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Note 2 - Summary of Significant Accounting Policies
3 Months Ended
Mar. 31, 2019
Notes to Financial Statements  
Significant Accounting Policies [Text Block]
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 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, 2018
consolidated financial statements and notes thereto which contain accounting policies and other disclosures required by GAAP. Our audited
December 31, 2018
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, 2018
consolidated financial statements and Management’s Discussion and Analysis of Financial Condition and Results of Operations 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.
 
Recently Adopted Accounting Guidance
 
In
February 2016,
the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”)
No.
2016
-
02,
"Leases (Topic
842
)." The objective of this update is to increase transparency and comparability among organizations by recognizing lease assets and lease liabilities on the balance sheet and disclosing key information about leasing arrangements. This ASU is effective for fiscal years beginning after
December 15, 2018,
including interim periods within those annual periods and is to be applied either retrospectively to each prior reporting period presented in the financial statements or retrospectively at the beginning of the period of adoption.
 
The Company adopted the standard as of
January 1, 2019,
electing the transition method that allows it to apply the standard as of the adoption date and record a cumulative adjustment in retained earnings, if applicable. We did
not
have a cumulative adjustment to retained earnings. The interim condensed consolidated financial statements for the period ending
March 31, 2019,
are presented under the new standard, while comparative years presented are
not
adjusted and continue to be reported in accordance with our historical accounting policy.
 
On
June 20, 2018,
the FASB issued ASU
No.
2018
-
07,
“Compensation – Stock Compensation (Topic
718
): Improvements to Nonemployee Share-based Payment Accounting.” ASU
No.
2018
-
07
simplifies the accounting for share-based payments granted to nonemployees for goods and services. Under the ASU, most of the guidance on such payments to nonemployees is aligned with the requirements for share-based payments granted to employees. On
January 1, 2019,
the Company early adopted the provisions of ASU
No.
2018
-
07
and this standard did
not
have an impact on our consolidated financial statements.
 
On
August 28, 2018,
the FASB issued ASU
No.
2018
-
13,
“Fair Value Measurement (Topic
820
): Disclosure Framework – Changes to the Disclosure Requirements for Fair Value Measurement.” ASU
No.
2018
-
13
changes the fair value measurement disclosure requirements of Accounting Standards Codification (“ASC”)
820.
Entities are
no
longer required to disclose the amount of and reasons for transfers between Level
1
and Level
2
of the fair value hierarchy, but they will be required to disclose the range and weighted average used to develop significant unobservable inputs for Level
3
fair value measurements. On
January 1, 2019,
the Company early adopted the provisions of ASU
No.
2018
-
13
and this standard did
not
have a material impact on our consolidated financial statements.
 
Recent Accounting Guidance
Not
Yet Adopted
 
     
In
June 2016,
the FASB issued ASU
No.
2016
-
13,
“Financial Instruments – Credit Losses: Measurement of Credit Losses on Financial Instruments.” ASU
No.
2016
-
13
adds to U.S. GAAP an impairment model that is based on expected losses rather than incurred losses. Under the new guidance, an entity recognizes as an allowance its estimate of expected credit losses, which the FASB believes will result in more timely recognition of such losses. The ASU is also intended to reduce the complexity of U.S. GAAP by decreasing the number of credit impairment models that entities use to account for debt instruments. This ASU is effective for fiscal years beginning after
December 15, 2019,
including interim periods within those annual periods, with early adoption permitted for fiscal years beginning after
December 15, 2018.
We are currently evaluating the impact this standard will have on our policies and procedures and internal control framework.
 
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, and home health care 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.
 
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.
 
The Company determines the transaction price based on established billing rates reduced by contractual adjustments provided to
third
party payors. Contractual adjustments are based on contractual agreements and historical experience. The Company considers the patient's ability and intent to pay the amount of consideration upon admission. Subsequent changes resulting from a patient’s ability to pay are recorded as bad debt expense, which is included as a component of other operating expenses in the interim condensed consolidated statements of operations. Bad debt expense was
$1,047,000
and
$959,000
for the
three
months ended
March 31, 2019
and
2018,
respectively. As of
March 31, 2019,
and
December 31, 2018,
the Company has recorded allowance for doubtful accounts of
$5,169,000
and
$4,610,000,
respectively, as our best estimate of probable losses inherent in the accounts receivable balance.
 
Other Revenues
 
Other revenues include revenues from the provision of insurance services, management and accounting services to other long–term care providers, and rental income. Our insurance revenues consist of premiums that are generally paid in advance and then amortized into income over the policy period. We charge for management services based on a percentage of net revenues. We charge for accounting services based on a monthly fee or a fixed fee per bed of the healthcare center under contract. We record other revenues as the performance obligations are satisfied based on the terms of our contractual arrangements.
 
Segment Reporting
 
In accordance with the provisions of 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
one
behavioral health hospital, and (
2
) homecare 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
6
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.
 
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
$5,144,000
and
$6,678,000
for the
three
months ended
March 31, 2019
and
2018,
respectively.
 
Property and Equipment
 
Property and equipment are recorded at cost. Depreciation is provided by the straight-line method over the expected useful lives of the assets estimated as follows: buildings and improvements,
20
-
40
years and equipment and furniture,
3
-
15
years. Leasehold improvements are amortized over periods that do
not
exceed the non-cancelable respective lease terms using the straight-line method.
 
Finance leases are recorded at cost. Finance leases are amortized in accordance with the provision codified within ASC
842,
Leases
. Amortization of finance lease assets is included in depreciation and amortization expense.
 
Accrued Risk Reserves
  
 
We are self–insured for risks related to health insurance and have wholly–owned limited purpose insurance companies that insure risks related to workers’ compensation and general and professional liability insurance claims. 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. As of
March 31, 2019,
we and/or our managed centers are defendants in
63
such claims. It remains possible that those pending matters plus potential unasserted claims could exceed our reserves, which could have a material adverse effect on our consolidated financial position, results of operations and cash flows. It is also possible that future events could cause us to make significant adjustments or revisions to these reserve estimates and cause our reported net income to vary significantly from period to period.
 
We are principally self-insured for incidents occurring in all centers owned or leased by us. The coverages include both primary policies and excess policies. In all years, settlements, if any, in excess of available insurance policy limits and our own reserves would be expensed by us.
 
Continuing Care Contracts and Refundable Entrance Fee
 
We have
one
continuing care retirement center (“CCRC”) within our operations. Residents at this retirement center
may
enter into continuing care contracts with us. The contracts provide that
10%
of the resident entry fee becomes non-refundable upon occupancy, and the remaining refundable portion of the entry fee is calculated using the lessor of the price at which the apartment is re-assigned or
90%
of the original entry fee, plus
40%
of any appreciation if the apartment exceeds the original resident’s entry fee.
 
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 non-current liabilities in our consolidated balance sheets. As of
March 31, 2019,
and
December 31, 2018,
we have recorded a refundable entrance fee in the amount of
$8,078,000.
 
Obligation to Provide Future Services
 
We 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 (obligation to provide future services) with a corresponding charge to income. As of
March 31, 2019,
and
December 31, 2018,
we have recorded a future service obligation in the amount of
$2,172,000.
 
Other Noncurrent Liabilities
 
Other noncurrent liabilities include reserves primarily related to various uncertain income tax positions.
 
D
eferred Revenue
 
Deferred revenue includes the deferred gain on the sale of assets to National Health Corporation (“National”), the non-refundable portion (
10%
) of CCRC entrance fees being amortized over the remaining life expectancies of the residents, and premiums received within our workers’ compensation and professional liability companies in which the performance obligations have
not
been satisfied.
 
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 subsidiary earnings based on ownership interest.
 
Variable Interest Entities
 
We have equity interests in unconsolidated limited liability companies that operate various post-acute and senior healthcare businesses. We analyze our investments in these limited liability companies to determine if the company is considered a variable interest entity (“VIE”) and would require consolidation. To the extent that we own interests in a VIE and we (i) are the sole entity that has the power to direct the activities of the VIE and (ii) have the obligation or rights to absorb the VIE's losses or receive its benefits, then we would be determined to be the primary beneficiary and would consolidate the VIE. To the extent we own interests in a VIE, then at each reporting period, we re-assess our conclusions as to which, if any, party within the VIE is considered the primary beneficiary.
 
The Company's maximum exposure to losses in its investments in unconsolidated VIEs cannot be quantified and
may
or
may
not
be limited to its investment in the unconsolidated VIE. The investments in unconsolidated VIEs are classified as “investments in limited liability companies” in the consolidated balance sheets.