National HealthCare (NHC) 10-K 19 Feb 21 2020 FY Annual report Financial data

Document And Entity Information

Document And Entity Information - USD ($)	12 Months Ended
	Dec. 31, 2020	Feb. 10, 2021	Jun. 30, 2020
Document Information [Line Items]
Entity Central Index Key	0001047335
Entity Registrant Name	NATIONAL HEALTHCARE CORP
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Document Fiscal Period Focus	FY
Document Fiscal Year Focus	2020
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2020
Document Transition Report	false
Entity File Number	001-13489
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	52-2057472
Entity Address, Address Line One	100 E. Vine Street
Entity Address, City or Town	Murfreesboro
Entity Address, State or Province	TN
Entity Address, Postal Zip Code	37130
City Area Code	615
Local Phone Number	890–2020
Title of 12(b) Security	Shares of Common Stock
Trading Symbol	NHC
Security Exchange Name	NYSE
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Public Float			$ 604,800,000
Entity Common Stock, Shares Outstanding		15,370,042

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Revenues:
Net patient revenues	$ 931,795,000	$ 947,872,000	$ 932,774,000
Other revenues	48,917,000	48,511,000	47,575,000
Government stimulus income	47,505,000	0	0
Net operating revenues and grant income	1,028,217,000	996,383,000	980,349,000
Costs and Expenses:
Salaries, wages and benefits	609,306,000	592,831,000	582,721,000
Other operating	286,845,000	268,442,000	254,038,000
Facility rent	40,494,000	40,518,000	40,923,000
Depreciation and amortization	42,018,000	42,419,000	41,894,000
Interest	1,399,000	3,135,000	4,697,000
Total costs and expenses	980,062,000	947,345,000	924,273,000
Income from operations	48,155,000	49,038,000	56,076,000
Other income:
Non-operating income	28,234,000	26,747,000	17,670,000
Equity Securities, FV-NI, Unrealized Gain (Loss), Total	(23,966,000)	12,230,000	1,138,000
Income before income taxes	52,423,000	88,015,000	74,884,000
Income tax provision	(10,433,000)	(20,039,000)	(16,185,000)
Net income	41,990,000	67,976,000	58,699,000
Net (income) loss attributable to noncontrolling interest	(119,000)	235,000	265,000
Net income attributable to National HealthCare Corporation	$ 41,871,000	$ 68,211,000	$ 58,964,000
Earnings per share attributable to National HealthCare Corporation stockholders:
Basic (in dollars per share)	$ 2.74	$ 4.47	$ 3.87
Diluted (in dollars per share)	$ 2.72	$ 4.44	$ 3.87
Basic (in shares)	15,306,174	15,270,154	15,224,886
Diluted (in shares)	15,369,523	15,360,046	15,236,826
Dividends declared to common stockholders, per share (in dollars per share)	$ 2.08	$ 2.06	$ 1.98

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Net income	$ 41,990	$ 67,976	$ 58,699
Other comprehensive income (loss):
Unrealized gains (losses) on investments in marketable debt securities	3,352	6,842	(2,574)
Reclassification adjustment for realized gains on sale of marketable debt securities	(195)	(127)	(18)
Income tax (expense) benefit related to items of other comprehensive income (loss)	(660)	(1,410)	544
Other comprehensive income (loss), net of tax	2,497	5,305	(2,048)
Net (income) loss attributable to noncontrolling interest	(119)	235	265
Comprehensive income attributable to National HealthCare Corporation	$ 44,368	$ 73,516	$ 56,916

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($)	Dec. 31, 2020	Dec. 31, 2019
Current Assets:
Cash and cash equivalents	$ 147,093,000	$ 50,334,000
Restricted cash and cash equivalents, current portion	9,673,000	8,944,000
Marketable equity securities	128,590,000	152,453,000
Marketable debt securities	47,762,000	0
Restricted marketable equity securities	4,680,000	0
Restricted marketable debt securities, current portion	16,601,000	20,576,000
Accounts receivable	89,670,000	92,975,000
Inventories	8,781,000	7,441,000
Prepaid expenses and other assets	2,977,000	6,635,000
Notes receivable, current portion	928,000	1,695,000
Total current assets	456,755,000	341,053,000
Property and Equipment:
Property and equipment, at cost	1,030,426,000	1,017,204,000
Accumulated depreciation and amortization	(510,108,000)	(481,774,000)
Net property and equipment	520,318,000	535,430,000
Other Assets:
Restricted cash and cash equivalents, less current portion	1,736,000	1,732,000
Restricted marketable debt securities, less current portion	125,472,000	126,830,000
Deposits and other assets	4,580,000	5,124,000
Operating lease right-of use assets	179,055,000	202,909,000
Goodwill	21,341,000	20,995,000
Notes receivable, less current portion	12,093,000	13,384,000
Investments in unconsolidated companies	40,782,000	39,191,000
Total other assets	385,059,000	410,165,000
Total assets	1,362,132,000	1,286,648,000
Current Liabilities:
Trade accounts payable	21,112,000	18,903,000
Finance lease obligations, current portion	4,423,000	4,166,000
Operating lease liabilities, current portion	25,451,000	24,243,000
Accrued payroll	86,183,000	69,826,000
Amounts due to third party payors	16,454,000	15,108,000
Accrued risk reserves, current portion	30,953,000	29,520,000
Other current liabilities	21,344,000	15,029,000
Provider relief funds	16,068,000	0
Contract liabilities	51,253,000	0
Dividends payable	7,987,000	7,968,000
Current maturities of long-term debt	0	10,000,000
Total current liabilities	281,228,000	194,763,000
Finance lease obligations, less current portion	10,540,000	14,963,000
Operating lease liabilities, less current portion	153,604,000	178,666,000
Accrued risk reserves, less current portion	68,584,000	66,491,000
Refundable entrance fees	7,462,000	7,455,000
Deferred income taxes	14,079,000	24,012,000
Other noncurrent liabilities	28,375,000	21,229,000
Total liabilities	563,872,000	507,579,000
Equity:
Common stock, $.01 par value; 45,000,000 shares authorized; 15,369,745 and 15,332,206 shares, respectively, issued and outstanding	153,000	153,000
Capital in excess of par value	226,943,000	222,787,000
Retained earnings	563,024,000	553,093,000
Accumulated other comprehensive income	5,057,000	2,560,000
Total National HealthCare Corporation stockholders’ equity	795,177,000	778,593,000
Noncontrolling interest	3,083,000	476,000
Total equity	798,260,000	779,069,000
Total liabilities and equity	$ 1,362,132,000	$ 1,286,648,000

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parentheticals) - $ / shares	Dec. 31, 2020	Dec. 31, 2019
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)	15,369,745	15,332,206
Common stock, shares outstanding (in shares)	15,369,745	15,332,206

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Cash Flows From Operating Activities:
Net income	$ 41,990,000	$ 67,976,000	$ 58,699,000
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	42,018,000	42,419,000	41,894,000
Equity in earnings of unconsolidated investments	(12,342,000)	(9,744,000)	(1,020,000)
Distributions from unconsolidated investments	10,050,000	3,902,000	5,241,000
Unrealized losses (gains) on marketable equity securities	23,966,000	(12,230,000)	(1,138,000)
Gains on sale of marketable debt securities	(195,000)	(127,000)	(18,000)
Gain on acquisition of equity method investment	(1,707,000)	(1,975,000)	(2,050,000)
Gain on sale of skilled nursing facility	(2,784,000)	0	(1,668,000)
Deferred income taxes	10,593,000	(4,052,000)	(718,000)
Stock–based compensation	2,453,000	1,878,000	1,778,000
Changes in operating assets and liabilities:
Accounts receivable	4,529,000	4,299,000	(9,398,000)
Federal income tax receivable	0	(2,560,000)	5,465,000
Inventories	(1,249,000)	29,000	(317,000)
Prepaid expenses and other assets	4,727,000	(287,000)	(1,743,000)
Trade accounts payable	1,429,000	(856,000)	3,467,000
Accrued payroll	15,948,000	2,208,000	516,000
Amounts due to third party payors	1,200,000	(1,000,000)	(1,281,000)
Accrued risk reserves	3,454,000	540,000	2,818,000
Provider relief funds	16,068,000	0	0
Contract liabilities	51,253,000	0	0
Other current liabilities	5,898,000	780,000	(2,050,000)
Other noncurrent liabilities	7,146,000	799,000	(1,478,000)
Net cash provided by operating activities	203,259,000	100,103,000	98,435,000
Cash Flows From Investing Activities:
Purchases of property and equipment	(21,873,000)	(26,400,000)	(29,772,000)
Proceeds from the sale of skilled nursing facility	6,750,000	0	4,300,000
Investments in unconsolidated companies	(305,000)	(222,000)	(444,000)
Acquisition of equity method investment	(6,648,000)	(15,589,000)	(527,000)
Investments in notes receivable	(425,000)	(5,462,000)	0
Collections of notes receivable	2,483,000	1,379,000	1,553,000
Purchases of marketable securities	(84,854,000)	(12,471,000)	(13,311,000)
Sale of marketable securities	40,994,000	44,500,000	4,539,000
Net cash used in investing activities	(63,878,000)	(14,265,000)	(33,662,000)
Cash Flows From Financing Activities:
Borrowings under credit facility	40,000,000	0	0
Principal payments under credit facility	(50,000,000)	(45,000,000)	(45,000,000)
Principal payments under finance lease obligations	(4,166,000)	(3,923,000)	(3,696,000)
Dividends paid to common stockholders	(31,921,000)	(31,208,000)	(29,827,000)
Issuance of common shares	1,756,000	2,346,000	2,865,000
Repurchase of common shares	(53,000)	(872,000)	(867,000)
Noncontrolling interest contributions (distributions)	2,488,000	(468,000)	0
Entrance fee deposits (refunds)	7,000	(623,000)	(749,000)
Net cash used in financing activities	(41,889,000)	(79,748,000)	(77,274,000)
Net Increase (Decrease) in Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents	97,492,000	6,090,000	(12,501,000)
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, Beginning of Period	61,010,000	54,920,000	67,421,000
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, End of Period	158,502,000	61,010,000	54,920,000
Balance Sheet Classifications:
Cash and cash equivalents	147,093,000	50,334,000	43,247,000
Restricted Cash and Cash Equivalents	11,409,000	10,676,000	11,673,000
Total Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents	158,502,000	61,010,000	54,920,000
Supplemental Information:
Cash payments for interest	1,425,000	3,118,000	4,899,000
Cash payments for income taxes	$ 16,524,000	$ 20,889,000	$ 9,182,000

Consolidated Statements of Equi

Consolidated Statements of Equity - USD ($) $ in Thousands	Cumulative Effect, Period of Adoption, Adjustment [Member]Retained Earnings [Member]	Cumulative Effect, Period of Adoption, Adjustment [Member]AOCI Attributable to Parent [Member]	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, 2017			15,212,133
Balance at Dec. 31, 2017	$ 68,201	$ (68,201)	$ 152	$ 215,659	$ 419,423	$ 67,504	$ 694	$ 703,432
Net income					58,964		(265)	58,699
Equity contributed by noncontrolling interest							750	750
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)
Contributions attributable to noncontrolling interest							750	750
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
Net income					68,211		(235)	67,976
Other comprehensive income (loss)						5,305		5,305
Stock–based compensation				1,878				$ 1,878
Shares sold – options exercised (in shares)			87,600					346,168
Shares sold – options exercised				2,346				$ 2,346
Repurchase of common shares (in shares)			(10,396)
Repurchase of common shares				(872)				(872)
Dividends declared to common stockholders					(31,553)			(31,553)
Distributions attributable to noncontrolling interest							(468)	(468)
Balance (in shares) at Dec. 31, 2019			15,332,206
Balance at Dec. 31, 2019			$ 153	222,787	553,093	2,560	476	779,069
Net income					41,871		119	41,990
Equity contributed by noncontrolling interest							2,488	2,488
Other comprehensive income (loss)						2,497		2,497
Stock–based compensation				2,453				$ 2,453
Shares sold – options exercised (in shares)			38,336					43,630
Shares sold – options exercised				1,756				$ 1,756
Repurchase of common shares (in shares)			(797)
Repurchase of common shares				(53)				(53)
Dividends declared to common stockholders					(31,940)			(31,940)
Contributions attributable to noncontrolling interest							2,488	2,488
Balance (in shares) at Dec. 31, 2020			15,369,745
Balance at Dec. 31, 2020			$ 153	$ 226,943	$ 563,024	$ 5,057	$ 3,083	$ 798,260

Consolidated Statements of Eq_2

Consolidated Statements of Equity (Parentheticals) - $ / shares	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Dividends declared to common stockholders, per share (in dollars per share)	$ 2.08	$ 2.06	$ 1.98
Dividends declared to common stockholders, per share (in dollars per share)	$ 2.08	$ 2.06	$ 1.98

Note 1 - Summary of Significant

Note 1 - Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Significant Accounting Policies [Text Block]	Note 1 Nature of Operations National HealthCare Corporation ("NHC" or "the Company") operates, manages or provides services to skilled nursing facilities, assisted living facilities, independent living facilities, home health care programs, and a behavioral health hospital 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 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, including but not 19” 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 not The Company determines the transaction price based on established billing rates reduced by contractual adjustments provided to third December 31, 2020, 2019, 2018, December 31, 2020, 2019, Other Revenues As discussed in Note 4, We recognize rental income based on the terms of our operating leases. Under certain of our leases, we receive variable rent, which is based on the increase in revenues of a lessee over a base year. We recognize variable rent annually or monthly, as applicable, when, based on the actual revenue of the lessee is earned. Government Grants Given the absence of specific guidance to account for government grants under U.S. GAAP, we have concluded to account for government grants in accordance with International Accounting Standard (“IAS”) 20, Accounting for Government Grants and Disclosure of Government Assistance Segment Reporting In accordance with the provisions of Accounting Standards Codification (“ASC”) 280, Segment Reporting two 1 one 2 6 Other Operating Expenses Other operating expenses include the costs of care and services that we provide to the residents of our facilities and the costs of maintaining our facilities. Our primary patient care costs include drugs, medical supplies, purchased professional services, food, 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 $31,983,000, $24,758,000, and $28,710,000 for the years ended December 31, 2020, 2019, 2018, 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 represent assets that are primarily 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 No. 2016 01 No. 2016 01 Our investments in marketable equity securities are carried at fair value with the changes in unrealized gains and losses recognized in our results of operations at each measurement date. Our investments in marketable debt securities are classified as available for sale securities and carried at fair value with the unrealized gains and losses recognized through accumulated other comprehensive income at each measurement date. For available for sale debt securities in an unrealized loss position, we first not not Inventories Inventories consist generally of food and supplies and are valued at the lower of cost or net realizable value, 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 Property and Equipment Property and equipment are recorded at cost. Depreciation is provided by the straight–line method over the expected useful lives of the assets estimated as follows: buildings and improvements, 20–40 3–15 not 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 Long-Term Leases The Company’s lease portfolio primarily consists of finance and operating real estate leases for certain skilled nursing facilities, assisted and independent living facilities, homecare offices, and pharmacy warehouses. The original terms of the leases typically range from two fifteen may not The Company records right-of-use assets and liabilities on the consolidated balance sheets for non-cancelable real estate operating leases with original or remaining lease terms in excess of one 12 not not Operating lease right-of-use assets and liabilities are recorded at the present value of the lease payments over the lease term. The present values of the lease payments are discounted using the incremental borrowing rate associated with each lease. The variable components of the lease payment that fluctuate with the operations of a healthcare facility are 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 ( in thousands Year Ended December 31, 2020 Inpatient Services Homecare All Other Total January 1, 2018 $ – $ 17,600 $ – $ 17,600 Additions 3,395 – – 3,395 December 31, 2018 3,395 17,600 – 20,995 Additions – – – – December 31, 2019 3,395 17,600 – 20,995 Additions 346 – – 346 December 31, 2020 $ 3,741 $ 17,600 $ – $ 21,341 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 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, 2020 December 31, 2019 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. The obligation to provide future services is included in other noncurrent liabilities in the Company’s consolidated balance sheets. At December 31, 2020 2019, Other Noncurrent Liabilities Other noncurrent liabilities include reserves primarily related to various uncertain income tax positions, deferred revenue, and obligations to provide services to our CCRC residents. Deferred revenue includes the deferred gain on the sale of assets to National Health Corporation (“National”) and the non-refundable portion ( 10% Income Taxes We utilize ASC Topic 740, Income Taxes 14 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 are 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. 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 credit loss. We evaluate the need to provide reserves for potential credit losses on our financial instruments based on management's periodic review of the portfolio on an instrument-by-instrument basis. Recently Adopted Accounting Guidance In June 2016, No. 2016 13 , Financial Instruments – Credit Losses: Measurement of Credit Losses on Financial Instruments No. 2016 13 December 15, 2019, January 1, 2020. not On December 18, 2019, No. 2019 12 , Income Taxes (Topic 740 No. 2019 12 December 15, 2020, January 1, 2020, No. 2019 12. not

Note 2 - Coronavirus Pandemic (

Note 2 - Coronavirus Pandemic ("COVID-19")	12 Months Ended
	Dec. 31, 2020
COVID 19 [Member]
Notes to Financial Statements
Unusual or Infrequent Items, or Both, Disclosure [Text Block]	Note 2 – Coronavirus Pandemic ("COVID- 19" In early March 2020, 19, 19 2020. fourth 2020 19 The U.S. government enacted several laws beginning in March 2020 19 $2.2 $100 19. April 24, 2020, $75 $175 During the second, third, and fourth 2020, 19. $63,573,000 December 31, 2020 As of December 31, 2020, not 19 $16,068,000 Additionally, as part of the CARES Act, the legislation included an expansion of the Medicare Accelerated and Advance Payment Program. The expanded Medicare Accelerated and Advance Payment Program is a streamlined version of existing policy that allows the Medicare Administrative Contractors (“MAC’s”) to issue up to three October 8, 2020 2021 one first eleven twenty-five six fifty not twenty-nine four December 31, 2020, not The CARES Act temporarily suspended Medicare sequestration beginning May 1, 2020 December 31, 2020. 2 2030 2020 2nd, 3rd, 4th eight The CARES Act also temporarily permitted employers to defer the deposit and payment of the employer’s portion of the social security taxes ( 6.2% March 27, 2020 December 31, 2020. two December 31, 2021, December 31, 2022. December 31, 2020, December 31, 2020, We have also received from many of the states in which we operate a supplemental Medicaid payment to help mitigate the incremental costs resulting from the COVID- 19 December 31, 2020,

Note 3 - Net Patient Revenues

Note 3 - Net Patient Revenues	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Revenue from Contract with Customer [Text Block]	Note 3 – 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) 2020 2019 2018 Inpatient services $ 879,693 $ 893,201 $ 872,912 Homecare services 52,102 54,671 59,862 Total net patient revenue $ 931,795 $ 947,872 $ 932,774 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 period of care or on a per-visit basis. Typically, patients and third As our performance obligations relate to contracts with a duration of one not no one 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 2020 2019 2018 Medicare 33% 34% 35% Managed Care 11% 12% 12% Medicaid 31% 27% 26% Private Pay and Other 25% 27% 27% 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 three 19 For homecare services, Medicare pays based on the acuity level of the patient and based on periods of care. A period of care is defined as a length of care up to 30 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 revenue is recorded on an accrual basis based upon the date of services at amounts equal to its established or estimated per-visit rates. Contract Liabilities Included in the Company’s consolidated balance sheets are contract liabilities, which represent payments the Company receives in advance of services provided. As of December 31, 2020, one A summary of the contract liabilities are follows ( in thousands Balance, January 1, 2020 $ – Payments received 51,253 Payments recognized – Balance, December 31, 2020 $ 51,253 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. Settlements with third not no not December 31, 2020 2019,

Note 4 - Other Revenues

Note 4 - Other Revenues	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Other Revenues [Text Block]	Note 4 – Other Revenues Other revenues are outlined in the table below. Revenues from rental income include health care real estate properties owned by us and leased to third Year Ended December 31, (in thousands) 2020 2019 2018 Rental income $ 22,768 $ 22,641 $ 22,262 Management and accounting service fees 17,147 18,533 15,175 Insurance services 5,447 6,209 7,084 Other 771 1,128 1,386 Gain on sale of skilled nursing facility 2,784 – 1,668 Total other revenues $ 48,917 $ 48,511 $ 47,575 Rental Income The Company leases real estate assets consisting of skilled nursing facilities and assisted living facilities to third four 7 Year Ended December 31, (in thousands) 2020 2019 2018 Operating lease payments $ 22,019 $ 21,937 $ 21,516 Variable lease payments 749 704 746 Total rental income $ 22,768 $ 22,641 $ 22,262 The following table sets forth the undiscounted cash flows for future minimum lease payments receivable for leases in effect at December 31, 2020 ( in thousands 2021 $ 23,011 2022 22,907 2023 22,738 2024 22,730 2025 22,730 Thereafter 220 Total future minimum lease payments $ 114,336 Management Fees from National We have managed skilled nursing facilities for National since 1988, five 19 During 2020, 2019 2018, December 31, 2020 2019, The unpaid fees from these five not may five may may may no Management Fees and Financial and Accounting Services for Other Healthcare Centers During 2020, 2019 2018, five third December 31, 2020, 2019 2018, Insurance Services For workers’ compensation insurance services, the premium revenues reflected in the consolidated statements of operations for the years ended December 31, 2020, 2019 2018 For professional liability insurance services, the premium revenues reflected in the consolidated statements of operations for the years ended December 31, 2020, 2019 2018 Gain on sale of skilled nursing facility In November 2020, In October 2018,

Note 5 - Non-operating Income

Note 5 - Non-operating Income	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Other Nonoperating Income and Expense [Text Block]	Note 5 – Non–Operating Income Non–operating income includes equity in earnings of unconsolidated investments, dividends and other realized gains and losses on marketable securities, and interest income. Year Ended December 31, (in thousands) 2020 2019 2018 Equity in earnings of unconsolidated investments $ 12,342 $ 9,744 $ 1,020 Dividends and net realized gains on sale of securities 8,390 7,840 7,417 Interest income 5,795 7,188 7,183 Gain on acquisitions of equity method investments 1,707 1,975 2,050 Total non-operating income $ 28,234 $ 26,747 $ 17,670 Caris HealthCare, L.P. (“Caris”) Our most significant equity method investment is a 75.1% non–controlling ownership interest in Caris, a business that specializes in hospice care services. The carrying value of our investment is $38,916,000 and $36,673,000 at December 31, 2020 2019, Gain on acquisition s of equity method investment s On February 27, 2020, 166 Upon acquiring the remaining ownership interest, the Company recorded and increased its previously held equity interest up to fair value as of the acquisition date. This remeasurement of our equity interest at fair value resulted in a gain of $1,707,000. Additionally, the excess of the fair value over the amounts assigned to the assets and liabilities of the investee resulted in recording goodwill in the amount of $346,000 on the acquisition date. In June 2019, 60 June 2019 In July 2018, 16 July 2018

Note 6 - Business Segments

Note 6 - Business Segments	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Segment Reporting Disclosure [Text Block]	Note 6 – Business Segments The Company has two 1 2 The Company also reports an “all other” category that includes revenues from rental income, management and accounting services fees, insurance services, and costs of the corporate office. For additional information on these reportable segments see Note 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, 2020 Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 879,693 $ 52,102 $ – $ 931,795 Other revenues 3,403 – 45,514 48,917 Government stimulus income 47,505 – – 47,505 Net operating revenues and grant income 930,601 52,102 45,514 1,028,217 Costs and Expenses: Salaries, wages and benefits 538,775 33,104 37,427 609,306 Other operating 261,643 14,689 10,513 286,845 Facility rent 33,090 1,802 5,602 40,494 Depreciation and amortization 38,217 377 3,424 42,018 Interest 1,374 – 25 1,399 Total costs and expenses 873,099 49,972 56,991 980,062 Income (loss) before non-operating income 57,502 2,130 (11,477 ) 48,155 Non-operating income – – 28,234 28,234 Unrealized losses on marketable equity securities – – (23,966 ) (23,966 ) Income (loss) before income taxes $ 57,502 $ 2,130 $ (7,209 ) $ 52,423 Year Ended December 31, 2019 Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 893,201 $ 54,671 $ – $ 947,872 Other revenues 910 – 47,601 48,511 Net operating revenues 894,111 54,671 47,601 996,383 Costs and Expenses: Salaries, wages and benefits 526,430 33,037 33,364 592,831 Other operating 242,435 17,003 9,004 268,442 Facility rent 32,748 1,854 5,916 40,518 Depreciation and amortization 38,731 250 3,438 42,419 Interest 1,578 – 1,557 3,135 Total costs and expenses 841,922 52,144 53,279 947,345 Income (loss) before non-operating income 52,189 2,527 (5,678 ) 49,038 Non-operating income – – 26,747 26,747 Unrealized gains on marketable equity securities – – 12,230 12,230 Income before income taxes $ 52,189 $ 2,527 $ 33,299 $ 88,015 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

Note 7 - Long-term Leases

Note 7 - Long-term Leases	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Leases of Lessee Disclosure [Text Block]	Note 7 – Long–Term Leases As of December 31, 2020, seven three two first four third On January 1, 2007, 15–year three December 2012, first three five 2026. two 2007 In September 2013 second 2014 seven 13th Base rent expense under both NHI lease agreements totals $34,200,000 annually. Percentage rent under the leases is based on a quarterly calculation of revenue increases and is payable on a quarterly basis. Percentage rent expense under both leases for 2020, 2019, 2018 We have a right of first 180 Finance Leases Effective June 1, 2014, three three third ten two five 2014 Fixed assets recorded under the finance leases, which are included in property and equipment in the consolidated balance sheets, are as follows (in thousands) December 31, 2020 2019 Buildings and personal property $ 39,032 $ 39,032 Accumulated amortization (26,739 ) (22,859 ) $ 12,293 $ 16,173 Lease Classification The Company recorded the following on the consolidated balance sheets ( in thousands December 31, Right-of-Use Assets Balance Sheet Classification 2020 2019 Finance lease assets Net property and equipment $ 12,293 $ 16,173 Operating lease right-of use assets Operating lease right-of-use assets 179,055 202,909 Total $ 191,348 219,082 December 31, Lease Liabilities Balance Sheet Classification 2020 2019 Current: Finance lease liabilities Finance lease obligations, current portion $ 4,423 $ 4,166 Operating lease liabilities Operating lease liabilities, current portion 25,451 24,243 Noncurrent: Finance lease liabilities Finance lease obligations, less current portion 10,540 14,963 Operating lease liabilities Operating lease liabilities, less current portion 153,604 178,666 Total $ 194,018 $ 222,038 Weighted-average remaining lease terms and discount rates were as follows: December 31, 2020 2019 Weighted-average remaining lease terms (in years) Finance 3.2 4.2 Operating 6.2 7.1 Weighted-average discount rate Finance 6.0 % 6.0 % Operating 6.0 % 6.0 % Lease Costs Lease costs recorded in the consolidated statement of operations are as follows (in thousands): December 31, 2020 2019 Finance lease costs: Depreciation of leased assets $ 3,906 $ 3,889 Interest of lease liabilities 1,064 1,306 Total finance lease costs 4,970 5,195 Operating lease costs: Operating lease costs 35,656 35,881 Variable lease costs 3,617 3,587 Short-term lease costs 1,221 1,050 Total operating lease costs 40,494 40,518 Total lease costs $ 45,464 $ 45,713 Minimum Lease Payments The following table summarizes the maturity of our finance and operating lease liabilities as of December 31, 2020 ( in thousands Finance Leases Operating Leases 2021 $ 5,200 $ 35,292 2022 5,200 34,971 2023 5,200 34,613 2024 867 34,414 2025 – 34,253 Thereafter – 39,950 Total minimum lease payments $ 16,467 $ 213,493 Less: amounts representing interest (1,504 ) (34,438 ) Present value of future minimum lease payments 14,963 179,055 Less: current portion (4,423 ) (25,451 ) Noncurrent lease liabilities $ 10,540 $ 153,604 Other Supplemental cash flow data were as follows (in thousands) December 31, 2020 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 35,655 $ 35,881 Operating cash flows for finance leases 1,064 1,306 Financing cash flows for finance leases 4,166 3,923

Note 8 - Earning Per Share

Note 8 - Earning Per Share	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Earnings Per Share [Text Block]	Note 8 – 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, 2020 2019 2018 Basic: Weighted average common shares outstanding 15,306,174 15,270,154 15,224,886 Net income attributable to common stockholders of National Healthcare Corporation $ 41,871 $ 68,211 $ 58,964 Earnings per common share, basic $ 2.74 $ 4.47 $ 3.87 Diluted: Weighted average common shares outstanding 15,306,174 15,270,154 15,224,886 Dilutive effect of stock options 63,349 89,892 11,940 Assumed average common shares outstanding 15,369,523 15,360,046 15,236,826 Net income attributable to common stockholders of National Healthcare Corporation $ 41,871 $ 68,211 $ 58,964 Earnings per common share, diluted $ 2.72 $ 4.44 $ 3.87

Note 9 - Investments in Marketa

Note 9 - Investments in Marketable Securities	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Investments in Debt and Marketable Equity Securities (and Certain Trading Assets) Disclosure [Text Block]	Note 9 – Investments in Marketable Securities Our investments in marketable securities include marketable equity securities and marketable debt securities. Our investments in marketable equity securities are carried at fair value with the changes in unrealized gains and losses recognized in our results of operations at each measurement date. Our investments in marketable debt securities are classified as available for sale securities and carried at fair value with the unrealized gains and losses recognized through accumulated other comprehensive income at each measurement date. Any credit related decline in fair market value of our available for sale debt securities are recorded in our results of operations through an allowance for credit losses. Realized gains and losses from securities sales are recognized in results of operations upon disposition of the securities using the specific identification method on a trade date basis. Marketable securities consist of the following (in thousands) December 31, 2020 December 31, 2019 (in thousands) Amortized Cost Fair Value Amortized Cost Fair Value Investments available for sale: Marketable equity securities $ 30,176 $ 128,590 $ 30,176 $ 152,453 Corporate debt securities 25,812 25,778 – – Asset-backed securities 2,485 2,480 – – U.S. Treasury securities 19,519 19,504 – – Restricted investments available for sale: Marketable equity securities 4,783 4,680 – – Corporate debt securities 61,709 66,247 63,414 65,653 Asset–backed securities 40,655 41,769 54,451 55,185 U.S. Treasury securities 20,760 21,159 13,379 13,410 State and municipal securities 12,497 12,898 12,922 13,158 $ 218,396 323,105 $ 174,342 $ 299,859 Included in the marketable equity securities available for sale are the following (in thousands, except share amounts) December 31, 2020 December 31, 2019 Shares Cost Fair Value Shares Cost Fair Value NHI Common Stock 1,630,642 $ 24,734 $ 112,792 1,630,642 $ 24,734 $ 132,865 The amortized cost and estimated fair value of debt securities classified as available for sale, by contractual maturity, are as follows: December 31, 2020 December 31, 2019 (in thousands) Cost Fair Value Cost Fair Value Maturities: Within 1 year $ 49,694 $ 49,863 $ 15,726 $ 15,767 1 to 5 years 99,143 103,002 88,314 90,408 6 to 10 years 34,326 36,685 40,126 41,231 Over 10 years 274 285 – – $ 183,437 $ 189,835 $ 144,166 $ 147,406 Gross unrealized gains related to marketable equity securities are $98,445,000 and $122,290,000 as of December 31, 2020 2019, December 31, 2020 2019, December 31, 2020 2019, Gross unrealized gains related to available for sale marketable debt securities are $6,759,000 and $3,407,000 as of December 31, 2020 2019, December 31, 2020 2019, The Company has not December 31, 2020, 2019, 2018. For the marketable debt securities in gross unrealized loss positions, (a) it is more likely than not not Proceeds from the sale of available for sale marketable debt securities during the years ended December 31, 2020, 2019, 2018 December 31, 2020, 2019, 2018, No December 31, 2020, 2019, 2018.

Note 10 - Fair Value Measuremen

Note 10 - Fair Value Measurements	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Fair Value Disclosures [Text Block]	Note 10 – Fair Value Measurements The accounting standard for fair value measurements provides a framework for measuring fair value and requires expanded disclosures regarding fair value measurements. Fair value is defined as the price that would be received for an asset or the exit price that would be paid to transfer a liability in the principal or most advantageous market in an orderly transaction between market participants on the measurement date. This accounting standard establishes a fair value hierarchy, which requires an entity to maximize the use of observable inputs, where available. The following summarizes the three may Level 1 Level 2 not Level 3 no 3 A financial instrument’s level within the fair value hierarchy is based on the lowest level of input that is significant to the fair value measurement. 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, 2020 2019. 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. At December 31, 2020 2019, no The following table summarizes fair value measurements by level at December 31, 2020 December 31, 2019 (in thousands) Fair Value Measurements Using December 31, 2020 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 $ 147,093 $ 147,093 $ – $ – Restricted cash and cash equivalents 11,409 11,409 – – Marketable equity securities 133,270 133,270 – – Corporate debt securities 92,025 56,772 35,253 – Asset–backed securities 44,249 – 44,249 – U.S. Treasury securities 40,663 40,663 – – State and municipal securities 12,898 – 12,898 – Total financial assets $ 481,607 $ 389,207 $ 92,400 $ – Fair Value Measurements Using December 31, 2019 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 $ 50,334 $ 50,334 $ – $ – Restricted cash and cash equivalents 10,676 10,676 – – Marketable equity securities 152,453 152,453 – – Corporate debt securities 65,653 48,584 17,069 – Asset–backed securities 55,185 - 55,185 – U.S. Treasury securities 13,410 13,410 – – State and municipal securities 13,158 1,975 11,183 – Total financial assets $ 360,869 $ 277,432 $ 83,437 $ –

Note 11 - Property and Equipmen

Note 11 - Property and Equipment	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Property, Plant and Equipment Disclosure [Text Block]	Note 1 1 – Property and Equipment Property and equipment, at cost, consists of the following (in thousands) December 31, 2020 2019 Land $ 64,385 $ 61,018 Leasehold improvements 125,889 122,520 Buildings and improvements 641,367 644,236 Furniture and equipment 180,463 177,717 Construction in progress 18,322 11,713 Property and equipment, at cost 1,030,426 1,017,204 Less: Accumulated depreciation (510,108 ) (481,774 ) Net property and equipment $ 520,318 $ 535,430 The Company estimates the cost to complete construction in progress is approximately $380,000 at December 31, 2020.

Note 12 - Notes Receivable

Note 12 - Notes Receivable	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Loans, Notes, Trade and Other Receivables Disclosure [Text Block]	Note 1 2 – Notes Receivable At December 31, 2020 2019, first 2022 2025.

Note 13 - Long-term Debt

Note 13 - Long-term Debt	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Debt Disclosure [Text Block]	Note 1 3 – Long–Term Debt Long–term debt consists of the following (dollars in thousands) December 31, Maturity 2020 2019 Credit Facility, interest payable monthly 2020 $ – $ 10,000 Less current portion – (10,000) $ – $ – On August 13, 2020, December 31, 2020, not

Note 14 - Income Taxes

Note 14 - Income Taxes	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Income Tax Disclosure [Text Block]	Note 1 4 – Income Taxes The provision for income taxes is comprised of the following components (in thousands) Year Ended December 31, 2020 2019 2018 Current tax provision Federal $ 19,054 $ 13,356 $ 13,583 State 2,337 1,101 1,612 Total current tax provision 21,391 14,457 15,195 Deferred tax provision Federal (8,349 ) 4,048 610 State (2,609 ) 1,534 380 Total deferred tax provision (10,958 ) 5,582 990 Income tax provision $ 10,433 $ 20,039 $ 16,185 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, 2020 2019 Deferred tax assets: Accrued risk reserves $ 1,764 1,625 Accrued expenses 11,803 5,926 Financial reporting depreciation in excess of tax depreciation 4,125 3,966 Stock based compensation 1,063 666 Deferred revenue 4,215 5,425 Operating lease liabilities 45,486 52,870 Other 698 665 Total gross deferred tax assets 69,154 71,143 Less: valuation allowance – – Deferred tax assets less valuation allowance $ 69,154 $ 71,143 Deferred tax liabilities: Unrealized gains on marketable securities $ (27,040 ) $ (32,638 ) Deferred gain on sale of assets, net (2,042 ) (2,094 ) Book basis in excess of tax basis of intangible assets (2,360 ) (2,063 ) Book basis in excess of tax basis of securities (2,514 ) (2,172 ) Long–term investments (3,791 ) (3,318 ) Operating lease assets (45,486 ) (52,870 ) Total deferred tax liabilities $ (83,233 ) $ (95,155 ) Net deferred tax liability $ (14,079 ) $ (24,012 ) 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, 2020 2019 2018 Tax provision at federal statutory rate $ 11,009 $ 18,483 $ 15,726 Increase (decrease) in income taxes resulting from: State, net of federal benefit 1,631 3,850 3,213 Return to provision (382 ) (793 ) (1,418 ) Unrecognized tax benefits 166 512 586 Expiration of statute of limitations (2,366 ) (2,064 ) (2,222 ) Other net 375 51 300 Total increases (decreases) (576 ) 1,556 459 Effective income tax expense $ 10,433 $ 20,039 $ 16,185 Our deferred tax assets have been evaluated for realization based on historical taxable income, tax planning strategies, the expected timing of reversals of existing temporary differences and future taxable income anticipated. Our deferred tax assets are more likely than not Uncertain tax positions may may 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 740 Income Taxes 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, 2018 $ 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 Additions based on tax positions related to the current year 1,418 1,418 – 1,418 Additions for tax positions of prior years 907 1,002 973 1,975 Reductions for statute of limitation expirations (475 ) (1,604 ) (935 ) (2,539 ) Balance, December 31, 2019 7,413 12,749 3,309 16,058 Additions based on tax positions related to the current year 1,229 1,229 – 1,229 Additions (reductions) for tax positions of prior years (2,432 ) (2,273 ) 403 (1,870 ) Reductions for statute of limitation expirations (544 ) (1,812 ) (1,098 ) (2,910 ) Balance, December 31, 2020 $ 5,666 $ 9,893 $ 2,614 $ 12,507 During the year ended December 31, 2020, December 31, 2019 2018, $2,064,000 Unrecognized tax benefits of $4,727,000, net of federal benefit at December 31, 2020, not 2021 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 $(695,000), $38,000, and $(4,000) for the years ended December 31, 2020, 2019, 2018, The Company is no 2017

Note 15 - Stock Repurchase Prog

Note 15 - Stock Repurchase Program	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Treasury Stock [Text Block]	Note 1 5 – Stock Repurchase Program The stock repurchase plan began on September 1, 2019 August 31, 2020. 2020, 2019, 2018,

Note 16 - Stock-based Compensat

Note 16 - Stock-based Compensation	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Share-based Payment Arrangement [Text Block]	Note 1 6 – 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 2020, 2020 “2020 December 31, 2020, 2020 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 $2,453,000, $1,878,000, and $1,778,000, for the years ended December 31, 2020, 2019, 2018, December 31, 2020, 2019, 2018, December 31, 2020, 2018 2018, At December 31, 2020, two 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, 2020 2019 2018 Risk–free interest rate 0.87 % 2.30 % 2.46 % Expected volatility 20.1 % 17.4 % 16.1 % Expected life, in years 2.2 2.3 3.0 Expected dividend yield 2.91 % 2.73 % 3.29 % The following table summarizes option activity: Number of Shares Weighted Average Exercise Price Aggregate Intrinsic Value Options outstanding at January 1, 2018 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 − Options granted 77,316 77.89 − Options exercised (346,168 ) 71.57 − Options cancelled (85,000 ) 72.94 − Options outstanding at December 31, 2019 809,529 71.24 − Options granted 104,057 73.98 − Options exercised (43,630 ) 63.37 − Options cancelled (3,000 ) 72.94 − Options outstanding at December 31, 2020 866,956 $ 72.11 $ 572,790 Options exercisable at December 31, 2020 215,456 $ 68.35 $ 572,790 Options Outstanding December 31, 2020 Exercise Prices Weighted Average Exercise Price Weighted Average Remaining Contractual Life in Years 153,000 $60.73 – 64.64 $ 62.67 2.3 713,956 $72.94 – $84.30 74.14 1.3 866,956 $ 72.11 1.3

Note 17 - Contingencies and Com

Note 17 - Contingencies and Commitments	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Commitments and Contingencies Disclosure [Text Block]	Note 1 7 – Contingencies and Guarantees 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 $99,537,000 and $96,011,000 at December 31, 2020 2019, 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 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. The Company has been, and continues to be, subject to claims and legal actions that arise in the ordinary course of business, including potential claims related to patient care and treatment. The defense of these lawsuits may Insurance coverage for all years includes primary policies and excess policies. The primary coverage is in the amount of a per incident claim and a per location claim with an annual primary policy aggregate limit that is adjusted on an annual basis. Additional insurance is purchased through third There is certain additional litigation incidental to our business, none Nutritional Support Services, L.P., Qui Tam Litigation On June 19, 2018, No. 6:17 2608 not April 16, 2018, March 14, 2020, May 6, 2020, 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 following 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. There have been several enacted and proposed federal and state relief measures as a result of COVID- 19 not Debt Guarantees At December 31, 2020, no

Note 18 - Equity Method Investm

Note 18 - Equity Method Investment in Caris HealthCare, L.P.	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Cost and Equity Method Investments Disclosure [Text Block]	Note 1 8 – Equity Method Investment in Caris HealthCare, L.P. As of December 31, 2020, December 31, 2020 2019, December 31, 2020, 2019, 2018 (in thousands) December 31, 2020 2019 2018 Current assets $ 27,737 $ 25,664 $ 17,539 Noncurrent assets 12,083 12,336 10,266 Liabilities 9,825 10,784 8,657 Partners’ capital 29,995 27,216 19,148 Revenue 68,649 62,034 56,410 Expenses 52,522 48,803 55,507 Net income 16,127 13,231 903 We have included separate audited financial statements for Caris as an exhibit to this filing. Consolidation Considerations 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 19 - Relationship With Nat

Note 19 - Relationship With National Health Corporation	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Related Party Transactions Disclosure [Text Block]	Note 1 9 – Relationship 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. 4 Financing Activities In conjunction with our management contract, we have entered into a line of credit arrangement whereby we may December 31, 2019, not The maximum line of credit commitment amount of $2,000,000 is also the amount of a deferred gain that has been outstanding since NHC sold certain assets to National in 1988. January 2028. Payroll and Related Services The personnel conducting our business, including our executive management team, are employees of National and may December 31, 2020, 2019, 2018 December 31, 2020 2019, National’s Ownership of Our Stock At December 31, 2020, 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 20 - Variable Interest Ent

Note 20 - Variable Interest Entity	12 Months Ended
	Dec. 31, 2020
Notes to Financial Statements
Variable Interest Entity Disclosure [Text Block]	Note 20 – Variable Interest Entity Accounting guidance requires that a variable interest entity (“VIE”), according to the provisions of ASC Topic 810, Consolidation December 31, 2020, one Springfield, Missouri Lease In December 2010, 120–bed ten five five third 120–bed third third December 31, 2020 2019 December 31, 2020 2019

Schedule II - Valuation and Qua

Schedule II - Valuation and Qualifying Accounts	12 Months Ended
	Dec. 31, 2020
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, 2020, 2019, 2018 (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, 2018 Accrued risk reserves $ 93,275 $ 75,052 $ − $ 72,303 $ 96,024 For the year ended December 31, 2019 Accrued risk reserves $ 96,024 $ 79,959 $ − $ 79,972 $ 96,011 For the year ended December 31, 2020 Accrued risk reserves $ 96,011 $ 86,918 $ − $ 83,392 $ 99,537

Significant Accounting Policies

Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2020
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
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, including but not 19”
Revenue [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 not The Company determines the transaction price based on established billing rates reduced by contractual adjustments provided to third December 31, 2020, 2019, 2018, December 31, 2020, 2019,
Revenue Recognition for Alternative Revenue Programs, Policy [Policy Text Block]	Other Revenues As discussed in Note 4, We recognize rental income based on the terms of our operating leases. Under certain of our leases, we receive variable rent, which is based on the increase in revenues of a lessee over a base year. We recognize variable rent annually or monthly, as applicable, when, based on the actual revenue of the lessee is earned.
Government Grants, policy [Policy Text Block]	Government Grants Given the absence of specific guidance to account for government grants under U.S. GAAP, we have concluded to account for government grants in accordance with International Accounting Standard (“IAS”) 20, Accounting for Government Grants and Disclosure of Government Assistance
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 6
Other Operating Expenses Policy [Policy Text Block]	Other Operating Expenses Other operating expenses include the costs of care and services that we provide to the residents of our facilities and the costs of maintaining our facilities. Our primary patient care costs include drugs, medical supplies, purchased professional services, food, 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 $31,983,000, $24,758,000, and $28,710,000 for the years ended December 31, 2020, 2019, 2018,
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 represent assets that are primarily 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 No. 2016 01 No. 2016 01 Our investments in marketable equity securities are carried at fair value with the changes in unrealized gains and losses recognized in our results of operations at each measurement date. Our investments in marketable debt securities are classified as available for sale securities and carried at fair value with the unrealized gains and losses recognized through accumulated other comprehensive income at each measurement date. For available for sale debt securities in an unrealized loss position, we first not not
Inventory, Policy [Policy Text Block]	Inventories Inventories consist generally of food and supplies and are valued at the lower of cost or net realizable value, with cost determined on a first–in, first–out (FIFO) basis.
Financing Receivable [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]	Property and Equipment Property and equipment are recorded at cost. Depreciation is provided by the straight–line method over the expected useful lives of the assets estimated as follows: buildings and improvements, 20–40 3–15 not 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
Lessee, Leases [Policy Text Block]	Long-Term Leases The Company’s lease portfolio primarily consists of finance and operating real estate leases for certain skilled nursing facilities, assisted and independent living facilities, homecare offices, and pharmacy warehouses. The original terms of the leases typically range from two fifteen may not The Company records right-of-use assets and liabilities on the consolidated balance sheets for non-cancelable real estate operating leases with original or remaining lease terms in excess of one 12 not not Operating lease right-of-use assets and liabilities are recorded at the present value of the lease payments over the lease term. The present values of the lease payments are discounted using the incremental borrowing rate associated with each lease. The variable components of the lease payment that fluctuate with the operations of a healthcare facility are 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 ( in thousands Year Ended December 31, 2020 Inpatient Services Homecare All Other Total January 1, 2018 $ – $ 17,600 $ – $ 17,600 Additions 3,395 – – 3,395 December 31, 2018 3,395 17,600 – 20,995 Additions – – – – December 31, 2019 3,395 17,600 – 20,995 Additions 346 – – 346 December 31, 2020 $ 3,741 $ 17,600 $ – $ 21,341
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 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, 2020 December 31, 2019 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. The obligation to provide future services is included in other noncurrent liabilities in the Company’s consolidated balance sheets. At December 31, 2020 2019,
Income Tax Uncertainties, Policy [Policy Text Block]	Other Noncurrent Liabilities Other noncurrent liabilities include reserves primarily related to various uncertain income tax positions, deferred revenue, and obligations to provide services to our CCRC residents. Deferred revenue includes the deferred gain on the sale of assets to National Health Corporation (“National”) and the non-refundable portion ( 10%
Income Tax, Policy [Policy Text Block]	Income Taxes We utilize ASC Topic 740, Income Taxes 14 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 Payment Arrangement [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 are 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. 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 credit loss. We evaluate the need to provide reserves for potential credit losses on our financial instruments based on management's periodic review of the portfolio on an instrument-by-instrument basis.
New Accounting Pronouncements, Policy [Policy Text Block]	Recently Adopted Accounting Guidance In June 2016, No. 2016 13 , Financial Instruments – Credit Losses: Measurement of Credit Losses on Financial Instruments No. 2016 13 December 15, 2019, January 1, 2020. not On December 18, 2019, No. 2019 12 , Income Taxes (Topic 740 No. 2019 12 December 15, 2020, January 1, 2020, No. 2019 12. not

Note 1 - Summary of Significa_2

Note 1 - Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2020
Notes Tables
Schedule of Goodwill [Table Text Block]	Year Ended December 31, 2020 Inpatient Services Homecare All Other Total January 1, 2018 $ – $ 17,600 $ – $ 17,600 Additions 3,395 – – 3,395 December 31, 2018 3,395 17,600 – 20,995 Additions – – – – December 31, 2019 3,395 17,600 – 20,995 Additions 346 – – 346 December 31, 2020 $ 3,741 $ 17,600 $ – $ 21,341

Note 3 - Net Patient Revenues (

Note 3 - Net Patient Revenues (Tables)	12 Months Ended
	Dec. 31, 2020
Notes Tables
Disaggregation of Revenue [Table Text Block]	Year Ended December 31, (in thousands) 2020 2019 2018 Inpatient services $ 879,693 $ 893,201 $ 872,912 Homecare services 52,102 54,671 59,862 Total net patient revenue $ 931,795 $ 947,872 $ 932,774 Year Ended December 31, Source 2020 2019 2018 Medicare 33% 34% 35% Managed Care 11% 12% 12% Medicaid 31% 27% 26% Private Pay and Other 25% 27% 27% Total 100% 100% 100%
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Table Text Block]	Balance, January 1, 2020 $ – Payments received 51,253 Payments recognized – Balance, December 31, 2020 $ 51,253

Note 4 - Other Revenues (Tables

Note 4 - Other Revenues (Tables)	12 Months Ended
	Dec. 31, 2020
Notes Tables
Schedule of Other Revenues [Table Text Block]	Year Ended December 31, (in thousands) 2020 2019 2018 Rental income $ 22,768 $ 22,641 $ 22,262 Management and accounting service fees 17,147 18,533 15,175 Insurance services 5,447 6,209 7,084 Other 771 1,128 1,386 Gain on sale of skilled nursing facility 2,784 – 1,668 Total other revenues $ 48,917 $ 48,511 $ 47,575
Operating Lease, Lease Income [Table Text Block]	Year Ended December 31, (in thousands) 2020 2019 2018 Operating lease payments $ 22,019 $ 21,937 $ 21,516 Variable lease payments 749 704 746 Total rental income $ 22,768 $ 22,641 $ 22,262
Lessor, Operating Lease, Payment to be Received, Fiscal Year Maturity [Table Text Block]	2021 $ 23,011 2022 22,907 2023 22,738 2024 22,730 2025 22,730 Thereafter 220 Total future minimum lease payments $ 114,336

Note 5 - Non-operating Income (

Note 5 - Non-operating Income (Tables)	12 Months Ended
	Dec. 31, 2020
Notes Tables
Schedule of Other Nonoperating Income, by Component [Table Text Block]	Year Ended December 31, (in thousands) 2020 2019 2018 Equity in earnings of unconsolidated investments $ 12,342 $ 9,744 $ 1,020 Dividends and net realized gains on sale of securities 8,390 7,840 7,417 Interest income 5,795 7,188 7,183 Gain on acquisitions of equity method investments 1,707 1,975 2,050 Total non-operating income $ 28,234 $ 26,747 $ 17,670

Note 6 - Business Segments (Tab

Note 6 - Business Segments (Tables)	12 Months Ended
	Dec. 31, 2020
Notes Tables
Schedule of Segment Reporting Information, by Segment [Table Text Block]	Year Ended December 31, 2020 Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 879,693 $ 52,102 $ – $ 931,795 Other revenues 3,403 – 45,514 48,917 Government stimulus income 47,505 – – 47,505 Net operating revenues and grant income 930,601 52,102 45,514 1,028,217 Costs and Expenses: Salaries, wages and benefits 538,775 33,104 37,427 609,306 Other operating 261,643 14,689 10,513 286,845 Facility rent 33,090 1,802 5,602 40,494 Depreciation and amortization 38,217 377 3,424 42,018 Interest 1,374 – 25 1,399 Total costs and expenses 873,099 49,972 56,991 980,062 Income (loss) before non-operating income 57,502 2,130 (11,477 ) 48,155 Non-operating income – – 28,234 28,234 Unrealized losses on marketable equity securities – – (23,966 ) (23,966 ) Income (loss) before income taxes $ 57,502 $ 2,130 $ (7,209 ) $ 52,423 Year Ended December 31, 2019 Inpatient Services Homecare All Other Total Revenues: Net patient revenues $ 893,201 $ 54,671 $ – $ 947,872 Other revenues 910 – 47,601 48,511 Net operating revenues 894,111 54,671 47,601 996,383 Costs and Expenses: Salaries, wages and benefits 526,430 33,037 33,364 592,831 Other operating 242,435 17,003 9,004 268,442 Facility rent 32,748 1,854 5,916 40,518 Depreciation and amortization 38,731 250 3,438 42,419 Interest 1,578 – 1,557 3,135 Total costs and expenses 841,922 52,144 53,279 947,345 Income (loss) before non-operating income 52,189 2,527 (5,678 ) 49,038 Non-operating income – – 26,747 26,747 Unrealized gains on marketable equity securities – – 12,230 12,230 Income before income taxes $ 52,189 $ 2,527 $ 33,299 $ 88,015 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

Note 7 - Long-term Leases (Tabl

Note 7 - Long-term Leases (Tables)	12 Months Ended
	Dec. 31, 2020
Notes Tables
Schedule of Capital Leased Assets [Table Text Block]	December 31, 2020 2019 Buildings and personal property $ 39,032 $ 39,032 Accumulated amortization (26,739 ) (22,859 ) $ 12,293 $ 16,173
Lease, Balance Sheet Classification [Table Text Block]	December 31, Right-of-Use Assets Balance Sheet Classification 2020 2019 Finance lease assets Net property and equipment $ 12,293 $ 16,173 Operating lease right-of use assets Operating lease right-of-use assets 179,055 202,909 Total $ 191,348 219,082 December 31, Lease Liabilities Balance Sheet Classification 2020 2019 Current: Finance lease liabilities Finance lease obligations, current portion $ 4,423 $ 4,166 Operating lease liabilities Operating lease liabilities, current portion 25,451 24,243 Noncurrent: Finance lease liabilities Finance lease obligations, less current portion 10,540 14,963 Operating lease liabilities Operating lease liabilities, less current portion 153,604 178,666 Total $ 194,018 $ 222,038
Lease, Cost [Table Text Block]	December 31, 2020 2019 Weighted-average remaining lease terms (in years) Finance 3.2 4.2 Operating 6.2 7.1 Weighted-average discount rate Finance 6.0 % 6.0 % Operating 6.0 % 6.0 % December 31, 2020 2019 Finance lease costs: Depreciation of leased assets $ 3,906 $ 3,889 Interest of lease liabilities 1,064 1,306 Total finance lease costs 4,970 5,195 Operating lease costs: Operating lease costs 35,656 35,881 Variable lease costs 3,617 3,587 Short-term lease costs 1,221 1,050 Total operating lease costs 40,494 40,518 Total lease costs $ 45,464 $ 45,713
Lessee, Lease, Liability, Maturity [Table Text Block]	Finance Leases Operating Leases 2021 $ 5,200 $ 35,292 2022 5,200 34,971 2023 5,200 34,613 2024 867 34,414 2025 – 34,253 Thereafter – 39,950 Total minimum lease payments $ 16,467 $ 213,493 Less: amounts representing interest (1,504 ) (34,438 ) Present value of future minimum lease payments 14,963 179,055 Less: current portion (4,423 ) (25,451 ) Noncurrent lease liabilities $ 10,540 $ 153,604
Lease, Cash Flow Information [Table Text Block]	December 31, 2020 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 35,655 $ 35,881 Operating cash flows for finance leases 1,064 1,306 Financing cash flows for finance leases 4,166 3,923

Note 8 - Earning Per Share (Tab

Note 8 - Earning Per Share (Tables)	12 Months Ended
	Dec. 31, 2020
Notes Tables
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	Year Ended December 31, 2020 2019 2018 Basic: Weighted average common shares outstanding 15,306,174 15,270,154 15,224,886 Net income attributable to common stockholders of National Healthcare Corporation $ 41,871 $ 68,211 $ 58,964 Earnings per common share, basic $ 2.74 $ 4.47 $ 3.87 Diluted: Weighted average common shares outstanding 15,306,174 15,270,154 15,224,886 Dilutive effect of stock options 63,349 89,892 11,940 Assumed average common shares outstanding 15,369,523 15,360,046 15,236,826 Net income attributable to common stockholders of National Healthcare Corporation $ 41,871 $ 68,211 $ 58,964 Earnings per common share, diluted $ 2.72 $ 4.44 $ 3.87

Note 9 - Investments in Marke_2

Note 9 - Investments in Marketable Securities (Tables)	12 Months Ended
	Dec. 31, 2020
Notes Tables
Available-for-sale Securities [Table Text Block]	December 31, 2020 December 31, 2019 (in thousands) Amortized Cost Fair Value Amortized Cost Fair Value Investments available for sale: Marketable equity securities $ 30,176 $ 128,590 $ 30,176 $ 152,453 Corporate debt securities 25,812 25,778 – – Asset-backed securities 2,485 2,480 – – U.S. Treasury securities 19,519 19,504 – – Restricted investments available for sale: Marketable equity securities 4,783 4,680 – – Corporate debt securities 61,709 66,247 63,414 65,653 Asset–backed securities 40,655 41,769 54,451 55,185 U.S. Treasury securities 20,760 21,159 13,379 13,410 State and municipal securities 12,497 12,898 12,922 13,158 $ 218,396 323,105 $ 174,342 $ 299,859
Schedule of Available-for-sale Securities Reconciliation [Table Text Block]	December 31, 2020 December 31, 2019 Shares Cost Fair Value Shares Cost Fair Value NHI Common Stock 1,630,642 $ 24,734 $ 112,792 1,630,642 $ 24,734 $ 132,865
Investments Classified by Contractual Maturity Date [Table Text Block]	December 31, 2020 December 31, 2019 (in thousands) Cost Fair Value Cost Fair Value Maturities: Within 1 year $ 49,694 $ 49,863 $ 15,726 $ 15,767 1 to 5 years 99,143 103,002 88,314 90,408 6 to 10 years 34,326 36,685 40,126 41,231 Over 10 years 274 285 – – $ 183,437 $ 189,835 $ 144,166 $ 147,406

Note 10 - Fair Value Measurem_2

Note 10 - Fair Value Measurements (Tables)	12 Months Ended
	Dec. 31, 2020
Notes Tables
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis [Table Text Block]	Fair Value Measurements Using December 31, 2020 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 $ 147,093 $ 147,093 $ – $ – Restricted cash and cash equivalents 11,409 11,409 – – Marketable equity securities 133,270 133,270 – – Corporate debt securities 92,025 56,772 35,253 – Asset–backed securities 44,249 – 44,249 – U.S. Treasury securities 40,663 40,663 – – State and municipal securities 12,898 – 12,898 – Total financial assets $ 481,607 $ 389,207 $ 92,400 $ – Fair Value Measurements Using December 31, 2019 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 $ 50,334 $ 50,334 $ – $ – Restricted cash and cash equivalents 10,676 10,676 – – Marketable equity securities 152,453 152,453 – – Corporate debt securities 65,653 48,584 17,069 – Asset–backed securities 55,185 - 55,185 – U.S. Treasury securities 13,410 13,410 – – State and municipal securities 13,158 1,975 11,183 – Total financial assets $ 360,869 $ 277,432 $ 83,437 $ –

Note 11 - Property and Equipm_2

Note 11 - Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2020
Notes Tables
Property, Plant and Equipment [Table Text Block]	December 31, 2020 2019 Land $ 64,385 $ 61,018 Leasehold improvements 125,889 122,520 Buildings and improvements 641,367 644,236 Furniture and equipment 180,463 177,717 Construction in progress 18,322 11,713 Property and equipment, at cost 1,030,426 1,017,204 Less: Accumulated depreciation (510,108 ) (481,774 ) Net property and equipment $ 520,318 $ 535,430

Note 13 - Long-term Debt (Table

Note 13 - Long-term Debt (Tables)	12 Months Ended
	Dec. 31, 2020
Notes Tables
Schedule of Debt [Table Text Block]	December 31, Maturity 2020 2019 Credit Facility, interest payable monthly 2020 $ – $ 10,000 Less current portion – (10,000) $ – $ –

Note 14 - Income Taxes (Tables)

Note 14 - Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2020
Notes Tables
Schedule of Components of Income Tax Expense (Benefit) [Table Text Block]	Year Ended December 31, 2020 2019 2018 Current tax provision Federal $ 19,054 $ 13,356 $ 13,583 State 2,337 1,101 1,612 Total current tax provision 21,391 14,457 15,195 Deferred tax provision Federal (8,349 ) 4,048 610 State (2,609 ) 1,534 380 Total deferred tax provision (10,958 ) 5,582 990 Income tax provision $ 10,433 $ 20,039 $ 16,185
Schedule of Deferred Tax Assets and Liabilities [Table Text Block]	December 31, 2020 2019 Deferred tax assets: Accrued risk reserves $ 1,764 1,625 Accrued expenses 11,803 5,926 Financial reporting depreciation in excess of tax depreciation 4,125 3,966 Stock based compensation 1,063 666 Deferred revenue 4,215 5,425 Operating lease liabilities 45,486 52,870 Other 698 665 Total gross deferred tax assets 69,154 71,143 Less: valuation allowance – – Deferred tax assets less valuation allowance $ 69,154 $ 71,143 Deferred tax liabilities: Unrealized gains on marketable securities $ (27,040 ) $ (32,638 ) Deferred gain on sale of assets, net (2,042 ) (2,094 ) Book basis in excess of tax basis of intangible assets (2,360 ) (2,063 ) Book basis in excess of tax basis of securities (2,514 ) (2,172 ) Long–term investments (3,791 ) (3,318 ) Operating lease assets (45,486 ) (52,870 ) Total deferred tax liabilities $ (83,233 ) $ (95,155 ) Net deferred tax liability $ (14,079 ) $ (24,012 )
Schedule of Effective Income Tax Rate Reconciliation [Table Text Block]	Year Ended December 31, 2020 2019 2018 Tax provision at federal statutory rate $ 11,009 $ 18,483 $ 15,726 Increase (decrease) in income taxes resulting from: State, net of federal benefit 1,631 3,850 3,213 Return to provision (382 ) (793 ) (1,418 ) Unrecognized tax benefits 166 512 586 Expiration of statute of limitations (2,366 ) (2,064 ) (2,222 ) Other net 375 51 300 Total increases (decreases) (576 ) 1,556 459 Effective income tax expense $ 10,433 $ 20,039 $ 16,185
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, 2018 $ 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 Additions based on tax positions related to the current year 1,418 1,418 – 1,418 Additions for tax positions of prior years 907 1,002 973 1,975 Reductions for statute of limitation expirations (475 ) (1,604 ) (935 ) (2,539 ) Balance, December 31, 2019 7,413 12,749 3,309 16,058 Additions based on tax positions related to the current year 1,229 1,229 – 1,229 Additions (reductions) for tax positions of prior years (2,432 ) (2,273 ) 403 (1,870 ) Reductions for statute of limitation expirations (544 ) (1,812 ) (1,098 ) (2,910 ) Balance, December 31, 2020 $ 5,666 $ 9,893 $ 2,614 $ 12,507

Note 16 - Stock-based Compens_2

Note 16 - Stock-based Compensation (Tables)	12 Months Ended
	Dec. 31, 2020
Notes Tables
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions [Table Text Block]	Year Ended December 31, 2020 2019 2018 Risk–free interest rate 0.87 % 2.30 % 2.46 % Expected volatility 20.1 % 17.4 % 16.1 % Expected life, in years 2.2 2.3 3.0 Expected dividend yield 2.91 % 2.73 % 3.29 %
Share-based Payment Arrangement, Option, Activity [Table Text Block]	Number of Shares Weighted Average Exercise Price Aggregate Intrinsic Value Options outstanding at January 1, 2018 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 − Options granted 77,316 77.89 − Options exercised (346,168 ) 71.57 − Options cancelled (85,000 ) 72.94 − Options outstanding at December 31, 2019 809,529 71.24 − Options granted 104,057 73.98 − Options exercised (43,630 ) 63.37 − Options cancelled (3,000 ) 72.94 − Options outstanding at December 31, 2020 866,956 $ 72.11 $ 572,790 Options exercisable at December 31, 2020 215,456 $ 68.35 $ 572,790
Share-based Payment Arrangement, Option, Exercise Price Range [Table Text Block]	Options Outstanding December 31, 2020 Exercise Prices Weighted Average Exercise Price Weighted Average Remaining Contractual Life in Years 153,000 $60.73 – 64.64 $ 62.67 2.3 713,956 $72.94 – $84.30 74.14 1.3 866,956 $ 72.11 1.3

Note 18 - Equity Method Inves_2

Note 18 - Equity Method Investment in Caris HealthCare, L.P. (Tables)	12 Months Ended
	Dec. 31, 2020
Notes Tables
Equity Method Investments [Table Text Block]	December 31, 2020 2019 2018 Current assets $ 27,737 $ 25,664 $ 17,539 Noncurrent assets 12,083 12,336 10,266 Liabilities 9,825 10,784 8,657 Partners’ capital 29,995 27,216 19,148 Revenue 68,649 62,034 56,410 Expenses 52,522 48,803 55,507 Net income 16,127 13,231 903

Schedule II - Valuation and Q_2

Schedule II - Valuation and Qualifying Accounts (Tables)	12 Months Ended
	Dec. 31, 2020
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, 2018 Accrued risk reserves $ 93,275 $ 75,052 $ − $ 72,303 $ 96,024 For the year ended December 31, 2019 Accrued risk reserves $ 96,024 $ 79,959 $ − $ 79,972 $ 96,011 For the year ended December 31, 2020 Accrued risk reserves $ 96,011 $ 86,918 $ − $ 83,392 $ 99,537

Note 1 - Summary of Significa_3

Note 1 - Summary of Significant Accounting Policies (Details Textual)	12 Months Ended			24 Months Ended
	Dec. 31, 2020USD ($)	Dec. 31, 2019USD ($)	Dec. 31, 2018USD ($)	Dec. 31, 2020USD ($)	Dec. 31, 2010
Accounts Receivable, Credit Loss Expense (Reversal)	$ 3,339,000	$ 2,403,000	$ 1,524,000
Accounts Receivable, Allowance for Credit Loss, Ending Balance	$ 5,672,000	4,451,000		$ 5,672,000
Number of Reportable Segments	2
General and Administrative Expense, Total	$ 31,983,000	24,758,000	28,710,000
Lessee, Operating Lease, Term of Contract (Year)					10 years
Contract with Customer, Refund Liability, Total	7,462,000	7,455,000		7,462,000
Continuing Care Retirement Communities, Refund Obligation	$ 2,177,000	$ 2,035,000		$ 2,177,000
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%
Minimum [Member]
Lessee, Operating Lease, Term of Contract (Year)	2 years			2 years
Maximum [Member]
Lessee, Operating Lease, Term of Contract (Year)	15 years			15 years
Building and Building Improvements [Member] | Minimum [Member]
Property, Plant and Equipment, Useful Life (Year)	20 years
Building and Building Improvements [Member] | Maximum [Member]
Property, Plant and Equipment, Useful Life (Year)	40 years
Equipment and Furniture [Member] | Minimum [Member]
Property, Plant and Equipment, Useful Life (Year)	3 years
Equipment and Furniture [Member] | Maximum [Member]
Property, Plant and Equipment, Useful Life (Year)				15 years
Accounting Standards Update 2016-01 [Member]
Reclassification of Net Unrealized Gains From AOCI To Retained Earnings			$ 68,073,000
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, 2020	Dec. 31, 2019	Dec. 31, 2018
Balance	$ 20,995
Balance	21,341	$ 20,995
Inpatient Services Segment [Member]
Balance	3,395	3,395	$ 0
Additions	346	0	3,395
Balance	3,741	3,395	3,395
Homecare Services Segment [Member]
Balance	17,600	17,600	17,600
Additions	0	0	0
Balance	17,600	17,600	17,600
Other Segments [Member]
Balance	20,995	20,995	17,600
Additions	346	0	3,395
Balance	$ 21,341	$ 20,995	$ 20,995

Note 2 - Coronavirus Pandemic_2

Note 2 - Coronavirus Pandemic ("COVID-19") (Details Textual) - USD ($)	9 Months Ended	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Proceeds from Government Assistance Cares Act	$ 63,573,000
Government Assistance Stimulus Income CARES Act		$ 47,505,000	$ 0	$ 0
Provider Relief Funds	$ 16,068,000	16,068,000	0
Proceeds from Medicare Accelerated and Advance Payment Program		51,253,000
Revenue from Contract with Customer, Including Assessed Tax		931,795,000	$ 947,872,000	$ 932,774,000
Proceeds from Government Assistance Medicare Accelerated and Advance Payment Program		51,253,000
Medicare Accelerated and Advance Payment Program [Member]
Proceeds from Government Assistance Medicare Accelerated and Advance Payment Program		21,158,000
Supplemental Medicaid Payments [Member]
Revenue from Contract with Customer, Including Assessed Tax		$ 26,179,000
COVID 19 [Member]
Occupancy in Skilled Nursing Centers	83.60%	83.60%
COVID 19 [Member] | Net Patient Revenues Sequestration Policy Extension [Member]
Revenue from Contract with Customer, Including Assessed Tax		$ 2,900,000

Note 3 - Net Patient Revenues_2

Note 3 - Net Patient Revenues (Details Textual) - USD ($)	Dec. 31, 2020	Dec. 31, 2019
Contract with Customer, Liability, Current	$ 51,253,000	$ 0
Accounts Receivable, Allowance for Credit Loss, Ending Balance	5,672,000	4,451,000
Medicare and Medicaid [Member]
Accounts Receivable, Allowance for Credit Loss, Ending Balance	$ 16,454,000	$ 15,108,000

Note 3 - Net Patient Revenues -

Note 3 - Net Patient Revenues - Revenue Disaggregation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Net patient revenues	$ 931,795	$ 947,872	$ 932,774
Revenue, concentration percentage	100.00%	100.00%	100.00%
Inpatient Services [Member]
Net patient revenues	$ 879,693	$ 893,201	$ 872,912
Medicare [Member]
Revenue, concentration percentage	33.00%	34.00%	35.00%
Homecare [Member]
Net patient revenues	$ 52,102	$ 54,671	$ 59,862
Managed Care [Member]
Revenue, concentration percentage	11.00%	12.00%	12.00%
Medicaid [Member]
Revenue, concentration percentage	31.00%	27.00%	26.00%
Private Pay and Other [Member]
Revenue, concentration percentage	25.00%	27.00%	27.00%

Note 3 - Net Patient Revenues_3

Note 3 - Net Patient Revenues - Contract Liabilities (Details)	12 Months Ended
	Dec. 31, 2020USD ($)
Balance	$ 0
Payments received	51,253,000
Balance	$ 51,253,000

Note 4 - Other Revenues (Detail

Note 4 - Other Revenues (Details Textual)	1 Months Ended		12 Months Ended
	Nov. 30, 2020USD ($)	Oct. 31, 2018USD ($)	Dec. 31, 2020USD ($)	Dec. 31, 2019USD ($)	Dec. 31, 2018USD ($)
Insurance Services Revenue, Total			$ 5,447,000	$ 6,209,000	$ 7,084,000
Proceeds from Sale of Productive Assets, Total	$ 6,750,000	$ 4,300,000	6,750,000	0	4,300,000
Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property			2,784,000	0	1,668,000
Other Revenue [Member]
Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property	$ 2,784,000	$ 1,668,000
Workers Compensation Revenue [Member]
Insurance Services Revenue, Total			3,300,000	3,536,000	4,392,000
Professional Liability Insurance [Member]
Insurance Services Revenue, Total			$ 2,147,000	$ 2,673,000	2,692,000
National [Member]
Number of Skilled Nursing Centers			5	5
Property Management Fee Revenue			$ 4,729,000	$ 6,627,000	4,304,000
Unbilled Receivables, Current			18,971,000	19,148,000
Management Services Provided to Other Facilities [Member]
Property Management Fee Revenue			$ 2,973,000	$ 2,952,000	$ 2,532,000
FLORIDA
Number of Skilled Nursing Centers			4

Note 4 - Other Revenues - Summa

Note 4 - Other Revenues - Summary of Other Revenues (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Rental income	$ 22,768	$ 22,641	$ 22,262
Management and accounting service fees	17,147	18,533	15,175
Insurance services	5,447	6,209	7,084
Other	771	1,128	1,386
Gain on sale of skilled nursing facility	2,784	0	1,668
Total other revenues	$ 48,917	$ 48,511	$ 47,575

Note 4 - Other Revenues - Renta

Note 4 - Other Revenues - Rental Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Operating lease payments	$ 22,019	$ 21,937	$ 21,516
Variable lease payments	749	704	746
Total rental income	$ 22,768	$ 22,641	$ 22,262

Note 4 - Other Revenues - Minim

Note 4 - Other Revenues - Minimum Lease Payments Receivable (Details) $ in Thousands	Dec. 31, 2020USD ($)
2021	$ 23,011
2022	22,907
2023	22,738
2024	22,730
2025	22,730
Thereafter	220
Total future minimum lease payments	$ 114,336

Note 5 - Non-operating Income_2

Note 5 - Non-operating Income (Details Textual) - USD ($)	Feb. 27, 2020	Jun. 30, 2019	Jul. 31, 2018	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Gain (Loss) on Acquisition of Equity Method Investment				$ 1,707,000	$ 1,975,000	$ 2,050,000
Nonoperating Income (Expense) [Member]
Gain (Loss) on Acquisition of Equity Method Investment	$ 1,707,000	$ 1,975,000
Caris [Member]
Equity Method Investment, Ownership Percentage				75.10%
Equity Method Investments				$ 38,916,000	$ 36,673,000
Skilled Nursing Facility in Knoxville, Tennessee [Member]
Equity Method Investment, Ownership Percentage	25.00%
Goodwill, Acquired During Period	$ 346,000
Psychiatric Hospital in Osage Beach, Missouri [Member]
Gain (Loss) on Acquisition of Equity Method Investment			$ 2,050,000

Note 5 - Non-operating Income -

Note 5 - Non-operating Income - Summary of Non-operating Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Equity in earnings of unconsolidated investments	$ 12,342	$ 9,744	$ 1,020
Dividends and net realized gains on sale of securities	8,390	7,840	7,417
Interest income	5,795	7,188	7,183
Gain on acquisitions of equity method investments	1,707	1,975	2,050
Total non-operating income	$ 28,234	$ 26,747	$ 17,670

Note 6 - Business Segments (Det

Note 6 - Business Segments (Details Textual)	12 Months Ended
	Dec. 31, 2020
Number of Operating Segments	2

Note 6 - Business Segments - Su

Note 6 - Business Segments - Summary of Financial Information by Reporting Segment (Details) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Revenues:
Net patient revenues	$ 931,795,000	$ 947,872,000	$ 932,774,000
Other revenues	48,917,000	48,511,000	47,575,000
Government stimulus income	47,505,000	0	0
Net operating revenues and grant income	1,028,217,000	996,383,000	980,349,000
Costs and Expenses:
Salaries, wages and benefits	609,306,000	592,831,000	582,721,000
Other operating	286,845,000	268,442,000	254,038,000
Facility rent	40,494,000	40,518,000	40,923,000
Depreciation and amortization	42,018,000	42,419,000	41,894,000
Interest	1,399,000	3,135,000	4,697,000
Total costs and expenses	980,062,000	947,345,000	924,273,000
Income (loss) before non-operating income	48,155,000	49,038,000	56,076,000
Non-operating income (loss)	28,234,000	26,747,000	17,670,000
Unrealized losses on marketable equity securities	(23,966,000)	12,230,000	1,138,000
Income (loss) before income taxes	52,423,000	88,015,000	74,884,000
Inpatient Services Segment [Member]
Revenues:
Net patient revenues	879,693,000	893,201,000	872,912,000
Other revenues	3,403,000	910,000	2,494,000
Government stimulus income	47,505,000
Net operating revenues and grant income	930,601,000	894,111,000	875,406,000
Costs and Expenses:
Salaries, wages and benefits	538,775,000	526,430,000	513,647,000
Other operating	261,643,000	242,435,000	225,133,000
Facility rent	33,090,000	32,748,000	33,052,000
Depreciation and amortization	38,217,000	38,731,000	38,372,000
Interest	1,374,000	1,578,000	1,504,000
Total costs and expenses	873,099,000	841,922,000	811,708,000
Income (loss) before non-operating income	57,502,000	52,189,000	63,698,000
Non-operating income (loss)	0	0	0
Unrealized losses on marketable equity securities	0	0	0
Income (loss) before income taxes	57,502,000	52,189,000	63,698,000
Homecare Services Segment [Member]
Revenues:
Net patient revenues	52,102,000	54,671,000	59,862,000
Other revenues	0	0	0
Government stimulus income	0
Net operating revenues and grant income	52,102,000	54,671,000	59,862,000
Costs and Expenses:
Salaries, wages and benefits	33,104,000	33,037,000	33,339,000
Other operating	14,689,000	17,003,000	19,566,000
Facility rent	1,802,000	1,854,000	1,945,000
Depreciation and amortization	377,000	250,000	229,000
Interest	0	0	0
Total costs and expenses	49,972,000	52,144,000	55,079,000
Income (loss) before non-operating income	2,130,000	2,527,000	4,783,000
Non-operating income (loss)	0	0	0
Unrealized losses on marketable equity securities	0	0	0
Income (loss) before income taxes	2,130,000	2,527,000	4,783,000
Other Segments [Member]
Revenues:
Net patient revenues	0	0	0
Other revenues	45,514,000	47,601,000	45,081,000
Government stimulus income	0
Net operating revenues and grant income	45,514,000	47,601,000	45,081,000
Costs and Expenses:
Salaries, wages and benefits	37,427,000	33,364,000	35,735,000
Other operating	10,513,000	9,004,000	9,339,000
Facility rent	5,602,000	5,916,000	5,926,000
Depreciation and amortization	3,424,000	3,438,000	3,293,000
Interest	25,000	1,557,000	3,193,000
Total costs and expenses	56,991,000	53,279,000	57,486,000
Income (loss) before non-operating income	(11,477,000)	(5,678,000)	(12,405,000)
Non-operating income (loss)	28,234,000	26,747,000	17,670,000
Unrealized losses on marketable equity securities	(23,966,000)	12,230,000	1,138,000
Income (loss) before income taxes	$ (7,209,000)	$ 33,299,000	$ 6,403,000

Note 7 - Long-term Leases (Deta

Note 7 - Long-term Leases (Details Textual)	Jan. 01, 2007USD ($)	Sep. 30, 2013USD ($)	Dec. 31, 2020USD ($)	Dec. 31, 2019USD ($)	Dec. 31, 2018USD ($)	Dec. 31, 2010
Lessee, Operating Lease, Term of Contract (Year)						10 years
Number of Additional Lease Options						5
Facility Purchase Price		$ 49,000,000
Lessee, Operating Lease, Renewal Term (Year)						5 years
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 Skilled Nursing Facilities Subleased			4
Lessee, Operating Lease, Term of Contract (Year)	15 years
Number of Additional Lease Options	3
Lessee, Lease, Annual Base Rent	$ 30,750,000
Lessee, Operating Lease Additional Percentage Rent Percentage	4.00%
Lessee, Operating Lease, Renewal Term (Year)	5 years
Lease Two with NHI [Member]
Lessee, Operating Lease, Term of Contract (Year)		15 years
Lessee, Lease, Annual Base Rent		$ 3,450,000
Lessee, Operating Lease Additional Percentage Rent Percentage		4.00%
Number of Skilled Nursing Centers		7
Both NHI Lease Agreements [Member]
Lessee, Lease, Annual Base Rent			$ 34,200,000
Operating Leases Percentage Rent Expense			$ 3,617,000	$ 3,587,000	$ 3,713,000
Senior Healthcare Facilities [Member]
Number of Additional Lease Options			2
Number of Facilities under Finance Leases			3
Number of Finance Lease Agreements			3
Lessee, Finance Lease, Term of Contract (Year)			10 years
Lessee, Finance Lease, Annual Base Rent Expense			$ 5,200,000
Lessee, Finance Lease Additional Percentage Rent Percentage			4.00%
Lessee, Finance Lease, Renewal Term (Year)			5 years

Note 7 - Long-term Leases - Fix

Note 7 - Long-term Leases - Fixed Assets Recorded Under Capital Leases (Details) - Buildings and Personal Property [Member] - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Buildings and personal property	$ 39,032	$ 39,032
Accumulated amortization	(26,739)	(22,859)
Total capital leases	$ 12,293	$ 16,173

Note 7 - Long-term Leases - Bal

Note 7 - Long-term Leases - Balance Sheet Classification (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Finance lease assets	$ 12,293	$ 16,173
Operating lease right-of use assets	179,055	202,909
Total	191,348	219,082
Finance lease liabilities	4,423	4,166
Operating lease liabilities	25,451	24,243
Noncurrent lease liabilities, finance leases	10,540	14,963
Noncurrent lease liabilities, operating leases	153,604	178,666
Total	$ 194,018	$ 222,038

Note 7 - Long-term Leases - Lea

Note 7 - Long-term Leases - Lease Information and Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Finance (Year)	3 years 2 months 12 days	4 years 2 months 12 days
Operating (Year)	6 years 2 months 12 days	7 years 1 month 6 days
Finance	6.00%	6.00%
Operating	6.00%	6.00%
Depreciation of leased assets	$ 3,906	$ 3,889
Interest of lease liabilities	1,064	1,306
Total finance lease costs	4,970	5,195
Operating lease costs	35,656	35,881
Variable lease costs	3,617	3,587
Short-term lease costs	1,221	1,050
Total operating lease costs	40,494	40,518
Total lease costs	$ 45,464	$ 45,713

Note 7 - Long-term Leases - Mat

Note 7 - Long-term Leases - Maturity of Lease Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
2021, finance leases	$ 5,200
2021, operating leases	35,292
2022, finance leases	5,200
2022, operating leases	34,971
2023, finance leases	5,200
2023, operating leases	34,613
2024, finance leases	867
2024, operating leases	34,414
2025, finance leases	0
2025, operating leases	34,253
Thereafter, finance leases	0
Thereafter, operating leases	39,950
Total minimum lease payments, finance leases	16,467
Total minimum lease payments, operating leases	213,493
Less: amounts representing interest, finance leases	(1,504)
Less: amounts representing interest, operating leases	(34,438)
Present value of future minimum lease payments, finance leases	14,963
Present value of future minimum lease payments, operating leases	179,055
Less: current portion, finance leases	(4,423)	$ (4,166)
Less: current portion, operating leases	(25,451)	(24,243)
Noncurrent lease liabilities, finance leases	10,540	14,963
Noncurrent lease liabilities, operating leases	$ 153,604	$ 178,666

Note 7 - Long-term Leases - Cas

Note 7 - Long-term Leases - Cash Flow Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Operating cash flows for operating leases	$ 35,655	$ 35,881
Operating cash flows for finance leases	1,064	1,306
Financing cash flows for finance leases	$ 4,166	$ 3,923	$ 3,696

Note 8 - Earning Per Share - Su

Note 8 - 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	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Basic:
Weighted average common shares outstanding (in shares)	15,306,174	15,270,154	15,224,886
Net income attributable to common stockholders of National Healthcare Corporation	$ 41,871	$ 68,211	$ 58,964
Earnings per common share, basic (in dollars per share)	$ 2.74	$ 4.47	$ 3.87
Diluted:
Weighted average common shares outstanding (in shares)	15,306,174	15,270,154	15,224,886
Assumed average common shares outstanding (in shares)	15,369,523	15,360,046	15,236,826
Net income attributable to common stockholders of National Healthcare Corporation	$ 41,871	$ 68,211	$ 58,964
Earnings per common share, diluted (in dollars per share)	$ 2.72	$ 4.44	$ 3.87
Share-based Payment Arrangement, Option [Member]
Diluted:
Dilutive effect of share-based awards (in shares)	63,349	89,892	11,940

Note 9 - Investments in Marke_3

Note 9 - Investments in Marketable Securities (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Equity Securities Fv Ni Gross Unrealized Gain	$ 98,445,000	$ 122,290,000
Equity Securities Fv Ni Gross Unrealized Loss	134,000	13,000
Equity Securities, FV-NI, Unrealized Gain (Loss), Total	(23,966,000)	12,230,000	$ 1,138,000
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Gain, before Tax	6,759,000	3,407,000
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Loss, before Tax	361,000	137,000
Other-than-temporary Impairment Loss, Debt Securities, Available-for-sale, Total	0	0	0
Proceeds from Sale of Debt Securities, Available-for-sale	40,994,000	44,500,000	4,539,000
Realized Investment Gains (Losses), Total	195,000	127,000	18,000
Proceeds from Sale and Maturity of Marketable Securities, Total	$ 0	$ 0	$ 0

Note 9 - Investments in Marke_4

Note 9 - Investments in Marketable Securities - Marketable Securities and Restricted Marketable Securities (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Marketable equity securities	$ 128,590	$ 152,453
Unrestricted investments available for sale, debt, amortized cost	183,437	144,166
Unrestricted investments available for sale, debt, fair value	189,835	147,406
Restricted marketable equity securities	4,680	0
Investments available for sale, amortized cost	218,396	174,342
Marketable Securities, Total	323,105	299,859
Equity Securities [Member]
Unrestricted investments available for sale, equity, amortized cost	30,176	30,176
Marketable equity securities	128,590	152,453
Restricted investments available for sale, equity, amortized cost	4,783	0
Restricted marketable equity securities	4,680	0
Corporate Debt Securities [Member]
Unrestricted investments available for sale, debt, amortized cost	25,812	0
Unrestricted investments available for sale, debt, fair value	25,778	0
Restricted investments available for sale, debt, amortized cost	61,709	63,414
Restricted investments available for sale, debt, fair value	66,247	65,653
Asset-backed Securities [Member]
Unrestricted investments available for sale, debt, amortized cost	2,485	0
Unrestricted investments available for sale, debt, fair value	2,480	0
Restricted investments available for sale, debt, amortized cost	40,655	54,451
Restricted investments available for sale, debt, fair value	41,769	55,185
US Government Corporations and Agencies Securities [Member]
Unrestricted investments available for sale, debt, amortized cost	19,519	0
Unrestricted investments available for sale, debt, fair value	19,504	0
Restricted investments available for sale, debt, amortized cost	20,760	13,379
Restricted investments available for sale, debt, fair value	21,159	13,410
US States and Political Subdivisions Debt Securities [Member]
Restricted investments available for sale, debt, amortized cost	12,497	12,922
Restricted investments available for sale, debt, fair value	$ 12,898	$ 13,158

Note 9 - Investments in Marke_5

Note 9 - Investments in Marketable Securities - Available for Sale Marketable Equity Securities (Details) - NHI Common Stock [Member] - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
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	$ 112,792	$ 132,865

Note 9 - Investments in Marke_6

Note 9 - Investments in Marketable Securities - Amortized Cost and Estimated Fair Value of Debt Securities as Available for Sale (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Within 1 year, cost	$ 49,694	$ 15,726
Within 1 year, fair value	49,863	15,767
1 to 5 years, cost	99,143	88,314
1 to 5 years, fair value	103,002	90,408
6 to 10 years, cost	34,326	40,126
6 to 10 years, fair value	36,685	41,231
Over 10 years, cost	274	0
Over 10 years, fair value	285	0
Cost	183,437	144,166
Fair Value	$ 189,835	$ 147,406

Note 10 - Fair Value Measurem_3

Note 10 - Fair Value Measurements - Summary of Fair Value Measurements by Level (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Restricted cash and cash equivalents	$ 11,409	$ 10,676	$ 11,673
Available-for-sale securities	189,835	147,406
Corporate Debt Securities [Member]
Available-for-sale securities	25,778	0
Asset-backed Securities [Member]
Available-for-sale securities	2,480	0
Fair Value, Recurring [Member]
Cash and cash equivalents	147,093	50,334
Restricted cash and cash equivalents	11,409	10,676
Total financial assets	481,607	360,869
Fair Value, Recurring [Member] | Equity Securities [Member]
Available-for-sale securities	133,270	152,453
Fair Value, Recurring [Member] | Corporate Debt Securities [Member]
Available-for-sale securities	92,025	65,653
Fair Value, Recurring [Member] | Asset-backed Securities [Member]
Available-for-sale securities	44,249	55,185
Fair Value, Recurring [Member] | US Treasury Securities [Member]
Available-for-sale securities	40,663	13,410
Fair Value, Recurring [Member] | US States and Political Subdivisions Debt Securities [Member]
Available-for-sale securities	12,898	13,158
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member]
Cash and cash equivalents	147,093	50,334
Restricted cash and cash equivalents	11,409	10,676
Total financial assets	389,207	277,432
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Equity Securities [Member]
Available-for-sale securities	133,270	152,453
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Corporate Debt Securities [Member]
Available-for-sale securities	56,772	48,584
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Asset-backed Securities [Member]
Available-for-sale securities	0	0
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | US Treasury Securities [Member]
Available-for-sale securities	40,663	13,410
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | US States and Political Subdivisions Debt Securities [Member]
Available-for-sale securities	0	1,975
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member]
Cash and cash equivalents	0	0
Restricted cash and cash equivalents	0	0
Total financial assets	92,400	83,437
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Equity Securities [Member]
Available-for-sale securities	0	0
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Corporate Debt Securities [Member]
Available-for-sale securities	35,253	17,069
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Asset-backed Securities [Member]
Available-for-sale securities	44,249	55,185
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | US Treasury Securities [Member]
Available-for-sale securities	0	0
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | US States and Political Subdivisions Debt Securities [Member]
Available-for-sale securities	$ 12,898	$ 11,183

Note 11 - Property and Equipm_3

Note 11 - Property and Equipment (Details Textual)	Dec. 31, 2020USD ($)
Cost to Complete Construction in Progress	$ 380,000

Note 11 - Property and Equipm_4

Note 11 - Property and Equipment - Property and Equipment, at Cost (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Land	$ 64,385	$ 61,018
Leasehold improvements	125,889	122,520
Buildings and improvements	641,367	644,236
Furniture and equipment	180,463	177,717
Construction in progress	18,322	11,713
Property and equipment, at cost	1,030,426	1,017,204
Less: Accumulated depreciation	(510,108)	(481,774)
Net property and equipment	$ 520,318	$ 535,430

Note 12 - Notes Receivable (Det

Note 12 - Notes Receivable (Details Textual) - USD ($)	Dec. 31, 2020	Dec. 31, 2019
Financing Receivable, before Allowance for Credit Loss, Total	$ 13,021,000	$ 15,079,000
Prime Rate [Member] | Maximum [Member]
Loans Receivable, Basis Spread on Variable Rate	8.00%

Note 13 - Long-term Debt - Summ

Note 13 - Long-term Debt - Summary of Long-term Debt (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Less current portion	$ 0	$ (10,000)
Line of Credit [Member]
Credit Facility, interest payable monthly	2020
Credit Facility, interest payable monthly	$ 0	$ 10,000

Note 14 - Income Taxes (Details

Note 14 - Income Taxes (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Unrecognized Tax Benefits, Period Increase (Decrease), Total	$ (1,812,000)
Effective Income Tax Rate Reconciliation, Benefit Resulting from Expiration of Applicable Statute Limitations, Amount	2,366,000	$ 2,064,000	$ 2,222,000
Unrecognized Tax Benefits, Reduction Resulting from CARES Act	2,273,000
Unrecognized Tax Benefits, Ending Balance	4,727,000
Significant Change in Unrecognized Tax Benefits is Reasonably Possible, Amount of Unrecorded Benefit	2,286,000
Income Tax Examination, Penalties and Interest Expense, Total	(695,000)	38,000	(4,000)
Liability for Interest and Penalties [Member]
Unrecognized Tax Benefits, Reduction Resulting from Lapse of Applicable Statute of Limitations	1,098,000	935,000	941,000
Unrecognized Tax Benefits, Ending Balance	$ 2,614,000	$ 3,309,000	$ 3,271,000	$ 3,275,000

Note 14 - Income Taxes - Provis

Note 14 - Income Taxes - Provision for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Federal	$ 19,054	$ 13,356	$ 13,583
State	2,337	1,101	1,612
Total current tax provision	21,391	14,457	15,195
Federal	(8,349)	4,048	610
State	(2,609)	1,534	380
Total deferred tax provision	(10,958)	5,582	990
Effective income tax expense	$ 10,433	$ 20,039	$ 16,185

Note 14 - Income Taxes - Deferr

Note 14 - Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Accrued risk reserves	$ 1,764	$ 1,625
Accrued expenses	11,803	5,926
Financial reporting depreciation in excess of tax depreciation	4,125	3,966
Stock based compensation	1,063	666
Deferred revenue	4,215	5,425
Operating lease liabilities	45,486	52,870
Other	698	665
Total gross deferred tax assets	69,154	71,143
Less: valuation allowance	0	0
Deferred tax assets less valuation allowance	69,154	71,143
Unrealized gains on marketable securities	(27,040)	(32,638)
Deferred gain on sale of assets, net	(2,042)	(2,094)
Book basis in excess of tax basis of intangible assets	(2,360)	(2,063)
Book basis in excess of tax basis of securities	(2,514)	(2,172)
Long–term investments	(3,791)	(3,318)
Operating lease assets	(45,486)	(52,870)
Total deferred tax liabilities	(83,233)	(95,155)
Net deferred tax liability	$ (14,079)	$ (24,012)

Note 14 - Income Taxes - Reconc

Note 14 - Income Taxes - Reconciliation of Income Tax Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Tax provision at federal statutory rate	$ 11,009	$ 18,483	$ 15,726
State, net of federal benefit	(1,631)	(3,850)	(3,213)
Return to provision	(382)	(793)	(1,418)
Unrecognized tax benefits	166	512	586
Expiration of statute of limitations	(2,366)	(2,064)	(2,222)
Other net	375	51	300
Total increases (decreases)	(576)	1,556	459
Effective income tax expense	$ 10,433	$ 20,039	$ 16,185

Note 14 - Income Taxes - Reco_2

Note 14 - Income Taxes - Reconciliation of Unrecognized Tax Benefits (Details) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Balance	$ 4,727,000
Deferred Tax Assets [Member]
Balance	7,413,000	$ 5,563,000	$ 5,048,000
Additions based on tax positions related to the current year	1,229,000	1,418,000	811,000
Additions for tax positions of prior years		907,000	209,000
Reductions for statute of limitation expirations	(544,000)	(475,000)	(505,000)
Additions (reductions) for tax positions of prior years	(2,432,000)
Balance	5,666,000	7,413,000	5,563,000
Liability for Unrecognized Tax Benefits [Member]
Balance	12,749,000	11,933,000	12,520,000
Additions based on tax positions related to the current year	1,229,000	1,418,000	811,000
Additions for tax positions of prior years		1,002,000	388,000
Reductions for statute of limitation expirations	(1,812,000)	(1,604,000)	(1,786,000)
Additions (reductions) for tax positions of prior years	(2,273,000)
Balance	9,893,000	12,749,000	11,933,000
Liability for Interest and Penalties [Member]
Balance	3,309,000	3,271,000	3,275,000
Additions based on tax positions related to the current year	0	0	0
Additions for tax positions of prior years		973,000	937,000
Reductions for statute of limitation expirations	(1,098,000)	(935,000)	(941,000)
Additions (reductions) for tax positions of prior years	403,000
Balance	2,614,000	3,309,000	3,271,000
Total Liability [Member]
Balance	16,058,000	15,204,000	15,795,000
Additions based on tax positions related to the current year	1,229,000	1,418,000	811,000
Additions for tax positions of prior years		1,975,000	1,325,000
Reductions for statute of limitation expirations	(2,910,000)	(2,539,000)	(2,727,000)
Additions (reductions) for tax positions of prior years	(1,870,000)
Balance	$ 12,507,000	$ 16,058,000	$ 15,204,000

Note 15 - Stock Repurchase Pr_2

Note 15 - Stock Repurchase Program (Details Textual) - Common Stock [Member] - USD ($)	8 Months Ended	12 Months Ended
	Aug. 31, 2019	Dec. 31, 2020	Dec. 31, 2018
Stock Repurchased and Retired During Period, Shares (in shares)	10,396	797	14,506
Stock Repurchased and Retired During Period, Value	$ 872,000	$ 53,000	$ 867,000

Note 16 - Stock-based Compens_3

Note 16 - Stock-based Compensation (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	May 31, 2020
Share-based Payment Arrangement, Expense	$ 2,453,000	$ 1,878,000	$ 1,778,000
Share-based Payment Arrangement, Expense, Tax Benefit	677,000	3,918,000	1,047,000
Share-based Compensation Arrangement by Share-based Payment Award, Options, Exercises in Period, Intrinsic Value	677,000	$ 3,960,000	$ 1,047,000
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount, Total	$ 2,581,000
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year)	2 years
The 2010 Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant (in shares)	2,444,943			2,500,000
Share-based Payment Arrangement, Option [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Expiration Period (Year)		10 years

Note 16 - Stock-based Compens_4

Note 16 - Stock-based Compensation - Summary of Assumptions Used to Value Options Granted (Details)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Risk–free interest rate	0.87%	2.30%	2.46%
Expected volatility	20.10%	17.40%	16.10%
Expected life (Year)	2 years 2 months 12 days	2 years 3 months 18 days	3 years
Expected dividend yield	2.91%	2.73%	3.29%

Note 16 - Stock-based Compens_5

Note 16 - Stock-based Compensation - Summary of Options Outstanding (Details) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Options outstanding, shares (in shares)	809,529	1,163,381	1,239,407
Options outstanding, weighted average exercise price (in dollars per share)	$ 71.24	$ 71.16	$ 71.19
Options granted, shares (in shares)	104,057	77,316	110,265
Options granted, weighted average exercise price (in dollars per share)	$ 73.98	$ 77.89	$ 61.39
Options exercised, shares (in shares)	(43,630)	(346,168)	(68,291)
Options exercised, weighted average exercise price (in dollars per share)	$ 63.37	$ 71.57	$ 54.31
Options cancelled, shares (in shares)	(3,000)	(85,000)	(118,000)
Options cancelled, weighted average exercise price (in dollars per share)	$ 72.94	$ 72.94	$ 72.11
Options outstanding, shares (in shares)	866,956	809,529	1,163,381
Options outstanding, weighted average exercise price (in dollars per share)	$ 72.11	$ 71.24	$ 71.16
Options outstanding, aggregate intrinsic value	$ 572,790
Options exercisable, shares (in shares)	215,456
Options exercisable, weighted average exercise price (in dollars per share)	$ 68.35
Options exercisable, aggregate intrinsic value	$ 572,790

Note 16 - Stock-based Compens_6

Note 16 - Stock-based Compensation - Options Outstanding by Exercise Price Range (Details)	12 Months Ended
	Dec. 31, 2020$ / sharesshares
Options outstanding (in shares) | shares	866,956
Weighted average exercise price (in dollars per share)	$ 72.11
Weighted average remaining contractual life (Year)	1 year 3 months 18 days
Exercise Price Range 1 [Member]
Options outstanding (in shares) | shares	153,000
Exercise price, lower range (in dollars per share)	$ 60.73
Exercise price, upper range (in dollars per share)	64.64
Weighted average exercise price (in dollars per share)	$ 62.67
Weighted average remaining contractual life (Year)	2 years 3 months 18 days
Exercise Price Range 2 [Member]
Options outstanding (in shares) | shares	713,956
Exercise price, lower range (in dollars per share)	$ 72.94
Exercise price, upper range (in dollars per share)	84.30
Weighted average exercise price (in dollars per share)	$ 74.14
Weighted average remaining contractual life (Year)	1 year 3 months 18 days

Note 17 - Contingencies and C_2

Note 17 - Contingencies and Commitments (Details Textual) - USD ($)	Dec. 31, 2020	Dec. 31, 2019
Self Insurance Reserve	$ 99,537,000	$ 96,011,000

Note 18 - Equity Method Inves_3

Note 18 - Equity Method Investment in Caris HealthCare, L.P. (Details Textual) - Caris [Member] - USD ($)	Dec. 31, 2020	Dec. 31, 2019
Equity Method Investment, Ownership Percentage	75.10%
Equity Method Investments	$ 38,916,000	$ 36,673,000

Note 18 - Equity Method Inves_4

Note 18 - Equity Method Investment in Caris HealthCare, L.P. - Summary of Financial Information of Caris (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Current assets	$ 456,755	$ 341,053
Liabilities	563,872	507,579
Partners’ capital	795,177	778,593
Revenue	1,028,217	996,383	$ 980,349
Expenses	980,062	947,345	924,273
Net income	41,990	67,976	58,699
Caris [Member]
Current assets	27,737	25,664	17,539
Noncurrent assets	12,083	12,336	10,266
Liabilities	9,825	10,784	8,657
Partners’ capital	29,995	27,216	19,148
Revenue	68,649	62,034	56,410
Expenses	52,522	48,803	55,507
Net income	$ 16,127	$ 13,231	$ 903

Note 19 - Relationship With N_2

Note 19 - Relationship With National Health Corporation (Details Textual)	12 Months Ended
	Dec. 31, 2020USD ($)shares	Dec. 31, 2019USD ($)shares	Dec. 31, 2018USD ($)shares	Dec. 31, 2017shares
Common Stock [Member]
Shares, Outstanding, Ending Balance (in shares) | shares	15,369,745	15,332,206	15,255,002	15,212,133
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	$ 5,026,000	$ 5,131,000	$ 5,064,000
Employee-related Receivables	0	1,653,000
Employee-related Liabilities, Total	$ 3,140,000	79,000
National [Member] | Common Stock [Member]
Shares, Outstanding, Ending Balance (in shares) | shares	1,084,763
Equity Owned by Related Parties	7.10%
Line of Credit [Member] | National Health Care [Member]
Line of Credit Facility, Maximum Borrowing Capacity	$ 2,000,000
Long-term Line of Credit, Total		$ 0
National [Member]
Number of Skilled Nursing Centers	5	5

Note 20 - Variable Interest E_2

Note 20 - Variable Interest Entity (Details Textual)	12 Months Ended
	Dec. 31, 2020USD ($)	Dec. 31, 2019USD ($)	Dec. 31, 2010USD ($)
Number of Variable Interest Entities	1
Number of Patient Beds in Facility			120
Lessee, Operating Lease, Term of Contract (Year)			10 years
Number of Additional Lease Options			5
Lessee, Operating Lease, Renewal Term (Year)			5 years
Financing Receivable, before Allowance for Credit Loss, Current			$ 4,500,000
Increase (Decrease) in Notes Payable, Current, Total	$ 11,047,000	$ 11,047,000

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, 2020	Dec. 31, 2019	Dec. 31, 2018
Beginning Balance	$ 96,011	$ 96,024	$ 93,275
Charged to Costs and Expenses	86,918	79,959	75,052
Charged to other Accounts	0	0	0
Deductions	83,392	79,972	72,303
Accrued risk reserves	$ 99,537	$ 96,011	$ 96,024