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BUSINESS SEGMENTS
 12 Months Ended
Dec. 31, 2024
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, 2024, the skilled services segment includes 286 skilled nursing and 30 campus operations that provide both skilled nursing and rehabilitative care services and senior living services. The Company's Standard Bearer segment consists of 124 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 30 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, other ancillary operations and the Service Center. 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 segment structure reflects the Company's current operational and financial management and provides the best structure to maximize the quality of care and investment strategy provided, while maintaining financial discipline.

Segment income (loss) is defined as income or loss before provision for income taxes, excluding gain or loss from sale of real estate, real estate insurance recoveries and impairment of long-lived assets. The Company's CODM, who is the Chief Executive Officer, reviews segment income or loss for each operating segment to evaluate performance and allocate capital resources. The CODM uses segment income or loss to analyze actual results as part of operational planning and to decide whether to reinvest profits into the segments or into other parts of the Company, such as through acquisitions, to pay dividends or to recommend a stock repurchase program. The Company's CODM does not review assets by segment in his resource allocation and therefore assets by segment are not disclosed below.

Intercompany revenue is eliminated in consolidation, along with corresponding intercompany expenses. 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, 2024
 Skilled ServicesStandard Bearer
Total
Service revenue(1)
$4,076,825 $— $4,076,825 
Rental revenue
— 95,086 95,086 
Segment revenue
$4,076,825 $95,086 $4,171,911 
Reconciliation of revenue:
All other revenue(2)
192,881 
Elimination of intercompany revenue(3)
(104,307)
TOTAL CONSOLIDATED REVENUE
$4,260,485 
Less:
Other segment items(4)
3,513,167 9,152 
Depreciation and amortization45,195 29,297 
Interest expense(5)
— 27,302 
Segment income
$518,463 $29,335 $547,798 
Reconciliation of profit or loss:
All other loss
(161,704)
INCOME BEFORE PROVISION FOR INCOME TAXES
$386,094 
(1) Skilled services service revenue does not include intercompany 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 "Elimination of intercompany revenue".
(2) All other revenue includes $181,066 of service revenue and $11,815 of rental revenue for the year ended December 31, 2024, both of which include intercompany revenue that is eliminated in "Elimination of intercompany revenue".
(3) Elimination of intercompany revenue includes the elimination of intercompany rental revenue of $83,941 and intercompany service revenue of $20,366 for the year ended December 31, 2024.
(4) Other segment items includes cost of services and rent expense for the skilled services segment and cost of services, rent expense and general and administrative expenses for the Standard Bearer segment. Additionally, there are intercompany expenses of $104,307 during the year ended December 31, 2024, which are eliminated in consolidation.
(5) Included in interest expense in Standard Bearer is interest from intercompany debt arrangements between Standard Bearer and The Ensign Group, Inc. of $20,285 during the year ended December 31, 2024, which is eliminated in consolidation.

 Year Ended December 31, 2023
 Skilled ServicesStandard BearerTotal
Service revenue(1)
$3,578,855 $— $3,578,855 
Rental revenue
— 82,486 82,486 
Segment revenue
$3,578,855 $82,486 $3,661,341 
Reconciliation of revenue:
All other revenue(2)
155,804 
Elimination of intercompany revenue(3)
(87,790)
TOTAL CONSOLIDATED REVENUE
$3,729,355 
Less:
Other segment items(4)
3,075,164 8,455 
Depreciation and amortization38,766 25,205 
Interest expense(5)
— 19,761 
Segment income$464,925 $29,065 $493,990 
Reconciliation of profit or loss:
All other loss
(221,228)
INCOME BEFORE PROVISION FOR INCOME TAXES
$272,762 
(1) Skilled services service revenue does not include intercompany 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 "Elimination of intercompany revenue".
(2) All Other revenue includes $144,667 of service revenue and $11,137 of rental revenue for the year ended December 31, 2023, both of which include intercompany revenue that is eliminated in "Elimination of intercompany revenue".
(3) Elimination of intercompany revenue includes the elimination intercompany rental revenue of $72,339 and intercompany service revenue of $15,451 for the year ended December 31, 2023.
(4) Other segment items includes cost of services and rent expense for the skilled services segment and cost of services, rent expense and general and administrative expenses for the Standard Bearer segment. Additionally, there are intercompany expenses of $87,790 during the year ended December 31, 2023, which is eliminated in consolidation.
(5) Included in interest expense in Standard Bearer is interest from intercompany debt arrangements between Standard Bearer and The Ensign Group, Inc. of $12,902 during the year ended December 31, 2023, which is eliminated in consolidation.
 
Year Ended December 31, 2022
 Skilled ServicesStandard BearerTotal
Service revenue(1)
$2,906,215 $— $2,906,215 
Rental revenue
— 72,937 72,937 
Segment revenue
$2,906,215 $72,937 $2,979,152 
Reconciliation of revenue:
All other revenue(2)
122,610 
Elimination of intercompany revenue(3)
(76,294)
TOTAL CONSOLIDATED REVENUE
$3,025,468 
Less:
Other segment items(4)
2,464,259 7,746 
Depreciation and amortization33,224 21,613 
Interest expense(5)
— 15,707 
Segment income$408,732 $27,871 $436,603 
Reconciliation of profit or loss:
All other loss
(147,514)
INCOME BEFORE PROVISION FOR INCOME TAXES
$289,089 
(1) Skilled services service revenue does not include intercompany 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 "Elimination of intercompany revenue".
(2) All Other revenue includes $115,214 of service revenue and $7,396 of rental revenue for the year ended December 31, 2022, both of which include intercompany revenue that is eliminated in "Elimination of intercompany revenue".
(3) Elimination of intercompany revenue includes the elimination of intercompany rental revenue of $63,576 and intercompany service revenue of $12,718 for the year ended December 31, 2022.
(4) Other segment items includes cost of services and rent expense for the skilled services segment and cost of services, rent expense and general and administrative expenses for the Standard Bearer segment. Additionally, there are intercompany expenses of $76,294 during the year ended December 31, 2022, which is eliminated in consolidation.
(5) Included in interest expense in Standard Bearer is interest from intercompany debt arrangements between Standard Bearer and The Ensign Group, Inc. of $8,646 during the year ended December 31, 2022, which is eliminated in consolidation.

Service revenue by major payor source were as follows:
 Year Ended December 31, 2024
 Skilled Services
All Other (3)
Total Service RevenueRevenue %
Medicaid(1)
$1,646,422 $35,922 $1,682,344 39.7 %
Medicare1,055,226 — 1,055,226 24.9 
Medicaid-skilled266,738 — 266,738 6.3 
Subtotal$2,968,386 $35,922 $3,004,308 70.9 %
Managed care789,643 — 789,643 18.6 
Private and other(2)
318,796 124,778 443,574 10.5 
TOTAL SERVICE REVENUE$4,076,825 $160,700 $4,237,525 100.0 %
(1) Medicaid payor includes revenue generated from senior living operations.
(2) Private and other payors also includes revenue from senior living operations and all revenue generated in other ancillary services.
(3) All Other incorporates intercompany eliminations.
 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 
Subtotal$2,660,885 $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 revenue 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.