The Ensign Group (ENSG) Q4 2025 earnings summary

Executive summary

• Achieved record annual and quarterly results in revenue, net income, and EPS, driven by strong operational performance, clinical excellence, and a patient-focused culture.

• Outperformed industry peers in CMS survey results and quality measures, with significant improvements in staff retention and leadership stability.

• Expanded to 378 facilities with over 42,000 beds/units and 56,000+ employees across 17 states, adding 51 new operations in 2025 and 17 in Q4.

• Emphasizes a decentralized, entrepreneurial leadership model and cluster-based operational structure to drive superior clinical and financial outcomes.

• Achieved a 16% annual revenue and EBITDAR growth rate since 2014, with a total shareholder return of 4,589% since IPO.

Financial highlights

• FY25 GAAP diluted EPS: $5.84 (+14.1% YoY); adjusted EPS: $6.57 (+19.5% YoY); GAAP net income: $344M (+15.4% YoY); adjusted net income: $386.6M (+20.6% YoY).

• FY25 consolidated revenue: $5.06B (+18.7% YoY); Q4 revenue: $1.36B (+20.2% YoY); adjusted net income Q4: $107.8M (+23.2% YoY).

• Adjusted EBITDAR for 2025: $841.7M; adjusted EBITDA: $602.4M (up from $490.4M in 2024).

• Cash and equivalents: $503.9M; cash flow from operations: $564.3M; available credit: $591.6M.

• Increased dividend for 23rd consecutive year; $0.065 per share paid in Q4.

Outlook and guidance

• FY26 earnings guidance: $7.41–$7.61 per diluted share; revenue guidance: $5.77B–$5.84B.

• Midpoint of FY26 EPS guidance is 14.3% above FY25 and 36.5% above FY24.

• Guidance assumes 60M diluted shares, 25% tax rate, normalized insurance costs, and excludes certain non-recurring charges.

• Guidance includes expected Q1 2026 acquisitions and assumes continued progress in occupancy, skilled mix, and operational initiatives.