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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, Inc.'s recent performance was driven by strong Q4 earnings, beating estimates with $1.82 per share, a 22% year-over-year increase. Growing occupancy rates fueled the earnings beat. The company has a 23-year dividend hike streak, showcasing its financial stability. Institutional investors, such as SG Americas Securities LLC, have increased their stakes, with a 378.6% boost. The company's strong acquisitions and revenue growth have bolstered its long-term investment appeal.

1.c. Company Highlights

2. Ensign's Strong Q4 Results Driven by Clinical Outcomes and Strategic Acquisitions

Ensign's fourth-quarter results showed a 20.2% increase in consolidated revenue, reaching $1.44 billion, and a 19.8% increase in GAAP net income. Earnings per share (EPS) came in at $1.82, beating analyst estimates of $1.75. The company's revenue growth was driven by a 15.7% increase in Medicare revenue for same-store operations and an 8.9% increase in managed care revenue. The company's focus on clinical outcomes has led to improved occupancy rates, with same-store occupancy reaching 83.8% and transitioning occupancy at 84.9%. As Barry Port, Ensign's CEO, noted, "Our clinical achievements are bearing fruit in many ways, including an increase in same-store and transitioning occupancy."

Publication Date: Feb -15

📋 Highlights
  • Record Occupancy & Revenue Growth: Same-store occupancy reached 83.8%, transitioning at 84.9%, with Medicare revenue up 15.7% and managed care revenue rising 8.9% (same-store) to 15% (transitioning).
  • 2026 Earnings Guidance: Anticipated diluted EPS of $7.41–$7.61 (14.3% YoY growth over 2025) and revenue of $5.77B–$5.84B (36.5% increase vs. 2024 midpoint).
  • Acquisition Expansion: Added 17 new operations (12 real estate) in Q4 2025, including a 7-building Utah portfolio and 3 Texas facilities, diversifying across healthcare markets.
  • South Bay EBIT Growth: Achieved 127% EBIT growth in Q4 2025, driven by 25% skilled revenue mix increase, 86% Medicare days growth, and 22% managed care volume rise.
  • Shoreline Staff Retention: CMS nursing turnover 60% below state average, 7-year average frontline staff tenure, and 0 registry staffing for 2 consecutive years post-transition.

Operational Highlights

The company's operational performance was strong, with significant improvements in clinical outcomes and staffing. South Bay Post Acute, an Ensign affiliate, achieved 127% earnings before income tax growth in the fourth quarter, driven by a skilled revenue mix increase of 25%. Shoreline Health and Rehabilitation, a 114-bed skilled nursing operation, demonstrated a disciplined focus on staffing, resulting in a 60% lower CMS nursing turnover rate compared to the state average.

Growth Strategy and Outlook

Ensign is confident in its ability to grow in a healthy and sustainable way, with a focus on acquiring high-quality assets. The company has issued its annual 2026 earnings guidance of $7.41 to $7.61 per diluted share, representing a 14.3% increase over 2025 results. Analysts estimate revenue growth of 9.4% next year. With a current P/E Ratio of 35.71 and EV/EBITDA of 28.26, the market is pricing in a certain level of growth. The company's ability to adapt to changes in reimbursement programs and its focus on clinical leadership and data-driven decision-making are key strengths.

Valuation and Dividend Yield

Ensign's current valuation metrics, including a P/E Ratio of 35.71 and P/S Ratio of 2.45, indicate a premium valuation. However, the company's dividend yield of 0.12% is relatively low. The company's return on equity (ROE) of 16.58% and return on invested capital (ROIC) of 6.86% are positive indicators of its financial performance.

3. NewsRoom

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The Ensign Group, Inc. (NASDAQ:ENSG) Receives Average Recommendation of “Moderate Buy” from Analysts

Feb -22

Source: defenseworld.net

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The Ensign Group, Inc. $ENSG Stock Position Trimmed by Crow s Nest Holdings LP

Feb -16

Source: defenseworld.net

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The Ensign Group: Real Estate Value Anchors A Growth Story

Feb -12

Source: seekingalpha.com

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The Ensign Group (NASDAQ:ENSG) CFO Suzanne Snapper Sells 4,573 Shares

Feb -10

Source: defenseworld.net

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The Ensign Group (NASDAQ:ENSG) CFO Suzanne Snapper Sells 8,258 Shares of Stock

Feb -10

Source: defenseworld.net

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The Ensign Group, Inc. $ENSG Shares Sold by Principal Financial Group Inc.

Feb -07

Source: defenseworld.net

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Ensign Group Q4 Earnings Beat Estimates on Growing Occupancy

Feb -06

Source: zacks.com

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The Ensign Group, Inc. (ENSG) Q4 2025 Earnings Call Transcript

Feb -05

Source: seekingalpha.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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Quality: 7.0

Yield: 2.0

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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

210.64$

Current Price

210.64$

Potential

-0.00%

Expected Cash-Flows