Operations Overview - As of March 31, 2024, the company operates 65 skilled nursing facilities with a total of 8,421 licensed beds, 24 assisted living facilities with 1,365 units, and 35 homecare agencies[127]. - The overall occupancy rate in owned and leased skilled nursing facilities for the three months ending March 31, 2024, was 88.5%, an increase from 87.4% for the same period a year ago[131]. - The company has 40 skilled nursing facilities rated 4 and 5 stars, representing 62% of its total facilities, compared to the industry average of 36%[135]. - The average census at owned and leased skilled nursing facilities increased to 88.5% from 87.4% year-over-year[167]. - The average census at skilled nursing facilities increased to 87.4% from 82.7% year-over-year, with a 3.3% increase in composite skilled nursing facility per diem[182]. Financial Performance - For the first three months of 2024, net operating revenues increased by 10.2% to $297,176,000 compared to $269,563,000 for the same period in 2023[165]. - Net patient revenues rose by $27,816,000, or 10.8%, to $285,823,000 compared to $258,007,000 in the prior year[166]. - Total costs and expenses increased by $21,996,000, or 8.5%, to $281,547,000 from $259,551,000[171]. - Salaries, wages, and benefits as a percentage of net operating revenues decreased to 61.6% from 62.3% year-over-year[172]. - GAAP net income attributable to the company was $26,213,000 for Q1 2024, compared to $11,723,000 in Q1 2023[165]. - Non-GAAP net income for Q1 2024 was $15,048,000, up from $12,071,000 in Q1 2023[165]. - The effective income tax rate for the three months ended March 31, 2024, was 26.5%, resulting in an income tax provision of $9,462,000[177]. - For the quarter ended March 31, 2023, GAAP net income attributable to the company was $11,723,000, a decrease from $15,318,000 in the same period in 2022[180]. - Adjusted net income for the quarter was $12,071,000, down from $14,081,000 year-over-year, primarily due to a decrease of $10,620,000 in government stimulus income[180]. Revenue Sources - The average Medicare per diem rate for skilled nursing facilities increased by 4.7% in the first three months of 2024 compared to the same period in 2023[142]. - For the first three months of 2024, the average Medicaid per diem increased by 12.0% compared to the same period in 2023[148]. - The company estimates an annual revenue increase of approximately $15 million from Tennessee's Medicaid facility increases, $9 million from South Carolina, and $5 million from Missouri for fiscal year 2024[144][145][146]. - The fiscal year 2024 Medicare payment rates for skilled nursing facilities include a net increase of 4.0%, equating to approximately $1.4 billion in additional payments compared to 2023 levels[140]. - The composite skilled nursing facility per diem increased by 8.8%, with Medicare per diem rates up 4.7% and Medicaid rates up 12.0%[167]. Cash Flow and Investments - Cash provided by operating activities was $9,646,000, a decrease of 30.4% from $13,857,000 in the same period last year[196]. - Cash used in investing activities totaled $2,415,000, compared to $1,427,000 for the same period in the previous year[199]. - Cash used in financing activities was $12,067,000, a slight decrease from $12,619,000 year-over-year, with dividend payments totaling $9,051,000[200]. - As of March 31, 2024, the fair value of the company's marketable equity securities is approximately $152.7 million[211]. - The investment in NHI comprises approximately $102.5 million, or 67.1%, of the total fair value of the equity securities portfolio[211]. - A hypothetical 10% change in quoted market prices would result in a related increase or decrease in the fair value of equity investments of approximately $15.3 million[211]. - The company's equity securities had net unrealized gains of $98.0 million as of March 31, 2024[211]. - Of the $98.0 million in unrealized gains, $77.7 million is related to the investment in NHI[211]. Risk Management - The company does not currently use any derivative instruments to hedge interest rate exposure[209]. - Credit risk is managed by diversifying the fixed maturity portfolio to avoid concentrations in any single industry group or issuer[210]. - The company has not used derivative instruments for trading purposes, and future use would require approvals from the Investment Committee[209]. - A hypothetical 1% change in interest rates would have minimal impact on future earnings and cash flows related to cash instruments[208]. - The company's cash and cash equivalents consist of highly liquid investments with a maturity of less than three months when purchased[208]. Expansion and Acquisitions - The company is expanding its senior care operations, including new agencies and acquisitions, such as a 66-bed skilled nursing facility acquired in Nashville, TN, in May 2023[137]. Liabilities - The accrued professional liability and workers' compensation reserves totaled $108.237 million as of March 31, 2024[138].

Financial Performance - Net patient revenues for the year ended December 31, 2023, were $956,077,000, an increase from $900,231,000 in 2022[193]. - For the year ended December 31, 2023, net income attributable to National HealthCare Corporation was $66,798,000, a significant increase from $22,445,000 in 2022[198]. - Net patient revenues totaled $1,087,614,000, reflecting a $58,529,000 increase, or 5.7%, compared to the prior year[207]. - Same-facility net operating revenues increased by 11.3% when excluding government stimulus income and operations ceased in September 2022[205]. - The Company reported income before income taxes of $88,738,000 for the year ended December 31, 2023, compared to $27,231,000 in 2022[193]. - GAAP net income attributable to the company for 2022 was $22,445,000, a significant decrease from $138,590,000 in 2021, largely due to a $95.2 million gain from the Caris acquisition in 2021[221]. - Net patient revenues totaled $1,029,085,000 for 2022, reflecting a 6.6% increase compared to the prior year, with supplemental Medicaid payments contributing $19,442,000 in 2022[222]. - Comprehensive income attributable to National HealthCare Corporation for 2023 was $69,726, compared to $11,308 in 2022, reflecting a substantial increase[276]. - Earnings per share (EPS) for 2023 were $4.36 (basic), compared to $1.46 in 2022, representing a growth of 198.6%[273]. - Net income for 2023 was $65,288,000, a significant increase from $19,977,000 in 2022, reflecting a growth of approximately 226%[285]. Revenue Sources - The Company recorded government stimulus income from the Provider Relief Funds of $63,360,000, $11,457,000, and $0 for the years ended December 31, 2021, 2022, and 2023, respectively[180]. - Supplemental Medicaid payments contributed $20,214,000 to net patient revenues in 2023, slightly down from $20,482,000 in 2021[339]. - Medicare accounted for 34% of net patient revenues in 2023, down from 37% in 2022, while Medicaid increased to 30% from 28%[345]. - Other revenues totaled $53,930,000 in 2023, an increase from $45,196,000 in 2022[355]. - Rental income for 2023 was $23,926,000, a slight increase from $23,451,000 in 2022[356]. - Management fees from other healthcare centers amounted to $13,344,000 in 2023, up from $11,828,000 in 2022[361]. Operational Metrics - The overall occupancy rate in owned and leased skilled nursing facilities increased to 87.9% in 2023 from 83.8% in 2022 and 80.6% in 2021[183]. - The Company operates or manages 68 skilled nursing facilities with 8,732 licensed beds, 26 assisted living facilities with 1,501 units, and 35 homecare agencies across 8 states as of December 31, 2023[178]. - The Company has 40 skilled nursing facilities rated 4 or 5 stars, representing 59% of its total facilities, compared to an industry average of 36%[186]. - New operations contributed an increase of $25,821,000 in net patient revenues for the year ended December 31, 2023[209]. - The average census in owned and leased skilled nursing facilities rose to 83.8% in 2022 from 80.6% in 2021, with Medicare and managed care per diem rates increasing by 2.3% and 6.0%, respectively[223]. Costs and Expenses - Total costs and expenses for the year ended December 31, 2023, were $1,084,410,000, compared to $1,053,842,000 in 2022[193]. - Salaries, wages, and benefits increased by $26,175,000, or 3.8%, totaling $712,344,000, while the percentage of net operating revenues decreased to 62.4% from 63.2%[213]. - Total costs and expenses rose by $30,568,000, or 2.9%, to $1,084,410,000 in 2023[212]. - General and administrative costs for the year ended December 31, 2023, were $21,412,000, compared to $20,651,000 in 2022 and $20,160,000 in 2021[304]. Cash Flow and Liquidity - Cash provided by operating activities for the year ended December 31, 2023 was $111,216,000, a substantial increase from $8,742,000 in 2022[237]. - The company expects to meet its short-term liquidity requirements primarily from cash flows from operating activities, with current cash on hand of $107,076,000 and unrestricted marketable securities of $116,544,000[241]. - Total cash, cash equivalents, restricted cash, and restricted cash equivalents at the end of 2023 amounted to $125,968,000, up from $74,865,000 in 2022, representing a 68% increase[285]. - The company’s total cash and cash equivalents increased by $51,103,000 in 2023, compared to a decrease of $44,878,000 in 2022[285]. Investments and Marketable Securities - The fair value of the company's marketable equity securities is approximately $137,896,000, with an investment in NHI comprising about $91,071,000, or 66.0%, of the total[262]. - The company has net unrealized gains of $83,586,000 in its equity securities, with approximately $66,337,000 related to the investment in NHI[262]. - The company recorded unrealized gains of $14,944,000 from marketable equity securities for the year ended December 31, 2023[218]. - The company reported unrealized losses on marketable equity securities of $14,944,000 in 2023, contrasting with unrealized gains of $15,806,000 in 2022[285]. Liabilities and Reserves - The accrued professional liability and workers' compensation reserves totaled $103,259,000 as of December 31, 2023, compared to $102,469,000 in 2022[189]. - As of December 31, 2023, the accrued risk reserves totaled $103,259,000, which includes professional liability claims reserves for unpaid reported claims and estimates for incurred but unreported claims[270]. - Total liabilities for 2023 were $400,316, slightly up from $397,936 in 2022, indicating a marginal increase of 0.4%[281]. Accounting and Compliance - The company recognizes revenue as performance obligations are completed, with net patient revenues derived from various healthcare services[249]. - Medicare and Medicaid program revenues are subject to audit and retroactive adjustment, impacting the estimated transaction price for providing patient care[252]. - The company has not adopted any new accounting standards during 2023[247].

Operations and Facilities - As of September 30, 2023, the company operates or manages 68 skilled nursing facilities with a total of 8,732 licensed beds, 26 assisted living facilities with 1,501 units, and 35 homecare agencies[135]. - The overall census in owned and leased skilled nursing facilities for the three months ending September 30, 2023, was 88.1%, up from 83.7% for the same period a year ago[143]. - The company has 39 skilled nursing facilities rated 4 and 5 stars, representing 57% of its total skilled nursing facilities, compared to 36% in the industry[147]. - The company has undertaken various development activities, including the acquisition of a 66-bed skilled nursing facility in Nashville, TN, in May 2023[149]. Financial Performance - The company reported a total net operating revenue of $288.485 million for the three months ended September 30, 2023, compared to $270.843 million for the same period in 2022, reflecting a year-over-year increase of approximately 6.5%[169]. - For the three months ended September 30, 2023, net operating revenues increased by 6.5% compared to the same period in 2022, primarily driven by occupancy increases in skilled nursing facilities and higher per diem rates from government payors[178]. - For the nine months ended September 30, 2023, net patient revenues reached $804.617 million, up from $776.661 million in the same period of 2022, indicating a growth of approximately 3.7%[170]. - The company’s non-GAAP net income for the three months ended September 30, 2023, was $13.250 million, compared to $7.783 million for the same period in 2022, representing an increase of approximately 70.3%[174]. - GAAP net income attributable to NHC for the quarter was $10,388,000, a significant improvement from a net loss of $2,429,000 in the same quarter of 2022[179]. - GAAP net income attributable to NHC for the nine months was $38,392,000, compared to $16,092,000 for the same period in 2022[193]. Revenue Sources - Inpatient services generated net patient revenues of $243.865 million, while homecare and hospice services contributed $33.140 million for the three months ended September 30, 2023, totaling $277.005 million in net patient revenues[169]. - The company recorded $0 of government stimulus income from the Provider Relief Funds for the three months ended September 30, 2023, compared to $10,940,000 for the same period in 2022[141]. - The company has recorded $4,232,000 in net patient revenues for supplemental Medicaid payments for the three months ended September 30, 2023, compared to $4,773,000 for the same period in 2022[142]. Costs and Expenses - Total costs and expenses for the three months ended September 30, 2023, were $275.460 million, resulting in an income from operations of $13.025 million[169]. - Total costs and expenses for the nine months ended September 30, 2023, increased by $5,277,000, or 0.7%, to $803,616,000[198]. - Salaries, wages, and benefits increased by $9,466,000, or 5.5%, to $182,664,000, but as a percentage of net operating revenues, it decreased to 63.3% from 63.9%[186]. Cash Flow and Liquidity - Cash provided by operating activities for the nine months ended September 30, 2023, was $85,483,000, a significant increase from cash used in operating activities of $3,192,000 in the same period last year, representing a change of 2,778.0%[207]. - Cash used in investing activities totaled $7,382,000 for the nine months ended September 30, 2023, compared to $8,810,000 for the same period in 2022, reflecting a decrease of 16.2%[209]. - Cash used in financing activities was $32,711,000 for the nine months ended September 30, 2023, down from $35,541,000 in the same period last year, a reduction of 8.0%[210]. - Cash, cash equivalents, restricted cash, and restricted cash equivalents at the end of the period increased to $120,255,000, up 66.6% from $72,200,000 at the end of the same period last year[206]. - The company expects to meet its short-term liquidity requirements primarily from cash flows from operating activities, with current cash on hand of $100,308,000 and marketable securities of $110,186,000[211]. Regulatory and Payment Updates - The fiscal year 2024 rule equates to a net increase of 4.0%, or approximately $1.4 billion, in Medicare Part A payments to skilled nursing facilities compared to 2023 levels[153]. - Effective July 1, 2023, the state of Tennessee implemented specific individual nursing facility increases, estimated to result in approximately $15,000,000 annually, or $3,750,000 per quarter[156]. - The average Medicaid per diem increased by 7.9% for the first nine months of 2023 compared to the same period in 2022[160]. - The company anticipates a decrease in Medicare payments to home health agencies by 2.2% or $375 million for fiscal year 2024, relative to the prior year[163]. - The hospice payment update for fiscal year 2024 includes a rate increase of 3.1%, or $780 million, effective October 1, 2023[165]. - The statutory aggregate cap amount for hospice payments for FY2024 is set at $33,494, up from $32,487 in FY2023[165]. Investments and Marketable Securities - The fair value of marketable equity securities was approximately $125,820,000 as of September 30, 2023, with an investment in NHI comprising about $83,700,000, or 66.5% of the total fair value[220]. - At September 30, 2023, the company had available-for-sale marketable debt securities amounting to $126,911,000, allowing flexibility in responding to interest rate fluctuations[216]. - The company reported net unrealized gains of $71,600,000 in its equity securities, with $59,000,000 related to its investment in NHI[220]. - The company does not currently use derivative instruments to hedge interest rate exposure, and any future use would require approval from the Investment Committee of the Board of Directors[218].

Table of Contents UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 10-Q ☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the quarterly period ended June 30, 2023 OR ☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from to Commission file number 001-13489 (Exact name of registrant as specified in its Charter) Delaware 52-2057472 (State or other jurisdiction of (I.R.S. E ...

Table of Contents UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 10-Q ☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the quarterly period ended March 31, 2023 OR ☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from to Commission file number 001-13489 (Exact name of registrant as specified in its Charter) Delaware 52-2057472 (State or other jurisdiction of (I.R.S. ...

Table of Contents UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 10-K (Mark One) ☒ ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES AND EXCHANGE ACT OF 1934 For the fiscal year ended December 31, 2022 OR ☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from __________ to _____________ Commission File No. 001-13489 (Exact name of registrant as specified in its Corporate Charter) Delaware 52-205747 ...

Table of Contents UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 10-Q ☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the quarterly period ended June 30, 2022 OR ☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from to Commission file number 001-13489 (Exact name of registrant as specified in its Charter) Delaware 52-2057472 (State or other jurisdiction of (I.R.S. E ...

Table of Contents UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 10-Q ☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the quarterly period ended March 31, 2022 OR ☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from _____ to ____________ Commission file number 001-13489 (Exact name of registrant as specified in its Charter) Delaware 52-2057472 (State or other juris ...

Table of Contents UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 (Mark One) ☒ ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES AND EXCHANGE ACT OF 1934 For the fiscal year ended December 31, 2021 OR ☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from __________ to _____________ Commission File No. 001-13489 (Exact name of registrant as specified in its Corporate Charter) Delaware 52-2057472 (State o ...

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 10-Q ☒QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the quarterly period ended September 30, 2021 OR ☐TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from _____ to ____________ Commission file number 001-13489 (Exact name of registrant as specified in its Charter) Delaware 52-2057472 (State or other jurisdiction of (I.R. ...