National HealthCare (NHC) 10-Q 9 May 24 2024 Q1 Quarterly report Financial data

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