third quarter 2026
Filed Oct 27, 2026The Ensign Group Reports Third Quarter 2026 Results; Raises 2026 Annual Earnings Guidance
Third-quarter GAAP diluted EPS increased 23.9%, adjusted diluted EPS increased 23.8%, consolidated revenue increased 14.5%, and the Company raised its annual 2026 earnings and revenue guidance.
Key metrics
shortened, hover for the filing’s print| Metric | Value | q/q | y/y |
|---|---|---|---|
| Q3 2026 service revenueGAAP | $1.48B | – | – |
| Q3 2026 rental revenueGAAP | $7.17M | – | – |
| Q3 2026 total revenueGAAP | $1.48B | – | 14.5% |
| Q3 2026 cost of servicesGAAP | 1.17B | – | – |
| Q3 2026 rent—cost of servicesGAAP | 66.97M | – | – |
| Q3 2026 general and administrative expenseGAAP | 79.59M | – | – |
| Q3 2026 depreciation and amortizationGAAP | 32.65M | – | – |
| Q3 2026 total expensesGAAP | $1.35B | – | – |
| Q3 2026 income from operationsGAAP | 138.0M | – | – |
| Q3 2026 income before provision for income taxesGAAP | 140.2M | – | – |
| Q3 2026 net incomeGAAP | $104.4M | – | 24.4% |
| Q3 2026 net income attributable to The Ensign Group, Inc.GAAP | $104.3M | – | – |
| Q3 2026 diluted earnings per shareGAAP | $ 1.76 | – | 23.9% |
| Q3 2026 basic earnings per shareGAAP | $ 1.80 | – | – |
| Q3 2026 adjusted net incomenon-GAAP | $120.5M | – | 24.9% |
| Q3 2026 adjusted earnings per sharenon-GAAP | $ 2.03 | – | 23.8% |
| Q3 2026 EBITDAnon-GAAP | $170.3M | – | – |
| Q3 2026 adjusted EBITDAnon-GAAP | $190.7M | – | – |
| Q3 2026 adjusted EBTnon-GAAP | $160.8M | – | – |
| Nine months 2026 total revenueGAAP | $4.31B | – | – |
| Nine months 2026 income from operationsGAAP | 385.3M | – | – |
| Nine months 2026 net incomeGAAP | $304.0M | – | – |
| Nine months 2026 diluted earnings per shareGAAP | $ 5.11 | – | – |
| Nine months 2026 adjusted net incomenon-GAAP | $345.0M | – | – |
| Nine months 2026 adjusted earnings per sharenon-GAAP | $ 5.80 | – | – |
| Nine months 2026 EBITDAnon-GAAP | $485.3M | – | – |
| Nine months 2026 adjusted EBITDAnon-GAAP | $543.0M | – | – |
| Nine months 2026 adjusted EBTnon-GAAP | $460.4M | – | – |
Segments
| Segment | Revenue | q/q | y/y |
|---|---|---|---|
| Skilled ServicesTotal facility skilled services revenue increased by $ 182,875 (In thousands); actual patient days increased by 364,251 and occupancy percentage—operational beds was 83.1 % versus 82.3 %. | $1.42B | – | – |
| Standard BearerTotal rental revenue included $ 42,142 (In thousands) generated from Ensign's independent subsidiaries and $ 5,562 (In thousands) from third-party tenants; FFO was $ 27,316 (In thousands). | $47.70M | – | – |
Amounts quoted below without a unit are in thousands, as in the filing’s tables. Per-share figures are as printed.
annual 2026 outlook
- Revenue$5.89 billion to $5.92 billion
- Tax rate25.0% tax rate
- Note$7.94 to $8.02 per diluted share
- Notediluted weighted average common shares outstanding of approximately 59.5 million
- NoteGuidance excludes certain charges that arise outside the normal course of business, amortization of system implementation costs, acquisition related costs and share-based compensation.
Capital returns
- The Company paid a quarterly cash dividend of $0.065 per share of Ensign common stock.
What drove it
- Same Facilities occupancy was 84.1% and Transitioning Facilities occupancy was 86.1%, increases of 1.6% and 3.9%, respectively, over the prior year quarter.
- Same Facilities and Transitioning Facilities skilled mix revenue increased by 10.7% and 10.5%, respectively, over the prior year quarter.
- Same Facilities Medicare revenue increased by 11.1% and managed care revenue increased by 9.1% over the prior year quarter.
- Transitioning Facilities Medicare revenue increased by 7.8% and managed care revenue increased by 7.2% over the prior year quarter.
- During the quarter and since, the Company added 22 new operations, including three real estate assets and 19 leased operations, and acquired five real estate properties that were under lease arrangements that it operates.
- Ensign's portfolio consisted of 418 healthcare operations across 18 states, and it owned 189 real estate assets, 150 of which were operated by an Ensign affiliate.
Concerns
- Recently Acquired Facility occupancy percentage—operational beds was 77.4 %, compared with 76.9 % in the prior-year quarter, below Total Facility Results occupancy percentage—operational beds of 83.1 %.
- Recently Acquired Facility skilled mix by nursing revenue was 43.2 %, compared with 45.6 % in the prior-year quarter.
- Cash and cash equivalents declined to $ 337,592 (In thousands) from $ 503,881 (In thousands) at December 31, 2025, alongside $ (690,937) (In thousands) of nine-month investing cash flow.
- Long-term debt—less current maturities increased to 194,684 (In thousands) from 137,529 (In thousands) at December 31, 2025.
What to watch
- Execution against annual 2026 guidance of $7.94 to $8.02 per diluted share and revenue guidance of $5.89 billion to $5.92 billion.
- Occupancy, skilled mix, Medicare revenue and managed care revenue trends at Same Facilities, Transitioning Facilities and Recently Acquired Facilities.
- Performance and integration of the 22 new operations and five acquired real estate properties.
- Cash deployment, investing activities, line-of-credit capacity and long-term debt as acquisition activity continues.
- Standard Bearer rental revenue and FFO, including rental revenue from Ensign's independent subsidiaries.
Balance sheet and cash flow
- Cash and cash equivalents were $ 337,592 (In thousands) at September 30, 2026, compared with $ 503,881 (In thousands) at December 31, 2025.
- Available capacity under its line-of-credit was $731.6 million.
- Long-term debt—less current maturities was 194,684 (In thousands) at September 30, 2026, compared with 137,529 (In thousands) at December 31, 2025.
- Net cash provided by operating activities for the nine months ended September 30, 2026 was $ 512,348 (In thousands), compared with $ 380,950 (In thousands).
- Net cash used in investing activities for the nine months ended September 30, 2026 was (690,937) (In thousands), compared with (389,237) (In thousands).
- Net decrease in cash and cash equivalents for the nine months ended September 30, 2026 was $ (166,289) (In thousands), compared with $ (20,930) (In thousands).
Analysis
Ensign delivered a strong third quarter, with total revenue of $ 1,484,002 (In thousands), up 14.5% over the prior-year quarter. GAAP net income rose 24.4% to $ 104,384 (In thousands), while GAAP diluted earnings per share increased 23.9% to $ 1.76. Adjusted net income was $ 120,456 (In thousands) and adjusted earnings per share was $ 2.03, up 24.9% and 23.8%, respectively. Income from operations was 137,989 (In thousands), compared with 96,218 (In thousands) in the prior-year quarter.
Operating indicators point to broad demand strength. Same Facilities occupancy reached 84.1% and Transitioning Facilities occupancy reached 86.1%, with reported prior-year-quarter increases of 1.6% and 3.9%, respectively. Same Facilities skilled mix revenue increased 10.7% and Transitioning Facilities skilled mix revenue increased 10.5%. Medicare and managed care revenue increased across both populations, while Total Facility Results actual patient days increased by 364,251. Recently Acquired Facilities added material scale but reported occupancy of 77.4 % and skilled mix by nursing revenue of 43.2 %.
Growth was supported by both skilled services and real estate. Skilled Services revenue was $ 1,421,971 (In thousands), and Standard Bearer generated $ 47,704 (In thousands) of rental revenue and $ 27,316 (In thousands) of FFO. The Company added 22 new operations during the quarter and since, including three real estate assets and 19 leased operations, while also acquiring five real estate properties previously under third-party triple-net lease arrangements. The portfolio expanded to 418 healthcare operations across 18 states.
Liquidity included $ 337,592 (In thousands) of cash and cash equivalents and $731.6 million of available line-of-credit capacity. Nine-month operating cash flow was $ 512,348 (In thousands), while investing activities used $ (690,937) (In thousands), consistent with acquisition and real-estate expansion. Long-term debt—less current maturities was 194,684 (In thousands), compared with 137,529 (In thousands) at December 31, 2025. The Company continued its dividend with a quarterly cash dividend of $0.065 per share.
Management raised annual 2026 earnings guidance to $7.94 to $8.02 per diluted share from its original $7.75 to $7.85 range and raised the lower end of revenue guidance to $5.89 billion while maintaining the upper end at $5.92 billion. Guidance assumes approximately 59.5 million diluted weighted average common shares outstanding and a 25.0% tax rate, and excludes specified non-routine and non-GAAP adjustment items. The reported guide reflects management's stated confidence in fourth-quarter operating performance and expected acquisitions through the fourth quarter of 2026.
Management, verbatim
We continue to see strong demand across our portfolio and experienced growth in occupancy and skilled mix during the quarter.
Barry Port, Chief Executive Officer of The Ensign Group
Due to the strength of the third quarter and our confidence in the fourth quarter, we are increasing our annual 2026 earnings guidance to $7.94 to $8.02 per diluted share, up from our original guidance of $7.75 to $7.85.
Barry Port, Chief Executive Officer of The Ensign Group
We continue to acquire new operations with significant long-term upside and expect to maintain a healthy pace of growth as we expand our mission driven approach to transform and dignify post-acute care.
Chad Keetch, Ensign’s Chief Investment Officer and Executive Vice President
Not in the filing
stated, not guessed- Prior outlook section was not provided; therefore, no comparison of actual results with prior guidance is included.
- Gross margin was not reported.
- Quarterly operating cash flow was not reported.
- Free cash flow was not reported.
- Share repurchases were not reported.
- Gross-margin, operating-expense and tax-rate guidance beyond the stated 25.0% tax-rate assumption were not reported.
- Prior-quarter comparisons for the reported quarterly metrics were not reported.
AlphAI analysis generated from the company’s SEC earnings filing (Form 8-K Item 2.02, or Form 6-K for a foreign private issuer). Every figure was cross-checked against the filing text; consensus estimates, price targets and share-price reactions are not shown because they are not in the filing. AI-generated research, not investment advice.