Ensign Group Inc (NASDAQ: ENSG) is a post-acute healthcare company that owns and operates skilled nursing facilities and senior living communities across the United States. Revenue comes primarily from patient care services billed to Medicaid, Medicare, managed care and commercial insurance payors, and private pay patients, with service revenue representing 99.5% of total revenue in both FY2025 and FY2024. As of December 31, 2025, the company operated 373 facilities with 37,911 operational skilled nursing beds and 3,402 senior living units across 17 states, held through a combination of long-term leases and owned real estate. A captive REIT subsidiary, Standard Bearer Healthcare REIT Inc., owns properties and generates rental revenue, which accounted for 0.5% of total revenue in FY2025. The skilled services segment produced $616.4 million in segment income in FY2025, up from $518.5 million in FY2024. The Standard Bearer segment contributed $37.6 million in segment income in FY2025. The holding company structure places all operating assets, employees, and revenues in separate, wholly-owned independent subsidiaries, with a centralized Service Center providing shared accounting, payroll, HR, IT, legal, and risk management functions.

Revenue model

Fee-for-service billing to Medicaid, Medicare, managed care and commercial insurance payors, and private pay patients for skilled nursing and senior living care. A small rental revenue stream (0.5% of total revenue in FY2025) comes from the Standard Bearer REIT subsidiary leasing properties to third-party operators. Cost of services ran 79.5% of revenue in FY2025, producing an operating income margin of 8.4%.

Products and services

Skilled nursing care including short-stay and long-stay services for patients with chronic conditions, strokes, cardiovascular and respiratory conditions, neurological conditions, and joint replacements. Specialty services include on-site dialysis, ventilator care, and cardiac and pulmonary management. Senior living communities offering 3,402 units as of December 31, 2025. Standard services include room and board, nutritional programs, social services, and recreational activities.

Customers and end markets

Primary end market is elderly and high-acuity patients requiring post-acute or long-term care. Payors are Medicaid (state and federal programs), Medicare, managed care and commercial insurers, and private pay individuals. Revenue is highly dependent on Medicaid and Medicare reimbursement rates and payment models.

Value-chain role

Direct operator of post-acute care facilities. Sits at the point-of-care delivery layer in the post-acute continuum, downstream from acute-care hospitals that discharge patients requiring skilled nursing or rehabilitation. Facilities accept physician-directed care plans and deploy interdisciplinary clinical teams. Captive insurance subsidiary manages risk internally. Service Center subsidiary provides centralized back-office functions to operating subsidiaries.

Geographic exposure

17 states as of December 31, 2025: Alabama, Alaska, Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, Oregon, South Carolina, Tennessee, Texas, Utah, Washington, and Wisconsin. Largest property concentrations include Texas (35 total properties), Wisconsin (26), Arizona (18), Utah (15), and California (15) based on Standard Bearer property data in the FY2025 10-K.

Source: SEC 10-K, filed 2026-02-04

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