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, Medicare revenue, and managed care census 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, including 21 real estate assets, expanding presence in Texas, Arizona, and Wisconsin; portfolio now includes 395 healthcare operations across 17 states.

• Maintains a diversified business model with real estate ownership, new ventures, and a captive REIT structure for capital flexibility.

Financial highlights

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

• Consolidated GAAP and adjusted revenues both increased 18.4% to $1.39 billion.

• GAAP net income grew 24.2% to $99.7 million; adjusted net income up 23.9% to $110.2 million.

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

• Cash and cash equivalents at $539.5 million; cash flow from operations $100.2 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, with midpoint EPS up 15% over 2025 and 37% over 2024.

• Guidance incorporates acquisitions closed and expected through Q2 2026, assumes 60 million diluted shares, 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.

• Anticipates typical seasonality with lighter Q2/Q3 skilled mix and stronger Q4.