Executive Summary

Q4 2024 delivered double‑digit top-line growth and strong earnings: total revenue rose 15.5% year over year to $1.13B and GAAP diluted EPS was $1.36; adjusted diluted EPS was $1.49 .
Management issued 2025 guidance of $6.16–$6.34 diluted EPS and $4.83–$4.91B revenue; the EPS midpoint implies ~13.8% growth vs 2024, supported by continued occupancy and skilled mix momentum and a robust acquisition pipeline .
Liquidity and balance sheet are strong with $464.6M cash, $572.1M revolver capacity, and a record low lease‑adjusted net debt/EBITDA of 1.9x; quarterly dividend of $0.0625 was paid, following a 22nd consecutive annual increase in December 2024 .
Stock reaction catalysts: above‑trend unit growth (12 new operations during and after the quarter), accelerating Standard Bearer REIT FFO ($15.3M), and confident tone on continued disciplined M&A and 2025 execution .

What Went Well and What Went Wrong

What Went Well

“Record clinical and financial results” with Q4 revenue up 15.5% YoY and adjusted EPS up 16.4% YoY; same‑store occupancy reached 81.7% and transitioning occupancy 77.5% .
Managed care census and skilled days inflected: managed care days up 6.6% (same store) and 27.7% (transitioning) YoY; skilled days up 3.8% (same store) and 10.9% (transitioning) YoY .
Standard Bearer momentum: rental revenue $25.1M and FFO $15.3M in Q4, with 129 owned properties and 2.5x EBITDAR‑to‑rent coverage cited on the call .

Management quotes:

“Our leaders…posted record clinical and financial results… we were pleased to see same store and transitioning occupancy increase to 81.7% and 77.5% for the fourth quarter” – CEO Barry Port .
“We are issuing our annual 2025 earnings guidance of $6.16 to $6.34 per diluted share and annual revenue guidance of $4.83 billion to $4.91 billion” – CEO Barry Port .
“We continue to add…12 new operations… focusing on acquisitions accretive in the near- and long-term” – CIO Chad Keetch .

What Went Wrong

Slight decline in skilled mix vs prior year: skilled mix by nursing revenue fell to 47.8% from 49.0% YoY (total) despite occupancy gains, reflecting payer mix shifts including more Medicaid .
Cash flow timing headwind: CFO flagged delayed Medicaid certifications/licensing for acquisitions stretching cash conversion near term .
Policy/regulatory uncertainty: management discussed potential Medicaid program changes under a new administration, though they currently see no specific program at risk; still a monitoring item for investors .

Financial Results

Headline P&L vs Prior Periods and Prior Year

Metric	Q4 2023	Q2 2024	Q3 2024	Q4 2024
Total Revenue ($USD Millions)	$980.4	$1,036.3	$1,081.8	$1,132.3
Service Revenue ($USD Millions)	$974.7	$1,030.6	$1,076.1	$1,126.4
GAAP Diluted EPS ($)	$0.38	$1.22	$1.34	$1.36
Adjusted Diluted EPS ($)	$1.28	$1.32	$1.39	$1.49
GAAP Net Income ($USD Millions)	$21.8	$71.2	$78.6	$79.8
Income from Operations ($USD Millions)	$22.8	$86.0	$89.3	$100.8

Consensus estimate comparisons were unavailable due to S&P Global request limits; therefore, beats/misses versus Street are not included here.

Margins

Metric	Q4 2023	Q2 2024	Q3 2024	Q4 2024
EBITDA Margin %	4.7%*	10.4%*	10.6%*	10.9%*
Net Income Margin %	2.2%*	6.9%*	7.2%*	7.0%*
EBIT Margin %	2.3%*	8.3%*	8.2%*	8.9%*

Values marked with an asterisk were retrieved from S&P Global. Values retrieved from S&P Global.

Adjusted EBITDA and Rent (as reported)

Metric ($USD Millions)	Q4 2023	Q3 2024	Q4 2024
Adjusted EBITDA	$112.9	$123.9	$133.6
Rent – Cost of Services	$50.6	$54.8	$56.1
Adjusted EBITDAR	$189.7	$178.7	$189.7

Segment Breakdown

Segment ($USD Millions)	Q4 2023	Q3 2024	Q4 2024
Skilled Services Revenue	$940.8	$1,033.1	$1,082.8
Standard Bearer Rental Revenue	$21.9	$24.4	$25.1
Standard Bearer FFO	$14.2	$14.8	$15.3

KPIs

KPI	Q4 2023	Q3 2024	Q4 2024
Actual Patient Days (Total)	2,227,888	2,407,709	2,469,517
Occupancy % — Operational Beds (Total)	79.2%	80.9%	80.9%
Skilled Mix by Nursing Days (Total)	29.5%	29.7%	29.1%
Same Facility Occupancy %	79.9%	81.7%	81.7%
Transitioning Facility Occupancy %	74.0%	76.9%	77.5%

Guidance Changes

Metric	Period	Previous Guidance	Current Guidance	Change
Diluted EPS	FY 2024	$5.38–$5.50 (Q2)	$5.46–$5.52 (Q3)	Raised/Narrowed
Revenue	FY 2024	$4.20–$4.22B (Q2)	$4.25–$4.26B (Q3)	Raised
Diluted EPS	FY 2025	—	$6.16–$6.34	New
Revenue	FY 2025	—	$4.83–$4.91B	New
Shares (assumption)	FY 2025	—	~59.5M diluted	New
Tax Rate (assumption)	FY 2025	—	25.0%	New
Dividend per Share (Quarterly)	Q4 2024	$0.060 (Q3)	$0.0625 paid (Q4); increased Dec 2024	Raised

Notes: Guidance excludes certain non‑recurring charges (e.g., stock‑based compensation, acquisition costs), assumes normalized health insurance costs and current reimbursement rate expectations .

Earnings Call Themes & Trends

Topic	Previous Mentions (Q2 & Q3)	Current Period (Q4)	Trend
Occupancy & Skilled Mix	Same‑store occupancy 80.8% (Q2); record same‑store occupancy 81.7% (Q3), skilled days up across payors	Same‑store 81.7%, transitioning 77.5%; skilled days +3.8%/+10.9% YoY, managed care census +6.6%/+27.7%	Sustained strength
Managed Care Penetration	Managed care revenue +12.2% (Q2), +11.2% (Q3)	Continued managed care day growth; facility examples driving preferred status	Improving
M&A Pipeline & Discipline	Raised deal count across multiple states; focus on disciplined pricing and leader‑driven clusters	12 new operations during/after quarter; selective, accretive acquisitions; Standard Bearer added assets	Accelerating
Labor & Agencies	Lower turnover 11th straight quarter; decreasing agency use (Q2)	Gradual labor improvement; 2025 California Workforce Standards baked into guidance	Tailwind
Policy/Regulatory	N/A	Medicaid backdrop monitored; no specific programs at risk identified; industry engagement	Watch item
Cash Flow Timing	N/A	Temporary CF stretch from licensing/Medicaid delays on acquisitions	Near‑term headwind

Management Commentary

CEO Barry Port: “We are issuing our annual 2025 earnings guidance of $6.16 to $6.34 per diluted share and annual revenue guidance of $4.83 billion to $4.91 billion… we are well‑positioned to have another outstanding year in 2025” .
CFO Suzanne Snapper: “As the company’s liquidity remains strong, we plan to continue [our] long history of paying dividends… cash and cash equivalents of $464.6 million and cash flow from operations of $347.2 million” .
CIO Chad Keetch: “We continue to see more and more opportunities to acquire new operations, and our focus is to carefully choose the acquisitions that will be accretive to shareholders in both the near‑ and long‑term” .
COO Spencer Burton: Highlighted operational turnarounds (e.g., Boulder Canyon: occupancy 84.4%, managed care days +200% YoY, EBIT +131%) driven by leadership and clinical outcomes .

Q&A Highlights

Medicaid landscape: Management sees no specific program at risk now; engaged with industry associations, expects broader cuts would be difficult; preparing for various scenarios .
Tennessee outlook: Supplemental programs approved through July 1 with efforts to extend; established local relationships to build preferred provider status .
Seasonality: EPS and occupancy historically strongest in Q4/Q1; Q3 strength rolled into Q4 and continued into Q1 2025 .
Cash flow: Temporary stretch from licensing/Medicaid certification delays on acquisitions; Q4 impacted by a settlement payment flagged in Q3 .
Labor costs: Gradual improvement; California Workforce Standards fully included in 2025 guidance .
Deal terms/competition: Abundant deal flow; disciplined on lease coverage and price per bed; avoid paying for pro forma performance .

Estimates Context

Wall Street consensus (S&P Global) for Q4 EPS and revenue was unavailable due to request limits. As a result, we cannot determine formal beats/misses versus Street this quarter.
Given management’s 2025 guidance ($6.16–$6.34 EPS; $4.83–$4.91B revenue), models may need alignment with assumptions on 59.5M diluted shares and a 25% tax rate, as well as continued acquisition contributions and occupancy/mix momentum .

Key Takeaways for Investors

Strong operating momentum with Q4 revenue +15.5% YoY and adjusted EPS +16.4% YoY; same‑store occupancy anchored at 81.7% and transitioning occupancy up to 77.5% .
2025 guide implies double‑digit EPS growth; confident tone backed by liquidity ($464.6M cash, $572.1M revolver) and record low lease‑adjusted net debt/EBITDA of 1.9x .
Composition shift (skilled mix % modestly lower YoY) warrants monitoring, but managed care days and skilled days improved meaningfully, supporting rate/mix resilience .
M&A runway remains a core growth driver; management emphasizes disciplined underwriting (lease coverage, price per bed) and leader‑driven clustering to ensure accretive outcomes .
Near‑term cash flow timing could be choppy due to licensing/Medicaid processing delays on acquisitions; investors should look through temporary working capital variability .
Dividend growth story intact (22nd annual increase) and ongoing quarterly payments support total return; Standard Bearer FFO growth adds durable REIT income stream .
Trading lens: Absent Street estimates, the narrative is driven by visible 2025 guide, operating KPIs, and acquisition cadence—watch upcoming asset closings and any state reimbursement updates (e.g., Tennessee) for catalyst windows .

ENSIGN GROUP, INC (ENSG)·Q4 2024 Earnings Summary