Jennifer Lee Estes Tr 031093 and James Norman Estes Jr Tr jointly lead Alabama’s skilled nursing facility sector with 30 facilities each, according to the most recent Centers for Medicare & Medicaid Services (CMS) data from January 2025. These related trusts share ownership interests in 45 facilities across four states, with Alabama representing their strongest market presence. The Estes family operates these facilities through NHS Management, LLC, a company led by J. Norman Estes as President and CEO.
Ownership Structure and Portfolio Distribution
The Estes trusts maintain primarily indirect ownership stakes in their facilities, with Jennifer Lee Estes Tr 031093 holding 6.25% indirect ownership in 16 facilities and 5.32% in another 13 facilities. The trust’s portfolio extends beyond Alabama to include 5 facilities each in Arkansas, Florida, and Missouri. Across all facilities affiliated with Estes family trusts, the most common ownership percentages are 6.25% (21 facilities), 18.25% (16 facilities), and 5.32% (13 facilities). The vast majority of these ownership interests (37 facilities) are classified as “5% Or Greater Indirect Ownership Interest,” with 10 facilities having “5% Or Greater Direct Ownership Interest.”
Geographic Footprint
The Jennifer Lee Estes Tr 031093 portfolio is concentrated in Alabama with 30 facilities, while maintaining a smaller presence in Arkansas (5), Missouri (5), and Florida (5). Within Alabama, the Estes-affiliated facilities are spread across 23 cities, with the highest concentrations in Birmingham (4), Northport (4), and Mobile (3). The facilities vary in size, ranging from 63 to 200 beds, with concentrations at 120 beds (5 facilities) and 140 beds (4 facilities).
Management Structure and Leadership
The Estes family has a long-standing connection to the nursing home industry. J. Norman Estes is the President and CEO of NHS Management, LLC. He started with three nursing facilities in 1981 and has since expanded to operate or manage 50 facilities. This continues a family tradition in the nursing facility business that spans three generations.
Jennifer Estes Agee, a fourth-generation member of the family to own and operate skilled nursing homes, is also involved with NHS Management, LLC, serving in a corporate capacity focusing on operations, human resources, and community outreach. She is a licensed nursing home administrator.
NHS Management, LLC provides administrative and consulting services to skilled nursing and rehabilitation facilities. They offer support in areas like operations, financial analysis, clinical expertise, human resources, and information technology. The company states that its top priority is ensuring high-quality care for patients and residents in the facilities it serves. NHS Management supports a network of facilities across several southeastern states, including Alabama, Arkansas, Florida, and Missouri. It is headquartered in Alabama.
Alabama Regulatory Environment
Alabama has a Certificate of Need (CON) program that requires state approval for offering or expanding certain healthcare services, including the construction, establishment, or acquisition of new SNFs. This process aims to ensure that new facilities serve the public interest. There are exemptions, such as an increase in beds by up to 10% under certain conditions.
The Alabama Medicaid Agency reimburses approximately 219 enrolled SNFs. Reimbursement is based on a per diem rate determined by cost reports submitted by facilities. New owners have the option to accept the previous owner’s per diem rate or submit a six-month budget cost report to establish a new rate. Alabama Medicaid may adjust the ceiling for reimbursement rates during a fiscal year if SNFs face increased allowable costs due to unforeseen circumstances. The state also has a quality incentive program for nursing facilities that meet specific quality measures. Alabama Nursing Home Medicaid covers long-term care for eligible residents, including room and board, and medical and non-medical services. Recipients contribute most of their income towards care costs, retaining a small personal needs allowance.
Regional Competitors
Other major players in Alabama’s skilled nursing sector include Regions Bank with 22 facilities and ServisFirst Bank with 20 facilities [1]. Diversicare Healthcare Services LLC (19 facilities) and several family trusts also maintain substantial portfolios in the state.
