Document And Entity Information
Document And Entity Information - shares | 3 Months Ended | |
Mar. 31, 2022 | May 01, 2022 | |
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 | Q1 | |
Document Fiscal Year Focus | 2022 | |
Document Type | 10-Q | |
Document Quarterly Report | true | |
Document Period End Date | Mar. 31, 2022 | |
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 | Common, $0.01 par value | |
Trading Symbol | NHC | |
Security Exchange Name | NYSE | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Large Accelerated Filer | |
Entity Small Business | false | |
Entity Emerging Growth Company | false | |
Entity Shell Company | false | |
Entity Common Stock, Shares Outstanding | 15,471,431 |
Interim Condensed Consolidated
Interim Condensed Consolidated Statements of Operations (Unaudited) - USD ($) | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Revenues: | ||
Net patient revenues | $ 256,337,000 | $ 216,855,000 |
Other revenues | 12,026,000 | 11,369,000 |
Government stimulus income | 10,620,000 | 22,749,000 |
Net operating revenues and grant income | 278,983,000 | 250,973,000 |
Costs and expenses: | ||
Salaries, wages, and benefits | 170,694,000 | 149,159,000 |
Other operating | 74,085,000 | 66,124,000 |
Rent | 10,065,000 | 10,063,000 |
Depreciation and amortization | 9,757,000 | 10,161,000 |
Interest | 165,000 | 244,000 |
Total costs and expenses | 264,766,000 | 235,751,000 |
Income from operations | 14,217,000 | 15,222,000 |
Other income: | ||
Non–operating income | 3,199,000 | 6,260,000 |
Unrealized gains on marketable equity securities | 3,126,000 | 7,059,000 |
Income before income taxes | 20,542,000 | 28,541,000 |
Income tax provision | (5,193,000) | (7,233,000) |
Net income | 15,349,000 | 21,308,000 |
Net income attributable to noncontrolling interest | (31,000) | (41,000) |
Net income attributable to National HealthCare Corporation | $ 15,318,000 | $ 21,267,000 |
Earnings per share attributable to National HealthCare Corporation stockholders: | ||
Basic (in dollars per share) | $ 0.99 | $ 1.39 |
Diluted (in dollars per share) | $ 0.99 | $ 1.38 |
Basic (in shares) | 15,416,836 | 15,327,520 |
Diluted (in shares) | 15,463,855 | 15,390,076 |
Dividends declared to common stockholders, per share (in dollars per share) | $ 0.55 | $ 0.52 |
Interim Condensed Consolidate_2
Interim Condensed Consolidated Statements of Comprehensive Income (Loss) (Unaudited) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Net income | $ 15,349 | $ 21,308 |
Other comprehensive loss: | ||
Unrealized losses on investments in marketable debt securities | (6,327) | (2,440) |
Reclassification adjustment for realized gains on sales of marketable debt securities | (107) | 0 |
Income tax benefit related to items of other comprehensive income | 1,374 | 518 |
Other comprehensive loss, net of tax | (5,060) | (1,922) |
Net income attributable to noncontrolling interest | (31) | (41) |
Comprehensive income attributable to National HealthCare Corporation | $ 10,258 | $ 19,345 |
Interim Condensed Consolidate_3
Interim Condensed Consolidated Balance Sheets (Unaudited) - USD ($) | Mar. 31, 2022 | Dec. 31, 2021 |
Current Assets: | ||
Cash and cash equivalents | $ 56,993,000 | $ 107,607,000 |
Restricted cash and cash equivalents, current portion | 17,187,000 | 10,407,000 |
Marketable equity securities | 118,048,000 | 113,108,000 |
Marketable debt securities | 30,987,000 | 35,310,000 |
Restricted marketable equity securities | 25,249,000 | 26,958,000 |
Restricted marketable debt securities, current portion | 13,703,000 | 20,727,000 |
Accounts receivable | 101,748,000 | 96,124,000 |
Inventories | 8,586,000 | 8,582,000 |
Prepaid expenses and other assets | 11,519,000 | 7,815,000 |
Total current assets | 384,020,000 | 426,638,000 |
Property and Equipment: | ||
Property and equipment, at cost | 1,073,293,000 | 1,064,337,000 |
Accumulated depreciation and amortization | (553,092,000) | (543,341,000) |
Net property and equipment | 520,201,000 | 520,996,000 |
Other Assets: | ||
Restricted cash and cash equivalents, less current portion | 1,736,000 | 1,729,000 |
Restricted marketable debt securities, less current portion | 118,098,000 | 116,063,000 |
Deposits and other assets | 4,956,000 | 4,499,000 |
Operating lease right-of-use assets | 150,191,000 | 156,116,000 |
Goodwill | 168,295,000 | 168,295,000 |
Intangible assets | 7,038,000 | 7,038,000 |
Investments in unconsolidated companies | 2,476,000 | 2,022,000 |
Total other assets | 452,790,000 | 455,762,000 |
Total assets | 1,357,011,000 | 1,403,396,000 |
Current Liabilities: | ||
Trade accounts payable | 25,842,000 | 22,488,000 |
Finance lease obligations, current portion | 4,766,000 | 4,695,000 |
Operating lease liabilities, current portion | 28,005,000 | 27,574,000 |
Accrued payroll | 73,877,000 | 106,698,000 |
Amounts due to third party payors | 17,319,000 | 17,595,000 |
Accrued risk reserves, current portion | 30,890,000 | 31,134,000 |
Other current liabilities | 21,760,000 | 20,059,000 |
Provider relief funds | 516,000 | 9,443,000 |
Contract liabilities | 5,003,000 | 15,022,000 |
Dividends payable | 8,509,000 | 8,493,000 |
Total current liabilities | 216,487,000 | 263,201,000 |
Finance lease obligations, less current portion | 4,627,000 | 5,845,000 |
Operating lease liabilities, less current portion | 122,186,000 | 128,542,000 |
Accrued risk reserves, less current portion | 70,523,000 | 66,914,000 |
Refundable entrance fees | 6,097,000 | 7,011,000 |
Deferred income taxes | 8,078,000 | 6,852,000 |
Other noncurrent liabilities | 17,957,000 | 16,571,000 |
Total liabilities | 445,955,000 | 494,936,000 |
Equity: | ||
Common stock, $.01 par value; 45,000,000 shares authorized; 15,471,331 and 15,452,033 shares, respectively, issued and outstanding | 154,000 | 154,000 |
Capital in excess of par value | 232,733,000 | 232,167,000 |
Retained earnings | 675,887,000 | 669,078,000 |
Accumulated other comprehensive income (loss) | (3,455,000) | 1,605,000 |
Total National HealthCare Corporation stockholders’ equity | 905,319,000 | 903,004,000 |
Noncontrolling interest | 5,737,000 | 5,456,000 |
Total equity | 911,056,000 | 908,460,000 |
Total liabilities and equity | $ 1,357,011,000 | $ 1,403,396,000 |
Interim Condensed Consolidate_4
Interim Condensed Consolidated Balance Sheets (Unaudited) (Parentheticals) - $ / shares | Mar. 31, 2022 | Dec. 31, 2021 |
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) | 15,471,331 | 15,452,033 |
Common stock, shares outstanding (in shares) | 15,471,331 | 15,452,033 |
Interim Condensed Consolidate_5
Interim Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Cash Flows From Operating Activities: | ||
Net income | $ 15,349,000 | $ 21,308,000 |
Adjustments to reconcile net income to net cash (used in)/provided by operating activities: | ||
Depreciation and amortization | 9,757,000 | 10,161,000 |
Equity in earnings of unconsolidated investments | (454,000) | (2,911,000) |
Distributions from unconsolidated investments | 0 | 5,897,000 |
Unrealized gains on marketable equity securities | (3,126,000) | (7,059,000) |
Gains on sale of marketable securities | (45,000) | 0 |
Deferred income taxes | (2,600,000) | (1,596,000) |
Stock–based compensation | 712,000 | 496,000 |
Changes in operating assets and liabilities: | ||
Accounts receivable | (5,624,000) | (4,622,000) |
Inventories | (4,000) | 664,000 |
Prepaid expenses and other assets | (4,385,000) | (601,000) |
Trade accounts payable | 3,354,000 | (4,999,000) |
Accrued payroll | (32,821,000) | (21,777,000) |
Amounts due to third party payors | (276,000) | (880,000) |
Accrued risk reserves | 3,365,000 | 1,945,000 |
Provider relief funds | (8,927,000) | 7,442,000 |
Contract liabilities | (10,019,000) | 0 |
Other current liabilities | 1,701,000 | 4,331,000 |
Other noncurrent liabilities | 1,386,000 | 1,598,000 |
Net cash (used in)/provided by operating activities | (27,457,000) | 12,589,000 |
Cash Flows From Investing Activities: | ||
Purchases of property and equipment | (8,962,000) | (4,327,000) |
Collections of notes receivable | 224,000 | 255,000 |
Purchases of marketable securities | (14,128,000) | (7,866,000) |
Proceeds from sale of marketable securities | 16,946,000 | 6,086,000 |
Net cash used in investing activities | (5,920,000) | (5,852,000) |
Cash Flows From Financing Activities: | ||
Principal payments under finance lease obligations | (1,147,000) | (1,081,000) |
Dividends paid to common stockholders | (8,493,000) | (7,988,000) |
Noncontrolling interest contributions | 250,000 | 0 |
Issuance of common shares | 0 | 327,000 |
Repurchase of common shares | (146,000) | (278,000) |
Entrance fee refunds | (914,000) | (128,000) |
Net cash used in financing activities | (10,450,000) | (9,148,000) |
Net Decrease in Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents | (43,827,000) | (2,411,000) |
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, Beginning of Period | 119,743,000 | 158,502,000 |
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, End of Period | 75,916,000 | 156,091,000 |
Balance Sheet Classifications: | ||
Cash and cash equivalents | 56,993,000 | 134,107,000 |
Restricted Cash and Cash Equivalents | 18,923,000 | 21,984,000 |
Total Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents | $ 75,916,000 | $ 156,091,000 |
Interim Condensed Consolidate_6
Interim Condensed Consolidated Statements of Stockholders' Equity (Unaudited) - USD ($) $ in Thousands | Common Stock [Member] | Additional Paid-in Capital [Member] | Retained Earnings [Member] | AOCI Attributable to Parent [Member] | Noncontrolling Interest [Member] | Total |
Balance (in shares) at Dec. 31, 2020 | 15,369,745 | |||||
Balance at Dec. 31, 2020 | $ 153 | $ 226,943 | $ 563,024 | $ 5,057 | $ 3,083 | $ 798,260 |
Net income | 0 | 0 | 21,267 | 0 | 41 | 21,308 |
Other comprehensive loss | 0 | 0 | 0 | (1,922) | 0 | (1,922) |
Stock–based compensation | $ 0 | 496 | 0 | 0 | 0 | 496 |
Shares sold – options exercised (in shares) | 24,331 | |||||
Shares sold – options exercised | $ 1 | 326 | 0 | 0 | 0 | 327 |
Repurchase of common shares (in shares) | (3,936) | |||||
Repurchase of common shares | $ 0 | (278) | 0 | 0 | 0 | (278) |
Dividends declared to common stockholders | $ 0 | 0 | (8,003) | 0 | 0 | (8,003) |
Balance (in shares) at Mar. 31, 2021 | 15,390,140 | |||||
Balance at Mar. 31, 2021 | $ 154 | 227,487 | 576,288 | 3,135 | 3,124 | 810,188 |
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 |
Shares sold – options exercised (in shares) | 541,736 | |||||
Balance (in shares) at Dec. 31, 2021 | 15,452,033 | |||||
Balance at Dec. 31, 2021 | $ 154 | 232,167 | 669,078 | 1,605 | 5,456 | $ 908,460 |
Net income | 0 | 0 | 15,318 | 0 | 31 | 15,349 |
Other comprehensive loss | 0 | 0 | 0 | (5,060) | 0 | (5,060) |
Stock–based compensation | $ 0 | 712 | 0 | 0 | 0 | 712 |
Shares sold – options exercised (in shares) | 21,463 | |||||
Shares sold – options exercised | $ 0 | 0 | 0 | 0 | 0 | 0 |
Repurchase of common shares (in shares) | (2,165) | |||||
Repurchase of common shares | $ 0 | (146) | 0 | 0 | 0 | (146) |
Dividends declared to common stockholders | 0 | 0 | (8,509) | 0 | 0 | (8,509) |
Equity contributed by noncontrolling interest | $ 0 | 0 | 0 | 0 | 250 | 250 |
Balance (in shares) at Mar. 31, 2022 | 15,471,331 | |||||
Balance at Mar. 31, 2022 | $ 154 | $ 232,733 | $ 675,887 | $ (3,455) | $ 5,737 | $ 911,056 |
Interim Condensed Consolidate_7
Interim Condensed Consolidated Statements of Stockholders' Equity (Unaudited) (Parentheticals) - $ / shares | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Dividends declared to common stockholders, per share (in dollars per share) | $ 0.55 | $ 0.52 |
Note 1 - Description of Busines
Note 1 - Description of Business | 3 Months Ended |
Mar. 31, 2022 | |
Notes to Financial Statements | |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block] | Note 1 Description of Business National HealthCare Corporation March 31, 2022, |
Note 2 - Summary of Significant
Note 2 - Summary of Significant Accounting Policies | 3 Months Ended |
Mar. 31, 2022 | |
Notes to Financial Statements | |
Significant Accounting Policies [Text Block] | Note 2 Summary of Significant Accounting Policies The listing below is not not December 31, 2021 December 31, 2021 www.nhccare.com Basis of Presentation The unaudited interim condensed consolidated financial statements to which these notes are attached include all normal, recurring adjustments which are necessary to fairly present the financial position, results of operations and cash flows of NHC. All significant intercompany transactions and balances have been eliminated in consolidation. The consolidated financial statements include the accounts of all entities controlled by NHC. The Company presents noncontrolling interest within the equity section of its consolidated balance sheets. The Company presents the amount of consolidated net income that is attributable to NHC and the noncontrolling interest in its consolidated statements of operations. We assume that users of these interim financial statements have read or have access to the audited December 31, 2021 may not may Estimates and Assumptions The preparation of financial statements in conformity with U.S. GAAP requires us to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates and could cause our reported net income to vary significantly from period to period, 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, home health care services, and hospice 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 three March 31, 2022 2021, March 31, 2022, December 31, 2021, Other Revenues Other revenues include revenues from the provision of insurance services, management and accounting services to other long–term care providers, and rental income. Our insurance revenues consist of premiums that are generally paid in advance and then amortized into income over the policy period. We charge for management services based on a percentage of net revenues. We charge for accounting services based on a monthly fee or a fixed fee per bed of the healthcare center under contract. We record other revenues as the performance obligations are satisfied based on the terms of our contractual arrangements. 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 In 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 1 one 2 7 Other Operating Expenses Other operating expenses include the costs of care and services that we provide to the residents of our facilities and the costs of maintaining our facilities. Our primary patient care costs include drugs, medical supplies, purchased professional services, food, and professional liability insurance and licensing fees. The primary facility costs include utilities and property insurance. General and Administrative Costs With the Company being a healthcare provider, the majority of our expenses are "cost of revenue" items. Costs that could be classified as "general and administrative" by the Company would include its corporate office costs, excluding stock-based compensation, which were $5,787,000 and $5,369,000 for the three March 31, 2022 2021, 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 and hospice 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 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 value 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 health facility are 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 years and equipment and furniture, 3-15 years. Leasehold improvements are amortized over periods that do not Finance leases are recorded at cost. Finance leases are amortized in accordance with the provision codified within ASC 842, Leases Business Combinations We account for acquisitions using the acquisition method of accounting in accordance with ASC 805, Business Combinations. Goodwill and Other Intangible Assets Goodwill represents the excess of purchase price over the fair value of identifiable net assets acquired in business combinations. Goodwill is not first fourth not The Company’s indefinite-lived intangible assets consist of trade names and certificates of need and licenses. The Company reviews indefinite-lived intangible assets for impairment on an annual basis or more frequently if events or changes in circumstances indicate that the carrying amount of the intangible asset may not Accrued Risk Reserves We are self–insured for risks related to health insurance and have wholly–owned limited purpose insurance companies that insure risks related to workers’ compensation and general and professional liability insurance claims. The accrued risk reserves include a liability for reported claims and estimates for incurred but unreported claims. Our policy is to engage an external, independent actuary to assist in estimating our exposure for claims obligations (for both asserted and unasserted claims). We reassess our accrued risk reserves on a quarterly basis. Professional liability remains an area of particular concern to us. The long-term care industry has seen an increase in personal injury/wrongful death claims based on alleged negligence by skilled nursing facilities and their employees in providing care to residents. 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. A significant increase in the number of these claims, or an increase in the amounts due as a result of these claims could have a material adverse effect on our consolidated financial position, results of operations and cash flows. It is also possible that future events could cause us to make significant adjustments or revisions to these reserve estimates and cause our reported net income to vary significantly from period to period. We are principally self-insured for incidents occurring in all centers owned or leased by us. The coverages include both primary policies and excess policies. In all years, settlements, if any, in excess of available insurance policy limits and our own reserves would be expensed by us. Continuing Care Contracts We have one may Non-refundable fees are included as a component of the transaction price and are amortized into revenue over the actuarily 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 March 31, 2022, December 31, 2021, We also annually estimate the present value of the cost of future services and the use of facilities to be provided to the current CCRC residents and compare that amount with the balance of non-refundable deferred revenue from entrance fees received. If the present value of the cost of future services exceeds the related anticipated revenues, a liability is recorded with a corresponding charge to income. As of March 31, 2022, December 31, 2021, Other Noncurrent Liabilities Other noncurrent liabilities include reserves primarily related to various uncertain income tax positions, deferred revenue, and obligations to provide future 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% Noncontrolling Interest The noncontrolling interest in a subsidiary is presented within total equity in the Company's interim condensed consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to NHC in its interim condensed consolidated statements of operations. The Company’s earnings per share is calculated based on net income attributable to NHC’s stockholders. The carrying amount of the noncontrolling interest is adjusted based on an allocation of the subsidiary earnings, contributions, and distributions. Variable Interest Entities We have equity interests in unconsolidated limited liability companies that operate various post-acute and senior healthcare businesses. We analyze our investments in these limited liability companies to determine if the company is considered a variable interest entity (“VIE”) and would require consolidation. To the extent that we own interests in a VIE and we (i) have the power to direct the activities of the VIE and (ii) have the obligation or rights to absorb the VIE's losses or receive its benefits, then we would be determined to be the primary beneficiary and would consolidate the VIE. To the extent we own interests in a VIE, then at each reporting period, we re-assess our conclusions as to which, if any, party within the VIE is considered the primary beneficiary. The Company's maximum exposure to losses in its investments in unconsolidated VIEs cannot be quantified and may may not Reclassifications Certain accounts in the prior-year financial statements have been reclassified for comparative purposes to conform to the presentation in the current-year financial statements. |
Note 3 - Coronavirus Pandemic
Note 3 - Coronavirus Pandemic | 3 Months Ended |
Mar. 31, 2022 | |
COVID 19 [Member] | |
Notes to Financial Statements | |
Unusual or Infrequent Items, or Both, Disclosure [Text Block] | Note 3 Coronavirus Pandemic In early March 2020, 19, March 2020 19 $178 Public Health and Social Services Emergency Fund 19. The Provider Relief Fund grants come with terms and condition certifications in which all providers are required to submit documents to ensure the funds are used for healthcare-related expenses or lost revenue attributable to COVID- 19. three March 31, 2022 2021, 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 one first eleven twenty-five nine fifty not twenty-nine four second 2021. March 31, 2022 December 31, 2021, The CARES Act and subsequent related legislation temporarily suspended Medicare sequestration beginning May 1, 2020 March 31, 2022. 2 April 1, 2022, 1% April 1, 2022 June 30, 2022. 2% July 1, 2022. 2030 2030 3%. 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. March 31, 2022 December 31, 2021, We have also received supplemental Medicaid payments from many of the states in which we operate to help mitigate the incremental costs resulting from the COVID- 19 three March 31, 2022 2021, |
Note 4 - Net Patient Revenues
Note 4 - Net Patient Revenues | 3 Months Ended |
Mar. 31, 2022 | |
Notes to Financial Statements | |
Revenue from Contract with Customer [Text Block] | Note 4 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 (in thousands) Three Months Ended March 31 2022 2021 Net patient revenues: Inpatient services $ 224,842 $ 203,242 Homecare and hospice 31,495 13,613 Total net patient revenue $ 256,337 $ 216,855 For inpatient and hospice 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: Three Months Ended March 31 Source 2021 2020 Medicare 37% 35% Managed Care 10% 12% Medicaid 28% 29% Private Pay and Other 25% 24% Total 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 For hospice services, Medicare pays a daily rate to cover the hospice’s costs for providing services included in the patient care plan. Medicare makes daily payments based on 1 4 Our hospice service revenue is subject to certain limitations on payments from Medicare. We are subject to an inpatient cap limit and an overall Medicare payment cap for each provider number. We monitor these caps on a provider-by-provider basis and estimate amounts due back to Medicare if we estimate a cap has been exceeded. If applicable, we record these cap adjustments as a reduction to revenue. 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 center's 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 interim condensed consolidated balance sheets are contract liabilities, which represent payments the Company receives in advance of services provided. As of March 31, 2022 December 31, 2021, second 2021. A summary of the contract liabilities are follows ( in thousands Balance at December 31, 2021 $ 15,022 Payments received - Payments recouped (10,019 ) Balance at March 31, 2022 $ 5,003 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 following 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 March 31, 2022 December 31, 2021, |
Note 5 - Other Revenues
Note 5 - Other Revenues | 3 Months Ended |
Mar. 31, 2022 | |
Notes to Financial Statements | |
Other Revenues [Text Block] | Note 5 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 (in thousands) Three Months Ended March 31 2022 2021 Rental income $ 5,982 $ 5,647 Management and accounting services fees 4,304 4,324 Insurance services 1,247 1,264 Other 493 134 Total other revenues $ 12,026 $ 11,369 Rental Income The Company leases real estate assets consisting of skilled nursing facilities and assisted living facilities to third 8 Management Fees from National Health Corporation We manage five skilled nursing facilities owned by National Health Corporation (“National”). For the three March 31, 2022 2021, Insurance Services For workers’ compensation insurance services, the premium revenues reflected in the interim condensed consolidated statements of operations for the three March 31, 2022 2021 For professional liability insurance services, the premium revenues reflected in the interim condensed consolidated statements of operations for the three March 31, 2022 2021 |
Note 6 - Non-operating Income
Note 6 - Non-operating Income | 3 Months Ended |
Mar. 31, 2022 | |
Notes to Financial Statements | |
Other Nonoperating Income and Expense [Text Block] | Note 6 Non Operating Income Non–operating income includes equity in earnings of unconsolidated investments, dividends and other realized gains and losses on sales of marketable securities, and interest income (in thousands) Three Months Ended March 31 2022 2021 Equity in earnings of unconsolidated investments $ 454 $ 2,911 Dividends and net realized gains on sales of securities 1,753 1,962 Interest income 992 1,387 Total non-operating income $ 3,199 $ 6,260 Caris HealthCare, L.P. On June 11, 2021, June 11, 2021 no |
Note 7 - Business Segments
Note 7 - Business Segments | 3 Months Ended |
Mar. 31, 2022 | |
Notes to Financial Statements | |
Segment Reporting Disclosure [Text Block] | Note 7 Business Segments The Company has two reportable operating segments: ( 1 2 The Company also reports an “all other” category that includes revenues from rental income, management and accounting services fees, insurance services, and costs of the corporate office. For additional information on these reportable segments see Note 2 Summary of Significant Accounting Policies. The Company’s CODM evaluates performance and allocates capital resources to each segment based on an operating model that is designed to improve the quality of patient care and profitability of the Company while enhancing long-term shareholder value. The CODM does not not The following table sets forth the Company’s unaudited interim condensed consolidated statements of operations by business segment (in thousands Three Months Ended March 31, 2022 Inpatient Homecare and Hospice All Other Total Revenues: Net patient revenues $ 224,842 $ 31,495 $ - $ 256,337 Other revenues 114 - 11,912 12,026 Government stimulus income 10,620 - - 10,620 Net operating revenues and grant income 235,576 31,495 11,912 278,983 Costs and expenses: Salaries, wages, and benefits 142,185 19,401 9,108 170,694 Other operating 64,383 7,095 2,607 74,085 Rent 8,347 592 1,126 10,065 Depreciation and amortization 8,838 113 806 9,757 Interest 165 - - 165 Total costs and expenses 223,918 27,201 13,647 264,766 Income (loss) from operations 11,658 4,294 (1,735 ) 14,217 Non-operating income - - 3,199 3,199 Unrealized gains on marketable equity securities - - 3,126 3,126 Income before income taxes $ 11,658 $ 4,294 $ 4,590 $ 20,542 Three Months Ended March 31, 2021 Inpatient Homecare All Other Total Revenues: Net patient revenues $ 203,242 $ 13,613 $ - $ 216,855 Other revenues 98 - 11,271 11,369 Government stimulus income 22,749 - - 22,749 Net operating revenues and grant income 226,089 13,613 11,271 250,973 Costs and expenses: Salaries, wages, and benefits 131,811 9,435 7,913 149,159 Other operating 61,808 1,915 2,401 66,124 Rent 8,194 431 1,438 10,063 Depreciation and amortization 9,263 87 811 10,161 Interest 244 - - 244 Total costs and expenses 211,320 11,868 12,563 235,751 Income/(loss) from operations 14,769 1,745 (1,292 ) 15,222 Non-operating income - - 6,260 6,260 Unrealized gains on marketable equity securities - - 7,059 7,059 Income before income taxes $ 14,769 $ 1,745 $ 12,027 $ 28,541 |
Note 8 - Long-term Leases
Note 8 - Long-term Leases | 3 Months Ended |
Mar. 31, 2022 | |
Notes to Financial Statements | |
Lessee, Operating and Finance Leases [Text Block] | Note 8 Long-Term Leases Operating Leases At March 31, 2022, first third three March 31, 2022 2021, Finance Leases At March 31, 2022, third ten 2014 Minimum Lease Payments The following table summarizes the maturity of our finance and operating lease liabilities as of March 31, 2022 ( in thousands Finance Leases Operating Leases 2023 $ 5,200 $ 36,046 2024 4,767 35,489 2025 - 35,033 2026 - 34,756 2027 - 26,704 Thereafter - 4,888 Total minimum lease payments 9,967 172,916 Less: amounts representing interest (574 ) (22,725 ) Present value of future minimum lease payments 9,393 150,191 Less: current portion (4,766 ) (28,005 ) Noncurrent lease liabilities $ 4,627 $ 122,186 |
Note 9 - Earnings Per Share
Note 9 - Earnings Per Share | 3 Months Ended |
Mar. 31, 2022 | |
Notes to Financial Statements | |
Earnings Per Share [Text Block] | Note 9 Earnings per Share Basic net income per share is computed based on the weighted average number of common shares outstanding for each period presented. Diluted net income per share reflects the potential dilution that would have occurred if securities to issue common stock were exercised, converted, or resulted in the issuance of common stock that would have then shared in our earnings. The following table summarizes the earnings and the weighted average number of common shares used in the calculation of basic and diluted earnings per share (in thousands, except for share and per share amounts): Three Months Ended March 31 2022 2021 Basic: Weighted average common shares outstanding 15,416,836 15,327,520 Net income attributable to National HealthCare Corporation $ 15,318 $ 21,267 Earnings per common share, basic $ 0.99 $ 1.39 Diluted: Weighted average common shares outstanding 15,416,836 15,327,520 Effects of dilutive instruments 47,019 62,556 Weighted average common shares outstanding 15,463,855 15,390,076 Net income attributable to National HealthCare Corporation $ 15,318 $ 21,267 Earnings per common share, diluted $ 0.99 $ 1.38 |
Note 10 - Investments in Market
Note 10 - Investments in Marketable Securities | 3 Months Ended |
Mar. 31, 2022 | |
Notes to Financial Statements | |
Investments in Debt and Marketable Equity Securities (and Certain Trading Assets) Disclosure [Text Block] | Note 10 Investments in Marketable Securities Our investments in marketable equity securities are carried at fair value with the changes in unrealized gains and losses recognized in our results of operations at each measurement date. Our investments in marketable debt securities are classified as available for sale securities and carried at fair value with the unrealized gains and losses recognized through accumulated other comprehensive income at each measurement date. Any credit related decline in fair market values 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. Refer to Note 11 Marketable securities consist of the following (in thousands) March 31, 2022 December 31, 2021 Amortized Cost Fair Value Amortized Cost Fair Value Investments available for sale: Marketable equity securities $ 30,176 $ 118,048 $ 30,176 $ 113,108 Corporate debt securities 17,030 16,554 19,038 18,843 Asset-backed securities 501 493 1,481 1,469 U.S. Treasury securities 14,189 13,940 15,082 14,998 Restricted investments available for sale: Marketable equity securities 25,546 25,249 25,442 26,958 Corporate debt securities 62,399 61,699 60,816 62,936 Asset-based securities 30,715 29,982 32,918 33,301 U.S. Treasury securities 37,403 35,181 33,052 32,630 State and municipal securities 4,972 4,939 7,700 7,923 $ 222,931 $ 306,085 $ 225,705 312,166 Included in the marketable equity securities are the following (in thousands, except share amounts): March 31, 2022 December 31, 2021 Shares Cost Fair Value Shares Cost Fair Value NHI Common Stock 1,630,642 $ 24,734 $ 96,224 1,630,642 $ 24,734 $ 93,713 The amortized cost and estimated fair value of debt securities classified as available for sale, by contractual maturity, are as follows (in thousands) March 31, 2022 December 31, 2021 Cost Fair Value Cost Fair Value Maturities: Within 1 year $ 34,236 $ 34,159 $ 32,718 $ 32,843 1 to 5 years 89,482 87,771 95,293 96,937 6 to 10 years 43,491 40,858 41,580 41,835 Over 10 years – – 496 485 $ 167,209 $ 162,788 $ 170,087 $ 172,100 Gross unrealized gains related to marketable equity securities are $88,514,000 and $85,394,000 as of March 31, 2022 December 31, 2021, March 31, 2022 December 31, 2021, three March 31, 2022 2021, Gross unrealized gains related to available for sale marketable debt securities are $484,000 and $3,189,000 as of March 31, 2022 December 31, 2021, March 31, 2022 December 31, 2021, The Company has not three March 31, 2022 2021. For the marketable securities in gross unrealized loss positions, (a) it is more likely than not not Proceeds from the sale of marketable securities during the three March 31, 2022 2021 three March 31, 2022. three March 31, 2021. |
Note 11 - Fair Value Measuremen
Note 11 - Fair Value Measurements | 3 Months Ended |
Mar. 31, 2022 | |
Notes to Financial Statements | |
Fair Value Disclosures [Text Block] | Note 11 Fair Value Measurements The accounting standard for fair value measurements provides a framework for measuring fair value and requires expanded disclosures regarding fair value measurements. Fair value is defined as the price that would be received for an asset or the exit price that would be paid to transfer a liability in the principal or most advantageous market in an orderly transaction between market participants on the measurement date. This accounting standard establishes a fair value hierarchy, which requires an entity to maximize the use of observable inputs, where available. The following summarizes the three may Level 1 Level 2 not Level 3 no 3 A financial instrument’s level within the fair value hierarchy is based on the lowest level of input that is significant to the fair value measurement. The following table summarizes fair value measurements by level at March 31, 2022 December 31, 2021 (in thousands) Fair Value Measurements Using March 31, 2022 Fair Value Quoted Prices in Active For Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Cash and cash equivalents $ 56,993 $ 56,993 $ – $ – Restricted cash and cash equivalents 18,923 18,923 – – Marketable equity securities 143,297 143,297 – – Corporate debt securities 78,253 43,059 35,194 – Mortgage–backed securities 30,475 – 30,475 – U.S. Treasury securities 49,121 49,121 – – State and municipal securities 4,939 – 4,939 – Total financial assets $ 382,001 $ 311,393 $ 70,608 $ – Fair Value Measurements Using December 31, 2021 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 $ 107,607 $ 107,607 $ – $ – Restricted cash and cash equivalents 12,136 12,136 – – Marketable equity securities 140,066 140,066 – – Corporate debt securities 81,779 50,005 31,774 – Asset–backed securities 34,770 – 34,770 – U.S. Treasury securities 47,628 47,628 – – State and municipal securities 7,923 – 7,923 – Total financial assets $ 431,909 $ 357,442 $ 74,467 $ – |
Note 12 - Goodwill and Other In
Note 12 - Goodwill and Other Intangible Assets | 3 Months Ended |
Mar. 31, 2022 | |
Notes to Financial Statements | |
Goodwill and Intangible Assets Disclosure [Text Block] | Note 12 Goodwill and Other Intangible Assets At March 31, 2022, 19" three March 31, 2022 19. not may At March 31, 2022, in thousands Inpatient Services Homecare and Hospice All Other Total January 1, 2022 $ 3,741 $ 164,554 $ – $ 168,295 Additions – – – – March 31, 2022 $ 3,741 $ 164,554 $ – $ 168,295 We also have recorded indefinite-lived intangible assets that consist of trade names ($4,340,000) and certificates of need and licenses ($2,698,000). |
Note 13 - Stock Repurchase Prog
Note 13 - Stock Repurchase Program | 3 Months Ended |
Mar. 31, 2022 | |
Notes to Financial Statements | |
Treasury Stock [Text Block] | Note 13 During the three March 31, 2022, three March 31, 2021, |
Note 14 - Stock-based Compensat
Note 14 - Stock-based Compensation | 3 Months Ended |
Mar. 31, 2022 | |
Notes to Financial Statements | |
Share-Based Payment Arrangement [Text Block] | Note 14 Stock Based Compensation NHC recognizes stock–based compensation expense for all stock options granted over the requisite service period using the fair value at the date of grant using the Black–Scholes pricing model. Stock–based compensation totaled $712,000 and $496,000 for the three March 31, 2022 2021, At March 31, 2022, three Stock Options The following table summarizes the significant assumptions used to value the options granted for the three March 31, 2022 December 31, 2021. March 31, 2022 December 31, Risk–free interest rate 1.63% 0.21% Expected volatility 30.95% 34.90% Expected life, in years 2.9 2.2 Expected dividend yield 3.62% 3.00% The following table summarizes our outstanding stock options for the three March 31, 2022 December 31, 2021. Number of Shares Weighted Average Exercise Price Aggregate Intrinsic Value Options outstanding at January 1, 2021 866,956 $ 72.11 $ – Options granted 55,706 70.80 – Options exercised (541,736 ) 71.39 – Options cancelled (6,000 ) 72.94 – Options outstanding at December 31, 2021 374,926 72.95 – Options granted 249,640 64.15 – Options cancelled (157,240 ) 76.99 – Options outstanding at March 31, 2022 467,326 66.88 $ 2,085,879 Options exercisable at March 31, 2022 172,686 69.60 $ 567,923 Options Outstanding March 31, 2022 Exercise Prices Weighted Average Exercise Price Weighted Average Remaining Contractual Life in Years 332,620 61.90 - 68.84 63.96 4.1 134,706 71.64 - 77.92 74.11 2.1 467,326 66.88 3.5 |
Note 15 - Income Taxes
Note 15 - Income Taxes | 3 Months Ended |
Mar. 31, 2022 | |
Notes to Financial Statements | |
Income Tax Disclosure [Text Block] | Note 15 Income Taxes The Company's income tax provision as a percentage of our income before income taxes was 25.3% for the three March 31, 2022 2021. Typically, these percentages vary from the U.S. federal statutory income tax rate of 21% primarily due to state income taxes, excess tax benefits from stock-based compensation, benefits resulting from the lapsing of statute of limitations of items in our tax contingency reserve, and non-deductible expenses. For the three March 31, 2022 2021, Our quarterly income tax provision, and our estimate of our annual effective income tax rate, is subject to variation due to several factors, including volatility based on the amount of pre-tax income or loss. The Company is no 2018 |
Note 16 - Contingencies and Com
Note 16 - Contingencies and Commitments | 3 Months Ended |
Mar. 31, 2022 | |
Notes to Financial Statements | |
Commitments and Contingencies Disclosure [Text Block] | Note 16 Contingencies and Commitments Accrued Risk Reserves We are self–insured for risks related to health insurance and have wholly–owned limited purpose insurance companies that insure risks related to workers’ compensation and general and professional liability insurance claims both for our owned and 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 $101,413,000 and $98,048,000 at March 31, 2022 December 31, 2021, As a result of the terms of our insurance policies and our use of wholly owned limited purpose insurance companies, we have retained significant insurance risk with respect to workers’ compensation and general and professional liability. We consider the professional services of independent actuaries to assist us in estimating our exposures for claims obligations (for both asserted and unasserted claims) related to deductibles and exposures in excess of coverage limits, and we maintain reserves for these obligations. Such estimates are based on many variables including historical and statistical information and other factors. Workers Compensation For workers’ compensation, we utilize a wholly–owned Tennessee domiciled property/casualty insurance company to write coverage for NHC affiliates and for third–party customers. Policies are written for a duration of twelve 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 third There is certain additional litigation incidental to our business, none Qui Tam Litigation United States of America, ex rel. Jennifer Cook and Sally Gaither v. Integrated Behavioral Health, Inc., NHC HealthCare/Moulton, LLC, et al. , Case No. 2:20 00877 qui tam June 22, 2020. March 1, 2021. November 4, 2021. January 28, 2022, one no 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 |
Note 17 - Subsequent Event
Note 17 - Subsequent Event | 3 Months Ended |
Mar. 31, 2022 | |
Notes to Financial Statements | |
Subsequent Events [Text Block] | Note 17 Subsequent Event On May 3, 2022, seven 90 seven third third 2022. The seven three March 31, 2022 2021, seven three March 31, 2022 2021, December 31, 2021, seven In conjunction with the OTAs, we have signed an acknowledgement agreement with NHI that will terminate our lease agreement with the seven |
Significant Accounting Policies
Significant Accounting Policies (Policies) | 3 Months Ended |
Mar. 31, 2022 | |
Accounting Policies [Abstract] | |
Basis of Accounting, Policy [Policy Text Block] | Basis of Presentation The unaudited interim condensed consolidated financial statements to which these notes are attached include all normal, recurring adjustments which are necessary to fairly present the financial position, results of operations and cash flows of NHC. All significant intercompany transactions and balances have been eliminated in consolidation. The consolidated financial statements include the accounts of all entities controlled by NHC. The Company presents noncontrolling interest within the equity section of its consolidated balance sheets. The Company presents the amount of consolidated net income that is attributable to NHC and the noncontrolling interest in its consolidated statements of operations. We assume that users of these interim financial statements have read or have access to the audited December 31, 2021 may not may |
Use of Estimates, Policy [Policy Text Block] | Estimates and Assumptions The preparation of financial statements in conformity with U.S. GAAP requires us to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates and could cause our reported net income to vary significantly from period to period, 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, home health care services, and hospice 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 three March 31, 2022 2021, March 31, 2022, December 31, 2021, |
Revenue Recognition for Alternative Revenue Programs, Policy [Policy Text Block] | Other Revenues Other revenues include revenues from the provision of insurance services, management and accounting services to other long–term care providers, and rental income. Our insurance revenues consist of premiums that are generally paid in advance and then amortized into income over the policy period. We charge for management services based on a percentage of net revenues. We charge for accounting services based on a monthly fee or a fixed fee per bed of the healthcare center under contract. We record other revenues as the performance obligations are satisfied based on the terms of our contractual arrangements. 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 Assistance [Policy Text Block] | Government Grants In 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 1 one 2 7 |
Other Operating Expenses Policy [Policy Text Block] | Other Operating Expenses Other operating expenses include the costs of care and services that we provide to the residents of our facilities and the costs of maintaining our facilities. Our primary patient care costs include drugs, medical supplies, purchased professional services, food, and professional liability insurance and licensing fees. The primary facility costs include utilities and property insurance. |
Selling, General and Administrative Expenses, Policy [Policy Text Block] | General and Administrative Costs With the Company being a healthcare provider, the majority of our expenses are "cost of revenue" items. Costs that could be classified as "general and administrative" by the Company would include its corporate office costs, excluding stock-based compensation, which were $5,787,000 and $5,369,000 for the three March 31, 2022 2021, |
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 and hospice 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 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 value 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 health facility are 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 years and equipment and furniture, 3-15 years. Leasehold improvements are amortized over periods that do not Finance leases are recorded at cost. Finance leases are amortized in accordance with the provision codified within ASC 842, Leases |
Business Combinations Policy [Policy Text Block] | Business Combinations We account for acquisitions using the acquisition method of accounting in accordance with ASC 805, Business Combinations. |
Goodwill and Intangible Assets, Goodwill, Policy [Policy Text Block] | Goodwill and Other Intangible Assets Goodwill represents the excess of purchase price over the fair value of identifiable net assets acquired in business combinations. Goodwill is not first fourth not The Company’s indefinite-lived intangible assets consist of trade names and certificates of need and licenses. The Company reviews indefinite-lived intangible assets for impairment on an annual basis or more frequently if events or changes in circumstances indicate that the carrying amount of the intangible asset may not |
Liability Reserve Estimate, Policy [Policy Text Block] | Accrued Risk Reserves We are self–insured for risks related to health insurance and have wholly–owned limited purpose insurance companies that insure risks related to workers’ compensation and general and professional liability insurance claims. The accrued risk reserves include a liability for reported claims and estimates for incurred but unreported claims. Our policy is to engage an external, independent actuary to assist in estimating our exposure for claims obligations (for both asserted and unasserted claims). We reassess our accrued risk reserves on a quarterly basis. Professional liability remains an area of particular concern to us. The long-term care industry has seen an increase in personal injury/wrongful death claims based on alleged negligence by skilled nursing facilities and their employees in providing care to residents. 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. A significant increase in the number of these claims, or an increase in the amounts due as a result of these claims could have a material adverse effect on our consolidated financial position, results of operations and cash flows. It is also possible that future events could cause us to make significant adjustments or revisions to these reserve estimates and cause our reported net income to vary significantly from period to period. We are principally self-insured for incidents occurring in all centers owned or leased by us. The coverages include both primary policies and excess policies. In all years, settlements, if any, in excess of available insurance policy limits and our own reserves would be expensed by us. |
Continuing Care Contracts and Refundable Entrance Fees, Policy [Policy Text Block] | Continuing Care Contracts We have one may Non-refundable fees are included as a component of the transaction price and are amortized into revenue over the actuarily 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 March 31, 2022, December 31, 2021, We also annually estimate the present value of the cost of future services and the use of facilities to be provided to the current CCRC residents and compare that amount with the balance of non-refundable deferred revenue from entrance fees received. If the present value of the cost of future services exceeds the related anticipated revenues, a liability is recorded with a corresponding charge to income. As of March 31, 2022, December 31, 2021, |
Other Noncurrent Liabilities [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 future 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% |
Consolidation, Subsidiaries or Other Investments, Consolidated Entities, Policy [Policy Text Block] | Noncontrolling Interest The noncontrolling interest in a subsidiary is presented within total equity in the Company's interim condensed consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to NHC in its interim condensed consolidated statements of operations. The Company’s earnings per share is calculated based on net income attributable to NHC’s stockholders. The carrying amount of the noncontrolling interest is adjusted based on an allocation of the subsidiary earnings, contributions, and distributions. |
Consolidation, Variable Interest Entity, Policy [Policy Text Block] | Variable Interest Entities We have equity interests in unconsolidated limited liability companies that operate various post-acute and senior healthcare businesses. We analyze our investments in these limited liability companies to determine if the company is considered a variable interest entity (“VIE”) and would require consolidation. To the extent that we own interests in a VIE and we (i) have the power to direct the activities of the VIE and (ii) have the obligation or rights to absorb the VIE's losses or receive its benefits, then we would be determined to be the primary beneficiary and would consolidate the VIE. To the extent we own interests in a VIE, then at each reporting period, we re-assess our conclusions as to which, if any, party within the VIE is considered the primary beneficiary. The Company's maximum exposure to losses in its investments in unconsolidated VIEs cannot be quantified and may may not |
Reclassification, Comparability Adjustment [Policy Text Block] | Reclassifications Certain accounts in the prior-year financial statements have been reclassified for comparative purposes to conform to the presentation in the current-year financial statements. |
Note 4 - Net Patient Revenues (
Note 4 - Net Patient Revenues (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Notes Tables | |
Disaggregation of Revenue [Table Text Block] | Three Months Ended March 31 2022 2021 Net patient revenues: Inpatient services $ 224,842 $ 203,242 Homecare and hospice 31,495 13,613 Total net patient revenue $ 256,337 $ 216,855 Three Months Ended March 31 Source 2021 2020 Medicare 37% 35% Managed Care 10% 12% Medicaid 28% 29% Private Pay and Other 25% 24% Total 100% 100% |
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Table Text Block] | Balance at December 31, 2021 $ 15,022 Payments received - Payments recouped (10,019 ) Balance at March 31, 2022 $ 5,003 |
Note 5 - Other Revenues (Tables
Note 5 - Other Revenues (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Notes Tables | |
Schedule of Other Revenues [Table Text Block] | Three Months Ended March 31 2022 2021 Rental income $ 5,982 $ 5,647 Management and accounting services fees 4,304 4,324 Insurance services 1,247 1,264 Other 493 134 Total other revenues $ 12,026 $ 11,369 |
Note 6 - Non-operating Income (
Note 6 - Non-operating Income (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Notes Tables | |
Schedule of Other Nonoperating Income, by Component [Table Text Block] | Three Months Ended March 31 2022 2021 Equity in earnings of unconsolidated investments $ 454 $ 2,911 Dividends and net realized gains on sales of securities 1,753 1,962 Interest income 992 1,387 Total non-operating income $ 3,199 $ 6,260 |
Note 7 - Business Segments (Tab
Note 7 - Business Segments (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Notes Tables | |
Schedule of Segment Reporting Information, by Segment [Table Text Block] | Three Months Ended March 31, 2022 Inpatient Homecare and Hospice All Other Total Revenues: Net patient revenues $ 224,842 $ 31,495 $ - $ 256,337 Other revenues 114 - 11,912 12,026 Government stimulus income 10,620 - - 10,620 Net operating revenues and grant income 235,576 31,495 11,912 278,983 Costs and expenses: Salaries, wages, and benefits 142,185 19,401 9,108 170,694 Other operating 64,383 7,095 2,607 74,085 Rent 8,347 592 1,126 10,065 Depreciation and amortization 8,838 113 806 9,757 Interest 165 - - 165 Total costs and expenses 223,918 27,201 13,647 264,766 Income (loss) from operations 11,658 4,294 (1,735 ) 14,217 Non-operating income - - 3,199 3,199 Unrealized gains on marketable equity securities - - 3,126 3,126 Income before income taxes $ 11,658 $ 4,294 $ 4,590 $ 20,542 Three Months Ended March 31, 2021 Inpatient Homecare All Other Total Revenues: Net patient revenues $ 203,242 $ 13,613 $ - $ 216,855 Other revenues 98 - 11,271 11,369 Government stimulus income 22,749 - - 22,749 Net operating revenues and grant income 226,089 13,613 11,271 250,973 Costs and expenses: Salaries, wages, and benefits 131,811 9,435 7,913 149,159 Other operating 61,808 1,915 2,401 66,124 Rent 8,194 431 1,438 10,063 Depreciation and amortization 9,263 87 811 10,161 Interest 244 - - 244 Total costs and expenses 211,320 11,868 12,563 235,751 Income/(loss) from operations 14,769 1,745 (1,292 ) 15,222 Non-operating income - - 6,260 6,260 Unrealized gains on marketable equity securities - - 7,059 7,059 Income before income taxes $ 14,769 $ 1,745 $ 12,027 $ 28,541 |
Note 8 - Long-term Leases (Tabl
Note 8 - Long-term Leases (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Notes Tables | |
Lessee, Lease, Liability, Maturity [Table Text Block] | Finance Leases Operating Leases 2023 $ 5,200 $ 36,046 2024 4,767 35,489 2025 - 35,033 2026 - 34,756 2027 - 26,704 Thereafter - 4,888 Total minimum lease payments 9,967 172,916 Less: amounts representing interest (574 ) (22,725 ) Present value of future minimum lease payments 9,393 150,191 Less: current portion (4,766 ) (28,005 ) Noncurrent lease liabilities $ 4,627 $ 122,186 |
Note 9 - Earnings Per Share (Ta
Note 9 - Earnings Per Share (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Notes Tables | |
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block] | Three Months Ended March 31 2022 2021 Basic: Weighted average common shares outstanding 15,416,836 15,327,520 Net income attributable to National HealthCare Corporation $ 15,318 $ 21,267 Earnings per common share, basic $ 0.99 $ 1.39 Diluted: Weighted average common shares outstanding 15,416,836 15,327,520 Effects of dilutive instruments 47,019 62,556 Weighted average common shares outstanding 15,463,855 15,390,076 Net income attributable to National HealthCare Corporation $ 15,318 $ 21,267 Earnings per common share, diluted $ 0.99 $ 1.38 |
Note 10 - Investments in Mark_2
Note 10 - Investments in Marketable Securities (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Notes Tables | |
Marketable Securities [Table Text Block] | March 31, 2022 December 31, 2021 Amortized Cost Fair Value Amortized Cost Fair Value Investments available for sale: Marketable equity securities $ 30,176 $ 118,048 $ 30,176 $ 113,108 Corporate debt securities 17,030 16,554 19,038 18,843 Asset-backed securities 501 493 1,481 1,469 U.S. Treasury securities 14,189 13,940 15,082 14,998 Restricted investments available for sale: Marketable equity securities 25,546 25,249 25,442 26,958 Corporate debt securities 62,399 61,699 60,816 62,936 Asset-based securities 30,715 29,982 32,918 33,301 U.S. Treasury securities 37,403 35,181 33,052 32,630 State and municipal securities 4,972 4,939 7,700 7,923 $ 222,931 $ 306,085 $ 225,705 312,166 |
Schedule of Available-for-Sale Securities Reconciliation [Table Text Block] | March 31, 2022 December 31, 2021 Shares Cost Fair Value Shares Cost Fair Value NHI Common Stock 1,630,642 $ 24,734 $ 96,224 1,630,642 $ 24,734 $ 93,713 |
Investments Classified by Contractual Maturity Date [Table Text Block] | March 31, 2022 December 31, 2021 Cost Fair Value Cost Fair Value Maturities: Within 1 year $ 34,236 $ 34,159 $ 32,718 $ 32,843 1 to 5 years 89,482 87,771 95,293 96,937 6 to 10 years 43,491 40,858 41,580 41,835 Over 10 years – – 496 485 $ 167,209 $ 162,788 $ 170,087 $ 172,100 |
Note 11 - Fair Value Measurem_2
Note 11 - Fair Value Measurements (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Notes Tables | |
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis [Table Text Block] | Fair Value Measurements Using March 31, 2022 Fair Value Quoted Prices in Active For Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Cash and cash equivalents $ 56,993 $ 56,993 $ – $ – Restricted cash and cash equivalents 18,923 18,923 – – Marketable equity securities 143,297 143,297 – – Corporate debt securities 78,253 43,059 35,194 – Mortgage–backed securities 30,475 – 30,475 – U.S. Treasury securities 49,121 49,121 – – State and municipal securities 4,939 – 4,939 – Total financial assets $ 382,001 $ 311,393 $ 70,608 $ – Fair Value Measurements Using December 31, 2021 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 $ 107,607 $ 107,607 $ – $ – Restricted cash and cash equivalents 12,136 12,136 – – Marketable equity securities 140,066 140,066 – – Corporate debt securities 81,779 50,005 31,774 – Asset–backed securities 34,770 – 34,770 – U.S. Treasury securities 47,628 47,628 – – State and municipal securities 7,923 – 7,923 – Total financial assets $ 431,909 $ 357,442 $ 74,467 $ – |
Note 12 - Goodwill and Other _2
Note 12 - Goodwill and Other Intangible Assets (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Notes Tables | |
Schedule of Goodwill [Table Text Block] | Inpatient Services Homecare and Hospice All Other Total January 1, 2022 $ 3,741 $ 164,554 $ – $ 168,295 Additions – – – – March 31, 2022 $ 3,741 $ 164,554 $ – $ 168,295 |
Note 14 - Stock-based Compens_2
Note 14 - Stock-based Compensation (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Notes Tables | |
Schedule of Share-Based Payment Award, Stock Options, Valuation Assumptions [Table Text Block] | March 31, 2022 December 31, Risk–free interest rate 1.63% 0.21% Expected volatility 30.95% 34.90% Expected life, in years 2.9 2.2 Expected dividend yield 3.62% 3.00% |
Share-Based Payment Arrangement, Option, Activity [Table Text Block] | Number of Shares Weighted Average Exercise Price Aggregate Intrinsic Value Options outstanding at January 1, 2021 866,956 $ 72.11 $ – Options granted 55,706 70.80 – Options exercised (541,736 ) 71.39 – Options cancelled (6,000 ) 72.94 – Options outstanding at December 31, 2021 374,926 72.95 – Options granted 249,640 64.15 – Options cancelled (157,240 ) 76.99 – Options outstanding at March 31, 2022 467,326 66.88 $ 2,085,879 Options exercisable at March 31, 2022 172,686 69.60 $ 567,923 |
Share-Based Payment Arrangement, Option, Exercise Price Range [Table Text Block] | Options Outstanding March 31, 2022 Exercise Prices Weighted Average Exercise Price Weighted Average Remaining Contractual Life in Years 332,620 61.90 - 68.84 63.96 4.1 134,706 71.64 - 77.92 74.11 2.1 467,326 66.88 3.5 |
Note 1 - Description of Busin_2
Note 1 - Description of Business (Details Textual) | Mar. 31, 2022 |
Number of Skilled Nursing Centers | 75 |
Number of Beds | 9,456 |
Number of Assisted Living Facilities | 24 |
Number of Independent Living Facilities | 5 |
Number of Geriatric Psychiatric Hospitals | 1 |
Number of Homecare Programs | 35 |
Number of Hospice Agencies | 29 |
Number of States in which Entity Operates | 10 |
Note 2 - Summary of Significa_2
Note 2 - Summary of Significant Accounting Policies (Details Textual) | 3 Months Ended | ||
Mar. 31, 2022USD ($) | Mar. 31, 2021USD ($) | Dec. 31, 2021USD ($) | |
Accounts Receivable, Credit Loss Expense (Reversal) | $ 2,536,000 | $ 919,000 | |
Accounts Receivable, Allowance for Credit Loss, Ending Balance | $ 6,726,000 | $ 6,411,000 | |
Number of Reportable Segments | 2 | ||
General and Administrative Expense, Total | $ 5,787,000 | $ 5,369,000 | |
Contract with Customer, Refund Liability, Total | 6,097,000 | 7,011,000 | |
Continuing Care Retirement Communities, Refund Obligation | $ 2,338,000 | $ 2,338,000 | |
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 | ||
Minimum [Member] | Building and Building Improvements [Member] | |||
Property, Plant and Equipment, Useful Life (Year) | 20 years | ||
Minimum [Member] | Equipment and Furniture [Member] | |||
Property, Plant and Equipment, Useful Life (Year) | 3 years | ||
Maximum [Member] | |||
Lessee, Operating Lease, Term of Contract (Year) | 15 years | ||
Maximum [Member] | Building and Building Improvements [Member] | |||
Property, Plant and Equipment, Useful Life (Year) | 40 years | ||
Maximum [Member] | Equipment and Furniture [Member] | |||
Property, Plant and Equipment, Useful Life (Year) | 15 years |
Note 3 - Coronavirus Pandemic (
Note 3 - Coronavirus Pandemic (Details Textual) - USD ($) | 3 Months Ended | |||
Mar. 31, 2022 | Mar. 31, 2021 | Jun. 30, 2020 | Dec. 31, 2021 | |
Proceeds from Medicare Accelerated and Advance Payment Program | $ 51,253,000 | |||
Contract with Customer, Liability, Current | $ 5,003,000 | $ 15,022,000 | ||
Revenue from Contract with Customer, Including Assessed Tax | 256,337,000 | $ 216,855,000 | ||
Supplemental Medicaid Payments [Member] | ||||
Revenue from Contract with Customer, Including Assessed Tax | 5,538,000 | 3,955,000 | ||
Other Noncurrent Liabilities [Member] | ||||
Accrued Payroll Taxes | 10,545,000 | |||
Provider Relief Fund Under CARES Act [Member] | ||||
Government Assistance, Amount | $ 10,620,000 | $ 22,749,000 |
Note 4 - Net Patient Revenues_2
Note 4 - Net Patient Revenues (Details Textual) - USD ($) | Mar. 31, 2022 | Dec. 31, 2021 |
Contract with Customer, Liability, Current | $ 5,003,000 | $ 15,022,000 |
Accounts Receivable, Allowance for Credit Loss, Ending Balance | 6,726,000 | 6,411,000 |
Medicare and Medicaid [Member] | ||
Accounts Receivable, Allowance for Credit Loss, Ending Balance | $ 17,319,000 | $ 17,595,000 |
Note 4 - Net Patient Revenues -
Note 4 - Net Patient Revenues - Revenue Disaggregation (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Net patient revenues | $ 256,337 | $ 216,855 |
Revenue, concentration percentage | 100.00% | 100.00% |
Medicare [Member] | ||
Revenue, concentration percentage | 37.00% | 35.00% |
Inpatient Services [Member] | ||
Net patient revenues | $ 224,842 | $ 203,242 |
Managed Care [Member] | ||
Revenue, concentration percentage | 10.00% | 12.00% |
Homecare and Hospice Services [Member] | ||
Net patient revenues | $ 31,495 | $ 13,613 |
Medicaid [Member] | ||
Revenue, concentration percentage | 28.00% | 29.00% |
Private Pay and Other [Member] | ||
Revenue, concentration percentage | 25.00% | 24.00% |
Note 4 - Net Patient Revenues_3
Note 4 - Net Patient Revenues - Contract Liabilities (Details) | 3 Months Ended |
Mar. 31, 2022USD ($) | |
Balance | $ 15,022,000 |
Payments received | 0 |
Payments recouped | (10,019,000) |
Balance | $ 5,003,000 |
Note 5 - Other Revenues (Detail
Note 5 - Other Revenues (Details Textual) | 3 Months Ended | |
Mar. 31, 2022USD ($) | Mar. 31, 2021USD ($) | |
Number of Skilled Nursing Centers | 75 | |
Insurance Services Revenue, Total | $ 1,247,000 | $ 1,264,000 |
Workers Compensation Revenue [Member] | ||
Insurance Services Revenue, Total | 728,000 | 753,000 |
Professional Liability Insurance [Member] | ||
Insurance Services Revenue, Total | $ 519,000 | 511,000 |
National [Member] | ||
Number of Skilled Nursing Centers | 5 | |
Property Management Fee Revenue | $ 981,000 | $ 896,000 |
FLORIDA | ||
Number of Skilled Nursing Centers | 4 |
Note 5 - Other Revenues - Summa
Note 5 - Other Revenues - Summary of Other Revenues (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Rental income | $ 5,982 | $ 5,647 |
Management and accounting services fees | 4,304 | 4,324 |
Insurance services | 1,247 | 1,264 |
Other | 493 | 134 |
Total other revenues | $ 12,026 | $ 11,369 |
Note 6 - Non-operating Income_2
Note 6 - Non-operating Income (Details Textual) - Acquisition of Caris [Member] | Jun. 11, 2021 | Dec. 31, 2020 |
Business Acquisition, Percentage of Voting Interests Acquired | 24.90% | |
Business Combination, Step Acquisition, Equity Interest in Acquiree, Percentage | 75.10% |
Note 6 - Non-operating Income -
Note 6 - Non-operating Income - Summary of Non-operating Income (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Equity in earnings of unconsolidated investments | $ 454 | $ 2,911 |
Dividends and net realized gains on sales of securities | 1,753 | 1,962 |
Interest income | 992 | 1,387 |
Total non-operating income | $ 3,199 | $ 6,260 |
Note 7 - Business Segments (Det
Note 7 - Business Segments (Details Textual) | 3 Months Ended |
Mar. 31, 2022 | |
Number of Operating Segments | 2 |
Note 7 - Business Segments - Su
Note 7 - Business Segments - Summary of Financial Information by Reporting Segment (Details) - USD ($) | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Revenues: | ||
Net patient revenues | $ 256,337,000 | $ 216,855,000 |
Other revenues | 12,026,000 | 11,369,000 |
Government stimulus income | 10,620,000 | 22,749,000 |
Net operating revenues and grant income | 278,983,000 | 250,973,000 |
Costs and expenses: | ||
Salaries, wages, and benefits | 170,694,000 | 149,159,000 |
Other operating | 74,085,000 | 66,124,000 |
Rent | 10,065,000 | 10,063,000 |
Depreciation and amortization | 9,757,000 | 10,161,000 |
Interest | 165,000 | 244,000 |
Total costs and expenses | 264,766,000 | 235,751,000 |
Income (loss) from operations | 14,217,000 | 15,222,000 |
Non-operating income (loss) | 3,199,000 | 6,260,000 |
Unrealized gains on marketable equity securities | 3,126,000 | 7,059,000 |
Income before income taxes | 20,542,000 | 28,541,000 |
Inpatient Services Segment [Member] | ||
Revenues: | ||
Net patient revenues | 224,842,000 | 203,242,000 |
Other revenues | 114,000 | 98,000 |
Government stimulus income | 10,620,000 | 22,749,000 |
Net operating revenues and grant income | 235,576,000 | 226,089,000 |
Costs and expenses: | ||
Salaries, wages, and benefits | 142,185,000 | 131,811,000 |
Other operating | 64,383,000 | 61,808,000 |
Rent | 8,347,000 | 8,194,000 |
Depreciation and amortization | 8,838,000 | 9,263,000 |
Interest | 165,000 | 244,000 |
Total costs and expenses | 223,918,000 | 211,320,000 |
Income (loss) from operations | 11,658,000 | 14,769,000 |
Non-operating income (loss) | 0 | 0 |
Unrealized gains on marketable equity securities | 0 | 0 |
Income before income taxes | 11,658,000 | 14,769,000 |
Homecare Services Segment [Member] | ||
Revenues: | ||
Net patient revenues | 31,495,000 | 13,613,000 |
Other revenues | 0 | 0 |
Government stimulus income | 0 | 0 |
Net operating revenues and grant income | 31,495,000 | 13,613,000 |
Costs and expenses: | ||
Salaries, wages, and benefits | 19,401,000 | 9,435,000 |
Other operating | 7,095,000 | 1,915,000 |
Rent | 592,000 | 431,000 |
Depreciation and amortization | 113,000 | 87,000 |
Interest | 0 | 0 |
Total costs and expenses | 27,201,000 | 11,868,000 |
Income (loss) from operations | 4,294,000 | 1,745,000 |
Non-operating income (loss) | 0 | 0 |
Unrealized gains on marketable equity securities | 0 | 0 |
Income before income taxes | 4,294,000 | 1,745,000 |
Other Segments [Member] | ||
Revenues: | ||
Net patient revenues | 0 | 0 |
Other revenues | 11,912,000 | 11,271,000 |
Government stimulus income | 0 | 0 |
Net operating revenues and grant income | 11,912,000 | 11,271,000 |
Costs and expenses: | ||
Salaries, wages, and benefits | 9,108,000 | 7,913,000 |
Other operating | 2,607,000 | 2,401,000 |
Rent | 1,126,000 | 1,438,000 |
Depreciation and amortization | 806,000 | 811,000 |
Interest | 0 | 0 |
Total costs and expenses | 13,647,000 | 12,563,000 |
Income (loss) from operations | (1,735,000) | (1,292,000) |
Non-operating income (loss) | 3,199,000 | 6,260,000 |
Unrealized gains on marketable equity securities | 3,126,000 | 7,059,000 |
Income before income taxes | $ 4,590,000 | $ 12,027,000 |
Note 8 - Long-term Leases (Deta
Note 8 - Long-term Leases (Details Textual) | 3 Months Ended | |
Mar. 31, 2022USD ($) | Mar. 31, 2021USD ($) | |
Operating Lease, Expense | $ 10,065,000 | $ 10,063,000 |
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 | |
Both NHI Lease Agreements [Member] | ||
Lessee, Lease, Annual Base Rent | $ 34,200,000 | |
Lessee, Operating Lease Additional Percentage Rent Percentage | 4.00% | |
Operating Lease, Expense | $ 9,252,000 | $ 9,411,000 |
Senior Healthcare Facilities [Member] | ||
Number of Facilities under Finance Leases | 3 | |
Number of Finance Lease Agreements | 3 | |
Lessee, Finance Lease, Term of Contract (Year) | 10 years | |
Number of Additional Lease Options | 2 | |
Lessee, Finance Lease, Annual Base Rent Expense | $ 5,200,000 | |
Lessee, Finance Lease Additional Percentage Rent Percentage | 4.00% |
Note 8 - Long-term Leases - Mat
Note 8 - Long-term Leases - Maturity of Lease Liabilities (Details) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
2023, finance leases | $ 5,200 | |
2023, operating leases | 36,046 | |
2024, finance leases | 4,767 | |
2024, operating leases | 35,489 | |
2025, finance leases | 0 | |
2025, operating leases | 35,033 | |
2026, finance leases | 0 | |
2026, operating leases | 34,756 | |
2027, finance leases | 0 | |
2027, operating leases | 26,704 | |
Thereafter, finance leases | 0 | |
Thereafter, operating leases | 4,888 | |
Total minimum lease payments, finance leases | 9,967 | |
Total minimum lease payments, operating leases | 172,916 | |
Less: amounts representing interest, finance leases | (574) | |
Less: amounts representing interest, operating leases | (22,725) | |
Present value of future minimum lease payments, finance leases | 9,393 | |
Present value of future minimum lease payments, operating leases | 150,191 | |
Less: current portion, finance leases | (4,766) | $ (4,695) |
Less: current portion, operating leases | (28,005) | (27,574) |
Noncurrent lease liabilities, finance leases | 4,627 | 5,845 |
Noncurrent lease liabilities, operating leases | $ 122,186 | $ 128,542 |
Note 9 - Earnings Per Share - S
Note 9 - Earnings Per Share - Summary of Earnings and Weighted Average Number of Common Shares Used in Calculation of Basic and Diluted Earnings Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Basic: | ||
Weighted average common shares outstanding (in shares) | 15,416,836 | 15,327,520 |
Net income attributable to National HealthCare Corporation | $ 15,318 | $ 21,267 |
Earnings per common share, basic (in dollars per share) | $ 0.99 | $ 1.39 |
Diluted: | ||
Weighted average common shares outstanding (in shares) | 15,416,836 | 15,327,520 |
Effects of dilutive instruments (in shares) | 47,019 | 62,556 |
Weighted average common shares outstanding (in shares) | 15,463,855 | 15,390,076 |
Net income attributable to National HealthCare Corporation | $ 15,318 | $ 21,267 |
Earnings per common share, diluted (in dollars per share) | $ 0.99 | $ 1.38 |
Note 10 - Investments in Mark_3
Note 10 - Investments in Marketable Securities (Details Textual) - USD ($) | 3 Months Ended | ||
Mar. 31, 2022 | Mar. 31, 2021 | Dec. 31, 2021 | |
Equity Securities Fv Ni Gross Unrealized Gain | $ 88,514,000 | $ 85,394,000 | |
Equity Securities Fv Ni Gross Unrealized Loss | 939,000 | 946,000 | |
Equity Securities, FV-NI, Unrealized Gain (Loss), Total | 3,126,000 | $ 7,059,000 | |
Debt Securities, Available-for-Sale, Accumulated Gross Unrealized Gain, before Tax | 484,000 | 3,189,000 | |
Debt Securities, Available-for-Sale, Accumulated Gross Unrealized Loss, before Tax | 4,905,000 | $ 1,176,000 | |
Other-than-temporary Impairment Loss, Debt Securities, Available-for-sale, Total | 0 | 0 | |
Proceeds from Sale and Maturity of Marketable Securities | 16,946,000 | 6,086,000 | |
Debt Securities, Realized Gain (Loss), Total | $ 45,000 | $ 0 |
Note 10 - Investments in Mark_4
Note 10 - Investments in Marketable Securities - Marketable Securities and Restricted Marketable Securities (Details) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Marketable equity securities | $ 118,048 | $ 113,108 |
Unrestricted investments available for sale, debt, amortized cost | 167,209 | 170,087 |
Unrestricted investments available for sale, debt, fair value | 162,788 | 172,100 |
Restricted marketable equity securities | 25,249 | 26,958 |
Investments available for sale, amortized cost | 222,931 | 225,705 |
Marketable Securities, Total | 306,085 | 312,166 |
Equity Securities [Member] | ||
Unrestricted investments available for sale, equity, amortized cost | 30,176 | 30,176 |
Marketable equity securities | 118,048 | 113,108 |
Restricted investments available for sale, equity, amortized cost | 25,546 | 25,442 |
Restricted marketable equity securities | 25,249 | 26,958 |
Corporate Debt Securities [Member] | ||
Unrestricted investments available for sale, debt, amortized cost | 17,030 | 19,038 |
Unrestricted investments available for sale, debt, fair value | 16,554 | 18,843 |
Restricted investments available for sale, debt, amortized cost | 62,399 | 60,816 |
Restricted investments available for sale, debt, fair value | 61,699 | 62,936 |
Asset-Backed Securities [Member] | ||
Unrestricted investments available for sale, debt, amortized cost | 501 | 1,481 |
Unrestricted investments available for sale, debt, fair value | 493 | 1,469 |
Restricted investments available for sale, debt, amortized cost | 30,715 | 32,918 |
Restricted investments available for sale, debt, fair value | 29,982 | 33,301 |
US Government Corporations and Agencies Securities [Member] | ||
Unrestricted investments available for sale, debt, amortized cost | 14,189 | 15,082 |
Unrestricted investments available for sale, debt, fair value | 13,940 | 14,998 |
Restricted investments available for sale, debt, amortized cost | 37,403 | 33,052 |
Restricted investments available for sale, debt, fair value | 35,181 | 32,630 |
US States and Political Subdivisions Debt Securities [Member] | ||
Restricted investments available for sale, debt, amortized cost | 4,972 | 7,700 |
Restricted investments available for sale, debt, fair value | $ 4,939 | $ 7,923 |
Note 10 - Investments in Mark_5
Note 10 - Investments in Marketable Securities - Available for Sale Marketable Equity Securities (Details) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
NHI Common Stock, fair value | $ 118,048 | $ 113,108 |
NHI Common Stock [Member] | ||
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 | $ 96,224 | $ 93,713 |
Note 10 - Investments in Mark_6
Note 10 - Investments in Marketable Securities - Amortized Cost and Estimated Fair Value of Debt Securities as Available for Sale (Details) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Within 1 year, cost | $ 34,236 | $ 32,718 |
Within 1 year, fair value | 34,159 | 32,843 |
1 to 5 years, cost | 89,482 | 95,293 |
1 to 5 years, fair value | 87,771 | 96,937 |
6 to 10 years, cost | 43,491 | 41,580 |
6 to 10 years, fair value | 40,858 | 41,835 |
Over 10 years, cost | 0 | 496 |
Over 10 years, fair value | 0 | 485 |
Cost | 167,209 | 170,087 |
Fair Value | $ 162,788 | $ 172,100 |
Note 11 - Fair Value Measurem_3
Note 11 - Fair Value Measurements - Summary of Fair Value Measurements by Level (Details) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 | Mar. 31, 2021 |
Restricted cash and cash equivalents | $ 18,923 | $ 21,984 | |
Available-for-sale securities (USD) | 162,788 | $ 172,100 | |
Corporate Debt Securities [Member] | |||
Available-for-sale securities (USD) | 16,554 | 18,843 | |
Asset-Backed Securities [Member] | |||
Available-for-sale securities (USD) | 493 | 1,469 | |
Fair Value, Recurring [Member] | |||
Cash and cash equivalents | 56,993 | 107,607 | |
Restricted cash and cash equivalents | 18,923 | 12,136 | |
Total financial assets | 382,001 | 431,909 | |
Fair Value, Recurring [Member] | Equity Securities [Member] | |||
Marketable equity securities | 143,297 | 140,066 | |
Fair Value, Recurring [Member] | Corporate Debt Securities [Member] | |||
Available-for-sale securities (USD) | 78,253 | 81,779 | |
Fair Value, Recurring [Member] | Collateralized Mortgage-Backed Securities [Member] | |||
Available-for-sale securities (USD) | 30,475 | ||
Fair Value, Recurring [Member] | Asset-Backed Securities [Member] | |||
Available-for-sale securities (USD) | 34,770 | ||
Fair Value, Recurring [Member] | US Treasury Securities [Member] | |||
Available-for-sale securities (USD) | 49,121 | 47,628 | |
Fair Value, Recurring [Member] | US States and Political Subdivisions Debt Securities [Member] | |||
Available-for-sale securities (USD) | 4,939 | 7,923 | |
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | |||
Cash and cash equivalents | 56,993 | 107,607 | |
Restricted cash and cash equivalents | 18,923 | 12,136 | |
Total financial assets | 311,393 | 357,442 | |
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Equity Securities [Member] | |||
Marketable equity securities | 143,297 | 140,066 | |
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Corporate Debt Securities [Member] | |||
Available-for-sale securities (USD) | 43,059 | 50,005 | |
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Collateralized Mortgage-Backed Securities [Member] | |||
Available-for-sale securities (USD) | 0 | ||
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Asset-Backed Securities [Member] | |||
Available-for-sale securities (USD) | 0 | ||
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | US Treasury Securities [Member] | |||
Available-for-sale securities (USD) | 49,121 | 47,628 | |
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | US States and Political Subdivisions Debt Securities [Member] | |||
Available-for-sale securities (USD) | 0 | 0 | |
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 | 70,608 | 74,467 | |
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Equity Securities [Member] | |||
Marketable equity securities | 0 | 0 | |
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Corporate Debt Securities [Member] | |||
Available-for-sale securities (USD) | 35,194 | 31,774 | |
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Collateralized Mortgage-Backed Securities [Member] | |||
Available-for-sale securities (USD) | 30,475 | ||
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Asset-Backed Securities [Member] | |||
Available-for-sale securities (USD) | 34,770 | ||
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | US Treasury Securities [Member] | |||
Available-for-sale securities (USD) | 0 | 0 | |
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | US States and Political Subdivisions Debt Securities [Member] | |||
Available-for-sale securities (USD) | $ 4,939 | $ 7,923 |
Note 12 - Goodwill and Other _3
Note 12 - Goodwill and Other Intangible Assets (Details Textual) | 3 Months Ended |
Mar. 31, 2022USD ($) | |
Goodwill and Intangible Asset Impairment, Total | $ 0 |
Acquisition of Caris [Member] | Trade Names [Member] | |
Indefinite-lived Intangible Assets Acquired | 4,340,000 |
Acquisition of Caris [Member] | Certificates of Need and Licenses [Member] | |
Indefinite-lived Intangible Assets Acquired | $ 2,698,000 |
Note 12 - Goodwill and Other _4
Note 12 - Goodwill and Other Intangible Assets - Activity Related to Goodwill By Segment (Details) $ in Thousands | 3 Months Ended |
Mar. 31, 2021USD ($) | |
Goodwill, balance | $ 168,295 |
Goodwill, additions | 0 |
Goodwill, balance | 168,295 |
Inpatient Services Segment [Member] | |
Goodwill, balance | 3,741 |
Goodwill, additions | 0 |
Goodwill, balance | 3,741 |
Homecare and Hospice Segment [Member] | |
Goodwill, balance | 164,554 |
Goodwill, additions | 0 |
Goodwill, balance | $ 164,554 |
Note 13 - Stock Repurchase Pr_2
Note 13 - Stock Repurchase Program (Details Textual) - Common Stock [Member] - USD ($) | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Stock Repurchased and Retired During Period, Shares (in shares) | 2,165 | 3,936 |
Stock Repurchased and Retired During Period, Value | $ 146,000 | $ 278,000 |
Note 14 - Stock-based Compens_3
Note 14 - Stock-based Compensation (Details Textual) - USD ($) | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount, Total | $ 4,432,000 | |
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year) | 3 years | |
Salaries, Wages, and Benefits [Member] | ||
Share-Based Payment Arrangement, Expense | $ 712,000 | $ 496,000 |
Note 14 - Stock-based Compens_4
Note 14 - Stock-based Compensation - Summary of Assumptions Used to Value Options Granted (Details) | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Risk–free interest rate | 1.63% | 0.21% |
Expected volatility | 30.95% | 34.90% |
Expected life (Year) | 2 years 10 months 24 days | 2 years 2 months 12 days |
Expected dividend yield | 3.62% | 3.00% |
Note 14 - Stock-based Compens_5
Note 14 - Stock-based Compensation - Summary of Options Outstanding (Details) - USD ($) | 3 Months Ended | 12 Months Ended |
Mar. 31, 2022 | Dec. 31, 2021 | |
Options outstanding, shares (in shares) | 374,926 | 866,956 |
Options outstanding, weighted average exercise price (in dollars per share) | $ 72.95 | $ 72.11 |
Options granted, shares (in shares) | 249,640 | 55,706 |
Options granted, weighted average exercise price (in dollars per share) | $ 64.15 | $ 70.80 |
Options exercised, shares (in shares) | (541,736) | |
Options exercised, weighted average exercise price (in dollars per share) | $ 71.39 | |
Options cancelled, shares (in shares) | (157,240) | (6,000) |
Options cancelled, weighted average exercise price (in dollars per share) | $ 76.99 | $ 72.94 |
Options outstanding, shares (in shares) | 467,326 | 374,926 |
Options outstanding, weighted average exercise price (in dollars per share) | $ 66.88 | $ 72.95 |
Options outstanding, aggregate intrinsic value | $ 2,085,879 | |
Options exercisable, shares (in shares) | 172,686 | |
Options exercisable, weighted average exercise price (in dollars per share) | $ 69.60 | |
Options exercisable, aggregate intrinsic value | $ 567,923 |
Note 14 - Stock-based Compens_6
Note 14 - Stock-based Compensation - Options Outstanding by Exercise Price Range (Details) | 3 Months Ended |
Mar. 31, 2022$ / sharesshares | |
Options outstanding (in shares) | shares | 467,326 |
Exercise price, upper range (in dollars per share) | |
Weighted average exercise price (in dollars per share) | $ 66.88 |
Weighted average remaining contractual life (Year) | 3 years 6 months |
Exercise Price Range 1 [Member] | |
Exercise price, lower range (in dollars per share) | $ 61.90 |
Options outstanding (in shares) | shares | 332,620 |
Exercise price, upper range (in dollars per share) | $ 68.84 |
Weighted average exercise price (in dollars per share) | $ 63.96 |
Weighted average remaining contractual life (Year) | 4 years 1 month 6 days |
Exercise Price Range 2 [Member] | |
Exercise price, lower range (in dollars per share) | $ 71.64 |
Options outstanding (in shares) | shares | 134,706 |
Exercise price, upper range (in dollars per share) | $ 77.92 |
Weighted average exercise price (in dollars per share) | $ 74.11 |
Weighted average remaining contractual life (Year) | 2 years 1 month 6 days |
Note 15 - Income Taxes (Details
Note 15 - Income Taxes (Details Textual) | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Effective Income Tax Rate Reconciliation, Percent, Total | 25.30% | 25.30% |
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent | 21.00% | 21.00% |
Open Tax Year | 2018 2019 2020 2021 |
Note 16 - Contingencies and C_2
Note 16 - Contingencies and Commitments (Details Textual) - USD ($) | Mar. 31, 2022 | Dec. 31, 2021 |
Self Insurance Reserve | $ 101,413,000 | $ 98,048,000 |
Note 17 - Subsequent Event (Det
Note 17 - Subsequent Event (Details Textual) | May 03, 2022 | Mar. 31, 2022USD ($) | Mar. 31, 2021USD ($) | Dec. 31, 2021USD ($) |
Revenue from Contract with Customer, Including Assessed Tax | $ 256,337,000 | $ 216,855,000 | ||
Income (Loss) from Continuing Operations before Income Taxes, Domestic | 20,542,000 | 28,541,000 | ||
Operations Transfer Agreements for Transfer of Skilled Nursing Facilities [Member] | Seven Skilled Nursing Facilities [Member] | ||||
Revenue from Contract with Customer, Including Assessed Tax | 17,801,000 | 15,377,000 | $ 67,161,000 | |
Income (Loss) from Continuing Operations before Income Taxes, Domestic | $ 635,000 | $ 2,769,000 | $ 3,741,000 | |
Operations Transfer Agreements for Transfer of Skilled Nursing Facilities [Member] | Subsequent Event [Member] | ||||
Operations Agreement, Skilled Nursing Facilities Transferred | 7 |