Ensign Group operates skilled nursing facilities (SNFs) across 17 states, with 357 SNF operations and nearly 38,000 beds. SNFs serve patients who need short- or long-term nursing and rehabilitative care following hospitalization — recovering from strokes, joint replacements, and other complex medical events. Ensign also provides specialty services including on-site dialysis, ventilator care, and cardiac management. Skilled nursing accounts for roughly 96% of total revenue. Ensign earns revenue by billing government programs and insurers a per-patient-day rate. Medicaid (~47% of skilled services revenue) pays a fixed daily rate per patient but is the lowest-reimbursement payor. Medicare (~25% of skilled services revenue) reimburses at the highest per-day rate. The key financial driver is "skilled mix" — the share of patient days from Medicare, managed care, and other higher-acuity payors. Ensign's growth model combines acquisitions of underperforming SNFs with organic occupancy and skilled mix improvement within existing facilities. Ensign also owns a captive REIT, Standard Bearer, which holds 152 healthcare properties and leases them back to Ensign's operating subsidiaries and some third-party operators. Standard Bearer gives Ensign flexibility in structuring acquisitions. Labor is the dominant cost at roughly 60% of total expenses, making workforce management central to profitability. Ensign operates with a conservative balance sheet and has paid a growing quarterly dividend for 22 consecutive years.