National HealthCare (NHC) 10-K 17 Feb 23 2022 FY Annual report Financial data

Document And Entity Information

Document And Entity Information - USD ($)	12 Months Ended
	Dec. 31, 2022	Feb. 06, 2023	Jun. 30, 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	FY
Document Fiscal Year Focus	2022
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 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	Shares of Common Stock
Trading Symbol	NHC
Security Exchange Name	NYSE
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	true
Entity Shell Company	false
Entity Public Float			$ 719,700,000
Entity Common Stock, Shares Outstanding		15,355,389
Auditor Name	Ernst & Young LLP
Auditor Location	Nashville, Tennessee
Auditor Firm ID	42

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Revenues:
Net patient revenues	$ 1,029,085,000	$ 965,542,000	$ 931,795,000
Other revenues	45,196,000	45,400,000	48,917,000
Government stimulus income	11,457,000	63,360,000	47,505,000
Net operating revenues and grant income	1,085,738,000	1,074,302,000	1,028,217,000
Costs and Expenses:
Salaries, wages and benefits	686,169,000	666,063,000	620,992,000
Other operating	289,372,000	266,754,000	275,159,000
Facility rent	40,977,000	40,818,000	40,494,000
Depreciation and amortization	40,489,000	40,672,000	42,018,000
Interest	563,000	845,000	1,399,000
Impairment (recovery) of assets	(3,728,000)	8,225,000	0
Total costs and expenses	1,053,842,000	1,023,377,000	980,062,000
Income from operations	31,896,000	50,925,000	48,155,000
Other income:
Non-operating income	11,141,000	17,774,000	26,527,000
Gain on acquisitions of equity method investments	0	95,202,000	1,707,000
Unrealized losses on marketable equity securities	(15,806,000)	(13,863,000)	(23,966,000)
Income before income taxes	27,231,000	150,038,000	52,423,000
Income tax provision	(7,254,000)	(10,951,000)	(10,433,000)
Net income	19,977,000	139,087,000	41,990,000
Net (income) loss attributable to noncontrolling interest	2,468,000	(497,000)	(119,000)
Net income attributable to National HealthCare Corporation	$ 22,445,000	$ 138,590,000	$ 41,871,000
Earnings per share attributable to National HealthCare Corporation stockholders:
Basic (in dollars per share)	$ 1.46	$ 9.03	$ 2.74
Diluted (in dollars per share)	$ 1.45	$ 8.99	$ 2.72
Basic (in shares)	15,410,222	15,347,129	15,306,174
Diluted (in shares)	15,447,211	15,416,716	15,369,523
Dividends declared to common stockholders, per share (in dollars per share)	$ 2.26	$ 2.11	$ 2.08

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Net income/(loss)	$ 19,977	$ 139,087	$ 41,990
Other comprehensive income (loss):
Unrealized gains (losses) on investments in marketable debt securities	(12,946)	(4,171)	3,352
Reclassification adjustment for realized gains on sale of marketable debt securities	(129)	(214)	(195)
Income tax (expense) benefit related to items of other comprehensive income (loss)	1,938	933	(660)
Other comprehensive income (loss), net of tax	(11,137)	(3,452)	2,497
Net (income) loss attributable to noncontrolling interest	2,468	(497)	(119)
Comprehensive income attributable to National HealthCare Corporation	$ 11,308	$ 135,138	$ 44,368

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($)	Dec. 31, 2022	Dec. 31, 2021
Current Assets:
Cash and cash equivalents	$ 58,667,000	$ 107,607,000
Restricted cash and cash equivalents, current portion	15,121,000	10,407,000
Marketable equity securities	100,786,000	113,108,000
Marketable debt securities	23,136,000	35,310,000
Restricted marketable equity securities	22,358,000	26,958,000
Restricted marketable debt securities, current portion	16,244,000	20,727,000
Accounts receivable	99,986,000	96,124,000
Inventories	7,088,000	8,582,000
Prepaid expenses and other assets	10,244,000	7,362,000
Notes receivable	302,000	453,000
Total current assets	353,932,000	426,638,000
Property and Equipment:
Property and equipment, at cost	1,081,219,000	1,064,337,000
Accumulated depreciation and amortization	(574,687,000)	(543,341,000)
Net property and equipment	506,532,000	520,996,000
Other Assets:
Restricted cash and cash equivalents, less current portion	1,077,000	1,729,000
Restricted marketable debt securities, less current portion	103,267,000	116,063,000
Deposits and other assets	12,728,000	4,499,000
Operating lease – right-of-use assets	120,521,000	156,116,000
Goodwill	168,295,000	168,295,000
Intangible assets	7,038,000	7,038,000
Investments in unconsolidated companies	2,060,000	2,022,000
Total other assets	414,986,000	455,762,000
Total assets	1,275,450,000	1,403,396,000
Current Liabilities:
Trade accounts payable	16,958,000	22,488,000
Finance lease obligations, current portion	4,985,000	4,695,000
Operating lease liabilities, current portion	29,075,000	27,574,000
Accrued payroll	72,510,000	106,698,000
Amounts due to third party payors	16,631,000	17,595,000
Accrued risk reserves, current portion	31,365,000	31,134,000
Other current liabilities	17,615,000	20,059,000
Provider relief funds	0	9,443,000
Contract liabilities	0	15,022,000
Dividends payable	8,748,000	8,493,000
Total current liabilities	197,887,000	263,201,000
Finance lease obligations, less current portion	860,000	5,845,000
Operating lease liabilities, less current portion	91,016,000	128,542,000
Accrued risk reserves, less current portion	71,104,000	66,914,000
Refundable entrance fees	6,207,000	7,011,000
Deferred income taxes	10,909,000	6,852,000
Other noncurrent liabilities	19,953,000	16,571,000
Total liabilities	397,936,000	494,936,000
Equity:
Common stock, $.01 par value; 45,000,000 shares authorized; 15,357,746 and 15,452,033 shares, respectively, issued and outstanding	153,000	154,000
Capital in excess of par value	226,991,000	232,167,000
Retained earnings	656,664,000	669,078,000
Accumulated other comprehensive income (loss)	(9,532,000)	1,605,000
Total National HealthCare Corporation stockholders’ equity	874,276,000	903,004,000
Noncontrolling interest	3,238,000	5,456,000
Total equity	877,514,000	908,460,000
Total liabilities and equity	$ 1,275,450,000	$ 1,403,396,000

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parentheticals) - $ / shares	Dec. 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)	15,357,746	15,452,033
Common stock, shares outstanding (in shares)	15,357,746	15,452,033

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Cash Flows From Operating Activities:
Net income/(loss)	$ 19,977,000	$ 139,087,000	$ 41,990,000
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	40,489,000	40,672,000	42,018,000
Equity in earnings of unconsolidated investments	(477,000)	(5,111,000)	(12,342,000)
Distributions from unconsolidated investments	439,000	6,314,000	10,050,000
Unrealized losses on marketable equity securities	15,806,000	13,863,000	23,966,000
(Gains) losses on sale of marketable securities	1,326,000	(1,042,000)	(195,000)
Gains on acquisition of equity method investments	0	(95,202,000)	(1,707,000)
Gain on sale of property and equipment	0	0	(2,784,000)
Recovery of assets	(3,728,000)	8,225,000	0
Deferred income taxes	(5,995,000)	6,294,000	10,593,000
Stock–based compensation	2,612,000	2,620,000	2,453,000
Changes in operating assets and liabilities:
Accounts receivable	(3,862,000)	4,090,000	4,529,000
Inventories	1,494,000	199,000	(1,249,000)
Prepaid expenses and other assets	(11,111,000)	(3,298,000)	4,727,000
Operating lease obligations	(430,000)	0	0
Trade accounts payable	(5,530,000)	(2,083,000)	1,429,000
Accrued payroll	(34,188,000)	17,292,000	15,948,000
Amounts due to third party payors	(964,000)	649,000	1,200,000
Accrued risk reserves	4,421,000	(1,489,000)	3,454,000
Provider relief funds	(9,443,000)	(6,625,000)	16,068,000
Contract liabilities	(15,022,000)	(36,231,000)	51,253,000
Other current liabilities	(2,444,000)	(1,380,000)	5,898,000
Other noncurrent liabilities	3,382,000	(11,862,000)	7,146,000
Net cash provided by operating activities	8,742,000	62,394,000	203,259,000
Cash Flows From Investing Activities:
Purchases of property and equipment	(30,200,000)	(39,399,000)	(21,873,000)
Proceeds from the sale of property and equipment	4,175,000	0	6,750,000
Investments in unconsolidated companies	0	(350,000)	(305,000)
Acquisition of equity method investments	0	(28,713,000)	(6,648,000)
Investments in notes receivable	0	0	(425,000)
Collections of notes receivable	3,879,000	8,840,000	2,483,000
Purchases of marketable securities	(33,793,000)	(108,187,000)	(84,854,000)
Sale of marketable securities	49,961,000	101,920,000	40,994,000
Net cash used in investing activities	(5,978,000)	(65,889,000)	(63,878,000)
Cash Flows From Financing Activities:
Borrowings under credit facility	0	0	40,000,000
Principal payments under credit facility	0	0	(50,000,000)
Principal payments under finance lease obligations	(4,695,000)	(4,423,000)	(4,166,000)
Dividends paid to common stockholders	(34,604,000)	(32,030,000)	(31,921,000)
Issuance of common shares	2,114,000	3,441,000	1,756,000
Repurchase of common shares	(9,903,000)	(836,000)	(53,000)
Noncontrolling interest contributions (distributions)	250,000	(964,000)	2,488,000
Entrance fee deposits (refunds)	(804,000)	(452,000)	7,000
Net cash used in financing activities	(47,642,000)	(35,264,000)	(41,889,000)
Net Increase (Decrease) in Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents	(44,878,000)	(38,759,000)	97,492,000
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, Beginning of Period	119,743,000	158,502,000	61,010,000
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, End of Period	74,865,000	119,743,000	158,502,000
Balance Sheet Classifications:
Cash and cash equivalents	58,667,000	107,607,000	147,093,000
Restricted Cash and Cash Equivalents	16,198,000	12,136,000	11,409,000
Total Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents	74,865,000	119,743,000	158,502,000
Supplemental Information:
Cash payments for interest	493,000	845,000	1,425,000
Cash payments for income taxes	8,765,000	22,881,000	16,524,000
Non-cash activities include:
Noncontrolling interest contribution of land	$ 0	$ 2,840,000	$ 0

Consolidated Statements of Equi

Consolidated Statements of Equity - USD ($) $ in Thousands	Common Stock [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	AOCI Attributable to Parent [Member]	Noncontrolling Interest [Member]	Total
Balance (in shares) at Dec. 31, 2019	15,332,206
Balance at Dec. 31, 2019	$ 153	$ 222,787	$ 553,093	$ 2,560	$ 476	$ 779,069
Net income/(loss)	0	0	41,871	0	119	41,990
Contributions attributable to noncontrolling interest	0	0	0	0	2,488	2,488
Other comprehensive income	0	0	0	2,497	0	2,497
Stock–based compensation	$ 0	2,453	0	0	0	$ 2,453
Shares sold – options exercised (in shares)	38,336					43,630
Shares sold – options exercised	$ 0	1,756	0	0	0	$ 1,756
Repurchase of common shares (in shares)	(797)
Repurchase of common shares	$ 0	(53)	0	0	0	(53)
Dividends declared to common stockholders	$ 0	0	(31,940)	0	0	(31,940)
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/(loss)	0	0	138,590	0	497	139,087
Contributions attributable to noncontrolling interest	0	0	0	0	1,876	1,876
Other comprehensive income	0		0	(3,452)	0	(3,452)
Stock–based compensation	$ 0	2,620	0	0	0	$ 2,620
Shares sold – options exercised (in shares)	90,725					541,736
Shares sold – options exercised	$ 1	3,440	0	0	0	$ 3,441
Repurchase of common shares (in shares)	(8,437)
Repurchase of common shares	$ 0	(836)	0	0	0	(836)
Dividends declared to common stockholders	$ 0	0	(32,536)	0	0	(32,536)
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/(loss)	0	0	22,445	0	(2,468)	19,977
Contributions attributable to noncontrolling interest	0	0	0	0	250	250
Other comprehensive income	0	0	0	(11,137)	0	(11,137)
Stock–based compensation	$ 0	2,612	0	0	0	$ 2,612
Shares sold – options exercised (in shares)	54,260					32,597
Shares sold – options exercised	$ 0	2,114	0	0	0	$ 2,114
Repurchase of common shares (in shares)	(148,547)
Repurchase of common shares	$ (1)	(9,902)	0	0	0	(9,903)
Dividends declared to common stockholders	$ 0	0	(34,859)	0	0	(34,859)
Balance (in shares) at Dec. 31, 2022	15,357,746
Balance at Dec. 31, 2022	$ 153	$ 226,991	$ 656,664	$ (9,532)	$ 3,238	$ 877,514

Consolidated Statements of Eq_2

Consolidated Statements of Equity (Parentheticals) - $ / shares	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Dividends declared to common stockholders, per share (in dollars per share)	$ 2.26	$ 2.11	$ 2.08

Note 1 - Summary of Significant

Note 1 - Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Significant Accounting Policies [Text Block]	Notes to Consolidated Financial Statements Note 1 Summary of Significant Accounting Policies Nature of Operations National HealthCare Corporation ("NHC" or "the Company") operates, manages or provides services to skilled nursing facilities, assisted living facilities, independent living facilities, home health care agencies, hospice agencies, and behavioral health hospitals located in 8 Principles of Consolidation and Basis of Presentation The consolidated financial statements, which are prepared in accordance with U.S. generally accepted accounting principles (“GAAP”), include our wholly owned and controlled subsidiaries and affiliates. All significant intercompany transactions and balances have been eliminated in consolidation. The Company presents noncontrolling interest within the equity section of its consolidated balance sheets. The Company presents the amount of consolidated net income that is attributable to NHC and the noncontrolling interest in its consolidated statements of operations. Variable interest entities (“VIEs”) in which we have an interest have been consolidated when we have been identified as the primary beneficiary. Investments in ventures in which we have the ability to exercise significant influence but do not Use of Estimates The preparation of financial statements in conformity with U.S. GAAP requires 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, hospice services, and behavioral health 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 explicit price concessions provided to third December 31, 2022, 2021, 2020, December 31, 2022, 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 We 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 2 6 Other Operating Expenses Other operating expenses include the costs of care and services that we provide to the residents of our facilities and the costs of maintaining our facilities. Our primary patient care costs include drugs, medical supplies, purchased professional services, food, and professional liability insurance and licensing fees. The primary facility costs include utilities and property insurance. General and Administrative Costs With the Company being a healthcare provider, the majority of our expenses are "cost of revenue" items. Costs that could be classified as "general and administrative" by the Company would include its corporate office costs, excluding stock-based compensation, which were $20,651,000, $20,160,000, and $19,934,000 for the years ended December 31, 2022, 2021, 2020, Cash and Cash Equivalents Cash equivalents include highly liquid investments with an original maturity of three Restricted Cash and Cash Equivalents and Restricted Marketable Securities Restricted cash and cash equivalents and restricted marketable securities represent assets that are primarily held by our wholly owned limited purpose insurance companies for workers' compensation and professional liability claims. Investments in Marketable Securities and Restricted Marketable Securities Our investments in marketable equity securities are carried at fair value with the changes in unrealized gains and losses recognized in our results of operations at each measurement date. Our investments in marketable debt securities are classified as available for sale securities and carried at fair value with the unrealized gains and losses recognized through accumulated other comprehensive income at each measurement date. For available for sale debt securities in an unrealized loss position, we first not not Inventories Inventories consist generally of food and supplies and are valued at the lower of cost or market, with cost determined on a first–in, first–out (FIFO) basis. Mortgage and Other Notes Receivable In accordance with ASC Topic 310, Receivables may not For the year ended December 31, 2022, December 31, 2021, $3,728,00 Property and Equipment Property and equipment are recorded at cost. Depreciation is provided by the straight–line method over the expected useful lives of the assets estimated as follows: buildings and improvements, 20–40 3–15 not Expenditures for repairs and maintenance are charged to expense as incurred. Betterments, which significantly extend the useful life, are capitalized. We remove the costs and related allowances for accumulated depreciation or amortization from the accounts for properties sold or retired, and any resulting gains or losses are included in income. In accordance with ASC Topic 360, Property, Plant, and Equipment may not December 31, 2022, 2021, 2020, 2021 August 2022 seven Business Combinations We account for acquisitions using the acquisition method of accounting in accordance with ASC 805, Business Combinations 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 Goodwill and Other Intangible Assets Goodwill represents the excess of the 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 principally self–insured for risks related to employee health insurance and utilize wholly owned limited purpose insurance companies for workers’ compensation and professional liability claims. Accrued risk reserves primarily represent the accrual for risks associated with employee health insurance, workers’ compensation and professional liability claims. The accrued risk reserves include a liability for unpaid reported claims and estimates for incurred but unreported claims. Our policy with respect to a significant portion of our workers’ compensation and professional and general liability claims is to use an actuary to assist management in estimating our exposure for claims obligation (for both asserted and unasserted claims). Our health insurance reserve is based on our known claims incurred and an estimate of incurred but unreported claims determined by our analysis of historical claims paid. We reassess our accrued risk reserves on a quarterly basis, with changes in estimated losses being recorded in the consolidated statements of operations in the period first Other Current Liabilities Other current liabilities primarily represent accruals for current federal and state income taxes, real estate taxes and other current liabilities. Continuing Care Contracts and Refundable Entrance Fees We have one may Non-refundable fees are included as a component of the transaction price and are amortized into revenue over the actuarially determined remaining life of the resident, which is the expected period of occupancy by the resident. We pay the refundable portion of our entry fees to residents when they relocate from our community and the apartment is re-occupied. Refundable entrance fees are not December 31, 2022 December 31, 2021 We annually estimate the present value of the net cost of future services and the use of facilities to be provided to the current CCRC residents and compare that amount with the balance of non–refundable deferred revenue from entrance fees received. If the present value of the net cost of future services exceeds the related anticipated revenues, a liability is recorded (obligation to provide future services) with a corresponding charge to income. The obligation to provide future services is included in other noncurrent liabilities in the Company’s consolidated balance sheets. At December 31, 2022 2021, Other Noncurrent Liabilities Other noncurrent liabilities include reserves primarily related to various uncertain income tax positions, deferred revenue, and obligations to provide services to our CCRC residents. Deferred revenue includes the deferred gain on the sale of assets to National Health Corporation (“National”) and the non-refundable portion ( 10% Income Taxes We utilize ASC Topic 740, Income Taxes 13 Also, under ASC Topic 740, Income Taxes 50 Noncontrolling Interest The noncontrolling interest in a subsidiary is presented within total equity in the Company’s consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to NHC in its consolidated statements of operations. The Company’s earnings per share is calculated based on net income attributable to NHC’s stockholders. The carrying amount of the noncontrolling interest is adjusted based on an allocation of subsidiary earnings based on ownership interest. Stock Based Compensation Stock–based awards granted include stock options, restricted stock units, and stock purchased under our employee stock purchase plan. Stock–based compensation cost is measured at the grant date, based on the fair value of the awards, and is recognized as expense over the requisite service period only for those equity awards expected to vest. The fair value of the restricted stock units is determined based on the stock price on the date of grant. We estimated the fair value of stock options and stock purchased under our employee stock purchase plan using the Black–Scholes model. This model utilizes the estimated fair value of common stock and requires that, at the date of grant, we use the expected term of the grant, the expected volatility of the price of our common stock, risk–free interest rates and expected dividend yield of our common stock. The fair value is amortized on a straight–line basis over the requisite service periods of the awards. Comprehensive Income ASC Topic 220, Comprehensive Income, Concentration of Credit Risks Our credit risks primarily relate to cash and cash equivalents, restricted cash and cash equivalents, accounts receivable, marketable securities, restricted marketable securities and notes receivable. Cash and cash equivalents are primarily held in bank accounts and overnight investments. Restricted cash and cash equivalents are primarily invested in commercial paper and certificates of deposit with financial institutions and other interest-bearing accounts. Accounts receivable consist primarily of amounts due from patients (funded through Medicare, Medicaid, other contractual programs and through private payors) and from other health care companies for management, accounting and other services. We perform continual credit evaluations of our clients and maintain appropriate allowances for doubtful accounts on any accounts receivable proving uncollectible, and continually monitor and adjust these allowances as necessary. Marketable securities and restricted marketable securities are held primarily in accounts with brokerage institutions. Notes receivable relate primarily to secured loans with health care facilities. At any point in time we have funds in our operating accounts and restricted cash accounts that are with third may Our financial instruments, principally our notes receivable, are subject to the possibility of loss of the carrying values as a result of the failure of other parties to perform according to their contractual obligations. We obtain various collateral and other protective rights, and continually monitor these rights in order to reduce such possibilities of credit loss. We evaluate the need to provide reserves for potential credit losses on our financial instruments based on management's periodic review of the portfolio on an instrument-by-instrument basis. 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 2 - Coronavirus Pandemic

Note 2 - Coronavirus Pandemic	12 Months Ended
	Dec. 31, 2022
COVID 19 [Member]
Notes to Financial Statements
Unusual or Infrequent Items, or Both, Disclosure [Text Block]	Note 2 Coronavirus Pandemic ("COVID- 19" In early March 2020, 19, March 2020 19 $178 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. December 31, 2022, 2021 2020, 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 second 2020, one 2021 2022. 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. December 31, 2021 December 31, 2022. 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 December 31, 2022, 2021 2020,

Note 3 - Net Patient Revenues

Note 3 - Net Patient Revenues	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Revenue from Contract with Customer [Text Block]	Note 3 Net Patient Revenues The Company disaggregates revenue from contracts with customers by service type and by payor. Revenue by Service Type The Company’s net patient services can generally be classified into the following two 1 2 Year Ended December 31, 2022 2021 2020 Inpatient services $ 900,231 $ 868,687 $ 879,693 Homecare services 128,854 96,855 52,102 Total net patient revenues $ 1,029,085 $ 965,542 $ 931,795 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: Year Ended December 31, Source 2022 2021 2020 Medicare 37% 36% 33% Managed Care 10% 11% 11% Medicaid 28% 29% 31% Private Pay and Other 25% 24% 25% Total 100% 100% 100% Medicare covers skilled nursing services for beneficiaries who require nursing care and/or rehabilitation services following a hospitalization of at least three 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 consolidated balance sheets are contract liabilities, which represent payments the Company receives in advance of services provided. As of December 31, 2022 2021, second 2021. A summary of the contract liabilities are follows ( in thousands Balance, January 1, 2021 $ 51,253 Payments recouped (36,231 ) Balance, December 31, 2021 15,022 Payments recouped (15,022 ) Balance, December 31, 2022 $ – 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 December 31, 2022 2021,

Note 4 - Other Revenues

Note 4 - Other Revenues	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Other Revenues [Text Block]	Note 4 Other Revenues Other revenues are outlined in the table below. Revenues from rental income include health care real estate properties owned by us and leased to third in thousands Year Ended December 31, 2022 2021 2020 Rental income $ 23,451 $ 22,717 $ 22,768 Management and accounting service fees 16,160 17,139 17,147 Insurance services 4,766 5,019 5,447 Other 819 525 771 Gain on sale of property and equipment – – 2,784 Total other revenues $ 45,196 $ 45,400 $ 48,917 Rental Income The Company leases real estate assets consisting of skilled nursing facilities and assisted living facilities to third 7 (in thousands) Year Ended December 31, 2022 2021 2020 Operating lease payments $ 23,039 $ 22,609 $ 22,019 Variable lease payments 412 108 749 Total rental income $ 23,451 $ 22,717 $ 22,768 The following table sets forth the undiscounted cash flows for future minimum lease payments receivable for leases in effect at December 31, 2022 ( in thousands 2023 $ 22,738 2024 22,730 2025 22,730 2026 20,220 2027 – Thereafter – Total future minimum lease payments $ 88,418 Management Fees from National We have managed skilled nursing facilities for National since 1988, 17 During 2022, 2021 2020, December 31, 2022 2021, The unpaid fees from these five not may five may may may no Management Fees and Financial and Accounting Services for Other Healthcare Centers We provide management services and financial and accounting services to certain healthcare facilities (in addition to the five third December 31, 2022, 2021 2020, Insurance Services For workers’ compensation insurance services, the premium revenues reflected in the consolidated statements of operations for the years ended December 31, 2022, 2021 2020 For professional liability insurance services, the premium revenues reflected in the consolidated statements of operations for the years ended December 31, 2022, 2021 2020

Note 5 - Non-operating Income

Note 5 - Non-operating Income	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Other Nonoperating Income and Expense [Text Block]	Note 5 Non Operating Income Non–operating income includes equity in earnings of unconsolidated investments, dividends and other realized gains and losses on marketable securities, and interest income (in thousands) Year Ended December 31, 2022 2021 2020 Equity in earnings of unconsolidated investments $ 477 $ 5,111 $ 12,342 Dividends and net realized gains or losses on the sale of securities 5,530 7,998 8,390 Interest income 5,134 4,665 5,795 Total non-operating income $ 11,141 $ 17,774 $ 26,527 Caris HealthCare, L.P. ( Caris ) On June 11, 2021, June 11, 2021 no

Note 6 - Business Segments

Note 6 - Business Segments	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Segment Reporting Disclosure [Text Block]	Note 6 Business Segments The Company has two reportable operating segments: ( 1 2 The Company’s CODM evaluates performance and allocates capital resources to each segment based on an operating model that is designed to improve the quality of patient care and profitability of the Company while enhancing long-term shareholder value. The CODM does not not The following tables set forth the Company’s consolidated statements of operations by business segment (in thousands Year Ended December 31, 2022 Inpatient Services Homecare and Hospice All Other Total Revenues: Net patient revenues $ 900,231 $ 128,854 $ – $ 1,029,085 Other revenues 136 – 45,060 45,196 Government stimulus income 11,457 – – 11,457 Net operating revenues and grant income 911,824 128,854 45,060 1,085,738 Costs and Expenses: Salaries, wages and benefits 580,707 77,688 27,774 686,169 Other operating 251,355 26,319 11,698 289,372 Facility rent 32,956 2,327 5,694 40,977 Depreciation and amortization 36,522 691 3,276 40,489 Interest 563 – – 563 Recovery of assets – – (3,728 ) (3,728 ) Total costs and expenses 902,103 107,025 44,714 1,053,842 Income before non-operating income 9,721 21,829 346 31,896 Non-operating income – – 11,141 11,141 Unrealized losses on marketable equity securities – – (15,806 ) (15,806 ) Income (loss) before income taxes $ 9,721 $ 21,829 $ (4,319 ) $ 27,231 Year Ended December 31, 2021 Inpatient Services Homecare and Hospice All Other Total Revenues: Net patient revenues $ 868,687 $ 96,855 $ – $ 965,542 Other revenues 386 – 45,014 45,400 Government stimulus income 63,360 – – 63,360 Net operating revenues and grant income 932,433 96,855 45,014 1,074,302 Costs and Expenses: Salaries, wages and benefits 557,604 59,226 49,233 666,063 Other operating 238,354 16,053 12,347 266,754 Facility rent 32,819 2,064 5,935 40,818 Depreciation and amortization 36,890 443 3,339 40,672 Interest 845 – – 845 Impairment of assets 4,497 – 3,728 8,225 Total costs and expenses 871,009 77,786 74,582 1,023,377 Income (loss) before non-operating income 61,424 19,069 (29,568 ) 50,925 Non-operating income – – 17,774 17,774 Gain on acquisition of equity method investment – – 95,202 95,202 Unrealized losses on marketable equity securities – – (13,863 ) (13,863 ) Income before income taxes $ 61,424 $ 19,069 $ 69,545 $ 150,038 Year Ended December 31, 2020 Inpatient Services Homecare and Hospice All Other Total Revenues: Net patient revenues $ 879,693 $ 52,102 $ – $ 931,795 Other revenues 3,403 – 45,514 48,917 Government stimulus income 47,505 – – 47,505 Net operating revenues and grant income 930,601 52,102 45,514 1,028,217 Costs and Expenses: Salaries, wages and benefits 546,188 37,377 37,427 620,992 Other operating 254,230 10,416 10,513 275,159 Facility rent 33,090 1,802 5,602 40,494 Depreciation and amortization 38,217 377 3,424 42,018 Interest 1,374 – 25 1,399 Total costs and expenses 873,099 49,972 56,991 980,062 Income (loss) before non-operating income 57,502 2,130 (11,477 ) 48,155 Non-operating income – – 26,527 26,527 Gain on acquisition of equity method investment – – 1,707 1,707 Unrealized losses on marketable equity securities – – (23,966 ) (23,966 ) Income (loss) before income taxes $ 57,502 $ 2,130 $ (7,209 ) $ 52,423

Note 7 - Long-term Leases

Note 7 - Long-term Leases	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Lessee, Operating and Finance Leases [Text Block]	Note 7 Long Term Leases Operating Leases At December 31, 2022, one third On September 1, 2022, third third 842, Leases four one third 2023 2024 2025 2026 Base rent expense under the NHI lease agreements for 2022, 2021, 2020 2022, 2021, 2020 We have a right of first 180 Finance Leases Effective June 1, 2014, three three third ten 2014 Fixed assets recorded under the finance leases, which are included in property and equipment in the consolidated balance sheets, are as follows (in thousands) December 31, 2022 2021 Buildings and personal property $ 39,011 $ 39,014 Accumulated amortization (34,482 ) (30,604 ) $ 4,529 $ 8,410 Lease Classification The Company recorded the following on the consolidated balance sheets ( in thousands December 31, Right-of-Use Assets Balance Sheet Classification 2022 2021 Finance lease assets Net property and equipment $ 4,529 $ 8,410 Operating lease right-of use assets Operating lease right-of-use assets 120,521 156,116 Total $ 125,050 $ 164,526 December 31, Lease Liabilities Balance Sheet Classification 2022 2021 Current: Finance lease liabilities Finance lease obligations, current portion $ 4,985 $ 4,695 Operating lease liabilities Operating lease liabilities, current portion 29,075 27,574 Noncurrent: Finance lease liabilities Finance lease obligations, less current portion 860 5,845 Operating lease liabilities Operating lease liabilities, less current portion 91,016 128,542 Total $ 125,936 $ 166,656 Weighted-average remaining lease terms and discount rates were as follows: December 31, 2022 2021 Weighted-average remaining lease terms (in years) Finance 1.2 2.2 Operating 4.0 5.2 Weighted-average discount rate Finance 6.0% 6.0% Operating 6.6% 6.0% Lease Costs Lease costs recorded in the consolidated statement of operations are as follows (in thousands): December 31, 2022 2021 2020 Finance lease costs: Depreciation of leased assets $ 3,878 $ 3,905 $ 3,906 Interest of lease liabilities 534 807 1,064 Total finance lease costs 4,412 4,712 4,970 Operating lease costs: Operating lease costs 36,051 36,079 35,656 Variable lease costs 3,887 3,721 3,617 Short-term lease costs 1,039 1,018 1,221 Total operating lease costs 40,977 40,818 40,494 Total lease costs $ 45,389 $ 45,530 $ 45,464 Minimum Lease Payments The following table summarizes the maturity of our finance and operating lease liabilities as of December 31, 2022 ( in thousands Finance Leases Operating Leases 2023 $ 5,200 $ 35,973 2024 867 34,013 2025 – 33,224 2026 – 32,589 2027 – 208 Thereafter – – Total minimum lease payments $ 6,067 $ 136,007 Less: amounts representing interest (222 ) (15,916 ) Present value of future minimum lease payments 5,845 120,091 Less: current portion (4,985 ) (29,075 ) Noncurrent lease liabilities $ 860 $ 91,016 Other Supplemental cash flow data were as follows (in thousands) December 31, 2022 2021 2020 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 36,051 $ 36,079 $ 35,656 Operating cash flows for finance leases 534 807 1,064 Financing cash flows for finance leases 4,695 4,423 4,166

Note 8 - Earnings Per Share

Note 8 - Earnings Per Share	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Earnings Per Share [Text Block]	Note 8 Earning Per Share The following table summarizes the earnings and the weighted average number of common shares used in the calculation of basic and diluted earnings per share (in thousands, except share and per share amounts) Year Ended December 31, 2022 2021 2020 Basic: Weighted average common shares outstanding 15,410,222 15,347,129 15,306,174 Net income attributable to common stockholders of National Healthcare Corporation $ 22,445 $ 138,590 $ 41,871 Earnings per common share, basic $ 1.46 $ 9.03 $ 2.74 Diluted: Weighted average common shares outstanding 15,410,222 15,347,129 15,306,174 Dilutive effect of stock options 36,989 69,587 63,349 Assumed average common shares outstanding 15,447,211 15,416,716 15,369,523 Net income attributable to common stockholders of National Healthcare Corporation $ 22,445 $ 138,590 $ 41,871 Earnings per common share, diluted $ 1.45 $ 8.99 $ 2.72 In the above table, options to purchase 375,638, 291,946, and 713,956 shares of our common stock have been excluded for the years ended December 31, 2022, 2021, 2020,

Note 9 - Investments in Marketa

Note 9 - Investments in Marketable Securities	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Investments in Debt and Marketable Equity Securities (and Certain Trading Assets) Disclosure [Text Block]	Note 9 Investments in Marketable Securities Marketable securities consist of the following (in thousands) December 31, 2022 December 31, 2021 Amortized Cost Fair Value Amortized Cost Fair Value Investments available for sale: Marketable equity securities $ 30,176 $ 100,786 $ 30,176 $ 113,108 Corporate debt securities 14,317 13,885 19,038 18,843 Asset-backed securities 500 494 1,481 1,469 U.S. Treasury securities 9,009 8,757 15,082 14,998 Restricted investments available for sale: Marketable equity securities 24,326 22,358 25,442 26,958 Corporate debt securities 54,412 51,009 60,816 62,936 Asset–backed securities 24,605 22,437 32,918 33,301 U.S. Treasury securities 45,989 41,294 33,052 32,630 State and municipal securities 4,877 4,771 7,700 7,923 $ 208,211 265,791 $ 225,705 $ 312,166 Included in the marketable equity securities available for sale are the following (in thousands, except share amounts) December 31, 2022 December 31, 2021 Shares Cost Fair Value Shares Cost Fair Value NHI Common Stock 1,630,642 $ 24,734 $ 85,152 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) December 31, 2022 December 31, 2021 Cost Fair Value Cost Fair Value Maturities: Within 1 year $ 33,662 $ 33,037 $ 32,718 $ 32,843 1 to 5 years 81,500 76,394 95,293 96,937 6 to 10 years 38,547 33,216 41,580 41,835 Over 10 years – – 496 485 $ 153,709 $ 142,647 $ 170,087 $ 172,100 Gross unrealized gains related to marketable equity securities are $71,869,000 and $85,394,000 as of December 31, 2022 2021, December 31, 2022 2021, December 31, 2022, 2021, 2020 Gross unrealized gains related to available for sale marketable debt securities are $9,000 and $3,189,000 as of December 31, 2022 2021, December 31, 2022 2021, The Company’s unrealized losses in our available for sale marketable debt securities were determined to be non-credit related. The Company has not December 31, 2022 2021. For the marketable debt securities in gross unrealized loss positions, (a) it is more likely than not not Proceeds from the sale of available for sale marketable securities during the years ended December 31, 2022, 2021, 2020 December 31, 2022, 2021, 2020,

Note 10 - Fair Value Measuremen

Note 10 - Fair Value Measurements	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Fair Value Disclosures [Text Block]	Note 10 Fair Value Measurements The accounting standard for fair value measurements provides a framework for measuring fair value and requires expanded disclosures regarding fair value measurements. Fair value is defined as the price that would be received for an asset or the exit price that would be paid to transfer a liability in the principal or most advantageous market in an orderly transaction between market participants on the measurement date. This accounting standard establishes a fair value hierarchy, which requires an entity to maximize the use of observable inputs, where available. The following summarizes the three may Level 1 Level 2 not Level 3 no 3 A financial instrument’s level within the fair value hierarchy is based on the lowest level of input that is significant to the fair value measurement. The Company's non-financial assets, which includes goodwill, intangible assets, property and equipment and right-of-use assets, are not may not Valuation of Marketable Securities The Company determines fair value for marketable securities with Level 1 2 2 third We validated the prices provided by our broker by reviewing their pricing methods, obtaining market values from other pricing sources, analyzing pricing data in certain instances and confirming that the relevant markets are active. After completing our validation procedures, we did not December 31, 2022 2021. Other The carrying amounts of cash and cash equivalents, restricted cash and cash equivalents, accounts receivable, and accounts payable approximate fair value due to their short–term nature. The estimated fair value of notes receivable approximates the carrying value based principally on their underlying interest rates and terms, maturities, collateral and credit status of the receivables. At December 31, 2022 2021, no The following table summarizes fair value measurements by level at December 31, 2022 December 31, 2021 (in thousands) Fair Value Measurements Using December 31, 2022 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 $ 58,667 $ 58,667 $ – $ – Restricted cash and cash equivalents 16,198 16,198 – – Marketable equity securities 123,144 123,144 – – Corporate debt securities 64,894 48,525 16,369 – Asset–backed securities 22,931 – 22,931 – U.S. Treasury securities 50,051 50,051 – – State and municipal securities 4,771 1,337 3,434 – Total financial assets $ 340,656 $ 297,922 $ 42,734 $ – 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 11 - Property and Equipmen

Note 11 - Property and Equipment	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Property, Plant and Equipment Disclosure [Text Block]	Note 11 Property and Equipment Property and equipment, at cost, consists of the following (in thousands) December 31, 2022 2021 Land $ 67,165 $ 66,267 Leasehold improvements 125,142 122,391 Buildings and improvements 688,433 654,656 Furniture and equipment 187,743 185,320 Construction in progress 12,736 35,703 Property and equipment, at cost 1,081,219 1,064,337 Less: Accumulated depreciation (574,687 ) (543,341 ) Net property and equipment $ 506,532 $ 520,996

Note 12 - Goodwill and Other In

Note 12 - Goodwill and Other Intangible Assets	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Goodwill and Intangible Assets Disclosure [Text Block]	Note 12 Goodwill and Other Intangible Assets As of December 31, 2022, 1 2 350, Intangibles - Goodwill and Other December 31, 2022, 2021, 2020. The following table represents activity in goodwill by segment as of and for the year ended December 31, 2022 ( in thousands Year Ended December 31, 2022 Inpatient Services Homecare All Other Total January 1, 2020 $ 3,395 $ 17,600 $ – $ 20,995 Additions 346 – – 346 December 31, 2020 3,741 17,600 – 21,341 Additions – 146,954 – 146,954 December 31, 2021 3,741 164,554 – 168,295 Additions – – – – December 31, 2022 $ 3,741 $ 164,554 $ – $ 168,295 As part of the Caris acquisition in June 2021,

Note 13 - Income Taxes

Note 13 - Income Taxes	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Income Tax Disclosure [Text Block]	Note 13 Income Taxes The provision for income taxes is comprised of the following components (in thousands) Year Ended December 31, 2022 2021 2020 Current tax provision Federal $ 717 $ 15,072 $ 19,054 State 251 1,164 2,337 Total current tax provision 968 16,236 21,391 Deferred tax provision Federal 4,595 (3,866 ) (8,349 ) State 1,691 (1,419 ) (2,609 ) Total deferred tax provision 6,286 (5,285 ) (10,958 ) Income tax provision $ 7,254 $ 10,951 $ 10,433 The deferred tax assets and liabilities, consisting of temporary differences tax effected at the respective income tax rates, are as follows (in thousands) December 31, 2022 2021 Deferred tax assets: Accrued risk reserves $ 2,209 $ 1,803 Accrued expenses 6,441 9,663 Financial reporting depreciation in excess of tax depreciation 5,505 5,610 Stock based compensation 742 527 Deferred revenue 3,393 8,019 Operating lease liabilities 30,558 39,629 Other 1,711 1,991 Total gross deferred tax assets 50,559 67,242 Less: valuation allowance (978 ) – Deferred tax assets less valuation allowance $ 49,581 $ 67,242 Deferred tax liabilities: Unrealized gains on marketable securities $ (15,396 ) $ (22,401 ) Deferred gain on sale of assets, net (2,045 ) (2,040 ) Book basis in excess of tax basis of intangible assets (3,063 ) (2,708 ) Book basis in excess of tax basis of securities (3,164 ) (2,822 ) Long–term investments (6,155 ) (4,494 ) Operating lease assets (30,667 ) (39,629 ) Total deferred tax liabilities $ (60,490 ) $ (74,094 ) Net deferred tax liability $ (10,909 ) $ (6,852 ) A reconciliation of income tax expense and the amount computed by applying the statutory federal income tax rate to income before income taxes is as follows (in thousands) Year Ended December 31, 2022 2021 2020 Tax provision at federal statutory rate $ 5,719 $ 31,508 $ 11,009 Increase (decrease) in income taxes resulting from: State, net of federal benefit 1,034 1,113 1,631 Nontaxable revaluation gain – (19,758 ) – Unrecognized tax benefits 730 (158 ) 166 Expiration of statute of limitations (1,032 ) (1,901 ) (2,366 ) Tax (expense) benefit of minority interest 518 (104 ) (30 ) Other 285 251 23 Total increases (decreases) 1,535 (20,557 ) (576 ) Effective income tax expense $ 7,254 $ 10,951 $ 10,433 Our deferred tax assets have been evaluated for realization based on historical taxable income, tax planning strategies, the expected timing of reversals of existing temporary differences and future taxable income anticipated. Our deferred tax assets, with the exception of certain state tax net operating losses and certain deferred tax assets associated with unrealized losses on marketable securities, are more likely than not Uncertain tax positions may may 740, 50 In accordance with current guidance, the Company has established a liability for unrecognized tax benefits, which are differences between a tax position taken or expected to be taken in a tax return and the benefit recognized and measured. Generally, a liability is created for an unrecognized tax benefit because it represents a company’s potential future obligation to a taxing authority for a tax position that was not 740 Income Taxes A reconciliation of the beginning and ending amount of unrecognized tax benefits is as follows (in thousands) Deferred Tax Asset Liability For Unrecognized Tax Benefits Liability For Interest and Penalties Liability Total Balance, January 1, 2020 $ 7,413 $ 12,749 $ 3,309 $ 16,058 Additions based on tax positions related to the current year 1,229 1,229 – 1,229 Additions (reductions) for tax positions of prior years (2,432 ) (2,273 ) 403 (1,870 ) Reductions for statute of limitation expirations (544 ) (1,812 ) (1,098 ) (2,910 ) Balance, December 31, 2020 5,666 9,893 2,614 12,507 Additions based on tax positions related to the current year 665 665 – 665 Additions (reductions) for tax positions of prior years (441 ) (187 ) 543 356 Reductions for statute of limitation expirations (435 ) (1,469 ) (867 ) (2,336 ) Balance, December 31, 2021 5,455 8,902 2,290 11,192 Additions based on tax positions related to the current year 636 636 – 636 Additions (reductions) for tax positions of prior years (1,097 ) (273 ) 900 627 Reductions for statute of limitation expirations (240 ) (760 ) (512 ) (1,272 ) Balance, December 31, 2022 $ 4,754 $ 8,505 $ 2,678 $ 11,183 Unrecognized tax benefits of $4,109,000, net of federal benefit at December 31, 2022, not 2023 Interest and penalties expense related to U.S. federal and state income tax returns are included within income tax expense. The Company is no 2019

Note 14 - Stock Repurchase Prog

Note 14 - Stock Repurchase Program	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Treasury Stock [Text Block]	Note 14 Stock Repurchases During 2022,

Note 15 - Stock-based Compensat

Note 15 - Stock-based Compensation	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Share-Based Payment Arrangement [Text Block]	Note 15 Stock Based Compensation NHC recognizes stock–based compensation for all stock options and restricted stock granted over the requisite service period using the fair value for these grants as estimated at the date of grant either using the Black–Scholes pricing model for stock options or the quoted market price for restricted stock. The Compensation Committee of the Board of Directors ("the Committee") has the authority to select the participants to be granted options; to designate whether the option granted is an incentive stock option ("ISO"), a non–qualified option, or a stock appreciation right; to establish the number of shares of common stock that may may not 100% may not ten not 100% In May 2020, 2020 “2020 December 31, 2022, 2020 Additionally, we have an employee stock purchase plan that allows employees to purchase our shares of stock through payroll deductions. The plan allows employees to terminate participation at any time. Compensation expense is recognized only for the awards that ultimately vest. The Company accounts for forfeitures when they occur. Stock–based compensation totaled $2,612,000, $2,620,000, and $2,453,000, for the years ended December 31, 2022, 2021, 2020, December 31, 2022, 2021 2020, At December 31, 2022, two Stock Options The Company is required to estimate the fair value of stock–based awards on the date of grant. The fair value of each option award is estimated using the Black–Scholes option valuation model with the weighted average assumptions indicated in the following table. Each grant is valued as a single award with an expected term based upon expected employment and termination behavior. Compensation cost is recognized over the requisite service period in a manner consistent with the option vesting provisions. The straight–line attribution method requires that compensation expense is recognized at least equal to the portion of the grant–date fair value that is vested at that date. The expected volatility is derived using weekly historical data for periods immediately preceding the date of grant. The risk–free interest rate is the approximate yield on the United States Treasury Strips having a life equal to the expected option life on the date of grant. The expected life is an estimate of the number of years an option will be held before it is exercised. The following table summarizes the assumptions used to value the options granted in the periods shown. Year Ended December 31, 2022 2021 2020 Risk–free interest rate 1.83% 0.21% 0.87% Expected volatility 31.4% 34.9% 20.1% Expected life, in years 2.9 2.2 2.2 Expected dividend yield 3.57% 3.00% 2.91% The following table summarizes option activity: Number of Shares Weighted Average Exercise Price Aggregate Intrinsic Value Options outstanding at January 1, 2020 809,529 $ 71.24 − Options granted 104,057 73.98 − Options exercised (43,630 ) 63.37 − Options cancelled (3,000 ) 72.94 − Options outstanding at December 31, 2020 866,956 72.11 − 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 302,266 64.72 − Options exercised (32,597 ) 64.49 − Options cancelled (199,451 ) 75.98 − Options outstanding at December 31, 2022 445,144 66.62 − Options exercisable at December 31, 2022 157,901 $ 69.78 $ − Options Outstanding December 31, 2022 Exercise Prices Weighted Exercise Weighted Average Remaining Life in 356,749 $61.90 – $69.19 $ 64.61 3.7 88,395 $71.64 – $77.92 74.72 2.4 445,144 $ 66.62 3.4

Note 16 - Contingencies and Com

Note 16 - Contingencies and Commitments	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Commitments and Contingencies Disclosure [Text Block]	Note 16 Contingencies and Guarantees Accrued Risk Reserves We are self–insured for risks related to health insurance and have wholly–owned limited purpose insurance companies that insure risks related to workers’ compensation and general and professional liability insurance claims both for our owned 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 $102,469,000 and $98,048,000 at December 31, 2022 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 Insurance coverage for all years includes primary policies and excess policies. The primary coverage is in the amount of a per incident claim and a per location claim with an annual primary policy aggregate limit that is adjusted on an annual basis. Additional insurance is purchased through third There is certain additional litigation incidental to our business, none 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 June 22, 2020. March 1, 2021. November 4, 2021. January 28, 2022, one 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 federal and state relief measures as a result of COVID- 19 Debt Guarantees At December 31, 2022, no

Note 17 - Relationship With Nat

Note 17 - Relationship With National Health Corporation	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Related Party Transactions Disclosure [Text Block]	Note 17 Relationship with National Health Corporation National Health Corporation ("National"), which is wholly owned by the National Health Corporation Leveraged Employee Stock Ownership Plan ("ESOP"), was formed in 1986 may Management Contracts We currently manage five January 1, 2028. 4 Financing Activities In conjunction with our management contract, we have entered into a line of credit arrangement whereby we may December 31, 2022 2021, not The maximum line of credit commitment amount of $2,000,000 is also the amount of a deferred gain that has been outstanding since NHC sold certain assets to National in 1988. January 2028. Payroll and Related Services The personnel conducting our business, including our executive management team, are employees of National and may December 31, 2022, 2021, 2020 December 31, 2022 2021, National s Ownership of Our Stock At December 31, 2022, 2021, 2020, Consolidation Considerations Because of the contractual and management relationships between NHC and National as described in this note above, we have considered whether National should be consolidated by NHC under the guidance provided in ASC Topic 810, Consolidation not 1 not 2 3 1 may 2 50% not

Note 18 - Variable Interest Ent

Note 18 - Variable Interest Entity	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Variable Interest Entity Disclosure [Text Block]	Note 18 Variable Interest Entity Accounting guidance requires that a variable interest entity (“VIE”), according to the provisions of ASC Topic 810, Consolidation December 31, 2022 2021, one Springfield, Missouri Lease In December 2010, 120–bed ten five five third 120–bed third third December 31, 2022 2021 December 31, 2022 2021

Note 19 - Massachusetts and New

Note 19 - Massachusetts and New Hampshire Skilled Nursing Facilities	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
Facilities to be Transferred [Text Block]	Note 19 Massachusetts and New Hampshire Skilled Nursing Facilities On September 1, 2022, third seven third seven 7 The seven December 31, 2022, 2021, 2020, seven December 31, 2022, 2021, 2020,

Schedule II - Valuation and Qua

Schedule II - Valuation and Qualifying Accounts	12 Months Ended
	Dec. 31, 2022
Notes to Financial Statements
SEC Schedule, 12-09, Schedule of Valuation and Qualifying Accounts Disclosure [Text Block]	NATIONAL HEALTHCARE CORPORATION SCHEDULE II – VALUATION AND QUALIFYING ACCOUNTS FOR THE YEARS ENDED DECEMBER 31, 2022, 2021, 2020 (in thousands) Column A Column B Column C Column D Column E Additions Description Balance– Beginning of Period Charged to Costs and Expenses Charged to other Accounts Deductions Balance– End of Period For the year ended December 31, 2020 Accrued risk reserves $ 96,011 $ 86,918 $ − $ 83,392 $ 99,537 For the year ended December 31, 2021 Accrued risk reserves $ 99,537 $ 82,219 $ − $ 83,708 $ 98,048 For the year ended December 31, 2022 Accrued risk reserves $ 98,048 $ 81,743 $ − $ 77,322 $ 102,469 All other financial statement schedules are not

Significant Accounting Policies

Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2022
Accounting Policies [Abstract]
Basis of Accounting, Policy [Policy Text Block]	Principles of Consolidation and Basis of Presentation The consolidated financial statements, which are prepared in accordance with U.S. generally accepted accounting principles (“GAAP”), include our wholly owned and controlled subsidiaries and affiliates. All significant intercompany transactions and balances have been eliminated in consolidation. The Company presents noncontrolling interest within the equity section of its consolidated balance sheets. The Company presents the amount of consolidated net income that is attributable to NHC and the noncontrolling interest in its consolidated statements of operations. Variable interest entities (“VIEs”) in which we have an interest have been consolidated when we have been identified as the primary beneficiary. Investments in ventures in which we have the ability to exercise significant influence but do not
Use of Estimates, Policy [Policy Text Block]	Use of Estimates The preparation of financial statements in conformity with U.S. GAAP requires 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, hospice services, and behavioral health 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 explicit price concessions provided to third December 31, 2022, 2021, 2020, December 31, 2022, 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 Grants, policy [Policy Text Block]	Government Grants We 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 2 6
Other Operating Expenses Policy [Policy Text Block]	Other Operating Expenses Other operating expenses include the costs of care and services that we provide to the residents of our facilities and the costs of maintaining our facilities. Our primary patient care costs include drugs, medical supplies, purchased professional services, food, and professional liability insurance and licensing fees. The primary facility costs include utilities and property insurance.
Selling, General and Administrative Expenses, Policy [Policy Text Block]	General and Administrative Costs With the Company being a healthcare provider, the majority of our expenses are "cost of revenue" items. Costs that could be classified as "general and administrative" by the Company would include its corporate office costs, excluding stock-based compensation, which were $20,651,000, $20,160,000, and $19,934,000 for the years ended December 31, 2022, 2021, 2020,
Cash and Cash Equivalents, Policy [Policy Text Block]	Cash and Cash Equivalents Cash equivalents include highly liquid investments with an original maturity of three
Cash and Restricted Cash and Cash Equivalents and Restricted Marketable Securities [Policy Text Block]	Restricted Cash and Cash Equivalents and Restricted Marketable Securities Restricted cash and cash equivalents and restricted marketable securities represent assets that are primarily held by our wholly owned limited purpose insurance companies for workers' compensation and professional liability claims.
Marketable Securities, Policy [Policy Text Block]	Investments in Marketable Securities and Restricted Marketable Securities Our investments in marketable equity securities are carried at fair value with the changes in unrealized gains and losses recognized in our results of operations at each measurement date. Our investments in marketable debt securities are classified as available for sale securities and carried at fair value with the unrealized gains and losses recognized through accumulated other comprehensive income at each measurement date. For available for sale debt securities in an unrealized loss position, we first not not
Inventory, Policy [Policy Text Block]	Inventories Inventories consist generally of food and supplies and are valued at the lower of cost or market, with cost determined on a first–in, first–out (FIFO) basis.
Financing Receivable [Policy Text Block]	Mortgage and Other Notes Receivable In accordance with ASC Topic 310, Receivables may not For the year ended December 31, 2022, December 31, 2021, $3,728,00
Property, Plant and Equipment, Policy [Policy Text Block]	Property and Equipment Property and equipment are recorded at cost. Depreciation is provided by the straight–line method over the expected useful lives of the assets estimated as follows: buildings and improvements, 20–40 3–15 not Expenditures for repairs and maintenance are charged to expense as incurred. Betterments, which significantly extend the useful life, are capitalized. We remove the costs and related allowances for accumulated depreciation or amortization from the accounts for properties sold or retired, and any resulting gains or losses are included in income. In accordance with ASC Topic 360, Property, Plant, and Equipment may not December 31, 2022, 2021, 2020, 2021 August 2022 seven
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
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
Goodwill and Intangible Assets, Goodwill, Policy [Policy Text Block]	Goodwill and Other Intangible Assets Goodwill represents the excess of the 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 principally self–insured for risks related to employee health insurance and utilize wholly owned limited purpose insurance companies for workers’ compensation and professional liability claims. Accrued risk reserves primarily represent the accrual for risks associated with employee health insurance, workers’ compensation and professional liability claims. The accrued risk reserves include a liability for unpaid reported claims and estimates for incurred but unreported claims. Our policy with respect to a significant portion of our workers’ compensation and professional and general liability claims is to use an actuary to assist management in estimating our exposure for claims obligation (for both asserted and unasserted claims). Our health insurance reserve is based on our known claims incurred and an estimate of incurred but unreported claims determined by our analysis of historical claims paid. We reassess our accrued risk reserves on a quarterly basis, with changes in estimated losses being recorded in the consolidated statements of operations in the period first
Other Current Liabilities [Policy Text Block]	Other Current Liabilities Other current liabilities primarily represent accruals for current federal and state income taxes, real estate taxes and other current liabilities.
Continuing Care Contracts and Refundable Entrance Fees, Policy [Policy Text Block]	Continuing Care Contracts and Refundable Entrance Fees We have one may Non-refundable fees are included as a component of the transaction price and are amortized into revenue over the actuarially determined remaining life of the resident, which is the expected period of occupancy by the resident. We pay the refundable portion of our entry fees to residents when they relocate from our community and the apartment is re-occupied. Refundable entrance fees are not December 31, 2022 December 31, 2021 We annually estimate the present value of the net cost of future services and the use of facilities to be provided to the current CCRC residents and compare that amount with the balance of non–refundable deferred revenue from entrance fees received. If the present value of the net cost of future services exceeds the related anticipated revenues, a liability is recorded (obligation to provide future services) with a corresponding charge to income. The obligation to provide future services is included in other noncurrent liabilities in the Company’s consolidated balance sheets. At December 31, 2022 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 services to our CCRC residents. Deferred revenue includes the deferred gain on the sale of assets to National Health Corporation (“National”) and the non-refundable portion ( 10%
Income Tax, Policy [Policy Text Block]	Income Taxes We utilize ASC Topic 740, Income Taxes 13 Also, under ASC Topic 740, Income Taxes 50
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 consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to NHC in its consolidated statements of operations. The Company’s earnings per share is calculated based on net income attributable to NHC’s stockholders. The carrying amount of the noncontrolling interest is adjusted based on an allocation of subsidiary earnings based on ownership interest.
Share-Based Payment Arrangement [Policy Text Block]	Stock Based Compensation Stock–based awards granted include stock options, restricted stock units, and stock purchased under our employee stock purchase plan. Stock–based compensation cost is measured at the grant date, based on the fair value of the awards, and is recognized as expense over the requisite service period only for those equity awards expected to vest. The fair value of the restricted stock units is determined based on the stock price on the date of grant. We estimated the fair value of stock options and stock purchased under our employee stock purchase plan using the Black–Scholes model. This model utilizes the estimated fair value of common stock and requires that, at the date of grant, we use the expected term of the grant, the expected volatility of the price of our common stock, risk–free interest rates and expected dividend yield of our common stock. The fair value is amortized on a straight–line basis over the requisite service periods of the awards.
Comprehensive Income, Policy [Policy Text Block]	Comprehensive Income ASC Topic 220, Comprehensive Income,
Concentration Risk, Credit Risk, Policy [Policy Text Block]	Concentration of Credit Risks Our credit risks primarily relate to cash and cash equivalents, restricted cash and cash equivalents, accounts receivable, marketable securities, restricted marketable securities and notes receivable. Cash and cash equivalents are primarily held in bank accounts and overnight investments. Restricted cash and cash equivalents are primarily invested in commercial paper and certificates of deposit with financial institutions and other interest-bearing accounts. Accounts receivable consist primarily of amounts due from patients (funded through Medicare, Medicaid, other contractual programs and through private payors) and from other health care companies for management, accounting and other services. We perform continual credit evaluations of our clients and maintain appropriate allowances for doubtful accounts on any accounts receivable proving uncollectible, and continually monitor and adjust these allowances as necessary. Marketable securities and restricted marketable securities are held primarily in accounts with brokerage institutions. Notes receivable relate primarily to secured loans with health care facilities. At any point in time we have funds in our operating accounts and restricted cash accounts that are with third may Our financial instruments, principally our notes receivable, are subject to the possibility of loss of the carrying values as a result of the failure of other parties to perform according to their contractual obligations. We obtain various collateral and other protective rights, and continually monitor these rights in order to reduce such possibilities of credit loss. We evaluate the need to provide reserves for potential credit losses on our financial instruments based on management's periodic review of the portfolio on an instrument-by-instrument basis.
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 3 - Net Patient Revenues (

Note 3 - Net Patient Revenues (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Disaggregation of Revenue [Table Text Block]	Year Ended December 31, 2022 2021 2020 Inpatient services $ 900,231 $ 868,687 $ 879,693 Homecare services 128,854 96,855 52,102 Total net patient revenues $ 1,029,085 $ 965,542 $ 931,795 Year Ended December 31, Source 2022 2021 2020 Medicare 37% 36% 33% Managed Care 10% 11% 11% Medicaid 28% 29% 31% Private Pay and Other 25% 24% 25% Total 100% 100% 100%
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Table Text Block]	Balance, January 1, 2021 $ 51,253 Payments recouped (36,231 ) Balance, December 31, 2021 15,022 Payments recouped (15,022 ) Balance, December 31, 2022 $ –

Note 4 - Other Revenues (Tables

Note 4 - Other Revenues (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Schedule of Other Revenues [Table Text Block]	Year Ended December 31, 2022 2021 2020 Rental income $ 23,451 $ 22,717 $ 22,768 Management and accounting service fees 16,160 17,139 17,147 Insurance services 4,766 5,019 5,447 Other 819 525 771 Gain on sale of property and equipment – – 2,784 Total other revenues $ 45,196 $ 45,400 $ 48,917
Operating Lease, Lease Income [Table Text Block]	Year Ended December 31, 2022 2021 2020 Operating lease payments $ 23,039 $ 22,609 $ 22,019 Variable lease payments 412 108 749 Total rental income $ 23,451 $ 22,717 $ 22,768
Lessor, Operating Lease, Payment to be Received, Fiscal Year Maturity [Table Text Block]	2023 $ 22,738 2024 22,730 2025 22,730 2026 20,220 2027 – Thereafter – Total future minimum lease payments $ 88,418

Note 5 - Non-operating Income (

Note 5 - Non-operating Income (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Schedule of Other Nonoperating Income, by Component [Table Text Block]	Year Ended December 31, 2022 2021 2020 Equity in earnings of unconsolidated investments $ 477 $ 5,111 $ 12,342 Dividends and net realized gains or losses on the sale of securities 5,530 7,998 8,390 Interest income 5,134 4,665 5,795 Total non-operating income $ 11,141 $ 17,774 $ 26,527

Note 6 - Business Segments (Tab

Note 6 - Business Segments (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Schedule of Segment Reporting Information, by Segment [Table Text Block]	Year Ended December 31, 2022 Inpatient Services Homecare and Hospice All Other Total Revenues: Net patient revenues $ 900,231 $ 128,854 $ – $ 1,029,085 Other revenues 136 – 45,060 45,196 Government stimulus income 11,457 – – 11,457 Net operating revenues and grant income 911,824 128,854 45,060 1,085,738 Costs and Expenses: Salaries, wages and benefits 580,707 77,688 27,774 686,169 Other operating 251,355 26,319 11,698 289,372 Facility rent 32,956 2,327 5,694 40,977 Depreciation and amortization 36,522 691 3,276 40,489 Interest 563 – – 563 Recovery of assets – – (3,728 ) (3,728 ) Total costs and expenses 902,103 107,025 44,714 1,053,842 Income before non-operating income 9,721 21,829 346 31,896 Non-operating income – – 11,141 11,141 Unrealized losses on marketable equity securities – – (15,806 ) (15,806 ) Income (loss) before income taxes $ 9,721 $ 21,829 $ (4,319 ) $ 27,231 Year Ended December 31, 2021 Inpatient Services Homecare and Hospice All Other Total Revenues: Net patient revenues $ 868,687 $ 96,855 $ – $ 965,542 Other revenues 386 – 45,014 45,400 Government stimulus income 63,360 – – 63,360 Net operating revenues and grant income 932,433 96,855 45,014 1,074,302 Costs and Expenses: Salaries, wages and benefits 557,604 59,226 49,233 666,063 Other operating 238,354 16,053 12,347 266,754 Facility rent 32,819 2,064 5,935 40,818 Depreciation and amortization 36,890 443 3,339 40,672 Interest 845 – – 845 Impairment of assets 4,497 – 3,728 8,225 Total costs and expenses 871,009 77,786 74,582 1,023,377 Income (loss) before non-operating income 61,424 19,069 (29,568 ) 50,925 Non-operating income – – 17,774 17,774 Gain on acquisition of equity method investment – – 95,202 95,202 Unrealized losses on marketable equity securities – – (13,863 ) (13,863 ) Income before income taxes $ 61,424 $ 19,069 $ 69,545 $ 150,038 Year Ended December 31, 2020 Inpatient Services Homecare and Hospice All Other Total Revenues: Net patient revenues $ 879,693 $ 52,102 $ – $ 931,795 Other revenues 3,403 – 45,514 48,917 Government stimulus income 47,505 – – 47,505 Net operating revenues and grant income 930,601 52,102 45,514 1,028,217 Costs and Expenses: Salaries, wages and benefits 546,188 37,377 37,427 620,992 Other operating 254,230 10,416 10,513 275,159 Facility rent 33,090 1,802 5,602 40,494 Depreciation and amortization 38,217 377 3,424 42,018 Interest 1,374 – 25 1,399 Total costs and expenses 873,099 49,972 56,991 980,062 Income (loss) before non-operating income 57,502 2,130 (11,477 ) 48,155 Non-operating income – – 26,527 26,527 Gain on acquisition of equity method investment – – 1,707 1,707 Unrealized losses on marketable equity securities – – (23,966 ) (23,966 ) Income (loss) before income taxes $ 57,502 $ 2,130 $ (7,209 ) $ 52,423

Note 7 - Long-term Leases (Tabl

Note 7 - Long-term Leases (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Schedule of Fixed Assets Under Finance Leases [Table Text Block]	December 31, 2022 2021 Buildings and personal property $ 39,011 $ 39,014 Accumulated amortization (34,482 ) (30,604 ) $ 4,529 $ 8,410
Lease, Balance Sheet Classification [Table Text Block]	December 31, Right-of-Use Assets Balance Sheet Classification 2022 2021 Finance lease assets Net property and equipment $ 4,529 $ 8,410 Operating lease right-of use assets Operating lease right-of-use assets 120,521 156,116 Total $ 125,050 $ 164,526 December 31, Lease Liabilities Balance Sheet Classification 2022 2021 Current: Finance lease liabilities Finance lease obligations, current portion $ 4,985 $ 4,695 Operating lease liabilities Operating lease liabilities, current portion 29,075 27,574 Noncurrent: Finance lease liabilities Finance lease obligations, less current portion 860 5,845 Operating lease liabilities Operating lease liabilities, less current portion 91,016 128,542 Total $ 125,936 $ 166,656
Lease, Cost [Table Text Block]	December 31, 2022 2021 Weighted-average remaining lease terms (in years) Finance 1.2 2.2 Operating 4.0 5.2 Weighted-average discount rate Finance 6.0% 6.0% Operating 6.6% 6.0% December 31, 2022 2021 2020 Finance lease costs: Depreciation of leased assets $ 3,878 $ 3,905 $ 3,906 Interest of lease liabilities 534 807 1,064 Total finance lease costs 4,412 4,712 4,970 Operating lease costs: Operating lease costs 36,051 36,079 35,656 Variable lease costs 3,887 3,721 3,617 Short-term lease costs 1,039 1,018 1,221 Total operating lease costs 40,977 40,818 40,494 Total lease costs $ 45,389 $ 45,530 $ 45,464
Lessee, Lease, Liability, Maturity [Table Text Block]	Finance Leases Operating Leases 2023 $ 5,200 $ 35,973 2024 867 34,013 2025 – 33,224 2026 – 32,589 2027 – 208 Thereafter – – Total minimum lease payments $ 6,067 $ 136,007 Less: amounts representing interest (222 ) (15,916 ) Present value of future minimum lease payments 5,845 120,091 Less: current portion (4,985 ) (29,075 ) Noncurrent lease liabilities $ 860 $ 91,016
Lease, Cash Flow Information [Table Text Block]	December 31, 2022 2021 2020 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 36,051 $ 36,079 $ 35,656 Operating cash flows for finance leases 534 807 1,064 Financing cash flows for finance leases 4,695 4,423 4,166

Note 8 - Earnings Per Share (Ta

Note 8 - Earnings Per Share (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	Year Ended December 31, 2022 2021 2020 Basic: Weighted average common shares outstanding 15,410,222 15,347,129 15,306,174 Net income attributable to common stockholders of National Healthcare Corporation $ 22,445 $ 138,590 $ 41,871 Earnings per common share, basic $ 1.46 $ 9.03 $ 2.74 Diluted: Weighted average common shares outstanding 15,410,222 15,347,129 15,306,174 Dilutive effect of stock options 36,989 69,587 63,349 Assumed average common shares outstanding 15,447,211 15,416,716 15,369,523 Net income attributable to common stockholders of National Healthcare Corporation $ 22,445 $ 138,590 $ 41,871 Earnings per common share, diluted $ 1.45 $ 8.99 $ 2.72

Note 9 - Investments in Marke_2

Note 9 - Investments in Marketable Securities (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Marketable Securities [Table Text Block]	December 31, 2022 December 31, 2021 Amortized Cost Fair Value Amortized Cost Fair Value Investments available for sale: Marketable equity securities $ 30,176 $ 100,786 $ 30,176 $ 113,108 Corporate debt securities 14,317 13,885 19,038 18,843 Asset-backed securities 500 494 1,481 1,469 U.S. Treasury securities 9,009 8,757 15,082 14,998 Restricted investments available for sale: Marketable equity securities 24,326 22,358 25,442 26,958 Corporate debt securities 54,412 51,009 60,816 62,936 Asset–backed securities 24,605 22,437 32,918 33,301 U.S. Treasury securities 45,989 41,294 33,052 32,630 State and municipal securities 4,877 4,771 7,700 7,923 $ 208,211 265,791 $ 225,705 $ 312,166
Schedule of Available-for-Sale Securities Reconciliation [Table Text Block]	December 31, 2022 December 31, 2021 Shares Cost Fair Value Shares Cost Fair Value NHI Common Stock 1,630,642 $ 24,734 $ 85,152 1,630,642 $ 24,734 $ 93,713
Investments Classified by Contractual Maturity Date [Table Text Block]	December 31, 2022 December 31, 2021 Cost Fair Value Cost Fair Value Maturities: Within 1 year $ 33,662 $ 33,037 $ 32,718 $ 32,843 1 to 5 years 81,500 76,394 95,293 96,937 6 to 10 years 38,547 33,216 41,580 41,835 Over 10 years – – 496 485 $ 153,709 $ 142,647 $ 170,087 $ 172,100

Note 10 - Fair Value Measurem_2

Note 10 - Fair Value Measurements (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis [Table Text Block]	Fair Value Measurements Using December 31, 2022 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 $ 58,667 $ 58,667 $ – $ – Restricted cash and cash equivalents 16,198 16,198 – – Marketable equity securities 123,144 123,144 – – Corporate debt securities 64,894 48,525 16,369 – Asset–backed securities 22,931 – 22,931 – U.S. Treasury securities 50,051 50,051 – – State and municipal securities 4,771 1,337 3,434 – Total financial assets $ 340,656 $ 297,922 $ 42,734 $ – 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 11 - Property and Equipm_2

Note 11 - Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Property, Plant and Equipment [Table Text Block]	December 31, 2022 2021 Land $ 67,165 $ 66,267 Leasehold improvements 125,142 122,391 Buildings and improvements 688,433 654,656 Furniture and equipment 187,743 185,320 Construction in progress 12,736 35,703 Property and equipment, at cost 1,081,219 1,064,337 Less: Accumulated depreciation (574,687 ) (543,341 ) Net property and equipment $ 506,532 $ 520,996

Note 12 - Goodwill and Other _2

Note 12 - Goodwill and Other Intangible Assets (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Schedule of Goodwill [Table Text Block]	Year Ended December 31, 2022 Inpatient Services Homecare All Other Total January 1, 2020 $ 3,395 $ 17,600 $ – $ 20,995 Additions 346 – – 346 December 31, 2020 3,741 17,600 – 21,341 Additions – 146,954 – 146,954 December 31, 2021 3,741 164,554 – 168,295 Additions – – – – December 31, 2022 $ 3,741 $ 164,554 $ – $ 168,295

Note 13 - Income Taxes (Tables)

Note 13 - Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Schedule of Components of Income Tax Expense (Benefit) [Table Text Block]	Year Ended December 31, 2022 2021 2020 Current tax provision Federal $ 717 $ 15,072 $ 19,054 State 251 1,164 2,337 Total current tax provision 968 16,236 21,391 Deferred tax provision Federal 4,595 (3,866 ) (8,349 ) State 1,691 (1,419 ) (2,609 ) Total deferred tax provision 6,286 (5,285 ) (10,958 ) Income tax provision $ 7,254 $ 10,951 $ 10,433
Schedule of Deferred Tax Assets and Liabilities [Table Text Block]	December 31, 2022 2021 Deferred tax assets: Accrued risk reserves $ 2,209 $ 1,803 Accrued expenses 6,441 9,663 Financial reporting depreciation in excess of tax depreciation 5,505 5,610 Stock based compensation 742 527 Deferred revenue 3,393 8,019 Operating lease liabilities 30,558 39,629 Other 1,711 1,991 Total gross deferred tax assets 50,559 67,242 Less: valuation allowance (978 ) – Deferred tax assets less valuation allowance $ 49,581 $ 67,242 Deferred tax liabilities: Unrealized gains on marketable securities $ (15,396 ) $ (22,401 ) Deferred gain on sale of assets, net (2,045 ) (2,040 ) Book basis in excess of tax basis of intangible assets (3,063 ) (2,708 ) Book basis in excess of tax basis of securities (3,164 ) (2,822 ) Long–term investments (6,155 ) (4,494 ) Operating lease assets (30,667 ) (39,629 ) Total deferred tax liabilities $ (60,490 ) $ (74,094 ) Net deferred tax liability $ (10,909 ) $ (6,852 )
Schedule of Effective Income Tax Rate Reconciliation [Table Text Block]	Year Ended December 31, 2022 2021 2020 Tax provision at federal statutory rate $ 5,719 $ 31,508 $ 11,009 Increase (decrease) in income taxes resulting from: State, net of federal benefit 1,034 1,113 1,631 Nontaxable revaluation gain – (19,758 ) – Unrecognized tax benefits 730 (158 ) 166 Expiration of statute of limitations (1,032 ) (1,901 ) (2,366 ) Tax (expense) benefit of minority interest 518 (104 ) (30 ) Other 285 251 23 Total increases (decreases) 1,535 (20,557 ) (576 ) Effective income tax expense $ 7,254 $ 10,951 $ 10,433
Schedule of Unrecognized Tax Benefits Roll Forward [Table Text Block]	Deferred Tax Asset Liability For Unrecognized Tax Benefits Liability For Interest and Penalties Liability Total Balance, January 1, 2020 $ 7,413 $ 12,749 $ 3,309 $ 16,058 Additions based on tax positions related to the current year 1,229 1,229 – 1,229 Additions (reductions) for tax positions of prior years (2,432 ) (2,273 ) 403 (1,870 ) Reductions for statute of limitation expirations (544 ) (1,812 ) (1,098 ) (2,910 ) Balance, December 31, 2020 5,666 9,893 2,614 12,507 Additions based on tax positions related to the current year 665 665 – 665 Additions (reductions) for tax positions of prior years (441 ) (187 ) 543 356 Reductions for statute of limitation expirations (435 ) (1,469 ) (867 ) (2,336 ) Balance, December 31, 2021 5,455 8,902 2,290 11,192 Additions based on tax positions related to the current year 636 636 – 636 Additions (reductions) for tax positions of prior years (1,097 ) (273 ) 900 627 Reductions for statute of limitation expirations (240 ) (760 ) (512 ) (1,272 ) Balance, December 31, 2022 $ 4,754 $ 8,505 $ 2,678 $ 11,183

Note 15 - Stock-based Compens_2

Note 15 - Stock-based Compensation (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
Schedule of Share-Based Payment Award, Stock Options, Valuation Assumptions [Table Text Block]	Year Ended December 31, 2022 2021 2020 Risk–free interest rate 1.83% 0.21% 0.87% Expected volatility 31.4% 34.9% 20.1% Expected life, in years 2.9 2.2 2.2 Expected dividend yield 3.57% 3.00% 2.91%
Share-Based Payment Arrangement, Option, Activity [Table Text Block]	Number of Shares Weighted Average Exercise Price Aggregate Intrinsic Value Options outstanding at January 1, 2020 809,529 $ 71.24 − Options granted 104,057 73.98 − Options exercised (43,630 ) 63.37 − Options cancelled (3,000 ) 72.94 − Options outstanding at December 31, 2020 866,956 72.11 − 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 302,266 64.72 − Options exercised (32,597 ) 64.49 − Options cancelled (199,451 ) 75.98 − Options outstanding at December 31, 2022 445,144 66.62 − Options exercisable at December 31, 2022 157,901 $ 69.78 $ −
Share-Based Payment Arrangement, Option, Exercise Price Range [Table Text Block]	Options Outstanding December 31, 2022 Exercise Prices Weighted Exercise Weighted Average Remaining Life in 356,749 $61.90 – $69.19 $ 64.61 3.7 88,395 $71.64 – $77.92 74.72 2.4 445,144 $ 66.62 3.4

Schedule II - Valuation and Q_2

Schedule II - Valuation and Qualifying Accounts (Tables)	12 Months Ended
	Dec. 31, 2022
Notes Tables
SEC Schedule, 12-09, Schedule of Valuation and Qualifying Accounts Disclosure [Table Text Block]	Column A Column B Column C Column D Column E Additions Description Balance– Beginning of Period Charged to Costs and Expenses Charged to other Accounts Deductions Balance– End of Period For the year ended December 31, 2020 Accrued risk reserves $ 96,011 $ 86,918 $ − $ 83,392 $ 99,537 For the year ended December 31, 2021 Accrued risk reserves $ 99,537 $ 82,219 $ − $ 83,708 $ 98,048 For the year ended December 31, 2022 Accrued risk reserves $ 98,048 $ 81,743 $ − $ 77,322 $ 102,469

Note 1 - Summary of Significa_2

Note 1 - Summary of Significant Accounting Policies (Details Textual)	12 Months Ended
	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)
Accounts Receivable, Credit Loss Expense (Reversal)	$ 4,711,000	$ 3,886,000	$ 3,339,000
Accounts Receivable, Allowance for Credit Loss, Ending Balance	$ 6,246,000	6,411,000
Number of Reportable Segments	2
General and Administrative Expense, Total	$ 20,651,000	20,160,000	19,934,000
Tangible Asset Impairment Charges, Total	0	4,497,000	$ 0
Contract with Customer, Refund Liability, Total	6,207,000	7,011,000
Continuing Care Retirement Communities, Refund Obligation	$ 2,218,000	2,338,000
Refundable Advance Fees [Member]
Nonrefundable Resident Entry Fee Percentage	10%
Original Entry Fee [Member]
Refundable Resident Entry Fee Percentage	90%
Appreciation [Member]
Appreciation of Apartment Over Original Residents Entry Fee Percentage	40%
Minimum [Member]
Lessee, Operating Lease, Term of Contract (Year)	2 years
Maximum [Member]
Lessee, Operating Lease, Term of Contract (Year)	15 years
Building and Building Improvements [Member] | Minimum [Member]
Property, Plant and Equipment, Useful Life (Year)	20 years
Building and Building Improvements [Member] | Maximum [Member]
Property, Plant and Equipment, Useful Life (Year)	40 years
Equipment and Furniture [Member] | Minimum [Member]
Property, Plant and Equipment, Useful Life (Year)	3 years
Equipment and Furniture [Member] | Maximum [Member]
Property, Plant and Equipment, Useful Life (Year)	15 years
Impairment (Recovery) of Assets [Member]
Accounts Receivable, Allowance for Credit Loss, Recovery	$ 3,728,000
Accounts Receivable, Allowance for Credit Loss, Writeoff		$ 3,728,000

Note 2 - Coronavirus Pandemic (

Note 2 - Coronavirus Pandemic (Details Textual) - USD ($)	3 Months Ended	12 Months Ended
	Jun. 30, 2020	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Proceeds from Medicare Accelerated and Advance Payment Program	$ 51,253,000
Repayments of Advanced Medicare Payments		$ 15,022,000	$ 36,231,000
Payments for Employers Portion of Social Security Taxes		10,545,000	10,613,000
Revenue from Contract with Customer, Including Assessed Tax		1,029,085,000	965,542,000	$ 931,795,000
Supplemental Medicaid Payments [Member]
Revenue from Contract with Customer, Including Assessed Tax		19,442,000	20,482,000	26,179,000
Provider Relief Fund Under CARES Act [Member]
Government Assistance, Amount		$ 11,457,000	$ 63,360,000	$ 47,505,000

Note 3 - Net Patient Revenues_2

Note 3 - Net Patient Revenues (Details Textual) - USD ($)	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Contract with Customer, Liability, Current	$ 0	$ 15,022,000	$ 51,253,000
Accounts Receivable, Allowance for Credit Loss, Ending Balance	6,246,000	6,411,000
Medicare and Medicaid [Member]
Accounts Receivable, Allowance for Credit Loss, Ending Balance	$ 16,631,000	$ 17,595,000

Note 3 - Net Patient Revenues -

Note 3 - Net Patient Revenues - Revenue Disaggregation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Net patient revenues	$ 1,029,085	$ 965,542	$ 931,795
Revenue, concentration percentage	100%	100%	100%
Inpatient Services [Member]
Net patient revenues	$ 900,231	$ 868,687	$ 879,693
Medicare [Member]
Revenue, concentration percentage	37%	36%	33%
Homecare and Hospice Services [Member]
Net patient revenues	$ 128,854	$ 96,855	$ 52,102
Managed Care [Member]
Revenue, concentration percentage	10%	11%	11%
Medicaid [Member]
Revenue, concentration percentage	28%	29%	31%
Private Pay and Other [Member]
Revenue, concentration percentage	25%	24%	25%

Note 3 - Net Patient Revenues_3

Note 3 - Net Patient Revenues - Contract Liabilities (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Balance	$ 15,022,000	$ 51,253,000
Payments recouped	(15,022,000)	(36,231,000)
Balance	$ 0	$ 15,022,000

Note 4 - Other Revenues (Detail

Note 4 - Other Revenues (Details Textual)	12 Months Ended
	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)
Insurance Services Revenue, Total	$ 4,766,000	$ 5,019,000	$ 5,447,000
Workers Compensation Revenue [Member]
Insurance Services Revenue, Total	2,689,000	2,974,000	3,300,000
Professional Liability Insurance [Member]
Insurance Services Revenue, Total	$ 2,077,000	2,045,000	2,147,000
National [Member]
Number of Skilled Nursing Centers	5
Property Management Fee Revenue	$ 4,332,000	3,915,000	4,729,000
Unbilled Receivables, Current	18,843,000	18,908,000
Management Services Provided to Other Facilities [Member]
Property Management Fee Revenue	$ 11,828,000	$ 13,224,000	$ 12,418,000
FLORIDA
Number of Skilled Nursing Centers	4

Note 4 - Other Revenues - Summa

Note 4 - Other Revenues - Summary of Other Revenues (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Rental income	$ 23,451	$ 22,717	$ 22,768
Management and accounting service fees	16,160	17,139	17,147
Insurance services	4,766	5,019	5,447
Other	819	525	771
Gain on sale of property and equipment	0	0	2,784
Total other revenues	$ 45,196	$ 45,400	$ 48,917

Note 4 - Other Revenues - Renta

Note 4 - Other Revenues - Rental Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Operating lease payments	$ 23,039	$ 22,609	$ 22,019
Variable lease payments	412	108	749
Total rental income	$ 23,451	$ 22,717	$ 22,768

Note 4 - Other Revenues - Minim

Note 4 - Other Revenues - Minimum Lease Payments Receivable (Details) $ in Thousands	Dec. 31, 2022 USD ($)
2023	$ 22,738
2024	22,730
2025	22,730
2026	20,220
2027	0
Thereafter	0
Total future minimum lease payments	$ 88,418

Note 5 - Non-operating Income_2

Note 5 - 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 5 - Non-operating Income -

Note 5 - Non-operating Income - Summary of Non-operating Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Equity in earnings of unconsolidated investments	$ 477	$ 5,111	$ 12,342
Dividends and net realized gains or losses on the sale of securities	5,530	7,998	8,390
Interest income	5,134	4,665	5,795
Total non-operating income	$ 11,141	$ 17,774	$ 26,527

Note 6 - Business Segments (Det

Note 6 - Business Segments (Details Textual)	12 Months Ended
	Dec. 31, 2022
Number of Operating Segments	2

Note 6 - Business Segments - Su

Note 6 - Business Segments - Summary of Financial Information by Reporting Segment (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Revenues:
Net patient revenues	$ 1,029,085,000	$ 965,542,000	$ 931,795,000
Other revenues	45,196,000	45,400,000	48,917,000
Government stimulus income	11,457,000	63,360,000	47,505,000
Net operating revenues and grant income	1,085,738,000	1,074,302,000	1,028,217,000
Costs and Expenses:
Salaries, wages and benefits	686,169,000	666,063,000	620,992,000
Other operating	289,372,000	266,754,000	275,159,000
Facility rent	40,977,000	40,818,000	40,494,000
Depreciation and amortization	40,489,000	40,672,000	42,018,000
Interest	563,000	845,000	1,399,000
Recovery of assets	(3,728,000)	8,225,000	0
Total costs and expenses	1,053,842,000	1,023,377,000	980,062,000
Income before non-operating income	31,896,000	50,925,000	48,155,000
Non-operating income (loss)	11,141,000	17,774,000	26,527,000
Unrealized losses on marketable equity securities	(15,806,000)	(13,863,000)	(23,966,000)
Income (loss) before income taxes	27,231,000	150,038,000	52,423,000
Impairment of assets	(3,728,000)	8,225,000	0
Gain on acquisition of equity method investment	0	95,202,000	1,707,000
Inpatient Services Segment [Member]
Revenues:
Net patient revenues	900,231,000	868,687,000	879,693,000
Other revenues	136,000	386,000	3,403,000
Government stimulus income	11,457,000	63,360,000	47,505,000
Net operating revenues and grant income	911,824,000	932,433,000	930,601,000
Costs and Expenses:
Salaries, wages and benefits	580,707,000	557,604,000	546,188,000
Other operating	251,355,000	238,354,000	254,230,000
Facility rent	32,956,000	32,819,000	33,090,000
Depreciation and amortization	36,522,000	36,890,000	38,217,000
Interest	563,000	845,000	1,374,000
Recovery of assets	0
Total costs and expenses	902,103,000	871,009,000	873,099,000
Income before non-operating income	9,721,000	61,424,000	57,502,000
Non-operating income (loss)	0	0	0
Unrealized losses on marketable equity securities	0	0	0
Income (loss) before income taxes	9,721,000	61,424,000	57,502,000
Impairment of assets		4,497,000
Gain on acquisition of equity method investment		0	0
Homecare Services Segment [Member]
Revenues:
Net patient revenues	128,854,000	96,855,000	52,102,000
Other revenues	0	0	0
Government stimulus income	0	0	0
Net operating revenues and grant income	128,854,000	96,855,000	52,102,000
Costs and Expenses:
Salaries, wages and benefits	77,688,000	59,226,000	37,377,000
Other operating	26,319,000	16,053,000	10,416,000
Facility rent	2,327,000	2,064,000	1,802,000
Depreciation and amortization	691,000	443,000	377,000
Interest	0	0	0
Recovery of assets	0
Total costs and expenses	107,025,000	77,786,000	49,972,000
Income before non-operating income	21,829,000	19,069,000	2,130,000
Non-operating income (loss)	0	0	0
Unrealized losses on marketable equity securities	0	0	0
Income (loss) before income taxes	21,829,000	19,069,000	2,130,000
Impairment of assets		0
Gain on acquisition of equity method investment		0	0
Other Segments [Member]
Revenues:
Net patient revenues	0	0	0
Other revenues	45,060,000	45,014,000	45,514,000
Government stimulus income	0	0	0
Net operating revenues and grant income	45,060,000	45,014,000	45,514,000
Costs and Expenses:
Salaries, wages and benefits	27,774,000	49,233,000	37,427,000
Other operating	11,698,000	12,347,000	10,513,000
Facility rent	5,694,000	5,935,000	5,602,000
Depreciation and amortization	3,276,000	3,339,000	3,424,000
Interest	0	0	25,000
Recovery of assets	(3,728,000)
Total costs and expenses	44,714,000	74,582,000	56,991,000
Income before non-operating income	346,000	(29,568,000)	(11,477,000)
Non-operating income (loss)	11,141,000	17,774,000	26,527,000
Unrealized losses on marketable equity securities	(15,806,000)	(13,863,000)	(23,966,000)
Income (loss) before income taxes	$ (4,319,000)	69,545,000	(7,209,000)
Impairment of assets		3,728,000
Gain on acquisition of equity method investment		$ 95,202,000	$ 1,707,000

Note 7 - Long-term Leases (Deta

Note 7 - Long-term Leases (Details Textual)		12 Months Ended
	Sep. 01, 2022 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Aug. 31, 2022 USD ($)
Lessee, Operating Lease, Liability, to be Paid, Year One		$ 35,973,000
Lessee, Operating Lease, Liability, to be Paid, Year Two		34,013,000
Lessee, Operating Lease, Liability, to be Paid, Year Three		33,224,000
Lessee, Operating Lease, Liability, to be Paid, Year Four		32,589,000
Operating Lease, Expense		$ 40,977,000	$ 40,818,000	$ 40,494,000
Two Leases with NHI [Member]
Number of Skilled Nursing Centers Leased from NHI		28
Number of Assisted Living Centers Leased from NHI		5
Number of Independent Living Centers Leased from NHI		3
Lease One With NHI [Member]
Number of Skilled Nursing Facilities Subleased		4
NHI Lease Agreement [Member]
Number of Skilled Nursing Facilities Leased	7
Number of Real Property Leased	7
Number of Skilled Nursing Facilities Terminated	7
Operating Lease, Expense, Increased Next Four and One-third Year	$ 8,775,000
Lessee, Operating Lease, Liability, to be Paid, Year One	34,075,000				$ 30,750,000
Lessee, Operating Lease, Liability, to be Paid, Year Two	32,625,000				30,750,000
Lessee, Operating Lease, Liability, to be Paid, Year Three	32,225,000				30,750,000
Lessee, Operating Lease, Liability, to be Paid, Year Four	$ 31,975,000				$ 30,750,000
Both NHI Lease Agreements [Member]
Operating Lease, Expense		$ 33,783,000	34,200,000	34,200,000
Operating Leases Percentage Rent Expense		$ 3,887,000	$ 3,721,000	$ 3,617,000
Senior Healthcare Facilities [Member]
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%

Note 7 - Long-term Leases - Fix

Note 7 - Long-term Leases - Fixed Assets Recorded Under Capital Leases (Details) - Buildings and Personal Property [Member] - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Buildings and personal property	$ 39,011	$ 39,014
Accumulated amortization	(34,482)	(30,604)
Property, Plant, and Equipment and Finance Lease Right-of-Use Asset, after Accumulated Depreciation and Amortization, Total	$ 4,529	$ 8,410

Note 7 - Long-term Leases - Bal

Note 7 - Long-term Leases - Balance Sheet Classification (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Operating lease right-of use assets	$ 120,521	$ 156,116
Total	125,050	164,526
Finance lease liabilities	4,985	4,695
Operating lease liabilities	29,075	27,574
Noncurrent lease liabilities, finance leases	860	5,845
Noncurrent lease liabilities, operating leases	91,016	128,542
Total	125,936	166,656
Net Property and Equipment [Member]
Finance lease assets	$ 4,529	$ 8,410

Note 7 - Long-term Leases - Lea

Note 7 - Long-term Leases - Lease Information and Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Finance (Year)	1 year 2 months 12 days	2 years 2 months 12 days
Operating (Year)	4 years	5 years 2 months 12 days
Finance	6%	6%
Operating	6.60%	6%
Depreciation of leased assets	$ 3,878	$ 3,905	$ 3,906
Interest of lease liabilities	534	807	1,064
Total finance lease costs	4,412	4,712	4,970
Operating lease costs	36,051	36,079	35,656
Variable lease costs	3,887	3,721	3,617
Short-term lease costs	1,039	1,018	1,221
Total operating lease costs	40,977	40,818	40,494
Total lease costs	$ 45,389	$ 45,530	$ 45,464

Note 7 - Long-term Leases - Mat

Note 7 - Long-term Leases - Maturity of Lease Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
2023, finance leases	$ 5,200
2023, operating leases	35,973
2024, finance leases	867
2024, operating leases	34,013
2025, finance leases	0
2025, operating leases	33,224
2026, finance leases	0
2026, operating leases	32,589
2027, finance leases	0
2027, operating leases	208
Thereafter, finance leases	0
Thereafter, operating leases	0
Total minimum lease payments, finance leases	6,067
Total minimum lease payments, operating leases	136,007
Less: amounts representing interest, finance leases	(222)
Less: amounts representing interest, operating leases	(15,916)
Present value of future minimum lease payments, finance leases	5,845
Present value of future minimum lease payments, operating leases	120,091
Less: current portion, finance leases	(4,985)	$ (4,695)
Less: current portion, operating leases	(29,075)	(27,574)
Noncurrent lease liabilities, finance leases	860	5,845
Noncurrent lease liabilities, operating leases	$ 91,016	$ 128,542

Note 7 - Long-term Leases - Cas

Note 7 - Long-term Leases - Cash Flow Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Operating cash flows for operating leases	$ 36,051	$ 36,079	$ 35,656
Operating cash flows for finance leases	534	807	1,064
Financing cash flows for finance leases	$ 4,695	$ 4,423	$ 4,166

Note 8 - Earnings Per Share (De

Note 8 - Earnings Per Share (Details Textual) - shares	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Share-Based Payment Arrangement, Option [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount (in shares)	375,638	291,946	713,956

Note 8 - Earnings Per Share - S

Note 8 - Earnings Per Share - Summary of Earnings and Weighted Average Number of Common Shares Used in Calculation of Basic and Diluted Earnings Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Basic:
Weighted average common shares outstanding (in shares)	15,410,222	15,347,129	15,306,174
Net income attributable to common stockholders of National Healthcare Corporation	$ 22,445	$ 138,590	$ 41,871
Earnings per common share, basic (in dollars per share)	$ 1.46	$ 9.03	$ 2.74
Diluted:
Weighted average common shares outstanding (in shares)	15,410,222	15,347,129	15,306,174
Assumed average common shares outstanding (in shares)	15,447,211	15,416,716	15,369,523
Net income attributable to common stockholders of National Healthcare Corporation	$ 22,445	$ 138,590	$ 41,871
Earnings per common share, diluted (in dollars per share)	$ 1.45	$ 8.99	$ 2.72
Share-Based Payment Arrangement, Option [Member]
Diluted:
Dilutive effect of stock options (in shares)	36,989	69,587	63,349

Note 9 - Investments in Marke_3

Note 9 - Investments in Marketable Securities (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Equity Securities Fv Ni Gross Unrealized Gain	$ 71,869,000	$ 85,394,000
Equity Securities Fv Ni Gross Unrealized Loss	3,227,000	946,000
Equity Securities, FV-NI, Unrealized Gain (Loss), Total	(15,806,000)	(13,863,000)	$ (23,966,000)
Debt Securities, Available-for-Sale, Accumulated Gross Unrealized Gain, before Tax	9,000	3,189,000
Debt Securities, Available-for-Sale, Accumulated Gross Unrealized Loss, before Tax	11,071,000	1,176,000
Other-than-temporary Impairment Loss, Debt Securities, Available-for-sale, Total	0
Proceeds from Sale and Maturity of Marketable Securities	49,961,000	101,920,000	40,994,000
Debt Securities, Realized Gain (Loss), Total	$ (1,326,000)	$ 1,042,000	$ 195,000

Note 9 - Investments in Marke_4

Note 9 - Investments in Marketable Securities - Marketable Securities and Restricted Marketable Securities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Marketable equity securities	$ 100,786	$ 113,108
Unrestricted investments available for sale, debt, amortized cost	153,709	170,087
Unrestricted investments available for sale, debt, fair value	142,647	172,100
Restricted marketable equity securities	22,358	26,958
Investments available for sale, amortized cost	208,211	225,705
Marketable Securities, Total	265,791	312,166
Equity Securities [Member]
Unrestricted investments available for sale, equity, amortized cost	30,176	30,176
Marketable equity securities	100,786	113,108
Restricted investments available for sale, equity, amortized cost	24,326	25,442
Restricted marketable equity securities	22,358	26,958
Corporate Debt Securities [Member]
Unrestricted investments available for sale, debt, amortized cost	14,317	19,038
Unrestricted investments available for sale, debt, fair value	13,885	18,843
Restricted investments available for sale, debt, amortized cost	54,412	60,816
Restricted investments available for sale, debt, fair value	51,009	62,936
Asset-Backed Securities [Member]
Unrestricted investments available for sale, debt, amortized cost	500	1,481
Unrestricted investments available for sale, debt, fair value	494	1,469
Restricted investments available for sale, debt, amortized cost	24,605	32,918
Restricted investments available for sale, debt, fair value	22,437	33,301
US Government Corporations and Agencies Securities [Member]
Unrestricted investments available for sale, debt, amortized cost	9,009	15,082
Unrestricted investments available for sale, debt, fair value	8,757	14,998
Restricted investments available for sale, debt, amortized cost	45,989	33,052
Restricted investments available for sale, debt, fair value	41,294	32,630
US States and Political Subdivisions Debt Securities [Member]
Restricted investments available for sale, debt, amortized cost	4,877	7,700
Restricted investments available for sale, debt, fair value	$ 4,771	$ 7,923

Note 9 - Investments in Marke_5

Note 9 - Investments in Marketable Securities - Available for Sale Marketable Equity Securities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
NHI Common Stock, fair value	$ 100,786	$ 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	$ 85,152	$ 93,713

Note 9 - Investments in Marke_6

Note 9 - Investments in Marketable Securities - Amortized Cost and Estimated Fair Value of Debt Securities as Available for Sale (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Within 1 year, cost	$ 33,662	$ 32,718
Within 1 year, fair value	33,037	32,843
1 to 5 years, cost	81,500	95,293
1 to 5 years, fair value	76,394	96,937
6 to 10 years, cost	38,547	41,580
6 to 10 years, fair value	33,216	41,835
Over 10 years, cost	0	496
Over 10 years, fair value	0	485
Cost	153,709	170,087
Fair Value	$ 142,647	$ 172,100

Note 10 - Fair Value Measurem_3

Note 10 - Fair Value Measurements - Summary of Fair Value Measurements by Level (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Restricted cash and cash equivalents	$ 16,198	$ 12,136	$ 11,409
Available-for-sale securities (USD)	142,647	172,100
Corporate Debt Securities [Member]
Available-for-sale securities (USD)	13,885	18,843
Asset-Backed Securities [Member]
Available-for-sale securities (USD)	494	1,469
Fair Value, Recurring [Member]
Cash and cash equivalents	58,667	107,607
Restricted cash and cash equivalents	16,198	12,136
Total financial assets	340,656	431,909
Fair Value, Recurring [Member] | Equity Securities [Member]
Marketable equity securities	123,144	140,066
Fair Value, Recurring [Member] | Corporate Debt Securities [Member]
Available-for-sale securities (USD)	64,894	81,779
Fair Value, Recurring [Member] | Asset-Backed Securities [Member]
Available-for-sale securities (USD)	22,931	34,770
Fair Value, Recurring [Member] | US Treasury Securities [Member]
Available-for-sale securities (USD)	50,051	47,628
Fair Value, Recurring [Member] | US States and Political Subdivisions Debt Securities [Member]
Available-for-sale securities (USD)	4,771	7,923
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member]
Cash and cash equivalents	58,667	107,607
Restricted cash and cash equivalents	16,198	12,136
Total financial assets	297,922	357,442
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Equity Securities [Member]
Marketable equity securities	123,144	140,066
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Corporate Debt Securities [Member]
Available-for-sale securities (USD)	48,525	50,005
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Asset-Backed Securities [Member]
Available-for-sale securities (USD)	0	0
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | US Treasury Securities [Member]
Available-for-sale securities (USD)	50,051	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)	1,337	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	42,734	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)	16,369	31,774
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Asset-Backed Securities [Member]
Available-for-sale securities (USD)	22,931	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)	$ 3,434	$ 7,923

Note 11 - Property and Equipm_3

Note 11 - Property and Equipment - Property and Equipment, at Cost (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Land	$ 67,165	$ 66,267
Leasehold improvements	125,142	122,391
Buildings and improvements	688,433	654,656
Furniture and equipment	187,743	185,320
Construction in progress	12,736	35,703
Property and equipment, at cost	1,081,219	1,064,337
Less: Accumulated depreciation	(574,687)	(543,341)
Property, Plant and Equipment, Net, Total	$ 506,532	$ 520,996

Note 12 - Goodwill and Other _3

Note 12 - Goodwill and Other Intangible Assets (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Goodwill and Intangible Asset Impairment, Total	$ 0	$ 0	$ 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) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Goodwill, balance	$ 168,295	$ 21,341	$ 20,995
Goodwill, additions	0	146,954	346
Goodwill, balance	168,295	168,295	21,341
Inpatient Services Segment [Member]
Goodwill, balance	3,741	3,741	3,395
Goodwill, additions	0	0	346
Goodwill, balance	3,741	3,741	3,741
Homecare and Hospice Segment [Member]
Goodwill, balance	164,554	17,600	17,600
Goodwill, additions	0	146,954	0
Goodwill, balance	$ 164,554	$ 164,554	$ 17,600

Note 13 - Income Taxes (Details

Note 13 - Income Taxes (Details Textual)	Dec. 31, 2022 USD ($)
Unrecognized Tax Benefits, Ending Balance	$ 4,109,000
Significant Change in Unrecognized Tax Benefits is Reasonably Possible, Amount of Unrecorded Benefit	$ 1,656,000

Note 13 - Income Taxes - Provis

Note 13 - Income Taxes - Provision for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Federal	$ 717	$ 15,072	$ 19,054
State	251	1,164	2,337
Total current tax provision	968	16,236	21,391
Federal	4,595	(3,866)	(8,349)
State	1,691	(1,419)	(2,609)
Total deferred tax provision	6,286	(5,285)	(10,958)
Effective income tax expense	$ 7,254	$ 10,951	$ 10,433

Note 13 - Income Taxes - Deferr

Note 13 - Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Accrued risk reserves	$ 2,209	$ 1,803
Accrued expenses	6,441	9,663
Financial reporting depreciation in excess of tax depreciation	5,505	5,610
Stock based compensation	742	527
Deferred revenue	3,393	8,019
Operating lease liabilities	30,558	39,629
Other	1,711	1,991
Total gross deferred tax assets	50,559	67,242
Less: valuation allowance	(978)	0
Deferred tax assets less valuation allowance	49,581	67,242
Unrealized gains on marketable securities	(15,396)	(22,401)
Deferred gain on sale of assets, net	(2,045)	(2,040)
Book basis in excess of tax basis of intangible assets	(3,063)	(2,708)
Book basis in excess of tax basis of securities	(3,164)	(2,822)
Long–term investments	(6,155)	(4,494)
Operating lease assets	(30,667)	(39,629)
Total deferred tax liabilities	(60,490)	(74,094)
Net deferred tax liability	$ (10,909)	$ (6,852)

Note 13 - Income Taxes - Reconc

Note 13 - Income Taxes - Reconciliation of Income Tax Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Tax provision at federal statutory rate	$ 5,719	$ 31,508	$ 11,009
State, net of federal benefit	(1,034)	(1,113)	(1,631)
Nontaxable revaluation gain	0	(19,758)	0
Unrecognized tax benefits	730	(158)	166
Expiration of statute of limitations	(1,032)	(1,901)	(2,366)
Tax (expense) benefit of minority interest	518	(104)	(30)
Other	285	251	23
Total increases (decreases)	1,535	(20,557)	(576)
Effective income tax expense	$ 7,254	$ 10,951	$ 10,433

Note 13 - Income Taxes - Reco_2

Note 13 - Income Taxes - Reconciliation of Unrecognized Tax Benefits (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Balance	$ 4,109,000
Deferred Tax Assets [Member]
Balance	5,455,000	$ 5,666,000	$ 7,413,000
Additions based on tax positions related to the current year	636,000	665,000	1,229,000
Additions (reductions) for tax positions of prior years	(1,097,000)	(441,000)	(2,432,000)
Reductions for statute of limitation expirations	(240,000)	(435,000)	(544,000)
Balance	4,754,000	5,455,000	5,666,000
Liability for Unrecognized Tax Benefits [Member]
Balance	8,902,000	9,893,000	12,749,000
Additions based on tax positions related to the current year	636,000	665,000	1,229,000
Additions (reductions) for tax positions of prior years	(273,000)	(187,000)	(2,273,000)
Reductions for statute of limitation expirations	(760,000)	(1,469,000)	(1,812,000)
Balance	8,505,000	8,902,000	9,893,000
Liability for Interest and Penalties [Member]
Balance	2,290,000	2,614,000	3,309,000
Additions based on tax positions related to the current year	0	0	0
Additions (reductions) for tax positions of prior years	900,000	543,000	403,000
Reductions for statute of limitation expirations	(512,000)	(867,000)	(1,098,000)
Balance	2,678,000	2,290,000	2,614,000
Total Liability [Member]
Balance	11,192,000	12,507,000	16,058,000
Additions based on tax positions related to the current year	636,000	665,000	1,229,000
Additions (reductions) for tax positions of prior years	627,000	356,000	(1,870,000)
Reductions for statute of limitation expirations	(1,272,000)	(2,336,000)	(2,910,000)
Balance	$ 11,183,000	$ 11,192,000	$ 12,507,000

Note 14 - Stock Repurchase Pr_2

Note 14 - Stock Repurchase Program (Details Textual) - Common Stock [Member]	12 Months Ended
	Dec. 31, 2022 USD ($) shares
Stock Repurchased and Retired During Period, Shares (in shares) | shares	148,547
Stock Repurchased and Retired During Period, Value | $	$ 9,903,000

Note 15 - Stock-based Compens_3

Note 15 - Stock-based Compensation (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	May 01, 2020
Share-Based Payment Arrangement, Expense, Tax Benefit	$ 583,000	$ 2,844,000	$ 677,000
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount, Total	$ 3,182,000
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year)	2 years
Salaries, Wages, and Benefits [Member]
Share-Based Payment Arrangement, Expense	$ 2,612,000	$ 2,620,000	$ 2,453,000
The 2020 Equity Incentive Plan [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award, Number of Shares Available for Grant (in shares)	2,042,701			2,500,000
Share-Based Payment Arrangement, Option [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award, Expiration Period (Year)	10 years

Note 15 - Stock-based Compens_4

Note 15 - Stock-based Compensation - Summary of Assumptions Used to Value Options Granted (Details)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Risk–free interest rate	1.83%	0.21%	0.87%
Expected volatility	31.40%	34.90%	20.10%
Expected life (Year)	2 years 10 months 24 days	2 years 2 months 12 days	2 years 2 months 12 days
Expected dividend yield	3.57%	3%	2.91%

Note 15 - Stock-based Compens_5

Note 15 - Stock-based Compensation - Summary of Options Outstanding (Details) - $ / shares	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Options outstanding, shares (in shares)	374,926	866,956	809,529
Options outstanding, weighted average exercise price (in dollars per share)	$ 72.95	$ 72.11	$ 71.24
Options granted, shares (in shares)	302,266	55,706	104,057
Options granted, weighted average exercise price (in dollars per share)	$ 64.72	$ 70.80	$ 73.98
Options exercised, shares (in shares)	(32,597)	(541,736)	(43,630)
Options exercised, weighted average exercise price (in dollars per share)	$ 64.49	$ 71.39	$ 63.37
Options cancelled, shares (in shares)	(199,451)	(6,000)	(3,000)
Options cancelled, weighted average exercise price (in dollars per share)	$ 75.98	$ 72.94	$ 72.94
Options outstanding, shares (in shares)	445,144	374,926	866,956
Options outstanding, weighted average exercise price (in dollars per share)	$ 66.62	$ 72.95	$ 72.11
Options exercisable, shares (in shares)	157,901
Options exercisable, weighted average exercise price (in dollars per share)	$ 69.78

Note 15 - Stock-based Compens_6

Note 15 - Stock-based Compensation - Options Outstanding by Exercise Price Range (Details)	12 Months Ended
	Dec. 31, 2022 $ / shares shares
Options outstanding (in shares) | shares
Weighted average exercise price (in dollars per share)	$ 3.4
Exercise Price Range 1 [Member]
Options outstanding (in shares) | shares	61.90
Exercise price, lower range (in dollars per share)	$ 69.19
Exercise price, upper range (in dollars per share)	64.61
Weighted average exercise price (in dollars per share)	$ 3.7
Exercise Price Range 2 [Member]
Options outstanding (in shares) | shares	71.64
Exercise price, lower range (in dollars per share)	$ 77.92
Exercise price, upper range (in dollars per share)	74.72
Weighted average exercise price (in dollars per share)	$ 2.4

Note 16 - Contingencies and C_2

Note 16 - Contingencies and Commitments (Details Textual) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
Self Insurance Reserve	$ 102,469,000	$ 98,048,000

Note 17 - Relationship With N_2

Note 17 - Relationship With National Health Corporation (Details Textual)	12 Months Ended
	Dec. 31, 2022 USD ($) shares	Dec. 31, 2021 USD ($) shares	Dec. 31, 2020 USD ($) shares	Dec. 31, 2019 shares
Common Stock [Member]
Shares, Outstanding, Ending Balance (in shares) | shares	15,357,746	15,452,033	15,369,745	15,332,206
National [Member]
Line of Credit Facility, Maximum Borrowing Capacity	$ 2,000,000
Payroll and Related Services Administrative Fee Percentage	1%
Payment for Administrative Fees	$ 5,074,000	$ 5,112,000	$ 5,026,000
Employee-related Liabilities, Total	$ 74,000	$ 2,684,000
National [Member] | Common Stock [Member]
Shares, Outstanding, Ending Balance (in shares) | shares	1,084,763	1,084,763	1,084,763
Equity Owned by Related Parties	7.10%	7%	7.10%
Line of Credit [Member] | National Health Care [Member]
Line of Credit Facility, Maximum Borrowing Capacity	$ 2,000,000
Long-Term Line of Credit, Total	$ 0	$ 0
National [Member]
Number of Skilled Nursing Centers	5

Note 18 - Variable Interest E_2

Note 18 - Variable Interest Entity (Details Textual)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2010 USD ($)
Property, Plant and Equipment, Net, Total	$ 506,532,000	$ 520,996,000
Variable Interest Entity, Primary Beneficiary [Member]
Number of Variable Interest Entities	1
Number of Patient Beds in Facility			120
Lessee, Operating Lease, Term of Contract (Year)			10 years
Number of Additional Lease Options			5
Lessee, Operating Lease, Renewal Term (Year)			5 years
Financing Receivable, before Allowance for Credit Loss, Current			$ 4,500,000
Variable Interest Entity, Primary Beneficiary [Member] | Land, Buildings and Improvements [Member]
Property, Plant and Equipment, Net, Total	$ 11,047,000	11,047,000
Variable Interest Entity, Primary Beneficiary [Member] | Consolidation, Eliminations [Member]
Financing Receivable, before Allowance for Credit Loss, Current	$ 11,047,000	$ 11,047,000

Note 19 - Massachusetts and N_2

Note 19 - Massachusetts and New Hampshire Skilled Nursing Facilities (Details Textual)		12 Months Ended
	Sep. 01, 2022	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)
Revenue from Contract with Customer, Including Assessed Tax		$ 1,029,085,000	$ 965,542,000	$ 931,795,000
Income (Loss) from Continuing Operations before Income Taxes, Domestic		27,231,000	150,038,000	52,423,000
Operations Transfer Agreements for Transfer of Skilled Nursing Facilities [Member]
Operations Agreement, Skilled Nursing Facilities Transferred	7
Operations Transfer Agreements for Transfer of Skilled Nursing Facilities [Member] | Seven Skilled Nursing Facilities [Member]
Revenue from Contract with Customer, Including Assessed Tax		49,155,000	67,161,000	70,644,000
Income (Loss) from Continuing Operations before Income Taxes, Domestic		$ 2,478,000	$ 13,410,000	$ 6,569,000

Schedule II - Valuation and Q_3

Schedule II - Valuation and Qualifying Accounts - Summary of Valuation and Qualifying Accounts (Details) - Accrued Risk Reserves [Member] - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Balance	$ 98,048	$ 99,537	$ 96,011
Charged to Costs and Expenses	81,743	82,219	86,918
Deductions	77,322	83,708	83,392
Balance	$ 102,469	$ 98,048	$ 99,537