Ensign Group Inc (ENSG) 2025 Q2 法說會逐字稿

Thank you for standing by. My name is Kate, and I will be your conference operator today. At this time, I would like to welcome everyone to the Ensign Group quarter two earnings call. (Operator Instructions)

感謝您的支持。我叫凱特，今天我將擔任您的會議主持人。現在，我歡迎大家參加 Ensign Group 第二季財報電話會議。（操作員指示）

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

現在我想將電話轉給首席投資長 Chad Keetch。請繼續。

Thank you, operator, and welcome, everyone. We filed our earnings press release yesterday, and it is available on the Investor Relations section of our website at ensigngroup.net. A replay of this call will also be available on our website until 5 PM Pacific on Friday, August 29, 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 ensigngroup.net 的「投資者關係」版塊查閱。本次電話會議的重播也將在我們的網站提供，直至2025年8月29日（星期五）太平洋時間下午5點。

We want to remind anyone that may be listening to a replay of this call that all statements made are as of today, July 25, 2025, and these statements have not been or 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. 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.

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（2025 年 7 月 25 日），並且這些聲明在今天的電話會議之後尚未更新，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。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。

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. 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.

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。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. Ensign also owns Standard Bearer Healthcare REIT, 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. The words Ensign, company, we, our, and us refer to the Ensign Group, Inc., and its consolidated subsidiaries.

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 還擁有 Standard Bearer Healthcare REIT, Inc.，這是一家專屬房地產投資信託公司，投資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。Ensign、公司、我們、我們的和我們指的是 Ensign Group, Inc. 及其合併子公司。

All of our independent subsidiaries, the Service Center, Standard Healthcare REIT, and the insurance captive are operated by separate independent companies that have their own management, employees, and assets. 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.

我們所有的獨立子公司、服務中心、標準醫療保健房地產投資信託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層、員工和資產。本文中對合併公司及其資產和活動的引用以及「我們」、「我們的」和類似術語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。

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

我們也使用非 GAAP 指標來補充我們的 GAAP 報告。與我們的 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 10-Q 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)。巴里？

Thanks, Chad, and thank you all for joining us today. Our local teams have achieved another outstanding quarter, raising the bar again for what is possible even in a quarter where we historically have experienced more seasonality. The clinical results they achieved continue to be an important driver of our success. As our teams work tirelessly to gain the trust of the communities they serve and deliver consistent outcomes, our operations continue to earn the reputation as the facility of choice for thousands of patients.

謝謝，查德，也謝謝大家今天加入我們。我們的本地團隊又取得了一個出色的季度業績，即使在我們歷史上經歷更多季節性變化的季度中，也再次提高了可能實現的目標。他們所取得的臨床成果持續成為我們成功的重要推手。由於我們的團隊不懈努力地贏得他們所服務社區的信任並提供一致的成果，我們的營運繼續贏得作為成千上萬患者的首選設施的聲譽。

This trust is apparent to strong upward trends in occupancy and skilled mix during the quarter, which we believe is only achievable through dependable clinical results delivered by dedicated local leaders, caregivers and outstanding team members. As we dissect the numbers, we set second quarter records for same-store and transitioning occupancy, which increased by 2% and 4.6% to 82.1% and 84%, respectively, over the prior year quarter. We also saw skilled census increase for both our same-store and transitioning operations by 7.4% and 13.5% respectively over the prior-year quarter. All these improvements are the result of many factors, but could never have happened without the relentless efforts by these local teams that we mentioned earlier, who implement standard-setting practices that lead to better outcomes.

這種信任明顯體現在本季度入住率和技術組合的強勁上升趨勢中，我們相信，這只有透過敬業的當地領導、護理人員和優秀的團隊成員提供可靠的臨床結果才能實現。透過分析這些數字，我們發現第二季同店入住率和過渡入住率均創下新高，分別比去年同期成長了 2% 和 4.6%，達到 82.1% 和 84%。我們還發現，與去年同期相比，同店和轉型業務的熟練工人數量分別增加了 7.4％ 和 13.5％。所有這些改進都是多種因素共同作用的結果，但如果沒有我們之前提到的這些當地團隊的不懈努力，這些改進就不可能發生，他們實施了標準制定實踐，從而取得了更好的結果。

We also continue to attract and develop carrying and passionate partners into post-acute care who are determined to join us as we pursue our mission to signify postacute care. In addition, we continue to see improvements in turnover as well as lower staffing agency labor, even in the face of increased occupancy. As we've said before, our people are at the heart of our efforts and seeing these metrics consistently improve is critical to maintaining our path of success and to achieve industry-leading results. On the regulatory front, we were pleased that the skilled nursing population was carved out of provider tax reduction in the recently passed reconciliation bill, which was a big win for our industry.

我們也將繼續吸引和培養對急性後期護理領域充滿熱情和愛心的合作夥伴，他們決心加入我們，共同追求代表急性後期護理的使命。此外，即使入住率有所提高，我們仍看到人員流動率有所改善，且人事仲介的勞動力數量有所減少。正如我們之前所說，員工是我們努力的核心，看到這些指標不斷提高對於維持我們的成功之路和取得業界領先的成果至關重要。在監管方面，我們很高興看到最近通過的和解法案將熟練護理人員排除在服務提供者減稅範圍之外，這對我們行業來說是一個巨大的勝利。

We feel optimistic that state and federal governments will continue to recognize the importance of properly funding the health care needs of the senior population. Now more than ever, it is essential that we elevate the voices of our patients and frontline team members. Their stories reflect the heart of what we do and we remain unwavering in our commitment to advocate for the resources and support needed to ensure they receive what they deserve. After such a strong first half of the year, we are raising our annual 2025 earnings guidance to between $6.34 and $6.46 per diluted share from the previously raised guidance of $6.22 an to $6.38 per diluted share.

我們樂觀地認為，州和聯邦政府將繼續認識到為老年人口的醫療保健需求提供適當資金的重要性。現在，我們比以往任何時候都更需要提高患者和第一線團隊成員的聲音。他們的故事反映了我們所做工作的核心，我們始終堅定不移地致力於爭取所需的資源和支持，確保他們得到應得的待遇。在經歷瞭如此強勁的上半年業績後，我們將 2025 年年度盈利預期從之前的每股 6.22 美元至 6.38 美元上調至每股 6.34 美元至 6.46 美元之間。

The new midpoint of this increased 2025 earnings guidance represents an increase of 16.4% over our 2024 results and is 34% higher than our 2023 results. We are also increasing our annual revenue guidance to $4.99 billion to $5.02 billion, up from $4.89 billion to $4.94 billion to account for our current quarter performance and acquisitions we anticipate closing through the third quarter. This increased guidance is due to the continued execution of our growth model with organic growth stemming from stronger occupancy and skilled mix, which is more than expected for the second quarter. Other than during the pandemic, we typically experienced a slowdown in both occupancy and skilled mix during the second quarter.

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 16.4%，比我們 2023 年的業績高出了 34%。我們還將年度收入預期從 48.9 億美元至 49.4 億美元上調至 49.9 億美元至 50.2 億美元，以反映我們本季的業績以及我們預計將在第三季完成的收購。這一成長預期得益於我們持續執行的成長模式，即有機成長源於更高的入住率和熟練的技術組合，而這一增長超出了第二季度的預期。除疫情期間外，第二季我們的入住率和技術組合通常會出現放緩。

However, due to the continued momentum and quality outcomes and the benefit from positive demographic trends, we were able to maintain stronger-than-expected performance in both occupancy and skilled mix without the use of increased agency or over time, which is also helping control our cost of services. In addition, many of our new acquisitions are performing well ahead of schedule, which highlights the continued improvement in our locally driven transition strategy, but also points towards solid underwriting and investment decisions. We're also excited about our performance so far this 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.

然而，由於持續的勢頭和品質成果以及積極的人口趨勢帶來的好處，我們能夠在不增加代理機構或加班的情況下，在入住率和技能組合方面保持強於預期的表現，這也有助於控制我們的服務成本。此外，我們的許多新收購項目都表現得比計劃提前，這凸顯了我們本地驅動的轉型策略的持續改善，同時也表明我們做出了穩健的核保和投資決策。我們對今年迄今的表現感到非常興奮，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。

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.

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

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

接下來，我想請查德對我們最近的發展提供一些額外的見解。查德?

Thank you, Barry. We continued our steady pace of growth by adding 8 new operations, including 3 real estate assets during the quarter and since. These include 4 in California, 3 in Idaho, and 1 in Washington. In total, we added 710 new skilled nursing beds and 68 senior living units across these 3 states.

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 8 個新業務，包括 3 個房地產資產。其中包括加州 4 例、愛達荷州 3 例和華盛頓州 1 例。總體而言，我們在這三個州增加了 710 張新的專業護理床位和 68 個老年生活單元。

This growth brings a number of operations acquired during 2024 and since to 52. We are always happy to expand our presence in some of our most mature markets, and each of these new acquisitions represents an opportunity to further deepen our commitment to the healthcare communities in some of our key states. Our growth this quarter illustrates that we continue to prioritize adding beds in our established geographies, which allows our customers to provide a comprehensive solution to the healthcare needs in those markets. We also point out that the distribution of our growth over the last several quarters spans across many states and markets, leaving us with significant bandwidth to grow in almost all of our markets.

這一成長使得 2024 年及以後收購的業務數量達到 52 項。我們始終樂於擴大我們在一些最成熟市場的影響力，每一次新的收購都代表著進一步深化我們對一些主要州的醫療保健社區的承諾的機會。本季的成長表明，我們繼續優先在現有地區增加床位，這使我們的客戶能夠為這些市場的醫療保健需求提供全面的解決方案。我們也指出，過去幾季我們的成長分佈在許多州和市場，這讓我們在幾乎所有市場都擁有巨大的成長空間。

While we look to grow in some of our new states, we still see significant opportunity to continue to add meaningful density in the markets we know best. 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 their opportunity to lead. During the quarter, we reached an all-time high for our AITs in our pipeline. This high-quality influx of local leadership talent combined with our decentralized transition model allows us to grow without being limited by typical corporate bottlenecks.

雖然我們希望在一些新州實現成長，但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巨大機會。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，他們正熱切地為自己的領導機會做準備。在本季度，我們的 AIT 管道達到了歷史最高水準。大量高品質的本地領導人才的湧入，加上我們分散的過渡模式，使得我們能夠不受典型企業瓶頸的限製而實現發展。

Therefore, our unique acquisition and transition strategy puts us in an excellent position to continue growing in a healthy and sustainable way. As we look at the current pipeline, we see opportunities that include everything from small to midsized owner-operated portfolios, landlords looking to replace current tenants, nonprofits looking to divest of their post-acute assets and a steady flow of our traditional onesie-twosies. We anticipate the current rate of acquisitions to continue this year and are expecting several to close our transition over the next few weeks and months. Given the growth on the near term -- near and long-term horizon, we wanted to provide an update on some of the larger portfolios we've acquired recently.

因此，我們獨特的收購和轉型策略使我們處於有利地位，能夠繼續以健康和可持續的方式成長。當我們審視當前的管道時，我們看到了各種各樣的機會，包括小型到中型業主自營投資組合、希望取代現有租戶的房東、希望剝離其後急性期資產的非營利組織以及我們傳統的連身衣和二件套的穩定流動。我們預計今年的收購速度將持續下去，並預計未來幾週和幾個月內將有幾家公司完成交接。考慮到近期和長期的成長，我們希望提供一些我們最近收購的較大投資組合的最新情況。

In the past, Ensign has sometimes been painted with a brush that would suggest that larger deals are not consistent with our model. While most of our growth has been and will continue to be driven by the aggregation of lots of small deals, our approach to transitioning each operation as the complex health businesses they are, also works on a larger scale. This is particularly true when a larger deal spans several markets and geographies. For example, in 2023, we transitioned the portfolio of 17 operations in California under a master lease with Sabra.

過去，Ensign 有時會被貼上這樣的標籤，即大型交易與我們的模式不符。雖然我們的大部分成長已經並將繼續受到大量小額交易的推動，但我們將每項業務轉變為複雜的健康業務的方法也適用於更大規模。當一筆較大的交易跨越多個市場和地區時，情況尤其如此。例如，2023 年，我們根據與 Sabra 簽訂的主租約，轉移了加州 17 家業務的投資組合。

To be clear, transitioning a large number of operations on the same day especially if attempted in one big bite like would happen in the traditional centralized company is definitely a huge undertaking. However, by applying lessons we had learned in years past, particularly from a large deal we did in Texas, our local leaders in California approached this deal as if it were six or seven small deals. As our local market leaders in California prepared to transition these operations, it collectively took responsibility for two or three buildings holding the new operation into an existing cluster of Ensign operated facilities. In doing so, each of the 17 operations received the same amount of time, attention, and resources that a single acquisition would have received.

需要明確的是，在同一天轉換大量操作，特別是如果像傳統的集中式公司那樣嘗試一次性完成，絕對是一項艱鉅的任務。然而，透過運用過去幾年的經驗教訓，特別是我們在德州達成的一筆大交易的經驗教訓，我們加州的當地領導人將這筆交易視為六、七筆小交易。當我們在加州的當地市場領導者準備轉變這些業務時，它共同負責將兩到三棟建築納入現有的 Ensign 營運設施群中的新業務。這樣一來，17 項行動中的每一項都會獲得與單一收購相同的時間、關注和資源。

This allowed the new operations and their teams to immediately have the benefits of their cluster partners for nearly all aspects of the transition, including training on new clinical systems and enzyme compliance standards, support and learning Ensign's unique cultural expectations and accessing the expertise of their new service center partners. Rather than viewing the transaction as a merger of one company into a larger company, our teams approached it the same way as when we acquire a single asset from a small business owner or family. As we look to that portfolio now, which comprises the majority of our transitioning budget, it's clear to see the positive clinical and financial contribution that this larger portfolio is making to the organization. Of the 17 operations, 12 have achieved four- or five-star rating from CMS, occupancy is over 92%, skilled mix days are 47% and all are making substantial contribution to our overall EBIT.

這使得新的營運部門及其團隊能夠立即享受到群聚合作夥伴在過渡期間幾乎所有方面帶來的好處，包括新臨床系統和酶合規標準的培訓、支持和學習 Ensign 獨特的文化期望以及獲取新服務中心合作夥伴的專業知識。我們的團隊並不將這筆交易視為一家公司與另一家大公司的合併，而是將其視為從小企業主或家庭收購單一資產時所採用的方式。現在，當我們審視這個佔據了我們過渡預算大部分的投資組合時，我們可以清楚地看到，這個更大的投資組合為組織做出了積極的臨床和財務貢獻。在 17 家營運公司中，有 12 家獲得了 CMS 的四星或五星評級，入住率超過 92%，熟練混合天數為 47%，並且都為我們的整體息稅前利潤做出了巨大貢獻。

More recently, we completed a few larger portfolios, some of which span multiple states. While each deal is unique, we are pleased with the progress we've achieved so far in these newly acquired operations. In the near future, we expect to announce the addition of a similar portfolio, and we expect that over the long term, we will continue to be presented with large and midsized portfolios. While we are continuously perfecting and improving the performance of our acquisitions in the portfolio setting, we are confident that our locally-led approach is scalable in both new and existing geographies.

最近，我們完成了一些較大的投資組合，其中一些跨越多個州。雖然每筆交易都是獨一無二的，但我們對這些新收購的業務迄今為止的進展感到滿意。在不久的將來，我們預計將宣布增加類似的投資組合，我們預計從長遠來看，我們將繼續推出大型和中型投資組合。在我們不斷完善和提高投資組合中收購業績的同時，我們相信，我們的本地主導方法在新地區和現有地區都是可擴展的。

All that said, we must and will remain committed to staying disciplined and true to the principles that have contributed to our consistent success, including ensuring that we pay prices that will allow the operations to have enough of the necessary resources to invest in the building and the clinical systems in order to achieve the highest possible clinical outcomes.

儘管如此，我們必須並將繼續致力於保持紀律並堅持那些有助於我們持續成功的原則，包括確保我們支付的價格能夠使營運擁有足夠的必要資源來投資於建築和臨床系統，從而實現最高的臨床結果。

Lastly, we are also pleased with the continued growth of Standard Bearer, which added five new assets during the quarter and since and now is comprised of 140 owned properties. Of these assets, 106 are leased to an Ensign affiliated operator and 35 are leased to third-party operators. We were excited to add to our growing list of relationships with unaffiliated operators, which further diversifies our tenant base and helps our organization as a whole as we continue to advance our mission by working closely with like-minded operators that want to make a difference in this industry.

最後，我們也對 Standard Bearer 的持續成長感到高興，該公司在本季增加了 5 項新資產，目前擁有 140 處自有房產。其中，106 項資產租賃給 Ensign 附屬業者，35 項資產租賃給第三方業者。我們很高興能夠與非關聯運營商建立更多的合作關係，這進一步豐富了我們的租戶基礎，並有助於我們整個組織，因為我們將繼續透過與志同道合、希望在這個行業有所作為的運營商密切合作來推進我們的使命。

Going forward, Standard Bearer will continue to work together with our existing partners and new relationships we are developing in order to acquire portfolios comprised of operations that Ensign would operate and facilities that third parties are interested in operating under lease. Collectively, Standard Bearer generated rental revenue of $31.5 million for the quarter of which $26.8 million was derived from Ensign affiliated operations. For the quarter, Standard Bearer reported $18.4 million in FFO and as of the end of the quarter, had an EBITDAR to rent coverage ratio of 2.5 times.

展望未來，Standard Bearer 將繼續與我們現有的合作夥伴和正在發展的新關係合作，以收購由 Ensign 經營的業務和第三方有興趣租賃營運的設施組成的投資組合。總體而言，Standard Bearer 本季的租賃收入為 3,150 萬美元，其中 2,680 萬美元來自 Ensign 附屬業務。本季度，Standard Bearer 報告其 FFO 為 1,840 萬美元，截至本季末，EBITDAR 與租金覆蓋率為 2.5 倍。

With that, I'll turn the call to Spencer, our COO, to add more color around operations. Spencer?

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

Thanks, Chad, and hello, everyone. As always, we'd like to share a few examples of how operations in various stages of their maturity are contributing to our outstanding results. It's the aggregation of achievements like these that comprise Ensign's story, and we believe that these examples are the best way to explain how we produce consistent results over time. The first operation I'll highlight exemplifies what we hope to see in operations as they transfer from our transitioning bucket into our same-store bucket.

謝謝，查德，大家好。像往常一樣，我們想分享一些例子，說明處於不同成熟階段的營運如何為我們取得優異的業績做出貢獻。正是這些成就的集合構成了 Ensign 的故事，我們相信這些例子最能解釋我們如何隨著時間的推移取得一致的成果。我要重點介紹的第一個操作體現了我們希望在操作從過渡桶轉移到同店桶時看到的內容。

Sedona Trace Health and Wellness is a 119-bed skilled nursing facility located in Austin, Texas. It is led by Rachel Hurley, CEO; and Tiana Roland, RM and COO. Sedona was acquired as part of a multi-facility deal back in Q3 of 2021. Despite being constructed in 2017 and having a beautiful physical plant, the operation was consistently losing money and struggled with a poor clinical reputation.

Sedona Trace Health and Wellness 是一家位於德克薩斯州奧斯汀的 119 張床位的專業護理機構。該公司由執行長 Rachel Hurley 和客戶經理兼營運長 Tiana Roland 領導。Sedona 是 2021 年第三季作為多設施交易的一部分被收購的。儘管該醫院於 2017 年建成並擁有漂亮的實體廠房，但一直在虧損，臨床聲譽不佳。

Compounding matters, the facility was in a staffing crisis with a large percentage of nursing labor coming from registry. Despite the challenges, the local team went to work. They focused on building a culture of high expectations and celebration, which started with hiring the right interdisciplinary leaders, who in turn focused on getting and training high-caliber frontline staff. As a result, the team was able to completely eliminate registry labor, and they have stayed fully staffed since 2023. As we consistently see with most transition in operations, this formula methodically improved clinical results.

更糟的是，該機構正面臨人員短缺危機，因為很大一部分護理人員來自登記處。儘管面臨挑戰，當地團隊仍繼續工作。他們致力於建立一種高期望和慶祝的文化，首先是聘請合適的跨學科領導者，而這些領導者則專注於獲得和培訓高素質的第一線員工。因此，該團隊能夠完全消除註冊勞動力，並且自 2023 年以來一直保持滿員狀態。正如我們在大多數手術轉變中不斷看到的那樣，該配方系統地改善了臨床結果。

CMS overall star ratings have jumped from two star to four star and the facility currently has a five-star rating for quality measures. Sedona is now an attractive continuing partner for hospitals, and it has earned preferred provider status with Austin's major hospital system as well as managed care networks. The result has been steady growth in overall occupancy, which is up 6.8% and skilled managed and Medicare days, which have increased 34.3% over prior year quarter. For the same period, revenues grew by 21%, while cost of services have remained stable.

CMS 整體星級評定已從兩星躍升至四星，目前該設施的品質指標評級為五星。塞多納目前是醫院頗具吸引力的持續合作夥伴，並已贏得奧斯汀主要醫院系統以及管理式醫療網絡的優先供應商地位。結果是整體入住率穩定成長，上漲了 6.8%，而專業管理和醫療保險天數較去年同期增加了 34.3%。同期，營收成長了21%，而服務成本維持穩定。

As a result, EBIT increased by an impressive 130% in Q2 over the prior-year quarter. We're proud of the transformation that has occurred at Sedona Trace. But as their team would be quick to point out, there is still so much more work to be done. It will be exciting to see the growth continue for years to come as the facility continues to contribute as part of our same-store operations bucket.

因此，第二季的息稅前利潤較去年同期大幅成長了 130%。我們為塞多納小徑發生的轉變感到自豪。但正如他們的團隊很快指出的那樣，還有很多工作要做。隨著該工廠繼續為我們的同店營運業務做出貢獻，我們將很高興看到其在未來幾年繼續保持成長勢頭。

For the second facility example, I'd like to highlight an exciting niche where we have been able to apply our post-acute expertise to help a local acute hospital elevate the performance of their skilled nursing operation. On a larger scale, we see a trend of hospitals choosing to focus on their core acute services, and we expect to have more and more opportunities to grow in this unique and important part of the continuum. Valley of the Moon post-acute is a 27-bed hospital-based skilled nursing facility located in Sonoma, California. It became an Ensign affiliate in 2019 when our Northern California company contracted with Sonoma Valley Hospital to take management and financial risk for the skilled nursing facility that they operated as part of their acute campus.

對於第二個設施範例，我想強調一個令人興奮的領域，我們能夠運用我們的急性後專業知識來幫助當地一家急性醫院提高其熟練護理操作的績效。從更大的範圍來看，我們看到醫院選擇專注於其核心急性服務的趨勢，我們期望在這個獨特而重要的連續體部分有越來越多的發展機會。月亮谷急性後期護理中心是位於加州索諾瑪的一所擁有 27 張床位的醫院式專業護理機構。2019 年，我們位於北加州的公司與索諾瑪谷醫院簽訂合同，承擔其作為急性校園一部分運營的專業護理機構的管理和財務風險，並成為 Ensign 的附屬機構。

Prior to this arrangement, this county-owned operation was underperforming clinically and was losing significant amounts of money. The hospital leadership was faced with either closing the facility or looking for help. The hospital was under significant pressure to find a solution as the community did not want to lose the SNF services in their hospital. After many months of interviews, and the public hearing, the hospital and county leadership selected our Northern California team to manage the SNF for them.

在此安排之前，這家縣立醫院的臨床表現不佳，並且虧損大量資金。醫院領導階層面臨關閉醫院或尋求協助的抉擇。由於社區不想失去醫院的 SNF 服務，醫院面臨著尋找解決方案的巨大壓力。經過數月的面試和公開聽證會，醫院和縣領導選擇了我們的北加州團隊來為他們管理 SNF。

Under this arrangement, our team maintains a close affiliation with the hospital management and board, including sharing certain services like nonclinical services such as laundry and housekeeping. The partnership has been an enormous success. Valley of the Moon’s CEO, Ryan Goldbarg; COO, Christina Ferrar; and their interdisciplinary team have established post-acute systems and elevated clinical outcomes while simultaneously bringing financial solvency to the operation. While running a small skilled nursing operation can be challenging, the Valley of the Moon team has embraced flexibility, teamwork, and an attitude of care without silos, and the results have been remarkable.

在這種安排下，我們的團隊與醫院管理層和董事會保持密切聯繫，包括共享某些服務，如洗衣和家事等非臨床服務。此次合作取得了巨大的成功。Valley of the Moon 的執行長 Ryan Goldbarg、營運長 Christina Ferrar 及其跨學科團隊建立了急性後期治療系統並提高了臨床療效，同時為該機構帶來了財務償付能力。雖然經營小型專業護理機構可能充滿挑戰，但月亮谷團隊秉持靈活性、團隊合作精神和不孤立的護理態度，取得了顯著成果。

Valley of the Moon uses zero Nursing registry, has consistently low turnover, and maintains one of the lowest overtime wage percentages in all of California. They also produce incredible healthcare outcomes, including one of the lowest return to acute rates in the state and a CMS five-star rating for quality measures. The partnership has been beneficial for everyone. The Sonoma community is benefiting from greater healthcare access.

月亮谷採用零護士登記制度，人員流動率一直很低，並且保持著全加州最低的加班工資百分比之一。他們還創造了令人難以置信的醫療保健成果，包括該州最低的急性回報率之一和 CMS 品質指標五星級評級。這種合作關係對每個人都有好處。索諾瑪社區正受益於更廣泛的醫療保健服務。

For example, an acquisition, the SNF was serving an average daily census of just 10 residents, whereas now census consistently runs over 95% or 25-plus patients. The hospital is benefiting from improved bed management and length of stay as they can now confidently discharge appropriate patients to step down level of care more easily. Payers benefit because more of their members can receive care in the most appropriate setting and cost-effective care setting. And residents, including some with challenging and complex medical cases, can receive skilled nursing level care without having to transfer off the hospital campus, while remaining under the care of the same physician providers.

例如，在一次收購中，SNF 平均每天僅為 10 名居民提供普查服務，而現在普查人數持續超過 95% 或超過 25 名患者。醫院受益於床位管理和住院時間的改善，因為他們現在可以自信地讓合適的患者出院，從而更輕鬆地降低護理等級。付款人受益是因為更多的成員可以在最合適的環境和最具成本效益的護理環境中接受護理。住院醫生，包括一些患有棘手和複雜疾病的住院醫生，可以接受熟練的護理水平護理，而不必轉出醫院，同時仍接受同一醫生的護理。

We are excited about the impact Valley of the Moon Post-Acute is having, and we look forward to continuing to find ways to help acute hospital partners throughout our footprint meet their communities full continuum of health care needs.

我們對月亮谷急性後期護理計畫產生的影響感到非常興奮，我們期待繼續尋找方法來幫助我們遍布各地的急性醫院合作夥伴滿足其社區的全方位醫療保健需求。

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，然後我們將開始回答問題。蘇珊娜？

Thank you, Spencer, and good morning, everyone. Detailed financial statements for the quarter are contained in our 10-Q and press release filed yesterday. Some additional highlights for the quarter include the following: GAAP diluted earnings per share was $1.44, an increase of 18%. Adjusted diluted earnings per share was $1.59, an increase of 20.5%.

謝謝你，史賓塞，大家早安。本季度的詳細財務報表包含在我們昨天提交的 10-Q 和新聞稿中。本季度的其他一些亮點包括：GAAP 稀釋每股收益為 1.44 美元，成長 18%。調整後每股攤薄收益為 1.59 美元，成長 20.5%。

Consolidated GAAP revenue and adjusted revenue were both $1.2 billion, an increase of 18.5%. GAAP net income was $84.4 million, an increase of 18.9%. And adjusted net income was $93.3 million, an increase of 22.1%. Other key metrics as of June 30, 2025, include cash and cash equivalents of $364 million and cash flow from operations of $228 million.

合併 GAAP 收入和調整後收入均為 12 億美元，成長 18.5%。GAAP淨收入為8,440萬美元，成長18.9%。調整後淨收入為 9,330 萬美元，成長 22.1%。截至 2025 年 6 月 30 日的其他關鍵指標包括 3.64 億美元的現金和現金等價物以及 2.28 億美元的營運現金流。

During the first half of 2025, we spent more than $210 million to execute on our strategic growth plan, most of which have been in the works for months. We made this investment from a position of strength as shown by our lease adjusted net debt-to-EBITDA ratio of 1.97 times, which is after taking these investments into consideration. Our continued ability to maintain low leverage even during 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. In addition, we have approximately $593 million of a build capacity on our line of credit, which, when combined with our cash on the balance sheet, gives us over $1 billion in dry powder for future investments.

2025 年上半年，我們花了超過 2.1 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。我們之所以進行這項投資，是因為我們的租賃調整後淨債務與 EBITDA 比率為 1.97 倍，這是考慮到這些投資之後的結果。尤其值得注意的是，即使在經濟大幅成長期間，我們仍能維持較低的槓桿率，這反映了我們對穩健成長的承諾，也顯示了我們能夠長期持續實現永續成長的信念。此外，我們的信用額度約為 5.93 億美元，加上我們資產負債表上的現金，我們可以為未來投資提供超過 10 億美元的資金。

We own 146 assets, of which 140 are held by Standard Bearer and 122 are owned completely debt-free and have gained significant value over turn, adding even more liquidity to help with future growth. Company paid a quarterly cash dividend of $0.0625 per share. We have a long history of paying dividends as an increased the annual dividend for 22 consecutive years. In addition, we currently have a stock repurchase program in place.

我們擁有 146 項資產，其中 140 項由 Standard Bearer 持有，122 項為完全無債務持有，並且在周轉過程中獲得了顯著價值，增加了更多流動性以幫助實現未來成長。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，連續22年增加年度股利。此外，我們目前已實施股票回購計畫。

As Barry mentioned, we are increasing our annual 2025 earnings guidance to between $6.34 to $6.46 per diluted share. And our annual revenue guidance between $4.99 billion and $5.02 billion. We have evaluated multiple scenarios, and based upon the strength in our performance and positive momentum, we have seen in our occupancy and skill mix as well as our continued progress on labor, agency management, and other operational initiatives, we have confidence that we can achieve these results. Our 2025 guidance is based on diluted weighted average common stock outstanding of approximately $59 million, a tax rate of 25%, the inclusion of acquisitions closed and expected to be closed during the third quarter of 2025, including a smaller portfolio that we expect to transition in the next few weeks, the inclusion of management's expectations on Medicare and Medicaid reimbursement rates net of provider tax, with the primary explosion coming from stock-based compensation.

正如巴里所提到的，我們將 2025 年年度獲利預期上調至每股攤薄收益 6.34 美元至 6.46 美元之間。我們的年度營收預期在 49.9 億美元至 50.2 億美元之間。我們評估了多種情況，並基於我們表現的強勁和積極的勢頭，我們看到我們的入住率和技能組合以及我們在勞動力、代理管理和其他運營舉措方面的持續進展，我們有信心能夠實現這些結果。我們對 2025 年的預期是基於約 5,900 萬美元的稀釋加權平均普通股流通股、25% 的稅率、已完成和預計將於 2025 年第三季度完成的收購（包括我們預計將在未來幾週內過渡的較小投資組合）、管理層對扣除供應商稅後的醫療保險和醫療保險薪酬率將來自於經濟保險率激增的較小投資組合）、融資主要的補助金報銷率將來自的經濟保險和醫療補助率將來自激增。

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

此外，其他可能影響我們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、入住率和技術組合的季節性、總體經濟對人口普查和人員配備的影響、我們的收購活動的短期影響、保險應計費用的變化以及其他因素。

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

說完這些，我會把話題交還給巴里。巴里？

Thanks, Suzanne. As we wrap up, we are as positive as ever about this industry that we collectively love and are committed to. It's hard not to be excited about. Our occupancy trends, our labor trends and our growth opportunities.

謝謝，蘇珊娜。總而言之，我們對這個我們共同熱愛並致力於的行業一如既往地充滿信心。很難不感到興奮。我們的入住趨勢、勞動力趨勢和成長機會。

But I can't emphasize enough how incredibly honored and grateful we all are to work alongside our operational leaders, field resources, clinical partners, and service center team. They are behind these record-setting results and it's their commitment that has blessed the lives of so many, including our own. And we're as excited about our future as ever because of them.

但我無法過度強調，我們所有人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工作是多麼的榮幸和感激。這些創紀錄的成果背後是他們，他們的奉獻精神為包括我們自己在內的許多人的生活帶來了祝福。因為他們，我們對我們的未來充滿期待。

And with that, we'll turn it now over to the Q&A portion of our call. Kate, will you please provide instructions for the Q&A.

接下來，我們將進入電話會議的問答部分。凱特，請您提供問答環節的說明。

(Operator Instructions) Tao Qiu, Macquarie Capital.

（操作員指示） 陶秋，麥格理資本。

Chad, I think you highlighted the success of the North American portfolio integration. Now we collect that deal with more of an opportunistic transaction. So based on the prepared comments, I get a sense that there is a strategy shift as you are more open to those larger multistate portfolio deals. I'm curious if you could highlight any changes you made in your system, personnel, operating model, lessons learned that give you more confidence in consistently executing those larger deals? And then what is the pipeline like for these larger transactions, and whether Ensign has more of a competitive advantage given your scale and balance sheet conditions?

查德，我認為你強調了北美投資組合整合的成功。現在我們收集的這筆交易更多的是一種機會主義交易。因此，根據準備好的評論，我感覺到您的策略發生了轉變，因為您對那些更大的跨州投資組合交易更加開放。我很好奇，您是否可以強調您在系統、人員、營運模式方面所做的任何改變，以及所獲得的經驗教訓，這些改變會讓您更有信心持續執行那些更大的交易？那麼這些較大交易的管道是什麼樣的呢？考慮到你們的規模和資產負債表條件，Ensign 是否有更大的競爭優勢？

So I wouldn't say there has necessarily been a strategy shift at all. I just -- I think it's more -- we're just trying to point out that we have done some of these more portfolio type deals including the one in Tennessee that we closed recently and then we did one in the Northwest with Providence Hospital systems recently.

所以我並不認為戰略必然會轉變。我只是——我認為更重要的是——我們只是想指出，我們已經完成了一些投資組合類型的交易，包括我們最近在田納西州完成的交易，以及最近我們與普羅維登斯醫院系統在西北地區完成的交易。

So yeah, I think we definitely see a pipeline for deals like that. And like I said in my prepared remarks, large, midsized, and smaller portfolios, they're all out there and I think the -- in terms of lessons learned and something that we've just experienced and that I highlighted again today was, for us, we look at a portfolio and we try to see geographically how it fits into our existing structure. And when we take a larger deal and split it up into a bunch of smaller pieces, and do that locally, right? So we're talking about taking -- like I said in that example, those 17 buildings were spread across six or seven of our markets. So it was really only two to three acquisitions per market or cluster.

是的，我認為我們肯定會看到這樣的交易。正如我在準備好的發言中所說的那樣，大型、中型和小型投資組合都存在，我認為——就經驗教訓和我們剛剛經歷的事情而言，我今天再次強調的是，對我們來說，我們看一個投資組合，我們試圖從地理上了解它如何適應我們現有的結構。當我們把一筆較大的交易拆分成許多小的交易，然後在本地進行，對嗎？所以我們正在談論接管——就像我在這個例子中所說的那樣，這 17 棟建築分佈在我們的六到七個市場中。因此，每個市場或集群實際上只有兩到三次收購。

That's a lot more digestible than trying to just kind of assume something and do more of like a merger style acquisition. So I think that's probably the -- and we've done both and certainly learned in that Texas example back in 2015 just trying to take a big organization and just fold it in all at once was not successful, and it took us a long time to kind of essentially transition that deal twice to get to win. Now it's obviously doing great. But that was probably the biggest lesson that we wanted to highlight today is that we have experience now.

這比僅僅假設某事並採取類似合併式收購的做法更容易理解。所以我認為這可能是——我們已經做過這兩件事，並且從 2015 年德克薩斯州的例子中我們了解到，僅僅試圖接管一個大組織並將其一次性全部納入是行不通的，我們花了很長時間才將這筆交易轉變兩次才獲得勝利。現在它顯然表現得很好。但這可能是我們今天想要強調的最大的教訓，那就是我們現在已經有了經驗。

We've done several of these portfolio deals, and they're going very well. And the key for us is to do it the way we've always done it. And each of these buildings are, as you know, highly complex businesses that demand a lot of time and attention starting on the transition date. And that's the part that we have to stay true to and disciplined about regardless of how big the deal is.

我們已經完成了幾筆這樣的投資組合交易，而且進展非常順利。對我們來說，關鍵是按照我們一貫的做法去做。如您所知，這些建築都是高度複雜的業務，從過渡日期開始就需要投入大量的時間和精力。無論交易有多大，我們都必須堅持並嚴守這項原則。

And to the extent we can do that, if it crosses several markets, several clusters, several states, then we feel like that is a scalable approach to growth and one that we can handle.

在我們能夠做到這一點的範圍內，如果它跨越多個市場、多個集群、多個州，那麼我們認為這是一種可擴展的成長方式，也是我們可以處理的。

Great. And to follow up on that topic, as you take on these larger deals, there may be assets that would fit a third-party operator better. I know that you added another third-party operator this quarter. Just curious how large do you think you can ramp up the exposure there, given what you consider qualified operator pool in your targeted markets? And also, if you could talk about the rent coverage you are underwriting these assets at, that will be much appreciated.

偉大的。接下來繼續討論這個問題，當你承接這些更大的交易時，可能會有一些資產更適合第三方營運商。我知道你們本季又增加了一家第三方營運商。我只是好奇，考慮到您認為目標市場中合格的營運商數量，您認為您能在那裡提高多大的曝光率？另外，如果您能談談您承保這些資產的租金覆蓋範圍，我們將不勝感激。

Yeah. Another great question. So yeah, the best example is this portfolio we closed in the Northwest. It was eight buildings. And we took six of them, and we leased two to a third party.

是的。又一個好問題。是的，最好的例子就是我們在西北地區完成的這個投資組合。共有八棟建築。我們租用了其中六間，並將兩間租給了第三方。

That's a perfect example of one where -- and that was a real estate-driven deal, of course. But that's a perfect example of the types of acquisitions that we feel like Standard Bearer helps us do and complete. And so, yeah, I think the key there is making sure that the price that we pay is correct and that we're not asking a third-party tenant to take on a lease payment that we ourselves wouldn't take on, right? So when you talk about coverages, we're always trying to target very healthy coverages.

這是一個完美的例子——當然，這是一筆由房地產驅動的交易。但這就是我們覺得 Standard Bearer 能夠幫助我們完成的收購類型的完美例子。所以，是的，我認為關鍵是確保我們支付的價格是正確的，並且我們不會要求第三方租戶承擔我們自己不會承擔的租賃費用，對嗎？因此，當您談論覆蓋範圍時，我們總是試圖瞄準非常健康的覆蓋範圍。

And so -- and obviously, it will vary by market, but I think we -- our goal is to be at a 1.5 or close to it. And maybe it's not 1.5 on the first month, but we could see a clear path to getting there in a short period of time. And the key, though, is finding sellers that are willing to do deals at the right prices so that you can have some coverage after the fact. And that's where, again, when we talk about our discipline, we're really hyperfocused on that.

所以 — — 顯然，它會因市場而異，但我認為我們 — — 我們的目標是達到 1.5 或接近它。也許第一個月不會達到 1.5，但我們可以看到在短時間內實現這一目標的明確途徑。但關鍵是找到願意以合適的價格進行交易的賣家，以便您在事後能夠獲得一些保障。這就是我們在談論我們的學科時真正高度關注的地方。

And in terms of relationships with third-party tenants, I mean, we're receiving more and more interest. Each time we kind of do one of these and announce it, we're getting more folks that are reaching out to kind of understand what it is that we're doing and how we're doing it and how we might work together. And so yes, as bigger portfolios come along, that certainly -- this pathway certainly gives us another way to do it and break it down into smaller bite-sized pieces.

就與第三方租戶的關係而言，我們正受到越來越多的關注。每次我們做其中一件事並宣布它時，都會有更多的人與我們聯繫，以了解我們在做什麼、我們如何做以及我們如何合作。是的，隨著更大的投資組合的出現，這條途徑無疑為我們提供了另一種方法，將其分解成更小的部分。

Ben Hendrix, RBC Capital Markets.

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

This is Michael Murray on for Ben. The skilled nursing industry appears to have dodged direct impacts of the one big beautiful bill, but there still seems to be some potential for potentially some indirect impacts related to smaller Medicaid budgets. So we'd love to hear your thoughts on the OBBB generally. And how are you sizing any indirect risks as a result of it?

我是邁克爾·默里，代替本。專業護理產業似乎已經避開了這項龐大法案的直接影響，但似乎仍有可能受到與醫療補助預算減少相關的一些間接影響。因此，我們很想聽聽您對 OBBB 的整體看法。您如何評估由此產生的間接風險？

I think it's important to point out that legislators were very over about making sure that they carved skilled nursing out of any large direct impacts to Medicaid and instead focus their efforts around reform with workforce requirements, eligibility requirements, and large directed payments and other types of payments that weren't necessarily in line with standard practice for the program that were giving large benefits where they ought not to be. And having to carve out on the provider tax piece, I think it was a clear indication from legislators that they wanted to protect funding for seniors.

我認為有必要指出的是，立法者並沒有確保熟練護理不會對醫療補助計劃產生任何重大的直接影響，而是將精力集中在改革勞動力要求、資格要求、大額定向支付和其他類型的支付上，這些支付不一定符合該計劃的標準做法，而這些支付卻在不應該給予巨額福利的地方給予了巨額福利。而且必須將提供者稅部分剔除，我認為這是立法者明確表示他們希望保護老年人的資金。

And I think is a good bellwether for states now is, yes, while they do will have in a few years maybe some more limited budget pull from, I think it sets a standard for how states should act. And -- the good news for us is that we have really good working relationships in every state that we operate in with our state legislators and governors offices. And now have time as there's, again, a couple of years before the -- some of these things start to get implemented. For us to work with them and make sure that we put ourselves in a position to remind them of how important funding for seniors is in the skilled nursing setting.

我認為現在對各州來說這是一個很好的風向標，是的，雖然幾年後各州的預算可能會更加有限，但我認為這為各州應該如何行動設定了一個標準。對我們來說好消息是，我們與開展業務的每個州的州立法者和州長辦公室都保持著良好的工作關係。現在有時間了，因為還有幾年的時間，其中一些事情才會開始實施。我們與他們合作，確保我們能夠提醒他們在專業護理環境中為老年人提供資金的重要性。

I suspect that with more finite budgets, there will be some movement in terms of how they shift dollars around. But -- it is -- there is not a state we operate in, where legislators have the sentiment that they feel like skilled nursing is overfunded. In every state we operate in, there's always a push to how do we find more money to get you better funded, not the opposite. So if we remember back to why Medicaid was created, it was created to help the elderly, the disabled and indigent children.

我懷疑，隨著預算越來越有限，資金的轉移方式將會發生一些變化。但是，在我們開展業務的任何一個州，立法者都沒有感覺到專業護理資金過剩。在我們開展業務的每個州，我們總是在努力尋找更多的資金來為您提供更好的資助，而不是相反。所以，如果我們回想一下醫療補助計畫的設立原因，它是為了幫助老人、殘疾人士和貧困兒童。

And I think we will be able to now have conversations around how to make sure the funding is directed to those recipients best. And I think skills nursing, senior funding will always be a priority for most of the states we operate in, and we feel confident that we'll have the data and the ability to have those discussions at a state level over the next couple of years. I don't -- we don't anticipate that there will be any other reconciliation bills and certainly no more discussion, at least in this -- during this presidential term around big changes to Medicaid. So I feel like we feel like the worst is behind us, and now we can have productive conversations at a state level to make sure that we're in good shape for the long term, which, by the way, is nothing new.

我認為我們現在可以討論如何確保資金以最佳方式流向受助者。我認為技能護理和高級資金始終是我們業務所在大多數州的優先事項，我們有信心在未來幾年內在州一級獲得數據並有能力進行這些討論。我預計不會再有任何其他和解法案，而且至少在本屆總統任期內，也不會再有關於醫療補助重大改革的討論。所以我覺得最糟糕的時期已經過去，現在我們可以在州一級進行富有成效的對話，以確保我們長期處於良好狀態，順便說一句，這並不是什麼新鮮事。

We have always had this dynamic at a state level where we're advocating for proper funding for skilled nursing, and this doesn't really change that much.

我們在州一級一直倡導為專業護理提供適當的資金，這種情況實際上並沒有太大改變。

Okay. That's helpful color. Just shifting to M&A. We've gotten some questions from investors recently on valuation of acquisitions over the past few years.

好的。這是很有幫助的顏色。剛剛轉向併購。我們最近收到了一些投資者關於過去幾年收購估值的問題。

It's hard to parse out just because you're doing more and more real estate transactions and geography also plays a big role in this. But to the extent you can normalize for this, how are valuations trending generally? And do you continue to see attractive opportunities and valuations in your current markets?

這很難分析，因為你進行的房地產交易越來越多，而且地理位置也扮演著重要角色。但是，在您可以將其正常化的範圍內，估值趨勢總體如何？您是否繼續看到當前市場中有吸引力的機會和估值？

Yes. Thanks for that question. I think we probably see valuations probably moderately increasing over time. Certainly post COVID with the rate environment being a little stronger and some of those things, I think, have gradually pushed pricing up a little bit.

是的。謝謝你的提問。我認為我們可能會看到估值隨著時間的推移而適度上升。當然，在新冠疫情之後，利率環境會稍微強勁一些，我認為其中一些因素已經逐漸推高了價格。

But I think the thing I just -- and obviously, when we're leasing buildings, it's a much different evaluation than if we're buying the real estate, and I know that can make it tricky to look from the outside to see how we're viewing it. I think probably the key to how we evaluate deals is -- and not to always talk about this, but it's locally driven. And our local teams in the geography in which we're looking to grow, they're the ones that are helping us decide kind of what the appropriate price to pay would be, whether it's a rent or a purchase. And the fundamentals of that decision are -- we basically break down the target opportunity and kind of leave an opening around what their DAR is going to be.

但我認為我只是——顯然，當我們租賃建築物時，評估與購買房地產時的評估有很大不同，而且我知道這可能會使從外部看我們如何看待它變得棘手。我認為我們評估交易的關鍵可能是——雖然並不總是談論這一點，但它是由當地驅動的。我們在尋求發展的地區的當地團隊正在幫助我們決定適當的價格，無論是租賃還是購買。這個決定的基礎是——我們基本上分解了目標機會，並為他們的 DAR 留下一個空缺。

And obviously, rent is a function of the price that we pay. And so our operators are very focused on what the DAR is going to be. And we sort of back into what price we feel like is appropriate based on what an appropriate DAR would be for that market. And that's sort of our driving factor into how we decide as to whether to do a deal or not and what we're willing to pay.

顯然，租金取決於我們支付的價格。因此我們的操作員非常關注 DAR 將會是什麼。然後，我們會根據適合該市場的 DAR 來確定我們認為合適的價格。這是我們決定是否達成交易以及願意支付多少錢的驅動因素。

And it's such a smarter way to do it than trying to follow some kind of macro trend, because we're forcing by doing it that way. The decision is driven on the fundamentals of -- at the facility level for each of these businesses. And that's probably, I think, the thing I'd like to highlight most. We're not -- and certainly, we're aware of the market trends and following those things closely.

這比試圖遵循某種宏觀趨勢要聰明得多，因為我們是透過這種方式來強制的。該決定是根據每個企業的設施層面的基本情況做出的。我想，這大概就是我最想強調的。我們不是——當然，我們了解市場趨勢並密切關注這些趨勢。

But -- but if pricing gets out of whack and people in the market are paying prices, we don't think are sustainable, then we just pass on those opportunities, and that's where we stay disciplined. But when the pricing is right, and we feel like we can pay a fair price that will leave us with a DAR that's sustainable over time. That's when we move forward and close those deals. So the environment has been really positive.

但是——但是如果定價失控並且市場上的人們支付的價格我們認為是不可持續的，那麼我們就會放棄這些機會，這就是我們保持紀律的地方。但當定價合適時，我們覺得我們可以支付一個公平的價格，這將使我們獲得一個可持續的 DAR。那時我們就會繼續前進並完成這些交易。所以環境確實非常積極。

I think we're -- obviously, our growth track record over the last couple of years shows that there's a lot of doable transactions out there. And we still feel like the pipeline looks really strong and healthy. And -- but we don't set growth goals. We don't start out the year saying we're going to do x number of deals.

我認為——顯然，我們過去幾年的成長記錄表明，有很多可行的交易。我們仍然覺得這條管道看起來非常強壯和健康。而且——但我們沒有設定成長目標。我們不會在年初就說要做 x 筆交易。

And so if pricing gets out of whack, like I said, will slow down. And if pricing is really good, that's when you'll see us be active. So hopefully, that's helpful.

因此，如果定價失衡，就像我說的，就會放緩。如果定價真的很好，那時你會看到我們積極行動。希望這會有所幫助。

Raj Kumar, Stephens Inc.

拉吉庫馬爾（Raj Kumar），史蒂芬斯公司

First question, just kind of thinking about Medicaid reimbursement and more particularly on the California workforce and quality incentive program, which is set to end by 2025. Can you speak to the current contribution Ensign receives from this program? And then maybe what are some of the conversations you or the industry are kind of having at the state level in order to kind of maintain adequate funding in California?

第一個問題，我只是在考慮醫療補助報銷，特別是加州勞動力和品質激勵計劃，該計劃將於 2025 年結束。您能談談 Ensign 目前從這個專案中獲得的貢獻嗎？那麼，為了在加州維持足夠的資金，您或業界在州一級進行哪些對話？

To start off, just a point of clarity, how we actually have been recording that program for us. We're actually expecting that funding to go through '26, just to how the state year works and how our revenue recognition works. And so it will actually be there for 2025 and 2026 based upon the recent change. And it's something that would look at -- and this is not just unique to California, but this is for every state-wide program.

首先，我們需要明確一點，我們實際上是如何錄製這個節目的。我們實際上預計這筆資金將持續到 26 年，這取決於州年度的運作方式以及我們的收入確認方式。因此，根據最近的變化，它實際上將在 2025 年和 2026 年存在。這是值得關注的事情——這不只是加州獨有的，而是每個州級計畫都應關注的。

Now we work with the state and how they're looking at their overall state budget. And a lot of these quality programs come -- originally came from the base rate, and we're really to incentivize providers to provide better quality care. And so as we work with them and we work with them about how that program will change over time, our goal would be for -- to help them remind them and see that the original amount came from the base freight. And as we continue to work with them, that's the talk that we're here starting to hear that they might be getting it back to the base rate.

現在我們與州政府合作，了解他們如何看待整個州的預算。許多此類品質計劃最初都來自基本費率，我們實際上是為了激勵提供者提供更優質的護理。因此，當我們與他們合作並與他們討論該計劃將如何隨著時間的推移而改變時，我們的目標是 - 幫助他們提醒他們並了解原始金額來自基本運費。隨著我們繼續與他們合作，我們開始聽到這樣的傳言：他們可能會將其恢復到基準利率。

And so that's something that we do in every state when there's a quality program, making sure that we understand how the quality program works, but how that also interacts with the base rate.

因此，當每個州都有品質計劃時，我們都會這樣做，確保我們了解品質計劃如何運作，以及它如何與基本費率互動。

Got it. And then just as a follow-up, kind of speaking to you had strong skill mix in the quarter and just thinking about as you guys kind of continue to add density in your market and kind of just the dynamics of managed care reimbursement and the typical discount versus fee-for-service. Or kind of any of your clusters or at the cluster level kind of participating or having engagements with payers around participating in like value-based care or into reimbursement as to maybe close that gap further?

知道了。然後作為後續問題，我跟您說您在本季度擁有強大的技能組合，並且考慮您將繼續增加市場密度，以及管理式醫療報銷的動態和典型的折扣與按服務收費。或您的任何集群或在集群級別參與或與付款人進行接觸，參與基於價值的護理或報銷，以進一步縮小差距？

Of course. I mean that is a continued discussion that we've had from the last several years. I think when you start to look at value-based care and value-based modeling, we're all in for it with the managed care participants in that particular area. We love to do things that are value-add both for us and for the MCO so that we can make sure that we're giving great quality of care to our residents.

當然。我的意思是這是我們過去幾年一直在討論的問題。我認為，當您開始專注於基於價值的護理和基於價值的建模時，我們會與該特定領域的管理式醫療參與者一起全力投入其中。我們喜歡做一些對我們和 MCO 都有增值作用的事情，這樣我們就可以確保為我們的居民提供高品質的護理。

I think when we talk about the volume that these value-based programs have encompassed over the years, they're relatively small. But we're definitely -- their partner -- the MCO partners in every market and really kind of come up with unique programs based on what's happening in that local market that's going to benefit what the MCO is trying to overcome in that market.

我認為，當我們談論這些基於價值的計劃多年來所涵蓋的數量時，它們相對較小。但我們絕對是他們的合作夥伴——MCO 在每個市場的合作夥伴，並且根據當地市場的情況制定出獨特的計劃，這將有利於 MCO 在該市場試圖克服的問題。

AJ Rice, UBS.

瑞銀的 AJ Rice。

Maybe a couple of questions. First, one of the things that I think the company talked about was potentially some of the more recent deals have been started at a more challenging point is jumping off on how they were performing before you acquired them. But it sounds like the deals in general are outperforming. I'm just trying to understand, are you realizing improvements quicker than maybe historically was the case? Or are -- are you -- did you just take a more conservative approach in the way you assume those would impact your financials?

也許有幾個問題。首先，我認為公司談論的事情之一是，最近的一些交易可能是在更具挑戰性的階段開始的，即根據收購前它們的表現來決定。但聽起來整體而言這些交易表現優異。我只是想了解，您是否比歷史上更快地實現了改進？或者—您—您是否只是採取了更保守的方法，認為這些會影響您的財務狀況？

It's a great question. I think there's a couple of things at play. I think our assumptions haven't really changed -- our projections haven't changed. We always try and break down the fairway of what we think is possible if we make aggressive changes as needed.

這是一個很好的問題。我認為有幾件事在起作用。我認為我們的假設並沒有真正改變——我們的預測也沒有改變。如果我們根據需要做出重大改變，我們總是會嘗試打破我們認為可能實現的局面。

And what we have seen is there is a slightly better environment that we're seeing some of the areas where we've grown recently around agency labor. A year or two back, we were seeing similar acquisitions where you're 50%, 60% of their labor was agency. And when you're having to completely rebuild a health care operation from the line staff up, that takes a little bit more time. So that's been an environmental thing that's slightly better.

我們看到，我們的環境略有好轉，最近我們在代理勞動力方面的一些領域有所發展。一兩年前，我們看到類似的收購，其中 50% 到 60% 的勞動力來自代理商。當你必須從第一線員工開始徹底重建醫療保健業務時，這需要更多時間。所以這對環境來說是一個稍微好一點的事情。

I'd say the biggest thing though, is we've -- as we have higher density and we have stronger clusters working around these acquisitions, we're just able to move things quicker. We're able to backfill some staff positions from cluster partner buildings, we've got a better program of developing talent. So one facility has a redundant talent that can go be leaders in another facility. And as you have higher density in your acquisitions, you're able to do that without asking those employees to move across the country.

不過，我想說最重要的是——由於我們的密度更高，並且圍繞著這些收購擁有更強大的集群，我們能夠更快地推進事情。我們能夠從群聚合作夥伴建築中填補一些員工職位，我們有一個更好的人才培養計劃。因此，一個機構擁有多餘的人才，可以去另一個機構擔任領導。而且由於您的收購密度較高，您無需要求這些員工搬到全國各地就可以做到這一點。

So there's a lot of things at play. I would say the final thing is just we learn every acquisition we do. Well, they're done locally, we have a great method for sharing and forum for sharing that. So we're constantly learning from our mistakes and from what we do right.

所以有很多事情在起作用。我想說的最後一件事是，我們要從每一次收購中學習。嗯，它們是在本地完成的，我們有很好的共享方法和共享論壇。因此，我們不斷地從錯誤和正確的事情中學習。

And the more we do that, you'd expect we get better and better over time. And I think we're seeing a bit of that.

我們做得越多，你會發現我們隨著時間的推移會變得越來越好。我認為我們已經看到了一些這樣的情況。

Okay. Great. Let me just ask you on -- I know you were asked earlier about the one big beautiful bill. I wondered about how it's translating into market activity, particularly two areas.

好的。偉大的。讓我問您一個問題——我知道您之前被問到過有關那張美麗的大鈔的問題。我想知道它是如何轉化為市場活動的，特別是兩個領域。

Have you seen it impact the pipeline in any way? Are there more or less sellers because of the chatter around that or people's expectations around pricing adjusted in any way? And then also in your discussion with states on rate updates, are you seeing any impact at this point? I think it's probably early, but I figured I'd ask, is it having any impact on composite rate expectations for this year or next year?

您是否看到它對管道產生任何影響？由於有關此事的討論或人們對價格調整的預期，賣家數量是否會增加或減少？另外，在您與各州討論利率更新時，您是否看到任何影響？我認為現在可能還為時過早，但我想問一下，這對今年或明年的綜合利率預期有影響嗎？

Yes. So I'll take the pipeline question. So I guess the short answer is, I guess, we've seen. But the thing about it is that last year, it was the minimum staffing bill, right? Like there's -- the content in our industry is there's always something out there that is basically regulatory change, whether it's rates or some kind of staffing requirement or whatever it is.

是的。因此我將回答管道問題。所以我想簡短的回答是，我想，我們已經看到了。但問題是，去年這是最低人員配備費用，對嗎？就像——我們行業的內容總是存在一些基本上是監管變化的東西，無論是利率還是某種人員配備要求，或者其他什麼。

And I think -- so I can't really say I've seen more deals come, but just -- it's been really steady. Maybe the reasons of why or kind of always shifting, but it's just a lot more deals than we could ever do are coming our way and so that allows us to be really selective.

我認為——我不能說我看到了更多的交易，但——它一直很穩定。或許原因總是在變化，但我們現在面臨的交易比以往多得多，因此我們可以進行選擇性。

And on the rate front, I mean, we're always active in having these discussions at a state level, like Barry mentioned, and we mentioned in our prepared remarks, I mean -- we don't see anyone shifting that way yet, but it's just part of who we are to be actively involved in the discussions at the local level in each state talking about what may or may not be happening with that state rate. And then to -- if we have a state where a rate does go down, that doesn't necessarily mean that it's going to go to the bottom line for us. And we've done that time and time again where our operational performance -- our operational reaction to a rate decrease, there are so many different ways that we can pivot through that. And so even when we do have -- have had to identify where the rate is going to go down, we were able to work through it by changing our operational performance.

在利率方面，我的意思是，我們一直積極地在州一級進行這些討論，就像巴里提到的那樣，我們在準備好的發言中也提到過，我的意思是——我們還沒有看到任何人朝這個方向轉變，但積極參與每個州地方一級的討論，討論該州利率可能發生或不可能發生的情況，這只是我們工作的一部分。然後——如果我們的利率確實下降了，這並不一定意味著它會影響我們的底線。我們已經一次又一次地做到了這一點，我們的營運表現——我們對利率下降的營運反應，有很多不同的方法來解決這個問題。因此，即使我們必須確定利率將下降到什麼程度，我們也能夠透過改變營運績效來解決這個問題。

Ladies and gentlemen, that concludes today's call. Thank you all for joining. You may now disconnect.

女士們、先生們，今天的電話會議到此結束。感謝大家的加入。您現在可以斷開連線。