Highlights Include:
GAAP diluted earnings per share for the quarter was $1.67, an increase of 21.9% over the prior year quarter, and adjusted diluted earnings per share(1) for the quarter was $1.85, an increase of 21.7% over the prior year quarter.
GAAP net income was $99.7 million for the quarter, an increase of 24.2% over the prior year quarter, and adjusted net income(1) was $110.2 million for the quarter, an increase of 23.9% over the prior year quarter.
Same Facilities and Transitioning Facilities occupancy for the quarter were 84.3% and 85.1%, an increase of 2.3% and 3.8%, respectively, over the prior year quarter.
Same Facilities and Transitioning Facilities skilled days for the quarter increased by 4.4% and 9.3%, respectively, over the prior year quarter.
Same Facilities and Transitioning Facilities Medicare revenue for the quarter improved by 9.8% and 9.2%, respectively, from prior year quarter and Medicare days for the quarter improved by 5.2% and 4.3%, respectively, from prior year quarter.
Combined Same Facilities and Transitioning Facilities managed care and Medicare census increased sequentially by 6.2% and 8.3%, respectively, over the prior quarter.
Total skilled services(2) revenue was $1.33 billion for the quarter, an increase of 18.4% over the prior year quarter. Same Facilities and Transitioning Facilities skilled services revenue for the quarter increased by 6.8% and 9.3% over the prior year quarter.
Consolidated revenue for the quarter was $1.39 billion, an increase of 18.4% over the prior year quarter.
Standard Bearer(2) revenue was $36.1 million for the quarter, an increase of 27.1% over the prior year quarter. FFO was $21.6 million for the quarter, an increase of 26.6% over the prior year quarter.(1) See "Reconciliation of GAAP to Non-GAAP Financial Information".(2) Our Skilled Services and Standard Bearer Segments are defined and outlined in Note 7 on Form 10-Q.
Operating Results
"Our local leaders and their teams continue to be examples of excellence in healthcare services as they earn the trust of patients, families, and their local healthcare communities through high-quality clinical outcomes. As each operation solidifies its reputation in its respective market, they are not only seeing more patients, but they are also being entrusted to care for increasingly complex cases, including a larger share of Medicare, managed care, and other skilled patients. As we've said many times, our consistent financial performance is a direct reflection of a relentless, patient-focused culture—one that empowers our frontline teams to deliver exceptional care in a family-like environment where people genuinely care about one another," said Barry Port, Ensign's Chief Executive Officer.
"Our clinical leaders also continue to drive outstanding outcomes, which is particularly impressive given our growth over the past several years. According to the most recently published CMS data, same-store Ensign-affiliated facilities outperformed their peers in annual survey results by 22% at the state level and 31% at the county level. This is especially notable given that many of these facilities were 1- and 2-star buildings at acquisition. Additionally, our same-store operations outperformed industry peers in 5-Star Quality Measure results by 24% nationally and 20% at the state level. These results reinforce our position as the provider of choice in our markets and demonstrate our ability to create long-term value through sustained clinical excellence," Port said.
He also noted that, "On the census front, our Same Facilities and Transitioning Facilities occupancy reached new record highs during the quarter of 84.3% and 85.1%, respectively. On the skilled mix front, our combined Same Facilities and Transitioning Facilities skilled revenue and days increased by 9.6% and 5.1%, respectively, over the prior year quarter. Medicare revenue increased for both our same store and transitioning operations by 9.8% and 9.2%, respectively.
We are also seeing strong managed care volumes across our portfolio. More specifically between Q4 and Q1 we saw growth across all skilled payors, with a combined Same Facilities and Transitioning Facilities managed care and Medicare census sequentially by 6.2% and 8.3%, respectively. While hospital and managed care volumes may ebb and flow as patients move through the system, we continue to see consistently strong occupancy and skilled mix trends as demonstrated by our current quarter results. As payors become more disciplined, that does not necessarily reduce our volume; in many cases, it shifts higher acuity patients toward operators who have proven they can deliver quality outcomes. It is also important to remember that Ensign's model is highly diversified across many geographies, payors, referral sources, and local community partners. We are not dependent on any single payor, region, or utilization trend. Even when one plan tightens in a specific market, we have consistently offset that through market share gains, stronger referral relationships, higher acuity admissions, and growth across other channels, as demonstrated by our current quarter results."
"Due to the strength of the first quarter and the acquisitions we announced yesterday, we are increasing our annual 2026 earnings guidance to $7.48 to $7.62 per diluted share, up from our original guidance of $7.41 to $7.61. We are also increasing annual revenue guidance to $5.81 billion to $5.86 billion, up from $5.77 billion to $5.84 billion. The midpoint of our earnings guidance represents a 15% increase over 2025 and 37% growth over 2024," Mr. Port said.
Speaking to the Company's acquisition growth, Chad Keetch, Ensign's Chief Investment Officer and Executive Vice President said, "During the quarter and since we accelerated our growth by adding 22 new operations, including 21 real estate assets, bringing the number of operations acquired during 2025 and since to 71. As we look at the current pipeline, we continue to see opportunities that include everything from larger portfolios, landlords looking to replace current tenants, non-profits looking to divest their post-acute assets and a steady flow of traditional one-sie two-sies. We have several new additions lining up for Q2 and Q3 of 2026 as our local leadership and their partners at the Service Center work together to source, underwrite and carefully select the right opportunities."
Suzanne Snapper, Ensign's Executive Vice President and Chief Financial Officer reported that the Company's liquidity remains strong with approximately $539.5 million of cash on hand and $591.6 million of available capacity under its line-of-credit. Ms. Snapper also indicated that, "Management's annual guidance is based on diluted weighted average common shares outstanding of approximately 60.0 million and a 25.0% tax rate. In addition, the guidance assumes, among other things, normalized insurance costs, acquisitions expected to close through the second quarter of 2026 and management's current expectations regarding reimbursement rates. It also excludes certain charges that arise outside the normal course of business, such as amortization of system implementation costs, acquisition related costs and share-based compensation."
A discussion of the Company's use of non-GAAP financial measures is set forth below. A reconciliation of net income to adjusted net income, adjusted EBT, EBITDA, adjusted EBITDAR, adjusted EBITDA and FFO for Standard Bearer, as well as a reconciliation of GAAP earnings per share to adjusted earnings per share appear in the financial data portion of this release. More complete information is contained in the Company's Quarterly Report on Form 10-Q for the quarter ended March 31, 2026, which is expected to be filed with the SEC today and can be viewed on the Company's website at http://www.ensigngroup.net.
Growth and Real Estate Highlights
Mr. Keetch added additional commentary on the Company's continued acquisition activity. "We were thrilled to complete these acquisitions and to expand our presence in some key markets in each of these states, particularly in Texas. We continue to learn from and improve our transition process and believe that those lessons are showing through in the performance of our recently acquired acquisitions. In particular, as we continue to scale, we have leadership spread across many mature markets, enhancing our ability to make larger deals smaller by breaking them into bite size pieces, transitioning in the traditional Ensign way, but with a local cluster-driven plan that gives each operation the time and attention they deserve. The performance of our newly acquired operations, particularly over the last few years, shows that our building-by-building approach to transitions works for single operations, small portfolios and larger portfolios," Mr. Keetch said.
Recent acquisitions include the following leased operation:
Agave Grove Post Acute, a 225-bed skilled nursing facility in Glendale, Arizona.
Standard Bearer also announced the following real estate acquisitions, which are operated by an Ensign-affiliate:
Timber Ridge Health and Rehabilitation, a 48-bed skilled nursing facility located in Stevens Point, Wisconsin;
Wylie Oaks Healthcare and Rehabilitation, a 106-bed skilled nursing facility located in Wylie, Texas;
Willow Park Rehabilitation and Care Center, a 125-bed skilled nursing facility located in Willow Park, Texas;
Southern Oaks Therapy and Living Center, a 150-bed skilled nursing facility located in Dallas, Texas;
Country Village Care / Country Village Senior Living, a healthcare campus with 136 skilled nursing beds, 38 assisted living units, and 32 memory care beds located in Angleton, Texas;
River Hills Health and Rehabilitation Center, a 150-bed skilled nursing facility located in Kerrville, Texas;
Willow Creek Lodge, a 135-bed skilled nursing facility located in Tomball, Texas;
Eagle Crest Rapid Recovery, a 125-bed skilled nursing facility located in Houston, Texas;
Falcon Point Post Acute, a 130-bed skilled nursing facility located in Katy, Texas;
Parks Health Center / Parks Assisted Living Center, a healthcare campus with 90 skilled nursing beds, 30 assisted living units, and 55 independent living units located in Odessa, Texas;
La Dora Nursing and Rehabilitation Center, a 62-bed skilled nursing facility located in Bedford, Texas;
River Bend Healthcare, a 115-bed skilled nursing facility located in Seguin, Texas;
Mustang Park Therapy and Living Center, 120-bed skilled nursing facility located in Carrollton, Texas;
Hilltop Village Nursing and Rehabilitation Center, 150-bed skilled nursing facility located in Kerrville, Texas;
Mallard Creek Therapy and living Center, 120-bed skilled nursing facility located in Fort Worth, Texas;
Harbor Valley Health and Rehabilitation, 120-bed skilled nursing facility located in San Antonio, Texas;
TruCare Living Centers - Columbus, 104-bed skilled nursing facility located in Columbus, Texas;
TruCare Living Centers - Palestine, 120-bed skilled nursing facility located in Palestine, Texas; and
TruCare Living Centers - Selma, 128-bed skilled nursing facility located in Selma, Texas;
In addition, in 2025, the Company acquired the following two real estate assets and assumed operations effective during the quarter. These operations are now operated by an Ensign‑affiliate:
The Chateau Waco, a 123-bed skilled nursing facility located in Waco, Texas; and
Sunset Valley Rehabilitation and Healthcare Center, an 80-bed skilled nursing facility located in Littlefield, Texas.
Lastly, the Company also acquired two real estate assets that are operated by a third-party under a triple net lease:
Emerald Ridge of Neenah, a 45-unit residential care apartment complex located in Neenah, Wisconsin; and
Anna's House Assisted Living, a 50 assisted living unit community based residential facility located in New Franken, Wisconsin.
Ensign's growing portfolio consists of 395 healthcare operations, 32 of which also include senior living operations, across 17 states. Ensign now owns 179 real estate assets, 141 which are operated by an Ensign affiliate. Mr. Keetch noted that Ensign's overall strategy will continue to include both leasing and acquiring the real estate, and that the Company is actively looking for performing and underperforming operations in several states.
The Company continues to provide additional disclosure on Standard Bearer which is comprised of 173 owned properties. Of these assets, 137 are leased to an Ensign-affiliated operator and 37 are leased to third-party operators. Mr. Keetch noted that each of these properties are subject to triple-net, long-term leases and generated rental revenue of $36.1 million for the quarter, of which $30.8 million was derived from Ensign affiliated operations. For the quarter, Standard Bearer reported $21.6 million in FFO. The Company also paid a quarterly cash dividend of $0.065 per share of Ensign common stock. Ms. Snapper noted that as the Company's liquidity remains strong, it plans to continue its long history of paying dividends into the future.
Conference Call
A live webcast will be held Friday, May 1, 2026, at 10:00 a.m. Pacific time (1:00 p.m. Eastern time) to discuss Ensign's first quarter of 2026 financial results. To listen to the webcast, or to view any financial or statistical information required by SEC Regulation G, please visit the Investors Relations section of Ensign's website at http://investor.ensigngroup.net. The webcast will be recorded and will be available for replay via the website until 5:00 p.m. Pacific time on Friday, May 29, 2026.
About Ensign™
The Ensign Group, Inc.'s independent subsidiaries provide a broad spectrum of skilled nursing and senior living services, physical, occupational and speech therapies and other rehabilitative and healthcare services at 395 healthcare facilities in Alabama, Alaska, Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, Oregon, South Carolina, Tennessee, Texas, Utah, Washington and Wisconsin. As part of its investment strategy, the Company will also acquire, lease and own healthcare real estate to service the post-acute care continuum through acquisition and investment opportunities in healthcare properties. Ensign's new business venture operating subsidiaries also offer several other post-acute-related services, including mobile x-ray, emergency and non-emergency transportation services, long-term care pharmacy and other consulting services also across several states. Each of these operations is operated by a separate, independent subsidiary that has its own management, employees and assets. References herein to the consolidated "Company" and "its" assets and activities, as well as the use of the terms "we," "us," "its" and similar verbiage, are not meant to imply that The Ensign Group, Inc. has direct operating assets, employees or revenue, or that any of the facilities, the Service Center, Standard Bearer or the captive insurance subsidiary are operated by the same entity. More information about Ensign is available at http://www.ensigngroup.net.
Safe Harbor Statement under the Private Securities Litigation Reform Act of 1995:
This press release contains, and the related conference call and webcast will include forward-looking statements that are based on management's current expectations, assumptions and beliefs about its business, financial performance, operating results, the industry in which it operates and other future events. Forward-looking statements can often be identified by words such as "anticipates," "expects," "intends," "plans," "predicts," "believes," "seeks," "estimates," "may," "will," "should," "would," "could," "potential," "continue," "ongoing," similar expressions, and variations or negatives of these words. These forward-looking statements include, but are not limited to, statements regarding growth prospects, future operating and financial performance, and acquisition activities. They are not guarantees of future results and are subject to risks, uncertainties and assumptions that could cause actual results to materially and adversely differ from those expressed in any forward-looking statement.
These risks and uncertainties relate to the Company's business, its industry and its common stock and include: reduced prices and reimbursement rates for its services; its ability to acquire, develop, manage or improve operations, its ability to manage its increasing borrowing costs as it incurs additional indebtedness to fund the acquisition and development of operations; its ability to access capital on a cost-effective basis to continue to successfully implement its growth strategy; its operating margins and profitability could suffer if it is unable to grow and manage effectively its increasing number of operations; competition from other companies in the acquisition, development and operation of facilities; its ability to defend claims and lawsuits, including professional liability claims alleging that our services resulted in personal injury, and other regulatory-related claims; and the application of existing or proposed government regulations, or the adoption of new laws and regulations, that could limit its business operations, require it to incur significant expenditures or limit its ability to relocate its operations if necessary. Additionally, our business and operations continue to be impacted by the unprecedented nature of the changes in the regulations and environment, as such, we are unable to predict the full extent and duration of the financial impact of these changes on our business, financial condition and results of operations. Therefore, our actual results could differ materially and adversely from those expressed in any forward-looking statements as a result of various factors. Readers should not place undue reliance on any forward-looking statements and are encouraged to review the Company's periodic filings with the Securities and Exchange Commission, including its Form 10-Q and 10-K, for a more complete discussion of the risks and other factors that could affect Ensign's business, prospects and any forward-looking statements. Except as required by the federal securities laws, Ensign does not undertake any obligation to publicly update or revise any forward-looking statements, whether as a result of new information, future events, changing circumstances or any other reason after the date of this press release.
Contact Information Investor/Media Relations, The Ensign Group, Inc., (949) 487-9500, [email protected]. SOURCE: The Ensign Group, Inc.
THE ENSIGN GROUP, INC.UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF INCOME
Three Months Ended March 31,
2026
2025
(In thousands, except per share data)
REVENUE
Service revenue
$
1,382,303
$
1,167,040
Rental revenue
6,893
6,001
TOTAL REVENUE
$
1,389,196
$
1,173,041
Expense:
Cost of services
1,095,826
927,849
Rent—cost of services
65,506
57,076
General and administrative expense
74,210
62,555
Depreciation and amortization
28,801
24,188
TOTAL EXPENSES
$
1,264,343
$
1,071,668
Income from operations
124,853
101,373
Other income (expense):
Interest expense
(1,932
)
(2,037
)
Interest income
6,536
6,883
Other (expense) income
(885
)
361
OTHER INCOME, NET
$
3,719
$
5,207
Income before provision for income taxes
128,572
106,580
Provision for income taxes
28,816
26,227
NET INCOME
$
99,756
$
80,353
Less: net income attributable to noncontrolling interests
88
76
NET INCOME ATTRIBUTABLE TO THE ENSIGN GROUP, INC.
$
99,668
$
80,277
NET INCOME PER SHARE ATTRIBUTABLE TO THE ENSIGN GROUP INC.
Basic
$
1.73
$
1.41
Diluted
$
1.67
$
1.37
WEIGHTED AVERAGE COMMON SHARES OUTSTANDING
Basic
57,771
57,099
Diluted
59,567
58,500
THE ENSIGN GROUP, INC.UNAUDITED CONDENSED CONSOLIDATED BALANCE SHEETS(In thousands)
March 31, 2026
December 31, 2025
ASSETS
Current assets:
Cash and cash equivalents
$
539,498
$
503,881
Accounts receivable—less allowance for doubtful accounts of $7,583 and $7,805 at March 31, 2026 and December 31, 2025, respectively
663,247
636,985
Investments—current
55,677
68,506
Prepaid expenses and other current assets
61,678
62,932
Total current assets
$
1,320,100
$
1,272,304
Property and equipment, net
1,720,225
1,696,863
Right-of-use assets
2,137,308
2,097,862
Insurance subsidiary deposits and investments
194,309
166,841
Deferred tax assets
83,169
83,138
Restricted and other assets
52,347
41,600
Intangible assets, net
6,322
6,381
Goodwill
97,981
97,981
TOTAL ASSETS
$
5,611,761
$
5,462,970
LIABILITIES AND EQUITY
Current liabilities:
Accounts payable
$
116,132
$
97,327
Accrued wages and related liabilities
313,517
422,326
Lease liabilities—current
116,500
114,816
Accrued self-insurance liabilities—current
94,868
81,623
Other accrued liabilities
202,766
174,027
Current maturities of long-term debt
4,263
4,227
Total current liabilities
$
848,046
$
894,346
Long-term lease liabilities—less current portion
1,987,386
1,949,213
Accrued self-insurance liabilities—less current portion
183,860
164,792
Other long-term liabilities
86,281
82,266
Long-term debt—less current maturities
136,491
137,529
Total equity
2,369,697
2,234,824
TOTAL LIABILITIES AND EQUITY
$
5,611,761
$
5,462,970
THE ENSIGN GROUP, INC.UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS(In thousands)
The following table presents selected data from our condensed consolidated statements of cash flows for the periods presented:
Three Months Ended March 31,
2026
2025
NET CASH PROVIDED BY (USED IN):
Operating activities
$
100,154
$
72,220
Investing activities
(71,187
)
(243,804
)
Financing activities
6,650
(10,348
)
Net increase (decrease) in cash and cash equivalents
$
35,617
$
(181,932
)
Cash and cash equivalents beginning of period
503,881
464,598
Cash and cash equivalents at end of period
$
539,498
$
282,666
THE ENSIGN GROUP, INC.UNAUDITED RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION(In thousands, except per share data)
RECONCILIATION OF GAAP TO NON-GAAP NET INCOME
The following table reconciles net income to Adjusted net income and diluted earnings per share to Adjusted earnings per share for the periods presented:
Three Months Ended March 31,
2026
2025
Net income attributable to The Ensign Group, Inc.
$
99,668
$
80,277
Adjustments:
Stock-based compensation expense(1)
13,895
10,724
Cost of services - loss on long-lived assets
1,284
—
Cost of services - acquisition related costs(2)
281
481
General and administrative - costs incurred related to system implementations
3,019
334
Depreciation and amortization - patient base(3)
—
611
Provision for income taxes on Non-GAAP adjustments(4)
(7,947
)
(3,455
)
Adjusted Net Income
$
110,200
