Years Ended December 31, | ||||||
(in thousands) | 2025 | 2024 | 2023 | |||
Net income | $230,135 | $299,708 | $128,977 | |||
Adjusted EBITDA Addbacks: | ||||||
Income tax expense | 56,223 | 63,352 | 22,637 | |||
Interest expense | 55,202 | 65,578 | 74,305 | |||
Depreciation and amortization | 155,703 | 146,288 | 140,842 | |||
Noncontrolling interest earnings | (94,324) | (89,365) | (75,073) | |||
Loss on extinguishment and modification of debt | 7,344 | 3,388 | — | |||
Other non-operating losses (gains) (a) | 1,130 | (4,910) | (1,613) | |||
Cybersecurity incident (recoveries) expenses, net (b) | (22,655) | (21,477) | 8,495 | |||
Certain legal matters and related costs (c) | 900 | 2,000 | — | |||
Restructuring, exit and acquisition-related costs (d) | 13,276 | 12,751 | 13,553 | |||
Epic expenses (e) | 4,837 | 3,173 | 1,781 | |||
Equity-based compensation | 39,293 | 17,978 | 904 | |||
Loss (income) from disposed operations | 207 | 9 | (60) | |||
Adjusted EBITDA | $447,271 | $498,473 | $314,748 | |||
(a) | Other non-operating losses (gains) include losses and gains realized on certain non-recurring events or events that are non-operational in nature. | |||||
(b) | Cybersecurity incident (recoveries) expenses, net represent insurance recovery proceeds, net of incremental information technology and litigation costs, related to a cybersecurity incident that impacted our operations and information technology systems in November 2023. | |||||
(c) | Certain legal matters and related costs represent external legal counsel costs and professional fees incurred in connection with the defense and resolution of specific, non-recurring litigation and regulatory matters that are not part of our ordinary course operations. These amounts do not include costs associated with routine professional and general liability claims. | |||||
(d) | Restructuring, exit and acquisition-related costs represent (i) enterprise restructuring costs, including severance costs related to work force reductions of $10.3 million, $10.4 million, and $12.4 million for the years ended December 31, 2025, 2024, and 2023, respectively, (ii) penalties and costs incurred for terminating pre-existing contracts at acquired facilities of $1.2 million, $0.8 million, and $0.7 million for the years ended December 31, 2025, 2024, and 2023, respectively, and (iii) third party professional fees and expenses incurred in connection with potential and completed acquisitions of $1.8 million, $1.6 million, and $0.5 million for the years ended December 31, 2025, 2024, and 2023, respectively. | |||||
(e) | Epic expenses consist of various costs incurred in connection with the implementation of Epic, our health information technology system. These costs included (i) professional fees of $2.1 million, $3.1 million, and $1.8 million for the years ended December 31, 2025, 2024, and 2023, respectively, (ii) salaries and benefits of $2.6 million and $0.1 million for the years ended December 31, 2025 and 2024, respectively, and (iii) other expenses related to one-time training and onboarding support costs of $0.1 million for the year ended December 31, 2025. Epic expenses do not include ongoing operating costs of the Epic system. | |||||
Three Months Ended December 31, 2025 | Year Ended December 31, 2025 | |||
(in thousands) | ||||
Net income | $74,262 | $230,135 | ||
Adjusted EBITDAR Addbacks: | ||||
Income tax expense | 18,109 | 56,223 | ||
Interest expense | 12,383 | 55,202 | ||
Depreciation and amortization | 41,037 | 155,703 | ||
Noncontrolling interest earnings | (29,306) | (94,324) | ||
Loss on extinguishment and modification of debt | — | 7,344 | ||
Other non-operating losses (a) | — | 1,130 | ||
Cybersecurity incident recoveries, net (b) | — | (22,655) | ||
Certain legal matters and related costs (c) | 900 | 900 | ||
Restructuring, exit and acquisition-related costs (d) | 5,332 | 13,276 | ||
Epic expenses (e) | 1,933 | 4,837 | ||
Equity-based compensation | 9,110 | 39,293 | ||
Loss from disposed operations | 185 | 207 | ||
Rent expense payable to REITs (f) | 41,786 | 164,308 | ||
Adjusted EBITDAR | $175,731 | $611,579 | ||
(a) | Other non-operating losses include losses and gains realized on certain non-recurring events or events that are non-operational in nature. | |||
(b) | Cybersecurity incident recoveries, net represent insurance recovery proceeds, net of incremental information technology and litigation costs, related to a cybersecurity incident that impacted our operations and information technology systems in November 2023. | |||
(c) | Certain legal matters and related costs represent external legal counsel costs and professional fees incurred in connection with the defense and resolution of specific, non-recurring litigation and regulatory matters that are not part of our ordinary course operations. These amounts do not include costs associated with routine professional and general liability claims. | |||
(d) | Restructuring, exit and acquisition-related costs represent (i) enterprise restructuring costs, including severance costs related to work force reductions of $4.3 million and $10.3 million for the three months ended and year ended December 31, 2025, respectively, (ii) penalties and costs incurred for terminating pre-existing contracts at acquired facilities of $0.8 million and $1.2 million for the three months ended and year ended December 31, 2025, respectively, and (iii) third party professional fees and expenses incurred in connection with potential and completed acquisitions of $0.2 million and $1.8 million for the three months ended and year ended December 31, 2025, respectively. | |||
(e) | Epic expenses consist of various costs incurred in connection with the implementation of Epic, our health information technology system. These costs included (i) professional fees of $0.6 million and $2.1 million for the three months ended and year ended December 31, 2025, respectively, (ii) salaries and benefits of $1.3 million and $2.6 million for the three months ended and year ended December 31, 2025, respectively, and (iii) other expenses related to one-time training and onboarding support costs of $0.1 million for the year ended December 31, 2025. Epic expenses do not include ongoing operating costs of the Epic system. | |||
(f) | Rent expense payable to REITs for the three months ended and year ended December 31, 2025 consists of rent expense of $38.9 million and $152.9 million, respectively, related to the Ventas Master Lease and other lease agreements with Ventas for medical office buildings and rent expense of $2.9 million and $11.4 million, respectively, related to a lease arrangement with MPT for the lease of Hackensack Meridian Mountainside Medical Center. | |||