The Ensign Group did not disappoint yet again with its latest quarterly results. The senior care provider reported an increase in GAAP diluted earnings per share of $3.42 for 2021, an increase of 11.8% over the prior year, while adjusted EPS rose 16.3% year over year to a record-high $3.64. Consolidated GAAP revenues increased by 9.5% to $2.6 billion in 2021, with GAAP net income reaching $194.7 million for the year, an increase of 14.2% compared with 2020. Those are all healthy increases in a year of numerous operational headwinds, with large companies especially susceptible to high employee turnover and stagnant census. That is the beauty of the decentralized operating model that Ensign uses.
Ensign did issue annual 2022 earnings guidance of $4.01 to $4.13 per diluted share and annual revenue guidance of $2.93 billion to $2.98 billion, representing an increase of the midpoint of 12% over the 2021 results and 30% higher than 2020 results.
Turning to occupancy, same store and transitioning occupancy (based on operational beds) increased by 3.0% and 6.8% from Q4:20, respectively, but only 0.4% and 1.7% from Q3:21. So, Ensign could not escape the feeble occupancy growth facing the industry this winter. Based on operational beds, occupancy rose from 70.7% in Q4:20 to 73.9% in Q4:21.
Total skilled services segment income increased to $373.6 million and $100.2 million, or 14.0% and 19.1% over the prior year and the prior year quarter, respectively. Actual patient days rose too, from just over 1.5 million in Q4:20 to a little more than 1.7 million in Q4:21, a 13.4% increase. But skilled mix fell year over year from 36.5% of nursing days in Q4:20 to 33.3% in Q4:21 for the same-facility portfolio. Skilled mix by nursing revenue also fell by 4.1% during the same period.
Ensign also announced that effective January 3, 2022, it completed the formation of a new captive REIT, Standard Bearer Healthcare REIT, Inc. to acquire high quality assets. Supposedly, transactions are already being evaluated, so we will soon have another buyer in the field that could push values even higher.
Ensign itself, as of December 31, has about $262 million of cash on hand and $343 million of available capacity under its line of credit, which has a built-in expansion option too. It already added 20 new operations to its portfolio in 2021, more recently acquiring the real estate for five skilled nursing and assisted living facilities in Arizona, California and Kansas, which had previously been operated by Ensign and The Pennant Group affiliates for a number of years. We imagine a lot of the buying will be left to Standard Bearer, but not all of it.
In the day after its earnings release, Ensign’s stock rose by 7.2% from $74.99 at close on February 9 to a high of $80.99 on February 10, with the share price around or above $79.00 for most of the day. Ensign had hit a roughly three-month low on February 7 at $70.96, and the share price is still well off of its one-year high of $98.66 from last spring. But there seems to be some positive momentum.
