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The Ensign Group Reports Fourth Quarter and Fiscal Year 2019 Results

February 5, 2020 4:18 PM

SAN JUAN CAPISTRANO, Calif., Feb. 05, 2020 (GLOBE NEWSWIRE) -- The Ensign Group, Inc. (Nasdaq: ENSG), the parent company of the Ensign(TM) group of companies, which provide skilled nursing services, senior living services, rehabilitative care services and other healthcare services, announced its operating results for the fourth quarter and full year 2019, reporting record GAAP diluted earnings per share of $0.49 and $1.97 for the quarter and year ended December 31, 2019, respectively. Ensign also reported a record adjusted earnings per share of $0.60 for the quarter and $2.24 for the year(2).

Highlights Include:

Operating Results

“We are thrilled to report a record quarter as we achieved our highest adjusted earnings per share in our history,” said Ensign’s Chief Executive Officer Barry Port. He credited the local operational and clinical leadership teams and all of their field-based and Service Center partners for achieving these impressive clinical and financial results even in the midst of completing a transformative spin-off transaction and implementing a brand new reimbursement system. “We are proud that our amazing operators were able to achieve these record results in the midst of potential distractions. We also want to remind you that we can see tremendous organic growth potential in our 73 transitioning and newly acquired operations and in same store operations. We are very excited about our continued operational momentum and expect it to continue into 2020,” he added.

Port noted that much of the improvement came from strong quarter over quarter improvements in occupancy and both skilled mix days and revenue across same store, transitioning and newly acquired operations. He added, “We are excited about the positive trends we continue to see in occupancy, as this is the fourth quarter in a row where we have experienced an increase of over 150 basis points in occupancy in both same store and transitioning operations, quarter over quarter.”

Mr. Port also commented on the organization’s experience in its first quarter of operations under CMS’s Patient Driven Payment Model (“PDPM”). Complimenting CMS on the new system, he said, “We believe PDPM is an excellent long-term, patient-centered program that rewards operators that achieve high quality outcomes.” Port noted, “After adjusting for the recent market basket increase, we experienced a range of rate growth from approximately 3% for our transitioning operations to approximately 6% for our same store operations, which generally serve a higher acuity patient as they mature into clinically complex operations. Our locally-driven model of improving our clinical capabilities has always been focused on increasing our acuity, which has resulted in consistent improvement in earnings, independent of the current rate environment. While we experienced a modest rate improvement in our first quarter under the new system, the lion’s share of our performance during the quarter is totally unrelated to the PDPM impact.”

Ensign also announced a 12.4% increase from its initial 2020 annual earnings guidance. “Given the strength of the quarter and our expectations for continued improvement over the next few quarters, we are raising our 2020 annual earnings guidance to $2.50 to $2.58 per diluted share and annual revenue guidance to $2.42 billion to $2.45 billion. We are very optimistic that with the continued upside that is inherent in our portfolio and the attractive acquisitions on the horizon, that we will be able to continue to meet or exceed our historic growth rates. To underline this confidence, the midpoint of our 2020 guidance represents an increase of 30.3% over our 2019 spin adjusted results, which was $1.95(3) per diluted share when adjusting for the full-year impact of the Pennant spin-off. In addition, this guidance represents an increase of 13.4% over our adjusted diluted 2019 results of $2.24(2), which includes Pennant results for the first nine months of 2019,” Port said.

“We are very excited about our performance this year and are confident that as our local leaders continue to stay true to our operating model, our operational strength will continue into 2020 and beyond,” he added. “In the fourth quarter, we more than replaced Pennant’s historical earnings, much sooner than anticipated, and we expect that trend to accelerate into 2020. We have not even come close to reaching our full potential, and to do so it will take a relentless commitment to our culture and the repetitious adherence to sound fundamentals,” Port said.

Chief Financial Officer, Suzanne Snapper reported that the company’s liquidity remains strong with approximately $135 million of availability on its new $350 million credit facility, which also has a built-in expansion option, and 72 unlevered real estate assets that add additional liquidity. Snapper also indicated that the company maintained a lease-adjusted net-debt-to-adjusted EBITDAR ratio of 3.95x at quarter end a decrease from 4.14x(1) (when adjusting for the Spin-off), even after heavy acquisitions during the fourth quarter, which tend to temporarily raise the ratio while EBITDAR from new acquisitions catches up.

A discussion of the company's use of non-GAAP and proforma financial measures is set forth below. A reconciliation of net income to EBITDA, adjusted EBITDAR, adjusted EBITDA, as well as a reconciliation of GAAP earnings per share, net income to adjusted net income and adjusted net earnings per share, and proforma metrics appear in the financial data portion of this release. More complete information is contained in the company’s Annual Report on Form 10-K for the year ended December 31, 2019, which is expected to be filed with the SEC today and can be viewed on the company’s website at http://www.ensigngroup.net.

Quarterly Growth

During the quarter, the Company paid a quarterly cash dividend of $0.05 per share of Ensign common stock. “We are pleased to announce our seventeenth consecutive annual dividend increase, which reflects our strong market position and continued commitment to return value to our shareholders,” said Chad Keetch, Ensign’s Chief Investment Officer.

Also during the quarter and since, Ensign’s affiliates acquired the following skilled nursing and healthcare campus operations:

“As we saw last quarter, the pipeline for our typical turnaround opportunities and well-priced strategic deals remains strong. We are still being very selective and are keeping plenty of dry powder on hand for what we believe will continue to be an attractive buyer’s market,” said Keetch. “We look forward to growing within our existing geographical footprint and will do so as we see significant advantages to adding strength in markets we know well, including some of our newer emerging markets as they continue to mature and prepare for growth. We remain confident that there are and will be many, many opportunities to be had at the right prices,” he added.

These additions bring Ensign's growing portfolio to 225 skilled nursing operations, 23 of which also include senior living operations across fourteen states. Ensign now owns 92 real estate assets, 62 of which it operates. Keetch reaffirmed that Ensign continues to actively seek transactions to acquire real estate and to lease both well-performing and struggling skilled nursing, senior living and other healthcare related businesses in new and existing markets.

Increased 2020 Guidance

Management raised guidance for 2020, with annual earnings per share guidance to $2.50 to 2.58 per diluted share and annual revenue guidance to $2.42 billion to $2.45 billion. The midpoint of this 2020 guidance represents an increase of 30.3% over 2019 spin adjusted results, which was $1.95 per diluted share when adjusting for the full-year impact of the Pennant spin-off. Management’s guidance is based on diluted weighted average common shares outstanding of approximately 57.6 million and a 25% tax rate. In addition, the guidance assumes, among other things, normalized health insurance costs, normal anticipated Medicare and Medicaid reimbursement rate increases, net of provider taxes, and acquisitions closed in the first half of 2020. It also excludes acquisition-related costs and amortization costs related to intangible assets acquired, share-based compensation and start-up losses.

Conference Call

A live webcast will be held Thursday, February 6, 2020 at 10:00 a.m. Pacific time (1:00 p.m. Eastern time) to discuss Ensign’s fourth quarter and fiscal year 2019 financial results. To listen to the webcast, or to view any financial or statistical information required by SEC Regulation G, please visit the Investors Relations section of Ensign’s website at http://investor.ensigngroup.net. The webcast will be recorded, and will be available for replay via the website until 5:00 p.m. Pacific Time on Friday, February 28, 2020.

About Ensign™

The Ensign Group, Inc.'s independent operating subsidiaries provide a broad spectrum of skilled nursing and assisted living services, physical, occupational and speech therapies and other rehabilitative and healthcare services at 225 healthcare facilities in Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, South Carolina, Texas, Utah, Washington and Wisconsin. Ensign’s new business venture operating subsidiaries also offer several other post-acute-related services, including mobile x-ray, lab, non-emergency transportation services and other consulting services also across several states. Each of these operations is operated by a separate, independent operating subsidiary that has its own management, employees and assets. References herein to the consolidated "company" and "its" assets and activities, as well as the use of the terms "we," "us," "its" and similar verbiage, are not meant to imply that The Ensign Group, Inc. has direct operating assets, employees or revenue, or that any of the facilities, the Service Center or the captive insurance subsidiary are operated by the same entity. More information about Ensign is available at http://www.ensigngroup.net. Safe Harbor Statement under the Private Securities Litigation Reform Act of 1995:

This press release contains, and the related conference call and webcast will include, forward-looking statements that are based on management’s current expectations, assumptions and beliefs about its business, financial performance, operating results, the industry in which it operates and other future events. Forward-looking statements can often be identified by words such as "anticipates," "expects," "intends," "plans," "predicts," "believes," "seeks," "estimates," "may," "will," "should," "would," "could," "potential," "continue," "ongoing," similar expressions, and variations or negatives of these words. These forward-looking statements include, but are not limited to, statements regarding growth prospects, future operating and financial performance, and acquisition activities. They are not guarantees of future results and are subject to risks, uncertainties and assumptions that could cause actual results to materially and adversely differ from those expressed in any forward-looking statement.

These risks and uncertainties relate to the company’s business, its industry and its common stock and include: reduced prices and reimbursement rates for its services; its ability to acquire, develop, manage or improve operations, its ability to manage its increasing borrowing costs as it incurs additional indebtedness to fund the acquisition and development of operations; its ability to access capital on a cost-effective basis to continue to successfully implement its growth strategy; its operating margins and profitability could suffer if it is unable to grow and manage effectively its increasing number of operations; competition from other companies in the acquisition, development and operation of facilities; its ability to defend claims and lawsuits, including professional liability claims alleging that our services resulted in personal injury, and other regulatory-related claims; and the application of existing or proposed government regulations, or the adoption of new laws and regulations, that could limit its business operations, require it to incur significant expenditures or limit its ability to relocate its operations if necessary. Readers should not place undue reliance on any forward-looking statements and are encouraged to review the company’s periodic filings with the Securities and Exchange Commission, including its Form 10-K, for a more complete discussion of the risks and other factors that could affect Ensign’s business, prospects and any forward-looking statements. Except as required by the federal securities laws, Ensign does not undertake any obligation to publicly update or revise any forward-looking statements, whether as a result of new information, future events, changing circumstances or any other reason after the date of this press release.

Contact Information

Investor/Media Relations, The Ensign Group, Inc., (949) 487-9500, [email protected].

SOURCE: The Ensign Group, Inc.

The following tables have been adjusted to reflect the operations transferred to The Pennant Group, Inc. as part of the Spin-Off as discontinued operations. Accordingly, the results are displayed using continuing and discontinued operations format. Supplemental data that outlines the impact of continuing and discontinued operations has been provided.
THE ENSIGN GROUP, INC. CONSOLIDATED STATEMENTS OF INCOME (In thousands, except per share data)
Three Months Ended December 31, Years Ended December 31,
2019 2018 2019 2018
Revenue from continuing operations$560,191 $462,439 $2,036,524 $1,754,601
Expense from continuing operations
Cost of services 443,382 372,066 1,620,628 1,418,249
Return of unclaimed class action settlement - - - (1,664)
Rent—cost of services 31,511 29,898 124,789 117,676
General and administrative expense 32,251 25,013 110,873 90,563
Depreciation and amortization 13,354 11,544 51,054 44,864
Total expenses 520,498 438,521 1,907,344 1,669,688
Income from operations from continuing operations 39,693 23,918 129,180 84,913
Other income (expense):
Interest expense (4,149) (3,711) (15,662) (15,182)
Interest income 792 549 2,649 2,016
Other expense, net (3,357) (3,162) (13,013) (13,166)
Income before provision for income taxes 36,336 20,756 116,167 71,747
Provision for income taxes 9,010 2,653 23,954 12,685
Net income from continuing operations, net of tax 27,326 18,103 92,213 59,062
Net income from discontinued operations, net of tax - 8,456 19,473 33,466
Net income 27,326 26,559 111,686 92,528
Less:
Net (loss)/income attributable to noncontrolling interests in continuing operations (68) 16 523 (431)
Net income attributable to noncontrolling interests in discontinued operations - 183 629 595
Net (loss)/ income attributable to noncontrolling interests (68) 199 1,152 164
Net income attributable to The Ensign Group, Inc.$27,394 $26,360 $110,534 $92,364
Amounts attributable to The Ensign Group, Inc.
Income from continuing operations attributable to The Ensign Group, Inc. 27,394 18,087 91,690 59,493
Income from discontinued operations, net of income tax - 8,273 18,844 32,871
Net income attributable to The Ensign Group, Inc.$27,394 $26,360 $110,534 $92,364
Net income per share attributable to The Ensign Group, Inc.:
Basic:
Continuing operations$0.51 $0.34 $1.72 $1.14
Discontinued operations$- $0.16 $0.35 $0.64
Basic income per share attributable to The Ensign Group, Inc.$0.51 $0.50 $2.07 $1.78
Diluted:
Continuing operations$0.49 $0.33 $1.64 $1.09
Discontinued operations$- $0.15 $0.33 $0.61
Diluted income per share attributable to The Ensign Group, Inc.$0.49 $0.48 $1.97 $1.70
Weighted average common shares outstanding:
Basic 53,397 52,449 53,452 52,016
Diluted 55,760 54,967 55,981 54,397

THE ENSIGN GROUP, INC.
GAAP, NON-GAAP AND PRO FORMA INFORMATION
(In thousands, except per share data)
(Unaudited)
The following table sets forth GAAP, Non-GAAP and pro forma results for our revenue, net income, diluted EPS, EBITDA and EBITDAR for the periods indicated:
Three Months Ended December 31, 2019 Three Months Ended December 31, 2018 Three Months Ended September 30, 2019
GAAP Non-GAAP(1)Pro Forma Non-GAAPAdjustments(2) GAAP Non-GAAP(1)Pro Forma Non-GAAPAdjustments(2) GAAP Non-GAAP(1)Pro Forma Non-GAAPAdjustments(2)
(In thousands, except per share data)
Net revenue - continuing operations$560,191$555,979$555,979 $462,439$445,455$448,293 $512,109$509,541$512,582
Net revenue - discontinued operations - - 75,336 75,291 88,398 88,325
Net revenue$560,191$555,979 $537,775$520,746 $600,507$597,866
Net income - continuing operations$27,394$33,529$33,529 $18,087$21,254$23,569 $22,148$22,447$25,487
Net income - discontinued operations - - 8,273 8,156 5,011 8,496
Net income$27,394$33,529 $26,360$29,410 $27,159$30,943
Fully diluted EPS - continuing operations$0.49$0.60$0.60 $0.33$0.39$0.43 $0.39$0.40$0.45
Fully diluted EPS - discontinued operations - - 0.15 0.15 0.09 0.15
Fully diluted EPS$0.49$0.60 $0.48$0.54 $0.48$0.55
EBITDA - continuing operations$53,115$60,430$60,430 $35,446$42,728$45,973 $43,814$46,160$50,286
EBITDA - discontinued operations - - 11,001 11,543 8,781 12,324
EBITDA$53,115$60,430 $46,447$54,271 $52,595$58,484
EBITDAR - continuing operations $91,498$91,498 $77,740$81,866
EBITDAR - discontinued operations - 18,173
EBITDAR $91,498 $95,913
(1) Refer to our reconciliation of GAAP to Non-GAAP financial information.
(2) Unaudited pro forma Non-GAAP results include adjustments of rental income and savings of general and administrative and interest expense as if the Spin-Off has occurred at the beginning of the period reported.

THE ENSIGN GROUP, INC.
GAAP, NON-GAAP AND PRO FORMA INFORMATION
(In thousands, except per share data)
(Unaudited)
The following table sets forth GAAP, Non-GAAP and pro forma results for our revenue, net income, diluted EPS, EBITDA and EBITDAR for the periods indicated:
Year Ended December 31, 2019 Year Ended December 31, 2018
GAAP Non-GAAP(1)Pro Forma Non-GAAPAdjustments(2) GAAP Non-GAAP(1)Pro Forma Non-GAAPAdjustments(2)Pro Forma Non-GAAPAdjustments(3)
(In thousands, except per share data) (In thousands, except per share data)
Net revenue - continuing operations$2,036,524$2,027,915$2,037,010 $1,754,601$1,688,214$1,699,568$1,688,214
Net revenue - discontinued operations 249,039 248,713 286,058 285,838 210,546
Net revenue$2,285,563$2,276,628 $2,040,659$1,974,052 $1,898,760
Net income - continuing operations$91,690$99,869$108,990 $59,493$68,319$77,584$68,319
Net income - discontinued operations 18,844 25,688 32,871 33,812 25,654
Net income$110,534$125,557 $92,364$102,131 $93,973
Fully diluted EPS - continuing operations$1.64$1.78$1.95 $1.09$1.26$1.43$1.26
Fully diluted EPS - discontinued operations 0.33 0.46 0.61 0.62 0.47
Fully diluted EPS$1.97$2.24 $1.70$1.88 $1.73
EBITDA - continuing operations$179,711$195,645$207,805 $130,208$147,988$160,968$147,988
EBITDA - discontinued operations 26,883 36,801 45,460 47,627 36,083
EBITDA$206,594$232,446 $175,668$195,615 $184,071
EBITDAR - continuing operations $319,513$331,674
EBITDAR - discontinued operations 54,084
EBITDAR $373,597
(1) Refer to our reconciliation of GAAP to Non-GAAP financial information.
(2) Unaudited pro forma Non-GAAP results include adjustments of rental income, savings of general and administrative and interest expense as if the Spin-Off had occurred at the beginning of the period reported.
(3) Unaudited pro forma Non-GAAP results include results of continuing operations for four quarters and three quarters of discontinued operations to be comparable to 2019 Non-GAAP results.

THE ENSIGN GROUP, INC. CONSOLIDATED BALANCE SHEETS (In thousands)
December 31,
2019 2018
Assets
Current assets:
Cash and cash equivalents$59,175 $31,042
Accounts receivable—less allowance for doubtful accounts of $2,472 and $2,270 at December 31, 2019 and 2018, respectively 308,985 251,915
Investments—current 17,754 8,682
Prepaid income taxes 739 6,219
Prepaid expenses and other current assets 24,428 19,576
Assets held for sale - current - 1,859
Current assets of discontinued operations - 28,779
Total current assets 411,081 348,072
Property and equipment, net 767,565 608,416
Right-of-use assets 1,046,901 -
Insurance subsidiary deposits and investments 30,571 36,168
Escrow deposits 14,050 7,271
Deferred tax assets 4,615 11,749
Restricted and other assets 26,207 18,459
Intangible assets, net 3,382 30,922
Goodwill 54,469 49,585
Other indefinite-lived intangibles 3,068 2,466
Long-term assets of discontinued operations - 68,850
Total assets$2,361,909 $1,181,958
Liabilities and equity
Current liabilities:
Accounts payable$44,973 $39,846
Accrued wages and related liabilities 151,009 106,870
Lease liabilities—current 44,964 -
Accrued self-insurance liabilities—current 29,252 25,446
Other accrued liabilities 70,273 56,711
Current maturities of long-term debt 2,702 10,105
Current liabilities of discontinued operations - 30,249
Total current liabilities 343,173 269,227
Long-term debt—less current maturities 325,217 233,135
Long-term lease liabilities—less current portion 973,983 -
Accrued self-insurance liabilities—less current portion 58,114 54,605
Other long-term liabilities 5,278 7,918
Deferred gain related to sale-leaseback - 11,417
Long-term liabilities of discontinued operations - 3,316
Total equity 656,144 602,340
Total liabilities and equity$2,361,909 $1,181,958
THE ENSIGN GROUP, INC. CONSOLIDATED STATEMENTS OF CASH FLOWS (In thousands)
The following table presents selected data from our consolidated statements of cash flows for the periods presented:
Year Ended December 31,
2019 2018
Net cash provided by (used in):
Continuing operating activities$168,927 $170,152
Continuing investing activities (224,030) (141,340)
Continuing financing activities 83,278 (70,345)
Net (decrease) increase in cash and cash equivalents from discontinued operations (83) 30,279
Net increase (decrease) in cash and cash equivalents 28,092 (11,254)
Cash and cash equivalents beginning of period, including cash of discontinued operations 31,083 42,337
Cash and cash equivalents end of period, including cash of discontinued operations$59,175 $31,083
Less cash of discontinued operations at end of period - 41
Cash and cash equivalents at end of period 59,175 31,042

THE ENSIGN GROUP, INC.
RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION
(In thousands, except per share data)
(Unaudited)
RECONCILIATION OF GAAP TO NON-GAAP NET INCOME
Three Months Ended December 31, Year Ended December 31,
2019 2018 2019 2018
Net income from continuing operations$27,394 $18,087 $91,690 $59,493
Net income from discontinued operations, net of tax - 8,273 18,844 32,871
Net income attributable to The Ensign Group, Inc. 27,394 26,360 110,534 92,364
Non-GAAP adjustments for continuing operations:
Results related to operations in the start-up phase(a) - 449 - 3,682
Return of unclaimed class action settlement - - - (1,664)
Share-based compensation expense(b) 3,107 2,211 11,322 8,367
Results related to closed operations and operations not at full capacity(c) 1,311 222 3,505 933
Acquisition related costs(d) 132 10 277 322
Depreciation and amortization - patient base(e) 260 79 521 154
General and administrative - Spin-Off transaction costs(f) 464 - 464 -
COS - impairment charges to fixed assets(g) 1,732 4,632 329 4,632
COS - business interruption gains(h) - - - (675)
COS - impairment of goodwill and intangibles(i) 941 - 941 3,177
Interest expense - write off of deferred financing fee(j) 329 - 329 -
Provision for income taxes on Non-GAAP adjustments(k) (2,141) (4,436) (9,509) (10,102)
Non-GAAP income from continuing operations 33,529 21,254 99,869 68,319
Non-GAAP income from discontinued operations(l) - 8,156 25,688 33,812
Non-GAAP Net Income$33,529 $29,410 $125,557 $102,131
Average number of shares outstanding 55,760 54,967 55,981 54,397
Diluted Earnings Per Share As Reported
Continuing operations$0.49 $0.33 $1.64 $1.09
Discontinued operations$- $0.15 $0.33 $0.61
Diluted income per share attributable to The Ensign Group, Inc.$0.49 $0.48 $1.97 $1.70
Adjusted Diluted Earnings Per Share
Continuing operations$0.60 $0.39 $1.78 $1.26
Discontinued operations$- $0.15 $0.46 $0.62
Net Income$0.60 $0.54 $2.24 $1.88
Footnotes:
(a) Represents operating results for start-up operations.
Three Months Ended December 31, Year Ended December 31,
2019 2018 2019 2018
Revenue$- $(16,984) $- $(66,386)
Cost of services - 13,581 - 54,758
Rent - 3,619 - 14,347
Depreciation and amortization - 233 - 963
Total Non-GAAP adjustment$- $449 $- $3,682
(b) Represents share-based compensation expense incurred.
Three Months Ended December 31, Year Ended December 31,
2019 2018 2019 2018
Cost of services$2,001 $1,379 $7,036 $5,183
General and administrative 1,106 832 4,286 3,184
Total Non-GAAP adjustment$3,107 $2,211 $11,322 $8,367
(c) Represents results at closed operations and operations not at full capacity
Three Months Ended December 31, Year Ended December 31,
2019 2018 2019 2018
Revenue$(4,212)$- $(8,609)$-
Cost of services 4,708 137 10,289 601
Rent 443 76 921 301
Depreciation and amortization 372 9 904 31
Total Non-GAAP adjustment$1,311 $222 $3,505 $933
(d) Represents costs incurred to acquire an operation which are not capitalizable.
(e) Included in depreciation and amortization are expenses related to patient base intangible assets at newly acquired skilled nursing and senior living facilities.
(f) Included in general and administrative expense are costs incurred in connection with the completed Spin-Off of our home health and hospice operations and substantially all of our senior living operations to a newly formed publicly traded company subsequent to the Spin-Off date. Expenses incurred prior to Spin-Off date are included in discontinued operations as an adjustment.
(g) Impairment charges to fixed assets includes impairment charges of $1.7 million at a leased skilled nursing operation during the three months ended December 31, 2019. Additionally, included in the year ended December 31, 2019, impairment charges of $1.5 million at two of our senior living operations and at the skilled nursing operation mentioned, offset by the gain recognized for the sale of real estate of $2.9 million.
(h) Business interruption recoveries related to insurance claims of the California fires that occurred in the fourth quarter of 2017.
(i) Impairment charges to goodwill and intangible assets at our other ancillary operations and a skilled nursing operation.
(j) Represents the write off of deferred financing fees associated with the amendment of the credit facility.
(k) Represents an adjustment to the provision for income tax to our historical year to date effective tax rate of 25.0% for the three months and years ended December 31, 2019 and 2018.
(l) Represents results of the home health, hospice and senior living operations we transferred to the Pennant Group, Inc. as a result of the Spin-Off.
Three Months Ended December 31, Year Ended December 31,
2019 2018 2019 2018
Revenue$- $75,291 $248,713 $285,838
Cost of services - (55,314) (185,963) (208,585)
General and administrative expenses - (2,819) (8,037) (8,225)
Rent - (5,432) (17,283) (20,805)
Depreciation and amortization - (643) (2,367) (2,392)
Interest income, net - 36 26 47
Provision for income taxes - (2,780) (8,772) (11,471)
Non-controlling interest - (183) (629) (595)
Non-GAAP net income from discontinued operations$- $8,156 $25,688 $33,812

THE ENSIGN GROUP, INC.
RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION
(In thousands)
(Unaudited)
The table below reconciles net income to EBITDA, Adjusted EBITDA and Adjusted EBITDAR for the periods presented:
Three Months Ended December 31, Year Ended December 31,
2019 2018 2019 2018
Consolidated Statements of Income Data:
Net income attributable to The Ensign Group, Inc.$27,326 $26,559 $111,686 $92,528
Less: net (loss)/income attributable to noncontrolling interests in continuing operations (68) 16 523 (431)
Less: net income from discontinued operations, net of tax - 8,456 19,473 33,466
Add: Interest expense, net 3,357 3,162 13,013 13,166
Provision for income taxes 9,010 2,653 23,954 12,685
Depreciation and amortization 13,354 11,544 51,054 44,864
EBITDA from continuing operations 53,115 35,446 179,711 130,208
EBITDA from discontinued operations (g) - 11,001 26,883 45,460
EBITDA$53,115 $46,447 $206,594 $175,668
Adjustments to EBITDA:
Earnings related to operations in the start-up phase (a) - (3,403) - (11,628)
Return of unclaimed class action settlement - - - (1,664)
Share-based compensation expense 3,107 2,211 11,322 8,367
Results related to closed operations and operations not at full capacity(b) 496 137 1,680 601
Acquisition related costs(c) 132 10 277 322
Spin-Off transaction costs(d) 464 - 464 -
Impairment charges to fixed assets, net of gain on sale(e) 1,732 4,632 329 4,632
Business interruption recoveries related to Hurricane Harvey and California fires - - - (675)
Impairment of goodwill and intangible assets(f) 941 - 941 3,177
Rent related to items above 443 3,695 921 14,648
Adjusted EBITDA from continuing operations 60,430 42,728 195,645 147,988
Adjusted EBITDA from discontinued operations(g) - 11,543 36,801 47,627
Adjusted EBITDA$60,430 $54,271 $232,446 $195,615
Rent—cost of services 31,511 29,898 124,789 117,676
Less: rent related to items above (443) (3,695) (921) (14,648)
Adjusted rent—cost of services 31,068 26,203 - 123,868 103,028
Adjusted rent included in discontinued operations - 5,432 17,283 20,805
Adjusted EBITDAR from continuing operations$91,498 $319,513
Adjusted EBITDAR$91,498 -$373,597
(a) Represents results related to facilities currently in the start-up phase after construction was completed. This amount excludes rent, depreciation and interest expense.
(b) Results at closed operations and operations not at full capacity during the periods presented.
(c) Costs incurred to acquire operations which are not capitalizable.
(d) Costs incurred in connection with the completed Spin-Off transaction of our home health and hospice operations and substantially all of our senior living operations to a newly formed publicly traded company. Transaction costs incurred prior to Spin-Off date are included in discontinued operations as an adjustment.
(e) Impairment charges to fixed assets includes impairment charges of $1.7 million at a leased skilled nursing operation during the three months ended December 31, 2019. Additionally, included in the year ended December 31, 2019, impairment charges of $1.5 million at two of our senior living operations and at the skilled nursing operation mentioned, offset by the gain recognized for the sale of real estate of $2.9 million.
(f) Impairment charges to goodwill and intangible assets at our other ancillary operations and a skilled nursing operation.
(g) All adjustments included in the table below are presented within net income from discontinued operations, net of tax within the consolidated statements of income for the periods presented.
Three Months Ended December 31, Year Ended December 31,
2019 2018 2019 2018
Consolidated Statements of Income Data:
Net income from discontinued operations, net of tax$- $8,456 $19,473 $33,466
Less: net income attributable to noncontrolling interests in discontinued operations - 183 629 595
Add: Interest income, net$- $(37) $(26)$(47)
Provision for income taxes - 2,110 5,663 10,156
Depreciation and amortization - 655 2,402 2,480
EBITDA from discontinued operations$- $11,001 $26,883 $45,460
Adjustments to EBITDA from discontinued operations:
Earnings related to operations in the start-up phase - 35 377 128
Share-based compensation expense - 486 1,018 1,970
Spin-Off transaction costs - 13 7,909 -
Acquisition related costs - - 603 39
Rent related to items above - 8 11 30
Adjusted EBITDA from discontinued operations$- $11,543 $36,801 $47,627

THE ENSIGN GROUP, INC.
SELECT PERFORMANCE INDICATORS
(Unaudited)
The following tables summarize our selected performance indicators for our transitional and skilled services segment along with other statistics, for each of the dates or periods indicated:
Three Months Ended December 31,
2019 2018 Change% Change
(Dollars in thousands)
Total Facility Results:
Transitional and skilled revenue$530,171 $441,714 $88,457 20.0%
Number of facilities at period end 190 168 22 13.1%
Number of campuses at period end* 23 19 4 21.1%
Actual patient days 1,591,163 1,393,783 197,380 14.2%
Occupancy percentage — Operational beds 79.1% 77.9% 1.2%
Skilled mix by nursing days 28.7% 28.6% 0.1%
Skilled mix by nursing revenue 49.2% 48.1% 1.1%
Three Months Ended December 31,
2019 2018 Change% Change
(Dollars in thousands)
Same Facility Results(1):
Transitional and skilled revenue$372,507 $339,210 $33,297 9.8%
Number of facilities at period end 131 131 - -%
Number of campuses at period end* 9 9 - -%
Actual patient days 1,065,825 1,032,926 32,899 3.2%
Occupancy percentage — Operational beds 80.6% 78.7% 1.9%
Skilled mix by nursing days 31.2% 30.4% 0.8%
Skilled mix by nursing revenue 52.0% 49.9% 2.1%
Three Months Ended December 31,
2019 2018 Change% Change
(Dollars in thousands)
Transitioning Facility Results(2):
Transitional and skilled revenue$94,778 $86,516 $8,262 9.5%
Number of facilities at period end 33 33 - -%
Number of campuses at period end* 7 7 - -%
Actual patient days 313,281 307,367 5,914 1.9%
Occupancy percentage — Operational beds 77.7% 76.2% 1.5%
Skilled mix by nursing days 25.4% 24.4% 1.0%
Skilled mix by nursing revenue 45.5% 43.8% 1.7%
Three Months Ended December 31,
2019 2018 Change% Change
(Dollars in thousands)
Recently Acquired Facility Results(3):
Transitional and skilled revenue$62,010 $13,017 $48,993 NM
Number of facilities at period end 26 4 22 NM
Number of campuses at period end* 7 3 4 NM
Actual patient days 209,255 43,387 165,868 NM
Occupancy percentage — Operational beds 74.2% 72.4% NM
Skilled mix by nursing days 20.9% 19.8% NM
Skilled mix by nursing revenue 38.1% 32.2% NM
Three Months Ended December 31,
2019 2018 Change% Change
(Dollars in thousands)
Facility Closed Results(4):
Transitional and skilled revenue$876 $2,971 $(2,095)NM
Actual patient days 2,802 10,103 (7,301)NM
Occupancy percentage — Operational beds 60.7% 73.7% NM
Skilled mix by nursing days 13.7% 15.1% NM
Skilled mix by nursing revenue 27.8% 29.9% NM
* Campus represents a facility that offers both skilled nursing and senior living services. Revenue and expenses related to skilled nursing and senior living services have been allocated and recorded in the respective reportable segment.
(1) Same Facility results represent all facilities purchased prior to January 1, 2016.
(2) Transitioning Facility results represent all facilities purchased from January 1, 2016 to December 31, 2017.
(3) Recently Acquired Facility (Acquisitions) results represent all facilities purchased on or subsequent to January 1, 2018.
(4) Facility Closed results represents closed operations during the three months ended December 31, 2019, which were excluded from Same Facilities results for the three months ended December 31, 2019 and 2018 for comparison purposes.
Year Ended December 31,
2019 2018 Change% Change
(Dollars in thousands)
Total Facility Results:
Transitional and skilled revenue$1,934,640 $1,679,012 $255,628 15.2%
Number of facilities at period end 190 168 22 13.1%
Number of campuses at period end* 23 19 4 21.1%
Actual patient days 5,987,027 5,405,952 581,075 10.7%
Occupancy percentage — Operational beds 79.2% 77.4% 1.8%
Skilled mix by nursing days 29.0% 29.5% (0.5)%
Skilled mix by nursing revenue 48.8% 49.6% (0.8)%
Year Ended December 31,
2019 2018 Change% Change
(Dollars in thousands)
Same Facility Results(1):
Transitional and skilled revenue$1,410,718 $1,307,882 $102,836 7.9%
Number of facilities at period end 131 131 - -%
Number of campuses at period end* 9 9 - -%
Actual patient days 4,199,374 4,070,122 129,252 3.2%
Occupancy percentage — Operational beds 80.3% 78.2% 2.1%
Skilled mix by nursing days 31.1% 31.2% (0.1)%
Skilled mix by nursing revenue 51.2% 51.1% 0.1%
Year Ended December 31,
2019 2018 Change% Change
(Dollars in thousands)
Transitioning Facility Results(2):
Transitional and skilled revenue$364,337 $330,795 $33,542 10.1%
Number of facilities at period end 33 33 - -%
Number of campuses at period end* 7 7 - -%
Actual patient days 1,247,573 1,201,138 46,435 3.9%
Occupancy percentage — Operational beds 78.1% 75.3% 2.8%
Skilled mix by nursing days 25.5% 25.2% 0.3%
Skilled mix by nursing revenue 44.9% 45.2% (0.3)%
Year Ended December 31,
2019 2018 Change% Change
(Dollars in thousands)
Recently Acquired Facility Results(3):
Transitional and skilled revenue$149,995 $28,580 $121,415 NM
Number of facilities at period end 26 4 22 NM
Number of campuses at period end* 7 3 4 NM
Actual patient days 510,541 95,034 415,507 NM
Occupancy percentage — Operational beds 74.0% 73.9% NM
Skilled mix by nursing days 20.9% 20.5% NM
Skilled mix by nursing revenue 36.4% 33.4% NM
Year Ended December 31,
2019 2018 Change% Change
(Dollars in thousands)
Facility Closed Results(4):
Transitional and skilled revenue$9,590 $11,755 $(2,165)NM
Actual patient days 29,539 39,658 (10,119)NM
Occupancy percentage — Operational beds 65.2% 72.9% NM
Skilled mix by nursing days 17.0% 16.1% NM
Skilled mix by nursing revenue 34.4% 33.4% NM
* Campus represents a facility that offers both skilled nursing and senior living services. Revenue and expenses related to skilled nursing and senior living services have been allocated and recorded in the respective reportable segment.
(1) Same Facility results represent all facilities purchased prior to January 1, 2016.
(2) Transitioning Facility results represent all facilities purchased from January 1, 2016 to December 31, 2017.
(3) Recently Acquired Facility (Acquisitions) results represent all facilities purchased on or subsequent to January 1, 2018.
(4) Facility Closed results represents closed operations during the year ended December 31, 2019, which were excluded from Same Facilities results for the year ended December 31, 2019 and 2018 for comparison purposes.

THE ENSIGN GROUP, INC.
SKILLED NURSING AVERAGE DAILY REVENUE RATES AND
PERCENT OF SKILLED NURSING REVENUE AND DAYS BY PAYOR
The following table reflects the change in skilled nursing average daily revenue rates by payor source, excluding services that are not covered by the daily rate:
Three Months Ended December 31,
Same FacilityTransitioningAcquisitionsTotal
2019 2018 2019 2018 2019 2018 2019 2018
Skilled Nursing Average Daily Revenue Rates:
Medicare$669.99$611.29$566.96$529.04$615.07$520.12$642.11$590.27
Managed care 486.07 461.46 429.96 415.66 439.18 424.28 470.83 450.91
Other skilled 511.16 485.01 495.11 581.69 323.27 249.05 501.46 486.26
Total skilled revenue 563.23 526.39 502.37 480.00 518.43 458.20 548.33 516.35
Medicaid 237.78 232.72 208.42 200.45 224.69 240.55 230.12 225.68
Private and other payors 226.89 228.35 195.88 194.95 211.72 237.21 216.97 219.89
Total skilled nursing revenue$338.08$321.86$281.18$268.05$284.27$283.32$319.72$308.52
Year Ended December 31,
Same FacilityTransitioningAcquisitionsTotal
2019 2018 2019 2018 2019 2018 2019 2018
Skilled Nursing Average Daily Revenue Rates:
Medicare$628.20$600.65$542.67$520.85$594.74$528.11$607.24$580.96
Managed care 470.85 457.09 420.48 410.87 432.41 423.94 458.26 447.34
Other skilled 496.37 475.12 491.15 522.24 327.22 246.85 490.93 475.59
Total skilled revenue 537.00 517.86 484.13 473.60 501.13 460.52 525.41 509.10
Medicaid 232.41 225.48 203.99 193.18 231.46 235.70 226.43 218.30
Private and other payors 231.87 225.31 202.19 198.33 229.17 237.61 223.97 218.42
Total skilled nursing revenue$327.48$317.01$275.25$264.81$287.52$282.07$313.11$304.57

The following tables set forth our percentage of skilled nursing patient revenue and days by payor source for the three months and years ended December 31, 2019 and 2018:
Three Months Ended December 31,
Same FacilityTransitioningAcquisitionsTotal
2019 2018 2019 2018 2019 2018 2019 2018
Percentage of Skilled Nursing Revenue:
Medicare24.2%23.2%26.0%25.2%22.8%17.4%24.3%23.4%
Managed care17.9 17.0 17.4 17.0 13.2 13.6 17.3 16.9
Other skilled9.9 9.7 2.1 1.6 2.1 1.2 7.6 7.8
Skilled mix52.0 49.9 45.5 43.8 38.1 32.2 49.2 48.1
Private and other payors7.4 7.5 11.1 11.0 9.8 13.1 8.4 8.4
Medicaid40.6 42.6 43.4 45.2 52.1 54.7 42.4 43.5
Total skilled nursing100.0%100.0%100.0%100.0%100.0%100.0%100.0%100.0%
Three Months Ended December 31,
Same FacilityTransitioningAcquisitionsTotal
2019 2018 2019 2018 2019 2018 2019 2018
Percentage of Skilled Nursing Days:
Medicare12.2%12.2%12.9%12.8%10.6%9.5%12.1%12.2%
Managed care12.5 11.8 11.4 10.9 8.6 9.0 11.7 11.5
Other skilled6.5 6.4 1.1 0.7 1.7 1.3 4.9 4.9
Skilled mix31.2 30.4 25.4 24.4 20.9 19.8 28.7 28.6
Private and other payors11.1 11.0 16.1 15.2 13.2 16.0 12.3 12.2
Medicaid57.7 58.6 58.5 60.4 65.9 64.2 59.0 59.2
Total skilled nursing100.0%100.0%100.0%100.0%100.0%100.0%100.0%100.0%
Year Ended December 31,
Same FacilityTransitioningAcquisitionsTotal
2019 2018 2019 2018 2019 2018 2019 2018
Percentage of Skilled Nursing Revenue:
Medicare23.2%23.6%25.1%26.8%20.6%17.9%23.4%24.2%
Managed care18.4 18.1 18.1 16.9 13.8 14.4 17.9 17.7
Other skilled9.6 9.4 1.7 1.5 2.0 1.1 7.5 7.7
Skilled mix51.2 51.1 44.9 45.2 36.4 33.4 48.8 49.6
Private and other payors7.5 7.6 11.3 11.5 11.0 14.1 8.5 8.5
Medicaid41.3 41.3 43.8 43.3 52.6 52.5 42.7 41.9
Total skilled nursing100.0%100.0%100.0%100.0%100.0%100.0%100.0%100.0%
Year Ended December 31,
Same FacilityTransitioningAcquisitionsTotal
2019 2018 2019 2018 2019 2018 2019 2018
Percentage of Skilled Nursing Days:
Medicare12.1%12.4%12.7%13.6%10.0%9.5%12.0%12.6%
Managed care12.7 12.5 11.8 10.8 9.2 9.6 12.2 12.0
Other skilled6.3 6.3 1.0 0.8 1.7 1.4 4.8 4.9
Skilled mix31.1 31.2 25.5 25.2 20.9 20.5 29.0 29.5
Private and other payors10.8 11.0 15.6 15.6 13.9 16.8 12.1 12.2
Medicaid58.1 57.8 58.9 59.2 65.2 62.7 58.9 58.3
Total skilled nursing100.0%100.0%100.0%100.0%100.0%100.0%100.0%100.0%

THE ENSIGN GROUP, INC.
REVENUE BY PAYOR SOURCE
The following table sets forth our total revenue by payor source and as a percentage of total revenue for the periods indicated:
Three Months Ended December 31, Year Ended December 31,
2019 2018 2019 2018
$%$% $%$%
(Dollars in thousands) (Dollars in thousands)
Revenue:
Medicaid$216,72938.7%$188,05840.7% $802,95239.4%$691,27639.4%
Medicare 144,21325.7 112,88424.4 499,35324.5 436,58024.9
Medicaid-skilled 36,5676.5 31,6626.9 132,8896.5 117,6866.7
Total Medicaid and Medicare 397,50970.9 332,60472.0 1,435,19470.4 1,245,54271.0
Managed Care 92,84916.6 76,00216.4 351,05417.2 301,86617.2
Private and Other(1) 69,83312.5 53,83311.6 250,27612.4 207,19311.8
Revenue$560,191100.0%$462,439100.0% $2,036,524100.0%$1,754,601100.0%
(1) Private and other payors also includes revenue from all payors generated in our other ancillary services for the three months and years ended December 31, 2019 and 2018. During the fiscal year 2019, private and other payors includes $5,812 of rental income.

THE ENSIGN GROUP, INC.
SUPPLEMENTAL RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION BY QUARTER
(In thousands, except per share data)
(Unaudited)
RECONCILIATION OF GAAP TO NON-GAAP NET INCOME
Three Months Ended
3/31/19 6/30/19 9/30/19 12/31/19
Net income from continuing operations$21,480 $20,668 $22,148 $27,394
Net income from discontinued operations, net of tax 5,892 7,941 5,011 -
Net income attributable to The Ensign Group, Inc. 27,372 28,609 27,159 27,394
Non-GAAP adjustments for continuing operations:
Share-based compensation expense(a) 2,456 2,930 2,829 3,107
Results related to closed operations and operations not at full capacity(b) 349 626 1,219 1,311
Acquisition related costs(c) 26 49 69 132
Depreciation and amortization - patient base(d) 70 87 104 260
General and administrative - Spin-Off transaction costs(e) - - - 464
COS - (gain on sale)/impairment charges to fixed assets(f) - - (1,402) 1,732
COS - impairment of goodwill and intangibles(g) - - - 941
Interest expense - write off of deferred financing fee(h) - - - 329
Provision for income taxes on Non-GAAP adjustments(i) (2,161) (2,687) (2,520) (2,141)
Non-GAAP income from continuing operations 22,220 21,673 22,447 33,529
Non-GAAP income from discontinued operations(j) 8,583 8,609 8,496 -
Non-GAAP Net Income$30,803 $30,282 $30,943 $33,529
Average number of shares outstanding 55,698 56,078 56,364 55,760
Diluted Earnings Per Share As Reported
Continuing operations$0.39 $0.37 $0.39 $0.49
Discontinued operations$0.10 $0.14 $0.09 $-
Diluted income per share attributable to The Ensign Group, Inc.$0.49 $0.51 $0.48 $0.49
Adjusted Diluted Earnings Per Share
Continuing operations$0.40 $0.39 $0.40 $0.60
Discontinued operations$0.15 $0.15 $0.15 $-
Net Income$0.55 $0.54 $0.55 $0.60
Footnotes:
(a) Represents share-based compensation expense incurred.
Three Months Ended
3/31/19 6/30/19 9/30/19 12/31/19
Cost of services$1,516 $1,779 $1,740 $2,001
General and administrative 940 1,151 1,089 1,106
Total Non-GAAP adjustment$2,456 $2,930 $2,829 $3,107
(b) Represents results at closed operations and operations not at full capacity
Three Months Ended
3/31/19 6/30/19 9/30/19 12/31/19
Revenue$- $(1,830) $(2,567) $(4,212)
Cost of services 264 2,195 3,122 4,708
Rent 76 107 295 443
Depreciation and amortization 9 154 369 372
Total Non-GAAP adjustment$349 $626 $1,219 $1,311
(c) Represents costs incurred to acquire an operation which are not capitalizable.
(d) Included in depreciation and amortization are expenses related to patient base intangible assets at newly acquired skilled nursing and senior living facilities.
(e) Included in general and administrative expense are costs incurred in connection with the completed Spin-Off of our home health and hospice operations and substantially all of our senior living operations to a newly formed publicly traded company.
(f) Impairment charges to fixed assets includes impairment charges of $1.7 million at a leased skilled nursing operations during the three months ended December 31, 2019. Included in the three months ended September 30, 2019, impairment charges of $1.5 million at two of our senior living operations, offset by the gain recognized for the sale of real estate of $2.9 million.
(g) Impairment charges to goodwill and intangible assets at our other ancillary operations and a skilled nursing operation.
(h) Represents the write off of deferred financing fees associated with the amendment of the credit facility.
(i) Represents an adjustment to the provision for income tax to our historical year to date effective tax rate of 25.0% for the periods presented.
(j) Represents results of the home health, hospice and senior living operations we transferred to the Pennant Group, Inc. as a result of the Spin-Off.
Three Months Ended
3/31/19 6/30/19 9/30/19 12/31/19
Revenue$77,730 $82,658 $88,325 $-
Cost of services (57,448) (61,534) (66,981) -
General and administrative expenses (2,393) (2,752) (2,892) -
Rent (5,598) (5,836) (5,849) -
Depreciation and amortization (658) (800) (909) -
Interest income, net 11 9 6 -
Provision for income taxes (2,911) (2,936) (2,925) -
Non-controlling interest (150) (200) (279) -
Non-GAAP net income from discontinued operations$8,583 $8,609 $8,496 $-

THE ENSIGN GROUP, INC.
SUPPLEMENTAL RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION BY QUARTER
(In thousands)
(Unaudited)
The table below reconciles net income to EBITDA, Adjusted EBITDA and Adjusted EBITDAR for the periods presented:
Three Months Ended
3/31/19 6/30/19 9/30/19 12/31/19
Consolidated Statements of Income Data:
Net income attributable to The Ensign Group, Inc. $27,607 $28,925 $27,828 $27,326
Less: net income/(loss) attributable to noncontrolling interests in continuing operations 85 116 390 (68)
Less: net income from discontinued operations, net of tax 6,042 8,141 5,290 -
Add: Interest expense, net 3,109 3,379 3,168 3,357
Provision for income taxes 5,275 4,576 5,093 9,010
Depreciation and amortization 11,929 12,366 13,405 13,354
EBITDA from continuing operations 41,793 40,989 43,814 53,115
EBITDA from discontinued operations(f) 8,374 9,725 8,781 -
EBITDA $50,167 $50,714 $52,595 $53,115
Adjustments to EBITDA:
Share-based compensation expense 2,456 2,930 2,829 3,107
Results related to closed operations and operations not at full capacity(a) 264 365 555 496
Acquisition related costs(b) 26 49 69 132
Spin-Off transaction costs(c) - - - 464
(Gain on sale)/impairment charges to fixed assets(d) - - (1,402) 1,732
Impairment of goodwill and intangible assets(e) - - - 941
Rent related to items above 76 107 295 443
Adjusted EBITDA from continuing operations 44,615 44,440 46,160 60,430
Adjusted EBITDA from discontinued operations(f) 12,141 12,336 12,324 -
Adjusted EBITDA $56,756 $56,776 $58,484 $60,430
Rent—cost of services 30,181 31,222 31,875 31,511
Less: rent related to items above (76) (107) (295) (443)
Adjusted rent—cost of services 30,105 31,115 31,580 31,068
Adjusted rent included in discontinued operations 5,598 5,836 5,849 -
Adjusted EBITDAR from continuing operations 74,720 75,555 77,740 91,498
Adjusted EBITDAR $92,459 $93,727 $95,913 $91,498
(a) Results at closed operations and operations not at full capacity during the periods presented.
(b) Costs incurred to acquire operations which are not capitalizable.
(c) Costs incurred in connection with the completed Spin-Off transaction of our home health and hospice operations and substantially all of our senior living operations to a newly formed publicly traded company.
(d) Impairment charges to fixed assets includes impairment charges of $1.7 million at a leased skilled nursing operations during the three months ended December 31, 2019. Included in the three months ended September 30, 2019, we recorded an impairment charges of $1.5 million at two of our senior living operations, offset by the gain recognized for the sale of real estate of $2.9 million.
(e) Impairment charges to goodwill and intangible assets at our other ancillary operations and a skilled nursing operation.
(f) All adjustments included in the table below are presented within net income from discontinued operations, net of tax within the consolidated statements of income for the periods presented.
Three Months Ended
3/31/19 6/30/19 9/30/19 12/31/19
Consolidated Statements of Income Data:
Net income from discontinued operations, net of tax $6,042 $8,141 $5,290 $-
Less: net income attributable to noncontrolling interests in discontinued operations 150 200 279 -
Add: Interest income, net (12) (10) (4) -
Provision for income taxes 1,825 976 2,860 -
Depreciation and amortization 669 818 914 -
EBITDA from discontinued operations $8,374 $9,725 $8,781 $-
Adjustments to EBITDA from discontinued operations:
Earnings related to operations in the start-up phase 236 82 59 -
Share-based compensation expense 497 372 149 -
Spin-Off transaction costs 2,990 1,658 3,261 -
Acquisition related costs 36 497 70 -
Rent related to items above 8 2 4 -
Adjusted EBITDA from discontinued operations $12,141 $12,336 $12,324 $-

Discussion of Non-GAAP Financial Measures

EBITDA consists of net income before (a) interest expense, net, (b) provisions for income taxes and (c) depreciation and amortization. Adjusted EBITDA consists of net income before (a) interest expense, net, (b) provisions for income taxes, (c) depreciation and amortization, (d) costs incurred for operations currently in start-up phase, excluding depreciation, interest and income taxes, (e) return of unclaimed class action settlement; (f) share-based compensation expense; (g) results of operations not at full capacity, excluding depreciation, interest and income taxes, (h) acquisition related costs; (i) spin-off transaction costs, (j) impairment charges to fixed assets, net of gain on sale of assets; (k) business interruption recoveries; and (l) impairment of intangible assets and goodwill. Adjusted EBITDAR consists of net income before (a) interest expense, net, (b) provisions for income taxes, (c) depreciation and amortization, (d) rent-cost of services, (e) costs incurred for facilities currently in start-up phase, excluding rent, depreciation, interest and income taxes, (f) return of unclaimed class action settlement; (g) share-based compensation expense; (h) results of operations not at full capacity, excluding rent, depreciation, interest and income taxes, (i) return of unclaimed class action settlement; (j) spin-off transaction costs, (k) impairment charges to fixed assets, net of gain on sale of assets; (l) business interruption recoveries; and (m) impairment of intangible assets and goodwill. The company believes that the presentation of EBITDA, adjusted EBITDA, adjusted net income and adjusted earnings per share provides important supplemental information to management and investors to evaluate the company’s operating performance. Adjusted EBITDAR is a financial valuation measure that is not specified in GAAP. This measure is not displayed as a performance measure as it excludes rent expense, which is a normal and recurring operating expense. The company believes disclosure of adjusted net income, adjusted net income per share, EBITDA, adjusted EBITDA and adjusted EBITDAR has substance because the excluded revenues and expenses are infrequent in nature and are variable in nature, or do not represent current revenues or cash expenditures. A material limitation associated with the use of these measures as compared to the GAAP measures of net income and diluted earnings per share is that they may not be comparable with the calculation of net income and diluted earnings per share for other companies in the company's industry. These non-GAAP financial measures should not be relied upon to the exclusion of GAAP financial measures.

We have included unaudited pro forma financials. The unaudited pro forma consolidated financial information were not prepared in accordance with Article 11 of Regulation S-X. The historical financial data has also been adjusted to give pro forma effect to events that are directly attributable to the Spin-Off transaction and have an ongoing effect on Ensign’s statement of operations. The unaudited pro forma consolidated financial statements include: (1) rental income generated from a master lease with Pennant; (2) reduction in estimated historical general and administrative expenses related to Pennant; (3) amendment of the credit facility in connection with the spin-off; and (4) the discontinued operation effect of the spin-off. For further information regarding why the company believes that this non-GAAP and pro forma measures provide useful information to investors, the specific manner in which management uses these measures, and some of the limitations associated with the use of these measures, please refer to the company's periodic filings with the Securities and Exchange Commission, including its Annual Report on Form 10-K and Quarterly Report on Form 10-Q. The company’s periodic filings are available on the SEC's website at www.sec.gov or under the "Financial Information" link of the Investor Relations section on Ensign’s website at http://www.ensigngroup.net.

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Source: The Ensign Group, Inc.

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