The Ensign Group (ENSG) Q1 2026 earnings summary

Executive summary

• Operates 395 facilities with over 44,000 beds/units and 57,000+ employees across 17 states, focusing on post-acute care, skilled nursing, senior living, and ancillary services.

• Achieved record year and quarter in key financial and operational metrics, with Q1 2026 revenue up 18.4% to $1.39B, driven by higher occupancy, rate increases, and acquisitions.

• Net income attributable to shareholders rose 24.2% to $99.7M, with GAAP diluted EPS up 21.9% to $1.67 and adjusted EPS up 21.7% to $1.85.

• Local leadership and cluster models, along with a patient-focused culture, drive superior clinical outcomes and operational rigor, supporting organic and acquisition-led growth.

• Same-store and transitioning occupancy reached record highs at 84.3% and 85.1%, with significant increases in skilled days and Medicare/Managed Care revenue.

Financial highlights

• Q1 2026 consolidated revenue was $1.39B (+18.4% YoY); service revenue $1.38B; rental revenue $36.1M (+27.1% YoY); GAAP net income $99.7M (+24.2% YoY); adjusted net income $110.2M (+23.9% YoY).

• Adjusted EBITDA for Q1 2026 was $171.2M; adjusted EBITDAR $236.7M.

• Cash and cash equivalents at quarter-end were $539.5M; cash flow from operations was $100.2M.

• Lease-adjusted net debt-to-EBITDA/EBITDAR improved to 1.73x at Q1 2026.

• Quarterly cash dividend of $0.065 per share paid for the 23rd consecutive year.

Outlook and guidance

• 2026 annual revenue guidance is $5.81B–$5.86B; diluted adjusted EPS guidance is $7.48–$7.62, representing a 15% increase over 2025 and 37% over 2024.

• Guidance incorporates expected acquisitions, reimbursement rates, normalized insurance costs, and a 25% tax rate.

• Existing cash, investments, and projected cash flows are expected to support operations and expansion.