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1. Company Snapshot

1.a. Company Description

The Ensign Group, Inc.provides health care services in the post-acute care continuum and other ancillary businesses.The company operates in two segments, Skilled Services and Real Estate.


The company offers skilled services, which include short and long-term nursing care services for patients with chronic conditions, prolonged illness, and the elderly; and physical, occupational, and speech therapies and other rehabilitative and healthcare services.It also provides standard services, such as room and board, special nutritional programs, social, recreational, entertainment, and other services.In addition, the company offers senior living, as well as mobile diagnostics services; leases real estate properties; and provides other ancillary services consisting of digital x-ray, ultrasound, electrocardiogram, laboratory, sub-acute, and patient transportation services to people in their homes or at long-term care facilities.


As of April 4, 2022, it operated 252 healthcare facilities in Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, South Carolina, Texas, Utah, Washington, and Wisconsin.The company was incorporated in 1999 and is based in San Juan Capistrano, California.

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1.b. Last Insights on ENSG

The Ensign Group's recent performance is driven by strong revenue growth, strategic acquisitions, and improved earnings. The company's Q2 2025 earnings per share (EPS) jumped 20.5% year-over-year, fueled by higher occupancy rates, patient days, and rental revenues. Additionally, the company raised its 2025 earnings and sales guidance, citing a solid growth trajectory. A recent rating upgrade to Buy by Zacks, reflecting growing optimism about the company's earnings prospects, further supports the positive outlook. The company's quarterly dividend declaration of $0.0625 per share also underscores its commitment to shareholder value.

1.c. Company Highlights

2. Ensign Group's Strong Q2 Earnings Driven by Clinical Performance and Strategic Growth

The Ensign Group reported robust financial performance in Q2, with GAAP diluted earnings per share of $1.42, an increase of 6%, and adjusted diluted earnings per share of $1.64, an increase of 18%. Revenue growth was driven by a 5.1% increase in skilled days for same-store operations and a 10.9% increase for transitioning operations. The company's cash and cash equivalents stood at $443.7 million, and cash flows from operations were $381 million. As Barry Port emphasized, "Our clinical performance continues to drive success, with exceptional patient outcomes."

Publication Date: Nov -15

📋 Highlights
  • Outperformed Peers: Same-store Ensign facilities outperformed peers by 24% (state) and 33% (county) in CMS clinical metrics.
  • Record Occupancy: Same-store and transitioning occupancy reached 83% and 84.4%, all-time highs, driven by trust in clinical outcomes.
  • Revenue Growth: 2025 guidance raised to $5.05–$5.07B revenue and $6.48–$6.54/share earnings, up from prior estimates.
  • Skilled Mix Expansion: Skilled days rose 5.1% (same-store) and 10.9% (transitioning), with Medicare revenue up 10% and 8.8%, respectively.
  • Acquisition Momentum: Added 73 new operations since 2024, including 22 in 2025, with 1,857 new skilled nursing beds across 6 states.

Operational Highlights

The company's operational performance was a key driver of its financial success. Same-store and transitioning occupancy increased to 83% and 84.4%, respectively, with skilled mix days driving revenue growth. The company's focus on clinical quality is evident in its CMS data, outperforming peers by 24% at the state level and 33% at the county level. Examples of successful operations include Beacon Harbor Healthcare & Rehabilitation in Texas and River Park Post Acute in Arizona, which have seen significant growth in occupancy, skilled mix, and revenue.

Growth Prospects

Ensign Group is increasing its 2025 earnings guidance to $6.48 to $6.54 per diluted share, up from $6.34 to $6.46 per diluted share. The company's growth is driven by its execution of its business model, with organic growth stemming from continued strength in occupancy and skilled mix. Analysts estimate next year's revenue growth at 12.4%. With a P/E Ratio of 31.1 and an EV/EBITDA of 21.91, the market is pricing in significant growth expectations.

Valuation and Outlook

Considering the company's valuation metrics, the P/S Ratio stands at 2.12, and the ROE is 16.62%. The Net Debt / EBITDA ratio is 2.92, indicating a manageable debt burden. As Spencer Burton noted, "The desire of payers to find the lowest-paying setting for high-acuity services is a tailwind for Ensign, positioning the company to continue delivering high-quality, low-cost alternatives to other care settings." With a strong track record of operational excellence and a favorable growth outlook, Ensign Group is well-positioned for continued success.

3. NewsRoom

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Ensign Group Expands Foothold in Three U.S. States With Facility Buyouts

Dec -03

Source: zacks.com

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The Ensign Group Grows Operations in Colorado

Dec -02

Source: globenewswire.com

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The Ensign Group Adds Real Estate and Operations in Kansas

Dec -02

Source: globenewswire.com

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The Ensign Group, Inc. $ENSG Stock Position Boosted by American Century Companies Inc.

Nov -26

Source: defenseworld.net

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Ensign Group Shares Decline 2.2% Despite Q3 Earnings Beat

Nov -13

Source: zacks.com

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Ensign Energy: Oilfield Services May Be Bottoming Out

Nov -10

Source: seekingalpha.com

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The Ensign Group, Inc. (ENSG) Q3 2025 Earnings Call Transcript

Nov -04

Source: seekingalpha.com

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The Ensign Group Reports Third Quarter 2025 Results; Raises Annual Earnings and Revenue Guidance

Nov -03

Source: globenewswire.com

4. Business Breakdown

4.a. Revenues by Country

4.b. Revenues by Segment

5. Expected revenues mid-term growth (11.55%)

6. Segments

Skilled Services

Expected Growth: 12%

The Ensign Group's Skilled Services segment growth is driven by increasing demand for post-acute care, strategic acquisitions, and expansion of service offerings. Additionally, the company's focus on operational efficiency, quality care, and strong relationships with healthcare partners contribute to its 12% growth rate.

All Other

Expected Growth: 8%

The 8% growth in All Other segment of The Ensign Group, Inc. is driven by increasing demand for non-medical services, expansion of existing service lines, and strategic acquisitions. Additionally, the company's focus on cost management and operational efficiencies has contributed to the growth. Furthermore, the segment has benefited from the company's ability to adapt to changing market conditions and capitalize on new opportunities.

Intercompany Elimination

Expected Growth: 0%

The Ensign Group, Inc.'s Intercompany Elimination with 0% growth is driven by the absence of significant transactions between subsidiaries, efficient management of internal operations, and a lack of material eliminations. This suggests a well-integrated business model with minimal intercompany activities, resulting in no eliminations required.

Standard Bearer

Expected Growth: 11%

The Ensign Group's 11% growth is driven by its diversified healthcare services, strategic acquisitions, and operational efficiencies. Its skilled nursing facilities, senior living operations, and home health and hospice services contribute to its growth. Additionally, its focus on value-based care, quality outcomes, and cost management enables it to maintain a strong market position.

7. Detailed Products

Skilled Nursing Facilities

The Ensign Group, Inc. operates skilled nursing facilities that provide 24-hour skilled nursing care and rehabilitation services to patients who require intensive therapy and nursing care.

Assisted Living Facilities

The Ensign Group, Inc. operates assisted living facilities that provide supportive care and services to seniors who require assistance with daily living activities.

Rehabilitation Therapy Services

The Ensign Group, Inc. provides rehabilitation therapy services, including physical, occupational, and speech therapy, to patients in its skilled nursing facilities and assisted living facilities.

Home Health and Hospice Services

The Ensign Group, Inc. provides home health and hospice services to patients in their homes, including skilled nursing care, therapy services, and palliative care.

Dialysis Services

The Ensign Group, Inc. operates outpatient dialysis centers that provide hemodialysis and peritoneal dialysis services to patients with end-stage renal disease.

Physician Services

The Ensign Group, Inc. provides physician services, including primary care and specialty care, to patients in its skilled nursing facilities and assisted living facilities.

8. The Ensign Group, Inc.'s Porter Forces

Forces Ranking

Threat Of Substitutes

The threat of substitutes for The Ensign Group, Inc. is medium due to the presence of alternative healthcare providers and services.

Bargaining Power Of Customers

The bargaining power of customers for The Ensign Group, Inc. is low due to the company's diversified customer base and lack of concentration.

Bargaining Power Of Suppliers

The bargaining power of suppliers for The Ensign Group, Inc. is medium due to the presence of multiple suppliers and the company's ability to negotiate prices.

Threat Of New Entrants

The threat of new entrants for The Ensign Group, Inc. is low due to the high barriers to entry in the healthcare industry, including regulatory hurdles and capital requirements.

Intensity Of Rivalry

The intensity of rivalry for The Ensign Group, Inc. is high due to the competitive nature of the healthcare industry, with many established players competing for market share.

9. SWOT Analysis

Strength

Weaknesses

Opportunities

Threats

10. Capital Structure

10.a. Balance Sheet

10.b. Weighted Average Cost of capital

Value
Debt Weight 55.64%
Debt Cost 3.95%
Equity Weight 44.36%
Equity Cost 8.69%
WACC 6.05%
Leverage 125.43%

11. Quality Control: The Ensign Group, Inc. passed 6 out of 9 key points

12.a Historical Valuation

12.b Price/Earnings Ratio

12.c Margin Valuation

12.d Peers Valuation

Peers Group Analysis

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Encompass Health

A-Score: 5.7/10

Value: 3.8

Growth: 5.1

Quality: 7.0

Yield: 1.0

Momentum: 8.5

Volatility: 8.7

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Tenet Healthcare

A-Score: 5.2/10

Value: 6.3

Growth: 6.8

Quality: 5.5

Yield: 0.0

Momentum: 7.5

Volatility: 5.3

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Ensign Group

A-Score: 5.0/10

Value: 2.0

Growth: 7.6

Quality: 4.4

Yield: 0.0

Momentum: 7.0

Volatility: 9.0

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DaVita

A-Score: 4.8/10

Value: 8.2

Growth: 7.0

Quality: 4.8

Yield: 0.0

Momentum: 2.0

Volatility: 7.0

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Chemed

A-Score: 4.2/10

Value: 2.9

Growth: 6.1

Quality: 7.3

Yield: 0.0

Momentum: 1.0

Volatility: 7.7

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Select Medical

A-Score: 3.8/10

Value: 6.8

Growth: 4.3

Quality: 2.5

Yield: 3.0

Momentum: 1.0

Volatility: 5.3

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Peers Metrics

12.e Scoring Insights

12.f DCF BETA

Parameters

Short Term Growth

Short term Time

Long-Term Growth

WACC

Target Price

177.97$

Current Price

177.97$

Potential

-0.00%

Expected Cash-Flows