AMERICAN HEALTHCARE REIT, INC., 10-K filed on 3/22/2024
Annual Report
v3.24.1
Document and Entity Information - USD ($)
12 Months Ended
Dec. 31, 2023
Mar. 15, 2024
Jun. 30, 2023
Cover [Abstract]      
Document Type 10-K    
Document Annual Report true    
Document Period End Date Dec. 31, 2023    
Current Fiscal Year End Date --12-31    
Document Transition Report false    
Entity File Number 001-41951    
Entity Registrant Name AMERICAN HEALTHCARE REIT, INC.    
Entity Incorporation, State or Country Code MD    
Entity Tax Identification Number 47-2887436    
Entity Address, Address Line One 18191 Von Karman Avenue    
Entity Address, Address Line Two Suite 300    
Entity Address, City or Town Irvine    
Entity Address, State or Province CA    
Entity Address, Postal Zip Code 92612    
City Area Code 949    
Local Phone Number 270-9200    
Title of 12(b) Security Common Stock, $0.01 par value per share    
Trading Symbol AHR    
Security Exchange Name NYSE    
Entity Well-known Seasoned Issuer No    
Entity Voluntary Filers No    
Entity Current Reporting Status Yes    
Entity Interactive Data Current Yes    
Entity Filer Category Non-accelerated Filer    
Entity Small Business false    
Entity Emerging Growth Company false    
ICFR Auditor Attestation Flag false    
Document Financial Statement Error Correction [Flag] false    
Entity Shell Company false    
Entity Public Float     $ 0
Entity Common Stock, Shares Outstanding   65,372,222  
Amendment Flag false    
Document Fiscal Year Focus 2023    
Document Fiscal Period Focus FY    
Entity Central Index Key 0001632970    
v3.24.1
Audit Information
12 Months Ended
Dec. 31, 2023
Auditor Information [Abstract]  
Auditor Firm ID 34
Auditor Name Deloitte & Touche LLP
Auditor Location Costa Mesa, California
v3.24.1
CONSOLIDATED BALANCE SHEETS - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
ASSETS    
Real estate investments, net $ 3,425,438 $ 3,581,609
Debt security investment, net 86,935 83,000
Cash and cash equivalents 43,445 65,052
Restricted cash 47,337 46,854
Accounts and other receivables, net 185,379 137,501
Identified intangible assets, net 180,470 236,283
Goodwill 234,942 231,611
Operating lease right-of-use assets, net 227,846 276,342
Other assets, net 146,141 128,446
Total assets 4,577,933 4,786,698
Liabilities:    
Mortgage loans payable, net [1] 1,302,396 1,229,847
Lines of credit and term loan, net [1] 1,223,967 1,281,794
Accounts payable and accrued liabilities [1] 242,905 243,831
Identified intangible liabilities, net 6,095 10,837
Financing obligations [1] 41,756 48,406
Operating lease liabilities [1] 225,502 273,075
Security deposits, prepaid rent and other liabilities [1] 76,134 49,545
Total liabilities 3,118,755 3,137,335
Commitments and Contingencies
Redeemable noncontrolling interests 33,843 81,598
Stockholders’ equity:    
Preferred stock, $0.01 par value per share; 200,000,000 shares authorized; none issued and outstanding 0 0
Additional paid-in capital 2,548,307 2,540,424
Accumulated deficit (1,276,222) (1,138,304)
Accumulated other comprehensive loss (2,425) (2,690)
Total stockholders’ equity 1,270,321 1,400,091
Noncontrolling interests 155,014 167,674
Total equity 1,425,335 1,567,765
Total liabilities, redeemable noncontrolling interests and equity 4,577,933 4,786,698
Common Class T    
Stockholders’ equity:    
Common stock 194 194
Common Class I    
Stockholders’ equity:    
Common stock $ 467 $ 467
[1] Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of December 31, 2023 and 2022. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2022 Credit Facility, as defined in Note 9, held by American Healthcare REIT Holdings, LP in the amount of $914,900 and $965,900, as of December 31, 2023 and 2022, respectively, which was guaranteed by American Healthcare REIT, Inc.
v3.24.1
CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Par value of preferred stock, authorized to be issued (in dollars per share) $ 0.01 $ 0.01
Preferred stock authorized (in shares) 200,000,000 200,000,000
Preferred stock issued (in shares) 0 0
Preferred stock outstanding (in shares) 0 0
Common stock authorized (in shares) 1,000,000,000 1,000,000,000
Lines of credit and term loan [1] $ 1,223,967 $ 1,281,794
2022 Corporate Line of Credit | Line of Credit    
Lines of credit and term loan $ 914,900 $ 965,900
Common Class T    
Common stock authorized (in shares) 200,000,000 200,000,000
Common stock, par value (in dollars per share) $ 0.01 $ 0.01
Common stock issued (in shares) 19,552,856 19,535,095
Common stock outstanding (in shares) 19,552,856 19,535,095
Common Class I    
Common stock authorized (in shares) 800,000,000 800,000,000
Common stock, par value (in dollars per share) $ 0.01 $ 0.01
Common stock issued (in shares) 46,673,320 46,675,367
Common stock outstanding (in shares) 46,673,320 46,675,367
[1] Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of December 31, 2023 and 2022. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2022 Credit Facility, as defined in Note 9, held by American Healthcare REIT Holdings, LP in the amount of $914,900 and $965,900, as of December 31, 2023 and 2022, respectively, which was guaranteed by American Healthcare REIT, Inc.
v3.24.1
CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME (LOSS) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Revenues and grant income:      
Resident fees and services $ 1,668,742 $ 1,412,156 $ 1,123,935
Real estate revenue 190,401 205,344 141,368
Grant income 7,475 25,675 16,951
Total revenues and grant income 1,866,618 1,643,175 1,282,254
Expenses:      
Property operating expenses 1,502,310 1,281,526 1,030,193
Rental expenses 57,475 59,684 38,725
General and administrative 47,510 43,418 43,199
Business acquisition expenses 5,795 4,388 13,022
Depreciation and amortization 182,604 167,957 133,191
Total expenses 1,795,694 1,556,973 1,258,330
Other income (expense):      
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishments) (163,191) (105,956) (80,937)
(Loss) gain in fair value of derivative financial instruments (926) 500 8,200
Gain (loss) on dispositions of real estate investments, net 32,472 5,481 (100)
Impairment of real estate investments (13,899) (54,579) (3,335)
Impairment of intangible assets and goodwill (10,520) (23,277) 0
(Loss) income from unconsolidated entities (1,718) 1,407 (1,355)
Gain on re-measurement of previously held equity interests 726 19,567 0
Foreign currency gain (loss) 2,307 (5,206) (564)
Other income 7,601 3,064 1,854
Total net other expense (147,148) (158,999) (76,237)
Loss before income taxes (76,224) (72,797) (52,313)
Income tax expense (663) (586) (956)
Net loss (76,887) (73,383) (53,269)
Net loss (income) attributable to noncontrolling interests 5,418 (7,919) 5,475
Net loss attributable to controlling interest $ (71,469) $ (81,302) $ (47,794)
Net loss per Class T and Class I common share attributable to controlling interest — basic $ (1.08) $ (1.24) $ (0.95)
Net loss per Class T and Class I common share attributable to controlling interest — diluted $ (1.08) $ (1.24) $ (0.95)
Weighted average number of Class T and Class I common shares outstanding — basic 66,047,114 65,807,868 50,081,140
Weighted average number of Class T and Class I common shares outstanding — diluted 66,047,114 65,807,868 50,081,140
Other comprehensive income (loss):      
Foreign currency translation adjustments $ 265 $ (724) $ (65)
Total other comprehensive income (loss) 265 (724) (65)
Comprehensive loss (76,622) (74,107) (53,334)
Comprehensive loss (income) attributable to noncontrolling interests 5,418 (7,919) 5,582
Comprehensive loss attributable to controlling interest $ (71,204) $ (82,026) $ (47,752)
v3.24.1
CONSOLIDATED STATEMENTS OF EQUITY - USD ($)
Total
Total Stockholders' Equity
Common Stock
Additional Paid-In Capital
Accumulated Deficit
Accumulated Other Comprehensive Loss
Noncontrolling Interests
Beginning balance, shares at Dec. 31, 2020     44,914,588        
Beginning balance Stockholders' Equity at Dec. 31, 2020 $ 1,034,483,000 $ 866,108,000 $ 449,000 $ 1,731,938,000 $ (864,271,000) $ (2,008,000) $ 168,375,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]              
Offering costs — common stock (14,000) (14,000)   (14,000)      
Issuance of common stock and purchase of noncontrolling interest in connection with the Merger, shares [1]     20,432,815        
Issuance of common stock and purchase of noncontrolling interest in connection with the Merger [1] 721,945,000 765,148,000 $ 204,000 764,944,000     (43,203,000)
Issuance of operating partnership units to acquire AHI 112,283,000 36,556,000   36,449,000   107,000 75,727,000
Issuance of common stock under the DRIP, shares     207,866        
Issuance of common stock under the DRIP 7,666,000 7,666,000 $ 2,000 7,664,000      
Issuance of vested and nonvested restricted common stock, shares     213,091        
Issuance of vested and nonvested restricted common stock, value 41,000 41,000 $ 3,000 38,000      
Amortization of nonvested common stock compensation 816,000 816,000   816,000      
Stock based compensation (14,000)           (14,000)
Repurchase of common stock, shares [2]     (10,356)        
Repurchase of common stock [2] (382,000)     (382,000)      
Distributions to noncontrolling interests (15,247,000)           (15,247,000)
Reclassification of noncontrolling interests to mezzanine equity (5,923,000)           (5,923,000)
Adjustment to value of redeemable noncontrolling interests (7,380,000) (7,549,000)   (7,549,000)     169,000
Distributions declared (39,238,000) (39,238,000)     (39,238,000)    
Net loss [3] (52,125,000) (47,794,000)     (47,794,000)   (4,331,000)
Other comprehensive income (loss) (65,000) (65,000)       (65,000)  
Ending balance, shares at Dec. 31, 2021     65,758,004        
Ending balance Stockholders' Equity at Dec. 31, 2021 1,756,846,000 1,581,293,000 $ 658,000 2,533,904,000 (951,303,000) (1,966,000) 175,553,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]              
Offering costs — common stock (2,000) (2,000)   (2,000)      
Issuance of common stock under the DRIP, shares     992,964        
Issuance of common stock under the DRIP 36,812,000 36,812,000 $ 8,000 36,804,000      
Issuance of vested and nonvested restricted common stock, shares     18,689        
Issuance of vested and nonvested restricted common stock, value 0 0 $ 1,000 (1,000)      
Amortization of nonvested common stock compensation 3,935,000 3,935,000   3,935,000      
Stock based compensation 83,000           83,000
Repurchase of common stock (20,699,000) (20,699,000) $ (6,000) (20,693,000)      
Distributions to noncontrolling interests (13,985,000)           (13,985,000)
Adjustment to noncontrolling interest in connection with the Merger [1]   (1,173,000)   (1,173,000)     1,173,000
Reclassification of noncontrolling interests to mezzanine equity (83,000)           (83,000)
Adjustment to value of redeemable noncontrolling interests (16,744,000) (13,353,000)   (13,353,000)     (3,391,000)
Purchase of redeemable noncontrolling interest 1,003,000 1,003,000   1,003,000      
Distributions declared [3] (105,699,000) (105,699,000)     (105,699,000)    
Net loss [3] (72,978,000) (81,302,000)     (81,302,000)   8,324,000
Other comprehensive income (loss) (724,000) (724,000)       (724,000)  
Ending balance, shares at Dec. 31, 2022     66,210,462        
Ending balance Stockholders' Equity at Dec. 31, 2022 1,567,765,000 1,400,091,000 $ 661,000 2,540,424,000 (1,138,304,000) (2,690,000) 167,674,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]              
Issuance of common stock under the DRIP, shares     0        
Issuance of common stock under the DRIP   0          
Issuance of vested and nonvested restricted common stock, shares     26,156        
Vested restricted stock units (in shares)     4,120        
Amortization of nonvested common stock compensation 5,385,000 5,385,000   5,385,000      
Stock based compensation 83,000           83,000
Repurchase of common stock, shares     (14,562)        
Repurchase of common stock (469,000) (469,000)   (469,000)      
Distributions to noncontrolling interests (8,210,000)           (8,210,000)
Reclassification of noncontrolling interests to mezzanine equity (83,000)           (83,000)
Adjustment to value of redeemable noncontrolling interests 2,944,000 3,039,000   3,039,000     (95,000)
Distributions declared (66,449,000) (66,449,000)     (66,449,000)    
Net loss [3] (75,824,000) (71,469,000)     (71,469,000)   (4,355,000)
Other comprehensive income (loss) 265,000 265,000       265,000  
Ending balance, shares at Dec. 31, 2023     66,226,176        
Ending balance Stockholders' Equity at Dec. 31, 2023 1,425,335,000 1,270,321,000 $ 661,000 2,548,307,000 $ (1,276,222,000) $ (2,425,000) $ 155,014,000
Increase (Decrease) in Stockholders' Equity [Roll Forward]              
Stock Issued During Period, Value, Restricted Stock Award, Net of Forfeitures $ (72,000) $ (72,000)   $ (72,000)      
[1] In connection with the Merger, as defined in Note 1, on October 1, 2021, a wholly-owned subsidiary of Griffin-American Healthcare REIT IV Holdings, LP sold its 6.0% interest in Trilogy REIT Holdings, LLC to GAHR III, as defined in Note 1. See Note 13, Equity — Noncontrolling Interests in Total Equity, for a further discussion.
[2] Prior to the Merger, but upon the closing of the AHI Acquisition, as defined in Note 1, GAHR III redeemed all 5,148 shares of its common stock held by GAHR III’s former advisor as well as all 5,208 shares of GAHR IV Class T common stock held by the former advisor of GAHR IV, as defined in Note 1.
[3] For the years ended December 31, 2023, 2022 and 2021, amounts exclude $(1,063,000), $(405,000) and $(1,144,000), respectively, of net loss attributable to redeemable noncontrolling interests. See Note 12, Redeemable Noncontrolling Interests, for a further discussion.
v3.24.1
CONSOLIDATED STATEMENTS OF EQUITY (Parenthetical) - USD ($)
$ in Thousands
12 Months Ended
Oct. 01, 2021
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Distributions declared (in usd per share)   $ 1.00 $ 1.60 $ 0.69
Net (loss) income attributable to redeemable noncontrolling interests   $ (1,063) $ (405) $ (1,144)
Common Stock        
Stock redeemed (in shares) 5,148      
Common Class T        
Stock redeemed (in shares) 5,208      
Griffin-American Healthcare REIT IV, Inc.        
Joint venture ownership interest 6.00%      
v3.24.1
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
CASH FLOWS FROM OPERATING ACTIVITIES      
Net loss $ (76,887) $ (73,383) $ (53,269)
Adjustments to reconcile net loss to net cash provided by operating activities:      
Depreciation and amortization 182,604 167,957 133,191
Other amortization 54,692 32,643 24,189
Deferred rent (3,480) (6,520) (2,673)
Stock based compensation 5,468 3,909 9,658
(Gain) loss on dispositions of real estate investments, net (32,472) (5,481) 100
Impairment of real estate investments 13,899 54,579 3,335
Impairment of intangible assets and goodwill 10,520 23,277 0
Loss (income) from unconsolidated entities 1,718 (1,407) 1,355
Gain on re-measurement of previously held equity interests (726) (19,567) 0
Foreign currency (gain) loss (2,282) 4,893 573
Loss on extinguishments of debt 345 5,166 2,655
Change in fair value of derivative financial instruments 926 (500) (8,200)
Other adjustments 0 0 466
Changes in operating assets and liabilities:      
Accounts and other receivables (34,724) (4,457) 3,691
Other assets (4,166) (8,303) (2,775)
Accounts payable and accrued liabilities 15,427 14,062 (32,571)
Accounts payable due to affiliates 0 (184) (7,140)
Operating lease liabilities (36,609) (24,699) (16,793)
Security deposits, prepaid rent and other liabilities 4,282 (14,217) (37,879)
Net cash provided by operating activities 98,535 147,768 17,913
CASH FLOWS FROM INVESTING ACTIVITIES      
Proceeds from dispositions of real estate investments 184,532 48,297 4,499
Developments and capital expenditures (99,791) (71,520) (79,695)
Acquisitions of real estate investments (45,382) (73,229) (80,109)
Acquisition of previously held equity interest (335) (13,714) 0
Cash, cash equivalents and restricted cash acquired in connection with the Merger and the AHI Acquisition 0 0 17,852
Investments in unconsolidated entities (12,592) (4,858) (650)
Issuance of real estate notes receivable (20,962) (3,000) 0
Principal repayments on real estate notes receivable 6,082 0 0
Real estate and other deposits (2,156) (554) (549)
Net cash provided by (used in) investing activities 9,396 (118,578) (138,652)
CASH FLOWS FROM FINANCING ACTIVITIES      
Borrowings under mortgage loans payable 160,442 120,057 298,515
Payments on mortgage loans payable (101,457) (125,454) (34,616)
Borrowings under the lines of credit and term loans 401,450 1,160,400 51,100
Payments on the lines of credit and term loans (459,361) (1,104,400) (157,000)
Borrowings under financing obligations 16,283 25,900 0
Payments on financing and other obligations (34,943) (13,677) (11,685)
Deferred financing costs (5,311) (7,550) (3,854)
Debt extinguishment costs (269) (3,243) (127)
Distributions paid to common stockholders (76,284) (51,122) (22,788)
Repurchase of common stock (469) (20,699) (382)
Payments to taxing authorities in connection with common stock directly withheld from employees (72) 0 0
Distributions to noncontrolling interests in total equity (8,628) (13,242) (14,875)
Contributions from redeemable noncontrolling interests 0 273 152
Distributions to redeemable noncontrolling interests (1,475) (2,627) (1,483)
Repurchase of redeemable noncontrolling interests and stock warrants (17,150) (4,679) (8,933)
Payment of offering costs (1,487) (2,084) (10)
Security deposits (331) (777) 95
Net cash (used in) provided by financing activities (129,062) (42,924) 94,109
NET CHANGE IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH (21,131) (13,734) (26,630)
EFFECT OF FOREIGN CURRENCY TRANSLATION ON CASH, CASH EQUIVALENTS AND RESTRICTED CASH 7 154 (74)
CASH, CASH EQUIVALENTS AND RESTRICTED CASH — Beginning of period 111,906 125,486 152,190
CASH, CASH EQUIVALENTS AND RESTRICTED CASH — End of period 90,782 111,906 125,486
Cash and cash equivalents at beginning of period 65,052 81,597 113,212
Restricted cash at beginning of period 46,854 43,889 38,978
Cash and cash equivalents at end of period 43,445 65,052 81,597
Restricted cash at end of period 47,337 46,854 43,889
Cash paid for:      
Interest 152,669 88,682 70,212
Income taxes 1,297 1,131 1,239
SUPPLEMENTAL DISCLOSURE OF NONCASH INVESTING AND FINANCING ACTIVITIES      
Accrued developments and capital expenditures 24,881 30,211 19,546
Capital expenditures from financing obligations 5,413 2,465 1,409
Tenant improvement overage 2,402 1,408 1,598
Acquisition of real estate investments with assumed mortgage loans payable, net 0 104,561 0
Assumption of mortgage loan payable for development 10,884 0 0
Acquisition of real estate investment with financing obligation 0 0 15,504
Issuance of common stock under the DRIP 0 36,812 7,666
Distributions declared but not paid to common stockholders 16,557 26,484 8,768
Distributions declared but not paid — limited partnership units 876 1,401 467
Distributions declared but not paid — restricted stock units 157 65 0
Accrued repurchase of redeemable noncontrolling interest 25,312 0 0
Accrued offering costs 1,619 1,256 0
Reclassification of noncontrolling interests to mezzanine equity 0 83 5,923
Issuance of redeemable noncontrolling interests 0 0 7,999
The following represents the net increase (decrease) in certain assets and liabilities in connection with our acquisitions and dispositions of investments:      
Accounts and other receivables (1,784) 2,410 (153)
Issuance of note receivable 0 5,000 0
Other assets, net (3,740) (12,337) (4,036)
Mortgage loans payable, net 0 33,241 0
Financing obligations 12 65 0
Accounts payable and accrued liabilities (1,560) 15,674 (161)
Security deposits and other liabilities (907) 15,919 0
Merger and AHI Acquisition (Note 1):      
Issuance of limited partnership units in the AHI Acquisition 0 0 131,674
Implied issuance of GAHR III common stock in exchange for net assets acquired and purchase of noncontrolling interests in connection with the Merger 0 0 722,169
Fair value of mortgage loans payable and lines of credit and term loans assumed in the Merger $ 0 $ 0 $ 507,503
v3.24.1
Organization and Description of Business
12 Months Ended
Dec. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]  
Organization and Description of Business
1. Organization and Description of Business
Overview and Background
American Healthcare REIT, Inc., a Maryland corporation, is a self-managed real estate investment trust, or REIT, that acquires, owns and operates a diversified portfolio of clinical healthcare real estate properties, focusing primarily on outpatient medical buildings, senior housing, skilled nursing facilities, or SNFs, and other healthcare-related facilities. We also operate healthcare-related facilities utilizing the structure permitted by the REIT Investment Diversification and Empowerment Act of 2007, which is commonly referred to as a “RIDEA” structure (the provisions of the Internal Revenue Code of 1986, as amended, or the Code, authorizing the RIDEA structure were enacted as part of the Housing and Economic Recovery Act of 2008). Our healthcare facilities operated under a RIDEA structure include our senior housing operating properties, or SHOP, and our integrated senior health campuses. We have originated and acquired secured loans and may also originate and acquire other real estate-related investments on an infrequent and opportunistic basis. We generally seek investments that produce current income; however, we have selectively developed, and may continue to selectively develop, healthcare real estate properties. We have elected to be taxed as a REIT for U.S. federal income tax purposes. We believe that we have been organized and operated, and we intend to continue to operate, in conformity with the requirements for qualification and taxation as a REIT under the Code.
On October 1, 2021, Griffin-American Healthcare REIT III, Inc., or GAHR III, merged with and into a wholly-owned subsidiary, or Merger Sub, of Griffin-American Healthcare REIT IV, Inc., or GAHR IV, with Merger Sub being the surviving company, which we refer to as the REIT Merger, and our operating partnership, Griffin-American Healthcare REIT IV Holdings, LP, or GAHR IV Operating Partnership, merged with and into Griffin-American Healthcare REIT III Holdings, LP, or the Surviving Partnership, with the Surviving Partnership being the surviving entity, which we refer to as the Partnership Merger and, together with the REIT Merger, the Merger. Following the Merger on October 1, 2021, our company, or the Combined Company, was renamed American Healthcare REIT, Inc. and the Surviving Partnership was renamed American Healthcare REIT Holdings, LP, or our operating partnership.
Also on October 1, 2021, immediately prior to the consummation of the Merger, GAHR III acquired a newly formed entity, American Healthcare Opps Holdings, LLC, or NewCo, which we refer to as the AHI Acquisition, pursuant to a contribution and exchange agreement dated June 23, 2021, or the Contribution Agreement, between GAHR III; our operating partnership; American Healthcare Investors, LLC, or AHI; Griffin Capital Company, LLC, or Griffin Capital; Platform Healthcare Investor T-II, LLC; Flaherty Trust; and Jeffrey T. Hanson, the non-executive Chairman of our board of directors, or our board, Danny Prosky, our Chief Executive Officer, President and director, and Mathieu B. Streiff, one of our directors, or collectively, the AHI Principals. NewCo owned substantially all of the business and operations of AHI, as well as all of the equity interests in (i) Griffin-American Healthcare REIT IV Advisor, LLC, or GAHR IV Advisor, a subsidiary of AHI that served as the external advisor of GAHR IV, and (ii) Griffin-American Healthcare REIT III Advisor, LLC, or GAHR III Advisor, also referred to as our former advisor, a subsidiary of AHI that served as the external advisor of GAHR III.
See Note 4, Business Combinations — 2021 Business Combinations, for a further discussion of the Merger and the AHI Acquisition.
Operating Partnership
We conduct substantially all of our operations through our operating partnership, and we are the sole general partner of our operating partnership. As of both December 31, 2023 and 2022, we owned 95.0% of the operating partnership units, or OP units, in our operating partnership, and the remaining 5.0% limited OP units were owned by the NewCo Sellers, as defined in Note 4, Business Combinations — 2021 Business Combinations. See Note 12, Redeemable Noncontrolling Interests, and Note 13, Equity — Noncontrolling Interests in Total Equity, for a further discussion of the ownership in our operating partnership.
Public Offerings
As of December 31, 2023, after taking into consideration the Merger and the impact of the reverse stock split as discussed in Note 2, Summary of Significant Accounting Policies, we had issued 65,445,557 shares for a total of $2,737,716,000 of common stock since February 26, 2014 in our initial public offerings and our distribution reinvestment plan, or DRIP, offerings (including historical offering amounts sold by GAHR III and GAHR IV prior to the Merger).
On February 9, 2024, pursuant to a Registration Statement filed with the United States Securities and Exchange Commission, or SEC, on Form S-11 (File No. 333-267464), as amended, we closed our underwritten public offering, or the 2024 Offering, through which we issued 64,400,000 shares of common stock, $0.01 par value per share, for a total of $772,800,000 in gross offering proceeds. Such amounts include the exercise in full of the underwriters’ overallotment option to purchase up to an additional 8,400,000 shares of common stock. These shares are listed on New York Stock Exchange, or NYSE, under the trading symbol “AHR” and began trading on February 7, 2024.
See Note 13, Equity — Common Stock, and Note 13, Equity — Distribution Reinvestment Plan, for a further discussion of our public offerings.
Our Real Estate Investments Portfolio
We currently operate through four reportable business segments: integrated senior health campuses, outpatient medical, or OM, (which was formerly known as medical office buildings, or MOBs), triple-net leased properties and SHOP. As of December 31, 2023, we owned and/or operated 296 buildings and integrated senior health campuses including completed development and expansion projects representing approximately 18,822,000 square feet of gross leasable area, or GLA, for an aggregate contract purchase price of $4,473,543,000. In addition, as of December 31, 2023, we also owned a real estate-related debt investment purchased for $60,429,000.
v3.24.1
Summary of Significant Accounting Policies
12 Months Ended
Dec. 31, 2023
Accounting Policies [Abstract]  
Summary of Significant Accounting Policies
2. Summary of Significant Accounting Policies
The summary of significant accounting policies presented below is designed to assist in understanding our accompanying consolidated financial statements. Such consolidated financial statements and the accompanying notes thereto are the representations of our management, who are responsible for their integrity and objectivity. These accounting policies conform to accounting principles generally accepted in the United States of America, or GAAP, in all material respects, and have been consistently applied in preparing our accompanying consolidated financial statements.
Basis of Presentation
Our accompanying consolidated financial statements include our accounts and those of our operating partnership, the wholly-owned subsidiaries of our operating partnership and all non-wholly owned subsidiaries in which we have control, as well as any VIEs, in which we are the primary beneficiary. The portion of equity in any subsidiary that is not wholly owned by us is presented in our accompanying consolidated financial statements as a noncontrolling interest. We evaluate our ability to control an entity, and whether the entity is a VIE and we are the primary beneficiary, by considering substantive terms of the arrangement and identifying which enterprise has the power to direct the activities of the entity that most significantly impacts the entity’s economic performance.
On November 15, 2022, we effected a one-for-four reverse stock split of our common stock and a corresponding reverse split of the OP units, or the Reverse Splits. All numbers of common shares and per share data, as well as the OP units, in our accompanying consolidated financial statements and related notes have been retroactively adjusted for all periods presented to give effect to the Reverse Splits.
We operate and intend to continue to operate in an umbrella partnership REIT structure in which our operating partnership, wholly-owned subsidiaries of our operating partnership and all non-wholly owned subsidiaries of which we have control will own substantially all of the interests in properties acquired on our behalf. We are the sole general partner of our operating partnership and as of both December 31, 2023 and 2022, we owned a 95.0% general partnership interest therein, and the remaining 5.0% limited partnership interest was owned by the NewCo Sellers, as defined in Note 4, Business Combinations — 2021 Business Combinations.
The accounts of our operating partnership are consolidated in our accompanying consolidated financial statements because we are the sole general partner of our operating partnership and have unilateral control over its management and major operating decisions (even if additional limited partners are admitted to our operating partnership). All intercompany accounts and transactions are eliminated in consolidation.
Use of Estimates
The preparation of our accompanying consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, as well as the disclosure of contingent assets and liabilities, at the date of our consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates and assumptions include, but are not limited
to, the initial and recurring valuation of certain assets acquired and liabilities assumed through property acquisitions including through business combinations, goodwill and its impairment, revenues and grant income, allowance for credit losses, impairment of long-lived and intangible assets and contingencies. These estimates are made and evaluated on an on-going basis using information that is currently available as well as various other assumptions believed to be reasonable under the circumstances. Actual results could differ from those estimates, perhaps in material adverse ways, and those estimates could be different under different assumptions or conditions.
Cash, Cash Equivalents and Restricted Cash
Cash and cash equivalents consist of all highly liquid investments with a maturity of three months or less when purchased. Restricted cash primarily comprises lender required accounts for property taxes, tenant improvements, capital improvements and insurance, which are restricted as to use or withdrawal.
Leases
Lessee: We determine if a contract is a lease upon inception of the lease and maintain a distinction between finance and operating leases. Pursuant to Financial Accounting Standards Board, or FASB, Accounting Standards Codification, or ASC, Topic 842, Leases, or ASC Topic 842, lessees are required to recognize the following for all leases with terms greater than 12 months at the commencement date: (i) a lease liability, which is a lessee’s obligation to make lease payments arising from a lease; and (ii) a right-of-use asset, which is an asset that represents the lessee’s right to use, or control the use of, a specified asset for the lease term. The lease liability is calculated by using either the implicit rate of the lease or the incremental borrowing rate. The accretion of lease liabilities and amortization expense on right-of-use assets for our operating leases are included in rental expenses, property operating expenses or general and administrative expenses in our accompanying consolidated statements of operations and comprehensive loss. Operating lease liabilities are calculated using our incremental borrowing rate based on the information available as of the lease commencement date.
For our finance leases, the accretion of lease liabilities are included in interest expense and the amortization expense on right-of-use assets are included in depreciation and amortization in our accompanying consolidated statements of operations and comprehensive loss. Further, finance lease assets are included within real estate investments, net and finance lease liabilities are included within financing obligations in our accompanying consolidated balance sheets.
Lessor: Pursuant to ASC Topic 842, lessors bifurcate lease revenues into lease components and non-lease components and separately recognize and disclose non-lease components that are executory in nature. Lease components continue to be recognized on a straight-line basis over the lease term and certain non-lease components may be accounted for under the revenue recognition guidance in ASC Topic 606, Revenue from Contracts with Customers, or ASC Topic 606. See the “Revenue Recognition” section below. ASC Topic 842 also provides for a practical expedient package that permits lessors to not separate non-lease components from the associated lease component if certain conditions are met. In addition, such practical expedient causes an entity to assess whether a contract is predominately lease- or service-based, and recognize the revenue from the entire contract under the relevant accounting guidance. We recognize revenue for our OM buildings and triple-net leased properties segments as real estate revenue. Minimum annual rental revenue is recognized on a straight-line basis over the term of the related lease (including rent holidays). Differences between real estate revenue recognized and cash amounts contractually due from tenants under the lease agreements are recorded to deferred rent receivable, which is included in other assets, net in our accompanying consolidated balance sheets. Tenant reimbursement revenue, which comprises additional amounts recoverable from tenants for common area maintenance expenses and certain other recoverable expenses, are considered non-lease components and variable lease payments. We qualified for and elected the practical expedient as outlined above to combine the non-lease component with the lease component, which is the predominant component, and therefore the non-lease component is recognized as part of real estate revenue. In addition, as lessors, we exclude certain lessor costs (i.e., property taxes and insurance) paid directly by a lessee to third parties on our behalf from our measurement of variable lease revenue and associated expense (i.e., no gross up of revenue and expense for these costs); and include lessor costs that we paid and are reimbursed by the lessee in our measurement of variable lease revenue and associated expense (i.e., gross up revenue and expense for these costs).
At our RIDEA facilities, we offer residents room and board (lease component), standard meals and healthcare services (non-lease component) and certain ancillary services that are not contemplated in the lease with each resident (i.e., laundry, guest meals, etc.). For our RIDEA facilities, we recognize revenue under ASC Topic 606 as resident fees and services, based on our predominance assessment from electing the practical expedient outlined above. See the “Revenue Recognition” section below.
See Note 17, Leases, for a further discussion of our leases.
Revenue Recognition
Real Estate Revenue
We recognize real estate revenue in accordance with ASC Topic 842. See the “Leases” section above.
Resident Fees and Services Revenue
We recognize resident fees and services revenue in accordance with ASC Topic 606. A significant portion of resident fees and services revenue represents healthcare service revenue that is reported at the amount that we expect to be entitled to in exchange for providing patient care. These amounts are due from patients, third-party payors (including health insurers and government programs), other healthcare facilities, and others and includes variable consideration for retroactive revenue adjustments due to settlement of audits, reviews, and investigations. Generally, we bill the patients, third-party payors and other healthcare facilities several days after the services are performed. Revenue is recognized as performance obligations are satisfied. Consistent with healthcare industry accounting practices, any changes to these governmental revenue estimates are recorded in the period the change or adjustment becomes known based on final settlement. Any differences between recorded revenues and subsequent adjustments are reflected in operations in the year finalized.
Performance obligations are determined based on the nature of the services provided by us. Revenue for performance obligations satisfied over time is recognized based on actual charges incurred in relation to total expected (or actual) charges. This method provides a depiction of the transfer of services over the term of the performance obligation based on the inputs needed to satisfy the obligation. Generally, performance obligations satisfied over time relate to patients receiving long-term healthcare services, including rehabilitation services. We measure the performance obligation from admission into the facility to the point when we are no longer required to provide services to that patient. Revenue for performance obligations satisfied at a point in time is recognized when goods or services are provided and we do not believe we are required to provide additional goods or services to the patient. Generally, performance obligations satisfied at a point in time relate to sales of our pharmaceuticals business or to sales of ancillary supplies.
Because all of our performance obligations relate to contracts with a duration of less than one year, we have elected to apply the optional exemption provided in ASC Topic 606 and, therefore, are 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 performance obligations for these contracts are generally completed within months of the end of the reporting period.
We determine the transaction price based on standard charges for goods and services provided, reduced, where applicable, by contractual adjustments provided to third-party payors, implicit price concessions provided to uninsured patients, and estimates of goods to be returned. We also determine the estimates of contractual adjustments based on Medicare and Medicaid pricing tables and historical experience. We determine the estimate of implicit price concessions based on the historical collection experience with each class of payor.
Agreements with third-party payors typically provide for payments at amounts less than established charges. The following is a summary of the payment arrangements with major third-party payors:
Medicare: Certain healthcare services are paid at prospectively determined rates based on cost-reimbursement methodologies subject to certain limits.
Medicaid: Reimbursements for Medicaid services are generally paid at prospectively determined rates. In the state of Indiana, we participate in an Upper Payment Limit program, or IGT, with various county hospital partners, which provides supplemental Medicaid payments to SNFs that are licensed to non-state, government-owned entities such as county hospital districts. We have operational responsibility through management agreements for facilities retained by the county hospital districts including this IGT. The licenses and management agreements between the nursing center division and hospital districts are terminable by either party to restore the previous licensed status.
Other: Payment agreements with certain commercial insurance carriers, health maintenance organizations and preferred provider organizations provide for payment using prospectively determined rates per discharge, discounts from established charges and prospectively determined periodic rates.
Laws and regulations concerning government programs, including Medicare and Medicaid, are complex and subject to varying interpretation. As a result of investigations by governmental agencies, various healthcare organizations have received requests for information and notices regarding alleged noncompliance with those laws and regulations, which, in some instances, have resulted in organizations entering into significant settlement agreements. Compliance with such laws and regulations may also be subject to future government review and interpretation as well as significant regulatory action, including fines, penalties and potential exclusion from the related programs. There can be no assurance that regulatory authorities will not challenge our compliance with these laws and regulations, and it is not possible to determine the impact such claims or penalties would have upon us, if any.
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 our 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 (that is, new information becomes available), or as years are settled or are no longer subject to such audits, reviews and investigations. Adjustments arising from a change in the transaction price were not significant for the years ended December 31, 2023, 2022 and 2021.
Disaggregation of Resident Fees and Services Revenue
We disaggregate revenue from contracts with customers according to lines of business and payor classes. The transfer of goods and services may occur at a point in time or over time; in other words, revenue may be recognized over the course of the underlying contract, or may occur at a single point in time based upon a single transfer of control. This distinction is discussed in further detail below. We determine that disaggregating revenue into these categories achieves the disclosure objective to depict how the nature, amount, timing and uncertainty of revenue and cash flows are affected by economic factors.
The following tables disaggregate our resident fees and services revenue by line of business, according to whether such revenue is recognized at a point in time or over time, for the years then ended (in thousands):
Integrated
Senior Health
Campuses
SHOP(1)Total
2023:
Over time$1,216,647 $182,200 $1,398,847 
Point in time265,233 4,662 269,895 
Total resident fees and services$1,481,880 $186,862 $1,668,742 
2022:
Over time$1,019,198 $154,268 $1,173,466 
Point in time235,467 3,223 238,690 
Total resident fees and services$1,254,665 $157,491 $1,412,156 
2021:
Over time$824,991 $96,000 $920,991 
Point in time200,708 2,236 202,944 
Total resident fees and services$1,025,699 $98,236 $1,123,935 
The following tables disaggregate our resident fees and services revenue by payor class for the years then ended (in thousands):
Integrated
Senior Health
Campuses
SHOP(1)Total
2023:
Private and other payors$696,147 $174,439 $870,586 
Medicare477,338 2,808 480,146 
Medicaid308,395 9,615 318,010 
Total resident fees and services$1,481,880 $186,862 $1,668,742 
2022:
Private and other payors$582,448 $144,771 $727,219 
Medicare429,129 — 429,129 
Medicaid243,088 12,720 255,808 
Total resident fees and services$1,254,665 $157,491 $1,412,156 
2021:
Private and other payors$462,828 $94,673 $557,501 
Medicare349,876 — 349,876 
Medicaid212,995 3,563 216,558 
Total resident fees and services$1,025,699 $98,236 $1,123,935 
___________
(1)Includes fees for basic housing, as well as fees for assisted living or skilled nursing care. We record revenue when services are rendered at amounts billable to individual residents. Residency agreements are generally for a term of 30 days, with resident fees billed monthly in advance. For patients under reimbursement arrangements with Medicaid, revenue is recorded based on contractually agreed-upon amounts or rates on a per resident, daily basis or as services are rendered.
Accounts Receivable, Net Resident Fees and Services Revenue
The beginning and ending balances of accounts receivable, net resident fees and services are as follows (in thousands):
Private
and
Other Payors
MedicareMedicaidTotal
Beginning balanceJanuary 1, 2023
$55,484 $45,669 $20,832 $121,985 
Ending balanceDecember 31, 2023
66,218 51,260 30,799 148,277 
Increase$10,734 $5,591 $9,967 $26,292 
Deferred Revenue Resident Fees and Services Revenue
Deferred revenue is included in security deposits, prepaid rent and other liabilities in our accompanying consolidated balance sheets. The beginning and ending balances of deferred revenue resident fees and services, almost all of which relates to private and other payors, are as follows (in thousands):
Total
Beginning balanceJanuary 1, 2023
$17,901 
Ending balance December 31, 2023
23,372 
Increase$5,471 
Financing Component
We have elected a practical expedient allowed under ASC Topic 606 and, therefore, we do not adjust the promised amount of consideration from patients and third-party payors for the effects of a significant financing component due to our expectation that the period between the time the service is provided to a patient and the time that the patient or a third-party payor pays for that service will be one year or less.
Contract Costs
We have applied the practical expedient provided by FASB ASC Topic 340, Other Assets and Deferred Costs, and, therefore, all incremental customer contract acquisition costs are expensed as they are incurred since the amortization period of the asset that we otherwise would have recognized is one year or less in duration.
Resident and Tenant Receivables and Allowances
Resident receivables, which are related to resident fees and services revenue, are carried net of an allowance for credit losses. An allowance is maintained for estimated losses resulting from the inability of residents and payors to meet the contractual obligations under their lease or service agreements. Substantially all of such allowances are recorded as direct reductions of resident fees and services revenue as contractual adjustments provided to third-party payors or implicit price concessions in our accompanying consolidated statements of operations and comprehensive loss. Our determination of the adequacy of these allowances is based primarily upon evaluations of historical loss experience, the residents’ financial condition, security deposits, cash collection patterns by payor and by state, current economic conditions, future expectations in estimating credit losses and other relevant factors. Tenant receivables, which are related to real estate revenue, and unbilled deferred rent receivables are reduced for amounts where collectability is not probable, which are recognized as direct reductions of real estate revenue in our accompanying consolidated statements of operations and comprehensive loss.
The following is a summary of our adjustments to allowances for the years ended December 31, 2023 and 2022 (in thousands):
Years Ended December 31,
20232022
Beginning balance
$14,071 $12,378 
Additional allowances20,774 21,538 
Write-offs(8,778)(10,684)
Recoveries collected or adjustments(9,030)(9,161)
Ending balance
$17,037 $14,071 
Real Estate Investments Purchase Price Allocation
Upon the acquisition of real estate properties or entities owning real estate properties, we determine whether the transaction is a business combination, which requires that the assets acquired and liabilities assumed constitute a business. If the assets acquired and liabilities assumed are not a business, we account for the transaction as an asset acquisition. Under both methods, we recognize the identifiable assets acquired and liabilities assumed; however, for a transaction accounted for as an asset acquisition, we capitalize transaction costs and allocate the purchase price using a relative fair value method allocating all accumulated costs, whereas for a transaction accounted for as a business combination, we immediately expense transaction costs incurred associated with the business combination and allocate the purchase price based on the estimated fair value of each separately identifiable asset and liability. For the years ended December 31, 2023, 2022 and 2021, our investment transactions were accounted for as asset acquisitions or as business combinations, as applicable. See Note 3, Real Estate Investments, Net — Acquisitions of Real Estate Investments, and Note 4, Business Combinations, for a further discussion.
We, with assistance from independent valuation specialists, measure the fair value of tangible and identified intangible assets and liabilities, as applicable, based on their respective fair values for acquired properties. Our method for allocating the purchase price to acquired investments in real estate requires us to make subjective assessments for determining fair value of the assets acquired and liabilities assumed. This includes determining the value of the buildings, land, leasehold interests, furniture, fixtures and equipment, above- or below-market rent, in-place leases, master leases, tenant improvements, above- or below-market debt assumed, derivative financial instruments assumed, and noncontrolling interest in the acquiree, if any. These estimates require significant judgment and in some cases involve complex calculations. These allocation assessments directly impact our results of operations, as amounts allocated to certain assets and liabilities have different depreciation or amortization
lives. In addition, we amortize the value assigned to above- or below-market rent as a component of revenue, unlike in-place leases and other intangibles, which we include in depreciation and amortization in our accompanying consolidated statements of operations and comprehensive loss.
The determination of the fair value of land is based upon comparable sales data. In cases where a leasehold interest in the land is acquired, only the above/below market consideration is necessary where the value of the leasehold interest is determined by discounting the difference between the contract ground lease payments and a market ground lease payment back to a present value as of the acquisition date. The fair value of buildings is based upon our determination of the value under two methods: one, as if it were to be replaced and vacant using cost data and, two, also using a residual technique based on discounted cash flow models, as vacant. Factors considered by us include an estimate of carrying costs during the expected lease-up periods considering current market conditions and costs to execute similar leases. We also recognize the fair value of furniture, fixtures and equipment on the premises, as well as the above- or below-market rent, the value of in-place leases, master leases, above- or below-market debt and derivative financial instruments assumed.
The value of the above- or below-market component of the acquired in-place leases is determined based upon the present value (using a discount rate that reflects the risks associated with the acquired leases) of the difference between: (i) the level payment equivalent of the contract rent paid pursuant to the lease; and (ii) our estimate of market rent payments taking into account the expected market rent growth. In the case of leases with options, a case-by-case analysis is performed based on all facts and circumstances of the specific lease to determine whether the option will be assumed to be exercised. The amounts related to above-market leases are included in identified intangible assets, net in our accompanying consolidated balance sheets and are amortized as a decrease to real estate revenue over the remaining non-cancelable lease term of the acquired leases with each property. The amounts related to below-market leases are included in identified intangible liabilities, net in our accompanying consolidated balance sheets and are amortized as an increase to real estate revenue over the remaining non-cancelable lease term plus any below-market renewal options of the acquired leases with each property.
The value of in-place lease costs are based on management’s evaluation of the specific characteristics of the tenant’s lease and our overall relationship with the tenants. Characteristics considered by us in allocating these values include the nature and extent of the credit quality and expectations of lease renewals, among other factors. The in-place lease intangible represents the value related to the economic benefit for acquiring a property with in-place leases as opposed to a vacant property, which is evaluated based on a review of comparable leases for a similar property, terms and conditions for marketing and executing new leases, and implied in the difference between the value of the whole property “as is” and “as vacant.” The net amounts related to in-place lease costs are included in identified intangible assets, net in our accompanying consolidated balance sheets and are amortized as an increase to depreciation and amortization expense over the average downtime of the acquired leases with each property. The net amounts related to the value of tenant relationships, if any, are included in identified intangible assets, net in our accompanying consolidated balance sheets and are amortized as an increase to depreciation and amortization expense over the average remaining non-cancelable lease term of the acquired leases plus the market renewal lease term. The value of a master lease, if any, in which a previous owner or a tenant is relieved of specific rental obligations as additional space is leased, is determined by discounting the expected real estate revenue associated with the master lease space over the assumed lease-up period.
The value of above- or below-market debt is determined based upon the present value of the difference between the cash flow stream of the assumed mortgage and the cash flow stream of a market rate mortgage at the time of assumption. The net value of above- or below-market debt is included in mortgage loans payable, net in our accompanying consolidated balance sheets and is amortized as an increase or decrease to interest expense, as applicable, over the remaining term of the assumed mortgage.
The values of contingent consideration assets and liabilities are analyzed at the time of acquisition. For contingent purchase options, the fair market value of the acquired asset is compared to the specified option price at the exercise date. If the option price is below market, it is assumed to be exercised and the difference between the fair market value and the option price is discounted to the present value at the time of acquisition.
The values of the redeemable and nonredeemable noncontrolling interests are estimated by applying the income approach based on a discounted cash flow analysis. The fair value measurement may apply significant inputs that are not observable in the market. See Note 4, Business Combinations — 2021 Business Combinations — Fair Value of Noncontrolling Interests, for a further discussion of our fair value measurement approach and the significant inputs used in the values of redeemable and nonredeemable noncontrolling interests in GAHR IV.
Real Estate Investments, Net
We carry our operating properties at our historical cost less accumulated depreciation. The cost of operating properties includes the cost of land and completed buildings and related improvements, including those related to financing obligations. Expenditures that increase the service life of properties are capitalized and the cost of maintenance and repairs is charged to expense as incurred. The cost of buildings and capital improvements is depreciated on a straight-line basis over the estimated useful lives of the buildings and capital improvements, up to 39 years, and the cost for tenant improvements is depreciated over the shorter of the lease term or useful life, up to 34 years. The cost of furniture, fixtures and equipment is depreciated over the estimated useful life, up to 28 years. When depreciable property is retired, replaced or disposed of, the related cost and accumulated depreciation is removed from the accounts and any gain or loss is reflected in earnings.
As part of the leasing process, we may provide the lessee with an allowance for the construction of leasehold improvements. These leasehold improvements are capitalized and recorded as tenant improvements and depreciated over the shorter of the useful life of the improvements or the lease term. If the allowance represents a payment for a purpose other than funding leasehold improvements, or in the event we are not considered the owner of the improvements, the allowance is considered to be a lease inducement and is included in other assets, net in our accompanying consolidated balance sheets. Lease inducement is amortized over the lease term as a reduction of real estate revenue on a straight-line basis. Factors considered during this evaluation include, among other things, who holds legal title to the improvements as well as other controlling rights provided by the lease agreement and provisions for substantiation of such costs (e.g., unilateral control of the tenant space during the build-out process). Determination of the appropriate accounting for the payment of a tenant allowance is made on a lease-by-lease basis, considering the facts and circumstances of the individual tenant lease. Recognition of lease revenue commences when the lessee is given possession of the leased space upon completion of tenant improvements when we are the owner of the leasehold improvements. However, when the leasehold improvements are owned by the tenant, the lease inception date (and the date on which recognition of lease revenue commences) is the date the tenant obtains possession of the leased space for purposes of constructing its leasehold improvements.
Goodwill
Goodwill represents the excess of consideration paid over the fair value of underlying identifiable net assets of a business acquired in a business combination. Our goodwill has an indeterminate life and is not amortized, but is tested for impairment on an annual basis, or more frequently if events or changes in circumstances indicate that the asset might be impaired. We take a qualitative approach, as applicable, to consider whether an impairment of goodwill exists prior to quantitatively determining the fair value of the reporting unit in step one of the impairment test. When step one of the impairment test is utilized, we compare the fair value of a reporting unit with its carrying amount. We recognize an impairment loss to the extent the carrying value of goodwill exceeds the implied value in the current period.
See Note 4, Business Combinations, for a further discussion of goodwill recognized in connection with our business combinations, and Note 18, Segment Reporting, for a further discussion of goodwill allocation by segment and impairment of goodwill.
Impairment of Long-Lived Assets and Intangible Assets
We periodically evaluate our long-lived assets, primarily consisting of investments in real estate that we carry at our historical cost less accumulated depreciation, for impairment when events or changes in circumstances indicate that its carrying value may not be recoverable. We consider the following indicators, among others, in our evaluation of impairment:
significant negative industry or economic trends;
a significant underperformance relative to historical or projected future operating results; and
a significant change in the extent or manner in which the asset is used or significant physical change in the asset.
If indicators of impairment of our long-lived assets are present, we evaluate the carrying value of the related real estate investments in relation to the future undiscounted cash flows of the underlying operations. In performing this evaluation, we consider market conditions and our current intentions with respect to holding or disposing of the asset. We adjust the net book value of properties we lease to others and other long-lived assets to fair value if the sum of the expected future undiscounted cash flows, including sales proceeds, is less than carrying value. We recognize an impairment loss at the time we make any such determination.
We test indefinite-lived intangible assets, other than goodwill, for impairment at least annually, and more frequently if indicators arise. We first assess qualitative factors to determine the likelihood that the fair value of the reporting group is less than its carrying value. If the carrying amount of an indefinite-lived intangible asset exceeds its fair value, an impairment loss is recognized. Fair values of other indefinite-lived intangible assets are usually determined based on discounted cash flows or appraised values, as appropriate.
If impairment indicators arise with respect to intangible assets with finite useful lives, we evaluate impairment by comparing the carrying amount of the asset to the estimated future undiscounted net cash flows expected to be generated by the asset. If the estimated future undiscounted net cash flows are less than the carrying amount of the asset, then we estimate the fair value of the asset and compare the estimated fair value to the intangible asset’s carrying value. For all of our reporting units, we recognize any shortfall from carrying value as an impairment loss in the current period.
See Note 3, Real Estate Investments, Net — Impairment of Real Estate Investments, for a further discussion of impairment of long-lived assets. See Note 6, Identified Intangible Assets and Liabilities, for a further discussion of impairment of intangible assets.
Properties Held for Sale
A property or a group of properties is reported in discontinued operations in our consolidated statements of operations and comprehensive loss for current and prior periods if the disposal represents a strategic shift that has (or will have) a major effect on an entity’s operations and financial results when either: (i) the component has been disposed of or (ii) is classified as held for sale. At such time as a property is held for sale, such property is carried at the lower of: (i) its carrying amount or (ii) fair value less costs to sell. In addition, a property being held for sale ceases to be depreciated. We classify operating properties as property held for sale in the period in which all of the following criteria are met:
management, having the authority to approve the action, commits to a plan to sell the asset;
the asset is available for immediate sale in its present condition subject only to terms that are usual and customary for sales of such assets;
an active program to locate a buyer or buyers and other actions required to complete the plan to sell the asset has been initiated;
the sale of the asset is probable and the transfer of the asset is expected to qualify for recognition as a completed sale within one year;
the asset is being actively marketed for sale at a price that is reasonable in relation to its current fair value; and
given the actions required to complete the plan to sell the asset, it is unlikely that significant changes to the plan would be made or that the plan would be withdrawn.
Our properties held for sale are included in other assets, net in our accompanying consolidated balance sheets. We did not recognize impairment charges on properties held for sale for the years ended December 31, 2023, 2022 and 2021.
For the year ended December 31, 2023, we did not dispose of any held for sale properties. For the year ended December 31, 2022, we disposed of two integrated senior health campuses included in properties held for sale for an aggregate contract sales price of $18,700,000 and recognized an aggregate net gain on sale of $3,421,000. For the year ended December 31, 2021, we disposed of two integrated senior health campuses included in properties held for sale for an aggregate contract sales price of $500,000 and recognized an aggregate net loss on sale of $(114,000).
For the year ended December 31, 2021, our former advisor agreed to waive $93,000 in disposition fees that may otherwise have been due to our former advisor pursuant to the Advisory Agreement, as defined in Note 14, Related Party Transactions. Our former advisor did not receive any additional securities, shares of stock or any other form of consideration or any repayment as a result of the waiver of such disposition fees. See Note 3, Real Estate Investments, Net — Dispositions of Real Estate Investments, for a further discussion of our property dispositions, as well as Note 13, Equity — Noncontrolling Interests in Total Equity, for a discussion of the disposition of membership interests in a consolidated limited liability company.
Debt Security Investment, Net
We classify our marketable debt security investment as held-to-maturity because we have the positive intent and ability to hold the security to maturity, and we have not recorded any unrealized holding gains or losses on such investment. Our held-to-maturity security is recorded at amortized cost and adjusted for the amortization of premiums or discounts through maturity.
See Note 5, Debt Security Investment, Net, for a further discussion.
Derivative Financial Instruments
We are exposed to the effect of interest rate changes in the normal course of business. We seek to mitigate these risks by following established risk management policies and procedures, which include the occasional use of derivatives. Our primary strategy in entering into derivative contracts, such as fixed-rate interest rate swaps and interest rate caps, is to add stability to interest expense and to manage our exposure to interest rate movements by effectively converting a portion of our variable-rate debt to fixed-rate debt. We do not enter into derivative instruments for speculative purposes.
Derivatives are recognized as either other assets or other liabilities in our accompanying consolidated balance sheets and are measured at fair value. We do not designate our derivative instruments as hedge instruments as defined by guidance under ASC Topic 815, Derivatives and Hedges, or ASC Topic 815, which allows for gains and losses on derivatives designated as hedges to be offset by the change in value of the hedged items or to be deferred in other comprehensive income (loss). Changes in the fair value of our derivative financial instruments are recorded as a component of interest expense in gain or loss in fair value of derivative financial instruments in our accompanying consolidated statements of operations and comprehensive loss.
See Note 10, Derivative Financial Instruments, and Note 15, Fair Value Measurements, for a further discussion of our derivative financial instruments.
Fair Value Measurements
The fair value of certain assets and liabilities is a market-based measurement, not an entity-specific measurement. Therefore, a fair value measurement should be determined based on the assumptions that market participants would use in pricing the asset or liability. As a basis for considering market participant assumptions in fair value measurements, we follow a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of our reporting entity (observable inputs that are classified within Levels 1 and 2 of the hierarchy) and our reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy).
Level 1 inputs are quoted prices (unadjusted) in active markets for identical assets or liabilities that we have the ability to access. An active market is defined as a market in which transactions for the assets or liabilities occur with sufficient frequency and volume to provide pricing information on an ongoing basis. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs that are observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates and yield curves that are observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input that is significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment and considers factors specific to the asset or liability.
See Note 15, Fair Value Measurements, for a further discussion.
Other Assets, Net
Other assets, net primarily consists of inventory, prepaid expenses and deposits, deferred financing costs related to our lines of credit, deferred rent receivables, deferred tax assets, investments in unconsolidated entities, lease inducements and lease commissions. Inventory consists primarily of pharmaceutical and medical supplies and is stated at the lower of cost (first-in, first-out) or market. Deferred financing costs related to our lines of credit include amounts paid to lenders and others to obtain such financing. Such costs are amortized using the straight-line method over the term of the related loan, which approximates the effective interest rate method. Amortization of deferred financing costs related to our lines of credit is included in interest expense in our accompanying consolidated statements of operations and comprehensive loss. Lease commissions are amortized using the straight-line method over the term of the related lease. Prepaid expenses are amortized over the related contract periods.
We report investments in unconsolidated entities using the equity method of accounting when we have the ability to exercise significant influence over the operating and financial policies. Under the equity method, our share of the investee’s
earnings or losses is included in our accompanying consolidated statements of operations and comprehensive loss. We generally do not recognize equity method losses when such losses exceed our net equity method investment balance unless we have committed to provide such investee additional financial support or guaranteed its obligations. To the extent that our cost basis is different from the basis reflected at the entity level, the basis difference is generally amortized over the lives of the related assets and liabilities, and such amortization is included in our share of equity in earnings of the entity. The initial carrying value of investments in unconsolidated entities is based on the amount paid to purchase the entity interest or the estimated fair value of the assets prior to the sale of interests in the entity. We have elected to follow the cumulative earnings approach when classifying distributions received from equity method investments in our consolidated statements of cash flows, whereby any distributions received up to the amount of cumulative equity earnings will be considered a return on investment and classified in operating activities and any excess distributions would be considered a return of investment and classified in investing activities. We evaluate our equity method investments for impairment based upon a comparison of the estimated fair value of the equity method investment to its carrying value. When we determine a decline in the estimated fair value of such an investment below its carrying value is other-than-temporary, an impairment is recorded.
See Note 7, Other Assets, Net, for a further discussion.
Accounts Payable and Accrued Liabilities
As of December 31, 2023 and 2022, accounts payable and accrued liabilities primarily include insurance reserves of $44,548,000 and $39,893,000, respectively, reimbursement of payroll-related costs to the managers of our SHOP and integrated senior health campuses of $42,698,000 and $38,624,000, respectively, accrued developments and capital expenditures to unaffiliated third parties of $24,881,000 and $30,211,000, respectively, accrued property taxes of $23,549,000 and $24,926,000, respectively, and accrued distributions to common stockholders of $16,557,000 and $26,484,000, respectively.
Stock Based Compensation
We follow ASC Topic 718, Compensation — Stock Compensation, or ASC Topic 718, to account for our stock compensation pursuant to the Second Amended and Restated 2015 Incentive Plan, or the AHR Incentive Plan, using the fair value method, which requires an estimate of fair value of the award at the time of grant and recognition of compensation expense on a straight-line basis over the requisite service period of the awards. Forfeitures of stock based awards are recognized as an adjustment to compensation expense as they occur. Awards granted under the AHR Incentive Plan consist of restricted stock or units issued to our executive officers and employees, in addition to restricted stock issued to our directors. See Note 13, Equity — Equity Compensation Plans, for a further discussion of awards granted under the AHR Incentive Plan.
Foreign Currency
We have real estate investments in the United Kingdom, or UK, and Isle of Man for which the functional currency is the UK Pound Sterling, or GBP. We translate the results of operations of our foreign real estate investments into United States Dollars, or USD, using the average currency rates of exchange in effect during the period, and we translate assets and liabilities using the currency exchange rate in effect at the end of the period. The resulting foreign currency translation adjustments are included in accumulated other comprehensive loss, a component of stockholders’ equity, in our accompanying consolidated balance sheets. Certain balance sheet items, primarily equity and capital-related accounts, are reflected at the historical currency exchange rates. We also have intercompany notes and payables denominated in GBP with our UK subsidiaries. Gains or losses resulting from remeasuring such intercompany notes and payables into USD at the end of each reporting period are reflected in our accompanying consolidated statements of operations and comprehensive loss. When such intercompany notes and payables are deemed to be of a long-term investment nature, they will be reflected in accumulated other comprehensive loss in our accompanying consolidated balance sheets.
Gains or losses resulting from foreign currency transactions are remeasured into USD at the rates of exchange prevailing on the date of the transactions. The effects of transaction gains or losses are included in our accompanying consolidated statements of operations and comprehensive loss.
Income Taxes
We qualify, and elect to be taxed, as a REIT under the Code, and we intend to continue to qualify to be taxed as a REIT. To maintain our qualification as a REIT, we must meet certain organizational and operational requirements, including a requirement to distribute to our stockholders a minimum of 90.0% of our annual taxable income, excluding net capital gains. We generally will not be subject to U.S. federal income taxes if we distribute 100% of our taxable income each year to our stockholders.
If we fail to maintain our qualification as a REIT in any taxable year, we will then be subject to U.S. federal income taxes on our taxable income at regular corporate rates and will not be permitted to qualify for treatment as a REIT for U.S. federal income tax purposes for four years following the year during which qualification is lost unless the Internal Revenue Service grants us relief under certain statutory provisions. Such an event could have a material adverse effect on our net income and net cash available for distribution to our stockholders.
We may be subject to certain state and local income taxes on our income, property or net worth in some jurisdictions, and, in certain circumstances, we may also be subject to federal excise taxes on undistributed income. In addition, certain activities that we undertake are conducted by subsidiaries, which we elected to be treated as taxable REIT subsidiaries, or TRS, to allow us to provide services that would otherwise be considered impermissible for REITs. Also, we have real estate investments in the UK and Isle of Man, which do not accord REIT status to United States REITs under their tax laws. Accordingly, we recognize an income tax benefit or expense for the federal, state and local income taxes incurred by our TRS and foreign income taxes on our real estate investments in the UK and Isle of Man.
We account for deferred income taxes using the asset and liability method and recognize deferred tax assets and liabilities for the expected future tax consequences of events that have been included in our financial statements or tax returns. Under this method, we determine deferred tax assets and liabilities based on the temporary differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases using enacted tax rates in effect for the year in which the differences are expected to reverse. Deferred tax assets reflect the impact of the future deductibility of operating loss carryforwards. A valuation allowance is provided if we believe it is more likely than not that all or some portion of the deferred tax asset will not be realized. Any increase or decrease in the valuation allowance that results from a change in circumstances, and that causes us to change our judgment about the realizability of the related deferred tax asset, is included in income tax benefit or expense in our accompanying consolidated statements of operations and comprehensive loss when such changes occur. Any increase or decrease in the deferred tax liability that results from a change in circumstances, and that causes us to change our judgment about expected future tax consequences of events, is recorded in income tax benefit or expense in our accompanying consolidated statements of operations and comprehensive loss.
Net deferred tax assets are included in other assets, or net deferred tax liabilities are included in security deposits, prepaid rent and other liabilities, in our accompanying consolidated balance sheets.
See Note 16, Income Taxes, for a further discussion.
Segment Disclosure
We segregate our operations into reporting segments in order to assess the performance of our business in the same way that management reviews our performance and makes operating decisions. During the quarter ended December 31, 2023, we modified how we evaluate our business and make resource allocations, and therefore determined that we operate through four reportable business segments; integrated senior health campuses, OM (which was formerly known as MOBs), triple-net leased properties and SHOP. All segment information included in the notes to the accompanying consolidated financial statements has been recast for all periods presented to reflect four reportable business segments and the change in segment name from MOBs to OM. The segment name change from MOBs to OM did not result in any changes to the composition of such segment or information reviewed by management, and therefore, had no impact on the historical results of operations.
See Note 18, Segment Reporting, for a further discussion.
GLA and Other Measures
GLA and other measures used to describe real estate investments included in our accompanying consolidated financial statements are presented on an unaudited basis.
Recently Issued Accounting Pronouncements
In March 2020, the FASB issued Accounting Standards Update, or ASU, 2020-04, Facilitation of the Effects of Reference Rate Reform of Financial Reporting, or ASU 2020-04, which provides optional expedients and exceptions for applying GAAP to contract modifications, hedging relationships and other transactions, subject to meeting certain criteria. ASU 2020-04 applies to the aforementioned transactions that reference the London Inter-bank Offered Rate, or LIBOR, or another reference rate expected to be discontinued because of the reference rate reform. In January 2021, the FASB issued ASU 2021-01, Reference Rate Reform (Topic 848), or ASU 2021-01, which clarifies that certain optional expedients and exceptions for contract modification and hedge accounting apply to derivative instruments that use an interest rate for margining,
discounting, or contract price alignment that is modified as a result of the discontinuation of the use of LIBOR as a benchmark interest rate due to reference rate reform. In December 2022, the FASB issued ASU 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848, or ASU 2022-06, which extends the period of time entities can utilize the reference rate reform relief guidance under ASU 2020-04 from December 31, 2022 to December 31, 2024. ASU 2020-04, ASU 2021-01 and ASU 2022-06 are effective for fiscal years and interim periods beginning after March 12, 2020 and through the effective date December 31, 2024, as extended by ASU 2022-06. We adopted such accounting pronouncements on January 1, 2023, which has not had a material impact on our consolidated financial statements and disclosures as of December 31, 2023.
In July 2023, the FASB issued ASU 2023-03, Presentation of Financial Statements (Topic 205), Income Statement-Reporting Comprehensive Income (Topic 220), Distinguishing Liabilities from Equity (Topic 480), Equity (Topic 505), and Compensation-Stock Compensation (Topic 718): Amendments to SEC Paragraphs Pursuant to SEC Staff Accounting Bulletin No. 120, SEC Staff Announcement at the March 24, 2022 EITF Meeting, and Staff Accounting Bulletin Topic 6.B, Accounting Series Release 280-General Revision of Regulation S-X: Income or Loss Applicable to Common Stock, or ASU 2023-03. ASU 2023-03 amends the Accounting Standards Codification, or ASC, for SEC updates pursuant to SEC Staff Accounting Bulletin No. 120; SEC Staff Announcement at the March 24, 2022 Emerging Issues Task Force Meeting; and Staff Accounting Bulletin Topic 6.B, Accounting Series Release 280 - General Revision of Regulation S-X: Income or Loss Applicable to Common Stock. These updates were immediately effective and did not have a material impact on our consolidated financial statements and disclosures.
In August 2023, the FASB issued ASU 2023-05, Business Combinations — Joint Venture Formations (Subtopic 805- 60): Recognition and Initial Measurement, or ASU 2023-05. ASU 2023-05 applies to the initial formation of a “joint venture” or a “corporate joint venture” as defined in the accounting literature and requires a joint venture to apply a new basis of accounting by initially measuring and recognizing all contributions received upon its formation at fair value. In particular, a joint venture will measure its total assets and liabilities upon formation as the fair value of the joint venture as a whole, which would equal the fair value of all of the joint venture’s outstanding equity interests. The new guidance does not change the definition of a joint venture, the accounting by the investors for their investments in a joint venture (e.g., equity method accounting) or the accounting by a joint venture for contributions received after its formation. ASU 2023-05 will be applied prospectively and is effective for all newly-formed joint venture entities with a formation date on or after January 1, 2025. Early adoption is permitted. We do not expect the adoption of ASU 2023-05 on January 1, 2025 to have a material impact to our consolidated financial statements and disclosures.
In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, or ASU 2023-07, which is intended to improve reportable segment disclosure requirements, primarily through enhanced disclosures about significant expenses. Such disclosure amendments include the requirement for public entities to disclose significant segment expenses that are regularly provided to the chief operating decision maker and included within each reported measure of segment profit or loss. ASU 2023-07 is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted and should be applied retrospectively to all prior periods presented in the financial statements. We are currently evaluating this guidance to determine the impact to our consolidated financial statements and disclosures.
In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures, or ASU 2023-09, which includes amendments that further enhance income tax disclosures, primarily through standardization and disaggregation of rate reconciliation categories and income taxes paid by jurisdiction. ASU 2023-09 is effective for annual periods beginning after December 15, 2024. Early adoption is permitted and should be applied prospectively; however, retrospective application is permitted. We are currently evaluating this guidance to determine the impact to our consolidated financial statements and disclosures.
In March 2024, the SEC adopted final rules, The Enhancement and Standardization of Climate-Related Disclosures for Investors. The final rules require a registrant to disclose, among other things: material climate-related risks; activities to mitigate or adapt to such risks, as well as a quantitative and qualitative description of material expenditures incurred and material impacts on financial estimates and assumptions that directly result from such mitigation or adaptation activities; material capitalized costs, expenses and losses incurred as a result of severe weather events and other natural conditions; information about the registrant’s board of directors’ oversight of climate-related risks and management’s role in managing material climate-related risks; and information on any climate-related targets or goals that are material to the registrant’s business, results of operations or financial condition. The rules require registrants to provide such climate-related disclosures in their annual reports, beginning with annual reports for the year ending December 31, 2025, for calendar-year-end large accelerated filers. We are currently evaluating this guidance to determine the impact to our consolidated financial statement disclosures.
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Real Estate Investments, Net
12 Months Ended
Dec. 31, 2023
Real Estate [Abstract]  
Real Estate Investments, Net
3. Real Estate Investments, Net
Our real estate investments, net consisted of the following as of December 31, 2023 and 2022 (in thousands):
 December 31,
 20232022
Building, improvements and construction in process$3,604,299 $3,670,361 
Land and improvements335,946 344,359 
Furniture, fixtures and equipment237,350 221,727 
4,177,595 4,236,447 
Less: accumulated depreciation(752,157)(654,838)
$3,425,438 $3,581,609 
Depreciation expense for the years ended December 31, 2023, 2022 and 2021 was $147,587,000, $141,257,000 and $109,036,000, respectively.
The following is a summary of our capital expenditures for the years ended December 31, 2023, 2022 and 2021 (in thousands):
Years Ended December 31,
202320222021
Integrated senior health campuses$64,011 $30,926 $62,596 
OM24,296 32,373 21,605 
SHOP12,244 9,280 3,539 
Triple-net leased properties420 31 
Total$100,971 $72,583 $87,771 
Included in the capital expenditure amounts above are costs for the development and expansion of our integrated senior health campuses. For the year ended December 31, 2023, we incurred $4,988,000 to expand three of our existing integrated senior health campuses. For the year ended December 31, 2022, we exercised our right to purchase a leased property that cost $15,462,000 to develop and incurred a total of $7,543,000 to expand three of our existing integrated senior health campuses. For the year ended December 31, 2021, we completed the development of three integrated senior health campuses for an aggregate $50,435,000 and incurred a total $22,720,000 to expand two of our existing integrated senior health campuses. We also exercised our right to purchase a leased property that cost $11,004,000.
Acquisitions of Real Estate Investments
2023 Acquisitions of Real Estate Investments
For the year ended December 31, 2023, using cash on hand and debt financing, we, through a majority-owned subsidiary of Trilogy Investors, LLC, or Trilogy, of which we owned 74.1%, completed the acquisition of one integrated senior health campus. The following is a summary of such property acquisition (in thousands):
LocationDate AcquiredContract
Purchase Price
Mortgage
Loan Payable
Louisville, KY02/15/23$11,000 $7,700 
In addition, on June 30, 2023, we, through a majority-owned subsidiary of Trilogy, acquired a land parcel in Ohio for a contract purchase price of $660,000, plus closing costs, for the future expansion of an existing integrated senior health campus.
For the year ended December 31, 2023, using cash on hand and debt financing, we, through a majority-owned subsidiary of Trilogy, acquired three previously leased real estate investments located in Indiana and Ohio. The following is a summary of such acquisitions, which are included in our integrated senior health campuses segment (in thousands):
LocationDate AcquiredContract
Purchase Price
Mortgage
Loan Payable
Financing
Obligation
Washington, IN07/13/23$14,200 $12,212 $— 
Tell City, IN07/13/232,400 1,988 — 
New Albany, OH07/13/2316,283 — 16,283 
Total$32,883 $14,200 $16,283 
We accounted for our acquisitions of land and real estate investments completed during the year ended December 31, 2023 as asset acquisitions. The following table summarizes the purchase price of such assets acquired at the time of acquisition based on their relative fair values and adjusted for $28,623,000 operating lease right-of-use assets and $30,498,000 operating lease liabilities (in thousands):
2023
Acquisitions
Building and improvements$38,517 
Land4,917 
Total assets acquired$43,434 
2022 Acquisitions of Real Estate Investments
For the year ended December 31, 2022, using cash on hand and debt financing, we, through a majority-owned subsidiary of Trilogy, of which we owned 73.1%, exercised purchase options to acquire four previously leased real estate investments located in Indiana and Kentucky for an aggregate contract purchase price of $54,805,000, which investments are included in our integrated senior health campus segment. We financed such acquisitions with cash on hand and a mortgage loan payable with a principal balance of $52,725,000. In addition, for the year ended December 31, 2022, we, through a majority-owned subsidiary of Trilogy, acquired land parcels in Indiana and Kentucky for the future development and expansion of our integrated senior health campuses for an aggregate contract purchase price of $1,020,000, plus closing costs.
We accounted for our acquisitions of land and real estate investments completed during the year ended December 31, 2022 as asset acquisitions. For the year ended December 31, 2022, we incurred and capitalized closing costs and direct acquisition related expenses of $303,000. The following table summarizes the purchase price of such assets acquired at the time of acquisition based on their relative fair values and adjusted for $37,464,000 operating lease right-of-use assets and $36,326,000 operating lease liabilities (in thousands):
2022
Acquisitions
Building and improvements$49,645 
Land and improvements8,885 
Total assets acquired$58,530 
2021 Acquisitions of Real Estate Investments
For the year ended December 31, 2021, using cash on hand and debt financing, we, through a majority-owned subsidiary of Trilogy, of which we owned 72.9%, acquired a portfolio of six previously leased real estate investments located in Indiana and Ohio. The following is a summary of such property acquisitions, which are included in our integrated senior health campuses segment (in thousands):
LocationDate
Acquired
Contract
Purchase Price
Mortgage
Loan Payable
Acquisition
Fee(1)
Kendallville, IN; and Delphos, Lima, Springfield, Sylvania and Union Township, OH01/19/21$76,549 $78,587 $1,164 
___________
(1)Our former advisor was paid, as compensation for services rendered in connection with the investigation, selection and acquisition of our properties, an acquisition fee of 2.25% of the portion of the contract purchase price of the properties attributed to our ownership interest in the Trilogy subsidiary that acquired the properties.
For the year ended December 31, 2021, and prior to the Merger, we, through a majority-owned subsidiary of Trilogy, acquired land parcels in Indiana and Ohio for the future development and expansion of our integrated senior health campuses for an aggregate contract purchase price of $1,459,000 plus closing costs. We paid to our former advisor an acquisition fee of 2.25% of the portion of the contract purchase price of each land parcel attributed to our ownership interest. On October 15, 2021, we, through a majority-owned subsidiary of Trilogy, acquired a land parcel in Ohio for a contract purchase price of $249,000, plus closing costs.
We accounted for our acquisitions of land and real estate investments completed during the year ended December 31, 2021 as asset acquisitions. For the year ended December 31, 2021, we incurred and capitalized closing costs and direct acquisition related expenses of $1,855,000. The following table summarizes the purchase price of such assets acquired at the time of acquisition based on their relative fair values and adjusted for $57,647,000 operating lease right-of-use assets and $54,564,000 operating lease liabilities (in thousands):
2021
Acquisitions
Building and improvements$66,167 
Land17,612 
Total assets acquired$83,779 
Dispositions of Real Estate Investments
2023 Dispositions of Real Estate Investments
For the year ended December 31, 2023, we disposed of six SHOP and 16 OM buildings. We recognized a total aggregate net gain on such dispositions of $32,717,000. The following is a summary of such dispositions (dollars in thousands):
LocationNumber of
Buildings
TypeDate
Disposed
Contract
Sales Price
Pinellas Park, FL(1)1SHOP02/01/23$7,730 
Olympia Fields, IL1OM04/10/233,750 
Auburn, CA1OM04/26/237,050 
Pottsville, PA1OM04/26/236,000 
New London, CT1OM05/24/234,200 
Stratford, CT1OM05/24/234,800 
Westbrook, CT1OM05/24/237,250 
Lakeland, FL(1)1SHOP06/01/237,080 
Winter Haven, FL(1)1SHOP06/01/2317,500 
Acworth, GA3OM06/14/238,775 
Lithonia, GA1OM06/14/233,445 
Stockbridge, GA1OM06/14/232,430 
Lake Placid, FL(1)1SHOP06/30/235,620 
Brooksville, FL(1)1SHOP06/30/237,800 
Spring Hill, FL(1)1SHOP08/01/237,800 
Morristown, NJ1OM08/09/2362,210 
Evendale, OH1OM08/29/2311,900 
Longview, TX1OM09/19/231,500 
Naperville, IL2OM10/03/2317,800 
Total22$194,640 
___________
(1)See Note 12, Redeemable Noncontrolling Interests, for information about the ownership of the Central Florida Senior Housing Portfolio.
2022 Dispositions of Real Estate Investments
For the year ended December 31, 2022, we disposed of one OM building in Tennessee and three facilities in Florida within our Central Florida Senior Housing Portfolio. We recognized a total aggregate net gain on such dispositions of $1,370,000. The following is a summary of such dispositions, which were included in our OM and SHOP segments, as applicable (in thousands):
LocationDate
Disposed
Contract
Sales Price
Brooksville, FL(1)11/15/22$2,640 
Sanford, FL(1)12/15/223,750 
Memphis, TN12/20/229,600 
Bradenton FL(1)12/30/227,215 
Total$23,205 
___________
(1)See Note 12, Redeemable Noncontrolling Interests, for information about the ownership of the Central Florida Senior Housing Portfolio.
2021 Disposition of Real Estate Investment
In July 2021, we, through a majority-owned subsidiary of Trilogy, sold an integrated senior health campus, or the Sold Property, to an unaffiliated third party, or the Buyer, and leased it back, while retaining control of the Sold Property. This transaction did not meet the criteria for a sale and leaseback under GAAP. The lease agreement includes a finance obligation with a present value of $15,504,000 representing our obligation to purchase the Sold Property between 2028 and 2029. Simultaneously, we, through a majority-owned subsidiary of Trilogy, purchased a previously leased integrated senior health campus, or the Purchased Property, from the Buyer which was in exchange for the Sold Property. No cash consideration was exchanged as part of the transactions explained above. As of the transaction date, the carrying value of the Purchased Property of $14,807,000 was recorded to real estate investments, net, in our accompanying consolidated balance sheet, and the carrying value of the finance obligation of $15,504,000 was recorded to financing obligations in our accompanying consolidated balance sheet.
Sale of Controlling Interests in Developments
On February 8, 2022, we sold approximately 74.0% of our ownership interests in several real estate development assets within our integrated senior health campuses segment for an aggregate sales price of $19,622,000, and we recognized an aggregate gain on sale of $$683,000 for the year ended December 31, 2022. At the time of sale, we retained approximately 26.0% ownership interests in such real estate development assets. As of December 31, 2023 and 2022, we own approximately 49.0% and 31.6% ownership interests, respectively, in such real estate development assets, which interests are accounted for as investments in unconsolidated entities within other assets, net in our accompanying consolidated balance sheet as of December 31, 2023 and 2022. For the year ended December 31, 2023 and from February 8, 2022 through December 31, 2022, our interests in the net earnings or losses of such unconsolidated entities were included in income or loss from unconsolidated entities in our accompanying consolidated statements of operations and comprehensive loss.
See Note 4, Business Combinations, for a discussion of real estate investment acquisitions accounted for business combinations for the years ended December 31, 2023, 2022 and 2021.
Impairment of Real Estate Investments
For the year ended December 31, 2023, as we continue to evaluate additional non-strategic properties for sale, we determined that two of our SHOP and one of our OM buildings were impaired and recognized an aggregate impairment charge of $13,899,000, which reduced the total aggregate carrying value of such assets to $20,439,000. The remaining $3,477,000 carrying value of one of the impaired SHOP was reclassified to properties held for sale during the third quarter of 2023, which is included in other assets, net in our accompanying condensed consolidated balance sheet. The fair value of one SHOP was based on its projected sales price from an independent third party letter of intent, and the fair value of such OM was determined by the sales price from an executed purchase and sale agreement with a third-party buyer, which were considered Level 2 measurements within the fair value hierarchy. The fair value of the other SHOP was determined by a third-party appraiser based on the sales comparison approach with the most significant inputs based on a price per unit and price per square foot analysis within the area for similar types of assets. The ranges of these inputs were $190,000 to $200,000 per unit and $250 to $260 per square foot, which were considered Level 3 measurements within the fair value hierarchy.
For the year ended December 31, 2022, we determined that 12 facilities within our SHOP segment were impaired and recognized an aggregate impairment charge of $54,579,000, which reduced the total aggregate carrying value of such facilities to $81,149,000. We disposed of three of such impaired facilities during the fourth quarter of 2022, and disposed of five of such impaired facilities during the year of 2023, as discussed in the “Dispositions of Real Estate Investments” section above. The fair value of one of our impaired facilities was determined by the sales price from an executed purchase and sale agreement with a third-party buyer, which was considered a Level 2 measurement within the fair value hierarchy. The fair values of our remaining 11 impaired facilities were based on their projected sales prices, which were considered Level 2 measurements within the fair value hierarchy.
For the year ended December 31, 2021, we determined that one OM building was impaired and recognized an impairment charge of $3,335,000, which reduced the carrying value of such asset to $2,880,000. The fair value of such property was determined by the sales price from an executed purchase and sale agreement with a third-party buyer, and adjusted for anticipated selling costs, which was considered a Level 2 measurement within the fair value hierarchy. We disposed of such impaired OM building in July 2021 for a contract sales price of $3,000,000 and recognized a net gain on sale of $346,000.
v3.24.1
Business Combinations
12 Months Ended
Dec. 31, 2023
Business Combination and Asset Acquisition [Abstract]  
Business Combinations
4. Business Combinations
2023 and 2022 Business Combinations
On February 15, 2023, we, through a majority-owned subsidiary of Trilogy, acquired from an unaffiliated third party a 60.0% controlling interest in a privately held company, Memory Care Partners, LLC, or MCP, that operated integrated senior health campuses located in Kentucky. The contract purchase price for the acquisition of MCP was $900,000, which was acquired using cash on hand. Prior to such acquisition, we owned a 40.0% interest in MCP, which was accounted for as an equity method investment and was included in investments in unconsolidated entities within other assets, net in our accompanying condensed consolidated balance sheet as of December 31, 2022. In connection with the acquisition of the remaining interest in MCP, we now own a 100% controlling interest in MCP. As a result, we re-measured the fair value of our previously held equity interest in MCP and recognized a gain on re-measurement of $726,000 in our accompanying consolidated statements of operations and comprehensive loss.
For the year ended December 31, 2022, we accounted for four acquisitions as business combinations, as discussed below, the first three of which are included within our integrated senior health campuses segment. Based on quantitative and qualitative considerations, such four business combinations were not material to us individually or in the aggregate, and, therefore, pro forma financial information is not provided.
On January 3, 2022, we, through a majority-owned subsidiary of Trilogy, acquired an integrated senior health campus in Kentucky from an unaffiliated third party. The contract purchase price for such property acquisition was $27,790,000 plus immaterial transaction costs. We acquired such property using cash on hand and placed a mortgage loan payable of $20,800,000 on the property at the time of acquisition.
On April 1, 2022, we, through a majority-owned subsidiary of Trilogy, acquired a 50.0% interest in a pharmaceutical business in Florida from an unaffiliated third party and incurred transaction costs of $938,000. Prior to such pharmaceutical business acquisition, we, through a majority-owned subsidiary of Trilogy, owned the other 50.0% interest in such business, which was accounted for as an equity method investment. Therefore, through March 31, 2022, our 50.0% interest in the net earnings or losses of such unconsolidated entity was included in income or loss from unconsolidated entities in our accompanying consolidated statements of operations and comprehensive loss.
On August 1, 2022, we, through a majority-owned subsidiary of Trilogy, acquired a 50.0% controlling interest in a privately held company, RHS Partners, LLC, or RHS, that owns and/or operates 16 integrated senior health campuses located in Indiana, from an unaffiliated third party. The contract purchase price for the acquisition of RHS was $36,661,000 plus immaterial closing costs, which was primarily acquired using cash on hand. Prior to such acquisition, we owned a 50.0% interest in RHS, which was accounted for as an equity method investment and was included in investments in unconsolidated entities within other assets, net in our accompanying consolidated balance sheet as of December 31, 2021. Therefore, through July 31, 2022, our 50.0% equity interest in the net earnings or losses of RHS was included in income or loss from unconsolidated entities in our accompanying consolidated statements of operations and comprehensive loss. In connection with the acquisition of the remaining interest in RHS, we now own a 100% controlling interest in RHS. As a result, we re-measured the fair value of our previously held equity interest in RHS and recognized a gain on re-measurement of $19,567,000 in our accompanying consolidated statements of operations and comprehensive loss.
On December 5, 2022, we acquired a portfolio of seven senior housing facilities in Texas from an unaffiliated third party, which facilities are included in our SHOP segment. These facilities are part of the underlying collateral pool of real estate assets securing our debt security investment, as defined and described at Note 5, Debt Security Investment, Net. We acquired the seven facilities by assuming the outstanding principal balance of each related mortgage loan payable from one of the borrowers as such borrower was in default on the required debt payments. The aggregated principal balance of such assumed mortgage loans payable was $110,627,000 at the time of acquisition. No cash consideration was exchanged as part of the transactions; however, we incurred transaction costs of $1,895,000 related to the acquisition of such facilities. See Note 5, Debt Security Investment, Net, for a further discussion.
Based on quantitative and qualitative considerations, such business combinations in 2022 and 2023 were not material to us individually or in the aggregate, and, therefore, pro forma financial information is not provided. The fair values of the assets acquired and liabilities assumed were preliminary estimates at acquisition. Any necessary adjustments are finalized within one year from the date of acquisition. The table below summarizes the acquisition date fair values of the assets acquired and liabilities assumed of our business combinations during the years ended December 31, 2023 and 2022 (in thousands):
2023
Acquisition
2022
Acquisitions
Operating lease right-of-use assets$— $153,777 
Building and improvements— 163,166 
Goodwill3,331 44,990 
Land— 20,514 
Accounts receivable, net— 19,472 
In-place leases— 18,834 
Cash and restricted cash565 12,331 
Certificates of need— 3,567 
Furniture, fixtures and equipment39 1,936 
Other assets66 1,798 
Total assets acquired4,001 440,385 
Operating lease liabilities— (161,121)
Mortgage loans payable (including debt discount of $6,066)
— (149,861)
Security deposits and other liabilities(812)(15,994)
Accounts payable and accrued liabilities(1,676)(16,012)
Financing obligations(12)(65)
Total liabilities assumed(2,500)(343,053)
Net assets acquired$1,501 $97,332 
2021 Business CombinationsMerger and the AHI Acquisition
As discussed in Note 1, Organization and Description of Business, on October 1, 2021, pursuant to an Agreement and Plan of Merger dated June 23, 2021, we completed the REIT Merger and Partnership Merger. At the effective time of the REIT Merger and prior to the reverse stock split, each issued and outstanding share of GAHR III’s common stock, $0.01 par value per share, converted into the right to receive 0.9266 shares of GAHR IV’s Class I common stock, $0.01 par value per share. At the effective time of the Partnership Merger and prior to the reverse stock split, (i) each unit of limited partnership interest in our operating partnership outstanding as of immediately prior to the effective time of the Partnership Merger was converted automatically into the right to receive 0.9266 of a Partnership Class I Unit, as defined in the agreement of limited partnership, as amended, of the Surviving Partnership and (ii) each unit of limited partnership interest in GAHR IV Operating Partnership outstanding as of immediately prior to the effective time of the Partnership Merger was converted automatically into the right to receive one unit of limited partnership interest of the Surviving Partnership of like class.
Additionally, on October 1, 2021, the AHI Acquisition closed immediately prior to the consummation of the Merger, and pursuant to the Contribution Agreement, AHI contributed substantially all of its business and operations to the Surviving Partnership, including its interest in GAHR III Advisor and GAHR IV Advisor, and Griffin Capital contributed its ownership interest in GAHR III Advisor and GAHR IV Advisor to the Surviving Partnership. In exchange for their contributions, the Surviving Partnership issued limited OP units. The total approximate value of these OP units at the time of consummation of the transactions contemplated by the Contribution Agreement, and prior to the reverse stock split, was approximately $131,674,000, with a reference value for purposes thereof of $8.71 per OP unit, such that the Surviving Partnership issued 15,117,529 OP units as consideration for the transaction. Such OP units were owned by AHI Group Holdings, LLC, or AHI Group Holdings, which is owned and controlled by the AHI Principals, Platform Healthcare Investor T-II, LLC, Flaherty Trust and a wholly-owned subsidiary of Griffin Capital, or collectively, the NewCo Sellers.
Further, upon consummation of the AHI Acquisition, we redeemed all 51 limited partnership units that our former advisor held in our operating partnership, as well as all 52 limited partnership units held by GAHR IV Advisor in GAHR IV Operating Partnership. Also, on October 1, 2021 and in connection with the AHI Acquisition, our operating partnership redeemed all 5,148 shares of our common stock owned by our former advisor and all 5,208 shares of our Class T common stock owned by GAHR IV Advisor in GAHR IV.
The AHI Acquisition was treated as a business combination for accounting purposes, with GAHR III as both the legal and accounting acquiror of NewCo. While GAHR IV was the legal acquiror of GAHR III in the REIT Merger, GAHR III was determined to be the accounting acquiror in the REIT Merger in accordance with FASB ASC Topic 805, Business Combinations, or ASC Topic 805, after considering the relative share ownership and the composition of the governing body of the Combined Company. Thus, the financial information set forth herein subsequent to the consummation of the Merger and the AHI Acquisition reflects results of the Combined Company, and the financial information set forth herein prior to the Merger and the AHI Acquisition reflects GAHR III’s results. For this reason, period-to-period comparisons may not be meaningful.
Purchase Consideration
REIT Merger
The fair value of the purchase consideration transferred was calculated as follows (in thousands):
Deemed equity consideration (1)$768,075
Consideration for acquisition of noncontrolling interest (2)(53,300)
Repurchase of GAHR IV Class T common stock192
Total purchase consideration$714,967
________________
(1)Represents the fair value of GAHR III common stock that is deemed to be issued for accounting purposes only. Taking into consideration the impact of the reverse stock split, the fair value of the purchase consideration is calculated based on 22,045,766 shares of common stock deemed to be issued by GAHR III at the fair value per share of $34.84.
(2)Represents the fair value of additional interest acquired in GAHR III’s subsidiary, Trilogy REIT Holdings, LLC, or Trilogy REIT Holdings. The acquisition of additional interest in Trilogy is accounted for separately from the REIT Merger in accordance with ASC Topic 810, Consolidation, or ASC Topic 810. See Note 13, Equity — Noncontrolling Interests in Total Equity, for a discussion of the Trilogy transaction.
AHI Acquisition
The fair value of the purchase consideration transferred was calculated as follows (in thousands):
Equity consideration (1)$131,674
Post-closing cash payment to NewCo Sellers related to net working capital adjustments73
Contingent consideration (2)
Total purchase consideration
$131,747
________________
(1)Taking into consideration the impact of the reverse stock split, the amount represents the estimated fair value of the 3,779,382 Surviving Partnership OP units issued as consideration, with a reference value for purposes thereof of $34.84 per unit. The issuance of Surviving Partnership OP units was accounted for separately from the AHI Acquisition.
(2)Represents the estimated fair value of contingent consideration based on the performance of a possible private investment fund under consideration by AHI. We have no definitive plans to establish the investment fund, and, therefore, the fair value of contingent consideration was estimated to be $0.
Purchase Price Allocation
REIT Merger
The following table sets forth the allocation of the purchase consideration to the fair values of identifiable tangible and intangible assets acquired and liabilities assumed recognized at the acquisition date of GAHR IV, as well as the fair value at the acquisition date of the noncontrolling interests in GAHR IV (in thousands):
Real estate investments$1,126,641
Cash and cash equivalents16,163
Accounts and other receivables, net2,086
Restricted cash986
Identified intangible assets115,824
Operating lease right-of-use assets11,939
Other assets3,938
Total assets1,277,577
Mortgage loans payable (including debt premium of $311)
(18,602)
Lines of credit and term loans(488,900)
Accounts payable and accrued liabilities(21,882)
Accounts payable due to affiliates(324)
Identified intangible liabilities(12,927)
Operating lease liabilities(7,568)
Security deposits, prepaid rent and other liabilities(8,354)
Total liabilities(558,557)
Net identifiable assets acquired719,020
Redeemable noncontrolling interests(2,525)
Noncontrolling interest in total equity(1,528)
Total purchase consideration$714,967
AHI Acquisition
The following table sets forth the allocation of the purchase consideration to the fair values of identifiable tangible and intangible assets acquired and liabilities assumed recognized at the acquisition date (in thousands):
Cash and cash equivalents$706
Operating lease right-of-use assets3,526
Other assets362
Total assets4,594
Accounts payable and accrued liabilities(3,910)
Operating lease liabilities(3,526)
Total liabilities(7,436)
Net identifiable liabilities assumed(2,842)
Goodwill134,589
Total purchase consideration$131,747
Acquisition-related Costs
The Merger and the AHI Acquisition were accounted for as business combinations, and as a result, acquisition-related costs incurred in connection with these transactions of $14,060,000 were expensed and included in business acquisition expenses in our accompanying consolidated statement of operations and comprehensive loss. Acquisition-related costs of $6,753,000 were incurred by GAHR IV in the period before the consummation of the Merger and are therefore not reflected in our accompanying consolidated statements of operations and comprehensive loss for the year ended December 31, 2021 as GAHR III was the accounting acquiror in the Merger under ASC Topic 805, as further explained above.
Fair Value of Noncontrolling Interests
The fair value of the redeemable and nonredeemable noncontrolling interest in GAHR IV was estimated by applying the income approach based on a discounted cash flow analysis. This fair value measurement is based on significant inputs not observable in the market. The key assumptions applied in the income approach include the estimates of stabilized occupancy, market rents, capitalization rates and discount rates.
AHI Acquisition — Goodwill
In connection with the AHI Acquisition, we recorded goodwill of $134,589,000 as a result of the consideration exceeding the fair value of the net assets acquired and liabilities assumed. Goodwill represents the estimated future benefits arising from other assets acquired that could not be individually identified and separately recognized. Goodwill recognized in this transaction is not deductible for tax purposes. See Note 18, Segment Reporting, for a further discussion.
The table below represents the allocation of goodwill on the acquisition date in connection with the AHI Acquisition to our reporting segments (in thousands):
OM$47,812
Integrated senior health campuses44,547
SHOP23,277
Triple-net leased properties:
Senior housing8,640
Hospitals5,924
SNFs4,389
Total$134,589 
REIT Merger — Real Estate Investments, Intangible Assets and Intangible Liabilities
Real estate investments consist of land, building improvements, site improvements, unamortized tenant improvement allowances and unamortized capital improvements. Intangibles assets consist of in-place leases, above-market leases and certificates of need. We amortize purchased real estate investments and intangible assets on a straight-line basis over their respective useful lives. The following tables present the approximate fair value and the weighted-average depreciation and amortization periods of each major type of asset and liability (dollars in thousands):
Real Estate InvestmentsApproximate
Fair Value
Estimated
Useful Lives
(in years)
Land$114,525N/A
Building improvements930,70039
Site improvements33,6447
Unamortized tenant improvement allowances42,4076
Unamortized capital improvements5,36511
Total real estate investments$1,126,641
Intangible AssetsApproximate
Fair Value
Estimated
Useful Lives
(in years)
In-place leases$79,8876
Above-market leases35,60610
Certificates of need331N/A
Total identified intangible assets$115,824
Intangible LiabilitiesApproximate
Fair Value
Estimated
Useful Life
(in years)
Below-market leases$12,92710
The fair values of the assets acquired and liabilities assumed, as well as the fair value of the noncontrolling interests, on October 1, 2021 were estimates determined using the cost approach and direct capitalization method under the income approach and in limited circumstances, the market approach. Any necessary adjustments were finalized within one year from the date of acquisition.
Pro Forma Financial Information (Unaudited)
The following unaudited pro forma operating information is presented as if the Merger and the AHI Acquisition occurred on January 1, 2020. Such unaudited pro forma information includes a nonrecurring adjustment to present acquisition-related expenses incurred in the year ended December 31, 2021 in the 2020 pro forma results. The pro forma results are not necessarily indicative of the operating results that would have been obtained had the Merger and the AHI Acquisition occurred at the beginning of the periods presented, nor are they necessarily indicative of future operating results. Unaudited pro forma revenue, net loss and net loss attributable to controlling interest would have been as follows (in thousands):
Years Ended December 31,
20212020
Revenue$1,392,884$1,397,261
Net loss$(45,253)$(17,116)
Net loss attributable to controlling interest$(35,140)$(20,642)
v3.24.1
Debt Security Investment, Net
12 Months Ended
Dec. 31, 2023
Debt Security Investment [Abstract]  
Debt Security Investment, Net
5. Debt Security Investment, Net
Our investment in a commercial mortgage-backed debt security, or debt security, bears an interest rate on the stated principal amount thereof equal to 4.24% per annum, the terms of which security provide for monthly interest-only payments. The debt security has underlying tranches that mature between August 25, 2025 and January 1, 2028 at an aggregate stated
amount of $93,433,000, resulting in an anticipated yield-to-maturity of 10.0% per annum. The debt security was issued by an unaffiliated mortgage trust and represents a 10.0% beneficial ownership interest in such mortgage trust. The debt security is subordinate to all other interests in the mortgage trust and is not guaranteed by a government-sponsored entity.
On December 5, 2022, we acquired a portfolio of seven senior housing facilities in Texas from an unaffiliated third party, which facilities are included in the underlying collateral pool securing our debt security investment. We acquired the seven facilities by assuming the outstanding principal balance of each related mortgage loan payable from one of the borrowers as such borrower was in default on the required debt payments. We did not grant any concessions to such borrowers, and the carrying value of our debt security investment at the time of acquisition did not exceed the fair value of such facilities. See Note 4, Business Combinations — 2022 and 2023 Business Combinations, for a further discussion of such acquisitions.
As of December 31, 2023 and 2022, the carrying amount of the debt security investment was $86,935,000 and $83,000,000, respectively, net of unamortized closing costs of $489,000 and $767,000, respectively. Accretion on the debt security for the years ended December 31, 2023, 2022 and 2021 was $4,213,000, $3,922,000 and $3,665,000, respectively, which is recorded as an increase to real estate revenue in our accompanying consolidated statements of operations and comprehensive loss. Amortization expense of closing costs for the years ended December 31, 2023, 2022 and 2021 was $278,000, $237,000 and $201,000, respectively, which is recorded as a decrease to real estate revenue in our accompanying consolidated statements of operations and comprehensive loss. We evaluated credit quality indicators such as the agency ratings and the underlying collateral of such investment in order to determine expected future credit loss. No credit loss was recorded for the years ended December 31, 2023, 2022 and 2021.
v3.24.1
Identified Intangible Assets and Liabilities
12 Months Ended
Dec. 31, 2023
Intangible Assets and Liabilities [Abstract]  
Identified Intangible Assets and Liabilities
6. Identified Intangible Assets and Liabilities
Identified intangible assets, net and identified intangible liabilities, net consisted of the following as of December 31, 2023 and 2022 (dollars in thousands):
 December 31,
20232022
Amortized intangible assets:
In-place leases, net of accumulated amortization of $35,437 and $38,930 as of December 31, 2023 and 2022, respectively (with a weighted average remaining life of 7.7 years and 7.0 years as of December 31, 2023 and 2022, respectively)
$42,615 $75,580 
Above-market leases, net of accumulated amortization of $7,079 and $6,360 as of December 31, 2023 and 2022, respectively (with a weighted average remaining life of 7.5 years and 9.0 years as of December 31, 2023 and 2022, respectively)
15,905 30,194 
Customer relationships, net of accumulated amortization of $934 and $785 as of December 31, 2023 and 2022, respectively (with a weighted average remaining life of 12.7 years and 13.7 years as of December 31, 2023 and 2022, respectively)
1,906 2,055 
Unamortized intangible assets:
Certificates of need99,777 97,667 
Trade names20,267 30,787 
Total identified intangible assets, net$180,470 $236,283 
Amortized intangible liabilities:
Below-market leases, net of accumulated amortization of $2,831 and $2,508 as of December 31, 2023 and 2022, respectively (with a weighted average remaining life of 7.2 years and 8.4 years as of December 31, 2023 and 2022, respectively)
$6,095 $10,837 
Total identified intangible liabilities, net$6,095 $10,837 
Amortization expense on identified intangible assets for the years ended December 31, 2023, 2022 and 2021 was $46,601,000, $28,378,000 and $22,460,000, respectively, which included $14,278,000, $4,444,000 and $1,349,000, respectively, of amortization recorded as a decrease to real estate revenue for above-market leases in our accompanying consolidated statements of operations and comprehensive loss. In March 2023, we transitioned our SNFs within Central Wisconsin Senior Care Portfolio from triple-net leased properties to a RIDEA structure, which resulted in a full amortization of $8,073,000 of above-market leases and $885,000 of in-place leases. In addition, we fully amortized $2,756,000 of above-market leases and $5,750,000 of in-place leases in connection with the transition of our senior housing facilities within Michigan ALF Portfolio from triple-net leased properties to a RIDEA structure in November 2023.
For the year ended December 31, 2023, we recognized an impairment loss of approximately $10,520,000 related to the write-off of trade name intangible assets at ancillary business units within Trilogy. For the years ended December 31, 2022 and 2021, we did not recognize any impairment losses with respect to trade name intangible assets.
Amortization expense on below-market leases for the years ended December 31, 2023, 2022 and 2021 was $4,534,000, $1,848,000 and $396,000, respectively, which is recorded as an increase to real estate revenue in our accompanying consolidated statements of operations and comprehensive loss. In connection with the transition of our senior housing facilities within Michigan ALF Portfolio to a RIDEA structure in November 2023, we fully amortized $112,000 of below-market leases.
The aggregate weighted average remaining life of the identified intangible assets was 7.8 years and 7.7 years as of December 31, 2023 and 2022, respectively. The aggregate weighted average remaining life of the identified intangible liabilities was 7.2 years and 8.4 years as of December 31, 2023 and 2022, respectively. As of December 31, 2023, estimated amortization expense on the identified intangible assets and liabilities for each of the next five years ending December 31 and thereafter was as follows (in thousands):
Amortization Expense
YearIntangible
Assets
Intangible
Liabilities
2024$11,618 $(1,073)
20258,797 (956)
20267,729 (840)
20277,205 (825)
20286,152 (709)
Thereafter18,925 (1,692)
Total$60,426 $(6,095)
v3.24.1
Other Assets, Net
12 Months Ended
Dec. 31, 2023
Other Assets [Abstract]  
Other Assets, Net
7. Other Assets, Net
Other assets, net consisted of the following as of December 31, 2023 and 2022 (dollars in thousands):
 December 31,
 20232022
Deferred rent receivables$47,540 $46,867 
Prepaid expenses, deposits, other assets and deferred tax assets, net33,204 25,866 
Investments in unconsolidated entities20,611 9,580 
Inventory — finished goods
19,472 19,775 
Lease commissions, net of accumulated amortization of $7,231 and $6,260 as of December 31, 2023 and 2022, respectively
17,565 19,217 
Deferred financing costs, net of accumulated amortization of $8,494 and $5,704 as of December 31, 2023 and 2022, respectively
3,830 4,334 
Lease inducement, net of accumulated amortization of $2,544 and $2,193 as of December 31, 2023 and 2022, respectively (with a weighted average remaining life of 6.9 years and 7.9 years as of December 31, 2023 and 2022, respectively)
2,456 2,807 
Derivative financial instrument1,463 — 
Total$146,141 $128,446 
Deferred financing costs included in other assets, net were related to the 2019 Trilogy Credit Facility, as defined in Note 9, and the senior unsecured revolving credit facility portion of the 2022 Credit Facility. See Note 9, Lines of Credit and Term Loan, for a further discussion. Amortization expense on lease inducement for each of the years ended December 31, 2023, 2022 and 2021 was $351,000 and is recorded as a decrease to real estate revenue in our accompanying consolidated statements of operations and comprehensive loss. For the years ended December 31, 2023, 2022 and 2021, we did not incur any impairment losses with respect to our investments in unconsolidated entities.
v3.24.1
Mortgage Loans Payable, Net
12 Months Ended
Dec. 31, 2023
Mortgage Loans Payable, Net [Abstract]  
Mortgage Loans Payable, Net
8. Mortgage Loans Payable, Net
Mortgage loans payable, net consisted of the following as of December 31, 2023 and 2022 (dollars in thousands):
December 31,
20232022
Total fixed-rate debt (76 loans and 68 loans as of December 31, 2023 and 2022, respectively)
$990,325 $885,892 
Total variable-rate debt (13 loans and 11 loans as of December 31, 2023 and 2022, respectively)
335,988 368,587 
Total fixed- and variable-rate debt1,326,313 1,254,479 
Less: deferred financing costs, net(9,713)(8,845)
Add: premium167 237 
Less: discount(14,371)(16,024)
Mortgage loans payable, net$1,302,396 $1,229,847 
    
Based on interest rates in effect as of December 31, 2023 and 2022, effective interest rates on mortgage loans payable ranged from 2.21% to 8.46% per annum and 2.21% to 7.26% per annum, respectively, with a weighted average effective interest rate of 4.72% and 5.29%, respectively. We are required by the terms of certain loan documents to meet certain reporting requirements and covenants, such as net worth ratios, fixed charge coverage ratios and leverage ratios.
The following table reflects the changes in the carrying amount of mortgage loans payable, net for the years ended December 31, 2023 and 2022 (in thousands):
Years Ended December 31,
20232022
Beginning balance$1,229,847 $1,095,594 
Additions:
Borrowings under mortgage loans payable160,442 186,227 
Assumption of mortgage loans payable, net10,884 149,861 
Amortization of deferred financing costs2,284 2,332 
Amortization of discount/premium on mortgage loans payable, net3,549 2,242 
Deductions:
Scheduled principal payments on mortgage loans payable(64,792)(104,384)
Early payoff of mortgage loans payable(9,809)(90,871)
Payoff of a mortgage loans payable due to disposition of real estate investments(26,856)(8,637)
Deferred financing costs(3,153)(2,517)
Ending balance$1,302,396 $1,229,847 
For the year ended December 31, 2023, we incurred a loss on the early extinguishment of a mortgage loan payable of $345,000, which is recorded as an increase to interest expense in our accompanying consolidated statements of operations and comprehensive loss. Such loss was related to the payoff of a mortgage loan payable due to the disposition of the underlying real estate investment in August 2023.
For the year ended December 31, 2022, we incurred an aggregate loss on the early extinguishment of mortgage loans payable of $2,005,000. Such aggregate loss was primarily related to the payoff of a mortgage loan payable due to the disposition of a real estate investment in September 2022, the payoff of a construction loan in December 2022 and the write-off of unamortized loan discount related to eight mortgage loans payable that we refinanced on January 1, 2022 that were due to mature in 2044 through 2052.
For the year ended December 31, 2021, we incurred an aggregate loss on the extinguishment of mortgage loans payable of $2,425,000. Such loss was primarily related to the write-off of unamortized deferred financing costs of 10 mortgage loans payable that we refinanced on January 29, 2021 and one mortgage loan payable that we refinanced on December 1, 2021 that were due to mature in 2053 and 2049, respectively.
As of December 31, 2023, the principal payments due on our mortgage loans payable for each of the next five years ending December 31 and thereafter were as follows (in thousands):
YearAmount
2024$311,445 
2025166,853 
2026171,432 
202750,175 
202816,421 
Thereafter609,987 
Total$1,326,313 
v3.24.1
Lines of Credit and Term Loans
12 Months Ended
Dec. 31, 2023
Line of Credit Facility [Abstract]  
Lines Of Credit and Term Loans
9. Lines of Credit and Term Loan
2022 Credit Facility
On January 19, 2022, we, through our operating partnership, as borrower, and certain of our subsidiaries, or the subsidiary guarantors, collectively as guarantors, entered into an agreement, or the 2022 Credit Agreement, to amend and restate the credit agreement for our existing credit facility with Bank of America, N.A., or Bank of America, KeyBank National Association, Citizens Bank, National Association, and the lenders named therein. The 2022 Credit Agreement provided for a credit facility with an aggregate maximum principal amount up to $1,050,000,000, or the 2022 Credit Facility, which consisted of a senior unsecured revolving credit facility in the initial aggregate amount of $500,000,000 and a senior unsecured term loan facility in the initial aggregate amount of $550,000,000. The proceeds of loans made under the 2022 Credit Facility could have been used for refinancing existing indebtedness and for general corporate purposes including for working capital, capital expenditures and other corporate purposes not inconsistent with obligations under the 2022 Credit Agreement. We could have also obtained up to $25,000,000 in the form of standby letters of credit pursuant to the 2022 Credit Facility. Unless defined herein, all capitalized terms under this “2022 Credit Facility” subsection are defined in the 2022 Credit Agreement.
Under the terms of the 2022 Credit Agreement, the revolving loans matured on January 19, 2026, and could have been extended for one 12-month period, subject to the satisfaction of certain conditions, including payment of an extension fee. The term loan would have matured on January 19, 2027, and could not be extended. The maximum principal amount of the 2022 Credit Facility could have been increased by an aggregate incremental amount of $700,000,000, subject to: (i) the terms of the 2022 Credit Agreement; and (ii) at least five business days’ prior written notice to Bank of America.
The 2022 Credit Facility bore interest at varying rates based upon, at our option, (i) Daily SOFR, plus the Applicable Rate for Daily SOFR Rate Loans or (ii) the Term SOFR, plus the Applicable Rate for Term SOFR Rate Loans. If, under the terms of the 2022 Credit Agreement, there was an inability to determine the Daily SOFR or the Term SOFR then the 2022 Credit Facility bore interest at a rate per annum equal to the Base Rate plus the Applicable Rate for Base Rate Loans. The loans could have been repaid in whole or in part without prepayment premium or penalty, subject to certain conditions.
The 2022 Credit Agreement required us to add additional subsidiaries as guarantors in the event the value of the assets owned by the subsidiary guarantors fell below a certain threshold as set forth in the 2022 Credit Agreement. In the event of default, Bank of America had the right to terminate the commitment of each Lender to make Loans and any obligation of the L/C Issuer to make L/C Credit Extensions under the 2022 Credit Agreement, and to accelerate the payment on any unpaid principal amount of all outstanding loans and interest thereon. On March 1, 2023, we entered into an amendment to the 2022 Credit Agreement, or the First Amendment. The material terms of the First Amendment provided for revisions to certain financial covenants for a limited period of time. Except as modified by the terms of the First Amendment, the material terms of the 2022 Credit Agreement remained in full force and effect.
As of both December 31, 2023 and 2022, our aggregate borrowing capacity under the 2022 Credit Facility was $1,050,000,000, excluding the $25,000,000 in standby letters of credit described above. As of December 31, 2023 and 2022, borrowings outstanding under the 2022 Credit Facility totaled $914,900,000 ($914,144,000, net of deferred financing costs related to the senior unsecured term loan facility portion of the 2022 Credit Facility) and $965,900,000 ($965,060,000, net of deferred financing costs related to the senior unsecured term loan facility portion of the 2022 Credit Facility), respectively, and the weighted average interest rate on such borrowings outstanding was 7.08% and 6.07% per annum, respectively. As of December 31, 2023, we entered into interest rate swaps to mitigate the risk associated with the entire $550,000,000 outstanding borrowing amount of our term loan. See Note 10, Derivative Financial Instruments, for a further discussion.
In January 2022, in connection with the 2022 Credit Agreement, we incurred an aggregate $3,161,000 loss on the extinguishment of a portion of senior unsecured term loan related to former credit facilities. Such loss on extinguishment of debt is recorded as an increase to interest expense in our accompanying condensed consolidated statements of operations and comprehensive loss, and primarily consisted of lender fees we paid to obtain the 2022 Credit Facility.
On February 14, 2024, we, through our operating partnership, entered into an agreement, or the 2024 Credit Agreement, that amends, restates, supersedes and replaces the 2022 Credit Agreement. See Note 21, Subsequent Events — 2024 Credit Facility, for a further discussion.
2019 Trilogy Credit Facility
We, through Trilogy RER, LLC, are party to an amended and restated loan agreement, or the 2019 Trilogy Credit Agreement, among certain subsidiaries of Trilogy OpCo, LLC, Trilogy RER, LLC, and Trilogy Pro Services, LLC; KeyBank; CIT Bank, N.A.; Regions Bank; KeyBanc Capital Markets, Inc.; Regions Capital Markets; Bank of America; The Huntington National Bank; and a syndicate of other banks, as lenders named therein, with respect to a senior secured revolving credit facility that had an aggregate maximum principal amount of $360,000,000, consisting of: (i) a $325,000,000 secured revolver supported by real estate assets and ancillary business cash flow and (ii) a $35,000,000 accounts receivable revolving credit facility supported by eligible accounts receivable, or the 2019 Trilogy Credit Facility. The proceeds of the 2019 Trilogy Credit Facility may be used for acquisitions, debt repayment and general corporate purposes. The maximum principal amount of the 2019 Trilogy Credit Facility could be increased by up to $140,000,000, for a total principal amount of $500,000,000, subject to certain conditions. Unless defined herein, all capitalized terms under this “2019 Trilogy Credit Facility” subsection are defined in the 2019 Trilogy Credit Agreement, as amended.
On December 20, 2022, we entered into an amendment to the 2019 Trilogy Credit Agreement, or the 2019 Trilogy Credit Amendment. The material terms of the 2019 Trilogy Credit Amendment provided for an increase to the secured revolver amount from $325,000,000 to $365,000,000, thereby increasing our aggregate maximum principal amount under the credit facility from $360,000,000 to $400,000,000. In addition, all references to LIBOR were replaced with the Secured Overnight Financing Rate, or SOFR. On March 30, 2023, we further amended the 2019 Trilogy Credit Agreement to update the definition of Implied Debt Service, which is used to calculate the Real Estate Borrowing Base Availability, for interest rate changes and to add an annual interest-only payment calculation option. Except as modified by the terms of the amendments, the material terms of the 2019 Trilogy Credit Agreement remain in full force and effect.
The 2019 Trilogy Credit Facility was due to mature on September 5, 2023; however, pursuant to the terms of the 2019 Trilogy Credit Agreement, at such time we extended the maturity date for one 12-month period to mature on September 5, 2024, and paid an extension fee of $600,000. On December 21, 2023, we further amended such agreement to extend the maturity date to June 5, 2025 and paid an extension fee of $745,000. At our option, the 2019 Trilogy Credit Facility bears interest at per annum rates equal to (a) SOFR, plus 2.75% for SOFR Rate Loans and (b) for Base Rate Loans, 1.75% plus the highest of: (i) the fluctuating rate per annum of interest in effect for such day as established from time to time by KeyBank as its prime rate, (ii) 0.50% above the Federal Funds Effective Rate, and (iii) 1.00% above one-month Adjusted Term SOFR.
As of both December 31, 2023 and 2022, our aggregate borrowing capacity under the 2019 Trilogy Credit Facility was $400,000,000. As of December 31, 2023 and 2022, borrowings outstanding under the 2019 Trilogy Credit Facility totaled $309,823,000 and $316,734,000, respectively, and the weighted average interest rate on such borrowings outstanding was 8.20% and 7.17% per annum, respectively. On December 21, 2023, we, through Trilogy RER, LLC, entered into an interest rate swap transaction to mitigate the risk with respect to $200,000,000 of our borrowings under the 2019 Trilogy Credit Facility. See Note 10, Derivative Financial Instruments, for a further discussion.
v3.24.1
Derivative Financial Instruments
12 Months Ended
Dec. 31, 2023
Derivative Instruments and Hedging Activities Disclosure [Abstract]  
Derivative Financial Instruments
10. Derivative Financial Instruments
We use derivative financial instruments to manage interest rate risk associated with variable-rate debt. We recorded such derivative financial instruments in our accompanying consolidated balance sheets as either an asset or a liability, as applicable, measured at fair value. We did not have any derivative financial instruments as of December 31, 2022. The following table lists the derivative financial instruments held by us as of December 31, 2023, which were included in other assets and other liabilities in our accompanying consolidated balance sheets (dollars in thousands):
InstrumentNotional AmountIndexInterest RateEffective DateMaturity DateFair Value
December 31, 2023
Swap$275,000 one month
Term SOFR
3.74%02/01/2301/19/26$1,463 
Swap275,000 one month
Term SOFR
4.41%08/08/2301/19/26(2,178)
Swap200,000 one month
Term SOFR
4.40%01/05/2406/05/25(211)
$750,000 $(926)
As of December 31, 2023, none of our derivative financial instruments were designated as hedges. Derivative financial instruments not designated as hedges are not speculative and are used to manage our exposure to interest rate movements, but do not meet the strict hedge accounting requirements. For the years ended December 31, 2023, 2022 and 2021, we recorded a net (loss) gain in the fair value of derivative financial instruments of $(926,000), $500,000 and $8,200,000, respectively, as a (increase)/decrease to total interest expense in our accompanying consolidated statements of operations and comprehensive loss. Included in the gain in the fair value of derivative instruments recognized for the year ended December 31, 2021 is $823,000 related to the fair value of an interest rate swap entered into by GAHR IV, which matured on November 19, 2021.
See Note 15, Fair Value Measurements, for a further discussion of the fair value of our derivative financial instruments.
v3.24.1
Commitments and Contingencies
12 Months Ended
Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]  
Commitments and Contingencies
11. Commitments and Contingencies
Litigation
We are not presently subject to any material litigation nor, to our knowledge, is any material litigation threatened against us, which, if determined unfavorably to us, would have a material adverse effect on our consolidated financial position, results of operations or cash flows.
Environmental Matters
We follow a policy of monitoring our properties for the presence of hazardous or toxic substances. While there can be no assurance that a material environmental liability does not exist at our properties, we are not currently aware of any environmental liability with respect to our properties that would have a material adverse effect on our consolidated financial position, results of operations or cash flows. Further, we are not aware of any material environmental liability or any unasserted claim or assessment with respect to an environmental liability that we believe would require additional disclosure or the recording of a loss contingency.
Other
Our other commitments and contingencies include the usual obligations of real estate owners and operators in the normal course of business, which include calls/puts to sell/acquire properties. In our view, these matters are not expected to have a material adverse effect on our consolidated financial position, results of operations or cash flows.
v3.24.1
Redeemable Noncontrolling Interests
12 Months Ended
Dec. 31, 2023
Temporary Equity [Abstract]  
Redeemable Noncontrolling Interest
12. Redeemable Noncontrolling Interests
As of both December 31, 2023 and 2022, we, through our direct and indirect subsidiaries, owned a 95.0% general partnership interest in our operating partnership, and the remaining 5.0% limited partnership interest in our operating partnership was owned by the NewCo Sellers. Some of the limited partnership units outstanding, which account for approximately 1.0% of our total operating partnership units outstanding, have redemption features outside of our control and are accounted for as redeemable noncontrolling interests presented outside of permanent equity in our accompanying consolidated balance sheets.
As of December 31, 2023 and 2022, we, through Trilogy REIT Holdings, in which we indirectly hold a 76.0% ownership interest, owned approximately 97.5% and 96.2%, respectively, of the outstanding equity interests of Trilogy. As of December 31, 2023 and 2022, certain members of Trilogy’s management and certain members of an advisory committee to Trilogy’s board of directors owned approximately 2.5% and 3.8%, respectively, of the outstanding equity interests of Trilogy. We account for such equity interests as redeemable noncontrolling interests in our accompanying consolidated balance sheets in accordance with FASB ASC Topic 480-10-S99-3A given certain features associated with such equity interests. For the year ended December 31, 2023, we redeemed a portion of the equity interests owned by a member of Trilogy’s management and a member of Trilogy’s advisory committee for an aggregate of $17,150,000. As of December 31, 2023, we reclassified the balance of the remaining equity interest owned by such member of Trilogy’s advisory committee from redeemable noncontrolling interest to other liabilities in our accompanying consolidated balance sheet, and subsequently redeemed such interest in January 2024 for cash of approximately $25,312,000. In October 2022, we redeemed a portion of the equity interests owned by certain previous or current members of Trilogy’s management and advisory committee for cash of $3,707,000.
As of December 31, 2023 and 2022, we own, through our operating partnership, approximately 98.0% of the joint ventures with an affiliate of Meridian Senior Living, LLC, or Meridian, that owned Central Florida Senior Housing Portfolio, Pinnacle Beaumont ALF and Pinnacle Warrenton ALF. The noncontrolling interests held by Meridian have redemption features outside of our control and are accounted for as redeemable noncontrolling interests in our accompanying consolidated balance sheets. See Note 3, Real Estate Investments, Net — Dispositions of Real Estate Investments, for dispositions within our Central Florida Senior Housing Portfolio in 2023 and 2022.
We previously owned 90.0% of the joint venture with Avalon Health Care, Inc., or Avalon, that owned Catalina West Haven ALF and Catalina Madera ALF. The noncontrolling interests held by Avalon had redemption features outside of our control and were accounted for as redeemable noncontrolling interests until December 1, 2022, when we exercised our right to purchase the remaining 10.0% of the joint venture with Avalon for a contract purchase price of $295,000. As such, 10.0% of the net earnings of such joint venture were allocated to redeemable noncontrolling interests in our accompanying consolidated statements of operations and comprehensive loss following the Merger and through November 30, 2022.
We record the carrying amount of redeemable noncontrolling interests at the greater of: (i) the initial carrying amount, increased or decreased for the noncontrolling interests’ share of net income or loss and distributions or (ii) the redemption value. The changes in the carrying amount of redeemable noncontrolling interests consisted of the following for the years ended December 31, 2023 and 2022 (in thousands):
December 31,
20232022
Beginning balance$81,598 $72,725 
Additional redeemable noncontrolling interest— 273 
Reclassification from equity83 83 
Reclassification to other liabilities(25,312)— 
Distributions(1,369)(2,817)
Repurchase of redeemable noncontrolling interests(17,150)(4,034)
Adjustment to redemption value(2,944)15,773 
Net loss attributable to redeemable noncontrolling interests(1,063)(405)
Ending balance$33,843 $81,598 
v3.24.1
Equity
12 Months Ended
Dec. 31, 2023
Equity [Abstract]  
Equity
13. Equity
Preferred Stock
Pursuant to our charter, we are authorized to issue 200,000,000 shares of our preferred stock, $0.01 par value per share. As of both December 31, 2023 and 2022, no shares of preferred stock were issued and outstanding.
Common Stock
Pursuant to our charter, as amended, we are authorized to issue 1,000,000,000 shares of our common stock, $0.01 par value per share, whereby 200,000,000 shares are classified as Class T common stock and 800,000,000 shares were classified as Class I common stock. On January 26, 2024, we further amended our charter to reclassify shares of our Class I common stock such that 200,000,000 shares are classified as Class T common stock, 100,000,000 shares are classified as Class I common stock and 700,000,000 shares are classified as common stock without any designation as to class or series.
On October 4, 2021, our board authorized the reinstatement of our distribution reinvestment plan, as amended, or the AHR DRIP, to offer up to $100,000,000 of shares of our common stock pursuant to a Registration Statement on Form S-3 under the Securities Act filed by GAHR IV, or the AHR DRIP Offering. On November 14, 2022, our board suspended the AHR DRIP Offering beginning with the distributions declared, if any, for the quarter ending December 31, 2022. As a result of the suspension of the AHR DRIP, unless and until our board reinstates the AHR DRIP Offering, stockholders who are current participants in the AHR DRIP will be paid future distributions in cash. See Note 1, Organization and Description of Business — Public Offerings, and the “Distribution Reinvestment Plan” section below for a further discussion.
We effected a one-for-four reverse split of our common stock on November 15, 2022 and a corresponding reverse split of the partnership units in our operating partnership. As a result of the Reverse Splits, every four shares of our common stock or four partnership units in our operating partnership were automatically combined and converted into one issued and outstanding share of our common stock of like class, or one partnership unit of like class, as applicable, rounded to the nearest 1/100th share or unit. The Reverse Splits impacted all classes of common stock and partnership units proportionately and had no impact on any stockholder’s or partner’s ownership percentage. Neither the number of authorized shares nor the par value of the Class T common stock and Class I common stock were ultimately impacted. All numbers of common shares and per share data, as well as partnership units in our operating partnership, in our accompanying consolidated financial statements and related notes have been retroactively adjusted for all periods presented to give effect to the Reverse Splits.
On February 9, 2024, we closed the 2024 Offering and issued 64,400,000 shares of common stock, $0.01 par value per share, for a total of $772,800,000 in gross proceeds, including the exercise in full of the underwriters’ overallotment option to purchase up to an additional 8,400,000 shares of common stock. In conjunction with the 2024 Offering, such shares of common stock were listed on the NYSE and began trading on February 7, 2024.
Our Class T common stock and Class I common stock are identical to our common stock, except that such shares are not currently listed on the NYSE or any other national securities exchange. Upon the six month anniversary of the listing of our common stock for trading on the NYSE, which is August 5, 2024, each share of our Class T common stock and Class I common stock will automatically, and without any stockholder action, convert into one share of our listed common stock.
Distribution Reinvestment Plan
Our DRIP allowed our stockholders to elect to reinvest an amount equal to the distributions declared on their shares of common stock in additional shares of our common stock in lieu of receiving cash distributions. However, on November 14, 2022, our board suspended the DRIP offering beginning with the distributions declared for the quarter ended December 31, 2022. As a result of the suspension of the DRIP offering, unless and until our board reinstates the DRIP offering, stockholders who are current participants in the DRIP were or will be paid distributions in cash. As of both December 31, 2023 and 2022, a total of $91,448,000 in distributions were reinvested that resulted in 2,431,695 shares of common stock being issued pursuant to the AHR DRIP Offering.
Since October 5, 2016, our board had approved and established an estimated per share net asset value, or NAV, annually. Commencing with the distribution payment to stockholders paid in the month following such board approval, shares of our common stock issued pursuant to our distribution reinvestment plan were issued at the current estimated per share NAV until such time as our board determined an updated estimated per share NAV.
For the year ended December 31, 2023, there were no distributions reinvested and no shares of our common stock were issued pursuant to our DRIP offerings. For the years ended December 31, 2022 and 2021, $36,812,000 and $7,666,000, respectively, in distributions were reinvested and 992,964 and 207,866 shares of our common stock, respectively, were issued pursuant to our DRIP offerings.
Share Repurchase Plan
Our share repurchase plan allowed for repurchases of shares of our common stock by us when certain criteria are met. Share repurchases were made at the sole discretion of our board. Subject to the availability of the funds for share repurchases and other certain conditions, we generally limited the number of shares of our common stock repurchased during any calendar year to 5.0% of the weighted average number of shares of our common stock outstanding during the prior calendar year; provided however, that shares subject to a repurchase requested upon the death or “qualifying disability,” as defined in our share repurchase plan, of a stockholder were not subject to this cap. Funds for the repurchase of shares of our common stock came from the cumulative proceeds we received from the sale of shares of our common stock pursuant to our DRIP offerings.
Pursuant to our share repurchase plan, the repurchase price is equal to the lesser of (i) the amount per share that a stockholder paid for their shares of our common stock, or (ii) the most recent estimated value of one share of our common stock, as determined by our board, except that the repurchase price with respect to repurchases resulting from the death or qualifying disability of stockholders was equal to the most recently published estimated per share NAV. On October 4, 2021, as a result of the Merger, our board authorized the partial reinstatement of our share repurchase plan with respect to requests to repurchase shares resulting from the death or qualifying disability of stockholders, effective with respect to qualifying repurchases for the fiscal quarter ending December 31, 2021. All share repurchase requests other than those requests resulting from the death or qualifying disability of stockholders were rejected. On November 14, 2022, our board suspended our share repurchase plan beginning with share repurchase requests for the quarter ending December 31, 2022. All share repurchase requests, including requests resulting from the death or qualifying disability of stockholders, commencing with the quarter ended December 31, 2022, will not be processed, will be considered canceled in full and will not be considered outstanding repurchase requests.
For the years ended December 31, 2023, 2022 and 2021, we repurchased 1,681, 559,195 and 10,356 shares of our common stock, respectively, for an aggregate of $62,000, $20,699,000 and $382,000, respectively, at an average repurchase price of $37.16, $37.02 and $36.88 per share, respectively, pursuant to our share repurchase plan. All shares were repurchased using the cumulative proceeds we received from the sale of shares of our common stock pursuant to our DRIP offerings.
Noncontrolling Interests in Total Equity
Membership Interest in Trilogy REIT Holdings
As of December 31, 2023 and 2022, Trilogy REIT Holdings owned approximately 97.5% and 96.2%, respectively, of Trilogy. Prior to October 1, 2021, we were the indirect owner of a 70.0% interest in Trilogy REIT Holdings pursuant to an amended joint venture agreement with an indirect, wholly-owned subsidiary of NorthStar Healthcare Income, Inc., or NHI, and a wholly-owned subsidiary of GAHR IV Operating Partnership. We serve as the managing member of Trilogy REIT Holdings. In connection with the Merger, the wholly-owned subsidiary of GAHR IV Operating Partnership sold its 6.0% interest in Trilogy REIT Holdings to GAHR III, thereby increasing our indirect ownership in Trilogy REIT Holdings to 76.0%. Through September 30, 2021, 30.0% of the net earnings of Trilogy REIT Holdings were allocated to noncontrolling interests, and since October 1, 2021, 24.0% of the net earnings of Trilogy REIT Holdings were allocated to a noncontrolling interest.
On November 3, 2023, we entered into a Membership Interest Purchase Agreement, or the MIPA, with subsidiaries of NHI, which provides us with the option to purchase their 24.0% minority membership interest in Trilogy REIT Holdings. If we exercise this purchase option, we will own 100% of Trilogy REIT Holdings, which (assuming that there are no changes in the equity capitalization of Trilogy prior to consummation of the purchase) will in turn cause us to indirectly own approximately 97.5% of Trilogy. Subject to our first satisfying certain closing conditions, the option is exercisable for a closing before September 30, 2025 assuming that we exercise both extension options described below. If we exercise our purchase option, the all-cash purchase price would be $240,500,000 if we consummate the purchase on or before March 31, 2024, would increase to $247,000,000 if we consummate the purchase from April 1, 2024 to and including December 31, 2024 and would further increase to $260,000,000 if we consummate the purchase on or after January 1, 2025.
The MIPA also allows us (at our election), instead of paying all cash, to consummate the purchase transaction by using a combination of cash and the issuance of new Series A Cumulative Convertible Preferred Stock, $0.01 par value per share, or our Convertible Preferred Stock, as purchase price consideration. We must pay at least a minimum amount of the purchase price in cash, in which case we would pay the remaining amount in shares of our Convertible Preferred Stock. The minimum cash amount will be $24,050,000 if we consummate the purchase on or before March 31, 2024, $24,700,000 if we consummate the purchase from April 1, 2024 to and including December 31, 2024, or $26,000,000 if we consummate the purchase on or after January 1, 2025. If issued, our Convertible Preferred Stock will be perpetual, will have a cumulative cash dividend with an
initial annual rate of 4.75% (on the liquidation preference per share of $25.00 of our Convertible Preferred Stock) and will be redeemable by us at any time. The annual dividend rate will increase over time, and the redemption price will vary based on the date of redemption. In addition, holders of shares of our Convertible Preferred Stock will have the right, at any time on or after July 1, 2026 and from time to time, to convert some or all of such shares into shares of our common stock, subject to certain customary exceptions. As of December 31, 2023, we did not exercise the MIPA purchase option.
Other Noncontrolling Interests
In connection with our acquisition and operation of Trilogy, profit interest units in Trilogy, or the Profit Interests, were issued to Trilogy Management Services, LLC and an independent director of Trilogy, both unaffiliated third parties that manage or direct the day-to-day operations of Trilogy. The Profit Interests consisted of time-based or performance-based commitments. The time-based Profit Interests were measured at their grant date fair value and vest in increments of 20.0% on each anniversary of the respective grant date over a five year period. We amortized the time-based Profit Interests on a straight-line basis over the vesting periods, which are recorded to general and administrative in our accompanying consolidated statements of operations and comprehensive loss. The performance-based Profit Interests were subject to a performance commitment and would have vested upon liquidity events as defined in the Profit Interests agreements. The performance-based Profit Interests were measured at their fair value on the adoption date of ASU 2018-07, Improvements to Nonemployee Share-Based Payment Accounting, using a modified retrospective approach. The nonvested awards are presented as noncontrolling interests in total equity in our accompanying consolidated balance sheets, and are re-classified to redeemable noncontrolling interests upon vesting as they had redemption features outside of our control similar to the common stock units held by Trilogy’s management. See Note 12, Redeemable Noncontrolling Interests, for a further discussion.
In December 2021, we redeemed a part of the time-based Profit Interests and all of the performance-based Profit Interests that were included in noncontrolling interests in total equity. We redeemed such Profit Interests for $16,517,000, which was paid $8,650,000 in cash and $7,867,000 through the issuance of additional equity interests in Trilogy that are classified as redeemable noncontrolling interests in our consolidated balance sheets. There were no canceled, expired or exercised Profit Interests during the years ended December 31, 2023 and 2022. For the years ended December 31, 2023, 2022 and 2021, we recognized stock compensation expense related to the Profit Interests of $83,000, $83,000 and $8,801,000, respectively.
One of our consolidated subsidiaries issued non-voting preferred shares of beneficial interests to qualified investors for total proceeds of $125,000. These preferred shares of beneficial interests are entitled to receive cumulative preferential cash dividends at the rate of 12.5% per annum. We classify the value of the subsidiary’s preferred shares of beneficial interests as noncontrolling interests in our accompanying consolidated balance sheets and the dividends of the preferred shares of beneficial interests in net income or loss attributable to noncontrolling interests in our accompanying consolidated statements of operations and comprehensive loss.
As of both December 31, 2023 and 2022, we owned an 86.0% interest in a consolidated limited liability company that owns Lakeview IN Medical Plaza. As such, 14.0% of the net earnings of Lakeview IN Medical Plaza were allocated to noncontrolling interests in our accompanying consolidated statements of operations and comprehensive loss for the years ended December 31, 2023, 2022 and 2021. On February 6, 2024, we purchased the 14.0% membership interest in the consolidated limited liability company that owns Lakeview IN Medical Plaza from an unaffiliated third party for a contract purchase price of $441,000. In connection with such purchase and as of such date, we own a 100% interest in such limited liability company.
As of both December 31, 2023 and 2022, we owned a 90.6% membership interest in a consolidated limited liability company that owns Southlake TX Hospital. As such, 9.4% of the net earnings of Southlake TX Hospital were allocated to noncontrolling interests in our accompanying consolidated statements of operations and comprehensive loss for the years ended December 31, 2023, 2022 and 2021.
Upon consummation of the Merger, through our operating partnership, we acquired an approximate 90.0% interest in a joint venture that owns the Louisiana Senior Housing Portfolio. As such, 10.0% of the net earnings of the joint venture were allocated to noncontrolling interests in our accompanying consolidated statements of operations and comprehensive loss since October 1, 2021.
As discussed in Note 1, Organization and Description of Business, as of both December 31, 2023 and 2022, we, through our direct and indirect subsidiaries, own a 95.0% general partnership interest in our operating partnership, and the remaining 5.0% limited partnership interest in our operating partnership is owned by the NewCo Sellers. As of both December 31, 2023 and 2022, 4.0% of our total operating partnership units outstanding is presented in total equity in our accompanying consolidated balance sheets. See Note 12, Redeemable Noncontrolling Interests, for a further discussion.
Equity Compensation Plans
GAHR III 2013 Incentive Plan
Prior to the REIT Merger, GAHR III adopted the Griffin-American Healthcare REIT III, Inc. Incentive Plan, or the 2013 Incentive Plan, pursuant to which its board, or a committee of its independent directors, could grant options, shares of our common stock, stock purchase rights, stock appreciation rights or other awards to its independent directors, employees and consultants.
Under the 2013 Incentive Plan, GAHR III granted an aggregate of 33,750 shares of its restricted common stock, or I RSAs as defined below, which is equal to 31,273 shares of restricted Class I common stock, using the conversion ratio of 0.9266 shares of GAHR IV Class I common stock for each share of GAHR III restricted common stock, as determined in the Merger. Such restricted shares vest as to 20.0% of the shares on the date of grant and on each anniversary thereafter over four years from the date of grant and are subject to continuous service through the vesting dates. As of the Merger date, 4,170 shares such I RSAs remained unvested with a weighted average grant date fair value of $40.38.
AHR Incentive Plan
Pursuant to the AHR Incentive Plan, our board (with respect to options and restricted shares of common stock granted to independent directors), or our compensation committee (with respect to any other award), may grant options, restricted shares of common stock, stock purchase rights, stock appreciation rights or other awards to our independent directors, officers, employees and consultants. The AHR Incentive Plan terminates on June 15, 2033, and the maximum number of shares of our common stock that may be issued pursuant to such plan is 4,000,000 shares.
Restricted common stock
Pursuant to the AHR Incentive Plan, through December 31, 2023, we granted an aggregate of 315,459 shares of our restricted common stock, or RSAs, which include restricted Class T common stock and restricted Class I common stock, as defined in the AHR Incentive Plan. RSAs were granted to our independent directors in connection with their initial election or re-election to our board or in consideration of their past services rendered. In addition, certain executive officers and key employees received grants of restricted Class T common stock. In February 2024, we also granted an aggregate of 972,222 RSAs to independent directors, executive officers and certain employees upon completion of the 2024 Offering. RSAs generally have a vesting period ranging from one to four years and are subject to continuous service through the vesting dates.
Restricted stock units
Pursuant to the AHR Incentive Plan, through December 31, 2023, we granted to our executive officers an aggregate 70,751 of performance-based restricted stock units, or PBUs, representing the right to receive shares of our Class T common stock upon vesting. We also granted to our executive officers and certain employees 169,529 time-based restricted stock units, or TBUs, representing the right to receive shares of our Class T common stock upon vesting. PBUs and TBUs are collectively referred to as RSUs. RSUs granted to executive officers and employees, generally have a vesting period of up to three years and are subject to continuous service through the vesting dates and any performance conditions, as applicable.
A summary of the status of our nonvested RSAs and RSUs as of December 31, 2023 and 2022 and the changes for the years ended December 31, 2023 and 2022 is presented below:
Number of 
Nonvested
RSAs
Weighted
Average
Grant Date
Fair Value
Number of 
Nonvested
RSUs
Weighted
Average
Grant Date
Fair Value
Balance — December 31, 2021
222,886 $36.99 — $— 
Granted18,689 $37.16 60,077 $37.16 
Vested(58,335)$37.14 — $— 
Forfeited— $— (11,524)$37.16 
Balance — December 31, 2022
183,240 $36.97 48,553 $37.16 
Granted26,156 $31.83 191,728 $31.40 
Vested(62,352)$37.11 (6,400)(1)$37.16 
Forfeited— — (5,800)$32.57 
Balance — December 31, 2023
147,044 $35.99 228,081 $32.43 
___________
(1)Amount includes 2,280 shares of common stock that were withheld from issuance to satisfy employee minimum tax withholding requirements associated with the vesting of RSUs during the year ended December 31, 2023.
For the years ended December 31, 2023 and 2022, pursuant to the AHR Incentive Plan, we granted 26,156 and 18,689 shares of our restricted common stock, respectively, at a weighted average grant date fair value of $31.83 and $37.16 per share, respectively, to our executives and to our independent directors in connection with their election or re-election to our board. For the years ended December 31, 2023 and 2022, we recognized stock compensation expense related to awards granted pursuant to the AHR Incentive Plan of $5,385,000 and $3,935,000, respectively, based on the grant date fair value, which is equal to the most recently published estimated per share NAV. Stock compensation expense is included in general and administrative expenses in our accompanying consolidated statements of operations and comprehensive loss. As of December 31, 2023 and 2022, there was $6,865,000 and $6,888,000, respectively, of total unrecognized compensation expense, net of estimated forfeitures, related to nonvested RSAs and RSUs. As of December 31, 2023, this expense is expected to be recognized over a remaining weighted average period of 1.6 years.
v3.24.1
Related Party Transactions
12 Months Ended
Dec. 31, 2023
Related Party Transactions [Abstract]  
Related Party Transactions
14. Related Party Transactions
Fees and Expenses Paid to Affiliates
Through September 30, 2021, we were externally advised by our former advisor pursuant to an advisory agreement, as amended, or the Advisory Agreement, between us and our former advisor. Our former advisor, subject to the oversight and review of our board, provided asset management, property management, acquisition, disposition and other advisory services on our behalf consistent with our investment policies and objectives. Until September 30, 2021, all of our executive officers were officers of our former advisor and officers, limited partners and/or members of one of our former co-sponsors and other affiliates of our former advisor.
Prior to the Merger and the AHI Acquisition, our former advisor was 75.0% owned and managed by wholly-owned subsidiaries of AHI and 25.0% owned by a wholly-owned subsidiary of Griffin Capital, or collectively, our former cosponsors. Prior to the AHI Acquisition, AHI was 47.1% owned by AHI Group Holdings, 45.1% indirectly owned by DigitalBridge Group, Inc. (NYSE: DBRG), or DigitalBridge, and 7.8% owned by James F. Flaherty III. We were not affiliated with Griffin Capital, DigitalBridge or Mr. Flaherty; however, we were affiliated with our former advisor, AHI and AHI Group Holdings.
On December 20, 2021, the Advisory Agreement was assigned to NewCo, and as a result, any fees that would have otherwise been payable to our former advisor are no longer being paid to a third party. Following the consummation of the Merger in October 2021, we became self-managed and as a result we no longer incur any fees or expense reimbursements to our former advisor and its affiliates arising from the Advisory Agreement.
We did not incur any fees and expenses to our third-party affiliates for the years ended December 31, 2023 and 2022. Fees and expenses incurred to our former advisor or its affiliates for the year ended December 31, 2021 were as follows (in thousands):
Year Ended
December 31, 2021
Asset management fees(1)$16,187 
Property management fees(2)1,993 
Acquisition fees(3)1,363 
Development fees(4)856 
Lease fees(5)410 
Operating expenses(6)160 
Construction management fees(7)144 
Total$21,113 
___________
(1)Asset management fees were included in general and administrative expenses in our accompanying consolidated statements of operations and comprehensive loss.
(2)Property management fees were included in rental expenses or general and administrative expenses in our accompanying consolidated statements of operations and comprehensive loss, depending on the property type from which the fee was incurred.
(3)Acquisition fees in connection with the acquisition of properties accounted for as asset acquisitions or the acquisition of real estate-related investments were capitalized as part of the associated investments in our accompanying consolidated balance sheets.
(4)Development fees were capitalized as part of the associated investments in our accompanying consolidated balance sheets.
(5)Lease fees were capitalized as costs of entering into new leases and included in other assets, net in our accompanying consolidated balance sheets.
(6)We reimbursed our former advisor or its affiliates for operating expenses incurred in rendering services to us, subject to certain limitations. For the 12 months ended December 31, 2021, our operating expenses did not exceed such limitations. Operating expenses were generally included in general and administrative expenses in our accompanying consolidated statements of operations and comprehensive loss.
(7)Construction management fees were capitalized as part of the associated asset and included in real estate investments, net in our accompanying consolidated balance sheets.
Registration Rights Agreement
Upon consummation of the AHI Acquisition, GAHR III and the Surviving Partnership entered into a registration rights agreement, or the Registration Rights Agreement, with Griffin-American Strategic Holdings, LLC, or HoldCo, pursuant to which, subject to certain limitations therein, as promptly as practicable following the later of the expiration of (i) the period commencing on the closing of the AHI Acquisition and ending upon the earliest to occur of (a) the second anniversary date of the issuance of the Surviving Partnership OP units issued in connection with the AHI Acquisition, (b) a change of control of Merger Sub and (c) the listing of shares of our common stock on a national securities exchange, or the Lock-Up Period; and (ii) the date on which we are eligible to file a registration statement (but in any event no later than 180 days after such date), we, as the indirect parent company of the Surviving Partnership, are required to file a shelf registration statement with the SEC under the Securities Act covering the resale of the shares of our Class I common stock issued or issuable in redemption of the Surviving Partnership OP units that the Surviving Partnership issued as consideration in the AHI Acquisition. The Registration Rights Agreement also grants HoldCo (or any successor holder of such shares) demand rights to request additional registration statement filings as well as “piggyback” registration rights, in each case on or after the expiration of the Lock-Up Period. In connection with the Merger, we assumed from GAHR III the Registration Rights Agreement and GAHR III’s obligations thereunder in their entirety. In connection with the 2024 Offering, the Holders (as defined in the Registration Rights
Agreement) have agreed that, without the prior written consent of the representatives on behalf of the underwriters of the 2024 Offering, during the period ending 180 days after the date of listing of our common stock for trading on a national securities exchange, they will not, and will not publicly disclose an intention to, directly or indirectly, among others, subject to certain exceptions, exercise their registration rights under the Registration Rights Agreement.
v3.24.1
Fair Value Measurements
12 Months Ended
Dec. 31, 2023
Fair Value Disclosures [Abstract]  
Fair Value Measurements
15. Fair Value Measurements
Assets and Liabilities Reported at Fair Value
The table below presents our assets and liabilities measured at fair value on a recurring basis as of December 31, 2023, aggregated by the level in the fair value hierarchy within which those measurements fall (in thousands):
Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)
Significant Other
Observable Inputs
(Level 2)
Significant
Unobservable
Inputs
(Level 3)
Total
Assets:
Derivative financial instrument$— $1,463 $— $1,463 
Total assets at fair value$— $1,463 $— $1,463 
Liabilities:
Derivative financial instruments$— $2,389 $— $2,389 
Total liabilities at fair value$— $2,389 $— $2,389 
We did not have any assets and liabilities measured at fair value on a recurring basis as of December 31, 2022. There were no transfers into and out of fair value measurement levels during the years ended December 31, 2023 and 2022.
Warrants
As of December 31, 2023, we did not have any warrants outstanding. During the fourth quarter of 2022, we redeemed all the warrants in common units held by certain members of Trilogy’s management for $678,000 in cash, and as a result, we did not have any warrants outstanding as of December 31, 2022. Such warrants had redemption features similar to the common units held by members of Trilogy’s management. See Note 12, Redeemable Noncontrolling Interests, for a further discussion.
Derivative Financial Instruments
We entered into interest rate swaps to manage interest rate risk associated with variable-rate debt. We also previously used interest rate caps to manage such interest rate risk. The valuation of these instruments was determined using widely accepted valuation techniques including a discounted cash flow analysis on the expected cash flows of each derivative. Such valuation reflected the contractual terms of the derivatives, including the period to maturity, and used observable market-based inputs, including interest rate curves, as well as option volatility. The fair values of our interest rate swaps were determined by netting the discounted future fixed cash payments and the discounted expected variable cash receipts. The variable cash receipts were based on an expectation of future interest rates derived from observable market interest rate curves.
We incorporated credit valuation adjustments to appropriately reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements. In adjusting the fair value of our derivative contracts for the effect of nonperformance risk, we considered the impact of netting and any applicable credit enhancements, such as collateral postings, thresholds, mutual puts and guarantees.
Although we determined that the majority of the inputs used to value our derivative financial instruments fell within Level 2 of the fair value hierarchy, the credit valuation adjustments associated with this instrument utilized Level 3 inputs, such as estimates of current credit spreads, to evaluate the likelihood of default by us and our counterparty. However, as of December 31, 2023, we assessed the significance of the impact of the credit valuation adjustments on the overall valuation of our derivative positions and determined that the credit valuation adjustments were not significant to the overall valuation of our derivatives. As a result, we determined that our derivative valuations in their entirety were classified in Level 2 of the fair value hierarchy. On January 25, 2022, our prior interest rate swap contracts matured and as of December 31, 2022, we did not have any derivative financial instruments.
Financial Instruments Disclosed at Fair Value
Our accompanying consolidated balance sheets include the following financial instruments: debt security investment, cash and cash equivalents, restricted cash, accounts and other receivables, accounts payable and accrued liabilities, mortgage loans payable and borrowings under our lines of credit and term loan.
We consider the carrying values of cash and cash equivalents, restricted cash, accounts and other receivables and accounts payable and accrued liabilities to approximate the fair value for these financial instruments based upon an evaluation of the underlying characteristics and market data, in light of the short period of time between origination of the instruments and their expected realization. The fair values of the other financial instruments are classified in Level 2 of the fair value hierarchy.
The fair value of our debt security investment is estimated using a discounted cash flow analysis using interest rates available to us for investments with similar terms and maturities. The fair values of our mortgage loans payable and our lines of credit and term loan are estimated using discounted cash flow analyses using borrowing rates available to us for debt instruments with similar terms and maturities. We have determined that the valuations of our debt security investment, mortgage loans payable and lines of credit and term loan are classified in Level 2 within the fair value hierarchy. The carrying amounts and estimated fair values of such financial instruments as of December 31, 2023 and 2022 were as follows (in thousands):
December 31,
20232022
 Carrying
Amount(1)
Fair
Value
Carrying
Amount(1)
Fair
Value
Financial Assets:
Debt security investment$86,935 $93,304 $83,000 $93,230 
Financial Liabilities:
Mortgage loans payable$1,302,396 $1,185,260 $1,229,847 $1,091,667 
Lines of credit and term loan$1,220,137 $1,225,890 $1,277,460 $1,285,205 
___________
(1)Carrying amount is net of any discount/premium and unamortized deferred financing costs.
v3.24.1
Income Taxes
12 Months Ended
Dec. 31, 2023
Income Tax Disclosure [Abstract]  
Income Taxes
16. Income Taxes
As a REIT, we generally will not be subject to U.S. federal income tax on taxable income that we distribute to our stockholders. We have elected to treat certain of our consolidated subsidiaries as TRS pursuant to the Code. TRS may participate in services that would otherwise be considered impermissible for REITs and are subject to federal and state income tax at regular corporate tax rates.
The components of income or loss before taxes for the years ended December 31, 2023, 2022 and 2021, were as follows (in thousands):
December 31,
202320222021
Domestic$(75,843)$(72,510)$(52,001)
Foreign(381)(287)(312)
Loss before income taxes$(76,224)$(72,797)$(52,313)
The components of income tax benefit or expense for the years ended December 31, 2023, 2022 and 2021 were as follows (in thousands):
December 31,
202320222021
Federal deferred$(655)$(8,176)$(12,033)
State deferred210 (2,099)(2,908)
Federal current10 — — 
State current(3)— 329 
Foreign current656 586 627 
Valuation allowances445 10,275 14,941 
Total income tax expense$663 $586 $956 
Current Income Tax
Federal and state income taxes are generally a function of the level of income recognized by our TRS. Foreign income taxes are generally a function of our income on our real estate located in the UK and Isle of Man.
Deferred Taxes
Deferred income tax is generally a function of the period’s temporary differences (primarily basis differences between tax and financial reporting for real estate assets and equity investments) and generation of tax NOL that may be realized in future periods depending on sufficient taxable income.
We recognize the effects of an uncertain tax position on the financial statements, when it is more likely than not, based on the technical merits of the tax position, that such a position will be sustained upon examination by the relevant tax authorities. If the tax benefit meets the “more likely than not” threshold, the measurement of the tax benefit will be based on our estimate of the ultimate tax benefit to be sustained if audited by the taxing authority. As of both December 31, 2023 and 2022, we did not have any tax benefits or liabilities for uncertain tax positions that we believe should be recognized in our accompanying consolidated financial statements.
We assess the available positive and negative evidence to estimate if sufficient future taxable income will be generated to use the existing deferred tax assets. A valuation allowance is established if we believe it is more likely than not that all or a portion of the deferred tax assets are not realizable. As of both December 31, 2023 and 2022, our valuation allowance fully reserves the net deferred tax assets due to historical losses and inherent uncertainty of future income. We will continue to monitor industry and economic conditions, and our ability to generate taxable income based on our business plan and available tax planning strategies, which would allow us to utilize the tax benefits of the net deferred tax assets and thereby allow us to reverse all, or a portion of, our valuation allowance in the future.
Any increases or decreases to the deferred income tax assets or liabilities are reflected in income tax (expense) benefit in our accompanying consolidated statements of operations and comprehensive loss. The components of deferred tax assets and liabilities as of December 31, 2023 and 2022 were as follows (in thousands):
December 31,
20232022
Deferred income tax assets:
Fixed assets and intangibles$7,297 $8,271 
Expense accruals and other10,535 18,189 
Net operating loss and other carry forwards57,011 50,101 
Reserves and accruals8,119 7,487 
Allowances for accounts receivable2,878 2,224 
Investments in unconsolidated entities75 — 
Total deferred income tax assets
$85,915 $86,272 
Deferred income tax liabilities:
Fixed assets and intangibles$(12,892)$(13,626)
Other — temporary differences(2,608)(2,676)
Total deferred income tax liabilities$(15,500)$(16,302)
Net deferred income tax assets before valuation allowance$70,415 $69,970 
Valuation allowances(70,415)(69,970)
Net deferred income tax assets (liabilities)$— $— 
At December 31, 2023 and 2022, we had a NOL carryforward of $203,320,000 and $196,779,000, respectively, related to our TRS. These amounts can be used to offset future taxable income, if any. The NOL carryforwards incurred before January 1, 2018 will begin to expire starting 2035, and NOL carryforwards incurred after December 31, 2017 will be carried forward indefinitely.
Tax Treatment of Distributions (Unaudited)
For U.S. federal income tax purposes, distributions to stockholders are characterized as ordinary income, capital gain distributions or nontaxable distributions. Nontaxable distributions will reduce United States stockholders’ basis (but not below zero) in their shares. The income tax treatment for distributions reportable for the years ended December 31, 2023, 2022 and 2021 was as follows (dollars in thousands):
Years Ended December 31,
202320222021
Ordinary income$2,208 2.9 %$40,745 46.5 %$7,989 26.3 %
Capital gain— — — — — — 
Return of capital73,614 97.1 46,890 53.5 22,406 73.7 
$75,822 100 %$87,635 100 %$30,395 100 %
Amounts listed above do not include distributions paid on nonvested RSAs and RSUs, which have been separately reported.
v3.24.1
Leases
12 Months Ended
Dec. 31, 2023
Leases [Abstract]  
Leases
17. Leases
Lessor
We have operating leases with tenants that expire at various dates through 2050. For the years ended December 31, 2023, 2022 and 2021, we recognized $185,064,000, $200,526,000 and $136,294,000, respectively, of revenues related to operating lease payments, of which $38,415,000 and $39,278,000, $23,340,000, respectively, was for variable lease payments. As of December 31, 2023, the following table sets forth the undiscounted cash flows for future minimum base rents due under operating leases for each of the next five years ending December 31 and thereafter for properties that we wholly own (in thousands):
YearAmount
2024$134,438 
2025125,035 
2026115,544 
2027109,950 
202898,546 
Thereafter466,484 
Total$1,049,997 
Lessee
We lease certain land, buildings, furniture, fixtures, campus and office equipment and automobiles. We have lease agreements with lease and non-lease components, which are generally accounted for separately. Most leases include one or more options to renew, with renewal terms that generally can extend at various dates through 2107, excluding extension options. The exercise of lease renewal options is at our sole discretion. Certain leases also include options to purchase the leased property.
The depreciable life of assets and leasehold improvements are limited by the expected lease term, unless there is a transfer of title or purchase option reasonably certain of exercise. Certain of our lease agreements include rental payments that are adjusted periodically based on the United States Bureau of Labor Statistics’ Consumer Price Index and may also include other variable lease costs (i.e., common area maintenance, property taxes and insurance). Our lease agreements do not contain any material residual value guarantees or material restrictive covenants.
The components of lease costs were as follows (in thousands):
Years Ended December 31,
Lease CostClassification202320222021
Operating lease cost(1)Property operating expenses, rental expenses or general and administrative expenses$44,141 $30,566 $23,774 
Finance lease cost
Amortization of leased assetsDepreciation and amortization1,360 1,249 1,447 
Interest on lease liabilitiesInterest expense353 261 384 
Sublease incomeResident fees and services revenue or other income(572)(693)(210)
Total lease cost$45,282 $31,383 $25,395 
___________
(1)Includes short-term leases and variable lease costs, which are immaterial.
Additional information related to our leases for the periods presented below was as follows (dollars in thousands):
December 31,
Lease Term and Discount Rate202320222021
Weighted average remaining lease term (in years)
Operating leases12.212.816.9
Finance leases1.52.33.6
Weighted average discount rate
Operating leases5.76 %5.69 %5.52 %
Finance leases7.78 %7.66 %7.68 %
Years Ended December 31,
Supplemental Disclosure of Cash Flows Information202320222020
Operating cash outflows related to finance leases$353 $262 $384 
Financing cash outflows related to finance leases$62 $54 $170 
Right-of-use assets obtained in exchange for operating lease liabilities$6,153 $173,832 $29,523 
Operating Leases
As of December 31, 2023, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for each of the next five years ending December 31 and thereafter, as well as the reconciliation of those cash flows to operating lease liabilities on our accompanying consolidated balance sheet (in thousands):
YearAmount
2024$35,834 
202535,153 
202635,073 
202735,618 
202835,707 
Thereafter166,313 
Total undiscounted operating lease payments343,698 
Less: interest118,196 
Present value of operating lease liabilities$225,502 
Finance Leases
As of December 31, 2023, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for each of the next five years ending December 31 and thereafter, as well as a reconciliation of those cash flows to finance lease liabilities (in thousands):
YearAmount
2024$76 
202531 
2026— 
2027— 
2028— 
Thereafter— 
Total undiscounted finance lease payments107 
Less: interest
Present value of finance lease liabilities$100 
Leases
17. Leases
Lessor
We have operating leases with tenants that expire at various dates through 2050. For the years ended December 31, 2023, 2022 and 2021, we recognized $185,064,000, $200,526,000 and $136,294,000, respectively, of revenues related to operating lease payments, of which $38,415,000 and $39,278,000, $23,340,000, respectively, was for variable lease payments. As of December 31, 2023, the following table sets forth the undiscounted cash flows for future minimum base rents due under operating leases for each of the next five years ending December 31 and thereafter for properties that we wholly own (in thousands):
YearAmount
2024$134,438 
2025125,035 
2026115,544 
2027109,950 
202898,546 
Thereafter466,484 
Total$1,049,997 
Lessee
We lease certain land, buildings, furniture, fixtures, campus and office equipment and automobiles. We have lease agreements with lease and non-lease components, which are generally accounted for separately. Most leases include one or more options to renew, with renewal terms that generally can extend at various dates through 2107, excluding extension options. The exercise of lease renewal options is at our sole discretion. Certain leases also include options to purchase the leased property.
The depreciable life of assets and leasehold improvements are limited by the expected lease term, unless there is a transfer of title or purchase option reasonably certain of exercise. Certain of our lease agreements include rental payments that are adjusted periodically based on the United States Bureau of Labor Statistics’ Consumer Price Index and may also include other variable lease costs (i.e., common area maintenance, property taxes and insurance). Our lease agreements do not contain any material residual value guarantees or material restrictive covenants.
The components of lease costs were as follows (in thousands):
Years Ended December 31,
Lease CostClassification202320222021
Operating lease cost(1)Property operating expenses, rental expenses or general and administrative expenses$44,141 $30,566 $23,774 
Finance lease cost
Amortization of leased assetsDepreciation and amortization1,360 1,249 1,447 
Interest on lease liabilitiesInterest expense353 261 384 
Sublease incomeResident fees and services revenue or other income(572)(693)(210)
Total lease cost$45,282 $31,383 $25,395 
___________
(1)Includes short-term leases and variable lease costs, which are immaterial.
Additional information related to our leases for the periods presented below was as follows (dollars in thousands):
December 31,
Lease Term and Discount Rate202320222021
Weighted average remaining lease term (in years)
Operating leases12.212.816.9
Finance leases1.52.33.6
Weighted average discount rate
Operating leases5.76 %5.69 %5.52 %
Finance leases7.78 %7.66 %7.68 %
Years Ended December 31,
Supplemental Disclosure of Cash Flows Information202320222020
Operating cash outflows related to finance leases$353 $262 $384 
Financing cash outflows related to finance leases$62 $54 $170 
Right-of-use assets obtained in exchange for operating lease liabilities$6,153 $173,832 $29,523 
Operating Leases
As of December 31, 2023, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for each of the next five years ending December 31 and thereafter, as well as the reconciliation of those cash flows to operating lease liabilities on our accompanying consolidated balance sheet (in thousands):
YearAmount
2024$35,834 
202535,153 
202635,073 
202735,618 
202835,707 
Thereafter166,313 
Total undiscounted operating lease payments343,698 
Less: interest118,196 
Present value of operating lease liabilities$225,502 
Finance Leases
As of December 31, 2023, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for each of the next five years ending December 31 and thereafter, as well as a reconciliation of those cash flows to finance lease liabilities (in thousands):
YearAmount
2024$76 
202531 
2026— 
2027— 
2028— 
Thereafter— 
Total undiscounted finance lease payments107 
Less: interest
Present value of finance lease liabilities$100 
Leases
17. Leases
Lessor
We have operating leases with tenants that expire at various dates through 2050. For the years ended December 31, 2023, 2022 and 2021, we recognized $185,064,000, $200,526,000 and $136,294,000, respectively, of revenues related to operating lease payments, of which $38,415,000 and $39,278,000, $23,340,000, respectively, was for variable lease payments. As of December 31, 2023, the following table sets forth the undiscounted cash flows for future minimum base rents due under operating leases for each of the next five years ending December 31 and thereafter for properties that we wholly own (in thousands):
YearAmount
2024$134,438 
2025125,035 
2026115,544 
2027109,950 
202898,546 
Thereafter466,484 
Total$1,049,997 
Lessee
We lease certain land, buildings, furniture, fixtures, campus and office equipment and automobiles. We have lease agreements with lease and non-lease components, which are generally accounted for separately. Most leases include one or more options to renew, with renewal terms that generally can extend at various dates through 2107, excluding extension options. The exercise of lease renewal options is at our sole discretion. Certain leases also include options to purchase the leased property.
The depreciable life of assets and leasehold improvements are limited by the expected lease term, unless there is a transfer of title or purchase option reasonably certain of exercise. Certain of our lease agreements include rental payments that are adjusted periodically based on the United States Bureau of Labor Statistics’ Consumer Price Index and may also include other variable lease costs (i.e., common area maintenance, property taxes and insurance). Our lease agreements do not contain any material residual value guarantees or material restrictive covenants.
The components of lease costs were as follows (in thousands):
Years Ended December 31,
Lease CostClassification202320222021
Operating lease cost(1)Property operating expenses, rental expenses or general and administrative expenses$44,141 $30,566 $23,774 
Finance lease cost
Amortization of leased assetsDepreciation and amortization1,360 1,249 1,447 
Interest on lease liabilitiesInterest expense353 261 384 
Sublease incomeResident fees and services revenue or other income(572)(693)(210)
Total lease cost$45,282 $31,383 $25,395 
___________
(1)Includes short-term leases and variable lease costs, which are immaterial.
Additional information related to our leases for the periods presented below was as follows (dollars in thousands):
December 31,
Lease Term and Discount Rate202320222021
Weighted average remaining lease term (in years)
Operating leases12.212.816.9
Finance leases1.52.33.6
Weighted average discount rate
Operating leases5.76 %5.69 %5.52 %
Finance leases7.78 %7.66 %7.68 %
Years Ended December 31,
Supplemental Disclosure of Cash Flows Information202320222020
Operating cash outflows related to finance leases$353 $262 $384 
Financing cash outflows related to finance leases$62 $54 $170 
Right-of-use assets obtained in exchange for operating lease liabilities$6,153 $173,832 $29,523 
Operating Leases
As of December 31, 2023, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for each of the next five years ending December 31 and thereafter, as well as the reconciliation of those cash flows to operating lease liabilities on our accompanying consolidated balance sheet (in thousands):
YearAmount
2024$35,834 
202535,153 
202635,073 
202735,618 
202835,707 
Thereafter166,313 
Total undiscounted operating lease payments343,698 
Less: interest118,196 
Present value of operating lease liabilities$225,502 
Finance Leases
As of December 31, 2023, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for each of the next five years ending December 31 and thereafter, as well as a reconciliation of those cash flows to finance lease liabilities (in thousands):
YearAmount
2024$76 
202531 
2026— 
2027— 
2028— 
Thereafter— 
Total undiscounted finance lease payments107 
Less: interest
Present value of finance lease liabilities$100 
v3.24.1
Segment Reporting
12 Months Ended
Dec. 31, 2023
Segment Reporting [Abstract]  
Segment Reporting Disclosure
18. Segment Reporting
We evaluate our business and make resource allocations based on four reportable business segments: integrated senior health campuses, or ISHC, OM, triple-net leased properties and SHOP. Our OM buildings are typically leased to multiple tenants under separate leases, thus requiring active management and responsibility for many of the associated operating expenses (much of which are, or can effectively be, passed through to the tenants). Our integrated senior health campuses each provide a range of independent living, assisted living, memory care, skilled nursing services and certain ancillary businesses that are owned and operated utilizing a RIDEA structure. Our triple-net leased properties segment includes senior housing, skilled nursing facilities and hospital investments, which are single-tenant properties for which we lease the facilities to unaffiliated tenants under triple-net and generally master leases that transfer the obligation for all facility operating costs (including maintenance, repairs, taxes, insurance and capital expenditures) to the tenant. In addition, our triple-net leased properties segment includes our debt security investment. Our SHOP segment includes senior housing, which may provide assisted living care, independent living, memory care or skilled nursing services that are owned and operated utilizing a RIDEA structure.
While we believe that net income (loss), as defined by GAAP, is the most appropriate earnings measurement, we evaluate our segments’ performance based upon segment net operating income, or NOI. We define segment NOI as total revenues and grant income, less property operating expenses and rental expenses, which excludes depreciation and amortization, general and administrative expenses, business acquisition expenses, interest expense, gain or loss on dispositions of real estate investments, impairment of real estate investments, impairment of intangible assets and goodwill, income or loss from unconsolidated entities, gain on re-measurement of previously held equity interest, foreign currency gain or loss, other income and income tax benefit or expense for each segment. We believe that segment NOI serves as an appropriate supplemental performance measure to net income (loss) because it allows investors and our management to measure unlevered property-level operating results and to compare our operating results to the operating results of other real estate companies and between periods on a consistent basis.
Interest expense, depreciation and amortization and other expenses not attributable to individual properties are not allocated to individual segments for purposes of assessing segment performance. Non-segment assets primarily consist of corporate assets, including cash and cash equivalents, other receivables, deferred financing costs and other assets not attributable to individual properties.
Summary information for the reportable segments during the years ended December 31, 2023, 2022 and 2021 was as follows (in thousands):
Integrated
Senior Health
Campuses
SHOPOMTriple-Net
Leased
Properties
Year Ended
December 31,
2023
Revenues and grant income:
Resident fees and services
$1,481,880 $186,862 $— $— $1,668,742 
Real estate revenue
— — 146,068 44,333 190,401 
Grant income7,475 — — — 7,475 
Total revenues and grant income1,489,355 186,862 146,068 44,333 1,866,618 
Expenses:
Property operating expenses
1,335,817 166,493 — — 1,502,310 
Rental expenses
— — 54,457 3,018 57,475 
Segment net operating income$153,538 $20,369 $91,611 $41,315 $306,833 
Expenses:
General and administrative
$47,510 
Business acquisition expenses5,795 
Depreciation and amortization
182,604 
Other income (expense):
Interest expense:
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishments)(163,191)
Loss in fair value of derivative financial instruments(926)
Gain on dispositions of real estate investments32,472 
Impairment of real estate investments
(13,899)
Impairment of intangible assets(10,520)
Loss from unconsolidated entities(1,718)
Gain on re-measurement of previously held equity interest726 
Foreign currency gain2,307 
Other income
7,601 
Total net other expense(147,148)
Loss before income taxes(76,224)
Income tax expense(663)
Net loss$(76,887)
Integrated
Senior Health
Campuses
SHOPOMTriple-Net
Leased
Properties
Year Ended
December 31,
2022
Revenues and grant income:
Resident fees and services$1,254,665 $157,491 $— $— $1,412,156 
Real estate revenue— — 148,717 56,627 205,344 
Grant income24,820 855 — — 25,675 
Total revenues and grant income1,279,485 158,346 148,717 56,627 1,643,175 
Expenses:
Property operating expenses1,133,480 148,046 — — 1,281,526 
Rental expenses— — 56,390 3,294 59,684 
Segment net operating income$146,005 $10,300 $92,327 $53,333 $301,965 
Expenses:
General and administrative$43,418 
Business acquisition expenses4,388 
Depreciation and amortization167,957 
Other income (expense):
Interest expense:
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishments) (105,956)
Gain in fair value of derivative financial instruments500 
Gain on dispositions of real estate investments5,481 
Impairment of real estate investments(54,579)
Impairment of goodwill(23,277)
Income from unconsolidated entities1,407 
Gain on re-measurement of previously held equity interest19,567 
Foreign currency loss(5,206)
Other income3,064 
Total net other expense(158,999)
Loss before income taxes(72,797)
Income tax expense(586)
Net loss$(73,383)
Integrated
Senior Health
Campuses
SHOPOMTriple-Net
Leased
Properties
Year Ended
December 31,
2021
Revenues and grant income:
Resident fees and services$1,025,699 $98,236 $— $— $1,123,935 
Real estate revenue
— — 97,297 44,071 141,368 
Grant income13,911 3,040 — — 16,951 
Total revenues and grant income1,039,610 101,276 97,297 44,071 1,282,254 
Expenses:
Property operating expenses
943,743 86,450 — — 1,030,193 
Rental expenses
— — 36,375 2,350 38,725 
Segment net operating income
$95,867 $14,826 $60,922 $41,721 $213,336 
Expenses:
General and administrative$43,199 
Business acquisition expenses13,022 
Depreciation and amortization133,191 
Other income (expense):
Interest expense:
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishments)(80,937)
Gain in fair value of derivative financial instruments8,200 
Loss on dispositions of real estate investments(100)
Impairment of real estate investments(3,335)
Loss from unconsolidated entities(1,355)
Foreign currency loss(564)
Other income1,854 
Total net other expense(76,237)
Loss before income taxes(52,313)
Income tax expense(956)
Net loss$(53,269)
Total assets by reportable segment as of December 31, 2023 and 2022 were as follows (in thousands):
 December 31,
 20232022
Integrated senior health campuses$2,197,762 $2,157,748 
OM1,232,310 1,379,502 
SHOP630,373 635,190 
Triple-net leased properties502,836 601,360 
Other14,652 12,898 
Total assets$4,577,933 $4,786,698 
As of and for the years ended December 31, 2023 and 2022, goodwill by reportable segment was as follows (in thousands):
Integrated
Senior Health
Campuses
OMSHOPTriple-Net
Leased
Properties
Total
Balance December 31, 2021
$119,856 $47,812 $23,277 $18,953 $209,898 
Goodwill acquired 44,990 — — — 44,990 
Impairment loss— — (23,277)— (23,277)
Balance December 31, 2022
$164,846 $47,812 $— $18,953 $231,611 
Goodwill acquired 3,331 — — — 3,331 
Balance December 31, 2023
$168,177 $47,812 $— $18,953 $234,942 
See Note 4, Business Combinations, for a further discussion of goodwill recognized in connection with our business combinations. During the year ended December 31, 2022, we performed the quantitative step one test of the goodwill impairment guidance for each of our reporting units in connection with our annual assessments of goodwill. The fair value of each reporting unit was determined based on various methodologies, including the income approach and the market approach models. For the year ended December 31, 2022, we determined that the fair value of the reporting unit under the SHOP reporting segment compared to its carrying value, including goodwill, was lower than its carrying value. As a result, goodwill pertaining to our SHOP reporting segment was fully impaired and we recognized an impairment loss of $23,277,000 in our accompanying consolidated statements of operations and comprehensive loss for the year ended December 31, 2022. Therefore, as of December 31, 2022, we did not have any remaining goodwill associated with our SHOP reporting segment.
Our portfolio of properties and other investments are located in the United States, the UK and Isle of Man. Revenues and grant income and assets are attributed to the country in which the property is physically located. The following is a summary of geographic information for our operations for the periods presented (in thousands):
Years Ended December 31,
 202320222021
Revenues and grant income:
United States$1,861,954 $1,638,557 $1,277,095 
International4,664 4,618 5,159 
$1,866,618 $1,643,175 $1,282,254 
The following is a summary of real estate investments, net by geographic regions as of December 31, 2023 and 2022 (in thousands):
 December 31,
 20232022
Real estate investments, net:
United States$3,382,115 $3,539,453 
International43,323 42,156 
$3,425,438 $3,581,609 
v3.24.1
Concentration of Credit Risk
12 Months Ended
Dec. 31, 2023
Risks and Uncertainties [Abstract]  
Concentration of Credit Risk
19. Concentration of Credit Risk
Financial instruments that potentially subject us to a concentration of credit risk are primarily our debt security investment, cash and cash equivalents, restricted cash and accounts and other receivables. We are exposed to credit risk with respect to our debt security investment, but we believe collection of the outstanding amount is probable. Cash and cash equivalents are generally invested in investment-grade, short-term instruments with a maturity of three months or less when purchased. We have cash and cash equivalents in financial institutions that are insured by the Federal Deposit Insurance Corporation, or FDIC. As of December 31, 2023 and 2022, we had cash and cash equivalents in excess of FDIC insured limits. We believe this risk is not significant. Concentration of credit risk with respect to accounts receivable from tenants and residents is limited. We perform credit evaluations of prospective tenants and security deposits are obtained at the time of property acquisition and upon lease execution.
Based on leases as of December 31, 2023, properties in two states in the United States accounted for 10.0% or more of our total consolidated property portfolio’s annualized base rent or annualized NOI, which is based on contractual base rent from leases in effect for our non-RIDEA properties and annualized NOI for our SHOP and integrated senior health campuses as of December 31, 2023. Properties located in Indiana and Michigan accounted for 35.3% and 10.4%, respectively, of our total consolidated property portfolio’s annualized base rent or annualized NOI. Accordingly, there is a geographic concentration of risk subject to fluctuations in each state’s economy.
Based on leases as of December 31, 2023, our four reportable business segments, integrated senior health campuses, OM, triple-net leased properties and SHOP accounted for 51.0%, 28.7%, 11.5% and 8.8%, respectively, of our total consolidated property portfolio’s annualized base rent or annualized NOI. As of December 31, 2023, none of our tenants at our properties accounted for 10.0% or more of our total consolidated property portfolio’s annualized base rent or annualized NOI
v3.24.1
Per Share Data
12 Months Ended
Dec. 31, 2023
Earnings Per Share [Abstract]  
Per Share Data
20. Per Share Data
Basic earnings (loss) per share for all periods presented are computed by dividing net income (loss) applicable to common stock by the weighted average number of shares of our common stock outstanding during the period. Net income (loss) applicable to common stock is calculated as net income (loss) attributable to controlling interest less distributions allocated to participating securities of $3,803,000, $5,967,000 and $1,440,000, respectively, for the years ended December 31, 2023, 2022 and 2021. Diluted earnings (loss) per share are computed based on the weighted average number of shares of our common stock and all potentially dilutive securities, if any. TBUs, nonvested shares of our RSAs and limited partnership units of our operating partnership are participating securities and give rise to potentially dilutive shares of our common stock.
As of December 31, 2023 and 2022, there were 147,044 and 183,240 nonvested shares, respectively, of our RSAs outstanding, but such shares were excluded from the computation of diluted earnings (loss) per share because such shares were anti-dilutive during these periods. As of both December 31, 2023 and 2022, there were 3,501,976 limited partnership units of our operating partnership outstanding, but such units were also excluded from the computation of diluted earnings (loss) per share because such units were anti-dilutive during these periods. As of December 31, 2023 and 2022, there were 157,329 and 19,200 nonvested TBUs outstanding, respectively, but such units were excluded from the computation of diluted earnings (loss) per share because such restricted stock units were anti-dilutive during the period.
As of December 31, 2023 and 2022, there were 70,751 and 29,352 nonvested PBUs outstanding, respectively, which were treated as contingently issuable shares pursuant to ASC Topic 718, Compensation — Stock Compensation. Such contingently issuable shares were excluded from the computation of diluted earnings (loss) per share because they were anti-dilutive during the period.
v3.24.1
Subsequent Events
12 Months Ended
Dec. 31, 2023
Subsequent Events [Abstract]  
Subsequent Events
21. Subsequent Events
Acquisition of Senior Housing Portfolio
On February 1, 2024, we acquired a portfolio of 12 senior housing facilities in Oregon from an unaffiliated third party, which facilities are included in our SHOP segment. These facilities are part of the underlying collateral pool of real estate assets securing our debt security investment. We acquired such 12 facilities by assuming the outstanding principal balance of each related mortgage loan payable from one of the borrowers. The aggregated principal balance of such assumed mortgage loans payable was $94,461,000 at the time of acquisition.
2024 Underwritten Public Offering and Listing
On February 9, 2024, pursuant to a Registration Statement filed with the SEC on Form S-11 (File No. 333-267464), as amended, we closed the 2024 Offering, through which we issued 64,400,000 shares of common stock, $0.01 par value per share, for a total of $772,800,000 in gross offering proceeds. Such amounts include the exercise in full of the underwriters’ overallotment option to purchase up to an additional 8,400,000 shares of common stock. These shares are listed on New York Stock Exchange under the trading symbol “AHR” and began trading on February 7, 2024. We received $724,625,000 in net proceeds, which was primarily used to repay $176,145,000 of mortgage loans payable and $545,010,000 on our lines of credit in February 2024.
2024 Credit Facility
On February 14, 2024, we, through our operating partnership, as borrower, and certain of our subsidiaries, or the subsidiary guarantors, and our company, collectively as guarantors, entered into an agreement, or the 2024 Credit Agreement, that amends, restates, supersedes and replaces the 2022 Credit Agreement with Bank of America, KeyBank, Citizens Bank and a syndicate of other banks, as lenders, to obtain a credit facility with an aggregate maximum principal amount up to $1,150,000,000, or the 2024 Credit Facility. The 2024 Credit Facility consists of a senior unsecured revolving credit facility in the initial aggregate amount of $600,000,000 and a senior unsecured term loan facility in the initial aggregate amount of $550,000,000. Unless defined herein, all capitalized terms under this “2024 Credit Facility” subsection are defined in the 2024 Credit Agreement.
Under the terms of the 2024 Credit Agreement, the Revolving Loans mature on February 14, 2028, and may be extended for one 12-month period, subject to the satisfaction of certain conditions, including payment of an extension fee. The Term Loan matures on January 19, 2027, and may not be extended. The maximum principal amount of the 2024 Credit Facility may be increased by an aggregate incremental amount of $600,000,000, subject to: (i) the terms of the 2024 Credit Agreement; and (ii) at least five business days’ prior written notice to Bank of America.
The 2024 Credit Facility bears interest at varying rates based upon, at our option, (i) Daily SOFR, plus the Applicable Rate for Daily SOFR Rate Loans or (ii) Term SOFR, plus the Applicable Rate for Term SOFR Rate Loans. If, under the terms of the 2024 Credit Agreement, there is an inability to determine the Daily SOFR or the Term SOFR, then the 2024 Credit Facility will bear interest at a rate per annum equal to the Base Rate plus the Applicable Rate for Base Rate Loans. The loans may be repaid in whole or in part without prepayment premium or penalty, subject to certain conditions.
We are required to pay a fee on the unused portion of the lenders’ commitments under the 2024 Credit Agreement computed at (a) 0.25% per annum if the actual daily Commitment Utilization Percentage for such quarter is less than or equal to 50% and (b) 0.20% per annum if the actual daily Commitment Utilization Percentage for such quarter is greater than 50%, which fee shall be computed on the actual daily amount of the Available Commitments during the period for which payment is made and payable in arrears on a quarterly basis.
The 2024 Credit Agreement requires us to add additional subsidiaries as guarantors in the event the value of the assets owned by the subsidiary guarantors falls below a certain threshold as set forth in the 2024 Credit Agreement. In the event of default, Bank of America has the right to terminate the commitment of each Lender to make Loans and any obligation of the L/C Issuer to make L/C Credit Extensions under the 2024 Credit Agreement and to accelerate the payment on any unpaid principal amount of all outstanding loans and all interest accrued and unpaid thereon. The 2024 Credit Facility replaces the 2022 Credit Facility.
Distributions Declared
On March 13, 2024, our board authorized a quarterly distribution of $0.25 per share to all of our stockholders of record as of the close of business on March 28, 2024. The distribution for the quarter commencing January 1, 2024 to March 31, 2024, which will be paid on or about April 19, 2024, represents an annualized distribution rate of $1.00 per share.
v3.24.1
Schedule III Real Estate and Accumulated Depreciation
12 Months Ended
Dec. 31, 2023
SEC Schedule, 12-28, Real Estate Companies, Investment in Real Estate and Accumulated Depreciation Disclosure [Abstract]  
Schedule III Real Estate and Accumulated Depreciation
   Initial Cost to Company Gross Amount of Which Carried at Close of Period(f)  
Description(a)EncumbrancesLand and ImprovementsBuildings and
Improvements
Cost
Capitalized
Subsequent to
Acquisition(b)
Land and
Improvements
Buildings and
Improvements
Total(e)Accumulated
Depreciation
(g)(h)
Date of
Construction
Date 
Acquired
Wichita KS OM (Outpatient Medical)Wichita, KS$— $943 $6,288 $812 $943 $7,100 $8,043 $(2,316)1980/199609/04/14
Delta Valley ALF Portfolio (SHOP)Batesville, MS— 331 5,103 (335)331 4,768 5,099 (1,295)1999/200509/11/14
Cleveland, MS— 348 6,369 (921)355 5,441 5,796 (1,460)200409/11/14
Springdale, AR— 891 6,538 (705)891 5,833 6,724 (1,502)1998/200501/08/15
Lee’s Summit MO OM (Outpatient Medical)Lee’s Summit, MO— 1,045 5,068 1,530 1,045 6,598 7,643 (2,190)200609/18/14
Carolina Commons OM (Outpatient Medical)Indian Land, SC— 1,028 9,430 4,931 1,028 14,361 15,389 (4,378)200910/15/14
Mount Olympia OM Portfolio (Outpatient Medical)Mount Dora, FL— 393 5,633 — 393 5,633 6,026 (1,576)200912/04/14
Southlake TX Hospital (Hospital)Southlake, TX91,601 5,089 108,517 — 5,089 108,517 113,606 (26,425)201312/04/14
East Texas OM Portfolio (Outpatient Medical)Longview, TX— — 19,942 9,079 — 29,021 29,021 (6,397)200812/12/14
Longview, TX— 759 1,696 140 759 1,836 2,595 (912)199812/12/14
Longview, TX— — 8,027 — 8,028 8,028 (2,489)200412/12/14
Longview, TX— — 696 41 — 737 737 (335)195612/12/14
Longview, TX— — 27,601 5,494 — 33,095 33,095 (10,359)1985/1993/ 200412/12/14
Marshall, TX— 368 1,711 110 368 1,821 2,189 (856)197012/12/14
Premier OM (Outpatient Medical)Novi, MI— 644 10,420 2,031 644 12,451 13,095 (3,808)200612/19/14
Independence OM Portfolio (Outpatient Medical)Southgate, KY— 411 11,005 2,530 411 13,535 13,946 (4,112)198801/13/15
Somerville, MA28,474 1,509 46,775 6,500 1,509 53,275 54,784 (12,866)198501/13/15
Verona, NJ— 1,683 9,405 2,409 1,683 11,814 13,497 (3,175)197001/13/15
   Initial Cost to Company Gross Amount of Which Carried at Close of Period(f)  
Description(a)EncumbrancesLand and ImprovementsBuildings and
Improvements
Cost
Capitalized
Subsequent to
Acquisition(b)
Land and
Improvements
Buildings and
Improvements
Total(e)Accumulated
Depreciation
(g)(h)
Date of
Construction
Date 
Acquired
Bronx, NY$— $— $19,593 $3,403 $— $22,996 $22,996 $(6,098)1987/198801/26/15
King of Prussia PA OM (Outpatient Medical)King of Prussia, PA— 3,427 13,849 6,305 3,427 20,154 23,581 (6,232)1946/200001/21/15
North Carolina ALF Portfolio (SHOP)Clemmons, NC— 596 13,237 (412)596 12,825 13,421 (3,296)201406/29/15
Garner, NC— 1,723 11,517 196 1,723 11,713 13,436 (1,988)201403/27/19
Huntersville, NC— 2,033 11,494 95 2,033 11,589 13,622 (2,573)201501/18/17
Matthews, NC— 949 12,537 (5)949 12,532 13,481 (2,248)201708/30/18
Mooresville, NC— 835 15,894 (350)835 15,544 16,379 (3,945)201201/28/15
Raleigh, NC— 1,069 21,235 (429)1,069 20,806 21,875 (5,036)201301/28/15
Wake Forest, NC— 772 13,596 (432)772 13,164 13,936 (3,144)201406/29/15
Orange Star Medical Portfolio (Outpatient Medical and Hospital)Durango, CO— 623 14,166 483 623 14,649 15,272 (3,664)200402/26/15
Durango, CO— 788 10,467 1,242 788 11,709 12,497 (3,059)200402/26/15
Friendswood, TX— 500 7,664 1,114 500 8,778 9,278 (2,338)200802/26/15
Keller, TX— 1,604 7,912 873 1,604 8,785 10,389 (2,453)201102/26/15
Wharton, TX— 259 10,590 3,543 259 14,133 14,392 (2,978)198702/26/15
Kingwood OM Portfolio (Outpatient Medical)Kingwood, TX— 820 8,589 526 820 9,115 9,935 (2,475)200503/11/15
Kingwood, TX— 781 3,943 64 781 4,007 4,788 (1,137)200803/11/15
Mt Juliet TN OM (Outpatient Medical)Mount Juliet, TN— 1,188 10,720 516 1,188 11,236 12,424 (2,893)201203/17/15
Homewood AL OM (Outpatient Medical)Homewood, AL— 405 6,590 (665)405 5,925 6,330 (1,961)201003/27/15
Paoli PA Medical Plaza (Outpatient Medical)Paoli, PA— 2,313 12,447 8,809 2,313 21,256 23,569 (6,149)195104/10/15
Paoli, PA— 1,668 7,357 2,193 1,668 9,550 11,218 (3,123)197504/10/15
   Initial Cost to Company Gross Amount of Which Carried at Close of Period(f)  
Description(a)EncumbrancesLand and ImprovementsBuildings and
Improvements
Cost
Capitalized
Subsequent to
Acquisition(b)
Land and
Improvements
Buildings and
Improvements
Total(e)Accumulated
Depreciation
(g)(h)
Date of
Construction
Date 
Acquired
Glen Burnie MD OM (Outpatient Medical)Glen Burnie, MD$— $2,692 $14,095 $4,289 $2,692 $18,384 $21,076 $(5,666)198105/06/15
Marietta GA OM (Outpatient Medical)Marietta, GA— 1,347 10,947 749 1,347 11,696 13,043 (2,992)200205/07/15
Mountain Crest Senior Housing Portfolio (SHOP)Elkhart, IN— 793 6,009 682 793 6,691 7,484 (1,960)199705/14/15
Elkhart, IN— 782 6,760 819 782 7,579 8,361 (2,346)200005/14/15
Hobart, IN— 604 11,529 (799)— 11,334 11,334 (3,180)200805/14/15
LaPorte, IN— 392 14,894 (6,101)— 9,185 9,185 (4,057)200805/14/15
Mishawaka, IN— 3,670 14,416 1,382 3,670 15,798 19,468 (4,375)197807/14/15
Niles, MI— 404 5,050 802 404 5,852 6,256 (1,775)200006/11/15 and 11/20/15
Nebraska Senior Housing Portfolio (SHOP)Bennington, NE— 981 20,427 1,418 981 21,845 22,826 (5,422)200905/29/15
Omaha, NE— 1,274 38,619 1,865 1,274 40,484 41,758 (9,569)200005/29/15
Pennsylvania Senior Housing Portfolio (SHOP)Bethlehem, PA— 1,542 22,249 1,012 1,542 23,261 24,803 (6,340)200506/30/15
Boyertown, PA22,932 480 25,544 814 480 26,358 26,838 (6,513)200006/30/15
York, PA12,432 972 29,860 1,560 972 31,420 32,392 (7,417)198606/30/15
Southern Illinois OM Portfolio (Outpatient Medical)Waterloo, IL— 94 1,977 — 94 1,977 2,071 (595)201507/01/15
Waterloo, IL— 738 6,332 588 738 6,920 7,658 (2,010)199507/01/15, 12/19/17 and 04/17/18
Waterloo, IL— 200 2,648 (69)200 2,579 2,779 (707)201107/01/15
Napa Medical Center (Outpatient Medical)Napa, CA— 1,176 13,328 2,223 1,176 15,551 16,727 (4,695)198007/02/15
Chesterfield Corporate Plaza (Outpatient Medical)Chesterfield, MO— 8,030 24,533 3,617 8,030 28,150 36,180 (9,020)198908/14/15
   Initial Cost to Company Gross Amount of Which Carried at Close of Period(f)  
Description(a)EncumbrancesLand and ImprovementsBuildings and
Improvements
Cost
Capitalized
Subsequent to
Acquisition(b)
Land and
Improvements
Buildings and
Improvements
Total(e)Accumulated
Depreciation
(g)(h)
Date of
Construction
Date 
Acquired
Richmond VA ALF (SHOP)North Chesterfield, VA$— $2,146 $56,671 $1,237 $2,146 $57,908 $60,054 $(12,955)200909/11/15
Crown Senior Care Portfolio (Senior Housing)Peel, Isle of Man— 1,164 6,952 82 1,164 7,034 8,198 (1,736)201509/15/15
St. Albans, UK— 1,174 12,344 681 1,174 13,025 14,199 (3,224)201510/08/15
Salisbury, UK— 1,248 11,986 55 1,248 12,041 13,289 (2,961)201512/08/15
Aberdeen, UK— 2,025 6,037 337 2,025 6,374 8,399 (1,266)198611/15/16
Felixstowe, UK— 704 5,800 514 704 6,314 7,018 (1,328)2010/201111/15/16
Felixstowe, UK— 531 2,542 343 531 2,885 3,416 (681)2010/201111/15/16
Washington DC SNF (Skilled Nursing)Washington, DC60,100 1,194 34,200 — 1,194 34,200 35,394 (9,056)198310/29/15
Stockbridge GA OM II (Outpatient Medical)Stockbridge, GA— 499 8,353 1,623 485 9,990 10,475 (2,396)200612/03/15
Marietta GA OM II (Outpatient Medical)Marietta, GA— 661 4,783 309 661 5,092 5,753 (1,298)200712/09/15
Lakeview IN Medical Plaza (Outpatient Medical)Indianapolis, IN20,155 2,375 15,911 9,762 2,375 25,673 28,048 (7,326)198701/21/16
Pennsylvania Senior Housing Portfolio II (SHOP)Palmyra, PA19,114 835 24,424 703 835 25,127 25,962 (6,528)200702/01/16
Snellville GA OM (Outpatient Medical)Snellville, GA— 332 7,781 2,329 332 10,110 10,442 (2,285)200502/05/16
Stockbridge GA OM III (Outpatient Medical)Stockbridge, GA— 606 7,924 1,946 606 9,870 10,476 (2,453)200703/29/16
Joplin MO OM (Outpatient Medical)Joplin, MO— 1,245 9,860 200 1,245 10,060 11,305 (2,727)200005/10/16
Austell GA OM (Outpatient Medical)Austell, GA— 663 10,547 224 663 10,771 11,434 (2,467)200805/25/16
   Initial Cost to Company Gross Amount of Which Carried at Close of Period(f)  
Description(a)EncumbrancesLand and ImprovementsBuildings and
Improvements
Cost
Capitalized
Subsequent to
Acquisition(b)
Land and
Improvements
Buildings and
Improvements
Total(e)Accumulated
Depreciation
(g)(h)
Date of
Construction
Date 
Acquired
Middletown OH OM (Outpatient Medical)Middletown, OH$— $— $17,389 $3,242 $— $20,631 $20,631 $(4,206)200706/16/16
Fox Grape SNF Portfolio (Skilled Nursing)Braintree, MA— 1,844 10,847 31 1,844 10,878 12,722 (2,327)201507/01/16
Brighton, MA— 779 2,661 475 779 3,136 3,915 (702)198207/01/16
Duxbury, MA— 2,921 11,244 1,933 2,921 13,177 16,098 (3,155)198307/01/16
Hingham, MA— 2,316 17,390 (166)2,316 17,224 19,540 (3,670)199007/01/16
Quincy, MA13,329 3,537 13,697 459 3,537 14,156 17,693 (2,930)199511/01/16
Voorhees NJ OM (Outpatient Medical)Voorhees, NJ— 1,727 8,451 2,655 1,727 11,106 12,833 (2,845)200807/08/16
Norwich CT OM Portfolio (Outpatient Medical)Norwich, CT— 403 1,601 1,234 403 2,835 3,238 (1,050)201412/16/16
Norwich, CT— 804 12,094 1,265 804 13,359 14,163 (2,882)199912/16/16
Middletown OH OM II (Outpatient Medical)Middletown, OH— — 3,949 683 — 4,632 4,632 (791)200712/20/17
Homewood Health Campus (ISHC)Lebanon, IN8,354 973 9,702 2,467 1,100 12,042 13,142 (2,334)200012/01/15
Ashford Place Health Campus (ISHC)Shelbyville, IN5,663 664 12,662 1,412 857 13,881 14,738 (3,100)200412/01/15
Mill Pond Health Campus (ISHC)Greencastle, IN6,701 1,576 8,124 727 1,629 8,798 10,427 (1,905)200512/01/15
St. Andrews Health Campus (ISHC)Batesville, IN4,228 552 8,213 705 772 8,698 9,470 (1,964)200512/01/15
Hampton Oaks Health Campus (ISHC)Scottsburg, IN5,952 720 8,145 824 845 8,844 9,689 (2,023)200612/01/15
Forest Park Health Campus (ISHC)Richmond, IN6,500 535 9,399 893 647 10,180 10,827 (2,281)200712/01/15
The Maples at Waterford Crossing (ISHC)Goshen, IN5,533 344 8,027 1,989 363 9,997 10,360 (1,753)200612/01/15
Morrison Woods Health Campus (ISHC)Muncie, IN26,888 1,903 21,806 1,414 1,922 23,201 25,123 (4,039)2008/202212/01/15, 09/14/16 and 03/03/21
   Initial Cost to Company Gross Amount of Which Carried at Close of Period(f)  
Description(a)EncumbrancesLand and ImprovementsBuildings and
Improvements
Cost
Capitalized
Subsequent to
Acquisition(b)
Land and
Improvements
Buildings and
Improvements
Total(e)Accumulated
Depreciation
(g)(h)
Date of
Construction
Date 
Acquired
Woodbridge Health Campus (ISHC)Logansport, IN$7,910 $228 $11,812 $536 $262 $12,314 $12,576 $(2,687)200312/01/15
Bridgepointe Health Campus (ISHC)Vincennes, IN6,775 747 7,469 2,004 909 9,311 10,220 (1,892)2002/202212/01/15
Greenleaf Living Center (ISHC)Elkhart, IN10,851 492 12,157 1,234 521 13,362 13,883 (2,854)200012/01/15
Forest Glen Health Campus (ISHC)Springfield, OH9,056 846 12,754 1,195 1,055 13,740 14,795 (3,062)200712/01/15
The Meadows of Kalida Health Campus (ISHC)Kalida, OH7,492 298 7,628 598 394 8,130 8,524 (1,726)200712/01/15
The Heritage (ISHC)Findlay, OH12,311 1,312 13,475 730 1,434 14,083 15,517 (3,105)197512/01/15
Genoa Retirement Village (ISHC)Genoa, OH7,911 881 8,113 1,728 1,054 9,668 10,722 (2,059)198512/01/15
Waterford Crossing (ISHC)Goshen, IN7,581 344 4,381 1,001 349 5,377 5,726 (1,197)200412/01/15
St. Elizabeth Healthcare (ISHC)Delphi, IN8,351 522 5,463 5,490 643 10,832 11,475 (2,255)198612/01/15
Cumberland Pointe (ISHC)West Lafayette, IN8,846 1,645 13,696 818 1,905 14,254 16,159 (3,480)198012/01/15
Franciscan Healthcare Center (ISHC)Louisville, KY9,922 808 8,439 3,218 915 11,550 12,465 (2,535)197512/01/15
Blair Ridge Health Campus (ISHC)Peru, IN7,311 734 11,648 1,041 789 12,634 13,423 (3,119)200112/01/15
Glen Oaks Health Campus (ISHC)New Castle, IN4,855 384 8,189 504 419 8,658 9,077 (1,756)201112/01/15
Covered Bridge Health Campus (ISHC)Seymour, IN(c)386 9,699 927 45 10,967 11,012 (2,407)200212/01/15
Stonebridge Health Campus (ISHC)Bedford, IN9,409 1,087 7,965 2,223 1,144 10,131 11,275 (1,958)200412/01/15
RiverOaks Health Campus (ISHC)Princeton, IN14,018 440 8,953 2,557 764 11,186 11,950 (2,187)200412/01/15
Park Terrace Health Campus (ISHC)Louisville, KY(c)2,177 7,626 1,749 2,177 9,375 11,552 (2,152)197712/01/15
Cobblestone Crossing (ISHC)Terre Haute, IN(c)1,462 13,860 5,892 1,564 19,650 21,214 (4,160)200812/01/15
   Initial Cost to Company Gross Amount of Which Carried at Close of Period(f)  
Description(a)EncumbrancesLand and ImprovementsBuildings and
Improvements
Cost
Capitalized
Subsequent to
Acquisition(b)
Land and
Improvements
Buildings and
Improvements
Total(e)Accumulated
Depreciation
(g)(h)
Date of
Construction
Date 
Acquired
Creasy Springs Health Campus (ISHC)Lafayette, IN$15,531 $2,111 $14,337 $6,223 $2,512 $20,159 $22,671 $(4,286)201012/01/15
Avalon Springs Health Campus (ISHC)Valparaiso, IN16,894 1,542 14,107 277 1,607 14,319 15,926 (3,092)201212/01/15
Prairie Lakes Health Campus (ISHC)Noblesville, IN8,525 2,204 13,227 623 2,342 13,712 16,054 (2,937)201012/01/15
RidgeWood Health Campus (ISHC)Lawrenceburg, IN13,278 1,240 16,118 437 1,268 16,527 17,795 (3,483)200912/01/15
Westport Place Health Campus (ISHC)Louisville, KY(c)1,245 9,946 1,299 1,262 11,228 12,490 (2,229)201112/01/15
Paddock Springs (ISHC)Warsaw, IN13,195 488 — 10,638 660 10,466 11,126 (1,437)201902/14/19
Amber Manor Care Center (ISHC)Petersburg, IN5,390 446 6,063 538 515 6,532 7,047 (1,506)199012/01/15
The Meadows of Leipsic Health Campus (ISHC)Leipsic, OH(c)1,242 6,988 967 1,428 7,769 9,197 (1,803)198612/01/15
Springview Manor (ISHC)Lima, OH(c)260 3,968 649 408 4,469 4,877 (986)197812/01/15
Willows at Bellevue (ISHC)Bellevue, OH15,821 587 15,575 1,530 790 16,902 17,692 (3,726)200812/01/15
Briar Hill Health Campus (ISHC)North Baltimore, OH(c)673 2,688 569 756 3,174 3,930 (793)197712/01/15
Cypress Pointe Health Campus (ISHC)Englewood, OH(c)921 10,291 11,066 1,850 20,428 22,278 (3,277)201012/01/15
The Oaks at NorthPointe Woods (ISHC)Battle Creek, MI(c)567 12,716 240 571 12,952 13,523 (2,741)200812/01/15
Westlake Health Campus (ISHC)Commerce, MI13,809 815 13,502 202 547 13,972 14,519 (2,953)201112/01/15
Springhurst Health Campus (ISHC)Greenfield, IN19,200 931 14,114 4,170 2,330 16,885 19,215 (4,357)200712/01/15 and 05/16/17
Glen Ridge Health Campus (ISHC)Louisville, KY(c)1,208 9,771 2,569 1,402 12,146 13,548 (2,769)200612/01/15
St. Mary Healthcare (ISHC)Lafayette, IN5,058 348 2,710 344 393 3,009 3,402 (694)196912/01/15
The Oaks at Woodfield (ISHC)Grand Blanc, MI14,880 897 12,270 676 1,130 12,713 13,843 (2,790)201212/01/15
   Initial Cost to Company Gross Amount of Which Carried at Close of Period(f)  
Description(a)EncumbrancesLand and ImprovementsBuildings and
Improvements
Cost
Capitalized
Subsequent to
Acquisition(b)
Land and
Improvements
Buildings and
Improvements
Total(e)Accumulated
Depreciation
(g)(h)
Date of
Construction
Date 
Acquired
Stonegate Health Campus (ISHC)Lapeer, MI$10,976 $538 $13,159 $406 $717 $13,386 $14,103 $(2,930)201212/01/15
Senior Living at Forest Ridge (ISHC)New Castle, IN(c)204 5,470 363 325 5,712 6,037 (1,255)200512/01/15
River Terrace Health Campus (ISHC)Madison, IN(c)— 13,378 4,346 76 17,648 17,724 (3,966)201603/28/16
St. Charles Health Campus (ISHC)Jasper, IN11,053 467 14,532 2,404 558 16,845 17,403 (3,690)200006/24/16 and 06/30/16
Bethany Pointe Health Campus (ISHC)Anderson, IN18,945 2,337 26,524 2,812 2,550 29,123 31,673 (6,509)199906/30/16
River Pointe Health Campus (ISHC)Evansville, IN13,606 1,118 14,736 1,998 1,204 16,648 17,852 (3,802)199906/30/16
Waterford Place Health Campus (ISHC)Kokomo, IN14,404 1,219 18,557 6,653 1,805 24,624 26,429 (4,680)2000/202206/30/16
Autumn Woods Health Campus (ISHC)New Albany, IN(c)1,016 13,414 1,850 1,048 15,232 16,280 (3,710)200006/30/16
Oakwood Health Campus (ISHC)Tell City, IN8,842 783 11,880 1,396 868 13,191 14,059 (3,191)200006/30/16
Cedar Ridge Health Campus (ISHC)Cynthiana, KY(c)102 8,435 3,745 205 12,077 12,282 (3,276)200506/30/16
Aspen Place Health Campus (ISHC)Greensburg, IN9,188 980 10,970 963 1,212 11,701 12,913 (2,669)201208/16/16
The Willows at East Lansing (ISHC)East Lansing, MI15,878 1,449 15,161 1,681 1,496 16,795 18,291 (3,940)201408/16/16
The Willows at Howell (ISHC)Howell, MI(c)1,051 12,099 6,763 1,158 18,755 19,913 (3,429)201508/16/16
The Willows at Okemos (ISHC)Okemos, MI7,277 1,171 12,326 1,045 1,229 13,313 14,542 (3,139)201408/16/16
Shelby Crossing Health Campus (ISHC)Macomb, MI16,686 2,533 18,440 2,404 2,620 20,757 23,377 (5,154)201308/16/16
Village Green Healthcare Center (ISHC)Greenville, OH6,763 355 9,696 1,175 448 10,778 11,226 (2,314)201408/16/16
The Oaks at Northpointe (ISHC)Zanesville, OH(c)624 11,665 1,106 722 12,673 13,395 (2,973)201308/16/16
The Oaks at Bethesda (ISHC)Zanesville, OH4,417 714 10,791 949 812 11,642 12,454 (2,635)201308/16/16
   Initial Cost to Company Gross Amount of Which Carried at Close of Period(f)  
Description(a)EncumbrancesLand and ImprovementsBuildings and
Improvements
Cost
Capitalized
Subsequent to
Acquisition(b)
Land and
Improvements
Buildings and
Improvements
Total(e)Accumulated
Depreciation
(g)(h)
Date of
Construction
Date 
Acquired
White Oak Health Campus (ISHC)Monticello, IN$20,088 $1,005 $13,207 $208 $1,005 $13,415 $14,420 $(2,173)201009/23/16 and 07/30/20
Woodmont Health Campus (ISHC)Boonville, IN7,584 790 9,633 1,236 1,010 10,649 11,659 (2,547)200002/01/17
Silver Oaks Health Campus (ISHC)Columbus, IN(c)1,776 21,420 1,499 24,687 24,695 (5,513)200102/01/17
Thornton Terrace Health Campus (ISHC)Hanover, IN5,375 764 9,209 1,601 873 10,701 11,574 (2,386)200302/01/17
The Willows at Hamburg (ISHC)Lexington, KY11,192 1,740 13,422 1,676 1,810 15,028 16,838 (2,912)201202/01/17
The Lakes at Monclova (ISHC)Monclova, OH19,130 2,869 12,855 10,302 3,186 22,840 26,026 (3,884)201312/01/17
The Willows at Willard (ISHC)Willard, OH(c)610 12,256 10,003 223 22,646 22,869 (4,267)201202/01/17
Westlake Health Campus — Commerce Villa (ISHC)Commerce, MI(c)261 6,610 1,270 553 7,588 8,141 (1,458)201711/17/17
Orchard Grove Health Campus (ISHC)Romeo, MI27,515 2,065 11,510 18,156 3,515 28,216 31,731 (3,902)201607/20/18 and 11/30/17
The Meadows of Ottawa (ISHC)Ottawa, OH— 695 7,752 1,168 728 8,887 9,615 (1,729)201412/15/17
Valley View Healthcare Center (ISHC)Fremont, OH10,237 930 7,635 1,546 1,107 9,004 10,111 (1,353)201707/20/18
Novi Lakes Health Campus (ISHC)Novi, MI12,154 1,654 7,494 2,770 1,702 10,216 11,918 (2,420)201607/20/18
The Willows at Fritz Farm (ISHC)Lexington, KY8,918 1,538 8,637 455 1,563 9,067 10,630 (1,316)201707/20/18
Trilogy Real Estate Gahanna, LLC (ISHC)Gahanna, OH(c)1,146 — 16,745 1,218 16,673 17,891 (1,361)202011/13/20
Oaks at Byron Center (ISHC)Byron Center, MI14,264 2,000 — 15,932 2,193 15,739 17,932 (1,517)202007/08/20
Harrison Springs Health Campus (ISHC)Corydon, IN(c)2,017 11,487 5,933 2,305 17,132 19,437 (1,775)2016/202209/05/19
   Initial Cost to Company Gross Amount of Which Carried at Close of Period(f)  
Description(a)EncumbrancesLand and ImprovementsBuildings and
Improvements
Cost
Capitalized
Subsequent to
Acquisition(b)
Land and
Improvements
Buildings and
Improvements
Total(e)Accumulated
Depreciation
(g)(h)
Date of
Construction
Date 
Acquired
The Cloister at Silvercrest (ISHC)New Albany, IN(c)$139 $634 $$139 $640 $779 $(70)194010/01/19
Trilogy Healthcare of Ferdinand II, LLC (ISHC)Ferdinand, IN16,805 — — 14,619 — 14,619 14,619 (1,541)201911/19/19
Forest Springs Health Campus (ISHC)Louisville, KY(c)964 16,691 363 1,000 17,018 18,018 (1,654)201507/30/20
Gateway Springs Health Campus (ISHC)Hamilton, OH11,505 1,277 10,923 1,615 1,431 12,384 13,815 (1,016)202012/28/20
Orchard Pointe Health Campus (ISHC)Kendallville, IN10,176 1,806 9,243 15 1,806 9,258 11,064 (1,003)201601/19/21
The Meadows of Delphos (ISHC)Delphos, OH9,330 2,345 8,150 98 2,382 8,211 10,593 (1,140)201801/19/21
The Springs of Lima (ISHC)Lima, OH10,765 2,397 9,638 50 2,403 9,682 12,085 (1,216)201801/19/21
Wooded Glen (ISHC)Springfield, OH14,450 2,803 11,928 15 2,803 11,943 14,746 (1,436)201801/19/21
The Lakes of Sylvania (ISHC)Sylvania, OH19,493 3,208 15,059 232 3,265 15,234 18,499 (1,869)201701/19/21
The Glen (ISHC)Union Township, OH14,741 2,789 12,343 35 2,789 12,378 15,167 (1,431)201801/19/21
Harrison Trial Health Campus (ISHC)Harrison, OH15,632 1,750 17,114 86 2,048 16,902 18,950 (1,266)202104/28/21
The Oaks of Belmont (ISHC)Grand Rapids, MI14,795 767 17,043 192 1,068 16,934 18,002 (1,349)202103/13/21
Cedar Creek Health Campus (ISHC)Lowell, IN(c)2,326 12,650 770 2,864 12,882 15,746 (833)201407/07/21
Charlottesville OM (Outpatient Medical)Charlottesville, VA— 4,902 19,741 785 4,902 20,526 25,428 (1,652)200110/01/21
Rochester Hills OM (Outpatient Medical)Rochester Hills, MI1,813 2,218 8,380 947 2,218 9,327 11,545 (918)199010/01/21
Cullman OM III (Outpatient Medical)Cullman, AL— — 19,224 (587)— 18,637 18,637 (1,080)201010/01/21
Iron OM Portfolio (Outpatient Medical)Cullman, AL— — 14,799 1,382 — 16,181 16,181 (1,552)199410/01/21
Cullman, AL— — 12,287 438 — 12,725 12,725 (1,071)199810/01/21
   Initial Cost to Company Gross Amount of Which Carried at Close of Period(f)  
Description(a)EncumbrancesLand and ImprovementsBuildings and
Improvements
Cost
Capitalized
Subsequent to
Acquisition(b)
Land and
Improvements
Buildings and
Improvements
Total(e)Accumulated
Depreciation
(g)(h)
Date of
Construction
Date 
Acquired
Sylacauga, AL$— $— $11,273 $2,161 $— $13,434 $13,434 $(976)199710/01/21
Mint Hill OM (Outpatient Medical)Mint Hill, NC— — 24,110 (26)— 24,084 24,084 (1,981)200710/01/21
Lafayette Assisted Living Portfolio (SHOP)Lafayette, LA— 1,206 9,076 697 1,206 9,773 10,979 (569)199610/01/21
Lafayette, LA— 1,039 4,684 255 1,039 4,939 5,978 (316)201410/01/21
Battle Creek OM (Outpatient Medical)Battle Creek, MI— 1,156 7,910 10 1,156 7,920 9,076 (855)199610/01/21
Reno OM (Outpatient Medical)Reno, NV— — 82,515 735 — 83,250 83,250 (6,090)200510/01/21
Athens OM Portfolio (Outpatient Medical)Athens, GA— 860 7,989 120 860 8,109 8,969 (689)200610/01/21
Athens, GA— 1,106 11,531 456 1,106 11,987 13,093 (962)200610/01/21
SW Illinois Senior Housing Portfolio (Senior Housing)Columbia, IL— 1,117 9,700 — 1,117 9,700 10,817 (640)200710/01/21
Columbia, IL— 147 2,106 — 147 2,106 2,253 (135)199910/01/21
Millstadt, IL— 259 3,980 — 259 3,980 4,239 (256)200410/01/21
Red Bud, IL— 690 5,175 — 690 5,175 5,865 (332)200610/01/21
Waterloo, IL— 934 8,932 — 934 8,932 9,866 (576)201210/01/21
Lawrenceville OM (Outpatient Medical)Lawrenceville, GA— 1,663 12,019 250 1,663 12,269 13,932 (1,019)200510/01/21
Northern California Senior Housing Portfolio (SHOP)Belmont, CA— 10,491 9,650 (6,971)10,491 2,679 13,170 (624)1958/200010/01/21
Menlo Park, CA— 3,730 3,018 (6,741)— — 194510/01/21
Roseburg OM (Outpatient Medical)Roseburg, OR— — 28,140 134 — 28,274 28,274 (2,180)200310/01/21
Fairfield County OM (Outpatient Medical)Trumbull, CT— 2,797 10,400 274 2,797 10,674 13,471 (1,137)198710/01/21
Central Wisconsin Senior Care Portfolio (SHOP)Sun Prairie, WI— 543 2,587 70 543 2,657 3,200 (202)1960/200610/01/21
Waunakee, WI— 2,171 10,198 423 2,171 10,621 12,792 (796)1974/200510/01/21
   Initial Cost to Company Gross Amount of Which Carried at Close of Period(f)  
Description(a)EncumbrancesLand and ImprovementsBuildings and
Improvements
Cost
Capitalized
Subsequent to
Acquisition(b)
Land and
Improvements
Buildings and
Improvements
Total(e)Accumulated
Depreciation
(g)(h)
Date of
Construction
Date 
Acquired
Sauk Prairie OM (Outpatient Medical)Prairie du Sac, WI$— $2,044 $19,669 $401 $2,044 $20,070 $22,114 $(1,558)201410/01/21
Surprise OM (Outpatient Medical)Surprise, AZ— 1,827 10,968 443 1,827 11,411 13,238 (881)201210/01/21
Southfield OM (Outpatient Medical)Southfield, MI5,408 1,634 16,550 1,187 1,634 17,737 19,371 (1,824)1975/201410/01/21
Pinnacle Beaumont ALF (SHOP)Beaumont, TX— 1,775 17,541 39 1,775 17,580 19,355 (1,062)201210/01/21
Grand Junction OM (Outpatient Medical)Grand Junction, CO— 2,460 34,188 42 2,460 34,230 36,690 (2,749)201310/01/21
Edmonds OM (Outpatient Medical)Edmonds, WA— 4,523 22,414 338 4,523 22,752 27,275 (1,826)1991/200810/01/21
Pinnacle Warrenton ALF (SHOP)Warrenton, MO— 514 7,059 (2,240)— 5,333 5,333 (462)198610/01/21
Glendale OM (Outpatient Medical)Glendale, WI— 665 6,782 410 665 7,192 7,857 (701)200410/01/21
Missouri SNF Portfolio (Skilled Nursing)Florissant, MO— 800 10,363 — 800 10,363 11,163 (692)198710/01/21
Kansas City, MO— 2,090 10,527 — 2,090 10,527 12,617 (821)197410/01/21
Milan, MO— 493 7,057 — 493 7,057 7,550 (464)198010/01/21
Missouri, MO— 729 10,187 — 729 10,187 10,916 (658)196310/01/21
Salisbury, MO— 515 8,852 — 515 8,852 9,367 (584)197010/01/21
Sedalia, MO— 631 24,172 — 631 24,172 24,803 (1,466)197510/01/21
St. Elizabeth, MO— 437 4,561 — 437 4,561 4,998 (307)198110/01/21
Trenton, MO— 310 4,875 — 310 4,875 5,185 (316)196710/01/21
Flemington OM Portfolio (Outpatient Medical)Flemington, NJ— 1,419 11,110 553 1,419 11,663 13,082 (1,107)200210/01/21
Flemington, NJ— 578 3,340 297 578 3,637 4,215 (370)199310/01/21
   Initial Cost to Company Gross Amount of Which Carried at Close of Period(f)  
Description(a)EncumbrancesLand and ImprovementsBuildings and
Improvements
Cost
Capitalized
Subsequent to
Acquisition(b)
Land and
Improvements
Buildings and
Improvements
Total(e)Accumulated
Depreciation
(g)(h)
Date of
Construction
Date 
Acquired
Lawrenceville OM II (Outpatient Medical)Lawrenceville, GA$— $1,058 $9,709 $1,718 $1,058 $11,427 $12,485 $(994)199010/01/21
Mill Creek OM (Outpatient Medical)Mill Creek, WA— 1,344 7,516 535 1,344 8,051 9,395 (610)199110/01/21
Modesto OM (Outpatient Medical)Modesto, CA— — 16,065 479 — 16,544 16,544 (1,310)1991/201610/01/21
Michigan ALF Portfolio (SHOP)Grand Rapids, MI— 1,196 8,955 — 1,196 8,955 10,151 (619)1953/201610/01/21
Grand Rapids, MI9,608 1,291 11,308 — 1,291 11,308 12,599 (779)198910/01/21
Holland, MI— 716 6,534 — 716 6,534 7,250 (518)2007/201710/01/21
Howell, MI— 836 4,202 — 836 4,202 5,038 (290)200310/01/21
Lansing, MI— 1,300 11,629 1,300 11,632 12,932 (767)1988/201510/01/21
Wyoming, MI— 1,343 13,347 — 1,343 13,347 14,690 (881)1964/201610/01/21
Lithonia OM (Outpatient Medical)Lithonia, GA— 1,676 10,871 895 1,676 11,766 13,442 (1,015)201510/01/21
West Des Moines SNF (Skilled Nursing)West Des Moines, IA— 509 3,813 — 509 3,813 4,322 (260)200410/01/21
Great Nord OM Portfolio (Outpatient Medical)Tinley Park, IL— — 15,423 945 — 16,368 16,368 (1,491)200210/01/21
Chesterton, IN— 743 9,070 260 743 9,330 10,073 (912)200710/01/21
Crown Point, IN— 265 5,467 — 265 5,467 5,732 (451)200510/01/21
Plymouth, MN— 1,491 12,994 68 1,491 13,062 14,553 (1,106)201410/01/21
Overland Park OM (Outpatient Medical)Overland Park, KS— 2,803 23,639 640 2,803 24,279 27,082 (1,942)201710/01/21
Blue Badger OM (Outpatient Medical)Marysville, OH— 1,518 12,543 28 1,518 12,571 14,089 (948)201410/01/21
Bloomington OM (Outpatient Medical)Bloomington, IL— 2,114 17,363 — 2,114 17,363 19,477 (1,102)199010/01/21
   Initial Cost to Company Gross Amount of Which Carried at Close of Period(f)  
Description(a)EncumbrancesLand and ImprovementsBuildings and
Improvements
Cost
Capitalized
Subsequent to
Acquisition(b)
Land and
Improvements
Buildings and
Improvements
Total(e)Accumulated
Depreciation
(g)(h)
Date of
Construction
Date 
Acquired
Haverhill OM (Outpatient Medical)Haverhill, MA$— $1,393 $15,477 $96 $1,393 $15,573 $16,966 $(1,493)198710/01/21
Fresno OM (Outpatient Medical)Fresno, CA— 1,536 8,964 291 1,536 9,255 10,791 (850)200710/01/21
Colorado Foothills OM Portfolio (Outpatient Medical)Arvada, CO— 695 6,369 292 695 6,661 7,356 (786)197910/01/21
Centennial, CO— 873 11,233 346 873 11,579 12,452 (1,037)197910/01/21
Colorado Springs, CO— 2,225 12,520 1,007 2,225 13,527 15,752 (1,052)199910/01/21
Catalina West Haven ALF (SHOP)West Haven, UT— 1,936 10,415 253 1,936 10,668 12,604 (697)201210/01/21
Louisiana Senior Housing Portfolio (SHOP)Gonzales, LA— 1,123 5,668 142 1,123 5,810 6,933 (404)199610/01/21
Monroe, LA— 834 4,037 393 834 4,430 5,264 (268)199410/01/21
New Iberia, LA— 952 5,257 54 952 5,311 6,263 (357)199610/01/21
Shreveport, LA— 1,177 6,810 54 1,177 6,864 8,041 (437)199610/01/21
Slidell, LA— 801 4,348 194 801 4,542 5,343 (320)199610/01/21
Catalina Madera ALF (SHOP)Madera, CA— 1,312 15,299 375 1,312 15,674 16,986 (1,008)200510/01/21
The Willows at Springhurst (ISHC)Louisville, KY20,800 1,876 12,595 (547)1,952 11,972 13,924 (702)197901/01/22
Louisville, KY— 1,184 6,483 (34)1,184 6,449 7,633 (375)197901/01/22
The Willows at Harrodsburg (ISHC)Harrodsburg, KY7,125 918 10,181 1,396 1,594 10,901 12,495 (567)201805/20/22
North River Health Campus (ISHC)Evansville, IN17,100 2,614 15,031 94 2,631 15,108 17,739 (874)201705/20/22
Trilogy Healthcare of Jefferson III, LLC (ISHC)Louisville, KY14,175 2,265 14,077 356 2,265 14,433 16,698 (722)201805/20/22
Pickerington Health Campus (ISHC)Pickerington, OH13,050 860 15,575 30 880 15,585 16,465 (1,712)201905/20/22
Mt. Washington Development Project (ISHC)Mt. Washington14,325 2,054 10,225 24 2,054 10,249 12,303 (578)202005/20/22
Silvercrest Health Center (ISHC)New Albany, IN20,259 1,920 24,965 352 1,920 25,317 27,237 (1,018)201308/01/22
   Initial Cost to Company Gross Amount of Which Carried at Close of Period(f)  
Description(a)EncumbrancesLand and ImprovementsBuildings and
Improvements
Cost
Capitalized
Subsequent to
Acquisition(b)
Land and
Improvements
Buildings and
Improvements
Total(e)Accumulated
Depreciation
(g)(h)
Date of
Construction
Date 
Acquired
The Springs of Mooresville (ISHC)Mooresville, IN$13,853 $1,460 $12,617 $99 $1,460 $12,716 $14,176 $(510)201608/01/22
Hearthstone Health Campus (ISHC)Bloomington, IN19,008 2,140 16,928 202 2,160 17,110 19,270 (732)201408/01/22
AHR Texas ALF Portfolio (SHOP)Temple, TX14,561 1,819 11,090 217 1,819 11,307 13,126 (416)199812/05/22
Cedar Park, TX5,744 1,347 5,250 114 1,347 5,364 6,711 (206)199812/05/22
Corpus Christi, TX14,174 1,229 12,663 98 1,229 12,761 13,990 (465)199712/05/22
League City, TX15,537 1,435 15,475 125 1,435 15,600 17,035 (512)199912/05/22
Round Rock, TX21,123 2,124 14,895 383 2,124 15,278 17,402 (502)199712/05/22
Sugarland, TX27,780 2,674 12,751 155 2,674 12,906 15,580 (450)199912/05/22
Tyler, TX9,667 1,131 10,510 103 1,131 10,613 11,744 (384)199812/05/22
The Legacy at English Station (ISHC)Louisville, KY7,700 912 10,139 56 912 10,195 11,107 (255)201602/15/23
The Villages at Oak Ridge (ISHC)Washington, IN12,901 1,483 11,551 1,799 1,483 13,350 14,833 (174)201507/13/23
Smith's Mill Health Campus (ISHC)New Albany, OH— 1,323 15,271 46 1,323 15,317 16,640 (255)201907/13/23
Oakwood Health Center Villas (ISHC)Tell City, IN1,988 535 1,555 131 541 1,680 2,221 (47)201307/13/23
$1,312,019 $325,412 $3,228,159 $355,820 $332,402 $3,576,989 $3,909,391 $(627,189)
Leased properties(d)$— $1,130 $84,944 $157,431 $2,051 $241,454 $243,505 $(123,997)
Construction in progress14,294 925 15,870 7,904 1,493 23,206 24,699 (971)
$1,326,313 $327,467 $3,328,973 $521,155 $335,946 $3,841,649 $4,177,595 $(752,157)
___________
(a)We own 100% of our properties as of December 31, 2023, with the exception of Trilogy, Lakeview IN Medical Plaza, Southlake TX Hospital, Pinnacle Beaumont ALF, Pinnacle Warrenton ALF and Louisiana Senior Housing Portfolio.
(b)The cost capitalized subsequent to acquisition is shown net of dispositions and impairments.
(c)These properties are used as collateral for the secured revolver portion of the 2019 Trilogy Credit Facility, which had an outstanding balance of $309,823 as of December 31, 2023. See Note 9, Lines of Credit and Term Loan — 2019 Trilogy Credit Facility, for a further discussion.
(d)Represents furniture, fixtures, equipment, land and improvements associated with properties under operating leases.
(e)     The changes in total real estate for the years ended December 31, 2023, 2022 and 2021 are as follows (in thousands):
 Amount
Balance — December 31, 2020$2,762,272 
Acquisitions1,225,626 
Additions87,909 
Dispositions and impairments(36,645)
Foreign currency translation adjustment(590)
Balance — December 31, 2021
$4,038,572 
Acquisitions$254,947 
Additions72,802 
Dispositions and impairments(123,841)
Foreign currency translation adjustment(6,033)
Balance — December 31, 2022
$4,236,447 
Acquisitions$55,658 
Additions97,667 
Dispositions and impairments(214,906)
Foreign currency translation adjustment2,729 
Balance — December 31, 2023
$4,177,595 
(f)     As of December 31, 2023, the unaudited aggregate cost of our properties was $4,051,405 for U.S. federal income tax purposes.
(g)     The changes in accumulated depreciation for the years ended December 31, 2023, 2022 and 2021 are as follows (in thousands):
 Amount
Balance — December 31, 2020$425,272 
Additions109,036 
Dispositions and impairments(10,320)
Foreign currency translation adjustment(102)
Balance — December 31, 2021
$523,886 
Additions$141,257 
Dispositions and impairments(9,355)
Foreign currency translation adjustment(950)
Balance — December 31, 2022
$654,838 
Additions$147,587 
Dispositions and impairments(50,790)
Foreign currency translation adjustment522 
Balance — December 31, 2023
$752,157 
(h)     The cost of buildings and capital improvements is depreciated on a straight-line basis over the estimated useful lives of the buildings and capital improvements, up to 39 years, and the cost of tenant improvements is depreciated over the shorter of the lease term or useful life, up to 34 years. The cost of furniture, fixtures and equipment is depreciated over the estimated useful life, up to 28 years.
v3.24.1
Summary of Significant Accounting Policies (Policies)
12 Months Ended
Dec. 31, 2023
Accounting Policies [Abstract]  
Basis of Presentation
Basis of Presentation
Our accompanying consolidated financial statements include our accounts and those of our operating partnership, the wholly-owned subsidiaries of our operating partnership and all non-wholly owned subsidiaries in which we have control, as well as any VIEs, in which we are the primary beneficiary. The portion of equity in any subsidiary that is not wholly owned by us is presented in our accompanying consolidated financial statements as a noncontrolling interest. We evaluate our ability to control an entity, and whether the entity is a VIE and we are the primary beneficiary, by considering substantive terms of the arrangement and identifying which enterprise has the power to direct the activities of the entity that most significantly impacts the entity’s economic performance.
On November 15, 2022, we effected a one-for-four reverse stock split of our common stock and a corresponding reverse split of the OP units, or the Reverse Splits. All numbers of common shares and per share data, as well as the OP units, in our accompanying consolidated financial statements and related notes have been retroactively adjusted for all periods presented to give effect to the Reverse Splits.
We operate and intend to continue to operate in an umbrella partnership REIT structure in which our operating partnership, wholly-owned subsidiaries of our operating partnership and all non-wholly owned subsidiaries of which we have control will own substantially all of the interests in properties acquired on our behalf. The accounts of our operating partnership are consolidated in our accompanying consolidated financial statements because we are the sole general partner of our operating partnership and have unilateral control over its management and major operating decisions (even if additional limited partners are admitted to our operating partnership). All intercompany accounts and transactions are eliminated in consolidation.
Use of Estimates
Use of Estimates
The preparation of our accompanying consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, as well as the disclosure of contingent assets and liabilities, at the date of our consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates and assumptions include, but are not limited
to, the initial and recurring valuation of certain assets acquired and liabilities assumed through property acquisitions including through business combinations, goodwill and its impairment, revenues and grant income, allowance for credit losses, impairment of long-lived and intangible assets and contingencies. These estimates are made and evaluated on an on-going basis using information that is currently available as well as various other assumptions believed to be reasonable under the circumstances. Actual results could differ from those estimates, perhaps in material adverse ways, and those estimates could be different under different assumptions or conditions.
Cash, Cash Equivalents and Restricted Cash
Cash, Cash Equivalents and Restricted Cash
Cash and cash equivalents consist of all highly liquid investments with a maturity of three months or less when purchased. Restricted cash primarily comprises lender required accounts for property taxes, tenant improvements, capital improvements and insurance, which are restricted as to use or withdrawal.
Lessee, Leases
Leases
Lessee: We determine if a contract is a lease upon inception of the lease and maintain a distinction between finance and operating leases. Pursuant to Financial Accounting Standards Board, or FASB, Accounting Standards Codification, or ASC, Topic 842, Leases, or ASC Topic 842, lessees are required to recognize the following for all leases with terms greater than 12 months at the commencement date: (i) a lease liability, which is a lessee’s obligation to make lease payments arising from a lease; and (ii) a right-of-use asset, which is an asset that represents the lessee’s right to use, or control the use of, a specified asset for the lease term. The lease liability is calculated by using either the implicit rate of the lease or the incremental borrowing rate. The accretion of lease liabilities and amortization expense on right-of-use assets for our operating leases are included in rental expenses, property operating expenses or general and administrative expenses in our accompanying consolidated statements of operations and comprehensive loss. Operating lease liabilities are calculated using our incremental borrowing rate based on the information available as of the lease commencement date.
For our finance leases, the accretion of lease liabilities are included in interest expense and the amortization expense on right-of-use assets are included in depreciation and amortization in our accompanying consolidated statements of operations and comprehensive loss. Further, finance lease assets are included within real estate investments, net and finance lease liabilities are included within financing obligations in our accompanying consolidated balance sheets.
Lessor, Leases
Leases
Lessor: Pursuant to ASC Topic 842, lessors bifurcate lease revenues into lease components and non-lease components and separately recognize and disclose non-lease components that are executory in nature. Lease components continue to be recognized on a straight-line basis over the lease term and certain non-lease components may be accounted for under the revenue recognition guidance in ASC Topic 606, Revenue from Contracts with Customers, or ASC Topic 606. See the “Revenue Recognition” section below. ASC Topic 842 also provides for a practical expedient package that permits lessors to not separate non-lease components from the associated lease component if certain conditions are met. In addition, such practical expedient causes an entity to assess whether a contract is predominately lease- or service-based, and recognize the revenue from the entire contract under the relevant accounting guidance. We recognize revenue for our OM buildings and triple-net leased properties segments as real estate revenue. Minimum annual rental revenue is recognized on a straight-line basis over the term of the related lease (including rent holidays). Differences between real estate revenue recognized and cash amounts contractually due from tenants under the lease agreements are recorded to deferred rent receivable, which is included in other assets, net in our accompanying consolidated balance sheets. Tenant reimbursement revenue, which comprises additional amounts recoverable from tenants for common area maintenance expenses and certain other recoverable expenses, are considered non-lease components and variable lease payments. We qualified for and elected the practical expedient as outlined above to combine the non-lease component with the lease component, which is the predominant component, and therefore the non-lease component is recognized as part of real estate revenue. In addition, as lessors, we exclude certain lessor costs (i.e., property taxes and insurance) paid directly by a lessee to third parties on our behalf from our measurement of variable lease revenue and associated expense (i.e., no gross up of revenue and expense for these costs); and include lessor costs that we paid and are reimbursed by the lessee in our measurement of variable lease revenue and associated expense (i.e., gross up revenue and expense for these costs).
At our RIDEA facilities, we offer residents room and board (lease component), standard meals and healthcare services (non-lease component) and certain ancillary services that are not contemplated in the lease with each resident (i.e., laundry, guest meals, etc.). For our RIDEA facilities, we recognize revenue under ASC Topic 606 as resident fees and services, based on our predominance assessment from electing the practical expedient outlined above. See the “Revenue Recognition” section below.
Revenue Recognition
Revenue Recognition
Real Estate Revenue
We recognize real estate revenue in accordance with ASC Topic 842. See the “Leases” section above.
Resident Fees and Services Revenue
We recognize resident fees and services revenue in accordance with ASC Topic 606. A significant portion of resident fees and services revenue represents healthcare service revenue that is reported at the amount that we expect to be entitled to in exchange for providing patient care. These amounts are due from patients, third-party payors (including health insurers and government programs), other healthcare facilities, and others and includes variable consideration for retroactive revenue adjustments due to settlement of audits, reviews, and investigations. Generally, we bill the patients, third-party payors and other healthcare facilities several days after the services are performed. Revenue is recognized as performance obligations are satisfied. Consistent with healthcare industry accounting practices, any changes to these governmental revenue estimates are recorded in the period the change or adjustment becomes known based on final settlement. Any differences between recorded revenues and subsequent adjustments are reflected in operations in the year finalized.
Performance obligations are determined based on the nature of the services provided by us. Revenue for performance obligations satisfied over time is recognized based on actual charges incurred in relation to total expected (or actual) charges. This method provides a depiction of the transfer of services over the term of the performance obligation based on the inputs needed to satisfy the obligation. Generally, performance obligations satisfied over time relate to patients receiving long-term healthcare services, including rehabilitation services. We measure the performance obligation from admission into the facility to the point when we are no longer required to provide services to that patient. Revenue for performance obligations satisfied at a point in time is recognized when goods or services are provided and we do not believe we are required to provide additional goods or services to the patient. Generally, performance obligations satisfied at a point in time relate to sales of our pharmaceuticals business or to sales of ancillary supplies.
Because all of our performance obligations relate to contracts with a duration of less than one year, we have elected to apply the optional exemption provided in ASC Topic 606 and, therefore, are 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 performance obligations for these contracts are generally completed within months of the end of the reporting period.
We determine the transaction price based on standard charges for goods and services provided, reduced, where applicable, by contractual adjustments provided to third-party payors, implicit price concessions provided to uninsured patients, and estimates of goods to be returned. We also determine the estimates of contractual adjustments based on Medicare and Medicaid pricing tables and historical experience. We determine the estimate of implicit price concessions based on the historical collection experience with each class of payor.
Agreements with third-party payors typically provide for payments at amounts less than established charges. The following is a summary of the payment arrangements with major third-party payors:
Medicare: Certain healthcare services are paid at prospectively determined rates based on cost-reimbursement methodologies subject to certain limits.
Medicaid: Reimbursements for Medicaid services are generally paid at prospectively determined rates. In the state of Indiana, we participate in an Upper Payment Limit program, or IGT, with various county hospital partners, which provides supplemental Medicaid payments to SNFs that are licensed to non-state, government-owned entities such as county hospital districts. We have operational responsibility through management agreements for facilities retained by the county hospital districts including this IGT. The licenses and management agreements between the nursing center division and hospital districts are terminable by either party to restore the previous licensed status.
Other: Payment agreements with certain commercial insurance carriers, health maintenance organizations and preferred provider organizations provide for payment using prospectively determined rates per discharge, discounts from established charges and prospectively determined periodic rates.
Laws and regulations concerning government programs, including Medicare and Medicaid, are complex and subject to varying interpretation. As a result of investigations by governmental agencies, various healthcare organizations have received requests for information and notices regarding alleged noncompliance with those laws and regulations, which, in some instances, have resulted in organizations entering into significant settlement agreements. Compliance with such laws and regulations may also be subject to future government review and interpretation as well as significant regulatory action, including fines, penalties and potential exclusion from the related programs. There can be no assurance that regulatory authorities will not challenge our compliance with these laws and regulations, and it is not possible to determine the impact such claims or penalties would have upon us, if any.
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 our 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 (that is, new information becomes available), or as years are settled or are no longer subject to such audits, reviews and investigations. Adjustments arising from a change in the transaction price were not significant for the years ended December 31, 2023, 2022 and 2021.
Disaggregation of Resident Fees and Services Revenue
We disaggregate revenue from contracts with customers according to lines of business and payor classes. The transfer of goods and services may occur at a point in time or over time; in other words, revenue may be recognized over the course of the underlying contract, or may occur at a single point in time based upon a single transfer of control. This distinction is discussed in further detail below. We determine that disaggregating revenue into these categories achieves the disclosure objective to depict how the nature, amount, timing and uncertainty of revenue and cash flows are affected by economic factors.
Financing Component
We have elected a practical expedient allowed under ASC Topic 606 and, therefore, we do not adjust the promised amount of consideration from patients and third-party payors for the effects of a significant financing component due to our expectation that the period between the time the service is provided to a patient and the time that the patient or a third-party payor pays for that service will be one year or less.
Contract Costs
We have applied the practical expedient provided by FASB ASC Topic 340, Other Assets and Deferred Costs, and, therefore, all incremental customer contract acquisition costs are expensed as they are incurred since the amortization period of the asset that we otherwise would have recognized is one year or less in duration.
Real Estate Investments Purchase Price Allocation
Real Estate Investments Purchase Price Allocation
Upon the acquisition of real estate properties or entities owning real estate properties, we determine whether the transaction is a business combination, which requires that the assets acquired and liabilities assumed constitute a business. If the assets acquired and liabilities assumed are not a business, we account for the transaction as an asset acquisition. Under both methods, we recognize the identifiable assets acquired and liabilities assumed; however, for a transaction accounted for as an asset acquisition, we capitalize transaction costs and allocate the purchase price using a relative fair value method allocating all accumulated costs, whereas for a transaction accounted for as a business combination, we immediately expense transaction costs incurred associated with the business combination and allocate the purchase price based on the estimated fair value of each separately identifiable asset and liability. For the years ended December 31, 2023, 2022 and 2021, our investment transactions were accounted for as asset acquisitions or as business combinations, as applicable. See Note 3, Real Estate Investments, Net — Acquisitions of Real Estate Investments, and Note 4, Business Combinations, for a further discussion.
We, with assistance from independent valuation specialists, measure the fair value of tangible and identified intangible assets and liabilities, as applicable, based on their respective fair values for acquired properties. Our method for allocating the purchase price to acquired investments in real estate requires us to make subjective assessments for determining fair value of the assets acquired and liabilities assumed. This includes determining the value of the buildings, land, leasehold interests, furniture, fixtures and equipment, above- or below-market rent, in-place leases, master leases, tenant improvements, above- or below-market debt assumed, derivative financial instruments assumed, and noncontrolling interest in the acquiree, if any. These estimates require significant judgment and in some cases involve complex calculations. These allocation assessments directly impact our results of operations, as amounts allocated to certain assets and liabilities have different depreciation or amortization
lives. In addition, we amortize the value assigned to above- or below-market rent as a component of revenue, unlike in-place leases and other intangibles, which we include in depreciation and amortization in our accompanying consolidated statements of operations and comprehensive loss.
The determination of the fair value of land is based upon comparable sales data. In cases where a leasehold interest in the land is acquired, only the above/below market consideration is necessary where the value of the leasehold interest is determined by discounting the difference between the contract ground lease payments and a market ground lease payment back to a present value as of the acquisition date. The fair value of buildings is based upon our determination of the value under two methods: one, as if it were to be replaced and vacant using cost data and, two, also using a residual technique based on discounted cash flow models, as vacant. Factors considered by us include an estimate of carrying costs during the expected lease-up periods considering current market conditions and costs to execute similar leases. We also recognize the fair value of furniture, fixtures and equipment on the premises, as well as the above- or below-market rent, the value of in-place leases, master leases, above- or below-market debt and derivative financial instruments assumed.
The value of the above- or below-market component of the acquired in-place leases is determined based upon the present value (using a discount rate that reflects the risks associated with the acquired leases) of the difference between: (i) the level payment equivalent of the contract rent paid pursuant to the lease; and (ii) our estimate of market rent payments taking into account the expected market rent growth. In the case of leases with options, a case-by-case analysis is performed based on all facts and circumstances of the specific lease to determine whether the option will be assumed to be exercised. The amounts related to above-market leases are included in identified intangible assets, net in our accompanying consolidated balance sheets and are amortized as a decrease to real estate revenue over the remaining non-cancelable lease term of the acquired leases with each property. The amounts related to below-market leases are included in identified intangible liabilities, net in our accompanying consolidated balance sheets and are amortized as an increase to real estate revenue over the remaining non-cancelable lease term plus any below-market renewal options of the acquired leases with each property.
The value of in-place lease costs are based on management’s evaluation of the specific characteristics of the tenant’s lease and our overall relationship with the tenants. Characteristics considered by us in allocating these values include the nature and extent of the credit quality and expectations of lease renewals, among other factors. The in-place lease intangible represents the value related to the economic benefit for acquiring a property with in-place leases as opposed to a vacant property, which is evaluated based on a review of comparable leases for a similar property, terms and conditions for marketing and executing new leases, and implied in the difference between the value of the whole property “as is” and “as vacant.” The net amounts related to in-place lease costs are included in identified intangible assets, net in our accompanying consolidated balance sheets and are amortized as an increase to depreciation and amortization expense over the average downtime of the acquired leases with each property. The net amounts related to the value of tenant relationships, if any, are included in identified intangible assets, net in our accompanying consolidated balance sheets and are amortized as an increase to depreciation and amortization expense over the average remaining non-cancelable lease term of the acquired leases plus the market renewal lease term. The value of a master lease, if any, in which a previous owner or a tenant is relieved of specific rental obligations as additional space is leased, is determined by discounting the expected real estate revenue associated with the master lease space over the assumed lease-up period.
The value of above- or below-market debt is determined based upon the present value of the difference between the cash flow stream of the assumed mortgage and the cash flow stream of a market rate mortgage at the time of assumption. The net value of above- or below-market debt is included in mortgage loans payable, net in our accompanying consolidated balance sheets and is amortized as an increase or decrease to interest expense, as applicable, over the remaining term of the assumed mortgage.
The values of contingent consideration assets and liabilities are analyzed at the time of acquisition. For contingent purchase options, the fair market value of the acquired asset is compared to the specified option price at the exercise date. If the option price is below market, it is assumed to be exercised and the difference between the fair market value and the option price is discounted to the present value at the time of acquisition.
The values of the redeemable and nonredeemable noncontrolling interests are estimated by applying the income approach based on a discounted cash flow analysis. The fair value measurement may apply significant inputs that are not observable in the market. See Note 4, Business Combinations — 2021 Business Combinations — Fair Value of Noncontrolling Interests, for a further discussion of our fair value measurement approach and the significant inputs used in the values of redeemable and nonredeemable noncontrolling interests in GAHR IV.
Real Estate Investments, Net
Real Estate Investments, Net
We carry our operating properties at our historical cost less accumulated depreciation. The cost of operating properties includes the cost of land and completed buildings and related improvements, including those related to financing obligations. Expenditures that increase the service life of properties are capitalized and the cost of maintenance and repairs is charged to expense as incurred. The cost of buildings and capital improvements is depreciated on a straight-line basis over the estimated useful lives of the buildings and capital improvements, up to 39 years, and the cost for tenant improvements is depreciated over the shorter of the lease term or useful life, up to 34 years. The cost of furniture, fixtures and equipment is depreciated over the estimated useful life, up to 28 years. When depreciable property is retired, replaced or disposed of, the related cost and accumulated depreciation is removed from the accounts and any gain or loss is reflected in earnings.
As part of the leasing process, we may provide the lessee with an allowance for the construction of leasehold improvements. These leasehold improvements are capitalized and recorded as tenant improvements and depreciated over the shorter of the useful life of the improvements or the lease term. If the allowance represents a payment for a purpose other than funding leasehold improvements, or in the event we are not considered the owner of the improvements, the allowance is considered to be a lease inducement and is included in other assets, net in our accompanying consolidated balance sheets. Lease inducement is amortized over the lease term as a reduction of real estate revenue on a straight-line basis. Factors considered during this evaluation include, among other things, who holds legal title to the improvements as well as other controlling rights provided by the lease agreement and provisions for substantiation of such costs (e.g., unilateral control of the tenant space during the build-out process). Determination of the appropriate accounting for the payment of a tenant allowance is made on a lease-by-lease basis, considering the facts and circumstances of the individual tenant lease. Recognition of lease revenue commences when the lessee is given possession of the leased space upon completion of tenant improvements when we are the owner of the leasehold improvements. However, when the leasehold improvements are owned by the tenant, the lease inception date (and the date on which recognition of lease revenue commences) is the date the tenant obtains possession of the leased space for purposes of constructing its leasehold improvements.
Goodwill
Goodwill
Goodwill represents the excess of consideration paid over the fair value of underlying identifiable net assets of a business acquired in a business combination. Our goodwill has an indeterminate life and is not amortized, but is tested for impairment on an annual basis, or more frequently if events or changes in circumstances indicate that the asset might be impaired. We take a qualitative approach, as applicable, to consider whether an impairment of goodwill exists prior to quantitatively determining the fair value of the reporting unit in step one of the impairment test. When step one of the impairment test is utilized, we compare the fair value of a reporting unit with its carrying amount. We recognize an impairment loss to the extent the carrying value of goodwill exceeds the implied value in the current period.
See Note 4, Business Combinations, for a further discussion of goodwill recognized in connection with our business combinations, and Note 18, Segment Reporting, for a further discussion of goodwill allocation by segment and impairment of goodwill.
Impairment of Long-Lived Assets and Intangible Assets
Impairment of Long-Lived Assets and Intangible Assets
We periodically evaluate our long-lived assets, primarily consisting of investments in real estate that we carry at our historical cost less accumulated depreciation, for impairment when events or changes in circumstances indicate that its carrying value may not be recoverable. We consider the following indicators, among others, in our evaluation of impairment:
significant negative industry or economic trends;
a significant underperformance relative to historical or projected future operating results; and
a significant change in the extent or manner in which the asset is used or significant physical change in the asset.
If indicators of impairment of our long-lived assets are present, we evaluate the carrying value of the related real estate investments in relation to the future undiscounted cash flows of the underlying operations. In performing this evaluation, we consider market conditions and our current intentions with respect to holding or disposing of the asset. We adjust the net book value of properties we lease to others and other long-lived assets to fair value if the sum of the expected future undiscounted cash flows, including sales proceeds, is less than carrying value. We recognize an impairment loss at the time we make any such determination.
We test indefinite-lived intangible assets, other than goodwill, for impairment at least annually, and more frequently if indicators arise. We first assess qualitative factors to determine the likelihood that the fair value of the reporting group is less than its carrying value. If the carrying amount of an indefinite-lived intangible asset exceeds its fair value, an impairment loss is recognized. Fair values of other indefinite-lived intangible assets are usually determined based on discounted cash flows or appraised values, as appropriate.
If impairment indicators arise with respect to intangible assets with finite useful lives, we evaluate impairment by comparing the carrying amount of the asset to the estimated future undiscounted net cash flows expected to be generated by the asset. If the estimated future undiscounted net cash flows are less than the carrying amount of the asset, then we estimate the fair value of the asset and compare the estimated fair value to the intangible asset’s carrying value. For all of our reporting units, we recognize any shortfall from carrying value as an impairment loss in the current period.
Properties Held for Sale
Properties Held for Sale
A property or a group of properties is reported in discontinued operations in our consolidated statements of operations and comprehensive loss for current and prior periods if the disposal represents a strategic shift that has (or will have) a major effect on an entity’s operations and financial results when either: (i) the component has been disposed of or (ii) is classified as held for sale. At such time as a property is held for sale, such property is carried at the lower of: (i) its carrying amount or (ii) fair value less costs to sell. In addition, a property being held for sale ceases to be depreciated. We classify operating properties as property held for sale in the period in which all of the following criteria are met:
management, having the authority to approve the action, commits to a plan to sell the asset;
the asset is available for immediate sale in its present condition subject only to terms that are usual and customary for sales of such assets;
an active program to locate a buyer or buyers and other actions required to complete the plan to sell the asset has been initiated;
the sale of the asset is probable and the transfer of the asset is expected to qualify for recognition as a completed sale within one year;
the asset is being actively marketed for sale at a price that is reasonable in relation to its current fair value; and
given the actions required to complete the plan to sell the asset, it is unlikely that significant changes to the plan would be made or that the plan would be withdrawn.
Our properties held for sale are included in other assets, net in our accompanying consolidated balance sheets.
Debt Security Investment, Net
Debt Security Investment, Net
We classify our marketable debt security investment as held-to-maturity because we have the positive intent and ability to hold the security to maturity, and we have not recorded any unrealized holding gains or losses on such investment. Our held-to-maturity security is recorded at amortized cost and adjusted for the amortization of premiums or discounts through maturity.
Derivative Financial Instruments
Derivative Financial Instruments
We are exposed to the effect of interest rate changes in the normal course of business. We seek to mitigate these risks by following established risk management policies and procedures, which include the occasional use of derivatives. Our primary strategy in entering into derivative contracts, such as fixed-rate interest rate swaps and interest rate caps, is to add stability to interest expense and to manage our exposure to interest rate movements by effectively converting a portion of our variable-rate debt to fixed-rate debt. We do not enter into derivative instruments for speculative purposes.
Derivatives are recognized as either other assets or other liabilities in our accompanying consolidated balance sheets and are measured at fair value. We do not designate our derivative instruments as hedge instruments as defined by guidance under ASC Topic 815, Derivatives and Hedges, or ASC Topic 815, which allows for gains and losses on derivatives designated as hedges to be offset by the change in value of the hedged items or to be deferred in other comprehensive income (loss). Changes in the fair value of our derivative financial instruments are recorded as a component of interest expense in gain or loss in fair value of derivative financial instruments in our accompanying consolidated statements of operations and comprehensive loss.
Fair Value Measurements
Fair Value Measurements
The fair value of certain assets and liabilities is a market-based measurement, not an entity-specific measurement. Therefore, a fair value measurement should be determined based on the assumptions that market participants would use in pricing the asset or liability. As a basis for considering market participant assumptions in fair value measurements, we follow a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of our reporting entity (observable inputs that are classified within Levels 1 and 2 of the hierarchy) and our reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy).
Level 1 inputs are quoted prices (unadjusted) in active markets for identical assets or liabilities that we have the ability to access. An active market is defined as a market in which transactions for the assets or liabilities occur with sufficient frequency and volume to provide pricing information on an ongoing basis. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs that are observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates and yield curves that are observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input that is significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment and considers factors specific to the asset or liability.
Other Assets, Net
Other Assets, Net
Other assets, net primarily consists of inventory, prepaid expenses and deposits, deferred financing costs related to our lines of credit, deferred rent receivables, deferred tax assets, investments in unconsolidated entities, lease inducements and lease commissions.
Other Assets, Net Inventory consists primarily of pharmaceutical and medical supplies and is stated at the lower of cost (first-in, first-out) or market.
Other Assets, Net Deferred financing costs related to our lines of credit include amounts paid to lenders and others to obtain such financing. Such costs are amortized using the straight-line method over the term of the related loan, which approximates the effective interest rate method. Amortization of deferred financing costs related to our lines of credit is included in interest expense in our accompanying consolidated statements of operations and comprehensive loss. Lease commissions are amortized using the straight-line method over the term of the related lease. Prepaid expenses are amortized over the related contract periods.
Other Assets, Net
We report investments in unconsolidated entities using the equity method of accounting when we have the ability to exercise significant influence over the operating and financial policies. Under the equity method, our share of the investee’s
earnings or losses is included in our accompanying consolidated statements of operations and comprehensive loss. We generally do not recognize equity method losses when such losses exceed our net equity method investment balance unless we have committed to provide such investee additional financial support or guaranteed its obligations. To the extent that our cost basis is different from the basis reflected at the entity level, the basis difference is generally amortized over the lives of the related assets and liabilities, and such amortization is included in our share of equity in earnings of the entity. The initial carrying value of investments in unconsolidated entities is based on the amount paid to purchase the entity interest or the estimated fair value of the assets prior to the sale of interests in the entity. We have elected to follow the cumulative earnings approach when classifying distributions received from equity method investments in our consolidated statements of cash flows, whereby any distributions received up to the amount of cumulative equity earnings will be considered a return on investment and classified in operating activities and any excess distributions would be considered a return of investment and classified in investing activities. We evaluate our equity method investments for impairment based upon a comparison of the estimated fair value of the equity method investment to its carrying value. When we determine a decline in the estimated fair value of such an investment below its carrying value is other-than-temporary, an impairment is recorded.
Accounts Payable and Accrued Liabilities
Accounts Payable and Accrued Liabilities
As of December 31, 2023 and 2022, accounts payable and accrued liabilities primarily include insurance reserves of $44,548,000 and $39,893,000, respectively, reimbursement of payroll-related costs to the managers of our SHOP and integrated senior health campuses of $42,698,000 and $38,624,000, respectively, accrued developments and capital expenditures to unaffiliated third parties of $24,881,000 and $30,211,000, respectively, accrued property taxes of $23,549,000 and $24,926,000, respectively, and accrued distributions to common stockholders of $16,557,000 and $26,484,000, respectively.
Stock Compensation
Stock Based Compensation
We follow ASC Topic 718, Compensation — Stock Compensation, or ASC Topic 718, to account for our stock compensation pursuant to the Second Amended and Restated 2015 Incentive Plan, or the AHR Incentive Plan, using the fair value method, which requires an estimate of fair value of the award at the time of grant and recognition of compensation expense on a straight-line basis over the requisite service period of the awards. Forfeitures of stock based awards are recognized as an adjustment to compensation expense as they occur. Awards granted under the AHR Incentive Plan consist of restricted stock or units issued to our executive officers and employees, in addition to restricted stock issued to our directors.
Foreign Currency
Foreign Currency
We have real estate investments in the United Kingdom, or UK, and Isle of Man for which the functional currency is the UK Pound Sterling, or GBP. We translate the results of operations of our foreign real estate investments into United States Dollars, or USD, using the average currency rates of exchange in effect during the period, and we translate assets and liabilities using the currency exchange rate in effect at the end of the period. The resulting foreign currency translation adjustments are included in accumulated other comprehensive loss, a component of stockholders’ equity, in our accompanying consolidated balance sheets. Certain balance sheet items, primarily equity and capital-related accounts, are reflected at the historical currency exchange rates. We also have intercompany notes and payables denominated in GBP with our UK subsidiaries. Gains or losses resulting from remeasuring such intercompany notes and payables into USD at the end of each reporting period are reflected in our accompanying consolidated statements of operations and comprehensive loss. When such intercompany notes and payables are deemed to be of a long-term investment nature, they will be reflected in accumulated other comprehensive loss in our accompanying consolidated balance sheets.
Gains or losses resulting from foreign currency transactions are remeasured into USD at the rates of exchange prevailing on the date of the transactions. The effects of transaction gains or losses are included in our accompanying consolidated statements of operations and comprehensive loss.
Income Taxes
Income Taxes
We qualify, and elect to be taxed, as a REIT under the Code, and we intend to continue to qualify to be taxed as a REIT. To maintain our qualification as a REIT, we must meet certain organizational and operational requirements, including a requirement to distribute to our stockholders a minimum of 90.0% of our annual taxable income, excluding net capital gains. We generally will not be subject to U.S. federal income taxes if we distribute 100% of our taxable income each year to our stockholders.
If we fail to maintain our qualification as a REIT in any taxable year, we will then be subject to U.S. federal income taxes on our taxable income at regular corporate rates and will not be permitted to qualify for treatment as a REIT for U.S. federal income tax purposes for four years following the year during which qualification is lost unless the Internal Revenue Service grants us relief under certain statutory provisions. Such an event could have a material adverse effect on our net income and net cash available for distribution to our stockholders.
We may be subject to certain state and local income taxes on our income, property or net worth in some jurisdictions, and, in certain circumstances, we may also be subject to federal excise taxes on undistributed income. In addition, certain activities that we undertake are conducted by subsidiaries, which we elected to be treated as taxable REIT subsidiaries, or TRS, to allow us to provide services that would otherwise be considered impermissible for REITs. Also, we have real estate investments in the UK and Isle of Man, which do not accord REIT status to United States REITs under their tax laws. Accordingly, we recognize an income tax benefit or expense for the federal, state and local income taxes incurred by our TRS and foreign income taxes on our real estate investments in the UK and Isle of Man.
We account for deferred income taxes using the asset and liability method and recognize deferred tax assets and liabilities for the expected future tax consequences of events that have been included in our financial statements or tax returns. Under this method, we determine deferred tax assets and liabilities based on the temporary differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases using enacted tax rates in effect for the year in which the differences are expected to reverse. Deferred tax assets reflect the impact of the future deductibility of operating loss carryforwards. A valuation allowance is provided if we believe it is more likely than not that all or some portion of the deferred tax asset will not be realized. Any increase or decrease in the valuation allowance that results from a change in circumstances, and that causes us to change our judgment about the realizability of the related deferred tax asset, is included in income tax benefit or expense in our accompanying consolidated statements of operations and comprehensive loss when such changes occur. Any increase or decrease in the deferred tax liability that results from a change in circumstances, and that causes us to change our judgment about expected future tax consequences of events, is recorded in income tax benefit or expense in our accompanying consolidated statements of operations and comprehensive loss.
Net deferred tax assets are included in other assets, or net deferred tax liabilities are included in security deposits, prepaid rent and other liabilities, in our accompanying consolidated balance sheets.
Segment Disclosure
Segment Disclosure
We segregate our operations into reporting segments in order to assess the performance of our business in the same way that management reviews our performance and makes operating decisions. During the quarter ended December 31, 2023, we modified how we evaluate our business and make resource allocations, and therefore determined that we operate through four reportable business segments; integrated senior health campuses, OM (which was formerly known as MOBs), triple-net leased properties and SHOP. All segment information included in the notes to the accompanying consolidated financial statements has been recast for all periods presented to reflect four reportable business segments and the change in segment name from MOBs to OM. The segment name change from MOBs to OM did not result in any changes to the composition of such segment or information reviewed by management, and therefore, had no impact on the historical results of operations.
GLA and Other Measures
GLA and Other Measures
GLA and other measures used to describe real estate investments included in our accompanying consolidated financial statements are presented on an unaudited basis.
Recently Issued Accounting Pronouncements
Recently Issued Accounting Pronouncements
In March 2020, the FASB issued Accounting Standards Update, or ASU, 2020-04, Facilitation of the Effects of Reference Rate Reform of Financial Reporting, or ASU 2020-04, which provides optional expedients and exceptions for applying GAAP to contract modifications, hedging relationships and other transactions, subject to meeting certain criteria. ASU 2020-04 applies to the aforementioned transactions that reference the London Inter-bank Offered Rate, or LIBOR, or another reference rate expected to be discontinued because of the reference rate reform. In January 2021, the FASB issued ASU 2021-01, Reference Rate Reform (Topic 848), or ASU 2021-01, which clarifies that certain optional expedients and exceptions for contract modification and hedge accounting apply to derivative instruments that use an interest rate for margining,
discounting, or contract price alignment that is modified as a result of the discontinuation of the use of LIBOR as a benchmark interest rate due to reference rate reform. In December 2022, the FASB issued ASU 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848, or ASU 2022-06, which extends the period of time entities can utilize the reference rate reform relief guidance under ASU 2020-04 from December 31, 2022 to December 31, 2024. ASU 2020-04, ASU 2021-01 and ASU 2022-06 are effective for fiscal years and interim periods beginning after March 12, 2020 and through the effective date December 31, 2024, as extended by ASU 2022-06. We adopted such accounting pronouncements on January 1, 2023, which has not had a material impact on our consolidated financial statements and disclosures as of December 31, 2023.
In July 2023, the FASB issued ASU 2023-03, Presentation of Financial Statements (Topic 205), Income Statement-Reporting Comprehensive Income (Topic 220), Distinguishing Liabilities from Equity (Topic 480), Equity (Topic 505), and Compensation-Stock Compensation (Topic 718): Amendments to SEC Paragraphs Pursuant to SEC Staff Accounting Bulletin No. 120, SEC Staff Announcement at the March 24, 2022 EITF Meeting, and Staff Accounting Bulletin Topic 6.B, Accounting Series Release 280-General Revision of Regulation S-X: Income or Loss Applicable to Common Stock, or ASU 2023-03. ASU 2023-03 amends the Accounting Standards Codification, or ASC, for SEC updates pursuant to SEC Staff Accounting Bulletin No. 120; SEC Staff Announcement at the March 24, 2022 Emerging Issues Task Force Meeting; and Staff Accounting Bulletin Topic 6.B, Accounting Series Release 280 - General Revision of Regulation S-X: Income or Loss Applicable to Common Stock. These updates were immediately effective and did not have a material impact on our consolidated financial statements and disclosures.
In August 2023, the FASB issued ASU 2023-05, Business Combinations — Joint Venture Formations (Subtopic 805- 60): Recognition and Initial Measurement, or ASU 2023-05. ASU 2023-05 applies to the initial formation of a “joint venture” or a “corporate joint venture” as defined in the accounting literature and requires a joint venture to apply a new basis of accounting by initially measuring and recognizing all contributions received upon its formation at fair value. In particular, a joint venture will measure its total assets and liabilities upon formation as the fair value of the joint venture as a whole, which would equal the fair value of all of the joint venture’s outstanding equity interests. The new guidance does not change the definition of a joint venture, the accounting by the investors for their investments in a joint venture (e.g., equity method accounting) or the accounting by a joint venture for contributions received after its formation. ASU 2023-05 will be applied prospectively and is effective for all newly-formed joint venture entities with a formation date on or after January 1, 2025. Early adoption is permitted. We do not expect the adoption of ASU 2023-05 on January 1, 2025 to have a material impact to our consolidated financial statements and disclosures.
In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, or ASU 2023-07, which is intended to improve reportable segment disclosure requirements, primarily through enhanced disclosures about significant expenses. Such disclosure amendments include the requirement for public entities to disclose significant segment expenses that are regularly provided to the chief operating decision maker and included within each reported measure of segment profit or loss. ASU 2023-07 is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted and should be applied retrospectively to all prior periods presented in the financial statements. We are currently evaluating this guidance to determine the impact to our consolidated financial statements and disclosures.
In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures, or ASU 2023-09, which includes amendments that further enhance income tax disclosures, primarily through standardization and disaggregation of rate reconciliation categories and income taxes paid by jurisdiction. ASU 2023-09 is effective for annual periods beginning after December 15, 2024. Early adoption is permitted and should be applied prospectively; however, retrospective application is permitted. We are currently evaluating this guidance to determine the impact to our consolidated financial statements and disclosures.
In March 2024, the SEC adopted final rules, The Enhancement and Standardization of Climate-Related Disclosures for Investors. The final rules require a registrant to disclose, among other things: material climate-related risks; activities to mitigate or adapt to such risks, as well as a quantitative and qualitative description of material expenditures incurred and material impacts on financial estimates and assumptions that directly result from such mitigation or adaptation activities; material capitalized costs, expenses and losses incurred as a result of severe weather events and other natural conditions; information about the registrant’s board of directors’ oversight of climate-related risks and management’s role in managing material climate-related risks; and information on any climate-related targets or goals that are material to the registrant’s business, results of operations or financial condition. The rules require registrants to provide such climate-related disclosures in their annual reports, beginning with annual reports for the year ending December 31, 2025, for calendar-year-end large accelerated filers. We are currently evaluating this guidance to determine the impact to our consolidated financial statement disclosures.
Credit Loss, Financial Instrument
Resident and Tenant Receivables and Allowances
Resident receivables, which are related to resident fees and services revenue, are carried net of an allowance for credit losses. An allowance is maintained for estimated losses resulting from the inability of residents and payors to meet the contractual obligations under their lease or service agreements. Substantially all of such allowances are recorded as direct reductions of resident fees and services revenue as contractual adjustments provided to third-party payors or implicit price concessions in our accompanying consolidated statements of operations and comprehensive loss. Our determination of the adequacy of these allowances is based primarily upon evaluations of historical loss experience, the residents’ financial condition, security deposits, cash collection patterns by payor and by state, current economic conditions, future expectations in estimating credit losses and other relevant factors. Tenant receivables, which are related to real estate revenue, and unbilled deferred rent receivables are reduced for amounts where collectability is not probable, which are recognized as direct reductions of real estate revenue in our accompanying consolidated statements of operations and comprehensive loss.
v3.24.1
Summary of Significant Accounting Policies (Tables)
12 Months Ended
Dec. 31, 2023
Accounting Policies [Abstract]  
Disaggregation of Revenue
The following tables disaggregate our resident fees and services revenue by line of business, according to whether such revenue is recognized at a point in time or over time, for the years then ended (in thousands):
Integrated
Senior Health
Campuses
SHOP(1)Total
2023:
Over time$1,216,647 $182,200 $1,398,847 
Point in time265,233 4,662 269,895 
Total resident fees and services$1,481,880 $186,862 $1,668,742 
2022:
Over time$1,019,198 $154,268 $1,173,466 
Point in time235,467 3,223 238,690 
Total resident fees and services$1,254,665 $157,491 $1,412,156 
2021:
Over time$824,991 $96,000 $920,991 
Point in time200,708 2,236 202,944 
Total resident fees and services$1,025,699 $98,236 $1,123,935 
The following tables disaggregate our resident fees and services revenue by payor class for the years then ended (in thousands):
Integrated
Senior Health
Campuses
SHOP(1)Total
2023:
Private and other payors$696,147 $174,439 $870,586 
Medicare477,338 2,808 480,146 
Medicaid308,395 9,615 318,010 
Total resident fees and services$1,481,880 $186,862 $1,668,742 
2022:
Private and other payors$582,448 $144,771 $727,219 
Medicare429,129 — 429,129 
Medicaid243,088 12,720 255,808 
Total resident fees and services$1,254,665 $157,491 $1,412,156 
2021:
Private and other payors$462,828 $94,673 $557,501 
Medicare349,876 — 349,876 
Medicaid212,995 3,563 216,558 
Total resident fees and services$1,025,699 $98,236 $1,123,935 
___________
(1)Includes fees for basic housing, as well as fees for assisted living or skilled nursing care. We record revenue when services are rendered at amounts billable to individual residents. Residency agreements are generally for a term of 30 days, with resident fees billed monthly in advance. For patients under reimbursement arrangements with Medicaid, revenue is recorded based on contractually agreed-upon amounts or rates on a per resident, daily basis or as services are rendered.
Contract with Customer, Asset and Liability
Accounts Receivable, Net Resident Fees and Services Revenue
The beginning and ending balances of accounts receivable, net resident fees and services are as follows (in thousands):
Private
and
Other Payors
MedicareMedicaidTotal
Beginning balanceJanuary 1, 2023
$55,484 $45,669 $20,832 $121,985 
Ending balanceDecember 31, 2023
66,218 51,260 30,799 148,277 
Increase$10,734 $5,591 $9,967 $26,292 
Deferred Revenue Resident Fees and Services Revenue
Deferred revenue is included in security deposits, prepaid rent and other liabilities in our accompanying consolidated balance sheets. The beginning and ending balances of deferred revenue resident fees and services, almost all of which relates to private and other payors, are as follows (in thousands):
Total
Beginning balanceJanuary 1, 2023
$17,901 
Ending balance December 31, 2023
23,372 
Increase$5,471 
Financing Receivable, Allowance for Credit Loss
The following is a summary of our adjustments to allowances for the years ended December 31, 2023 and 2022 (in thousands):
Years Ended December 31,
20232022
Beginning balance
$14,071 $12,378 
Additional allowances20,774 21,538 
Write-offs(8,778)(10,684)
Recoveries collected or adjustments(9,030)(9,161)
Ending balance
$17,037 $14,071 
v3.24.1
Real Estate Investments, Net (Tables)
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Real Estate [Abstract]      
Real Estate Investments, Net
Our real estate investments, net consisted of the following as of December 31, 2023 and 2022 (in thousands):
 December 31,
 20232022
Building, improvements and construction in process$3,604,299 $3,670,361 
Land and improvements335,946 344,359 
Furniture, fixtures and equipment237,350 221,727 
4,177,595 4,236,447 
Less: accumulated depreciation(752,157)(654,838)
$3,425,438 $3,581,609 
   
Schedule Of Capital Expenditures Incurred
The following is a summary of our capital expenditures for the years ended December 31, 2023, 2022 and 2021 (in thousands):
Years Ended December 31,
202320222021
Integrated senior health campuses$64,011 $30,926 $62,596 
OM24,296 32,373 21,605 
SHOP12,244 9,280 3,539 
Triple-net leased properties420 31 
Total$100,971 $72,583 $87,771 
   
Summary of Assets Acquisitions The following is a summary of such property acquisition (in thousands):
LocationDate AcquiredContract
Purchase Price
Mortgage
Loan Payable
Louisville, KY02/15/23$11,000 $7,700 
The following table summarizes the purchase price of such assets acquired at the time of acquisition based on their relative fair values and adjusted for $28,623,000 operating lease right-of-use assets and $30,498,000 operating lease liabilities (in thousands):
2023
Acquisitions
Building and improvements$38,517 
Land4,917 
Total assets acquired$43,434 
The following table summarizes the purchase price of such assets acquired at the time of acquisition based on their relative fair values and adjusted for $37,464,000 operating lease right-of-use assets and $36,326,000 operating lease liabilities (in thousands):
2022
Acquisitions
Building and improvements$49,645 
Land and improvements8,885 
Total assets acquired$58,530 
The following table summarizes the purchase price of such assets acquired at the time of acquisition based on their relative fair values and adjusted for $57,647,000 operating lease right-of-use assets and $54,564,000 operating lease liabilities (in thousands):
2021
Acquisitions
Building and improvements$66,167 
Land17,612 
Total assets acquired$83,779 
Summary of Acquisitions of Previously Leased Real Estate Investments The following is a summary of such acquisitions, which are included in our integrated senior health campuses segment (in thousands):
LocationDate AcquiredContract
Purchase Price
Mortgage
Loan Payable
Financing
Obligation
Washington, IN07/13/23$14,200 $12,212 $— 
Tell City, IN07/13/232,400 1,988 — 
New Albany, OH07/13/2316,283 — 16,283 
Total$32,883 $14,200 $16,283 
  The following is a summary of such property acquisitions, which are included in our integrated senior health campuses segment (in thousands):
LocationDate
Acquired
Contract
Purchase Price
Mortgage
Loan Payable
Acquisition
Fee(1)
Kendallville, IN; and Delphos, Lima, Springfield, Sylvania and Union Township, OH01/19/21$76,549 $78,587 $1,164 
___________
(1)Our former advisor was paid, as compensation for services rendered in connection with the investigation, selection and acquisition of our properties, an acquisition fee of 2.25% of the portion of the contract purchase price of the properties attributed to our ownership interest in the Trilogy subsidiary that acquired the properties.
Schedule of Asset Dispositions, by Disposition The following is a summary of such dispositions (dollars in thousands):
LocationNumber of
Buildings
TypeDate
Disposed
Contract
Sales Price
Pinellas Park, FL(1)1SHOP02/01/23$7,730 
Olympia Fields, IL1OM04/10/233,750 
Auburn, CA1OM04/26/237,050 
Pottsville, PA1OM04/26/236,000 
New London, CT1OM05/24/234,200 
Stratford, CT1OM05/24/234,800 
Westbrook, CT1OM05/24/237,250 
Lakeland, FL(1)1SHOP06/01/237,080 
Winter Haven, FL(1)1SHOP06/01/2317,500 
Acworth, GA3OM06/14/238,775 
Lithonia, GA1OM06/14/233,445 
Stockbridge, GA1OM06/14/232,430 
Lake Placid, FL(1)1SHOP06/30/235,620 
Brooksville, FL(1)1SHOP06/30/237,800 
Spring Hill, FL(1)1SHOP08/01/237,800 
Morristown, NJ1OM08/09/2362,210 
Evendale, OH1OM08/29/2311,900 
Longview, TX1OM09/19/231,500 
Naperville, IL2OM10/03/2317,800 
Total22$194,640 
___________
(1)See Note 12, Redeemable Noncontrolling Interests, for information about the ownership of the Central Florida Senior Housing Portfolio.
The following is a summary of such dispositions, which were included in our OM and SHOP segments, as applicable (in thousands):
LocationDate
Disposed
Contract
Sales Price
Brooksville, FL(1)11/15/22$2,640 
Sanford, FL(1)12/15/223,750 
Memphis, TN12/20/229,600 
Bradenton FL(1)12/30/227,215 
Total$23,205 
___________
(1)See Note 12, Redeemable Noncontrolling Interests, for information about the ownership of the Central Florida Senior Housing Portfolio.
 
v3.24.1
Business Combinations and Asset Acquisitions (Tables)
12 Months Ended
Dec. 31, 2023
Business Combination and Asset Acquisition [Abstract]  
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed
2023
Acquisition
2022
Acquisitions
Operating lease right-of-use assets$— $153,777 
Building and improvements— 163,166 
Goodwill3,331 44,990 
Land— 20,514 
Accounts receivable, net— 19,472 
In-place leases— 18,834 
Cash and restricted cash565 12,331 
Certificates of need— 3,567 
Furniture, fixtures and equipment39 1,936 
Other assets66 1,798 
Total assets acquired4,001 440,385 
Operating lease liabilities— (161,121)
Mortgage loans payable (including debt discount of $6,066)
— (149,861)
Security deposits and other liabilities(812)(15,994)
Accounts payable and accrued liabilities(1,676)(16,012)
Financing obligations(12)(65)
Total liabilities assumed(2,500)(343,053)
Net assets acquired$1,501 $97,332 
REIT Merger
The following table sets forth the allocation of the purchase consideration to the fair values of identifiable tangible and intangible assets acquired and liabilities assumed recognized at the acquisition date of GAHR IV, as well as the fair value at the acquisition date of the noncontrolling interests in GAHR IV (in thousands):
Real estate investments$1,126,641
Cash and cash equivalents16,163
Accounts and other receivables, net2,086
Restricted cash986
Identified intangible assets115,824
Operating lease right-of-use assets11,939
Other assets3,938
Total assets1,277,577
Mortgage loans payable (including debt premium of $311)
(18,602)
Lines of credit and term loans(488,900)
Accounts payable and accrued liabilities(21,882)
Accounts payable due to affiliates(324)
Identified intangible liabilities(12,927)
Operating lease liabilities(7,568)
Security deposits, prepaid rent and other liabilities(8,354)
Total liabilities(558,557)
Net identifiable assets acquired719,020
Redeemable noncontrolling interests(2,525)
Noncontrolling interest in total equity(1,528)
Total purchase consideration$714,967
AHI Acquisition
The following table sets forth the allocation of the purchase consideration to the fair values of identifiable tangible and intangible assets acquired and liabilities assumed recognized at the acquisition date (in thousands):
Cash and cash equivalents$706
Operating lease right-of-use assets3,526
Other assets362
Total assets4,594
Accounts payable and accrued liabilities(3,910)
Operating lease liabilities(3,526)
Total liabilities(7,436)
Net identifiable liabilities assumed(2,842)
Goodwill134,589
Total purchase consideration$131,747
Fair Value of Purchase Consideration
REIT Merger
The fair value of the purchase consideration transferred was calculated as follows (in thousands):
Deemed equity consideration (1)$768,075
Consideration for acquisition of noncontrolling interest (2)(53,300)
Repurchase of GAHR IV Class T common stock192
Total purchase consideration$714,967
________________
(1)Represents the fair value of GAHR III common stock that is deemed to be issued for accounting purposes only. Taking into consideration the impact of the reverse stock split, the fair value of the purchase consideration is calculated based on 22,045,766 shares of common stock deemed to be issued by GAHR III at the fair value per share of $34.84.
(2)Represents the fair value of additional interest acquired in GAHR III’s subsidiary, Trilogy REIT Holdings, LLC, or Trilogy REIT Holdings. The acquisition of additional interest in Trilogy is accounted for separately from the REIT Merger in accordance with ASC Topic 810, Consolidation, or ASC Topic 810. See Note 13, Equity — Noncontrolling Interests in Total Equity, for a discussion of the Trilogy transaction.
AHI Acquisition
The fair value of the purchase consideration transferred was calculated as follows (in thousands):
Equity consideration (1)$131,674
Post-closing cash payment to NewCo Sellers related to net working capital adjustments73
Contingent consideration (2)
Total purchase consideration
$131,747
________________
(1)Taking into consideration the impact of the reverse stock split, the amount represents the estimated fair value of the 3,779,382 Surviving Partnership OP units issued as consideration, with a reference value for purposes thereof of $34.84 per unit. The issuance of Surviving Partnership OP units was accounted for separately from the AHI Acquisition.
(2)Represents the estimated fair value of contingent consideration based on the performance of a possible private investment fund under consideration by AHI. We have no definitive plans to establish the investment fund, and, therefore, the fair value of contingent consideration was estimated to be $0.
Allocation of Goodwill
The table below represents the allocation of goodwill on the acquisition date in connection with the AHI Acquisition to our reporting segments (in thousands):
OM$47,812
Integrated senior health campuses44,547
SHOP23,277
Triple-net leased properties:
Senior housing8,640
Hospitals5,924
SNFs4,389
Total$134,589 
Real Estate Investments, Intangible Assets and Intangible Liabilities
Real estate investments consist of land, building improvements, site improvements, unamortized tenant improvement allowances and unamortized capital improvements. Intangibles assets consist of in-place leases, above-market leases and certificates of need. We amortize purchased real estate investments and intangible assets on a straight-line basis over their respective useful lives. The following tables present the approximate fair value and the weighted-average depreciation and amortization periods of each major type of asset and liability (dollars in thousands):
Real Estate InvestmentsApproximate
Fair Value
Estimated
Useful Lives
(in years)
Land$114,525N/A
Building improvements930,70039
Site improvements33,6447
Unamortized tenant improvement allowances42,4076
Unamortized capital improvements5,36511
Total real estate investments$1,126,641
Intangible AssetsApproximate
Fair Value
Estimated
Useful Lives
(in years)
In-place leases$79,8876
Above-market leases35,60610
Certificates of need331N/A
Total identified intangible assets$115,824
Intangible LiabilitiesApproximate
Fair Value
Estimated
Useful Life
(in years)
Below-market leases$12,92710
Pro Forma Financial Information
The following unaudited pro forma operating information is presented as if the Merger and the AHI Acquisition occurred on January 1, 2020. Such unaudited pro forma information includes a nonrecurring adjustment to present acquisition-related expenses incurred in the year ended December 31, 2021 in the 2020 pro forma results. The pro forma results are not necessarily indicative of the operating results that would have been obtained had the Merger and the AHI Acquisition occurred at the beginning of the periods presented, nor are they necessarily indicative of future operating results. Unaudited pro forma revenue, net loss and net loss attributable to controlling interest would have been as follows (in thousands):
Years Ended December 31,
20212020
Revenue$1,392,884$1,397,261
Net loss$(45,253)$(17,116)
Net loss attributable to controlling interest$(35,140)$(20,642)
v3.24.1
Identified Intangible Assets and Liabilities (Tables)
12 Months Ended
Dec. 31, 2023
Intangible Assets and Liabilities [Abstract]  
Schedule of Intangible Assets and Liabilities
Identified intangible assets, net and identified intangible liabilities, net consisted of the following as of December 31, 2023 and 2022 (dollars in thousands):
 December 31,
20232022
Amortized intangible assets:
In-place leases, net of accumulated amortization of $35,437 and $38,930 as of December 31, 2023 and 2022, respectively (with a weighted average remaining life of 7.7 years and 7.0 years as of December 31, 2023 and 2022, respectively)
$42,615 $75,580 
Above-market leases, net of accumulated amortization of $7,079 and $6,360 as of December 31, 2023 and 2022, respectively (with a weighted average remaining life of 7.5 years and 9.0 years as of December 31, 2023 and 2022, respectively)
15,905 30,194 
Customer relationships, net of accumulated amortization of $934 and $785 as of December 31, 2023 and 2022, respectively (with a weighted average remaining life of 12.7 years and 13.7 years as of December 31, 2023 and 2022, respectively)
1,906 2,055 
Unamortized intangible assets:
Certificates of need99,777 97,667 
Trade names20,267 30,787 
Total identified intangible assets, net$180,470 $236,283 
Amortized intangible liabilities:
Below-market leases, net of accumulated amortization of $2,831 and $2,508 as of December 31, 2023 and 2022, respectively (with a weighted average remaining life of 7.2 years and 8.4 years as of December 31, 2023 and 2022, respectively)
$6,095 $10,837 
Total identified intangible liabilities, net$6,095 $10,837 
Amortization Expense on identified Intangible Assets and Liabilities As of December 31, 2023, estimated amortization expense on the identified intangible assets and liabilities for each of the next five years ending December 31 and thereafter was as follows (in thousands):
Amortization Expense
YearIntangible
Assets
Intangible
Liabilities
2024$11,618 $(1,073)
20258,797 (956)
20267,729 (840)
20277,205 (825)
20286,152 (709)
Thereafter18,925 (1,692)
Total$60,426 $(6,095)
v3.24.1
Other Assets, Net (Tables)
12 Months Ended
Dec. 31, 2023
Other Assets [Abstract]  
Other Assets, Net
Other assets, net consisted of the following as of December 31, 2023 and 2022 (dollars in thousands):
 December 31,
 20232022
Deferred rent receivables$47,540 $46,867 
Prepaid expenses, deposits, other assets and deferred tax assets, net33,204 25,866 
Investments in unconsolidated entities20,611 9,580 
Inventory — finished goods
19,472 19,775 
Lease commissions, net of accumulated amortization of $7,231 and $6,260 as of December 31, 2023 and 2022, respectively
17,565 19,217 
Deferred financing costs, net of accumulated amortization of $8,494 and $5,704 as of December 31, 2023 and 2022, respectively
3,830 4,334 
Lease inducement, net of accumulated amortization of $2,544 and $2,193 as of December 31, 2023 and 2022, respectively (with a weighted average remaining life of 6.9 years and 7.9 years as of December 31, 2023 and 2022, respectively)
2,456 2,807 
Derivative financial instrument1,463 — 
Total$146,141 $128,446 
v3.24.1
Mortgage Loans Payable, Net (Tables)
12 Months Ended
Dec. 31, 2023
Mortgage Loans Payable, Net [Abstract]  
Mortgage Loans Payable, Net Mortgage loans payable, net consisted of the following as of December 31, 2023 and 2022 (dollars in thousands):
December 31,
20232022
Total fixed-rate debt (76 loans and 68 loans as of December 31, 2023 and 2022, respectively)
$990,325 $885,892 
Total variable-rate debt (13 loans and 11 loans as of December 31, 2023 and 2022, respectively)
335,988 368,587 
Total fixed- and variable-rate debt1,326,313 1,254,479 
Less: deferred financing costs, net(9,713)(8,845)
Add: premium167 237 
Less: discount(14,371)(16,024)
Mortgage loans payable, net$1,302,396 $1,229,847 
Schedule of Activity Related to Mortgage Loans Payable
The following table reflects the changes in the carrying amount of mortgage loans payable, net for the years ended December 31, 2023 and 2022 (in thousands):
Years Ended December 31,
20232022
Beginning balance$1,229,847 $1,095,594 
Additions:
Borrowings under mortgage loans payable160,442 186,227 
Assumption of mortgage loans payable, net10,884 149,861 
Amortization of deferred financing costs2,284 2,332 
Amortization of discount/premium on mortgage loans payable, net3,549 2,242 
Deductions:
Scheduled principal payments on mortgage loans payable(64,792)(104,384)
Early payoff of mortgage loans payable(9,809)(90,871)
Payoff of a mortgage loans payable due to disposition of real estate investments(26,856)(8,637)
Deferred financing costs(3,153)(2,517)
Ending balance$1,302,396 $1,229,847 
For the year ended December 31, 2023, we incurred a loss on the early extinguishment of a mortgage loan payable of $345,000, which is recorded as an increase to interest expense in our accompanying consolidated statements of operations and comprehensive loss. Such loss was related to the payoff of a mortgage loan payable due to the disposition of the underlying real estate investment in August 2023.
Principal Payments Due on Mortgage Loans Payable
As of December 31, 2023, the principal payments due on our mortgage loans payable for each of the next five years ending December 31 and thereafter were as follows (in thousands):
YearAmount
2024$311,445 
2025166,853 
2026171,432 
202750,175 
202816,421 
Thereafter609,987 
Total$1,326,313 
v3.24.1
Derivative Financial Instruments (Tables)
12 Months Ended
Dec. 31, 2023
Derivative Instruments and Hedging Activities Disclosure [Abstract]  
Schedule of Derivative Financial Instruments The following table lists the derivative financial instruments held by us as of December 31, 2023, which were included in other assets and other liabilities in our accompanying consolidated balance sheets (dollars in thousands):
InstrumentNotional AmountIndexInterest RateEffective DateMaturity DateFair Value
December 31, 2023
Swap$275,000 one month
Term SOFR
3.74%02/01/2301/19/26$1,463 
Swap275,000 one month
Term SOFR
4.41%08/08/2301/19/26(2,178)
Swap200,000 one month
Term SOFR
4.40%01/05/2406/05/25(211)
$750,000 $(926)
v3.24.1
Redeemable Noncontrolling Interests (Tables)
12 Months Ended
Dec. 31, 2023
Temporary Equity [Abstract]  
Redeemable Noncontrolling Interest The changes in the carrying amount of redeemable noncontrolling interests consisted of the following for the years ended December 31, 2023 and 2022 (in thousands):
December 31,
20232022
Beginning balance$81,598 $72,725 
Additional redeemable noncontrolling interest— 273 
Reclassification from equity83 83 
Reclassification to other liabilities(25,312)— 
Distributions(1,369)(2,817)
Repurchase of redeemable noncontrolling interests(17,150)(4,034)
Adjustment to redemption value(2,944)15,773 
Net loss attributable to redeemable noncontrolling interests(1,063)(405)
Ending balance$33,843 $81,598 
v3.24.1
Equity (Tables)
12 Months Ended
Dec. 31, 2023
Equity [Abstract]  
Schedule of Nonvested RSAs and RSUs
A summary of the status of our nonvested RSAs and RSUs as of December 31, 2023 and 2022 and the changes for the years ended December 31, 2023 and 2022 is presented below:
Number of 
Nonvested
RSAs
Weighted
Average
Grant Date
Fair Value
Number of 
Nonvested
RSUs
Weighted
Average
Grant Date
Fair Value
Balance — December 31, 2021
222,886 $36.99 — $— 
Granted18,689 $37.16 60,077 $37.16 
Vested(58,335)$37.14 — $— 
Forfeited— $— (11,524)$37.16 
Balance — December 31, 2022
183,240 $36.97 48,553 $37.16 
Granted26,156 $31.83 191,728 $31.40 
Vested(62,352)$37.11 (6,400)(1)$37.16 
Forfeited— — (5,800)$32.57 
Balance — December 31, 2023
147,044 $35.99 228,081 $32.43 
___________
(1)Amount includes 2,280 shares of common stock that were withheld from issuance to satisfy employee minimum tax withholding requirements associated with the vesting of RSUs during the year ended December 31, 2023.
v3.24.1
Related Party Transactions (Tables)
12 Months Ended
Dec. 31, 2023
Related Party Transactions [Abstract]  
Schedule of Related Party Transactions Fees and expenses incurred to our former advisor or its affiliates for the year ended December 31, 2021 were as follows (in thousands):
Year Ended
December 31, 2021
Asset management fees(1)$16,187 
Property management fees(2)1,993 
Acquisition fees(3)1,363 
Development fees(4)856 
Lease fees(5)410 
Operating expenses(6)160 
Construction management fees(7)144 
Total$21,113 
___________
(1)Asset management fees were included in general and administrative expenses in our accompanying consolidated statements of operations and comprehensive loss.
(2)Property management fees were included in rental expenses or general and administrative expenses in our accompanying consolidated statements of operations and comprehensive loss, depending on the property type from which the fee was incurred.
(3)Acquisition fees in connection with the acquisition of properties accounted for as asset acquisitions or the acquisition of real estate-related investments were capitalized as part of the associated investments in our accompanying consolidated balance sheets.
(4)Development fees were capitalized as part of the associated investments in our accompanying consolidated balance sheets.
(5)Lease fees were capitalized as costs of entering into new leases and included in other assets, net in our accompanying consolidated balance sheets.
(6)We reimbursed our former advisor or its affiliates for operating expenses incurred in rendering services to us, subject to certain limitations. For the 12 months ended December 31, 2021, our operating expenses did not exceed such limitations. Operating expenses were generally included in general and administrative expenses in our accompanying consolidated statements of operations and comprehensive loss.
(7)Construction management fees were capitalized as part of the associated asset and included in real estate investments, net in our accompanying consolidated balance sheets.
v3.24.1
Fair Value Measurements (Tables)
12 Months Ended
Dec. 31, 2023
Fair Value Disclosures [Abstract]  
Assets and Liabilities Measured at Fair Value on Recurring Basis
The table below presents our assets and liabilities measured at fair value on a recurring basis as of December 31, 2023, aggregated by the level in the fair value hierarchy within which those measurements fall (in thousands):
Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)
Significant Other
Observable Inputs
(Level 2)
Significant
Unobservable
Inputs
(Level 3)
Total
Assets:
Derivative financial instrument$— $1,463 $— $1,463 
Total assets at fair value$— $1,463 $— $1,463 
Liabilities:
Derivative financial instruments$— $2,389 $— $2,389 
Total liabilities at fair value$— $2,389 $— $2,389 
Fair Value, by Balance Sheet Grouping The carrying amounts and estimated fair values of such financial instruments as of December 31, 2023 and 2022 were as follows (in thousands):
December 31,
20232022
 Carrying
Amount(1)
Fair
Value
Carrying
Amount(1)
Fair
Value
Financial Assets:
Debt security investment$86,935 $93,304 $83,000 $93,230 
Financial Liabilities:
Mortgage loans payable$1,302,396 $1,185,260 $1,229,847 $1,091,667 
Lines of credit and term loan$1,220,137 $1,225,890 $1,277,460 $1,285,205 
___________
(1)Carrying amount is net of any discount/premium and unamortized deferred financing costs.
v3.24.1
Income Taxes (Tables)
12 Months Ended
Dec. 31, 2023
Income Tax Disclosure [Abstract]  
Schedule of Income before Income Tax, Domestic and Foreign
The components of income or loss before taxes for the years ended December 31, 2023, 2022 and 2021, were as follows (in thousands):
December 31,
202320222021
Domestic$(75,843)$(72,510)$(52,001)
Foreign(381)(287)(312)
Loss before income taxes$(76,224)$(72,797)$(52,313)
Schedule of Components of Income Tax (Benefit) Expense
The components of income tax benefit or expense for the years ended December 31, 2023, 2022 and 2021 were as follows (in thousands):
December 31,
202320222021
Federal deferred$(655)$(8,176)$(12,033)
State deferred210 (2,099)(2,908)
Federal current10 — — 
State current(3)— 329 
Foreign current656 586 627 
Valuation allowances445 10,275 14,941 
Total income tax expense$663 $586 $956 
Schedule of Deferred Tax Assets and Liabilities The components of deferred tax assets and liabilities as of December 31, 2023 and 2022 were as follows (in thousands):
December 31,
20232022
Deferred income tax assets:
Fixed assets and intangibles$7,297 $8,271 
Expense accruals and other10,535 18,189 
Net operating loss and other carry forwards57,011 50,101 
Reserves and accruals8,119 7,487 
Allowances for accounts receivable2,878 2,224 
Investments in unconsolidated entities75 — 
Total deferred income tax assets
$85,915 $86,272 
Deferred income tax liabilities:
Fixed assets and intangibles$(12,892)$(13,626)
Other — temporary differences(2,608)(2,676)
Total deferred income tax liabilities$(15,500)$(16,302)
Net deferred income tax assets before valuation allowance$70,415 $69,970 
Valuation allowances(70,415)(69,970)
Net deferred income tax assets (liabilities)$— $— 
Summary of Tax Treatment of Distributions The income tax treatment for distributions reportable for the years ended December 31, 2023, 2022 and 2021 was as follows (dollars in thousands):
Years Ended December 31,
202320222021
Ordinary income$2,208 2.9 %$40,745 46.5 %$7,989 26.3 %
Capital gain— — — — — — 
Return of capital73,614 97.1 46,890 53.5 22,406 73.7 
$75,822 100 %$87,635 100 %$30,395 100 %
v3.24.1
Leases (Tables)
12 Months Ended
Dec. 31, 2023
Leases [Abstract]  
Schedule of Lease Payments to be Received As of December 31, 2023, the following table sets forth the undiscounted cash flows for future minimum base rents due under operating leases for each of the next five years ending December 31 and thereafter for properties that we wholly own (in thousands):
YearAmount
2024$134,438 
2025125,035 
2026115,544 
2027109,950 
202898,546 
Thereafter466,484 
Total$1,049,997 
Schedule of Lease Cost
The components of lease costs were as follows (in thousands):
Years Ended December 31,
Lease CostClassification202320222021
Operating lease cost(1)Property operating expenses, rental expenses or general and administrative expenses$44,141 $30,566 $23,774 
Finance lease cost
Amortization of leased assetsDepreciation and amortization1,360 1,249 1,447 
Interest on lease liabilitiesInterest expense353 261 384 
Sublease incomeResident fees and services revenue or other income(572)(693)(210)
Total lease cost$45,282 $31,383 $25,395 
___________
(1)Includes short-term leases and variable lease costs, which are immaterial.
Additional information related to our leases for the periods presented below was as follows (dollars in thousands):
December 31,
Lease Term and Discount Rate202320222021
Weighted average remaining lease term (in years)
Operating leases12.212.816.9
Finance leases1.52.33.6
Weighted average discount rate
Operating leases5.76 %5.69 %5.52 %
Finance leases7.78 %7.66 %7.68 %
Years Ended December 31,
Supplemental Disclosure of Cash Flows Information202320222020
Operating cash outflows related to finance leases$353 $262 $384 
Financing cash outflows related to finance leases$62 $54 $170 
Right-of-use assets obtained in exchange for operating lease liabilities$6,153 $173,832 $29,523 
Schedule of Operating Lease Liability
As of December 31, 2023, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for each of the next five years ending December 31 and thereafter, as well as the reconciliation of those cash flows to operating lease liabilities on our accompanying consolidated balance sheet (in thousands):
YearAmount
2024$35,834 
202535,153 
202635,073 
202735,618 
202835,707 
Thereafter166,313 
Total undiscounted operating lease payments343,698 
Less: interest118,196 
Present value of operating lease liabilities$225,502 
Schedule of Finance Lease Liability
Finance Leases
As of December 31, 2023, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for each of the next five years ending December 31 and thereafter, as well as a reconciliation of those cash flows to finance lease liabilities (in thousands):
YearAmount
2024$76 
202531 
2026— 
2027— 
2028— 
Thereafter— 
Total undiscounted finance lease payments107 
Less: interest
Present value of finance lease liabilities$100 
v3.24.1
Segment Reporting (Tables)
12 Months Ended
Dec. 31, 2023
Segment Reporting [Abstract]  
Summary Information by Reportable Segment
Summary information for the reportable segments during the years ended December 31, 2023, 2022 and 2021 was as follows (in thousands):
Integrated
Senior Health
Campuses
SHOPOMTriple-Net
Leased
Properties
Year Ended
December 31,
2023
Revenues and grant income:
Resident fees and services
$1,481,880 $186,862 $— $— $1,668,742 
Real estate revenue
— — 146,068 44,333 190,401 
Grant income7,475 — — — 7,475 
Total revenues and grant income1,489,355 186,862 146,068 44,333 1,866,618 
Expenses:
Property operating expenses
1,335,817 166,493 — — 1,502,310 
Rental expenses
— — 54,457 3,018 57,475 
Segment net operating income$153,538 $20,369 $91,611 $41,315 $306,833 
Expenses:
General and administrative
$47,510 
Business acquisition expenses5,795 
Depreciation and amortization
182,604 
Other income (expense):
Interest expense:
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishments)(163,191)
Loss in fair value of derivative financial instruments(926)
Gain on dispositions of real estate investments32,472 
Impairment of real estate investments
(13,899)
Impairment of intangible assets(10,520)
Loss from unconsolidated entities(1,718)
Gain on re-measurement of previously held equity interest726 
Foreign currency gain2,307 
Other income
7,601 
Total net other expense(147,148)
Loss before income taxes(76,224)
Income tax expense(663)
Net loss$(76,887)
Integrated
Senior Health
Campuses
SHOPOMTriple-Net
Leased
Properties
Year Ended
December 31,
2022
Revenues and grant income:
Resident fees and services$1,254,665 $157,491 $— $— $1,412,156 
Real estate revenue— — 148,717 56,627 205,344 
Grant income24,820 855 — — 25,675 
Total revenues and grant income1,279,485 158,346 148,717 56,627 1,643,175 
Expenses:
Property operating expenses1,133,480 148,046 — — 1,281,526 
Rental expenses— — 56,390 3,294 59,684 
Segment net operating income$146,005 $10,300 $92,327 $53,333 $301,965 
Expenses:
General and administrative$43,418 
Business acquisition expenses4,388 
Depreciation and amortization167,957 
Other income (expense):
Interest expense:
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishments) (105,956)
Gain in fair value of derivative financial instruments500 
Gain on dispositions of real estate investments5,481 
Impairment of real estate investments(54,579)
Impairment of goodwill(23,277)
Income from unconsolidated entities1,407 
Gain on re-measurement of previously held equity interest19,567 
Foreign currency loss(5,206)
Other income3,064 
Total net other expense(158,999)
Loss before income taxes(72,797)
Income tax expense(586)
Net loss$(73,383)
Integrated
Senior Health
Campuses
SHOPOMTriple-Net
Leased
Properties
Year Ended
December 31,
2021
Revenues and grant income:
Resident fees and services$1,025,699 $98,236 $— $— $1,123,935 
Real estate revenue
— — 97,297 44,071 141,368 
Grant income13,911 3,040 — — 16,951 
Total revenues and grant income1,039,610 101,276 97,297 44,071 1,282,254 
Expenses:
Property operating expenses
943,743 86,450 — — 1,030,193 
Rental expenses
— — 36,375 2,350 38,725 
Segment net operating income
$95,867 $14,826 $60,922 $41,721 $213,336 
Expenses:
General and administrative$43,199 
Business acquisition expenses13,022 
Depreciation and amortization133,191 
Other income (expense):
Interest expense:
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishments)(80,937)
Gain in fair value of derivative financial instruments8,200 
Loss on dispositions of real estate investments(100)
Impairment of real estate investments(3,335)
Loss from unconsolidated entities(1,355)
Foreign currency loss(564)
Other income1,854 
Total net other expense(76,237)
Loss before income taxes(52,313)
Income tax expense(956)
Net loss$(53,269)
Assets by Reportable Segment
Total assets by reportable segment as of December 31, 2023 and 2022 were as follows (in thousands):
 December 31,
 20232022
Integrated senior health campuses$2,197,762 $2,157,748 
OM1,232,310 1,379,502 
SHOP630,373 635,190 
Triple-net leased properties502,836 601,360 
Other14,652 12,898 
Total assets$4,577,933 $4,786,698 
Revenues and Grant Income and Real Estate Investments by Geographical Areas The following is a summary of geographic information for our operations for the periods presented (in thousands):
Years Ended December 31,
 202320222021
Revenues and grant income:
United States$1,861,954 $1,638,557 $1,277,095 
International4,664 4,618 5,159 
$1,866,618 $1,643,175 $1,282,254 
The following is a summary of real estate investments, net by geographic regions as of December 31, 2023 and 2022 (in thousands):
 December 31,
 20232022
Real estate investments, net:
United States$3,382,115 $3,539,453 
International43,323 42,156 
$3,425,438 $3,581,609 
Schedule of Goodwill
As of and for the years ended December 31, 2023 and 2022, goodwill by reportable segment was as follows (in thousands):
Integrated
Senior Health
Campuses
OMSHOPTriple-Net
Leased
Properties
Total
Balance December 31, 2021
$119,856 $47,812 $23,277 $18,953 $209,898 
Goodwill acquired 44,990 — — — 44,990 
Impairment loss— — (23,277)— (23,277)
Balance December 31, 2022
$164,846 $47,812 $— $18,953 $231,611 
Goodwill acquired 3,331 — — — 3,331 
Balance December 31, 2023
$168,177 $47,812 $— $18,953 $234,942 
v3.24.1
Organization and Description of Business - Narrative (Details)
$ / shares in Units, ft² in Thousands
12 Months Ended 118 Months Ended 132 Months Ended
Feb. 09, 2024
USD ($)
$ / shares
shares
Dec. 31, 2023
ft²
segment
campus
shares
Dec. 31, 2022
Nov. 15, 2022
Oct. 01, 2021
USD ($)
$ / shares
shares
Dec. 31, 2023
USD ($)
ft²
segment
campus
shares
Dec. 31, 2022
USD ($)
shares
Dec. 31, 2021
USD ($)
Dec. 31, 2023
USD ($)
ft²
campus
shares
Dec. 31, 2023
USD ($)
ft²
campus
shares
Aug. 01, 2022
Apr. 01, 2022
Sep. 30, 2021
Jan. 18, 2019
USD ($)
Schedule of Capitalization, Equity [Line Items]                            
Issuance of common stock and purchase of noncontrolling interest in connection with the Merger [1]               $ 721,945,000            
Issuance of common stock under the DRIP             $ 36,812,000 $ 7,666,000            
Number of reportable segments | segment   4       4                
GLA (Sq Ft) | ft²   18,822       18,822     18,822 18,822        
Acquisition aggregated cost of acquired properties purchase price, net of dispositions                   $ 4,473,543,000        
Acquisition aggregated cost of acquired real estate-related investments purchase price, net of principal repayments                   $ 60,429,000        
Number Of Buildings And Integrated Senior Health Campuses Owned And/Or Operated | campus   296       296     296 296        
Subsequent Event                            
Schedule of Capitalization, Equity [Line Items]                            
Common stock issued (in shares) | shares 64,400,000                          
Proceeds from Issuance or Sale of Equity $ 772,800,000                          
Common stock, par value (in dollars per share) | $ / shares $ 0.01                          
Subsequent Event | Over-Allotment Option                            
Schedule of Capitalization, Equity [Line Items]                            
Common stock issued (in shares) | shares 8,400,000                          
Limited Partnership Units | GAHR IV Advisor                            
Schedule of Capitalization, Equity [Line Items]                            
Stock redeemed (in shares) | shares         52                  
Limited Partnership Units | Former Advisor                            
Schedule of Capitalization, Equity [Line Items]                            
Stock redeemed (in shares) | shares         51                  
Operating Partnership Units                            
Schedule of Capitalization, Equity [Line Items]                            
Reverse stock split ratio       0.25                    
Common Stock                            
Schedule of Capitalization, Equity [Line Items]                            
Common stock issued (in shares) | shares   65,445,557       65,445,557     65,445,557 65,445,557        
Proceeds from Issuance or Sale of Equity                 $ 2,737,716,000          
DRIP S-3 Public Offering                            
Schedule of Capitalization, Equity [Line Items]                            
Issuance of common stock under the DRIP           $ 91,448,000 $ 91,448,000              
Issuance of common stock under the DRIP, shares | shares           2,431,695 2,431,695              
Maximum dollar amount of common stock issuable under public offering                           $ 100,000,000
General Partnership                            
Schedule of Capitalization, Equity [Line Items]                            
Percentage of ownership in operating partnership   95.00% 95.00%                      
NewCo Sellers                            
Schedule of Capitalization, Equity [Line Items]                            
Percentage of limited partnership interest   5.00% 5.00%                      
AHI Group Holdings, LLC                            
Schedule of Capitalization, Equity [Line Items]                            
Ownership percentage in affiliate                         4710.00%  
Colony Capital Inc.                            
Schedule of Capitalization, Equity [Line Items]                            
Ownership percentage in affiliate                         4510.00%  
James F. Flaherty III                            
Schedule of Capitalization, Equity [Line Items]                            
Ownership percentage in affiliate                         780.00%  
AHI                            
Schedule of Capitalization, Equity [Line Items]                            
Contingent consideration obligation         $ 0                  
AHI | OP Units                            
Schedule of Capitalization, Equity [Line Items]                            
Issuance of common stock and purchase of noncontrolling interest in connection with the Merger         $ 131,674,000                  
Issuance of stock (in dollars per share) | $ / shares         $ 8.71                  
April 1, 2022 Acquisition                            
Schedule of Capitalization, Equity [Line Items]                            
Business Combination, Step Acquisition, Equity Interest in Acquiree, Percentage                       50.00%    
RHS                            
Schedule of Capitalization, Equity [Line Items]                            
Business Combination, Step Acquisition, Equity Interest in Acquiree, Percentage   100.00%       100.00%   50.00% 100.00% 100.00% 50.00%      
[1] In connection with the Merger, as defined in Note 1, on October 1, 2021, a wholly-owned subsidiary of Griffin-American Healthcare REIT IV Holdings, LP sold its 6.0% interest in Trilogy REIT Holdings, LLC to GAHR III, as defined in Note 1. See Note 13, Equity — Noncontrolling Interests in Total Equity, for a further discussion.
v3.24.1
Summary of Significant Accounting Policies (Detail)
12 Months Ended
Dec. 31, 2023
USD ($)
segment
Dec. 31, 2022
USD ($)
Feb. 08, 2022
USD ($)
Dec. 31, 2023
USD ($)
segment
Dec. 31, 2022
USD ($)
campus
Dec. 31, 2021
USD ($)
campus
Jan. 01, 2023
USD ($)
Resident fees and services       $ 1,668,742,000 $ 1,412,156,000 $ 1,123,935,000  
Grant income       7,475,000 25,675,000 16,951,000  
Accounts receivable, allowance for credit loss $ 17,037,000 $ 14,071,000   17,037,000 14,071,000 12,378,000  
Accounts receivable, allowance for credit loss, increase       20,774,000 21,538,000    
Increase (decrease) in allowances for collections or adjustments       9,030,000 9,161,000    
Receivables written off against the allowance for uncollectible accounts       8,778,000 10,684,000    
Asset impairment charges       10,520,000      
Impairment of real estate held for sale       0 0    
Impairment of real estate investments       13,899,000 $ 54,579,000 $ 3,335,000  
Number of integrated senior health campuses disposed of | campus         2 2  
Contract sales price of dispositions     $ 19,622,000 194,640,000 $ 23,205,000    
Gain (loss) on dispositions of real estate investments, net     $ 683,000 32,472,000 5,481,000 $ (100,000)  
Disposition fee           21,113,000  
Other asset impairment charges       0 0 0  
Payroll related costs 42,698,000 38,624,000   42,698,000 38,624,000    
Insurance reserves 44,548,000 39,893,000   44,548,000 39,893,000    
Accrued developments and capital expenditures 24,881,000 30,211,000   24,881,000 30,211,000    
Accrued property taxes 23,549,000 24,926,000   23,549,000 24,926,000    
Distributions declared but not paid to common stockholders $ 16,557,000 $ 26,484,000   $ 16,557,000 26,484,000 8,768,000  
Percentage of income required to be distributed as dividends 90.00%     90.00%      
Number of reportable segments | segment 4     4      
Disposition Fees Waived              
Disposition fee           93,000  
General Partnership              
Percentage of ownership in operating partnership 95.00% 95.00%          
NewCo Sellers              
Percentage of limited partnership interest 5.00% 5.00%          
Building and Building Improvements [Member]              
Estimated useful life 39 years     39 years      
Leasehold Improvements [Member] | Maximum              
Estimated useful life 34 years     34 years      
Furniture, fixtures and equipment | Maximum              
Estimated useful life 28 years     28 years      
Integrated Senior Health Campuses              
Contract sales price of dispositions         18,700,000 500,000  
Gain (loss) on dispositions of real estate investments, net         3,421,000 (114,000)  
Integrated Senior Health Campuses              
Resident fees and services       $ 1,481,880,000 1,254,665,000 1,025,699,000  
Grant income       7,475,000 24,820,000 13,911,000  
SHOP              
Resident fees and services       186,862,000 157,491,000 98,236,000  
Grant income       0 855,000 3,040,000  
Impairment of real estate investments         54,579,000    
Resident Fees and Services [Member]              
Resident fees and services       1,668,742,000 1,412,156,000 1,123,935,000  
Accounts receivable, net - resident fees and services, beginning balance $ 148,277,000     148,277,000     $ 121,985,000
Accounts receivable, net - resident fees and services, ending balance 148,277,000     148,277,000     121,985,000
(Decrease) increase in accounts receivable, net - resident fees and services       26,292,000      
Deferred revenue, net - resident fees and services 23,372,000     23,372,000     17,901,000
Increase in deferred revenue, resident fees and services       5,471,000      
Resident Fees and Services [Member] | Integrated Senior Health Campuses              
Resident fees and services       1,481,880,000 1,254,665,000 1,025,699,000  
Resident Fees and Services [Member] | SHOP              
Resident fees and services       186,862,000 157,491,000 98,236,000  
Resident Fees and Services [Member] | Transferred at Point in Time [Member]              
Resident fees and services       269,895,000 238,690,000 202,944,000  
Resident Fees and Services [Member] | Transferred at Point in Time [Member] | Integrated Senior Health Campuses              
Resident fees and services       265,233,000 235,467,000 200,708,000  
Resident Fees and Services [Member] | Transferred at Point in Time [Member] | SHOP              
Resident fees and services       4,662,000 3,223,000 2,236,000  
Resident Fees and Services [Member] | Transferred over Time [Member]              
Resident fees and services       1,398,847,000 1,173,466,000 920,991,000  
Resident Fees and Services [Member] | Transferred over Time [Member] | Integrated Senior Health Campuses              
Resident fees and services       1,216,647,000 1,019,198,000 824,991,000  
Resident Fees and Services [Member] | Transferred over Time [Member] | SHOP              
Resident fees and services       182,200,000 154,268,000 96,000,000  
Private and Other Payors [Member] | Resident Fees and Services [Member]              
Resident fees and services       870,586,000 727,219,000 557,501,000  
Accounts receivable, net - resident fees and services, beginning balance 66,218,000     66,218,000     55,484,000
Accounts receivable, net - resident fees and services, ending balance 66,218,000     66,218,000     55,484,000
(Decrease) increase in accounts receivable, net - resident fees and services       10,734,000      
Private and Other Payors [Member] | Resident Fees and Services [Member] | Integrated Senior Health Campuses              
Resident fees and services       696,147,000 582,448,000 462,828,000  
Private and Other Payors [Member] | Resident Fees and Services [Member] | SHOP              
Resident fees and services       174,439,000 144,771,000 94,673,000  
Medicare [Member] | Resident Fees and Services [Member]              
Resident fees and services       480,146,000 429,129,000 349,876,000  
Accounts receivable, net - resident fees and services, beginning balance 51,260,000     51,260,000     45,669,000
Accounts receivable, net - resident fees and services, ending balance 51,260,000     51,260,000     45,669,000
(Decrease) increase in accounts receivable, net - resident fees and services       5,591,000      
Medicare [Member] | Resident Fees and Services [Member] | Integrated Senior Health Campuses              
Resident fees and services       477,338,000 429,129,000 349,876,000  
Medicare [Member] | Resident Fees and Services [Member] | SHOP              
Resident fees and services       2,808,000 0 0  
Medicaid [Member] | Resident Fees and Services [Member]              
Resident fees and services       318,010,000 255,808,000 216,558,000  
Accounts receivable, net - resident fees and services, beginning balance 30,799,000     30,799,000     20,832,000
Accounts receivable, net - resident fees and services, ending balance $ 30,799,000     30,799,000     $ 20,832,000
(Decrease) increase in accounts receivable, net - resident fees and services       9,967,000      
Medicaid [Member] | Resident Fees and Services [Member] | Integrated Senior Health Campuses              
Resident fees and services       308,395,000 243,088,000 212,995,000  
Medicaid [Member] | Resident Fees and Services [Member] | SHOP              
Resident fees and services       $ 9,615,000 $ 12,720,000 $ 3,563,000  
v3.24.1
Real Estate Investments, Net - Investments in Consolidated Properties (Detail) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Real Estate Properties [Line Items]    
Real estate investments, at cost $ 4,177,595 $ 4,236,447
Less: accumulated depreciation (752,157) (654,838)
Real estate investments, net 3,425,438 3,581,609
Building, improvements and construction in process    
Real Estate Properties [Line Items]    
Real estate investments, at cost 3,604,299 3,670,361
Land and improvements    
Real Estate Properties [Line Items]    
Real estate investments, at cost 335,946 344,359
Furniture, fixtures and equipment    
Real Estate Properties [Line Items]    
Real estate investments, at cost $ 237,350 $ 221,727
v3.24.1
Real Estate Investments, Net - Capital Expenditure (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Real Estate Properties [Line Items]      
Capital expenditures $ 100,971 $ 72,583 $ 87,771
Integrated Senior Health Campuses      
Real Estate Properties [Line Items]      
Capital expenditures 64,011 30,926 62,596
Outpatient Medical      
Real Estate Properties [Line Items]      
Capital expenditures 24,296 32,373 21,605
SHOP      
Real Estate Properties [Line Items]      
Capital expenditures 12,244 9,280 3,539
Triple-net leased properties      
Real Estate Properties [Line Items]      
Capital expenditures $ 420 $ 4 $ 31
v3.24.1
Real Estate Investments, Net - Additional Information (Details)
3 Months Ended 12 Months Ended
Dec. 05, 2022
campus
Feb. 08, 2022
USD ($)
Oct. 15, 2021
USD ($)
Dec. 31, 2022
USD ($)
facility
Dec. 31, 2023
USD ($)
$ / unit
facility
campus
Dec. 31, 2022
USD ($)
campus
facility
Dec. 31, 2021
USD ($)
Building
campus
Real Estate Properties [Line Items]              
Depreciation         $ 147,587,000 $ 141,257,000 $ 109,036,000
Number of integrated senior health campuses development completed | campus             3
Total completed development cost of leased property             $ 11,004,000
Number of integrated senior health campuses expanded | campus         3 3 2
Number of outpatient medical buildings impaired         1   1
Impairment of real estate investments         $ 13,899,000 $ 54,579,000 $ 3,335,000
Contract sales price of dispositions   $ 19,622,000     194,640,000 23,205,000  
Gain (loss) on dispositions of real estate investments, net   $ 683,000     32,472,000 5,481,000 (100,000)
Payments to Acquire and Develop Real Estate         $ 45,382,000 $ 73,229,000 80,109,000
Number of SHOP Impaired | facility         2 12  
Number Of Real Estate Investment To Be Disposed Of         22    
Number of impaired facilities, fair value determined by sales price from executed sales agreement | facility           1  
Number of impaired facilities, fair value based on projected sales price | campus           11  
Disposal Of Impaired SHOP Facilities, Number Of Facilities | facility       3      
Number Of SHOP Reclassified To Properties Held For Sale | campus         1    
Number Of Impaired Facilities, Fair Value Determined By Sales Price From Letters Of Intent | facility         1    
Asset impairment charges         $ 10,520,000    
Increase (decrease) to right-of-use asset             57,647,000
Operating lease liabilities         $ (36,609,000) $ (24,699,000) $ (16,793,000)
Sale of Ownership Interest in Real Estate, Percent   74.00%          
Ownership Interest in Real Estate, Percent   26.00%   31.60% 49.00% 31.60%  
Number of properties acquired | campus 7            
Price Per Square Foot Analysis | Minimum | Measurement Input, Appraised Value              
Real Estate Properties [Line Items]              
Alternative Investment, Measurement Input | $ / unit         250    
Price Per Square Foot Analysis | Maximum | Measurement Input, Appraised Value              
Real Estate Properties [Line Items]              
Alternative Investment, Measurement Input | $ / unit         260    
Price Per Unit Analysis | Minimum | Measurement Input, Appraised Value              
Real Estate Properties [Line Items]              
Alternative Investment, Measurement Input | $ / unit         190,000    
Price Per Unit Analysis | Maximum | Measurement Input, Appraised Value              
Real Estate Properties [Line Items]              
Alternative Investment, Measurement Input | $ / unit         200,000    
Integrated Senior Health Campuses              
Real Estate Properties [Line Items]              
Gain (loss) on dispositions of real estate investments, net           $ 1,370,000  
Outpatient Medical              
Real Estate Properties [Line Items]              
Number Of Real Estate Investment To Be Disposed Of | campus           1  
Central Florida Senior Housing Portfolio              
Real Estate Properties [Line Items]              
Number Of Real Estate Investment To Be Disposed Of | campus           3  
SHOP              
Real Estate Properties [Line Items]              
Number Of Real Estate Investment To Be Disposed Of | facility         5    
Two Thousand Twenty One Acquisitions, Previously Leased              
Real Estate Properties [Line Items]              
Percentage of contract purchase price paid acquisition fee, in cash           2.25% 2.25%
Two Thousand Twenty One Acquisitions, Previously Leased | Trilogy Investors, LLC              
Real Estate Properties [Line Items]              
Property ownership percentage             72.90%
Number of integrated senior health campuses acquired from unaffiliated parties | campus             6
2021 Acquisition              
Real Estate Properties [Line Items]              
Acquisition contract purchase price of land acquired     $ 249,000        
Acquisition fees and direct acquisition related expenses             $ 1,855,000
Two Thousand Twenty Acquisition              
Real Estate Properties [Line Items]              
Acquisition contract purchase price of land acquired             1,459,000
Two Thousand Twenty Two Acquisitions, Previously Leased              
Real Estate Properties [Line Items]              
Property ownership percentage           73.10%  
Two Thousand Twenty Two Acquisitions              
Real Estate Properties [Line Items]              
Acquisition contract purchase price of land acquired           $ 1,020,000  
2022 Acquisitions              
Real Estate Properties [Line Items]              
Acquisition fees and direct acquisition related expenses       $ 303,000   303,000  
Increase (decrease) to right-of-use asset           37,464,000  
Outpatient Medical Building              
Real Estate Properties [Line Items]              
Impairment of real estate investments             3,335,000
Carrying value after impairment             2,880,000
Contract sales price of dispositions             3,000,000
Gain (loss) on dispositions of real estate investments, net             346,000
SHOP              
Real Estate Properties [Line Items]              
Carrying value after impairment       $ 81,149,000 $ 20,439,000 81,149,000  
SHOP | SHOP              
Real Estate Properties [Line Items]              
Property, Plant and Equipment, Net         3,477,000    
Integrated Senior Health Campuses              
Real Estate Properties [Line Items]              
Total completed development cost           15,462,000 50,435,000
Total completed expansion cost         $ 4,988,000 7,543,000 $ 22,720,000
SHOP              
Real Estate Properties [Line Items]              
Impairment of real estate investments           $ 54,579,000  
v3.24.1
Real Estate Investments, Net - Acquisitions of Real Estate (Details)
$ in Thousands
12 Months Ended
Jul. 13, 2023
USD ($)
Feb. 15, 2023
USD ($)
Dec. 31, 2023
USD ($)
realEstate
Dec. 31, 2022
USD ($)
realEstate
Dec. 31, 2021
USD ($)
Real Estate Properties [Line Items]          
Asset acquisition, contract purchase price $ 32,883        
Operating lease liabilities     $ (36,609) $ (24,699) $ (16,793)
Increase (decrease) to right-of-use asset         57,647
Line of credit 14,200        
Asset Acquisition, Financing Obligation 16,283        
Capital expenditures     100,971 72,583 87,771
Triple-net leased properties          
Real Estate Properties [Line Items]          
Capital expenditures     $ 420 $ 4 $ 31
Two Thousand Twenty Two Acquisitions, Previously Leased          
Real Estate Properties [Line Items]          
Property ownership percentage       73.10%  
Number of previously leased real estate investments purchased | realEstate       4  
Loans payable       $ 52,725  
Asset acquisition, contract purchase price       54,805  
2022 Acquisitions          
Real Estate Properties [Line Items]          
Increase (decrease) to right-of-use asset       37,464  
Increase (decrease) to operating lease liability       $ 36,326  
Two Thousand Twenty One Acquisitions, Previously Leased          
Real Estate Properties [Line Items]          
Percentage of contract purchase price paid acquisition fee, in cash       2.25% 2.25%
Two Thousand Twenty One Acquisitions          
Real Estate Properties [Line Items]          
Operating lease liabilities         $ 54,564
Two Thousand Twenty Three Acquisitions          
Real Estate Properties [Line Items]          
Number of previously leased real estate investments purchased | realEstate     3    
Asset acquisition, contract purchase price     $ 660    
Acquisition ownership percentage     74.10%    
Kendallville, IN; and Delphos, Lima, Springfield, Sylvania and Union Township, OH | Two Thousand Twenty One Acquisitions, Previously Leased          
Real Estate Properties [Line Items]          
Date of acquisition of property       Jan. 19, 2021  
Contract purchase price       $ 76,549  
Line of credit       78,587  
Acquisition fees       $ 1,164  
Louisville, KY | Two Thousand Twenty Three Acquisitions          
Real Estate Properties [Line Items]          
Asset acquisition, contract purchase price   $ 11,000      
Line of credit   $ 7,700      
Washington, IN | Two Thousand Twenty Three Acquisitions          
Real Estate Properties [Line Items]          
Asset acquisition, contract purchase price 14,200        
Line of credit 12,212        
Asset Acquisition, Financing Obligation 0        
Tell City, IN | Two Thousand Twenty Three Acquisitions          
Real Estate Properties [Line Items]          
Asset acquisition, contract purchase price 2,400        
Line of credit 1,988        
Asset Acquisition, Financing Obligation 0        
New Albany, OH | Two Thousand Twenty Three Acquisitions          
Real Estate Properties [Line Items]          
Asset acquisition, contract purchase price 16,283        
Line of credit 0        
Asset Acquisition, Financing Obligation $ 16,283        
v3.24.1
Real Estate Investments, Net - Dispositions of Real Estate Investments (Details)
1 Months Ended 12 Months Ended
Feb. 08, 2022
USD ($)
Jul. 31, 2021
USD ($)
Dec. 31, 2023
USD ($)
$ / unit
campus
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
Real Estate Properties [Line Items]          
Contract sales price of dispositions $ 19,622,000   $ 194,640,000 $ 23,205,000  
Number Of Real Estate Investment To Be Disposed Of     22    
Present value of finance lease liabilities     $ 100,000    
Asset Acquisition, Carrying Value   $ 14,807,000      
Payments to Acquire Productive Assets   0      
Finance Lease, Liability, Statement of Financial Position [Extensible Enumeration]     Security deposits, prepaid rent and other liabilities Security deposits, prepaid rent and other liabilities  
Finance Lease, Liability, Noncurrent   $ 15,504,000      
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration]   Financing obligations      
(Gain) loss on dispositions of real estate investments, net $ (683,000)   $ (32,472,000) $ (5,481,000) $ 100,000
Price Per Square Foot Analysis | Minimum | Measurement Input, Appraised Value          
Real Estate Properties [Line Items]          
Alternative Investment, Measurement Input | $ / unit     250    
Price Per Square Foot Analysis | Maximum | Measurement Input, Appraised Value          
Real Estate Properties [Line Items]          
Alternative Investment, Measurement Input | $ / unit     260    
Brooksville, FL          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 7,800,000 2,640,000  
Number Of Real Estate Investment To Be Disposed Of     1    
Sanford, FL          
Real Estate Properties [Line Items]          
Contract sales price of dispositions       3,750,000  
Memphis, TN          
Real Estate Properties [Line Items]          
Contract sales price of dispositions       9,600,000  
Bradenton, FL          
Real Estate Properties [Line Items]          
Contract sales price of dispositions       $ 7,215,000  
Longview, TX          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 1,500,000    
Number Of Real Estate Investment To Be Disposed Of     1    
Pinellas Park, FL          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 7,730,000    
Number Of Real Estate Investment To Be Disposed Of     1    
Olympia Fields, IL          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 3,750,000    
Number Of Real Estate Investment To Be Disposed Of     1    
Auburn, CA          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 7,050,000    
Number Of Real Estate Investment To Be Disposed Of     1    
Pottsville, PA          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 6,000,000    
Number Of Real Estate Investment To Be Disposed Of     1    
New London, CT          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 4,200,000    
Number Of Real Estate Investment To Be Disposed Of     1    
Stratford, CT          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 4,800,000    
Number Of Real Estate Investment To Be Disposed Of     1    
Westbrook, CT          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 7,250,000    
Number Of Real Estate Investment To Be Disposed Of     1    
Lakeland, FL          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 7,080,000    
Number Of Real Estate Investment To Be Disposed Of     1    
Winter Haven, FL          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 17,500,000    
Number Of Real Estate Investment To Be Disposed Of     1    
Acworth, GA          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 8,775,000    
Number Of Real Estate Investment To Be Disposed Of     3    
Lithonia, GA [Member]          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 3,445,000    
Number Of Real Estate Investment To Be Disposed Of     1    
Stockbridge, GA [Member]          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 2,430,000    
Number Of Real Estate Investment To Be Disposed Of     1    
Lake Placid, FL          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 5,620,000    
Number Of Real Estate Investment To Be Disposed Of     1    
Spring Hill, FL          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 7,800,000    
Number Of Real Estate Investment To Be Disposed Of     1    
Morristown, NJ [Member]          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 62,210,000    
Number Of Real Estate Investment To Be Disposed Of     1    
Evendale, OH          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 11,900,000    
Number Of Real Estate Investment To Be Disposed Of     1    
Naperville, IL Two          
Real Estate Properties [Line Items]          
Contract sales price of dispositions     $ 17,800,000    
Number Of Real Estate Investment To Be Disposed Of     2    
SHOP          
Real Estate Properties [Line Items]          
Number Of Real Estate Investment To Be Disposed Of | campus     6    
Outpatient Medical          
Real Estate Properties [Line Items]          
Number Of Real Estate Investment To Be Disposed Of | campus     16    
SHOP and OMs          
Real Estate Properties [Line Items]          
(Gain) loss on dispositions of real estate investments, net     $ (32,717,000)    
v3.24.1
Real Estate Investments, Net - Purchase Price of Assets (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Real Estate Properties [Line Items]      
Increase (decrease) to right-of-use asset     $ 57,647
Operating lease right-of-use assets, net $ 227,846 $ 276,342  
Operating lease liabilities [1] 225,502 273,075  
Operating lease liabilities (36,609) (24,699) (16,793)
Two Thousand Twenty Two Acquisitions      
Real Estate Properties [Line Items]      
Building and improvements   49,645  
Land   8,885  
Total assets acquired   $ 58,530  
Two Thousand Twenty One Acquisitions      
Real Estate Properties [Line Items]      
Building and improvements     66,167
Land     17,612
Total assets acquired     83,779
Operating lease liabilities     $ 54,564
Two Thousand Twenty Three Acquisitions      
Real Estate Properties [Line Items]      
Building and improvements 38,517    
Land 4,917    
Total assets acquired 43,434    
Operating lease right-of-use assets, net 28,623    
Operating lease liabilities $ 30,498    
[1] Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of December 31, 2023 and 2022. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2022 Credit Facility, as defined in Note 9, held by American Healthcare REIT Holdings, LP in the amount of $914,900 and $965,900, as of December 31, 2023 and 2022, respectively, which was guaranteed by American Healthcare REIT, Inc.
v3.24.1
Business Combinations - Narrative (Details)
1 Months Ended 12 Months Ended
Jul. 13, 2023
USD ($)
Feb. 15, 2023
USD ($)
Dec. 05, 2022
USD ($)
campus
Oct. 01, 2021
USD ($)
$ / shares
shares
Aug. 31, 2022
USD ($)
Dec. 31, 2023
USD ($)
$ / shares
shares
Dec. 31, 2022
USD ($)
campus
$ / shares
Dec. 31, 2021
USD ($)
Feb. 14, 2023
Aug. 01, 2022
campus
Apr. 01, 2022
USD ($)
Business Acquisitions [Line Items]                      
Gain on re-measurement of previously held equity interests           $ (726,000) $ (19,567,000) $ 0      
Acquisition-related costs     $ 1,895,000 $ 14,060,000              
Goodwill           234,942,000 $ 231,611,000 209,898,000      
Business Combination, Number | campus             4        
Number of properties acquired | campus     7                
Post-closing cash payment to NewCo Sellers related to net working capital adjustments     $ 0                
Line of credit $ 14,200,000                    
Issuance of common stock and purchase of noncontrolling interest in connection with the Merger [1]               721,945,000      
Security deposits           (331,000) $ (777,000) 95,000      
Integrated Senior Health Campuses                      
Business Acquisitions [Line Items]                      
Goodwill           $ 168,177,000 $ 164,846,000 $ 119,856,000      
Business Combination, Number | campus             3        
Texas Ranger Portfolio | Two Thousand Twenty Two Acquisitions                      
Business Acquisitions [Line Items]                      
Contract purchase price     $ 110,627,000                
AHI                      
Business Acquisitions [Line Items]                      
Goodwill       134,589,000              
Total purchase consideration       131,747,000              
Post-closing cash payment to NewCo Sellers related to net working capital adjustments       73,000              
April 1, 2022 Acquisition                      
Business Acquisitions [Line Items]                      
Business Combination, Step Acquisition, Equity Interest in Acquiree, Percentage                     50.00%
Acquisition-related costs                     $ 938,000
RHS                      
Business Acquisitions [Line Items]                      
Gain on re-measurement of previously held equity interests         $ (19,567,000)            
Business Combination, Step Acquisition, Equity Interest in Acquiree, Percentage           100.00%   50.00%   50.00%  
Total purchase consideration         $ 36,661,000            
January 3, 2022 Acquisition                      
Business Acquisitions [Line Items]                      
Total purchase consideration             $ 27,790,000        
Line of credit             $ 20,800,000        
Memory Care Partners, LLC                      
Business Acquisitions [Line Items]                      
Gain on re-measurement of previously held equity interests   $ (726,000)                  
Business Combination, Step Acquisition, Equity Interest in Acquiree, Percentage   60.00%             40.00%    
Total purchase consideration   $ 900,000                  
Business Acquisition, Percentage of Voting Interests Acquired   100.00%                  
OP Units | AHI                      
Business Acquisitions [Line Items]                      
Issuance of common stock and purchase of noncontrolling interest in connection with the Merger       $ 131,674,000              
Stock purchased (shares) | shares       15,117,529              
Issuance of stock (in dollars per share) | $ / shares       $ 8.71              
Common Class I                      
Business Acquisitions [Line Items]                      
Common stock, par value (in dollars per share) | $ / shares           $ 0.01 $ 0.01        
Conversion ratio (in shares) | shares       0.9266              
Griffin-American Healthcare REIT III                      
Business Acquisitions [Line Items]                      
Common stock, par value (in dollars per share) | $ / shares       $ 0.01              
Griffin-American Healthcare REIT III | Partnership Class I Unit                      
Business Acquisitions [Line Items]                      
Conversion ratio (in shares) | shares       0.9266              
Griffin-American Healthcare REIT III | Common Class I                      
Business Acquisitions [Line Items]                      
Conversion ratio (in shares) | shares           0.9266          
Griffin-American Healthcare REIT IV, Inc.                      
Business Acquisitions [Line Items]                      
Acquisition-related costs       $ 6,753,000              
Griffin-American Healthcare REIT IV, Inc. | Common Class I                      
Business Acquisitions [Line Items]                      
Common stock, par value (in dollars per share) | $ / shares       $ 0.01              
RHS                      
Business Acquisitions [Line Items]                      
Number Of Senior Health Campuses Owns | campus                   16  
[1] In connection with the Merger, as defined in Note 1, on October 1, 2021, a wholly-owned subsidiary of Griffin-American Healthcare REIT IV Holdings, LP sold its 6.0% interest in Trilogy REIT Holdings, LLC to GAHR III, as defined in Note 1. See Note 13, Equity — Noncontrolling Interests in Total Equity, for a further discussion.
v3.24.1
Business Combinations - Fair Value of Purchase Consideration (Details) - USD ($)
$ / shares in Units, $ in Thousands
Dec. 05, 2022
Oct. 01, 2021
Business Acquisitions [Line Items]    
Post-closing cash payment to NewCo Sellers related to net working capital adjustments $ 0  
REIT Merger    
Business Acquisitions [Line Items]    
Equity consideration   $ 768,075
Consideration for acquisition of noncontrolling interest   (53,300)
Repurchase of GAHR IV Class T common stock   192
Total purchase consideration   $ 714,967
REIT Merger | Griffin-American Healthcare REIT III    
Business Acquisitions [Line Items]    
Number of shares issued (in shares)   22,045,766
Share price (in dollars per share)   $ 34.84
AHI    
Business Acquisitions [Line Items]    
Equity consideration   $ 131,674
Post-closing cash payment to NewCo Sellers related to net working capital adjustments   73
Contingent consideration   0
Total purchase consideration   131,747
Contingent consideration obligation   $ 0
AHI | OP Units    
Business Acquisitions [Line Items]    
Number of shares issued (in shares)   3,779,382
Share price (in dollars per share)   $ 34.84
Issuance of stock (in dollars per share)   $ 8.71
v3.24.1
Business Combinations - Purchase Price Allocation (Details) - USD ($)
$ in Thousands
Oct. 01, 2021
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Business Acquisitions [Line Items]        
Goodwill   $ 234,942 $ 231,611 $ 209,898
REIT Merger        
Business Acquisitions [Line Items]        
Real estate investments $ 1,126,641      
Cash and cash equivalents 16,163      
Accounts and other receivables, net 2,086      
Restricted cash 986      
Identified intangible assets 115,824      
Operating lease right-of-use assets 11,939      
Other assets 3,938      
Total assets 1,277,577      
Mortgage loans payable (including debt premium of $311) (18,602)      
Lines of credit and term loans (488,900)      
Accounts payable and accrued liabilities (21,882)      
Accounts payable due to affiliates (324)      
Identified intangible liabilities (12,927)      
Operating lease liabilities (7,568)      
Security deposits, prepaid rent and other liabilities (8,354)      
Total liabilities (558,557)      
Net identifiable assets acquired 719,020      
Redeemable noncontrolling interests (2,525)      
Noncontrolling interest in total equity (1,528)      
Total purchase consideration 714,967      
Add: premium 311      
AHI        
Business Acquisitions [Line Items]        
Cash and cash equivalents 706      
Operating lease right-of-use assets 3,526      
Other assets 362      
Total assets 4,594      
Accounts payable and accrued liabilities (3,910)      
Operating lease liabilities (3,526)      
Total liabilities (7,436)      
Net identifiable assets acquired (2,842)      
Goodwill 134,589      
Total purchase consideration $ 131,747      
2022 Acquisitions        
Business Acquisitions [Line Items]        
Cash and cash equivalents     12,331  
Accounts and other receivables, net     19,472  
Operating lease right-of-use assets     153,777  
Total assets     440,385  
Total liabilities     (343,053)  
Net identifiable assets acquired     97,332  
Goodwill     $ 44,990  
v3.24.1
Business Combinations - Allocation of Goodwill (Details) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Oct. 01, 2021
Business Acquisitions [Line Items]        
Goodwill $ 234,942 $ 231,611 $ 209,898  
AHI        
Business Acquisitions [Line Items]        
Goodwill       $ 134,589
AHI | Outpatient Medical        
Business Acquisitions [Line Items]        
Goodwill       47,812
AHI | Integrated Senior Health Campuses        
Business Acquisitions [Line Items]        
Goodwill       44,547
AHI | SHOP        
Business Acquisitions [Line Items]        
Goodwill       23,277
AHI | Skilled Nursing Facilities        
Business Acquisitions [Line Items]        
Goodwill       4,389
AHI | Senior Housing        
Business Acquisitions [Line Items]        
Goodwill       8,640
AHI | Hospitals        
Business Acquisitions [Line Items]        
Goodwill       $ 5,924
v3.24.1
Business Combinations - Real Estate Investments (Details) - REIT Merger
$ in Thousands
Oct. 01, 2021
USD ($)
Business Acquisitions [Line Items]  
Approximate Fair Value $ 1,126,641
Land  
Business Acquisitions [Line Items]  
Approximate Fair Value 114,525
Building Improvements  
Business Acquisitions [Line Items]  
Approximate Fair Value $ 930,700
Estimated Useful Lives (in years) 39 years
Site Improvements  
Business Acquisitions [Line Items]  
Approximate Fair Value $ 33,644
Estimated Useful Lives (in years) 7 years
Tenant Improvement Allowances  
Business Acquisitions [Line Items]  
Approximate Fair Value $ 42,407
Estimated Useful Lives (in years) 6 years
Capital Improvements  
Business Acquisitions [Line Items]  
Approximate Fair Value $ 5,365
Estimated Useful Lives (in years) 11 years
v3.24.1
Business Combinations - Intangible Assets and Intangible Liabilities (Details) - REIT Merger
$ in Thousands
Oct. 01, 2021
USD ($)
Business Acquisitions [Line Items]  
Approximate Fair Value $ 115,824
Below-market leases $ 12,927
Below Market Lease, Gross, Weighted Average Useful Life 10 years
In-Place Leases  
Business Acquisitions [Line Items]  
Approximate Fair Value $ 79,887
Estimated Useful Lives (in years) 6 years
Above-Market Leases  
Business Acquisitions [Line Items]  
Approximate Fair Value $ 35,606
Estimated Useful Lives (in years) 10 years
Certificates Of Need  
Business Acquisitions [Line Items]  
Approximate Fair Value $ 331
v3.24.1
Business Combinations - Pro Forma Financial Information (Details) - REIT Merger - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Business Acquisitions [Line Items]    
Revenue $ 1,392,884 $ 1,397,261
Net loss (45,253) (17,116)
Net loss attributable to controlling interest $ 35,140 $ 20,642
v3.24.1
Business Combinations - Schedule of Recognized Identified Assets Acquired and Liabilities Assumed (Details) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Asset Acquisition [Line Items]      
Goodwill $ 234,942 $ 231,611 $ 209,898
Business Acquisitions [Line Items]      
Goodwill 234,942 231,611 $ 209,898
2022 Acquisitions      
Asset Acquisition [Line Items]      
Operating lease right-of-use assets   153,777  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Buildings   163,166  
Goodwill   44,990  
Accounts and other receivables, net   19,472  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, In-Place Leases   18,834  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Land   20,514  
Cash and cash equivalents   12,331  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Certificates of Need   3,567  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Equipment   1,936  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Prepaid Expense and Other Assets   1,798  
Total assets   440,385  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed,, Operating Lease Liabilities   (161,121)  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Noncurrent Liabilities, Long-Term Debt   (149,861)  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Security Deposits   (15,994)  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities   (16,012)  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Financing Obligations   (65)  
Liabilities assumed   (343,053)  
Net identifiable assets acquired   97,332  
Business Acquisitions [Line Items]      
Operating lease right-of-use assets   153,777  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Buildings   163,166  
Goodwill   44,990  
Accounts and other receivables, net   19,472  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, In-Place Leases   18,834  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Land   20,514  
Cash and cash equivalents   12,331  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Certificates of Need   3,567  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Equipment   1,936  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Prepaid Expense and Other Assets   1,798  
Total assets   440,385  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed,, Operating Lease Liabilities   161,121  
Debt Instrument, Unamortized Discount   6,066  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Noncurrent Liabilities, Long-Term Debt   149,861  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Security Deposits   15,994  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities   16,012  
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Financing Obligations   65  
Liabilities assumed   343,053  
Net identifiable assets acquired   $ 97,332  
2023 Acquisitions      
Asset Acquisition [Line Items]      
Operating lease right-of-use assets 0    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Buildings 0    
Goodwill 3,331    
Accounts and other receivables, net 0    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, In-Place Leases 0    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Land 0    
Cash and cash equivalents 565    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Certificates of Need 0    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Equipment 39    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Prepaid Expense and Other Assets 66    
Total assets 4,001    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed,, Operating Lease Liabilities 0    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities (1,676)    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Financing Obligations (12)    
Liabilities assumed (2,500)    
Net identifiable assets acquired 1,501    
Business Acquisitions [Line Items]      
Operating lease right-of-use assets 0    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Buildings 0    
Goodwill 3,331    
Accounts and other receivables, net 0    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, In-Place Leases 0    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Land 0    
Cash and cash equivalents 565    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Certificates of Need 0    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Equipment 39    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Prepaid Expense and Other Assets 66    
Total assets 4,001    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed,, Operating Lease Liabilities 0    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities 1,676    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Financing Obligations 12    
Liabilities assumed 2,500    
Net identifiable assets acquired 1,501    
Business Combination, Recognized Identifiable Assets Acquired And Liabilities Assumed, Mortgage Loans Payable 0    
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Security Deposits and Other Liabilities $ (812)    
v3.24.1
Debt Security Investmen, Net - Additional Information (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Oct. 15, 2015
Debt Security Investment, Net        
Debt security investment, net $ 86,935 $ 83,000    
Held-to-Maturity, debt securities, unamortized closing costs 489 767    
Accretion on debt security 4,213 3,922 $ 3,665  
Amortization of closing costs $ 278 $ 237 $ 201  
Debt security investment [Member]        
Debt Security Investment, Net        
Stated interest rate       4.24%
Stated amount after maturity       $ 93,433
Yield to maturity interest rate       10.00%
Beneficial ownership interest in mortgage trust       10.00%
v3.24.1
Identified Intangible Assets and Liabilities - Summary of Intangible Assets and Liabilities (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]    
Identified intangible assets, net $ 180,470 $ 236,283
Identified intangible liabilities, net 6,095 $ 10,837
Amortized intangible assets    
Amortized intangible assets $ 60,426  
Weighted average remaining life 7 years 9 months 18 days 7 years 8 months 12 days
Amortized intangible liabilities    
Total identified intangible liabilities, net $ 6,095 $ 10,837
Below-Market Lease    
Finite-Lived Intangible Assets [Line Items]    
Identified intangible liabilities, net 6,095 10,837
Amortized intangible liabilities    
Intangible liabilities accumulated amortization $ (2,831) $ 2,508
Weighted average remaining life 7 years 2 months 12 days 8 years 4 months 24 days
Certificates Of Need    
Unamortized intangible assets    
Unamortized intangible assets $ 99,777 $ 97,667
Trade Names    
Unamortized intangible assets    
Unamortized intangible assets 20,267 30,787
In-Place Leases    
Amortized intangible assets    
Amortized intangible assets 42,615 75,580
Intangible assets accumulated amortization $ 35,437 $ 38,930
Weighted average remaining life 7 years 8 months 12 days 7 years
Customer Relationships    
Amortized intangible assets    
Amortized intangible assets $ 1,906 $ 2,055
Intangible assets accumulated amortization $ 934 $ 785
Weighted average remaining life 12 years 8 months 12 days 13 years 8 months 12 days
Above-Market Leases    
Amortized intangible assets    
Amortized intangible assets $ 15,905 $ 30,194
Intangible assets accumulated amortization $ 7,079 $ 6,360
Weighted average remaining life 7 years 6 months 9 years
v3.24.1
Identified Intangible Assets and Liabilities - Additional Information (Details) - USD ($)
$ in Thousands
3 Months Ended 12 Months Ended
Mar. 01, 2023
Dec. 31, 2023
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]          
Amortization expense     $ 46,601 $ 28,378 $ 22,460
Asset impairment charges     $ 10,520    
Weighted average remaining life   7 years 9 months 18 days 7 years 9 months 18 days 7 years 8 months 12 days  
Below-Market Lease          
Finite-Lived Intangible Assets [Line Items]          
Amortization expense     $ 4,534 $ 1,848 396
Weighted average remaining life     7 years 2 months 12 days 8 years 4 months 24 days  
Above-Market Leases          
Finite-Lived Intangible Assets [Line Items]          
Amortization expense     $ 14,278 $ 4,444 $ 1,349
Write-Off Of Amortization Of Intangible Assets $ 8,073 $ 2,756      
In-Place Leases          
Finite-Lived Intangible Assets [Line Items]          
Write-Off Of Amortization Of Intangible Assets $ 885 5,750      
Below-Market Lease          
Finite-Lived Intangible Assets [Line Items]          
Write-Off Of Amortization Of Intangible Assets   $ 112      
v3.24.1
Identified Intangible Assets and Liabilities - Summary of Amortization Expense on Identified Intangible Assets and Liabilities, Net (Details) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Intangible Assets    
2024 $ 11,618  
2025 8,797  
2026 7,729  
2027 7,205  
2028 6,152  
Thereafter 18,925  
Finite-lived intangible assets, gross 60,426  
Intangible Liabilities    
2024 (1,073)  
2025 (956)  
2026 (840)  
2027 (825)  
2028 (709)  
Thereafter (1,692)  
Finite-lived intangible liabilities, gross $ (6,095) $ (10,837)
v3.24.1
Other Assets, Net - Schedule of Other Assets, Net (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Other Assets [Abstract]    
Deferred rent receivables $ 47,540 $ 46,867
Prepaid expenses, deposits, other assets and deferred tax assets, net 33,204 25,866
Inventory — finished goods 19,472 19,775
Lease commissions, net of accumulated amortization of $7,231 and $6,260 as of December 31, 2023 and 2022, respectively 17,565 19,217
Equity Method Investments 20,611 9,580
Debt Issuance Costs, Net 3,830 4,334
Incentive to Lessee 2,456 2,807
Other Assets, net 146,141 128,446
Accumulated amortization, lease commissions 7,231 6,260
Accumulated amortization, deferred financing costs 8,494 5,704
Accumulated amortization, lease inducements $ 2,544 $ 2,193
Lease inducements, weighted average remaining life 6 years 10 months 24 days 7 years 10 months 24 days
Derivative Asset, Statement of Financial Position [Extensible Enumeration] Other Assets, net Other Assets, net
Derivative Asset $ 1,463 $ 0
v3.24.1
Other Assets, Net - Narrative (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Other Assets [Abstract]      
Amortization of deferred lease inducements $ 351 $ 351 $ 351
v3.24.1
Mortgage Loans Payable, Net - Narrative (Details)
$ in Thousands
12 Months Ended
Dec. 31, 2023
USD ($)
MortgageLoan
Dec. 31, 2022
USD ($)
MortgageLoan
Dec. 31, 2021
USD ($)
campus
Debt Instrument [Line Items]      
Mortgage loans payable, gross $ 1,326,313    
Mortgage loans payable, net $ 1,302,396 [1] $ 1,229,847 [1] $ 1,095,594
Number of fixed-rate mortgage loans payable | MortgageLoan 76 68  
Number of variable-rate mortgage loans payable | MortgageLoan 13 11  
Loss on extinguishments of debt $ 345 $ 5,166 $ 2,655
Number of debt instruments extinguished | campus     10
Secured Debt      
Debt Instrument [Line Items]      
Loss on extinguishments of debt 345 2,005 $ 2,425
Mortgage Loans Payable, Net      
Debt Instrument [Line Items]      
Mortgage loans payable, gross 1,326,313 1,254,479  
Mortgage loans payable, net $ 1,302,396 $ 1,229,847  
Debt, weighted average interest rate (as a percent) 4.72% 5.29%  
Minimum      
Debt Instrument [Line Items]      
Effective interest rate (as a percent) 2.21% 2.21%  
Maximum      
Debt Instrument [Line Items]      
Effective interest rate (as a percent) 8.46% 7.26%  
[1] Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of December 31, 2023 and 2022. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2022 Credit Facility, as defined in Note 9, held by American Healthcare REIT Holdings, LP in the amount of $914,900 and $965,900, as of December 31, 2023 and 2022, respectively, which was guaranteed by American Healthcare REIT, Inc.
v3.24.1
Mortgage Loans Payable, Net - Mortgage Loans Payable, Net (Details) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Debt Instrument [Line Items]      
Mortgage loans payable, gross $ 1,326,313    
Mortgage loans payable, net 1,302,396 [1] $ 1,229,847 [1] $ 1,095,594
Fixed Rate Debt      
Debt Instrument [Line Items]      
Mortgage loans payable, gross 990,325 885,892  
Variable Rate Debt      
Debt Instrument [Line Items]      
Mortgage loans payable, gross 335,988 368,587  
Mortgage Loans Payable, Net      
Debt Instrument [Line Items]      
Mortgage loans payable, gross 1,326,313 1,254,479  
Less: deferred financing costs, net (9,713) (8,845)  
Add: premium 167 237  
Less: discount (14,371) (16,024)  
Mortgage loans payable, net $ 1,302,396 $ 1,229,847  
[1] Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of December 31, 2023 and 2022. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2022 Credit Facility, as defined in Note 9, held by American Healthcare REIT Holdings, LP in the amount of $914,900 and $965,900, as of December 31, 2023 and 2022, respectively, which was guaranteed by American Healthcare REIT, Inc.
v3.24.1
Mortgage Loans Payable, Net - Changes in Carrying Amount of Mortgage Loans Payable, Net (Details)
$ in Thousands
12 Months Ended
Dec. 31, 2023
USD ($)
MortgageLoan
Dec. 31, 2022
USD ($)
MortgageLoan
Mortgage Loan Activities [Roll Forward]    
Beginning balance $ 1,229,847 [1] $ 1,095,594
Borrowings under mortgage loans payable 160,442 186,227
Assumption of mortgage loans payable, net 10,884 149,861
Amortization of deferred financing costs 2,284 2,332
Amortization of discount/premium on mortgage loans payable, net 3,549 2,242
Scheduled principal payments on mortgage loans payable (64,792) (104,384)
Early payoff of mortgage loans payable 9,809 90,871
Payoff of a mortgage loans payable due to disposition of real estate investments (26,856) (8,637)
Deferred financing costs (3,153) (2,517)
Ending balance [1] $ 1,302,396 $ 1,229,847
Number of fixed-rate mortgage loans payable | MortgageLoan 76 68
Mortgage loans payable, gross $ 1,326,313  
Minimum    
Mortgage Loan Activities [Roll Forward]    
Effective interest rate (as a percent) 2.21% 2.21%
Maximum    
Mortgage Loan Activities [Roll Forward]    
Effective interest rate (as a percent) 8.46% 7.26%
Mortgage Loans Payable, Net    
Mortgage Loan Activities [Roll Forward]    
Beginning balance $ 1,229,847  
Ending balance 1,302,396 $ 1,229,847
Mortgage loans payable, gross $ 1,326,313 $ 1,254,479
Debt, weighted average interest rate (as a percent) 4.72% 5.29%
[1] Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of December 31, 2023 and 2022. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2022 Credit Facility, as defined in Note 9, held by American Healthcare REIT Holdings, LP in the amount of $914,900 and $965,900, as of December 31, 2023 and 2022, respectively, which was guaranteed by American Healthcare REIT, Inc.
v3.24.1
Mortgage Loans Payable, Net - Schedule of Principal Payments Due on Mortgage Loans Payable (Details)
$ in Thousands
Dec. 31, 2023
USD ($)
Mortgage Loans Payable, Net [Abstract]  
2024 $ 311,445
2025 166,853
2026 171,432
2027 50,175
2028 16,421
Thereafter 609,987
Total $ 1,326,313
v3.24.1
Lines of Credit and Term Loans (Details)
1 Months Ended
Dec. 31, 2023
USD ($)
Aug. 30, 2023
USD ($)
Jan. 19, 2022
USD ($)
Sep. 05, 2019
Extension
Jan. 31, 2022
USD ($)
Dec. 31, 2022
USD ($)
Dec. 20, 2022
USD ($)
Oct. 01, 2021
USD ($)
Debt Instrument [Line Items]                
Lines of credit and term loan [1] $ 1,223,967,000         $ 1,281,794,000    
2019 Trilogy Credit Facility [Member] | Line of Credit | Alternate Base Rate                
Debt Instrument [Line Items]                
Variable interest rate (as a percent)       1.75%        
2019 Trilogy Credit Facility [Member] | Line of Credit | LIBOR                
Debt Instrument [Line Items]                
Variable interest rate (as a percent)       2.75%        
2019 Trilogy Credit Facility [Member] | Line of Credit | Federal Funds Effective Rate                
Debt Instrument [Line Items]                
Variable interest rate (as a percent)       0.50%        
2019 Trilogy Credit Facility [Member] | Line of Credit | One-Month LIBOR                
Debt Instrument [Line Items]                
Variable interest rate (as a percent)       1.00%        
2022 Corporate Line of Credit | Line of Credit                
Debt Instrument [Line Items]                
Line of credit facility, maximum borrowing capacity 1,050,000,000   $ 1,050,000,000     1,050,000,000    
Revolving Credit Facility | 2022 Corporate Line of Credit                
Debt Instrument [Line Items]                
Number of extensions | Extension       1        
Extension term       12 months        
2022 Credit Agreement                
Debt Instrument [Line Items]                
Number of business days     5 days          
Revolving Credit Facility | 2019 Trilogy Credit Facility [Member]                
Debt Instrument [Line Items]                
Lines of credit and term loan $ 309,823,000         $ 316,734,000    
Debt, weighted average interest rate (as a percent) 8.20%         7.17%    
Current borrowing capacity $ 400,000,000              
Revolving Credit Facility | 2019 Trilogy Credit Facility [Member] | Real Estate Assets and Ancillary Business Cash Flow                
Debt Instrument [Line Items]                
Line of credit facility, maximum borrowing capacity             $ 365,000,000 $ 325,000,000
Revolving Credit Facility | 2019 Trilogy Credit Facility [Member] | Eligible Accounts Receivable                
Debt Instrument [Line Items]                
Line of credit facility, maximum borrowing capacity               35,000,000
Revolving Credit Facility | 2019 Trilogy Credit Facility [Member] | Line of Credit                
Debt Instrument [Line Items]                
Line of credit facility, maximum borrowing capacity             $ 400,000,000 360,000,000
Potential maximum borrowing capacity               500,000,000
Increase to maximum borrowing capacity               $ 140,000,000
Revolving Credit Facility | 2022 Corporate Line of Credit                
Debt Instrument [Line Items]                
Line of credit facility, maximum borrowing capacity     $ 500,000,000          
Lines of credit and term loan $ 914,144,000              
Revolving Credit Facility | 2022 Credit Agreement                
Debt Instrument [Line Items]                
Debt, weighted average interest rate (as a percent) 7.08%         607.00%    
Long-Term Debt           $ 965,060,000    
Revolving Credit Facility | 2019 Trilogy Credit Facility 1                
Debt Instrument [Line Items]                
Current borrowing capacity $ 200,000,000              
Line of Credit | 2022 Corporate Line of Credit                
Debt Instrument [Line Items]                
Lines of credit and term loan 914,900,000         965,900,000    
Term Loan | 2022 Corporate Line of Credit                
Debt Instrument [Line Items]                
Line of credit facility, maximum borrowing capacity 550,000,000   550,000,000          
Increase in maximum borrowing capacity     700,000,000          
Term Loan | 2022 Credit Agreement                
Debt Instrument [Line Items]                
Write off of unamortized deferred financing fees         $ 3,161,000      
Standby Letters of Credit [Member] | 2022 Corporate Line of Credit                
Debt Instrument [Line Items]                
Line of credit facility, maximum borrowing capacity 25,000,000   $ 25,000,000     $ 25,000,000    
2019 Trilogy Credit Facility [Member]                
Debt Instrument [Line Items]                
Extension fee $ 745,000 $ 600,000            
[1] Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of December 31, 2023 and 2022. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2022 Credit Facility, as defined in Note 9, held by American Healthcare REIT Holdings, LP in the amount of $914,900 and $965,900, as of December 31, 2023 and 2022, respectively, which was guaranteed by American Healthcare REIT, Inc.
v3.24.1
Derivative Financial Instruments (Detail)
$ in Thousands
12 Months Ended
Dec. 31, 2023
USD ($)
Derivative [Line Items]  
Notional Amount $ 750,000
Not Designated as Hedging Instrument  
Derivative [Line Items]  
Fair Value $ (926)
Not Designated as Hedging Instrument | Swap, 2.10% Interest Rate  
Derivative [Line Items]  
Instrument Swap
Notional Amount $ 275,000
Index one month Term SOFR
Interest Rate 3.74%
Maturity Date Jan. 19, 2026
Fair Value $ 1,463
Not Designated as Hedging Instrument | Swap, 1.98% Interest Rate  
Derivative [Line Items]  
Instrument Swap
Notional Amount $ 275,000
Index one month Term SOFR
Interest Rate 4.41%
Maturity Date Jan. 19, 2026
Fair Value $ (2,178)
Not Designated as Hedging Instrument | Swap, 0.20% Interest Rate  
Derivative [Line Items]  
Instrument Swap
Notional Amount $ 200,000
Index one month Term SOFR
Interest Rate 4.40%
Maturity Date Jun. 05, 2025
Fair Value $ (211)
v3.24.1
Derivative Financial Instruments - Additional Information (Details)
$ in Thousands
12 Months Ended
Dec. 31, 2023
USD ($)
instrument
Dec. 31, 2022
USD ($)
instrument
Dec. 31, 2021
USD ($)
(Loss) gain in fair value of derivative financial instruments $ (926) $ 500 $ 8,200
Interest Rate Swap      
(Loss) gain in fair value of derivative financial instruments     $ 823
Not Designated as Hedging Instrument      
Number of derivative financial instruments | instrument 0 0  
v3.24.1
Redeemable Noncontrolling Interests - Additional Information (Details) - USD ($)
$ in Thousands
1 Months Ended 12 Months Ended 15 Months Ended 24 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 01, 2022
Oct. 06, 2022
Dec. 31, 2021
Oct. 01, 2021
Jan. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2022
Dec. 31, 2022
Sep. 30, 2021
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items]                          
Percent of partnership units outstanding with redemption features                       1.00%  
Adjustment to redemption value               $ (2,944) $ 16,744 $ 7,380      
Contributions from redeemable noncontrolling interests               $ 0 $ 273 $ 152      
Trilogy REIT Holdings, LLC                          
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items]                          
Joint venture ownership interest 76.00%             76.00%         70.00%
Trilogy Investors, LLC                          
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items]                          
Ownership percentage equity interest 97.50% 96.20%           97.50% 96.20%   96.20% 96.20%  
Contributions from redeemable noncontrolling interests       $ 3,707       $ 17,150          
Trilogy Investors, LLC | Subsequent Event                          
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items]                          
Contributions from redeemable noncontrolling interests             $ 25,312            
General Partnership                          
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items]                          
Percentage of ownership in operating partnership 95.00% 95.00%                      
NewCo Sellers                          
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items]                          
Percentage of limited partnership interest 5.00% 5.00%                      
Trilogy Investors, LLC                          
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items]                          
Noncontrolling interest, ownership percentage by noncontrolling owners 2.50% 3.80%           2.50% 3.80%   3.80% 3.80%  
Meridan                          
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items]                          
Joint venture acquired (as a percent)           98.00%              
Avalon                          
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items]                          
Joint venture acquired (as a percent)     10.00%   90.00%                
Payments to Acquire Interest in Joint Venture     $ 295                    
Redeemable Noncontrolling Interest, Percent Of Earnings                     10.00%    
v3.24.1
Redeemable Noncontrolling Interests Redeemable Noncontrolling Interests - Changes in Carrying Amount (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Changes in carrying amount of redeemable noncontrolling interest [Roll Forward]      
Beginning balance $ 81,598 $ 72,725  
Additional redeemable noncontrolling interest 0 273  
Reclassification from equity 83 83 $ 5,923
Reclassification to other liabilities (25,312) 0  
Distributions (1,369) (2,817)  
Repurchase of redeemable noncontrolling interests (17,150) (4,034)  
Adjustment to redemption value (2,944) 15,773  
Net loss attributable to redeemable noncontrolling interests (1,063) (405) (1,144)
Ending balance $ 33,843 $ 81,598 $ 72,725
v3.24.1
Equity - Preferred Stock and Common Stock (Details)
12 Months Ended 118 Months Ended
Feb. 09, 2024
USD ($)
$ / shares
shares
Nov. 03, 2023
$ / shares
Nov. 15, 2022
Oct. 01, 2021
$ / shares
shares
Dec. 31, 2023
$ / shares
Rate
shares
Dec. 31, 2022
$ / shares
shares
Dec. 31, 2023
USD ($)
$ / shares
shares
Jan. 26, 2024
shares
Jan. 18, 2019
USD ($)
Class of Stock [Line Items]                  
Number of shares of preferred stock, authorized to be issued         200,000,000 200,000,000 200,000,000    
Par value of preferred stock, authorized to be issued (in dollars per share) | $ / shares         $ 0.01 $ 0.01 $ 0.01    
Preferred stock outstanding (in shares)         0 0 0    
Preferred stock issued (in shares)         0 0 0    
Common stock authorized (in shares)         1,000,000,000 1,000,000,000 1,000,000,000    
Dividend rate of preferred stock (as a percent) | Rate         12.50%        
Subsequent Event                  
Class of Stock [Line Items]                  
Common stock, par value (in dollars per share) | $ / shares $ 0.01                
Common stock authorized (in shares) 64,400,000                
Common stock issued (in shares) 64,400,000                
Proceeds from Issuance or Sale of Equity | $ $ 772,800,000                
Subsequent Event | Over-Allotment Option                  
Class of Stock [Line Items]                  
Common stock issued (in shares) 8,400,000                
DRIP S-3 Public Offering                  
Class of Stock [Line Items]                  
Maximum dollar amount of common stock issuable under public offering | $                 $ 100,000,000
Issuance of common stock under the DRIP, shares         2,431,695 2,431,695      
Common Stock                  
Class of Stock [Line Items]                  
Common stock issued (in shares)         65,445,557   65,445,557    
Proceeds from Issuance or Sale of Equity | $             $ 2,737,716,000    
Common Class I                  
Class of Stock [Line Items]                  
Common stock, par value (in dollars per share) | $ / shares         $ 0.01 $ 0.01 $ 0.01    
Common stock authorized (in shares)         800,000,000 800,000,000 800,000,000    
Common stock issued (in shares)         46,673,320 46,675,367 46,673,320    
Common Class I | Subsequent Event                  
Class of Stock [Line Items]                  
Shares Reclassified               100,000,000  
Common Class T                  
Class of Stock [Line Items]                  
Common stock, par value (in dollars per share) | $ / shares         $ 0.01 $ 0.01 $ 0.01    
Stock redeemed (in shares)       5,208          
Common stock authorized (in shares)         200,000,000 200,000,000 200,000,000    
Common stock issued (in shares)         19,552,856 19,535,095 19,552,856    
Common Class T | Subsequent Event                  
Class of Stock [Line Items]                  
Shares Reclassified               200,000,000  
Common Stock                  
Class of Stock [Line Items]                  
Stock redeemed (in shares)       5,148          
Reverse stock split ratio     0.25            
Common Stock | Subsequent Event                  
Class of Stock [Line Items]                  
Shares Reclassified               700,000,000  
Operating Partnership Units                  
Class of Stock [Line Items]                  
Reverse stock split ratio     0.25            
Series A Preferred Stock                  
Class of Stock [Line Items]                  
Par value of preferred stock, authorized to be issued (in dollars per share) | $ / shares   $ 0.01              
Dividend rate of preferred stock (as a percent)   4.75%              
Griffin-American Healthcare REIT III                  
Class of Stock [Line Items]                  
Common stock, par value (in dollars per share) | $ / shares       $ 0.01          
v3.24.1
Equity - Distribution Reinvestment Plan (Details) - USD ($)
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Jan. 18, 2019
Class of Stock [Line Items]        
Issuance of common stock under the DRIP   $ 36,812,000 $ 7,666,000  
Total Stockholders' Equity        
Class of Stock [Line Items]        
Issuance of common stock under the DRIP $ 0 36,812,000 $ 7,666,000  
Common Stock        
Class of Stock [Line Items]        
Issuance of common stock and purchase of noncontrolling interest in connection with the Merger, shares [1]     20,432,815  
Issuance of common stock under the DRIP   $ 8,000 $ 2,000  
Issuance of common stock under the DRIP, shares 0 992,964 207,866  
DRIP S-3 Public Offering        
Class of Stock [Line Items]        
Maximum dollar amount of common stock issuable under public offering       $ 100,000,000
Issuance of common stock under the DRIP $ 91,448,000 $ 91,448,000    
Issuance of common stock under the DRIP, shares 2,431,695 2,431,695    
[1] In connection with the Merger, as defined in Note 1, on October 1, 2021, a wholly-owned subsidiary of Griffin-American Healthcare REIT IV Holdings, LP sold its 6.0% interest in Trilogy REIT Holdings, LLC to GAHR III, as defined in Note 1. See Note 13, Equity — Noncontrolling Interests in Total Equity, for a further discussion.
v3.24.1
Equity - Share Repurchase Plan (Details) - USD ($)
$ / shares in Units, $ in Thousands
1 Months Ended 12 Months Ended 118 Months Ended
Oct. 01, 2021
Feb. 26, 2014
Feb. 29, 2024
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2023
Class of Stock [Line Items]              
Maximum percentage of common stock repurchased during the period   5.00%          
Repurchase of common stock       $ (469) $ (20,699) $ (382) [1]  
Stock acquired average cost per share       $ 37.16 $ 37.02 $ 36.88  
Stock based compensation       $ 5,468 $ 3,909 $ 9,658  
Share Repurchase Plan              
Class of Stock [Line Items]              
Repurchase of common stock, shares       1,681 559,195 10,356  
Repurchase of common stock       $ (62) $ (20,699) $ (382) [1]  
Restricted Stock              
Class of Stock [Line Items]              
Granted (shares)       26,156 18,689    
Granted (usd per share)       $ 31.83 $ 37.16    
Number of unnvested units (in shares)       147,044 183,240 222,886 147,044
Restricted Stock | Griffin-American Healthcare REIT III              
Class of Stock [Line Items]              
Granted (shares)       33,750      
Common Class I              
Class of Stock [Line Items]              
Conversion ratio (in shares) 0.9266            
Common Class I | Griffin-American Healthcare REIT III              
Class of Stock [Line Items]              
Conversion ratio (in shares)       0.9266      
Common Class I | Restricted Stock | Griffin-American Healthcare REIT III              
Class of Stock [Line Items]              
Granted (shares)       31,273      
Two Thousand Thirteen Incentive Plan | Restricted Stock | Independent Directors              
Class of Stock [Line Items]              
Number of unnvested units (in shares) 4,170            
Two Thousand Fifteen Incentive Plan | Restricted Stock              
Class of Stock [Line Items]              
Granted (shares)             315,459
Stock based compensation       $ 5,385 $ 3,935    
Subsequent Event | Two Thousand Fifteen Incentive Plan | Restricted Stock              
Class of Stock [Line Items]              
Granted (shares)     972,222        
[1] Prior to the Merger, but upon the closing of the AHI Acquisition, as defined in Note 1, GAHR III redeemed all 5,148 shares of its common stock held by GAHR III’s former advisor as well as all 5,208 shares of GAHR IV Class T common stock held by the former advisor of GAHR IV, as defined in Note 1.
v3.24.1
Equity - Noncontrolling Interest in Total Equity (Details) - USD ($)
1 Months Ended 5 Months Ended 9 Months Ended 12 Months Ended 15 Months Ended
Jan. 01, 2025
Feb. 06, 2024
Dec. 31, 2023
Nov. 03, 2023
Dec. 31, 2022
Sep. 30, 2021
Dec. 01, 2015
Dec. 31, 2021
Mar. 31, 2024
Dec. 31, 2024
Dec. 31, 2020
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2022
Oct. 01, 2021
Jan. 06, 2016
Noncontrolling Interest [Line Items]                                  
Stock based compensation                       $ 5,468,000 $ 3,909,000 $ 9,658,000      
Preferred stock, value, subscriptions                                 $ 125,000
Dividend rate of preferred stock (as a percent)                       12.50%          
Operating partnership units outstanding presented in total equity (as a percent)     4.00%                 4.00%          
Preferred Stock, Par or Stated Value Per Share     $ 0.01   $ 0.01             $ 0.01 $ 0.01   $ 0.01    
Payments to Acquire Businesses, Net of Cash Acquired                       $ 335,000 $ 13,714,000 $ 0      
Series A Preferred Stock                                  
Noncontrolling Interest [Line Items]                                  
Dividend rate of preferred stock (as a percent)       4.75%                          
Preferred Stock, Liquidation Preference Per Share     $ 25.00                 $ 25.00          
Preferred Stock, Par or Stated Value Per Share       $ 0.01                          
Lakeview IN Medical Plaza                                  
Noncontrolling Interest [Line Items]                                  
Joint venture ownership interest     86.00%   86.00%             86.00% 86.00%   86.00%    
Net earning of joint venture allocated to noncontrolling interest                       14.00% 14.00% 14.00%      
Lakeview IN Medical Plaza | Subsequent Event                                  
Noncontrolling Interest [Line Items]                                  
Joint venture ownership interest   100.00%                              
Payments to Acquire Businesses, Net of Cash Acquired   $ 441,000                              
MetSL Property Investor, LLC                                  
Noncontrolling Interest [Line Items]                                  
Joint venture ownership interest     90.60%   90.60%             90.60% 90.60%   90.60%    
Net earning of joint venture allocated to noncontrolling interest                     9.40%            
Louisiana Senior Housing Portfolio                                  
Noncontrolling Interest [Line Items]                                  
Joint venture ownership interest                               90.00%  
Net earning of joint venture allocated to noncontrolling interest                             10.00%    
Profits Interests                                  
Noncontrolling Interest [Line Items]                                  
Forfeited (shares)                         0 0      
Exercised (shares)                         0 0      
Profits Interests | Trilogy Joint Venture                                  
Noncontrolling Interest [Line Items]                                  
Vesting percentage             20.00%                    
Vesting period             5 years                    
Stock based compensation                       $ 83,000 $ 83,000 $ 8,801,000      
Redemption of award               $ 16,517,000                  
Payments for redemption of award               8,650,000                  
Issuance of additional equity interests               $ 7,867,000                  
General Partnership                                  
Noncontrolling Interest [Line Items]                                  
Percentage of ownership in operating partnership     95.00%   95.00%                        
NewCo Sellers                                  
Noncontrolling Interest [Line Items]                                  
Percentage of limited partnership interest     5.00%   5.00%                        
Trilogy Investors, LLC                                  
Noncontrolling Interest [Line Items]                                  
Subsidiary, Ownership Percentage, Parent       97.50%                          
Noncontrolling interest, ownership percentage by noncontrolling owners     2.50%   3.80%             2.50% 3.80%   3.80%    
Trilogy REIT Holdings, LLC                                  
Noncontrolling Interest [Line Items]                                  
Subsidiary, Ownership Percentage, Parent     100.00%                 100.00%          
Trilogy REIT Holdings, LLC | Forecast [Member]                                  
Noncontrolling Interest [Line Items]                                  
Payments to Acquire Businesses, Net of Cash Acquired $ 260,000,000               $ 240,500,000 $ 247,000,000              
Trilogy REIT Holdings, LLC | Forecast [Member] | Minimum                                  
Noncontrolling Interest [Line Items]                                  
Payments to Acquire Businesses, Net of Cash Acquired $ 26,000,000               $ 24,050,000 $ 24,700,000              
Lakeview IN Medical Plaza | Lakeview IN Medical Plaza | Subsequent Event                                  
Noncontrolling Interest [Line Items]                                  
Percentage of ownership in operating partnership   14.00%                              
Trilogy Investors, LLC                                  
Noncontrolling Interest [Line Items]                                  
Ownership percentage equity interest     97.50%   96.20%             97.50% 96.20%   96.20%    
Trilogy REIT Holdings, LLC                                  
Noncontrolling Interest [Line Items]                                  
Joint venture ownership interest     76.00%     70.00%           76.00%          
Net earning of joint venture allocated to noncontrolling interest           30.00%                      
Trilogy REIT Holdings, LLC | Griffin-American Healthcare REIT IV, Inc.                                  
Noncontrolling Interest [Line Items]                                  
Joint venture ownership interest     6.00%   6.00%             6.00% 6.00%   6.00%    
Trilogy REIT Holdings, LLC | NorthStar Healthcare Income, Inc.                                  
Noncontrolling Interest [Line Items]                                  
Joint venture ownership interest     24.00%                 24.00%          
NHI | Trilogy REIT Holdings, LLC                                  
Noncontrolling Interest [Line Items]                                  
Noncontrolling interest, ownership percentage by noncontrolling owners       24.00%                          
v3.24.1
Equity - Equity Compensation Plans (Details) - USD ($)
$ / shares in Units, $ in Thousands
1 Months Ended 12 Months Ended 118 Months Ended
Oct. 01, 2021
Feb. 29, 2024
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2023
Jun. 15, 2023
Weighted Average Grant Date Fair Value              
Stock based compensation     $ 5,468 $ 3,909 $ 9,658    
Unrecognized compensation expense     $ 6,865 6,888   $ 6,865  
Unrecognized compensation expense, period of recognition     1 year 7 months 6 days        
Repurchase of common stock, value     $ 469 $ 20,699 $ 382 [1]    
Stock acquired average cost per share     $ 37.16 $ 37.02 $ 36.88    
Common Class I              
Weighted Average Grant Date Fair Value              
Conversion ratio (in shares) 0.9266            
Common Class I | Griffin-American Healthcare REIT III              
Weighted Average Grant Date Fair Value              
Conversion ratio (in shares)     0.9266        
Two Thousand Fifteen Incentive Plan | Common Stock              
Weighted Average Grant Date Fair Value              
Share-based compensation arrangement by share-based payment award, number of shares authorized             4,000,000
Restricted Stock              
Number of Nonvested Shares of our Restricted Common Stock              
Number of Nonvested Units, beginning balance (in shares)     183,240 222,886      
Granted (shares)     26,156 18,689      
Vested (in shares)     (62,352) (58,335)      
Forfeited (shares)     0 0      
Number of Nonvested Units, ending balance (in shares)     147,044 183,240 222,886 147,044  
Weighted Average Grant Date Fair Value              
Nonvested, Weighted Average Grant Date Fair Value, beginning balance (in usd per share)     $ 36.97 $ 36.99      
Granted, Weighted Average Grant Date Fair Value (in usd per share)     31.83 37.16      
Vested, Weighted Average Grant Date Fair Value (in usd per share)     37.11 37.14      
Forfeited, Weighted average Grant Date Fair Value (in usd per share)     0 0      
Nonvested, Weighted Average Grant Date Fair Value, ending balance (in usd per share)     $ 35.99 $ 36.97 $ 36.99 $ 35.99  
Restricted Stock | Griffin-American Healthcare REIT III              
Number of Nonvested Shares of our Restricted Common Stock              
Granted (shares)     33,750        
Restricted Stock | Common Class I | Griffin-American Healthcare REIT III              
Number of Nonvested Shares of our Restricted Common Stock              
Granted (shares)     31,273        
Weighted Average Grant Date Fair Value              
Vesting percentage     20.00%        
Vesting period     four year        
Restricted Stock | Two Thousand Thirteen Incentive Plan | Independent Directors              
Number of Nonvested Shares of our Restricted Common Stock              
Number of Nonvested Units, ending balance (in shares) 4,170            
Weighted Average Grant Date Fair Value              
Nonvested, Weighted Average Grant Date Fair Value, ending balance (in usd per share) $ 40.38            
Restricted Stock | Two Thousand Fifteen Incentive Plan              
Number of Nonvested Shares of our Restricted Common Stock              
Granted (shares)           315,459  
Weighted Average Grant Date Fair Value              
Stock based compensation     $ 5,385 $ 3,935      
Restricted Stock | Two Thousand Fifteen Incentive Plan | Subsequent Event              
Number of Nonvested Shares of our Restricted Common Stock              
Granted (shares)   972,222          
Restricted Stock | Two Thousand Fifteen Incentive Plan | Minimum              
Weighted Average Grant Date Fair Value              
Vesting period     1 year        
Restricted Stock | Two Thousand Fifteen Incentive Plan | Maximum              
Weighted Average Grant Date Fair Value              
Vesting period     4 years        
Restricted Stock Units (RSUs)              
Number of Nonvested Shares of our Restricted Common Stock              
Number of Nonvested Units, beginning balance (in shares)     48,553 0      
Granted (shares)     191,728 60,077      
Vested (in shares)     (6,400) 0      
Forfeited (shares)     (5,800) (11,524)      
Number of Nonvested Units, ending balance (in shares)     228,081 48,553 0 228,081  
Weighted Average Grant Date Fair Value              
Nonvested, Weighted Average Grant Date Fair Value, beginning balance (in usd per share)     $ 37.16 $ 0      
Granted, Weighted Average Grant Date Fair Value (in usd per share)     31.40 37.16      
Vested, Weighted Average Grant Date Fair Value (in usd per share)     37.16 0      
Forfeited, Weighted average Grant Date Fair Value (in usd per share)     32.57 37.16      
Nonvested, Weighted Average Grant Date Fair Value, ending balance (in usd per share)     $ 32.43 $ 37.16 $ 0 $ 32.43  
Share-Based Payment Arrangement, Shares Withheld for Tax Withholding Obligation     2,280        
Restricted Stock Units (RSUs) | Two Thousand Fifteen Incentive Plan | Maximum              
Weighted Average Grant Date Fair Value              
Vesting period     3 years        
Performance Based Unit | Two Thousand Fifteen Incentive Plan              
Number of Nonvested Shares of our Restricted Common Stock              
Granted (shares)           70,751  
Time Based Unit | Two Thousand Fifteen Incentive Plan              
Number of Nonvested Shares of our Restricted Common Stock              
Granted (shares)           169,529  
[1] Prior to the Merger, but upon the closing of the AHI Acquisition, as defined in Note 1, GAHR III redeemed all 5,148 shares of its common stock held by GAHR III’s former advisor as well as all 5,208 shares of GAHR IV Class T common stock held by the former advisor of GAHR IV, as defined in Note 1.
v3.24.1
Related Party Transactions - Additional Information (Details)
Sep. 30, 2021
Griffin Capital Company  
Related Party Transaction [Line Items]  
Ownership percentage in affiliate 2500.00%
American Healthcare Investors  
Related Party Transaction [Line Items]  
Ownership percentage in affiliate 7500.00%
v3.24.1
Related Party Transactions - Schedule of Amounts Outstanding to Affiliates (Detail)
$ in Thousands
12 Months Ended
Dec. 31, 2021
USD ($)
Related Party Transaction [Line Items]  
Related Party Transaction, Amounts of Transaction $ 21,113
Asset Management  
Related Party Transaction [Line Items]  
Related Party Transaction, Amounts of Transaction 16,187
Property Management Fee  
Related Party Transaction [Line Items]  
Related Party Transaction, Amounts of Transaction 1,993
Development Fees  
Related Party Transaction [Line Items]  
Related Party Transaction, Amounts of Transaction 1,363
Operating Expense  
Related Party Transaction [Line Items]  
Related Party Transaction, Amounts of Transaction 856
Construction Management Fee  
Related Party Transaction [Line Items]  
Related Party Transaction, Amounts of Transaction 410
Lease Commissions  
Related Party Transaction [Line Items]  
Related Party Transaction, Amounts of Transaction 160
Acquistion Fees  
Related Party Transaction [Line Items]  
Related Party Transaction, Amounts of Transaction $ 144
v3.24.1
Fair Value Measurements - Schedule of Assets and Liabilities Measured at Fair Value on Recurring Basis (Details) - Fair Value, Recurring
$ in Thousands
Dec. 31, 2023
USD ($)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]  
Derivative financial instrument $ 1,463
Total assets at fair value 1,463
Liabilities:  
Derivative financial instruments 2,389
Total liabilities at fair value 2,389
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1)  
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]  
Derivative financial instrument 0
Total assets at fair value 0
Liabilities:  
Derivative financial instruments 0
Total liabilities at fair value 0
Significant Other Observable Inputs (Level 2)  
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]  
Derivative financial instrument 1,463
Total assets at fair value 1,463
Liabilities:  
Derivative financial instruments 2,389
Total liabilities at fair value 2,389
Significant Unobservable Inputs (Level 3)  
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]  
Derivative financial instrument 0
Total assets at fair value 0
Liabilities:  
Derivative financial instruments 0
Total liabilities at fair value $ 0
v3.24.1
Fair Value Measurements - Narrative (Details)
$ in Thousands
3 Months Ended
Dec. 31, 2022
USD ($)
Business Acquisitions [Line Items]  
Warrants redeemed $ 678
v3.24.1
Fair Value Measurements Fair Value by Balance Sheet Grouping (Details) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Financial Instruments, Financial Assets, Balance Sheet Groupings [Abstract]      
Debt security investment, net $ 86,935 $ 83,000  
Debt security investment, fair value 93,304 93,230  
Financial Instruments, Financial Liabilities, Balance Sheet Groupings [Abstract]      
Mortgage loans payable, net 1,302,396 [1] 1,229,847 [1] $ 1,095,594
Mortgage loans payable, net fair value 1,185,260 1,091,667  
Lines of credit and term loan, net 1,220,137 1,277,460  
Lines of credit and term loan, net fair value $ 1,225,890 $ 1,285,205  
[1] Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of December 31, 2023 and 2022. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2022 Credit Facility, as defined in Note 9, held by American Healthcare REIT Holdings, LP in the amount of $914,900 and $965,900, as of December 31, 2023 and 2022, respectively, which was guaranteed by American Healthcare REIT, Inc.
v3.24.1
Income Taxes - Income Before Income Tax (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Income Tax Disclosure [Abstract]      
Domestic $ (75,843) $ (72,510) $ (52,001)
Foreign (381) (287) (312)
Loss before income taxes $ (76,224) $ (72,797) $ (52,313)
v3.24.1
Income Taxes - Income Tax (Benefit) Expense (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Income Tax Disclosure [Abstract]      
Federal deferred $ (655) $ (8,176) $ (12,033)
State deferred 210 (2,099) (2,908)
Federal current 10 0 0
State current (3) 0 329
Foreign current 656 586 627
Valuation allowances 445 10,275 14,941
Total income tax expense $ 663 $ 586 $ 956
v3.24.1
Income Taxes - Deferred Taxes (Details) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Income Tax Disclosure [Abstract]    
Fixed assets and intangibles $ 7,297 $ 8,271
Expense accruals and other 10,535 18,189
Net operating loss and other carry forwards 57,011 50,101
Reserves and accruals 8,119 7,487
Allowances for accounts receivable 2,878 2,224
Investments in unconsolidated entities 75 0
Total deferred income tax assets 85,915 86,272
Fixed assets and intangibles (12,892) (13,626)
Other — temporary differences (2,608) (2,676)
Total deferred income tax liabilities (15,500) (16,302)
Net deferred income tax assets before valuation allowance 70,415 69,970
Valuation allowances (70,415) (69,970)
Net deferred income tax assets (liabilities) $ 0 $ 0
v3.24.1
Income Taxes - Additional Information (Details) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Income Tax Disclosure [Abstract]    
NOL carryforwards $ 203,320 $ 196,779
v3.24.1
Income Taxes - Tax Treatment of Distributions (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Income Tax Disclosure [Abstract]      
Ordinary income $ 2,208 $ 40,745 $ 7,989
Capital gain 0 0 0
Return of capital 73,614 46,890 22,406
Distributions reportable $ 75,822 $ 87,635 $ 30,395
Ordinary income (as a percent) 2.90% 46.50% 26.30%
Capital gain (as a percent) 0.00% 0.00% 0.00%
Return of capital (as a percent) 97.10% 53.50% 73.70%
Percentage distribution reportable (as a percent) 100.00% 100.00% 100.00%
v3.24.1
Leases Additional Information (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Lessee, Lease, Description [Line Items]      
Operating lease revenue $ 185,064 $ 200,526 $ 136,294
Variable lease payments $ 38,415 $ 39,278 $ 23,340
v3.24.1
Leases Lessor, Future Minimum Rents Due (Details)
$ in Thousands
Dec. 31, 2023
USD ($)
Future Minimum Rent [Abstract]  
2024 $ 134,438
2025 125,035
2026 115,544
2027 109,950
2028 98,546
Thereafter 466,484
Total $ 1,049,997
v3.24.1
Leases Components of Lease Cost (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Leases [Abstract]      
Operating Lease, Cost $ 44,141 $ 30,566 $ 23,774
Amortization of leased assets 1,360 1,249 1,447
Interest on lease liabilities 353 261 384
Sublease income (572) (693) (210)
Total lease cost $ 45,282 $ 31,383 $ 25,395
v3.24.1
Leases Lease Term and Discount Rate (Details)
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Leases [Abstract]      
Operating leases, weighted average remaining lease term 12 years 2 months 12 days 12 years 9 months 18 days 16 years 10 months 24 days
Finance leases, weighted average remaining lease term 1 year 6 months 2 years 3 months 18 days 3 years 7 months 6 days
Operating leases, weighted average discount rate 5.76% 5.69% 5.52%
Finance leases, weighted average discount rate 7.78% 7.66% 7.68%
v3.24.1
Leases Supplemental Disclosure of Cash Flows Information (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Leases [Abstract]      
Operating cash outflows related to finance leases $ 353 $ 262 $ 384
Financing cash outflows related to finance leases 62 54 170
Right-of-use assets obtained in exchange for operating lease liabilities $ 6,153 $ 173,832 $ 29,523
v3.24.1
Leases Future Minimum Rent Payments, Operating Leases (Details) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Lessee, Operating Lease, Description [Abstract]    
2024 $ 35,834  
2025 35,153  
2026 35,073  
2027 35,618  
2028 35,707  
Thereafter 166,313  
Total undiscounted operating lease payments 343,698  
Less: interest 118,196  
Present value of operating lease liabilities [1] $ 225,502 $ 273,075
[1] Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of December 31, 2023 and 2022. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2022 Credit Facility, as defined in Note 9, held by American Healthcare REIT Holdings, LP in the amount of $914,900 and $965,900, as of December 31, 2023 and 2022, respectively, which was guaranteed by American Healthcare REIT, Inc.
v3.24.1
Leases Future Minimum Rent Payments, Finance Leases (Details) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Lessee, Finance Lease, Description [Abstract]    
2024 $ 76  
2025 31  
2026 0  
2027 0  
2028 0  
Thereafter 0  
Total undiscounted finance lease payments 107  
Less: interest 7  
Present value of finance lease liabilities $ 100  
Finance Lease, Liability, Statement of Financial Position [Extensible Enumeration] Security deposits, prepaid rent and other liabilities Security deposits, prepaid rent and other liabilities
v3.24.1
Segment Reporting - Summary Information for Reportable Segments (Details)
$ in Thousands
12 Months Ended
Dec. 31, 2023
USD ($)
segment
Dec. 05, 2022
campus
Feb. 08, 2022
USD ($)
Dec. 31, 2023
USD ($)
segment
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
Segment Reporting [Line Items]            
Number of reportable segments | segment 4     4    
Number of properties acquired | campus   7        
Goodwill $ 234,942     $ 234,942 $ 231,611 $ 209,898
Revenues and grant income:            
Resident fees and services       1,668,742 1,412,156 1,123,935
Real estate revenue       190,401 205,344 141,368
Grant income       7,475 25,675 16,951
Total revenues and grant income       1,866,618 1,643,175 1,282,254
Expenses:            
Property operating expenses       1,502,310 1,281,526 1,030,193
Rental expenses       57,475 59,684 38,725
Segment net operating income       306,833 301,965 213,336
Expenses:            
General and administrative       47,510 43,418 43,199
Business acquisition expenses       5,795 4,388 13,022
Depreciation and amortization       182,604 167,957 133,191
Gain on re-measurement of previously held equity interests       726 19,567 0
Other income (expense):            
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishments)       (163,191) (105,956) (80,937)
(Loss) gain in fair value of derivative financial instruments       (926) 500 8,200
Gain (loss) on dispositions of real estate investments, net     $ 683 32,472 5,481 (100)
Impairment of real estate investments       (13,899) (54,579) (3,335)
Impairment loss       (10,520) (23,277) 0
(Loss) income from unconsolidated entities       (1,718) 1,407 (1,355)
Foreign currency gain (loss)       2,307 (5,206) (564)
Other income       7,601 3,064 1,854
Total net other expense       (147,148) (158,999) (76,237)
Income before income taxes       (76,224) (72,797) (52,313)
Income tax expense       (663) (586) (956)
Net loss       (76,887) (73,383) (53,269)
Integrated Senior Health Campuses            
Segment Reporting [Line Items]            
Goodwill 168,177     168,177 164,846 119,856
Revenues and grant income:            
Resident fees and services       1,481,880 1,254,665 1,025,699
Real estate revenue       0 0 0
Grant income       7,475 24,820 13,911
Total revenues and grant income       1,489,355 1,279,485 1,039,610
Expenses:            
Property operating expenses       1,335,817 1,133,480 943,743
Rental expenses       0 0 0
Segment net operating income       153,538 146,005 95,867
Other income (expense):            
Impairment loss         0  
SHOP            
Segment Reporting [Line Items]            
Goodwill 0     0 0 23,277
Revenues and grant income:            
Resident fees and services       186,862 157,491 98,236
Real estate revenue       0 0 0
Grant income       0 855 3,040
Total revenues and grant income       186,862 158,346 101,276
Expenses:            
Property operating expenses       166,493 148,046 86,450
Rental expenses       0 0 0
Segment net operating income       20,369 10,300 14,826
Other income (expense):            
Impairment of real estate investments         (54,579)  
Impairment loss         (23,277)  
Outpatient Medical            
Segment Reporting [Line Items]            
Goodwill 47,812     47,812 47,812 47,812
Revenues and grant income:            
Resident fees and services       0 0 0
Real estate revenue       146,068 148,717 97,297
Grant income       0 0 0
Total revenues and grant income       146,068 148,717 97,297
Expenses:            
Property operating expenses       0 0 0
Rental expenses       54,457 56,390 36,375
Segment net operating income       91,611 92,327 60,922
Other income (expense):            
Impairment loss         0  
Triple-net leased properties            
Segment Reporting [Line Items]            
Goodwill $ 18,953     18,953 18,953 18,953
Revenues and grant income:            
Resident fees and services       0 0 0
Real estate revenue       44,333 56,627 44,071
Grant income       0 0 0
Total revenues and grant income       44,333 56,627 44,071
Expenses:            
Property operating expenses       0 0 0
Rental expenses       3,018 3,294 2,350
Segment net operating income       $ 41,315 53,333 $ 41,721
Other income (expense):            
Impairment loss         $ 0  
v3.24.1
Segment Reporting - Assets by Reportable Segment (Details) - USD ($)
$ in Thousands
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Oct. 01, 2021
Segment Reporting [Line Items]        
Total assets $ 4,577,933 $ 4,786,698    
Goodwill 234,942 231,611 $ 209,898  
AHI        
Segment Reporting [Line Items]        
Goodwill       $ 134,589
AHI | Outpatient Medical        
Segment Reporting [Line Items]        
Goodwill       47,812
AHI | Skilled Nursing Facilities        
Segment Reporting [Line Items]        
Goodwill       4,389
AHI | Hospitals        
Segment Reporting [Line Items]        
Goodwill       5,924
AHI | SHOP        
Segment Reporting [Line Items]        
Goodwill       23,277
AHI | Senior Housing        
Segment Reporting [Line Items]        
Goodwill       8,640
AHI | Integrated Senior Health Campuses        
Segment Reporting [Line Items]        
Goodwill       $ 44,547
Integrated Senior Health Campuses        
Segment Reporting [Line Items]        
Total assets 2,197,762 2,157,748    
Goodwill 168,177 164,846 119,856  
Outpatient Medical        
Segment Reporting [Line Items]        
Total assets 1,232,310 1,379,502    
Goodwill 47,812 47,812 47,812  
SHOP        
Segment Reporting [Line Items]        
Total assets 630,373 635,190    
Goodwill 0 0 23,277  
Triple-net leased properties        
Segment Reporting [Line Items]        
Total assets 502,836 601,360    
Goodwill 18,953 18,953 $ 18,953  
Other        
Segment Reporting [Line Items]        
Total assets $ 14,652 $ 12,898    
v3.24.1
Segment Reporting - Goodwill by Segment (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Goodwill [Roll Forward]      
Goodwill, beginning balance $ 231,611 $ 209,898  
Goodwill acquired 3,331 44,990  
Impairment loss (10,520) (23,277) $ 0
Goodwill, ending balance 234,942 231,611 209,898
Integrated Senior Health Campuses      
Goodwill [Roll Forward]      
Goodwill, beginning balance 164,846 119,856  
Goodwill acquired 3,331 44,990  
Impairment loss   0  
Goodwill, ending balance 168,177 164,846 119,856
Outpatient Medical      
Goodwill [Roll Forward]      
Goodwill, beginning balance 47,812 47,812  
Goodwill acquired 0 0  
Impairment loss   0  
Goodwill, ending balance 47,812 47,812 47,812
SHOP      
Goodwill [Roll Forward]      
Goodwill, beginning balance 0 23,277  
Goodwill acquired 0 0  
Impairment loss   (23,277)  
Goodwill, ending balance 0 0 23,277
Triple-net leased properties      
Goodwill [Roll Forward]      
Goodwill, beginning balance 18,953 18,953  
Goodwill acquired 0 0  
Impairment loss   0  
Goodwill, ending balance $ 18,953 $ 18,953 $ 18,953
v3.24.1
Segment Reporting - Segment Information by Geographic Region (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Segment Reporting [Line Items]      
Total revenues and grant income $ 1,866,618 $ 1,643,175 $ 1,282,254
Real estate investments, net 3,425,438 3,581,609  
United States      
Segment Reporting [Line Items]      
Total revenues and grant income 1,861,954 1,638,557 1,277,095
Real estate investments, net 3,382,115 3,539,453  
International      
Segment Reporting [Line Items]      
Total revenues and grant income 4,664 4,618 $ 5,159
Real estate investments, net $ 43,323 $ 42,156  
v3.24.1
Concentration of Credit Risk (Details)
12 Months Ended
Dec. 31, 2023
segment
tenant
State
Dec. 31, 2023
segment
tenant
State
Concentration of Credit Risk    
Number of states that generated at least 10% of annualized base rent | State 2 2
Minimum percent share of each state annualized base rent that company owned 10.00% 10.00%
Number of reportable segments | segment 4 4
Number of tenants with more than ten percent of annual base rent | tenant 0 0
Minimum percent share of annualized base rent accounted by tenants 10.00% 10.00%
Outpatient Medical    
Concentration of Credit Risk    
Percentage of annual base rent 28.70% 28.70%
Integrated Senior Health Campuses    
Concentration of Credit Risk    
Percentage of annual base rent 51.00% 51.00%
Triple-net leased properties    
Concentration of Credit Risk    
Percentage of annual base rent 11.50% 11.50%
SHOP    
Concentration of Credit Risk    
Percentage of annual base rent 8.80% 8.80%
Indiana    
Concentration of Credit Risk    
Percentage of annual base rent 35.30% 35.30%
MICHIGAN    
Concentration of Credit Risk    
Percentage of annual base rent 10.40% 10.40%
v3.24.1
Per Share Data (Detail) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Anti-dilutive Securities Excluded from Computation of Earnings Per Share [Line Items]      
Participating securities, distributed and undistributed earnings (loss), basic $ 3,803 $ 5,967 $ 1,440
Restricted Common Stock      
Anti-dilutive Securities Excluded from Computation of Earnings Per Share [Line Items]      
Anti-dilutive securities excluded from computation of earnings per share 147,044 183,240  
Limited Partnership Units      
Anti-dilutive Securities Excluded from Computation of Earnings Per Share [Line Items]      
Anti-dilutive securities excluded from computation of earnings per share 3,501,976 3,501,976  
Restricted Stock Units (RSUs) | Time Based Unit      
Anti-dilutive Securities Excluded from Computation of Earnings Per Share [Line Items]      
Anti-dilutive securities excluded from computation of earnings per share 157,329 19,200  
Restricted Stock Units (RSUs) | Performance Based Unit      
Anti-dilutive Securities Excluded from Computation of Earnings Per Share [Line Items]      
Anti-dilutive securities excluded from computation of earnings per share 70,751 29,352  
v3.24.1
Subsequent Events (Details)
12 Months Ended
Mar. 13, 2024
$ / shares
Feb. 09, 2024
USD ($)
$ / shares
shares
Dec. 31, 2023
USD ($)
$ / shares
shares
Dec. 31, 2022
USD ($)
$ / shares
shares
Dec. 31, 2021
USD ($)
$ / shares
Feb. 14, 2024
USD ($)
Feb. 01, 2024
USD ($)
facility
Subsequent Events [Line Items]              
Common stock authorized (in shares) | shares     1,000,000,000 1,000,000,000      
Repayments of Lines of Credit     $ 459,361,000 $ 1,104,400,000 $ 157,000,000    
Distributions declared (in usd per share) | $ / shares     $ 1.00 $ 1.60 $ 0.69    
Subsequent Event              
Subsequent Events [Line Items]              
Common stock authorized (in shares) | shares   64,400,000          
Common stock, par value (in dollars per share) | $ / shares   $ 0.01          
Proceeds from Issuance of Common Stock   $ 772,800,000          
Sale of Stock, Consideration Received on Transaction   724,625,000          
Repayments of Long-Term Debt   176,145,000          
Repayments of Lines of Credit   $ 545,010,000          
Subsequent Event | Over-Allotment Option              
Subsequent Events [Line Items]              
Sale of Stock, Number of Shares Issued in Transaction | shares   8,400,000          
Subsequent Event | Senior Housing Facility              
Subsequent Events [Line Items]              
Number of Housing Facilities Acquired | facility             12
Liabilities assumed             $ 94,461,000
Subsequent Event | Quarterly Dividend              
Subsequent Events [Line Items]              
Distributions declared (in usd per share) | $ / shares $ 0.25            
Subsequent Event | Annual Dividend              
Subsequent Events [Line Items]              
Distributions declared (in usd per share) | $ / shares $ 1.00            
Subsequent Event | Commitment Utilization Scenario 1 | Minimum              
Subsequent Events [Line Items]              
Commitment Utilization Percentage used for fee calculation           0.25%  
Subsequent Event | Commitment Utilization Scenario 1 | Maximum              
Subsequent Events [Line Items]              
Commitment Utilization Percentage used for fee calculation           50.00%  
Subsequent Event | Commitment Utilization Scenario 2 | Minimum              
Subsequent Events [Line Items]              
Commitment Utilization Percentage used for fee calculation           0.20%  
Subsequent Event | Commitment Utilization Scenario 2 | Maximum              
Subsequent Events [Line Items]              
Commitment Utilization Percentage used for fee calculation           50.00%  
Subsequent Event | Revolving Credit Facility              
Subsequent Events [Line Items]              
Line of credit facility, maximum borrowing capacity           $ 1,150,000,000  
Subsequent Event | Senior Unsecured Revolving Credit Facility              
Subsequent Events [Line Items]              
Line of credit facility, maximum borrowing capacity           600,000,000  
Subsequent Event | Senior Unsecured Term Loan Facility              
Subsequent Events [Line Items]              
Line of credit facility, maximum borrowing capacity           $ 550,000,000  
v3.24.1
Schedule III Real Estate and Accumulated Depreciation (Details) - USD ($)
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances $ 1,326,313,000      
Initial cost to company, land 327,467,000      
Initial cost to company, buildings and improvements 3,328,973,000      
Cost capitalized subsequent to acquisition 521,155,000      
Gross amount of which carried at close of period, land 335,946,000      
Gross amount of which carried at close of period, buildings and improvements 3,841,649,000      
Gross amount of which carried at close of period, total 4,177,595,000 $ 4,236,447,000 $ 4,038,572,000 $ 2,762,272,000
Gross amount of which carried at close of period, accumulated deprecation (752,157,000) $ (654,838,000) $ (523,886,000) $ (425,272,000)
Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 1,312,019,000      
Initial cost to company, land 325,412,000      
Initial cost to company, buildings and improvements 3,228,159,000      
Cost capitalized subsequent to acquisition 355,820,000      
Gross amount of which carried at close of period, land 332,402,000      
Gross amount of which carried at close of period, buildings and improvements 3,576,989,000      
Gross amount of which carried at close of period, total 3,909,391,000      
Gross amount of which carried at close of period, accumulated deprecation (627,189,000)      
Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,130,000      
Initial cost to company, buildings and improvements 84,944,000      
Cost capitalized subsequent to acquisition 157,431,000      
Gross amount of which carried at close of period, land 2,051,000      
Gross amount of which carried at close of period, buildings and improvements 241,454,000      
Gross amount of which carried at close of period, total 243,505,000      
Gross amount of which carried at close of period, accumulated deprecation (123,997,000)      
Construction in Progress [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 14,294,000      
Initial cost to company, land 925,000      
Initial cost to company, buildings and improvements 15,870,000      
Cost capitalized subsequent to acquisition 7,904,000      
Gross amount of which carried at close of period, land 1,493,000      
Gross amount of which carried at close of period, buildings and improvements 23,206,000      
Gross amount of which carried at close of period, total 24,699,000      
Gross amount of which carried at close of period, accumulated deprecation (971,000)      
Wichita KS OM [Member] | Wichita, KS [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 943,000      
Initial cost to company, buildings and improvements 6,288,000      
Cost capitalized subsequent to acquisition 812,000      
Gross amount of which carried at close of period, land 943,000      
Gross amount of which carried at close of period, buildings and improvements 7,100,000      
Gross amount of which carried at close of period, total 8,043,000      
Gross amount of which carried at close of period, accumulated deprecation (2,316,000)      
Delta Valley ALF Portfolio [Member] | Batesville, MS [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 331,000      
Initial cost to company, buildings and improvements 5,103,000      
Cost capitalized subsequent to acquisition (335,000)      
Gross amount of which carried at close of period, land 331,000      
Gross amount of which carried at close of period, buildings and improvements 4,768,000      
Gross amount of which carried at close of period, total 5,099,000      
Gross amount of which carried at close of period, accumulated deprecation (1,295,000)      
Delta Valley ALF Portfolio [Member] | Cleveland, MS [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 348,000      
Initial cost to company, buildings and improvements 6,369,000      
Cost capitalized subsequent to acquisition (921,000)      
Gross amount of which carried at close of period, land 355,000      
Gross amount of which carried at close of period, buildings and improvements 5,441,000      
Gross amount of which carried at close of period, total 5,796,000      
Gross amount of which carried at close of period, accumulated deprecation (1,460,000)      
Delta Valley ALF Portfolio [Member] | Springdale, AR [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 891,000      
Initial cost to company, buildings and improvements 6,538,000      
Cost capitalized subsequent to acquisition (705,000)      
Gross amount of which carried at close of period, land 891,000      
Gross amount of which carried at close of period, buildings and improvements 5,833,000      
Gross amount of which carried at close of period, total 6,724,000      
Gross amount of which carried at close of period, accumulated deprecation (1,502,000)      
Lee's Summit MO OM [Member] | Lee's Summit, MO [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,045,000      
Initial cost to company, buildings and improvements 5,068,000      
Cost capitalized subsequent to acquisition 1,530,000      
Gross amount of which carried at close of period, land 1,045,000      
Gross amount of which carried at close of period, buildings and improvements 6,598,000      
Gross amount of which carried at close of period, total 7,643,000      
Gross amount of which carried at close of period, accumulated deprecation (2,190,000)      
Carolina Commons OM [Member] | Indian Land, SC [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,028,000      
Initial cost to company, buildings and improvements 9,430,000      
Cost capitalized subsequent to acquisition 4,931,000      
Gross amount of which carried at close of period, land 1,028,000      
Gross amount of which carried at close of period, buildings and improvements 14,361,000      
Gross amount of which carried at close of period, total 15,389,000      
Gross amount of which carried at close of period, accumulated deprecation (4,378,000)      
Mount Olympia OM Portflio [Member] | Mount Dora, FL [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 393,000      
Initial cost to company, buildings and improvements 5,633,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 393,000      
Gross amount of which carried at close of period, buildings and improvements 5,633,000      
Gross amount of which carried at close of period, total 6,026,000      
Gross amount of which carried at close of period, accumulated deprecation (1,576,000)      
Southlake TX Hospital [Member] | Southlake, TX [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 91,601,000      
Initial cost to company, land 5,089,000      
Initial cost to company, buildings and improvements 108,517,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 5,089,000      
Gross amount of which carried at close of period, buildings and improvements 108,517,000      
Gross amount of which carried at close of period, total 113,606,000      
Gross amount of which carried at close of period, accumulated deprecation (26,425,000)      
East Texas OM Portfolio [Member] | Longview, TX One [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 19,942,000      
Cost capitalized subsequent to acquisition 9,079,000      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 29,021,000      
Gross amount of which carried at close of period, total 29,021,000      
Gross amount of which carried at close of period, accumulated deprecation (6,397,000)      
East Texas OM Portfolio [Member] | Longview, TX Three [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 759,000      
Initial cost to company, buildings and improvements 1,696,000      
Cost capitalized subsequent to acquisition 140,000      
Gross amount of which carried at close of period, land 759,000      
Gross amount of which carried at close of period, buildings and improvements 1,836,000      
Gross amount of which carried at close of period, total 2,595,000      
Gross amount of which carried at close of period, accumulated deprecation (912,000)      
East Texas OM Portfolio [Member] | Longview, TX Four [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 8,027,000      
Cost capitalized subsequent to acquisition 1,000      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 8,028,000      
Gross amount of which carried at close of period, total 8,028,000      
Gross amount of which carried at close of period, accumulated deprecation (2,489,000)      
East Texas OM Portfolio [Member] | Longview, TX Five [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 696,000      
Cost capitalized subsequent to acquisition 41,000      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 737,000      
Gross amount of which carried at close of period, total 737,000      
Gross amount of which carried at close of period, accumulated deprecation (335,000)      
East Texas OM Portfolio [Member] | Longview, TX Six [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 27,601,000      
Cost capitalized subsequent to acquisition 5,494,000      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 33,095,000      
Gross amount of which carried at close of period, total 33,095,000      
Gross amount of which carried at close of period, accumulated deprecation (10,359,000)      
East Texas OM Portfolio [Member] | Marshall, TX [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 368,000      
Initial cost to company, buildings and improvements 1,711,000      
Cost capitalized subsequent to acquisition 110,000      
Gross amount of which carried at close of period, land 368,000      
Gross amount of which carried at close of period, buildings and improvements 1,821,000      
Gross amount of which carried at close of period, total 2,189,000      
Gross amount of which carried at close of period, accumulated deprecation (856,000)      
Premier OM [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 644,000      
Initial cost to company, buildings and improvements 10,420,000      
Cost capitalized subsequent to acquisition 2,031,000      
Gross amount of which carried at close of period, land 644,000      
Gross amount of which carried at close of period, buildings and improvements 12,451,000      
Gross amount of which carried at close of period, total 13,095,000      
Gross amount of which carried at close of period, accumulated deprecation (3,808,000)      
Premier OM [Member] | Novi, MI [Domain] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Independence OM Portfolio [Member] | Southgate, KY [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 411,000      
Initial cost to company, buildings and improvements 11,005,000      
Cost capitalized subsequent to acquisition 2,530,000      
Gross amount of which carried at close of period, land 411,000      
Gross amount of which carried at close of period, buildings and improvements 13,535,000      
Gross amount of which carried at close of period, total 13,946,000      
Gross amount of which carried at close of period, accumulated deprecation (4,112,000)      
Independence OM Portfolio [Member] | Somerville, MA [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 28,474,000      
Initial cost to company, land 1,509,000      
Initial cost to company, buildings and improvements 46,775,000      
Cost capitalized subsequent to acquisition 6,500,000      
Gross amount of which carried at close of period, land 1,509,000      
Gross amount of which carried at close of period, buildings and improvements 53,275,000      
Gross amount of which carried at close of period, total 54,784,000      
Gross amount of which carried at close of period, accumulated deprecation (12,866,000)      
Independence OM Portfolio [Member] | Verona, NJ [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,683,000      
Initial cost to company, buildings and improvements 9,405,000      
Cost capitalized subsequent to acquisition 2,409,000      
Gross amount of which carried at close of period, land 1,683,000      
Gross amount of which carried at close of period, buildings and improvements 11,814,000      
Gross amount of which carried at close of period, total 13,497,000      
Gross amount of which carried at close of period, accumulated deprecation (3,175,000)      
Independence OM Portfolio [Member] | Bronx, NY [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 19,593,000      
Cost capitalized subsequent to acquisition 3,403,000      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 22,996,000      
Gross amount of which carried at close of period, total 22,996,000      
Gross amount of which carried at close of period, accumulated deprecation (6,098,000)      
King of Prussia PA OM [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 3,427,000      
Initial cost to company, buildings and improvements 13,849,000      
Cost capitalized subsequent to acquisition 6,305,000      
Gross amount of which carried at close of period, land 3,427,000      
Gross amount of which carried at close of period, buildings and improvements 20,154,000      
Gross amount of which carried at close of period, total 23,581,000      
Gross amount of which carried at close of period, accumulated deprecation (6,232,000)      
North Carolina ALF Portfolio | Clemmons, NC [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 596,000      
Initial cost to company, buildings and improvements 13,237,000      
Cost capitalized subsequent to acquisition (412,000)      
Gross amount of which carried at close of period, land 596,000      
Gross amount of which carried at close of period, buildings and improvements 12,825,000      
Gross amount of which carried at close of period, total 13,421,000      
Gross amount of which carried at close of period, accumulated deprecation (3,296,000)      
North Carolina ALF Portfolio | Garner, NC [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,723,000      
Initial cost to company, buildings and improvements 11,517,000      
Cost capitalized subsequent to acquisition 196,000      
Gross amount of which carried at close of period, land 1,723,000      
Gross amount of which carried at close of period, buildings and improvements 11,713,000      
Gross amount of which carried at close of period, total 13,436,000      
Gross amount of which carried at close of period, accumulated deprecation (1,988,000)      
North Carolina ALF Portfolio | Huntersville, NC [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 2,033,000      
Initial cost to company, buildings and improvements 11,494,000      
Cost capitalized subsequent to acquisition 95,000      
Gross amount of which carried at close of period, land 2,033,000      
Gross amount of which carried at close of period, buildings and improvements 11,589,000      
Gross amount of which carried at close of period, total 13,622,000      
Gross amount of which carried at close of period, accumulated deprecation (2,573,000)      
North Carolina ALF Portfolio | Matthews, NC [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 949,000      
Initial cost to company, buildings and improvements 12,537,000      
Cost capitalized subsequent to acquisition (5,000)      
Gross amount of which carried at close of period, land 949,000      
Gross amount of which carried at close of period, buildings and improvements 12,532,000      
Gross amount of which carried at close of period, total 13,481,000      
Gross amount of which carried at close of period, accumulated deprecation (2,248,000)      
North Carolina ALF Portfolio | Mooresville, NC [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 835,000      
Initial cost to company, buildings and improvements 15,894,000      
Cost capitalized subsequent to acquisition (350,000)      
Gross amount of which carried at close of period, land 835,000      
Gross amount of which carried at close of period, buildings and improvements 15,544,000      
Gross amount of which carried at close of period, total 16,379,000      
Gross amount of which carried at close of period, accumulated deprecation (3,945,000)      
North Carolina ALF Portfolio | Raleigh, NC [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,069,000      
Initial cost to company, buildings and improvements 21,235,000      
Cost capitalized subsequent to acquisition (429,000)      
Gross amount of which carried at close of period, land 1,069,000      
Gross amount of which carried at close of period, buildings and improvements 20,806,000      
Gross amount of which carried at close of period, total 21,875,000      
Gross amount of which carried at close of period, accumulated deprecation (5,036,000)      
North Carolina ALF Portfolio | Wake Forest, NC [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 772,000      
Initial cost to company, buildings and improvements 13,596,000      
Cost capitalized subsequent to acquisition (432,000)      
Gross amount of which carried at close of period, land 772,000      
Gross amount of which carried at close of period, buildings and improvements 13,164,000      
Gross amount of which carried at close of period, total 13,936,000      
Gross amount of which carried at close of period, accumulated deprecation (3,144,000)      
Orange Star Medical Portfolio [Member] | Durango, CO One [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 623,000      
Initial cost to company, buildings and improvements 14,166,000      
Cost capitalized subsequent to acquisition 483,000      
Gross amount of which carried at close of period, land 623,000      
Gross amount of which carried at close of period, buildings and improvements 14,649,000      
Gross amount of which carried at close of period, total 15,272,000      
Gross amount of which carried at close of period, accumulated deprecation (3,664,000)      
Orange Star Medical Portfolio [Member] | Durango, CO Two [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 788,000      
Initial cost to company, buildings and improvements 10,467,000      
Cost capitalized subsequent to acquisition 1,242,000      
Gross amount of which carried at close of period, land 788,000      
Gross amount of which carried at close of period, buildings and improvements 11,709,000      
Gross amount of which carried at close of period, total 12,497,000      
Gross amount of which carried at close of period, accumulated deprecation (3,059,000)      
Orange Star Medical Portfolio [Member] | Friendswood, TX [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 500,000      
Initial cost to company, buildings and improvements 7,664,000      
Cost capitalized subsequent to acquisition 1,114,000      
Gross amount of which carried at close of period, land 500,000      
Gross amount of which carried at close of period, buildings and improvements 8,778,000      
Gross amount of which carried at close of period, total 9,278,000      
Gross amount of which carried at close of period, accumulated deprecation (2,338,000)      
Orange Star Medical Portfolio [Member] | Keller, TX [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,604,000      
Initial cost to company, buildings and improvements 7,912,000      
Cost capitalized subsequent to acquisition 873,000      
Gross amount of which carried at close of period, land 1,604,000      
Gross amount of which carried at close of period, buildings and improvements 8,785,000      
Gross amount of which carried at close of period, total 10,389,000      
Gross amount of which carried at close of period, accumulated deprecation (2,453,000)      
Orange Star Medical Portfolio [Member] | Wharton, TX [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 259,000      
Initial cost to company, buildings and improvements 10,590,000      
Cost capitalized subsequent to acquisition 3,543,000      
Gross amount of which carried at close of period, land 259,000      
Gross amount of which carried at close of period, buildings and improvements 14,133,000      
Gross amount of which carried at close of period, total 14,392,000      
Gross amount of which carried at close of period, accumulated deprecation (2,978,000)      
Kingwood OM Portfolio [Member] | Kingwood, TX One [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 820,000      
Initial cost to company, buildings and improvements 8,589,000      
Cost capitalized subsequent to acquisition 526,000      
Gross amount of which carried at close of period, land 820,000      
Gross amount of which carried at close of period, buildings and improvements 9,115,000      
Gross amount of which carried at close of period, total 9,935,000      
Gross amount of which carried at close of period, accumulated deprecation (2,475,000)      
Kingwood OM Portfolio [Member] | Kingwood, TX Two [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 781,000      
Initial cost to company, buildings and improvements 3,943,000      
Cost capitalized subsequent to acquisition 64,000      
Gross amount of which carried at close of period, land 781,000      
Gross amount of which carried at close of period, buildings and improvements 4,007,000      
Gross amount of which carried at close of period, total 4,788,000      
Gross amount of which carried at close of period, accumulated deprecation (1,137,000)      
Mt. Juliet TN OM [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,188,000      
Initial cost to company, buildings and improvements 10,720,000      
Cost capitalized subsequent to acquisition 516,000      
Gross amount of which carried at close of period, land 1,188,000      
Gross amount of which carried at close of period, buildings and improvements 11,236,000      
Gross amount of which carried at close of period, total 12,424,000      
Gross amount of which carried at close of period, accumulated deprecation (2,893,000)      
Homewood AL OM [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 405,000      
Initial cost to company, buildings and improvements 6,590,000      
Cost capitalized subsequent to acquisition (665,000)      
Gross amount of which carried at close of period, land 405,000      
Gross amount of which carried at close of period, buildings and improvements 5,925,000      
Gross amount of which carried at close of period, total 6,330,000      
Gross amount of which carried at close of period, accumulated deprecation (1,961,000)      
Paoli PA Medical Plaza [Member] | Paoli, PA One [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 2,313,000      
Initial cost to company, buildings and improvements 12,447,000      
Cost capitalized subsequent to acquisition 8,809,000      
Gross amount of which carried at close of period, land 2,313,000      
Gross amount of which carried at close of period, buildings and improvements 21,256,000      
Gross amount of which carried at close of period, total 23,569,000      
Gross amount of which carried at close of period, accumulated deprecation (6,149,000)      
Paoli PA Medical Plaza [Member] | Paoli, PA Two [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,668,000      
Initial cost to company, buildings and improvements 7,357,000      
Cost capitalized subsequent to acquisition 2,193,000      
Gross amount of which carried at close of period, land 1,668,000      
Gross amount of which carried at close of period, buildings and improvements 9,550,000      
Gross amount of which carried at close of period, total 11,218,000      
Gross amount of which carried at close of period, accumulated deprecation (3,123,000)      
Glen Burnie MD OM [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 2,692,000      
Initial cost to company, buildings and improvements 14,095,000      
Cost capitalized subsequent to acquisition 4,289,000      
Gross amount of which carried at close of period, land 2,692,000      
Gross amount of which carried at close of period, buildings and improvements 18,384,000      
Gross amount of which carried at close of period, total 21,076,000      
Gross amount of which carried at close of period, accumulated deprecation (5,666,000)      
Marietta GA OM [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,347,000      
Initial cost to company, buildings and improvements 10,947,000      
Cost capitalized subsequent to acquisition 749,000      
Gross amount of which carried at close of period, land 1,347,000      
Gross amount of which carried at close of period, buildings and improvements 11,696,000      
Gross amount of which carried at close of period, total 13,043,000      
Gross amount of which carried at close of period, accumulated deprecation (2,992,000)      
Mountain Crest Senior Housing Portfolio [Member] | Elkhart, IN One [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 793,000      
Initial cost to company, buildings and improvements 6,009,000      
Cost capitalized subsequent to acquisition 682,000      
Gross amount of which carried at close of period, land 793,000      
Gross amount of which carried at close of period, buildings and improvements 6,691,000      
Gross amount of which carried at close of period, total 7,484,000      
Gross amount of which carried at close of period, accumulated deprecation (1,960,000)      
Mountain Crest Senior Housing Portfolio [Member] | Elkhart, IN Two [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 782,000      
Initial cost to company, buildings and improvements 6,760,000      
Cost capitalized subsequent to acquisition 819,000      
Gross amount of which carried at close of period, land 782,000      
Gross amount of which carried at close of period, buildings and improvements 7,579,000      
Gross amount of which carried at close of period, total 8,361,000      
Gross amount of which carried at close of period, accumulated deprecation (2,346,000)      
Mountain Crest Senior Housing Portfolio [Member] | Hobart, IN [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 604,000      
Initial cost to company, buildings and improvements 11,529,000      
Cost capitalized subsequent to acquisition (799,000)      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 11,334,000      
Gross amount of which carried at close of period, total 11,334,000      
Gross amount of which carried at close of period, accumulated deprecation (3,180,000)      
Mountain Crest Senior Housing Portfolio [Member] | LaPorte, IN [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 392,000      
Initial cost to company, buildings and improvements 14,894,000      
Cost capitalized subsequent to acquisition (6,101,000)      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 9,185,000      
Gross amount of which carried at close of period, total 9,185,000      
Gross amount of which carried at close of period, accumulated deprecation (4,057,000)      
Mountain Crest Senior Housing Portfolio [Member] | Mishawaka, IN [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 3,670,000      
Initial cost to company, buildings and improvements 14,416,000      
Cost capitalized subsequent to acquisition 1,382,000      
Gross amount of which carried at close of period, land 3,670,000      
Gross amount of which carried at close of period, buildings and improvements 15,798,000      
Gross amount of which carried at close of period, total 19,468,000      
Gross amount of which carried at close of period, accumulated deprecation (4,375,000)      
Mountain Crest Senior Housing Portfolio [Member] | Niles, MI [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 404,000      
Initial cost to company, buildings and improvements 5,050,000      
Cost capitalized subsequent to acquisition 802,000      
Gross amount of which carried at close of period, land 404,000      
Gross amount of which carried at close of period, buildings and improvements 5,852,000      
Gross amount of which carried at close of period, total 6,256,000      
Gross amount of which carried at close of period, accumulated deprecation (1,775,000)      
Nebraska Senior Housing Portfolio [Member] | Bennington, NE [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 981,000      
Initial cost to company, buildings and improvements 20,427,000      
Cost capitalized subsequent to acquisition 1,418,000      
Gross amount of which carried at close of period, land 981,000      
Gross amount of which carried at close of period, buildings and improvements 21,845,000      
Gross amount of which carried at close of period, total 22,826,000      
Gross amount of which carried at close of period, accumulated deprecation (5,422,000)      
Nebraska Senior Housing Portfolio [Member] | Omaha, NE [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,274,000      
Initial cost to company, buildings and improvements 38,619,000      
Cost capitalized subsequent to acquisition 1,865,000      
Gross amount of which carried at close of period, land 1,274,000      
Gross amount of which carried at close of period, buildings and improvements 40,484,000      
Gross amount of which carried at close of period, total 41,758,000      
Gross amount of which carried at close of period, accumulated deprecation (9,569,000)      
Pennsylvania Senior Housing Portfolio [Member] | Bethlehem, PA [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,542,000      
Initial cost to company, buildings and improvements 22,249,000      
Cost capitalized subsequent to acquisition 1,012,000      
Gross amount of which carried at close of period, land 1,542,000      
Gross amount of which carried at close of period, buildings and improvements 23,261,000      
Gross amount of which carried at close of period, total 24,803,000      
Gross amount of which carried at close of period, accumulated deprecation (6,340,000)      
Pennsylvania Senior Housing Portfolio [Member] | Boyertown, PA [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 22,932,000      
Initial cost to company, land 480,000      
Initial cost to company, buildings and improvements 25,544,000      
Cost capitalized subsequent to acquisition 814,000      
Gross amount of which carried at close of period, land 480,000      
Gross amount of which carried at close of period, buildings and improvements 26,358,000      
Gross amount of which carried at close of period, total 26,838,000      
Gross amount of which carried at close of period, accumulated deprecation (6,513,000)      
Pennsylvania Senior Housing Portfolio [Member] | York, PA [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 12,432,000      
Initial cost to company, land 972,000      
Initial cost to company, buildings and improvements 29,860,000      
Cost capitalized subsequent to acquisition 1,560,000      
Gross amount of which carried at close of period, land 972,000      
Gross amount of which carried at close of period, buildings and improvements 31,420,000      
Gross amount of which carried at close of period, total 32,392,000      
Gross amount of which carried at close of period, accumulated deprecation (7,417,000)      
Southern Illinois OM Portfolio [Member] | Waterloo, IL One [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 94,000      
Initial cost to company, buildings and improvements 1,977,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 94,000      
Gross amount of which carried at close of period, buildings and improvements 1,977,000      
Gross amount of which carried at close of period, total 2,071,000      
Gross amount of which carried at close of period, accumulated deprecation (595,000)      
Southern Illinois OM Portfolio [Member] | Waterloo, IL Two [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 738,000      
Initial cost to company, buildings and improvements 6,332,000      
Cost capitalized subsequent to acquisition 588,000      
Gross amount of which carried at close of period, land 738,000      
Gross amount of which carried at close of period, buildings and improvements 6,920,000      
Gross amount of which carried at close of period, total 7,658,000      
Gross amount of which carried at close of period, accumulated deprecation (2,010,000)      
Southern Illinois OM Portfolio [Member] | Waterloo, IL Three [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 200,000      
Initial cost to company, buildings and improvements 2,648,000      
Cost capitalized subsequent to acquisition (69,000)      
Gross amount of which carried at close of period, land 200,000      
Gross amount of which carried at close of period, buildings and improvements 2,579,000      
Gross amount of which carried at close of period, total 2,779,000      
Gross amount of which carried at close of period, accumulated deprecation (707,000)      
Napa Medical Center [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,176,000      
Initial cost to company, buildings and improvements 13,328,000      
Cost capitalized subsequent to acquisition 2,223,000      
Gross amount of which carried at close of period, land 1,176,000      
Gross amount of which carried at close of period, buildings and improvements 15,551,000      
Gross amount of which carried at close of period, total 16,727,000      
Gross amount of which carried at close of period, accumulated deprecation (4,695,000)      
Chesterfield Corporate Plaza [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 8,030,000      
Initial cost to company, buildings and improvements 24,533,000      
Cost capitalized subsequent to acquisition 3,617,000      
Gross amount of which carried at close of period, land 8,030,000      
Gross amount of which carried at close of period, buildings and improvements 28,150,000      
Gross amount of which carried at close of period, total 36,180,000      
Gross amount of which carried at close of period, accumulated deprecation (9,020,000)      
Richmond VA ALF Senior Housing Portfolio [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 2,146,000      
Initial cost to company, buildings and improvements 56,671,000      
Cost capitalized subsequent to acquisition 1,237,000      
Gross amount of which carried at close of period, land 2,146,000      
Gross amount of which carried at close of period, buildings and improvements 57,908,000      
Gross amount of which carried at close of period, total 60,054,000      
Gross amount of which carried at close of period, accumulated deprecation (12,955,000)      
Crown Senior Care Portfolio - Peel, Isle of Man [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,164,000      
Initial cost to company, buildings and improvements 6,952,000      
Cost capitalized subsequent to acquisition 82,000      
Gross amount of which carried at close of period, land 1,164,000      
Gross amount of which carried at close of period, buildings and improvements 7,034,000      
Gross amount of which carried at close of period, total 8,198,000      
Gross amount of which carried at close of period, accumulated deprecation (1,736,000)      
Crown Senior Care Portfolio - St. Albans [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,174,000      
Initial cost to company, buildings and improvements 12,344,000      
Cost capitalized subsequent to acquisition 681,000      
Gross amount of which carried at close of period, land 1,174,000      
Gross amount of which carried at close of period, buildings and improvements 13,025,000      
Gross amount of which carried at close of period, total 14,199,000      
Gross amount of which carried at close of period, accumulated deprecation (3,224,000)      
Crown Senior Care Portfolio - Salisbury [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,248,000      
Initial cost to company, buildings and improvements 11,986,000      
Cost capitalized subsequent to acquisition 55,000      
Gross amount of which carried at close of period, land 1,248,000      
Gross amount of which carried at close of period, buildings and improvements 12,041,000      
Gross amount of which carried at close of period, total 13,289,000      
Gross amount of which carried at close of period, accumulated deprecation (2,961,000)      
Crown Senior Care Portfolio - Aberdeen [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 2,025,000      
Initial cost to company, buildings and improvements 6,037,000      
Cost capitalized subsequent to acquisition 337,000      
Gross amount of which carried at close of period, land 2,025,000      
Gross amount of which carried at close of period, buildings and improvements 6,374,000      
Gross amount of which carried at close of period, total 8,399,000      
Gross amount of which carried at close of period, accumulated deprecation (1,266,000)      
Crown Senior Care Portfolio - Felixstowe One [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 704,000      
Initial cost to company, buildings and improvements 5,800,000      
Cost capitalized subsequent to acquisition 514,000      
Gross amount of which carried at close of period, land 704,000      
Gross amount of which carried at close of period, buildings and improvements 6,314,000      
Gross amount of which carried at close of period, total 7,018,000      
Gross amount of which carried at close of period, accumulated deprecation (1,328,000)      
Crown Senior Care Portfolio - Felixstowe Two [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 531,000      
Initial cost to company, buildings and improvements 2,542,000      
Cost capitalized subsequent to acquisition 343,000      
Gross amount of which carried at close of period, land 531,000      
Gross amount of which carried at close of period, buildings and improvements 2,885,000      
Gross amount of which carried at close of period, total 3,416,000      
Gross amount of which carried at close of period, accumulated deprecation (681,000)      
Washington DC SNF [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 60,100,000      
Initial cost to company, land 1,194,000      
Initial cost to company, buildings and improvements 34,200,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 1,194,000      
Gross amount of which carried at close of period, buildings and improvements 34,200,000      
Gross amount of which carried at close of period, total 35,394,000      
Gross amount of which carried at close of period, accumulated deprecation (9,056,000)      
Stockbridge GA OM II [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 499,000      
Initial cost to company, buildings and improvements 8,353,000      
Cost capitalized subsequent to acquisition 1,623,000      
Gross amount of which carried at close of period, land 485,000      
Gross amount of which carried at close of period, buildings and improvements 9,990,000      
Gross amount of which carried at close of period, total 10,475,000      
Gross amount of which carried at close of period, accumulated deprecation (2,396,000)      
Marietta GA OM II [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 661,000      
Initial cost to company, buildings and improvements 4,783,000      
Cost capitalized subsequent to acquisition 309,000      
Gross amount of which carried at close of period, land 661,000      
Gross amount of which carried at close of period, buildings and improvements 5,092,000      
Gross amount of which carried at close of period, total 5,753,000      
Gross amount of which carried at close of period, accumulated deprecation (1,298,000)      
Lakeview IN Medical Plaza | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 20,155,000      
Initial cost to company, land 2,375,000      
Initial cost to company, buildings and improvements 15,911,000      
Cost capitalized subsequent to acquisition 9,762,000      
Gross amount of which carried at close of period, land 2,375,000      
Gross amount of which carried at close of period, buildings and improvements 25,673,000      
Gross amount of which carried at close of period, total 28,048,000      
Gross amount of which carried at close of period, accumulated deprecation (7,326,000)      
Pennsylvania Senior Housing Portfolio II [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 19,114,000      
Initial cost to company, land 835,000      
Initial cost to company, buildings and improvements 24,424,000      
Cost capitalized subsequent to acquisition 703,000      
Gross amount of which carried at close of period, land 835,000      
Gross amount of which carried at close of period, buildings and improvements 25,127,000      
Gross amount of which carried at close of period, total 25,962,000      
Gross amount of which carried at close of period, accumulated deprecation (6,528,000)      
Snellville GA OM [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 332,000      
Initial cost to company, buildings and improvements 7,781,000      
Cost capitalized subsequent to acquisition 2,329,000      
Gross amount of which carried at close of period, land 332,000      
Gross amount of which carried at close of period, buildings and improvements 10,110,000      
Gross amount of which carried at close of period, total 10,442,000      
Gross amount of which carried at close of period, accumulated deprecation (2,285,000)      
Stockbridge GA OM III [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 606,000      
Initial cost to company, buildings and improvements 7,924,000      
Cost capitalized subsequent to acquisition 1,946,000      
Gross amount of which carried at close of period, land 606,000      
Gross amount of which carried at close of period, buildings and improvements 9,870,000      
Gross amount of which carried at close of period, total 10,476,000      
Gross amount of which carried at close of period, accumulated deprecation (2,453,000)      
Joplin MO OM [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,245,000      
Initial cost to company, buildings and improvements 9,860,000      
Cost capitalized subsequent to acquisition 200,000      
Gross amount of which carried at close of period, land 1,245,000      
Gross amount of which carried at close of period, buildings and improvements 10,060,000      
Gross amount of which carried at close of period, total 11,305,000      
Gross amount of which carried at close of period, accumulated deprecation (2,727,000)      
Austell GA OM [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 663,000      
Initial cost to company, buildings and improvements 10,547,000      
Cost capitalized subsequent to acquisition 224,000      
Gross amount of which carried at close of period, land 663,000      
Gross amount of which carried at close of period, buildings and improvements 10,771,000      
Gross amount of which carried at close of period, total 11,434,000      
Gross amount of which carried at close of period, accumulated deprecation (2,467,000)      
Middletown OH OM [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 17,389,000      
Cost capitalized subsequent to acquisition 3,242,000      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 20,631,000      
Gross amount of which carried at close of period, total 20,631,000      
Gross amount of which carried at close of period, accumulated deprecation (4,206,000)      
Fox Grape SNF Portfolio - Braintree, MA [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,844,000      
Initial cost to company, buildings and improvements 10,847,000      
Cost capitalized subsequent to acquisition 31,000      
Gross amount of which carried at close of period, land 1,844,000      
Gross amount of which carried at close of period, buildings and improvements 10,878,000      
Gross amount of which carried at close of period, total 12,722,000      
Gross amount of which carried at close of period, accumulated deprecation (2,327,000)      
Fox Grape SNF Portfolio - Brighton, MA [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 779,000      
Initial cost to company, buildings and improvements 2,661,000      
Cost capitalized subsequent to acquisition 475,000      
Gross amount of which carried at close of period, land 779,000      
Gross amount of which carried at close of period, buildings and improvements 3,136,000      
Gross amount of which carried at close of period, total 3,915,000      
Gross amount of which carried at close of period, accumulated deprecation (702,000)      
Fox Grape SNF Portfolio - Duxbury, MA [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 2,921,000      
Initial cost to company, buildings and improvements 11,244,000      
Cost capitalized subsequent to acquisition 1,933,000      
Gross amount of which carried at close of period, land 2,921,000      
Gross amount of which carried at close of period, buildings and improvements 13,177,000      
Gross amount of which carried at close of period, total 16,098,000      
Gross amount of which carried at close of period, accumulated deprecation (3,155,000)      
Fox Grape SNF Portfolio - Hingham, MA [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 2,316,000      
Initial cost to company, buildings and improvements 17,390,000      
Cost capitalized subsequent to acquisition (166,000)      
Gross amount of which carried at close of period, land 2,316,000      
Gross amount of which carried at close of period, buildings and improvements 17,224,000      
Gross amount of which carried at close of period, total 19,540,000      
Gross amount of which carried at close of period, accumulated deprecation (3,670,000)      
Fox Grape SNF Portfolio - Quincy, MA [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 13,329,000      
Initial cost to company, land 3,537,000      
Initial cost to company, buildings and improvements 13,697,000      
Cost capitalized subsequent to acquisition 459,000      
Gross amount of which carried at close of period, land 3,537,000      
Gross amount of which carried at close of period, buildings and improvements 14,156,000      
Gross amount of which carried at close of period, total 17,693,000      
Gross amount of which carried at close of period, accumulated deprecation (2,930,000)      
Voorhees NJ OM [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,727,000      
Initial cost to company, buildings and improvements 8,451,000      
Cost capitalized subsequent to acquisition 2,655,000      
Gross amount of which carried at close of period, land 1,727,000      
Gross amount of which carried at close of period, buildings and improvements 11,106,000      
Gross amount of which carried at close of period, total 12,833,000      
Gross amount of which carried at close of period, accumulated deprecation (2,845,000)      
Norwich CT OM Portfolio [Member] | Norwich, CT One [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 403,000      
Initial cost to company, buildings and improvements 1,601,000      
Cost capitalized subsequent to acquisition 1,234,000      
Gross amount of which carried at close of period, land 403,000      
Gross amount of which carried at close of period, buildings and improvements 2,835,000      
Gross amount of which carried at close of period, total 3,238,000      
Gross amount of which carried at close of period, accumulated deprecation (1,050,000)      
Norwich CT OM Portfolio [Member] | Norwich, CT Two [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 804,000      
Initial cost to company, buildings and improvements 12,094,000      
Cost capitalized subsequent to acquisition 1,265,000      
Gross amount of which carried at close of period, land 804,000      
Gross amount of which carried at close of period, buildings and improvements 13,359,000      
Gross amount of which carried at close of period, total 14,163,000      
Gross amount of which carried at close of period, accumulated deprecation (2,882,000)      
Middletown OH OM II [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 3,949,000      
Cost capitalized subsequent to acquisition 683,000      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 4,632,000      
Gross amount of which carried at close of period, total 4,632,000      
Gross amount of which carried at close of period, accumulated deprecation (791,000)      
Homewood Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 8,354,000      
Initial cost to company, land 973,000      
Initial cost to company, buildings and improvements 9,702,000      
Cost capitalized subsequent to acquisition 2,467,000      
Gross amount of which carried at close of period, land 1,100,000      
Gross amount of which carried at close of period, buildings and improvements 12,042,000      
Gross amount of which carried at close of period, total 13,142,000      
Gross amount of which carried at close of period, accumulated deprecation (2,334,000)      
Ashford Place Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 5,663,000      
Initial cost to company, land 664,000      
Initial cost to company, buildings and improvements 12,662,000      
Cost capitalized subsequent to acquisition 1,412,000      
Gross amount of which carried at close of period, land 857,000      
Gross amount of which carried at close of period, buildings and improvements 13,881,000      
Gross amount of which carried at close of period, total 14,738,000      
Gross amount of which carried at close of period, accumulated deprecation (3,100,000)      
Mill Pond Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 6,701,000      
Initial cost to company, land 1,576,000      
Initial cost to company, buildings and improvements 8,124,000      
Cost capitalized subsequent to acquisition 727,000      
Gross amount of which carried at close of period, land 1,629,000      
Gross amount of which carried at close of period, buildings and improvements 8,798,000      
Gross amount of which carried at close of period, total 10,427,000      
Gross amount of which carried at close of period, accumulated deprecation (1,905,000)      
St. Andrews Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 4,228,000      
Initial cost to company, land 552,000      
Initial cost to company, buildings and improvements 8,213,000      
Cost capitalized subsequent to acquisition 705,000      
Gross amount of which carried at close of period, land 772,000      
Gross amount of which carried at close of period, buildings and improvements 8,698,000      
Gross amount of which carried at close of period, total 9,470,000      
Gross amount of which carried at close of period, accumulated deprecation (1,964,000)      
Hampton Oaks Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 5,952,000      
Initial cost to company, land 720,000      
Initial cost to company, buildings and improvements 8,145,000      
Cost capitalized subsequent to acquisition 824,000      
Gross amount of which carried at close of period, land 845,000      
Gross amount of which carried at close of period, buildings and improvements 8,844,000      
Gross amount of which carried at close of period, total 9,689,000      
Gross amount of which carried at close of period, accumulated deprecation (2,023,000)      
Forest Park Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 6,500,000      
Initial cost to company, land 535,000      
Initial cost to company, buildings and improvements 9,399,000      
Cost capitalized subsequent to acquisition 893,000      
Gross amount of which carried at close of period, land 647,000      
Gross amount of which carried at close of period, buildings and improvements 10,180,000      
Gross amount of which carried at close of period, total 10,827,000      
Gross amount of which carried at close of period, accumulated deprecation (2,281,000)      
The Maples at Waterford Crossing [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 5,533,000      
Initial cost to company, land 344,000      
Initial cost to company, buildings and improvements 8,027,000      
Cost capitalized subsequent to acquisition 1,989,000      
Gross amount of which carried at close of period, land 363,000      
Gross amount of which carried at close of period, buildings and improvements 9,997,000      
Gross amount of which carried at close of period, total 10,360,000      
Gross amount of which carried at close of period, accumulated deprecation (1,753,000)      
Morrison Woods Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 26,888,000      
Initial cost to company, land 1,903,000      
Initial cost to company, buildings and improvements 21,806,000      
Cost capitalized subsequent to acquisition 1,414,000      
Gross amount of which carried at close of period, land 1,922,000      
Gross amount of which carried at close of period, buildings and improvements 23,201,000      
Gross amount of which carried at close of period, total 25,123,000      
Gross amount of which carried at close of period, accumulated deprecation (4,039,000)      
Woodbridge Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 7,910,000      
Initial cost to company, land 228,000      
Initial cost to company, buildings and improvements 11,812,000      
Cost capitalized subsequent to acquisition 536,000      
Gross amount of which carried at close of period, land 262,000      
Gross amount of which carried at close of period, buildings and improvements 12,314,000      
Gross amount of which carried at close of period, total 12,576,000      
Gross amount of which carried at close of period, accumulated deprecation (2,687,000)      
Bridgepointe Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 6,775,000      
Initial cost to company, land 747,000      
Initial cost to company, buildings and improvements 7,469,000      
Cost capitalized subsequent to acquisition 2,004,000      
Gross amount of which carried at close of period, land 909,000      
Gross amount of which carried at close of period, buildings and improvements 9,311,000      
Gross amount of which carried at close of period, total 10,220,000      
Gross amount of which carried at close of period, accumulated deprecation (1,892,000)      
Greenleaf Living Center [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 10,851,000      
Initial cost to company, land 492,000      
Initial cost to company, buildings and improvements 12,157,000      
Cost capitalized subsequent to acquisition 1,234,000      
Gross amount of which carried at close of period, land 521,000      
Gross amount of which carried at close of period, buildings and improvements 13,362,000      
Gross amount of which carried at close of period, total 13,883,000      
Gross amount of which carried at close of period, accumulated deprecation (2,854,000)      
Forest Glen Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 9,056,000      
Initial cost to company, land 846,000      
Initial cost to company, buildings and improvements 12,754,000      
Cost capitalized subsequent to acquisition 1,195,000      
Gross amount of which carried at close of period, land 1,055,000      
Gross amount of which carried at close of period, buildings and improvements 13,740,000      
Gross amount of which carried at close of period, total 14,795,000      
Gross amount of which carried at close of period, accumulated deprecation (3,062,000)      
The Meadows of Kalida Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 7,492,000      
Initial cost to company, land 298,000      
Initial cost to company, buildings and improvements 7,628,000      
Cost capitalized subsequent to acquisition 598,000      
Gross amount of which carried at close of period, land 394,000      
Gross amount of which carried at close of period, buildings and improvements 8,130,000      
Gross amount of which carried at close of period, total 8,524,000      
Gross amount of which carried at close of period, accumulated deprecation (1,726,000)      
The Heritage [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 12,311,000      
Initial cost to company, land 1,312,000      
Initial cost to company, buildings and improvements 13,475,000      
Cost capitalized subsequent to acquisition 730,000      
Gross amount of which carried at close of period, land 1,434,000      
Gross amount of which carried at close of period, buildings and improvements 14,083,000      
Gross amount of which carried at close of period, total 15,517,000      
Gross amount of which carried at close of period, accumulated deprecation (3,105,000)      
Genoa Retirement Village [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 7,911,000      
Initial cost to company, land 881,000      
Initial cost to company, buildings and improvements 8,113,000      
Cost capitalized subsequent to acquisition 1,728,000      
Gross amount of which carried at close of period, land 1,054,000      
Gross amount of which carried at close of period, buildings and improvements 9,668,000      
Gross amount of which carried at close of period, total 10,722,000      
Gross amount of which carried at close of period, accumulated deprecation (2,059,000)      
Waterford Crossing [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 7,581,000      
Initial cost to company, land 344,000      
Initial cost to company, buildings and improvements 4,381,000      
Cost capitalized subsequent to acquisition 1,001,000      
Gross amount of which carried at close of period, land 349,000      
Gross amount of which carried at close of period, buildings and improvements 5,377,000      
Gross amount of which carried at close of period, total 5,726,000      
Gross amount of which carried at close of period, accumulated deprecation (1,197,000)      
St. Elizabeth Healthcare [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 8,351,000      
Initial cost to company, land 522,000      
Initial cost to company, buildings and improvements 5,463,000      
Cost capitalized subsequent to acquisition 5,490,000      
Gross amount of which carried at close of period, land 643,000      
Gross amount of which carried at close of period, buildings and improvements 10,832,000      
Gross amount of which carried at close of period, total 11,475,000      
Gross amount of which carried at close of period, accumulated deprecation (2,255,000)      
Cumberland Pointe [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 8,846,000      
Initial cost to company, land 1,645,000      
Initial cost to company, buildings and improvements 13,696,000      
Cost capitalized subsequent to acquisition 818,000      
Gross amount of which carried at close of period, land 1,905,000      
Gross amount of which carried at close of period, buildings and improvements 14,254,000      
Gross amount of which carried at close of period, total 16,159,000      
Gross amount of which carried at close of period, accumulated deprecation (3,480,000)      
Franciscan Healthcare Center [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 9,922,000      
Initial cost to company, land 808,000      
Initial cost to company, buildings and improvements 8,439,000      
Cost capitalized subsequent to acquisition 3,218,000      
Gross amount of which carried at close of period, land 915,000      
Gross amount of which carried at close of period, buildings and improvements 11,550,000      
Gross amount of which carried at close of period, total 12,465,000      
Gross amount of which carried at close of period, accumulated deprecation (2,535,000)      
Blair Ridge Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 7,311,000      
Initial cost to company, land 734,000      
Initial cost to company, buildings and improvements 11,648,000      
Cost capitalized subsequent to acquisition 1,041,000      
Gross amount of which carried at close of period, land 789,000      
Gross amount of which carried at close of period, buildings and improvements 12,634,000      
Gross amount of which carried at close of period, total 13,423,000      
Gross amount of which carried at close of period, accumulated deprecation (3,119,000)      
Glen Oaks Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 4,855,000      
Initial cost to company, land 384,000      
Initial cost to company, buildings and improvements 8,189,000      
Cost capitalized subsequent to acquisition 504,000      
Gross amount of which carried at close of period, land 419,000      
Gross amount of which carried at close of period, buildings and improvements 8,658,000      
Gross amount of which carried at close of period, total 9,077,000      
Gross amount of which carried at close of period, accumulated deprecation (1,756,000)      
Covered Bridge Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 386,000      
Initial cost to company, buildings and improvements 9,699,000      
Cost capitalized subsequent to acquisition 927,000      
Gross amount of which carried at close of period, land 45,000      
Gross amount of which carried at close of period, buildings and improvements 10,967,000      
Gross amount of which carried at close of period, total 11,012,000      
Gross amount of which carried at close of period, accumulated deprecation (2,407,000)      
Stonebridge Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 9,409,000      
Initial cost to company, land 1,087,000      
Initial cost to company, buildings and improvements 7,965,000      
Cost capitalized subsequent to acquisition 2,223,000      
Gross amount of which carried at close of period, land 1,144,000      
Gross amount of which carried at close of period, buildings and improvements 10,131,000      
Gross amount of which carried at close of period, total 11,275,000      
Gross amount of which carried at close of period, accumulated deprecation (1,958,000)      
RiverOaks Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 14,018,000      
Initial cost to company, land 440,000      
Initial cost to company, buildings and improvements 8,953,000      
Cost capitalized subsequent to acquisition 2,557,000      
Gross amount of which carried at close of period, land 764,000      
Gross amount of which carried at close of period, buildings and improvements 11,186,000      
Gross amount of which carried at close of period, total 11,950,000      
Gross amount of which carried at close of period, accumulated deprecation (2,187,000)      
Park Terrace Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 2,177,000      
Initial cost to company, buildings and improvements 7,626,000      
Cost capitalized subsequent to acquisition 1,749,000      
Gross amount of which carried at close of period, land 2,177,000      
Gross amount of which carried at close of period, buildings and improvements 9,375,000      
Gross amount of which carried at close of period, total 11,552,000      
Gross amount of which carried at close of period, accumulated deprecation (2,152,000)      
Cobblestone Crossing [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 1,462,000      
Initial cost to company, buildings and improvements 13,860,000      
Cost capitalized subsequent to acquisition 5,892,000      
Gross amount of which carried at close of period, land 1,564,000      
Gross amount of which carried at close of period, buildings and improvements 19,650,000      
Gross amount of which carried at close of period, total 21,214,000      
Gross amount of which carried at close of period, accumulated deprecation (4,160,000)      
Creasy Springs Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 15,531,000      
Initial cost to company, land 2,111,000      
Initial cost to company, buildings and improvements 14,337,000      
Cost capitalized subsequent to acquisition 6,223,000      
Gross amount of which carried at close of period, land 2,512,000      
Gross amount of which carried at close of period, buildings and improvements 20,159,000      
Gross amount of which carried at close of period, total 22,671,000      
Gross amount of which carried at close of period, accumulated deprecation (4,286,000)      
Avalon Springs Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 16,894,000      
Initial cost to company, land 1,542,000      
Initial cost to company, buildings and improvements 14,107,000      
Cost capitalized subsequent to acquisition 277,000      
Gross amount of which carried at close of period, land 1,607,000      
Gross amount of which carried at close of period, buildings and improvements 14,319,000      
Gross amount of which carried at close of period, total 15,926,000      
Gross amount of which carried at close of period, accumulated deprecation (3,092,000)      
Prairie Lakes Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 8,525,000      
Initial cost to company, land 2,204,000      
Initial cost to company, buildings and improvements 13,227,000      
Cost capitalized subsequent to acquisition 623,000      
Gross amount of which carried at close of period, land 2,342,000      
Gross amount of which carried at close of period, buildings and improvements 13,712,000      
Gross amount of which carried at close of period, total 16,054,000      
Gross amount of which carried at close of period, accumulated deprecation (2,937,000)      
RidgeWood Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 13,278,000      
Initial cost to company, land 1,240,000      
Initial cost to company, buildings and improvements 16,118,000      
Cost capitalized subsequent to acquisition 437,000      
Gross amount of which carried at close of period, land 1,268,000      
Gross amount of which carried at close of period, buildings and improvements 16,527,000      
Gross amount of which carried at close of period, total 17,795,000      
Gross amount of which carried at close of period, accumulated deprecation (3,483,000)      
Westport Place Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 1,245,000      
Initial cost to company, buildings and improvements 9,946,000      
Cost capitalized subsequent to acquisition 1,299,000      
Gross amount of which carried at close of period, land 1,262,000      
Gross amount of which carried at close of period, buildings and improvements 11,228,000      
Gross amount of which carried at close of period, total 12,490,000      
Gross amount of which carried at close of period, accumulated deprecation (2,229,000)      
Paddock Springs [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 13,195,000      
Initial cost to company, land 488,000      
Initial cost to company, buildings and improvements 0      
Cost capitalized subsequent to acquisition 10,638,000      
Gross amount of which carried at close of period, land 660,000      
Gross amount of which carried at close of period, buildings and improvements 10,466,000      
Gross amount of which carried at close of period, total 11,126,000      
Gross amount of which carried at close of period, accumulated deprecation (1,437,000)      
Amber Manor Care Center [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 5,390,000      
Initial cost to company, land 446,000      
Initial cost to company, buildings and improvements 6,063,000      
Cost capitalized subsequent to acquisition 538,000      
Gross amount of which carried at close of period, land 515,000      
Gross amount of which carried at close of period, buildings and improvements 6,532,000      
Gross amount of which carried at close of period, total 7,047,000      
Gross amount of which carried at close of period, accumulated deprecation (1,506,000)      
The Meadows of Leipsic Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 1,242,000      
Initial cost to company, buildings and improvements 6,988,000      
Cost capitalized subsequent to acquisition 967,000      
Gross amount of which carried at close of period, land 1,428,000      
Gross amount of which carried at close of period, buildings and improvements 7,769,000      
Gross amount of which carried at close of period, total 9,197,000      
Gross amount of which carried at close of period, accumulated deprecation (1,803,000)      
Springview Manor [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 260,000      
Initial cost to company, buildings and improvements 3,968,000      
Cost capitalized subsequent to acquisition 649,000      
Gross amount of which carried at close of period, land 408,000      
Gross amount of which carried at close of period, buildings and improvements 4,469,000      
Gross amount of which carried at close of period, total 4,877,000      
Gross amount of which carried at close of period, accumulated deprecation (986,000)      
Willows at Bellevue [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 15,821,000      
Initial cost to company, land 587,000      
Initial cost to company, buildings and improvements 15,575,000      
Cost capitalized subsequent to acquisition 1,530,000      
Gross amount of which carried at close of period, land 790,000      
Gross amount of which carried at close of period, buildings and improvements 16,902,000      
Gross amount of which carried at close of period, total 17,692,000      
Gross amount of which carried at close of period, accumulated deprecation (3,726,000)      
Briar Hill Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 673,000      
Initial cost to company, buildings and improvements 2,688,000      
Cost capitalized subsequent to acquisition 569,000      
Gross amount of which carried at close of period, land 756,000      
Gross amount of which carried at close of period, buildings and improvements 3,174,000      
Gross amount of which carried at close of period, total 3,930,000      
Gross amount of which carried at close of period, accumulated deprecation (793,000)      
Cypress Pointe Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 921,000      
Initial cost to company, buildings and improvements 10,291,000      
Cost capitalized subsequent to acquisition 11,066,000      
Gross amount of which carried at close of period, land 1,850,000      
Gross amount of which carried at close of period, buildings and improvements 20,428,000      
Gross amount of which carried at close of period, total 22,278,000      
Gross amount of which carried at close of period, accumulated deprecation (3,277,000)      
The Oaks at NorthPointe Woods [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 567,000      
Initial cost to company, buildings and improvements 12,716,000      
Cost capitalized subsequent to acquisition 240,000      
Gross amount of which carried at close of period, land 571,000      
Gross amount of which carried at close of period, buildings and improvements 12,952,000      
Gross amount of which carried at close of period, total 13,523,000      
Gross amount of which carried at close of period, accumulated deprecation (2,741,000)      
Westlake Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 13,809,000      
Initial cost to company, land 815,000      
Initial cost to company, buildings and improvements 13,502,000      
Cost capitalized subsequent to acquisition 202,000      
Gross amount of which carried at close of period, land 547,000      
Gross amount of which carried at close of period, buildings and improvements 13,972,000      
Gross amount of which carried at close of period, total 14,519,000      
Gross amount of which carried at close of period, accumulated deprecation (2,953,000)      
Springhurst Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 19,200,000      
Initial cost to company, land 931,000      
Initial cost to company, buildings and improvements 14,114,000      
Cost capitalized subsequent to acquisition 4,170,000      
Gross amount of which carried at close of period, land 2,330,000      
Gross amount of which carried at close of period, buildings and improvements 16,885,000      
Gross amount of which carried at close of period, total 19,215,000      
Gross amount of which carried at close of period, accumulated deprecation (4,357,000)      
Glen Ridge Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 1,208,000      
Initial cost to company, buildings and improvements 9,771,000      
Cost capitalized subsequent to acquisition 2,569,000      
Gross amount of which carried at close of period, land 1,402,000      
Gross amount of which carried at close of period, buildings and improvements 12,146,000      
Gross amount of which carried at close of period, total 13,548,000      
Gross amount of which carried at close of period, accumulated deprecation (2,769,000)      
St. Mary Healthcare [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 5,058,000      
Initial cost to company, land 348,000      
Initial cost to company, buildings and improvements 2,710,000      
Cost capitalized subsequent to acquisition 344,000      
Gross amount of which carried at close of period, land 393,000      
Gross amount of which carried at close of period, buildings and improvements 3,009,000      
Gross amount of which carried at close of period, total 3,402,000      
Gross amount of which carried at close of period, accumulated deprecation (694,000)      
The Oaks at Woodfield [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 14,880,000      
Initial cost to company, land 897,000      
Initial cost to company, buildings and improvements 12,270,000      
Cost capitalized subsequent to acquisition 676,000      
Gross amount of which carried at close of period, land 1,130,000      
Gross amount of which carried at close of period, buildings and improvements 12,713,000      
Gross amount of which carried at close of period, total 13,843,000      
Gross amount of which carried at close of period, accumulated deprecation (2,790,000)      
Stonegate Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 10,976,000      
Initial cost to company, land 538,000      
Initial cost to company, buildings and improvements 13,159,000      
Cost capitalized subsequent to acquisition 406,000      
Gross amount of which carried at close of period, land 717,000      
Gross amount of which carried at close of period, buildings and improvements 13,386,000      
Gross amount of which carried at close of period, total 14,103,000      
Gross amount of which carried at close of period, accumulated deprecation (2,930,000)      
Senior Living at Forest Ridge [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 204,000      
Initial cost to company, buildings and improvements 5,470,000      
Cost capitalized subsequent to acquisition 363,000      
Gross amount of which carried at close of period, land 325,000      
Gross amount of which carried at close of period, buildings and improvements 5,712,000      
Gross amount of which carried at close of period, total 6,037,000      
Gross amount of which carried at close of period, accumulated deprecation (1,255,000)      
River Terrace Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 13,378,000      
Cost capitalized subsequent to acquisition 4,346,000      
Gross amount of which carried at close of period, land 76,000      
Gross amount of which carried at close of period, buildings and improvements 17,648,000      
Gross amount of which carried at close of period, total 17,724,000      
Gross amount of which carried at close of period, accumulated deprecation (3,966,000)      
St. Charles Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 11,053,000      
Initial cost to company, land 467,000      
Initial cost to company, buildings and improvements 14,532,000      
Cost capitalized subsequent to acquisition 2,404,000      
Gross amount of which carried at close of period, land 558,000      
Gross amount of which carried at close of period, buildings and improvements 16,845,000      
Gross amount of which carried at close of period, total 17,403,000      
Gross amount of which carried at close of period, accumulated deprecation (3,690,000)      
Bethany Pointe Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 18,945,000      
Initial cost to company, land 2,337,000      
Initial cost to company, buildings and improvements 26,524,000      
Cost capitalized subsequent to acquisition 2,812,000      
Gross amount of which carried at close of period, land 2,550,000      
Gross amount of which carried at close of period, buildings and improvements 29,123,000      
Gross amount of which carried at close of period, total 31,673,000      
Gross amount of which carried at close of period, accumulated deprecation (6,509,000)      
River Pointe Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 13,606,000      
Initial cost to company, land 1,118,000      
Initial cost to company, buildings and improvements 14,736,000      
Cost capitalized subsequent to acquisition 1,998,000      
Gross amount of which carried at close of period, land 1,204,000      
Gross amount of which carried at close of period, buildings and improvements 16,648,000      
Gross amount of which carried at close of period, total 17,852,000      
Gross amount of which carried at close of period, accumulated deprecation (3,802,000)      
Waterford Place Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 14,404,000      
Initial cost to company, land 1,219,000      
Initial cost to company, buildings and improvements 18,557,000      
Cost capitalized subsequent to acquisition 6,653,000      
Gross amount of which carried at close of period, land 1,805,000      
Gross amount of which carried at close of period, buildings and improvements 24,624,000      
Gross amount of which carried at close of period, total 26,429,000      
Gross amount of which carried at close of period, accumulated deprecation (4,680,000)      
Autumn Woods Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 1,016,000      
Initial cost to company, buildings and improvements 13,414,000      
Cost capitalized subsequent to acquisition 1,850,000      
Gross amount of which carried at close of period, land 1,048,000      
Gross amount of which carried at close of period, buildings and improvements 15,232,000      
Gross amount of which carried at close of period, total 16,280,000      
Gross amount of which carried at close of period, accumulated deprecation (3,710,000)      
Oakwood Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 8,842,000      
Initial cost to company, land 783,000      
Initial cost to company, buildings and improvements 11,880,000      
Cost capitalized subsequent to acquisition 1,396,000      
Gross amount of which carried at close of period, land 868,000      
Gross amount of which carried at close of period, buildings and improvements 13,191,000      
Gross amount of which carried at close of period, total 14,059,000      
Gross amount of which carried at close of period, accumulated deprecation (3,191,000)      
Cedar Ridge Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 102,000      
Initial cost to company, buildings and improvements 8,435,000      
Cost capitalized subsequent to acquisition 3,745,000      
Gross amount of which carried at close of period, land 205,000      
Gross amount of which carried at close of period, buildings and improvements 12,077,000      
Gross amount of which carried at close of period, total 12,282,000      
Gross amount of which carried at close of period, accumulated deprecation (3,276,000)      
Aspen Place Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 9,188,000      
Initial cost to company, land 980,000      
Initial cost to company, buildings and improvements 10,970,000      
Cost capitalized subsequent to acquisition 963,000      
Gross amount of which carried at close of period, land 1,212,000      
Gross amount of which carried at close of period, buildings and improvements 11,701,000      
Gross amount of which carried at close of period, total 12,913,000      
Gross amount of which carried at close of period, accumulated deprecation (2,669,000)      
The WIllows at East Lansing [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 15,878,000      
Initial cost to company, land 1,449,000      
Initial cost to company, buildings and improvements 15,161,000      
Cost capitalized subsequent to acquisition 1,681,000      
Gross amount of which carried at close of period, land 1,496,000      
Gross amount of which carried at close of period, buildings and improvements 16,795,000      
Gross amount of which carried at close of period, total 18,291,000      
Gross amount of which carried at close of period, accumulated deprecation (3,940,000)      
The Willows at Howell [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 1,051,000      
Initial cost to company, buildings and improvements 12,099,000      
Cost capitalized subsequent to acquisition 6,763,000      
Gross amount of which carried at close of period, land 1,158,000      
Gross amount of which carried at close of period, buildings and improvements 18,755,000      
Gross amount of which carried at close of period, total 19,913,000      
Gross amount of which carried at close of period, accumulated deprecation (3,429,000)      
The Willows at Okemos [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 7,277,000      
Initial cost to company, land 1,171,000      
Initial cost to company, buildings and improvements 12,326,000      
Cost capitalized subsequent to acquisition 1,045,000      
Gross amount of which carried at close of period, land 1,229,000      
Gross amount of which carried at close of period, buildings and improvements 13,313,000      
Gross amount of which carried at close of period, total 14,542,000      
Gross amount of which carried at close of period, accumulated deprecation (3,139,000)      
Shelby Crossing Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 16,686,000      
Initial cost to company, land 2,533,000      
Initial cost to company, buildings and improvements 18,440,000      
Cost capitalized subsequent to acquisition 2,404,000      
Gross amount of which carried at close of period, land 2,620,000      
Gross amount of which carried at close of period, buildings and improvements 20,757,000      
Gross amount of which carried at close of period, total 23,377,000      
Gross amount of which carried at close of period, accumulated deprecation (5,154,000)      
Village Green Healthcare Center [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 6,763,000      
Initial cost to company, land 355,000      
Initial cost to company, buildings and improvements 9,696,000      
Cost capitalized subsequent to acquisition 1,175,000      
Gross amount of which carried at close of period, land 448,000      
Gross amount of which carried at close of period, buildings and improvements 10,778,000      
Gross amount of which carried at close of period, total 11,226,000      
Gross amount of which carried at close of period, accumulated deprecation (2,314,000)      
The Oaks at Northpointe [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 624,000      
Initial cost to company, buildings and improvements 11,665,000      
Cost capitalized subsequent to acquisition 1,106,000      
Gross amount of which carried at close of period, land 722,000      
Gross amount of which carried at close of period, buildings and improvements 12,673,000      
Gross amount of which carried at close of period, total 13,395,000      
Gross amount of which carried at close of period, accumulated deprecation (2,973,000)      
The Oaks at Bethesda [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 4,417,000      
Initial cost to company, land 714,000      
Initial cost to company, buildings and improvements 10,791,000      
Cost capitalized subsequent to acquisition 949,000      
Gross amount of which carried at close of period, land 812,000      
Gross amount of which carried at close of period, buildings and improvements 11,642,000      
Gross amount of which carried at close of period, total 12,454,000      
Gross amount of which carried at close of period, accumulated deprecation (2,635,000)      
White Oak Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 20,088,000      
Initial cost to company, land 1,005,000      
Initial cost to company, buildings and improvements 13,207,000      
Cost capitalized subsequent to acquisition 208,000      
Gross amount of which carried at close of period, land 1,005,000      
Gross amount of which carried at close of period, buildings and improvements 13,415,000      
Gross amount of which carried at close of period, total 14,420,000      
Gross amount of which carried at close of period, accumulated deprecation (2,173,000)      
Woodmont Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 7,584,000      
Initial cost to company, land 790,000      
Initial cost to company, buildings and improvements 9,633,000      
Cost capitalized subsequent to acquisition 1,236,000      
Gross amount of which carried at close of period, land 1,010,000      
Gross amount of which carried at close of period, buildings and improvements 10,649,000      
Gross amount of which carried at close of period, total 11,659,000      
Gross amount of which carried at close of period, accumulated deprecation (2,547,000)      
Silver Oaks Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 1,776,000      
Initial cost to company, buildings and improvements 21,420,000      
Cost capitalized subsequent to acquisition 1,499,000      
Gross amount of which carried at close of period, land 8,000      
Gross amount of which carried at close of period, buildings and improvements 24,687,000      
Gross amount of which carried at close of period, total 24,695,000      
Gross amount of which carried at close of period, accumulated deprecation (5,513,000)      
Thornton Terrace Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 5,375,000      
Initial cost to company, land 764,000      
Initial cost to company, buildings and improvements 9,209,000      
Cost capitalized subsequent to acquisition 1,601,000      
Gross amount of which carried at close of period, land 873,000      
Gross amount of which carried at close of period, buildings and improvements 10,701,000      
Gross amount of which carried at close of period, total 11,574,000      
Gross amount of which carried at close of period, accumulated deprecation (2,386,000)      
The Willows at Hamburg [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 11,192,000      
Initial cost to company, land 1,740,000      
Initial cost to company, buildings and improvements 13,422,000      
Cost capitalized subsequent to acquisition 1,676,000      
Gross amount of which carried at close of period, land 1,810,000      
Gross amount of which carried at close of period, buildings and improvements 15,028,000      
Gross amount of which carried at close of period, total 16,838,000      
Gross amount of which carried at close of period, accumulated deprecation (2,912,000)      
The Lakes at Monclova [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 19,130,000      
Initial cost to company, land 2,869,000      
Initial cost to company, buildings and improvements 12,855,000      
Cost capitalized subsequent to acquisition 10,302,000      
Gross amount of which carried at close of period, land 3,186,000      
Gross amount of which carried at close of period, buildings and improvements 22,840,000      
Gross amount of which carried at close of period, total 26,026,000      
Gross amount of which carried at close of period, accumulated deprecation (3,884,000)      
The Willows at Willard [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 610,000      
Initial cost to company, buildings and improvements 12,256,000      
Cost capitalized subsequent to acquisition 10,003,000      
Gross amount of which carried at close of period, land 223,000      
Gross amount of which carried at close of period, buildings and improvements 22,646,000      
Gross amount of which carried at close of period, total 22,869,000      
Gross amount of which carried at close of period, accumulated deprecation (4,267,000)      
Westlake Health Campus - Commerce Villa [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 261,000      
Initial cost to company, buildings and improvements 6,610,000      
Cost capitalized subsequent to acquisition 1,270,000      
Gross amount of which carried at close of period, land 553,000      
Gross amount of which carried at close of period, buildings and improvements 7,588,000      
Gross amount of which carried at close of period, total 8,141,000      
Gross amount of which carried at close of period, accumulated deprecation (1,458,000)      
Orchard Grove Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 27,515,000      
Initial cost to company, land 2,065,000      
Initial cost to company, buildings and improvements 11,510,000      
Cost capitalized subsequent to acquisition 18,156,000      
Gross amount of which carried at close of period, land 3,515,000      
Gross amount of which carried at close of period, buildings and improvements 28,216,000      
Gross amount of which carried at close of period, total 31,731,000      
Gross amount of which carried at close of period, accumulated deprecation (3,902,000)      
The Meadows of Ottawa [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 695,000      
Initial cost to company, buildings and improvements 7,752,000      
Cost capitalized subsequent to acquisition 1,168,000      
Gross amount of which carried at close of period, land 728,000      
Gross amount of which carried at close of period, buildings and improvements 8,887,000      
Gross amount of which carried at close of period, total 9,615,000      
Gross amount of which carried at close of period, accumulated deprecation (1,729,000)      
Valley View Healthcare Center [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 10,237,000      
Initial cost to company, land 930,000      
Initial cost to company, buildings and improvements 7,635,000      
Cost capitalized subsequent to acquisition 1,546,000      
Gross amount of which carried at close of period, land 1,107,000      
Gross amount of which carried at close of period, buildings and improvements 9,004,000      
Gross amount of which carried at close of period, total 10,111,000      
Gross amount of which carried at close of period, accumulated deprecation (1,353,000)      
Novi Lakes Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 12,154,000      
Initial cost to company, land 1,654,000      
Initial cost to company, buildings and improvements 7,494,000      
Cost capitalized subsequent to acquisition 2,770,000      
Gross amount of which carried at close of period, land 1,702,000      
Gross amount of which carried at close of period, buildings and improvements 10,216,000      
Gross amount of which carried at close of period, total 11,918,000      
Gross amount of which carried at close of period, accumulated deprecation (2,420,000)      
The Willows at Fritz Farm [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 8,918,000      
Initial cost to company, land 1,538,000      
Initial cost to company, buildings and improvements 8,637,000      
Cost capitalized subsequent to acquisition 455,000      
Gross amount of which carried at close of period, land 1,563,000      
Gross amount of which carried at close of period, buildings and improvements 9,067,000      
Gross amount of which carried at close of period, total 10,630,000      
Gross amount of which carried at close of period, accumulated deprecation (1,316,000)      
Trilogy Real Estate Gahanna, LLC [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 1,146,000      
Initial cost to company, buildings and improvements 0      
Cost capitalized subsequent to acquisition 16,745,000      
Gross amount of which carried at close of period, land 1,218,000      
Gross amount of which carried at close of period, buildings and improvements 16,673,000      
Gross amount of which carried at close of period, total 17,891,000      
Gross amount of which carried at close of period, accumulated deprecation (1,361,000)      
Oaks at Byron Center [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 14,264,000      
Initial cost to company, land 2,000,000      
Initial cost to company, buildings and improvements 0      
Cost capitalized subsequent to acquisition 15,932,000      
Gross amount of which carried at close of period, land 2,193,000      
Gross amount of which carried at close of period, buildings and improvements 15,739,000      
Gross amount of which carried at close of period, total 17,932,000      
Gross amount of which carried at close of period, accumulated deprecation (1,517,000)      
Harrison Springs Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 2,017,000      
Initial cost to company, buildings and improvements 11,487,000      
Cost capitalized subsequent to acquisition 5,933,000      
Gross amount of which carried at close of period, land 2,305,000      
Gross amount of which carried at close of period, buildings and improvements 17,132,000      
Gross amount of which carried at close of period, total 19,437,000      
Gross amount of which carried at close of period, accumulated deprecation (1,775,000)      
The Cloister at Silvercrest | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 139,000      
Initial cost to company, buildings and improvements 634,000      
Cost capitalized subsequent to acquisition 6,000      
Gross amount of which carried at close of period, land 139,000      
Gross amount of which carried at close of period, buildings and improvements 640,000      
Gross amount of which carried at close of period, total 779,000      
Gross amount of which carried at close of period, accumulated deprecation (70,000)      
Trilogy Healthcare of Ferdinand II, LLC [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 16,805,000      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 0      
Cost capitalized subsequent to acquisition 14,619,000      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 14,619,000      
Gross amount of which carried at close of period, total 14,619,000      
Gross amount of which carried at close of period, accumulated deprecation (1,541,000)      
Forest Springs Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 964,000      
Initial cost to company, buildings and improvements 16,691,000      
Cost capitalized subsequent to acquisition 363,000      
Gross amount of which carried at close of period, land 1,000,000      
Gross amount of which carried at close of period, buildings and improvements 17,018,000      
Gross amount of which carried at close of period, total 18,018,000      
Gross amount of which carried at close of period, accumulated deprecation (1,654,000)      
Gateway Springs Health Campus [Member] | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 11,505,000      
Initial cost to company, land 1,277,000      
Initial cost to company, buildings and improvements 10,923,000      
Cost capitalized subsequent to acquisition 1,615,000      
Gross amount of which carried at close of period, land 1,431,000      
Gross amount of which carried at close of period, buildings and improvements 12,384,000      
Gross amount of which carried at close of period, total 13,815,000      
Gross amount of which carried at close of period, accumulated deprecation (1,016,000)      
The Meadows of Delphos | Kendallville, IN | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Gross amount of which carried at close of period, accumulated deprecation (1,003,000)      
The Meadows of Delphos | Delphos, OH | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 9,330,000      
Initial cost to company, land 2,345,000      
Initial cost to company, buildings and improvements 8,150,000      
Cost capitalized subsequent to acquisition 98,000      
Gross amount of which carried at close of period, land 2,382,000      
Gross amount of which carried at close of period, buildings and improvements 8,211,000      
Gross amount of which carried at close of period, total 10,593,000      
Gross amount of which carried at close of period, accumulated deprecation (1,140,000)      
Harrison Trail Health Campus | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 15,632,000      
Initial cost to company, land 1,750,000      
Initial cost to company, buildings and improvements 17,114,000      
Cost capitalized subsequent to acquisition 86,000      
Gross amount of which carried at close of period, land 2,048,000      
Gross amount of which carried at close of period, buildings and improvements 16,902,000      
Gross amount of which carried at close of period, total 18,950,000      
Gross amount of which carried at close of period, accumulated deprecation (1,266,000)      
Charlottesville OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 4,902,000      
Initial cost to company, buildings and improvements 19,741,000      
Cost capitalized subsequent to acquisition 785,000      
Gross amount of which carried at close of period, land 4,902,000      
Gross amount of which carried at close of period, buildings and improvements 20,526,000      
Gross amount of which carried at close of period, total 25,428,000      
Gross amount of which carried at close of period, accumulated deprecation (1,652,000)      
Rochester Hills OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 1,813,000      
Initial cost to company, land 2,218,000      
Initial cost to company, buildings and improvements 8,380,000      
Cost capitalized subsequent to acquisition 947,000      
Gross amount of which carried at close of period, land 2,218,000      
Gross amount of which carried at close of period, buildings and improvements 9,327,000      
Gross amount of which carried at close of period, total 11,545,000      
Gross amount of which carried at close of period, accumulated deprecation (918,000)      
Cullman OM III | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 19,224,000      
Cost capitalized subsequent to acquisition (587,000)      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 18,637,000      
Gross amount of which carried at close of period, total 18,637,000      
Gross amount of which carried at close of period, accumulated deprecation (1,080,000)      
Iron OM Portfolio | Iron OM Portfolio One | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 14,799,000      
Cost capitalized subsequent to acquisition 1,382,000      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 16,181,000      
Gross amount of which carried at close of period, total 16,181,000      
Gross amount of which carried at close of period, accumulated deprecation (1,552,000)      
Iron OM Portfolio | Iron OM Portfolio Two | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 12,287,000      
Cost capitalized subsequent to acquisition 438,000      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 12,725,000      
Gross amount of which carried at close of period, total 12,725,000      
Gross amount of which carried at close of period, accumulated deprecation (1,071,000)      
Iron OM Portfolio | Iron OM Portfolio Three | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 11,273,000      
Cost capitalized subsequent to acquisition 2,161,000      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 13,434,000      
Gross amount of which carried at close of period, total 13,434,000      
Gross amount of which carried at close of period, accumulated deprecation (976,000)      
Mint Hill OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 24,110,000      
Cost capitalized subsequent to acquisition (26,000)      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 24,084,000      
Gross amount of which carried at close of period, total 24,084,000      
Gross amount of which carried at close of period, accumulated deprecation (1,981,000)      
Lafayette Assisted Living Portfolio | Lafayette Assisted Living Portfolio One | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,206,000      
Initial cost to company, buildings and improvements 9,076,000      
Cost capitalized subsequent to acquisition 697,000      
Gross amount of which carried at close of period, land 1,206,000      
Gross amount of which carried at close of period, buildings and improvements 9,773,000      
Gross amount of which carried at close of period, total 10,979,000      
Gross amount of which carried at close of period, accumulated deprecation (569,000)      
Lafayette Assisted Living Portfolio | Lafayette Assisted Living Portfolio Two | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,039,000      
Initial cost to company, buildings and improvements 4,684,000      
Cost capitalized subsequent to acquisition 255,000      
Gross amount of which carried at close of period, land 1,039,000      
Gross amount of which carried at close of period, buildings and improvements 4,939,000      
Gross amount of which carried at close of period, total 5,978,000      
Gross amount of which carried at close of period, accumulated deprecation (316,000)      
Battle Creek OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,156,000      
Initial cost to company, buildings and improvements 7,910,000      
Cost capitalized subsequent to acquisition 10,000      
Gross amount of which carried at close of period, land 1,156,000      
Gross amount of which carried at close of period, buildings and improvements 7,920,000      
Gross amount of which carried at close of period, total 9,076,000      
Gross amount of which carried at close of period, accumulated deprecation (855,000)      
Reno OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 82,515,000      
Cost capitalized subsequent to acquisition 735,000      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 83,250,000      
Gross amount of which carried at close of period, total 83,250,000      
Gross amount of which carried at close of period, accumulated deprecation (6,090,000)      
Athens OM | Athens OM Portfolio One | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 860,000      
Initial cost to company, buildings and improvements 7,989,000      
Cost capitalized subsequent to acquisition 120,000      
Gross amount of which carried at close of period, land 860,000      
Gross amount of which carried at close of period, buildings and improvements 8,109,000      
Gross amount of which carried at close of period, total 8,969,000      
Gross amount of which carried at close of period, accumulated deprecation (689,000)      
Athens OM | Athens OM Portfolio Two | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,106,000      
Initial cost to company, buildings and improvements 11,531,000      
Cost capitalized subsequent to acquisition 456,000      
Gross amount of which carried at close of period, land 1,106,000      
Gross amount of which carried at close of period, buildings and improvements 11,987,000      
Gross amount of which carried at close of period, total 13,093,000      
Gross amount of which carried at close of period, accumulated deprecation (962,000)      
SW Illinois Senior Housing Portfolio | SW Illinois Senior Housing Portfolio One | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,117,000      
Initial cost to company, buildings and improvements 9,700,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 1,117,000      
Gross amount of which carried at close of period, buildings and improvements 9,700,000      
Gross amount of which carried at close of period, total 10,817,000      
Gross amount of which carried at close of period, accumulated deprecation (640,000)      
SW Illinois Senior Housing Portfolio | SW Illinois Senior Housing Portfolio Two | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 147,000      
Initial cost to company, buildings and improvements 2,106,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 147,000      
Gross amount of which carried at close of period, buildings and improvements 2,106,000      
Gross amount of which carried at close of period, total 2,253,000      
Gross amount of which carried at close of period, accumulated deprecation (135,000)      
SW Illinois Senior Housing Portfolio | SW Illinois Senior Housing Portfolio Three | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 259,000      
Initial cost to company, buildings and improvements 3,980,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 259,000      
Gross amount of which carried at close of period, buildings and improvements 3,980,000      
Gross amount of which carried at close of period, total 4,239,000      
Gross amount of which carried at close of period, accumulated deprecation (256,000)      
SW Illinois Senior Housing Portfolio | SW Illinois Senior Housing Portfolio Four | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 690,000      
Initial cost to company, buildings and improvements 5,175,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 690,000      
Gross amount of which carried at close of period, buildings and improvements 5,175,000      
Gross amount of which carried at close of period, total 5,865,000      
Gross amount of which carried at close of period, accumulated deprecation (332,000)      
SW Illinois Senior Housing Portfolio | SW Illinois Senior Housing Portfolio Five | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 934,000      
Initial cost to company, buildings and improvements 8,932,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 934,000      
Gross amount of which carried at close of period, buildings and improvements 8,932,000      
Gross amount of which carried at close of period, total 9,866,000      
Gross amount of which carried at close of period, accumulated deprecation (576,000)      
Lawrenceville OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,663,000      
Initial cost to company, buildings and improvements 12,019,000      
Cost capitalized subsequent to acquisition 250,000      
Gross amount of which carried at close of period, land 1,663,000      
Gross amount of which carried at close of period, buildings and improvements 12,269,000      
Gross amount of which carried at close of period, total 13,932,000      
Gross amount of which carried at close of period, accumulated deprecation (1,019,000)      
Northern California Senior Housing Portfolio | Northern California Senior Housing Portfolio One | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 10,491,000      
Initial cost to company, buildings and improvements 9,650,000      
Cost capitalized subsequent to acquisition (6,971,000)      
Gross amount of which carried at close of period, land 10,491,000      
Gross amount of which carried at close of period, buildings and improvements 2,679,000      
Gross amount of which carried at close of period, total 13,170,000      
Gross amount of which carried at close of period, accumulated deprecation (624,000)      
Northern California Senior Housing Portfolio | Northern California Senior Housing Portfolio Three | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 3,730,000      
Initial cost to company, buildings and improvements 3,018,000      
Cost capitalized subsequent to acquisition (6,741,000)      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 7,000      
Gross amount of which carried at close of period, total 7,000      
Gross amount of which carried at close of period, accumulated deprecation 0      
Roseburg OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 28,140,000      
Cost capitalized subsequent to acquisition 134,000      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 28,274,000      
Gross amount of which carried at close of period, total 28,274,000      
Gross amount of which carried at close of period, accumulated deprecation (2,180,000)      
Fairfield County OM | Fairfield County OM Portfolio Two | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 2,797,000      
Initial cost to company, buildings and improvements 10,400,000      
Cost capitalized subsequent to acquisition 274,000      
Gross amount of which carried at close of period, land 2,797,000      
Gross amount of which carried at close of period, buildings and improvements 10,674,000      
Gross amount of which carried at close of period, total 13,471,000      
Gross amount of which carried at close of period, accumulated deprecation (1,137,000)      
Central Wisconsin Senior Care Portfolio | Central Wisconsin Senior Care Portfolio One | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 543,000      
Initial cost to company, buildings and improvements 2,587,000      
Cost capitalized subsequent to acquisition 70,000      
Gross amount of which carried at close of period, land 543,000      
Gross amount of which carried at close of period, buildings and improvements 2,657,000      
Gross amount of which carried at close of period, total 3,200,000      
Gross amount of which carried at close of period, accumulated deprecation (202,000)      
Central Wisconsin Senior Care Portfolio | Central Wisconsin Senior Care Portfolio Two | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 2,171,000      
Initial cost to company, buildings and improvements 10,198,000      
Cost capitalized subsequent to acquisition 423,000      
Gross amount of which carried at close of period, land 2,171,000      
Gross amount of which carried at close of period, buildings and improvements 10,621,000      
Gross amount of which carried at close of period, total 12,792,000      
Gross amount of which carried at close of period, accumulated deprecation (796,000)      
Sauk Prairie OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 2,044,000      
Initial cost to company, buildings and improvements 19,669,000      
Cost capitalized subsequent to acquisition 401,000      
Gross amount of which carried at close of period, land 2,044,000      
Gross amount of which carried at close of period, buildings and improvements 20,070,000      
Gross amount of which carried at close of period, total 22,114,000      
Gross amount of which carried at close of period, accumulated deprecation (1,558,000)      
Surprise OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,827,000      
Initial cost to company, buildings and improvements 10,968,000      
Cost capitalized subsequent to acquisition 443,000      
Gross amount of which carried at close of period, land 1,827,000      
Gross amount of which carried at close of period, buildings and improvements 11,411,000      
Gross amount of which carried at close of period, total 13,238,000      
Gross amount of which carried at close of period, accumulated deprecation (881,000)      
Southfield OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 5,408,000      
Initial cost to company, land 1,634,000      
Initial cost to company, buildings and improvements 16,550,000      
Cost capitalized subsequent to acquisition 1,187,000      
Gross amount of which carried at close of period, land 1,634,000      
Gross amount of which carried at close of period, buildings and improvements 17,737,000      
Gross amount of which carried at close of period, total 19,371,000      
Gross amount of which carried at close of period, accumulated deprecation (1,824,000)      
Pinnacle Beaumont ALF | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,775,000      
Initial cost to company, buildings and improvements 17,541,000      
Cost capitalized subsequent to acquisition 39,000      
Gross amount of which carried at close of period, land 1,775,000      
Gross amount of which carried at close of period, buildings and improvements 17,580,000      
Gross amount of which carried at close of period, total 19,355,000      
Gross amount of which carried at close of period, accumulated deprecation (1,062,000)      
Grand Junction OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 2,460,000      
Initial cost to company, buildings and improvements 34,188,000      
Cost capitalized subsequent to acquisition 42,000      
Gross amount of which carried at close of period, land 2,460,000      
Gross amount of which carried at close of period, buildings and improvements 34,230,000      
Gross amount of which carried at close of period, total 36,690,000      
Gross amount of which carried at close of period, accumulated deprecation (2,749,000)      
Edmonds OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 4,523,000      
Initial cost to company, buildings and improvements 22,414,000      
Cost capitalized subsequent to acquisition 338,000      
Gross amount of which carried at close of period, land 4,523,000      
Gross amount of which carried at close of period, buildings and improvements 22,752,000      
Gross amount of which carried at close of period, total 27,275,000      
Gross amount of which carried at close of period, accumulated deprecation (1,826,000)      
Pinnacle Warrenton ALF | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 514,000      
Initial cost to company, buildings and improvements 7,059,000      
Cost capitalized subsequent to acquisition (2,240,000)      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 5,333,000      
Gross amount of which carried at close of period, total 5,333,000      
Gross amount of which carried at close of period, accumulated deprecation (462,000)      
Glendale OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 665,000      
Initial cost to company, buildings and improvements 6,782,000      
Cost capitalized subsequent to acquisition 410,000      
Gross amount of which carried at close of period, land 665,000      
Gross amount of which carried at close of period, buildings and improvements 7,192,000      
Gross amount of which carried at close of period, total 7,857,000      
Gross amount of which carried at close of period, accumulated deprecation (701,000)      
Missouri Skilled Nursing Facility Portfolio | Missouri SNF Portfolio One | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 800,000      
Initial cost to company, buildings and improvements 10,363,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 800,000      
Gross amount of which carried at close of period, buildings and improvements 10,363,000      
Gross amount of which carried at close of period, total 11,163,000      
Gross amount of which carried at close of period, accumulated deprecation (692,000)      
Missouri Skilled Nursing Facility Portfolio | Missouri SNF Portfolio Two | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 2,090,000      
Initial cost to company, buildings and improvements 10,527,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 2,090,000      
Gross amount of which carried at close of period, buildings and improvements 10,527,000      
Gross amount of which carried at close of period, total 12,617,000      
Gross amount of which carried at close of period, accumulated deprecation (821,000)      
Missouri Skilled Nursing Facility Portfolio | Missouri SNF Portfolio Three | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 493,000      
Initial cost to company, buildings and improvements 7,057,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 493,000      
Gross amount of which carried at close of period, buildings and improvements 7,057,000      
Gross amount of which carried at close of period, total 7,550,000      
Gross amount of which carried at close of period, accumulated deprecation (464,000)      
Missouri Skilled Nursing Facility Portfolio | Missouri SNF Portfolio Four | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 729,000      
Initial cost to company, buildings and improvements 10,187,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 729,000      
Gross amount of which carried at close of period, buildings and improvements 10,187,000      
Gross amount of which carried at close of period, total 10,916,000      
Gross amount of which carried at close of period, accumulated deprecation (658,000)      
Missouri Skilled Nursing Facility Portfolio | Missouri SNF Portfolio Five | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 515,000      
Initial cost to company, buildings and improvements 8,852,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 515,000      
Gross amount of which carried at close of period, buildings and improvements 8,852,000      
Gross amount of which carried at close of period, total 9,367,000      
Gross amount of which carried at close of period, accumulated deprecation (584,000)      
Missouri Skilled Nursing Facility Portfolio | Missouri SNF Portfolio Six | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 631,000      
Initial cost to company, buildings and improvements 24,172,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 631,000      
Gross amount of which carried at close of period, buildings and improvements 24,172,000      
Gross amount of which carried at close of period, total 24,803,000      
Gross amount of which carried at close of period, accumulated deprecation (1,466,000)      
Missouri Skilled Nursing Facility Portfolio | Missouri SNF Portfolio Seven | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 437,000      
Initial cost to company, buildings and improvements 4,561,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 437,000      
Gross amount of which carried at close of period, buildings and improvements 4,561,000      
Gross amount of which carried at close of period, total 4,998,000      
Gross amount of which carried at close of period, accumulated deprecation (307,000)      
Missouri Skilled Nursing Facility Portfolio | Missouri SNF Portfolio Eight | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 310,000      
Initial cost to company, buildings and improvements 4,875,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 310,000      
Gross amount of which carried at close of period, buildings and improvements 4,875,000      
Gross amount of which carried at close of period, total 5,185,000      
Gross amount of which carried at close of period, accumulated deprecation (316,000)      
Flemington OM | Flemington OM Portfolio One | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,419,000      
Initial cost to company, buildings and improvements 11,110,000      
Cost capitalized subsequent to acquisition 553,000      
Gross amount of which carried at close of period, land 1,419,000      
Gross amount of which carried at close of period, buildings and improvements 11,663,000      
Gross amount of which carried at close of period, total 13,082,000      
Gross amount of which carried at close of period, accumulated deprecation (1,107,000)      
Flemington OM | Flemington OM Portfolio Two | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 578,000      
Initial cost to company, buildings and improvements 3,340,000      
Cost capitalized subsequent to acquisition 297,000      
Gross amount of which carried at close of period, land 578,000      
Gross amount of which carried at close of period, buildings and improvements 3,637,000      
Gross amount of which carried at close of period, total 4,215,000      
Gross amount of which carried at close of period, accumulated deprecation (370,000)      
Lawrenceville OM II | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,058,000      
Initial cost to company, buildings and improvements 9,709,000      
Cost capitalized subsequent to acquisition 1,718,000      
Gross amount of which carried at close of period, land 1,058,000      
Gross amount of which carried at close of period, buildings and improvements 11,427,000      
Gross amount of which carried at close of period, total 12,485,000      
Gross amount of which carried at close of period, accumulated deprecation (994,000)      
Mill Creek OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,344,000      
Initial cost to company, buildings and improvements 7,516,000      
Cost capitalized subsequent to acquisition 535,000      
Gross amount of which carried at close of period, land 1,344,000      
Gross amount of which carried at close of period, buildings and improvements 8,051,000      
Gross amount of which carried at close of period, total 9,395,000      
Gross amount of which carried at close of period, accumulated deprecation (610,000)      
Modesto OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 16,065,000      
Cost capitalized subsequent to acquisition 479,000      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 16,544,000      
Gross amount of which carried at close of period, total 16,544,000      
Gross amount of which carried at close of period, accumulated deprecation (1,310,000)      
Michigan ALF Portfolio | Michigan ALF Portfolio One | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,196,000      
Initial cost to company, buildings and improvements 8,955,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 1,196,000      
Gross amount of which carried at close of period, buildings and improvements 8,955,000      
Gross amount of which carried at close of period, total 10,151,000      
Gross amount of which carried at close of period, accumulated deprecation (619,000)      
Michigan ALF Portfolio | Michigan ALF Portfolio Two | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 9,608,000      
Initial cost to company, land 1,291,000      
Initial cost to company, buildings and improvements 11,308,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 1,291,000      
Gross amount of which carried at close of period, buildings and improvements 11,308,000      
Gross amount of which carried at close of period, total 12,599,000      
Gross amount of which carried at close of period, accumulated deprecation (779,000)      
Michigan ALF Portfolio | Michigan ALF Portfolio Three | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 716,000      
Initial cost to company, buildings and improvements 6,534,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 716,000      
Gross amount of which carried at close of period, buildings and improvements 6,534,000      
Gross amount of which carried at close of period, total 7,250,000      
Gross amount of which carried at close of period, accumulated deprecation (518,000)      
Michigan ALF Portfolio | Michigan ALF Portfolio Four | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 836,000      
Initial cost to company, buildings and improvements 4,202,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 836,000      
Gross amount of which carried at close of period, buildings and improvements 4,202,000      
Gross amount of which carried at close of period, total 5,038,000      
Gross amount of which carried at close of period, accumulated deprecation (290,000)      
Michigan ALF Portfolio | Michigan ALF Portfolio Five | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,300,000      
Initial cost to company, buildings and improvements 11,629,000      
Cost capitalized subsequent to acquisition 3,000      
Gross amount of which carried at close of period, land 1,300,000      
Gross amount of which carried at close of period, buildings and improvements 11,632,000      
Gross amount of which carried at close of period, total 12,932,000      
Gross amount of which carried at close of period, accumulated deprecation (767,000)      
Michigan ALF Portfolio | Michigan ALF Portfolio Six | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,343,000      
Initial cost to company, buildings and improvements 13,347,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 1,343,000      
Gross amount of which carried at close of period, buildings and improvements 13,347,000      
Gross amount of which carried at close of period, total 14,690,000      
Gross amount of which carried at close of period, accumulated deprecation (881,000)      
Lithonia OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,676,000      
Initial cost to company, buildings and improvements 10,871,000      
Cost capitalized subsequent to acquisition 895,000      
Gross amount of which carried at close of period, land 1,676,000      
Gross amount of which carried at close of period, buildings and improvements 11,766,000      
Gross amount of which carried at close of period, total 13,442,000      
Gross amount of which carried at close of period, accumulated deprecation (1,015,000)      
West Des Moines SNF | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 509,000      
Initial cost to company, buildings and improvements 3,813,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 509,000      
Gross amount of which carried at close of period, buildings and improvements 3,813,000      
Gross amount of which carried at close of period, total 4,322,000      
Gross amount of which carried at close of period, accumulated deprecation (260,000)      
Great Nord OM Portfolio | Great Nord OM Portfolio One | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 0      
Initial cost to company, buildings and improvements 15,423,000      
Cost capitalized subsequent to acquisition 945,000      
Gross amount of which carried at close of period, land 0      
Gross amount of which carried at close of period, buildings and improvements 16,368,000      
Gross amount of which carried at close of period, total 16,368,000      
Gross amount of which carried at close of period, accumulated deprecation (1,491,000)      
Great Nord OM Portfolio | Great Nord OM Portfolio Two | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 743,000      
Initial cost to company, buildings and improvements 9,070,000      
Cost capitalized subsequent to acquisition 260,000      
Gross amount of which carried at close of period, land 743,000      
Gross amount of which carried at close of period, buildings and improvements 9,330,000      
Gross amount of which carried at close of period, total 10,073,000      
Gross amount of which carried at close of period, accumulated deprecation (912,000)      
Great Nord OM Portfolio | Great Nord OM Portfolio Three | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 265,000      
Initial cost to company, buildings and improvements 5,467,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 265,000      
Gross amount of which carried at close of period, buildings and improvements 5,467,000      
Gross amount of which carried at close of period, total 5,732,000      
Gross amount of which carried at close of period, accumulated deprecation (451,000)      
Great Nord OM Portfolio | Great Nord OM Portfolio Four | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,491,000      
Initial cost to company, buildings and improvements 12,994,000      
Cost capitalized subsequent to acquisition 68,000      
Gross amount of which carried at close of period, land 1,491,000      
Gross amount of which carried at close of period, buildings and improvements 13,062,000      
Gross amount of which carried at close of period, total 14,553,000      
Gross amount of which carried at close of period, accumulated deprecation (1,106,000)      
Overland Park OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 2,803,000      
Initial cost to company, buildings and improvements 23,639,000      
Cost capitalized subsequent to acquisition 640,000      
Gross amount of which carried at close of period, land 2,803,000      
Gross amount of which carried at close of period, buildings and improvements 24,279,000      
Gross amount of which carried at close of period, total 27,082,000      
Gross amount of which carried at close of period, accumulated deprecation (1,942,000)      
Blue Badger OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,518,000      
Initial cost to company, buildings and improvements 12,543,000      
Cost capitalized subsequent to acquisition 28,000      
Gross amount of which carried at close of period, land 1,518,000      
Gross amount of which carried at close of period, buildings and improvements 12,571,000      
Gross amount of which carried at close of period, total 14,089,000      
Gross amount of which carried at close of period, accumulated deprecation (948,000)      
Bloomington OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 2,114,000      
Initial cost to company, buildings and improvements 17,363,000      
Cost capitalized subsequent to acquisition 0      
Gross amount of which carried at close of period, land 2,114,000      
Gross amount of which carried at close of period, buildings and improvements 17,363,000      
Gross amount of which carried at close of period, total 19,477,000      
Gross amount of which carried at close of period, accumulated deprecation (1,102,000)      
Haverhill OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,393,000      
Initial cost to company, buildings and improvements 15,477,000      
Cost capitalized subsequent to acquisition 96,000      
Gross amount of which carried at close of period, land 1,393,000      
Gross amount of which carried at close of period, buildings and improvements 15,573,000      
Gross amount of which carried at close of period, total 16,966,000      
Gross amount of which carried at close of period, accumulated deprecation (1,493,000)      
Fresno OM | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,536,000      
Initial cost to company, buildings and improvements 8,964,000      
Cost capitalized subsequent to acquisition 291,000      
Gross amount of which carried at close of period, land 1,536,000      
Gross amount of which carried at close of period, buildings and improvements 9,255,000      
Gross amount of which carried at close of period, total 10,791,000      
Gross amount of which carried at close of period, accumulated deprecation (850,000)      
Colorado Foothills OM Portfolio | Colorado Foothills OM Portfolio One | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 695,000      
Initial cost to company, buildings and improvements 6,369,000      
Cost capitalized subsequent to acquisition 292,000      
Gross amount of which carried at close of period, land 695,000      
Gross amount of which carried at close of period, buildings and improvements 6,661,000      
Gross amount of which carried at close of period, total 7,356,000      
Gross amount of which carried at close of period, accumulated deprecation (786,000)      
Colorado Foothills OM Portfolio | Colorado Foothills OM Portfolio Two | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 873,000      
Initial cost to company, buildings and improvements 11,233,000      
Cost capitalized subsequent to acquisition 346,000      
Gross amount of which carried at close of period, land 873,000      
Gross amount of which carried at close of period, buildings and improvements 11,579,000      
Gross amount of which carried at close of period, total 12,452,000      
Gross amount of which carried at close of period, accumulated deprecation (1,037,000)      
Colorado Foothills OM Portfolio | Colorado Foothills OM Portfolio Three | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 2,225,000      
Initial cost to company, buildings and improvements 12,520,000      
Cost capitalized subsequent to acquisition 1,007,000      
Gross amount of which carried at close of period, land 2,225,000      
Gross amount of which carried at close of period, buildings and improvements 13,527,000      
Gross amount of which carried at close of period, total 15,752,000      
Gross amount of which carried at close of period, accumulated deprecation (1,052,000)      
Catalina West Haven ALF | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,936,000      
Initial cost to company, buildings and improvements 10,415,000      
Cost capitalized subsequent to acquisition 253,000      
Gross amount of which carried at close of period, land 1,936,000      
Gross amount of which carried at close of period, buildings and improvements 10,668,000      
Gross amount of which carried at close of period, total 12,604,000      
Gross amount of which carried at close of period, accumulated deprecation (697,000)      
Louisiana Senior Housing Portfolio | Louisiana Senior Housing Portfolio One | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,123,000      
Initial cost to company, buildings and improvements 5,668,000      
Cost capitalized subsequent to acquisition 142,000      
Gross amount of which carried at close of period, land 1,123,000      
Gross amount of which carried at close of period, buildings and improvements 5,810,000      
Gross amount of which carried at close of period, total 6,933,000      
Gross amount of which carried at close of period, accumulated deprecation (404,000)      
Louisiana Senior Housing Portfolio | Louisiana Senior Housing Portfolio Two | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 834,000      
Initial cost to company, buildings and improvements 4,037,000      
Cost capitalized subsequent to acquisition 393,000      
Gross amount of which carried at close of period, land 834,000      
Gross amount of which carried at close of period, buildings and improvements 4,430,000      
Gross amount of which carried at close of period, total 5,264,000      
Gross amount of which carried at close of period, accumulated deprecation (268,000)      
Louisiana Senior Housing Portfolio | Louisiana Senior Housing Portfolio Three | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 952,000      
Initial cost to company, buildings and improvements 5,257,000      
Cost capitalized subsequent to acquisition 54,000      
Gross amount of which carried at close of period, land 952,000      
Gross amount of which carried at close of period, buildings and improvements 5,311,000      
Gross amount of which carried at close of period, total 6,263,000      
Gross amount of which carried at close of period, accumulated deprecation (357,000)      
Louisiana Senior Housing Portfolio | Louisiana Senior Housing Portfolio Four | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,177,000      
Initial cost to company, buildings and improvements 6,810,000      
Cost capitalized subsequent to acquisition 54,000      
Gross amount of which carried at close of period, land 1,177,000      
Gross amount of which carried at close of period, buildings and improvements 6,864,000      
Gross amount of which carried at close of period, total 8,041,000      
Gross amount of which carried at close of period, accumulated deprecation (437,000)      
Louisiana Senior Housing Portfolio | Louisiana Senior Housing Portfolio Five | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 801,000      
Initial cost to company, buildings and improvements 4,348,000      
Cost capitalized subsequent to acquisition 194,000      
Gross amount of which carried at close of period, land 801,000      
Gross amount of which carried at close of period, buildings and improvements 4,542,000      
Gross amount of which carried at close of period, total 5,343,000      
Gross amount of which carried at close of period, accumulated deprecation (320,000)      
Catalina Madera ALF | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,312,000      
Initial cost to company, buildings and improvements 15,299,000      
Cost capitalized subsequent to acquisition 375,000      
Gross amount of which carried at close of period, land 1,312,000      
Gross amount of which carried at close of period, buildings and improvements 15,674,000      
Gross amount of which carried at close of period, total 16,986,000      
Gross amount of which carried at close of period, accumulated deprecation (1,008,000)      
Cedar Creek Health Campus | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 2,326,000      
Initial cost to company, buildings and improvements 12,650,000      
Cost capitalized subsequent to acquisition 770,000      
Gross amount of which carried at close of period, land 2,864,000      
Gross amount of which carried at close of period, buildings and improvements 12,882,000      
Gross amount of which carried at close of period, total 15,746,000      
Gross amount of which carried at close of period, accumulated deprecation (833,000)      
The Oaks of Belmont | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 14,795,000      
Initial cost to company, land 767,000      
Initial cost to company, buildings and improvements 17,043,000      
Cost capitalized subsequent to acquisition 192,000      
Gross amount of which carried at close of period, land 1,068,000      
Gross amount of which carried at close of period, buildings and improvements 16,934,000      
Gross amount of which carried at close of period, total 18,002,000      
Gross amount of which carried at close of period, accumulated deprecation (1,349,000)      
The Willows at Springhurst (ISHC) | Louisville, KY One | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 20,800,000      
Initial cost to company, land 1,876,000      
Initial cost to company, buildings and improvements 12,595,000      
Cost capitalized subsequent to acquisition (547,000)      
Gross amount of which carried at close of period, land 1,952,000      
Gross amount of which carried at close of period, buildings and improvements 11,972,000      
Gross amount of which carried at close of period, total 13,924,000      
Gross amount of which carried at close of period, accumulated deprecation (702,000)      
The Willows at Springhurst (ISHC) | Louisville, KY Two | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,184,000      
Initial cost to company, buildings and improvements 6,483,000      
Cost capitalized subsequent to acquisition (34,000)      
Gross amount of which carried at close of period, land 1,184,000      
Gross amount of which carried at close of period, buildings and improvements 6,449,000      
Gross amount of which carried at close of period, total 7,633,000      
Gross amount of which carried at close of period, accumulated deprecation (375,000)      
The Willows at Harrodsburg (ISHC) | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 7,125,000      
Initial cost to company, land 918,000      
Initial cost to company, buildings and improvements 10,181,000      
Cost capitalized subsequent to acquisition 1,396,000      
Gross amount of which carried at close of period, land 1,594,000      
Gross amount of which carried at close of period, buildings and improvements 10,901,000      
Gross amount of which carried at close of period, total 12,495,000      
Gross amount of which carried at close of period, accumulated deprecation (567,000)      
North River Health Campus (ISHC) | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 17,100,000      
Initial cost to company, land 2,614,000      
Initial cost to company, buildings and improvements 15,031,000      
Cost capitalized subsequent to acquisition 94,000      
Gross amount of which carried at close of period, land 2,631,000      
Gross amount of which carried at close of period, buildings and improvements 15,108,000      
Gross amount of which carried at close of period, total 17,739,000      
Gross amount of which carried at close of period, accumulated deprecation (874,000)      
Trilogy Healthcare of Jefferson III, LLC (ISHC) | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 14,175,000      
Initial cost to company, land 2,265,000      
Initial cost to company, buildings and improvements 14,077,000      
Cost capitalized subsequent to acquisition 356,000      
Gross amount of which carried at close of period, land 2,265,000      
Gross amount of which carried at close of period, buildings and improvements 14,433,000      
Gross amount of which carried at close of period, total 16,698,000      
Gross amount of which carried at close of period, accumulated deprecation (722,000)      
Pickerington Health Campus (ISHC) | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 13,050,000      
Initial cost to company, land 860,000      
Initial cost to company, buildings and improvements 15,575,000      
Cost capitalized subsequent to acquisition 30,000      
Gross amount of which carried at close of period, land 880,000      
Gross amount of which carried at close of period, buildings and improvements 15,585,000      
Gross amount of which carried at close of period, total 16,465,000      
Gross amount of which carried at close of period, accumulated deprecation (1,712,000)      
Mt. Washington Development Project (ISHC) | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 14,325,000      
Initial cost to company, land 2,054,000      
Initial cost to company, buildings and improvements 10,225,000      
Cost capitalized subsequent to acquisition 24,000      
Gross amount of which carried at close of period, land 2,054,000      
Gross amount of which carried at close of period, buildings and improvements 10,249,000      
Gross amount of which carried at close of period, total 12,303,000      
Gross amount of which carried at close of period, accumulated deprecation (578,000)      
Silvercrest Health Center (ISHC) | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 20,259,000      
Initial cost to company, land 1,920,000      
Initial cost to company, buildings and improvements 24,965,000      
Cost capitalized subsequent to acquisition 352,000      
Gross amount of which carried at close of period, land 1,920,000      
Gross amount of which carried at close of period, buildings and improvements 25,317,000      
Gross amount of which carried at close of period, total 27,237,000      
Gross amount of which carried at close of period, accumulated deprecation (1,018,000)      
The Springs of Mooresville (ISHC) | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 13,853,000      
Initial cost to company, land 1,460,000      
Initial cost to company, buildings and improvements 12,617,000      
Cost capitalized subsequent to acquisition 99,000      
Gross amount of which carried at close of period, land 1,460,000      
Gross amount of which carried at close of period, buildings and improvements 12,716,000      
Gross amount of which carried at close of period, total 14,176,000      
Gross amount of which carried at close of period, accumulated deprecation (510,000)      
Hearthstone Health Campus (ISHC) | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 19,008,000      
Initial cost to company, land 2,140,000      
Initial cost to company, buildings and improvements 16,928,000      
Cost capitalized subsequent to acquisition 202,000      
Gross amount of which carried at close of period, land 2,160,000      
Gross amount of which carried at close of period, buildings and improvements 17,110,000      
Gross amount of which carried at close of period, total 19,270,000      
Gross amount of which carried at close of period, accumulated deprecation (732,000)      
AHR Texas ALF Portfolio (SHOP) | Temple, TX | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 14,561,000      
Initial cost to company, land 1,819,000      
Initial cost to company, buildings and improvements 11,090,000      
Cost capitalized subsequent to acquisition 217,000      
Gross amount of which carried at close of period, land 1,819,000      
Gross amount of which carried at close of period, buildings and improvements 11,307,000      
Gross amount of which carried at close of period, total 13,126,000      
Gross amount of which carried at close of period, accumulated deprecation (416,000)      
AHR Texas ALF Portfolio (SHOP) | Cedar Park, TX | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 5,744,000      
Initial cost to company, land 1,347,000      
Initial cost to company, buildings and improvements 5,250,000      
Cost capitalized subsequent to acquisition 114,000      
Gross amount of which carried at close of period, land 1,347,000      
Gross amount of which carried at close of period, buildings and improvements 5,364,000      
Gross amount of which carried at close of period, total 6,711,000      
Gross amount of which carried at close of period, accumulated deprecation (206,000)      
AHR Texas ALF Portfolio (SHOP) | Corpus Christi, TX | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 14,174,000      
Initial cost to company, land 1,229,000      
Initial cost to company, buildings and improvements 12,663,000      
Cost capitalized subsequent to acquisition 98,000      
Gross amount of which carried at close of period, land 1,229,000      
Gross amount of which carried at close of period, buildings and improvements 12,761,000      
Gross amount of which carried at close of period, total 13,990,000      
Gross amount of which carried at close of period, accumulated deprecation (465,000)      
AHR Texas ALF Portfolio (SHOP) | League City, TX | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 15,537,000      
Initial cost to company, land 1,435,000      
Initial cost to company, buildings and improvements 15,475,000      
Cost capitalized subsequent to acquisition 125,000      
Gross amount of which carried at close of period, land 1,435,000      
Gross amount of which carried at close of period, buildings and improvements 15,600,000      
Gross amount of which carried at close of period, total 17,035,000      
Gross amount of which carried at close of period, accumulated deprecation (512,000)      
AHR Texas ALF Portfolio (SHOP) | Round Rock, TX | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 21,123,000      
Initial cost to company, land 2,124,000      
Initial cost to company, buildings and improvements 14,895,000      
Cost capitalized subsequent to acquisition 383,000      
Gross amount of which carried at close of period, land 2,124,000      
Gross amount of which carried at close of period, buildings and improvements 15,278,000      
Gross amount of which carried at close of period, total 17,402,000      
Gross amount of which carried at close of period, accumulated deprecation (502,000)      
AHR Texas ALF Portfolio (SHOP) | Sugarland, TX | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 27,780,000      
Initial cost to company, land 2,674,000      
Initial cost to company, buildings and improvements 12,751,000      
Cost capitalized subsequent to acquisition 155,000      
Gross amount of which carried at close of period, land 2,674,000      
Gross amount of which carried at close of period, buildings and improvements 12,906,000      
Gross amount of which carried at close of period, total 15,580,000      
Gross amount of which carried at close of period, accumulated deprecation (450,000)      
AHR Texas ALF Portfolio (SHOP) | Tyler, TX | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 9,667,000      
Initial cost to company, land 1,131,000      
Initial cost to company, buildings and improvements 10,510,000      
Cost capitalized subsequent to acquisition 103,000      
Gross amount of which carried at close of period, land 1,131,000      
Gross amount of which carried at close of period, buildings and improvements 10,613,000      
Gross amount of which carried at close of period, total 11,744,000      
Gross amount of which carried at close of period, accumulated deprecation (384,000)      
Orchard Pointe Health Campus | Kendallville, IN | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 10,176,000      
Initial cost to company, land 1,806,000      
Initial cost to company, buildings and improvements 9,243,000      
Cost capitalized subsequent to acquisition 15,000      
Gross amount of which carried at close of period, land 1,806,000      
Gross amount of which carried at close of period, buildings and improvements 9,258,000      
Gross amount of which carried at close of period, total 11,064,000      
The Springs of Lima | Lima, OH | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 10,765,000      
Initial cost to company, land 2,397,000      
Initial cost to company, buildings and improvements 9,638,000      
Cost capitalized subsequent to acquisition 50,000      
Gross amount of which carried at close of period, land 2,403,000      
Gross amount of which carried at close of period, buildings and improvements 9,682,000      
Gross amount of which carried at close of period, total 12,085,000      
Gross amount of which carried at close of period, accumulated deprecation (1,216,000)      
Wooded Glen | Springfield, OH | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 14,450,000      
Initial cost to company, land 2,803,000      
Initial cost to company, buildings and improvements 11,928,000      
Cost capitalized subsequent to acquisition 15,000      
Gross amount of which carried at close of period, land 2,803,000      
Gross amount of which carried at close of period, buildings and improvements 11,943,000      
Gross amount of which carried at close of period, total 14,746,000      
Gross amount of which carried at close of period, accumulated deprecation (1,436,000)      
The Lake of Sylvania | Sylvania, OH | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 19,493,000      
Initial cost to company, land 3,208,000      
Initial cost to company, buildings and improvements 15,059,000      
Cost capitalized subsequent to acquisition 232,000      
Gross amount of which carried at close of period, land 3,265,000      
Gross amount of which carried at close of period, buildings and improvements 15,234,000      
Gross amount of which carried at close of period, total 18,499,000      
Gross amount of which carried at close of period, accumulated deprecation (1,869,000)      
The Glen | Union Township, OH | Property, Excluding Leased Property [Member]        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 14,741,000      
Initial cost to company, land 2,789,000      
Initial cost to company, buildings and improvements 12,343,000      
Cost capitalized subsequent to acquisition 35,000      
Gross amount of which carried at close of period, land 2,789,000      
Gross amount of which carried at close of period, buildings and improvements 12,378,000      
Gross amount of which carried at close of period, total 15,167,000      
Gross amount of which carried at close of period, accumulated deprecation (1,431,000)      
The Legacy at English Station | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Initial cost to company, land 912,000      
Initial cost to company, buildings and improvements 10,139,000      
Cost capitalized subsequent to acquisition 56,000      
Gross amount of which carried at close of period, land 912,000      
Gross amount of which carried at close of period, buildings and improvements 10,195,000      
Gross amount of which carried at close of period, total 11,107,000      
Gross amount of which carried at close of period, accumulated deprecation (255,000)      
The Legacy at English Station | Louisville, KY | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 7,700,000      
The Village at Oak Ridge | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 12,901,000      
Initial cost to company, land 1,483,000      
Initial cost to company, buildings and improvements 11,551,000      
Cost capitalized subsequent to acquisition 1,799,000      
Gross amount of which carried at close of period, land 1,483,000      
Gross amount of which carried at close of period, buildings and improvements 13,350,000      
Gross amount of which carried at close of period, total 14,833,000      
Gross amount of which carried at close of period, accumulated deprecation (174,000)      
Smith's Mill Health Campus | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 0      
Initial cost to company, land 1,323,000      
Initial cost to company, buildings and improvements 15,271,000      
Cost capitalized subsequent to acquisition 46,000      
Gross amount of which carried at close of period, land 1,323,000      
Gross amount of which carried at close of period, buildings and improvements 15,317,000      
Gross amount of which carried at close of period, total 16,640,000      
Gross amount of which carried at close of period, accumulated deprecation (255,000)      
Oakwood Health Center Villas | Property, Excluding Construction in Progress        
Real Estate and Accumulated Depreciation [Line Items]        
Encumbrances 1,988,000      
Initial cost to company, land 535,000      
Initial cost to company, buildings and improvements 1,555,000      
Cost capitalized subsequent to acquisition 131,000      
Gross amount of which carried at close of period, land 541,000      
Gross amount of which carried at close of period, buildings and improvements 1,680,000      
Gross amount of which carried at close of period, total 2,221,000      
Gross amount of which carried at close of period, accumulated deprecation $ (47,000)      
v3.24.1
Schedule III Real Estate and Accumulated Depreciation (Details 2) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Real Estate and Accumulated Depreciation [Line Items]    
Ownership percentage, excluding joint venture, properties 100.00%  
Lines of credit and term loan [1] $ 1,223,967 $ 1,281,794
Aggregate cost of properties for federal income tax purposes $ 4,051,405  
Building and Building Improvements [Member]    
Real Estate and Accumulated Depreciation [Line Items]    
Estimated useful life 39 years  
Leasehold Improvements [Member] | Maximum    
Real Estate and Accumulated Depreciation [Line Items]    
Estimated useful life 34 years  
Furniture, fixtures and equipment | Maximum    
Real Estate and Accumulated Depreciation [Line Items]    
Estimated useful life 28 years  
Revolving Credit Facility | 2019 Trilogy Credit Facility [Member]    
Real Estate and Accumulated Depreciation [Line Items]    
Lines of credit and term loan $ 309,823 $ 316,734
[1] Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of December 31, 2023 and 2022. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2022 Credit Facility, as defined in Note 9, held by American Healthcare REIT Holdings, LP in the amount of $914,900 and $965,900, as of December 31, 2023 and 2022, respectively, which was guaranteed by American Healthcare REIT, Inc.
v3.24.1
Schedule III Real Estate and Accumulated Depreciation (Changes in Total Real Estate Assets) (Detail) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Reconciliation of Carrying Amount of Real Estate Investments [Roll Forward]      
Beginning balance $ 4,236,447 $ 4,038,572 $ 2,762,272
Acquisitions 55,658 254,947 1,225,626
Additions 97,667 72,802 87,909
Dispositions and impairments (214,906) (123,841) (36,645)
Foreign currency translation adjustment 2,729 (6,033) (590)
Ending balance 4,177,595 $ 4,236,447 $ 4,038,572
Aggregate cost of properties for federal income tax purposes $ 4,051,405    
v3.24.1
Schedule III Real Estate and Accumulated Depreciation (Changes in Accumulated Depreciation) (Detail) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Reconciliation of Real Estate Accumulated Depreciation [Roll Forward]      
Beginning balance $ 654,838 $ 523,886 $ 425,272
Additions 147,587 141,257 109,036
Dispositions and impairments (50,790) (9,355) (10,320)
Foreign currency translation adjustment 522 (950) (102)
Ending balance $ 752,157 $ 654,838 $ 523,886