National HealthCare (NHC) 10-Q 4 Aug 16 2016 Q2 Quarterly report Financial data

Document And Entity Information

Document And Entity Information - shares	6 Months Ended
	Jun. 30, 2016	Aug. 01, 2016
Document Information [Line Items]
Entity Registrant Name	NATIONAL HEALTHCARE CORP
Entity Central Index Key	1,047,335
Trading Symbol	nhc
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Well-known Seasoned Issuer	No
Entity Common Stock, Shares Outstanding (in shares)		15,279,239
Document Type	10-Q
Document Period End Date	Jun. 30, 2016
Document Fiscal Year Focus	2,016
Document Fiscal Period Focus	Q2
Amendment Flag	false

Interim Condensed Consolidated

Interim Condensed Consolidated Statements of Income (Unaudited) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Revenues:
Net patient revenues	$ 216,487,000	$ 214,433,000	$ 434,593,000	$ 426,494,000
Other revenues	11,281,000	10,469,000	22,763,000	20,815,000
Net operating revenues	227,768,000	224,902,000	457,356,000	447,309,000
Cost and Expenses:
Salaries, wages and benefits	135,068,000	131,914,000	265,088,000	257,630,000
Other operating	57,306,000	57,467,000	118,615,000	117,214,000
Facility rent	10,319,000	9,981,000	20,646,000	19,966,000
Depreciation and amortization	9,495,000	9,236,000	18,849,000	18,169,000
Interest	939,000	598,000	1,893,000	1,188,000
Total costs and expenses	213,127,000	209,196,000	425,091,000	414,167,000
Income Before Non–Operating Income	14,641,000	15,706,000	32,265,000	33,142,000
Non–Operating Income	4,925,000	4,130,000	9,698,000	8,352,000
Income Before Income Taxes	19,566,000	19,836,000	41,963,000	41,494,000
Income Tax Provision	(7,700,000)	(7,478,000)	(16,398,000)	(15,894,000)
Net Income	11,866,000	12,358,000	25,565,000	25,600,000
Dividends to Preferred Stockholders		(2,167,000)		(4,335,000)
Net Income Available to Common Stockholders	$ 11,866,000	$ 10,191,000	$ 25,565,000	$ 21,265,000
Earnings Per Common Share:
Basic (in dollars per share)	$ 0.78	$ 0.74	$ 1.69	$ 1.54
Diluted (in dollars per share)	$ 0.78	$ 0.71	$ 1.68	$ 1.48
Weighted Average Common Shares Outstanding:
Basic (in shares)	15,266,559	13,772,873	15,091,732	13,767,248
Diluted (in shares)	15,289,104	14,381,746	15,212,275	14,336,027
Dividends declared to common stockholders per share (in dollars per share)	$ 0.45	$ 0.40	$ 0.85	$ 0.74

Interim Condensed Consolidated3

Interim Condensed Consolidated Statements of Comprehensive Income (Unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Net income	$ 11,866	$ 12,358	$ 25,565	$ 25,600
Other Comprehensive Income (Loss):
Unrealized gains (losses) on investments in marketable securities	18,123	(19,072)	30,627	(15,085)
Reclassification adjustment for realized gains on sale of securities	(261)	(80)	(540)	(421)
Income tax (expense) benefit related to items of other comprehensive income	(6,887)	7,379	(11,554)	6,013
Other comprehensive income (loss), net of tax	10,975	(11,773)	18,533	(9,493)
Comprehensive Income	$ 22,841	$ 585	$ 44,098	$ 16,107

Interim Condensed Consolidated4

Interim Condensed Consolidated Balance Sheets (Current Period Unaudited) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Current Assets:
Cash and cash equivalents	$ 37,543	$ 38,208
Restricted cash and cash equivalents	14,364	8,793
Marketable securities	141,756	116,168
Restricted marketable securities	13,220	18,276
Accounts receivable, less allowance for doubtful accounts of $7,336 and $5,583, respectively	77,228	84,095
Inventories	7,137	7,568
Prepaid expenses and other assets	3,138	2,171
Notes receivable, current portion	1,977	460
Federal income tax receivable	915	3,203
Total current assets	297,278	278,942
Property and Equipment:
Property and equipment, at cost	911,303	875,287
Accumulated depreciation and amortization	(357,979)	(339,241)
Net property and equipment	553,324	536,046
Other Assets:
Restricted cash and cash equivalents	2,336	2,313
Restricted marketable securities	159,840	151,590
Deposits and other assets	8,213	8,451
Goodwill	17,600	17,600
Notes receivable, less current portion	12,970	12,704
Investments in limited liability companies	36,005	37,683
Total other assets	236,964	230,341
Total assets	1,087,566	1,045,329
Current Liabilities:
Trade accounts payable	21,803	20,128
Capital lease obligations, current portion	3,378	3,279
Accrued payroll	50,005	65,338
Amounts due to third party payors	18,410	16,654
Accrued risk reserves, current portion	27,584	27,069
Other current liabilities	12,773	12,192
Dividends payable	6,876	5,996
Total current liabilities	140,829	150,656
Long-term debt, noncurrent	120,000	120,000
Capital lease obligations, less current portion	28,515	30,228
Accrued risk reserves, less current portion	70,930	71,439
Refundable entrance fees	9,831	9,865
Obligation to provide future services	3,440	3,440
Deferred income taxes	20,406	9,096
Other noncurrent liabilities	17,367	16,294
Deferred revenue	4,705	3,315
Stockholders’ Equity:
Common stock, $.01 par value; 30,000,000 shares authorized; 15,279,239 and 15,000,616 shares, respectively, issued and outstanding	153	150
Capital in excess of par value	218,896	209,469
Retained earnings	380,597	368,013
Accumulated other comprehensive income	71,897	53,364
Total stockholders’ equity	671,543	630,996
Total liabilities and stockholders’ equity	$ 1,087,566	$ 1,045,329

Interim Condensed Consolidated5

Interim Condensed Consolidated Balance Sheets (Current Period Unaudited) (Parentheticals) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Allowance for doubtful accounts	$ 7,336	$ 5,583
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	30,000,000	30,000,000
Common stock, shares issued (in shares)	15,279,239	15,000,616
Common stock, shares outstanding (in shares)	15,279,239	15,000,616

Interim Condensed Consolidated6

Interim Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015
Cash Flows From Operating Activities:
Net income	$ 25,565	$ 25,600
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	18,849	18,169
Provision for doubtful accounts receivable	3,795	3,763
Equity in earnings of unconsolidated investments	(3,120)	(2,386)
Distributions from unconsolidated investments	5,635	4,749
Gains on sale of restricted marketable securities	(540)	(421)
Deferred income taxes	(244)	(4,869)
Stock–based compensation	494	1,132
Changes in operating assets and liabilities, net of the effect of acquisitions:
Restricted Cash and Cash Equivalents	(10,342)	(5,701)
Accounts receivable	3,072	(2,877)
Income tax receivable	2,288	4,727
Inventories	431	(146)
Prepaid expenses and other assets	(967)	(699)
Trade accounts payable	1,675	1,244
Accrued payroll	(15,333)	(10,849)
Amounts due to third party payors	1,756	2,526
Other current liabilities and accrued risk reserves	609	3,295
Other noncurrent liabilities	1,073	1,386
Deferred revenue	1,390	1,533
Net cash provided by operating activities	36,086	40,176
Cash Flows From Investing Activities:
Additions to property and equipment	(36,127)	(23,046)
Investments in unconsolidated limited liability companies	(904)	(323)
Investments in notes receivable	(2,144)	(4,237)
Collections of notes receivable	428	228
Change in restricted cash and cash equivalents	4,748	5,738
Purchase of restricted marketable securities	(23,852)	(35,952)
Sale of restricted marketable securities	25,697	28,296
Net cash used in investing activities	(32,154)	(29,296)
Cash Flows From Financing Activities:
Tax (expense) benefit from stock–based compensation	(1,134)	342
Principal payments under capital lease obligations	(1,614)	(1,521)
Dividends paid to preferred stockholders		(4,335)
Dividends paid to common stockholders	(12,101)	(9,667)
Issuance of common shares	10,070	5,743
Entrance fee deposits	(34)	(203)
Change in deposits	216	494
Net cash used in financing activities	(4,597)	(9,147)
Net (Decrease) Increase in Cash and Cash Equivalents	(665)	1,733
Cash and Cash Equivalents, Beginning of Period	38,208	69,767
Cash and Cash Equivalents, End of Period	$ 37,543	$ 71,500

Interim Condensed Consolidated7

Interim Condensed Consolidated Statements of Stockholders' Equity (Unaudited) - USD ($) $ in Thousands	Preferred Stock [Member]	Common Stock [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	AOCI Attributable to Parent [Member]	Total
Balance, shares (in shares) at Dec. 31, 2014	10,836,659	14,110,859
Balance at Dec. 31, 2014	$ 170,494	$ 140	$ 154,965	$ 343,941	$ 64,608	$ 734,148
Net income				25,600		25,600
Other comprehensive income (loss)					(9,493)	(9,493)
Stock–based compensation			1,132			1,132
Tax benefit (expense) from exercise of stock options			342			342
Shares sold – options exercised, shares (in shares)		123,001
Shares sold – options exercised		$ 2	5,741			5,743
Shares issued in conversion of preferred stock to common stock (in shares)	(63,947)	15,476
Shares issued in conversion of preferred stock to common stock	$ (1,015)		1,015
Dividends declared to preferred stockholders ($0.40 per share)				(4,335)		(4,335)
Dividends declared to common stockholders ($0.74 per share)				(10,534)		(10,534)
Balance, shares (in shares) at Jun. 30, 2015	10,772,712	14,249,336
Balance at Jun. 30, 2015	$ 169,479	$ 142	163,195	354,672	55,115	742,603
Other comprehensive income					(9,493)	(9,493)
Balance, shares (in shares) at Dec. 31, 2014	10,836,659	14,110,859
Balance at Dec. 31, 2014	$ 170,494	$ 140	154,965	343,941	64,608	$ 734,148
Shares sold – options exercised, shares (in shares)						389,498
Balance, shares (in shares) at Dec. 31, 2015		15,000,616
Balance at Dec. 31, 2015		$ 150	209,469	368,013	53,364	$ 630,996
Net income				25,565		25,565
Other comprehensive income (loss)					18,533	18,533
Stock–based compensation			494			494
Tax benefit (expense) from exercise of stock options			(1,134)			$ (1,134)
Shares sold – options exercised, shares (in shares)		278,623				480,275
Shares sold – options exercised		$ 3	10,067			$ 10,070
Dividends declared to preferred stockholders ($0.40 per share)
Dividends declared to common stockholders ($0.74 per share)				(12,981)		(12,981)
Balance, shares (in shares) at Jun. 30, 2016		15,279,239
Balance at Jun. 30, 2016		$ 153	$ 218,896	$ 380,597	71,897	671,543
Other comprehensive income					$ 18,533	$ 18,533

Interim Condensed Consolidated8

Interim Condensed Consolidated Statements of Stockholders' Equity (Unaudited) (Parentheticals) - $ / shares	6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015
Preferred Stock [Member]
Dividends declared to preferred stockholders per share (in dollars per share)		$ 0.40
Common Stock [Member]
Dividends declared to common stockholders per share (in dollars per share)	$ 0.85	0.74
Dividends declared to common stockholders per share (in dollars per share)	$ 0.85	$ 0.74

Note 1 - Description of Busines

Note 1 - Description of Business	6 Months Ended
	Jun. 30, 2016
Notes to Financial Statements
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block]	Note 1 – Description of Business National HealthCare Corporation (“NHC” or the “Company”) is a leading provider of senior health care services. As of June 30, 2016, we operate or manage, through certain affiliates, 74 long-term care centers with a total of 9,390 licensed beds, 21 assisted living facilities, five independent living facilities, and 36 homecare programs. We operate specialized care units within certain of our healthcare centers such as Alzheimer's disease care units and sub-acute nursing units. We also have a non-controlling ownership interest in a hospice care business that services NHC owned health care centers and others. In addition, we provide insurance services, management and accounting services, and we lease properties to operators of skilled nursing centers. We operate in 10 states and are located primarily in the southeastern United States.

Note 2 - Summary of Significant

Note 2 - Summary of Significant Accounting Policies	6 Months Ended
	Jun. 30, 2016
Notes to Financial Statements
Significant Accounting Policies [Text Block]	Note 2 – Summary of Significant Accounting Policies The listing below is not intended to be a comprehensive list of all of our significant accounting policies. In many cases, the accounting treatment of a particular transaction is specifically dictated by generally accepted accounting principles, with limited need for management’s judgment in their application. There are also areas in which management’s judgment in selecting any available alternative would not produce a materially different result. See our audited December 31, 2015 consolidated financial statements and notes thereto which contain accounting policies and other disclosures required by generally accepted accounting principles. Our audited December 31, 2015 consolidated financial statements are available at our web site: www.nhccare.com. Basis of Presentation The unaudited interim condensed consolidated financial statements to which these notes are attached include all normal, recurring adjustments which are necessary to fairly present the financial position, results of operations and cash flows of NHC. All significant intercompany transactions and balances have been eliminated in consolidation. We assume that users of these interim financial statements have read or have access to the audited December 31, 2015 consolidated financial statements and Management’s Discussion and Analysis of Financial Condition and Results of Operations and that the adequacy of additional disclosure needed for a fair presentation, except in regard to material contingencies, may be determined in that context. Accordingly, footnotes and other disclosures which would substantially duplicate the disclosure contained in our most recent annual report to stockholders have been omitted. This interim financial information is not necessarily indicative of the results that may be expected for a full year for a variety of reasons. Estimates and Assumptions The preparation of financial statements in conformity with accounting principles generally accepted in the United States requires us 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 financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates and could cause our reported net income to vary significantly from period to period. Recently Adopted Accounting Guidance In November 2015, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") No. 2015-17, “Income Taxes” which requires that deferred tax liabilities and assets be classified as noncurrent in a classified balance sheet. Prior to the issuance of the standard, deferred tax liabilities and assets were required to be separately classified into a current amount and a noncurrent amount in the balance sheet. The new accounting guidance represents a change in accounting principle and the standard is required to be adopted in annual periods beginning after December 15, 2016. Early adoption is permitted and the Company elected to early adopt this guidance as of December 31, 2015. In April 2015, the FASB issued ASU 2015-03, "Imputation of Interest (Sub-Topic 835.30): Simplifying the Presentation of Debt Issuance Costs". ASU 2015-03 requires debt issuance costs related to a recognized debt liability be presented in the balance sheet as a direct deduction from the carrying amount of that debt liability, consistent with debt discounts. In August 2015, the FASB issued ASU 2015-15 clarifying the application of this guidance to line of credit arrangements. The amendments in the ASUs are effective retrospectively for fiscal years, and for interim periods within those fiscal years, beginning after December 15, 2015. This guidance did not have a material impact on our consolidated financial statements. In February 2015, the FASB issued ASU No. 2015-02 “Amendments to the Consolidation Analysis”. This update is in response to stakeholders that have expressed concerns that current generally accepted accounting principles (“GAAP”) might require a reporting entity to consolidate another legal entity in situations in which the reporting entity’s contractual rights do not give it the ability to act primarily on its own behalf, the reporting entity does not hold a majority of the legal entity’s voting rights, or the reporting entity is not exposed to a majority of the legal entity’s economic benefits or obligations. Thus, the update modifies the evaluation of whether limited partnerships and similar legal entities are variable interest entities (“VIEs”) or voting interest entities. It eliminates the presumption that a general partner should consolidate a limited partnership, for limited partnerships and similar legal entities that qualify as voting interest entities; a limited partner with a controlling financial interest should consolidate a limited partnership. A controlling financial interest may be achieved through holding a limited partner interest that provides substantive kick-out rights. Finally, it requires consideration of the effects of fee arrangements and related parties on the primary beneficiary determination. The amendments in this update are effective for annual reporting periods beginning after December 15, 2015, including interim periods within that reporting period. This guidance did not have a material impact on our consolidated financial statements. Recent Accounting Guidance Not Yet Adopted In March 2016, the FASB issued ASU 2016-09, “Compensation – Stock Compensation (Topic 718): Improvements to Employee Share-Based Payment Accounting.” ASU 2016-09 simplifies the accounting for share-based payment award transactions including: income tax consequences, classification of awards as either equity or liabilities and classification on the statement of cash flows. ASU 2016-09 is effective for fiscal years beginning after December 15, 2016, including interim periods within those fiscal years. Early adoption is permitted. We are currently evaluating the requirements of ASU 2016-09 and have not yet determined its impact on our consolidated financial statements. In February 2016, the FASB issued ASU 2016-02, "Leases (Topic 842)." The objective of this update is to increase transparency and comparability among organizations by recognizing lease assets and lease liabilities on the balance sheet and disclosing key information about leasing arrangements. This ASU is effective for fiscal years beginning after December 15, 2018, including interim periods within those annual periods and is to be applied utilizing a modified retrospective approach. We anticipate this standard will have a material impact on our consolidated financial statements. Additionally, we are currently evaluating the impact this standard will have on our policies and procedures and internal control framework. In January 2016, the FASB issued ASU No. 2016-01, “Financial Instruments - Recognition and Measurement of Financial Assets and Financial Liabilities (Topic 825)”. ASU No. 2016-01 revises the classification and measurement of investments in certain equity investments and the presentation of certain fair value changes for certain financial liabilities measured at fair value. ASU No. 2016-01 requires the change in fair value of many equity investments to be recognized in net income. ASU No. 2016-01 is effective for interim and annual periods beginning after December 15, 2017, with early adoption permitted. Adopting ASU No. 2016-01 may result in a cumulative effect adjustment to the Company’s retained earnings as of the beginning of the year of adoption. We are currently evaluating the potential effects of adopting the provisions of ASU No. 2016-01. In May 2014, the FASB issued ASU No. 2014-09 “Revenue from Contracts with Customers”. This update is the result of a collaborative effort by the FASB and the International Accounting Standards Board to simplify revenue recognition guidance, remove inconsistencies in the application of revenue recognition, and to improve comparability of revenue recognition practices across entities, industries, jurisdictions, and capital markets. The FASB is amending the Accounting Standards Codification and creating a new Topic 606, “Revenue from Contracts with Customers”. The core principle of the guidance is that an entity should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. For a public entity, the amendments in this update are effective for annual reporting periods beginning after December 15, 2017, including interim periods within that reporting period. The Company is currently evaluating the impact of this guidance on our consolidated financial statements and control framework. Revenue Recognition – Third Party Payors Approximately 65% of our net patient revenues are derived from Medicare, Medicaid, and other government programs. Amounts earned under these programs are subject to review by the Medicare and Medicaid intermediaries or their agents. In our opinion, adequate provision has been made for any adjustments that may result from these reviews. Any differences between our original estimates of reimbursements and subsequent revisions are reflected in operations in the period in which the revisions are made often due to final determination or the period of payment no longer being subject to audit or review. We have recorded liabilities of approximately $18,410,000 and $16,654,000 as of June 30, 2016 and December 31, 2015, respectively, for various Medicare and Medicaid current and prior year cost reports and claims reviews. Revenue Recognition – Private P ay For private pay patients in skilled nursing or assisted living facilities, we bill room and board in advance with payment being due in the month the services are performed. Charges for ancillary, pharmacy, therapy and other services to private patients are billed in the month following the performance of services; however, all billings are recognized as revenue when the services are performed. Revenue Recognition – Subordination of Fees and Uncert ain Collections We provide management services to certain senior care facilities and to others we provide accounting and financial services. We generally charge 6% to 7% of net operating revenues for our management services and a predetermined fixed rate per bed for the accounting and financial services. Our policy is to recognize revenues associated with both management services and accounting and financial services on an accrual basis as the services are provided. However, under the terms of our management contracts, payments for our management services are subject to subordination to other expenditures of the long–term care center being managed. Furthermore, for certain of the third parties with whom we have contracted to provide services and which we have determined that collection is not reasonably assured, our policy is to recognize income only in the period in which the amounts are realized. We may receive payment for the unpaid and unrecognized management fees in whole or in part in the future only if cash flows from the operating and investing activities of the centers or proceeds from the sale of the centers are sufficient to pay the fees. There can be no assurance that such future cash flows will occur. The realization of such previously unrecognized revenue could cause our reported net income to vary significantly from period to period. We agree to subordinate our fees to the other expenses of a managed center because we believe we know how to improve the quality of patient services and finances of a senior healthcare center. We believe subordinating our fees demonstrates to the owner and employees of the managed center how confident we are of the impact we can have in making the center operations successful. We may continue to provide services to certain managed centers despite not being fully paid currently so that we may be able to collect unpaid fees in the future from improved operating results and because the incremental savings from discontinuing services to a center may be small compared to the potential benefit. Also, we may benefit from providing other ancillary services to the managed center. Other Operating Expenses Other operating expenses include the costs of care and services that we provide to the residents of our facilities and the costs of maintaining our facilities. Our primary patient care costs include drugs, medical supplies, purchased professional services, food, and professional liability insurance and licensing fees. The primary facility costs include utilities and property insurance. General and Administrative Costs With the Company being a healthcare provider, the majority of our expenses are "cost of revenue" items. Costs that could be classified as "general and administrative" by the Company would include its corporate office costs, which were $15,457,000 and $15,044,000 for the six months ended June 30, 2016 and 2015, respectively. Property and Equipment Property and equipment are recorded at cost. Depreciation is provided by the straight-line method over the expected useful lives of the assets estimated as follows: buildings and improvements, 20-40 years and equipment and furniture, 3-15 years. Leasehold improvements are amortized over periods that do not exceed the non-cancelable respective lease terms using the straight-line method. Capital leases are recorded at the lower of fair market value or the present value of future minimum lease payments. Capital leases are amortized in accordance with the provision codified within Accounting Standards Codification (“ASC”) Subtopic 840-30, Leases – Capital Leases Accrued Risk Reserves We are self– insured for risks related to health insurance and have wholly–owned limited purpose insurance companies that insure risks related to workers’ compensation and general and professional liability insurance claims. The accrued risk reserves include a liability for reported claims and estimates for incurred but unreported claims. Our policy is to engage an external, independent actuary to assist in estimating our exposure for claims obligations (for both asserted and unasserted claims). We reassess our accrued risk reserves on a quarterly basis. Professional liability remains an area of particular concern to us. The long term care industry has seen an increase in personal injury/wrongful death claims based on alleged negligence by skilled nursing facilities and their employees in providing care to residents. As of June 30 2016, we and/or our managed centers are defendants in 36 such claims inclusive of years 2005 through June 30, 2016. It remains possible that those pending matters plus potential unasserted claims could exceed our reserves, which could have a material adverse effect on our consolidated financial position, results of operations and cash flows. It is also possible that future events could cause us to make significant adjustments or revisions to these reserve estimates and cause our reported net income to vary significantly from period to period. We are principally self-insured for incidents occurring in all centers owned or leased by us. The coverages include both primary policies and excess policies. In all years, settlements, if any, in excess of available insurance policy limits and our own reserves would be expensed by us. Continuing Care Contracts and Refundable Entrance Fee We have one continuing care retirement center (“CCRC”) within our operations. Residents at this retirement center may enter into continuing care contracts with us. The contracts provide that 10% of the resident entry fee becomes non-refundable upon occupancy, and the remaining refundable portion of the entry fee is calculated using the lessor of the price at which the apartment is re-assigned or 90% of the original entry fee, plus 40% of any appreciation if the apartment exceeds the original resident’s entry fee. In each case, we amortize the non-refundable part of these fees into revenue over the actuarially determined remaining life of the resident, which is the expected period of occupancy by the resident. We pay the refundable portion of our entry fees to residents when they relocate from our community and the apartment is re-occupied. Refundable entrance fees are classified as non-current liabilities and non-refundable entrance fees are classified as deferred revenue in the Company's consolidated balance sheets. The balances of refundable entrance fees as of June 30, 2016 and December 31, 2015 were $9,831,000 and $9,865,000, respectively. Obligation to Provide Future Services W e annually estimate the present value of the cost of future services and the use of facilities to be provided to the current CCRC residents and compare that amount with the balance of non-refundable deferred revenue from entrance fees received. If the present value of the cost of future services exceeds the related anticipated revenues, a liability is recorded (obligation to provide future services) with a corresponding charge to income. As of June 30, 2016 and December 31, 2015, we have recorded a future service obligation in the amount of $3,440,000. Other Noncurrent Liabilities Other noncurrent liabilities include reserves primarily related to various uncertain income tax positions (See Note 12). D eferred Revenue Deferred revenue includes the deferred gain on the sale of assets to National Health Corporation (“National”), the non-refundable portion (10%) of CCRC entrance fees being amortized over the remaining life expectancies of the residents, and premiums received within our workers’ compensation and professional liability companies that are not yet earned. Variable Interest Entities We have equity interests in unconsolidated limited liability companies that operate various post-acute and senior healthcare businesses. We analyze our investments in these limited liability companies to determine if the company is considered a VIE and would require consolidation. To the extent that we own interests in a VIE and we (i) are the sole entity that has the power to direct the activities of the VIE and (ii) have the obligation or rights to absorb the VIE's losses or receive its benefits, then we would be determined to be the primary beneficiary and would consolidate the VIE. To the extent we own interests in a VIE, then at each reporting period, we re-assess our conclusions as to which, if any, party within the VIE is considered the primary beneficiary. The Company's maximum exposure to losses in its investments in unconsolidated VIEs cannot be quantified and may or may not be limited to its investment in the unconsolidated VIE. The investments in unconsolidated VIEs are classified as “investments in limited liability companies” in the consolidated balance sheets.

Note 3 - Other Revenues

Note 3 - Other Revenues	6 Months Ended
	Jun. 30, 2016
Notes to Financial Statements
Other Revenues [Text Block]	N ote 3 – Other Revenues Other revenues are outlined in the table below. Revenues from management and accounting services include management and accounting fees provided to managed healthcare facilities and other health care centers. Revenues from rental income include health care real estate properties owned by us and leased to third party operators. Revenues from insurance services include premiums for workers’ compensation and professional liability insurance policies that our wholly–owned limited purpose insurance subsidiaries have written for certain health care centers to which we provide management or accounting services. "Other" revenues include miscellaneous health care related earnings. Other revenues include the following: Three Months Ended June 30 Six Months Ended June 30 (in thousands) 2016 2015 2016 2015 Management and accounting services fees $ 3,506 $ 3,532 $ 7,255 $ 7,036 Rental income 5,435 4,776 11,005 9,578 Insurance services 1,815 1,900 3,739 3,607 Other 525 261 764 594 $ 11,281 $ 10,469 $ 22,763 $ 20,815 Management Fees from National We manage five skilled nursing facilities owned by National. For the three months and six months ended June 30, 2016, we recognized management fees and interest on management fees of $926,000 and $1,895,000 from these centers, respectively. For the three months and six months ended June 30, 2015, we recognized management fees and interest on management fees of $890,000 and $1,824,000, respectively, from these centers. Because the amount collectable cannot be reasonably determined when the management services are provided, and because we cannot estimate the timing or amount of expected future collections, the unpaid fees from the five centers owned by National will be recognized as revenues only when the collectability of these fees can be reasonably assured. Under the terms of our management agreement with National, the payment of these fees to us may be subordinated to other expenditures of the five long–term care centers. We continue to manage these centers so that we may be able to collect our fees in the future and because the incremental savings from discontinuing services to a center may be small compared to the potential benefit. We may receive payment for the unrecognized management fees in whole or in part in the future only if cash flows from the operating and investing activities of the five centers or the proceeds from the sale of the centers are sufficient to pay the fees. There can be no assurance that such future improved cash flows will occur. Insurance Services For workers’ compensation insurance services, the premium revenues reflected in the interim condensed consolidated statements of income for the three and six months ended June 30, 2016 were $1,150,000 and $2,383,000, respectively. For the three months and six months ended June 30, 2015, the workers' compensation premium revenues reflected in the interim condensed consolidated statements of income were $1,203,000 and $2,213,000. Associated losses and expenses are reflected in the interim condensed consolidated statements of income as "Salaries, wages and benefits." For professional liability insurance services, the premium revenues reflected in the interim condensed consolidated statements of income for the three months and six months ended June 30, 2016 were $665,000 and $1,356,000, respectively. For the three months and six months ended June 30, 2015, the professional liability insurance premium revenues reflected in the interim condensed consolidated statements of income were $697,000 and $1,394,000. Associated losses and expenses including those for self–insurance are included in the interim condensed consolidated statements of income as "Other operating costs and expenses".

Note 4 - Non-operating Income

Note 4 - Non-operating Income	6 Months Ended
	Jun. 30, 2016
Notes to Financial Statements
Other Nonoperating Income and Expense [Text Block]	Note 4 – Non–Operating Income Non–operating income is outlined in the table below. Non–operating income includes equity in earnings of unconsolidated investments, dividends and other realized gains and losses on marketable securities, and interest income. Our most significant equity method investment is a 75.1% non–controlling ownership interest in Caris HealthCare L.P. (“Caris”), a business that specializes in hospice care services. Three Months Ended June 30 Six Months Ended June 30 (in thousands) 2016 2015 2016 2015 Equity in earnings of unconsolidated investments $ 1,615 $ 1,268 $ 3,120 $ 2,386 Dividends and other net realized gains and losses on sales of securities 1,901 1,629 3,762 3,505 Interest income 1,409 1,233 2,816 2,461 $ 4,925 $ 4,130 $ 9,698 $ 8,352

Note 5 - Long-term Leases

Note 5 - Long-term Leases	6 Months Ended
	Jun. 30, 2016
Notes to Financial Statements
Leases of Lessee Disclosure [Text Block]	Note 5 – Long-Term Leases Capital Leases Fixed assets recorded under the capital leases, which are included in property and equipment in the interim condensed consolidated balance sheets, are as follows: June 30, 2016 December 31, 2015 (in thousands) Buildings and personal property $ 39,032 $ 39,032 Accumulated amortization (9,158 ) (7,196 ) $ 29,874 $ 31,836 Operating Leases At June 30, 2016, NHC leases from National Health Investors, Inc. (“NHI”) the real property of 35 skilled nursing facilities, seven assisted living facilities and three independent living facilities under two separate lease agreements. Base rent expense under both lease agreements totals $34,200,000 annually with rent thereafter escalating by 4% of the increase in facility revenue over the base year. Total facility rent expense to NHI was $9,480,000 and $9,177,000 for the quarter ended June 30, 2016 and 2015, respectively. Total facility rent expense to NHI was $18,960,000 and $18,355,000 for the six months ended June 30, 2016 and 2015, respectively. Minimum Lease Payments The approximate future minimum lease payments required under all leases that have remaining non-cancelable lease terms at June 30, 2016 are as follows: Operating Leases Capital Leases (in thousands) 2017 $ 34,200 $ 5,200 2018 34,200 5,200 2019 34,200 5,200 2020 34,200 5,200 2021 34,200 5,200 Thereafter 193,850 13,867 Total minimum lease payments $ 364,850 $ 39,867 Less: Amounts representing interest (7,974 ) Present value of minimum lease payments 31,893 Less: Current portion (3,378 ) Long-term capital lease obligations $ 28,515

Note 6 - Earnings Per Share

Note 6 - Earnings Per Share	6 Months Ended
	Jun. 30, 2016
Notes to Financial Statements
Earnings Per Share [Text Block]	Note 6 – Earnings per Share Basic net income per share is computed based on the weighted average number of common shares outstanding for each period presented. Diluted net income per share reflects the potential dilution that would have occurred if securities to issue common stock were exercised, converted, or resulted in the issuance of common stock that would have then shared in our earnings. The following table summarizes the earnings and the weighted average number of common shares used in the calculation of basic and diluted earnings per share. Three Months Ended June 30 Six Months Ended June 30 (in thousands, except for share and per share amounts) 2016 2015 2016 2015 Basic: Weighted average common shares outstanding 15,266,559 13,772,873 15,091,732 13,767,248 Net income $ 11,866 $ 12,358 $ 25,565 $ 25,600 Dividends to preferred stockholders – (2,167 ) – (4,335 ) Net income available to common stockholders $ 11,866 $ 10,191 $ 25,565 $ 21,265 Earnings per common share, basic $ 0.78 $ 0.74 $ 1.69 $ 1.54 Diluted: Weighted average common shares outstanding 15,266,559 13,772,873 15,091,732 13,767,248 Dilutive effect of stock options 22,545 158,387 23,406 155,972 Dilutive effect of restricted stock – – – 2,366 Dilutive effect of contingent issuable stock – 450,486 97,137 410,441 Assumed average common shares outstanding 15,289,104 14,381,746 15,212,275 14,336,027 Net income available to common stockholders $ 11,866 $ 10,191 $ 25,565 $ 21,265 Earnings per common share, diluted $ 0.78 $ 0.71 $ 1.68 $ 1.48 In the above table, options to purchase 12,120 and 11,804 shares of our common stock have been excluded for the quarter ended and six months ended June 30, 2016 and 2015, respectively, due to their anti–dilutive impact.

Note 7 - Investments in Marketa

Note 7 - Investments in Marketable Securities	6 Months Ended
	Jun. 30, 2016
Notes to Financial Statements
Investments in Debt and Marketable Equity Securities (and Certain Trading Assets) Disclosure [Text Block]	Note 7 – Inve stments in Marketable Securities Our investments in marketable securities are classified as available for sale securities. Realized gains and losses from securities sales are recognized in results of operations upon disposition of the securities using the specific identification method on a trade date basis. Refer to Note 8 for a description of the Company's methodology for determining the fair value of marketable securities. Marketable securities and restricted marketable securities consist of the following: June 30, 2016 December 31, 2015 (in thousands) Amortized Cost Fair Value Amortized Cost Fair Value Investments available for sale: Marketable equity securities $ 30,176 $ 141,756 $ 30,176 $ 116,168 Restricted investments available for sale: Corporate debt securities 73,194 75,118 71,960 71,143 Commercial mortgage–backed securities 56,751 56,903 61,645 60,910 U.S. Treasury securities 24,814 25,373 21,123 21,033 State and municipal securities 15,111 15,666 16,446 16,780 $ 200,046 $ 314,816 $ 201,350 $ 286,034 Included in the available for sale marketable equity securities are the following (in thousands, except share amounts) : June 30, 2016 December 31, 2015 Shares Cost Fair Value Shares Cost Fair Value NHI Common Stock 1,630,642 $ 24,734 $ 122,445 1,630,642 $ 24,734 $ 99,257 The amortized cost and estimated fair value of debt securities classified as available for sale, by contractual maturity, are as follows: June 30, 2016 December 31, 2015 (in thousands) Cost Fair Value Cost Fair Value Maturities: Within 1 year $ 43,077 $ 43,936 $ 23,291 $ 23,273 1 to 5 years 70,519 71,159 74,747 74,671 6 to 10 years 55,279 56,977 71,442 70,223 Over 10 years 995 988 1,694 1,699 $ 169,870 $ 173,060 $ 171,174 $ 169,866 Gross unrealized gains related to available for sale securities are $115,280,000 and $86,921,000 as of June 30, 2016 and December 31, 2015, respectively. Gross unrealized losses related to available for sale securities are $510,000 and $2,237,000 as of June 30, 2016 and December 31, 2015, respectively. For the marketable securities in gross unrealized loss positions, (a) it is more likely than not that the Company will not be required to sell the investment securities before recovery of the unrealized losses, and (b) the Company expects that the contractual principal and interest will be received on the investment securities. As a result, the Company recognized no other-than-temporary impairment during the six months ended June 30, 2016 or for the year ended December 31, 2015. Proceeds from the sale of securities during the six months ended June 30, 2016 and 2015 were $25,697,000 and $28,296,000, respectively. Investment gains of $540,000 and $421,000 were realized on these sales during the six months ended June 30, 2016 and 2015, respectively.

Note 8 - Fair Value Measurement

Note 8 - Fair Value Measurements	6 Months Ended
	Jun. 30, 2016
Notes to Financial Statements
Fair Value Disclosures [Text Block]	Note 8 – Fair Value Measurements The accounting standard for fair value measurements provides a framework for measuring fair value and requires expanded disclosures regarding fair value measurements. Fair value is defined as the price that would be received for an asset or the exit price that would be paid to transfer a liability in the principal or most advantageous market in an orderly transaction between market participants on the measurement date. This accounting standard establishes a fair value hierarchy, which requires an entity to maximize the use of observable inputs, where available. The following summarizes the three levels of inputs that may be used to measure fair value: Level 1 Level 2 Level 3 A financial instrument’s level within the fair value hierarchy is based on the lowest level of input that is significant to the fair value measurement. Valuation of Marketable Securities The Company determines fair value for marketable securities with Level 1 inputs through quoted market prices. The Company determines fair value for marketable securities with Level 2 inputs through broker or dealer quotations or alternative pricing sources with reasonable levels of price transparency. Our Level 2 marketable securities have been initially valued at the transaction price and subsequently valued, at the end of each month, typically utilizing third party pricing services or other market observable data. The pricing services utilize industry standard valuation models, including both income and market based approaches and observable market inputs to determine value. These observable market inputs include reportable trades, benchmark yields, credit spreads, broker/dealer quotes, bids, offers, and other industry and economic events. We validated the prices provided by our broker by reviewing their pricing methods, obtaining market values from other pricing sources, analyzing pricing data in certain instances and confirming that the relevant markets are active. After completing our validation procedures, we did not adjust or override any fair value measurements provided by our broker as of June 30, 2016. We did not have any transfers of assets between Level 1 and Level 2 of the fair value measurement hierarchy during the six months ended June 30, 2016. Other The carrying amounts of cash and cash equivalents, restricted cash and cash equivalents, accounts receivable, and accounts payable approximate fair value due to their short–term nature. The estimated fair value of notes receivable approximates the carrying value based principally on their underlying interest rates and terms, maturities, collateral and credit status of the receivables. Our long–term debt approximates fair value due to variable interest rates, but fair value is also determined using Level 2 inputs through alternative pricing sources. At June 30, 2016, there were no material differences between the carrying amounts and fair values of NHC’s financial instruments. The following table summarizes fair value measurements by level at June 30, 2016 and December 31, 2015 for assets and liabilities measured at fair value on a recurring basis (in thousands) Fair Value Measurements Using June 30, 2016 Fair Value Quoted Prices in Active Markets For Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Cash and cash equivalents $ 37,543 $ 37,543 $ – $ – Restricted cash and cash equivalents 16,700 16,700 – – Marketable equity securities 141,756 141,756 – – Corporate debt securities 75,118 38,282 36,836 – Commercial mortgage–backed securities 56,903 – 56,903 – U.S. Treasury securities 25,373 25,373 – – State and municipal securities 15,666 – 15,666 – Total financial assets $ 369,059 $ 259,654 $ 109,405 $ – Fair Value Measurements Using December 31, 2015 Fair Value Quoted Prices in Active Markets For Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Cash and cash equivalents $ 38,208 $ 38,208 $ – $ – Restricted cash and cash equivalents 11,106 11,106 – – Marketable equity securities 116,168 116,168 – – Corporate debt securities 71,143 32,683 38,460 – Mortgage-backed securities 60,910 – 60,910 – U.S. Treasury securities 21,033 21,033 – – State and municipal securities 16,780 – 16,780 – Total financial assets $ 335,348 $ 219,198 $ 116,150 $ –

Note 9 - Long-term Debt

Note 9 - Long-term Debt	6 Months Ended
	Jun. 30, 2016
Notes to Financial Statements
Debt Disclosure [Text Block]	Note 9 – Long – Term Debt Long–term debt consists of the following: Weighted Average Interest Rate Maturities June 30, 2016 December 31, 2015 Variable (dollars in thousands) Revolving Credit Facility, interest payable monthly 1.9% 2020 $ 110,000 $ 110,000 Unsecured term note payable to National, interest payable quarterly, principal payable at maturity 3.0% 2018 10,000 10,000 120,000 120,000 Less current portion – – $ 120,000 $ 120,000 $175,000,000 Credit Facility The Credit Agreement contains customary representations and financial covenants, including covenants that restrict, among other things, asset dispositions, mergers and acquisitions, dividends, restricted payments, debt, liens, investments and affiliate transactions. The Credit Agreement contains customary events of default. The aggregate maturities of long-term debt for the five years subsequent to June 30, 2016 are as follows: Long-Term Debt (in thousands) 2017 $ − 2018 10,000 2019 − 2020 − 2021 110,000 Total $ 120,000

Note 10 - Stock Repurchase Prog

Note 10 - Stock Repurchase Program	6 Months Ended
	Jun. 30, 2016
Notes to Financial Statements
Treasury Stock [Text Block]	Note 1 0 - Stock Repurchase Program On May 7, 2015, the Board of Directors authorized two new stock repurchase programs, one that allowed for the repurchase of up to $25 million of its common stock and one that allowed for the repurchase of up to $25 million of its preferred stock. As of November 3, 2015, all of the Company’s preferred stock was redeemed. Therefore, no future repurchases of the preferred stock will be performed. The common stock repurchase plan expires on August 31, 2016. No repurchases of common stock have been executed under the current program.

Note 11 - Stock-based Compensat

Note 11 - Stock-based Compensation	6 Months Ended
	Jun. 30, 2016
Notes to Financial Statements
Disclosure of Compensation Related Costs, Share-based Payments [Text Block]	Note 11 – Stock–Based Compensation NHC recognizes stock–based compensation expense for all stock options and restricted stock granted over the requisite service period using the fair value for these grants as estimated at the date of grant either using the Black–Scholes pricing model for stock options or the quoted market price for restricted stock. The 2005 and 2010 Stock–Based Compensation Plans The Compensation Committee of the Board of Directors (“the Committee”) has the authority to select the participants to be granted options; to designate whether the option granted is an incentive stock option (“ISO”), a non–qualified option, or a stock appreciation right; to establish the number of shares of common stock that may be issued upon exercise of the option; to establish the vesting provision for any award; and to establish the term any award may be outstanding. The exercise price of any ISO’s granted will not be less than the fair market value of the shares of common stock on the date granted and the term of an ISO may not be any more than ten years. The exercise price of any non–qualified options granted will not be less than the fair market value of the shares of common stock on the date granted unless so determined by the Committee. In May 2005, our stockholders approved the 2005 Stock Option, Employee Stock Purchase, Physician Stock Purchase and Stock Appreciation Rights Plan (“the 2005 Plan”) pursuant to which 1,200,000 shares of our common stock were available to grant as stock–based payments to key employees, directors, and non–employee consultants. The shares granted during the six months ended June 30, 2016 consisted of 45,000 shares to the Directors of the Company. At June 30, 2016, 131,276 shares were available for future grants under the 2005 Plan. In May 2010, our stockholders approved the 2010 Omnibus Equity Incentive Plan (“the 2010 Plan”) pursuant to which 1,200,000 shares of our common stock were available to grant as stock–based payments to key employees, directors, and non–employee consultants. In May 2015, our stockholders voted to amend the 2010 Plan to increase the number of shares of our common stock authorized under the Plan from the original 1,200,000 shares to 2,575,000 shares. The shares granted during the six months ended June 30, 2016 consisted of 12,120 shares through the Employee Stock Purchase Plan. At June 30, 2016, 1,750,494 shares were available for future grants under the amended 2010 Plan. Compensation expense is recognized only for the awards that ultimately vest. Stock–based compensation totaled $208,000 and $654,000 for the three months ended June 30, 2016 and 2015, respectively. Stock–based compensation totaled $494,000 and $1,132,000 for the six months ended June 30, 2016 and 2015, respectively. Stock–based compensation is included in “Salaries, wages and benefits” in the interim condensed consolidated statements of income. Stock Options The following table summarizes the significant assumptions used to value the options granted for the six months ended June 30, 2016 and for the year ended December 31, 2015. 2016 2015 Risk–free interest rate 0.88 % 0.71 % Expected volatility 15.8 % 16.5 % Expected life, in years 2.2 2.2 Expected dividend yield 3.08 % 2.73 % The following table summarizes our outstanding stock options for the six months ended June 30, 2016 and for the year ended December 31, 2015. Number of Shares Weighted Average Exercise Price Aggregate Intrinsic Value Options outstanding at January 1, 2015 954,678 $ 46.92 $ – Options granted 56,210 61.47 – Options exercised (389,498 ) 47.06 – Options outstanding at December 31, 2015 621,390 48.15 – Options granted 57,120 62.53 – Options exercised (480,275 ) 46.81 – Options forfeited (656 ) 46.69 – Options outstanding at June 30, 2016 197,579 $ 55.55 $ 1,816,000 Options exercisable at June 30, 2016 185,459 $ 55.15 $ 1,778,000 Options Outstanding June 30, 2016 Exercise Prices Weighted Average Exercise Price Weighted Average Remaining Contractual Life in Years 97,500 $4.80 - $52.93 $ 48.95 2.0 100,079 $1.59 - $62.78 61.98 3.9 197,579 $ 55.55 3.0

Note 12 - Income Taxes

Note 12 - Income Taxes	6 Months Ended
	Jun. 30, 2016
Notes to Financial Statements
Income Tax Disclosure [Text Block]	Note 12 – Income Taxes The income tax provision for the three months ended June 30, 2016 is $7,700,000 (an effective income tax rate of 39.4%). The income tax provision and effective tax rate for the three months ended June 30, 2016 were unfavorably impacted by adjustments to unrecognized tax benefits of $190,000 and permanent differences including nondeductible expenses of $143,000 resulting in an increase in the provision. The income tax provision for the three months ended June 30, 2015 was $7,478,000 (an effective income tax rate of 37.7%). The income tax provision and effective tax rate for the three months ended June 30, 2015 were unfavorably impacted by adjustments to unrecognized tax benefits of $121,000 and permanent differences including nondeductible expenses of $15,000 resulting in an increase in the provision. The income tax provision for the six months ended June 30, 2016 is $16,398,000 (an effective income tax rate of 39.1%). The income tax provision and effective tax rate for the six months ended June 30, 2016 were unfavorably impacted by adjustments to unrecognized tax benefits of $365,000 and permanent differences including nondeductible expenses of $229,000 resulting in an increase in the provision. The income tax provision for the six months ended June 30, 2015 was $15,894,000 (an effective income tax rate of 38.3%). The income tax provision and effective tax rate for the six months ended June 30, 2015 were unfavorably impacted by adjustments to unrecognized tax benefits of $330,000 and permanent differences including nondeductible expenses of $38,000 resulting in an increase in the provision. Our deferred tax assets have been evaluated for realization based on historical taxable income, tax planning strategies, the expected timing of reversals of existing temporary differences and future taxable income anticipated. Our deferred tax assets are more likely than not to be realized in full due to the existence of sufficient taxable income of the appropriate character under the tax law. As such, there is no need for a valuation allowance. Uncertain tax positions may arise where tax laws may allow for alternative interpretations or where the timing of recognition of income is subject to judgment. We believe we have made adequate provision for unrecognized tax benefits related to uncertain tax positions. However, because of uncertainty of interpretation by various tax authorities and the possibility that there are issues that have not been recognized by management, we cannot guarantee we have accurately estimated our tax liabilities. We believe that our liabilities reflect the anticipated outcome of known uncertain tax positions in conformity with ASC Topic 740, Income Taxes . At June 30, 2016, we had $13,768,000 of unrecognized tax benefits, composed of $7,936,000 of deferred tax assets and $5,832,000 of permanent differences. Accrued interest and penalties of $3,599,000 relate to unrecognized tax benefits at June 30, 2016. Unrecognized tax benefits of $5,831,000 net of federal benefit, at June 30, 2016, attributable to permanent differences, would favorably impact our effective tax rate if recognized. Accrued interest and penalties of $3,372,000 relate to these permanent differences at June 30, 2016. We do not expect to recognize significant increases or decreases in unrecognized tax benefits within the twelve months beginning July 1, 2016, except for the effect of decreases related to the lapse of statute of limitations estimated at $2,046,000, composed of temporary differences of $842,000, and permanent tax differences of $1,204,000. Interest and penalties of $727,000 relate to these temporary and permanent difference changes within 12 months beginning June 30, 2016. Interest and penalties expense related to U.S. federal and state income tax returns are included within income tax expense. The Company is no longer subject to U.S. federal and state examinations by tax authorities for years before 2012 (with certain state exceptions). Currently, the 2012 U.S. federal return is under examination.

Note 13 - Contingencies and Com

Note 13 - Contingencies and Commitments	6 Months Ended
	Jun. 30, 2016
Notes to Financial Statements
Commitments and Contingencies Disclosure [Text Block]	Note 13 – Contingencies and Commitments Accrued Risk Reserves We are self– insured for risks related to health insurance and have wholly–owned limited purpose insurance companies that insure risks related to workers’ compensation and general and professional liability insurance claims both for our owned or leased entities and certain of the entities to which we provide management or accounting services. The liability we have recognized for reported claims and estimates for incurred but unreported claims totals $98,514,000 and $98,508,000 at June 30, 2016 and December 31, 2015, respectively. The liability is included in accrued risk reserves in the interim condensed consolidated balance sheets and is subject to adjustment for actual claims incurred. It is possible that these claims plus unasserted claims could exceed our insurance coverages and our reserves, which could have a material adverse effect on our consolidated financial position, results of operations and cash flows. As a result of the terms of our insurance policies and our use of wholly–owned limited purpose insurance companies, we have retained significant insurance risk with respect to workers’ compensation and general and professional liability. We consider the professional services of independent actuaries to assist us in estimating our exposures for claims obligations (for both asserted and unasserted claims) related to deductibles and exposures in excess of coverage limits, and we maintain reserves for these obligations. Such estimates are based on many variables including historical and statistical information and other factors. Workers ’ Compensation For workers’ compensation, we utilize a wholly–owned Tennessee domiciled property/casualty insurance company to write coverage for NHC affiliates and for third–party customers. Policies are written for a duration of twelve months and cover only risks related to workers’ compensation losses. All customers are companies which operate in the senior care industry. Business is written on a direct basis. Direct business coverage is written for statutory limits and the insurance company’s losses in excess of $1,000,000 per claim are covered by reinsurance. General and Professional Liability Lawsuits and Insurance The senior care industry has experienced increases in both the number of personal injury/wrongful death claims and in the severity of awards based upon alleged negligence by nursing facilities and their employees in providing care to residents. As of June 30, 2016, we and/or our managed centers are currently defendants in 36 such claims. In 2002, due to the unavailability and/or prohibitive cost of third–party professional liability insurance coverage, we established and capitalized a wholly–owned licensed liability insurance company incorporated in the Cayman Islands, for the purpose of managing our losses related to these risks. Thus, since 2002, insurance coverage for incidents occurring at all NHC owned providers, and most providers managed by us, is provided through this wholly–owned insurance company. Insurance coverage for all years includes both primary policies and excess policies. Beginning in 2003, both primary and excess coverage is provided through our wholly–owned insurance company. The primary coverage is in the amount of $1.0 million per incident, $3.0 million per location with an annual primary policy aggregate limit that is adjusted on an annual basis. The excess coverage is $7.5 million annual excess in the aggregate applicable to years 2005–2007, $9.0 million annual excess in the aggregate for years 2008–2010, $4.0 million excess per occurrence for 2011–2013 and $9.0 million excess per occurrence for 2014-2016. Beginning in 2008 and continuing through June 30, 2016, additional insurance is purchased through third party providers that serve to supplement the coverage provided through our wholly–owned captive insurance company. Civil Investigative Demand On December 19, 2013, the Company was served with a civil investigative demand (“CID”) from the U.S. Department of Justice and the Office of the U.S. Attorney for the Eastern District of Tennessee (“DOJ Investigation”) requesting the production of documents and interrogatory responses regarding the billing for and medical necessity of certain rehabilitative therapy services. Based upon our review, the CID appears to relate to services provided at our facilities based in Knoxville, Tennessee. On October 7, 2014, the Company received a subpoena from the Office of Inspector General of the United Department of Health and Human Services (“OIG Subpoena”) related to the current DOJ Investigation. The OIG Subpoena requests certain financial and organizational documents from the Company and certain of its subsidiaries and SNFs and medical records from certain of the Company’s Tennessee-based SNFs. The Company is cooperating fully with these requests. We are unable to evaluate the outcome of this investigation at this time. It is possible that this investigation could lead to a claim that could have a material adverse effect on our consolidated financial position, results of operations and cash flows. Caris HealthCare, L.P. Investigation On December 9, 2014, Caris Healthcare, L.P., a business that specializes in hospice care services in Company-owned health care centers and in other settings, received notice from the U.S. Attorney’s Office for the Eastern District of Tennessee and the Attorney Generals’ Offices for the State of Tennessee and State of Virginia that those government entities were conducting an investigation regarding patient eligibility for hospice services provided by Caris precipitated by a qui tam The qui tam United States of America, State of Tennessee, and State of Virginia ex rel. Barbara Hinkle v. Caris Healthcare, L.P. On June 16, 2016, the State of Tennessee and the State of Virginia declined to intervene in the qui tam Caris denies the allegations in the qui tam South Carolina Medicaid Audits The South Carolina Office of State Auditor (“State Auditor”) conducted Medicaid cost report audits for eleven of the Company’s South Carolina skilled nursing facilities. The State Auditor has issued audit findings for the fiscal years ending September 30, 2013 and September 30, 2014. During 2015, the Company paid the South Carolina Department of Health and Human Services $6.8 million due to the State Auditor findings. The Company has filed administrative appeals with the South Carolina Department of Health and Human Services to recoup these funds and this process is continuing within the legal system. At June 30, 2016, there are no amounts recorded in our interim condensed consolidated balance sheets pertaining to the potential recoupment of these funds. Financing Commitments Effective January 1, 2016 and in conjunction with the signed rental agreement for eleven of our healthcare properties, we entered into a short-term line of credit arrangement with a third party operator. The maximum commitment under the line of credit is $10,000,000 and the maturity date is December 30, 2016, or earlier with 30 days written notice. At June 30, 2016, the third party operator had an outstanding balance on the line of credit of $1,892,000. This amount is classified in the current portion of notes receivable in the interim condensed consolidated balance sheets. In conjunction with our management contract with National, we have entered into a line of credit arrangement whereby we may have amounts due from National from time to time. The maximum loan commitment under the line of credit is $2,000,000. At June 30, 2016, National did not have an outstanding balance on the line of credit. Governmental Regulations Laws and regulations governing the Medicare, Medicaid and other federal healthcare programs are complex and subject to interpretation. Management believes that it is in compliance with all applicable laws and regulations in all material respects. However, compliance with such laws and regulations can be subject to future government review and interpretation as well as significant regulatory action including fines, penalties, and exclusions from the Medicare, Medicaid and other federal healthcare programs.

Significant Accounting Policies

Significant Accounting Policies (Policies)	6 Months Ended
	Jun. 30, 2016
Accounting Policies [Abstract]
Basis of Accounting, Policy [Policy Text Block]	Basis of Presentation The unaudited interim condensed consolidated financial statements to which these notes are attached include all normal, recurring adjustments which are necessary to fairly present the financial position, results of operations and cash flows of NHC. All significant intercompany transactions and balances have been eliminated in consolidation. We assume that users of these interim financial statements have read or have access to the audited December 31, 2015 consolidated financial statements and Management’s Discussion and Analysis of Financial Condition and Results of Operations and that the adequacy of additional disclosure needed for a fair presentation, except in regard to material contingencies, may be determined in that context. Accordingly, footnotes and other disclosures which would substantially duplicate the disclosure contained in our most recent annual report to stockholders have been omitted. This interim financial information is not necessarily indicative of the results that may be expected for a full year for a variety of reasons.
Use of Estimates, Policy [Policy Text Block]	Estimates and Assumptions The preparation of financial statements in conformity with accounting principles generally accepted in the United States requires us 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 financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates and could cause our reported net income to vary significantly from period to period.
New Accounting Pronouncements, Policy [Policy Text Block]	Recently Adopted Accounting Guidance In November 2015, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") No. 2015-17, “Income Taxes” which requires that deferred tax liabilities and assets be classified as noncurrent in a classified balance sheet. Prior to the issuance of the standard, deferred tax liabilities and assets were required to be separately classified into a current amount and a noncurrent amount in the balance sheet. The new accounting guidance represents a change in accounting principle and the standard is required to be adopted in annual periods beginning after December 15, 2016. Early adoption is permitted and the Company elected to early adopt this guidance as of December 31, 2015. In April 2015, the FASB issued ASU 2015-03, "Imputation of Interest (Sub-Topic 835.30): Simplifying the Presentation of Debt Issuance Costs". ASU 2015-03 requires debt issuance costs related to a recognized debt liability be presented in the balance sheet as a direct deduction from the carrying amount of that debt liability, consistent with debt discounts. In August 2015, the FASB issued ASU 2015-15 clarifying the application of this guidance to line of credit arrangements. The amendments in the ASUs are effective retrospectively for fiscal years, and for interim periods within those fiscal years, beginning after December 15, 2015. This guidance did not have a material impact on our consolidated financial statements. In February 2015, the FASB issued ASU No. 2015-02 “Amendments to the Consolidation Analysis”. This update is in response to stakeholders that have expressed concerns that current generally accepted accounting principles (“GAAP”) might require a reporting entity to consolidate another legal entity in situations in which the reporting entity’s contractual rights do not give it the ability to act primarily on its own behalf, the reporting entity does not hold a majority of the legal entity’s voting rights, or the reporting entity is not exposed to a majority of the legal entity’s economic benefits or obligations. Thus, the update modifies the evaluation of whether limited partnerships and similar legal entities are variable interest entities (“VIEs”) or voting interest entities. It eliminates the presumption that a general partner should consolidate a limited partnership, for limited partnerships and similar legal entities that qualify as voting interest entities; a limited partner with a controlling financial interest should consolidate a limited partnership. A controlling financial interest may be achieved through holding a limited partner interest that provides substantive kick-out rights. Finally, it requires consideration of the effects of fee arrangements and related parties on the primary beneficiary determination. The amendments in this update are effective for annual reporting periods beginning after December 15, 2015, including interim periods within that reporting period. This guidance did not have a material impact on our consolidated financial statements. Recent Accounting Guidance Not Yet Adopted In March 2016, the FASB issued ASU 2016-09, “Compensation – Stock Compensation (Topic 718): Improvements to Employee Share-Based Payment Accounting.” ASU 2016-09 simplifies the accounting for share-based payment award transactions including: income tax consequences, classification of awards as either equity or liabilities and classification on the statement of cash flows. ASU 2016-09 is effective for fiscal years beginning after December 15, 2016, including interim periods within those fiscal years. Early adoption is permitted. We are currently evaluating the requirements of ASU 2016-09 and have not yet determined its impact on our consolidated financial statements. In February 2016, the FASB issued ASU 2016-02, "Leases (Topic 842)." The objective of this update is to increase transparency and comparability among organizations by recognizing lease assets and lease liabilities on the balance sheet and disclosing key information about leasing arrangements. This ASU is effective for fiscal years beginning after December 15, 2018, including interim periods within those annual periods and is to be applied utilizing a modified retrospective approach. We anticipate this standard will have a material impact on our consolidated financial statements. Additionally, we are currently evaluating the impact this standard will have on our policies and procedures and internal control framework. In January 2016, the FASB issued ASU No. 2016-01, “Financial Instruments - Recognition and Measurement of Financial Assets and Financial Liabilities (Topic 825)”. ASU No. 2016-01 revises the classification and measurement of investments in certain equity investments and the presentation of certain fair value changes for certain financial liabilities measured at fair value. ASU No. 2016-01 requires the change in fair value of many equity investments to be recognized in net income. ASU No. 2016-01 is effective for interim and annual periods beginning after December 15, 2017, with early adoption permitted. Adopting ASU No. 2016-01 may result in a cumulative effect adjustment to the Company’s retained earnings as of the beginning of the year of adoption. We are currently evaluating the potential effects of adopting the provisions of ASU No. 2016-01. In May 2014, the FASB issued ASU No. 2014-09 “Revenue from Contracts with Customers”. This update is the result of a collaborative effort by the FASB and the International Accounting Standards Board to simplify revenue recognition guidance, remove inconsistencies in the application of revenue recognition, and to improve comparability of revenue recognition practices across entities, industries, jurisdictions, and capital markets. The FASB is amending the Accounting Standards Codification and creating a new Topic 606, “Revenue from Contracts with Customers”. The core principle of the guidance is that an entity should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. For a public entity, the amendments in this update are effective for annual reporting periods beginning after December 15, 2017, including interim periods within that reporting period. The Company is currently evaluating the impact of this guidance on our consolidated financial statements and control framework.
Contractual Adjustments and Third Party Settlements, Policy [Policy Text Block]	Revenue Recognition – Third Party Payors Approximately 65% of our net patient revenues are derived from Medicare, Medicaid, and other government programs. Amounts earned under these programs are subject to review by the Medicare and Medicaid intermediaries or their agents. In our opinion, adequate provision has been made for any adjustments that may result from these reviews. Any differences between our original estimates of reimbursements and subsequent revisions are reflected in operations in the period in which the revisions are made often due to final determination or the period of payment no longer being subject to audit or review. We have recorded liabilities of approximately $18,410,000 and $16,654,000 as of June 30, 2016 and December 31, 2015, respectively, for various Medicare and Medicaid current and prior year cost reports and claims reviews.
Revenue Recognition for Alternative Revenue Programs, Policy [Policy Text Block]	Revenue Recognition – Private P ay For private pay patients in skilled nursing or assisted living facilities, we bill room and board in advance with payment being due in the month the services are performed. Charges for ancillary, pharmacy, therapy and other services to private patients are billed in the month following the performance of services; however, all billings are recognized as revenue when the services are performed.
Premiums Receivable, Allowance for Doubtful Accounts, Estimation Methodology, Policy [Policy Text Block]	Revenue Recognition – Subordination of Fees and Uncert ain Collections We provide management services to certain senior care facilities and to others we provide accounting and financial services. We generally charge 6% to 7% of net operating revenues for our management services and a predetermined fixed rate per bed for the accounting and financial services. Our policy is to recognize revenues associated with both management services and accounting and financial services on an accrual basis as the services are provided. However, under the terms of our management contracts, payments for our management services are subject to subordination to other expenditures of the long–term care center being managed. Furthermore, for certain of the third parties with whom we have contracted to provide services and which we have determined that collection is not reasonably assured, our policy is to recognize income only in the period in which the amounts are realized. We may receive payment for the unpaid and unrecognized management fees in whole or in part in the future only if cash flows from the operating and investing activities of the centers or proceeds from the sale of the centers are sufficient to pay the fees. There can be no assurance that such future cash flows will occur. The realization of such previously unrecognized revenue could cause our reported net income to vary significantly from period to period. We agree to subordinate our fees to the other expenses of a managed center because we believe we know how to improve the quality of patient services and finances of a senior healthcare center. We believe subordinating our fees demonstrates to the owner and employees of the managed center how confident we are of the impact we can have in making the center operations successful. We may continue to provide services to certain managed centers despite not being fully paid currently so that we may be able to collect unpaid fees in the future from improved operating results and because the incremental savings from discontinuing services to a center may be small compared to the potential benefit. Also, we may benefit from providing other ancillary services to the managed center.
Other Operating Expenses Policy [Policy Text Block]	Other Operating Expenses Other operating expenses include the costs of care and services that we provide to the residents of our facilities and the costs of maintaining our facilities. Our primary patient care costs include drugs, medical supplies, purchased professional services, food, and professional liability insurance and licensing fees. The primary facility costs include utilities and property insurance.
Selling, General and Administrative Expenses, Policy [Policy Text Block]	General and Administrative Costs With the Company being a healthcare provider, the majority of our expenses are "cost of revenue" items. Costs that could be classified as "general and administrative" by the Company would include its corporate office costs, which were $15,457,000 and $15,044,000 for the six months ended June 30, 2016 and 2015, respectively.
Property, Plant and Equipment, Policy [Policy Text Block]	Property and Equipment Property and equipment are recorded at cost. Depreciation is provided by the straight-line method over the expected useful lives of the assets estimated as follows: buildings and improvements, 20-40 years and equipment and furniture, 3-15 years. Leasehold improvements are amortized over periods that do not exceed the non-cancelable respective lease terms using the straight-line method. Capital leases are recorded at the lower of fair market value or the present value of future minimum lease payments. Capital leases are amortized in accordance with the provision codified within Accounting Standards Codification (“ASC”) Subtopic 840-30, Leases – Capital Leases
Liability Reserve Estimate, Policy [Policy Text Block]	Accrued Risk Reserves We are self– insured for risks related to health insurance and have wholly–owned limited purpose insurance companies that insure risks related to workers’ compensation and general and professional liability insurance claims. The accrued risk reserves include a liability for reported claims and estimates for incurred but unreported claims. Our policy is to engage an external, independent actuary to assist in estimating our exposure for claims obligations (for both asserted and unasserted claims). We reassess our accrued risk reserves on a quarterly basis. Professional liability remains an area of particular concern to us. The long term care industry has seen an increase in personal injury/wrongful death claims based on alleged negligence by skilled nursing facilities and their employees in providing care to residents. As of June 30 2016, we and/or our managed centers are defendants in 36 such claims inclusive of years 2005 through June 30, 2016. It remains possible that those pending matters plus potential unasserted claims could exceed our reserves, which could have a material adverse effect on our consolidated financial position, results of operations and cash flows. It is also possible that future events could cause us to make significant adjustments or revisions to these reserve estimates and cause our reported net income to vary significantly from period to period. We are principally self-insured for incidents occurring in all centers owned or leased by us. The coverages include both primary policies and excess policies. In all years, settlements, if any, in excess of available insurance policy limits and our own reserves would be expensed by us.
Continuing Care Retirement Communities, Advance Fees, Policy [Policy Text Block]	Continuing Care Contracts and Refundable Entrance Fee We have one continuing care retirement center (“CCRC”) within our operations. Residents at this retirement center may enter into continuing care contracts with us. The contracts provide that 10% of the resident entry fee becomes non-refundable upon occupancy, and the remaining refundable portion of the entry fee is calculated using the lessor of the price at which the apartment is re-assigned or 90% of the original entry fee, plus 40% of any appreciation if the apartment exceeds the original resident’s entry fee. In each case, we amortize the non-refundable part of these fees into revenue over the actuarially determined remaining life of the resident, which is the expected period of occupancy by the resident. We pay the refundable portion of our entry fees to residents when they relocate from our community and the apartment is re-occupied. Refundable entrance fees are classified as non-current liabilities and non-refundable entrance fees are classified as deferred revenue in the Company's consolidated balance sheets. The balances of refundable entrance fees as of June 30, 2016 and December 31, 2015 were $9,831,000 and $9,865,000, respectively. Obligation to Provide Future Services W e annually estimate the present value of the cost of future services and the use of facilities to be provided to the current CCRC residents and compare that amount with the balance of non-refundable deferred revenue from entrance fees received. If the present value of the cost of future services exceeds the related anticipated revenues, a liability is recorded (obligation to provide future services) with a corresponding charge to income. As of June 30, 2016 and December 31, 2015, we have recorded a future service obligation in the amount of $3,440,000.
Other Noncurrent Liabilities [Policy Text Block]	Other Noncurrent Liabilities Other noncurrent liabilities include reserves primarily related to various uncertain income tax positions (See Note 12).
Revenue Recognition, Deferred Revenue [Policy Text Block]	D eferred Revenue Deferred revenue includes the deferred gain on the sale of assets to National Health Corporation (“National”), the non-refundable portion (10%) of CCRC entrance fees being amortized over the remaining life expectancies of the residents, and premiums received within our workers’ compensation and professional liability companies that are not yet earned.
Consolidation, Variable Interest Entity, Policy [Policy Text Block]	Variable Interest Entities We have equity interests in unconsolidated limited liability companies that operate various post-acute and senior healthcare businesses. We analyze our investments in these limited liability companies to determine if the company is considered a VIE and would require consolidation. To the extent that we own interests in a VIE and we (i) are the sole entity that has the power to direct the activities of the VIE and (ii) have the obligation or rights to absorb the VIE's losses or receive its benefits, then we would be determined to be the primary beneficiary and would consolidate the VIE. To the extent we own interests in a VIE, then at each reporting period, we re-assess our conclusions as to which, if any, party within the VIE is considered the primary beneficiary. The Company's maximum exposure to losses in its investments in unconsolidated VIEs cannot be quantified and may or may not be limited to its investment in the unconsolidated VIE. The investments in unconsolidated VIEs are classified as “investments in limited liability companies” in the consolidated balance sheets.

Note 3 - Other Revenues (Tables

Note 3 - Other Revenues (Tables)	6 Months Ended
	Jun. 30, 2016
Notes Tables
Schedule of Other Revenues [Table Text Block]	Three Months Ended June 30 Six Months Ended June 30 (in thousands) 2016 2015 2016 2015 Management and accounting services fees $ 3,506 $ 3,532 $ 7,255 $ 7,036 Rental income 5,435 4,776 11,005 9,578 Insurance services 1,815 1,900 3,739 3,607 Other 525 261 764 594 $ 11,281 $ 10,469 $ 22,763 $ 20,815

Note 4 - Non-operating Income (

Note 4 - Non-operating Income (Tables)	6 Months Ended
	Jun. 30, 2016
Notes Tables
Schedule of Other Nonoperating Income, by Component [Table Text Block]	Three Months Ended June 30 Six Months Ended June 30 (in thousands) 2016 2015 2016 2015 Equity in earnings of unconsolidated investments $ 1,615 $ 1,268 $ 3,120 $ 2,386 Dividends and other net realized gains and losses on sales of securities 1,901 1,629 3,762 3,505 Interest income 1,409 1,233 2,816 2,461 $ 4,925 $ 4,130 $ 9,698 $ 8,352

Note 5 - Long-term Leases (Tabl

Note 5 - Long-term Leases (Tables)	6 Months Ended
	Jun. 30, 2016
Notes Tables
Schedule of Capital Leased Assets [Table Text Block]	June 30, 2016 December 31, 2015 (in thousands) Buildings and personal property $ 39,032 $ 39,032 Accumulated amortization (9,158 ) (7,196 ) $ 29,874 $ 31,836
Schedule of Future Minimum Lease Payments for Capital Leases [Table Text Block]	Operating Leases Capital Leases (in thousands) 2017 $ 34,200 $ 5,200 2018 34,200 5,200 2019 34,200 5,200 2020 34,200 5,200 2021 34,200 5,200 Thereafter 193,850 13,867 Total minimum lease payments $ 364,850 $ 39,867 Less: Amounts representing interest (7,974 ) Present value of minimum lease payments 31,893 Less: Current portion (3,378 ) Long-term capital lease obligations $ 28,515

Note 6 - Earnings Per Share (Ta

Note 6 - Earnings Per Share (Tables)	6 Months Ended
	Jun. 30, 2016
Notes Tables
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	Three Months Ended June 30 Six Months Ended June 30 (in thousands, except for share and per share amounts) 2016 2015 2016 2015 Basic: Weighted average common shares outstanding 15,266,559 13,772,873 15,091,732 13,767,248 Net income $ 11,866 $ 12,358 $ 25,565 $ 25,600 Dividends to preferred stockholders – (2,167 ) – (4,335 ) Net income available to common stockholders $ 11,866 $ 10,191 $ 25,565 $ 21,265 Earnings per common share, basic $ 0.78 $ 0.74 $ 1.69 $ 1.54 Diluted: Weighted average common shares outstanding 15,266,559 13,772,873 15,091,732 13,767,248 Dilutive effect of stock options 22,545 158,387 23,406 155,972 Dilutive effect of restricted stock – – – 2,366 Dilutive effect of contingent issuable stock – 450,486 97,137 410,441 Assumed average common shares outstanding 15,289,104 14,381,746 15,212,275 14,336,027 Net income available to common stockholders $ 11,866 $ 10,191 $ 25,565 $ 21,265 Earnings per common share, diluted $ 0.78 $ 0.71 $ 1.68 $ 1.48

Note 7 - Investments in Marke27

Note 7 - Investments in Marketable Securities (Tables)	6 Months Ended
	Jun. 30, 2016
Notes Tables
Available-for-sale Securities [Table Text Block]	June 30, 2016 December 31, 2015 (in thousands) Amortized Cost Fair Value Amortized Cost Fair Value Investments available for sale: Marketable equity securities $ 30,176 $ 141,756 $ 30,176 $ 116,168 Restricted investments available for sale: Corporate debt securities 73,194 75,118 71,960 71,143 Commercial mortgage–backed securities 56,751 56,903 61,645 60,910 U.S. Treasury securities 24,814 25,373 21,123 21,033 State and municipal securities 15,111 15,666 16,446 16,780 $ 200,046 $ 314,816 $ 201,350 $ 286,034
Schedule of Available-for-sale Securities Reconciliation [Table Text Block]	June 30, 2016 December 31, 2015 Shares Cost Fair Value Shares Cost Fair Value NHI Common Stock 1,630,642 $ 24,734 $ 122,445 1,630,642 $ 24,734 $ 99,257
Investments Classified by Contractual Maturity Date [Table Text Block]	June 30, 2016 December 31, 2015 (in thousands) Cost Fair Value Cost Fair Value Maturities: Within 1 year $ 43,077 $ 43,936 $ 23,291 $ 23,273 1 to 5 years 70,519 71,159 74,747 74,671 6 to 10 years 55,279 56,977 71,442 70,223 Over 10 years 995 988 1,694 1,699 $ 169,870 $ 173,060 $ 171,174 $ 169,866

Note 8 - Fair Value Measureme28

Note 8 - Fair Value Measurements (Tables)	6 Months Ended
	Jun. 30, 2016
Notes Tables
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis [Table Text Block]	Fair Value Measurements Using June 30, 2016 Fair Value Quoted Prices in Active Markets For Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Cash and cash equivalents $ 37,543 $ 37,543 $ – $ – Restricted cash and cash equivalents 16,700 16,700 – – Marketable equity securities 141,756 141,756 – – Corporate debt securities 75,118 38,282 36,836 – Commercial mortgage–backed securities 56,903 – 56,903 – U.S. Treasury securities 25,373 25,373 – – State and municipal securities 15,666 – 15,666 – Total financial assets $ 369,059 $ 259,654 $ 109,405 $ – Fair Value Measurements Using December 31, 2015 Fair Value Quoted Prices in Active Markets For Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Cash and cash equivalents $ 38,208 $ 38,208 $ – $ – Restricted cash and cash equivalents 11,106 11,106 – – Marketable equity securities 116,168 116,168 – – Corporate debt securities 71,143 32,683 38,460 – Mortgage-backed securities 60,910 – 60,910 – U.S. Treasury securities 21,033 21,033 – – State and municipal securities 16,780 – 16,780 – Total financial assets $ 335,348 $ 219,198 $ 116,150 $ –

Note 9 - Long-term Debt (Tables

Note 9 - Long-term Debt (Tables)	6 Months Ended
	Jun. 30, 2016
Notes Tables
Schedule of Debt [Table Text Block]	Weighted Average Interest Rate Maturities June 30, 2016 December 31, 2015 Variable (dollars in thousands) Revolving Credit Facility, interest payable monthly 1.9% 2020 $ 110,000 $ 110,000 Unsecured term note payable to National, interest payable quarterly, principal payable at maturity 3.0% 2018 10,000 10,000 120,000 120,000 Less current portion – – $ 120,000 $ 120,000
Schedule of Maturities of Long-term Debt [Table Text Block]	Long-Term Debt (in thousands) 2017 $ − 2018 10,000 2019 − 2020 − 2021 110,000 Total $ 120,000

Note 11 - Stock-based Compens30

Note 11 - Stock-based Compensation (Tables)	6 Months Ended
	Jun. 30, 2016
Notes Tables
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions [Table Text Block]	2016 2015 Risk–free interest rate 0.88 % 0.71 % Expected volatility 15.8 % 16.5 % Expected life, in years 2.2 2.2 Expected dividend yield 3.08 % 2.73 %
Schedule of Share-based Compensation, Stock Options, Activity [Table Text Block]	Number of Shares Weighted Average Exercise Price Aggregate Intrinsic Value Options outstanding at January 1, 2015 954,678 $ 46.92 $ – Options granted 56,210 61.47 – Options exercised (389,498 ) 47.06 – Options outstanding at December 31, 2015 621,390 48.15 – Options granted 57,120 62.53 – Options exercised (480,275 ) 46.81 – Options forfeited (656 ) 46.69 – Options outstanding at June 30, 2016 197,579 $ 55.55 $ 1,816,000 Options exercisable at June 30, 2016 185,459 $ 55.15 $ 1,778,000
Schedule of Share-based Compensation, Shares Authorized under Stock Option Plans, by Exercise Price Range [Table Text Block]	Options Outstanding June 30, 2016 Exercise Prices Weighted Average Exercise Price Weighted Average Remaining Contractual Life in Years 97,500 $4.80 - $52.93 $ 48.95 2.0 100,079 $1.59 - $62.78 61.98 3.9 197,579 $ 55.55 3.0

Note 1 - Description of Busin31

Note 1 - Description of Business (Details Textual)	Jun. 30, 2016
Number of Skilled Nursing Centers	74
Number of Beds	9,390
Number of Assisted Living Facilities	21
Number of Independent Living Facilities	5
Number of Homecare Programs	36
Number of States in which Entity Operates	10

Note 2 - Summary of Significa32

Note 2 - Summary of Significant Accounting Policies (Details Textual)	6 Months Ended
	Jun. 30, 2016USD ($)	Jun. 30, 2015USD ($)	Dec. 31, 2015USD ($)
Percent of Revenues Derived from Medicare, Medicaid and Other Government Programs [Member]
Concentration Risk, Percentage	65.00%
Medicare and Medicaid [Member]
Allowance for Doubtful Accounts Receivable	$ 18,410,000		$ 16,654,000
Minimum [Member] | Building and Building Improvements [Member]
Property, Plant and Equipment, Useful Life	20 years
Minimum [Member] | Equipment and Furniture [Member]
Property, Plant and Equipment, Useful Life	3 years
Minimum [Member]
Management Services Fees	6.00%
Maximum [Member] | Building and Building Improvements [Member]
Property, Plant and Equipment, Useful Life	40 years
Maximum [Member] | Equipment and Furniture [Member]
Property, Plant and Equipment, Useful Life	15 years
Maximum [Member]
Management Services Fees	7.00%
Corporate Office Costs [Member]
General and Administrative Expense	$ 15,457,000	$ 15,044,000
Appreciation [Member]
Malpractice Loss Contingency, Number of Claims	36
Appreciation of Apartment Over Original Residents Entry Fee Percentage	40.00%
Refundable Advance Fees [Member]
Nonrefundable Resident Entry Fee Percentage	10.00%
Customer Refundable Fees	$ 9,831,000		9,865,000
Original Entry Fee [Member]
Refundable Resident Entry Fee Percentage	90.00%
Continuing Care Retirement Communities Advance Fees, Obligation for Future Services, Amount	$ 3,440,000		$ 3,440,000
Malpractice Loss Contingency, Number of Claims	36

Note 3 - Other Revenues (Detail

Note 3 - Other Revenues (Details Textual)	3 Months Ended		6 Months Ended
	Jun. 30, 2016USD ($)	Jun. 30, 2015USD ($)	Jun. 30, 2016USD ($)	Jun. 30, 2015USD ($)
National [Member]
Number of Skilled Nursing Centers	5		5
Management Fees Revenue	$ 926,000	$ 890,000	$ 1,895,000	$ 1,824,000
Workers Compensation Premium Revenue [Member]
Health Care Organization, Premium Revenue	1,150,000	1,203,000	2,383,000	2,213,000
Professional Liability Insurance [Member]
Health Care Organization, Premium Revenue	$ 665,000	$ 697,000	$ 1,356,000	$ 1,394,000
Number of Skilled Nursing Centers	74		74

Note 3 - Summary of Other Reven

Note 3 - Summary of Other Revenues (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Management and Accounting Services Fees [Member]
Other Revenues	$ 3,506	$ 3,532	$ 7,255	$ 7,036
Rental Income [Member]
Other Revenues	5,435	4,776	11,005	9,578
Insurance Services [Member]
Other Revenues	1,815	1,900	3,739	3,607
Other Income [Member]
Other Revenues	525	261	764	594
Other Revenues	$ 11,281	$ 10,469	$ 22,763	$ 20,815

Note 4 - Non-operating Income35

Note 4 - Non-operating Income (Details Textual)	Jun. 30, 2016
Caris [Member]
Equity Method Investment, Ownership Percentage	75.10%

Note 4 - Non-operating Income C

Note 4 - Non-operating Income Component (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Equity in earnings of unconsolidated investments	$ 1,615	$ 1,268	$ 3,120	$ 2,386
Dividends and other net realized gains and losses on sales of securities	1,901	1,629	3,762	3,505
Interest income	1,409	1,233	2,816	2,461
Other non-operating income	$ 4,925	$ 4,130	$ 9,698	$ 8,352

Note 5 - Long-term Leases (Deta

Note 5 - Long-term Leases (Details Textual)	3 Months Ended		6 Months Ended
	Jun. 30, 2016USD ($)	Jun. 30, 2015USD ($)	Jun. 30, 2016USD ($)	Jun. 30, 2015USD ($)
Two Leases with NHI [Member]
Number of Skilled Nursing Centers Leased from NHI	35		35
Number of Assisted Living Centers Leased from NHI	7		7
Number of Independent Living Centers Leased from NHI	3		3
Number of Lease Agreements with NHI	2		2
Operating Leases, Rent Expense, Minimum Rentals			$ 34,200,000
Operating Lease Additional Percentage Rent Percentage			4.00%
Operating Leases, Rent Expense	$ 9,480,000	$ 9,177,000	$ 18,960,000	$ 18,355,000
Operating Leases, Rent Expense	$ 10,319,000	$ 9,981,000	$ 20,646,000	$ 19,966,000

Note 5 - Fixed Assets Recorded

Note 5 - Fixed Assets Recorded under Capital Leases (Details) - Buildings and Personal Property [Member] - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Buildings and personal property	$ 39,032	$ 39,032
Accumulated amortization	(9,158)	(7,196)
Total capital leases	$ 29,874	$ 31,836

Note 5 - Future Minimum Lease P

Note 5 - Future Minimum Lease Payments (Details) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
2017, operating leases	$ 34,200
2017, capital leases	5,200
2018, operating leases	34,200
2018, capital leases	5,200
2019, operating leases	34,200
2019, capital leases	5,200
2020, operating leases	34,200
2020, capital leases	5,200
2021, operating leases	34,200
2021, capital leases	5,200
Thereafter, operating leases	193,850
Thereafter, capital leases	13,867
Total minimum lease payments, operating leases	364,850
Total minimum lease payments, capital leases	39,867
Less: Amounts representing interest, capital leases	(7,974)
Present value of minimum lease payments, capital leases	31,893
Less: Current portion, capital leases	(3,378)	$ (3,279)
Long-term capital lease obligations, capital leases	$ 28,515	$ 30,228

Note 6 - Earnings Per Share (De

Note 6 - Earnings Per Share (Details Textual) - shares	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Incentive Stock Option [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	12,120	11,804	12,120	11,804

Note 6 - Summary of Earnings an

Note 6 - Summary of Earnings and Weighted Average Number of Common Shares Used in Calculation of Basic and Diluted Earnings Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Employee Stock Option [Member]
Dilutive effect of options (in shares)	22,545	158,387	23,406	155,972
Restricted Stock [Member]
Dilutive effect of options (in shares)				2,366
Basic (in shares)	15,266,559	13,772,873	15,091,732	13,767,248
Net income	$ 11,866	$ 12,358	$ 25,565	$ 25,600
Dividends to preferred stockholders		(2,167)		(4,335)
Net income available to common stockholders	$ 11,866	$ 10,191	$ 25,565	$ 21,265
Basic (in dollars per share)	$ 0.78	$ 0.74	$ 1.69	$ 1.54
Dilutive effect of contingent issuable stock (in shares)		450,486	97,137	410,441
Diluted (in shares)	15,289,104	14,381,746	15,212,275	14,336,027
Diluted (in dollars per share)	$ 0.78	$ 0.71	$ 1.68	$ 1.48

Note 7 - Investments in Marke42

Note 7 - Investments in Marketable Securities (Details Textual) - USD ($)	6 Months Ended		12 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Dec. 31, 2015
Other than Temporary Impairment Losses, Investments, Available-for-sale Securities	$ 0		$ 0
Available-for-sale Securities, Accumulated Gross Unrealized Gain, before Tax	115,280,000		86,921,000
Available-for-sale Securities, Accumulated Gross Unrealized Loss, before Tax	510,000		$ 2,237,000
Proceeds from Sale and Maturity of Marketable Securities	25,697,000	$ 28,296,000
Realized Investment Gains (Losses)	$ 540,000	$ 421,000

Note 7 - Marketable Securities

Note 7 - Marketable Securities and Restricted Marketable Securities (Details) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Equity Securities [Member]
NHI Common Stock, Cost	$ 30,176	$ 30,176
NHI Common Stock, Fair Value	141,756	116,168
Corporate Debt Securities [Member]
Amortized Cost	73,194	71,960
Fair Value	75,118	71,143
Commercial Mortgage Backed Securities [Member]
Amortized Cost	56,751	61,645
Fair Value	56,903	60,910
US Government Corporations and Agencies Securities [Member]
Amortized Cost	24,814	21,123
Fair Value	25,373	21,033
US States and Political Subdivisions Debt Securities [Member]
Amortized Cost	15,111	16,446
Fair Value	15,666	16,780
Amortized Cost	169,870	171,174
Total amortized cost	200,046	201,350
Available-for-sale securities	$ 314,816	$ 286,034

Note 7 - Available for Sale Mar

Note 7 - Available for Sale Marketable Equity Securities (Details) - NHI Common Stock [Member] - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
NHI Common Stock, Shares (in shares)	1,630,642	1,630,642
NHI Common Stock, Cost	$ 24,734	$ 24,734
NHI Common Stock, Fair Value	$ 122,445	$ 99,257

Note 7 - Amortized Cost and Est

Note 7 - Amortized Cost and Estimated Fair Value of Debt Securities as Available for Sale (Details) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Cost Value	$ 43,077	$ 23,291
Fair Value	43,936	23,273
Cost Value	70,519	74,747
Fair Value	71,159	74,671
Cost Value	55,279	71,442
Fair Value	56,977	70,223
Cost Value	995	1,694
Fair Value	988	1,699
Amortized Cost	169,870	171,174
Fair Value	$ 173,060	$ 169,866

Note 8 - Summary of Fair Value

Note 8 - Summary of Fair Value Measurements by Level (Details) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Equity Securities [Member]
Available-for-sale securities	$ 141,756	$ 116,168
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Corporate Debt Securities [Member]
Available-for-sale securities	38,282	32,683
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Commercial Mortgage Backed Securities [Member]
Available-for-sale securities
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | US Treasury Securities [Member]
Available-for-sale securities	25,373	21,033
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | US States and Political Subdivisions Debt Securities [Member]
Available-for-sale securities
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member]
Cash and cash equivalents	37,543	38,208
Restricted cash and cash equivalents	16,700	11,106
Total financial assets	259,654	219,198
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Equity Securities [Member]
Available-for-sale securities
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Corporate Debt Securities [Member]
Available-for-sale securities	36,836	38,460
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Commercial Mortgage Backed Securities [Member]
Available-for-sale securities	56,903	60,910
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | US Treasury Securities [Member]
Available-for-sale securities
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | US States and Political Subdivisions Debt Securities [Member]
Available-for-sale securities	15,666	16,780
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 2 [Member]
Cash and cash equivalents
Restricted cash and cash equivalents
Total financial assets	109,405	116,150
Fair Value, Measurements, Recurring [Member] | Equity Securities [Member]
Available-for-sale securities	141,756	116,168
Fair Value, Measurements, Recurring [Member] | Corporate Debt Securities [Member]
Available-for-sale securities	75,118	71,143
Fair Value, Measurements, Recurring [Member] | Commercial Mortgage Backed Securities [Member]
Available-for-sale securities	56,903	60,910
Fair Value, Measurements, Recurring [Member] | US Treasury Securities [Member]
Available-for-sale securities	25,373	21,033
Fair Value, Measurements, Recurring [Member] | US States and Political Subdivisions Debt Securities [Member]
Available-for-sale securities	15,666	16,780
Fair Value, Measurements, Recurring [Member]
Cash and cash equivalents	37,543	38,208
Restricted cash and cash equivalents	16,700	11,106
Total financial assets	369,059	335,348
Available-for-sale securities	$ 314,816	$ 286,034

Note 9 - Long-term Debt (Detail

Note 9 - Long-term Debt (Details Textual) - Bank of America [Member] - USD ($) $ in Millions	Oct. 07, 2015	Oct. 22, 2014
London Interbank Offered Rate (LIBOR) [Member]
Debt Instrument, Basis Spread on Variable Rate	1.40%
Debt Instrument, Basis Spread on Base Rate	1.00%
Base Rate [Member]
Debt Instrument, Basis Spread on Variable Rate	0.40%
Federal Funds Effective Swap Rate [Member]
Debt Instrument, Basis Spread on Base Rate	0.50%
Line of Credit Facility, Maximum Borrowing Capacity	$ 175	$ 75

Note 9 - Long-term Debt Compone

Note 9 - Long-term Debt Components (Details) - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2016	Dec. 31, 2015
Revolving Credit Facility [Member]
Long-term debt, interest rate	1.90%
Long-term debt maturity	2,020
Long-term debt	$ 110	$ 110
Unsecured Term Note Payable [Member]
Long-term debt, interest rate	3.00%
Long-term debt maturity	2,018
Long-term debt	$ 10	10
Long-term debt	120	120
Long-term debt, noncurrent	$ 120	$ 120

Note 9 - Aggregate Maturities o

Note 9 - Aggregate Maturities of Long-term Debt (Details) - USD ($) $ in Millions	Jun. 30, 2016	Dec. 31, 2015
2,018	$ 10
2,021	110
Total	$ 120	$ 120

Note 10 - Stock Repurchase Pr50

Note 10 - Stock Repurchase Program (Details Textual) $ in Millions	May 07, 2015USD ($)
Common Stock [Member]
Stock Repurchase Program, Authorized Amount	$ 25
Preferred Stock [Member]
Stock Repurchase Program, Authorized Amount	$ 25
Stock Repurchase Program Number of Plans	2

Note 11 - Stock-based Compens51

Note 11 - Stock-based Compensation (Details Textual) - USD ($)	3 Months Ended		6 Months Ended		12 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015	Dec. 31, 2015	May 31, 2010	May 30, 2010	May 31, 2005
Incentive Stock Option [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Expiration Period			10 years
2005 Plan [Member] | Director [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Shares Issued in Period			45,000
2005 Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Authorized								1,200,000
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant	131,276		131,276
2010 Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Authorized							1,200,000
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant	1,750,494		1,750,494			1,200,000
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Gross			12,120
Employee Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Authorized						2,575,000
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Gross			57,120		56,210
Allocated Share-based Compensation Expense	$ 208,000	$ 654,000	$ 494,000	$ 1,132,000

Note 11 - Summary of Assumption

Note 11 - Summary of Assumptions Used to Value Options Granted (Details)	6 Months Ended	12 Months Ended
	Jun. 30, 2016	Dec. 31, 2015
Risk–free interest rate	0.88%	0.71%
Expected volatility	15.80%	16.50%
Expected life, in years	2 years 73 days	2 years 73 days
Expected dividend yield	3.08%	2.73%

Note 11 - Summary of Outstandin

Note 11 - Summary of Outstanding Stock Options (Details) - USD ($)	6 Months Ended	12 Months Ended
	Jun. 30, 2016	Dec. 31, 2015
Options outstanding, shares (in shares)	621,390	954,678
Options outstanding, weighted average exercise price (in dollars per share)	$ 48.15	$ 46.92
Options outstanding, aggregate intrinsic value
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Gross	57,120	56,210
Weighted Average Exercise Price - Options Granted (in dollars per share)	$ 62.53	$ 61.47
Number of Shares - Options Exercised (in shares)	(480,275)	(389,498)
Weighted Average Exercise Price - Options Exercised (in dollars per share)	$ 46.81	$ 47.06
Options outstanding, shares (in shares)	197,579	621,390
Options outstanding, weighted average exercise price (in dollars per share)	$ 55.55	$ 48.15
Options outstanding, aggregate intrinsic value	$ 1,816,000
Number of Shares - Options Forfeited (in shares)	(656)
Weighted Average Exercise Price - Options Forfeited (in dollars per share)	$ 46.69
Options exercisable at March 31, 2015, shares (in shares)	185,459
Options exercisable at March 31, 2015, weighted average exercise price (in dollars per share)	$ 55.15
Options exercisable at March 31, 2015, aggregate intrinsic value	$ 1,778,000

Note 11 - Options Outstanding (

Note 11 - Options Outstanding (Details)	6 Months Ended
	Jun. 30, 2016$ / sharesshares
Exercise Price Range 1 [Member]
97,500 (in shares) | shares	4.8
100,079 (in dollars per share)	$ 1.59
100,079 (in dollars per share)
100,079 (in dollars per share)	$ 62.78
100,079	61 years 357 days
Exercise Price Range 2 [Member]
97,500 (in shares) | shares

Note 12 - Income Taxes (Details

Note 12 - Income Taxes (Details Textual) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Earliest Tax Year [Member]
Open Tax Year			2,012
Permanent Differences [Member]
Unrecognized Tax Benefits, Period Increase (Decrease)	$ 143,000	$ 15,000	$ 229,000	$ 38,000
Unrecognized Tax Benefits	5,832,000		5,832,000
Unrecognized Tax Benefits, Income Tax Penalties and Interest Accrued	3,372,000		3,372,000
Deferred Tax Assets [Member]
Unrecognized Tax Benefits	7,936,000		7,936,000
Lapse of Statute of Limitations [Member]
Significant Change in Unrecognized Tax Benefits is Reasonably Possible, Amount of Unrecorded Benefit	2,046,000		2,046,000
Temporary Difference [Member]
Significant Change in Unrecognized Tax Benefits is Reasonably Possible, Amount of Unrecorded Benefit	(842,000)		(842,000)
Permanent and Temporary Differences [Member]
Unrecognized Tax Benefits, Income Tax Penalties and Interest Accrued	727,000		727,000
Income Tax Expense (Benefit)	$ 7,700,000	$ 7,478,000	$ 16,398,000	$ 15,894,000
Effective Income Tax Rate Reconciliation, Percent	39.40%	37.70%	39.10%	38.30%
Unrecognized Tax Benefits, Period Increase (Decrease)	$ 190,000	$ 121,000	$ 365,000	$ 330,000
Unrecognized Tax Benefits	13,768,000		13,768,000
Unrecognized Tax Benefits, Income Tax Penalties and Interest Accrued	3,599,000		3,599,000
Unrecognized Tax Benefits that Would Impact Effective Tax Rate	5,831,000		5,831,000
Significant Change in Unrecognized Tax Benefits is Reasonably Possible, Amount of Unrecorded Benefit	$ 1,204,000		$ 1,204,000

Note 13 - Contingencies and C56

Note 13 - Contingencies and Commitments (Details Textual)	6 Months Ended		24 Months Ended	36 Months Ended
	Jun. 30, 2016USD ($)	Jun. 30, 2015USD ($)	Dec. 31, 2015USD ($)	Dec. 31, 2013USD ($)	Dec. 31, 2010USD ($)	Dec. 31, 2007USD ($)
South Carolina Department of Health and Human Services [Member]
Loss Contingency, Receivable	$ 0
Payments for Legal Settlements		$ 6,800,000
Long-term Line of Credit [Member] | National [Member] | National Health Care [Member]
Long-term Line of Credit	0
Line of Credit Facility, Maximum Borrowing Capacity	2,000,000
Short-term Line of Credit [Member] | Third Party Operator [Member]
Line of Credit Facility, Maximum Borrowing Capacity	$ 10,000,000
Written Notice, Number of Days	30 days
Short-term Debt	$ 1,892,000
Coverage Amount Per Incident [Member]
Primary Insurance Coverage Amount Per Incident	1,000,000
Primary Insurance Coverage, Amount Per Location	$ 3,000,000
Caris [Member]
Equity Method Investment, Ownership Percentage	75.10%
Self Insurance Reserve	$ 98,514,000		$ 98,508,000
Direct Business Coverage Statutory Limits	$ 1,000,000
Malpractice Loss Contingency, Number of Claims	36
Annual Excess Coverage			$ 9,000,000	$ 4,000,000	$ 9,000,000	$ 7,500,000
Number of Nursing Facilities under Medicaid Cost Report Audits	11