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BUSINESS SEGMENTS | 12 Months Ended
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Dec. 31, 2023
Segment Reporting [Abstract] |
BUSINESS SEGMENTS | BUSINESS SEGMENTS The Company has two reportable segments: (1) skilled services, which includes the operation of skilled nursing facilities and rehabilitation therapy services and (2) Standard Bearer, which is comprised of selected real estate properties owned by Standard Bearer and leased to skilled nursing and senior living operators. As of December 31, 2023, the skilled services segment includes 259 skilled nursing operations and 27 campus operations that provide both skilled nursing and rehabilitative care services and senior living services. The Company's Standard Bearer segment consists of 108 owned real estate properties. The Company also reports an “All Other” category that includes results from its senior living operations, which includes 11 stand-alone senior living operations and the senior living operations at 27 campus operations that provide both skilled nursing and rehabilitative care services and senior living services. In addition, the "All Other" category includes mobile diagnostics, medical transportation, other real estate and other ancillary operations. Services included in the “All Other” category are insignificant individually, and therefore do not constitute a reportable segment. The Company’s reportable segments are significant operating segments that offer differentiated services. The Company's CODM reviews financial information for each operating segment to evaluate performance and allocate capital resources. This structure reflects its current operational and financial management and provides the best structure to maximize the quality of care and investment strategy provided, while maintaining financial discipline. The Company's CODM does not review assets by segment in his resource allocation and therefore assets by segment are not disclosed below. The accounting policies of the reportable segments are the same as those described in Note 2, Summary of Significant Accounting Policies. Intercompany revenue is eliminated in consolidation, along with corresponding intercompany expenses. Segment income and loss is defined as profit or loss from operations before provision for income taxes, excluding gain or loss from sale of real estate, real estate insurance recoveries and losses and impairment charges from operations. Included in segment income for Standard Bearer is expense for intercompany services provided by the Service Center as described in Note 6, Standard Bearer, as it is part of the CODM financial information. The following tables set forth financial information for the segments:
|  | Year Ended December 31, 2023
|  | Skilled Services |  | Standard Bearer |  | All Other (1) |  | Intercompany Elimination |  | Total
Service revenue(2) |  | $ | 3,578,855 |  |  | $ | — |  |  | $ | 144,667 |  |  | $ | (15,451) |  |  | $ | 3,708,071 |
Rental revenue(3) |  | — |  |  | 82,486 |  |  | 11,137 |  |  | (72,339) |  |  | 21,284 |
TOTAL REVENUE |  | $ | 3,578,855 |  |  | $ | 82,486 |  |  | $ | 155,804 |  |  | $ | (87,790) |  |  | $ | 3,729,355 |
Segment income (loss) |  | 464,925 |  |  | 29,065 |  |  | (221,251) |  |  | — |  |  | 272,739 |
Gain on sale of assets and insurance recoveries from real estate, net |  |  |  |  |  |  |  |  |  | 23 |
Income before provision for income taxes |  |  |  |  |  |  |  |  |  | $ | 272,762 |
Depreciation and amortization |  | 38,766 |  |  | 25,205 |  |  | 8,416 |  |  | — |  |  | 72,387 |
Interest expense(4) |  | $ | — |  |  | $ | 19,761 |  |  | $ | 1,228 |  |  | $ | (12,902) |  |  | $ | 8,087 |
(1) All Other primarily includes all ancillary operations, stand-alone senior living operations and the Service Center. (2) Intercompany service revenue represents service revenue generated by ancillary operations provided to the Company's independent subsidiaries and management service revenue generated by the Service Center with Standard Bearer. Intercompany service revenue is eliminated in consolidation along with corresponding intercompany cost of service. (3) All Other rental revenue includes rental revenue associated with the Company's subleases to third parties of $3,897 for the year ended December 31, 2023. Intercompany rental revenue represents rental income generated by both Standard Bearer and other real estate properties with the Company's independent subsidiaries. Intercompany rental revenue is eliminated in consolidation along with corresponding intercompany rent expense. (4) Included in interest expense in Standard Bearer is interest expense incurred from intercompany debt arrangements between Standard Bearer and The Ensign Group, Inc. Intercompany interest expense is eliminated in the "Intercompany Elimination" column.
|  | Year Ended December 31, 2022
|  | Skilled Services |  | Standard Bearer |  | All Other (1) |  | Intercompany Elimination |  | Total
Service revenue(2) |  | $ | 2,906,215 |  |  | $ | — |  |  | $ | 115,214 |  |  | $ | (12,718) |  |  | $ | 3,008,711 |
Rental revenue(3) |  | — |  |  | 72,937 |  |  | 7,396 |  |  | (63,576) |  |  | 16,757 |
TOTAL REVENUE |  | $ | 2,906,215 |  |  | $ | 72,937 |  |  | $ | 122,610 |  |  | $ | (76,294) |  |  | $ | 3,025,468 |
Segment income (loss) |  | 408,732 |  |  | 27,871 |  |  | (150,781) |  |  | — |  |  | 285,822 |
Gain on sale of assets and insurance recoveries from real estate, net |  |  |  |  |  |  |  |  |  | 3,267 |
Income before provision for income taxes |  |  |  |  |  |  |  |  |  | $ | 289,089 |
Depreciation and amortization |  | 33,224 |  |  | 21,613 |  |  | 7,518 |  |  | — |  |  | 62,355 |
Interest expense(4) |  | $ | — |  |  | $ | 15,707 |  |  | $ | 1,870 |  |  | $ | (8,646) |  |  | $ | 8,931 |
(1) All Other primarily includes all ancillary operations, stand-alone senior living operations and the Service Center. (2) Intercompany service revenue represents service revenue generated by ancillary operations provided to the Company's independent subsidiaries and management service revenue generated by the Service Center with Standard Bearer. Intercompany service revenue is eliminated in consolidation along with corresponding intercompany cost of service. (3) Intercompany rental revenue represents rental income generated by both Standard Bearer and other real estate properties with the Company's independent subsidiaries. Intercompany rental revenue is eliminated in consolidation along with corresponding intercompany rent expense. (4) Included in interest expense in Standard Bearer is interest expense incurred from intercompany debt arrangements between Standard Bearer and The Ensign Group, Inc. Intercompany interest expense is eliminated in the "Intercompany Elimination" column.
|  | Year Ended December 31, 2021
|  | Skilled Services |  | Standard Bearer |  | All Other (1) |  | Intercompany Elimination |  | Total
Service revenue(2) |  | $ | 2,523,234 |  |  | $ | — |  |  | $ | 95,276 |  |  | $ | (7,034) |  |  | $ | 2,611,476 |
Rental revenue(3) |  | — |  |  | 58,127 |  |  | 7,409 |  |  | (49,551) |  |  | 15,985 |
TOTAL REVENUE |  | $ | 2,523,234 |  |  | $ | 58,127 |  |  | $ | 102,685 |  |  | $ | (56,585) |  |  | $ | 2,627,461 |
Segment income (loss) |  | 373,603 |  |  | 31,876 |  |  | (147,915) |  |  | — |  |  | 257,564 |
Gain on real estate insurance recoveries |  |  |  |  |  |  |  |  |  | 440 |
Income before provision for income taxes |  |  |  |  |  |  |  |  |  | $ | 258,004 |
Depreciation and amortization |  | 30,681 |  |  | 17,558 |  |  | 7,746 |  |  | — |  |  | 55,985 |
Interest expense |  | $ | — |  |  | $ | 6,842 |  |  | $ | 7 |  |  | $ | — |  |  | $ | 6,849 |
(1) All Other primarily includes all ancillary operations, stand-alone senior living operations and the Service Center. (2) Intercompany service revenue represents service revenue generated by ancillary operations provided to the Company's independent subsidiaries and management service revenue generated by the Service Center with Standard Bearer. Intercompany service revenue is eliminated in consolidation along with corresponding intercompany cost of service. (3) Intercompany rental revenue represents rental income generated by both Standard Bearer and other real estate properties with the Company's independent subsidiaries. Intercompany rental revenue is eliminated in consolidation along with corresponding intercompany rent expense. Service revenue by major payor source were as follows:
|  | Year Ended December 31, 2023
|  | Skilled Services |  |  |  |  |  | All Other (3) |  |  |  | Total Service Revenue |  | Revenue %
Medicaid(1) |  | $ | 1,429,473 |  |  |  |  |  |  | $ | 29,976 |  |  |  |  | $ | 1,459,449 |  |  | 39.4 | %
Medicare |  | 985,749 |  |  |  |  |  |  | — |  |  |  |  | 985,749 |  |  | 26.6 |
Medicaid-skilled |  | 245,663 |  |  |  |  |  |  | — |  |  |  |  | 245,663 |  |  | 6.6 |
Subtotal |  | 2,660,885 |  |  |  |  |  |  | 29,976 |  |  |  |  | 2,690,861 |  |  | 72.6 |
Managed care |  | 666,129 |  |  |  |  |  |  | — |  |  |  |  | 666,129 |  |  | 18.0 |
Private and other(2) |  | 251,841 |  |  |  |  |  |  | 99,240 |  |  |  |  | 351,081 |  |  | 9.4 |
TOTAL SERVICE REVENUE |  | $ | 3,578,855 |  |  |  |  |  |  | $ | 129,216 |  |  |  |  | $ | 3,708,071 |  |  | 100.0 | %
(1) Medicaid payor includes revenue generated from senior living operations and revenue related to state relief funding. (2) Private and other payors also includes revenue from senior living operations and all payors generated in other ancillary services. (3) All Other incorporates intercompany eliminations.
|  | Year Ended December 31, 2022
|  | Skilled Services |  |  |  |  |  | All Other (3) |  |  |  | Total Service Revenue |  | Revenue %
Medicaid(1) |  | $ | 1,158,309 |  |  |  |  |  |  | $ | 24,847 |  |  |  |  | $ | 1,183,156 |  |  | 39.3 | %
Medicare |  | 832,160 |  |  |  |  |  |  | — |  |  |  |  | 832,160 |  |  | 27.7 |
Medicaid-skilled |  | 200,878 |  |  |  |  |  |  | — |  |  |  |  | 200,878 |  |  | 6.7 |
Subtotal |  | 2,191,347 |  |  |  |  |  |  | 24,847 |  |  |  |  | 2,216,194 |  |  | 73.7 |
Managed care |  | 525,710 |  |  |  |  |  |  | — |  |  |  |  | 525,710 |  |  | 17.5 |
Private and other(2) |  | 189,158 |  |  |  |  |  |  | 77,649 |  |  |  |  | 266,807 |  |  | 8.8 |
TOTAL SERVICE REVENUE |  | $ | 2,906,215 |  |  |  |  |  |  | $ | 102,496 |  |  |  |  | $ | 3,008,711 |  |  | 100.0 | %
(1) Medicaid payor includes revenue generated from senior living operations and revenue related to state relief funding. (2) Private and other payors also includes revenue from senior living operations and all payors generated in other ancillary services. (3) All Other incorporates intercompany eliminations.
|  | Year Ended December 31, 2021 |  |
|  | Skilled Services |  |  |  |  |  | All Other (3) |  | Total Service Revenue |  | Revenue % |  |
Medicaid(1) |  | $ | 1,007,061 |  |  |  |  |  |  | $ | 15,399 |  |  | $ | 1,022,460 |  |  | 39.2 | % |  |
Medicare |  | 727,103 |  |  |  |  |  |  | — |  |  | 727,103 |  |  | 27.8 |  |  |
Medicaid-skilled |  | 172,770 |  |  |  |  |  |  | — |  |  | 172,770 |  |  | 6.6 |  |  |
Subtotal |  | 1,906,934 |  |  |  |  |  |  | 15,399 |  |  | 1,922,333 |  |  | 73.6 |  |  |
Managed care |  | 456,728 |  |  |  |  |  |  | — |  |  | 456,728 |  |  | 17.5 |  |  |
Private and other(2) |  | 159,572 |  |  |  |  |  |  | 72,843 |  |  | 232,415 |  |  | 8.9 |  |  |
TOTAL SERVICE REVENUE |  | $ | 2,523,234 |  |  |  |  |  |  | $ | 88,242 |  |  | $ | 2,611,476 |  |  | 100.0 | % |  |
(1) Medicaid payor includes revenue generated from senior living operations and revenue related to state relief funding. (2) Private and other payors also includes revenue from senior living operations and all payors generated in other ancillary services. (3) All Other incorporates intercompany eliminations.

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- Definition The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 22 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-22 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 15 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-15 Reference 3: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 31 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-31 Reference 4: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 32 -Subparagraph (d) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-32 Reference 5: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 42 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-42 Reference 6: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 32 -Subparagraph (f) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-32 Reference 7: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 40 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-40 Reference 8: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -Name Accounting Standards Codification -Publisher FASB -URI https://asc.fasb.org//280/tableOfContent Reference 9: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 26 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-26 Reference 10: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 34 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-34 Reference 11: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 41 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-41 Reference 12: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 21 -Subparagraph (a) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-21 Reference 13: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 21 -Subparagraph (b) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-21 Reference 14: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 32 -Subparagraph (e) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-32 + Details
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