Document And Entity Information
Document And Entity Information - shares | 3 Months Ended | |
Mar. 31, 2024 | May 01, 2024 | |
Document Information [Line Items] | ||
Entity Central Index Key | 0001047335 | |
Entity Registrant Name | NATIONAL HEALTHCARE CORP | |
Amendment Flag | false | |
Current Fiscal Year End Date | --12-31 | |
Document Fiscal Period Focus | Q1 | |
Document Fiscal Year Focus | 2024 | |
Document Type | 10-Q | |
Document Quarterly Report | true | |
Document Period End Date | Mar. 31, 2024 | |
Document Transition Report | false | |
Entity File Number | 001-13489 | |
Entity Incorporation, State or Country Code | DE | |
Entity Tax Identification Number | 52-2057472 | |
Entity Address, Address Line One | 100 E. Vine Street | |
Entity Address, City or Town | Murfreesboro | |
Entity Address, State or Province | TN | |
Entity Address, Postal Zip Code | 37130 | |
City Area Code | 615 | |
Local Phone Number | 890–2020 | |
Title of 12(b) Security | Common, $0.01 par value | |
Trading Symbol | NHC | |
Security Exchange Name | NYSEAMER | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Large Accelerated Filer | |
Entity Small Business | false | |
Entity Emerging Growth Company | false | |
Entity Shell Company | false | |
Entity Common Stock, Shares Outstanding | 15,399,724 |
Interim Condensed Consolidated
Interim Condensed Consolidated Statements of Operations (Unaudited) - USD ($) | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Revenues: | ||
Net patient revenues | $ 285,823,000 | $ 258,007,000 |
Other revenues | 11,353,000 | 11,556,000 |
Net operating revenues | 297,176,000 | 269,563,000 |
Costs and expenses: | ||
Salaries, wages, and benefits | 183,138,000 | 167,824,000 |
Other operating | 77,429,000 | 71,489,000 |
Facility rent | 10,348,000 | 10,092,000 |
Depreciation and amortization | 10,586,000 | 10,048,000 |
Interest | 46,000 | 98,000 |
Total costs and expenses | 281,547,000 | 259,551,000 |
Income from operations | 15,629,000 | 10,012,000 |
Other income: | ||
Non–operating income | 5,685,000 | 4,323,000 |
Unrealized gains on marketable equity securities | 14,399,000 | 1,386,000 |
Income before income taxes | 35,713,000 | 15,721,000 |
Income tax provision | (9,462,000) | (4,436,000) |
Net income | 26,251,000 | 11,285,000 |
Net (income)/loss attributable to noncontrolling interest | (38,000) | 438,000 |
Net income attributable to National HealthCare Corporation | $ 26,213,000 | $ 11,723,000 |
Earnings per share attributable to National HealthCare Corporation stockholders: | ||
Basic (in dollars per share) | $ 1.71 | $ 0.76 |
Diluted (in dollars per share) | $ 1.69 | $ 0.76 |
Basic (in shares) | 15,350,240 | 15,337,423 |
Diluted (in shares) | 15,505,096 | 15,356,335 |
Dividends declared per common share (in dollars per share) | $ 0.59 | $ 0.57 |
Interim Condensed Consolidate_2
Interim Condensed Consolidated Statements of Comprehensive Income (Unaudited) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Net income | $ 26,251 | $ 11,285 |
Other comprehensive income/(loss): | ||
Unrealized gains/(losses) on investments in marketable debt securities | (472) | 1,958 |
Reclassification adjustment for realized gains on sales of marketable debt securities | (10) | 0 |
Income tax (expense)/benefit related to items of other comprehensive income | 45 | (279) |
Other comprehensive income/(loss), net of tax | (437) | 1,679 |
Net (income)/loss attributable to noncontrolling interest | (38) | 438 |
Comprehensive income attributable to National HealthCare Corporation | $ 25,776 | $ 13,402 |
Interim Condensed Consolidate_3
Interim Condensed Consolidated Balance Sheets (Current Period Unaudited) - USD ($) | Mar. 31, 2024 | Dec. 31, 2023 |
Current Assets: | ||
Cash and cash equivalents | $ 93,982,000 | $ 107,076,000 |
Restricted cash and cash equivalents, current portion | 26,010,000 | 17,725,000 |
Marketable equity securities | 123,040,000 | 111,117,000 |
Marketable debt securities | 484,000 | 5,427,000 |
Restricted marketable equity securities | 29,616,000 | 26,779,000 |
Restricted marketable debt securities, current portion | 4,790,000 | 12,822,000 |
Accounts receivable | 125,664,000 | 108,545,000 |
Inventories | 6,763,000 | 7,386,000 |
Prepaid expenses and other assets | 6,750,000 | 8,855,000 |
Notes receivable | 487,000 | 503,000 |
Total current assets | 417,586,000 | 406,235,000 |
Property and Equipment: | ||
Property and equipment, at cost | 1,065,543,000 | 1,101,681,000 |
Accumulated depreciation and amortization | (576,845,000) | (608,352,000) |
Net property and equipment | 488,698,000 | 493,329,000 |
Other Assets: | ||
Restricted cash and cash equivalents, less current portion | 1,140,000 | 1,167,000 |
Restricted marketable debt securities, less current portion | 119,042,000 | 109,478,000 |
Deposits and other assets | 13,738,000 | 14,786,000 |
Operating lease right-of-use assets | 87,356,000 | 94,201,000 |
Goodwill | 168,295,000 | 168,295,000 |
Intangible assets | 7,038,000 | 7,038,000 |
Investments in unconsolidated companies | 16,747,000 | 16,267,000 |
Total other assets | 413,356,000 | 411,232,000 |
Total assets | 1,319,640,000 | 1,310,796,000 |
Current Liabilities: | ||
Trade accounts payable | 20,697,000 | 19,194,000 |
Finance lease obligations, current portion | 0 | 860,000 |
Operating lease liabilities, current portion | 29,733,000 | 29,352,000 |
Accrued payroll | 64,156,000 | 84,110,000 |
Amounts due to third party payors | 19,988,000 | 18,369,000 |
Accrued risk reserves, current portion | 30,800,000 | 30,549,000 |
Other current liabilities | 24,302,000 | 22,991,000 |
Contract liabilities | 7,667,000 | 0 |
Dividends payable | 9,086,000 | 9,051,000 |
Total current liabilities | 206,429,000 | 214,476,000 |
Operating lease liabilities, less current portion | 56,004,000 | 63,175,000 |
Accrued risk reserves, less current portion | 77,437,000 | 72,710,000 |
Refundable entrance fees | 5,708,000 | 6,376,000 |
Deferred income taxes | 19,639,000 | 17,200,000 |
Other noncurrent liabilities | 27,909,000 | 26,379,000 |
Total liabilities | 393,126,000 | 400,316,000 |
Equity: | ||
Common stock, $.01 par value; 45,000,000 shares authorized; 15,399,724 and 15,350,661 shares, respectively, issued and outstanding | 154,000 | 153,000 |
Capital in excess of par value | 226,909,000 | 227,604,000 |
Retained earnings | 704,726,000 | 687,599,000 |
Accumulated other comprehensive loss | (7,041,000) | (6,604,000) |
Total National HealthCare Corporation stockholders’ equity | 924,748,000 | 908,752,000 |
Noncontrolling interest | 1,766,000 | 1,728,000 |
Total equity | 926,514,000 | 910,480,000 |
Total liabilities and equity | $ 1,319,640,000 | $ 1,310,796,000 |
Interim Condensed Consolidate_4
Interim Condensed Consolidated Balance Sheets (Current Period Unaudited) (Parentheticals) - $ / shares | Mar. 31, 2024 | Dec. 31, 2023 |
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) | 15,399,724 | 15,350,661 |
Common stock, shares outstanding (in shares) | 15,399,724 | 15,350,661 |
Interim Condensed Consolidate_5
Interim Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Cash Flows From Operating Activities: | ||
Net income | $ 26,251,000 | $ 11,285,000 |
Adjustments to reconcile net income to net cash provided by operating activities: | ||
Depreciation and amortization | 10,586,000 | 10,048,000 |
Equity in earnings of unconsolidated investments | (67,000) | (1,535,000) |
Unrealized gains on marketable equity securities | (14,399,000) | (1,386,000) |
(Gains)/losses on sale of marketable securities | (344,000) | 492,000 |
Gain on sale of unconsolidated company | (1,024,000) | 0 |
Deferred income taxes | (2,484,000) | (331,000) |
Stock–based compensation | 793,000 | 639,000 |
Changes in operating assets and liabilities: | ||
Accounts receivable | (17,119,000) | (3,148,000) |
Inventories | 623,000 | 142,000 |
Prepaid expenses and other assets | 3,153,000 | 1,957,000 |
Operating lease obligations | 55,000 | (316,000) |
Trade accounts payable | 1,503,000 | (4,018,000) |
Accrued payroll | (19,954,000) | (15,800,000) |
Amounts due to third party payors | 1,619,000 | 48,000 |
Accrued risk reserves | 4,978,000 | 3,157,000 |
Contract liabilities | 7,667,000 | 0 |
Other current liabilities | 1,311,000 | 5,407,000 |
Other noncurrent liabilities | 1,530,000 | 6,554,000 |
Net cash provided by operating activities | 9,646,000 | 13,857,000 |
Cash Flows From Investing Activities: | ||
Purchases of property and equipment | (5,955,000) | (6,640,000) |
Proceeds from sale of unconsolidated company | 2,100,000 | 0 |
Investments in unconsolidated companies | (1,488,000) | 0 |
Collections of notes receivable | 16,000 | 2,000 |
Purchases of marketable securities | (8,703,000) | (10,281,000) |
Proceeds from sale of marketable securities | 11,615,000 | 15,492,000 |
Net cash used in investing activities | (2,415,000) | (1,427,000) |
Cash Flows From Financing Activities: | ||
Principal payments under finance lease obligations | (860,000) | (1,218,000) |
Dividends paid to common stockholders | (9,051,000) | (8,748,000) |
Issuance of common stock | 8,412,000 | 0 |
Repurchase of common shares | (9,900,000) | (2,482,000) |
Entrance fee refunds | (668,000) | (171,000) |
Net cash used in financing activities | (12,067,000) | (12,619,000) |
Net Decrease in Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents | (4,836,000) | (189,000) |
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, Beginning of Period | 125,968,000 | 74,865,000 |
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, End of Period | 121,132,000 | 74,676,000 |
Balance Sheet Classifications: | ||
Cash and cash equivalents | 93,982,000 | 46,144,000 |
Restricted Cash and Cash Equivalents | 27,150,000 | 28,532,000 |
Total Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents | $ 121,132,000 | $ 74,676,000 |
Interim Condensed Consolidate_6
Interim Condensed Consolidated Statements of Stockholders' Equity (Unaudited) - USD ($) $ in Thousands | Common Stock [Member] | Additional Paid-in Capital [Member] | Retained Earnings [Member] | AOCI Attributable to Parent [Member] | Noncontrolling Interest [Member] | Total |
Balance (in shares) at Dec. 31, 2022 | 15,357,746 | |||||
Balance at Dec. 31, 2022 | $ 153 | $ 226,991 | $ 656,664 | $ (9,532) | $ 3,238 | $ 877,514 |
Net income | 0 | 0 | 11,723 | 0 | (438) | 11,285 |
Other comprehensive income (loss) | 0 | 0 | 0 | 1,679 | 0 | 1,679 |
Stock–based compensation | $ 0 | 639 | 0 | 0 | 0 | 639 |
Shares sold – options exercised (in shares) | 7,046 | |||||
Shares sold – options exercised | $ 0 | 0 | 0 | 0 | 0 | 0 |
Repurchase of common shares (in shares) | (44,349) | |||||
Repurchase of common shares | $ 0 | (2,482) | 0 | 0 | 0 | (2,482) |
Dividends declared to common stockholders | $ 0 | 0 | (8,733) | 0 | 0 | (8,733) |
Balance (in shares) at Mar. 31, 2023 | 15,320,443 | |||||
Balance at Mar. 31, 2023 | $ 153 | 225,148 | 659,654 | (7,853) | 2,800 | 879,902 |
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 |
Shares sold – options exercised (in shares) | 103,481 | |||||
Balance (in shares) at Dec. 31, 2023 | 15,350,661 | |||||
Balance at Dec. 31, 2023 | $ 153 | 227,604 | 687,599 | (6,604) | 1,728 | $ 910,480 |
Net income | 0 | 0 | 26,213 | 0 | 38 | 26,251 |
Other comprehensive income (loss) | 0 | 0 | 0 | (437) | 0 | (437) |
Stock–based compensation | $ 0 | 793 | 0 | 0 | 0 | $ 793 |
Shares sold – options exercised (in shares) | 150,194 | 137,874 | ||||
Shares sold – options exercised | $ 1 | 8,412 | 0 | 0 | 0 | $ 8,413 |
Repurchase of common shares (in shares) | (101,131) | |||||
Repurchase of common shares | $ 0 | (9,900) | 0 | 0 | 0 | (9,900) |
Dividends declared to common stockholders | $ 0 | 0 | (9,086) | 0 | 0 | (9,086) |
Balance (in shares) at Mar. 31, 2024 | 15,399,724 | |||||
Balance at Mar. 31, 2024 | $ 154 | $ 226,909 | $ 704,726 | $ (7,041) | $ 1,766 | $ 926,514 |
Interim Condensed Consolidate_7
Interim Condensed Consolidated Statements of Stockholders' Equity (Unaudited) (Parentheticals) - $ / shares | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Dividends declared to common stockholders, per share (in dollars per share) | $ 0.59 | $ 0.57 |
Note 1 - Description of Busines
Note 1 - Description of Business | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block] | Note 1 Description of Business National HealthCare Corporation (“NHC” or the “Company”) is a leading provider of senior health care services. As of March 31, 2024, 1,365 |
Note 2 - Summary of Significant
Note 2 - Summary of Significant Accounting Policies | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Significant Accounting Policies [Text Block] | Note 2 Summary of Significant Accounting Policies The listing below is not not December 31, 2023 December 31, 2023 www.nhccare.com Basis of Presentation The unaudited interim condensed consolidated financial statements to which these notes are attached include all normal, recurring adjustments which are necessary to fairly present the financial position, results of operations and cash flows of NHC. All significant intercompany transactions and balances have been eliminated in consolidation. The consolidated financial statements include the accounts of all entities controlled by NHC. The Company presents noncontrolling interest within the equity section of its consolidated balance sheets. The Company presents the amount of consolidated net income that is attributable to NHC and the noncontrolling interest in its consolidated statements of operations. We assume that users of these interim financial statements have read or have access to the audited December 31, 2023 may not may Estimates and Assumptions The preparation of financial statements in conformity with U.S. GAAP requires us to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates and could cause our reported net income to vary significantly from period to period. 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 three March 31, 2024 2023, March 31, 2024, December 31, 2023, 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. 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 $6,164,000 and $5,653,000 for the three March 31, 2024 2023, Long-Term Leases The Company’s lease portfolio primarily consists of operating real estate leases for certain skilled nursing facilities, assisted and independent living facilities, homecare and hospice offices, and pharmacy warehouses. The original terms of the leases typically range from two fifteen may not The Company records right-of-use assets and liabilities for non-cancelable real estate operating leases with original or remaining lease terms in excess of one 12 not not Operating lease right-of-use assets and liabilities are recorded at the present value of the lease payments over the lease term. The present value of the lease payments are discounted using the incremental borrowing rate associated with each lease. The variable components of the lease payment that fluctuate with the operations of a health facility are not Property and Equipment Property and equipment are recorded at cost. Depreciation is provided by the straight-line method over the expected useful lives of the assets estimated as follows: buildings and improvements, 20-40 years and equipment and furniture, 3-15 years. Leasehold improvements are amortized over periods that do not Business Combinations We account for acquisitions using the acquisition method of accounting in accordance with ASC 805, Business Combinations. Goodwill and Other Intangible Assets Goodwill represents the excess of 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 self–insured for risks related to workers’ compensation and general and professional liability insurance. We have two Professional liability remains an area of particular concern to us. The long-term care industry has seen an increase in personal injury/wrongful death claims based on alleged negligence by skilled nursing facilities and their employees in providing care to residents. The Company has been, and continues to be, subject to claims and legal actions that arise in the ordinary course of business, including potential claims related to patient care and treatment. A significant increase in the number of these claims, or an increase in the amounts due as a result of these claims could have a material adverse effect on our consolidated financial position, results of operations and cash flows. It is also possible that future events could cause us to make significant adjustments or revisions to these reserve estimates and cause our reported net income to vary significantly from period to period. We are principally self-insured for incidents occurring in all centers owned or leased by us. The coverages include both primary policies and excess policies. In all years, settlements, if any, in excess of available insurance policy limits and our own reserves would be expensed by us. Continuing Care Contracts We have one may Non-refundable fees are included as a component of the transaction price and are amortized into revenue over the actuarily determined remaining life of the resident, which is the expected period of occupancy by the resident. We pay the refundable portion of our entry fees to residents when they relocate from our community and the apartment is re-occupied. Refundable entrance fees are not We also annually estimate the present value of the cost of future services and the use of facilities to be provided to the current CCRC residents and compare that amount with the balance of non-refundable deferred revenue from entrance fees received. If the present value of the cost of future services exceeds the related anticipated revenues, a liability is recorded with a corresponding charge to income. As of March 31, 2024, December 31, 2023, Other Noncurrent Liabilities Other noncurrent liabilities include reserves primarily related to various uncertain income tax positions, deferred revenue, and obligations to provide future services to our CCRC residents. Deferred revenue includes the deferred gain on the sale of assets to National Health Corporation (“National”) and the non-refundable portion ( 10% Other noncurrent liabilities also include funds received related to the Employee Retention Credit ("ERC"), a refundable tax credit for businesses that sustained a partial suspension of operations limiting commerce due to COVID- 19 2020 2021. Noncontrolling Interest The noncontrolling interest in a subsidiary is presented within total equity in the Company's interim condensed consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to NHC in its interim condensed consolidated statements of operations. The Company’s earnings per share is calculated based on net income attributable to NHC’s stockholders. The carrying amount of the noncontrolling interest is adjusted based on an allocation of the subsidiary earnings, contributions, and distributions. Variable Interest Entities We have equity interests in unconsolidated limited liability companies that operate various post-acute and senior healthcare businesses. We analyze our investments in these limited liability companies to determine if the company is considered a variable interest entity (“VIE”) and would require consolidation. To the extent that we own interests in a VIE and we (i) have the power to direct the activities of the VIE and (ii) have the obligation or rights to absorb the VIE's losses or receive its benefits, then we would be determined to be the primary beneficiary and would consolidate the VIE. To the extent we own interests in a VIE, then at each reporting period, we re-assess our conclusions as to which, if any, party within the VIE is considered the primary beneficiary. The Company's maximum exposure to losses in its investments in unconsolidated VIEs cannot be quantified and may may not Recently Issued Accounting Guidance In November 2023, No. 2023 07, Segment Reporting (Topic 280 December 15, 2023, 2024, December 15, 2024. |
Note 3 - Net Patient Revenues
Note 3 - Net Patient Revenues | 3 Months Ended |
Mar. 31, 2024 | |
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 (in thousands) Three Months Ended March 31 2024 2023 Net patient revenues: Inpatient services $ 252,254 $ 226,169 Homecare and hospice 33,569 31,838 Total net patient revenues $ 285,823 $ 258,007 For inpatient and hospice services, revenue is recognized on a daily basis as each day represents a separate contract and performance obligation. For homecare, revenue is recognized when services are provided based on the number of days of service rendered in the period of care or on a per-visit basis. Typically, patients and third As our performance obligations relate to contracts with a duration of one not no one not Revenue by Payor Certain groups of patients receive funds to pay the cost of their care from a common source. The following table sets forth sources of net patient revenues for the periods indicated: Three Months Ended March 31 Source 2024 2023 Medicare 34% 36% Managed Care 10% 11% Medicaid 28% 27% Private Pay and Other 28% 26% Total 100% 100% Medicare covers skilled nursing services for beneficiaries who require nursing care and/or rehabilitation services following a hospitalization of at least three 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. State Relief Supplemental Funding The Company received supplemental Medicaid payments from various states, including healthcare relief funding under the American Rescue Plan Act ("ARPA") and other state specific relief programs. The funding generally incorporates specific use requirements primarily for direct patient care including labor related expenses or various patient care related expenses. We have recorded $3,462,000 and $4,883,000 in net patient revenues for these supplemental Medicaid payments for the three March 31, 2024 2023, Contract Liabilities Included in the Company’s interim condensed consolidated balance sheets are contract liabilities, which represent payments the Company receives in advance of services provided. As of March 31, 2024 December 31, 2023, first 2024 February 21, 2024. first 2024. A summary of the activity related to contract liabilities follows ( in thousands Balance at December 31, 2023 $ - Payments received 9,881 Payments recouped (2,214 ) Balance at March 31, 2024 $ 7,667 Third Party Payors Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. Noncompliance with such laws and regulations can be subject to regulatory actions including fines, penalties, and exclusion from the Medicare and Medicaid programs. We believe that we are following all applicable laws and regulations. Medicare and Medicaid program revenues, as well as certain Managed Care program revenues, are subject to audit and retroactive adjustment by government representatives or their agents. Settlements with third not no not March 31, 2024 December 31, 2023, |
Note 4 - Other Revenues
Note 4 - Other Revenues | 3 Months Ended |
Mar. 31, 2024 | |
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) Three Months Ended March 31 2024 2023 Rental income $ 5,959 $ 6,043 Management and accounting services fees 4,438 4,097 Insurance services 872 1,048 Other 84 368 Total other revenues $ 11,353 $ 11,556 Rental Income The Company leases real estate assets consisting of skilled nursing facilities and assisted living facilities to third 7 Management Fees from National Health Corporation We manage five skilled nursing facilities owned by National Health Corporation (“National”). For the three March 31, 2024 2023, Insurance Services For workers’ compensation insurance services, the premium revenues reflected in the interim condensed consolidated statements of operations for the three March 31, 2024 2023 For professional liability insurance services, the premium revenues reflected in the interim condensed consolidated statements of operations for the three March 31, 2024 2023 |
Note 5 - Non-operating Income
Note 5 - Non-operating Income | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Other Nonoperating Income and Expense [Text Block] | Note 5 Non Operating Income Non–operating income is comprised of the following (in thousands): Three Months Ended March 31 2024 2023 Dividends and net realized gains and losses on sales of securities $ 2,056 $ 1,233 Interest income 2,538 1,555 Equity in earnings of unconsolidated investments 67 1,535 Gain on sale of unconsolidated company 1,024 - Total non-operating income $ 5,685 $ 4,323 Gain on sale of unconsolidated company In January 2024, |
Note 6 - Business Segments
Note 6 - Business Segments | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Segment Reporting Disclosure [Text Block] | Note 6 Business Segments The Company has two 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 table sets forth the Company’s unaudited interim condensed consolidated statements of operations by business segment (in thousands Three Months Ended March 31, 2024 Inpatient Homecare and Hospice All Other Total Revenues: Net patient revenues $ 252,254 $ 33,569 $ - $ 285,823 Other revenues 15 - 11,338 11,353 Net operating revenues 252,269 33,569 11,338 297,176 Costs and expenses: Salaries, wages, and benefits 150,890 21,009 11,239 183,138 Other operating 68,683 5,972 2,774 77,429 Rent 8,112 566 1,670 10,348 Depreciation and amortization 9,630 187 769 10,586 Interest 46 - - 46 Total costs and expenses 237,361 27,734 16,452 281,547 Income/(loss) from operations 14,908 5,835 (5,114 ) 15,629 Non-operating income - - 5,685 5,685 Unrealized gains on marketable equity securities - - 14,399 14,399 Income before income taxes $ 14,908 $ 5,835 $ 14,970 $ 35,713 Three Months Ended March 31, 2023 Inpatient Homecare and Hospice All Other Total Revenues: Net patient revenues $ 226,169 $ 31,838 $ - $ 258,007 Other revenues 271 - 11,285 11,556 Net operating revenues 226,440 31,838 11,285 269,563 Costs and expenses: Salaries, wages, and benefits 138,939 20,244 8,641 167,824 Other operating 62,264 5,499 3,726 71,489 Rent 8,168 558 1,366 10,092 Depreciation and amortization 9,117 185 746 10,048 Interest 98 - - 98 Total costs and expenses 218,586 26,486 14,479 259,551 Income/(loss) from operations 7,854 5,352 (3,194 ) 10,012 Non-operating income - - 4,323 4,323 Unrealized gains on marketable equity securities - - 1,386 1,386 Income before income taxes $ 7,854 $ 5,352 $ 2,515 $ 15,721 |
Note 7 - Long-term Leases
Note 7 - Long-term Leases | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Lessee, Operating and Finance Leases [Text Block] | Note 7 Long-Term Leases Operating Leases At March 31, 2024, one third 2024, 2025, 2026 December 2026. three March 31, 2024 2023, Minimum Lease Payments The following table summarizes the maturity of our operating lease liabilities as of March 31, 2024 ( in thousands Operating Leases 2025 $ 34,351 2026 33,590 2027 24,933 2028 493 2029 207 Thereafter 21 Total minimum lease payments 93,595 Less: amounts representing interest (7,858 ) Present value of future minimum lease payments 85,737 Less: current portion (29,733 ) Noncurrent lease liabilities $ 56,004 |
Note 8 - Earnings Per Share
Note 8 - Earnings Per Share | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Earnings Per Share [Text Block] | Note 8 Earnings per Share Basic net income per share is computed based on the weighted average number of common shares outstanding for each period presented. Diluted net income per share reflects the potential dilution that would have occurred if securities to issue common stock were exercised, converted, or resulted in the issuance of common stock that would have then shared in our earnings. The following table summarizes the earnings and the weighted average number of common shares used in the calculation of basic and diluted earnings per share (in thousands, except for share and per share amounts): Three Months Ended 2024 2023 Basic: Weighted average common shares outstanding 15,350,240 15,337,423 Net income attributable to National HealthCare Corporation $ 26,213 $ 11,723 Earnings per common share, basic $ 1.71 $ 0.76 Diluted: Weighted average common shares outstanding 15,350,240 15,337,423 Effects of dilutive instruments 154,856 18,912 Weighted average common shares outstanding 15,505,096 15,356,335 Net income attributable to National HealthCare Corporation $ 26,213 $ 11,723 Earnings per common share, diluted $ 1.69 $ 0.76 For the three March 31, 2024, three March 31, 2023, |
Note 9 - Investments in Marketa
Note 9 - Investments in Marketable Securities | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Investments in Debt and Marketable Equity Securities (and Certain Trading Assets) Disclosure [Text Block] | Note 9 Investments in Marketable Securities Our investments in marketable equity securities are carried at fair value with the changes in unrealized gains and losses recognized in our results of operations at each measurement date. Our investments in marketable debt securities are classified as available for sale securities and carried at fair value with the unrealized gains and losses recognized through accumulated other comprehensive income at each measurement date. Any credit-related decline in fair market values below the amortized cost of our available for sale debt securities are recorded in our results of operations through an allowance for credit losses. Realized gains and losses from securities sales are recognized in results of operations upon disposition of the securities using the specific identification method on a trade date basis. Refer to Note 10 Marketable securities consist of the following (in thousands) March 31, 2024 December 31, 2023 Amortized Cost Fair Value Amortized Cost Fair Value Investments available for sale: Marketable equity securities $ 30,176 $ 123,040 $ 30,176 $ 111,117 Corporate debt securities 494 484 2,497 2,441 U.S. Treasury securities - - 2,990 2,986 Restricted investments available for sale: Marketable equity securities 24,495 29,616 24,134 26,779 Corporate debt securities 61,488 59,398 59,586 57,731 Asset-based securities 19,026 17,438 19,388 17,659 U.S. Treasury securities 47,323 43,004 46,771 42,863 State and municipal securities 4,079 3,992 4,106 4,047 $ 187,081 $ 276,972 $ 189,648 265,623 Included in the marketable equity securities are the following (in thousands, except share amounts): March 31, 2024 December 31, 2023 Shares Cost Fair Value Shares Cost Fair Value NHI Common Stock 1,630,642 $ 24,734 $ 102,453 1,630,642 $ 24,734 $ 91,071 The amortized cost and estimated fair value of debt securities classified as available for sale, by contractual maturity, are as follows (in thousands) March 31, 2024 December 31, 2023 Cost Fair Value Cost Fair Value Maturities: Within 1 year $ 21,299 $ 20,785 $ 19,664 $ 19,328 1 to 5 years 77,738 73,370 81,517 77,118 6 to 10 years 32,012 28,925 33,515 30,802 Over 10 years 1,361 1,236 642 479 $ 132,410 $ 124,316 $ 135,338 $ 127,727 Gross unrealized gains related to marketable equity securities are $98,459,000 and $84,514,000 as of March 31, 2024 December 31, 2023, March 31, 2024 December 31, 2023, three March 31, 2024 2023, Gross unrealized gains related to available for sale marketable debt securities are $179,000 and $326,000 as of March 31, 2024 December 31, 2023, March 31, 2024 December 31, 2023, The Company’s unrealized losses in our available for sale marketable debt securities were determined to be non-credit related. The Company has not three March 31, 2024 2023. For the marketable 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 three March 31, 2024 2023 three March 31, 2024 2023, |
Note 10 - Fair Value Measuremen
Note 10 - Fair Value Measurements | 3 Months Ended |
Mar. 31, 2024 | |
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 following table summarizes fair value measurements by level at March 31, 2024 December 31, 2023 (in thousands) Fair Value Measurements Using March 31, 2024 Fair Value Quoted Prices in Active For Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Cash and cash equivalents $ 93,982 $ 93,982 $ – $ – Restricted cash and cash equivalents 27,150 27,150 – – Marketable equity securities 152,656 152,656 – – Corporate debt securities 59,882 42,611 17,271 – Asset–backed securities 17,438 – 16,961 477 U.S. Treasury securities 43,004 43,004 – – State and municipal securities 3,992 – 3,992 – Total financial assets $ 398,104 $ 359,403 $ 38,224 $ 477 Fair Value Measurements Using December 31, 2023 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 $ 107,076 $ 107,076 $ – $ – Restricted cash and cash equivalents 18,892 18,892 – – Marketable equity securities 137,896 137,896 – – Corporate debt securities 60,171 42,860 17,311 – Asset–backed securities 17,659 – 17,210 449 U.S. Treasury securities 45,850 45,850 – – State and municipal securities 4,047 – 4,047 – Total financial assets $ 391,591 $ 352,574 $ 38,568 $ 449 |
Note 11 - Goodwill and Other In
Note 11 - Goodwill and Other Intangible Assets | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Goodwill and Intangible Assets Disclosure [Text Block] | Note 11 Goodwill and Other Intangible Assets At March 31, 2024, not may At March 31, 2024, in thousands Inpatient Services Homecare and Hospice All Other Total January 1, 2024 $ 3,741 $ 164,554 $ – $ 168,295 Additions – – – – March 31, 2024 $ 3,741 $ 164,554 $ – $ 168,295 We also have recorded indefinite-lived intangible assets that consist of trade names ($4,340,000) and certificates of need and licenses ($2,698,000). |
Note 12 - Stock Repurchase Prog
Note 12 - Stock Repurchase Program | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Treasury Stock [Text Block] | Note 12 During the three March 31, 2024, three March 31, 2023, |
Note 13 - Stock-based Compensat
Note 13 - Stock-based Compensation | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Share-Based Payment Arrangement [Text Block] | Note 13 Stock Based Compensation NHC recognizes stock–based compensation expense for all stock options granted over the requisite service period using the fair value at the date of grant using the Black–Scholes pricing model. Stock–based compensation totaled $793,000 and $639,000 for the three March 31, 2024 2023, At March 31, 2024, three Stock Options The following table summarizes the significant assumptions used to value the options granted for the three March 31, 2024 December 31, 2023. March 31, 2024 December 31, Risk–free interest rate 4.33% 4.52% Expected volatility 24.1% 29.3% Expected life, in years 2.9 2.9 Expected dividend yield 2.64% 4.41% The following table summarizes our outstanding stock options for the three March 31, 2024 December 31, 2023. Number of Shares Weighted Average Exercise Price Aggregate Intrinsic Value Options outstanding at January 1, 2023 445,144 $ 66.62 $ – Options granted 299,278 54.44 – Options exercised (103,481 ) 64.72 – Options cancelled (52,407 ) 60.58 – Options outstanding at December 31, 2023 588,534 61.30 – Options granted 245,726 94.07 – Options exercised (137,874 ) 60.95 – Options outstanding at March 31, 2024 696,386 $ 72.93 $ 15,025,015 Options exercisable at March 31, 2024 174,105 $ 68.48 $ 4,531,876 Options Outstanding March 31, 2024 Exercise Prices Weighted Average Exercise Price Weighted Average Remaining Contractual Life in Years 377,405 53.94 - 69.19 58.92 3.5 318,981 71.64 - 94.10 89.51 4.0 696,386 72.93 3.7 |
Note 14 - Income Taxes
Note 14 - Income Taxes | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Income Tax Disclosure [Text Block] | Note 14 Income Taxes The Company's income tax provision as a percentage of our income before income taxes was 26.5% and 28.2% for the three March 31, 2024 2023, Typically, these percentages vary from the U.S. federal statutory income tax rate of 21% primarily due to state income taxes, excess tax benefits from stock-based compensation, benefits resulting from the lapsing of statute of limitations of items in our tax contingency reserve, and non-deductible expenses. For the three March 31, 2024 2023, Our quarterly income tax provision, and our estimate of our annual effective income tax rate, is subject to variation due to several factors, including volatility based on the amount of pre-tax income or loss. The Company is no 2020 |
Note 15 - Credit Facility - Sch
Note 15 - Credit Facility - Schedule of Long-Term Debt Instruments | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Schedule of Long-Term Debt Instruments [Table Text Block] | Note 15 Credit Facility In May 2023, 364 one SOFR one SOFR As of March 31, 2024, not |
Note 16 - Contingencies and Com
Note 16 - Contingencies and Commitments | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Commitments and Contingencies Disclosure [Text Block] | Note 16 Contingencies and Commitments Accrued Risk Reserves We have wholly-owned limited purpose insurance companies that insure risks related to workers’ compensation 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 $108,237,000 and $103,259,000 at March 31, 2024 December 31, 2023, As a result of the terms of our insurance policies and our use of wholly owned limited purpose insurance companies, we have retained significant insurance risk with respect to workers’ compensation and general and professional liability. We consider the professional services of independent actuaries to assist us in estimating our exposures for claims obligations (for both asserted and unasserted claims) related to deductibles and exposures in excess of coverage limits, and we maintain reserves for these obligations. Such estimates are based on many variables including historical and statistical information and other factors. Workers Compensation For workers’ compensation, we utilize a wholly–owned Tennessee domiciled property/casualty insurance company to write coverage for NHC affiliates and for third–party customers. Policies are written for a duration of twelve General and Professional Liability Insurance and Lawsuits The senior care industry has experienced significant increases in both the number of personal injury/wrongful death claims and in the severity of awards based upon alleged negligence by skilled nursing facilities and their employees in providing care to residents. The Company has been, and continues to be, subject to claims and legal actions that arise in the ordinary course of business, including potential claims related to patient care and treatment. The defense of these lawsuits may third There is certain additional litigation incidental to our business, none Qui Tam Litigation United States of America, ex rel. Jennifer Cook and Sally Gaither v. Integrated Behavioral Health, Inc., NHC HealthCare/Moulton, LLC, et al., Case No. 2:20 00877 June 22, 2020. March 1, 2021. November 4, 2021. January 28, 2022, one March 23, 2023 April 4, 2023, April 20, 2023 December 21, 2023, Governmental Regulations Laws and regulations governing 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. |
Insider Trading Arrangements
Insider Trading Arrangements | 3 Months Ended |
Mar. 31, 2024 | |
Insider Trading Arr Line Items | |
Material Terms of Trading Arrangement [Text Block] | 5. Other Information. None |
Rule 10b5-1 Arrangement Adopted [Flag] | false |
Non-Rule 10b5-1 Arrangement Adopted [Flag] | false |
Rule 10b5-1 Arrangement Terminated [Flag] | false |
Non-Rule 10b5-1 Arrangement Terminated [Flag] | false |
Significant Accounting Policies
Significant Accounting Policies (Policies) | 3 Months Ended |
Mar. 31, 2024 | |
Accounting Policies [Abstract] | |
Basis of Accounting, Policy [Policy Text Block] | Basis of Presentation The unaudited interim condensed consolidated financial statements to which these notes are attached include all normal, recurring adjustments which are necessary to fairly present the financial position, results of operations and cash flows of NHC. All significant intercompany transactions and balances have been eliminated in consolidation. The consolidated financial statements include the accounts of all entities controlled by NHC. The Company presents noncontrolling interest within the equity section of its consolidated balance sheets. The Company presents the amount of consolidated net income that is attributable to NHC and the noncontrolling interest in its consolidated statements of operations. We assume that users of these interim financial statements have read or have access to the audited December 31, 2023 may not may |
Use of Estimates, Policy [Policy Text Block] | Estimates and Assumptions The preparation of financial statements in conformity with U.S. GAAP requires us to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates and could cause our reported net income to vary significantly from period to period. |
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 three March 31, 2024 2023, March 31, 2024, December 31, 2023, |
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. |
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 $6,164,000 and $5,653,000 for the three March 31, 2024 2023, |
Lessee, Leases [Policy Text Block] | Long-Term Leases The Company’s lease portfolio primarily consists of operating real estate leases for certain skilled nursing facilities, assisted and independent living facilities, homecare and hospice offices, and pharmacy warehouses. The original terms of the leases typically range from two fifteen may not The Company records right-of-use assets and liabilities for non-cancelable real estate operating leases with original or remaining lease terms in excess of one 12 not not Operating lease right-of-use assets and liabilities are recorded at the present value of the lease payments over the lease term. The present value of the lease payments are discounted using the incremental borrowing rate associated with each lease. The variable components of the lease payment that fluctuate with the operations of a health facility are not |
Property, Plant and Equipment, Policy [Policy Text Block] | Property and Equipment Property and equipment are recorded at cost. Depreciation is provided by the straight-line method over the expected useful lives of the assets estimated as follows: buildings and improvements, 20-40 years and equipment and furniture, 3-15 years. Leasehold improvements are amortized over periods that do not |
Business Combinations Policy [Policy Text Block] | Business Combinations We account for acquisitions using the acquisition method of accounting in accordance with ASC 805, Business Combinations. |
Goodwill and Intangible Assets, Goodwill, Policy [Policy Text Block] | Goodwill and Other Intangible Assets Goodwill represents the excess of 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 self–insured for risks related to workers’ compensation and general and professional liability insurance. We have two Professional liability remains an area of particular concern to us. The long-term care industry has seen an increase in personal injury/wrongful death claims based on alleged negligence by skilled nursing facilities and their employees in providing care to residents. The Company has been, and continues to be, subject to claims and legal actions that arise in the ordinary course of business, including potential claims related to patient care and treatment. A significant increase in the number of these claims, or an increase in the amounts due as a result of these claims could have a material adverse effect on our consolidated financial position, results of operations and cash flows. It is also possible that future events could cause us to make significant adjustments or revisions to these reserve estimates and cause our reported net income to vary significantly from period to period. We are principally self-insured for incidents occurring in all centers owned or leased by us. The coverages include both primary policies and excess policies. In all years, settlements, if any, in excess of available insurance policy limits and our own reserves would be expensed by us. |
Continuing Care Contracts and Refundable Entrance Fees, Policy [Policy Text Block] | Continuing Care Contracts We have one may Non-refundable fees are included as a component of the transaction price and are amortized into revenue over the actuarily determined remaining life of the resident, which is the expected period of occupancy by the resident. We pay the refundable portion of our entry fees to residents when they relocate from our community and the apartment is re-occupied. Refundable entrance fees are not We also annually estimate the present value of the cost of future services and the use of facilities to be provided to the current CCRC residents and compare that amount with the balance of non-refundable deferred revenue from entrance fees received. If the present value of the cost of future services exceeds the related anticipated revenues, a liability is recorded with a corresponding charge to income. As of March 31, 2024, December 31, 2023, |
Other Noncurrent Liabilities [Policy Text Block] | Other Noncurrent Liabilities Other noncurrent liabilities include reserves primarily related to various uncertain income tax positions, deferred revenue, and obligations to provide future services to our CCRC residents. Deferred revenue includes the deferred gain on the sale of assets to National Health Corporation (“National”) and the non-refundable portion ( 10% Other noncurrent liabilities also include funds received related to the Employee Retention Credit ("ERC"), a refundable tax credit for businesses that sustained a partial suspension of operations limiting commerce due to COVID- 19 2020 2021. |
Consolidation, Subsidiaries or Other Investments, Consolidated Entities, Policy [Policy Text Block] | Noncontrolling Interest The noncontrolling interest in a subsidiary is presented within total equity in the Company's interim condensed consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to NHC in its interim condensed consolidated statements of operations. The Company’s earnings per share is calculated based on net income attributable to NHC’s stockholders. The carrying amount of the noncontrolling interest is adjusted based on an allocation of the subsidiary earnings, contributions, and distributions. |
Consolidation, Variable Interest Entity, Policy [Policy Text Block] | Variable Interest Entities We have equity interests in unconsolidated limited liability companies that operate various post-acute and senior healthcare businesses. We analyze our investments in these limited liability companies to determine if the company is considered a variable interest entity (“VIE”) and would require consolidation. To the extent that we own interests in a VIE and we (i) have the power to direct the activities of the VIE and (ii) have the obligation or rights to absorb the VIE's losses or receive its benefits, then we would be determined to be the primary beneficiary and would consolidate the VIE. To the extent we own interests in a VIE, then at each reporting period, we re-assess our conclusions as to which, if any, party within the VIE is considered the primary beneficiary. The Company's maximum exposure to losses in its investments in unconsolidated VIEs cannot be quantified and may may not |
New Accounting Pronouncements, Policy [Policy Text Block] | Recently Issued Accounting Guidance In November 2023, No. 2023 07, Segment Reporting (Topic 280 December 15, 2023, 2024, December 15, 2024. |
Note 3 - Net Patient Revenues (
Note 3 - Net Patient Revenues (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Disaggregation of Revenue [Table Text Block] | Three Months Ended March 31 2024 2023 Net patient revenues: Inpatient services $ 252,254 $ 226,169 Homecare and hospice 33,569 31,838 Total net patient revenues $ 285,823 $ 258,007 Three Months Ended March 31 Source 2024 2023 Medicare 34% 36% Managed Care 10% 11% Medicaid 28% 27% Private Pay and Other 28% 26% Total 100% 100% |
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Table Text Block] | Balance at December 31, 2023 $ - Payments received 9,881 Payments recouped (2,214 ) Balance at March 31, 2024 $ 7,667 |
Note 4 - Other Revenues (Tables
Note 4 - Other Revenues (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Schedule of Other Revenues [Table Text Block] | Three Months Ended March 31 2024 2023 Rental income $ 5,959 $ 6,043 Management and accounting services fees 4,438 4,097 Insurance services 872 1,048 Other 84 368 Total other revenues $ 11,353 $ 11,556 |
Note 5 - Non-operating Income (
Note 5 - Non-operating Income (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Schedule of Other Nonoperating Income, by Component [Table Text Block] | Three Months Ended March 31 2024 2023 Dividends and net realized gains and losses on sales of securities $ 2,056 $ 1,233 Interest income 2,538 1,555 Equity in earnings of unconsolidated investments 67 1,535 Gain on sale of unconsolidated company 1,024 - Total non-operating income $ 5,685 $ 4,323 |
Note 6 - Business Segments (Tab
Note 6 - Business Segments (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Schedule of Segment Reporting Information, by Segment [Table Text Block] | Three Months Ended March 31, 2024 Inpatient Homecare and Hospice All Other Total Revenues: Net patient revenues $ 252,254 $ 33,569 $ - $ 285,823 Other revenues 15 - 11,338 11,353 Net operating revenues 252,269 33,569 11,338 297,176 Costs and expenses: Salaries, wages, and benefits 150,890 21,009 11,239 183,138 Other operating 68,683 5,972 2,774 77,429 Rent 8,112 566 1,670 10,348 Depreciation and amortization 9,630 187 769 10,586 Interest 46 - - 46 Total costs and expenses 237,361 27,734 16,452 281,547 Income/(loss) from operations 14,908 5,835 (5,114 ) 15,629 Non-operating income - - 5,685 5,685 Unrealized gains on marketable equity securities - - 14,399 14,399 Income before income taxes $ 14,908 $ 5,835 $ 14,970 $ 35,713 Three Months Ended March 31, 2023 Inpatient Homecare and Hospice All Other Total Revenues: Net patient revenues $ 226,169 $ 31,838 $ - $ 258,007 Other revenues 271 - 11,285 11,556 Net operating revenues 226,440 31,838 11,285 269,563 Costs and expenses: Salaries, wages, and benefits 138,939 20,244 8,641 167,824 Other operating 62,264 5,499 3,726 71,489 Rent 8,168 558 1,366 10,092 Depreciation and amortization 9,117 185 746 10,048 Interest 98 - - 98 Total costs and expenses 218,586 26,486 14,479 259,551 Income/(loss) from operations 7,854 5,352 (3,194 ) 10,012 Non-operating income - - 4,323 4,323 Unrealized gains on marketable equity securities - - 1,386 1,386 Income before income taxes $ 7,854 $ 5,352 $ 2,515 $ 15,721 |
Note 7 - Long-term Leases (Tabl
Note 7 - Long-term Leases (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Lessee, Lease, Liability, Maturity [Table Text Block] | Operating Leases 2025 $ 34,351 2026 33,590 2027 24,933 2028 493 2029 207 Thereafter 21 Total minimum lease payments 93,595 Less: amounts representing interest (7,858 ) Present value of future minimum lease payments 85,737 Less: current portion (29,733 ) Noncurrent lease liabilities $ 56,004 |
Note 8 - Earnings Per Share (Ta
Note 8 - Earnings Per Share (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block] | Three Months Ended 2024 2023 Basic: Weighted average common shares outstanding 15,350,240 15,337,423 Net income attributable to National HealthCare Corporation $ 26,213 $ 11,723 Earnings per common share, basic $ 1.71 $ 0.76 Diluted: Weighted average common shares outstanding 15,350,240 15,337,423 Effects of dilutive instruments 154,856 18,912 Weighted average common shares outstanding 15,505,096 15,356,335 Net income attributable to National HealthCare Corporation $ 26,213 $ 11,723 Earnings per common share, diluted $ 1.69 $ 0.76 |
Note 9 - Investments in Marke_2
Note 9 - Investments in Marketable Securities (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Marketable Securities [Table Text Block] | March 31, 2024 December 31, 2023 Amortized Cost Fair Value Amortized Cost Fair Value Investments available for sale: Marketable equity securities $ 30,176 $ 123,040 $ 30,176 $ 111,117 Corporate debt securities 494 484 2,497 2,441 U.S. Treasury securities - - 2,990 2,986 Restricted investments available for sale: Marketable equity securities 24,495 29,616 24,134 26,779 Corporate debt securities 61,488 59,398 59,586 57,731 Asset-based securities 19,026 17,438 19,388 17,659 U.S. Treasury securities 47,323 43,004 46,771 42,863 State and municipal securities 4,079 3,992 4,106 4,047 $ 187,081 $ 276,972 $ 189,648 265,623 |
Schedule of Available-for-Sale Securities Reconciliation [Table Text Block] | March 31, 2024 December 31, 2023 Shares Cost Fair Value Shares Cost Fair Value NHI Common Stock 1,630,642 $ 24,734 $ 102,453 1,630,642 $ 24,734 $ 91,071 |
Investments Classified by Contractual Maturity Date [Table Text Block] | March 31, 2024 December 31, 2023 Cost Fair Value Cost Fair Value Maturities: Within 1 year $ 21,299 $ 20,785 $ 19,664 $ 19,328 1 to 5 years 77,738 73,370 81,517 77,118 6 to 10 years 32,012 28,925 33,515 30,802 Over 10 years 1,361 1,236 642 479 $ 132,410 $ 124,316 $ 135,338 $ 127,727 |
Note 10 - Fair Value Measurem_2
Note 10 - Fair Value Measurements (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis [Table Text Block] | Fair Value Measurements Using March 31, 2024 Fair Value Quoted Prices in Active For Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Cash and cash equivalents $ 93,982 $ 93,982 $ – $ – Restricted cash and cash equivalents 27,150 27,150 – – Marketable equity securities 152,656 152,656 – – Corporate debt securities 59,882 42,611 17,271 – Asset–backed securities 17,438 – 16,961 477 U.S. Treasury securities 43,004 43,004 – – State and municipal securities 3,992 – 3,992 – Total financial assets $ 398,104 $ 359,403 $ 38,224 $ 477 Fair Value Measurements Using December 31, 2023 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 $ 107,076 $ 107,076 $ – $ – Restricted cash and cash equivalents 18,892 18,892 – – Marketable equity securities 137,896 137,896 – – Corporate debt securities 60,171 42,860 17,311 – Asset–backed securities 17,659 – 17,210 449 U.S. Treasury securities 45,850 45,850 – – State and municipal securities 4,047 – 4,047 – Total financial assets $ 391,591 $ 352,574 $ 38,568 $ 449 |
Note 11 - Goodwill and Other _2
Note 11 - Goodwill and Other Intangible Assets (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Schedule of Goodwill [Table Text Block] | Inpatient Services Homecare and Hospice All Other Total January 1, 2024 $ 3,741 $ 164,554 $ – $ 168,295 Additions – – – – March 31, 2024 $ 3,741 $ 164,554 $ – $ 168,295 |
Note 13 - Stock-based Compens_2
Note 13 - Stock-based Compensation (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Schedule of Share-Based Payment Award, Stock Options, Valuation Assumptions [Table Text Block] | March 31, 2024 December 31, Risk–free interest rate 4.33% 4.52% Expected volatility 24.1% 29.3% Expected life, in years 2.9 2.9 Expected dividend yield 2.64% 4.41% |
Share-Based Payment Arrangement, Option, Activity [Table Text Block] | Number of Shares Weighted Average Exercise Price Aggregate Intrinsic Value Options outstanding at January 1, 2023 445,144 $ 66.62 $ – Options granted 299,278 54.44 – Options exercised (103,481 ) 64.72 – Options cancelled (52,407 ) 60.58 – Options outstanding at December 31, 2023 588,534 61.30 – Options granted 245,726 94.07 – Options exercised (137,874 ) 60.95 – Options outstanding at March 31, 2024 696,386 $ 72.93 $ 15,025,015 Options exercisable at March 31, 2024 174,105 $ 68.48 $ 4,531,876 |
Share-Based Payment Arrangement, Option, Exercise Price Range [Table Text Block] | Options Outstanding March 31, 2024 Exercise Prices Weighted Average Exercise Price Weighted Average Remaining Contractual Life in Years 377,405 53.94 - 69.19 58.92 3.5 318,981 71.64 - 94.10 89.51 4.0 696,386 72.93 3.7 |
Note 1 - Description of Busin_2
Note 1 - Description of Business (Details Textual) | Mar. 31, 2024 |
Number of Skilled Nursing Centers | 65 |
Number of Beds | 8,421 |
Number of Assisted Living Facilities | 24 |
Number of Independent Living Facilities | 5 |
Number of Behavioral Health Hospitals | 3 |
Number of Homecare Programs | 35 |
Number of Hospice Agencies | 30 |
Number of States in which Entity Operates | 8 |
Note 2 - Summary of Significa_2
Note 2 - Summary of Significant Accounting Policies (Details Textual) | 3 Months Ended | ||
Mar. 31, 2024 USD ($) | Mar. 31, 2023 USD ($) | Dec. 31, 2023 USD ($) | |
Accounts Receivable, Credit Loss Expense (Reversal) | $ 2,471,000 | $ 1,811,000 | |
Accounts Receivable, Allowance for Credit Loss | $ 9,174,000 | $ 8,054,000 | |
Number of Reportable Segments | 2 | ||
General and Administrative Expense | $ 6,164,000 | $ 5,653,000 | |
Continuing Care Retirement Communities, Refund Obligation | $ 1,606,000 | $ 1,606,000 | |
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 | ||
Minimum [Member] | Building and Building Improvements [Member] | |||
Property, Plant and Equipment, Useful Life (Year) | 20 years | ||
Minimum [Member] | Equipment and Furniture [Member] | |||
Property, Plant and Equipment, Useful Life (Year) | 3 years | ||
Maximum [Member] | |||
Lessee, Operating Lease, Term of Contract (Year) | 15 years | ||
Maximum [Member] | Building and Building Improvements [Member] | |||
Property, Plant and Equipment, Useful Life (Year) | 40 years | ||
Maximum [Member] | Equipment and Furniture [Member] | |||
Property, Plant and Equipment, Useful Life (Year) | 15 years |
Note 3 - Net Patient Revenues_2
Note 3 - Net Patient Revenues (Details Textual) - USD ($) | 3 Months Ended | ||
Mar. 31, 2024 | Mar. 31, 2023 | Dec. 31, 2023 | |
Revenue from Contract with Customer, Including Assessed Tax | $ 285,823,000 | $ 258,007,000 | |
Contract with Customer, Liability, Current | 7,667,000 | $ 0 | |
Accounts Receivable, Allowance for Credit Loss | 9,174,000 | 8,054,000 | |
Medicare and Medicaid [Member] | |||
Accounts Receivable, Allowance for Credit Loss | 19,988,000 | $ 18,369,000 | |
Medicaid [Member] | |||
Revenue from Contract with Customer, Including Assessed Tax | $ 3,462,000 | $ 4,883,000 |
Note 3 - Net Patient Revenues -
Note 3 - Net Patient Revenues - Revenue Disaggregation (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Net patient revenues | $ 285,823 | $ 258,007 |
Revenue, concentration percentage | 100% | 100% |
Medicare [Member] | ||
Revenue, concentration percentage | 34% | 36% |
Inpatient Services [Member] | ||
Net patient revenues | $ 252,254 | $ 226,169 |
Managed Care [Member] | ||
Revenue, concentration percentage | 10% | 11% |
Homecare and Hospice [Member] | ||
Net patient revenues | $ 33,569 | $ 31,838 |
Medicaid [Member] | ||
Revenue, concentration percentage | 28% | 27% |
Private Pay and Other [Member] | ||
Revenue, concentration percentage | 28% | 26% |
Note 3 - Net Patient Revenues_3
Note 3 - Net Patient Revenues - Contract Liabilities (Details) | 3 Months Ended |
Mar. 31, 2024 USD ($) | |
Balance | $ 0 |
Payments received | 9,881,000 |
Payments recouped | (2,214,000) |
Balance | $ 7,667,000 |
Note 4 - Other Revenues (Detail
Note 4 - Other Revenues (Details Textual) | 3 Months Ended | |
Mar. 31, 2024 USD ($) | Mar. 31, 2023 USD ($) | |
Number of Skilled Nursing Centers | 65 | |
Insurance Services Revenue | $ 872,000 | $ 1,048,000 |
Workers Compensation Revenue [Member] | ||
Insurance Services Revenue | 582,000 | 736,000 |
Professional Liability Insurance [Member] | ||
Insurance Services Revenue | $ 290,000 | 312,000 |
National [Member] | ||
Number of Skilled Nursing Centers | 5 | |
Property Management Fee Revenue | $ 1,320,000 | $ 1,190,000 |
FLORIDA | ||
Number of Skilled Nursing Centers | 4 |
Note 4 - Other Revenues - Summa
Note 4 - Other Revenues - Summary of Other Revenues (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Rental income | $ 5,959 | $ 6,043 |
Management and accounting services fees | 4,438 | 4,097 |
Insurance services | 872 | 1,048 |
Other | 84 | 368 |
Total other revenues | $ 11,353 | $ 11,556 |
Note 5 - Non-operating Income_2
Note 5 - Non-operating Income (Details Textual) - USD ($) | 1 Months Ended | 3 Months Ended | ||
Jan. 31, 2024 | Mar. 31, 2024 | Mar. 31, 2023 | Dec. 31, 2023 | |
Proceeds from Sale of Unconsolidated Company | $ 2,100,000 | $ 2,100,000 | $ 0 | |
Gain (Loss) on Sale of Unconsolidated Company | $ 1,024,000 | $ 1,024,000 | $ 0 | |
Homecare Agency in Nashville, Tennessee [Member] | ||||
Equity Method Investment, Ownership Percentage | 50% |
Note 5 - Non-operating Income -
Note 5 - Non-operating Income - Summary of Non-operating Income (Details) - USD ($) | 1 Months Ended | 3 Months Ended | |
Jan. 31, 2024 | Mar. 31, 2024 | Mar. 31, 2023 | |
Dividends and net realized gains and losses on sales of securities | $ 2,056,000 | $ 1,233,000 | |
Interest income | 2,538,000 | 1,555,000 | |
Equity in earnings of unconsolidated investments | 67,000 | 1,535,000 | |
Gain on sale of unconsolidated company | $ 1,024,000 | 1,024,000 | 0 |
Total non-operating income | $ 5,685,000 | $ 4,323,000 |
Note 6 - Business Segments (Det
Note 6 - Business Segments (Details Textual) | 3 Months Ended |
Mar. 31, 2024 | |
Number of Operating Segments | 2 |
Note 6 - Business Segments - Su
Note 6 - Business Segments - Summary of Financial Information by Reporting Segment (Details) - USD ($) | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Revenues: | ||
Net patient revenues | $ 285,823,000 | $ 258,007,000 |
Other revenues | 11,353,000 | 11,556,000 |
Net operating revenues | 297,176,000 | 269,563,000 |
Costs and expenses: | ||
Salaries, wages, and benefits | 183,138,000 | 167,824,000 |
Other operating | 77,429,000 | 71,489,000 |
Rent | 10,348,000 | 10,092,000 |
Depreciation and amortization | 10,586,000 | 10,048,000 |
Interest | 46,000 | 98,000 |
Total costs and expenses | 281,547,000 | 259,551,000 |
Income/(loss) from operations | 15,629,000 | 10,012,000 |
Non-operating income (loss) | 5,685,000 | 4,323,000 |
Unrealized gains on marketable equity securities | 14,399,000 | 1,386,000 |
Income before income taxes | 35,713,000 | 15,721,000 |
Inpatient Services Segment [Member] | ||
Revenues: | ||
Net patient revenues | 252,254,000 | 226,169,000 |
Other revenues | 15,000 | 271,000 |
Net operating revenues | 252,269,000 | 226,440,000 |
Costs and expenses: | ||
Salaries, wages, and benefits | 150,890,000 | 138,939,000 |
Other operating | 68,683,000 | 62,264,000 |
Rent | 8,112,000 | 8,168,000 |
Depreciation and amortization | 9,630,000 | 9,117,000 |
Interest | 46,000 | 98,000 |
Total costs and expenses | 237,361,000 | 218,586,000 |
Income/(loss) from operations | 14,908,000 | 7,854,000 |
Non-operating income (loss) | 0 | 0 |
Unrealized gains on marketable equity securities | 0 | 0 |
Income before income taxes | 14,908,000 | 7,854,000 |
Homecare Services Segment [Member] | ||
Revenues: | ||
Net patient revenues | 33,569,000 | 31,838,000 |
Other revenues | 0 | 0 |
Net operating revenues | 33,569,000 | 31,838,000 |
Costs and expenses: | ||
Salaries, wages, and benefits | 21,009,000 | 20,244,000 |
Other operating | 5,972,000 | 5,499,000 |
Rent | 566,000 | 558,000 |
Depreciation and amortization | 187,000 | 185,000 |
Interest | 0 | 0 |
Total costs and expenses | 27,734,000 | 26,486,000 |
Income/(loss) from operations | 5,835,000 | 5,352,000 |
Non-operating income (loss) | 0 | 0 |
Unrealized gains on marketable equity securities | 0 | 0 |
Income before income taxes | 5,835,000 | 5,352,000 |
Other Operating Segment [Member] | ||
Revenues: | ||
Net patient revenues | 0 | 0 |
Other revenues | 11,338,000 | 11,285,000 |
Net operating revenues | 11,338,000 | 11,285,000 |
Costs and expenses: | ||
Salaries, wages, and benefits | 11,239,000 | 8,641,000 |
Other operating | 2,774,000 | 3,726,000 |
Rent | 1,670,000 | 1,366,000 |
Depreciation and amortization | 769,000 | 746,000 |
Interest | 0 | 0 |
Total costs and expenses | 16,452,000 | 14,479,000 |
Income/(loss) from operations | (5,114,000) | (3,194,000) |
Non-operating income (loss) | 5,685,000 | 4,323,000 |
Unrealized gains on marketable equity securities | 14,399,000 | 1,386,000 |
Income before income taxes | $ 14,970,000 | $ 2,515,000 |
Note 7 - Long-term Leases (Deta
Note 7 - Long-term Leases (Details Textual) | 3 Months Ended | |
Mar. 31, 2024 USD ($) | Mar. 31, 2023 USD ($) | |
Lessee, Operating Lease, Liability, to be Paid, Year One | $ 34,351,000 | |
Lessee, Operating Lease, Liability, to be Paid, Year Two | 33,590,000 | |
Lessee, Operating Lease, Liability, to be Paid, Year Three | 24,933,000 | |
Operating Lease, Expense | $ 10,348,000 | $ 10,092,000 |
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] | ||
Lessee, Operating Lease, Liability, to be Paid, Year One | $ 32,625,000 | |
Lessee, Operating Lease, Liability, to be Paid, Year Two | 32,225,000 | |
Lessee, Operating Lease, Liability, to be Paid, Year Three | 31,975,000 | |
Both NHI Lease Agreements [Member] | ||
Operating Lease, Expense | $ 9,472,000 | $ 9,295,000 |
Note 7 - Long-term Leases - Mat
Note 7 - Long-term Leases - Maturity of Lease Liabilities (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
2025 | $ 34,351 | |
2026 | 33,590 | |
2027 | 24,933 | |
2028 | 493 | |
2029 | 207 | |
Thereafter | 21 | |
Total minimum lease payments | 93,595 | |
Less: amounts representing interest | (7,858) | |
Present value of future minimum lease payments | 85,737 | |
Less: current portion | (29,733) | $ (29,352) |
Noncurrent lease liabilities | $ 56,004 | $ 63,175 |
Note 8 - Earnings Per Share (De
Note 8 - Earnings Per Share (Details Textual) - shares | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Share-Based Payment Arrangement, Option [Member] | ||
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount (in shares) | 245,726 | 691,580 |
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 | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Basic: | ||
Weighted average common shares outstanding (in shares) | 15,350,240 | 15,337,423 |
Net income attributable to National HealthCare Corporation | $ 26,213 | $ 11,723 |
Earnings per common share, basic (in dollars per share) | $ 1.71 | $ 0.76 |
Diluted: | ||
Weighted average common shares outstanding (in shares) | 15,350,240 | 15,337,423 |
Effects of dilutive instruments (in shares) | 154,856 | 18,912 |
Weighted average common shares outstanding (in shares) | 15,505,096 | 15,356,335 |
Net income attributable to National HealthCare Corporation | $ 26,213 | $ 11,723 |
Earnings per common share, diluted (in dollars per share) | $ 1.69 | $ 0.76 |
Note 9 - Investments in Marke_3
Note 9 - Investments in Marketable Securities (Details Textual) - USD ($) | 3 Months Ended | ||
Mar. 31, 2024 | Mar. 31, 2023 | Dec. 31, 2023 | |
Equity Securities Fv Ni Gross Unrealized Gain | $ 98,459,000 | $ 84,514,000 | |
Equity Securities Fv Ni Gross Unrealized Loss | 474,000 | 928,000 | |
Equity Securities, FV-NI, Unrealized Gain (Loss) | 14,399,000 | $ 1,386,000 | |
Debt Securities, Available-for-Sale, Accumulated Gross Unrealized Gain, before Tax | 179,000 | 326,000 | |
Debt Securities, Available-for-Sale, Accumulated Gross Unrealized Loss, before Tax | 8,273,000 | $ 7,937,000 | |
Proceeds from Sale and Maturity of Marketable Securities | 11,615,000 | 15,492,000 | |
Debt Securities, Realized Gain (Loss) | $ 344,000 | $ (492,000) |
Note 9 - Investments in Marke_4
Note 9 - Investments in Marketable Securities - Marketable Securities and Restricted Marketable Securities (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Unrestricted investments available for sale, equity, amortized cost | $ 24,734 | $ 24,734 |
Marketable equity securities | 123,040 | 111,117 |
Unrestricted investments available for sale, debt, amortized cost | 132,410 | 135,338 |
Unrestricted investments available for sale, debt, fair value | 124,316 | 127,727 |
Restricted marketable equity securities | 29,616 | 26,779 |
Investments available for sale, amortized cost | 187,081 | 189,648 |
Marketable Securities | 276,972 | 265,623 |
Equity Securities [Member] | ||
Unrestricted investments available for sale, equity, amortized cost | 30,176 | 30,176 |
Marketable equity securities | 123,040 | 111,117 |
Restricted investments available for sale, equity, amortized cost | 24,495 | 24,134 |
Restricted marketable equity securities | 29,616 | 26,779 |
Corporate Debt Securities [Member] | ||
Unrestricted investments available for sale, debt, amortized cost | 494 | 2,497 |
Unrestricted investments available for sale, debt, fair value | 484 | 2,441 |
Restricted investments available for sale, debt, amortized cost | 61,488 | 59,586 |
Restricted investments available for sale, debt, fair value | 59,398 | 57,731 |
US Government Corporations and Agencies Securities [Member] | ||
Unrestricted investments available for sale, debt, amortized cost | 0 | 2,990 |
Unrestricted investments available for sale, debt, fair value | 0 | 2,986 |
Restricted investments available for sale, debt, amortized cost | 47,323 | 46,771 |
Restricted investments available for sale, debt, fair value | 43,004 | 42,863 |
Asset-Backed Securities [Member] | ||
Restricted investments available for sale, debt, amortized cost | 19,026 | 19,388 |
Restricted investments available for sale, debt, fair value | 17,438 | 17,659 |
US States and Political Subdivisions Debt Securities [Member] | ||
Restricted investments available for sale, debt, amortized cost | 4,079 | 4,106 |
Restricted investments available for sale, debt, fair value | $ 3,992 | $ 4,047 |
Note 9 - Investments in Marke_5
Note 9 - Investments in Marketable Securities - Available for Sale Marketable Equity Securities (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
NHI Common Stock, Shares (in shares) | 1,630,642 | 1,630,642 |
NHI Common Stock, Cost | $ 24,734 | $ 24,734 |
NHI Common Stock, fair value | 123,040 | 111,117 |
NHI Common Stock [Member] | ||
NHI Common Stock, fair value | $ 102,453 | $ 91,071 |
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 | Mar. 31, 2024 | Dec. 31, 2023 |
Within 1 year, cost | $ 21,299 | $ 19,664 |
Within 1 year, fair value | 20,785 | 19,328 |
1 to 5 years, cost | 77,738 | 81,517 |
1 to 5 years, fair value | 73,370 | 77,118 |
6 to 10 years, cost | 32,012 | 33,515 |
6 to 10 years, fair value | 28,925 | 30,802 |
Over 10 years, cost | 1,361 | 642 |
Over 10 years, fair value | 1,236 | 479 |
Cost | 132,410 | 135,338 |
Fair Value | $ 124,316 | $ 127,727 |
Note 10 - Fair Value Measurem_3
Note 10 - Fair Value Measurements - Summary of Fair Value Measurements by Level (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 | Mar. 31, 2023 |
Restricted cash and cash equivalents | $ 27,150 | $ 28,532 | |
Available-for-sale securities (USD) | 124,316 | $ 127,727 | |
Total financial assets | 398,104 | ||
Corporate Debt Securities [Member] | |||
Available-for-sale securities (USD) | 484 | 2,441 | |
Fair Value, Inputs, Level 1 [Member] | |||
Total financial assets | 359,403 | ||
Fair Value, Inputs, Level 2 [Member] | |||
Total financial assets | 38,224 | ||
Fair Value, Inputs, Level 3 [Member] | |||
Total financial assets | 477 | ||
Fair Value, Recurring [Member] | |||
Cash and cash equivalents | 93,982 | 107,076 | |
Restricted cash and cash equivalents | 27,150 | 18,892 | |
Total financial assets | 391,591 | ||
Fair Value, Recurring [Member] | Equity Securities [Member] | |||
Marketable equity securities | 152,656 | 137,896 | |
Fair Value, Recurring [Member] | Corporate Debt Securities [Member] | |||
Available-for-sale securities (USD) | 59,882 | 60,171 | |
Fair Value, Recurring [Member] | Asset-Backed Securities [Member] | |||
Available-for-sale securities (USD) | 17,438 | 17,659 | |
Fair Value, Recurring [Member] | US Treasury Securities [Member] | |||
Available-for-sale securities (USD) | 43,004 | 45,850 | |
Fair Value, Recurring [Member] | US States and Political Subdivisions Debt Securities [Member] | |||
Available-for-sale securities (USD) | 3,992 | 4,047 | |
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | |||
Cash and cash equivalents | 93,982 | 107,076 | |
Restricted cash and cash equivalents | 27,150 | 18,892 | |
Total financial assets | 352,574 | ||
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Equity Securities [Member] | |||
Marketable equity securities | 152,656 | 137,896 | |
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | Corporate Debt Securities [Member] | |||
Available-for-sale securities (USD) | 42,611 | 42,860 | |
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 1 [Member] | US Treasury Securities [Member] | |||
Available-for-sale securities (USD) | 43,004 | 45,850 | |
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | |||
Total financial assets | 38,568 | ||
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Corporate Debt Securities [Member] | |||
Available-for-sale securities (USD) | 17,271 | 17,311 | |
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | Asset-Backed Securities [Member] | |||
Available-for-sale securities (USD) | 16,961 | 17,210 | |
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 2 [Member] | US States and Political Subdivisions Debt Securities [Member] | |||
Available-for-sale securities (USD) | 3,992 | 4,047 | |
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 3 [Member] | |||
Total financial assets | 449 | ||
Fair Value, Recurring [Member] | Fair Value, Inputs, Level 3 [Member] | Asset-Backed Securities [Member] | |||
Available-for-sale securities (USD) | $ 477 | $ 449 |
Note 11 - Goodwill and Other _3
Note 11 - Goodwill and Other Intangible Assets (Details Textual) | 3 Months Ended |
Mar. 31, 2024 USD ($) | |
Goodwill and Intangible Asset Impairment, Total | $ 0 |
Acquisition of Caris [Member] | Trade Names [Member] | |
Indefinite-lived Intangible Assets Acquired | 4,340,000 |
Acquisition of Caris [Member] | Certificates of Need and Licenses [Member] | |
Indefinite-lived Intangible Assets Acquired | $ 2,698,000 |
Note 11 - Goodwill and Other _4
Note 11 - Goodwill and Other Intangible Assets - Activity Related to Goodwill By Segment (Details) $ in Thousands | 3 Months Ended |
Mar. 31, 2024 USD ($) | |
Goodwill, balance | $ 168,295 |
Goodwill, additions | 0 |
Goodwill, balance | 168,295 |
Inpatient Services Segment [Member] | |
Goodwill, balance | 3,741 |
Goodwill, additions | 0 |
Goodwill, balance | 3,741 |
Homecare and Hospice Segment [Member] | |
Goodwill, balance | 164,554 |
Goodwill, additions | 0 |
Goodwill, balance | $ 164,554 |
Note 12 - Stock Repurchase Pr_2
Note 12 - Stock Repurchase Program (Details Textual) - Common Stock [Member] - USD ($) | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Stock Repurchased and Retired During Period, Shares (in shares) | 101,131 | 44,349 |
Stock Repurchased and Retired During Period, Value | $ 9,900,000 | $ 2,482,000 |
Note 13 - Stock-based Compens_3
Note 13 - Stock-based Compensation (Details Textual) - USD ($) | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount | $ 7,652,000 | |
Salaries, Wages, and Benefits [Member] | ||
Share-Based Payment Arrangement, Expense | $ 793,000 | $ 639,000 |
Note 13 - Stock-based Compens_4
Note 13 - Stock-based Compensation - Summary of Assumptions Used to Value Options Granted (Details) | 3 Months Ended | 12 Months Ended |
Mar. 31, 2024 | Dec. 31, 2023 | |
Risk–free interest rate | 4.33% | 4.52% |
Expected volatility | 24.10% | 29.30% |
Expected life (Year) | 2 years 10 months 24 days | 2 years 10 months 24 days |
Expected dividend yield | 2.64% | 4.41% |
Note 13 - Stock-based Compens_5
Note 13 - Stock-based Compensation - Summary of Options Outstanding (Details) - USD ($) | 3 Months Ended | 12 Months Ended |
Mar. 31, 2024 | Dec. 31, 2023 | |
Options outstanding, shares (in shares) | 588,534 | 445,144 |
Options outstanding, weighted average exercise price (in dollars per share) | $ 61.3 | $ 66.62 |
Options granted, shares (in shares) | 245,726 | 299,278 |
Options granted, weighted average exercise price (in dollars per share) | $ 94.07 | $ 54.44 |
Options exercised, shares (in shares) | (137,874) | (103,481) |
Options exercised, weighted average exercise price (in dollars per share) | $ 60.95 | $ 64.72 |
Options cancelled, shares (in shares) | (52,407) | |
Options cancelled, weighted average exercise price (in dollars per share) | $ 60.58 | |
Options outstanding, shares (in shares) | 696,386 | 588,534 |
Options outstanding, weighted average exercise price (in dollars per share) | $ 72.93 | $ 61.3 |
Options outstanding, aggregate intrinsic value | $ 15,025,015 | |
Options exercisable, shares (in shares) | 174,105 | |
Options exercisable, weighted average exercise price (in dollars per share) | $ 68.48 | |
Options exercisable, aggregate intrinsic value | $ 4,531,876 |
Note 13 - Stock-based Compens_6
Note 13 - Stock-based Compensation - Options Outstanding by Exercise Price Range (Details) - $ / shares | 3 Months Ended | ||
Mar. 31, 2024 | Dec. 31, 2023 | Dec. 31, 2022 | |
Options outstanding (in shares) | 696,386 | 588,534 | 445,144 |
Options outstanding, weighted average exercise price (in dollars per share) | $ 72.93 | ||
Options outstanding, weighted average remaining contractual life (Year) | 3 years 8 months 12 days | ||
Exercise Price Range 1 [Member] | |||
Options outstanding (in shares) | 377,405 | ||
Options outstanding, exercise price, lower range (in dollars per share) | $ 53.94 | ||
Options outstanding, exercise price, upper range (in dollars per share) | 69.19 | ||
Options outstanding, weighted average exercise price (in dollars per share) | $ 58.92 | ||
Options outstanding, weighted average remaining contractual life (Year) | 3 years 6 months | ||
Exercise Price Range 2 [Member] | |||
Options outstanding (in shares) | 318,981 | ||
Options outstanding, exercise price, lower range (in dollars per share) | $ 71.64 | ||
Options outstanding, exercise price, upper range (in dollars per share) | 94.1 | ||
Options outstanding, weighted average exercise price (in dollars per share) | $ 89.51 | ||
Options outstanding, weighted average remaining contractual life (Year) | 4 years |
Note 14 - Income Taxes (Details
Note 14 - Income Taxes (Details Textual) | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Effective Income Tax Rate Reconciliation, Percent | 26.50% | 28.20% |
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent | 21% |
Note 15 - Credit Facility - S_2
Note 15 - Credit Facility - Schedule of Long-Term Debt Instruments (Details Textual) - USD ($) | 1 Months Ended | |
May 31, 2023 | Mar. 31, 2024 | |
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration] | Secured Overnight Financing Rate (SOFR) [Member] | |
Credit Facility [Member] | ||
Debt Instrument, Face Amount | $ 50,000,000 | |
Debt Instrument, Basis Spread on Variable Rate | 1.25% | |
Debt Instrument, Basis Spread on Variable Rate, With Maintained Levels of Deposits | 1.10% | |
Long-Term Debt, Gross | $ 0 |
Note 16 - Contingencies and C_2
Note 16 - Contingencies and Commitments (Details Textual) - USD ($) | Mar. 31, 2024 | Dec. 31, 2023 |
Self Insurance Reserve | $ 108,237,000 | $ 103,259,000 |