Ensign Group Inc (ENSG) 2024 Q3 法說會逐字稿

Greetings and welcome to the Ensign Group Incorporated third quarter, 2024 earnings conference call. (Operator Instructions)

歡迎參加 Ensign 集團公司 2024 年第三季財報電話會議。（操作員說明）

At this time, I would like to turn the call over to Mr. Keetch.

這時，我想把電話轉給基奇先生。

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. A replay of this call will also be available on our website until 5:00 PM. Pacific on Friday, November 29, 2024.

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。下午 5:00 之前，我們的網站上還將提供本次電話會議的重播。太平洋時間，2024 年 11 月 29 日星期五。

We want to remind anyone that may be listening to a replay of this call that all statements made are as of today, October 25, 2024, and these statements have not been or will be updated subsequent to today's call.

我們想提醒任何可能正在收聽本次電話會議重播的人，所有聲明均截至今天（2024 年 10 月 25 日），並且這些聲明尚未或將在今天的電話會議後更新。

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. 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.

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。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。

Except as required by Federal Securities Laws, Ensign and its independent subsidiaries 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.

除聯邦證券法要求外，Ensign 及其獨立子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 independent subsidiaries, collectively referred to as the service center, provide accounting, payroll, human resources, information technology, legal, risk management and other services to the other independent subsidiaries through contractual relationships with such subsidiaries.

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。我們的某些獨立子公司（統稱為服務中心）透過與其他獨立子公司的合約關係向其他獨立子公司提供會計、薪資、人力資源、資訊科技、法律、風險管理和其他服務。

In addition, our capital 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. Ensign also owns Standard Bearer Healthcare REIT, Inc., which is a captive real estate investment trust that invest in health care properties and enters into a lease arrangement with certain independent subsidiaries of Ensign as well as third-party tenants that are unaffiliated with the Ensign Group.

此外，我們的資本保險子公司（我們稱為保險自保人）向我們的營運公司提供某些索賠，涵蓋一般責任和專業責任以及工人賠償保險責任。Ensign 也擁有 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 無關的第三方租戶達成租賃安排團體。

The words Ensign, company, we, our and us, refer to the Ensign Group, Inc. and its consolidated subsidiaries. All of our independent subsidiaries, the Service Center, Standard Bearer Healthcare REIT and the Insurance Captive are operated by separate independent companies that have their own management, employees and assets.

Ensign、公司、我們、我們的和我們這些字詞是指 Ensign Group, Inc. 及其合併子公司。我們所有的獨立子公司、服務中心、Standard Bearer Healthcare REIT 和保險自保公司均由獨立的公司經營，這些公司擁有自己的管理階層、員工和資產。

References herein to the consolidated company and its assets and activities as well as the use of the words, we, us, our and similar terms 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使用「我們」、「我們的」和類似術語並不意味著也不應被解釋為 Ensign 集團擁有直接營運資產、員工或收入或任何子公司由Ensign 集團營運。

Also, we supplement our GAAP reporting with non-GAAP metrics. When reviewed 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 at 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.

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 結果一起審查時，我們相信這些措施可以提供對我們業務的更全面的了解，但不應在排除 GAAP 報告的情況下依賴它們。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。

And with that, I'll turn the call over to Barry Port, our CEO. Barry?

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, everyone, for joining us today. Our local leaders continue to consistently drive outstanding clinical and financial performance, and we are happy to report another record quarter. We're particularly impressed with these results given that we've added 53 new operations across several markets in our recently acquired bucket and yet our leaders and resource teams have shown their strength by simultaneously integrating these new operations into their clusters while achieving outstanding results in their own operations.

謝謝查德，也謝謝大家今天加入我們。我們的當地領導者繼續持續推動出色的臨床和財務業績，我們很高興報告另一個創紀錄的季度。我們對這些結果印象特別深刻，因為我們在最近收購的多個市場中增加了53 個新業務，但我們的領導者和資源團隊透過將這些新業務同時整合到他們的集群中，同時在以下方面取得了出色的成果，展現了他們的實力：他們自己的經營。

As those that have been following us for years know well, our modeling heavily on our local clusters and existing operations to take a lead on our decision-making around acquisitions as well as provide the transition support for these newly acquired operations.

正如多年來關注我們的人所熟知的那樣，我們在很大程度上基於本地集群和現有業務進行建模，以引導我們圍繞收購進行決策，並為這些新收購的業務提供過渡支援。

As we continue to perfect and improve our deal underwriting and transition process, our new acquisitions, almost all of which were distressed at the time we acquire them, are beginning to contribute earlier. This allows our leaders to return their focus to our transitioning and same-store leading to strong performance across all our operational buckets.

隨著我們不斷改進和改進我們的交易承銷和過渡流程，我們的新收購（幾乎所有這些收購在我們收購時都陷入困境）開始更早做出貢獻。這使我們的領導者能夠將注意力重新集中到我們的轉型和同店上，從而在我們所有的營運領域中取得強勁的業績。

More specifically, during the quarter, we saw same-store occupancies grow to 81.7%, a 2.8% increase over the prior year quarter, establishing a new high watermark for same-store occupancy. This is especially noteworthy during a quarter where we historically have experienced seasonally softer occupancies.

更具體地說，本季同店入住率成長至 81.7%，比去年同期成長 2.8%，創下同店入住率新高。在我們歷來經歷過季節性入住率疲軟的季度中，這一點尤其值得注意。

We also saw skilled days increase across all skilled payer sources in our same-store operations which increased, which by 6.1% over the prior year quarter, all of which translated to a 7.3% revenue growth for our same-store operations.

我們還發現同店營運中所有熟練付款人來源的熟練工作天數均有所增加，比去年同期增長了 6.1%，所有這些都意味著我們同店運營的收入增長了 7.3%。

We simultaneously grew our managed care census by 9.1% and 23.2% for our same-store and transitioning operations, respectively, over the prior year quarter. Managed care is a very important and growing part of our business and the consistent occupancy increases points to the trust our leaders are continuing to gain by achieving high-quality outcomes.

同時，我們的同店和轉型業務的管理式醫療普查數據比去年同期分別成長了 9.1% 和 23.2%。管理式醫療是我們業務中非常重要且不斷增長的一部分，入住率的持續成長表明我們的領導者透過實現高品質的成果而不斷獲得信任。

As we look ahead, we couldn't be more excited about the opportunities we have to unlock the enormous organic upside in our existing portfolio. One of the keys to our success over time has been to have multiple ways to achieve financial consistency that do not depend entirely on new acquisitions.

展望未來，我們對釋放現有投資組合巨大有機優勢的機會感到非常興奮。隨著時間的推移，我們成功的關鍵之一是採用多種方法來實現財務一致性，而不完全依賴新的收購。

In fact, even during a busy period of acquisitions, 46% of our increased revenue for the quarter was generated purely from organic growth. Also, if you look back over time, you will see a very steady growth rate in both revenue and EBITDA growth, even though our disciplined acquisition activity varies based on market conditions.

事實上，即使在收購繁忙時期，我們本季營收成長的 46% 也純粹來自有機成長。此外，如果你回顧一段時間，你會發現營收和 EBITDA 成長都非常穩定，儘管我們嚴格的收購活動根據市場狀況而有所不同。

This is made possible by our local CEOs and COOs who are relentlessly working to improve and adapt to the needs of their markets. As they do so, they continue to pull various levers to increase skilled mix and drive occupancies higher and closer to the occupancies achieved by dozens of our most mature same-store operations, most of which are well above our same-store average.

這是我們當地執行長和營運長不懈努力改進和適應市場需求的結果。在這樣做的同時，他們繼續利用各種槓桿來增加熟練的組合，並推動入住率更高，更接近我們數十家最成熟的同店運營所達到的入住率，其中大多數都遠高於我們的同店平均水準。

At the same time, and as we demonstrated this quarter, we are prepared for and will continue to acquire lower occupancy operations at very attractive prices, which provides a significant long-term ramp with years of upside.

同時，正如我們本季所展示的那樣，我們已做好準備並將繼續以極具吸引力的價格收購較低的入住率業務，這將帶來顯著的長期增長，並具有多年的上升空間。

Due to our solid skilled mix and occupancy growth in our existing operations as well as continued strength from our recent acquisitions, we are raising and narrowing our annual 2024 earnings guidance to between $5.46 to $5.52 per diluted share, up from $5.38 to $5.50 per diluted share. The new midpoint of our 2024 earnings guidance represents an increase of more than 15.1% of our 2023 results and is 32.6% higher than our 2022 results.

由於我們現有業務的堅實技術組合和入住率增長，以及最近收購帶來的持續實力，我們將2024 年年度盈利指導上調並縮小至稀釋後每股5.46 美元至5.52 美元，從稀釋後每股5.38美元至5.50 美元。我們 2024 年獲利指引的新中點代表我們 2023 年業績成長超過 15.1%，比 2022 年業績高出 32.6%。

We are also increasing our annual revenue guidance to between $4.25 billion and $4.26 billion, up from our previous guidance of $4.22 billion to account for our current quarter growth and acquisitions we anticipate closing by the end of the year. We're excited about the upcoming year and are confident that our partners will continue to manage and innovate while balancing the addition of newly acquired operations.

我們還將年度收入指引從先前的 42.2 億美元提高到 42.5 億美元至 42.6 億美元，以考慮到我們目前季度的成長和預計在年底完成的收購。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，同時平衡新收購業務的增加。

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 grow our portfolio and are very excited about the 12 new operations and three real estate assets we added during the quarter. And since bringing the number of operations acquired during the year to 27 these new acquisitions include the following nine in Colorado, one in Kansas, one in Iowa and one in Nebraska. In total, we added 1,279 new skilled nursing beds and 20 senior living units in four of our 14 states. Of these new operations, three of them included the real estate assets that were acquired by Standard Bearer at least to an Ensign affiliated operator. These additions were all carefully selected amongst the many opportunities available to us and were chosen because of the huge clinical and financial potential.

謝謝你，巴里。正如我們預期的那樣，我們繼續擴大投資組合，並對本季新增的 12 項新業務和 3 項房地產資產感到非常興奮。自從今年收購的業務數量達到 27 家以來，這些新收購包括科羅拉多州的 9 家、堪薩斯州的 1 家、愛荷華州的 1 家和內布拉斯加州的 1 家。我們總共在 14 個州中的 4 個州新增了 1,279 張新的專業護理床位和 20 個老年居住單元。在這些新業務中，其中三項包括 Standard Bearer 至少向 Ensign 附屬業者收購的房地產資產。這些新增內容都是我們從眾多可用機會中精心挑選出來的，因為其巨大的臨床和財務潛力。

We continue to see a very healthy pipeline of new acquisition opportunities and are making progress on several additions that we expect to close in the fourth quarter and into next year. We remain committed, especially in times when there are lots of opportunities in front of us, to remain disciplined and grow in a healthy way. Our scalable, decentralized growth model is not dependent on a few individuals in an office, but instead is driven by local leadership and supported by a dedicated team of resources.

我們繼續看到一系列非常健康的新收購機會，並在幾項新增收購方面取得了進展，預計將在第四季度和明年完成。我們仍然致力於保持紀律並以健康的方式成長，尤其是在我們面前有很多機會的時候。我們的可擴展、去中心化的成長模式並不依賴辦公室中的幾個人，而是由當地領導層推動並得到專門的資源團隊的支持。

In times like these, when deal opportunities are abundant, we rely on a proven set of deal criteria, including a deep local knowledge of their respective health care markets to ensure that those who are operationalizing the acquisitions have buy-in and specific plans to help them become facilities of choice in their markets.

在這樣的時代，當交易機會充足時，我們依靠一套行之有效的交易標準，包括對各自醫療保健市場的深入了解，以確保那些正在實施收購的人有支持和具體計劃來幫助它們成為其市場的首選設施。

One of the foundational elements of our consistent performance has been to insist that the prices we pay are commensurate with the historical operational performance, which will result in a cost structure that allows us to achieve healthy returns over a long period of time.

我們始終如一的業績的基本要素之一是堅持我們支付的價格與歷史經營業績相稱，這將形成一個成本結構，使我們能夠在很長一段時間內實現健康的回報。

As we've shown again this quarter, we continue to prioritize growth in our established geographies as it allows our clusters to work together and with their acute care partners to provide comprehensive solution to their health care needs.

正如我們本季再次表明的那樣，我們繼續優先考慮現有地區的成長，因為這使我們的集群能夠與他們的急診合作夥伴共同努力，為他們的醫療保健需求提供全面的解決方案。

We are also excited to build clusters in new states or in markets where we have significant room to add more density and expect additional growth in some of our newer markets in the next several months. We have and will continue to grow when we see deals that will be accretive to shareholders in both the near and long term.

我們也很高興能夠在新的州或市場建立集群，在這些州或市場中，我們有很大的空間來增加密度，並預計在未來幾個月內我們的一些新市場將進一步成長。當我們看到短期和長期對股東有利的交易時，我們已經並將繼續發展。

We continue to provide additional disclosure on Standard Bearer, which is currently comprised of 117 owned properties. Of these assets, 88 are leased to Ensign affiliated operator and 30 are leased to third-party operators.

我們繼續提供有關 Standard Bearer 的更多披露，該公司目前由 117 處自有房產組成。其中，88 項資產出租給 Ensign 附屬業者，30 項出租給第三方業者。

All of these properties are subject to triple-net long-term leases and generated rental revenue of $24.4 million for the quarter, of which $20.2 million was derived from Ensign affiliated operations. Also, for the quarter, we reported $14.8 million in FFO. And as of the end of the quarter, had an EBITDA to rent coverage ratio of 2.4 times.

所有這些物業均受三重淨長期租賃約束，本季度產生的租金收入為 2,440 萬美元，其中 2,020 萬美元來自 Ensign 附屬業務。此外，我們報告本季的 FFO 為 1,480 萬美元。截至本季末，EBITDA 與租金覆蓋率比率為 2.4 倍。

And with that, I'll turn the call over to Spencer, our COO, to add more color on operations. Spencer?

接下來，我會將電話轉給我們的營運長 Spencer，為營運增添更多色彩。斯賓塞？

Thanks, Chad, and hello, everyone. As Chad mentioned, we've continued to welcome acquisitions throughout the year, with a large concentration of the growth occurring in Colorado and the Midwest. In fact, newly acquired facilities now account for over 14.4% of our total service revenue, up from 8.6% a year ago.

謝謝查德，大家好。正如查德所提到的，我們全年繼續歡迎收購，其中成長主要集中在科羅拉多州和中西部地區。事實上，新收購的設施目前占我們服務總收入的 14.4% 以上，高於一年前的 8.6%。

Today, I'd like to give you some insights into the tremendous work and transformation that occurs during the first quarters following an acquisition. To do that, the first facility I've chosen to highlight today is a recent acquisition in the state of Colorado. Rehab and Nursing Center of the Rockies, RNCR, located in Fort Collins, Colorado, is a 98 bed skilled nursing facility that was acquired August 1, 2023.

今天，我想向您介紹一下收購後第一季發生的巨大工作和轉型。為此，我今天選擇強調的第一個設施是最近在科羅拉多州收購的設施。落基山脈復健與護理中心 (RNCR) 位於科羅拉多州柯林斯堡，是一家擁有 98 張床位的熟練護理機構，於 2023 年 8 月 1 日收購。

Upon transition, Todd Truax, an experienced CEO, who is operating a successful Ensign affiliated building nearby, transferred to RNCR and became the licensed administrator. They joined a facility leadership team with many talented and compassionate professionals, including longtime Don Sarah Case.

過渡後，經驗豐富的執行長 Todd Truax 調到了 RNCR，並成為了有執照的管理員，他在附近經營著一座成功的 Ensign 附屬建築。他們加入了一個由許多才華橫溢、富有同情心的專業人士組成的設施領導團隊，其中包括長期任職的唐·莎拉·凱斯(Don Sarah Case)。

Sarah and her team were intelligent and committed but lacked the information and tools needed to manage some basic operating fundamentals. Following the transition, Todd, together with local cluster partners, including department leaders from nearby facilities, began to empower the RNCR team with increased education data and transparent access to daily, weekly and monthly report.

莎拉和她的團隊聰明且忠誠，但缺乏管理一些基本營運基礎所需的資訊和工具。過渡後，Todd 與當地集群合作夥伴（包括附近設施的部門領導）一起開始為 RNCR 團隊提供更多的教育數據以及對每日、每周和每月報告的透明訪問。

The team responded to the support beautifully. They went to work increasing occupancy and skilled mix while simultaneously rightsizing labor and controlling other variable expenses. The results have been remarkable. Occupancy, which sat at 63% on transition, is now at 90%. During that same period, managed care centers has increased by over 600% and major health plans have invited RNCR to join their narrow network.

該團隊對支援做出了出色的回應。他們開始努力增加入住率和技能組合，同時調整勞動力規模並控制其他可變費用。結果是顯著的。過渡時期的入住率為 63%，現在為 90%。在同一時期，管理式醫療中心增加了 600% 以上，主要健康計劃已邀請 RNCR 加入其狹窄的網絡。

As occupancy and skilled mix have grown, the team has carefully managed expense growth. And as a result, EBIT margins have increased by nearly 180%, but the financial success is only a small part of the RNCR transition story. Clinically, the facility has embraced additional training and education, which in turn has led to RNCR recently having one of the best health inspection scores in the state and achieving overall five-star status from CMS.

隨著入住率和技能組合的增長，該團隊仔細管理了費用增長。結果，息稅前利潤率增加了近 180%，但財務上的成功只是 RNCR 轉型故事的一小部分。在臨床上，該機構接受了額外的培訓和教育，這反過來又導致 RNCR 最近成為該州最好的健康檢查分數之一，並獲得 CMS 的整體五星級評估。

On the employee front, nursing turnover has plummeted since transition. Further, the facility recently opened its own CNA certification program, and graduates are not only strengthening the staffing situation at RNCR but are also helping improve staffing at the nearby facilities, which were recently acquired over the past few months.

在員工方面，自轉型以來，護理人員流動率大幅下降。此外，該設施最近開設了自己的 CNA 認證計劃，畢業生不僅加強了 RNCR 的人員配置，而且還幫助改善了過去幾個月最近收購的附近設施的人員配置。

While transforming acquisitions is an exciting part of Ensign's story, equally important is the enormous potential that can be unlocked as mature teams continue to innovate and meet the heightened clinical needs of their communities.

雖然收購轉型是 Ensign 故事中令人興奮的一部分，但同樣重要的是，隨著成熟團隊不斷創新並滿足其社區日益增長的臨床需求，可以釋放出巨大的潛力。

Our second highlight comes from one of our more mature operations in the Phoenix, Arizona Metro area. Peoria Post-Acute & Rehabilitation is a large 179 bed skilled nursing facility and subacute campus that was acquired back in 2018. Over the past six years, CEO, Mark Glazier, and COO, [Katherine Eliser] together with their team have consistently improved clinical and financial results and become their community's facility of choice.

我們的第二個亮點來自我們在亞利桑那州鳳凰城都會區更成熟的業務之一。皮奧裡亞急性後復健中心是一家擁有 179 張床位的大型專業護理機構和亞急性園區，於 2018 年收購。在過去的六年裡，執行長 Mark Glazier 和營運長 [Katherine Eliser] 與他們的團隊一起不斷改善臨床和財務成果，並成為他們社區的首選設施。

But despite the high bar already set, during the quarter, the team at Peoria grew revenues by 20% and EBIT by 29% compared to the prior year quarter. Their formula is simple to understand but hard to execute. This starts with finding, developing and retaining incredible talent. This, in turn, allows the multidisciplinary team to commit to and relentlessly pursue quality, which is evident in Peoria's five-star rating from CMS for health inspections, quality measures and overall excellence.

儘管已經設定了很高的標準，但與去年同期相比，皮奧裡亞團隊在本季的營收成長了 20%，息稅前利潤成長了 29%。他們的公式很容易理解，但很難執行。首先是尋找、培養和留住優秀的人才。這反過來又使多學科團隊能夠致力於並不懈地追求質量，這一點從皮奧裡亞在健康檢查、質量措施和整體卓越性方面獲得 CMS 的五星級評級就可見一斑。

The strong clinical foundation has allowed Peoria to climb the acuity ladder and meet the needs of community physicians, health plans and hospitals. In fact, in addition to traditional long-term and skilled care, today, Peoria provides subacute services for patients needing ventilator care, advanced wound care and bedside dialysis. This combination of high acuity and exceptional quality has made Peoria one of only a few facilities to attain preferred provider status with every major hospital system in Arizona.

強大的臨床基礎使皮奧裡亞能夠攀登敏銳度階梯並滿足社區醫生、健康計劃和醫院的需求。事實上，除了傳統的長期和熟練護理外，如今，皮奧裡亞還為需要呼吸器護理、高級傷口護理和床邊透析的患者提供亞急性服務。這種高敏銳度和卓越品質的結合使皮奧裡亞成為少數獲得亞利桑那州各大醫院系統首選提供者地位的機構之一。

The result has been consistently strong demand for services, which is evidenced in skilled mix increases of 44% for Medicare days and 13% for managed care days from Q3 of last year. To address growing demand a few years ago, the facility expanded its license count by 51 beds and opened a completely remodeled sub acute wing and dialysis center. That new wing is now completely full and the overall campus averaged 96% occupancy over the course of quarter three, up 12- percentage-points from the prior year quarter.

結果是對服務的需求持續強勁，從去年第三季開始，醫療保險天數增加了 44%，管理式照護天數增加了 13%，證明了這一點。為了滿足幾年前不斷增長的需求，該機構將其許可證數量增加了 51 個床位，並開設了一個經過徹底改造的亞急性病區和透析中心。該新翼現已完全入住，第三季整個園區的平均入住率為 96%，比去年同期增加 12 個百分點。

Today, there is a long waiting list for admission to Peoria. Facilities like Peoria demonstrate the enormous continued upside in same-store operations that is being covered and access through the hard work, discipline and vision of empowered local leaders and the support and commitment of service center resource partners.

如今，等待進入皮奧裡亞的名單已經排得很長。像皮奧裡亞這樣的設施展示了同店運營的巨大持續優勢，這是透過當地領導人的辛勤工作、紀律和遠見以及服務中心資源合作夥伴的支持和承諾所覆蓋和獲得的。

And with that, I'll turn the time over to Suzanne Snapper, our CFO, for more detail on our financial results. Suzanne?

接下來，我將把時間交給我們的財務長 Suzanne Snapper，以了解有關我們財務表現的更多詳細資訊。蘇珊娜？

Thank you, 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 compared to the prior year quarter includes diluted earnings per share was $1.34, an increase of 20.7%.

謝謝你，史賓塞，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。與去年同期相比，本季的一些其他亮點包括攤薄後每股收益為 1.34 美元，成長 20.7%。

Adjusted diluted earnings per share was $1.39, an increase of 15.8%. Consolidated GAAP revenue and adjusted revenues were both $1.1 billion, an increase of 15%. GAAP net income was $78.4 million, an increase of 22.8%.

調整後攤薄每股收益為 1.39 美元，成長 15.8%。合併 GAAP 收入和調整後收入均為 11 億美元，成長 15%。GAAP 淨利為 7,840 萬美元，成長 22.8%。

Adjusted net income was $81.1 million, an increase of 17.7%. Other key metrics as of September 30, 2024, include cash and cash equivalents of $532.1 million and cash flow from operations of $246.7 million. The Company paid a quarterly cash dividend of $0.06 per share. We have a long history of paying dividends and have increased the annual dividend for 21 consecutive years.

調整後淨利為 8,110 萬美元，成長 17.7%。截至 2024 年 9 月 30 日的其他關鍵指標包括現金和現金等價物 5.321 億美元以及營運現金流 2.467 億美元。公司派發季度現金股利每股0.06美元。我們派息歷史悠久，已連續21年增加年度股利。

We also continued to [delever] our portfolio, achieving a record low lease adjusted net debt-to-EBITDA ratio of 1.88 times. Our ability to delever and even in periods of significant growth is particularly noteworthy and demonstrates our commitment to disciplined growth as well as our belief that we can continue to achieve sustainable growth in the long run.

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 1.88 倍的歷史新低。我們的去槓桿化能力，甚至是在顯著成長時期的去槓桿化能力尤其值得關注，這體現了我們對有紀律的成長的承諾，以及我們對長期可持續成長的信念。

In addition, we currently have approximately $572 million of availability under our line of credit, which, when combined with cash on our balance sheet, gives us over $1 billion in dry powder for future investments. We also own 122 assets out with 117 are held by Standard Bearer and 98 of which are owned completely debt-free and are gaining significant value over time, adding even more liquidity to help with our future growth.

此外，我們目前的信用額度下還有大約 5.72 億美元的可用資金，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 122 項資產，其中 117 項由標準持有者持有，其中 98 項完全無債務，並且隨著時間的推移正在獲得巨大的價值，增加更多的流動性以幫助我們未來的成長。

As Barry mentioned, we are increasing and nearing our annual 2024 earnings guidance to between $5.46 to $5.52 per diluted share. We are also raising our annual revenue guidance to between $4.25 billion to $4.26 billion. We have evaluated multiple scenarios and based upon the strength in our performance, the positive momentum we have seen in occupancy and skilled mix as well as the continued progress on agency management and other operational initiatives, we feel confident that we can achieve these results.

正如 Barry 所提到的，我們正在將 2024 年年度獲利指引提高至稀釋後每股 5.46 美元至 5.52 美元，並接近這一目標。我們也將年收入指導提高至 42.5 億美元至 42.6 億美元。我們評估了多種情景，並基於我們的業績實力、入住率和技能組合方面的積極勢頭以及機構管理和其他運營舉措的持續進展，我們對實現這些成果充滿信心。

Our updated 2024 guidance is based on diluted weighted average common shares outstanding of approximately $58.5 million, a tax rate of 25%, the inclusion of acquisitions closed and expected to close in 2024, the inclusion of management's expectations for Medicare and Medicaid reimbursement rates, net of provider tax and with the biggest exclusion coming from stock-based compensation.

我們更新的2024 年指引基於約5,850 萬美元的稀釋加權平均已發行普通股、25% 的稅率、包括已完成和預計將於2024 年完成的收購、包括管理層對醫療保險和醫療補助報銷率的預期、淨額提供者稅，其中最大的排除來自於基於股票的薪酬。

Additionally, other factors that could impact quarterly performance include variations in reimbursement systems, delays and changes in state budgets, seasonality in occupancy and skilled mix, the influence of general economy and census and staffing, the short-term impact of acquisition activities, variations in insurance accruals and other factors.

此外，其他可能影響季度業績的因素包括報銷制度的變化、國家預算的延遲和變化、入住率和技能組合的季節性、總體經濟和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。

And with that, I'll turn it back over to Barry. Barry?

有了這個，我會把它轉回給巴里。巴里？

Thanks, Suzanne. As we wrap up, we'll end as we normally do by reiterating how incredibly honored and grateful, we are to work alongside our facility leaders, field resources, clinical partners and service center team that are behind these record-setting results. We're in awe of their incredible industry-leading leadership as they focus on supporting our collective mission to dignify post-acute care in new and innovative ways for many generations to come.

謝謝，蘇珊娜。在結束時，我們將像往常一樣，重申我們是多麼榮幸和感激，我們將與這些創紀錄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。我們對他們令人難以置信的行業領先領導能力感到敬畏，因為他們專注於支持我們的集體使命，以新穎和創新的方式為子孫後代提供有尊嚴的急性後護理。

This commitment has blessed the lives of so many people, including our own. We're excited about our future and the opportunity to build an enduring legacy in the industry because of these amazing partners. We work alongside people who truly care about one another first, which is why we have the confidence that our model has staying power and will have a long-term impact for good. We have complete faith in them and the culture they have collectively built and continued to improve.

這項承諾造福了許多人的生活，包括我們自己。由於這些出色的合作夥伴，我們對我們的未來以及在行業中建立持久遺產的機會感到興奮。我們與真正關心彼此的人一起工作，這就是為什麼我們相信我們的模式具有持久力，並將產生長期的良好影響。我們對他們以及他們共同建立並持續改進的文化充滿信心。

And now, we'll Turn it over to the Q&A portion of our call. Ellie, can you please instruct the listeners on the Q&A procedure?

現在，我們將把它轉入電話會議的問答部分。艾莉，你能指導聽眾一下問答程序嗎？

Thank you. (Operator Instructions)

謝謝。（操作員說明）

Tao Qiu, Macquarie.

邱濤，麥格理。

Thank you. Good morning. So the same store occupancy is already above pre pandemic levels. I think historically, the high point in terms of same store occupancy was about 84%. Would you be able to number one? Give us an idea of the distribution occupancy across your same store portfolio? And second, could you quantify for us the potential upside from here? Given the strong demographic trend, you know, your initiative to increase higher acuity, patient base and the managed care momentum you alluded to earlier. Thanks.

謝謝。早安.因此，同一家商店的入住率已經高於大流行前的水平。我認為從歷史上看，同店入住率的最高點約為 84%。你能排第一嗎？請告訴我們您同一商店組合中的分銷佔用情況？其次，您能為我們量化一下這裡的潛在優勢嗎？鑑於強勁的人口趨勢，您知道，您提高敏銳度、患者基礎和您之前提到的管理式護理勢頭的舉措。謝謝。

Yeah, I think our high watermark pre-COVID was 80.1%. So yeah, we are above that. As far as limits, it's why we are so excited about where our occupancy is today, albeit higher than where we've been. We know that there is so much potential for growth. As we look in our same-store portfolio and look at even more mature operations in that bucket, you have operations that are well into the 90% range, and that's happened over the course of many, many, many years and quarters, and there's continued improvement even amongst our most mature operations, which is why we try to point out some of those stories in our examples in the script.

是的，我認為新冠疫情爆發前我們的高水位線是 80.1%。所以是的，我們超越了這一點。就限製而言，這就是為什麼我們對今天的入住率如此興奮，儘管比我們之前的入住率要高。我們知道成長潛力巨大。當我們查看我們的同店投資組合併查看該桶中更成熟的運營時，您的運營遠遠超出了 90％ 的範圍，並且這是在許多年和季度的過程中發生的，並且有即使在我們最成熟的營運中也不斷改進，這就是為什麼我們試圖在腳本的範例中指出其中一些故事。

To speak to the skilled mix potential, Tao, yeah, there's great opportunity for us to continue to drive acuity frankly, is the basis of our model, which is to continue to deliver what our acute partners need, which is a sicker-and-sicker patient that needs care, and we're seeing that play out as time goes on, and we've broken past the kind of post COVID norms into what is kind of a steady state of just ever-increasing acuity. Our local leaders are tied in with our hospital partners and our managed care partners. They're in touch with what the needs are.

談到熟練的組合潛力，Tao，是的，坦率地說，我們有很大的機會繼續提高敏銳度，這是我們模型的基礎，即繼續提供我們敏銳的合作夥伴所需要的東西，這是一個更病態的-病情較重的病人需要護理，隨著時間的推移，我們看到這種情況逐漸顯現，我們已經突破了新冠疫情后的常態，進入了一種穩定的狀態，病情的嚴重程度不斷提高。我們的當地領導人與我們的醫院合作夥伴和管理式醫療合作夥伴緊密合作。他們了解需求是什麼。

And as Spencer pointed out in the example of Peoria, they continue to adapt by adding things like subacute services and bedside dialysis and other service lines to meet those ever-changing needs. And so that's what they'll continue to do as we stay aligned. And what you can see over -- again, the course of many quarters since COVID, is that our skilled mix does continue to gradually move higher and higher.

正如斯賓塞在皮奧裡亞的例子中指出的那樣，他們透過增加亞急性服務和床邊透析以及其他服務線等服務來不斷適應這些不斷變化的需求。因此，當我們保持一致時，他們將繼續這樣做。你可以再次看到，自新冠疫情以來的許多季度裡，我們的技術人員組合確實在繼續逐漸提高。

Got it. Suzanne, could you give us a update on the timing and the amount expected from some of the state supplemental payments, quality payment you're expecting in the next few months or quarters and any information you could share in terms of the early discussion among your states on 2026 Medicaid rate?

知道了。蘇珊娜（Suzanne），您能否向我們介紹一些州補充付款的預計時間和金額、您預計在未來幾個月或幾個季度內獲得的高品質付款以及您可以在您的早期討論中分享的任何資訊？

Sure. I think. One of the things that to note for us, of how we look at supplemental payments, as you guys know, we recognize the supplemental payment in our Medicaid rate. So every quarter, we have supplemental payments embedded within the rates that we're disclosing. For every state that we're in, we actually estimate the amount of supplemental payment that we anticipate receiving in for that particular quarter based upon the days and the programs and the quality of the performance of the programs that we have.

當然。我認為。我們需要注意的一件事是，我們如何看待補充付款，正如你們所知，我們在醫療補助費率中承認補充付款。因此，每個季度，我們都會在所揭露的費率中嵌入補充付款。對於我們所在的每個州，我們實際上根據天數、計劃以及我們擁有的計劃的執行品質來估計我們預計在該特定季度收到的補充付款金額。

And so every quarter, every day, we actually have supplemental rates embedded in the Medicaid rate that we're disclosing and as you kind of look through changes in supplemental rates. And as we talked about last year, a lot of the net dollars went away. A lot of those were replaced by a combination of rates and base rates as well as supplemental rates. For the most part, all of those supplemental programs went into effect with the last one. Really being cash probably January of this year with California.

因此，每季、每天，我們實際上都會在我們揭露的醫療補助費率中嵌入補充費率，當您查看補充費率的變更時。正如我們去年談到的，很多淨美元都消失了。其中許多被費率和基本費率以及補充費率的組合所取代。在大多數情況下，所有這些補充計劃都與最後一個計劃一起生效。真正的現金可能是今年一月與加州的現金。

And now it's just a matter of building through the normal course and the normal program. So, most states update their supplemental program consistent with our base rate program year. So, for example, in the current quarter, we had Texas, their program year is September 1st. That rate just updated. And so that went into effect in September.

現在只需按照正常的路線和正常的計劃進行建設即可。因此，大多數州都會根據我們的基本費率計劃年份更新其補充計劃。例如，在本季度，我們有德克薩斯州，他們的計劃年是 9 月 1 日。該匯率剛剛更新。該規定於 9 月生效。

And yeah, really good overall performance in all of those. No real surprises. I think sometimes the timing of those true-ups of the estimate of the accrual changes and when it changes, then we can take that in the current quarter.

是的，所有這些方面的整體表現都非常好。沒有真正的驚喜。我認為有時應計費用估計的調整時間會發生變化，當它發生變化時，我們可以在當前季度進行調整。

Great. That's very helpful. Thank you. Have a good weekend.

偉大的。這非常有幫助。謝謝。有一個美好的周末。

Thanks.

謝謝。

Ben Hendrix, RBC Capital Markets.

本‧亨德里克斯，加拿大皇家銀行資本市場部。

Great. Thank you very much. A couple of M&A related questions. It seems like the pace of Tuck Ins is kind of picked up a little bit first. I just wanted to know if there's anything kind of structurally that's kind of driving the acceleration. Is there a change in among sentiment among sellers? Is there something anything structurally, whether it be minimum staffing or anything that's got is incenting more transaction fluidity in the market? Any comments you have there?

偉大的。非常感謝。幾個併購相關的問題。Tuck Ins 的步伐似乎先加快了一點。我只是想知道是否有某種結構上的因素可以推動加速度。賣家的情緒有改變嗎？結構上是否有什麼東西，無論是最低限度的人員配置還是任何東西都可以刺激市場上的交易流動性？有什麼意見嗎？

I mean, yes, to all of that. This is Chad. I think all those things are true. I mean -- I think it's -- especially for smaller operators, it's much harder to keep up with all the constant changes. And that's the one thing that for sure we will have in this industry is constant change. And minimum staffing, we feel pretty confident that's not going to happen.

我的意思是，是的，對於所有這些。這是乍得。我認為所有這些都是真的。我的意思是——我認為——特別是對於規模較小的營運商來說，跟上所有不斷的變化要困難得多。在這個行業中，我們肯定會遇到的一件事就是不斷變化。在人員配置最少的情況下，我們非常有信心這種情況不會發生。

But nonetheless, we definitely hear sentiment from sellers of just like just kind of exhaustion with some of that stuff that's always out there. So that's part of it. I'd say there's also maybe sort of post-COVID, I think a lot of folks feeling like maybe we got through that and now is a time where conditions are a little more stable and maybe it's a good time. Maybe they were looking to sell before then COVID came and they kind of had it pushed through it and now they're at a spot where they feel stable enough to see what they can get for their businesses. So, we're seeing a lot of that.

但儘管如此，我們確實聽到了賣家的情緒，他們對那些總是存在的東西感到有點疲憊。這就是其中的一部分。我想說，也許還有某種後新冠疫情，我想很多人都覺得我們可能已經度過了難關，現在是一個條件更加穩定的時期，也許這是一個好時機。也許他們在新冠疫情到來之前就打算出售，他們已經度過了難關，現在他們感覺足夠穩定，可以看到他們能為自己的業務帶來什麼。所以，我們看到了很多這樣的情況。

But it's always true too, Ben, that because of overaggressive real estate deals, there's definitely a large amount of distressed opportunities for us where someone overpaid and they're not paying the ren. The rent payments aren't coming through now, right, and they're distressed and looking to find a replacement. And so, lots of those two.

但本，這也是事實，由於房地產交易過於激進，我們肯定有大量陷入困境的機會，因為有人支付過高的費用，而他們卻沒有支付租金。現在租金還沒付清，對吧，他們很苦惱，正在尋找替代者。所以，很多都是這兩個。

So, it's kind of a lot of all those factors. And we're just -- in terms of our pace of acquisitions, because we have this local approach and lean heavily on our local teams and we now have 30 markets across the 14 states we're in. We can grow very comfortably leaning on those local teams as they transition these operations. And as we grow, right, our capacity to grow also grows with it, right? So, in terms of a percentage of growth, we've actually stayed pretty steady. But I do expect that as we get bigger that our capacity to grow, will grow with it.

所以，所有這些因素都有很多。就我們的收購速度而言，我們只是採用本地方法，並且嚴重依賴本地團隊，而且我們現在在 14 個州擁有 30 個市場。當地團隊過渡這些業務時，我們可以非常輕鬆地依靠他們來成長。隨著我們的成長，我們的成長能力也會跟著成長，對吧？因此，就成長百分比而言，我們實際上保持相當穩定。但我確實預計，隨著我們變得更大，我們的成長能力也會跟著成長。

Got you. And just a follow-up on that. Is the profile of the acquisitions you're targeting changing at all? I know that you bought an LTAC a couple of quarters ago. And then you mentioned like dialysis capabilities in Peoria, which we typically associate with higher-level care like LTAC. Is there -- and then also you're expanding in markets where you already have strong cluster presence. So, I'm wondering if maybe you're kind of broadening the scope into higher acuity in terms of some of these opportunities?

明白你了。這只是後續行動。您目標收購的情況是否改變了？我知道您在幾個季度前購買了 LTAC。然後您提到了皮奧裡亞的透析能力，我們通常將其與 LTAC 等更高級別的護理聯繫起來。是否存在—然後您還在已經擁有強大集群影響力的市場中進行擴張。所以，我想知道您是否正在將其中一些機會的範圍擴大到更高的敏銳度？

That's a great question. I would say, you know, not really, I think, I think the LTAC thing was a really unique set of circumstances and so far, that's going great. And maybe down the road, if we prove that model can work, that that's something we could look at. But for the most part, our targets are very similar to what they've been. A lot of the efforts to move up the acuity chain happens sort of post-acquisition. And so, I wouldn't say that we're necessarily targeting a different type of acquisition opportunity.

這是一個很好的問題。我想說，你知道，不是真的，我認為 LTAC 的事情是一個非常獨特的情況，到目前為止，一切都很順利。也許在未來，如果我們證明模型可行，我們可以考慮這一點。但在大多數情況下，我們的目標與過去的目標非常相似。許多提升敏銳度鏈的努力都是在收購後進行的。因此，我不會說我們一定要瞄準不同類型的收購機會。

I will say, though, that while our first preference is to grow in states we're in, that's kind of the lowest hanging fruit and there's lots of room to continue to do that. We definitely have opportunities in lots of new markets. And I think I said this in my prepared remarks, but you'll see some growth in the near future in newer markets that are states that we haven't been in for too long and also even adding some new states. So, that's also part of our kind of -- in terms of just the set of deals we're looking at, we are expanding the geographical footprint.

不過，我要說的是，雖然我們的首要任務是在我們所在的州發展，但這是最容易實現的目標，而且還有很大的空間可以繼續這樣做。我們在許多新市場肯定有機會。我想我在準備好的演講中說過這一點，但在不久的將來，您會看到新市場的一些成長，這些市場是我們進入時間不長的州，甚至會增加一些新的州。因此，這也是我們的一部分——就我們正在考慮的一系列交易而言，我們正在擴大地理足跡。

Great. Thank you very much.

偉大的。非常感謝。

David MacDonald, Truist Securities.

大衛麥克唐納 (David MacDonald)，Truist 證券公司。

Good afternoon, everyone. A couple of questions just want to follow up on Ben's question a little deeper on M&A and just ask with regards to Colorado specifically, obviously a fair amount of activity there, is there anything specific to the state that you guys would call out or is that just kind of how those fell? And then I guess to follow up on the last answer that you gave, could you just provide an update on, kind of Tennessee and how's how that's been going? Just any high level thoughts there?

大家下午好。有幾個問題只是想更深入地跟進本關於併購的問題，並具體詢問科羅拉多州，顯然那裡有相當多的活動，是否有任何特定於該州的事情是你們會指出的，或者是那些是怎麼掉下來的？然後我想跟進您給出的最後一個答案，您能否提供有關田納西州的最新情況以及進展如何？只是有什麼高層次的想法嗎？

Yeah. So, as I said, our priority is always to grow in markets we know and that we know well, and we have a really strong track record, and Colorado is a perfect example of that. And so, it's a state that we've just been in for a while and have just an amazing team of leaders, both clinical and otherwise.

是的。因此，正如我所說，我們的首要任務始終是在我們熟悉且熟悉的市場中實現成長，並且我們擁有非常出色的業績記錄，科羅拉多州就是一個完美的例子。因此，我們處於這種狀態已經有一段時間了，並且擁有一支令人驚嘆的臨床和其他領域的領導團隊。

We've recently kind of -- as we've grown, we have divided it into two markets. So, and by that, that sort of gives our leadership more bandwidth. And that's been an important sort of structural thing we've done there to prepare for some of that growth. And that's typical of how we've grown in California, in Texas and Arizona and other places, too.

最近，隨著我們的發展，我們將其分為兩個市場。因此，這樣就為我們的領導階層提供了更多的空間。這是我們在那裡所做的一項重要的結構性工作，為部分成長做好準備。這也是我們在加州、德州和亞利桑那州以及其他地方的典型發展方式。

And so, it's kind of combining the strength of our team, the strength of our reputation there with deal opportunities that just come up, right, opportunistically, we were just prepared to take some larger, I guess, acquisitions in Colorado. So, there's really nothing super unique about Colorado other than it's a state we love, and there happened to be some great deals that have come up and that we are prepared to take.

因此，這有點將我們團隊的實力、我們在那裡的聲譽與剛剛出現的交易機會結合起來，對，機會主義的，我們剛剛準備好在科羅拉多州進行一些規模更大的收購。因此，科羅拉多州確實沒有什麼特別之處，除了它是一個我們熱愛的州，而且碰巧出現了一些很棒的交易，我們準備接受。

So, in terms of Tennessee, obviously, we're still new to the state. We have three buildings there, continuing to prepare for future growth in that state. And that's definitely one of the states I was alluding to earlier as one that we plan to grow in, in the near future. But we haven't gotten to a point to announce anything there yet, but you'll see something soon on that front.

因此，就田納西州而言，顯然我們對這個州來說仍然是個新手。我們在那裡擁有三座大樓，並繼續為該州的未來發展做好準備。這絕對是我之前提到的我們計劃在不久的將來發展的州之一。但我們還沒有到要宣布任何事情的程度，但你很快就會看到這方面的事情。

But really excited about the momentum we have in Tennessee. Our leadership team there, again, is just first class. And having three buildings is obviously just a start. And as we continue to grow there, that will allow us to build extra resources and extra strength in that market and also South Carolina and other parts of that part of the country that we're really excited about as well.

但我們對田納西州的勢頭感到非常興奮。我們在那裡的領導團隊再次是一流的。擁有三棟建築顯然只是一個開始。隨著我們在那裡繼續發展，這將使我們能夠在該市場以及南卡羅來納州和該國其他地區建立額外的資源和額外的實力，我們也對此感到非常興奮。

Well. One thing I'd add to that David is, we have got -- we have a new market leader program which is effectively prepares leaders that are experienced and have a good track record with us and in leading in other states that have interest in other states. And we spent some time working with these leaders to look at preparation to enter new geographies that align with their interests and the interests of the organization.

出色地。我要補充的一件事是，大衛，我們有一個新的市場領導者計劃，該計劃可以有效地培養經驗豐富、在我們這裡有良好記錄的領導者，並在其他對其他領域感興趣的州發揮領導作用。我們花了一些時間與這些領導者合作，研究進入符合他們利益和組織利益的新地區的準備。

And that combined with, you know, 60 plus a its in the pipeline. We are prepared for growth in other states. It's not to say that well rapidly jump in. We take a pretty methodical approach to that, but don't be surprised if you see us entering some new geographies next year.

你知道，這與 60 加上一個正在醞釀中的項目相結合。我們已準備好在其他州實現成長。這並不是說我們可以快速投入。我們對此採取了相當有條理的方法，但如果您看到我們明年進入一些新的地區，請不要感到驚訝。

Okay. And, and just one other guys, look, I realize you obviously haven't put anything out for 2025. But I'm just curious any high level kind of early comments about, you know, just the growth opportunities you see in front of you, any potential 2025 headwinds and tailwinds that you would point to and lay out, I guess just any preliminary high level conversations about 2025.

好的。還有另外一個人，聽著，我意識到你們顯然還沒有為 2025 年發布任何內容。但我只是好奇任何高層的早期評論，你知道，你在你面前看到的增長機會，你會指出和闡述的任何潛在的 2025 年逆風和順風，我想只是任何初步的高點關於2025 年的級別對話。

I think my last comment kind of speaks to that. I mean, we certainly are excited about growth opportunities, acquisition opportunities. We -- so much so that we've tried to make sure that both from a support perspective here at the service center and building our bench of leadership talent in the field that we've got solid preparation to be able to handle what we see as a pretty attractive environment for growth.

我認為我最後的評論已經說明了這一點。我的意思是，我們當然對成長機會和收購機會感到興奮。我們如此努力，以至於我們試圖確保從服務中心的支持角度以及在該領域建立我們的領導人才庫來看，我們已經做好了堅實的準備，能夠處理我們所看到的情況作為一個非常有吸引力的成長環境。

But that aside, we also can't overemphasize enough how pleased we are with the progress we're seeing in almost every market that we're in across the portfolio from a transitioning and same-store perspective. There's really solid growth fundamentals in all three of our buckets, but our same-store operations continue to improve nicely and -- which speaks to the fact that we're able to balance better than we ever have before, having growth along with solid organic opportunity as well and having those two things kind of go hand-in-hand.

但除此之外，從轉型和同店的角度來看，我們對我們在整個投資組合中幾乎每個市場所看到的進展感到多麼高興都不為過。我們的三個業務領域都有非常堅實的成長基本面，但我們的同店營運持續良好改善，這說明我們能夠比以往更好地實現平衡，在成長的同時實現堅實的有機業務機會也是如此，並且這兩件事是齊頭並進的。

So, we feel good about where we're headed for 2025. We don't want to be overly confident. There's certainly a lot of things we need to do to improve always, but we feel pretty excited about the horizon.

因此，我們對 2025 年的發展方向感到滿意。我們不想過於自信。當然，我們需要做很多事情來不斷改進，但我們對未來感到非常興奮。

Okay, thanks very much.

好的，非常感謝。

Scott Fidel, Stephens.

斯科特·菲德爾，史蒂芬斯。

Hi. Thanks everyone. Hi. First question just as we sort of round out the rest of the year, just interested on any call outs you'd want to make just around for modeling considerations for the fourth quarter. Either from the P&L perspective of obviously of the the new Medicare rate coming in FY25 but any other call out and then also from the cash flow perspective, any seasonal dynamics that you just want to highlight when modeling cash flows?

你好。謝謝大家。你好。第一個問題就像我們對今年剩餘時間的總結一樣，只是對您想要為第四季度的建模考慮而提出的任何要求感興趣。無論是從損益表的角度來看，顯然是2025 財年新的醫療保險費率，還是從其他方面來看，然後從現金流的角度來看，您在建模現金流時只想強調任何季節性動態嗎？

Yeah, Great question, Scott. As you mentioned, we had that Medicare rate come in October 1, we will be slightly above what the net market basket rate increases due to the states that we're in. When we kind of look at the Medicaid rates, I think that we're pretty in a pretty steady state there based upon where we ended up with the Q3 rate going into Q4 just because not a lot of changes happening in Q4 and some of the supplementals that I talked to a little bit of supplemental payments, the ebbs and flows are about even between Q3 and Q4. So that's a pretty steady state there.

是的，好問題，史考特。正如您所提到的，我們的醫療保險費率將於 10 月 1 日公佈，由於我們所在的州，我們將略高於淨市場籃子費率的增幅。當我們查看醫療補助費率時，我認為我們處於相當穩定的狀態，基於我們最終將第三季度的費率進入第四季度，因為第四季度並沒有發生太多變化，而且一些我談到了一些補充付款，第三季和第四季之間的潮起潮落基本持平。所以這是一個相當穩定的狀態。

With regards to kind of margins and other things, we're looking really consistent as we model into Q4 as well. Obviously, we have a little bit seasonality coming into it with higher skilled mix usually and continued growth in occupancy is usually in there as well. And then just running out the quarter, we had a lot of acquisitions at the end of Q3. So those 12 acquisitions coming in for a full quarter in Q4. And then flipping to the cash flow, just a reminder that we do have a large payment going out for the settlement that we did earlier in the year. We anticipate that going out towards the beginning of Q4. And then everything else is pretty steady state.

關於利潤率和其他方面，我們在第四季度的模型中看起來非常一致。顯然，我們通常會遇到一些季節性因素，通常會出現較高技能的組合，且入住率也通常會持續成長。然後，就在本季結束時，我們在第三季末進行了許多收購。因此，這 12 項收購是在第四季度整個季度進行的。然後轉向現金流，這只是提醒我們，我們確實為今年早些時候所做的和解支付了大筆款項。我們預計在第四季初就會出現這種情況。然後其他一切都處於相當穩定的狀態。

Okay, great. And then just my follow up question interested if you wanted to provide your thoughts on, you know, some of the discussion that's out in the marketplace, just just around the the trends around levels of insurer claims denials, you know, both in sort of commercial managed care and in Medicare advantage, most of the the commentary has been from the acute hospital side and then, then the managed care companies that have sort of been trading some barbs against the hospitals. So definitely would be interested just from your perspective, more on the Postek and the skilled nursing side, you know, how those trends have been in terms of engaging, with the health insurers and sort of what you've been seeing in terms of, you know, prior authorization and, and claims denial type of interactions with them.

好的，太好了。然後是我的後續問題，如果您想提供您的想法，您知道，市場上的一些討論，只是圍繞保險公司索賠拒絕水平的趨勢，您知道，兩者都在某種程度上在商業管理式醫療和醫療保險優勢方面，大部分評論來自急性醫院方面，然後是管理式醫療公司，他們對醫院進行了一些倒刺。因此，從您的角度來看，我們肯定會對 Postek 和熟練護理方面的更多內容感興趣，您知道，這些趨勢在與健康保險公司的接觸方面以及您所看到的方面如何，您知道，與他們的互動是事先授權和拒絕聲明類型的。

Yeah, Look, I think the commentary you're hearing and the congressional reporting on this topic is fairly indicative of what the provider community at large, generally deals with in that relationship and not to say it's all entirely negative. There's a healthy back and forth when you're working with managed care providers on coding and length of stay and rate levels and authorizations.

是的，你看，我認為你聽到的評論和國會關於這個主題的報告相當表明了整個提供者社區在這種關係中通常處理的問題，而不是說這完全是負面的。當您與管理式醫療服務提供者就編碼、住院時間、費率等級和授權進行合作時，會進行健康的來回交流。

And really, frankly, that -- there's nothing new there, at least as far as how we work with our managed care partners. Our approach really has been to have a healthy embrace of that process and to make sure that we try to seek to understand what it is that they're looking for and how we kind of work within that structure and build trust so that when we are seeking changes to authorizations and levels and things like that, there's a trust that's built mostly with a foundation based in outcomes.

坦白說，這並沒有什麼新鮮事，至少就我們與管理式醫療合作夥伴的合作方式而言。我們的方法實際上是健康地擁抱這個過程，並確保我們努力了解他們正在尋找什麼，以及我們如何在該結構中工作並建立信任，以便當我們尋求對授權和級別以及類似的事情進行更改，這是一種主要建立在基於結果的基礎上的信任。

And look, I will tell you, sometimes it's really difficult to have those discussions because what they want and what we want for the patient are sometimes conflicting. But that said, I think the spotlight that's kind of put on this lately is probably healthy. There probably isn't quite as much accountability for the managed care providers as there are for us as providers. It tends to be somewhat one-sided conversation sometimes and that shouldn't always be the case.

我會告訴你，有時進行這些討論確實很困難，因為他們想要的東西和我們想要為病人提供的東西有時是衝突的。但話雖如此，我認為最近對此的關注可能是健康的。管理式醫療提供者的責任可能不如我們身為提供者的責任那麼多。有時談話往往是片面的，但情況不應該總是如此。

So, I think, look, the dialogue around this is healthy and helpful. I think there should be some checks and balances to how some of those inner workings play out in terms of the impact on the patient and the providers that are hands on with the care. So, look, at the end of the day, there's probably no meaningful impact to us because we feel confident about our relationships with managed care providers, but I think accountability in the space is always healthy and helpful.

所以，我認為，圍繞這個問題的對話是健康且有益的。我認為應該對這些內部運作在對病人和負責照護的提供者的影響方面如何發揮作用進行一些制衡。因此，歸根結底，這可能不會對我們產生任​​何有意義的影響，因為我們對與管理式醫療提供者的關係充滿信心，但我認為該領域的問責制始終是健康且有益的。

But that said, I think the spotlight that's, that's kind of put on this lately is probably healthy. I I, you know, there, there probably isn't quite as much accountability for the managed care providers as there are for the, for, for, for us as providers. It, it tends to be somewhat one sided conversation sometimes. And, and that shouldn't always be the case. So I think, I think, look the dialogue around this is, is, is healthy and helpful. I think there, there should be some checks and balances to, you know, how, how, how some of the, the those inner workings play out in terms of, you know, the impact on the patient and the providers that are, that are, you know, hands on with the care. So look at the end of the day, there, there's probably no no meaningful impact to us because we feel confident about our relationships with managed care providers. But I think accountability in the space is, is always healthy and helpful.

但話雖如此，我認為最近對此的關注可能是健康的。我，你知道，管理式醫療提供者的責任可能不如我們作為提供者的責任那麼多。有時，這往往是一種片面的談話。而且，情況不應該總是如此。所以我認為，我認為，圍繞這個問題的對話是健康且有益的。我認為，應該有一些制衡，你知道，這些內部運作如何、如何、如何發揮作用，你知道，對病人和提供者的影響，你知道，是親力親為的照顧者。因此，歸根結底，這可能對我們沒有任何有意義的影響，因為我們對與管理醫療提供者的關係充滿信心。但我認為這個領域的問責制總是健康且有益的。

Okay, I appreciate the feedback there. That's it for me. Thanks.

好的，我很欣賞那裡的回饋。對我來說就是這樣。謝謝。

Thanks Scott.

謝謝斯科特。

Thank you. That concludes our Q&A session. Thank you so much for attending today's call. You may now disconnect. Have a wonderful day.

謝謝。我們的問答環節到此結束。非常感謝您參加今天的電話會議。您現在可以斷開連線。祝你有美好的一天。