The Ensign Group, Inc. (NASDAQ:ENSG) Q4 2022 Earnings Call Transcript

Suzanne Snapper: Yes, great question and a couple of different aspects to that. Obviously, in the current quarter for Q4, we had a lot of acquisitions. And so what we talked about, and just want to remind people, during stages of heavy acquisitions are anticipated collections will be slower. That is just a normal part of doing acquisitions as we go through the change in ownership process and transfer everything over. As we kind of look for fourth quarter, it was just a little bit slower in normal and the normal basis as well. And that really had to do with a lot of managed care organizations and a couple of states paying a little bit slower than they normally do at the end of the year. With regards to the risk factor, what we added on, we did just want to highlight that there are more and more states that are changing from a direct pay system to a managed care system.

So now almost all of our large states are all in managed Medicaid states. When the program goes from just a railer direct pay to managed Medicaid, the payments do come slower to us. And so our — one of our big states, California switched in 2023 to that. And so, we just want to get people a heads up that we’d expect some slowdown in our Medicaid collections in the state of California due to that transition.

Tao Qiu: Got you. And a final question, if I may. If I look at the balance sheet, right, obviously, that’s under levered and you have abundant liquidity and very strong cash flow. We are forecasting somewhere around $300 million of operating cash flow and really $200 million of free cash flow for the next few years. Just curious in terms of capital allocations, what are the things that you would prioritize? I know that you have raised the dividend. You had a stock repurchase program last year. How should we think about where you would allocate capital?

Chad Keetch: Yes, Tao, I can take that. This is Chad. Certainly, acquisitions would be the top of our list. We see ourselves very much in growth mode and will continue to be. And then obviously, CapEx on the physical plants is another big spend, right? And one note on the cash flows, too. When we have large or heavier periods of acquisition like we have over the last six months, that can tend to have a little bit of a drag on our cash flows and as we see AR climb a little bit with just the nature of licensing and just part of kind of the process of a transition from one operator to another. So that will actually probably impact our cash flow a little bit. I think you’ll see that. But yes, I mean, as we’ve talked about a lot, we keep our balance sheet the way it is so that we can be ready when great opportunities arise.

And as I said in my prepared part of the script, I think we expect to see additional opportunities coming up this year and next and we want to be prepared for that. So, that’s how we kind of look at the balance sheet.

Suzanne Snapper: And prepared both on the operating front as well as the Standard Bearer REIT front. So, I think as we kind of look at that multifaceted ability to acquire that would definitely be our number one use of those flows.

Operator: Thank you. One moment for our next question please. And it comes from the line of Scott Fidel with Stephens. Please go ahead.