Ensign Group Inc (ENSG) 2025 Q1 法說會逐字稿

Thank you for standing by. My name is Kate and I'll be your conference operator today.

感謝您的支持。我叫凱特，今天我將擔任您的會議主持人。

At this time, I would like to welcome everyone to the Ensign Group Inc. First quarter FY 2025 earnings conference call.

現在，我歡迎大家參加 Ensign Group Inc. 2025 財年第一季財報電話會議。

All lights have been placed on you to prevent any background noise. After the speaker's remarks, there will be a question-and-answer session.

所有燈光都對著你，以防止任何背景噪音。演講者發言後，將進行問答環節。

(Operator Instructions)

（操作員指示）

I would not like to turn the call over to Mr. Keetch. Please go ahead.

我不想把電話轉給基奇先生。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 www.ensigngroup.net. A replay of this call will also be available on our website until 5 p.m. Pacific on Saturday, May 31, 2025.

謝謝接線員，歡迎大家。我們昨天提交了收益新聞稿，可在我們網站 www.ensigngroup.net 的投資者關係部分查閱。本次通話的重播也將在我們的網站上提供，直至下午 5 點。太平洋時間 2025 年 5 月 31 日星期六。

We want to remind anyone that maybe you're listening to a replay of this call that all statements made are as of today, April 30, 2025, and these statements have not been nor will be updated subsequent to today's call. 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.

我們想提醒大家，也許您正在收聽本次電話會議的重播，所有聲明均截至今天（2025 年 4 月 30 日），並且這些聲明在今天的電話會議之後沒有更新，也不會更新。此外，今天所做的任何前瞻性陳述均基於管理層對我們的業務和經營環境的當前預期、假設和信念。這些聲明受風險和不確定性的影響，可能導致我們的實際結果與今天電話會議上表達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 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.

聽眾不應過度依賴前瞻性陳述，並鼓勵他們查看我們向美國證券交易委員會提交的文件，以便更全面地討論可能影響我們結果的因素。除聯邦證券法要求外，Ensign 及其獨立子公司不承諾在因新資訊、未來事件、情況變化或任何其他原因而發生變化時公開更新或修改任何前瞻性聲明。

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.

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 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，我們的自保保險子公司（我們稱之為保險自保公司）為我們的營運公司提供一般和專業責任以及工人賠償保險責任的某些索賠保險。

Ensign also owns Standard Bearer Healthcare Inc. Which is a captive real estate investment trust that invests in healthcare 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.

Ensign 還擁有 Standard Bearer Healthcare Inc.，這是一家專屬房地產投資信託公司，投資醫療保健房地產並與 Ensign 的某些獨立子公司以及與 Ensign 集團無關的第三方租戶簽訂租賃協議。

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

Ensign 公司、我們、我們的和我們的單字指的是 Ensign Group Inc 及其合併子公司。我們所有的獨立子公司、服務中心、史丹醫療保健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 words we, us and our in 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.

本文中對合併公司及其資產和活動的提及以及「我們」、「我們」和「我們的」等類似詞彙的使用並不意味著，也不應被解釋為 Ensign 集團擁有直接經營資產、員工或收入，或任何子公司由 Ensign 集團經營。

Also, we supplement our GAAP reporting with non-GAAP metrics. When viewed together with 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 10Q.

此外，我們也以非 GAAP 指標來補充我們的 GAAP 報告。與 GAAP 結果一起查看時，我們相信這些指標可以更全面地了解我們的業務，但不應依賴它們而排除 GAAP 報告。昨天的新聞稿中提供了 GAAP 與非 GAAP 的對帳表，也可以在我們的 10Q 表中找到。

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

說完這些，我將把電話轉給我們的執行長巴里波特 (Barry Port)。

Thanks, Chad, and thank you everyone for joining us today. We are thrilled to announce another record setting quarter achieved by our local teams. In spite of all the industry noise, our results this quarter demonstrate that we've never been stronger, showing yet again that sound fundamentals coupled with an incredible passion can forge consistency even in an ever changing environment.

謝謝，查德，也謝謝大家今天加入我們。我們很高興地宣布，我們的本地團隊又創下了一個新的季度紀錄。儘管行業噪音不斷，但本季的業績表明我們從未像現在這樣強大，再次表明，良好的基本面加上令人難以置信的熱情，即使在不斷變化的環境中也能形成一致性。

Our operators set several all-time highs during the quarter, which are only made possible by strong clinical outcomes achieved by our dedicated team of caregivers and frontline staff.

我們的操作員在本季度創下了多項歷史新高，這只有透過我們敬業的護理人員和第一線員工團隊取得的出色臨床成果才有可能實現。

During the quarter we saw substantial growth across all of our buckets and in almost every market we serve more specifically, we achieved an all-time high in the same store and transitioning occupancy which increased to 82.6% and 83.5% respectively over the prior year quarter. We also saw a skilled census increase for both our same store and transitioning operations by 7.6% and 9.9% respectively over the prior year quarter. In addition, our managed care census grew by 8.9% and 15.6% for our same store in transitioning operations respectively over the prior year quarter.

本季度，我們的所有業務都實現了大幅增長，更具體地說，在我們服務的幾乎每個市場中，同店入住率和過渡入住率都創下了歷史新高，分別比去年同期增長至 82.6% 和 83.5%。我們還發現，與去年同期相比，同店和轉型營運的熟練工人數量分別增加了 7.6% 和 9.9%。此外，與去年同期相比，我們在轉型營運中的同店管理式醫療普查分別成長了 8.9% 和 15.6%。

All these improvements are the result of many factors, including the relentless efforts by our local leaders to share and implement best practices that lead to stronger outcomes and earn the confidence from our residents, acute care partners, ACOs, and managed care networks.

所有這些改進都是多種因素共同作用的結果，其中包括我們當地領導人不懈努力，分享和實施最佳實踐，從而取得更好的成果，並贏得我們的居民、急性護理合作夥伴、ACO 和管理式醫療網絡的信任。

While the quarter was strong, we were even more excited about our results because they were achieved while simultaneously adding 47 new operations since January of 2024 across almost every market we serve, some of which are already performing at or above our expectations.

雖然本季表現強勁，但我們對業績更加興奮，因為這些業績是在我們自 2024 年 1 月以來幾乎在我們服務的每一個市場都增加了 47 個新業務的同時實現的，其中一些業務的表現已經達到或超過了我們的預期。

The combination of improvements in occupancy and skilled mix in our more mature operations and the long term upside in our newly acquired operations shows the enormous organic growth potential in our existing portfolio.

我們更成熟的業務中入住率和熟練技能組合的提高，以及我們新收購的業務的長期上升趨勢，表明我們現有投資組合具有巨大的有機成長潛力。

We continue to attract and develop caregivers and leaders and are building a formidable bullpen of caring and passionate partners who are determined to live our mission to dignified post acute care.

我們將繼續吸引和培養護理人員和領導者，並正在建立一支強大的充滿愛心和熱情的合作夥伴隊伍，他們決心履行我們的使命，為患者提供有尊嚴的急性後期護理。

In addition, we continue to see improvements in turnover and limited use of agency staffing labor, all of which are critical to maintaining our cultural values and continuity of care.

此外，我們繼續看到人員流動率的改善和代理人員勞動力的有限使用，所有這些對於維護我們的文化價值和護理的連續性都至關重要。

After such a strong first quarter, including some faster than expected contributions from some of our newly acquired operations, we are raising our annual 2025 earnings guidance to between $6.22 per diluted share and $6.38 per diluted share, up from $6.16 per diluted share to $6.34 per diluted share.

在經歷瞭如此強勁的第一季度之後，包括一些新收購業務的貢獻速度快於預期，我們將 2025 年年度盈利預期上調至每股攤薄收益 6.22 美元至每股攤薄收益 6.38 美元之間，高於每股攤薄收益 6.16 美元至每股攤薄收益 6.34 美元。

The new midpoint of this increased 2025 earnings guidance represents an increase of 14.5% over our 2024 results and is 32% higher than our 2023 results. We're also increasing our annual revenue guidance to $4.89 billion to $4.94 billion up from $4.83 billion to $4.91 billion to account for our current quarter growth and acquisitions we anticipate closing during the first half of 2025.

此次上調的 2025 年獲利預期的新中點比我們 2024 年的業績成長了 14.5%，比我們 2023 年的業績高出了 32%。我們也將年度營收預期從 48.3 億美元至 49.1 億美元上調至 48.9 億美元至 49.4 億美元，以反映本季的成長以及我們預計將在 2025 年上半年完成的收購。

We are excited about our start to the year and are confident that our partners will continue to manage and innovate while balancing the addition of newly acquired operations. We are eager to continue to drive organic improvements and take advantage of the acquisition opportunities that we see on the horizon.

我們對新的一年的開始感到興奮，並相信我們的合作夥伴將繼續管理和創新，同時平衡新收購的業務。我們渴望繼續推動有機改進並利用我們即將看到的收購機會。

When we consider the current health of our organization combined with our culture and proven local leadership strategy, we are well positioned to continue executing our operational model. With all that said, we see so much more room for further improvement, and we continue to optimize operational efficiencies, expand services, and create new partnerships, all of which will drive further improvements in occupancy and skilled mix. We look forward to continuing to build on the momentum from the first quarter into the rest of the year as we continue to successfully unlock value and opportunity in the dozens of recently acquired operations.

當我們考慮到我們組織的當前健康狀況以及我們的文化和經過驗證的本地領導策略時，我們已準備好繼續執行我們的營運模式。儘管如此，我們看到還有很大的改進空間，我們將繼續優化營運效率、擴展服務並建立新的合作夥伴關係，所有這些都將推動入住率和技術組合的進一步改善。我們期待在第一季和今年剩餘時間內繼續保持這一勢頭，繼續在最近收購的數十家公司中成功釋放價值和機會。

This performance is not due to some large event or single transformative transaction, but instead is the result of steady and consistent growth in performance quarter after quarter, which comes from a collective belief and a commitment held by all of our partners to expand our mission in a methodical and thoughtful way.

這項業績並非源自於某個大型事件或單一變革性交易，而是業績逐季穩定成長的結果，這源自於我們所有合作夥伴的共同信念和承諾，即以有條不紊、深思熟慮的方式拓展我們的使命。

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

接下來，我想請查德分享一些有關我們最近發展的額外見解，查德。

Thank you, Barry. We continued our steady pace of growth by adding 19 new operations, including 8 real estate assets during the quarter and since. These include the following one in Alabama, one in Oregon, one in Washington, one in Texas, two in Alaska, two in Arizona, three in California, and eight in Tennessee. In total, we added 1,906 new skilled nursing beds and 200 senior living units across eight states. This growth brings a number of operations acquired during 2024 to 47.

謝謝你，巴里。我們繼續保持穩定的成長步伐，在本季及之後增加了 19 個新業務，包括 8 個房地產資產。其中包括阿拉巴馬州 1 例、俄勒岡州 1 例、華盛頓州 1 例、德州 1 例、阿拉斯加州 2 例、亞利桑那州 2 例、加州 3 例以及田納西州 8 例。總體而言，我們在八個州增加了 1,906 張新的專業護理床位和 200 個老年生活單元。這一成長使得 2024 年收購的業務數量達到 47 項。

We're very excited to add density to one of our newest markets in Tennessee and to add our first operation in Alabama. When we enter into new states, we tend to see an uptick in opportunities in those geographies. We are seeing more opportunities to deepen our presence in the Southeast and expect to do so over time.

我們非常高興能夠在田納西州的一個新市場增加密度，並在阿拉巴馬州開展我們的第一項業務。當我們進入新的州時，我們往往會看到這些地區的機會增加。我們看到了更多加強我們在東南部影響力的機會，並期望隨著時間的推移做到這一點。

We're also excited to grow in Oregon and Alaska for the first time. As with our other new states, our entrance into these new markets have been driven by proven Ensign leaders who are committed to and have a connection with the new geography.

我們也很高興首次在俄勒岡州和阿拉斯加州發展業務。與我們進入其他新州一樣，我們進入這些新市場也是由經驗豐富的 Ensign 領導者推動的，他們致力於新地理環境並與新地理環境有著密切的聯繫。

As we have seen and said before, when we go into a new state, we typically look to start with one or two buildings so we can establish a solid launching point for more growth. This was played out time and time again with our most recent example being Tennessee. These footholds eventually lead to growth into multiple clusters which will eventually comprise a sizable market. We look forward to bolstering our presence in those markets over time.

正如我們之前所看到和說過的，當我們進入一個新州時，我們通常會從一兩棟建築開始，這樣我們就可以建立一個堅實的起點，實現更多的成長。這種情況一次又一次地發生，最近的例子就是田納西州。這些立足點最終將發展成多個集群，並最終形成一個相當大的市場。我們期待隨著時間的推移加強我們在這些市場的地位。

In the meantime, we continue to prioritize growth in our established geographies as it allows our clusters to provide a comprehensive solution to the healthcare needs in those markets. While we continue to evaluate new states that fit our criteria, we will prioritize growth in our established geographies.

同時，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為這些市場的醫療保健需求提供全面的解決方案。在我們繼續評估符合我們標準的新州的同時，我們將優先考慮現有地區的成長。

This not only allows us to deepen our commitment to those markets, but because our transitions don't rely on a centralized acquisition team, our growth is not limited by typical corporate bottlenecks. Instead, we look to the local cluster partners to implement the transition plans. So, while our pace of growth remains strong, the distribution of our growth across many markets leaves us with significant bandwidth to grow in most of our markets. We still see significant opportunities to continue to add meaningful density in the markets we know best and are making progress on several editions that we expect to close in the next few months.

這不僅使我們能夠深化對這些市場的承諾，而且由於我們的轉型不依賴集中的收購團隊，我們的成長不會受到典型的企業瓶頸的限制。相反，我們希望當地集群合作夥伴來實施過渡計畫。因此，雖然我們的成長速度依然強勁，但我們的成長分佈在許多市場，這讓我們在大多數市場擁有巨大的成長空間。我們仍然看到了在我們最了解的市場中繼續增加有意義的密度的重大機會，並且我們正在幾個版本上取得進展，預計將在未來幾個月內完成。

Our local leaders continue to recruit future CEOs for Ensign affiliated operations, and we have a deep bench of CEOs and training that are eagerly preparing for an opportunity to lead. We still see evidence that many operators in this industry are struggling, and we expect the operating environment will translate into many near-term and long-term opportunities to both lease and acquire post acute care assets.

我們的當地領導人繼續為 Ensign 附屬營運招募未來的首席執行官，我們擁有一群優秀的首席執行官和培訓人員，他們正熱切地為領導機會做準備。我們仍然看到有證據表明該行業的許多營運商正在苦苦掙扎，我們預計營運環境將轉化為許多短期和長期機會，以租賃和收購急性後期護理資產。

However, we do not set arbitrary growth goals and will remain true to our discipline acquisition strategy. We only grow when we have the right leaders in place and the pricing is right. The scalability of our growth model, our healthy balance sheet combined with numerous opportunities you see in our existing footprint, give us enormous potential to continue to apply our proven acquisition and transition strategies in 2025.

然而，我們不會任意設定成長目標，並將堅持我們的學科獲取策略。只有在擁有合適的領導者和合適的定價的情況​​下，我們才能成長。我們的成長模式具有可擴展性，我們的資產負債表健康，再加上您在我們現有業務中看到的眾多機遇，這為我們在 2025 年繼續應用我們行之有效的收購和轉型策略提供了巨大的潛力。

We anticipate the current rate of acquisitions to continue this year and remain committed to staying true to the proven deal criteria that has allowed us to grow in a healthy and sustainable way.

我們預計今年的收購速度將持續下去，並將繼續致力於遵循已證實的交易標準，這使我們能夠以健康和可持續的方式成長。

We continue to see more opportunities to acquire new operations, and our focus is to carefully choose the acquisitions that will be accred to our shareholders both in the near and long term.

我們繼續看到更多收購新業務的機會，我們的重點是謹慎選擇短期和長期內能為股東帶來回報的收購。

We are also providing additional disclosure on standard bearer, which added 13 new assets during the quarter and since and is now comprised of 137 owned properties of these assets, 104 are leased to an Ensign affiliated operator and 34 are leased to third party operators.

我們還提供了有關標準承載者的額外披露，該公司在本季度增加了 13 項新資產，目前由 137 處自有房產組成，其中 104 處出租給 Ensign 附屬運營商，34 處出租給第三方運營商。

Going forward, Standard Bearer will continue to work together with its operating partners at Ensign to acquire portfolios comprised of operations that Ensign would operate and facilities that third parties are interested in operating under a lease.

展望未來，Standard Bearer 將繼續與 Ensign 的營運合作夥伴合作，收購由 Ensign 營運的業務和第三方有興趣透過租賃方式營運的設施組成的投資組合。

Collectively, Standard Bear generated rental revenue of $28.4 million for the quarter, of which $23.9 million was derived from Ensign affiliated operations. For the quarter, Standard Bearer reported a $17.1 million in FFO as of the end of the quarter and had an EBITDA to rent coverage ratio of 2.6 times.

總體而言，Standard Bear 本季的租賃收入為 2,840 萬美元，其中 2,390 萬美元來自 Ensign 附屬業務。截至本季末，Standard Bearer 報告的 FFO 為 1,710 萬美元，EBITDA 與租金覆蓋率為 2.6 倍。

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

說完這些，我將把電話轉給我們的營運長史賓塞 (Spencer)，為營運增添更多色彩。斯賓塞。

Thanks, Chad, and hello everyone. Today I'm excited to share two facility examples that illustrate the consistent operational momentum that we are seeing as local teams continue to respond to stakeholders in their communities.

謝謝，查德，大家好。今天，我很高興與大家分享兩個設施範例，它們展示了我們所看到的持續營運勢頭，即當地團隊繼續響應其社區的利益相關者。

I hope that these real-life examples can help explain why we feel so encouraged by our Q1 results and confident in the ability of our model to continue to produce exceptional results going forward, regardless of the external forces or challenges that may exist.

我希望這些現實生活中的例子能幫助解釋為什麼我們對第一季的業績感到如此鼓舞，並對我們的模型能夠繼續產生卓越成果的能力充滿信心，無論存在什麼樣的外部力量或挑戰。

The first example comes from our transitioning bucket. Lomita Post Acute Care Center, located in the Los Angeles, California area and led by executive director Kyle Armstrong and director of nurses, Carla Limueco this 68-bed skilled nursing facility was acquired during Q1 of 2023.

第一個例子來自我們的過渡桶。洛米塔急性後期護理中心位於加州洛杉磯地區，由執行董事凱爾·阿姆斯特朗 (Kyle Armstrong) 和護士長卡拉·利穆科 (Carla Limueco) 領導，這家擁有 68 張床位的專業護理機構於 2023 年第一季被收購。

During the recently closed quarter, Lamita saw revenues increase by 17.7%, and EBIT improved by an impressive 86.4% compared to Q1 of 2024. Over the same period, occupancy grew by 2%, but the bigger story was the facility's strategic growth in skilled mix. For example, Medicare days increased by 19.8% and managed care days grew by 85.7% this growth in skilled census was made possible by the facility's commitment to quality, which is evident in it being the only skilled facility in its geography that carries a five-star quality measures and five-star overall rating from CMS.

在最近結束的這個季度中，Lamita 的營收成長了 17.7%，息稅前利潤與 2024 年第一季相比大幅提升了 86.4%。在同一時期，入住率成長了 2%，但更大的問題是該設施的技術組合策略性成長。例如，醫療保險天數增加了 19.8%，管理式醫療天數增加了 85.7%，熟練醫療普查的這種增長得益於該機構對質量的承諾，這一點顯而易見，它是其所在地區唯一一家擁有五星級質量指標和 CMS 五星級總體評級的熟練醫療機構。

The five-star ratings have given the Lomita team strong credibility with the health plans, the hospitals, and discharging facilities in their area. Another major factor in Lomita's financial success has been their ability to improve the continuity of care and reduce labor costs through improved staff retention.

五星級評級使洛米塔團隊在其所在地區的健康計劃、醫院和出院設施中贏得了良好的信譽。Lomita 財務成功的另一個主要因素是他們能夠透過提高員工留任率來改善護理的連續性並降低勞動成本。

During Q1, Lomita reduced its caregiver turnover by 36% compared to prior year quarter. This workforce stabilization directly decreased onboarding and overtime costs, and in turn increased EBIT margin. But most importantly, it's resulted in a healthy work environment where caregivers can trust their coworkers, build a clinical competency, and achieve great healthcare outcomes for the residents they serve.

第一季度，Lomita 的護理人員流動率與去年同期相比降低了 36%。勞動力的穩定直接降低了入職和加班成本，進而提高了息稅前利潤率。但最重要的是，它創造了一個健康的工作環境，護理人員可以信任他們的同事，建立臨床能力，並為他們服務的居民取得良好的醫療保健結果。

The second facility to highlight I want to share represents the exciting same sort of growth that continues to occur in facilities that have been part of the organization for a long time. Copperfield Health Care and Rehabilitation in Houston, Texas is a 124-bed sniff that was acquired in 2016.

我要重點分享的第二個設施代表了該組織長期以來一直隸屬於的設施中持續發生的令人興奮的相同增長。位於德州休士頓的 Copperfield 醫療保健和復健中心是一家擁有 124 張床位的醫院，於 2016 年收購。

During the period following transition, Copperfield made steady clinical and financial progress. However, during the past year, the facility has truly transformed into the community's facility of choice under the leadership of Ruhi Kapoor, CEO, and Wanda Preston, Director of nursing. For example, in Q1, Copperfield averaged 90.7% occupancy, an increase of 11% over prior year quarter to give some context, the average occupancy for non-affiliated sniffs in the state of Texas is under 64%.

在轉型後的時期內，Copperfield 取得了穩定的臨床和財務進展。然而，在過去的一年裡，在執行長 Ruhi Kapoor 和護理主任 Wanda Preston 的領導下，該機構真正轉變為社區的首選機構。例如，第一季度，Copperfield 的平均入住率為 90.7%，比去年同期成長了 11%，而德州非附屬嗅探店的平均入住率低於 64%。

During that same period, skilled Medicare days grew by nearly 43%, while the already healthy managed care census improved by 14.8%. As you would expect, there's a clinical story behind the strong increases in skilled mix that Copperfield has achieved.

在同一時期，熟練的醫療保險天數增加了近 43%，而原本健康的管理式醫療普查則提高了 14.8%。正如您所料，Copperfield 的技術組合強勁成長背後有一個臨床故事。

In a medical hub like Houston, health plans and hospital systems demand quality from their post-acute partners, and Copperfield's ability to maintain CMS five-star quality measures and overall ratings has provided the facility access to contracts that are closed to most providers.

在休士頓這樣的醫療中心，健康計劃和醫院系統要求其急性後期治療合作夥伴提供高品質的服務，而 Copperfield 能夠維持 CMS 五星級品質指標和整體評級，這使得該機構能夠獲得大多數供應商無法獲得的合約。

Notably, many of the Medicare lives in Houston are now being managed through ACOs, which means that the hospital systems can be at financial risk if the patients they discharge have poor health outcomes or have to return to acute hospitals.

值得注意的是，休士頓的許多醫療保險現在都是透過 ACO 進行管理的，這意味著如果醫院出院的病患健康狀況不佳或必須返回急診醫院，醫院系統可能會面臨財務風險。

Similarly, managed care plans in the area have narrowed their networks and are guiding their members needing post-acute care to providers like Copperfield that score high on quality outcomes.

同樣，該地區的管理式醫療計劃也縮小了其網絡，並引導需要急性後期護理的成員前往像 Copperfield 這樣在品質結果方面得分高的提供者。

As acute has increased, Copperfield's multidisciplinary clinical team has partnered with and even received training from their acute hospital partners, which has empowered Copperfield to confidently care for patients with medical conditions and equipment that would overwhelm most sniff level care teams.

隨著急性病的增加，Copperfield 的多學科臨床團隊與急性病醫院合作夥伴建立了合作關係，甚至接受了他們的培訓，這使得 Copperfield 能夠自信地照顧患有大多數嗅探級護理團隊無法承受的疾病和設備的患者。

As demonstrated by both Lomita and Copperfield, it's a very exciting time to be in post-acute care. There continues to be strong demand for quality care and as facilities like Lomita and Copperfield demonstrate clinical competency and willingness to partner with hospitals and health plans, they are rewarded with higher occupancy, improved payer mix, and the ability to provide life changing outcomes for more and more patients and staff.

正如洛米塔和科波菲爾所證明的那樣，現在是急性後期護理的一個非常令人興奮的時刻。對優質照護的需求持續強勁，隨著 Lomita 和 Copperfield 等醫療機構展示出臨床能力並願意與醫院和健康計劃合作，它們將獲得更高的入住率、更好的付款人結構，以及為越來越多的患者和員工提供改變生活的結果的能力。

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 up for questions, Suzanne.

接下來，我將把時間交給蘇珊娜，讓她提供有關公司財務表現和我們的指導的更多細節，然後我們將開始提問，蘇珊娜。

Thank you, Spencer, and good morning everyone. Detailed financials for the quarter are contained in our 10 and press release filed yesterday. Some additional highlights include the following GAAP is diluted earnings per share was $1.37 an increase of 15.1% adjusted diluted earnings per share was $1.02 an increase of 16.9%. Consolidated GAAP revenue and adjusted revenues were both $1.2 billion an increase of 16.1%. GAAP net income was $80.3 million, an increase of 16.6%. Adjusted net income was $89 million an increase of 18%. Other key metrics as of March 30, first include cash and cash equivalent of $282.7 million and cash flow from operations of $72.2 million.

謝謝你，史賓塞，大家早安。該季度的詳細財務數據包含在我們昨天提交的 10 份新聞稿中。其他一些亮點包括：根據 GAAP 計算，每股攤薄收益為 1.37 美元，成長 15.1%；調整後每股稀釋收益為 1.02 美元，成長 16.9%。合併 GAAP 收入和調整後收入均為 12 億美元，成長 16.1%。GAAP淨收入為8,030萬美元，成長16.6%。調整後淨收入為 8,900 萬美元，成長 18%。截至 3 月 30 日的其他關鍵指標首先包括 2.827 億美元的現金和現金等價物以及 7,220 萬美元的營運現金流。

During the quarter, we spent more than $190 million to execute our strategic growth plans, most of which has been in the works for months. We made this investment from a position of strength, as shown by our least adjusted net debt to EBITDA ratio of 2.13 times after taking these investments into consideration.

本季度，我們花費了超過 1.9 億美元來執行我們的策略成長計劃，其中大部分計劃已經籌備了數月。我們以優勢地位進行了這項投資，考慮到這些投資後，我們調整後的淨債務與 EBITDA 比率最低為 2.13 倍。

Our continued ability to maintain low leverage even during periods of significant growth is particularly noteworthy and demonstrates our commitment to discipline growth, as well as our belief that we can continue to achieve sustainable growth in the long run.

即使在大幅成長期間，我們仍能維持低槓桿率，這一點尤其值得注意，這表明我們致力於規範成長，並相信我們能夠長期繼續實現永續成長。

In addition, we currently have approximately $572 million of available capacity under our line of credit, which, when combined with cash and investments on our balance sheet, gives us over a billion dollars in dry powder for future growth. We also own 143 assets, of which 137 are held by standard bearers, and 119 are owned completely debt free and are gaining significant value over time, adding even more liquidity to help with future growth.

此外，我們目前的信用額度下有大約 5.72 億美元的可用容量，加上我們資產負債表上的現金和投資，為我們未來的成長提供了超過 10 億美元的資金。我們還擁有 143 項資產，其中 137 項由標準持有者持有，119 項完全無債務，並且隨著時間的推移價值顯著增加，增加了更多流動性以幫助未來成長。

The company paid a quarterly cash dividend of $0.0625 per common share. We have a long history of paying dividends and have increased the annual dividend for 22 consecutive years.

該公司支付了每股 0.0625 美元的季度現金股息。我們有著長期派發股利的歷史，並已連續22年增加年度股利。

In addition, as one of our many ways to deploy capital, we recently completed a $20 million stock repurchase program we believe at attractive prices. As we've done in the past, we'll always consider stock repurchases when we feel the market is undervaluing our shares.

此外，作為我們部署資本的眾多方式之一，我們最近完成了一項 2000 萬美元的股票回購計劃，我們認為其價格具有吸引力。正如我們過去所做的那樣，當我們覺得市場低估我們的股票時，我們總是會考慮回購股票。

As Barry mentioned, we are increasing our annual 2025 earnings guidance to between $6.22 to $6.38 per diluted share, and our annual revenue guidance to $4.89 billion to $4.94 billion.

正如巴里所提到的，我們將 2025 年年度盈利預期上調至每股攤薄收益 6.22 美元至 6.38 美元之間，年度收入預期上調至 48.9 億美元至 49.4 億美元。

We have evaluated multiple scenarios and based on the strength in our performance and positive momentum we have seen in occupancy and skill mix as well as the continued progress on labor, agency management and other operational initiatives, we have confidence that we can achieve these goals.

我們評估了多種情況，並基於我們的業績表現和我們在入住率和技能組合方面看到的積極勢頭以及勞動力、代理管理和其他營運舉措的持續進展，我們有信心實現這些目標。

Our 2025 guidance is based on diluted weighted average common shares outstanding of approximately $59.5 million. A tax rate of 25% the inclusion of acquisitions closed are expected to be closed through the second quarter of 2025. The inclusion of management's expectations on Medicare and Medicaid reimbursement rates, net the provider tax, with the primary exclusion coming from stock-based compensation.

我們對 2025 年的預期是基於約 5,950 萬美元的稀釋加權平均流通普通股。已完成的收購預計將於 2025 年第二季完成，稅率為 25%。包括管理階層對醫療保險和醫療補助報銷率的預期，扣除提供者稅，主要排除來自股票薪酬。

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

此外，其他可能影響季度業績的因素包括報銷系統的變化、國家預算的延遲和變化、季節性和入住率以及技術組合、對我們的總體經濟和人口普查和人員配置的影響、我們活動的短期影響、保險和控制的變化以及其他因素。

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

說完這些，我就把話題轉回給巴瑞。

Suzanne, as we wrap up, we can't emphasize how again incredibly honored and grateful we are to work alongside our operational leaders, our field resources, our clinical partners, and our service center team that are behind these record setting results. We never cease to be amazed by their impressive resiliency, innovation, and passion. 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 in the culture that they have collectively built.

蘇珊娜，在我們結束演講時，我們無法強調我們再次感到多麼榮幸和感激，能夠與我們的營運領導、現場資源、臨床合作夥伴和服務中心團隊一起努力，創造這些創紀錄的成果。他們令人印象深刻的韌性、創新精神和熱情總是讓我們驚嘆不已。他們的承諾為包括我們自己在內的許多人的生活帶來了祝福，有了這些了不起的合作夥伴，我們對我們的未來充滿期待。我們對他們以及他們共同建立的文化充滿信心。

Now we'll take some questions. Kate, can you instruct us on the Q&A procedure.

現在我們來回答一些問題。凱特，您能指導我們的問答流程嗎？

(Operator Instructions)

（操作員指示）

Ben Hendrix, RBC Capital Market.

加拿大皇家銀行資本市場 (RBC Capital Market) 的 Ben Hendrix。

Great, thank you very much, guys, and thank you for the color on Lomita and Copperfield. I wanted to follow up on a couple of points there, specifically the comments you made around managed care contracting and the narrowing of networks just maybe. You can give us an overview of what you're seeing broadly in terms of the appetite for value based and outcome-based contracts and how that's helping you guys gain a little confidence in supporting this this guidance raise. Thanks.

太好了，非常感謝你們，也感謝你們為《洛米塔》和《科波菲爾》增添色彩。我想跟進一下其中的幾點，特別是您就管理式醫療承包和網路縮小所發表的評論。您可以向我們概述您對基於價值和基於結果的合約的需求的總體看法，以及這如何幫助您增強信心來支持此次指導意見的提高。謝謝。

Great question. We really have had a long history of this, managed care isn't new to us. I think, a lot of others might have shied away from managed care, but we've embraced it from the get-go, and I think when you really try and strive to have partnerships with the NCOs and create a different level of relationship locally because we have. Leadership, it allows us to have a different connection to them. It allows us to actually drive and create the ability to have success together with them.

好問題。我們在這方面確實有著悠久的歷史，管理式醫療對我們來說並不是什麼新鮮事。我認為，許多其他人可能已經迴避了管理式醫療，但我們從一開始就接受了它，而且我認為當你真正嘗試並努力與 NCO 建立合作夥伴關係並在當地建立不同層次的關係時，我們已經做到了。領導力讓我們與他們建立了不同的連結。它使我們能夠真正推動並創造與他們共同取得成功的能力。

And so, I think those examples that Spencer shared are really just what we're trying to do throughout the organization of having that partnership at a deeper level for us to make it a when for both the MCO as well as our local facilities and as we go through that's how it works it's really that that discussion on the local level, how can we help each other really get their members, our patients in a better spot clinically and that then when you go with that clinical focus, the financial return usually typically comes. Along with that, and so that's what we strive for and having those relationships continue to develop and enhance with our resources from the managed care team and the SDR team really pushing on that as well as that local partnership with the facility.

所以，我認為斯賓塞分享的那些例子實際上就是我們在整個組織中試圖做的事情，即在更深層次上建立這種夥伴關係，以便我們為 MCO 和我們當地的設施創造一個機會，隨著我們的發展，這就是它的運作方式，實際上是在地方層面進行討論，我們如何才能互相幫助，真正讓他們的成員、我們的患者在臨床財務上得到更好的回報除此之外，這就是我們所追求的，透過管理式醫療團隊和 SDR 團隊的資源，這些關係將繼續發展和加強，並真正推動與該機構的本地合作夥伴關係。

And I think just to add a tiny bit more color on that is that you know what's important is that you combine all of that the relationships, the drive, the understanding of the market and the environment with a sophisticated back office that allows leaders to see real-time metrics and share some of those metrics with their partners and work in collaboration with them to achieve the outcomes for the members that they're driving and hoping for. It creates an opportunity where you have a partnership between local leaders and those managed care plans that ultimately drives volume because of their ability to take, a sicker patient profile and achieve what's expected.

我認為，只需稍微補充一點，您知道重要的是將所有這些關係、動力、對市場和環境的理解與先進的後台辦公室結合起來，使領導者能夠查看實時指標並與合作夥伴分享其中一些指標，並與他們合作，為成員實現他們所推動和希望的成果。它創造了一個機會，讓你在當地領導人和那些管理式醫療計劃之間建立合作關係，最終推動治療量，因為他們有能力接受病情更嚴重的患者，並實現預期目標。

Great, thank you for that. And then, just, in light of the guidance phrase, we just get lots and lots of questions on, your positioning against policy. So, forgive me for the requisite policy question, but you know just how are you guys, what are your latest thoughts on, you know what could come out of Washington, how your position and specifically around the potential for supplemental Medicaid cuts.

太好了，謝謝你。然後，根據指導方針，我們收到了很多關於您的政策定位的問題。所以，請原諒我提出這個必要的政策問題，但你們好嗎，你們最近有什麼想法，你們知道華盛頓可能會做出什麼決定，你們的立場如何，特別是圍繞補充醫療補助削減的可能性。

Thanks.

謝謝。

Yes, no problem. We're totally, transparent and open about our thoughts on this. We are approaching this in very much the same way we did with the staffing minimum issue that we've dealt with over the last year or so, which is to say that we are actively involved in the advocacy process. I've personally met with leadership in both the House and the Senate. Our association has been Enormously efficient and effective at setting up meetings to educate members of Congress and help them understand the implications of any potential changes or discussions around certain funding aspects whether it be provider tax related or directed payments to states.

是的，沒問題。我們對此的想法是完全透明和公開的。我們處理這個問題的方式與過去一年左右處理人員最低限度問題的方式非常相似，也就是說，我們積極參與倡議過程。我親自會見了眾議院和參議院的領導。我們的協會非常有效率且有效地組織會議來教育國會議員並幫助他們了解有關某些資金方面任何潛在變化或討論的影響，無論是供應商稅相關還是直接向各州支付。

And they've been great meetings. There's been some light bulb moments where we've had members of Congress come into a new understanding of how some of these programs that have been around for 30 Plus years that have that have been, that are CMS approved every rate cycle, how they work and why they work the way they do, there's certainly op opportunity for change in the Medicaid program.

這次會議非常成功。有一些靈光一現的時刻，國會議員們對一些已經存在 30 多年的項目有了新的認識，這些項目在每個費率週期都得到了 CMS 的批准，它們如何運作以及為什麼它們以這種方式運作，醫療補助計劃肯定存在變革的機會。

And we know that, and they know that, but our approach right now is to make sure they're fully educated and understanding of what's good for funding to the industry and what is potentially harmful because they don't always necessarily see how everything trickles down, and functions and they've been incredibly receptive.

我們知道這一點，他們也知道這一點，但我們現在的方法是確保他們充分了解什麼對行業資助有益，什麼可能有害，因為他們並不總是能看到一切是如何涓滴而下和運作的，而他們對此非常容易接受。

I highlight that, President Trump has been very direct about his both view of the Medicaid program and his protection of it, I think members of Congress are hearing that loud and clear as we sit here today, what we feel like as far as the direction things are headed is that there's more of a focus on the expansion population, even news you heard about yesterday on per capita caps and other ideas are all primarily targeted towards the expansion population and not who the original recipients of the Medicaid program were intended for, and that's what we see, the trends at least in the last week or two are positive this won't be done soon. The reconciliation process will probably continue through July at least, and we'll continue to stay very active and involved in the process and make sure that we continue to make sure our voices are heard on all of these issues.

我想強調的是，川普總統非常直接地表達了他對醫療補助計劃的看法以及他對該計劃的保護，我想國會議員們今天坐在這裡清楚地聽到了這一點，就事態發展的方向而言，我們感覺更多的是關注擴張人口，甚至你昨天聽到的關於人均上限和其他想法的消息都主要擴張人口，而不是醫療保健計劃最初的兩週，這就是我們所看到的人口。和解進程可能至少會持續到七月，我們將繼續積極參與這一進程，並確保我們的聲音在所有這些問題上都能被聽到。

And just to, as you remember, we were not a big beneficiary of that expansion population, so that part of it is, it goes well for us if that's the continued focus.

而且，正如你所記得的，我們並不是人口擴張的最大受益者，所以，如果我們繼續關注這一點，那麼對我們來說會很順利。

Thanks guys.

謝謝大家。

Tao Qiu, Macquarie Capital

邱濤，麥格理資本

Thank you. Good morning. First question, the $200 million investment spent this quarter sets a record in company history. I think it was mainly from one, health system seller. There was another billion dollar portfolio transaction in February. Are you seeing any changes in your volume, market dynamics, or any seller mentality changes. In other words, how sustainable do you think the current pa of investment is in the next 12 months. And then if you could comment on kind of the mix between real estate versus lease deals in your investment pipeline.

謝謝。早安.第一個問題，本季2億美元的投資創下了公司歷史上的最高紀錄。我認為這主要來自一個醫療系統賣家。2月又有一筆價值10億美元的投資組合交易。您是否發現您的交易量、市場動態或賣家心態有任何變化。換句話說，您認為目前的投資成長率在未來 12 個月內有多大的可持續性。然後，如果您可以評論一下您的投資管道中房地產與租賃交易的組合。

Yes, thanks.

是的，謝謝。

So, it certainly was a strong quarter from a perspective of putting capital to work for sure.

因此，從資本投入的角度來看，這無疑是一個強勁的季度。

In terms of the deal flow, I would say it's really, just a continuation of what we've seen over the last year to 18 months, and that's just a lot of stuff for sale all the time. So, you know there's more deals out there than we could ever do and so we're, as I said in my prepared remarks, we're sticking to, our principles and our disciplined approach there and remain very selective in the deals that we underwrite and ultimately consummate, the $200 million-ish in investment, in the quarter was mostly driven by the fact that a lot of our of our deals were real estate and as and those that have been following us know well, we if we have a wish list, our first desire would be to own the real estate and operate it with an Ensign affiliated operator.

就交易流程而言，我想說這實際上只是我們在過去一年到一年半中看到的情況的延續，而且一直有很多東西在出售。所以，你知道，現在有比我們能做的更多的交易，所以，正如我在準備好的發言中所說的那樣，我們堅持我們的原則和嚴謹的態度，對我們承銷和最終完成的交易保持非常嚴格的選擇性，本季度 2 億美元左右的投資主要是因為我們的很多交易都是房地產，而且那些一直關注我們的人都知道，如果我們有一個願望清單，我們擁有第一個的願望。

Our second priority would be to get enter into a lease and have an Ensign affiliated operator operate it, and then the third would be to buy the real estate and then have a third party enter into a lease with our real estate entity and I think the deal flow and as you look through our press release, you'll kind of see how those priorities lay out. This particular quarter there was more real estate than I would say as usual, but we're always trying to achieve that.

我們的第二個優先事項是簽訂租約並讓 Ensign 附屬運營商來運營它，然後第三個優先事項是購買房地產，然後讓第三方與我們的房地產實體簽訂租約，我認為交易流程以及當您瀏覽我們的新聞稿時，您會看到這些優先事項是如何安排的。本季度的房地產數量比往常要多，但我們一直在努力實現這一目標。

So, certainly our cash position and the amount of liquidity we have from, and Suzanne mentioned, a revolving line of credit, we have tons of dry powder to continue on that pace. I will say that you know the deals that we have, for the remainder of the year, at least the ones that we have visibility into right now, are probably more least focused than real estate.

因此，當然，憑藉我們的現金狀況和流動資金量（蘇珊娜提到過，還有循環信貸額度），我們有足夠的資金來繼續保持這種速度。我想說的是，你知道，在今年剩餘時間裡，我們所做的交易，至少是我們現在所能預見的交易，可能比房地產更不受關注。

And again, we're just opportunistic about how that plays out, but certainly, excited about the opportunities that are in front of us and the real focus and the real question is making sure that we have a leadership pipeline that's ready to go to take on these operations and that still remains kind of our most important, I guess, limiter on growth is talent, less so on capital.

再說一次，我們只是對事情的發展持機會主義態度，但當然，我們對擺在我們面前的機會感到興奮，真正的重點和真正的問題是確保我們擁有一支隨時可以承擔這些業務的領導隊伍，我想，這仍然是我們最重要的增長限制因素，人才，而不是資本。

Appreciate the color. My second question is on staffing, your portfolio occupancy is at a record high. I think it's 200 basis points above pre-pandemic levels. skilled mix is also higher than 2019, but if we look at nursing facility jobs, broadly, they haven't, fully recovered and they are intense competition with other healthcare settings, particularly for, skilled staff. I'm wondering if you could comment on number one, whether there's still staffing constraints or pressure points that limit admissions, particularly around skilled patients. And second, where do you think we need to be what, when we will see accelerating operating leverage, assuming it is not a linear relationship.

欣賞色彩。我的第二個問題是關於人員配備，您的投資組合入住率達到了歷史最高水準。我認為它比疫情前的水平高出 200 個基點。熟練技術人員的比例也高於 2019 年，但如果我們看一下護理機構的工作，總體而言，它們尚未完全恢復，並且與其他醫療機構的競爭非常激烈，特別是在技術人員方面。我想知道您是否可以對第一點發表評論，是否仍然存在人員限製或限制入院的壓力點，特別是對於技術熟練的患者。其次，您認為我們需要達到什麼程度，何時我們會看到經營槓桿加速上升，假設它不是線性關係。

Yes, it's a great question, from a macro perspective, certainly, when you look at the amount of workers that left our sector during COVID, it's our sector itself is not fully recovered yet, and there are fewer workers in post-acute care than there were in specifically skilled nursing care than there were prior to the pandemic, while all other sectors have recovered and then some.

是的，這是一個很好的問題，從宏觀角度來看，當然，當你看看在新冠​​疫情期間離開我們行業的工人數量時，你會發現我們行業本身還沒有完全恢復，而且在急性後期護理中，從事專門技術護理的工人比疫情之前要少，而其他所有行業都已經恢復了，甚至有所恢復。

That said, we're probably an anomaly when it comes to that, our recovery, while I would never say it's always, completely, finished we're somewhere near pre-pandemic levels in agency staffing, our turnover is consistently improving.

話雖如此，就這一點而言，我們可能是一個異常現象，儘管我永遠不會說我們的復甦總是完全完成的，但我們的機構人員配備已經接近疫情前的水平，我們的營業額也在持續提高。

Our pace of wage inflation has moderated to pre-pandemic levels, and I say we, referring to our operators and leaders in the field, have been very successful at staying ahead of the curve when it comes to, finding talent and recovering enough to be able to do what they've been doing, which is to continue to see occupancy rise without any compromise in how they staff, they've been able to fill positions in order to do so, and I, we have a high level of confidence that they'll continue to be able to, remain on that path without having to compromise in some way by adding agency staffing.

我們的薪資通膨速度已放緩至疫情前的水平，我說我們，指的是我們的運營商和該領域的領導者，在尋找人才和恢復到足以做他們一直在做的事情方面非常成功地保持領先地位，即繼續看到入住率上升，而無需在人員配備方面做出任何妥協，他們已經能夠填補這一職位，而且我，我們相信他們將繼續通過保持某種代理人員。

And we feel confident in that it's just in seeing what the trends have been over the last many months, which is to say that agency staffing continues to decrease while our overall occupancy continues to increase. So, you're right to point out that the demand is there. I wouldn't say we're limiting admissions because of staffing, because our leaders have found ways to fill positions and keep the flywheel moving.

我們有信心，這只是看到了過去幾個月的趨勢，也就是說，代理人員配備持續減少，而我們的整體入住率持續增加。所以，您指出需求是存在的，這是正確的。我不會說我們因為人員配備而限制招生，因為我們的領導者已經找到了填補職位並保持飛輪運轉的方法。

If I may just, on the second part of my question, I know that some senior living operators, they call 85% I see kind of imagine number, where they will see, increasing offering leverage. I mean, are you seeing, is there a magic number in skilled nursing, in your experience.

如果我可以就我問題的第二部分做出回答，我知道一些老年生活運營商，他們稱之為 85%，我看到了某種可想像的數字，他們會看到提供槓桿的增加。我的意思是，根據您的經驗，您是否看到，熟練護理中是否存在一個神奇的數字。

No, we don't see some magic number. In fact, I think we see the organic, upside as something that has always been an opportunity that we've Been deliberate in explaining to folks that even if we had to stop growing through acquisitions because of pricing or leadership concerns, we see facilities with all of that upside to take advantage of that could keep our growth, moving for several years even. So no, we don't see a cap. We don't see a sweet spot. We see facilities that continuously move. If you were to take our same store operations and examine them closely, you would see a pathway or a movement kind of to higher and higher occupancy over many years. And so, that's why we have that confidence because we see how that's played out over the course of our history.

不，我們沒有看到一些神奇的數字。事實上，我認為我們認為有機成長、上行潛力一直是一個機會，我們一直在向人們解釋，即使我們因為定價或領導力問題而不得不停止透過收購實現成長，我們也看到擁有所有上行潛力的設施可以利用，這可以讓我們保持成長，甚至持續數年。所以，我們沒有看到上限。我們沒有看到最佳點。我們看到設施不斷移動。如果您仔細觀察我們相同的門市營運情況並進行檢查，您會發現多年來門市入住率一直呈不斷上升的趨勢。這就是我們有信心的原因，因為我們看到了它在我們的歷史進程中是如何發揮作用的。

Yes, and on the leveraging question, I think we have and see kind of like that stability, and I think during COVID we were playing catch up first was trying to add your agency. Second was then trying to right size where the wages were at on an individual basis, and I think you saw that through last year and all of our commentary through last year was we're still having to have and we're running after wages. This year what we're saying is that we see stability now.

是的，關於槓桿問題，我認為我們已經看到了類似的穩定性，而且我認為在 COVID 期間，我們首先在追趕，試圖增加您的代理商。第二，試著根據個人情況確定合適的工資規模，我想你們在去年就看到了這一點，我們去年的所有評論都是，我們仍然需要工資，而且我們仍在追求工資。今年我們要說的是，我們現在看到了穩定。

And so I think stability after stability becomes the ability to leverage after on the on the leveraging points. And so, I would say right now we're in stability phase, and then I think there's an ability for us to continue to leverage, especially if there's recession, right. One of the things that happens for us is when there's recession, we do definitely see more opportunity on the on the nursing front and other things where people come back into the workforce, which creates even more leveragability and that cross the line.

因此，我認為，穩定之後，就會形成一個又一個的槓桿能力。所以，我想說，現在我們正處於穩定階段，然後我認為我們有能力繼續利用槓桿，特別是在出現經濟衰退的情況下，對吧。對我們來說，發生的事情之一是，當出現經濟衰退時，我們確實在護理方面和其他方面看到了更多的機會，人們重返勞動力市場，這創造了更多的槓桿作用，並且跨越了界限。

That's super helpful. Thank you.

這非常有幫助。謝謝。

A.J. Rice, UBS.

A.J.賴斯，瑞銀。

Thanks. Hi everybody. Maybe just first to ask about, a little further, on your deal activity seemed like your enthusiasm level for what you're seeing in the pipeline, and all is even a little increased I wonder two aspects to that, is the competitive landscape from your perspective, who you're seeing when you're looking at properties is it somehow easing. Are you seeing a little less competition for deals right now and then you mentioned moving into some new markets, particularly, I know that the Southeast. I know the payment rates are generally for Medicaid lower down there, but the, labor rates are also lower. Can you get the same economics and some of those newer markets that you've gotten historically and some of your more established markets.

謝謝。大家好。也許首先我想問一下，進一步說，在您的交易活動中，您對所看到的交易的熱情程度似乎有所提高，我想知道其中的兩個方面，從您的角度來看，競爭格局，當您查看房產時，您看到的競爭是否有所緩和。您是否發現目前的交易競爭減少？然後您提到要進入一些新市場，特別是我知道的東南部市場。我知道那裡的醫療補助支付率通常較低，但勞動力率也較低。您能否獲得與您過去所獲得的一些較新的市場和一些較成熟的市場相同的經濟效益？

Yes, great question. So, in terms of the competition for deals, I would tell you that we haven't really seen that change. It's kind of the same usual suspects that we keep bumping into and most of that, I would say is probably, private equity and other sort of family-based funds and groups like that are that are frequently looking to buy in our space.

是的，很好的問題。因此，就交易競爭而言，我想告訴你，我們還沒有真正看到這種變化。這有點像我們經常碰到的慣常對象，我想說，其中大多數可能是私募股權和其他類型的家族基金和類似的團體，他們經常尋求在我們的領域進行收購。

So, this last deal that involved 8 buildings in the Northwest as an example, that was a process that the Providence Health system was very selective in choosing who the buyer would be. And of course, the economics were part of it, but they did several interviews and came to tour our buildings and met with our leadership team and they selected us as the buyer because of our operational history and reputation and our track record on closing successfully, especially deals from nonprofit faith-based sellers. So, that's an example of one that, we tend to win the deals that that that we want and that we think are fair.

因此，以這筆涉及西北地區 8 棟建築的最新交易為例，普羅維登斯醫療系統在選擇買家時非常謹慎。當然，經濟因素也是其中的一部分，但他們進行了幾次面試，參觀了我們的建築，並與我們的領導團隊會面，最後他們選擇我們作為買家，因為我們的營運歷史和聲譽以及我們成功成交的記錄，尤其是來自非營利性信仰賣家的交易。所以，這是一個例子，我們傾向於贏得我們想要的和我們認為公平的交易。

So, yes, competition is really kind of the same, I would say in terms of kind of the southwest or the Southeast we're really excited about the market there and certainly labor dynamics play into that and that's where, as Barry was talking about, earlier, having a local operators on, boots on the ground in those markets, having their input and their heavy involvement in underwriting all these acquisitions is really the key to how we evaluate these.

所以，是的，競爭實際上是一樣的，我想說，就西南或東南地區而言，我們對那裡的市場感到非常興奮，當然勞動力動態也發揮了作用，這就是巴里之前所說的，擁有當地運營商，在那些市場有實地業務，他們的投入和深度參與承銷所有這些收購，才是我們如何評估這些收購的關鍵。

Those dynamics of the labor environment and, the rate environment and really all of it which is so unique by market we don't have to be the experts on that necessarily here because they are they're the experts in their particular market and so, with those folks out in in, that have kind of gone to the southeast to help plant a flag there, leading the way, I fully expect that we can accomplish there what we have in some of our most mature states.

勞動力環境的動態、利率環境以及所有這一切都是因市場而異的，我們不必成為這方面的專家，因為他們就是特定市場的專家，因此，有了那些前往東南部幫助在那裡樹立旗幟、引領潮流的人，我完全相信我們可以在那裡取得在我們一些最成熟的州所取得的成就。

Okay, and maybe just one follow up.

好的，也許只需要跟進一次。

I appreciate your comments earlier about all the noise out of Washington and how to think about that. I wondered in your discussions with states right now and what you're hearing with regard to rate updates and so forth on the Medicaid side, is any of that discussion or overhanging of what's going on in Washington seeping into those discussions.

我很欣賞您之前對華盛頓的所有喧囂以及如何看待這些喧囂的評論。我想知道，在您現在與各州的討論中，以及您所聽到的有關醫療補助費率更新等信息中，華盛頓正在發生的事情是否滲透到這些討論中。

Do you have a thought on what you anticipated composite Medicaid rate update across your portfolio might look like I know there's a lot of mid-year updates and, how are they thinking about contingency planning for the discussion around all these variables, provider taxes, etc. that are under review in Washington.

您是否想過，您預計您的投資組合的綜合醫療補助費率更新會是什麼樣子？我知道有很多年中更新，他們如何考慮針對所有這些變數、提供者稅等的討論制定應急計劃？這些正在華盛頓審查中。

Well, it's a great question, and there's an assumption there that the states act proactively when it comes to discussions around Medicaid funding, and I think for the most part we have not heard any proactive discussions nor had an invitation to be involved in any and I think most of that is justified.

嗯，這是一個很好的問題，人們認為各州在討論醫療補助資金時會積極主動，但我認為，在大多數情況下，我們沒有聽到任何積極的討論，也沒有收到參與任何討論的邀請，我認為大多數情況都是合理的。

This environment around, Medicaid discussions in Washington, it changes literally daily, and where their focus and attention is changes almost daily and because of that, I think people are pretty slow to want to overly anticipate or overly react to one narrative or another that may or may not be included in the reconciliation process. So, to answer your question, generally, no, there really hasn't been any meaningful discussion with the states and nor do I feel like many of them are doing a whole heck of a lot to make adjustments until they have more clarity on what could be the potential changes for them.

華盛頓有關醫療補助討論的環境幾乎每天都在變化，他們的焦點和注意力也幾乎每天都在變化，正因為如此，我認為人們不太願意過度預期或過度反應可能包含在或不包含在和解過程中的一個或另一個敘述。因此，回答你的問題，一般來說，沒有，確實沒有與各州進行過任何有意義的討論，而且我也不覺得他們中的許多人正在做大量調整，直到他們更清楚地了解可能對他們產生的潛在變化。

As for rate visibility, luckily most of our rate cycles are kind of determined ahead of the year and so throughout this year we, we've got really good visibility into where things are headed regardless of what happens.

至於利率可見性，幸運的是，我們的大多數利率週期都是在年初確定的，因此，今年全年，無論發生什麼，我們都能很好地了解事態的發展方向。

So, like when you starting to talk about states, we're always actively involved in talking to them about what's happening in the next rate setting year continuously educating them on what's going on at our local facilities and kind of the pressures that we have or don't have in particular. And so, I think that's a continuous process that we're actively involved in at the state level, the state rates that come kind of and like early Q3 and like Q3, but so like those discussions are going overall very well it's just helping us understand the environment.

因此，就像您開始談論各州時一樣，我們總是積極地與他們討論下一個利率制定年度將發生的情況，並不斷向他們介紹我們當地設施的情況以及我們面臨的或沒有面臨的壓力。所以，我認為這是一個持續的過程，我們在州一級積極參與其中，州利率就像第三季度初和第三季度那樣，但這些討論總體上進展順利，它只是幫助我們了解環境。

Okay, thanks a lot.

好的，非常感謝。

Ladies and gentlemen, that concludes today's call.

女士們、先生們，今天的電話會議到此結束。

Thank you for joining. You may now disconnect.

感謝您的加入。您現在可以斷開連線。