National HealthCare Corporation, which we also refer to as NHC or the Company, began business in 1971.
−Removed: Our principal business is the operation of skilled nursing facilities, assisted living facilities, independent living facilities, homecare and hospice agencies, and a behavioral health hospital.
+Added: Our principal business is the operation of skilled nursing facilities, assisted living facilities, independent living facilities, homecare and hospice agencies, and behavioral health hospitals.
Our business activities include providing sub–acute and post–acute skilled nursing care, intermediate nursing care, rehabilitative care, memory and Alzheimer’s care, senior living services, home health care services, hospice services, and behavioral health services.
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We also own the real estate of 13 healthcare properties and lease these properties to third party operators.
−Removed: We operate in 10 states, and our owned and leased properties are located in the Southeastern, Northeastern, and Midwestern parts of the United States.
+Added: We operate in 8 states and our operations are primarily located in the Southeastern and Midwestern parts of the United States.
Description of the Business
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Percentage of total
+Added: Behavioral Health Hospitals
+Added: Number of facilities
+Added: Percentage of total
+Added: Licensed beds
+Added: Percentage of total
Homecare Agencies
Hospice Agencies
−Removed: We also operate a 16-bed behavioral health hospital that specializes in geriatric behavioral health.
−Removed: We currently have a 64-bed behavioral health hospital and a 16-bed behavioral health hospital under construction that are set to open in early 2022.
Net Patient Revenues.
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Medical Specialty Units.
−Removed:  All our skilled nursing facilities participate in the Medicare program, and we have expanded our range of offerings by the creation of center–specific medical specialty units such as our memory care units and sub-acute nursing units.
+Added:  All our skilled nursing facilities participate in the Medicare program, and we have expanded our range of offerings by the creation of facility–specific medical specialty units such as our memory care units and sub-acute nursing units.
Our trained staff provides care for Alzheimer’s patients in early, middle and advanced stages of the disease.
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thus, these facilities offer an expansion of our continuum of care.
−Removed: We believe these independent living units offer a positive marketing aspect to all our senior care offerings and services. 
−Removed: In 2021, the rate of occupancy was 88.1% compared to 92.1% in 2020.  
+Added: We believe these independent living units offer a positive marketing aspect to all our senior care offerings and services.
+Added: In 2022, the rate of occupancy was 89.0% compared to 88.1% in 2021.
We have one independent living facility which is a "continuing care community", where the resident pays a substantial entrance fee and a monthly maintenance fee.
The resident then receives a full range of services, including skilled nursing and home health, without additional charge.
−Removed: Behavioral Health Hospitals.  
−Removed: Our comprehensive continuum of care includes behavioral health services to both adults and geriatric patients with psychiatric, emotional, and addictive disorders. 
−Removed: Currently, we operate a 16-bed hospital to adult and geriatric patients who require inpatient hospitalization due to mental disorders, including cognitive illnesses. 
−Removed: We are completing construction, and will open in early 2022, two additional behavioral health hospitals (64-bed hospital and 16-bed hospital) that will provide the same level of comprehensive care for adults and geriatric patients with psychiatric, emotional, and addictive disorders. 
−Removed: We also will be offering intensive outpatient programs with individualized treatment plans based on the patient's clinical needs.  
+Added: Behavioral Health Hospitals.
+Added:   Our comprehensive continuum of care includes behavioral health services to both adults and geriatric patients with psychiatric, emotional, and addictive disorders.  Currently, we operate three behavioral hospitals for adult and geriatric patients who require inpatient hospitalization due to mental disorders, including cognitive illnesses.  We also offer intensive outpatient programs with individualized treatment plans based on the patient's clinical needs.
Homecare Agencies .
−Removed: Our home health care programs (“homecares”) assist those who wish to stay at home or in assisted living residences but still require some degree of medical care or assistance with daily activities.
+Added: Our home health agencies (“homecares”) assist those who wish to stay at home or in assisted living residences but still require some degree of medical care or assistance with daily activities.
Registered and licensed practical nurses and therapy professionals provide skilled services such as infusion therapy, wound care and physical, occupational and speech therapies.
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Under the Medicare reimbursement payment system, we receive a prospectively determined amount per patient per 30-day period of care.
−Removed: Under our managed care contracts, we may receive a period of care payment or be paid by a per-visit payment model.
+Added: Under our managed care contracts, we may receive a period of care payment or be paid by a per-visit payment model.
In 2022, we served an average census of 3,036 patients and provided 315,643 visits.
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Rental Income.
−Removed:  The healthcare properties currently owned and leased to third party operators include nine skilled nursing facilities and four assisted living communities.
+Added:  The healthcare properties currently owned and leased to third party operators include nine skilled nursing facilities and four assisted living communities.  
Government Stimulus Income.
−Removed: We received government stimulus funds in 2021 and 2020 as part of the Coronavirus Aid, Relief, and Economic Security Act (the "CARES ACT"). 
−Removed: The CARES Act provided $2.2 trillion of economy-wide financial stimulus in the form of financial aid to individuals, businesses, nonprofits, states and municipalities. 
−Removed: The CARES Act appropriated $178 billion to the Public Health and Social Services Emergency Fund , which is referred to as the Provider Relief Fund ("PRF"). 
−Removed: The Company recorded $63,360,000 and $47,505,000 of government stimulus income from the PRF for the years ended December 31, 2021 and 2020, respectively. 
−Removed: As of December 31, 2021, government stimulus funds received but not recognized as income are $9,443,000 and are reflected in the current liability section of our consolidated balance sheet (provider relief funds).
+Added: We received government stimulus funds as part of the Coronavirus Aid, Relief, and Economic Security Act (the "CARES ACT").
+Added: The CARES Act provided $2.2 trillion of economy-wide financial stimulus in the form of financial aid to individuals, businesses, nonprofits, states and municipalities.
+Added: The CARES Act appropriated $178 billion to the Public Health and Social Services Emergency Fund, which is referred to as the Provider Relief Fund ("PRF").
+Added: The Company recorded $11,457,000, $63,360,000 and $47,505,000 of government stimulus income from the PRF for the years ended December 31, 2022, 2021, and 2020, respectively.
Operating Income.
We generate non–operating income from equity in earnings of unconsolidated investments, dividends and realized gains and losses on marketable securities, interest income, and other miscellaneous non–operating income.
−Removed: The significant source of non–operating income is described as follows:
−Removed: Equity in Earnings of Unconsolidated Investments .
−Removed: Earnings from investments in entities in which we lack control but have the ability to exercise significant influence over operating and financial policies are accounted for on the equity method.
−Removed: During the first five months of 2021, our most significant equity method investment was a 75.1% non–controlling ownership interest in Caris.
−Removed: As of June 11, 2021, the Company acquired the remaining 24.9% equity interest in Caris. 
−Removed: As of the acquisition date, Caris’
−Removed: operations are consolidated into the Company's financial statements.
Quality of Patient Care
−Removed: Centers for Medicare and Medicaid Services (“CMS”) introduced the Five-Star Quality Rating System to help consumers, their families and caregivers compare skilled nursing facilities more easily.
−Removed: The Five-Star Quality Rating System gives each skilled nursing operation a rating of between one and five stars in various categories (five stars being the best).
+Added: CMS introduced the Five-Star Quality Rating System to help consumers, their families and caregivers compare skilled nursing facilities more easily.
+Added: 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.
+Added: In July 2022, CMS launched its enhanced Five-Star Quality Rating System which integrates weekend staffing rates for nurses and information on annual turnover among nurses and administrators.
The tables below summarize NHC's overall performance in these Five-Star ratings versus the skilled nursing industry as of December 31, 2022:
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December 2020
+Added: Tullahoma, TN
Behavioral Health Hospital
−Removed: Under Construction
−Removed: Behavior Health Hospital
Knoxville, TN
−Removed: Under Construction
−Removed: For the two behavioral health hospitals under construction, the two facilities are expected to begin operations late in the first quarter of 2022 or the beginning of the second quarter of 2022.  
+Added: Behavioral Health Hospital
Business Segments
The Company has two reportable operating segments:
−Removed: (1) inpatient services, which includes the operation of skilled nursing facilities, assisted and independent living facilities, and the one behavioral health hospital, and (2) homecare and hospice services.
+Added: (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”
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Certain groups of patients receive funds to pay the cost of their care from a common source.
−Removed: The following table sets forth sources of net patient revenues for the periods indicated:
+Added: The following table sets forth sources of net patient revenues for the periods indicated: 
Year Ended December 31,
Private Pay and Other
−Removed: We attempt to attract an increased percentage of Medicare, managed care, and private pay patients by providing rehabilitative and other post–acute care services.
+Added: We attempt to attract an increased percentage of Medicare and private pay patients by providing rehabilitative and other post–acute care services.
These services are designed to speed the patient's recovery and allow the patient to return home as soon as it is practical.
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These regulatory bodies, among other things, require us annually to license our skilled nursing facilities and other health care businesses.
−Removed: To operate nursing facilities and provide health care services we must comply with federal, state and local laws relating to the delivery and adequacy of medical care, distribution of pharmaceuticals, equipment, personnel, operating policies, fire prevention, rate–setting, building codes and environmental protection. 
−Removed: Changes in the laws or new interpretations of existing laws as applied to the skilled nursing facilities, assisted living facilities, home health, or other components of our health care businesses, may have a significant impact on our operations. 
−Removed: Governmental and other authorities periodically inspect our healthcare facilities and home health and hospice agencies to assure that we continue to comply with their various standards.
+Added: To operate skilled nursing facilities and provide health care services we must comply with federal, state and local laws relating to the delivery and adequacy of medical care, distribution of pharmaceuticals, equipment, personnel, operating policies, fire prevention, rate–setting, building codes and environmental protection.
+Added: Changes in the laws or new interpretations of existing laws as applied to the skilled nursing facilities, home health and hospice, or other components of our health care businesses, may have a significant impact on our operations.
+Added: Governmental and other authorities periodically inspect our healthcare facilities and home health and hospice agencies to assure that we continue to comply with their various standards.
We must pass these inspections to continue our licensing under state law, to obtain certification under the Medicare and Medicaid programs, and to continue our participation in the Veterans Administration program.
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These notices may require us to take corrective action and may impose civil money penalties and/or other operating restrictions.
−Removed: If our skilled nursing facilities, home health agencies, or hospice agencies fail to comply with these directives or otherwise fail to comply substantially with licensure and certification laws, rules and regulations, we could lose our certification as a Medicare and Medicaid provider and/or lose our licenses.
+Added: If our skilled nursing facilities or home health and hospice agencies fail to comply with these directives or otherwise fail to comply substantially with licensure and certification laws, rules and regulations, we could lose our certification as a Medicare and Medicaid provider and/or lose our licenses.
Local and state health and social service agencies and other regulatory authorities specific to their location regulate, to varying degrees, our assisted living facilities.
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There is no advance assurance that we will be able to obtain a Certificate of Need in any instance.
−Removed: In some states, approval is also necessary in order to purchase existing health care beds, although the purchaser is normally permitted to avoid a full-scale Certificate of Need application procedure by giving advance written notice of the acquisition and giving written assurance to the state regulatory agency that the change of ownership will not result in a change in the number of beds, services offered and, in some cases, reimbursement rates at the facility.
+Added: In some states, approval is also necessary in order to purchase existing health care beds, although the purchaser is normally permitted to avoid a full-scale Certificate of Need application procedure by giving advance written notice of the acquisition and giving written assurance to the state regulatory agency that the change of ownership will not result in a change in the number of beds, services offered and, in some cases, reimbursement rates at the facility. 
While there are currently no significant legislative proposals to eliminate Certificates of Need pertaining to skilled nursing care in the states in which we do business, deregulation in the Certificate of Need area would likely result in increased competition and could adversely affect occupancy rates and the supply of licensed and certified personnel.
−Removed: Health Care Reform   
−Removed: In recent years, the U.S.
−Removed: Congress and certain state legislatures have passed a large number of laws and regulations intended to effect major change within the U.S.
−Removed: health care system, including the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively the "ACA").
−Removed: Since a significant goal of federal health care reform is to transform the delivery of health care by holding providers accountable for the cost and quality of care provided, Medicare and many commercial third-party payors are implementing Accountable Care Organization ("ACO") models in which groups of providers share in the benefit and risk of providing care to an assigned group of individuals.
+Added: A significant goal of the federal health care system is to transform the delivery of health care by holding providers accountable for the cost and quality of care provided, Medicare and many commercial third-party payors are implementing Accountable Care Organization ("ACO") models in which groups of providers share in the benefit and risk of providing care to an assigned group of individuals.
Other reimbursement methodology reforms in which we are participating or expect to participate in include value–based purchasing, in which a portion of provider reimbursement is redistributed based on relative performance on designated economic, clinical quality, and patient satisfaction metrics.
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All but eight (seven owned and one managed) of our affiliated skilled nursing facilities participate in Medicaid.
−Removed: All our homecare and hospice agencies participate in the Medicare and Medicaid programs, with Medicare comprising the majority of their revenue. 
−Removed: Our behavioral health hospital also participates in the Medicare and Medicaid program.
+Added: All our homecare and hospice agencies participate in the Medicare and Medicaid programs, with Medicare comprising the majority of their revenue.
+Added: Our behavioral health hospitals also participate in the Medicare and Medicaid program.
During the fiscal years, we received payments from Medicare and, if participating, from Medicaid.
We record as receivables the amounts we ultimately expect to receive under the Medicare and Medicaid programs and record into profit or loss any differences in amounts received at the time of interim or final settlements.
−Removed: There have not been any adjustments that have had a material adverse effect on the Company within the last three years.
+Added: There have not been any adjustments that have had a material adverse effect on the Company within the last three years.  
Medicare Legislation and Regulations
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Medicare is uniform nationwide and reimburses skilled nursing facilities under a fixed payment methodology called the Skilled Nursing Facility Prospective Payment System ("SNF PPS").
−Removed: The SNF PPS includes a case-mix model called the Patient-Driven Payment Model (“PDPM”), which focuses on a resident’s condition and care needs, rather than the amount of care provided to determine reimbursement levels.
+Added: The SNF PPS includes a new case-mix model called the Patient-Driven Payment Model (“PDPM”), which focuses on a resident’s condition and care needs, rather than the amount of care provided to determine reimbursement levels.
PDPM utilizes clinically relevant factors for determining Medicare payment by using ICD-10 diagnosis codes and other patient characteristics as the basis for patient classification.
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physical therapy (“PT”), occupational therapy (“OT”), speech language pathology (“SLP”), nursing and social services and non-therapy ancillary services (“NTA”).
−Removed: It also uses a sixth non-case mix component to cover utilization of skilled nursing facility resources that do not vary depending on resident characteristics.
−Removed: On July 29, 2021, CMS released its final rule outlining fiscal year 2022 Medicare payment rates and policy changes for skilled nursing facilities, which began October 1, 2021.
−Removed: The fiscal year 2022 rule provided for an approximate 1.2% increase, or $410 million, compared to 2021 levels.
−Removed: The net increase includes a 2.7% market-basket update that is offset by a 0.7% productivity adjustment and a 0.8% market-basket forecast error adjustment.
+Added: It also uses a sixth non-case mix component to cover utilization of skilled nursing facility (“SNF”) resources that do not vary depending on resident characteristics.
+Added: In July 2022, CMS released its final rule outlining fiscal year 2023 Medicare payment rates and policy changes for skilled nursing facilities, which began on October 1, 2022.
+Added: The fiscal year 2023 rule provided for an approximate 2.7% increase, or $904 million, compared to 2022 levels.
+Added: The net increase includes a 3.9% market-basket increase plus a 1.5% market basket forecast error adjustment, less a 0.3% productivity adjustment and a 2.3% decrease in the FY 2023 SNF PPS rates as a result of the recalibrated parity adjustment.
+Added: The recalibrated parity adjustment is a total of 4.6% and is being phased in over the next two years (2.3% annually).
The Coronavirus Aid, Relief and Economic Security Act (the “CARES”
−Removed: Act) and subsequent related legislation temporarily suspended Medicare sequestration beginning May 1, 2020 through March 31, 2022.
+Added: Act) and other subsequent Congressional actions temporarily suspended Medicare sequestration beginning May 1, 2020 through March 31, 2022.
The Medicare sequestration policy reduces fee-for-service Medicare payments by 2 percent.
−Removed: Beginning April 1, 2022, the sequestration reductions will then be 1% from April 1, 2022 through June 30, 2022. 
−Removed: The full 2% reduction is scheduled to go back into effect July 1, 2022.  The CARES Act extends the sequestration policy through 2030 in exchange for this temporary suspension, which the sequestration reduction for 2030 has been increased up to 3%. 
+Added: Effective April 1, 2022, sequestration was reinstated but only 1% was reduced from Medicare payments from April 1, 2022 through June 30, 2022. 
+Added: Beginning July 1, 2022, sequestration was increased back to the 2% reduction of Medicare payments for the remainder of 2022. The CARES Act extends the sequestration policy through 2030 in exchange for this temporary suspension. 
Medicare is uniform nationwide and reimburses homecare agencies under a Patient-Driven Groupings Model (“PDGM”).
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The payment under the Medicare program is also adjusted for certain variables.
−Removed: In November 2021, CMS released its final rule outlining calendar year 2022 Medicare payment rates.
−Removed: CMS projects payments to home health agencies in 2022 will increase in aggregate by 3.2%, or $570 million.
−Removed: The increase reflects the effects of the 2022 home health payment update percentage of 2.6%, an estimated 0.7% increase that reflects the effects of the updated fixed-dollar loss ratio, and an estimated 0.1% decrease in payments due to the changes in the rural add-on percentages for 2022.
−Removed: Additionally, CMS is expanding the Home Health Value-Based Purchasing (“HHVBP”) model nationwide with the first performance year of the expanded HHVBP Model to occur in 2023.
−Removed: Quality performance data from 2023 will be used to calculate payment adjustments under the expanded Model in 2025.
+Added: In October 2022, CMS released its final rule outlining fiscal year 2023 Medicare payment rates.
+Added: CMS projects payments to home health agencies in fiscal year 2023 will increase in aggregate by 0.7%, or $125 million.
+Added: The increase reflects the effects of the home health payment update percentage of 4.0%, a permanent behavioral assumption adjustment resulting in a decrease of 3.5%, and an estimated 0.2% increase that reflects the effects of an update to the fixed-dollar loss ratio used in determining outlier payments.
Medicare payment rates are calculated as daily rates for each of four levels of care we deliver.
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Continuous Home Care .
−Removed: Care for patients experiencing a medical crisis that requires nursing services to achieve palliation and symptom control for a minimum of eight hours of care within a 24-hour period.
+Added: Care for patients experiencing a medical crisis that requires nursing services to achieve palliation and symptom control if the agency provides a minimum of eight hours of care within a 24-hour period.
Inpatient Respite Care .
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CMS issued a rate increase of 3.8%, or $825 million, effective October 1, 2022.
−Removed: The increase is the result of a 2.7% market basket increase reduced by a 0.7% productivity adjustment.
−Removed: The fiscal year 2022 hospice payment updates also include an update to the statutory aggregate cap amount, which limits the overall payments per patient that are made annually.
−Removed: The cap amount for fiscal year 2022 is $31,297.61 compared to $30,683.93 for FY 2021.
+Added: The increase is the result of a 4.1% inpatient hospital market basket increase reduced by a 0.3% productivity adjustment.
+Added: The FY2023 hospice payment update also includes an update to the statutory aggregate cap amount, which limits the overall payments per patient that are made annually.
+Added: The cap amount for FY2023 is $32,487.
Medicaid Legislation and Regulations
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Changes in federal funding coupled with state budget problems and Medicaid expansion under the Affordable Care Act have produced an uncertain environment.
−Removed: Most states will not keep pace with post-acute healthcare inflation.
+Added: 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.
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We estimate the resulting increase in revenue for the 2023 fiscal year will be approximately $3,200,000 annually, or $800,000 per quarter.
−Removed: Effective July 1, 2021 and for the fiscal year 2022, the state of Missouri implemented specific individual nursing facility increases.
+Added: Effective October 1, 2022 and for the fiscal year 2023, the state of South Carolina implemented specific individual nursing facility increases.
We estimate the resulting increase in revenue for the 2023 fiscal year will be approximately $3,735,000 annually, or $934,000 per quarter.
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For the years ended December 31, 2022, 2021 and 2020, we have recorded $19,442,000, $20,482,000 and $26,179,000, respectively, due to these supplemental Medicaid payments.
−Removed: We have recorded these payments in net patient revenues in our consolidated statements of operations.
−Removed: In most of the communities in which we operate health care facilities, we compete with other health care facilities in the area. 
−Removed: There are hundreds of operators of post-acute healthcare services in each of these states and no single operator, including us, dominates any of the markets, except for some small rural markets which might have limited competition.
+Added: We have recorded these payments in net patient revenues in our consolidated statements of operations.  
+Added: In most of the communities in which we operate health care facilities, we compete with other health care facilities in the area.
+Added: There are hundreds of operators of post-acute healthcare services in each of these states and no single operator, including us, dominates any of the markets, except for some small rural markets which might have limited competition.
In competing for patients and staff, we depend upon referrals from acute care hospitals, physicians, residential care facilities, church groups and other community service organizations.
The reputation in the community and the physical appearance of our facilities are important in obtaining patients since members of the patient’s family generally participate to a greater extent in selecting skilled nursing facilities than in selecting an acute care hospital.
−Removed: We believe that by providing and emphasizing rehabilitative, as well as patient-centered healthcare services, we can broaden our patient base and to differentiate our operations from competing operations.
−Removed: As we continue to expand into the senior living communities and behavioral health hospitals, we monitor proposed or existing competing operations.
−Removed: Our development goal is to link our skilled nursing facilities with our senior living communities and behavioral health hospitals, thereby obtaining a competitive advantage for both.
−Removed: Our homecare and hospice agencies compete with other agencies in most communities we serve.
−Removed: Competition occurs for patients and employees.
−Removed: Our homecare and hospice agencies depend on hospital and physician referrals and reputation to maintain a healthy census.
+Added: We believe that by providing and emphasizing rehabilitative, as well as patient-centered healthcare services, we can broaden our patient base and to differentiate our operations from competing operations.
+Added: As we continue to expand into all areas of senior health care, we monitor proposed or existing competing operations.
+Added: Our development goal is to link our skilled nursing facilities with our senior living communities, home health and hospice operations, and behavioral health hospitals;
+Added: therefore, obtaining a competitive advantage for our operations.
Human Capital
As of December 31, 2022, we had 12,355 full-time and part-time employees (“partners”) through our Administrative Services Contractor (National Health Corporation).
−Removed: None were represented by a collective bargaining agreement.
+Added: None of our partners were represented by a collective bargaining agreement.
We believe relations with our partners are good.
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To enhance our competitive position, we offer a robust educational tuition reimbursement program, an American Dietetic Association approved internship program, specialty designed nurse aide training classes, and there is financial scholarship aid available for various health care vocation programs.
−Removed: We also conduct an "Administrator in Training" course, which is 24 months in duration, for the professional training of administrators.
−Removed: Presently, we have five (two female and three male) full–time individuals in this program.
−Removed: Both of our regional senior vice presidents, four regional vice presidents, one regional administrator, and 53 of our 75 health care center administrators are graduates of this program.
+Added: We also conduct an "Administrator in Training" course, which is 24 months in duration, for the professional training of skilled nursing facility administrators.
+Added: Presently, we have three (two male and one female) full–time individuals in this program.
+Added: All six of our regional vice presidents and 50 of our 68 health care center administrators are graduates of this program.
We regularly utilize third-party consultants to conduct anonymous surveys to seek feedback from our partners on a variety of topics, including but not limited to, confidence in company leadership, competitiveness of our compensation and benefits package, career growth opportunities and improvements on how we can continue to make our company an employer of choice.
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When the pandemic began, we ensured and continue to ensure that our partners have access to masks, thermometers, protective gloves, sanitizing supplies, and all personal protective equipment needed in order to protect themselves.
−Removed: We closely follow the recommendations of the World Health Organization, the U.S.
−Removed: Centers for Disease Control and local governments, and we take actions to ensure the safety of our partners.
+Added: We closely followed the recommendations of the World Health Organization, the U.S.
+Added: Centers for Disease Control and local governments, and we took action to ensure our partners were safe.
Some of the preventative measure we have implemented included:
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Environmental Sustainability
−Removed: We are working diligently to minimize our effect on the environment by conserving energy and protecting our natural resources. 
−Removed: We are focusing on being more energy efficient and reducing our water use and wastewater discharges while continuing to provide a healthy environment for our patients, partners and visitors. 
−Removed: We are committed to adhering to applicable federal, state and local environmental regulations. 
−Removed: Our goal is to minimize environmental risks to our patients and in the communities which we operate. 
−Removed: Through recycling programs, we are working to reduce the amount of waste sent to landfills. 
−Removed: Our electronic waste is recycled through a zero-landfill recycling company. 
+Added: We are working diligently to minimize our effect on the environment by conserving energy and protecting our natural resources.
+Added: We are focusing on being more energy efficient and reducing our water use and wastewater discharges while continuing to provide a healthy environment for our patients, partners and visitors.
+Added: We are committed to adhering to applicable federal, state and local environmental regulations.
+Added: Our goal is to minimize environmental risks to our patients and in the communities which we operate.
+Added: Through recycling programs, we are working to reduce the amount of waste sent to landfills.
+Added: Our electronic waste is recycled through a zero-landfill recycling company.
Available Information
−Removed: The Company's Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q and Current Reports on Form 8-K, and amendments to those reports filed or furnished pursuant to Section 13(a) or 15(d) of the Securities Exchange Act of 1934, are available free of charge at 
−Removed: www.nhccare.com , as soon as reasonably practicable after the reports are electronically filed or furnished with the U.S.
+Added: The Company's Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q and Current Reports on Form 8-K, and amendments to those reports filed or furnished pursuant to Section 13(a) or 15(d) of the Securities Exchange Act of 1934, are available free of charge at www.nhccare.com, as soon as reasonably practicable after the reports are electronically filed or furnished with the U.S.
Securities and Exchange Commission ("SEC").
The SEC maintains a website that contains these reports as well as proxy statements and other information regarding issuers that file electronically.
−Removed: The SEC's website is at 
−Removed: www.sec.gov .
+Added: The SEC's website is at www.sec.gov.
NHC's website and its content are not deemed incorporated by reference into this report.
Compared sentence by sentence after normalising whitespace, quotation marks, case and digits, so re-formatting and restated figures do not read as changed language. Wording changes appear as one removal and one addition. The current filing and the prior one are authoritative.