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The Ensign Group, Inc. (ENSG) is a healthcare company that operates through independent subsidiaries to provide a wide range of post-acute care services. Founded in 1999, ENSG specializes in skilled nursing, senior living, rehabilitative care, and ancillary services such as mobile diagnostics and medical transportation. The company also owns, develops, and leases healthcare-related properties through its real estate investment trust (REIT), Standard Bearer Healthcare REIT, Inc., supporting both its subsidiaries and third-party operators.
- Skilled Services - Offers skilled nursing, senior living, and other healthcare services, focusing on post-acute care, rehabilitation, and long-term care.
- Standard Bearer - Manages real estate operations, including ownership, acquisition, and leasing of healthcare-related properties to subsidiaries and third-party operators.
- All Other - Includes ancillary operations such as mobile diagnostics, medical transportation, and centralized services like accounting, payroll, and risk management.
| Name | Position | External Roles | Short Bio | |
|---|---|---|---|---|
Barry R. Port ExecutiveBoard | Chief Executive Officer and Director | None | Barry R. Port has been CEO since May 2019. He previously served as COO of Ensign Services and has extensive experience in skilled nursing and senior living operations. | |
Christopher R. Christensen ExecutiveBoard | Executive Chairman and Chairman of the Board | Board Member at The Pennant Group, Inc. | Co-founder of ENSG in 1999, served as CEO until May 2019, and has been instrumental in the company's growth and spin-offs of Care Trust REIT and The Pennant Group. | |
Suzanne D. Snapper ExecutiveBoard | Chief Financial Officer, Executive Vice President, and Director | None | Suzanne D. Snapper has been CFO since at least February 2025, with no additional details on prior roles or external positions provided in the documents. | |
Chad A. Keetch Executive | Chief Investment Officer, Executive Vice President, and Secretary | President of Standard Bearer Healthcare REIT, Inc. | Joined ENSG in 2010, leads acquisitions and real estate growth, and played a key role in the spin-offs of Care Trust REIT and The Pennant Group. | |
Spencer W. Burton Executive | President and Chief Operating Officer, Ensign Services, Inc. | None | Appointed in May 2019, Burton has nearly two decades of experience in post-acute care and has held leadership roles in affiliated operations across multiple states. | |
Ann S. Blouin Board | Director | President of PSQ Advisory; Board Member at the Institute for Healthcare Improvement; Editorial Advisor for the Journal of Nursing Administration; Assistant Professor at Loyola University of Chicago | Joined ENSG's board in November 2018, chairs the Quality Assurance and Compliance Committee, and has over 30 years of healthcare experience. | |
Barry M. Smith Board | Director | None | Joined ENSG's board in 2014, previously served as CEO of Magellan Health and has extensive experience in healthcare leadership. | |
Daren J. Shaw Board | Director | Board Member at Profire Energy, Inc. | Joined ENSG's board in March 2012, chairs the Audit Committee, and has over 35 years of experience in financial services and investment banking. | |
John O. Agwunobi Board | Director | Director at Blue Bird Bio Inc.; Board Member of the U.S. African Development Foundation | Appointed to ENSG's board in January 2023, previously served as CEO of Herbalife Nutrition and held leadership roles at Walmart and the U.S. Department of Health and Human Services. | |
Mark Parkinson Board | Director | Principal of AHCA/NCAL | Appointed to ENSG's board in October 2024, previously served as CEO of AHCA/NCAL and as Governor of Kansas, with extensive experience in healthcare policy and governance. | |
Swati B. Abbott Board | Director | Board Member at TalkSpace, Inc.; Director at Prognos, Inc. | Joined ENSG's board in January 2020, chairs the Compensation Committee, and has extensive experience in healthcare data analytics. |
- Given the ongoing delays in licensing processes and Medicaid approvals you've mentioned, how are these affecting your cash flow projections for 2025, and what measures are you implementing to mitigate these impacts?
- With labor costs showing only gradual improvement, how do you plan to manage labor expenses in light of the California Workforce Standards program, and what effects do you anticipate on your margins in 2025?
- As you continue to acquire a significant number of operations, how are you ensuring that your disciplined growth strategy remains effective, particularly in terms of integration risks and maintaining a healthy balance sheet amid rapid expansion?
- Considering potential Medicaid reimbursement changes under the new administration, are there specific supplemental programs or quality incentive payments you are concerned about, and how would significant cuts affect your financial outlook and operations?
- In entering new markets like Tennessee and Alabama, which have different Medicaid structures and competitive landscapes, what challenges do you anticipate in establishing preferred provider relationships, and how will you ensure these new acquisitions become accretive to shareholders?
| Customer | Relationship | Segment | Details |
|---|---|---|---|
Medicaid | Government Reimbursement Program | Skilled Services | 46.9% of skilled services revenue in 2024 ; no separate $ data (N/A) |
Medicare | Government Reimbursement Program | Skilled Services | 25.9% of skilled services revenue in 2024 ; no separate $ data (N/A) |
Notable M&A activity and strategic investments in the past 3 years.
| Company | Year | Details |
|---|---|---|
5 Stand‐alone Skilled Nursing Operations (Q1 2024) | 2024 | Acquired five stand-alone skilled nursing operations adding 591 operational beds, with Standard Bearer acquiring the real estate of one facility that was leased back to an independent subsidiary, aligning with a strategy to grow both operations and real estate portfolios. |
5 Additional SN Ops, 1 LTAC Hospital & 2 Campus Ops (Post–Q1 2024) | 2024 | Acquired five additional stand-alone skilled nursing operations, one long-term acute care hospital, and two campus operations—adding 625 skilled nursing beds, 43 LTAC beds, and 202 senior living units, with real estate purchase of five operations leased back to subsidiaries. |
24 Stand‐alone SN Ops & 2 Campus Ops (Nine Months Ended Sept. 30, 2024) | 2024 | Acquired 24 stand‐alone skilled nursing operations and two campus operations that added a total of 2,565 skilled nursing beds (including 43 LTAC) and 202 senior living units, with real estate for nine operations purchased and leased back, structured via long-term leases and purchases. |
1 Campus Operation (Post–Sept. 30, 2024) | 2024 | Acquired one campus operation where Standard Bearer purchased the associated real estate for a total price of $3,140, adding 83 skilled nursing beds and 20 senior living units operated by an independent subsidiary. |
19 Stand‐alone SN Ops (Q1 2023) | 2023 | Added 19 stand‐alone skilled nursing operations through long-term leases that contributed 1,764 operational beds, with acquisitions executed via separate operations transfer agreements and without assuming significant liabilities. |
19 Stand‐alone SN Ops (Q2 2023) | 2023 | Added another 19 stand‐alone skilled nursing operations through long-term leases, again contributing 1,764 operational beds and involving transfer agreements with prior operators, reflecting a consistent expansion strategy. |
24 Stand‐alone SN Ops (Q3 2023) | 2023 | Acquired 24 stand‐alone skilled nursing operations through long-term leases, with Standard Bearer Healthcare REIT purchasing real estate for three of these operations (then leased back) and adding a total of 2,340 operational beds, reinforcing the integrated operational/real estate model. |
1 Stand‐alone SN Operation (Post–Sept. 30, 2023) | 2023 | Acquired one stand‐alone skilled nursing operation via a long-term lease that added 45 operational beds, furthering the company’s expansion in its core service areas without acquiring additional material assets or liabilities. |
4 SN Ops & 2 Senior Living Ops (Q1 2022) | 2022 | Expanded by acquiring four stand‐alone skilled nursing operations and two senior living operations—adding 453 SN beds and 403 senior living units—with an aggregate purchase price of $33,410 (split between real estate purchases and goodwill), aligning with a dual strategy of lease and purchase transactions. |
Additional Acquisitions (July–August 2022) | 2022 | Completed further acquisitions in July and August 2022 that were not reflected in the Q2 bed count, indicating post–second quarter expansion though detailed capacity figures were not provided. |
17 New Operations (Q3 2022) | 2022 | Added 17 new operations across Arizona, Nevada, South Carolina, and Texas, contributing 2,276 new operational beds, with Standard Bearer acquiring seven related real estate operations and Ensign entering into 13 new long-term leases, reinforcing geographic and operational expansion. |
11 SN Ops, 1 Campus Op & 5 Senior Living Ops (Nine Months Ended Sept. 30, 2022) | 2022 | Acquired 11 stand‐alone skilled nursing operations, one campus operation, and transferred five senior living operations from Pennant, adding 1,553 SN beds and 674 senior living units with a total purchase price of $82,099 (detailed into asset acquisitions and goodwill), supporting a broad portfolio expansion strategy. |
Recent press releases and 8-K filings for ENSG.
- The 2025 Annual Meeting of Stockholders was held on May 15, 2025 with a record date of March 20, 2025; 57,626,065 shares were eligible to vote and 53,021,533 shares were represented in person or by proxy.
- Four board director nominees were elected, including Mark V. Parkinson for a two-year term and Dr. Ann S. Blouin, Dr. John O. Agwunobi, and Mr. Barry R. Port for three-year terms, with detailed voting results provided.
- The meeting also resulted in the ratification of Deloitte & Touche LLP as the independent auditor, advisory approval of executive compensation, and approval of the amendment to the 2022 Omnibus Incentive Plan.