Summit Healthcare REIT 10-K 22 Mar 19 2018 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($)	12 Months Ended
	Dec. 31, 2018	Mar. 15, 2019	Jun. 30, 2018
Document and Entity Information [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2018
Document Fiscal Year Focus	2018
Document Fiscal Period Focus	FY
Entity Registrant Name	Summit Healthcare REIT, Inc
Entity Central Index Key	0001310383
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Filer Category	Non-accelerated Filer
Entity Public Float			$ 0
Entity Common Stock, Shares Outstanding		23,027,978
Entity Shell Company	false
Entity Emerging Growth Company	false
Entity Small Business	true

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($)	Dec. 31, 2018	Dec. 31, 2017
ASSETS
Cash and cash equivalents	$ 11,463,000	$ 3,851,000
Restricted cash	3,493,000	3,447,000
Real estate properties, net	67,002,000	69,063,000
Notes receivable	730,000	3,854,000
Tenant and other receivables, net	4,666,000	4,106,000
Deferred leasing commissions, net	1,133,000	1,273,000
Other assets, net	319,000	234,000
Equity-method investments	9,719,000	9,241,000
Assets of Friendswood TRS held for sale	0	1,762,000
Total assets	98,525,000	96,831,000
LIABILITIES AND EQUITY
Accounts payable and accrued liabilities	3,868,000	1,902,000
Accrued salaries and benefits	33,000	96,000
Security deposits	1,208,000	1,208,000
Loans payable, net of debt issuance costs	64,050,000	60,831,000
Liabilities of Friendswood TRS held for sale	0	898,000
Total liabilities	69,159,000	64,935,000
Commitments and contingencies
Stockholders' Equity
Preferred stock, $0.001 par value; 10,000,000 shares authorized; no shares issued or outstanding at December 31, 2018 and 2017	0	0
Common stock, $0.001 par value; 290,000,000 shares authorized; 23,027,978 shares issued and outstanding at December 31, 2018 and 2017	23,000	23,000
Additional paid-in capital	115,950,000	117,349,000
Accumulated deficit	(86,956,000)	(86,040,000)
Total stockholders' equity	29,017,000	31,332,000
Noncontrolling interests	349,000	564,000
Total equity	29,366,000	31,896,000
Total liabilities and equity	$ 98,525,000	$ 96,831,000

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Dec. 31, 2018	Dec. 31, 2017
Preferred stock, par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized	10,000,000	10,000,000
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized	290,000,000	290,000,000
Common stock, shares issued	23,027,978	23,027,978
Common stock, shares outstanding	23,027,978	23,027,978

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Revenues:
Tenant reimbursements	$ 1,128,000	$ 862,000
Interest income from notes receivable	42,000	180,000
Revenues, Total	10,136,000	8,266,000
Expenses:
Property operating costs	1,223,000	989,000
General and administrative	4,004,000	5,051,000
Depreciation and amortization	3,000,000	3,083,000
Costs and Expenses, Total	8,227,000	9,123,000
Operating income (loss)	1,909,000	(857,000)
Income from equity-method investees	455,000	586,000
Other income	100,000	40,000
Interest expense	(3,625,000)	(3,013,000)
Gain on notes receivable	186,000	0
Loss from continuing operations	(975,000)	(3,244,000)
Discontinued operations:
Gain on disposition of Friendswood TRS	109,000	0
Income from Friendswood TRS	0	1,933,000
Income from discontinued operations	109,000	1,933,000
Net loss	(866,000)	(1,311,000)
Noncontrolling interests' share in net (income) loss	(50,000)	38,000
Net loss applicable to common stockholders	$ (916,000)	$ (1,273,000)
Basic and diluted loss per common share:
Continuing operations	$ (0.04)	$ (0.14)
Discontinued operations	0	0.08
Net loss applicable to common stockholders	$ (0.04)	$ (0.06)
Weighted average shares used to calculate basic and diluted net loss per common share	23,027,978	23,027,978
Real Estate [Member]
Revenues:
Operating Leases, Income Statement, Lease Revenue	$ 8,264,000	$ 6,386,000
Financial Service, Other [Member]
Revenues:
Revenue from Contract with Customer, Including Assessed Tax	$ 702,000	$ 838,000

CONSOLIDATED STATEMENTS OF EQUI

CONSOLIDATED STATEMENTS OF EQUITY - USD ($)	Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Accumulated Deficit [Member]	Total Stockholders' Equity [Member]	Noncontrolling Interests [Member]
Balance at Dec. 31, 2016	$ 33,243,000	$ 23,000	$ 117,243,000	$ (84,767,000)	$ 32,499,000	$ 744,000
Balance (in shares) at Dec. 31, 2016		23,027,978
Stock-based compensation	106,000	$ 0	106,000	0	106,000	0
Distributions paid to noncontrolling interests	(142,000)	0	0	0	0	(142,000)
Net (loss) income	(1,311,000)	0	0	(1,273,000)	(1,273,000)	(38,000)
Balance at Dec. 31, 2017	31,896,000	$ 23,000	117,349,000	(86,040,000)	31,332,000	564,000
Balance (in shares) at Dec. 31, 2017		23,027,978
Stock-based compensation	100,000	$ 0	100,000	0	100,000	0
Distributions declared	(1,499,000)	0	(1,499,000)	0	(1,499,000)	0
Distributions paid to noncontrolling interests	(265,000)	0	0	0	0	(265,000)
Net (loss) income	(866,000)	0	0	(916,000)	(916,000)	50,000
Balance at Dec. 31, 2018	$ 29,366,000	$ 23,000	$ 115,950,000	$ (86,956,000)	$ 29,017,000	$ 349,000
Balance (in shares) at Dec. 31, 2018		23,027,978

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Cash flows from operating activities:
Net loss	$ (866,000)	$ (1,311,000)
Adjustments to reconcile net loss to net cash provided by operating activities:
Amortization of debt issuance costs	214,000	212,000
Depreciation and amortization	3,000,000	3,139,000
Straight line rents	(629,000)	(662,000)
Bad debt expense	0	219,000
Write-off of debt issuance costs	94,000	0
Stock-based compensation expense	100,000	106,000
Gain on disposition of Friendswood TRS	(109,000)	0
Gain on note receivable	(186,000)	0
Income from equity-method investees	(455,000)	(586,000)
Change in operating assets and liabilities:
Tenant and other receivables, net	632,000	319,000
Other assets	(94,000)	52,000
Accounts payable and accrued liabilities	467,000	(244,000)
Accrued salaries and benefits	(63,000)	(83,000)
Net cash provided by operating activities	2,105,000	1,161,000
Cash flows from investing activities:
Real estate acquisitions	(715,000)	(13,452,000)
Real estate additions	(75,000)	(194,000)
Investments in equity-method investees	(1,313,000)	(4,624,000)
Distributions received from equity-method investees	728,000	596,000
Payments from notes receivable	4,282,000	947,000
Net cash provided by (used in) investing activities	2,907,000	(16,727,000)
Cash flows from financing activities:
Proceeds from issuance of loans payable	21,369,000	10,050,000
Payments of loans payable	(17,876,000)	(976,000)
Distributions paid to noncontrolling interests	(265,000)	(142,000)
Debt issuance costs	(582,000)	(172,000)
Net cash provided by financing activities	2,646,000	8,760,000
Net increase (decrease) in cash, cash equivalents and restricted cash	7,658,000	(6,806,000)
Cash, cash equivalents and restricted cash - beginning of year	7,298,000	14,563,000
Cash, cash equivalents and restricted cash - end of year (including cash of Friendswood TRS)	14,956,000	7,757,000
Cash of Friendswood TRS held for sale - end of year (see Note 11)	0	(459,000)
Cash, cash equivalents and restricted cash - end of year	14,956,000	7,298,000
Supplemental disclosure of cash flow information:
Cash paid for interest:	3,002,000	2,492,000
Supplemental disclosure of non-cash financing activities:
Distributions declared not paid	$ 1,499,000	$ 0

Organization

Organization	12 Months Ended
	Dec. 31, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block]	1. Organization Summit Healthcare REIT, Inc. (“Summit”) is a real estate investment trust that owns 100% of six properties, 95.3% of four properties, 95% of one property, a 10% equity interest in an unconsolidated equity-method investment that holds 17 properties, a 35% equity interest in an unconsolidated equity-method investment that holds two properties, a 20% equity interest in an unconsolidated equity-method investment that holds two properties, a 10% equity interest in an unconsolidated equity-method investment that holds nine properties and a 10% equity interest in an unconsolidated equity-method investment that holds six properties. Summit is a Maryland corporation, formed in 2004 under the General Corporation Law of Maryland for the purpose of investing in and owning real estate. As used in these notes, the “Company”, “we”, “us” and “our” refer to Summit and its consolidated subsidiaries, except where the context otherwise requires. We conduct substantially all of our operations through Summit Healthcare Operating Partnership, L.P. (the “Operating Partnership”), which is a Delaware limited partnership. We own a 99.88% general partner interest in the Operating Partnership, and Cornerstone Realty Advisors, LLC (“CRA”), a former affiliate, owns a 0.12% limited partnership interest. Our financial statements and the financial statements of the Operating Partnership are consolidated in the accompanying consolidated financial statements. Cornerstone Healthcare Partners LLC We own 95% of Cornerstone Healthcare Partners LLC (“CHP LLC”), which was formed in 2012, and the remaining 5% noncontrolling interest is owned by Cornerstone Healthcare Real Estate Fund, Inc. (“CHREF”), an affiliate of CRA. CHP LLC is consolidated with our financial statements and owns five properties (each, a “JV Property” and collectively, the “JV Properties”). As of December 31, 2018, we own a 95.3% interest in four of the JV Properties, and CHREF owns a 4.7% interest. We continue to own a 95% interest in the fifth JV Property, and CHREF owns a 5% interest in the fifth JV Property. Summit Union Life Holdings, LLC In April, 2015, through our Operating Partnership, we entered into a limited liability company agreement with Best Years, LLC (“Best Years”), an unrelated entity and a U.S.-based affiliate of Union Life Insurance Co, Ltd. (a Chinese corporation), and formed Summit Union Life Holdings, LLC (the “SUL JV”). The SUL JV is not consolidated in our consolidated financial statements and is accounted for under the equity-method in our consolidated financial statements (see Note 5). As of December 31, 2018 and 2017, we have a 10% interest in the SUL JV which owns 17 properties. Summit Fantasia Holdings, LLC In September 2016, through our Operating Partnership, we entered into a limited liability company agreement with Fantasia Investment III LLC (“Fantasia”), an unrelated entity and a U.S.-based affiliate of Fantasia Holdings Group Co., Limited (a Chinese corporation listed on the Stock Exchange of Hong Kong (HKEX)), and formed Summit Fantasia Holdings, LLC (the “Fantasia JV”). The Fantasia JV is not consolidated in our consolidated financial statements and is accounted for under the equity-method in our consolidated financial statements. In April 2018, we made an additional capital contribution of $1.25 million to the Fantasia JV and as a result of this capital contribution, the Operating Partnership has a 35% equity investment (see Note 5) as of December 31, 2018. As of December 31, 2018 and 2017, we have a 35% and 20% interest, respectively, in the Fantasia JV which owns two properties. Summit Fantasia Holdings II, LLC In December 2016, through our Operating Partnership, we entered into a limited liability company agreement with Fantasia, and formed Summit Fantasia Holdings II, LLC (the “Fantasia II JV”). The Fantasia II JV is not consolidated in our consolidated financial statements and is accounted for under the equity-method in our consolidated financial statements. As of December 31, 2018 and 2017, we have a 20% interest in the Fantasia II JV which owns two properties. Summit Fantasia Holdings III, LLC In July 2017, through our Operating Partnership, we entered into a limited liability company agreement with Fantasia and formed Summit Fantasia Holdings III, LLC (the “Fantasia III JV”). The Fantasia III JV is not consolidated in our consolidated financial statements and is accounted for under the equity-method in the Company’s consolidated financial statements. As of December 31, 2018 and 2017, we have a 10% interest in the Fantasia III JV which owns nine properties. Summit Fantasy Pearl Holdings, LLC In October 2017, through our Operating Partnership, we entered into a limited liability company agreement with Fantasia, Atlantis Senior Living 9, LLC, a Delaware limited liability company (“Atlantis”), and Fantasy Pearl LLC, a Delaware limited liability company (“Fantasy”), and formed Summit Fantasy Pearl Holdings, LLC (the “FPH JV”). The FPH JV is not consolidated in our consolidated financial statements and is accounted for under the equity-method in the Company’s consolidated financial statements. As of December 31, 2018 and 2017, we have a 10% interest in the FPH JV which owns six properties. Summit Healthcare Asset Management, LLC (TRS) Summit Healthcare Asset Management, LLC (“SAM TRS”) is our wholly-owned taxable REIT subsidiary (“TRS”). We serve as the manager of the SUL JV, Fantasia JV, Fantasia II JV, Fantasia III JV and FPH JV (collectively, our “Equity-Method Investments”), and provide management services in exchange for fees and reimbursements. All acquisition fees and asset management fees earned by us are paid to SAM TRS and expenses incurred by us, as the manager, are reimbursed from SAM TRS. See Notes 5 and 7 for further information. Friendswood TRS Friendswood TRS (“Friendswood TRS”) was our wholly-owned TRS, and is the licensed operator and tenant of Friendship Haven Healthcare and Rehabilitation Center (“Friendship Haven”). Effective as of January 1, 2018, we assigned our interest in Friendswood TRS to HMG Park Manor of Friendswood, LLC (“HMG”), the management company of Friendship Haven. See Note 11 for further information regarding the transaction and the classification of assets, liabilities and operations for Friendswood TRS as of December 31, 2017.

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2018
Accounting Policies [Abstract]
Significant Accounting Policies [Text Block]	2. Summary of Significant Accounting Policies The summary of significant accounting policies presented below is designed to assist in understanding our consolidated financial statements. Such consolidated financial statements and accompanying notes are the representations of our management, which is responsible for their integrity and objectivity. These accounting policies conform to accounting principles generally accepted in the United States of America, or GAAP, in all material respects, and have been consistently applied in preparing the accompanying consolidated financial statements. Principles of Consolidation and Basis of Presentation The consolidated financial statements include the accounts of the Company, its wholly-owned subsidiaries, the Operating Partnership (of which the Company owns 99.88%) and CHP, LLC (of which the Company owns 95%). All intercompany accounts and transactions have been eliminated in consolidation. The Financial Accounting Standards Board (“FASB”) issued Accounting Standard Codification (“ASC”) 810, Consolidation , which addresses how a business enterprise should evaluate whether it has a controlling interest in an entity through means other than voting rights and accordingly should consolidate the entity. Before concluding that it is appropriate to apply the voting interest consolidation model to an entity, an enterprise must first determine that the entity is not a variable interest entity. We evaluate, as appropriate, our interests, if any, in joint ventures and other arrangements to determine if consolidation is appropriate. Use of Estimates The preparation of our consolidated financial statements requires us to make estimates and judgments that affect the reported amounts of assets, liabilities, revenues and expenses. We base these estimates on various assumptions that we believe to be reasonable under the circumstances, and these estimates form the basis for our judgments concerning the carrying values of assets and liabilities that are not readily apparent from other sources. We periodically evaluate these estimates and judgments based on available information and experience. Actual results could differ from our estimates under different assumptions and conditions. If actual results significantly differ from our estimates, our financial condition and results of operations could be materially impacted. Cash and Cash Equivalents We consider all short-term, highly liquid investments that are readily convertible to cash with a maturity of three months or less at the time of purchase to be cash equivalents. As of December 31, 2018, we had cash accounts in excess of FDIC-insured limits. We do not believe we are exposed to any significant credit risk on cash and cash equivalents. Restricted Cash See below under Recently Adopted Accounting Pronouncements for further information. Our restricted cash consists of escrows from our tenants for property taxes, insurance and capital improvements required by and held by our lenders. The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the consolidated balance sheets that sum to the total of the same such amounts shown on the consolidated statements of cash flows. December 31, 2018 December 31, 2017 Cash and cash equivalents $ 11,463,000 $ 3,851,000 Restricted cash 3,493,000 3,447,000 Total cash, cash equivalents, and restricted cash shown on the consolidated statements of cash flows $ 14,956,000 $ 7,298,000 Investments in Real Estate and Depreciation We allocate the purchase price of our properties in accordance with ASC 805 – Business Combinations . If the acquisition does not meet the definition of a business, we record the acquisition as an asset acquisition. For transactions that are business combinations, acquisition costs are expensed as incurred. For transactions that are an asset acquisition, acquisition costs are capitalized as incurred. Upon an asset acquisition of a property, we allocate the purchase price of the property based upon the relative fair value of the assets acquired and liabilities assumed, which generally consists of land, buildings, site improvements, and furniture and fixtures. We allocate the purchase price to tangible assets of an acquired property by valuing the property as if it were vacant. We are required to make subjective assessments as to the estimated useful lives of our depreciable assets. We consider the period of future benefit of the assets to determine the appropriate estimated useful lives. Depreciation of our assets is being charged to expense on a straight-line basis over the estimated useful lives. We depreciate the fair value allocated to building and improvements over estimated useful lives ranging from 15 to 39 years. We estimate the value of furniture and fixtures based on the assets’ depreciated replacement cost. We depreciate the fair value allocated to furniture and fixtures over estimated useful lives ranging from three to six years. Assets held for sale are not depreciated. Impairment of Real Estate Assets We evaluate the recoverability of the carrying value of our real estate properties on a property-by-property basis. On a quarterly basis, we review our properties for recoverability when events or circumstances, including significant physical changes in the property, significant adverse changes in general economic conditions and significant deteriorations of the underlying cash flows of the property, indicate that the carrying amount of the property may not be fully recoverable. The need to recognize an impairment charge is based on estimated undiscounted future cash flows from a property compared to the carrying value of that property. If recognition of an impairment charge is necessary, it is measured as the amount by which the carrying amount of the property exceeds the fair value of the property. We recorded no impairment charges in 2018 and 2017. Fair Value Measurements ASC 825, Financial Instruments , requires the disclosure of fair value information about financial instruments whether or not recognized on the face of the balance sheet, for which it is practical to estimate that value. Fair value represents the estimate of the proceeds to be received, or paid in the case of a liability, in a current transaction between willing parties. ASC 820, Fair Value Measurement, establishes a fair value hierarchy to categorize the inputs used in valuation techniques to measure fair value. Inputs are either observable or unobservable in the marketplace. Observable inputs are based on market data from independent sources and unobservable inputs reflect the reporting entity’s assumptions about market participant assumptions used to value an asset or liability. Financial assets and liabilities are categorized based on the inputs to the valuation techniques as follows: Level 1. Quoted prices in active markets for identical instruments. Level 2. Observable inputs other than Level 1 prices, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 3. Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities. Assets and liabilities measured at fair value are classified according to the lowest level input that is significant to their valuation. A financial instrument that has a significant unobservable input along with significant observable inputs may still be classified as a Level 3 instrument. We generally determine or calculate the fair value of financial instruments using quoted market prices in active markets when such information is available or use appropriate present value or other valuation techniques, such as discounted cash flow analyses, incorporating available market discount rate information for similar types of instruments and our estimates for non-performance and liquidity risk. These techniques are significantly affected by the assumptions used, including the discount rate, credit spreads, and estimates of future cash flow. There were no assets measured at fair value on a nonrecurring basis during the year ended December 31, 2018. Fair Value Measurement of Financial Instruments Our consolidated balance sheets include the following financial instruments: cash and cash equivalents, restricted cash, notes receivable, deposits, tenant and other receivables, certain other assets, accounts payable and accrued liabilities, security deposits and loans payable. With the exception of the Friendswood TRS note receivable (see Note 6) and loans payable discussed below, we consider the carrying values to approximate fair value for such financial instruments because of the short period of time between origination of the instruments and their expected payment. As of December 31, 2018, the fair value of the Friendswood TRS note receivable (see Note 6) was $0.7 million compared to the carrying value of $0.7 million. The fair value of the note receivable was estimated based on cash flow analysis at a weighted-average discount rate of 4.7%. As the inputs to our valuation estimate are neither observable in nor supported by market activity, our notes receivable are classified as Level 3 assets within the fair value hierarchy. As of December 31, 2018 and 2017, the fair value of loans payable was $66.5 million and $63.3 million, compared to the principal balance (excluding debt discount) of $66.1 million and $62.6 million, respectively. The fair value of loans payable was estimated using lending rates available to us for financial instruments with similar terms and maturities. To estimate fair value as of December 31, 2018, we utilized discount rates ranging from 4.4% to 6.3% and a weighted average discount rate of 4.7%. As the inputs to our valuation estimate are neither observable in nor supported by market activity, our loans payable are classified as Level 3 assets within the fair value hierarchy. At December 31, 2018 and 2017, we do not have any significant financial assets or financial liabilities that are measured at fair value on a recurring basis in our consolidated financial statements. Variable Interest Entities We analyze our contractual and/or other interests to determine whether such interests constitute an interest in a variable interest entity (“VIE”) in accordance with ASC 810, Consolidation , and, if so, whether we are the primary beneficiary. If we are determined to be the primary beneficiary of a VIE, we must consolidate the VIE. A VIE is an entity with insufficient equity investment or in which the equity investors lack some of the characteristics of a controlling financial interest. In determining whether it is the primary beneficiary, we consider, among other things, whether it has the power to direct the activities of the VIE that most significantly impact the entity’s economic performance, including, but not limited to, determining or limiting the scope or purpose of the VIE, selling or transferring property owned or controlled by the VIE, or arranging financing for the VIE. We also consider whether we have the obligation to absorb losses of the VIE or the right to receive benefits from the VIE. Tenant and Other Receivables and Valuation of Receivables Tenant and other receivables are comprised of rental and reimbursement billings due from tenants, the cumulative amount of future adjustments necessary to present rental income on a straight-line basis, asset management fees and distributions receivable. Tenant receivables for rental revenues are recorded at the original amount earned, less an allowance for any doubtful accounts. Management assesses the likelihood of realizing tenant receivables and other fees on an ongoing basis and provides for allowances as such balances, or portions thereof, are estimated to become uncollectible. As of December 31, 2018 and 2017, there were no allowances recorded for tenant receivables. Deferred Financing Costs Costs incurred with potential financing arrangements are recorded as deferred debt issuance costs. Costs incurred in connection with completed debt financing are recorded as debt issuance costs. Debt issuance costs are amortized using the straight-line basis which approximates the effective interest rate method, over the contractual terms of the respective financings, and are presented net of loans payable in loans payable, net of debt issuance costs, in the consolidated balance sheets. Deferred Leasing Commissions Leasing commissions (paid to CRA prior to April 1, 2014) were capitalized at cost and are being amortized on a straight-line basis over the related lease term. As of December 31, 2018 and 2017, total costs incurred were $1.9 million, and the unamortized balance was approximately $1.1 million and $1.3 million, respectively. Amortization expense for the years ended December 31, 2018 and 2017 was approximately $140,000. Other Assets Other assets consist primarily of deferred financing costs, prepaid insurance, property taxes and other. Additionally, other assets will be amortized to expense over their future service periods. Balances without future economic benefit are expensed as they are identified. Equity-Method Investments We report our investments in unconsolidated entities, over whose operating and financial policies we have the ability to exercise significant influence but not control, under the equity method of accounting. Under this method of accounting, our pro rata share of the applicable entity’s earnings or losses is included in our consolidated statements of operations. We initially record our investments based on either the carrying value for properties contributed or the cash invested. We evaluate our equity-method investments for impairment whenever events or changes in circumstances indicate that the carrying value of our investments may exceed the fair value. If it is determined that a decline in the fair value of our investments is not temporary, and if such reduced fair value is below its carrying value, an impairment is recorded. Determining fair value involves significant judgment. Our estimates consider available evidence including the present value of the expected future cash flows discounted at market rates, general economic conditions and other relevant factors. We did not record any impairments related to our equity-method investments for the years ended December 31, 2018 and 2017. Revenue Recognition On January 1, 2018, the Company adopted Revenue from Contracts with Customers (Topic 606) . Our adoption of this new revenue recognition standard did not have a significant impact on our consolidated financial statements as our rental revenue relates to triple net leases and related tenant reimbursements, which are excluded from this standard. Additionally, interest income from our notes receivable is excluded from this standard. Acquisition fees arise from contractual agreements with our joint venture partners and are earned and paid at the time we close an acquisition, therefore, satisfying our performance obligations at that time. We earn our asset management fees based on a percentage of the purchase price or equity raised. As the manager, our duty is to manage the day-to-day operations of the special-purpose entities which own the properties. Asset management fees are recognized as a single performance obligation (managing the properties) comprised of a series of distinct services (handling issues with our tenants, etc.). We believe that the overall service of asset management is substantially the same each day and has the same pattern of performance over the term of the agreement. As a result, each day of service represents a performance obligation satisfied at that point in time. These fees are recognized at the end of each period for services performed during that period, billed monthly and paid quarterly. Revenue recognition for acquisition and asset management fees did not change under the new standard. The Company elected the modified retrospective transition method, however, no adjustments were required. Stock-Based Compensation We record stock-based compensation expense for share-based payments to employees and directors, including grants of stock options based on the estimated fair value of the options on the date of grant using the Black-Scholes option-pricing model. Compensation expense is recognized ratably over the vesting term and is included in general and administrative expense in our consolidated statements of operations. Forfeitures are recognized as they occur. See Note 10 for further information. Noncontrolling Interest in Consolidated Subsidiary Noncontrolling interest relates to the interest in the consolidated entities that are not wholly-owned by us. As of December 31, 2018 and 2017, the noncontrolling interest mainly relates to CHP, LLC. ASC 810-10-65, “ Consolidation” , clarifies that a noncontrolling interest in a subsidiary is an ownership interest in the consolidated entity that should be reported as equity in the consolidated financial statements. ASC 810-10-65 also requires consolidated net income to be reported at amounts that include the amounts attributable to both the parent and the noncontrolling interest and requires disclosure, on the face of the consolidated statements of operations, of the amounts of consolidated net income attributable to the parent and to the noncontrolling interest. We periodically evaluate individual noncontrolling interests for the ability to continue to recognize the noncontrolling interest as permanent equity in the consolidated balance sheets. Any noncontrolling interest that fails to qualify as permanent equity will be reclassified as temporary equity and adjusted to the greater of (a) the carrying amount, or (b) its redemption value as of the end of the period in which the determination is made. Income Taxes We have elected to be taxed as a REIT, under Sections 856 through 860 of the Internal Revenue Code of 1986, as amended (the “Code”) beginning with our taxable year ending December 31, 2006. To qualify as a REIT, we must meet certain organizational and operational requirements, including a requirement to currently distribute at least 90% of the REIT’s ordinary taxable income to stockholders. As a REIT, we generally will not be subject to federal income tax on taxable income that we distribute to our stockholders. If we fail to qualify as a REIT in any taxable year, we will then be subject to federal income taxes on our taxable income at regular corporate rates and will not be permitted to qualify for treatment as a REIT for federal income tax purposes for four years following the year during which qualification is lost unless the Internal Revenue Service were to grant us relief under certain statutory provisions. Such an event could materially and adversely affect our net income and net cash available for distribution to stockholders. However, we believe that we will be organized and operate in such a manner as to qualify for treatment as a REIT and intend to operate for the foreseeable future in such a manner so that we will remain qualified as a REIT for federal income tax purposes. Given the applicable statute of limitations, we generally are subject to audit by the Internal Revenue Service (“IRS”) for the year ended December 31, 2015 and subsequent years, and state income tax returns are subject to audit for the year ended December 31, 2014 and subsequent years. We have elected to treat SAM TRS as a taxable REIT subsidiary, which generally may engage in any business, including the provision of customary or non-customary services for our tenants. SAM TRS is treated as a regular corporation and is subject to federal income tax and applicable state income and franchise taxes at regular corporate rates. SAM TRS has deferred tax assets related to their NOL (which expires in or after 2035 for federal and state) for a total of $1,081,000, which has a full valuation allowance as of December 31, 2018 and 2017. Due to the losses incurred and the full valuation allowance on deferred tax assets, there was no tax provision related to SAM TRS in 2018 and 2017. Uncertain Tax Positions In accordance with the requirements of ASC 740, “ Income Taxes,” favorable tax positions are included in the calculation of tax liabilities if it is more likely than not that our adopted tax position will prevail if challenged by tax authorities. As a result of our REIT status, we are able to claim a dividends-paid deduction on our tax return to deduct the full amount of common dividends paid to stockholders when computing our annual taxable income, which results in our taxable income being passed through to our stockholders. A REIT is subject to a 100% tax on the net income from prohibited transactions. A “prohibited transaction” is the sale or other disposition of property held primarily for sale to customers in the ordinary course of a trade or business. There is a safe harbor provision which, if met, expressly prevents the Internal Revenue Service from asserting the prohibited transaction test. We have no income tax expense, deferred tax assets or deferred tax liabilities associated with any such uncertain tax positions for the operations of any entity included in the consolidated results of operations. We classify interest and penalties related to uncertain tax positions, if any, in our consolidated financial statements as a component of general and administrative expense. Basic and Diluted Net Loss and Distributions per Common Share Basic and diluted net loss per common share applicable to common stockholders is computed by dividing net loss applicable to common stockholders by the weighted-average number of common shares outstanding for the period. For each of the years ended December 31, 2018 and 2017, 1,230,908 and 895,408 stock options, respectively, have been excluded from the weighted-average number of shares outstanding since their effect was anti-dilutive. The basic and diluted loss applicable to common stockholders for the years ended December 31, 2018 and 2017 is computed by dividing the loss applicable to common stockholders of $0.9 million and $1.3 million by the weighted average number of shares outstanding of 23,027,978, respectively. Recently Adopted Accounting Pronouncements Restricted Cash On January 1, 2018, the Company adopted the FASB Accounting Standards Update (“ASU”) No. 2016-18, Statement of Cash Flows (Topic 230): Restricted Cash. The amendments in this ASU require that a statement of cash flows explain the change during the period in the total of cash, cash equivalents and amounts generally described as restricted cash or restricted cash equivalents. As a result, amounts generally described as restricted cash and restricted cash equivalents should be included with cash and cash equivalents when reconciling the beginning-of-period and end-of-period total amounts shown on the statement of cash flows. The Company’s statements of cash flows for the year ended December 31, 2017 has been retroactively restated for the effect of adopting this ASU, adding approximately $3.8 million to the beginning of the period cash, cash equivalents and restricted cash and approximately $3.4 million to the end of the period cash, cash equivalents and restricted cash. This reclassification resulted in an decrease to cash, cash equivalents and restricted cash provided by operating activities by $32,000 (related to the change in restricted cash held for operating activities) and an increase to cash, cash equivalents and restricted cash used in investing activities by $327,000 (related to the change in restricted cash held for capital improvements). See Revenue Recognition above for further information regarding our adoption of Revenue from Contracts with Customers (Topic 606) on January 1, 2018. Recently Issued Accounting Pronouncements In February 2016, the FASB issued ASU No. 2016-02, Leases Leases - Targeted Improvements In November 2018, the FASB has issued ASU No. 2018-20, Leases (Topic 842): Narrow-Scope Improvements for Lessors The Company plans to adopt the requirements of Topic 842 effective January 1, 2019, the first day of fiscal year 2019, and will use the cumulative-effect transition method. The Company anticipates taking advantage of the practical expedient options, which allows an entity not to reassess whether any existing or expired contracts contain leases, and lease classifications for existing or expired leases, and initial direct costs for existing leases, and the Company is further evaluating other optional practical expedients. We continue to evaluate the impact of our adoption of this new standard in 2019 and we estimate the effect on our consolidated balance sheet could be approximately $0.3 million, as we have an operating lease that will be added to the assets and liabilities of our consolidated balance sheet. As generally accepted accounting principles for lessors remains mostly unchanged, we do not expect it to have an impact on the total amount of revenues recognized from our leases from our tenants, however, beginning in 2019, the presentation of our rental revenues and tenant reimbursements will be combined into one line item on our consolidated statements of operations under lease revenue. In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments , which requires that entities use a new forward looking “expected loss” model that generally will result in the earlier recognition of allowance for credit losses. The measurement of expected credit losses is based upon historical experience, current conditions, and reasonable and supportable forecasts that affect the collectability of the reported amount. In November 2018, the FASB issued ASU 2018-19, Codification Improvements to Topic 326, Financial Instruments—Credit Losses (“ASU 2018-19”), which amends ASU 2016-13 to clarify that receivables arising from operating leases are not within the scope of Subtopic 326-20, and instead, impairment of such receivables should be accounted for in accordance with Topic 842, Leases. ASU 2016-13 and ASU 2018-19 are effective for fiscal years and interim periods within those years beginning after December 15, 2019, with early adoption permitted as of the fiscal years beginning after December 15, 2018. An entity will apply the amendments in these updates through a cumulative-effect adjustment to retained earnings as of the beginning of the first reporting period in which the guidance is effective (that is, a modified-retrospective approach). The Company is currently evaluating the impact this guidance will have on its consolidated financial statements when adopted. Reclassifications See above under Recently Adopted Accounting Pronouncements for reclassifications due to the adoption of ASU No. 2016-18, Statement of Cash Flows (Topic 230): Restricted Cash.

Investments in Real Estate Prop

Investments in Real Estate Properties	12 Months Ended
	Dec. 31, 2018
Real Estate [Abstract]
Real Estate Disclosure [Text Block]	3. Investments in Real Estate Properties As of December 31, 2018 and 2017, investments in real estate properties including those held by our consolidated subsidiaries: 2018 2017 Land $ 8,003,000 $ 7,318,000 Buildings and improvements 69,284,000 69,254,000 Less: accumulated depreciation (11,162,000 ) (9,012,000 ) Buildings and improvements, net 58,122,000 60,242,000 Furniture and fixtures 6,829,000 6,755,000 Less: accumulated depreciation (5,952,000 ) (5,252,000 ) Furniture and fixtures, net 877,000 1,503,000 Real estate properties, net $ 67,002,000 $ 69,063,000 Depreciation expense (excluding leasing commission amortization) for the years ended December 31, 2018 and 2017 was approximately $2.9 million. As of December 31, 2018, our portfolio consisted of 11 real estate properties which were 100% leased to the tenants of the related facilities. The following table provides summary information regarding our portfolio (excluding the 36 properties owned by our unconsolidated Equity-Method Investments) as of December 31, 2018: Property Location Date Purchased Type (1) Purchase Price Loans Payable, Excluding Debt Issuance Costs Number of Beds Sheridan Care Center Sheridan, OR August 3, 2012 SNF $ 4,100,000 $ 4,634,000 51 Fernhill Care Center Portland, OR August 3, 2012 SNF 4,500,000 4,065,000 63 Friendship Haven Healthcare and Rehabilitation Center Galveston County, TX September 14, 2012 SNF 15,000,000 10,725,000 150 Pacific Health and Rehabilitation Center Tigard, OR December 24, 2012 SNF 8,140,000 6,777,000 73 Danby House Winston-Salem, NC January 31, 2013 AL/MC 9,700,000 7,522,000 100 Brookstone of Aledo Aledo, IL July 2, 2013 AL 8,625,000 7,101,000 66 The Shelby House Shelby, NC October 4, 2013 AL 4,500,000 4,644,000 72 The Hamlet House Hamlet, NC October 4, 2013 AL 6,500,000 3,924,000 60 The Carteret House Newport, NC October 4, 2013 AL 4,300,000 3,310,000 64 Sundial Assisted Living Redding, CA December 18, 2013 AL 3,500,000 2,800,000 65 Pennington Gardens Chandler, AZ July 17, 2017 AL/MC 13,400,000 10,610,000 90 Total: $ 82,265,000 $ 66,112,000 854 (1) SNF is an abbreviation for skilled nursing facility. AL is an abbreviation for assisted living facility. MC is an abbreviation for memory care facility. Future Minimum Lease Payments The future minimum lease payments to be received under existing operating leases for properties owned as of December 31, 2018 are as follows: Years ending December 31, 2019 7,740,000 2020 7,902,000 2021 8,068,000 2022 8,237,000 2023 8,409,000 Thereafter 52,579,000 $ 92,935,000 2018 Acquisitions Land Purchase – Redding, CA On March 30, 2018, we purchased the land under the HP Redding facility, Sundial Assisted Living, for $685,000 plus approximately $30,000 in acquisition costs. Additionally, the existing lease agreement for the Sundial Assisted Living tenant was amended to increase the annual rental payment by $36,000. 2017 Acquisition – Pennington Gardens On July 17, 2017, we acquired a 100% interest in Pennington Gardens, a 90-bed assisted living/memory care facility located in Chandler, Arizona (“Pennington Gardens”) for a purchase price of $13.4 million plus approximately $52,000 in acquisition costs (allocated values were approximately $1.8 million to land, $10.9 million to building and improvements and $750,000 to furniture and fixtures), which was funded through cash on hand plus a collateralized loan (see Note 4). Pennington Gardens is leased pursuant to a 15-year triple net lease with two five-year renewal options, and per the lease agreement, we received a letter of credit in lieu of a cash security deposit.

Loans Payable

Loans Payable	12 Months Ended
	Dec. 31, 2018
Debt Disclosure [Abstract]
Debt Disclosure [Text Block]	4. Loans Payable As of December 31, 2018 and 2017, loans payable consisted of the following: December 31, 2018 December 31, 2017 Loan payable to CIBC Bank USA in monthly installments of approximately $70,000, including cash collateral and interest at LIBOR plus 3.75% (6.1% at December 31, 2018), due in March 2021, and collateralized by Friendship Haven. $ 10,725,000 $ - Loan payable to Capital One Multifamily Finance, LLC (insured by HUD) in monthly installments of approximately $49,000, including interest at a fixed rate of 4.23%, due in September 2053, and collateralized by Pennington Gardens. $ 10,610,000 $ - Loan payable to Capital One, National Association in monthly installments of approximately $36,000, including interest at LIBOR plus 2.95% (4.3% at December 31, 2017), was terminated in September 2018 and was collateralized by Pennington Gardens. $ - $ 10,050,000 Loan payable to Healthcare Financial Solutions, LLC in monthly installments of approximately $15,000, including interest at LIBOR (floor of 0.50%) plus 4.0% (6.4% and 5.3% at December 31, 2018 and 2017, respectively), and is due in July 2019, and is collateralized by Sundial Assisted Living. $ 2,800,000 $ 2,800,000 Loan payable to Oxford Finance, LLC in monthly installments of approximately $53,000, including interest at LIBOR (floor of 0.75%) plus 6.50% (8.1% as of December 31, 2017), was terminated in March 2018 and was collateralized by Friendship Haven as of December 31, 2017. $ - $ 6,880,000 Loans payable to Lancaster Pollard (insured by HUD) in monthly installments of approximately $209,000, including interest, ranging from a fixed rate of 3.70% to 3.78%, due in September 2039 through January 2051, and collateralized by Sheridan, Fernhill, Pacific Health, Shelby, Hamlet, Carteret, Aledo and Danby. 41,977,000 42,889,000 66,112,000 62,619,000 Less debt issuance costs (2,062,000 ) (1,788,000 ) Total loans payable $ 64,050,000 $ 60,831,000 As of December 31, 2018, we have total debt obligations of approximately $66.1 million that will mature between 2019 and 2053. See Note 3 for loans payable balance for each property. All of the loans payable have certain financial and non-financial covenants, including ratios and financial statement considerations. As of December 31, 2018, we were in compliance with all of our debt covenants. In connection with our loans payable, we incurred debt issuance costs. As of December 31, 2018 and 2017, the unamortized balance of the debt issuance costs was approximately $2.1 million and $1.8 million, respectively. These debt issuance costs are being amortized over the life of their respective financing agreements using the straight-line basis which approximates the effective interest rate method. For the years ended December 31, 2018 and 2017, approximately $0.3 million and $0.2 million, respectively, of debt issuance costs were amortized and included in interest expense in our consolidated statements of operations. See below under Oxford Finance, LLC and under Capital One regarding termination expenses. During the years ended December 31, 2018 and 2017, we incurred approximately $3.3 million and $2.8 million, respectively, of interest expense related (excluding debt issuance cost amortization) to our loans payable. The principal payments due on the loans payable (excluding debt issuance costs) for each of the five following years and thereafter ending December 31 are as follows: Year Principal Amount 2019 4,115,000 2020 1,367,000 2021 11,433,000 2022 1,219,000 2023 1,266,000 Thereafter 46,712,000 $ 66,112,000 The following information notes the loan activity for the years ended December 31, 2018 and 2017: CIBC Bank USA On March 30, 2018, CHP Friendswood SNF, LLC entered into a $10,725,000, three-year term loan and security agreement with CIBC Bank USA, which is collateralized by the Friendship Haven facility. We received approximately $9.0 million on March 30, 2018 (which was used to pay off the Oxford Finance loan discussed below) and the remaining $1.7 million on April 16, 2018. The loan bears interest at One Month LIBOR (London Interbank Offered Rate) plus 3.75%, and matures on March 30, 2021. The monthly payments, commencing in May 2018, consist of interest plus approximately $18,000 of cash loan guarantee payments, (increasing to $19,000 for year 2 and $20,000 for year 3), which will be held in a cash loan guarantee fund until maturity date. As of December 31, 2018, the total amount of approximately $147,000 is included in restricted cash on our consolidated balance sheet. If the loan is refinanced prior to the maturity date, the loan payments in the cash loan guarantee fund will be released to us; otherwise at the maturity date, the loan payments in the cash loan guarantee fund will be released to the lender and applied to the outstanding principal balance. The loan may be prepaid with no penalty if the property is refinanced through United States Department of Housing and Urban Development (“HUD”); otherwise we will be required to pay a prepayment premium of 2% of the loan balance prior to the first anniversary and 1% thereafter through maturity. We incurred approximately $0.2 million in debt issuance costs. See table above listing loans payable for further information. Capital One We had a secured term loan agreement with Capital One, National Association collateralized by the Pennington Gardens facility that was terminated on September 27, 2018 as the loan was refinanced with Capital One Multifamily Finance, LLC and insured by HUD (“HUD Pennington Loan”). We expensed the unamortized balance of approximately $15,000 of debt issuance costs related to the original Capital One loan, which is included in interest expense in our consolidated statements of operations. The HUD Pennington Loan is collateralized by the Pennington Gardens facility. The loan bears interest at a fixed rate of 4.23%, plus 0.65% for mortgage insurance premiums, for the term of the loan. The loan matures in September 2053 and amortizes over 35 years. We incurred approximately $0.3 million in debt issuance costs. The note contains a prepayment penalty of 10% in year 1, which reduces each year by 100 basis points, until there is no longer a prepayment penalty beginning in year 11. See table above listing loans payable for further information. Healthcare Financial Solutions, LLC (a.k.a. Capital One) We have an amended loan agreement for the Sundial Assisted Living property located in Redding with Healthcare Financial Solutions, LLC (“HFS”). See table above listing loans payable for further information. The loan was interest-only through January 2017 and then the loan payments increased to approximately $15,000 a month, including interest. The principal payment portion of this loan payment commencing in February 2017 is being held in a cash loan guarantee fund until maturity date. As of December 31, 2018, the total amount of approximately $105,000 is included in restricted cash on our consolidated balance sheet. If the loan is refinanced prior to the maturity date, the loan payments in the cash loan guarantee fund will be released to us; otherwise at the maturity date, the loan payments in the cash loan guarantee fund will be released to the lender and applied to the outstanding principal balance. Additionally, the loan is collateralized by the property and cross-guaranteed with several properties owned by the SUL JV, which will be released from the guarantee when the property is refinanced with a HUD-insured loan or upon repayment at the maturity date. Oxford Finance, LLC On March 30, 2018, we terminated our secured term loan agreement with Oxford Finance, LLC, which was collateralized by the Friendship Haven facility. See table above listing loans payable for further information. As we prepaid the loan prior to the maturity date of October 2019, we paid an exit fee of $87,500, a prepayment penalty of approximately $69,000 and $10,000 in other costs. Additionally, we expensed the unamortized balance of approximately $79,000 of debt issuance costs related to this loan. These payments were expensed to interest expense in our consolidated statements of operations in March 2018. Lancaster Pollard Mortgage Company, LLC We have several properties with HUD-insured loans from the Lancaster Pollard Mortgage Company, LLC (“Lancaster Pollard”). See table above listing loans payable for further information. All of the HUD-insured loans are subject to customary representations, warranties and ongoing covenants and agreements with respect to the operation of the facilities, including the provision for certain maintenance and other reserve accounts for property tax, insurance, and capital expenditures, with respect to the facilities all as described in the HUD agreements. These reserves are included in restricted cash in our consolidated balance sheets.

Equity-Method Investments

Equity-Method Investments	12 Months Ended
	Dec. 31, 2018
Equity Method Investments and Joint Ventures [Abstract]
Equity Method Investments and Joint Ventures Disclosure [Text Block]	5. Equity-Method Investments As of December 31, 2018 and 2017, the balances of our Equity-Method Investments were approximately $9.7 million and $9.2 million, respectively, and are as follows: Summit Union Life Holdings, LLC The SUL JV will exist until an event of dissolution occurs, as defined in the limited liability company agreement of the SUL JV (the “SUL LLC Agreement”). Under the SUL LLC Agreement, net operating cash flow of the SUL JV will be distributed monthly, first to the Operating Partnership and Best Years pari passu up to a 9% to 10% annual return, as defined, and thereafter to Best Years 75% and the Operating Partnership 25%. All capital proceeds from the sale of the properties held by the SUL JV, a refinancing or another capital event will be paid first to the Operating Partnership and Best Years pari passu until each has received an amount equal to its accrued but unpaid 9% to 10% return plus its total contribution, and thereafter to Best Years 75% and the Operating Partnership 25%. In April 2015, the Operating Partnership recorded a receivable for approximately $362,000 for distributions that could not be paid prior to the contribution of the original six properties contributed in April 2015 (“JV 2 Properties”) due to cash restrictions related to the loans payable for the contributed JV 2 Properties. In April 2017, we received approximately $122,000 to pay down the distribution receivable from one of the JV 2 properties. In December 2017, we received approximately $56,000 to pay down the distribution receivable from two of the JV 2 properties. As of December 31, 2018 and 2017, the receivable of $184,000, due from the JV 2 properties is included in tenant and other receivables on our consolidated balance sheets. In April 2017, one of the JV 2 properties that owed Summit approximately $110,000 in distributions payable was able to repay the funds; however, the cash was retained by the property to fund future capital calls. Through December 31, 2018, we applied approximately $5,000 of this as additional capital. As of December 31, 2018 and 2017, the remaining balance of $105,000 is included in tenant and other receivables in our consolidated balance sheets. As of December 31, 2018 and 2017, the balance of our equity-method investment related to the SUL JV was approximately $3.3 million and $3.6 million, respectively. Summit Fantasia Holdings, LLC The Fantasia JV will exist until an event of dissolution occurs, as defined in the limited liability company agreement of the Fantasia JV (the “Fantasia LLC Agreement”). In April 2018, we made an additional capital contribution of $1.25 million to the Fantasia JV. As a result of this capital contribution, as of April 27, 2018, the Operating Partnership has a 35% equity investment and each member will receive a distribution of net operating cash flow and capital proceeds of 50% (instead of 70% for Fantasia and 30% for the Operating Partnership) after the Operating Partnership and Fantasia receive their accrued, but unpaid, returns. Under the Fantasia LLC Agreement, as amended in April 2018, net operating cash flow of the Fantasia JV will be distributed quarterly, first to the Operating Partnership and Fantasia pari passu until each member has received an amount equal to its accrued, but unpaid 8% return, and thereafter 50% to Fantasia and 50% to the Operating Partnership. All capital proceeds from the sale of the properties held by the Fantasia JV, a refinancing or another capital event, will be paid first to the Operating Partnership and Fantasia pari passu until each has received an amount equal to its accrued but unpaid 8% return plus its total capital contribution, and thereafter 50% to Fantasia and 50% to the Operating Partnership. As of December 31, 2018 and 2017, the balance of our equity-method investment related to the Fantasia JV was approximately $2.2 million and $1.1 million, respectively. Summit Fantasia Holdings II, LLC The Fantasia II JV will exist until an event of dissolution occurs, as defined in the limited liability company agreement of the Fantasia II JV (the “Fantasia II LLC Agreement”). In February 2017, through the Fantasia II JV, we acquired a 20% interest in two skilled nursing facilities, located in Rhode Island. Fantasia II JV paid a total aggregate purchase price of $27 million, which was funded through capital contributions from the members of the Fantasia II JV plus the proceeds from a collateralized loan. The facilities consist of a total of 318 licensed beds, and are operated by and leased to a third party operator. We contributed approximately $1.9 million for the acquisition, which includes approximately $0.2 million of acquisition costs paid in 2016. Under the Fantasia II LLC Agreement, net operating cash flow of the Fantasia JV will be distributed quarterly, first to the Operating Partnership and Fantasia pari passu until each member has received an amount equal to its accrued, but unpaid 8% return, and thereafter 70% to Fantasia and 30% to the Operating Partnership. All capital proceeds from the sale of the properties held by the Fantasia II JV, a refinancing or another capital event, will be paid first to the Operating Partnership and Fantasia pari passu until each has received an amount equal to its accrued but unpaid 8% return plus its total capital contribution, and thereafter 70% to Fantasia and 30% to the Operating Partnership. As of December 31, 2018 and 2017, the balance of our equity-method investment related to the Fantasia II JV was approximately $1.6 million and $1.8 million, respectively. Summit Fantasia Holdings III, LLC The Fantasia III JV will continue until an event of dissolution occurs, as defined in the limited liability company agreement of the Fantasia III JV (the “Fantasia III LLC Agreement”). On August 10, 2017, through the Fantasia III JV, we acquired a 10 Under the Fantasia III LLC Agreement, net operating cash flow of the Fantasia III JV will be distributed quarterly, first to the Operating Partnership and Fantasia pari passu until each member has received an amount equal to its accrued, but unpaid 9% return, and thereafter 75% to Fantasia and 25% to the Operating Partnership. All capital proceeds from the sale of the properties held by the Fantasia III JV, a refinancing or another capital event, will be paid first to the Operating Partnership and Fantasia pari passu until each has received an amount equal to its accrued but unpaid 9% return plus its total capital contribution, and thereafter 75% to Fantasia and 25% to the Operating Partnership. As of December 31, 2018 and 2017, the balance of our equity-method investment related to the Fantasia III JV was approximately $1.7 million and $1.8 million, respectively. Summit Fantasy Pearl Holdings, LLC The FPH JV will continue until an event of dissolution occurs, as defined in the limited liability company agreement of the FPH JV (the “FPH LLC Agreement”). In November 2017, through the FPH JV, we acquired a 10% interest in six skilled nursing facilities, located in Iowa. FPH JV paid a total aggregate purchase price of $29.5 million for the properties, which was funded through capital contributions from the members of the FPH JV plus the proceeds from a collateralized loan. The facilities consist of a total of 511 licensed beds, and are operated by and leased to a third party operator. We contributed approximately $0.9 million to the FPH JV in connection with the acquisition. Under the FPH LLC Agreement, net operating cash flow of the FPH JV will be distributed quarterly, first to the members pari passu until each member has received an amount equal to its accrued, but unpaid 9% return, and thereafter 65.25% to Fantasy, 7.5% to Atlantis, 7.25% to Fantasia and 20% to the Operating Partnership. All capital proceeds from the sale of the properties held by the FPH JV, a refinancing or another capital event, will be paid to the members pari passu until each has received an amount equal to its accrued but unpaid 9% return plus its total capital contribution, and thereafter 65.25% to Fantasy, 7.5% to Atlantis, 7.25% to Fantasia, and 20% to the Operating Partnership. As of December 31, 2018 and 2017, the balance of our equity-method investment related to the FPH JV was approximately $0.9 million and $0.9 million, respectively. Summarized Financial Data for Equity-Method Investments Our Equity-Method Investments are significant equity-method investments in the aggregate. The results of operations of our Equity-Method Investments for the year ending December 31, 2018 are summarized below: SUL JV Fantasia JV Fantasia II JV Fantasia III JV FPH JV Combined Total Revenue $ 16,676,000 $ 2,043,000 $ 3,509,000 $ 7,812,000 $ 3,559,000 $ 33,599,000 Net Operating Income $ 14,226,000 $ 1,769,000 $ 2,844,000 $ 5,911,000 $ 3,052,000 $ 27,802,000 Income from Operations $ 8,110,000 $ 1,009,000 $ 1,922,000 $ 4,135,000 $ 1,707,000 $ 16,883,000 Net Income $ 1,832,000 $ 34,000 $ 459,000 $ 1,358,000 $ 305,000 $ 3,988,000 Summit interest in Equity-Method Investments net income $ 183,000 $ 14,000 $ 92,000 $ 136,000 $ 30,000 $ 455,000 Our Equity-Method Investments are significant equity-method investments in the aggregate. The results of operations of our Equity-Method Investments for the year ending December 31, 2017 are summarized below: SUL JV Fantasia JV Fantasia II JV Fantasia III JV FPH JV Combined Total Revenue $ 15,657,000 $ 2,027,000 $ 2,789,000 $ 3,021,000 $ 493,000 $ 23 987,000 Net Operating Income $ 14,316,000 $ 1,799,000 $ 2,378,000 $ 2,286,000 $ 412,000 $ 21,191,000 Income from Operations $ 8,156,000 $ 1,037,000 $ 1,604,000 $ 1,618,000 $ 237,000 $ 12,652,000 Net Income $ 3,561,000 $ 119,000 $ 681,000 $ 648,000 $ 51,000 $ 5,060,000 Summit interest in Equity-Method Investments net income $ 356,000 $ 24,000 $ 136,000 $ 65,000 $ 5,000 $ 586,000 Distributions from Equity-Method Investments As of December 31, 2018 and 2017, we have distributions receivable, which is included in tenant and other receivables in our consolidated balance sheets, as follows: December 31, 2018 December 31, 2017 SUL JV $ 168,000 $ 169,000 Fantasia JV 156,000 30,000 Fantasia II JV 52,000 58,000 Fantasia III JV 90,000 97,000 FPH JV 13,000 17,000 Total $ 479,000 $ 371,000 For the years ended December 31, 2018 and 2017, we received cash distributions, which are included in our cash flows from operating activities in tenant and other receivables, and cash flows from investing activities, using the cumulative earnings approach, as follows: Year Ended December 31, 2018 Year Ended December 31, 2017 Total Cash Distributions Received Cash Flow from Operating Cash Flow from Investing Total Cash Distributions Received Cash Flow from Operating Cash Flow from Investing SUL JV $ 494,000 $ 183,000 $ 311,000 $ 690,000 $ 356,000 $ 334,000 Fantasia JV 45,000 14,000 31,000 180,000 24,000 156,000 Fantasia II JV 259,000 92,000 167,000 237,000 136,000 101,000 Fantasia III JV 300,000 136,000 164,000 70,000 65,000 5,000 FPH JV 85,000 30,000 55,000 - - - Total $ 1,183,000 $ 455,000 $ 728,000 $ 1,177,000 $ 581,000 $ 596,000 Acquisition and Asset Management Fees We serve as the manager of our Equity-Method Investments and provide management services in exchange for fees and reimbursements. As the manager, we are paid an acquisition fee, as defined in the agreements. Additionally, we are paid an annual asset management fee for managing the properties held by our Equity-Method Investments, as defined in the agreements. For the years ended December 31, 2018 and 2017, we recorded approximately $0.7 million and $0.8 million, respectively, in acquisition and asset management fees from our Equity-Method Investments.

Receivables

Receivables	12 Months Ended
	Dec. 31, 2018
Receivables [Abstract]
Loans, Notes, Trade and Other Receivables Disclosure [Text Block]	6. Receivables Notes Receivable Friendswood TRS Note The Operating Partnership entered into an amended and restated promissory note dated January 1, 2018, with Friendswood TRS for approximately $1.1 million. The note does not bear interest and is due in 48 equal payments of approximately $22,000. We recorded a discount of approximately $95,000 on the note using an imputed interest rate of 4.25%. As of December 31, 2018, the balance on the note was approximately $0.7 million. Fernhill Note In September 2014, we loaned approximately $140,000 to the operator of the Fernhill facility for certain property improvements at a fixed rate of interest of 6% payable in monthly installments through January 2019. As of December 31, 2018 and 2017, the balance on the note was approximately $3,000 and $0.1 million, respectively. The note was paid in full in January 2019. Nantucket Note In January 2015, through our Operating Partnership, we sold Sherburne Commons to The Residences at Sherburne Commons, Inc. (“Sherburne Buyer”), an unaffiliated Massachusetts non-profit corporation, in exchange for $5.0 million, as evidenced by a purchase money note from Sherburne Buyer to us as the lender. The $5.0 million purchase money note matured on December 31, 2017. In December 2017, we provided an extension on the note until January 2018. Additionally, in December 2017, we collected approximately $0.9 million related to the principal on the note and as of December 31, 2017, the net carrying amount of the note receivable was approximately $3.8 million. In January 2018, we received approximately $4.0 million in full payoff of the note and recorded a gain on the note of approximately $0.2 million. For the years ended December 31, 2018 and 2017, we received interest payments from the note of approximately $18,000 and $177,000, respectively, which is recorded as interest income from notes receivable in our consolidated statements of operations. Tenant and Other Receivables, net Tenant and other receivables, net consists of: December 31, 2018 December 31, 2017 Straight-line rent receivables $ 3,675,000 $ 3,046,000 Distribution receivables from Equity-Method Investments 479,000 371,000 Receivable from JV 2 properties 184,000 184,000 Asset management fees 214,000 170,000 Other receivables 114,000 335,000 Total $ 4,666,000 $ 4,106,000

Related Party Transactions

Related Party Transactions	12 Months Ended
	Dec. 31, 2018
Related Party Transactions [Abstract]
Related Party Transactions Disclosure [Text Block]	7. Related Party Transactions CRA Prior to the termination of our advisory agreement on April 1, 2014 with CRA (our former advisor, a related party), we incurred costs related to fees paid and costs reimbursed for services rendered to us by CRA through March 31, 2014. Some of the fees we had paid to CRA were considered to be in excess of allowed amounts and, therefore, CRA was required to reimburse us for the amount of the excess costs we paid to them. As of December 31, 2018 and 2017, the receivables from CRA are fully reserved due to the uncertainty of collectability and are included in tenant and other receivables in our consolidated balance sheets (see Note 9). As of December 31, 2018 and 2017, we had the following receivables and reserves: Receivables Reserves Balance Organizational and offering costs $ 738,000 $ (738,000 ) $ - Asset management fees and expenses 32,000 (32,000 ) - Operating expenses (direct and indirect) 189,000 (189,000 ) - Operating expenses (2%/25% Test) 1,717,000 (1,717,000 ) - Total Real Estate Properties $ 2,676,000 $ (2,676,000 ) $ - Equity-Method Investments See Note 5 for further discussion of distributions and acquisition and asset management fees related to our Equity-Method Investments.

Concentration of Risk

Concentration of Risk	12 Months Ended
	Dec. 31, 2018
Risks and Uncertainties [Abstract]
Concentration Risk Disclosure [Text Block]	8. Concentration of Risk Our cash is generally invested in investment-grade short-term money market instruments. As of December 31, 2018, we had cash and cash equivalent accounts in excess of FDIC-insured limits. However, we do not believe the risk associated with this excess is significant. As of December 31, 2018, we owned one property in California, three properties in Oregon, four properties in North Carolina, one property in Texas, one property in Illinois, and one property in Arizona (excluding the 36 properties held by our Equity-Method Investments). Accordingly, there is a geographic concentration of risk subject to economic conditions in certain states. Additionally, for the year ended December 31, 2018, we leased our 11 real estate properties to four different tenants under long-term triple net leases, three of which comprise 41%, 23% and 13% of our tenant rental revenue. For the year ended December 31, 2017, we leased our 11 real estate properties to four different tenants under long-term triple net leases, three of which comprise 55%, 30% and 13% of our tenant rental revenue. As of December 31, 2018 and 2017, we have one tenant that constitutes a significant asset concentration, as the net assets under lease with the tenant were 31% and 33%, respectively, of our total assets.

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2018
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies Disclosure [Text Block]	9. Commitments and Contingencies We inspect our properties under a Phase I assessment for the presence of hazardous or toxic substances. While there can be no assurance that a material environmental liability does not exist, we are not currently aware of any environmental liability with respect to the properties that would have a material effect on our consolidated financial condition, results of operations and cash flows. Further, we are not aware of any environmental liability or any unasserted claim or assessment with respect to an environmental liability that we believe would require additional disclosure or the recording of a loss contingency. Our commitments and contingencies include the usual obligations of real estate owners and licensed operators in the normal course of business. In the opinion of management, these matters are not expected to have a material impact on our consolidated financial condition, results of operations and cash flows. We are also subject to contingent losses resulting from litigation against the Company. On April 1, 2014, CRA and Cornerstone Ventures, Inc. filed a complaint in the Superior Court of California for the County of Orange-Central Justice Center, Case No. 30-2014-00714004-CU-BT-CJC, naming the Company, its directors and two of its officers as defendants, seeking declaratory and injunctive relief and compensatory and punitive damages. On September 17, 2014, we filed a First Amended Cross-Complaint seeking compensatory damages and an accounting pursuant to Sections 10(c)(i) and 17(c)(ii) of the Advisory Agreement and including any monies Plaintiffs and Terry Roussel directly or indirectly received from or paid to the Company. On February 22, 2018, the action was assigned to a different trial judge. On November 30, 2018, the new trial judge vacated the trial date, pending resolution of the Company’s motion for terminating and monetary sanctions. On February 13, 2019, the trial judge held another hearing on the Company’s motion for terminating and monetary sanctions and indicated that it intended to grant the Company’s motion for terminating sanctions and award the Company monetary sanctions. However, the trial court has not yet entered an order on the Company’s motion. In September 2015, a bankruptcy petition was filed against Healthcare Real Estate Partners, LLC (“HCRE”) by the investors in Healthcare Real Estate Fund, LLC and Healthcare Real Estate Qualified Purchasers Fund, LLC (collectively, the “Funds”). HCRE did not timely respond to the involuntary petition and the Bankruptcy Court entered an Order of Relief making HCRE a debtor in bankruptcy. As a result, HCRE was removed as manager under the Funds’ operating agreement. Thereafter the Company became the manager of the Funds and purchased the investors’ interests in the Funds for approximately $0.9 million. Following the subsequent dismissal of the involuntary bankruptcy petition filed against it, HCRE filed a motion for attorneys’ fees and damages and a separate complaint for violation of the automatic stay against the petitioning creditors and the Company in the United States Bankruptcy Court of the District of Delaware. The Bankruptcy Court granted a motion to dismiss the complaint for violation of the automatic stay filed jointly by the petitioning creditors and us, and dismissed the complaint with prejudice. HCRE appealed the Bankruptcy Court’s decision to the United States District Court for the District of Delaware which affirmed the Bankruptcy Court’s dismissal of the complaint in a decision dated September 9, 2018. On October 11, 2018, HCRE appealed the District Court’s decision affirming the Bankruptcy Court’s dismissal of the complaint to the United States Court of Appeals for the Third Circuit. The appeal is currently being briefed by the parties. The Bankruptcy Court has stayed all litigation on HCRE’s motion for damages pending resolution of the appeal on the complaint for violation of the automatic stay by the Court of Appeals. We believe that all of HCRE’s remaining alleged claims are without merit and will vigorously defend ourselves. Delbert Freeman and his company, Freescan Ventures, Inc. (collectively, “Freeman”), filed an action against us and Mr. Eikanas, our President, on December 21, 2017 for breach of contract arising out of the sale of the Athens project in Georgia. We originally guaranteed a lease for the development of the Athens project, which was ultimately sold to a third party in June of 2016, thereby releasing us from our obligation. Freeman sued for breach of contract based on an allegation that he was not paid profits he was promised from the proceeds of the project. Freeman is also alleging that he was promised consulting fees of $270,000 from us arising out of an alleged oral agreement to pay consulting fees of $10,000 per month. A trial date has been set for June 30, 2019. We believe that his claims are without merit and are vigorously defending them. Lake Forest Lease We entered into a lease agreement, as amended, for corporate office space located in Lake Forest, California, which expires in April 2022. Lease payments for the next four years are as follows: Year Lease payments 2019 100,000 2020 104,000 2021 108,000 2022 36,000 $ 348,000 Indemnification and Employment Agreements We have entered into indemnification agreements with certain of our executive officers and directors which indemnify them against all judgments, penalties, fines and amounts paid in settlement and all expenses actually and reasonably incurred by him or her in connection with any proceeding. Additionally, effective October 1, 2018, we amended our employment agreements with our executive officers to extend the term of each agreement for an additional three years. These employment agreements include customary terms relating to salary, bonus, position, duties and benefits (including eligibility for equity compensation), as well as a cash payment following a change in control of the Company, as defined in such agreements. Management of our Equity-Method Investments As the manager of our Equity-Method Investments, we are responsible for managing the day-to-day operations and are, thus, subject to contingencies that may arise in the normal course of their operations. Additionally, we could be subject to a capital call from our Equity-Method Investments.

Equity

Equity	12 Months Ended
	Dec. 31, 2018
Equity [Abstract]
Stockholders' Equity Note Disclosure [Text Block]	10. Equity Common Stock Our articles of incorporation authorize 290,000,000 shares of common stock with a par value of $0.001 and 10,000,000 shares of preferred stock with a par value of $0.001. Distributions The Company declared a cash distribution per common share in November 2018, which was paid on January 31, 2019 to shareholders of record as of January 15, 2019. The $1.5 million distribution was recorded as a distribution payable as of December 31, 2018 which is included in accounts payable and accrued liabilities in our consolidated balance sheets. The Company declared no cash distributions per common share during the year ended December 31, 2017. Our distribution reinvestment plan was suspended indefinitely effective December 31, 2010. At this time, we cannot provide any assurance as to if or when we will resume our distribution reinvestment plan. Share-Based Compensation Plans Upon the grant of stock options, we determine the exercise price by using our estimated per-share value, which is calculated by aggregating the estimated fair value of our investments in real estate and the estimated fair value of our other assets, subtracting the book value, utilizing a discount for the fact that the shares are not currently traded on a national securities exchange and a control premium, and divided by the total by the number of our common shares outstanding at the time the options were granted. The fair value of each grant is estimated on the date of grant using the Black-Scholes option-pricing model. Assumptions required by the model include the risk-free interest rate, the expected life of the options, the expected stock price volatility over the expected life of the options, and the expected distribution yield. Compensation expense for employee stock options is recognized ratably over the vesting term. The expected life of the options was based on evaluations of expected future exercise behavior. The risk-free interest rate was based on the U.S. Treasury yield curve at the date of grant with maturity dates approximating the expected term of the options at the date of grant. Volatility was based on historical volatility of the stock prices for a sample of publicly traded companies with risk profiles similar to ours. The valuation model applied in this calculation utilizes highly subjective assumptions that could potentially change over time, including the expected stock price volatility and the expected life of an option. Summit Healthcare REIT, Inc. 2015 Omnibus Incentive Plan On October 28, 2015, we adopted the Summit Healthcare REIT, Inc. 2015 Omnibus Incentive Plan (“Incentive Plan”). The purpose of the Incentive Plan is to provide a means through which to attract and retain key personnel and to provide a means whereby current or prospective directors, officers, employees, consultants and advisors can acquire and maintain an equity interest in us, or be paid incentive compensation, including incentive compensation measured by reference to the value of our common stock, thereby strengthening their commitment to our welfare and aligning their interests with those of our stockholders. We may grant non-qualified stock options and incentive stock options, stock appreciation rights, restricted stock and restricted stock units, and performance based compensation awards. Stock options granted under the Incentive Plan are required to have a per share exercise price that is not less than 100% of the fair market value of our common stock underlying such stock options on the date an option is granted (other than in the case of options that are substitute awards). All stock options that are intended to qualify as incentive stock options must be granted pursuant to an award agreement expressly stating that the option is intended to qualify as an incentive stock option, and will be subject to the terms and conditions that comply with the rules as may be prescribed by Section 422 of the Code. The maximum term for stock options granted under the Incentive Plan will be ten years from the initial date of grant. The Incentive Plan provides that the total number of shares of common stock that may be issued is 3,000,000, of which 1,769,092 is available for future issuances as of December 31, 2018. On January 1, 2018, the Compensation Committee of the Board of Directors approved the issuance of 41,500 stock options under our Summit Healthcare REIT, Inc. 2015 Omnibus Incentive Plan (“Incentive Plan”) to our non-executive employees. The stock options vest monthly beginning on February 1, 2018 and continuing over a three-year period through January 1, 2021. The options expire 10 years from the grant date. The weighted-average fair value per share of the stock options granted was $0.40. On April 1, 2018, the Compensation Committee of the Board of Directors approved the issuance of 200,000 stock options under our Incentive Plan to executive management related to their performance goals for 2017. The stock options were granted under the Incentive Plan, with 33% vesting on the grant date and the remaining 67% vesting in equal monthly installments beginning May 1, 2018 and continuing over a two-year period through May 1, 2020. The options expire 10 years from the grant date. The weighted-average fair value per share of the stock options granted was $0.32. On April 1, 2018, the Compensation Committee of the Board of Directors approved the issuance of 100,000 stock options under our Incentive Plan to our directors. The stock options vest monthly beginning on May 1, 2018 and continuing over a three-year period through May 1, 2021. The options expire 10 years from the grant date. The weighted-average fair value per share of the stock options granted was $0.42. The estimated fair value using the Black-Scholes option-pricing model with the following weighted average assumptions: 2018 Stock options granted 341,500 Expected Volatility 21.97 % Expected lives 2.4 years Risk-free interest rate 2.27 % Dividends 0 % Fair value per share $ 0.36 The following table summarizes our stock options as of December, 2018: Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term Aggregate Intrinsic Value Options outstanding at January 1, 2018 895,408 $ 1.90 Granted 341,500 2.24 Exercised — Cancelled/forfeited (6,000 ) 2.13 Options outstanding at December 31, 2018 1,230,908 $ 1.99 8.05 $ 1,029,000 Options exercisable at December 31, 2018 970,179 $ 1.94 7.81 $ 864,000 For our outstanding non-vested options as of December 31, 2018, the weighted average grant date fair value per share was $0.36. As of December 31, 2018, we have unrecognized stock-based compensation expense related to unvested stock options, which is expected to be recognized as follows: Years Ending December 31, 2019 $ 62,000 2020 27,000 2021 5,000 $ 94,000 The stock-based compensation expense reported for the years ended December 31, 2018 and 2017 was approximately $100,000 and $106,000, respectively, and is included in general and administrative expense in the consolidated statements of operations.

Dispositions

Dispositions	12 Months Ended
	Dec. 31, 2018
Discontinued Operations and Disposal Groups [Abstract]
Disposal Groups, Including Discontinued Operations, Disclosure [Text Block]	11. Dispositions In accordance with ASC 360, Property, Plant & Equipment , we report results of operations from real estate assets that meet the definition of a component of an entity that have been sold, or meet the criteria to be classified as held for sale, as discontinued operations. TRS Disposition Effective January 1, 2018, we assigned our interest in Friendswood TRS, the licensed operator and tenant of Friendship Haven, to HMG, the management company of Friendship Haven. Therefore, as of January 1, 2018, Friendswood TRS is no longer consolidated in our consolidated financial statements. The consolidated statement of operations for the year ended December 31, 2017 has been restated to present the operations of Friendswood TRS as a discontinued operation. We made the decision to dispose of Friendswood TRS primarily because we are not in the business of operating facilities; we are in the business of acquiring senior housing facilities and leasing them to independent third party operators under triple-net leases. Friendswood TRS recorded the operations of Friendship Haven as resident services and fee income and resident services costs in their financial statements, which were then consolidated in our consolidated balance sheets and consolidated statements of operations and cash flows. The disposition represented a strategic shift to divest ourselves of being a tenant and licensed operator of our facilities, and had a material effect on the Company’s operations and financial results as we will no longer record resident services and fee income and resident services costs. Prior to January 1, 2018, HMG provided management services to Friendship Haven pursuant to a management agreement with Friendswood TRS. We do not have any continuing obligations under the management agreement as of January 1, 2018. Effective January 1, 2018, the new owners of Friendswood TRS entered into an Amended and Restated 10-year triple-net lease with two five-year renewal options, with CHP Friendswood SNF, LLC, our majority-owned consolidated subsidiary. Additionally, the Operating Partnership entered into an amended and restated promissory note with Friendswood TRS for approximately $1.1 million. The note does not bear interest and is due in 48 equal payments of approximately $22,000. We recorded a discount of approximately $95,000 on the note using an imputed interest rate of 4.25%. The income from discontinued operations presented in the consolidated statements of operations related to Friendswood TRS consists for the following for the years ended December 31, 2017: December 31, 2017 Revenues: Resident services and fee income $ 9,354,000 Other revenues 11,000 9,365,000 Expenses: Property operating costs 603,000 Resident services costs 6,657,000 General and administrative 116,000 Depreciation and amortization 56,000 7,432,000 Income from discontinued operations $ 1,933,000 The assets and liabilities of the discontinued operations are presented separately under the captions “Assets of Friendswood TRS held for sale” and “Liabilities of Friendswood TRS held for sale,” respectively, in the accompanying consolidated balance sheets at December 31, 2017, and consist of the following: December 31, 2017 ASSETS: Cash and cash equivalents $ 459,000 Real estate properties, net 320,000 Tenant and other receivables, net 947,000 Other assets 36,000 Total assets $ 1,762,000 LIABILITIES: Accounts payable and accrued liabilities 821,000 Accrued salaries and benefits 77,000 Total liabilities of property held for sale $ 898,000 Total operating, investing and financing activities from cash flows of the discontinued operations were $455,000, $(71,000) and $72,000, respectively, for the year ended December 31, 2017. In January 2018, we recorded a gain of $109,000 on the disposition of Friendswood TRS, which is recorded in discontinued operations in the consolidated statements of operations.

Segment Reporting

Segment Reporting	12 Months Ended
	Dec. 31, 2018
Segment Reporting [Abstract]
Segment Reporting Disclosure [Text Block]	12. Segment Reporting ASC 280, Segment Reporting , establishes standards for reporting financial and descriptive information about an enterprise’s reportable segments. As of December 31, 2018 and 2017, we operate in one reportable segment: healthcare real estate. We are managed as one segment, rather than multiple segments for internal purposes and for internal decision making.

Subsequent Events

Subsequent Events	12 Months Ended
	Dec. 31, 2018
Subsequent Events [Abstract]
Subsequent Events [Text Block]	13. Subsequent Events Issuance of Stock Options On January 1, 2019, the Compensation Committee of the Board of Directors approved the issuance of 47,500 stock options to our employees. The stock options will be granted under the Incentive Plan (see Note 10), will vest monthly over three years and expire 10 years from the grant date. On March 20, 2019, the Compensation Committee of the Board of Directors approved the issuance of 225,000 stock options to each of our executives. The stock options will be granted under the Incentive Plan (see Note 10) and the options vested 33% on the grant date and the remaining 67% will vest in equal monthly installments beginning April 1, 2019 and continuing over a two-year period through March 1, 2021. The options expire 10 years from the grant date. On March 20, 2019, the Compensation Committee of the Board of Directors approved the issuance of 110,000 stock options under our Incentive Plan to our directors. The stock options vest monthly beginning on April 1, 2019 and continuing over a three-year period through March 1, 2022. The options expire 10 years from the grant date. Sale of Four North Carolina Properties On February 14, 2019, our wholly-owned subsidiaries HP Shelby, LLC, HP Hamlet, LLC, HP Carteret, LLC, and the Company’s 95%-owned subsidiary, HP Winston-Salem, LLC, pursuant to a Purchase and Sale Agreement (the “Agreement”) with Agemark Acquisition, LLC (the “Purchaser”), sold to the Purchaser (the “Sale”) the following four properties located in North Carolina (“NC Properties”): The Shelby House, a 72-bed assisted living facility located in Shelby, North Carolina; The Hamlet House, a 60-bed assisted living facility located in Hamlet, North Carolina, The Carteret House, a 64-bed assisted living facility located in Newport, North Carolina and Danby House, a 100-bed assisted living and memory care facility located in Winston-Salem, North Carolina. The total consideration received by the Company and its subsidiaries pursuant to the Agreement was $27.0 million in the form of cash. On the date of the Sale, the aggregate carrying value of the NC Properties on the Company’s consolidated balance sheet was approximately $2.6 million, and the total assets of the NC Properties were approximately $22.1 million, less liabilities of approximately $19.5 million, including approximately $19.4 million of outstanding principal under U.S. Department of Housing and Urban Development-insured loans (the “HUD Loans”). The HUD Loans were paid off in full using the proceeds of the Sale. As a result of the Sale, as of February 15, 2019, the NC Properties will no longer be included in the Company’s consolidated financial statements. Indiana acquisition On February 28, 2019 we formed a new joint venture (“Indiana JV”), and on March 13, 2019, we entered into a Limited Liability Company Agreement (“Indiana JV Agreement”) through our wholly-owned subsidiary, Summit Indiana, LLC, with two unrelated parties: a real estate holding company and a global institutional asset management firm, both Delaware limited liability companies. W e have a 15 % membership On March 13, 2019, through the Indiana JV, we acquired a 15% $128.7 We serve as the operating member of the Indiana JV and provide management services in exchange for fees and reimbursements. Under the Indiana JV Agreement, as the operating member, we are paid an annual asset management fee equal to 5 % of the then base rents payable under the master lease. We contributed approximately $ 4.9 million for this equity investment.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2018
Accounting Policies [Abstract]
Basis of Accounting, Policy [Policy Text Block]	Principles of Consolidation and Basis of Presentation The consolidated financial statements include the accounts of the Company, its wholly-owned subsidiaries, the Operating Partnership (of which the Company owns 99.88%) and CHP, LLC (of which the Company owns 95%). All intercompany accounts and transactions have been eliminated in consolidation. The Financial Accounting Standards Board (“FASB”) issued Accounting Standard Codification (“ASC”) 810, Consolidation , which addresses how a business enterprise should evaluate whether it has a controlling interest in an entity through means other than voting rights and accordingly should consolidate the entity. Before concluding that it is appropriate to apply the voting interest consolidation model to an entity, an enterprise must first determine that the entity is not a variable interest entity. We evaluate, as appropriate, our interests, if any, in joint ventures and other arrangements to determine if consolidation is appropriate.
Use of Estimates, Policy [Policy Text Block]	Use of Estimates The preparation of our consolidated financial statements requires us to make estimates and judgments that affect the reported amounts of assets, liabilities, revenues and expenses. We base these estimates on various assumptions that we believe to be reasonable under the circumstances, and these estimates form the basis for our judgments concerning the carrying values of assets and liabilities that are not readily apparent from other sources. We periodically evaluate these estimates and judgments based on available information and experience. Actual results could differ from our estimates under different assumptions and conditions. If actual results significantly differ from our estimates, our financial condition and results of operations could be materially impacted.
Cash and Cash Equivalents, Policy [Policy Text Block]	Cash and Cash Equivalents We consider all short-term, highly liquid investments that are readily convertible to cash with a maturity of three months or less at the time of purchase to be cash equivalents. As of December 31, 2018, we had cash accounts in excess of FDIC-insured limits. We do not believe we are exposed to any significant credit risk on cash and cash equivalents.
Cash and Cash Equivalents, Restricted Cash and Cash Equivalents, Policy [Policy Text Block]	Restricted Cash See below under Recently Adopted Accounting Pronouncements for further information. Our restricted cash consists of escrows from our tenants for property taxes, insurance and capital improvements required by and held by our lenders. The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the consolidated balance sheets that sum to the total of the same such amounts shown on the consolidated statements of cash flows. December 31, 2018 December 31, 2017 Cash and cash equivalents $ 11,463,000 $ 3,851,000 Restricted cash 3,493,000 3,447,000 Total cash, cash equivalents, and restricted cash shown on the consolidated statements of cash flows $ 14,956,000 $ 7,298,000
Real Estate, Policy [Policy Text Block]	Investments in Real Estate and Depreciation We allocate the purchase price of our properties in accordance with ASC 805 – Business Combinations . If the acquisition does not meet the definition of a business, we record the acquisition as an asset acquisition. For transactions that are business combinations, acquisition costs are expensed as incurred. For transactions that are an asset acquisition, acquisition costs are capitalized as incurred. Upon an asset acquisition of a property, we allocate the purchase price of the property based upon the relative fair value of the assets acquired and liabilities assumed, which generally consists of land, buildings, site improvements, and furniture and fixtures. We allocate the purchase price to tangible assets of an acquired property by valuing the property as if it were vacant. We are required to make subjective assessments as to the estimated useful lives of our depreciable assets. We consider the period of future benefit of the assets to determine the appropriate estimated useful lives. Depreciation of our assets is being charged to expense on a straight-line basis over the estimated useful lives. We depreciate the fair value allocated to building and improvements over estimated useful lives ranging from 15 to 39 years. We estimate the value of furniture and fixtures based on the assets’ depreciated replacement cost. We depreciate the fair value allocated to furniture and fixtures over estimated useful lives ranging from three to six years. Assets held for sale are not depreciated.
Impairment or Disposal of Long-Lived Assets, Policy [Policy Text Block]	Impairment of Real Estate Assets We evaluate the recoverability of the carrying value of our real estate properties on a property-by-property basis. On a quarterly basis, we review our properties for recoverability when events or circumstances, including significant physical changes in the property, significant adverse changes in general economic conditions and significant deteriorations of the underlying cash flows of the property, indicate that the carrying amount of the property may not be fully recoverable. The need to recognize an impairment charge is based on estimated undiscounted future cash flows from a property compared to the carrying value of that property. If recognition of an impairment charge is necessary, it is measured as the amount by which the carrying amount of the property exceeds the fair value of the property. We recorded no impairment charges in 2018 and 2017.
Fair Value Measurement, Policy [Policy Text Block]	Fair Value Measurements ASC 825, Financial Instruments , requires the disclosure of fair value information about financial instruments whether or not recognized on the face of the balance sheet, for which it is practical to estimate that value. Fair value represents the estimate of the proceeds to be received, or paid in the case of a liability, in a current transaction between willing parties. ASC 820, Fair Value Measurement, establishes a fair value hierarchy to categorize the inputs used in valuation techniques to measure fair value. Inputs are either observable or unobservable in the marketplace. Observable inputs are based on market data from independent sources and unobservable inputs reflect the reporting entity’s assumptions about market participant assumptions used to value an asset or liability. Financial assets and liabilities are categorized based on the inputs to the valuation techniques as follows: Level 1. Quoted prices in active markets for identical instruments. Level 2. Observable inputs other than Level 1 prices, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 3. Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities. Assets and liabilities measured at fair value are classified according to the lowest level input that is significant to their valuation. A financial instrument that has a significant unobservable input along with significant observable inputs may still be classified as a Level 3 instrument. We generally determine or calculate the fair value of financial instruments using quoted market prices in active markets when such information is available or use appropriate present value or other valuation techniques, such as discounted cash flow analyses, incorporating available market discount rate information for similar types of instruments and our estimates for non-performance and liquidity risk. These techniques are significantly affected by the assumptions used, including the discount rate, credit spreads, and estimates of future cash flow. There were no assets measured at fair value on a nonrecurring basis during the year ended December 31, 2018.
Fair Value of Financial Instruments, Policy [Policy Text Block]	Fair Value Measurement of Financial Instruments Our consolidated balance sheets include the following financial instruments: cash and cash equivalents, restricted cash, notes receivable, deposits, tenant and other receivables, certain other assets, accounts payable and accrued liabilities, security deposits and loans payable. With the exception of the Friendswood TRS note receivable (see Note 6) and loans payable discussed below, we consider the carrying values to approximate fair value for such financial instruments because of the short period of time between origination of the instruments and their expected payment. As of December 31, 2018, the fair value of the Friendswood TRS note receivable (see Note 6) was $0.7 million compared to the carrying value of $0.7 million. The fair value of the note receivable was estimated based on cash flow analysis at a weighted-average discount rate of 4.7%. As the inputs to our valuation estimate are neither observable in nor supported by market activity, our notes receivable are classified as Level 3 assets within the fair value hierarchy. As of December 31, 2018 and 2017, the fair value of loans payable was $66.5 million and $63.3 million, compared to the principal balance (excluding debt discount) of $66.1 million and $62.6 million, respectively. The fair value of loans payable was estimated using lending rates available to us for financial instruments with similar terms and maturities. To estimate fair value as of December 31, 2018, we utilized discount rates ranging from 4.4% to 6.3% and a weighted average discount rate of 4.7%. As the inputs to our valuation estimate are neither observable in nor supported by market activity, our loans payable are classified as Level 3 assets within the fair value hierarchy. At December 31, 2018 and 2017, we do not have any significant financial assets or financial liabilities that are measured at fair value on a recurring basis in our consolidated financial statements.
Consolidation, Variable Interest Entity, Policy [Policy Text Block]	Variable Interest Entities We analyze our contractual and/or other interests to determine whether such interests constitute an interest in a variable interest entity (“VIE”) in accordance with ASC 810, Consolidation , and, if so, whether we are the primary beneficiary. If we are determined to be the primary beneficiary of a VIE, we must consolidate the VIE. A VIE is an entity with insufficient equity investment or in which the equity investors lack some of the characteristics of a controlling financial interest. In determining whether it is the primary beneficiary, we consider, among other things, whether it has the power to direct the activities of the VIE that most significantly impact the entity’s economic performance, including, but not limited to, determining or limiting the scope or purpose of the VIE, selling or transferring property owned or controlled by the VIE, or arranging financing for the VIE. We also consider whether we have the obligation to absorb losses of the VIE or the right to receive benefits from the VIE.
Trade and Other Accounts Receivable, Unbilled Receivables, Policy [Policy Text Block]	Tenant and Other Receivables and Valuation of Receivables Tenant and other receivables are comprised of rental and reimbursement billings due from tenants, the cumulative amount of future adjustments necessary to present rental income on a straight-line basis, asset management fees and distributions receivable. Tenant receivables for rental revenues are recorded at the original amount earned, less an allowance for any doubtful accounts. Management assesses the likelihood of realizing tenant receivables and other fees on an ongoing basis and provides for allowances as such balances, or portions thereof, are estimated to become uncollectible. As of December 31, 2018 and 2017, there were no allowances recorded for tenant receivables.
Deferred Charges, Policy [Policy Text Block]	Deferred Financing Costs Costs incurred with potential financing arrangements are recorded as deferred debt issuance costs. Costs incurred in connection with completed debt financing are recorded as debt issuance costs. Debt issuance costs are amortized using the straight-line basis which approximates the effective interest rate method, over the contractual terms of the respective financings, and are presented net of loans payable in loans payable, net of debt issuance costs, in the consolidated balance sheets.
Deferred Leasing Commissions Policy Text Block	Deferred Leasing Commissions Leasing commissions (paid to CRA prior to April 1, 2014) were capitalized at cost and are being amortized on a straight-line basis over the related lease term. As of December 31, 2018 and 2017, total costs incurred were $1.9 million, and the unamortized balance was approximately $1.1 million and $1.3 million, respectively. Amortization expense for the years ended December 31, 2018 and 2017 was approximately $140,000.
Other Assets Policy Text Block	Other Assets Other assets consist primarily of deferred financing costs, prepaid insurance, property taxes and other. Additionally, other assets will be amortized to expense over their future service periods. Balances without future economic benefit are expensed as they are identified.
Equity Method Investments [Policy Text Block]	Equity-Method Investments We report our investments in unconsolidated entities, over whose operating and financial policies we have the ability to exercise significant influence but not control, under the equity method of accounting. Under this method of accounting, our pro rata share of the applicable entity’s earnings or losses is included in our consolidated statements of operations. We initially record our investments based on either the carrying value for properties contributed or the cash invested. We evaluate our equity-method investments for impairment whenever events or changes in circumstances indicate that the carrying value of our investments may exceed the fair value. If it is determined that a decline in the fair value of our investments is not temporary, and if such reduced fair value is below its carrying value, an impairment is recorded. Determining fair value involves significant judgment. Our estimates consider available evidence including the present value of the expected future cash flows discounted at market rates, general economic conditions and other relevant factors. We did not record any impairments related to our equity-method investments for the years ended December 31, 2018 and 2017.
Revenue Recognition, Policy [Policy Text Block]	Revenue Recognition On January 1, 2018, the Company adopted Revenue from Contracts with Customers (Topic 606) . Our adoption of this new revenue recognition standard did not have a significant impact on our consolidated financial statements as our rental revenue relates to triple net leases and related tenant reimbursements, which are excluded from this standard. Additionally, interest income from our notes receivable is excluded from this standard. Acquisition fees arise from contractual agreements with our joint venture partners and are earned and paid at the time we close an acquisition, therefore, satisfying our performance obligations at that time. We earn our asset management fees based on a percentage of the purchase price or equity raised. As the manager, our duty is to manage the day-to-day operations of the special-purpose entities which own the properties. Asset management fees are recognized as a single performance obligation (managing the properties) comprised of a series of distinct services (handling issues with our tenants, etc.). We believe that the overall service of asset management is substantially the same each day and has the same pattern of performance over the term of the agreement. As a result, each day of service represents a performance obligation satisfied at that point in time. These fees are recognized at the end of each period for services performed during that period, billed monthly and paid quarterly. Revenue recognition for acquisition and asset management fees did not change under the new standard. The Company elected the modified retrospective transition method, however, no adjustments were required.
Share-based Compensation, Option and Incentive Plans Policy [Policy Text Block]	Stock-Based Compensation We record stock-based compensation expense for share-based payments to employees and directors, including grants of stock options based on the estimated fair value of the options on the date of grant using the Black-Scholes option-pricing model. Compensation expense is recognized ratably over the vesting term and is included in general and administrative expense in our consolidated statements of operations. Forfeitures are recognized as they occur. See Note 10 for further information.
Consolidation, Subsidiary Stock Issuances, Policy [Policy Text Block]	Noncontrolling Interest in Consolidated Subsidiary Noncontrolling interest relates to the interest in the consolidated entities that are not wholly-owned by us. As of December 31, 2018 and 2017, the noncontrolling interest mainly relates to CHP, LLC. ASC 810-10-65, “ Consolidation” , clarifies that a noncontrolling interest in a subsidiary is an ownership interest in the consolidated entity that should be reported as equity in the consolidated financial statements. ASC 810-10-65 also requires consolidated net income to be reported at amounts that include the amounts attributable to both the parent and the noncontrolling interest and requires disclosure, on the face of the consolidated statements of operations, of the amounts of consolidated net income attributable to the parent and to the noncontrolling interest. We periodically evaluate individual noncontrolling interests for the ability to continue to recognize the noncontrolling interest as permanent equity in the consolidated balance sheets. Any noncontrolling interest that fails to qualify as permanent equity will be reclassified as temporary equity and adjusted to the greater of (a) the carrying amount, or (b) its redemption value as of the end of the period in which the determination is made.
Regulatory Income Taxes, Policy [Policy Text Block]	Income Taxes We have elected to be taxed as a REIT, under Sections 856 through 860 of the Internal Revenue Code of 1986, as amended (the “Code”) beginning with our taxable year ending December 31, 2006. To qualify as a REIT, we must meet certain organizational and operational requirements, including a requirement to currently distribute at least 90% of the REIT’s ordinary taxable income to stockholders. As a REIT, we generally will not be subject to federal income tax on taxable income that we distribute to our stockholders. If we fail to qualify as a REIT in any taxable year, we will then be subject to federal income taxes on our taxable income at regular corporate rates and will not be permitted to qualify for treatment as a REIT for federal income tax purposes for four years following the year during which qualification is lost unless the Internal Revenue Service were to grant us relief under certain statutory provisions. Such an event could materially and adversely affect our net income and net cash available for distribution to stockholders. However, we believe that we will be organized and operate in such a manner as to qualify for treatment as a REIT and intend to operate for the foreseeable future in such a manner so that we will remain qualified as a REIT for federal income tax purposes. Given the applicable statute of limitations, we generally are subject to audit by the Internal Revenue Service (“IRS”) for the year ended December 31, 2015 and subsequent years, and state income tax returns are subject to audit for the year ended December 31, 2014 and subsequent years. We have elected to treat SAM TRS as a taxable REIT subsidiary, which generally may engage in any business, including the provision of customary or non-customary services for our tenants. SAM TRS is treated as a regular corporation and is subject to federal income tax and applicable state income and franchise taxes at regular corporate rates. SAM TRS has deferred tax assets related to their NOL (which expires in or after 2035 for federal and state) for a total of $1,081,000, which has a full valuation allowance as of December 31, 2018 and 2017. Due to the losses incurred and the full valuation allowance on deferred tax assets, there was no tax provision related to SAM TRS in 2018 and 2017.
Income Tax Uncertainties, Policy [Policy Text Block]	Uncertain Tax Positions In accordance with the requirements of ASC 740, “ Income Taxes,” favorable tax positions are included in the calculation of tax liabilities if it is more likely than not that our adopted tax position will prevail if challenged by tax authorities. As a result of our REIT status, we are able to claim a dividends-paid deduction on our tax return to deduct the full amount of common dividends paid to stockholders when computing our annual taxable income, which results in our taxable income being passed through to our stockholders. A REIT is subject to a 100% tax on the net income from prohibited transactions. A “prohibited transaction” is the sale or other disposition of property held primarily for sale to customers in the ordinary course of a trade or business. There is a safe harbor provision which, if met, expressly prevents the Internal Revenue Service from asserting the prohibited transaction test. We have no income tax expense, deferred tax assets or deferred tax liabilities associated with any such uncertain tax positions for the operations of any entity included in the consolidated results of operations. We classify interest and penalties related to uncertain tax positions, if any, in our consolidated financial statements as a component of general and administrative expense.
Basic And Diluted Net Loss Per Common Share Applicable To Common Shares Policy Text Block	Basic and Diluted Net Loss and Distributions per Common Share Basic and diluted net loss per common share applicable to common stockholders is computed by dividing net loss applicable to common stockholders by the weighted-average number of common shares outstanding for the period. For each of the years ended December 31, 2018 and 2017, 1,230,908 and 895,408 stock options, respectively, have been excluded from the weighted-average number of shares outstanding since their effect was anti-dilutive. The basic and diluted loss applicable to common stockholders for the years ended December 31, 2018 and 2017 is computed by dividing the loss applicable to common stockholders of $0.9 million and $1.3 million by the weighted average number of shares outstanding of 23,027,978, respectively.
New Accounting Pronouncements, Policy [Policy Text Block]	Recently Adopted Accounting Pronouncements Restricted Cash On January 1, 2018, the Company adopted the FASB Accounting Standards Update (“ASU”) No. 2016-18, Statement of Cash Flows (Topic 230): Restricted Cash. The amendments in this ASU require that a statement of cash flows explain the change during the period in the total of cash, cash equivalents and amounts generally described as restricted cash or restricted cash equivalents. As a result, amounts generally described as restricted cash and restricted cash equivalents should be included with cash and cash equivalents when reconciling the beginning-of-period and end-of-period total amounts shown on the statement of cash flows. The Company’s statements of cash flows for the year ended December 31, 2017 has been retroactively restated for the effect of adopting this ASU, adding approximately $3.8 million to the beginning of the period cash, cash equivalents and restricted cash and approximately $3.4 million to the end of the period cash, cash equivalents and restricted cash. This reclassification resulted in an decrease to cash, cash equivalents and restricted cash provided by operating activities by $32,000 (related to the change in restricted cash held for operating activities) and an increase to cash, cash equivalents and restricted cash used in investing activities by $327,000 (related to the change in restricted cash held for capital improvements). See Revenue Recognition above for further information regarding our adoption of Revenue from Contracts with Customers (Topic 606) on January 1, 2018. Recently Issued Accounting Pronouncements In February 2016, the FASB issued ASU No. 2016-02, Leases Leases - Targeted Improvements In November 2018, the FASB has issued ASU No. 2018-20, Leases (Topic 842): Narrow-Scope Improvements for Lessors The Company plans to adopt the requirements of Topic 842 effective January 1, 2019, the first day of fiscal year 2019, and will use the cumulative-effect transition method. The Company anticipates taking advantage of the practical expedient options, which allows an entity not to reassess whether any existing or expired contracts contain leases, and lease classifications for existing or expired leases, and initial direct costs for existing leases, and the Company is further evaluating other optional practical expedients. We continue to evaluate the impact of our adoption of this new standard in 2019 and we estimate the effect on our consolidated balance sheet could be approximately $0.3 million, as we have an operating lease that will be added to the assets and liabilities of our consolidated balance sheet. As generally accepted accounting principles for lessors remains mostly unchanged, we do not expect it to have an impact on the total amount of revenues recognized from our leases from our tenants, however, beginning in 2019, the presentation of our rental revenues and tenant reimbursements will be combined into one line item on our consolidated statements of operations under lease revenue. In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments , which requires that entities use a new forward looking “expected loss” model that generally will result in the earlier recognition of allowance for credit losses. The measurement of expected credit losses is based upon historical experience, current conditions, and reasonable and supportable forecasts that affect the collectability of the reported amount. In November 2018, the FASB issued ASU 2018-19, Codification Improvements to Topic 326, Financial Instruments—Credit Losses (“ASU 2018-19”), which amends ASU 2016-13 to clarify that receivables arising from operating leases are not within the scope of Subtopic 326-20, and instead, impairment of such receivables should be accounted for in accordance with Topic 842, Leases. ASU 2016-13 and ASU 2018-19 are effective for fiscal years and interim periods within those years beginning after December 15, 2019, with early adoption permitted as of the fiscal years beginning after December 15, 2018. An entity will apply the amendments in these updates through a cumulative-effect adjustment to retained earnings as of the beginning of the first reporting period in which the guidance is effective (that is, a modified-retrospective approach). The Company is currently evaluating the impact this guidance will have on its consolidated financial statements when adopted.
Reclassification, Policy [Policy Text Block]	Reclassifications See above under Recently Adopted Accounting Pronouncements for reclassifications due to the adoption of ASU No. 2016-18, Statement of Cash Flows (Topic 230): Restricted Cash.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2018
Accounting Policies [Abstract]
Restrictions on Cash and Cash Equivalents [Table Text Block]	The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the consolidated balance sheets that sum to the total of the same such amounts shown on the consolidated statements of cash flows. December 31, 2018 December 31, 2017 Cash and cash equivalents $ 11,463,000 $ 3,851,000 Restricted cash 3,493,000 3,447,000 Total cash, cash equivalents, and restricted cash shown on the consolidated statements of cash flows $ 14,956,000 $ 7,298,000

Investments in Real Estate Pr_2

Investments in Real Estate Properties (Tables)	12 Months Ended
	Dec. 31, 2018
Business Combinations [Abstract]
Schedule of Business Acquisitions, by Acquisition [Table Text Block]	As of December 31, 2018 and 2017, investments in real estate properties including those held by our consolidated subsidiaries: 2018 2017 Land $ 8,003,000 $ 7,318,000 Buildings and improvements 69,284,000 69,254,000 Less: accumulated depreciation (11,162,000 ) (9,012,000 ) Buildings and improvements, net 58,122,000 60,242,000 Furniture and fixtures 6,829,000 6,755,000 Less: accumulated depreciation (5,952,000 ) (5,252,000 ) Furniture and fixtures, net 877,000 1,503,000 Real estate properties, net $ 67,002,000 $ 69,063,000
Schedule of Real Estate Properties [Table Text Block]	The following table provides summary information regarding our portfolio (excluding the 36 properties owned by our unconsolidated Equity-Method Investments) as of December 31, 2018: Property Location Date Purchased Type (1) Purchase Loans Payable, Number of Sheridan Care Center Sheridan, OR August 3, 2012 SNF $ 4,100,000 $ 4,634,000 51 Fernhill Care Center Portland, OR August 3, 2012 SNF 4,500,000 4,065,000 63 Friendship Haven Healthcare and Rehabilitation Center Galveston County, TX September 14, 2012 SNF 15,000,000 10,725,000 150 Pacific Health and Rehabilitation Center Tigard, OR December 24, 2012 SNF 8,140,000 6,777,000 73 Danby House Winston-Salem, NC January 31, 2013 AL/MC 9,700,000 7,522,000 100 Brookstone of Aledo Aledo, IL July 2, 2013 AL 8,625,000 7,101,000 66 The Shelby House Shelby, NC October 4, 2013 AL 4,500,000 4,644,000 72 The Hamlet House Hamlet, NC October 4, 2013 AL 6,500,000 3,924,000 60 The Carteret House Newport, NC October 4, 2013 AL 4,300,000 3,310,000 64 Sundial Assisted Living Redding, CA December 18, 2013 AL 3,500,000 2,800,000 65 Pennington Gardens Chandler, AZ July 17, 2017 AL/MC 13,400,000 10,610,000 90 Total: $ 82,265,000 $ 66,112,000 854 (1) SNF is an abbreviation for skilled nursing facility. AL is an abbreviation for assisted living facility. MC is an abbreviation for memory care facility.
Schedule of Future Minimum Rental Payments for Operating Leases [Table Text Block]	The future minimum lease payments to be received under existing operating leases for properties owned as of December 31, 2018 are as follows: Years ending December 31, 2019 7,740,000 2020 7,902,000 2021 8,068,000 2022 8,237,000 2023 8,409,000 Thereafter 52,579,000 $ 92,935,000

Loans Payable (Tables)

Loans Payable (Tables)	12 Months Ended
	Dec. 31, 2018
Debt Disclosure [Abstract]
Schedule of Debt [Table Text Block]	As of December 31, 2018 and 2017, loans payable consisted of the following: December 31, 2018 December 31, 2017 Loan payable to CIBC Bank USA in monthly installments of approximately $70,000, including cash collateral and interest at LIBOR plus 3.75% (6.1% at December 31, 2018), due in March 2021, and collateralized by Friendship Haven. $ 10,725,000 $ - Loan payable to Capital One Multifamily Finance, LLC (insured by HUD) in monthly installments of approximately $49,000, including interest at a fixed rate of 4.23%, due in September 2053, and collateralized by Pennington Gardens. $ 10,610,000 $ - Loan payable to Capital One, National Association in monthly installments of approximately $36,000, including interest at LIBOR plus 2.95% (4.3% at December 31, 2017), was terminated in September 2018 and was collateralized by Pennington Gardens. $ - $ 10,050,000 Loan payable to Healthcare Financial Solutions, LLC in monthly installments of approximately $15,000, including interest at LIBOR (floor of 0.50%) plus 4.0% (6.4% and 5.3% at December 31, 2018 and 2017, respectively), and is due in July 2019, and is collateralized by Sundial Assisted Living. $ 2,800,000 $ 2,800,000 Loan payable to Oxford Finance, LLC in monthly installments of approximately $53,000, including interest at LIBOR (floor of 0.75%) plus 6.50% (8.1% as of December 31, 2017), was terminated in March 2018 and was collateralized by Friendship Haven as of December 31, 2017. $ - $ 6,880,000 Loans payable to Lancaster Pollard (insured by HUD) in monthly installments of approximately $209,000, including interest, ranging from a fixed rate of 3.70% to 3.78%, due in September 2039 through January 2051, and collateralized by Sheridan, Fernhill, Pacific Health, Shelby, Hamlet, Carteret, Aledo and Danby. 41,977,000 42,889,000 66,112,000 62,619,000 Less debt issuance costs (2,062,000 ) (1,788,000 ) Total loans payable $ 64,050,000 $ 60,831,000
Schedule of Maturities of Long-term Debt [Table Text Block]	The principal payments due on the loans payable (excluding debt issuance costs) for each of the five following years and thereafter ending December 31 are as follows: Year Principal Amount 2019 4,115,000 2020 1,367,000 2021 11,433,000 2022 1,219,000 2023 1,266,000 Thereafter 46,712,000 $ 66,112,000

Equity-Method Investments (Tabl

Equity-Method Investments (Tables)	12 Months Ended
	Dec. 31, 2018
Equity Method Investments and Joint Ventures [Abstract]
Equity Method Investments [Table Text Block]	Our Equity-Method Investments are significant equity-method investments in the aggregate. The results of operations of our Equity-Method Investments for the year ending December 31, 2018 are summarized below: SUL JV Fantasia JV Fantasia II JV Fantasia III JV FPH JV Combined Total Revenue $ 16,676,000 $ 2,043,000 $ 3,509,000 $ 7,812,000 $ 3,559,000 $ 33,599,000 Net Operating Income $ 14,226,000 $ 1,769,000 $ 2,844,000 $ 5,911,000 $ 3,052,000 $ 27,802,000 Income from Operations $ 8,110,000 $ 1,009,000 $ 1,922,000 $ 4,135,000 $ 1,707,000 $ 16,883,000 Net Income $ 1,832,000 $ 34,000 $ 459,000 $ 1,358,000 $ 305,000 $ 3,988,000 Summit interest in Equity-Method Investments net income $ 183,000 $ 14,000 $ 92,000 $ 136,000 $ 30,000 $ 455,000 Our Equity-Method Investments are significant equity-method investments in the aggregate. The results of operations of our Equity-Method Investments for the year ending December 31, 2017 are summarized below: SUL JV Fantasia JV Fantasia II JV Fantasia III JV FPH JV Combined Total Revenue $ 15,657,000 $ 2,027,000 $ 2,789,000 $ 3,021,000 $ 493,000 $ 23 987,000 Net Operating Income $ 14,316,000 $ 1,799,000 $ 2,378,000 $ 2,286,000 $ 412,000 $ 21,191,000 Income from Operations $ 8,156,000 $ 1,037,000 $ 1,604,000 $ 1,618,000 $ 237,000 $ 12,652,000 Net Income $ 3,561,000 $ 119,000 $ 681,000 $ 648,000 $ 51,000 $ 5,060,000 Summit interest in Equity-Method Investments net income $ 356,000 $ 24,000 $ 136,000 $ 65,000 $ 5,000 $ 586,000
Schedule Of Distribution From Equity Method Investments [Table Text Block]	As of December 31, 2018 and 2017, we have distributions receivable, which is included in tenant and other receivables in our consolidated balance sheets, as follows: December 31, 2018 December 31, 2017 SUL JV $ 168,000 $ 169,000 Fantasia JV 156,000 30,000 Fantasia II JV 52,000 58,000 Fantasia III JV 90,000 97,000 FPH JV 13,000 17,000 Total $ 479,000 $ 371,000
Schedule Of Cash Distributions Included In Cash Flows From Operating And Investing Activities [Table Text Block]	For the years ended December 31, 2018 and 2017, we received cash distributions, which are included in our cash flows from operating activities in tenant and other receivables, and cash flows from investing activities, using the cumulative earnings approach, as follows: Year Ended December 31, 2018 Year Ended December 31, 2017 Total Cash Distributions Received Cash Flow from Operating Cash Flow from Investing Total Cash Distributions Received Cash Flow from Operating Cash Flow from Investing SUL JV $ 494,000 $ 183,000 $ 311,000 $ 690,000 $ 356,000 $ 334,000 Fantasia JV 45,000 14,000 31,000 180,000 24,000 156,000 Fantasia II JV 259,000 92,000 167,000 237,000 136,000 101,000 Fantasia III JV 300,000 136,000 164,000 70,000 65,000 5,000 FPH JV 85,000 30,000 55,000 - - - Total $ 1,183,000 $ 455,000 $ 728,000 $ 1,177,000 $ 581,000 $ 596,000

Receivables (Tables)

Receivables (Tables)	12 Months Ended
	Dec. 31, 2018
Receivables [Abstract]
Schedule of Accounts, Notes, Loans and Financing Receivable [Table Text Block]	Tenant and other receivables, net consists of: December 31, 2018 December 31, 2017 Straight-line rent receivables $ 3,675,000 $ 3,046,000 Distribution receivables from Equity-Method Investments 479,000 371,000 Receivable from JV 2 properties 184,000 184,000 Asset management fees 214,000 170,000 Other receivables 114,000 335,000 Total $ 4,666,000 $ 4,106,000

Related Party Transactions (Tab

Related Party Transactions (Tables)	12 Months Ended
	Dec. 31, 2018
Related Party Transactions [Abstract]
Schedule of Related Party Transactions [Table Text Block]	As of December 31, 2018 and 2017, we had the following receivables and reserves: Receivables Reserves Balance Organizational and offering costs $ 738,000 $ (738,000 ) $ - Asset management fees and expenses 32,000 (32,000 ) - Operating expenses (direct and indirect) 189,000 (189,000 ) - Operating expenses (2%/25% Test) 1,717,000 (1,717,000 ) - Total Real Estate Properties $ 2,676,000 $ (2,676,000 ) $ -

Commitments and Contingencies (

Commitments and Contingencies (Tables)	12 Months Ended
	Dec. 31, 2018
Commitments and Contingencies Disclosure [Abstract]
Schedule Of Future Minimum Rental Payment For Operating Leases [Table Text Block]	We entered into a lease agreement, as amended, for corporate office space located in Lake Forest, California, which expires in April 2022. Lease payments for the next four years are as follows: Year Lease payments 2019 100,000 2020 104,000 2021 108,000 2022 36,000 $ 348,000

Equity (Tables)

Equity (Tables)	12 Months Ended
	Dec. 31, 2018
Equity [Abstract]
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions [Table Text Block]	The estimated fair value using the Black-Scholes option-pricing model with the following weighted average assumptions: 2018 Stock options granted 341,500 Expected Volatility 21.97 % Expected lives 2.4 years Risk-free interest rate 2.27 % Dividends 0 % Fair value per share $ 0.36
Share-based Compensation, Stock Options, Activity [Table Text Block]	The following table summarizes our stock options as of December, 2018: Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term Aggregate Intrinsic Value Options outstanding at January 1, 2018 895,408 $ 1.90 Granted 341,500 2.24 Exercised — Cancelled/forfeited (6,000 ) 2.13 Options outstanding at December 31, 2018 1,230,908 $ 1.99 8.05 $ 1,029,000 Options exercisable at December 31, 2018 970,179 $ 1.94 7.81 $ 864,000
Schedule of Unrecognized Compensation Cost, Nonvested Awards [Table Text Block]	For our outstanding non-vested options as of December 31, 2018, the weighted average grant date fair value per share was $0.36. As of December 31, 2018, we have unrecognized stock-based compensation expense related to unvested stock options, which is expected to be recognized as follows: Years Ending December 31, 2019 $ 62,000 2020 27,000 2021 5,000 $ 94,000

Dispositions (Tables)

Dispositions (Tables)	12 Months Ended
	Dec. 31, 2018
Discontinued Operations and Disposal Groups [Abstract]
Disposal Groups, Including Discontinued Operations [Table Text Block]	The income from discontinued operations presented in the consolidated statements of operations related to Friendswood TRS consists for the following for the years ended December 31, 2017: December 31, 2017 Revenues: Resident services and fee income $ 9,354,000 Other revenues 11,000 9,365,000 Expenses: Property operating costs 603,000 Resident services costs 6,657,000 General and administrative 116,000 Depreciation and amortization 56,000 7,432,000 Income from discontinued operations $ 1,933,000 The assets and liabilities of the discontinued operations are presented separately under the captions “Assets of Friendswood TRS held for sale” and “Liabilities of Friendswood TRS held for sale,” respectively, in the accompanying consolidated balance sheets at December 31, 2017, and consist of the following: December 31, 2017 ASSETS: Cash and cash equivalents $ 459,000 Real estate properties, net 320,000 Tenant and other receivables, net 947,000 Other assets 36,000 Total assets $ 1,762,000 LIABILITIES: Accounts payable and accrued liabilities 821,000 Accrued salaries and benefits 77,000 Total liabilities of property held for sale $ 898,000

Organization (Details Textual)

Organization (Details Textual) - USD ($)	1 Months Ended	12 Months Ended
	Apr. 30, 2018	Dec. 31, 2018	Dec. 31, 2017
Organization [Line Items]
Payments to Acquire Equity Method Investments		$ 1,313,000	$ 4,624,000
Cornerstone Operating Partnership [Member]
Organization [Line Items]
Limited Liability Company (LLC) or Limited Partnership (LP), Members or Limited Partners, Ownership Interest		99.88%
Cornerstone Operating Partnership [Member] | Cornerstone Realty Advisors, LLC [Member]
Organization [Line Items]
Limited Liability Company (LLC) or Limited Partnership (LP), Members or Limited Partners, Ownership Interest by Affiliates		0.12%
Cornerstone Healthcare Partners LLC [Member]
Organization [Line Items]
Limited Liability Company (LLC) or Limited Partnership (LP), Members or Limited Partners, Ownership Interest		95.00%
Cornerstone Healthcare Real Estate Fund [Member]
Organization [Line Items]
Limited Liability Company (LLC) or Limited Partnership (LP), Members or Limited Partners, Ownership Interest by Affiliates		5.00%
JV Properties [Member]
Organization [Line Items]
Noncontrolling Interest, Ownership Percentage by Noncontrolling Owners		4.70%
Summit Union Life Holding [Member]
Organization [Line Items]
Limited Liability Company (LLC) or Limited Partnership (LP), Members or Limited Partners, Ownership Interest		10.00%
Equity Method Investment, Ownership Percentage			10.00%
Summit Healthcare Five Properties One [Member]
Organization [Line Items]
Real Estate Investment Trust Owne Percentage		95.00%
Five Jv Properties [Member] | Chref One [Member]
Organization [Line Items]
Limited Liability Company (LLC) or Limited Partnership (LP), Members or Limited Partners, Ownership Interest		95.00%
Five Jv Properties [Member] | Chref Two [Member]
Organization [Line Items]
Noncontrolling Interest, Ownership Percentage by Noncontrolling Owners		5.00%
Four Jv Properties [Member]
Organization [Line Items]
Limited Liability Company (LLC) or Limited Partnership (LP), Members or Limited Partners, Ownership Interest		95.30%
Summit Health Care Two Properties [Member]
Organization [Line Items]
Equity Method Investment, Ownership Percentage		35.00%
Summit Fantasia Holdings Llc [Member]
Organization [Line Items]
Limited Liability Company (LLC) or Limited Partnership (LP), Members or Limited Partners, Ownership Interest by Affiliates		20.00%	20.00%
Equity Method Investment, Ownership Percentage		35.00%
Payments to Acquire Equity Method Investments	$ 1,250,000
Summit Fantasia Holdings III, LLC
Organization [Line Items]
Limited Liability Company (LLC) or Limited Partnership (LP), Members or Limited Partners, Ownership Interest		10.00%
Limited Liability Company (LLC) or Limited Partnership (LP), Members or Limited Partners, Ownership Interest by Affiliates		10.00%	10.00%
Summit Fantasy Pearl Holdings, LLC [Member]
Organization [Line Items]
Equity Method Investment, Ownership Percentage		10.00%
Summit Union Life Holdings, LLC
Organization [Line Items]
Equity Method Investment, Ownership Percentage		10.00%
Summit Fantasia Holdings, LLC
Organization [Line Items]
Limited Liability Company (LLC) or Limited Partnership (LP), Members or Limited Partners, Ownership Interest by Affiliates		35.00%	20.00%
Equity Method Investment, Ownership Percentage			20.00%
Summit Health care Six Properties One [Member]
Organization [Line Items]
Equity Method Investment, Ownership Percentage		100.00%
Summit Health Care Four Properties [Member]
Organization [Line Items]
Limited Liability Company (LLC) or Limited Partnership (LP), Members or Limited Partners, Ownership Interest by Affiliates		95.30%

Summary of Significant Accoun_4

Summary of Significant Accounting Policies (Details) - USD ($)	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Cash and cash equivalents	$ 11,463,000	$ 3,851,000
Restricted cash	3,493,000	3,447,000
Total cash, cash equivalents, and restricted cash shown on the consolidated statements of cash flows	$ 14,956,000	$ 7,298,000	$ 14,563,000

Summary of Significant Accoun_5

Summary of Significant Accounting Policies (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Summary of Significant Accounting Policies [Line Items]
Income (Loss) from Discontinued Operations, Net of Tax, Including Portion Attributable to Noncontrolling Interest	$ 109,000	$ 1,933,000
Net Income (Loss) Available to Common Stockholders, Basic	900,000	1,300,000
New Accounting Pronouncement or Change in Accounting Principle Decrease in Cash, Cash Equivalents and Restricted Cash Investing Activities		327,000
Loans Payable, Fair Value Disclosure	66,500,000	63,300,000
Deferred Costs, Total	1,900,000	1,900,000
Deferred Costs, Leasing, Net, Total	1,133,000	1,273,000
Amortization	140,000	140,000
Notes Receivable, Fair Value Disclosure	700,000
Financing Receivable, Net	730,000	3,854,000
Loans Payable	$ 66,112,000	$ 62,619,000
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	1,230,908	895,408
Weighted Average Number of Shares Outstanding, Basic and Diluted	23,027,978	23,027,978
Deferred Tax Assets, Valuation Allowance	$ 1,081,000	$ 1,081,000
Operating Lease, Right-of-Use Asset	300,000
Operating Lease, Liability	300,000
Adjustments for New Accounting Pronouncement [Member]
Summary of Significant Accounting Policies [Line Items]
Income (Loss) from Discontinued Operations, Net of Tax, Including Portion Attributable to Noncontrolling Interest	$ 32,000
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Period Increase (Decrease), Including Exchange Rate Effect		$ 3,400,000	$ 3,800,000
Operating Partnership [Member]
Summary of Significant Accounting Policies [Line Items]
Noncontrolling Interest, Ownership Percentage by Parent	99.88%
Cornerstone Healthcare Partners [Member]
Summary of Significant Accounting Policies [Line Items]
Noncontrolling Interest, Ownership Percentage by Parent	95.00%
Real Estate Investment Trust [Member]
Summary of Significant Accounting Policies [Line Items]
Percentage Of Taxable Income	90.00%
Minimum [Member]
Summary of Significant Accounting Policies [Line Items]
Fair Value, Inputs Discount Rate, Loans payable	4.40%
Minimum [Member] | Property, Plant and Equipment, Other Types [Member]
Summary of Significant Accounting Policies [Line Items]
Property, Plant and Equipment, Useful Life	15 years
Maximum [Member]
Summary of Significant Accounting Policies [Line Items]
Fair Value, Inputs Discount Rate, Loans payable	6.30%
Maximum [Member] | Property, Plant and Equipment, Other Types [Member]
Summary of Significant Accounting Policies [Line Items]
Property, Plant and Equipment, Useful Life	39 years
Weighted Average [Member]
Summary of Significant Accounting Policies [Line Items]
Fair Value, Inputs Discount Rate, Loans payable	4.70%

Investments in Real Estate Pr_3

Investments in Real Estate Properties (Details) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Real Estate Properties [Line Items]
Real estate properties, net	$ 67,002,000	$ 69,063,000
Land [Member]
Real Estate Properties [Line Items]
Real estate properties, net	8,003,000	7,318,000
Buildings and improvements [Member]
Real Estate Properties [Line Items]
Investments in real estate	69,284,000	69,254,000
Less: accumulated depreciation	(11,162,000)	(9,012,000)
Real estate properties, net	58,122,000	60,242,000
Furniture and Fixture [Member]
Real Estate Properties [Line Items]
Investments in real estate	6,829,000	6,755,000
Less: accumulated depreciation	(5,952,000)	(5,252,000)
Real estate properties, net	$ 877,000	$ 1,503,000

Investments in Real Estate Pr_4

Investments in Real Estate Properties (Details 1)	12 Months Ended
	Dec. 31, 2018USD ($)
Real Estate Properties [Line Items]
Purchase Price	$ 82,265,000
Loans Payable, Excluding Debt Issuance Costs	$ 66,112,000
Number of Beds	854
Sheridan Care Center [Member]
Real Estate Properties [Line Items]
Location	Sheridan, OR
Date Purchased	Aug. 3, 2012
Type Of property	SNF	[1]
Purchase Price	$ 4,100,000
Loans Payable, Excluding Debt Issuance Costs	$ 4,634,000
Number of Beds	51
Fernhill Care Center [Member]
Real Estate Properties [Line Items]
Location	Portland, OR
Date Purchased	Aug. 3, 2012
Type Of property	SNF	[1]
Purchase Price	$ 4,500,000
Loans Payable, Excluding Debt Issuance Costs	$ 4,065,000
Number of Beds	63
Friendship Haven Healthcare and Rehabilitation Center [Member]
Real Estate Properties [Line Items]
Location	Galveston County, TX
Date Purchased	Sep. 14, 2012
Type Of property	SNF	[1]
Purchase Price	$ 15,000,000
Loans Payable, Excluding Debt Issuance Costs	$ 10,725,000
Number of Beds	150
Pacific Health and Rehabilitation Center [Member]
Real Estate Properties [Line Items]
Location	Tigard, OR
Date Purchased	Dec. 24, 2012
Type Of property	SNF	[1]
Purchase Price	$ 8,140,000
Loans Payable, Excluding Debt Issuance Costs	$ 6,777,000
Number of Beds	73
Danby House [Member]
Real Estate Properties [Line Items]
Location	Winston-Salem, NC
Date Purchased	Jan. 31, 2013
Type Of property	AL/MC	[1]
Purchase Price	$ 9,700,000
Loans Payable, Excluding Debt Issuance Costs	$ 7,522,000
Number of Beds	100
Brookstone of Aledo [Member]
Real Estate Properties [Line Items]
Location	Aledo, IL
Date Purchased	Jul. 2, 2013
Type Of property	AL	[1]
Purchase Price	$ 8,625,000
Loans Payable, Excluding Debt Issuance Costs	$ 7,101,000
Number of Beds	66
The Shelby House [Member]
Real Estate Properties [Line Items]
Location	Shelby, NC
Date Purchased	Oct. 4, 2013
Type Of property	AL	[1]
Purchase Price	$ 4,500,000
Loans Payable, Excluding Debt Issuance Costs	$ 4,644,000
Number of Beds	72
The Hamlet House [Member]
Real Estate Properties [Line Items]
Location	Hamlet, NC
Date Purchased	Oct. 4, 2013
Type Of property	AL	[1]
Purchase Price	$ 6,500,000
Loans Payable, Excluding Debt Issuance Costs	$ 3,924,000
Number of Beds	60
The Carteret House [Member]
Real Estate Properties [Line Items]
Location	Newport, NC
Date Purchased	Oct. 4, 2013
Type Of property	AL	[1]
Purchase Price	$ 4,300,000
Loans Payable, Excluding Debt Issuance Costs	$ 3,310,000
Number of Beds	64
Sundial Assisted Living [Member]
Real Estate Properties [Line Items]
Location	Redding, CA
Date Purchased	Dec. 18, 2013
Type Of property	AL	[1]
Purchase Price	$ 3,500,000
Loans Payable, Excluding Debt Issuance Costs	$ 2,800,000
Number of Beds	65
Pennington Gardens [Member]
Real Estate Properties [Line Items]
Location	Chandler, AZ
Date Purchased	Jul. 17, 2017
Type Of property	AL/MC	[1]
Purchase Price	$ 13,400,000
Loans Payable, Excluding Debt Issuance Costs	$ 10,610,000
Number of Beds	90
[1]	SNF is an abbreviation for skilled nursing facility. AL is an abbreviation for assisted living facility. MC is an abbreviation for memory care facility.

Investments in Real Estate Pr_5

Investments in Real Estate Properties (Details 2)	Dec. 31, 2018USD ($)
Real Estate Properties [Line Items]
2019	$ 7,740,000
2020	7,902,000
2021	8,068,000
2022	8,237,000
2023	8,409,000
Thereafter	52,579,000
Operating Leases, Future Minimum Payments Receivable	$ 92,935,000

Investments in Real Estate Pr_6

Investments in Real Estate Properties (Details Textual)	1 Months Ended		12 Months Ended
	Mar. 30, 2018USD ($)	Jul. 17, 2017USD ($)	Dec. 31, 2018USD ($)	Dec. 31, 2017USD ($)
Real Estate Properties [Line Items]
Number of Real Estate Properties			11
Percentage of Real Estate Properties			100.00%
Depreciation			$ 2,900,000	$ 2,900,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Land		$ 1,800,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Buildings		$ 10,900,000
Payments to Acquire Land	$ 685,000
Acquisition Costs, Period Cost	30,000
Increase In Annual Rental Payments	$ 36,000
Pennington Gardens [Member]
Real Estate Properties [Line Items]
Lessee, Finance Lease, Term of Contract		15 years
Business Acquisition, Percentage of Voting Interests Acquired		100.00%
Business Combination, Consideration Transferred		$ 13,400,000
Business Combination, Acquisition Related Costs		52,000
Furniture and Fixtures [Member] | Pennington Gardens [Member]
Real Estate Properties [Line Items]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Property, Plant, and Equipment		$ 750,000

Loans Payable (Details)

Loans Payable (Details) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Debt Instrument [Line Items]
Long-term Debt, Gross	$ 66,112,000	$ 62,619,000
Less debt issuance costs	(2,062,000)	(1,788,000)
Total loans payable	64,050,000	60,831,000
General Electric Capital Corporation [Member]
Debt Instrument [Line Items]
Long-term Debt, Gross	0	10,050,000
Lancaster Pollard Mortgage Company, LLC [Member]
Debt Instrument [Line Items]
Long-term Debt, Gross	41,977,000	42,889,000
Healthcare Financial Solutions, LLC [Member]
Debt Instrument [Line Items]
Long-term Debt, Gross	2,800,000	2,800,000
Housing and Healthcare Finance [Member]
Debt Instrument [Line Items]
Long-term Debt, Gross	0	6,880,000
Cibc Bank [Member]
Debt Instrument [Line Items]
Long-term Debt, Gross	10,725,000	0
Capital One Multifamily Finance LLC [Member]
Debt Instrument [Line Items]
Long-term Debt, Gross	$ 10,610,000	$ 0

Loans Payable (Details) _Parent

Loans Payable (Details) [Parenthetical] - USD ($)	1 Months Ended	12 Months Ended
	Mar. 30, 2018	Dec. 31, 2018	Dec. 31, 2017
Cibc Bank [Member]
Debt Instrument, Periodic Payment		$ 70,000
Debt Instrument, Description of Variable Rate Basis		LIBOR plus 3.75%
Debt Instrument, Basis Spread on Variable Rate	3.75%	3.75%
Debt Instrument, Interest Rate, Stated Percentage		6.10%
Debt Instrument, Maturity Date, Description		due in March 2021
Capital One National Association Loan [Member]
Debt Instrument, Periodic Payment		$ 36,000
Debt Instrument, Description of Variable Rate Basis		LIBOR plus 2.95%
Debt Instrument, Interest Rate, Stated Percentage		2.95%	4.30%
Healthcare Financial Solutions Llc [Member]
Debt Instrument, Periodic Payment		$ 15,000
Debt Instrument, Description of Variable Rate Basis		LIBOR (floor of 0.50%) plus 4.0%
Debt Instrument, Basis Spread on Variable Rate		4.00%
Debt Instrument, Interest Rate, Stated Percentage		6.40%	5.30%
Debt Instrument, Maturity Date, Description		due in July 2019
Oxford Finance, LLC [Member]
Debt Instrument, Periodic Payment		$ 53,000
Debt Instrument, Description of Variable Rate Basis		LIBOR (floor of 0.75%) plus 6.50%
Debt Instrument, Basis Spread on Variable Rate		0.75%
Debt Instrument, Interest Rate, Stated Percentage		6.50%	8.10%
Lancaster Pollard Mortgage Company, LLC Sheridan Loan [Member]
Debt Instrument, Periodic Payment		$ 209,000
Debt Instrument, Maturity Date, Description		due in September 2039 through January 2051
Lancaster Pollard Mortgage Company, LLC Sheridan Loan [Member] | Minimum [Member]
Debt Instrument, Interest Rate, Stated Percentage		3.70%
Lancaster Pollard Mortgage Company, LLC Sheridan Loan [Member] | Maximum [Member]
Debt Instrument, Interest Rate, Stated Percentage		3.78%
Capital One Multifamily Finance LLC [Member]
Debt Instrument, Periodic Payment		$ 49,000
Debt Instrument, Interest Rate, Stated Percentage		4.23%
Debt Instrument, Maturity Date, Description		due in September 2053,

Loans Payable (Details 1)

Loans Payable (Details 1)	Dec. 31, 2018USD ($)
Debt Instrument [Line Items]
2019	$ 4,115,000
2020	1,367,000
2021	11,433,000
2022	1,219,000
2023	1,266,000
Thereafter	46,712,000
Total	$ 66,112,000

Loans Payable (Details Textual)

Loans Payable (Details Textual) - USD ($)	1 Months Ended		12 Months Ended				36 Months Ended
	Apr. 16, 2018	Mar. 30, 2018	Mar. 30, 2020	Mar. 30, 2019	Dec. 31, 2018	Dec. 31, 2017	Mar. 30, 2021
Debt Instrument [Line Items]
Amortization of Debt Issuance Costs					$ 214,000	$ 212,000
Interest Expense, Debt					3,300,000	2,800,000
Long-term Debt, Gross					66,112,000	62,619,000
Debt Instrument, Unamortized Discount					2,062,000	1,788,000
Amortization of Debt Discount (Premium)					300,000	200,000
Proceeds from Notes Payable					$ 21,369,000	10,050,000
Debt Instrument, Redemption, Description					prepayment penalty of 10% in year 1, which reduces each year by 100 basis points
Prepaid Penalty					$ 69,000
Prepaid Penalty One					10,000
Payments of Debt Issuance Costs					582,000	$ 172,000
Hfs Formerly Ge Capital [Member]
Debt Instrument [Line Items]
Debt Instrument, Periodic Payment					15,000
Restricted Cash					105,000
Capital One National Association Loan [Member]
Debt Instrument [Line Items]
Debt Instrument, Periodic Payment					$ 36,000
Debt Instrument, Interest Rate, Stated Percentage					2.95%	4.30%
Debt Extinguishment Percentage					10.00%
Payments of Debt Issuance Costs					$ 300,000
Debt Instrument, Term					35 years
Debt Issuance Costs, Gross					$ 15,000
Cibc Bank [Member]
Debt Instrument [Line Items]
Debt Instrument, Periodic Payment					$ 70,000
Debt Instrument, Interest Rate, Stated Percentage					6.10%
Debt Instrument, Maturity Date		Mar. 30, 2021
Long-term Debt, Gross					$ 10,725,000	$ 0
Debt Instrument, Basis Spread on Variable Rate		3.75%			3.75%
Long-term Debt, Fair Value		$ 10,725,000
Proceeds from Notes Payable	$ 1,700,000	$ 9,000,000
Debt Instrument, Redemption, Description					we will be required to pay a prepayment premium of 2% of the loan balance prior to the first anniversary and 1% thereafter through maturity
Payments of Debt Issuance Costs					$ 200,000
Restricted Cash					147,000
Cibc Bank [Member] | Scenario, Forecast [Member]
Debt Instrument [Line Items]
Debt Instrument, Periodic Payment			$ 19,000	$ 18,000			$ 20,000
Oxford Finance [Member]
Debt Instrument [Line Items]
Amortization of Debt Issuance Costs					79,000
Payment for Debt Extinguishment or Debt Prepayment Cost					$ 87,500
HUD Pennington Loan [Member]
Debt Instrument [Line Items]
Debt Instrument, Interest Rate, Stated Percentage					4.23%
Debt Instrument Mortgage Insurance Premium percentage					0.65%

Equity-Method Investments (Deta

Equity-Method Investments (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Schedule of Equity Method Investments [Line Items]
Revenue	$ 33,599,000	$ 23,987,000
Net Operating Income	27,802,000	21,191,000
Income from Operations	16,883,000	12,652,000
Net Income	3,988,000	5,060,000
Summit interest in Equity-Method Investments net income	455,000	586,000
SUL JV [Member]
Schedule of Equity Method Investments [Line Items]
Revenue	16,676,000	15,657,000
Net Operating Income	14,226,000	14,316,000
Income from Operations	8,110,000	8,156,000
Net Income	1,832,000	3,561,000
Summit interest in Equity-Method Investments net income	183,000	356,000
Fantasia JV [Member]
Schedule of Equity Method Investments [Line Items]
Revenue	2,043,000	2,027,000
Net Operating Income	1,769,000	1,799,000
Income from Operations	1,009,000	1,037,000
Net Income	34,000	119,000
Summit interest in Equity-Method Investments net income	14,000	24,000
Fantasia II Jv [Member]
Schedule of Equity Method Investments [Line Items]
Revenue	3,509,000	2,789,000
Net Operating Income	2,844,000	2,378,000
Income from Operations	1,922,000	1,604,000
Net Income	459,000	681,000
Summit interest in Equity-Method Investments net income	92,000	136,000
Fantasia III Jv [Member]
Schedule of Equity Method Investments [Line Items]
Revenue	7,812,000	3,021,000
Net Operating Income	5,911,000	2,286,000
Income from Operations	4,135,000	1,618,000
Net Income	1,358,000	648,000
Summit interest in Equity-Method Investments net income	136,000	65,000
FPH JV [Member]
Schedule of Equity Method Investments [Line Items]
Revenue	3,559,000	493,000
Net Operating Income	3,052,000	412,000
Income from Operations	1,707,000	237,000
Net Income	305,000	51,000
Summit interest in Equity-Method Investments net income	$ 30,000	$ 5,000

Equity-Method Investments (De_2

Equity-Method Investments (Details 1) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Dividends Receivable	$ 479,000	$ 371,000
SUL JV
Dividends Receivable	168,000	169,000
Fantasia JV
Dividends Receivable	156,000	30,000
Fantasia II JV
Dividends Receivable	52,000	58,000
Fantasia III JV
Dividends Receivable	90,000	97,000
FPH JV
Dividends Receivable	$ 13,000	$ 17,000

Equity-Method Investments (De_3

Equity-Method Investments (Details 2) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Total Cash Distributions Received	$ 1,183,000	$ 1,177,000
Cash Flow from Operating	455,000	581,000
Cash Flow from Investing	728,000	596,000
SUL JV
Total Cash Distributions Received	494,000	690,000
Cash Flow from Operating	183,000	356,000
Cash Flow from Investing	311,000	334,000
Fantasia JV
Total Cash Distributions Received	45,000	180,000
Cash Flow from Operating	14,000	24,000
Cash Flow from Investing	31,000	156,000
Fantasia II JV
Total Cash Distributions Received	259,000	237,000
Cash Flow from Operating	92,000	136,000
Cash Flow from Investing	167,000	101,000
Fantasia III JV
Total Cash Distributions Received	300,000	70,000
Cash Flow from Operating	136,000	65,000
Cash Flow from Investing	164,000	5,000
FPH JV
Total Cash Distributions Received	85,000	0
Cash Flow from Operating	30,000	0
Cash Flow from Investing	$ 55,000	$ 0

Equity-Method Investments (De_4

Equity-Method Investments (Details Textual) - USD ($)	Aug. 10, 2017	Nov. 30, 2017	Apr. 30, 2017	Feb. 28, 2017	Dec. 31, 2018	Dec. 31, 2017	Apr. 30, 2018	Dec. 31, 2016	Apr. 30, 2015
Limited Liability Company or Limited Partnership, Managing Member or General Partner, Compensation					the Operating Partnership has a 35% equity investment and each member will receive a distribution of net operating cash flow and capital proceeds of 50% (instead of 70% for Fantasia and 30% for the Operating Partnership) after the Operating Partnership and Fantasia receive their accrued, but unpaid, returns.
Equity Method Investments					$ 9,719,000	$ 9,241,000
Dividends Receivable					479,000	371,000
Proceeds from Dividends Received					$ 455,000	581,000
Disposal Group, Including Discontinued Operation, Accounts, Notes and Loans Receivable, Net						947,000
Summit Fantasia Holdings III, LLC [Member]
Limited Liability Company or Limited Partnership, Managing Member or General Partner, Compensation					Under the Fantasia III LLC Agreement, net operating cash flow of the Fantasia III JV will be distributed quarterly, first to the Operating Partnership and Fantasia pari passu until each member has received an amount equal to its accrued, but unpaid 9% return, and thereafter 75% to Fantasia and 25% to the Operating Partnership. All capital proceeds from the sale of the properties held by the Fantasia III JV, a refinancing or another capital event, will be paid first to the Operating Partnership and Fantasia pari passu until each has received an amount equal to its accrued but unpaid 9% return plus its total capital contribution, and thereafter 75% to Fantasia and 25% to the Operating Partnership.
Equity Method Investment, Ownership Percentage	10.00%
Equity Method Investments	$ 2,000,000				$ 1,700,000	1,800,000
Payments to Acquire Businesses, Gross	$ 60,000,000
SUL JV acquired [Member]
Limited Liability Company or Limited Partnership, Managing Member or General Partner, Compensation					Under the SUL LLC Agreement, net operating cash flow of the SUL JV will be distributed monthly, first to the Operating Partnership and Best Years pari passu up to a 9% to 10% annual return, as defined, and thereafter to Best Years 75% and the Operating Partnership 25%. All capital proceeds from the sale of the properties held by the SUL JV, a refinancing or another capital event will be paid first to the Operating Partnership and Best Years pari passu until each has received an amount equal to its accrued but unpaid 9% to 10% return plus its total contribution, and thereafter to Best Years 75% and the Operating Partnership 25%.
Proceeds from Dividends Received			$ 122,000
Disposal Group, Including Discontinued Operation, Accounts, Notes and Loans Receivable, Net					$ 105,000	105,000
Summit Fantasia ll Holdings LLC [Member]
Limited Liability Company or Limited Partnership, Managing Member or General Partner, Compensation					Under the Fantasia II LLC Agreement, net operating cash flow of the Fantasia JV will be distributed quarterly, first to the Operating Partnership and Fantasia pari passu until each member has received an amount equal to its accrued, but unpaid 8% return, and thereafter 70% to Fantasia and 30% to the Operating Partnership. All capital proceeds from the sale of the properties held by the Fantasia II JV, a refinancing or another capital event, will be paid first to the Operating Partnership and Fantasia pari passu until each has received an amount equal to its accrued but unpaid 8% return plus its total capital contribution, and thereafter 70% to Fantasia and 30% to the Operating Partnership.
Equity Method Investments					$ 1,600,000	1,800,000
Revenue from Contract with Customer, Including Assessed Tax					$ 700,000	800,000
Payments to Acquire Businesses, Gross				$ 27,000,000
Summit Fantasia Holdings Llc [Member]
Limited Liability Company or Limited Partnership, Managing Member or General Partner, Compensation					Under the Fantasia LLC Agreement, as amended in April 2018, net operating cash flow of the Fantasia JV will be distributed quarterly, first to the Operating Partnership and Fantasia pari passu until each member has received an amount equal to its accrued, but unpaid 8% return, and thereafter 50% to Fantasia and 50% to the Operating Partnership. All capital proceeds from the sale of the properties held by the Fantasia JV, a refinancing or another capital event, will be paid first to the Operating Partnership and Fantasia pari passu until each has received an amount equal to its accrued but unpaid 8% return plus its total capital contribution, and thereafter 50% to Fantasia and 50% to the Operating Partnership.
Equity Method Investments				$ 1,900,000	$ 2,200,000	1,100,000		$ 200,000
Additional Paid in Capital							$ 1,250,000
Summit Fantasy Pearl Holdings, LLC [Member]
Limited Liability Company or Limited Partnership, Managing Member or General Partner, Compensation					Under the FPH LLC Agreement, net operating cash flow of the FPH JV will be distributed quarterly, first to the members pari passu until each member has received an amount equal to its accrued, but unpaid 9% return, and thereafter 65.25% to Fantasy, 7.5% to Atlantis, 7.25% to Fantasia and 20% to the Operating Partnership. All capital proceeds from the sale of the properties held by the FPH JV, a refinancing or another capital event, will be paid to the members pari passu until each has received an amount equal to its accrued but unpaid 9% return plus its total capital contribution, and thereafter 65.25% to Fantasy, 7.5% to Atlantis, 7.25% to Fantasia, and 20% to the Operating Partnership.
Equity Method Investments		$ 900,000			$ 900,000	900,000
Payments to Acquire Businesses, Gross		$ 29,500,000
Summit Union Life Holdings, LLC [Member]
Equity Method Investments					$ 3,300,000	3,600,000
Best Years Llc [Member] | Minimum [Member]
Equity Method Investment, Ownership Percentage					9.00%
Best Years Llc [Member] | Maximum [Member]
Equity Method Investment, Ownership Percentage					10.00%
JV 2 Properties [Member]
Dividends Receivable			$ 110,000		$ 184,000	184,000			$ 362,000
Proceeds from Dividends Received						$ 56,000
Adjustment To Additional Paid In Capital Increase From Cash Addition					$ 5,000

Receivables (Details)

Receivables (Details) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
Straight-line rent receivables	$ 3,675,000	$ 3,046,000
Distribution receivables from Equity-Method Investments	479,000	371,000
Receivable from JV 2 properties	184,000	184,000
Asset management fees	214,000	170,000
Other receivables	114,000	335,000
Total	$ 4,666,000	$ 4,106,000

Receivables (Details Textual)

Receivables (Details Textual) - USD ($)	1 Months Ended		12 Months Ended
	Jan. 31, 2018	Dec. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Jan. 31, 2015	Sep. 30, 2014
Accounts, Notes, Loans and Financing Receivable [Line Items]
Interest Income Note Receivable			$ 18,000	$ 177,000
Financing Receivable, Net		$ 3,854,000	$ 730,000	3,854,000
Receivable with Imputed Interest, Effective Yield (Interest Rate)			4.25%
Debt Instrument, Frequency of Periodic Payment			22,000
Receivable with Imputed Interest, Face Amount			$ 1,100,000
Proceeds from Sale of Notes Receivable			4,282,000	947,000
Gain (Loss) on Sale of Notes Receivable			186,000	0
Accounts and Notes Receivable, Net			700,000
Nantucket Note [Member]
Accounts, Notes, Loans and Financing Receivable [Line Items]
Proceeds from Sale of Notes Receivable	$ 4,000,000
Gain (Loss) on Sale of Notes Receivable	$ 200,000
Accounts and Notes Receivable, Net		3,800,000		3,800,000
Friendswood TRS [Member]
Accounts, Notes, Loans and Financing Receivable [Line Items]
Financing Receivable, Net			95,000
Sherburne Commons, Inc., Money Note [Member]
Accounts, Notes, Loans and Financing Receivable [Line Items]
Receivable with Imputed Interest, Face Amount		5,000,000		5,000,000	$ 5,000,000
Proceeds from Sale of Notes Receivable		900,000
Operator [Member]
Accounts, Notes, Loans and Financing Receivable [Line Items]
Financing Receivable, Net		$ 100,000	$ 3,000	$ 100,000		$ 140,000
Debt Instrument, Interest Rate, Stated Percentage			6.00%

Related Party Transactions (Det

Related Party Transactions (Details) - Cornerstone Realty Advisors, LLC [Member]	Dec. 31, 2018USD ($)
Receivables	$ 2,676,000
Reserves	(2,676,000)
Balance	0
Organizational and offering costs [Member]
Receivables	738,000
Reserves	(738,000)
Balance	0
Asset management fees and expenses [Member]
Receivables	32,000
Reserves	(32,000)
Balance	0
Operating expenses (direct and indirect) [Member]
Receivables	189,000
Reserves	(189,000)
Balance	0
Operating expenses (2%/25% Test) [Member]
Receivables	1,717,000
Reserves	(1,717,000)
Balance	$ 0

Related Party Transactions (D_2

Related Party Transactions (Details Textual)	12 Months Ended
	Dec. 31, 2018
Minimum [Member]
Related Party Transaction [Line Items]
Percentage Of Restricted Operating Expenses	2.00%
Maximum [Member]
Related Party Transaction [Line Items]
Percentage Of Restricted Operating Expenses	25.00%

Concentration of Risk (Details

Concentration of Risk (Details Textual)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Tenant One, Concentration Risk [Member]
Concentration Risk [Line Items]
Concentration Risk, Percentage	41.00%	55.00%
Tenant Two, Concentration Risk [Member]
Concentration Risk [Line Items]
Concentration Risk, Percentage	23.00%	30.00%
Tenant Three, Concentration Risk [Member]
Concentration Risk [Line Items]
Concentration Risk, Percentage	13.00%	13.00%
Assets, Total [Member]
Concentration Risk [Line Items]
Concentration Risk, Percentage	31.00%	33.00%

Commitments and Contingencies_2

Commitments and Contingencies (Details) - Lake Forest Lease [Member]	Dec. 31, 2018USD ($)
Operating Leased Assets [Line Items]
2019	$ 100,000
2020	104,000
2021	108,000
2022	36,000
Operating Leases, Future Minimum Payments Due	$ 348,000

Commitments and Contingencies_3

Commitments and Contingencies (Details Textual) - USD ($)	Dec. 21, 2017	Dec. 31, 2018
consulting fees	$ 270,000
Payments for Repurchase of Equity		$ 900,000
Alleged agreement [Member]
consulting fees	$ 10,000

Equity (Details)

Equity (Details)	12 Months Ended
	Dec. 31, 2018$ / sharesshares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options granted | shares	341,500
Expected Volatility	21.97%
Expected lives	2 years 4 months 24 days
Risk-free interest rate	2.27%
Dividends	0.00%
Fair value per share | $ / shares	$ 0.36

Equity (Details 1)

Equity (Details 1)	12 Months Ended
	Dec. 31, 2018USD ($)$ / sharesshares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options outstanding, Beginning Balance	895,408
Options, Granted	341,500
Options, Exercised	0
Options, Cancelled/forfeited	(6,000)
Options outstanding, Ending Balance	1,230,908
Options exercisable, Ending Balance	970,179
Weighted Average Exercise Price, Outstanding at Beginning Balance | $ / shares	$ 1.90
Weighted Average Exercise Price, Granted | $ / shares	2.24
Weighted Average Exercise Price, Cancelled/forfeited | $ / shares	2.13
Weighted Average Exercise Price, Outstanding at Ending Balance | $ / shares	1.99
Weighted Average Exercise Price, Exercisable at Ending Balance | $ / shares	$ 1.94
Options outstanding, Weighted Average Remaining Contractual Term	8 years 18 days
Options exercisable, Weighted Average Remaining Contractual Term	7 years 9 months 22 days
Options outstanding, Aggregate Intrinsic Value | $	$ 1,029,000
Options exercisable, Aggregate Intrinsic Value | $	$ 864,000

Equity (Details 2)

Equity (Details 2)	Dec. 31, 2018USD ($)
Schedule of Equity Method Investments [Line Items]
Unrecognized stock-based compensation expense related to unvested stock options, net of forfeitures	$ 94,000
2019 [Member]
Schedule of Equity Method Investments [Line Items]
Unrecognized stock-based compensation expense related to unvested stock options, net of forfeitures	62,000
2020 [Member]
Schedule of Equity Method Investments [Line Items]
Unrecognized stock-based compensation expense related to unvested stock options, net of forfeitures	27,000
2021 [Member]
Schedule of Equity Method Investments [Line Items]
Unrecognized stock-based compensation expense related to unvested stock options, net of forfeitures	$ 5,000

Equity (Details Textual)

Equity (Details Textual) - USD ($)	Jan. 02, 2018	Nov. 30, 2018	May 31, 2018	Apr. 02, 2018	Dec. 31, 2018	Dec. 31, 2017
Schedule of Equity [Line Items]
Options, Granted					341,500
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Weighted Average Grant Date Fair Value					$ 0.36
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Remaining Contractual Term					8 years 18 days
Common Stock, Shares Authorized					290,000,000	290,000,000
Common Stock, Par or Stated Value Per Share					$ 0.001	$ 0.001
Preferred Stock, Shares Authorized					10,000,000	10,000,000
Preferred Stock, Par or Stated Value Per Share					$ 0.001	$ 0.001
Share-based Compensation Arrangement by Share-based Payment Award, Options, Nonvested, Weighted Average Exercise Price, Beginning Balance					$ 0.36
Dividends Payable					$ 1,500,000
Dividends Payable, Date of Record		Jan. 15, 2019
Dividends Payable, Date to be Paid		Jan. 31, 2019
General and Administrative Expense [Member]
Schedule of Equity [Line Items]
Allocated Share-based Compensation Expense					$ 100,000	$ 106,000
Omnibus Incentive Plan [Member]
Schedule of Equity [Line Items]
Options, Granted	41,500			200,000
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Weighted Average Grant Date Fair Value	$ 0.40
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Remaining Contractual Term	10 years
Common Stock, Capital Shares Reserved for Future Issuance					1,769,092
Share-based Compensation Arrangement by Share-based Payment Award, Number of Shares Available for Grant					3,000,000
Omnibus Incentive Plan [Member] | Executive Management [Member]
Schedule of Equity [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Weighted Average Grant Date Fair Value				$ 0.32
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Rights, Percentage				33.00%
Omnibus Incentive Plan [Member] | Executive Management [Member] | Vest in Equal Monthly Installment [Member]
Schedule of Equity [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Rights, Percentage			67.00%
Omnibus Incentive Plan [Member] | Employee [Member]
Schedule of Equity [Line Items]
Options, Granted				100,000
Incentive Plan [Member]
Schedule of Equity [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Expiration Period				10 years
Incentive Plan [Member] | Director [Member]
Schedule of Equity [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Weighted Average Grant Date Fair Value				$ 0.42
Director Incentive Stock Plan [Member]
Schedule of Equity [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Remaining Contractual Term				10 years

Dispositions (Details)

Dispositions (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Revenues:
Resident services and fee income		$ 9,354,000
Other revenues		11,000
Disposal Group, Including Discontinued Operation, Revenue		9,365,000
Expenses:
Property operating costs		603,000
Resident services costs		6,657,000
General and administrative		116,000
Depreciation and amortization		56,000
Disposal Group, Including Discontinued Operation, Total Expenses		7,432,000
Income from discontinued operations	$ 109,000	$ 1,933,000

Dispositions (Details 1)

Dispositions (Details 1) - USD ($)	Dec. 31, 2018	Dec. 31, 2017
ASSETS:
Cash and cash equivalents	$ 0	$ 459,000
Real estate properties, net		320,000
Tenant and other receivables, net		947,000
Other assets		36,000
Total assets	0	1,762,000
LIABILITIES:
Accounts payable and accrued liabilities		821,000
Accrued salaries and benefits		77,000
Total liabilities of property held for sale	$ 0	$ 898,000

Dispositions (Details Textual)

Dispositions (Details Textual) - USD ($)	1 Months Ended	12 Months Ended
	Jan. 31, 2018	Dec. 31, 2018	Dec. 31, 2017
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Receivable with Imputed Interest, Face Amount		$ 1,100,000
Receivable with Imputed Interest, Periodic payment		$ 22,000
Receivable with Imputed Interest, Effective Yield (Interest Rate)		4.25%
Cash Provided by (Used in) Operating Activities, Discontinued Operations			$ 455,000
Cash Provided by (Used in) Investing Activities, Discontinued Operations			(71,000)
Cash Provided by (Used in) Financing Activities, Discontinued Operations			$ 72,000
Receivable with Imputed Interest, Discount		$ 95,000
Gain (Loss) on Disposition of Real Estate, Discontinued Operations	$ 109,000

Subsequent Events (Details Text

Subsequent Events (Details Textual) - USD ($)	Mar. 13, 2019	Mar. 20, 2019	Feb. 14, 2019	Jan. 01, 2019	Dec. 31, 2018	Dec. 31, 2017
Subsequent Event [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Gross					341,500
Equity Method Investments					$ 9,719,000	$ 9,241,000
Liabilities					$ 69,159,000	$ 64,935,000
Subsequent Event [Member]
Subsequent Event [Line Items]
Equity Method Investment, Ownership Percentage			95.00%
Proceeds from Divestiture of Businesses			$ 27,000,000
Disposal Group, Including Discontinued Operation, Liabilities			19,500,000
Percentage of Annual Asset Management Fee Receivable	5.00%
Subsequent Event [Member] | Indiana JV [Member]
Subsequent Event [Line Items]
Equity Method Investment, Ownership Percentage	15.00%
Equity Method Investments	$ 4,900,000
Subsequent Event [Member] | 14 skilled nursing facilities [Member]
Subsequent Event [Line Items]
Business Acquisition, Percentage of Voting Interests Acquired	15.00%
Payments to Acquire Businesses, Gross	$ 128,700,000
Subsequent Event [Member] | North Carolina Properties [Member]
Subsequent Event [Line Items]
Property, Plant and Equipment, Net			2,600,000
Liabilities			22,100,000
Loans Payable Transferred Upon Disposition Of Properties			$ 19,400,000
Subsequent Event [Member] | Incentive Plan [Member]
Subsequent Event [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Expiration Period				10 years
Subsequent Event [Member] | Incentive Plan [Member] | Employee [Member]
Subsequent Event [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Gross		225,000		47,500
Share-based Compensation Arrangement by Share-based Payment Award, Expiration Period		10 years
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Rights, Percentage		33.00%
Sharebased Compensation Arrangement by Sharebased Payment Award Option Granted Vesting Rights Remaining Percentage		67.00%
Subsequent Event [Member] | Incentive Plan [Member] | Director [Member]
Subsequent Event [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Gross		110,000
Share-based Compensation Arrangement by Share-based Payment Award, Expiration Period		10 years