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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 September 30, 2026

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

 
nhc01.jpg
 

(Exact name of registrant as specified in its Charter)

 

Delaware

52-2057472

(State or other jurisdiction of

(I.R.S. Employer

incorporation or organization

Identification No.)

 

100 E. Vine Street

Murfreesboro, TN

37130

(Address of principal executive offices)

(Zip Code)

 

(615) 890–2020

Registrant's telephone number, including area code

 

Securities registered pursuant to Section 12(b) of the Exchange Act:

 

Title of each class

Trading

Symbols(s)

Name of each exchange on which

registered

Common, $0.01 par value

NHC

NYSE American

 

Indicate by check mark whether the registrant: (1) Has filed all reports required to be filed by Section 13 or 15(d), of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐

 

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S–T (§ 232.405 of this chapter) during the preceding 12 months (or for such period that the registrant was required to submit such files).    Yes ☒      No ☐

 

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.

  

Large Accelerated filer ☒

Accelerated filer ☐

  

Non–accelerated filer ☐

Smaller reporting company ☐

  
 

Emerging growth company ☐

 

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.  ☐

 

Indicate by check mark whether the registrant is a shell company (as is defined in Rule 12b–2 of the Exchange Act). Yes ☐   No ☒

 

15,664,304 shares of common stock of the registrant were outstanding as of November 2, 2026.

 



 

1

  

 

Table of Contents

 

 

PART I. FINANCIAL INFORMATION

 

Page

Item 1.

Financial Statements

3
     

Item 2.

Management's Discussion and Analysis of Financial Condition and Results of Operations

30
     

Item 3.

Quantitative and Qualitative Disclosures About Market Risk

41
     

Item 4.

Controls and Procedures

42
 

PART II. OTHER INFORMATION

 

Item 1.

Legal Proceedings

42
     

Item 1A

Risk Factors

42
     

Item 2.

Unregistered Sales of Equity Securities and Use of Proceeds

42
     

Item 3.

Defaults Upon Senior Securities

42
     

Item 4.

Mine Safety Disclosures

42
     

Item 5.

Other Information

42
     

Item 6.

Exhibits

43

 

2

  

 

PART I. FINANCIAL INFORMATION

 

Item 1. Financial Statements.

 

 

NATIONAL HEALTHCARE CORPORATION

Interim Condensed Consolidated Statements of Operations

(in thousands, except share and per share amounts)

(unaudited)

 

  

Three Months Ended

September 30

  

Nine Months Ended

September 30

 
  

2026

  

2025

  

2026

  

2025

 
                 

Revenues:

                

Net patient revenues

 $397,446  $370,989  $1,145,610  $1,095,945 

Other revenues

  10,525   11,672   52,207   35,323 

Net operating revenues

  407,971   382,661   1,197,817   1,131,268 
                 

Cost and expenses:

                

Salaries, wages, and benefits

  251,937   233,176   728,913   687,840 

Other operating

  99,461   96,604   285,173   281,004 

Facility rent

  1,365   11,345   24,548   34,038 

Depreciation and amortization

  14,576   11,158   37,363   33,151 

Total costs and expenses

  367,339   352,283   1,075,997   1,036,033 
                 

Income from operations

  40,632   30,378   121,820   95,235 
                 

Other income (expense):

                

Non–operating income

  3,637   4,660   11,566   13,871 

Interest expense

  (6,991)  (1,456)  (7,273)  (5,555)

Unrealized gains/(losses) on marketable equity securities

  (17,599)  20,827   (7,610)  26,748 
                 

Income before income taxes

  19,679   54,409   118,503   130,299 

Income tax provision

  (5,498)  (13,400)  (27,682)  (32,887)

Net income

  14,181   41,009   90,821   97,412 

Net income attributable to noncontrolling interest

  (544)  (1,770)  (1,008)  (2,246)
                 

Net income attributable to National HealthCare Corporation

 $13,637  $39,239  $89,813  $95,166 
                 

Earnings per share attributable to National HealthCare Corporation stockholders:

                

Basic

 $0.87  $2.53  $5.76  $6.15 

Diluted

 $0.85  $2.50  $5.66  $6.10 
                 

Weighted average common shares outstanding:

             

Basic

  15,638,814   15,484,464   15,599,724   15,461,804 

Diluted

  15,964,895   15,664,530   15,866,957   15,613,505 

 

The accompanying notes to interim condensed consolidated financial statements are an integral part of these consolidated statements.

 

3

 

 

NATIONAL HEALTHCARE CORPORATION

Interim Condensed Consolidated Statements of Comprehensive Income

(unaudited – in thousands)

 

  

Three Months Ended

September 30

  

Nine Months Ended

September 30

 
  

2026

  

2025

  

2026

  

2025

 
                 

Net income

 $14,181  $41,009  $90,821  $97,412 
                 

Other comprehensive income/(loss):

                

Unrealized gains/(losses) on investments in marketable debt securities

  (1,866)  868   (3,444)  3,543 

Reclassification adjustment for realized (gains)/losses on sales of marketable debt securities

  (1,337)  11   (1,326)  663 

Income tax (expense)/benefit related to items of other comprehensive income

  463   (124)  702   (619)

Other comprehensive income/(loss), net of tax

  (2,740)  755   (4,068)  3,587 
                 

Net income attributable to noncontrolling interest

  (544)  (1,770)  (1,008)  (2,246)
                 

Comprehensive income attributable to National HealthCare Corporation

 $10,897  $39,994  $85,745  $98,753 

 

The accompanying notes to interim condensed consolidated financial statements are an integral part of these consolidated statements.

 

4

 

 

NATIONAL HEALTHCARE CORPORATION

Interim Condensed Consolidated Balance Sheets

(in thousands)

 

  

September 30,

2026

  

December 31,

2025

 
  

unaudited

     

Assets

        

Current Assets:

        

Cash and cash equivalents

 $66,795  $92,829 

Restricted cash and cash equivalents, current portion

  18,315   18,118 

Marketable equity securities

  154,530   162,972 

Restricted marketable equity securities

  19,153   17,197 

Restricted marketable debt securities, current portion

  17,814   18,062 

Accounts receivable

  129,748   139,002 

Inventories

  8,658   7,795 

Prepaid expenses and other assets

  4,817   5,845 

Total current assets

  419,830   461,820 
         

Property and Equipment:

        

Property and equipment, at cost

  1,962,802   1,308,891 

Accumulated depreciation and amortization

  (672,783)  (635,094)

Net property and equipment

  1,290,019   673,797 
         

Other Assets:

        

Restricted cash and cash equivalents, less current portion

  1,211   1,240 

Restricted marketable debt securities, less current portion

  96,381   105,231 

Deposits and other assets

  8,778   7,478 

Operating lease right-of-use assets

  16,096   47,778 

Goodwill

  170,478   170,478 

Intangible assets

  20,364   19,864 

Investments in unconsolidated companies

  45,039   38,733 

Total other assets

  358,347   390,802 

Total assets

 $2,068,196  $1,526,419 

 

The accompanying notes to interim condensed consolidated financial statements are an integral part of these consolidated statements.

 

5

 

NATIONAL HEALTHCARE CORPORATION

Interim Condensed Consolidated Balance Sheets (continued)

(in thousands, except share and per share amounts)

 

  

September 30,

2026

  

December 31,

2025

 
  

unaudited

     

Liabilities and Stockholders’ Equity

        

Current Liabilities:

        

Trade accounts payable

 $22,432  $22,767 

Operating lease liabilities, current portion

  2,644   33,611 

Accrued payroll

  122,405   103,917 

Amounts due to third party payors

  15,563   13,739 

Accrued risk reserves, current portion

  36,129   36,180 

Other current liabilities

  50,507   25,977 

Dividends payable

  10,495   9,941 

Long-term debt, current portion

  23,750   7,500 

Total current liabilities

  283,925   253,632 
         

Long-term debt

  478,313   32,500 

Operating lease liabilities, less current portion

  13,662   13,461 

Accrued risk reserves, less current portion

  90,636   85,415 

Refundable entrance fees

  6,526   6,178 

Deferred income taxes

  41,166   42,687 

Other noncurrent liabilities

  22,750   18,031 

Total liabilities

  936,978   451,904 
         

Equity:

        

Common stock, $.01 par value; 45,000,000 shares authorized; 15,664,304 and 15,536,427 shares, respectively, issued and outstanding

  156   155 

Capital in excess of par value

  237,791   236,412 

Retained earnings

  891,820   832,984 

Accumulated other comprehensive loss

  (4,847)  (779)

Total National HealthCare Corporation stockholders’ equity

  1,124,920   1,068,772 

Noncontrolling interest

  6,298   5,743 

Total equity

  1,131,218   1,074,515 

Total liabilities and equity

 $2,068,196  $1,526,419 

 

The accompanying notes to interim condensed consolidated financial statements are an integral part of these consolidated statements.

 

6

 

 

NATIONAL HEALTHCARE CORPORATION

Interim Condensed Consolidated Statements of Cash Flows

(unaudited – in thousands)

 

  

Nine Months Ended

September 30

 
  

2026

  

2025

 

Cash Flows From Operating Activities:

        

Net income

 $90,821  $97,412 

Adjustments to reconcile net income to net cash provided by operating activities:

        

Depreciation and amortization

  37,363   33,151 

Equity in losses/(earnings) of unconsolidated investments

  866   (512)

Distributions from unconsolidated investments

  812   616 

Unrealized (gains)/losses on marketable equity securities

  7,610   (26,748)

Realized gains on sale of marketable securities

  (1,023)  (872)

Gain on sale of property and equipment

  -   (3,606)

Deferred income taxes

  (819)  2,600 

Stock–based compensation

  5,285   3,499 

Changes in operating assets and liabilities:

        

Accounts receivable

  15,516   2,877 

Inventories

  (525)  1,195 

Prepaid expenses and other assets

  451   2,582 

Operating lease obligations

  916   524 

Trade accounts payable

  (2,064)  (2,926)

Accrued payroll

  15,203   17,272 

Amounts due to third party payors

  1,824   (291)

Accrued risk reserves

  5,170   10,416 

Other current liabilities

  22,828   30,250 

Other noncurrent liabilities

  4,719   832 

Net cash provided by operating activities

  204,953   168,271 

Cash Flows From Investing Activities:

        

Purchases of property and equipment

  (35,654)  (26,049)

Acquisition of skilled nursing facilities and other assets

  (54,698)  - 

Acquisition of real estate assets

  (564,340)  - 

Investments in unconsolidated companies

  (7,983)  (3,123)

Purchases of marketable securities

  (18,456)  (56,953)

Proceeds from sale of marketable securities

  22,683   64,689 

Collections of notes receivable

  -   512 

Net cash used in investing activities

  (658,448)  (20,924)

Cash Flows From Financing Activities:

        

Borrowings under term loan and credit facility

  530,000   - 

Repayments under credit facility

  (67,937)  (63,875)

Dividends paid to common stockholders

  (30,423)  (28,773)

Issuance of common shares

  20,766   9,415 

Repurchase of common shares

  (24,672)  (9,566)

Noncontrolling interest distributions

  (453)  - 

Entrance fee deposits

  348   64 

Net cash provided by/(used in) financing activities

  427,629   (92,735)

Net Increase/(Decrease) in Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents

  (25,866)  54,612 

Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, Beginning of Period

  112,187   96,922 

Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, End of Period

 $86,321  $151,534 
         

Balance Sheet Classifications:

        

Cash and cash equivalents

 $66,795  $130,629 

Restricted cash and cash equivalents

  19,526   20,905 

Total Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents

 $86,321  $151,534 

 

The accompanying notes to interim condensed consolidated financial statements are an integral part of these consolidated statements.

 

7

 

 

NATIONAL HEALTHCARE CORPORATION

Interim Condensed Consolidated Statements of Stockholders’ Equity

(in thousands, except share and per share amounts)

(unaudited)

 

For the nine months ended September 30, 2026:

 

  

Common Stock

                     
  

Shares

  

Amount

  

Capital

in

Excess

of Par

Value

  

Retained

Earnings

  

Accumulated

Other

Comprehensive

Loss

  

Non-

controlling

Interest

  

Total

Stockholders'

Equity

 

Balance at January 1, 2026

  15,536,427  $155  $236,412  $832,984  $(779) $5,743  $1,074,515 

Net income

  –   –   –   35,857   –   246   36,103 

Distributions attributable to noncontrolling interest

  –   –   –   –   –   (324)  (324)

Other comprehensive loss

  –   –   –   –   (919)  –   (919)

Stock–based compensation

  –   –   1,280   –   –   –   1,280 

Shares sold – options exercised

  168,497   1   12,268   –   –   –   12,269 

Repurchase of common shares

  (97,720)  –   (16,321)  –   –   –   (16,321)

Dividends declared to common stockholders ($0.64 per share)

  –   –   –   (9,989)  –   –   (9,989)

Balance at March 31, 2026

  15,607,204  $156  $233,639  $858,852  $(1,698) $5,665  $1,096,614 

Net income

  –   –   –   40,319   –   218   40,537 

Distributions attributable to noncontrolling interest

  –   –   –   –   –   (129)  (129)

Other comprehensive loss

  –   –   –   –   (409)  –   (409)

Stock–based compensation

  –   –   1,986   –   –   –   1,986 

Shares sold – options exercised

  93,422   –   7,190   –   –   –   7,190 

Repurchase of common shares

  (39,231)  –   (7,240)  –   –   –   (7,240)

Dividends declared to common stockholders ($0.67 per share)

  –   –   –   (10,493)  –   –   (10,493)

Balance at June 30, 2026

  15,661,395  $156  $235,575  $888,678  $(2,107) $5,754  $1,128,056 

Net income

  –   –   –   13,637   –   544   14,181 

Other comprehensive loss

  –   –   –   –   (2,740)  –   (2,740)

Stock–based compensation

  –   –   2,019   –   –   –   2,019 

Shares sold – options exercised

  7,600   –   1,308   –   –   –   1,308 

Repurchase of common shares

  (4,691)  –   (1,111)  –   –   –   (1,111)

Dividends declared to common stockholders ($0.67 per share)

  –   –   –   (10,495)  –   –   (10,495)

Balance at September 30, 2026

  15,664,304  $156  $237,791  $891,820  $(4,847) $6,298  $1,131,218 

 

8

 

For the nine months ended September 30, 2025:

 

  

Common Stock

                     
  

Shares

  

Amount

  

Capital

in

Excess

of Par

Value

  

Retained

Earnings

  

Accumulated

Other

Comprehensive

Loss

  

Non-

controlling

Interest

  

Total

Stockholders'

Equity

 

Balance at January 1, 2025

  15,450,003  $154  $232,530  $752,193  $(4,716) $3,002  $983,163 

Net income

  –   –   –   32,205   –   85   32,290 

Other comprehensive income

  –   –   –   –   1,390   –   1,390 

Stock–based compensation

  –   –   1,027   –   –   –   1,027 

Shares sold – options exercised

  32,262   –   1,278   –   –   –   1,278 

Repurchase of common shares

  (17,409)  –   (1,722)  –   –   –   (1,722)

Dividends declared to common stockholders ($0.61 per share)

  –   –   –   (9,444)  –   –   (9,444)

Balance at March 31, 2025

  15,464,856  $154  $233,113  $774,954  $(3,326) $3,087  $1,007,982 

Net income

  –   –   –   23,722   –   391   24,113 

Other comprehensive income

  –   –   –   –   1,442   –   1,442 

Stock–based compensation

  –   –   1,233   –   –   –   1,233 

Shares sold – options exercised

  77,689   –   5,184   –   –   –   5,184 

Repurchase of common shares

  (43,372)  –   (4,662)  –   –   –   (4,662)

Dividends declared to common stockholders ($0.64 per share)

  –   –   –   (9,909)  –   –   (9,909)

Balance at June 30, 2025

  15,499,173  $154  $234,868  $788,767  $(1,884) $3,478  $1,025,383 

Net income

  –   –   –   39,239   –   1,770   41,009 

Other comprehensive income

  –   –   –   –   755   –   755 

Stock–based compensation

  –   –   1,239   –   –   –   1,239 

Shares sold – options exercised

  43,894   –   2,953   –   –   –   2,953 

Repurchase of common shares

  (27,957)  –   (3,182)  –   –   –   (3,182)

Dividends declared to common stockholders ($0.64 per share)

  –   –   –   (9,930)  –   –   (9,930)

Balance at September 30, 2025

  15,515,110  $154  $235,878  $818,076  $(1,129) $5,248  $1,058,227 

 

The accompanying notes to interim condensed consolidated financial statements are an integral part of these consolidated statements.

 

9

 

NATIONAL HEALTHCARE CORPORATION

Notes to Interim Condensed Consolidated Financial Statements

September 30, 2026

(unaudited) 

 

 

 

Note 1 – Description of Business

 

National HealthCare Corporation (“NHC” or the “Company”) is a leading provider of senior health care services. As of September 30, 2026, we operate or manage, through certain affiliates, 80 skilled nursing facilities with a total of 10,323 licensed beds, 26 assisted living facilities with 1,413 units, nine independent living facilities, three behavioral health hospitals, 34 homecare agencies, and 33 hospice agencies. We operate specialized care units within certain of our healthcare centers such as Alzheimer's disease care units and sub-acute nursing units. In addition, we provide insurance services, management and accounting services, and we lease properties to operators of skilled nursing and assisted living facilities. We operate in 9 states and are located primarily in the southeastern United States.

  

 

Note 2 – Summary of Significant Accounting Policies

 

The listing below is not intended to be a comprehensive list of all our significant accounting policies. In many cases, the accounting treatment of a particular transaction is specifically dictated by U.S. generally accepted accounting principles (“GAAP”), with limited need for management’s judgment in their application. There are also areas in which management’s judgment in selecting any available alternative would not produce a materially different result. See our audited December 31, 2025 consolidated financial statements and notes thereto which contain accounting policies and other disclosures required by U.S. GAAP. Our audited December 31, 2025 consolidated financial statements are available at our web site: www.nhccare.com.

 

Basis of Presentation

 

The unaudited interim condensed consolidated financial statements to which these notes are attached include all normal, recurring adjustments which are necessary to fairly present the financial position, results of operations and cash flows of NHC. All significant intercompany transactions and balances have been eliminated in consolidation. The consolidated financial statements include the accounts of all entities controlled by NHC. The Company presents noncontrolling interest within the equity section of its consolidated balance sheets. The Company presents the amount of consolidated net income that is attributable to NHC and the noncontrolling interest in its consolidated statements of operations.

 

We assume that users of these interim financial statements have read or have access to the audited December 31, 2025 consolidated financial statements and that the adequacy of additional disclosure needed for a fair presentation, except in regard to material contingencies, may be determined in that context. Accordingly, footnotes and other disclosures which would substantially duplicate the disclosure contained in our most recent annual report to stockholders have been omitted. This interim financial information is not necessarily indicative of the results that may be expected for a full year for a variety of reasons.

 

Estimates and Assumptions

 

The preparation of financial statements in conformity with U.S. GAAP requires us to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates and could cause our reported net income to vary significantly from period to period.

 

Net Patient Revenues and Accounts Receivable

 

Net patient revenues are derived from services rendered to patients for skilled and intermediate nursing, rehabilitation therapy, assisted living and independent living, home health care services, hospice services, and behavioral health services. Net patient revenue is reported at the amount that reflects the consideration to which the Company expects to be entitled in exchange for providing patient services. These amounts are due from patients, governmental programs, and other third-party payors, and include variable consideration for retroactive revenue adjustments due to settlement of audits, reviews, and investigations.

 

10

 

The Company recognizes revenue as its performance obligations are completed. Routine services are treated as a single performance obligation satisfied over time as services are rendered. These routine services represent a bundle of services that are not capable of being distinct. The performance obligations are satisfied over time as the patient simultaneously receives and consumes the benefits of the healthcare services provided. Additionally, there may be ancillary services which are not included in the daily rates for routine services, but instead are treated as separate performance obligations satisfied at a point in time when those services are rendered.  

 

We determine the transaction price based on contractually agreed-upon amounts or rates, adjusted for estimates of variable consideration, such as implicit price concessions. We utilize the expected value method to determine the amount of variable consideration that should be included to arrive at the transaction price, using contractual agreements and historical reimbursement experience within each payor type. We constrain the transaction price, such that net revenues are recorded only to the extent that it is probable that a significant reversal in the amount of the cumulative revenue recognized will not occur in the future. If actual amounts of consideration ultimately received differ from our estimates, we adjust these estimates, which would affect net revenue in the period such variances become known.

 

Other Revenues

 

Other revenues include revenues from the provision of insurance services to other healthcare providers, management and accounting services to other healthcare providers, and rental income. Our insurance revenues consist of premiums that are generally paid in advance and then amortized into income over the policy period. We charge for management services based on a percentage of net revenues. We charge for accounting services based on a monthly fee or a fixed fee per bed of the healthcare center under contract. We record other revenues as the performance obligations are satisfied based on the terms of our contractual arrangements.

 

We recognize rental income based on the terms of our operating leases. Under certain of our leases, we receive variable rent, which is based on the increase in revenues of a lessee over a base year. We recognize variable rent annually or monthly, as applicable, when, based on the actual revenue of the lessee is earned.

 

During the second quarter of 2026, we recognized management fees of $18,325,000 previously earned for management services prior to 2025, but these management fees were not previously recognized as such revenues. These revenues did not previously meet the recognition criteria of ASC Topic 606, Revenue from Contracts with Customers, because the underlying consideration was constrained. Upon the acquisition of the five skilled nursing facilities from National Health Corporation on June 1, 2026, and as noted in Note 3 - Acquisitions, the revenue recognition criteria was met and the management fees were paid and recognized in the current period.

 

Segment Reporting

 

In accordance with the provisions of Accounting Standards Codification ("ASC") 280, Segment Reporting, the Company is required to report financial and descriptive information about its reportable operating segments. The Company has two reportable operating segments: (1) inpatient services, which includes the operation of skilled nursing facilities, assisted and independent living facilities, and behavioral health hospitals, and (2) homecare and hospice services. The Company also reports an “all other” category that includes revenues from rental income, management and accounting services fees, insurance services, and costs of the corporate office. See Note 7 for further disclosure of the Company’s operating segments.

 

Other Operating Expenses

 

Other operating expenses include the costs of care and services that we provide to the residents of our facilities and the costs of maintaining our facilities. Our primary patient care costs include drugs, medical supplies, purchased professional services, food, and professional liability insurance and licensing fees. The primary facility costs include utilities and property insurance.  

 

During the second quarter of 2025, we contributed land to a newly-formed limited liability company resulting in an equity interest in the new entity. The fair value of the land contributed to the new entity was $5,625,000. The related cost basis of the contributed land was $2,019,000, which resulted in a gain of $3,606,000.  The gain has been included in the interim condensed consolidated statements of operations as a reduction of "other operating expenses."

 

General and Administrative Costs

 

With the Company being a healthcare provider, the majority of our expenses are "cost of revenue" items. Costs that could be classified as "general and administrative" by the Company would include its corporate office costs, excluding stock-based compensation, which were $8,721,000 and $26,502,000 for the three and nine months ended September 30, 2026, respectively. General and administrative costs were $8,117,000 and $25,463,000 for the three and nine months ended September 30, 2025, respectively.

 

11

 

Long-Term Leases

 

The Company’s lease portfolio primarily consists of operating real estate leases for certain skilled nursing facilities, assisted and independent living facilities, homecare and hospice offices, regional offices, and pharmacy warehouses. The original terms of the leases typically range from two to fifteen years. Several of the real estate leases include renewal options which vary in length and may not include specific rent renewal amounts. We determine if an arrangement is a lease at inception of a contract. We determine the lease term by assuming exercise of renewal options that are reasonably certain.

 

The Company records right-of-use assets and liabilities for non-cancelable real estate operating leases with original or remaining lease terms in excess of one year. Leases with a lease term of 12 months or less at inception are not recorded and are expensed on a straight-line basis over the lease term. We recognize lease components and non-lease components together and not as separate parts of a lease for real estate leases.

 

Operating lease right-of-use assets and liabilities are recorded at the present value of the lease payments over the lease term. The present value of the lease payments are discounted using the incremental borrowing rate associated with each lease. The variable components of the lease payment that fluctuate with the operations of a health facility are not included in determining the right-of-use assets and lease liabilities. Rather, these variable components are expensed as incurred.

 

Property and Equipment

 

Property and equipment are recorded at cost or fair value, if acquired. Depreciation is provided by the straight-line method over the expected useful lives of the assets estimated as follows: buildings and improvements, 20-40 years and equipment and furniture, 3-15 years. Leasehold improvements are amortized over periods that do not exceed the non-cancelable respective lease terms using the straight-line method.

 

Investments in Unconsolidated Companies

 

We use the equity method to account for our investments in joint ventures in which we have the ability to exercise significant influence. Original investments in these entities are recorded at cost and subsequently adjusted by our share of equity in income or losses. As of September 30, 2026, the majority of our investments in unconsolidated companies relate to two multi-family developments in Franklin, Tennessee and Hermitage, Tennessee.  

 

Business Combinations

 

We account for transactions that represent business combinations using the acquisition method of accounting in accordance with ASC 805, Business Combinations. Acquisitions are accounted for as purchases and are included in our consolidated financial statements from their respective acquisition dates. Assets acquired and liabilities assumed, if any, are measured at fair value on the acquisition date using the appropriate valuation method. Goodwill generated from acquisitions is recognized for the excess of the purchase price over the fair value of tangible and identifiable intangible assets acquired and liabilities assumed. In determining the fair value of identifiable assets, we use various valuation techniques. These valuation methods require us to make estimates and assumptions surrounding projected revenues and costs, future growth, and discount rates.

 

Goodwill and Other Intangible Assets

 

Goodwill represents the excess of the purchase price over the fair value of identifiable net assets acquired in business combinations. Goodwill is not amortized but is subject to an annual impairment test. We perform our annual goodwill impairment assessment on the first day of the fourth quarter.  Tests are performed more frequently if events occur, or circumstances change that would more likely than not reduce the fair value of the reporting unit below its carrying amount.

 

The Company’s indefinite-lived intangible assets consist of trade names and certificates of need and licenses. The Company reviews indefinite-lived intangible assets for impairment on an annual basis or more frequently if events or changes in circumstances indicate that the carrying amount of the intangible asset is below its carrying amount.

 

Accrued Risk Reserves  

 

We are self–insured for risks related to workers’ compensation and general and professional liability insurance. We have two wholly–owned limited purpose insurance companies that insure these risks. The accrued risk reserves include a liability for reported claims and estimates for incurred but unreported claims. Our policy is to engage an external, independent actuary to assist in estimating our exposure for claims obligations (for both asserted and unasserted claims). We reassess our accrued risk reserves on a quarterly basis.

 

Professional liability remains an area of particular concern to us. The long-term care industry has seen an increase in personal injury/wrongful death claims based on alleged negligence by skilled nursing facilities and their employees in providing care to residents. The Company has been, and continues to be, subject to claims and legal actions that arise in the ordinary course of business, including potential claims related to patient care and treatment. A significant increase in the number of these claims, or an increase in the amounts due as a result of these claims could have a material adverse effect on our consolidated financial position, results of operations and cash flows. It is also possible that future events could cause us to make significant adjustments or revisions to these reserve estimates and cause our reported net income to vary significantly from period to period.

 

12

 

We are principally self-insured for incidents occurring in all centers owned or leased by us. The coverage includes both primary policies and excess policies. In all years, settlements, if any, in excess of available insurance policy limits and our own reserves would be expensed by us.

 

Continuing Care Contracts

 

We have continuing care retirement centers (“CCRC”) within our operations. Residents at these retirement centers may enter into continuing care contracts with us.

 

Non-refundable fees are included as a component of the transaction price and are amortized into revenue over the actuarily determined remaining life of the resident, which is the expected period of occupancy by the resident. We pay the refundable portion of our entry fees to residents when they relocate from our community and the apartment is re-occupied. Refundable entrance fees are not included as part of the transaction price and are classified as noncurrent liabilities in our consolidated balance sheets. 

 

We also annually estimate the present value of the cost of future services and the use of facilities to be provided to the current CCRC residents and compare that amount with the balance of non-refundable deferred revenue from entrance fees received. If the present value of the cost of future services exceeds the related anticipated revenues, a liability is recorded with a corresponding charge to income. As of September 30, 2026 and December 31, 2025, we have recorded a future service obligation liability in the amount of $1,482,000. This obligation is reflected within other noncurrent liabilities in the interim condensed consolidated balance sheets. 

 

Other Noncurrent Liabilities

 

Other noncurrent liabilities include reserves primarily related to various uncertain income tax positions, deferred revenue, and obligations to provide future services to our CCRC residents. Deferred revenue includes the deferred gain on the sale of assets to National Health Corporation (“National”) and the non-refundable portion of CCRC entrance fees being amortized over the remaining life expectancies of the residents.

 

Noncontrolling Interest

 

The noncontrolling interest in a subsidiary is presented within total equity in the Company's interim condensed consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to NHC in its interim condensed consolidated statements of operations. The Company’s earnings per share is calculated based on net income attributable to NHC’s stockholders. The carrying amount of the noncontrolling interest is adjusted based on an allocation of the subsidiary earnings, contributions, and distributions.

 

Recently Adopted Accounting Guidance

 

In October 2023, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) 2023-06, "Codification Amendments in Response to the SEC's Disclosure Update and Simplification Initiative," which amends U.S. GAAP to include certain disclosure requirements that are currently required under SEC Regulation S-X or Regulation S-K. Each amendment will be effective on the date on which the SEC removes the related disclosure requirement from SEC Regulation S-X or Regulation S-K. The adoption is not expected to have a material impact on the Company's financial statements as these requirements were previously incorporated under the SEC Regulations.

 

In November 2024, the FASB issued ASU 2024-03 "Disaggregation of Income Statement Expenses," which requires the Company to disaggregate key expense categories such as employee compensation and depreciation within its financial statements. ASU 2024-03 is effective for annual periods beginning with the Company's fiscal year 2027, and interim periods with the Company's fiscal year 2028, with early adoption permitted. We are currently evaluating the impact this ASU will have on the company's financial statements and related disclosures.

 

13

  
 

Note 3 – Acquisitions

 

Five Skilled Nursing Facilities from National Health Corporation

 

On June 1, 2026, the Company purchased the land, buildings, and other specified assets and assumed certain liabilities of five skilled nursing facilities from National Health Corporation (“National”) for a purchase price of $50,500,000. National is considered an affiliate and related party, as well as provides payroll services to NHC. The operations have 639 licensed skilled nursing beds in the states of South Carolina and Tennessee. The acquisition represents both an expansion of NHC’s operations into these states and a strategic advancement of its growth in its existing operational footprint. 

 

The Company utilized widely accepted income-based, market-based, and cost-based valuation approaches to perform the preliminary purchase price allocation.

 

The Company has performed a preliminary valuation analysis of the fair market value of the assets acquired and liabilities assumed from National. The final valuation of the assets acquired and liabilities assumed was not complete as of September 30, 2026, but will be finalized within the allowable measurement period. The following table summarizes the allocation of the preliminary purchase price as of the transaction’s closing date (in thousands):

 

  

Amount

 

Accounts receivable

 $6,262 

Inventory

  338 

Prepaid expenses and other assets

  747 

Property and equipment

  51,091 

Intangible assets

  500 

Total assets acquired

  58,938 
     

Trade accounts payable

  1,729 

Accrued payroll

  3,285 

Other current liabilities

  1,726 

Total liabilities assumed

  6,740 
     

Total estimated fair value of the acquisition

 $52,198 

 

The indefinite-lived intangible assets acquired include the skilled nursing certificates of need and licenses.

 

The operations added during the three and nine months ended September 30, 2026 were not material to the Company. Accordingly, pro-forma financial information is not presented. As of September 30, 2026, these additions have been included in the interim condensed consolidated balance sheet of the Company. The operating results have been included in the interim condensed consolidated statements of operations since the date the Company gained effective control, which was June 1, 2026.

 

For the three and nine months ended September 30, 2026, these five skilled nursing facilities contributed net operating revenues of $19,288,000 and $25,290,000, respectively. For the three and nine months ended September 30, 2026, these five skilled nursing facilities contributed income from operations of $2,658,000 and $3,268,000, respectively.

 

Thirty-Two Skilled Nursing Facilities and Three Independent Living Facilities from National Health Investors

 

On July 1, 2026, the Company purchased the land, facilities, and improvements of thirty-two skilled nursing facilities and three independent living facilities, previously leased by us as tenant, from National Health Investors (“NHI”) for a purchase price of $560,000,000. On the closing date of the transaction, the lease agreement with NHI was terminated. The Company operates all of the facilities, except four Florida skilled nursing facilities. The four Florida skilled nursing facilities are leased to a third-party operator.

 

The facilities are located in Alabama, Florida, Kentucky, Missouri, South Carolina, Tennessee, and Virginia. NHC operates multiple skilled nursing facilities, assisted living and independent living communities, as well as homecare and hospice operations within this geographic footprint. The acquisition complements NHC’s current asset portfolio within these regions.

 

The Company previously controlled the right to use these properties through lease agreements; therefore, the transaction was accounted for as a termination of the existing lease and the acquisition of the underlying real estate assets. At the closing date, the Company derecognized the associated “operating lease right-of-use assets” of $16,197,000 and the “operating lease liabilities” of $15,763,000. The net difference of $434,000 between the pre-existing lease balances was included in the initial cost basis of the acquired assets. Additionally, transactions costs of $3,906,000 were also capitalized and included in the initial cost basis of the acquired assets.

 

14

 

The following table summarizes the cost allocation based on the relative fair values of the assets at the acquisition date (in thousands):

 

  

Allocated Cost

Basis

 

Land

 $44,483 

Buildings and improvements

  519,857 

Total assets acquired

 $564,340 

 

The fair value of the land was determined utilizing the sales comparison approach. The fair value of the buildings was determined utilizing the cost approach for each location, including replacement cost methods specific to skilled nursing asset classes. No goodwill or intangible assets were recognized in connection with this transaction.

  

 

Note 4 – Net Patient Revenues

 

The Company disaggregates revenue from contracts with customers by service type and by payor.

 

Revenue by Service Type

 

The Company’s net patient services can generally be classified into the following two categories: (1) inpatient services, which includes the operation of skilled nursing facilities, assisted and independent living facilities, and behavioral health hospitals, and (2) homecare and hospice services (in thousands).

 

  

Three Months Ended

September 30

  

Nine Months Ended

September 30

 
  

2026

  

2025

  

2026

  

2025

 

Net patient revenues:

                

Inpatient services

 $356,143  $331,349  $1,023,778  $981,838 

Homecare and hospice

  41,303   39,640   121,832   114,107 

Total net patient revenues

 $397,446  $370,989  $1,145,610  $1,095,945 

 

15

 

For inpatient and hospice services, revenue is recognized on a daily basis as each day represents a separate contract and performance obligation. For homecare, revenue is recognized when services are provided based on the number of days of service rendered in the period of care or on a per-visit basis. Typically, patients and third-party payors are billed monthly after services are performed or the patient is discharged, and payments are due based on contract terms.

 

As our performance obligations relate to contracts with a duration of one year or less, the Company is not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period. The Company has minimal unsatisfied performance obligations at the end of the reporting period as our patients are typically under no obligation to remain admitted in our facilities or under our care. As the period between the time of service and time of payment is typically one year or less, the Company did not adjust for the effects of a significant financing component.

 

Revenue by Payor

 

Certain groups of patients receive funds to pay the cost of their care from a common source. The following table sets forth sources of net patient revenues for the periods indicated:

 

  

Three Months Ended

September 30

  

Nine Months Ended

September 30

 

Source

 

2026

  

2025

  

2026

  

2025

 

Medicare

  29%  31%  30%  31%

Managed Care

  13%  12%  13%  12%

Medicaid

  30%  29%  30%  30%

Private Pay and Other

  28%  28%  27%  27%

Total

  100%  100%  100%  100%

 

Medicare covers skilled nursing services for beneficiaries who require nursing care and/or rehabilitation services following a hospitalization of at least three consecutive days. For each eligible day a Medicare beneficiary is in a skilled nursing facility, Medicare pays the facility a daily payment, subject to adjustment for certain factors such as a wage index in the geographic area. The payment covers all services provided by the skilled nursing facility for the beneficiary that day, including room and board, nursing, therapy and drugs, as well as an estimate of capital–related costs to deliver those services.

 

For homecare services, Medicare pays based on the acuity level of the patient and based on periods of care. A period of care is defined as a length of care up to 30 days with multiple continuous periods allowed. The services covered by the payment include all disciplines of care, in addition to medical supplies, within the scope of the home health benefit.

 

For hospice services, Medicare pays a daily rate to cover the hospice’s costs for providing services included in the patient care plan. Medicare makes daily payments based on 1 of 4 levels of hospice care. All hospice care and services offered to patients and their families must follow an individualized written plan of care that meets the patient’s needs.

 

16

 

Our hospice service revenue is subject to certain limitations on payments from Medicare. We are subject to an inpatient cap limit and an overall Medicare payment cap for each provider number. We monitor these caps on a provider-by-provider basis and estimate amounts due back to Medicare if we estimate a cap has been exceeded. If applicable, we record these cap adjustments as a reduction to revenue.

 

Medicaid is operated by individual states with the financial participation of the federal government. The states in which we operate currently use prospective cost–based reimbursement systems. Under cost–based reimbursement systems, the skilled nursing facility is reimbursed for the reasonable direct and indirect allowable costs it incurred in a base year in providing routine resident care services as defined by the program.

 

Private pay, managed care, and other payment sources include commercial insurance, individual patient funds, managed care plans and the Veterans Administration. Private paying patients, private insurance carriers and the Veterans Administration generally pay based on the healthcare center's charges or specifically negotiated contracts. For private pay patients in skilled nursing, assisted living and independent living facilities, the Company bills for room and board charges, with the remittance being due on receipt of the statement and generally by the 10th day of the month the services are performed.

 

Certain managed care payors for homecare services pay on a per-visit basis. This revenue is recorded on an accrual basis based upon the date of services at amounts equal to its established or estimated per-visit rates.

 

State Supplemental Funding

 

The Company received supplemental Medicaid payments from various states. The funding generally incorporates specific use requirements primarily for direct patient care including labor related expenses or various patient care related expenses.  We recorded $0 and $1,838,000 in net patient revenues for these supplemental Medicaid payments for the three months ended September 30, 2026 and 2025, respectively. We have recorded $3,605,000 and $5,522,000 in net patient revenues for these supplemental Medicaid payments for the nine months ended September 30, 2026 and 2025, respectively.

 

Third Party Payors

 

Laws and regulations governing Medicare and Medicaid programs are complex and subject to interpretation. Noncompliance with such laws and regulations can be subject to regulatory actions including fines, penalties, and exclusion from the Medicare and Medicaid programs. We believe that we are following all applicable laws and regulations.

 

Medicare and Medicaid program revenues, as well as certain Managed Care program revenues, are subject to audit and retroactive adjustment by government representatives or their agents. Settlements with third-party payors for retroactive adjustments due to audits, reviews or investigations are considered variable consideration and are included in the determination of the estimated transaction price for providing patient care. These settlements are estimated based on the terms of the payment agreement with the payor, correspondence from the payor and the Company’s historical settlement activity, including an assessment to ensure that it is probable that a significant reversal in the amount of cumulative revenue recognized will not occur when the uncertainty associated with the retroactive adjustment is subsequently resolved. Estimated settlements are adjusted in future periods as adjustments become known, or as years are settled or are no longer subject to such audits, reviews, and investigations. We believe that any differences between the net revenues recorded, and final determination will not materially affect the consolidated financial statements. We have made provisions of approximately $15,563,000 and $13,739,000 as of September 30, 2026 and December 31, 2025, respectively, for various Medicare, Medicaid, and Managed Care claims reviews and current and prior year cost reports.

  

 

Note 5 – Other Revenues

 

Other revenues are outlined in the table below. Revenues from rental income include health care real estate properties owned by us and leased to third party operators. Revenues from management and accounting services include fees provided to manage and provide accounting services to other healthcare operators. Revenues from insurance services include premiums for workers’ compensation and professional liability insurance policies that our wholly owned insurance subsidiaries have written for certain healthcare operators to which we provide management or accounting services, as well as other miscellaneous health care related earnings (in thousands).

 

  

Three Months Ended

September 30

  

Nine Months Ended

September 30

 
  

2026

  

2025

  

2026

  

2025

 

Rental income

 $6,393  $6,177  $19,284  $18,800 

Management and accounting services fees

  3,404   4,115   29,918   12,623 

Insurance services and other

  728   1,380   3,005   3,900 

Total other revenues

 $10,525  $11,672  $52,207  $35,323 

 

17

 

Rental Income

 

The Company leases real estate assets consisting of skilled nursing facilities and assisted living facilities to third party operators.

 

Management Fees from National Health Corporation

 

Prior to the acquisition of the five skilled nursing facilities from National on June 1, 2026, we managed the five skilled nursing facilities. We recognized management fees and interest on management fees from these facilities of $0 and $1,377,000 for the three months ended September 30, 2026 and 2025, respectively. We recognized management fees and interest on management fees from these facilities of $2,395,000 and $4,161,000 for the nine months ended September 30, 2026 and 2025, respectively. 

 

During the second quarter of 2026, we also recognized management fees of $18,325,000 previously earned for management services prior to 2025, but these management fees were not previously recognized as such revenues. These revenues did not previously meet the recognition criteria of ASC Topic 606, Revenue from Contracts with Customers, because the underlying consideration was constrained. Upon the acquisition of the five skilled nursing facilities from National Health Corporation on June 1, 2026, and as noted in Note 3 - Acquisitions, the revenue recognition criteria was met and the management fees were paid and recognized in the current period.

  

 

Note 6 – Non–Operating Income

 

Non–operating income is comprised of the following (in thousands):

 

  

Three Months Ended

September 30

  

Nine Months Ended

September 30

 
  

2026

  

2025

  

2026

  

2025

 

Dividends and net realized gains and losses on sales of securities

 $2,665  $2,089  $6,292  $5,971 

Interest income

  1,715   2,676   6,140   7,388 

Equity in earnings/(loss) of unconsolidated investments

  (743)  (105)  (866)  512 

Total non-operating income

 $3,637  $4,660  $11,566  $13,871 

  

 

Note 7 – Business Segments

 

The Company has two reportable operating segments: (1) inpatient services, which includes the operation of skilled nursing facilities, assisted and independent living facilities, and behavioral health hospitals; and (2) homecare and hospice services. These reportable operating segments are consistent with information used by the Company’s Chief Executive Officer, as chief operating decision maker (“CODM”), to assess performance and allocate resources. The Company also reports an “all other” category that includes revenues from rental income, management and accounting services fees, insurance services, and costs of the corporate office.

 

18

 

The Company’s CODM evaluates performance including pretax earnings and allocates capital resources to each segment based on an operating model that is designed to improve the quality of patient care and profitability of the Company while enhancing long-term shareholder value. The CODM does not review assets by segment in his resource allocation and therefore, assets by segment are not disclosed below.

 

The following table sets forth the Company’s unaudited interim condensed consolidated statements of operations by business segment (in thousands):

 

  

Three Months Ended September 30, 2026

 
  

Inpatient
Services

  

Homecare

and Hospice

  

All Other

  

Total

 

Revenues:

                

Net patient revenues

 $356,143  $41,303  $-  $397,446 

Other revenues

  339   -   10,186   10,525 

Net operating revenues

  356,482   41,303   10,186   407,971 
                 

Costs and expenses:

                

Salaries, wages, and benefits

  212,869   24,819   14,249   251,937 

Other operating

  88,492   7,313   3,656   99,461 

Rent

  415   641   309   1,365 

Depreciation and amortization

  12,898   138   1,540   14,576 

Total costs and expenses

  314,674   32,911   19,754   367,339 
                 

Income/(loss) from operations

  41,808   8,392   (9,568)  40,632 

Non-operating income

  -   -   3,637   3,637 

Interest expense

  (6,991)  -   -   (6,991)

Unrealized losses on marketable equity securities

  -   -   (17,599)  (17,599)
                 

Income/(loss) before income taxes

 $34,817  $8,392  $(23,530) $19,679 

 

  

Three Months Ended September 30, 2025

 
  

Inpatient
Services

  

Homecare

and Hospice

  

All Other

  

Total

 

Revenues:

                

Net patient revenues

 $331,349  $39,640  $-  $370,989 

Other revenues

  393   -   11,279   11,672 

Net operating revenues

  331,742   39,640   11,279   382,661 
                 

Costs and expenses:

                

Salaries, wages, and benefits

  195,745   23,788   13,643   233,176 

Other operating

  86,745   6,664   3,195   96,604 

Rent

  8,823   601   1,921   11,345 

Depreciation and amortization

  10,219   141   798   11,158 

Total costs and expenses

  301,532   31,194   19,557   352,283 
                 

Income/(loss) from operations

  30,210   8,446   (8,278)  30,378 

Non-operating income

  -   -   4,660   4,660 

Interest expense

  (1,456)  -   -   (1,456)

Unrealized gains on marketable equity securities

  -   -   20,827   20,827 
                 

Income before income taxes

 $28,754  $8,446  $17,209  $54,409 

 

19

 
  

Nine Months Ended September 30, 2026

 
  

Inpatient
Services

  

Homecare

and Hospice

  

All Other

  

Total

 

Revenues:

                

Net patient revenues

 $1,023,778  $121,832  $-  $1,145,610 

Other revenues

  1,086   -   51,121   52,207 

Net operating revenues

  1,024,864   121,832   51,121   1,197,817 
                 

Costs and expenses:

                

Salaries, wages, and benefits

  612,759   74,303   41,851   728,913 

Other operating

  252,473   21,099   11,601   285,173 

Rent

  18,436   1,892   4,220   24,548 

Depreciation and amortization

  33,575   399   3,389   37,363 

Total costs and expenses

  917,243   97,693   61,061   1,075,997 
                 

Income/(loss) from operations

  107,621   24,139   (9,940)  121,820 

Non-operating income

  -   -   11,566   11,566 

Interest expense

  (7,273)  -   -   (7,273)

Unrealized losses on marketable equity securities

  -   -   (7,610)  (7,610)
                 

Income/(loss) before income taxes

 $100,348  $24,139  $(5,984) $118,503 

 

  

Nine Months Ended September 30, 2025

 
  

Inpatient
Services

  

Homecare

and Hospice

  

All Other

  

Total

 

Revenues:

                

Net patient revenues

 $981,838  $114,107  $-  $1,095,945 

Other revenues

  1,197   -   34,126   35,323 

Net operating revenues

  983,035   114,107   34,126   1,131,268 
                 

Costs and expenses:

                

Salaries, wages, and benefits

  578,824   69,375   39,641   687,840 

Other operating

  252,064   20,969   7,971   281,004 

Rent

  26,486   1,790   5,762   34,038 

Depreciation and amortization

  30,380   402   2,369   33,151 

Total costs and expenses

  887,754   92,536   55,743   1,036,033 
                 

Income/(loss) from operations

  95,281   21,571   (21,617)  95,235 

Non-operating income

  -   -   13,871   13,871 

Interest expense

  (5,555)  -   -   (5,555)

Unrealized gains on marketable equity securities

  -   -   26,748   26,748 
                 

Income before income taxes

 $89,726  $21,571  $19,002  $130,299 

 

20

  
 

Note 8 – Long-Term Leases

 

The following table summarizes the maturity of our operating lease liabilities as of September 30, 2026 (in thousands):

 

  

Operating

Leases

 

2027

 $3,642 

2028

  2,845 

2029

  2,407 

2030

  2,050 

2031

  1,707 

Thereafter

  9,303 

Total minimum lease payments

  21,954 

Less: amounts representing interest

  (5,648)

Present value of future minimum lease payments

  16,306 

Less: current portion

  (2,644)

Noncurrent lease liabilities

 $13,662 

 

21

  
 

Note 9 – Earnings per Share

 

Basic net income per share is computed based on the weighted average number of common shares outstanding for each period presented. Diluted net income per share reflects the potential dilution that would have occurred if securities to issue common stock were exercised, converted, or resulted in the issuance of common stock that would have then shared in our earnings.

 

The following table summarizes the earnings and the weighted average number of common shares used in the calculation of basic and diluted earnings per share (in thousands, except for share and per share amounts):

 

  

Three Months Ended
September 30

  

Nine Months Ended
September 30

 
  

2026

  

2025

  

2026

  

2025

 

Basic:

                

Weighted average common shares outstanding

  15,638,814   15,484,464   15,599,724   15,461,804 

Net income attributable to National HealthCare Corporation

 $13,637  $39,239  $89,813  $95,166 

Earnings per common share, basic

 $0.87  $2.53  $5.76  $6.15 
                 

Diluted:

                

Weighted average common shares outstanding

  15,638,814   15,484,464   15,599,724   15,461,804 

Effects of dilutive instruments

  326,081   180,066   267,233   151,701 

Weighted average common shares outstanding

  15,964,895   15,664,530   15,866,957   15,613,505 
                 

Net income attributable to National HealthCare Corporation

 $13,637  $39,239  $89,813  $95,166 

Earnings per common share, diluted

 $0.85  $2.50  $5.66  $6.10 

 

For the three and nine months ended September 30, 2026, no stock options were excluded from the calculation of diluted weighted average shares of common stock outstanding because the inclusion of these securities would have an anti-dilutive impact. For the three and nine months ended September 30 2025, 6,450 stock options were excluded from the calculation of diluted weighted average shares of common stock outstanding because the inclusion of these securities would have an anti-dilutive effect. 

  

 

Note 10 – Investments in Marketable Securities

 

Our investments in marketable equity securities are carried at fair value with the changes in unrealized gains and losses recognized in our results of operations at each measurement date. Our investments in marketable debt securities are classified as available for sale securities and carried at fair value with the unrealized gains and losses recognized through accumulated other comprehensive income at each measurement date. Any credit-related decline in fair market values below the amortized cost of our available for sale debt securities are recorded in our results of operations through an allowance for credit losses. Realized gains and losses from securities sales are recognized in results of operations upon disposition of the securities using the specific identification method on a trade date basis. Refer to Note 11 – Fair Value Measurements for a description of the Company's methodology for determining the fair value of marketable securities. 

 

Marketable securities consist of the following (in thousands):

 

  

September 30, 2026

  

December 31, 2025

 
  

Amortized

Cost

  

Fair

Value

  

Amortized

Cost

  

Fair

Value

 

Investments available for sale:

                

Marketable equity securities

 $30,176  $154,530  $30,176  $162,972 

Restricted investments available for sale:

                

Marketable equity securities

  14,229   19,153   13,104   17,197 

Corporate debt securities

  60,124   58,064   58,458   58,898 

Asset-based securities

  16,399   15,283   16,886   16,236 

U.S. Treasury securities

  42,155   39,846   43,384   42,836 

State and municipal securities

  1,005   1,002   5,282   5,323 
  $164,088  $287,878  $167,290   303,462 

 

22

 

Included in the marketable equity securities are the following (in thousands, except share amounts):

 

  

September 30, 2026

  

December 31, 2025

 
  

Shares

  

Cost

  

Fair

Value

  

Shares

  

Cost

  

Fair

Value

 

NHI Common Stock

  1,630,642  $24,734  $107,019   1,630,642  $24,734  $124,532 

 

The amortized cost and estimated fair value of debt securities classified as available for sale, by contractual maturity, are as follows (in thousands):

 

  

September 30, 2026

  

December 31, 2025

 
  

Cost

  

Fair

Value

  

Cost

  

Fair

Value

 

Maturities:

                

Within 1 year

 $14,459  $14,342  $14,309  $14,236 

1 to 5 years

  65,692   62,866   69,316   68,390 

6 to 10 years

  38,722   36,236   40,385   40,667 

Over 10 years

  810   751   –   – 
  $119,683  $114,195  $124,010  $123,293 

 

Gross unrealized gains related to marketable equity securities are $129,818,000 and $137,436,000 as of September 30, 2026 and December 31, 2025, respectively. Gross unrealized losses related to marketable equity securities are $540,000 and $547,000 as of September 30, 2026 and December 31, 2025, respectively. For the three months ended September 30, 2026 and 2025, the Company recognized net unrealized losses of $17,599,000 and net unrealized gains of $20,827,000, respectively, for the changes in fair market value of the marketable equity securities in the interim condensed consolidated statements of operations. For the nine months ended September 30, 2026 and 2025, the Company recognized net unrealized losses of $7,610,000 and net unrealized gains of $26,748,000, respectively, for the changes in fair market value of the marketable equity securities in the interim condensed consolidated statements of operations.

 

Gross unrealized gains related to available for sale marketable debt securities are $10,000 and $1,464,000 as of September 30, 2026 and December 31, 2025, respectively. Gross unrealized losses related to available for sale marketable debt securities are $5,498,000 and $2,181,000 as of September 30, 2026 and December 31, 2025, respectively.

 

The Company’s unrealized losses in our available for sale marketable debt securities were determined to be non-credit related. The Company has not recognized any credit related impairments for the nine months ended  September 30, 2026 and 2025.

 

For the marketable debt securities in gross unrealized loss positions, (a) it is more likely than not that the Company will not be required to sell the investment securities before recovery of the unrealized losses, and (b) the Company expects that the contractual principal and interest will be received on the investment securities.

 

Proceeds from the sale of available for sale marketable securities during the nine months ended September 30, 2026 and 2025 were $22,683,000 and $64,689,000, respectively. Investment gains of $1,023,000 and $872,000 were realized on these sales during the nine months ended September 30, 2026 and 2025, respectively. 

  

 

Note 11 – Fair Value Measurements

 

The accounting standard for fair value measurements provides a framework for measuring fair value and requires expanded disclosures regarding fair value measurements. Fair value is defined as the price that would be received for an asset or the exit price that would be paid to transfer a liability in the principal or most advantageous market in an orderly transaction between market participants on the measurement date. This accounting standard establishes a fair value hierarchy, which requires an entity to maximize the use of observable inputs, where available. The following summarizes the three levels of inputs that may be used to measure fair value:

 

Level 1  – The valuation is based on quoted prices in active markets for identical instruments.

Level 2 – The valuation is based on observable inputs such as quoted prices for similar instruments in active markets, quoted prices for identical or similar instruments in markets that are not active, and model–based valuation techniques for which all significant assumptions are observable in the market.

Level 3 – The valuation is based on unobservable inputs that are supported by minimal or no market activity and that are significant to the fair value of the instrument. Level 3 valuations are typically performed using pricing models, discounted cash flow methodologies, or similar techniques that incorporate management’s own estimates of assumptions that market participants would use in pricing the instrument, or valuations that require significant management judgment or estimation.

 

23

 

A financial instrument’s level within the fair value hierarchy is based on the lowest level of input that is significant to the fair value measurement.

 

The following table summarizes fair value measurements by level at September 30, 2026 and December 31, 2025 for assets and liabilities measured at fair value on a recurring basis (in thousands):

 

  

Fair Value Measurements Using

 

September 30, 2026

 

Fair

Value

  

Quoted

Prices in

Active
Markets

For Identical

Assets

(Level 1)

  

Significant

Other

Observable

Inputs

(Level 2)

  

Significant

Unobservable

Inputs

(Level 3)

 

Cash and cash equivalents

 $66,795  $66,795  $–  $– 

Restricted cash and cash equivalents

  19,526   19,526   –   – 

Marketable equity securities

  173,683   173,683   –   – 

Corporate debt securities

  58,064   42,980   15,084   – 

Asset–backed securities

  15,283   –   15,283   – 

U.S. Treasury securities

  39,846   39,846   –   – 

State and municipal securities

  1,002   –   1,002   – 

Total financial assets

 $374,199  $342,830  $31,369  $– 

 

  

Fair Value Measurements Using

 

December 31, 2025

 

Fair

Value

  

Quoted

Prices in

Active

Markets

For Identical

Assets

(Level 1)

  

Significant

Other

Observable

Inputs

(Level 2)

  

Significant

Unobservable

Inputs

(Level 3)

 

Cash and cash equivalents

 $92,829  $92,829  $–  $– 

Restricted cash and cash equivalents

  19,358   19,358   –   – 

Marketable equity securities

  180,169   180,169   –   – 

Corporate debt securities

  58,898   45,948   12,950   – 

Asset–backed securities

  16,236   –   16,236   – 

U.S. Treasury securities

  42,836   42,836   –   – 

State and municipal securities

  5,323   877   4,446   – 

Total financial assets

 $415,649  $382,017  $33,632  $– 

  

 

Note 12 – Goodwill and Other Intangible Assets

 

At September 30, 2026, we evaluated potential triggering events that might be indicators that our goodwill and indefinite lived intangibles were impaired. As a result of the review, there were no impairment indicators regarding the Company’s goodwill that required a quantitative test to be performed. However, our accounting estimates could materially change from period to period due to changing market factors. We will continue to monitor future events, changes in circumstances, and the potential impact thereof. If actual results are not consistent with our assumptions and estimates, we may be exposed to future goodwill impairment losses.

 

24

 

At September 30, 2026, the following table represents the activity related to our goodwill by segment (in thousands):

 

  

Inpatient

Services

  

Homecare

and Hospice

  

All Other

  

Total

 

January 1, 2026

 $5,924  $164,554  $–  $170,478 

Additions

  –   –   –   – 

September 30, 2026

 $5,924  $164,554  $–  $170,478 

 

Indefinite-lived intangible assets consist of the following (in thousands):

 

  

September 30,

2026

  

December 31,

2025

 

Trade names

 $15,896  $15,896 

Certificates of need

  2,256   1,756 

Licenses

  2,212   2,212 

Total

 $20,364  $19,864 

  

 

Note 13 - Stock Repurchase Program

 

During the nine months ended September 30, 2026, the Company repurchased 141,642 shares of its common stock for a total cost of $24,672,000. During the nine months ended September 30, 2025, the Company repurchased 88,738 shares of its common stock for a total cost of $9,566,000. The shares were funded from cash on hand and were cancelled and returned to the status of authorized but unissued. 

  

 

Note 14 – Stock–Based Compensation

 

NHC recognizes stock–based compensation expense for all stock options granted over the requisite service period using the fair value at the date of grant using the Black–Scholes pricing model. Stock–based compensation totaled $2,019,000 and $1,239,000 for the three months ended September 30, 2026 and 2025, respectively. Stock-based compensation totaled $5,285,000 and $3,499,000 for the nine months ended September 30, 2026 and 2025, respectively. Stock–based compensation is included in “Salaries, wages and benefits” in the interim condensed consolidated statements of operations.

 

At September 30, 2026, the Company had $11,615,000 of unrecognized compensation cost related to unvested stock–based compensation awards. This unrecognized compensation cost will be amortized over an approximate two-year period.

 

Stock Options

 

The following table summarizes the significant assumptions used to value the options granted for the nine months ended September 30, 2026 and for the year ended December 31, 2025.

 

  

September 30,

2026

  

December 31,
2025

 

Risk–free interest rate

  3.5%  4.1%

Expected volatility

  29.0%  27.0%

Expected life, in years

  2.9   2.9 

Expected dividend yield

  1.7%  2.8%

 

25

 

The following table summarizes our outstanding stock options for the nine months ended September 30, 2026 and for the year ended December 31, 2025.

 

  

Number of

Shares

  

Weighted

Average

Exercise Price

  

Aggregate

Intrinsic

Value

 

Options outstanding at January 1, 2025

  631,242  $74.73  $– 

Options granted

  306,148   91.42   – 

Options exercised

  (202,281)  70.17   – 

Options cancelled

  (87,134)  85.94   – 

Options outstanding at December 31, 2025

  647,975   82.53   – 

Options granted

  317,136   159.25   – 

Options exercised

  (254,657)  80.95   – 

Options cancelled

  (10,169)  112.65   – 

Options outstanding at September 30, 2026

  700,285  $117.42  $71,493,000 
             

Options exercisable at September 30, 2026

  191,793  $78.19  $27,103,322 

 

Options

Outstanding

September 30, 2026

  

Exercise Prices

  

Weighted Average

Exercise Price

  

Weighted Average

Remaining

Contractual

Life in Years

 
393,899  $53.94-$96.03  $85.09  2.64 
306,386  $130.41-$171.42   158.98  4.35 
700,285       $117.42  3.39 

  

 

Note 15 – Income Taxes

 

The Company's income tax provision as a percentage of our income before income taxes was 27.9% and 24.6% for the three months ended September 30, 2026 and 2025, respectively.

 

The Company's income tax provision as a percentage of our income before income taxes was 23.4% and 25.2% for the nine months ended September 30, 2026 and 2025, respectively. 

 

Typically, these percentages vary from the U.S. federal statutory income tax rate of 21% primarily due to state income taxes, excess tax benefits from stock-based compensation, benefits resulting from the lapsing of statute of limitations of items in our tax contingency reserve, and non-deductible expenses.  For the nine months ended September 30, 2026 and 2025, the accrual of state income tax was the most significant reconciling item.

 

26

 

Our quarterly income tax provision, and our estimate of our annual effective income tax rate, is subject to variation due to several factors, including volatility based on the amount of pre-tax income or loss.  

 

The Company is no longer subject to U.S. federal and state examinations by tax authorities for years before 2022 (with certain state exceptions).    

  

 

Note 16 – Long-Term Debt

 

Long–term debt consists of the following (dollars in thousands):

 

  

Interest rate at

September 30,

2026

(Variable)

  

Maturity

  

September 30,

2026

  

December 31,

2025

 

Term loan facility

  5.2%   2031  $469,063  $– 

Credit facility

  5.2%   2031   33,000   40,000 

Total debt

          502,063   40,000 

Less current portion

          (23,750)  (7,500)

Total long-term debt

         $478,313  $32,500 

 

On May 26, 2026, the Company entered into a credit agreement, consisting of a $475,000,000 senior unsecured term loan facility and a $75,000,000 senior unsecured revolving credit facility (“credit agreement”). The credit agreement became effective on July 1, 2026, in conjunction with the transaction with NHI. The term loan facility and credit facility will mature on the fifth anniversary of the date of initial funding to the Company under the credit agreement, or July 1, 2031. The term loan facility will amortize in quarterly installments of approximately $5,938,000, with the remaining balance due at maturity. Borrowings under the credit facility require interest only payments.

 

Borrowings under the credit agreement will bear interest, at NHC’s option, at a rate based on either Term SOFR or a base rate, in each case plus an applicable margin. The applicable margin will vary based on the Company’s consolidated leverage ratio and, based on the applicable pricing grid, will range from 1.25% to 1.75% per annum for Term SOFR borrowings and 0.25% to 0.75% per annum for base rate borrowings. The base rate is a variable daily interest rate set at the highest among: (1) the Federal Funds Rate plus 0.50%, (2) Bank of America’s publicly announced prime rate, or (3) Term SOFR plus 1.00%. In all cases, the base rate has a floor of 1.00%. The applicable rate as of the Funding Date and until the first business day following delivery of the compliance certificate for the fiscal quarter ending December 31, 2026 will be Term SOFR + 1.50% or base rate + 0.50%. NHC is also required to pay a commitment fee on the daily unused portion of the revolving credit facility, which ranges from 0.20% to 0.30% per annum based on the consolidated leverage ratio, payable quarterly in arrears.

 

The credit agreement contains customary representations and warranties, financial covenants, and other customary affirmative and negative covenants. The credit agreement also contains customary events of default. Based on level 2 inputs, the carrying value of the Company's long-term debt is considered to approximate the fair value of such debt based upon the interest rates that the Company believes it can currently obtain for similar debt.

 

The aggregate maturities of long–term debt for the five years subsequent to September 30, 2026 are as follows (in thousands):

 

  

Long–Term Debt

 

2027

 $23,750 

2028

  23,750 

2029

  23,750 

2030

  23,750 

2031

  407,063 

Total

 $502,063 

 

27

  
 

Note 17 – Contingencies, Commitments and Other Matters

 

Accrued Risk Reserves

 

We have wholly–owned limited purpose insurance companies that insure risks related to workers’ compensation and general and professional liability insurance claims both for our owned and leased entities and certain of the entities to which we provide management or accounting services. The liability we have recognized for reported claims and estimates for incurred but unreported claims totals $126,765,000 and $121,595,000 at September 30, 2026 and December 31, 2025, respectively. The liability is included in accrued risk reserves in the interim condensed consolidated balance sheets and is subject to adjustment for actual claims incurred. It is possible that these claims plus unasserted claims could exceed our insurance coverages and our reserves, which could have a material adverse effect on our consolidated financial position, results of operations and cash flows.

 

As a result of the terms of our insurance policies and our use of wholly owned limited purpose insurance companies, we have retained significant insurance risk with respect to workers’ compensation and general and professional liability. We consider the professional services of independent actuaries to assist us in estimating our exposures for claims obligations (for both asserted and unasserted claims) related to deductibles and exposures in excess of coverage limits, and we maintain reserves for these obligations. Such estimates are based on many variables including historical and statistical information and other factors.

 

Workers’ Compensation

 

For workers’ compensation, we utilize a wholly–owned Tennessee domiciled property/casualty insurance company to write coverage for NHC affiliates and for third–party customers. Policies are written for a duration of twelve months and cover only risks related to workers’ compensation losses. All customers are companies which operate in the senior care industry. Business is written on a direct basis. 

 

General and Professional Liability Insurance and Lawsuits

 

The senior care industry has experienced significant increases in both the number of personal injury/wrongful death claims and in the severity of awards based upon alleged negligence by skilled nursing facilities and their employees in providing care to residents. The Company has been, and continues to be, subject to claims and legal actions that arise in the ordinary course of business, including potential claims related to patient care and treatment. The defense of these lawsuits may result in significant legal costs, regardless of the outcome, and can result in large settlement amounts or damage awards. Additional insurance is purchased through third party providers that serve to supplement the coverage provided through our wholly owned captive insurance company.

 

There is certain additional litigation incidental to our business, none of which, based upon information available to date, would be material to our financial position, results of operations, or cash flows. In addition, the long–term care industry is continuously subject to scrutiny by governmental regulators, which could result in litigation or claims related to regulatory compliance matters.

 

28

 

Governmental Regulations

 

Laws and regulations governing Medicare, Medicaid and other federal healthcare programs are complex and subject to interpretation. Management believes that it is following all applicable laws and regulations in all material respects. However, compliance with such laws and regulations can be subject to future government review and interpretation as well as significant regulatory action including fines, penalties, and exclusions from the Medicare, Medicaid and other federal healthcare programs.

 

Indemnities

 

From time to time, the Company enters into certain types of contracts that contingently require it to indemnify parties against third-party claims. These contracts primarily include (i) certain real estate leases, under which the Company may be required to indemnify property owners or prior facility operators for post-transfer liabilities and other claims arising from the Company’s use of the applicable premises, (ii) operations transfer agreements, in which the Company agrees to indemnify past operators of facilities against certain liabilities arising from the transfer of the operation and/or the operation thereof after the transfer to the Company or its subsidiary, (iii) certain lending agreements, under which the Company may be required to indemnify the lender against various claims and liabilities, (iv) certain agreements by and between the Company and/or its subsidiaries or affiliates, and (v) certain agreements with the Company officers, directors and others, under which the Company may be required to indemnify such persons for liabilities arising out of the nature of their relationship to the Company and/or its subsidiaries and affiliates. The terms of such obligations vary by contract and, in most instances, do not expressly state or include a specific or maximum dollar amount. Generally, amounts under these contracts cannot be reasonably estimated until a specific claim is asserted. 

 

29

  
 

Item 2.

Management's Discussion and Analysis of Financial Condition and Results of Operations.

 

Forward–Looking Statements

 

References throughout this document to the Company include National HealthCare Corporation and its wholly owned subsidiaries. In accordance with the Securities and Exchange Commissions “Plain English” guidelines, this Quarterly Report on Form 10–Q has been written in the first person. In this document, the words “we”, “our”, “ours” and “us” refer only to National HealthCare Corporation and its wholly–owned subsidiaries and not any other person.

 

This Quarterly Report on Form 10–Q and other information we provide from time to time, contains certain “forward–looking” statements as that term is defined by the Private Securities Litigation Reform Act of 1995. All statements regarding our expected future financial position, results of operations or cash flows, continued performance improvements, ability to service and refinance our debt obligations, ability to finance growth opportunities, ability to control our patient care liability costs, ability to respond to changes in government regulations, ability to execute our three–year strategic plan, and similar statements including, without limitations, those containing words such as “believes”, “anticipates”, “expects”, “intends”, “estimates”, “plans”, and other similar expressions are forward–looking statements.

 

Forward–looking statements involve known and unknown risks and uncertainties that may cause our actual results in future periods to differ materially from those projected or contemplated in the forward–looking statements as a result of, but not limited to, the following factors:

 

●

national and local economic conditions, including their effect on the availability and cost of labor, utilities and materials;

 

●

the effect of government regulations and changes in regulations governing the healthcare industry, including our compliance with such regulations;

 

●

changes in Medicare and Medicaid payment levels and methodologies and the application of such methodologies by the government and its fiscal intermediaries;

 

●

liabilities and other claims asserted against us, including patient care liabilities, as well as the resolution of current litigation (see Note 17 to Interim Condensed Consolidated Financial Statements included in this Form 10-Q);

 

●

the ability to attract and retain qualified personnel;

 

●

the availability and terms of capital to fund acquisitions and capital improvements;

 

30

 

●

the competitive environment in which we operate;

 

●

our need to make investments continually in our processes and information systems to protect the privacy of patients, partners and other persons and reduce the risk of successful cybersecurity attacks;

 

●

damage to our reputation, regulatory penalties, legal claims and liability under state and federal laws that we could suffer upon any cybersecurity or privacy breaches;

 

●

the ability to maintain and increase census levels; and

 

●

demographic changes.

 

See the notes to the quarterly financial statements, and “Item 1. Business” in our 2025 Annual Report on Form 10–K for a discussion of various governmental regulations and other operating factors relating to the healthcare industry and the risk factors inherent in them. This may be found on our web site at www.nhccare.com. You should carefully consider these risks before making any investment in the Company. These risks and uncertainties are not the only ones facing us. There may be additional risks that we do not presently know of or that we currently deem immaterial. If any of the risks occur, our business, financial condition or results of operations could be materially adversely affected. In that case, the trading price of our shares of stock could decline, and you may lose all or part of your investment. Given these risks and uncertainties, we can give no assurances that these forward–looking statements will, in fact, transpire and, therefore, caution investors not to place undue reliance on them.

 

Overview

 

National HealthCare Corporation (“NHC” or the “Company”) is a leading provider of senior health care services. As of September 30, 2026, we operate or manage, through certain affiliates, 80 skilled nursing facilities with a total of 10,323 licensed beds, 26 assisted living facilities with 1,413 units, nine independent living facilities, three behavioral health hospitals, 34 homecare agencies, and 33 hospice agencies. We operate specialized care units within certain of our healthcare centers such as Alzheimer's disease care units and sub-acute nursing units. In addition, we provide insurance services, management and accounting services, and we lease properties to operators of skilled nursing and assisted living facilities. We operate in 9 states and are located primarily in the southeastern United States.

 

Summary of Goals and Areas of Focus

 

Occupancy

 

A primary area of management focus continues to be the rates of occupancy within our skilled nursing facilities. The overall census in owned and leased skilled nursing facilities for the three months ending September 30, 2026 was 90.4% compared to 90.0% for the same period a year ago.  For the nine months ended September 30, 2026, overall census in our owned and leased skilled nursing facilities was 90.1% compared to 89.6% for the same period a year ago.

 

31

 

Due to America’s healthcare labor shortage, the challenge of maintaining desirable patient census levels has been amplified. Management has undertaken a number of steps in order to best position our current and future health care facilities. This includes working internally to examine and improve systems to be most responsive to referral sources and payors, as well as find creative initiatives to retain and attract qualified healthcare professionals. Additionally, NHC is in various stages of partnerships with hospital systems, payors, and other post–acute alliances to better position ourselves so we are an active participant in the delivery of post-acute healthcare services.

 

Quality of Patient Care

 

CMS introduced the Five-Star Quality Rating System to help consumers, their families and caregivers compare skilled nursing facilities more easily. The Five-Star Quality Rating System gives each skilled nursing operation a rating ranging between one and five stars in various categories (five stars being the best). The Company has always strived for patient-centered care and quality outcomes as precursors to outstanding financial performance.

 

The tables below summarize NHC's overall performance in these Five-Star ratings versus the skilled nursing industry as of September 30, 2026:

 

   

NHC Ratings

   

Industry Ratings

 

Total number of skilled nursing facilities, end of period

    80          

Number of 4 and 5-star rated skilled nursing facilities

    51          

Percentage of 4 and 5-star rated skilled nursing facilities

    64%       36%  

Average rating for all skilled nursing facilities, end of period

    3.8       2.9  

 

Development and Growth

 

We are undertaking to expand our senior care operations while protecting our existing operations and markets. The following table lists our activities that are currently under development.

 

Type of

Operation

 

Description

 

Size

 

Location

 

Expected Date

Placed in Service

Assisted Living Facility

 

New Operation

 

79 units

 

Tullahoma, TN

 

Q2 2027

 

On June 1, 2026, the Company purchased the land, buildings, and other specified assets and assumed certain liabilities of five skilled nursing facilities from National for a purchase price of $50,500,000. The operations have 639 licensed skilled nursing beds in the states of South Carolina and Tennessee. 

 

On July 1, 2026, the Company purchased the land, facilities, and improvements of thirty-two skilled nursing facilities and three independent living facilities, currently leased by us as tenant, from NHI for a purchase price of $560,000,000. On the closing date of the transaction, the lease agreement with NHI terminated. The Company currently operates all of the facilities, except four Florida skilled nursing facilities. The four Florida skilled nursing facilities are leased to a third-party operator.

 

We also have two multi-family developments that are either under construction or in the lease-up phase, both of which we are noncontrolling owners. These developments are located in Franklin, Tennessee and Hermitage, Tennessee with 332 units and 315 units, respectively. Our capital contributions in these developments are included in the line item "Investments in unconsolidated companies" in our interim condensed consolidated balance sheets.

 

Accrued Risk Reserves

 

Our accrued professional liability and workers’ compensation reserves totaled $126,765,000 at September 30, 2026 and are a primary area of management focus. We have set aside restricted cash and cash equivalents and marketable securities to fund our estimated professional liability and workers’ compensation liabilities.

 

As to exposure for professional liability claims, we have developed performance certification criteria to measure and bring focus to the patient care issues most likely to produce professional liability exposure, including in–house acquired pressure ulcers, significant weight loss and numbers of falls. These programs for certification, which we regularly modify and improve, have produced measurable improvements in reducing these incidents. Our experience is that achieving goals in these patient care areas improves both patient and employee satisfaction.

 

32

 

Government Reimbursement Programs

 

Medicare – Skilled Nursing Facilities

 

In July 2025, CMS released its final rule outlining fiscal year 2026 Medicare payment rates and policy changes for skilled nursing facilities, which began on October 1, 2025. The fiscal year 2026 rule equates to a net 3.2% increase in Medicare Part A payments to SNFs in fiscal year 2026 compared to 2025 levels. The rule includes a market basket increase of 3.3%, an increase of 0.6% to the market basket forecast error adjustment, and a negative 0.7% productivity adjustment. These figures do not incorporate the SNF Value Based Purchasing (“VBP”) reduction for certain SNFs subject to the net reduction in payments under the SNF VBP; those adjustments are estimated to total $208.4 million in fiscal year 2026.

 

In July 2026, CMS released its final rule outlining fiscal year 2027 Medicare payment rates and policy changes for skilled nursing facilities, which began on October 1, 2026. The fiscal year 2027 proposal equates to a net 2.4% increase in Medicare Part A payments to SNFs in fiscal year 2027 compared to 2026 levels. The rule includes a market basket increase of 3.3% minus a 0.9% productivity adjustment. CMS also finalized its proposals related to the SNF Quality Reporting Program, including the removal of two measures related to COVID-19 vaccination, a shortened data reporting timeline, and the requirement to submit assessment data for all patients regardless of payer.

 

For the first nine months of 2026, our average Medicare per diem rate for skilled nursing facilities increased 2.3% as compared to the same period in 2025. 

 

Medicaid – Skilled Nursing Facilities

 

Effective July 1, 2026 and for the fiscal year 2027, the state of Tennessee implemented specific individual nursing facility increases. We estimate the resulting increase in revenue for the 2027 fiscal year will be approximately $2,000,000 annually, or $500,000 per quarter.

 

Effective October 1, 2026 and for the fiscal year 2027, the state of South Carolina implemented specific individual nursing facility increases. We estimate the resulting increase in revenue for the 2027 fiscal year will be approximately $7,000,000 annually, or $1,750,000 per quarter.

 

For the first nine months of 2026, our average Medicaid per diem increased 2.4% compared to the same period in 2025.

 

State Medicaid plans subject to budget constraints are of particular concern to us. Changes in federal funding coupled with state budget problems and Medicaid expansion under the Affordable Care Act have produced an uncertain environment. Some states will not keep pace with post-acute healthcare inflation. States are currently under pressure to pursue other alternatives to skilled nursing care such as community and home–based services. Medicaid programs are funded jointly by the federal government and the states and are administered by states under approved plans. Most state Medicaid payments are made under a prospective payment system or under programs which negotiate payment levels with individual providers. Some states use, or have applied to use, waivers granted by CMS to implement expansion, impose different eligibility or enrollment restrictions, or otherwise implement programs that vary from federal standards.

 

Medicare – Homecare Programs

 

In November 2025, CMS released its final rule outlining fiscal year 2026 Medicare payment rates. CMS projects payments to home health agencies in fiscal year 2026 will decrease by 1.3% or $220 million, relative to the prior year. This increase reflects a 2.4% home health payment update, reduced by a 0.9% decrease that reflects the final permanent adjustment, an estimated 2.7% decrease that reflects the final temporary adjustment, and a 0.1% decrease that reflects the updated fixed-dollar loss ratio for outlier payments. In addition, CMS is finalizing recalibrated PDGM case-mix weights, updated low-utilization payment adjustment (“LUPA”) thresholds, updated functional impairment levels, and comorbidity adjustment subgroups for 2026.

 

In July 2026, CMS released its proposed rule outlining fiscal year 2027 Medicare payment rates. The proposal includes a 2.4% update, which includes a 3.1% market basket update, reduced by a 1.0% point cut for productivity, as well as an 0.3% increase related to outlier payments. In addition, the agency proposes a temporary cut of 3.0% that it states is necessary to achieve budget-neutral implementation of the Patient-driven Groupings Model. CMS also proposes several policy changes related to provider enrollment provisions that it states would help reduce improper Medicare payments and protect beneficiaries. The provisions would affect any providers and suppliers participating in the Medicare program.

 

33

 

Medicare – Hospice

 

In August 2025, CMS released its final rule outlining fiscal year 2026 Medicare payment rates. CMS issued a rate increase of 2.6%, or $750 million, effective October 1, 2025. This increase results from the proposed 3.3% inpatient hospital market basket percentage increase reduced by a proposed 0.7% point productivity adjustment, required by law. The FY2026 hospice payment update also includes an update to the statutory aggregate cap amount, which limits the overall payments per patient that are made annually. The proposed hospice cap amount for FY2026 is $35,361.

 

In July 2026, CMS released its final rule outlining fiscal year 2027 Medicare payment rates. The final rule includes a 2.3% net increase, which includes a 3.2% market basket update and a 0.9% cut for productivity. The hospice cap would increase to $36,175. Also under the final rule, CMS finalized the fraud-based tool, the service and spending variation index (SSVI), which includes a comprehensive scoring system calculated using nine claims-based measures, each representing a different aspect of hospice utilization as well as nonhospice spending.

 

Segment Reporting

 

The Company has two reportable operating segments: (1) inpatient services, which includes the operation of skilled nursing facilities, assisted and independent living facilities, and behavioral health hospitals; and (2) homecare and hospice services. These reportable operating segments are consistent with information used by the Company’s Chief Executive Officer, as chief operating decision maker (“CODM”), to assess performance and allocate resources. The Company also reports an "all other" category that includes revenues from rental income, management and accounting services fees, insurance services, and costs of the corporate office.

 

The Company’s CODM evaluates performance including pretax earnings and allocates capital resources to each segment based on an operating model that is designed to improve the quality of patient care and profitability of the Company while enhancing long-term shareholder value. The CODM does not review assets by segment in his resource allocation and therefore, assets by segment are not disclosed below.

 

The following table sets forth the Company’s unaudited interim condensed consolidated statements of operations by business segment (in thousands): 

 

   

Three Months Ended September 30, 2026

 
   

Inpatient
Services

   

Homecare

and Hospice

   

All Other

   

Total

 

Revenues:

                               

Net patient revenues

  $ 356,143     $ 41,303     $ -     $ 397,446  

Other revenues

    339       -       10,186       10,525  

Net operating revenues

    356,482       41,303       10,186       407,971  
                                 

Costs and expenses:

                               

Salaries, wages, and benefits

    212,869       24,819       14,249       251,937  

Other operating

    88,492       7,313       3,656       99,461  

Rent

    415       641       309       1,365  

Depreciation and amortization

    12,898       138       1,540       14,576  

Total costs and expenses

    314,674       32,911       19,754       367,339  
                                 

Income/(loss) from operations

    41,808       8,392       (9,568 )     40,632  

Non-operating income

    -       -       3,637       3,637  

Interest expense

    (6,991 )     -       -       (6,991 )

Unrealized losses on marketable equity securities

    -       -       (17,599 )     (17,599 )
                                 

Income/(loss) before income taxes

  $ 34,817     $ 8,392     $ (23,530 )   $ 19,679  

 

   

Three Months Ended September 30, 2025

 
   

Inpatient
Services

   

Homecare

and Hospice

   

All Other

   

Total

 

Revenues:

                               

Net patient revenues

  $ 331,349     $ 39,640     $ -     $ 370,989  

Other revenues

    393       -       11,279       11,672  

Net operating revenues

    331,742       39,640       11,279       382,661  
                                 

Costs and expenses:

                               

Salaries, wages, and benefits

    195,745       23,788       13,643       233,176  

Other operating

    86,745       6,664       3,195       96,604  

Rent

    8,823       601       1,921       11,345  

Depreciation and amortization

    10,219       141       798       11,158  

Total costs and expenses

    301,532       31,194       19,557       352,283  
                                 

Income/(loss) from operations

    30,210       8,446       (8,278 )     30,378  

Non-operating income

    -       -       4,660       4,660  

Interest expense

    (1,456 )     -       -       (1,456 )

Unrealized gains on marketable equity securities

    -       -       20,827       20,827  
                                 

Income before income taxes

  $ 28,754     $ 8,446     $ 17,209     $ 54,409  

 

34

 

   

Nine Months Ended September 30, 2026

 
   

Inpatient
Services

   

Homecare

and Hospice

   

All Other

   

Total

 

Revenues:

                               

Net patient revenues

  $ 1,023,778     $ 121,832     $ -     $ 1,145,610  

Other revenues

    1,086       -       51,121       52,207  

Net operating revenues

    1,024,864       121,832       51,121       1,197,817  
                                 

Costs and expenses:

                               

Salaries, wages, and benefits

    612,759       74,303       41,851       728,913  

Other operating

    252,473       21,099       11,601       285,173  

Rent

    18,436       1,892       4,220       24,548  

Depreciation and amortization

    33,575       399       3,389       37,363  

Total costs and expenses

    917,243       97,693       61,061       1,075,997  
                                 

Income/(loss) from operations

    107,621       24,139       (9,940 )     121,820  

Non-operating income

    -       -       11,566       11,566  

Interest expense

    (7,273 )     -       -       (7,273 )

Unrealized losses on marketable equity securities

    -       -       (7,610 )     (7,610 )
                                 

Income/(loss) before income taxes

  $ 100,348     $ 24,139     $ (5,984 )   $ 118,503  

 

   

Nine Months Ended September 30, 2025

 
   

Inpatient
Services

   

Homecare

and Hospice

   

All Other

   

Total

 

Revenues:

                               

Net patient revenues

  $ 981,838     $ 114,107     $ -     $ 1,095,945  

Other revenues

    1,197       -       34,126       35,323  

Net operating revenues

    983,035       114,107       34,126       1,131,268  
                                 

Costs and expenses:

                               

Salaries, wages, and benefits

    578,824       69,375       39,641       687,840  

Other operating

    252,064       20,969       7,971       281,004  

Rent

    26,486       1,790       5,762       34,038  

Depreciation and amortization

    30,380       402       2,369       33,151  

Total costs and expenses

    887,754       92,536       55,743       1,036,033  
                                 

Income/(loss) from operations

    95,281       21,571       (21,617 )     95,235  

Non-operating income

    -       -       13,871       13,871  

Interest expense

    (5,555 )     -       -       (5,555 )

Unrealized gains on marketable equity securities

    -       -       26,748       26,748  
                                 

Income before income taxes

  $ 89,726     $ 21,571     $ 19,002     $ 130,299  

 

35

 

Results of Operations

 

The following table and discussion set forth items from the interim condensed consolidated statements of operations as a percentage of net operating revenues for the three and nine months ended September 30, 2026 and 2025.

 

Percentage of Net Operating Revenues

 

   

Three Months Ended
September 30

   

Nine Months Ended

September 30

 
   

2026

   

2025

   

2026

   

2025

 

Net operating revenues

    100.0 %     100.0 %     100.0 %     100.0 %

Costs and expenses:

                               

Salaries, wages, and benefits

    61.8       60.9       60.9       60.8  

Other operating

    24.5       25.2       23.8       24.8  

Facility rent

    0.3       3.0       2.0       3.0  

Depreciation and amortization

    3.5       3.0       3.1       2.9  

Total costs and expenses

    90.1       92.1       89.8       91.5  

Income from operations

    9.9       7.9       10.2       8.5  

Non–operating income

    0.9       1.2       1.0       1.2  

Interest expense

    (1.7 )     (0.4 )     (0.7 )     (0.5 )

Unrealized gains/(losses) on marketable equity securities

    (4.3 )     5.5       (0.6 )     2.4  

Income before income taxes

    4.8       14.2       9.9       11.6  

Income tax provision

    (1.3 )     (3.5 )     (2.3 )     (3.0 )

Net income

    3.5       10.7       7.6       8.6  

Net income attributable to noncontrolling interest

    (0.1 )     (0.4 )     (0.1 )     (0.2 )

Net income attributable to stockholders of NHC

    3.4       10.3       7.5       8.4  

 

Three Months Ended September 30, 2026 Compared to Three Months Ended September 30, 2025

 

Results for the quarter ended September 30, 2026 compared to the third quarter of 2025 include an 6.6% increase in net operating revenues. For the quarter ended September 30, 2026, GAAP net income attributable to NHC was $13,637,000 compared to net income of $39,239,000 for the same period in 2025. Excluding the unrealized gains and losses in our marketable equity securities portfolio and other non-GAAP adjustments, adjusted net income for the quarter ended September 30, 2026 was $28,154,000 compared to $24,744,000 for the same period in 2025, an increase of 13.8%. 

 

The increase in adjusted net income for the quarter ended September 30, 2026 was primarily driven by the June 1, 2026 acquisition of the five skilled nursing facilities and the July 1, 2026 acquisition of the real estate of thirty-two skilled nursing facilities and three independent living facilities from NHI. 

 

Net operating revenues

 

Net patient revenues increased $26,457,000, or 7.1%, compared to the same period last year.

 

The total census at owned and leased skilled nursing facilities for the quarter averaged 90.4%, compared to an average of 90.0% for the same quarter a year ago. Overall, the composite skilled nursing facility per diem increased 5.0% compared to the same quarter a year ago. Our Medicare and Managed Care per diem rates increased 1.7% and 20.1%, respectively, compared to the same quarter a year ago. Medicaid and private pay per diem rates increased 2.3% and 5.5%, respectively, compared to the same quarter a year ago. For the three months ended September 30, 2026 and 2025, respectively, $0 and $1,838,000 have been included in our net patient revenues for supplemental Medicaid payments from the state of Tennessee. 

 

The operations of the five skilled nursing facilities that we acquired from National attributed to an increase of $19,278,000 in net patient revenues for the quarter ended September 30, 2026 compared to the same period in 2025.

 

Other revenues decreased $1,147,000, or 9.8%, compared to the same quarter last year, as further detailed in Note 5 to our interim condensed consolidated financial statements.

 

36

 

Total costs and expenses

 

Total costs and expenses for the three months ended September 30, 2026 compared to the same period of 2025 increased $15,056,000, or 4.3% to $367,339,000 from $352,283,000.

 

Salaries, wages, and benefits increased $18,761,000, or 8.0%, to $251,937,000 from $233,176,000. Salaries, wages, and benefits as a percentage of net operating revenues was 61.8% compared to 60.9% for the three months ended September 30, 2026 and 2025, respectively. 

 

The operations of the five skilled nursing facilities that we acquired from National attributed to an increase of $10,901,000 in salaries, wages, and benefits for the quarter ended September 30, 2026 compared to the same period in 2025.

 

Other operating expenses increased $2,857,000, or 3.0%, to $99,461,000 for the 2026 period compared to $96,604,000 for the 2025 period. Other operating expenses as a percentage of net operating revenues was 24.4% and 25.2% for the three months ended September 30, 2026 and 2025, respectively. The operations of the five skilled nursing facilities that we acquired from National attributed to an increase of $5,193,000 for the quarter ended September 30, 2026 compared to the same period in 2025.

 

Facility rent expense decreased $9,980,000 for the third quarter of 2026 compared to the prior year period.  The rent decrease is due from the July 1, 2026 acquisition of the thirty-five real estate assets from NHI.  Upon the July 1, 2026 acquisition, our lease agreement with NHI was terminated.  The July 1, 2026 acquisition of the thirty-five real estate assets was also the primary driver of depreciation expense increasing for the third quarter of 2026 compared to the prior year period.   

 

Other income

 

Non–operating income decreased by $1,023,000 compared to the same period last year, as further detailed in Note 6 to our interim condensed consolidated financial statements. The primary driver of the decrease in non-operating income are losses at the multi-family development in Franklin, Tennessee.  The multi-family development is opening the apartment buildings in phases and we are currently in the lease-up phase.  We have incurred losses of $743,000 during the third quarter of 2026 related to this development.  

 

Income taxes

 

The income tax provision for the three months ended September 30, 2026 is $5,498,000 (an effective income tax rate of 27.9%). 

 

Noncontrolling interest

 

The noncontrolling interest in subsidiaries is presented within total equity of the Company’s consolidated balance sheets. The Company presents the noncontrolling interest and the amount of consolidated net income attributable to NHC in its consolidated statements of operations. The Company’s earnings per share is calculated based on net income attributable to NHC’s stockholders. The carrying amount of the noncontrolling interest is adjusted based on an allocation of subsidiary earnings based on ownership interest.

 

Nine Months Ended September 30, 2026 Compared to Nine Months Ended September 30, 2025

 

Results for the nine months ended September 30, 2026 compared to the same period of 2025 include a 5.9% increase in net operating revenues. For the nine months ended September 30, 2026, GAAP net income attributable to NHC was $89,813,000 compared to net income of $95,166,000 for the same period in 2025. Excluding the unrealized gains and losses in our marketable equity securities portfolio and other non-GAAP adjustments, adjusted net income for the nine months ended September 30, 2026 was $85,795,000 compared to $75,293,000 for the same period in 2025, an increase of 13.9%. 

 

The increase in adjusted net income for the nine months ended September 30, 2026 was driven by our same-facility operations continuing to perform well, along with the June 1, 2026 acquisition of the five skilled nursing facilities and the July 1, 2026 acquisition of the real estate of thirty-two skilled nursing facilities and three independent living facilities from NHI.

 

37

 

Net operating revenues

 

Net patient revenues increased $49,665,000, or 4.5%, compared to the same period last year.

 

The total census at owned and leased skilled nursing facilities for the nine months ended September 30, 2026 averaged 90.1%, compared to an average of 89.6% for the same period a year ago. Overall, the composite skilled nursing facility per diem increased 3.2% compared to the same period a year ago. Our Medicare per diem rates increased 2.3% and managed care per diem rates increased 8.1% compared to the same period a year ago. Medicaid and private pay per diem rates increased 2.4% and 4.1%, respectively, compared to the same period a year ago. For the nine months ended September 30, 2026 and 2025, $3,605,000 and $5,522,000, respectively, have been included in our net patient revenues for supplemental Medicaid payments.

 

The operations of the five skilled nursing facilities that we acquired from National attributed to an increase of $25,277,000 in net patient revenues for the nine months ended September 30, 2026 compared to the same period in 2025.

 

Other revenues increased $16,884,000, or 47.8%, compared to the same period last year, as further detailed in Note 5 to our interim condensed consolidated financial statements. During the second quarter of 2026, we recognized management fees of $18,325,000 previously earned for management services prior to 2025, but these management fees were not previously recognized as such revenues. These revenues did not previously meet the recognition criteria of ASC Topic 606, Revenue from Contracts with Customers, because the underlying consideration was constrained. Upon the acquisition of the five skilled nursing facilities from National on June 1, 2026, the revenue recognition criteria was met and the management fees were paid and recognized in the current period.

 

Total costs and expenses

 

Total costs and expenses for the nine months ended September 30, 2026 compared to the same period of 2025 increased $39,964,000, or 3.9% to $1,075,997,000 from $1,036,033,000.

 

Salaries, wages, and benefits increased $41,073,000, or 6.0%, to $728,913,000 from $687,840,000. Salaries, wages, and benefits as a percentage of net operating revenues was 60.9% compared to 60.8% for the nine months ended September 30, 2026 and 2025, respectively. The operations of the five skilled nursing facilities that we acquired from National attributed to an increase of $14,632,000 in salaries, wages, and benefits for the nine months ended September 30, 2026 compared to the same period in 2025.

 

Other operating expenses increased $4,169,000, or 1.5%, to $285,173,000 for the 2026 period compared to $281,004,000 for the 2025 period. Other operating expenses as a percentage of net operating revenues was 23.8% and 24.8% for the nine months ended September 30, 2026 and 2025, respectively. The operations of the five skilled nursing facilities that we acquired from National attributed to an increase of $6,681,000 for the nine months ended September 30, 2026 compared to the same period in 2025.

 

During the second quarter of 2025, we contributed land to a newly-formed limited liability company resulting in an equity interest in the new entity. The fair value of the land contributed to the new entity was $5,625,000. The related cost basis of the contributed land was $2,019,000, which resulted in a gain of $3,606,000. This gain was netted with other operating expenses resulting in a decrease of $3,606,000 in other operating expenses in the prior year period.

 

Facility rent expense decreased $9,490,000 for the nine months ended September 30, 2026 compared to the prior year period.  The rent decrease is due from the July 1, 2026 acquisition of the thirty-five real estate assets from NHI.  Upon the July 1, 2026 acquisition, our lease agreement with NHI was terminated.  The July 1, 2026 acquisition of the thirty-five real estate assets was also the primary driver of depreciation expense increasing in 2026 compared to the prior year period.   

 

Other income

 

Non–operating income decreased by $2,305,000 compared to the same period last year, as further detailed in Note 6 to our interim condensed consolidated financial statements. The primary driver of the decrease in non-operating income are losses at the multi-family development in Franklin, Tennessee.  The multi-family development is opening the apartment buildings in phases and we are currently in the lease-up phase.  For the nine months ending September 30, 2026, we have incurred losses of $1,678,000 related to this development.  

 

Income taxes

 

The income tax provision for the nine months ended September 30, 2026 is $27,682,000 (an effective income tax rate of 23.4%). 

 

38

 

Non-GAAP Financial Presentation

 

The Company is providing certain non-GAAP financial measures as the Company believes that these figures are helpful in allowing investors to more accurately assess the ongoing nature of the Company’s operations and measure the Company’s performance more consistently across periods. Therefore, the Company believes this information is meaningful in addition to the information contained in the GAAP presentation of financial information. The presentation of this additional non-GAAP financial information is not intended to be considered in isolation or as a substitute for the financial information prepared and presented in accordance with GAAP.

 

The tables below provide reconciliations of GAAP to non-GAAP items (dollars in thousands, except per share data):

 

   

Three Months Ended

September 30

   

Nine Months Ended

September 30

 
   

2026

   

2025

   

2026

   

2025

 
                                 

Net income attributable to National Healthcare Corporation

  $ 13,637     $ 39,239     $ 89,813     $ 95,166  

Non-GAAP adjustments:

                               

Unrealized (gains)/losses on marketable equity securities

    17,599       (20,827 )     7,610       (26,748 )

Share-based compensation expense

    2,019       1,239       5,285       3,499  

National management fee revenue from prior periods

    -       -       (18,325 )     -  

Gain on sale of property and equipment

    -       -       -       (3,606 )

Income tax expense/(benefit) on non-GAAP adjustments

    (5,101 )     5,093       1,412       6,982  

Non-GAAP Net income

  $ 28,154     $ 24,744     $ 85,795     $ 75,293  
                                 
                                 

GAAP diluted earnings per share

  $ 0.85     $ 2.50     $ 5.66     $ 6.10  

Non-GAAP adjustments:

                               

Unrealized (gains)/losses on marketable equity securities

    1.10       (1.33 )     0.48       (1.71 )

Share-based compensation expense

    0.13       0.08       0.33       0.22  

National management fee revenue from prior periods

    -       -       (1.15 )     -  

Gain on sale of property and equipment

    -       -       -       (0.23 )

Income tax expense/(benefit) on non-GAAP adjustments

    (0.32 )     0.33       0.09       0.45  

Non-GAAP diluted earnings per share

  $ 1.76     $ 1.58     $ 5.41     $ 4.83  

 

39

 

Liquidity, Capital Resources, and Financial Condition

 

Our primary sources of cash include revenues from the operations of our healthcare and senior living facilities, management and accounting services, rental income, and investment income. Our primary uses of cash include salaries, wages and other operating costs of our healthcare and senior living facilities, the cost of additions to and acquisitions of real property, facility rent expenses, long-term debt payments, and dividend distributions. These sources and uses of cash are reflected in our interim condensed consolidated statements of cash flows and are discussed in further detail below.

 

The following is a summary of our sources and uses of cash flows (dollars in thousands):

 

   

Nine Months Ended

September 30

   

Nine Month Change

 
   

2026

   

2025

   

$

   

%

 

Cash, cash equivalents, restricted cash, and restricted cash equivalents, at beginning of period

  $ 112,187     $ 96,922     $ 15,265       15.7 %
                                 

Cash provided by operating activities

    204,953       168,271       36,682       21.8  
                                 

Cash used in investing activities

    (658,448 )     (20,924 )     (637,524 )     (3,046.9 )
                                 

Cash provided by/(used in) financing activities

    427,629       (92,735 )     520,364       561.1  
                                 

Cash, cash equivalents, restricted cash, and restricted cash equivalents, at end of period

  $ 86,321     $ 151,534     $ (65,213 )     (43.0 )%

 

Operating Activities

 

Net cash provided by operating activities for the nine months ended September 30, 2026 was $204,953,000 as compared to $168,271,000 in the same period last year. Cash provided by operating activities consisted of net income of $90,821,000 and adjustments for non–cash items of $50,305,000. There was cash provided by working capital in the amount of $64,038,000 and $62,731,000 for the nine months ended September 30, 2026 and 2025, respectively. 

 

Included in the adjustments for non-cash items are depreciation expense, equity in earnings of unconsolidated investments, unrealized gains on our marketable equity securities, gain on sale of property and equipment, deferred taxes, and stock compensation. 

 

Investing Activities

 

Net cash used in investing activities totaled $658,448,000 for the nine months ended September 30, 2026, compared to $20,924,000 for the nine months ended September 30, 2025. During 2026, the Company acquired five skilled nursing centers from National for $52,198,000, acquired thirty-two skilled nursing facilities and three independent living facilities from NHI for $564,340,000, and also purchased land in Mount Juliet, Tennessee for $2,500,000.   

 

Cash used for property and equipment additions was $35,654,000 and $26,049,000 for the nine months ended September 30, 2026, and 2025, respectively. The increase in property additions in 2026 was primarily due to the continued development and construction of an assisted living and memory care facility in Tullahoma, Tennessee. For the nine months ended September 30, 2026, we contributed capital of $6,983,000 for one of the joint venture, multi-family developments that is under construction in Nashville, Tennessee compared to $3,123,000 for the same period in the prior year. Proceeds from the sale of marketable securities, net of purchases, resulted in cash provided by investing activities of $4,227,000 and $7,736,000 for the nine months ended September 30, 2026 and 2025, respectively.

 

Financing Activities 

 

Net cash provided by financing activities totaled $427,629,000 for the nine months ended September 30, 2026 compared to net cash used in financing activities of $92,735,000 for the nine months ended September 30, 2025. The funding for the NHI acquisition was provided by the Company’s cash on hand and borrowings of $530,000,000. During 2026, cash of $67,937,000 was used to pay down the outstanding principal balance of the long-term debt compared to $63,875,000 for the same period in the prior year. Cash used for dividend payments to common stockholders totaled $30,423,000 and $28,773,000 for the nine months ended September 30, 2026 and 2025, respectively. Proceeds from the issuance of common stock totaled $20,766,000 and $9,415,000 for the nine months ended September 30, 2026 and 2025, respectively. We repurchased common shares outstanding in the amount of $24,672,000 and $9,566,000 for the nine months ended September 30, 2026 and 2025, respectively.  The repurchased common shares were all from employee stock option exercises and were not from repurchases on the open market. 

 

40

 

Short–term liquidity

 

We expect to meet our short-term liquidity requirements primarily from our cash flows from operating activities. In addition to cash flows from operations, we have current cash on hand of $66,795,000 and unrestricted marketable equity securities of $154,530,000. We also have unencumbered real estate and the borrowing capacity on our available line of credit. We believe these various resources are adequate to meet our contractual obligations and growth and development plans in the next twelve months.

 

Long–term liquidity

 

We expect to meet our long-term liquidity requirements primarily from our cash flows from operating activities, our current cash on hand of $66,795,000, our unrestricted marketable equity securities of $154,530,000, and our borrowing capacity on our available line of credit. We also have substantial value in our unencumbered real estate assets, which could potentially be used as collateral in future borrowing opportunities.

 

Our ability to meet our long–term contractual obligations, and to finance our operating requirements and growth plans will depend upon our future performance. Our future performance will be affected by business, economic, financial and other factors, including potential changes in state and federal government payment rates for healthcare, customer demand, success of our marketing efforts, pressures from competitors, and the state of the economy, including the state of financial and credit markets, as well as many unforeseen factors.

.

Commitment and Contingencies

 

Governmental Regulations

 

Laws and regulations governing Medicare, Medicaid and other federal healthcare programs are complex and subject to interpretation. Management believes that it is following all applicable laws and regulations in all material respects. However, compliance with such laws and regulations can be subject to future government review and interpretation as well as significant regulatory action including fines, penalties, and exclusions from the Medicare, Medicaid, and other federal healthcare programs.

 

Item 3.

Quantitative and Qualitative Disclosures About Market Risk.

 

Market risk represents the potential economic loss arising from adverse changes in the fair value of financial instruments. Currently, our exposure to market risk relates primarily to our fixed–income and equity portfolios. These investment portfolios are exposed primarily to, but not limited to, interest rate risk, credit risk, equity price risk, and concentration risk. We also have exposure to market risk that includes our cash and cash equivalents. The Company's senior management has established comprehensive risk management policies and procedures to manage these market risks.

 

Interest Rate Risk

 

The fair values of our fixed–income investments fluctuate in response to changes in market interest rates. Increases and decreases in prevailing interest rates generally translate into decreases and increases, respectively, in the fair values of those instruments. Additionally, the fair values of interest rate sensitive instruments may be affected by the creditworthiness of the issuer, prepayment options, the liquidity of the instrument and other general market conditions. At September 30, 2026, we have available for sale marketable debt securities in the amount of $114,195,000. The fixed maturity portfolio is comprised of investments with primarily short–term and intermediate–term maturities. The fixed maturity portfolio allows our insurance company subsidiaries to achieve an adequate risk–adjusted return while maintaining sufficient liquidity to meet obligations.

 

Our cash and cash equivalents consist of highly liquid investments with a maturity of less than three months when purchased. As a result of the short–term nature of our cash instruments, a hypothetical 1% change in interest rates would have minimal impact on our future earnings and cash flows related to these instruments.

 

Our credit facility and term loan facility expose us to variability in interest payments due to changes in Secured Overnight Financing Rate ("SOFR") interest rates.  We manage our exposure to this interest rate risk by monitoring available financing alternatives. 

 

We do not currently use any derivative instruments to hedge our interest rate exposure. We have not used derivative instruments for trading purposes and the use of such instruments in the future would be subject to approvals by the Investment Committee of the Board of Directors.

 

Credit Risk

 

Credit risk is managed by diversifying the fixed maturity portfolio to avoid concentrations in any single industry group or issuer and by limiting investments in securities with lower credit ratings.

 

41

 

Equity Price and Concentration Risk

 

Our marketable equity securities are recorded at their fair market value based on quoted market prices. Thus, there is exposure to equity price risk, which is the potential change in fair value due to a change in quoted market prices. At September 30, 2026, the fair value of our marketable equity securities is approximately $173,683,000. Of the $173.7 million equity securities portfolio, our investment in NHI comprises approximately $107.0 million, or 61.6%, of the total fair value. We manage our exposure to NHI by closely monitoring the financial condition, performance, and outlook of the company. Hypothetically, a 10% change in quoted market prices would result in a related increase or decrease in the fair value of our equity investments of approximately $17.4 million. At September 30, 2026, our equity securities had net unrealized gains of $129.3 million. Of the $129.3 million of net unrealized gains, $82.3 million is related to our investment in NHI.

 

Item 4.

Controls and Procedures.

 

As of September 30, 2026, an evaluation was performed under the supervision and with the participation of the Company’s management, including the Chief Executive Officer (“CEO”) and Chief Financial Officer (“CFO”), of the effectiveness of the design and operation of the Company’s disclosure controls and procedures. Based on that evaluation, the Company’s management, including the CEO and CFO, concluded that the Company’s disclosure controls and procedures were effective as of September 30, 2026.

 

During the period covered by this report, there have been no changes in our internal control over financial reporting that have materially affected or are reasonably likely to materially affect our internal control over financial reporting.

 

 

 

PART II. OTHER INFORMATION

 

Item 1.

Legal Proceedings.

 

For a discussion of prior, current, and pending litigation of material significance to NHC, please see Note 17 to Interim Condensed Consolidated Financial Statements included in this Form 10-Q.

 

Item 1A.

Risk Factors.

 

During the nine months ended September 30, 2026, there were no material changes to the risk factors that were disclosed in Item 1A of National HealthCare Corporation’s Annual Report on Form 10-K for the year ended December 31, 2025.

 

Item 2.

Unregistered Sales of Equity Securities and Use of Proceeds.

 

Not applicable

 

Item 3.

Defaults Upon Senior Securities.

 

None

 

Item 4.

Mine Safety Disclosures.

 

Not applicable

 

 

Item 5.

Other Information.

 

None

 

42

  
 

Item 6.

Exhibits. 

 

 

(a)

List of exhibits

 

EXHIBIT INDEX

 

Exhibit

No.

 

Description

     

3.1.1

 

Certificate of Incorporation of National HealthCare Corporation (Incorporated by reference to Exhibit 3.1 to the Registrant’s registration statement on Form S-4 (File No. 333-37185) dated October 3, 1997.)

     

3.1.2

 

Certificate of Amendment to the Certificate of Incorporation of National HealthCare Corporation (Incorporated by reference to Exhibit 3.5 to the quarterly report on Form 10-Q filed on August 3, 2017.)

     

3.4

 

Restated Bylaws as amended February 14, 2013 (Incorporated by reference to Exhibit 3.5 to the quarterly report on Form 10-Q filed on May 8, 2013.)

     

4.1

 

Form of Common Stock (Incorporated by reference to Exhibit 4.1 to the quarterly report on Form 10-Q filed on August 3, 2017.)

     

10.1

 

Purchase and Sale Agreement dated May 14, 2026 between NHC/OP, L.P., a wholly owned subsidiary of NHC, and National Health Corporation (Incorporated by reference to Exhibit 10.1 to the quarterly report on Form 10-Q filed on August 6, 2026).

     

10.2

 

Purchase and Sale Agreement dated April 21, 2026 between NHC/OP, L.P., a wholly owned subsidiary of NHC, and National Health Investors, Inc. (Incorporated by reference to Exhibit 10.1 to the quarterly report on Form 10-Q filed on August 6, 2026).

     

31.1

 

Rule 13a-14(a)/15d-14(a) Certification of Chief Executive Officer

     

31.2

 

Rule 13a-14(a)/15d-14(a) Certification of Chief Financial Officer

     

32

 

Certification pursuant to 18 U.S.C. Section 1350 by Chief Executive Officer and Chief Financial Officer

     

101.INS

 

Inline XBRL Instance Document (the instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document)

     

101.SCH

 

Inline XBRL Taxonomy Extension Schema Document

     

101.CAL

 

Inline XBRL Taxonomy Extension Calculation Linkbase Document

     

101.DEF

 

Inline XBRL Taxonomy Extension Definition Linkbase Document

     

101.LAB

 

Inline XBRL Taxonomy Extension Label Linkbase Document

     

101.PRE

 

Inline XBRL Taxonomy Extension Presentation Linkbase Document

     

104

 

Cover Page Interactive File (embedded within the Inline XBRL document and include in Exhibit 101)

 

43

 

SIGNATURES

 

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

 

 

NATIONAL HEALTHCARE CORPORATION

 

(Registrant)

 
     

Date: November 5, 2026

/s/ Stephen F. Flatt

 
 

Stephen F. Flatt

 
 

Chief Executive Officer

 
     
     

Date: November 5, 2026

/s/ Brian F. Kidd

 
 

Brian F. Kidd

 
 

Senior Vice President and Chief Financial Officer

 

 

44

ATTACHMENTS / EXHIBITS

ATTACHMENTS / EXHIBITS

EXHIBIT 31.1

EXHIBIT 31.2

EXHIBIT 32

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