Ensign Group, Inc (NASDAQ: ENSG)

Sector: Healthcare Industry: Medical Care Facilities CIK: 0001125376
Market Cap 12.18 Bn
P/B 5.46
P/E 35.41
P/S 2.41
ROIC (Qtr) 7.17
Div Yield % 0.12
Rev 1y % (Qtr) 20.17
Total Debt (Qtr) 2.21 Bn
Debt/Equity (Qtr) 0.99
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About

Investment thesis

Bull case

  • Healthy cash reserves of 503.88M provide 4.23x coverage of short-term debt 119.04M, demonstrating strong liquidity position and minimal refinancing risk.
  • Operating cash flow of 564.27M provides exceptional 1925.84x coverage of minority interest expenses 293000, showing strong core operations.
  • Operating cash flow of 564.27M provides strong 11.68x coverage of stock compensation 48.30M, indicating sustainable incentive practices.
  • Operating cash flow of 564.27M provides exceptional 70.64x coverage of interest expenses 7.99M, showing strong debt service capability.
  • Robust free cash flow of 370.71M exceeds capital expenditure of 193.56M by 1.92x, indicating strong organic growth funding capability.

Bear case

  • Operating cash flow of 564.27M barely covers its investment activities of (513.18M), with a coverage ratio of -1.10, indicating heavy reliance on external financing for growth which may not be sustainable in a tighter credit environment.
  • Operating cash flow of 564.27M provides thin coverage of dividend payments of (14.41M) with a -39.16 ratio, suggesting potential dividend sustainability issues if operational performance deteriorates.
  • Cash reserves of 503.88M provide limited coverage of acquisition spending of (323.26M), which is -1.56x, suggesting aggressive expansion might strain liquidity if market conditions deteriorate.
  • Free cash flow of 370.71M represents just -90.73x of debt issuance (4.09M), suggesting concerning reliance on leverage rather than internal cash generation for growth.
  • R&D investment of 0 represents just 0x of SG&A expenses of 269.82M, indicating potential underinvestment in innovation relative to administrative overhead.

Customer Breakdown of Revenue (2025)

Segments Breakdown of Revenue (2025)

Peer comparison

Companies in the Medical Care Facilities
S.No. Ticker Company Market Cap P/E P/S Total Debt (Qtr)
1 HCA HCA Healthcare, Inc. 126.41 Bn 18.63 1.67 48.35 Bn
2 UHS Universal Health Services Inc 23.26 Bn 34.22 2.61 5.11 Bn
3 THC Tenet Healthcare Corp 21.11 Bn 15.01 0.99 13.17 Bn
4 FMS Fresenius Medical Care AG 14.42 Bn 17.06 0.62 14.98 Bn
5 EHC Encompass Health Corp 13.38 Bn 30.01 2.91 2.66 Bn
6 ENSG Ensign Group, Inc 12.18 Bn 35.41 2.41 2.21 Bn
7 DVA Davita Inc. 11.17 Bn 14.95 0.82 12.87 Bn
8 CHE Chemed Corp 8.11 Bn 81.70 5.57 0.14 Bn

Industry comparisons

Current Valuation Value Ind Avg Percentile
EV to Assets EV to Assets 2.54 1.24
EV to Cash from Ops. EV/CFO 24.62 15.08
EV to Debt EV to Debt 6.30 11.01
EV to EBIT EV/EBIT 29.99 15.96
EV to EBITDA EV/EBITDA 26.23 11.44
EV to Free Cash Flow [EV/FCF] EV/FCF 37.48 21.76
EV to Market Cap EV to Market Cap 1.14 619.57
EV to Revenue EV/Rev 2.75 2.71
Price to Book Value [P/B] P/B 5.46 -6.00
Price to Earnings [P/E] P/E 35.41 12.61
Dividend Metrics Value Ind Avg Percentile
Dividend Coverage Ratio Div Coverage (Qtr) 23.87 0.14
Dividend Payout Ratio % Div Payout % (Qtr) 4.20 -13.46
Dividend per Basic Share Div per Share (Qtr) 0.25 0.27
FCF Dividend Payout Ratio % FCF Div Payout % (Qtr) 3.91 5.42
Interest Coverage Int. cover (Qtr) 58.00 -94.29
Growth Metrics Value Ind Avg Percentile
Capex Growth (1y) % Capex 1y % (Qtr) -22.32 -116.62
Cash and Equivalents Growth (1y) % Cash & Equiv 1y % (Qtr) 8.46 46.03
Dividend Growth (1y) % Div 1y % (Qtr) 4.55 0.98
EBIAT Growth (1y) % EBIAT 1y % (Qtr) 14.99 -42.57
EBITDA Growth (1y) % EBITDA 1y % (Qtr) 19.71 91.55
EBIT Growth (1y) % EBIT 1y % (Qtr) 17.62 -56.79
EBT Growth (1y) % EBT 1y % (Qtr) 18.08 -111.80
EPS Growth (1y) % EPS 1y % (Qtr) 14.07 -19.28
FCF Growth (1y) % FCF 1y % (Qtr) 96.20 188.37
Gross Profit Growth (1y) % Gross Profit 1y % (Qtr) 19.75 20.14
Liquidity Ratios Value Ind Avg Percentile
Asset Utilization Ratio Asset Util Ratio (Qtr) 0.93 1.02
Cash Payout Ratio Cash Payout (Qtr) 0.02 0.04
Cash Ratio Cash Ratio (Qtr) 0.56 0.40
Current Ratio Curr Ratio (Qtr) 1.42 1.36
Debt to Equity Ratio Debt/Equity (Qtr) 0.99 -13.23
Interest Cover Ratio Int Coverage (Qtr) 58.00 -94.29
Times Interest Earned Times Interest Earned (Qtr) 58.00 -94.29
Profitability Value Ind Avg Percentile
EBITDA Margin % EBITDA Margin % (Qtr) 11.20 -75.46
EBIT Margin % EBIT Margin % (Qtr) 9.16 -74.60
EBT Margin % EBT Margin % (Qtr) 9.00 -85.12
Gross Margin % Gross Margin % (Qtr) 15.80 23.17
Net Profit Margin % Net Margin % (Qtr) 6.80 -85.79