)	66.10%

Significant Transactions and _6

Significant Transactions and Events - Restructuring Transactions (Details) $ / shares in Units, $ in Millions	Apr. 01, 2018	Mar. 31, 2018	Feb. 21, 2018USD ($)$ / sharesshares	Jan. 01, 2018USD ($)lease	Dec. 31, 2019	Dec. 31, 2018$ / shares	Mar. 06, 2018	Dec. 31, 2017$ / shares
Estimated reduction to annual cash fixed charges				$ 62
Estimated additional cash and borrowing availability				$ 70
Number of material master leases that did not amend financial covenants | lease				2
Omnibus Agreement [Abstract]
Exercise price of warrant | $ / shares						$ 1.33		$ 1
Welltower Master Lease Amendment
Lease Term and Discount Rate
Amount of reduction to annual base rent payment				$ 35
Percentage of Annual Escalators	2.50%	2.90%			2.00%
Period of extension of initial term of master lease			5 years
Period of extension of the renewal term of the master lease			5 years
Incremental rent reset cap			$ 35
Welltower Inc | Omnibus Agreement
Omnibus Agreement [Abstract]
Debt Instrument, Term			10 years
Amount of debt to be written off upon satisfying certain conditions			$ 50
Paid-in-kind interest rate			2.00%
Welltower and Omega Warrants | Omnibus Agreement
Omnibus Agreement [Abstract]
Exercise price of warrant | $ / shares			$ 1.33
Minimum | Welltower and Omega Warrants
Omnibus Agreement [Abstract]
Period from date of issuance that warrant may be exercised			6 months
Maximum | Term Loan Amendment
Omnibus Agreement [Abstract]
Paid-in-kind interest rate							5.00%
Maximum | Omnibus Agreement | Term Loan Amendment
Omnibus Agreement [Abstract]
Debt Instrument, Face Amount			$ 40
Maximum | Welltower Inc | Omnibus Agreement
Omnibus Agreement [Abstract]
Amount of outstanding real estate bridge loans that may be converted into equity upon satisfying certain conditions			$ 50
Maximum | Welltower and Omega Warrants
Omnibus Agreement [Abstract]
Period from date of issuance that warrant may be exercised			5 years
Class A Common Stock | Welltower Warrant | Omnibus Agreement
Omnibus Agreement [Abstract]
Number of shares per warrant | shares			900,000
Class A Common Stock | Omega Warrant | Omnibus Agreement
Omnibus Agreement [Abstract]
Number of shares per warrant | shares			600,000

Net Revenues and Accounts Rec_3

Net Revenues and Accounts Receivable - Disaggregation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Disaggregation of revenue
Total net revenues	$ 4,565,834	$ 4,976,650
Inpatient Services
Disaggregation of revenue
Total net revenues	3,956,032	4,296,873
Rehabilitation therapy service
Disaggregation of revenue
Total net revenues	462,546	547,914
Other Services
Disaggregation of revenue
Total net revenues	147,256	131,863
Medicare
Disaggregation of revenue
Net revenues	891,064	1,003,129
Medicare | Inpatient Services
Disaggregation of revenue
Net revenues	800,253	913,615
Medicare | Rehabilitation therapy service
Disaggregation of revenue
Net revenues	90,811	89,514
Medicaid
Disaggregation of revenue
Net revenues	2,315,623	2,463,324
Medicaid | Inpatient Services
Disaggregation of revenue
Net revenues	2,313,479	2,461,228
Medicaid | Rehabilitation therapy service
Disaggregation of revenue
Net revenues	2,144	2,096
Insurance
Disaggregation of revenue
Net revenues	485,408	540,583
Insurance | Inpatient Services
Disaggregation of revenue
Net revenues	463,135	517,512
Insurance | Rehabilitation therapy service
Disaggregation of revenue
Net revenues	22,273	23,071
Private
Disaggregation of revenue
Net revenues	310,318	340,118
Private | Inpatient Services
Disaggregation of revenue
Net revenues		339,680
Net revenues	310,022
Private | Rehabilitation therapy service
Disaggregation of revenue
Net revenues	296	438
Assisted living | Inpatient Services
Disaggregation of revenue
Total net revenues	93,100	96,100
Third party providers
Disaggregation of revenue
Net revenues	415,218	499,493
Third party providers | Rehabilitation therapy service
Disaggregation of revenue
Net revenues	336,509	415,541
Third party providers | Other Services
Disaggregation of revenue
Net revenues	78,709	83,952
Other
Disaggregation of revenue
Net revenues	148,203	130,003
Other | Inpatient Services
Disaggregation of revenue
Net revenues	69,143	64,838
Other | Rehabilitation therapy service
Disaggregation of revenue
Net revenues	10,513	17,254
Other | Other Services
Disaggregation of revenue
Net revenues	$ 68,547	$ 47,911

Earnings (Loss) Per Share - Gen

Earnings (Loss) Per Share - General Information (Details)	12 Months Ended
	Dec. 31, 2019class
Income Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Number of classes of common stock	3
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	2

Earnings (Loss) Per Share - Cal

Earnings (Loss) Per Share - Calculation of Basic net income (loss) per common share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Numerator:
Net income (loss)	$ 7,474	$ (372,417)
Less net loss attributable to noncontrolling interests	7,145	137,186
Net income (loss) attributable to Genesis Healthcare, Inc.	$ 14,619	$ (235,231)
Denominator:
Weighted-average shares outstanding for basic net income (loss) per share	107,286	101,007
Basic net income (loss) per common share attributable to Genesis Healthcare, Inc.	$ 0.14	$ (2.33)

Earnings (Loss) Per Share - C_2

Earnings (Loss) Per Share - Calculation of diluted net income (loss) per common share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Numerator:
Net income (loss)	$ 7,474	$ (372,417)
Less net loss attributable to noncontrolling interests	7,145	137,186
Net loss attributable to Genesis Healthcare, Inc	14,619	(235,231)
Plus: Assumed conversion of noncontrolling interests	1,868
Net loss attributable to Genesis Healthcare, Inc	$ 16,487	$ (235,231)
Denominator:
Weighted-average common shares outstanding	107,286	101,007
Plus: Assumed conversion of noncontrolling interests	57,074
Plus: Unvested restricted stock units and stock warrants	954
Adjusted weighted-average common shares outstanding, diluted	165,314	101,007
Diluted net income (loss) per common share attributable to Genesis Healthcare, Inc.	$ 0.10	$ (2.33)

Earnings (Loss) Per Share - Ant

Earnings (Loss) Per Share - Antidilutive Securities (Details) - $ / shares	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Number of units attributed to the noncontrolling interests outstanding	59,700,000
Exercise price of warrant	$ 1.33	$ 1
Assumed conversion of noncontrolling interests, unvested restricted stock units and stock warrants
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive shares	61,500,000
Class A Common Stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Number of shares that may be purchased under warrant	600,000	900,000

Segment Information - Segment R

Segment Information - Segment Reporting (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2019USD ($)segment	Dec. 31, 2018USD ($)
Segment Reporting Information
Number of Reportable Segments | segment	3
Net revenues	$ 4,565,834	$ 4,976,650
Increase (Decrease) in Net Revenue From Prior Period	(410,816)
Salaries, wages and benefits	2,485,010	2,786,908
Other operating expenses	1,374,847	1,479,880
General and administrative costs	144,471	149,182
Lease expense	387,063
Lease expense under Topic 840		129,859
Depreciation and amortization expense	123,159	220,896
Interest expense	180,392	463,738
(Gain) loss on early extinguishment of debt	(122)	391
Investment income	(7,296)	(6,832)
Other income	(173,505)	(12,920)
Transaction costs	26,362	31,953
Long-lived asset impairments	16,937	104,997
Goodwill and identifiable intangible asset impairments		3,538
Equity in net income of unconsolidated affiliates	(712)	(100)
Income (loss) before income tax expense (benefit)	9,228	(374,840)
Income tax expense (benefit)	1,754	(2,423)
Net income (loss)	$ 7,474	$ (372,417)
Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	100.00%	100.00%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(8.30%)
Inpatient Services
Segment Reporting Information
Net revenues	$ 3,956,032	$ 4,296,873
Increase (Decrease) in Net Revenue From Prior Period	$ (340,841)
Inpatient Services | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	86.50%	86.40%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(7.90%)
Inpatient Services | Product Concentration Risk | Revenue
Segment Reporting Information
Concentration Risk, Percentage	87.00%
Inpatient Services | Skilled Nursing Facilities
Segment Reporting Information
Net revenues	$ 3,857,793
Net revenues		$ 4,195,596
Increase (Decrease) in Net Revenue From Prior Period	$ (337,803)
Inpatient Services | Skilled Nursing Facilities | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	84.40%	84.30%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(8.10%)
Inpatient Services | Assisted Senior Living Facilities
Segment Reporting Information
Net revenues	$ 93,054
Net revenues		$ 95,571
Increase (Decrease) in Net Revenue From Prior Period	$ (2,517)
Inpatient Services | Assisted Senior Living Facilities | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	2.00%	1.90%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(2.60%)
Inpatient Services | Administration of third party facilities
Segment Reporting Information
Net revenues	$ 8,310
Net revenues		$ 8,733
Increase (Decrease) in Net Revenue From Prior Period	$ (423)
Inpatient Services | Administration of third party facilities | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	0.20%	0.20%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(4.80%)
Rehabilitation therapy service
Segment Reporting Information
Net revenues	$ 462,546	$ 547,914
Increase (Decrease) in Net Revenue From Prior Period	$ (85,368)
Rehabilitation therapy service | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	10.20%	11.00%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(15.60%)
Rehabilitation therapy service | Product Concentration Risk | Revenue
Segment Reporting Information
Concentration Risk, Percentage	10.00%
Rehabilitation therapy service | Therapy Services
Segment Reporting Information
Net revenues	$ 738,124
Net revenues		$ 889,069
Increase (Decrease) in Net Revenue From Prior Period	$ (150,945)
Rehabilitation therapy service | Therapy Services | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	16.20%	17.90%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(17.00%)
Other Services
Segment Reporting Information
Net revenues	$ 147,256	$ 131,863
Increase (Decrease) in Net Revenue From Prior Period	$ 15,393
Other Services | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	3.30%	2.60%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	11.70%
Other Services | Other Services
Segment Reporting Information
Net revenues	$ 198,920
Net revenues		$ 161,038
Increase (Decrease) in Net Revenue From Prior Period	$ 37,882
Other Services | Other Services | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	4.40%	3.20%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	23.50%
Operating Segments | Inpatient Services
Segment Reporting Information
Net revenues	$ 3,959,157
Net revenues		$ 4,299,900
Salaries, wages and benefits	1,761,273	1,944,091
Other operating expenses	1,599,549	1,740,537
Lease expense	382,897
Lease expense under Topic 840		127,323
Depreciation and amortization expense	99,529	193,930
Interest expense	83,887	367,562
Other income	(172,709)	(14,872)
Long-lived asset impairments	16,937	104,997
Goodwill and identifiable intangible asset impairments		3,538
Income (loss) before income tax expense (benefit)	187,794	(167,206)
Net income (loss)	187,794	(167,206)
Operating Segments | Rehabilitation therapy service
Segment Reporting Information
Net revenues	738,124
Net revenues		889,069
Salaries, wages and benefits	601,196	733,763
Other operating expenses	44,088	51,590
Lease expense	1,297
Depreciation and amortization expense	12,230	12,779
Interest expense	55	55
Other income	(926)	1,942
Income (loss) before income tax expense (benefit)	80,184	88,940
Net income (loss)	80,184	88,940
Operating Segments | Other Services
Segment Reporting Information
Net revenues	198,676
Net revenues		160,913
Salaries, wages and benefits	122,541	109,054
Other operating expenses	62,104	61,110
Lease expense	1,463
Lease expense under Topic 840		1,289
Depreciation and amortization expense	720	684
Interest expense	35	36
Other income	112	78
Income (loss) before income tax expense (benefit)	11,701	(11,338)
Net income (loss)	11,701	(11,338)
Corporate, Non-Segment
Segment Reporting Information
Net revenues	244
Net revenues		125
General and administrative costs	144,471	149,182
Lease expense	1,406
Lease expense under Topic 840		1,247
Depreciation and amortization expense	10,775	13,503
Interest expense	97,831	96,085
(Gain) loss on early extinguishment of debt	(122)	391
Investment income	(8,712)	(6,832)
Other income	18	(68)
Transaction costs	26,362	31,953
Equity in net income of unconsolidated affiliates	4,091	(1,608)
Income (loss) before income tax expense (benefit)	(275,876)	(283,728)
Income tax expense (benefit)	1,754	(2,423)
Net income (loss)	(277,630)	(281,305)
Elimination
Segment Reporting Information
Net revenues	(330,367)
Net revenues		(373,357)
Other operating expenses	(330,894)	(373,357)
Depreciation and amortization expense	(95)
Interest expense	(1,416)
Investment income	1,416
Equity in net income of unconsolidated affiliates	(4,803)	1,508
Income (loss) before income tax expense (benefit)	5,425	(1,508)
Net income (loss)	5,425	(1,508)
Elimination | Inpatient Services
Segment Reporting Information
Net revenues	(3,125)
Net revenues		(3,027)
Increase (Decrease) in Net Revenue From Prior Period	$ (98)
Elimination | Inpatient Services | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	(0.10%)
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(3.20%)
Elimination | Rehabilitation therapy service
Segment Reporting Information
Net revenues	$ (275,578)
Net revenues		$ (341,155)
Increase (Decrease) in Net Revenue From Prior Period	$ 65,577
Elimination | Rehabilitation therapy service | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	(6.00%)	(6.90%)
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	19.20%
Elimination | Other Services
Segment Reporting Information
Net revenues	$ (51,664)
Net revenues		$ (29,175)
Increase (Decrease) in Net Revenue From Prior Period	$ (22,489)
Elimination | Other Services | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	(1.10%)	(0.60%)
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(77.10%)

Segment Information - Assets an

Segment Information - Assets and Goodwill by Segment (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Segment Reporting, Asset Reconciling Item
Segment total assets	$ 4,662,140	$ 4,263,623
Corporate and Eliminations
Segment Reporting, Asset Reconciling Item
Segment total assets	108,706	161,918
Inpatient Services
Segment Reporting, Asset Reconciling Item
Segment total assets	4,221,579	3,735,778
Rehabilitation therapy service
Segment Reporting, Asset Reconciling Item
Segment total assets	281,978	329,687
Other Services
Segment Reporting, Asset Reconciling Item
Segment total assets	$ 49,877	$ 36,240

Restricted Investments in Mar_3

Restricted Investments in Marketable Securities - Components (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Schedule of Available-for-sale Securities [Line Items]
Amortized cost	$ 136,053	$ 136,911
Unrealized gains	942	129
Unrealized losses, less than 12 months	(39)	(44)
Unrealized losses, greater than 12 months	(14)	(843)
Total fair value	136,942	136,153
Less: Current portion of restricted investments	(31,855)	(35,631)
Long-term restricted investments	105,087	100,522
Mortgage/Government Backed Securities
Schedule of Available-for-sale Securities [Line Items]
Amortized cost	20,957	11,945
Unrealized gains	90	4
Unrealized losses, less than 12 months	(17)
Unrealized losses, greater than 12 months	(7)	(130)
Total fair value	21,023	11,819
Corporate Bonds
Schedule of Available-for-sale Securities [Line Items]
Amortized cost	48,362	56,199
Unrealized gains	566	49
Unrealized losses, less than 12 months		(42)
Unrealized losses, greater than 12 months	(2)	(387)
Total fair value	48,926	55,819
Government Bonds
Schedule of Available-for-sale Securities [Line Items]
Amortized cost	66,734	68,767
Unrealized gains	286	76
Unrealized losses, less than 12 months	(22)	(2)
Unrealized losses, greater than 12 months	(5)	(326)
Total fair value	$ 66,993	$ 68,515

Restricted Investments in Mar_4

Restricted Investments in Marketable Securities (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Proceeds from maturities of restricted investments	$ 69.2	$ 65.7
Proceeds from sales of investments	2	$ 3.5
Restricted cash pledged as security	0.7
Restricted investments pledged as security, amortized cost	136.1
Market value of restricted investments pledged as security	136.9
Letter of Credit
Letters of credit issued	$ 125

Restricted Investments in Mar_5

Restricted Investments in Marketable Securities - Maturities (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Restricted Investments in Marketable Securities
Maturity term of investment grade government and corporate debt securities	5 years
Restricted investments amortized cost maturity
Amortized cost, Due in one year or less	$ 46,681
Amortized cost, Due after 1 year through 5 years	86,372
Amortized cost, Due after 10 years	3,000
Total amortized cost	136,053	$ 136,911
Restricted investments fair value maturity
Fair value, Due in one year or less	46,766
Fair value, Due after 1 year through 5 years	87,165
Fair value, Due after 10 years	3,011
Total fair value	$ 136,942	$ 136,153

Property and Equipment - Tabula

Property and Equipment - Tabular Disclosure (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Property, Plant and Equipment [Line Items]
Gross property and equipment	$ 1,393,466	$ 3,864,356
Less accumulated depreciation	(431,361)	(976,802)
Net property and equipment	962,105	2,887,554
Land, Buildings and Improvements
Property, Plant and Equipment [Line Items]
Gross property and equipment	1,004,447	469,575
Finance lease land, buildings and improvements
Property, Plant and Equipment [Line Items]
Gross property and equipment		693,546
Financing obligation land, buildings and improvements
Property, Plant and Equipment [Line Items]
Gross property and equipment		2,274,211
Equipment, furniture and fixtures
Property, Plant and Equipment [Line Items]
Gross property and equipment	386,248	417,684
Construction in progress
Property, Plant and Equipment [Line Items]
Gross property and equipment	$ 2,771	$ 9,340

Property and Equipment - Lease

Property and Equipment - Lease updates (Details) $ in Thousands	Sep. 12, 2019facility	Jan. 31, 2019USD ($)facility	Dec. 31, 2019USD ($)facility	Jun. 30, 2019facility	Dec. 31, 2019USD ($)facility	Dec. 31, 2018USD ($)	Jan. 01, 2019USD ($)
Property, Plant and Equipment [Line Items]
Property and equipment derecognized from PP&E due to adoption of Topic 842							$ 1,700,000
Assets held for sale
Number of facilities sold | facility			7
Amount reclassified from property and equipment to assets held for sale			$ 36,900		$ 36,900
Other Asset Impairment Charges					$ 16,937	$ 104,997
California Divestitures
Assets held for sale
Number of facilities sold | facility					7
Amount reclassified from property and equipment to assets held for sale			$ 16,300		$ 16,300
Skilled Nursing Facilities
Assets held for sale
Number of facilities presented as assets held for sale | facility			8		8
Number of facilities removed from the purchase and sale agreement | facility					8
Property, plant and equipment, gross, period (Decrease)					$ 10,700
Skilled Nursing Facilities | California Divestitures
Assets held for sale
Number of facilities presented as assets held for sale | facility			1		1
Divestiture | Skilled Nursing Facilities
Assets held for sale
Number of facilities sold | facility				3
Finance lease land, buildings and improvements | ASU 2016-02
Property, Plant and Equipment [Line Items]
Net finance lease reclassified to ROU assets							600,000
Improvements reclassified to Land, buildings and improvements			$ 12,700		$ 12,700
Financing obligation land, buildings and improvements | ASU 2016-02
Property, Plant and Equipment [Line Items]
Property and equipment derecognized from PP&E due to adoption of Topic 842							$ 1,700,000
Improvements reclassified to Land, buildings and improvements			73,600		73,600
Next Partnership | Skilled Nursing Facilities
Assets held for sale
Number of facilities sold | facility		7
Next Partnership | Land, Buildings and Improvements
Assets held for sale
Property, plant and equipment, net, increase due to consolidation		$ 173,500
Vantage Point Partnership
Assets held for sale
Amount reclassified from property and equipment to assets held for sale			$ 29,400		29,400
Vantage Point Partnership | Skilled Nursing Facilities
Assets held for sale
Number of facilities sold | facility	18
Vantage Point Partnership | Land, Buildings and Improvements
Assets held for sale
Property, plant and equipment, net, increase due to consolidation					$ 512,700

Leases - General Information (D

Leases - General Information (Details)	12 Months Ended
	Dec. 31, 2019item
Leases
Percentage of centers that are leased properties (as a percent)	78.00%
Percentage of centers under master lease agreements (as a percent)	45.00%
Number of landlords with master lease agreements	4

Leases - Terms and Lease Transa

Leases - Terms and Lease Transactions (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2019USD ($)
Operating leases
Lessee, Operating Lease, Existence of Option to Extend	true
Lessee, Operating Lease, Existence of Option to Terminate	true
Finance leases
Lessee, Finance Lease, Existence of Option to Extend	true
Lessee, Finance Lease, Existence of Option to Terminate	true
Reduction in ROU Assets	$ 117,127
Skilled Nursing Facilities
Finance leases
Reduction in ROU Assets	$ 6,200
Minimum
Operating leases
Term of operating lease	10 years
Operating lease renewal term	5 years
Finance leases
Term of finance lease	10 years
Finance lease renewal term (in years)	5 years
Maximum
Operating leases
Term of operating lease	15 years
Operating lease renewal term	10 years
Finance leases
Term of finance lease	15 years
Finance lease renewal term (in years)	10 years

Leases - Operating Leases - Mat

Leases - Operating Leases - Maturity - ASC 842 (Details) $ in Thousands	Dec. 31, 2019USD ($)
Maturity of operating lease obligations
2020	$ 382,926
2021	386,440
2022	384,450
2023	382,649
2024	388,091
Thereafter	3,045,668
Total operating lease payments	$ 4,970,224

Leases - Operating Leases - Tot

Leases - Operating Leases - Total Lease Obligation - ASC 842 (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Jan. 01, 2019
Operating leases
Total operating lease payments	$ 4,970,224
Less interest	(2,147,934)
Total operating lease obligations	2,822,290	$ 600,000
Less current portion	(140,887)
Long-term operating lease obligations	$ 2,681,403

Leases - Finance Leases - Matur

Leases - Finance Leases - Maturity - ASC 842 (Details) $ in Thousands	Dec. 31, 2019USD ($)
Maturity of finance lease obligations
2020	$ 7,659
2021	7,468
2022	7,264
2023	7,032
2024	6,812
Thereafter	35,886
Total finance lease payments	$ 72,121

Leases - Finance Leases - Total

Leases - Finance Leases - Total Lease Obligation - ASC 842 (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Finance leases
Total finance lease payments	$ 72,121
Less interest	(29,947)
Total finance lease obligations	42,174
Less current portion	(2,839)
Long-term finance lease obligations	$ 39,335	$ 967,942

Leases - Finance Leases - Addit

Leases - Finance Leases - Additional Information - ASC 842 (Details) $ in Millions	Dec. 31, 2019USD ($)
Leases
Portion of finance lease payments due related to options to extend lease terms	$ 37.2

Leases - Finance Leases - Mat_2

Leases - Finance Leases - Maturity - ASC 840 (Details) $ in Thousands	Dec. 31, 2018USD ($)
Capital lease future minimum payments under ASC 840
2020	$ 88,793
2021	89,397
2022	91,292
2023	93,281
2024	95,376
Thereafter	3,325,042
Total future minimum lease payments	3,783,181
Less amount representing interest	(2,813,068)
Capital lease obligation	$ 970,113

Leases - Finance Leases - Tot_2

Leases - Finance Leases - Total Lease Obligation - ASC 840 (Details) $ in Thousands	Dec. 31, 2018USD ($)
Finance leases
Capital lease obligation	$ 970,113
Less current portion	(2,171)
Finance lease obligations under Topic 840	$ 967,942

Leases - Financing Obligations

Leases - Financing Obligations - Maturity - ASC 840 (Details) $ in Thousands	Dec. 31, 2018USD ($)
Financing obligations under ASC 840
2020	$ 237,335
2021	242,052
2022	245,311
2023	242,214
2024	247,852
Thereafter	6,661,624
Total future minimum lease payments	7,876,388
Less amount representing interest	(5,141,448)
Financing obligations	$ 2,734,940

Leases - Financing Obligation_2

Leases - Financing Obligations - Total Lease Obligation - ASC 840 (Details) $ in Thousands	Dec. 31, 2018USD ($)
Leases
Financing obligations	$ 2,734,940
Less current portion	(2,001)
Long-term financing obligations	$ 2,732,939

Leases - Operating Leases - M_2

Leases - Operating Leases - Maturity - ASC 840 (Details) $ in Thousands	Dec. 31, 2018USD ($)
Operating leases future minimum payments under ASC 840
2020	$ 110,755
2021	109,391
2022	106,031
2023	84,003
2024	76,701
Thereafter	373,753
Total future minimum lease payments	$ 860,634

Leases - Lease Cost (Details)

Leases - Lease Cost (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2019USD ($)
Lease cost
Operating lease cost	$ 387,063
Amortization of finance lease right-of-use assets	16,224
Interest on finance lease liabilities	50,162
Total finance lease expense	66,386
Variable lease cost	37,841
Short-term leases	24,297
Total lease cost	$ 515,587

Leases - Lease Term and Discoun

Leases - Lease Term and Discount Rate (Details)	Dec. 31, 2019
Leases
Weighted-average remaining lease term - operating leases	12 years 7 months 6 days
Weighted-average remaining lease term - finance leases	10 years 2 months 12 days
Weighted-average discount rate - operating leases	9.60%
Weighted-average discount rate - finance leases	12.20%

Leases - Other Information (Det

Leases - Other Information (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2019USD ($)
Leases
Operating cash flows from operating leases	$ 364,334
Operating cash flows from finance leases	47,188
Financing cash flows from finance leases	2,645
Right-of-use assets obtained in exchange for new lease obligations, operating leases	96,718
Right-of-use assets obtained in exchange for new lease obligations, finance leases	$ 1,160

Leases - Lease Covenants (Detai

Leases - Lease Covenants (Details)	12 Months Ended
	Dec. 31, 2019agreementfacility
Leases
Number of leases with unmet financial covenants | agreement	1
Number of facilities under leases with unmet financial covenants | facility	2
Welltower - CBYW
Leases
Number of master lease agreements | agreement	2
Number of facilities in the master lease agreement | facility	28
Number of leases with unmet financial covenants | agreement	1
Number of facilities under leases with unmet financial covenants | facility	2

Goodwill and Identifiable Int_3

Goodwill and Identifiable Intangible Assets - Changes in carrying value of goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2019	Dec. 31, 2018
Goodwill [Line Items]
Goodwill		$ 85,642	$ 85,642
Goodwill, net		85,642	85,642
Inpatient Services
Goodwill [Line Items]
Goodwill impairment charge	$ 351,500
Rehabilitation therapy service
Goodwill [Line Items]
Goodwill		73,814	73,814
Goodwill, net		73,814	73,814
Other Services
Goodwill [Line Items]
Goodwill		11,828	11,828
Goodwill, net		$ 11,828	$ 11,828

Goodwill and Identifiable Int_4

Goodwill and Identifiable Intangible Assets - Intangible Assets (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Schedule of Finite and Indefinite-Lived Intangible Assets [Line Items]
Identifiable intangible assets	$ 87,446	$ 119,082
Accumulated amortization on intangible assets	76,243	99,160
Trade names
Schedule of Finite and Indefinite-Lived Intangible Assets [Line Items]
Trade names	50,555	50,556
Customer relationships, net
Schedule of Finite and Indefinite-Lived Intangible Assets [Line Items]
Finite-lived intangible assets	36,891	47,077
Accumulated amortization on intangible assets	$ 76,243	$ 65,756
Weighted Average Remaining Life	8 years	8 years
Favorable lease contracts, net
Schedule of Finite and Indefinite-Lived Intangible Assets [Line Items]
Finite-lived intangible assets		$ 21,449
Accumulated amortization on intangible assets		$ 33,404
Weighted Average Remaining Life		10 years

Goodwill and Identifiable Int_5

Goodwill and Identifiable Intangible Assets (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity
2019	$ 5.2
2020	5.1
2021	5
2022	4.6
2023	4.6
Thereafter	12.4
Customer relationships, net
Finite-Lived Intangible Assets
Amortization expense	10.5	$ 10.5
Favorable lease contracts, net
Finite-Lived Intangible Assets
Amortization expense		6.5
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity
Impairment charges	$ 0	$ 3.5

Long-Term Debt - General Inform

Long-Term Debt - General Information (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Long-term debt
Total long-term debt	$ 1,613,420	$ 1,205,464
Current installments of long-term debt	(162,426)	(122,531)
Long-term debt	1,450,994	1,082,933
ABL Credit Facilities
Long-term debt
Total long-term debt	412,346	419,289
Debt issuance costs	8,615	11,335
Real estate loans
Long-term debt
Total long-term debt	265,700	307,690
Debt issuance costs	3,846	5,360
Debt premium	19,328	28,992
HUD insured loans
Long-term debt
Total long-term debt	117,117	181,762
Debt issuance costs	2,909	5,247
Debt premium	0	860
Welltower Notes
Long-term debt
Total long-term debt	116,952	81,398
Mortgages and other secured debt (recourse)
Long-term debt
Total long-term debt	6,369	4,190
Mortgages and other secured debt (non-recourse)
Long-term debt
Total long-term debt	498,222	26,483
Debt issuance costs	9,349	187
Debt premium	1,422	1,520
New term loan agreement
Long-term debt
Total long-term debt	196,714	184,652
Debt issuance costs	1,084	1,851
Debt premium	$ 4,816	$ 8,446

Long-Term Debt - New Asset Base

Long-Term Debt - New Asset Based Lending Facilities (Details) - USD ($) $ in Thousands	Jun. 05, 2019	Mar. 06, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2020	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020
Debt Instrument [Line Items]
Payment of first lien term loan facility			$ 4,630,664	$ 4,548,815
Restricted Cash and Cash Equivalents			113,700	$ 121,400
ABL Credit Facilities
Debt Instrument [Line Items]
Number of days prior to maturity of various loan agreements that the maturity of the credit facilities may be accelerated		90 days
Restricted Cash and Cash Equivalents			50,600
Borrowings			420,961
Total borrowing base capacity			436,500
Available borrowing capacity under the ABL Credit Facilities			$ 15,500
Term Loan And Revolving Credit Facility
Debt Instrument [Line Items]
Termination fees, if loan repaid within next twelve months (as a percent)			2.00%
Termination fees, if loan repaid after year two (as a percent)			1.50%
First Lien Term Loan Facility
Debt Instrument [Line Items]
Debt instrument exit fees amount			$ 1,600
Borrowings			285,000
First Lien Revolving Credit Facility
Debt Instrument [Line Items]
Debt instrument exit fees amount			1,000
Revolving credit facility (Non-HUD)
Debt Instrument [Line Items]
Borrowings			78,860
HUD Tranche
Debt Instrument [Line Items]
Borrowings			$ 27,101
Delayed Draw Term Loan Facility
Debt Instrument [Line Items]
Commitment fee rate (as percentage)			2.00%
Borrowings			$ 30,000
Delayed Draw Term Loan Facility | Forecast
Debt Instrument [Line Items]
Promissory note					$ 20,000	$ 22,500	$ 25,000	$ 27,500
New Asset Based Lending Facilities | ABL Credit Facilities
Debt Instrument [Line Items]
Promissory note		$ 555,000
Term of debt		5 years
New Asset Based Lending Facilities | First Lien Term Loan Facility
Debt Instrument [Line Items]
Promissory note		$ 325,000
New Asset Based Lending Facilities | First Lien Revolving Credit Facility
Debt Instrument [Line Items]
Promissory note		200,000
New Asset Based Lending Facilities | Delayed Draw Term Loan Facility
Debt Instrument [Line Items]
Promissory note		$ 30,000
New Asset Based Lending Facilities | 90-Day LIBOR | Term Loan And Revolving Credit Facility
Debt Instrument [Line Items]
Floor rate (as a percent)		0.50%
Applicable margin		6.00%
New Asset Based Lending Facilities | 90-Day LIBOR | Delayed Draw Term Loan Facility
Debt Instrument [Line Items]
Floor rate (as a percent)		1.00%
Applicable margin		11.00%
Revolving Credit Facility
Debt Instrument [Line Items]
Commitment fee rate (as percentage)			0.50%
Borrowings			$ 421,000
Revolving Credit Facility | Long Term Debt Current | ABL Credit Facilities
Debt Instrument [Line Items]
Borrowings			136,000
Letter of Credit
Debt Instrument [Line Items]
Borrowings			$ 125,000
Revolving Credit Facility Amendment | New Asset Based Lending Facilities | ABL Credit Facilities
Debt Instrument [Line Items]
Borrowings	$ 240,000
Revolving Credit Facility Amendment | New Asset Based Lending Facilities | First Lien Term Loan Facility
Debt Instrument [Line Items]
Payment of first lien term loan facility	40,000
Borrowings	285,000
Revolving Credit Facility Amendment | New Asset Based Lending Facilities | Revolving credit facility (Non-HUD)
Debt Instrument [Line Items]
Increase in aggregate revolving credit facility	$ 40,000

Long-Term Debt - New Asset Ba_2

Long-Term Debt - New Asset Based Lending Facilities - Borrowings and Interest Rates (Details) $ in Thousands	Dec. 31, 2019USD ($)
ABL Credit Facilities
Debt Instrument [Line Items]
Commitment	$ 555,000
Borrowings	$ 420,961
Weighted Average Interest	8.26%
First Lien Term Loan Facility
Debt Instrument [Line Items]
Commitment	$ 285,000
Borrowings	$ 285,000
Weighted Average Interest	7.91%
Revolving credit facility (Non-HUD)
Debt Instrument [Line Items]
Commitment	$ 168,000
Borrowings	$ 78,860
Weighted Average Interest	7.91%
HUD Tranche
Debt Instrument [Line Items]
Commitment	$ 72,000
Borrowings	$ 27,101
Weighted Average Interest	7.91%
Delayed Draw Term Loan Facility
Debt Instrument [Line Items]
Commitment	$ 30,000
Borrowings	$ 30,000
Weighted Average Interest	12.91%

Long-Term Debt - Term Loan Agre

Long-Term Debt - Term Loan Agreement (Details) - USD ($) $ in Millions	Jan. 01, 2021	Dec. 31, 2019	May 09, 2019	Dec. 31, 2018	Mar. 06, 2018	Mar. 05, 2018
Term Loans and 2018 Term Loan
Term Loan Facility and New Term Loan Agreement
Outstanding principal balance under term loan facility		$ 193		$ 178.1
2018 Term Loan
Term Loan Facility and New Term Loan Agreement
Fixed interest rate					14.00%
2018 Term Loan | Maximum
Term Loan Facility and New Term Loan Agreement
Paid-in-kind interest rate					9.00%
Term Loan Amendment
Term Loan Facility and New Term Loan Agreement
Additional Term Loan			$ 40
Fixed interest rate					10.00%
Term Loan Amendment | Term Loan Amendment
Term Loan Facility and New Term Loan Agreement
Aggregate principal amount			$ 160
Term Loan Amendment | Maximum
Term Loan Facility and New Term Loan Agreement
Paid-in-kind interest rate					5.00%
New Term Loan Facility [Member] | Minimum
Term Loan Facility and New Term Loan Agreement
Leverage ratio	1.00%	1.00%
New Term Loan Facility [Member] | Maximum
Term Loan Facility and New Term Loan Agreement
Leverage ratio		1.70%
New Term Loan Facility [Member] | Forecast | Minimum
Term Loan Facility and New Term Loan Agreement
Leverage ratio	1.80%
Affiliate Of Welltower Inc And Affiliate Of Omega Healthcare Investors Inc | Term Loan
Term Loan Facility and New Term Loan Agreement
Aggregate principal amount						$ 120

Long-Term Debt - Real Estate Lo

Long-Term Debt - Real Estate Loans (Details) $ in Millions	May 01, 2019USD ($)item	Nov. 08, 2018USD ($)loan	Apr. 01, 2018USD ($)	Mar. 30, 2018USD ($)facilityloan	Sep. 30, 2019USD ($)item	Dec. 31, 2019USD ($)facility	Dec. 31, 2018USD ($)facility	Feb. 15, 2018
Long-term debt
Number of facilities divested or closed | facility						44	55
Mid Cap Real Estate Loans
Long-term debt
Number of real estate loans | loan		1		2
Additional borrowings		$ 10
Aggregate principal amount				$ 75		$ 42.2	$ 83
Term of debt				5 years
Number of facilities pledged | facility				12
Repayments of Debt	$ 27.7				$ 12.1
Mid Cap Real Estate Loans | 30-day LIBOR
Long-term debt
Floor rate (as a percent)		2.00%		1.50%
Applicable margin		6.25%		5.85%
Mid Cap Real Estate Loan One [Member] | 30-day LIBOR
Long-term debt
Aggregate principal amount						$ 208	$ 201.1
Welltower Real Estate Loans | Welltower Real Estate Loan Amendments
Long-term debt
Term of debt						10 years
Fixed interest rate								12.00%
Cash interest rate								7.00%
Paid-in-kind interest rate								5.00%
Amount of increase to cash component of interest payments			$ 2
Repayment required for conversion option, condition						$ 105
Outstanding principal balance						$ 50
Welltower Real Estate Loans | Welltower Real Estate Loan Amendments | Minimum
Long-term debt
Amount that must be repaid by date certain to maintain the decreased cash pay interest rate			$ 105
Welltower Real Estate Loans | Welltower Real Estate Loan Amendments | Maximum
Long-term debt
Paid-in-kind interest rate						2.00%
Debt conversion option						$ 50
California | Mid Cap Real Estate Loans | Divestiture of real property and operations
Long-term debt
Number of facilities divested or closed | item	3
California | Welltower Real Estate Loans | Divestiture of real property and operations
Long-term debt
Number of facilities divested or closed | item	5
New Jersey | Divestiture of real property and operations
Long-term debt
Number of facilities divested or closed | item					2
Maryland | Divestiture of real property and operations
Long-term debt
Number of facilities divested or closed | item					1

Long-Term Debt - HUD Insured Lo

Long-Term Debt - HUD Insured Loans (Details) $ in Thousands	Feb. 26, 2020facility	Feb. 02, 2015	Dec. 31, 2019USD ($)facility	Dec. 31, 2019USD ($)facility	Sep. 30, 2019facilityitem	Jun. 30, 2019facility	Dec. 31, 2018USD ($)facility	Dec. 31, 2019USD ($)facilityloan	Dec. 31, 2018USD ($)facility
Long-term debt
Number of facilities divested or closed								44	55
Debt instrument retired | $								$ 199,626	$ 544,077
Number Of Facilities Sold				7
Assisted Senior Living Facilities
Long-term debt
Number of facilities divested or closed									1
Assets held for sale
Long-term debt
Number Of Facilities Classified As Held For Sale			1	1			7	1	7
Assets held for sale | Skilled Nursing Facilities
Long-term debt
Number Of Facilities Classified As Held For Sale							7		7
Divestiture of real property and operations | Skilled Nursing Facilities
Long-term debt
Number of facilities divested or closed					11
HUD insured loans
Long-term debt
Aggregate principal amount | $			$ 41,700	$ 41,700				$ 41,700
Term of debt			35 years
Debt instrument average remaining term (in years)								29 years
Fixed interest rate			3.15%	3.15%				3.15%
Weighted Average Interest			3.30%	3.30%				3.30%
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 | Minimum
Long-term debt
Term of debt		30 years
Fixed interest rate			3.00%	3.00%				3.00%
HUD insured loans | Maximum
Long-term debt
Term of debt		35 years
Fixed interest rate			3.50%	3.50%				3.50%
HUD insured loans | Skilled Nursing Facilities
Long-term debt
Aggregate principal amount | $			$ 140,600	$ 140,600			$ 210,000	$ 140,600	$ 210,000
HUD insured loans | Prepaid Expenses and Other Current Assets
Long-term debt
Escrow reserve funds | $			11,700	11,700				11,700
HUD insured loans | Assets held for sale | Skilled Nursing Facilities
Long-term debt
Principal balance outstanding | $			$ 20,200	$ 20,200				20,200
HUD insured loans | Assets held for sale | Skilled Nursing Facilities
Long-term debt
Principal balance outstanding | $							$ 26,600		26,600
Net debt issuance costs, debt premiums and escrow reserve funds | $								$ 1,100	$ 3,400
California | Assets held for sale
Long-term debt
Number Of Facilities Classified As Held For Sale			1	1				1
California | Assets held for sale | Skilled Nursing Facilities
Long-term debt
Number Of Facilities Classified As Held For Sale			7	7				7
California | Divestiture of real property and operations | Skilled Nursing Facilities
Long-term debt
Number of facilities divested or closed					1	5
California | Divestiture of real property and operations | Assisted Senior Living Facilities
Long-term debt
Number of facilities divested or closed					1
California | HUD insured loans | Skilled Nursing Facilities | Subsequent Events
Long-term debt
Number Of Facilities Sold	1
California | HUD insured loans | Divestiture of real property and operations | Skilled Nursing Facilities
Long-term debt
Number of facilities divested or closed								3
Debt instrument retired | $								$ 23,800
California | HUD insured loans | Divestiture of real property and operations | Assisted Senior Living Facilities
Long-term debt
Number of facilities divested or closed								1
New Jersey | Divestiture of real property and operations
Long-term debt
Number of facilities divested or closed | item					2
New Jersey | Divestiture of real property and operations | Skilled Nursing Facilities
Long-term debt
Number Of Facilities Sold								1
New Virgina Member | Divestiture of real property and operations | Skilled Nursing Facilities
Long-term debt
Number Of Facilities Sold								1
New Jersey And Virginia Member | HUD insured loans | Skilled Nursing Facilities
Long-term debt
Debt instrument retired | $								$ 18,400
Texas | Assets held for sale | Skilled Nursing Facilities
Long-term debt
Number of facilities divested or closed							7
Number Of Facilities Classified As Held For Sale							23		23
Texas | Divestiture of real property and operations | Skilled Nursing Facilities
Long-term debt
Number Of Facilities Sold							23
Texas | HUD insured loans | Assets held for sale | Skilled Nursing Facilities
Long-term debt
Number Of Facilities Classified As Held For Sale							3		3
Texas | HUD insured loans | Divestiture of real property and operations | Skilled Nursing Facilities
Long-term debt
Debt instrument retired | $								$ 23,400
Number Of Facilities Sold								3
Skilled Nursing Facility | HUD insured loans
Long-term debt
Number of debt instruments insured by HUD | loan								16

Long-Term Debt - Notes Payable

Long-Term Debt - Notes Payable (Details) - USD ($) $ in Millions	Feb. 01, 2017	Dec. 23, 2016	Dec. 31, 2019	Nov. 30, 2019	Oct. 31, 2019	Dec. 31, 2018	Jan. 17, 2018	Nov. 01, 2016
Short-term notes payable
Long-term debt
Debt converted	$ 19.6
Fixed interest rate							5.75%
Note outstanding balance						$ 7.8
Welltower note payable due October 30, 2020
Long-term debt
Principal balance outstanding								$ 51.2
Cash interest rate								3.00%
Paid-in-kind interest rate								7.00%
Welltower Notes Due December 2021
Long-term debt
Notes Issued		$ 11.7
Note Payable Due December 15 2021
Long-term debt
Principal balance outstanding			$ 14.6			13.6
Cash interest rate		3.00%
Paid-in-kind interest rate		7.00%
Note Payable Due September 30, 2022 | Short-term notes payable
Long-term debt
Fixed interest rate					3.50%
Trade Payable Converted Amount					$ 23.2
Note Payable Due April 30, 2020 [Member]
Long-term debt
Notes Payable, Current				$ 15
Welltower Inc | Welltower Notes
Long-term debt
Loan forgiven on conditions			6
Welltower Inc | Welltower note payable due October 30, 2020
Long-term debt
Principal balance outstanding			$ 64.2			$ 60

Long-Term Debt - Other (Details

Long-Term Debt - Other (Details) $ in Millions	Jan. 10, 2020USD ($)	Dec. 31, 2019USD ($)loan	Sep. 12, 2019USD ($)	Jan. 31, 2019USD ($)	Nov. 08, 2018USD ($)
Mortgages and other secured debt (recourse)
Long-term debt
Weighted Average Interest		1.50%
Amount of debt refinanced					$ 10
Mortgages and other secured debt (non-recourse)
Long-term debt
Weighted Average Interest		7.20%
Debt premium available to offset non-recourse loans		$ 1.4
Number of debt instruments with a debt premium | loan		1
Next Partnership
Long-term debt
Non-recourse debt				$ 165.7
Number Of H U D insured Loans Used For Refinancing | loan		3
Repayments of Debt		$ 38.7
Principal balance outstanding		$ 103.4
Next Partnership | Three-year term loan
Long-term debt
Term of debt		3 years
Non-recourse debt		$ 142.1
Next Partnership | 10-year mezzanine loan
Long-term debt
Term of debt		10 years
Non-recourse debt		$ 27
Vantage Point Partnership
Long-term debt
Non-recourse debt			$ 306.1
Vantage Point Partnership | Seven Year Term Loan Member
Long-term debt
Aggregate principal amount		$ 240.9
Term of debt		7 years
Proceeds from Short-term Debt	$ 7.3	$ 233.6
Promissory note		240.9
Vantage Point Partnership | Short-term notes payable
Long-term debt
Aggregate principal amount		76.8
Promissory note		76.8
Prepaid Expenses and Other Current Assets | Mortgages and other secured debt (non-recourse)
Long-term debt
Escrow reserve funds		$ 3.9

Long-Term Debt - Debt Covenants

Long-Term Debt - Debt Covenants (Details) $ in Thousands	Dec. 31, 2019USD ($)
Twelve months ended December 31,
2020	$ 162,482
2021	278,941
2022	346,155
2023	344,985
2024	11,171
Thereafter	469,923
Total long-term debt	$ 1,613,657

Stockholders_ Deficit (Details)

Stockholders’ Deficit (Details) - $ / shares	Dec. 31, 2019	Dec. 31, 2018
Class of Stock
Maximum number of shares from all classes combined, authorized	1,200,000,000
Preferred stock, authorized (in shares)	30,000,000	30,000,000
Preferred stock, par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, issued (in shares)	0	0
Class A Common Stock
Class of Stock
Common stock, authorized (in shares)	1,000,000,000	1,000,000,000
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, issued (in shares)	107,888,854	101,235,935
Class B Common Stock
Class of Stock
Common stock, authorized (in shares)	20,000,000	20,000,000
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, issued (in shares)	744,396	744,396
Class C Common Stock
Class of Stock
Common stock, authorized (in shares)	150,000,000	150,000,000
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, issued (in shares)	56,172,193	59,700,801

Stock-Based Compensation (Detai

Stock-Based Compensation (Details) - 2015 Plan	12 Months Ended
	Dec. 31, 2019shares
Class A Common Stock
Share-based Compensation Arrangement by Share-based Payment Award
Shares authorized (in shares)	24,400,000
Restricted Stock Units (RSUs)
Share-based Compensation Arrangement by Share-based Payment Award
Award vesting period	3 years
Restricted Stock Units (RSUs) | Class A Common Stock
Share-based Compensation Arrangement by Share-based Payment Award
Number of common stock shares per RSU or PSU vested	1

Stock-Based Compensation - Nonv

Stock-Based Compensation - Nonvested Units Activity (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Restricted Stock Units (RSUs)
Number of Units
Non-vested beginning balance	10,192
Granted	4,778
Vested	(3,375)
Forfeited	(1,636)
Non-vested ending balance	9,959	10,192
Weighted-Average Grant Date Fair Value
Non-vested beginning balance	$ 1.89
Granted	1.30	$ 2.43
Vested	1.82
Forfeited	1.24
Non-vested ending balance	$ 1.74	$ 1.89
Unrecognized compensation costs	$ 12.3
Weighted average term expected to recognize stock-based compensation expense not yet recognized	1 year 7 months 6 days
Fair value of shares vested	$ 4.4	$ 5.8
Share-based Payment Arrangement, Expense, Tax Benefit	4.4	4.8
Restricted Stock Units (RSUs) | General and Administrative Expense
Weighted-Average Grant Date Fair Value
Compensation expense	$ 7.3	$ 8.8
Class A Common Stock | 2015 Plan
Weighted-Average Grant Date Fair Value
Shares available for grant (in shares)	5,300

Income Taxes - Total Tax Provis

Income Taxes - Total Tax Provision (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Total income tax (benefit) expense
Income tax expense (benefit)	$ 1,754	$ (2,423)
Stockholder's deficit	346	(115)
Total	$ 2,100	$ (2,538)
FC-GEN Operations Investment, LLC
Ownership interest	66.10%

Income Taxes - Components of In

Income Taxes - Components of Income Tax Provision (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Components of provision for income taxes
Current: Federal	$ 1,014	$ 1,064
Current: State	28	(12)
Total current	1,042	1,052
Deferred: Federal	29	(521)
Deferred: State	683	(2,954)
Total deferred	712	(3,475)
Income tax (benefit) expense	$ 1,754	$ (2,423)

Income Taxes - Tax Cuts And Job

Income Taxes - Tax Cuts And Jobs Act (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2019	Dec. 31, 2018
Valuation allowance
Deferred tax asset valuation allowance		$ 386,216	$ 342,635
Federal
Tax Cuts and Jobs Act
Period that NOLs that occurred prior to December 31, 2017 may be carried forward	20 years
Maximum usage limit in any given year for NOLs occurring after December 31, 2017	80.00%

Income Taxes - Reconciliation o

Income Taxes - Reconciliation of Income Tax Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Income Tax Expense (Benefit), Continuing Operations, Income Tax Reconciliation
Computed “expected” expense (benefit)	$ 1,939	$ (78,716)
State and local income taxes, net of federal tax benefit	107	113
Income tax credits	(2,088)	(2,397)
Non-controlling interest	4,038	28,366
Adjustment to deferred taxes, including credits and valuation allowance	(2,977)	50,302
FIN 48		(38)
Other, net	735	(53)
Income tax (benefit) expense	$ 1,754	$ (2,423)
Effective tax rate	19.00%	0.60%

Income Taxes - Deferred Income

Income Taxes - Deferred Income Taxes (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Deferred tax assets:
Investment in partnership	$ 224,215	$ 195,095
Net operating loss carryforwards	133,611	121,111
Discounted unpaid loss reserve	2,156	3,567
General business credits	30,006	28,729
Total deferred tax assets	389,988	348,502
Valuation allowance	(386,216)	(342,635)
Deferred tax assets, net of valuation allowance	3,772	5,867
Deferred tax liabilities:
Long-lived assets: intangible property	(5,245)	(6,281)
Total deferred tax liabilities	(5,245)	(6,281)
Net deferred tax liabilities	$ (1,473)	$ (414)

Income Taxes - Unrecognized Tax

Income Taxes - Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns
Balance at December 31,	$ 77	$ 115
Reductions due to lapses of applicable statute of limitations		(38)
Balance at December 31,	$ 77	77
Tax savings payable, as a percent	90.00%
Maximum
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns
Accrued interest related to unrecognized tax benefits	$ 100	$ 100
State | Minimum
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns
Number of Open Tax Years	3 years
State | Maximum
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns
Number of Open Tax Years	6 years

Income Taxes - Exchange Rights

Income Taxes - Exchange Rights and Tax Receivable Agreement (Details) - USD ($) shares in Millions, $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Goodwill Tax Deductible Amount Tax Basis Step Up	$ 16.9	$ 9.6
Tax Savings Payable to Former Owners, as a Percent	90.00%
F C Gen Units And Class C Shares
Number of membership units and Class C shares exchanged for Class A shares	3.5	1.9
Class A Common Stock
Number of Class A shares issued in exchange for membership units and Class C shares	3.5	1.9

Related Party Transactions (Det

Related Party Transactions (Details) $ in Thousands	Jun. 01, 2018USD ($)facilityitem	Sep. 30, 2019USD ($)	Dec. 31, 2019USD ($)facilityitemcustomer	Dec. 31, 2018USD ($)	Feb. 01, 2019USD ($)	Dec. 31, 2016USD ($)
Related Party Transaction
Number of customers owned and operated | customer			2
Options to renew			true
Lease cost			$ 515,587
Consulting Agreement Term		1 year
Related party administrative services fees		$ 600
Maximum
Related Party Transaction
Operating lease renewal term			10 years
Minimum
Related Party Transaction
Operating lease renewal term			5 years
Class A Common Stock | Minimum
Related Party Transaction
Ownership interest			5.00%
Rehabilitation Services | Customer One
Related Party Transaction
Net revenue from related party			$ 114,300	$ 126,400
Net accounts receivable from related party			28,900	32,300
Reserves posted against note receivable			55,000
Notes receivable from related party			56,300
Rehabilitation Services | Customer Two
Related Party Transaction
Net revenue from related party			6,600	1,900
Net accounts receivable from related party			$ 1,400	1,100
FC Compassus LLC | Board of directors | Maximum
Related Party Transaction
Aggregate ownership interest in counterparty indirectly held by certain board members, as a percent			10.00%
FC Compassus LLC | Disposed by sale | Hospice And Home Health Operations
Related Party Transaction
Principal amount of notes receivable						$ 12,000
Notes receivable from related party			$ 23,200
Trident USA | Board of directors | Maximum
Related Party Transaction
Aggregate ownership interest in counterparty indirectly held by certain board members, as a percent			10.00%
Trident USA | Mobile Radiology And Laboratory Diagnostic Services [Member]
Related Party Transaction
Amount of services in period			$ 8,400	$ 12,600
Next Landlord Entities
Related Party Transaction
Initial annualized lease rent paid	$ 13,000				$ 19,500
Next Landlord Entities | Board of directors
Related Party Transaction
Ownership interest percentage			4.00%
Next Landlord Entities | New Hampshire And Florida [Member]
Related Party Transaction
Number of facilities under lease | facility	12
Number of LLCs affiliated with Next Healthcare | item	12
Next Landlord Entities | Pennsylvania, New Jersey, Connecticut, Massachusetts and West Virginia
Related Party Transaction
Ownership interest percentage			46.00%
Number of facilities under lease | facility			15
Number of LLCs affiliated with Next Healthcare | item			15
Welltower Inc
Related Party Transaction
Number of facilities under lease | facility			43
Shares of the Company’s			8.90%
Operating lease renewal term			11 years
Options to renew			true
Annual rent escalators			2.00%
Lease cost			$ 73,700
Welltower Inc | Class A Common Stock
Related Party Transaction
Voting power			5.80%

Defined Contribution Plan (Deta

Defined Contribution Plan (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Defined Contribution Plan
Defined contribution plan, employer discretionary contribution amount	$ 0	$ 0

Other Income (Details)

Other Income (Details) $ in Thousands	3 Months Ended	12 Months Ended
	Dec. 31, 2019facility	Dec. 31, 2019USD ($)facility	Dec. 31, 2018USD ($)facility
Gain on sale of owned assets | $		$ (90,723)
Loss recognized for exit costs associated with divestiture of operations | $		12,997	$ 21,459
Gain on lease termination or modification | $		(95,779)	(34,379)
Total other (income) loss | $		$ (173,505)	$ (12,920)
Number Of Facilities Sold	7
Number Of Facilities Divested Or Closed		44	55
Disposed by sale | Skilled Nursing Facilities
Number Of Facilities Sold		13	22
Number Of Facilities Divested Or Closed			54
Disposed by sale | Assisted Or Senior Living Facility
Number Of Facilities Sold		2	1

Asset Impairment Charges (Detai

Asset Impairment Charges (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Asset Impairment Charges
Impairment of Long-Lived Assets Held-for-use	$ 0	$ 0
Inpatient Services
Asset Impairment Charges
Impairment of Long-Lived Assets Held-for-use	16,900	105,000
Trade names
Asset Impairment Charges
Impairment of indefinite-lived intangible assets	$ 0	0
Favorable Leases | Goodwill And Intangible Asset Impairments [Member]
Asset Impairment Charges
Impairment charges on favorable lease intangible assets with a definite useful life		$ 3,500

Assets Held for Sale (Details)

Assets Held for Sale (Details) $ in Thousands	Feb. 26, 2020USD ($)facility	Dec. 31, 2019USD ($)facility	Dec. 31, 2018USD ($)facility	Dec. 31, 2019USD ($)facility	Dec. 31, 2018USD ($)facility	Feb. 01, 2020USD ($)	Mar. 31, 2018USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities sold		7
Assets held for sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities classified as held for sale		1	7	1	7
Assets and Liabilities of Disposal Group
Prepaid expenses | $		$ 1,171	$ 3,375	$ 1,171	$ 3,375
Property and equipment, net of accumulated depreciation of $2,201 and $3,640 at December 31, 2019 and December 31, 2018, respectively | $		16,306	16,087	16,306	16,087
Accumulated depreciation | $		2,201	3,640	2,201	3,640
Total Assets | $		17,477	19,462	17,477	19,462
Current installments of long-term debt | $		368	639	368	639
Long-term debt | $		19,789	25,942	19,789	25,942
Total Liabilities | $		$ 20,157	$ 26,581	$ 20,157	$ 26,581
Skilled Nursing Facilities
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities removed from the purchase and sale agreement				8
Skilled Nursing Facilities | Disposed by sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities sold				13	22
Skilled Nursing Facilities | Disposed by sale | Welltower Real Estate Loans
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities sold			16
Skilled Nursing Facilities | Assets held for sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities classified as held for sale			7		7
Assisted Or Senior Living Facility | Disposed by sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities sold				2	1
Texas | Skilled Nursing Facilities | Disposed by sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities sold		7	23
Texas | Skilled Nursing Facilities | Assets held for sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities classified as held for sale			23		23
Sales consideration amount | $		$ 20,100		$ 20,100			$ 20,100
Texas | Skilled Nursing Facilities | Assets held for sale | Welltower Real Estate Loans
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities classified as held for sale			4		4
Texas | Skilled Nursing Facilities | Assets held for sale | HUD insured loans
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities classified as held for sale			3		3
California | Assets held for sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities classified as held for sale		1		1
California | Skilled Nursing Facilities | Assets held for sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities classified as held for sale		7		7
California | Assisted Or Senior Living Facility | Assets held for sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities classified as held for sale		1		1
California | Skilled Nursing Facilities And Assisted Or Senior Living Facility Member | Disposed by sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities sold				7
California | Skilled Nursing Facilities And Assisted Or Senior Living Facility Member | Assets held for sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities classified as held for sale		8		8
Sales consideration amount | $		$ 88,800		$ 88,800
Subsequent Events | Skilled Nursing Facilities | Disposed by sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Sales consideration amount | $						$ 61,800
Subsequent Events | California | Skilled Nursing Facilities | HUD insured loans
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities sold	1
Sales consideration amount | $	$ 20,800

Commitments and Contingencies -

Commitments and Contingencies - Self Insurance Risks (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Commitments and Contingencies
Workers' Compensation discount rate (as a percentage)	1.60%
Potential effect of discounting on Workers Compensation reserve	$ 12	$ 8.3
Provision for general and professional liability	70.1	102.5
Reserve for general and professional liability	392.8	435.3
Provision for workers' compensation	47.6	49.9
Reserve for workers' compensation risks	160.5	168.3
Health insurance reserve	$ 15.1	$ 16.6

Commitments and Contingencies_2

Commitments and Contingencies - Litigation (Details) $ in Millions	1 Months Ended	12 Months Ended
	Jul. 31, 2016item	Dec. 31, 2018USD ($)	Dec. 31, 2019USD ($)
Loss Contingencies
Number of matters under agreement in principle | item	4
Accrued expenses
Loss Contingencies
Litigation settlement amount		$ 52.7
Environmental Remediation at Leased Sites [Member]
Loss Contingencies
Estimated settlement value			$ 16.9
Environmental Remediation at Leased Sites [Member] | Other long-term liabilities
Loss Contingencies
Asset Retirement Obligation		$ 9	6.6
Creekside Hospice Therapy Matters Investigation Staffing Matters Investigation And Sundance Part B Therapy Matter (Member)
Loss Contingencies
Accrued contingent liability			25.7
Creekside Hospice Therapy Matters Investigation Staffing Matters Investigation And Sundance Part B Therapy Matter (Member) | Other long-term liabilities
Loss Contingencies
Accrued contingent liability			13.6
Creekside Hospice Therapy Matters Investigation Staffing Matters Investigation And Sundance Part B Therapy Matter (Member) | Accrued expenses
Loss Contingencies
Accrued contingent liability			$ 12.1

Fair Value of Financial Instr_3

Fair Value of Financial Instruments - Recurring Measures (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Assets, Fair Value Disclosure [Abstract]
Cash and cash equivalents	$ 12,097	$ 20,865
Restricted cash and equivalents	113,709	121,411
Assets, Fair Value Disclosure, Total	262,748	278,429
Mortgage/Government Backed Securities
Assets, Fair Value Disclosure [Abstract]
Restricted investments in marketable securities	21,023	11,819
Corporate Bond Securities [Member]
Assets, Fair Value Disclosure [Abstract]
Restricted investments in marketable securities	48,926	55,819
Government Bonds
Assets, Fair Value Disclosure [Abstract]
Restricted investments in marketable securities	66,993	68,515
Level 1
Assets, Fair Value Disclosure [Abstract]
Cash and cash equivalents	12,097	20,865
Restricted cash and equivalents	113,709	121,411
Assets, Fair Value Disclosure, Total	171,709	182,975
Level 1 | Government Bonds
Assets, Fair Value Disclosure [Abstract]
Restricted investments in marketable securities	45,903	40,699
Level 2
Assets, Fair Value Disclosure [Abstract]
Assets, Fair Value Disclosure, Total	91,039	95,454
Level 2 | Mortgage/Government Backed Securities
Assets, Fair Value Disclosure [Abstract]
Restricted investments in marketable securities	21,023	11,819
Level 2 | Corporate Bond Securities [Member]
Assets, Fair Value Disclosure [Abstract]
Restricted investments in marketable securities	48,926	55,819
Level 2 | Government Bonds
Assets, Fair Value Disclosure [Abstract]
Restricted investments in marketable securities	$ 21,090	$ 27,816

Fair Value of Financial Instr_4

Fair Value of Financial Instruments - Debt Instruments (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Financial Liabilities Fair Value Disclosure [Abstract]
Principal balance outstanding, net	$ 1,613,420	$ 1,205,464
Asset based lending facilities
Financial Liabilities Fair Value Disclosure [Abstract]
Principal balance outstanding, net	412,346	419,289
New term loan agreement
Financial Liabilities Fair Value Disclosure [Abstract]
Principal balance outstanding, net	196,714	184,652
Real estate loans
Financial Liabilities Fair Value Disclosure [Abstract]
Principal balance outstanding, net	265,700	307,690
HUD insured loans
Financial Liabilities Fair Value Disclosure [Abstract]
Principal balance outstanding, net	117,117	181,762
Welltower Notes
Financial Liabilities Fair Value Disclosure [Abstract]
Principal balance outstanding, net	116,952	81,398
Mortgages and other secured debt (recourse)
Financial Liabilities Fair Value Disclosure [Abstract]
Principal balance outstanding, net	6,369	4,190
Mortgages and other secured debt (non-recourse)
Financial Liabilities Fair Value Disclosure [Abstract]
Principal balance outstanding, net	498,222	26,483
Level 2
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	1,613,420	1,204,652
Level 2 | Asset based lending facilities
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	412,346	419,289
Level 2 | New term loan agreement
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	196,714	184,652
Level 2 | Real estate loans
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	265,700	307,690
Level 2 | HUD insured loans
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	117,117	180,950
Level 2 | Welltower Notes
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	116,952	81,398
Level 2 | Mortgages and other secured debt (recourse)
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	6,369	4,190
Level 2 | Mortgages and other secured debt (non-recourse)
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	$ 498,222	$ 26,483

Fair Value of Financial Instr_5

Fair Value of Financial Instruments - Nonrecurring Measures (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Jan. 01, 2019
Non-recurring Fair Value Measures
Finance lease right-of-use assets, net	$ 37,097
Operating lease right-of-use assets	2,399,505		$ 500,000
Fair Value, Measurements, Nonrecurring [Member]
Non-recurring Fair Value Measures
Property and equipment, net	962,105	$ 2,887,554
Property and equipment, Impairment Charges	10,696	104,997
Finance lease right-of-use assets, net	37,097
Operating lease right-of-use assets	2,399,505
Operating lease right-of-use assets, Impairment Charges	6,241
Intangible assets, net	87,446	119,082
Intangible assets, Impairment Loss		3,538
Goodwill	$ 85,642	$ 85,642

Subsequent Events (Details)

Subsequent Events (Details) $ in Millions	Mar. 04, 2020USD ($)facility	Feb. 26, 2020USD ($)facility	Feb. 01, 2020USD ($)facility	Jan. 31, 2020USD ($)facility	Jan. 10, 2020USD ($)facility	Sep. 12, 2019USD ($)facility	Dec. 31, 2019facility	Dec. 31, 2019USD ($)facility	Dec. 31, 2018facility
Subsequent Events
Number Of Facilities Divested Or Closed | facility								44	55
Number Of Facilities Sold | facility							7
California | Subsequent Events
Subsequent Events
Net revenues		$ 14
Pre-tax net income (loss)		0.1
Montana | Subsequent Events
Subsequent Events
Net revenues	$ 2.5
Pre-tax net income (loss)	$ 0.1
California, Washington and Nevada | Subsequent Events
Subsequent Events
Ownership interest			50.00%
North Carolina And Maryland [Member] | Subsequent Events
Subsequent Events
Number Of Facilities Sold | facility			3
Net revenues			$ 38.7
Pre-tax net income (loss)			$ 0.5
Vantage Point Partnership
Subsequent Events
Net revenues						$ 84.1
Pre-tax net income (loss)						2.6
Annual rent credits						$ 30.3
Vantage Point Partnership | Massachusetts | Subsequent Events
Subsequent Events
Non-recourse debt					$ 7.3
Increase of annual rent					$ 0.9
New Generation Health, LLC | California, Washington and Nevada | Subsequent Events
Subsequent Events
Number Of Facilities Divested Or Closed | facility			19
Sales price			$ 78.9
Investments in facilities			15
Amount of finance provided to partnership			9
Repayments of loans			33.7
HUD insured loans | California | Subsequent Events
Subsequent Events
Repayments of loans		$ 20.5
HUD insured loans | North Carolina And Maryland [Member] | Subsequent Events
Subsequent Events
Repayments of loans			$ 29.1
Skilled Nursing Facilities | Vantage Point Partnership
Subsequent Events
Number Of Facilities Sold | facility						18
Skilled Nursing Facilities | New Generation Health, LLC | California, Washington and Nevada | Subsequent Events
Subsequent Events
Number Of Facilities Sold | facility			6
Skilled Nursing Facilities | HUD insured loans | California | Subsequent Events
Subsequent Events
Number Of Facilities Sold | facility		1
Sales price		$ 20.8
Assisted Senior Living Facilities
Subsequent Events
Number Of Facilities Divested Or Closed | facility									1
Skilled Nursing, Behavioral Health And Assisted Living Facilities [Member] | New Generation Health, LLC | California, Washington and Nevada | Subsequent Events
Subsequent Events
Number Of Facilities Sold | facility			13
Disposed by sale | Skilled Nursing Facilities
Subsequent Events
Number Of Facilities Divested Or Closed | facility									54
Number Of Facilities Sold | facility								13	22
Disposed by sale | Skilled Nursing Facilities | Subsequent Events
Subsequent Events
Sales price			$ 61.8
Disposed by sale | Skilled Nursing Facilities | North Carolina | Subsequent Events
Subsequent Events
Number Of Facilities Sold | facility			2
Disposed by sale | Skilled Nursing Facilities | Maryland | Subsequent Events
Subsequent Events
Number Of Facilities Sold | facility			1
Disposed by sale | Skilled Nursing Facilities | Vantage Point Partnership | Massachusetts | Subsequent Events
Subsequent Events
Number Of Facilities Sold | facility					1
Sales price					$ 9.1
Disposed by sale | Skilled Nursing Facilities | Real estate loans | Massachusetts | Subsequent Events
Subsequent Events
Number Of Facilities Sold | facility				1
Lease termination | Skilled Nursing Facilities | Massachusetts | Subsequent Events
Subsequent Events
Annual rent credit				$ 0.4
Lease termination | Assisted Senior Living Facilities | Montana | Subsequent Events
Subsequent Events
Number Of Facilities Divested Or Closed | facility	1
Annual rent credit	$ 0.7
Lease termination | Welltower Inc | Subsequent Events
Subsequent Events
Annual rent credits					$ 0.7
Vantage Point Partnership Master Agreement | Subsequent Events
Subsequent Events
Number of facilities under lease | facility					18
Land, Buildings and Improvements | Vantage Point Partnership
Subsequent Events
Property, plant and equipment, net, increase due to consolidation								$ 512.7
Land, Buildings and Improvements | Vantage Point Partnership | Massachusetts | Subsequent Events
Subsequent Events
Property, plant and equipment, net, increase due to consolidation					$ 9.1