The Ensign Group, Inc. · NASDAQ:ENSG
The Ensign — Q1 2026 Earnings Presentation
53 slides from The Ensign's earnings presentation, May 1, 2026
Slide 1: Investor Presentation
ENSIGN GROUP April 2026 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 390+ 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 395 179 Operated Facilities Owned Properties 44,000+ 84.3% (1) Beds / Units Across the Care Continuum Same Store Occupancy Rate 57,000+ 32.6% (1) Employees Same Store Skilled Mix Days 16% 836% $5.84B (1) Annual Reve
Slide 6: Entrepreneurial Evolution Of Ensign
Entrepreneurial Evolution Of Ensign Completed the Completed spin- Continues to Ensign formed Ensign The Ensign Established New Ensign Ensign entered Senior living completed 125 spin-off of its off of home execute on a Captive REIT, Group was Market CEO completes an into the home portfolio acquisitio
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 1 1714 15 5 States 8 9 3 395 29 39 Facilities 85 12 11 44,000+ 42 9 Beds 2 57,000+ 105 Employees 2 Skilled Nursing Operations - 346 Senior Living Operations - 16 Campus Operations - 32 LTAC – 1 Source: Data effective as of 05/01/2026 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. Polaris Transitional Care Stonehenge of Springville Pacific Haven Alaska Utah California Facilities are purpose-built or Assets
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 Our independent subsidiaries offer a broad Local leadership a
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(4) Ensign vs. S NF Count by CMS S tar Rating Comparative States 1-3 S tar 4-5 S tar 400 Our Same Store Cycle 1 health inspections are 300 more than 22% better.(3) 200 100 Our Sa
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 31.6% of Ensign’s skilled nursing operations have been Proven track record of achieving significant improvement in operated less than three full years just 5 quarters (5) Occupancy EBITDAR 14.2% M
Slide 17: Demonstrated Track Record of Significant Operational Improvements QTD Q1 2026
Demonstrated Track Record of Significant Operational Improvements QTD Q1 2026 (7)(8)(9) (10) (7)(8)(9) (10) (11) S killed Mix Revenue Medicare Rates Consolidated 50.7% $822 Medicaid $316 51.2% 49.7% 48.9% $810 $881 $810 Same Store Transitioning Recently Acquired Same Store Transitioning Recently Acq
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 As of May 1, 2026
Significant Real Estate Portfolio As of May 1, 2026 Real Estate Distribution on Ensign operated Ensign Triple Net Master facilities of 395 and 38 Owned Real Estate Leased Leases with Quality Third Party Operators to Third Party Operators (12) 179 Facilities 1.8% 41.4% Lease • Multiple “triple-net” m
Slide 20: Standard Bearer REIT Structure Summary & Key Benefits
Standard Bearer REIT Structure Summary & Key Benefits Independent Operating Subsidiaries • Skilled Services • Real Estate Ownership • Senior Living Services • Real Estate Management & Monitoring • New Ventures • Investment Evaluation and Execution • Real Estate Portfolio Performance Reporting Increa
Slide 21: Standard Bearer at a Glance
Standard Bearer at a Glance Geographic Footprint Key Statistics 8 (13) 173 $2.15B 1 Properties Real Estate 6 29 Fair Value 1 3 1 15 7 17,492 7 16 14 States Operating Beds / Units 3 18 5 53 13.8 Years 89.3% (14) 2 Weighted Avg. Lease Tenor Ensign Operated Note: Figures represent the number of owned p
Slide 22: Standard Bearer Continuation & Expansion of Real Estate Success
Standard Bearer Continuation & Expansion of Real Estate Success Cumulative Investments Over Time (15) $1,489 14,000 $1,400 Cumulative Real Estate Investments (in millions) 12,000 $1,200 Total No. of SNF Beds / ALF Units 10,000 $1,000 8,000 $800 6,000 $600 4,000 $400 $200 2,000 $- - 15 26 25 24 23 22
Slide 23: Standard Bearer Strong Long Term Leases
Standard Bearer Strong Long Term Leases 13.8 years 99% (16) Weighted Average of leases expire Lease Tenor after 2031 Annualized Rent Revenue Expirations by Year Tenant Rent Coverage Summary 26.6 26 24 Q1 Q2 Q3 Q4 Q1 22 20 19.0 2025 2025 2025 2025 2026 18 16 Ensign 14 2.67 2.60 2.59 2.69 2.81 12 11.6
Slide 24: Standard Bearer Metrics Quarter Over Quarter
Standard Bearer Metrics Quarter Over Quarter Rental Revenue - Trend Other Real Estate Metrics In $ Millions In $ Millions $36.1 $34.5 $32.6 $5.3 $31.5 $5.2 $28.4 $5.0 $4.7 $10.8 $10.3 $4.5 $9.6 $9.1 $8.6 $29.3 $30.8 $26.8 $27.6 $23.9 $21.6 $19.3 $20.4 $17.1 $18.4 Q1 2025 Q2 2025 Q3 2025 Q4 2025 Q1 2
Slide 25: Ensign Represents The Growth Story
Ensign Represents The Growth Story In the Facility-Based Healthcare Services & Post-Acute Sector Revenue Adjusted EBITDAR ($mm) $5,058 ($mm) $842 : 16% % 0 25 CAGR $4,260 AGR: 16 $706 2014 – 2 $3,729 2014 – 2 025 C $623 $533 $3,025 $478 $2,627 $424 $2,403 $374 $2,037 $285 $319 $1,755 $221 $262 $237
Slide 26: Liquidity Financials Measure
Liquidity Financials Measure Three Months Ended March 31, Summary of Cash Flows (In millions) 2026 2025 Net cash provided by (used in): Operating activities $100.2 $72.2 Investing activities(23) (71.2) (243.8) Financing activities 6.7 (10.3) Net increase (decrease) in cash and cash equivalents 35.6
Slide 27: Quarter Over Quarter Highlights
Quarter Over Quarter Highlights (in millions) Q1 2026 Q1 2025 REVENUE 18.4% $1,389.2 $1,173.0 SAME FACILITY SKILLED NURSING FACILITY 6.8% $979.2 $916.5 REVENUE CONSOLIDATED ADJUSTED NET INCOME 23.9% $110.2 $89.0 Ensign Group | Investor Presentation 27
Slide 28: Guidance
Annual Revenue Guidance $5.81B to $5.86B 2026 Diluted Adjusted EPS $7.48 to $7.62 Diluted Adjusted EPS Midpoint is: 15% over 2025 37% over 2024 28
Slide 29: Strong Shareholder Returns Since IPO
Strong Shareholder Returns Since IPO Total Shareholder Return Company Since IPO 1 Yr 3 Yr 5 Yr 10 Yr 5,090% 51% 97% 116% 836% 5,400% 5,090% 4,800% 4,200% 3,600% 3,000% 2,400% 1,800% 1,200% 600% —% 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Source:
Slide 30: Ensign Management Team
Ensign Management Team Barry Suzanne Chad Spencer Marivic Port Snapper Keetch Burton Uychiat Chief Executive Officer Chief Financial Officer, EVP Chief Investment Officer, EVP President, Chief Operating EVP of Clinical Services and and Chairman of the Board and Director and Secretary Officer Directo
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 (24) Aging Population over 80 projected to nearly double by 2060, Population and growth of 49% from 2022 to 2030. (25) (25) Estimated Population Over 65 Estimated Population Over 80 100,000 35,000 30,000 80,000 25,
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 (26) (27) Medicare Spending Projection Post-Acute Destinations - % of Medicare Dollars (in Billions) 2% 2,500 13% 2,000 42% 1,500 43% 1,000 500 0 2016 2018 2020 2022 2024 2026 2028 2030 2032 2
Slide 35: Reconciliation of GAAP to Non-GAAP Income
Reconciliation of GAAP to Non-GAAP Income Three Months Ended March 31, $ in millions 2026 2025 Net income attributable to The Ensign Group, Inc. $99,668 $80,277 Non-GAAP adjustments Stock-based compensation expense(28) 13,895 10,724 Cost of services – loss on long-lived assets 1,284 — Cost of servic
Slide 36: Reconciliation of GAAP to Non-GAAP Financial Measures
Reconciliation of GAAP to Non-GAAP Financial Measures Three Months Ended March 31, $ in millions 2026 2025 Income before provision for income taxes $128,572 $106,580 Non-GAAP adjustments Stock-based compensation expense(28) 13,895 10,724 Costs incurred related to system implementations 3,019 334 Los
Slide 37: Reconciliation of GAAP to Non-GAAP Financial Measures
Reconciliation of GAAP to Non-GAAP Financial Measures Three Months Ended March 31, $ in millions 2026 2025 Net income $99,756 $80,353 Less: net income attributable to noncontrolling interests 88 76 Interest income 6,536 6,883 Add: Provision for income taxes 28,816 26,227 Depreciation and amortizatio
Slide 38: Reconciliation From Segment Income to Income Before Provisions For Income Taxes
Reconciliation From Segment Income to Income Before Provisions For Income Taxes QTD Q1 2026 $ in millions Skilled Services Standard Bearer All Other Eliminations Consolidated Total Revenue $1,330,835 $36,102 $62,256 $(39,997) $1,389,196 Cost of services 1,052,724 625 48,418 (5,941) 1,095,826 Interna
Slide 39: Reconciliation From Segment Income to GAAP EBITDA and Non-GAAP EBITDA
Reconciliation From Segment Income to GAAP EBITDA and Non-GAAP EBITDA QTD Q1 2026 $ in millions Skilled Services Standard Bearer All Other Consolidated Segment income (loss) $174,017 $10,809 $(56,254) $128,572 Interest expense (income) — 11,388 (15,992) (4,604) Depreciation and amortization 15,310 1
Slide 40: Skilled Services Segment
Skilled Services Segment Three Months Ended March 31, $ in millions 2026 2025 Statements of Income Data: Segment income(34) $174,017 $143,931 Depreciation and amortization 15,310 13,213 EBITDA $189,327 $157,144 Adjustments to EBITDA: Stock-based compensation expense(28) 8,751 6,880 Adjusted EBITDA $
Slide 41: Standard Bearer Segment
Standard Bearer Segment Three Months Ended March 31, $ in millions 2026 2025 Rental revenue generated from third-party tenants $5,270 $4,497 Rental revenue generated from Ensign’s independent subsidiaries 30,832 23,904 Total rental revenue $36,102 $28,401 Segment income(19) 10,809 8,583 Depreciation
Slide 42: Deferred Compensation Plan (DCP) Impact
Deferred Compensation Plan (DCP) Impact 5 Quarter Trend $ in millions Q1 2026 Q4 2025 Q3 2025 Q2 2025 Q1 2025 Non-GAAP Revenue 1,389,196 1,360,626 1,296,405 1,227,769 1,173,041 Non-GAAP cost of services 1,085,091 1,066,369 1,025,104 964,252 920,209 Less: DCP gain (loss) related to cost of services (
Slide 43: Standard Bearer Property Locations
Standard Bearer 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 Senior Living Community Anna's House Assisted Living WI Senior Living 50 Arrowhead Springs Healthcare CA S
Slide 44: Standard Bearer Property Locations
Standard Bearer Property Locations # of Operating Beds / Property Name State Property Type Tenant Units Crestwood Health & Rehabilitation Center TX Campus 148 Crystal Heights Care Center IA SNF 72 Decatur County Healthcare TN SNF 115 Deer Creek Senior Living TX Senior Living 37 Pennant Desert Blosso
Slide 45: Standard Bearer Property Locations
Standard Bearer Property Locations # of Operating Beds / Property Name State Property Type Tenant Units Kenosha Senior Living WI Senior Living 37 Pennant Kirkwood Manor TX SNF 162 La Dora Nursing and Rehabilitation Center TX SNF 62 Lake Pointe Villa Assisted Living WI Senior Living 19 Pennant Legend
Slide 46: Standard Bearer Property Locations
Standard Bearer Property Locations # of Operating Beds / Property Name State Property Type Tenant Units Mother Joseph Care Center WA SNF 152 Hill Valley Mountain Terrace Senior Living WI Senior Living 74 Pennant Mt. Angel Health and Rehabilitation OR Campus 148 Mt. Ogden Health and Rehabilitation Ce
Slide 47: Standard Bearer Property Locations
Standard Bearer Property Locations # of Operating Beds / Property Name State Property Type Tenant Units Puget Sound Transitional Care WA SNF 125 Rehabilitation and Nursing Center of the Rockies CO SNF 99 Rio Vista Post Acute and Rehabilitation AZ SNF 150 River Bend Healthcare TX SNF 115 River Hills
Slide 48: Standard Bearer Property Locations
Standard Bearer Property Locations # of Operating Beds / Property Name State Property Type Tenant Units St. Joseph Rehabilitation and Care Center and Skyview Villa Assisted Living NE Campus 99 Stonehenge of American Fork UT SNF 90 Stonehenge of Cedar City UT SNF 50 Stonehenge of Ogden UT SNF 52 Ston
Slide 49: Standard Bearer Property Locations
Standard Bearer Property Locations # of Operating Beds / Property Name State Property Type Tenant Units The Villages of Dallas TX Campus 304 The Villas at Rock Canyon CO Senior Living 20 Pennant The Waterton Healthcare and Rehab TX SNF 76 Timber Ridge Health and Rehabilitation WI SNF 48 Timber Sprin
Slide 50: End Notes
End Notes www.ensigngroup.net
Slide 51: End Notes
End Notes 1 — Occupancy and Skilled Mix metrics represent same store metrics for Q1'26. Reflects midpoints of 2026 guidance ranges of $5.81B to $5.86B for annual revenue and $7.48 to $7.62 for diluted adjusted EPS. [Slide 5] 2 — Adjusted EBITDAR consists of net income before (a) interest income, (b)
Slide 52: End Notes
End Notes 19 —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 53: Thank You
ENSIGN <== GROUP