Ensign Group, Inc (NASDAQ: ENSG)

The Ensign Group, Inc. is a holding company with independent subsidiaries that provide skilled nursing, senior living and rehabilitative services, as well as other ancillary businesses including mobile diagnostics and medical transportation, in 17 states. As part of its investment strategy, the company acquires, leases and owns healthcare real estate to service the post-acute care continuum through acquisition and investment opportunities in healthcare properties. For the year ended December 31, 2025, it generated approximately 95.6% of its revenue from skilled nursing facilities, with the remainder primarily generated from real estate properties, senior living services and other ancillary services.

The company generates revenue primarily from the operation of skilled nursing facilities, which includes Medicaid, Medicare, managed care, commercial insurance and private pay sources. It also derives revenue from senior living operations, mobile diagnostics, transportation, other real estate and other ancillary operations, which together comprise approximately 4.6% of annual revenue. Additionally, through its Standard Bearer segment, the company generates rental revenue by leasing post-acute care properties it acquired to healthcare operators under triple-net lease arrangements, where tenants are responsible for property taxes, insurance and maintenance and repair costs.

The company operates through the following segments: skilled services, Standard Bearer and an all other category.

• Skilled Services: This segment includes the operation of skilled nursing facilities and rehabilitation therapy services. As of December 31, 2025, the company provided skilled nursing care at 357 operations with 37,911 operational beds across multiple states. It offers short and long-term nursing care services for patients with chronic conditions, prolonged illness and the elderly, including those recovering from strokes, cardiovascular and respiratory conditions, neurological conditions, joint replacements and other muscular or skeletal disorders. The segment uses interdisciplinary teams of experienced medical professionals to provide services prescribed by physicians, including on-site dialysis, ventilator care, cardiac and pulmonary management, as well as standard services such as room and board, special nutritional programs, social services, recreational activities and entertainment. Revenue is generated from Medicaid, Medicare, managed care, commercial insurance and private pay, with approximately 46.6% and 24.7% of skilled services revenue derived from Medicaid and Medicare programs, respectively, during the year ended December 31, 2025.

• Standard Bearer: This segment is comprised of select properties owned by the company through its captive REIT and leased to skilled nursing and senior living operations, including its own independent subsidiaries and third-party operators. As of December 31, 2025, the real estate portfolio within Standard Bearer consisted of 152 real estate properties located in multiple states, with 116 leased to independent subsidiaries and 37 leased to third-party operators. During the year ended December 31, 2025, the segment generated rental revenues of $126.9 million, of which $107.6 million was derived from independent subsidiaries and therefore eliminated in consolidation. The segment engages in the acquisition and leasing of skilled nursing and senior living properties under triple-net lease arrangements.

• All Other: This category includes operating results from senior living operations, other real estate, other ancillary operations and the Service Center. Services in this category are individually insignificant and do not constitute a reportable segment. As of December 31, 2025, the company had an aggregate of 3,402 senior living units across 47 operations, providing residential accommodations, activities, meals, housekeeping and assistance in activities of daily living to seniors. Ancillary services, including mobile diagnostics and medical transportation, were operated by independent subsidiaries in select states and were not meaningful contributors to operating results during the period.

The Ensign Group, Inc. is well positioned within the post-acute care industry, which is large and highly fragmented, characterized by numerous local and regional providers alongside large national providers. The company believes its ability to acquire, integrate and improve facilities is a direct result of its experienced and dedicated employees, unique incentive programs, staff and leadership development, innovative Service Center approach, proven track record of successful acquisitions, successful real estate investment strategy, reputation for quality care, community focused approach and investment in information technology. These competitive strengths enable the company to attract patients requiring more intensive and medically complex care and generally result in higher reimbursement rates than lower acuity patients.

The company serves patients requiring skilled nursing care, senior living services and rehabilitative therapy, including those with chronic conditions, prolonged illness and the elderly. Its customer base includes individuals paying through Medicaid, Medicare, managed care, commercial insurance and private pay sources. The company also serves seniors in independent living units and those receiving ancillary services such as mobile diagnostics and medical transportation. Specific customer names are not disclosed in the filing.