National HealthCare (NHC) 10-K 20 Feb 19 2018 FY Annual report Financial data

Document And Entity Information

Document And Entity Information - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Feb. 18, 2019	Jun. 30, 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 Emerging Growth Company	false
Entity Small Business	false
Entity Common Stock, Shares Outstanding (in shares)		15,255,921
Entity Public Float			$ 705
Document Type	10-K
Document Period End Date	Dec. 31, 2018
Document Fiscal Year Focus	2,018
Document Fiscal Period Focus	FY
Amendment Flag	false
Entity Shell Company	false

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($)	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Revenues:
Net patient revenues									$ 932,774,000	$ 916,742,000	$ 877,666,000
Other revenues									47,575,000	47,153,000	45,914,000
Net operating revenues	$ 248,920,000	$ 246,326,000	$ 242,142,000	$ 242,961,000	$ 246,311,000	$ 241,196,000	$ 238,695,000	$ 238,538,000	980,349,000	963,895,000	923,580,000
Costs and Expenses:
Salaries, wages and benefits									582,721,000	572,043,000	548,007,000
Other operating									254,038,000	249,833,000	230,775,000
Facility rent									40,923,000	40,367,000	41,292,000
Depreciation and amortization									41,894,000	42,652,000	39,023,000
Interest									4,697,000	4,890,000	3,941,000
Total costs and expenses									924,273,000	909,785,000	863,038,000
Income from operations	17,194,000	10,834,000	12,165,000	15,883,000	$ 16,323,000	$ 9,785,000	$ 12,138,000	$ 15,864,000	56,076,000	54,110,000	60,542,000
Other income:
Non-operating income									17,670,000	20,439,000	19,665,000
Unrealized gains on marketable securities	$ 721,000	$ 3,486,000	$ 12,448,000	$ (15,517,000)					1,138,000
Income before income taxes									74,884,000	74,549,000	80,207,000
Income tax provision									(16,185,000)	(18,867,000)	(29,669,000)
Net income									58,699,000	55,682,000	50,538,000
Net loss attributable to noncontrolling interest									265,000	523,000
Net income attributable to common stockholders of National HealthCare Corporation									$ 58,964,000	$ 56,205,000	$ 50,538,000
Earnings per share attributable to National HealthCare Corporation stockholders:
Basic (in dollars per share)	$ 1.19	$ 1.39	$ 1.48	$ (0.18)	$ 1.41	$ 0.75	$ 0.70	$ 0.84	$ 3.87	$ 3.70	$ 3.34
Diluted (in dollars per share)	$ 1.19	$ 1.39	$ 1.47	$ (0.18)	$ 1.41	$ 0.75	$ 0.70	$ 0.84	$ 3.87	$ 3.69	$ 3.32
Weighted average common shares outstanding:
Basic (in shares)									15,224,886	15,189,920	15,134,518
Diluted (in shares)									15,236,826	15,218,962	15,206,997
Dividends declared per common share (in dollars per share)									$ 1.98	$ 1.89	$ 1.75

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Net income	$ 58,699	$ 55,682	$ 50,538
Other comprehensive income (loss):
Unrealized gains (losses) on investments in restricted marketable debt securities	(2,574)	1,644	(140)
Unrealized gains (losses) on investments in marketable equity securities		1,073	21,845
Reclassification adjustment for realized gains on sale of securities	(18)	(262)	(816)
Income tax (expense) benefit related to items of other comprehensive income (loss)	544	(1,019)	(8,185)
Other comprehensive income (loss), net of tax	(2,048)	1,436	12,704
Net loss attributable to noncontrolling interest	265	523
Comprehensive income attributable to National HealthCare Corporation	$ 56,916	$ 57,641	$ 63,242

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Current Assets:
Cash and cash equivalents	$ 43,247,000	$ 59,118,000
Restricted cash and cash equivalents	9,967,000	6,397,000
Marketable securities	140,223,000	139,085,000
Restricted marketable securities	18,676,000	21,012,000
Accounts receivable	97,274,000	86,767,000
Inventories	7,470,000	7,153,000
Prepaid expenses and other assets	3,863,000	2,864,000
Notes receivable, current portion	1,289,000	1,450,000
Federal income tax receivable		5,465,000
Total current assets	322,009,000	329,311,000
Property and Equipment:
Property and equipment, at cost	979,088,000	958,748,000
Accumulated depreciation and amortization	(444,438,000)	(409,429,000)
Net property and equipment	534,650,000	549,319,000
Other Assets:
Restricted cash and cash equivalents	1,706,000	1,906,000
Restricted marketable securities	153,917,000	145,383,000
Deposits and other assets	5,602,000	4,867,000
Goodwill	20,995,000	17,600,000
Notes receivable, less current portion	9,707,000	11,801,000
Investments in limited liability companies	32,362,000	36,339,000
Total other assets	224,289,000	217,896,000
Total assets	1,080,948,000	1,096,526,000
Current Liabilities:
Trade accounts payable	19,759,000	15,978,000
Capital lease obligations, current portion	3,924,000	3,696,000
Accrued payroll	67,618,000	67,102,000
Amounts due to third party payors	16,108,000	17,389,000
Accrued risk reserves, current portion	28,643,000	27,409,000
Other current liabilities	14,249,000	16,194,000
Dividends payable	7,623,000	7,297,000
Total current liabilities	157,924,000	155,065,000
Long–term debt	55,000,000	100,000,000
Capital lease obligations, less current portion	19,128,000	23,052,000
Accrued risk reserves, less current portion	67,381,000	65,866,000
Refundable entrance fees	8,078,000	8,827,000
Obligation to provide future services	2,172,000	2,887,000
Deferred income taxes	18,550,000	18,376,000
Other noncurrent liabilities	15,204,000	15,795,000
Deferred revenue	3,054,000	3,226,000
Total liabilities	346,491,000	393,094,000
Equity:
Common stock, $.01 par value; 45,000,000 shares authorized; 15,255,002 and 15,212,133 shares, respectively, issued and outstanding	153,000	152,000
Capital in excess of par value	219,435,000	215,659,000
Retained earnings	516,435,000	419,423,000
Accumulated other comprehensive income (loss)	(2,745,000)	67,504,000
Total National HealthCare Corporation stockholders’ equity	733,278,000	702,738,000
Noncontrolling interest	1,179,000	694,000
Total equity	734,457,000	703,432,000
Total liabilities and equity	$ 1,080,948,000	$ 1,096,526,000

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parentheticals) - $ / shares	Dec. 31, 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)	15,255,002	15,212,133
Common stock, shares outstanding (in shares)	15,255,002	15,212,133

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Cash Flows From Operating Activities:
Net income	$ 58,699,000	$ 55,682,000	$ 50,538,000
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	41,894,000	42,652,000	39,023,000
Equity in earnings of unconsolidated investments	(1,020,000)	(6,932,000)	(6,636,000)
Distributions from unconsolidated investments	5,241,000	7,829,000	8,059,000
Unrealized gains on marketable securities	(1,138,000)
Gains on sale of marketable securities	(18,000)	(262,000)	(816,000)
Gain on acquisition of equity method investment	(2,050,000)
Gain on sale of skilled nursing facility	(1,668,000)
Deferred income taxes	(718,000)	4,714,000	(4,791,000)
Stock–based compensation	1,778,000	1,678,000	509,000
Changes in operating assets and liabilities:
Accounts receivable	(9,398,000)	(4,236,000)	1,564,000
Federal income tax receivable	5,465,000	(800,000)	(1,462,000)
Inventories	(317,000)	355,000	60,000
Prepaid expenses and other assets	(1,743,000)	(796,000)	(477,000)
Trade accounts payable	3,467,000	(2,615,000)	(1,535,000)
Accrued payroll	516,000	1,190,000	574,000
Amounts due to third party payors	(1,281,000)	370,000	365,000
Accrued risk reserves	2,818,000	3,070,000	(4,541,000)
Other current liabilities	(2,050,000)	2,987,000	1,015,000
Obligation to provide future services	(715,000)	(349,000)	(204,000)
Other noncurrent liabilities	(591,000)	(507,000)	8,000
Deferred revenue	(172,000)	(136,000)	47,000
Net cash provided by operating activities	98,435,000	94,466,000	90,882,000
Cash Flows From Investing Activities:
Additions to property and equipment	(29,772,000)	(32,347,000)	(62,601,000)
Proceeds from the sale of skilled nursing facility	4,300,000
Investments in unconsolidated companies	(444,000)	(246,000)	(1,282,000)
Acquisition of equity method investment, net of cash acquired	(527,000)
Investments in notes receivable		(202,000)	(5,251,000)
Collections of notes receivable	1,553,000	4,282,000	1,636,000
Purchases of marketable securities	(13,311,000)	(31,244,000)	(48,620,000)
Sale of marketable securities	4,539,000	50,197,000	34,642,000
Net cash used in investing activities	(33,662,000)	(9,560,000)	(81,476,000)
Cash Flows From Financing Activities:
Principal payments under line of credit agreement	(45,000,000)	(20,000,000)
Principal payments under capital lease obligations	(3,696,000)	(3,481,000)	(3,278,000)
Dividends paid to common stockholders	(29,827,000)	(28,237,000)	(25,795,000)
Issuance of common shares	2,865,000	2,524,000	10,772,000
Repurchase of common shares	(867,000)		(8,195,000)
Equity attributable to noncontrolling interest		1,217,000
Tax expense from exercise of stock options			(1,096,000)
Entrance fee deposits (refunds)	(749,000)	(1,097,000)	59,000
Change in deposits			402,000
Net cash used in financing activities	(77,274,000)	(49,074,000)	(27,131,000)
Net Increase (Decrease) in Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents	(12,501,000)	35,832,000	(17,725,000)
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, Beginning of Period	67,421,000	31,589,000	49,314,000
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, End of Period	54,920,000	67,421,000	31,589,000
Balance Sheet Classifications:
Total Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents	67,421,000	67,421,000	31,589,000
Supplemental Information:
Cash payments for interest	4,899,000	5,183,000	4,528,000
Cash payments for income taxes	$ 9,182,000	$ 23,550,000	$ 27,668,000

Consolidated Statements of Equi

Consolidated Statements of Equity - 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, 2015	15,000,616
Balance at Dec. 31, 2015	$ 150	$ 209,469	$ 368,013	$ 53,364		$ 630,996
Net income attributable to National HealthCare Corporation			50,538			50,538
Other comprehensive income (loss)				12,704		12,704
Stock–based compensation		509				509
Tax expense from exercise of stock options		(1,096)				$ (1,096)
Shares sold – options exercised (in shares)	292,322					499,066
Shares sold – options exercised	$ 3	10,769				$ 10,772
Repurchase of common shares (in shares)	(130,000)
Repurchase of common shares	$ (1)	(8,194)				(8,195)
Dividends declared to common stockholders			(26,617)			(26,617)
Net loss attributable to noncontrolling interest
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			56,205			56,205
Other comprehensive income (loss)				1,436		1,436
Stock–based compensation		1,678				$ 1,678
Shares sold – options exercised (in shares)	49,195					48,995
Shares sold – options exercised		2,524				$ 2,524
Dividends declared to common stockholders			(28,716)			(28,716)
Net loss attributable to noncontrolling interest					(523)	(523)
Equity contributed by noncontrolling interest					1,217	1,217
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			58,964			58,964
Other comprehensive income (loss)				(2,048)		(2,048)
Stock–based compensation		1,778				$ 1,778
Shares sold – options exercised (in shares)	57,375					68,291
Shares sold – options exercised	$ 1	2,865				$ 2,866
Repurchase of common shares (in shares)	(14,506)
Repurchase of common shares		(867)				(867)
Dividends declared to common stockholders			(30,153)			(30,153)
Net loss attributable to noncontrolling interest					(265)	(265)
Equity contributed by noncontrolling interest					750	750
Reclassification due to new accounting standards at Dec. 31, 2017			68,201	(68,201)
Balance (in shares) at Dec. 31, 2018	15,255,002
Balance at Dec. 31, 2018	$ 153	$ 219,435	$ 516,435	$ (2,745)	$ 1,179	$ 734,457

Consolidated Statements of Eq_2

Consolidated Statements of Equity (Parentheticals) - $ / shares	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Common Stock [Member]
Dividends declared to common stockholders, per share (in dollars per share)	$ 1.98	$ 1.48	$ 1.75
Dividends declared to common stockholders, per share (in dollars per share)	$ 1.98	$ 1.89	$ 1.75

Note 1 - Summary of Significant

Note 1 - Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Significant Accounting Policies [Text Block]	Note 1 – Summary of Significant Accounting Policies Nature of Operation s National HealthCare Corporation ("NHC" or "the Company") operates, manages or provides services to skilled nursing facilities, assisted living facilities, independent living facilities, and home health care programs located in 10 Principles of Consolidation and Basis of Presentation The consolidated financial statements, which are prepared in accordance with U.S. generally accepted accounting principles (“GAAP”), include our wholly owned and controlled subsidiaries and affiliates. All significant intercompany transactions and balances have been eliminated in consolidation. The Company presents noncontrolling interest within the equity section of its consolidated balance sheets. The Company presents the amount of consolidated net income that is attributable to NHC and the noncontrolling interest in its consolidated statements of operations. Variable interest entities (“VIEs”) in which we have an interest have been consolidated when we have been identified as the primary beneficiary. Investments in ventures in which we have the ability to exercise significant influence but do not 75.1% Use of Estimates The preparation of financial statements in conformity with U.S. GAAP requires management 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. Net Patient Revenues and Accounts Receivable 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 recognizes revenue as its performance obligations are completed. Routine services are treated as a single performance obligation satisfied over time as services are rendered. These routine services represent a bundle of services that are not may not The Company determines the transaction price based on established billing rates reduced by contractual adjustments provided to third $1,524,000, $1,895,000, $2,539,000 December 31, 2018, 2017, 2016, December 31, 2018 2017, $4,610,000 $5,041,000, Other Revenues As discussed in Note 3, We recognize rental income based on the terms of our operating leases. Under certain of our leases, we receive contingent rent, which is based on the increase in revenues of a lessee over a base year. We recognize contingent rent annually or monthly, as applicable, when, based on the actual revenue of the lessee is earned. Segment Reporting In accordance with the provisions of Accounting Standards Codification “ASC” 280, Segment Reporting two 1 one 2 5 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, professional 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 $28.7 $29.8 $28.8 December 31, 2018, 2017, 2016, Cash and Cash Equivalents Cash equivalents include highly liquid investments with an original maturity of three Restricted Cash and Cash Equivalents and Restricted Marketable Securities Restricted cash and cash equivalents and restricted marketable securities primarily represent assets that are held by our wholly–owned limited purpose insurance companies for workers' compensation and professional liability claims. Investments in Marketable Securities and Restricted Marketable Securities On January 1, 2018, No. 2016 01, January 1, 2018. not Inventories Inventories consist generally of food and supplies and are valued at the lower of cost or market, with cost determined on a first–in, first–out (FIFO) basis. Mortgage and Other Notes Receivable In accordance with ASC Topic 310, Receivables may not Pro perty 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 Expenditures for repairs and maintenance are charged to expense as incurred. Betterments, which significantly extend the useful life, are capitalized. We remove the costs and related allowances for accumulated depreciation or amortization from the accounts for properties sold or retired, and any resulting gains or losses are included in income. In accordance with ASC Topic 360, Property, Plant, and Equipment may not Goodwill The Company accounts for goodwill under ASC Topic 350, Intangibles – Goodwill and Other not 350. first fourth The following table represents activity in goodwill by segment as of and for the year ended December 31, 2018 ( in thousands Year Ended December 31, 2018 Inpatient Services Homecare All Other Total January 1, 2016 $ - $ 17,600 $ - $ 17,600 Additions - - - - December 31, 2016 - 17,600 - 17,600 Additions - - - - December 31, 2017 - 17,600 - 17,600 Additions 3,395 - - 3,395 December 31, 2018 $ 3,395 $ 17,600 $ - $ 20,995 See Note 4 Non-operating income 2018. Accrued Risk Reserves We are principally self–insured for risks related to employee health insurance and utilize wholly–owned limited purpose insurance companies for workers’ compensation and professional liability claims. Accrued risk reserves primarily represent the accrual for risks associated with employee health insurance, workers’ compensation and professional liability claims. The accrued risk reserves include a liability for unpaid reported claims and estimates for incurred but unreported claims. Our policy with respect to a significant portion of our workers’ compensation and professional and general liability claims is to use an actuary to assist management in estimating our exposure for claims obligation (for both asserted and unasserted claims). Our health insurance reserve is based on our known claims incurred and an estimate of incurred but unreported claims determined by our analysis of historical claims paid. We reassess our accrued risk reserves on a quarterly basis, with changes in estimated losses being recorded in the consolidated statements of operations in the period first Other Current Liabilities Other current liabilities primarily represent accruals for current federal and state income taxes, real estate taxes and other current liabilities. Continuing Care Contracts and Refundable Entrance Fees 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 December 31, 2018 December 31, 2017 $8,078,000 $8,827,000, Obligation to Provide Future Services We annually estimate the present value of the net 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 net cost of future services exceeds the related anticipated revenues, a liability is recorded (obligation to provide future services) with a corresponding charge to income. At December 31, 2018 2017, $2,172,000 $2,887,000, Other Noncurrent Liabilities Other noncurrent liabilities include reserves primarily related to various uncertain income tax positions. Deferred Revenue Deferred revenue includes the deferred gain on the sale of assets to National Health Corporation (“National”), as discussed in Note 18, 10% Income Taxes We utilize ASC Topic 740, Income Taxes 13 Also, under ASC Topic 740, Income Taxes 50 Noncontrolling Interest The noncontrolling interest in a subsidiary is presented within total equity in the Company’s consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to NHC in its 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. Stock – Based Compensation Stock–based awards granted include stock options, restricted stock units, and stock purchased under our employee stock purchase plan. Stock–based compensation cost is measured at the grant date, based on the fair value of the awards, and is recognized as expense over the requisite service period only for those equity awards expected to vest. The fair value of the restricted stock units is determined based on the stock price on the date of grant. We estimated the fair value of stock options and stock purchased under our employee stock purchase plan using the Black–Scholes model. This model utilizes the estimated fair value of common stock and requires that, at the date of grant, we use the expected term of the grant, the expected volatility of the price of our common stock, risk–free interest rates and expected dividend yield of our common stock. The fair value is amortized on a straight–line basis over the requisite service periods of the awards. Comprehensive Income ASC Topic 220, Comprehensive Income, Concentration of Credit Risks Our credit risks primarily relate to cash and cash equivalents, restricted cash and cash equivalents, accounts receivable, marketable securities, restricted marketable securities and notes receivable. Cash and cash equivalents are primarily held in bank accounts and overnight investments. Restricted cash and cash equivalents is primarily invested in commercial paper and certificates of deposit with financial institutions and other interest-bearing accounts. Accounts receivable consist primarily of amounts due from patients (funded through Medicare, Medicaid, other contractual programs and through private payors) and from other health care companies for management, accounting and other services. We perform continual credit evaluations of our clients and maintain appropriate allowances for doubtful accounts on any accounts receivable proving uncollectible, and continually monitor and adjust these allowances as necessary. Marketable securities and restricted marketable securities are held primarily in accounts with brokerage institutions. Notes receivable relate primarily to secured loans with health care facilities (recorded as notes receivable in the consolidated balance sheets) as discussed in Note 11. At any point in time we have funds in our operating accounts and restricted cash accounts that are with third may Our financial instruments, principally our notes receivable, are subject to the possibility of loss of the carrying values as a result of the failure of other parties to perform according to their contractual obligations. We obtain various collateral and other protective rights, and continually monitor these rights in order to reduce such possibilities of loss. We evaluate the need to provide reserves for potential losses on our financial instruments based on management's periodic review of the portfolio on an instrument by instrument basis. See Note 11 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 December 31, 2017 2016 January 1, 2018: Consolidated Statements of O perations ( in thousands Year Ended December 31, 2017 As Previously Reported Effect of Accounting Change As Adjusted Net patient revenues $ 919,843 $ (3,101 ) $ 916,742 Net operating revenues 966,996 (3,101 ) 963,895 Other operating expenses 252,934 (3,101 ) 249,833 Total costs and expenses 912,886 (3,101 ) 909,785 Net income 55,682 – 55,682 Year Ended December 31, 2016 As Previously Reported Effect of Accounting Change As Adjusted Net patient revenues $ 880,724 $ (3,058 ) $ 877,666 Net operating revenues 926,638 (3,058 ) 923,580 Other operating expenses 233,833 (3,058 ) 230,775 Total costs and expenses 866,096 (3,058 ) 863,038 Net income 50,538 – 50,538 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 December 31, 2018, $1,138,000 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, The Company adopted the standard as of January 1, 2019, not 1 not 2 While substantially complete, the Company is still in the process of finalizing its evaluation of the effect of Topic 842 first 2019. In June 2016, No. 2016 13, No. 2016 13 December 15, 2019, December 15, 2018. Prior Period Classifications Certain amounts in prior periods have been reclassified to conform with current period presentation.

Note 2 - Net Patient Revenues

Note 2 - Net Patient Revenues	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Revenue from Contract with Customer [Text Block]	Note 2 – Net Patient Revenues 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 Year Ended December 31, (in thousands) 2018 2017 2016 Inpatient services $ 872,912 $ 853,662 $ 814,010 Homecare services 59,862 63,080 63,656 Total net patient revenue $ 932,774 $ 916,742 $ 877,666 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: Year Ended December 31, Source 2018 2017 2016 Medicare 35 % 35 % 37 % Managed Care 12 % 13 % 12 % Medicaid 26 % 26 % 26 % Private Pay and Other 27 % 26 % 25 % Total 100 % 100 % 100 % 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 $16,108,000 $17,389,000 December 31, 2018 2017,

Note 3 - Other Revenues

Note 3 - Other Revenues	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Other Revenues [Text Block]	Note 3 – Other Revenues Other revenues are outlined in the table below. Revenues from insurance services include premiums for workers’ compensation and professional liability insurance policies that our wholly–owned insurance subsidiaries have written for certain healthcare operators to which we provide management or accounting services. Revenues from management and accounting services include fees provided to manage and provide accounting services to other healthcare operators. Revenues from rental income include health care real estate properties owned by us and leased to third Year Ended December 31, (in thousands) 2018 2017 2016 Insurance services $ 7,084 $ 8,003 $ 7,195 Management and accounting service fees 15,175 16,169 15,953 Rental income 22,262 21,957 21,835 Other 1,386 1,024 931 Gain on sale of skilled nursing facility 1,668 -- -- Total other revenues $ 47,575 $ 47,153 $ 45,914 Insurance Services For workers’ compensation insurance services, the premium revenues reflected in the consolidated statements of operations for the years ended December 31, 2018, 2017 2016 $4,392,000, $5,300,000, $4,508,000, For professional liability insurance services, the premium revenues reflected in the consolidated statements of operations for the years ended December 31, 2018, 2017 2016 $2,692,000, $2,703,000, $2,687,000, Management Fees from National We have managed skilled nursing facilities for National since 1988, five 18 During 2018, 2017 2016, $4,304,000, $4,194,000, $3,777,000, $21,398,000 $21,384,000 December 31, 2018 2017, The unpaid fees from these five not no may five may may may no Management Fees and Financial and Accounting Services for Other Healthcare Centers During 2018 2017, seven five third 2016, six five third December 31, 2018, 2017 2016, $2,532,000, $2,794,000 $2,172,000 During 2018 2017, 20 No Rental Income The health care properties currently owned and leased to third nine four January 1, 2016, eleven thirteen ten December 31, 2025. Gain on sale of skilled nursing facility In October 2018, $4,300,000, $1,669,000.

Note 4 - Non-operating Income

Note 4 - Non-operating Income	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Other Nonoperating Income and Expense [Text Block]	Note 4 – Non – Operating Income Non–operating income includes equity in earnings of unconsolidated investments, dividends and other realized gains and losses on marketable securities, interest income, and a gain on the acquisition of additional ownership interest of a behavioral health hospital. Our most significant equity method investment is a 75.1% 2018, $8,364,000 first two 16 Contingencies and Commitments Year Ended December 31, (in thousands) 2018 2017 2016 Equity in earnings of unconsolidated investments $ 1,020 $ 6,932 $ 6,636 Dividends and net realized gains on sale of securities 7,417 7,335 7,547 Interest income 7,183 6,172 5,482 Gain on acquisition of equity method investment 2,050 - - Total non-operating income $ 17,670 $ 20,439 $ 19,665 Gain on acquisition of equity method investment In July 2018, 14 Upon acquiring a controlling financial interest in the investee, we valued the business and our previously held equity position based upon the hospital's fair value. This remeasurement of our equity interest at fair value resulted in a gain of $2,050,000 third 2018. $3,395,000.

Note 5 - Business Segments

Note 5 - Business Segments	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Segment Reporting Disclosure [Text Block]	Note 5 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 1 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 tables set forth the Company’s consolidated statements of operations by business segment (in thousands Year Ended December 31, 2018 Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 872,912 $ 59,862 $ - $ 932,774 Other revenues 2,494 - 45,081 47,575 Net operating revenues 875,406 59,862 45,081 980,349 Costs and Expenses: Salaries, wages and benefits 513,647 33,339 35,735 582,721 Other operating 225,133 19,566 9,339 254,038 Facility rent 33,052 1,945 5,926 40,923 Depreciation and amortization 38,372 229 3,293 41,894 Interest 1,504 - 3,193 4,697 Total costs and expenses 811,708 55,079 57,486 924,273 Income (loss) before non-operating income 63,698 4,783 (12,405 ) 56,076 Non-operating income - - 17,670 17,670 Unrealized gains on marketable securities - - 1,138 1,138 Income before income taxes $ 63,698 $ 4,783 $ 6,403 $ 74,884 Year Ended December 31, 2017 (As adjusted) Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 853,662 $ 63,080 $ - $ 916,742 Other revenues 663 - 46,490 47,153 Net operating revenues 854,325 63,080 46,490 963,895 Costs and Expenses: Salaries, wages and benefits 501,510 33,059 37,474 572,043 Other operating 221,414 20,855 7,564 249,833 Facility rent 32,744 1,980 5,643 40,367 Depreciation and amortization 38,246 177 4,229 42,652 Interest 1,719 - 3,171 4,890 Total costs and expenses 795,633 56,071 58,081 909,785 Income (loss) before non-operating income 58,692 7,009 (11,591 ) 54,110 Non-operating income - - 20,439 20,439 Income before income taxes $ 58,692 $ 7,009 $ 8,848 $ 74,549 Year Ended December 31, 2016 (As adjusted) Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 814,010 $ 63,656 $ - $ 877,666 Other revenues 651 - 45,263 45,914 Net operating revenues 814,661 63,656 45,263 923,580 Costs and Expenses: Salaries, wages and benefits 480,058 32,597 35,352 548,007 Other operating 202,827 20,705 7,243 230,775 Facility rent 33,129 1,932 6,231 41,292 Depreciation and amortization 34,423 190 4,410 39,023 Interest 1,921 - 2,020 3,941 Total costs and expenses 752,358 55,424 55,256 863,038 Income (loss) before non-operating income 62,303 8,232 (9,993 ) 60,542 Non-operating income - - 19,665 19,665 Income before income taxes $ 62,303 $ 8,232 $ 9,672 $ 80,207

Note 6 - Long-term Leases

Note 6 - Long-term Leases	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Leases of Lessee Disclosure [Text Block]	Note 6 – Long – Term Leases Capital Leases Effective March 1, 2014, three three third ten two $5,200,000 4% 2014 not not Fixed assets recorded under the capital leases, which are included in property and equipment in the consolidated balance sheets, are as follows (in thousands) December 31, 2018 2017 Buildings and personal property $ 39,032 $ 39,032 Accumulated amortization (18,970 ) (15,045 ) $ 20,062 $ 23,987 Operating Leases At December 31, 2018, 35 seven three two first four third On January 1, 2007, 15–year three December 2012, first three 2026. two $30,750,000 4% 2007 In September 2013 second seven 15 $3,450,000 4% 2014 seven 13 th $49,000,000. Base rent expense under both NHI lease agreements totals $34,200,000. 2018, 2017, 2016 $3,713,000, $3,057,000, $3,720,000, Each lease with NHI is a "triple net lease" under which we are responsible for paying all taxes, utilities, insurance premium costs, repairs and other charges relating to the ownership of the facilities. We are obligated at our expense to maintain adequate insurance on the facilities' assets. We have a right of first 180 Minimum Lease Payments The approximate future minimum lease payments required under all leases that have remaining non–cancelable lease terms at December 31, 2018 (in thousands) Operating Leases Capital Leases 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 108,350 867 Total minimum lease payments $ 279,350 $ 26,867 Less: amounts representing interest (3,815 ) Present value of minimum lease payments 23,052 Less: current portion (3,924 ) Long–term capital lease obligations $ 19,128

Note 7 - Earning Per Share

Note 7 - Earning Per Share	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Earnings Per Share [Text Block]	Note 7 – Earning Per Share 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 share and per share amounts) Year Ended December 31, 2018 2017 2016 Basic: Weighted average common shares outstanding 15,224,886 15,189,920 15,134,518 Net income attributable to common stockholders of National Healthcare Corporation $ 58,964 $ 56,205 $ 50,538 Earnings per common share, basic $ 3.87 $ 3.70 $ 3.34 Diluted: Weighted average common shares outstanding 15,224,886 15,189,920 15,134,518 Dilutive effect of stock options 11,940 29,042 24,176 Dilutive effect of contingent issuable stock -- – 48,303 Assumed average common shares outstanding 15,236,826 15,218,962 15,206,997 Net income attributable to common stockholders of National Healthcare Corporation $ 58,964 $ 56,205 $ 50,538 Earnings per common share, diluted $ 3.87 $ 3.69 $ 3.32

Note 8 - Investments in Marketa

Note 8 - Investments in Marketable Securities	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Investments in Debt and Marketable Equity Securities (and Certain Trading Assets) Disclosure [Text Block]	Note 8 – Investments in Marketable Securities Our investments in marketable securities include marketable equity securities and marketable debt securities. Our marketable debt securities are classified as available for sale securities. Realized gains and losses from securities sales are determined on the specific identification of the securities. Marketable securities and restricted marketable securities consist of the following: December 31, 2018 December 31, 2017 (in thousands) Amortized Cost Fair Value Amortized Cost Fair Value Investments available for sale: Marketable equity securities $ 30,176 $ 140,223 $ 30,176 $ 139,085 Restricted investments available for sale: Corporate debt securities 69,439 67,632 65,107 65,461 Asset–backed securities 62,772 62,068 54,030 53,544 U.S. Treasury securities 22,038 21,457 21,685 21,172 State and municipal securities 21,818 21,436 26,455 26,218 $ 206,243 $ 312,816 $ 197,453 $ 305,480 Included in the marketable equity securities are the following (in thousands, except share amounts) December 31, 2018 December 31, 2017 Shares Cost Fair Value Shares Cost Fair Value NHI Common Stock 1,630,642 $ 24,734 $ 123,179 1,630,642 $ 24,734 $ 122,918 The amortized cost and estimated fair value of debt securities classified as available for sale, by contractual maturity, are as follows: December 31, 2018 December 31, 2017 (in thousands) Cost Fair Value Cost Fair Value Maturities: Within 1 year $ 11,448 $ 11,401 $ 18,492 $ 18,499 1 to 5 years 98,487 97,430 70,331 70,157 6 to 10 years 64,932 62,527 77,657 76,943 Over 10 years 1,200 1,235 797 796 $ 176,067 $ 172,593 $ 167,277 $ 166,395 Gross unrealized gains related to marketable equity securities are $110,081,000 $108,934,000 December 31, 2018 2017, $34,000 $24,000 December 31, 2018 2017, December 31, 2018, $1,138,000 Gross unrealized gains related to available for sale marketable debt securities are $335,000 $823,000 December 31, 2018 2017, $3,809,000 $1,705,000 December 31, 2018 2017, For the marketable securities in gross unrealized loss positions, (a) it is more likely than not not no December 31, 2018 2017. Proceeds from the sale of available for sale marketable debt securities during the years ended December 31, 2018, 2017, 2016 $4,539,000, $50,197,000, $34,642,000, $18,000, $262,000, $816,000 December 31, 2018, 2017, 2016, No December 31, 2018, 2017, 2016.

Note 9 - Fair Value Measurement

Note 9 - Fair Value Measurements	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Fair Value Disclosures [Text Block]	Note 9 – 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. Valuation of Marketable Securities The Company determines fair value for marketable securities with Level 1 2 2 third We validated the prices provided by our broker by reviewing their pricing methods, obtaining market values from other pricing sources, analyzing pricing data in certain instances and confirming that the relevant markets are active. After completing our validation procedures, we did not December 31, 2018 2017. Other The carrying amounts of cash and cash equivalents, restricted cash and cash equivalents, accounts receivable, and accounts payable approximate fair value due to their short–term nature. The estimated fair value of notes receivable approximates the carrying value based principally on their underlying interest rates and terms, maturities, collateral and credit status of the receivables. Our long–term debt approximates fair value due to variable interest rates. At December 31, 2018 2017, no The following table summarizes fair value measurements by level at December 31, 2018 December 31, 2017 (in thousands) Fair Value Measurements Using December 31, 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 $ 43,247 $ 43,247 $ – $ – Restricted cash and cash equivalents 11,673 11,673 – – Marketable equity securities 140,223 140,223 – – Corporate debt securities 67,632 47,921 19,711 – Asset–backed securities 62,068 – 62,068 – U.S. Treasury securities 21,457 21,457 – – State and municipal securities 21,436 – 21,436 – Total financial assets $ 367,736 $ 264,521 $ 103,215 $ – 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 – Asset–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 10 - Property and Equipmen

Note 10 - Property and Equipment	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Property, Plant and Equipment Disclosure [Text Block]	Note 10 – Property and Equipment Property and equipment, at cost, consists of the following (in thousands) December 31, 2018 2017 Land $ 59,300 $ 59,778 Leasehold improvements 118,142 114,480 Buildings and improvements 611,516 603,289 Furniture and equipment 171,058 167,564 Construction in progress 19,072 13,637 Property and equipment, at cost 979,088 958,748 Less: Accumulated depreciation (444,438 ) (409,429 ) Net property and equipment $ 534,650 $ 549,319 The Company estimates the cost to complete construction in progress is approximately $774,000 December 31, 2018.

Note 11 - Notes Receivable

Note 11 - Notes Receivable	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Loans, Notes, Trade and Other Receivables Disclosure [Text Block]	Note 1 1 – Notes Receivable At December 31, 2018 2017, $10,996,000 $13,251,000, first 8% 2020 2022.

Note 12 - Long-term Debt

Note 12 - Long-term Debt	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Debt Disclosure [Text Block]	Note 1 2 – Long – Term Debt Long–term debt consists of the following (dollars in thousands) Interest Rate at December 31, Dec. 31, 2018 Maturities 2018 2017 Credit Facility, interest payable monthly Variable, 3.9% 2020 $ 55,000 $ 90,000 Unsecured term note payable to National, interest payable quarterly, principal payable at maturity -- 2028 – 10,000 55,000 100,000 Less current portion – – $ 55,000 $ 100,000 $ 11 0 ,000,000 Credit Facility In October 2015, $175 five October 2020). 1.40% 0.40%. 1%, 1.00%. During the second 2018, $175 $150 third 2018, $150 $110 The Credit Agreement contains customary representations and financial covenants, including covenants that restrict, among other things, asset dispositions, mergers and acquisitions, dividends, restricted payments, debt, liens, investments and affiliate transactions. The Credit Agreement contains customary events of default. The aggregate maturities of long–term debt for the five December 31, 2018 (in thousands) Long–Term Debt 2019 $ − 2020 55,000 2021 -- 2022 − 2023 − Thereafter -- Total $ 55,000

Note 13 - Income Taxes

Note 13 - Income Taxes	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Income Tax Disclosure [Text Block]	Note 1 3 – Income Taxes The provision for income taxes is comprised of the following components (in thousands) Year Ended December 31, 2018 2017 2016 Current Tax Provision Federal $ 13,583 $ 23,038 $ 24,012 State 1,612 2,150 661 Total current tax provision 15,195 25,188 24,673 Deferred Tax Provision Federal 610 (6,548 ) 4,208 State 380 227 788 Total deferred tax provision 990 (6,321 ) 4,996 Income Tax Provision $ 16,185 $ 18,867 $ 29,669 The deferred tax assets and liabilities, consisting of temporary differences tax effected at the respective income tax rates, are as follows (in thousands) December 31, 2018 2017 Deferred tax assets: Allowance for doubtful accounts receivable $ 48 $ 1,304 Accrued risk reserves 1,433 1,288 Accrued expenses 5,504 5,556 Financial reporting depreciation in excess of tax depreciation 6,340 5,301 Stock based compensation 959 607 Non-refundable entrance fees 103 121 Obligation to provide future services 580 747 Deferred revenue 3,480 2,753 State net operating loss carryforwards 5,762 4,732 Total gross deferred tax assets 24,209 22,409 Less: Valuation allowance (5,762 ) (4,732 ) Deferred tax assets less valuation allowance $ 18,447 $ 17,677 Deferred tax liabilities: Unrealized gains on marketable securities $ (28,032 ) $ (28,278 ) Deferred gain on sale of assets, net (2,146 ) (2,078 ) Book basis in excess of tax basis of intangible assets (1,748 ) (1,337 ) Book basis in excess of tax basis of securities (1,889 ) (1,585 ) Long–term investments (3,182 ) (2,775 ) Total deferred tax liabilities $ (36,997 ) $ (36,053 ) Net deferred tax liability $ (18,550 ) $ (18,376 ) A reconciliation of income tax expense and the amount computed by applying the statutory federal income tax rate to income before income taxes is as follows (in thousands) Year Ended December 31, 2018 2017 2016 Tax provision at federal statutory rate $ 15,726 $ 26,092 $ 28,072 Increase (decrease) in income taxes resulting from: Tax expense from minority interest 71 204 - State, net of federal benefit 3,213 2,647 1,783 Nondeductible expenses 478 230 156 Return to provision (1,418 ) - - Share based payments (136 ) (237 ) - Insurance expense (128 ) (103 ) 27 Revalue tax assets/liabilities due to federal tax reform - (8,488 ) - Other, net 15 (338 ) 283 Unrecognized tax benefits 586 613 716 Expiration of statute of limitations (2,222 ) (1,753 ) (1,368 ) Total increases (decreases) 459 (7,225 ) 1,597 Effective income tax expense $ 16,185 $ 18,867 $ 29,669 The exercise of non–qualified stock options results in state and federal income tax benefits to the Company related to the difference between the market price at the date of exercise and the option exercise price. During 2018, 2017 2016, $136,000, $237,000, 1,096,000 2017, 2016, Our deferred tax assets have been evaluated for realization based on historical taxable income, tax planning strategies, the expected timing of reversals of existing temporary differences and future taxable income anticipated. Our deferred tax assets, with the exception of certain state tax net operating losses, are more likely than not On December 22, 2017, 2017 “2017 No. 118 118” 2017 December 31, 2017, $8,488,000, 2017 not December 31, 2017. Uncertain tax positions may may not 740 Income Taxes Also, under ASC Topic 740, 50 In accordance with current guidance, the Company has established a liability for unrecognized tax benefits, which are differences between a tax position taken or expected to be taken in a tax return and the benefit recognized and measured. Generally, a liability is created for an unrecognized tax benefit because it represents a company’s potential future obligation to a taxing authority for a tax position that was not A reconciliation of the beginning and ending amount of unrecognized tax benefits is as follows (in thousands) Deferred Tax Asset Liability For Unrecognized Tax Benefits Liability For Interest and Penalties Liability Total Balance, January 1, 2016 $ 7,818 $ 13,162 $ 3,132 $ 16,294 Additions based on tax positions related to the current year 1,249 1,249 - 1,249 Additions for tax positions of prior years 481 718 934 1,652 Reductions for statute of limitation expirations (1,525 ) (2,164 ) (729 ) (2,893 ) Balance, December 31, 2016 8,023 12,965 3,337 16,302 Additions based on tax positions related to the current year 1,219 1,219 - 1,219 Additions for tax positions of prior years 342 844 865 1,709 Reductions for statute of limitation expirations (1,682 ) (2,508 ) (927 ) (3,435 ) Revaluation due to federal tax reform (2,854 ) - - - Balance, December 31, 2017 5,048 12,520 3,275 15,795 Additions based on tax positions related to the current year 811 811 - 811 Additions for tax positions of prior years 209 388 937 1,325 Reductions for statute of limitation expirations (505 ) (1,786 ) (941 ) (2,727 ) Balance, December 31, 2018 $ 5,563 $ 11,933 $ 3,271 $ 15,204 During the year ended December 31, 2018, $1,786,000 $941,000 $2,222,000. December 31, 2017 2016, $1,753,000 $1,368,000, Unrecognized tax benefits of $6,911,000, December 31, 2018, not twelve December 31, 2018, $2,460,000. Interest and penalties expense related to U.S. federal and state income tax returns are included within income tax expense. Interest and penalties expense (benefit) was $( 4,000 62,000 $205,000 December 31, 2018, 2017, 2016, The Company is no 2015

Note 14 - Stock Repurchase Prog

Note 14 - Stock Repurchase Program	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Treasury Stock [Text Block]	Note 1 4 – Stock Repurchase Program In August 2018, $25 September 1, 2018 August 31, 2019. No During the first 2018 August 31, 2018, 14,506 $867,000. On August 5, 2016 August 31, 2017, 130,000 $8,195,000. Under the common stock repurchase program, the Company may may may

Note 15 - Stock-based Compensat

Note 15 - Stock-based Compensation	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Disclosure of Compensation Related Costs, Share-based Payments [Text Block]	Note 1 5 – Stock – Based Compensation NHC recognizes stock–based compensation for all stock options and restricted stock granted over the requisite service period using the fair value for these grants as estimated at the date of grant either using the Black–Scholes pricing model for stock options or the quoted market price for restricted stock. The Compensation Committee of the Board of Directors ("the Committee") has the authority to select the participants to be granted options; to designate whether the option granted is an incentive stock option ("ISO"), a non–qualified option, or a stock appreciation right; to establish the number of shares of common stock that may may not 100% may not ten not 100% In May 2010, 2010 1,200,000 May 2015, 1,200,000 2,575,000 December 31, 2018, 601,244 Additionally, we have an employee stock purchase plan that allows employees to purchase our shares of stock through payroll deductions. The plan allows employees to terminate participation at any time. Compensation expense is recognized only for the awards that ultimately vest. The Company accounts for forfeitures when they occur. Stock–based compensation totaled $1,778,000, $1,678,000, $509,000, December 31, 2018, 2017, 2016, $1,047,000, $933,000, $5,680,000 December 31, 2018, 2017, 2016, $1,047,000, $933,000, $7,431,000 December 31, 2018, 2017 2016, At December 31, 2018, $4,961,000 three Stock Options The Company is required to estimate the fair value of stock–based awards on the date of grant. The fair value of each option award is estimated using the Black–Scholes option valuation model with the weighted average assumptions indicated in the following table. Each grant is valued as a single award with an expected term based upon expected employment and termination behavior. Compensation cost is recognized over the requisite service period in a manner consistent with the option vesting provisions. The straight–line attribution method requires that compensation expense is recognized at least equal to the portion of the grant–date fair value that is vested at that date. The expected volatility is derived using weekly historical data for periods immediately preceding the date of grant. The risk–free interest rate is the approximate yield on the United States Treasury Strips having a life equal to the expected option life on the date of grant. The expected life is an estimate of the number of years an option will be held before it is exercised. The following table summarizes the assumptions used to value the options granted in the periods shown. Year Ended December 31, 2018 2017 2016 Risk–free interest rate 2.46 % 2.08 % 0.89 % Expected volatility 16.1 % 16.6 % 15.8 % Expected life, in years 3.0 4.8 2.2 Expected dividend yield 3.29 % 3.10 % 3.09 % The following table summarizes option activity: Number of Shares Weighted Average Exercise Price Aggregate Intrinsic Value Options outstanding at January 1, 2016 621,390 $ 48.15 $ − Options granted 56,291 62.54 − Options exercised (499,066 ) 47.16 − Options cancelled (656 ) 46.69 − Options outstanding at December 31, 2016 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 110,265 61.39 -- Options exercised (68,291 ) 54.31 -- Options cancelled (118,000 ) 72.11 -- Options outstanding at December 31, 2018 1,163,381 $ 71.16 $ 8,483,000 Options exercisable at December 31, 2018 185,881 $ 64.41 $ 2,609,000 Options Outstanding December 31, 2018 Exercise Prices Weighted Average Exercise Price Weighted Average Remaining Contractual Life in Years 175,106 $52.93 – $62.78 $ 61.10 2.8 988,275 $72.94 72.94 3.2 1,163,381 $ 71.16 3.1

Note 16 - Contingencies and Gua

Note 16 - Contingencies and Guarantees	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Commitments and Contingencies Disclosure [Text Block]	Note 1 6 – Contingencies and Guar antees 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 $96,024,000 $93,275,000 December 31, 2018 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 use independent actuaries to assist management 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 Insurance and Lawsuits The senior care industry has experienced significant increases in both the number of personal injury/wrongful death claims and in the severity of awards based upon alleged negligence by skilled nursing facilities and their employees in providing care to residents. As of December 31, 2018, 59 Insurance coverage for all years includes primary policies and excess policies. The primary coverage is in the amount of $1.0 $3.0 2018, $9.0 third There is certain additional litigation incidental to our business, none Caris HealthCare, L.P. Investigation and Related Litigation On December 9, 2014, 75.1% A qui tam lawsuit was filed on May 22, 2014, No. 3:14–cv–212 On June 16, 2016, 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, 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. Debt Guarantees At December 31, 2018, no

Note 17 - Equity Method Investm

Note 17 - Equity Method Investment in Caris HealthCare, L.P.	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Cost and Equity Method Investments Disclosure [Text Block]	Note 1 7 – Equity Method Investment in Caris HealthCare, L.P. As of December 31, 2018, 75.1% $30,625,000 $34,951,000 December 31, 2018 2017, December 31, 2018, 2017, 2016 (in thousands) December 31, 2018 2017 2016 Current assets $ 17,539 $ 24,582 $ 23,174 Noncurrent assets 10,266 10,490 10,673 Liabilities 8,657 10,113 9,118 Partners’ capital 19,148 24,959 24,729 Revenue 56,410 53,586 53,211 Expenses 55,507 46,436 44,091 Net income 903 7,150 9,120 Consolidation Consideration s Due to our ownership percentage in Caris, we have considered whether Caris should be consolidated by NHC under the guidance provided in ASC Topic 810, Consolidation not 1 2 3 1 2 3 no

Note 18 - Relationship With Nat

Note 18 - Relationship With National Health Corporation	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Related Party Transactions Disclosure [Text Block]	Note 18 with National Health Corporation National Health Corporation ("National"), which is wholly–owned by the National Health Corporation Leveraged Employee Stock Ownership Plan ("ESOP"), was formed in 1986 may Management Contracts We currently manage five January 1, 2028. 3 Financing Activities During 1991, $10,000,000 0.85 third 2018. In conjunction with our management contract, we have entered into a line of credit arrangement whereby we may $2,000,000. December 31, 2018, not The maximum line of credit commitment amount of $2,000,000 1988. January 2028. Payroll and Related Services The personnel conducting our business, including our executive management team, are employees of National and may 1% December 31, 2018, 2017, 2016 $5,064,000, $5,134,000, $4,701,000, December 31, 2018 2017, $3,081,000 $2,521,000, $80,000 $86,000, National ’ s Ownership of Our Stock At December 31, 2018, 1,084,763 7.1% Consolidation Considerations Because of the contractual and management relationships between NHC and National as described in this note above, we have considered whether National should be consolidated by NHC under the guidance provided in ASC Topic 810, Consolidation not 1 not 2 3 1 may 2 50% not

Note 19 - Variable Interest Ent

Note 19 - Variable Interest Entity	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Variable Interest Entity Disclosure [Text Block]	Note 1 9 – Variable Interest Entity Accounting guidance requires that a variable interest entity (“VIE”), according to the provisions of ASC Topic 810, Consolidation December 31, 2018, one Springfield, Missouri L ease In December 2010, 120–bed ten five five third 120–bed third $4,500,000, third $11,047,000 $8,408,000 December 31, 2018 2017, $11,047,000 $8,408,000 December 31, 2018 2017,

Note 20 - Series B Junior Parti

Note 20 - Series B Junior Participating Preferred Stock	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Stockholder Rights Plan Disclosure [Text Block]	Note 20 – Series B Junior Participating Preferred Stock On August 2, 2007, one August 2, 2007. one $0.01 $250 August 7, 2017 no

Note 21 - Selected Quarterly Fi

Note 21 - Selected Quarterly Financial Data	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
Quarterly Financial Information [Text Block]	Note 2 1 – Selected Quarterly Financial Data (unaudited, in thousands, except per share amounts) The following table sets forth selected quarterly financial data for the two 2018 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Net operating revenues $ 242,961 $ 242,142 $ 246,326 $ 248,920 Income from operations 15,883 12,165 10,834 17,194 Non–operating income (3,065 ) 5,654 8,467 6,614 Unrealized (loss) gains on marketable equity securities (15,517 ) 12,448 3,486 721 Net (loss) income attributable to NHC (2,791 ) 22,461 21,142 18,152 Basic earnings per share (0.18 ) 1.48 1.39 1.19 Diluted earnings per share (0.18 ) 1.47 1.39 1.19 2017 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Net operating revenues $ 238,538 $ 238,695 $ 241,196 $ 246,311 Income from operations 15,864 12,138 9,785 16,323 Non–operating income 4,768 5,189 6,090 4,392 Net income attributable to NHC 12,728 10,655 11,352 21,470 Basic earnings per share .84 .70 .75 1.41 Diluted earnings per share .84 .70 .75 1.41

Schedule II - Valuation and Qua

Schedule II - Valuation and Qualifying Accounts	12 Months Ended
	Dec. 31, 2018
Notes to Financial Statements
SEC Schedule, 12-09, Schedule of Valuation and Qualifying Accounts Disclosure [Text Block]	NATIONAL HEALTHCARE CORPORATION SCHEDULE II – VALUATION AND QUALIFYING ACCOUNTS FOR THE YEARS ENDED DECEMBER 31, 2018, 2017 2016 (in thousands) Column A Column B Column C Column D Column E Additions Description Balance– Beginning of Period Charged to Costs and Expenses Charged to other Accounts Deductions Balance– End of Period For the year ended December 31, 2016 Accrued risk reserves $ 98,508 $ 63,596 $ − $ 70,942 $ 91,162 For the year ended December 31, 2017 Accrued risk reserves $ 91,162 $ 71,229 $ − $ 69,116 $ 93,275 For the year ended December 31, 2018 Accrued risk reserves $ 93,275 $ 75,052 $ − $ 72,303 $ 96,024

Significant Accounting Policies

Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2018
Accounting Policies [Abstract]
Basis of Accounting, Policy [Policy Text Block]	Principles of Consolidation and Basis of Presentation The consolidated financial statements, which are prepared in accordance with U.S. generally accepted accounting principles (“GAAP”), include our wholly owned and controlled subsidiaries and affiliates. All significant intercompany transactions and balances have been eliminated in consolidation. The Company presents noncontrolling interest within the equity section of its consolidated balance sheets. The Company presents the amount of consolidated net income that is attributable to NHC and the noncontrolling interest in its consolidated statements of operations. Variable interest entities (“VIEs”) in which we have an interest have been consolidated when we have been identified as the primary beneficiary. Investments in ventures in which we have the ability to exercise significant influence but do not 75.1%
Use of Estimates, Policy [Policy Text Block]	Use of Estimates The preparation of financial statements in conformity with U.S. GAAP requires management 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.
Revenue Recognition, Policy [Policy Text Block]	Net Patient Revenues and Accounts Receivable 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 recognizes revenue as its performance obligations are completed. Routine services are treated as a single performance obligation satisfied over time as services are rendered. These routine services represent a bundle of services that are not may not The Company determines the transaction price based on established billing rates reduced by contractual adjustments provided to third $1,524,000, $1,895,000, $2,539,000 December 31, 2018, 2017, 2016, December 31, 2018 2017, $4,610,000 $5,041,000,
Revenue Recognition for Alternative Revenue Programs, Policy [Policy Text Block]	Other Revenues As discussed in Note 3, We recognize rental income based on the terms of our operating leases. Under certain of our leases, we receive contingent rent, which is based on the increase in revenues of a lessee over a base year. We recognize contingent rent annually or monthly, as applicable, when, based on the actual revenue of the lessee is earned.
Segment Reporting, Policy [Policy Text Block]	Segment Reporting In accordance with the provisions of Accounting Standards Codification “ASC” 280, Segment Reporting two 1 one 2 5
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, professional 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 $28.7 $29.8 $28.8 December 31, 2018, 2017, 2016,
Cash and Cash Equivalents, Policy [Policy Text Block]	Cash and Cash Equivalents Cash equivalents include highly liquid investments with an original maturity of three
Cash and Restricted Cash and Cash Equivalents and Restricted Marketable Securities [Policy Text Block]	Restricted Cash and Cash Equivalents and Restricted Marketable Securities Restricted cash and cash equivalents and restricted marketable securities primarily represent assets that are held by our wholly–owned limited purpose insurance companies for workers' compensation and professional liability claims.
Marketable Securities, Policy [Policy Text Block]	Investments in Marketable Securities and Restricted Marketable Securities On January 1, 2018, No. 2016 01, January 1, 2018. not
Inventory, Policy [Policy Text Block]	Inventories Inventories consist generally of food and supplies and are valued at the lower of cost or market, with cost determined on a first–in, first–out (FIFO) basis.
Finance, Loans and Leases Receivable, Policy [Policy Text Block]	Mortgage and Other Notes Receivable In accordance with ASC Topic 310, Receivables may not
Property, Plant and Equipment, Policy [Policy Text Block]	Pro perty 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 Expenditures for repairs and maintenance are charged to expense as incurred. Betterments, which significantly extend the useful life, are capitalized. We remove the costs and related allowances for accumulated depreciation or amortization from the accounts for properties sold or retired, and any resulting gains or losses are included in income. In accordance with ASC Topic 360, Property, Plant, and Equipment may not
Goodwill and Intangible Assets, Goodwill, Policy [Policy Text Block]	Goodwill The Company accounts for goodwill under ASC Topic 350, Intangibles – Goodwill and Other not 350. first fourth The following table represents activity in goodwill by segment as of and for the year ended December 31, 2018 ( in thousands Year Ended December 31, 2018 Inpatient Services Homecare All Other Total January 1, 2016 $ - $ 17,600 $ - $ 17,600 Additions - - - - December 31, 2016 - 17,600 - 17,600 Additions - - - - December 31, 2017 - 17,600 - 17,600 Additions 3,395 - - 3,395 December 31, 2018 $ 3,395 $ 17,600 $ - $ 20,995 See Note 4 Non-operating income 2018.
Liability Reserve Estimate, Policy [Policy Text Block]	Accrued Risk Reserves We are principally self–insured for risks related to employee health insurance and utilize wholly–owned limited purpose insurance companies for workers’ compensation and professional liability claims. Accrued risk reserves primarily represent the accrual for risks associated with employee health insurance, workers’ compensation and professional liability claims. The accrued risk reserves include a liability for unpaid reported claims and estimates for incurred but unreported claims. Our policy with respect to a significant portion of our workers’ compensation and professional and general liability claims is to use an actuary to assist management in estimating our exposure for claims obligation (for both asserted and unasserted claims). Our health insurance reserve is based on our known claims incurred and an estimate of incurred but unreported claims determined by our analysis of historical claims paid. We reassess our accrued risk reserves on a quarterly basis, with changes in estimated losses being recorded in the consolidated statements of operations in the period first
Other Current Liabilities [Policy Text Block]	Other Current Liabilities Other current liabilities primarily represent accruals for current federal and state income taxes, real estate taxes and other current liabilities.
Continuing Care Contracts and Refundable Entrance Fees, Policy [Policy Text Block]	Continuing Care Contracts and Refundable Entrance Fees 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 December 31, 2018 December 31, 2017 $8,078,000 $8,827,000, Obligation to Provide Future Services We annually estimate the present value of the net 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 net cost of future services exceeds the related anticipated revenues, a liability is recorded (obligation to provide future services) with a corresponding charge to income. At December 31, 2018 2017, $2,172,000 $2,887,000,
Income Tax Uncertainties, Policy [Policy Text Block]	Other Noncurrent Liabilities Other noncurrent liabilities include reserves primarily related to various uncertain income tax positions.
Contract with Customer Liability, Policy [Policy Text Block]	Deferred Revenue Deferred revenue includes the deferred gain on the sale of assets to National Health Corporation (“National”), as discussed in Note 18, 10%
Income Tax, Policy [Policy Text Block]	Income Taxes We utilize ASC Topic 740, Income Taxes 13 Also, under ASC Topic 740, Income Taxes 50
Noncontrolling Interest, Policy [Policy Text Block]	Noncontrolling Interest The noncontrolling interest in a subsidiary is presented within total equity in the Company’s consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to NHC in its 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.
Share-based Compensation, Option and Incentive Plans Policy [Policy Text Block]	Stock – Based Compensation Stock–based awards granted include stock options, restricted stock units, and stock purchased under our employee stock purchase plan. Stock–based compensation cost is measured at the grant date, based on the fair value of the awards, and is recognized as expense over the requisite service period only for those equity awards expected to vest. The fair value of the restricted stock units is determined based on the stock price on the date of grant. We estimated the fair value of stock options and stock purchased under our employee stock purchase plan using the Black–Scholes model. This model utilizes the estimated fair value of common stock and requires that, at the date of grant, we use the expected term of the grant, the expected volatility of the price of our common stock, risk–free interest rates and expected dividend yield of our common stock. The fair value is amortized on a straight–line basis over the requisite service periods of the awards.
Comprehensive Income, Policy [Policy Text Block]	Comprehensive Income ASC Topic 220, Comprehensive Income,
Concentration Risk, Credit Risk, Policy [Policy Text Block]	Concentration of Credit Risks Our credit risks primarily relate to cash and cash equivalents, restricted cash and cash equivalents, accounts receivable, marketable securities, restricted marketable securities and notes receivable. Cash and cash equivalents are primarily held in bank accounts and overnight investments. Restricted cash and cash equivalents is primarily invested in commercial paper and certificates of deposit with financial institutions and other interest-bearing accounts. Accounts receivable consist primarily of amounts due from patients (funded through Medicare, Medicaid, other contractual programs and through private payors) and from other health care companies for management, accounting and other services. We perform continual credit evaluations of our clients and maintain appropriate allowances for doubtful accounts on any accounts receivable proving uncollectible, and continually monitor and adjust these allowances as necessary. Marketable securities and restricted marketable securities are held primarily in accounts with brokerage institutions. Notes receivable relate primarily to secured loans with health care facilities (recorded as notes receivable in the consolidated balance sheets) as discussed in Note 11. At any point in time we have funds in our operating accounts and restricted cash accounts that are with third may Our financial instruments, principally our notes receivable, are subject to the possibility of loss of the carrying values as a result of the failure of other parties to perform according to their contractual obligations. We obtain various collateral and other protective rights, and continually monitor these rights in order to reduce such possibilities of loss. We evaluate the need to provide reserves for potential losses on our financial instruments based on management's periodic review of the portfolio on an instrument by instrument basis. See Note 11
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 December 31, 2017 2016 January 1, 2018: Consolidated Statements of O perations ( in thousands Year Ended December 31, 2017 As Previously Reported Effect of Accounting Change As Adjusted Net patient revenues $ 919,843 $ (3,101 ) $ 916,742 Net operating revenues 966,996 (3,101 ) 963,895 Other operating expenses 252,934 (3,101 ) 249,833 Total costs and expenses 912,886 (3,101 ) 909,785 Net income 55,682 – 55,682 Year Ended December 31, 2016 As Previously Reported Effect of Accounting Change As Adjusted Net patient revenues $ 880,724 $ (3,058 ) $ 877,666 Net operating revenues 926,638 (3,058 ) 923,580 Other operating expenses 233,833 (3,058 ) 230,775 Total costs and expenses 866,096 (3,058 ) 863,038 Net income 50,538 – 50,538 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 December 31, 2018, $1,138,000 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, The Company adopted the standard as of January 1, 2019, not 1 not 2 While substantially complete, the Company is still in the process of finalizing its evaluation of the effect of Topic 842 first 2019. In June 2016, No. 2016 13, No. 2016 13 December 15, 2019, December 15, 2018.
Reclassification, Policy [Policy Text Block]	Prior Period Classifications Certain amounts in prior periods have been reclassified to conform with current period presentation.

Note 1 - Summary of Significa_2

Note 1 - Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of Goodwill [Table Text Block]	Year Ended December 31, 2018 Inpatient Services Homecare All Other Total January 1, 2016 $ - $ 17,600 $ - $ 17,600 Additions - - - - December 31, 2016 - 17,600 - 17,600 Additions - - - - December 31, 2017 - 17,600 - 17,600 Additions 3,395 - - 3,395 December 31, 2018 $ 3,395 $ 17,600 $ - $ 20,995
Schedule of Prospective Adoption of New Accounting Pronouncements [Table Text Block]	Year Ended December 31, 2017 As Previously Reported Effect of Accounting Change As Adjusted Net patient revenues $ 919,843 $ (3,101 ) $ 916,742 Net operating revenues 966,996 (3,101 ) 963,895 Other operating expenses 252,934 (3,101 ) 249,833 Total costs and expenses 912,886 (3,101 ) 909,785 Net income 55,682 – 55,682 Year Ended December 31, 2016 As Previously Reported Effect of Accounting Change As Adjusted Net patient revenues $ 880,724 $ (3,058 ) $ 877,666 Net operating revenues 926,638 (3,058 ) 923,580 Other operating expenses 233,833 (3,058 ) 230,775 Total costs and expenses 866,096 (3,058 ) 863,038 Net income 50,538 – 50,538

Note 2 - Net Patient Revenues (

Note 2 - Net Patient Revenues (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Disaggregation of Revenue [Table Text Block]	Year Ended December 31, (in thousands) 2018 2017 2016 Inpatient services $ 872,912 $ 853,662 $ 814,010 Homecare services 59,862 63,080 63,656 Total net patient revenue $ 932,774 $ 916,742 $ 877,666 Year Ended December 31, Source 2018 2017 2016 Medicare 35 % 35 % 37 % Managed Care 12 % 13 % 12 % Medicaid 26 % 26 % 26 % Private Pay and Other 27 % 26 % 25 % Total 100 % 100 % 100 %

Note 3 - Other Revenues (Tables

Note 3 - Other Revenues (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of Other Revenues [Table Text Block]	Year Ended December 31, (in thousands) 2018 2017 2016 Insurance services $ 7,084 $ 8,003 $ 7,195 Management and accounting service fees 15,175 16,169 15,953 Rental income 22,262 21,957 21,835 Other 1,386 1,024 931 Gain on sale of skilled nursing facility 1,668 -- -- Total other revenues $ 47,575 $ 47,153 $ 45,914

Note 4 - Non-operating Income (

Note 4 - Non-operating Income (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of Other Nonoperating Income, by Component [Table Text Block]	Year Ended December 31, (in thousands) 2018 2017 2016 Equity in earnings of unconsolidated investments $ 1,020 $ 6,932 $ 6,636 Dividends and net realized gains on sale of securities 7,417 7,335 7,547 Interest income 7,183 6,172 5,482 Gain on acquisition of equity method investment 2,050 - - Total non-operating income $ 17,670 $ 20,439 $ 19,665

Note 5 - Business Segments (Tab

Note 5 - Business Segments (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of Segment Reporting Information, by Segment [Table Text Block]	Year Ended December 31, 2018 Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 872,912 $ 59,862 $ - $ 932,774 Other revenues 2,494 - 45,081 47,575 Net operating revenues 875,406 59,862 45,081 980,349 Costs and Expenses: Salaries, wages and benefits 513,647 33,339 35,735 582,721 Other operating 225,133 19,566 9,339 254,038 Facility rent 33,052 1,945 5,926 40,923 Depreciation and amortization 38,372 229 3,293 41,894 Interest 1,504 - 3,193 4,697 Total costs and expenses 811,708 55,079 57,486 924,273 Income (loss) before non-operating income 63,698 4,783 (12,405 ) 56,076 Non-operating income - - 17,670 17,670 Unrealized gains on marketable securities - - 1,138 1,138 Income before income taxes $ 63,698 $ 4,783 $ 6,403 $ 74,884 Year Ended December 31, 2017 (As adjusted) Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 853,662 $ 63,080 $ - $ 916,742 Other revenues 663 - 46,490 47,153 Net operating revenues 854,325 63,080 46,490 963,895 Costs and Expenses: Salaries, wages and benefits 501,510 33,059 37,474 572,043 Other operating 221,414 20,855 7,564 249,833 Facility rent 32,744 1,980 5,643 40,367 Depreciation and amortization 38,246 177 4,229 42,652 Interest 1,719 - 3,171 4,890 Total costs and expenses 795,633 56,071 58,081 909,785 Income (loss) before non-operating income 58,692 7,009 (11,591 ) 54,110 Non-operating income - - 20,439 20,439 Income before income taxes $ 58,692 $ 7,009 $ 8,848 $ 74,549 Year Ended December 31, 2016 (As adjusted) Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 814,010 $ 63,656 $ - $ 877,666 Other revenues 651 - 45,263 45,914 Net operating revenues 814,661 63,656 45,263 923,580 Costs and Expenses: Salaries, wages and benefits 480,058 32,597 35,352 548,007 Other operating 202,827 20,705 7,243 230,775 Facility rent 33,129 1,932 6,231 41,292 Depreciation and amortization 34,423 190 4,410 39,023 Interest 1,921 - 2,020 3,941 Total costs and expenses 752,358 55,424 55,256 863,038 Income (loss) before non-operating income 62,303 8,232 (9,993 ) 60,542 Non-operating income - - 19,665 19,665 Income before income taxes $ 62,303 $ 8,232 $ 9,672 $ 80,207

Note 6 - Long-term Leases (Tabl

Note 6 - Long-term Leases (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of Capital Leased Assets [Table Text Block]	December 31, 2018 2017 Buildings and personal property $ 39,032 $ 39,032 Accumulated amortization (18,970 ) (15,045 ) $ 20,062 $ 23,987
Schedule of Future Minimum Lease Payments for Capital Leases [Table Text Block]	Operating Leases Capital Leases 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 108,350 867 Total minimum lease payments $ 279,350 $ 26,867 Less: amounts representing interest (3,815 ) Present value of minimum lease payments 23,052 Less: current portion (3,924 ) Long–term capital lease obligations $ 19,128

Note 7 - Earning Per Share (Tab

Note 7 - Earning Per Share (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	Year Ended December 31, 2018 2017 2016 Basic: Weighted average common shares outstanding 15,224,886 15,189,920 15,134,518 Net income attributable to common stockholders of National Healthcare Corporation $ 58,964 $ 56,205 $ 50,538 Earnings per common share, basic $ 3.87 $ 3.70 $ 3.34 Diluted: Weighted average common shares outstanding 15,224,886 15,189,920 15,134,518 Dilutive effect of stock options 11,940 29,042 24,176 Dilutive effect of contingent issuable stock -- – 48,303 Assumed average common shares outstanding 15,236,826 15,218,962 15,206,997 Net income attributable to common stockholders of National Healthcare Corporation $ 58,964 $ 56,205 $ 50,538 Earnings per common share, diluted $ 3.87 $ 3.69 $ 3.32

Note 8 - Investments in Marke_2

Note 8 - Investments in Marketable Securities (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Available-for-sale Securities [Table Text Block]	December 31, 2018 December 31, 2017 (in thousands) Amortized Cost Fair Value Amortized Cost Fair Value Investments available for sale: Marketable equity securities $ 30,176 $ 140,223 $ 30,176 $ 139,085 Restricted investments available for sale: Corporate debt securities 69,439 67,632 65,107 65,461 Asset–backed securities 62,772 62,068 54,030 53,544 U.S. Treasury securities 22,038 21,457 21,685 21,172 State and municipal securities 21,818 21,436 26,455 26,218 $ 206,243 $ 312,816 $ 197,453 $ 305,480
Schedule of Available-for-sale Securities Reconciliation [Table Text Block]	December 31, 2018 December 31, 2017 Shares Cost Fair Value Shares Cost Fair Value NHI Common Stock 1,630,642 $ 24,734 $ 123,179 1,630,642 $ 24,734 $ 122,918
Investments Classified by Contractual Maturity Date [Table Text Block]	December 31, 2018 December 31, 2017 (in thousands) Cost Fair Value Cost Fair Value Maturities: Within 1 year $ 11,448 $ 11,401 $ 18,492 $ 18,499 1 to 5 years 98,487 97,430 70,331 70,157 6 to 10 years 64,932 62,527 77,657 76,943 Over 10 years 1,200 1,235 797 796 $ 176,067 $ 172,593 $ 167,277 $ 166,395

Note 9 - Fair Value Measureme_2

Note 9 - Fair Value Measurements (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis [Table Text Block]	Fair Value Measurements Using December 31, 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 $ 43,247 $ 43,247 $ – $ – Restricted cash and cash equivalents 11,673 11,673 – – Marketable equity securities 140,223 140,223 – – Corporate debt securities 67,632 47,921 19,711 – Asset–backed securities 62,068 – 62,068 – U.S. Treasury securities 21,457 21,457 – – State and municipal securities 21,436 – 21,436 – Total financial assets $ 367,736 $ 264,521 $ 103,215 $ – 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 – Asset–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 10 - Property and Equipm_2

Note 10 - Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Property, Plant and Equipment [Table Text Block]	December 31, 2018 2017 Land $ 59,300 $ 59,778 Leasehold improvements 118,142 114,480 Buildings and improvements 611,516 603,289 Furniture and equipment 171,058 167,564 Construction in progress 19,072 13,637 Property and equipment, at cost 979,088 958,748 Less: Accumulated depreciation (444,438 ) (409,429 ) Net property and equipment $ 534,650 $ 549,319

Note 12 - Long-term Debt (Table

Note 12 - Long-term Debt (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of Debt [Table Text Block]	Interest Rate at December 31, Dec. 31, 2018 Maturities 2018 2017 Credit Facility, interest payable monthly Variable, 3.9% 2020 $ 55,000 $ 90,000 Unsecured term note payable to National, interest payable quarterly, principal payable at maturity -- 2028 – 10,000 55,000 100,000 Less current portion – – $ 55,000 $ 100,000
Schedule of Maturities of Long-term Debt [Table Text Block]	Long–Term Debt 2019 $ − 2020 55,000 2021 -- 2022 − 2023 − Thereafter -- Total $ 55,000

Note 13 - Income Taxes (Tables)

Note 13 - Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of Components of Income Tax Expense (Benefit) [Table Text Block]	Year Ended December 31, 2018 2017 2016 Current Tax Provision Federal $ 13,583 $ 23,038 $ 24,012 State 1,612 2,150 661 Total current tax provision 15,195 25,188 24,673 Deferred Tax Provision Federal 610 (6,548 ) 4,208 State 380 227 788 Total deferred tax provision 990 (6,321 ) 4,996 Income Tax Provision $ 16,185 $ 18,867 $ 29,669
Schedule of Deferred Tax Assets and Liabilities [Table Text Block]	December 31, 2018 2017 Deferred tax assets: Allowance for doubtful accounts receivable $ 48 $ 1,304 Accrued risk reserves 1,433 1,288 Accrued expenses 5,504 5,556 Financial reporting depreciation in excess of tax depreciation 6,340 5,301 Stock based compensation 959 607 Non-refundable entrance fees 103 121 Obligation to provide future services 580 747 Deferred revenue 3,480 2,753 State net operating loss carryforwards 5,762 4,732 Total gross deferred tax assets 24,209 22,409 Less: Valuation allowance (5,762 ) (4,732 ) Deferred tax assets less valuation allowance $ 18,447 $ 17,677 Deferred tax liabilities: Unrealized gains on marketable securities $ (28,032 ) $ (28,278 ) Deferred gain on sale of assets, net (2,146 ) (2,078 ) Book basis in excess of tax basis of intangible assets (1,748 ) (1,337 ) Book basis in excess of tax basis of securities (1,889 ) (1,585 ) Long–term investments (3,182 ) (2,775 ) Total deferred tax liabilities $ (36,997 ) $ (36,053 ) Net deferred tax liability $ (18,550 ) $ (18,376 )
Schedule of Effective Income Tax Rate Reconciliation [Table Text Block]	Year Ended December 31, 2018 2017 2016 Tax provision at federal statutory rate $ 15,726 $ 26,092 $ 28,072 Increase (decrease) in income taxes resulting from: Tax expense from minority interest 71 204 - State, net of federal benefit 3,213 2,647 1,783 Nondeductible expenses 478 230 156 Return to provision (1,418 ) - - Share based payments (136 ) (237 ) - Insurance expense (128 ) (103 ) 27 Revalue tax assets/liabilities due to federal tax reform - (8,488 ) - Other, net 15 (338 ) 283 Unrecognized tax benefits 586 613 716 Expiration of statute of limitations (2,222 ) (1,753 ) (1,368 ) Total increases (decreases) 459 (7,225 ) 1,597 Effective income tax expense $ 16,185 $ 18,867 $ 29,669
Schedule of Unrecognized Tax Benefits Roll Forward [Table Text Block]	Deferred Tax Asset Liability For Unrecognized Tax Benefits Liability For Interest and Penalties Liability Total Balance, January 1, 2016 $ 7,818 $ 13,162 $ 3,132 $ 16,294 Additions based on tax positions related to the current year 1,249 1,249 - 1,249 Additions for tax positions of prior years 481 718 934 1,652 Reductions for statute of limitation expirations (1,525 ) (2,164 ) (729 ) (2,893 ) Balance, December 31, 2016 8,023 12,965 3,337 16,302 Additions based on tax positions related to the current year 1,219 1,219 - 1,219 Additions for tax positions of prior years 342 844 865 1,709 Reductions for statute of limitation expirations (1,682 ) (2,508 ) (927 ) (3,435 ) Revaluation due to federal tax reform (2,854 ) - - - Balance, December 31, 2017 5,048 12,520 3,275 15,795 Additions based on tax positions related to the current year 811 811 - 811 Additions for tax positions of prior years 209 388 937 1,325 Reductions for statute of limitation expirations (505 ) (1,786 ) (941 ) (2,727 ) Balance, December 31, 2018 $ 5,563 $ 11,933 $ 3,271 $ 15,204

Note 15 - Stock-based Compens_2

Note 15 - Stock-based Compensation (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions [Table Text Block]	Year Ended December 31, 2018 2017 2016 Risk–free interest rate 2.46 % 2.08 % 0.89 % Expected volatility 16.1 % 16.6 % 15.8 % Expected life, in years 3.0 4.8 2.2 Expected dividend yield 3.29 % 3.10 % 3.09 %
Share-based Compensation, Stock Options, Activity [Table Text Block]	Number of Shares Weighted Average Exercise Price Aggregate Intrinsic Value Options outstanding at January 1, 2016 621,390 $ 48.15 $ − Options granted 56,291 62.54 − Options exercised (499,066 ) 47.16 − Options cancelled (656 ) 46.69 − Options outstanding at December 31, 2016 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 110,265 61.39 -- Options exercised (68,291 ) 54.31 -- Options cancelled (118,000 ) 72.11 -- Options outstanding at December 31, 2018 1,163,381 $ 71.16 $ 8,483,000 Options exercisable at December 31, 2018 185,881 $ 64.41 $ 2,609,000
Schedule of Share-based Compensation, Shares Authorized under Stock Option Plans, by Exercise Price Range [Table Text Block]	Options Outstanding December 31, 2018 Exercise Prices Weighted Average Exercise Price Weighted Average Remaining Contractual Life in Years 175,106 $52.93 – $62.78 $ 61.10 2.8 988,275 $72.94 72.94 3.2 1,163,381 $ 71.16 3.1

Note 17 - Equity Method Inves_2

Note 17 - Equity Method Investment in Caris HealthCare, L.P. (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Equity Method Investments [Table Text Block]	December 31, 2018 2017 2016 Current assets $ 17,539 $ 24,582 $ 23,174 Noncurrent assets 10,266 10,490 10,673 Liabilities 8,657 10,113 9,118 Partners’ capital 19,148 24,959 24,729 Revenue 56,410 53,586 53,211 Expenses 55,507 46,436 44,091 Net income 903 7,150 9,120

Note 21 - Selected Quarterly _2

Note 21 - Selected Quarterly Financial Data (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Quarterly Financial Information [Table Text Block]	2018 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Net operating revenues $ 242,961 $ 242,142 $ 246,326 $ 248,920 Income from operations 15,883 12,165 10,834 17,194 Non–operating income (3,065 ) 5,654 8,467 6,614 Unrealized (loss) gains on marketable equity securities (15,517 ) 12,448 3,486 721 Net (loss) income attributable to NHC (2,791 ) 22,461 21,142 18,152 Basic earnings per share (0.18 ) 1.48 1.39 1.19 Diluted earnings per share (0.18 ) 1.47 1.39 1.19 2017 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Net operating revenues $ 238,538 $ 238,695 $ 241,196 $ 246,311 Income from operations 15,864 12,138 9,785 16,323 Non–operating income 4,768 5,189 6,090 4,392 Net income attributable to NHC 12,728 10,655 11,352 21,470 Basic earnings per share .84 .70 .75 1.41 Diluted earnings per share .84 .70 .75 1.41

Schedule II - Valuation and Q_2

Schedule II - Valuation and Qualifying Accounts (Tables)	12 Months Ended
	Dec. 31, 2018
Notes Tables
Summary of Valuation Allowance [Table Text Block]	Column A Column B Column C Column D Column E Additions Description Balance– Beginning of Period Charged to Costs and Expenses Charged to other Accounts Deductions Balance– End of Period For the year ended December 31, 2016 Accrued risk reserves $ 98,508 $ 63,596 $ − $ 70,942 $ 91,162 For the year ended December 31, 2017 Accrued risk reserves $ 91,162 $ 71,229 $ − $ 69,116 $ 93,275 For the year ended December 31, 2018 Accrued risk reserves $ 93,275 $ 75,052 $ − $ 72,303 $ 96,024

Note 1 - Summary of Significa_3

Note 1 - Summary of Significant Accounting Policies (Details Textual) - USD ($)	3 Months Ended				12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Number of States in which Entity Operates	10				10
Provision for Doubtful Accounts					$ 1,524,000	$ 1,895,000	$ 2,539,000
Allowance for Doubtful Accounts Receivable, Ending Balance	$ 4,610,000				$ 4,610,000	5,041,000
Number of Reportable Segments					2
Contract with Customer, Refund Liability, Total	8,078,000				$ 8,078,000	8,827,000
Continuing Care Retirement Communities, Refund Obligation	2,172,000				2,172,000	2,887,000
Equity Securities, FV-NI, Unrealized Gain (Loss), Total	$ 721,000	$ 3,486,000	$ 12,448,000	$ (15,517,000)	1,138,000
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
Refundable Advance Fees [Member]
Nonrefundable Resident Entry Fee Percentage					10.00%
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					$ 28,700,000	$ 29,800,000	$ 28,800,000
Caris [Member]
Equity Method Investment, Ownership Percentage	75.10%				75.10%

Note 1 - Summary of Significa_4

Note 1 - Summary of Significant Accounting Policies - Goodwill Activity (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Balance	$ 17,600	$ 17,600	$ 17,600
Additions	3,395
Balance	20,995	17,600	17,600
Inpatient Services Segment [Member]
Balance
Additions	3,395
Balance	3,395
Homecare Services Segment [Member]
Balance	17,600	17,600	17,600
Additions
Balance	17,600	17,600	17,600
Other Segments [Member]
Balance
Additions
Balance

Note 1 - Summary of Significa_5

Note 1 - Summary of Significant Accounting Policies - Effect of Accounting Change (Details) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Net patient revenues									$ 932,774	$ 916,742	$ 877,666
Net operating revenues	$ 248,920	$ 246,326	$ 242,142	$ 242,961	$ 246,311	$ 241,196	$ 238,695	$ 238,538	980,349	963,895	923,580
Other operating expenses									254,038	249,833	230,775
Total costs and expenses									924,273	909,785	863,038
Net income									$ 58,699	55,682	50,538
Previously Reported [Member]
Net patient revenues										919,843	880,724
Net operating revenues										966,996	926,638
Other operating expenses										252,934	233,833
Total costs and expenses										912,886	866,096
Net income										55,682	50,538
Restatement Adjustment [Member]
Net patient revenues										(3,101)	(3,058)
Net operating revenues										(3,101)	(3,058)
Other operating expenses										(3,101)	(3,058)
Total costs and expenses										(3,101)	(3,058)
Net income

Note 2 - Net Patient Revenues_2

Note 2 - Net Patient Revenues (Details Textual) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Allowance for Doubtful Accounts Receivable, Ending Balance	$ 4,610,000	$ 5,041,000
Medicare and Medicaid [Member]
Allowance for Doubtful Accounts Receivable, Ending Balance	$ 16,108,000	$ 17,389,000

Note 2 - Net Patient Revenues -

Note 2 - Net Patient Revenues - Revenue Disaggregation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Net patient revenues	$ 932,774	$ 916,742	$ 877,666
Revenue, concentration percentage	100.00%	100.00%	100.00%
Inpatient Services [Member]
Net patient revenues	$ 872,912	$ 853,662	$ 814,010
Medicare [Member]
Revenue, concentration percentage	35.00%	35.00%	37.00%
Homecare [Member]
Net patient revenues	$ 59,862	$ 63,080	$ 63,656
Managed Care [Member]
Revenue, concentration percentage	12.00%	13.00%	12.00%
Medicaid [Member]
Revenue, concentration percentage	26.00%	26.00%	26.00%
Private Pay and Other [Member]
Revenue, concentration percentage	27.00%	26.00%	25.00%

Note 3 - Other Revenues (Detail

Note 3 - Other Revenues (Details Textual)	1 Months Ended	12 Months Ended
	Oct. 31, 2018USD ($)	Dec. 31, 2018USD ($)	Dec. 31, 2017USD ($)	Dec. 31, 2016USD ($)	Dec. 31, 2010
Insurance Services Revenue, Total		$ 7,084,000	$ 8,003,000	$ 7,195,000
Number of Skilled Nursing Centers		9
Unbilled Receivables, Current		$ 21,398,000	21,384,000
Number of Assisted Living Facilities		4
Number of New Triple Net Lease Agreements Entered Into During the Period		11
Number of Health Care Properties Owned and Leased to Third Party Operators		13
Lessee, Operating Lease, Term of Contract		10 years			10 years
Proceeds from Sale of Productive Assets, Total	$ 4,300,000	$ 4,300,000
Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property		$ 1,668,000
Other Revenue [Member]
Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property	$ 1,669,000
National [Member]
Number of Skilled Nursing Centers		5	5	5
Property Management Fee Revenue		$ 4,304,000	$ 4,194,000	$ 3,777,000
Management Services Provided to Other Facilities [Member]
Property Management Fee Revenue		$ 2,532,000	$ 2,794,000	$ 2,172,000
Number of Healthcare Facilities		7	7	6
Accounting and Financial Services Provided to Other Facilities [Member]
Number of Healthcare Facilities		20	20
Workers Compensation Revenue [Member]
Insurance Services Revenue, Total		$ 4,392,000	$ 5,300,000	$ 4,508,000
Professional Liability Insurance [Member]
Insurance Services Revenue, Total		$ 2,692,000	$ 2,703,000	$ 2,687,000

Note 3 - Other Revenues - Summa

Note 3 - Other Revenues - Summary of Other Revenues (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Insurance services	$ 7,084	$ 8,003	$ 7,195
Management and accounting service fees	15,175	16,169	15,953
Rental income	22,262	21,957	21,835
Other	1,386	1,024	931
Gain on sale of skilled nursing facility	1,668
Total other revenues	$ 47,575	$ 47,153	$ 45,914

Note 4 - Non-operating Income_2

Note 4 - Non-operating Income (Details Textual) - USD ($)	3 Months Ended	12 Months Ended
	Sep. 30, 2018	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Gain (Loss) on Acquisition of Equity Method Investment		$ 2,050,000
Goodwill, Ending Balance		$ 20,995,000	$ 17,600,000	$ 17,600,000	$ 17,600,000
Caris [Member]
Equity Method Investment, Ownership Percentage		75.10%
Loss Contingency, Damages Paid, Value		$ 8,364,000
Psychiatric Hospital in Osage Beach, Missouri [Member]
Gain (Loss) on Acquisition of Equity Method Investment	$ 2,050,000
Goodwill, Ending Balance	$ 3,395,000

Note 4 - Non-operating Income -

Note 4 - Non-operating Income - Summary of Non-operating Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Equity in earnings of unconsolidated investments	$ 1,020	$ 6,932	$ 6,636
Dividends and net realized gains on sale of securities	7,417	7,335	7,547
Interest income	7,183	6,172	5,482
Gain on acquisition of equity method investment	2,050
Total non-operating income	$ 17,670	$ 20,439	$ 19,665

Note 5 - Business Segments (Det

Note 5 - Business Segments (Details Textual)	12 Months Ended
	Dec. 31, 2018
Number of Operating Segments	2

Note 5 - Business Segments - Su

Note 5 - Business Segments - Summary of Financial Information by Reporting Segment (Details) - USD ($)	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Revenues:
Net patient revenues									$ 932,774,000	$ 916,742,000	$ 877,666,000
Other revenues									47,575,000	47,153,000	45,914,000
Net operating revenues	$ 248,920,000	$ 246,326,000	$ 242,142,000	$ 242,961,000	$ 246,311,000	$ 241,196,000	$ 238,695,000	$ 238,538,000	980,349,000	963,895,000	923,580,000
Costs and Expenses:
Salaries, wages and benefits									582,721,000	572,043,000	548,007,000
Other operating									254,038,000	249,833,000	230,775,000
Facility rent									40,923,000	40,367,000	41,292,000
Depreciation and amortization									41,894,000	42,652,000	39,023,000
Interest									4,697,000	4,890,000	3,941,000
Total costs and expenses									924,273,000	909,785,000	863,038,000
Income (loss) before non-operating income	17,194,000	10,834,000	12,165,000	15,883,000	$ 16,323,000	$ 9,785,000	$ 12,138,000	$ 15,864,000	56,076,000	54,110,000	60,542,000
Non-operating income									17,670,000	20,439,000	19,665,000
Unrealized gains on marketable securities	$ 721,000	$ 3,486,000	$ 12,448,000	$ (15,517,000)					1,138,000
Income before income taxes									74,884,000	74,549,000	80,207,000
Inpatient Services Segment [Member]
Revenues:
Net patient revenues									872,912,000	853,662,000	814,010,000
Other revenues									2,494,000	663,000	651,000
Net operating revenues									875,406,000	854,325,000	814,661,000
Costs and Expenses:
Salaries, wages and benefits									513,647,000	501,510,000	480,058,000
Other operating									225,133,000	221,414,000	202,827,000
Facility rent									33,052,000	32,744,000	33,129,000
Depreciation and amortization									38,372,000	38,246,000	34,423,000
Interest									1,504,000	1,719,000	1,921,000
Total costs and expenses									811,708,000	795,633,000	752,358,000
Income (loss) before non-operating income									63,698,000	58,692,000	62,303,000
Non-operating income
Unrealized gains on marketable securities
Income before income taxes									63,698,000	58,692,000	62,303,000
Homecare Services Segment [Member]
Revenues:
Net patient revenues									59,862,000	63,080,000	63,656,000
Other revenues
Net operating revenues									59,862,000	63,080,000	63,656,000
Costs and Expenses:
Salaries, wages and benefits									33,339,000	33,059,000	32,597,000
Other operating									19,566,000	20,855,000	20,705,000
Facility rent									1,945,000	1,980,000	1,932,000
Depreciation and amortization									229,000	177,000	190,000
Interest
Total costs and expenses									55,079,000	56,071,000	55,424,000
Income (loss) before non-operating income									4,783,000	7,009,000	8,232,000
Non-operating income
Unrealized gains on marketable securities
Income before income taxes									4,783,000	7,009,000	8,232,000
Other Segments [Member]
Revenues:
Net patient revenues
Other revenues									45,081,000	46,490,000	45,263,000
Net operating revenues									45,081,000	46,490,000	45,263,000
Costs and Expenses:
Salaries, wages and benefits									35,735,000	37,474,000	35,352,000
Other operating									9,339,000	7,564,000	7,243,000
Facility rent									5,926,000	5,643,000	6,231,000
Depreciation and amortization									3,293,000	4,229,000	4,410,000
Interest									3,193,000	3,171,000	2,020,000
Total costs and expenses									57,486,000	58,081,000	55,256,000
Income (loss) before non-operating income									(12,405,000)	(11,591,000)	(9,993,000)
Non-operating income									17,670,000	20,439,000	19,665,000
Unrealized gains on marketable securities									1,138,000
Income before income taxes									$ 6,403,000	$ 8,848,000	$ 9,672,000

Note 6 - Long-term Leases (Deta

Note 6 - Long-term Leases (Details Textual)	Mar. 01, 2014USD ($)	Jan. 01, 2007USD ($)	Sep. 30, 2013USD ($)	Dec. 31, 2018USD ($)	Dec. 31, 2017USD ($)	Dec. 31, 2016USD ($)	Dec. 31, 2010
Number of Facilities Under Capitalized Lease	3
Number of Capitalized Lease Agreements	3
Number of Additional Lease Options							5
Capital Leases, Future Minimum Payments, Net Minimum Payments, Total	$ 5,200,000
Lessee, Operating Lease, Term of Contract				10 years			10 years
Number of Skilled Nursing Centers				9
Capital Lease [Member]
Initial Lease Term	10 years
Number of Additional Lease Options	2
Capital Lease Additional Percentage Rent Percentage	4.00%
Term of Additional Lease Option	5 years
Capital Lease [Member] | Skilled Nursing Facility [Member]
Number of Facilities Under Capitalized Lease	2
Two Leases with NHI [Member]
Number of Skilled Nursing Centers Leased from NHI				35
Number of Assisted Living Centers Leased from NHI				7
Number of Independent Living Centers Leased from NHI				3
Number of Lease Agreements with NHI				2
Lease One With NHI [Member]
Number of Additional Lease Options		3
Number of Skilled Nursing Facilities Subleased				4
Lessee, Operating Lease, Term of Contract		15 years
Operating Leases, Rent Expense, Minimum Rentals		$ 30,750,000
Operating Lease Additional Percentage Rent Percentage		4.00%
Term of Additional Lease Option		5 years
Lease Two with NHI [Member]
Lessee, Operating Lease, Term of Contract			15 years
Operating Leases, Rent Expense, Minimum Rentals			$ 3,450,000	$ 34,200,000
Operating Lease Additional Percentage Rent Percentage			4.00%
Number of Skilled Nursing Centers			7
Facility Purchase Price			$ 49,000,000
Both NHI Lease Agreements [Member]
Operating Leases Percentage Rent Expense				$ 3,713,000	$ 3,057,000	$ 3,720,000

Note 6 - Long-term Leases - Fix

Note 6 - Long-term Leases - Fixed Assets Recorded Under Capital Leases (Details) - Buildings and Personal Property [Member] - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Buildings and personal property	$ 39,032	$ 39,032
Accumulated amortization	(18,970)	(15,045)
Total capital leases	$ 20,062	$ 23,987

Note 6 - Long-term Leases - Lon

Note 6 - Long-term Leases - Long-term Leases (Details) - USD ($) $ in Thousands	Dec. 31, 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	108,350
Thereafter, capital leases	867
Total minimum lease payments, operating leases	279,350
Total minimum lease payments, capital leases	26,867
Less: Amounts representing interest, capital leases	(3,815)
Present value of minimum lease payments, capital leases	23,052
Less: Current portion, capital leases	(3,924)	$ (3,696)
Long-term capital lease obligations, capital leases	$ 19,128	$ 23,052

Note 7 - Earning Per Share - Su

Note 7 - Earning 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								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Weighted average common shares outstanding (in shares)									15,224,886	15,189,920	15,134,518
Net income attributable to common stockholders of National Healthcare Corporation	$ 18,152	$ 21,142	$ 22,461	$ (2,791)	$ 21,470	$ 11,352	$ 10,655	$ 12,728	$ 58,964	$ 56,205	$ 50,538
Basic earnings per share (in dollars per share)	$ 1.19	$ 1.39	$ 1.48	$ (0.18)	$ 1.41	$ 0.75	$ 0.70	$ 0.84	$ 3.87	$ 3.70	$ 3.34
Diluted (in shares)									15,236,826	15,218,962	15,206,997
Diluted earnings per share (in dollars per share)	$ 1.19	$ 1.39	$ 1.47	$ (0.18)	$ 1.41	$ 0.75	$ 0.70	$ 0.84	$ 3.87	$ 3.69	$ 3.32
Employee Stock Option [Member]
Dilutive effect of share-based awards (in shares)									11,940	29,042	24,176
Restricted Stock [Member]
Dilutive effect of share-based awards (in shares)											48,303

Note 8 - Investments in Marke_3

Note 8 - Investments in Marketable Securities (Details Textual) - USD ($)	3 Months Ended				12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Equity Securities Fv Ni Gross Unrealized Gain	$ 110,081,000				$ 110,081,000	$ 108,934,000
Equity Securities Fv Ni Gross Unrealized Loss	34,000				34,000	24,000
Equity Securities, FV-NI, Unrealized Gain (Loss), Total	721,000	$ 3,486,000	$ 12,448,000	$ (15,517,000)	1,138,000
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Gain, before Tax	335,000				335,000	823,000
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Loss, before Tax	$ 3,809,000				3,809,000	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					4,539,000	50,197,000	34,642,000
Realized Investment Gains (Losses), Total					18,000	262,000	816,000
Proceeds from Sale and Maturity of Marketable Securities, Total					$ 0	$ 0	$ 0

Note 8 - Investments in Marke_4

Note 8 - Investments in Marketable Securities - Marketable Securities and Restricted Marketable Securities (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Restricted investments available for sale, amortized cost	$ 176,067	$ 167,277
Restricted investments available for sale, fair value	172,593	166,395
Investments available for sale, amortized cost	206,243	197,453
Investments available for sale, fair value	312,816	305,480
Equity Securities [Member]
Unrestricted investments available for sale, amortized cost	30,176	30,176
Unrestricted investments available for sale, fair value	140,223	139,085
Corporate Debt Securities [Member]
Restricted investments available for sale, amortized cost	69,439	65,107
Restricted investments available for sale, fair value	67,632	65,461
Collateralized Mortgage Backed Securities [Member]
Restricted investments available for sale, amortized cost	62,772	54,030
Restricted investments available for sale, fair value	62,068	53,544
US Government Corporations and Agencies Securities [Member]
Restricted investments available for sale, amortized cost	22,038	21,685
Restricted investments available for sale, fair value	21,457	21,172
US States and Political Subdivisions Debt Securities [Member]
Restricted investments available for sale, amortized cost	21,818	26,455
Restricted investments available for sale, fair value	$ 21,436	$ 26,218

Note 8 - Investments in Marke_5

Note 8 - Investments in Marketable Securities - Available for Sale Marketable Equity Securities (Details) - NHI Common Stock [Member] - USD ($) $ in Thousands	Dec. 31, 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	$ 123,179	$ 122,918

Note 8 - Investments in Marke_6

Note 8 - Investments in Marketable Securities - Amortized Cost and Estimated Fair Value of Debt Securities as Available for Sale (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Within 1 year, cost	$ 11,448	$ 18,492
Within 1 year, fair value	11,401	18,499
1 to 5 years, cost	98,487	70,331
1 to 5 years, fair value	97,430	70,157
6 to 10 years, cost	64,932	77,657
6 to 10 years, fair value	62,527	76,943
Over 10 years, cost	1,200	797
Over 10 years, fair value	1,235	796
Cost	176,067	167,277
Fair Value	$ 172,593	$ 166,395

Note 9 - Fair Value Measureme_3

Note 9 - Fair Value Measurements - Summary of Fair Value Measurements by Level (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Restricted cash and cash equivalents	$ 11,673	$ 8,303	$ 5,254
Available-for-sale securities	172,593	166,395
Corporate Debt Securities [Member]
Available-for-sale securities	67,632	65,461
US States and Political Subdivisions Debt Securities [Member]
Available-for-sale securities	21,436	26,218
Fair Value, Measurements, Recurring [Member]
Cash and cash equivalents	43,247	59,118
Restricted cash and cash equivalents	11,673	8,303
Total financial assets	367,736	372,901
Fair Value, Measurements, Recurring [Member] | Equity Securities [Member]
Available-for-sale securities	140,223	139,085
Fair Value, Measurements, Recurring [Member] | Corporate Debt Securities [Member]
Available-for-sale securities	67,632	65,461
Fair Value, Measurements, Recurring [Member] | Asset-backed Securities [Member]
Available-for-sale securities	62,068	53,544
Fair Value, Measurements, Recurring [Member] | US Treasury Securities [Member]
Available-for-sale securities	21,457	21,172
Fair Value, Measurements, Recurring [Member] | US States and Political Subdivisions Debt Securities [Member]
Available-for-sale securities	21,436	26,218
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member]
Cash and cash equivalents	43,247	59,118
Restricted cash and cash equivalents	11,673	8,303
Total financial assets	264,521	270,751
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Equity Securities [Member]
Available-for-sale securities	140,223	139,085
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Corporate Debt Securities [Member]
Available-for-sale securities	47,921	43,073
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Asset-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	21,457	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	103,215	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	19,711	22,388
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Asset-backed Securities [Member]
Available-for-sale securities	62,068	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	$ 21,436	$ 26,218

Note 10 - Property and Equipm_3

Note 10 - Property and Equipment (Details Textual)	Dec. 31, 2018USD ($)
Cost to Complete Construction in Progress	$ 774,000

Note 10 - Property and Equipm_4

Note 10 - Property and Equipment - Property and Equipment, at Cost (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Land	$ 59,300	$ 59,778
Leasehold improvements	118,142	114,480
Buildings and improvements	611,516	603,289
Furniture and equipment	171,058	167,564
Construction in progress	19,072	13,637
Property and equipment, at cost	979,088	958,748
Less: Accumulated depreciation	(444,438)	(409,429)
Net property and equipment	$ 534,650	$ 549,319

Note 11 - Notes Receivable (Det

Note 11 - Notes Receivable (Details Textual) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Financing Receivable, Gross	$ 10,996,000	$ 13,251,000
Prime Rate [Member] | Maximum [Member]
Loans Receivable, Basis Spread on Variable Rate	8.00%	8.00%

Note 12 - Long-term Debt (Detai

Note 12 - Long-term Debt (Details Textual) - Bank of America [Member] - USD ($) $ in Millions	1 Months Ended
	Oct. 31, 2015	Sep. 30, 2018	Jun. 30, 2018
Line of Credit Facility, Maximum Borrowing Capacity	$ 175	$ 110	$ 150
Debt Instrument, Term	5 years
London Interbank Offered Rate (LIBOR) [Member]
Debt Instrument, Basis Spread on Variable Rate	1.40%
Debt Instrument, Basis Spread on Base Rate	1.00%
Base Rate [Member]
Debt Instrument, Basis Spread on Variable Rate	0.40%
Federal Funds Effective Swap Rate [Member]
Debt Instrument, Basis Spread on Base Rate	0.50%

Note 12 - Long-term Debt - Summ

Note 12 - Long-term Debt - Summary of Long-term Debt (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Long-term debt	$ 55	$ 100
Less current portion
Long-term debt, noncurrent	$ 55	100
Line of Credit [Member]
Long-term debt, weighted average interest rate	3.90%
Long-term debt, maturities	2,020
Long-term debt	$ 55	90
Unsecured Term Note Payable [Member]
Long-term debt, maturities	2,028
Long-term debt		$ 10

Note 12 - Long-term Debt - Aggr

Note 12 - Long-term Debt - Aggregate Maturities of Long-term Debt (Details) - USD ($) $ in Millions	Dec. 31, 2018	Dec. 31, 2017
2,019
2,020	55
2,021
2,022
2,023
Thereafter
Total	$ 55	$ 100

Note 13 - Income Taxes (Details

Note 13 - Income Taxes (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Effective Income Tax Rate Reconciliation, Share-based Compensation, Excess Tax Expense (Benefit), Amount	$ (136,000)	$ (237,000)	$ 1,096,000
Income Tax Expense (Benefit), Continuing Operations, Adjustment of Deferred Tax (Asset) Liability		(8,488,000)
Unrecognized Tax Benefits, Period Increase (Decrease), Total	(1,786,000)
Effective Income Tax Rate Reconciliation, Benefit Resulting from Expiration of Applicable Statute Limitations, Amount	2,222,000	1,753,000	1,368,000
Significant Change in Unrecognized Tax Benefits is Reasonably Possible, Amount of Unrecorded Benefit	2,460,000
Income Tax Examination, Penalties and Interest Expense, Total	$ 4,000	62,000	205,000
Open Tax Year	2,015
Liability for Interest and Penalties [Member]
Unrecognized Tax Benefits, Reduction Resulting from Lapse of Applicable Statute of Limitations	$ 941,000	927,000	729,000
Unrecognized Tax Benefits, Ending Balance	3,271,000	$ 3,275,000	$ 3,337,000	$ 3,132,000
Permanent Differences [Member]
Unrecognized Tax Benefits, Ending Balance	$ 6,911,000

Note 13 - Income Taxes - Provis

Note 13 - Income Taxes - Provision for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Federal	$ 13,583	$ 23,038	$ 24,012
State	1,612	2,150	661
Total current tax provision	15,195	25,188	24,673
Federal	610	(6,548)	4,208
State	380	227	788
Total deferred tax provision	990	(6,321)	4,996
Effective income tax expense	$ 16,185	$ 18,867	$ 29,669

Note 13 - Income Taxes - Deferr

Note 13 - Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Allowance for doubtful accounts receivable	$ 48	$ 1,304
Accrued risk reserves	1,433	1,288
Accrued expenses	5,504	5,556
Financial reporting depreciation in excess of tax depreciation	6,340	5,301
Stock based compensation	959	607
Non-refundable entrance fees	103	121
Obligation to provide future services	580	747
Deferred revenue	3,480	2,753
State net operating loss carryforwards	5,762	4,732
Total gross deferred tax assets	24,209	22,409
Less: Valuation allowance	(5,762)	(4,732)
Deferred tax assets less valuation allowance	18,447	17,677
Unrealized gains on marketable securities	(28,032)	(28,278)
Deferred gain on sale of assets, net	(2,146)	(2,078)
Book basis in excess of tax basis of intangible assets	(1,748)	(1,337)
Book basis in excess of tax basis of securities	(1,889)	(1,585)
Long–term investments	(3,182)	(2,775)
Total deferred tax liabilities	(36,997)	(36,053)
Net deferred tax liability	$ (18,550)	$ (18,376)

Note 13 - Income Taxes - Reconc

Note 13 - Income Taxes - Reconciliation of Income Tax Expense (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Tax provision at federal statutory rate	$ 15,726,000	$ 26,092,000	$ 28,072,000
Tax expense from minority interest	71,000	204,000
State, net of federal benefit	(3,213,000)	(2,647,000)	(1,783,000)
Nondeductible expenses	478,000	230,000	156,000
Return to provision	(1,418,000)
Share based payments	(136,000)	(237,000)	1,096,000
Insurance expense	(128,000)	(103,000)	27,000
Revalue tax assets/liabilities due to federal tax reform		(8,488,000)
Other, net	15,000	(338,000)	283,000
Unrecognized tax benefits	586,000	613,000	716,000
Expiration of statute of limitations	(2,222,000)	(1,753,000)	(1,368,000)
Total increases (decreases)	459,000	(7,225,000)	1,597,000
Effective income tax expense	$ 16,185,000	$ 18,867,000	$ 29,669,000

Note 13 - Income Taxes - Reco_2

Note 13 - Income Taxes - Reconciliation of Unrecognized Tax Benefits (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Deferred Tax Assets [Member]
Balance	$ 5,048,000	$ 8,023,000	$ 7,818,000
Additions based on tax positions related to the current year	811,000	1,219,000	1,249,000
Additions for tax positions of prior years	209,000	342,000	481,000
Reductions for statute of limitation expirations	(505,000)	(1,682,000)	(1,525,000)
Revaluation due to federal tax reform		(2,854,000)
Balance	5,563,000	5,048,000	8,023,000
Liability for Unrecognized Tax Benefits [Member]
Balance	12,520,000	12,965,000	13,162,000
Additions based on tax positions related to the current year	811,000	1,219,000	1,249,000
Additions for tax positions of prior years	388,000	844,000	718,000
Reductions for statute of limitation expirations	(1,786,000)	(2,508,000)	(2,164,000)
Revaluation due to federal tax reform
Balance	11,933,000	12,520,000	12,965,000
Liability for Interest and Penalties [Member]
Balance	3,275,000	3,337,000	3,132,000
Additions based on tax positions related to the current year
Additions for tax positions of prior years	937,000	865,000	934,000
Reductions for statute of limitation expirations	(941,000)	(927,000)	(729,000)
Revaluation due to federal tax reform
Balance	3,271,000	3,275,000	3,337,000
Total Liability [Member]
Balance	15,795,000	16,302,000	16,294,000
Additions based on tax positions related to the current year	811,000	1,219,000	1,249,000
Additions for tax positions of prior years	1,325,000	1,709,000	1,652,000
Reductions for statute of limitation expirations	(2,727,000)	(3,435,000)	(2,893,000)
Revaluation due to federal tax reform
Balance	$ 15,204,000	$ 15,795,000	$ 16,302,000

Note 14 - Stock Repurchase Pr_2

Note 14 - Stock Repurchase Program (Details Textual) - Common Stock [Member] - USD ($)	Aug. 05, 2016	Dec. 31, 2018	Aug. 31, 2018
Stock Repurchase Program, Authorized Amount			$ 25,000,000
Stock Repurchased and Retired During Period, Shares	130,000	0	14,506
Stock Repurchased and Retired During Period, Value	$ 8,195,000		$ 867,000

Note 15 - Stock-based Compens_3

Note 15 - Stock-based Compensation (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	May 31, 2015	May 30, 2015	May 31, 2010
Allocated Share-based Compensation Expense, Total	$ 1,778,000	$ 1,678,000	$ 509,000
Employee Service Share-based Compensation, Tax Benefit from Compensation Expense	1,047,000	933,000	5,680,000
Share-based Compensation Arrangement by Share-based Payment Award, Options, Exercises in Period, Intrinsic Value	1,047,000	$ 933,000	$ 7,431,000
Employee Service Share-based Compensation, Nonvested Awards, Compensation Cost Not yet Recognized, Total	$ 4,961,000
Employee Service Share-based Compensation, Nonvested Awards, Compensation Cost Not yet Recognized, Period for Recognition	3 years
The 2010 Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant	601,244					1,200,000
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Authorized				2,575,000	1,200,000
Employee Stock Option [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Expiration Period	10 years

Note 15 - Stock-based Compens_4

Note 15 - Stock-based Compensation - Summary of Assumptions Used to Value Options Granted (Details)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Risk–free interest rate	2.46%	2.08%	0.89%
Expected volatility	16.10%	16.60%	15.80%
Expected life (Year)	3 years	4 years 292 days	2 years 73 days
Expected dividend yield	3.29%	3.10%	3.09%

Note 15 - Stock-based Compens_5

Note 15 - Stock-based Compensation - Summary of Options Outstanding (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Options outstanding, shares (in shares)	1,239,407	177,959	621,390
Options outstanding, weighted average exercise price (in dollars per share)	$ 71.19	$ 55.48	$ 48.15
Options granted, shares (in shares)	110,265	1,125,443	56,291
Options granted, weighted average exercise price (in dollars per share)	$ 61.39	$ 72.96	$ 62.54
Options exercised, shares (in shares)	(68,291)	(48,995)	(499,066)
Options exercised, weighted average exercise price (in dollars per share)	$ 54.31	$ 51.25	$ 47.16
Options cancelled, shares (in shares)	(118,000)	(15,000)	(656)
Options cancelled, weighted average exercise price (in dollars per share)	$ 72.11	$ 72.94	$ 46.69
Options outstanding, shares (in shares)	1,163,381	1,239,407	177,959
Options outstanding, weighted average exercise price (in dollars per share)	$ 71.16	$ 71.19	$ 55.48
Options outstanding, aggregate intrinsic value	$ 8,483,000
Options exercisable, shares (in shares)	185,881
Options exercisable, weighted average exercise price (in dollars per share)	$ 64.41
Options exercisable, aggregate intrinsic value	$ 2,609,000

Note 15 - Stock-based Compens_6

Note 15 - Stock-based Compensation - Options Outstanding by Exercise Price Range (Details)	12 Months Ended
	Dec. 31, 2018$ / sharesshares
Options outstanding (in shares) | shares	1,163,381
Weighted average exercise price (in dollars per share)	$ 71.16
Weighted average remaining contractual life (Year)	3 years 36 days
Exercise Price Range 1 [Member]
Options outstanding (in shares) | shares	175,106
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)	$ 61.10
Weighted average remaining contractual life (Year)	2 years 292 days
Exercise Price Range 2 [Member]
Options outstanding (in shares) | shares	988,275
Exercise price, lower range (in dollars per share)	$ 72.94
Exercise price, upper range (in dollars per share)	72.94
Weighted average exercise price (in dollars per share)	$ 72.94
Weighted average remaining contractual life (Year)	3 years 73 days

Note 16 - Contingencies and G_2

Note 16 - Contingencies and Guarantees (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2018	Jun. 25, 2018	Dec. 31, 2017
Self Insurance Reserve	$ 96,024,000		$ 93,275,000
Direct Business Coverage Statutory Limits	$ 1,000,000
Malpractice Loss Contingency, Number of Claims	59
Primary Insurance Coverage, Amount Per Incident	$ 1,000,000
Primary Insurance Coverage, Amount Per Location	3,000,000
Annual Excess Coverage	$ 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%

Note 17 - Equity Method Inves_3

Note 17 - Equity Method Investment in Caris HealthCare, L.P. (Details Textual) - Caris [Member] - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Equity Method Investment, Ownership Percentage	75.10%
Equity Method Investments	$ 30,625,000	$ 34,951,000

Note 17 - Equity Method Inves_4

Note 17 - Equity Method Investment in Caris HealthCare, L.P. - Summary of Financial Information of Caris (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Current assets	$ 17,539	$ 24,582	$ 23,174
Noncurrent assets	10,266	10,490	10,673
Liabilities	8,657	10,113	9,118
Partners’ capital	19,148	24,959	24,729
Revenue	56,410	53,586	53,211
Expenses	55,507	46,436	44,091
Net income	$ 903	$ 7,150	$ 9,120

Note 18 - Relationship With N_2

Note 18 - Relationship With National Health Corporation (Details Textual)	12 Months Ended
	Dec. 31, 2018USD ($)shares	Dec. 31, 2017USD ($)shares	Dec. 31, 2016USD ($)shares	Dec. 31, 1991USD ($)	Dec. 31, 2015shares
Number of Skilled Nursing Centers	9
Common Stock [Member]
Shares, Outstanding, Ending Balance | shares	15,255,002	15,212,133	15,162,938		15,000,616
National [Member]
Line of Credit Facility, Maximum Borrowing Capacity	$ 2,000,000
Payroll and Related Services Administrative Fee Percentage	1.00%
Payment for Administrative Fees	$ 5,064,000	$ 5,134,000	$ 4,701,000
Employee-related Receivables	3,081,000	2,521,000
Employee-related Liabilities, Total	$ 80,000	$ 86,000
National [Member] | Common Stock [Member]
Shares, Outstanding, Ending Balance | shares	1,084,763
Equity Owned by Related Parties	7.10%
Loans Payable [Member] | National [Member]
Notes Payable, Related Parties				$ 10,000,000
Debt Instrument, Basis Spread on Variable Rate				0.85%
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
National [Member]
Number of Skilled Nursing Centers	5	5	5

Note 19 - Variable Interest E_2

Note 19 - Variable Interest Entity (Details Textual)	12 Months Ended
	Dec. 31, 2018USD ($)	Dec. 31, 2017USD ($)	Dec. 31, 2010USD ($)
Number of Variable Interest Entities	1
Number of Patient Beds in Facility			120
Lessee, Operating Lease, Term of Contract	10 years		10 years
Number of Additional Lease Options			5
Lessee, Operating Lease, Renewal Term			5 years
Notes, Loans and Financing Receivable, Gross, Current			$ 4,500,000
Increase (Decrease) in Notes Payable, Current, Total	$ 11,047,000	$ 8,408,000

Note 20 - Series B Junior Par_2

Note 20 - Series B Junior Participating Preferred Stock (Details Textual) shares in Thousands	137 Months Ended
	Dec. 31, 2018shares	Aug. 02, 2007$ / shares
Dividend Distribution Rights		1
Series B Junior Participating Preferred Stock [Member]
Preferred Stock, Par or Stated Value Per Share		$ 0.01
Preferred Stock, Redemption Price Per Share		$ 250
Stock Issued During Period, Shares, Stockholder Rights Plan | shares	0

Note 21 - Selected Quarterly _3

Note 21 - Selected Quarterly Financial Data - Selected Quarterly Financial Data (Details) - USD ($)	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Net operating revenues	$ 248,920,000	$ 246,326,000	$ 242,142,000	$ 242,961,000	$ 246,311,000	$ 241,196,000	$ 238,695,000	$ 238,538,000	$ 980,349,000	$ 963,895,000	$ 923,580,000
Income from operations	17,194,000	10,834,000	12,165,000	15,883,000	16,323,000	9,785,000	12,138,000	15,864,000	56,076,000	54,110,000	60,542,000
Non–operating income	6,614,000	8,467,000	5,654,000	(3,065,000)	4,392,000	6,090,000	5,189,000	4,768,000
Unrealized (loss) gains on marketable equity securities	721,000	3,486,000	12,448,000	(15,517,000)					1,138,000
Net (loss) income attributable to NHC	$ 18,152,000	$ 21,142,000	$ 22,461,000	$ (2,791,000)	$ 21,470,000	$ 11,352,000	$ 10,655,000	$ 12,728,000	$ 58,964,000	$ 56,205,000	$ 50,538,000
Basic earnings per share (in dollars per share)	$ 1.19	$ 1.39	$ 1.48	$ (0.18)	$ 1.41	$ 0.75	$ 0.70	$ 0.84	$ 3.87	$ 3.70	$ 3.34
Diluted earnings per share (in dollars per share)	$ 1.19	$ 1.39	$ 1.47	$ (0.18)	$ 1.41	$ 0.75	$ 0.70	$ 0.84	$ 3.87	$ 3.69	$ 3.32

Schedule II - Valuation and Q_3

Schedule II - Valuation and Qualifying Accounts - Summary of Valuation and Qualifying Accounts (Details) - Accrued Risk Reserves [Member] - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Beginning Balance	$ 93,275	$ 91,162	$ 98,508
Charged to Costs and Expenses	75,052	71,229	63,596
Charged to other Accounts
Deductions	72,303	69,116	70,942
Accrued risk reserves	$ 96,024	$ 93,275	$ 91,162