The Ensign Group, Inc. · NASDAQ:ENSG
The Ensign — Q4 2025 Earnings Presentation
58 slides from The Ensign's earnings presentation, Feb 5, 2026
Slide 1: Investor Presentation
ENSIGN GROUP February 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 370+ 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 378 160 Operated Facilities Owned Properties 42,000+ 83.8% (1) Beds / Units Across the Care Continuum Same Store Occupancy Rate 56,000+ 32.0% (1) Employees Same Store Skilled Mix Days 16% 752% $5.80B (1) Annual Reve
Slide 6: Entrepreneurial Evolution Of Ensign
Entrepreneurial Evolution Of Ensign Ensign Senior living Completed the Completed spin- Continues to Ensign formed Ensign The Ensign Established New Ensign entered completes an portfolio spin-off of its off of home execute on a Captive REIT, completed 108 Group was Market CEO into the home IPO in com
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 3 378 29 39 Facilities 85 12 11 42,000+ 42 9 Beds 2 56,000+ 88 Employees 2 Skilled Nursing Operations - 330 Senior Living Operations - 16 Campus Operations - 31 LTAC – 1 Source: Data as of 02/03/2026 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. SNF Count by CMS Star Rating Comparative States 1-3 Star 4-5 Star 400 Our Same Store Cycle 1 health inspections are 300 more than 24% better.(3) 200 100 Our Same S
Slide 15: Multifaceted Growth Opportunities Creating Value
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 34.2% of Ensign’s skilled nursing operations have been Proven track record of achieving significant improvement in (5) operated less than three full years just 5 quarters Occupancy 14.0% EBITDAR M
Slide 17: Demonstrated Track Record of Significant Operational Improvements QTD Q4 2025
Demonstrated Track Record of Significant Operational Improvements QTD Q4 2025 (7)(8)(9) (10) (7)(8)(9) (10) (11) Skilled Mix Revenue Medicare Rates Consolidated 49.2% $827 Medicaid $316 50.8% 50.5% 41.8% $817 $900 $787 Same Store Transitioning Recently Acquired Same Store Transitioning Recently Acqu
Slide 18: Demonstrated Track Record of Significant Operational Improvements of YTD 2025
Demonstrated Track Record of Significant Operational Improvements of YTD 2025 (7)(8)(9) (10) (7)(8)(9) (10) (11) Skilled Mix Revenue Medicare Rates Consolidated $801 49.4% Medicaid $308 51.2% 50.8% 38.3% $795 $867 $734 Same Store Transitioning Recently Acquired Same Store Transitioning Recently Acqu
Slide 19: Track Record of Successfully Incubating New Ventures
Track Record of Successfully Incubating New Ventures Completed 2019 Completed in 2014 Completed in 2016 19 19 Spin Offs Divestitures Current 19
Slide 20: Significant Real Estate Portfolio
Significant Real Estate Portfolio As of February 3, 2026 Real Estate Distribution on Ensign operated Ensign Triple Net Master facilities of 378 and 36 Owned Real Estate Leased Leases with Quality Third Party Operators to Third Party Operators (12) 1.9% 160 Facilities Lease • Multiple “triple-net” ma
Slide 21: 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 22: Standard Bearer at a Glance
Standard Bearer at a Glance Geographic Footprint Key Statistics 8 (13) 154 $1.7B 1 Properties Real Estate 6 27 Fair Value 1 3 1 15 7 15,210 7 16 14 States Operating Beds / Units 3 18 5 36 13.9 Years 85.0% (14) 2 Weighted Avg. Lease Tenor Ensign Operated Note: Figures represent the number of owned pr
Slide 23: Standard Bearer Continuation & Expansion of Real Estate Success
Standard Bearer Continuation & Expansion of Real Estate Success Cumulative Investments Over Time (15) $1,460 14,000 $1,400 Cumulative Real Estate Investments (in millions) 12,000 $1,200 $1,088 Total No. of SNF Beds / ALF Units 10,000 $1,000 $921 $832 8,000 $800 $722 $624 6,000 $583 $600 $422 4,000 $
Slide 24: Standard Bearer Strong Long Term Leases
Standard Bearer Strong Long Term Leases 13.9 years 98% (16) Weighted Average of leases expire Lease Tenor after 2031 Annualized Rent Revenue Expirations by Year Tenant Rent Coverage Summary 26 24 Q4 Q1 Q2 Q3 Q4 22 20 20.1 2024 2025 2025 2025 2025 18 16 14.7 Ensign 14 2.68 2.67 2.60 2.59 2.69 12 10.2
Slide 25: Standard Bearer Metrics Quarter Over Quarter
Standard Bearer Metrics Quarter Over Quarter Rental Revenue - Trend Other Real Estate Metrics In $ Millions $34.5 In $ Millions $32.6 $31.5 $5.2 $28.4 $5.0 $4.7 $25.1 $4.5 $10.3 $4.4 $9.6 $9.1 $8.6 $7.4 $29.3 $26.8 $27.6 $23.9 $20.7 $20.4 $18.4 $19.3 $17.1 $15.3 Q4 2024 Q1 2025 Q2 2025 Q3 2025 Q4 20
Slide 26: Ensign Represents The Growth Story
Ensign Represents The Growth Story In the Facility-Based Healthcare Services & Post-Acute Sector Revenue Adjusted EBITDAR ($mm) $5,058 ($mm) $842 : 16% % 0 25 CAGR AGR: 16 $706 2014 – 2 C $4,260 025 $3,729 2014 – 2 $623 $533 $3,025 $478 $2,627 $424 $2,403 $374 $285 $319 $2,037 $262 $1,755 $221 $1,43
Slide 27: Liquidity Financials Measure
Liquidity Financials Measure Year Ended December 31, Summary of Cash Flows (In millions) 2025 2024 Net cash provided by (used in): Operating activities $564.3 $347.2 Investing activities(23) (513.2) (390.1) Financing activities (11.8) (2.2) Net increase (decrease) in cash and cash equivalents 39.3 (
Slide 28: Quarter Over Quarter Highlights
Quarter Over Quarter Highlights (in millions) Q4 2025 Q4 2024 REVENUE 20.2% $1,360.6 $1,132.3 SAME FACILITY SKILLED NURSING FACILITY 7.4% $884.7 $823.8 REVENUE CONSOLIDATED ADJUSTED NET INCOME 23.2% $107.8 $87.6 Ensign Group | Investor Presentation 28
Slide 29: Year Over Year Highlights
Year Over Year Highlights (in millions) 2025 2024 REVENUE 18.7% $5,057.8 $4,260.5 SAME FACILITY SKILLED NURSING FACILITY 6.5% $3,424.4 $3,214.9 REVENUE CONSOLIDATED ADJUSTED NET INCOME 20.6% $386.6 $320.5 Ensign Group | Investor Presentation 29
Slide 30: Guidance
Annual Revenue Guidance $5.77B to $5.84B 2026 Diluted Adjusted EPS $7.41 to $7.61 Diluted Adjusted EPS Midpoint is: 14.3% over 2025 36.5% over 2024 30
Slide 31: Strong Shareholder Returns Since IPO
Strong Shareholder Returns Since IPO Total Shareholder Return Company Since IPO 1 Yr 3 Yr 5 Yr 10 Yr 4,642% 22% 89% 103% 850% 5,200% 4,800% 4,400% 4,642% 4,000% 3,600% 3,200% 2,800% 2,400% 2,000% 1,600% 1,200% 800% 400% —% 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 20
Slide 32: 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 33: Appendix
Appendix www.ensigngroup.net
Slide 34: 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 35: 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 36: 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 12% 2,000 42% 1,500 44% 1,000 500 0 2016 2018 2020 2022 2024 2026 2028 2030 2032 2
Slide 37: Reconciliation of GAAP to Non-GAAP Income
Reconciliation of GAAP to Non-GAAP Income Three Months Ended December 31, Year Ended December 31, $ in millions 2025 2024 2025 2024 Net income attributable to The Ensign Group, Inc. $95,454 $79,687 $343,971 $297,973 Non-GAAP adjustments Stock-based compensation expense(29) 12,924 9,820 48,299 36,226
Slide 38: Reconciliation of GAAP to Non-GAAP Financial Measures
Reconciliation of GAAP to Non-GAAP Financial Measures Three Months Ended December 31, Year Ended December 31, $ in millions 2025 2024 2025 2024 Income before provision for income taxes $130,084 $105,758 $455,622 $386,094 Non-GAAP adjustments Stock-based compensation expense(29) 12,924 9,820 48,299 3
Slide 39: Reconciliation of GAAP to Non-GAAP Financial Measures
Reconciliation of GAAP to Non-GAAP Financial Measures Three Months Ended December 31, Year Ended December 31, $ in millions 2025 2024 2025 2024 Net income $95,534 $79,750 $344,264 $298,458 Less: net income attributable to noncontrolling interests 80 63 293 485 Interest income 6,221 7,598 24,512 28,7
Slide 40: Reconciliation From Segment Income to Income Before Provisions For Income Taxes QTD Q4 2025
Reconciliation From Segment Income to Income Before Provisions For Income Taxes QTD Q4 2025 $ in millions Skilled Services Standard Bearer All Other Eliminations Consolidated Total Revenue $1,301,583 $34,451 $62,510 $(37,918) $1,360,626 Cost of services 1,032,191 467 47,306 (5,176) 1,074,788 Interna
Slide 41: Reconciliation From Segment Income to Income Before Provisions For Income Taxes YTD 2025
Reconciliation From Segment Income to Income Before Provisions For Income Taxes YTD 2025 $ in millions Skilled Services Standard Bearer All Other Eliminations Consolidated Total Revenue $4,837,809 $126,930 $232,846 $(139,744) $5,057,841 Cost of services(38) 3,846,828 2,133 188,108 (19,066) 4,018,003
Slide 42: Reconciliation From Segment Income to GAAP EBITDA and Non-GAAP EBITDA QTD Q4 2025
Reconciliation From Segment Income to GAAP EBITDA and Non-GAAP EBITDA QTD Q4 2025 $ in millions Skilled Services Standard Bearer All Other Consolidated Segment income (loss) $169,336 $10,292 $(49,544) $130,084 Interest expense (income) — 11,131 (15,397) (4,266) Depreciation and amortization 14,703 1
Slide 43: Reconciliation From Segment Income to GAAP EBITDA and Non-GAAP EBITDA YTD 2025
Reconciliation From Segment Income to GAAP EBITDA and Non-GAAP EBITDA YTD 2025 $ in millions Skilled Services Standard Bearer All Other Consolidated Segment income (loss) $616,397 $37,623 $(197,325) $456,695 Interest expense (income) — 40,498 (57,022) (16,524) Depreciation and amortization 55,821 37
Slide 44: Skilled Services Segment
Skilled Services Segment Three Months Ended December 31, Year Ended December 31, $ in millions 2025 2024 2025 2024 Statements of Income Data: Segment income(39) $169,336 $140,980 $616,397 $518,463 Depreciation and amortization 14,703 12,207 55,821 45,195 EBITDA $184,039 $153,187 $672,218 $563,658 Ad
Slide 45: Standard Bearer Segment
Standard Bearer Segment Three Months Ended December 31, Year Ended December 31, $ in millions 2025 2024 2025 2024 Rental revenue generated from third-party tenants $5,185 $4,388 $19,370 $16,976 Rental revenue generated from Ensign’s independent subsidiaries 29,266 20,714 107,560 78,110 Total rental
Slide 46: Deferred Compensation Plan (DCP) Impact Quarter Trend
Deferred Compensation Plan (DCP) Impact 5 Quarter Trend $ in millions Q4 2025 Q3 2025 Q2 2025 Q1 2025 Q4 2024 Non-GAAP Revenue 1,360,626 1,296,405 1,227,769 1,173,041 1,132,252 Non-GAAP cost of services 1,066,369 1,025,104 964,252 920,209 890,214 Less: DCP gain (loss) related to cost of services 627
Slide 47: Deferred Compensation Plan (DCP) Impact
Deferred Compensation Plan (DCP) Impact YTD Comparison Year Ended December 31, $ in millions 2025 2024 Non-GAAP Revenue 5,057,841 4,260,485 Non-GAAP cost of services 3,975,934 3,351,284 Less: DCP gain (loss) related to cost of services 4,391 2,779 Non-GAAP cost of services without DCP 3,971,543 3,34
Slide 48: 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 Arrowhead Springs Healthcare CA SNF 99 Atchison Senior Village Rehabilitation and
Slide 49: Standard Bearer Property Locations
Standard Bearer Property Locations # of Operating Beds / Property Name State Property Type Tenant Units Creekside Transitional Care and Rehabilitation ID SNF 139 Crestwood Health & Rehabilitation Center TX Campus 148 Crystal Heights Care Center IA SNF 72 Decatur County Healthcare TN SNF 115 Deer Cre
Slide 50: Standard Bearer Property Locations
Standard Bearer Property Locations # of Operating Beds / Property Name State Property Type Tenant Units Kirkwood Manor TX SNF 162 Lake Pointe Villa Assisted Living WI Senior Living 19 Pennant Legend Healthcare and Rehabilitation - Paris TX SNF 120 Lila Doyle Post Acute SC SNF 120 Lo-Har Senior Livin
Slide 51: 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 52: Standard Bearer Property Locations
Standard Bearer Property Locations # of Operating Beds / Property Name State Property Type Tenant Units Pueblo Springs Rehabilitation Center AZ SNF 115 Puget Sound Transitional Care WA SNF 125 Rehabilitation and Nursing Center of the Rockies CO SNF 98 Rio Vista Post Acute and Rehabilitation AZ SNF 1
Slide 53: Standard Bearer Property Locations
Standard Bearer Property Locations # of Operating Beds / Property Name State Property Type Tenant Units St. George Rehabilitation UT SNF 99 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 5
Slide 54: Standard Bearer Property Locations
Standard Bearer Property Locations # of Operating Beds / Property Name State Property Type Tenant Units The Pines Post Acute and Memory Care WI SNF 50 The Shores of Sheboygan Assisted Living WI Senior Living 67 Pennant The Springs at Pacific Regent CA SNF 59 The Terrace at Mt. Ogden UT SNF 114 The V
Slide 55: End Notes
End Notes www.ensigngroup.net
Slide 56: End Notes
End Notes 1 — Occupancy and Skilled Mix metrics represent same store metrics for Q4'25. Reflects midpoints of 2025 guidance ranges of $5.77B to $5.84B for annual revenue and $7.41 to $7.61 for diluted adjusted EPS. [Slide 5] 2 — Adjusted EBITDAR consists of net income before (a) interest income, (b)
Slide 57: 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 December 31
Slide 58: Thank You
ENSIGN <== GROUP