Document And Entity Information
Document And Entity Information - shares | 6 Months Ended | |
Jun. 30, 2018 | Aug. 07, 2018 | |
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 | Large Accelerated Filer | |
Entity Current Reporting Status | Yes | |
Entity Voluntary Filers | No | |
Entity Well-known Seasoned Issuer | No | |
Entity Common Stock, Shares Outstanding (in shares) | 15,225,654 | |
Document Type | 10-Q | |
Document Period End Date | Jun. 30, 2018 | |
Document Fiscal Year Focus | 2,018 | |
Document Fiscal Period Focus | Q2 | |
Amendment Flag | false |
Interim Condensed Consolidated
Interim Condensed Consolidated Statements of Operations (Unaudited) - USD ($) | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Revenues: | ||||
Other revenues | $ 11,488,000 | $ 11,610,000 | $ 22,757,000 | $ 22,894,000 |
Net operating revenues | 242,142,000 | 238,695,000 | 485,103,000 | 477,233,000 |
Costs and expenses: | ||||
Salaries, wages and benefits | 145,466,000 | 142,684,000 | 285,561,000 | 280,739,000 |
Other operating | 62,589,000 | 62,094,000 | 127,761,000 | 125,272,000 |
Facility rent | 10,272,000 | 10,079,000 | 20,501,000 | 20,167,000 |
Depreciation and amortization | 10,397,000 | 10,481,000 | 20,739,000 | 20,776,000 |
Interest | 1,253,000 | 1,219,000 | 2,493,000 | 2,277,000 |
Total costs and expenses | 229,977,000 | 226,557,000 | 457,055,000 | 449,231,000 |
Income from operations | 12,165,000 | 12,138,000 | 28,048,000 | 28,002,000 |
Non–operating income | 5,654,000 | 5,189,000 | 2,589,000 | 9,957,000 |
Unrealized gains (losses) on marketable equity securities | 12,448,000 | (3,069,000) | ||
Income before income taxes | 30,267,000 | 17,327,000 | 27,568,000 | 37,959,000 |
Income tax provision | (7,892,000) | (6,758,000) | (8,092,000) | (14,757,000) |
Net income | 22,375,000 | 10,569,000 | 19,476,000 | 23,202,000 |
Net loss attributable to noncontrolling interest | 86,000 | 86,000 | 194,000 | 181,000 |
Net income attributable to National HealthCare Corporation | $ 22,461,000 | $ 10,655,000 | $ 19,670,000 | $ 23,383,000 |
Earnings per share attributable to National HealthCare Corporation stockholders: | ||||
Basic (in dollars per share) | $ 1.48 | $ 0.70 | $ 1.29 | $ 1.54 |
Diluted (in dollars per share) | $ 1.47 | $ 0.70 | $ 1.29 | $ 1.54 |
Weighted average common shares outstanding: | ||||
Basic (in shares) | 15,221,262 | 15,189,818 | 15,218,962 | 15,181,700 |
Diluted (in shares) | 15,228,305 | 15,220,448 | 15,224,958 | 15,216,336 |
Dividends declared to common stockholders, per share (in dollars per share) | $ 0.50 | $ 0.48 | $ 0.98 | $ 0.93 |
Net Patient Revenues [Member] | ||||
Revenues: | ||||
Revenues | $ 230,654,000 | $ 227,085,000 | $ 462,346,000 | $ 454,339,000 |
Interim Condensed Consolidated3
Interim Condensed Consolidated Statements of Comprehensive Income (Unaudited) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Net income | $ 22,375 | $ 10,569 | $ 19,476 | $ 23,202 |
Other comprehensive loss: | ||||
Unrealized gains (losses) on investments in restricted marketable securities | (794) | 13,297 | (3,592) | 12,356 |
Reclassification adjustment for realized gains on sale of securities | (14) | (204) | (25) | (238) |
Income tax benefit (expense) related to items of other comprehensive income | 169 | (5,054) | 759 | (4,646) |
Other comprehensive income (loss), net of tax | (639) | 8,039 | (2,858) | 7,472 |
Net loss attributable to noncontrolling interest | 86 | 86 | 194 | 181 |
Comprehensive income attributable to National HealthCare Corporation | $ 21,822 | $ 18,694 | $ 16,812 | $ 30,855 |
Interim Condensed Consolidated4
Interim Condensed Consolidated Balance Sheets (Current Period Unaudited) - USD ($) | Jun. 30, 2018 | Dec. 31, 2017 |
Current Assets: | ||
Cash and cash equivalents | $ 59,322,000 | $ 59,118,000 |
Restricted cash and cash equivalents | 7,629,000 | 6,397,000 |
Marketable equity securities | 136,016,000 | 139,085,000 |
Restricted marketable debt securities | 20,064,000 | 21,012,000 |
Accounts receivable, net | 82,230,000 | 86,767,000 |
Inventories | 7,306,000 | 7,153,000 |
Prepaid expenses and other assets | 3,428,000 | 2,864,000 |
Notes receivable, current portion | 1,499,000 | 1,450,000 |
Federal income tax receivable | 5,465,000 | |
Total current assets | 317,494,000 | 329,311,000 |
Property and Equipment: | ||
Property and equipment, at cost | 974,049,000 | 958,748,000 |
Accumulated depreciation and amortization | (430,014,000) | (409,429,000) |
Net property and equipment | 544,035,000 | 549,319,000 |
Other Assets: | ||
Restricted cash and cash equivalents | 1,920,000 | 1,906,000 |
Restricted marketable securities | 144,885,000 | 145,383,000 |
Deposits and other assets | 5,849,000 | 4,867,000 |
Goodwill | 17,600,000 | 17,600,000 |
Notes receivable, less current portion | 10,952,000 | 11,801,000 |
Investments in limited liability companies | 28,014,000 | 36,339,000 |
Total other assets | 209,220,000 | 217,896,000 |
Total assets | 1,070,749,000 | 1,096,526,000 |
Current Liabilities: | ||
Trade accounts payable | 16,166,000 | 15,978,000 |
Capital lease obligations, current portion | 3,808,000 | 3,696,000 |
Accrued payroll | 55,688,000 | 67,102,000 |
Amounts due to third party payors | 17,218,000 | 17,389,000 |
Accrued risk reserves, current portion | 27,693,000 | 27,409,000 |
Other current liabilities | 14,808,000 | 16,194,000 |
Dividends payable | 7,612,000 | 7,297,000 |
Total current liabilities | 142,993,000 | 155,065,000 |
Long–term debt | 85,000,000 | 100,000,000 |
Capital lease obligations, less current portion | 21,120,000 | 23,052,000 |
Accrued risk reserves, less current portion | 67,115,000 | 65,866,000 |
Refundable entrance fees | 8,668,000 | 8,827,000 |
Obligation to provide future services | 2,887,000 | 2,887,000 |
Deferred income taxes | 15,240,000 | 18,376,000 |
Other noncurrent liabilities | 16,335,000 | 15,795,000 |
Deferred revenue | 4,621,000 | 3,226,000 |
Total liabilities | 363,979,000 | 393,094,000 |
Equity: | ||
Common stock, $.01 par value; 45,000,000 shares authorized; 15,225,654 and 15,212,133 shares, respectively, issued and outstanding | 152,000 | 152,000 |
Capital in excess of par value | 217,296,000 | 215,659,000 |
Retained earnings | 492,377,000 | 419,423,000 |
Accumulated other comprehensive income (loss) | (3,555,000) | 67,504,000 |
Total National HealthCare Corporation stockholders’ equity | 706,270,000 | 702,738,000 |
Noncontrolling interest | 500,000 | 694,000 |
Total equity | 706,770,000 | 703,432,000 |
Total liabilities and equity | $ 1,070,749,000 | $ 1,096,526,000 |
Interim Condensed Consolidated5
Interim Condensed Consolidated Balance Sheets (Current Period Unaudited) (Parentheticals) - $ / shares | Jun. 30, 2018 | Dec. 31, 2017 |
Common stock, par value (in dollars per share) | $ 0.01 | $ 0.01 |
Common stock, shares authorized (in shares) | 45,000,000 | 45,000,000 |
Common stock, shares issued (in shares) | 15,225,654 | 15,212,133 |
Common stock, shares outstanding (in shares) | 15,225,654 | 15,212,133 |
Interim Condensed Consolidated6
Interim Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) | 6 Months Ended | |
Jun. 30, 2018 | Jun. 30, 2017 | |
Cash Flows From Operating Activities: | ||
Net income | $ 19,476,000 | $ 23,202,000 |
Adjustments to reconcile net income to net cash provided by operating activities: | ||
Depreciation and amortization | 20,739,000 | 20,776,000 |
Equity in (earnings) losses of unconsolidated investments | 4,584,000 | (3,380,000) |
Distributions from unconsolidated investments | 3,741,000 | 4,337,000 |
Unrealized losses on marketable equity securities | 3,069,000 | |
Gains on sale of restricted marketable securities | (25,000) | (238,000) |
Deferred income taxes | (2,376,000) | (1,540,000) |
Stock–based compensation | 1,177,000 | 832,000 |
Changes in operating assets and liabilities: | ||
Accounts receivable | 4,537,000 | 2,891,000 |
Income tax receivable | 5,465,000 | 2,218,000 |
Inventories | (153,000) | 310,000 |
Prepaid expenses and other assets | (1,551,000) | (969,000) |
Trade accounts payable | 188,000 | (3,855,000) |
Accrued payroll | (11,414,000) | (12,601,000) |
Amounts due to third party payors | (171,000) | 931,000 |
Accrued risk reserves | 1,538,000 | 3,379,000 |
Other current liabilities | (1,386,000) | 1,440,000 |
Other noncurrent liabilities | 540,000 | 1,048,000 |
Deferred revenue | 1,395,000 | 1,524,000 |
Net cash provided by operating activities | 49,373,000 | 40,305,000 |
Cash Flows From Investing Activities: | ||
Additions to property and equipment | (15,456,000) | (16,681,000) |
Investments in unconsolidated companies | (176,000) | |
Collections of notes receivable | 800,000 | 3,651,000 |
Purchase of restricted marketable securities | (6,545,000) | (22,775,000) |
Sale of restricted marketable securities | 4,399,000 | 44,756,000 |
Net cash (used in) provided by investing activities | (16,802,000) | 8,775,000 |
Cash Flows From Financing Activities: | ||
Principal payments on debt | (15,000,000) | |
Principal payments under capital lease obligations | (1,820,000) | (1,715,000) |
Dividends paid to common stockholders | (14,602,000) | (13,649,000) |
Issuance of common shares | 1,327,000 | 1,496,000 |
Repurchase of common shares | (867,000) | |
Equity attributable to noncontrolling interest | 970,000 | |
Entrance fee refunds | (159,000) | (757,000) |
Change in deposits | (418,000) | |
Net cash used in financing activities | (31,121,000) | (14,073,000) |
Net Increase in Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents | 1,450,000 | 35,007,000 |
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, Beginning of Period | 67,421,000 | 31,589,000 |
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, End of Period | 68,871,000 | 66,596,000 |
Balance Sheet Classifications: | ||
Total Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents | $ 67,421,000 | $ 31,589,000 |
Interim Condensed Consolidated7
Interim Condensed Consolidated Statements of Stockholders' Equity (Unaudited) - USD ($) $ in Thousands | Common Stock [Member] | Additional Paid-in Capital [Member] | Retained Earnings [Member] | AOCI Attributable to Parent [Member] | Noncontrolling Interest [Member] | Total |
Balance (in shares) at Dec. 31, 2016 | 15,162,938 | |||||
Balance at Dec. 31, 2016 | $ 152 | $ 211,457 | $ 391,934 | $ 66,068 | $ 669,611 | |
Net income attributable to National HealthCare Corporation | 23,383 | 23,383 | ||||
Net loss attributable to noncontrolling interest | (181) | (181) | ||||
Equity contributed by noncontrolling interest | 970 | 970 | ||||
Other comprehensive income (loss) | 7,472 | 7,472 | ||||
Stock–based compensation | 832 | 832 | ||||
Shares sold – options exercised (in shares) | 32,092 | |||||
Shares sold – options exercised | 1,496 | 1,496 | ||||
Dividends declared to common stockholders | (14,125) | (14,125) | ||||
Balance (in shares) at Jun. 30, 2017 | 15,195,030 | |||||
Balance at Jun. 30, 2017 | $ 152 | 213,785 | 401,192 | 73,540 | 789 | 689,458 |
Balance (in shares) at Dec. 31, 2016 | 15,162,938 | |||||
Balance at Dec. 31, 2016 | $ 152 | 211,457 | 391,934 | 66,068 | $ 669,611 | |
Shares sold – options exercised (in shares) | 48,995 | |||||
Balance (in shares) at Dec. 31, 2017 | 15,212,133 | |||||
Balance at Dec. 31, 2017 | $ 152 | 215,659 | 419,423 | 67,504 | 694 | $ 703,432 |
Net income attributable to National HealthCare Corporation | 19,670 | 19,670 | ||||
Net loss attributable to noncontrolling interest | (194) | (194) | ||||
Other comprehensive income (loss) | (2,858) | (2,858) | ||||
Stock–based compensation | 1,177 | $ 1,177 | ||||
Shares sold – options exercised (in shares) | 28,027 | 33,526 | ||||
Shares sold – options exercised | 1,327 | $ 1,327 | ||||
Dividends declared to common stockholders | (14,917) | (14,917) | ||||
Repurchase of common shares (in shares) | (14,506) | |||||
Repurchase of common shares | (867) | (867) | ||||
Balance (in shares) at Jun. 30, 2018 | 15,225,654 | |||||
Balance at Jun. 30, 2018 | $ 152 | 217,296 | 492,377 | (3,555) | 500 | 706,770 |
Reclassification due to new accounting standards | $ 68,201 | $ (68,201) |
Interim Condensed Consolidated8
Interim Condensed Consolidated Statements of Stockholders' Equity (Unaudited) (Parentheticals) - $ / shares | 6 Months Ended | |
Jun. 30, 2018 | Jun. 30, 2017 | |
Common Stock [Member] | ||
Dividends declared to common stockholders, per share (in dollars per share) | $ 0.98 | $ 0.93 |
Dividends declared to common stockholders, per share (in dollars per share) | $ 0.98 | $ 0.93 |
Note 1 - Description of Busines
Note 1 - Description of Business | 6 Months Ended |
Jun. 30, 2018 | |
Notes to Financial Statements | |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block] | Note 1 – Description of Business National HealthCare Corporation June 30, 2018, 76 9,629 24 five 36 10 |
Note 2 - Summary of Significant
Note 2 - Summary of Significant Accounting Policies | 6 Months Ended |
Jun. 30, 2018 | |
Notes to Financial Statements | |
Significant Accounting Policies [Text Block] | Note 2 – Summary of Significant Accounting Policies The listing below is not not December 31, 2017 December 31, 2017 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. The consolidated financial statements include the accounts of all entities controlled by NHC. The Company presents noncontrolling interest within the equity section of its consolidated balance sheets. The Company presents the amount of consolidated net income (loss) that is attributable to NHC and the noncontrolling interest in its consolidated statements of operations. We assume that users of these interim condensed consolidated financial statements have read or have access to the audited December 31, 2017 may not may 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 May 2014, No. 2014–09 five 1. 2. 3. 4. 5. For a public entity, this update is effective for annual reporting periods beginning after December 15, 2017, On January 1, 2018, No. 2014 09 No. 2014 09. not No. 2014 09 no three six June 30, 2017 January 1, 2018: Consolidated Statements of Operations ( in thousands Three Months Ended June 30, 2017 As Previously Reported Effect of Accounting Change As Adjusted Net patient revenues $ 227,847 $ (762 ) $ 227,085 Net operating revenues 239,457 (762 ) 238,695 Other operating expenses 62,856 (762 ) 62,094 Total costs and expenses 227,319 (762 ) 226,557 Net income $ 10,569 $ - $ 10,569 Six Months Ended June 30, 2017 As Previously Reported Effect of Accounting Change As Adjusted Net patient revenues $ 455,806 $ (1,467 ) $ 454,339 Net operating revenues 478,700 (1,467 ) 477,233 Other operating expenses 126,739 (1,467 ) 125,272 Total costs and expenses 450,698 (1,467 ) 449,231 Net income $ 23,202 $ - $ 23,202 In January 2016, No. 2016–01, 825 No. 2016–01 No. 2016–01 January 1, 2018, No. 2016 01 No. 2016 01 $68,073,000 three six June 30, 2018, $12,448,000 $3,069,000, No. 2016 01 In August 2016, No. 2016 15, No. 2016 15 eight 1 2 January 1, 2018, No. 2016 15 not In May 2017, No. 2017 09, 718 No. 2017 09 718. January 1, 2018, No. 2017 09 not In February 2018, No. 2018 02, No. 2018 02 2017 January 1, 2018, No. 2018 02. $128,000, Recent Accounting Guidance Not In February 2016, No. 2016 02, 842 December 15, 2018, In June 2016, No. 2016 13, No. 2016 13 December 15, 2019, December 15, 2018. Segment Reporting In accordance with the provisions of ASC 280, two 1 2 6 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, excluding stock-based compensation, which were $6,573,000 $13,250,000 three six June 30, 2018, $6,390,000 $15,262,000 three six June 30, 2017, 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 3 15 not 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, 2018, 63 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 may 10% 90% 40% Non-refundable fees are included as a component of the transaction price and are amortized 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 not June 30, 2018 December 31, 2017 $8,668,000 $8,827,000, Obligation to Provide Future Services We 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, 2018, December 31, 2017, $2,887,000. Other Noncurrent Liabilities Other noncurrent liabilities include reserves primarily related to various uncertain income tax positions. D eferred Revenue Deferred revenue includes the deferred gain on the sale of assets to National Health Corporation (“National”), the non-refundable portion ( 10% not Noncontrolling Interest The noncontrolling interest in a subsidiary is presented within total equity in the Company's interim condensed consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to NHC in its interim condensed consolidated statements of operations. The Company’s earnings per share is calculated based on net income attributable to NHC’s stockholders. The carrying amount of the noncontrolling interest is adjusted based on an allocation of subsidiary earnings based on ownership interest. 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 may not Prior Period Classifications Certain amounts in prior periods have been reclassified to conform with current period presentation. |
Note 3 - Net Patient Revenues
Note 3 - Net Patient Revenues | 6 Months Ended |
Jun. 30, 2018 | |
Notes to Financial Statements | |
Revenue from Contract with Customer [Text Block] | Note 3 – Net Patient Revenue s Net patient revenues are derived from services rendered to patients for skilled and intermediate nursing, rehabilitation therapy, assisted living and independent living, and home health care services. Net patient revenue is reported at the amount that reflects the consideration to which the Company expects to be entitled in exchange for providing patient services. These amounts are due from patients, governmental programs, and other third The Company disaggregates revenue from contracts with customers by service type and by payor. Revenue by Service Type The Company’s net patient services can generally be classified into the following two 1 2 Three Months Ended June 30 Six Months Ended June 30 (in thousands) 2018 2017 2018 2017 Net patient revenues: Inpatient services $ 215,617 $ 211,057 $ 431,968 $ 422,497 Homecare 15,037 16,028 30,378 31,842 Total net patient revenue $ 230,654 $ 227,085 $ 462,346 $ 454,339 The Company recognizes revenue as its performance obligations are completed. The performance obligations are satisfied over time as the patient simultaneously receives and consumes the benefits of the healthcare services provided. For inpatient services, revenue is recognized on a daily basis as each day represents a separate contract and performance obligation. For homecare, revenue is recognized when services are provided based on the number of days of service rendered in the episode or on a per-visit basis. Typically, patients and third As our performance obligations relate to contracts with a duration of one 606 10 50 14 not no As the period between the time of service and time of payment is typically one 606 10 32 18 not Revenue by Payor Certain groups of patients receive funds to pay the cost of their care from a common source. The following table sets forth sources of net patient revenues for the periods indicated: Three Months Ended June 30 Six Months Ended June 30 Source 2018 2017 2018 2017 Medicare 35 % 35 % 36 % 35 % Managed Care 12 % 13 % 12 % 13 % Medicaid 26 % 26 % 26 % 26 % Private Pay and Other 27 % 26 % 26 % 26 % Total 100 % 100 % 100 % 100 % The Company determines the transaction price based on established billing rates reduced by contractual adjustments provided to third $1,064,000 $2,023,000 three six June 30, 2018, $1,055,000 $2,233,000 three six June 30, 2017, Medicare covers skilled nursing services for beneficiaries who require nursing care and/or rehabilitation services following a hospitalization of at least three For homecare services, Medicare pays based on the acuity level of the patient and based on episodes of care. An episode of care is defined as a length of care up to 60 60% not Medicaid is operated by individual states with the financial participation of the federal government. The states in which we operate currently use prospective cost–based reimbursement systems. Under cost–based reimbursement systems, the skilled nursing facility is reimbursed for the reasonable direct and indirect allowable costs it incurred in a base year in providing routine resident care services as defined by the program. Private pay, managed care, and other payment sources include commercial insurance, individual patient funds, managed care plans and the Veterans Administration. Private paying patients, private insurance carriers and the Veterans Administration generally pay based on the healthcare facilities charges or specifically negotiated contracts. For private pay patients in skilled nursing, assisted living and independent living facilities, the Company bills for room and board charges, with the remittance being due on receipt of the statement and generally by the 10th Certain managed care payors for homecare services pay on a per-visit basis. This non-episodic based revenue is recorded on an accrual basis based upon the date of services at amounts equal to its established or estimated per-visit rates. Third Party Payors Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. Noncompliance with such laws and regulations can be subject to regulatory actions including fines, penalties, and exclusion from the Medicare and Medicaid programs. We believe that we are in compliance with all applicable laws and regulations. Medicare and Medicaid program revenues, as well as certain Managed Care program revenues, are subject to audit and retroactive adjustment by government representatives or their agents. The Medicare PPS methodology requires that patients be assigned to Resource Utilization Groups ("RUGs") based on the acuity level of the patient to determine the amount paid to us for patient services. The assignment of patients to the various RUG categories is subject to post–payment review by Medicare intermediaries or their agents. Settlements with third not no not $17,218,000 $17,389,000 June 30, 2018 December 31, 2017, |
Note 4 - Other Revenues
Note 4 - Other Revenues | 6 Months Ended |
Jun. 30, 2018 | |
Notes to Financial Statements | |
Other Revenues [Text Block] | N ote 4 – Other Revenues Revenues from rental income include health care real estate properties owned by us and leased to third third third Other revenues include the following: Three Months Ended June 30 Six Months Ended June 30 (in thousands) 2018 2017 2018 2017 Rental income $ 5,553 $ 5,515 $ 11,086 $ 11,001 Management and accounting services fees 3,738 3,752 7,446 7,611 Insurance services 1,955 2,087 3,646 3,644 Other 242 256 579 638 Total other revenues $ 11,488 $ 11,610 $ 22,757 $ 22,894 Management Fees from National We manage five three six June 30, 2018, $1,038,000 $2,053,000 three six June 30, 2017, $989,000 $1,925,000 Insurance Services For workers’ compensation insurance services, the premium revenues reflected in the interim condensed consolidated statements of operations for the three six June 30, 2018 $1,282,000 $2,300,000, three six June 30, 2017, $1,409,000 $2,688,000. For professional liability insurance services, the premium revenues reflected in the interim condensed consolidated statements of operations for the three six June 30, 2018 $673,000 $1,346,000, three six June 30, 2017 $678,000 $956,000, |
Note 5 - Non-operating Income
Note 5 - Non-operating Income | 6 Months Ended |
Jun. 30, 2018 | |
Notes to Financial Statements | |
Other Nonoperating Income and Expense [Text Block] | N ote 5 – Non – Operating Income Non–operating income includes equity in earnings (losses) of unconsolidated investments, dividends and other realized gains and losses on marketable securities, interest income, and unrealized losses on our equity marketable securities. Our most significant equity method investment is a 75.1% three six June 30, 2018, $136,000 $8,364,000, 15 Contingencies and Commitments Three Months Ended June 30 Six Months Ended June 30 (in thousands) 2018 2017 2018 2017 Equity in earnings (losses) of unconsolidated investments $ 2,001 $ 1,854 $ (4,584 ) $ 3,380 Dividends and net realized gains on sales of securities 1,795 1,899 3,597 3,623 Interest income 1,858 1,436 3,576 2,954 Total non-operating income $ 5,654 $ 5,189 $ 2,589 $ 9,957 |
Note 6 - Business Segments
Note 6 - Business Segments | 6 Months Ended |
Jun. 30, 2018 | |
Notes to Financial Statements | |
Segment Reporting Disclosure [Text Block] | Note 6 – Business Segments The Company has two 1 2 The Company also reports an “all other” category that includes revenues from rental income, management and accounting services fees, insurance services, and costs of the corporate office. For additional information on these reportable segments see Note 2 Summary of Significant Accounting Policies. The Company’s CODM evaluates performance and allocates capital resources to each segment based on an operating model that is designed to improve the quality of patient care and profitability of the Company while enhancing long-term shareholder value. The CODM does not not The following table sets forth the Company’s unaudited interim condensed consolidated statements of operations by business segment (in thousands Three Months Ended June 30, 2018 Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 215,617 $ 15,037 $ - $ 230,654 Other revenues 181 - 11,307 11,488 Net operating revenues 215,798 15,037 11,307 242,142 Costs and expenses: Salaries, wages and benefits 128,115 8,611 8,740 145,466 Other operating 56,069 4,740 1,780 62,589 Rent 8,267 485 1,520 10,272 Depreciation and amortization 9,571 44 782 10,397 Interest 383 - 870 1,253 Total costs and expenses 202,405 13,880 13,692 229,977 Income (loss) from operations 13,393 1,157 (2,385 ) 12,165 Non-operating income - - 5,654 5,654 Unrealized gains on marketable equity securities - - 12,448 12,448 Income before income taxes $ 13,393 $ 1,157 $ 15,717 $ 30,267 Three Months Ended June 30, 2017 (As adjusted) Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 211,057 $ 16,028 $ - $ 227,085 Other revenues 225 - 11,385 11,610 Net operating revenues 211,282 16,028 11,385 238,695 Costs and expenses: Salaries, wages and benefits 125,614 8,615 8,455 142,684 Other operating 55,227 5,058 1,809 62,094 Rent 8,257 499 1,323 10,079 Depreciation and amortization 9,396 39 1,046 10,481 Interest 436 - 783 1,219 Total costs and expenses 198,930 14,211 13,416 226,557 Income (loss) from operations 12,352 1,817 (2,031 ) 12,138 Non-operating income - - 5,189 5,189 Income before income taxes $ 12,352 $ 1,817 $ 3,158 $ 17,327 Six Months Ended June 30, 2018 Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 431,968 $ 30,378 $ - $ 462,346 Other revenues 451 - 22,306 22,757 Net operating revenues 432,419 30,378 22,306 485,103 Costs and expenses: Salaries, wages and benefits 251,495 16,642 17,424 285,561 Other operating 113,904 10,019 3,838 127,761 Rent 16,524 973 3,004 20,501 Depreciation and amortization 19,032 82 1,625 20,739 Interest 780 - 1,713 2,493 Total costs and expenses 401,735 27,716 27,604 457,055 Income (loss) from operations 30,684 2,662 (5,298 ) 28,048 Non-operating income - - 2,589 2,589 Unrealized losses on marketable equity securities - - (3,069 ) (3,069 ) Income (loss) before income taxes $ 30,684 $ 2,662 $ (5,778 ) $ 27,568 Six Months Ended June 30, 2017 (As adjusted) Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 422,497 $ 31,842 $ - $ 454,339 Other revenues 451 - 22,443 22,894 Net operating revenues 422,948 31,842 22,443 477,233 Costs and expenses: Salaries, wages and benefits 245,238 16,442 19,059 280,739 Other operating 111,392 10,193 3,687 125,272 Rent 16,424 987 2,756 20,167 Depreciation and amortization 18,605 80 2,091 20,776 Interest 886 - 1,391 2,277 Total costs and expenses 392,545 27,702 28,984 449,231 Income (loss) from operations 30,403 4,140 (6,541 ) 28,002 Non-operating income - - 9,957 9,957 Income before income taxes $ 30,403 $ 4,140 $ 3,416 $ 37,959 |
Note 7 - Long-term Leases
Note 7 - Long-term Leases | 6 Months Ended |
Jun. 30, 2018 | |
Notes to Financial Statements | |
Leases of Lessee Disclosure [Text Block] | Note 7 – 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, 2018 December 31, 2017 (in thousands) Buildings and personal property $ 39,032 $ 39,032 Accumulated amortization (17,008 ) (15,045 ) $ 22,024 $ 23,987 Operating Leases The Company leases from National Health Investors, Inc. (“NHI”) the real property of 35 seven three two $34,200,000 4% $9,478,000 $9,314,000 three June 30, 2018 2017, $18,956,000 $18,628,000 six June 30, 2018 2017, Minimum Lease Payments The approximate future minimum lease payments required under all leases that have remaining non-cancelable lease terms at June 30, 2018 Operating Leases Capital Leases (in thousands) 2019 $ 34,200 $ 5,200 2020 34,200 5,200 2021 34,200 5,200 2022 34,200 5,200 2023 34,200 5,200 Thereafter 125,450 3,467 Total minimum lease payments $ 296,450 $ 29,467 Less: Amounts representing interest (4,539 ) Present value of minimum lease payments 24,928 Less: Current portion (3,808 ) Long-term capital lease obligations $ 21,120 |
Note 8 - Earnings Per Share
Note 8 - Earnings Per Share | 6 Months Ended |
Jun. 30, 2018 | |
Notes to Financial Statements | |
Earnings Per Share [Text Block] | Note 8 – 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 (in thousands, except for share and per share amounts) : Three Months Ended June 30 Six Months Ended June 30 2018 2017 2018 2017 Basic: Weighted average common shares outstanding 15,221,262 15,189,818 15,218,962 15,181,700 Net income attributable to National HealthCare Corporation $ 22,461 $ 10,655 $ 19,670 $ 23,383 Earnings per common share, basic $ 1.48 $ 0.70 $ 1.29 $ 1.54 Diluted: Weighted average common shares outstanding 15,221,262 15,189,818 15,218,962 15,181,700 Dilutive effect of stock options 7,043 30,630 5,996 34,636 Weighted average common shares outstanding 15,228,305 15,220,448 15,224,958 15,216,336 Net income attributable to National HealthCare Corporation $ 22,461 $ 10,655 $ 19,670 $ 23,383 Earnings per common share, diluted $ 1.47 $ 0.70 $ 1.29 $ 1.54 In the above table, options to purchase 1,137,015 1,124,689 six June 30, 2018 2017, |
Note 9 - Investments in Marketa
Note 9 - Investments in Marketable Securities | 6 Months Ended |
Jun. 30, 2018 | |
Notes to Financial Statements | |
Investments in Debt and Marketable Equity Securities (and Certain Trading Assets) Disclosure [Text Block] | Note 9 – Inve stments in Marketable Securities Our investments in marketable equity securities are carried at fair value with the changes in unrealized gains and losses recognized in our results of operations at each measurement date. Our investments in marketable debt securities are classified as available for sale securities and carried at fair value with the unrealized gains and losses recognized through accumulated other comprehensive income at each measurement date. 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 10 Fair Value Measurements Marketable securities and restricted marketable securities consist of the following (in thousands) June 30, 2018 December 31, 2017 Amortized Cost Fair Value Amortized Cost Fair Value Non-restricted investments: Marketable equity securities $ 30,176 $ 136,016 $ 30,176 $ 139,085 Restricted investments: Corporate debt securities 68,796 66,949 65,107 65,461 Commercial mortgage–backed securities 54,802 53,586 54,030 53,544 U.S. Treasury securities 21,516 20,676 21,685 21,172 State and municipal securities 24,334 23,738 26,455 26,218 $ 199,624 $ 300,965 $ 197,453 $ 305,480 Included in the marketable equity securities are the following (in thousands, except share amounts) : June 30, 2018 December 31, 2017 Shares Cost Fair Value Shares Cost Fair Value NHI Common Stock 1,630,642 $ 24,734 $ 120,146 1,630,642 $ 24,734 $ 122,918 The amortized cost and estimated fair value of the marketable debt securities classified as available for sale, by contractual maturity, are as follows (in thousands) June 30, 2018 December 31, 2017 Cost Fair Value Cost Fair Value Maturities: Within 1 year $ 18,660 $ 18,627 $ 18,492 $ 18,499 1 to 5 years 80,101 78,615 70,331 70,157 6 to 10 years 68,842 65,862 77,657 76,943 Over 10 years 1,845 1,845 797 796 $ 169,448 $ 164,949 $ 167,277 $ 166,395 Gross unrealized gains related to marketable equity securities are $105,851,000 $108,933,000 June 30, 2018 December 31, 2017, $11,000 $24,000 June 30, 2018 December 31, 2017, three six June 30, 2018, $12,448,000 $3,069,000, Gross unrealized gains related to available for sale marketable debt securities are $110,000 $823,000 June 30, 2018 December 31, 2017, $4,609,000 $1,705,000 June 30, 2018 December 31, 2017, For the marketable securities in gross unrealized loss positions, (a) it is more likely than not not no six June 30, 2018 December 31, 2017. Proceeds from the sale of available for sale marketable debt securities during the six June 30, 2018 2017 $4,399,000 $44,756,000, $25,000 $238,000 six June 30, 2018 2017, No six June 30, 2018 2017, |
Note 10 - Fair Value Measuremen
Note 10 - Fair Value Measurements | 6 Months Ended |
Jun. 30, 2018 | |
Notes to Financial Statements | |
Fair Value Disclosures [Text Block] | Note 10 – 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 may Level 1 Level 2 not Level 3 no 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. The following table summarizes fair value measurements by level at June 30, 2018 December 31, 2017 (in thousands) Fair Value Measurements Using June 30, 2018 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 $ 59,322 $ 59,322 $ – $ – Restricted cash and cash equivalents 9,549 9,549 – – Marketable equity securities 136,016 136,016 – – Corporate debt securities 66,949 43,803 23,146 – Mortgage–backed securities 53,586 – 53,586 – U.S. Treasury securities 20,676 20,676 – – State and municipal securities 23,738 – 23,738 – Total financial assets $ 369,836 $ 269,366 $ 100,470 $ – Fair Value Measurements Using December 31, 2017 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 $ 59,118 $ 59,118 $ – $ – Restricted cash and cash equivalents 8,303 8,303 – – Marketable equity securities 139,085 139,085 – – Corporate debt securities 65,461 43,073 22,388 – Mortgage-backed securities 53,544 – 53,544 – U.S. Treasury securities 21,172 21,172 – – State and municipal securities 26,218 – 26,218 – Total financial assets $ 372,901 $ 270,751 $ 102,150 $ – |
Note 11 - Long-term Debt
Note 11 - Long-term Debt | 6 Months Ended |
Jun. 30, 2018 | |
Notes to Financial Statements | |
Debt Disclosure [Text Block] | Note 1 1 – Long – Term Debt Long–term debt consists of the following: Weighted Average Interest Rate Maturities June 30, 2018 December 31, 2017 Variable (dollars in thousands) Credit Facility, interest payable monthly 3.5% 2020 $ 75,000 $ 90,000 Unsecured term note payable to National, interest payable quarterly, principal payable at maturity 4.3% 2028 10,000 10,000 85,000 100,000 Less current portion – – $ 85,000 $ 100,000 $1 50 ,000,000 During the second 2018, $175 $150 five October 2020). 1.40% 0.40%. |
Note 12 - Stock Repurchase Prog
Note 12 - Stock Repurchase Program | 6 Months Ended |
Jun. 30, 2018 | |
Notes to Financial Statements | |
Treasury Stock [Text Block] | Note 1 2 - Stock Repurchase Program In August 2017, $25 six June 30, 2018, 14,506 $867,000. |
Note 13 - Stock-based Compensat
Note 13 - Stock-based Compensation | 6 Months Ended |
Jun. 30, 2018 | |
Notes to Financial Statements | |
Disclosure of Compensation Related Costs, Share-based Payments [Text Block] | Note 1 3 – S tock – Based Compensation NHC recognizes stock–based compensation expense for all stock options granted over the requisite service period using the fair value at the date of grant using the Black–Scholes pricing model. Stock–based compensation totaled $749,000 $740,000 three June 30, 2018 2017, $1,177,000 $832,000 six June 30, 2018 2017, At June 30, 2018, $6,329,000 four Stock Options The following table summarizes the significant assumptions used to value the options granted for the six June 30, 2018 December 31, 2017. 2018 2017 Risk–free interest rate 2.46 % 2.08 % Expected volatility 16.1 % 16.6 % Expected life, in years 3.0 4.8 Expected dividend yield 3.29 % 3.10 % The following table summarizes our outstanding stock options for the six June 30, 2018 December 31, 2017. Number of Shares Weighted Average Exercise Price Aggregate Intrinsic Value Options outstanding at January 1, 2017 177,959 $ 55.48 $ – Options granted 1,125,443 72.96 – Options exercised (48,995 ) 51.25 – Options cancelled (15,000 ) 72.94 – Options outstanding at December 31, 2017 1,239,407 71.19 – Options granted 111,240 61.40 – Options exercised (33,526 ) 51.25 – Options cancelled (20,000 ) 72.94 – Options outstanding at June 30, 2018 1,297,121 $ 70.84 $ 2,167,000 Options vested at June 30, 2018 210,881 $ 63.35 $ 1,613,000 Options Outstanding June 30, 2018 Exercise Prices Weighted Average Exercise Price Weighted Average Remaining Contractual Life in Years 218,846 $52.93 - $62.78 $ 59.77 2.9 1,078,275 $72.94 72.94 3.7 1,297,121 $ 70.84 3.6 |
Note 14 - Income Taxes
Note 14 - Income Taxes | 6 Months Ended |
Jun. 30, 2018 | |
Notes to Financial Statements | |
Income Tax Disclosure [Text Block] | Note 1 4 – Income Taxes The income tax provision for the three June 30, 2018 $7,892,000 26.1% three June 30, 2017 $6,758,000 39.0% three June 30, 2017 $146,200 $84,000 $123,000 The income tax provision for the six June 30, 2018 $8,092,000 29.4% six June 30, 2018 $881,000 3.2% six six June 30, 2018 $3,069,000 2018, not six June 30, 2017 $14,757,000 38.9% six June 30, 2017 $321,000 $133,400 $244,000 On December 22, 2017, 2017 "2017 No. 118 118" 2017 December 31, 2017, $8,488,000, June 30, 2018. 2018. Interest and penalties expense related to U.S. federal and state income tax returns are included within income tax expense. The Company is no 2014 |
Note 15 - Contingencies and Com
Note 15 - Contingencies and Commitments | 6 Months Ended |
Jun. 30, 2018 | |
Notes to Financial Statements | |
Commitments and Contingencies Disclosure [Text Block] | Note 1 5 – 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 $94,808,000 $93,275,000 June 30, 2018 December 31, 2017, 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 $1,000,000 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, 2018, 63 Insurance coverage for both periods includes both primary policies and excess policies. The primary coverage is in the amount of $1.0 $3.0 2017 2018, $9.0 third Financing Commitments In conjunction with our management contract with National, we have entered into a line of credit arrangement whereby we may $2,000,000. June 30, 2018, not Caris HealthCare, L.P. Investigation and Related Litigation On December 9, 2014, qui tam 75.1% A qui tam May 22, 2014, United States of America, State of Tennessee, and State of Virginia ex rel. Barbara Hinkle v. Caris Healthcare, L.P. No. 3:14–cv–212 On June 16, 2016, qui tam June 20, 2016, October 11, 2016, June 2013 December 2013 April 2010 June 2013. On March 9, 2018, 90 June 25, 2018, $8.5 April 1, 2010, December 31, 2013. June 28, 2018, Nutritional Support Services, L.P., Qui Tam Litigation On June 19, 2018, U.S. ex rel. McClain v. Nutritional Support Services, L.P., No. 6:17 2608 not April 16, 2018, 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, 2018 | |
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. The consolidated financial statements include the accounts of all entities controlled by NHC. The Company presents noncontrolling interest within the equity section of its consolidated balance sheets. The Company presents the amount of consolidated net income (loss) that is attributable to NHC and the noncontrolling interest in its consolidated statements of operations. We assume that users of these interim condensed consolidated financial statements have read or have access to the audited December 31, 2017 may not may |
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 May 2014, No. 2014–09 five 1. 2. 3. 4. 5. For a public entity, this update is effective for annual reporting periods beginning after December 15, 2017, On January 1, 2018, No. 2014 09 No. 2014 09. not No. 2014 09 no three six June 30, 2017 January 1, 2018: Consolidated Statements of Operations ( in thousands Three Months Ended June 30, 2017 As Previously Reported Effect of Accounting Change As Adjusted Net patient revenues $ 227,847 $ (762 ) $ 227,085 Net operating revenues 239,457 (762 ) 238,695 Other operating expenses 62,856 (762 ) 62,094 Total costs and expenses 227,319 (762 ) 226,557 Net income $ 10,569 $ - $ 10,569 Six Months Ended June 30, 2017 As Previously Reported Effect of Accounting Change As Adjusted Net patient revenues $ 455,806 $ (1,467 ) $ 454,339 Net operating revenues 478,700 (1,467 ) 477,233 Other operating expenses 126,739 (1,467 ) 125,272 Total costs and expenses 450,698 (1,467 ) 449,231 Net income $ 23,202 $ - $ 23,202 In January 2016, No. 2016–01, 825 No. 2016–01 No. 2016–01 January 1, 2018, No. 2016 01 No. 2016 01 $68,073,000 three six June 30, 2018, $12,448,000 $3,069,000, No. 2016 01 In August 2016, No. 2016 15, No. 2016 15 eight 1 2 January 1, 2018, No. 2016 15 not In May 2017, No. 2017 09, 718 No. 2017 09 718. January 1, 2018, No. 2017 09 not In February 2018, No. 2018 02, No. 2018 02 2017 January 1, 2018, No. 2018 02. $128,000, Recent Accounting Guidance Not In February 2016, No. 2016 02, 842 December 15, 2018, In June 2016, No. 2016 13, No. 2016 13 December 15, 2019, December 15, 2018. |
Segment Reporting, Policy [Policy Text Block] | Segment Reporting In accordance with the provisions of ASC 280, two 1 2 6 |
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, excluding stock-based compensation, which were $6,573,000 $13,250,000 three six June 30, 2018, $6,390,000 $15,262,000 three six June 30, 2017, |
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 3 15 not 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, 2018, 63 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 may 10% 90% 40% Non-refundable fees are included as a component of the transaction price and are amortized 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 not June 30, 2018 December 31, 2017 $8,668,000 $8,827,000, |
Other Noncurrent Liabilities [Policy Text Block] | Other Noncurrent Liabilities Other noncurrent liabilities include reserves primarily related to various uncertain income tax positions. |
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% not |
Noncontrolling Interest, Policy [Policy Text Block] | Noncontrolling Interest The noncontrolling interest in a subsidiary is presented within total equity in the Company's interim condensed consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to NHC in its interim condensed consolidated statements of operations. The Company’s earnings per share is calculated based on net income attributable to NHC’s stockholders. The carrying amount of the noncontrolling interest is adjusted based on an allocation of subsidiary earnings based on ownership interest. |
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 may not |
Reclassification, Policy [Policy Text Block] | Prior Period Classifications Certain amounts in prior periods have been reclassified to conform with current period presentation. |
Note 2 - Summary of Significa25
Note 2 - Summary of Significant Accounting Policies (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Notes Tables | |
Schedule of Prospective Adoption of New Accounting Pronouncements [Table Text Block] | Three Months Ended June 30, 2017 As Previously Reported Effect of Accounting Change As Adjusted Net patient revenues $ 227,847 $ (762 ) $ 227,085 Net operating revenues 239,457 (762 ) 238,695 Other operating expenses 62,856 (762 ) 62,094 Total costs and expenses 227,319 (762 ) 226,557 Net income $ 10,569 $ - $ 10,569 Six Months Ended June 30, 2017 As Previously Reported Effect of Accounting Change As Adjusted Net patient revenues $ 455,806 $ (1,467 ) $ 454,339 Net operating revenues 478,700 (1,467 ) 477,233 Other operating expenses 126,739 (1,467 ) 125,272 Total costs and expenses 450,698 (1,467 ) 449,231 Net income $ 23,202 $ - $ 23,202 |
Note 3 - Net Patient Revenues (
Note 3 - Net Patient Revenues (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Notes Tables | |
Disaggregation of Revenue [Table Text Block] | Three Months Ended June 30 Six Months Ended June 30 (in thousands) 2018 2017 2018 2017 Net patient revenues: Inpatient services $ 215,617 $ 211,057 $ 431,968 $ 422,497 Homecare 15,037 16,028 30,378 31,842 Total net patient revenue $ 230,654 $ 227,085 $ 462,346 $ 454,339 Three Months Ended June 30 Six Months Ended June 30 Source 2018 2017 2018 2017 Medicare 35 % 35 % 36 % 35 % Managed Care 12 % 13 % 12 % 13 % Medicaid 26 % 26 % 26 % 26 % Private Pay and Other 27 % 26 % 26 % 26 % Total 100 % 100 % 100 % 100 % |
Note 4 - Other Revenues (Tables
Note 4 - Other Revenues (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Notes Tables | |
Schedule of Other Revenues [Table Text Block] | Three Months Ended June 30 Six Months Ended June 30 (in thousands) 2018 2017 2018 2017 Rental income $ 5,553 $ 5,515 $ 11,086 $ 11,001 Management and accounting services fees 3,738 3,752 7,446 7,611 Insurance services 1,955 2,087 3,646 3,644 Other 242 256 579 638 Total other revenues $ 11,488 $ 11,610 $ 22,757 $ 22,894 |
Note 5 - Non-operating Income (
Note 5 - Non-operating Income (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Notes Tables | |
Schedule of Other Nonoperating Income, by Component [Table Text Block] | Three Months Ended June 30 Six Months Ended June 30 (in thousands) 2018 2017 2018 2017 Equity in earnings (losses) of unconsolidated investments $ 2,001 $ 1,854 $ (4,584 ) $ 3,380 Dividends and net realized gains on sales of securities 1,795 1,899 3,597 3,623 Interest income 1,858 1,436 3,576 2,954 Total non-operating income $ 5,654 $ 5,189 $ 2,589 $ 9,957 |
Note 6 - Business Segments (Tab
Note 6 - Business Segments (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Notes Tables | |
Schedule of Segment Reporting Information, by Segment [Table Text Block] | Three Months Ended June 30, 2018 Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 215,617 $ 15,037 $ - $ 230,654 Other revenues 181 - 11,307 11,488 Net operating revenues 215,798 15,037 11,307 242,142 Costs and expenses: Salaries, wages and benefits 128,115 8,611 8,740 145,466 Other operating 56,069 4,740 1,780 62,589 Rent 8,267 485 1,520 10,272 Depreciation and amortization 9,571 44 782 10,397 Interest 383 - 870 1,253 Total costs and expenses 202,405 13,880 13,692 229,977 Income (loss) from operations 13,393 1,157 (2,385 ) 12,165 Non-operating income - - 5,654 5,654 Unrealized gains on marketable equity securities - - 12,448 12,448 Income before income taxes $ 13,393 $ 1,157 $ 15,717 $ 30,267 Three Months Ended June 30, 2017 (As adjusted) Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 211,057 $ 16,028 $ - $ 227,085 Other revenues 225 - 11,385 11,610 Net operating revenues 211,282 16,028 11,385 238,695 Costs and expenses: Salaries, wages and benefits 125,614 8,615 8,455 142,684 Other operating 55,227 5,058 1,809 62,094 Rent 8,257 499 1,323 10,079 Depreciation and amortization 9,396 39 1,046 10,481 Interest 436 - 783 1,219 Total costs and expenses 198,930 14,211 13,416 226,557 Income (loss) from operations 12,352 1,817 (2,031 ) 12,138 Non-operating income - - 5,189 5,189 Income before income taxes $ 12,352 $ 1,817 $ 3,158 $ 17,327 Six Months Ended June 30, 2018 Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 431,968 $ 30,378 $ - $ 462,346 Other revenues 451 - 22,306 22,757 Net operating revenues 432,419 30,378 22,306 485,103 Costs and expenses: Salaries, wages and benefits 251,495 16,642 17,424 285,561 Other operating 113,904 10,019 3,838 127,761 Rent 16,524 973 3,004 20,501 Depreciation and amortization 19,032 82 1,625 20,739 Interest 780 - 1,713 2,493 Total costs and expenses 401,735 27,716 27,604 457,055 Income (loss) from operations 30,684 2,662 (5,298 ) 28,048 Non-operating income - - 2,589 2,589 Unrealized losses on marketable equity securities - - (3,069 ) (3,069 ) Income (loss) before income taxes $ 30,684 $ 2,662 $ (5,778 ) $ 27,568 Six Months Ended June 30, 2017 (As adjusted) Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 422,497 $ 31,842 $ - $ 454,339 Other revenues 451 - 22,443 22,894 Net operating revenues 422,948 31,842 22,443 477,233 Costs and expenses: Salaries, wages and benefits 245,238 16,442 19,059 280,739 Other operating 111,392 10,193 3,687 125,272 Rent 16,424 987 2,756 20,167 Depreciation and amortization 18,605 80 2,091 20,776 Interest 886 - 1,391 2,277 Total costs and expenses 392,545 27,702 28,984 449,231 Income (loss) from operations 30,403 4,140 (6,541 ) 28,002 Non-operating income - - 9,957 9,957 Income before income taxes $ 30,403 $ 4,140 $ 3,416 $ 37,959 |
Note 7 - Long-term Leases (Tabl
Note 7 - Long-term Leases (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Notes Tables | |
Schedule of Capital Leased Assets [Table Text Block] | June 30, 2018 December 31, 2017 (in thousands) Buildings and personal property $ 39,032 $ 39,032 Accumulated amortization (17,008 ) (15,045 ) $ 22,024 $ 23,987 |
Schedule of Future Minimum Lease Payments for Capital Leases [Table Text Block] | Operating Leases Capital Leases (in thousands) 2019 $ 34,200 $ 5,200 2020 34,200 5,200 2021 34,200 5,200 2022 34,200 5,200 2023 34,200 5,200 Thereafter 125,450 3,467 Total minimum lease payments $ 296,450 $ 29,467 Less: Amounts representing interest (4,539 ) Present value of minimum lease payments 24,928 Less: Current portion (3,808 ) Long-term capital lease obligations $ 21,120 |
Note 8 - Earnings Per Share (Ta
Note 8 - Earnings Per Share (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Notes Tables | |
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block] | Three Months Ended June 30 Six Months Ended June 30 2018 2017 2018 2017 Basic: Weighted average common shares outstanding 15,221,262 15,189,818 15,218,962 15,181,700 Net income attributable to National HealthCare Corporation $ 22,461 $ 10,655 $ 19,670 $ 23,383 Earnings per common share, basic $ 1.48 $ 0.70 $ 1.29 $ 1.54 Diluted: Weighted average common shares outstanding 15,221,262 15,189,818 15,218,962 15,181,700 Dilutive effect of stock options 7,043 30,630 5,996 34,636 Weighted average common shares outstanding 15,228,305 15,220,448 15,224,958 15,216,336 Net income attributable to National HealthCare Corporation $ 22,461 $ 10,655 $ 19,670 $ 23,383 Earnings per common share, diluted $ 1.47 $ 0.70 $ 1.29 $ 1.54 |
Note 9 - Investments in Marke32
Note 9 - Investments in Marketable Securities (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Notes Tables | |
Available-for-sale Securities [Table Text Block] | June 30, 2018 December 31, 2017 Amortized Cost Fair Value Amortized Cost Fair Value Non-restricted investments: Marketable equity securities $ 30,176 $ 136,016 $ 30,176 $ 139,085 Restricted investments: Corporate debt securities 68,796 66,949 65,107 65,461 Commercial mortgage–backed securities 54,802 53,586 54,030 53,544 U.S. Treasury securities 21,516 20,676 21,685 21,172 State and municipal securities 24,334 23,738 26,455 26,218 $ 199,624 $ 300,965 $ 197,453 $ 305,480 |
Schedule of Available-for-sale Securities Reconciliation [Table Text Block] | June 30, 2018 December 31, 2017 Shares Cost Fair Value Shares Cost Fair Value NHI Common Stock 1,630,642 $ 24,734 $ 120,146 1,630,642 $ 24,734 $ 122,918 |
Investments Classified by Contractual Maturity Date [Table Text Block] | June 30, 2018 December 31, 2017 Cost Fair Value Cost Fair Value Maturities: Within 1 year $ 18,660 $ 18,627 $ 18,492 $ 18,499 1 to 5 years 80,101 78,615 70,331 70,157 6 to 10 years 68,842 65,862 77,657 76,943 Over 10 years 1,845 1,845 797 796 $ 169,448 $ 164,949 $ 167,277 $ 166,395 |
Note 10 - Fair Value Measurem33
Note 10 - Fair Value Measurements (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Notes Tables | |
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis [Table Text Block] | Fair Value Measurements Using June 30, 2018 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 $ 59,322 $ 59,322 $ – $ – Restricted cash and cash equivalents 9,549 9,549 – – Marketable equity securities 136,016 136,016 – – Corporate debt securities 66,949 43,803 23,146 – Mortgage–backed securities 53,586 – 53,586 – U.S. Treasury securities 20,676 20,676 – – State and municipal securities 23,738 – 23,738 – Total financial assets $ 369,836 $ 269,366 $ 100,470 $ – Fair Value Measurements Using December 31, 2017 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 $ 59,118 $ 59,118 $ – $ – Restricted cash and cash equivalents 8,303 8,303 – – Marketable equity securities 139,085 139,085 – – Corporate debt securities 65,461 43,073 22,388 – Mortgage-backed securities 53,544 – 53,544 – U.S. Treasury securities 21,172 21,172 – – State and municipal securities 26,218 – 26,218 – Total financial assets $ 372,901 $ 270,751 $ 102,150 $ – |
Note 11 - Long-term Debt (Table
Note 11 - Long-term Debt (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Notes Tables | |
Schedule of Debt [Table Text Block] | Weighted Average Interest Rate Maturities June 30, 2018 December 31, 2017 Variable (dollars in thousands) Credit Facility, interest payable monthly 3.5% 2020 $ 75,000 $ 90,000 Unsecured term note payable to National, interest payable quarterly, principal payable at maturity 4.3% 2028 10,000 10,000 85,000 100,000 Less current portion – – $ 85,000 $ 100,000 |
Note 13 - Stock-based Compens35
Note 13 - Stock-based Compensation (Tables) | 6 Months Ended |
Jun. 30, 2018 | |
Notes Tables | |
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions [Table Text Block] | 2018 2017 Risk–free interest rate 2.46 % 2.08 % Expected volatility 16.1 % 16.6 % Expected life, in years 3.0 4.8 Expected dividend yield 3.29 % 3.10 % |
Share-based Compensation, Stock Options, Activity [Table Text Block] | Number of Shares Weighted Average Exercise Price Aggregate Intrinsic Value Options outstanding at January 1, 2017 177,959 $ 55.48 $ – Options granted 1,125,443 72.96 – Options exercised (48,995 ) 51.25 – Options cancelled (15,000 ) 72.94 – Options outstanding at December 31, 2017 1,239,407 71.19 – Options granted 111,240 61.40 – Options exercised (33,526 ) 51.25 – Options cancelled (20,000 ) 72.94 – Options outstanding at June 30, 2018 1,297,121 $ 70.84 $ 2,167,000 Options vested at June 30, 2018 210,881 $ 63.35 $ 1,613,000 |
Schedule of Share-based Compensation, Shares Authorized under Stock Option Plans, by Exercise Price Range [Table Text Block] | Options Outstanding June 30, 2018 Exercise Prices Weighted Average Exercise Price Weighted Average Remaining Contractual Life in Years 218,846 $52.93 - $62.78 $ 59.77 2.9 1,078,275 $72.94 72.94 3.7 1,297,121 $ 70.84 3.6 |
Note 1 - Description of Busin36
Note 1 - Description of Business (Details Textual) | Jun. 30, 2018 |
Number of Skilled Nursing Centers | 76 |
Number of Beds | 9,629 |
Number of Assisted Living Facilities | 24 |
Number of Independent Living Facilities | 5 |
Number of Homecare Programs | 36 |
Number of States in which Entity Operates | 10 |
Note 2 - Summary of Significa37
Note 2 - Summary of Significant Accounting Policies (Details Textual) | 3 Months Ended | 6 Months Ended | ||||
Jun. 30, 2018USD ($) | Jun. 30, 2017USD ($) | Jun. 30, 2018USD ($) | Jun. 30, 2017USD ($) | Mar. 31, 2018 | Dec. 31, 2017USD ($) | |
Equity Securities, FV-NI, Unrealized Gain (Loss), Total | $ 12,448,000 | $ (3,069,000) | ||||
Number of Reportable Segments | 2 | |||||
Malpractice Loss Contingency, Number of Claims | 63 | 63 | 63 | |||
Customer Refundable Fees | $ 8,668,000 | $ 8,668,000 | $ 8,827,000 | |||
Continuing Care Retirement Communities, Refund Obligation | 2,887,000 | $ 2,887,000 | 2,887,000 | |||
Refundable Advance Fees [Member] | ||||||
Nonrefundable Resident Entry Fee Percentage | 10.00% | |||||
Customer Refundable Fees | 8,668,000 | $ 8,668,000 | $ 8,827,000 | |||
Original Entry Fee [Member] | ||||||
Refundable Resident Entry Fee Percentage | 90.00% | |||||
Appreciation [Member] | ||||||
Appreciation of Apartment Over Original Residents Entry Fee Percentage | 40.00% | |||||
Building and Building Improvements [Member] | Minimum [Member] | ||||||
Property, Plant and Equipment, Useful Life | 20 years | |||||
Building and Building Improvements [Member] | Maximum [Member] | ||||||
Property, Plant and Equipment, Useful Life | 40 years | |||||
Equipment and Furniture [Member] | Minimum [Member] | ||||||
Property, Plant and Equipment, Useful Life | 3 years | |||||
Equipment and Furniture [Member] | Maximum [Member] | ||||||
Property, Plant and Equipment, Useful Life | 15 years | |||||
Corporate Office Costs [Member] | ||||||
General and Administrative Expense, Total | $ 6,573,000 | $ 6,390,000 | $ 13,250,000 | $ 15,262,000 | ||
Accounting Standards Update 2016-01 [Member] | ||||||
Reclassification of Net Unrealized Gains From AOCI To Retained Earnings | 68,073,000 | |||||
Accounting Standards Update 2018-02 [Member] | ||||||
Reclassification of Stranded Tax Effects From AOCI to Retained Earnings | $ 128,000 |
Note 2 - Summary of Significa38
Note 2 - Summary of Significant Accounting Policies - Effect of Accounting Change (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Net operating revenues | $ 242,142 | $ 238,695 | $ 485,103 | $ 477,233 |
Other operating expenses | 62,589 | 62,094 | 127,761 | 125,272 |
Total costs and expenses | 229,977 | 226,557 | 457,055 | 449,231 |
Net income | 22,375 | 10,569 | 19,476 | 23,202 |
Previously Reported [Member] | ||||
Net operating revenues | 239,457 | 478,700 | ||
Other operating expenses | 62,856 | 126,739 | ||
Total costs and expenses | 227,319 | 450,698 | ||
Net income | 10,569 | 23,202 | ||
Restatement Adjustment [Member] | ||||
Net operating revenues | (762) | (1,467) | ||
Other operating expenses | (762) | (1,467) | ||
Total costs and expenses | (762) | (1,467) | ||
Net income | ||||
Net Patient Revenues [Member] | ||||
Revenues | $ 230,654 | 227,085 | $ 462,346 | 454,339 |
Net Patient Revenues [Member] | Previously Reported [Member] | ||||
Revenues | 227,847 | 455,806 | ||
Net Patient Revenues [Member] | Restatement Adjustment [Member] | ||||
Revenues | $ (762) | $ (1,467) |
Note 3 - Net Patient Revenues39
Note 3 - Net Patient Revenues (Details Textual) - USD ($) | 3 Months Ended | 6 Months Ended | |||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | Dec. 31, 2017 | |
Provision for Doubtful Accounts | $ 1,064,000 | $ 1,055,000 | $ 2,023,000 | $ 2,233,000 | |
Medicare and Medicaid [Member] | |||||
Allowance for Doubtful Accounts Receivable, Ending Balance | $ 17,218,000 | $ 17,218,000 | $ 17,389,000 |
Note 3 - Net Patient Revenues -
Note 3 - Net Patient Revenues - Revenue Dissagregation (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Revenue, concentration percentage | 100.00% | 100.00% | 100.00% | 100.00% |
Net Patient Revenues [Member] | ||||
Net patient revenues | $ 230,654 | $ 227,085 | $ 462,346 | $ 454,339 |
Medicare [Member] | ||||
Revenue, concentration percentage | 35.00% | 35.00% | 36.00% | 35.00% |
Inpatient Services [Member] | Net Patient Revenues [Member] | ||||
Net patient revenues | $ 215,617 | $ 211,057 | $ 431,968 | $ 422,497 |
Managed Care [Member] | ||||
Revenue, concentration percentage | 12.00% | 13.00% | 12.00% | 13.00% |
Homecare [Member] | Net Patient Revenues [Member] | ||||
Net patient revenues | $ 15,037 | $ 16,028 | $ 30,378 | $ 31,842 |
Medicaid [Member] | ||||
Revenue, concentration percentage | 26.00% | 26.00% | 26.00% | 26.00% |
Private Pay and Other [Member] | ||||
Revenue, concentration percentage | 27.00% | 26.00% | 26.00% | 26.00% |
Note 4 - Other Revenues (Detail
Note 4 - Other Revenues (Details Textual) | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018USD ($) | Jun. 30, 2017USD ($) | Jun. 30, 2018USD ($) | Jun. 30, 2017USD ($) | |
Number of Skilled Nursing Centers | 76 | 76 | ||
Insurance Services Revenue, Total | $ 1,955,000 | $ 2,087,000 | $ 3,646,000 | $ 3,644,000 |
Workers Compensation Revenue [Member] | ||||
Insurance Services Revenue, Total | 1,282,000 | 1,409,000 | 2,300,000 | 2,688,000 |
Professional Liability Insurance [Member] | ||||
Insurance Services Revenue, Total | $ 673,000 | 678,000 | $ 1,346,000 | 956,000 |
National [Member] | ||||
Number of Skilled Nursing Centers | 5 | 5 | ||
Property Management Fee Revenue | $ 1,038,000 | $ 989,000 | $ 2,053,000 | $ 1,925,000 |
Note 4 - Other Revenues - Summa
Note 4 - Other Revenues - Summary of Other Revenues (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Rental income | $ 5,553 | $ 5,515 | $ 11,086 | $ 11,001 |
Management and accounting services fees | 3,738 | 3,752 | 7,446 | 7,611 |
Insurance services | 1,955 | 2,087 | 3,646 | 3,644 |
Other | 242 | 256 | 579 | 638 |
Total other revenues | $ 11,488 | $ 11,610 | $ 22,757 | $ 22,894 |
Note 5 - Non-operating Income43
Note 5 - Non-operating Income (Details Textual) - Caris [Member] - USD ($) | 3 Months Ended | 6 Months Ended | |
Jun. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | |
Equity Method Investment, Ownership Percentage | 75.10% | 75.10% | 75.10% |
Loss Contingency, Damages Paid, Value | $ 136,000 | $ 8,364,000 |
Note 5 - Non-operating Income -
Note 5 - Non-operating Income - Summary of Non-operating Income (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Equity in earnings (losses) of unconsolidated investments | $ 2,001 | $ 1,854 | $ (4,584) | $ 3,380 |
Dividends and net realized gains on sales of securities | 1,795 | 1,899 | 3,597 | 3,623 |
Interest income | 1,858 | 1,436 | 3,576 | 2,954 |
Total non-operating income | $ 5,654 | $ 5,189 | $ 2,589 | $ 9,957 |
Note 6 - Business Segments (Det
Note 6 - Business Segments (Details Textual) | 6 Months Ended |
Jun. 30, 2018 | |
Number of Operating Segments | 2 |
Number of Reportable Segments | 2 |
Note 6 - Business Segments - Su
Note 6 - Business Segments - Summary of Financial Information by Reporting Segment (Details) - USD ($) | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Revenues: | ||||
Other revenues | $ 11,488,000 | $ 11,610,000 | $ 22,757,000 | $ 22,894,000 |
Net operating revenues | 242,142,000 | 238,695,000 | 485,103,000 | 477,233,000 |
Costs and expenses: | ||||
Salaries, wages and benefits | 145,466,000 | 142,684,000 | 285,561,000 | 280,739,000 |
Other operating | 62,589,000 | 62,094,000 | 127,761,000 | 125,272,000 |
Rent | 10,272,000 | 10,079,000 | 20,501,000 | 20,167,000 |
Depreciation and amortization | 10,397,000 | 10,481,000 | 20,739,000 | 20,776,000 |
Interest | 1,253,000 | 1,219,000 | 2,493,000 | 2,277,000 |
Total costs and expenses | 229,977,000 | 226,557,000 | 457,055,000 | 449,231,000 |
Income (loss) from operations | 12,165,000 | 12,138,000 | 28,048,000 | 28,002,000 |
Non-operating income | 5,654,000 | 5,189,000 | 2,589,000 | 9,957,000 |
Unrealized gains on marketable equity securities | 12,448,000 | (3,069,000) | ||
Income before income taxes | 30,267,000 | 17,327,000 | 27,568,000 | 37,959,000 |
Net Patient Revenues [Member] | ||||
Revenues: | ||||
Net patient revenues | 230,654,000 | 227,085,000 | 462,346,000 | 454,339,000 |
Inpatient Services Segment [Member] | ||||
Revenues: | ||||
Other revenues | 181,000 | 225,000 | 451,000 | 451,000 |
Net operating revenues | 215,798,000 | 211,282,000 | 432,419,000 | 422,948,000 |
Costs and expenses: | ||||
Salaries, wages and benefits | 128,115,000 | 125,614,000 | 251,495,000 | 245,238,000 |
Other operating | 56,069,000 | 55,227,000 | 113,904,000 | 111,392,000 |
Rent | 8,267,000 | 8,257,000 | 16,524,000 | 16,424,000 |
Depreciation and amortization | 9,571,000 | 9,396,000 | 19,032,000 | 18,605,000 |
Interest | 383,000 | 436,000 | 780,000 | 886,000 |
Total costs and expenses | 202,405,000 | 198,930,000 | 401,735,000 | 392,545,000 |
Income (loss) from operations | 13,393,000 | 12,352,000 | 30,684,000 | 30,403,000 |
Non-operating income | ||||
Unrealized gains on marketable equity securities | ||||
Income before income taxes | 13,393,000 | 12,352,000 | 30,684,000 | 30,403,000 |
Inpatient Services Segment [Member] | Net Patient Revenues [Member] | ||||
Revenues: | ||||
Net patient revenues | 215,617,000 | 211,057,000 | 431,968,000 | 422,497,000 |
Homecare Services Segment [Member] | ||||
Revenues: | ||||
Other revenues | ||||
Net operating revenues | 15,037,000 | 16,028,000 | 30,378,000 | 31,842,000 |
Costs and expenses: | ||||
Salaries, wages and benefits | 8,611,000 | 8,615,000 | 16,642,000 | 16,442,000 |
Other operating | 4,740,000 | 5,058,000 | 10,019,000 | 10,193,000 |
Rent | 485,000 | 499,000 | 973,000 | 987,000 |
Depreciation and amortization | 44,000 | 39,000 | 82,000 | 80,000 |
Interest | ||||
Total costs and expenses | 13,880,000 | 14,211,000 | 27,716,000 | 27,702,000 |
Income (loss) from operations | 1,157,000 | 1,817,000 | 2,662,000 | 4,140,000 |
Non-operating income | ||||
Unrealized gains on marketable equity securities | ||||
Income before income taxes | 1,157,000 | 1,817,000 | 2,662,000 | 4,140,000 |
Homecare Services Segment [Member] | Net Patient Revenues [Member] | ||||
Revenues: | ||||
Net patient revenues | 15,037,000 | 16,028,000 | 30,378,000 | 31,842,000 |
Other Segments [Member] | ||||
Revenues: | ||||
Other revenues | 11,307,000 | 11,385,000 | 22,306,000 | 22,443,000 |
Net operating revenues | 11,307,000 | 11,385,000 | 22,306,000 | 22,443,000 |
Costs and expenses: | ||||
Salaries, wages and benefits | 8,740,000 | 8,455,000 | 17,424,000 | 19,059,000 |
Other operating | 1,780,000 | 1,809,000 | 3,838,000 | 3,687,000 |
Rent | 1,520,000 | 1,323,000 | 3,004,000 | 2,756,000 |
Depreciation and amortization | 782,000 | 1,046,000 | 1,625,000 | 2,091,000 |
Interest | 870,000 | 783,000 | 1,713,000 | 1,391,000 |
Total costs and expenses | 13,692,000 | 13,416,000 | 27,604,000 | 28,984,000 |
Income (loss) from operations | (2,385,000) | (2,031,000) | (5,298,000) | (6,541,000) |
Non-operating income | 5,654,000 | 5,189,000 | 2,589,000 | 9,957,000 |
Unrealized gains on marketable equity securities | 12,448,000 | (3,069,000) | ||
Income before income taxes | 15,717,000 | 3,158,000 | (5,778,000) | 3,416,000 |
Other Segments [Member] | Net Patient Revenues [Member] | ||||
Revenues: | ||||
Net patient revenues |
Note 7 - Long-term Leases (Deta
Note 7 - Long-term Leases (Details Textual) | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018USD ($) | Jun. 30, 2017USD ($) | Jun. 30, 2018USD ($) | Jun. 30, 2017USD ($) | |
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% | |||
Both NHI Lease Agreements [Member] | ||||
Operating Leases Percentage Rent Expense | $ 9,478,000 | $ 9,314,000 | $ 18,956,000 | $ 18,628,000 |
Note 7 - Long-term Leases - Fix
Note 7 - Long-term Leases - Fixed Assets Recorded Under Capital Leases (Details) - Buildings and Personal Property [Member] - USD ($) $ in Thousands | Jun. 30, 2018 | Dec. 31, 2017 |
Buildings and personal property | $ 39,032 | $ 39,032 |
Accumulated amortization | (17,008) | (15,045) |
Total capital leases | $ 22,024 | $ 23,987 |
Note 7 - Long-term Leases - Fut
Note 7 - Long-term Leases - Future Minimum Lease Payments (Details) - USD ($) $ in Thousands | Jun. 30, 2018 | Dec. 31, 2017 |
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 | |
2022, operating leases | 34,200 | |
2022, capital leases | 5,200 | |
2023, operating leases | 34,200 | |
2023, capital leases | 5,200 | |
Thereafter, operating leases | 125,450 | |
Thereafter, capital leases | 3,467 | |
Total minimum lease payments, operating leases | 296,450 | |
Total minimum lease payments, capital leases | 29,467 | |
Less: Amounts representing interest, capital leases | (4,539) | |
Present value of minimum lease payments, capital leases | 24,928 | |
Less: Current portion, capital leases | (3,808) | $ (3,696) |
Long-term capital lease obligations, capital leases | $ 21,120 | $ 23,052 |
Note 8 - Earnings Per Share (De
Note 8 - Earnings Per Share (Details Textual) - shares | 6 Months Ended | |
Jun. 30, 2018 | Jun. 30, 2017 | |
Employee Stock Option [Member] | ||
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount | 1,137,015 | 1,124,689 |
Note 8 - Earnings Per Share - S
Note 8 - Earnings Per Share - 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, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Basic: | ||||
Weighted average common shares outstanding (in shares) | 15,221,262 | 15,189,818 | 15,218,962 | 15,181,700 |
Net income attributable to National HealthCare Corporation | $ 22,461 | $ 10,655 | $ 19,670 | $ 23,383 |
Earnings per common share, basic (in dollars per share) | $ 1.48 | $ 0.70 | $ 1.29 | $ 1.54 |
Diluted: | ||||
Weighted average common shares outstanding (in shares) | 15,221,262 | 15,189,818 | 15,218,962 | 15,181,700 |
Weighted average common shares outstanding (in shares) | 15,228,305 | 15,220,448 | 15,224,958 | 15,216,336 |
Net income attributable to National HealthCare Corporation | $ 22,461 | $ 10,655 | $ 19,670 | $ 23,383 |
Earnings per common share, diluted (in dollars per share) | $ 1.47 | $ 0.70 | $ 1.29 | $ 1.54 |
Employee Stock Option [Member] | ||||
Diluted: | ||||
Dilutive effect of share-based awards (in shares) | 7,043 | 30,630 | 5,996 | 34,636 |
Note 9 - Investments in Marke52
Note 9 - Investments in Marketable Securities (Details Textual) - USD ($) | 3 Months Ended | 6 Months Ended | 12 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | Dec. 31, 2017 | |
Equity Securities Fv Ni Gross Unrealized Gain | $ 105,851,000 | $ 105,851,000 | $ 108,933,000 | ||
Equity Securities Fv Ni Gross Unrealized Loss | 11,000 | 11,000 | 24,000 | ||
Equity Securities, FV-NI, Unrealized Gain (Loss), Total | 12,448,000 | (3,069,000) | |||
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Gain, before Tax | 110,000 | 110,000 | 823,000 | ||
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Loss, before Tax | $ 4,609,000 | 4,609,000 | 1,705,000 | ||
Other than Temporary Impairment Losses, Investments, Available-for-sale Securities, Total | 0 | $ 0 | |||
Proceeds from Sale of Debt Securities, Available-for-sale | 4,399,000 | 44,756,000 | |||
Realized Investment Gains (Losses), Total | 25,000 | 238,000 | |||
Proceeds from Sale and Maturity of Marketable Securities, Total | $ 0 | $ 0 |
Note 9 - Investments in Marke53
Note 9 - Investments in Marketable Securities - Marketable Securities and Restricted Marketable Securities (Details) - USD ($) $ in Thousands | Jun. 30, 2018 | Dec. 31, 2017 |
Restricted investments available for sale, amortized cost | $ 169,448 | $ 167,277 |
Restricted investments available for sale, fair value | 164,949 | 166,395 |
Investments available for sale, amortized cost | 199,624 | 197,453 |
Investments available for sale, fair value | 300,965 | 305,480 |
Equity Securities [Member] | ||
Unrestricted investments available for sale, amortized cost | 30,176 | 30,176 |
Unrestricted investments available for sale, fair value | 136,016 | 139,085 |
Corporate Debt Securities [Member] | ||
Restricted investments available for sale, amortized cost | 68,796 | 65,107 |
Restricted investments available for sale, fair value | 66,949 | 65,461 |
Collateralized Mortgage Backed Securities [Member] | ||
Restricted investments available for sale, amortized cost | 54,802 | 54,030 |
Restricted investments available for sale, fair value | 53,586 | 53,544 |
US Government Corporations and Agencies Securities [Member] | ||
Restricted investments available for sale, amortized cost | 21,516 | 21,685 |
Restricted investments available for sale, fair value | 20,676 | 21,172 |
US States and Political Subdivisions Debt Securities [Member] | ||
Restricted investments available for sale, amortized cost | 24,334 | 26,455 |
Restricted investments available for sale, fair value | $ 23,738 | $ 26,218 |
Note 9 - Investments in Marke54
Note 9 - Investments in Marketable Securities - Available for Sale Marketable Equity Securities (Details) - NHI Common Stock [Member] - USD ($) $ in Thousands | Jun. 30, 2018 | Dec. 31, 2017 |
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 | $ 120,146 | $ 122,918 |
Note 9 - Investments in Marke55
Note 9 - Investments in Marketable Securities - Amortized Cost and Estimated Fair Value of Debt Securities as Available for Sale (Details) - USD ($) $ in Thousands | Jun. 30, 2018 | Dec. 31, 2017 |
Within 1 year, cost | $ 18,660 | $ 18,492 |
Within 1 year, fair value | 18,627 | 18,499 |
1 to 5 years, cost | 80,101 | 70,331 |
1 to 5 years, fair value | 78,615 | 70,157 |
6 to 10 years, cost | 68,842 | 77,657 |
6 to 10 years, fair value | 65,862 | 76,943 |
Over 10 years, cost | 1,845 | 797 |
Over 10 years, fair value | 1,845 | 796 |
Cost | 169,448 | 167,277 |
Fair Value | $ 164,949 | $ 166,395 |
Note 10 - Fair Value Measurem56
Note 10 - Fair Value Measurements - Summary of Fair Value Measurements by Level (Details) - USD ($) $ in Thousands | Jun. 30, 2018 | Dec. 31, 2017 | Jun. 30, 2017 |
Restricted cash and cash equivalents | $ 9,549 | $ 5,748 | |
Available-for-sale securities | 164,949 | $ 166,395 | |
Corporate Debt Securities [Member] | |||
Available-for-sale securities | 66,949 | 65,461 | |
Collateralized Mortgage Backed Securities [Member] | |||
Available-for-sale securities | 53,586 | 53,544 | |
US States and Political Subdivisions Debt Securities [Member] | |||
Available-for-sale securities | 23,738 | 26,218 | |
Fair Value, Measurements, Recurring [Member] | |||
Cash and cash equivalents | 59,322 | 59,118 | |
Restricted cash and cash equivalents | 9,549 | 8,303 | |
Total financial assets | 369,836 | 372,901 | |
Fair Value, Measurements, Recurring [Member] | Equity Securities [Member] | |||
Available-for-sale securities | 136,016 | 139,085 | |
Fair Value, Measurements, Recurring [Member] | Corporate Debt Securities [Member] | |||
Available-for-sale securities | 66,949 | 65,461 | |
Fair Value, Measurements, Recurring [Member] | Collateralized Mortgage Backed Securities [Member] | |||
Available-for-sale securities | 53,586 | 53,544 | |
Fair Value, Measurements, Recurring [Member] | US Treasury Securities [Member] | |||
Available-for-sale securities | 20,676 | 21,172 | |
Fair Value, Measurements, Recurring [Member] | US States and Political Subdivisions Debt Securities [Member] | |||
Available-for-sale securities | 23,738 | 26,218 | |
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | |||
Cash and cash equivalents | 59,322 | 59,118 | |
Restricted cash and cash equivalents | 9,549 | 8,303 | |
Total financial assets | 269,366 | 270,751 | |
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Equity Securities [Member] | |||
Available-for-sale securities | 136,016 | 139,085 | |
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Corporate Debt Securities [Member] | |||
Available-for-sale securities | 43,803 | 43,073 | |
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Collateralized 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 | 20,676 | 21,172 | |
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 2 [Member] | |||
Cash and cash equivalents | |||
Restricted cash and cash equivalents | |||
Total financial assets | 100,470 | 102,150 | |
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 | 23,146 | 22,388 | |
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Collateralized Mortgage Backed Securities [Member] | |||
Available-for-sale securities | 53,586 | 53,544 | |
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 | $ 23,738 | $ 26,218 |
Note 11 - Long-term Debt (Detai
Note 11 - Long-term Debt (Details Textual) - Bank of America [Member] - USD ($) $ in Millions | 6 Months Ended | |
Jun. 30, 2018 | Mar. 31, 2018 | |
Line of Credit Facility, Maximum Borrowing Capacity | $ 150 | $ 175 |
Debt Instrument, Term | 5 years | |
London Interbank Offered Rate (LIBOR) [Member] | ||
Debt Instrument, Basis Spread on Variable Rate | 1.40% | |
Base Rate [Member] | ||
Debt Instrument, Basis Spread on Variable Rate | 0.40% |
Note 11 - Long-term Debt - Summ
Note 11 - Long-term Debt - Summary of Long-term Debt (Details) - USD ($) $ in Millions | 6 Months Ended | |
Jun. 30, 2018 | Dec. 31, 2017 | |
Long-term debt | $ 85 | $ 100 |
Less current portion | ||
Long-term debt, noncurrent | $ 85 | 100 |
Line of Credit [Member] | ||
Long-term debt, weighted average interest rate | 3.50% | |
Long-term debt, maturities | 2,020 | |
Long-term debt | $ 75 | 90 |
Unsecured Term Note Payable [Member] | ||
Long-term debt, weighted average interest rate | 4.30% | |
Long-term debt, maturities | 2,028 | |
Long-term debt | $ 10 | $ 10 |
Note 12 - Stock Repurchase Pr59
Note 12 - Stock Repurchase Program (Details Textual) - Common Stock [Member] - USD ($) | 6 Months Ended | |
Jun. 30, 2018 | Aug. 31, 2017 | |
Stock Repurchase Program, Authorized Amount | $ 25,000,000 | |
Stock Repurchased and Retired During Period, Shares | 14,506 | |
Stock Repurchased and Retired During Period, Value | $ 867,000 |
Note 13 - Stock-based Compens60
Note 13 - Stock-based Compensation (Details Textual) - USD ($) | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | |
Allocated Share-based Compensation Expense, Total | $ 749,000 | $ 740,000 | $ 1,177,000 | $ 832,000 |
Employee Service Share-based Compensation, Nonvested Awards, Compensation Cost Not yet Recognized, Total | $ 6,329,000 | $ 6,329,000 | ||
Employee Service Share-based Compensation, Nonvested Awards, Compensation Cost Not yet Recognized, Period for Recognition | 4 years |
Note 13 - Stock-based Compens61
Note 13 - Stock-based Compensation - Summary of Assumptions Used to Value Options Granted (Details) | 6 Months Ended | |
Jun. 30, 2018 | Jun. 30, 2017 | |
Risk–free interest rate | 2.46% | 2.08% |
Expected volatility | 16.10% | 16.60% |
Expected life (Year) | 3 years | 4 years 292 days |
Expected dividend yield | 3.29% | 3.10% |
Note 13 - Stock-based Compens62
Note 13 - Stock-based Compensation - Summary of Options Outstanding (Details) - USD ($) | 6 Months Ended | 12 Months Ended |
Jun. 30, 2018 | Dec. 31, 2017 | |
Options outstanding, shares (in shares) | 1,239,407 | 177,959 |
Options outstanding, weighted average exercise price (in dollars per share) | $ 71.19 | $ 55.48 |
Options granted, shares (in shares) | 111,240 | 1,125,443 |
Options granted, weighted average exercise price (in dollars per share) | $ 61.40 | $ 72.96 |
Options exercised, shares (in shares) | (33,526) | (48,995) |
Options exercised, weighted average exercise price (in dollars per share) | $ 51.25 | $ 51.25 |
Options cancelled, shares (in shares) | (20,000) | (15,000) |
Options cancelled, weighted average exercise price (in dollars per share) | $ 72.94 | $ 72.94 |
Options outstanding, shares (in shares) | 1,297,121 | 1,239,407 |
Options outstanding, weighted average exercise price (in dollars per share) | $ 70.84 | $ 71.19 |
Options outstanding, aggregate intrinsic value | $ 2,167,000 | |
Options vested, shares (in shares) | 210,881 | |
Options vested, weighted average exercise price (in dollars per share) | $ 63.35 | |
Options vested, aggregate intrinsic value | $ 1,613,000 |
Note 13 - Stock-based Compens63
Note 13 - Stock-based Compensation - Options Outstanding by Exercise Price Range (Details) | 6 Months Ended |
Jun. 30, 2018$ / sharesshares | |
Options outstanding (in shares) | shares | 1,297,121 |
Weighted average exercise price (in dollars per share) | $ 70.84 |
Weighted average remaining contractual life in years (Year) | 3 years 219 days |
Exercise Price Range 1 [Member] | |
Options outstanding (in shares) | shares | 218,846 |
Exercise price, lower range (in dollars per share) | $ 52.93 |
Exercise price, upper range (in dollars per share) | 62.78 |
Weighted average exercise price (in dollars per share) | $ 59.77 |
Weighted average remaining contractual life in years (Year) | 2 years 328 days |
Exercise Price Range 2 [Member] | |
Options outstanding (in shares) | shares | 1,078,275 |
Weighted average exercise price (in dollars per share) | $ 72.94 |
Weighted average remaining contractual life in years (Year) | 3 years 255 days |
Note 14 - Income Taxes (Details
Note 14 - Income Taxes (Details Textual) - USD ($) | 3 Months Ended | 6 Months Ended | 12 Months Ended | ||
Jun. 30, 2018 | Jun. 30, 2017 | Jun. 30, 2018 | Jun. 30, 2017 | Dec. 31, 2017 | |
Income Tax Expense (Benefit), Total | $ 7,892,000 | $ 6,758,000 | $ 8,092,000 | $ 14,757,000 | |
Effective Income Tax Rate Reconciliation, Percent, Total | 26.10% | 39.00% | 29.40% | 38.90% | |
Effective Income Tax Rate Reconciliation, Tax Contingency, Amount, Total | $ 146,200 | $ 321,000 | |||
Effective Income Tax Rate Reconciliation, Nondeductible Expense, Amount, Total | 84,000 | $ 881,000 | 133,400 | ||
Effective Income Tax Rate Reconciliation, Exercise of Stock Options, Amount | 123,000 | 244,000 | |||
Effective Income Tax Rate Reconciliation, Nondeductible Expense, Percent, Total | 3.20% | ||||
Equity Securities, FV-NI, Unrealized Gain (Loss), Total | $ 12,448,000 | $ (3,069,000) | |||
Income Tax Expense (Benefit), Continuing Operations, Adjustment of Deferred Tax (Asset) Liability | $ (8,488,000) | ||||
Earliest Tax Year [Member] | |||||
Open Tax Year | 2,014 |
Note 15 - Contingencies and C65
Note 15 - Contingencies and Commitments (Details Textual) - USD ($) | 6 Months Ended | |||
Jun. 30, 2018 | Jun. 30, 2017 | Mar. 31, 2018 | Dec. 31, 2017 | |
Self Insurance Reserve | $ 94,808,000 | $ 93,275,000 | ||
Direct Business Coverage Statutory Limits | $ 1,000,000 | |||
Malpractice Loss Contingency, Number of Claims | 63 | 63 | ||
Primary Insurance Coverage, Amount Per Incident | $ 1,000,000 | |||
Primary Insurance Coverage, Amount Per Location | 3,000,000 | |||
Annual Excess Coverage | 9,000,000 | $ 9,000,000 | ||
Qui Tam [Member] | Caris [Member] | ||||
Loss Contingency Accrual, Ending Balance | $ 8,500,000 | |||
Caris [Member] | ||||
Equity Method Investment, Ownership Percentage | 75.10% | 75.10% | ||
Line of Credit [Member] | National Health Care [Member] | ||||
Line of Credit Facility, Maximum Borrowing Capacity | $ 2,000,000 | |||
Long-term Line of Credit, Total | $ 0 |