The Ensign Group, Inc. · NASDAQ:ENSG
The Ensign — Q2 2026 Earnings Presentation
52 slides from The Ensign's earnings presentation, 2026
Slide 1: Investor Presentation
ENSIGN == GROUP INVESTOR PRESENTATION
Slide 2: 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
Slide 3: The Ensign Group: Leading Operator
The Ensign Group Founded 1999 States 17 Leading Operated Facilities 398 Owned Properties 185 Operator Beds / units across the care continuum 44K Same Facilities Occupancy Rate(1) 84.1% Employees 60K Unique residents cared for in 2026 annualized 200K+ C LI N I CAL S T REN G T H S HAREH O LDE R RET U
Slide 4: Executive Summary
The Ensign Group Executive Summary Clinical excellenc e Local leadership creates Proven model Provider of choice fuels sustainable enduring competitive Transforms clinical and in the communities growth advantage financial resul ts we serve Ensign Group 2026 Investor Presentation | 4
Slide 5: At a Glance
The Ensign Group GEOGRAPHIC FOOTPRINT (3) At a Glance 18 K EY ST AT I ST I C S ( 3) States 17 1 15 5 Total Operations 398 3 29 8 10 39 Skilled Nursing Operations 350 85 12 11 Senior Living Operations 16 42 2 9 Campus Operations 32 107 2 2 A Fragmented Industry 2.5% 12% 14,700 Top 10 Operators SKILLE
Slide 6: Key Highlights
The Ensign Group Key Highlights MISSION LEADERSHIP GROWTH REAL ESTATE FINANCIALS Founded with a mission that Every person, process, and Empowered local leaders Leading operator with a long Disciplined investments Strong financial results are fosters an enduring culture. system is aligned around buil
Slide 7: Our Mission and Values
The Ensign Group Our Mission and Values To dignify post-acute care in the eyes of the world through Moments of Truth CUSTOMER SECOND, ACCOUNTABILITY, PASSION FOR LEARNING, LOVE ONE ANOTHER, INTELLIGENT RISK TAKING, CELEBRATION, OWNERSHIP What is a Moment of Truth? A values-based leadership framework
Slide 8: Moments of Truth
Moments of Truth A Culture of Caring for Our Residents – Highlights from the quarter Lacey K.’s Passport to Flavor program brings the world to Polaris Transitional Care residents through monthly cultural and culinary experiences. Through her creativity, dedication, and personal investment, Lacey has
Slide 9: Winning the Ensign Flag
The Ensign Group Winning the Ensign Flag Winning The Flag is one of Ensign’s highest What Defines a Flag Winner • Proven Local Leadership honors, recognizing operations that excel in clinical quality, culture, compliance, employee • Best-in-Class Compliance • Highly Engaged Workforce • Industry-Lead
Slide 10: Clinical Focus
The Ensign Group Clinical Focus OneClinical unites nursing and therapy as one team, creating enhanced clinical outcomes through shared expertise and accountability. Mary Spaeder, Therapy Leader S HO RT -S TA Y MEA SU RES FO R L ON G -S TA Y M EA SU RES FO R T EAM RET EN T IO N S AME FAC IL I T IE S
Slide 11: Raising the Standard of Care
Raising the Standard of Care The Reserve represents a remarkable turnaround story. Prior to its acquisition by Ensign affiliates, the facility had been designated a CMS Special Focus Facility and faced significant regulatory challenges, including Immediate Jeopardy findings in 2023. Since then, mana
Slide 12: Resident and Staff Perspectives
RES ID ENT PE RS PE CT I VES S TA FF PE RS PE CT I VES “The facility has improved greatly from “Over the past 2.5 years The Reserve Bob B., Maintenance Director, brings joy to residents the flowers in the front, to the people, has grown in multiple areas, improving through special projects, includin
Slide 13: Quality Outcomes: Health Inspection Results
Quality Outcomes Clinical quality is the foundation of everything we do. Achieving strong Cycle 1 health inspection results not only validates the quality of care we provide, but also strengthens referral relationships, supports census growth, and reinforces our ability to deliver sustainable long-t
Slide 14: Quality Outcomes: CMS Quality Measure Rating
Quality Outcomes What is the CMS Quality Measure Rating? CMS Quality Measures reflect resident outcomes and clinical effectiveness, tracking how successfully facilities improve health, function, and quality of life. A higher score is better. T O T AL Q UAL I TY MEAS U RE VE RSU S T O P PEERS B Y SC
Slide 15: Local Leadership: Cluster Model
Local Leadership CLUSTER MODEL Economic Benefits Payor Benefits Scale efficiencies are achieved Clusters create scale, alignment, and What is a Cluster? market influence across the continuum of through shared resources and expertise care Regional collaboration and connectivity between operations wit
Slide 16: Partnerships that Advance Our Mission
Partnerships that Advance Our Mission Drive outcomes for patients, market share and occupancy Collaborate with accountable care organizations and managed care organizations to improve outcomes, reduce costs, and advance value-based care. Deploy captive ancillary businesses that are purpose-built to
Slide 17: Partnership Highlight: Becoming an Operation of Choice
Partnership Highlight x Becoming an Operation of Choice Sun West Choice operates in the Phoenix healthcare market which is heavily penetrated by managed care organizations who emphasize strong outcomes, shorter lengths of stay and reduced rehospitalizations. To become an Operation of Choice: Acquire
Slide 18: Operational Growth: Acquisitions Year to Date
ACQUI SITI ON T YPE BY STAT E Operations Acquired Real Estate Only Operational Growth BY THE NUMBE RS (Y EA R TO D AT E 2026) ( 3) Wisconsin • 1 Skilled Nursing Facility • 2 Real Estate Only and Leased to Third Party Operation Expansions 25 California • 1 Real Estate Only and Leased to Third Party •
Slide 19: History of Growth
The Ensign Group Formed captive REIT 398 History of Growth Completed spin-off 373 327 Completed spin-off 297 20% 271 Facility 245 CAGR 228 Completed IPO 223 194 187 175 150 Founded in 1999 with three facilities in Texas 121 107 93 98 72 77 57 59 53 38 40 43 19 23 13 7 Q2 (3) 1999 2000 2001 2002 2003
Slide 20: Ensign Represents the Growth Story: Revenue
Ensign Represents the Growth Story REVENUE $5,058 $4,260 $3,729 $3,025 $2,830 $2,627 $2,403 $2,037 $1,598 $1,755 $1,438 $1,027 $1,183 2014 2015 2016 2017 2018 2019 (6) 2020 2021 2022 2023 2024 2025 1H 2026 16% 10% 8% Facility-Based Post-Acute(8) Healthcare Services(7) We view growth not as an end in
Slide 21: Ensign Represents the Growth Story: Adjusted EBITDAR
Ensign Represents the Growth Story ADJUSTED EBITDAR* $842 $706 $623 $533 $478 $484 $424 $374 $319 $262 $285 $221 $159 2014 2015 2016 2017 2018 2019(6) 2020 2021 2022 2023 2024 2025 1H 2026 16% 14% 8% Facility-Based Post-Acute (8) Healthcare Services (7) Dollars presented in millions Ensign Group 202
Slide 22: Achieving Significant Improvements Over 45 Quarters
Achieving Significant Improvements Over 45 Quarters ADJUSTED EBITDAR* INCREASE (10) 59.6% 47.9% 27.2% 5th Quarter 15th Quarter 45th Quarter Insert Picture SKILLED MIX REVENUE INCREASE (10) 44.8% 15.2% 8.5% 5th Quarter 15th Quarter 45th Quarter Ensign Group 2026 Investor Presentation | 22
Slide 23: Strong Shareholder Return Since IPO
Strong Shareholder Return Since IPO 6000% 5000% 4,629% Growth Since IPO(9) 4000% 3000% 680% Growth During Same Period(9) 2000% 1000% 0% 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Ensign Group 2026 Investor Presentation | 23
Slide 24: Standard Bearer: At a Glance
Standard Bearer GEOGRAPHIC FOOT PRI NT (3) At a Glance 8 Number of owned properties per state K EY ST AT I ST I C S ( 3) 1 6 29 Properties 179 4 1 1 15 Real estate fair value (11) $2.2B 17 7 7 18 3 States 16 5 55 Operating beds/unit 17.8K 2 Weighted avg. Lease tenor 13.7 Years Ensign operated (11) 8
Slide 25: Purpose-Built for Care
Purpose-Built for Grossmont Post Acute Care represents a significant investment in post-acute care for East San Diego County as the area's first new skilled nursing facility in over 30 years. The replacement facility added 15 licensed beds and increased daily skilled census from 72 to 100 patients w
Slide 26: 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. PO L ARI S T RANS I T IO N AL C ARE S TO N EH EN G E OF S PRI N G VIL L E PAC I FI C H AVEN ALASKA UTAH CALIFORNIA Assets inclu
Slide 27: Standard Bearer Performance
Standard Bearer Performance RENTAL REVENUE $6.3 $5.2 $5.3 $4.7 $5.0 $37.8 $29.3 $30.8 $26.8 $27.6 Q2 2025 Q3 2025 Q4 2025 Q1 2026 Q2 2026 Ensign Affiliates Third-Party OTHER REAL ESTATE METRICS (12) $12.1 $10.3 $10.8 $9.1 $9.6 $21.6 $24.7 $20.4 $18.4 $19.3 Q2 2025 Q3 2025 Q4 2025 Q1 2026 Q2 2026 FFO
Slide 28: Significant Real Estate Portfolio
Significant Real Estate Portfolio Owned and Leased to 3rd Parties Multiple triple-net master Lease Structure Owned and 1 leases with quality third Operated party operators 33% Initial terms from 10 to 20 Typical Terms 2 years with extension options 9% Rent Terms 3 CPI-based escalators Third-party op
Slide 29: Quarter Financial Highlights
Quarter Financial Highlights CONSOLIDATED REVENUE 18% $2,830 17% $2,401 Insert Picture $1,440 $1,228 Q2 2025 Q2 2026 Q2 2025 Q2 2026 Quarter to Date Year to Date SAME FACILITY SKILLED NURSING REVENUE (13) SAME FACILITY OCCUPANCY % 7% 7% $1,843 $1,968 $927 $988 Insert Picture 84.2% 84.1% 82.1% 81.9%
Slide 30: Demonstrated Track Record of Significant Operational Improvements
Demonstrated Track Record of Significant Operational Improvements QTD Q2 2026 S KI L LED MI X REVEN U E ( 13 ) MEDI C ARE RATE S ( 13 ) CONSOLIDATED CONSOLIDATED 50.0% $822 $890 51.0% 49.7% $815 MEDICAID $785 45.1% $314 Same Store Transitioning Recently Acquired Same Store Transitioning Recently Acq
Slide 31: Quarter Financial Highlights: Adjusted Net Income and EPS
Quarter Financial Highlights CONSOLIDATED ADJUSTED NET INCOME (IN MILLIONS) 23% 23% $225 $182 $114 Insert Picture $93 Q2 2025 Q2 2026 Q2 2025 Q2 2026 Quarter to Date Year to Date CONSOLIDATED ADJUSTED DILUTED EPS 21% $3.77 21% $3.11 $1.92 Insert Picture $1.59 Q2 2025 Q2 2026 Q2 2025 Q2 2026 Quarter
Slide 32: Liquidity Financial Measures
Liquidity Financial Measures Six Months Ended June 30, $ in thousands 2026 2025 Net cash provided by (used in) Operating activities $272,108 $227,950 Investing activities (14) (478,893) (311,924) Financing activities (34,796) (16,655) Net decrease in cash and cash equivalents $(241,581) $(100,629) C
Slide 33: Increased Guidance
Increased Guidance $5.87B to $5.92B Annual Revenue Adjusted Diluted EPS* $7.75 to $7.85 Midpoint Adjusted Diluted EPS* 19% over 2025 42% over 2024 Ensign Group 2026 Investor Presentation | 33
Slide 34: A Culture of Experienced Leaders Driving the Mission
A Culture of Experienced Leaders Driving the Mission Barry Port Suzanne Snapper Chad Keetch Spencer Burton Marivic Uychiat Chief Executive Officer and Chief Financial Officer, Chief Investment Officer, President, Registered Nurse, EVP of Clinical Chairman of the Board EVP and Director EVP Chief Oper
Slide 35: Appendix
APPENDIX Ensign Group 2026 Investor Presentation |
Slide 36: Reconciliation of GAAP to Non-GAAP Income
Reconciliation of GAAP to Non-GAAP Income Three Months Ended June 30, Six Months Ended June 30, $ in thousands except earnings per share 2026 2025 2026 2025 Net income attributable to The Ensign Group, Inc. $99,738 $84,396 $199,406 $164,673 Adjustments: Stock-based compensation expense 16,166 11,662
Slide 37: Reconciliation of GAAP to Non-GAAP Financial Measures
Reconciliation of GAAP to Non-GAAP Financial Measures Three Months Ended June 30, Six Months Ended June 30, $ in thousands 2026 2025 2026 2025 Income before provision for income taxes $133,674 $112,358 $262,246 $218,938 Adjustments: Stock-based compensation expense 16,166 11,662 30,061 22,386 Costs
Slide 38: Deferred Compensation Plan (DCP) Impact on the P&L
Deferred Compensation Plan (DCP) Impact on the P&L Three Months Ended June 30, $ in thousands Q2 2026 Q1 2026 Q4 2025 Q3 2025 Q2 2025 Consolidated Revenue $1,440,481 $1,389,196 $1,360,626 $1,296,405 $1,227,769 Non-GAAP Cost of Services (COS) with DCP 1,122,995 1,085,091 1,066,369 1,025,104 964,252 L
Slide 39: Reconciliation of GAAP to Non-GAAP Financial Measures
Reconciliation of GAAP to Non-GAAP Financial Measures Three Months Ended June 30, Six Months Ended June 30, $ in thousands 2026 2025 2026 2025 Net income $99,834 $84,466 $199,590 $164,819 Less: Net income attributable to noncontrolling interests 96 70 184 146 Interest income 4,633 5,240 11,169 12,12
Slide 40: Segment Income to Income Before Provisions For Income Taxes QTD Q2 2026
Reconciliation From Segment Income to Income Before Provisions For Income Taxes QTD Q2 2026 Three Months Ended June 30, 2026 $ in thousands Skilled Services Standard Bearer All Other Eliminations Consolidated Total Revenue $1,379,912 $44,133 $64,268 $(47,832) $1,440,481 Cost of Services 1,089,109 50
Slide 41: Segment Income to Income Before Provisions For Income Taxes YTD 2026
Reconciliation From Segment Income to Income Before Provisions For Income Taxes YTD 2026 Six Months Ended June 30, 2026 $ in thousands Skilled Services Standard Bearer All Other Eliminations Consolidated Total Revenue $2,710,747 $80,235 $126,524 $(87,829) $2,829,677 Cost of Services 2,141,833 1,125
Slide 42: Segment Income to EBITDA and Adjusted EBITDA QTD Q2 2026
Reconciliation From Segment Income to EBITDA and Adjusted EBITDA QTD Q2 2026 Three Months Ended June 30, 2026 $ in thousands Skilled Services Standard Bearer All Other Consolidated Segment income (loss) $179,621 $12,070 $(58,017) $133,674 Interest expense (income) — 15,766 (18,466) (2,700) Depreciat
Slide 43: Segment Income to EBITDA and Adjusted EBITDA YTD Q2 2026
Reconciliation From Segment Income to EBITDA and Adjusted EBITDA YTD Q2 2026 Three Months Ended June 30, 2026 $ in thousands Skilled Services Standard Bearer All Other Consolidated Segment income (loss) $353,638 $22,879 $(114,271) $262,246 Interest expense (income) — 27,154 (34,458) (7,304) Deprecia
Slide 44: Skilled Service Segment
Skilled Service Segment Three Months Ended June 30, Six Months Ended June 30, $ in thousands 2026 2025 2026 2025 Statements of Income Data: Segment income(20) $179,621 $150,004 $353,638 $293,935 Depreciation and amortization 15,445 13,750 30,755 26,963 EBITDA $195,066 $163,754 $384,393 $320,898 Adju
Slide 45: Standard Bearer Segment
Standard Bearer Segment Three Months Ended June 30, Six Months Ended June 30, $ in thousands 2026 2025 2026 2025 Rental revenue generated from third-party tenants $6,348 $4,712 $11,618 $9,209 Rental revenue generated from Ensign’s independent subsidiaries 37,785 26,756 68,617 50,660 Total revenue $4
Slide 46: Ensign's Commitment to The Care Continuum
Ensign’s Commitment to The Care Continuum Local leadership strategy Denotes Ensign Business focused on acquisitions in fragmented markets Acute Care High quality healthcare Patient Service Intensity Inpatient LTACH outcomes across the Rehab continuum driving local Outpatient Rehab reputation and Ski
Slide 47: Fragmented Industry = Acquisition Opportunities
Fragmented Industry = Acquisition Opportunities POPULATION PROJECTIONS OF 80+ YEAR OLDS FROM 2022 THROUGH 2026 (MILLIONS) (21) 30.1 30.1 30.5 29.4 26.8 80+ Population To Double by 2060 22.9 18.8 14.8 13.2 4+ million more people in 5 years 2022 2025 2030 2035 2040 2045 2050 2055 2060 A Favorable Back
Slide 48: 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 MEDICARE SPENDI NG PROJECT ION POST-ACU TE DESTI NATI ONS - % OF MEDICARE DOLLARS (IN BILLIONS) LTACH 2,500 2% IRF 13% 2,000 1,500 Skilled Nursing 42% 1,000 500 Home Health 43% 0 2016 2018 202
Slide 49: Lower Cost Provider of Higher Acuity Care
Lower Cost Provider of Higher Acuity Care DISC HARGE TO POST -ACU TE CARE SETTI NGS COST OF CARE BY FACI LITY T YPE PER DAY $3,500 Skilled Nursing 42% $3,000 $2,500 $2,000 $1,500 IRF $1,000 13% $500 LTACH 2% $- Home Health Hospital IRF LTACH SNF 43% High Acuity Lower Cost Source: Medicare Payment Ad
Slide 50: End Notes
END NOTES Ensign Group 2026 Investor Presentation |
Slide 51: End Notes
End Notes * — Non-GAAP (adjusted) measures are reconciled to GAAP measures in the Appendix. Occupancy metric represent Same Facilities metric for Q2'26. Reflects midpoints of 2026 guidance ranges of $5.87B to $5.92B for annual revenue and $7.75 to $7.85 for diluted adjusted 1 — EPS. The data source
Slide 52: End Notes
End Notes Real estate fair value reflects the most recent third-party valuation. Ensign-operated percentage is based on percentage of annualized rent for assets as of June 30, 2026. Funds from Operations (FFO) for our Standard Bearer segment consists of segment income, excluding depreciation and amo