The Ensign Group (ENSG) Q4 2024 earnings summary

Executive summary

• Achieved record clinical and financial results in 2024, driven by strong leadership, operational fundamentals, and a decentralized, entrepreneurial culture with empowered local leadership.

• Operates 334 facilities across 15 states with over 49,000 employees, focusing on post-acute care, skilled nursing, senior living, and ancillary services.

• Added 64 new operations since 2023, expanding into new states and deepening market presence.

• Achieved a 15% annual revenue CAGR and 16% annual EBITDAR CAGR from 2014 to 2024.

• Total shareholder return since IPO in 2007 reached 3,709%.

Financial highlights

• Full-year 2024 GAAP diluted EPS was $5.12, up 40.3% year-over-year; adjusted diluted EPS was $5.50, up 15.3%.

• GAAP net income reached $298 million, a 42.3% increase; adjusted net income was $320.5 million, up 17.2%.

• Consolidated GAAP and adjusted revenues were $4.26 billion, up 14.2% year-over-year; Q4 revenues were $1.13 billion, up 15.5%.

• Adjusted EBITDA for 2024 was $490.4 million, up from $425.8 million in 2023.

• Cash and cash equivalents at year-end 2024 were $464.6 million; net debt to adjusted EBITDAR at 1.90x.

Outlook and guidance

• 2025 earnings guidance: $6.16–$6.34 per diluted share; revenue guidance: $4.83–$4.91 billion.

• Midpoint of 2025 EPS guidance is 13.8% above 2024 and 31% above 2023.

• Guidance includes acquisitions through Q2 2025, assumes normalized health insurance costs, and factors in Medicare/Medicaid reimbursement expectations.