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Here are 1-3 brief analogies to describe Ensign (ENSG):

• The Marriott of skilled nursing and senior living facilities.
• A healthcare chain like HCA Healthcare, but focused on skilled nursing and senior living.
• Like an expanded Brookdale Senior Living, offering not just senior living but also skilled nursing, hospice, and home health services.

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• Skilled Nursing Services: Provides comprehensive post-acute and long-term medical care, including rehabilitation, delivered by licensed healthcare professionals.
• Assisted Living Services: Offers supportive residential care for seniors needing help with daily activities in a less intensive environment than skilled nursing.
• Home Health Services: Delivers medical and rehabilitative care to patients in their private residences.
• Hospice Services: Provides specialized comfort care and support for terminally ill patients and their families.

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The Ensign Group, Inc. (ENSG) primarily sells its services to **individuals** rather than other companies.

Ensign operates skilled nursing facilities, assisted living facilities, and other healthcare services. Its major customer categories, based on the type and level of care required, are:

1. Patients Requiring Post-Acute Skilled Nursing and Rehabilitation: These are individuals, often seniors, who are discharged from hospitals after surgery, illness, or injury and require a temporary stay in a skilled nursing facility for intensive therapy (physical, occupational, speech) and medical care to recover and regain functionality before returning home.

2. Long-Term Skilled Nursing Residents: This category includes individuals, typically seniors, with chronic conditions, disabilities, or complex medical needs who require ongoing 24/7 medical care, supervision, and comprehensive assistance with activities of daily living (ADLs) in a skilled nursing facility.

3. Assisted Living Residents (Including Memory Care): These are individuals, predominantly seniors, who need assistance with some activities of daily living (e.g., medication management, bathing, dressing) but do not require the continuous medical supervision found in a skilled nursing facility. This category also includes residents in specialized memory care units designed for individuals with Alzheimer's disease or other forms of dementia.

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Barry Port, Chief Executive Officer and Board Member

Barry Port has served as Chief Executive Officer and Board Member since May 2019 and was appointed Chairman of the Board in September 2025. Prior to his CEO role, he was the Chief Operating Officer of Ensign Services, Inc. from 2012 to 2019, directing field support and administrative services for affiliated skilled nursing and senior living operations. From 2006 to 2011, Mr. Port served as President of Keystone Care, Inc., where he oversaw and expanded a network of facilities throughout Texas from four to 23 buildings in five years. His healthcare leadership career began with operational leadership roles at skilled nursing campuses in Arizona and Texas. Before joining Ensign in 2004, he was a supply chain management executive at Sprint. He also serves on the Board of Directors of the American Health Care Association (AHCA) and co-chairs Partners Advancing Post-Acute Care.

Suzanne D. Snapper, Chief Financial Officer, Executive Vice President, and Director

Suzanne D. Snapper joined Ensign in April 2007 and has served as Chief Financial Officer since August 2009. As Vice President of Finance, she played an instrumental role in guiding the company through its initial public offering in 2007 and spearheaded the implementation of internal controls over financial reporting. As CFO, Ms. Snapper played a pivotal role in the successful spin-offs of CareTrust REIT in 2014 and The Pennant Group in 2019, and contributed to the formation of the Standard Bearer REIT in 2022. Before her tenure at Ensign, she spent ten years as a senior manager at KPMG LLP from 1996 to April 2007, providing audit services for public companies in various industries. She is a Certified Public Accountant.

Chad A. Keetch, Chief Investment Officer, Executive Vice President, and Secretary

Chad A. Keetch assumed the roles of Chief Investment Officer, Executive Vice President, and Secretary on May 30, 2019. He previously served as Executive Vice President and Secretary since June 2014 and as Vice President of Acquisitions and Business Legal Affairs and Assistant Secretary from 2010 to 2014. Mr. Keetch leads the company's acquisition and growth initiatives, contributing to the growth from 62 skilled nursing facilities in 2010 to over 340 operations, including over 150 real estate purchases. In 2022, he was also appointed President of the company's real estate subsidiary, Standard Bearer Healthcare REIT, Inc. He was instrumental in the spin-off of CareTrust REIT, Inc. in 2014 and The Pennant Group, Inc. in 2019. Before joining Ensign, Mr. Keetch was a transactional attorney at Stoel Rives LLP from 2008 to 2010 and at Kirkland & Ellis LLP from 2005 to 2008, where his practice emphasized private equity, mergers and acquisitions, leveraged buyouts, and capital markets transactions.

Christopher R. Christensen, Executive Chairman

Christopher R. Christensen co-founded The Ensign Group in 1999. He served as President and CEO of The Ensign Group since its founding until May 2019, when he transitioned to Executive Chairman. Mr. Christensen has over 30 years of healthcare management experience and has served on the boards of several healthcare organizations.

Spencer Burton, President & Chief Operating Officer

Spencer Burton was appointed as President & Chief Operating Officer on May 30, 2019. He is a seasoned executive with nearly two decades of experience in post-acute care. Prior to his current role, he served as president of Pennant Healthcare, Inc., Ensign Services' Northwest-based portfolio company, and as Executive Director at affiliated operations in California, Texas, and Washington. Mr. Burton has a track record of navigating complex regulatory landscapes, fostering a culture of clinical excellence, and orchestrating growth.

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1. Dependence on Government Reimbursement and Regulatory Changes: A substantial portion of Ensign Group's revenue comes from government entitlement programs such as Medicare and Medicaid, with 71% of total revenues for the nine months ended September 30, 2024, originating from these sources. This reliance makes the company highly vulnerable to reductions in prices and reimbursement rates for its services. Potential spending cuts by federal and state governments, driven by budget deficits, or new political reforms in the healthcare system, could significantly impact the amount of revenue Ensign Group generates. The application of existing or proposed government regulations, or the adoption of new laws, could also limit business operations, necessitate significant expenditures, or restrict the company's ability to relocate facilities. Specifically, budget reductions or delays in states like California, Texas, and Arizona, where the company has a significant presence, could adversely affect net patient service revenue and profitability.
2. Labor Shortages and Increasing Labor Costs: The healthcare industry, particularly skilled nursing, is experiencing a persistent shortage of skilled nurses and other healthcare professionals. This shortage can lead to increased labor costs for Ensign Group's operations. The pressure on labor markets makes it challenging to attract and retain qualified staff, directly impacting operational expenses and potentially affecting the quality of care. The company has already reported expectations of increased labor costs per patient.
3. Litigation and Professional Liability Claims: Ensign Group's business, which involves caring for elderly and often frail patients in skilled nursing facilities, carries a significant risk of liability. The industry has seen an increase in the number and severity of litigation claims, including professional liability claims alleging personal injury, and substantial punitive damage awards. The company's ability to defend against these lawsuits and other regulatory-related claims is crucial. Furthermore, an investigation into potential breaches of fiduciary duties by the company's directors was announced in July 2025, signaling potential governance issues that could lead to legal liabilities and affect investor confidence and the company's financial health.

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The most significant emerging threat for Ensign (ENSG) is the rapid expansion of advanced home-based care models, including "hospital-at-home" programs and robust post-acute care services delivered in the home setting. These models, often leveraging telehealth, remote monitoring, and mobile care teams, provide a direct alternative to traditional skilled nursing facilities (SNFs) and some senior living services. Driven by payer incentives (value-based care), technological advancements, and patient preference for care in a familiar environment, these services aim to reduce costly institutional stays and improve outcomes. As these programs scale and gain broader acceptance and reimbursement, they directly compete for the patient population that Ensign traditionally serves in its facilities, potentially eroding demand for facility-based skilled nursing and rehabilitative care.

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The Ensign Group, Inc. (ENSG) operates primarily within the U.S. healthcare services industry, with its main products and services centered around skilled nursing, senior living, and rehabilitative care. It also provides various ancillary services, including mobile diagnostics and medical transportation.

Skilled Nursing Services

The addressable market for skilled nursing facilities in the U.S. was estimated at approximately USD 199.72 billion in 2024 and is projected to reach USD 290.02 billion by 2033, growing at a CAGR of 4.39% from 2025 to 2033. Another estimate placed the U.S. skilled nursing facility market size at USD 202.4 billion in 2025, with a projection to reach USD 279.9 billion by 2035.

Senior Living Services (including Assisted Living and Independent Living)

The U.S. senior living market, which includes assisted living and independent living, was estimated at USD 907.59 billion in 2024 and is expected to grow to USD 1.33 trillion by 2033, with a CAGR of 4.42% from 2025 to 2033. Another report valued the U.S. senior living market at USD 923.20 billion in 2023, with a projection to reach approximately USD 1.22 trillion by 2030.

Rehabilitation Services

Ensign provides rehabilitation services, including physical, occupational, and speech therapy, often within its skilled nursing facilities. The market size for rehabilitation services is largely integrated within the broader skilled nursing and post-acute care markets. Therefore, a separate addressable market size for standalone rehabilitation services offered by Ensign is not distinctly available. Based on available information, a specific separate market size cannot be identified, so it is null for this category.

Other Ancillary Businesses (Mobile Diagnostics, Medical Transportation, Home Health, and Hospice Services)

Ensign's other ancillary businesses encompass services such as mobile diagnostics, medical transportation, home health, and hospice care. While these services contribute to the overall healthcare market, specific addressable market sizes for these individual segments directly related to Ensign's operational scope were not readily available in the provided search results. Therefore, for these specific ancillary services, the addressable market size is null.

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1. Strategic Acquisitions and Expansion: Ensign consistently expands its footprint by acquiring new skilled nursing and senior living operations. For instance, the company acquired 22 new operations in a recent quarter, adding significant capacity with 1,857 new skilled nursing beds and 109 senior living units. Since 2023, Ensign has completed 73 acquisitions, with a strategic focus on integrating these facilities into existing clusters to maximize operational synergies and expand its geographic presence across 17 states. This disciplined acquisition strategy directly adds to the company's revenue-generating assets.
2. Increasing Occupancy Rates: The company has demonstrated a strong ability to increase occupancy rates in both its same-store and transitioning facilities. Ensign achieved record-high occupancy rates of 83% in same-store facilities and 84.4% in transitioning facilities in a recent quarter, showcasing its capacity to optimize facility utilization. In Q3 2024, same-store occupancies grew to 81.7%, a 2.8% increase over the prior year quarter. This growth in customer volume directly translates to higher service revenues.
3. Growth in Skilled Mix Days and Medicare/Managed Care Revenue: Ensign is focused on enhancing its "skilled mix days" and increasing revenue from higher-reimbursement sources like Medicare and managed care. The company improved skilled mix days by 5.1% and 10.9% for same-store and transitioning operations, respectively, in a recent period. Medicare revenue also increased by 10% and 8.8% for these segments. In Q3 2024, skilled days increased across all skilled payer sources in same-store operations by 6.1%, contributing to a 7.3% revenue growth for these operations. This strategy shifts the patient mix towards more complex care, leading to higher average revenue per patient.
4. Operational Efficiencies and Clinical Excellence: While not a direct new product or service, Ensign's emphasis on clinical excellence and a unique decentralized operating model drives better performance and higher quality ratings, which in turn attract more patients and higher reimbursement rates. The company's facilities have shown superior performance compared to peers, and it has reduced its percentage of 1-star facilities, indicating improved care quality and operational effectiveness. These operational improvements contribute to increased demand and sustained revenue growth by enhancing reputation and service quality.
5. Favorable Demographic Trends: The long-term demographic trend of an aging U.S. population, particularly the expected growth of those aged 80 and older, is a significant underlying driver for Ensign's services. This demographic shift is anticipated to increase the demand for skilled nursing and senior living facilities, providing a tailwind for sustained revenue growth in the healthcare services industry.

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Share Repurchases

• The Ensign Group authorized a share repurchase program of $20 million, valid for 12 months from March 26, 2025.
• A $20.0 million share repurchase program was completed, and the company confirmed having a stock repurchase program in place as of July 24, 2025.
• Quarterly share repurchases were $10.78 million in Q1 2025 and $9.19 million in Q2 2025.

Share Issuance

• The number of shares outstanding increased from 54.65 million at the end of 2021 to 57.157 million as of November 2025.
• The diluted weighted average common shares outstanding guidance for 2025 is approximately 59.0 million.
• Employee stock options and minor share acquisitions by insiders contribute to changes in outstanding shares.

Outbound Investments

• Ensign Group is consistently making strategic acquisitions of skilled nursing and senior living facilities, spending over $210 million on deals in the first half of 2025 alone.
• Recent significant acquisitions include seven skilled nursing facilities in Utah and one in Alabama in November 2025, which expanded its portfolio to 369 healthcare operations across 17 states.
• Many of the real estate assets for these acquisitions are acquired by its captive real estate subsidiary, Standard Bearer Healthcare REIT, Inc.

Capital Expenditures

• Annual capital expenditures were $158.24 million in 2024, $173.978 million in 2023, and $172.3 million in 2022.
• The trailing twelve months (TTM) capital expenditures as of June 30, 2025, were $190.688 million.
• Capital expenditures are primarily focused on acquisitions and associated real estate investments, driving the company's growth strategy and investment in new buildings and upgrades for its healthcare facilities.