Ensign Group is a healthcare holding company operating skilled nursing facilities, senior living communities, and ancillary healthcare services across multiple states. The company derives the majority of its revenue from skilled nursing operations serving high-acuity patients covered by Medicaid, Medicare, managed care, and private pay sources, with supplementary revenue from senior living communities offering residential accommodations and services primarily to private-pay residents, and from ancillary services and real estate operations. Ensign employs a decentralized subsidiary structure that emphasizes local operational leadership and decision-making while leveraging centralized support services, and pursues growth through facility acquisitions, occupancy optimization, and development of its real estate portfolio, competing primarily on clinical quality outcomes, experienced local management, and proven integration capabilities.