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The Ensign Group, Inc. provides skilled nursing, senior living, and rehabilitative services. It operates through two segments: Skilled Services and Standard Bearer. The Skilled Services segment provides short and long-term nursing care services for patients with chronic conditions, prolonged illness, and the elderly; specialty care, such as on-site dialysis, ventilator care, cardiac, and pulmonary management; and standard services, such as room and board, special nutritional programs, social services, recreational activities, entertainment, and other services. The Standard Bearer segment leases post-acute care properties to healthcare operators. In addition, the company operates senior living units; and provides ancillary services consisting of digital x-ray, ultrasound, electrocardiograms, sub-acute services, dialysis, respiratory, and long-term care pharmacy and patient transportation to people in their homes or at long-term care facilities, as well as mobile diagnostics. The company operates healthcare facilities in Alabama, Alaska, Arizona, Colorado, Idaho, Iowa, Kansas, Oregon, Nebraska, Nevada, South Carolina, Tennessee, Texas, Utah, Washington, and Wisconsin. The company was incorporated in 1999 and is based in San Juan Capistrano, California.
5-year financial trends. Figures in USD millions.
Latest fiscal year: 2025
Year-by-year revenue, profitability, and cash flow (USD millions, last 10 years)
| Year | Revenue | EBITDA | Net Profit | FCF | ROE | Rev Growth 1Y | NP Growth 1Y |
|---|---|---|---|---|---|---|---|
| 2025 | $5.1B | $568M | $344M | $371M | 15.4% | 18.7% | 15.4% |
| 2024 | $4.3B | $479M | $298M | $189M | 16.2% | 14.2% | 42.3% |
| 2023 | $3.7B | $353M | $209M | $270M | 14.0% | 23.3% | -6.8% |
| 2022 | $3.0B | $360M | $225M | $185M | 18.0% | - | - |
Income statement, balance sheet, and cash flow as reported
Consolidated Figures in USD Millions.
| Metric | 2022 | 2023 | 2024 | 2025 |
|---|---|---|---|---|
| Total Revenue | 3,025.47 | 3,729.36 | 4,260.48 | 5,057.84 |
| Cost Of Revenue | 2,507.48 | 3,138.60 | 3,592.90 | 4,258.39 |
| Gross Profit | 517.99 | 590.76 | 667.59 | 799.45 |
| Operating Expense | 221.16 | 335.39 | 309.28 | 374.15 |
| Operating Income | 296.82 | 255.37 | 358.30 | 425.31 |
| EBITDA | 360.38 | 353.24 | 478.52 | 567.94 |
| EBIT | 298.02 | 280.85 | 394.38 | 463.61 |
| Pretax Income | 289.09 | 272.76 | 386.09 | 455.62 |
| Tax Provision | 64.44 | 62.91 | 87.64 | 111.36 |
| Net Income | 224.68 | 209.40 | 297.97 | 343.97 |
| Net Income Common Stockholders | 224.68 | 209.40 | 297.97 | 343.97 |
| Total Expenses | 2,728.64 | 3,473.99 | 3,902.18 | 4,632.53 |
| Interest Expense | 8.93 | 8.09 | 8.29 | 7.99 |
| Interest Income | 5.04 | 19.22 | 28.75 | 24.51 |
| Selling General And Administration | 158.81 | 263 | 225.14 | 269.82 |
| Normalized EBITDA | 360.38 | 353.24 | 478.52 | 567.94 |
| Normalized Income | 224.68 | 209.40 | 297.97 | 343.97 |
| Basic EPS | 4.09 | 3.76 | 5.26 | 0 |
| Diluted EPS | 3.95 | 3.65 | 5.12 | 0 |
| Tax Effect Of Unusual Items | 0 | 0 | 0 | 0 |
| Tax Rate For Calcs | 0.22 | 0.23 | 0.23 | 0.24 |
| Net Income From Continuing Operation Net Minority Interest | 224.68 | 209.40 | 297.97 | 343.97 |
| Reconciled Depreciation | 62.35 | 72.39 | 84.14 | 104.33 |
| Reconciled Cost Of Revenue | 2,507.48 | 3,138.60 | 3,592.90 | 4,258.39 |
| Net Interest Income | -3.90 | 11.13 | 20.46 | 16.52 |
| Net Income From Continuing And Discontinued Operation | 224.68 | 209.40 | 297.97 | 343.97 |
| Rent Expense Supplemental | 153.05 | 197.36 | 216.02 | 239.31 |
| Total Operating Income As Reported | 296.82 | 255.37 | 358.30 | 425.31 |
| Diluted Average Shares | 56.87 | 57.32 | 58.24 | 0 |
| Basic Average Shares | 54.89 | 55.71 | 56.66 | 0 |
| Diluted NI Availto Com Stockholders | 224.68 | 209.40 | 297.97 | 343.97 |
| Minority Interests | 0.03 | -0.45 | -0.48 | -0.29 |
| Net Income Including Noncontrolling Interests | 224.65 | 209.85 | 298.46 | 344.26 |
| Net Income Discontinuous Operations | 0 | 0 | 0 | 0 |
| Net Income Continuous Operations | 224.65 | 209.85 | 298.46 | 344.26 |
| Other Income Expense | -3.84 | 6.27 | 7.33 | 13.79 |
| Other Non Operating Income Expenses | -3.84 | 6.27 | 7.33 | 13.79 |
| Net Non Operating Interest Income Expense | -3.90 | 11.13 | 20.46 | 16.52 |
| Interest Expense Non Operating | 8.93 | 8.09 | 8.29 | 7.99 |
| Interest Income Non Operating | 5.04 | 19.22 | 28.75 | 24.51 |
| Depreciation Amortization Depletion Income Statement | 62.35 | 72.39 | 84.14 | 104.33 |
| Depreciation And Amortization In Income Statement | 62.35 | 72.39 | 84.14 | 104.33 |
| General And Administrative Expense | 158.81 | 263 | 225.14 | 269.82 |
| Other Gand A | 158.81 | 263 | 225.14 | 269.82 |
| Operating Revenue | 3,025.47 | 3,729.36 | 4,260.48 | 5,057.84 |
Healthcare sector peers, ranked by market cap
| Company | Ticker | Market Cap | P/E | P/B | ROE | EV/EBITDA |
|---|---|---|---|---|---|---|
| The Ensign Group, Inc.this co. | ENSG | $10.9B | 31.92 | 4.82 | 15.4% | 23.43 |
| BridgeBio Pharma, Inc. | BBIO | $13.8B | - | -6.62 | 34.9% | -30.28 |
| Madrigal Pharmaceuticals, Inc. | MDGL | $12.0B | - | 19.65 | -47.8% | -37.71 |
| Guardant Health, Inc. | GH | $11.1B | - | -109.75 | 419.2% | -28.87 |
| Axsome Therapeutics, Inc. | AXSM | $9.5B |
| - |
| 106.02 |
| -207.5% |
| -58.09 |
| Praxis Precision Medicines, Inc. | PRAX | $9.0B | - | 9.27 | -34.5% | -25.77 |
| Vaxcyte, Inc. | PCVX | $8.3B | - | 2.80 | -28.5% | -7.50 |
| Nuvalent, Inc. | NUVL | $7.8B | - | 6.21 | -34.1% | - |
| Cytokinetics, Incorporated | CYTK | $7.4B | - | -11.11 | 119.0% | -13.11 |
| Peer Median | - | - | 4.50 | -31.3% | -28.87 | |