The Ensign Group, Inc.ENSG
NasdaqGS•Healthcare•Medical Care Facilities
The Ensign Group, Inc. provides skilled nursing, senior living, and rehabilitative services. It operates through two segments: Skilled Services and Standard Bearer. The Skilled Services segment provides short and long-term nursing care services for patients with chronic conditions, prolonged illness, and the elderly; specialty care, such as on-site dialysis, ventilator care, cardiac, and pulmonary management; and standard services, such as room and board, special nutritional programs, social services, recreational activities, entertainment, and other services. The Standard Bearer segment leases post-acute care properties to healthcare operators. In addition, the company operates senior living units; and provides ancillary services consisting of digital x-ray, ultrasound, electrocardiograms, sub-acute services, dialysis, respiratory, and long-term care pharmacy and patient transportation to people in their homes or at long-term care facilities, as well as mobile diagnostics. The company operates healthcare facilities in Alabama, Alaska, Arizona, Colorado, Idaho, Iowa, Kansas, Oregon, Nebraska, Nevada, South Carolina, Tennessee, Texas, Utah, Washington, and Wisconsin. The company was incorporated in 1999 and is based in San Juan Capistrano, California.
The Ensign Group, Inc. (ENSG) reported trailing twelve months revenue of $5.24B as of March 2026, a 18.5% increase year-over-year. Quarterly revenue reached $1.38B, reflecting continued top-line momentum.
The Ensign Group, Inc. generated $363.36M in TTM net income, with quarterly EBITDA of $153.65M. The operating margin expanded from 8.6% to 9.0%, suggesting improving cost efficiency and pricing discipline.
The spread between operating margin (9.0%) and net margin (7.2%) indicates tight cost control with minimal non-operating drag. Net margin has improved from 6.8% a year ago, signaling stronger bottom-line efficiency.
ENSG trades at a P/E of 31.9x (a premium multiple) and a P/S of 2.2x. The price-to-book ratio of 4.9x reflects a moderate premium to book value.
The company generated $64.68M in free cash flow over the trailing twelve months, a 120.8% increase year-over-year, indicating cash generation ability. The balance sheet shows $5.61B in total assets with $136.49M in long-term debt against $2.37B in stockholders equity for a debt-to-equity ratio of 0.1, a conservative capital structure. Data based on the most recent quarterly reports.
Competitive analysis based on 21 quarters of fundamental data
Operating margins are positive at ~8.5% on average, but show some variability — pricing power may be sensitive to market conditions.
ROE averages 15.2% but has fluctuated — the competitive advantage may be cyclical or emerging.
Free cash flow is consistently positive and growing — a hallmark of a capital-light business that can self-fund growth.
TTM revenue has grown consistently (7 of 7 quarters up), with ~32.1% growth over the period. Strong demand durability.
Data-driven red flags and warnings across 21 quarters
Margins are stable or improving at ~8.5% — no sign of cost or pricing stress.
FCF/Net Income has dropped below 0.7x in 4 quarters — monitor for earnings quality deterioration.
D/E ratio is 0.1 — conservative capital structure with low financial risk.
Revenue is stable or growing over recent quarters — demand appears durable.
Free cash flow is consistently positive — the business self-funds without external capital reliance.
Shares outstanding rose 2.2% — mild dilution. Compare to earnings growth to assess net per-share impact.
Quarterly standardized metrics.
Stock price and market valuation
Revenue and earnings growth across quarters
Assets, cash, debt, and leverage
Price multiples and return ratios
Operating efficiency and return metrics
Free cash flow, earnings quality, and capital allocation