ENSIGN GROUP, INC 10-Q

Item 1. FINANCIAL STATEMENTS THE ENSIGN GROUP, INC. UNAUDITED CONDENSED CONSOLIDATED BALANCE SHEETS (In thousands, except par values) March 31, 2026 December 31, 2025 ASSETS Current assets: Cash and cash equivalents $ 539,498 $ 503,881 Accounts receivable—less allowance for doubtful accounts of $ 7,583 and $ 7,805 at March 31, 2026 and December 31, 2025, respectively 663,247 636,985 Investments—current 55,677 68,506 Prepaid expenses and other current assets 61,678 62,932 Total current assets $ 1,320,100 $ 1,272,304 Property and equipment, net 1,720,225 1,696,863 Right-of-use assets 2,137,308 2,097,862 Insurance subsidiary deposits and investments 194,309 166,841 Deferred tax assets 83,169 83,138 Restricted and other assets 52,347 41,600 Intangible assets, net 6,322 6,381 Goodwill 97,981 97,981 TOTAL ASSETS $ 5,611,761 $ 5,462,970 LIABILITIES AND EQUITY Current liabilities: Accounts payable $ 116,132 $ 97,327 Accrued wages and related liabilities 313,517 422,326 Lease liabilities—current 116,500 114,816 Accrued self-insurance liabilities—current 94,868 81,623 Other accrued liabilities 202,766 174,027 Current maturities of long-term debt 4,263 4,227 Total current liabilities $ 848,046 $ 894,346 Long-term lease liabilities—less current portion 1,987,386 1,949,213 Accrued self-insurance liabilities—less current portion 183,860 164,792 Other long-term liabilities 86,281 82,266 Long-term debt—less current maturities 136,491 137,529 TOTAL LIABILITIES $ 3,242,064 $ 3,228,146 Commitments and contingencies (Notes 13 and 18) EQUITY Ensign Group, Inc. stockholders' equity: Common stock: $ 0.001 par value; 150,000 shares authorized; 61,990 and 58,423 shares issued and shares outstanding at March 31, 2026, respectively, and 61,652 and 58,085 shares issued and shares outstanding at December 31, 2025, respectively 62 62 Additional paid-in capital 653,401 614,724 Retained earnings 1,852,008 1,756,137 Treasury stock, at cost, 3,567 shares at March 31, 2026 and December 31, 2025 ( 139,221 ) ( 139,198 ) Total Ensign Group, Inc. stockholders' equity $ 2,366,250 $ 2,231,725 Non-controlling interest 3,447 3,099 Total equity $ 2,369,697 $ 2,234,824 TOTAL LIABILITIES AND EQUITY $ 5,611,761 $ 5,462,970 See accompanying notes to the condensed consolidated financial statements. 1 Table of Contents THE ENSIGN GROUP, INC. UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF INCOME Three Months Ended March 31, 2026 2025 (In thousands, except per share data) REVENUE Service revenue $ 1,382,303 $ 1,167,040 Rental revenue 6,893 6,001 TOTAL REVENUE $ 1,389,196 $ 1,173,041 Expense: Cost of services 1,095,826 927,849 Rent—cost of services 65,506 57,076 General and administrative expense 74,210 62,555 Depreciation and amortization 28,801 24,188 TOTAL EXPENSES $ 1,264,343 $ 1,071,668 Income from operations 124,853 101,373 Other income (expense): Interest expense ( 1,932 ) ( 2,037 ) Interest income 6,536 6,883 Other (expense) income ( 885 ) 361 OTHER INCOME, NET $ 3,719 $ 5,207 Income before provision for income taxes 128,572 106,580 Provision for income taxes 28,816 26,227 NET INCOME $ 99,756 $ 80,353 Less: Net income attributable to noncontrolling interests 88 76 NET INCOME ATTRIBUTABLE TO THE ENSIGN GROUP, INC. $ 99,668 $ 80,277 NET INCOME PER SHARE ATTRIBUTABLE TO THE ENSIGN GROUP INC. Basic $ 1.73 $ 1.41 Diluted $ 1.67 $ 1.37 WEIGHTED AVERAGE COMMON SHARES OUTSTANDING Basic 57,771 57,099 Diluted 59,567 58,500 See accompanying notes to the condensed consolidated financial statements. 2 Table of Contents THE ENSIGN GROUP, INC. UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY Common Stock Additional Paid-In Capital Retained Earnings Treasury Stock Non-Controlling Interest (In thousands) Shares Amount Shares Amount Total BALANCE - JANUARY 1, 2026 58,085 $ 62 $ 614,724 $ 1,756,137 3,567 $ ( 139,198 ) $ 3,099 $ 2,234,824 Issuance of common stock to employees and directors resulting from the exercise of stock options 188 — 11,490 — — — — 11,490 Issuance of restricted stock, net of forfeitures 150 — 13,555 — — — — 13,555 Shares of common stock used to satisfy tax withholding obligations — — — — — ( 23 ) — ( 23 ) Dividends declared ($ 0.0650 per share) — — — ( 3,797 ) — — — ( 3,797 ) Employee stock award compensation — — 13,693 — — — — 13,693 Net income attributable to noncontrolling interest — — — — — — 88 88 Noncontrolling interests attributable to subsidiary equity plan — — ( 61 ) — — — 260 199 Net income attributable to the Ensign Group, Inc. — — — 99,668 — — — 99,668 BALANCE - MARCH 31, 2026 58,423 $ 62 $ 653,401 $ 1,852,008 3,567 $ ( 139,221 ) $ 3,447 $ 2,369,697 Common Stock Additional Paid-In Capital Retained Earnings Treasury Stock Non-Controlling Interest (In thousands) Shares Amount Shares Amount Total BALANCE - JANUARY 1, 2025 57,438 $ 61 $ 528,052 $ 1,426,762 3,400 $ ( 117,764 ) $ 3,317 $ 1,840,428 Issuance of common stock to employees and directors resulting from the exercise of stock options 106 — 5,050 — — — — 5,050 Issuance of restricted stock, net of forfeitures 87 — 8,003 — — — — 8,003 Shares of common stock used to satisfy tax withholding obligations — — — — — ( 14 ) — ( 14 ) Dividends declared ($ 0.0625 per share) — — — ( 3,597 ) — — — ( 3,597 ) Employee stock award compensation — — 10,691 — — — — 10,691 Repurchase of common stock (Note 19) ( 84 ) — — — 84 ( 10,775 ) — ( 10,775 ) Acquisition of noncontrolling interest shares — — ( 11 ) — — — — ( 11 ) Net income attributable to noncontrolling interest — — — — — — 76 76 Noncontrolling interests attributable to subsidiary equity plan — — 82 — — — ( 53 ) 29 Net income attributable to the Ensign Group, Inc. — — — 80,277 — — — 80,277 BALANCE - MARCH 31, 2025 57,547 $ 61 $ 551,867 $ 1,503,442 3,484 $ ( 128,553 ) $ 3,340 $ 1,930,157 See accompanying notes to the condensed consolidated financial statements. 3 Table of Contents THE ENSIGN GROUP, INC. UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS Three Months Ended March 31, (In thousands) 2026 2025 Cash flows from operating activities: Net income $ 99,756 $ 80,353 Adjustments to reconcile net income to net cash provided by operating activities: Depreciation and amortization 28,801 24,188 Amortization of deferred financing fees 264 266 Stock-based compensation 13,895 10,724 Insurance proceeds and (gain) loss on long-lived assets, net 1,915 420 Other operating activities, net 613 646 Change in operating assets and liabilities Accounts receivable ( 24,009 ) ( 14,589 ) Prepaid income taxes 1,878 13,057 Prepaid expenses and other assets ( 986 ) ( 9,360 ) Cash surrender value of life insurance policy premiums ( 7,490 ) ( 7,489 ) Deferred compensation liability 6,926 7,441 Operating lease obligations ( 183 ) ( 102 ) Accounts payable 18,705 ( 3,521 ) Accrued wages and related liabilities ( 97,663 ) ( 60,021 ) Other accrued liabilities 27,283 21,497 Accrued self-insurance liabilities 30,449 8,710 NET CASH PROVIDED BY OPERATING ACTIVITIES $ 100,154 $ 72,220 Cash flows from investing activities: Purchase of property and equipment ( 35,473 ) ( 42,926 ) Cash payments for acquisitions ( 28,737 ) ( 194,241 ) Cash proceeds from insurance recoveries and sale of assets 83 1,494 Purchases of investments ( 36,866 ) ( 25,984 ) Maturities of investments 29,717 17,862 Other investing activities, net 89 ( 9 ) NET CASH USED IN INVESTING ACTIVITIES $ ( 71,187 ) $ ( 243,804 ) Cash flows from financing activities: Payments on debt ( 1,042 ) ( 1,009 ) Issuance of common stock upon exercise of options 11,490 5,050 Repurchase of shares of common stock to satisfy tax withholding obligations ( 23 ) ( 14 ) Repurchase of shares of common stock (Note 19) — ( 10,775 ) Dividends paid ( 3,775 ) ( 3,589 ) Other financing activities — ( 11 ) NET CASH PROVIDED BY (USED IN) FINANCING ACTIVITIES $ 6,650 $ ( 10,348 ) Net increase (decrease) in cash and cash equivalents 35,617 ( 181,932 ) Cash and cash equivalents beginning of period 503,881 464,598 Cash and cash equivalents end of period $ 539,498 $ 282,666 4 Table of Contents Three Months Ended March 31, (In thousands) 2026 2025 SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION Cash paid during the period for: Interest $ 1,664 $ 1,769 Income taxes 425 — Lease liabilities 66,078 59,165 Non-cash financing and investing activity Accrued capital expenditures $ 9,970 $ 7,800 Accrued dividends declared 3,797 3,597 Right-of-use assets obtained in exchange for new and modified operating lease obligations 68,296 57,961 See accompanying notes to the condensed consolidated financial statements. 5 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Dollars, shares and options in thousands, except per share data) 1. DESCRIPTION OF BUSINESS The Company — The Ensign Group, Inc. (collectively, Ensign or the Company), is a holding company with no direct operating assets, employees or revenue. The Company's independent subsidiaries provide health care services across the post-acute care continuum and engage in the ownership, acquisition, development and leasing of skilled nursing, senior living and other healthcare-related properties and ancillary businesses. As of March 31, 2026, the Company's independent subsidiaries operated 378 facilities and other ancillary operations located in 17 states. The Company's independent subsidiaries have a collective capacity of approximately 38,500 operational skilled nursing beds and 3,400 senior living units. As of March 31, 2026, the Company's independent subsidiaries operated 254 facilities under long-term lease arrangements and had options to purchase eight of those 254 facilities. The Company's real estate portfolio consists of 160 owned real estate properties, which includes 124 facilities operated and managed by the Company's independent subsidiaries, 36 operations leased to and operated by third-party operators and the Service Center (defined below) location. Of those 36 third-party operations, one senior living operation is located on the same real estate property as a skilled nursing operation that an independent subsidiary operates. During the three months ended March 31, 2026, the Company expanded its presence with the addition of five stand-alone skilled nursing operations in three states . These new operations added a total of 582 operational skilled nursing beds to be operated by the Company's independent subsidiaries. Additionally, the Company entered into definitive agreements to acquire 15 stand-alone skilled nursing operations and two campus operations in Texas subsequent to March 31, 2026, subject to customary closing conditions. These new operations will add 2,080 operational skilled nursing beds and 155 senior living units to be operated by the Company's independent subsidiaries. The Company's captive real estate investment trust (REIT), Standard Bearer Healthcare REIT, Inc. (Standard Bearer), owns and manages its real estate business. The REIT structure provides the Company with an efficient vehicle for future acquisitions of properties that could be operated by Ensign's independent subsidiaries or other third parties. Standard Bearer has elected to be taxed as a REIT for U.S. federal income tax purposes. Refer to Note 6, Standard Bearer for additional information on Standard Bearer. To support its growth efforts and operational needs, the Company maintains a centralized support structure through its Service Center and captive insurance subsidiary, which provide essential services and risk management to its wholly-owned independent subsidiaries. Certain of the Company’s wholly-owned independent subsidiaries, collectively referred to as the Service Center, provide specific accounting, payroll, human resources, compliance, information technology, legal, risk management and other centralized services to the other independent subsidiaries. The Company also has a wholly-owned captive insurance subsidiary that provides some claims-made coverage to the Company’s independent subsidiaries for general and professional liabilities, as well as coverage for certain workers’ compensation insurance liabilities. Each of the Company's wholly-owned independent subsidiaries has its own management, employees and assets. References herein to the consolidated “Company” and “its” assets and activities in this Quarterly Report are not meant to imply, nor should it be construed as meaning that The Ensign Group, Inc. has direct operating assets, employees or revenue, or that any of the subsidiaries are operated by The Ensign Group, Inc. Other Information — The accompanying condensed consolidated financial statements as of March 31, 2026 and for the three months ended March 31, 2026 and 2025 (collectively, the Interim Financial Statements) are unaudited. Certain information and note disclosures normally included in the annual consolidated financial statements have been condensed or omitted, as permitted under applicable rules and regulations. Readers of the Interim Financial Statements should refer to the Company’s audited consolidated financial statements and notes thereto for the year ended December 31, 2025 which are included in the Company’s Annual Report on Form 10-K, File No. 001-33757 (the Annual Report) filed with the Securities and Exchange Commission (SEC). Management believes that the Interim Financial Statements reflect all adjustments which are of a normal and recurring nature necessary to present fairly the Company’s financial position and results of operations in all material respects. The results of operations presented in the Interim Financial Statements are not necessarily representative of operations for the entire year. 6 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) 2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Basis of Presentation — The accompanying Interim Financial Statements have been prepared in accordance with accounting principles generally accepted in the United States (GAAP). The Company is the sole member or stockholder of various consolidated limited liability companies and corporations established to operate various acquired skilled nursing operations, senior living operations and related ancillary services. All intercompany transactions and balances have been eliminated in consolidation. The Company presents noncontrolling interests within the equity section of its condensed consolidated balance sheets and the amount of consolidated net income that is attributable to The Ensign Group, Inc. and the noncontrolling interests in its condensed consolidated statements of income. The Interim Financial Statements include the accounts of all independent subsidiaries controlled by the Company through its ownership of a majority voting interest. The preparation of the Interim Financial Statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the Interim Financial Statements and the reported amounts of revenue and expenses during the reporting periods. The most significant estimates in the Company’s Interim Financial Statements relate to revenue, acquired property and equipment, goodwill, right-of-use assets, impairment of long-lived assets, lease liabilities, general and professional liabilities, workers' compensation and healthcare claims included in accrued self-insurance liabilities and income taxes. Actual results could differ from those estimates. Certain amounts in the prior period statements of cash flows have been reclassified to conform to the presentation of the current period financial statements. These reclassifications had no effect on previously reported net income. Recent Accounting Pronouncements — Except for rules and interpretive releases of the Securities and Exchange Commission (SEC) under authority of federal securities laws and a limited number of grandfathered standards, the FASB ASC is the sole source of authoritative GAAP literature recognized by the FASB and applicable to the Company. For any new pronouncements announced, the Company considers whether the new pronouncements could alter previous generally accepted accounting principles and determines whether any new or modified principles will have a material impact on the Company's reported financial position or operations in the near term. The applicability of any standard is subject to the formal review of the Company's financial management and certain standards are under consideration. Recently Issued Accounting Pronouncements Not Yet Adopted — In November 2024, the FASB issued ASU 2024-03 " Disaggregation of Income Statement Expenses, " which requires the Company to disaggregate key expense categories such as employee compensation, depreciation and intangible asset amortization within its financial statements. ASU 2024-03 is effective for annuals periods beginning with the Company's fiscal year 2027, and interim periods within the Company's fiscal year 2028, with early adoption permitted. The Company is currently evaluating the impact of this ASU on its Notes to the Consolidated Financial Statements. In September 2025, the FASB issued ASU 2025-06 " Targeted Improvements to the Accounting for Internal-Use Software ," which amends the accounting for and disclosure of software costs under the existing standards. The amendments clarify the requirement for capitalizing software costs. ASU 2025-06 is effective beginning with the Company's fiscal year 2028 for both interim and annual periods, with early adoption permitted. The Company is currently evaluating the impact of this ASU on its Consolidated Financial Statements. 3. REVENUE AND ACCOUNTS RECEIVABLE The Company's service revenue is derived primarily from providing healthcare services to its patients. Revenue is recognized when services are provided to patients at the amount that reflects the consideration that the Company expects to be entitled from patients and third-party payors, including Medicaid, Medicare and insurers (private and Medicare replacement plans), in exchange for providing patient care. Disaggregation of Revenue The Company disaggregates revenue from contracts with its patients by payors. The Company has determined that disaggregating revenue into these categories achieves the disclosure objectives to depict how the nature, amount, timing and uncertainty of revenue and cash flows are affected by economic factors. 7 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) Revenue by Payor The Company’s revenue is derived primarily from providing healthcare services to patients and is recognized on the date services are provided at amounts billable to individual patients, adjusted for estimates for variable consideration. For patients under reimbursement arrangements with third-party payors, including Medicaid, Medicare and private insurers, revenue is recorded based on contractually agreed-upon amounts or rates, adjusted for estimates for variable consideration, on a per patient, daily basis or as services are performed. Revenue from the Medicare and Medicaid programs accounted for 69.1 % and 69.5 % of all service revenue for the three months ended March 31, 2026 and 2025, respectively. Settlements with Medicare, Medicaid and managed care payors for retroactive adjustments due to audits and reviews are considered variable consideration and are included in the determination of the estimated transaction price. These settlements are estimated based on the terms of the payment agreement with the payor, correspondence from the payor and the Company’s historical settlement activity. Consistent with healthcare industry practices, any changes to these revenue estimates are recorded in the period the change or adjustment becomes known based on the final settlement. The Company recorded adjustments to revenue which were not material to the Company's revenue for the three months ended March 31, 2026 and 2025. Service revenue for the three months ended March 31, 2026 and 2025 is summarized in the following tables: Three Months Ended March 31, 2026 2025 Revenue % of Revenue Revenue % of Revenue Medicaid (1) $ 543,450 39.3 % $ 453,840 38.9 % Medicare 335,829 24.3 287,751 24.7 Medicaid-skilled 75,238 5.5 69,551 5.9 Total Medicaid and Medicare $ 954,517 69.1 % $ 811,142 69.5 % Managed care 260,851 18.9 227,217 19.5 Private and other (2) 166,935 12.0 128,681 11.0 SERVICE REVENUE $ 1,382,303 100.0 % $ 1,167,040 100.0 % (1) Medicaid payor includes revenue for senior living operations. (2) Private and other includes revenue for skilled services (private, Veteran Affairs and hospice payors), senior living and ancillary operations. In addition to the service revenue above, the Company's rental revenue derived from triple-net lease arrangements with third parties was $ 6,893 and $ 6,001 , respectively, for the three months ended March 31, 2026 and 2025. Balance Sheet Impact Included in the Company’s condensed consolidated balance sheets are contract balances, comprised of billed accounts receivable and unbilled receivables, which are the result of the timing of revenue recognition, billings and cash collections, as well as contract liabilities, which primarily represent payments the Company receives in advance of services provided. The Company had no material contract liabilities or contract assets as of March 31, 2026 and December 31, 2025, or activity during the three months ended March 31, 2026 and 2025. Accounts receivable consist primarily of amounts due from Medicare and Medicaid programs, other government programs, managed care health plans and private payor sources, net of estimates for variable consideration and doubtful accounts. Accounts receivable as of March 31, 2026 and December 31, 2025, is summarized in the following table: March 31, 2026 December 31, 2025 Medicaid $ 291,960 $ 296,649 Managed care 180,438 163,463 Medicare 115,292 102,693 Private and other payors 83,140 81,985 $ 670,830 $ 644,790 Less: allowance for doubtful accounts ( 7,583 ) ( 7,805 ) ACCOUNTS RECEIVABLE, NET $ 663,247 $ 636,985 8 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) 4. COMPUTATION OF NET INCOME PER COMMON SHARE Basic net income per share is computed by dividing income from operations attributable to stockholders of The Ensign Group, Inc. by the weighted average number of outstanding common shares for the period. The computation of diluted net income per share is similar to the computation of basic net income per share, except that the denominator is increased to include the number of additional common shares that would have been outstanding if the dilutive potential common shares had been issued. A reconciliation of the numerator and denominator used in the calculation of basic net income per common share follows: Three Months Ended March 31, 2026 2025 NUMERATOR: Net income $ 99,756 $ 80,353 Less: net income attributable to noncontrolling interests 88 76 Net income attributable to The Ensign Group, Inc. $ 99,668 $ 80,277 DENOMINATOR: Weighted average shares outstanding 57,771 57,099 Basic net income per common share: $ 1.73 $ 1.41 A reconciliation of the numerator and denominator used in the calculation of diluted net income per common share follows: Three Months Ended March 31, 2026 2025 NUMERATOR: Net income $ 99,756 $ 80,353 Less: net income attributable to noncontrolling interests 88 76 Net income attributable to The Ensign Group, Inc. $ 99,668 $ 80,277 DENOMINATOR: Weighted average common shares outstanding 57,771 57,099 Plus: incremental shares from assumed conversion (1) 1,796 1,401 Adjusted weighted average common shares outstanding 59,567 58,500 Diluted net income per common share: $ 1.67 $ 1.37 (1) Options and restricted stock awards outstanding that were anti-dilutive and therefore excluded from the calculation of the weighted average common shares outstanding were 733 and 1,171 for the three months ended March 31, 2026 and 2025, respectivel y. 5. FAIR VALUE MEASUREMENTS The Company's financial assets include held-to-maturity investments carried at amortized cost basis of $ 156,945 and $ 150,119 , of which $ 100,578 and $ 81,816 are designated to support insurance subsidiary liabilities, as of March 31, 2026 and December 31, 2025, respectively. As of March 31, 2026 and December 31, 2025, the amortized cost basis of these financial assets are considered to approximate fair value and are derived using Level 2 inputs. The Company believes its amortized cost basis investments that were in an unrealized loss position as of March 31, 2026 and December 31, 2025 do not require an allowance for expected credit losses, nor has any event occurred through the filing date of this report that would indicate differently. 9 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) The Company's financial assets also include the contracts insuring the lives of certain employees who are eligible to participate in non-qualified deferred compensation plans that are held in a rabbi trust. The cash surrender value of these contracts is based on funds that shadow the investment allocations specified by participants in the deferred compensation plan and are held at fair value. As of March 31, 2026 and December 31, 2025, the fair value of the investment funds was $ 81,895 and $ 74,405 , respectively, which are derived using Level 2 inputs. Refer to Note 16, Defined Contribution Plans for more information. Additionally, the Company has other investments held at historical cost basis, which are not material, for which the fair value is derived using Level 3 inputs. 6. STANDARD BEARER Standard Bearer's real estate portfolio consists of 154 of the Company's 160 owned real estate properties, of which 120 are operated and managed by the Company's independent subsidiaries and 35 are leased to and operated by third-party operators. Of those 35 operations, one senior living operation is located on the same real estate property as a skilled nursing operation that an independent subsidiary operates. During the three months ended March 31, 2026, Standard Bearer added $ 17,468 of real estate assets associated with two stand-alone skilled nursing operations, both of which are operated by the Company's independent subsidiaries . Additionally , during the three months ended March 31, 2026, the operating responsibility for two stand-alone skilled nursing operations previously acquired by Standard Bearer was transitioned from third-party operators to the Company's independent subsidiaries. R efer to Note 8, Property and Equipment - Net, for additional information on real estate acquisitions subsequent to March 31, 2026. During the three months ended March 31, 2025, Standard Bearer added $ 147,796 of real estate assets associated with eight stand-alone skilled nursing operations, one stand-alone senior living operation and two campus operations. Four of these additions were related to the exercise of purchase options under an existing lease arrangement from CareTrust REIT, Inc. (CareTrust). All these additions are operated by the Company's independent subsidiaries. As part of the formation of Standard Bearer, certain of the Company's independent subsidiaries , Standard Bearer and Standard Bearer's independent real estate subsidiaries entered into several agreements that include leasing, management services and debt arrangements between the operations . All intercompany transactions have been eliminated in consolidation. Refer to Note 7, Business Segments , for additional information related to these intercompany eliminations as well as Standard Bearer as a reportable segment. Intercompany master lease agreements Certain of the Company's independent subsidiaries and 120 Standard Bearer independent real estate subsidiaries have entered into seven triple-net master lease agreements (collectively, the Standard Bearer Master Leases). The lease periods range from 15 to 19 years with three five-year renewal options beyond the initial term, on the same terms and conditions. The rent structure under the Standard Bearer Master Leases includes a fixed component, subject to annual escalation equal to the lesser of (1) the percentage change in the Consumer Price Index (but not less than zero ) or (2) 2.5 %. In addition to rent, the independent subsidiaries are required to pay the following: (1) all impositions and taxes levied on or with respect to the leased properties; (2) all utilities and other services necessary or appropriate for the leased properties and the business conducted on the leased properties; (3) all insurance required in connection with the leased properties and the business conducted on the leased properties; (4) all facility maintenance and repair costs; and (5) all fees in connection with any licenses or authorizations necessary or appropriate for the leased properties and the business conducted on the leased properties. Intercompany rental revenue generated from Ensign-affiliated operations for the three months ended March 31, 2026 and 2025 was $ 30,832 and $ 23,904 , respectively, which has been eliminated in consolidation. Intercompany management agreement Standard Bearer has no employees. The Service Center provides personnel and services to Standard Bearer pursuant to the management agreement between Standard Bearer and the Service Center. The management agreement provides for a base management fee that is equal to 5.0 % of total rental revenue and an incentive management fee that is equal to 5.0 % of funds from operations (FFO) and is capped at 1.0 % of total rental revenue, for a total of 6.0 %. Management fee generated between Standard Bearer and the Service Center for the three months ended March 31, 2026 and 2025 was $ 2,163 and $ 1,692 , respectively, which has been eliminated in consolidation. 10 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) Intercompany debt arrangements Standard Bearer obtains its funding through various sources including operating cash flows, access to debt arrangements and intercompany loans. The intercompany debt arrangements include mortgage loans and a credit facility to fund acquisitions and working capital needs. The interest rate under the credit facility is a base rate plus a margin ranging from 0.25 % to 1.25 % per annum or SOFR plus a margin ranging from 1.25 % to 2.25 % per annum. In addition, as the Department of Housing and Urban Development (HUD) mortgage loans and promissory note are entered into by real estate subsidiaries of Standard Bearer, the interest expense incurred from these debts are included in Standard Bearer's segment income. Refer to Note 13, Debt , for additional information related to these debts. Equity Instrument Denominated in the Shares of a Subsidiary As part of the formation of Standard Bearer in 2022, the Company established the Standard Bearer Healthcare REIT, Inc. 2022 Omnibus Incentive Plan (Standard Bearer Equity Plan). The Company may grant stock options and restricted stock awards under the Standard Bearer Equity Plan to employees and management of Ensign's independent subsidiaries. These awards generally vest over a period of five years or upon the occurrence of certain prescribed events. The value of the stock options and restricted stock awards is tied to the value of the common stock of Standard Bearer, which is determined based on an independent valuation of Standard Bearer. The Company can also call the awards, generally upon employee termination. During the three months ended March 31, 2026 and 2025, the Company did not grant any stock options or restricted shares under the Standard Bearer Equity Plan. During the three months ended March 31, 2026 and 2025, there were no restricted stock awards vested for the periods. The grant-date fair value of the awards is recognized as compensation expense over the relevant vesting periods, with a corresponding adjustment to noncontrolling interests. The grant value was determined based on an independent valuation of the subsidiary shares. For the three months ended March 31, 2026 and 2025, share-based compensation expense under the Standard Bearer Equity Plan was not material. 7. BUSINESS SEGMENTS The Company has two reportable segments: (1) skilled services, which includes the operation of skilled nursing facilities and rehabilitation therapy services and (2) Standard Bearer, which is comprised of selected real estate properties owned by Standard Bearer and leased to skilled nursing and senior living operators. As of March 31, 2026, the skilled services segment includes 331 skilled nursing and 31 campus operations that provide both skilled nursing and rehabilitative care services and senior living services. The Company's Standard Bearer segment consists of 154 owned real estate properties. The Company also reports an “All Other” category that includes results from its senior living operations, which includes 16 stand-alone senior living operations and the senior living operations at 31 campus operations that provide both skilled nursing and rehabilitative care services and senior living services. In addition, the "All Other" category includes mobile diagnostics, medical transportation, other real estate, other ancillary operations and the Service Center. Services included in the “All Other” category are insignificant individually and therefore do not constitute a reportable segment. The Company’s reportable segments are significant operating segments that offer differentiated services. The segment structure reflects the Company's current operational and financial management and provides the best structure to maximize the quality of care and investment strategy provided, while maintaining financial discipline. Segment income is defined as income before provision for income taxes, excluding gain or loss from sale of real estate, real estate insurance recoveries and impairment of long-lived assets. The Company's chief operating decision maker or CODM, who is the Chief Executive Officer, reviews segment income for each operating segment to evaluate performance and allocate capital resources. The CODM uses segment income to analyze actual results as part of operational planning and to decide whether to reinvest profits into the segments or into other parts of the Company, such as through acquisitions, to pay dividends or to recommend a stock repurchase program. The Company's CODM does not review assets by segment in his resource allocation and therefore assets by segment are not disclosed below. Intercompany revenue is eliminated in consolidation, along with corresponding intercompany expenses. Included in segment income for Standard Bearer is expense for intercompany services provided by the Service Center as described in Note 6, Standard Bearer , as it is part of the CODM financial information. 11 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) The following tables set forth financial information for the segments: Three Months Ended March 31, 2026 Skilled Services Standard Bearer Total Service revenue (1) $ 1,330,835 $ — $ 1,330,835 Rental revenue — 36,102 36,102 Segment revenue $ 1,330,835 $ 36,102 $ 1,366,937 Reconciliation of revenue: All other revenue (2) 62,256 Elimination of intercompany revenue (3) ( 39,997 ) TOTAL CONSOLIDATED REVENUE $ 1,389,196 Less: Other segment items (4) 1,141,508 3,122 Depreciation and amortization 15,310 10,783 Interest expense (5) — 11,388 Segment income $ 174,017 $ 10,809 $ 184,826 Reconciliation of profit or loss: All other not included in segment income ( 56,254 ) INCOME BEFORE PROVISION FOR INCOME TAXES $ 128,572 (1) Skilled services service revenue does not include intercompany service revenue generated by ancillary operations provided to the Company's independent subsidiaries and management service revenue generated by the Service Center with Standard Bearer. Intercompany service revenue is eliminated in "Elimination of intercompany revenue". (2) All other revenue includes $ 59,061 of service revenue and $ 3,195 of rental revenue for the three months ended March 31, 2026, both of which include intercompany revenue that is eliminated in "Elimination of intercompany revenue". (3) Elimination of intercompany revenue includes the elimination of intercompany rental revenue of $ 32,404 and intercompany service revenue of $ 7,593 for the three months ended March 31, 2026. (4) Other segment items include cost of services of $ 1,052,724 and rent expense of $ 88,784 for the skilled services segment, and cost of services of $ 625 , rent expense of $ 265 and general and administrative expenses of $ 2,232 for the Standard Bearer segment. Additionally, there are intercompany expenses of $ 39,997 during the three months ended March 31, 2026, which are eliminated in consolidation. (5) Included in interest expense in Standard Bearer is interest from intercompany debt arrangements between Standard Bearer and The Ensign Group, Inc. of $ 9,767 during the three months ended March 31, 2026, which is eliminated in consolidation. 12 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) Three Months Ended March 31, 2025 Skilled Services Standard Bearer Total Service revenue (1) $ 1,123,554 $ — $ 1,123,554 Rental revenue — 28,401 28,401 Segment revenue $ 1,123,554 $ 28,401 $ 1,151,955 Reconciliation of revenue: All other revenue (2) 52,426 Elimination of intercompany revenue (3) ( 31,340 ) TOTAL CONSOLIDATED REVENUE $ 1,173,041 Less: Other segment items (4) 966,410 2,606 Depreciation and amortization 13,213 8,476 Interest expense (5) — 8,736 Segment income $ 143,931 $ 8,583 $ 152,514 Reconciliation of profit or loss: All other not included in segment income ( 45,934 ) INCOME BEFORE PROVISION FOR INCOME TAXES $ 106,580 (1) Skilled services service revenue does not include intercompany service revenue generated by ancillary operations provided to the Company's independent subsidiaries and management service revenue generated by the Service Center with Standard Bearer. Intercompany service revenue is eliminated in "Elimination of intercompany revenue". (2) All Other revenue includes $ 49,427 of service revenue and $ 2,999 of rental revenue for the three months ended March 31, 2025, both of which include intercompany revenue that is eliminated in "Elimination of intercompany revenue". (3) Elimination of intercompany revenue includes the elimination of intercompany rental revenue of $ 25,399 and intercompany service revenue of $ 5,941 for the three months ended March 31, 2025. (4) Other segment items include cost of services of $ 891,855 and rent expense of $ 74,555 for the skilled services segment, and cost of services of $ 598 , rent expense of $ 257 and general and administrative expenses of $ 1,751 for the Standard Bearer segment. Additionally, there are intercompany expenses of $ 31,340 during the three months ended March 31, 2025, which is eliminated in consolidation. (5) Included in interest expense in Standard Bearer is interest from intercompany debt arrangements between Standard Bearer and The Ensign Group, Inc. of $ 7,040 during the three months ended March 31, 2025, which is eliminated in consolidation. Service revenue by major payor source were as follows: Three Months Ended March 31, 2026 Skilled Services All Other (3) Total Service Revenue Revenue % Medicaid (1) $ 529,333 $ 14,117 $ 543,450 39.3 % Medicare 335,829 — 335,829 24.3 Medicaid-skilled 75,238 — 75,238 5.5 Subtotal $ 940,400 $ 14,117 $ 954,517 69.1 % Managed care 260,851 — 260,851 18.9 Private and other (2) 129,584 37,351 166,935 12.0 TOTAL SERVICE REVENUE $ 1,330,835 $ 51,468 $ 1,382,303 100.0 % (1) Medicaid payor includes revenue generated from senior living operations and revenue related to state relief funding. (2) Private and other includes revenue for skilled services (private, Veteran Affairs and hospice payors), senior living and ancillary operations. (3) All Other incorporates intercompany eliminations. 13 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) Three Months Ended March 31, 2025 Skilled Services All Other (3) Total Service Revenue Revenue % Medicaid (1) $ 443,411 $ 10,429 $ 453,840 38.9 % Medicare 287,751 — 287,751 24.7 Medicaid-skilled 69,551 — 69,551 5.9 Subtotal $ 800,713 $ 10,429 $ 811,142 69.5 % Managed care 227,217 — 227,217 19.5 Private and other (2) 95,624 33,057 128,681 11.0 TOTAL SERVICE REVENUE $ 1,123,554 $ 43,486 $ 1,167,040 100.0 % (1) Medicaid payor includes revenue generated from senior living operations and revenue related to state relief funding. (2) Private and other includes revenue for skilled services (private, Veteran Affairs and hospice payors), senior living and ancillary operations. (3) All Other incorporates intercompany eliminations. 8. PROPERTY AND EQUIPMENT - NET Property and equipment, net consists of the following: March 31, 2026 December 31, 2025 Land $ 221,208 $ 219,857 Buildings and improvements 1,288,713 1,231,704 Leasehold improvements 268,599 254,309 Equipment 496,938 478,729 Furniture and fixtures 4,647 4,588 Construction in progress 19,341 58,615 $ 2,299,446 $ 2,247,802 Less: accumulated depreciation ( 579,221 ) ( 550,939 ) PROPERTY AND EQUIPMENT, NET $ 1,720,225 $ 1,696,863 Real Estate Acquisitions A majority of the real estate properties were acquired by subsidiaries of Standard Bearer, as detailed in Note 6 . Standard Bearer . The aggregate purchase price for the real estate purchases during the three months ended March 31, 2026 was $ 18,086 , which primarily consists of building and improveme nts of $ 16,117 and land of $ 1,351 , respectively. The aggregate purchase price for the real estate purchases during the three months ended March 31, 2025 was $ 159,172 , which primarily consists of building and improvements of $ 135,654 and land of $ 20,453 , respectively. The Company finalized the purchase price allocation for certain acquisitions during the three months ended March 31, 2025 resulting in no activities in goodwill during that period. During the three months ended March 31, 2026, the Company, including Standard Bearer, entered into definitive agreements to acquire real estate assets associated with 19 operations subsequent to March 31, 2026, subject to customary closing conditions, for an aggregate purchase price of approximately $ 342,350 . The real estate assets are associated with 15 stand-alone skilled nursing operations and two campus operations to be operated by the Company's independent subsidiaries and two stand-alone senior living operations to be leased to a third-party operator beginning on May 1, 2026, in each case, assuming the closing of the acquisitions. 9. INTANGIBLE ASSETS - NET March 31, 2026 December 31, 2025 Weighted Average Life (Years) Gross Carrying Amount Accumulated Amortization Gross Carrying Amount Accumulated Amortization Intangible Assets Net Net Facility trade name 30.0 733 ( 493 ) 240 733 ( 486 ) 247 Customer relationships 18.4 4,582 ( 3,166 ) 1,416 4,582 ( 3,114 ) 1,468 TOTAL $ 5,315 $ ( 3,659 ) $ 1,656 $ 5,315 $ ( 3,600 ) $ 1,715 14 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) During the three months ended March 31, 2026 and 2025, amortization expense was $ 333 and $ 811 , respectively, of which $ 274 and $ 142 was related to the amortization of right-of-use assets, respectively. Estimated amortization expense for each of the years ending December 31 is as follows: Year Amount 2026 (remainder) $ 179 2027 238 2028 238 2029 238 2030 238 2031 238 Thereafter 287 $ 1,656 Other indefinite-lived intangible assets consist of the following: March 31, 2026 December 31, 2025 Trade name $ 889 $ 889 Medicare and Medicaid licenses 3,777 3,777 TOTAL $ 4,666 $ 4,666 10. GOODWILL Goodwill is subject to annual testing for impairment during the fourth quarter of each year. In addition, goodwill is tested for impairment if events occur or circumstances indicate that its carrying value may not be recoverable. There were no indicators of goodwill impairment noted during the three months ended March 31, 2026. The Company anticipates that the majority of goodwill recognized will be fully deductible for tax purposes as of March 31, 2026. There were no activities in goodwill during the three months ended March 31, 2026. The following table represents goodwill value by the skilled services segment and "all other" category for March 31, 2026 and December 31, 2025: Skilled Services All Other Total Goodwill $ 88,626 $ 9,355 $ 97,981 11. OTHER ACCRUED LIABILITIES Other accrued liabilities consist of the following: March 31, 2026 December 31, 2025 Quality assurance fee $ 15,869 $ 17,398 Refunds, deferred revenue and advances 104,401 105,642 Cash held in trust for patients 8,208 8,653 Dividends payable 3,797 3,775 Property taxes 11,590 7,150 Income tax payable 27,352 818 Accrued litigation (Note 18) 12,000 12,000 Other 19,549 18,591 OTHER ACCRUED LIABILITIES $ 202,766 $ 174,027 Quality assurance fee represents the aggregate of amounts payable to various states that have a mandated fee based on patient days or licensed beds. Refunds, deferred revenue and advances consist of liabilities related to duplicate payments and credit balances from various payor sources, as well as payments received from residents in advance of services provided. Cash held in trust for patients reflects monies received from or on behalf of patients. Maintaining a trust account for patients is a regulatory requirement and, while the trust assets offset the liabilities, the Company assumes a fiduciary responsibility for these funds. The cash balance related to this liability is included in other current assets in the condensed consolidated balance sheets. 15 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) 12. INCOME TAXES The Company recorded income tax expense of $ 28,816 and $ 26,227 during the three months ended March 31, 2026 and 2025, respectively, or 22.4 % of earnings before income taxes for the three months ended March 31, 2026, compared to 24.6 % for the three months ended March 31, 2025. The effective tax rate for both periods is driven by the impact of excess tax benefits from stock-based compensation, offset by non-deductible expenses including non-deductible compensation. The Company is not currently under examination by any major income tax jurisdiction. During 2026, the statutes of limitations will lapse on the Company's 2022 federal tax year and certain 2021 and 2022 state tax years. The Company does not believe the federal or state statute lapses or any other event will significantly impact the balance of unrecognized tax benefits in the next twelve months. The net balance of unrecognized tax benefits was not material to the Interim Financial Statements for the three months ended March 31, 2026 and 2025. 13. DEBT Debt consists of the following: March 31, 2026 December 31, 2025 Mortgage loans and promissory note $ 143,310 $ 144,352 Less: current maturities ( 4,263 ) ( 4,227 ) Less: debt issuance costs, net ( 2,556 ) ( 2,596 ) LONG-TERM DEBT LESS CURRENT MATURITIES $ 136,491 $ 137,529 Credit Facility with a Lending Consortium Arranged by Truist The Company maintains a revolving credit facility between the Company and its independent subsidiaries, including Standard Bearer as co-borrowers, and Truist Securities (Truist) (the Credit Facility) with a revolving line of credit of up to $ 600,000 in aggregate principal amount with a maturity date of April 8, 2027. Borrowings are supported by a lending consortium arranged by Truist. The interest rates applicable to loans under the Credit Facility are, at the Company's option, equal to either a base rate plus a margin ranging from 0.25 % to 1.25 % per annum or SOFR plus a margin ranging from 1.25 % to 2.25 % per annum, based on the Consolidated Total Net Debt to Consolidated EBITDA ratio (as defined in the Credit Facility). In addition, there is a commitment fee on the unused portion of the commitments that ranges from 0.20 % to 0.40 % per annum, depending on the Consolidated Total Net Debt to Consolidated EBITDA ratio. Borrowings made under the Credit Facility are guaranteed, jointly and severally, by certain of the Company’s wholly-owned subsidiaries, and are secured by a pledge of stock of the Company's material independent subsidiaries as well as a first lien on substantially all of such independent subsidiaries' personal property. The Credit Facility contains customary covenants that, among other things, restrict, subject to certain exceptions, the ability of the Company and its independent subsidiaries to grant liens on their assets, incur indebtedness, sell assets, make investments, engage in acquisitions, mergers or consolidations, amend certain material agreements and pay certain dividends and other restricted payments. Under the terms of the Credit Facility, the Company must comply with financial maintenance covenants to be tested quarterly, consisting of (i) a maximum consolidated total net debt to consolidated EBITDA ratio (which shall not be greater than 3.75 :1.00; provided that if the aggregate consideration for approved acquisitions in a six month period is greater than $ 50,000 , then the ratio can be increased at the election of the Company with notice to the administrative agent to 4.25 :1.00 for the first fiscal quarter and the immediately following three fiscal quarters), and (ii) a minimum interest/rent coverage ratio (which cannot be less than 1.50 :1.00). As of March 31, 2026, there was no outstanding debt under the Credit Facility. The Company was in compliance with all loan covenants as of March 31, 2026. Mortgage Loans and Promissory Note As of March 31, 2026, the Company has 23 subsidiaries that have mortgage loans insured with HUD in the aggregate amount of $ 142,571 , which subjects these subsidiaries to HUD oversight and periodic inspections. The mortgage loans bear effective interest rates in a range of 3.1 % to 4.2 %, including fixed interest rates in a range of 2.4 % to 3.3 % per annum. In addition to the interest rate, the Company incurs other fees for HUD placement, including, but not limited to audit fees. Amounts borrowed under the mortgage loans may be prepaid, subject to prepayment fees based on the principal balance on the date of prepayment. For the majority of the loans, during the first three years, the prepayment fee is 10.0 % and is reduced by 3.0 % in the fourth year of the loan and reduced by 1.0 % per year for years five through ten of the loan. There is no prepayment penalty after year ten. The terms for all the mortgage loans are 25 to 35 years. 16 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) In addition to the HUD mortgage loans above, the Company has a promissory note of $ 739 that bears a fixed interest rate of 5.3 % per annum and has a term of 12 years. The note, which was assumed as part of an acquisition, is secured by the real property comprising the facility and the rent, issues and profits thereof, as well as all personal property used in the operation of the facility. Off-Balance Sheet Arrangements As of March 31, 2026 and December 31, 2025, the Company had approximately $ 8,402 of borrowing capacity under the Credit Facility pledged as collateral to secure outstanding letters of credit. The Company believes that its outstanding letters of credit as of March 31, 2026 do not require an allowance for expected credit losses, nor has any event occurred through the filing date of this report that would indicate differently. 14. OPTIONS AND AWARDS Stock-based compensation expense consists of stock-based payment awards made to employees and directors, including employee stock options and restricted stock awards, based on estimated fair values. As stock-based compensation expense recognized in the Company’s condensed consolidated statements of income for the three months ended March 31, 2026 and 2025 was based on awards expected to vest, it has been reduced for estimated forfeitures. The Company estimates forfeitures at the time of grant and, if necessary, revises the estimate in subsequent periods if actual forfeitures differ. The Company grants equity awards under the Amended and Restated 2022 Omnibus Incentive Plan (the Amended and Restated Plan), the amendment and restatement of which was approved by the Company’s stockholders during the second quarter of 2025. There are 4,231 shares of common stock available for issuance under the Amended and Restated Plan, and the number of shares available for issuance is reduced by one share for each share subject to an option or stock appreciation right award and by two shares for each share subject to an award other than an option or stock appreciation right. At March 31, 2026, 2,804 shares remained available for future issuance under the Amended and Restated Plan. Non-employee director stock options, to the extent granted, vest and become exercisable in three equal annual installments, or over the term of the award if less than three years , subject to continued service from the grant date through the date of vesting. All other stock options generally vest over five years at a rate of 20 % per year on each anniversary of the grant date. Stock options expire ten years from the grant date. The Company uses the Black-Scholes option-pricing model to recognize the value of stock-based compensation expense for stock option awards. Determining the appropriate fair-value model and calculating the fair value of stock option awards at the grant date requires judgment, including estimating stock price volatility, expected option life, and forfeiture rates. The fair-value of the restricted stock awards at the grant date is based on the market price on the grant date, adjusted for forfeiture rates. The Company develops estimates based on historical data and market information, which can change significantly over time. Stock Options The Company used the following assumptions for stock options granted during the three months ended March 31, 2026 and 2025: Grant Year Options Granted Weighted Average Risk-Free Rate Expected Life Weighted Average Volatility Weighted Average Dividend Yield 2026 312 3.7 % 6.2 years 38.4 % 0.1 % 2025 152 4.3 % 6.2 years 39.8 % 0.2 % For the three months ended March 31, 2026 and 2025, the following represents the exercise price and fair value displayed at grant date for stock option grants: Grant Year Granted Weighted Average Exercise Price Weighted Average Fair Value of Options 2026 312 $ 212.65 $ 93.07 2025 152 $ 126.34 $ 57.17 The weighted average exercise price equaled the weighted average fair value of common stock on the grant date for all options granted during the three months ended March 31, 2026 and 2025 and therefore, the intrinsic value was $ 0 at the date of grant. 17 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) The following table represents the employee stock option activity during the three months ended March 31, 2026: Number of Options Outstanding Weighted Average Exercise Price Number of Options Vested Weighted Average Exercise Price of Options Vested January 1, 2026 4,071 $ 96.87 1,991 $ 67.10 Granted 312 212.65 Forfeited ( 22 ) 123.35 Exercised ( 188 ) 61.08 March 31, 2026 4,173 $ 107.01 1,955 $ 70.45 The aggregate intrinsic value of options outstanding, vested, expected to vest and exercised as of March 31, 2026 and December 31, 2025 is as follows: Options March 31, 2026 December 31, 2025 Outstanding $ 397,796 $ 317,984 Vested 256,158 213,189 Expected to vest 132,838 98,487 The intrinsic value is calculated as the difference between the market value of the underlying common stock and the exercise price of the options . The aggregate intrinsic value of options that vested during the three months ended March 31, 2026 and 2025 was $ 12,451 and $ 6,045 , respectively. The total intrinsic value of options exercised during the three months ended March 31, 2026 and 2025 was $ 26,483 and $ 9,470 , respectively. Restricted Stock Awards The Company granted 155 and 92 restricted stock awards during the three months ended March 31, 2026 and 2025 , respectively. All awards were granted at an issue price of $ 0 and generally vest over five years . The fair value per share of restricted awards granted during the three months ended March 31, 2026 and 2025 ranged from $ 183.54 to $ 212.65 and $ 126.34 to $ 134.58 , respectively. The fair value per share includes quarterly stock awards to non-employee directors. Included in the restricted stock award grants are $ 13,555 and $ 8,003 of annual bonuses that were settled in vested restricted stock awards during the three months ended March 31, 2026 and 2025, respectively. A summary of the status of the Company's non-vested restricted stock awards as of March 31, 2026 and changes during the three months ended March 31, 2026 is presented below: Non-Vested Restricted Awards Weighted Average Grant Date Fair Value Nonvested at January 1, 2026 436 $ 129.54 Granted 155 210.77 Vested ( 100 ) 175.06 Forfeited ( 5 ) 116.28 Nonvested at March 31, 2026 486 $ 146.30 During the three months ended March 31, 2026, the Company granted three automatic quarterly stock awards to non-employee directors for their service on the Company's board of directors. The fair value per share of these stock awards was $ 183.54 based on the market price on the grant date. 18 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) Stock-based compensation expense Stock-based compensation expense recognized for the Company's equity incentive plans and long-term incentive plan for the three months ended March 31, 2026 and 2025 was as follows: Three Months Ended March 31, 2026 2025 Stock-based compensation expense related to stock options $ 8,652 $ 6,805 Stock-based compensation expense related to restricted stock awards 4,380 3,402 Stock-based compensation expense related to restricted stock awards to non-employee directors 661 484 TOTAL $ 13,693 $ 10,691 In future periods, the Company expects to recognize approximately $ 121,924 and $ 62,954 in stock-based compensation expense for unvested options and unvested restricted stock awards, respectively, that were outstanding as of March 31, 2026. Future stock-based compensation expense will be recognized over 3.9 and 4.0 weighted average years for unvested options and restricted stock awards, respectively. There were 2,218 unvested and outstanding options as of March 31, 2026, of which 2,049 options are expected to vest. The weighted average contractual life for options outstanding, vested and expected to vest as of March 31, 2026 was 6.8 years. 15. LEASES The Company leases real property associated with 104 independent skilled nursing and senior living facilities under eight triple‑net master lease agreements with CareTrust REIT, Inc. (collectively, the Master Leases). The Master Leases have initial terms ranging from 13 to 20 years and include two or three five‑year renewal options at the Company’s election, subject to customary conditions. If the Company elects to renew the term of a Master Lease, the renewal will be effective to all, but not less than all, of the leased property then subject to such Master Lease. The Master Leases are non‑cancelable prior to expiration without the consent of CareTrust. Rent consists of a fixed base amount subject to annual escalation equal to the lesser of 2.5 % or the percentage change in the Consumer Price Index (not less than zero ). As triple‑net leases, the Company is responsible for substantially all property‑level operating costs, including taxes, insurance, utilities, and maintenance. Total rent expense under the Master Leases was $ 19,631 and $ 17,126 for the three months ended March 31, 2026 and 2025, respectively. The Master Leases require the Company to comply with certain financial covenants, including portfolio coverage and minimum rent coverage ratios, as well as customary reporting and other requirements. The Company was in compliance with all such requirements as of March 31, 2026. The Company leases facilities where its independent subsidiaries operate under non-cancelable operating leases, most of which have initial lease terms ranging from 15 to 20 years. Most of these leases contain renewal options, certain of which involve rent increases. The Company's 104 independent subsidiaries, excluding the subsidiaries that are operated under the Master Leases with CareTrust, are operated under 19 separate master lease arrangements. Under the master leases, a default at a single facility could subject one or more of the other facilities covered by the same master lease to the same default risk. Failure to comply with Medicare and Medicaid provider requirements is an event of default under several of the Company’s leases, master lease agreements and debt financing instruments. In addition, other potential defaults related to an individual facility may cause a default of an entire master lease portfolio and could trigger cross-default provisions in the Company’s outstanding debt arrangements and other leases. With an indivisible lease, it is difficult to restructure the composition of the portfolio or economic terms of the lease without the consent of the landlord. 19 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) The components of operating lease expense are as follows: Three Months Ended March 31, 2026 2025 Rent - cost of services (1) $ 65,506 $ 57,076 Cost of services (2) 6,979 6,429 General and administrative expense 220 199 $ 72,705 $ 63,704 (1) Rent - cost of services includes deferred rent expense adju stments of $ 321 and $ 208 for the three months ended March 31, 2026 and 2025, respectively. Additionally, rent - cost of services includes other variable lease costs such as consumer price index increases and short-term leases of $ 5,131 and $ 4,004 for the three months ended March 31, 2026 and 2025, respectively. (2) Cost of services includes variable lease costs consisting of property taxes and insurance. Future minimum lease payments for all third-party leases as of March 31, 2026 are as follows: Year Amount 2026 (remainder) $ 182,707 2027 243,258 2028 242,307 2029 236,831 2030 231,410 2031 221,291 Thereafter 1,780,951 TOTAL LEASE PAYMENTS $ 3,138,755 Less: present value adjustment ( 1,034,869 ) PRESENT VALUE OF TOTAL LEASE LIABILITIES $ 2,103,886 Less: current lease liabilities ( 116,500 ) LONG-TERM OPERATING LEASE LIABILITIES $ 1,987,386 Operating lease liabilities are based on the net present value of the remaining lease payments over the remaining lease term. In determining the present value of lease payments, the Company used its incremental borrowing rate based on the information available at the lease commencement date. As of March 31, 2026, the weighted average remaining lease term is 13.9 years and the weighted average discount rate used to determine the operating lease liabilities is 6.2 %. Lessor Activities The Company leases 36 owned real estate properties to third‑party operators, including 32 senior living operations operated by The Pennant Group, Inc. (Pennant). All of the leases are triple‑net arrangements, under which the tenants are responsible for substantially all property‑level operating costs, including taxes, insurance, utilities, and maintenance. The initial terms range from 14 to 16 years. During the three months ended March 31, 2026, the Company, through Standard Bearer, entered into a definitive agreement to acquire real estate assets associated with two stand-alone senior living operations on May 1, 2026 subject to customary closing conditions. Assuming the closing of the acquisitions, these operations will be leased to a third-party operator beginning on May 1, 2026. Total rental income from all third-party sources for the three months ended March 31, 2026 and 2025 is as follows: Three Months Ended March 31, 2026 2025 Pennant (1) $ 4,213 $ 4,122 Other third-party (2) 2,680 1,879 TOTAL $ 6,893 $ 6,001 (1) Pennant rental income includes variable rent such as property taxes of $ 312 and $ 310 during the three months ended March 31, 2026 and 2025, respectively. (2) Other third-party includes rental revenue associated with the Company's subleases to third parties of $ 1,135 and $ 1,107 for the three months ended March 31, 2026 and 2025. 20 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) Future contractual minimum annual rental income for all third-party leases as of March 31, 2026 were as follows: Year Amount 2026 (remainder) $ 20,641 2027 26,922 2028 26,495 2029 26,380 2030 25,316 2031 25,310 Thereafter 98,758 TOTAL $ 249,822 16. DEFINED CONTRIBUTION PLANS The Company has a 401(k) defined contribution plan (the 401(k) Plan), whereby eligible employees may contribute up to 90 % of their annual basic earnings, subject to applicable annual Internal Revenue Code limits. Additionally, the 401(k) Plan provides for discretionary matching contributions (as defined in the 401(k) Plan) by the Company. The Company has a non-qualified deferred compensation plan (DCP), whereby highly compensated employees may defer the receipt of a portion of their base compensation and, for certain employees, up to 100 % of their eligible bonuses. Additionally, the DCP allows for the employee deferrals to be deposited into a rabbi trust and the funds are generally invested in individual variable life insurance contracts owned by the Company that are specifically designed to fund savings plans of this nature. As of March 31, 2026 and December 31, 2025, the Company accrued $ 86,070 and $ 81,553 , respectively, as long term deferred compensation in other long term liabilities on the condensed consolidated balance sheets. Cash surrender value of the contracts is based on investment funds that shadow the investment allocations specified by participants in the deferred compensation plan. Refer to Note 5, Fair Value Measurements for more information on the funds. For the three months ended March 31, 2026 and 2025, the Company recorded a loss on its DCP of $ 1,694 and $ 282 , respectively, which is included in other income, net. During the same periods, the Company recorded an offsetting reduction in expenses of $ 1,598 and $ 234 , respectively, which is allocated between cost of services and general and administrative expenses. 17. SELF INSURANCE LIABILITIES The Company is partially self-insured for general and professional liability claims up to a base amount per claim (the self-insured retention) with an aggregate, one-time deductible above this limit. Losses beyond these amounts are insured through third-party policies with coverage limits per claim, per location and on an aggregate basis for the Company. The combined self-insured retention for the Company's independent subsidiaries in California is $ 1,000 per claim ($ 750 if an enforceable arbitration agreement applies), subject to an additional one-time deductible of $ 3,950 . For the independent subsidiaries not in California, the self-insured claim is $ 750 per claim ($ 650 if an enforceable arbitration agreement applies), subject to an additional one-time, deductible of $ 5,100 . For all independent subsidiaries, except those located in Colorado, the third-party coverage above these limits is $ 1,000 per claim, $ 3,000 per operation, with a $ 10,000 blanket aggregate limit and an additional state-specific aggregate where required by state law. In Colorado, the third-party coverage above these limits is $ 1,000 per claim and $ 3,000 per operation, which is independent of the aforementioned blanket aggregate limits that apply outside of Colorado. The majority of the self-insured retention and deductible limits for general and professional liabilities and workers' compensation liabilities are self-insured through the captive insurance subsidiary, the related assets and liabilities of which are included in the accompanying condensed consolidated balance sheets. The captive insurance subsidiary is subject to certain statutory requirements as an insurance provider. The Company’s policy is to accrue amounts equal to the actuarial estimated costs to settle open claims of insureds, as well as an estimate of the cost of insured claims that have been incurred but not reported. The Company develops information about the size of the ultimate claims based on historical experience, current industry information and actuarial analysis, and evaluates the estimates for claim loss exposure on a quarterly basis. The Company uses actuarial valuations to estimate the liability based on historical experience and industry information. 21 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) The Company’s independent subsidiaries are self-insured for workers’ compensation liabilities in California. To protect itself against loss exposure in California with this policy, the Company has purchased individual specific excess insurance coverage that insures individual claims that exceed $ 625 per occurrence. In Texas, the independent subsidiaries have elected non-subscriber status for workers’ compensation claims and the Company has purchased individual stop-loss coverage that insures individual claims that exceed $ 750 per occurrence. The Company’s independent subsidiaries in all other states, with the exception of Washington, are under a loss sensitive plan that insures individual claims that exceed $ 350 per occurrence. In the State of Washington, the Company is self-insured and has purchased individual specific excess insurance coverage that insures individual claims that exceed $ 500 per occurrence. For all of the self-insured plans and retention, the Company accrues amounts equal to the estimated costs to settle open claims, as well as an estimate of the cost of claims that have been incurred but not reported. The Company uses actuarial valuations to estimate the liability based on historical experience and industry information. The Company self-funds medical (including prescription drugs) and dental healthcare benefits for the majority of its employees. The Company is fully liable for all financial and legal aspects of these benefit plans. To protect itself against loss exposure with this policy, the Company has purchased individual stop-loss insurance coverage that insures individual claims that exceed $ 525 for each covered person for fiscal year 2026. The following table represents the Company's self-insurance insurance liabilities, on an undiscounted basis, inclusive of anticipated insurance recoveries, as of March 31, 2026 and December 31, 2025: March 31, 2026 December 31, 2025 Accrued general liability and professional malpractice liabilities $ 214,460 $ 186,780 Accrued workers’ compensation liabilities 43,871 42,121 Accrued health benefits 20,397 17,514 TOTAL SELF-INSURANCE LIABILITIES $ 278,728 $ 246,415 Less: current self-insurance liabilities 94,868 81,623 LONG-TERM SELF-INSURANCE LIABILITIES $ 183,860 $ 164,792 The anticipated insurance recoveries included in the self-insurance liabilities are presented gross rather than net with the corresponding asset of $ 19,007 and $ 17,143 , as of March 31, 2026 and December 31, 2025, respectively, included in Restricted and other assets on the consolidated balance sheets. The Company believes that adequate provision has been made in the Interim Financial Statements for liabilities that may arise out of patient care, workers’ compensation, healthcare benefits and related services provided to date. 18. COMMITMENTS AND CONTINGENCIES Indemnities — From time to time, the Company enters into certain types of contracts that contingently require the Company to indemnify parties against third-party claims. The terms of such obligations vary by contract and, in most instances, do not expressly state or include a specific or maximum dollar amount. Generally, amounts under these contracts cannot be reasonably estimated until a specific claim is asserted. Consequently, because no claims have been asserted, no liabilities have been recorded for these obligations on the Company’s condensed consolidated balance sheets for any of the periods presented. Litigation and Regulatory Matters — The Company and its independent subsidiaries are party to various legal actions and administrative proceedings and are subject to various claims arising in the ordinary course of business. Such claims may be related to, but are not limited to, the Health Insurance Portability and Accountability Act of 1996, alleged Medicare or Medicaid false claims, qui tam or "whistleblower" claims related to alleged violations of the False Claims Act and/or the Anti-Kickback Statute, alleged violations of state and federal wage and hour laws, environmental matters, investigations, examinations, audits and surveys or other claims in connection with the delivery of healthcare and non-healthcare services and general business operations. These claims may come from a variety of governmental agencies, including but not limited to, the following federal agencies: U.S. Department of Health and Human Services (HHS), including the Centers for Disease Control and Prevention (CDC), Centers for Medicare and Medicaid Services (CMS), Office for Civil Rights (OCR) and Office of Inspector General (OIG); U.S. Department of Justice (DOJ); Occupational Safety and Health Administration (OHSA), U.S. Equal Employment Opportunity Commission (EEOC); National Labor Relations Board (NLRB); U.S. Department of Labor (DOL); U.S. Department of Housing and Urban Development (HUD); U.S. Department of Veterans Affairs (VA); Environmental Protection Agency (EPA); and Office of Health Care Affordability (OHCA). In addition to these federal agencies, there are also a variety of state and local authorities with the ability to bring claims against our independent subsidiaries. 22 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) The Company and its independent subsidiaries are also subject to requests for information and investigations by other state and federal governmental entities. For example, representatives of the State Attorney General's Office or the State OIG Office may and do request medical records, operational information, and other such documents and materials from the Company's independent subsidiaries. The Company cannot predict or provide any assurance as to the possible outcome of any such request, inquiry, investigation or subsequent litigation. If any such request, inquiry, investigation or related litigation were to proceed, and the Company and/or its independent subsidiaries are subjected to, alleged to be liable for, or agree to a settlement of related claims or obligations under federal Medicare statutes, the FCA, or similar state and federal statutes and regulations. In addition, if the Company and/or its independent subsidiaries are alleged or found to be liable on theories of general or professional negligence or conduct alleged to be related to its employment practices (including wage and hour violations), the Company's business, financial condition and results of operations and cash flows could be materially and adversely affected and its stock price could be adversely impacted. Among other things, any settlement or litigation could involve the payment of substantial sums to settle any alleged violations and may also include the assumption of specific procedural and financial obligations by the Company or its independent subsidiaries under a Corporate Integrity Agreement and/or other such arrangement. From time to time, various state or Federal agencies may issue requests for information, including but not limited to a subpoena. As an example, California's Office of Health Care Affordability is currently conducting a Cost and Market Impact Review (CMIR) with respect to specific components of a proposed transaction involving three of the Company's independent subsidiaries in California. The Company provided OHCA with requested information regarding specific components of the proposed transaction as part of the CMIR. The Company has been unable to effect resolution including attempts to narrow the scope, and limit the requests to its independent subsidiaries operating in California. The Company has filed a Petition in the Superior Court of the State of California, County of Orange, seeking a declaration that the CMIR regulations violate the United States Constitution and/or the California Constitution, and is void and unenforceable as applied to the Company. It also has requested that OHCA be ordered to withdraw the subpoena and close the inquiry, so the underlying transaction can be completed. Other claims and suits, including class actions, continue to be filed against the Company and other companies in its industry. The Company and its independent subsidiaries have been subjected to, and are currently involved in, class action litigation alleging violations (alone or in combination) of state and federal wage and hour laws as related to the alleged failure to pay wages, to timely provide and compensate for meal and rest breaks, and related causes of action. In 2025, the Company agreed to settle substantially all alleged wage, hour or labor code-related violations asserted on a class or representative basis against its independent subsidiaries in California for purported violations occurring during the six year period ending December 2025, pending court approval. Accordingly, the Company has recorded an accrual of $ 12,000 within Other accrued liabilities on the condensed consolidated balance sheet as of December 31, 2025. The Company does not believe that the ultimate resolution of these actions will have an ongoing material adverse effect on the Company’s business, cash flows, financial condition or results of operations. From time to time, the Company has received Civil Investigative Demands (CID) from the U.S. Department of Justice (DOJ). Certain of these matters resulted in settlements that were material to the Company’s financial statements in prior periods. In 2024, the Company, on behalf of its independent subsidiaries, received a CID indicating that the DOJ is investigating the Company to determine whether claims have been submitted to Medicare and Texas Medicaid for services which were unnecessary or otherwise not consistent with existing reimbursement requirements. The CID covers the period from January 1, 2016, to the present. As a general matter, the Company's independent subsidiaries maintain policies and procedures to promote compliance with all applicable Medicare and Medicaid requirements, including but not limited to those relating to the presentation of claims for reimbursement for services provided . The Company is fully cooperating with the DOJ in response to the CID. However, the Company cannot predict the outcome of the investigation or its potential impact on the consolidated financial statements. In 2023, following a four-week medical negligence trial in the State of Arizona, the jury returned a verdict against one of the Company’s independent subsidiaries. The Company is in the process of appealing the jury verdict. The Company has in the past appealed similar decisions and has, in some circumstances, received decisions in its favor. Although the Company intends to vigorously defend against these specific claims and in general these types of claims and cases, there can be no assurance that the outcomes of these matters will not have a material adverse effect on operational results and financial condition. The Company has recorded an estimated liability for this matter. 23 Table of Contents THE ENSIGN GROUP, INC. NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS - (Continued) Medicare Revenue Recoupments — The Company's independent subsidiaries are subject to regulatory reviews relating to the provision of Medicare and Medicaid services, billings and potential overpayments as a result of Recovery Audit Contractors (RAC), and various Program Safeguard Contractors and Medicaid Integrity Contractors (collectively referred to as Reviews). Reviews vary in claim selection size and processes, ranging from a single episode/claim month to larger, multi-claim batches; and from single rounds of review to reviews of multiple rounds with pass/fail criteria. If an operation has a significant error rate or fails a Review and/or subsequent Reviews, the operation could then be subject to extended review or an extrapolation of the identified error rate to billings in the same time period. The Company anticipates that these Reviews could increase in frequency in the future. As of March 31, 2026, and through the filing date of this report, 22 of the Company's independent subsidiaries had multi-claim Reviews scheduled or in process. Concentrations Credit Risk — The Company has significant accounts receivable balances, the collectability of which is dependent on the availability of funds from certain governmental programs, primarily Medicare and Medicaid. These receivables represent the only significant concentration of credit risk for the Company. The Company does not believe there are significant credit risks associated with these governmental programs. The Company believes that an appropriate allowance has been recorded for the possibility of these receivables proving uncollectible and continually monitors and adjusts these allowances as necessary. The Company’s receivables from Medicare and Medicaid payor programs accounted for 60.7 % and 61.9 % of its total accounts receivable as of March 31, 2026 and December 31, 2025, respectively. Revenue from reimbursement under the Medicare and Medicaid programs accounted for 69.1 % and 69.5 % of the Company's revenue for the three months ended March 31, 2026 and 2025, respectively. 19. COMMON STOCK REPURCHASE PROGRAM On May 15, 2025, the Board of Directors approved a stock repurchase program pursuant to which the Company is authorized to repurchase up to $ 20,000 of its common stock under the program for a period of approximately 12 months from June 16, 2025. During the three months ended March 31, 2026, the Company did not repurchase any shares pursuant to this stock repurchase program. As of March 31, 2026, the full $ 20,000 authorized for repurchase remained available under the stock repurchase program. On February 21, 2025, the Board of Directors approved a stock repurchase program pursuant to which the Company was authorized to repurchase up to $ 20,000 of its common stock under the program for a period of approximately 12 months from March 26, 2025. During the first quarter of 2025, the Company repurchased 84 shares of its common stock for $ 10,775 . Subsequent to March 31, 2025, the Company repurchased an additional 73 shares of its common stock for $ 9,225 . This repurchase program expired upon the repurchase of the fully authorized amount under the plan. Under the repurchase program, the Company is authorized to repurchase its issued and outstanding common shares from time to time in open-market and privately negotiated transactions, tender offers, pursuant to contractual provisions, and block trades, or otherwise in accordance with federal securities laws. The share repurchase program does not obligate the Company to acquire any specific number of shares. Any such repurchases will depend on the Company's business strategy, prevailing market conditions, the Company's liquidity requirements, contractual restrictions or covenants, compliance with securities laws, and other factors. The amounts involved in any such transaction may be material.