The Ensign Group, Inc. · NASDAQ:ENSG
The Ensign — Investor Presentation (May 2025)
52 slides from The Ensign's investor presentation, May 2025
Slide 1: Investor Presentation
ENSIGN GROUP May 2025 INVESTOR PRESENTATION www.ensigngroup.net
Slide 2: Table Of Contents
Table Of Contents About US Portfolio Our Services Financials Since 1999, the independent subsidiaries Each of the 350+ businesses are run Our independent subsidiaries offer a A clinically strong foundation combined of The Ensign Group, Inc. (ENSG) have independently encompassing services delivered b
Slide 3: Disclaimers
Disclaimers This presentation contains, and other communications of The Ensign Group, Inc. (“Ensign” or the “Company”) may contain, forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These statements can be identified by the fact that they do not r
Slide 4: Our Mission
Our Mission We rely on our culture to accomplish our mission CAPLICO Our mission is to support the operations we serve in dignifying post-acute care in the eyes of the world. We do that through “Moments of Truth” – everyday situations that are met with out-of-the-ordinary service that surpasses all
Slide 5: Leading Healthcare Services Operator With Proven Track Record
Leading Healthcare Services Operator With Proven Track Record 1999 17 Founded States 344 144 Operated Facilities Owned Properties 38,500+ 82.6% (1) Beds / Units Across the Care Continuum Occupancy Rate 50,500+ 33.1% (1) Employees Skilled Mix Days 15% 1,340% $4.91B (1) Annual Revenue Growth Total Sha
Slide 6: Entrepreneurial Evolution Of Ensign
Entrepreneurial Evolution Of Ensign The Ensign Group Established New Ensign Ensign entered Senior living Completed the Completed spin- Continues to Ensign formed Ensign was founded Market CEO completes an into the home portfolio spin-off of its off of home execute on local a Captive REIT, completed
Slide 7: Ensign's Commitment to The Care Continuum
Ensign’s Commitment to The Care Continuum Denotes Ensign Business Acute Care Local leadership strategy focused on acquisitions in fragmented markets. LTACH Inpatient Outpatient Rehab High quality healthcare outcomes across the Patient Service Intensity Rehab continuum driving local reputation and Sk
Slide 8: Ensign Strategically Positioned to Deliver Long-Term Value
Ensign Strategically Positioned to Deliver Long-Term Value Experienced Management Management team with combined experience over 90 years at Ensign alone. Presence in Attractive Markets Multiple Business Lines Presence in strategic markets across 17 states with Diversified operations including skille
Slide 9: Ensign's Investment Thesis
Ensign’s Investment Thesis Ensign is Positioned to Deliver Superior Clinical Results that Will Superior Results Generate Strong Financial and Operating Results Growth Opportunities Organic, Strategic, Real Estate and New Ventures Clinical Excellence Strategic Continuum of Care Culture 9
Slide 10: Leading Operational Presence in Attractive Markets
Leading Operational Presence in Attractive Markets 18 1714 1 3 States 12 8 344 3 8 Facilities 22 37 73 11 11 38,000+ 9 Beds 40 1 2 85 50,500+ Employees Skilled Nursing Operations - 299 Senior Living Operations - 13 Campus Operations - 31 LTAC – 1 Source: Data as of 05/01/2025 10
Slide 11: High-Quality Portfolio Of Assets
High-Quality Portfolio Of Assets Ensign’s real estate portfolio includes attractive assets in appealing markets that provide the foundation for patient care and well-being. Katella Senior Living Community Hillside Village of De Soto Alamitos West Health & Rehabilitation California Kansas California
Slide 12: Business Leaders Drive Results
Business Leaders Drive Results Track record of attracting, empowering & retaining clinically-focused business leaders. Local Leadership Superior Clinical Local Operation Clusters Outcomes of Choice Empowering local leaders and their teams We partner with many other healthcare Our independent subsidi
Slide 13: Local Leaders are Empowered by our Cluster Model
Local Leaders are Empowered by our Cluster Model Best Practices Shared Across Clusters Along with Economic and Payor Benefits at Cluster Level What is a Cluster? • Collaboration and connectivity between operations (“ops”) that are Economic Benefits geographically close together. • Sharing of resourc
Slide 14: Organizational Focus on Clinical Quality Leads to Superior Financial Results
Organizational Focus on Clinical Quality Leads to Superior Financial Results Clinical Quality Translates to Organic Growth(3) Ensign vs. Comparative States Our Cycle 1 health inspections are 9% better.(3) 21 38 45 60 77 72 86 100 91 102 116 114 113 130 129 145 2010 2011 2012 2013 2014 2015 2016 2017
Slide 15: Multifaceted Growth Opportunities
Multifaceted Growth Opportunities Driven by Organic as well as Strategic Opportunities Creating Value Skilled Mix Disciplined Acquisitions Organic Occupancy Distressed Assets Strategic Fundamentals New Ventures 15
Slide 16: A Disciplined Approach to Acquisitions & Track Record of Improving Operations
A Disciplined Approach to Acquisitions & Track Record of Improving Operations to Drive Continued Growth 28.8% of Ensign’s skilled nursing operations have been Proven track record of achieving significant improvement in (4) operated less than three full years just 5 quarters Occupancy EBITDAR Margin
Slide 17: Demonstrated Track Record of Significant Operational Improvements of Acquired Assets
Demonstrated Track Record of Significant Operational Improvements of Acquired Assets QTD Q1 2025 Consolidated (6) Consolidated 50.2% $784 Medicaid $300 (7) (8) (9) (10) Consolidated Consolidated 31.4% 81.9% 17 Refer to pages 50 - 51 for end notes. Source: Data as of Q1'25.
Slide 18: Track Record of Successfully Incubating New Ventures
Track Record of Successfully Incubating New Ventures Completed 2019 Completed in 2014 Completed in 2016 18 18 Spin Offs Divestitures Current 18
Slide 19: Significant Real Estate Portfolio
Significant Real Estate Portfolio As of May 1, 2025 Real Estate Distribution on Ensign operated Ensign Triple Net Master facilities of 344 and 36 Owned Real Estate Leases with Third Party Operators Leased to Third Party Operators (11) Lease • Multiple “triple-net” master leases 36 facilities Structu
Slide 20: Standard Bearer REIT Structure Summary & Key Benefits
Standard Bearer REIT Structure Summary & Key Benefits Ensign Affiliated Operations • Skilled Services • Real Estate Ownership • Senior Living Services • Real Estate Management & Monitoring • New Ventures • Investment Evaluation and Execution • Real Estate Portfolio Performance Reporting Increased Vi
Slide 21: Standard Bearer at a Glance
Standard Bearer at a Glance Geographic Footprint Key Statistics 8 $1.5B (12) 138 Real Estate 1 5 25 Properties Fair Value 1 2 1 8 14 7 6 14,037 16 3 States Operating 5 Beds / Units 18 32 2 14.3 Years 83.9% (13) Weighted Avg. Ensign Operated Lease Tenor Note: Figures represent the number of owned pro
Slide 22: Standard Bearer Continuation & Expansion of Real Estate Success
Standard Bearer Continuation & Expansion of Real Estate Success (14) Refer to pages 50–51 for end notes. Source: Data as of Q1 2025. 22
Slide 23: Standard Bearer Strong Long Term Leases
Standard Bearer Strong Long Term Leases 14.3 years 98% (15) Weighted Average of leases expire Lease Tenor after 2031 Tenant Rent Coverage Summary Q1 Q2 Q3 Q4 Q1 2024 2024 2024 2024 2025 Ensign Affiliated(16) 2.68 2.51 2.48 2.69 2.67 Third-Party 1.63 1.59 1.75 1.79 1.87 Total 2.5 2.36 2.36 2.53 2.56
Slide 24: Standard Bearer Metrics Quarter Over Quarter
Standard Bearer Metrics Quarter Over Quarter In $ Millions In $ Millions (17) (18) Refer to pages 50–51 for end notes. Source: Data as of Q1 2025. 24
Slide 25: Ensign Represents The Growth Story
Ensign Represents The Growth Story In the Facility-Based Healthcare Services & Post-Acute Sector ($mm) ($mm) (19) (19) (20) (21) (20) (21) Refer to pages 50 - 51 for end notes. 25
Slide 26: Liquidity Financials Measure
Liquidity Financials Measure Three Months Ended March 31, Summary of Cash Flows (In millions) 2025 2024 Net cash provided by (used in): Operating activities $72.2 $35.3 Investing activities (35) (243.8) (34.7) Financing activities (10.3) 1.6 Net (decrease) increase in cash and cash equivalents (181.
Slide 27: Quarter Over Quarter Highlights
Quarter Over Quarter Highlights (in millions) Q1 2025 Q1 2024 REVENUE 16.1% $1,173.0 $1,010.2 SAME FACILITY SKILLED NURSING FACILITY 5.6% $834.8 $790.8 REVENUE CONSOLIDATED ADJUSTED NET 18.0% $89.0 $75.4 INCOME Ensign Group | Investor Presentation 27
Slide 28: Guidance
Annual Revenue Guidance $4.89B to $4.94B 2025 Diluted Adjusted EPS $6.22 to $6.38 Diluted Adjusted EPS Midpoint is: 15% over 2024 32% over 2023 28
Slide 29: Strong Shareholder Returns Since IPO
Strong Shareholder Returns Since IPO Source: Data as of 05/09/2025. 29
Slide 30: Ensign Management Team
Ensign Management Team Christopher Barry Suzanne Chad Spencer Christensen Port Snapper Keetch Burton Executive Chairman Chief Executive Officer Chief Financial Officer, EVP Chief Investment Officer, EVP President, Chief Operating 25 Years and Director and Director and Secretary Officer 21 Years 18 Y
Slide 31: Appendix
Appendix www.ensigngroup.net
Slide 32: Fundamentals Remain Favorable for Strong Organic Growth
Fundamentals Remain Favorable for Strong Organic Growth Key Drivers of Organic Growth Over the last 10 years the CMS Shift to value-based care, will Shift to Value- Reimbursement reimbursement rates in the SNF continue to benefit low cost, high based Care Environment industry have increased at a ste
Slide 33: Fundamentals Remain Favorable for Strong Organic Growth
Fundamentals Remain Favorable for Strong Organic Growth Key Drivers of Organic Growth Aging Population over 65 projected to Population nearly double by 2060 (22) (23) (23) Favorable Backdrop for Growth in the Skilled Services Industry Refer to pages 50 - 51 for end notes. 33
Slide 34: One of The Largest Beneficiary Of Medicare Post-Acute Dollars
One of The Largest Beneficiary Of Medicare Post-Acute Dollars While Medicare Spending Continues to Increase (24) (25) Medicare Spending Projection Post-Acute Destinations - % of Medicare Dollars (in Billions) Ensign Group | Investor Presentation Refer to pages 50 - 51 for end notes. 34
Slide 35: Skilled Services Segment
Skilled Services Segment Three Months Ended March 31, $ in millions 2025 2024 Statements of Income Data: Segment income (26) $143,931 $126,809 Depreciation and amortization 13,213 10,536 EBITDA $157,144 $137,345 Adjustments to EBITDA: Stock-based compensation expense (28) 6,880 5,214 Adjusted EBITDA
Slide 36: Standard Bearer Segment
Standard Bearer Segment Three Months Ended March 31, $ in millions 2025 2024 Rental revenue generated from third-party tenants $4,497 $4,195 Rental revenue generated from Ensign’s independent subsidiaries 23,904 18,006 Total rental revenue $28,401 $22,201 Segment income (18) 8,583 7,258 Depreciation
Slide 37: Reconciliation of GAAP to Non-GAAP Income
Reconciliation of GAAP to Non-GAAP Income Three Months Ended March 31, $ in millions 2025 2024 Net income attributable to The Ensign Group, Inc. $80,277 $68,835 Non-GAAP adjustments Stock-based compensation expense (28) 10,724 8,238 Litigation (27) — 764 Cost of services – impairment of long-lived a
Slide 38: Reconciliation of GAAP to Non-GAAP Financial Measures
Reconciliation of GAAP to Non-GAAP Financial Measures Three Months Ended March 31, $ in millions 2025 2024 Income before provision for income taxes $106,580 $89,598 Non-GAAP adjustments Stock-based compensation (28) 10,724 8,238 Litigation (27) — 764 Impairment of long-lived assets — 1,849 Acquisiti
Slide 39: Reconciliation of GAAP to Non-GAAP Financial Measures
Reconciliation of GAAP to Non-GAAP Financial Measures Three Months Ended March 31, $ in millions 2025 2024 Net income $80,353 $68,960 Less: net income attributable to noncontrolling interests 76 125 Interest income 6,883 6,460 Add: Provision for income taxes 26,227 20,638 Depreciation and amortizati
Slide 40: Reconciliation From Segment Income to Income Before Provisions For Income Taxes
Reconciliation From Segment Income to Income Before Provisions For Income Taxes QTD Q1 2025 Skilled Services Standard Bearer All Other Eliminations Consolidated $ in millions Total Revenue $1,123,554 $28,401 $52,426 $(31,340) $1,173,041 Cost of services 891,855 598 39,792 (4,396) 927,849 Internal re
Slide 41: Reconciliation From Segment Income to GAAP EBITDA and Non-GAAP EBITDA
Reconciliation From Segment Income to GAAP EBITDA and Non-GAAP EBITDA QTD Q1 2025 $ in millions Skilled Services Standard Bearer All Other Eliminations Consolidated Segment income (loss) $143,931 $8,583 $(45,934) — $106,580 Interest expense (income) — 8,736 (13,582) — (4,846) Depreciation and amorti
Slide 42: Reconciliation of Deferred Compensation Plan (DCP)
Reconciliation of Deferred Compensation Plan (DCP) Impact 5 Quarter Trend $ in millions Q1 2025 Q4 2024 Q3 2024 Q2 2024 Q1 2024 Non-GAAP Revenue 1,173,041 1,132,252 1,081,776 1,036,285 1,010,172 Non-GAAP cost of services 920,209 890,214 853,260 815,911 791,899 Less: DCP gain (loss) related to cost o
Slide 43: Property Locations
Property Locations # of Operating Beds / Property Name State Property Type Tenant Units Alta Mesa Health and Rehabilitation and The Groves Assisted and Independent AZ Campus 176 Ensign Senior Living Community Arrowhead Springs Healthcare CA SNF 99 Ensign Atchison Senior Village Rehabilitation and Nu
Slide 44: Property Locations
Property Locations # of Operating Beds / Property Name State Property Type Tenant Units Crestwood Health & Rehabilitation Center TX Campus 148 Ensign Decatur County Healthcare TN SNF 115 Ensign Deer Creek Senior Living TX Senior Living 37 Pennant Desert Blossom Health and Rehabilitation Center AZ SN
Slide 45: Property Locations
Property Locations # of Operating Beds / Property Name State Property Type Tenant Units Lo-Har Senior Living CA Senior Living 29 Pennant Lotus Gardens Senior Living WI Senior Living 44 Pennant Madison Pointe Senior Living WI Senior Living 39 Pennant Magnolia Post Acute Care CA SNF 99 Ensign Maple Me
Slide 46: Property Locations
Property Locations # of Operating Beds / Property Name State Property Type Tenant Units Olive Ridge Senior Living AZ Senior Living 73 Ensign Olympia Transitional Care and Rehabilitation WA SNF 113 Ensign Opus Post Acute Rehabilitation SC SNF 98 Ensign Pacific Haven Subacute and Healthcare Center CA
Slide 47: Property Locations
Property Locations # of Operating Beds / Property Name State Property Type Tenant Units Riverwalk Post Acute and Rehabilitation CO SNF 60 Ensign Rock Canyon Respiratory & Rehabilitation Center CO SNF 81 Ensign Rock Creek of Ottawa KS Campus 146 Ensign Rock Hill Post Acute Care Center SC SNF 99 Ensig
Slide 48: Property Locations
Property Locations # of Operating Beds / Property Name State Property Type Tenant Units The Healthcare Resort of Leawood KS Campus 94 Ensign The Healthcare Resort of Topeka KS Campus 94 Ensign The Medical Lodge of Amarillo TX SNF 82 Ensign The Mildred & Shirley L. Garrison Geriatric Education and Ca
Slide 49: End Notes
End Notes www.ensigngroup.net
Slide 50: End Notes
End Notes 1 — Occupancy and Skilled Mix metrics represent same store metrics for Q1'25. Reflects midpoints of 2025 guidance ranges of $4.89B to $4.94B for annual revenue and $6.22 to $6.38 for diluted adjusted EPS. [Slide 5] 2 — Adjusted EBITDAR consists of net income before (a) interest income, (b)
Slide 51: End Notes
End Notes 18 —Segment income reflects profit or loss from operations before provision for income taxes, gain or loss from sale of real estate, insurance recoveries from real estate, and impairment of long-lived assets. Included in Standard Bearer segment income for the three months ended March 31, 2
Slide 52: Thank You
ENSIGN <== GROUP