6 unchanged sentences
COVID-19 and other pandemics, epidemics, or outbreaks of a contagious illness may adversely affect our operating results, cash flows and financial condition.
−Removed:  The COVID-19 pandemic has had a negative impact and is expected to continue to have a negative impact on our business and results of operations.
−Removed: Although vaccines for the COVID-19 virus are widely available in the United States, COVID-19 cases remain high in some areas, and the disease continues to result in a significant number of hospitalizations.
+Added: The COVID-19 pandemic has had a negative impact and is expected to continue to have a negative impact on our business and results of operations.
+Added: Although vaccines for the COVID-19 virus are widely available in the United States, COVID-19 cases remain high in some areas.
According to the Centers for Disease Control and Prevention, older adults and people with certain underlying medical conditions are at higher risk for serious illness and death from COVID-19.
COVID-19 and other pandemics, epidemics, or outbreaks of a contagious illness, and similar events, may cause harm to us, our partners (employees), our patients, our vendors and supply chain partners, and financial institutions, which could have a material adverse effect on our results of operations, financial condition and cash flows.
−Removed: The COVID-19 impacts may include, but would not be limited to:
+Added: The COVID-19 impacts may include, but would not be limited to: 
Disruption to operations due to the unavailability of partners due to illness, quarantines, risk of illness, travel restrictions or factors that limit our existing or potential workforce.
6 unchanged sentences
The further spread of COVID-19, and the measures taken by federal and state governments and local health authorities intended to limit the spread of the virus, could impact the resources required to carry out our business as usual and may have a material adverse effect on our results of operations, financial condition and cash flows.
−Removed: For example, CMS issued an interim final rule in November 2021 that will require COVID-19 vaccinations for workers in certain Medicare- and Medicaid-certified providers and suppliers, including hospices, home health agencies and long-term care facilities, including SNFs.
−Removed: This vaccine mandate may result in heightened labor challenges.
The extent to which the COVID-19 pandemic will impact our business and our financial results will depend on future developments, which are highly uncertain and cannot be predicted.
8 unchanged sentences
CMS began imposing a 2% reduction on Medicare claims in 2013, and these reductions have been extended through 2030.
−Removed: The CARES Act and related legislation temporarily suspends this 2% reduction through March 31, 2022, and reduces the sequestration adjustment from 2% to 1% from April 1 through June 30, 2022.
−Removed: The full 2% reduction will take effect July 1, 2022, and the reductions for 2030 have been increased to up to 3%.
−Removed: As a result of the American Rescue Plan Act of 2021 ("ARPA"), an additional Medicare payment reduction of up to 4% was required to take effect in January 2022, but Congress has delayed implementation of this reduction until 2023.
+Added: The CARES Act and related legislation temporarily suspended this 2% reduction through March 31, 2022, and reduced the sequestration adjustment from 2% to 1% from April 1 through June 30, 2022.
+Added: The full 2% reduction took effect July 1, 2022.
Net revenue realizable under third–party payor agreements can change after examination and retroactive adjustment by payors during the claims settlement processes or as a result of post–payment audits.
Payors may disallow requests for reimbursement based on determinations that certain costs are not reimbursable or reasonable because additional documentation is necessary or because certain services were not covered or were not reasonable and medically necessary.
−Removed: There continue to be new laws, regulations, and proposals that could directly impose or indirectly result in further limitations on government and private payments to health care providers.
−Removed: For example, the Improving Medicare Post-Acute Care Transformation Act of 2014 (“IMPACT Act”) requires HHS, in conjunction with the Medicare Payment Advisory Commission, to propose a unified post-acute care payment model by 2023.
−Removed: A unified post-acute care payment system would pay post-acute care providers, such as long-term care facilities, skilled nursing facilities, and home health agencies, under a single framework according to a patient’s characteristics, rather than the post-acute care setting where the patient receives treatment.
−Removed: In some cases, states have enacted or are considering enacting measures designed to reduce their Medicaid expenditures, including transitioning Medicaid beneficiaries to managed care organizations, redefining Medicaid eligibility standards and shifting care away from institutional settings and toward home and community-based services.
−Removed: Several states are using demonstration projects to test new or existing approaches to payment and delivery of Medicaid benefits.
−Removed: Some private third-party payors rely on government payment systems to determine payment rates;
−Removed: therefore, reductions in Medicare, Medicaid and other government program reimbursement rates may negatively impact payments from private payors.
Our hospice agencies are subject to two payment caps that limit Medicare reimbursement each federal fiscal year, an inpatient cap and an aggregate cap.
6 unchanged sentences
See Item 1, "Business –
−Removed: Government Regulation" and "Business - Medicare Legislation and Regulations".
+Added: Government Regulation" and "Business - Medicare Legislation and Regulations". 
The industry trend toward value-based purchasing may negatively impact our revenues.
−Removed: There is a growing trend in the healthcare industry among both government and commercial payors toward value-based purchasing of healthcare services. 
−Removed: Value-based purchasing programs emphasize quality and efficiency of services, rather than volume of services. For example, CMS reimburses SNF providers using the PDPM, a payment methodology that classifies patients into payment groups based on clinical factors using diagnosis codes rather than by volume of services.
+Added: There continues to be a growing trend in the healthcare industry among both government and commercial payors toward value-based purchasing of healthcare services.
+Added: Value-based purchasing programs emphasize quality and efficiency of services, rather than volume of services.
+Added: For example, CMS reimburses SNF providers using the PDPM, a payment methodology that classifies patients into payment groups based on clinical factors using diagnosis codes rather than by volume of services.
In addition, CMS requires SNFs, home health agencies and hospices to report quality data in order to receive full reimbursement.
2 unchanged sentences
Under the SNF Value-Based Purchasing Program, CMS reduces SNF Medicare payments by 2 percentage points and redistributes the majority of these funds as incentive payments based on SNF quality measure performance.
−Removed: CMS has implemented a measure suppression policy for the SNF Value-Based Purchasing Program for federal fiscal year 2022, in order to mitigate the effect that performance measures impacted by COVID-19 would otherwise have on performance scores and incentive payments.
In January 2022, CMS began implementing a nationwide expansion of the Home Health Value-Based Purchasing (“HHVBP) Model.
2 unchanged sentences
Calendar year 2023 is the first performance year under the expanded HHVBP Model that will affect payments.
−Removed: Other initiatives aimed at improving the cost of care include alternative payment models, such as ACOs and bundled payment arrangements. 
−Removed: Medicare and many commercial third-party payors are implementing ACO models, in which groups of providers share in the benefit and risk of providing care to an assigned group of individuals at a lower cost.
+Added: Other initiatives aimed at improving the cost of care include alternative payment models, such as ACOs and bundled payment arrangements.
+Added: Medicare and many commercial third-party payors are implementing ACO models, in which groups of providers share in the benefit and risk of providing care to an assigned group of individuals at a lower cost.
In addition, CMS is implementing programs to bundle acute care and post-acute care reimbursement to hold providers accountable for costs across a broader continuum of care.
6 unchanged sentences
If we fail to meet or exceed quality performance standards under any applicable value-based purchasing program, perform at a level below the outcomes demonstrated by our competitors, or otherwise fail to effectively provide or coordinate the efficient delivery of quality health care services, our reputation in the industry may be negatively impacted, we may receive reduced reimbursement amounts, and we may owe repayments to payors, causing our revenues to decline.
−Removed: Failure to respond successfully to value-based purchasing trends could negatively impact our business, results of operations and/or financial condition.
+Added: Failure to respond successfully to value-based purchasing trends could negatively impact our business, results of operations and/or financial condition.  
By undertaking to provide management services, advisory services, and/or financial services to other entities, we become at least partially responsible for meeting the regulatory requirements of those entities.
24 unchanged sentences
Finally, staffing ratings are not suppressed for nursing homes that have five or more days with residents and no nurse staffing hours reported.
−Removed: CMS posts information on nursing home staffing measures on the Care Compare website including, as of January 2022, staff turnover rates and weekend staffing levels.
−Removed: This new data will be incorporated into the Nursing Home Five Star Quality Rating System in July 2022.
+Added: CMS posts information on nursing home staffing measures on the Care Compare website including staff turnover rates and weekend staffing levels.
+Added: This new data has been incorporated into the Nursing Home Five Star Quality Rating System.
Although we currently have no collective bargaining agreements with unions at our facilities, there is no assurance this will continue to be the case.
37 unchanged sentences
In addition, the cost to replace our existing centers through acquisition or construction is substantially higher than the carrying value of our centers.
−Removed: We are undertaking a process to allocate more aggressive capital spending within our owned and leased facilities in an effort to address issues that arise in connection with an aging physical plant.
+Added: We are undertaking a process to allocate more aggressive capital spending within our owned and leased facilities in an effort to address issues that arise in connection with an aging physical plant.
If factors, including factors indicated in these "Risk Factors" and other factors beyond our control render us unable to direct the necessary financial and human resources to the maintenance, upgrade and modernization of our physical plant and equipment, our business, results of operations, financial condition and cash flow could be adversely impacted.
20 unchanged sentences
Some of our competitors' facilities are located in newer buildings and may offer services not provided by us or are operated by entities having greater financial and other resources than us.
−Removed: Certain of our competitors are operated by not-for-profit, non-taxpaying or governmental agencies that can finance capital expenditures on a tax-exempt basis and that receive funds and charitable contributions unavailable to us. 
−Removed: Consolidations of not-for-profit entities may intensify this competitive pressure. 
+Added: Certain of our competitors are operated by not-for-profit, non-taxpaying or governmental agencies that can finance capital expenditures on a tax-exempt basis and that receive funds and charitable contributions unavailable to us.
+Added: Consolidations of not-for-profit entities may intensify this competitive pressure.
Many competing general acute care hospitals are larger and more established than our facilities.
−Removed: There is also increasing consolidation in the third-party payer industry, including vertical integration efforts among third-party payers and healthcare providers. 
−Removed: Healthcare industry participants are increasingly implementing physician alignment strategies, such as employing physicians, acquiring physician practice groups and participating in ACOs or other clinical integration models. 
−Removed: Other industry participants, such as large employer groups and their affiliates, may intensify competitive pressure and affect the industry in ways that are difficult to predict. 
−Removed: Trends toward clinical transparency and value-based purchasing may impact our competitive position and patient volumes. 
+Added: There is also increasing consolidation in the third-party payer industry, including vertical integration efforts among third-party payers and healthcare providers.
+Added: Healthcare industry participants are increasingly implementing physician alignment strategies, such as employing physicians, acquiring physician practice groups and participating in ACOs or other clinical integration models.
+Added: Other industry participants, such as large employer groups and their affiliates, may intensify competitive pressure and affect the industry in ways that are difficult to predict.
+Added: Trends toward clinical transparency and value-based purchasing may impact our competitive position and patient volumes.
Our facilities compete based on factors such as our reputation for quality care;
18 unchanged sentences
As a result of competitive pressures, our ability to maintain operating margins through price increases to private patients is limited.
−Removed: In addition, the failure to obtain, renew, or retain payor agreements with favorable contract terms may negatively impact our results of operations and/or revenue.
+Added: In addition, the failure to obtain, renew, or retain payor agreements with favorable contract terms may negatively impact our results of operations and/or revenue.
Our ability to contract with payors depends on our quality of service and reputation, as well as other factors of which we may have little or no control, such as state appropriations and changes in provider eligibility requirements.
−Removed: We are permitted to incur substantial debt, which could further exacerbate the risks described above.
+Added: We are permitted to incur substantially more debt, which could further exacerbate the risks described above.
We and our subsidiaries may be able to incur substantial indebtedness in the future.
4 unchanged sentences
These regulations include those relating to licensure, certification and enrollment with government programs, conduct of operations, ownership of facilities, construction of new and additions to existing facilities, allowable costs, adequacy and quality of services, qualifications and training of personnel, communications with patients and consumers, billing and coding for services, adequacy and manner of documentation for services provided, minimum direct care spending ratios, services and prices for services, and pharmaceuticals and controlled substances.
−Removed: Various laws, including federal and state anti–kickback and anti–fraud statutes, prohibit certain business practices and relationships that might affect the provision and cost of health care services reimbursable under federal and/or state health care programs such as Medicare and Medicaid, including the payment or receipt of remuneration for the referral of patients whose care will be paid by federal governmental programs or fee-splitting arrangements between health care providers that are designed to induce the referral of patients to a provider for medical products and services. 
−Removed: Furthermore, many states prohibit business corporations from providing or holding themselves out as a provider of medical care. 
+Added: Various laws, including federal and state anti–kickback and anti–fraud statutes, prohibit certain business practices and relationships that might affect the provision and cost of health care services reimbursable under federal and/or state health care programs such as Medicare and Medicaid, including the payment or receipt of remuneration for the referral of patients whose care will be paid by federal governmental programs or fee-splitting arrangements between health care providers that are designed to induce the referral of patients to a provider for medical products and services.
+Added: Furthermore, many states prohibit business corporations from providing or holding themselves out as a provider of medical care.
In addition, the Stark Law broadly defines the scope of prohibited physician referrals under federal health care programs to providers with which they have ownership or other financial arrangements.
Many states have adopted, or are considering, legislative proposals similar to these laws, some of which extend beyond federal health care programs, to prohibit the payment or receipt of remuneration for the referral of patients and physician referrals regardless of the source of the payment for the care.
−Removed: We also are subject to potential lawsuits under a federal whistle-blower statute designed to combat fraud and abuse in the health care industry, known as the federal False Claims Act. 
−Removed: These lawsuits can involve significant monetary awards to private plaintiffs who successfully bring these suits. 
−Removed: When a private party brings a qui tam action under the False Claims Act, it files the complaint with the court under seal, and the defendant will generally not be aware of the lawsuit until the government makes a determination whether it will intervene and take a lead in the litigation. 
−Removed: Even if, during an investigation, the court partially unseals a complaint to allow the government and a defendant to work toward a resolution of the complaint's allegations, the defendant is prohibited from revealing to anyone the existence of the complaint or that the partial unsealing has occurred. 
+Added: We also are subject to potential lawsuits under a federal whistle-blower statute designed to combat fraud and abuse in the health care industry, known as the federal False Claims Act.
+Added: These lawsuits can involve significant monetary awards to private plaintiffs who successfully bring these suits.
+Added: When a private party brings a qui tam action under the False Claims Act, it files the complaint with the court under seal, and the defendant will generally not be aware of the lawsuit until the government makes a determination whether it will intervene and take a lead in the litigation.
+Added: Even if, during an investigation, the court partially unseals a complaint to allow the government and a defendant to work toward a resolution of the complaint's allegations, the defendant is prohibited from revealing to anyone the existence of the complaint or that the partial unsealing has occurred.
These laws and regulations are complex and limited judicial or regulatory interpretation exists.
7 unchanged sentences
From time to time, we may seek guidance as to the interpretation of these laws;
−Removed: however, there can be no assurance that such laws will ultimately be interpreted in a manner consistent with our practices. 
−Removed: In addition, we could be forced to expend considerable resources responding to an investigation or other enforcement action under these laws or regulations. 
+Added: however, there can be no assurance that such laws will ultimately be interpreted in a manner consistent with our practices.
+Added: In addition, we could be forced to expend considerable resources responding to an investigation or other enforcement action under these laws or regulations.
While we believe that our business practices are consistent with Medicare and Medicaid criteria, those criteria are often vague and subject to change and interpretation.
5 unchanged sentences
In response to the COVID-19 pandemic, federal and state governments have passed legislation, promulgated regulations and taken other administrative actions intended to assist healthcare providers in providing care to COVID-19 and other patients and to provide financial relief to healthcare providers.
−Removed: Together, the CARES Act, the Paycheck Protection Program and Health Care Enhancement Act (“PPPHCE Act”), the Consolidated Appropriations Act, 2021 (“CAA”) and the American Rescue Plan Act of 2021 authorize over $186 billion in funding to be distributed to health care providers through the Provider Relief Fund.
−Removed: These funds are intended to reimburse eligible providers, including public entities and Medicare and/or Medicaid-enrolled providers and suppliers, for healthcare-related expenses or lost revenues attributable to COVID-19.
−Removed: Recipients are not required to repay these funds, provided that they attest to and comply with certain terms and conditions, including not using Provider Relief Fund payments to reimburse expenses or losses that other sources are obligated to reimburse and submitting reports as required by HHS.
+Added: Together, the CARES Act, the Paycheck Protection Program and Health Care Enhancement Act (“PPPHCE Act”), the Consolidated Appropriations Act, 2021 (“CAA”) and the American Rescue Plan Act of 2021 authorized over $186 billion in funding to be distributed to health care providers through the Provider Relief Fund.
+Added: These funds were intended to reimburse eligible providers, including public entities and Medicare and/or Medicaid-enrolled providers and suppliers, for healthcare-related expenses or lost revenues attributable to COVID-19.
+Added: Recipients were not required to repay these funds, provided that they attest to and comply with certain terms and conditions, including not using Provider Relief Fund payments to reimburse expenses or losses that other sources are obligated to reimburse and submitting reports as required by HHS.
Recipients of Provider Relief Fund payments are subject to audit requirements, and we expect that recipients of funds from the Provider Relief Fund will be subject to significant scrutiny by the federal government.
−Removed: We have structured and will continue to structure our use of these funds in accordance with the terms and conditions, but federal regulators may disagree with our interpretation of these terms and conditions and require that we repay some or all amounts received at our facilities or impose other penalties.
+Added: We have structured our use of these funds in accordance with the terms and conditions, but federal regulators may disagree with our interpretation of these terms and conditions and require that we repay some or all amounts received at our facilities or impose other penalties.
Beyond financial assistance, federal and state governments have enacted legislation and established regulations intended to expand access to and payment for telehealth services, increase access to medical supplies and equipment, prioritize review of drug applications to help with shortages of emergency drugs, and ease various legal and regulatory burdens on health care providers.
2 unchanged sentences
There is still a high degree of uncertainty surrounding the implementation of the CARES Act and related legislation passed in response to the COVID-19 pandemic, and the pandemic continues to evolve.
−Removed: Some of the measures allowing for flexibility in delivery of care and various financial supports for health care providers are available only for the duration of the national public health emergency (“PHE”) declared by HHS as a result of the pandemic, and it is unclear whether or for how long the PHE declaration will be extended.
−Removed: The current PHE determination expires April 16, 2022.
−Removed: The HHS Secretary may choose to renew the PHE declaration for successive 90-day periods for as long as the emergency continues to exist and may terminate the declaration whenever he determines that the PHE no longer exists.
−Removed: The federal government may consider additional stimulus and relief efforts, but we are unable to predict whether additional measures will be enacted or their impact.
+Added: Some of the measures allowing for flexibility in delivery of care and various financial supports for health care providers are available only for the duration of the national public health emergency (“PHE”) declared by HHS as a result of the pandemic. 
+Added: The Biden administration announced on January 30, 2023 that the COVID-19 public health emergency is set to end on May 11, 2023. The federal government may consider additional stimulus and relief efforts, but we are unable to predict whether additional measures will be enacted or their impact.
There can be no assurance as to the total amount of financial and other types of assistance we will ultimately receive under stimulus and relief legislation, and it is difficult to predict the impact of such legislation on our operations.
15 unchanged sentences
We are required to comply with laws governing the transmission and privacy and security of health information.
−Removed: The Health Insurance Portability and Accountability Act of 1996, or ("HIPAA"), requires the use of uniform electronic data transmission standards for healthcare claims and payment transactions submitted or received electronically. 
−Removed: In addition, as required by HIPAA, the HHS has issued privacy and security regulations that extensively regulate the use and disclosure of individually identifiable health information (known as Protected Health Information, or PHI) and require covered entities, including healthcare providers and health plans, and vendors known as "business associates," to implement administrative, physical and technical safeguards to protect the security of PHI. 
−Removed: Covered entities must report breaches of unsecured PHI without unreasonable delay to affected individuals, HHS and, in the case of larger breaches, the media. 
−Removed: The privacy, security and breath notification regulations have imposed, and will continue to impose, significant compliance costs on our operations. 
−Removed: There are numerous other laws and legislative and regulatory initiatives at the federal and state levels addressing privacy and security concerns. 
−Removed: These laws vary and may impose additional obligations or penalties. 
+Added: The Health Insurance Portability and Accountability Act of 1996, or ("HIPAA"), requires the use of uniform electronic data transmission standards for healthcare claims and payment transactions submitted or received electronically.
+Added: In addition, as required by HIPAA, the HHS has issued privacy and security regulations that extensively regulate the use and disclosure of individually identifiable health information (known as Protected Health Information, or PHI) and require covered entities, including healthcare providers and health plans, and vendors known as "business associates," to implement administrative, physical and technical safeguards to protect the security of PHI.
+Added: Covered entities must report breaches of unsecured PHI without unreasonable delay to affected individuals, HHS and, in the case of larger breaches, the media.
+Added: The privacy, security and breath notification regulations have imposed, and will continue to impose, significant compliance costs on our operations.
+Added: There are numerous other laws and legislative and regulatory initiatives at the federal and state levels addressing privacy and security concerns.
+Added: These laws vary and may impose additional obligations or penalties.
For example, additional federal and state obligations may apply to behavioral, addictive disorder and other types of sensitive information.
−Removed: Further, various state laws and regulations may require us to notify affected individuals in the event of a data breach involving individually identifiable information (even if no health-related information is involved). 
−Removed: In addition, the Federal Trade Commission uses its consumer protection authority to initiate enforcement actions in response to data breaches. 
+Added: Further, various state laws and regulations may require us to notify affected individuals in the event of a data breach involving individually identifiable information (even if no health-related information is involved).
+Added: In addition, the Federal Trade Commission uses its consumer protection authority to initiate enforcement actions in response to data breaches.
To the extent we fail to comply with one or more federal and/or state privacy and security requirements or if we are found to be responsible for the non-compliance of our vendors, we could be subject to substantial fines or penalties, as well as third-party claims, and suffer harm to our reputation, which could have a material adverse effect on our business, financial position, results of operations and liquidity.
In addition, health care providers and industry participants are also subject to a growing number of requirements intended to promote the interoperability and exchange of patient health information.
−Removed: For example, beginning April 5, 2021, most health care providers and certain other entities are subject to information blocking restrictions pursuant to the 21st Century Cures Act that prohibit practices that are likely to interfere with the access, exchange or use of electronic health information, except as required by law or specified by HHS as a reasonable and necessary activity.
+Added: For example, most health care providers and certain other entities are subject to information blocking restrictions pursuant to the 21st Century Cures Act that prohibit practices that are likely to interfere with the access, exchange or use of electronic health information, except as required by law or specified by HHS as a reasonable and necessary activity.
We are subject to employment-related laws and regulations which could increase our cost of doing business and subject us to significant back pay awards, fines and lawsuits.
Our operations are subject to a variety of federal, state and local employment-related laws and regulations, including, but not limited to, the U.S.
−Removed: Fair Labor Standards Act, which governs such matters as minimum wages, the Family Medical Leave Act, overtime pay, compensable time, record keeping and other working conditions, Title VII of the Civil Rights Act, the Employee Retirement Income Security Act, the Americans with Disabilities Act, the National Labor Relations Act, regulations of the Equal Employment Opportunity Commission, regulations of the Office of Civil Rights, regulations of the Department of Labor (DOL), federal and state wage and hour laws, and a variety of similar laws enacted by the federal and state governments that govern these and other employment-related matters. 
−Removed: Because labor represents such a large portion of our operating costs, compliance with these evolving federal and state laws and regulations could substantially increase our cost of doing business while failure to do so could subject us to significant back pay awards, fines and lawsuits. 
−Removed: In addition, federal proposals to introduce a system of mandated health insurance and flexible work time and other similar initiatives could, if implemented, adversely affect our operations. 
−Removed: Our failure to comply with federal and state employment-related laws and regulations could have a material adverse effect on our business, financial position, results of operations and liquidity. 
+Added: Fair Labor Standards Act, which governs such matters as minimum wages, the Family Medical Leave Act, overtime pay, compensable time, record keeping and other working conditions, Title VII of the Civil Rights Act, the Employee Retirement Income Security Act, the Americans with Disabilities Act, the National Labor Relations Act, regulations of the Equal Employment Opportunity Commission, regulations of the Office of Civil Rights, regulations of the Department of Labor (DOL), federal and state wage and hour laws, and a variety of similar laws enacted by the federal and state governments that govern these and other employment-related matters.
+Added: Because labor represents such a large portion of our operating costs, compliance with these evolving federal and state laws and regulations could substantially increase our cost of doing business while failure to do so could subject us to significant back pay awards, fines and lawsuits.
+Added: In addition, federal proposals to introduce a system of mandated health insurance and flexible work time and other similar initiatives could, if implemented, adversely affect our operations.
+Added: Our failure to comply with federal and state employment-related laws and regulations could have a material adverse effect on our business, financial position, results of operations and liquidity.
Our business is subject to a variety of federal, state and local environmental laws and regulations.
14 unchanged sentences
We believe we have adequate provisions for unrecognized tax benefits related to uncertain tax positions.
−Removed: However, because of uncertainty of interpretation by various tax authorities and the possibility that there are issues that have not been recognized by management, we cannot guarantee we have accurately estimated our tax liabilities.
+Added: Although we believe we have accurately estimated our tax liabilities, uncertainty of interpretation by various tax authorities and the possibility that there are issues that have not been recognized by management could result in additional tax liability.
We believe that our liabilities reflect the anticipated outcome of known uncertain tax positions in conformity with ASC Topic 740 Income Taxes.
−Removed: We are also subject to regular reviews, examinations, and audits by the Internal Revenue Service and other taxing authorities with respect to our taxes. 
−Removed: There are uncertainties and ambiguities in the application of the Tax Act and it is possible that the IRS cold issue subsequent guidance or take positions on audit that differ from our interpretations and assumptions. 
−Removed: Although we believe our tax estimates are reasonable, if a taxing authority disagrees with the positions we have taken, we could face additional tax liability, including interest and penalties. 
+Added: We are also subject to regular reviews, examinations, and audits by the Internal Revenue Service and other taxing authorities with respect to our taxes.
+Added: There are uncertainties and ambiguities in the application of the Tax Cuts and Jobs Act of 2017 ("Tax Act") and it is possible that the IRS could issue subsequent guidance or take positions on audit that differ from our interpretations and assumptions.
+Added: Although we believe our tax estimates are reasonable, if a taxing authority disagrees with the positions we have taken, we could face additional tax liability, including interest and penalties.
Our effective tax rate could be adversely affected by changes in the mix of earnings in states with different statutory tax rates, changes in the valuation of deferred tax assets and liabilities, change in tax laws and regulations, changes in our interpretations of tax laws, including the Tax Act.
−Removed: Unanticipated changes in our tax rates or exposure to additional income tax liabilities could affect our profitability. 
+Added: Unanticipated changes in our tax rates or exposure to additional income tax liabilities could affect our profitability.
There can be no assurance that payment of such additional amounts upon final adjudication of any disputes will not have a material impact on our results of operations and financial position.
15 unchanged sentences
As a result, we may be required to spend substantially more than we currently estimate, and may need to divert resources from other activities, as we develop our compliance plans.
−Removed: New accounting pronouncements or new interpretations of existing standards could require us to make adjustments in our accounting policies that could affect our financial statements.
−Removed: The Financial Accounting Standards Board ("FASB"), the SEC, or other accounting organizations or governmental entities issue new pronouncements or new interpretations of existing accounting standards that sometimes require us to change our accounting policies and procedures.
−Removed: Future pronouncements or interpretations could require us to change our policies or procedures and have a significant impact on our future financial statements.
Provision for losses in our financial statements may not be adequate.
23 unchanged sentences
In addition, the COVID-19 pandemic may have an adverse impact on our information technology systems and our ability to securely preserve confidential information, including risks associated with telecommuting issues when our employees work remotely.
−Removed: If personally identifiable information of our patients or others is improperly accessed, tampered with or distributed, we may incur significant costs to remediate possible injury to the affected patients, and we may be subject to sanctions and civil or criminal penalties if we are found to be in violation of the privacy or security rules under HIPAA or other similar federal or state laws protecting confidential personally identifiable information. 
+Added: If personally identifiable information of our patients or others is improperly accessed, tampered with or distributed, we may incur significant costs to remediate possible injury to the affected patients, and we may be subject to sanctions and civil or criminal penalties if we are found to be in violation of the privacy or security rules under HIPAA or other similar federal or state laws protecting confidential personally identifiable information.
Security breaches, including physical or electronic break–ins, computer viruses, attacks by hackers and similar breaches can create system disruptions or shutdowns or the unauthorized disclosure of confidential information.
Additionally, healthcare businesses are increasingly targets of cyberattacks, whereby hackers disrupt business operations or obtain protected health information, often demanding large ransoms.
−Removed: As cyber threats continue to evolve, we may be required to expend significant additional resources to continue to modify or enhance our protective measures or to investigate and remediate any cybersecurity vulnerabilities. 
+Added: As cyber threats continue to evolve, we may be required to expend significant additional resources to continue to modify or enhance our protective measures or to investigate and remediate any cybersecurity vulnerabilities.
The occurrence of any of these events could result in harm to patients;
3 unchanged sentences
reputational damage;
−Removed: or federal and state governmental inquiries. 
−Removed: Any failure to maintain proper functionality and security of our information systems could have a material adverse effect on our business, financial condition, and results of operations. 
+Added: or federal and state governmental inquiries.
+Added: Any failure to maintain proper functionality and security of our information systems could have a material adverse effect on our business, financial condition, and results of operations.
We may not be able to meet all our capital needs.
We cannot assure you that our business will generate cash flow from operations that anticipated revenue growth and improvement of operating efficiencies will be realized or that future borrowings will be available to us in an amount sufficient to enable us to service any future indebtedness or to fund our other liquidity needs.
−Removed: We may need incur indebtedness, sell assets or certain discretionary capital expenditures.
+Added: We may need to incur indebtedness, sell assets, or make certain discretionary capital expenditures.
The performances of our fixed –
36 unchanged sentences
We may not be able to pay or maintain dividends and the failure to do so would adversely affect our stock price . 
−Removed: We currently pay a quarterly dividend on our common stock and our Board intends to continue to pay a quarterly dividend. 
−Removed: However, our ability to pay and maintain cash dividends is based on many factors, including our financial condition, funds from operations, the level of our capital expenditures and future business prospects, our ability to make and finance acquisitions, anticipated operating cost levels, the level of demand for our beds, the rates we charge and actual results that may vary substantially from estimates. 
−Removed: Some of the factors are beyond our control and a change in any such factor could affect our ability to pay or maintain dividends. 
−Removed: The failure to pay or maintain dividends could adversely affect our stock price. 
+Added: We currently pay a quarterly dividend on our common stock and our Board intends to continue to pay a quarterly dividend.
+Added: However, our ability to pay and maintain cash dividends is based on many factors, including our financial condition, funds from operations, the level of our capital expenditures and future business prospects, our ability to make and finance acquisitions, anticipated operating cost levels, the level of demand for our beds, the rates we charge and actual results that may vary substantially from estimates.
+Added: Some of the factors are beyond our control and a change in any such factor could affect our ability to pay or maintain dividends.
+Added: The failure to pay or maintain dividends could adversely affect our stock price.
UNRESOLVED STAFF COMMENTS
Compared sentence by sentence after normalising whitespace, quotation marks, case and digits, so re-formatting and restated figures do not read as changed language. Wording changes appear as one removal and one addition. The current filing and the prior one are authoritative.