GEN Genesis Healthcare Inc

Genesis Healthcare, Inc. (Genesis, or the Company) (NYSE: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 OptimizationGenesis 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 CallGenesis 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. (NYSE: 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 StatementsThis 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