ENSIGN GROUP, INCENSG
ENSIGN GROUP, INC Revenue Disclosure
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.
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 69.5%, 70.9% and 72.6% for the years ended December 31, 2025, 2024 and 2023, respectively. Settlements with Medicare and Medicaid 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 years ended December 31, 2025, 2024 and 2023.
Service revenue for the years ended December 31, 2025, 2024 and 2023 is summarized in the following tables:
| Year Ended December 31, | |||||||||||||||||||||||||||||||||||
| 2025 | 2024 | 2023 | |||||||||||||||||||||||||||||||||
| Revenue | % of Revenue | Revenue | % of Revenue | Revenue | % of Revenue | ||||||||||||||||||||||||||||||
Medicaid(1)(2) | $ | 2,002,007 | 39.8 | % | $ | 1,682,344 | 39.7 | % | $ | 1,459,449 | 39.4 | % | |||||||||||||||||||||||
| Medicare | 1,194,554 | 23.7 | 1,055,226 | 24.9 | 985,749 | 26.6 | |||||||||||||||||||||||||||||
Medicaid-skilled | 301,122 | 6.0 | 266,738 | 6.3 | 245,663 | 6.6 | |||||||||||||||||||||||||||||
Total Medicaid and Medicare | $ | 3,497,683 | 69.5 | % | $ | 3,004,308 | 70.9 | % | $ | 2,690,861 | 72.6 | % | |||||||||||||||||||||||
| Managed care | 944,316 | 18.8 | 789,643 | 18.6 | 666,129 | 18.0 | |||||||||||||||||||||||||||||
Private and other(3) | 590,119 | 11.7 | 443,574 | 10.5 | 351,081 | 9.4 | |||||||||||||||||||||||||||||
| SERVICE REVENUE | $ | 5,032,118 | 100.0 | % | $ | 4,237,525 | 100.0 | % | $ | 3,708,071 | 100.0 | % | |||||||||||||||||||||||
(1) Medicaid payor includes revenue for senior living operations. | |||||||||||||||||||||||||||||||||||
| (2) Medicaid payor includes revenue related to state relief funding during the year ended December 31, 2023. | |||||||||||||||||||||||||||||||||||
| (3) 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 is $25,723, $22,960 and $21,284 for the years ended December 31, 2025, 2024 and 2023.
State relief funding
During the year ended December 31, 2023, the Company received $64,238 in state relief funding and recognized $64,753 as revenue. The state relief funding were provided through Medicaid programs from various states, including healthcare relief funding under the American Rescue Plan Act (ARPA), increases in the Federal Medical Assistance Percentage (FMAP) under the Families First Coronavirus Response Act (FFCRA) and other state specific relief programs. The funding generally incorporates specific use requirements primarily for direct patient care including labor related expenses that are attributable to the COVID-19 pandemic or are associated with providing patient care.
Due to the expiration of the COVID-19 Public Health Emergency in May 2023, the Company did not receive additional funding during the years ended December 31, 2025 and 2024.
Revenues from these additional payments are recognized in accordance with ASC 606, subject to variable consideration constraints. In certain operations where the Company received additional payments that exceeded expenses incurred related to specific qualifiers, the Company recorded deferred revenue for the excess amount until additional expenses are incurred for recognition. Accordingly, the amount of state relief revenue recognized is limited to the actual related expenses incurred.
Balance Sheet Impact
Included in the Company’s 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 December 31, 2025 and 2024, or activity during the years ended December 31, 2025, 2024 and 2023.
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 December 31, 2025 and 2024, is summarized in the following table:
| December 31, | |||||||||||
| 2025 | 2024 | ||||||||||
| Medicaid | $ | 296,649 | $ | 228,872 | |||||||
| Managed care | 163,463 | 139,711 | |||||||||
| Medicare | 102,693 | 77,056 | |||||||||
| Private and other payors | 81,985 | 132,693 | |||||||||
| $ | 644,790 | $ | 578,332 | ||||||||
| Less: allowance for doubtful accounts | (7,805) | (8,435) | |||||||||
| ACCOUNTS RECEIVABLE, NET | $ | 636,985 | $ | 569,897 | |||||||
Historical Timeline
| Fiscal Year | Filed | |
|---|---|---|
| 2025 | Feb 4, 2026 | Showing above |
| 2024 | Feb 5, 2025 | |
| 2023 | Feb 1, 2024 | |
| 2022 | Feb 2, 2023 | |
| 2021 | Feb 9, 2022 | |
| 2020 | Feb 3, 2021 | |
| 2019 | Feb 5, 2020 | |
| 2018 | Feb 6, 2019 | |
| 2017 | Feb 8, 2018 | |
| 2016 | Feb 8, 2017 | |
| 2015 | Feb 10, 2016 | |
About Revenue Disclosures
Revenue disclosures under ASC 606 explain how a company identifies performance obligations, allocates transaction prices, and determines when revenue is recognized. This section is essential for understanding whether reported revenue reflects genuine economic activity or aggressive accounting choices. Analysts examine the mix of point-in-time versus over-time recognition, which directly affects revenue timing and comparability.
Key signals: rising contract liabilities (deferred revenue) suggest strong future revenue visibility, while declining contract assets may indicate slowing project milestones. Watch for variable consideration estimates — rebates, returns, and performance bonuses that require management judgment. Significant changes in disaggregated revenue by geography or product line can reveal shifting business mix before it appears in headline numbers. Compare revenue growth against contract liability growth to assess sustainability, and scrutinize any changes in the timing of recognition that coincide with earnings pressure.