ENSIGN GROUP (ENSG)·Q4 2025 Earnings Summary

Ensign Group Delivers Record Q4 as Occupancy Hits All-Time High, Guides +14% EPS Growth

February 4, 2026 · by Fintool AI Agent

The Ensign Group (NASDAQ: ENSG) delivered another record quarter with Q4 2025 results that beat on both the top and bottom line, powered by all-time high occupancy and accelerating skilled mix. The skilled nursing operator reported adjusted EPS of $1.82, crushing consensus by 13%, while revenue of $1.36 billion topped estimates by 6.3%.

Management issued 2026 guidance above Street expectations, projecting 14% EPS growth at the midpoint—signaling confidence in the company's organic growth runway and acquisition pipeline.

Did Ensign Beat Earnings?

Yes, decisively. Ensign delivered a double beat with strong momentum across all key metrics:

This marks Ensign's seventh consecutive EPS beat over the past eight quarters, with only Q2 2025 showing a slight miss. The company has established a pattern of under-promising and over-delivering.

Year-Over-Year Momentum

What Did Management Guide?

Management's 2026 outlook came in above consensus, reflecting confidence in continued organic execution and acquisition integration:

Key assumptions in guidance:

• Diluted weighted average shares: ~60.0 million
• Tax rate: 25.0%
• Includes acquisitions expected to close through Q1 2026
• Excludes stock-based compensation and acquisition-related costs

CEO Barry Port emphasized the organic growth runway: "At 83%, we have enough organic growth potential left in our organization to sustain our consistent earnings and revenue growth, even if we stopped acquiring."

What Changed From Last Quarter?

Occupancy Hits Record Levels

The key story this quarter is occupancy—same-facility occupancy reached 83.8%, an all-time high, up 2.9% year-over-year.

Skilled Mix Expansion Continues

Higher-acuity patients (Medicare, managed care, and other skilled) now represent 30.5% of nursing days, up from 29.1% a year ago. This drives higher revenue per patient day.

Medicare revenue improvements:

• Same Facilities: +15.7% YoY in Q4
• Transitioning Facilities: +11.3% YoY in Q4

Clinical Quality Driving Referrals

Management highlighted CMS data showing Ensign-affiliated facilities outperformed peers:

• 24% better annual survey results vs. state peers
• 33% better vs. county-level peers
• 19% advantage in 4- and 5-star rated buildings

Acquisition Activity

Ensign accelerated its acquisition pace, adding 17 operations during Q4 and since, including 12 real estate assets. For full-year 2025, the company acquired 51 operations.

Q4 2025 Acquisitions Included:

Leased Operations:

• The Health Center of Eastview (90 beds, Birmingham, AL)
• The Rehabilitation Center at Sandalwood (103 beds, Wheat Ridge, CO)
• Edgewater Health and Rehabilitation (69 beds, Lakewood, CO)
• Santa Rosa Care Center (144 beds, Tucson, AZ)
• Agave Grove Post Acute (225 beds, Glendale, AZ)

Real Estate Acquisitions (Standard Bearer):

• Stonehenge portfolio (7 facilities, Utah)
• Willow Point Rehabilitation (45 beds, Kansas City, KS)
• The Chateau Waco (123 beds, Waco, TX)
• Sunset Valley Rehabilitation (80 beds, Littlefield, TX)
• Wylie Oaks Healthcare (106 beds, Wylie, TX)
• Timber Ridge Health (48 beds, Stevens Point, WI)

Chief Investment Officer Chad Keetch noted: "Our building-by-building approach to transitions works for single operations, small portfolios and larger portfolios, particularly when a larger deal spans several markets and geographies."

Current Portfolio:

• 378 healthcare operations across 17 states
• 31 campuses with senior living
• 160 owned real estate assets (124 operated by Ensign affiliates)

Standard Bearer Real Estate Segment

The company's real estate segment (Standard Bearer) continues to deliver strong growth:

Full-year 2025 rental revenue reached $126.9M (+33.5% YoY) with FFO of $75.2M (+28.3% YoY).

Balance Sheet and Liquidity

Ensign maintains a strong financial position to fund continued acquisitions:

Cash from operations totaled $564.3 million for full-year 2025, up 63% from $347.2 million in 2024.

The company raised its quarterly dividend for the 23rd consecutive year (current rate: $0.065/share).

How Did the Stock React?

ENSG shares closed at $173.18 on February 4, 2026, down 0.2% on the day. However, the earnings were released after market close, so the full market reaction will be visible in the February 5 session.

Recent Trading Context:

• 52-week high: $194.00
• 52-week low: $118.73
• Current market cap: ~$10.0 billion
• Stock is up ~46% from its 52-week low

The conference call is scheduled for February 5, 2026 at 10:00 AM PT, where management will take analyst questions.

Key Takeaways

1. Double Beat: Revenue +6.3% and adjusted EPS +13% above consensus, marking the 7th beat in 8 quarters
2. Record Occupancy: Same-facility occupancy hit all-time high of 83.8%, with room to grow toward the mid-90s seen at mature facilities
3. Guidance Above Street: 2026 EPS midpoint of $7.51 is 3.3% above consensus, with 14% YoY growth implied
4. Acquisition Machine Continues: 51 operations acquired in 2025, with more expected in Q1 2026
5. Skilled Mix Tailwind: Higher-acuity patients now 30.5% of days, driving revenue per patient day expansion
6. Strong Cash Generation: Operating cash flow up 63% YoY to $564M, funding organic growth and acquisitions

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Related Links:

• ENSG Company Profile
• Q4 2025 8-K Filing
• Q3 2025 Earnings Recap