“Doros Generation Trust U/A/D 1/3/12” has established itself as one of the dominant players in the skilled nursing facility (SNF) sector across the Midwest, with a particularly strong presence in South Dakota, according to the latest CMS data analysis.
Portfolio Overview
The trust currently owns 61 skilled nursing facilities across three Midwest states, with Illinois representing its largest market at 41 facilities, followed by South Dakota with 14 facilities, and Iowa with 6 facilities. Doros Generation Trust is one of the top three owners of skilled nursing facilities in South Dakota, alongside Gpn Family Trust U/A/D 04/28/08 and Legacy Healthcare Financial Services LLC.
Ownership Structure
Of its 61 facilities, 32 (52%) are operated with a 50% ownership stake, while 29 facilities (48%) have ownership percentages ranging from 5% to 42.5%. This diversified ownership model suggests a partnership-based approach to facility management and expansion.
The most common ownership percentages in the trust’s portfolio are:
- 50% ownership: 32 facilities
- 25.5% ownership: 12 facilities
- 17% ownership: 9 facilities
Market Context
The skilled nursing sector in South Dakota has faced significant challenges in recent years, with historically low Medicaid reimbursement rates contributing to financial pressures. However, South Dakota has implemented several policy changes that could impact M&A activity in the sector, including relaxed regulations for bed redistribution and substantial increases in Medicaid reimbursement rates. The state legislature approved a 25.5% increase in Medicaid rates for nursing homes in 2023, following previous increases of 6% in 2022 and 10.6% in 2021.
