Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
	Dec. 31, 2016	Dec. 31, 2015	Dec. 31, 2014
Cash Flows From Operating Activities:
Net Income	$ 50,538,000	$ 53,143,000	$ 53,369,000
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	39,023,000	37,114,000	34,384,000
Provision for Doubtful Accounts	5,967,000	6,583,000	6,228,000
Equity in earnings of unconsolidated investments	(6,636,000)	(5,845,000)	(6,675,000)
Distributions from unconsolidated investments	8,059,000	6,505,000	10,288,000
Gains on sale of marketable securities	(816,000)	(566,000)	(379,000)
Deferred income taxes	4,791,000	(648,000)	(1,434,000)
Stock–based compensation	509,000	1,982,000	2,021,000
Changes in operating assets and liabilities, net of the effect of acquisitions:
Accounts receivable	(4,403,000)	(11,835,000)	(5,215,000)
Income tax receivable	(1,462,000)	1,524,000	(4,727,000)
Inventories	60,000	(441,000)	19,000
Prepaid expenses and other assets	(477,000)	89,000	(2,587,000)
Trade accounts payable	(1,535,000)	4,251,000	2,827,000
Accrued payroll	574,000	5,479,000	(3,603,000)
Amounts due to third party payors	365,000	(6,277,000)	1,312,000
Other current liabilities and accrued risk reserves	(3,526,000)	(7,455,000)	(5,652,000)
Obligation to provide future services	(204,000)	(487,000)	238,000
Other noncurrent liabilities	8,000	283,000	1,486,000
Deferred revenue	47,000	(44,000)	39,000
Net cash provided by operating activities	90,882,000	83,355,000	81,939,000
Cash Flows From Investing Activities:
Additions to property and equipment	(62,601,000)	(58,416,000)	(53,298,000)
Investments in unconsolidated companies	(1,282,000)	(674,000)	(1,975,000)
Acquisition of non–controlling interest			(768,000)
Investments in notes receivable	(5,251,000)	(5,676,000)	(767,000)
Collections of notes receivable	1,636,000	4,948,000	3,156,000
Purchases of marketable securities	(48,620,000)	(60,540,000)	(62,165,000)
Sale of marketable securities	34,642,000	47,574,000	48,786,000
Net cash used in investing activities	(81,476,000)	(72,784,000)	(67,031,000)
Cash Flows From Financing Activities:
Borrowings under credit facility		110,000,000
Redemption of preferred shareholders		(130,538,000)
Principal payments under capital lease obligations	(3,278,000)	(3,089,000)	(2,436,000)
Dividends paid to preferred stockholders		(8,986,000)	(8,670,000)
Dividends paid to common stockholders	(25,795,000)	(21,089,000)	(18,704,000)
Issuance of common shares	10,772,000	10,634,000	7,429,000
Repurchase of common shares	(8,195,000)		(6,995,000)
Tax (expense) benefit from exercise of stock options	(1,096,000)	1,942,000	201,000
Debt issuance costs		(601,000)
Entrance fee deposits (refunds)	59,000	(354,000)	(501,000)
Change in deposits	402,000	406,000	(448,000)
Net cash used in financing activities	(27,131,000)	(41,675,000)	(30,124,000)
Net Decrease in Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents	(17,725,000)	(31,104,000)	(15,216,000)
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, Beginning of Period	49,314,000	80,418,000	95,634,000
Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents, End of Period	31,589,000	49,314,000	80,418,000
Balance Sheet Classifications:
Total Cash, Cash Equivalents, Restricted Cash, and Restricted Cash Equivalents	49,314,000	49,314,000	80,418,000
Supplemental Information:
Cash payments for interest	4,528,000	2,965,000	2,242,000
Cash payments for income taxes	27,668,000	29,183,000	36,642,000
Non–cash financing and investing activities include:
Buildings, personal property, and obligations recorded under capital lease agreements			$ 39,032,000