Ensign Group Inc (ENSG) 2023 Q3 法說會逐字稿

Thank you for standing by. My name is Bailey, and I will be your conference operator today. At this time, I would like to welcome everyone to the Ensign Q3 Earnings Call. (Operator Instructions).

謝謝你的支持。我叫貝利，今天我將擔任你們的會議操作員。此時此刻，我歡迎大家參加 Ensign 第三季財報電話會議。 （操作員說明）。

I would now like to turn the call over to Chad Keetch, Chief Investment Officer. Please go ahead.

我現在想將電話轉給首席投資長 Chad Keetch。請繼續。

Thank you, operator, and welcome, everyone. We filed our earnings press release yesterday, and it is available on the Investor Relations section of our website at ensigngroup.net.

謝謝運營商，歡迎大家。我們昨天提交了收益新聞稿，可在我們網站 ensigngroup.net 的投資者關係部分取得。

A replay of this call will also be available on our website until 5:00 p.m. Pacific on Friday, November 24, 2023. We want to remind any listeners that may be listening to a replay of this call that all the statements made are as of today, October 26, 2023, and these statements have not been nor will be updated subsequent to today's call.

本次電話會議的重播也將在我們的網站上提供，直至下午 5:00。太平洋時間，星期五，2023 年 11 月 24 日。我們想提醒所有正在收聽本次電話會議重播的聽眾，所有聲明均截至今天，即 2023 年 10 月 26 日，並且這些聲明尚未更新，也不會更新在今天的電話會議之後。

Also, any forward-looking statements made today are based on management's current expectations, assumptions and beliefs about our business and the environment in which we operate. These statements are subject to risks and uncertainties that could cause our actual results to materially differ from those expressed or implied on today's call.

此外，今天所做的任何前瞻性陳述均基於管理層目前對我們的業務和營運環境的預期、假設和信念。這些陳述存在風險和不確定性，可能導致我們的實際結果與今天電話會議中明示或暗示的結果有重大差異。

Listeners should not place undue reliance on forward-looking statements and are encouraged to review our SEC filings for a more complete discussion of factors that could impact our results. Except as required by federal securities laws, Ensign and its affiliates do not undertake to publicly update or revise any forward-looking statements where changes arise as a result of new information, future events, changing circumstances or for any other reason.

聽眾不應過度依賴前瞻性陳述，並鼓勵聽眾查看我們向 SEC 提交的文件，以更全面地討論可能影響我們業績的因素。除聯邦證券法要求外，Ensign 及其附屬公司不承諾公開更新或修改因新資訊、未來事件、情況變化或任何其他原因而發生變化的任何前瞻性聲明。

In addition, the Ensign Group, Inc. is a holding company with no direct operating assets, employees or revenues. Certain of our wholly owned independent subsidiaries, collectively referred to as a service center provide accounting, payroll, human resources, information technology, legal, risk management and other services to other operating subsidiaries through contractual relationships with such subsidiaries. In addition, our wholly owned captive insurance subsidiary, which we refer to as the insurance captive, provides certain claims-made coverage to our operating companies for general and professional liability as well as for workers' compensation insurance liabilities.

此外，Ensign Group, Inc. 是一家控股公司，沒有直接營運資產、員工或收入。我們的某些全資獨立子公司（統稱為服務中心）透過與其他營運子公司的合約關係向其他營運子公司提供會計、薪資、人力資源、資訊科技、法律、風險管理和其他服務。此外，我們全資擁有的自保子公司（我們稱之為保險自保）為我們的營運公司提供某些索賠保險，涵蓋一般責任和專業責任以及工人賠償保險責任。

Ensign also owns Standard Bearer Healthcare, REIT, Inc., which is a captive real estate investment trust that invests in health care properties and enters into lease agreements with certain independent subsidiaries of Ensign as well as third-party tenants that are unaffiliated with the Ensign Group. The words Ensign, company, we, our and us refer to the Ensign Group, Inc. and its consolidated subsidiaries. All of our operating subsidiaries, the Service Center, Standard Bearer Healthcare REIT and the insurance captive are operated by separate wholly owned independent companies that have their own management, employees and assets.

Ensign 還擁有 Standard Bearer Healthcare, REIT, Inc.，這是一家專屬房地產投資信託公司，投資於醫療保健物業，並與 Ensign 的某些獨立子公司以及與 Ensign 無關的第三方租戶簽訂租賃協議團體。 Ensign、公司、我們、我們的和我們這些字詞均指 Ensign Group, Inc. 及其合併子公司。我們所有的營運子公司、服務中心、Standard Bearer Healthcare REIT 和保險自保公司均由單獨的全資獨立公司經營，這些公司擁有自己的管理層、員工和資產。

References herein to the consolidated company and its assets and activities as well as the use of words we, us, our and similar terms we may use today are not meant to imply nor should it be construed as meaning that the Ensign Group has direct operating assets, employees or revenue or that any of the subsidiaries are operated by the Ensign Group.

本文中提及的合併公司及其資產和活動以及我們今天可能使用的「我們」、「我們的」和類似術語並不意味著也不應被解釋為意味著 Ensign 集團擁有直接營運資產、員工或營收或任何子公司均由Ensign 集團營運。

Also, we supplement our GAAP reporting with non-GAAP metrics. When viewed together with our GAAP results, we believe that these measures can provide a more complete understanding of our business, but they should not be relied upon to the exclusion of GAAP reports. A GAAP to non-GAAP reconciliation is available in yesterday's press release and is available on our Form 10-Q. And with that, I'll turn the call over to Barry Port, our CEO. Barry?

此外，我們也以非 GAAP 指標來補充我們的 GAAP 報告。當與我們的 GAAP 結果一起查看時，我們相信這些措施可以提供對我們業務的更全面的了解，但不應依賴它們來排除 GAAP 報告。昨天的新聞稿中提供了 GAAP 與非 GAAP 的調整表，也可在我們的 10-Q 表格中找到。接下來，我會將電話轉給我們的執行長巴里波特 (Barry Port)。巴里？

Thanks, Chad, and thank you all for joining us today. We are proud to report another strong quarter and are pleased that we have been able to continue to improve our clinical and financial results across our portfolio. We are grateful for the efforts and commitment of our teams and caregivers and leaders who work endlessly to support and love one another, which allows for the high-quality patient outcomes they consistently achieve.

謝謝查德，也謝謝大家今天加入我們。我們很自豪地報告又一個強勁的季度，並且很高興我們能夠繼續改善整個產品組合的臨床和財務表現。我們感謝我們的團隊、護理人員和領導者的努力和承諾，他們不斷地相互支持和關懷，這使得他們能夠不斷實現高品質的病患治療結果。

During the quarter, we saw continued improvement in occupancies in managed care revenues, which is particularly impressive given the persistent labor market pressures and the return of more typical seasonality. More specifically, we were pleased to see same-store occupancy of 79.5%, which grew by 290 basis points over the prior year quarter and by 97 basis points sequentially over the second quarter. Given the upward trend in same-store occupancy through the quarter, we are confident that we are on a path to reach and eventually exceed our pre-COVID same-store occupancy at 80.1% as we move into higher mission months of fall and winter.

在本季度，我們看到管理式醫療收入的入住率持續改善，考慮到持續的勞動力市場壓力和更典型的季節性回歸，這一點尤其令人印象深刻。更具體地說，我們很高興看到同店入住率達到 79.5%，比去年同期增長 290 個基點，比第二季度環比增長 97 個基點。鑑於本季同店入住率呈上升趨勢，我們有信心，隨著秋季和冬季的更高使命月份的到來，我們將有望達到並最終超過新冠疫情爆發前的 80.1% 同店入住率。

We also continue to build stronger relationships with our managed care partners due to better coordination of care, increased capabilities and strong clinical outcomes. As a result, we saw increased volume in our same-store and transitioning combined managed care census and managed care revenue, which increased during the quarter by 6.6% and 13.8%, respectively, over the prior year.

由於更好的護理協調、增強的能力和強大的臨床成果，我們也繼續與我們的管理式護理合作夥伴建立更牢固的關係。因此，我們的同店銷售和轉型綜合管理式醫療普查和管理式醫療收入有所增加，本季分別比前一年增長 6.6% 和 13.8%。

As expected, we saw a seasonal decrease to skilled mix during the quarter. However, due to our local operators strong clinical reputations, we are continuing to see elevated skilled mix when compared to pre-COVID levels. This continued growth in skilled mix demonstrates the increasing and sustainable demand for skilled post-acute services, including within the context of our managed care patients.

正如預期的那樣，我們看到本季技術人員組合出現季節性下降。然而，由於我們當地的營運商擁有良好的臨床聲譽，與新冠疫情之前的水平相比，我們繼續看到技術人員的組合有所提高。熟練人員組合的持續增長表明，對熟練急性後服務的需求不斷增長且可持續，包括在我們的管理式護理患者的背景下。

We are very excited to see our local field and service center partners share and apply best practices as they respond to the persistent labor market challenges. As they instill our customers second culture into each operation, we have seen and will continue to see lower turnover. Likewise, we are also seeing less usage of third-party nursing agencies, which improved again for the ninth month in a row as of September representing a reduction in agency usage of 55% since its peak in December of 2022.

我們非常高興看到我們當地的現場和服務中心合作夥伴在應對持續存在的勞動力市場挑戰時分享和應用最佳實踐。隨著他們將客戶的第二文化灌輸到每項業務中，我們已經看到並將繼續看到營業額下降。同樣，我們也看到第三方護理機構的使用量減少，截至9 月，第三方護理機構的使用量連續第九個月再次改善，這意味著機構使用量自2022 年12 月的峰值以來減少了55%。

We are also encouraged to see wage inflation slow down and our ability to successfully recruit new talent growth. As of the end of the quarter, we saw a number of new hires increased by 69% since the end of March. Due to our solid results during the quarter, as well as continued strength from our recent acquisitions, we are increasing our annual 2023 earnings guidance to between $4.73 and $4.79 per diluted share up from $4.70 to $4.78 per diluted share. This new midpoint of our 2023 earnings guidance represents an increase of 15% over our 2022 results and is 30.8% higher than our 2021 results.

我們也很高興看到薪資上漲放緩以及我們成功招募新人才的能力成長。截至本季末，我們看到新員工數量自 3 月底以來增加了 69%。由於我們本季的穩健業績，以及近期收購帶來的持續強勁表現，我們將 2023 年攤薄後每股收益指引從 4.70 美元至 4.78 美元上調至 4.73 美元至 4.79 美元之間。我們 2023 年獲利指引的新中點比 2022 年業績成長 15%，較 2021 年業績成長 30.8%。

We are also raising our annual revenue guidance to between $3.72 billion and $3.73 billion, up from our previous guidance of $3.69 billion to $3.73 billion. This increased guidance comes on top of the enormous growth we experienced in the last few years. To put this performance in perspective, since we spun out the Pennant Group in 2019, we have seen adjusted EPS grow by 167% with a compound annual growth rate of 28%. This performance is not due to some large events or single transformative transaction, but instead is the result of consistent growth and performance quarter after quarter that comes from following proven Ensign principles.

我們也將年度收入指引從先前的 36.9 億美元至 37.3 億美元提高至 37.2 億至 37.3 億美元。這一增加的指導是在我們過去幾年經歷的巨大增長的基礎上提出的。從這一表現來看，自 2019 年分拆 Pennant 集團以來，調整後每股收益成長了 167%，複合年增長率為 28%。這項績效並非源自於某些大型事件或單一變革性交易，而是遵循經過驗證的 Ensign 原則，逐季持續成長和績效的結果。

We are excited about the upcoming year and are confident that our partners will continue to manage and innovate through all the lingering challenges on the labor front. In spite of our impressive results, we also recognize that there are many opportunities to improve on certain operational fundamentals, both in existing operations and the growing number of new acquisitions. As we evaluate our expanding portfolio, we see more organic growth potential within our existing portfolio than ever before. There are so many opportunities in front of us to improve labor and drive occupancy and skilled mix as we continue to successfully transition dozens of recently acquired operations.

我們對即將到來的一年感到興奮，並相信我們的合作夥伴將繼續管理和創新，以應對勞工方面所有揮之不去的挑戰。儘管我們取得了令人印象深刻的業績，但我們也意​​識到，無論是在現有業務還是在不斷增加的新收購中，都有很多改進某些營運基礎的機會。當我們評估不斷擴大的投資組合時，我們發現現有投資組合比以往任何時候都具有更大的有機成長潛力。隨著我們繼續成功轉型數十個最近收購的業務，我們面前有許多改善勞動力、提高入住率和技能組合的機會。

We also see enormous growth opportunities and skilled mix in a way that best serves each unique healthcare market. When combined with a number of very attractive acquisition opportunities that we see on the near and far horizon, we are poised to again showcase our ability to find, acquire and transition performing and underperforming operations by applying proven Ensign principles developed over 2 decades.

我們也看到了巨大的成長機會和技術組合，以最好的方式服務每個獨特的醫療保健市場。結合我們在近期和遠期看到的許多非常有吸引力的收購機會，我們準備再次展示我們透過應用 20 年來成熟的 Ensign 原則來尋找、收購和轉型績效和績效不佳業務的能力。

As we relentlessly follow and protect the cultural fundamentals that got us here, we are confident that we will continue to consistently produce world-class clinical and financial performance.

當我們不懈地遵循和保護使我們走到今天的文化基礎時，我們有信心我們將繼續持續創造世界一流的臨床和財務表現。

Next, I'll ask Chad to add some additional insights regarding our recent growth. Chad?

接下來，我將請查德補充一些關於我們近期成長的額外見解。查德?

Thank you, Barry. As we expected, we continue to add to our growing portfolio and are very excited about the 6 new operations and 4 real estate assets we added during the quarter and since bringing the number of operations in our newly acquired bucket to 51. These skilled nursing operations include 2 operations in South Carolina, 1 operation in Kansas, 1 operation in Colorado and 2 operations in Washington, totaling an additional 621 new operational beds. We are excited to continue to grow in some of our most mature states, including Colorado and Washington and to add an operation in Kansas that was formerly operated by a hospital.

謝謝你，巴里。正如我們預期的那樣，我們繼續增加我們不斷增長的投資組合，並對我們在本季度添加的6 個新業務和4 個房地產資產感到非常興奮，因為我們新收購的業務數量已達到51 個。這些熟練的護理業務其中包括南卡羅來納州 2 個營運中心、堪薩斯州 1 個營運中心、科羅拉多州 1 個營運中心和華盛頓州 2 個營運中心，總計新增 621 個營運床位。我們很高興能夠在科羅拉多州和華盛頓州等一些最成熟的州繼續發展，並在堪薩斯州增加一家以前由醫院運營的業務。

We are also thrilled to close on a transaction where Standard Bearer was able to acquire the real estate in Washington and lease a portion of the portfolio to a third-party tenant. We have seen many transactions similar to the one we closed in Washington that have been presented to us in the past and are anxious to utilize this new strategy to do more deals we likely would have missed out on prior to implementing this approach.

我們也很高興完成一項交易，Standard Bearer 能夠收購華盛頓的房地產並將部分投資組合出租給第三方租戶。我們已經看到許多與我們過去在華盛頓完成的交易類似的交易，並且渴望利用這一新策略來完成更多在實施這種方法之前我們可能會錯過的交易。

All of these additions were carefully selected amongst the many opportunities we had and each of these were chosen because of the enormous clinical and financial potential in each operation. We have been patient and look forward to seeing our discipline pay off as these new operations continue to improve.

所有這些新增項目都是我們從眾多機會中精心挑選的，之所以選擇這些機會，是因為每項手術都具有巨大的臨床和財務潛力。我們一直保持耐心，並期待隨著這些新業務的不斷改進，我們的紀律得到回報。

As a result of the skilled service expansion so far in 2023, occupancy and skilled mix days for the skilled nursing operations in the newly acquired bucket was 77.4% and 26.1%, respectively, for the quarter. For those that have been following us for years will note, this is a very impressive starting point from which to build. However, when compared to our same-store occupancy and skilled mix days of 79.5% and 30.7% respectively, there is enormous upside in each of these operations as they continue to transform into same-store caliber operations.

由於 2023 年迄今熟練服務的擴張，本季新收購的熟練護理業務的佔用率和熟練混合天數分別為 77.4% 和 26.1%。對於多年來一直關注我們的人來說，這是一個非常令人印象深刻的建造起點。然而，與我們分別為 79.5% 和 30.7% 的同店入住率和熟練混合天數相比，隨著這些業務繼續轉型為同店水準業務，它們都有巨大的上升空間。

We are very optimistic about the organic growth potential within our existing portfolio as our new acquisitions are already contributing to our results, in many cases, ahead of schedule.

我們對現有投資組合的有機成長潛力非常樂觀，因為我們的新收購在許多情況下已經提前為我們的業績做出了貢獻。

Looking forward, we have another busy fall and winter ahead of us and are preparing for even more growth in 2024. We continue to see a steady pipeline of new opportunities and are beginning to see the effects of higher interest rates on pricing with more real estate opportunities coming to market at reasonable prices due to tighter financial markets. We also continue to see evidence that many operators are struggling. And as a result, we still expect there will be lots of opportunities that will arise. However, as we always remind you, we do not set arbitrary growth goals, and will remain true to our disciplined acquisition strategy only growing when we have the right leaders in place and the pricing is right.

展望未來，我們將面臨另一個繁忙的秋冬季節，並為 2024 年的更大增長做好準備。我們繼續看到穩定的新機會，並開始看到利率上升對更多房地產定價的影響由於金融市場趨緊，機會以合理的價格進入市場。我們也繼續看到許多業者陷入困境的證據。因此，我們仍然預計將會出現很多機會。然而，正如我們一直提醒您的那樣，我們不會設定任意的成長目標，並且將堅持我們嚴格的收購策略，只有在我們擁有合適的領導者並且定價合適的情況下才會成長。

With our locally driven operating model, we have lots of operational bandwidth to grow across dozens of markets. We continue to provide additional disclosure on Standard Bearer, which is now comprised of 107 properties owned by the company and leased to 78 affiliated skilled nursing and senior living operations, 1 campus operation to an unaffiliated tenant and 29 senior living operations that are leased to the Pennant Group, Inc. Each of these properties is subject to a triple-net long-term lease and generated rental revenue of $21 million for the quarter of which $17 million was derived from Ensign affiliated operations. Also for the quarter, Standard Bearer produced $13.6 million in FFO and as of the end of the quarter, had an EBITDAR to rent coverage ratio of 2.3x.

憑藉我們本地驅動的營運模式，我們擁有大量營運頻寬來在數十個市場中實現成長。我們繼續提供有關Standard Bearer 的更多披露，該公司目前包括該公司擁有的107 處房產，並出租給78 家附屬熟練護理和老年生活機構、1 處出租給非附屬租戶的校園機構以及29 處出租給該公司的老年生活機構。 Pennant Group, Inc. 的每個房產均受三重淨值長期租賃約束，本季產生的租金收入為 2,100 萬美元，其中 1,700 萬美元來自 Ensign 附屬業務。同樣在本季度，Standard Bearer 的 FFO 產量為 1,360 萬美元，截至本季末，EBITDAR 與租金覆蓋比率為 2.3 倍。

Looking forward, we are poised to grow with over $1 billion in dry powder for future investments. But more importantly, our local leaders are constantly recruiting future CEOs of our operations, and we have a deep bench of CEOs in training that are eagerly preparing for their opportunity to lead. We look forward to actively seeking opportunities to acquire real estate and to lease both well-performing and struggling skilled nursing, senior living and other healthcare-related businesses in our current footprint and in a few new states. And with that I'll turn the call over to Spencer, our COO, to add more color around our operations. Spencer?

展望未來，我們準備為未來投資提供超過 10 億美元的乾粉以實現成長。但更重要的是，我們的當地領導者不斷招募未來的首席執行官，我們擁有一大批正在接受培訓的首席執行官，他們正在熱切地為他們的領導機會做好準備。我們期待在我們目前的業務範圍和幾個新州積極尋求收購房地產和租賃表現良好和陷入困境的熟練護理、老年生活和其他醫療保健相關業務的機會。接下來，我會將電話轉給我們的營運長 Spencer，為我們的營運增添更多色彩。斯賓塞？

Thank you, Chad, and hello, everyone. As Barry highlighted, we have seen some exciting trends in occupancy, managed care growth and cost containment as well as continued progress in our recently acquired operations. For the next few minutes, I'd like to share highlights from 2 facilities to illustrate how local leaders are driving these improvements in spite of ongoing headwinds. The first example comes from Santa Rosa, California. One of the first facilities we ever acquired. Since joining the organization in the year 2000, Summerfield Healthcare Center has consistently achieved strong outcomes year after year, while also providing strength to sister facilities in the Northern California area.

謝謝查德，大家好。正如巴里所強調的那樣，我們看到了入住率、管理式醫療成長和成本控制的一些令人興奮的趨勢，以及我們最近收購的業務的持續進展。在接下來的幾分鐘裡，我想分享兩個設施的亮點，以說明當地領導人如何在持續的阻力下推動這些改進。第一個例子來自加州聖羅莎。我們收購的第一批設施之一。自 2000 年加入該組織以來，薩默菲爾德醫療保健中心年復一年地取得了強勁的成果，同時也為北加州地區的姊妹機構提供了力量。

However, over the past year, COO and Director of Nursing, Enedina De La Cruz and CEO, Cason Bush have taken performance to the next level. Compared to the prior year quarter, Summerfield's overall occupancy has increased by 7.5%, and skilled days have increased by 52.3% with meaningful improvement in both Medicare and managed care payers. As a result, total net revenue has improved by 40%, while EBIT has soared by 126%, all while maintaining top-notch customer satisfaction and 5 Star CMS ratings in quality measures and overall.

然而，在過去的一年裡，營運長兼護理總監 Enedina De La Cruz 和執行長 Cason Bush 將績效提升到了一個新的水平。與去年同期相比，Summerfield 的整體入住率增加了 7.5%，熟練工作天數增加了 52.3%，醫療保險和管理式醫療付款人均顯著改善。結果，總淨收入提高了 40%，息稅前利潤飆升 126%，同時保持一流的客戶滿意度和品質指標和整體 5 星 CMS 評級。

But the impact of Summerfield goes far beyond the performance of their facility. For example, when the North American transition occurred in February, 3 of these newly acquired facilities joined Summerfield's cluster. Leading up to the transition and since Cason and Enedina as cluster leaders have given countless hours of time and support to help their new partners acclimatize to the new culture and embrace the rigor of the cluster model. Results have followed. For example, despite initially having high agency and some of the newly acquired facilities, the entire cluster is now agency free.

但薩默菲爾德的影響遠遠超出了其設施的性能。例如，當北美過渡發生在 2 月時，其中 3 個新收購的設施加入了薩默菲爾德的集群。在過渡之前以及自擔任集群領導者以來，Cason 和 Enedina 付出了無數個小時的時間和支持，幫助他們的新合作夥伴適應新文化並接受集群模式的嚴格性。結果隨之而來。例如，儘管最初擁有較高的代理商和一些新收購的設施，但整個集群現在沒有代理商。

At the same time, clinical systems have strengthened, skilled mix has increased and financial results have consistently improved. The second highlight demonstrates a similar story of highly competent leaders achieving great results in spite of challenges. Redmond Care and Rehabilitation is a 5-star building located in Redmond, Washington. This amazing team, led by longtime CEO, Nate Holmes and COO, Debbie Dumandan were one of the first facilities to confront COVID-19 when the pandemic emerged in Washington in early 2020. And like many of our strongest affiliates, the Redmond team found a way to turn the crucible of the past few years into clinical, cultural and financial excellence that far exceeds their pre-pandemic performance.

同時，臨床系統得到了加強，技術人員組合增加，財務表現持續改善。第二個亮點展示了一個類似的故事，即儘管面臨挑戰，高素質的領導者仍取得了巨大的成果。雷德蒙護理與復健中心是一棟位於華盛頓州雷德蒙的五星級建築。這個令人驚嘆的團隊由長期擔任首席執行官Nate Holmes 和首席營運官Debbie Dumandan 領導，是2020 年初在華盛頓爆發新冠肺炎(COVID-19) 疫情時最先應對新冠肺炎(COVID-19) 的機構之一。與我們許多最強大的附屬機構一樣，雷德蒙德團隊發現了將過去幾年的嚴峻考驗轉變為臨床、文化和財務方面的卓越表現，遠遠超出了大流行前的表現。

For example, by focusing on infection prevention and prioritizing their employees' well-being, they have been able to recruit and develop some of the top clinical talent in the Greater Seattle area during a time of intense staffing shortages. Strong recruiting, combined with turnover rates far below state and national averages, has, in turn, led to consistently exceptional clinical outcomes, such as a 5-star CMS rating and some of the lowest hospitalization rates in the state. These outcomes in turn enhance relationships of trust with hospitals and other healthcare continuum providers, which result in increased referrals.

例如，透過專注於感染預防並優先考慮員工的福祉，他們能夠在人員嚴重短缺的時期招募和培養大西雅圖地區的一些頂尖臨床人才。強勁的招募，加上遠低於州和全國平均水平的流動率，反過來又帶來了持續出色的臨床結果，例如五星級的 CMS 評級和該州最低的住院率。這些結果反過來又增強了與醫院和其他醫療保健連續體提供者的信任關係，從而導致轉診量增加。

For example, Redmond grew overall occupancy by 9% and skilled days by 30% compared to Q3 of 2022. And as you would expect, revenues have soared by nearly 20%. The benefits of Redmond's employee-first formula extend far beyond just improved clinical reputation and occupancy. Redmond Care's emphasis on taking care of employees has actually led to a decrease in the cost of services because they aren't incurring expensive recruiting and onboarding costs nor wasting money on high-priced agency staffing. Instead, the facility continues to invest in rewarding their own staff and increasing clinical competency, which will allow the impressive results to continue perpetually.

例如，與 2022 年第三季相比，雷德蒙德的整體入住率增長了 9%，熟練工作天數增長了 30%。正如您所料，收入猛增了近 20%。雷德蒙員工優先原則的好處遠遠超出了提高臨床聲譽和入住率。 Redmond Care 對照顧員工的重視實際上導致了服務成本的下降，因為他們不會產生昂貴的招聘和入職成本，也不會在高價的機構人員配置上浪費金錢。相反，該機構繼續投資獎勵自己的員工並提高臨床能力，這將使令人印象深刻的成果永遠持續下去。

We recognize there is still so much opportunity to improve in our operations. And having examples like Summerfield and Redmond gives us confidence that as we are disciplined in applying tried and true principles, our future is bright. With that, I'll turn the time over to Suzanne to provide more detail on the company's financial performance and our guidance, and then we'll open it up for questions. Suzanne?

我們認識到我們的營運仍有許多改進的機會。像薩默菲爾德和雷德蒙德這樣的例子讓我們相信，只要我們嚴格遵守經過檢驗的正確原則，我們的未來就會光明。接下來，我將把時間交給蘇珊娜，提供有關公司財務業績和我們指導的更多詳細信息，然後我們將開放提問。蘇珊娜？

Thanks, Spencer, and good morning, everyone. Detailed financials for the quarter are contained in our 10-Q and press release filed yesterday. Some additional highlights for the quarter include the following: GAAP diluted earnings per share was $1.11, an increase of 12.1%. Adjusted diluted earnings per share was $1.20, an increase of 15.4%. Consolidated GAAP revenues and adjusted revenues were both $940.8 million, an increase of 22.2%. GAAP net income was $63.9 million, an increase of 13.7% and adjusted net income was $69 million, an increase of 16.6%.

謝謝斯賓塞，大家早安。該季度的詳細財務資訊包含在我們昨天提交的 10 季財務報告和新聞稿中。本季度的一些其他亮點包括： GAAP 攤薄後每股收益為 1.11 美元，成長 12.1%。調整後攤薄每股收益為 1.20 美元，成長 15.4%。合併 GAAP 收入和調整後收入均為 9.408 億美元，成長 22.2%。 GAAP 淨利潤為 6,390 萬美元，成長 13.7%，調整後淨利為 6,900 萬美元，成長 16.6%。

Other key metrics as of September 30, 2023, include cash and cash equivalents of $467.9 million and cash flow from operations of $291.4 million. Currently, we have $593 million of available capacity under our revolving line of credit, which, combined with the cash on our balance sheet, give us over $1 billion in dry powder for future investments. We also own 112 assets of which 107 are held by Standard Bearer and 88 are owned completely debt-free and gaining significant value over time, adding even more liquidity to help us with future growth.

截至 2023 年 9 月 30 日的其他關鍵指標包括現金和現金等價物 4.679 億美元以及營運現金流 2.914 億美元。目前，我們的循環信貸額度下有 5.93 億美元的可用產能，加上我們資產負債表上的現金，為我們未來的投資提供了超過 10 億美元的乾粉。我們還擁有 112 項資產，其中 107 項由標準持有者持有，88 項資產完全無債務，並隨著時間的推移獲得顯著價值，增加更多流動性以幫助我們未來的成長。

During the quarter, we paid a quarterly cash dividend of $0.0575 per share. We also continued to delever our portfolio, achieving a lease adjusted net debt-to-EBITDA ratio of 1.99x, which is particularly noteworthy given the amount of growth we have taken over the last year.

本季度，我們支付了每股 0.0575 美元的季度現金股息。我們也繼續去槓桿化我們的投資組合，實現了租賃調整後淨債務與 EBITDA 比率 1.99 倍，考慮到我們去年的成長量，這一點尤其值得注意。

As many of you know, CMS issued a proposed federal minimum staffing rule. We are now in the comment period and CMS has received and will continue to receive thousands of comments on the rule. However, if a final rule is implemented, we do not expect the rule to impact us in 2023 or 2024.

眾所周知，CMS 發布了一項擬議的聯邦最低人員配置規則。我們現在正處於意見徵詢期，CMS 已收到並將繼續收到數千條有關該規則的意見。然而，如果最終規則得以實施，我們預計該規則不會在 2023 年或 2024 年對我們產生影響。

We are encouraged by the strong reimbursement environment for Medicare and other payers. As of October 1, we will receive a healthy net Medicare rate increase of 4%. In addition, most of the states we operate in have already adjusted their reimbursement to offset some of the reimbursement linked to the public health emergency that ended in May. For example, key states like Washington and Colorado announced encouraging increases to the rates. The combination of the rate environment and the slowing of inflation in some of our biggest costs, including labor, we'll continue to add to the operational momentum we have gained this year.

我們對醫療保險和其他付款人強大的報銷環境感到鼓舞。自 10 月 1 日起，我們的健康淨醫療保險費率將增加 4%。此外，我們開展業務的大多數州已經調整了報銷金額，以抵消與 5 月結束的公共衛生緊急情況相關的部分報銷金額。例如，華盛頓州和科羅拉多州等關鍵州宣布令人鼓舞地提高費率。利率環境和我們一些最大成本（包括勞動力）的通膨放緩相結合，我們將繼續增加今年獲得的營運動力。

As Barry mentioned, we are increasing our annual 2023 earnings guidance to between $4.73 to $4.79 per diluted share, up from $4.70 to $4.78 per diluted share. We are also raising our annual revenue guidance to between $3.72 billion and $3.73 billion. We have evaluated multiple scenarios and based on the strength in our performance and the positive momentum we have seen in occupancy and a strong skilled mix as well as some additional strength in Medicaid and managed care programs, we are confident that we can meet this guidance.

正如巴里所提到的，我們將 2023 年攤薄後每股收益指引從每股攤薄後 4.70 美元至 4.78 美元上調至 4.73 美元至 4.79 美元。我們也將年收入指引提高至 37.2 億美元至 37.3 億美元之間。我們評估了多種情景，並基於我們的業績實力、入住率方面的積極勢頭、強大的技術組合以及醫療補助和管理式醫療計劃的一些額外優勢，我們有信心能夠滿足這一指導。

Our 2023 guidance is based on diluted weighted average common shares outstanding of approximately 57.7 million, a tax rate of 25%, the inclusion of acquisitions closed in 2023, the inclusion of management's expectations for Medicare and Medicaid reimbursement rates net of provider tax, with the primary exclusion coming from stock-based compensation and certain expenses related to legal defense.

我們的2023 年指引基於稀釋後加權平均已發行普通股約5,770 萬股、稅率為25%、包括2023 年完成的收購、管理層對醫療保險和醫療補助報銷率（扣除提供者稅）的預期，以及主要排除來自股票補償和與法律辯護相關的某些費用。

Additionally, other factors that could impact quarterly performance include durations in reimbursement systems, delays and changes in state budgets, seasonality in occupancy and skilled mix, influence of the general economy on census and staffing, the short-term impact of acquisition activities, variations in insurance accruals and other factors. And with that, I'll turn it back over to Barry. Barry?

此外，其他可能影響季度績效的因素包括報銷系統的持續時間、國家預算的延遲和變化、入住率和技能組合的季節性、總體經濟對人口普查和人員配置的影響、採購活動的短期影響、保險應計費用和其他因素。有了這個，我會把它轉回給巴里。巴里？

Thanks, Suzanne. As we wrap up, I can't emphasize enough how incredibly honored and grateful we are to work alongside our facility leaders, field resources, clinical partners, and our service center team that are behind these record-setting results. We never cease to be amazed by the impressive resiliency as they focus on supporting one another in new and innovative ways. Their commitment has blessed the lives of so many, including our own, and we're excited about our future because of these amazing partners. We have complete faith in them and the culture they have collectively built. With that, we'll turn it now over to the Q&A portion of our call. Bailey, can you please instruct the audience on the Q&A procedure?

謝謝，蘇珊娜。在我們結束時，我無法充分強調我們是多麼的榮幸和感激，能夠與這些創紀錄的結果背後的設施領導、現場資源、臨床合作夥伴和服務中心團隊一起工作。當他們專注於以新的和創新的方式相互支持時，我們從未停止對令人印象深刻的彈性感到驚訝。他們的承諾造福了包括我們自己在內的許多人的生活，由於這些出色的合作夥伴，我們對我們的未來感到興奮。我們對他們以及他們共同建立的文化充滿信心。至此，我們現在將其轉入電話會議的問答部分。 Bailey，您能指導一下觀眾問答程序嗎？

(Operator Instructions) Your first question comes from the line of Ben Hendrix with RBC Capital Markets.

（操作員說明）您的第一個問題來自 RBC Capital Markets 的 Ben Hendrix。

A quick M&A-related question, and I think I've asked this on past calls, but I wanted to get an update I appreciate the commentary on the leadership development and price being, kind of gating items for M&A, but I wanted to get -- any thoughts on -- or any changes to strategy with regard to financing acquisitions amid the current rate environment? And if there's any kind of capital allocation considerations from that perspective?

一個與​​併購相關的快速問題，我想我在過去的電話中曾問過這個問題，但我想了解最新情況，我很欣賞對領導力發展和價格的評論，這是併購的一種門控項目，但我想了解- 在當前利率環境下，對融資收購的策略有什麼想法或改變嗎？從這個角度來看，是否有任何資本配置的考量？

Yes. Great question, Ben. Thanks for that. As we mentioned in the call, we have over $1 billion in dry powder. A good portion of that is cash. So we've got a lot of cash and then our revolver has been completely -- it's just totally available to us. So usually, what we do is, it's some kind of a blend between the two and our debt levels are extremely low. And frankly, our overall sort of cost of capital is attractive. It's SOFR-based with spread to it that I think is very, very competitive and certainly puts us in a spot that is enviable amongst many financial buyers, in particular.

是的。好問題，本。感謝那。正如我們在電話中提到的，我們擁有超過 10 億美元的乾粉。其中很大一部分是現金。所以我們有很多現金，然後我們的左輪手槍就完全可用了。所以通常情況下，我們所做的是，兩者之間的某種混合，我們的債務水平極低。坦白說，我們的整體資本成本很有吸引力。它是基於 SOFR 的，我認為它的價差非常非常有競爭力，並且肯定使我們處於令許多金融買家尤其羨慕的位置。

So pretty excited about the ability we have both with cash and to use our revolver to fund it. Obviously, we have a lot of real estate that we own that's completely unlevered as well. That's doing mortgage financing is something that we've done in the past. Given current rates, though, that's probably not on the horizon at least in the near term.

對於我們擁有現金和使用左輪手槍為其提供資金的能力感到非常興奮。顯然，我們擁有許多完全無槓桿的房地產。抵押貸款融資是我們過去做過的事情。不過，考慮到目前的利率，至少在短期內這可能不會出現。

Your next question comes from the line of Scott Fidel with Stephens.

你的下一個問題來自斯科特·菲德爾和史蒂芬斯的對話。

I actually wanted to just follow up on the same topic, as Ben just talked about with the M&A opportunity and just given the extensive capital available to you. Just interested if maybe you could drill into the profile of deals looking out to 2024 that may be available when thinking about the larger portfolio deal you did with North America this year. And I guess, with the pipeline of sort of other portfolio opportunities may look like as compared to some of the more targeted deals that you often also do during the course of the year.

實際上，我想跟進同一主題，因為本剛剛談到了併購機會，並為您提供了廣泛的可用資本。只是有興趣，如果您可以深入了解展望 2024 年的交易概況，當您考慮今年與北美進行的較大投資組合交易時，這些交易可能會可用。我想，與您在一年中經常進行的一些更有針對性的交易相比，其他投資組合機會的管道可能看起來像是這樣。

Yes. Great question, Scott. So first of all, the onesie, twosies, the deals have really built Ensign, those are -- there's lots of them. So that's kind of, I guess, our typical pattern, and we expect to follow that. But in terms of portfolio deals, we have seen, even just in the last couple of months, an uptick and the number of larger deals that are out there. It's an interesting mix. Some include real estate that would require an actual cash payment. Others are more lease heavy. And as we've shown, we prefer to buy the real estate where we can, but really attractive leases are a great way for us to grow as well.

是的。好問題，史考特。首先，連身衣、雙人衣、這些交易確實造就了 Ensign，這些都是──有很多。我想這就是我們的典型模式，我們希望遵循這個模式。但就投資組合交易而言，即使在過去幾個月，我們也看到了交易量的上升以及較大交易的數量。這是一個有趣的組合。有些包括需要實際現金支付的房地產。其他人則更注重租賃。正如我們所表明的，我們更願意購買力所能及的房地產，但真正有吸引力的租賃也是我們發展的好方法。

I would say really all the portfolios that we've seen and the sizable ones are very much distressed in a turnaround situation. That is a little bit different than the North American deal we did last year. That one was unique for sure in terms of occupancy, it's California-based. But all that said, the biggest factor as it was alluded to earlier, is the leadership and having leaders in our pipeline that are waiting for those opportunities.

我想說的是，我們所見過的所有投資組合以及規模較大的投資組合在扭虧為盈的情況下都非常痛苦。這與我們去年達成的北美協議略有不同。就入住率而言，這家酒店是獨一無二的，它位於加利福尼亞州。但話雖如此，正如之前提到的，最大的因素是領導力以及我們管道中正在等待這些機會的領導者。

And obviously, geography is important as well. We want to stay in the states we're in and is sort of our first priority simply because there's a lot of benefit in building scale in the same markets. We know them, there's a lot of benefit in having relationships with hospital systems and managed care payers and all of that. So that's our first -- our very first priority is to grow in the states we're in and some of these opportunities are in states we're in.

顯然，地理也很重要。我們希望留在我們所在的州，這是我們的首要任務，因為在同一市場擴大規模有許多好處。我們了解他們，與醫院系統和管理式醫療付款人等建立關係有很多好處。所以這是我們的首要任務——我們的首要任務是在我們所在的州實現成長，其中一些機會就在我們所在的州。

The next one would be states that we're not in, but that are close by. And that -- so there are a few new states that could potentially happen either at the end of this year or early next. We take those very seriously. It's a lot of work to go into a new state. But that's definitely something on the horizon as well. Anything I missed, [Anna Bailey]?

下一個將是我們不在但在附近的州。因此，有一些新的州可能會在今年年底或明年初發生。我們非常重視這些。進入一個新的狀態需要做很多工作。但這也絕對是即將發生的事。我錯過了什麼嗎，[安娜貝利]？

Okay. Great. And then a follow-up question, just wanted to pivot over to the staffing rule. And I guess just asked a question about sort of, I guess, how you're approaching this from the advocacy versus the operational perspective, I think everyone recognizes how disruptive this proposal would be for the industry if it went forward, and it seems realistic to think that there will be some meaningful changes made in the final rule, but at the same time, we may not even see that till next summer or so.

好的。偉大的。然後是一個後續問題，只是想轉向人員配置規則。我想只是問了一個問題，我想，你是如何從倡導和運營的角度來處理這個問題的，我想每個人都認識到這個提案如果繼續下去將對行業產生多大的破壞性，而且它看起來很現實認為最終規則將會做出一些有意義的改變，但同時，我們甚至可能要等到明年夏天左右才能看到。

So I'm just curious, are you at this point, largely just focusing your efforts on sort of the advocacy side? Or are you also considering any types of starting to pursue operational adjustments, looking out over a multiyear time frame that this rule would go into effect?

所以我只是很好奇，您現在主要將精力集中在宣傳方面？或者您是否也在考慮開始進行任何類型的營運調整，並在多年的時間範圍內關注該規則的生效？

Yes. It's a great question, Scott. Operationally, I don't think there's much that we feel like we need to do to adjust other than making sure we're really, really focused on the things that we're always focused on, which are keeping turnover as low as we can by making sure we've just got amazing practices around how we treat and incentivize and celebrate our people, making sure that we're the employer of choice in every market, making sure that we're very efficient in how we staff and the communication we have with our staff on how and why we're staffing a certain way, and getting their input on that as well.

是的。這是一個很好的問題，斯科特。在營運方面，我認為除了確保我們真正真正專注於我們一直關注的事情之外，我們不需要做太多調整，這些事情可以將人員流動率保持在盡可能低的水平確保我們在如何對待、激勵和慶祝我們的員工方面有令人驚嘆的實踐，確保我們是每個市場的首選雇主，確保我們在員工和溝通方面非常高效我們與員工就如何以及為何以某種方式配備人員進行了交流，並聽取了他們的意見。

So that has been our focus for quite some time, removing agency and ensuring that the workplace is a place where people really want to be. That really is our focus because if and when there is some adjustment to how the Federal Government decides we should staff on a building-by-building basis. If our people systems aren't where they ought to be, then that becomes more challenging. So our efforts operationally are around making sure that we continue to be the absolute best employer we can be. And -- so the silver lining of this whole noise around this proposed rule is that it gives us impetus in a rally cry to kind of focus on making sure that we're the best at being great partners with our employees.

因此，這一直是我們相當長一段時間以來的重點，消除代理商並確保工作場所是人們真正想要去的地方。這確實是我們關注的焦點，因為如果聯邦政府決定如何調整我們應該逐棟大樓配備人員的方式。如果我們的人員系統沒有達到應有的水平，那麼這就變得更具挑戰性。因此，我們在營運方面的努力是為了確保我們繼續成為絕對最好的雇主。因此，圍繞這項擬議規則的整個噪音的一線希望是，它為我們提供了動力，讓我們集中精力確保我們成為員工的最佳合作夥伴。

As it relates to what we're doing organizationally, it really is very much a grassroot kind of focus. So we're in a heavy comment period right now, ends November 6. Our organization has produced well over 1,000 comments. The industry has produced over 11,000 comments. Congress just recently had -- nearly 100 Congress people send a letter that they've signed. So we're even getting comments from lawmakers and now our efforts really are focused on as an industry, making sure that we're in the offices and in front of legislators that can have influence over this.

因為它與我們在組織上所做的事情有關，所以它確實是一種草根關注。因此，我們現在正處於大量意見徵詢期，截至 11 月 6 日。我們的組織已收到超過 1,000 條意見。業界已產生超過 11,000 則評論。國會最近——近 100 名國會議員發送了一封他們已簽署的信。因此，我們甚至收到了立法者的評論，現在我們的努力真正集中在作為一個行業，確保我們在辦公室和立法者面前能夠對此產生影響。

And really, the ultimate goal there isn't necessarily to fight it, although you see some legislation that's been proposed. And given the continuing resolution around the budget, there is a window and potentially an opportunity to have that legislation somehow make its way into a voting situation. But that's an outside chance. Really, our focus is really on shaping the rule at this point. I think it would be a futile effort to rally too much energy around getting it just completely struck down. There really is because it's so White House and union driven, there's far too much support for that to essentially be a real possibility.

事實上，最終的目標不一定是反對它，儘管你看到已經提出了一些立法。鑑於圍繞預算的持續決議，存在一個窗口，並且可能有機會讓該立法以某種方式進入投票階段。但這是一個外在機會。事實上，我們目前的重點確實是製定規則。我認為，集中太多精力來徹底擊垮它是徒勞無功的。確實存在，因為它是由白宮和工會驅動的，因此有太多的支持，這本質上是一種真正的可能性。

So our goal and our focus is to shape it and make it something that really that we can all live with and make some sense and then potentially set that up for a legal challenge down the road. And again, that's something you deal with after the fact. But again, our focus is on shaping it rather than trying to do anything less productive.

因此，我們的目標和重點是塑造它，使其成為我們都能接受並具有一定意義的東西，然後可能為未來的法律挑戰做好準備。再說一遍，這是事後你要處理的事情。但同樣，我們的重點是塑造它，而不是試圖做任何效率較低的事情。

I appreciate those comments. If I could just slip one more question in, too, for you. Just I know there's a Medicaid rebasing process that's underway. I think in California, would appreciate maybe if you could just bring us up to speed on sort of what exactly is going on there and sort of what you'd be looking for out of that process underway?

我很欣賞這些評論。如果我能為你再插一個問題就好了。我只知道醫療補助計劃的重新調整過程正在進行中。我想在加州，如果您能讓我們了解那裡到底發生了什麼以及您希望從正在進行的過程中尋找什麼，也許我們會很感激？

Yes. Great question, Scott. Definitely a lot of things happening in California with regards to the Medicaid rate. We're very, very, very active with both our associations, lobbyists in California and the Department in shaping what that will ultimately look like. And so we continue to be very active in that and be a part of this discussion.

是的。好問題，史考特。關於醫療補助費率，加州肯定發生了很多事情。我們非常、非常、非常積極地與我們的協會、加州的遊說者和國務院一起塑造最終的樣子。因此，我們將繼續非常積極地參與這項討論。

As far as any rebasing, we really don't feel like there's any overarching threat to the population that we serve, it's more community-based Medicaid patients that are being redetermined and I know there are some questions about the redetermination process on Medicaid in some states, and you've asked about that before too, which is separate from what you asked Suzanne about. That piece too is something that is really not much of a threat to what we're seeing in our facilities as far as our patient population other than it's just creating a slowdown in terms of getting Medicaid patients approved.

就任何重新基準而言，我們確實不認為對我們所服務的人群有任何總體威脅，正在重新確定的是更多基於社區的醫療補助患者，我知道在某些地區對醫療補助的重新確定過程存在一些問題。狀態，你以前也問過這個問題，這與你問蘇珊娜的問題是分開的。就我們的患者群體而言，這對我們在設施中看到的情況實際上並沒有太大威脅，除了它只是導致醫療補助患者獲得批准的速度放緩之外。

There are no further questions at this time. Mr. Port, I will turn the call back over to you.

目前沒有其他問題。波特先生，我會將電話轉回給您。

Okay. Thanks, Bailey, and thanks, everyone, for joining us today. We appreciate, obviously, your support and look forward to a strong finish to the year.

好的。謝謝貝利，也謝謝大家今天加入我們。顯然，我們感謝您的支持，並期待今年圓滿成功。

This concludes today's conference call. You may now disconnect.

今天的電話會議到此結束。您現在可以斷開連線。