Genesis Healthcare (GENN) 10-K 16 Mar 21 2020 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2020	Mar. 12, 2021	Jun. 30, 2020
Document Information [Line Items]
Entity Central Index Key	0001351051
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2020
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
ICFR Auditor Attestation Flag	true
Entity Public Float			$ 66.7
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2020
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		111,728,783
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		54,877,924

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 212,071	$ 12,097
Restricted cash and equivalents	49,998	63,101
Restricted investments in marketable securities	39,526	31,855
Accounts receivable	426,927	567,636
Prepaid expenses	93,476	108,908
Other current assets	47,132	44,079
Assets held for sale		1,171
Total current assets	869,130	828,847
Property and equipment, net of accumulated depreciation of $429,705 and $431,361 at December 31, 2020 and December 31, 2019, respectively	984,712	962,105
Finance lease right-of-use assets, net of accumulated amortization of $16,328 and $23,401 at December 31, 2020 and December 31, 2019, respectively	27,848	37,097
Operating lease right-of-use assets	1,715,532	2,399,505
Restricted cash and equivalents	51,151	50,608
Restricted investments in marketable securities	114,326	105,087
Other long-term assets	116,371	85,725
Deferred income taxes	2,278	3,772
Identifiable intangible assets, net of accumulated amortization of $81,387 and $76,243 at December 31, 2020 and December 31, 2019, respectively	82,270	87,446
Goodwill	85,642	85,642
Assets held for sale	12,986	16,306
Total assets	4,062,246	4,662,140
Current liabilities:
Current portion of long-term debt	905,788	162,426
Current portion of finance lease obligations	2,949	2,839
Current portion of operating lease obligations	2,071,841	140,887
Accounts payable	211,357	238,384
Accrued expenses	335,837	226,092
Accrued compensation	162,870	153,698
Self-insurance reserves	153,669	146,476
Current portion of liabilities held for sale	403	368
Total current liabilities	3,844,714	1,071,170
Long-term liabilities:
Long-term debt	634,934	1,450,994
Finance lease obligations	34,943	39,335
Operating lease obligations	159,711	2,681,403
Deferred income taxes	5,071	5,245
Self-insurance reserves	385,084	406,864
Liabilities held for sale	18,271	19,789
Other long-term liabilities	141,765	69,905
Commitments and contingencies
Stockholders' deficit:
Additional paid-in-capital	247,472	248,594
Accumulated deficit	(1,069,259)	(1,010,296)
Accumulated other comprehensive income	1,396	602
Total stockholders' deficit before noncontrolling interests	(820,224)	(760,935)
Noncontrolling interests	(342,023)	(321,630)
Total stockholders' deficit	(1,162,247)	(1,082,565)
Total liabilities and stockholders' deficit	4,062,246	4,662,140
Class A Common Stock
Stockholders' deficit:
Common stock	111	108
Class B Common Stock
Stockholders' deficit:
Common stock	1	1
Class C Common Stock
Stockholders' deficit:
Common stock	$ 55	$ 56

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parentheticals) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Other assets:
Accumulated depreciation on property and equipment	$ 429,705	$ 431,361
Accumulated amortization on finance lease ROU asset	16,328	23,401
Finite-lived intangible assets, net, Accumulated amortization on intangible assets	$ 81,387	$ 76,243
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)	110,801,462	107,888,854
Common stock, shares, outstanding (in shares)	110,801,462	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)	55,250,921	56,172,193
Common stock, shares, outstanding (in shares)	55,250,921	56,172,193

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
CONSOLIDATED STATEMENTS OF OPERATIONS
Net revenues	$ 3,906,223	$ 4,565,834
Salaries, wages and benefits	2,256,200	2,485,010
Other operating expenses	1,270,571	1,374,847
General and administrative costs	175,057	144,471
Lease expense	366,339	387,063
Depreciation and amortization expense	107,833	123,159
Interest expense	135,439	180,392
Loss (gain) on early extinguishment of debt	8,979	(122)
Investment income	(3,989)	(7,296)
Other income	(202,272)	(173,505)
Transaction costs	34,279	26,362
Long-lived asset impairments	179,000	16,937
Federal and state stimulus - COVID-19 other income	(306,067)
Equity in net income of unconsolidated affiliates	(8,169)	(712)
(Loss) income before income tax (benefit) expense	(106,977)	9,228
Income tax (benefit) expense	(3,610)	1,754
Net (loss) income	(103,367)	7,474
Less: Net loss attributable to noncontrolling interests	44,404	7,145
Net (loss) income attributable to Genesis Healthcare, Inc.	$ (58,963)	$ 14,619
Basic:
Weighted-average shares outstanding for basic net (loss) income per share (in shares)	111,851	107,286
Basic net (loss) income per common share attributable to Genesis Healthcare, Inc. (in dollars per share)	$ (0.53)	$ 0.14
Diluted:
Weighted-average shares outstanding for diluted net (loss) income per share (in shares)	111,851	165,314
Diluted net (loss) income per common share attributable to Genesis Healthcare, Inc. (in dollars per share)	$ (0.53)	$ 0.10

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS)
Net (loss) income	$ (103,367)	$ 7,474
Net unrealized gain on marketable securities, net of tax	1,188	1,198
Comprehensive (loss) income	(102,179)	8,672
Less: comprehensive loss attributable to noncontrolling interests	44,010	6,811
Comprehensive (loss) income attributable to Genesis Healthcare, Inc.	$ (58,169)	$ 15,483

CONSOLIDATED STATEMENTS OF STOC

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' DEFICIT - USD ($) shares in Thousands, $ in Thousands	Common StockClass A Common Stock	Common StockClass B Common Stock	Common StockClass C Common Stock	Additional Paid-In Capital	Accumulated DeficitCumulative Effect, Period of Adoption, Adjustment	Accumulated Deficit	Accumulated Other Comprehensive Income	Stockholders' DeficitCumulative Effect, Period of Adoption, Adjustment	Stockholders' Deficit	Noncontrolling InterestsCumulative Effect, Period of Adoption, Adjustment	Noncontrolling Interests	Cumulative Effect, Period of Adoption, Adjustment	Total
Balance, beginning of period at Dec. 31, 2018	$ 101	$ 1	$ 60	$ 270,408		$ (1,609,828)	$ (262)		$ (1,339,520)		$ (705,346)		$ (2,044,866)
Balance, beginning of period (in shares) at Dec. 31, 2018	101,236	744	59,701
Increase (decrease) in stockholders' deficit
Net (loss) income						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
Balance, end of period at Dec. 31, 2019	$ 108	$ 1	$ 56	248,594	$ 584,913	(1,010,296)	602	$ 584,913	(760,935)	$ 340,129	(321,630)	$ 925,042	(1,082,565)
Balance, end of period (in shares) at Dec. 31, 2019	107,889	744	56,172
Increase (decrease) in stockholders' deficit
Net (loss) income						(58,963)			(58,963)		(44,404)		(103,367)
Net unrealized gain (loss) on marketable securities, net of tax							794		794		394		1,188
Share-based compensation				6,480					6,480				6,480
Issuance of common stock	$ 2			(2)
Issuance of common stock, shares	1,991
Conversion of common stock among classes	$ 1		$ (1)	(7,600)					(7,600)		7,600
Conversion of common stock among classes (in shares)	921		(921)
Distributions to noncontrolling interests											(5,707)		(5,707)
Contributions from noncontrolling interests											21,724		21,724
Balance, end of period at Dec. 31, 2020	$ 111	$ 1	$ 55	$ 247,472		$ (1,069,259)	$ 1,396		$ (820,224)		$ (342,023)		$ (1,162,247)
Balance, end of period (in shares) at Dec. 31, 2020	110,801	744	55,251

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Cash flows from operating activities
Net (loss) income	$ (103,367)	$ 7,474
Adjustments to reconcile net (loss) income to net cash provided by operating activities:
Non-cash interest and leasing arrangements, net	25,043	27,311
Other non-cash gain, net	(202,273)	(173,505)
Share based compensation	6,480	7,309
Depreciation and amortization expense	107,833	123,159
Reduction in the carrying amount of operating lease right-of-use assets	113,325	117,127
Recovery for losses on accounts receivable	(604)	(4,469)
Equity in net income of unconsolidated affiliates	(8,169)	(712)
Benefit for deferred taxes	1,005	(179)
Loss (income) on early extinguishment of debt	3,754	(2,822)
Long-lived asset impairments	179,000	16,937
Changes in assets and liabilities:
Accounts receivable	125,511	45,745
Accounts payable and other accrued expenses and other	18,548	(76,911)
Medicare advance payments	155,824
Operating lease obligations	(106,179)	(93,630)
Net cash provided by (used in) operating activities	315,731	(7,166)
Cash flows from investing activities:
Capital expenditures	(55,616)	(62,727)
Purchases of marketable securities	(79,285)	(70,316)
Proceeds on maturity or sale of marketable securities	63,880	71,174
Purchases of assets	(207,313)	(591,660)
Sales of assets	259,514	257,806
Restricted deposits	12,772	(3,820)
Investments in joint venture	(17,520)
Loan provided to joint venture	(9,000)
Notes receivable and other investment additions		12,590
Other, net	(964)	(50)
Net cash used in investing activities	(33,532)	(387,003)
Cash flows from financing activities:
Borrowings under revolving credit facilities	4,546,161	4,661,000
Repayments under revolving credit facilities	(4,682,122)	(4,630,664)
Proceeds from issuance of long-term debt	228,714	538,538
Repayment of long-term debt	(191,781)	(199,626)
Repayment of finance lease obligations	(2,905)	(2,645)
Debt issuance and settlement costs	(8,869)	(10,182)
Contributions from noncontrolling interests	21,724	27,031
Distributions to noncontrolling interests and stockholders	(5,707)	(5,753)
Net cash (used in) provided by financing activities	(94,785)	377,699
Net increase (decrease) in cash, cash equivalents and restricted cash and equivalents	187,414	(16,470)
Cash, cash equivalents and restricted cash and equivalents:
Beginning of period	125,806	142,276
End of period	313,220	125,806
Supplemental cash flow information:
Interest paid	109,242	153,589
Net taxes paid	2,910	1,496
Federal and state stimulus - COVID-19 other income	306,067
Non-cash investing and financing activities:
Finance lease obligations, net write-down due to lease activity	(1,378)
Finance lease obligations, net write-down due to lease activity		(930,110)
Assets subject to finance lease obligations, net write-down due to lease activity	(572)	(53,588)
Operating lease obligations, net (write-down) gross-up due to lease activity	(484,558)	2,916,017
Assets subject to operating leases, net write-down (gross-up) due to lease activity	$ 407,799	(2,523,708)
Financing obligations, net write-down due to lease activity under ASC 840		(2,734,940)
Assets subject to financing obligations, net write-down due to lease activity under ASC 840		$ 1,718,507

General Information

General Information	12 Months Ended
	Dec. 31, 2020
General Information
General Information	(1) General Informatio n ​ 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, 2020, the Company provided inpatient services through states. Revenues of the Company’s owned, leased and otherwise consolidated inpatient businesses constitute approximately ​ 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 contracts with healthcare facilities operated by third parties. 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 ​ 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 subsidiaries. All intercompany transactions have been eliminated in consolidation. The Company presents noncontrolling interests within the stockholders’ deficit section of its consolidated balance sheets. The Company presents the amount of net (loss) income attributable to Genesis Healthcare, Inc. and net (loss) income attributable to noncontrolling interests in its consolidated statements of operations. ​ The consolidated financial statements include the accounts of all entities controlled by the Company through its ownership of a majority voting interest and the accounts of 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 the years ended December 31, 2020 and 2019, the Company entered into three partnerships that acquired the real property of 43 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 Partnerships ​ Going Concern Considerations ​ On March 11, 2020, the World Health Organization declared the coronavirus outbreak (COVID-19) a pandemic. COVID-19 is a complex and previously unknown virus which disproportionately impacts older adults, particularly those having other underlying health conditions. ​ The Company’s primary focus as the effects of COVID-19 began to impact the United States was the health and safety of its patients, residents, employees and their respective families. The Company implemented various measures to provide the safest possible environment within its sites of service during this pandemic and will continue to do so. ​ The United States broadly continues to experience the pandemic caused by COVID-19, which has significantly disrupted, and likely will continue to disrupt for some period, the nation’s economy, the healthcare industry and the Company’s businesses. The rapid spread of the virus has led to the implementation of various responses, including federal, state and local government-imposed quarantines, shelter-in-place mandates, sweeping restrictions on travel, and substantial changes to selected protocols within the healthcare system across the United States. A significant number of the Company’s facilities and operations are geographically located and highly concentrated in markets with close proximity to areas of the United States that have experienced widespread and severe COVID-19 outbreaks. COVID-19 has materially and adversely affected the Company’s operations and supply chains, resulting in a reduction in its operating occupancy and related revenues, and an increase in its expenditures. ​ The Company performed an assessment to determine whether there are conditions or events, considered in the aggregate, that raise substantial doubt about its ability to continue as a going concern within one year after the date the financial statements are issued. Initially, this assessment does not consider the potential mitigating effect of management’s plans that have not been fully implemented. When substantial doubt exists, management assesses the mitigating effect of its plans to determine if it is probable that (1) the plans will be effectively implemented within one year after the date the financial statements are issued, and (2) when implemented, the plans will mitigate the relevant conditions or events that raise substantial doubt about the entity’s ability to continue as a going concern. ​ In completing its going concern assessment, the Company considered the uncertainties around the impact of COVID-19 on its future results of operations as well as its current financial condition and liquidity sources, including current funds available, forecasted future cash flows and the Company’s indebtedness and other conditional and unconditional obligations due within 12 months following the date its financial statements were issued. Without giving effect to the prospect, timing and adequacy of future governmental funding support and other mitigating plans, many of which are beyond the Company’s control, it is unlikely that the Company will be able to generate sufficient cash flows to meet its required financial obligations, including its rent and debt obligations, and maintain compliance with financial covenants. The existence of these conditions raises substantial doubt about the Company’s ability to continue as a going concern for the twelve-month period following the date the financial statements are issued. ​ In response to COVID-19, and other conditions that raise substantial doubt about the Company’s ability to continue as a going concern, the Company has taken the following measures: ​ ● The Company applied for and received government-sponsored financial relief related to the pandemic; ● The Company is utilizing the Coronavirus Aid, Relief, and Economic Security Act of 2020 (CARES Act) payroll tax deferral program to delay payment of a portion of payroll taxes incurred through December 2020, with 50% to be repaid in December 2021 and the remaining 50% to be repaid in December 2022; ● While it vigorously advocates, for itself and the skilled nursing industry, regarding the need for additional government-sponsored funding, the Company continues to explore and to take advantage of existing government-sponsored funding programs implemented to support businesses impacted by COVID-19; ● The Company continues to seek and implement measures to adapt its operational model to function for the long-term in a COVID-19 environment; ● The Company has pursued, and will continue to pursue, creative and accretive opportunities to sell assets and enter into joint venture structures in order to provide liquidity; ● The Company executed a series of transactions, as described at Note 23 – “Subsequent Events – Restructuring Transactions,” that are expected to improve its liquidity position; and ● The Company is exploring and evaluating a number of strategic and other alternatives to manage and to improve its liquidity position, in order to address the maturity of material indebtedness and other obligations over the twelve-month period following the date the financial statements are issued. ​ These measures and other plans and initiatives are needed to provide the Company with adequate liquidity to meet its obligations for at least the twelve-month period following the date its financial statements are issued. However, such plans and initiatives are dependent on factors that are beyond the Company’s control or may not be available on terms acceptable to the Company, or at all. Accordingly, management determined it could not be certain that the plans and initiatives would be effectively implemented within one year after the date the financial statements are issued. Further, even if the Company receives additional funding support from government sources and/or is able to execute successfully all of these plans and initiatives, given the unpredictable nature of, and the operating challenges presented by, the COVID-19 virus, the Company’s operating plans and resulting cash flows along with its cash and cash equivalents and other sources of liquidity may not be sufficient to fund operations for the twelve-month period following the date the financial statements are issued. Such events or circumstances could force the Company to seek reorganization under the U.S. Bankruptcy Code. ​ The accompanying consolidated financial statements have been prepared assuming the Company will continue as a going concern, which contemplates continuity of operations, realization of assets and the satisfaction of liabilities in the normal course of business for the twelve-month period following the date the financial statements are issued. At December 31, 2020, the Company was not in compliance with or had not received waivers with respect to the financial covenants contained in certain of its leases containing cross-default provisions with other lease agreements and debt agreements. The lease and debt obligations associated with these agreements have been classified as current liabilities. Otherwise, the accompanying consolidated financial statements do not include any adjustments relating to the recoverability and classification of assets and their carrying amounts, or the amount and classification of liabilities that may result should the Company be unable to continue as a going concern. ​

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2020
Summary of Significant Accounting Policies
Summary of Significant Accounting Policies	(2) Summary of Significant Accounting Policies ​ 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 valuation of revenues and accounts receivable, self-insured liabilities, income taxes, long-lived assets and goodwill, lease obligations and other contingencies. Actual results could differ from those estimates. ​ Revenue Recognition ​ The Company generates revenues, primarily by providing healthcare services to its customers. The Company applies Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) Topic 606, Revenue from Contracts with Customers ​ Performance obligations are determined based on the nature of the services provided. The majority of the Company's healthcare services are highly interrelated and represent multiple inputs to deliver the combined output for which a customer has entered into a contract with the Company. As such, the bundle of services is treated as a single performance obligation satisfied over time as services are rendered. The Company also provides certain ancillary services, such as activities, meals, security, housekeeping, and assistance in the activities of daily living, including barber and beauty services. Separate and distinct performance obligations exist relative to the performance of the non-medical ancillary services. As such, revenues from ancillary services are recognized 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. The Company constrains 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. 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 is entitled to compensation for the value of the services provided, as they are performed, so it recognizes the related revenue in the statements of operations as the services are performed. Since the Company has performed its obligation under the contract, it has unconditional rights to the consideration recorded and, therefore, classifies those billed and unbilled rights 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 patients who either do not have insurance or who have insurance with Medicare, Medicaid, private and commercial insurance entities, 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.” ​ 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, 2020 and 2019 were $153.9 million and $136.9 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 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, 2020 and 2019 was $98.5 million and $96.1 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 customer relationships. 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 Asset Impairment Charges ​ Self-Insurance Reserves ​ The Company provides for self-insurance reserves for both general and professional liabilities 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 and settling claims, and the relationship of past reported incidents to eventual claim 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 claims are discounted based on actuarial estimates of claim payment patterns whereas the reserves for general and professional liability claims are recorded on an undiscounted basis. Estimated insurance recoveries related to recorded liabilities are reflected as assets in the Company’s consolidated balance sheets when the receipt of such amounts is deemed to be probable. 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 (benefit) expense in the consolidated statement of operations. ​ Leases ​ The Company leases skilled nursing facilities and assisted/senior living facilities, as well as certain office space, land, and equipment. 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.” ​ (Loss) Earnings Per Share ​ The Company follows the FASB’s authoritative guidance for the financial reporting of (loss) earnings per share. (Loss) earnings per share excludes dilution and is based upon the weighted average number of common shares outstanding during the respective periods. Diluted (loss) earnings 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 – “(Loss) Earnings Per Share ​ Recently Adopted Accounting Pronouncements ​ In August 2018 , the FASB issued Accounting Standard Update (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. ​ Recently Issued Accounting Pronouncements ​ 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. Further, the FASB issued ASU 2019-04 and ASU 2019-05 to provide additional guidance on the credit losses standard. The standard is effective for fiscal years beginning after December 15, 2022 , for smaller reporting companies, 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 new standard became effective for the Company on January 1, 2021 . The Company is evaluating the effect, if any, that the standard will have on its consolidated financial statements . ​

Certain Significant Risks and U

Certain Significant Risks and Uncertainties	12 Months Ended
	Dec. 31, 2020
Certain Significant Risks and Uncertainties
Certain Significant Risks and Uncertainties	(3) Certain Significant Risks and Uncertainties ​ COVID-19 ​ The COVID-19 pandemic has materially and adversely affected, and will continue to materially and adversely affect, the Company’s patients, staff and operations, which in turn has materially and adversely affected its revenues and expenses. The Company began to experience the negative impact of the COVID-19 pandemic beginning in late February 2020. For a more detailed discussion of the impact of COVID-19 on the Company’s operations, net revenues, operating expenses and liquidity, see Note 4 – “ Significant Transactions and Events – COVID-19 ​ Revenue Sources ​ The Company receives revenues from patients who either do not have insurance or who have insurance with Medicare, Medicaid, private and commercial insurance entities, 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 of its revenue from patients who are insured by 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, 2020 and 2019: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ 2020 2019 Medicare ​ 21 % ​ 20 % Medicaid ​ 59 % ​ 58 % Insurance ​ 11 % ​ 12 % Private ​ 7 % ​ 7 % Other ​ 2 % ​ 3 % 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 the historical reimbursement experience within each payor type. Changes in the case mix of the patients as well as payor mix of the patients among Medicare, Medicaid and private pay patients can significantly affect the Company’s profitability. ​ It is difficult to quantify fully the effect of legislative changes, public and private subsidy, and grant programs related to COVID-19, the interpretation or administration of such legislation or other governmental initiatives on the Company’s 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 businesses 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 approximately 150 distinct customers, many being chain operators with more than one location. One of the Company’s customers, a related party, comprises “Related Party Transactions.” ​ 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 a significant adverse impact on the Company’s financial position. ​ At December 31, 2020, the Company was not in compliance with or had not received waivers with respect to the financial covenants contained in certain of its leases because certain of its other lease agreements and debt agreements contain cross-default provisions that are triggered if the Company is in default of such leases. The lease and debt obligations associated with these agreements have been classified as current liabilities. As of the date of this Form 10-K filing, all rent and debt service payments have been made timely and no material creditors have pursued remedies with respect to breaches of financial covenants. ​ The ongoing uncertainty related to the impact of healthcare reform initiatives and the effect of the COVID-19 pandemic may have an adverse impact on the Company’s ability to remain in compliance with or return to compliance with its financial covenants through March 16, 2022. Without giving effect to the prospect of timely and adequate future governmental funding support and other mitigating plans, many of which are beyond the Company’s control, it is unlikely that the Company will be able to generate sufficient cash flows to timely meet its required financial obligations, including its rent obligations, its debt service obligations and other obligations due to third parties. The existence of these conditions raises substantial doubt about the Company’s ability to continue as a going concern for the twelve-month period following the date the financial statements are issued. ​ 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 and receive adequate government-sponsored financial support in response to the COVID-19 pandemic as well as possible waivers, deferrals and/or adjustments of debt and lease terms. 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, 2020
Significant Transactions and Events
Significant Transactions and Events	(4) Significant Transactions and Events ​ COVID-19 ​ As discussed in Note 1 – “ General Information – Going Concern Considerations,” serve to outline the estimated impact of COVID-19 on its business through December 31, 2020, including the impact of emergency legislation, temporary changes to regulations and reimbursements issued in response to COVID-19. ​ Operations ​ The Company’s first report of a positive case of COVID-19 in one of its facilities occurred on March 16, 2020. Since that time, facilities have experienced one or more positive cases of COVID-19 among patients and residents. Over of the patient and resident positive COVID-19 cases in its facilities have occurred in the states of Connecticut, Maryland, Massachusetts, New Jersey, New Mexico, Pennsylvania, and West Virginia, which correspond to many of the largest community outbreak areas across the country. The Company’s facilities in these seven states represent ​ The Company’s occupancy decreased in the early months of the pandemic following the efforts by referring hospitals to cancel or reschedule elective procedures in anticipation of an increasing number of COVID-19 cases in their communities. As the pandemic progressed, occupancy was further decreased by, among other things, implementation of both self-imposed and state or local admission holds in facilities having exposure to positive cases of COVID-19 among patients, residents and employees. These self-imposed, and sometimes mandatory, restrictions on admissions were instituted to limit risks of potential spread of the virus by individuals that either tested positive for COVID-19, exhibited symptoms of COVID-19 but had not yet been tested positive due to a severe shortage of testing materials, or were asymptomatic of COVID-19 but potentially positive and contagious. ​ Net Revenues ​ The Company’s net revenues for the year ended December 31, 2020 were materially and adversely impacted by a significant decline in occupancy as a result of COVID-19. The Company’s skilled nursing facility operating occupancy decreased from 88.2% for the three months ended March 31, 2020 to 76.6% for the three months ended December 31, 2020. The revenue lost from the decline in occupancy was partially offset by incremental state sponsored funding programs, changes in payor mix, and the enactment of COVID-19 relief programs, as discussed below. See Regulatory and Reimbursement Relief . After considering a commensurate reduction in related and direct operating expenses, the Company lost revenue caused by COVID-19 during the year ended December 31, 2020. ​ Operating Expenses ​ The Company’s operating expenses for the year ended December 31, 2020 were materially and adversely impacted due to increases in costs as a result of the pandemic, with more dramatic increases occurring at facilities with positive COVID-19 cases among patients, residents and employees. During the year ended December 31, 2020, the Company incurred million of incremental operating expenses in response to the pandemic. Increases in cost primarily stemmed from higher labor costs, including increased use of overtime and bonus pay, as well as a significant increase in both the cost and usage of personal protective equipment, workers compensation, testing, medical equipment, enhanced cleaning and environmental sanitation costs and the impact of utilizing less efficient modes of providing therapy in order to avoid the grouping of patients. Additionally, the future cost of securing adequate insurance coverages through annual renewals may be significantly higher than existing coverages, and the same level of coverage may no longer be available or affordable. This includes workers compensation and general and professional liability coverages, which are requirements in most states in which we operate. ​ The Company is not reasonably able to predict the total amount of costs it will incur related to the pandemic and to what extent such incremental costs can be reduced or will be borne by or offset by actions taken by public and private entities in response to the pandemic. ​ Liquidity ​ The Company has taken, and will continue to take, actions to enhance and to preserve its liquidity in response to the pandemic. During the year ended December 31, 2020, the Company’s usual sources of liquidity have been supplemented by grants and advanced Medicare payments under programs expanded or created under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Specifically, in the second quarter of 2020, the Company applied for and received million of relief grants and other forms of federal relief, such as the temporary suspension of Medicare sequestration. In addition, the Company has elected to implement the CARES Act payroll tax deferral program, which preserved, on an interest free basis, million of cash, representing the employer portion of payroll taxes incurred between March 27, 2020 and December 31, 2020. The advance Medicare payments of million, which are also interest free, are expected to be recouped between April 2021 and February 2022, while one-half of the payroll tax deferral amount will become due on each of December 31, 2021 and December 31, 2022. In addition to relief funding under the CARES Act, funding of ​ The Company continues to seek opportunities to enhance and to preserve its liquidity, including through reducing expenses, continuing to evaluate its capital structure and seeking further government-sponsored financial relief related to the pandemic. The Company cannot provide assurance that such efforts will be successful, timely or adequate to offset the lost revenue and escalating operating expenses as a result of the pandemic. See Note 1 – “ General Information – Going Concern Considerations.” ​ Regulatory and Reimbursement Relief ​ On March 18, 2020, the Families First Coronavirus Response Act was enacted, which provided a temporary 6.2% increase to each qualifying state’s Medicaid Federal Medical Assistance Percentage (FMAP) effective January 1, 2020. The temporary FMAP increase will extend through the last day of the calendar quarter in which the COVID-19 public health emergency declared by the U.S. Department of Health and Human Services (HHS), including any extensions or termination, which currently expires on April 20, 2021. As part of the requirements for receiving the temporary FMAP increase, states must cover testing services and treatments for COVID-19 and may not impose deductibles, copayments, coinsurance or other cost sharing charges for any quarter in which the temporarily increased FMAP is claimed. Further, a number of additional states in which the Company operates have implemented incremental FMAP related reimbursement provisions and other forms of support to assist providers. For the year ended December 31, 2020, the Company recognized FMAP reimbursement relief of $82.3 million as net revenues and other forms of state support grants of $39.1 million as Federal and state stimulus – COVID-19 other income in the consolidated statements of operations. At December 31, 2020, the Company deferred recognition of ​ In further response to the pandemic, on March 27, 2020, the former U.S. Presidential administration signed into law the bipartisan CARES Act, which authorized the cash distribution of relief funds to reimburse healthcare providers for health care related expenses or lost revenues that are attributable to coronavirus. Nursing facility operators participating in Medicare and Medicaid may be eligible to receive compensation for costs incurred in the course of providing medical services, such as those related to obtaining personal protective equipment, COVID-19 related testing supplies, and increased staffing or training, provided that such costs are not compensated by another source. The secretary of HHS has broad authority and discretion to determine payment eligibility and the amount of such payments. ​ The Company was impacted by certain provisions of the CARES Act, as summarized below. ​ ● Temporary suspension of certain patient coverage criteria and documentation and care requirements . The CARES Act and a series of temporary waivers and guidance issued by the Centers for Medicare and Medicaid Services (CMS) suspend various Medicare patient coverage criteria as well as certain documentation and care requirements. These accommodations are intended to ensure patients have access to care notwithstanding the burdens placed on healthcare providers due to the COVID-19 pandemic. ​ ● Relief Funds. The CARES Act authorized HHS to distribute relief fund grants to healthcare providers to support healthcare-related expenses or lost revenue attributable to COVID-19. HHS has made several rounds of distributions to providers based upon a variety of factors and providers have been able to apply for additional funding. To retain the funds, providers must submit an attestation accepting certain terms and conditions. During April 2020, the Company first began receiving relief grants from CARES Act funds administered by HHS. Through December 31, 2020, the Company has received $198.7 million in these initial relief grants, the majority of which are related to skilled nursing care provided through the Company’s Inpatient Services segment. On July 22, 2020, the former U.S. presidential administration announced an additional relief fund to be used to protect residents of long term care facilities and nursing homes from the impact of COVID-19. Through December 31, 2020, the Company received $68.3 million of relief grants under the program. The relief fund included: o Payments to be used primarily to support increased testing and meet staffing and personal protective equipment needs. o Subsequent distributions as part of the Quality Incentive Payments Program (QIP). In order to qualify for payments under QIP, a facility must have an active state certification as a nursing home or skilled nursing facility and receive reimbursement from CMS. HHS will administer quality checks on nursing home certification status to identify and remove facilities that have a terminated, expired, or revoked certification or enrollment. Facilities must also report to at least one of three data sources that will be used to establish eligibility and collect necessary provider data to inform payment. The QIP Program has been divided into four performance periods (September, October, November and December 2020). All nursing homes or skilled nursing facilities meeting the previously noted qualifications were eligible for each of the performance periods. o Distributions to “COVID only” facilities. o Distributions to providers that participate in approved training programs to better enable nursing home employees to administer COVID-19-related safety practices. ​ The Company recognizes relief funds as income once there is reasonable assurance that the applicable terms and conditions required to retain the funds have been met. During the year ended December 31, 2020, the Company recognized $306.1 million of aggregate relief funds within the “Federal and state stimulus – COVID-19 other income” caption in the consolidated statement of operations. ​ On June 9, 2020 as part of its ongoing efforts to provide financial relief to healthcare providers impacted by COVID-19, HHS announced the Phase 2 general distribution to Medicaid, Medicaid managed care, Children's Health Insurance Program (CHIP) and dental providers. HHS anticipates distributing approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs that did not receive a payment from the Provider Relief Fund General Allocation (Phase 1). Eligible applicants will receive 2% of Gross Revenues from Patient Care for calendar years 2017, 2018 or 2019 as selected by applicant. The Company has submitted applications for its assisted living facilities that meet the eligibility criteria. ​ ● Medicare Accelerated and Advanced Payment Program. During the second quarter of 2020, the Company applied for and received $156.8 million of interest free advanced Medicare payments. These payments will be subsequently recouped over time as revenue is recognized for claims submitted for services provided to Medicare patients. In October 2020, CMS extended the recoupment period to begin one year from the date the advanced payments were issued. The Company’s recoupment period for the advanced payments is expected to be from April 2021 to February 2022. The Company has reported advanced payments of $118.8 million and $36.7 million within accrued expenses and other long-term liabilities, respectively, in the consolidated balance sheet as of December 31, 2020. ​ ● Payroll Tax Deferral . Under the CARES Act, the Company has elected to defer payment, on an interest free basis, of the employer portion of social security payroll taxes incurred from March 27, 2020 to December 31, 2020. One-half of the deferral amount is due on each of December 31, 2021 and December 31, 2022. The Company has presented $46.1 million of the deferred payroll tax balance within accrued expenses and $46.1 million within other long-term liabilities in the consolidated balance sheet as of December 31, 2020. ​ ● Temporary Suspension of Medicare Sequestration . The Budget Control Act of 2011 requires a mandatory, across the board reduction in federal spending, called a sequestration. Medicare fee for service claims with dates of service or dates of discharge on or after April 1, 2013 incur a 2.0% reduction in Medicare payments. All Medicare rate payments and settlements have incurred this mandatory reduction and it will continue to remain in place through at least 2023, unless Congress takes further action. In response to COVID-19, the CARES Act temporarily suspended the automatic 2.0% reduction of Medicare claim reimbursements for the period of May 1, 2020 through December 31, 2020; this period was subsequently extended through March 31, 2021. During the year ended December 31, 2020, the suspension of sequestration resulted in net revenues of $8.4 million. ​ Strategic Partnerships ​ NewGen Partnership ​ On February 1, 2020, the Company transitioned operational responsibility for 19 facilities in the states of California, Washington and Nevada to a partnership with New Generation Health, LLC (the NewGen Partnership). The Company sold the real estate and operations of six skilled nursing facilities and transferred the operations to 13 skilled nursing, behavioral health and assisted living facilities for $78.7 million. Net transaction proceeds were used by the Company to repay indebtedness, including prepayment penalties, of $33.7 million, fund its initial 50% equity contribution and working capital requirement of $14.9 million, and provide financing to the partnership of $9.0 million. The Company recorded a gain on sale of assets and transition of leased facilities of $58.8 million and loss on early extinguishment of debt of $1.0 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. ​ On May 15, 2020, the Company transitioned operational responsibility for four additional leased facilities in California to the NewGen Partnership. The four facilities generated annual revenues of $55.0 million and pre-tax loss of $0.5 million. On October 1, 2020, the Company transitioned operational responsibility for one additional leased facility in the state of Washington to the NewGen Partnership. The facility generated annual revenues of $12.3 million and pre-tax income of $0.2 million. ​ The Company does not hold a controlling financial interest in the NewGen Partnership. As such, the Company has applied the equity method of accounting for its 50% interest in the NewGen Partnership. The Company’s investment in the NewGen Partnership, $25.1 million, is included within other long-term assets in the consolidated balance sheet as of December 31, 2020. ​ Cascade Partnership ​ On July 2, 2020, the Company sold one facility to an affiliate of Cascade Capital Group, LLC (Cascade) for $26.1 million, using proceeds from the sale to retire U.S. Department of Housing and Urban Development (HUD) financed debt of $10.5 million, pay aggregate prepayment penalties and other closing costs of $1.0 million, and partially fund its investment in a partnership with Cascade (the Cascade Partnership). The Cascade Partnership also acquired eight facilities that the Company operated under a master lease agreement with Second Spring. The Company continues to operate all nine of these facilities subject to a new master lease agreement with affiliates of Cascade. The master lease agreement contains an initial term of 10 years with one five-year renewal option and base rent of $20.7 million with no rent escalators for the first five years and annual rent escalators of 2.5% thereafter. The Company also obtained a fixed price option to purchase the nine facilities for $251.6 million that is exercisable from July 2023 through June 2025. The Company executed a promissory note with Cascade for $20.3 million, which was subsequently converted into a 49% membership interest in the Cascade Partnership. ​ The Company has concluded that the Cascade Partnership is a VIE and it is the primary beneficiary. Consequently, the Company has consolidated all of the accounts of the Cascade Partnership in the accompanying financial statements. Additionally, all leasing activity associated with the master lease has been fully eliminated in consolidation. The Cascade Partnership acquired all nine skilled nursing facilities for an aggregate purchase price of $223.6 million. The initial consolidation primarily resulted in property and equipment of $208.6 million, non-recourse debt of $190.3 million, net of debt issuance costs, and noncontrolling interests of $21.2 million. ​ 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 available. The Company will pay annual rent of 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 ​ The Company has concluded the Next Partnership is a VIE and it is the primary beneficiary. Consequently, the Company has consolidated all of the accounts of the Next Partnership in the accompanying financial statements. Additionally, all leasing activity associated with the master lease has been fully eliminated in consolidation. The Next Partnership acquired million. The initial consolidation of the remaining ​ 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 available. The Company will pay annual rent of approximately 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 premium over the original purchase price. 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 is a VIE and it is the primary beneficiary. Consequently, the Company has consolidated all of the accounts of the Vantage Point Partnership in the accompanying financial statements. Additionally, all leasing activity associated with the master lease has been fully eliminated in consolidation. The Vantage Point Partnership acquired all million. The initial consolidation primarily resulted in property and equipment of ​ 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. “Property and Equipment” “Long-Term Debt – Real Estate Loans” “Long-Term Debt – HUD Insured Loans.” facility ​ On January 10, 2020, Welltower sold the real estate of one skilled nursing facility located in Massachusetts to the Vantage Point Partnership. The sale represents the final component of the transaction. As a result of the January 10, 2020 transaction, the Company will receive an annual rent credit of $0.7 million from Welltower and recorded a gain of $0.2 million 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 consolidation of this additional 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 operates all 19 facilities owned by the Vantage Point Partnership. ​ Divestiture of Non-Strategic Facilities ​ 2020 Divestitures ​ In addition to the 24 facilities transitioned into the NewGen Partnership, the Company divested the operations of 39 owned and leased facilities in 2020. ​ During the first quarter of 2020, the Company sold four owned skilled nursing facilities and divested the operations of one leased senior/assisted living facility. Additionally, Omega Healthcare Investors, Inc. (Omega) sold the real estate of one skilled nursing facility located in Massachusetts that the Company leased under a master lease agreement, but had closed on July 1, 2019. The facilities generated annual revenues of $55.2 million and pre-tax income of $0.5 million. The sales resulted in aggregate proceeds of $82.6 million, of which, $49.6 million was used to repay indebtedness. The Company recognized an aggregate gain on the sale of the facilities of million. ​ During the second quarter of 2020, the Company sold three owned skilled nursing facilities and divested the operations of 12 leased skilled nursing facilities. The facilities generated annual revenues of million was used to repay indebtedness. The Company recognized an aggregate gain on the sale of the facilities of ​ During the third quarter of 2020, the Company sold one owned skilled nursing facility and several rehab clinics. The facility generated annual revenues of million was used to repay indebtedness. The Company recognized a gain on the sale of the facility and rehab clinics of ​ During the fourth quarter of 2020, the Company sold five owned facilities and divested the operations of 13 leased skilled nursing facilities. The facilities generated annual revenues of million was used to repay indebtedness. The Company recognized an aggregate gain on the sale and divestitures of ​ 2019 Divestitures ​ In addition to the nine divestitures noted in the Vantage Point Partnership owned and leased facilities in 2019. The Company also sold the real property of ​ 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 million. The Company recognized a loss on exit reserves of million. The Company also completed the closure of facility located in Ohio. The facility generated annual revenues of ​ 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” “Long-Term Debt – Real Estate Loans” “Long-Term Debt – HUD Insured Loans.” million. The divestiture resulted in a gain of million. In addition, the Company divested the operations of ​ 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. million. In addition, the Company sold the real property and divested the operations of million were paid on the facilities at closing. See Note 9 – “Property and Equipment” “Long-Term Debt – HUD Insured Loans.” ​ 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 operations of these facilities were divested in 2018. The net proceeds were used principally to repay the indebtedness of the facilities. The Company recognized a net gain of ​ Also during the fourth quarter of 2019, the Company divested the operations of two leased skilled nursing facilities. The facility generated annual revenues of $28.1 million and pre-tax net loss of $1.7 million. The divestitures resulted in a loss of $1.3 million, which was primarily attributable to exit costs. ​ 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 2020 and 2019, respectively. These gains are included in other income on the consolidated statements of operations. Below is a summary of the more material lease transactions. ​ NewGen Partnership ​ As noted above, the Company transitioned the operations of 18 leased skilled nursing, behavioral health and assisted living facilities to the NewGen Partnership during the year ended December 31, 2020. In total, the lease transitions resulted in a net reduction to operating lease ROU assets and obligations of $17.0 million and $26.8 million, respectively, and a gain of $19.7 million, which includes proceeds from the sale of leasehold rights. ​ Welltower ​ During the year ended December 31, 2020, the Company amended the Welltower Master Lease several times to reflect the lease termination of one facility and rent credits associated with the sale of previously closed locations. The Company received annual rent credits of approximately million. In total, the amendments resulted in a net reduction to operating lease ROU assets and obligations of ​ 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 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 facilities subject to the Welltower Master Lease were classified as operating leases. In total, the amendments resulted in a net reduction to finance lease ROU assets and obligations of ​ Omega ​ During the year ended December 31, 2020, the Company amended the Omega Master Lease several times to reflect the lease termination of five facilities. The Company received annual rent credits of approximately million. In total, the amendments resulted in a net reduction to operating lease ROU assets and obligations of ​ During the year ended December 31, 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 million, respectively. The lease termination and remeasurement resulted in an aggregate gain of million. In addition, the Company recorded a gain of ​ During the year ended December 31, 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 facilities upon addition to the master lease. The lease assessment and measurement resulted in operating lease classification with a liability gross up. In addition, the Company received million as a short-term note payable. See Note 12 – “ Long-Term Debt – Notes Payable.” ​ Second Spring ​ During the year ended December 31, 2020, the Company amended its master lease several times with Second Spring to reflect the lease termination of 22 facilities subject to the lease and received annual rent credits of $41.2 million. In conjunction with the lease termination, operating lease ROU assets and lease obligations of $304.0 million and $340.1 million, respectively, were written off. The lease termination and remeasurement resulted in a gain of ​ During the year ended December 31, 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 million, respectively. The lease termination and remeasurement resulted in an aggregate gain of ​ Other Lease Transactions ​ During the year ended December 31, 2020, the Company amended three master lease agreements to reflect the lease termination of a combined 13 facilities from the master lease agreements. In conjunction with the lease terminations, operating lease ROU assets and lease obligations of ​ During the year ended December 31, 2020, the Company extended the lease agreements of several facilities and offices resulting in an increase in ROU assets and lease liabilities ​ During the year ended December 31, 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 cer

Net Revenues and Accounts Recei

Net Revenues and Accounts Receivable	12 Months Ended
	Dec. 31, 2020
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, 2020 and 2019 was as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, 2020 ​ ​ ​ ​ ​ ​ Rehabilitation ​ ​ ​ ​ ​ ​ ​ ​ Inpatient ​ Therapy ​ Other ​ ​ ​ ​ ​ ​ Services ​ Services ​ Services ​ Total Medicare ​ $ 697,160 ​ $ 87,896 ​ $ — ​ $ 785,056 ​ Medicaid ​ 1,982,156 ​ 1,440 ​ — ​ 1,983,596 ​ Insurance ​ ​ 351,293 ​ 22,038 ​ — ​ 373,331 ​ Private ​ ​ 248,962 (1) ​ 191 ​ ​ — ​ ​ 249,153 ​ Third party providers ​ ​ — ​ ​ 264,893 ​ ​ 91,641 ​ ​ 356,534 ​ Other ​ ​ 59,284 (2) ​ 24,746 (2) ​ 74,523 (3) ​ 158,553 ​ Total net revenues ​ $ 3,338,855 ​ $ 401,204 ​ $ 166,164 ​ $ 3,906,223 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 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 (1) ​ 296 ​ ​ — ​ ​ 310,318 ​ Third party providers ​ ​ — ​ ​ 336,509 ​ ​ 78,709 ​ ​ 415,218 ​ Other ​ ​ 69,143 (2) ​ 10,513 (2) ​ 68,547 (3) ​ 148,203 ​ Total net revenues ​ $ 3,956,032 ​ $ 462,546 ​ $ 147,256 ​ $ 4,565,834 ​ ​ (1) Includes Assisted/Senior living revenue of $79.3 million and $93.1 million for the years ended December 31, 2020 and 2019, respectively. Such amounts do not represent contracts with customers under Topic 606. (2) Primarily consists of revenue from patients with Veteran Affairs insurance and administration of third party facilities. (3) Includes net revenues from all payors generated by the other services, excluding third party providers.

(Loss) Earnings Per Share

(Loss) Earnings Per Share	12 Months Ended
	Dec. 31, 2020
(Loss) Earnings Per Share
(Loss) Earnings Per Share	(6) (Loss) Earnings 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 ​ The noncontrolling owners of FC-GEN have the right to exchange their membership units in FC-GEN , ​ Basic EPS was computed by dividing net (loss) income attributable to Genesis Healthcare, Inc. by the weighted-average number of outstanding common shares for the period. Diluted EPS is computed by dividing net (loss) income 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 (loss) income per common share follows (in thousands, except per share data): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ 2020 2019 Numerator: ​ ​ ​ ​ ​ ​ Net (loss) income ​ $ (103,367) ​ $ 7,474 Less: Net loss attributable to noncontrolling interests ​ 44,404 ​ 7,145 Net (loss) income attributable to Genesis Healthcare, Inc. ​ $ (58,963) ​ $ 14,619 Denominator: ​ ​ ​ ​ ​ ​ Weighted-average shares outstanding for basic net (loss) income per share ​ 111,851 ​ 107,286 ​ ​ ​ ​ ​ ​ ​ Basic net (loss) income per common share attributable to Genesis Healthcare, Inc. ​ $ (0.53) ​ $ 0.14 ​ A reconciliation of the numerator and denominator used in the calculation of diluted net (loss) income per common share follows (in thousands, except per share data): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ 2020 2019 Numerator: ​ ​ ​ ​ ​ ​ Net (loss) income ​ $ (103,367) ​ $ 7,474 Less: Net loss attributable to noncontrolling interests ​ 44,404 ​ 7,145 Net (loss) income attributable to Genesis Healthcare, Inc. ​ $ (58,963) ​ $ 14,619 Plus: Assumed conversion of noncontrolling interests ​ — ​ 1,868 Net (loss) income available to common stockholders after assumed conversions ​ $ (58,963) ​ $ 16,487 Denominator: ​ ​ ​ ​ ​ ​ Weighted-average common shares outstanding ​ 111,851 ​ 107,286 Plus: Assumed conversion of noncontrolling interests ​ ​ — ​ ​ 57,074 Plus: Unvested restricted stock units and stock warrants ​ ​ — ​ ​ 954 Adjusted weighted-average common shares outstanding, diluted ​ ​ 111,851 ​ ​ 165,314 ​ ​ ​ ​ ​ ​ ​ Diluted net (loss) income per common share attributable to Genesis Healthcare, Inc. ​ $ (0.53) ​ $ 0.10 ​ The computation of diluted net (loss) income per common share attributable to Genesis Healthcare, Inc. excludes the effects of anti-dilutive shares attributable to the assumed conversion of noncontrolling interests, unvested restricted stock units, and stock warrants, which were 55.7 million for the year ended December 31, 2020. There were 55.3 million and 56.2 million units attributable to the noncontrolling interests outstanding as of December 31, 2020 and 2019, respectively.

Segment Information

Segment Information	12 Months Ended
	Dec. 31, 2020
Segment Information
Segment Information	(7) Segment Information ​ The Company has three reportable operating segments: (i) inpatient services; (ii) rehabilitation therapy services; and (iii) other services. For additional information on these reportable segments, see Note 1 – “ General Information – Description of Business ​ A summary of the Company’s segmented revenues follows (in thousands, except percentages): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ ​ ​ ​ ​ ​ ​ 2020 ​ 2019 ​ Increase / (Decrease) ​ ​ Revenue Revenue Revenue Revenue ​ ​ ​ ​ ​ ​ ​ Dollars ​ Percentage ​ Dollars ​ Percentage ​ Dollars ​ Percentage ​ Revenues: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Inpatient services: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Skilled nursing facilities ​ $ 3,254,715 83.4 % $ 3,857,793 84.4 % $ (603,078) ​ (15.6) % Assisted/Senior living facilities ​ 79,314 2.0 % 93,054 2.0 % (13,740) ​ (14.8) % Administration of third party facilities ​ 7,866 0.2 % 8,310 0.2 % (444) ​ (5.3) % Elimination of administrative services ​ (3,040) (0.1) % (3,125) (0.1) % 85 ​ 2.7 % Inpatient services, net ​ 3,338,855 85.5 % 3,956,032 86.5 % (617,177) (15.6) % ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Rehabilitation therapy services: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total therapy services ​ 622,601 15.9 % 738,124 16.2 % (115,523) ​ (15.7) % Elimination of intersegment rehabilitation therapy services ​ (221,397) (5.7) % (275,578) (6.0) % 54,181 ​ 19.7 % Third party rehabilitation therapy services, net ​ 401,204 10.2 % 462,546 10.2 % (61,342) (13.3) % ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Other services: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total other services ​ 263,806 6.8 % 198,920 4.4 % 64,886 ​ 32.6 % Elimination of intersegment other services ​ (97,642) (2.5) % (51,664) (1.1) % (45,978) ​ (89.0) % Third party other services, net ​ 166,164 4.3 % 147,256 3.3 % 18,908 12.8 % ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Net revenues ​ $ 3,906,223 100.0 % $ 4,565,834 100.0 % $ (659,611) ​ (14.4) % ​ A summary of the Company’s condensed consolidated statement of operations follows (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, 2020 ​ ​ ​ ​ ​ ​ Rehabilitation ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Inpatient ​ Therapy ​ Other ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Services Services Services Corporate Eliminations Consolidated Net revenues ​ $ 3,341,895 ​ $ 622,601 ​ $ 263,806 ​ $ — ​ $ (322,079) ​ $ 3,906,223 ​ Salaries, wages and benefits ​ 1,593,013 ​ 501,093 ​ 162,094 ​ — ​ — ​ 2,256,200 ​ Other operating expenses ​ ​ 1,482,488 ​ 31,431 ​ 79,194 ​ — ​ (322,542) ​ 1,270,571 ​ General and administrative costs ​ ​ — ​ ​ — ​ ​ — ​ ​ 175,057 ​ ​ — ​ ​ 175,057 ​ Lease expense ​ ​ 362,384 ​ 1,019 ​ 1,739 ​ 1,197 ​ — ​ 366,339 ​ Depreciation and amortization expense ​ ​ 91,084 ​ 6,731 ​ 825 ​ 9,457 ​ (264) ​ 107,833 ​ Interest expense ​ ​ 57,634 ​ 27 ​ 38 ​ 82,460 ​ (4,720) ​ 135,439 ​ Loss on early extinguishment of debt ​ ​ — ​ — ​ — ​ 8,979 ​ — ​ 8,979 ​ Investment income ​ ​ — ​ — ​ — ​ (8,709) ​ 4,720 ​ (3,989) ​ Other (income) loss ​ ​ (203,100) ​ 621 ​ 207 ​ — ​ — ​ (202,272) ​ Transaction costs ​ ​ — ​ — ​ — ​ 34,279 ​ — ​ 34,279 ​ Long-lived asset impairments ​ ​ 179,000 ​ ​ — ​ ​ — ​ ​ — ​ ​ — ​ ​ 179,000 ​ Federal and state stimulus - COVID-19 other income ​ ​ (301,719) ​ ​ (3,649) ​ ​ (699) ​ ​ — ​ ​ — ​ ​ (306,067) ​ Equity in net income of unconsolidated affiliates ​ ​ — ​ — ​ — ​ (7,091) ​ (1,078) ​ (8,169) ​ Income (loss) before income tax benefit ​ ​ 81,111 ​ 85,328 ​ 20,408 ​ (295,629) ​ 1,805 ​ (106,977) ​ Income tax benefit ​ ​ — ​ — ​ — ​ (3,610) ​ — ​ (3,610) ​ Net income (loss) ​ $ 81,111 ​ $ 85,328 ​ $ 20,408 ​ $ (292,019) ​ $ 1,805 ​ $ (103,367) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 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 ​ Income 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 benefit ​ ​ 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 ​ ​ ​ The following table presents the segment assets as of December 31, 2020 compared to December 31, 2019 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2020 December 31, 2019 Inpatient services ​ $ 3,555,291 ​ $ 4,221,579 ​ Rehabilitation therapy services ​ 252,575 ​ 281,978 ​ Other services ​ 47,448 ​ 49,877 ​ Corporate and eliminations ​ 206,932 ​ 108,706 ​ Total assets ​ $ 4,062,246 ​ $ 4,662,140 ​ ​

Restricted Investments in Marke

Restricted Investments in Marketable Securities	12 Months Ended
	Dec. 31, 2020
Restricted Investments in Marketable Securities
Restricted Investments in Marketable Securities	(8) Restricted Investments in Marketable Securities ​ 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, 2020 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 ​ $ 23,727 ​ $ 166 ​ $ — ​ $ — ​ $ 23,893 Corporate bonds ​ ​ 59,936 ​ ​ 867 ​ ​ (1) ​ ​ — ​ ​ 60,802 Government bonds ​ ​ 67,794 ​ ​ 1,364 ​ ​ — ​ ​ (1) ​ ​ 69,157 ​ ​ $ 151,457 ​ $ 2,397 ​ $ (1) ​ $ (1) ​ ​ 153,852 Less: Current portion of restricted investments ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ (39,526) Long-term restricted investments ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ $ 114,326 ​ 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 ​ Maturities of restricted investments yielded proceeds of $35.1 million and $69.2 million for the years ended December 31, 2020 and 2019, respectively. ​ Sales of investments yielded proceeds of $29.0 million and $2.0 million for the years ended December 31, 2020 and 2019, respectively. Associated gross realized gain and loss for the years ended December 31, 2020 and 2019 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, 2020 mature as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Amortized ​ Fair ​ cost value Due in one year or less ​ $ 36,550 ​ $ 36,834 Due after 1 year through 5 years ​ ​ 111,907 ​ ​ 114,019 Due after 5 years through 10 years ​ ​ — ​ ​ — Due after 10 years ​ ​ 3,000 ​ ​ 2,999 ​ ​ $ 151,457 ​ $ 153,852 ​ 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 $143.3 million at December 31, 2020 to its third party administrators and excess insurance carriers. Restricted cash of

Property and Equipment

Property and Equipment	12 Months Ended
	Dec. 31, 2020
Property and Equipment
Property and Equipment	(9) Property and Equipment ​ Property and equipment consisted of the following as of December 31, 2020 and 2019 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2020 December 31, 2019 Land, buildings and improvements ​ $ 1,052,095 ​ $ 1,004,447 ​ Equipment, furniture and fixtures ​ 358,546 ​ 386,248 ​ Construction in progress ​ 3,776 ​ 2,771 ​ Gross property and equipment ​ 1,414,417 ​ 1,393,466 ​ Less: accumulated depreciation ​ (429,705) ​ (431,361) ​ Net property and equipment ​ $ 984,712 ​ $ 962,105 ​ ​ ​ ​ ​ ​ ​ ​ ​ Net property and equipment included $735.1 million and $535.9 million at December 31, 2020 and 2019, respectively, associated with the Company's consolidated VIEs. ​ During the years ended December 31, 2020 and 2019, the Company recorded long-lived asset impairment charges to its property and equipment of $11.5 million and $10.7 million, respectively. See Note 19 – “ Asset Impairment Charges – Long-Lived Assets with a Definite Useful Life.”

Leases

Leases	12 Months Ended
	Dec. 31, 2020
Leases
Leases	(10) Leases ​ 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, 2020, the Company leased approximately landlords. The Company also leases certain office space, land, and equipment. ​ The Company’s real estate leases generally have initial lease terms lease term five 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 for accounting purposes. 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. ​ As of December 31, 2020, the Company held fixed-price options to purchase 58 facilities, 15 of which are subject to third-party leases and 43 of which are owned by the Company’s consolidated VIEs. The Company assesses the likelihood of exercising purchase options 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 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 years ended December 31, 2020 and 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 years ended December 31, 2020 and 2019, the Company recognized impairment charges resulting in the reduction of ROU assets of $167.5 million and $6.2 million, respectively. The current year’s impairment charges were primarily driven by the impact of COVID-19 on the facilities’ operations. See Note 19 – “ Asset Impairment Charges – Long-Lived Assets with a Definite Useful Life.” ​ The maturity of total operating and finance lease obligations at December 31, 2020 is as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ Year ending December 31, Operating Leases Finance Leases (1) 2021 ​ $ 324,840 ​ $ 6,798 2022 ​ 328,039 ​ 6,597 2023 ​ 330,147 ​ 6,420 2024 ​ 334,231 ​ 6,195 2025 ​ 333,225 ​ 5,968 Thereafter ​ 2,250,977 ​ 28,950 Total lease payments ​ 3,901,459 ​ 60,928 Less interest ​ (1,669,907) ​ (23,036) Total lease obligations ​ 2,231,552 ​ 37,892 Less current portion ​ (2,071,841) ​ (2,949) Long-term lease obligations ​ $ 159,711 ​ $ 34,943 ​ (1) Finance lease payments include $37.2 million related to options to renew lease terms that are reasonably certain of being exercised. ​ The impact of the lease covenant defaults described below and the transactions described within Note 23 – “Subsequent Events – Restructuring Transactions” ​ The following table provides lease costs and income by line item on the consolidated statements of operations for the years ended December 31, 2020 and 2019 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ Classification 2020 2019 Operating lease cost Lease expense ​ $ 366,339 ​ $ 387,063 Finance lease cost: ​ ​ ​ ​ ​ Amortization of finance lease ROU assets Depreciation and amortization expense ​ 3,818 ​ 16,224 Interest on finance lease obligations Interest expense ​ ​ 4,402 ​ ​ 50,162 Total finance lease expense ​ ​ ​ 8,220 ​ ​ 66,386 Variable lease cost Other operating expenses ​ 34,601 ​ 37,841 Short-term leases Other operating expenses ​ ​ 18,516 ​ ​ 24,297 Sublease income Net revenues ​ ​ (6,058) ​ ​ - Total ​ ​ $ 421,618 ​ $ 515,587 ​ The following table provides remaining lease term and discount rates by lease classification as of December 31, 2020 and 2019: ​ ​ ​ ​ ​ ​ ​ ​ Lease Term and Discount Rate December 31, 2020 ​ December 31, 2019 Weighted-average remaining lease term (years) ​ ​ ​ ​ ​ ​ Operating leases ​ 11.4 ​ 12.6 Finance leases ​ 9.5 ​ 10.2 Weighted-average discount rate ​ ​ ​ ​ ​ ​ Operating leases ​ 10.1% ​ 9.6% Finance leases ​ 10.6% ​ 12.2% ​ The following table includes supplemental lease information for the years ended December 31, 2020 and 2019 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, Other information 2020 2019 Cash paid for amounts included in the measurement of lease obligations ​ ​ ​ ​ ​ ​ Operating cash flows from operating leases ​ $ 348,034 ​ $ 364,334 Operating cash flows from finance leases ​ 7,305 ​ 47,188 Financing cash flows from finance leases ​ 2,905 ​ 2,645 Right-of-use assets obtained in exchange for new lease obligations ​ ​ ​ ​ Operating leases ​ 27,229 ​ 96,718 Finance leases ​ 1,033 ​ 1,160 ​ ​ Lease Covenants ​ The Company’s lease agreements generally contain covenant requirements 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, such as a minimum level of consolidated liquidity, a maximum consolidated net leverage ratio and a minimum consolidated fixed charge coverage. Certain of the Company’s leases include cross-default provisions with each other and certain material debt instruments. ​ At December 31, 2020, the Company was not in compliance with or had not received waivers with respect to the financial covenants contained in certain of its leases because certain of its other lease agreements and debt agreements contain cross-default provisions that are triggered if the Company is in default of such leases. The lease and debt obligations associated with these agreements have been classified as current liabilities. As of the date of this Form 10-K filing, all rent and debt service payments have been made timely and no material creditors have pursued remedies with respect to breaches of financial covenants. The Company’s ability to maintain compliance with its lease covenants depends in part on management’s ability to increase revenue, control costs and receive timely and adequate government-sponsored financial support in response to the COVID-19 pandemic. See Note 1 – “ General Information – Going Concern Considerations Significant Transactions and Events – COVID-19 ” for discussions that could impact future covenant compliance. 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 a significant adverse impact on the Company’s financial position.

Goodwill and Identifiable Intan

Goodwill and Identifiable Intangible Assets	12 Months Ended
	Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Identifiable Intangible Assets	(11) Goodwill and Identifiable Intangible Assets ​ 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. ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Rehabilitation Therapy Services Other Services Consolidated Balance at December 31, 2019 ​ ​ ​ ​ ​ ​ ​ ​ ​ Goodwill ​ $ 73,814 ​ $ 11,828 ​ $ 85,642 Accumulated impairment losses ​ ​ — ​ ​ — ​ ​ — ​ ​ $ 73,814 ​ $ 11,828 ​ $ 85,642 Balance at December 31, 2020 ​ ​ ​ ​ ​ ​ ​ ​ ​ 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 ​ Identifiable intangible assets consist of the following at December 31, 2020 and 2019 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2020 Weighted Average Remaining Life (Years) Customer relationship assets, net of accumulated amortization of $81,387 ​ $ 31,715 ​ 7 Trade names ​ ​ 50,555 ​ Indefinite Identifiable intangible assets ​ $ 82,270 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 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 ​ ​ ​ ​ ​ Identifiable intangible assets consist of customer relationship assets 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. ● 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, 2020 and 2019 was $5.1 million and $10.5 million, respectively. ​ Based upon amounts recorded at December 31, 2020, amortization expense related to identifiable intangible assets is estimated to be $5.0 million in 2021, $5.0 million in 2022, $4.6 million in 2023, $4.5 million in 2024, and $3.3 million in 2025 and $9.3 million, thereafter. The Company recorded no impairment charges related to identifiable intangible assets during the years ended December 31, 2020 and 2019.

Long-Term Debt

Long-Term Debt	12 Months Ended
	Dec. 31, 2020
Long-Term Debt
Long-Term Debt	(12) Long-Term Debt ​ Long-term debt at December 31, 2020 and 2019 consisted of the following (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2020 ​ December 31, 2019 Asset based lending facilities, net of debt issuance costs of $5,894 and $8,615 at December 31, 2020 and December 31, 2019, respectively ​ $ 279,106 ​ $ 412,346 ​ Term loan agreements, net of debt issuance costs of $525 and $1,084 and debt premium balance of $2,221 and $4,816 at December 31, 2020 and December 31, 2019, respectively ​ 210,913 ​ 196,714 ​ Real estate loans, net of debt issuance costs of $860 and $3,846 and debt premium balance of $9,664 and $19,328 at December 31, 2020 and December 31, 2019, respectively ​ 215,848 ​ 265,700 ​ HUD insured loans, net of debt issuance costs of $633 and $2,909 at December 31, 2020 and December 31, 2019, respectively ​ 26,221 ​ 117,117 ​ Notes payable ​ ​ 104,598 ​ ​ 116,952 ​ Mortgages and other secured debt (recourse) ​ 6,987 ​ 6,369 ​ Mortgages and other secured debt (non-recourse), net of debt issuance costs of $10,711 and $9,349 and debt premium balance of $1,323 and $1,422 at December 31, 2020 and December 31, 2019, respectively ​ 697,049 ​ 498,222 ​ ​ ​ 1,540,722 ​ 1,613,420 ​ Less: Current portion of long-term debt ​ (905,788) ​ (162,426) ​ Long-term debt ​ $ 634,934 ​ $ 1,450,994 ​ ​ Asset Based Lending Facilities ​ The Company maintains an asset based lending facility, as amended, that was previously comprised of (a) a $285.0 million first lien term loan facility, (b) a $240.0 million first lien revolving credit facility and (c) a $30.0 million delayed draw term loan facility (collectively, the ABL Credit Facilities) with affiliates of MidCap Financial Services, LLC (MidCap). The commitments under the delayed draw term loan facility were reduced to ​ The Company originally entered into the ABL Credit Facilities in March 2018. The ABL Credit Facilities have a stated maturity of March 6, 2023 and include a springing maturity clause that would accelerate the maturity date “Subsequent Events – Restructuring Transactions,” Cash million received under the ABL Credit Facilities remain in a restricted account. This amount is pledged to cash collateralize letters of credit. 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 in the consolidated balance sheets at December 31, 2020 and 2019. ​ 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 ​ 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 on the delayed draw term loan facility. ​ The term loan facility and revolving credit facility include a termination fee equal to 1.5% . The term loan facility and revolving credit facility include an exit fee equal to ​ 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, 2020 (dollars in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ ​ ​ Average ABL Credit Facilities ​ Commitment ​ ​ Borrowings ​ Interest Term loan facility ​ $ 285,000 ​ ​ $ 285,000 ​ 6.50 % Revolving credit facility (Non-HUD) ​ ​ 168,000 ​ ​ ​ — ​ 6.50 % Revolving credit facility (HUD) ​ ​ 72,000 ​ ​ — 6.50 % Delayed draw term loan facility ​ ​ 20,000 ​ ​ ​ — ​ 12.00 % ​ ​ $ 545,000 ​ $ 285,000 6.50 % ​ As of December 31, 2020, the Company had a total borrowing base capacity of $324.8 million with outstanding borrowings under the ABL Credit Facilities of $285.0 million, leaving the Company with approximately $39.8 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 “Subsequent Events – Restructuring Transactions,” ​ 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 a maximum leverage ratio, a minimum interest coverage ratio and a minimum fixed charge coverage ratio, the most restrictive of which is the minimum interest coverage ratio which requires the Company to maintain a coverage ratio, as defined therein, of no less than ​ Real Estate Loans ​ MidCap Real Estate Loans ​ The Company originally entered into two real estate loans, as amended, with MidCap (MidCap Real Estate Loans) with combined available proceeds of $85.0 million during 2018. The MidCap Real Estate Loans were secured by skilled nursing facilities and a corporate office building. The loans had a stated maturity of March 30, 2023, subject to acceleration upon repayment of the ABL Credit Facilities. The loans were subject to principal amortization payments and bore an annual interest rate equal to 30-day LIBOR (subject to a floor ranging from ​ During the years ending December 31, 2020 and 2019, the Company divested the real property and operations of eight and six facilities, respectively, that were subject to the MidCap Real Estate Loans, using the sale proceeds to repay $41.3 million and $39.8 million on the loans, respectively. The MidCap Real Estate Loans were repaid in full during the fourth quarter of 2020 and had an outstanding principal balance of ​ Welltower Real Estate Loans ​ The Company is subject to two 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. The Welltower Real Estate Loans had a maturity date of January 1, 2022. However, on March 2, 2021, the Company entered into a series of transactions, as described within Note 23 – “Subsequent Events – Restructuring Transactions,” million under the Welltower Real Estate Loans plus interest accrued thereon, upon the future satisfaction of certain conditions, and provided an increase in the portion of interest payable under the loans that may be paid in kind. As of December 31, 2020, the Welltower Real Estate Loans bore an annual interest rate of paid in kind 2020, the Welltower Real Estate Loans are unsecured. ​ During the first quarter of 2020, the Company divested the real property and operations of the remaining facility that was subject to the Welltower Real Estate Loans, using the sale proceeds to repay $9.0 million on the loans. The Welltower Real Estate Loans had an outstanding accreted principal balance of $207.0 million and $208.0 million at December 31, 2020 and 2019, respectively. ​ HUD Insured Loans ​ As of December 31, 2020, the Company had five 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 28.5 with fixed interest rates ranging from 3.0% to 3.4% 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. 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, 2020, the Company has total escrow reserve funds of ​ During December 31, 2019, the Company sold the real property and operations of eight skilled nursing facilities and one assisted/senior living facility that were subject to HUD financing, using the sale proceeds to retire HUD insured loans totaling $65.6 million. During the year ended December 31, 2020, the Company sold the real property and operations of eleven skilled nursing facilities that were subject to HUD financing, one of which was classified as held for sale at December 31, 2019. The sale proceeds were used to retire HUD insured loans totaling million. The HUD insured loans for owned facilities had an aggregate principal balance of ​ Additionally, the HUD insured loans of two facilities with an aggregate principal balance of $19.2 million were classified as held for sale at December 31, 2020. See Note 20 – “Assets Held for Sale.” “Subsequent Events – NewGen Partnership.” ​ Notes Payable ​ In November 2016, the Company issued a note totaling $51.2 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 May 1 and November 1. The note was set to mature on December 15, 2021. However, on March 2, 2021, the Company entered into a series of transactions, as described within Note 23 – “Subsequent Events – Restructuring Transactions,” ​ In December 2016, the Company issued a second note totaling $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 was set to mature on December 15, 2021. However, on March 2, 2021, the Company entered into a series of transactions, as described at Note 23 – “Subsequent Events – Restructuring Transactions,” ​ 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%. As of December 31, 2020 and 2019, the outstanding principal balance of the note payable was $20.2 million and $23.1 million, respectively. The balance of the note is due on September 30, 2022. ​ In November 2019, the Company issued a short-term note payable for $15.0 million. The note was repaid in full during the year ended December 31, 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 rate of ​ Mortgages and other secured debt (non-recourse). The Company’s consolidated joint ventures and VIEs are subject to various loans, as set forth below. These 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. ​ Next Partnership Debt ​ The Company holds a 46% ownership interest in a partnership with Next Healthcare (Next), a related party (the Next Partnership). The Company has concluded the Next Partnership, which includes facilities, 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 Next Partnership is subject to a term loan agreement with an original principal balance of $142.1 million and maturity date of January 31, 2022. The term loan bears interest at LIBOR plus 3.50% and is subject to interest-only payments through January 31, 2021. Beginning in April 2021, principal payments calculated based on a ​ The Next Partnership is subject to a mezzanine loan with an original principal balance of $27.0 million and maturity date of February 1, 2029. The mezzanine loan bears interest at 11.50% and is subject to interest-only payments through January 2022, with payments including a principal component thereafter. The mezzanine loan had an outstanding principal balance of ​ The Next Partnership includes five facilities that are subject to HUD-insured loans, two of which were entered into during the year ended December 31, 2020. The loans mature on dates ranging from January 1, 2055 through June 1, 2055. The loans bear interest at fixed rates ranging from ​ Vantage Point Partnership Debt ​ The Company holds an approximately 30% ownership interest in a partnership with Vantage Point Capital, LLC (the Vantage Point Partnership). The Company has concluded the Vantage Point Partnership, which includes facilities, 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 consolidated financial statements. ​ The Vantage Point Partnership is subject to a term loan agreement with an aggregate original principal balance of $240.9 million and maturity date of September 12, 2026. The term loan bears interest at LIBOR (subject to a floor of 1.75%) plus 3.75% and is subject to interest-only payments through October 1, 2021. The interest-only period can be extended through October 1, 2022 upon satisfaction of certain conditions, such as the achievement of a specified debt service coverage ratio and ratio of adjusted net operating income to the outstanding term loan balance. Following the interest-only period, principal payments calculated based on a 2020 and 2019, respectively. The term loan was collateralized by ​ The Vantage Point Partnership is subject to a promissory note in the amount of $76.8 million, the entire balance of which was outstanding 2020 and 2019. The promissory note bears interest at ​ Cascade Partnership Debt ​ The Cascade Partnership is subject to a term loan agreement with an aggregate principal balance of $183.5 million and maturity date of July 2, 2023. The term loan bears interest at LIBOR (subject to a floor of 1.50%) plus 4.75% and is subject to interest-only payments through the maturity date. The term loan also has two one-year optional extension periods that become exercisable upon satisfaction of certain conditions, such as achieving a specified debt service coverage ratio. The debt service payments during the extension periods include a principal component that will be calculated based on the outstanding balance, an assumed interest rate of 2020. The term loan is collateralized by ​ The Cascade Partnership is subject to a note payable in the amount of $10.0 million, the entire balance of which was outstanding will be paid in kind. Paid in kind interest compounds annually beginning July 1, 2021. Subsequent to July 1, 2022, quarterly principal payments are required based on cash flows generated by the Cascade Partnership, with the remaining balance due at maturity. ​ Other Non-Recourse Debt ​ The Company has other non-recourse loans consisting principally of revenue bonds and secured bank loans with maturities ranging from 2023 through 2034. The 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 ​ Debt Covenants ​ The Company’s ability to maintain compliance with its debt covenants depends in part on management’s ability to increase revenue, control costs and receive timely and adequate government-sponsored financial support in response to the COVID-19 pandemic. See Note 1 – “ General Information – Going Concern Considerations “Significant Transactions and Events – COVID-19” ​ At December 31, 2020, the Company was not in compliance with or had not received waivers with respect to the financial covenants contained in certain of its leases because certain of its other lease agreements and debt agreements contain cross-default provisions that are triggered if the Company is in default of such leases. The lease and debt obligations associated with these agreements have been classified as current liabilities. As of the date of this Form 10-K, all rent and debt service payments have been made timely and no material creditors have pursued remedies with respect to breaches of financial covenants. ​ The scheduled maturity of total debt of $1.5 billion, excluding debt issuance costs and other non-cash debt discounts and premiums, at December 31, 2020 is as follows (in thousands): ​ ​ ​ ​ ​ Twelve months ended December 31, ​ ​ 2021 ​ $ 380,890 2022 ​ ​ 522,672 2023 ​ ​ 204,123 2024 ​ ​ 19,528 2025 ​ ​ 9,516 Thereafter ​ ​ 409,408 Total debt maturity ​ $ 1,546,137 ​ The impact of the debt covenant defaults described above and the transactions described within Note 23 – “Subsequent Events – Restructuring Transactions”

Stockholders' Deficit

Stockholders' Deficit	12 Months Ended
	Dec. 31, 2020
Stockholders' Deficit.
Stockholders' Deficit	(13) Stockholders’ Deficit ​ 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 110,801,462 shares and 107,888,854 shares were issued at December 31, 2020 and 2019, 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, 2020 and 2019, respectively; ● 150,000,000 shares of Class C common stock, par value $0.001 per share, of which 55,250,921 shares and 56,172,193 shares were issued at December 31, 2020 and 2019, respectively; and ● 30,000,000 shares of Preferred Stock, par value $0.001 per share, of which no shares were issued at December 31, 2020 and 2019. ​

Stock-Based Compensation

Stock-Based Compensation	12 Months Ended
	Dec. 31, 2020
Stock-Based Compensation
Stock-Based Compensation	(14) Stock-Based Compensation ​ Omnibus Equity Incentive Plans ​ The Company maintains two stock-based employee compensation plans: the 2020 Omnibus Equity Incentive Plan (the “2020 Plan”) and the Amended and Restated 2015 Omnibus Equity Incentive Plan (the “Prior Plan”). During the second quarter of 2020, the Company’s shareholders approved the 2020 Plan. shares previously registered on Forms S-8 filed with the SEC that were available for issuance under the Prior Plan. ​ The Company provides stock-based compensation to attract and retain employees while also aligning employees’ interests with the interests of its shareholders. The 2020 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 2020 Plan permits the grant of up to million shares of Class A common stock, subject to certain adjustments and limitations. ​ On March 2, 2021, the Company executed certain transactions that among other things, require that the Company use reasonable best efforts to (i) delist the Class A Shares from the NYSE, (ii) deregister the Class A Shares under the Exchange Act, and (iii) suspend any Exchange Act reporting obligations in respect of the Class A Shares. Refer to Note 23 – “Subsequent Events – Restructuring Transactions.” ​ 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 has granted restricted stock units to certain employees and directors under the 2020 Plan and the Prior Plan. Each unit represents an obligation to deliver to the holder 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 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. ​ During the year ended December 31, 2020, the Company’s board of directors voluntarily forfeited an aggregate 887,940 restricted stock units having an aggregate grant date fair value of $0.8 million. ​ A summary of the Company’s non-vested restricted stock units as of and for the year ended December 31, 2020 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, 2020 ​ ​ 9,959 ​ $ 1.74 ​ Granted ​ 3,540 ​ ​ 0.96 ​ Vested ​ (2,880) ​ ​ 1.68 ​ Forfeited ​ (2,248) ​ ​ 1.13 ​ Non-vested balance at December 31, 2020 ​ ​ 8,371 ​ $ 1.60 ​ ​ For the year ended December 31, 2019, the weighted-average grant date fair value of restricted stock units granted was $1.30 . As of December 31, 2020, there was approximately years. During the years ended December 31, 2020 and 2019, the fair value of restricted stock units that vested was million, respectively. At December 31, 2020, ​ Stock-based compensation expense related to restricted stock units included in general and administrative costs was $6.5 million and $7.3 million for the years ended December 31, 2020 and 2019, respectively. The income tax benefit for stock-based compensation expense was

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2020
Income Taxes
Income Taxes	(15) Income Taxes ​ 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 66.9% of FC-GEN, which is an entity taxed as a partnership for U.S. income tax purposes and the Company’s only source of taxable income. FC-GEN is subject to income taxes in several U.S. state and local jurisdictions. The income taxes assessed by these jurisdictions are included in the Company’s tax provision, but at its ​ Income Tax Provision ​ The total income tax (benefit) expense for the periods presented was as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ 2020 2019 ​ ​ ​ ​ ​ ​ ​ Continuing operations ​ $ (3,610) ​ $ 1,754 Stockholder's deficit ​ ​ 316 ​ ​ 346 Total ​ $ (3,294) ​ $ 2,100 ​ The components of the provision for income taxes on (loss) income for the years ended December 31, 2020 and 2019 were as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ 2020 2019 Current: ​ ​ ​ ​ ​ ​ Federal ​ $ (4,814) ​ $ 1,014 State ​ ​ 200 ​ ​ 28 ​ ​ ​ (4,614) ​ ​ 1,042 Deferred: ​ ​ ​ ​ ​ ​ Federal ​ ​ (563) ​ ​ 29 State ​ ​ 1,567 ​ ​ 683 ​ ​ ​ 1,004 ​ ​ 712 Total ​ $ (3,610) ​ $ 1,754 ​ The Company’s 2020 tax year was impacted by certain provisions contained in the CARES Act, such as increased limits on interest expense deductions, acceleration of refunds related to alternative minimum tax credits, payroll tax deferrals, and the employee retention tax credits. ​ At December 31, 2020 and 2019, the current income taxes were primarily generated on the taxable income of the Company’s Bermuda captive insurance company. million taxable loss in the year ended December 31, 2020. Under the CARES Act, any loss sustained during 2020 is permitted to be carried back for five years. Management has recorded a ​ 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. The Company’s 2020 state deferred tax expense is primarily the result of applying a full valuation allowance against the Company’s state deferred tax incurred by the FC-GEN partnership. ​ 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. The Company has estimated the impact of the U.S. Tax Cuts and Jobs Act on state income taxes reflected in its income tax provision for the years ended December 31, 2020 and 2019. ​ 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. ​ The Company previously established a full valuation allowance against the majority of its net deferred tax assets based on its assessment that the Company will not realize such assets. The Company continues to assess the requirement for, and amount of, the valuation allowance for its deferred tax assets. At December 31, 2020 and 2019, the Company has established a full valuation allowance against the majority of its net deferred tax assets in the amount of ​ Total income tax (benefit) expense for the periods presented was as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ 2020 2019 Computed “expected” (benefit) expense ​ $ (22,465) ​ $ 1,939 Increase (reduction) in income taxes resulting from: ​ ​ ​ ​ ​ ​ State and local income taxes, net of federal tax benefit ​ ​ 116 ​ ​ 107 Income tax credits ​ ​ (1,847) ​ ​ (2,088) Non-controlling interest ​ ​ 8,306 ​ ​ 4,038 Adjustment to deferred taxes, including credits and valuation allowance ​ ​ 17,389 ​ ​ (2,977) US federal refund carryback claim ​ ​ (5,107) ​ ​ — FIN 48 ​ ​ (13) ​ ​ — Other, net ​ ​ 11 ​ ​ 735 Total income tax (benefit) expense ​ $ (3,610) ​ $ 1,754 ​ The Company’s effective income tax rates were 3.4% and 19.0% for the years ended December 31, 2020 and 2019, respectively. The reduction in the effective tax rate was primarily attributable to the million taxable loss generated by the Company’s Bermuda captive insurance company during the year ended December 31, 2020. This loss was carried back to tax periods during which the U.S. Federal income tax rate was ​ The tax effects of temporary differences that give rise to significant portions of the deferred tax assets and deferred tax liabilities at December 31, 2020 and 2019 are presented below (in thousands): ​ ​ ​ ​ ​ ​ ​ 2020 2019 Deferred tax assets: ​ ​ ​ ​ Investment in partnership $ 252,214 $ 240,247 Net operating loss carryforwards ​ 136,709 ​ 133,611 Discounted unpaid loss reserve ​ 2,278 ​ 2,156 General business credits ​ 29,895 ​ 30,006 Total deferred tax assets ​ 421,096 ​ 406,020 Valuation allowance ​ (408,379) ​ (391,257) Deferred tax assets, net of valuation allowance $ 12,717 $ 14,763 Deferred tax liabilities: ​ ​ ​ ​ Long-lived assets: intangible property ​ (15,509) ​ (16,236) Total deferred tax liabilities ​ (15,509) ​ (16,236) Net deferred tax liabilities $ (2,792) $ (1,473) ​ 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 and Hong Kong. However, these business operations have generated current taxable losses since their inception. 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, 2018 ​ $ 77 Reductions due to lapses of applicable statute of limitations ​ ​ — Balance, December 31, 2019 ​ $ 77 Reductions due to lapses of applicable statute of limitations ​ ​ (13) Balance, December 31, 2020 ​ $ 64 ​ 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 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 2020 and 2019. 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 2014 through 2019 are ​ Exchange Rights and Tax Receivable Agreement ​ The noncontrolling owners of FC-GEN have the right to exchange their membership units in FC-GEN , As a result of such exchanges, the Company increases its holding interest in FC-GEN at the cost of the fair market value of the stock that was exchanged with the noncontrolling owners for their interest in FC-GEN. The cost of the exchanges to the Company in excess of the tax basis of the Company’s increased share of the assets of FC-GEN is adjusted to the tax basis of the Company’s increased share of the assets of FC-GEN, pursuant to internal revenue code (IRC) Section 743(b), because of FC-GEN’s IRC Section 754 election. The exchanges during the years ended December 31, 2020 and 2019 resulted in IRC Section 743(b) deductible goodwill of ​ The Company is party to a tax receivable agreement (TRA) with the noncontrolling owners of FC-GEN. The agreement provides for the payment by the Company to the noncontrolling 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 noncontrolling 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, such as the timing of exchanges, the price of shares of the Company’s Class A common stock at the time of the exchange, the amount and timing of the Company’s income, and future tax rates of jurisdictions in which the Company has tax liability. ​ The TRA also provides that upon certain mergers, asset sales, other forms of business combinations or other changes of control, FC-GEN (or its successor’s) obligations under the TRA would be based on certain assumptions defined in the TRA. As a result of these assumptions, FC-GEN could be required to make payments under the TRA that are greater or less than the specified percentage of the actual benefits realized by the Company that are subject to the TRA. In addition, if FC-GEN elects to terminate the TRA early, it would be required to make an early termination payment, which upfront payment may be made significantly in advance of the anticipated future tax benefits. ​ Payments generally are due under the TRA within a specified period of time following the filing of FC-GEN’s U.S. federal and state income tax return for the taxable year with respect to which the payment obligation arises. Payments under the TRA generally will be based on the tax reporting positions that FC-GEN will determine. Although FC-GEN does not expect the 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, 2020
Related Party Transactions
Related Party Transactions	(16) Related Party Transactions ​ 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 observer, 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 2020 and 2019, respectively. The services resulted in net accounts receivable balances of 2020 and 2019, respectively. Further, the Company holds a note receivable from this customer, which was derived from past due accounts receivable, in the principal amount of million. The Company has reserved 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, the Company recorded net revenues of ​ Certain subsidiaries of the Company are subject to leases of facilities from affiliates of Next (the Next Landlord Entities). Certain members of the Company’s Board of Directors each directly or indirectly hold an ownership interest in the Next Landlord Entities totaling less than 5% in the aggregate. These members have earned acquisition fees, and may earn asset management fees and other fees from the Next Landlord Entities. ​ During the years ended December 31, 2020 and 2019, the Company was subject to a lease of seven facilities in New Hampshire and five facilities in Florida from affiliates of the Next Landlord Entities. The lease contained initial annual rent of $13.0 million and included an option to purchase the facilities. During the fourth quarter of 2020, the Next Landlord Entities sold the real estate of three of the New Hampshire facilities and all five of the Florida facilities to new owners. In conjunction with these sales, the Company no longer operates these eight facilities. Additionally, the Next Landlord Entities sold the other ​ The Company is also subject to a lease of 15 facilities from affiliates of the Next Landlord Entities associated with the Next Partnership, of which Genesis holds a 46% membership interest. The Company has consolidated the Next Partnership within the accompanying financial statements and consequently, all leasing activity has been eliminated in consolidation. The lease for these five seven ​ As of December 31, 2020, Welltower held greater than 5% of the Company’s Class A common stock. 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. Annual rent escalators under the master lease are 2.0%. During the years ended December 31, 2020 and 2019, the Company paid rent of approximately $77.8 million and $81.9 million to Welltower. The Company holds options to purchase certain facilities subject to the master lease. At December 31, 2020, the Company leased 51 facilities from Welltower. The Company and certain of its affiliates are also party to certain debt instruments with Welltower. During the years ended December 31, 2020 and 2019, the Company recorded cash interest on debt instruments due to Welltower of ​ During the year ended December 31, 2020, the Company transitioned operational responsibility for 24 facilities in the states of California, Washington and Nevada to the NewGen Partnership. The Company does not hold a controlling financial interest in the NewGen Partnership. As such, the Company has applied the equity method of accounting for its million in financing to the NewGen Partnership. 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 provides 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 also subleases facilities to the NewGen Partnership. Total income recorded related to these services and the subleases was ​ An affiliate of the Company entered into an agreement to receive telehealth and telemedicine services from a company in which certain members of the Company’s board of directors and shareholders with greater than 5% of the Company’s Class A common stock beneficially own an ownership interest. The cost of these services for the Company were approximately ​ Certain skilled nursing facilities of the Company entered into agreements to receive dialysis services from a company in which a member of the Company’s board of directors beneficially owns an ownership interest. The cost of these services for the Company were approximately ​

Defined Contribution Plan

Defined Contribution Plan	12 Months Ended
	Dec. 31, 2020
Defined Contribution Plan
Defined Contribution Plan	(17) Defined Contribution Plan ​ 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 2020 and 2019. ​

Other Income

Other Income	12 Months Ended
	Dec. 31, 2020
Other Income
Other Income	(18) Other Income ​ In the years ended December 31, 2020 and 2019, 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. ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ 2020 2019 Gain on sale of owned assets (1) ​ $ (120,357) ​ $ (90,723) Loss recognized for exit costs associated with divestiture of operations (2) ​ ​ 16,671 ​ ​ 12,997 Gain on lease termination or modification (3) ​ ​ (98,586) ​ ​ (95,779) Total other income ​ $ (202,272) ​ $ (173,505) ​ ​ (1) The Company sold 19 owned skilled nursing facilities during the year ended December 31, 2020. The Company sold 13 owned skilled nursing facilities and two assisted/senior living facilities during the year ended December 31, 2019. The gain represents sale proceeds in excess of the carrying value of the assets sold. (2) The Company divested the operations of 63 facilities, including the sold facilities noted above, in the year ended December 31, 2020. The Company divested operations of 44 facilities, including the facilities described in Note 16 – “Related Party Transactions , ” in the year ended December 31, 2019. 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 amended numerous lease agreements in the years ended December 31, 2020 and 2019. These transactions resulted in a combination of base rent reductions, lease term extensions or reductions and facility terminations. Lease terminations may be the result of divested operations or sales of real property between landlords for retained operations. Each lease amendment triggers a lease reassessment, which includes possible lease reclassification and assumption of renewal options. Upon termination, the respective lease liability and ROU asset balances are adjusted proportionately, with offsetting adjustments recorded as other income, in certain circumstances.

Asset Impairment Charges

Asset Impairment Charges	12 Months Ended
	Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Asset Impairment Charges	( 19) Asset Impairment Charges ​ 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 primary asset in each long-lived asset group is principally a building or ROU asset in the inpatient segment and customer relationship assets in the rehabilitation therapy services segment. 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 each long-lived asset group. The Company recognized impairment charges in the inpatient segment of ​ Goodwill and Identifiable Intangible Assets with an Indefinite Useful Life ​ The Company performed its annual goodwill impairment test as of September 30, 2020 and 2019, 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.”

Assets Held for Sale

Assets Held for Sale	12 Months Ended
	Dec. 31, 2020
Assets Held for Sale
Assets Held for Sale	(20) Assets Held for Sale ​ 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. ​ At December 31, 2020, two skilled nursing facilities owned and operated by the Company in California and Nevada, as well as a land parcel in Texas, were classified as held for sale. Neither the facilities nor the land parcel met the criteria as discontinued operations. The Company is party to purchase and sale agreements, as amended, to sell the facilities for an aggregate $19.2 million and the land parcel for $2.7 million. On February 1, 2021, the Company completed the sale of the “Subsequent Events.” ​ At December 31, 2019, the Company classified one skilled nursing facility operated by the Company in California as held for sale. The facility did not meet the criteria as a discontinued operation. The sale of the facility, which was subject to a HUD insured loan, was completed on February 26, 2020. ​ The following table sets forth the major classes of assets and liabilities included as part of the disposal groups as of December 31, 2020 and 2019 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2020 December 31, 2019 Current assets: ​ ​ ​ ​ Prepaid expenses ​ $ — ​ $ 1,171 Long-term assets: ​ ​ ​ ​ Property and equipment, net of accumulated depreciation of $3,015 and $2,201 at December 31, 2020 and December 31, 2019, respectively ​ 12,986 ​ 16,306 Total assets ​ $ 12,986 ​ $ 17,477 Current liabilities: ​ ​ ​ ​ ​ ​ Current portion of long-term debt ​ $ 403 ​ $ 368 Long-term liabilities: ​ ​ ​ ​ Long-term debt ​ 18,271 ​ 19,789 Total liabilities ​ $ 18,674 ​ $ 20,157 ​

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2020
Commitments and Contingencies
Commitments and Contingencies	(21) Commitments and Contingencies ​ Loss Reserves For Certain Self-Insured Programs ​ General and Professional Liability and Workers’ Compensation ​ The Company self-insures for certain insurable risks, including general and professional liabilities and workers’ compensation liabilities through the use of self-insurance or retrospective and self-funded insurance policies and other hybrid policies, which vary among states in which the Company operates, including wholly-owned captive insurance subsidiaries, to provide for potential liabilities for general and professional liability claims and workers’ compensation claims. 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. Estimated insurance recoveries related to recorded liabilities are reflected as assets in the Company’s consolidated balance sheets when the receipt of such amounts is deemed to be probable. ​ 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 $60.3 million and $70.1 million for the years ended December 31, 2020 and 2019, respectively. The reserves for general and professional liability, which are recorded on an undiscounted basis, were ​ The provision for workers’ compensation risks totaled $74.0 million and $47.6 million for the years ended December 31, 2020 and 2019, respectively. The reserves for loss for workers’ compensation risks were $173.6 million and $160.5 million as of December 31, 2020 and 2019, respectively. These reserves are discounted based on actuarial estimates of claim payment patterns using a discount rate for the current policy year of 0.2%. 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 $9.7 million and $12.0 million as of December 31, 2020 and 2019, 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 2020 and 2019, 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. ​ Select Subcommittee on the Coronavirus Crisis ​ A U.S. House of Representatives subcommittee, the Select Subcommittee on the Coronavirus Crisis (the Committee), announced an investigation into the ongoing COVID-19 crisis in nursing homes, demanding information from both the federal government and five large operators, including the Company. The Company has provided all requested information. On October 30, 2020, the Committee issued an “Interim Staff Report.” ​ Legal Proceedings ​ The Company and certain of its subsidiaries are involved in or have received notice of various investigations, litigation and potential claims related to the COVID-19 pandemic, including inquiries from state and federal agencies; professional liability claims; and employment-related lawsuits and claims. Such claims may be subject to liability protection provisions within various state executive orders or legislation and/or federal legislation. The applicability of such protection has not yet been adjudicated in any pending claim against the Company. ​ While there can be no assurance, based on the Company’s evaluation of information currently available, management does not believe the results of such litigation and 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 may evolve based upon further developments in the proceedings at issue. The results of legal proceedings are inherently uncertain, and material adverse outcomes are possible. ​ 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, 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 may be affected by limited information (particularly in the early stages of government investigations). Accordingly, the Company’s assessment 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 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 31, 2023. The remaining outstanding Settlement Amount at December 31, 2020 was 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, 2020 and 2019, the Company has a liability for the asset retirement obligation associated primarily with the cost of asbestos removal aggregating approximately $6.6 million and $6.6 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 million through the estimated settlement dates extending from 2021 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. ​ Lease Guarantees ​ The Company is subject to lease guaranty agreements on six of the facilities leased by the NewGen Partnership, under which it guarantees all payments and performance obligations of the tenants. As of December 31, 2020, the ​

Fair Value of Financial Instrum

Fair Value of Financial Instruments	12 Months Ended
	Dec. 31, 2020
Fair Value of Financial Instruments
Fair Value of Financial Instruments	​ (22) Fair Value of Financial Instruments ​ 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, 2020 and 2019, 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: ​ 2020 ​ (Level 1) (Level 2) (Level 3) ​ Cash and cash equivalents ​ $ 212,071 ​ $ 212,071 ​ $ — ​ $ — ​ Restricted cash and equivalents ​ ​ 101,149 ​ ​ 101,149 ​ ​ — ​ ​ — ​ Restricted investments in marketable securities: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Mortgage/government backed securities ​ ​ 23,893 ​ ​ — ​ ​ 23,893 ​ ​ — ​ Corporate bonds ​ ​ 60,802 ​ ​ — ​ ​ 60,802 ​ ​ — ​ Government bonds ​ ​ 69,157 ​ ​ 39,480 ​ ​ 29,677 ​ ​ — ​ Total ​ $ 467,072 ​ $ 352,700 ​ $ 114,372 ​ $ — ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 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 ​ $ — ​ ​ 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. Certain 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 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2020 ​ December 31, 2019 ​ Carrying Value Fair Value Carrying Value Fair Value Asset based lending facilities ​ $ 279,106 ​ $ 279,106 ​ $ 412,346 ​ $ 412,346 ​ Term loan agreements ​ ​ 210,913 ​ 210,913 ​ 196,714 ​ 196,714 ​ Real estate loans ​ 215,848 ​ 215,848 ​ 265,700 ​ 265,700 ​ HUD insured loans ​ 26,221 ​ 26,221 ​ 117,117 ​ 117,117 ​ Notes payable ​ ​ 104,598 ​ ​ 104,598 ​ ​ 116,952 ​ ​ 116,952 ​ Mortgages and other secured debt (recourse) ​ 6,987 ​ 6,987 ​ 6,369 ​ 6,369 ​ Mortgages and other secured debt (non-recourse) ​ 697,049 ​ 697,049 ​ 498,222 ​ 498,222 ​ ​ ​ $ 1,540,722 ​ $ 1,540,722 ​ $ 1,613,420 ​ $ 1,613,420 ​ ​ 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, 2020 December 31, 2020 Assets: ​ ​ ​ ​ ​ ​ Property and equipment, net ​ $ 984,712 ​ $ 11,500 Finance lease right-of-use assets, net ​ 27,848 ​ 6,000 Operating lease right-of-use assets ​ 1,715,532 ​ 161,500 Intangible assets, net ​ 82,270 ​ — Goodwill ​ 85,642 ​ — ​ ​ ​ ​ ​ ​ ​ ​ 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 ​ — ​ 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, 2020
Subsequent Events
Subsequent Events	(23) Subsequent Events ​ NewGen Partnership ​ On February 1, 2021, the Company sold the real estate and operations of two skilled nursing facilities in California and Nevada to the NewGen Partnership for a price of $19.2 million, which represented the outstanding HUD insured loans as of the closing date. The associated asset and loan balances were presented as held for sale in the consolidated balance sheet at December 31, 2020. The facilities generated annual revenues of ​ Restructuring Transactions ​ Second Spring ​ On March 12, 2021, Second Spring sold the real estate of 16 of the 21 skilled nursing facilities, in which the Company operates and leased from Second Spring, to affiliates of Cascade. The Company continues to operate all 16 centers under an interim master lease, with a reduced monthly lease rate. As part of the transaction, the Company entered into operations transfer agreements with two prospective new operators and anticipates transferring operations of the facilities as early as May 1, 2021. Upon transfer, the Company will receive a payment of million of facility related liabilities will be assumed by the new operators or reimbursed to the Company. The Company has signed operations transfer agreements for four of the facilities and expects to transfer those operations upon the receipt of licensure approval. No definitive plans have been determined as to the fifth remaining facility. ​ The 21 facilities leased from Second Spring generated annual revenues of $276.4 million and pre-tax loss of $35.3 million during the year ended December 31, 2020. The ROU assets and lease obligations associated with the facilities were ​ The Investment Agreement ​ On March 2, 2021, the Company entered into an investment agreement (the Investment Agreement) with FC-GEN Operations Investment, LLC (FC-GEN), a subsidiary of the Company, and ReGen Healthcare, LLC, (the Investor). ​ (a) The Notes ​ In accordance with the terms of the Investment Agreement, on March 2, 2021 (the Initial Closing Date), the Investor purchased for $50.0 million a convertible promissory note of FC-GEN (the Initial Note), which is convertible into 69,500,755 baskets of securities (Conversion Baskets), each comprised of one Class A common unit of FC-GEN (Class A Unit) and one Class C common stock of Genesis (Class C Share), subject to adjustment, which represent 25% of the fully diluted share capital of the Company (the Initial Closing). Under the Investment Agreement, the Investor has an option exercisable on or prior to March 31, 2021 to purchase for of the fully diluted share capital of the Company as of the Initial Closing Date, subject to certain adjustments (the Second Closing). The conversion of the Notes are subject to, among other things, receipt of certain regulatory approvals. The number of Conversion Baskets issuable upon conversion assumes that the Welltower Shares (as defined below) have been issued. If such Welltower Shares have not been issued in part or in full, the Investor would receive a lesser amount of Conversion Baskets upon conversion and be issued the remainder of the Conversion Baskets upon the issuance of the Welltower Shares or the remainder of the Welltower Shares, as applicable. ​ (b) ​ Under the Investment Agreement, upon the closing of the Supplemental Purchase, the Investor will receive a warrant (the ReGen Warrant) to purchase baskets of Class A Units and Class C Shares, with each such basket consisting of one Class A Unit and one Class C Share, subject to adjustment pursuant to the terms of the ReGen Warrant (together, the Exercise Basket) at an exercise price equal to $1.00 per Exercise Basket, subject to adjustment pursuant to the terms of the ReGen Warrant. The ReGen Warrant will be exercisable for 55,600,604 Exercise Baskets (subject to certain adjustments) by the Investor during the term commencing on the date of the Second Closing and ending on the third anniversary of the Second Closing. ​ (c) ​ In accordance with the terms of the Investment Agreement, the board of directors (the Board) has fixed the size of the Board at seven (7) members. In accordance with the terms of the Investment Agreement, at the Initial Closing, two directors resigned from the Board and the vacancies were filled with two directors selected by the Investor (each, an Investor Director). Any change in the size of the Board from Investor Director to the Board. Effective March 2, 2021, Robert Fish resigned as Chairman of the Board and David Harrington, an Investor Director, was appointed as Chairman. So long as the Investor is entitled to ​ In the event that the Second Closing occurs, the Company is obligated to cause an additional director who is not an Investor Director (a Non-Investor Director) to resign from the Board and for the vacancy to be filled with an Investor Director. In the event that the Second Closing occurs, the Investor will continue to be entitled to designate of the Class A Units and Class C Shares under the Initial Note and Supplemental Note the Investor acquired beneficial ownership of at the Initial Closing and the Second Closing (the 3 Director Beneficial Ownership Requirement). If at any time the 3 Director Beneficial Ownership Requirement is not met, the Investor will be entitled to designate Investor Director then on the Board to resign. If at any time the 2 Director Beneficial Ownership Requirement is not met, the Investor will be entitled to designate of the Class A Units and Class C Shares under the Initial Note the Investor acquired beneficial ownership of at the Initial Closing (the 1 Director Beneficial Ownership Requirement) and the Investor will cause any Investor Director(s) then on the Board in excess of one to resign. If at any time the 1 Director Beneficial Ownership Requirement is not met, the Investor will not be entitled to designate any Investor Directors to the Board and the Investor will cause all Investor Directors then on the Board to resign. Until the ​ In accordance with the terms of the Investment Agreement, so long as the 1 Director Beneficial Ownership Requirement is satisfied, the Investor has the right to designate an observer to the Board (the Observer), who (i) may attend meetings of the Board but may not vote or otherwise participate in them and (ii) is bound to confidentiality obligations as set forth in the Investment Agreement. ​ In accordance with the terms of the Investment Agreement, Genesis has formed an independent committee of the Board comprised of up to three (3) directors (the Independent Committee), each of whom must be a Non-Investor Directors and qualify as an independent director under the listing standards of the New York Stock Exchange (the NYSE) except that the CEO as of the Initial Closing Date may serve on the Independent Committee if he is a director. The initial Independent Committee is comprised of James McKeon, James Bloem and Robert Fish. ​ The Investment Agreement further provides that the Investor may not convert Class A Units that would be issued upon conversion of the Initial Note or Supplemental Note or exercise of the ReGen Warrant into shares of Class A common stock of Genesis (the Class A Shares). ​ The Waiver Agreement ​ The Investment Agreement requires the Company to use reasonable best efforts to (i) delist the Class A Shares from the NYSE, (ii) deregister the Class A Shares under the Exchange Act, and (iii) suspend any Exchange Act reporting obligations in respect of the Class A Shares (collectively, the Delisting and Deregistration). In connection with the Delisting and Deregistration, on March 2, 2021, the Company entered into a Waiver Agreement (the Waiver Agreement) with certain stockholders of the Company (the Waiving Holders) who are parties to the Registration Rights Agreement, dated as of August 18, 2014, by and among the Company and the stockholders signatory thereto (the Registration Rights Agreement). Under the Waiver Agreement, the Waiving Holders have agreed to waive the provisions of the Registration Rights Agreement that require that the Company maintain a shelf registration statement, provide the stockholders party thereto with demand registration rights and file with the SEC reports required under the Securities Act of 1933, as amended (the Securities Act) and the Securities Exchange Act of 1934, as amended (the Exchange Act). In the event that subsequent to the completion of the Delisting and Deregistration, the Class A Shares are both registered under the Exchange Act and listed on a national securities exchange, the Waiver Agreement automatically becomes null and void. ​ The Transaction Agreement ​ On March 2, 2021 (the Effective Date), the Company entered into a Transaction Agreement (together with the exhibits and schedules thereto, the Transaction Agreement) with Welltower, pursuant to which the Company has agreed to support Welltower in connection with the sale to third party purchasers of Welltower’s interests in certain facilities that the Company leases from Welltower (the Facilities), terminate the leases on 51 of its facilities leased from Welltower and transition operations to new operators (the New Operators) in return for an $86 million payment; the $86 million will be used to repay Company obligations to Welltower which shall occur incrementally over time upon the transition of the Facilities. In connection therewith, the Company has agreed to transfer management and/or operations of such Facilities to designated replacement operators (the Transitions), subject to the retention of certain liabilities related thereto by the Company, the assumption of certain liabilities by the New Operators and the delivery of certain indemnities by Welltower relating to the Transitions. ​ The 51 facilities leased from Welltower, as described above, generated annual revenues of $629.8 million and pre-tax loss of $82.5 million during the year ended December 31, 2020. The ROU assets and lease obligations associated with the facilities were million and $686.5 million, respectively, as of December 31, 2020. The Company is evaluating the accounting for these transactions, which is expected to be finalized later in 2021 upon the satisfaction of certain conditions and the related timing. ​ The Transaction Agreement further provides that, upon the Company satisfying certain conditions, including transition of the Facilities, in consideration for Genesis undertaking the transactions contemplated in the section below entitled “The Welltower Warrant and Shares” (a) an additional approximately $170 million of outstanding unsecured indebtedness owed to Welltower will be written off and (b) the Company’s obligations in respect of the yet outstanding secured and unsecured indebtedness will be restructured (the Debt Write-Down). Concurrently with the Debt Write-Down, the Company will issue a warrant to Welltower for its purchase of shares in the Company and Class A Shares, in each case as more particularly described below. ​ (a) The Welltower Warrant and Shares ​ Pursuant to the Transaction Agreement, concurrently with the debt restructure, the Company will (i) issue to a subsidiary of Welltower (TRS Holdco) a warrant (the Welltower Warrant) to purchase 900,000 Class A Shares at an exercise price equal to $1.00 per share, which Welltower Warrant will be exercisable by TRS Holdco during the period commencing on the date which is six months following the issuance date of the Welltower Warrant (the Issuance Date), and ending on the date which is five years following the Issuance Date; and (ii) issue to Welltower Class A Shares (the Welltower Shares) representing 20% of the indirect ownership of FC-GEN, provided that such issuance will be subject to dilution from new capital (including the Initial Note and the Supplemental Note). ​ (b) The Term Loan Amendments ​ Pursuant to the Transaction Agreement, the Company and Welltower have agreed to certain amendments (the Term Loan Amendments) to the Term Loan Agreement, dated as of July 29, 2016 (as may be amended, restated, amended and restated, extended, supplemented or otherwise modified from time to time, including as amended by the Term Loan Amendments, the Term Loan Agreement), among the Company, FC-GEN Operations Investment, LLC, as the borrower (the Term Borrower), certain other subsidiaries of the Company party thereto, Markglen, Inc. (the Welltower Lender) and OHI Mezz Lender, LLC and any other lender from time to time party thereto and Welltower, as administrative agent and collateral agent. ​ Among other things, the Term Loan Agreement (i) provides that all interest payable on the term loans of the Welltower Lender (the Welltower Term Loans) may be paid in-kind at the option of the Company, (ii) extends the maturity of the term loans to January 1, 2024, (iii) removes the financial covenants (except for the covenant with respect to capital expenditures), (iv) includes additional negative covenants restricting, among other things, asset sales and the issuance of capital stock by certain subsidiaries of the Company and (v) permits the Company and its subsidiaries to enter into certain other transactions, including the Transitions and the transactions contemplated by the Transaction Agreement. ​ The Term Loan Amendments to the Term Loan Agreement are effective as of the Effective Date. However, if the Company has not completed any Transitions by September 1, 2021, then several of the Term Loan Amendments (including the changes that permit all interest payable on the Welltower Term Loans to be paid in-kind) will no longer be effective. Moreover, if the Company does not complete Transitions with respect to ​ (c) The Asset Based Lending Facility ​ On the Effective Date, the Company also entered into an Amendment No. 7 (the ABL Amendment) to the Fourth Amended and Restated Credit Agreement, dated as of March 6, 2018 (as may be amended, restated, amended and restated, extended, supplemented or otherwise modified from time to time, the ABL Credit Agreement), among the Company, certain subsidiaries of the Company party thereto as borrowers and/or as guarantors, the lenders party thereto, the letter of credit issuers party thereto and MidCap Funding IV Trust, as administrative agent. ​ Among other things, the ABL Amendment, permits the Company and its subsidiaries to enter into certain transactions, including, among other things, the Transitions, the Term Loan Amendments and certain other transactions contemplated by the Transaction Agreement. ​ Tax Benefit Preservation Plan ​ On March 11, 2021, the Company entered into a Tax Benefits Preservation Plan (the Plan) with Equiniti Trust Company as rights agent (the Rights Agent), and the Board of Directors of the Company declared a dividend distribution of one right (a Right) for each outstanding share of common stock, par value $0.001 per share, of the Company to stockholders of record at the close of business on March 11, 2021 (the Record Date). Each Right is governed by the terms of the Plan and entitles the registered holder to purchase from the Company a unit consisting of one one ​ The Right will be triggered upon the acquisition of 4.9% or more of the Company’s outstanding common stock or future acquisitions by any existing holder of 4.9% or more of the Company’s outstanding common stock. If a person or group acquires 4.9% or more of the Company’s common stock, all rights holders, except the acquirer, will be entitled to acquire, at the then exercise price of a Right, that number of shares of the Company common stock which, at the time, has a market value of two times the exercise price of the Right. In connection with the adoption of the Plan, the Board of Directors approved the Certificate of Designation, Preferences, and Rights of Series A Preferred Stock, which designates the rights, preferences and privileges of 4,000,000 shares of a series of the Company’s preferred stock, par value $0.001 per share, designated as Series A Junior Participating Preferred Stock. ​

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2020
Summary of Significant Accounting Policies
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, 2020, the Company provided inpatient services through states. Revenues of the Company’s owned, leased and otherwise consolidated inpatient businesses constitute approximately ​ 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 contracts with healthcare facilities operated by third parties. 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 ​ 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 subsidiaries. All intercompany transactions have been eliminated in consolidation. The Company presents noncontrolling interests within the stockholders’ deficit section of its consolidated balance sheets. The Company presents the amount of net (loss) income attributable to Genesis Healthcare, Inc. and net (loss) income attributable to noncontrolling interests in its consolidated statements of operations. ​ The consolidated financial statements include the accounts of all entities controlled by the Company through its ownership of a majority voting interest and the accounts of 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 the years ended December 31, 2020 and 2019, the Company entered into three partnerships that acquired the real property of 43 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 Partnerships
Going Concern Considerations	Going Concern Considerations ​ On March 11, 2020, the World Health Organization declared the coronavirus outbreak (COVID-19) a pandemic. COVID-19 is a complex and previously unknown virus which disproportionately impacts older adults, particularly those having other underlying health conditions. ​ The Company’s primary focus as the effects of COVID-19 began to impact the United States was the health and safety of its patients, residents, employees and their respective families. The Company implemented various measures to provide the safest possible environment within its sites of service during this pandemic and will continue to do so. ​ The United States broadly continues to experience the pandemic caused by COVID-19, which has significantly disrupted, and likely will continue to disrupt for some period, the nation’s economy, the healthcare industry and the Company’s businesses. The rapid spread of the virus has led to the implementation of various responses, including federal, state and local government-imposed quarantines, shelter-in-place mandates, sweeping restrictions on travel, and substantial changes to selected protocols within the healthcare system across the United States. A significant number of the Company’s facilities and operations are geographically located and highly concentrated in markets with close proximity to areas of the United States that have experienced widespread and severe COVID-19 outbreaks. COVID-19 has materially and adversely affected the Company’s operations and supply chains, resulting in a reduction in its operating occupancy and related revenues, and an increase in its expenditures. ​ The Company performed an assessment to determine whether there are conditions or events, considered in the aggregate, that raise substantial doubt about its ability to continue as a going concern within one year after the date the financial statements are issued. Initially, this assessment does not consider the potential mitigating effect of management’s plans that have not been fully implemented. When substantial doubt exists, management assesses the mitigating effect of its plans to determine if it is probable that (1) the plans will be effectively implemented within one year after the date the financial statements are issued, and (2) when implemented, the plans will mitigate the relevant conditions or events that raise substantial doubt about the entity’s ability to continue as a going concern. ​ In completing its going concern assessment, the Company considered the uncertainties around the impact of COVID-19 on its future results of operations as well as its current financial condition and liquidity sources, including current funds available, forecasted future cash flows and the Company’s indebtedness and other conditional and unconditional obligations due within 12 months following the date its financial statements were issued. Without giving effect to the prospect, timing and adequacy of future governmental funding support and other mitigating plans, many of which are beyond the Company’s control, it is unlikely that the Company will be able to generate sufficient cash flows to meet its required financial obligations, including its rent and debt obligations, and maintain compliance with financial covenants. The existence of these conditions raises substantial doubt about the Company’s ability to continue as a going concern for the twelve-month period following the date the financial statements are issued. ​ In response to COVID-19, and other conditions that raise substantial doubt about the Company’s ability to continue as a going concern, the Company has taken the following measures: ​ ● The Company applied for and received government-sponsored financial relief related to the pandemic; ● The Company is utilizing the Coronavirus Aid, Relief, and Economic Security Act of 2020 (CARES Act) payroll tax deferral program to delay payment of a portion of payroll taxes incurred through December 2020, with 50% to be repaid in December 2021 and the remaining 50% to be repaid in December 2022; ● While it vigorously advocates, for itself and the skilled nursing industry, regarding the need for additional government-sponsored funding, the Company continues to explore and to take advantage of existing government-sponsored funding programs implemented to support businesses impacted by COVID-19; ● The Company continues to seek and implement measures to adapt its operational model to function for the long-term in a COVID-19 environment; ● The Company has pursued, and will continue to pursue, creative and accretive opportunities to sell assets and enter into joint venture structures in order to provide liquidity; ● The Company executed a series of transactions, as described at Note 23 – “Subsequent Events – Restructuring Transactions,” that are expected to improve its liquidity position; and ● The Company is exploring and evaluating a number of strategic and other alternatives to manage and to improve its liquidity position, in order to address the maturity of material indebtedness and other obligations over the twelve-month period following the date the financial statements are issued. ​ These measures and other plans and initiatives are needed to provide the Company with adequate liquidity to meet its obligations for at least the twelve-month period following the date its financial statements are issued. However, such plans and initiatives are dependent on factors that are beyond the Company’s control or may not be available on terms acceptable to the Company, or at all. Accordingly, management determined it could not be certain that the plans and initiatives would be effectively implemented within one year after the date the financial statements are issued. Further, even if the Company receives additional funding support from government sources and/or is able to execute successfully all of these plans and initiatives, given the unpredictable nature of, and the operating challenges presented by, the COVID-19 virus, the Company’s operating plans and resulting cash flows along with its cash and cash equivalents and other sources of liquidity may not be sufficient to fund operations for the twelve-month period following the date the financial statements are issued. Such events or circumstances could force the Company to seek reorganization under the U.S. Bankruptcy Code. ​ The accompanying consolidated financial statements have been prepared assuming the Company will continue as a going concern, which contemplates continuity of operations, realization of assets and the satisfaction of liabilities in the normal course of business for the twelve-month period following the date the financial statements are issued. At December 31, 2020, the Company was not in compliance with or had not received waivers with respect to the financial covenants contained in certain of its leases containing cross-default provisions with other lease agreements and debt agreements. The lease and debt obligations associated with these agreements have been classified as current liabilities. Otherwise, the accompanying consolidated financial statements do not include any adjustments relating to the recoverability and classification of assets and their carrying amounts, or the amount and classification of liabilities that may result should the Company be unable to continue as a going concern.
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 valuation of revenues and accounts receivable, self-insured liabilities, income taxes, long-lived assets and goodwill, lease obligations and other contingencies. Actual results could differ from those estimates.
Revenue Recognition	Revenue Recognition ​ The Company generates revenues, primarily by providing healthcare services to its customers. The Company applies Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) Topic 606, Revenue from Contracts with Customers ​ Performance obligations are determined based on the nature of the services provided. The majority of the Company's healthcare services are highly interrelated and represent multiple inputs to deliver the combined output for which a customer has entered into a contract with the Company. As such, the bundle of services is treated as a single performance obligation satisfied over time as services are rendered. The Company also provides certain ancillary services, such as activities, meals, security, housekeeping, and assistance in the activities of daily living, including barber and beauty services. Separate and distinct performance obligations exist relative to the performance of the non-medical ancillary services. As such, revenues from ancillary services are recognized 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. The Company constrains 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. 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 is entitled to compensation for the value of the services provided, as they are performed, so it recognizes the related revenue in the statements of operations as the services are performed. Since the Company has performed its obligation under the contract, it has unconditional rights to the consideration recorded and, therefore, classifies those billed and unbilled rights 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 patients who either do not have insurance or who have insurance with Medicare, Medicaid, private and commercial insurance entities, 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.”
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, 2020 and 2019 were $153.9 million and $136.9 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 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, 2020 and 2019 was $98.5 million and $96.1 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 customer relationships. 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 Asset Impairment Charges
Self-Insurance Reserves	Self-Insurance Reserves ​ The Company provides for self-insurance reserves for both general and professional liabilities 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 and settling claims, and the relationship of past reported incidents to eventual claim 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 claims are discounted based on actuarial estimates of claim payment patterns whereas the reserves for general and professional liability claims are recorded on an undiscounted basis. Estimated insurance recoveries related to recorded liabilities are reflected as assets in the Company’s consolidated balance sheets when the receipt of such amounts is deemed to be probable. 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 (benefit) expense in the consolidated statement of operations.
Leases	Leases ​ The Company leases skilled nursing facilities and assisted/senior living facilities, as well as certain office space, land, and equipment. 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.” ​
(Loss) Earnings Per Share	(Loss) Earnings Per Share ​ The Company follows the FASB’s authoritative guidance for the financial reporting of (loss) earnings per share. (Loss) earnings per share excludes dilution and is based upon the weighted average number of common shares outstanding during the respective periods. Diluted (loss) earnings 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 – “(Loss) Earnings Per Share
Recently Adopted Accounting Pronouncements	Recently Adopted Accounting Pronouncements ​ In August 2018 , the FASB issued Accounting Standard Update (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. ​ Recently Issued Accounting Pronouncements ​ 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. Further, the FASB issued ASU 2019-04 and ASU 2019-05 to provide additional guidance on the credit losses standard. The standard is effective for fiscal years beginning after December 15, 2022 , for smaller reporting companies, 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 new standard became effective for the Company on January 1, 2021 . The Company is evaluating the effect, if any, that the standard will have on its consolidated financial statements .

Certain Significant Risks and_2

Certain Significant Risks and Uncertainties (Tables)	12 Months Ended
	Dec. 31, 2020
Certain Significant Risks and Uncertainties
Schedule of revenue by major source (in thousands)	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ 2020 2019 Medicare ​ 21 % ​ 20 % Medicaid ​ 59 % ​ 58 % Insurance ​ 11 % ​ 12 % Private ​ 7 % ​ 7 % Other ​ 2 % ​ 3 % Total ​ 100 % ​ 100 %

Net Revenues and Accounts Rec_2

Net Revenues and Accounts Receivable (Tables)	12 Months Ended
	Dec. 31, 2020
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, 2020 and 2019 was as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, 2020 ​ ​ ​ ​ ​ ​ Rehabilitation ​ ​ ​ ​ ​ ​ ​ ​ Inpatient ​ Therapy ​ Other ​ ​ ​ ​ ​ ​ Services ​ Services ​ Services ​ Total Medicare ​ $ 697,160 ​ $ 87,896 ​ $ — ​ $ 785,056 ​ Medicaid ​ 1,982,156 ​ 1,440 ​ — ​ 1,983,596 ​ Insurance ​ ​ 351,293 ​ 22,038 ​ — ​ 373,331 ​ Private ​ ​ 248,962 (1) ​ 191 ​ ​ — ​ ​ 249,153 ​ Third party providers ​ ​ — ​ ​ 264,893 ​ ​ 91,641 ​ ​ 356,534 ​ Other ​ ​ 59,284 (2) ​ 24,746 (2) ​ 74,523 (3) ​ 158,553 ​ Total net revenues ​ $ 3,338,855 ​ $ 401,204 ​ $ 166,164 ​ $ 3,906,223 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 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 (1) ​ 296 ​ ​ — ​ ​ 310,318 ​ Third party providers ​ ​ — ​ ​ 336,509 ​ ​ 78,709 ​ ​ 415,218 ​ Other ​ ​ 69,143 (2) ​ 10,513 (2) ​ 68,547 (3) ​ 148,203 ​ Total net revenues ​ $ 3,956,032 ​ $ 462,546 ​ $ 147,256 ​ $ 4,565,834 ​ ​ (1) Includes Assisted/Senior living revenue of $79.3 million and $93.1 million for the years ended December 31, 2020 and 2019, respectively. Such amounts do not represent contracts with customers under Topic 606. (2) Primarily consists of revenue from patients with Veteran Affairs insurance and administration of third party facilities. (3) Includes net revenues from all payors generated by the other services, excluding third party providers.

(Loss) Earnings Per Share (Tabl

(Loss) Earnings Per Share (Tables)	12 Months Ended
	Dec. 31, 2020
(Loss) Earnings Per Share
Reconciliation of the numerator and denominator used in the calculation of net income per share	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ 2020 2019 Numerator: ​ ​ ​ ​ ​ ​ Net (loss) income ​ $ (103,367) ​ $ 7,474 Less: Net loss attributable to noncontrolling interests ​ 44,404 ​ 7,145 Net (loss) income attributable to Genesis Healthcare, Inc. ​ $ (58,963) ​ $ 14,619 Denominator: ​ ​ ​ ​ ​ ​ Weighted-average shares outstanding for basic net (loss) income per share ​ 111,851 ​ 107,286 ​ ​ ​ ​ ​ ​ ​ Basic net (loss) income per common share attributable to Genesis Healthcare, Inc. ​ $ (0.53) ​ $ 0.14 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ 2020 2019 Numerator: ​ ​ ​ ​ ​ ​ Net (loss) income ​ $ (103,367) ​ $ 7,474 Less: Net loss attributable to noncontrolling interests ​ 44,404 ​ 7,145 Net (loss) income attributable to Genesis Healthcare, Inc. ​ $ (58,963) ​ $ 14,619 Plus: Assumed conversion of noncontrolling interests ​ — ​ 1,868 Net (loss) income available to common stockholders after assumed conversions ​ $ (58,963) ​ $ 16,487 Denominator: ​ ​ ​ ​ ​ ​ Weighted-average common shares outstanding ​ 111,851 ​ 107,286 Plus: Assumed conversion of noncontrolling interests ​ ​ — ​ ​ 57,074 Plus: Unvested restricted stock units and stock warrants ​ ​ — ​ ​ 954 Adjusted weighted-average common shares outstanding, diluted ​ ​ 111,851 ​ ​ 165,314 ​ ​ ​ ​ ​ ​ ​ Diluted net (loss) income per common share attributable to Genesis Healthcare, Inc. ​ $ (0.53) ​ $ 0.10

Segment Information (Tables)

Segment Information (Tables)	12 Months Ended
	Dec. 31, 2020
Segment Information
Summary of segmented revenues	A summary of the Company’s segmented revenues follows (in thousands, except percentages): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ ​ ​ ​ ​ ​ ​ 2020 ​ 2019 ​ Increase / (Decrease) ​ ​ Revenue Revenue Revenue Revenue ​ ​ ​ ​ ​ ​ ​ Dollars ​ Percentage ​ Dollars ​ Percentage ​ Dollars ​ Percentage ​ Revenues: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Inpatient services: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Skilled nursing facilities ​ $ 3,254,715 83.4 % $ 3,857,793 84.4 % $ (603,078) ​ (15.6) % Assisted/Senior living facilities ​ 79,314 2.0 % 93,054 2.0 % (13,740) ​ (14.8) % Administration of third party facilities ​ 7,866 0.2 % 8,310 0.2 % (444) ​ (5.3) % Elimination of administrative services ​ (3,040) (0.1) % (3,125) (0.1) % 85 ​ 2.7 % Inpatient services, net ​ 3,338,855 85.5 % 3,956,032 86.5 % (617,177) (15.6) % ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Rehabilitation therapy services: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total therapy services ​ 622,601 15.9 % 738,124 16.2 % (115,523) ​ (15.7) % Elimination of intersegment rehabilitation therapy services ​ (221,397) (5.7) % (275,578) (6.0) % 54,181 ​ 19.7 % Third party rehabilitation therapy services, net ​ 401,204 10.2 % 462,546 10.2 % (61,342) (13.3) % ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Other services: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Total other services ​ 263,806 6.8 % 198,920 4.4 % 64,886 ​ 32.6 % Elimination of intersegment other services ​ (97,642) (2.5) % (51,664) (1.1) % (45,978) ​ (89.0) % Third party other services, net ​ 166,164 4.3 % 147,256 3.3 % 18,908 12.8 % ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Net revenues ​ $ 3,906,223 100.0 % $ 4,565,834 100.0 % $ (659,611) ​ (14.4) %
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, 2020 ​ ​ ​ ​ ​ ​ Rehabilitation ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Inpatient ​ Therapy ​ Other ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Services Services Services Corporate Eliminations Consolidated Net revenues ​ $ 3,341,895 ​ $ 622,601 ​ $ 263,806 ​ $ — ​ $ (322,079) ​ $ 3,906,223 ​ Salaries, wages and benefits ​ 1,593,013 ​ 501,093 ​ 162,094 ​ — ​ — ​ 2,256,200 ​ Other operating expenses ​ ​ 1,482,488 ​ 31,431 ​ 79,194 ​ — ​ (322,542) ​ 1,270,571 ​ General and administrative costs ​ ​ — ​ ​ — ​ ​ — ​ ​ 175,057 ​ ​ — ​ ​ 175,057 ​ Lease expense ​ ​ 362,384 ​ 1,019 ​ 1,739 ​ 1,197 ​ — ​ 366,339 ​ Depreciation and amortization expense ​ ​ 91,084 ​ 6,731 ​ 825 ​ 9,457 ​ (264) ​ 107,833 ​ Interest expense ​ ​ 57,634 ​ 27 ​ 38 ​ 82,460 ​ (4,720) ​ 135,439 ​ Loss on early extinguishment of debt ​ ​ — ​ — ​ — ​ 8,979 ​ — ​ 8,979 ​ Investment income ​ ​ — ​ — ​ — ​ (8,709) ​ 4,720 ​ (3,989) ​ Other (income) loss ​ ​ (203,100) ​ 621 ​ 207 ​ — ​ — ​ (202,272) ​ Transaction costs ​ ​ — ​ — ​ — ​ 34,279 ​ — ​ 34,279 ​ Long-lived asset impairments ​ ​ 179,000 ​ ​ — ​ ​ — ​ ​ — ​ ​ — ​ ​ 179,000 ​ Federal and state stimulus - COVID-19 other income ​ ​ (301,719) ​ ​ (3,649) ​ ​ (699) ​ ​ — ​ ​ — ​ ​ (306,067) ​ Equity in net income of unconsolidated affiliates ​ ​ — ​ — ​ — ​ (7,091) ​ (1,078) ​ (8,169) ​ Income (loss) before income tax benefit ​ ​ 81,111 ​ 85,328 ​ 20,408 ​ (295,629) ​ 1,805 ​ (106,977) ​ Income tax benefit ​ ​ — ​ — ​ — ​ (3,610) ​ — ​ (3,610) ​ Net income (loss) ​ $ 81,111 ​ $ 85,328 ​ $ 20,408 ​ $ (292,019) ​ $ 1,805 ​ $ (103,367) ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 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 ​ Income 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 benefit ​ ​ 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 ​ ​ ​ The following table presents the segment assets as of December 31, 2020 compared to December 31, 2019 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2020 December 31, 2019 Inpatient services ​ $ 3,555,291 ​ $ 4,221,579 ​ Rehabilitation therapy services ​ 252,575 ​ 281,978 ​ Other services ​ 47,448 ​ 49,877 ​ Corporate and eliminations ​ 206,932 ​ 108,706 ​ Total assets ​ $ 4,062,246 ​ $ 4,662,140 ​

Restricted Investments in Mar_2

Restricted Investments in Marketable Securities (Tables)	12 Months Ended
	Dec. 31, 2020
Restricted Investments in Marketable Securities
Schedule of Restricted Investments in Marketable Securities	Restricted investments in marketable securities at December 31, 2020 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 ​ $ 23,727 ​ $ 166 ​ $ — ​ $ — ​ $ 23,893 Corporate bonds ​ ​ 59,936 ​ ​ 867 ​ ​ (1) ​ ​ — ​ ​ 60,802 Government bonds ​ ​ 67,794 ​ ​ 1,364 ​ ​ — ​ ​ (1) ​ ​ 69,157 ​ ​ $ 151,457 ​ $ 2,397 ​ $ (1) ​ $ (1) ​ ​ 153,852 Less: Current portion of restricted investments ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ (39,526) Long-term restricted investments ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ $ 114,326 ​ 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
Schedule of Maturities of Restricted Investments in Marketable Securities	Restricted investments in marketable securities held at December 31, 2020 mature as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Amortized ​ Fair ​ cost value Due in one year or less ​ $ 36,550 ​ $ 36,834 Due after 1 year through 5 years ​ ​ 111,907 ​ ​ 114,019 Due after 5 years through 10 years ​ ​ — ​ ​ — Due after 10 years ​ ​ 3,000 ​ ​ 2,999 ​ ​ $ 151,457 ​ $ 153,852

Property and Equipment (Tables)

Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2020
Property and Equipment
Schedule of property and equipment	Property and equipment consisted of the following as of December 31, 2020 and 2019 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2020 December 31, 2019 Land, buildings and improvements ​ $ 1,052,095 ​ $ 1,004,447 ​ Equipment, furniture and fixtures ​ 358,546 ​ 386,248 ​ Construction in progress ​ 3,776 ​ 2,771 ​ Gross property and equipment ​ 1,414,417 ​ 1,393,466 ​ Less: accumulated depreciation ​ (429,705) ​ (431,361) ​ Net property and equipment ​ $ 984,712 ​ $ 962,105 ​

Leases (Tables)

Leases (Tables)	12 Months Ended
	Dec. 31, 2020
Leases
Schedule of operating lease liability maturities	​ ​ ​ ​ ​ ​ ​ ​ Year ending December 31, Operating Leases Finance Leases (1) 2021 ​ $ 324,840 ​ $ 6,798 2022 ​ 328,039 ​ 6,597 2023 ​ 330,147 ​ 6,420 2024 ​ 334,231 ​ 6,195 2025 ​ 333,225 ​ 5,968 Thereafter ​ 2,250,977 ​ 28,950 Total lease payments ​ 3,901,459 ​ 60,928 Less interest ​ (1,669,907) ​ (23,036) Total lease obligations ​ 2,231,552 ​ 37,892 Less current portion ​ (2,071,841) ​ (2,949) Long-term lease obligations ​ $ 159,711 ​ $ 34,943
Schedule of finance lease liability maturities	​ ​ ​ ​ ​ ​ ​ ​ Year ending December 31, Operating Leases Finance Leases (1) 2021 ​ $ 324,840 ​ $ 6,798 2022 ​ 328,039 ​ 6,597 2023 ​ 330,147 ​ 6,420 2024 ​ 334,231 ​ 6,195 2025 ​ 333,225 ​ 5,968 Thereafter ​ 2,250,977 ​ 28,950 Total lease payments ​ 3,901,459 ​ 60,928 Less interest ​ (1,669,907) ​ (23,036) Total lease obligations ​ 2,231,552 ​ 37,892 Less current portion ​ (2,071,841) ​ (2,949) Long-term lease obligations ​ $ 159,711 ​ $ 34,943
Schedule of leases	The following table provides lease costs and income by line item on the consolidated statements of operations for the years ended December 31, 2020 and 2019 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ Classification 2020 2019 Operating lease cost Lease expense ​ $ 366,339 ​ $ 387,063 Finance lease cost: ​ ​ ​ ​ ​ Amortization of finance lease ROU assets Depreciation and amortization expense ​ 3,818 ​ 16,224 Interest on finance lease obligations Interest expense ​ ​ 4,402 ​ ​ 50,162 Total finance lease expense ​ ​ ​ 8,220 ​ ​ 66,386 Variable lease cost Other operating expenses ​ 34,601 ​ 37,841 Short-term leases Other operating expenses ​ ​ 18,516 ​ ​ 24,297 Sublease income Net revenues ​ ​ (6,058) ​ ​ - Total ​ ​ $ 421,618 ​ $ 515,587 ​ The following table provides remaining lease term and discount rates by lease classification as of December 31, 2020 and 2019: ​ ​ ​ ​ ​ ​ ​ ​ Lease Term and Discount Rate December 31, 2020 ​ December 31, 2019 Weighted-average remaining lease term (years) ​ ​ ​ ​ ​ ​ Operating leases ​ 11.4 ​ 12.6 Finance leases ​ 9.5 ​ 10.2 Weighted-average discount rate ​ ​ ​ ​ ​ ​ Operating leases ​ 10.1% ​ 9.6% Finance leases ​ 10.6% ​ 12.2% ​ The following table includes supplemental lease information for the years ended December 31, 2020 and 2019 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, Other information 2020 2019 Cash paid for amounts included in the measurement of lease obligations ​ ​ ​ ​ ​ ​ Operating cash flows from operating leases ​ $ 348,034 ​ $ 364,334 Operating cash flows from finance leases ​ 7,305 ​ 47,188 Financing cash flows from finance leases ​ 2,905 ​ 2,645 Right-of-use assets obtained in exchange for new lease obligations ​ ​ ​ ​ Operating leases ​ 27,229 ​ 96,718 Finance leases ​ 1,033 ​ 1,160

Goodwill and Identifiable Int_2

Goodwill and Identifiable Intangible Assets (Tables)	12 Months Ended
	Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of changes in carrying value of goodwill	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Rehabilitation Therapy Services Other Services Consolidated Balance at December 31, 2019 ​ ​ ​ ​ ​ ​ ​ ​ ​ Goodwill ​ $ 73,814 ​ $ 11,828 ​ $ 85,642 Accumulated impairment losses ​ ​ — ​ ​ — ​ ​ — ​ ​ $ 73,814 ​ $ 11,828 ​ $ 85,642 Balance at December 31, 2020 ​ ​ ​ ​ ​ ​ ​ ​ ​ Goodwill ​ $ 73,814 ​ $ 11,828 ​ $ 85,642 Accumulated impairment losses ​ ​ — ​ ​ — ​ ​ — ​ ​ $ 73,814 ​ $ 11,828 ​ $ 85,642
Schedule of identifiable intangible assets, finite-lived	Identifiable intangible assets consist of the following at December 31, 2020 and 2019 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2020 Weighted Average Remaining Life (Years) Customer relationship assets, net of accumulated amortization of $81,387 ​ $ 31,715 ​ 7 Trade names ​ ​ 50,555 ​ Indefinite Identifiable intangible assets ​ $ 82,270 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 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 ​ ​ ​ ​

Long-term Debt (Tables)

Long-term Debt (Tables)	12 Months Ended
	Dec. 31, 2020
Long-Term Debt
Schedule of long-term debt	​ Long-term debt at December 31, 2020 and 2019 consisted of the following (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2020 ​ December 31, 2019 Asset based lending facilities, net of debt issuance costs of $5,894 and $8,615 at December 31, 2020 and December 31, 2019, respectively ​ $ 279,106 ​ $ 412,346 ​ Term loan agreements, net of debt issuance costs of $525 and $1,084 and debt premium balance of $2,221 and $4,816 at December 31, 2020 and December 31, 2019, respectively ​ 210,913 ​ 196,714 ​ Real estate loans, net of debt issuance costs of $860 and $3,846 and debt premium balance of $9,664 and $19,328 at December 31, 2020 and December 31, 2019, respectively ​ 215,848 ​ 265,700 ​ HUD insured loans, net of debt issuance costs of $633 and $2,909 at December 31, 2020 and December 31, 2019, respectively ​ 26,221 ​ 117,117 ​ Notes payable ​ ​ 104,598 ​ ​ 116,952 ​ Mortgages and other secured debt (recourse) ​ 6,987 ​ 6,369 ​ Mortgages and other secured debt (non-recourse), net of debt issuance costs of $10,711 and $9,349 and debt premium balance of $1,323 and $1,422 at December 31, 2020 and December 31, 2019, respectively ​ 697,049 ​ 498,222 ​ ​ ​ 1,540,722 ​ 1,613,420 ​ Less: Current portion of long-term debt ​ (905,788) ​ (162,426) ​ Long-term debt ​ $ 634,934 ​ $ 1,450,994 ​
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, 2020 (dollars in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ ​ ​ Average ABL Credit Facilities ​ Commitment ​ ​ Borrowings ​ Interest Term loan facility ​ $ 285,000 ​ ​ $ 285,000 ​ 6.50 % Revolving credit facility (Non-HUD) ​ ​ 168,000 ​ ​ ​ — ​ 6.50 % Revolving credit facility (HUD) ​ ​ 72,000 ​ ​ — 6.50 % Delayed draw term loan facility ​ ​ 20,000 ​ ​ ​ — ​ 12.00 % ​ ​ $ 545,000 ​ $ 285,000 6.50 %
Schedule of maturity of total debt	​ ​ ​ ​ ​ Twelve months ended December 31, ​ ​ 2021 ​ $ 380,890 2022 ​ ​ 522,672 2023 ​ ​ 204,123 2024 ​ ​ 19,528 2025 ​ ​ 9,516 Thereafter ​ ​ 409,408 Total debt maturity ​ $ 1,546,137

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	12 Months Ended
	Dec. 31, 2020
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, 2020 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, 2020 ​ ​ 9,959 ​ $ 1.74 ​ Granted ​ 3,540 ​ ​ 0.96 ​ Vested ​ (2,880) ​ ​ 1.68 ​ Forfeited ​ (2,248) ​ ​ 1.13 ​ Non-vested balance at December 31, 2020 ​ ​ 8,371 ​ $ 1.60 ​

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2020
Income Taxes
Schedule of total income tax (benefit) expense by income category	The total income tax (benefit) expense for the periods presented was as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ 2020 2019 ​ ​ ​ ​ ​ ​ ​ Continuing operations ​ $ (3,610) ​ $ 1,754 Stockholder's deficit ​ ​ 316 ​ ​ 346 Total ​ $ (3,294) ​ $ 2,100
Schedule of Components of Income Tax Expense (Benefit)	The components of the provision for income taxes on (loss) income for the years ended December 31, 2020 and 2019 were as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ 2020 2019 Current: ​ ​ ​ ​ ​ ​ Federal ​ $ (4,814) ​ $ 1,014 State ​ ​ 200 ​ ​ 28 ​ ​ ​ (4,614) ​ ​ 1,042 Deferred: ​ ​ ​ ​ ​ ​ Federal ​ ​ (563) ​ ​ 29 State ​ ​ 1,567 ​ ​ 683 ​ ​ ​ 1,004 ​ ​ 712 Total ​ $ (3,610) ​ $ 1,754
Schedule of Effective Income Tax Rate Reconciliation	Total income tax (benefit) expense for the periods presented was as follows (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ 2020 2019 Computed “expected” (benefit) expense ​ $ (22,465) ​ $ 1,939 Increase (reduction) in income taxes resulting from: ​ ​ ​ ​ ​ ​ State and local income taxes, net of federal tax benefit ​ ​ 116 ​ ​ 107 Income tax credits ​ ​ (1,847) ​ ​ (2,088) Non-controlling interest ​ ​ 8,306 ​ ​ 4,038 Adjustment to deferred taxes, including credits and valuation allowance ​ ​ 17,389 ​ ​ (2,977) US federal refund carryback claim ​ ​ (5,107) ​ ​ — FIN 48 ​ ​ (13) ​ ​ — Other, net ​ ​ 11 ​ ​ 735 Total income tax (benefit) expense ​ $ (3,610) ​ $ 1,754
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, 2020 and 2019 are presented below (in thousands): ​ ​ ​ ​ ​ ​ ​ 2020 2019 Deferred tax assets: ​ ​ ​ ​ Investment in partnership $ 252,214 $ 240,247 Net operating loss carryforwards ​ 136,709 ​ 133,611 Discounted unpaid loss reserve ​ 2,278 ​ 2,156 General business credits ​ 29,895 ​ 30,006 Total deferred tax assets ​ 421,096 ​ 406,020 Valuation allowance ​ (408,379) ​ (391,257) Deferred tax assets, net of valuation allowance $ 12,717 $ 14,763 Deferred tax liabilities: ​ ​ ​ ​ Long-lived assets: intangible property ​ (15,509) ​ (16,236) Total deferred tax liabilities ​ (15,509) ​ (16,236) Net deferred tax liabilities $ (2,792) $ (1,473)
Schedule of Unrecognized Tax Benefits Roll Forward	A reconciliation of unrecognized tax benefits follows (in thousands): ​ ​ ​ ​ ​ Balance, December 31, 2018 ​ $ 77 Reductions due to lapses of applicable statute of limitations ​ ​ — Balance, December 31, 2019 ​ $ 77 Reductions due to lapses of applicable statute of limitations ​ ​ (13) Balance, December 31, 2020 ​ $ 64

Other Income (Tables)

Other Income (Tables)	12 Months Ended
	Dec. 31, 2020
Other Income
Summary of Net (Gain) Loss Recorded as Other Income	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Year ended December 31, ​ 2020 2019 Gain on sale of owned assets (1) ​ $ (120,357) ​ $ (90,723) Loss recognized for exit costs associated with divestiture of operations (2) ​ ​ 16,671 ​ ​ 12,997 Gain on lease termination or modification (3) ​ ​ (98,586) ​ ​ (95,779) Total other income ​ $ (202,272) ​ $ (173,505) ​ ​ (1) The Company sold 19 owned skilled nursing facilities during the year ended December 31, 2020. The Company sold 13 owned skilled nursing facilities and two assisted/senior living facilities during the year ended December 31, 2019. The gain represents sale proceeds in excess of the carrying value of the assets sold. (2) The Company divested the operations of 63 facilities, including the sold facilities noted above, in the year ended December 31, 2020. The Company divested operations of 44 facilities, including the facilities described in Note 16 – “Related Party Transactions , ” in the year ended December 31, 2019. 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 amended numerous lease agreements in the years ended December 31, 2020 and 2019. These transactions resulted in a combination of base rent reductions, lease term extensions or reductions and facility terminations. Lease terminations may be the result of divested operations or sales of real property between landlords for retained operations. Each lease amendment triggers a lease reassessment, which includes possible lease reclassification and assumption of renewal options. Upon termination, the respective lease liability and ROU asset balances are adjusted proportionately, with offsetting adjustments recorded as other income, in certain circumstances.

Assets Held for Sale (Tables)

Assets Held for Sale (Tables)	12 Months Ended
	Dec. 31, 2020
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, 2020 and 2019 (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2020 December 31, 2019 Current assets: ​ ​ ​ ​ Prepaid expenses ​ $ — ​ $ 1,171 Long-term assets: ​ ​ ​ ​ Property and equipment, net of accumulated depreciation of $3,015 and $2,201 at December 31, 2020 and December 31, 2019, respectively ​ 12,986 ​ 16,306 Total assets ​ $ 12,986 ​ $ 17,477 Current liabilities: ​ ​ ​ ​ ​ ​ Current portion of long-term debt ​ $ 403 ​ $ 368 Long-term liabilities: ​ ​ ​ ​ Long-term debt ​ 18,271 ​ 19,789 Total liabilities ​ $ 18,674 ​ $ 20,157

Fair Value of Financial Instr_2

Fair Value of Financial Instruments (Tables)	12 Months Ended
	Dec. 31, 2020
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, 2020 and 2019, 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: ​ 2020 ​ (Level 1) (Level 2) (Level 3) ​ Cash and cash equivalents ​ $ 212,071 ​ $ 212,071 ​ $ — ​ $ — ​ Restricted cash and equivalents ​ ​ 101,149 ​ ​ 101,149 ​ ​ — ​ ​ — ​ Restricted investments in marketable securities: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Mortgage/government backed securities ​ ​ 23,893 ​ ​ — ​ ​ 23,893 ​ ​ — ​ Corporate bonds ​ ​ 60,802 ​ ​ — ​ ​ 60,802 ​ ​ — ​ Government bonds ​ ​ 69,157 ​ ​ 39,480 ​ ​ 29,677 ​ ​ — ​ Total ​ $ 467,072 ​ $ 352,700 ​ $ 114,372 ​ $ — ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 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 ​ $ — ​
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, 2020 ​ December 31, 2019 ​ Carrying Value Fair Value Carrying Value Fair Value Asset based lending facilities ​ $ 279,106 ​ $ 279,106 ​ $ 412,346 ​ $ 412,346 ​ Term loan agreements ​ ​ 210,913 ​ 210,913 ​ 196,714 ​ 196,714 ​ Real estate loans ​ 215,848 ​ 215,848 ​ 265,700 ​ 265,700 ​ HUD insured loans ​ 26,221 ​ 26,221 ​ 117,117 ​ 117,117 ​ Notes payable ​ ​ 104,598 ​ ​ 104,598 ​ ​ 116,952 ​ ​ 116,952 ​ Mortgages and other secured debt (recourse) ​ 6,987 ​ 6,987 ​ 6,369 ​ 6,369 ​ Mortgages and other secured debt (non-recourse) ​ 697,049 ​ 697,049 ​ 498,222 ​ 498,222 ​ ​ ​ $ 1,540,722 ​ $ 1,540,722 ​ $ 1,613,420 ​ $ 1,613,420 ​
Schedule of hierarchy of nonfinancial assets measured at fair value on a nonrecurring basis	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Impairment Charges - ​ ​ Carrying Value ​ Year ended ​ December 31, 2020 December 31, 2020 Assets: ​ ​ ​ ​ ​ ​ Property and equipment, net ​ $ 984,712 ​ $ 11,500 Finance lease right-of-use assets, net ​ 27,848 ​ 6,000 Operating lease right-of-use assets ​ 1,715,532 ​ 161,500 Intangible assets, net ​ 82,270 ​ — Goodwill ​ 85,642 ​ — ​ ​ ​ ​ ​ ​ ​ ​ 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 ​ — ​

General Information (Details)

General Information (Details)	12 Months Ended
	Dec. 31, 2020facilitystateitem	Dec. 31, 2019facilityitem	Mar. 11, 2020
Description of business
Repayment of payroll taxes through Dec 2021 (as a percent)			50.00%
Repayment of payroll taxes through Dec 2022 (as a percent)			50.00%
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%	10.20%
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	341
Number of states with facilities | state	24
Inpatient Services | Product Concentration Risk
Concentration risk
Concentration risk (as a percent)	85.50%	86.50%
Inpatient Services | Revenue | Product Concentration Risk
Concentration risk
Concentration risk (as a percent)	86.00%
Skilled Nursing Facility - DO NOT USE ON DISPOSAL GROUPS AXIS OR EXTENDED AXIS
Concentration risk
Number of facilities leased from VIE in partnership	43	43
Number of Partnerships | item	3	3

Summary of Significant Accoun_3

Summary of Significant Accounting Policies - Revenue recognition through Restricted Investments (Details) - USD ($) $ in Millions	Dec. 31, 2020	Dec. 31, 2019
Restricted Cash and Investments in Marketable Securities
Restricted cash and equivalents	$ 101.1	$ 113.7
Restricted investments in marketable securities	$ 153.9	$ 136.9

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - PP&E (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Property and Equipment
Depreciation expense	$ 98.5	$ 96.1
Buildings Building Improvements And Land Improvements [Member] | Minimum
Property and Equipment
Property and equipment, useful life	20 years
Buildings Building Improvements And Land Improvements [Member] | Maximum
Property and Equipment
Property and equipment, useful life	35 years
Equipment, furniture and fixtures | Minimum
Property and Equipment
Property and equipment, useful life	3 years
Equipment, furniture and fixtures | Maximum
Property and Equipment
Property and equipment, useful life	15 years

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Recent Accounting Pronouncements (Details)	Dec. 31, 2020
Accounting Standards Update 2018-13
Recent Accounting Pronouncements
Change in Accounting Principle, Accounting Standards Update, Adopted	true
Change in Accounting Principle, Accounting Standards Update, Adoption Date	Jan. 1, 2020
Change in Accounting Principle, Accounting Standards Update, Early Adoption	false
Accounting Standards Update 2016-13
Recent Accounting Pronouncements
Change in Accounting Principle, Accounting Standards Update, Adopted	false
Change in Accounting Principle, Accounting Standards Update, Early Adoption	false
Accounting Standards Update 2019-12
Recent Accounting Pronouncements
Change in Accounting Principle, Accounting Standards Update, Adoption Date	Jan. 1, 2021

Certain Significant Risks and_3

Certain Significant Risks and Uncertainties - Revenue Sources (Details) - Government contracts - Inpatient Services	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Revenue Sources
Concentration Risk, Percentage	100.00%	100.00%
Medicare
Revenue Sources
Concentration Risk, Percentage	21.00%	20.00%
Medicaid
Revenue Sources
Concentration Risk, Percentage	59.00%	58.00%
Insurance
Revenue Sources
Concentration Risk, Percentage	11.00%	12.00%
Private
Revenue Sources
Concentration Risk, Percentage	7.00%	7.00%
Other
Revenue Sources
Concentration Risk, Percentage	2.00%	3.00%
Revenue | Medicare and Medicaid
Revenue Sources
Concentration Risk, Percentage	80.00%

Certain Significant Risks and_4

Certain Significant Risks and Uncertainties - Concentration of Credit Risk (Details) $ in Millions	12 Months Ended
	Dec. 31, 2020USD ($)customer
Related Party Customer One | Rehabilitation therapy service
Concentration Risk
Contract receivables, net | $	$ 30.5
Credit Concentration Risk [Member] | Accounts Receivable | Minimum | Rehabilitation Services
Concentration Risk
Number of distinct customers | customer	150
Credit Concentration Risk [Member] | Related Party Customer One | Accounts Receivable | Rehabilitation therapy service
Concentration Risk
Concentration risk (as a percent)	44.00%

Significant Transactions and _2

Significant Transactions and Events - COVID-19 (Details) $ in Thousands	Jul. 22, 2020USD ($)	Dec. 31, 2020USD ($)facility	Jun. 30, 2020USD ($)	Mar. 31, 2020	Dec. 31, 2020USD ($)facility
Unusual or Infrequent Item, or Both [Line Items]
Number of facilities, COVID-19, patients, residents, and employees, positive cases | facility		292			292
Number of facilities | facility		341			341
Number of facilities, COVID-19, positive cases, concentration percentage, New Jersey, Connecticut, Massachusetts, Pennsylvania, and Maryland (as a percent)		71.00%			71.00%
Number of facilities, operating beds, concentration percentage, New Jersey, Connecticut, Massachusetts, Pennsylvania, and Maryland (as a percent)		60.00%			60.00%
Medicare advance payments					$ 155,824
Federal stimulus - COVID-19 other income					306,067
COVID 19
Unusual or Infrequent Item, or Both [Line Items]
Operating occupancy, skilled nursing facilities (as a percent)		76.60%		88.20%
COVID-19 incremental operating expense					257,900
Medicare advance payments			$ 156,800
Relief grants other forms of federal relief					275,400
Relief grants	$ 68,300				198,700
Coronavirus Aid, Relief, and Economic Security Act, payroll tax deferral program, amount realized					92,200
COVID-19 state funding committed		$ 124,700			124,700
Additional FMAP reimbursement relief					82,300
Federal stimulus - COVID-19 other income					306,100
Medicare advance payments, contract liability, current		118,800			118,800
Medicare advance payments, contract liability, noncurrent		36,700			36,700
Revenue from suspension of sequestration					8,400
COVID-19 related Medicaid reimbursement relief					39,100
Regulatory and Reimbursement Relief Income					3,300
COVID 19 | Other long-term liabilities
Unusual or Infrequent Item, or Both [Line Items]
Deferred payroll taxes		$ 46,100			$ 46,100

Significant Transactions and _3

Significant Transactions and Events - Strategic Partnerships - Equity Method Investments (Details)	Oct. 01, 2020USD ($)facility	May 15, 2020USD ($)facility	Feb. 01, 2020USD ($)facility	Mar. 31, 2020USD ($)	Sep. 30, 2019USD ($)	Dec. 31, 2020USD ($)facility	Dec. 31, 2019USD ($)
Equity Method Investments
Repayments of loans				$ 49,600,000	$ 9,600,000
Investments in joint venture						$ 17,520,000
Gain (loss) on early extinguishment of debt						$ (8,979,000)	$ 122,000
NewGen Partnership
Equity Method Investments
Number of facilities transitioned operational responsibility | facility						24
Number of facilities transferred operations						18
Repayments of loans			$ 33,700,000
Ownership interest (as a percent)			50.00%			50.00%
Investments in joint venture			$ 14,900,000
Amount of finance provided to partnership			9,000,000
Facilities transitioned operational responsibility, gain (loss) on sale of assets and transition of leased facilities			58,800,000
Gain (loss) on early extinguishment of debt			$ (1,000,000)
Investment in unconsolidated joint venture						$ 25,100,000
NewGen Partnership | Twenty-three Facilities in California, Washington and Nevada
Equity Method Investments
Number of facilities transitioned operational responsibility | facility						24
NewGen Partnership | Nineteen facilities in California, Washington and Nevada
Equity Method Investments
Number of facilities transitioned operational responsibility | facility			19
Number of facilities sold real estate and operations | facility			6
Number of facilities transferred operations | facility			13
Facilities transitioned operational responsibility, net transaction proceeds			$ 78,700,000
NewGen Partnership | Four leased facilities in California
Equity Method Investments
Number of facilities transitioned operational responsibility | facility		4
Facilities transitioned operational responsibility, annual revenues		$ 55,000,000
Facilities transitioned operational responsibility, pre-tax gain (loss)		$ (500,000)
NewGen Partnership | One Leased Facility in Washington
Equity Method Investments
Number of facilities transitioned operational responsibility | facility	1
Facilities transitioned operational responsibility, annual revenues	$ 12,300,000
Facilities transitioned operational responsibility, pre-tax gain (loss)	$ 200,000

Significant Transactions and _4

Significant Transactions and Events - Strategic Partnerships - Variable Interest Entities - General Information (Details) $ in Thousands	Jul. 02, 2020USD ($)facility	Jan. 10, 2020USD ($)facility	Sep. 12, 2019USD ($)facility	Jan. 31, 2019USD ($)facility	Dec. 31, 2020USD ($)facility	Dec. 31, 2019USD ($)
Variable Interest Entities
Net property and equipment					$ 984,712	$ 962,105
Affiliates of Cascade Capital Group, LLC
Variable Interest Entities
Number of facilities acquired | facility	8
Variable Interest Entity, Primary Beneficiary
Variable Interest Entities
Net property and equipment					$ 735,100	$ 535,900
Cascade Partnership
Variable Interest Entities
Number of facilities acquired | facility	9
Variable interest entity, equity interest	$ 20,300
Variable interest entity, ownership interest (as a percent)	49.00%
Purchase price of facilities acquired	$ 223,600
Net property and equipment	208,600
Non-recourse debt	190,300
Non-controlling interest	$ 21,200
Next Partnership
Variable Interest Entities
Number of facilities acquired | facility				22
Variable interest entity, equity interest				$ 16,000
Variable interest entity, ownership interest (as a percent)				46.00%	46.00%
Purchase price of facilities acquired				$ 252,500
Net property and equipment				173,500
Non-recourse debt				165,700
Non-controlling interest				$ 18,500
Next Partnership | Welltower, Inc.
Variable Interest Entities
Number of facilities acquired | facility				15
Vantage Point Partnership
Variable Interest Entities
Number of facilities acquired | facility		1	18
Variable interest entity, equity interest			$ 37,500
Variable interest entity, ownership interest (as a percent)			30.00%		30.00%
Purchase price of facilities acquired		$ 9,100	$ 339,200
Net property and equipment		9,100	339,200
Non-recourse debt		$ 7,300	306,100
Number of properties | facility					19
Non-controlling interest			$ 8,500
Vantage Point Partnership | Welltower, Inc.
Variable Interest Entities
Number of facilities acquired | facility			4
Vantage Point Partnership | Second Spring Healthcare Investments
Variable Interest Entities
Number of facilities acquired | facility			14
Vantage Point Partnership | Vantage Point Capital, LLC
Variable Interest Entities
Variable interest entity, equity interest, partner			$ 85,300
Variable interest entity, equity interest, partner, equity investment			8,500
Variable interest entity, equity interest, partner, loan formation			$ 76,800

Significant Transactions and _5

Significant Transactions and Events - Strategic Partnerships - Variable Interest Entities - Master Leases (Details) $ in Millions	Jul. 02, 2020USD ($)facilityOption	Jan. 10, 2020USD ($)	Sep. 12, 2019USD ($)Option	Jan. 31, 2019USD ($)Option	Dec. 31, 2020
Leases
Options to renew					true
Affiliates of Cascade Capital Group, LLC, Master Lease Agreement
Leases
Number of facilities | facility	9
Term of operating lease	10 years
Number of renewal options | Option	1
Options to renew	true
Operating lease renewal term	5 years
Annual base rent	$ 20.7
No rent escalation period	5 years
Annual rent escalation (as a percent)	2.50%
Number of facilities, fixed price option | facility	9
Fixed price option to purchase facilities	$ 251.6
Next Partnership, Master Lease Agreement
Leases
Term of operating lease				15 years
Number of renewal options | Option				2
Options to renew				true
Operating lease renewal term				5 years
Annual base rent				$ 19.5
No rent escalation period				5 years
Annual rent escalation (as a percent)				2.00%
Fixed price option to purchase facilities, premium over original purchase price (as a percent)				10.00%
Lessee, Operating Lease, Annual Rent Credit Received				$ 17.2
Vantage Point Partnership, Master Lease Agreement
Leases
Term of operating lease			15 years
Number of renewal options | Option			2
Options to renew			true
Operating lease renewal term			5 years
Annual base rent			$ 33.1
No rent escalation period			4 years
Annual rent escalation (as a percent)			2.00%
Fixed price option to purchase facilities, premium over original purchase price (as a percent)			10.00%
Lessee, Operating Lease, Annual Rent Credit Received		$ 0.7	$ 30.3

Significant Transactions and _6

Significant Transactions and Events - Divestiture of Non-Strategic Facilities - Owned Facilities (Details) $ in Thousands	Jul. 02, 2020USD ($)facility	Jan. 31, 2019USD ($)facility	Dec. 31, 2020USD ($)facility	Sep. 30, 2020USD ($)facility	Jun. 30, 2020USD ($)facility	Mar. 31, 2020USD ($)facility	Dec. 31, 2019USD ($)facility	Sep. 30, 2019USD ($)facility	Jun. 30, 2019USD ($)facility	Dec. 31, 2020USD ($)facility	Dec. 31, 2019USD ($)facility
Divestitures
Repayments of loans						$ 49,600		$ 9,600
Gain (loss) on early extinguishment of debt										$ (8,979)	$ 122
Prepayment penalties and other closing costs at extinguishment									$ 2,400
Secured Debt
Divestitures
Repayments of loans			$ 22,400		$ 22,700
Gain (loss) on early extinguishment of debt			$ (2,400)		$ (1,400)	$ (3,000)
HUD insured loans
Divestitures
Repayments of loans	$ 10,500								$ 41,800
Gain (loss) on early extinguishment of debt							$ 2,600
Mid Cap Real Estate Loans
Divestitures
Repayments of loans				$ 5,500
Seven Facilities in Texas, Real Property
Divestitures
Number of facilities sold | facility							7
Disposal Group, Disposed of by Sale, Not Discontinued Operations
Divestitures
Number of facilities sold | facility										19	13
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Four Owned Skilled Nursing Facilities, Sold, First Quarter, 2020
Divestitures
Number of facilities sold | facility						4
Consideration						$ 82,600
Gain (loss) recognized in disposal group						$ 27,400
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Three Skilled Nursing Facilities, Two in New Jersey and One in Maryland
Divestitures
Number of facilities sold | facility					3
Consideration					$ 45,800
Gain (loss) recognized in disposal group					$ 16,100
Disposal Group, Disposed of by Sale, Not Discontinued Operations | One Owned Skilled Nursing Facility in Rhode Island
Divestitures
Number of facilities sold | facility				1
Consideration				$ 10,500
Annual revenues				9,900
Pre-tax net income (loss)				200
Gain (loss) recognized in disposal group				$ 5,500
Disposal Group, Disposed of by Sale, Not Discontinued Operations | One Skilled Nursing Facility (Sold to Affiliate of Cascade Capital Group, LLC) | Affiliate of Cascade Capital Group, LLC
Divestitures
Number of facilities sold | facility	1
Consideration	$ 26,100
Aggregate prepayment penalties and other closing costs	$ 1,000
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Seven Skilled Nursing Facilities and One Assisted Senior Living Facility in Georgia, New Jersey, Virgina, and Maryland (Sold to Affiliates of Vantage Point Partnership) | Affiliates of Vantage Point Partnership
Divestitures
Consideration								$ 91,800
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Seven Skilled Nursing Facilities (Sold to Affiliates of Vantage Point Partnership) | Affiliates of Vantage Point Partnership
Divestitures
Number of facilities sold | facility								7
Disposal Group, Disposed of by Sale, Not Discontinued Operations | One Assisted Senior Living Facility (Sold to Affiliates of Vantage Point Partnership) | Affiliates of Vantage Point Partnership
Divestitures
Number of facilities sold | facility								1
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Five Owned Facilities, Sold, Fourth Quarter, 2020
Divestitures
Number of facilities sold | facility			5
Consideration			$ 40,900							$ 40,900
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Seven Skilled Nursing Facilities, Acquired by Next Partnership | Next Partnership
Divestitures
Number of facilities sold | facility		7
Consideration		$ 79,000
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Five Skilled Nursing Facilities in California, Real Property
Divestitures
Number of facilities sold | facility									5
Consideration									$ 56,500
Annual revenues									53,000
Pre-tax net income (loss)									1,600
Gain (loss) recognized in disposal group									$ 25,000
Disposal Group, Disposed of by Sale, Not Discontinued Operations | One Skilled Nursing Facility and One Assisted Senior Living Facility in California
Divestitures
Consideration								$ 11,500
Annual revenues								10,400
Pre-tax net income (loss)								100
Gain (loss) recognized in disposal group								$ 600
Disposal Group, Disposed of by Sale, Not Discontinued Operations | One Skilled Nursing Facility in California
Divestitures
Number of facilities sold | facility								1
Disposal Group, Disposed of by Sale, Not Discontinued Operations | One Assisted Senior Living Facility in California
Divestitures
Number of facilities sold | facility								1
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Seven Facilities in Texas, Real Property
Divestitures
Number of facilities sold | facility							7
Consideration							$ 20,100				$ 20,100
Gain (loss) recognized in disposal group							$ 3,300
Disposal Group, Held-for-sale, Not Discontinued Operations | One U.S. Department of Housing and Urban Development Insured Skilled Nursing Facility in California
Divestitures
Number of facilities classified as held for sale | facility							1				1

Significant Transactions and _7

Significant Transactions and Events - Divestiture of Non-Strategic Facilities - Leased Facilities (Details) $ in Thousands	Jan. 10, 2020USD ($)	Dec. 31, 2020USD ($)facility	Jun. 30, 2020facility	Mar. 31, 2020facility	Dec. 31, 2019USD ($)facility	Sep. 30, 2019USD ($)facility	Jun. 30, 2019USD ($)facility	Mar. 31, 2019USD ($)facility	Dec. 31, 2020USD ($)facility	Dec. 31, 2019USD ($)facility
Leases
Number of facilities divested | facility			12	1					63	44
Gain (loss) on lease termination or modification									$ 98,586	$ 95,779
Loss (gain) on early extinguishment of debt									$ 8,979	$ (122)
Next Partnership
Leases
Number of facilities divested | facility									39
One Skilled Nursing Facility in Massachusetts, Omega Healthcare Investors, Inc.
Leases
Number of facilities sold by counterparty | facility				1
Four Facilities, Divested or Closed, Third Quarter, 2019, Omega Healthcare Investors, Inc
Leases
Number of facilities divested or closed | facility						4
Three Facilities, Divested, Third Quarter, 2019, Omega Healthcare Investors, Inc
Leases
Number of facilities divested | facility						3
Annual rent credit						$ 1,900
Thirteen Skilled Nursing Facilities, Divested, Fourth Quarter 2020
Leases
Number of facilities divested | facility		13
Gain (loss) on lease termination or modification		$ 10,800
Thirty-five Facilities Divested in 2019
Leases
Number of facilities divested | facility										35
Welltower, Inc.
Leases
Gain (loss) on lease termination or modification	$ 200
Nine Facilities in New Jersey and Ohio, Welltower, Inc.
Leases
Number of facilities divested | facility								9
Gain (loss) on lease termination or modification								$ (3,500)
Annual revenues generated								90,200
Annual pre-tax income (loss) generated								$ (6,000)
Two Skilled Nursing Facilities in Connecticut, Welltower, Inc.
Leases
Number of facilities divested | facility							2
One Facility in Ohio
Leases
Number of facilities closed | facility								1
Gain (loss) on lease termination or modification								$ (200)
Annual revenues generated								7,700
Annual pre-tax income (loss) generated								$ (1,600)
One Behavioral Health Center in California
Leases
Number of facilities divested | facility							1
Gain (loss) on lease termination or modification							$ (100)
Annual revenues generated							3,100
Annual pre-tax income (loss) generated							$ (300)
Three Skilled Nursing Facilities, Two in Connecticut and One in Ohio
Leases
Number of facilities divested | facility							3
Gain (loss) on lease termination or modification							$ (1,100)
Annual revenues generated							24,700
Annual pre-tax income (loss) generated							$ (2,900)
Twelve Facilities, Divested and Closed, Third Quarter, 2019
Leases
Number of facilities divested | facility						11
Number of facilities closed | facility						1
Number of facilities divested or closed | facility						12
Gain (loss) on lease termination or modification						$ (3,500)
Annual revenues generated						75,600
Annual pre-tax income (loss) generated						$ (4,600)
Nine Facilities, Inpatient, in Ohio
Leases
Number of facilities divested or closed | facility						9
Three Facilities, One in Massachusetts, One in Utah, and One in Idaho
Leases
Number of facilities divested or closed | facility						3
Seven Skilled Nursing Facilities and One Assisted Senior Living Facility in Georgia, New Jersey, Virgina, and Maryland, and One Skilled Nursing Facility in Georgia
Leases
Number of facilities divested | facility						9
Seven Skilled Nursing Facilities and One Assisted Senior Living Facility in Georgia, New Jersey, Virgina, and Maryland (Sold to Affiliates of Vantage Point Partnership)
Leases
Number of facilities divested | facility						7
Number of facilities divested, subject to real estate loans | facility						3
Number of facilities divested, subject to insured loans | facility						2
Gain (loss) on lease termination or modification						$ 57,800
Annual revenues generated						84,100
Annual pre-tax income (loss) generated						$ 2,600
One Skilled Nursing Facility in Georgia
Leases
Number of facilities divested | facility						1
Two Skilled Nursing Facilities, Divested, Fourth Quarter, 2019
Leases
Number of facilities divested | facility					2
Gain (loss) on lease termination or modification					$ (1,300)
Annual revenues generated					28,100
Annual pre-tax income (loss) generated					$ (1,700)

Significant Transactions and _8

Significant Transactions and Events - Divestiture of Non-Strategic Facilities - Owned and Leased Facilities (Details) - USD ($) $ in Millions	3 Months Ended
	Dec. 31, 2020	Jun. 30, 2020	Mar. 31, 2020
Significant Transactions and Events
Non-strategic facilities, sold and divested, annual revenues	$ 173.9	$ 136.1	$ 55.2
Non-strategic facilities, sold and divested, pre-tax income (loss)	$ (8.8)	$ (1.8)	$ 0.5

Significant Transactions and _9

Significant Transactions and Events - Lease Transactions (Details)	3 Months Ended		12 Months Ended
	Sep. 30, 2019USD ($)facility	Mar. 31, 2019facility	Dec. 31, 2020USD ($)facilitylease	Dec. 31, 2019USD ($)facility
Lessee, gain (loss) on lease termination or modification
Gain (loss) on lease termination or modification			$ 98,586,000	$ 95,779,000
Operating lease right-of-use assets			1,715,532,000	2,399,505,000
Current portion of operating lease obligations			$ 2,071,841,000	140,887,000
Note Payable Due April 30, 2020 | Note Payable
Leases
Aggregate principal amount				$ 15,000,000
Welltower Inc, Master Lease Agreement
Leases
Lessee, Operating Lease, Lease Termination, Facilities, Number | facility			1	30
Lessee, Operating Lease, Lease Termination, Sold, Facilities, Number | facility				15
Lessee, Operating Lease, Annual Rent Credit Received			$ 1,100,000	$ 25,900,000
Lessee, gain (loss) on lease termination or modification
Finance lease right-of-use assets, written-off				11,700,000
Finance lease liabilities, written-off				22,400,000
Operating lease ROU assets, written-off			37,600,000	112,800,000
Operating lease liabilities, written-off			57,400,000	150,400,000
Gain (loss) on lease termination or modification			$ 19,800,000	$ 48,300,000
Omega Healthcare Investors, Inc, Master Lease Agreement
Leases
Lessee, Operating Lease, Lease Termination, Facilities, Number | facility			5
Lessee, Operating Lease, Annual Rent Credit Received			$ 2,600,000
Lessee, gain (loss) on lease termination or modification
Operating lease ROU assets, written-off			16,000,000
Operating lease liabilities, written-off			24,600,000
Gain (loss) on lease termination or modification			8,600,000
Omega Healthcare Investors, Inc, Master Lease Agreement, Three Facilities
Leases
Number of facilities terminated from master lease agreement | facility				3
Lessee, Operating Lease, Annual Rent Credit Received				$ 1,900,000
Lessee, gain (loss) on lease termination or modification
Finance lease right-of-use assets, written-off				10,100,000
Finance lease liabilities, written-off				16,800,000
Operating lease ROU assets, written-off				164,600,000
Operating lease liabilities, written-off				181,300,000
Gain (loss) on lease termination or modification				23,400,000
Gain (loss) on reassessment of the assumed timing of a variable rent buyout				$ 1,900,000
Omega Healthcare Investors, Inc, Master Lease Agreement, Nine Skilled Nursing Facilities and One Assisted Living Facility in New Mexico and Arizona
Leases
Lessee, Operating Lease, Amended Lease, Facilities, Number | facility				10
Operating Lease, Right-of-Use Asset, Increase (Decrease)				$ 10,600,000
Operating Lease, Liability, Increase (Decrease)				$ 10,600,000
Omega Healthcare Investors, Inc, Master Lease Agreement, Nine Skilled Nursing Facilities
Leases
Lessee, Operating Lease, Amended Lease, Facilities, Number | facility				9
Omega Healthcare Investors, Inc, Master Lease Agreement, One Assisted Living Facility
Leases
Number of facilities terminated from master lease agreement | facility				1
Affiliates of Cascade Capital Group, LLC, Master Lease Agreement and Second Spring Healthcare Investments, Master Lease Agreement
Lessee, gain (loss) on lease termination or modification
Gain (loss) on lease termination or modification			$ 36,100,000
Second Spring Healthcare Investments, Master Lease Agreement
Leases
Lessee, Operating Lease, Lease Termination, Facilities, Number | facility			22	14
Lessee, Operating Lease, Annual Rent Credit Received			$ 41,200,000	$ 28,400,000
Operating Lease, Right-of-Use Asset, Increase (Decrease)	$ 54,400,000		304,000,000
Operating Lease, Liability, Increase (Decrease)	33,300,000		$ 340,100,000
Lessee, gain (loss) on lease termination or modification
Finance lease right-of-use assets, written-off				5,900,000
Finance lease liabilities, written-off				8,800,000
Operating lease ROU assets, written-off				202,700,000
Operating lease liabilities, written-off				205,400,000
Gain (loss) on lease termination or modification	$ 26,900,000
Three Master Lease Agreements Amended in 2020
Leases
Lessee, Operating Lease, Amended Lease, Master Leases, Number | lease			3
Lessee, Operating Lease, Amended Lease, Facilities, Number | facility			13
Operating Lease, Right-of-Use Asset, Increase (Decrease)			$ 59,600,000
Operating Lease, Liability, Increase (Decrease)			64,000,000
Lessee, gain (loss) on lease termination or modification
Gain (loss) on lease termination or modification			4,400,000
Lease Agreements Extended in 2020
Leases
Operating Lease, Right-of-Use Asset, Increase (Decrease)			28,000,000
Operating Lease, Liability, Increase (Decrease)			$ 28,000,000
Nineteen Skilled Nursing Facilities, Master Lease Agreement
Leases
Lessee, Operating Lease, Amended Lease, Facilities, Number | facility		19
Lessee, Operating Lease, Term of Contract, Extension		5 years
Operating Lease, Right-of-Use Asset, Increase (Decrease)				77,200,000
Operating Lease, Liability, Increase (Decrease)				$ 77,200,000
One Master Lease Agreement Amended in 2019
Leases
Lessee, Operating Lease, Lease Termination, Facilities, Number | facility	6
Lessee, gain (loss) on lease termination or modification
Operating lease ROU assets, written-off	$ 4,900,000
Gain (loss) on lease termination or modification	$ (4,900,000)
NewGen Partnership
Lessee, gain (loss) on lease termination or modification
Number of facilities transferred operations			18
Operating lease right-of-use assets			$ 17,000,000
Current portion of operating lease obligations			26,800,000
Gain (loss) on reassessment of the assumed timing of a variable rent buyout			$ 19,700,000

Net Revenues and Accounts Rec_3

Net Revenues and Accounts Receivable (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Disaggregation of revenue
Total net revenues	$ 3,906,223	$ 4,565,834
Inpatient Services
Disaggregation of revenue
Total net revenues	3,338,855	3,956,032
Rehabilitation therapy service
Disaggregation of revenue
Total net revenues	401,204	462,546
Other Services
Disaggregation of revenue
Total net revenues	166,164	147,256
Medicare
Disaggregation of revenue
Net revenues	785,056	891,064
Medicare | Inpatient Services
Disaggregation of revenue
Net revenues	697,160	800,253
Medicare | Rehabilitation therapy service
Disaggregation of revenue
Net revenues	87,896	90,811
Medicaid
Disaggregation of revenue
Net revenues	1,983,596	2,315,623
Medicaid | Inpatient Services
Disaggregation of revenue
Net revenues	1,982,156	2,313,479
Medicaid | Rehabilitation therapy service
Disaggregation of revenue
Net revenues	1,440	2,144
Insurance
Disaggregation of revenue
Net revenues	373,331	485,408
Insurance | Inpatient Services
Disaggregation of revenue
Net revenues	351,293	463,135
Insurance | Rehabilitation therapy service
Disaggregation of revenue
Net revenues	22,038	22,273
Private
Disaggregation of revenue
Net revenues	249,153	310,318
Private | Inpatient Services
Disaggregation of revenue
Net revenues	248,962	310,022
Private | Rehabilitation therapy service
Disaggregation of revenue
Net revenues	191	296
Assisted living | Inpatient Services
Disaggregation of revenue
Revenue not accounted for under Topic 606	79,300	93,100
Third party providers
Disaggregation of revenue
Net revenues	356,534	415,218
Third party providers | Rehabilitation therapy service
Disaggregation of revenue
Net revenues	264,893	336,509
Third party providers | Other Services
Disaggregation of revenue
Net revenues	91,641	78,709
Other
Disaggregation of revenue
Net revenues	158,553	148,203
Other | Inpatient Services
Disaggregation of revenue
Net revenues	59,284	69,143
Other | Rehabilitation therapy service
Disaggregation of revenue
Net revenues	24,746	10,513
Other | Other Services
Disaggregation of revenue
Net revenues	$ 74,523	$ 68,547

(Loss) Earnings Per Share - Gen

(Loss) Earnings Per Share - General Information (Details) shares in Millions	12 Months Ended
	Dec. 31, 2020classshares	Dec. 31, 2019shares
Class of Stock [Line Items]
Number of classes of common stock | class	3
Class C Common Stock
Class of Stock [Line Items]
Voting ratio	1
Number of units exchanged	0.9	3.5
Class A Common Stock
Class of Stock [Line Items]
Number of shares converted	0.9	3.5

(Loss) Earnings Per Share - Cal

(Loss) Earnings Per Share - Calculation of Basic Net (Loss) Income Per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Numerator:
Net (loss) income	$ (103,367)	$ 7,474
Less: Net loss attributable to noncontrolling interests	44,404	7,145
Net (loss) income attributable to Genesis Healthcare, Inc. - basic	$ (58,963)	$ 14,619
Denominator:
Weighted-average shares outstanding for basic net (loss) income per share (in shares)	111,851	107,286
Basic net (loss) income per common share
Basic net (loss) income per common share attributable to Genesis Healthcare, Inc. (in dollars per share)	$ (0.53)	$ 0.14

(Loss) Earnings Per Share - C_2

(Loss) Earnings Per Share - Calculation of Diluted Net (Loss) Income Per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Numerator:
Net (loss) income	$ (103,367)	$ 7,474
Less: Net loss attributable to noncontrolling interests	44,404	7,145
Net (loss) income attributable to Genesis Healthcare, Inc. - basic	(58,963)	14,619
Plus: Assumed conversion of noncontrolling interests		1,868
Net (loss) income available to common stockholders after assumed conversions	$ (58,963)	$ 16,487
Denominator:
Weighted-average shares outstanding for basic net income (loss) per share	111,851	107,286
Plus: Assumed conversion of noncontrolling interests		57,074
Plus: Unvested restricted stock units and stock warrants		954
Adjusted weighted-average common shares outstanding, diluted	111,851	165,314
Diluted net (loss) income per common share
Diluted net (loss) income per common share attributable to Genesis Healthcare, Inc. (in dollars per share)	$ (0.53)	$ 0.10

(Loss) Earnings Per Share - Ant

(Loss) Earnings Per Share - Antidilutive Securities (Details) - shares shares in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
(Loss) Earnings Per Share
Antidilutive shares	55.7
Number of units attributed to the noncontrolling interests outstanding	55.3	56.2

Segment Information - Segment R

Segment Information - Segment Reporting (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2020USD ($)segment	Dec. 31, 2019USD ($)
Segment Reporting Information
Number of reportable segments | segment	3
Net revenues	$ 3,906,223	$ 4,565,834
Increase (Decrease) in Net Revenue From Prior Period	(659,611)
Salaries, wages and benefits	2,256,200	2,485,010
Other operating expenses	1,270,571	1,374,847
General and administrative costs	175,057	144,471
Lease expense	366,339	387,063
Depreciation and amortization expense	107,833	123,159
Interest expense	135,439	180,392
Loss (gain) on early extinguishment of debt	8,979	(122)
Investment income	(3,989)	(7,296)
Other income	(202,272)	(173,505)
Transaction costs	34,279	26,362
Long-lived asset impairments	179,000	16,937
Federal and state stimulus - COVID-19 other income	(306,067)
Equity in net income of unconsolidated affiliates	(8,169)	(712)
(Loss) income before income tax (benefit) expense	(106,977)	9,228
Income tax (benefit) expense	(3,610)	1,754
Net (loss) income	$ (103,367)	$ 7,474
Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	100.00%	100.00%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(14.40%)
Inpatient Services
Segment Reporting Information
Net revenues	$ 3,338,855	$ 3,956,032
Increase (Decrease) in Net Revenue From Prior Period	$ (617,177)
Inpatient Services | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	85.50%	86.50%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(15.60%)
Inpatient Services | Product Concentration Risk | Revenue
Segment Reporting Information
Concentration Risk, Percentage	86.00%
Inpatient Services | Skilled Nursing Facilities
Segment Reporting Information
Net revenues	$ 3,254,715	$ 3,857,793
Increase (Decrease) in Net Revenue From Prior Period	$ (603,078)
Inpatient Services | Skilled Nursing Facilities | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	83.40%	84.40%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(15.60%)
Inpatient Services | Assisted Senior Living Facilities - DO NOT USE ON DISPOSAL GROUPS AXIS OR EXTENDED AXIS
Segment Reporting Information
Net revenues	$ 79,314	$ 93,054
Increase (Decrease) in Net Revenue From Prior Period	$ (13,740)
Inpatient Services | Assisted Senior Living Facilities - DO NOT USE ON DISPOSAL GROUPS AXIS OR EXTENDED AXIS | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	2.00%	2.00%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(14.80%)
Inpatient Services | Administration of third party facilities
Segment Reporting Information
Net revenues	$ 7,866	$ 8,310
Increase (Decrease) in Net Revenue From Prior Period	$ (444)
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	(5.30%)
Rehabilitation therapy service
Segment Reporting Information
Net revenues	$ 401,204	$ 462,546
Increase (Decrease) in Net Revenue From Prior Period	$ (61,342)
Rehabilitation therapy service | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	10.20%	10.20%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(13.30%)
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	$ 622,601	$ 738,124
Increase (Decrease) in Net Revenue From Prior Period	$ (115,523)
Rehabilitation therapy service | Therapy Services | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	15.90%	16.20%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(15.70%)
Other Services
Segment Reporting Information
Net revenues	$ 166,164	$ 147,256
Increase (Decrease) in Net Revenue From Prior Period	$ 18,908
Other Services | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	4.30%	3.30%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	12.80%
Other Services | Other Services
Segment Reporting Information
Net revenues	$ 263,806	$ 198,920
Increase (Decrease) in Net Revenue From Prior Period	$ 64,886
Other Services | Other Services | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	6.80%	4.40%
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	32.60%
Operating Segments | Inpatient Services
Segment Reporting Information
Net revenues	$ 3,341,895	$ 3,959,157
Salaries, wages and benefits	1,593,013	1,761,273
Other operating expenses	1,482,488	1,599,549
Lease expense	362,384	382,897
Depreciation and amortization expense	91,084	99,529
Interest expense	57,634	83,887
Other income	(203,100)	(172,709)
Long-lived asset impairments	179,000	16,937
Federal and state stimulus - COVID-19 other income	(301,719)
(Loss) income before income tax (benefit) expense	81,111	187,794
Net (loss) income	81,111	187,794
Operating Segments | Rehabilitation therapy service
Segment Reporting Information
Net revenues	622,601	738,124
Salaries, wages and benefits	501,093	601,196
Other operating expenses	31,431	44,088
Lease expense	1,019	1,297
Depreciation and amortization expense	6,731	12,230
Interest expense	27	55
Other income	621	(926)
Federal and state stimulus - COVID-19 other income	(3,649)
(Loss) income before income tax (benefit) expense	85,328	80,184
Net (loss) income	85,328	80,184
Operating Segments | Other Services
Segment Reporting Information
Net revenues	263,806	198,676
Salaries, wages and benefits	162,094	122,541
Other operating expenses	79,194	62,104
Lease expense	1,739	1,463
Depreciation and amortization expense	825	720
Interest expense	38	35
Other income	207	112
Federal and state stimulus - COVID-19 other income	(699)
(Loss) income before income tax (benefit) expense	20,408	11,701
Net (loss) income	20,408	11,701
Corporate, Non-Segment
Segment Reporting Information
Net revenues		244
General and administrative costs	175,057	144,471
Lease expense	1,197	1,406
Depreciation and amortization expense	9,457	10,775
Interest expense	82,460	97,831
Loss (gain) on early extinguishment of debt	8,979	(122)
Investment income	(8,709)	(8,712)
Other income		18
Transaction costs	34,279	26,362
Equity in net income of unconsolidated affiliates	(7,091)	4,091
(Loss) income before income tax (benefit) expense	(295,629)	(275,876)
Income tax (benefit) expense	(3,610)	1,754
Net (loss) income	(292,019)	(277,630)
Elimination
Segment Reporting Information
Net revenues	(322,079)	(330,367)
Other operating expenses	(322,542)	(330,894)
Depreciation and amortization expense	(264)	(95)
Interest expense	(4,720)	(1,416)
Investment income	4,720	1,416
Equity in net income of unconsolidated affiliates	(1,078)	(4,803)
(Loss) income before income tax (benefit) expense	1,805	5,425
Net (loss) income	1,805	5,425
Elimination | Inpatient Services
Segment Reporting Information
Net revenues	(3,040)	$ (3,125)
Increase (Decrease) in Net Revenue From Prior Period	$ 85
Elimination | Inpatient Services | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	(0.10%)	(0.10%)
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	2.70%
Elimination | Rehabilitation therapy service
Segment Reporting Information
Net revenues	$ (221,397)	$ (275,578)
Increase (Decrease) in Net Revenue From Prior Period	$ 54,181
Elimination | Rehabilitation therapy service | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	(5.70%)	(6.00%)
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	19.70%
Elimination | Other Services
Segment Reporting Information
Net revenues	$ (97,642)	$ (51,664)
Increase (Decrease) in Net Revenue From Prior Period	$ (45,978)
Elimination | Other Services | Product Concentration Risk
Segment Reporting Information
Concentration Risk, Percentage	(2.50%)	(1.10%)
Increase (Decrease) in Net Revenue as Percent of Prior Period Revenue	(89.00%)

Segment Information - Assets an

Segment Information - Assets and Goodwill by Segment (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Segment Reporting, Asset Reconciling Item
Segment total assets	$ 4,062,246	$ 4,662,140
Corporate and Eliminations
Segment Reporting, Asset Reconciling Item
Segment total assets	206,932	108,706
Inpatient Services
Segment Reporting, Asset Reconciling Item
Segment total assets	3,555,291	4,221,579
Rehabilitation therapy service
Segment Reporting, Asset Reconciling Item
Segment total assets	252,575	281,978
Other Services
Segment Reporting, Asset Reconciling Item
Segment total assets	$ 47,448	$ 49,877

Restricted Investments in Mar_3

Restricted Investments in Marketable Securities - Components (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Schedule of Available-for-sale Securities [Line Items]
Amortized cost	$ 151,457	$ 136,053
Unrealized gains	2,397	942
Unrealized losses, less than 12 months	(1)	(39)
Unrealized losses, greater than 12 months	(1)	(14)
Total fair value	153,852	136,942
Less: Current portion of restricted investments	(39,526)	(31,855)
Long-term restricted investments	114,326	105,087
Mortgage/Government Backed Securities
Schedule of Available-for-sale Securities [Line Items]
Amortized cost	23,727	20,957
Unrealized gains	166	90
Unrealized losses, less than 12 months		(17)
Unrealized losses, greater than 12 months		(7)
Total fair value	23,893	21,023
Corporate Bonds
Schedule of Available-for-sale Securities [Line Items]
Amortized cost	59,936	48,362
Unrealized gains	867	566
Unrealized losses, less than 12 months	(1)
Unrealized losses, greater than 12 months		(2)
Total fair value	60,802	48,926
Government Bonds
Schedule of Available-for-sale Securities [Line Items]
Amortized cost	67,794	66,734
Unrealized gains	1,364	286
Unrealized losses, less than 12 months		(22)
Unrealized losses, greater than 12 months	(1)	(5)
Total fair value	$ 69,157	$ 66,993

Restricted Investments in Mar_4

Restricted Investments in Marketable Securities - General Information (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Proceeds from maturities of restricted investments	$ 35.1	$ 69.2
Proceeds from sales of investments	29	$ 2
Restricted cash pledged as security	2.6
Restricted investments pledged as security, amortized cost	151.5
Market value of restricted investments pledged as security	153.9
Letter of Credit
Letters of credit issued	$ 143.3

Restricted Investments in Mar_5

Restricted Investments in Marketable Securities - Maturities (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
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	$ 36,550
Amortized cost, Due after 1 year through 5 years	111,907
Amortized cost, Due after 10 years	3,000
Total amortized cost	151,457	$ 136,053
Restricted investments fair value maturity
Fair value, Due in one year or less	36,834
Fair value, Due after 1 year through 5 years	114,019
Fair value, Due after 10 years	2,999
Total fair value	$ 153,852	$ 136,942

Property and Equipment - Tabula

Property and Equipment - Tabular Disclosure (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Property and Equipment
Gross property and equipment	$ 1,414,417	$ 1,393,466
Less: accumulated depreciation	(429,705)	(431,361)
Net property and equipment	984,712	962,105
Land, buildings and improvements
Property and Equipment
Gross property and equipment	1,052,095	1,004,447
Equipment, furniture and fixtures
Property and Equipment
Gross property and equipment	358,546	386,248
Construction in progress
Property and Equipment
Gross property and equipment	$ 3,776	$ 2,771

Property and Equipment - Consol

Property and Equipment - Consolidated VIEs (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Property and Equipment
Net property and equipment	$ 984,712	$ 962,105
Variable Interest Entity, Primary Beneficiary
Property and Equipment
Net property and equipment	$ 735,100	$ 535,900

Property and Equipment - Impair

Property and Equipment - Impairment (Details) - USD ($) $ in Thousands	9 Months Ended		12 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2020	Dec. 31, 2019
Property and Equipment
Property and equipment, impairment charges	$ 0	$ 0	$ 11,500	$ 10,700

Leases - General Information (D

Leases - General Information (Details)	12 Months Ended
	Dec. 31, 2020item
Leases
Percentage of centers that are leased properties (as a percent)	72.00%
Percentage of centers under master lease agreements (as a percent)	43.00%
Number of landlords with master lease agreements	4

Leases - Terms and Lease Transa

Leases - Terms and Lease Transactions (Details)	12 Months Ended
	Dec. 31, 2020
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
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 - Fixed-price Options (D

Leases - Fixed-price Options (Details)	Dec. 31, 2020facility
Leases
Fixed-price options to purchase facilities, number of facilities	58
Fixed-price options to purchase facilities, subject to third-party leases, number of facilities	15
Fixed-price options to purchase facilities, subject to lease arrangements with consolidated variable interest entities, number of facilities	43

Leases - Finance Leases - Impai

Leases - Finance Leases - Impairment (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Income and Expenses, Lessee [Abstract]
Finance lease right-of-use assets, net, Impairment charges	$ 167.5	$ 6.2

Leases - Operating Leases - Mat

Leases - Operating Leases - Maturity (Details) $ in Thousands	Dec. 31, 2020USD ($)
Maturity of operating lease obligations
2021	$ 324,840
2022	328,039
2023	330,147
2024	334,231
2025	333,225
Thereafter	2,250,977
Total operating lease payments	$ 3,901,459

Leases - Operating Leases - Tot

Leases - Operating Leases - Total Lease Obligation (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Operating leases
Total operating lease payments	$ 3,901,459
Less interest	(1,669,907)
Total operating lease obligations	2,231,552
Less current portion	(2,071,841)	$ (140,887)
Long-term operating lease obligations	$ 159,711	$ 2,681,403

Leases - Finance Leases - Matur

Leases - Finance Leases - Maturity (Details) $ in Thousands	Dec. 31, 2020USD ($)
Maturity of finance lease obligations
2021	$ 6,798
2022	6,597
2023	6,420
2024	6,195
2025	5,968
Thereafter	28,950
Total finance lease payments	$ 60,928

Leases - Finance Leases - Total

Leases - Finance Leases - Total Lease Obligation (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Finance leases
Total finance lease payments	$ 60,928
Less interest	(23,036)
Total finance lease obligations	37,892
Less current portion	(2,949)	$ (2,839)
Long-term finance lease obligations	$ 34,943	$ 39,335

Leases - Finance Leases - Addit

Leases - Finance Leases - Additional Information (Details) $ in Millions	Dec. 31, 2020USD ($)
Leases
Portion of finance lease payments due related to options to extend lease terms	$ 37.2

Leases - Lease Cost (Details)

Leases - Lease Cost (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Lease cost
Operating lease cost	$ 366,339	$ 387,063
Amortization of finance lease right-of-use assets	3,818	16,224
Interest on finance lease liabilities	4,402	50,162
Total finance lease expense	8,220	66,386
Variable lease cost	34,601	37,841
Short-term leases	18,516	24,297
Sublease income	(6,058)
Total lease cost	$ 421,618	$ 515,587

Leases - Lease Term and Discoun

Leases - Lease Term and Discount Rate (Details)	Dec. 31, 2020	Dec. 31, 2019
Leases
Weighted-average remaining lease term (years) - operating leases	11 years 4 months 24 days	12 years 7 months 6 days
Weighted-average remaining lease term (years) - finance leases	9 years 6 months	10 years 2 months 12 days
Weighted-average discount rate - operating leases	10.10%	9.60%
Weighted-average discount rate - finance leases	10.60%	12.20%

Leases - Other Information (Det

Leases - Other Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Leases
Operating cash flows from operating leases	$ 348,034	$ 364,334
Operating cash flows from finance leases	7,305	47,188
Financing cash flows from finance leases	2,905	2,645
Right-of-use assets obtained in exchange for new lease obligations, operating leases	27,229	96,718
Right-of-use assets obtained in exchange for new lease obligations, finance leases	$ 1,033	$ 1,160

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, 2020	Dec. 31, 2019
Goodwill
Goodwill		$ 85,642	$ 85,642
Goodwill, net		85,642	85,642
Rehabilitation therapy service
Goodwill
Goodwill		73,814	73,814
Goodwill, net		73,814	73,814
Other Services
Goodwill
Goodwill		11,828	11,828
Goodwill, net		$ 11,828	$ 11,828
Inpatient Services
Goodwill
Goodwill, Impairment Loss	$ 351,500

Goodwill and Identifiable Int_4

Goodwill and Identifiable Intangible Assets - Finite-lived Intangible Assets Weighted Average Remaining Life (Details)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Customer relationships, net
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted average remaining life	7 years	8 years

Goodwill and Identifiable Int_5

Goodwill and Identifiable Intangible Assets - Identifiable Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Identifiable intangible assets
Finite-lived intangible assets, net, Accumulated amortization on intangible assets	$ 81,387	$ 76,243
Finite-lived intangible assets, net	31,715	36,891
Trade names	50,555	50,555
Identifiable intangible assets	82,270	87,446
Customer relationships, net
Identifiable intangible assets
Finite-lived intangible assets, net, Accumulated amortization on intangible assets	$ 81,387	$ 76,243

Goodwill and Identifiable Int_6

Goodwill and Identifiable Intangible Assets - Amortization Expense (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Customer relationships, net
Finite-Lived Intangible Assets [Line Items]
Amortization expense	$ 5.1	$ 10.5

Goodwill and Identifiable Int_7

Goodwill and Identifiable Intangible Assets - Maturity (Details) $ in Millions	Dec. 31, 2020USD ($)
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity
2021	$ 5
2022	5
2023	4.6
2024	4.5
2025	3.3
Thereafter	$ 9.3

Goodwill and Identifiable Int_8

Goodwill and Identifiable Intangible Assets - Indefinite-lived Intangible Assets Impairment (Details) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Asset Impairment Charges [Abstract]
Indefinite-lived intangible assets, impairment charges	$ 0	$ 0

Long-Term Debt - General Inform

Long-Term Debt - General Information (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Long-term debt
Total long-term debt	$ 1,540,722	$ 1,613,420
Current installments of long-term debt	(905,788)	(162,426)
Long-term debt	634,934	1,450,994
ABL Credit Facilities
Long-term debt
Total long-term debt	279,106	412,346
Debt issuance costs	5,894	8,615
Real estate loans
Long-term debt
Total long-term debt	215,848	265,700
Debt issuance costs	860	3,846
Debt premium	9,664	19,328
HUD insured loans
Long-term debt
Total long-term debt	26,221	117,117
Debt issuance costs	633	2,909
Notes payable
Long-term debt
Total long-term debt	104,598	116,952
Mortgages and other secured debt (recourse)
Long-term debt
Total long-term debt	6,987	6,369
Mortgages and other secured debt (non-recourse)
Long-term debt
Total long-term debt	697,049	498,222
Debt issuance costs	10,711	9,349
Debt premium	1,323	1,422
New term loan agreement
Long-term debt
Total long-term debt	210,913	196,714
Debt issuance costs	525	1,084
Debt premium	$ 2,221	$ 4,816

Long-Term Debt - New Asset Base

Long-Term Debt - New Asset Based Lending Facilities - General Information (Details) - USD ($) $ in Thousands	Mar. 06, 2018	Dec. 31, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Payment of first lien term loan facility		$ 4,682,122	$ 4,630,664
Restricted Cash and Cash Equivalents		101,100	$ 113,700
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
Cash proceeds		51,200
Restricted Cash and Cash Equivalents		51,200
Borrowings		285,000
Total borrowing base capacity		324,800
Available borrowing capacity under the ABL Credit Facilities		$ 39,800
Term Loan And Revolving Credit Facility
Debt Instrument [Line Items]
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
Delayed Draw Term Loan Facility
Debt Instrument [Line Items]
Promissory note	$ 30,000	$ 20,000
Commitment fee rate (as percentage)		2.00%
New Asset Based Lending Facilities | First Lien Term Loan Facility
Debt Instrument [Line Items]
Promissory note	285,000
New Asset Based Lending Facilities | Delayed Draw Term Loan Facility
Debt Instrument [Line Items]
Promissory note	$ 240,000
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		$ 285,000
Letter of Credit
Debt Instrument [Line Items]
Borrowings		$ 143,300

Long-Term Debt - New Asset Ba_2

Long-Term Debt - New Asset Based Lending Facilities - Borrowings and Interest Rates (Details) $ in Thousands	Dec. 31, 2020USD ($)
ABL Credit Facilities
Debt Instrument [Line Items]
Commitment	$ 545,000
Borrowings	$ 285,000
Weighted Average Interest	6.50%
First Lien Term Loan Facility
Debt Instrument [Line Items]
Commitment	$ 285,000
Borrowings	$ 285,000
Weighted Average Interest	6.50%
Revolving credit facility (Non-HUD)
Debt Instrument [Line Items]
Commitment	$ 168,000
Weighted Average Interest	6.50%
HUD Tranche
Debt Instrument [Line Items]
Commitment	$ 72,000
Weighted Average Interest	6.50%
Delayed Draw Term Loan Facility
Debt Instrument [Line Items]
Commitment	$ 20,000
Weighted Average Interest	12.00%

Long-Term Debt - Term Loan Agre

Long-Term Debt - Term Loan Agreement (Details) - USD ($) $ in Millions	Jan. 01, 2021	Dec. 31, 2020	Dec. 31, 2019	May 09, 2019	Mar. 06, 2018
Term Loan
Term Loan Facility and New Term Loan Agreement
Outstanding principal balance under term loan facility		$ 209.2	$ 193
Term Loan | Term Loan Amendment
Term Loan Facility and New Term Loan Agreement
Fixed interest rate					10.00%
Term Loan Amendment
Term Loan Facility and New Term Loan Agreement
Additional Term Loan				$ 40
Term Loan Amendment | Term Loan Amendment
Term Loan Facility and New Term Loan Agreement
Aggregate principal amount		$ 160
Fixed interest rate					14.00%
Term Loan Amendment | Minimum
Term Loan Facility and New Term Loan Agreement
Paid-in-kind interest rate					9.00%
Term Loan Amendment | Maximum
Term Loan Facility and New Term Loan Agreement
Paid-in-kind interest rate					5.00%
New Term Loan Facility [Member] | Maximum
Term Loan Facility and New Term Loan Agreement
Leverage ratio		1.70%
New Term Loan Facility [Member] | Forecast
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
Affiliate of Welltower Inc
Term Loan Facility and New Term Loan Agreement
Percentage of Outstanding Balance		60.00%
Affiliate Of Omega
Term Loan Facility and New Term Loan Agreement
Percentage of Outstanding Balance		40.00%

Long-Term Debt - Real Estate Lo

Long-Term Debt - Real Estate Loans (Details) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2020USD ($)	Dec. 31, 2020USD ($)loanfacility	Dec. 31, 2019USD ($)facility	Dec. 31, 2018USD ($)loan
Long-term debt
Repayments of Debt		$ 41,300	$ 39,800
Interest Paid, Net		$ 109,242	$ 153,589
Number of facilities divested or closed | facility		8	6
Outstanding principal balance			$ 42,200
Mid Cap Real Estate Loans
Long-term debt
Number of real estate loans | loan				2
Aggregate principal amount				$ 85,000
Mid Cap Real Estate Loans | LIBOR | Minimum
Long-term debt
Floor rate (as a percent)		1.50%
Applicable margin		5.85%
Mid Cap Real Estate Loans | LIBOR | Maximum
Long-term debt
Floor rate (as a percent)		2.00%
Applicable margin		6.25%
Welltower Real Estate Loans
Long-term debt
Aggregate principal amount		$ 207,000	$ 208,000
Welltower Real Estate Loans | Welltower Real Estate Loan Amendments
Long-term debt
Number of real estate loans | loan		2
Debt instrument of forgiveness		$ 169,800
Repayments of Debt	$ 9,000
Fixed interest rate		12.00%
Cash interest rate		7.00%
Interest Paid, Net		$ 2,000
Paid-in-kind interest rate		5.00%
Paid-in-Kind Interest		$ (2,000)

Long-Term Debt - HUD Insured Lo

Long-Term Debt - HUD Insured Loans (Details) $ in Thousands	Feb. 01, 2021facility	Dec. 31, 2020USD ($)facilityloan	Dec. 31, 2019USD ($)facility
Long-term debt
Repayments of debt | $		$ 41,300	$ 39,800
Number of facilities divested or closed		8	6
Debt instrument retired | $		$ 191,781	$ 199,626
Disposal Group, Disposed of by Sale, Not Discontinued Operations
Long-term debt
Number of Facilities Sold		19	13
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Skilled Nursing Facilities
Long-term debt
Number of facilities classified as held for sale			1
Number of Facilities Sold		11
Disposal Group, Held-for-sale, Not Discontinued Operations | Subsequent Events
Long-term debt
Number of facilities classified as held for sale	2
Disposal Group, Held-for-sale, Not Discontinued Operations | Skilled Nursing Facilities Subject to US Department of Housing and Urban Development Financing
Long-term debt
Number of facilities divested or closed			8
Disposal Group, Held-for-sale, Not Discontinued Operations | One U.S. Department of Housing and Urban Development Insured Skilled Nursing Facility in California
Long-term debt
Number of facilities divested or closed			1
Number of facilities classified as held for sale			1
HUD insured loans
Long-term debt
Number of debt instruments insured by HUD | loan		5
Principal balance outstanding | $		$ 46,000	$ 140,600
Repayments of debt | $			65,600
Debt instrument average remaining term (in years)		28 years 6 months
Weighted Average Interest		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%
Debt instrument retired | $		$ 93,200
HUD insured loans | Minimum
Long-term debt
Term of debt		30 years
Fixed interest rate		3.00%
HUD insured loans | Maximum
Long-term debt
Term of debt		35 years
Fixed interest rate		3.40%
HUD insured loans | Subsequent Events
Long-term debt
Number of facilities sold by counterparty	2
HUD insured loans | Prepaid Expenses and Other Current Assets
Long-term debt
Escrow reserve funds | $		$ 3,400
HUD insured loans | Disposal Group, Held-for-sale, Not Discontinued Operations
Long-term debt
Principal balance outstanding | $		$ 19,200
Number of facilities financed by HUD		2
Note Payable Due September 30, 2022
Long-term debt
Principal balance outstanding | $		$ 20,200	$ 23,100

Long-Term Debt - Notes Payable

Long-Term Debt - Notes Payable (Details) $ in Millions	Dec. 23, 2016USD ($)	Dec. 31, 2020USD ($)facility	Dec. 31, 2019USD ($)	Nov. 30, 2019USD ($)	Oct. 31, 2019USD ($)	Nov. 01, 2016USD ($)
Long-term debt
Repayments of debt		$ 41.3	$ 39.8
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		15.6	14.6
Cash interest rate	3.00%
Paid-in-kind interest rate	7.00%
Note Payable Due September 30, 2022
Long-term debt
Principal balance outstanding		$ 20.2	23.1
Note Payable Due September 30, 2022 | Note Payable
Long-term debt
Fixed interest rate					3.50%
Trade Payable Converted Amount					$ 23.2
Note Payable Due April 30, 2020
Long-term debt
Notes Payable, Current				$ 15
Note Payable Due April 30, 2020 | Note Payable
Long-term debt
Promissory note			15
Welltower Inc | Note Payable
Long-term debt
Number Of Facilities Under Lease Option | facility		51
Welltower Inc | Welltower note payable due October 30, 2020
Long-term debt
Principal balance outstanding		$ 68.8	$ 64.2
Welltower Inc | Welltower note payable due October 30, 2020 | Note Payable
Long-term debt
Proceeds from termination of leases		$ 86.3

Long-Term Debt - Other (Details

Long-Term Debt - Other (Details) $ in Millions	Jul. 02, 2020USD ($)	Sep. 12, 2019USD ($)	Jan. 31, 2019USD ($)	Dec. 31, 2020USD ($)facilityloan	Dec. 31, 2019USD ($)	Jan. 10, 2020USD ($)
Long-term debt
Repayments of debt				$ 41.3	$ 39.8
Mortgages and other secured debt (recourse)
Long-term debt
Weighted Average Interest				0.50%
Mortgages and other secured debt (non-recourse)
Long-term debt
Weighted Average Interest				4.20%
Aggregate outstanding principal balance				$ 22.4	23.8
Term Loan
Long-term debt
Floor rate				1.50%
Applicable margin rate (as a percent)				4.75%
HUD insured loans
Long-term debt
Weighted Average Interest				3.30%
Number of debt instruments insured by HUD | loan				5
Repayments of debt					65.6
Principal balance outstanding				$ 46	140.6
Next Partnership
Long-term debt
Variable interest entity, ownership interest (as a percent)			46.00%	46.00%
Number of facilities included in VIE | facility				15
Aggregate outstanding principal balance			$ 165.7
Next Partnership | Term Loan
Long-term debt
Aggregate principal amount				$ 142.1
Applicable margin rate (as a percent)				3.50%
Number of debt instruments insured by HUD | facility				2
Repayments of debt				$ 24.6
Term of debt				25 years
Number of facilities included | facility				5
Fixed interest rate				11.50%
Principal balance outstanding				$ 78.8	103.4
Number of collateralized facilities | facility				10
Next Partnership | Mezzanine loan
Long-term debt
Aggregate principal amount				$ 27
Principal balance outstanding				27	27
Next Partnership | HUD insured loans
Long-term debt
Principal balance outstanding				$ 67	41.7
Vantage Point Partnership
Long-term debt
Variable interest entity, ownership interest (as a percent)		30.00%		30.00%
Ownership interest percentage				19.00%
Aggregate outstanding principal balance		$ 306.1				$ 7.3
Vantage Point Partnership | Term Loan
Long-term debt
Aggregate principal amount				$ 240.9
Floor rate				1.75%
Applicable margin rate (as a percent)				3.75%
Term of debt				25 years
Principal balance outstanding				$ 240.9	233.6
Number of collateralized facilities | facility				19
Vantage Point Partnership | Promissory note
Long-term debt
Aggregate principal amount				$ 76.8	76.8
Fixed interest rate				14.00%
Principal balance outstanding					$ 76.8
Cascade Partnership
Long-term debt
Variable interest entity, ownership interest (as a percent)	49.00%
Aggregate outstanding principal balance	$ 190.3
Cascade Partnership | Term Loan
Long-term debt
Aggregate principal amount				$ 183.5
Interest rate (as a percentage)				6.00%
Term of debt				25 years
Principal balance outstanding				$ 183.5
Number of collateralized facilities | facility				9
Cascade Partnership | Note Payable
Long-term debt
Aggregate principal amount				$ 10
Fixed interest rate				10.00%
Cash interest rate				5.00%
Paid in kind interest rate				5.00%
Principal balance outstanding				$ 10
Minimum | HUD insured loans
Long-term debt
Term of debt				30 years
Fixed interest rate				3.00%
Minimum | Next Partnership | HUD insured loans
Long-term debt
Fixed interest rate				2.79%
Maximum | HUD insured loans
Long-term debt
Term of debt				35 years
Fixed interest rate				3.40%
Maximum | Next Partnership | HUD insured loans
Long-term debt
Fixed interest rate				3.15%

Long-Term Debt - Debt Covenants

Long-Term Debt - Debt Covenants (Details) $ in Thousands	Dec. 31, 2020USD ($)
Twelve months ended December 31,
2021	$ 380,890
2022	522,672
2023	204,123
2024	19,528
2025	9,516
Thereafter	409,408
Total long-term debt	$ 1,546,137

Stockholders' Deficit (Details)

Stockholders' Deficit (Details) - $ / shares	Dec. 31, 2020	Dec. 31, 2019
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)	110,801,462	107,888,854
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)	55,250,921	56,172,193

Stock-Based Compensation - Gene

Stock-Based Compensation - General Information (Details) $ in Millions	Jun. 03, 2020shares	Dec. 31, 2020USD ($)itemshares
2020 Plan
Share-based Compensation Arrangement by Share-based Payment Award
stock based compensation plans | item		2
Shares authorized (in shares)	6,462,605
Additional shares authorized (in shares)	3,500,000
Available for issuance under prior plan (in shares)	2,962,605
2020 Plan | Class A Common Stock
Share-based Compensation Arrangement by Share-based Payment Award
Shares authorized (in shares)		27,900,000
Restricted Stock Units (RSUs)
Share-based Compensation Arrangement by Share-based Payment Award
Sharebased compensation forfeited in period		887,940
Equity Instruments Other than Options, Forfeited | $		$ 0.8
Restricted Stock Units (RSUs) | 2020 Plan | Class A Common Stock
Share-based Compensation Arrangement by Share-based Payment Award
Number of common stock shares per RSU or PSU vested		1
Restricted Stock Units (RSUs) | 2020 Plan | Minimum
Share-based Compensation Arrangement by Share-based Payment Award
Award vesting period		3 years
Restricted Stock Units (RSUs) | 2020 Plan | Maximum
Share-based Compensation Arrangement by Share-based Payment Award
Award vesting period		4 years

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, 2020	Dec. 31, 2019
Restricted Stock Units (RSUs)
Number of Units
Non-vested beginning balance	9,959
Granted	3,540
Vested	(2,880)
Forfeited	(2,248)
Non-vested ending balance	8,371	9,959
Weighted-Average Grant Date Fair Value
Non-vested beginning balance	$ 1.74
Granted	0.96	$ 1.30
Vested	1.68
Forfeited	1.13
Non-vested ending balance	$ 1.60	$ 1.74
Unrecognized compensation costs	$ 7.4
Weighted average term expected to recognize stock-based compensation expense not yet recognized	1 year 7 months 6 days
Fair value of shares vested	$ 2.2	$ 4.4
Share-based Payment Arrangement, Expense, Tax Benefit	0.3	1.1
Restricted Stock Units (RSUs) | General and Administrative Expense
Weighted-Average Grant Date Fair Value
Compensation expense	$ 6.5	$ 7.3
Class A Common Stock | 2020 Plan
Weighted-Average Grant Date Fair Value
Shares available for grant (in shares)	7,400

Income Taxes - Total Tax Provis

Income Taxes - Total Tax Provision (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Total income tax (benefit) expense
Income tax (benefit) expense	$ (3,610)	$ 1,754
Stockholder's deficit	316	346
Total	$ (3,294)	$ 2,100
FC-GEN Operations Investment, LLC
Noncontrolling interest by Company (as a percent)	66.90%

Income Taxes - Components of In

Income Taxes - Components of Income Tax Provision (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Components of provision for income taxes
Current: Federal	$ (4,814)	$ 1,014
Current: State	200	28
Total current	(4,614)	1,042
Deferred: Federal	(563)	29
Deferred: State	1,567	683
Total deferred	1,004	712
Income tax (benefit) expense	$ (3,610)	$ 1,754

Income Taxes - Tax Cuts And Job

Income Taxes - Tax Cuts And Jobs Act (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Taxable loss	$ (14,600)
Current Income Tax Receivable	$ 5,100
Federal statutory income tax rate	21.00%	35.00%
Valuation allowance
Deferred tax asset valuation allowance	$ 408,379	$ 391,257
Tax Cuts and Jobs Act
Federal statutory income tax rate	21.00%	35.00%
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, 2020	Dec. 31, 2019
Income Tax Expense (Benefit), Continuing Operations, Income Tax Reconciliation
Computed "expected" expense (benefit)	$ (22,465)	$ 1,939
State and local income taxes, net of federal tax benefit	116	107
Income tax credits	(1,847)	(2,088)
Non-controlling interest	8,306	4,038
Adjustment to deferred taxes, including credits and valuation allowance	17,389	(2,977)
US federal refund carryback claim	(5,107)
FIN 48	(13)
Other, net	11	735
Income tax (benefit) expense	$ (3,610)	$ 1,754
Effective tax rate (as a percent)	3.40%	19.00%

Income Taxes - Deferred Income

Income Taxes - Deferred Income Taxes (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Deferred tax assets:
Investment in partnership	$ 252,214	$ 240,247
Net operating loss carryforwards	136,709	133,611
Discounted unpaid loss reserve	2,278	2,156
General business credits	29,895	30,006
Total deferred tax assets	421,096	406,020
Valuation allowance	(408,379)	(391,257)
Deferred tax assets, net of valuation allowance	12,717	14,763
Deferred tax liabilities:
Long-lived assets: intangible property	(15,509)	(16,236)
Total deferred tax liabilities	(15,509)	(16,236)
Net deferred tax liabilities	$ (2,792)	$ (1,473)

Income Taxes - Unrecognized Tax

Income Taxes - Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns
Balance at December 31,	$ 77
Reductions due to lapses of applicable statute of limitations	(13)
Balance at December 31,	64
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) - FC-GEN Operations Investment, LLC - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Noncontrolling Interest [Line Items]
Tax basis step-up in deductible goodwill of FC-GEN.	$ 6.2	$ 16.9
Tax receivable agreement, potential payment as percentage of cash savings	90.00%

Related Party Transactions - Be

Related Party Transactions - Beneficial Owners - Customers (Details) $ in Millions	Jan. 31, 2019USD ($)Option	Dec. 31, 2020USD ($)facilitycustomer	Dec. 31, 2020USD ($)facilitycustomer	Dec. 31, 2019USD ($)facility
Next Partnership, Master Lease Agreement
Related Party Transaction [Line Items]
Initial Annual Lease Rent	$ 19.5
Term of operating lease	15 years
Operating lease renewal term	5 years
Lessee, Operating Lease, Option to Extend, Number | Option	2
Annual rent escalation (as a percent)	2.00%
No rent escalation period	5 years
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%
Lessee, Operating Lease, Fixed Price Option to Purchase Facilities, Minimum Premium over Original Purchase Price, Percentage	10.00%
New Hampshire
Related Party Transaction [Line Items]
Number of facilities sold real estate and operations | facility			4
Maximum
Related Party Transaction [Line Items]
Term of operating lease		15 years	15 years
Operating lease renewal term		10 years	10 years
Minimum
Related Party Transaction [Line Items]
Term of operating lease		10 years	10 years
Operating lease renewal term		5 years	5 years
Beneficial Owner
Related Party Transaction [Line Items]
Number of customers owned and operated | customer		2	2
Beneficial Owner | Related Party Customer One
Related Party Transaction [Line Items]
Net revenue from related party			$ 102	$ 114.3
Net accounts receivable from related party		$ 30.5	30.5	28.9
Notes receivable from related party		56.3	56.3
Reserves posted against note receivable			55
Beneficial Owner | Related Party Customer Two
Related Party Transaction [Line Items]
Net revenue from related party			5.3	6.6
Net accounts receivable from related party		$ 1.2	1.2	$ 1.4
Next Landlord Entities
Related Party Transaction [Line Items]
Initial Annual Lease Rent			$ 13
Number of facilities sold real estate and operations | facility			8
Next Landlord Entities | New Hampshire
Related Party Transaction [Line Items]
Number of facilities sold real estate and operations | facility		3
Number of facilities under lease | facility		7	7	7
Next Landlord Entities | Pennsylvania, New Jersey, Connecticut, Massachusetts and West Virginia | Next Partnership, Master Lease Agreement
Related Party Transaction [Line Items]
Ownership interest percentage		46.00%	46.00%
Number of facilities under lease | facility		15	15
Next Landlord Entities | Florida
Related Party Transaction [Line Items]
Number of facilities sold real estate and operations | facility		5
Number of facilities under lease | facility		5	5	5

Related Party Transactions - Bo

Related Party Transactions - Board of Directors (Details)	Dec. 31, 2020
Director | Next Landlord Entities
Related Party Transaction [Line Items]
Ownership interest percentage	5.00%

Related Party Transactions - _2

Related Party Transactions - Beneficial Owners - Master Lease (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2020USD ($)facility	Dec. 31, 2019USD ($)
Related Party Transaction
Options to renew	true
Lease cost	$ 421,618	$ 515,587
Beneficial Owner | Welltower Inc
Related Party Transaction
Interest paid	$ 24,800	24,100
Welltower Inc
Related Party Transaction
Operating lease renewal term	11 years
Options to renew	true
Annual rent escalators	2.00%
Lease cost	$ 77,800	$ 81,900
Percentage of Shareholding	5.00%
Number of facilities under lease | facility	51

Related Party Transactions - Eq

Related Party Transactions - Equity Method Investment (Details) $ in Millions	12 Months Ended
	Dec. 31, 2020USD ($)facility	Dec. 31, 2019USD ($)	Feb. 01, 2020
Telehealth and Telemedicine Services
Related Party Transaction
Interest paid	$ 0.8	$ 1
Dialysis Services | Skilled Nursing Facilities
Related Party Transaction
Interest paid	$ 0.4	$ 0.3
NewGen Partnership
Related Party Transaction
Number of facilities transitioned operational responsibility | facility	24
Ownership interest (as a percent)	50.00%		50.00%
NewGen Partnership | Twenty-three Facilities in California, Washington and Nevada
Related Party Transaction
Number of facilities transitioned operational responsibility | facility	24
Equity Method Investee | NewGen Partnership
Related Party Transaction
Number of facilities subleased to related party | facility	6
Net revenue from related party	$ 25.4
Equity Method Investee | NewGen Partnership
Related Party Transaction
Financing provided	$ 9

Defined Contribution Plan (Deta

Defined Contribution Plan (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Defined Contribution Plan
Defined contribution plan, employer discretionary contribution amount	$ 0	$ 0

Other Income - Tabular Disclosu

Other Income - Tabular Disclosure (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Other Income
Gain on sale of owned assets	$ (120,357)	$ (90,723)
Loss recognized for exit costs associated with divestiture of operations	16,671	12,997
Gain on lease termination or modification	(98,586)	(95,779)
Total other (income) loss	$ (202,272)	$ (173,505)

Other Income - Owned Facilities

Other Income - Owned Facilities (Details) - Disposal Group, Disposed of by Sale, Not Discontinued Operations - facility	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Divestitures
Number of facilities sold	19	13
Number of skilled nursing, assisted/senior living and behavioral health centers through which inpatient services are provided		2

Other Income - Leased Facilitie

Other Income - Leased Facilities (Details) - facility	3 Months Ended		12 Months Ended
	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2020	Dec. 31, 2019
Other Income
Number of facilities divested	12	1	63	44

Asset Impairment Charges (Detai

Asset Impairment Charges (Details) - USD ($)	9 Months Ended		12 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2020	Dec. 31, 2019
Asset Impairment Charges
Impairment on long-lived assets	$ 0	$ 0	$ 11,500,000	$ 10,700,000
Impairment of indefinite-lived intangible assets			0	0
Inpatient Services
Asset Impairment Charges
Impairment on long-lived assets			$ 179,000,000	$ 16,900,000

Assets Held for Sale - General

Assets Held for Sale - General Information (Details) - Disposal Group, Held-for-sale, Not Discontinued Operations $ in Millions	Feb. 01, 2021facility	Dec. 31, 2020USD ($)facility	Dec. 31, 2019facility
Two Skilled Nursing Facilities, One in California and One in Nevada
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities classified as held for sale		2
One U.S. Department of Housing and Urban Development Insured Skilled Nursing Facility in California
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities classified as held for sale			1
Facilities
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Consideration | $		$ 19.2
Land Parcel
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Consideration | $		$ 2.7
Subsequent Events
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of facilities classified as held for sale	2

Assets Held for Sale - Tabular

Assets Held for Sale - Tabular Disclosure (Details) - Disposal Group, Held-for-sale, Not Discontinued Operations - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Assets and Liabilities of Disposal Group
Prepaid expenses		$ 1,171
Property and equipment, net of accumulated depreciation of $3,015 and $2,201 at December 31, 2020 and December 31, 2019, respectively	$ 12,986	16,306
Accumulated depreciation	3,015	2,201
Total Assets	12,986	17,477
Current portion of long-term debt	403	368
Long-term debt	18,271	19,789
Total Liabilities	$ 18,674	$ 20,157

Commitments and Contingencies -

Commitments and Contingencies - Workers' Compensation (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Commitments and Contingencies
Workers' Compensation discount rate (as a percentage)	0.20%
Potential effect of discounting on Workers Compensation reserve	$ 9.7	$ 12
Provision for general and professional liability	60.3	70.1
Reserve for general and professional liability	365.2	392.8
Provision for workers' compensation	74	47.6
Reserve for workers' compensation risks	173.6	160.5
Health insurance reserve	$ 13.7	$ 15.1

Commitments and Contingencies_2

Commitments and Contingencies - Litigation (Details) $ in Millions	1 Months Ended	12 Months Ended
	Jul. 31, 2016item	Dec. 31, 2018USD ($)	Dec. 31, 2020USD ($)	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			$ 16.6
Environmental Remediation at Leased Sites [Member] | Other long-term liabilities
Loss Contingencies
Asset Retirement Obligation			6.6	$ 6.6
Creekside Hospice Therapy Matters Investigation Staffing Matters Investigation And Sundance Part B Therapy Matter (Member)
Loss Contingencies
Accrued contingent liability			22.6
Creekside Hospice Therapy Matters Investigation Staffing Matters Investigation And Sundance Part B Therapy Matter (Member) | Other long-term liabilities
Loss Contingencies
Accrued contingent liability			10.5
Creekside Hospice Therapy Matters Investigation Staffing Matters Investigation And Sundance Part B Therapy Matter (Member) | Accrued expenses
Loss Contingencies
Accrued contingent liability			$ 12.1

Commitments and Contingencies_3

Commitments and Contingencies - Lease Guarantees (Details) - NewGen Partnership $ in Millions	Dec. 31, 2020USD ($)lease
Schedule of Equity Method Investments [Line Items]
Leasehold rights transferred, lease guarantee agreements, executed, number of facilities | lease	6
Leasehold rights transferred, lease guarantee agreements, executed, undiscounted cash rent obligations | $	$ 84.7

Fair Value of Financial Instr_3

Fair Value of Financial Instruments - Recurring Measures (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Assets, Fair Value Disclosure [Abstract]
Cash and cash equivalents	$ 212,071	$ 12,097
Restricted cash and equivalents	101,149	113,709
Assets, Fair Value Disclosure, Total	467,072	262,748
Mortgage/Government Backed Securities
Assets, Fair Value Disclosure [Abstract]
Restricted investments in marketable securities	23,893	21,023
Government Bonds
Assets, Fair Value Disclosure [Abstract]
Restricted investments in marketable securities	69,157	66,993
Corporate Bond Securities
Assets, Fair Value Disclosure [Abstract]
Restricted investments in marketable securities	60,802	48,926
Level 1
Assets, Fair Value Disclosure [Abstract]
Cash and cash equivalents	212,071	12,097
Restricted cash and equivalents	101,149	113,709
Assets, Fair Value Disclosure, Total	352,700	171,709
Level 1 | Government Bonds
Assets, Fair Value Disclosure [Abstract]
Restricted investments in marketable securities	39,480	45,903
Level 2
Assets, Fair Value Disclosure [Abstract]
Assets, Fair Value Disclosure, Total	114,372	91,039
Level 2 | Mortgage/Government Backed Securities
Assets, Fair Value Disclosure [Abstract]
Restricted investments in marketable securities	23,893	21,023
Level 2 | Government Bonds
Assets, Fair Value Disclosure [Abstract]
Restricted investments in marketable securities	29,677	21,090
Level 2 | Corporate Bond Securities
Assets, Fair Value Disclosure [Abstract]
Restricted investments in marketable securities	$ 60,802	$ 48,926

Fair Value of Financial Instr_4

Fair Value of Financial Instruments - Debt Instruments (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Financial Liabilities Fair Value Disclosure [Abstract]
Principal balance outstanding, net	$ 1,540,722	$ 1,613,420
Asset based lending facilities
Financial Liabilities Fair Value Disclosure [Abstract]
Principal balance outstanding, net	279,106	412,346
New term loan agreement
Financial Liabilities Fair Value Disclosure [Abstract]
Principal balance outstanding, net	210,913	196,714
Real estate loans
Financial Liabilities Fair Value Disclosure [Abstract]
Principal balance outstanding, net	215,848	265,700
HUD insured loans
Financial Liabilities Fair Value Disclosure [Abstract]
Principal balance outstanding, net	26,221	117,117
Notes payable
Financial Liabilities Fair Value Disclosure [Abstract]
Principal balance outstanding, net	104,598	116,952
Mortgages and other secured debt (recourse)
Financial Liabilities Fair Value Disclosure [Abstract]
Principal balance outstanding, net	6,987	6,369
Mortgages and other secured debt (non-recourse)
Financial Liabilities Fair Value Disclosure [Abstract]
Principal balance outstanding, net	697,049	498,222
Level 2
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	1,540,722	1,613,420
Level 2 | Asset based lending facilities
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	279,106	412,346
Level 2 | New term loan agreement
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	210,913	196,714
Level 2 | Real estate loans
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	215,848	265,700
Level 2 | HUD insured loans
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	26,221	117,117
Level 2 | Notes payable
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	104,598	116,952
Level 2 | Mortgages and other secured debt (recourse)
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	6,987	6,369
Level 2 | Mortgages and other secured debt (non-recourse)
Financial Liabilities Fair Value Disclosure [Abstract]
Fair Value	$ 697,049	$ 498,222

Fair Value of Financial Instr_5

Fair Value of Financial Instruments - Nonrecurring Measures (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Non-recurring Fair Value Measures
Finance lease right-of-use assets, net	$ 27,848	$ 37,097
Finance lease right-of-use assets, net, Impairment charges	167,500	6,200
Operating lease right-of-use assets	1,715,532	2,399,505
Fair Value, Measurements, Nonrecurring
Non-recurring Fair Value Measures
Property and equipment, net	984,712	962,105
Property and equipment, Impairment Charges	11,500	10,696
Finance lease right-of-use assets, net	27,848	37,097
Finance lease right-of-use assets, net, Impairment charges	6,000
Operating lease right-of-use assets	1,715,532	2,399,505
Operating lease right-of-use assets, Impairment Charges	161,500	6,241
Intangible assets, net	82,270	87,446
Goodwill	$ 85,642	$ 85,642

Subsequent Events (Details)

Subsequent Events (Details)	Mar. 29, 2021USD ($)item	Mar. 12, 2021facility	Mar. 02, 2021USD ($)directoritemfacility$ / sharesshares	Feb. 01, 2021USD ($)facility	Dec. 31, 2020USD ($)facility	Dec. 31, 2019USD ($)	Dec. 31, 2018USD ($)
Subsequent Events
Right of use asset					$ 1,715,532,000	$ 2,399,505,000
Operating lease liability					2,231,552,000
Operating Lease, Right-of-Use Asset					1,715,532,000	2,399,505,000
Operating Lease, Liability					2,231,552,000
Repayments of debt					$ 41,300,000	39,800,000
Second Spring
Subsequent Events
Number of facilities sold | facility					21
Right of use asset					$ 174,000,000
Operating lease liability					189,000,000
Net revenues					276,400,000
Income (Loss) from Individually Significant Component Disposed of or Held-for-sale, Excluding Discontinued Operations, before Income Tax					35,300,000
Operating Lease, Right-of-Use Asset					174,000,000
Operating Lease, Liability					189,000,000
NewGen Partnership
Subsequent Events
Right of use asset					17,000,000
Impairment charge recognized to reflect decrease in sale price of disposal group					700,000
Operating Lease, Right-of-Use Asset					$ 17,000,000
Subsequent Events | Skilled Nursing Facilities | Second Spring
Subsequent Events
Number of facilities in the master lease agreement | facility		21
Subsequent Events | NewGen Partnership
Subsequent Events
Net operating income (loss) of discontinued businesses				$ 1,700,000
Net revenues				$ 15,700,000
Subsequent Events | NewGen Partnership | Skilled Nursing Facilities
Subsequent Events
Number of facilities sold | facility				2
Welltower, Inc.
Subsequent Events
Number of facilities sold | facility					51
Net operating income (loss) of discontinued businesses					$ 82,500,000
Right of use asset					552,000,000
Operating lease liability					686,500,000
Net revenues					629,800,000
Operating Lease, Right-of-Use Asset					552,000,000
Operating Lease, Liability					686,500,000
Welltower, Inc. | Subsequent Events | Transaction Agreement [Member]
Subsequent Events
Number of facilities, leases terminated | facility			51
Proceeds from termination of leases			$ 86,000,000
Repayments of debt			$ 86,000,000
Affiliates of Cascade Capital Group, LLC, Master Lease Agreement and Second Spring Healthcare Investments, Master Lease Agreement
Subsequent Events
Consideration					9,300,000
Facility related liabilities					$ 13,800,000
Affiliates of Cascade Capital Group, LLC, Master Lease Agreement and Second Spring Healthcare Investments, Master Lease Agreement | Subsequent Events | Second Spring
Subsequent Events
Number of facilities sold | facility		16
The ReGen Warrant [Member] | Subsequent Events | Investment Agreement [Member]
Subsequent Events
Exercise price of warrant | $ / shares			$ 1
Warrant to purchase | shares			55,600,604
Weltower Warrant [Member] | Subsequent Events | Transaction Agreement [Member]
Subsequent Events
Debt written down			$ 170,000,000
Weltower Warrant [Member] | Welltower, Inc. | Subsequent Events | Term Loan Agreement [Member]
Subsequent Events
Percentage of indirect ownership interest			20.00%
Weltower Warrant [Member] | Welltower, Inc. | Subsequent Events | Term Loan Agreement [Member] | Term Commencing from Issuance Date [Member]
Subsequent Events
Term of warrants and rights outstanding			6 months
Weltower Warrant [Member] | Welltower, Inc. | Subsequent Events | Term Loan Agreement [Member] | Term Ending from Issuance Date [Member]
Subsequent Events
Term of warrants and rights outstanding			5 years
Class C Common Stock | Subsequent Events | Investment Agreement [Member]
Subsequent Events
Number of common units in each basket of securities | item			1
Class C Common Stock | The ReGen Warrant [Member] | Subsequent Events | Investment Agreement [Member]
Subsequent Events
Number of common units in each basket of securities | item			1
Class A Unit [Member] | Subsequent Events | Investment Agreement [Member]
Subsequent Events
Number of common units in each basket of securities | item			1
Class A Unit [Member] | The ReGen Warrant [Member] | Subsequent Events | Investment Agreement [Member]
Subsequent Events
Number of common units in each basket of securities | item			1
Class A Unit [Member] | Weltower Warrant [Member] | Welltower, Inc. | Subsequent Events
Subsequent Events
Exercise price of warrant | $ / shares			$ 1
Warrant to purchase | shares			900,000
Convertible Promissory Notes [Member] | Subsequent Events | Investment Agreement [Member]
Subsequent Events
Debt instrument, face amount			$ 50,000,000
Securities issued in exchange of convertible promissory note | shares			69,500,755
Percentage of fully diluted shares capital			25.00%
Second Convertible Promissory Note [Member] | Subsequent Events | Investment Agreement [Member]
Subsequent Events
Debt instrument, face amount	$ 25
Number of common units in each basket of securities | item	34,594,079
Percentage of fully diluted shares capital	33.30%
HUD insured loans
Subsequent Events
Repayments of debt						$ 65,600,000
HUD insured loans | Subsequent Events | NewGen Partnership
Subsequent Events
Debt instrument, face amount				$ 19,200,000
Mid Cap Real Estate Loans
Subsequent Events
Debt instrument, face amount							$ 85,000,000
Governance Matters [Member] | Subsequent Events | Investment Agreement [Member]
Subsequent Events
Number of board members | director			7
Term of anniversary			1 year
Number of non investor director in the independent committee | director			3
Number of remaining directors on independent committee | director			2
Governance Matters [Member] | Subsequent Events | Investment Agreement [Member] | Initial Closing [Member]
Subsequent Events
Number of directors resigned | director			2
Number of investor director | director			2
Number of seats on the board | director			2
Governance Matters [Member] | Subsequent Events | Investment Agreement [Member] | Event of Occurrence of Second Closing [Member]
Subsequent Events
Number of investor director | director			1
Percentage of shares under initial note			75.00%
Governance Matters [Member] | Subsequent Events | Investment Agreement [Member] | Event of Non Occurrence of Second Closing [Member]
Subsequent Events
Number of investor director | director			1
Percentage of shares under initial note			25.00%
Governance Matters [Member] | Subsequent Events | Investment Agreement [Member] | Three Director Beneficial Ownership is Met [Member]
Subsequent Events
Number of investor director | director			3
Governance Matters [Member] | Subsequent Events | Investment Agreement [Member] | Two Director Beneficial Ownership is Not Met [Member]
Subsequent Events
Number of investor director | director			1
Governance Matters [Member] | Minimum | Subsequent Events | Investment Agreement [Member] | Three Director Beneficial Ownership is Met [Member]
Subsequent Events
Percentage of shares under initial note			75.00%
Governance Matters [Member] | Minimum | Subsequent Events | Investment Agreement [Member] | Three Director Beneficial Ownership is Not Met [Member]
Subsequent Events
Number of investor director | director			2
Percentage of shares under initial note			50.00%
Governance Matters [Member] | Minimum | Subsequent Events | Investment Agreement [Member] | Two Director Beneficial Ownership is Not Met [Member]
Subsequent Events
Percentage of shares under initial note			25.00%
Term Loan Amendments [Member] | Subsequent Events
Subsequent Events
Percentage of facilities transitions not completed			85.00%

Subsequent Events - Tax Benefit

Subsequent Events - Tax Benefit Preservation Plan (Details)	Mar. 11, 2021item$ / sharesshares	Dec. 31, 2020$ / shares	Dec. 31, 2019$ / shares
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Preferred Stock, Par or Stated Value Per Share		$ 0.001	$ 0.001
Subsequent Events
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Ratio of Market Value to Exercise price	2
Stock Issued During Period, Shares, New Issues | shares	4,000,000
Preferred Stock, Par or Stated Value Per Share	$ 0.001
Subsequent Events | Minimum
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Equity Method Investment, Ownership Percentage	4.90%
Tax Benefit Preservation Plan | Subsequent Events
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Common Stock, Par or Stated Value Per Share	$ 0.001
Number of rights per share | item	1
Tax Benefit Preservation Plan | Subsequent Events | Series A Junior Participating Preferred Stock
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Share Price	$ 4.50
Number of Shares in Each Unit | item	100
Preferred Stock, Par or Stated Value Per Share	$ 0.001