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 |