The Ensign Group (ENSG) Q1 2026 earnings summary

Executive summary

• Achieved record same-store and transitioning occupancy rates of 84.3% and 85.1% in Q1 2026, with strong growth in skilled mix and Medicare revenue year-over-year.

• Revenue for Q1 2026 increased 18.4% year-over-year to $1.39 billion, driven by higher occupancy, rate increases, and acquisitions.

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

• Added 22 new operations in the quarter, expanding presence in Texas, Arizona, and Wisconsin, and bringing total recent acquisitions to 71 since 2025.

• Portfolio now includes 395 healthcare operations across 17 states, with 179 owned real estate assets and over 44,000 beds/units.

Financial highlights

• GAAP diluted EPS was $1.67, up 21.9% year-over-year; adjusted diluted EPS was $1.85, up 21.7%.

• Consolidated GAAP and adjusted revenues were $1.39 billion, up 18.4% year-over-year.

• GAAP net income was $99.7 million, up 24.2%; adjusted net income was $110.2 million, up 23.9%.

• Cash and cash equivalents stood at $539.5 million; cash flow from operations was $100.2 million.

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

Outlook and guidance

• Raised 2026 annual earnings guidance to $7.48–$7.62 per diluted share and revenue to $5.81–$5.86 billion, reflecting 15% EPS growth over 2025 and 37% over 2024.

• Guidance includes acquisitions closed and expected through Q2 2026, assumes a 25% tax rate, and excludes stock-based compensation and system implementation costs.

• Management expects continued growth from recent and pending acquisitions, with $342.4 million in real estate purchases pending.

• Seasonal trends expected: Q2 and Q3 typically lighter for skilled mix, with stronger Q4.