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BUSINESS SEGMENTS (Tables)
12 Months Ended
Dec. 31, 2023
Segment Reporting [Abstract]  
Schedule of Segment Financial Information
The following tables set forth financial information for the segments:
 Year Ended December 31, 2023
 Skilled ServicesStandard Bearer
All Other (1)
Intercompany EliminationTotal
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 amortization38,766 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 ServicesStandard Bearer
All Other (1)
Intercompany EliminationTotal
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 amortization33,224 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 ServicesStandard Bearer
All Other (1)
Intercompany EliminationTotal
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 recoveries440 
Income before provision for income taxes $258,004 
Depreciation and amortization30,681 17,558 7,746 — 55,985 
Interest expense$— $6,842 $$— $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.
Schedule of Service Revenue by Major Payor Source
Service revenue by major payor source were as follows:
 Year Ended December 31, 2023
 Skilled Services
All Other (3)
Total Service RevenueRevenue %
Medicaid(1)
$1,429,473 $29,976 $1,459,449 39.4 %
Medicare985,749 — 985,749 26.6 
Medicaid-skilled245,663 — 245,663 6.6 
Subtotal2,660,885 29,976 2,690,861 72.6 
Managed care666,129 — 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 RevenueRevenue %
Medicaid(1)
$1,158,309 $24,847 $1,183,156 39.3 %
Medicare832,160 — 832,160 27.7 
Medicaid-skilled200,878 — 200,878 6.7 
Subtotal2,191,347 24,847 2,216,194 73.7 
Managed care525,710 — 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 RevenueRevenue %
Medicaid(1)
$1,007,061 $15,399 $1,022,460 39.2 %
Medicare727,103 — 727,103 27.8 
Medicaid-skilled172,770 — 172,770 6.6 
Subtotal1,906,934 15,399 1,922,333 73.6 
Managed care456,728 — 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.