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Genesis Healthcare Reports Solid Second Quarter 2019 Results

KENNETT SQUARE, Pa., Aug. 08, 2019 (GLOBE NEWSWIRE) -- Genesis Healthcare, Inc. (Genesis, or the Company) (GEN), one of the largest post-acute care providers in the United States, today announced operating results for the second quarter ended June 30, 2019. 

Second Quarter 2019 Results

  • US GAAP revenue in the second quarter of 2019 was $1.15 billion compared to $1.27 billion in the second quarter of 2018; 
     
  • US GAAP net loss attributable to Genesis Healthcare, Inc. in the second quarter of 2019 was $4.8 million compared to a net loss of $39.6 million in the second quarter of 2018; and
     
  • Adjusted EBITDAR in the second quarter of 2019 was $156.0 million compared to $163.3 million in the second quarter of 2018.

“We are pleased to announce another consecutive strong quarter for Genesis,” noted George V. Hager, Jr., Chief Executive Officer of Genesis.  “Current quarter “same-store” Adjusted EBITDAR grew 4.1% and the related margin expanded by 80 basis points, as compared to the prior year quarter.  “Our inpatient segment continues the steady and improving performance experienced over the past few quarters led by “same-store” occupancy growth of 80 basis points and effective expense management.”

“Our team of dedicated professionals remains focused on providing quality outcomes to our patients, optimizing our portfolio of assets, improving operating performance and making final preparations for the October 1, 2019 transition to the new Medicare Patient Driven Payment Model, which we expect will be good for our patients and accretive for Genesis,” continued Hager.

Portfolio Optimization
Genesis continues to exit underperforming facilities and certain low density markets in order to focus on investment and growth in core, strategic markets. During the second quarter of 2019, Genesis divested, exited or closed the operations of nine facilities.  During the first and second quarter of 2019, Genesis exited a total of 19 facilities with approximate annual net revenue of $179.0 million, a pre-tax net loss of $9.1 million and Adjusted EBITDA of $4.4 million. These transactions resulted in the reduction of approximately $4.3 million of annual cash lease payments.
             
Subsequent to June 30, 2019, Genesis divested 11 leased facilities and one owned assisted living facility.  As a result of these divestitures, Genesis completed its exit from the inpatient business in Ohio.  The 12 divested facilities resulted in a reduction of $1.9 million of annual cash lease payments.  In aggregate, these 12 facilities generate approximate annual net revenue of $73.5 million, a pre-tax net loss of $4.7 million and Adjusted EBITDA of $2.4 million.

“In addition to divestitures, we are prioritizing future transactions that will lessen the burden of lease escalators, allow us to participate in future real estate appreciation, reduce our overall cost of capital and set the stage for greater facility ownership in the future,” commented Hager.

Adoption of New Lease Accounting Standard
On January 1, 2019, Genesis adopted FASB Accounting Standards Codification Topic 842, Leases (Topic 842), which requires lessees to recognize leases on-balance sheet.  Therefore, comparative information for periods prior to January 1, 2019 has not been adjusted.

Topic 842 had a material effect on Genesis’s consolidated financial statements.  The most significant effects of adoption relate to (1) the recognition of new right-of-use (ROU) assets and lease liabilities on its consolidated balance sheet for real estate operating leases; (2) the derecognition of existing assets and liabilities for sale-leaseback transactions that previously did not qualify for sale accounting; and (3) providing significant new disclosures about its leasing activities.  In addition, for the three and six months ended June 30, 2019, adoption of Topic 842 is the primary driver of the increase to lease expense and the decrease to interest expense, when compared to the same periods in the prior year, since the prior year has not been adjusted. 

Conference Call
Genesis Healthcare, Inc. will hold a conference call at 8:30 a.m. Eastern Time on Thursday, August 8, 2019.  Investors can access the conference call by calling (855) 849-2198 or live via a listen-only webcast through the Genesis website at http://www.genesishcc.com/investor-relations/, where a replay of the call will also be posted for one year. 

About Genesis Healthcare, Inc.
Genesis Healthcare, Inc. (GEN) is a holding company with subsidiaries that, on a combined basis, comprise one of the nation's largest post-acute care providers with approximately 400 skilled nursing facilities and assisted/senior living communities in 27 states nationwide. Genesis subsidiaries also supply rehabilitation therapy to approximately 1,200 healthcare providers in 46 states, the District of Columbia and China.  References made in this release to "Genesis," "the Company," "we," "us" and "our" refer to Genesis Healthcare, Inc. and each of its wholly-owned companies. Visit our website at www.genesishcc.com

Forward-Looking Statements
This release includes “forward-looking statements” within the meaning of the federal securities laws, including the Private Securities Litigation Reform Act of 1995. You can identify these statements by the fact that they do not relate strictly to historical or current facts. These statements contain words such as “may,” “will,” “project,” “might,” “expect,” “believe,” “anticipate,” “intend,” “could,” “would,” “estimate,” “continue,” “pursue,” “plans,” or “prospect,” or the negative or other variations thereof or comparable terminology. They include, but are not limited to, statements about Genesis’ expectations and beliefs regarding its future financial performance, anticipated cost management, anticipated business development, anticipated financing activities and anticipated demographic and supply-demand trends facing the industry. These forward-looking statements are based on current expectations and projections about future events, including the assumptions stated in this release, and there can be no assurance that they will be achieved or occur, in whole or in part, in the timeframes anticipated by the Company or at all. Investors are cautioned that forward-looking statements are not guarantees of future performance or results and involve risks and uncertainties that cannot be predicted or quantified and, consequently, the actual performance of Genesis may differ materially from that expressed or implied by such forward-looking statements.

These risks and uncertainties include, but are not limited to, the following:

  • reductions and/or delays in Medicare or Medicaid reimbursement rates, or changes in the rules governing the Medicare or Medicaid programs could have a material adverse effect on our revenues, financial condition and results of operations;
  • reforms to the U.S. healthcare system that have imposed new requirements on us and uncertainties regarding potential material changes to such reforms;
  • revenue we receive from Medicare and Medicaid being subject to potential retroactive reduction;
  • our success being dependent upon retaining key executives and personnel;
  • it can be difficult to attract and retain qualified nurses, therapists, healthcare professionals and other key personnel, which, along with a growing number of minimum wage and compensation related regulations, can increase our costs related to these employees;
  • recently enacted changes in Medicare reimbursements for physician and non-physician services could impact reimbursement for medical professionals;
  • we are subject to extensive and complex laws and government regulations. If we are not operating in compliance with these laws and regulations or if these laws and regulations change, we could be required to make significant expenditures or change our operations in order to bring our facilities and operations into compliance;
  • our physician services operations are subject to corporate practice of medicine laws and regulations. Our failure to comply with these laws and regulations could have a material adverse effect on our business and operations;
  • we face inspections, reviews, audits and investigations under federal and state government programs, such as the Department of Justice. These investigations and audits could result in adverse findings that may negatively affect our business, including our results of operations, liquidity, financial condition, and reputation;
  • significant legal actions, which are commonplace in our industry, could subject us to increased operating costs, which could materially and adversely affect our results of operations, liquidity, financial condition, and reputation;
  • insurance coverages, including professional liability coverage, may become increasingly expensive and difficult to obtain for health care companies, and our self-insurance may expose us to significant losses;
  • failure to maintain effective internal control over financial reporting could have an adverse effect on our ability to report on our financial results on a timely and accurate basis;
  • we may be unable to reduce costs to offset decreases in our patient census levels or other expenses timely and completely;
  • completed and future acquisitions may consume significant resources, may be unsuccessful and could expose us to unforeseen liabilities and integration risks;
  • we lease a significant number of our facilities and may experience risks relating to lease termination, lease expense escalators, lease extensions, special charges and leases that are not economically efficient in the current business environment;
  • our substantial indebtedness, scheduled maturities and disruptions in the financial markets could affect our ability to obtain financing or to extend or refinance debt as it matures, which could negatively impact our results of operations, liquidity, financial condition and the market price of our common stock;
  • exposure to the credit and non-payment risk of our contracted customer relationships, including as a result from bankruptcy, receivership, liquidation, reorganization or insolvency, especially during times of systemic industry pressures, economic conditions, regulatory uncertainty and tight credit markets, which could result in material losses; and
  • some of our directors are significant stockholders or representatives of significant stockholders, which may present issues regarding diversion of corporate opportunities and other potential conflicts.

The Company’s Annual Report on Form 10-K for the year ended December 31, 2018, Quarterly Reports on Form 10-Q, Current Reports on Form 8-K, and other filings with the U.S. Securities and Exchange Commission, discuss the foregoing risks as well as other important risks and uncertainties of which investors should be aware. Any forward-looking statements contained herein are made only as of the date of this release. Genesis disclaims any obligation to update its forward-looking statements or any of the information contained in this release. Investors are cautioned not to place undue reliance on these forward-looking statements.
                   
Genesis HealthCare Contact:   
Investor Relations                                           
610-925-2000


           
GENESIS HEALTHCARE, INC.
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
(UNAUDITED)
(IN THOUSANDS, EXCEPT PER SHARE DATA)

                         
    Three months ended June 30,    Six months ended June 30, 
    2019
  2018    2019
  2018
Net revenues   $  1,145,052     $  1,272,360     $  2,306,692     $  2,573,432  
Salaries, wages and benefits      626,159        705,754        1,268,569        1,441,524  
Other operating expenses      332,528        370,555        675,066        754,715  
General and administrative costs      35,562        39,046        71,094        78,921  
Lease expense      94,586        32,111        188,647        65,182  
Depreciation and amortization expense      28,268        63,495        66,463        114,998  
Interest expense      52,975        117,955        104,491        232,992  
(Gain) loss on early extinguishment of debt      (24 )      (501 )      (24 )      9,785  
Investment income      (2,143 )      (1,631 )      (4,007 )      (2,678 )
Other income      (23,413 )      (22,220 )      (40,330 )      (22,152 )
Transaction costs      8,823        3,112        10,084        15,207  
Long-lived asset impairments      900        27,257        900        55,617  
Goodwill and identifiable intangible asset impairments      —        1,132        —        1,132  
Equity in net (income) loss of unconsolidated affiliates      (24 )      38        (85 )      258  
Loss before income tax benefit      (9,145 )      (63,743 )      (34,176 )      (172,069 )
Income tax benefit      (162 )      (886 )      (111 )      (539 )
Net loss      (8,983 )      (62,857 )      (34,065 )      (171,530 )
Less net loss attributable to noncontrolling interests      4,164        23,245        13,983        63,380  
Net loss attributable to Genesis Healthcare, Inc.   $  (4,819 )   $  (39,612 )   $  (20,082 )   $  (108,150 )
Loss per common share:                        
Basic and diluted:                        
Weighted-average shares outstanding for loss from continuing operations per share      106,846        100,596        105,289        99,430  
Net loss attributable to Genesis Healthcare, Inc.   $  (0.05 )   $  (0.39 )   $  (0.19 )   $  (1.09 )
                         


GENESIS HEALTHCARE, INC.
CONDENSED CONSOLIDATED BALANCE SHEETS
(UNAUDITED)
(IN THOUSANDS)

             
    June 30,    December 31, 
    2019
  2018 
Assets:            
Current assets:            
Cash and equivalents   $  11,857     $  20,865  
Restricted cash and equivalents      32,600        73,762  
Accounts receivable, net of allowance for doubtful accounts      558,907        622,717  
Other current assets      143,264        158,281  
Total current assets      746,628        875,625  
Property and equipment, net of accumulated depreciation      673,911        2,887,554  
Finance lease right-of-use asset, net of accumulated amortization      516,537        —  
Operating lease right-of-use asset      2,200,252        —  
Restricted cash and equivalents      52,334        47,649  
Identifiable intangible assets, net of accumulated amortization      92,397        119,082  
Goodwill      85,642        85,642  
Other long-term assets      274,879        248,071  
Total assets   $  4,642,580     $  4,263,623  
             
Liabilities and Stockholders' Deficit:            
Current liabilities:            
Accounts payable and accrued expenses   $  448,579     $  462,599  
Accrued compensation      155,639        172,726  
Other current liabilities      359,841        276,887  
Total current liabilities      964,059        912,212  
             
Long-term debt      1,142,079        1,082,933  
Finance lease obligations      839,196        967,942  
Operating lease obligations      2,250,790        —  
Financing obligations      —        2,732,939  
Other long-term liabilities      579,435        612,463  
Stockholders' deficit      (1,132,979 )      (2,044,866 )
Total liabilities and stockholders' deficit   $  4,642,580     $  4,263,623  
             

GENESIS HEALTHCARE, INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(UNAUDITED)
(IN THOUSANDS)

               
      Six months ended June 30, 
      2019
  2018 
Net cash provided by operating activities (1)     $  36,081     $  11,469  
Net cash used in investing activities        (162,208 )      (35,082 )
Net cash provided by financing activities        80,642        108,047  
Net (decrease) increase in cash, cash equivalents and restricted cash and equivalents        (45,485 )      84,434  
Beginning of period        142,276        58,638  
End of period     $  96,791     $  143,072  

(1) - Net cash provided by operating activities in the six months ended June 30, 2019 and 2018 includes approximately $10.1 million and $15.2 million, respectively, of cash payments for transaction-related costs.


GENESIS HEALTHCARE, INC.
KEY PERFORMANCE AND VALUATION MEASURES
(UNAUDITED)

                           
    Three months ended  June 30,      Six months ended June 30, 
    2019
  2018
    2019
  2018 
Financial Results (in thousands)                          
Net revenues   $  1,145,052     $  1,272,360       $  2,306,692     $  2,573,432  
EBITDA      72,098        117,707          136,778        175,921  
Adjusted EBITDAR      156,019        163,326          304,516        313,943  
Adjusted EBITDA      61,433        131,215          115,869        248,761  
Net loss attributable to Genesis Healthcare, Inc.      (4,819 )      (39,612 )        (20,082 )      (108,150 )

INPATIENT SEGMENT:

                             
    Three months ended  June 30,      Six months ended June 30,   
    2019   2018     2019   2018  
Occupancy Statistics - Inpatient                            
Available licensed beds in service at end of period      46,353      52,303        46,353      52,303  
Available operating beds in service at end of period      44,408      50,182        44,408      50,182  
Available patient days based on licensed beds      4,213,333      4,759,573        8,378,173      9,466,843  
Available patient days based on operating beds      4,036,602      4,567,679        8,027,459      9,087,860  
Actual patient days      3,496,046      3,840,181        6,977,410      7,681,223  
Occupancy percentage - licensed beds      83.0 %    80.7 %      83.3    81.1
Occupancy percentage - operating beds      86.6 %    84.1 %      86.9    84.5
Skilled mix      18.2 %    18.9 %      18.6    19.6
Average daily census      38,418      42,200        38,549      42,438  
Revenue per patient day (skilled nursing facilities)                            
Medicare Part A   $  528   $  528     $  526   $  526  
Insurance      454      461        456      458  
Private and other      364      337        361      335  
Medicaid      231      223        231      223  
Medicaid (net of provider taxes)      211      204        211      204  
Weighted average (net of provider taxes)   $  277   $  274     $  278   $  275  
Patient days by payor (skilled nursing facilities)                            
Medicare      344,916      400,370        704,651      834,094  
Insurance      252,272      285,935        518,739      591,221  
Total skilled mix days      597,188      686,305        1,223,390      1,425,315  
Private and other      193,603      227,920        379,838      454,823  
Medicaid      2,505,024      2,726,538        4,975,038      5,405,661  
Total Days      3,295,815      3,640,763        6,578,266      7,285,799  
Patient days as a percentage of total patient days (skilled nursing facilities)                            
Medicare      10.5 %    11.0 %      10.7    11.4
Insurance      7.7 %    7.9 %      7.9    8.2
Skilled mix      18.2 %    18.9 %      18.6    19.6
Private and other      5.9 %    6.3 %      5.8    6.2
Medicaid      75.9 %    74.8 %      75.6    74.2
Total      100.0 %    100.0 %      100.0    100.0
Facilities at end of period                            
Skilled nursing facilities                            
Leased      311      341        311      341  
Owned      37      44        37      44  
Joint Venture      20      5        20      5  
Managed *      12      35        12      35  
Total skilled nursing facilities      380      425        380      425  
Total licensed beds      46,108      52,232        46,108      52,232  
Assisted/Senior living facilities:                            
Leased      21      19        21      19  
Owned      3      4        3      4  
Joint Venture      1      1        1      1  
Managed      2      2        2      2  
Total assisted/senior living facilities      27      26        27      26  
Total licensed beds      2,233      2,209        2,233      2,209  
Total facilities      407      451        407      451  
                             
Total Jointly Owned and Managed— (Unconsolidated)      14      15        14      15  

REHABILITATION THERAPY SEGMENT**:

                             
    Three months ended  June 30,      Six months ended June 30,   
    2019   2018     2019   2018  
Revenue mix %:                            
Company-operated      36    37 %      36    37
Non-affiliated      64    63 %      64    63
Sites of service (at end of period)      1,203      1,424        1,203      1,424  
Revenue per site   $  153,373   $  158,619     $  302,642   $  315,914  
Therapist efficiency %      73    68 %      72    68

* In 2018, includes 20 facilities located in Texas for which the real estate is owned by Genesis.

** Excludes respiratory therapy services.

Reasons for Non-GAAP Financial Disclosure

The following discussion includes references to Adjusted EBITDAR, EBITDA and Adjusted EBITDA, which are non-GAAP financial measures (collectively, Non-GAAP Financial Measures).  A Non-GAAP Financial Measure is a numerical measure of a registrant’s historical or future financial performance, financial position and cash flows that excludes amounts, or is subject to adjustments that have the effect of excluding amounts, that are included in the most directly comparable financial measure calculated and presented in accordance with GAAP in the statement of operations, balance sheet or statement of cash flows (or equivalent statements) of the registrant; or includes amounts, or is subject to adjustments that have the effect of including amounts, that are excluded from the most directly comparable financial measure so calculated and presented.  In this regard, GAAP refers to generally accepted accounting principles in the United States.  We have provided reconciliations of the Non-GAAP Financial Measures to the most directly comparable GAAP financial measures.

We believe the presentation of Non-GAAP Financial Measures provides useful information to investors regarding our results of operations because these financial measures are useful for trending, analyzing and benchmarking the performance and value of our business.  By excluding certain expenses and other items that may not be indicative of our core business operating results, these Non-GAAP Financial Measures:

  • allow investors to evaluate our performance from management’s perspective, resulting in greater transparency with respect to supplemental information used by us in our financial and operational decision making;
     
  • facilitate comparisons with prior periods and reflect the principal basis on which management monitors financial performance;
     
  • facilitate comparisons with the performance of others in the post-acute industry;
     
  • provide better transparency as to the measures used by management and others who follow our industry to estimate the value of our company; and
     
  • allow investors to view our financial performance and condition in the same manner as our significant landlords and lenders require us to report financial information to them in connection with determining our compliance with financial covenants.

We use Non-GAAP Financial Measures primarily as performance measures and believe that the GAAP financial measure most directly comparable to them is net income (loss) attributable to Genesis Healthcare, Inc.  We use Non-GAAP Financial Measures to assess the value of our business and the performance of our operating businesses, as well as the employees responsible for operating such businesses.  Non-GAAP Financial Measures are useful in this regard because they do not include such costs as interest expense, income taxes and depreciation and amortization expense which may vary from business unit to business unit depending upon such factors as the method used to finance the original purchase of the business unit or the tax law in the state in which a business unit operates.  By excluding such factors when measuring financial performance, many of which are outside of the control of the employees responsible for operating our business units, we are better able to evaluate value and the operating performance of the business unit and the employees responsible for business unit performance.  Consequently, we use these Non-GAAP Financial Measures to determine the extent to which our employees have met performance goals, and therefore the extent to which they may or may not be eligible for incentive compensation awards.

We also use Non-GAAP Financial Measures in our annual budget process.  We believe these Non-GAAP Financial Measures facilitate internal comparisons to historical operating performance of prior periods and external comparisons to competitors’ historical operating performance.  The presentation of these Non-GAAP Financial Measures is consistent with our past practice and we believe these measures further enable investors and analysts to compare current non-GAAP measures with non-GAAP measures presented in prior periods.

Although we use Non-GAAP Financial Measures as financial measures to assess value and the performance of our business, the use of these Non-GAAP Financial Measures is limited because they do not consider certain material costs necessary to operate the business.  These costs include our lease expense (only in the case of Adjusted EBITDAR), the cost to service debt, the depreciation and amortization associated with our long-lived assets, losses on early extinguishment of debt, transaction costs, long-lived asset impairment charges, federal and state income tax expenses, the operating results of our discontinued businesses and the income or loss attributable to noncontrolling interests.  Because Non-GAAP Financial Measures do not consider these important elements of our cost structure, a user of our financial information who relies on Non-GAAP Financial Measures as the only measures of our performance could draw an incomplete or misleading conclusion regarding our financial performance.  Consequently, a user of our financial information should consider net loss attributable to Genesis Healthcare, Inc. as an important measure of its financial performance because it provides the most complete measure of our performance.

Other companies may define Non-GAAP Financial Measures differently and, as a result, our Non-GAAP Financial Measures may not be directly comparable to those of other companies.  Non-GAAP Financial Measures do not represent net income (loss), as defined by GAAP. Non-GAAP Financial Measures should be considered in addition to, not as a substitute for, or superior to, GAAP Financial Measures.

We use the following Non-GAAP Financial Measures that we believe are useful to investors as key valuation and operating performance measures:

EBITDA

We believe EBITDA is useful to an investor in evaluating our operating performance because it helps investors evaluate and compare the results of our operations from period to period by removing the impact of our capital structure (interest expense) and our asset base (depreciation and amortization expense) from our operating results.  In addition, covenants in our debt agreements use EBITDA as a measure of financial compliance.

Adjustments to EBITDA

We adjust EBITDA when evaluating our performance because we believe that the exclusion of certain additional items described below provides useful supplemental information to investors regarding our ongoing operating performance, in the case of Adjusted EBITDA.  We believe that the presentation of Adjusted EBITDA, when combined with GAAP net loss attributable to Genesis Healthcare, Inc., and EBITDA, is beneficial to an investor’s complete understanding of our operating performance. In addition, such adjustments are substantially similar to the adjustments to EBITDA provided for in the financial covenant calculations contained in our lease and debt agreements.

We adjust EBITDA for the following items:

  • (Gain) loss on early extinguishment of debt.  We recognize gains or losses on the early extinguishment of debt when we refinance our debt prior to its original term, requiring us to write-off any unamortized deferred financing fees.  We exclude the effect of gains or losses recorded on the early extinguishment of debt because we believe these gains and losses do not accurately reflect the underlying performance of our operating businesses.
     
  • Other income.  We primarily use this income statement caption to capture gains and losses on the sale or disposition of assets.  We exclude the effect of such gains and losses because we believe they do not accurately reflect the underlying performance of our operating businesses.
     
  • Transaction costs. In connection with our acquisition and disposition transactions, we incur costs consisting of investment banking, legal, transaction-based compensation and other professional service costs.  We exclude acquisition and disposition related transaction costs expensed during the period because we believe these costs do not reflect the underlying performance of our operating businesses.
     
  • Long-lived asset impairments.  We exclude non-cash long-lived asset impairment charges because we believe including them does not reflect the ongoing performance of our operating businesses.  Additionally, such impairment charges represent accelerated depreciation expense, and depreciation expense is also excluded from EBITDA.
     
  • Goodwill and identifiable intangible asset impairments.  We exclude non-cash goodwill and identifiable intangible asset impairment charges because we believe including them does not reflect the ongoing operating performance of our operating businesses.
     
  • Severance and restructuring.  We exclude severance costs from planned reduction in force initiatives associated with restructuring activities intended to adjust our cost structure in response to changes in the business environment.  We believe these costs do not reflect the underlying performance of our operating businesses.  We do not exclude severance costs that are not associated with such restructuring activities.
     
  • Loss (income) of newly acquired, constructed or divested businesses.  The acquisition and construction of new businesses is an element of our growth strategy.  Many of the businesses we acquire have a history of operating losses and continue to generate operating losses in the months that follow our acquisition.  Newly constructed or developed businesses also generate losses while in their start-up phase.  We view these losses as both temporary and an expected component of our long-term investment in the new venture.  We adjust these losses when computing Adjusted EBITDA in order to better analyze the performance of our mature ongoing business.  The activities of such businesses are adjusted when computing Adjusted EBITDA until such time as a new business generates positive Adjusted EBITDA.  The divestiture of underperforming or non-strategic facilities is also an element of our business strategy.  We eliminate the results of divested facilities beginning in the quarter in which they become divested.  We view the income or losses associated with the wind-down of such divested facilities as not indicative of the performance of our ongoing operating business.
     
  • Stock-based compensation.  We exclude stock-based compensation expense because it does not result in an outlay of cash and such non-cash expenses do not reflect the underlying performance of our operating businesses.
     
  • Regulatory defense and related costs.  We exclude the costs of investigating and defending the inherited legal matters associated with prior transactions.  We believe these costs are non-recurring in nature as they will no longer be recognized following the final settlement of these matters. Also, we do not believe the excluded costs reflect underlying performance of our operating businesses.
     
  • Other non-recurring costs.  In the three and six months ended June 30, 2019 and June 30, 2018, we excluded an insurance recovery and costs related to the hurricane events of fiscal year 2017.  We do not believe the excluded costs reflect the performance of our ongoing operating business.

See the reconciliation of net loss attributable to Genesis Healthcare, Inc. to EBITDA and Adjusted EBITDA included herein.

Adjusted EBITDAR

We use Adjusted EBITDAR as one measure in determining the value of prospective acquisitions or divestitures.  Adjusted EBITDAR is also a commonly used measure to estimate the enterprise value of businesses in the healthcare industry. In addition, financial covenants in our lease agreements use Adjusted EBITDAR as a measure of compliance.

The adjustments made and previously described in the computation of Adjusted EBITDA are also made when computing Adjusted EBITDAR.  See the reconciliation of net loss attributable to Genesis Healthcare, Inc. to Adjusted EBITDAR included herein.

GENESIS HEALTHCARE, INC.
RECONCILIATION OF NET LOSS ATTRIBUTABLE TO GENESIS HEALTHCARE, INC. TO EBITDA AND ADJUSTED EBITDA
(UNAUDITED)
(IN THOUSANDS)

                           
    Three months ended June 30,      Six months ended June 30, 
    2019
  2018
    2019
  2018 
                           
Net loss attributable to Genesis Healthcare, Inc.   $  (4,819 )   $  (39,612 )     $  (20,082 )   $  (108,150 )
Adjustments to compute EBITDA:                          
Net loss attributable to noncontrolling interests      (4,164 )      (23,245 )        (13,983 )      (63,380 )
Depreciation and amortization expense      28,268        63,495          66,463        114,998  
Interest expense      52,975        117,955          104,491        232,992  
Income tax benefit      (162 )      (886 )        (111 )      (539 )
EBITDA   $  72,098     $  117,707          136,778        175,921  
Adjustments to compute Adjusted EBITDA:                          
(Gain) loss on early extinguishment of debt      (24 )      (501 )        (24 )      9,785  
Other income      (23,413 )      (22,220 )        (40,330 )      (22,152 )
Transaction costs      8,823        3,112          10,084        15,207  
Long-lived asset impairments      900        27,257          900        55,617  
Goodwill and identifiable intangible asset impairments      —        1,132          —        1,132  
Severance and restructuring      673        3,493          2,119        6,333  
Loss (income) of newly acquired, constructed, or divested businesses      865        (925 )        2,744        2,175  
Stock-based compensation      1,748        2,129          3,835        4,556  
Regulatory defense and related costs      —        31          —        140  
Other non-recurring costs      (237 )      —          (237 )      47  
Adjusted EBITDA   $  61,433     $  131,215       $  115,869     $  248,761  
                           
Additional lease payments not included in GAAP lease expense   $  11,302     $  74,564       $  24,869     $  152,496  
Total cash lease payments made pursuant to operating leases, finance leases and financing obligations      105,888        106,675          213,516        217,678  

GENESIS HEALTHCARE, INC.
RECONCILIATION OF NET LOSS ATTRIBUTABLE TO GENESIS HEALTHCARE, INC. TO ADJUSTED
EBITDAR

(UNAUDITED)
(IN THOUSANDS)

                           
    Three months ended June 30,      Six months ended June 30, 
    2019
  2018      2019
  2018
                           
Net loss attributable to Genesis Healthcare, Inc.   $  (4,819 )   $  (39,612 )     $  (20,082 )   $  (108,150 )
Adjustments to compute Adjusted EBITDAR:                          
Net loss attributable to noncontrolling interests      (4,164 )      (23,245 )        (13,983 )      (63,380 )
Depreciation and amortization expense      28,268        63,495          66,463        114,998  
Interest expense      52,975        117,955          104,491        232,992  
Income tax benefit      (162 )      (886 )        (111 )      (539 )
Lease expense      94,586        32,111          188,647        65,182  
(Gain) loss on early extinguishment of debt      (24 )      (501 )        (24 )      9,785  
Other income      (23,413 )      (22,220 )        (40,330 )      (22,152 )
Transaction costs      8,823        3,112          10,084        15,207  
Long-lived asset impairments      900        27,257          900        55,617  
Goodwill and identifiable intangible asset impairments      —        1,132          —        1,132  
Severance and restructuring      673        3,493          2,119        6,333  
Loss (income) of newly acquired, constructed, or divested businesses      865        (925 )        2,744        2,175  
Stock-based compensation      1,748        2,129          3,835        4,556  
Regulatory defense and related costs      —        31          —        140  
Other non-recurring costs      (237 )      —          (237 )      47  
Adjusted EBITDAR   $  156,019     $  163,326       $  304,516     $  313,943