Ensign Group
34 named things its latest annual report says its results depend on, each in the company's own words. 14 of them are also named by other companies we've read.
Customers
Third-party operator tenants of Standard Bearer
earns from · 38 of our propertiesnamed as a riskAs of December 31, 2025, we lease 38 of our properties to third-party operators.Risk factors (Item 1A)
Managed care organizations (Managed Medicaid)
earns fromnamed as a riskThe additional steps created by the use of MCOs in disbursement of funds creates more risk of delayed, reduced, or recouped payments for our independent subsidiaries, and additional avenues for risks that include fines and other sanctions, including suspension or exclusion from participation in various governmental programs.Risk factors (Item 1A)
Also named by LH
Suppliers
Leased facilities (landlords)
depends on · 253 of our 373 facilitiesnamed as a riskAs of December 31, 2025, our independent subsidiaries operated 253 of our 373 facilities under long term lease arrangements.Risk factors (Item 1A)
Partners and platforms
Hospital and physician referral sources
depends onnamed as a riskWe rely significantly on appropriate referrals from hospitals, physicians, and other healthcare providers in the communities in which we deliver our services to attract appropriate residents and patients to our independent subsidiaries.Risk factors (Item 1A)
Other companies
Truist
depends on · up to $600.0 millionWe have a Credit Facility with Truist of up to $600.0 million in aggregate principal.Market risk (Item 7A)
Pennant
named as a riskCertain of our directors who serve on our Board of Directors also serve on the board of directors of Pennant.Risk factors (Item 1A)
Places
California
concentrated in · over 23% of our independent subsidiariesnamed as a riskMoreover, since over 23% of our independent subsidiaries are located in California, we are particularly susceptible to revenue loss, cost increase or damage caused by natural disasters such as electrical power shortages, fires, earthquakes or mudslides, or increased liabilities that may arise from regulations as discussed within Item 1., under Government Regulation.Risk factors (Item 1A)
Also named by A, AAON, AFRM, ALK, ALLY, AN, ARE, AVAV and 88 more
Texas
concentrated in · the majority of our total revenuenamed as a riskSince a significant portion of our revenue is generated from our skilled nursing independent subsidiaries in California, Texas and Arizona, any budget reductions or delays in these states could adversely affect our net patient service revenue and profitability.Risk factors (Item 1A)
Also named by ABR, AFRM, ALLY, AN, ASO, ASTS, ATO, AXP and 70 more
Hazards
Earthquakes and wildfires
concentrated innamed as a riskMoreover, since over 23% of our independent subsidiaries are located in California, we are particularly susceptible to revenue loss, cost increase or damage caused by natural disasters such as electrical power shortages, fires, earthquakes or mudslides, or increased liabilities that may arise from regulations as discussed within Item 1., under Government Regulation.Risk factors (Item 1A)
Commodities and inputs
Medical supplies tariffs
exposed to its pricenamed as a riskAs it pertains to our independent subsidiaries, tariffs on medical supplies may lead to higher costs to providers and the federal government through the Medicare and Medicaid programs and may impact the formulas used to calculate federal reimbursements.Risk factors (Item 1A)
Regulators
U.S. Department of Housing and Urban Development (HUD)
subject to · $143.4 millionnamed as a riskTwenty-three of our subsidiaries have mortgage loans insured with the Department of Housing and Urban Development (HUD) for an aggregate amount of $143.4 million, which subjects these subsidiaries to HUD oversight and periodic inspections.Risk factors (Item 1A)
Medicare Administrative Contractors / CMS claim reviews
subject to · 25 of our independent subsidiariesnamed as a riskAs of December 31, 2025 and through the filing date of this report, 25 of our independent subsidiaries had multi-claim reviews scheduled or in process, either pre- or post-payment.Risk factors (Item 1A)
Centers for Medicare and Medicaid Services (CMS)
subject tonamed as a riskCMS often changes the rules governing the Medicare program, including those governing reimbursement.Risk factors (Item 1A)
Also named by ABBV, CDNA, CHE, DGX, DOC, GD, GEHC, GHC and 6 more
HHS Office of Inspector General (OIG)
subject tonamed as a riskThese efforts may place us under greater scrutiny with the OIG, CMS, our fiscal intermediaries, recovery audit contractors and others.Risk factors (Item 1A)
California Office of Health Care Affordability (OHCA)
subject tonamed as a riskThe California OHCA CMIR process may delay, and potentially ultimately prevent, the closing of certain proposed transactions.Risk factors (Item 1A)
Laws and programs
Medicare
earns from · 23.7% of our service revenuenamed as a riskWe derived 23.7% and 24.9% of our service revenue from the Medicare programs for the years ended December 31, 2025 and 2024, respectively.Risk factors (Item 1A)
Also named by ABT, ARWR, AXGN, BAX, BDX, BMY, BSX, CAH and 48 more
Medicaid
earns from · 45.8% of our revenuenamed as a riskIn fact, Medicaid is our largest source of revenue, accounting for 45.8% and 46.0% of our revenue for the years ended December 31, 2025 and 2024, respectively.Risk factors (Item 1A)
Also named by ABBV, ABT, ARE, ARWR, BAX, BMY, BSX, CHE and 39 more
Medicare sequestration (Budget Control Act of 2011 / PAYGO)
subject to · 2.0% reduction in Medicare paymentsnamed as a riskMedicare FFS claims with dates of service or dates of discharge on or after April 1, 2013, incur a 2.0% reduction in Medicare payments through at least the end of 2025, unless Congress takes further action.Business (Item 1)
Special Focus Facility (SFF) program
subject to · one facility placed on SFF statusnamed as a riskWe currently have one facility placed on SFF status.Risk factors (Item 1A)
Medicare Part B Physician Fee Schedule
subject to · reduced by 2.83% in the CY 2025 PFSnamed as a riskOf specific concern has been CMS efforts to lower Medicare Part B reimbursement rates for outpatient therapy services, which are reduced by 2.83% in the CY 2025 PFS.Risk factors (Item 1A)
California medical malpractice non-economic damages cap law
subject to · maximum of $0.75 millionnamed as a riskThe cap increases from $0.25 million to $0.35 million beginning on January 1, 2023, then increases over the following 10 years until the cap reaches a maximum of $0.75 million, with further adjustments for inflation.Risk factors (Item 1A)
SNF Quality Reporting Program (IMPACT Act)
subject to · reduced by 2.0%named as a riskIf a SNF does not submit required quality data as required by the IMPACT Act, its payment rates are reduced by 2.0% for each such fiscal year, which may result in payment rates for a fiscal year being less than the preceding fiscal year.Business (Item 1)
Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS)
subject to · 3.2% increaseFor fiscal year 2026, which began on October 1, 2025 and ends on September 30, 2026, CMS has finalized a 3.2% increase to SNF PPS payment rates.Business (Item 1)
One Big Beautiful Bill Act (OBBB)
subject tonamed as a riskA key risk to our revenue is that states may generally have fewer financial resources available without federal contributions to Medicaid.Business (Item 1)
Also named by AA, ABR, ADI, ADM, ALB, AMAT, AMGN, AMKR and 121 more
REIT qualification (Internal Revenue Code)
subject tonamed as a riskIf Standard Bearer fails to remain qualified to be taxed as a REIT in any year, it would be subject to U.S. federal income tax, including any applicable alternative minimum tax, on our taxable income at regular corporate rates, and dividends paid to its stockholders would not be deductible by it in computing its taxable income.Risk factors (Item 1A)
Also named by ABR, AMT, CCI, DLR, FPI, KIM, LAMR, O and 6 more
CMS Five-Star Quality Rating System
subject tonamed as a riskIf we should fail to achieve our internal rating goals or fail to exceed the national average rating on the Five-Star Quality Rating System, including due to nursing and administrative staffing and turnover, or have facilities displaying a consumer alert icon for incidents of abuse, neglect, or exploitation, it may affect our ability to generate referrals, which could have a material adverse effect upon our business and consolidated financial condition, results of operations and cash flows.Risk factors (Item 1A)
Also named by OHI
California Skilled Nursing Facility Ownership and Management Reform Act of 2022
subject tonamed as a riskAs a result, this new law may delay or impede growth within California.Risk factors (Item 1A)
Washington Medicaid direct care spending requirement
subject tonamed as a riskWashington state first adopted this care-based payment model in 2015 and has periodically updated it since, including in 2020, 2022, and 2023; it is expected that Washington will continue to amend this law in the future.Risk factors (Item 1A)
Texas patient care expense ratio (PCER)
subject tonamed as a riskFor state fiscal year 2025, Texas is replacing the previous spending requirement with the patient care expense ratio (PCER) which measures the proportion of a facility's Medicaid revenue that is spent on patient care expenses.Risk factors (Item 1A)
California minimum wage increases for healthcare workers
subject tonamed as a riskIn addition, state laws regarding minimum wage increases, such as California’s minimum wage increases for both healthcare and fast-food workers, may intensify competition for unskilled labor in both skilled and unskilled settings.Risk factors (Item 1A)
CMS Ownership Transparency Final Rule
subject tonamed as a riskThe breadth of disclosure required by this new rule may be adverse to our business interests and detrimental to our operations, revenue, and profitability and may have a chilling effect on investment due to the depth of the new reporting and transparency requirements.Risk factors (Item 1A)
Texas workers compensation non-subscriber status
operates innamed as a riskWe also have implemented a self-insurance program for workers compensation in all states, and elected non-subscriber status for workers compensation in Texas.Risk factors (Item 1A)