0001075415dhc:South25thStreet222TerraHauteINMemberus-gaap:SegmentContinuingOperationsMember2020-12-310001075415us-gaap:SegmentContinuingOperationsMemberdhc:OldCountyRoad200MineolaNYMember2023-01-012023-12-31
Table of Contents

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
FORM 10-K
ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the fiscal year ended December 31, 20202023
or
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
Commission file number 1-15319
DIVERSIFIED HEALTHCARE TRUST
(Exact Name of Registrant as Specified in Its Charter)
Maryland04-3445278
(State of Organization)(IRSI.R.S. Employer Identification No.)
Two Newton Place, 255 Washington Street, Suite 300, Newton, MA 02458-1634
(Address of Principal Executive Offices) (Zip Code)
617-796-8350
(Registrant's Telephone Number, Including Area Code)
Securities registered pursuant to Section 12(b) of the Act:
Title Of Each ClassTrading Symbol(s)Name Of Each Exchange On Which Registered
Common Shares of Beneficial InterestDHCThe Nasdaq Stock Market LLC
5.625% Senior Notes due 2042DHCNIThe Nasdaq Stock Market LLC
6.25% Senior Notes due 2046DHCNLThe Nasdaq Stock Market LLC
    Securities registered pursuant to Section 12(g) of the Act: None
    Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes x  No ¨
    Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes ¨  No x
    Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes x  No ¨
    Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes x  No ¨    
    Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company” and “emerging growth company” in Rule 12b-2 of the Exchange Act.
Large accelerated filerxAccelerated filerxNon-Accelerated filer
Smaller reporting companyEmerging growth company
    If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ¨
    Indicate by check mark whether the registrant has filed a report on and attestation to its management's assessment of the effectiveness of its internal control over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the registered public accounting firm that prepared or issued its audit report.
    If securities are registered pursuant to Section 12(b) of the Act, indicate by check mark whether the financial statements of the registrant included in the filing reflect the correction of an error to previously issued financial statements.
    Indicate by check mark whether any of those error corrections are restatements that required a recovery analysis of incentive-based compensation received by any of the registrant's executive officers during the relevant recovery period pursuant to § 240.10D-1(b).
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes  No x
    The aggregate market value of the voting common shares of beneficial interest, $.01 par value, or common shares, of the registrant held by non-affiliates was approximately $1.0 billion$485.2 million based on the $4.43$2.25 closing price per common share on The Nasdaq Stock Market LLC on June 30, 2020.2023. For purposes of this calculation, an aggregate of 3,014,39024,133,010 common shares held directly by, or by affiliates of, the trustees and the executive officers of the registrant have been included in the number of common shares held by affiliates.
    Number of the registrant's common shares outstanding as of February 23, 2021: 238,268,478.21, 2024: 240,418,363
    References in this Annual Report on Form 10-K to the Company, DHC, we, us or our mean Diversified Healthcare Trust and its consolidated subsidiaries unless otherwise expressly stated or the context indicates otherwise.
DOCUMENTS INCORPORATED BY REFERENCE
    Certain information required by Items 10, 11, 12, 13 and 14 of Part III of this Annual Report on Form 10-K is incorporated by reference to our definitive Proxy Statement for the 20212024 Annual Meeting of Shareholders, to be filed with the Securities and Exchange Commission within 120 days after the fiscal year ended December 31, 2020.2023.


Table of Contents

Warning Concerning Forward-Looking Statements
This Annual Report on Form 10-K contains statements that constitute forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 and other securities laws. Also, whenever we uselaws that are subject to risks and uncertainties. These statements may include words such as “believe,” “expect,” “anticipate,” “intend,” “plan,” “estimate,” “will,”“believe”, “expect”, “anticipate”, “intend”, “plan”, “estimate”, “will”, “may” and negatives or derivatives of these or similar expressions, we are making forward-looking statements.expressions. These forward-looking statements include, among others, statements about: our efforts to manage costs and increase occupancy at our Senior Housing Operating Portfolio, or SHOP, communities; demand for medical office and life science leased space; our future leasing activity; market demand and supply for healthcare services for older adults and senior living communities; our leverage; the sufficiency of our liquidity; our liquidity needs and sources; our capital expenditure plans and commitments; the transition of operations at certain of our senior living communities to new managers; our acquisitions and our pending or potential property dispositions; our redevelopment, repositioning and construction activities and plans; and the amount and timing of future distributions.
Forward-looking statements reflect our current expectations, are based uponon judgments and assumptions, are inherently uncertain and are subject to risks, uncertainties and other factors, which could cause our present intent, beliefsactual results, performance or expectations, butachievements to differ materially from expected future results, performance or achievements expressed or implied in those forward-looking statements. Some of the risks, uncertainties and other factors that may cause our actual results, performance or achievements to differ materially from those expressed or implied by forward-looking statements include, but are not guaranteedlimited to, occur and may not occur. Forward-looking statements in this Annual Report on Form 10-K relate to various aspects of our business, including:    the following:
The durationimpact of unfavorable market and severity ofcommercial real estate industry conditions due to possible reduced demand for healthcare related space and senior living communities, high interest rates, wage and commodity price inflation, limited labor availability, increased insurance costs, supply chain disruptions, volatility in the public equity and debt markets, pandemics, geopolitical instability and tensions, economic downturn resulting from the COVID-19 pandemic and its impactdownturns or a possible recession or changes in real estate utilization, among other things, on us and our tenants'managers and operators' businesses, including the ability of ourother operators and tenants, and senior living community residents to pay rent to us,
Our abilitysenior living operators' abilities to pay distributions to our shareholderssuccessfully and to sustainprofitably operate the amount of such distributions,communities they manage for us,
The abilitycontinuing impact of Five Star Senior Living Inc.,changing market practices, including those that arose or Five Star,intensified during the manager ofCOVID-19 pandemic, or delayed returns to prior market practices on us and our managedmanagers and other operators and tenants, such as reduced demand for leased office space and residencies at senior living communities, to minimize the negative impact from the COVID-19 pandemic on our senior living communitiesincreased operating costs and to manage them profitably and increase our returns,labor availability constraints,
Our belief that we are well positioned to weather the present disruptions facing the real estate industry and, in particular, the real estate healthcare industry, including the senior living industry,
Our belief that the healthcare sector and manyThe financial strength of our tenantsmanagers and our manager provide essential services across the United Statesother operators and the implication that our and our tenants' and managers' businesses will remain open to provide such essential services,tenants,
Whether the aging U.S. population and increasing life spans of seniors will increase the demand for senior living communities and other medical and healthcare related properties and healthcare services,
Our ability to retainWhether our existing tenants attract newwill renew or extend their leases or whether we will obtain replacement tenants and maintain or increase current rental rates on terms as favorable to us as our prior leases,
The credit qualities oflikelihood that our tenants and residents will pay rent or be negatively impacted by continuing unfavorable market and commercial real estate industry conditions,
Our abilitymanagers' abilities to compete for tenancies and acquisitions effectively,
Our abilityincrease or maintain rates charged to maintain and increase occupancy, revenues and net operating income, or NOI, at our properties, or to limit their decline during the COVID-19 pandemic and economic downturn,
The expectation that, other than inresidents of our senior housingliving communities and manage operating portfolio, or SHOP, segment, overall tenant retention levels may increase as a result of the COVID-19 pandemic and its aftermath,
Our applicationcosts for additional funds under the Coronavirus Aid, Relief, and Economic Security Act Provider Relief Fund may be denied and we may not receive any additional funding,
Our acquisitions and sales of properties,
Our closures of senior livingthose communities,
Our ability to raise debtincrease or equity capital,maintain occupancy at our properties on terms desirable to us,
Our ability to complete dispositions,increase rents when our leases expire or renew,
The future availability of borrowings underCosts we incur and concessions we grant to lease our revolving credit facility,properties,
Our policiesRisk and plansuncertainties regarding investments, financingsthe costs and dispositions,timing of development, redevelopment and repositioning activities, including as a result of prolonged high inflation, cost overruns, supply chain challenges, labor shortages, construction delays or inability to obtain necessary permits or volatility in the commercial real estate markets,
Our ability to pay interest onmanage our capital expenditures and principal ofother operating costs effectively and to maintain and enhance our debt,properties and their appeal to tenants and residents,
i

Table of Contents

Our ability to appropriatelyeffectively raise and balance our use of debt and equity capital,
Our ability to comply with the financial covenants under our debt agreements,
Our ability to make required payments on our debt,
Our ability to maintain sufficient liquidity and otherwise manage leverage,
Our credit ratings,
Our expectation thatability to sell properties at prices or returns we target,
Our ability to sell additional equity interests in, or contribute additional properties to, our existing joint ventures, or enter into additional real estate joint ventures or to attract co-venturers and benefit from our relationships withexisting joint ventures or any real estate joint ventures we may enter into,
Our ability to acquire, develop, redevelop or reposition properties that realize our targeted returns,
Our ability to pay distributions to our shareholders and to maintain or increase the amount of such distributions,
The ability of our manager, The RMR Group LLC, or RMR, LLC,to successfully manage us,
Our qualification for taxation as aCompetition in the real estate investment trust, or REIT, andindustry, particularly in those markets in which our properties are located,
Other matters.
Our actual results may differ materially from those contained in or implied by our forward-looking statements. Forward-looking statements involve knownGovernment regulations affecting Medicare and unknown risks, uncertaintiesMedicaid reimbursement rates and other factors, some of which are beyond our control. Risks, uncertainties and other factors that could have a material adverse effect on our forward-looking statements and upon our business, results of operations, financial condition, funds from operations attributable to common shareholders, or FFO attributable to common shareholders, normalized funds from operations attributable to common shareholders, or Normalized FFO attributable to common shareholders, NOI, cash flows, liquidity and prospects include, but are not limited to:
The impacts of the COVID-19 pandemic and its aftermath on us and our tenants' and operators' businesses,
The impact of conditions in the economy and the capital markets on us and our tenants and operators,operational requirements,
Compliance with, and changes to, federal, state and local laws and regulations, accounting rules, tax laws and similar matters,
Limitations imposed on our businessExposure to litigation and our abilityregulatory and government proceedings due to satisfy complex rules in order for us to maintain our qualification for taxation as a REIT for U.S. federal income tax purposes,
Competition within the healthcarenature of the senior living and real estate industries, particularly in those markets in which our properties are located,other health and wellness related service businesses,
Actual and potential conflicts of interest with our related parties, including our Managing Trustees, RMR, ABP Trust, AlerisLife Inc., or AlerisLife, including Five Star RMR LLCSenior Living, or Five Star, and others affiliated with them,
Limitations imposed by and our ability to satisfy complex rules to maintain our qualification for taxation as a real estate investment trust, or REIT, for U.S. federal income tax purposes,
Acts of terrorism, outbreaks or continuation of pandemics including the COVID-19 pandemic,or other public health safety events or conditions, war or other hostilities, material or prolonged disruption to supply chains, global climate change or other manmade or natural disasters beyond our control.
For example:
If the severity of the COVID-19 pandemic continues for an extended period or if business activity and the economy fail to sufficiently improve if and when the substantial adverse impacts of the COVID-19 pandemic abate, we may realize sustained losses and liquidity challenges. Further, we may incur increased operating expenses, particularly at our senior living communities, for supplies and personnel to address the current COVID-19 pandemic and we may be prevented from accepting additional residents at certain of our senior living communities if we become restricted from doing so due to the COVID-19 pandemic. In addition, under the current economic conditions, our tenants and operators may not be able to profitably operate their businesses at our properties, our tenants may become unable or unwilling to pay rent owed to us, or the manager of our senior living communities may be unable to generate our minimum returns for sustained periods. Additionally, our ability to borrow under our credit facility is subject to us satisfying financial and other covenants, and if we default under our credit facility or other debt obligations due to the impacts of the COVID-19 pandemic or otherwise, we may be required to repay our outstanding borrowings and other debt. Further, although we have taken steps to enhance our ability to maintain sufficient liquidity, unanticipated events, such as emergencies in addition to, or as an expansion of, the current impacts of the COVID-19 pandemic, may require us to expend amounts not currently planned,
This Annual Report on Form 10-K states that, as of February 20, 2021, more than 87% of residents and more than 43% of staff at our SHOP communities have received vaccinations and that we expect vaccination clinics for SHOP community residents and staff to be substantially complete by the end of the first quarter of 2021; however, the availability and rate of vaccinations may not continue at the current pace and may be delayed, including for reasons beyond our control,
ii

Table of Contents
This Annual Report on Form 10-K discusses recent increases in sales leads; however, recent increases in sales leads may not result in substantial move-ins by residents in the future, SHOP segment occupancy rates may not improve and could decline further and senior living performance may take longer to recover than we expect,
Five Star, the manager of our managed senior living communities, has experienced significant operating and financial challenges, resulting from a number of factors, some of which are beyond Five Star's control, and which challenges directly impact our operating results from our managed senior living communities, including, but not limited to:
The impacts of the COVID-19 pandemic,
Increases in Five Star's labor costs or in costs Five Star pays for goods and services,
Competition within the senior living industry,
Seniors delaying or forgoing moving into senior living communities or purchasing healthcare services that Five Star provides,
The impact of changes in the economy and the capital markets on Five Star and its residents and other customers,
Changes in Medicare or Medicaid policies and regulations or the possible future repeal, replacement or modification of these or other existing or proposed legislation or regulations,
Increases in compliance costs,
Continued efforts by third party payers to reduce healthcare costs,
Increases in tort and insurance liability costs, and
Five Star's exposure to litigation and regulatory and government proceedings due to the nature of its business.
We cannot be sure that the vaccination clinics that are being conducted by Five Star for SHOP community residents and staff will be substantially complete by the end of the first quarter of 2021,
We own a significant number of Five Star common shares and we expect to own these shares for the foreseeable future. However, we may sell some or all of our Five Star common shares, or our ownership interest in Five Star may otherwise be diluted in the future,
Our current cash distribution rate to common shareholders is $0.01 per share per quarter, or $0.04 per share per year, due to the operating challenges and uncertain economic challenges as a result of the COVID-19 pandemic. Our distribution rate may be set and reset from time to time by our Board of Trustees. Our Board of Trustees will consider many factors when setting or resetting our distribution rate, including our historical and projected net income, Normalized FFO, our then current and expected needs and availability of cash to pay our obligations, distributions which we may be required to pay to satisfy our REIT distribution requirements, limitations in the agreements governing our debt and other factors deemed relevant by our Board of Trustees in its discretion. Further, our projected cash available for distribution may change and may vary from our expectations. Accordingly, future distributions to our shareholders may be increased or decreased and we cannot be sure as to the rate at which future distributions will be paid,
Our ability to make future distributions to our shareholders and to make payments of principal and interest on our indebtedness depends upon a number of factors, including our future earnings, the capital costs we incur to lease and operate our properties and our working capital requirements. We may be unable to pay our debt obligations or to maintain our current rate of distributions on our common shares and future distributions may be reduced or eliminated,
We may be unable to repay our debt obligations when they become due,
We intend to conduct our business activities in a manner that will afford us reasonable access to capital for investment and financing activities. However, we may not succeed in this regard and we may not have reasonable access to capital,
iii

Table of Contents
Subject to limitations on acquisitions in agreements governing our debt, we plan to selectively sell certain properties from time to time to fund future acquisitions, and to strategically update, rebalance and reposition our investment portfolio, which we refer to as our capital recycling program. In addition, to reduce our leverage, we have sold properties and other assets and have identified additional properties to sell. We expect that the pace of our future asset sales will slow considerably because of current market conditions related to the COVID-19 pandemic. We cannot be sure we will sell any of these properties or what the terms or timing of any such sales may be. In addition, in the case of our capital recycling program, we cannot be sure that we will acquire replacement properties that improve the quality of our portfolio or our ability to increase our distributions to shareholders, and, we may sell properties at prices that are less than expected and less than their carrying values and therefore incur losses,
Contingencies in our acquisition and sale agreements that we may enter may not be satisfied and any acquisitions and sales pursuant to such agreements and any related management arrangements we may expect to enter may not occur, may be delayed or the terms of such transactions or arrangements may change,
The capital investments we are making at our senior living communities and our plan to invest additional capital into our senior living communities to better position them in their respective markets in order to increase our future returns may not be successful and may not achieve our expected results. Our senior living communities may not be competitive, despite these capital investments, or these capital investments may be delayed due to the COVID-19 pandemic,
Our redevelopment projects may not be successful and may cost more or take longer to complete than we currently expect. In addition, we may not realize the returns we expect from these projects and we may incur losses from these projects,
We may spend more for capital expenditures than we currently expect,
Our existing joint venture and any other joint ventures that we may enter may not be successful,
Our tenants may experience losses and default on their rent obligations to us,
Some of our tenants may not renew expiring leases, and we may be unable to obtain new tenants to maintain or increase the historical occupancy rates of, or rents from, our properties,
Our ability to grow our business and maintain or increase our distributions to shareholders depends in large part upon our ability to buy properties and arrange for their profitable operation or lease them for rents, less their property operating expenses, that exceed our capital costs. We are currently generally prohibited from making acquisitions pursuant to the agreement governing our revolving credit facility, or our credit agreement, during the Amendment Period (as defined below). In addition, even after these restrictions expire, we may be unable to identify properties that we want to acquire, and we may fail to reach agreement with the sellers and complete the purchase of any properties we do want to acquire. In addition, we may not realize the returns we expect on any properties we acquire,
Rents that we can charge at our properties may decline upon renewals or expirations because of changing market conditions or otherwise,
We expect to enter into additional management arrangements with Five Star for additional senior living communities that we own or may acquire in the future. However, we cannot be sure that we will enter into any additional management or other arrangements with Five Star,
Although we obtained a limited waiver of certain financial covenants under our credit agreement through June 2022, or the Amendment Period, we may fail to satisfy other covenants or conditions contained in such agreement or in the agreements governing our public debt. Our ability to borrow under our revolving credit facility is subject to our satisfying financial covenants and other conditions. If our operating results and financial condition are further significantly and adversely impacted by the COVID-19 pandemic and its aftermath or otherwise, we may fail to satisfy those covenants and condition, including the ratio of income available for debt service to debt service covenant, in which case we may be unable to borrow additional amounts under our revolving credit facility,
Actual costs under our revolving credit facility or other floating rate debt will be higher than the stated rates because of fees and expenses associated with such debt,
iv

Table of Contents
We have options to extend the maturity date of our revolving credit facility upon payment of a fee and meeting other conditions; however, the applicable conditions may not be met,
The premiums used to determine the interest rate payable on our revolving credit facility and term loan and the facility fee payable on our revolving credit facility are based on our credit ratings, which are subject to change,
For the year ended December 31, 2020, substantially all of our NOI was generated from properties where a majority of the revenues are derived from our tenants' and residents' private resources. This may imply that we will maintain or increase the percentage of our NOI generated from private resources at our senior living communities. However, our residents and patients may become unable to fund our charges with private resources and we may be required or may elect for business reasons to accept or pursue revenues from government sources, which could result in an increased part of our NOI and revenue being generated from government payments and our becoming more dependent on government payments,
Circumstances that adversely affect the ability of seniors or their families to pay for our manager's and other operators' services, such as economic downturns, weak housing market conditions, higher levels of unemployment among our residents' family members, lower levels of consumer confidence, stock market volatility and/or changes in demographics generally could affect the profitability of our senior living communities,
It is difficult to accurately estimate tenant space preparation costs. Our unspent leasing related obligations may cost more or less and may take longer to complete than we currently expect, and we may incur increasing amounts for these and similar purposes in the future,
Our senior living communities are subject to extensive government regulation, licensure and oversight. We sometimes experience deficiencies in the operation of our senior living communities and some of our communities may be prohibited from admitting new residents or our license to continue operations at a community may be revoked. Also, operating deficiencies or a license revocation at one or more of our senior living communities may have an adverse impact on our ability to obtain licenses for or attract residents to our other communities,
We believe that our relationships with our related parties, including Five Star and RMR LLC and others affiliated with them may benefit us and provide us with competitive advantages in operating and growing our business. However, the advantages we believe we may realize from these relationships may not materialize, and
The businessOther matters.
These risks, uncertainties and property management agreements between usother factors are not exhaustive and RMR LLC have continuing 20 year terms. However, those agreements permit early terminationshould be read in certain circumstances. Accordingly, we cannot be sureconjunction with other cautionary statements that these agreements will remain in effect for continuing 20 year terms.
Currently unexpected results could occur due to many different circumstances, some of which are beyond our control, such as the COVID-19 pandemic and its aftermath, new legislation or regulations affecting our business or the businesses of our tenants or operators, changesincluded in our tenants' or operators' revenues or costs, worsening or lack of improvement of Five Star's financial condition or changes in our other tenants' financial conditions, deficiencies in operations by a tenant or manager of one or more of our senior living communities, changed Medicare or Medicaid rates, acts of terrorism, pandemics, natural disasters or changes in capital markets or the economy generally.
periodic filings. The information contained elsewhere in this Annual Report on Form 10-K or in our other filings with the Securities and Exchange commission,Commission, or SEC, including under the caption “Risk Factors,”Factors”, or incorporated herein or therein, identifies other important factors that could cause differences from our forward-looking statements. Our other filings with the SEC are available on the SEC's website at www.sec.gov.
You should not place undue reliance upon our forward-looking statements.
Except as required by law, we do not intend to update or change any forward-looking statements as a result of new information, future events or otherwise.
vii

Table of Contents

Statement Concerning Limited Liability

The Amended and Restated Declaration of Trust establishing Diversified Healthcare Trust, dated September 20, 1999, as amended and supplemented, as filed with the State Department of Assessments and Taxation of Maryland, provides that no trustee, officer, shareholder, employee or agent of Diversified Healthcare Trust shall be held to any personal liability, jointly or severally, for any obligation of, or claim against, Diversified Healthcare Trust. All persons dealing with Diversified Healthcare Trust in any way shall look only to the assets of Diversified Healthcare Trust for the payment of any sum or the performance of any obligation.
viiii

Table of Contents

DIVERSIFIED HEALTHCARE TRUST
20202023 FORM 10-K ANNUAL REPORT
Table of Contents
    
  Page
  
  
  
  
   
  
 
 

viiiv

Table of Contents

PART I
Item 1.  Business.
Our Company
We are a real estate investment trust, or REIT, that was organized under Maryland law in 1998. We primarily own medical office and life science properties, senior living communities and other healthcare related properties throughout the United States. As of December 31, 2020,2023, we owned 397371 properties, including three closed senior living communities, located in 36 states and Washington, D.C. On that date, the gross book value of our real estate assets at cost plus certain acquisition costs, before depreciation and purchase price allocations and less impairment write downs, was $8.2$7.2 billion.
As of December 31, 2023, we owned an equity interest in each of two unconsolidated joint ventures that own medical office and life science properties located in five states with an aggregate of approximately 2.2 million rentable square feet that were 98% leased with an average (by annualized rental income) remaining lease term of 5.3 years.
Our principal executive offices are located at Two Newton Place, 255 Washington Street, Suite 300, Newton, Massachusetts 02458-1634, and our telephone number is (617) 796-8350.
Our Business Strategy
The healthcare industry remains one of the most resilient commercial real estate sectors, in part due to the scale of the U.S. healthcare market, which collectively represents approximately 17% of the U.S. gross domestic product, or GDP, according to the Centers for Medicare and Medicaid Services, or CMS. The healthcare sector’s continued expansion has been driven by rising standards of care, increasing life expectancies and other demographic trends, as well as funding from both public and private sources.
We believe that the aging of the U.S. population benefits our portfolio of healthcare real estate. According to U.S. Census data, between now and 2030, more than 20% of the total U.S. population will reachbe age 65 or older, with that demographic projected to grow thereafter by the equivalent of 10,000 people per day. We believe that this will increase demand for our senior living communities (including active adult communities) and for healthcare services and products supplied by the tenants in our medical office and life science properties. The primary market for senior living services is individuals age 80 and older. According to U.S. Census data, the age 75+ demographic is projected to be among the fastest growing age cohorts in the United States over the next 20 years, and according to the Centers for Medicare & Medicaid Services, or CMS, the age 85+ demographic is projected to grow over 30% over the next five years. Also, as a result of medical advances, seniors are living longer, and CMS reports that healthcare spending is projected to grow at an average rate of 5.7%5.4% per year and reach $6.0$6.8 trillion by 2027.2030.
In lightWe believe there is a favorable mix of these demographic trends, we believe that the aging of the U.S. population will increaseincreased demand for existing medical office and life science properties,limited supply for senior living communities (including active adult rental properties) and other medical and healthcare related properties. Althoughwhich we are currently generally prohibited from making acquisitions or other capital investments pursuant to the terms of the agreements governing our revolving credit facilityexpect will benefit us and our $200.0 million term loan,existing portfolio of senior living communities in the future. As a result of elevated financing and construction costs over recent years, inventory growth for senior living communities has reached a new low. According to The National Investment Center for Seniors Housing and Care, or collectively,NIC, annual inventory growth was 1.3% across all markets during the fourth quarter of 2023. Additionally, annual absorption was 4.1% for the fourth quarter of 2023, according to NIC. We expect improving market fundamentals and constrained supply to continue to result in increased occupancy at our credit and term loan agreements, which are described below, wesenior living communities over the next 12 to 24 months.
We plan to seek to profit from this demand in the future by, over time, investing in our properties, acquiring additional properties and entering into leaseslease and management arrangements with qualified tenants, managers and managersoperators which enhance our cash flow and generate returns to us that exceed our operating and capital costs to us, including structuring leases that provide for or permit periodic rent increases. Despite this trend, future economic downturns, softness in the U.S. housing market, higher levels of unemployment among our potential residents’ family members, lower levels of consumer confidence, stock market volatility and/or changes in demographics could adversely affect the ability of seniors to afford the resident fees at our senior living communities. Further, as discussed further elsewhere in this Annual Report on Form 10-K, the COVID-19 pandemic and expected economic impacts therefrom may negatively impact our senior living operations.
We also seek to selectively sell properties from time to time when we determine our continued ownership or ongoing required capital expenditures will not achieve desired returns, when we believe we have maximized returns or when we believe we can successfully pursue more desirable opportunities than retaining these properties. We also expect tomay use future sales proceeds at such time as we are no longer prohibited from doing so pursuant to the agreement governingmanage our revolving credit facility, orleverage, to invest in our credit agreement,properties and to acquire new properties that we believe will help us reduce the overall average age of our properties, increase our weighted average lease term, reduce our ongoing capital requirements and/or increase our distributions to shareholders. We referAdditionally, we seek to this asselectively develop, redevelop or reposition our capital recycling program.properties when we believe the returns will be satisfactory.
1

Table of Contents

Office Portfolio
Our portfolio of medical office and life science properties, or our Office Portfolio, consists of commercial properties constructed for use or operated as medical office space for physicians and other healthcare personnel and other businesses in medical related fields, including clinics and life science or laboratory uses. Some of our medical office properties are occupied as administrative facilities, for healthcare companies, such as hospitals and healthcare insurance companies.companies or similar uses. As our lease expirations approach, we will seek to renew our leases with existing tenants or to enter into new leases with new tenants, in both circumstances at rental rates equal to or higher than current rental rates for the same space. Our ability to renew leases with our existing tenants or to enter into new leases with new tenants and the rents we are able to charge will depend in large part upon market and economic conditions, which are beyond our control.
Senior Living Communities
Independent Living Communities.  Independent living communities provide high levels of privacy to residents and require residents to be capable of relatively high degrees of independence. An independent living community usually bundles
1

Table of Contents
several services as part of a regular monthly charge. For example, an independent living community may include one or two meals per day in a central dining room, daily or weekly maid service or a social director in the base charge. Additional services are generally available from staff employees on a fee for service basis. In some of our independent living communities, separate parts of the property are dedicated to assisted living and/or nursing services. We also own an active adult rental property,community, which we have classified as an independent living community.
Assisted Living Communities.  Assisted living communities typically have one bedroom or studio units which include private bathrooms and efficiency kitchens. Services bundled within one charge usually include three meals per day in a central dining room, daily housekeeping, laundry, medical reminders and 24 hour availability of assistance with the activities of daily living, such as dressing and bathing. Professional nursing and healthcare services are usually available at the property on call or at regularly scheduled times. These communities may also include Alzheimer's or memory care services. In some of our assisted living communities, separate parts of the property are dedicated to independent living and/or nursing services.
Skilled Nursing Facilities.  Skilled nursing facilities, or SNFs, generally provide extensive nursing and healthcare services similar to those available in hospitals, without the high costs associated with operating rooms, emergency rooms or intensive care units. A typical purpose built SNF includes mostly rooms with one or two beds, a separate bathroom and shared dining facilities. Licensed nursing professionals staff SNFs 24 hours per day.
Wellness Centers
Wellness centers typically have gymnasiums,exercise classes, strength and cardiovascular equipment areas, tennis and racquet sports facilities, pools, spas and children's centers. Professional sports training and therapist services are often available. Wellness centers often market themselves as clubs for which members may pay monthly fees plus additional fees for specific services.
Other Types of Real Estate
In the past, we have considered investing in real estate different from our existing property types and some properties located outside the United States. For example, we recently acquired an age restricted active adult rental property which we have classified as an independent living community, to diversify our portfolio of senior living communities. We may explore these or other alternative investments in the future.
Lease Terms
Our medical office and life science property leases primarily include both “triple net” leases, as described below,where the tenant is generally responsible for the payment of property operating expenses and capital expenditures during the lease term, and “net” and “modified gross” leases, where we are responsible for operating and maintaining the properties and we charge the tenants for some or all of the property operating expenses. A small percentageportion of our medical office and life science property leases are “full service” leases where we receive fixed rent from the tenants and do not charge the tenants for any property operating expenses. TheMost of our leases for some of our senior living communities and all of our wellness centers are “triple net” leases.
Triple net leases generally require the tenants to pay rent and all property operating expenses, to indemnify us from liability which may arise by reason of our ownership of the properties, to maintain the properties at their expense, to remove and dispose of hazardous substances on the properties in compliance with applicable law and to maintain insurance on the properties for their and our benefit. In the event of any damage, or immaterial condemnation, of a leased property, the tenants are generally required to rebuild with insurance or condemnation proceeds or, if such proceeds are insufficient, other amounts made available by us, if any, but if other amounts are made available by us, the rent will be increased accordingly. In the event of any material or total condemnation of a leased property, generally the lease will terminate with respect to that leased property, in which event we will be entitled to the condemnation proceeds and the rent will be reduced accordingly. In the event of any material or total destruction of a leased property, in certain cases the applicable tenant may terminate the lease with respect to that leased property, in which event the tenant will be required to pay us any shortfall in the amount of proceeds we receive from insurance compared to the replacement cost of that leased property.
Senior Housing Operating Portfolio Management Agreements
Because we are a REIT for U.S. federal income tax purposes, we generally may not operate our senior living communities. For mostnearly all of our senior living communities, we use a taxable REIT subsidiary, or TRS, structure authorized by the REIT Investment Diversification and Empowerment Act. Under this structure, we lease certain of our communities to
2

Table of Contents

our TRSs, and our TRSs enter into long term management agreements with third parties for the operation of such communities. These management agreements generally provide the managermanagers with a management fee, which is a percentage of the gross revenues realized at the communities, plus reimbursement for the manager'smanagers' direct costs and expenses related to the communities. The managermanagers may
2

Table of Contents
also receive an annual incentive fee equal to a percentage of the amount by which the annual earnings before interest, taxes, depreciation and amortization, or EBITDA, of allthe applicable communities on a combined basis exceeds the target EBITDA for allthe applicable communities.
Our managed senior living communities on a combined basis for such calendar year, provided that in no event shall the incentive fee be greater than a percentageare operated by third parties pursuant to management agreements. As of the gross revenues realized.
Effective January 1, 2020, we completed a restructuring of our business arrangements, or the Restructuring Transaction, withDecember 31, 2023, Five Star Senior Living, Inc., or Five Star, pursuant to which among other things, our previously existing master leases with Five Star for 166is an operating division of AlerisLife Inc., or AlerisLife, managed 119 of our senior living communities and our previously existing management and pooling agreements for 78communities. Also as of December 31, 2023, 113 of our senior living communities were terminated and replaced, or the Conversion, with new management agreements and a related omnibus agreement, or collectively, the Five Star management agreements.
Although we have various rights as owner under the Five Star management agreements, we rely on the manager's personnel, good faith, expertise, performance, technical resources, operating efficiencies, information systems, proprietary information and judgment to manage our managed senior living communities efficiently and effectively.by other third party managers. We also rely on the manager to set resident fees and otherwise operate our managed senior living communities in compliance with the Five Star management agreements.
Under the Five Star management agreements, we assume the operational risks and fund the operations and capital and maintenance requirements forlease nearly all those senior living communities that Five Star previously leased from us and now manages for our account. As a result, we are required to maintain sufficient funding for these purposes. Further, any funding we maintain for these purposes will not be available for other business purposes, which may limit our ability to pursue other business opportunities and could limit the amount of distributions we can pay to our shareholders. As a result of the Restructuring Transaction and the terms of the Five Star management agreements commencing January 1, 2020, the operating results of our senior living communities that were previously leased from us and operated by Five Star and are now managed by Five Star forto our account are included in our operating results. The operating results of our other pre-existing and subsequently acquired or transitioned senior living communities managed by Five Star for our account are similarly included in our operating results. The change in our historical arrangements with Five Star from mostly leased to now managed has resulted, and likely will continue to result in future periods, in our realizing significantly increased variability in our operating results from our senior living communities from what we experienced in the past.TRSs.
For more information about the Restructuring Transaction and the terms of the management agreements with Five Star management agreements,and the other third party managers, see Note 6 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
COVID-19 Pandemic
In March 2020, the World Health Organization declared the outbreak of COVID-19 as a pandemicEconomic and in response to the outbreak, the U.S. Health and Human Services Secretary declared a public health emergency in the United States and many states and municipalities declared public health emergencies. The virus that causes COVID-19 has continued to spread throughout the United States and the world. Various governmental and market responses attempting to contain and mitigate the spread of the virus have negatively impacted, and continue to negatively impact, the global economy, including the U.S. economy. States and municipalities across the United States have generally allowed most businesses to re-open and have generally eased certain restrictions they had previously implemented in response to the COVID-19 pandemic, often in stages that are phased in over time, although some states and municipalities have imposed or re-imposed certain restrictions in response to increases in COVID-19 infections experienced since then. Recently, economic data have indicated that the U.S. economy has increasingly improved since the lowest periods experienced in March and April 2020, although the U.S. gross domestic product remains below pre-pandemic levels. It is unclear whether the increases in the number of COVID-19 infections will continue or amplify in the United States or elsewhere and, if so, what the impact of that would be on human health and safety, the economy, our manager and tenants or our business.
Our business is focused on healthcare related properties, including medical office and life science properties, senior living communities, wellness centers and other medical and healthcare related properties. We believe that the healthcare sector and many of our tenants provide essential services across the United States. Due to restrictions intended to prevent the spread of the virus that causes COVID-19, certain of our medical office and wellness center tenants, which include physician practices that had discontinued non-essential surgeries and procedures and fitness centers, that had been ordered closed by state executive orders have experienced disruptions to their businesses. Our senior living community operators have also experienced disruptions, including limitations on in-person tours and new admissions, and are experiencing challenges in attracting new residents to their communities in addition to experiencing increased expenses due to increased labor costs, including higher health benefits costs, and increased costs and consumption of supplies, including personal protective equipment. There will be lasting impacts of the COVID-19 pandemic, even as states and municipalities have eased and may further ease restrictions. Our
3

Table of Contents
tenants and their businesses may become increasingly negatively impacted, which may result in our tenants seeking assistance from us regarding their rent obligations owed to us, their being unable or unwilling to pay us rent, their ceasing to pay us rent and their ceasing to continue as going concerns.Market Conditions
We are closely monitoring the impacts of the COVID-19 pandemiccurrent economic and market conditions on all aspects of our business, including:including, but not limited to, high interest rates, prolonged high inflation, labor market challenges, supply chain disruptions, volatility in the public equity and debt markets, geopolitical risks, economic downturns or a possible recession and changes in real estate utilization. We expect continued volatility in labor, insurance and food costs in our Senior Housing Operating Portfolio, or SHOP segment.
our tenantsIn response to significant and their ability to withstandprolonged increases in inflation, the U.S. Federal Reserve has raised interest rates multiple times since the beginning of 2022. Although the U.S. Federal Reserve has indicated that it may lower interest rates in 2024, we cannot be sure that it will do so, and interest rates may remain at the current economic conditions andhigh levels or continue to pay us rent;
our senior living community operators' ability to operate our communities, mitigate and contain the spread of the virus that causes COVID-19 at our communities and to keep the residents and our operators' employees at our communities safe and healthy;
our operations, liquidity and capital needs and resources;
actively communicating with our tenants, our operators and other key constituents and stakeholders in order to help assess market conditions, opportunities, best practices and mitigate risks and potential adverse impacts; and
monitoring, with the assistance of counsel and other specialists, possible government relief funding sources and other programs that may be available to us, our tenants, or our operators to enable us and them to operate through the current economic conditions and enhance our tenants' ability to pay us rent or our operators' ability to operate our communities.
With respect to our SHOP segment, we expect that our senior living community operators will be operating our communities at lower average occupancy with higher operating expenses per resident, which will likely lead to decreased returns to us as a result of the COVID-19 pandemic. Our operators continue to follow federal, state and local health department guidelines and their own infection prevention protocols but we expect to see additional cases of COVID-19 in our senior living communities.
Five Star, the manager of our senior living communities, has taken a number of proactive measures to protect the health and safety of their staff and our residents and patients, including:
restricting access to our senior living communities to essential visitors and team members and only reopening communities when it is determined safe to do so in accordance with applicable federal, state and local regulations and guidelines and Five Star's internal criteria;
enhancing infectious disease prevention and control policies, procedures and protocols;
providing additional and enhanced training to team members at all levels of the organization;
working with vendors to provide adequate supplies and personal protective equipment to our senior living communities; and
effectively transitioning to virtual sales and marketing activities and thoughtfully proceeding with resident move-ins, when appropriate.
In December 2020, the U.S. Food and Drug Administration issued emergency use authorizations, or EUAs, to Pfizer Inc. / BioNTech SE and Moderna, Inc. for vaccines for the prevention of COVID-19. The Centers for Disease Control and Prevention's, or CDC's, Advisory Committee on Immunization Practices, or ACIP, has placed long-term care facility residents and healthcare personnelincrease. These inflationary pressures in the highest priority group to receive COVID-19 vaccines during "Phase 1a." Despite the issuances of these EUAs, and potentially others for additional vaccines in the future, it is expected to take an extended period of time, and considerable effort and expense, to vaccinate residents and employees at our senior living communities who wish to be vaccinated and several months for the vaccines to be produced, distributed and administered to a sufficient number of people to enable the cessation of the COVID-19 pandemic. Five Star has partnered with CVS Health Corporation to administer vaccines to SHOP community residents and staff, which commenced in December 2020. We expect vaccination clinics for SHOP community residents and staff to be substantially complete by the end of the first quarter of 2021. As it pertains to our SHOP segment, as of February 20, 2021:
4

Table of Contents
approximately 23,500 total residents and staff, or more than 87% of residents and more than 43% of staff, of our senior living communities have received one or more doses of the vaccine, including over 14,500 residents and staff who have received both doses of the vaccine;
approximately 99% of our senior living communities are currently open to new admissions; and
approximately 2.5% of our senior living community residents have active cases of COVID-19, and approximately 72% of those who have tested positive for COVID-19 during the pandemic have since recovered, as defined by CDC guidelines.
We may be subject to claims by residents and staff related to vaccines our manager administers or the care our manager provides following administration of the vaccine. However, any such potential liability will be limited by the Public Readiness and Emergency Preparedness, or PREP, Act, which provides immunity protections under federal and state law for individuals and entities, or Covered Persons, against claims of loss relating to certain COVID-19 countermeasures, or Covered Countermeasures. We and our manager's personnel that administer Covered Countermeasures such as the COVID-19 vaccine are classified as Covered Persons immune to claims arising from COVID-19 vaccine administration with the exception of death or serious physical injury caused by willful misconduct.
We also believe that we, Five Star and our impacted tenants may benefit from provisions of the Coronavirus Aid, Relief, and Economic Security Act, or the CARES Act, signed into law in March 2020, or other federal or state relief programs allowing them to continue or resume business activity. During the year ended December 31, 2020, we recognized $17.5 million in interest and other income in our consolidated statement of comprehensive income (loss) related to funds received under the CARES Act and also deferred $22.2 million in payroll taxes as allowed under the CARES Act and recognized these taxes in other liabilities in our consolidated balance sheet as of December 31, 2020.
We believe that our current financial position and recent financing activities will enable us to withstand the COVID-19 pandemic and its aftermath due in part to the following:
In June 2020, we issued $1.0 billion aggregate principal amount of 9.75% senior notes due 2025. We used the net proceeds from this offering to prepay in full our $250.0 million term loan that was scheduled to mature on June 12, 2020 and to reduce amounts outstanding under our revolving credit facility;
In February 2021, we issued $500.0 million aggregate principal amount of 4.375% senior notes due 2031. We used the net proceeds from this offering to prepay our $200.0 million term loan and expect to use the remaining net proceeds to redeem all of our outstanding 6.75% senior notes due 2021 in June 2021, when those notes become redeemable with no prepayment premium;
Also in June 2020, we amended certain financial covenants under our credit and term loan agreements through June 30, 2021 in order to provide us with additional flexibility, and in January 2021, we further amended our credit and term loan agreements to, among other things, obtain waivers from compliance with certain financial covenants through June 2022, or the Amendment Period; and
Beginning in the second quarter of 2020, we reduced our quarterly cash distribution rate on our common shares to $0.01 per share, conserving approximately $33.3 million of cash per calendar quarter compared to our prior quarterly distribution rate.
In light of the above actions, resources, expectations and conditions, we believe that we are well positioned to weather the present disruptions facing the real estate industry and, in particular, the real estate healthcare industry, including senior living. However, as a result of the COVID-19 pandemic, some of our tenants have requested relief from their obligations to pay rent due to us. While the number and value of these monthly requests have been declining, we continue to evaluate these requests as they are made on a tenant-by-tenant basis. For further information concerning these requests, see “Management's Discussion and Analysis of Financial Condition and Results of Operations” in Part II, Item 7 of this Annual Report on Form 10-K.
We do not have any employees and the personnel and various services we require to operate our business are provided to us by The RMR Group LLC, or RMR LLC, pursuant to our business management agreement, and with respect to our Office Portfolio, our property management agreement, with RMR LLC. RMR LLC has implemented enhanced cleaning protocols and social distancing guidelines at its corporate headquarters and regional offices,United States, as well as business continuity plansglobal geopolitical instability and tensions, have given rise to ensureuncertainty regarding economic downturns or a possible recession and potential disruptions in the financial markets. An economic recession, or continued or intensified disruptions in the financial markets, could adversely affect our financial condition and that
5

Table of Contents
RMR LLC employees remain safeour managers, operators and abletenants, could adversely impact the ability or willingness of our managers, operators, tenants or residents to supportpay amounts owed to us, could impair our ability to effectively deploy our capital or realize our target returns on our investments, may restrict our access to, and other companies managed by RMR LLC or its subsidiaries, including providing appropriate information technology such as notebook computers, smart phones, computer applications, information technology security applicationswould likely increase our cost of capital, and technology support.
All RMR LLC property management and engineering personnel have been trained on COVID-19 precaution procedures. As states and local communities acrossmay cause the United States moved to stay at home orders, RMR LLC worked to reduce and optimize our operating costs atvalues of our properties by:and of our securities to decline.
deferring non-emergency work;
implementing energy reduction protocols for lighting and HVAC systems;
reducing non-essential building services and staff; and
reducing the frequency of trash removal.
RMR LLC's property management teams have also established business continuity plans to ensure operational stability at our properties. RMR LLC regional management offices limit walk-in visitors and maintain maximum office occupancy limits as required by state and local guidelines, including weekly rotations of employees as needed.
As stay at home orders were and may be lifted or loosened across the United States, RMR LLC has implemented additional procedures at our properties based on recommended guidelines from the CDC and other regulatory agencies. For example:
focusing on sanitizing high touch points in common areas and restrooms;
shutting down certain building amenities;
prudently managing the execution or deferment of tenant work orders to limit RMR LLC staff and tenant interactions at our properties;
installing signage throughout our properties with social distancing reminders;
changing certain building HVAC systems and equipment, including adjusting outdoor air control programs to increase the amount of outside air delivered to interior spaces and to adjust control sequences to maintain space relative humidity in order to help minimize the concentration of the virus;
flushing domestic water systems to prepare for re-occupancy;
performing service calls and preventative maintenance after business hours to limit social interactions;
requiring vendors to follow best practices under COVID-19 pandemic conditions, including providing RMR LLC with documented preventative measures for their employees and requiring staff to wear appropriate personal protective equipment when working at our properties; and
altering cleaning schedules to perform vacuuming at times intended to reduce the potential airborne spread of the virus.
RMR LLC has significantly reduced non-essential work travel and its regional leadership personnel have not been allowed to work in the same locations at the same time. RMR LLC also requires its employees who work at our properties to use personal protective equipment and business continuity bonus payments have been provided by RMR LLC to certain essential workers at our properties.
There are extensive uncertainties surrounding the COVID-19 pandemic and its aftermath. These uncertainties include, among others:
the duration and severity of the negative economic impact;
the strength and sustainability of any economic recovery;
6

Table of Contents
the timing and process for how federal, state and local governments and other market participants may oversee and conduct the return of economic activity when the COVID-19 pandemic abates, such as what continuing restrictions and protective measures may remain in place or be added and what restrictions and protective measures may be lifted or reduced in order to foster a return of increased economic activity in the United States; and
the responses of governments, businesses and the general public to any increased level or rates of COVID-19 infections.
As a result of these uncertainties, we are unable to determine what the ultimate impacts will be on our, our tenants’, our operators’ and other stakeholders’ businesses, operations, financial results and financial position. For further information and risks relating to the COVID-19 pandemic and its aftermath on us and our business,these economic uncertainties, see elsewhere in this Annual Report on Form 10-K, including “Warning Concerning Forward-Looking Statements”, Part I, Item 1A, “Risk Factors” and Part II, Item 7, "Management's Discussion and Analysis of Financial Condition and Results of Operations".

Our Investment and Operating Policies
Our investment objectives include increasing cash flows from operations from dependable and diverse sources in order to make distributions to our shareholders. To seek to achieve these objectives, we seek to: maintain a strong capital base of shareholders' equity; invest in strong credit quality properties with strong market fundamentals and high credit quality tenants and managers; use debt leverage to fund additional investments which increase cash flow from operations because of positive spreads between our cost of investment capital and investment yields; structuremake structured investments, including joint venture arrangements, which generate a minimum return and provide an opportunity to participate in operating growth at our properties; when market conditions permit, refinance maturing debt with additionalnew equity or long term debt; and pursue diversification so that our cash flow from operations comes from diverse properties and tenants.
Our Board of Trustees may change our investment and operating policies at any time without a vote of, or notice to, our shareholders.
Acquisition Policies
Subject to the current limitations on acquisitions imposed by our credit agreement discussed elsewhere in this Annual Report on Form 10-K, including "Management's Discussion and Analysis of Financial Condition and Results of Operations" in Part II, Item 7 and Note 9 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K, ourOur acquisition strategy is to seek to acquire additional properties primarily for income and secondarily for appreciation potential. We may purchase individual properties or multiple properties in one portfolio. In implementing this acquisition strategy, we consider a range of factors relating to each proposed acquisition, including, but not limited to:
3

Table of Contents

the use and size of the property;
our cost of capital compared to projected returns we may realize by owning the property;
the location of the property;
the proposed acquisition price;price at which the property may be acquired as compared to the estimated replacement cost of the property;
the existing or proposed lease or management terms;
the existence of alternative sources, uses or needs for our capital and our leverage;
the availability and reputation of experienced and financially qualified tenants, managers or guarantors;
the historical and projected cash flows from the operations of the property;
the estimated replacement cost of the property;
the design, construction quality, physical condition and agedesign of the property, andincluding various environmental sustainability factors;
the expected capital expenditures or improvements that may be needed at the property;
the competitive market environment of the property;
the growth, tax and regulatory environments of the market in which the property is located;
7

Table of Contents
the price segment and payment sources in which the property is operated;
the strategic fit of the property withinwith the rest of our portfolio;
our weighted average long term cost of capital compared to projected returns we may realize by owning the property; and
the level of permitted services and regulatory history of the property and its historical tenants and managers; and
the existence of alternative sources, uses or needs for capital.managers.
An important part of our acquisition strategy is to identify and select or create, qualified, experienced and financially stable tenants and managers.
Disposition Policies
We plan to selectively sell certain properties from time to time to manage our leverage and improve our liquidity, to fund future acquisitions and to strategically update, rebalance and reposition our investment portfolio and to achieve and maintain leverage consistent with our investment grade rated peers with a goal of (1) reducing our leverage, (2) improving the asset quality of our portfolio by reducing the overall average age lengtheningof our properties and increasing the weighted average term of our leases and increasing the likelihood of retaining our tenants and (2)(3) increasing our distributions to shareholders. We expect further disruptions to future disposition activity due to uncertain market conditions as a result of the COVID-19 pandemic and its resulting economic conditions.
Other than as described, we generally consider ourselves to be a long term owner of properties and are more interested in the long term earnings potential of our properties and stability of our portfolio than selling properties for short term gains. However, from time to time, we may consider the sale of all or a stake in one or more of our properties or other investments. We make disposition decisions based on a number of factors, including, but not limited to, the following:
our ability to lease or operate the affected property on terms acceptable to us or have the affected property managed with our realizing acceptable returns;
our ability to lease or operate the affected property on terms acceptable to us or have the affected property managed with our realizing acceptable returns;
the manager's or tenant's desire to operate the affected property;
the manager's or tenant's desire to dispose of or cease operating the affected property;
the proposed sale price;price or targeted returns;
the existence of alternative sources, uses or needs for our capital and our leverage;
the remaining length of the lease relating to the property and its other terms;
our evaluation of future cash flows which may be achieved from the property;
4

Table of Contents

the strategic fit of the property or investment withinwith the rest of our portfolio;
the age and capital required to maintain the property;
the estimated value we may receive by selling the property;
our intended use of the proceeds we may realize from the sale of a property;
the expected benefits that can be achieved from contributing additional properties to our existing or any new joint ventures; and
the existence of alternative sources, uses or needs for capital.tax implications to us and our shareholders.    
Other Investments
We have no policies which specifically limit the percentage of our assets that may be invested in any individual property, in any one type of property, in properties leased to any one tenant or to an affiliated group of tenants or in properties operated by any one tenant or manager or by an affiliated group of tenants or managers or in securities of one or more persons.
8

TableOn February 2, 2023, AlerisLife entered into an Agreement and Plan of ContentsMerger, or the ALR Merger Agreement, with certain subsidiaries of ABP Trust, pursuant to which ABP Trust acquired all of the publicly held outstanding AlerisLife common shares, at a price of $1.31 per share, or the Tender Offer Price, by tender offer, or the AlerisLife Transaction.
In connection with the ALR Merger Agreement, on February 2, 2023, we agreed to tender all the AlerisLife common shares that we and our subsidiary then owned into the tender offer at the Tender Offer Price, subject to the right, but not the obligation, to purchase, on or before December 31, 2023, AlerisLife common shares at the Tender Offer Price, and otherwise pursuant to a stockholders agreement to be entered into at the time of any such purchase. On December 20, 2023, we and ABP Trust extended our right to purchase AlerisLife common shares until March 31, 2024.
On February 16, 2024, we exercised this purchase right and acquired, together with our applicable TRS, approximately 34.0% of the currently outstanding AlerisLife common shares from ABP Trust at the Tender Offer Price, for a total purchase price of $14.9 million, and we, our applicable TRS, ABP Trust and AlerisLife entered into a stockholders agreement. Following this acquisition, ABP Trust owns the remaining approximate 66.0% of AlerisLife.
We own a significant number of common shares of Five Star, and we expect to own these shares for the foreseeable future. However, we may sell some or all of our Five Star common shares, or our ownership interest in Five Star may otherwise be diluted in the future. We may also in the future acquire additional common shares or securities of other entities, including entities engaged in real estate activities. We may invest in the securities of other entities for the purpose of exercising control, or otherwise, make loans to other persons or entities, engage in the sale of investments, offer securities in exchange for property or repurchase or reacquire our securities. As of December 31, 2020, Five Star managed 235 senior living communities for our account.
We preferHistorically, we have primarily owned wholly owned investments in fee interests. However, circumstances may arise in which we may invest in leaseholds, joint ventures, mortgages and other real estate interests. We may invest or enter into additional real estate joint ventures if we conclude that by doing so we may benefit from the participation of co-venturersjoint venture partners or that our opportunity to participate in the investment is contingent on the use of a joint venture structure. For example,As of December 31, 2023, we owned a 10% equity interest in March 2017, we entered aan unconsolidated joint venture withthat owns a life science property located in Boston, Massachusetts, or the Seaport JV, and a 20% equity interest in an institutional investorunconsolidated joint venture for one of our10 medical office and life science properties, located in Boston, Massachusetts.or the LSMD JV. Further, we may acquire interests in joint ventures as part of an acquisition of properties or entities or we may contribute wholly owned properties into our existing or new joint ventures. We also may invest in participating, convertible or other types of mortgages if we conclude that by doing so, we may benefit from the cash flow or appreciation in the value of a property which is not available for purchase.
Mergers and Strategic Combinations
In the past, we have considered the possibility of entering into mergers or strategic combinations with other companies and we may explore such possibilities in the future, subject to the current limitations on acquisitions imposed by our credit agreement discussed further elsewhere in this Annual Report on Form 10-K, including "Management's Discussion and Analysis of Financial Condition and Results of Operations" in Part II, Item 7 and Note 9 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
Our Financing Policies
Although there are no limitations in our organizational documents on the amount of indebtedness we may incur, the agreement governing our $800.0 million revolving credit facility and our unsecured senior notes indentures and their supplements contain financial covenants which, among other things, restrict our ability to incur indebtednessdebts and generally require us to maintain certain financial ratios. For further information relating to our indebtedness, see elsewhere in this Annual Report on Form 10-K, including Note 9 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
We may seek additional capital through secured or unsecured debt financing or refinancing transactions, sales of properties or equity offerings, debt financings,interests in properties, retention of cash flows in excess of distributions to shareholders, sales of propertiesequity offerings or a combination of these methods or other transactions. To the extent we obtain additional debt financing, we may do so on an unsecured basis or a secured basis. We may seek to obtain lines of credit or to issue securities senior to our
5

Table of Contents

common shares, including preferred shares or debt securities, some of which may be convertible into our common shares or be accompanied by warrants to purchase our common shares. We may also finance acquisitions by assuming debt, through an exchange of properties or through the issuance of equity or other securities. The proceeds from any of our financings may be used to pay distributions, to provide working capital,make investments in our properties, to refinance existing indebtedness or to finance acquisitions, and improvements of existingdevelopment, redevelopment or new properties, subject to limitations in agreements governing our debt.repositionings.
As of December 31, 2020, we had a $1.0 billion revolving credit facility. Pursuant to the January 2021 amendment to our credit agreement, the revolving credit facility commitments have been reduced from $1.0 billion to $800.0 million. We use our revolving credit facility for working capital and general business purposes and for funding investments on an interim basis until we are able to refinance them with equity or long term debt. In some instances, we may assume debt in connection with our acquisition of properties or place new mortgages on properties we own. For more information regarding our financing sources and activities, see “Management's Discussion and Analysis of Financial Condition and Results of Operations—Liquidity and Capital Resources—Our Investment and Financing Liquidity and Resources” in Part II, Item 7 of this Annual Report on Form 10-K.
Generally, we intend to manage our leverage in a way that may allow us to eventually regain “investment grade” ratings from nationally recognized statistical rating organizations; however, we cannot be sure that we will be able to regain investment grade ratings.
Our Board of Trustees may change our financing policies at any time without a vote of, or notice to, our shareholders.
9

Table of Contents
Our Manager
The RMR Group Inc., or RMR Inc., is a holding company and substantially all of its business is conducted by its majority owned subsidiary, The RMR LLC.Group LLC, or RMR. The Chair of our Board of Trustees and one of our Managing Trustees, Adam D. Portnoy, is the sole trustee, an officer and the controlling shareholder of ABP Trust, which is the controlling shareholder of RMR Inc., chair of the board of directors, a managing director and the president and chief executive officer of RMR Inc. and an officer and employee of RMR LLC.RMR. Jennifer B. Clark,F. Francis, our other Managing Trustee and our former President and Chief Executive Officer, served as an officer of RMR until December 31, 2023 and will remain an employee of RMR until her retirement on July 1, 2024. Jennifer B. Clark, our Secretary and former Managing Trustee, also serves as a managing director and asthe executive vice president, general counsel and secretary of RMR Inc., an officer of ABP Trust and an officer and employee of RMR LLC.and an officer of ABP Trust. Our day to day operations are conducted by RMR. RMR LLC. RMR LLC originates and presents investment and divestment opportunities to our Board of Trustees and provides management and administrative services to us. RMR LLC has a principal place of business at Two Newton Place, 255 Washington Street, Suite 300, Newton, Massachusetts, 02458-1634, and its telephone number is (617) 796-8390. RMR LLC is an alternative asset management company that is focused on commercial real estate and related businesses. RMR LLC or its subsidiaries also act as a manager to other publicly traded real estate companies, privately held real estate funds and real estate related operating businesses. In addition, RMR provides management services to joint ventures, including our existing joint ventures. As of the date of this Annual Report on Form 10-K,February 21, 2024, the executive officers of RMR LLC are: Adam D. Portnoy, president and chief executive officer; Christopher J. Bilotto, executive vice president; Jennifer B. Clark, executive vice president, general counsel and secretary; Matthew P. Jordan, executive vice president, chief financial officer and treasurer; and John G. Murray, executive vice president. Mr. Bilotto is also our President and Chief Executive Officer; Jennifer B. Clark, Executive Vice President, General Counsel and Secretary; Jennifer F. Francis, Executive Vice President; Matthew P. Jordan, Executive Vice President, Chief Financial Officer, and Treasurer; John G. Murray, Executive Vice President; and Jonathan M. Pertchik, Executive Vice President. In addition, our Chief Financial Officer and Treasurer, Richard W. Siedel, Jr.,Matthew C. Brown, is a Senior Vice Presidentsenior vice president of RMR LLC.RMR. Mr. SiedelBilotto, Mr. Brown and other officers of RMR LLC also serve as officers of other companies to which RMR LLC or its subsidiaries providesprovide management services.
In July 2020, our manager, RMR LLC, released its first annual Sustainability Report, which summarizes the environmental, social and governance initiatives RMR LLC and its client companies, including us, employ. RMR LLC's Sustainability Report may be accessed on RMR Inc.'s website at www.rmrgroup.com/corporate-sustainability/default.aspx. The information on or accessible through RMR Inc.'s website is not incorporated by reference into this Annual Report on Form 10-K.
Employees
We have no employees. Services which would otherwise be provided to us by employees are provided by RMR LLC and by our Managing Trustees and officers. As of December 31, 2020, RMR LLC had more than 600 full time employees in its headquarters and regional offices located throughout the United States.
Government Regulation and Reimbursement
The senior living and healthcare industries are subject to extensive, frequently changing federal, state and local laws and regulations. Although most of these laws and regulations affect the manner in which our tenants and managers operate our properties, some of them also impact us and the values of our properties. Some of the laws that impact or may impact us or our tenants or managers include: state and local licensure laws; laws protecting consumers against deceptive practices; laws relating to the operation of our properties and how our tenants and managers conduct their operations, such as health and safety, fire and privacy laws; federal and state laws affecting assisted living communities that participate in Medicaid and federal and state laws affecting SNFs, clinics and other healthcare facilities that participate in both Medicaid and Medicare that mandate allowable costs, pricing, reimbursement procedures and limitations, quality of services and care, food service and physical plants; resident rights laws (including abuse and neglect laws) and fraud laws; anti-kickback and physician referral laws; the Americans with Disabilities Act and similar state and local laws; and safety and health standards set by the federal Occupational Safety and Health Administration, or OSHA. Medicaid funding is available in some, but not all, states for assisted living services. State licensure standards for assisted living communities, SNFs, clinics and other healthcare facilities typically address facility policies, staffing, quality of services and care, resident rights, fire safety and physical plant matters, and related matters. In addition, the spread of COVID-19 has brought increased government regulation includingincreased and additional compliance obligations were imposed in 2020.response to the COVID-19 pandemic, some of which have since been, or are expected in the near future to be, reduced or removed as a result of the abating of the COVID-19 pandemic. We are unable to predict the future course of federal, state and local legislation or regulation.regulations. Changes in the regulatory framework could have a material adverse effect on the ability of our tenants to pay us rent, the profitability of our managed senior living communities and the values of our properties.
State and local health and social service agencies and other regulatory authorities regulate and license many senior living communities. State health authorities regulate and license clinics and other healthcare facilities. In most states in which we own properties, we and our tenants and managers are prohibited from providing certain services without first obtaining
6

Table of Contents

appropriate licenses. In addition, mostsome states require a certificate of need, or CON, before an entity may open aan assisted living community or SNF or expand services at an existing community. According to the National Conference of State Legislatures, some states also limit the number of assisted living facilities by requiring CONs.facility. In addition, some states (such as California and Texas) that have
10

Table of Contents
eliminated CON laws have retained other means of limiting development of SNFs,facilities, including moratoria, licensing laws and limitations upon participation in the state Medicaid program. Senior living communities and certain other healthcare facilities must also comply with applicable state and local building, zoning, fire and food service codes before licensing or Medicare and Medicaid certification are granted. These laws and regulatory requirements could affect our ability and that of our tenants and managers to expand into new markets or to expand communities in existing markets.
In addition, government authorities have been subjecting healthcare facilities such as those that we own to increasing numbers of inspections, surveys, investigations, audits and other potential enforcement actions. We and our tenants and managers expend considerable resources to respond to such actions. Unannounced inspections or surveys may occur annually or biannually, or even more regularly, such as following a regulatory body's receipt of a complaint about a facility. From time to time in the ordinary course of business, we and our tenants and managers receive deficiency reports from state regulatory bodies resulting from those inspections and surveys. We and our tenants and managers seek to resolve most inspection deficiencies through a plan of corrective action relating to the affected facility's operations. If we or our tenants or managers fail to comply with any applicable legal requirements, or are unable to cure deficiencies, certain sanctions may be imposed and, if imposed, may adversely affect the ability of our tenants to pay their rent to us, the profitability of our managed senior living communities and the values of our properties. In addition, government agencies typically have the authority to take or seek further action against a licensed or certified facility, including the ability to impose civil money penalties or fines; suspend, modify, or revoke a license or Medicare or Medicaid participation; suspend or deny admissions of residents; deny payments in full or in part; institute state oversight, temporary management or receivership; and impose criminal penalties. Loss, suspension or modification of a license or certification or the imposition of other sanctions or penalties could adversely affect the values of our properties, the ability of our tenants to pay their rents and the profitability of our managed senior living communities.
The Centers for Medicare and Medicaid Services, or CMS of the U.S. Department of Health and Human Services, or HHS, has increased its oversight of state survey agencies in recent years, focusing its enforcement efforts on SNFs and chains of SNF operators with findings of substandard care or repeat and continuing deficiencies and violations. CMS has also sought to provide consumers with additional information relating to SNFs. Moreover, state Attorneys General typically enforce consumer protection laws relating to senior living services, clinics and other healthcare facilities. In addition, state Medicaid fraud control agencies may investigate and prosecute assisted living communities and SNFs, clinics and other healthcare facilities under fraud and patient abuse and neglect laws.
Current state laws and regulations allow enforcement officials to make determinations as to whether the care provided by or on behalf of our tenants or by our managers at our facilities exceeds the level of care for which a particular facility is licensed, which could result in closure of the community and the immediate discharge and transfer of residents, which could adversely affect the ability of that tenant to pay rent to us, the profitability of our managed senior living communities and the values of our properties. Citations or revocation of a license could impact the ability for us or Five Starour managers to obtain new licenses or certifications or maintain or renew existing licenses and certifications which would trigger defaults under management agreements and leases with us and adversely affect our ability to operate. Furthermore, some states and the federal government allow certain citations of one facility to impact other facilities owned or operated by the same entity or a related entity, including facilities in other states. Revocation of a license or certification at one facility could therefore impact our or a tenant's or manager's ability to obtain new licenses or certifications or to maintain or renew existing licenses at other facilities, which could adversely affect the ability of that tenant to pay rent to us, the profitability of that manager, the profitability and values of our properties and trigger defaults under our tenants' leases and managers' management agreements and our or our tenants' or managers' credit arrangements, or adversely affect our or our tenants' or managers' ability to obtain financing in the future. In addition, an adverse finding by state officials could serve as the basis for lawsuits by private plaintiffs and lead to investigations under federal and state laws, which could result in civil and/or criminal penalties against the facility as well as a related entity.
For the year ended December 31, 2020,2023, substantially all of our net operating income, or NOI, from our senior living communities was generated from properties where a majority of the revenues are derived from our tenants' and residents' private resources, and a small amount of our NOI was generated from propertiesour senior living communities where a majority of the revenue is dependent upon Medicare and Medicaid programs. Our tenants and managers operate facilities in many states and they and we participate in federal and state healthcare payment programs, including the federal Medicare and state Medicaid benefit programs for services in SNFs and other similar facilities and state Medicaid programs for services in assisted living communities.
In addition, the Federal government took several measures to address the financial impact of the pandemic. The Coronavirus Aid, Relief, and Economic Security Act, or the CARES Act, was signed into law on March 27, 2020. The CARES Act, among other things, provides billions of dollars of reliefprovided $2.0 trillion in aid to certain individuals, businesses and businesses suffering from the COVID-19 pandemic, including as follows:
It temporarily suspended the 2% Medicare sequestration payment reductions from May 1, 2020 through December 31, 2020. This suspension was extended to March 31, 2021 as part of the Consolidated Appropriations Act, 2021 signed into law on December 27, 2020.state and local governments
117

Table of Contents

It established a Provider Relief Fund for allocation by HHS. On April 10, 2020, HHS began to distribute these funds, or the General Distribution, to healthcare providers who received Medicare fee-for-service reimbursement in 2018 and 2019. On May 22, 2020, HHS announced that Provider Relief Funds would be available to SNFs with six or more certified beds that have been impacted bysuffering from the COVID-19 pandemic. On June 9, 2020, HHS announced Phase 2 General Distributions, includingAdditionally, the Medicaid and Children's Health Insurance Program programs. On September 3, 2020, HHS announced details of a $2 billion incentive-payment distribution to nursing homes, of which approximately $333 million was distributed in the first round and $523 million in the second round. On October 1, 2020, HHS announced Phase 3 General Distributions, intended to balance payments of 2% of annual revenue from patient care for all applicants plus a possible add-on payment to account for revenue losses and expenses attributable to COVID-19. On December 16, 2020, HHS announced that Phase 3 funds would be distributed in amounts up to 88% of reported losses.
It established an option for companies to elect to defer payment of the employer portion of social security payroll taxes incurred from March 27, 2020 to December 31, 2020. The first half of the deferred payments will become due on December 31, 2020, with the remainder due December 31, 2021.
It created the employee retention credit calculated at 50% of qualifying wages up to $10,000 in total per employee, resulting in a maximum credit of $5,000 per employee for employers with 100American Rescue Plan Act, or fewer employees.
In addition, the Consolidated Appropriations Act, 2021ARPA, was signed into law on March 11, 2021 to provide additional economic stimulus. For a description of the governmental funding and subsequent legislation, see our Annual Report on Form 10-K for the year ended December 27, 2020. Among other things, this31, 2021.
The CARES Act further supplemented thecreated a Provider Relief Fund, with an additional $3 billion. Information on future allocationswhich allocated financial support to providers who experienced lost revenues and increased expenses as a result of the Provider Relief Fund are not yet known, though the statute requires that no less than 85 percent of unobligated balances of the fund and funds recovered from providers after the enactment date be allocated based on financial losses and changes in operating expenses occurring in the third or fourth quarter of calendar year 2020. The Consolidated Appropriations Act, 2021 also extended the credits and modified the calculation to 70% of qualifying wages up to $10,000 per quarter per employee for employers with up to 500 employees.
We have received funds as part of certain relief programs provided under the CARES Act.COVID-19 pandemic. The terms and conditions of the Provider Relief Fund require that the funds are utilized to compensate for lost revenues that are attributable to the COVID-19 pandemic and for eligible costs to prevent, prepare for and respond to the COVID-19 pandemic that are not covered by other sources. In addition, Provider Relief Fund recipients are subject to other terms and conditions, including certain reporting requirements. Any funds not used in accordance with the terms and conditions must be returned to HHS. Receipt of additional government funds and other benefits from the CARES Act is subject to, in certain circumstances, a detailed application and approval process and it is too soon to accurately predict whether we will meet any eligibility requirements. As of December 31, 2020, weWe have received $20.0 million of funds related to certain programs under the CARES Act, ARPA and various state programs in which certain of our communities in our SHOP segment are located. We recognized $17.5$1.6 million of these funds in interest and other income in our consolidated statement of comprehensive income (loss)operations for which we believe we have met the required terms and conditions for the year ended December 31, 2020. The remaining $2.5 million of funds we have received for which we have not yet met the required terms and conditions were included in other liabilities in our consolidated balance sheet as of December 31, 2020. We have also deferred approximately $22.2 million of payroll taxes as allowed under the CARES Act. These deferred payroll taxes were included in other liabilities in our consolidated balance sheet as of December 31, 2020 and we expect to pay these deferred taxes in the second half of 2021.
In addition to federal measures, many states have taken actions to waive or modify healthcare laws or regulations and Medicaid reimbursement rules. Both state and federal waivers and other temporary actions in response to the COVID-19 pandemic are expected to last throughout the national emergency, the duration of which is currently unknown. Additional measures may be taken prior to and after the conclusion of the national emergency to alleviate the economic impact of the COVID-19 pandemic. Governmental responses to COVID-19 are rapidly evolving, and it is not yet known what the duration or impact of such responses will be.2023.
Government Payors.Payers. In light of the current and projected federal budget deficit and challenging state fiscal conditions, there have been numerous recent legislative and regulatory actions or proposed actions with respect to federal Medicare rates and state Medicaid rates and federal payments to states for Medicaid programs, each of which, or in any combination, could have a material adverse effect on the ability of our tenants to pay us rent, the profitability of our managed senior living communities and the values of our properties.
Our tenants' and managers' Medicare Part B outpatient therapy revenue rates are tied to the Medicare Physician Fee Schedule, or MPFS, which has been subject to separate limitations on rate growth.
12

Table of Contents
It is unclear whether any adjustments in Medicare rates will compensate for the increased costs our tenants and managers may incur for services to residents whose services are paid for by Medicare.
Medicaid Reimbursement. Current and future programmatic changes to Medicaid eligibility and rates may also impact us.
Quality-Based Reimbursement. In addition to the programmatic and reimbursement changes discussed above, payments to SNFs will be increasingly determined by the quality of care provided.
Enforcement. Federal and state efforts to target false claims, fraud and abuse and violations of anti-kickback, physician referral and privacy laws by providers under Medicare, Medicaid and other public and private programs have increased in recent years, as have civil monetary penalties, treble damages, repayment requirements and criminal sanctions for noncompliance.noncompliance, loss of licensure, termination of government payments, exclusion from any government health care program and damage assessments. The federal False Claims Act, as amended and expanded by the Fraud Enforcement and Recovery Act of 2009 and the Patient Protection and Affordable Care Act of 2010, or the ACA, provides significant civil monetary penalties and treble damages for false claims and authorizes individuals to bring claims on behalf of the federal government for false claims and earn a percentage of the government's recovery should the government intervene. These incentives have led to a steady increase in whistleblower actions. The federal Civil Monetary Penalties Law authorizes the Secretary of HHS to impose substantial civil penalties, treble damages and program exclusions administratively for false claims or violations of the federal anti-kickback statute. In addition, the ACA increased penalties under federal sentencing guidelines between 20% and 50% for healthcare fraud offenses involving more than $1.0 million.
Government authorities are devoting increasing attention and resources to the prevention, detection and prosecution of healthcare fraud and abuse. CMS contractors are also expanding the retroactive audits of Medicare claims submitted by SNFs and other providers and recouping alleged overpayments for services determined by auditors not to have been appropriately billed (e.g., not medically necessary or not to meetmeeting Medicare coverage criteria as billed.criteria). State Medicaid programs and other third party payers are conducting similar medical necessity and compliance audits. The ACA facilitates the Department of Justice's, or the DOJ's, ability to investigate allegations of wrongdoing or fraud at SNFs,healthcare facilities, in part because of increased cooperation and data sharing among CMS, the United States Department of Health and Human Services,HHS, Office of the Inspector General, or the OIG, the DOJ and the states. On October 20, 2020, the DOJ issued its Annual Report to Congress on its Work to Combat Elder Fraud and Abuse, highlighting among its nursing home cases a $15 million settlement and Corporate Integrity Agreement resolving False Claims Act allegations regarding medically unnecessary rehabilitation services. The significant nature of the settlement indicates that the federal government is increasingly focused on the appropriateness of billing practices of, and medical necessity of services provided at, SNFs. The DOJ has also established 10 regional intergovernmental Elder Justice Task Forces across the country to identify and take enforcement action against SNFs that provide substandard care to residents. In September 2019, the DOJ announced that it intends to identify criminal charges, such as wire fraud or healthcare fraud, that can be brought alongside civil actions against SNFs and employees accused of abusing or defrauding elderly patients.
In addition, the ACA requires all states to terminate the Medicaid participation of any provider that has been terminated under Medicare or any Medicaid state plan. We and our tenants and managers expend significant resources to comply with these laws and regulations.
In addition, federal agencies have announced intentions to enhance enforcement efforts to improve the qualityData Privacy and safety of care in nursing homes, which will impact our operations and increase our operating costs. For example, in accordance with the previously announced attention by CMS regarding overuse of antipsychotics in nursing homes, CMS stated its intention to use civil monetary penalties and denial of Medicare reimbursement to penalize nursing homes that fail to adopt strategies to lower medically-unnecessary use of antipsychotic medications. Further, the DOJ announced a National Nursing Home Initiative to pursue civil and criminal penalties against “nursing homes that provide grossly substandard care to their residents.” The DOJ stated that it would consider a number of factors in identifying problematic nursing homes, including: (1) consistent failure to provide adequate nursing staff; (2) failure to adhere to basic protocols for hygiene and infection control; (3) failure to provide sufficient food to residents; (4) withholding of pain medication; and (5) use of physical or chemical restraints to restrain or sedate residents.
Other Matters.Security. Federal and state laws designed to protect the confidentiality and security of individually identifiable information apply to us, our tenants and our managers. Under the federal Health Insurance Portability and Accountability Act of 1996, or HIPAA, and the Health Information Technology for Economic and Clinical Health Act, or the HITECH Act, we, our managers and our tenants that are covered entities or business associates within the meaning of HIPAA must comply with rules adopted by HHS governing the privacy, security, use and disclosure of individually identifiable information, including financial information and protected health information, or PHI, and also with security rules for electronic PHI. There may be both civil monetary penalties and criminal sanctions for noncompliance with such federal laws. In January 2013, HHS released the
13

Table of Contents
HIPAA Omnibus Rule, or the Omnibus Rule, which modified various requirements, including the standard for providing breach notices, which previously required an analysis of the harm of any disclosure, to a more objective analysis relating to whether any PHI was actually acquired or viewed as a result of the breach. On December 10, 2020, HHS
8

Table of Contents

issued a proposed rule that would modify certain standards, definitions and patient rights under the previously-promulgatedpreviously promulgated Standards for Privacy of Individually Identifiable Health Information or the HIPAA Privacy Rule, to address barriers to coordinated care and case management. The effect of this proposed rule, if finalized, upon our operations is unknown at this time. HIPAA enforcement efforts have increased considerably over the past few years, with HHS, through its Office for Civil Rights, or OCR, entering into several multi-million dollar HIPAA settlements in prior years. OCR has also demonstrated a continuing commitment to enforce the obligation to provide individuals with timely access to their health information upon request. Finally, OCR and other regulatory bodies have become increasingly focused on cybersecurity risks, including the emerging threat of ransomware and similar cyberattacks. The increasing sophistication of cybersecurity threats presents challenges to the entire healthcare industry.
In addition, to HIPAA, many states have enacted their own security and privacy laws relating to individually identifiable information. For example, the California Consumer Privacy Act, (CCPA)or the CCPA, became effective in 2020, and wewas further modified by the California Privacy Rights Act, or the CPRA. The majority of CPRA provisions went into effect on January 1, 2023, with some requirements applying to data collected beginning on January 1, 2022. The CPRA significantly expanded the CCPA's data protection obligations. Failure to comply with the CCPA or CPRA could result in penalties for noncompliance of up to $7,500 per violation. We expect additional federal and state legislative and regulatory efforts to regulate consumer privacy in the future. In some states, these laws are more stringent than HIPAA, and we, our tenants and our managers must comply with both the applicable federal and state standards. HIPAA enforcement efforts have increased considerably over the past few years, with HHS, through its Office for Civil Rights, entering into several multi-million dollar HIPAA settlements in 2020 alone. Finally, the Office for Civil Rights and other regulatory bodies have become increasingly focused on cybersecurity risks, including the emerging threat of ransomware and similar cyberattacks. The increasing sophistication of cybersecurity threats presents challenges to the entire healthcare industry.
Other Matters.We require our tenants and managers to comply with all laws that regulate the operation of our senior living communities. The costs to comply with these laws may adversely affect the profitability of our managed senior living communities and the ability of our tenants to pay their rent to us. If we, our managers, or any of our tenants were subject to an action alleging violations of such laws or to any adverse determination concerning any of our or our tenants' or managers' licenses or eligibility for Medicare or Medicaid reimbursement or any substantial penalties, repayments or sanctions, these actions could materially and adversely affect the ability of our tenants to pay rent to us, the profitability of our managed senior living communities and the values of our properties. If our managers or any of our tenants becomes unable to operate our properties, or if any of our tenants becomes unable to pay its rent because it has violated government regulations or payment laws, we may experience difficulty in finding a substitute tenant or managersmanager or selling the affected property at a price that provides us with a desirable return, and the value of the affected property may decline materially.
Federal, state and local agencies regulate our medical office and life science property tenants that provide healthcare services. Many states require medical clinics, ambulatory surgery centers, clinical laboratories and other outpatient healthcare facilities to be licensed and inspected for compliance with licensure regulations concerning professional staffing, services, patient rights and physical plant requirements, among other matters. Our tenants must comply with the Americans with Disabilities Act, or ADA, and similar state and local laws to the extent that such facilities are “public accommodations” as defined in those statutes. The obligation to comply with the Americans with Disabilities ActADA and similar laws is an ongoing obligation, and our tenants expend significant resources to comply with such laws.
Healthcare providers and suppliers, including physicians and other licensed medical practitioners, that receive federal or state reimbursement under Medicare, Medicaid or other federal or state programs must comply with the requirements for their participation in those programs. Our tenants that are healthcare providers or suppliers are subject to reimbursement rates that are increasingly subject to cost control pressures and may be reduced or may not be increased sufficiently to cover their increasing costs, including our rents. Further, healthcare providers are experiencing heightened scrutiny under antitrust laws in the United States as integration and consolidation of health care delivery increase and affect competition. In addition, there has been a movement toward increased scrutiny of private equity and REIT interest in the healthcare industry, including the long-term care sector. For example, on November 15, 2023, CMS issued a final rule, effective January 16, 2024, that requires SNFs and Medicaid-participating nursing facilities to disclose certain additional data on their owners, operators and management in an effort to increase transparency of nursing facility ownership and to promote competition among nursing facilities by allowing patients to choose facilities based on publicly available data of their owners and operators.
The United States Food and Drug Administration, or the FDA, and other federal, state and local authorities extensively regulate our biotechnology laboratory tenants that develop, manufacture, market or distribute new drugs, biologicals or medical devices for human use. The FDA and such other authorities regulate the clinical development, testing, manufacture, quality control, safety, effectiveness, labeling, storage, record keeping, advertising and promotion of those products. Before a new pharmaceutical product or medical device may be marketed and distributed in the United States, the FDA must approve it as safe and effective for human use. Preclinical and clinical studies and documentation in connection with FDA approval of new pharmaceuticals or medical devices involve significant time, expense and risks of failure. Once a product is approved, the FDA maintains oversight of the product and its developer and can withdraw its approval, recall products or suspend their production, impose or seek to impose civil or criminal penalties on the developer or take other actions for the developer's failure to comply
9

Table of Contents

with regulatory requirements, including anti-fraud, false claims, anti-kickback or physician referral laws. Other concerns affecting our biotechnology laboratory tenants include the potential for subsequent discovery of safety concerns and related litigation, ensuring that the product qualifies for reimbursement under Medicare, Medicaid or other federal or state programs, cost control initiatives of payment programs, the potential for litigation over the validity or infringement of intellectual property rights related to the product, the eventual expiration of relevant patents and the need to raise additional capital. The cost of compliance with these regulations and the risks described in this paragraph, among others, could adversely affect the ability of our biotechnology laboratory tenants to pay rent to us. In addition, if these laws and regulations are altered, additional regulatory risks may arise. Depending upon what aspects of the laws and regulations are altered, the ability of our biotechnology laboratory tenants to pay rent to us could be adversely and materially affected.
14

Table of Contents
Competition
Investing inOwning and operating medical office and life science properties, senior living communities and other healthcare related properties and their operations, areis a highly competitive businesses.business. We compete against other REITs, numerous financial institutions, individuals and other public and private companies whothat are actively engaged in this business. Also, we compete for tenants and residents and for investments based on a number of factors including location, rents, rates, financings offered, underwriting criteria and reputation. Our ability to successfully compete is also impacted by current economic and populationindustry conditions, demographic trends, availability of acceptableattractive investment opportunities, our ability to negotiate beneficial investment terms, the availability and cost of capital limitations in agreements governing our debt and new and existing laws and regulations. Some of our competitors are dominant in selected geographic or property markets, including in markets we operate. Some of our competitors may have greater financial and other resources than we have. We believe the quality and diversity of our investments, the financial strength of many of our tenants and the experience and capabilities of our managers may afford us some competitive advantages and allow us to operate our business successfully despite the competitive nature of our business.
Our tenants and managers compete on a local and regional basis with operators of facilities that provide comparable services. Operators compete for residents and patients based on quality of care, reputation, physical appearance of properties, services offered, family preferences, physicians, staff, price and location. We and our tenants and managers also face competition from other healthcare facilities for qualified personnel, such as physicians and other healthcare providers that provide comparable facilities and services.
For additional information on competition and the risks associated with our business, see “Risk Factors” in Part I, Item 1A of this Annual Report on Form 10-K.
Corporate Sustainability
Our manager, RMR, periodically publishes its Sustainability Report, which summarizes the environmental, social and governance, or ESG, initiatives employed by RMR and its client companies, including us. RMR’s Sustainability Report may be accessed on the RMR Inc. website at www.rmrgroup.com/corporate-sustainability/default.aspx. The information on or accessible through RMR Inc.’s website is not incorporated by reference into this Annual Report on Form 10-K.
We believe corporate sustainability is a strategic part of our focus on operational practices, enhancing our competitive position, development and redevelopment efforts and economic performance. Our sustainability practices which align with those of our manager, RMR — minimizing our impact on the environment, embracing the communities where we operate and attracting top professionals — are critical elements supporting our long-term success.
We recognize our responsibility to minimize the impact of our business on the environment and seek to preserve natural resources and maximize efficiencies in order to reduce the impact our properties have on the planet. Our environmental sustainability strategies and best practices help to mitigate our properties’ environmental footprint, optimize operational efficiency and enhance our competitiveness in the marketplace. Our sustainability and community engagement strategies focus on a complementary set of objectives, including the following:
Responsible Investment. We seek to invest capital in our properties that both improves environmental performance and enhances asset value. During the property acquisition due diligence and annual budgeting processes, RMR assesses, among other things, environmental sustainability opportunities and physical and policy driven climate related risks.
Environmental Stewardship. We seek to improve the environmental footprint of our properties, including by reducing carbon emissions, energy consumption and water usage, especially when doing so may reduce operating
10

Table of Contents

costs and exposure to policies that call for a carbon tax or other emissions-based penalties and enhance the properties’ competitive position. Our existing business practices are intended to align with the Task Force on Climate Related Financial Disclosures framework across both the physical and transition risks and opportunities. With respect to our development and redevelopment activities, RMR considers how to best incorporate sustainability goals as part of the overall goal of any development or redevelopment project at our properties. In 2022, RMR announced its commitment to a goal of net zero emissions by 2050 with a 50% reduction commitment by 2030 from a 2019 baseline as it relates to Scope 1 and 2 emissions for all properties for which it directly manages energy.

We and our manager, RMR, drive value, manage risk and benchmark the performance of our properties by effectively capturing and managing data through real-time energy monitoring, or RTM. RTM facilitates advanced data analytics and access to detect faults and inefficiencies in equipment operations faster while enhancing building system control in a cost-effective and scalable way. RMR's RTM program captures 22 of our properties and generated $3.9 million in cumulative savings to date, of which $0.9 million was generated in 2023.
Furthermore, properties that reach specified levels of sustainability and energy efficiency may receive potential environmental designations and certifications, such as Leadership in Energy and Environmental Design, or LEED®, designations and/or “ENERGY STAR” certifications. LEED designations are administered by the U.S. Green Building Council. The ENERGY STAR program is a joint program of the U.S. Environmental Protection Agency and the U.S. Department of Energy which is focused on promoting energy efficient products and properties. The U.S. Government’s “green lease” policies permit government tenants to require LEED® designation in selecting new premises or renewing leases at existing premises and the General Services Administration gives preference to properties for lease that have received an ENERGY STAR certification. Our property manager, RMR, is a member of the ENERGY STAR program. Certain properties are not eligible for ENERGY STAR certification. For example, lab uses, medical office properties and properties less than 50% occupied cannot be ENERGY STAR certified. As of December 31, 2023, our LEED designations and ENERGY STAR certifications were as follows:
LEED: 23 of our Office Portfolio properties containing 2.2 million rentable square feet (22.5% and 25.6% of our Office Portfolio properties and rentable square feet, respectively).
ENERGY STAR: 25 of our properties containing 3.1 million square feet (11.2% and 15.1% of our eligible properties and rentable square feet, respectively).
In April 2021, we were selected by the U.S. Department of Energy's Better Buildings Alliance and Institute for Market Transformation as a Gold Level Green Lease Leader.
For more information, see “Risk Factors—Risks Related to Our Business—Ownership of real estate is subject to environmental risks and liabilities” and “Risk Factors—Risks Related to Our Business—We are subject to risks from adverse weather, natural disasters and adverse impact from global climate change, and we incur significant costs and invest significant amounts with respect to these matters” in Part I, Item 1A of this Annual Report on Form 10-K and “Management's Discussion and Analysis of Financial Condition and Results of Operations—Impact of Climate Change” in Part II, Item 7 of this Annual Report on Form 10-K.
Environmental Matters
Ownership of real estate is subject to risks associated with environmental hazards. Under various laws, owners as well as tenants and operators of real estate may be required to investigate and clean up or remove hazardous substances present at or migrating from properties they own, lease or operate and may be held liable for property damage or personal injuries that result from hazardous substances. These laws also expose us to the possibility that we may become liable to government agencies or third parties for costs and damages they incur in connection with hazardous substances. In addition, these laws also impose various requirements regarding the operation and maintenance of properties and recordkeeping and reporting requirements relating to environmental matters that require us or the tenants or managers of our properties to incur costs to comply with.
We reviewed environmental surveys of the properties we own prior to their purchase. Based upon those surveys, other studies we may have since reviewed and our understanding of the operations of these properties by our tenants and managers, we do not believe that there are environmental conditions at any of our properties that have had or will have a material adverse effect on us. However, we cannot be sure that conditions are not present at our properties or that costs we may be required to incur in the future to remediate contamination will not have a material adverse effect on our business or financial condition or results of operations.
11

Table of Contents

When majoradverse weather, or climate-related events,natural disasters and adverse impact from global climate change, such as hurricanes, floods or wildfires, occur near our properties, we, our tenants or our managers may relocate the residents at our senior living properties to alternative locations for their safety and we, our tenants or our managers may close or limit the operations of the impacted senior living community or office property until the event has ended and the property is then ready for operation. We or the tenants or managers of our properties may incur significant costs and losses as a result of these activities, both in terms of operating, preparing and repairing our properties in anticipation of, during and after a severeadverse weather, or climate-related eventnatural disasters and adverse impact from global climate change and in terms of potential lost business due to the interruption in operating our properties. Our insurance and our tenants' and managers' insurance may not adequately compensate us or them for these costs and losses.
Concerns about climate change have resulted in various treaties, laws and regulations that are intended to limit carbon emissions and address other environmental concerns. These and other laws may cause energy or other costs at our properties to increase. We do not expect the direct impact of these increases to be material to our results of operations, because the increased costs either would be the responsibility of our tenants directly or in the longer term, passed through and paid by tenants of our leased properties and residents at our managed senior living communities. Although we do not believe it is likely in the foreseeable future, laws enacted to mitigate climate change may make some of our buildings obsolete or cause us to make material investments in our properties, which could materially and adversely affect our financial condition or the financial condition of our tenants or managers and their ability to pay rent or returns to us. For more information regarding climate change and other environmental matters and their possible adverse impact on us, see “Risk Factors—Risks Related to Our Business—Ownership of real estate is subject to environmental risks,”risks” and “Risk Factors—Risks Related to Our Business—
15

Table of Contents
Ownership of real estate isWe are subject to risks from adverse weather, natural disasters and adverse impact from global climate events”change, and we incur significant costs and invest significant amounts with respect to these matters" in Part I, Item 1A of this Annual Report on Form 10-K and “Management's Discussion and Analysis of Financial Condition and Results of Operations—Impact of Climate Change”. in Part II, Item 7 of this Annual Report on Form 10-K.
Investments in Human Capital
We have no employees. We rely on our manager, RMR, to hire, train, and develop a workforce that meets the needs of our business, contributes positively to our society and helps reduce our impact on the natural environment.
Corporate Citizenship
We seek to be a responsible corporate citizen and to strengthen the communities in which we own properties. Our manager, RMR, regularly encourages its employees to engage in a variety of charitable and community programs, including participation in a company-wide service day and a charitable giving matching program.
Diversity and Inclusion
As of December 31, 2023, our Board of Trustees was comprised of six Trustees, of which four were independent trustees. Our Board of Trustees is comprised of 50% women and approximately 33% members of underrepresented minorities.
Insurance
We or our tenants are generally responsible for the costs of insurance coverage for our properties and the operations conducted on them, including for casualty, liability, fire, extended coverage and rental or business interruption losses. Either we purchase the insurance ourselves and, except in the case of our managed senior living communities, our tenants are required to reimburse us, or the tenants buy the insurance directly and are required to list us as an insured party.
Internet Website
Our internet website address is www.dhcreit.com. Copies of our governance guidelines, our code of business conduct and ethics, or our Code of Conduct, and the charters of our audit, compensation and nominating and governance committees are posted on our website and also may be obtained free of charge by writing to our Secretary, Diversified Healthcare Trust, Two Newton Place, 255 Washington Street, Suite 300, Newton, Massachusetts 02458-1634. We also have a policy outlining procedures for handling concerns or complaints about accounting, internal accounting controls or auditing matters and a governance hotline accessible on our website that shareholders can use to report concerns or complaints about accounting, internal accounting controls or auditing matters or violations or possible violations of our Code of Conduct. We make available, free of charge, through the "Investors" section of our website, our Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q, Current Reports on Form 8-K and amendments to these reports filed or furnished pursuant to Section 13(a) or 15(d)
12

Table of Contents

of the Securities Exchange Act of 1934, as amended, or the Exchange Act, as soon as reasonably practicable after these forms are filed with, or furnished to, the Securities and Exchange Commission, or SEC. Any material we file with or furnish to the SEC is also maintained on the SEC website, www.sec.gov. SecurityholdersSecurity holders may send communications to our Board of Trustees or individual Trustees by writing to the party for whom the communication is intended at c/o Secretary, Diversified Healthcare Trust, Two Newton Place, 255 Washington Street, Suite 300, Newton, Massachusetts 02458-1634 or by email at secretary@dhcreit.com. Our website address is included several times in this Annual Report on Form 10-K as a textual reference only. The information on or accessible through our website is not incorporated by reference into this Annual Report on Form 10-K or other documents we file with, or furnish to, the SEC. We intend to use our website as a means of disclosing material non-public information and for complying with our disclosure obligations under Regulation FD. Those disclosures will be included on our website in the “Investors��“Investors” section. Accordingly, investors should monitor our website, in addition to following our press releases, SEC filings and public conference calls and webcasts.
Segment Information
As of December 31, 2020,2023, we had two reporting segments: Office Portfolio and SHOP. Non-aggregated assets are classified as “non-segment” and include corporate assets and liabilities, certain triple net leased senior living communities and wellness centers. For further information, see “Management's Discussion and Analysis of Financial Condition and Results of Operations” in Part II, Item 7 of this Annual Report on Form 10-K and our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
MATERIAL UNITED STATES FEDERAL INCOME TAX CONSIDERATIONS
The following summary of material United States federal income tax considerations is based on existing law and is limited to investors who own our shares as investment assets rather than as inventory or as property used in a trade or business. The summary does not discuss all of the particular tax considerations that might be relevant to you if you are subject to special rules under federal income tax law, for example if you are:
a bank, insurance company or other financial institution;
a regulated investment company or REIT;
a subchapter S corporation;
a broker, dealer or trader in securities or foreign currencies;
a person who marks-to-market our shares for U.S. federal income tax purposes;
a U.S. shareholder (as defined below) that has a functional currency other than the U.S. dollar;
16

Table of Contents
a person who acquires or owns our shares in connection with employment or other performance of services;
a person subject to alternative minimum tax;
a person who acquires or owns our shares as part of a straddle, hedging transaction, constructive sale transaction, constructive ownership transaction or conversion transaction, or as part of a “synthetic security” or other integrated financial transaction;
a person who owns 10% or more (by vote or value, directly or constructively under the United States Internal Revenue Code of 1986, as amended, or the IRC) of any class of our shares;
a U.S. expatriate;
a non-U.S. shareholder (as defined below) whose investment in our shares is effectively connected with the conduct of a trade or business in the United States;
a nonresident alien individual present in the United States for 183 days or more during an applicable taxable year;
a “qualified shareholder” (as defined in Section 897(k)(3)(A) of the IRC);
13

Table of Contents

a “qualified foreign pension fund” (as defined in Section 897(l)(2) of the IRC) or any entity wholly owned by one or more qualified foreign pension funds;
a non-U.S. shareholder that is a passive foreign investment company or controlled foreign corporation;
a person subject to special tax accounting rules as a result of their use of applicable financial statements (within the meaning of Section 451(b)(3) of the IRC); or
except as specifically described in the following summary, a trust, estate, tax-exempt entity or foreign person.
The sections of the IRC that govern the federal income tax qualification and treatment of a REIT and its shareholders are complex. This presentation is a summary of applicable IRC provisions, related rules and regulations, and administrative and judicial interpretations, all of which are subject to change, possibly with retroactive effect. Future legislative, judicial or administrative actions or decisions could also affect the accuracy of statements made in this summary. We have not received a ruling from the U.S. Internal Revenue Service, or the IRS, with respect to any matter described in this summary, and we cannot be sure that the IRS or a court will agree with all of the statements made in this summary. The IRS could, for example, take a different position from that described in this summary with respect to our acquisitions, operations, valuations, restructurings or other matters, which, if a court agreed, could result in significant tax liabilities for applicable parties. In addition, this summary is not exhaustive of all possible tax considerations and does not discuss any estate, gift, state, local or foreign tax considerations. For all these reasons, we urge you and any holder of or prospective acquiror of our shares to consult with a tax advisor about the federal income tax and other tax consequences of the acquisition, ownership and disposition of our shares. Our intentions and beliefs described in this summary are based upon our understanding of applicable laws and regulations that are in effect as of the date of this Annual Report on Form 10-K.February 26, 2024. If new laws or regulations are enacted which impact us directly or indirectly, we may change our intentions or beliefs.
Your federal income tax consequences generally will differ depending on whether or not you are a “U.S. shareholder.” For purposes of this summary, a “U.S. shareholder” is a beneficial owner of our shares that is:
an individual who is a citizen or resident of the United States, including an alien individual who is a lawful permanent resident of the United States or meets the substantial presence residency test under the federal income tax laws;
an entity treated as a corporation for federal income tax purposes that is created or organized in or under the laws of the United States, any state thereof or the District of Columbia;
an estate the income of which is subject to federal income taxation regardless of its source; or
a trust if a court within the United States is able to exercise primary supervision over the administration of the trust and one or more U.S. persons have the authority to control all substantial decisions of the trust, or, to the extent provided in Treasury regulations, a trust in existence on August 20, 1996 that has elected to be treated as a domestic trust;
17

Table of Contents
whose status as a U.S. shareholder is not overridden by an applicable tax treaty. Conversely, a “non-U.S. shareholder” is a beneficial owner of our shares that is not an entity (or other arrangement) treated as a partnership for federal income tax purposes and is not a U.S. shareholder.
If any entity (or other arrangement) treated as a partnership for federal income tax purposes holds our shares, the tax treatment of a partner in the partnership generally will depend upon the tax status of the partner and the activities of the partnership. Any entity (or other arrangement) treated as a partnership for federal income tax purposes that is a holder of our shares and the partners in such a partnership (as determined for federal income tax purposes) are urged to consult their own tax advisors about the federal income tax consequences and other tax consequences of the acquisition, ownership and disposition of our shares.
Taxation as a REIT
We have elected to be taxed as a REIT under Sections 856 through 860 of the IRC, commencing with our 1999 taxable year. Our REIT election, assuming continuing compliance with the then applicable qualification tests, has continued and will continue in effect for subsequent taxable years. Although we cannot be sure, we believe that from and after our 1999 taxable year we have been organized and have operated, and will continue to be organized and to operate, in a manner that qualified us and will continue to qualify us to be taxed as a REIT under the IRC.
14

Table of Contents

As a REIT, we generally are not subject to federal income tax on our net income distributed as dividends to our shareholders. Distributions to our shareholders generally are included in our shareholders'shareholders’ income as dividends to the extent of our available current or accumulated earnings and profits. Our dividends are not generally entitled to the preferential tax rates on qualified dividend income, but a portion of our dividends may be treated as capital gain dividends or as qualified dividend income, all as explained below. In addition, for taxable years beginning before 2026 and pursuant to the deduction-without-outlay mechanism of Section 199A of the IRC, our noncorporate U.S. shareholders that meet specified holding period requirements are generally eligible for lower effective tax rates on our dividends that are not treated as capital gain dividends or as qualified dividend income. No portion of any of our dividends is eligible for the dividends received deduction for corporate shareholders. Distributions in excess of our current or accumulated earnings and profits generally are treated for federal income tax purposes as returns of capital to the extent of a recipient shareholder'sshareholder’s basis in our shares, and will reduce this basis. Our current or accumulated earnings and profits are generally allocated first to distributions made on our preferred shares, of which there are none outstanding at this time, and thereafter to distributions made on our common shares. For all these purposes, our distributions include cash distributions, any in kind distributions of property that we might make, and deemed or constructive distributions resulting from capital market activities (such as some redemptions), as described below.
Our counsel, Sullivan & Worcester LLP, is of the opinion that we have been organized and have qualified for taxation as a REIT under the IRC for our 1999 through 20202023 taxable years, and that our current and anticipated investments and plan of operation will enable us to continue to meet the requirements for qualification and taxation as a REIT under the IRC. Our counsel's opinions are conditioned upon the assumption that our leases, our declaration of trust, and all other legal documents to which we have been or are a party have been and will be complied with by all parties to those documents, upon the accuracy and completeness of the factual matters described in this Annual Report on Form 10-K and upon representations made by us to our counsel as to certain factual matters relating to our organization and operations and our expected manner of operation. If this assumption or a description or representation is inaccurate or incomplete, our counsel'scounsel’s opinions may be adversely affected and may not be relied upon. The opinions of our counsel are based upon the law as it exists today, but the law may change in the future, possibly with retroactive effect. Given the highly complex nature of the rules governing REITs, the ongoing importance of factual determinations, and the possibility of future changes in our circumstances, neither Sullivan & Worcester LLP nor we can be sure that we will qualify as or be taxed as a REIT for any particular year. Any opinion of Sullivan & Worcester LLP as to our qualification or taxation as a REIT will be expressed as of the date issued. Our counsel will have no obligation to advise us or our shareholders of any subsequent change in the matters stated, represented or assumed, or of any subsequent change in the applicable law. Also, the opinions of our counsel are not binding on either the IRS or a court, and either could take a position different from that expressed by our counsel.
Our continued qualification and taxation as a REIT will depend upon our compliance with various qualification tests imposed under the IRC and summarized below. While we believe that we have satisfied and will satisfy these tests, our counsel does not review compliance with these tests on a continuing basis. If we fail to qualify for taxation as a REIT in any year, then we will be subject to federal income taxation as if we were a corporation taxed under subchapter C of the IRC, or a C corporation, and our shareholders will be taxed like shareholders of a regular C corporations,corporation, meaning that federal income tax generally will be applied at both the corporate and shareholder levels. In this event, we could be subject to significant tax liabilities, and the amount of cash available for distribution to our shareholders could be reduced or eliminated.
18

Table of Contents
If we continue to qualify for taxation as a REIT and meet the tests described below, then we generally will not pay federal income tax on amounts that we distribute to our shareholders. However, even if we continue to qualify for taxation as a REIT, we may still be subject to federal tax in the following circumstances, as described below:
We will be taxed at regular corporate income tax rates on any undistributed “real estate investment trust taxable income,” determined by including our undistributed ordinary income and net capital gains, if any. We may elect to retain and pay income tax on our net capital gain. In addition, if we so elect by making a timely designation to our shareholders, a shareholder would be taxed on its proportionate share of our undistributed capital gain and would generally be expected to receive a credit or refund for its proportionate share of the tax we paid.
If we have net income from the disposition of “foreclosure property,” as described in Section 856(e) of the IRC, that is held primarily for sale to customers in the ordinary course of a trade or business or other nonqualifying income from foreclosure property, we will be subject to tax on this income at the highest regular corporate income tax rate.
If we have net income from “prohibited transactions”—that is, dispositions at a gain of inventory or property held primarily for sale to customers in the ordinary course of a trade or business other than dispositions of foreclosure property and other than dispositions excepted by statutory safe harbors — harbors—we will be subject to tax on this income at a 100% rate.
15

Table of Contents

If we fail to satisfy the 75% gross income test or the 95% gross income test discussed below, due to reasonable cause and not due to willful neglect, but nonetheless maintain our qualification for taxation as a REIT because of specified cure provisions, we will be subject to tax at a 100% rate on the greater of the amount by which we fail the 75% gross income test or the 95% gross income test, with adjustments, multiplied by a fraction intended to reflect our profitability for the taxable year.
If we fail to satisfy any of the REIT asset tests described below (other than a de minimis failure of the 5% or 10% asset tests) due to reasonable cause and not due to willful neglect, but nonetheless maintain our qualification for taxation as a REIT because of specified cure provisions, we will be subject to a tax equal to the greater of $50,000 or the highest regular corporate income tax rate multiplied by the net income generated by the nonqualifying assets that caused us to fail the test.
If we fail to satisfy any provision of the IRC that would result in our failure to qualify for taxation as a REIT (other than violations of the REIT gross income tests or violations of the REIT asset tests described below) due to reasonable cause and not due to willful neglect, we may retain our qualification for taxation as a REIT but will be subject to a penalty of $50,000 for each failure.
If we fail to distribute for any calendar year at least the sum of 85% of our REIT ordinary income for that year, 95% of our REIT capital gain net income for that year and any undistributed taxable income from prior periods, we will be subject to a 4% nondeductible excise tax on the excess of the required distribution over the amounts actually distributed.
If we acquire a REIT asset where our adjusted tax basis in the asset is determined by reference to the adjusted tax basis of the asset in the hands of a C corporation, under specified circumstances we may be subject to federal income taxation on all or part of the built-in gain (calculated as of the date the property ceased being owned by the C corporation) on such asset. We generally do not expect to sell assets if doing so would result in the imposition of a material built-in gains tax liability; but if and when we do sell assets that may have associated built-in gains tax exposure, then we expect to make appropriate provision for the associated tax liabilities on our financial statements.
If we acquire a corporation in a transaction where we succeed to its tax attributes, to preserve our qualification for taxation as a REIT we must generally distribute all of the C corporation earnings and profits inherited in that acquisition, if any, no later than the end of our taxable year in which the acquisition occurs. However, if we fail to do so, relief provisions would allow us to maintain our qualification for taxation as a REIT provided we distribute any subsequently discovered C corporation earnings and profits and pay an interest charge in respect of the period of delayed distribution.
Our subsidiaries that are C corporations, including our “taxable REIT subsidiaries”, as defined in Section 856(l) of the IRC, or TRSs, generally will be required to pay federal corporate income tax on their earnings, and a 100% tax may be imposed on any transaction between us and one of our TRSs that does not reflect arm'sarm’s length terms.
19

Table of Contents
As discussed below, we are invested in real estate through a subsidiarysubsidiaries that we believe qualifiesqualify for taxation as a REIT.REITs. If it is determined that this entityone of these entities failed to qualify for taxation as a REIT, we may fail one or more of the REIT asset tests. In such case, we expect that we would be able to avail ourselves of the relief provisions described below, but would be subject to a tax equal to the greater of $50,000 or the highest regular corporate income tax rate multiplied by the net income we earned from this subsidiary.
If we fail to qualify for taxation as a REIT in any year, then we will be subject to federal income tax in the same manner as a regular C corporation. Further, as a regular C corporation, distributions to our shareholders will not be deductible by us, nor will distributions be required under the IRC. Also, to the extent of our current and accumulated earnings and profits, all distributions to our shareholders will generally be taxable as ordinary dividends potentially eligible for the preferential tax rates discussed below under the heading “—Taxation of Taxable U.S. Shareholders” and, subject to limitations in the IRC, will be potentially eligible for the dividends received deduction for corporate shareholders. Finally, we will generally be disqualified from taxation as a REIT for the four taxable years following the taxable year in which the termination of our REIT status is effective. Our failure to qualify for taxation as a REIT for even one year could result in us reducing or eliminating distributions to our shareholders, or in us incurring substantial indebtedness or liquidating substantial investments in order to pay the resulting corporate-level income taxes. Relief provisions under the IRC may allow us to continue to qualify for taxation as a REIT even if we fail to comply with various REIT requirements, all as discussed in more detail below. However, it is impossible to state whether in any particular circumstance we would be entitled to the benefit of these relief provisions.
16

Table of Contents

REIT Qualification Requirements
General Requirements. Section 856(a) of the IRC defines a REIT as a corporation, trust or association:
(1)that is managed by one or more trustees or directors;
(2)the beneficial ownership of which is evidenced by transferable shares or by transferable certificates of beneficial interest;
(3)that would be taxable, but for Sections 856 through 859 of the IRC, as a domestic C corporation;
(4)that is not a financial institution or an insurance company subject to special provisions of the IRC;
(5)the beneficial ownership of which is held by 100 or more persons;
(6)that is not “closely held,” meaning that during the last half of each taxable year, not more than 50% in value of the outstanding shares are owned, directly or indirectly, by five or fewer “individuals” (as defined in the IRC to include specified tax-exempt entities); and
(7)that meets other tests regarding the nature of its income and assets and the amount of its distributions, all as described below.
Section 856(b) of the IRC provides that conditions (1) through (4) must be met during the entire taxable year and that condition (5) must be met during at least 335 days of a taxable year of 12 months, or during a proportionate part of a taxable year of less than 12 months. Although we cannot be sure, we believe that we have met conditions (1) through (7) during each of the requisite periods ending on or before the close of our most recently completed taxable year, and that we will continue to meet these conditions in our current and future taxable years.
To help comply with condition (6), our declaration of trust restrictsand bylaws restrict transfers of our shares that would otherwise result in concentrated ownership positions. These restrictions, however, do not ensure that we have previously satisfied, and may not ensure that we will in all cases be able to continue to satisfy, the share ownership requirements described in condition (6). If we comply with applicable Treasury regulations to ascertain the ownership of our outstanding shares and do not know, or by exercising reasonable diligence would not have known, that we failed condition (6), then we will be treated as having met condition (6). Accordingly, we have complied and will continue to comply with these regulations, including by requesting annually from holders of significant percentages of our shares information regarding the ownership of our shares. Under our declaration of trust, our shareholders are required to respond to these requests for information. A shareholder that fails or refuses to comply with the request is required by Treasury regulations to submit a statement with its federal income tax return disclosing its actual ownership of our shares and other information.
20

Table of Contents
For purposes of condition (6), an “individual” generally includes a natural person, a supplemental unemployment compensation benefit plan, a private foundation, or a portion of a trust permanently set aside or used exclusively for charitable purposes, but does not include a qualified pension plan or profit-sharing trust. As a result, REIT shares owned by an entity that is not an “individual” are considered to be owned by the direct and indirect owners of the entity that are individuals (as so defined), rather than to be owned by the entity itself. Similarly, REIT shares held by a qualified pension plan or profit-sharing trust are treated as held directly by the individual beneficiaries in proportion to their actuarial interests in such plan or trust. Consequently, five or fewer such trusts could own more than 50% of the interests in an entity without jeopardizing that entity'sentity’s qualification for taxation as a REIT.
The IRC provides that we will not automatically fail to qualify for taxation as a REIT if we do not meet conditions (1) through (6), provided we can establish that such failure was due to reasonable cause and not due to willful neglect. Each such excused failure will result in the imposition of a $50,000 penalty instead of REIT disqualification. This relief provision may apply to a failure of the applicable conditions even if the failure first occurred in a year prior to the taxable year in which the failure was discovered.
Our Wholly Owned Subsidiaries and Our Investments Through Partnerships. Except in respect of a TRS as discussed below, Section 856(i) of the IRC provides that any corporation, 100% of whose stock is held by a REIT and its disregarded subsidiaries, is a qualified REIT subsidiary and shall not be treated as a separate corporation for U.S. federal income tax purposes. The assets, liabilities and items of income, deduction and credit of a qualified REIT subsidiary are treated as the REIT's.REIT’s. We believe that each of our direct and indirect wholly owned subsidiaries, other than the TRSs discussed below (and entities whose equity is owned in whole or in part by thesuch TRSs), will be either a qualified REIT subsidiary within the meaning
17

Table of Contents

of Section 856(i)(2) of the IRC or a noncorporate entity that for federal income tax purposes is not treated as separate from its owner under Treasury regulations issued under Section 7701 of the IRC, each such entity referred to as a QRS. Thus, in applying all of the REIT qualification requirements described in this summary, all assets, liabilities and items of income, deduction and credit of our QRSs are treated as ours, and our investment in the stock and other securities of such QRSs will be disregarded.
We have invested and may in the future invest in real estate through one or more entities that are treated as partnerships for federal income tax purposes. In the case of a REIT that is a partner in a partnership, Treasury regulations under the IRC provide that, for purposes of the REIT qualification requirements regarding income and assets described below, the REIT is generally deemed to own its proportionate share, based on respective capital interests, of the income and assets of the partnership (except that for purposes of the 10% value test, described below, the REIT'sREIT’s proportionate share of the partnership'spartnership’s assets is based on its proportionate interest in the equity and specified debt securities issued by the partnership). In addition, for these purposes, the character of the assets and items of gross income of the partnership generally remains the same in the hands of the REIT. In contrast, for purposes of the distribution requirements discussed below, we must take into account as a partner our share of the partnership'spartnership’s income as determined under the general federal income tax rules governing partners and partnerships under Subchapter K of the IRC.
Subsidiary REITs. We indirectly own real estate through a subsidiarysubsidiaries that we believe hashave qualified and will remain qualified for taxation as a REITREITs under the IRC, and we may in the future invest in real estate through one or more other subsidiary entities that are intended to qualify for taxation as REITs. When a subsidiary qualifies for taxation as a REIT separate and apart from its REIT parent, the subsidiary'ssubsidiary’s shares are qualifying real estate assets for purposes of the REIT parent'sparent’s 75% asset test described below. However, failure of the subsidiary to separately satisfy the various REIT qualification requirements described in this summary or that are otherwise applicable (and failure to qualify for the applicable relief provisions) would generally result in (a) the subsidiary being subject to regular U.S. corporate income tax, as described above, and (b) the REIT parent'sparent’s ownership in the subsidiary (i) ceasing to be qualifying real estate assets for purposes of the 75% asset test and (ii) becoming subject to the 5% asset test, the 10% vote test and the 10% value test, each as described below, generally applicable to a REIT'sREIT’s ownership in corporations other than REITs and TRSs, and (iii) thereby jeopardizingTRSs. In such a situation, the REIT parent'sparent’s own REIT qualification and taxation as a REIT could be jeopardized on account of the subsidiary'ssubsidiary’s failure cascading up to the REIT parent, all as described below under the heading “—Asset Tests”.
We have joined with our subsidiary REITREITs in filing a protective TRS election, effective for the first quarter of 2017, and we have reaffirmed this protective election with this subsidiary every January thereafter,elections, and we may continue to do soannually make such elections unless and until our ownership of this subsidiarythese subsidiaries falls below 10%. Pursuant to thisthese protective TRS election,elections, we believe that if our subsidiaryone of these subsidiaries is not a REIT for some reason, then itthat subsidiary would instead be considered one of our TRSs, and as such its value would fit within our REIT gross asset tests described below. We expect to make similar protective TRS elections with respect to any other subsidiary REIT that we form or acquire.acquire and may implement other protective arrangements intended to avoid a cascading REIT failure if any of our intended subsidiary REITs were not to qualify for taxation as a REIT, but we cannot be sure that such protective elections or other arrangements will be effective to avoid or mitigate the resulting adverse consequences to us. We do not expect protective TRS elections to impact our compliance with the 75% and 95% gross income tests described below, because we do not expect our gains and dividends from a subsidiary REIT'sREIT’s shares to jeopardize compliance with these tests even if for some reason the subsidiary is not a REIT.
21

Table of Contents
Taxable REIT Subsidiaries. As a REIT, we are permitted to own any or all of the securities of a TRS, provided that no more than 20% of the total value of our assets, at the close of each quarter, is comprised of our investments in the stock or other securities of our TRSs. Very generally, a TRS is a subsidiary corporation other than a REIT in which a REIT directly or indirectly holds stock and that has made a joint election with its affiliatedsuch REIT to be treated as a TRS. A TRS is taxed as a regular C corporation, separate and apart from itsany affiliated REIT. Our ownership of stock and other securities in our TRSs is exempt from the 5% asset test, the 10% vote test and the 10% value test discussed below. Among other requirements, a TRS of ours must:
(1)not directly or indirectly operate or manage a lodging facility or a health care facility; and
(2)not directly or indirectly provide to any person, under a franchise, license or otherwise, rights to any brand name under which any lodging facility or health care facility is operated, except that in limited circumstances a subfranchise, sublicense or similar right can be granted to an independent contractor to operate or manage a lodging facility or a health care facility.
In addition, any corporation (other than a REIT)REIT and other than a QRS) in which a TRS directly or indirectly owns more than 35% of the voting power or value of the outstanding securities is automatically a TRS.TRS (excluding, for this purpose, certain “straight debt” securities). Subject to the discussion below, we believe that we and each of our TRSs have complied
18

Table of Contents

with, and will continue to comply with, the requirements for TRS status at all times during which we intend for the subsidiary'ssubsidiary’s TRS election is intended to be in effect, and we believe that the same will be true for any TRS that we later form or acquire.
As discussed below, TRSs can perform services for our tenants without disqualifying the rents we receive from those tenants under the 75% gross income test or the 95% gross income test discussed below. Moreover, because our TRSs are taxed as C corporations that are separate from us, their assets, liabilities and items of income, deduction and credit generally are not imputed to us for purposes of the REIT qualification requirements described in this summary. Therefore, our TRSs may generally conduct activities that would be treated as prohibited transactions or would give rise to nonqualified income if conducted by us directly. Additionally, while a REIT is generally limited in its ability to earn qualifying rental income from a TRS, a REIT can earn qualifying rental income from the lease of a qualified health care property to a TRS if an eligible independent contractor operates the facility, as discussed more fully below.
Restrictions and sanctions are imposed on TRSs and their affiliated REITs to ensure that the TRSs will be subject to an appropriate level of federal income taxation. For example, if a TRS pays interest, rent or other amounts to its affiliated REIT in an amount that exceeds what an unrelated third party would have paid in an arm'sarm’s length transaction, then the REIT generally will be subject to an excise tax equal to 100% of the excessive portion of the payment. Further, if in comparison to an arm'sarm’s length transaction, a third partythird-party tenant has overpaid rent to the REIT in exchange for underpaying the TRS for services rendered, and if the REIT has not adequately compensated the TRS for services provided to or on behalf of the third partythird-party tenant, then the REIT may be subject to an excise tax equal to 100% of the undercompensation to the TRS. A safe harbor exception to this excise tax applies if the TRS has been compensated at a rate at least equal to 150% of its direct cost in furnishing or rendering the service. Finally, the 100% excise tax also applies to the underpricing of services provided by a TRS to its affiliated REIT in contexts where the services are unrelated to services for REIT tenants. We cannot be sure that arrangements involving our TRSs will not result in the imposition of one or more of these restrictions or sanctions, but we do not believe that we or our TRSs are or will be subject to these impositions.
Income Tests. We must satisfy two gross income tests annually to maintain our qualification for taxation as a REIT. First, at least 75% of our gross income for each taxable year must be derived from investments relating to real property, including “rents from real property” within the meaning of Section 856(d) of the IRC, interest and gain from mortgages on real property or on interests in real property, income and gain from foreclosure property, gain from the sale or other disposition of real property (including specified ancillary personal property treated as real property under the IRC), or dividends on and gain from the sale or disposition of shares in other REITs (but excluding in all cases any gains subject to the 100% tax on prohibited transactions). When we receive new capital in exchange for our shares or in a public offering of our five-year or longer debt instruments, income attributable to the temporary investment of this new capital in stock or a debt instrument, if received or accrued within one year of our receipt of the new capital, is generally also qualifying income under the 75% gross income test. Second, at least 95% of our gross income for each taxable year must consist of income that is qualifying income for purposes of the 75% gross income test, other types of interest and dividends, gain from the sale or disposition of stock or securities, or any combination of these. Gross income from our sale of property that we hold primarily for sale to customers in the ordinary course of business, income and gain from specified “hedging transactions” that are clearly and timely identified as such, and income from the repurchase or discharge of indebtedness is excluded from both the numerator and the denominator in both gross income tests. In addition, specified foreign currency gains will be excluded from gross income for purposes of one or both of the gross income tests.
22

Table of Contents
In order to qualify as “rents from real property” within the meaning of Section 856(d) of the IRC, several requirements must be met:
The amount of rent received generally must not be based on the income or profits of any person, but may be based on a fixed percentage or percentages of receipts or sales.
Rents generally do not qualify if the REIT owns 10% or more by vote or value of stock of the tenant (or 10% or more of the interests in the assets or net profits of the tenant, if the tenant is not a corporation), whether directly or after application of attribution rules. We generally do not intend to lease property to any party if rents from that property would not qualify as “rents from real property,” but application of the 10% ownership rule is dependent upon complex attribution rules and circumstances that may be beyond our control. In this regard, prior to the termination of our leases with Five Star, we owned close to, but less than, 10% of the outstanding common shares of Five Star. Our declaration of trust and bylaws generally disallowsdisallow transfers or purported acquisitions, directly or by attribution, of our shares to the extent necessary to maintain our qualification for taxation as a REIT under the IRC. Nevertheless, we cannot be sure that these restrictions will be effective to prevent our qualification for taxation as a REIT from being jeopardized under the 10% affiliated tenant rule. Furthermore, we cannot be sure that we will be able to monitor and enforce these restrictions, nor will our shareholders necessarily be aware of ownership of our shares attributed to them under the IRC's attribution rules.
19

Table of Contents

There is a limited exception to the above prohibition on earning “rents from real property” from a 10% affiliated tenant where the tenant is a TRS. If at least 90% of the leased space of a property is leased to tenants other than TRSs and 10% affiliated tenants, and if the TRS's rent to the REIT for space at that property is substantially comparable to the rents paid by nonaffiliated tenants for comparable space at the property, then otherwise qualifying rents paid by the TRS to the REIT will not be disqualified on account of the rule prohibiting 10% affiliated tenants.
There is an additional exception to the above prohibition on earning “rents from real property” from a 10% affiliated tenant. For this additional exception to apply, a real property interest in a “qualified health care property” must be leased by the REIT to its TRS, and the facility must be operated on behalf of the TRS by a person who is an “eligible independent contractor,” all as described in Sections 856(d)(8)-(9) and 856(e)(6)(D) of the IRC. As described below, we believe our leases with our TRSs have satisfied and will continue to satisfy these requirements.
In order for rents to qualify, a REIT generally must not manage the property or furnish or render services to the tenants of the property, except through an independent contractor from whom it derives no income or through one of its TRSs. There is an exception to this rule permitting a REIT to perform customary management and tenant services of the sort that a tax-exempt organization could perform without being considered in receipt of “unrelated business taxable income” as defined in Section 512(b)(3) of the IRC, or UBTI. In addition, a de minimis amount of noncustomary services provided to tenants will not disqualify income as “rents from real property” as long as the value of the impermissible tenant services does not exceed 1% of the gross income from the property.
If rent attributable to personal property leased in connection with a lease of real property is 15% or less of the total rent received under the lease, then the rent attributable to personal property will qualify as “rents from real property;” if this 15% threshold is exceeded, then the rent attributable to personal property will not so qualify. The portion of rental income treated as attributable to personal property is determined according to the ratio of the fair market value of the personal property to the total fair market value of the real and personal property that is rented.
In addition, “rents from real property” includes both charges we receive for services customarily rendered in connection with the rental of comparable real property in the same geographic area, even if the charges are separately stated, as well as charges we receive for services provided by our TRSs when the charges are not separately stated. Whether separately stated charges received by a REIT for services that are not geographically customary and provided by a TRS are included in “rents from real property” has not been addressed clearly by the IRS in published authorities; however, our counsel, Sullivan & Worcester LLP, is of the opinion that, although the matter is not free from doubt, “rents from real property” also includes charges we receive for services provided by our TRSs when the charges are separately stated, even if the services are not geographically customary. Accordingly, we believe that our revenues from TRS-provided services, whether the charges are separately stated or not, qualify as “rents from real property” because the services satisfy the geographically customary standard, because the services have been provided by a TRS, or for both reasons.
We believe that all or substantially all of our rents and related service charges have qualified and will continue to qualify as “rents from real property” for purposes of Section 856 of the IRC.
23

Table of Contents
Absent the “foreclosure property” rules of Section 856(e) of the IRC, a REIT's receipt of active, nonrental gross income from a property would not qualify under the 75% and 95% gross income tests. But as foreclosure property, the active, nonrental gross income from the property would so qualify. Foreclosure property is generally any real property, including interests in real property, and any personal property incident to such real property:
that is acquired by a REIT as a result of the REIT having bid on such property at foreclosure, or having otherwise reduced such property to ownership or possession by agreement or process of law, after there was a default or when default was imminent on a lease of such property or on indebtedness that such property secured;
for which any related loan acquired by the REIT was acquired at a time when the default was not imminent or anticipated; and
for which the REIT makes a proper election to treat the property as foreclosure property.
Any gain that a REIT recognizes on the sale of foreclosure property held as inventory or primarily for sale to customers, plus any income it receives from foreclosure property that would not otherwise qualify under the 75% gross income test in the absence of foreclosure property treatment, reduced by expenses directly connected with the production of those items of income, would be subject to federal income tax at the highest regular corporate income tax rate under the foreclosure
20

Table of Contents

property income tax rules of Section 857(b)(4) of the IRC. Thus, if a REIT should lease foreclosure property in exchange for rent that qualifies as “rents from real property” as described above, then that rental income is not subject to the foreclosure property income tax.
Property generally ceases to be foreclosure property at the end of the third taxable year following the taxable year in which the REIT acquired the property, or longer if an extension is obtained from the IRS. However, this grace period terminates and foreclosure property ceases to be foreclosure property on the first day:
on which a lease is entered into for the property that, by its terms, will give rise to income that does not qualify for purposes of the 75% gross income test (disregarding income from foreclosure property), or any nonqualified income under the 75% gross income test is received or accrued by the REIT, directly or indirectly, pursuant to a lease entered into on or after such day;
on which any construction takes place on the property, other than completion of a building or any other improvement where more than 10% of the construction was completed before default became imminent and other than specifically exempted forms of maintenance or deferred maintenance; or
which is more than 90 days after the day on which the REIT acquired the property and the property is used in a trade or business which is conducted by the REIT, other than through an independent contractor from whom the REIT itself does not derive or receive any income or a TRS.
Other than sales of foreclosure property, any gain that we realize on the sale of property held as inventory or other property held primarily for sale to customers in the ordinary course of a trade or business, together known as dealer gains, may be treated as income from a prohibited transaction that is subject to a penalty tax at a 100% rate. The 100% tax does not apply to gains from the sale of property that is held through a TRS, although such income will be subject to tax in the hands of the TRS at regular corporate income tax rates; we may therefore utilize our TRSs in transactions in which we might otherwise recognize dealer gains. Whether property is held as inventory or primarily for sale to customers in the ordinary course of a trade or business is a question of fact that depends on all the facts and circumstances surrounding each particular transaction. Sections 857(b)(6)(C) and (E) of the IRC provide safe harbors pursuant to which limited sales of real property held for at least two years and meeting specified additional requirements will not be treated as prohibited transactions. However, compliance with the safe harbors is not always achievable in practice. We attempt to structure our activities to avoid transactions that are prohibited transactions, or otherwise conduct such activities through TRSs; but, we cannot be sure whether or not the IRS might successfully assert that one or more of our dispositions iswe are subject to the 100% penalty tax.tax with respect to any particular transaction. Gains subject to the 100% penalty tax are excluded from the 75% and 95% gross income tests, whereas real property gains that are not dealer gains or that are exempted from the 100% penalty tax on account of the safe harbors are considered qualifying gross income for purposes of the 75% and 95% gross income tests.
We believe that any gain from dispositions of assets that we have made,recognized, or that we might makewill recognize, in the future,connection with our disposition of assets and other transactions, including through any partnerships, will generally qualify as income that satisfies the 75% and 95% gross income tests, and will not be dealer gains or subject to the 100% penalty tax. This is because our general intent has been and is to: (a) own our assets for investment (including through joint ventures) with a view to long-term income production and capital appreciation; (b) engage in the business of developing,
24

Table of Contents
owning, leasing and managing our existing properties and acquiring, developing, owning, leasing and managing new properties; and (c) make occasional dispositions of our assets consistent with our long-term investment objectives.
If we fail to satisfy one or both of the 75% gross income test or the 95% gross income test in any taxable year, we may nevertheless qualify for taxation as a REIT for that year if we satisfy the following requirements: (a) our failure to meet the test is due to reasonable cause and not due to willful neglect; and (b) after we identify the failure, we file a schedule describing each item of our gross income included in the 75% gross income test or the 95% gross income test for that taxable year. Even if this relief provision does apply, a 100% tax is imposed upon the greater of the amount by which we failed the 75% gross income test or the amount by which we failed the 95% gross income test, with adjustments, multiplied by a fraction intended to reflect our profitability for the taxable year. This relief provision may apply to a failure of the applicable income tests even if the failure first occurred in a year prior to the taxable year in which the failure was discovered.
Based on the discussion above, we believe that we have satisfied, and will continue to satisfy, the 75% and 95% gross income tests outlined above on a continuing basis beginning with our first taxable year as a REIT.
Asset Tests. At the close of each calendar quarter of each taxable year, we must also satisfy the following asset percentage tests in order to qualify for taxation as a REIT for federal income tax purposes:
21

Table of Contents

At least 75% of the value of our total assets must consist of “real estate assets,” defined as real property (including interests in real property and interests in mortgages on real property or on interests in real property), ancillary personal property to the extent that rents attributable to such personal property are treated as rents from real property in accordance with the rules described above, cash and cash items, shares in other REITs, debt instruments issued by “publicly offered REITs” as defined in Section 562(c)(2) of the IRC, government securities and temporary investments of new capital (that is, any stock or debt instrument that we hold that is attributable to any amount received by us (a) in exchange for our stockshares or (b) in a public offering of our five-year or longer debt instruments, but in each case only for the one-year period commencing with our receipt of the new capital).
Not more than 25% of the value of our total assets may be represented by securities other than those securities that count favorably toward the preceding 75% asset test.
Of the investments included in the preceding 25% asset class, the value of any one non-REIT issuer'sissuer’s securities that we own may not exceed 5% of the value of our total assets. In addition, we may not own more than 10% of the vote or value of any one non-REIT issuer'sissuer’s outstanding securities, unless the securities are “straight debt” securities or otherwise excepted as discussed below. Our stock and other securities in a TRS are exempted from these 5% and 10% asset tests.
Not more than 20% of the value of our total assets may be represented by stock or other securities of our TRSs.
Not more than 25% of the value of our total assets may be represented by “nonqualified publicly offered REIT debt instruments” as defined in Section 856(c)(5)(L)(ii) of the IRC.
Our counsel, Sullivan & Worcester LLP, is of the opinion that, although the matter is not free from doubt, our investments in the equity or debt of a TRS of ours, to the extent that and during the period in which they qualify as temporary investments of new capital, will be treated as real estate assets, and not as securities, for purposes of the above REIT asset tests.
The above REIT asset tests must be satisfied at the close of each calendar quarter of each taxable year as a REIT. After a REIT meets the asset tests at the close of any quarter, it will not lose its qualification for taxation as a REIT in any subsequent quarter solely because of fluctuations in the values of its assets. This grandfathering rule may be of limited benefit to a REIT such as us that makes periodic acquisitions of both qualifying and nonqualifying REIT assets. When a failure to satisfy the above asset tests results from an acquisition of securities or other property during a quarter, the failure can be cured by disposition of sufficient nonqualifying assets within thirty days after the close of that quarter.
In addition, if we fail the 5% asset test, the 10% vote test or the 10% value test at the close of any quarter and we do not cure such failure within thirty days after the close of that quarter, that failure will nevertheless be excused if (a) the failure is de minimis and (b) within six months after the last day of the quarter in which we identify the failure, we either dispose of the assets causing the failure or otherwise satisfy the 5% asset test, the 10% vote test and the 10% value test. For purposes of this relief provision, the failure will be de minimis if the value of the assets causing the failure does not exceed the lesser of (a) 1% of the total value of our assets at the end of the relevant quarter or (b) $10,000,000. If our failure is not de minimis, or if any of the other REIT asset tests have been violated, we may nevertheless qualify for taxation as a REIT if (a) we provide the IRS with a description of each asset causing the failure, (b) the failure was due to reasonable cause
25

Table of Contents
and not willful neglect, (c) we pay a tax equal to the greater of (1) $50,000 or (2) the highest regular corporate income tax rate imposed on the net income generated by the assets causing the failure during the period of the failure, and (d) within six months after the last day of the quarter in which we identify the failure, we either dispose of the assets causing the failure or otherwise satisfy all of the REIT asset tests. These relief provisions may apply to a failure of the applicable asset tests even if the failure first occurred in a year prior to the taxable year in which the failure was discovered.
The IRC also provides an excepted securities safe harbor to the 10% value test that includes among other items (a) “straight debt” securities, (b) specified rental agreements in which payment is to be made in subsequent years, (c) any obligation to pay “rents from real property,” (d) securities issued by governmental entities that are not dependent in whole or in part on the profits of or payments from a nongovernmental entity, and (e) any security issued by another REIT. In addition, any debt instrument issued by an entity classified as a partnership for federal income tax purposes, and not otherwise excepted from the definition of a security for purposes of the above safe harbor, will not be treated as a security for purposes of the 10% value test if at least 75% of the partnership'spartnership’s gross income, excluding income from prohibited transactions, is qualifying income for purposes of the 75% gross income test.
22

Table of Contents

We have maintained and will continue to maintain records of the value of our assets to document our compliance with the above asset tests and intend to take actions as may be required to cure any failure to satisfy the tests within thirty days after the close of any quarter or within the six month periods described above.
Based on the discussion above, we believe that we have satisfied, and will continue to satisfy, the REIT asset tests outlined above on a continuing basis beginning with our first taxable year as a REIT.
Our RelationshipsRelationship with Five Star. AlerisLifePrior to January 1, 2020, we owned a significant percentage (but less than 10%) of the outstanding common shares of Five Star. Commencing with our 2002 taxable year and through and including our 2019 taxable year, we expect that the rental income we received from Five Star and its subsidiaries constituted “rents from real property” under Section 856(d) of the IRC, and therefore qualifying income under the 75% and 95% gross income tests described above. From and after January 1, 2020, we have come to. We currently own (directly and indirectly through one of our TRSs) approximately 34%less than 35% of the outstanding common shares of Five Star.AlerisLife. We have not elected to treat Five StarAlerisLife as a TRS, and it is not otherwise an automatic TRS because no TRS of ours owns more than 35% of Five Star.AlerisLife. This structure for our Five StarAlerisLife ownership permits our continued engagement of a corporate subsidiary of Five StarAlerisLife to manage health care facilities leased to our TRSs, as described below in greater detail. For further information regarding our relationship with AlerisLife, see Note 8 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
Our Relationship with Our Taxable REIT Subsidiaries. We currently own properties that we purchased to be leased to our TRSs or which are being leased to our TRSs as a result of modifications to, or expirations of, a prior lease, all as agreed to by applicable parties. For example, in connection with past lease defaults and expirations, we have terminated occupancy of some of our health care properties by the defaulting or expiring tenants and immediately leased these properties to our TRSs and entered into newother third-party management agreements for these properties. We may from time to time lease additional health care properties to our TRSs.
In lease transactions involving our TRSs, our general intent is for the rents paid to us by the TRS to qualify as “rents from real property” under the REIT gross income tests summarized above. In order for this to be the case, the manager operating the leased property on behalf of the applicable TRS must be an “eligible independent contractor” within the meaning of Section 856(d)(9)(A) of the IRC, and the properties leased to the TRS must be “qualified health care properties” within the meaning of Section 856(e)(6)(D) of the IRC. Qualified health care properties are defined as health care facilities and other properties necessary or incidental to the use of a health care facility.
For these purposes, a contractor qualifies as an “eligible independent contractor” if it is less than 35% affiliated with the REIT and, at the time the contractor enters into the agreement with the TRS to operate the qualified health care property, that contractor or any person related to that contractor is actively engaged in the trade or business of operating qualified health care properties for persons unrelated to the TRS or its affiliated REIT. For these purposes, an otherwise eligible independent contractor is not disqualified from that status on account of (a) the TRS bearing the expenses of the operation of the qualified health care property, (b) the TRS receiving the revenues from the operation of the qualified health care property, net of expenses for that operation and fees payable to the eligible independent contractor, or (c) the REIT receiving income from the eligible independent contractor pursuant to a preexisting or otherwise grandfathered lease of another property.
We have engaged as an intended eligible independent contractor a particular corporate subsidiary of Five Star.AlerisLife. This contractor and its affiliates are actively engaged in the trade or business of operating qualified health care properties for their own accounts, including pursuant to management contracts among themselves; however, this contractor and its affiliates have few if any management contracts for qualified health care properties with third parties other than us and our TRSs. Based on a
26

Table of Contents
plain reading of the statute as well as applicable legislative history, our counsel, Sullivan & Worcester LLP, has opined that this intended eligible independent contractor should in fact so qualify. If the IRS or a court determines that this opinion is incorrect, then the rental income we receive from our TRSs in respect of properties managed by this particular contractor would be nonqualifying income for purposes of the 75% and 95% gross income tests, possibly jeopardizing our compliance with one or both of these gross income tests. Under those circumstances, however, we expect we would qualify for the gross income tests'tests’ relief provision described above, and thereby would preserve our qualification for taxation as a REIT. If the relief provision were to apply to us, we would be subject to tax at a 100% rate upon the greater of the amount by which we failed the 75% gross income test or the amount by which we failed the 95% gross income test, with adjustments, multiplied by a fraction intended to reflect our profitability for the taxable year; even though we have little or no nonqualifying income from other sources in a typical taxable year, imposition of this 100% tax in this circumstance would be material because alla significant number of the properties leased to our TRSs are managed for the TRSs by this contractor.
As explained above, we will be subject to a 100% tax on the rents paid to us by any of our TRSs if the IRS successfully asserts that those rents exceed an arm'sarm’s length rental rate. Although there is no clear precedent to distinguish for federal income tax purposes among leases, management contracts, partnerships, financings, and other contractual arrangements, we believe that our leases and our TRSs'TRSs’ management agreements will be respected for purposes of the requirements of the IRC discussed above. Accordingly, we expect that the rental income from our current and future TRSs will qualify as “rents from real property,” and that the 100% tax on excessive rents from a TRS will not apply.
23

Table of Contents

Annual Distribution Requirements. In order to qualify for taxation as a REIT under the IRC, we are required to make annual distributions other than capital gain dividends to our shareholders in an amount at least equal to the excess of:    
(1)the sum of 90% of our “real estate investment trust taxable income” and 90% of our net income after tax, if any, from property received in foreclosure, over
(2)the amount by which our noncash income (e.g., imputed rental income or income from transactions inadvertently failing to qualify as like-kind exchanges) exceeds 5% of our “real estate investment trust taxable income.”
For these purposes, our “real estate investment trust taxable income” is as defined under Section 857 of the IRC and is computed without regard to the dividends paid deduction and our net capital gain and will generally be reduced by specified corporate-level income taxes that we pay (e.g., taxes on built-in gains or foreclosure property income).
The IRC generally limits the deductibility of net interest expense paid or accrued on debt properly allocable to a trade or business to 30% of “adjusted taxable income,” subject to specified exceptions. Any deduction in excess of the limitation is carried forward and may be used in a subsequent year, subject to that year'syear’s 30% limitation. The CARES Act changed the limitation on adjusted taxable income, increasing it from 30% to 50%, but only for 2019 and 2020. Moreover, taxpayers can elect to use their adjusted taxable income from their 2019 tax year for their adjusted taxable income in their 2020 tax year for purposes of calculating the limitation. Provided a taxpayer makes an election (which is irrevocable), the applicable limitation on the deductibility of net interest expense does not apply to a trade or business involving real property development, redevelopment, construction, reconstruction, acquisition, conversion, rental, operation, management, leasing, or brokerage, within the meaning of Section 469(c)(7)(C) of the IRC. Treasury regulations provide that a real property trade or business includes a trade or business conducted by a REIT. We have made an election to be treated as a real property trade or business and accordingly do not expect the foregoing interest deduction limitations to apply to us or to the calculation of our "real“real estate investment trust taxable income."
Distributions must be paid in the taxable year to which they relate, or in the following taxable year if declared before we timely file our federal income tax return for the earlier taxable year and if paid on or before the first regular distribution payment after that declaration. If a dividend is declared in October, November or December to shareholders of record during one of those months and is paid during the following January, then for federal income tax purposes such dividend will be treated as having been both paid and received on December 31 of the prior taxable year to the extent of any undistributed earnings and profits.
The 90% distribution requirements may be waived by the IRS if a REIT establishes that it failed to meet them by reason of distributions previously made to meet the requirements of the 4% excise tax discussed below. To the extent that we do not distribute all of our net capital gain and all of our “real estate investment trust taxable income,” as adjusted, we will be subject to federal income tax at regular corporate income tax rates on undistributed amounts. In addition, we will be subject to a 4% nondeductible excise tax to the extent we fail within a calendar year to make required distributions to our shareholders of 85% of our ordinary income and 95% of our capital gain net income plus the excess, if any, of the “grossed up required
27

Table of Contents
distribution” for the preceding calendar year over the amount treated as distributed for that preceding calendar year. For this purpose, the term “grossed up required distribution” for any calendar year is the sum of our taxable income for the calendar year without regard to the deduction for dividends paid and all amounts from earlier years that are not treated as having been distributed under the provision. We will be treated as having sufficient earnings and profits to treat as a dividend any distribution by us up to the amount required to be distributed in order to avoid imposition of the 4% excise tax.
If we do not have enough cash or other liquid assets to meet our distribution requirements, or if we so choose, we may find it necessary or desirable to arrange for new debt or equity financing to provide funds for required distributions in order to maintain our qualification for taxation as a REIT. We cannot be sure that financing would be available for these purposes on favorable terms, or at all.
We may be able to rectify a failure to pay sufficient dividends for any year by paying “deficiency dividends” to shareholders in a later year. These deficiency dividends may be included in our deduction for dividends paid for the earlier year, but an interest charge would be imposed upon us for the delay in distribution. While the payment of a deficiency dividend will apply to a prior year for purposes of our REIT distribution requirements and our dividends paid deduction, it will be treated as an additional distribution to the shareholders receiving it in the year such dividend is paid.
In addition to the other distribution requirements above, to preserve our qualification for taxation as a REIT, we are required to timely distribute all C corporation earnings and profits that we inherit from acquired corporations, as described below.
24

Table of Contents

We may elect to retain, rather than distribute, some or all of our net capital gain and pay income tax on such gain. In addition, if we so elect by making a timely designation to our shareholders, our shareholders would include their proportionate share of such undistributed capital gain in their taxable income, and they would receive a corresponding credit for their share of the federal corporate income tax that we pay thereon. Our shareholders would then increase the adjusted tax basis of their shares by the difference between (a) the amount of capital gain dividends that we designated and that they included in their taxable income, and (b) the tax that we paid on their behalf with respect to that capital gain.
Acquisitions of C Corporations
We have engaged in and may in the future engage in transactions where we acquire all of the outstanding stock of a C corporation. Upon these acquisitions, except to the extent we have made or do make an applicable TRS election, each of our acquired entities and their various wholly-owned corporate and noncorporate subsidiaries generally became or will become our QRSs. Thus, after such acquisitions, all assets, liabilities and items of income, deduction and credit of the acquired and then disregarded entities have been and will be treated as ours for purposes of the various REIT qualification tests described above. In addition, we generally have been and will be treated as the successor to the acquired (and then disregarded) entities'entities’ federal income tax attributes, such as those entities'entities’ (a) adjusted tax bases in their assets and their depreciation schedules; and (b) earnings and profits for federal income tax purposes, if any. The carryover of these attributes creates REIT implications such as built-in gains tax exposure and additional distribution requirements, as described below. However, when we make an election under Section 338(g) of the IRC with respect to corporations that we acquire, as we have done from time to time in the past, we generally will not be subject to such attribute carryovers in respect of attributes existing prior to such election.
Built-in Gains from C Corporations. Notwithstanding our qualification and taxation as a REIT, under specified circumstances we may be subject to corporate income taxation if we acquire a REIT asset where our adjusted tax basis in the asset is determined by reference to the adjusted tax basis of the asset as owned by a C corporation. For instance, we may be subject to federal income taxation on all or part of the built-in gain that was present on the last date an asset was owned by a C corporation, if we succeed to a carryover tax basis in that asset directly or indirectly from such C corporation and if we sell the asset during the five year period beginning on the day the asset ceased being owned by such C corporation. To the extent of our income and gains in a taxable year that are subject to the built-in gains tax, net of any taxes paid on such income and gains with respect to that taxable year, our taxable dividends paid in the following year will be potentially eligible for taxation to noncorporate U.S. shareholders at the preferential tax rates for “qualified dividends” as described below under the heading “—Taxation of Taxable U.S. Shareholders”. We generally do not expect to sell assets if doing so would result in the imposition of a material built-in gains tax liability; but if and when we do sell assets that may have associated built-in gains tax exposure, then we expect to make appropriate provision for the associated tax liabilities on our financial statements.
Earnings and Profits. Following a corporate acquisition, we must generally distribute all of the C corporation earnings and profits inherited in that transaction, if any, no later than the end of our taxable year in which the transaction occurs, in order to preserve our qualification for taxation as a REIT. However, if we fail to do so, relief provisions would allow us to maintain our qualification for taxation as a REIT, provided we distribute any subsequently discovered C corporation earnings and profits and pay an interest charge in respect of the period of delayed distribution. C corporation earnings and profits that we inherit are, in general, specially allocated under a priority rule to the earliest possible distributions following the event causing the inheritance, and only then is the balance of our earnings and profits for the taxable year allocated among our distributions to the extent not already treated as a distribution of C corporation earnings and profits under the priority rule. The distribution of these C corporation earnings and profits is potentially eligible for taxation to noncorporate U.S. shareholders at the preferential tax rates for “qualified dividends” as described below under the heading “—Taxation of Taxable U.S. Shareholders”.
28

Table of Contents
Depreciation and Federal Income Tax Treatment of Leases
Our initial tax bases in our assets will generally be our acquisition cost. We will generally depreciate our depreciable real property on a straight-line basis over forty years and our personal property over the applicable shorter periods. These depreciation schedules, and our initial tax bases, may vary for properties that we acquire through tax-free or carryover basis acquisitions, or that are the subject of cost segregation analyses.
We are entitled to depreciation deductions from our properties only if we are treated for federal income tax purposes as the owner of the properties. This means that the leases of our properties must be classified for U.S. federal income tax purposes as true leases, rather than as sales or financing arrangements, and we believe this to be the case.
25

Table of Contents

Distributions to our Shareholders
General. As described above, we expect to make distributions to our shareholders from time to time. These distributions may include cash distributions, in kind distributions of property, (such as our pro rata distribution that we paid on January 1, 2020, to our shareholders of record as of December 13, 2019, of the right to receive an aggregate number of Five Star common shares that equaled approximately 51% of Five Star's outstanding common shares, or the Five Star Distribution), and deemed or constructive distributions resulting from capital market activities. The U.S. federal income tax treatment of our distributions will vary based on the status of the recipient shareholder as more fully described below under the headings “—Taxation of Taxable U.S. Shareholders,” “—Taxation of Tax-Exempt U.S. Shareholders,” and “—Taxation of Non-U.S. Shareholders.”
Section 302 of the IRC treats a redemption of our shares for cash only as a distribution under Section 301 of the IRC, and hence taxable as a dividend to the extent of our available current or accumulated earnings and profits, unless the redemption satisfies one of the tests set forth in Section 302(b) of the IRC enabling the redemption to be treated as a sale or exchange of the shares. The redemption for cash only will be treated as a sale or exchange if it (a) is “substantially disproportionate” with respect to the surrendering shareholder'sshareholder’s ownership in us, (b) results in a “complete termination” of the surrendering shareholder'sshareholder’s entire share interest in us, or (c) is “not essentially equivalent to a dividend” with respect to the surrendering shareholder, all within the meaning of Section 302(b) of the IRC. In determining whether any of these tests have been met, a shareholder must generally take into account shares considered to be owned by such shareholder by reason of constructive ownership rules set forth in the IRC, as well as shares actually owned by such shareholder. In addition, if a redemption is treated as a distribution under the preceding tests, then a shareholder'sshareholder’s tax basis in the redeemed shares generally will be transferred to the shareholder'sshareholder’s remaining shares in us, if any, and if such shareholder owns no other shares in us, such basis generally may be transferred to a related person or may be lost entirely. Because the determination as to whether a shareholder will satisfy any of the tests of Section 302(b) of the IRC depends upon the facts and circumstances at the time that our shares are redeemed, we urge you to consult your own tax advisor to determine the particular tax treatment of any redemption.
Five Star Distribution. The Five Star Distribution is treated as a 2020 distribution by us to our common shareholders in the amount of the fair market value of the Five Star common shares that a shareholder ultimately received (including any fractional shares deemed to have been received, as described in the next sentence). Any cash received by a shareholder in lieu of a fractional Five Star common share is treated as if such fractional Five Star common share had been (i) received by such shareholder and then (ii) sold for the amount of cash received. Because we had neither current nor accumulated earnings and profits in 2020, each of our 2020 distributions (including the Five Star Distribution) was treated as a return of capital that reduced such shareholder's adjusted tax basis in our common shares. A shareholder's tax basis in the Five Star common shares received equals the fair market value of such shares on the issuance date, and the holding period for such Five Star common shares began the day after the issuance date.
Because of the factual nature of value determinations, Sullivan & Worcester LLP is unable to render an opinion on the fair market value of the Five Star common shares received by our common shareholders. Nevertheless, we believe that the fair market value of the Five Star common shares may be properly determined for federal income tax purposes as the closing price of the Five Star common shares in the public market on December 31, 2019 (the last trading day before issuance), or $3.71 per share. Accordingly, we have performed all federal income tax reporting, including statements supplied to shareholders and to the IRS, on the basis of this price.
For additional considerations applicable to a shareholder that received the Five Star Distribution, see the information set forth below under the headings "—Taxation of Taxable U.S. Shareholders," "—Taxation of Tax-Exempt U.S. Shareholders," and "—Taxation of Non-U.S. Shareholders."
29

Table of Contents
Taxation of Taxable U.S. Shareholders
For noncorporate U.S. shareholders, to the extent that their total adjusted income does not exceed applicable thresholds, the maximum federal income tax rate for long-term capital gains and most corporate dividends is generally 15%. For those noncorporate U.S. shareholders whose total adjusted income exceeds the applicable thresholds, the maximum federal income tax rate for long-term capital gains and most corporate dividends is generally 20%. However, because we are not generally subject to federal income tax on the portion of our “real estate investment trust taxable income” distributed to our shareholders, dividends on our shares generally are not eligible for these preferential tax rates, except that any distribution of C corporation earnings and profits and taxed built-in gain items will potentially be eligible for these preferential tax rates. As a result, our ordinary dividends generally are taxed at the higher federal income tax rates applicable to ordinary income (subject to the lower effective tax rates applicable to qualified REIT dividends via the deduction-without-outlay mechanism of Section 199A of the IRC, which is generally available to our noncorporate U.S. shareholders that meet specified holding period requirements for taxable years before 2026). To summarize, the preferential federal income tax rates for long-term capital gains and for qualified dividends generally apply to:
(1)long-term capital gains, if any, recognized on the disposition of our shares;
(2)our distributions designated as long-term capital gain dividends (except to the extent attributable to real estate depreciation recapture, in which case the distributions are subject to a maximum 25% federal income tax rate);
(3)our dividends attributable to dividend income, if any, received by us from C corporations such as TRSs;
(4)our dividends attributable to earnings and profits that we inherit from C corporations; and
(5)our dividends to the extent attributable to income upon which we have paid federal corporate income tax (such as taxes on foreclosure property income or on built-in gains), net of the corporate income taxes thereon.
As long as we qualify for taxation as a REIT, a distribution to our U.S. shareholders that we do not designate as a capital gain dividend generally will be treated as an ordinary income dividend to the extent of our available current or accumulated earnings and profits (subject to the lower effective tax rates applicable to qualified REIT dividends via the deduction-without-outlay mechanism of Section 199A of the IRC, which is generally available to our noncorporate U.S. shareholders that meet specified holding period requirements for taxable years before 2026). Distributions made out of our current or accumulated earnings and profits that we properly designate as capital gain dividends generally will be taxed as long-term capital gains, as discussed below, to the extent they do not exceed our actual net capital gain for the taxable year.
26

Table of Contents

However, corporate shareholders may be required to treat up to 20% of any capital gain dividend as ordinary income under Section 291 of the IRC.
In addition, we may elect to retain net capital gain income and treat it as constructively distributed. In that case:    
(1)we will be taxed at regular corporate capital gains tax rates on retained amounts;
(2)each of our U.S. shareholders will be taxed on its designated proportionate share of our retained net capital gains as though that amount were distributed and designated as a capital gain dividend;
(3)each of our U.S. shareholders will receive a credit or refund for its designated proportionate share of the tax that we pay;
(4)each of our U.S. shareholders will increase its adjusted basis in our shares by the excess of the amount of its proportionate share of these retained net capital gains over the U.S. shareholder's proportionate share of the tax that we pay; and
(5)both we and our corporate shareholders will make commensurate adjustments in our respective earnings and profits for federal income tax purposes.
If we elect to retain our net capital gains in this fashion, we will notify our U.S. shareholders of the relevant tax information within sixtydays after the close of the affected taxable year.
30

Table of Contents
If for any taxable year we designate capital gain dividends for our shareholders, then a portion of the capital gain dividends we designate will be allocated to the holders of a particular class of shares on a percentage basis equal to the ratio of the amount of the total dividends paid or made available for the year to the holders of that class of shares to the total dividends paid or made available for the year to holders of all outstanding classes of our shares. We will similarly designate the portion of any dividend that is to be taxed to noncorporate U.S. shareholders at preferential maximum rates (including any qualified dividend income and any capital gains attributable to real estate depreciation recapture that are subject to a maximum 25% federal income tax rate) so that the designations will be proportionate among all outstanding classes of our shares.
We may elect to retain and pay income taxes on some or all of our net capital gain. In addition, if we so elect by making a timely designation to our shareholders:
(1)each of our U.S. shareholders will be taxed on its designated proportionate share of our retained net capital gains as though that amount were distributed and designated as a capital gain dividend;
(2)each of our U.S. shareholders will receive a credit or refund for its designated proportionate share of the tax that we pay;
(3)each of our U.S. shareholders will increase its adjusted basis in our shares by the excess of the amount of its proportionate share of these retained net capital gains over the U.S. shareholder’s proportionate share of the tax that we pay; and
(4)both we and our corporate shareholders will make commensurate adjustments in our respective earnings and profits for federal income tax purposes.
Distributions in excess of our current or accumulated earnings and profits will not be taxable to a U.S. shareholder to the extent that they do not exceed the shareholder'sshareholder’s adjusted tax basis in our shares, but will reduce the shareholder'sshareholder’s basis in such shares. To the extent that these excess distributions exceed a U.S. shareholder'sshareholder’s adjusted basis in such shares, they will be included in income as capital gain, with long-term gain generally taxed to noncorporate U.S. shareholders at preferential maximum rates. No U.S. shareholder may include on its federal income tax return any of our net operating losses or any of our capital losses. In addition, no portion of any of our dividends is eligible for the dividends received deduction for corporate shareholders.
If a dividend is declared in October, November or December to shareholders of record during one of those months and is paid during the following January, then for federal income tax purposes the dividend will be treated as having been both paid and received on December 31 of the prior taxable year.
A U.S. shareholder will generally recognize gain or loss equal to the difference between the amount realized and the shareholder'sshareholder’s adjusted basis in our shares that are sold or exchanged. This gain or loss will be capital gain or loss, and will be long-term capital gain or loss if the shareholder'sshareholder’s holding period in our shares exceeds one year. In addition, any loss upon a sale or exchange of our shares held for six months or less will generally be treated as a long-term capital loss to the extent of any long-term capital gain dividends we paid on such shares during the holding period.
U.S. shareholders who are individuals, estates or trusts are generally required to pay a 3.8% Medicare tax on their net investment income (including dividends on our shares (without regard to any deduction allowed by Section 199A of the IRC) and gains from the sale or other disposition of our shares), or in the case of estates and trusts on their net investment income that is not distributed, in each case to the extent that their total adjusted income exceeds applicable thresholds. U.S. shareholders are urged to consult their tax advisors regarding the application of the 3.8% Medicare tax.
If a U.S. shareholder recognizes a loss upon a disposition of our shares in an amount that exceeds a prescribed threshold, it is possible that the provisions of Treasury regulations involving “reportable transactions” could apply, with a resulting requirement to separately disclose the loss-generating transaction to the IRS. These Treasury regulations are written quite broadly, and apply to many routine and simple transactions. A reportable transaction currently includes, among other things, a sale or exchange of our shares resulting in a tax loss in excess of (a) $10.0$10 million in any single year or $20.0$20 million in a prescribed combination of taxable years in the case of our shares held by a C corporation or by a partnership with only C corporation partners or (b) $2.0$2 million in any single year or $4.0$4 million in a prescribed combination of taxable years in the case of our shares held by any other partnership or an S corporation, trust or individual, including losses that flow through pass through
27

Table of Contents

entities to individuals. A taxpayer discloses a reportable transaction by filing IRS Form 8886 with its federal income tax return and, in the first year of filing, a copy of Form 8886 must be sent to the IRS's Office of Tax Shelter Analysis. The annual maximum penalty for failing to disclose a reportable transaction is generally $10,000 in the case of a natural person and $50,000 in any other case.
Noncorporate U.S. shareholders who borrow funds to finance their acquisition of our shares could be limited in the amount of deductions allowed for the interest paid on the indebtedness incurred. Under Section 163(d) of the IRC, interest paid or accrued on indebtedness incurred or continued to purchase or carry property held for investment is generally deductible only to the extent of the investor'sinvestor’s net investment income. A U.S. shareholder'sshareholder’s net investment income will include ordinary income dividend distributions received from us and, only if an appropriate election is made by the shareholder, capital gain dividend distributions and qualified dividends received from us; however, distributions treated as a nontaxable return of the shareholder'sshareholder’s basis will not enter into the computation of net investment income.
Taxation of Tax-Exempt U.S. Shareholders
The rules governing the federal income taxation of tax-exempt entities are complex, and the following discussion is intended only as a summary of material considerations of an investment in our shares relevant to such investors. If you are a tax-exempt shareholder, we urge you to consult your own tax advisor to determine the impact of federal, state, local and foreign
31

Table of Contents
tax laws, including any tax return filing and other reporting requirements, with respect to your acquisition of or investment in our shares.
Our distributions made toWe expect that shareholders that are tax-exempt pension plans, individual retirement accounts or other qualifying tax-exempt entities, and that receive (a) distributions from us, or (b) proceeds from the sale of our shares, should not constitutehave such amounts treated as UBTI, provided in each case (x) that the shareholder has not financed its acquisition of our shares with “acquisition indebtedness” within the meaning of the IRC, (y) that the shares are not otherwise used in an unrelated trade or business of the tax-exempt entity, and (z) that, consistent with our present intent, we do not hold a residual interest in a real estate mortgage investment conduit or otherwise hold mortgage assets or conduct mortgage securitization activities that generate “excess inclusion” income.
Taxation of Non-U.S. Shareholders
The rules governing the U.S. federal income taxation of non-U.S. shareholders are complex, and the following discussion is intended only as a summary of material considerations of an investment in our shares relevant to such investors. If you are a non-U.S. shareholder, we urge you to consult your own tax advisor to determine the impact of U.S. federal, state, local and foreign tax laws, including any tax return filing and other reporting requirements, with respect to your acquisition of or investment in our shares.
We expect that a non-U.S. shareholder'sshareholder’s receipt of (a) distributions from us, and (b) proceeds from the sale of our shares, will not be treated as income effectively connected with a U.S. trade or business and a non-U.S. shareholder will therefore not be subject to the often higher federal tax and withholding rates, branch profits taxes and increased reporting and filing requirements that apply to income effectively connected with a U.S. trade or business. This expectation and a number of the determinations below are predicated on our shares being listed on a U.S. national securities exchange, such as The Nasdaq Stock Market LLC, or Nasdaq. Each class of our shares has been listed on a U.S. national securities exchange; however, we cannot be sure that our shares will continue to be so listed in future taxable years or that any class of our shares that we may issue in the future will be so listed.
Distributions. A distribution by us to a non-U.S. shareholder that is not designated as a capital gain dividend will be treated as an ordinary income dividend to the extent that it is made out of our current or accumulated earnings and profits. A distribution of this type will generally be subject to U.S. federal income tax and withholding at the rate of 30%, or at a lower rate if the non-U.S. shareholder has in the manner prescribed by the IRS demonstrated to the applicable withholding agent its entitlement to benefits under a tax treaty. Because we cannot determine our current and accumulated earnings and profits until the end of the taxable year, withholding at the statutory rate of 30% or applicable lower treaty rate will generally be imposed on the gross amount of any distribution to a non-U.S. shareholder that we make and do not designate as a capital gain dividend. Notwithstanding this potential withholding on distributions in excess of our current and accumulated earnings and profits, these excess portions of distributions are a nontaxable return of capital to the extent that they do not exceed the non-U.S. shareholder'sshareholder’s adjusted basis in our shares, and the nontaxable return of capital will reduce the adjusted basis in these shares. To the extent that distributions in excess of our current and accumulated earnings and profits exceed the non-U.S. shareholder'sshareholder’s adjusted basis in our shares, the distributions will give rise to U.S. federal income tax liability only in the unlikely event that the non-U.S. shareholder would otherwise be subject to tax on any gain from the sale or exchange of these shares, as discussed
28

Table of Contents

below under the heading “—Dispositions of Our Shares.” A non-U.S. shareholder may seek a refund from the IRS of amounts withheld on distributions to it in excess of such shareholder'sshareholder’s allocable share of our current and accumulated earnings and profits.
For so long as a class of our shares is listed on a U.S. national securities exchange, capital gain dividends that we declare and pay to a non-U.S. shareholder on those shares, as well as dividends to such a non-U.S. shareholder on those shares attributable to our sale or exchange of “United States real property interests” within the meaning of Section 897 of the IRC, or USRPIs, will not be subject to withholding as though those amounts were effectively connected with a U.S. trade or business, and non-U.S. shareholders will not be required to file U.S. federal income tax returns or pay branch profits tax in respect of these dividends. Instead, these dividends will generally be treated as ordinary dividends and subject to withholding in the manner described above.
Tax treaties may reduce the withholding obligations on our distributions. Under some treaties, however, rates below 30% that are applicable to ordinary income dividends from U.S. corporations may not apply to ordinary income dividends from a REIT or may apply only if the REIT meets specified additional conditions. A non-U.S. shareholder must generally use an applicable IRS Form W-8, or substantially similar form, to claim tax treaty benefits. If the amount of tax withheld with respect to a distribution to a non-U.S. shareholder exceeds the shareholder'sshareholder’s U.S. federal income tax liability with respect to the distribution, the non-U.S. shareholder may file for a refund of the excess from the IRS. Treasury regulations also provide special rules to determine whether, for purposes of determining the applicability of a tax treaty, our distributions to a non-U.S.
32

Table of Contents
shareholder that is an entity should be treated as paid to the entity or to those owning an interest in that entity, and whether the entity or its owners are entitled to benefits under the tax treaty.
If, contrary to our expectation, a class of our shares was not listed on a U.S. national securities exchange and we made a distribution on those shares that was attributable to gain from the sale or exchange of a USRPI, then a non-U.S. shareholder holding those shares would be taxed as if the distribution was gain effectively connected with a trade or business in the United States conducted by the non-U.S. shareholder. In addition, the applicable withholding agent would be required to withhold from a distribution to such a non-U.S. shareholder, and remit to the IRS, up to 21% of the maximum amount of any distribution that was or could have been designated as a capital gain dividend. The non-U.S. shareholder also would generally be subject to the same treatment as a U.S. shareholder with respect to the distribution (subject to any applicable alternative minimum tax and a special alternative minimum tax in the case of a nonresident alien individual), would be subject to fulsome U.S. federal income tax return reporting requirements, and, in the case of a corporate non-U.S. shareholder, may owe the up to 30% branch profits tax under Section 884 of the IRC (or lower applicable tax treaty rate) in respect of these amounts.
Although the law is not entirely clear on the matter, it appears that amounts designated by us as undistributed capital gain in respect of our shares that are held by non-U.S. shareholders generally should be treated in the same manner as actual distributions by us of capital gain dividends. Under this approach, the non-U.S. shareholder would be able to offset as a credit against its resulting U.S. federal income tax liability its proportionate share of the tax paid by us on the undistributed capital gain treated as distributed to the non-U.S. shareholder, and receive from the IRS a refund to the extent its proportionate share of the tax paid by us were to exceed the non-U.S. shareholder’s actual U.S. federal income tax liability on such deemed distribution. If we were to designate any portion of our net capital gain as undistributed capital gain, a non-U.S. shareholder should consult its tax advisors regarding taxation of such undistributed capital gain.
Dispositions of Our Shares. If as expected our shares are not USRPIs, then a non-U.S. shareholder'sshareholder’s gain on the sale of these shares generally will not be subject to U.S. federal income taxation or withholding. We expect that our shares will not be USRPIs because one or both of the following exemptions will be available at all times.
First, for so long as a class of our shares is listed on a U.S. national securities exchange, a non-U.S. shareholder'sshareholder’s gain on the sale of those shares will not be subject to U.S. federal income taxation as a sale of a USRPI. Second, our shares will not constitute USRPIs if we are a “domestically controlled” REIT. We will be a “domestically controlled” REIT if less than 50% of the value of our shares (including any future class of shares that we may issue) is held, directly or indirectly, by non-U.S. shareholders at all times during the preceding five years, after applying specified presumptions regarding the ownership of our shares as described in Section 897(h)(4)(E) of the IRC. For these purposes, we believe that the statutory ownership presumptions apply to validate our status as a “domestically controlled” REIT. Accordingly, we believe that we are and will remain a “domestically controlled” REIT.
If, contrary to our expectation, a gain on the sale of our shares is subject to U.S. federal income taxation (for example, because neither of the above exemptions were then available, i.e., that class of our shares were not then listed on a U.S. national securities exchange and we were not a “domestically controlled” REIT), then (a) a non-U.S. shareholder would generally be subject to the same treatment as a U.S. shareholder with respect to its gain (subject to any applicable alternative minimum tax
29

Table of Contents

and a special alternative minimum tax in the case of nonresident alien individuals), (b) the non-U.S. shareholder would also be subject to fulsome U.S. federal income tax return reporting requirements, and (c) a purchaser of that class of our shares from the non-U.S. shareholder may be required to withhold 15% of the purchase price paid to the non-U.S. shareholder and to remit the withheld amount to the IRS.
Information Reporting, Backup Withholding, and Foreign Account Withholding
Information reporting, backup withholding, and foreign account withholding may apply to distributions or proceeds paid to our shareholders under the circumstances discussed below. If a shareholder is subject to backup or other U.S. federal income tax withholding, then the applicable withholding agent will be required to withhold the appropriate amount with respect to a deemed or constructive distribution or a distribution in kind even though there is insufficient cash from which to satisfy the withholding obligation. To satisfy this withholding obligation, the applicable withholding agent may collect the amount of U.S. federal income tax required to be withheld by reducing to cash for remittance to the IRS a sufficient portion of the property that the shareholder would otherwise receive or own, and the shareholder may bear brokerage or other costs for this withholding procedure.
Amounts withheld under backup withholding are generally not an additional tax and may be refunded by the IRS or credited against the shareholder'sshareholder’s federal income tax liability, provided that such shareholder timely files for a refund or credit with the IRS. A U.S. shareholder may be subject to backup withholding when it receives distributions on our shares or proceeds upon the sale, exchange, redemption, retirement or other disposition of our shares, unless the U.S. shareholder properly executes, or has previously properly executed, under penalties of perjury an IRS Form W-9 or substantially similar form that:
provides the U.S. shareholder'sshareholder’s correct taxpayer identification number;
certifies that the U.S. shareholder is exempt from backup withholding because (a) it comes within an enumerated exempt category, (b) it has not been notified by the IRS that it is subject to backup withholding, or (c) it has been notified by the IRS that it is no longer subject to backup withholding; and
33

Table of Contents
certifies that it is a U.S. citizen or other U.S. person.
If the U.S. shareholder has not provided and does not provide its correct taxpayer identification number and appropriate certifications on an IRS Form W-9 or substantially similar form, it may be subject to penalties imposed by the IRS, and the applicable withholding agent may have to withhold a portion of any distributions or proceeds paid to such U.S. shareholder. Unless the U.S. shareholder has established on a properly executed IRS Form W-9 or substantially similar form that it comes within an enumerated exempt category, distributions or proceeds on our shares paid to it during the calendar year, and the amount of tax withheld, if any, will be reported to it and to the IRS.
Distributions on our shares to a non-U.S. shareholder during each calendar year and the amount of tax withheld, if any, will generally be reported to the non-U.S. shareholder and to the IRS. This information reporting requirement applies regardless of whether the non-U.S. shareholder is subject to withholding on distributions on our shares or whether the withholding was reduced or eliminated by an applicable tax treaty. Also, distributions paid to a non-U.S. shareholder on our shares will generally be subject to backup withholding, unless the non-U.S. shareholder properly certifies to the applicable withholding agent its non-U.S. shareholder status on an applicable IRS Form W-8 or substantially similar form. Information reporting and backup withholding will not apply to proceeds a non-U.S. shareholder receives upon the sale, exchange, redemption, retirement or other disposition of our shares, if the non-U.S. shareholder properly certifies to the applicable withholding agent its non-U.S. shareholder status on an applicable IRS Form W-8 or substantially similar form. Even without having executed an applicable IRS Form W-8 or substantially similar form, however, in some cases information reporting and backup withholding will not apply to proceeds that a non-U.S. shareholder receives upon the sale, exchange, redemption, retirement or other disposition of our shares if the non-U.S. shareholder receives those proceeds through a broker'sbroker’s foreign office.
Non-U.S. financial institutions and other non-U.S. entities are subject to diligence and reporting requirements for purposes of identifying accounts and investments held directly or indirectly by U.S. persons. The failure to comply with these additional information reporting, certification and other requirements could result in a 30% U.S. withholding tax on applicable payments to non-U.S. persons, notwithstanding any otherwise applicable provisions of an income tax treaty. In particular, a payee that is a foreign financial institution that is subject to the diligence and reporting requirements described above must enter into an agreement with the U.S. Department of the Treasury requiring, among other things, that it undertake to identify accounts held by “specified United States persons” or “United States owned foreign entities” (each as defined in the IRC and administrative guidance thereunder), annually report information about such accounts, and withhold 30% on applicable payments to noncompliant foreign financial institutions and account holders. Foreign financial institutions located in
30

Table of Contents

jurisdictions that have an intergovernmental agreement with the United States with respect to these requirements may be subject to different rules. The foregoing withholding regime generally applies to payments of dividends on our shares. In general, to avoid withholding, any non-U.S. intermediary through which a shareholder owns our shares must establish its compliance with the foregoing regime, and a non-U.S. shareholder must provide specified documentation (usually an applicable IRS Form W-8) containing information about its identity, its status, and if required, its direct and indirect U.S. owners. Non-U.S. shareholders and shareholders who hold our shares through a non-U.S. intermediary are encouraged to consult their own tax advisors regarding foreign account tax compliance.
Other Tax Considerations
Our tax treatment and that of our shareholders may be modified by legislative, judicial or administrative actions at any time, which actions may have retroactive effect. The rules dealing with federal income taxation are constantly under review by the U.S. Congress, the IRS and the U.S. Department of the Treasury, and statutory changes, new regulations, revisions to existing regulations and revised interpretations of established concepts are issued frequently. Likewise, the rules regarding taxes other than U.S. federal income taxes may also be modified. No prediction can be made as to the likelihood of passage of new tax legislation or other provisions, or the direct or indirect effect on us and our shareholders. Revisions to tax laws and interpretations of these laws could adversely affect our ability to qualify and be taxed as a REIT, as well as the tax or other consequences of an investment in our shares. We and our shareholders may also be subject to taxation by state, local or other jurisdictions, including those in which we or our shareholders transact business or reside. These tax consequences may not be comparable to the U.S. federal income tax consequences discussed above.
3431

Table of Contents

ERISA PLANS, KEOGH PLANS AND INDIVIDUAL RETIREMENT ACCOUNTS
General Fiduciary Obligations
The Employee Retirement Income Security Act of 1974, as amended, or ERISA, the IRC and similar provisions to those described below under applicable foreign or state law, individually and collectively, impose certain duties on persons who are fiduciaries of any employee benefit plan subject to Title I of ERISA, or an ERISA Plan, or an individual retirement account or annuity, or an IRA, a Roth IRA, a tax-favored account (such as an Archer MSA, Coverdell education savings account or health savings account), a Keogh plan or other qualified retirement plan not subject to Title I of ERISA, each a Non-ERISA Plan. Under ERISA and the IRC, any person who exercises any discretionary authority or control over the administration of, or the management or disposition of the assets of, an ERISA Plan or Non-ERISA Plan, or who renders investment advice for a fee or other compensation to an ERISA Plan or Non-ERISA Plan, is generally considered to be a fiduciary of the ERISA Plan or Non-ERISA Plan.
Fiduciaries of an ERISA Plan must consider whether:
their investment in our shares or other securities satisfies the diversification requirements of ERISA;
the investment is prudent in light of possible limitations on the marketability of our shares;
they have authority to acquire our shares or other securities under the applicable governing instrument and Title I of ERISA; and
the investment is otherwise consistent with their fiduciary responsibilities.
Fiduciaries of an ERISA Plan may incur personal liability for any loss suffered by the ERISA Plan on account of a violation of their fiduciary responsibilities. In addition, these fiduciaries may be subject to a civil penalty of up to 20% of any amount recovered by the ERISA Plan on account of a violation. Fiduciaries of any Non-ERISA Plan should consider that the Non-ERISA Plan may only make investments that are authorized by the appropriate governing instrument and applicable law.
Fiduciaries considering an investment in our securities should consult their own legal advisors if they have any concern as to whether the investment is consistent with the foregoing criteria or is otherwise appropriate. The sale of our securities to an ERISA Plan or Non-ERISA Plan is in no respect a representation by us or any underwriter of the securities that the investment meets all relevant legal requirements with respect to investments by the arrangements generally or any particular arrangement, or that the investment is appropriate for arrangements generally or any particular arrangement.
Prohibited Transactions
Fiduciaries of ERISA Plans and persons making the investment decision for Non-ERISA Plans should consider the application of the prohibited transaction provisions of ERISA and the IRC in making their investment decision. Sales and other transactions between an ERISA Plan or a Non-ERISA Plan and disqualified persons or parties in interest, as applicable, are prohibited transactions and result in adverse consequences absent an exemption. The particular facts concerning the sponsorship, operations and other investments of an ERISA Plan or Non-ERISA Plan may cause a wide range of persons to be treated as disqualified persons or parties in interest with respect to it. A non-exempt prohibited transaction, in addition to imposing potential personal liability upon ERISA Plan fiduciaries, may also result in the imposition of an excise tax under the IRC or a penalty under ERISA upon the disqualified person or party in interest. If the disqualified person who engages in the transaction is the individual on behalf of whom an IRA, Roth IRA or other tax-favored account is maintained (or histheir beneficiary), the IRA, Roth IRA or other tax-favored account may lose its tax-exempt status and its assets may be deemed to have been distributed to the individual in a taxable distribution on account of the non-exempt prohibited transaction, but no excise tax will be imposed. Fiduciaries considering an investment in our securities should consult their own legal advisors as to whether the ownership of our securities involves a non-exempt prohibited transaction.
“Plan Assets” Considerations
The U.S. Department of Labor has issued a regulation defining “plan assets.” The regulation, as subsequently modified by ERISA, generally provides that when an ERISA Plan or a Non-ERISA Plan otherwise subject to Title I of ERISA and/or Section 4975 of the IRC acquires an interest in an entity that is neither a “publicly offered security” nor a security issued by an investment company registered under the Investment Company Act of 1940, as amended, the assets of the ERISA Plan or Non-ERISA Plan include both the equity interest and an undivided interest in each of the underlying assets of the entity, unless it is
3532

Table of Contents

established either that the entity is an operating company or that equity participation in the entity by benefit plan investors is not significant. We are not an investment company registered under the Investment Company Act of 1940, as amended.
Each class of our equity (that is, our common shares and any other class of equity that we may issue) must be analyzed separately to ascertain whether it is a publicly offered security. The regulation defines a publicly offered security as a security that is “widely held,” “freely transferable” and either part of a class of securities registered under the Exchange Act, or sold under an effective registration statement under the Securities Act of 1933, as amended, or the Securities Act, provided the securities are registered under the Exchange Act within 120 days after the end of the fiscal year of the issuer during which the offering occurred. Each class of our outstanding shares has been registered under the Exchange Act within the necessary time frame to satisfy the foregoing condition.
The regulation provides that a security is “widely held” only if it is part of a class of securities that is owned by 100 or more investors independent of the issuer and of one another. However, a security will not fail to be “widely held” because the number of independent investors falls below 100 subsequent to the initial public offering as a result of events beyond the issuer'sissuer’s control. Although we cannot be sure, we believe our common shares have been and will remain widely held, and we expect the same to be true of any future class of equity that we may issue.
The regulation provides that whether a security is “freely transferable” is a factual question to be determined on the basis of all relevant facts and circumstances. The regulation further provides that, where a security is part of an offering in which the minimum investment is $10,000 or less, some restrictions on transfer ordinarily will not, alone or in combination, affect a finding that these securities are freely transferable. The restrictions on transfer enumerated in the regulation as not affecting that finding include:
any restriction on or prohibition against any transfer or assignment that would result in a termination or reclassification for federal or state tax purposes, or would otherwise violate any state or federal law or court order;
any requirement that advance notice of a transfer or assignment be given to the issuer and any requirement that either the transferor or transferee, or both, execute documentation setting forth representations as to compliance with any restrictions on transfer that are among those enumerated in the regulation as not affecting free transferability, including those described in the preceding clause of this sentence;
any administrative procedure that establishes an effective date, or an event prior to which a transfer or assignment will not be effective; and
any limitation or restriction on transfer or assignment that is not imposed by the issuer or a person acting on behalf of the issuer.
We believe that the restrictions imposed under our declaration of trust and bylaws on the transfer of shares do not result in the failure of our shares to be “freely transferable.” Furthermore, we believe that there exist no other facts or circumstances limiting the transferability of our shares exist, other than those that are not included among those enumerated under the regulation as not affecting theirthe free transferability under the regulation, andof shares. In addition, we do not expect or intend to impose in the future, or to permit any person to impose on our behalf, any limitations or restrictions on transfer that would not be among the enumerated permissible limitations or restrictions.
Assuming that each class of our shares will be “widely held” and that no other facts and circumstances exist that restrict transferability of these shares, our counsel, Sullivan & Worcester LLP, is of the opinion that our shares will not fail to be “freely transferable” for purposes of the regulation due to the restrictions on transfer of our shares in our declaration of trust and bylaws and that under the regulation each class of our currently outstanding shares is publicly offered and our assets will not be deemed to be “plan assets” of any ERISA Plan or Non-ERISA Plan that acquires our shares in a public offering. This opinion is conditioned upon certain assumptions and representations, as discussed above under the heading “Material United States Federal Income Tax Considerations—Taxation as a REIT.”
33

Table of Contents

Item 1A.  Risk Factors.
Summary of Risk Factors
Our business is subject to a number of risks and uncertainties. The following is a summary below provides an overview of many of the risks we face that areprincipal risk factors described in this section. Additional risks, beyond those summarized below, discussed in this section or described elsewhere in this Annual Report on Form 10-K, may also materially and adversely impact our business, operations or financial results. Consistent with the foregoing, the risks we face include, but are not limited to, the following:
36

Table of Contents
section:
unfavorable market and commercial real estate industry conditions due to, among other things, high interest rates, prolonged high inflation, labor market challenges, supply chain disruptions, volatility in the public equity and debt markets, pandemics, geopolitical instability and tensions (such as the ongoing wars in Ukraine and the Middle East), economic downturns or a possible recession, changes in real estate utilization and other conditions beyond our control, may have a material adverse effect on our and our tenants’, managers’ and other operators’ results of operations and financial conditions, and our and their businesses may not return to the levels experienced prior to the COVID-19 pandemic, and its resulting economic impact has materially adversely affected our business, operations, financial resultstenants, managers and liquidity, and although we have taken several actions in an attemptother operators may fail to address the operating and financial impact from the COVID-19 pandemic and we continuesatisfy their obligations to assess and explore other actions, those actions and plans may not be sufficient to avoid continued and potentially increased substantial harm to our business, operations and financial condition;us;
we are dependentexposed to risks related to our dependence on Five Starour managers or other operators for the operation of most of our senior living communities, and we assume the operational risks and fund the operations and capital and maintenance requirements for those communities, and our results of operations are directly impacted by the operating results of those communities;
changes and trends in the healthcare industry including the continuing trend for seniors to delay or forgo moving to senior living communities, increases in labor costscould negatively impact our managers and reduced payments for healthcare costs by third party payers, could have a material adverse effect onother operators and our business, financial condition and results of operations;SHOP segment operating results;
we and our properties and their operations are subject to extensive regulations, and the nature of our manager'smanagers and other senior living community operators' businesses exposes usoperators and them to litigation and regulatory and government proceedings;tenants face significant competition;
we have debt and may incur additionala substantial amount of debt and we are subject to risks related to our debt, including our ability to refinance maturing debt and the cost of any such refinanced debt and our ability to reduce our debt leverage, which may remain at or above current levels for an indefinite period, covenants and conditions contained in the agreements governing our debt agreements which may restrict our operations by increasing our interest expense and limiting our ability to make investments in our properties, sell properties securing our debt and distributions;
we may need waivers frompay distributions to our lenders or noteholders in ordershareholders, potential downgrades to avoid defaulting under our credit agreement or our public debt agreements,ratings and the terms of such waivers may impose restrictionsother limitations on our ability to pay distributionsaccess capital at reasonable costs or at all, including the limited availability of debt capital to office and to make capital investments, and we may lose some or all of the equity interests in certain of our subsidiaries or face foreclosure on properties on which we provide first mortgage liens;healthcare REITs generally;
we may be unable to renew our leases with current tenants when our leasesthey expire lease our properties to new tenants without decreasing rents or incurring significant costs or at all;
our potential future development or redevelopment projects or sales or acquisitions may not be successful or may not be executed on the terms or within the timing we expect as a result of ongoing market and economic conditions, including capital market disruptions, high interest rates, prolonged high inflation, competition, or otherwise;
we and our manager and other operators and tenants face significant competition;
changes in market interest rates, including changes that may result from the expected phase out of LIBOR, may adversely affect us;
REIT distribution requirements and any limitations on our ability to access reasonably priced capital may adversely impact our ability to carry out our business plan and we are subject to risks associated withrelated to our qualification for taxation as a REIT;
ownership of real estate is subject to environmental risks and liabilities, as well as risks from adverse weather, natural disasters and climate events;
we may not be able to reduce our debt leverage, and our debt leverage may remain at or above current levels for an indefinite period;
insurance may not adequately cover our losses, and insurance costs may continue to increase;
we may not succeed in selling any assets we identify for sale, and the proceeds we receive from any sales we may complete may be less than expected, and we may incur losses with respect to any such sales;REIT, including REIT distribution requirements;
our existing and any future joint ventures may limit our flexibility with jointly owned investments and we may not realize the benefits we expect from these arrangements;arrangements or our joint ventures could require us to provide additional capital;
ownership of real estate is subject to environmental risks and liabilities, as well as risks from adverse weather, natural disasters and adverse impact from global climate change;
insurance may not adequately cover our losses, and insurance costs may continue to increase;
we rely onare subject to risks related to our dependence upon RMR LLC'sto implement our business strategies and Five Star's information technology and systems and the failure of such technology or systems could materially and adversely affect us;manage our day to day operations;
we depend upon RMR LLCare subject to managerisks related to the security of RMR’s or our business and implement our growth strategy, and RMR LLC has broad discretion in operating our day to day business;senior living community managers’ or other operators’ information technology;
37

Table of Contents
our management structure and agreements with RMR LLC and our relationships with our related parties, including our Managing Trustees, RMR, LLC,AlerisLife (including Five StarStar) and others affiliated with them, may create conflicts of interest;
ownership limitationssustainability initiatives, requirements and certain market expectations may impose additional costs and expose us to new risks;
34

Table of Contents

provisions in our declaration of trust, bylaws and other agreements, as well as certain provisions of Maryland law, may deter, delay or prevent a change in our control or unsolicited acquisition proposals;
proposals, limit our rights and the rights of our shareholders to take action against our Trustees and officers are limited, and our bylaws contain provisions that couldor limit our shareholders'shareholders’ ability to obtain a favorable judicial forum they deem favorable for certain disputes;
we may change our operational, financing and investment policies without shareholder approval; and
our distributions to our shareholders may remain at $0.01 per common share per quarter for an indefinite period or be eliminated and the form of payment could change; and
our public debt is structurally subordinated to the indebtedness and other liabilities of our subsidiaries that do not guarantee the notes and is effectively subordinated to our and such subsidiaries' existing and future secured indebtedness to the extent of the value of the assets securing such indebtedness.change.
The risks described below may not be the only risks we face but are risks we believe may be material at this time. Other risks of which we are not yet aware, or that we currently believe are not material, may also materially and adversely impact our business operations or financial results. If any of the events or circumstances described below occurs, our business, financial condition, liquidity, results of operations or ability to makepay distributions to our shareholders could be adversely impacted and the value of an investment in our securities could decline. Investors and prospective investors should consider the risks described below and the information contained under the caption “Warning Concerning Forward-Looking Statements” and elsewhere in this Annual Report on Form 10-K before deciding whether to invest in our securities. We may update these risk factors in our future periodic reports.
Risks Related to Our Business
The COVID-19 pandemicUnfavorable market and its resulting economic impactindustry conditions may have materiallya material adverse effect on our results of operations, financial condition and ability to pay distributions to our shareholders.
Our business and operations may be adversely affected by market and economic volatility experienced by the U.S. and global economies, the commercial real estate industry and/or the local economies in the markets in which our business, operations, financial resultsproperties are located. Unfavorable economic and liquidityindustry conditions may be due to, among other things, high interest rates, prolonged high inflation, labor market challenges, supply chain disruptions, volatility in the public equity and debt markets, pandemics, geopolitical instability and tensions (such as the ongoing wars in Ukraine and the extentMiddle East), economic downturns or a possible recession, changes in real estate utilization and duration ofother conditions beyond our control. As economic conditions in the COVID-19 pandemic are unknownUnited States may affect the demand for healthcare related space and unpredictable.
The COVID-19 pandemic has hadsenior living communities, real estate values, occupancy levels and property income, current and future economic conditions in the United States, including slower growth or a substantialpossible recession and capital market volatility or disruptions, could have a material adverse impact on our earnings and financial condition. Economic conditions may be affected by numerous factors, including, but not limited to, the global economy, includingpace of economic growth and/or recessionary concerns, inflation, increases in the U.S. economy. Theselevels of unemployment, energy prices, uncertainty about government fiscal and tax policy, geopolitical events, the regulatory environment, the availability of credit and interest rates. Current conditions have materially adverselynegatively impacted our ability to pay distributions to our shareholders and many ofthese or other conditions may continue to have similar impacts in the future and on our tenants' and our senior living communities' manager's businesses, results of operations and liquidity.financial condition.
SinceOur and our managers’ and other operators’ and tenants’ businesses may not return to the beginninglevels experienced prior to the COVID-19 pandemic and they may fail to satisfy their obligations to us.
Our business is focused on healthcare related properties, including medical office and life science properties, senior living communities and wellness centers. The senior living industry experienced significant disruptions during, and in the aftermath of, the COVID-19 pandemic, we have experienced reduced occupancy atpandemic. Although our senior living communities as a resultand certain of restrictions on allowing outside persons to enter senior living communities due to social distancingour managers’ and other containment measuresoperators’ and perceptions that senior living communities are unsafe during a pandemic or other widespread illness, whichtenants’ businesses have negatively impacted prospective residents visits and move-ins, as well as elevated levels of resident illness and move-outs. In addition, our senior living communities haveimproved from low points experienced increased operating costs. These increased costs result from staffing, including overtime, particularly if a community experiences a reduction in available personnel due to illness or otherwise, the increased need and cost for supplies, including personal protective equipment, adopting enhanced disinfection measures and/or implementing quarantines for residents. We expect occupancy at our senior living communities to continue to decline as a result of the pandemic and that the costs for operating those senior living communities may continue at elevated levels or increase during the COVID-19 pandemic, the recovery of our SHOP segment has been slower than previously anticipated and its aftermath,uneven, and these declineswe cannot be sure when or if the senior housing business will return to historic pre-pandemic levels due to changing market practices, delayed returns to prior market practices, current market and economic conditions, such as high interest rates, wage and commodity price inflation, limited labor availability, increased insurance costs, geopolitical risks and economic downturns or a possible recession, or otherwise. For example, although occupancy in our SHOP segment has increased, the rate of occupancy growth has been slower than previously anticipated and increases inuneven and increased operating costs may be significant. Those conditions would reduce the returns we realizeresulting from wage and commodity price inflation, limited labor availability and increased insurance costs, among other things, continue to negatively impact our margins. Additionally, while our senior living communities. Downturns or stagnationoperators have increased rates, those rates are increasing gradually and are not increasing at the same pace as our costs, putting further pressure on our margins. It is unclear whether COVID-19 infection rates will surge again in the U.S. housing market as a resultfuture or if other variants of an economic downturn could adversely affect the ability,that virus or perceived ability, of seniors to afford the resident fees and services at our senior living communities as prospective residents may use the proceeds from the sale of their homes to cover the cost of such fees.
In addition, economic downturns and recessionsother public health safety conditions will arise in the United States have historically negatively impactedor elsewhere and, if so, what the commercial office real estateimpact of that would be on human health and safety, the economy, or our managers’ and other operators’ and tenants’ businesses. It is also uncertain what the impact of changing market including increased tenant defaults, decreased occupancies and reduced rental rates. Our tenants have experienced and may continue to experience increased cancellations or rescheduling of elective procedures at the properties in our Office Portfolio due to the COVID-19 pandemic, which may negatively impact our tenants' operating results at those properties and their ability or willingness to pay us rent. The current economic conditions have had, and we expect that they will continue to have, similar negative impactswould be on our Office Portfolio and we expect that the extentour managers’ and other operators’ and tenants’ businesses. As a result of those negative consequences will depend to a large extent on the durationthese uncertainties, our and depth of the economic recession in the United Statesour managers’ and the strength and sustainability of any economic recovery that may follow.other
3835

Table of Contents

Further, despiteoperators’ and tenants’ businesses may not return to the issuanceslevels experienced prior to the COVID-19 pandemic. If those managers’, other operators’ and tenants’ businesses do not sufficiently improve, they may fail to pay amounts owed to us.
We have a substantial amount of debt and are subject to risks related to our debt, including our ability to refinance maturing debt and the EUAs,cost of any such refinanced debt.
As of December 31, 2023, our consolidated debt was $3.1 billion.
We are subject to numerous risks associated with our debt, including our ability to refinance maturing debt and potentially othersthe cost of any refinancing, the risk that our liquidity could be insufficient for us to make required payments and risks associated with high interest rates. There are no limits in our organizational documents on the amount of debt we may incur, and, subject to any limitations in our debt agreements, we may incur additional vaccinesdebt. Our debt may increase our vulnerability to adverse market and economic conditions, limit our flexibility in planning for changes in our business and place us at a disadvantage in relation to competitors that have lower debt levels. Our debt could increase our costs of capital, limit our ability to incur additional debt in the future, and Five Star's partnership with CVS Health Corporationincrease our exposure to administer the COVID-19 vaccine, it is expectedfloating interest rates or expose us to take an extended periodpotential events of time, and considerable effort and expense, to vaccinate residents and staffdefault (if not cured or waived) under covenants contained in our senior living communities who wish to be vaccinated and several months for the vaccines to be produced, distributed and administered todebt instruments that could have a sufficient number of people to enable the cessation of the pandemic. In addition, despite the protection of the PREP Act, which provides immunity protections under federal and state law for individuals and entities, or Covered Persons, against claims of loss relating to certain COVID-19 countermeasures, or Covered Countermeasures. We and our manager's personnel that administer Covered Countermeasures such as the COVID-19 vaccine are classified as Covered Persons immune to claims arising from COVID-19 vaccine administration with the exception of death or serious physical injury caused by willful misconduct.
We cannot predict the extent and duration of the COVID-19 pandemic or the severity and duration of its economic impact, but we expect that the ultimatematerial adverse impacteffect on our business, will be substantial. Further,financial condition and operating results. High interest rates have significantly increased our borrowing costs. Although we have an option to extend the extentmaturity date of certain of our debt upon payment of a fee and strength of any economic recovery aftermeeting other conditions, the COVID-19 pandemic ends or otherwise are uncertain and subject to various factors and conditions. Our business, operations and financial position may continue to be negatively impacted after the COVID-19 pandemic ends and may remain at depressed levels compared to prior to the outbreak of the COVID-19 pandemic and thoseapplicable conditions may continue for an extended period.
We have taken several actions in an attempt to address the operating and financial impact from the COVID-19 pandemic, and we continue to assess and explore other actions, but those actions and plans may not be sufficient to avoid continuedmet, and potentially increased substantial harm to our business, operations and financial condition.
As discussed elsewhere in this Annual Report on Form 10-K, including Part I, Item 1, "Business," we have taken several actions in an attempt to address the operating and financial impact from the COVID-19 pandemic. However, there can be no assurance that these actions or others that we may take will be successful or that they will enable us to maintain sufficient liquidity and withstand the current economic challenges posed by the COVID-19 pandemic.
Our investment activities, other than capital expenditures at our existing properties, have been significantly curtailed and we expect that to continue for an indefinite period.
We are not actively pursuing acquisitions at this time. In addition, we have reduced our expectations for capital spending significantly. In addition, our credit agreement limits our ability to make acquisitions. As a result, we will be limited in pursuing investments, which may limit our ability to grow and to act upon opportunities we believe would benefit us. Further, to the extent we defer capital expenditures, we may be required to make increasedrepay or refinance our existing debt with new debt on less favorable terms. Further, market and economic conditions may limit the availability and cost of government-sponsored enterprise and agency financing that we may otherwise have access to. Excessive or expensive debt could reduce the available cash flow to fund, or limit our ability to obtain financing for, working capital, capital expenditures, acquisitions, development or redevelopment projects, refinancing, lease obligations or other purposes and hinder our ability to pay distributions to our shareholders.
If we default under any of our debt obligations, we may be in later periodsdefault under other debt agreements of ours that have cross default provisions, including our senior notes indentures and their supplements, as applicable. In such case, our lenders or noteholders may demand immediate payment of any outstanding debt and could seek payment from the subsidiary guarantors under our senior notes indentures, seek to sell any pledged equity interests of certain subsidiaries or the mortgaged properties owned by certain pledging subsidiaries, or we could be forced to liquidate our assets for less than the values we would receive in a more orderly process.
We may fail to comply with the terms of our debt agreements, which could adversely affect our business and prohibit us from paying distributions to our shareholders.
Our debt agreements contain financial and/or operating covenants. These covenants may limit our operational flexibility and acquisition and disposition activities. We may not be able to satisfy all of these conditions or may default on some of these covenants for various reasons, including for reasons beyond our control. If any of the covenants in these debt agreements are breached and not cured within the applicable cure period, we could be required to repay the debt immediately, even in the absence of a payment default, or be prevented from refinancing maturing debt. As a result, covenants which limit our operational flexibility or a default under applicable debt covenants could have an adverse effect on our business, financial condition and results of operations.
In the future, we may obtain additional debt financing, and the covenants and conditions applicable to that debt may be more restrictive than the covenants and conditions that are contained in our existing debt agreements.
Secured debt exposes us to the possibility of foreclosure, which could result in the loss of our investment in certain of our subsidiaries or in a property or group of properties or other assets that secure that debt.
More than half of our debt is secured by properties that we or our joint ventures own or by a pledge of the equity interests of certain of our subsidiaries. Secured debt, including mortgage debt, increases our risk of asset and property losses because defaults on debt secured by our assets may result in foreclosure actions initiated by lenders and ultimately our loss of the property or other assets securing any loans for which we are in default. Any foreclosure on a mortgaged property or group of properties could have a material adverse effect on the overall value of our portfolio of properties and more generally on us. For tax purposes, a foreclosure of any of our properties would be treated as a result and somesale of the expenditures may be greaterproperty for a purchase price equal to the outstanding balance of the debt secured by the mortgage. If the outstanding balance of the debt secured by the mortgage exceeds our tax basis in scopethe property, we would recognize taxable income on foreclosure, but would not receive any cash proceeds, which could materially and amount than they may have been if made sooner.adversely affect us.
36

Table of Contents

We are limited in our ability to operate our senior living communities and depend upon Five Star to manage a substantial majority ofare thus dependent on our senior living communities, the results of operations for which represent a significant part of our consolidated operating results.managers or other operators.
Because federal income tax laws restrict REITs and their subsidiaries from operating or managing healthcare facilities, we do not operate or manage our senior living communities. Instead, we lease substantially all of our senior living communities to our subsidiaries of ours that qualify as TRSs under the IRC and retain third parties to manage those senior living communities or we lease our senior living communities to third party operating companies.communities. Our income from our properties may be adversely affected if our managermanagers or other operators fail to provide quality services and amenities to residents. While we monitor the performance of our managermanagers and other operators and apply asset management strategies and discipline, we have limited recourse under our management agreements and leases if we believe that our managermanagers or other operators are not performing adequately. Any failure by our managermanagers or other operators to fully perform the duties agreed to in our management agreements and leases could adversely affect our results of operations.
The senior living communities In addition, our managers and other operators operate, and, in some cases, own or have invested in, properties that Five Star manages for us represent mostcompete with our properties, which may result in conflicts of our senior living communities.interest. As a result, our managers and other operators have made, and may in the success offuture make, decisions regarding competing properties or our senior living communities depends upon Five Star's ability to efficiently and effectively operate them. Our ability to terminate our management agreements with Five Star is limited to the termination rights provided under such agreements or asproperties’ operations that may otherwisenot be recognized under law. As a result, we may be limited in our ability to replace Five Star as a manager if we determine it is in our best interests and which may result in a reduction of our returns.
We are exposed to do so,operational risks, liabilities and claims with respect to our SHOP segment that could adversely affect our revenues and operations.
We are exposed to various operational risks with respect to our SHOP segment that may increase our costs or adversely affect our ability to generate revenues. These risks include fluctuations in occupancy experienced during the normal course of business, Medicare and Medicaid reimbursement, if applicable, and private pay rates; economic conditions, such as high interest rates, prolonged high inflation, labor market challenges and economic downturns or a possible recession; competition; litigation and regulatory and government proceedings; federal, state, local, and industry-regulated licensure, certification and inspection laws, regulations, and standards; the availability and increases in cost of general and professional liability insurance coverage; increases in property taxes; state regulation and rights of residents related to entrance fees; federal and state housing laws and regulations; the availability and increases in the cost of labor (as a result of unionization or otherwise); and increases in commodity prices, such as the prices of food and construction materials, as a result of, among other things, supply chain challenges or other market conditions in the global economy, including the U.S. economy.
Further, we and our managers and other operators have been, are currently, and expect in the future to be involved in claims, lawsuits and regulatory and government audits, investigations and proceedings arising in the ordinary course of senior living operations. The defense and resolution of such claims, lawsuits and other proceedings may be requiredrequire our managers or other operators or us to pay Five Starincur significant expenses. In several well publicized instances, private litigation by residents of senior living communities for alleged abuses has resulted in large damage awards against senior living companies. As a significant termination fee if we terminateresult of these conditions, the management agreements. cost of liability insurance continues to increase.
In addition, if Five Star were to cease managingwe generally hold the applicable healthcare license and enroll in applicable government healthcare programs on behalf of the properties in our senior living communities, weoperations segment. This subjects us to potential liability under various healthcare laws and regulations. Healthcare laws and regulations are wide-ranging, and noncompliance may not be able to obtain a replacement manager as qualified as Five Starresult in the imposition of civil, criminal, and administrative penalties, including: the loss or at allsuspension of accreditation, licenses or CONs; suspension of or non-payment for new admissions; denial of reimbursement; fines; suspension, decertification, or exclusion from federal and westate healthcare programs; or facility closure. We may incur, significant expenses in connection with any replacement manager, including transitioning operational costs, capital expendituresor be obligated to renovatereimburse our senior living communities to the replacement manager's practicesmanagers or other operators for, compliance related fines, assessments, penalties and standardsreturns of government payments (such as Medicare or Medicaid payments) and declines in residents feescould have limitations imposed on our healthcare licenses.
Any one or a combination of these operational risks and services revenue. Although we have various rights as owner underother factors may adversely affect our management agreements, we rely on
39

Table of Contents
Five Star's personnel, good faith, expertise, performance, technical resources, operating efficiencies, information systems, proprietary informationrevenue and judgment. We also rely on the Five Star to set resident fees and otherwise operate our managed senior living communities in compliance with our management agreements. If Five Star does not manage our senior living communities profitably and in accordance with our expectations, our results of operations, financial condition and prospects, and the value of our senior living communities, may be materially adversely affected.operations.
The trend for seniors to delay moving to senior living communities until they require greater care or to forgo moving to senior living communities altogether has been exacerbated by the COVID-19 pandemic and could have a material adverse effect on our business, financial condition and results of operations.
Seniors have been increasingly delaying their moves to senior living communities until they require greater care or forgoing moving to senior living communities altogether. The COVID-19 pandemic has exacerbatedaltogether, and approximately 24% of the senior living communities we own are independent living communities which require residents to be capable of relatively high degrees of independence. These trends may continue to exacerbate these trends.and other factors, such as seniors' and their families’ concerns regarding the impact on seniors of infectious diseases, virus transmissions or other public health safety conditions, may intensify those trends in the future, as may current economic conditions, such as economic downturns or a possible recession, weak housing market conditions, high interest rates, prolonged high inflation and stock market volatility. Further, rehabilitation therapy and other services are increasingly being
37

Table of Contents

provided to seniors on an outpatient basis or in seniors'seniors’ personal residences in response to market demand and government regulation, which may increase the trend for seniors to delay moving to senior living communities. Such delays may cause decreases in occupancy rates and increases in resident turnover rates at our senior living communities. Moreover, older aged personsseniors may have greater care needs and require higher acuity services, which may increase costs at our senior living communities, expose our managermanagers or other operators to additional liability or result in lost business and shorter stays at our senior living communities if our managermanagers or other operators are not able to provide the requisite care services or fail to adequately provide those services. Further, if we or our managermanagers or other operators fail to successfully act upon and address these and other trends and changes in seniors'seniors’ needs and preferences or in the healthcare industry generally, we or they may be unable to offset associated lost revenues by growing other revenue sources, such as by offering new or increased service offerings to seniors, and our senior living communities may become unprofitable and the value of our senior living communities may decline.
Increases inIncreased labor costs, atdecreased labor availability and staffing turnover have negatively impacted our managed senior living communitiesmanagers and our SHOP segment operating results, and these conditions may have a material adverse effect on us.continue for an extended period.
Wages and employee benefits associated with the operations of our managed senior living communities represent a significant part of our managed senior living communities'communities’ operating expenses. PriorHistorical periods of low unemployment and the ongoingimpacts of the COVID-19 pandemic have resulted in increased labor costs, including higher health benefits costs, in the senior living industry. Further, legislation has been enacted and proposed to increase the minimum wage in various jurisdictions in recent years, which has put upward pressure on wages.
The market for Moreover, our managers and other operators face a competitive labor market. A periodic or geographic shortage of qualified nurses and other healthcare professionals is highly competitive, and periodic or geographic area shortages of such healthcare professionalscare givers or other trained personnel, union activities, wage laws, or general inflationary pressures on wages may require our managermanagers or other operators to increase the wagesenhance pay and benefits they offer to their employees in order to attract and retain thempackages or to utilize temporaryuse more expensive contract personnel, at an increased cost. Moreover, the COVID-19 pandemic and its aftermath may result in our managermanagers or other operators beingmay be unable to fully staff our senior living communities or having to pay overtime to adequately staff our senior living communities. In addition, employee benefitoffset these added costs including health insurance and workers' compensation insurance costs, have materially increased in recent years.
Our labor costs at our managed senior living communities have increased, including due to the COVID-19 pandemic. We cannot be sure that labor costs at our managed senior living communities will not continue to increase or that any increases will eventually be recovered by corresponding increases inincreasing the rates charged to residents or otherwise. Any significant failure by our manager or other operators to prudently control labor costs or to pass any increases on to residents through rate increases could have a material adverse effect on our business, financial condition and results of operations.residents. Staffing turnover at our senior living communities is common, and may increaseit increases in a competitive labor market and during the COVID-19 pandemic and the competitive environment in the senior living industry.market. Heightened levels of staffing turnover at our senior living communities, particularly with respect to key and skilled positions, such as management, regional and executive directors and other skilled and qualified personnel, may disrupt operations, limit or slow the execution of business strategies, and decrease revenues and increase costs at our managed senior living communities. In addition, employee benefit costs, including health insurance and workers’ compensation insurance costs, have materially increased in recent years and continue to increase. If these conditions continue, our managers and other operators may increasingly be challenged in fully operating our senior living communities, which may haverequire us to reduce our operations; as a material adverse effect onresult of these conditions, our business, financial condition, results of operationsrevenues and prospects.
Third party payersgrowth may decline and our costs may continue to try to reduce healthcare costs.
Third party payers such as insurance companies, Medicare and Medicaid continue their efforts to control healthcare costs through direct contracts with healthcare providers, increased utilization review practices and greater enrollment in managed care programs and preferred provider organizations. These efforts to limit the amount of payments we receive for healthcare services could adversely affect us. Future changes in the reimbursement rates or methods of third party payers, or the implementation of other measures to reduce payments for our services could result in a substantial reduction in our NOI with respect to our managed senior living communities.
40

Table of Contents
increase.
Termination of assisted living resident agreements and resident attrition could adversely affect revenues and earnings at our senior living communities.
Unlike apartment leases that typically have a one-year term, state regulations governing assisted living communities typically require that senior living community residents have the right to terminate their assisted living resident agreements for any reason on reasonable (for example, 30 days'days’) notice. Should a large number of our residents elect to terminate their resident agreements at or around the same time, revenues and earnings at our senior living communities could be materially and adversely affected. In addition, the advanced ages of our senior living residents may result in high resident turnover rates.
The high levels of infectedOur investments in our properties may not yield the returns we expect and may cost more than expected and take longer to complete.
We invest significant amounts in our properties. However, we may not realize the returns we expect from these investments, and these investments may cost more than we expect. For example, in recent years, the global economy, including the U.S. economy, experienced supply chain disruptions due to the COVID-19 patients and deaths at senior living communities and resulting negative publicity may have a long term significant detrimental impact on the senior living industry, including us, even if our senior living communities do not experience similar levels of COVID-19 infections and deaths as others in the industry.
COVID-19 has proven to be particularly harmful to seniors and persons with other pre-existing health conditions. If the senior living industry continues to experience high levels of residents infected with COVID-19pandemic and related deaths,factors, and news accounts emphasize these experiences, seniors may increasingly delay or forgo moving into senior living communities or using other services provided by senior living healthcare providers. As asupply chain challenges reduced the availability of goods and materials, which caused price inflation and increased the time from order to receipt of goods and materials. Although supply chain conditions have since stabilized, we cannot assure that there will not be future, similar supply chain disruptions. Such conditions could result in our operating results from our senior living communities,planned capital expenditures costing more than expected and the values of those communities, may experience a long term significant detrimental impact.
The nature of our manager's and other senior living community operators' businesses exposes us and themtaking longer to litigation and regulatory and government proceedings.
Our manager and other senior living community operators have been, are currently, and expect in the future to be involved in claims, lawsuits and regulatory and government audits, investigations and proceedings arising in the ordinary course of their and our businesses, some of which may involve material amounts, and we may also be involved in such claims, lawsuits and regulatory and government audits, investigations and proceedings at our managed communities. The defense and resolution of such claims, lawsuits and other proceedings may require our manager or other operators or us to incur significant expenses. In several well publicized instances, private litigation by residents of senior living communities for alleged abuses has resulted in large damage awards against senior living companies. Also, our manager and other operators may face increased exposures to lawsuits or other legal proceedings related to COVID-19 outbreaks. Some lawyers and law firms specialize in bringing litigation against senior living community operators. As a result, the cost of liability insurance continues to increase. Medical liability insurance reforms have not generally been adopted, and we expect that insurance costs may continue to increase. Insurance costs related to our managed senior living communities are, and the costs, claims, lawsuits and regulatory and government audits, investigations and proceedings related to our managed senior living communities may be, included as operating expenses of those communities, which reduce our returns from those communities.complete.
Depressed U.S. housing market conditions and other factors may reduce the willingness or ability of seniors to relocate to our senior living communities.
Downturns or stagnation in the U.S. housing market could adversely affect the ability, or perceived ability, of seniors to afford our senior living community entrance and resident fees, as prospective residents frequently use the proceeds from the sale of their homes to cover the cost of such fees. Historically, during periods of high interest rates, the U.S. housing market has experienced declines. If seniors have difficulty selling their homes, their ability to relocate to our senior living communities or
38

Table of Contents

finance their stays at our senior living communities with private resources could be adversely affected. Recent highRising unemployment as a result of the COVID-19 pandemic may also reduce the ability of family members to relocate seniors to senior living communities, and family members'members’ willingness and ability to offer free care may also affect seniors'seniors’ relocation to senior living communities. If these and other factors reduce seniors'seniors’ willingness or ability to relocate to our senior living communities, occupancy rates, revenues and cash flows at our senior living communities and our results of operations could be negatively impacted.
REIT distribution requirements and limitations on our ability to access reasonably priced capital at reasonable costs or at all may adversely impact our ability to carry out our business plan.
To maintain our qualification for taxation as a REIT under the IRC, we are required to satisfy distribution requirements imposed by the IRC. See “Material United States Federal Income Tax Considerations—REIT Qualification Requirements—Annual Distribution Requirements” included in Part I, Item 1 of this Annual Report on Form 10-K. Accordingly, we may not be able to retain sufficient cash to fund our operations, repay our debts, invest in our properties or fund our acquisitions andor development, and redevelopment or repositioning efforts. Our business strategies therefore depend, in part, upon our ability to raise additional capital at reasonable costs. The volatility in the availability of capital to businesses on a global basis in most debt and equity markets generally may limit our ability to raise reasonably priced capital. We may also be unable to raise reasonably priced
41

Table of Contents
capital at reasonable costs or at all because of reasons related to our business, market perceptions of our prospects, the terms of our indebtedness,debt, the extent of our leverage or for reasons beyond our control, such as capital market volatility, high interest rates and other market conditions. A protracted negative impact on the economy or the industries in which our properties and businesses operate, wage and commodity price inflation, high interest rates, increased insurance costs, geopolitical risks or other economic, market or industry conditions, such as the delayed recovery of the senior housing industry, economic downturns or a possible recession, may have various negative consequences. Such consequences may include a decline in the availability of financing and increased costs for financing, including with respect to government-sponsored enterprise and agency financing that we may otherwise have access to. Because the earnings we are permitted to retain are limited by the rules governing REIT qualification and taxation, if we are unable to raise reasonably priced capital, we may not be able to carry out our business plan.
WeHigh interest rates have a substantial amount of debtsignificantly increased our interest expense and may incur additional debt.
As of December 31, 2020, our consolidated indebtedness was $3.5 billion and our consolidated net debt to total gross assets ratio was 42.4%.
We are subject to numerous risks associated with our debt, including the risk that our cash flows could be insufficient for us to make required payments on our debt. There are no limits in our organizational documents on the amount of debt we may incur, and we may incur substantial debt. Our debt obligations could have important consequences to our securityholders. Our incurrence of debt may increase our vulnerability to adverse economic, market and industry conditions, limit our flexibility in planning for, or reacting to, changes in our business, and place us at a disadvantage in relation to competitors that have lower debt levels. Our incurrence of debt could also increase the costs to us of incurring additional debt, increase our exposure to floating interest rates or expose us to potential events of default (if not cured or waived) under covenants contained in debt instruments that could have a material adverse effect on our business, financial condition and operating results. Excessive debt could reduce the available cash flow to fund, or limit our ability to obtain financing for, working capital, capital expenditures, acquisitions, construction projects, refinancing, lease obligations or other purposes or to make or sustain distributions to our shareholders. If our credit ratings decline, our interest rates may increase.
If we default under any of our debt obligations, we may be in default under the agreements governing other debt obligations of ours which have cross default provisions, including our credit agreement and our senior unsecured notes indentures and their supplements. In such case, our lenders may demand immediate payment of any outstanding indebtedness and we could be forced to liquidate our assets for less than the values we would receive in a more orderly process.
We may need additional waivers from our lenders or noteholders in order to avoid defaulting under our credit agreement or our public debt agreements, and the terms of our current waivers under our credit agreement impose restrictions on our ability to pay distributions and make capital investments, and any future waiver or amendment may impose similar or additional restrictions.
In June 2020, we amended certain financial covenants under our credit and term loan agreements through June 30, 2021 in order to provide us with additional flexibility, and in January 2021, we further amended our credit and term loan agreements to, among other things, obtain waivers from compliance with certain financial covenants through June 2022. To obtain these waivers, we agreed to restrictions on our ability to pay distributions, other than as currently contemplated or to maintain our qualification for taxation as a REIT and to avoid the payment of certain income and excise taxes, and make capital investments. We may need to obtain additional waivers from our lenders or waivers from our noteholders in the future in order to avoid failing to satisfy certain financial covenants under our debt agreements, but our lenders or noteholders are not required to grant any such waivers and may determine not to do so. If we fail to receive any required waiver, we may be in default under our credit agreement and the lenders could terminate our revolving credit facility and term loan and require us to pay our then outstanding borrowings under our revolving credit facility and term loan. Any future waiver we may obtain may impose similar or additional restrictions, which may limit our ability to pay or increase distributions to our shareholders, make investments that we believe we should make and could reduce our ability to pursue business opportunities, grow our business and improve our operating results. In addition, continued availability of borrowings under our revolving credit facility is subject to our satisfying certain financial covenants and other credit facility conditions.
We may fail to comply with the terms of our credit agreement and our senior unsecured notes indentures and their supplements, which could adversely affect our business, would limit our ability to incur indebtedness and may prevent our making distributions to our shareholders.
Our credit agreement and our senior unsecured notes indentures and their supplements include various conditions, covenants and events of default. We may not be able to satisfy all of these conditions or may default on some of these covenants for various reasons, including for reasons beyond our control. For example, our credit agreement and our senior unsecured notes indentures and their supplements require us to maintain certain debt service ratios. Our ability to comply with such covenants will depend upon the net rental income and returns we receive from our properties. If the occupancy at our properties declines or if our rents or returns decline, we may be unable to borrow under our revolving credit facility. Complying with these covenants may limit our ability to take actions that may be beneficial to us and our securityholders. In addition, continued availability of borrowings under our revolving credit facility is subject to our satisfying certain financial covenants
42

Table of Contents
and other credit facility conditions. If our operating results and financial condition are significantly negatively impacted by the current economic conditions or otherwise we may fail to satisfy covenants and conditions under our credit agreement or fail to satisfy our public debt covenants. We expect the ratio of consolidated income available for debt service to debt service could fall below the 1.5x requirement under our revolving credit facility and our public debt covenants in the first half of 2021. We will not be allowed to incur additional debt while this ratio is below 1.5x, which could materially and adversely impact our business, operations, financial results and liquidity, and could cause us to borrow amounts available under our credit agreement earlier than we may otherwise choose to do so. An inability to incur additional indebtedness would require us to meet our capital needs from other sources, such as cash on hand, operating cash flow, equity financing or asset sales, which may not be available to us on attractive terms or at all and we may be unable to meet our obligations or grow our business by acquiring additional properties or otherwise.
Further, if we default under our credit agreement, our lenders may demand immediate payment and may elect not to fund future borrowings. During the continuance of any event of default under our credit agreement, we may be limited or in some cases prohibited from making distributions to our shareholders. Any default under our credit or term loan agreements that results in acceleration of our obligations to repay outstanding indebtedness or in our no longer being permitted to borrow under our revolving credit facility would likely have serious adverse consequences to us and would likely cause the value of our securities to decline.
In the future, we may obtain additional debt financing, and the covenants and conditions which apply to any such additional debt may be more restrictive than the covenants and conditions that are contained in our credit or term loan agreements or our senior unsecured notes indentures and their supplements.
Secured indebtedness exposes us to the possibility of foreclosure, which could result in the loss of our investment in certain of our subsidiaries or in a property or group of properties or other assets that secure that indebtedness.
At December 31, 2020, we had $684.5 million aggregate principal amount of mortgage notes (excluding premiums, discounts and net debt issuance costs) secured by seven properties, of which $620.0 million is related to a joint venture arrangement in which we own a 55% equity interest. We also had two properties subject to finance leases with lease obligations totaling $7.8 million at December 31, 2020. In addition, in connection with the January 2021 amendments to our credit and term loan agreements, we pledged certain equity interests of subsidiaries owning properties to secure our obligations under our credit and term loan agreements. We also agreed to provide first mortgage liens on 91 properties owned by certain pledged subsidiaries with an undepreciated book value of $1.4 billion as of December 31, 2020, to secure our obligations, which pledges and/or mortgage liens may be removed or new ones may be added during the Amendment Period based on outstanding debt amounts, among other things.
Incurring secured indebtedness, including mortgage indebtedness, increases our risk of asset and property losses because defaults on indebtedness secured by our assets may result in foreclosure actions initiated by lenders and ultimately our loss of the property or other assets securing our obligations under our credit agreement if we default on such obligations. Any foreclosure on a property or group of properties could have a material adverse effect on the overall value of our portfolio of properties and more generally on us. For tax purposes, a foreclosure of any of our properties would be treated as a sale of the property for a purchase price equal to the outstanding balance of the indebtedness secured by the mortgage. If the outstanding balance of the indebtedness secured by the mortgage exceeds our tax basis in the property, we would recognize taxable income on foreclosure, but would not receive any cash proceeds, which could materially and adverselynegatively affect us.
ChangesIn response to significant and prolonged increases in market interest rates, including changes that may result from the expected phase out of LIBOR, may adversely affect us.
Interest rates have remained at relatively low levels on a historical basis, andinflation, the U.S. Federal Reserve System, orhas raised interest rates multiple times since the beginning of 2022, which has significantly increased our interest expense. Although the U.S. Federal Reserve has indicated that it does not expect to raisemay lower interest rates in response to the COVID-19 pandemic and current market conditions until at least the end of 2023. There can be no assurance, however, that the U.S. Federal Reserve will not raise rates prior to that time. Low market interest rates, particularly if they remain over a sustained period, may increase our use of debt capital to fund property acquisitions, lower capitalization rates for property purchases and increase competition for property purchases, which may reduce our ability to acquire new properties.
In addition, as noted in Part II, Item 7A of this Annual Report on Form 10-K, LIBOR is currently expected to be phased out for new contracts by December 31, 2021 and for pre-existing contracts by June 30, 2023. The interest rates under our revolving credit facility and term loan are based on LIBOR and the interest we may pay on any future debt we may incur may also be based on LIBOR. We currently expect that the determination of interest under our credit agreement would be based on the alternative rates provided under those agreements or would be revised to provide for an interest rate that approximates
43

Table of Contents
the existing interest rate as calculated in accordance with LIBOR. Despite our current expectations,2024, we cannot be sure that if LIBOR is phased out or transitioned, the changes to the determination ofit will do so, and interest under our credit agreement would approximaterates may remain at the current calculation in accordance with LIBOR. An alternativehigh levels or continue to increase. High interest rate index that may replace LIBOR may result in our paying increased interest. Interest rate increasesrates may materially and negatively affect us in several ways, including:
Investors mayone of the factors that investors typically consider important in deciding whether to buy or sell our common shares based uponis the distribution rate on our common shares relative to the then prevailing market interest rates. If market interest rates, go up,and our quarterly cash distribution rate on our common shares is currently $0.01 per common share in order to enhance our liquidity until our leverage profile otherwise improves. At current interest rate levels, investors may expect a higher distribution rate than we are able to pay, which may increase our cost of capital, or they may sell our common shares and seek alternative investments that offerwith higher distribution rates. Sales of our common shares may cause a decline in the valuemarket price of our common shares;
Property values are often determined, in part, based upon a capitalization of rental income formula. When market interest rates increase, property investors often demand higher capitalization rates and that causes property values to decline. Increases in interest rates could lower the value of our properties and cause the value of our securities to decline; and
Amountsamounts outstanding under our revolving credit facility and term loanfuture debt we may incur may require interest to be paid at floating interest rates. When interest rates increase, our interestborrowing costs with respect to any such debt will increase, which could adversely affect our cash flows, our ability to pay principal and interest on our debt, our cost of refinancing our fixed rate debts when they become due and our ability to make or sustainpay distributions to our shareholders. Additionally, if we choose to hedge our interest rate risk, we cannot be sure that the hedge will be effective or that our hedging counterparty will meet its obligations to us.us; and
Our propertiesproperty values are often determined, in part, based upon a capitalization of rental income formula. When interest rates are high, such as they are currently, real estate transaction volumes slow due to increased borrowing costs and their operations are subjectproperty investors often demand higher capitalization rates, which causes property values to extensive laws and regulations which we and our manager and other senior living community operators are required to comply with.
Licensing, Medicare and Medicaid laws require our manager and other operators who operate senior living communities, clinics and other healthcare communities to comply with extensive standards governing their operations. The revenues our manager or other operators receive from Medicare and Medicaid may be subject to statutory and regulatory changes, retroactive rate adjustments, recovery of program overpayments or set offs, administrative rulings and policy interpretations, and payment delays. In addition, certain laws prohibit fraud by senior living operators, and other healthcare communities, including civil and criminal laws that prohibit false claims in Medicare, Medicaid and other programs and that regulate patient referrals. In recent years, the federal and state governments have devoted increasing resources to monitoring the quality of care at senior living communities and to anti-fraud investigations in healthcare operations generally. The ACA also facilitates the DOJ's ability to investigate allegations of wrongdoing or fraud at SNFs. When violations of anti-fraud, false claims, anti-kickback or physician referral laws are identified, federal or state authorities may impose civil monetary damages, treble damages, repayment requirements and criminal sanctions. Healthcare communities may also be subject to license revocation or conditional licensure and exclusion from Medicare and Medicaid participation or conditional participation. When quality of care deficiencies or improper billing are identified, various laws may authorize civil money penalties or fines; the suspension, modification or revocation of a license or Medicare/Medicaid participation; the suspension or denial of admissions of residents; the denial of payments in full or in part; the implementation of state oversight, temporary management or receivership; and the imposition of criminal penalties. We, our manager and other operators receive notices of potential sanctions from time to time, and government authorities impose such sanctions from time to time on our communities which our manager or other operators operate. If our manager or other operators are unable to cure deficiencies which have been identified or which are identified in the future, these sanctions may be imposed, and if imposed, may adversely affect our returns and our ability to identify substitute operators. Federal and state requirements for change in control of healthcare communities, including, as applicable, approvals of the proposed operator for licensure, CONs, and Medicare and Medicaid participation, may also limit or delay our ability to find substitute operators. If any of our operators becomes unable to operate our properties because it has violated government regulations or payment laws, such incidents may trigger a default or termination right under our management agreements or leases and our or our manager's or other operators' credit agreements, and we may experience difficulty in finding a substitute operator or selling the affected property for a fair and commercially reasonable price, anddecline. High interest rates could therefore lower the value of an affected property may decline materially.
Various laws administered byour properties and cause the FDA and other agencies regulate the operationsvalue of our tenants that operate biotechnology laboratories that develop, manufacture, market or distribute pharmaceuticals or medical devices. Once a product is approved, the FDA maintains oversight of the product and its developer and can withdraw its approval, recall products or suspend their production, impose or seeksecurities to impose civil or criminal penalties on the developer or take other actions for the developer's failure to comply with regulatory requirements, including anti-fraud, false claims, anti-kickback or physician referral laws. Other concerns affecting our biotechnology laboratory tenants include the potential for subsequent discovery of safety concerns and related litigation, ensuring that the product qualifies for reimbursement under Medicare, Medicaid or otherdecline.
4439

Table of Contents

federal or state programs, cost control initiatives of payment programs, the potential for litigation over the validity or infringement of intellectual property rights related to the product, the eventual expiration of relevant patents and the need to raise additional capital. The cost of compliance with these regulations and the risks described in this paragraph, among others, could adversely affect the ability of our biotechnology laboratory tenants to pay rent to us.
Our managermanagers or other operators may fail to comply with laws relating to the operation of our senior living communities.
We and our manager andmanagers or other senior living community operators are subject to, or impacted by, extensive and frequently changing federal, state and local laws and regulations, including: licensure laws; laws protecting consumers against deceptive practices; laws relating to the operation of our properties and how our managermanagers and other operators conduct their operations, such as with respect to health and safety, fire and privacy matters; laws affecting communities that participate in Medicaid; laws affecting SNFs, clinics and other healthcare facilities that participate in both Medicare and Medicaid which mandate allowable costs, pricing, reimbursement procedures and limitations, quality of services and care, food service and physical plants; resident rights laws (including abuse and neglect laws) and fraud laws; anti-kickback and physician referral laws; the Americans with Disabilities Act and similar laws; and safety and health standards established by OSHA. We and our managermanagers and other operators are also required to comply with federal and state laws governing the privacy, security, use and disclosure of individually identifiable information, including financial information and protected health information under HIPAA.
We and our managermanagers and other operators expend significant resources to maintain compliance with these laws and regulations. However, if we or our managermanagers or other operators are alleged to fail, or do fail, to comply with applicable legal requirements, we or they may have to expend significant resources to respond to such allegations, and if we or they are unable to cure deficiencies, certain sanctions may be imposed and we or they may be obligated to return payments and pay fines and interest, which may adversely affect the profitability of our senior living communities and ability to obtain, renew or maintain licenses at those communities.
We and our managermanagers and other operators and tenants face significant competition.
We face significant competition for acquisition opportunities from other investors, including publicly traded and private REITs, numerous financial institutions, individuals, foreign investors and other public and private companies. Because of competition, we may be unable to acquire, or may pay a significantly increased purchase price for, a desired property, which would reduce our expected returns from that property. Some of our competitors may have greater financial and other resources than us. Further, during prior periods of economic recession, some investors have focused on healthcare real estate investments because of a belief that these types of investments may be less affected by general economic circumstances than most other investments. Low historical market interest rates and increased leverage utilized by financial and other buyers have caused purchase prices for healthcare real estate investments to increase, therefore decreasing rates of returns. Such conditions have resulted in increased competition for investments, fewer available investment opportunities and lower spreads over the cost of capital. If such conditions continue for a protracted period, our ability to grow our business and improve our financial results may be materially and adversely affected.
We also face competition for tenants at our properties, particularly at our medical office and life science properties. Some competing properties may be newer, better located or more attractive to tenants. Competing properties may have lower rates of occupancy than our properties, which may result in competing owners offering available space at lower rents than we offer at our properties. Development activities may increase the supply of properties of the type we own in the leasing markets in which we own properties and increase the competition we face. Competition may make it difficult for us to attract and retain tenants and may reduce the rents we are able to charge and the values of our properties.
In recent years, aA significant number of new senior living communities have beenwere developed and continue to be developed.in recent years. Although the rate of new development of senior living communities has slowed which decline has accelerated during the COVID-19 pandemic,significantly, the increased supply of senior living communities from recentsuch development activity has increased competitive pressures on our managermanagers and other operators, particularly in certain geographic markets where we own senior living communities, and we expect these competitive challenges to continue for at least the next few years. Further, our senior living communities compete with numerous other senior living service providers, such as home healthcare companies and other real estate based service providers. Some of these senior living competitors are larger and have greater financial resources than our managermanagers or other senior living community operators do, and some of these competitors are not for-profit entities which have endowment income and may not face the same financial pressures that they do. We cannot be sure that our managermanagers or other operators will be able to attract a sufficient number of residents to our senior living communities at rates that will generate acceptable returns or that theyour managers or other operators will be able to attract employees and keep wages and other employee benefits,
45

insurance costs and other operating expenses at levels which will allow them to compete successfully and operate our senior living communities profitably.
These competitive challenges may prevent our managermanagers and other operators from maintaining or improving occupancy and rates at our senior living communities, which may reduce our returns from our senior living communities and adversely affect the profitability of our senior living communities, and may cause the values of our properties to decline.
We also face significant competition for acquisition opportunities from other investors, including publicly traded and private REITs, numerous financial institutions, individuals, foreign investors and other public and private companies. Some of our competitors may have greater financial and other resources than us and may be able to accept more risk than we can prudently manage, including risks with respect to the creditworthiness of property operators and the extent of leverage used in their capital structure. Because of competition for acquisitions, as well as limitations on acquisitions included in our debt agreements, we may be unable to acquire desirable properties or we may pay higher prices for, and realize lower net cash flows than we hope to achieve from, acquisitions.
40

We may be unable to lease our properties when our leases expire.
Although we typically will seek to renew or extend the terms of leases for our leasesproperties with current tenants when they expire, we cannot be sure that we will be successful in doing so. IfEconomic conditions, including prolonged high inflation, may cause our tenants do not to renew or extend their leases when they expire, or to seek to renew their leases for less space than they currently occupy. If we may beare unable to obtain new tenants to maintainextend or increase the historical occupancy rates of, or rents from, our properties.
We may experience declining rents or incur significant costs to renew our leases, or we renew leases for reduced space, it may be time consuming and expensive to relet some of these properties.
We are exposed to risks associated with current tenants orproperty development, redevelopment and repositioning that could adversely affect us, including our financial condition and results of operations.
We intend to leasecontinue to engage in development, redevelopment and repositioning activities with respect to our properties, and, as a result, we are subject to new tenants.
When we renew our leases with current tenantscertain risks. These risks include cost overruns and untimely completion of construction due to, among other things, weather conditions, inflation, labor or lease to new tenants, we may experience rent decreases, and we may have to spend substantial amounts for leasing commissions, tenant improvementsmaterial shortages or delays in receiving permits or other tenant inducements. Moreover, manygovernmental approvals, inability to achieve desired returns, as well as the availability and pricing of financing on favorable terms or at all. The global economy continues to experience commodity pricing and other inflation, including inflation impacting wages and employee benefits. Although inflation rates have recently declined, they remain higher than pre-pandemic levels. It is uncertain whether inflation will decline further, remain relatively steady or increase; however, some market forecasts indicate that inflation rates may remain elevated for a prolonged period. These conditions have increased the costs for materials, other goods and labor, including construction materials, and caused some delays in construction activities, and these conditions may continue and worsen. These pricing increases, as well as increases in labor costs, could result in substantial unanticipated delays and increased development and renovation costs and could prevent the initiation or the completion of development, redevelopment or repositioning activities. In addition, current economic conditions and volatility in the commercial real estate markets, generally, may cause delays in leasing these properties or possible loss of tenancies and negatively impact our medical officeability to generate cash flows from these properties that meet or exceed our cost of investment. Any of these risks associated with our current or future development, redevelopment and life science propertiesrepositioning activities could have been specially designed for the particular businessesa material adverse effect on our business, financial condition and results of our tenants; if the current leases for such properties are terminated or are not renewed, we may be required to renovate such properties at substantial costs, decrease the rents we charge or provide other concessions in order to lease such properties to new tenants.operations.
Ownership of real estate is subject to environmental risks and liabilities.
Ownership of real estate is subject to risks associated with environmental hazards. Under various laws, owners as well as tenants and operators of real estate may be required to investigate and clean up or remove hazardous substances present at or migrating from properties they own lease or operate and may be held liable for property damage or personal injuries that result from hazardous substances. These laws also expose us to the possibility that we may become liable to government agencies or third parties for costs and damages they incur in connection with hazardous substances. The costs and damages that may arise from environmental hazards may be substantial and are difficult to assess and estimate for numerous reasons, including uncertainty about the extent of contamination, alternative treatment methods that may be applied, the location of the property which subjects it to differing local laws and regulations and their interpretations, as well as the time it may take to remediate contamination. In addition, these laws also impose various requirements regarding the operation and maintenance of properties and recordkeeping and reporting requirements relating to environmental matters that require us or the operators or tenants of our properties to incur costs to comply with. Further, certain of our secured debt agreements contain exceptions to the general non-recourse provisions that obligate us to indemnify the lenders for certain potential environmental losses relating to hazardous materials and violations of environmental law. We may incur substantial liabilities and costs for environmental matters.
Ownership of real estate isWe are subject to risks from adverse weather, natural disasters and adverse impact from global climate events.change, and we incur significant costs and invest significant amounts with respect to these matters.
Severe weather may have anWe are subject to risks and could be exposed to additional costs from adverse effect on properties we own. Flooding caused by rising sea levels and severe weather events, including hurricanes, tornadoes and widespread fires, may have an adverse effect on properties we own and result in significant losses to us and interruption of our business. When major weather, natural disasters or climate-related events, such as hurricanes, floods and wildfires, occur nearadverse impact from global climate change. For example, our properties wecould be severely damaged or our managerdestroyed from either singular extreme weather events (such as floods, storms and wildfires) or other operatorsthrough long term impacts of climatic conditions (such as precipitation frequency, weather instability and rise of sea levels). Such events could also adversely impact us or tenants may be required to relocate the residents of those senior living properties to alternative locations for their safety and we or they may close or limit the operations of the impacted senior living communities or medical office or life science properties until the event has ended and the property is ready for operation. We or our manager or other operators or tenants of our properties if we or they are unable to operate our or their businesses due to damage resulting from such events. Insurance may not adequately cover all losses sustained by us or the tenants of our properties. If we fail to adequately prepare for such events, our revenues, results of operations and financial condition may be impacted. In addition, we may incur significant costs in preparing for possible future climate change or in response to our tenants’ requests for such investments and losses as a result of these activities, both in terms of operating, preparing and repairing our properties in anticipation of, during and after a severe weather, natural disaster or climate-related event and in terms of potential lost business due to the interruption in operating our properties. Our or our manager's or other operators' or tenants' insurancewe may not adequately compensate us or them for these costs and losses.
Also, concerns about climate change have resulted in various treaties, laws and regulations that are intended to limit carbon emissions and address other environmental concerns. These and other laws may cause energy or other costs at our properties to increase. Laws enacted to mitigate climate change may make some of our buildings obsolete or cause us to make material investments in our properties, which could materially and adversely affect our financial condition or the financial condition of our manager or other operators or tenants and their ability to generate sufficientrealize desirable returns for, or pay rent to, us and cause the values of our properties to decline. In addition, concerns about climate change and increasing storm intensities may increase the cost of our insurance for our properties or potentially render it unavailable to obtain.on those investments.
4641

Real estate ownership creates risksVacancies in a property could result in significant capital expenditures and liabilities.illiquidity and reduce the value of the property.
In additionThe loss or downsizing of a tenant may reduce the value of a property and require us to spend significant amounts of capital to renovate the property before it is suitable for a new tenant. Many of the leases we enter into or acquire are for properties that are especially suited to the risks discussed above,particular business of our businesstenants, such as our medical office and life science properties. Because these properties have been designed or physically modified for a particular tenant, if the current lease is subjectterminated, downsized or not renewed, we may be required to renovate the property at substantial costs, decrease the rent we charge or provide other risks associated with real estate ownership, including:
concessions in order to lease the illiquid nature of real estate markets,property to another tenant. We may also have difficulty selling the property due to the special purpose for which limitsthe property may have been designed or modified. This potential illiquidity may limit our ability to sellquickly modify our assets rapidly to respond to changing market conditions;
the subjectivity of real estate valuations and changesportfolio in such valuations over time;
current and future adverse national and local real estate trends, including increasing vacancy rates, declining rental rates and general deterioration of market conditions;
costs that may be incurred relating to property maintenance and repair, and the need to make expenditures dueresponse to changes in government regulations; and
liabilities and litigations arising from injuries on our propertieseconomic or otherwise incidental to the ownership of our properties.other conditions, including tenant demand.
RMR LLC and Five Starour senior living community managers rely on information technology and systems in their respective provision ofproviding services to us, and any material failure, inadequacy, interruption or security failurebreach of that technology or those systems could materially and adversely affectharm us.
RMR LLC and Five Starour senior living community managers rely on information technology and systems, including the Internet and cloud-based infrastructures and services, commercially available software and their respective internally developed applications, to process, transmit, store and safeguard information and to manage or support a variety of their business processes (including managing our building systems), including financial transactions and maintenance of records, which may include personal identifying information of employees, residents, tenants and tenantsguarantors and lease data. If these systemswe or our third party vendors experience material security or other failures, inadequacies or interruptions of itsin our or their information technology systems, we could incur material costs and losses and our operations could be disrupted as a result. Each ofdisrupted. RMR LLC and Five Star takesour senior living community managers take various actions, and incursincur significant costs, to maintain and protect the operation and security of its information technology and systems, including the data maintained in those systems. However, these measures may not prevent the systems'systems’ improper functioning or a compromise in security.security such as in the event of a cyberattack or the improper disclosure of personally identifiable information.
Security breaches, computer viruses, attacks by hackers, online fraud schemes and similar breaches have created and can create significant system disruptions, shutdowns, fraudulent transfer of assets or unauthorized disclosure of confidential information. OurThe risk of a security breach or disruption, particularly through cyberattack or cyber intrusion, including by computer hackers, foreign governments and cyber terrorists, has generally increased as the intensity and sophistication of attempted attacks and intrusions from around the world have increased. The cybersecurity risks to us or our third party vendors are heightened by, among other things, the evolving nature of the threats faced, advances in computer capabilities, new discoveries in the field of cryptography and new and increasingly sophisticated methods used to perpetrate illegal or fraudulent activities, including cyberattacks, email or wire fraud and other attacks exploiting security vulnerabilities in RMR LLC's, Five Star'sRMR’s, our senior living community managers’ or other third parties'parties’ information technology networks and systems or operations. Although most of RMR’s and our senior living community managers’ staff returned to their offices during the pandemic, flexible working arrangements have resulted in a higher extent of remote working than they experienced prior to the pandemic. This and other possible changing work practices have adversely impacted, and may in the future adversely impact, RMR’s, our senior living community managers’ or other third parties’ abilities to maintain the security, proper function and availability of their information technology and systems since remote working by their employees could strain their technology resources and introduce operational risk, including heightened cybersecurity risk. Remote working environments may be less secure and more susceptible to hacking attacks, including phishing and social engineering attempts that have sought, and may seek, to exploit remote working environments. In addition, RMR’s, our senior living community managers’ or other third parties’ data security, data privacy, investor reporting and business continuity processes could be impacted by a third party’s inability to perform in a remote work environment or by the failure of, or attack on, their information systems and technology. Any failure by usRMR, our senior living community managers or ourother third party vendors to maintain the security, proper function and availability of RMR LLC's or Five Star'stheir respective information technology and systems could result in financial losses, interrupt our operations, damage our reputation, cause us to be in default of material contracts and subject us to liability claims or regulatory penalties, any of which could materially and adversely affect our business and the value of our securities.
Real estate constructionSustainability initiatives, requirements and redevelopment creates risks.
Our business plans involve the development of new properties or the redevelopment of some of our existing properties as the existing leases expire, as our operators' or tenants' needs change or to pursue any other opportunities that we believe are desirable. The development and redevelopment of new and existing buildings involves significant risks in addition to those involved in the ownership and operation of leased properties, including the risks that constructionmarket expectations may not be completed on schedule or within budget, resulting in increased constructionimpose additional costs and delaysexpose us to new risks.
There continues to be increased focus from regulators, investors, tenants and other stakeholders concerning corporate sustainability. The SEC is considering climate change related regulations and certain states have enacted climate focused disclosure laws and we may incur significant costs in leasingcompliance with such propertiesrules. Some investors may use ESG factors to guide their investment strategies and, generating cash flows. Development activities are also subjectin some cases, may choose not to risksinvest in us, or otherwise do business with us, if they believe our or RMR’s policies relating to the inability to obtain, or delays in obtaining, all necessary zoning, land use, building, occupancy, and other required government permits and authorizations. Once completed, any new properties may perform below anticipated financial results. The occurrencecorporate sustainability are inadequate. Third party providers of one or more of these circumstances in connection with our development and redevelopment activities could have an adverse effect on our financial condition, results of operations and the values of our properties.corporate sustainability
4742

ratings and reports on companies have increased in number, resulting in varied and, in some cases, inconsistent standards. In addition, the criteria by which companies’ corporate sustainability practices are assessed are evolving, which could result in greater expectations of us and RMR and cause us and RMR to undertake costly initiatives to satisfy such new criteria. Alternatively, if we or RMR elect not to or are unable to satisfy such new criteria or do not meet the criteria of a specific third party provider, some investors may conclude that our or RMR’s policies with respect to corporate sustainability are inadequate. Pursuant to RMR’s zero emissions goal, RMR has pledged to reduce its Scope 1 and 2 emissions to net zero by 2050 with a 50% reduction commitment by 2030 from a 2019 baseline. We and RMR may face reputational damage in the event that our or their corporate sustainability procedures or standards do not meet the goals that we or RMR have set or the standards set by various constituencies. If we and RMR fail to comply with ESG related regulations and to satisfy the expectations of investors and our tenants and other stakeholders or our or RMR’s announced goals and other initiatives are not executed as planned, our and RMR’s reputation could be adversely affected, and our revenues, results of operations and ability to grow our business may be negatively impacted. In addition, we may incur significant costs in attempting to comply with regulatory requirements, ESG policies or third party expectations or demands.
Insurance may not adequately cover our losses, and insurance costs may continue to increase.
We or our tenants are generally responsible for the costs of insurance coverage for our properties and the operations conducted on them, including for casualty, liability, malpractice, fire, extended coverage and rental or business interruption loss insurance. In the past few years,future, we may acquire properties for which we are responsible for the costs of insurance. The costs of insurance have increased significantly and continue to increase, and these increased costs have had an adverse effect on us and our manager andmanagers or other operators and tenants. Increased insurance costs may adversely affect our manager's and other operators' abilitymanagers’ abilities to operate our properties profitably and provide us with desirable returns and our tenants'tenants’ abilities to pay us rent or result in downward pressure on rents we can charge under new or renewed leases. In the future, we may acquire additional properties for which we are responsible for the costs of insurance. Losses of a catastrophic nature, such as those caused by hurricanes, flooding, volcanic eruptions and earthquakes among other things,or losses as a result of outbreaks of pandemics including the COVID-19 pandemic, or losses fromacts of terrorism, may be covered by insurance policies with limitations such as large deductibles or co-payments that we or a responsible tenant may not be able to pay. Insurance proceeds may not be adequate to restore an affected property to its condition prior to a loss or to compensate us for our losses, including lost revenues or other costs. Certain losses, such as losses we may incur as a result of known or unknown environmental conditions, are not covered by our insurance. Market conditions or our loss history may limit the scope of insurance or coverage available to us or our tenants on economic terms. If we determine that an uninsured loss or a loss in excess of insured limits occurs and if we are not able to recover amounts from our manager and other operators and tenants fromfor certain losses, we may have to incur uninsured costs to mitigate such losses or lose all or a portion of the capital invested in a property, as well as the anticipated future revenue from the property.
We may not succeed in selling properties we have identifiedmay identify for sale and any proceeds we may receive from sales we do complete may be less than expected, and we may incur losses with respect to any such sales.
ToWe plan to selectively sell certain properties from time to time to reduce our leverage, we have sold propertiesfund capital expenditures and other assets, with a focus on the sale of underperforming senior living communitiesfuture acquisitions and non-core assets. However, as a result of current market conditions, including those related to the COVID-19 pandemic, the sales of some ofstrategically update, rebalance and reposition our properties that we previously identified for sale have and we expect will continue to be delayed.investment portfolio. Our ability to sell properties or any other assets and the prices we may receive uponin any sale,such sales, may be affected by various factors, including those related to the impacts of the COVID-19 pandemic, and we may be unable to execute our strategy to reduce our leverage.factors. In particular, these factors could arise from weaknesses in or a lack of established markets for the properties we have identifiedmay identify for sale, the availability of financing to potential purchasers on reasonable terms, changes in the financial condition or prospects of prospective purchasers for and the tenants of the properties, the terms of leases with tenants at certain of the properties, the characteristics, quality and prospects of the properties, the availability of financing to potential purchasers on reasonable terms, the number of prospective purchasers, the number of competing properties in the market, unfavorable local, national or international economic conditions, industry trendssuch as high interest rates, prolonged high inflation, labor market challenges, supply chain challenges and economic downturns or a possible recession, and changes in laws, regulations or fiscal policies of jurisdictions in which the properties are located. For example, current market conditions have caused, and may continue to cause, increased capitalization rates which, together with high interest rates, have resulted in reduced commercial real estate transaction volume, and such conditions may continue or worsen. We may not succeed in selling properties or other assets and any sales may be delayed or may not occur or, if sales do occur, the terms may not meet our expectations, and we may incur losses in connection with any sales. In addition, we may elect to change or abandon our strategy to reduce leverage and forego or abandon property or other asset sales. If we are unable to realize proceeds from the sale of assets sufficient to allow us to reduce our leverage to a level we, believe appropriate or which ratings agencies andor possible financing sources, believe appropriate, our credit ratings may be further lowered and we may further reducebe unable to fund capital expenditures or future acquisitions to grow our business. In addition, we may elect to change or abandon our strategy and forego or abandon property or other asset sales.
43

We may be unable to grow our business by acquiring additional properties, and we might encounter unanticipated difficulties and expenditures relating to our acquired properties.
Our business plan includes the acquisition of additional properties. Our ability to make profitable acquisitions is subject to risks, including, but not limited to, risks associated with:
the extent of our debt leverage;
the availability, terms and cost of debt and equity capital;
competition from other investors; and
contingencies in our acquisition activityagreements.
These risks may limit our ability to grow our business by acquiring additional properties. In addition, we might encounter unanticipated difficulties and expenditures relating to our acquired properties. For example:
notwithstanding pre-acquisition due diligence, we could acquire a property that contains undisclosed defects in design or investmentsconstruction or unknown liabilities, including those related to undisclosed environmental contamination, or our analyses and assumptions for the properties may prove to be incorrect;
an acquired property may be located in a new market where we may face risks associated with investing in an unfamiliar market;
the market in which an acquired property is located may experience unexpected changes that adversely affect the property’s value; and
property operating costs for our existing properties.acquired properties may be higher than anticipated and our acquired properties may not yield expected returns.
For these reasons, among others, we might not realize the anticipated benefits of our acquisitions, and our business plan to acquire additional properties may not succeed or may cause us to experience losses.
Our existing and any future joint ventures may limit our flexibility with jointly owned investments and we may not realize the benefits we expect from these arrangements.
We are party to a joint ventureventures with an institutional investor for one of our life science properties located in Boston, Massachusetts,investors, and we may in the future sell or contribute additional properties to, or acquire, develop or recapitalize properties in, thisour existing or any future joint venture or other joint ventures that we may enter.ventures. Our participation in our existing joint ventureventures is subject to risks, including the following:
we share approval rights over major decisions affecting the ownership or operation of the joint ventureventures and any property owned by the joint venture;ventures;
we may need to contribute additional capital in order to preserve, maintain or grow the joint ventureventures and itstheir investments;
our joint venture investorinvestors may have economic or other business interests or goals that are inconsistent with our business interests or goals, and thatwhich could affect our ability to lease, relet or operate the propertyproperties owned by the joint venture or maintain our or the joint venture's qualification for taxation as a REIT;ventures;
48

our joint venture investorinvestors may be subject to different laws or regulations than us, or may be structured differently than us for tax purposes, which could create conflicts of interest and/or affect our ability to maintain our qualification for taxation as a REIT;
our ability to sell our interest in, or sell additional properties to, the joint ventureventures or the joint venture'sventures’ ability to sell additional interests of, or properties owned by, the joint ventureventures when we so desire are subject to the approval rights of the other joint venture investorinvestors under the terms of the agreements governing the joint venture;ventures; and
disagreements with our joint venture investorinvestors could result in litigation or arbitration that could be expensive and distracting to management and could delay important decisions.
44

Any of the foregoing risks could have a material adverse effect on our business, financial condition and results of operations. Further, these, similar, enhanced or additional risks, including possible mandatory capital contribution requirements, may apply to any future additional or amended joint ventures that we may enter into.ventures.
Bankruptcy law may adversely impact us.
The occurrence of a tenant bankruptcy could reduce the rent we receive from that tenant. In addition,tenant, and the continued existence of the COVID-19 pandemiccurrent economic conditions, such as prolonged high inflation, high interest rates, labor market challenges, supply chain challenges and economic downturns or a possible recession, may increase the risk of our tenants and the managers and other operators of our senior living communities filing for bankruptcy. If a tenant becomes bankrupt,files for bankruptcy, federal law may prohibit us from evicting that tenant based solely upon its bankruptcy. In addition,bankruptcy, and a bankrupt tenant may be authorized to reject and terminate its lease with us. Any claims against a bankrupt tenant for unpaid future rent would be subject to statutory limitations that may be substantially less than the contractually specified rent we are owed under the lease, and any claim we have for unpaid past rent may not be paid in full. Further, ifIf any of our tenants, managers or other operators files for bankruptcy, we may experience delays in enforcing our rights, and may be limited in our ability to replace the tenant, manager or other operator. In the case of any tenant, manager or other operator andbankruptcy, we may incur substantial costs in protecting our investment and re-leasing or finding a replacement tenant, manager or other operator.
A severe cold or flu season, epidemics or any other widespread illnesses could adversely affect the occupancyoperations of our senior living communities.
Our revenues and our manager'smanagers’ and other operators'operators’ and tenants'tenants’ revenues with respect to our senior living communities are dependent on occupancy. Ifoccupancy and could significantly decrease in the event of a severe cold orand flu season, an epidemic or pandemic such as a new variant in the COVID-19 pandemic or any other widespread illnesses occurred in locations where our senior living communities are located,illness. Such a decrease could significantly impact our and our applicable operators'managers’ and tenants'tenants’ revenues from those communities would likely be significantly and negatively impacted. During such occasions, we and our manager and other operators and tenants may experience a decline in occupancy due to residents leaving our communities and, we, our manager or other operators and tenants may be required, or we, our manager or other operators and tenants may otherwise determine that it would be prudent, to quarantine some or all of the senior living community and not to permit new residents during that time. Further, depending on the severity of the occurrence, we, our manager or other operators and tenants may be required to incur costs to identify, contain and remedy the impacts of those occurrences at those senior living communities. As experienced during the COVID-19 pandemic, a result, these occurrencesfuture flu or other epidemic or pandemic could significantly increase the cost burdens faced by our managers or tenants, including if they are required to implement quarantines for residents, and adversely affect our and our manager's and other operators' and tenants' results of operations and adversely affect thetheir ability of our applicable tenants to pay us rent. See “—Our business, operations, financial results and liquidity have been materially and adversely impacted by the COVID-19 pandemic, and it is not known what the duration of this pandemic will be or what its ultimate adverse impact onmeet their obligations to us and our business will be, but we expect it will be substantial.” above for information regarding the risks from the impacts of the COVID-19 pandemic on our business and results of operations.
The benefits we have realized and may continue to realize from participating in relief programs provided under the CARES Act may not be sufficient to enable us to withstand the current economic conditions and any extended economic downturn or recessionreturns, which may result from the COVID-19 pandemic.
We have received funds under the CARES Act, and have benefited from other relief measures pursuant to the CARES Act, including the deferral of employer payroll taxes. Receipt of additional government funds and other benefits from the CARES Act is subject to, in certain circumstances, a detailed application and approval process and it is unclear whether we will meet any eligibility requirements, receive any funds and the extent to which these funds may offset our COVID-19 pandemic related cash flow disruptions. Further, funds we have received or may receive, either directly through participation in government programs, or indirectly through increased revenues attributable to a possible economic recovery generated in whole or in part by the CARES Act, may not be sufficient to mitigate the impact of the COVID-19 pandemic.
49

Changes within the life science industry may adversely impact our revenues and results of operations.
For the year ended December 31, 2020, life science properties in our Office Portfolio accounted for approximately 11% and 34% of our total revenues and NOI, respectively. Our life science investments could be adversely affected if the life science industry is impacted by an economic, financial, or banking crisis or if the life science industry migrates from the U.S. to other countries or to areas outside of primary life science markets in San Francisco, California, San Diego, California, and Boston, Massachusetts. Our ability to negotiate increases in rental rates will depend upon market conditions and the demand for life science properties at the time the leases are negotiated. If economic, financial or industry conditions adversely affect our life science tenants, we may not be able to lease or relet our properties in a timely manner or at favorable rates, which would negatively impact our revenues and results of operations. For example, some of our properties may be better suited for a particular life science industry client tenant and could require modification before we are able to relet vacant space to another life science industry client tenant, which may delay the reletting process and result in unrecovered costs. Additionally, some of our life science properties may not be suitable for lease to traditional office client tenants without significant expenditures on renovations, which could delay an attempt to reposition the property for rent to non-life science tenants. Because infrastructure improvements for life science properties typically are significantly more costly than improvements to other property types due to the highly specialized nature of the properties, and life science tenants typically require greater lease square footage relative to medical office tenants, repositioning efforts would have a disproportionatematerial adverse effect on our life science segment performance.financial results.
Risks Related to Our Relationships with RMR LLC and AlerisLife (including Five StarStar)
We are dependent upon RMR LLC to manage our business and implement our growth strategy.
We have no employees. Personnel and services that we require are provided to us by RMR LLC pursuant to our management agreements with RMR LLC.RMR. Our ability to achieve our business objectives depends on RMR LLC and its ability to effectively manage our properties, to appropriately identify and complete our acquisitions and dispositions and to execute our growth strategy. Accordingly, our business is dependent upon RMR LLC'sRMR’s business contacts, its ability to successfully hire, train, supervise and manage its personnel and its ability to maintain its operating systems. If we lose the services provided by RMR LLC or its key personnel, our business and growth prospects may decline. We may be unable to duplicate the quality and depth of management available to us by becoming internally managed or by hiring another manager. In the event RMR LLC is unwilling or unable to continue to provide management services to us, our cost of obtaining substitute services may be greater than the fees we pay RMR LLC under our management agreements, and as a result our expenses may increase.
RMR LLC has broad discretion in operating our day to day business.
Our manager, RMR, LLC, is authorized to follow broad operating and investment guidelines and, therefore, has discretion in identifying the properties that will be appropriate investments for us, as well as our individual operating and investment decisions. Our Board of Trustees periodically reviews our operating and investment guidelines and our operating activities and investments, but it does not review or approve each decision made by RMR LLC on our behalf. In addition, in conducting periodic reviews, our Board of Trustees relies primarily on information provided to it by RMR. RMR LLC. RMR LLC may exercise its discretion in a manner that results in investment returns that are substantially below expectations or that results in losses.
Our management structure and agreements and relationships with RMR LLC and RMR LLC'sRMR’s and its controlling shareholder'sshareholder’s relationships with others may create conflicts of interest, or the perception of such conflicts, and may restrict our investment activities.
RMR LLC is a majority-ownedmajority owned subsidiary of RMR Inc. The Chair of our Board of Trustees who is alsoand one of our Managing Trustees, Adam D. Portnoy, asis the sole trustee, an officer and the controlling shareholder of ABP Trust, which is the controlling shareholder of RMR Inc. and is, chair of the board of directors, a managing director and the president and chief executive officer of
45

RMR Inc. and an officer and employee of RMR. RMR LLC. RMR LLC or its subsidiarysubsidiaries also act as the manager to fourcertain other Nasdaq listed REITs: Office Properties Income Trust, or OPI, which primarily owns office properties leased to single tenantscompanies and high credit quality tenants, including government tenants; Industrial Logistics Properties Trust, or ILPT, which ownsprivate companies, and leases industrial and logistics properties; Service Properties Trust, or SVC, which owns a diverse portfolio of hotels and net lease service and necessity-based retail properties; and Tremont Mortgage Trust, or TRMT, which focuses on originating and investing in first mortgage whole loans secured by middle market and transitional commercial real estate. RMR LLC also provides services to other publicly and privately owned companies, including: Five Star, the manager of our managed senior living communities and of which we own 33.7% of its outstanding common shares as of December 31, 2020; TravelCenters of America Inc., or TA, which operates and franchises travel centers, standalone truck service facilities and restaurants; and Sonesta International Hotels Corporation, which operates, manages and
50

franchises hotels, resorts and cruise boats. A subsidiary of RMR LLC is an investment adviser to RMR Mortgage Trust (formerly known as RMR Real Estate Income Fund), or RMRM, which recently converted from a registered investment company to a publicly traded mortgage REIT. Mr. Portnoy serves as chair of the board of trustees or board of directors, as applicable, of OPI, ILPT, SVC, Five Star and TA and as managing director,a managing trustee, director or trustee, as applicable, of those companies, and as chair of the companies managed by RMR LLC or its subsidiaries.board of trustees of those Nasdaq listed companies.
Jennifer Francis,Christopher J. Bilotto, our President and Chief OperatingExecutive Officer, Richard Siedel, Jr.,and Matthew C. Brown, our Chief Financial Officer and Treasurer, and Jennifer Clark, our Secretary and one of our Managing Trustees, are also officers and employees of RMR. Ms. Francis, our other Managing Trustee, served as an officer of RMR LLC. Mr. Siedel is also the chief financial officeruntil December 31, 2023 and treasurerwill remain an employee of ILPT,RMR until her retirement on July 1, 2024. Messrs. Portnoy, Bilotto and Brown and Ms. Clark is also a managing director of Five Star and is the secretary of RMR Inc. and the other public companies to which RMR LLC or its subsidiaries provide management services. Mses. Francis and Clark and Mr. Siedel have duties to RMR, LLC, and Mr. Siedel has duties to ILPT, as well as to us, and we do not have their undivided attention. They and other RMR LLC personnel may have conflicts in allocating their time and resources between us and RMR LLC and other companies to which RMR LLC or its subsidiaries provide services. Some of our Independent Trustees also serve as independent directors or independent trustees of other public companies to which RMR LLC or its subsidiaries provide management services.
In addition, we may in the future enter into additional transactions with RMR, LLC, its affiliates or entities managed by it or its subsidiaries. In addition to his investments in RMR Inc. and RMR, LLC, AdamMr. Portnoy holds equity investments in other companies to which RMR LLC or its subsidiaries provide management services and some of these companies have significant cross ownership interests, including, for example: as of December 31, 2020,2023, Mr. Portnoy beneficially owned in aggregate, 1.1%9.8% of our outstanding common shares 6.3%and approximately 6.1% of Five Star'sAlerisLife’s outstanding common shares (including through ABP Trust), 1.2% of ILPT's outstanding common shares, 1.5% of OPI's outstanding common shares, 2.3% of RMRM's outstanding common shares, 1.1% of SVC's outstanding common shares, 4.5% of TA's outstanding common shares (including through RMR LLC) and 19.4% of TRMT's outstanding common shares (including through Tremont Realty Advisors LLC); and we owned 33.7% of Five Star's outstanding common shares.. Our executive officers may also own equity investments in other companies to which RMR LLC or its subsidiaries provide management services. These multiple responsibilities, relationships and cross ownerships may give rise to conflicts of interest or the perception of such conflicts of interest with respect to matters involving us, RMR Inc., RMR, LLC, our Managing Trustees, the other companies to which RMR LLC or its subsidiaries provide management services and their related parties. Conflicts of interest or the perception of conflicts of interest could have a material adverse impact on our reputation, business and the market price of our common shares and other securities and we may be subject to increased risk of litigation as a result.
In our management agreements with RMR, LLC, we acknowledge that RMR LLC may engage in other activities or businesses and act as the manager to any other person or entity (including other REITs) even though such person or entity has investment policies and objectives similar to our policies and objectives and we are not entitled to preferential treatment in receiving information, recommendations and other services from RMR LLC.RMR. Accordingly, we may lose investment opportunities to, and may compete for tenants with, other businesses managed by RMR LLC or its subsidiaries.subsidiaries, including our existing and any future joint ventures. We cannot be sure that our Code of Conduct or our governance guidelines, or other procedural protections we adopt will be sufficient to enable us to identify, adequately address or mitigate actual or alleged conflicts of interest or ensure that our transactions with related persons are made on terms that are at least as favorable to us as those that would have been obtained with an unrelated person.
Our management agreements with RMR LLC were not negotiated on an arm'sarm’s length basis and their fee and expense structure may not create proper incentives for RMR, LLC, which may increase the risk of an investment in our common shares.
As a result of our relationships with RMR LLC and its current and former controlling shareholder(s), our management agreements with RMR LLC were not negotiated on an arm'sarm’s length basis between unrelated parties, and therefore, while such agreements were negotiated with the use of a special committee and disinterested Trustees, the terms, including the fees payable to RMR, LLC, may not be as favorable to us as they would have been if they weredifferent from those negotiated on an arm'sarm’s length basis between unrelated parties. Our property management fees are calculated based on rents we receive and we also pay RMR construction supervision fees for construction at our properties overseen and managed by RMR, LLC, and our base business management fee is calculated based upon the lower of the historical costs of our real estate investments and our market capitalization. We pay RMR LLC substantial base management fees regardless of our financial results. These fee arrangements could incentivize RMR LLC to pursue acquisitions, capital transactions, tenancies and construction projects or to avoid disposing of our assets in order to increase or maintain its management fees and might reduce RMR LLC'sRMR’s incentive to devote its time and effort to seeking investments that provide attractive returns for us. If we do not effectively manage our investment, disposition and capital transactions and leasing, construction and other property management activities, we may pay increased management fees without proportional benefits to us. In addition, we are obligated under our management agreements to reimburse RMR LLC
51

for employment and related expenses of RMR LLC'sRMR’s employees assigned to work exclusively or partly at our properties, our share of the wages, benefits and other related costs of RMR LLC'sRMR’s centralized accounting personnel, and our share of RMR LLC'sRMR’s costs for providing our internal audit function.function and as otherwise agreed. We are also required to pay for third party costs incurred with respect to us. Our obligation to reimburse RMR LLC for certain of its costs and to pay third party costs may reduce RMR LLC'sRMR’s incentive to efficiently manage those costs, which may increase our costs.
46

The termination of our management agreements with RMR LLC may require us to pay a substantial termination fee, including in the case of a termination for unsatisfactory performance, which may limit our ability to end our relationship with RMR LLC.RMR.
The terms of our management agreements with RMR LLC automatically extend on December 31 of each year so that such terms thereafter end on the 20th anniversary of the date of the extension. We have the right to terminate these agreements: (1) at any time on 60 days'days’ written notice for convenience, (2) immediately upon written notice for cause, as defined in the agreements, (3) on written notice given within 60 days after the end of any applicable calendar year for a performance reason, as defined in the agreements, and (4) by written notice during the 12 months following a manager change of control, as defined in the agreements. However, if we terminate a management agreement for convenience, or if RMR LLC terminates a management agreement with us for good reason, as defined in such agreement, we are obligated to pay RMR LLC a termination fee in an amount equal to the sum of the present values of the monthly future fees, as defined in the applicable agreement, payable to RMR LLC for the term that was remaining before such termination, which, depending on the time of termination, would be between 19 and 20 years. Additionally, if we terminate a management agreement for a performance reason, as defined in the agreement, we are obligated to pay RMR LLC the termination fee calculated as described above, but assuming a remaining term of 10 years. These provisions substantially increase the cost to us of terminating the management agreements without cause, which may limit our ability to end our relationship with RMR LLC as our manager. The payment of the termination fee could have a material adverse effect on our financial condition, including our ability to pay dividendsdistributions to our shareholders.
Our management arrangements with RMR LLC may discourage a change of control of us.
Our management agreements with RMR LLC have continuing 20 year terms that renew annually. As noted in the preceding risk factor, if we terminate either of these management agreements other than for cause or upon a change of control of our manager, we are obligated to pay RMR LLC a substantial termination fee. For these reasons, our management agreements with RMR LLC may discourage a change of control of us, including a change of control which might result in payment of a premium for our common shares.
Our business dealings with AlerisLife (including Five StarStar) comprise a significant part of our business and operations and they may create conflicts of interest or the perception of such conflicts of interest.
Five Star was originally organized as our subsidiary. We distributed substantiallyIn March 2023, in connection with ABP Trust’s acquisition of AlerisLife by tender offer, we tendered all of our Five Starthe AlerisLife common shares we then owned, subject to the right to purchase AlerisLife common shares at the Tender Offer Price. On February 16, 2024, we exercised this purchase right and acquired, together with our shareholders on December 31, 2001.applicable TRS, approximately 34.0% of the currently outstanding AlerisLife common shares from ABP Trust at the Tender Offer Price, for a total purchase price of $14.9 million. Following this acquisition, ABP Trust owns the remaining approximate 66.0% of AlerisLife. RMR LLC provides management services to both us and Five Star. Adam Portnoy, theAlerisLife. The Chair of our Board who is alsoof Trustees and one of our Managing Trustees, asAdam D. Portnoy, is the sole trustee, an officer and the controlling shareholder of ABP Trust, and Mr. Portnoy is a significant shareholderthe sole director of AlerisLife. Five Star, beneficially owning 6.3%an operating division of Five Star's outstanding common shares as of December 31, 2020. Five StarAlerisLife, manages mostmany of our senior living communities. In addition, Mr. Portnoy is the chair of Five Star's board of directors and one of its managing directors and our other Managing Trustee and Secretary, Jennifer B. Clark, is Five Star's other managing director and secretary.
The historical and continuing relationships which we, RMR, LLCABP Trust and Mr. Portnoy have with Five StarAlerisLife could create, or appear to create, conflicts of interest with respect to matters involving us, the other companies to which RMR LLC or its subsidiaries provide management services and their related parties. As a result of these relationships, our agreements with AlerisLife (including Five StarStar) were not negotiated on an arm'sarm’s length basis between unrelated parties, and therefore, while such agreements were negotiated with the use of a special committee and/or disinterested Trustees, their terms thereof may be different from those negotiated on an arm'sarm’s length basis between unrelated parties. Conflicts of interest or the perception of conflicts of interest could have a material adverse impact on our reputation, business and the market price of our common shares and other securities and we may be subject to increased risk of litigation as a result.
We may not realize the benefits we expect from our investment in Five Star common shares.
As of December 31, 2020, we owned 10,691,658 Five Star common shares, or approximately 33.7% of Five Star's outstanding common shares. Our investment in Five Star is subject to various risks, including, among others, the COVID-19 pandemic and its aftermath; the highly competitive nature of the senior living industry; medical advances and healthcare services that allow some potential residents to defer the time when they require the special services available at senior living
52

communities that Five Star manages; a competitive labor market within the senior living industry that are increasing our and Five Star's employment costs, including labor costs that Five Star incurs and which we are not obligated to fund or reimburse; significant regulatory requirements imposed on Five Star's business; and other factors. Many of these factors are beyond our and Five Star's control. As a result, we may not realize the benefits we expect from our investment in Five Star common shares, and we could incur losses from our investment.
We may be required to pay a substantial termination fee to Five Star if Five Star terminates our management agreements due to our default.
If Five Star terminates our management agreements due to certain defaults by us, we are required to pay Five Star a termination fee equal to the present value of the base management fees that we would have paid to Five Star and the allocated incentive fee for the applicable communities, if any, between the date of termination and the scheduled initial expiration date of such management agreements (but not for a period exceeding 10 years), with such amounts determined based on the average base management and incentive fees for the applicable communities for each of the three calendar years ended prior to the date of termination. Further, the payment of the termination fee could have a material adverse effect on our financial condition, including our ability to pay distributions to our shareholders.
47

We may not realize the benefits we expect from our ownership interest in AlerisLife.
We own an approximately 34.0% ownership interest in AlerisLife. Risks that we have identified elsewhere in this Risk Factors section, particularly those relating to the senior living industry, are applicable to our ownership of AlerisLife common shares. In addition, AlerisLife is a private company that is owned by ABP Trust, of which Adam D. Portnoy, one of our Managing Trustees, is the sole trustee, an officer and the controlling shareholder. We have a minority interest in AlerisLife, and we will be limited in our ability to direct or influence AlerisLife’s corporate level decisions or to affect changes in AlerisLife’s business, strategies, operations and management. In addition, AlerisLife’s common shares are no longer publicly traded, therefore our ability to sell our AlerisLife shares will be limited. Further, any attempt we may make to sell our AlerisLife common shares may be unsuccessful and any price that we may be able to realize for those shares may be at a discount due to the minority interest they represent and the lack of an active trading market for those shares. As a result of the foregoing, and for other possible reasons, we may not realize any of the benefits we currently expect from our ownership of AlerisLife common shares, we may be prevented from selling our AlerisLife common shares and we could incur losses from our ownership of AlerisLife common shares, including our proportion of any operating or other losses that AlerisLife may realize.
We are party to transactions with related parties that may increase the risk of allegations of conflicts of interest, and such allegations may impair our ability to realize the benefits we expect from these transactions.interest.
We are party to transactions with related parties, including with entities controlled by Adam D. Portnoy or to which RMR LLC or its subsidiaries provide management services. Our agreements with related parties or in respect of transactions among related parties may not be on terms as favorable to us as they would have been if they had been negotiated among unrelated parties. We are subject to the risk that ourOur shareholders or the shareholders of Five Star, RMR Inc. or other related parties may challenge any such related party transactions and the agreements entered into as part of them.transactions. If such a challengeany challenges to related party transactions were to be successful, we might not realize the benefits expected from the transactions being challenged. Moreover, any such challenge could result in substantial costs and a diversion of our management'smanagement’s attention, could have a material adverse effect on our reputation, business and growth and could adversely affect our ability to realize the benefits expected from the transactions, whether or not the allegations have merit or are substantiated.
We may be at an increased risk for dissident shareholder activities due to perceived conflicts of interest arising from our management structure and relationships.
Companies with business dealings with related persons and entities may more often be the target of dissident shareholder trustee nominations, dissident shareholder proposals and shareholder litigation alleging conflicts of interest in their business dealings. OurThe various relationships with RMR LLC, Five Star, the other companies to which RMR LLC or its subsidiaries provide management services, Adam Portnoy and other related persons of RMR LLCnoted above may precipitate such activities. Certain proxy advisory firms which have significant influence over the voting by shareholders of public companies have, in the past, recommended, and in the future may recommend, that shareholders withhold votes for the election of our incumbent Trustees, vote against our say on pay vote or other management proposals or vote for shareholder proposals that we oppose. These recommendations by proxy advisory firms have affected the outcomes of past Board of Trustees elections and votes on our say on pay, and similar recommendations in the future would likely affect the outcome of future Board of Trustees elections and votes on our say on pay or other shareholder votes, which may increase shareholder activism and litigation. These activities, if instituted against us, could result in substantial costs and diversion of our management'smanagement’s attention and could have a material adverse impact on our reputation and business.
Risks Related to Our Organization and Structure
We may change our operational, financing and investment policies without shareholder approval.approval and we may become more highly leveraged, which may increase our risk of default under our debt obligations.
Our Board of Trustees determines our operational, financing and investment policies and may amend or revise our policies, including our policies with respect to our intention to remain qualified for taxation as a REIT, acquisitions, dispositions, growth, operations, indebtedness, capitalization and distributions, or approve transactions that deviate from these policies, without a vote of, or notice to, our shareholders. Policy changes could adversely affect the market price of our common shares and our ability to make or sustainpay distributions to our shareholders. Further, our organizational documents do not limit the amount or percentage of indebtedness, funded or otherwise, that we may incur; however, provisions in our debt agreements may limit us from incurring additional debt. Our Board of Trustees may alter or eliminate our current policy on borrowing at any time without shareholder approval. If this policy changes, we could become more highly leveraged, which could result in an increase in our debt service costs. Higher leverage also increases the risk of default on our obligations. In addition, a change in our investment policies, including the manner in which we allocate our resources across our portfolio or the types of assets in which we seek to invest, may increase our exposure to interest rate risk, real estate market fluctuations and liquidity risk.
5348

Ownership limitations and certain provisions in our declaration of trust, bylaws and agreements, as well as certain provisions of Maryland law, may deter, delay or prevent a change in our control or unsolicited acquisition proposals.
Our declaration of trust prohibits any shareholder, other than RMR LLC and its affiliates (as defined under Maryland law) and certain persons who have been exempted by our Board of Trustees,contains provisions that generally prohibit shareholders from owning directly and by attribution, more than 9.8% of the5% (in value or in number or value of shares, (whicheverwhichever is more restrictive) of any class or series of our outstanding shares, of beneficial interest, including our common shares. This provision ofThe ownership limitation in our declaration of trust is intended to amonghelp us preserve our ability to use our net operating losses and other purposes, assist withtax benefits to reduce our REIT compliance under the IRC and otherwisefuture taxable income. We also believe these provisions promote ourgood orderly governance. However, this provisionthese provisions may also inhibit acquisitions of a significant stake in us and may deter, delay or prevent a change in control of us or unsolicited acquisition proposals that a shareholder may consider favorable. Additionally, provisions contained in our declaration of trust and bylaws or under Maryland law may have a similar impact, including, for example, provisions relating to:
the current division of our Trustees into classes until our 2023 annual meeting of shareholders, with three classes remaining with terms expiring in 2021, 2022 and 2023, respectively, (although effective at our 2021 annual meeting of shareholders, Trustees of the class of trustees whose term expires at that meeting or expires at a subsequent annual meeting of shareholders will be elected annually, with all of our Trustees being elected annually as of our 2023 annual meeting of shareholders, and with a majority of our current Trustees having terms expiring at our 2022 annual meeting of shareholders);
limitations on shareholder voting rights with respect to certain actions that are not approved by our Board of Trustees;
the authority of our Board of Trustees, and not our shareholders, to adopt, amend or repeal our bylaws and to fill vacancies on our Board of Trustees;
shareholder voting standards which require a supermajority of shares for approval of certain actions;
the fact that only our Board of Trustees, or, if there are no Trustees, our officers, may call shareholder meetings and that shareholders are not entitled to act without a meeting;
required qualifications for an individual to serve as a Trustee and a requirement that certain of our Trustees be “Managing Trustees” and other Trustees be “Independent Trustees,” as defined in our governing documents;
limitations on the ability of our shareholders to propose nominees for election as Trustees and propose other business to be considered at a meeting of our shareholders;
limitations on the ability of our shareholders to remove our Trustees;
the authority of our Board of Trustees to create and issue new classes or series of shares (including shares with voting rights and other rights and privileges that may deter a change in control) and issue additional common shares;
restrictions on business combinations between us and an interested shareholder that have not first been approved by our Board of Trustees (including a majority of Trustees not related to the interested shareholder); and
the authority of our Board of Trustees, without shareholder approval, to implement certain takeover defenses.
As changes occur in the marketplace for corporate governance policies, the above provisions may change, be removed, or new ones may be added.
Our rights and the rights of our shareholders to take action against our Trustees and officers are limited.
Our declaration of trust limits the liability of our Trustees and officers to us and our shareholders for money damages to the maximum extent permitted under Maryland law. Under current Maryland law, our Trustees and officers will not have any liability to us and our shareholders for money damages other than liability resulting from:
actual receipt of an improper benefit or profit in money, property or services; or
active and deliberate dishonesty by the Trustee or officer that was established by a final judgment as being material to the cause of action adjudicated.
54

Our declaration of trust and indemnification agreements require us to indemnify, to the maximum extent permitted by Maryland law, any present or former Trustee or officer who is made or threatened to be made a party to a proceeding by reason of his or her service in these and certain other capacities. In addition, we may be obligated to pay or reimburse the expenses incurred by our present and former Trustees and officers without requiring a preliminary determination of their ultimate entitlement to indemnification.
49

As a result of these limitations on liability and indemnification obligations, we and our shareholders may have more limited rights against our present and former Trustees and officers than might otherwise exist absent the provisions in our declaration of trust and indemnification agreements or that might exist with other companies, which could limit our shareholders'shareholder recourse in the event of actions which some shareholders may believe are not in theirour best interest.
Shareholder litigation against us or our Trustees, officers, employees, managers or other agents may be referred to mandatory arbitration proceedings, which follow different procedures than in-court litigation and may be more restrictive to shareholders asserting claims than in-court litigation.
Our shareholders agree, by virtue of becoming shareholders, that they are bound by our governing documents, including the arbitration provisions of our bylaws, as they may be amended from time to time. Our bylaws provide that certain actions by one or more of our shareholders against us or any of our Trustees, officers, employees, managers or other agents, other than disputes, or any portion thereof, regarding the meaning, interpretation or validity of any provision of our declaration of trust or bylaws, will be referred to mandatory, binding and final arbitration proceedings if we, or any other party to such dispute, including any of our Trustees, officers, employees, managers or other agents, unilaterally so demands. As a result, we and our shareholders would not be able to pursue litigation in state or federal court against us or our Trustees, officers, employees, managers or other agents, including, for example, claims alleging violations of federal securities laws or breach of fiduciary duties or similar director or officer duties under Maryland law, if we or any of our Trustees, officers, employees, managers or other partiesagents against whom the claim is made unilaterally demands the matter be resolved by arbitration. Instead, our shareholders would be required to pursue such claims through binding and final arbitration.
Our bylaws provide that such arbitration proceedings would be conducted in accordance with the procedures of the Commercial Arbitration Rules of the American Arbitration Association, as modified in our bylaws. These procedures may provide materially more limited rights to our shareholders than litigation in a federal or state court. For example, arbitration in accordance with these procedures does not include the opportunity for a jury trial, document discovery is limited, arbitration hearings generally are not open to the public, there are no witness depositions in advance of arbitration hearings and arbitrators may have different qualifications or experiences than judges. In addition, although our bylaws'bylaws’ arbitration provisions contemplate that arbitration may be brought in a representative capacity or on behalf of a class of our shareholders, the rules governing such representation or class arbitration may be different from, and less favorable to shareholders than, the rules governing representative or class action litigation in courts. Our bylaws also generally provide that each party to such an arbitration is required to bear its own costs in the arbitration, including attorneys'attorneys’ fees, and that the arbitrators may not render an award that includes shifting of such costs or, in a derivative or class proceeding, award any portion of our award to any shareholder or such shareholder'sshareholder’s attorneys. The arbitration provisions of our bylaws may discourage our shareholders from bringing, and attorneys from agreeing to represent our shareholders wishing to bring, litigation against us or our Trustees, officers, employees, managers or other agents. Our agreements with AlerisLife (including Five StarStar) and RMR LLC have similar arbitration provisions to those in our bylaws.
We believe that the arbitration provisions in our bylaws are enforceable under both state and federal law, including with respect to federal securities laws claims. We are a Maryland real estate investment trust and Maryland courts have upheld the enforceability of arbitration bylaws.bylaws. In addition, the U.S. Supreme Court has repeatedly upheld agreements to arbitrate other federal statutory claims, including those that implicate important federal policies. However, some academics, legal practitioners and others are of the view that charter or bylaw provisions mandating arbitration are not enforceable with respect to federal securities laws claims. It is possible that the arbitration provisions of our bylaws may ultimately be determined to be unenforceable.
By agreeing to the arbitration provisions of our bylaws, shareholders will not be deemed to have waived compliance by us with federal securities laws and the rules and regulations thereunder.
Our bylaws designate the Circuit Court for Baltimore City, Maryland as the sole and exclusive forum for certain actions and proceedings that may be initiated by our shareholders, which could limit our shareholders'shareholders’ ability to obtain a favorable judicial forum they deem favorable for disputes with us or our Trustees, officers, employees, managers or other agents.
Our bylaws currently provide that, unless the dispute has been referred to binding arbitration, the Circuit Court for Baltimore City, Maryland will be the sole and exclusive forum for: (1) any derivative action or proceeding brought on our behalf; (2) any action asserting a claim for breach of a fiduciary duty owed by any Trustee, officer, manager, agentof our Trustees, officers, managers or employee
55

of oursother agents to us or our shareholders; (3) any action asserting a claim against us or any Trustee, officer, manager, agentof our Trustees, officers, managers or employee of oursother agents arising pursuant to Maryland law, our declaration of trust or bylaws brought by or on behalf of a shareholder, either on his, her or itssuch shareholder’s own behalf, on our behalf or on behalf of any series or class of shares of beneficial interest of ours or by our shareholders against us or any Trustee, officer, manager, agentof our Trustees, officers, managers or employee of ours,other agents, including any disputes, claims or controversies relating to the meaning, interpretation, effect, validity, performance or enforcement of our declaration of trust or
50

bylaws; or (4) any action asserting a claim against us or any Trustee, officer, manager, agentof our Trustees, officers, managers or employee of oursother agents that is governed by the internal affairs doctrine.doctrine of the State of Maryland. Our bylaws currently also provide that the Circuit Court for Baltimore City, Maryland will be the sole and exclusive forum for any dispute, or portion thereof, regarding the meaning, interpretation or validity of any provision of our declaration of trust or bylaws. The exclusive forum provision of our bylaws does not apply to any action for which the Circuit Court for Baltimore City, Maryland does not have jurisdiction or to a dispute that has been referred to binding arbitration in accordance with our bylaws. The exclusive forum provision of our bylaws does not establish exclusive jurisdiction in the Circuit Court for Baltimore City, Maryland for claims that arise under the Securities Act, the Exchange Act or other federal securities laws if there is exclusive or concurrent jurisdiction in the federal courts. Any person or entity purchasing or otherwise acquiring or holding any interest in our shares of beneficial interest shall be deemed to have notice of and to have consented to these provisions of our bylaws, as they may be amended from time to time. The arbitration and exclusive forum provisions of our bylaws may limit a shareholder'sshareholder’s ability to bring a claim in a judicial forum that the shareholder believes is favorable for disputes with us or our Trustees, officers, employees, managers or other agents, which may discourage lawsuits against us and our Trustees, officers, employees, managers or other agents.
Disputes with RMR may be referred to mandatory arbitration proceedings, which follow different procedures than in-court litigation and may be more restrictive to those asserting claims than in-court litigation.
Our agreements with RMR provide that any dispute arising thereunder will be referred to mandatory, binding and final arbitration proceedings if we, or any other party to such dispute, unilaterally so demands. As a result, we and our shareholders would not be able to pursue litigation in state or federal court against RMR if we or any other parties against whom the claim is made unilaterally demands the matter be resolved by arbitration. In addition, the ability to collect attorneys’ fees or other damages may be limited in the arbitration proceedings, which may discourage attorneys from agreeing to represent parties wishing to bring such litigation.
Risks Related to Our Taxation
Our failure to remain qualified for taxation as a REIT under the IRC could have significant adverse consequences.
As a REIT, we generally do not pay federal or most state income taxes as long as we distribute all of our REIT taxable income and meet other qualifications set forth in the IRC. However, actual qualification for taxation as a REIT under the IRC depends on our satisfying complex statutory requirements, for which there are only limited judicial and administrative interpretations. We believe that we have been organized and have operated, and will continue to be organized and to operate, in a manner that qualified and will continue to qualify us to be taxed as a REIT under the IRC. However, we cannot be sure that the IRS, upon review or audit, will agree with this conclusion. Furthermore, we cannot be sure that the federal government, or any state or other taxation authority, will continue to afford favorable income tax treatment to REITs and their shareholders.
Maintaining our qualification for taxation as a REIT under the IRC will require us to continue to satisfy tests concerning, among other things, the nature of our assets, the sources of our income and the amounts we distribute to our shareholders. In order to meet these requirements, it may be necessary for us to sell or forgo attractive investments.
If we cease to qualify for taxation as a REIT under the IRC, then our ability to raise capital might be adversely affected, we will be in breach under our revolving credit facility and term loan agreements, we may be subject to material amounts of federal and state income taxes, our cash available for distribution to our shareholders could be reduced, and the market price of our common shares could decline. In addition, if we lose or revoke our qualification for taxation as a REIT under the IRC for a taxable year, we will generally be prevented from requalifying for taxation as a REIT for the next four taxable years.
Distributions to shareholders generally will not qualify for reduced tax rates applicable to “qualified dividends.”
Dividends payable by U.S. corporations to noncorporate shareholders, such as individuals, trusts and estates, are generally eligible for reduced federal income tax rates applicable to “qualified dividends.” Distributions paid by REITs generally are not treated as “qualified dividends” under the IRC and the reduced rates applicable to such dividends do not generally apply. However, for tax years beginning before 2026, REIT dividends paid to noncorporate shareholders are generally taxed at an effective tax rate lower than applicable ordinary income tax rates due to the availability of a deduction under the IRC for specified forms of income from passthrough entities. More favorable rates will nevertheless continue to apply to regular corporate “qualified” dividends, which may cause some investors to perceive that an investment in a REIT is less attractive than an investment in a non-REIT entity that pays dividends, thereby reducing the demand and market price of our common shares.
51

REIT distribution requirements could adversely affect us and our shareholders.
We generally must distribute annually at least 90% of our REIT taxable income, subject to specified adjustments and excluding any net capital gain, in order to maintain our qualification for taxation as a REIT under the IRC. To the extent that we satisfy this distribution requirement, federal corporate income tax will not apply to the earnings that we distribute, but if we
56

distribute less than 100% of our REIT taxable income, then we will be subject to federal corporate income tax on our undistributed taxable income. We intend to makepay distributions to our shareholders to comply with the REIT requirements of the IRC. In addition, we will be subject to a 4% nondeductible excise tax if the actual amount that we pay out to our shareholders in a calendar year is less than a minimum amount specified under federal tax laws.
From time to time, we may generate taxable income greater than our income for financial reporting purposes prepared in accordance with U.S. generally accepted accounting principles, or GAAP, or differences in timing between the recognition of taxable income and the actual receipt of cash may occur. If we do not have other funds available in these situations, among other things, we may borrow funds on unfavorable terms, sell investments at disadvantageous prices or distribute amounts that would otherwise be invested in future acquisitions in order to makepay distributions sufficient to enable us to pay outdistribute enough of our taxable income to satisfy the REIT distribution requirement and to avoid corporate income tax and the 4% excise tax in a particular year. These alternatives could increase our costs or reduce our shareholders'shareholders’ equity. Thus, compliance with the REIT distribution requirements may hinder our ability to grow, which could cause the market price of our common shares to decline.
Even if we remain qualified for taxation as a REIT under the IRC, we may face other tax liabilities that reduce our cash flow.
Even if we remain qualified for taxation as a REIT under the IRC, we may be subject to federal, state and local taxes on our income and assets, including taxes on any undistributed income, excise taxes, state or local income, property and transfer taxes, and other taxes. Also, some jurisdictions may in the future limit or eliminate favorable income tax deductions, including the dividends paid deduction, which could increase our income tax expense. In addition, in order to meet the requirements for qualification and taxation as a REIT under the IRC, prevent the recognition of particular types of non-cash income, or avert the imposition of a 100% tax that applies to specified gains derived by a REIT from dealer property or inventory, we may hold or dispose of some of our assets and conduct some of our operations through our TRSs or other subsidiary corporations that will be subject to corporate level income tax at regular rates. In addition, while we intend that our transactions with our TRSs will be conducted on arm'sarm’s length bases, we may be subject to a 100% excise tax on a transaction that the IRS or a court determines was not conducted at arm'sarm’s length. Any of these taxes would decrease cash available for distribution to our shareholders.
If arrangements involving our TRSs fail to comply as intended with the REIT qualification and taxation rules, we may fail to qualify for taxation as a REIT under the IRC or be subject to significant penalty taxes.
We lease mostsubstantially all of our propertiessenior living communities to our TRSs pursuant to arrangements that, under the IRC, are intended to qualify the rents we receive from our TRSs as income that satisfies the REIT gross income tests. We also intend that our transactions with our TRSs be conducted on arm'sarm’s length bases so that we and our TRSs will not be subject to penalty taxes under the IRC applicable to mispriced transactions. While relief provisions can sometimes excuse REIT gross income test failures, significant penalty taxes may still be imposed.
For thoseour TRS arrangements intended to comply as intended with the REIT qualification and taxation rules under the IRC, a number of requirements must be satisfied, including:
our TRSs may not directly or indirectly operate or manage a healthcare facility, as defined by the IRC;
the leases to our TRSs must be respected as true leases for federal income tax purposes and not as service contracts, partnerships, joint ventures, financings or other types of arrangements;
the leased properties must constitute qualified healthcare properties (including necessary or incidental property) under the IRC;
our leased properties must be managed and operated on behalf of the TRSs by independent contractors who are less than 35% affiliated with us and who are actively engaged (or have affiliates so engaged) in the trade or business of managing and operating qualified healthcare properties for any person unrelated to us; and
52

the rental and other terms of the leases must be arm'sarm’s length.
We cannot be sure that the IRS or a court will agree with our assessment that our TRS arrangements comply as intended with REIT qualification and taxation rules. If arrangements involving our TRSs fail to comply as we intended, we may fail to qualify for taxation as a REIT under the IRC or be subject to significant penalty taxes.
57

Legislative or other actions affecting REITs could materially and adversely affect us and our shareholders.
The rules dealing with U.S. federal, state, and local taxation are constantly under review by persons involved in the legislative process and by the IRS, the U.S. Department of the Treasury and other taxation authorities. Changes to the tax laws, with or without retroactive application, could materially and adversely affect us and our shareholders. We cannot predict how changes in the tax laws might affect us or our shareholders. New legislation, Treasury regulations, administrative interpretations or court decisions could significantly and negatively affect our ability to remain qualified for taxation as a REIT or the tax consequences of such qualification to us and our shareholders.
Risks Related to Our Securities
We reduced ourOur quarterly cash distribution rate on our common shares tois currently $0.01 per common share and future distributions may remain at this level for an indefinite period or be eliminated and the form of payment could change.
Beginning in the second quarter ofDuring 2020, we reduced our quarterly cash distribution rate on our common shares to $0.01 per share. We currently intendcommon share to continue to make quarterly distributions toenhance our shareholders at this rate at least through the Amendment Period, and possibly thereafter,liquidity until our leverage profile otherwise improves, subject to applicable REIT tax requirements. However:requirements; however:
our ability to makepay distributions to our shareholders or sustain the rate of distributions may continue to be adversely affected byif any of the risks described in this Annual Report on Form 10-K occur, including any negative impact caused by the COVID-19 pandemiccurrent market and its aftermatheconomic conditions, such as high interest rates, prolonged high inflation and economic downturns or a possible recession, on our business, results of operations and liquidity;
our making of distributions is subject to restrictions contained in our credit agreement, including being limited to amounts required to maintain our qualification for taxation as a REIT and $0.01 per common share per quarter during the Amendment Period, and may be subject to restrictions in future debt obligations we may incur; during the continuance of any event of default under our credit agreement, we may be limited or in some cases prohibited from making distributions to our shareholders; and
the timing and amount of any distributions will be determined at the discretion of our Board of Trustees and will depend on various factors that our Board of Trustees deems relevant, including, but not limited to, our funds from operations, attributable to common shareholders, or FFO, attributable to common shareholders, our normalized funds from operations, attributable to common shareholders, or Normalized FFO, attributable to common shareholders, requirements to maintain our qualification for taxation as a REIT, limitations in the agreements governing our debt agreements, the availability to us of debt and equity capital, our expectation of our future capital requirements and operating performance and our expected needs for and availability of cash to pay our obligations.
For these reasons, among others, our distribution rate may not increase for an indefinite period or we may cease makingpaying distributions to our shareholders.
Further, in order to preserve liquidity, we may elect to, in part, pay distributions to our shareholders in part in a form other than cash, such as issuing additional common shares of ours to our shareholders, as permitted by the applicable tax rules.
We may use future debt leverage to pay distributions to our shareholders.
If our earnings are at any time insufficient to fund distributions to our shareholders at the level which may in the future be established by our Board of Trustees, we may pay distributions to our shareholders with the proceeds of borrowings or other leverage or from sales of our assets. The use of borrowings or sale proceeds for distributions may dilute our shareholders' ownership interests in us. In addition, funding distributions to our shareholders from our future borrowings or asset sales may constitute a return of capital to our investors, which would have the effect of reducing our shareholders' bases in our common shares.
The Notes and the Guarantees are structurally subordinated to the payment of all indebtedness and other liabilities and any preferred equity of our subsidiaries that do not guarantee the 2025 Notes, the 2026 Notes and the 2031 Notes.
We are the sole obligor on our outstanding senior unsecuredsecured notes and any notesdue 2026, or other debt securities we may issue in the future, or, together with2026 Notes, our outstanding senior unsecured notes, the Notes. Our subsidiaries that guaranteeincluding our 9.75% senior notes due 2025, or the 2025 Notes, and our 4.375% senior notes due 2031, or the 2031 Notes, and any notes or other debt securities we may issue in the future, or, together with the 2026 Notes and our outstanding senior unsecured notes, the Notes. Our subsidiaries that guarantee the Notes are the sole obligor on the guarantees of such notes, or the Guarantees. The subsidiaries that guarantee ourthe 2025 Notes, the 2026 Notes and the 2031 Notes do not currently guarantee any of our other Notes. Our non-guarantor subsidiaries are separate and distinct legal entities and have no obligation, contingent or otherwise, to pay any amounts due on the Notes or the Guarantees, or to make any funds available therefor,
58

whether by dividend, distribution, loan or other payments. The rights of holders of the Notes to benefit from any of the assets of our non-guarantor subsidiaries are subject to the prior satisfaction of claims of those subsidiaries' creditors and any preferred equity holders.subsidiaries’ creditors. As a result, the Notes and the Guarantees are, and, except to the extent that future Notes are guaranteed by our non-guarantor subsidiaries, will be, structurally subordinated to all indebtedness and other liabilities of our subsidiaries that do not guarantee the 2025 Notes, the 2026 Notes and the 2031 Notes, including guarantees of or pledges under other indebtedness of ours, payment obligations under lease agreements, trade payables and preferred equity. As of December 31, 2020,2023, our non-guarantor subsidiaries had total indebtedness and other liabilities of approximately $765.9$31.5 million (including guarantees of other indebtedness and trade payables
53

but excluding liabilities to us or a subsidiary guarantor), which are structurally senior to the 2025 Notes, the 2026 Notes and the 2031 Notes.
The Notes and the Guarantees, other than the 2026 Notes and related Guarantees on a senior secured basis, are unsecured and effectively subordinated to all of our and the subsidiary guarantors'guarantors’ existing and future secured indebtednessdebt to the extent of the value of the assets securing such indebtedness.debt.
The outstanding Notes and Guarantees, other than the 2026 Notes and related Guarantees on a senior secured basis, or the Unsecured Notes and Guarantees, are not secured and any Notes we may issue in the future may not be secured. Upon any distribution to our creditors in a bankruptcy, liquidation, reorganization or similar proceeding relating to us or our property, the holders of our secured debt, including debt under our credit agreementthe 2026 Notes (to the extent such debt remains outstanding and is still then secured), will be entitled to exercise the remedies available to a secured lender under applicable law and pursuant to the instruments governing such debt and to be paid in full, from the assets securing that secured debt before any payment may be made with respect to the Notes that are not secured by those assets. In that event, because suchthe Unsecured Notes and the Guarantees will not be secured by any of our assets, it is possible that there will be no assets from which claims of holders of such unsecured Notes can be satisfied or, if any assets remain, that the remaining assets will be insufficient to satisfy those claims in full. If the value of such remaining assets is less than the aggregate outstanding principal amount of such unsecured Notes and accrued interest and all future debt ranking equally with such Unsecured Notes and the Guarantees, we will be unable to fully satisfy our obligations under such unsecured Notes. In addition, if we fail to meet our payment or other obligations under our secured debt, the holders of that secured debt would be entitled to foreclose on our assets securing that secured debt and liquidate those assets. Accordingly, we may not have sufficient funds to pay amounts due on such unsecured Notes. As a result, noteholders may lose a portion or the entire value of their investment in such unsecured Notes. Further, the terms of the outstanding Unsecured Notes and the Guarantees permit, and the terms of any Notes we may issue in the future may permit, us to incur additional secured indebtednessdebt subject to compliance with certain debt ratios. The Unsecured Notes and the Guarantees will be effectively subordinated to any such additional secured indebtedness.debt.
Federal and state statutes allow courts, under specific circumstances, to void guarantees and require holders of notes to return payments received from guarantors.
Under the federal bankruptcy law and comparable provisions of state fraudulent transfer laws, a guarantee of the 2025 NotesGuarantees and the related liens, if applicable (or any future Notes that are guaranteed by our subsidiaries), could be voided, or claims in respect of a guarantee and the related lien, if applicable, could be subordinated to all other debts of that guarantor if, among other things, the guarantor, at the time it incurred the debt evidenced by its guarantee:guarantee and related lien, if applicable:
received less than reasonably equivalent value or fair consideration for the incurrence of such guarantee; andguarantee or granting of such lien, if applicable;
was insolvent or rendered insolvent by reason of such incurrence;
was engaged in a business or transaction for which the guarantor'sguarantor’s remaining assets constituted unreasonably small capital; or
intended to incur, or believed that it would incur, debts beyond its ability to pay such debts as they mature.
In addition, any payment by that guarantor pursuant to its guarantee could be voided and required to be returned to the guarantor, or to a fund for the benefit of our creditors or the creditors of the guarantor.
The measures of insolvency for purposes of these fraudulent transfer laws will vary depending upon the law applied in any proceeding to determine whether a fraudulent transfer has occurred. Generally, however, a guarantor would be considered insolvent if:
the sum of its debts, including contingent liabilities, was greater than the fair saleable value of all of its assets;
the present fair saleable value of its assets was less than the amount that would be required to pay its probable liability on its existing debts, including contingent liabilities, as they become absolute and mature; or
59

it could not pay its debts as they become due.
54

We cannot be sure as to what standard a court would apply in making these determinations. In addition, each Guarantee contains, and any future guarantees may contain, a provision intended to limit the guarantor'sguarantor’s liability to the maximum amount that it could incur without causing the incurrence of obligations under its guarantee to be a fraudulent transfer. This provision may not be effective to protect the Guarantees or any future guarantees from being voided under fraudulent transfer laws, or may eliminate the guarantor'sguarantor’s obligations or reduce the guarantor'sguarantor’s obligations to an amount that effectively makes the guarantee worthless.
There may be no public market for certain of the Notes, and one may not develop, be maintained or be liquid.
We have not applied for listing of certain of the Notes on any securities exchange or for quotation on any automatic dealer quotation system, and we may not do so for Notes issued in the future. We can give no assurances concerningcannot be sure of the liquidity of any market that may develop for such Notes, the ability of any holder to sell such Notes or the price at which holders would be able to sell such Notes. If a market for such Notes does not develop, holders may be unable to resell such Notes for an extended period of time, if at all. If a market for such Notes does develop, it may not continue or it may not be sufficiently liquid to allow holders to resell such Notes. Consequently, holders of the Notes may not be able to liquidate their investment readily, and lenders may not readily accept such Notes as collateral for loans.
The Notes may trade at a discount from their initial issue price or principal amount, depending upon many factors, including prevailing interest rates, the ratings assigned by rating agencies, the market for similar securities and other factors, including general economic conditions and our financial condition, performance and prospects. Any decline in market prices, regardless of cause, may adversely affect the liquidity and trading markets for the Notes.
A further downgrade in credit ratings could materially adversely affect the market price of the Notes and may increase our cost of capital.
The outstanding Notes are rated by two rating agencies and any Notes we may issue in the future may be rated by one or more rating agencies. These credit ratings are continually reviewed by rating agencies and may change at any time based upon, among other things, our results of operations and financial condition. In February 2021, Moody's Investors Service,January 2023, Moody’s Investor Services, or Moody's, downgraded the 2025 Notes and 2031 Notes ratings from B3 to Caa3 and our senior unsecured debt rating from Ba2Caa1 to B1 and our 9.75% senior notes due 2025 rating from Ba1 to Ba3 and assigned a Ba3 rating to our 4.375% senior notes due 2031 andCa. In February 2023, Standard & Poor's RatingsPoor’s Rating Services, or Standard & Poor's, downgraded the 2025 Notes and 2031 Notes ratings from BB- to B and our senior unsecured debt rating from BBB to BB-CCC+. In September 2023, Moody’s downgraded the 2025 Notes and 2031 Notes ratings from Caa3 to Ca and our 9.75% senior notes due 2025unsecured debt rating from BB+Ca to BBC. In September 2023, Standard & Poor’s downgraded the 2025 Notes and 2031 Notes ratings from B to CCC+ and our senior unsecured debt rating from CCC+ to CCC-. In January 2024, Standard & Poor’s upgraded the 2025 Notes and 2031 Notes ratings from CCC+ to B and our senior unsecured debt rating from CCC- to CCC+ and assigned a BBB rating for the 2026 Notes. Also in January 2024, Moody’s upgraded the 2025 Notes and 2031 Notes ratings from Ca to Caa3 and our 4.375% senior notes due 2031, respectively.unsecured debt rating from C to Ca and assigned a Caa2 rating for the 2026 Notes. Negative changes in the ratings assigned to our debt securities could have an adverse effect on the market price of the Notes and our cost and availability of capital, which could in turn have a material adverse effect on our results of operations and our ability to satisfy our debt service obligations.
We may not have the ability to raise the funds necessary to finance the repurchase of the 2025 Notes, the 2026 Notes and the 2031 Notes upon a change of control event as will be required by the indenture for the notes.required.
Upon the occurrence of a change of control, we will be required to offer to repurchase the outstanding 2025 Notes and 2031 Notes at 101% of the principal amount thereof, and the outstanding 2026 Notes at 100% of the principal amount thereof, in each case plus accrued and unpaid interest on such Notes, if any, to, but not including, the date of repurchase. However, it is possible that we will not have sufficient funds, or the ability to raise sufficient funds, at the time of the change of control to make the required repurchase of such Notes. In addition, the occurrence of certain events that constitute a change of control would constitute an event of default under our credit agreement, and restrictions under future debt we may incur may not allow us to repurchase such Notes upon a change of control, which could result in such debt becoming immediately due and payable and the commitments thereunder terminated. If we could not refinance such debt or otherwise obtain a waiver from the holders of such debt, we would be prohibited from repurchasing the 2025 Notes, the 2026 Notes and the 2031 Notes, which would constitute an event of default under the indentureindentures and related supplements governing such Notes, which in turn would constitute a default under such debt arrangements. In addition, certain important corporate events, such as leveraged recapitalizations that would increase the level of our indebtedness, would not constitute a “Change of Control” under the indentureindentures and related supplements governing the 2025 Notes, the 2026 Notes and the 2031 Notes although these types of transactions could affect our capital structure or credit ratings and the holders of such Notes. Further, courts interpreting change of control provisions under New York law (which is the governing law of the indentureindentures governing the 2025 Notes, the 2026 Notes and the 2031 Notes) have not provided clear and consistent meanings of such change of control provisions which leads to subjective judicial interpretation of what may constitute a “Change of Control.”
6055

Some or all of the Guarantees may be released automatically.
A subsidiary guarantor may be released from its Guarantee under certain circumstances. Such release may occur at any time upon a sale, disposition or transfer, in compliance with the provisions of the indentureindentures and related supplements governing 2025 Notes, the 20252026 Notes and the 2031 Notes, of the capital stock of such subsidiary guarantor or of substantially all of the assets of such subsidiary guarantor, or if such subsidiary guarantor becomes an Excluded Subsidiary or a Foreign Subsidiary, as such terms are defined in the applicable indenture or supplemental indenture. In addition, if the notes2025 Notes and the 2031 Notes have a Mid-BBB Investment Grade Rating, as such term is defined inrating equal to or higher than Baa2 (or the applicable supplemental indenture,equivalent) by both Moody's andMoody’s or BBB (or the equivalent) by Standard & Poor'sPoor’s and at such time no default or event of default under the indenture and related supplements governing the 2025 Notes and the 2031 notesNotes has occurred and is continuing, the Guarantees and all other obligations of the subsidiary guarantors under the indenture will automatically terminate and be released. Accordingly, the 2025 Notes, the 2026 Notes and the 2031 Notes may not at all times be guaranteed by some or all of the subsidiaries which guaranteed the 2025 Notes, orthe 2026 Notes and the 2031 Notes on the date they were initially issued.
Redemption may adversely affect noteholders' return on the Notes.
We have the right to redeem some or all of the outstanding Notes prior to maturity and may have such a right with respect to any Notes we issue in the future. We may redeem such Notes at times when prevailing interest rates may be relatively low compared to the interest rate of such Notes. Accordingly, noteholders may not be able to reinvest the redemption proceeds in a comparable security at an effective interest rate as high as that of the Notes.
Further issuances of debt or equity securities may adversely affect our shareholders.
As a REIT, we generally will not be able to retain sufficient cash to fund our operations, repay our debts, invest in our properties and fund acquisitions and development and redevelopment efforts, and therefore, our ability to execute our business strategy depends on our access to an appropriate blend of debt financing, which may include secured and unsecured debt, and equity financing, which may include common and preferred shares.
The interests of our existing shareholders could be diluted if we issue additional equity securities. In addition, if we decide in the future to issue debt or equity securities that rank senior to our common shares, it is likely that they will be governed by an indenture or other instrument containing covenants restricting our operating flexibility. Also, any convertible or exchangeable securities that we issue in the future may have rights, preferences and privileges more favorable than those of our common shares and may result in further dilution to our shareholders. Because our decision to issue debt or equity securities in any future offering will depend on market conditions and other factors beyond our control, we cannot predict or even estimate the amount, timing or nature of our future capital offerings. Thus, our shareholders will bear the risk of our future offerings reducing the market price of our common shares and diluting the value of their common shares.
Changes in interest rates could adversely affect the value of our securities.
We believe that one of the factors that investors consider important in deciding whether to buy or sell equity securities of a REIT is the distribution rate, considered as a percentage of the price of the equity securities, relative to market interest rates. Interest rates have been at historically low levels for an extended period of time. There is a general market perception that REIT shares outperform in low interest rate environments and underperform in rising interest rate environments when compared to the broader market. The U.S. Federal Reserve has indicated that it does not expect to raise interest rates in response to the COVID-19 pandemic and current market conditions until at least the end of 2023. There can be no assurance, however, that the U.S. Federal Reserve will not raise rates prior to that time. If the U.S. Federal Reserve increases interest rates or if there is a market expectation of such increases, prospective purchasers of REIT equity securities may want to achieve a higher distribution rate. Thus, higher market interest rates, or the expectation of higher interest rates, could cause the value of our securities to decline.
Item 1B.  Unresolved Staff Comments.
None.
Item 1C.  Cybersecurity.
We rely on the information technology and systems maintained by our managers, including RMR, and rely on our managers to identify and manage material risks from cybersecurity threats. RMR and our senior living community managers take various actions, and incur significant costs, to maintain and protect the operation and security of information technology and systems, including the data maintained in those systems. Our Audit Committee oversees cybersecurity matters, including the material risks related thereto, and regularly receives updates from RMR’s chief information officer regarding the development and advancement of its cybersecurity strategy, as well as the related risks. In the event of a cybersecurity incident, RMR has a detailed incident response plan in place for contacting authorities and informing key stakeholders, including our management. We have not been materially affected and do not believe we are reasonably likely to be materially affected by any risks from cybersecurity threats, including as a result of previous incidents.
Item 2.  Properties.
At December 31, 2020, we had real estate investments in 3972023, our portfolio was comprised of 371 owned properties. The gross book value of real estate assets at cost plus certain acquisition costs, before depreciation and purchase price allocations and less impairment write downs, of these investments totaled $8.2 billion at December 31, 2020. As of December 31, 2020, nine properties withor gross book value of real estate assets, of these properties totaled $7.2 billion at cost plus certain acquisition costs, before depreciation and purchase price allocations and less impairment write
61

downs, of $982.3 million andDecember 31, 2023, two properties with a netgross book value of $822.2real estate assets of $43.4 million were subject to secured financing and finance lease obligations with an aggregate principal balance of $692.3$3.9 million. As of December 31, 2023, one property with a gross book value of real estate assets of $25.0 million was encumbered by a mortgage with a principal balance of which $620.0 million is related to$9.1 million. As of December 31, 2023, 95 properties with a gross book value of real estate assets of $1.6 billion were encumbered by our senior secured notes with a principal balance of $940.5 million. The eleven properties owned by our unconsolidated joint venture arrangementventures in which we own a 55% equity interest. The principal amounts for these debts have not been adjusted10% and 20% interests were encumbered by three mortgages totaling $1.1 billion as of December 31, 2023. For more information regarding our finance leases, mortgages, senior secured notes and two unconsolidated joint ventures, see Notes 3 and 9 to reflect the equity interestsour Consolidated Financial Statements included in the joint venture that we do not own.Part IV, Item 15 of this Annual Report on Form 10-K.
6256

The following table summarizes certain information about our owned properties as of December 31, 2020.2023. All dollar amounts are in thousands:
Office PortfolioSenior Housing Operating PortfolioAll OtherConsolidated
Office PortfolioOffice PortfolioSenior Housing Operating PortfolioAll OtherConsolidated
StateStateNumber 
of
Properties
Gross Book Value of Real Estate Assets(1)
Net Book
Value
Number of
Properties
Gross Book Value of Real Estate Assets(1)
Net Book
Value
Number of
Properties
Gross Book Value of Real Estate Assets(1)
Net Book
Value
Number of
Properties
Gross Book Value of Real Estate Assets(1)
Net Book
Value
StateNumber 
of
Properties
Gross Book Value of Real Estate Assets(1)
Net Book
Value
Number of
Properties
Gross Book Value of Real Estate Assets(1)
Net Book
Value
Number of
Properties
Gross Book Value of Real Estate Assets(1)
Net Book
Value
Number of
Properties
Gross Book Value of Real Estate Assets(1)
Net Book
Value
ALAL$— $— 8$95,147 $71,273 $— $— 8$95,147 $71,273 
ARAR— — 342,632 27,327 — — 342,632 27,327 
AZAZ469,135 53,307 6139,310 89,057 13,510 2,119 11211,955 144,483 
CACA13626,433 486,255 9185,792 126,483 17,281 4,784 23819,506 617,522 
COCO220,532 13,534 888,129 59,786 218,652 13,380 12127,313 86,700 
CTCT17,616 5,721 — — — — 17,616 5,721 
DCDC2106,596 87,262 — — — — 2106,596 87,262 
DEDE— — 696,637 63,003 — — 696,637 63,003 
FLFL740,250 29,143 19607,804 413,539 212,326 11,021 28660,380 453,703 
GAGA574,542 50,423 17234,055 158,886 596,916 74,799 27405,513 284,108 
HIHI177,691 59,966 — — — — 177,691 59,966 
IDID— — — — 222,185 16,538 222,185 16,538 
ILIL469,740 46,748 11176,420 111,902 120,641 14,583 16266,801 173,233 
ININ122,362 13,654 11168,497 124,746 268,927 53,472 14259,786 191,872 
KSKS261,912 41,287 360,876 40,358 — — 5122,788 81,645 
KYKY— — 9103,585 62,017 — — 9103,585 62,017 
MAMA101,295,908 838,344 131,848 20,027 — — 111,327,756 858,371 
MDMD345,565 31,618 11243,110 175,265 120,964 15,841 15309,639 222,724 
MIMI— — — — 515,942 9,668 515,942 9,668 
MNMN9117,080 84,975 115,130 14,795 26,319 3,853 12138,529 103,623 
MOMO3138,727 96,221 569,574 48,052 — — 8208,301 144,273 
NCNC260,103 44,970 16223,893 175,335 16,839 4,141 19290,835 224,446 
NENE— — 17,611 5,127 126,702 19,890 234,313 25,017 
NJNJ— — 4106,357 75,129 — — 4106,357 75,129 
NMNM238,461 29,040 132,721 20,646 333,303 22,805 6104,485 72,491 
NVNV— — 282,650 61,181 — — 282,650 61,181 
NYNY5114,518 86,581 1113,027 86,160 — — 6227,545 172,741 
OHOH118,601 12,539 144,342 28,288 14,284 1,832 367,227 42,659 
OROR— — 145,965 43,921 — — 145,965 43,921 
PAPA561,545 45,262 982,900 54,448 23,535 2,179 16147,980 101,889 
SCSC215,075 9,655 14114,616 85,051 23,935 2,445 18133,626 97,151 
TNTN19,522 6,448 14166,112 134,481 215,667 11,462 17191,301 152,391 
TXTX13266,669 186,420 13351,189 248,367 120,502 14,961 27638,360 449,748 
VAVA8122,537 84,532 11137,807 97,496 — — 19260,344 182,028 
WAWA238,226 25,885 — — 218,665 12,159 456,891 38,044 
WIWI10169,236 124,690 7112,254 83,670 — — 17281,490 208,360 
WYWY— — 28,294 3,601 — — 28,294 3,601 
TotalTotal1183,688,582 2,594,480 2253,988,284 2,809,417 39427,095 311,932 3828,103,961 5,715,829 
Held for SaleHeld for Sale575,345 65,437 1039,433 39,334 — — 15114,778 104,771 
Held for Sale
Held for Sale
Grand TotalGrand Total123$3,763,927 $2,659,917 235$4,027,717 $2,848,751 39$427,095 $311,932 397$8,218,739 $5,820,600 
(1)     Represents gross book value of real estate assets at cost plus certain acquisition costs, before depreciation and purchase price allocations and less impairment write downs, if any.
6357

Table of Contents

Item 3.  Legal Proceedings.
From time to time, we may become involved in litigation matters incidental to the ordinary course of our business. Although we are unable to predict with certainty the eventual outcome of any litigation, we are currently not a party to any litigation which we expect to have a material adverse effect on our business.
Item 4.  Mine Safety Disclosures.
Not applicable.
PART II
Item 5.  Market for Registrant's Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities.
Our common shares are traded on Nasdaq (symbol: DHC).
As of February 19, 2021,21, 2024, there were 1,4393,269 shareholders of record of our common shares, although there is a larger number of beneficial owners.
Issuer purchases of equity securities. The following table provides information about our purchases of our equity securities during the quarter ended December 31, 2023:
Calendar Month
Number of Shares Purchased(1)
Average Price Paid per ShareTotal Number of Shares Purchased as Part of Publicly Announced Plans or ProgramsMaximum Approximate Dollar Value of Shares that May Yet Be Purchased Under the Plans or Programs
December 1 - December 31, 20232,451 $3.06 — — 
(1) These common share withholdings and purchases were made to satisfy tax withholding and payment obligations of a former employee of RMR in connection with the vesting of prior awards of our common shares. We withheld and purchased these shares at their fair market value based upon the trading price of our common shares at the close of trading on Nasdaq on the purchase dates.
Our current cash distribution rate to common shareholders is $0.01 per share per quarter, or $0.04 per share per year. However, the timing, amount and form of future distributions will be determined at the discretion of our Board of Trustees and will depend upon various factors that our Board of Trustees deems relevant, including, but not limited to, our historical and projected net income,FFO, our Normalized FFO, requirements to maintain our then currentqualification for taxation as a REIT, limitations in our debt agreements, the availability to us of debt and equity capital, our expectation of our future capital requirements and operating performance and our expected needs for and availability of cash to pay our obligations, distributions which we may be required to pay to satisfy our REIT distribution requirements, limitations in the agreements governing our debt and other factors deemed relevant by our Board of Trustees in its discretion.obligations. Therefore, we cannot be sure that we will continue to pay distributions in the future or that the amount of any distributions we do pay will not decrease.
Item 6.  [Reserved.[Reserved]
64

Table of Contents
Item 7.  Management's Discussion and Analysis of Financial Condition and Results of Operations.
The following discussion should be read in conjunction with our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
OVERVIEW
We are a REIT that was organized under Maryland law and whichthat primarily owns medical office and life science properties, senior living communities and other healthcare related properties throughout the United States. As of December 31, 2020,2023, we owned 397371 properties including 15 properties classified as held for sale and seven closed senior living communities, located in 36 states and Washington, D.C., including one life science property owned in a joint venture arrangement in which we own a 55% equity interest.classified as held for sale and three closed senior living communities. At December 31, 2020,2023, the gross book value of our real estate assets at cost plus certain acquisition costs, before depreciation and purchase price allocations and less impairment write downs, was $8.2 billion, including $114.8 million$7.2 billion.
As of gross book value classified as held for saleDecember 31, 2023, we owned an equity interest in our consolidated balance sheet.
Impacteach of COVID-19
In March 2020, the World Health Organization declared the outbreak of COVID-19 as a pandemic and, in response to the outbreak, the U.S. Health and Human Services Secretary declared a public health emergency in the United States and many states and municipalities declared public health emergencies. The virus that causes COVID-19 has continued to spread throughout the United StatesSeaport JV and the world. Various governmental and market responses attempting to contain and mitigate the spread of the virus have negatively impacted, and continue to negatively impact, the global economy, including the U.S. economy. States and municipalities across the United States have generally allowed most businesses to re-open and have generally eased certain restrictions they had previously implemented in response to the COVID-19 pandemic, often in stagesLSMD JV that are phased in over time, although some states and municipalities have imposed or re-imposed certain restrictions in response to increases in COVID-19 infections experienced since then. Recently, economic data have indicated that the U.S. economy has increasingly improved since the lowest periods experienced in March and April 2020, although the U.S. gross domestic product remains below pre-pandemic levels. It is unclear whether the increases in the number of COVID-19 infections will continue or amplify in the United States or elsewhere and, if so, what the impact of that would be on human health and safety, the economy, or our manager's and other operators' and tenants' businesses.
Our business is focused on healthcare related properties, includingown medical office and life science properties senior living communities, wellness centers and other medical and healthcare related properties. We believelocated in five states with an aggregate of approximately 2.2 million rentable square feet that the healthcare sector and manywere 98% leased with an average (by annualized rental income) remaining lease term of our tenants and our manager provide essential services across the United States. Due to restrictions intended to prevent the spread5.3 years.
58

Table of the virus that causes COVID-19, certain of our medical office and wellness center tenants, which include physician practices that had discontinued non-essential surgeries and procedures and fitness centers, that had been ordered closed by state executive orders have experienced disruptions to their businesses. Our senior living community operators have also experienced disruptions, including limitations on in-person tours and new admissions, and are experiencing challenges in attracting new residents to their communities in addition to experiencing increased expenses due to increased labor costs, including higher health benefits costs, and increased costs and consumption of supplies, including personal protective equipment. There will be lasting impacts of the COVID-19 pandemic, even as states and municipalities have eased and may further ease restrictions. Our tenants and their businesses may become increasingly negatively impacted, which may result in our tenants seeking assistance from us regarding their rent obligations owed to us, their being unable or unwilling to pay us rent, their ceasing to pay us rent and their ceasing to continue as going concerns. Contents

We are closely monitoring the impacts of the COVID-19 pandemiccurrent economic and market conditions on all aspects of our business, including, but not limited to, high interest rates, prolonged high inflation, labor market challenges, supply chain disruptions, volatility in the public equity and we believe that our current financial positiondebt markets, geopolitical risks, economic downturns or a possible recession and recent financing activities will enable us to withstand the COVID-19 pandemic and its aftermath.
In light of the above actions, resources, expectations and conditions, we believe that we are well positioned to weather the present disruptions facing thechanges in real estate industryutilization. We expect continued volatility in labor, insurance and in particular, the real estate healthcare industry, including senior living. However, as a result of the COVID-19 pandemic, some of our tenants have requested relief from their obligations to pay rent due to us. While the number and value of these monthly requests have been declining, we continue to evaluate these requests as they are made on a tenant-by-tenant basis. As of February 23, 2021, we had granted requests to 72 of our tenants to defer rent payments totaling $2.1 million with respect to leases that represented, as of December 31, 2020, approximately 5.5% of our annualized rental income. Those 72 of our tenants consist of 71 tenantsfood costs in our Office Portfolio segment, which accounted for $1.8 million of deferrals, which represented approximately 4.8% of our Office Portfolio segment annualized rental income as of December 31, 2020,SHOP segment. For further information and one triple net senior living tenant. As of December 31, 2020, we recognized an increase in our accounts receivable balance related to these deferred rent payments of $1.5 million. These tenants were obligated to pay, in most cases, the deferred rents in 12 equal monthly installments beginning in September 2020. For the three months ended December 31, 2020, we collected approximately 99% of our contractual rents due from tenants in our Office Portfolio segment.
65

Table of Contents
While these deferred amounts have not negatively impacted our results of operations, the deferred rents have temporarily reduced our operating cash flows.
The COVID-19 pandemic and related public health restrictions have had a negative impact on us and our business. For a discussion of and the risks relating to the COVID-19 pandemicthese economic uncertainties and their impact on usour business and our business,financial condition, see elsewhere in this Annual Report on Form 10-K, including "Warning Concerning Forward-Looking Statements," Part I, Item 1, "Business" and Part I, Item 1A, "Risk Factors".
In response to significant and prolonged increases in inflation, the U.S. Federal Reserve has raised interest rates multiple times since the beginning of 2022. Although the U.S. Federal Reserve has indicated that it may lower interest rates in 2024, we cannot be sure that it will do so, and interest rates may remain at the current high levels or continue to increase. These inflationary pressures in the United States, as well as global geopolitical instability and tensions, have given rise to uncertainty regarding economic downturns or a possible recession and potential disruptions in the financial markets. An economic recession, or continued or intensified disruptions in the financial markets, could adversely affect our financial condition and that of our managers, operators and tenants, could adversely impact the ability or willingness of our managers, operators, tenants or residents to pay amounts owed to us, could impair our ability to effectively deploy our capital or realize our target returns on our investments, may restrict our access to, and would likely increase our cost of, capital, and may cause the values of our properties and of our securities to decline.
We are encouraged by positive trends, including increases in rates and occupancy, in our SHOP segment. Additionally, we also expect favorable supply and demand dynamics in the senior living industry to enable our operators to generate better returns at our communities than we have experienced in the years following the COVID-19 pandemic. While certain costs, primarily labor, insurance and food costs, have increased, we expect these cost increases to moderate and decline, which will provide our operators the opportunity to increase rates in excess of increases in costs, resulting in improving returns to us.
On April 11, 2023, we and Office Properties Income Trust, or OPI, entered into an Agreement and Plan of Merger, or the Merger Agreement, pursuant to which we and OPI agreed that we would merge with and into OPI, with OPI as the surviving entity in the merger. On September 1, 2023, we and OPI mutually terminated the Merger Agreement, effective September 1, 2023. Neither we nor OPI were required to pay any termination fee as a result of the mutual decision to terminate the Merger Agreement, and we and OPI bore our and its respective costs and expenses related to the Merger Agreement in accordance with the terms of the Merger Agreement. We recorded $9.9 million of expenses during the year ended December 31, 2023 related to the terminated merger with OPI, which is included in acquisition and certain other transaction related costs in our consolidated statement of operations. For more information regarding the merger, see Note 8 to our consolidated financial statements included in Part IV, Item 15 of this Annual Report on Form 10-K.

PORTFOLIO OVERVIEW
The following tables present an overview of our portfolio (dollars in thousands, except investment per square foot or unit data):
(As of December 31, 2020)Number 
of
Properties
Square 
Feet or Number of Units
 

Gross Book Value of Real Estate Assets(1)
% of Total Gross Book Value of Real Estate Assets
Investment per
Square Foot or Unit(2)
2020 Revenues (3)
% of 2020 Revenues
2020
NOI(3)(4)
% of
2020 
NOI
Office Portfolio(5)
123 11,282,057 sq. ft.$3,763,927 45.8 %$334 $383,365 23.5 %$253,609 64.1 %
SHOP (6) (7)
235 26,969 units4,027,717 49.0 %$149,346 1,204,811 73.8 %98,210 24.8 %
Other triple net leased senior living communities29 2,366 units248,985 3.0 %$105,235 29,816 1.8 %29,816 7.5 %
Wellness centers10 812,000 sq. ft.178,110 2.2 %$219 14,034 0.9 %14,034 3.6 %
Total397 $8,218,739 100.0 %$1,632,026 100.0 %$395,669 100.0 %
(As of December 31, 2023)Number 
of
Properties
Square 
Feet or Number of Units
 

Gross Book Value of Real Estate Assets(1)
% of Total Gross Book Value of Real Estate Assets
Investment per
Square Foot or Unit(2)
2023 Revenues% of 2023 Revenues
2023
NOI(3)
% of
2023 
NOI
Office Portfolio(4)
102 8,609,921 sq. ft.$2,284,946 31.7 %$265 $220,530 15.6 %$122,566 51.9 %
SHOP232 25,209 units4,535,435 62.9 %$179,913 1,151,908 81.7 %76,817 32.5 %
Triple net leased senior living communities27 2,062 units202,908 2.8 %$98,403 24,588 1.7 %24,583 10.4 %
Wellness centers10 812,000 sq. ft.187,493 2.6 %$231 13,282 1.0 %12,191 5.2 %
Total371 $7,210,782 100.0 %$1,410,308 100.0 %$236,157 100.0 %
 Occupancy
As of and for the Year Ended December 31,
 20202019
Office Portfolio (8)
91.4 %92.2 %
SHOP77.2 %84.4 %
Other triple net leased senior living communities (9)(10)
83.4 %87.8 %
Wellness centers100.0 %100.0 %
59

Table of Contents

 Occupancy
As of and for the Year Ended December 31,
 20232022
Office Portfolio (5)
86.9 %84.7 %
SHOP78.1 %74.4 %
Triple net leased senior living communities (6)(7)
80.7 %79.9 %
Wellness centers (7)
100.0 %100.0 %
(1)Represents gross book value of real estate assets at cost plus certain acquisition costs, before depreciation and purchase price allocations and less impairment write downs, if any. Amounts include $114,778 of gross book value of 15 properties classified as held for sale as of December 31, 2020, which amounts are included in assets of properties held for sale in our consolidated balance sheet.
(2)Represents gross book value of real estate assets divided by number of rentable square feet or living units, as applicable, at December 31, 2020.2023.
(3)Includes $47,387 of revenues and $(2,996) of NOI from properties that we sold during the year ended December 31, 2020 and $41,496 of revenues and $7,725 of NOI from properties classified as held for sale in our consolidated balance sheet as of December 31, 2020.
(4)We calculate our NOI on a consolidated basis and by reportable segment. Our definition of NOI and our reconciliation of net income (loss) to NOI are included below under the heading “Non-GAAP Financial Measures”.
(5)(4)Our medical office and life science property leases include some triple net leases where, in addition to paying fixed rents, the tenants assume the obligation to operate and maintain the properties at their expense, and some net and modified gross leases where we are responsible for the operation and maintenance of the properties and we charge tenants for some or all of the property operating costs. A small percentageportion of our medical office and life science property leases are full-service leases where we receive fixed rent from our tenants and no reimbursement for our property operating costs.
(6)Includes $11,364 of revenues and $(5,786) of NOI from seven senior living communities that were closed during the year ended December 31, 2020.
66

Table of Contents
(7)Residents fees and services for the year ended December 31, 2020 for our SHOP segment is net of a $3,842 reserve for a Medicare refund we paid in January 2021. Property operating expenses for the year ended December 31, 2020 for our SHOP segment includes $1,928 of estimated penalties, compliance costs and professional fees, net of management fees reimbursable by Five Star, related to the Medicare refund. For further information regarding this matter, see elsewhere in this Annual Report on Form 10-K, including Note 6 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
(8)(5)Medical office and life science property occupancy data is as of December 31, 20202023 and 20192022 and includes (i) out of service assets undergoing redevelopment, (ii) space which is leased but is not occupied or is being offered for sublease by tenants and (iii) space being fitted out for occupancy.
(9)(6)Excludes data for periods prior to our ownership of certain properties, data for properties sold or classified as held for sale, if any, and data for which there was a transfer of operations during the periods presented.
(10)(7)Operating data for otherour triple net leased senior living communities leased to third party operators other than Five Star and wellness centers are presented based upon the operating results provided by our tenants for the 12 months ended September 30, 20202023 and 2019,2022, or the most recent prior period for which tenant operating results are made available to us. We have not independently verified tenant operating data.
Due to the COVID-19 pandemic, we anticipate that leasing activity may remain slow in our Office Portfolio and that we may continue to be prevented from, or impeded in, pursuing or accepting additional residents at our senior living communities due to restrictions intended to prevent the spread of the virus that causes COVID-19, including restricting nonessential visitors from some of our senior living communities. As a result, we expect to experience further decreases in occupancy at our senior living communities. Further, as noted above, we expect to continue to incur higher operating costs on a per resident basis at our senior living communities as a result of the COVID-19 pandemic. These expected declines in occupancy and increases in operating costs on a per resident basis at our senior living communities are expected to result in further decreases in income or returns from those properties.
We also believe that we, Five Star and our impacted tenants may benefit from provisions of the CARES Act or other federal or state relief programs allowing them to continue or resume business activity. During the year ended December 31, 2020, we recognized $17.5 million in interest and other income in our consolidated statement of comprehensive income (loss) related to funds received under the CARES Act.
We operate in, and report financial information for, the following two segments: Office Portfolio and SHOP. Our Office Portfolio segment consists of medical office properties leased to medical providers and other medical related businesses, as well as life science properties leased to biotech laboratories and other similar tenants. Our SHOP segment consists of managed senior living communities that provide short term and long term residential living and in some instances care and other services for residents where we pay fees to managers to operate the operator to manage the communities for our account. In addition, prior to January 1, 2020, our SHOP segment included triple net leased senior living communities that provided short term and long term residential living and in some instances care and other services for residents and from which we received rents from Five Star. Pursuant to the Restructuring Transaction, effective January 1, 2020, our previously existing master leases and management and pooling agreements with Five Star were terminated and replaced with the Five Star management agreements for all of our senior living communities operated by Five Star.communities.
We also continue to report “non-segment” operations, which consists of triple net leased senior living communities that are leased to third party operators other than Five Star from which we receive rents and wellness centers.
Office Portfolio
As of December 31, 2020,2023, we owned 123102 medical office and life science properties located in 2524 states and Washington, D.C. These properties have a total of 11.38.6 million square feet. During the year ended December 31, 2020, we entered into lease renewals for 716,351 square feet and new leases for 260,456 square feet at our medical office and life science properties. The weighted average annual rental rate for leases entered during 2020 was $24.58 per square foot, which was 1.1% higher than the previous weighted average annual rental rate for the same space. Weighted (by annualized rental income) average lease term for leases entered during 2020 was 6.4 years. Commitments for tenant improvements, leasing commission costs and concessions for leases we entered into during 2020 totaled $22.7 million, or $23.22 per square foot on average (approximately $3.63 per square foot per year of the lease term).
6760

Table of Contents

During the year ended December 31, 2023, we entered into new and renewal leases in our Office Portfolio segment as summarized in the following table (dollars and square feet in thousands, except per square foot amounts):
Year Ended December 31, 2023
 New LeasesRenewalsTotal
Square feet leased during the period284 602 886 
Weighted average rental rate change (by rentable square feet)12.8 %10.4 %11.1 %
Weighted average lease term (years)10.3 6.2 7.5 
Total leasing costs and concession commitments (1)
$24,151 $11,932 $36,083 
Total leasing costs and concession commitments per square foot (1)
$85.08 $19.82 $40.74 
Total leasing costs and concession commitments per square foot per year (1)
$8.24 $3.20 $5.42 
(1)Includes commitments made for leasing expenditures and concessions, such as tenant improvements, leasing commissions, tenant reimbursements and free rent.
As of December 31, 2020,2023, lease expirations at our medical office and life science properties in our Office Portfolio segment arewere as follows (dollars in thousands):
YearYearNumber of TenantsSquare Feet LeasedPercent of TotalCumulative Percent of Total
Annualized  Rental Income(1)
Percent of TotalCumulative Percent of Total
2021128910,418 8.8 %8.8 %$32,656 8.8 %8.8 %
20221071,310,305 12.7 %21.5 %36,804 9.9 %18.7 %
2023581,025,560 9.9 %31.4 %20,655 5.6 %24.3 %
Year
YearNumber of TenantsSquare Feet LeasedPercent of TotalCumulative Percent of Total
Annualized  Rental Income(1)
Percent of TotalCumulative Percent of Total
20242024781,818,870 17.6 %49.0 %49,720 13.4 %37.7 %202473654,7939.1 %9.1%$15,150 7.1%7.1%7.1%
20252025771,012,725 9.8 %58.8 %25,935 7.0 %44.7 %202576617,8578.5 %17.6%17,251 8.0%8.0%15.1%
2026202653737,389 7.1 %65.9 %22,936 6.2 %50.9 %202657759,84210.5 %28.1%23,768 11.1%11.1%26.2%
2027202728491,519 4.8 %70.7 %12,262 3.3 %54.2 %202762944,50913.1 %41.2%22,875 10.6%10.6%36.8%
20282028221,549,478 15.0 %85.7 %117,402 31.7 %85.9 %2028551,192,51616.5 %57.7%33,660 15.7%15.7%52.5%
2029202925233,567 2.3 %88.0 %10,442 2.8 %88.7 %202949550,3977.6 %65.3%16,408 7.6%7.6%60.1%
2030 and thereafter491,226,491 12.0 %100.0 %41,770 11.3 %100.0 %
2030203022287,9544.0 %69.3%7,239 3.4%63.5%
2031203120905,90712.5 %81.8%26,296 12.2%75.7%
2032203215266,0093.7 %85.5%11,858 5.5%81.2%
2033 and thereafter2033 and thereafter441,054,76314.5 %100.0%40,289 18.8%100.0%
TotalTotal62510,316,322 100.0 %$370,582 100.0 %
Weighted average remaining lease term (in years)Weighted average remaining lease term (in years)5.1 5.9 
Weighted average remaining lease term (in years)
Weighted average remaining lease term (in years)

(1)Annualized rental income is based on rents pursuant to existing leases as of December 31, 2020,2023, including straight line rent adjustments and estimated recurring expense reimbursements for certain net and modified gross leases and excluding lease value amortization at certain of our medical office and life science properties. Annualized rental income also includes 100% of rental income as reported under GAAP from our life science property owned in a joint venture arrangement in which we own a 55% equity interest.
6861

Table of Contents

The following table presents information concerning our medical office and life science propertyOffice Portfolio tenants that represent 1% or more of total medical office and life science propertyOffice Portfolio annualized rental income as of December 31, 20202023 (dollars in thousands):
TenantTenantSquare Feet
Leased
Percent of Total Square Feet Leased
Annualized
Rental
Income(1)
Percent of Total
Annualized
Rental
Income(1)
Lease
Expiration
TenantSquare Feet
Leased
Percent of Total Square Feet Leased
Annualized
Rental
Income(1)
Percent of Total
Annualized
Rental
Income(1)
Lease
Expiration
Vertex Pharmaceuticals Inc. (2)
1,082,417 10.5 %$97,340 26.3 %2028
Advocate Aurora HealthAdvocate Aurora Health643,499 6.2 %16,896 4.6 %2024Advocate Aurora Health631,5298.7%$16,939 7.9%7.9%2026 - 2031
Cedars-Sinai Medical Center147,695 1.4 %16,308 4.4 %2021- 2032
Ology Bioservices, Inc.165,586 1.6 %8,324 2.2 %2041
HCA Holdings, LLC217,179 2.1 %6,934 1.9 %2021 - 2029
Alamar Biosciences, Inc.Alamar Biosciences, Inc.88,5081.2%6,194 2.9%2034
KSQ Therapeutics, Inc.KSQ Therapeutics, Inc.54,6330.8%5,595 2.6%2032
Boston Children's HospitalBoston Children's Hospital99,0631.4%5,573 2.6%2028
Merck & Co., Inc.Merck & Co., Inc.55,1020.8%5,290 2.5%2033
Sonova Holding AGSonova Holding AG116,4441.6%4,875 2.3%2033
Magellan Health Inc.Magellan Health Inc.232,5213.2%4,643 2.2%2025
Medtronic, Inc.Medtronic, Inc.376,828 3.7 %5,666 1.5 %2022Medtronic, Inc.201,5222.8%4,512 2.1%2.1%2027 - 2028
Iqvia Holdings Inc.176,839 1.7 %5,316 1.4 %2023
Boston Children's Hospital99,063 1.0 %4,533 1.2 %2028
Magellan Health Inc.232,521 2.3 %4,507 1.2 %2025
Tokio Marine Holdings Inc.Tokio Marine Holdings Inc.81,0721.1%3,982 1.9%2024 - 2033
Abbvie Inc.Abbvie Inc.197,976 1.9 %4,505 1.2 %2021Abbvie Inc.197,9762.7%3,972 1.8%1.8%2027
Sonova Holding AG146,385 1.4 %4,452 1.2 %2024
Seattle Genetics, Inc.144,900 1.4 %4,101 1.1 %2024
Tokio Marine Holdings Inc.81,072 0.8 %3,980 1.1 %2021 - 2033
United Healthcare Services, Inc.United Healthcare Services, Inc.149,7192.1%3,947 1.8%2026
Cigna Holding Co.Cigna Holding Co.219,644 2.1 %3,914 1.1 %2024Cigna Holding Co.219,6443.0%3,914 1.8%1.8%2024
United Healthcare Services, Inc.149,719 1.5 %3,850 1.0 %2026
PerkinElmer Health Sciences, Inc.PerkinElmer Health Sciences, Inc.105,4621.5%3,681 1.7%2028
McKesson CorporationMcKesson Corporation475,2046.6%3,556 1.7%2025 - 2029
HCA Holdings Inc.HCA Holdings Inc.80,4781.1%3,490 1.6%2024 - 2027
Duke UniversityDuke University126,225 1.2 %3,737 1.0 %2024Duke University126,2251.7%3,359 1.6%1.6%2024
All other6,108,774 59.2 %176,219 47.6 %2021 - 2035
Hawaii Pacific HealthHawaii Pacific Health85,9561.2%3,289 1.5%2024 - 2029
New York UniversityNew York University109,9831.5%3,248 1.5%2024 - 2028
Ultragenyx Pharmaceutical Inc.Ultragenyx Pharmaceutical Inc.63,0480.9%3,123 1.5%2026
Virginia Commonwealth University Health SystemVirginia Commonwealth University Health System135,3751.9%2,920 1.4%2032
WRA Management, Inc.WRA Management, Inc.35,0670.5%2,609 1.2%2025 - 2045
The University of Kansas Health SystemThe University of Kansas Health System104,8151.4%2,462 1.1%2027 - 2028
Organogenesis Holdings Inc.Organogenesis Holdings Inc.22,9660.3%2,431 1.1%2031
Covenant Health SystemCovenant Health System55,8070.8%2,376 1.1%2034
Warner Chilcott LimitedWarner Chilcott Limited81,7121.1%2,280 1.1%2027
Cytek BioSciences, Inc.Cytek BioSciences, Inc.99,3781.4%2,241 1.0%2029
All Other TenantsAll Other Tenants3,525,33848.7%104,293 48.5%2024 - 2043
TotalsTotals10,316,322 100.0 %$370,582 100.0 %
Totals
Totals
(1)    Annualized rental income is based on rents pursuant to existing leases as of December 31, 2020,2023, including straight line rent adjustments and estimated recurring expense reimbursements for certain net and modified gross leases and excluding lease value amortization at certain of our medical office and life science properties.
(2)    The property leased by this tenant is owned by a joint venture arrangement in which we own a 55% equity interest. Rental income presented includes 100% of rental income as reported under GAAP.
Senior Housing Operating Portfolio
As of December 31, 2019, Five Star operated 244 of ourOur managed senior living communities inare operated by third parties pursuant to management agreements. Five Star, which is an operating division of AlerisLife, manages many of our SHOP segment, of which 166 communities, were leased to Five Star and 78 communities were managed by Five Star for our account. Pursuant to the Restructuring Transaction, effective January 1, 2020, our previously existing master leases and management and pooling agreements with Five Star were terminated and replaced with the Five Star management agreements forwe lease nearly all of our senior living communities, operatedincluding those managed by Five Star. The conversion ofthird party managers, to our leasing arrangements with Five Star toTRSs.
In June 2021, we amended our then existing management arrangements was a significant change in our historical arrangements with Five Star and has resulted, and likely will continueFive Star agreed to resultcooperate with us in future periods, in our realizing significantly different operating results fromtransitioning 108 of our senior living communities including increased variability. As of December 31, 2020,to other third party managers. We and Five Star managed 235entered into an amended and restated master management agreement, or the Master Management Agreement, for the senior living communities for our account.
Also pursuantthat Five Star is continuing to manage. Pursuant to the Restructuring Transaction, for the period beginning February 1, 2019 through December 31, 2019, the aggregate amount of monthly minimum rent payable to us byMaster Management Agreement, Five Star was reduced to $11.0 million as of February 1, 2019, which amount was then reduced during such period to approximately $10.8 million asreceives a result of dispositions, and no additional rent was payable to us by Five Star for the period beginning February 1, 2019 to the Conversion Time.
6962

Table of Contents

Pursuant to the Five Star management agreements, Five Star receives a management fee equal to 5% of the gross revenues realized at the applicable senior living communities plus reimbursement for its direct costs and expenses related to such communities. Commencing with the calendar year 2021, Five Star may receive an annual incentive fee equal to 15% of the amount by which the annual EBITDA of all communities on a combined basis exceeds the target EBITDA for all communities on a combined basis for such calendar year, provided that in no event shall the incentive fee be greater than 1.5% of the gross revenues realized at all communities on a combined basis for such calendar year. The target EBITDA for those senior living communities on a combined basis is increased annually based on the greater of the annual increase of the consumer price index, or CPI, or 2%, plus 6% of any capital investments funded at the managed senior living communities on a combined basis in excess of the target capital investment. Unless otherwise agreed, the target capital investment increases annually based on the greater of the annual increase of CPI or 2%.
Any senior living communities that are undergoing a major renovation or repositioning are excluded from the calculation of the incentive fee. The Five Star management agreements expireMaster Management Agreement expires in 2034,2036, subject to Five Star's right to extend for two consecutive five year terms if Five Star achieves certain performance targets for the combined managed communities portfolio, unless earlier terminated. The Five Star management agreements also provide us withPursuant to the Master Management Agreement, beginning in 2025, we have the right to terminate up to 10% of the senior living communities that Five Star management agreementsis continuing to manage, based on total revenues per year for any community that does not earn 90%failure to meet 80% of thea target EBITDA for such community for two consecutive calendar years or in any two of three consecutive calendar years, with the measurement period commencing January 1, 2021 (and the first termination not possible until the beginning of calendar year 2023), provided we may not in any calendar year terminate communities representing more than 20% of the combined revenues for all communities for the calendar year prior to such termination.applicable period. In addition, Five Star has guaranteeddelivered to us a related amended and restated guaranty agreement pursuant to which Five Star is continuing to guarantee the payment and performance of each of its applicable subsidiary's obligations under the applicable management agreements. As of December 31, 2023, Five Star managed 119 senior living communities for our account.
We completed the transition of 107 senior living communities from Five Star to other third party managers in 2021 and we have closed the remaining senior living community. In October 2022, we and one of our operators agreed to terminate the lease agreements for three of these senior living communities and replaced them with management agreements.agreements under our TRS structure, and an affiliate of the same operator will continue to operate these properties. Additionally, effective October 31, 2022, Five Star ceased managing our active adult community, and RMR assumed management of that community. For the years ended December 31, 2023, 2022 and 2021, we recorded $0, $2.1 million and $17.4 million, respectively, of costs that we incurred related to retention and other transition costs to acquisition and certain other transaction related costs in our consolidated statements of operations.
The terms of the management agreements with the other third party managers are generally as follows: the other third party managers will receive a management fee equal to 5% to 6% of the gross revenues realized at the applicable senior living communities plus reimbursement for direct costs and expenses related to such communities. These agreements generally also provide for the other third party managers to earn a minimum base fee for a portion of the term of the agreement. Additionally, the other third party managers have the ability to earn incentive fees equal to 15% to 25% of the amount by which EBITDA of the applicable communities exceeds the target EBITDA for the applicable communities. The other third party managers can also earn a construction supervision fee ranging between 3% and 5% of construction costs.
The initial terms of the management agreements with the other third party managers are generally five years, subject to automatic extensions of successive terms of two years each unless earlier terminated or timely notice of nonrenewal is delivered. The management agreements with the other third party managers also generally provide us with the right to terminate the management agreements for communities that do not earn 70% to 80% of the target EBITDA for such communities, after an agreed upon stabilized period.
In December 2023, we notified one of our third party managers, Cedarhurst Senior Living, which manages certain of our communities located in Wisconsin and Illinois, that we will be terminating our management agreement with respect to these communities. We expect to transition these communities during the first half of 2024 to another third party manager, Charter Senior Living, which we have an existing relationship with. We expect the terms of the management agreement for these communities to be generally consistent with the terms outlined above. We expect to pay a termination fee of approximately $1.0 million in connection with this transition.
63

Table of Contents

The following table presents a summary of the other third party managers as of December 31, 2023:
ManagerLocationNumber of CommunitiesNumber of Units
Cedarhurst Senior LivingIL/WI13767
Charter Senior LivingFL/MD/TN/VA17977
IntegraCare Senior LivingPA2143
Life Care ServicesDE3517
Navion Senior SolutionsSC5235
Northstar Senior LivingAZ/CA7418
Oaks-Caravita Senior CareGA/SC261,415
Oaks Senior LivingGA3264
Omega Senior LivingNE169
Phoenix Senior LivingAL/AR/KY/MO/NC/SC231,486
RMRTX1169
Stellar Senior LivingCO/TX/WY101,094
Total1117,554
For further information regarding the Restructuring Transactionterms of the Master Management Agreement and of the management agreements with the other third party managers and our other business arrangements with Five Star, see Note 6 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K, and for more information about our dealings and relationships with Five Star generally, and the risks which may arise as a result of these related person transactions, see “Risk Factors—Risks Related to Our Relationships with RMR LLC and AlerisLife (including Five Star”Star)” in Part I, Item 1A of this Annual Report on Form 10-K, “Management's Discussion and Analysis of Financial Condition and Results of Operations—“—Related Person Transactions” in Part II, Item 7 of this Annual Report on Form 10-Kbelow and Note 8 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
All Other
As of December 31, 2020,2023, lease expirations at our other triple net leased senior living communities leased to third party operators other than Five Star and wellness centers arewere as follows (dollars in thousands):
YearYearNumber of PropertiesNumber of Units or Square Feet
Annualized  Rental Income(1)
Percent of TotalCumulative Percent of TotalYearNumber of PropertiesNumber of Units or Square Feet
Annualized  Rental Income(1)
Percent of TotalCumulative Percent of Total
2021— — $— — %— %
2022— — — — %— %
2023 (2)
354,000 sq. ft.— — %— %
20242024180 units2,885 8.0 %8.0 %2024— $$— — — %— %
20252025— — — — %8.0 %20253129,500 sq. ft.1,458 3.7 3.7 %3.7 %
20262026— — — — %8.0 %2026— — — — — %3.7 %
20272027511 units4,218 11.7 %19.7 %20274533 units4,612 11.8 11.8 %15.5 %
20282028— — — — %19.7 %2028— — — — — %15.5 %
202920291155 units547 1.5 %21.2 %20291155 units547 1.4 1.4 %16.9 %
2030 and thereafter261,520 units and 458,000 sq. ft.28,277 78.8 %100.0 %
203020302283 units3,496 8.9 %25.8 %
203120311— — — %25.8 %
2032203218876 units9,836 25.1 %50.9 %
2033 and thereafter2033 and thereafter8215 units and 682,500 sq. ft.19,227 49.1 %100.0 %
TotalTotal39 $35,927 100.0 %

(1)    Annualized rental income is based on rents pursuant to existing leases as of December 31, 2020.2023. Annualized rental income includes estimated percentage rents and straight line rent adjustments and excludes lease value amortization.
(2)    As a result of the COVID-19 pandemic's impact on operations at our wellness centers, we are negotiating with the tenant of six of our wellness centers with total annualized rental income of approximately $7.9 million, which has been excluded from the table above as the tenant was in default under the applicable leases with us as of December 31, 2020.

7064

Table of Contents

During the year ended December 31, 2023 we entered into new leases at certain of our wellness centers in our "non-segment" operations as summarized in the following table (dollars and square feet in thousands, except per square foot amounts):
Year Ended December 31, 2023
New Leases
Square feet leased during the period225 
Weighted average rental rate change (by rentable square feet)(9.9)%
Weighted average lease term (years)18.6 
Total leasing costs and concession commitments (1)
$30,071 
Total leasing costs and concession commitments per square foot (1)
$133.95 
Total leasing costs and concession commitments per square foot per year (1)
$7.20 
(1)Includes commitments made for leasing expenditures and concessions, such as tenant improvements, leasing commissions, tenant reimbursements and free rent.
GENERAL INDUSTRY TRENDS
OurThe healthcare industry remains one of the most resilient commercial real estate sectors, in part due to the scale of the U.S. healthcare market, which collectively represents approximately 17% of the U.S. GDP, according to CMS. The healthcare sector’s continued expansion has been driven by rising standards of care, increasing life expectancies and other demographic trends, as well as funding from both public and private sources.
In the medical office and life science properties havesector, the industry has been impacted by at least two major industry trends for the past 10 years which are continuing at this time and that have impacted our investment activities.
First, medical practices are being consolidated into hospital systems. This has caused the numbertrending toward a greater proportion of free standing medical practices to decline. At the same time, theoutpatient care resulting in an increasing number of multi-practice medical office buildings, that are anchor leased by hospital systems, who employ doctors has increased. We believe hospital systems willand a decline in free-standing medical practices, a potential benefit to our Office Portfolio. The pandemic further accelerated this trend because of stronger consumer preference for off-campus care in more convenient locations. Costs within the industry continue the trend of providing an increasing amount of servicesto be in off campus medical offices away from main hospital campusesfocus with health system operating margins being under pressure in order to reduce costs and serve as many patients as possible,recent years, which is, reinforced by consumers' preference for healthcare services to be provided away from hospital campuses and closer to their residencewhile moderating, a theme that may continue in 2024.
In the life science sector, particularly with properties that provide laboratory or work locations.
Second, various advances in medical science have causedmanufacturing space, over the years there has been significant capital invested across the bio-medical research space, driving a large investmentincrease in new bio-medicaldemand for laboratory and research space. Venture capital funding reached an all-time high in 2021; however, such funding significantly declined in 2022 and 2023. Funding in the past two years has been increasingly concentrated on companies that require office, lablocated in the top three markets of Boston, San Francisco and medical products manufacturing space. We believe that about halfSan Diego with more stringent requirements.
New construction of our total investments in our Office Portfolio segment may be considered biotech and life science properties.properties hit record levels in 2021 and 2023 across major markets, and the construction pipeline, while decreasing, remains elevated into 2024. This has been met by softening demand from tenants and resulted in rising vacancy rates across the major life science markets.
We believe that the primary market for senior living services is individuals age 80 and older, and, accordingolder. According to U.S. Census data, that groupthe age 75+ demographic is projected to be among the fastest growing age cohortcohorts in the United States over the next 20 years, and according to CMS, the age 85+ demographic is projected to grow over 30% over the next five years. Also, as a result of medical advances, seniors are living longer. Due to these demographic trends, we expect the demand for senior living services and housing to increase for the foreseeable future. Despite this trend, future economic downturns, softness in the U.S. housing market, higher levels of unemployment among our potential residents' family members, changes in demand and market practices, lower levels of consumer confidence, stock market volatility and/or changes in demographics could adversely affect the ability of seniors to afford the resident fees at our senior living communities.
The medical advances which are increasing average life spans are also causing some seniors to delay moving to senior living communities until they require greater care or to forgo moving to senior living communities altogether, but we do not believe this factor is sufficient to offset the long term positive demographic trends causing increased demand for senior living communities for the foreseeable future.
In recent years,We believe there is a significant numberfavorable mix of newincreased demand and limited supply for senior living communities have been developedwhich we expect will benefit us and continue to be developed. Although there are indications that the rate of newly started developments has recently declined due to the COVID-19 pandemic, the increased supplyour existing portfolio of senior living communities that has resulted fromin the future. As a result of elevated financing and construction costs over recent development activity has increased competitive pressures on our managers and tenants, particularly in certain geographic markets where we ownyears, inventory growth for senior living communities has reached a new low. According to NIC, annual inventory growth was 1.3% across all markets during the fourth quarter of 2023. Additionally, annual absorption was
65

Table of Contents

4.1% for the fourth quarter of 2023, according to NIC. We expect improving market fundamentals and we expect these competitive challengesconstrained supply to continue for at least the next few years. These competitive challenges may prevent our managers and tenants from maintaining or improvingto result in increased occupancy and rates at our senior living communities which may increaseover the risk of default under our leases, reduce the rents and returns we may receive and earn from our leased and managed senior living communities and adversely affect the profitability of our senior living communities, and may cause the value of our propertiesnext 12 to decline. In response to these competitive pressures, we have invested capital in our existing senior living communities and expect to continue to do so in order that our communities may remain competitive with newer communities. For a discussion of and the risks relating to the COVID-19 pandemic on us and our business, see elsewhere in this Annual Report on Form 10-K, including "Warning Concerning Forward-Looking Statements," Part I, Item 1 "Business" and Part I, Item 1A "Risk Factors".
Recently, the costs of insurance have increased significantly, and these increased costs have had an adverse effect on us and our managers and tenants. Increased insurance costs may adversely affect our managers' ability to operate our properties profitably and provide us with desirable returns and our tenants' ability to pay us rent or result in downward pressure on rents we can charge under new or renewed leases.24 months.
The senior living industry is subject to extensive and frequently changing federal, state and local laws and regulations. For further information regarding these laws and regulations, and possible legislative and regulatory changes, see "Business—Government Regulation and Reimbursement" in Part I, Item 1 of this Annual Report on Form 10-K.
7166

Table of Contents

RESULTS OF OPERATIONS (dollars and square feet in thousands, unless otherwise noted)
The following table summarizes the results of operations of each of our segments for the years ended December 31, 20202023 and 2019:2022:
For the Year Ended December 31, For the Year Ended December 31,
20202019 20232022
Revenues:Revenues:
Office PortfolioOffice Portfolio$383,365 $405,016 
Office Portfolio
Office Portfolio
SHOPSHOP1,204,811 571,495 
Non-SegmentNon-Segment43,850 63,644 
Total revenuesTotal revenues$1,632,026 $1,040,155 
Net income (loss) attributable to common shareholders:
Net income (loss):
Office Portfolio
Office Portfolio
Office PortfolioOffice Portfolio$88,592 $68,884 
SHOPSHOP(114,693)28,446 
Non-SegmentNon-Segment(113,352)(185,564)
Net income (loss) attributable to common shareholders$(139,453)$(88,234)
Net income (loss)
The following sections analyze and discuss the results of operations of each of our segments for the periods presented.
Year Ended December 31, 20202023 Compared to Year Ended December 31, 2019:2022 (dollars and square feet in thousands, except average monthly rate):
Unless otherwise indicated, references in this section to changes or comparisons of results, income or expenses refer to comparisons of the results for the year ended December 31, 20202023 to the year ended December 31, 2019.2022. Our definition of NOI and our reconciliation of net income (loss) to NOI and a description of why we believe NOI is an appropriate supplemental measure are included below under the heading “Non-GAAP Financial Measures.” For a comparison of consolidated results for the year ended December 31, 20192022 compared to the year ended December 31, 2018,2021, see Part II, Item 7 “Management's Discussion and Analysis of Financial Condition and Results of Operations” in our Annual Report on Form 10-K for the fiscal year ended December 31, 2019.2022.
For the Year Ended December 31,
20232022$ Change% Change
NOI by segment:
Office Portfolio$122,566 $128,091 $(5,525)(4.3)%
SHOP76,817 8,726 68,091 nm
Non-Segment36,774 37,679 (905)(2.4)%
Total NOI236,157 174,496 61,661 35.3 %
Depreciation and amortization284,083 239,280 44,803 18.7 %
General and administrative26,131 26,435 (304)(1.1)%
Acquisition and certain other transaction related costs10,853 2,605 8,248 nm
Impairment of assets18,380 — 18,380 100.0 %
Gain on sale of properties1,205 321,862 (320,657)(99.6)%
Gains and losses on equity securities, net8,126 (25,660)33,786 (131.7)%
Interest and other income15,536 15,929 (393)(2.5)%
Interest expense(191,775)(209,383)17,608 (8.4)%
Loss on modification or early extinguishment of debt(2,468)(30,043)27,575 (91.8)%
Loss before income tax expense and equity in net (losses) earnings of investees(272,666)(21,119)(251,547)nm
Income tax expense(445)(710)265 (37.3)%
Equity in net (losses) earnings of investees(20,461)6,055 (26,516)nm
Net loss$(293,572)$(15,774)$(277,798)nm
nm – not meaningful
7267

Table of Contents

For the Year Ended December 31,
20202019$ Change% Change
NOI by segment:
Office Portfolio$253,609 $272,668 $(19,059)(7.0)%
SHOP98,210 214,773 (116,563)(54.3)%
Non-Segment43,850 63,644 (19,794)(31.1)%
Total NOI395,669 551,085 (155,416)(28.2)%
Depreciation and amortization270,147 289,025 (18,878)(6.5)%
General and administrative30,593 37,028 (6,435)(17.4)%
Acquisition and certain other transaction related costs814 13,102 (12,288)(93.8)%
Impairment of assets106,972 115,201 (8,229)(7.1)%
Gain on sale of properties6,487 39,696 (33,209)(83.7)%
Dividend income— 1,846 (1,846)(100.0)%
Gains and losses on equity securities, net34,106 (41,898)76,004 181.4 %
Interest and other income18,221 941 17,280 nm
Interest expense(201,483)(180,112)21,371 11.9 %
Gain on lease termination22,896 — 22,896 nm
Loss on early extinguishment of debt(427)(44)383 nm
Loss from continuing operations before income tax expense and equity in earnings of an investee(133,057)(82,842)50,215 60.6 %
Income tax expense(1,250)(436)814 186.7 %
Equity in earnings of an investee— 400 (400)(100.0)%
Net loss(134,307)(82,878)51,429 62.1 %
Net income attributable to noncontrolling interest(5,146)(5,356)(210)(3.9)%
Net loss attributable to common shareholders$(139,453)$(88,234)$51,219 58.0 %
nm – not meaningful
Office Portfolio:
 
Comparable Properties(1)
All Properties
 As of December 31,As of December 31,
 2020201920202019
Total buildings113 113 123 138 
Total square feet (2)
10,604 10,599 11,282 11,878 
Occupancy (3)
93.7 %93.6 %91.4 %92.2 %
 
Comparable Properties(1)
All Properties
 As of December 31,As of December 31,
 2023202220232022
Total buildings91 91 102 105 
Total square feet7,683 7,689 8,610 8,811 
Occupancy92.1 %92.1 %86.9 %84.7 %

Year Ended December 31,
Comparable (1)
Non-Comparable
Properties ResultsProperties ResultsConsolidated Properties Results
 20232022$
Change
%
Change
2023202220232022$
Change
%
Change
Rental income$197,840 $194,212 $3,628 1.9 %$22,690 $28,178 $220,530 $222,390 $(1,860)(0.8)%
Property operating expenses(83,177)(79,598)3,579 4.5 %(14,787)(14,701)(97,964)(94,299)3,665 3.9 %
NOI$114,663 $114,614 $49 0.0 %$7,903 $13,477 $122,566 $128,091 $(5,525)(4.3)%
(1)Consists of medical office and life science properties that we have owned and which have been in service continuously since January 1, 2019, including our life science property owned in a joint venture arrangement in which we own a 55% equity interest;2022; excludes properties classified as held for sale or out of service undergoing redevelopment, if any.
(2)Prior periods exclude space remeasurements made subsequent to those periods.
(3)Medical officeany, and life science property occupancy includes (i) outproperties owned by unconsolidated joint ventures in each of service assets undergoing redevelopment, (ii) space which is leased but is not occupied or is being offered for sublease by tenants, and (iii) space being fitted out for occupancy. Comparable property occupancy excludes out of service assets undergoing redevelopment.
Year Ended December 31,
Comparable (1)
Non-Comparable
Properties ResultsProperties ResultsConsolidated Properties Results
 20202019$
Change
%
Change
2020201920202019$
Change
%
Change
Rental income$364,376 $365,656 $(1,280)(0.4)%$18,989 $39,360 $383,365 $405,016 $(21,651)(5.3)%
Property operating expenses(124,123)(122,590)1,533 1.3 %(5,633)(9,758)(129,756)(132,348)(2,592)(2.0)%
NOI$240,253 $243,066 $(2,813)(1.2)%$13,356 $29,602 $253,609 $272,668 $(19,059)(7.0)%
(1)Consists of medical office and life science properties that we have owned and which have been in service continuously since January 1, 2019, including our life science property owned in a joint venture arrangement in which we own a 55%an equity interest; excludes properties classified as held for sale or out of service undergoing redevelopment, if any.interest.
73

Table of Contents
Rental income. Rental income decreased primarily due to a tenant default at one of our dispositionproperties resulting in a write off of 32the corresponding unamortized straight line rent receivable, the deconsolidation of 10 medical office and life science properties since January 1, 2019, assetscurrently owned by an unconsolidated joint venture in which we own an equity interest and certain of our properties being taken out of service and/or currently undergoing redevelopment, partially offset by the acquisition of one property since January 1, 2022 and a decreasean increase in rental income at our comparable properties and at certain of our recently redeveloped properties. Rental income decreasedincreased at our comparable properties primarily due to reduced parking revenuehigher average rents resulting from our new and renewal leasing activity, increases in property operating expense reimbursements at certain of our comparable properties, related to the COVID-19 pandemican early termination fee recognized at one of our properties and increased bad debt, partially offset by higher real estate tax and other property operating expense reimbursementsparking revenue at certain of our comparable properties.
Property operating expenses. Property operating expenses consist of real estate taxes, utility expenses, insurance, management fees, salaries and benefit costs of property level personnel, repairs and maintenance expense, cleaning expense and other direct costs of operating these properties. The decreaseincrease in property operating expenses is primarily due to our disposition of 32 properties since January 1, 2019, partially offset by an increase in property operating expenses at our comparable properties.properties and at certain of our recently developed properties, and our acquisition of one property since January 1, 2022, partially offset by the deconsolidation of 10 medical office and life science properties currently owned by an unconsolidated joint venture in which we own an equity interest. Property operating expenses at our comparable properties increased primarily due to increases in real estate taxesinsurance costs, repairs and insurancemaintenance expense, partially offset by decreases in utility expenses, landscaping expenses, parking expensesutilities expense and other direct costs at certain of our comparable properties.properties, partially offset by decreases in real estate taxes.
Net operating income. The change in NOI reflects the net changes in rental income and property operating expenses described above.
SHOP:
Comparable Properties (1)
All Properties
Comparable Properties (1)
All Properties
As of and For the Year Ended December 31,As of and For the Year Ended December 31, As of and For the Year Ended December 31,
2020201920202019 2023202220232022
Total propertiesTotal properties216 216 235 244 
# of units25,664 25,664 26,969 29,013 
Number of units
OccupancyOccupancy78.1 %85.2 %77.2 %84.4 %Occupancy78.5 %74.5 %78.1 %74.4 %
Average monthly rate (2)
Average monthly rate (2)
$4,551 $4,584 $4,530 $4,614 
68

Table of Contents

Year Ended December 31,
Comparable (1)
Non-Comparable
Properties ResultsProperties ResultsConsolidated Properties Results
 20232022$
Change
%
Change
2023202220232022$
Change
%
Change
Residents fees and services$1,132,280 $1,010,723 $121,557 12.0 %$19,628 $12,103 $1,151,908 $1,022,826 $129,082 12.6 %
Property operating expenses(1,054,545)(996,954)57,591 5.8 %(20,546)(17,146)(1,075,091)(1,014,100)60,991 6.0 %
NOI$77,735 $13,769 $63,966 464.6 %$(918)$(5,043)$76,817 $8,726 $68,091 780.3 %
(1)Consists of senior living communities that we have owned and which have been in service, reported in the same segment and operated by the same operator continuously since January 1, 2019;2022; excludes communities classified as held for sale, closed or closed,out of service, if any.
(2)Average monthly rate is calculated by taking the average daily rate, which is defined as total residents fees and services divided by occupied units during the period, and multiplying it by 30 days.
Year Ended December 31,
Comparable (1)
Non-Comparable
Properties ResultsProperties ResultsConsolidated Properties Results
 20202019$
Change
%
Change
2020201920202019$
Change
%
Change
Rental income$— $132,242 $(132,242)(100.0)%$— $5,656 $— $137,898 $(137,898)(100.0)%
Residents fees and services1,111,318 401,503 709,815 176.8 %93,493 32,094 1,204,811 433,597 771,214 177.9 %
Property operating expenses(998,895)(326,172)672,723 206.2 %(107,706)(30,550)(1,106,601)(356,722)749,879 210.2 %
NOI$112,423 $207,573 $(95,150)(45.8)%$(14,213)$7,200 $98,210 $214,773 $(116,563)(54.3)%
(1)Consists of senior living communities thatwe have owned and which have been operated by the same operator continuously since January 1, 2019; excludes communities classified as held for sale or closed, if any.
As a result of routine monitoring protocols that are a part of Five Star's compliance program activities related to Medicare billing, Five Star discovered potentially inadequate documentation at one of our senior living communities that Five Star manages. This monitoring was not initiated in response to any specific complaint or allegation but rather was of the type that Five Star periodically undertakes to test its compliance with applicable Medicare billing rules. We and Five Star voluntarily disclosed this matter to the OIG pursuant to the OIG's Provider Self-Disclosure Protocol. In January 2021, we and Five Star settled this matter with the OIG and we agreed to pay approximately $5,763 in exchange for a customary release, but we and Five Star did not admit any liability. We paid that amount to the OIG in January 2021. Five Star refunded to us $115 of management fees it previously received relating to the Medicare payments we refunded to the OIG. With respect to this settlement amount, we accrued a revenue reserve of $3,842 at December 31, 2020 for historical Medicare payments we received and agreed to repay to the OIG and we recorded expenses of $1,921 for the year ended December 31, 2020 for OIG-imposed penalties.
Rental income. Rental income decreased due to the termination of our previously existing master leases with Five Star. Pursuant to the Restructuring Transaction, effective January 1, 2020, our previously existing master leases and management and
74

Table of Contents
pooling agreements with Five Star were terminated and replaced with the Five Star management agreements for all of our senior living communities operated by Five Star. See Note 6 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K for information regarding the Restructuring Transaction.
Residents fees and services. Residents fees and services are the revenues earned at our managed senior living communities. We recognize these revenues as services are provided and related fees are accrued. Residents fees and services increased primarily due to the Restructuring Transaction and the resulting change to our management arrangement with Five Star for all of our senior living communities that it operates and our acquisition of one active adult rental property since January 1, 2019, partially offset by decreasesincreases in occupancy and average monthly rate primarilyat our communities and the transfer of three previously leased communities to our SHOP segment in October 2022 as described below, partially offset by one community that was taken out of service due to the impact of the COVID-19 pandemic at both comparable and non-comparable properties for the year ended December 31, 2020 compared to the year ended December 31, 2019. We expect to experience continued downward pressure on our occupancy and average monthly rates as normal resident move-outs may not be replaceddamage sustained by new resident move-ins and potential residents may increasingly delay or forgo moving into senior living communities as a result of the COVID-19 pandemic. Residents fees and services for the year ended December 31, 2020 is net of a $3,842 reserve for a Medicare refund we accrued as of December 31, 2020 and paid in January 2021.Hurricane Ian.
Property operating expenses. Property operating expenses consist of wages and benefit costs of community level personnel, real estate taxes, utility expenses, insurance, salaries and benefit costs of property level personnel, repairs and maintenance expense, management fees, cleaning expense and other direct costs of operating these communities. Property operating expenses increased primarily due to the Restructuring Transactionincreases in labor costs, dietary expenses, insurance costs, increased sales and marketing costs to improve occupancy and the resulting changetransfer of three previously leased communities to our management arrangement with Five Star for allSHOP segment as described below, partially offset by one community that was taken out of our senior living communities that it operates, our acquisition of one active adult rental property since January 1, 2019 and increased costs associated with staffing and suppliesservice due to the COVID-19 pandemic at both comparable and non-comparable properties for the year ended December 31, 2020 compared to the year ended December 31, 2019. As a result of the COVID-19 pandemic, we expect to continue experiencing higher operating expenses primarily drivendamage sustained by increased labor costs and increased cost and consumption of supplies, including personal protective equipment. Property operating expenses for the year ended December 31, 2020 include $1,928 of penalties, compliance costs and professional fees, net of management fees reimbursable by Five Star, related to the Medicare refund we accrued as of December 31, 2020 and paid in January 2021.Hurricane Ian.
Net operating income. The change in NOI reflects the net changes in rental income, residents fees and services and property operating expenses described above.
Non-Segment(1):
 
Comparable Properties (2)
All Properties
 As of and For the Year Ended December 31,As of and For the Year Ended December 31,
 2020201920202019
Total properties:
Other triple net leased senior living communities29 29 29 32 
Wellness centers10 10 10 10 
Rent coverage:
Other triple net leased senior living communities (3)
1.61 x1.71 x1.61 x1.71 x
Wellness centers (3)
1.32 x2.29 x1.32 x2.29 x
 
Comparable Properties (2)
All Properties
 As of and For the Year Ended December 31,As of and For the Year Ended December 31,
 2023202220232022
Total properties:
Triple net leased senior living communities26 26 27 27 
Wellness centers10 10 10 10 
Year Ended December 31,
Comparable (2)
Non-Comparable
Properties ResultsProperties ResultsConsolidated Properties Results
 20232022$
Change
%
Change
2023202220232022$
Change
%
Change
Rental income$37,033 $36,371 $662 1.8 %$837 $1,979 $37,870 $38,350 $(480)(1.3)%
Property operating expenses(1,096)(671)425 63.3 %— — (1,096)(671)425 63.3 %
NOI$35,937 $35,700 $237 0.7 %$837 $1,979 $36,774 $37,679 $(905)(2.4)%
(1)Non-segment operations consists of all of our other operations, including certain senior living communities and wellness centers that are leased to third party operators, other than Five Star and wellness centers, which segment we do not consider to be sufficiently material to constitute a separate reporting segment, and any other income or expenses that are not attributable to a specific reporting segment.
(2)Comparable properties consists of properties that we have owned and which have been leased to the same operator continuously since January 1, 2019; excludes properties classified as held for sale, if any.
(3)All tenant operating data presented is based upon the operating results provided by our tenants for the 12 months ended September 30, 2020 and 2019 or the most recent prior period for which tenant operating results are available to us. Rent coverage is calculated using the operating cash flows from our triple net lease tenants' operations of our properties, before subordinated charges, if any, divided by triple net lease minimum rents payable to us. We have not independently verified tenant operating data. Excludes data for historical periods prior to our ownership of certain properties, as well as data for properties sold or classified as held for sale during the periods presented. Excludes rent coverage for six of our wellness centers, the tenant of which was in default under the applicable leases with us on December 31, 2020.
75

Table of Contents
Year Ended December 31,
Comparable (1)
Non-Comparable
Properties ResultsProperties ResultsConsolidated Properties Results
 20202019$
Change
%
Change
2020201920202019$
Change
%
Change
Rental income$40,753 $45,607 $(4,854)(10.6)%$3,097 $18,037 $43,850 $63,644 $(19,794)(31.1)%
NOI$40,753 $45,607 $(4,854)(10.6)%$3,097 $18,037 $43,850 $63,644 $(19,794)(31.1)%
(1)Consists of properties that we have owned and which have been reported in the same segment and leased to the same operator continuously since January 1, 2019;2022; excludes properties classified as held for sale, if any.

Rental income. Rental income decreased primarily due to the saletermination of 14the lease agreements for three of our senior living communities leased to third-party operators and a decreasewhich were replaced with management agreements under our TRS structure in October 2022, partially offset by an increase in rental income at our comparable properties, partially offset by increased rents resulting from our purchase of improvements at ourproperties. The increase in comparable properties since January 1, 2019. Rentalrental income decreased at our comparable propertieswas primarily due to net leasing activity and increased property operating expense reimbursements at our wellness centers. In January 2023, we agreed to amend the lease for three of these wellness centers and repossess the remaining three wellness centers. In February 2023, we entered into a tenant default under15 year lease, which commenced in June 2023, with a private operator for
69

Table of Contents

one of these repossessed wellness centers. In March 2023, we entered into two separate 20 year leases, which are expected to commence in 2024, with an operator for sixthe remaining two repossessed wellness centers.
Property operating expenses. Property operating expenses consist of real estate taxes and other direct costs of operating certain of our wellness centers on December 31, 2020. Wecenters. Pursuant to an agreement with a previously defaulted tenant in January 2023, we expect to continue to evaluate our options with respectincur real estate taxes and other direct costs for three of these wellness centers. We will also continue to this tenant default. As a result of the COVID-19 pandemic, many of ourpay real estate taxes and other direct costs for two wellness centers had been ordered closed by state or local executive orders. In October 2020,until the lease for our other four wellness centers was renewed for a 12-year term at a lower average rental rate.leases commence, which we expect to occur in 2024.
Net operating income. The change in NOI reflects the net changes in rental income and property operating expenses described above.
Consolidated:
References to changes in the income and expense categories below relate to the comparison of consolidated results for the year ended December 31, 2020,2023, compared to the year ended December 31, 2019.2022.
Depreciation and amortization expense. Depreciation and amortization expense decreasedincreased primarily due to our disposition of 73 properties, certain depreciable leasing related assets becoming fully depreciated and certain of our acquired resident agreements becoming fully amortized since January 1, 2019, partially offset by our acquisition of an active adult rental property and the purchase of capital improvements at certain of our properties, the write off of unamortized assets as a result of a tenant default at one property in our Office Portfolio and the acquisition of one property since January 1, 2019.2022. Increases in depreciation and amortization expenses were partially offset by the deconsolidation of 10 medical office and life science properties owned by an unconsolidated joint venture in which we own an equity interest and certain depreciable assets becoming fully depreciated since January 1, 2022.
General and administrative expense. General and administrative expense consists of fees paid to RMR LLC under our business management agreement, legal and accounting fees, fees and expenses of our Trustees, equity compensation expense and other costs relating to our status as a publicly traded company. General and administrative expense decreased primarily due to a decrease in our base business management fees expense as a result of lower consolidated indebtedness and lower trading prices for our common shares during 20202023 compared to 2019.2022, partially offset by an increase in legal and other professional fees.
Acquisition and certain other transaction related costs. AcquisitionFor the year ended December 31, 2023, acquisition and certain other transaction related costs primarily represent costs incurred in connection with our terminated merger with OPI and costs incurred for financial advisory services regarding our then 2024 debt maturities. For the Restructuring Transaction.years ended December 31, 2023 and 2022, acquisition and certain other transaction related costs also include costs related to the transition of certain senior living communities to other third party managers.
Impairment of assets. For further information about our asset impairment charges, see Note 3 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
Gain on sale of properties. Gain on sale of properties is the net result of our salesales of certain of our properties and joint venture equity interests during 20202023 and 2019.2022. Our aggregate gain on sale of properties during 2023 was not significant. The gain on sale of properties during the year ended December 31, 2022 reflects our sale of 10 medical office and life science properties to the LSMD JV in which we retained a 20% equity interest and our sale of a 10% equity interest in the Seaport JV. For further information regarding gain on sale of properties, see Note 3 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
Dividend income. The decrease in dividend income is the result of our sale on July 1, 2019 of all of the RMR Inc. class A common stock that we owned.
Gains and losses on equity securities, net. Gains and losses on equity securities, net, represent the net realized and unrealized gains and losses to adjust our investment in Five Star and former investment in RMR Inc.AlerisLife to theirits fair values.
Interest and other income. The increase in interest and other income is primarily due to $17,485 of funds we received from the U.S. government pursuant to the CARES Act during the year ended December 31, 2020.
Interest expense. Interest expense increased primarily due to our issuance in June 2020 of $1,000,000 aggregate principal amount of our 9.75% senior notes due in 2025. This increase was partially offset by our redemption in May 2019 of all $400,000 of our 3.25% senior notes due 2019, our prepayment in December 2019 of our $350,000 term loan, a lower interest
76

Table of Contents
rate, as compared to our $350,000 term loan, on the $250,000 term loan we obtained in December 2019, which we subsequently repaid in June 2020, our redemption in April 2020 of all $200,000 of our 6.75% senior notes due 2020, a decrease in average borrowings under our revolving credit facility and decreases in LIBOR, resulting in a decrease in interest expense with respect to our floating rate debt.
Gain on lease termination. Gain on lease termination represents the gain recognized in connection with the Restructuring Transaction.value. For further information regarding the Restructuring Transaction,our former investment in AlerisLife, see Note 610 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
Interest and other income. The decrease in interest and other income is primarily due to $1,581 of funds we received from certain programs under the CARES Act, ARPA and various state programs during the year ended December 31, 2023 compared to $4,327 received during the year ended December 31, 2022, partially offset by higher interest earned during the year ended December 31, 2023, as a result of higher interest rates compared to the year ended December 31, 2022.
Interest expense. Interest expense decreased primarily due to our redemption in June 2022 of $500,000 of our 9.75% senior notes due 2025 and a decrease in average borrowings under our former credit facility in connection with repayments aggregating $700,000 during 2023 related to amendments to and repayment in full of such credit facility in December 2023.
70

Table of Contents

This decrease was partially offset by an increase in interest rates under our former credit facility during 2023 and the issuance of $940,534 of our senior secured notes due 2026 in December 2023, resulting in accretion of the discount totaling $2,720 in the 2023 period.
Loss on modification or early extinguishment of debt. WeDuring the year ended December 31, 2023, we recorded a loss on modification or early extinguishment of debt in connection with amendments to and repayment in full of our then credit facility as well as redemption of $250,000 of our 4.750% senior notes due May 2024. During the year ended December 31, 2022, we also recorded a loss on early extinguishment of debt in connection with our prepaymentredemption of $500,000 of our $250,000 term loan and mortgage9.75% senior notes during the year ended December 31, 2020. We recordeddue 2025, partially offset by a lossgain on early extinguishment of debt in connection with our prepayment of a mortgage notes and of our $350,000 term loan during the year ended December 31, 2019.note in April 2023.
Income tax expense. Income tax expense is the result of operating income we earned in certain jurisdictions where we are subject to state income taxes.
Equity in net earnings of an investee.investees. Equity in net earnings of an investee representsinvestees is the change in the fair value of our proportionate share of earnings frominvestments in our investment in Affiliates Insurance Company, or AIC. The decrease in equity in earnings of an investee is due to the dissolution of AIC in February 2020.unconsolidated joint ventures.
Non-GAAP Financial Measures (dollars in thousands, except per share amounts)
We present certain "non-GAAP financial measures" within the meaning of applicable SEC rules, including FFO, attributable to common shareholders, Normalized FFO attributable to common shareholders and NOI for the years ended December 31, 20202023 and 2019.2022. These measures do not represent cash generated by operating activities in accordance with GAAP and should not be considered alternatives to net income (loss) or net income (loss) attributable to common shareholders as indicators of our operating performance or as measures of our liquidity. These measures should be considered in conjunction with net income (loss) and net income (loss) attributable to common shareholders as presented in our consolidated statements of comprehensive income (loss).operations. We consider these non-GAAP measures to be appropriate supplemental measures of operating performance for a REIT, along with net income (loss) and net income (loss) attributable to common shareholders. We believe these measures provide useful information to investors because by excluding the effects of certain historical amounts, such as depreciation and amortization, they may facilitate a comparison of our operating performance between periods and with other REITs and, in the case of NOI, reflecting only those income and expense items that are generated and incurred at the property level may help both investors and management to understand the operations of our properties.
Funds From Operations and Normalized Funds From Operations Attributable to Common Shareholders
We calculate FFO attributable to common shareholders and Normalized FFO attributable to common shareholders as shown below. FFO attributable to common shareholders is calculated on the basis defined by the National Association of Real Estate Investment Trusts, which is net income (loss) attributable to common shareholders, calculated in accordance with GAAP, excluding any gain or loss on sale of properties, equity in net earnings or losses of unconsolidated joint ventures, loss on impairment of real estate assets, and gains or losses on equity securities, net, if any, and including adjustments to reflect our proportionate share of FFO of our former equity method investment in AlerisLife for the periods we had an equity investment in AlerisLife that we accounted for as an equity method investment and our proportionate share of FFO from our unconsolidated joint ventures, plus real estate depreciation and amortization and minus FFO adjustments attributable to noncontrolling interest,of consolidated properties, as well as certain other adjustments currently not applicable to us. In calculating Normalized FFO, attributable to common shareholders, we adjust for the items shown below and include business management incentive fees,including similar adjustments for our unconsolidated joint ventures, if any, only in the fourth quarter versus the quarter when they are recognized as an expense in accordance with GAAP due to their quarterly volatility not necessarily being indicative of our core operating performance and the uncertainty as to whether any such business management incentive fees will be payable when all contingencies for determining such fees are known at the end of the calendar year.any. FFO attributable to common shareholders and Normalized FFO attributable to common shareholders are among the factors considered by our Board of Trustees when determining the amount of distributions to our shareholders. Other factors include, but are not limited to, requirements to maintain our qualification for taxation as a REIT, limitations in the agreements governing our debt, the availability to us of debt and equity capital, our expectation of our future capital requirements and operating performance and our expected needs for and availability of cash to pay our obligations. Other real estate companies and REITs may calculate FFO attributable to common shareholders and Normalized FFO attributable to common shareholders differently than we do.
Our calculations of FFO attributable to common shareholders and Normalized FFO attributable to common shareholders for the years ended December 31, 20202023 and 20192022 and reconciliations of net income (loss) attributable to common shareholders,, the most directly comparable financial measure under GAAP reported in our consolidated financial statements, to
77

Table of Contents
FFO attributable to common shareholders and Normalized FFO attributable to common shareholders appear in the following table. This table also provides a comparison of distributions to shareholders, FFO attributable to common shareholders and Normalized FFO attributable to common shareholders and net income (loss) attributable to common shareholders per share for these periods.
 For the Year Ended December 31,
 20202019
Net loss attributable to common shareholders$(139,453)$(88,234)
Depreciation and amortization270,147 289,025 
Gain on sale of properties(6,487)(39,696)
Impairment of assets106,972 115,201 
Gains and losses on equity securities, net(34,106)41,898 
FFO adjustments attributable to noncontrolling interest(21,100)(21,147)
FFO attributable to common shareholders175,973 297,047 
Acquisition and certain other transaction related costs814 13,102 
Costs and payment obligations related to compliance assessment at one of our senior living communities5,770 — 
Gain on lease termination (1)
(22,896)— 
Loss on early extinguishment of debt427 44 
Normalized FFO attributable to common shareholders$160,088 $310,193 
Weighted average common shares outstanding (basic)237,739 237,604 
Weighted average common shares outstanding (diluted)237,739 237,604 
Per common share data (basic and diluted):
Net loss attributable to common shareholders$(0.59)$(0.37)
FFO attributable to common shareholders$0.74 $1.25 
Normalized FFO attributable to common shareholders$0.67 $1.31 
Distributions declared$0.18 $0.84 
71

Table of Contents
(1)    Gain on lease termination represents the gain recognized in connection with the Restructuring Transaction. For information regarding the Restructuring Transaction, see Note 6 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
 For the Year Ended December 31,
 20232022
Net loss$(293,572)$(15,774)
Depreciation and amortization284,083 239,280 
Gain on sale of properties(1,205)(321,862)
Impairment of assets18,380 — 
Gains and losses on equity securities, net(8,126)25,660 
Equity in net losses (earnings) of unconsolidated joint ventures20,461 (6,055)
Share of FFO from unconsolidated joint ventures7,738 11,518 
Adjustments to reflect our share of FFO attributable to an equity method investment(1,586)(7,715)
FFO26,173 (74,948)
Acquisition and certain other transaction related costs10,853 2,605 
Loss on modification or early extinguishment of debt2,468 30,043 
Adjustments to reflect our share of Normalized FFO attributable to an equity method investment1,576 3,975 
Normalized FFO$41,070 $(38,325)
Weighted average common shares outstanding (basic and diluted)238,836 238,314 
Per common share data (basic and diluted):
Net loss$(1.23)$(0.07)
FFO$0.11 $(0.31)
Normalized FFO$0.17 $(0.16)
Distributions declared$0.04 $0.04 
Property Net Operating Income (NOI)
We calculate NOI as shown below. The calculation of NOI excludes certain components of net income (loss) in order to provide results that are more closely related to our property level results of operations. We define NOI as income from our real estate less our property operating expenses. NOI excludes amortization of capitalized tenant improvement costs and leasing commissions that we record as depreciation and amortization. We use NOI to evaluate individual and company-wide property level performance. Other real estate companies and REITs may calculate NOI differently than we do.
72

Table of Contents

The calculation of NOI by reportable segment is included above in this Item 7. The following table includes the reconciliation of net income (loss)loss to NOI for the years ended December 31, 20202023 and 2019.2022.
78

Table of Contents
 For the Year Ended December 31,
 20202019
Reconciliation of Net Income (Loss) to NOI:  
Net loss$(134,307)$(82,878)
Equity in earnings of an investee— (400)
Income tax expense1,250 436 
Loss from continuing operations before income tax expense and equity in earnings of an investee(133,057)(82,842)
Loss on early extinguishment of debt427 44 
Gain on lease termination (1)
(22,896)— 
Interest expense201,483 180,112 
Interest and other income(18,221)(941)
Gains and losses on equity securities, net(34,106)41,898 
Dividend income— (1,846)
Gain on sale of properties(6,487)(39,696)
Impairment of assets106,972 115,201 
Acquisition and certain other transaction related costs814 13,102 
General and administrative30,593 37,028 
Depreciation and amortization270,147 289,025 
Total NOI$395,669 $551,085 
Office Portfolio NOI$253,609 $272,668 
SHOP NOI98,210 214,773 
Non-Segment NOI43,850 63,644 
Total NOI$395,669 $551,085 
(1)    Gain on lease termination represents the gain recognized in connection with the Restructuring Transaction. For information regarding the Restructuring Transaction, see Note 6 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
 For the Year Ended December 31,
 20232022
Reconciliation of Net Loss to NOI:  
Net loss$(293,572)$(15,774)
Equity in net losses (earnings) of investees20,461 (6,055)
Income tax expense445 710 
Loss from continuing operations before income tax expense and equity in net (losses) earnings of investees(272,666)(21,119)
Loss on modification or early extinguishment of debt2,468 30,043 
Interest expense191,775 209,383 
Interest and other income(15,536)(15,929)
Gains and losses on equity securities, net(8,126)25,660 
Gain on sale of properties(1,205)(321,862)
Impairment of assets18,380 — 
Acquisition and certain other transaction related costs10,853 2,605 
General and administrative26,131 26,435 
Depreciation and amortization284,083 239,280 
Total NOI$236,157 $174,496 
Office Portfolio NOI$122,566 $128,091 
SHOP NOI76,817 8,726 
Non-Segment NOI36,774 37,679 
Total NOI$236,157 $174,496 
LIQUIDITY AND CAPITAL RESOURCES
Our principal sources of cash to meet operating and capital expenses, pay debt service obligations and make distributions to our shareholders are the operating cash flows we generate as rental income from our leased properties, residents fees and services revenues from our managed communities borrowings under our revolving credit facility and proceeds from the disposition of certain properties. We believe that these sources of funds will be sufficient to meet our operating and capital expenses, pay debt service obligations and make distributions to our shareholders for at least the next 12 months and for the foreseeable future thereafter.months. Our future cash flows from operating activities will depend primarily upon:
our ability to receive rents from our tenants in light of the COVID-19 pandemic and its resulting economic downturn and generally;tenants;
our ability to maintain or increase the occupancy of, and the rental rates at, our properties or reduce the extent of the declines in occupancy and rental rates in response to the COVID-19 pandemic and its resulting economic downturn, particularly at our senior living communities;properties;
our abilityand our managers' abilities to control operating expenses and capital expenses at our properties, including increased operating expenses that we may incur in response to the COVID-19 pandemic;wage and commodity price inflation, limited labor availability and increased insurance costs; and
our manager's ability to operate our managed senior living communities during the COVID-19 pandemic and generally so asmanagers' abilities to maintain or increase our returns or,from our managed senior living communities.
The senior living industry has been adversely affected by a slow recovery from the COVID-19 pandemic, as well as economic and market conditions. These conditions continue to have a significant negative impact on our results of operations, financial position and cash flows. Although there have been signs of recovery and increased demand when compared to the low levels during the COVID-19 pandemic, the recovery of our SHOP segment has been slower than previously anticipated and its resulting economic downturn,uneven, and we cannot be sure when or if the senior living business will return to reducehistoric pre-pandemic levels. To mitigate the extenteffects of the declines in our returns.
We continue to carefully monitor the developments ofslow recovery coming from the COVID-19 pandemic and its resulting economic downturn and their impact onthe increased variability in operating cash flows from our tenants, operators and other stakeholders, including atSHOP communities, we continue to work with our senior living communities.operators to manage costs, especially labor costs, and to increase rates and occupancy. However, increased operating costs resulting from difficult labor market conditions, wage and
7973

Table of Contents

commodity price inflation and increased insurance costs, among other things, continue to negatively impact margins. Additionally, while our senior living operators have increased rates, those rates are increasing gradually and are not increasing at the same pace as our costs, putting further pressure on our margins. In responseorder to increase the operating challenges and uncertain economic challenges asprobability of a recovery of our cash flows, we have continued to invest capital in our SHOP segment. As a result of the COVID-19 pandemic,slow recovery of our SHOP segment and having $700.0 million of outstanding debt then becoming due within one year and only $338.4 million in cash and cash equivalents as of June 2020,30, 2023, we issued $1.0 billionconcluded as of May 8, 2023 that there was a substantial doubt about our ability to continue as a going concern for at least one year from the date of issuance of those condensed consolidated financial statements. Additionally, as of November 1, 2023 we were unable to demonstrate that our plans to alleviate the substantial doubt about our ability to continue as a going concern would be probable in mitigating the conditions that raised the substantial doubt given our plans were beyond our control.
On December 21, 2023, we completed a private offering of $940.5 million in aggregate principal amount at maturity of our 9.75% senior secured notes due 2025.January 2026, with a one-year extension option. The net proceeds from the offering were approximately $730.4 million after deducting initial purchaser discounts and estimated offering costs. We used a portion of the net proceeds from this offering to prepayrepay in full the $450.0 million outstanding under our then secured credit facility and to redeem $250.0 million term loanof our senior notes that waswere scheduled to mature onin May 2024. As a result of these transactions, we have no significant debt maturities until June 12, 20202025 when $500.0 million of our senior notes will become due, and as of December 31, 2023, we had $245.9 million of cash and cash equivalents. Additionally, as of December 31, 2023, our ratio of consolidated income available for debt service to reduce amounts outstandingdebt service is above the 1.5x incurrence requirement under our revolving credit facility. Further in February 2021, we issued $500.0 million aggregate principal amount of 4.375% senior notes, due 2031. We used neton a pro forma basis. As a result, we are able to refinance existing or maturing debt and issue new debt as long as this ratio is at or above 1.5x on a pro forma basis at the time of such refinancing or issuance. Our management has concluded that these transactions have successfully alleviated the conditions that raised the substantial doubt about our ability to continue as a going concern and that no substantial doubt about our ability to continue as going concern exists as of February 26, 2024.
Until its repayment in full and termination on December 21, 2023, we had a $450.0 million credit facility that was fully drawn.
In January 2022, we entered into a joint venture with two unrelated third party institutional investors for 10 medical office and life science properties we owned for aggregate proceeds, before closing costs and other adjustments, of $653.3 million. The equity interests that the investors acquired from this offering to prepay our $200.0 million term loanus equaled 41% and expect to use39%, respectively, of the remaining net proceeds to redeem all of our outstanding 6.75% senior notes due 2021 in June 2021, when those notes become redeemable with no prepayment premium. Also, beginningtotal equity interests in the second quarterjoint venture and we retained a 20% equity interest in the joint venture. Following the sale, we account for this joint venture using the equity method of 2020, we reduced our quarterly cash distribution rateaccounting under the fair value option. The initial investment amounts were based upon a property valuation of approximately $702.5 million, less approximately $456.6 million of secured debt on our common shares to $0.01 per share.the properties incurred by this joint venture.
During the year ended December 31, 2020,In June 2022, we sold 27an additional 10% equity interest in the Seaport JV to an existing joint venture investor for aggregate proceeds, before closing costs and other adjustments, of $108.0 million. After giving effect to this sale, we continue to own a 10% equity interest in this joint venture. Our initial investment amount was based on a property valuation of $1.7 billion, less $620.0 million of existing mortgage debts on the property that this joint venture assumed.
In February 2023, we sold three properties for an aggregate sales price of $152.9$2.8 million, excluding closing costs. In February 2021,October 2023, we sold one medical office propertythree properties for aan aggregate sales price of $9.0 million, excluding closing costs, and as of February 23, 2021, we had four properties under an agreement to sell for a sales price of approximately $95.5$10.8 million, excluding closing costs. The impacts of the COVID-19 pandemic and the resulting economic conditions are likely to cause many of theseIn November 2023, we sold one property sales to be delayed or occur over a protracted period of time or not at all. The measures noted above and anticipated sales of our properties may not sufficiently offset the decrease in cash flows from operations and capital investmentsfor $1.8 million, excluding closing costs. In December 2023, we make during the COVID-19 pandemic, which may negatively impact our liquidity and result in increased borrowings under our revolving credit facility.sold one property for $3.5 million, excluding closing costs.
The following is a summary of our sources and uses of cash flows for the periods presented, as reflected in our consolidated statements of cash flows (dollars in thousands):
Year Ended December 31, Year Ended December 31,
20202019 20232022
Cash and cash equivalents and restricted cash at beginning of periodCash and cash equivalents and restricted cash at beginning of period$52,224 $70,071 
Net cash provided by (used in):Net cash provided by (used in):
Operating activitiesOperating activities158,544 265,845 
Operating activities
Operating activities
Investing activitiesInvesting activities(40,436)86,171 
Financing activitiesFinancing activities(79,483)(369,863)
Cash and cash equivalents and restricted cash at end of periodCash and cash equivalents and restricted cash at end of period$90,849 $52,224 
74

Table of Contents

Our Operating Liquidity and Resources
We generally receive minimum rents from tenants at our tenantsOffice Portfolio properties, triple net leased senior living communities and wellness centers monthly, or quarterly, we receive residents fees and services revenues, net of expenses, from our managed senior living communities monthly and we receive percentage rents from tenants at certain of our senior living community tenantscommunities monthly, quarterly or annually.

The decreasechange in cash provided by (used in) operating activities for the year ended December 31, 20202023 compared to the prior year was primarily due to the Restructuring Transaction and the results from the converted managed communities for the 2020 period being less than our rental income for these communities in the 2019 period, as well as reducedincreased NOI as a result of dispositions of properties during 2019increased rates and 2020 and resulting changesoccupancy at the senior living communities in our working capital assets and liabilities from the converted managed communities which, asSHOP segment. Additionally, interest payments decreased in 2023 compared to 2022 primarily due to our redemption of January 1, 2020, are now included$500,000 of our 9.75% senior notes due 2025 in our consolidated balance sheets. The decreases noted above areJune 2022. These increases were partially offset by a decrease in business management fee expenses in the 2020 period compared to the 2019 period, particularly as a result of no business management incentive fee expense having been paid in the 2020 period.
As noted elsewhere in this Annual Report on Form 10-K, the COVID-19 pandemic has had a substantial adverse impact on the global economy. Depending on the duration and severity of this pandemic and the resulting economic downturn, our tenants' and operators' businesses may become significantly adversely impacted, which may result in their failing to pay rent to us or to renew their leases upon expiration, which would result in our realizing decreased returns from our senior living communities. We have granted requests for certain of our tenants to defer rent payments totaling $2.1 million. As of December 31, 2020, we recognized an increase in costs incurred in connection with our accounts receivable balance related to these deferred rent paymentsterminated merger with OPI.
Although we have seen signs of $1.5 million. These tenants are obligated to pay, in most cases, the deferred rents in 12 equal monthly installments beginning in September 2020. For the three months ended December 31, 2020, we collected approximately 99% of our contractual rents due from tenants in our Office Portfolio segment. While these deferred amounts have not negatively impacted our results of operations, the deferred rents have temporarily reduced our operating cash flows. We are handling requests from our tenants for relief on an individual basis. Asrecovery as it relates to our SHOP segment, we have also deferred approximately $22.2 millionthe recovery of payroll taxes as allowed under the CARES Act. These deferred payroll taxes were included in other liabilities in our consolidated balance sheet as of December 31, 2020 and we expect to pay these deferred taxes in the second half of 2021. We also believe that, other than in our SHOP segment overall tenant retention levelshas been slower than previously anticipated and uneven, and we face and may increase as a result of the COVID-19 pandemic.continue to face issues with limited labor availability and wage inflation along with cost pressures from increased insurance premiums and commodity price inflation and possible reduced demand for senior living communities.
80

Table of Contents
Our Investing Liquidity and Resources
The change in cash used in(used in) provided by investing activities for the year ended December 31, 20202023 compared to the cash provided by investing activities in the prior year was primarily due to lessproceeds in 2022 from our sale of 10 medical office and life science properties to the LSMD JV in which we retained a 20% equity interest and our sale of a 10% equity interest in the Seaport JV, partially offset by a property acquisition in 2022, a decrease in real estate improvements in 2023 compared to 2022, additional proceeds from the sale of real estate properties during 2020in 2023 as compared to 20192022 and our salethe proceeds received from the tender of all of the RMR Inc. class A10,691,658 AlerisLife common stock thatshares we owned at a price of $1.31 per share in the 2019 period, partially offset by a decrease in real estate acquisitions and improvements during 2020 compared to 2019.2023.
The following is a summary of cash used for capital expenditures, development, redevelopment and other activities for the periods presented (dollars in thousands):
For the Year Ended December 31, For the Year Ended December 31,
20202019 20232022
Office Portfolio segment capital expenditures:Office Portfolio segment capital expenditures:
Lease related costs (1)
Lease related costs (1)
$19,364 $26,537 
Lease related costs (1)
Lease related costs (1)
Building improvements (2)
Building improvements (2)
18,119 17,099 
SHOP segment fixed assets and capital improvements64,446 17,196 
Recurring capital expenditures - Office Portfolio segment
SHOP fixed assets and capital improvements
Wellness centers lease related costs (1)
Recurring capital expendituresRecurring capital expenditures$101,929 $60,832 
Development, redevelopment and other activities - Office Portfolio segment (3)
Development, redevelopment and other activities - Office Portfolio segment (3)
$55,642 $30,763 
Development, redevelopment and other activities - SHOP segment(3) (4)
27,098 144,957 
Development, redevelopment and other activities - Office Portfolio segment (3)
Development, redevelopment and other activities - Office Portfolio segment (3)
Development, redevelopment and other activities - SHOP segment (3)
Total development, redevelopment and other activitiesTotal development, redevelopment and other activities$82,740 $175,720 
(1)Office Portfolio segment leaseLease related costs generally include capital expenditures to improve tenants' space or amounts paid directly to tenants to improve their space and other leasing related costs, such as brokerage commissions and tenant inducements.
(2)Office Portfolio segment buildingBuilding improvements generally include capital expenditures to replace obsolete building components that extend the useful life of existing assets or other improvements to increase the marketability of the property.
(3)Development, redevelopment and other activities generally include capital expenditures that reposition a property or result in new sources of revenue.
(4)The year ended December 31, 2019 includes capital improvements for communities that were previously leased to Five Star.
During the year ended December 31, 2020, we invested $2.1 million in revenue producing capital improvements at certain of our triple net leased senior living communities leased to third-party operators, and, as a result, annual rent payable to us increased by approximately $0.1 million pursuant to the terms of the applicable leases. We used cash on hand and borrowings under our revolving credit facility to fund these purchases. These capital improvement amounts are not included in the table above.
During the year ended December 31, 2020, commitments made for expenditures in connection with leasing space in our medical office and life science properties, such as tenant improvements and leasing costs, were as follows (dollars and square feet in thousands, except per square foot amounts):
 New LeasesRenewalsTotal
Square feet leased during the year260 716 976 
Total leasing costs and concession commitments(1)
$16,833 $5,848 $22,681 
Total leasing costs and concession commitments per square foot(1)
$64.63 $8.16 $23.22 
Weighted average lease term (years)(2)
8.5 5.2 6.4 
Total leasing costs and concession commitments per square foot per year(1)
$7.60 $1.58 $3.63 
(1)    Includes commitments made for leasing expenditures and concessions, such as tenant improvements, leasing commissions, tenant reimbursements and free rent.
(2)    Weighted based on annualized rental income pursuant to existing leases as of December 31, 2020, including straight line rent adjustments and estimated recurring expense reimbursements, and excluding lease value amortization.
81

Table of Contents
Wegenerally plan to continue investing capital in our senior living communitiesproperties, including redevelopment projects, to better position these communitiesproperties in their respective markets in order to increase our returns in future years, but certain projectsyears. However, we have been delayeddeferred, and may continue to be delayed in the future duedefer, our capital expenditures to COVID-19 related community access restrictions and other state and local ordinances that may limit our ability to proceed with these projects on a timely basis. Our ability to make capital investments is currently limited pursuant to our credit agreement through the Amendment Period.preserve liquidity.
75

Table of Contents

As of December 31, 2020,2023, we havehad estimated unspent leasing related obligations at our triple net leased senior living communitieswellness centers and our medical office and life science properties of approximately $19.2$54.1 million, of which we expect to spend approximately $9.8$43.3 million during calendar year 2021.2024. We expect to fund these obligations using operating cash flows we generate as rental income from our leased properties, residents fees and services revenues from our managed communities, borrowings under our revolving credit facility andcash on hand, proceeds from the disposition of certain properties.properties, future financing activities with unencumbered properties and proceeds related to distributions from our two unconsolidated joint ventures.
We are currently in the process of redeveloping threecertain properties in our Office Portfolio locatedand a number of our managed senior living communities, which projects are expected to be completed at various times between 2024 and 2025. We continue to assess opportunities to redevelop other properties in Tempe, AZ, San Diego, CAour Office Portfolio and Lexington, MA.SHOP segment. These redevelopment projects may require significant capital expenditures and time to complete. Duringcomplete, and we have deferred, and may in the year ended December 31, 2020,future defer, certain redevelopment projects to preserve liquidity.
In July 2022, we entered into a new 10-year lease at a rental rate that is approximately 20% higher than the prior rental rate for the same space atacquired one of these buildingslife science property located in San Diego, CA. Physical improvements at our redevelopment in San Diego, CA have been substantially completed as of December 31, 2020California with approximately 88,508 square feet for approximately $75.1 million, including closing costs and credits. We funded this acquisition using cash on hand.
Due to labor availability constraints and wage and commodity price inflation, the capital investments we expect to incur additional substantial leasing costs in 2021 to lease the available space. We have continued to progress on our redevelopments during 2020 and expect to continue that progress into 2021.
We expect disruptions to future disposition activity, capital expenditures spending and redevelopment projects due to uncertain market conditions as a result of the COVID-19 pandemic and its resulting economic conditions. As noted above, our abilityplan to make capital investments is currently limited pursuant to our credit agreement through the Amendment Period.may be delayed or cost more than we expect. For further information regarding our acquisitions and dispositions, see Note 3 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
Pursuant to the Restructuring Transaction, on January 1, 2020, Five Star issued 10,268,158 common shares to us and an aggregate of 16,118,849 common shares to our shareholders of record as of December 13, 2019. In consideration of these share issuances, we provided Five Star with $75.0 million of additional consideration. For further information regarding the Restructuring Transaction, see Note 6 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
Our Financing Liquidity and Resources
The decreasechange in cash used in financing activities for the year ended December 31, 20202023 compared to the prior year was primarily due to net proceeds from ourthe issuance in June 2020 of $1.0 billion$940.5 million in aggregate principal amount at maturity of our senior secured notes due 2026 in a private offering, raising net proceeds of $730.4 million, after deducting initial purchaser discounts and estimated offering costs. Additionally, we redeemed in June 2022 $500.0 million of our outstanding 9.75% senior notes decreaseddue 2025. We also made repayments of senior unsecured notesunder our former credit facility aggregating $700.0 million during 2023 as compared to $100.0 million during 2022, and we redeemed in 2020 and a reduction in distributions paid to our shareholders in 2020, partially offset by our prepayment in June 2020December 2023 all $250.0 million of our $250.0 million term loan and increased repayments of borrowings under our revolving credit facility in 2020 compared to 2019.outstanding 4.750% senior notes due May 2024.
As of December 31, 2020,2023, we had $74.4$245.9 million of cash and cash equivalents and no outstanding borrowings under our revolving credit facility.equivalents. We typically use cash balances, borrowings under our revolving credit facility, net proceeds from offerings of securities, debt issuances or equity securities, net proceeds from the dispositiondispositions of assets and the cash flows from our operations to fund our operations, debt repayments, distributions, property acquisitions, investments, capital expenditures and other general business purposes.
In order to fund acquisitionsUntil its repayment in full and to meet cash needs that may result from timing differences between our receipt of rents and our desire or need to make distributions or pay operating or capital expenses,termination on December 21, 2023, we maintainhad a revolving credit facility. The maturity date of our revolving$450,000 credit facility is January 15, 2022, and, subject to the payment of an extension fee and meeting other conditions, we have two, one year options to extend the maturity date of the facility to January 2024. Our revolving credit facility provides that we can borrow, repay and re-borrow funds available under our revolving credit facility until maturity, and no principal repayment is due until maturity. The facility also includes a feature pursuant to which, following the termination of the Amendment Period, in certain circumstances maximum borrowings under the facility may be increased to up to $2.0 billion.was fully drawn. At December 31, 2020,21, 2023, our revolvingformer credit facility required interest to be paid on borrowings at the annual rate of 2.6%8.4%, plus a facility fee of 30 basis points$0.3 million per annum on the total amount of lending commitments under the facility. The interest rate premium and facility fee are each subject to adjustment based upon changes to our credit ratings. As of December 31, 2020 and February 23, 2021, we had no outstanding borrowings under our revolving credit facility.
In June 2020, we amended our credit and term loan agreements through June 30, 2021 in order to provide us with certain flexibility in light of the uncertainties related to the COVID-19 pandemic. In January 2021, we further amended our
82

Table of Contents
credit and term loan agreements to, among other things, obtain waivers from compliance with certain financial covenants through June 2022. Pursuant to the January 2021 amendments:
certain of the financial covenants under our credit and term loan agreements, including covenants that require us to maintain certain financial ratios, have been waived through June 2022;
the revolving credit facility commitments have been reduced from $1.0 billion to $800.0 million;
we pledged certain equity interests of subsidiaries owning properties to secure our obligations under our credit and term loan agreements and agreed to provide first mortgage liens on 91 medical office and life science properties with an aggregate gross book value of real estate assets of $1.4 billion as of December 31, 2020 to secure our obligations, which pledges and/or mortgage liens may be removed or new ones may be added during the Amendment Period based on outstanding debt amounts, among other things;
we have the ability to fund $350.0 million of capital expenditures per year and we are restricted in our ability to acquire real property as defined in the credit agreement;
the interest rate premium over LIBOR under our revolving credit facility and term loan increased by 30 basis points;
certain covenants and restrictions on distributions to common shareholders, share repurchases, capital expenditures, acquiring additional properties and incurring additional indebtedness (in each case subject to various exceptions), and the minimum liquidity requirement of $200.0 million will remain in place during the Amendment Period; and
we are generally required to apply the net cash proceeds from the disposition of assets, capital markets transactions, and debt financings to the repayment of our $300.0 million senior notes due in 2021, or maintain sufficient cash for such payment of these senior notes until they can be paid at par, our $200.0 million term loan and any amounts outstanding under our revolving credit facility. In February 2021, we prepaid in full our $200.0 million term loan using proceeds from our February 2021 issuance of $500.0 million aggregate principal amount of 4.375% senior notes due 2031. We expect to use the remaining net proceeds from this offering to redeem all of our outstanding 6.75% senior notes due 2021 in June 2021, when those notes become redeemable with no prepayment premium.
When significant amounts are outstanding under our revolving credit facility, or as the maturities of our indebtedness approach, we intend to explore refinancing alternatives. Such alternatives may include incurring additional debt, selling certain properties and issuing new equity securities. In addition, we may also seek to participate in joint ventures or other arrangements that may provide us additional sources of financing. We currently have an effective shelf registration statement that allows us to issue public securities on an expedited basis, but it does not assure that there will be buyers for such securities. We may also assume debt in connection with our acquisitions of properties or place new debt on properties we own.
Our $200.0 million term loan that was outstanding as of December 31, 2020 and was scheduled to mature in September 2022 required interest to be paid at the annual rate of 2.8% as of December 31, 2020. As discussed above, we prepaid this term loan in full in February 2021 with proceeds from the issuance of our 4.375% senior notes due 2031.quarter.
During the year ended December 31, 2020,2023, we paid quarterly cash distributions to our shareholders totaling approximately $42.8$9.6 million using existing cash balances and borrowings under our revolving credit facility.balances. For further information regarding the distributions we paid during 2020,2022, see Note 5 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
On January 14, 2021,11, 2024, we declared a quarterly distribution payable to common shareholders of record on January 25, 2021 in the amount22, 2024 of $0.01 per share, or approximately $2.4 million.million in aggregate. We paid this distribution on February 18, 202115, 2024, using cash on hand.
We believe we willmay have access to variouscertain types of financings, including debt or equity offerings, to fund our future acquisitionsoperations and to payrepay our debts and other obligations as they become due. Our ability to complete, and the costs associated with, future debt or equity transactions depends primarily upon credit market conditions and our then creditworthiness.creditworthiness and our ability to be in compliance with our debt covenants as discussed below. We have no control over market conditions. Our credit and debt ratings which were recently downgraded, depend upon evaluations by credit rating agencies of our business practices and plans, including our ability to maintain our earnings, to stagger our debt maturities and to balance our use of debt and equity capital so that our financial performance and leverage ratios afford us flexibility to withstand any reasonably anticipated adverse changes. Similarly, our ability to raise equity capital in the future will depend primarily upon equity capital market conditions and our ability to conduct our business to maintain and grow our
83

Table of Contents
operating cash flows. We intend to conduct our business activities in a manner which will afford us reasonable access to capital for investment and financing activities, but we cannot be sure that we will be able to successfully carry out that intention. As noted elsewhereA protracted negative impact on the economy or the industries in this Annual Report on Form 10-K, it is uncertain whatwhich our properties and businesses operate, wage and commodity price inflation, high interest rates, increased insurance costs, geopolitical risks or other economic, market or industry conditions, including the duration and severitydelayed recovery of the currentsenior housing industry, economic downturn resulting from the COVID-19 pandemic will be. A protracted economic downturndownturns and a possible recession, may have various negative consequences including a decline in financing availability and
76

Table of Contents

increased costs for financing. Further, suchthose conditions could also disrupt capital markets and limit our access to financing from public sources, particularly if the global financial markets experience significant disruptions.
In February 2020,2022, we prepaid a mortgage note securedand our lenders amended our credit agreement. Pursuant to the amendment, among other things, the facility commitments were reduced from $800.0 million to $700.0 million following our repayment of $100.0 million. In February 2022, we exercised our option to extend the maturity date of our former credit facility by one ofyear to January 2024. In January 2023, pursuant to our life science properties with ancredit agreement, we repaid $113.6 million in outstanding principal balance of approximately $1.6 million, a maturity date in March 2026 and an annual interest rate of 6.25%. We prepaid this mortgage using cash on hand and borrowings under our revolvingformer credit facility.facility and the facility commitments were reduced to $586.4 million. In February 2023, we and our lenders further amended our credit agreement. Pursuant to the amendment the facility commitments were reduced from $586.4 million to $450.0 million following our repayment of $136.4 million in then outstanding borrowings.
In April 2020, we redeemed all of our outstanding 6.75% senior notes due 2020 for a redemption price equal to the principal amount of $200.0 million plus accrued and unpaid interest of $6.75 million. We funded this redemption with cash on hand and borrowings under our revolving credit facility.
Also in May 2020,2022, we prepaid a mortgage note secured by one of our medical office properties with an outstanding principal balance of approximately $1.2$10.9 million, a maturity date in JanuaryJuly 2022 and an annual interest rate of 7.49%. We prepaid this mortgage6.28%, using cash on hand and borrowings under our revolving credit facility.hand.
In June 2020,2022, we issued $1.0 billion aggregate principal amountredeemed $500.0 million of our outstanding 9.75% senior notes due 2025 for a redemption price equal to 104.875% of the $500.0 million principal amount of the notes being redeemed plus accrued and unpaid interest of $1.1 million, using restricted cash on hand.
In July 2022, we prepaid a mortgage note secured by two of our senior living communities with an outstanding principal balance of approximately $15.3 million, a maturity date in October 2022 and an underwritten public offering.annual interest rate of 5.75%, using cash on hand.
In October 2022, we repaid at maturity a mortgage note secured by one of our life science properties with an outstanding principal balance of approximately $10.3 million and an annual interest rate of 4.85%, using cash on hand.
In April 2023, we prepaid a mortgage note secured by one of our senior living communities with an outstanding principal balance of approximately $14.6 million, a maturity date in June 2023 and an annual interest rate of 6.64% using cash on hand.
In December 2023, we issued $940.5 million in aggregate principal amount at maturity of our senior secured notes due 2026 in a private offering, raising net proceeds of $730.4 million, after deducting initial purchaser discounts and estimated offering costs. These notes are fully and unconditionally guaranteed, on a joint, several and senior secured basis, by certain of our subsidiaries that own 95 properties, or the Collateral Guarantors, and on a joint, several and unsecured basis, by all of our subsidiaries other than the Collateral Guarantors, except for certain excluded subsidiaries, including pledged subsidiaries under our creditsubsidiaries. These notes and term loan agreements.the guarantees provided by the Collateral Guarantors are secured by a first priority lien and security interest on each of the collateral properties and 100% of the equity interests in each of the Collateral Guarantors. These notes require no cash interest payments to accrue prior to maturity. The accreted value of these secured notes will increase at a rate of 11.25% per annum compounded semiannually on January 15 and July 15 of each year. We used the net proceeds from this offering to prepayrepay in full and terminate our then $450.0 million secured credit facility and to redeem $250.0 million term loan that wasof our senior notes which were scheduled to mature on June 12, 2020 and to reduce amounts outstanding under our revolving credit facility.in May 2024.
In February 2021, we issued $500.0 million aggregate principal amount ofJanuary 2023, Moody's downgraded our 9.75% senior notes due 2025 and our 4.375% senior notes due 2031 in an underwritten public offering. These notes are guaranteed by all of our subsidiaries, except for certain excluded subsidiaries, including pledged subsidiaries under our creditratings from B3 to Caa3 and term loan agreements. We used net proceeds from this offering to prepay our $200.0 million term loan and expect to use the remaining net proceeds to redeem all of our outstanding 6.75% senior notes due 2021 in June 2021, when those notes become redeemable with no prepayment premium.
In March 2020, Standard & Poor's downgraded our issuer credit rating to BB and downgraded the ratings on our then existing senior notes to BB+, and effective April 1, 2020, the interest rate premiums under our revolving credit facility and then existing term loan were increased as a result. In May 2020, Moody's downgraded our then existing unsecured credit rating to Ba2, and the interest rate premiums under our revolving credit facility and then existing term loans were not changed. In February 2021, Moody's downgraded our senior unsecured debt rating from Ba2Caa1 to B1Ca. In September 2023, Moody's downgraded our 9.75% senior notes due 2025 and our 4.375% senior notes due 2031 ratings from Caa3 to Ca and our senior unsecured debt rating from Ca to C. In January 2024, Moody's upgraded our 9.75% senior notes due 2025 and our 4.375% senior notes due 2031 ratings from Ca to Caa3 and our senior unsecured debt rating from C to Ca, and Moody's also assigned a Caa2 rating to our senior secured notes due 2026.
In February 2023, Standard & Poor's downgraded our 9.75% senior notes due 2025 and our 4.375% senior notes due 2031 ratings from BB- to B and our senior unsecured debt rating from B to CCC+. In September 2023, Standard & Poor's downgraded our 9.75% senior notes due 2025 and our 4.375% senior notes due 2031 ratings from B to CCC+ and our senior unsecured debt rating from CCC+ to CCC-. In January 2024, Standard & Poor's upgraded our 9.75% senior notes due 2025 rating from Ba1CCC+ to Ba3B, our 4.375% senior notes due 2031 rating from CCC+ to B and Standard & Poor's downgraded our senior unsecured debt rating from BBCCC- to BB-CCC, and Standard & Poor's also assigned a B rating to our 9.75% senior secured notes due 2025 rating from BB+ to BB, respectively.2026.
Our next significant debt maturity is $500.0 million of senior unsecured notes that mature in June 2025.
77

Table of Contents

For further information regarding our outstanding debt, see Note 9 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
Debt Covenants
Our principal debt obligations at December 31, 20202023 were: (1) $2.7$2.1 billion outstanding principal amount of senior unsecured notes; (2) $200.0$940.5 million outstanding principal amount under our term loan (which we prepaid in February 2021);of senior secured notes; and (3) $684.5$9.1 million aggregate principal amount of mortgage notes (excluding premiums, discounts and net debt issuance costs) secured by seven properties. On February 8, 2021, we issued $500.0 million aggregate principal amount of our 4.375% senior notes due 2031. We used net proceeds from this offering to prepay our $200.0 million term loan and expect to use the remaining net proceeds to redeem all of our outstanding 6.75% senior notes due 2021 in June 2021, when those notes become redeemable with no prepayment premium.one property. For further information regarding our indebtedness, see Note 9 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K.
Our senior unsecured notes are governed by our senior unsecured notes indentures and their supplements. Our credit agreement and our senior unsecured notes indentures and their supplements provide for acceleration of payment of all amounts outstanding upon the occurrence and continuation of certain events of default, such as, in the case of our credit agreement, a change of control of us, as defined, which includes RMR LLC ceasing to act as our business and property manager.default. Our senior unsecured notes indentures and their supplements and our credit agreement also contain covenants that restrict our ability to
84

Table of Contents
incur debts, including debts secured by mortgages on our properties, in excess of calculated amounts and require us to maintain various financial ratios, and our credit agreement contains covenants that restrict our ability to make distributions to our shareholders in certain circumstances.ratios. As of December 31, 2020,2023, we believe we were in compliance with all of the covenants under our senior unsecured notes indentures and their supplements our credit and term loan agreements and our other debt obligations. Although we have takencontinue to take steps to enhance our ability to maintain sufficient liquidity, as noted elsewhere in this Annual Report on Form 10-K, a protracted negative economic impact on the economy or the industries in which our properties and businesses operate resulting from wage or commodity price inflation, high interest rates, geopolitical risks or other economic, market or industry conditions, including the COVID-19 pandemicdelayed recovery of the senior housing industry, economic downturns or a possible recession, may cause increased pressure on our ability to satisfy financial and other covenants. Continued availability of borrowings under our revolving credit facility is subject to our satisfying certain financial covenants and other credit facility conditions. If our operating results and financial condition are significantly negatively impacted by the current economic conditions or otherwise, we may fail to satisfy our debt covenants and conditions under our credit agreement or fail to satisfy our public debt covenants. We expect our ratio of consolidated income available for debt service to debt service could fall below the 1.5x requirement under our revolving credit facility and our public debt covenants in the first half of 2021 as the COVID-19 pandemic continues to have an adverse impact on our operations. We will not be allowed to incur additional debt while this ratio is below 1.5x, and as a result, we may borrow the remaining balance of our revolving credit facility prior to falling below the 1.5x requirement as a precautionary measure in order to increase our cash position and preserve financial flexibility in light of continued uncertainty in the global markets resulting from the COVID-19 pandemic. The proceeds from this borrowing, if made, may be used for general business purposes. Further, if we believe we would not be able to satisfy our financial or other covenants, we would seek waivers, amendments, or in the case of our public debt covenants, draw upon any undrawn amounts from our revolving credit facility prior to any covenant violation, which may lead to increased costs and interest rates, additional restrictive covenants or other lender protections. We can provide no assurance that we would be able to obtain these waivers or amendments or repay the related debt facilities when due, which would lead to an event of default or potential acceleration of amounts due on our outstanding debt.conditions.
Neither ourOur senior unsecured notes indentures and their supplements nor our credit agreement,do not contain provisions for acceleration which could be triggered by our debt ratings. However, under our credit agreement, our senior unsecured debt ratings are used to determine the fees and interest rates we pay. Accordingly, following our debt ratings downgrades, our interest expense and related costs under our credit agreement has increased. See "—Our Financing Liquidity and Resources" above for information regarding recent downgrades ofchanges to our issuer credit rating and senior unsecured debt rating that resulted in a change in the interest rate premiums under our revolving credit facility and term loan.ratings.
Our senior unsecured notes indentures and their supplements contain cross default provisions to any other debts of more than $20.0 million ($50.0 million or more in the case of our senior unsecured notes indentures and supplements entered in February 2016, February 2018, June 2020, February 2021 and February 2021)December 2023). Similarly, our credit agreement have cross default provisions to other indebtedness that is recourse of $25.0 million or more and indebtedness that is non-recourse of $75.0 million or more.
The loan agreements governing the aggregate $620.0 million secured debt financing onrelated to the property owned by our joint ventureSeaport JV contain customary covenants and provide for acceleration of payment of all amounts due thereunder upon the occurrence and continuation of certain events of default.
Supplemental Guarantor Information
In March 2020, We no longer include this $620.0 million of secured debt financing in our consolidated balance sheet following the SEC released Release No. 33-10762, Financial Disclosures About Guarantors and Issuersdeconsolidation of Guaranteed Securities and Affiliates Whose Securities Collateralize a Registrant's Securities, or Release 33-10762. Release 33-10762 amends the disclosure requirements related to certain registered securities under SEC Regulation S-X, Rules 3-10 and 3-16, permitting registrantsnet assets of this joint venture; however, we continue to provide certain alternative financial disclosuresguaranties on this debt. The debt secured by the properties included in the LSMD JV in which we own a 20% equity interest is guaranteed by this joint venture and non-financial disclosures in lieu of separate consolidating financial statements for subsidiary issuers and guarantors of registered debt securities if certain conditions are met. The amendments in Release 33-10762 are generally effective for filings on or after January 4, 2021, with early adoption permitted. We adopted the new disclosure requirements permitted under Release 33-10762 effective for the period ended March 31, 2020.is non-recourse to us.
Supplemental Guarantor Information
On May 28, 2020, we issued $1.0 billion of our 9.75% senior notes due 2025. We subsequently redeemed $500.0 million of this debt in June 2022, with $500.0 million remaining outstanding. On February 3, 2021, we issued $500.0 million of our 4.375% senior notes due 2031. As of December 31, 2020,2023, all $1.0 billion$500.0 million of our 9.75% senior notes due 2025 and all $500.0 million of our 4.375% senior notes due 2031 were fully and unconditionally guaranteed, on a joint, and several basis and on a senior unsecured basis, by all of our subsidiaries, except for certain excluded subsidiaries, including pledged subsidiaries under our credit agreement.subsidiaries. The notes and the guarantees are effectively subordinated to all of our and the subsidiary guarantors' secured indebtedness, respectively, to the extent of the value of the collateral securing such secured indebtedness, and are structurally subordinated to all indebtedness and other liabilities and any preferred equity of any of our subsidiaries that do not guarantee the notes. Our 4.375% senior notes due 2031 are similarly guaranteed by substantially all of our subsidiaries, except for certain excluded subsidiaries, as our 9.75%
85

Table of Contents
senior notes due 2025. Our remaining $1.65$1.1 billion of senior unsecured notes do not have the benefit of any guarantees as of December 31, 2020. See Note 9 for a description of the terms and conditions of these notes, including covenants.2023.
A subsidiary guarantor's guarantee of our 9.75% senior notes due 2025 and our 4.375% senior notes due 2031, as applicable, and all other obligations of such subsidiary guarantor under the indenture governing the notes will automatically terminate and such subsidiary guarantor will automatically be released from all of its obligations under such subsidiary guarantee and the indenture under certain circumstances, including on or after the date (a) the notes have an investment grade rating from two rating agencies and one of such investment grade ratings is a mid-BBB investment grade rating and (b) no default or event of default has occurred and is continuing under the indenture. Our non-guarantor subsidiaries are separate and distinct legal entities and have no obligation, contingent or otherwise, to pay any amounts due on our 9.75% senior notes due 2025 or our 4.375% senior notes due 2031 or the respective guarantees, or to make any funds available therefor, whether by
78

Table of Contents

dividend, distribution, loan or other payments. The rights of holders of our 9.75% senior notes due 2025 and our 4.375% senior notes due 2031, as applicable, to benefit from any of the assets of our non-guarantor subsidiaries are subject to the prior satisfaction of claims of those subsidiaries' creditors and any preferred equity holders. As a result, our 9.75% senior notes due 2025 and our 4.375% senior notes due 2031 and the respective guarantees are structurally subordinated to all indebtedness, guarantees and other liabilities of our subsidiaries that do not guarantee our 9.75% senior notes due 2025 and our 4.375% senior notes due 2031, including guarantees of other indebtedness of ours, payment obligations under lease agreements, trade payables and preferred equity.
The following tables present summarized financial information for guarantor entities and issuer, on a combined basis after eliminating (i) intercompany transactions and balances among the guarantor entities and (ii) equity in earnings from, and any investments in, any subsidiary that is a non-guarantor (dollars in thousands):
December 31, 20202023
Real estate properties, net$5,016,5433,694,759 
Other assets, net380,286502,729 
Total assets$5,396,8294,197,488 
Indebtedness, net$2,815,0492,803,829 
Other liabilities276,223242,093 
Total liabilities$3,091,2723,045,922 
Year Ended December 31, 20202023
Revenues$1,454,4671,225,573 
Expenses1,477,2381,359,041 
Loss from continuing operations(124,714)(302,313)
Net loss(125,964)(323,219)
Net loss attributable to DHC(125,964)
Related Person Transactions
We have relationships and historical and continuing transactions with RMR, LLC, RMR Inc., AlerisLife (including Five StarStar) and others related to them. For further information about these and other such relationships and related person transactions, see Notes 3, 6, 7 and 8 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K, which are incorporated herein by reference and our other filings with the SEC including our definitive Proxy Statement for our 20212024 Annual Meeting of Shareholders, or our definitive Proxy Statement, to be filed with the SEC within 120 days after the fiscal year ended December 31, 2020.2023. For further information about the risks that may arise as a result of these and other related person transactions and relationships, see elsewhere in this Annual Report on Form 10-K, including “Warning Concerning Forward-Looking Statements,” Part I, Item 1, “Business” and Part I, Item 1A, “Risk Factors.” We may engage in additional transactions with related persons, including businesses to which RMR LLC or its subsidiaries provide management services.
86

Table of Contents
Critical Accounting Estimates
Our critical accounting policies are those that will have the most impact on the reporting of our financial condition and results of operations and those requiring significant judgments and estimates. We believe that our judgments and estimates have been and will be consistently applied and produce financial information that fairly presents our results of operations. Our most critical accounting policies involve our investments in real property. These policies affect our:
allocation of purchase prices among various asset categories, including allocations to above and below market leases, and the related impact on the recognition of rental income and depreciation and amortization expenses; and
assessment of the carrying values and impairments of long lived assets.
79

Table of Contents

We allocate the purchase prices of our properties to land, building and improvements based on determinations of the fair values of these assets assuming the properties are vacant. We determine the fair value of each property using methods similar to those used by independent appraisers, which may involve estimated cash flows that are based on a number of factors, including capitalization rates and discount rates, among others. In some circumstances, we engage independent real estate appraisal firms to provide market information and evaluations which are relevant to our purchase price allocations and determinations of depreciable useful lives; however, we are ultimately responsible for the purchase price allocations and determinations of useful lives. We allocate a portion of the purchase price to above market and below market leases based on the present value (using an interest rate which reflects the risks associated with acquired in place leases at the time each property was acquired by us) of the difference, if any, between (i) the contractual amounts to be paid pursuant to the acquired in place leases and (ii) our estimates of fair market lease rates for the corresponding leases, measured over a period equal to the terms of the respective leases. The terms of below market leases that include bargain renewal options, if any, are further adjusted if we determine that renewal is probable. We allocate a portion of the purchase price to acquired in place leases and tenant relationships based upon market estimates to lease up the property based on the leases in place at the time of purchase. In making these allocations, we consider factors such as estimated carrying costs during the expected lease up periods, including real estate taxes, insurance and other operating income and expenses and costs, such as leasing commissions, legal and other related expenses, to execute similar leases in current market conditions at the time a property was acquired by us. We allocate this aggregate value between acquired in place lease values and tenant relationships based on our evaluation of the specific characteristics of each tenant's lease. However, we have not separated the value of tenant relationships from the value of acquired in place leases because such value and related amortization expense is immaterial to our consolidated financial statements. If the value of tenant relationships becomes material in the future, we may separately allocate those amounts and amortize the allocated amount over the estimated life of the relationships.

We regularly evaluate our properties for indicators of impairment. Impairment indicators may include declining tenant or resident occupancy, weak or declining profitability from the property, decreasing tenant cash flows or liquidity, our decision to dispose of an asset before the end of its estimated useful life, and legislative, market or industry changes that could permanently reduce the value of a property. If indicators of impairment are present, we evaluate the carrying value of the related property by comparing it to the expected future cash flows to be generated from that property. If the sum of these expected future cash flows is less than the carrying value, we reduce the net carrying value of the property to its estimated fair value. This analysis requires us to judge whether indicators of impairment exist and to estimate likely future cash flows. The future cash flows are subjective and are based in part on assumptions regarding hold periods, market rents and terminal capitalization rates. If we misjudge or estimate incorrectly or if future tenant operations, market or industry factors differ from our expectations, we may record an impairment charge that is inappropriate or fail to record a charge when we should have done so, or the amount of any such charges may be inaccurate.
These accounting policies involve significant judgments made based upon our experience and the experience of our management and our Board of Trustees, including judgments about current valuations, ultimate realizable value, estimated useful lives, salvage or residual value, the ability and willingness of our tenants to perform their obligations to us, and the current and likely future operating and competitive environments in which our properties are operated. In the future, we may need to revise our carrying value assessments to incorporate information which is not now known, and such revisions could increase or decrease our depreciation expense or impairment charges related to properties we own, result in the classification of our leases as other than operating leases or decrease the carrying values of our assets.
Impact of Government Reimbursement
For the year ended December 31, 2020,2023, substantially all of our NOI was generated from properties where a majority of the revenues are derived from our tenants' and residents' private resources, and a small amount of our NOI was generated from properties where a majority of the revenues are derived from Medicare and Medicaid payments. Nonetheless, we own, and our
87

Table of Contents
tenants, managers and manageroperators operate, facilities in many states that participate in federal and state healthcare payment programs, including the federal Medicare and state Medicaid programs and other federal and state healthcare payment programs. Also, some of our medical office and life science property tenants participate in federal Medicare and state Medicaid programs and other government healthcare payment programs. Because of shifting policy priorities, the current and projected federal budget deficit, other federal spending priorities and challenging fiscal conditions in some states, there have been numerous recent legislative and regulatory actions or proposed actions with respect to federal Medicare rates, state Medicaid rates and federal payments to states for Medicaid programs, as well as existing regulations that impact these matters. Further, there are other existing and recently enacted legislation, and related litigation, related to government payments, insurance and healthcare delivery. Examples of these, and other information regarding such matters and developments, are provided under the caption “Business-Government“Business—Government Regulation and Reimbursement” above in Part I, Item 1 of this Annual Report on Form 10-K. We cannot currently predict the type and magnitude of the potential Medicare and Medicaid policy changes, rate changes or other changes that may be implemented, but we believe that some of these changes will cause these government funded
80

Table of Contents

healthcare programs to fail to provide rates that match our and our tenants' increasing expenses and that such changes may be material and adverse to our future financial results.
During the years ended December 31, 2023, December 31, 2022 and December 31, 2021, we recognized $1.6 million, $4.3 million and $19.6 million, respectively, in interest and other income in our consolidated statements of operations related to funds received under the CARES Act and ARPA.
Seasonality
Senior housing operations have historically reflected modest seasonality. During fourth quarter holiday periods, residents at such facilitiescommunities are sometimes discharged to spend time with family and admission decisions are often deferred. The first quarter of each calendar year usually coincides with increased illness among residents which can result in increased costs or discharges to hospitals. As a result of these and other factors, these operations sometimes produce greater earnings in the second and third quarters of a calendar year and lesser earnings in the fourth and first calendar quarters. We do not expect these seasonal differences to have a material impact upon the ability of our tenants to pay our rent or our ability to fund our managed senior living operations or our other businesses. Our medical office and life science properties and wellness centers do not typically experience seasonality.
Impact of Climate Change
Concerns about climate change have resulted in various treaties, laws and regulations that are intended to limit carbon emissions and address other environmental concerns. These and other laws may cause energy or other costs at our properties to increase. We do not expect the direct impact of these increases to be material to our results of operations, because the increased costs either would be the responsibility of our tenants directly or in the longer term, passed through and paid by tenants of our properties. Although we do not believe it is likely in the foreseeable future, laws enacted to mitigate climate change may make some of our buildings obsolete or cause us to make material investments in our properties, which could materially and adversely affect our financial condition or the financial condition of our tenants or managers and their ability to pay rent or returns to us.
In an effort to reduce the effects of any increased energy costs in the future, we continuously study ways to improve the energy efficiency at all of our properties. Our property manager, RMR, LLC, is a member of the ENERGY STAR program, a joint program of the U.S. Environmental Protection Agency and the U.S. Department of Energy that is focused on promoting energy efficiency at commercial properties through its “ENERGY STAR” partner program, and a member of the U.S. Green Building Council, a nonprofit organization focused on promoting energy efficiency at commercial properties through its leadership in energy and environmental design, or LEED®, green building program. RMR's annual Sustainability Report summarizes the ESG initiatives RMR and its clients, including DHC, employ. RMR's Sustainability Report may be accessed on RMR Inc.'s website at www.rmrgroup.com/corporate-sustainability/default.aspx. The information on or accessible through RMR Inc.'s website is not incorporated by reference into this Annual Report on Form 10-K. For more information, see "Business—Corporate Sustainability" in Part I, Item 1 of this Annual Report on Form 10-K.
Some observers believe severe weather in different parts of the world over the last few years is evidence of global climate change. Severe weather may have an adverse effect on certain properties we own. Rising sea levels could cause flooding at some of our properties, which may have an adverse effect on individual properties we own. We mitigate these risks by procuring, or requiring our tenants to procure, insurance coverage we believe adequate to protect us from material damages and losses resulting from the consequences of losses caused by climate change. However, we cannot be sure that our mitigation efforts will be sufficient or that future storms, rising sea levels or other changes that may occur due to future climate change could not have a material adverse effect on our financial results.
Item 7A.  Quantitative and Qualitative Disclosures About Market Risk.
We are exposed to risks associated with market changes in interest rates. We manage our exposure to this market risk by monitoring available financing alternatives. Other than as described below, we do not currently foresee any significant changes in our exposure to fluctuations in interest rates or in how we manage this exposure in the near future.
88

Table of Contents
Although we have no present plans to do so, weWe may in the future enter into hedge arrangements or derivative contracts from time to time to mitigate our exposure to changes in interest rates.
81

Table of Contents

Fixed Rate Debt
At December 31, 2020,2023, our outstanding fixed rate debt included the following (dollars in thousands):
 AnnualAnnual    Annual 
PrincipalInterestInterest Interest PrincipalInterest Interest
DebtDebt
Balance (1)
Rate (1)
ExpenseMaturityPayments Due  Debt
Balance (1)
Rate (1)
ExpenseMaturityPayments Due  
Senior unsecured notes (2)
$300,000 6.75 %$20,250 2021Semi-Annually
Senior unsecured notesSenior unsecured notes250,000 4.75 %11,875 2024Semi-AnnuallySenior unsecured notes500,000 9.750 9.750 %48,750 20252025Semi-Annually
Senior secured notes (2)
Senior secured notes (2)
940,534 0.000 %— 2026At Maturity
Senior unsecured notesSenior unsecured notes1,000,000 9.75 %97,500 2025Semi-AnnuallySenior unsecured notes500,000 4.750 4.750 %23,750 20282028Semi-Annually
Senior unsecured notesSenior unsecured notes500,000 4.75 %23,750 2028Semi-AnnuallySenior unsecured notes500,000 4.375 4.375 %21,875 20312031Semi-Annually
Senior unsecured notesSenior unsecured notes350,000 5.63 %19,705 2042QuarterlySenior unsecured notes350,000 5.625 5.625 %19,688 20422042Quarterly
Senior unsecured notesSenior unsecured notes250,000 6.25 %15,625 2046QuarterlySenior unsecured notes250,000 6.250 6.250 %15,625 20462046Quarterly
Mortgage noteMortgage note11,838 6.28 %743 2022MonthlyMortgage note9,109 6.444 6.444 %587 20432043Monthly
Mortgage note10,724 4.85 %520 2022Monthly
Mortgage note15,805 5.75 %909 2022Monthly
Mortgage note15,646 6.64 %1,039 2023Monthly
Mortgage notes (3)
620,000 3.53 %21,886 2026Monthly
Mortgage note10,470 4.44 %465 2043Monthly
$3,334,483 $214,267    $3,049,643 $$130,275   
(1)The principal balances and interest rates are the amounts stated in the applicable contracts. In accordance with GAAP, our carrying values and recorded interest expense may differ from these amounts because of market conditions at the time we assumed certain of these debts. This table does not include obligations under finance leases.
(2)In February 2021, we issued $500,000 aggregateThese notes require no cash interest to accrue prior to maturity and will accrete at a rate of 11.25% per annum compounded semiannually on January 15 and July 15 of each year, such that the accreted value will equal the principal amount of 4.375% senior notes due 2031. We used net proceeds from this offering prepay our $200,000 term loan and expect to use the remaining net proceeds to redeem all of our outstanding 6.75% senior notes due 2021 in June 2021, when those notes become redeemable with no prepayment premium.
(3)The life science property encumbered by these mortgages is owned in a joint venture arrangement in which we own a 55% equity interest. The principal amounts listed in the table for these debts have not been adjusted to reflect the equity interest in the joint venture that we do not own.at maturity.
No principal repayments are due under our unsecuredsenior notes until maturity. Our mortgage notes generally require principal and interest payments through maturity pursuant to amortization schedules. Because these debts require interest to be paid at a fixed rate, changes in market interest rates during the term of these debts will not affect our interest obligations. If these debts were refinanced at interest rates which are one percentage point higher or lower than shown above, our annual interest cost would increase or decrease by approximately $33.3 million.$21.1 million, which amount excludes our $940.5 million of our senior secured notes due 2026 as no interest is due until maturity.
Changes in market interest rates also would affect the fair value of our fixed rate debt obligations; increases in market interest rates decrease the fair value of our fixed rate debt, while decreases in market interest rates increase the fair value of our fixed rate debt. Based onIn response to significant and prolonged increases in inflation, the balances outstanding at December 31, 2020, and discounted cash flows analyses through the respective maturity dates, and assuming no other changes in factors that may affect the fair value of our fixed rate debt obligations, a hypothetical immediate one percentage point increase inU.S. Federal Reserve has raised interest rates would changemultiple times since the fair valuebeginning of those obligations by approximately $34.6 million.2022. Although the U.S. Federal Reserve has indicated that it may lower interest rates in 2024, we cannot be sure that it will do so, and interest rates may remain at the current high levels or continue to increase.
Our senior unsecured notes and certain of our mortgagesdebt agreements contain provisions that allow us to make repayments earlier than the stated maturity date. In some cases, we are not allowed to make early repayment prior to a cutoff date and we are generally allowed to make prepayments only at a premium equal to a make whole amount, as defined, which is generally designed to preserve a stated yield to the noteholder. In the past, we have repurchased and retired some of our outstanding debtsdebt and we may do so again in the future. These prepayment rights and our ability to repurchase and retire outstanding debt may afford us opportunities to mitigate the risk of refinancing our debts at maturity at higher rates by refinancing prior to maturity.
89

Table of Contents
Floating Rate Debt
At December 31, 2020, our2023 and February 21, 2024, we did not have any floating rate debt obligations consisted of our $1.0 billion revolving credit facility, under whichobligations. In December 2023, we had norepaid all amounts outstanding borrowings, and our $200.0 million term loan. Pursuant to the January 2021 amendments to our credit and term loan agreements, the revolving credit facility commitments have been reduced from $1.0 billion to $800.0 million. Our revolving credit facility matures in January 2022, and, subject to the payment of an extension fee and meeting other conditions, we have two, one year options to extend the maturity date of the facility to January 2024. Generally, no principal repayments are required under our revolving credit facility prior to maturity, and we can borrow, repay and re-borrow funds available, subject to conditions, at any time without penalty. We prepaid our $200.0 million term loan in February 2021 with a portion of the net proceeds from the issuance of our 4.375% senior notes due 2031.
Borrowings under our revolvingthen secured credit facility and term loan are in U.S. dollars and interest is required to be paid at the rate of LIBOR plus premiums that are subject to adjustment based upon changes to our credit ratings. Accordingly, we are exposed to interest rate risk for changes in U.S. dollar based short term rates, specifically LIBOR, and to changes in our credit ratings. In addition, upon renewal or refinancing of our revolving credit facility or our term loan, we are vulnerable to increases in interest rate premiums due to market conditions or our perceived credit characteristics. Generally, a change in interest rates would not affect the value of our floating rate debt but would affect our operating results.
The following table presents the impact a one percentage point increase in interest rates would have on our annual floating rate interest expense as of December 31, 2020 (dollars in thousands except per share amounts):
 Impact of Changes in Interest Rates
 
Interest Rate (1)
Outstanding
Floating Rate Debt
Total Interest
Expense Per Year
Annual
Earnings per Share
Impact(2)
At December 31, 20202.75 %$200,000 $5,500 $0.02 
One percentage point increase3.75 %$200,000 $7,500 $0.03 
(1)Weighted based on the respective interest rates and outstanding borrowings under our credit facility and term loan as of December 31, 2020.
(2)Based on weighted average number of shares outstanding (basic and diluted) for the year ended December 31, 2020.
The following table presents the impact a one percentage point increase in interest rates would have on our annual floating rate interest expense as of December 31, 2020 if we were fully drawn on our revolving credit facility and our term loan remained outstanding (dollars in thousands except per share amounts):
 Impact of Changes in Interest Rates
 
Interest Rate (1)
Outstanding
Floating Rate Debt
Total Interest
Expense Per Year
Annual
Earnings per Share
Impact(2)
At December 31, 20202.58 %$1,200,000 $30,960 $0.13 
One percentage point increase3.58 %$1,200,000 $42,960 $0.18 
(1)    Weighted based on the respective interest rates and outstanding borrowings under our credit facility (assuming fully drawn) and term loan as of December 31, 2020.
(2)    Based on weighted average number of shares outstanding (basic and diluted) for the year ended December 31, 2020.
The foregoing tables show the impact of an immediate increase in floating interest rates. If interest rates were to increase gradually over time, the impact would be spread over time. Our exposure to fluctuations in floating interest rates will increase or decrease in the future with increases or decreases in the amount of our borrowings outstanding under our revolving credit facility or other floating rate debt. Further, as noted above, in January 2021, the maximum capacity on our revolving credit facility was reduced to $800.0 million and we prepaid our $200.0 million term loan.
LIBOR Phase Out
LIBOR is currently expected to be phased out for new contracts by December 31, 2021 and for pre-existing contracts by June 30, 2023. We are required to pay interest on borrowings under our revolving credit facility and term loan at floating
90

Table of Contents
rates based on LIBOR. Interest we may pay on any future debt that we may incur may also require that we pay interest based upon LIBOR. We currently expect that the determination of interest under our credit facility and term loan agreements would be revised as provided underterminated the agreement or amended as necessary to provide for an interest rate that approximates the existing interest rate as calculated in accordance with LIBOR. Despite our current expectations, we cannot be sure that, if LIBOR is phased out or transitioned, the changes to the determination of interest under our agreements would approximate the current calculation in accordance with LIBOR. We do not know what standard, if any, will replace LIBOR if it is phased out or transitioned.governing such credit facility.
Item 8.  Financial Statements and Supplementary Data.
The information required by this item is included in Part IV, Item 15 of this Annual Report on Form 10-K.
Item 9.  Changes in and Disagreements With Accountants on Accounting and Financial Disclosure.
None.
82

Table of Contents

Item 9A.  Controls and Procedures.
As of the end of the period covered by this Annual Report on Form 10-K, our management carried out an evaluation, under the supervision and with the participation of our Managing Trustees, our President and Chief OperatingExecutive Officer and our Chief Financial Officer and Treasurer, of the effectiveness of our disclosure controls and procedures pursuant to Rules 13a-15 and 15d-15 under the Exchange Act. Based upon that evaluation, our Managing Trustees, our President and Chief OperatingExecutive Officer and our Chief Financial Officer and Treasurer concluded that our disclosure controls and procedures are effective.
There have been no changes in our internal control over financial reporting during the quarter ended December 31, 20202023 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.
Management Report on Assessment of Internal Control Over Financial Reporting.
We are responsible for establishing and maintaining adequate internal control over financial reporting. Our internal control system is designed to provide reasonable assurance to our management and Board of Trustees regarding the preparation and fair presentation of published financial statements. All internal control systems, no matter how well designed, have inherent limitations. Therefore, even those systems determined to be effective can provide only reasonable assurance with respect to financial statement preparation and presentation.
Our management assessed the effectiveness of our internal control over financial reporting as of December 31, 2020.2023. In making this assessment, it used the criteria set forth by the Committee of Sponsoring Organizations of the Treadway Commission in Internal Control—Integrated Framework (2013 framework). Based on this assessment, we believe that, as of December 31, 2020,2023, our internal control over financial reporting is effective.
Deloitte & Touche LLP, the independent registered public accounting firm that audited our 20202023 Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K, has issued an attestation report on our internal control over financial reporting. The report appears elsewhere herein.
Item 9B.  Other Information.
None.During the three months ended December 31, 2023, none of our Trustees and officers adopted or terminated a "Rule 10b5-1 trading arrangement" or "non-Rule 10b5-1 trading arrangement", as each term is defined in Item 408(a) of Regulation S-K.
Item 9C.  Disclosure Regarding Foreign Jurisdictions that Prevent Inspections.
Not applicable.
PART III
Item 10.  Directors, Executive Officers and Corporate Governance.
We have a Code of Conduct that applies to our officers and Trustees, RMR Inc. and RMR LLC, senior level officers of RMR LLC, senior level officers and directors of RMR Inc. and certain other officers and employees of RMR LLC.Trustees. Our Code of Conduct is posted on our website, www.dhcreit.com. A printed copy of our Code of Conduct is also available free of charge to any person who requests a copy by writing to our Secretary, Diversified Healthcare Trust, Two Newton Place, 255 Washington Street, Suite 300, Newton, MA 02458-1634. We intend to satisfy the requirements under Item 5.05 of Form 8-K regarding disclosure of amendments to, or waivers from, provisions of our Code of Conduct tothat apply to our principal executive officer,
91

Table of Contents
principal financial officer, principal accounting officer or controller, or any persons performing similar functions, on our website.
The remainder of the information required by Item 10 is incorporated by reference to our definitive Proxy Statement.
Item 11.  Executive Compensation.
The information required by Item 11 is incorporated by reference to our definitive Proxy Statement. 
83

Table of Contents

Item 12.  Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters.
Equity Compensation Plan Information. We may award common shares to our officers and other employees of RMR LLC under our Amended and Restated 2012 Equity Compensation Plan, as amended, or the 2012 Plan. In addition, each of our Trustees receives common shares as part of his or her annual compensation for serving as a Trustee and such shares are awarded under the 2012 Plan. The terms of awards made under the 2012 Plan are determined by the Compensation Committee of our Board of Trustees at the time of the awards. The following table is as of December 31, 2020:2023:
Number of securities to be
issued upon exercise of
outstanding options,
warrants and rights
Weighted-average
exercise price of
outstanding options,
warrants and rights
Number of securities
remaining available for
future issuance under our
equity compensation plan
excluding securities
reflected in column (a)
  Number of securities to be
issued upon exercise of
outstanding options,
warrants and rights
Weighted-average
exercise price of
outstanding options,
warrants and rights
Number of securities
remaining available for
future issuance under our
equity compensation plan
excluding securities
reflected in column (a)
 
Plan CategoryPlan Category(a)(b)(c) Plan Category(a)(b)(c) 
Equity compensation plans approved by securityholders—2012 PlanEquity compensation plans approved by securityholders—2012 PlanNone.None.1,843,617 (1)Equity compensation plans approved by securityholders—2012 PlanNone.1,938,197 (1)(1)
Equity compensation plan not approved by securityholdersEquity compensation plan not approved by securityholdersNone.None.None.
TotalTotalNone.None.1,843,617 (1)
Total
TotalNone.1,938,197 (1)
(1)Consists of common shares available for issuance pursuant to the terms of the 2012 Plan. Share awards that are repurchased or forfeited will be added to the common shares available for issuance under the 2012 Plan.
Payments by us to RMR LLC employees are described in Notes 5 and 8 to our Consolidated Financial Statements included in Part IV, Item 15 of this Annual Report on Form 10-K. The remainder of the information required by Item 12 is incorporated by reference to our definitive Proxy Statement.
Item 13.  Certain Relationships and Related Transactions, and Director Independence.
The information required by Item 13 is incorporated by reference to our definitive Proxy Statement.
Item 14.  Principal Accountant Fees and Services.
The information required by Item 14 is incorporated by reference to our definitive Proxy Statement. 
9284

Table of Contents

PART IV
Item 15.  Exhibits and Financial Statement Schedules.
(a)    Index to Financial Statements and Financial Statement Schedules
The following consolidated financial statements and financial statement schedules of Diversified Healthcare Trust are included on the pages indicated:
 Page
All other schedules for which provision is made in the applicable accounting regulations of the SEC are not required under the related instructions, or are inapplicable, and therefore have been omitted.
Financial information about Five Star may be found on the SEC's website by entering Five Star's name at http://www.sec.gov/edgar/searchedgar/companysearch.html. Reference to Five Star's financial information on this external website is presented to comply with applicable accounting regulations of the SEC. Except for such financial information contained therein as is required to be included herein under such regulations, Five Star's public filings and other information located in external websites are not incorporated by reference into these financial statements.

9385

Table of Contents

(b)    Exhibits
Exhibit
Number
Description
3.1
3.2
3.3
3.4
3.5
4.1
4.2
4.3
4.4
4.5
4.64.4
4.74.5
4.84.6
4.94.7
4.8
4.9
4.10
4.11
4.114.12
86

Table of Contents

4.13
4.14
4.15
4.16
4.124.17
8.1
10.1
10.2
10.3
10.310.4
10.4
94

Table of Contents
10.5
10.6
10.710.6
10.810.7
10.9
10.1010.8
10.1110.9
10.12
10.10
10.11
10.12
10.13
10.14
10.15
87

Table of Contents

10.16
10.14
10.15
10.16
10.17
10.18
10.19
10.20
10.18
21.1
22.1
23.1
23.2
23.3
31.1
31.2
31.3
31.4
95

Table of Contents
32.1
99.197.1
99.2
99.3
101.INSXBRL Instance Document - the instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.
101.SCHXBRL Taxonomy Extension Schema Document. (Filed herewith.)
101.CALXBRL Taxonomy Extension Calculation Linkbase Document. (Filed herewith.)
101.DEFXBRL Taxonomy Extension Definition Linkbase Document. (Filed herewith.)
101.LABXBRL Taxonomy Extension Label Linkbase Document. (Filed herewith.)
101.PREXBRL Taxonomy Extension Presentation Linkbase Document. (Filed herewith.)
104Cover Page Interactive Data File. (Formatted as Inline XBRL and contained in Exhibit 101.)

(+) Management contract or compensatory plan or arrangement.
9688

Table of Contents

Item 16.  Form 10-K Summary.
None.
9789

Table of Contents

REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Trustees and Shareholders of Diversified Healthcare Trust
Opinion on the Financial Statements
We have audited the accompanying consolidated balance sheetsheets of Diversified Healthcare Trust (the "Company") as of December 31, 2020,2023 and 2022, the related consolidated statements of comprehensive income (loss),operations, shareholders' equity, and cash flows, for each of the yearthree years in the period ended December 31, 2020,2023, and the related notes and financial statementthe schedule listed in the Index at Item 15(a) (collectively referred to as the "financial statements"). In our opinion, the financial statements present fairly, in all material respects, the financial position of the Company as of December 31, 2020,2023 and 2022, and the results of its operations and its cash flows for each of the yearthree years in the period ended December 31, 2020,2023, in conformity with accounting principles generally accepted in the United States of America.
We have also audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) (PCAOB), the Company's internal control over financial reporting as of December 31, 2020,2023, based on criteria established in Internal Control — Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission and our report dated February 25, 2021,26, 2024, expressed an unqualified opinion on the Company's internal control over financial reporting.
Basis for Opinion
These financial statements are the responsibility of the Company's management. Our responsibility is to express an opinion on the Company's financial statements based on our audit.audits. We are a public accounting firm registered with the PCAOB and are required to be independent with respect to the Company in accordance with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.
We conducted our auditaudits in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement, whether due to error or fraud. Our auditaudits included performing procedures to assess the risks of material misstatement of the financial statements, whether due to error or fraud, and performing procedures that respond to those risks. Such procedures included examining, on a test basis, evidence regarding the amounts and disclosures in the financial statements. Our auditaudits also included evaluating the accounting principles used and significant estimates made by management, as well as evaluating the overall presentation of the financial statements. We believe that our audit providesaudits provide a reasonable basis for our opinion.
Critical Audit MattersMatter
The critical audit matter communicated below is a matter arising from the current-period audit of the financial statements that was communicated or required to be communicated to the audit committee and that (1) relates to accounts or disclosures that are material to the financial statements and (2) involved our especially challenging, subjective, or complex judgments. The communication of critical audit matters does not alter in any way our opinion on the financial statements, taken as a whole, and we are not, by communicating the critical audit matter below, providing a separate opinion on the critical audit matter or on the accounts or disclosures to which it relates.
Impairment of Real Estate Properties - Refer to NotesNote 3 and 10 to the financial statements
Critical Audit Matter Description
The Company's investments in real estate assetsproperties are evaluated for impairment periodically or when events or changes in circumstances indicate that the carrying amount of a real estate assetproperty may not be recoverable. TheImpairment indicators may include declining tenant or resident occupancy, weak or declining profitability from the property, decreasing tenant cash flows or liquidity, the Company's evaluationdecision to dispose of a property before the end of its estimated useful life, and legislative, market or industry changes that could permanently reduce the value of a property. If indicators of impairment are identified for any real estate property, the Company evaluates the recoverability of that real estate assets involves the comparison ofproperty by comparing undiscounted future cash flows expected to be generated by eachthe real estate assetproperty over the Company's estimated holdingexpected remaining hold period to the respective carrying amount. The Company's undiscounted future cash flows analysis and the assessment of expected remaining holding period requires management to make significant estimates and assumptions related to future occupancy levels, rental rates, estimated sale proceeds,expected remaining hold periods, market rents, and terminal capitalization rates.
In the event that a real estate asset is not recoverable, the Company will adjust the real estate asset to its fair value based on third-party appraisals, broker selling estimates, sale agreements under negotiation, and/or final selling prices, when available, and recognize an impairment loss for the carrying amount in excess of fair value. During the year ended December 31, 2020, the Company identified ten real estate properties that had generated and continued to generate negative operating cash flows
F-1

Table of Contents

and elected to cease operations at seven of the properties. The Company recorded an impairment charge of $59.8 million in connection with change in planned use of nine of the properties.
We identified the impairment of real estate assetsproperties as a critical audit matter, because ofspecifically the significant estimates and assumptions management makes to evaluate the recoverability of and fair value of real estate assets.properties. This required a high degree of auditor judgment and an increased extent of effort when performing audit procedures to evaluate the reasonableness of the significant estimates and assumptions related to expected remaining hold periods, market rents, and terminal capitalization rates within management's undiscounted future cash flows analysis the assessment of expected remaining holding period, and the determination of fair value, each of which are sensitive to future market or industry considerations.
How the Critical Audit Matter Was Addressed in the Audit
Our audit procedures related to the undiscounted cash flows analysis and the assessmentfor each real estate property or group of the expected remaining hold periodproperties with possible impairment indicators included the following among others:
We tested the effectiveness of controls over management's evaluation of the recoverability of real estate property assets,properties, including the key inputsassumptions utilized in estimating the undiscounted future cash flows.
We evaluated the undiscounted cash flow analysis including estimates of future occupancy levels, rental rates, estimated sale proceeds,expected remaining hold period, market rents, and terminal capitalization rates for each real estate assetproperty or group of assetsproperties with possible impairment indicators by (1) evaluating the source information and assumptions used by management and (2) testing the mathematical accuracycomparing management's projections to external market sources and evidence obtained in other areas of the undiscounted future cash flows analysis.our audit.
We evaluated the reasonableness of management's undiscounted future cash flows analysis by comparing management's projectionsdeveloping an independent expectation of future undiscounted cash flows based on third party market data and compared that independent estimate to external market sources and evidence obtained in other areasthe carrying amount of the real estate property or group of properties with possible indicators of impairment. We compared our audit.analysis of the recoverability of the real estate property or group of properties to the Company's analysis.
We made inquiries of management about the current status of potential transactions and about management's judgments to understand the probability of future events that could affect the expected remaining hold period and other cash flow assumptions for the properties.
We evaluated the Company's determination of fair value for those assets with impairment indicators by performing the following:
With the assistance of our fair value specialists, we evaluated the reasonableness of the (1) valuation methodologies; (2) significant assumptions made, including third-party appraisals and estimated sale proceeds based on market comparable transactions; and (3) mathematical accuracy of the calculation by developing a range of independent estimates and comparing our estimates to those used by management.

/s/ Deloitte & Touche LLP
Boston, Massachusetts
February 25, 202126, 2024
We have served as the Company's auditor since 2020.
F-2

Table of Contents

REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Trustees and Shareholders of Diversified Healthcare Trust
Opinion on Internal Control over Financial Reporting
We have audited the internal control over financial reporting of Diversified Healthcare Trust (the “Company”) as of December 31, 2020,2023, based on criteria established in Internal Control — Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). In our opinion, the Company maintained, in all material respects, effective internal control over financial reporting as of December 31, 2020,2023, based on criteria established in Internal Control — Integrated Framework (2013) issued by COSO.
We have also audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) (PCAOB), the consolidated financial statements as of and for the year ended December 31, 2020,2023, of the Company and our report dated February 25, 2021,26, 2024, expressed an unqualified opinion on those financial statements.
Basis for Opinion
The Company's management is responsible for maintaining effective internal control over financial reporting and for its assessment of the effectiveness of internal control over financial reporting, included in the accompanying Management Report on Assessment of Internal Control over Financial Reporting. Our responsibility is to express an opinion on the Company's internal control over financial reporting based on our audit. We are a public accounting firm registered with the PCAOB and are required to be independent with respect to the Company in accordance with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.
We conducted our audit in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether effective internal control over financial reporting was maintained in all material respects. Our audit included obtaining an understanding of internal control over financial reporting, assessing the risk that a material weakness exists, testing and evaluating the design and operating effectiveness of internal control based on the assessed risk, and performing such other procedures as we considered necessary in the circumstances. We believe that our audit provides a reasonable basis for our opinion.
Definition and Limitations of Internal Control over Financial Reporting
A company's internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles. A company's internal control over financial reporting includes those policies and procedures that (1) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the company; (2) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with generally accepted accounting principles, and that receipts and expenditures of the company are being made only in accordance with authorizations of management and directors of the company; and (3) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of the company's assets that could have a material effect on the financial statements.
Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate.

/s/ Deloitte & Touche LLP
Boston, Massachusetts
February 25, 202126, 2024
F-3

Table of Contents
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
To the Trustees and Shareholders of Diversified Healthcare Trust
Opinion on the Financial Statements
We have audited the accompanying consolidated balance sheet of Diversified Healthcare Trust (the Company) as of December 31, 2019, the related consolidated statements of comprehensive income (loss), shareholders' equity and cash flows for each of the two years in the period ended December 31, 2019, and the related notes and financial statement schedule listed in the Index at Item 15(a) (collectively referred to as the “consolidated financial statements”). In our opinion, the consolidated financial statements present fairly, in all material respects, the financial position of the Company at December 31, 2019, and the results of its operations and its cash flows for each of the two years in the period ended December 31, 2019, in conformity with U.S. generally accepted accounting principles.
We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) (PCAOB), the Company's internal control over financial reporting as of December 31, 2019, based on criteria established in Internal Control-Integrated Framework issued by the Committee of Sponsoring Organizations of the Treadway Commission (2013 framework), and our report dated March 2, 2020 expressed an unqualified opinion thereon.
Basis for Opinion
These financial statements are the responsibility of the Company's management. Our responsibility is to express an opinion on the Company's financial statements based on our audits. We are a public accounting firm registered with the PCAOB and are required to be independent with respect to the Company in accordance with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.
We conducted our audits in accordance with the standards of the PCAOB. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement, whether due to error or fraud. Our audits included performing procedures to assess the risks of material misstatement of the financial statements, whether due to error or fraud, and performing procedures that respond to those risks. Such procedures included examining, on a test basis, evidence regarding the amounts and disclosures in the financial statements. Our audits also included evaluating the accounting principles used and significant estimates made by management, as well as evaluating the overall presentation of the financial statements. We believe that our audits provide a reasonable basis for our opinion.

/s/ Ernst & Young LLP
We served as the Company's auditor from 1998 to 2020.
Boston, Massachusetts
March 2, 2020

F-4

Table of Contents
DIVERSIFIED HEALTHCARE TRUST
CONSOLIDATED BALANCE SHEETS
(dollars in thousands, except share data)
December 31,
20202019
December 31,December 31,
202320232022
ASSETSASSETS
Real estate properties:Real estate properties:
Real estate properties:
Real estate properties:
Land
Land
LandLand$789,125 $793,123 
Buildings and improvementsBuildings and improvements6,621,605 6,668,463 
Total real estate properties, grossTotal real estate properties, gross7,410,730 7,461,586 
Accumulated depreciationAccumulated depreciation(1,694,901)(1,570,801)
Total real estate properties, netTotal real estate properties, net5,715,829 5,890,785 
Investments in unconsolidated joint ventures
Investments in unconsolidated joint ventures
Investments in unconsolidated joint ventures
Assets of properties held for saleAssets of properties held for sale112,437 209,570 
Cash and cash equivalentsCash and cash equivalents74,417 37,357 
Restricted cashRestricted cash16,432 14,867 
Investments in equity securitiesInvestments in equity securities73,772 1,571 
Due from affiliatesDue from affiliates1,990 
Acquired real estate leases and other intangible assets, netAcquired real estate leases and other intangible assets, net286,513 337,875 
Other assets, netOther assets, net197,024 159,811 
Total assetsTotal assets$6,476,424 $6,653,826 
LIABILITIES AND SHAREHOLDERS' EQUITYLIABILITIES AND SHAREHOLDERS' EQUITY  
Unsecured revolving credit facility$$537,500 
Unsecured term loans, net199,049 448,741 
LIABILITIES AND SHAREHOLDERS' EQUITY
LIABILITIES AND SHAREHOLDERS' EQUITY 
Secured credit facility
Senior secured notes, net
Senior secured notes, net
Senior secured notes, net
Senior unsecured notes, netSenior unsecured notes, net2,608,189 1,820,681 
Secured debt and finance leases, netSecured debt and finance leases, net691,573 694,739 
Liabilities of properties held for saleLiabilities of properties held for sale3,525 6,758 
Accrued interestAccrued interest23,772 24,060 
Due to affiliatesDue to affiliates24,547 8,779 
Assumed real estate lease obligations, net67,830 76,705 
Other liabilitiesOther liabilities238,717 158,813 
Total liabilitiesTotal liabilities3,857,202 3,776,776 
Commitments and contingenciesCommitments and contingencies00
Commitments and contingencies
Commitments and contingencies
Equity:
Equity attributable to common shareholders:
Common shares of beneficial interest, $0.01 par value: 300,000,000 shares authorized, 238,268,478 and 237,897,163 shares issued and outstanding, respectively2,383 2,379 
Shareholders' equity:
Shareholders' equity:
Shareholders' equity:
Common shares of beneficial interest, $.01 par value: 300,000,000 shares authorized, 240,423,898 and 239,694,842 shares issued and outstanding, respectively
Common shares of beneficial interest, $.01 par value: 300,000,000 shares authorized, 240,423,898 and 239,694,842 shares issued and outstanding, respectively
Common shares of beneficial interest, $.01 par value: 300,000,000 shares authorized, 240,423,898 and 239,694,842 shares issued and outstanding, respectively
Additional paid in capitalAdditional paid in capital4,613,904 4,612,511 
Cumulative net incomeCumulative net income1,913,109 2,052,562 
Cumulative distributionsCumulative distributions(4,033,559)(3,930,933)
Total equity attributable to common shareholders2,495,837 2,736,519 
Noncontrolling interest:
Total equity attributable to noncontrolling interest123,385 140,531 
Total equity2,619,222 2,877,050 
Total liabilities and equity$6,476,424 $6,653,826 
Cumulative distributions
Cumulative distributions
Total shareholders' equity
Total shareholders' equity
Total shareholders' equity
Total liabilities and shareholders' equity
The accompanying notes are an integral part of these consolidated financial statements.
F-4

Table of Contents

DIVERSIFIED HEALTHCARE TRUST
CONSOLIDATED STATEMENTS OF OPERATIONS
(amounts in thousands, except per share data)
Year Ended December 31,
202320222021
Revenues:
Rental income$258,400 $260,740 $408,589 
Residents fees and services1,151,908 1,022,826 974,623 
Total revenues1,410,308 1,283,566 1,383,212 
Expenses:
Property operating expenses1,174,151 1,109,070 1,091,812 
Depreciation and amortization284,083 239,280 271,131 
General and administrative26,131 26,435 34,087 
Acquisition and certain other transaction related costs10,853 2,605 17,506 
Impairment of assets18,380 — (174)
Total expenses1,513,598 1,377,390 1,414,362 
Gain on sale of properties1,205 321,862 492,272 
Gains and losses on equity securities, net8,126 (25,660)(42,232)
Interest and other income15,536 15,929 20,635 
Interest expense (including net amortization of debt premiums, discounts and issuance costs of $11,811, $8,658 and $13,408, respectively)(191,775)(209,383)(255,759)
Loss on modification or early extinguishment of debt(2,468)(30,043)(2,410)
(Loss) income from continuing operations before income tax expense and equity in net (losses) earnings of investees(272,666)(21,119)181,356 
Income tax expense(445)(710)(1,430)
Equity in net (losses) earnings of investees(20,461)6,055 — 
Net (loss) income(293,572)(15,774)179,926 
Net income attributable to noncontrolling interest— — (5,411)
Net (loss) income attributable to common shareholders$(293,572)$(15,774)$174,515 
Weighted average common shares outstanding (basic and diluted)238,836 238,314 237,967 
Per common share amounts (basic and diluted)
Net (loss) income attributable to common shareholders$(1.23)$(0.07)$0.73 
The accompanying notes are an integral part of these consolidated financial statements.
F-5

Table of Contents

DIVERSIFIED HEALTHCARE TRUST
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS)SHAREHOLDERS'EQUITY
(amountsdollars in thousands, except per share data)thousands)
Year Ended December 31,
202020192018
Revenues:
Rental income$427,215 $606,558 $700,641 
Residents fees and services1,204,811 433,597 416,523 
Total revenues1,632,026 1,040,155 1,117,164 
Expenses:
Property operating expenses1,236,357 489,070 451,581 
Depreciation and amortization270,147 289,025 286,235 
General and administrative30,593 37,028 85,885 
Acquisition and certain other transaction related costs814 13,102 194 
Impairment of assets106,972 115,201 66,346 
Total expenses1,644,883 943,426 890,241 
Gain on sale of properties6,487 39,696 261,916 
Dividend income1,846 2,901 
Gains and losses on equity securities, net34,106 (41,898)(20,724)
Interest and other income18,221 941 667 
Interest expense (including net amortization of debt premiums, discounts and issuance costs of $8,022, $6,032 and $6,221, respectively)(201,483)(180,112)(179,287)
Gain on lease termination22,896 
Loss on early extinguishment of debt(427)(44)(22)
(Loss) income from continuing operations before income tax expense and equity in earnings of an investee(133,057)(82,842)292,374 
Income tax expense(1,250)(436)(476)
Equity in earnings of an investee400 516 
Net (loss) income(134,307)(82,878)292,414 
Net income attributable to noncontrolling interest(5,146)(5,356)(5,542)
Net (loss) income attributable to common shareholders$(139,453)$(88,234)$286,872 
Other comprehensive income (loss):
Amounts reclassified from cumulative other comprehensive income to net income$$175 $
Equity in unrealized gain (loss) of an investee91 (68)
Other comprehensive income (loss)266 (68)
Comprehensive (loss) income(134,307)(82,612)292,346 
Comprehensive income attributable to noncontrolling interest(5,146)(5,356)(5,542)
Comprehensive (loss) income attributable to common shareholders$(139,453)$(87,968)$286,804 
Weighted average common shares outstanding (basic)237,739 237,604 237,511 
Weighted average common shares outstanding (diluted)237,739 237,604 237,546 
Per common share amounts (basic and diluted)
Net (loss) income attributable to common shareholders$(0.59)$(0.37)$1.21 
Number of
Shares
Common
Shares
Additional
Paid In
Capital
Cumulative
Net Income
Cumulative
Distributions
Total Equity Attributable to Common ShareholdersTotal Equity Attributable to Noncontrolling
Interest
Total Shareholders' Equity
Balance at December 31, 2020:238,268,478 $2,383 $4,613,904 $1,913,109 $(4,033,559)$2,495,837 $123,385 $2,619,222 
Net income— — — 174,515 — 174,515 5,411 179,926 
Distributions— — — — (9,540)(9,540)— (9,540)
Share grants838,000 1,956 — — 1,964 — 1,964 
Share repurchases(109,384)(1)(382)— — (383)— (383)
Share forfeitures(2,200)— (3)— — (3)— (3)
Distributions to noncontrolling interest— — — — — — (22,348)(22,348)
Sale of interest in joint venture— — — — — — (106,448)(106,448)
Balance at December 31, 2021:238,994,894 2,390 4,615,475 2,087,624 (4,043,099)2,662,390 — 2,662,390 
Net loss— — — (15,774)— (15,774)— (15,774)
Distributions— — — — (9,568)(9,568)— (9,568)
Share grants847,000 1,737 — — 1,745 — 1,745 
Share repurchases(133,752)(1)(170)— — (171)— (171)
Share forfeitures(13,300)— (11)— — (11)— (11)
Balance at December 31, 2022:239,694,842 2,397 4,617,031 2,071,850 (4,052,667)2,638,611 — 2,638,611 
Net loss— — — (293,572)— (293,572)— (293,572)
Distributions— — — — (9,595)(9,595)— (9,595)
Share grants960,000 1,841 — — 1,850 — 1,850 
Share repurchases(184,344)(1)(392)— — (393)— (393)
Share forfeitures(46,600)— (10)— — (10)— (10)
Balance at December 31, 2023:240,423,898 $2,405 $4,618,470 $1,778,278 $(4,062,262)$2,336,891 $— $2,336,891 
The accompanying notes are an integral part of these consolidated financial statements.
F-6

Table of Contents
DIVERSIFIED HEALTHCARE TRUST
CONSOLIDATED STATEMENTS OF SHAREHOLDERS'EQUITY
(dollars in thousands)
Number of
Shares
Common
Shares
Additional
Paid In
Capital
Cumulative
Net Income
Cumulative Other
Comprehensive
Income (Loss)
Cumulative
Distributions
Total Equity Attributable to Common ShareholdersTotal Equity Attributable to Noncontrolling
Interest
Total Equity
Balance at December 31, 2017:237,630,409 $2,376 $4,609,316 $1,766,495 $87,231 $(3,360,468)$3,104,950 $172,238 $3,277,188 
Cumulative adjustment upon adoption of ASU No. 2016-01
— — — 87,429 (87,429)— — — 
Balance at January 1, 2018:237,630,409 2,376 4,609,316 1,853,924 (198)(3,360,468)3,104,950 172,238 3,277,188 
Net income— — — 286,872 — — 286,872 5,542 292,414 
Other comprehensive loss— — — — (68)— (68)— (68)
Distributions— — — — — (370,746)(370,746)— (370,746)
Share grants123,800 2,514 — — — 2,515 — 2,515 
Share repurchases(22,999)— (413)— — — (413)— (413)
Share forfeitures(1,310)— — — — — 
Distributions to noncontrolling interest— — — — — — — (21,022)(21,022)
Balance at December 31, 2018:237,729,900 2,377 4,611,419 2,140,796 (266)(3,731,214)3,023,112 156,758 3,179,870 
Net (loss) income— — — (88,234)— — (88,234)5,356 (82,878)
Amounts reclassified from cumulative other comprehensive income to net income— — — — 175 — 175 — 175 
Other comprehensive income— — — — 91 — 91 — 91 
Distributions— — — — — (199,719)(199,719)— (199,719)
Share grants202,500 1,391 — — — 1,393 — 1,393 
Share repurchases(31,747)— (293)— — — (293)— (293)
Share forfeitures(3,490)— (6)— — — (6)— (6)
Distributions to noncontrolling interest— — — — — — — (21,583)(21,583)
Balance at December 31, 2019:237,897,163 2,379 4,612,511 2,052,562 (3,930,933)2,736,519 140,531 2,877,050 
Net (loss) income— — — (139,453)— — (139,453)5,146 (134,307)
Distributions— — — — — (42,825)(42,825)— (42,825)
Distribution to common shareholders of the right to receive Five Star Senior Living Inc. common stock— — — — — (59,801)(59,801)— (59,801)
Share grants420,000 1,570 — — — 1,574 — 1,574 
Share repurchases(47,375)— (171)— — — (171)— (171)
Share forfeitures(1,310)— (6)— — — (6)— (6)
Distributions to noncontrolling interest— — — — — — — (22,292)(22,292)
Balance at December 31, 2020:238,268,478 $2,383 $4,613,904 $1,913,109 $$(4,033,559)$2,495,837 $123,385 $2,619,222 
The accompanying notes are an integral part of these consolidated financial statements.
F-7

Table of Contents
DIVERSIFIED HEALTHCARE TRUST
 CONSOLIDATED STATEMENTS OF CASH FLOWS
(dollars in thousands)
Year Ended December 31, Year Ended December 31,
202020192018 202320222021
CASH FLOWS FROM OPERATING ACTIVITIES:CASH FLOWS FROM OPERATING ACTIVITIES:      CASH FLOWS FROM OPERATING ACTIVITIES:  
Net (loss) incomeNet (loss) income$(134,307)$(82,878)$292,414 
Adjustments to reconcile net (loss) income to cash provided by operating activities:
Adjustments to reconcile net (loss) income to cash provided by (used in) operating activities:
Depreciation and amortization
Depreciation and amortization
Depreciation and amortizationDepreciation and amortization270,147 289,025 286,235 
Net amortization of debt premiums, discounts and issuance costsNet amortization of debt premiums, discounts and issuance costs8,022 6,032 6,221 
Straight line rental incomeStraight line rental income(6,069)(4,508)(10,227)
Amortization of acquired real estate leases(7,405)(6,791)(5,787)
Loss on early extinguishment of debt51 44 22 
Gain on lease termination(22,896)
Amortization of acquired real estate leases and assumed real estate lease obligations, net
Loss on modification or early extinguishment of debt
Impairment of assets
Impairment of assets
Impairment of assetsImpairment of assets106,972 115,201 66,346 
Gain on sale of propertiesGain on sale of properties(6,487)(39,696)(261,916)
Gains and losses on equity securities, netGains and losses on equity securities, net(34,106)41,898 20,724 
Other non-cash adjustments, netOther non-cash adjustments, net(2,203)(3,771)(3,772)
Equity in earnings of an investee(400)(516)
Distribution of earnings from Affiliates Insurance Company2,574 
Other non-cash adjustments, net
Other non-cash adjustments, net
Unconsolidated joint venture distributions
Equity in net losses (earnings) of investees
Change in assets and liabilities:Change in assets and liabilities:
Change in assets and liabilities:
Change in assets and liabilities:
Deferred leasing costs, net
Deferred leasing costs, net
Deferred leasing costs, net
Other assetsOther assets(33,867)1,794 (3,586)
Accrued interestAccrued interest(305)(2,105)8,195 
Other liabilitiesOther liabilities20,997 (50,574)(1,513)
Net cash provided by operating activities158,544 265,845 392,840 
Net cash provided by (used in) operating activities
CASH FLOWS FROM INVESTING ACTIVITIES:
CASH FLOWS FROM INVESTING ACTIVITIES:
CASH FLOWS FROM INVESTING ACTIVITIES:CASH FLOWS FROM INVESTING ACTIVITIES:    
Real estate acquisitions and depositsReal estate acquisitions and deposits(2,526)(50,636)(129,494)
Real estate improvementsReal estate improvements(185,585)(222,417)(103,804)
Proceeds from sale of properties, netProceeds from sale of properties, net147,388 254,241 332,389 
Proceeds from sale of RMR Inc. common shares, net98,557 
Proceeds from sale of properties to joint venture, net
Proceeds from sale of interest in joint venture, net
Proceeds from insurance recoveries
Proceeds from AlerisLife Inc. tender offer
Proceeds from AlerisLife Inc. tender offer
Proceeds from AlerisLife Inc. tender offer
Distributions in excess of earnings from Affiliates Insurance CompanyDistributions in excess of earnings from Affiliates Insurance Company287 6,426 
Net cash (used in) provided by investing activitiesNet cash (used in) provided by investing activities(40,436)86,171 99,091 
CASH FLOWS FROM FINANCING ACTIVITIES:CASH FLOWS FROM FINANCING ACTIVITIES:   
CASH FLOWS FROM FINANCING ACTIVITIES:
CASH FLOWS FROM FINANCING ACTIVITIES: 
Proceeds from issuance of senior unsecured notes, netProceeds from issuance of senior unsecured notes, net985,000 491,560 
Proceeds from borrowings on revolving credit facility430,500 994,500 727,000 
Repayments of borrowings on revolving credit facility(968,000)(596,000)(1,184,000)
Repayment of senior unsecured notes(200,000)(400,000)
Proceeds from issuance of senior secured notes, net
Proceeds from borrowings on secured credit facility
Repayments of borrowings on secured credit facility
Redemption of senior unsecured notes
Repayment of term loanRepayment of term loan(250,000)(100,000)
Repayment of other debtRepayment of other debt(5,941)(46,345)(107,116)
Loss on early extinguishment of debt settled in cashLoss on early extinguishment of debt settled in cash(376)(150)
Payment of debt issuance costsPayment of debt issuance costs(5,378)(417)(4,296)
Repurchase of common sharesRepurchase of common shares(171)(299)(411)
Distributions to noncontrolling interestDistributions to noncontrolling interest(22,292)(21,583)(21,022)
Distributions to noncontrolling interest
Distributions to noncontrolling interest
Distributions to shareholdersDistributions to shareholders(42,825)(199,719)(370,746)
Net cash used in financing activities(79,483)(369,863)(469,181)
Net cash (used in) provided by financing activities
Increase (decrease) in cash and cash equivalents and restricted cash38,625 (17,847)22,750 
(Decrease) increase in cash and cash equivalents and restricted cash
(Decrease) increase in cash and cash equivalents and restricted cash
(Decrease) increase in cash and cash equivalents and restricted cash
Cash and cash equivalents and restricted cash at beginning of periodCash and cash equivalents and restricted cash at beginning of period52,224 70,071 47,321 
Cash and cash equivalents and restricted cash at end of periodCash and cash equivalents and restricted cash at end of period$90,849 $52,224 $70,071 
The accompanying notes are an integral part of these consolidated financial statements.
F-8F-7

Table of Contents

DIVERSIFIED HEALTHCARE TRUST
 CONSOLIDATED STATEMENTS OF CASH FLOWS (CONTINUED)
 (dollars in thousands)
Year Ended December 31,
202020192018
SUPPLEMENTAL CASH FLOW INFORMATION:
Interest paid$195,599 $177,308 $164,996 
Income taxes paid$399 $452 $474 
NON-CASH INVESTING ACTIVITIES:
Five Star Senior Living Inc. common stock$97,896 $$
Transaction Agreement additional consideration$(75,000)$$
Acquisitions funded by assumed debt$$$(44,386)
Capitalized interest$1,833 $1,124 $124 
NON-CASH FINANCING ACTIVITIES:
Distribution to common shareholders of the right to receive Five Star Senior Living Inc. common stock$(59,801)$$
Assumption of mortgage notes payable$$$44,386 
Year Ended December 31,
202320222021
SUPPLEMENTAL CASH FLOW INFORMATION:
Interest paid$186,534 $201,153 $235,994 
Income taxes paid$677 $935 $2,798 
NON-CASH INVESTING ACTIVITIES:
Decrease in assets and liabilities resulting from the deconsolidation of investments that were previously consolidated:
Real estate, net$— $(355,669)$(686,320)
Mortgage notes, net$— $— $618,452 
Real estate improvements accrued, not paid$38,777 $32,064 $20,031 
Capitalized interest$— $— $1,297 
Supplemental disclosure of cash and cash equivalents and restricted cash:
The following table provides a reconciliation of cash and cash equivalents and restricted cash reported within our consolidated balance sheets to the amount shown in our consolidated statements of cash flows:
As of December 31,
202020192018
As of December 31,As of December 31,
2023202320222021
Cash and cash equivalentsCash and cash equivalents$74,417 $37,357 $54,976 
Restricted cash (1)
Restricted cash (1)
16,432 14,867 15,095 
Total cash and cash equivalents and restricted cash shown in our consolidated statements of cash flowsTotal cash and cash equivalents and restricted cash shown in our consolidated statements of cash flows$90,849 $52,224 $70,071 
(1) As of December 31, 2022 and 2021, restricted cash consisted of proceeds from the sale of assets and proceeds from the sale of joint venture interests held as collateral pursuant to the agreement governing our former credit facility, or our credit agreement. In December 2023, we repaid all $450,000 outstanding under such secured credit facility with Wells Fargo Bank, National Association, as administrative agent and a lender, and a syndicate of other lenders, and then terminated our credit agreement in accordance with its terms and without penalty. As such, we are no longer required to hold any proceeds from the sale of properties as restricted cash. Restricted cash also consists of amounts escrowed for real estate taxes, insurance and capital expenditures at certain of our mortgaged properties and cash held for the operations of 1 of our life science properties that is owned in a joint venture arrangement in which we own a 55% equity interest.properties.

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

F-9F-8

Table of Contents

DIVERSIFIED HEALTHCARE TRUST
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
(dollar amounts in thousands, except per share data or as otherwise stated)
Note 1. OrganizationBusiness
Diversified Healthcare Trust is a real estate investment trust, or REIT, organized under Maryland law, which owns medical office and life science properties, senior living communities and other healthcare related properties throughout the United States. As of December 31, 2020,2023, we owned 397371 properties located in 36 states and Washington, D.C. On that date, the gross book value of our real estate assets was $7,410,730.$6,818,467, excluding properties held for sale, if any.
As of December 31, 2023, we also owned an equity interest in each of two unconsolidated joint ventures that own medical office and life science properties located in five states with an aggregate of approximately 2.2 million rentable square feet.
Going Concern
The senior living industry has been adversely affected by a slow recovery from the COVID-19 pandemic, as well as economic and market conditions. These conditions continue to have a significant negative impact on our results of operations, financial position and cash flows. Although there have been signs of recovery and increased demand when compared to the low levels during the COVID-19 pandemic, the recovery of our senior housing operating portfolio, or SHOP, segment has been slower than previously anticipated and uneven, and we cannot be sure when or if the senior living business will return to historic pre-pandemic levels. To mitigate the effects of the slow recovery coming from the COVID-19 pandemic and the increased variability in operating cash flows from our SHOP communities, we continue to work with our senior living operators to manage costs, especially labor costs, and to increase rates and occupancy. However, increased operating costs resulting from difficult labor market conditions, wage and commodity price inflation and increased insurance costs, among other things, continue to negatively impact margins. Additionally, while our senior living operators have increased rates, those rates are increasing gradually and are not increasing at the same pace as our costs, putting further pressure on our margins. In order to increase the probability of a recovery of our cash flows, we have continued to invest capital in our SHOP segment. As a result of the slow recovery of our SHOP segment and having $700,000 of outstanding debt then becoming due within one year and only $338,431 in cash and cash equivalents as of June 30, 2023, we concluded as of May 8, 2023 that there was a substantial doubt about our ability to continue as a going concern for at least one year from the date of issuance of those condensed consolidated financial statements. Additionally, as of November 1, 2023 we were unable to demonstrate that our plans to alleviate the substantial doubt about our ability to continue as a going concern would be probable in mitigating the conditions that raised the substantial doubt given our plans were beyond our control.
On December 21, 2023, we completed a private offering of $940,534 in aggregate principal amount at maturity of senior secured notes due January 2026, with a one-year extension option. The net proceeds from the offering were approximately $730,359 after deducting initial purchaser discounts and estimated offering costs. We used a portion of the net proceeds to repay in full the $450,000 outstanding under our then secured credit facility and to redeem $250,000 of our senior notes that were scheduled to mature in May 2024. As a result of these transactions, we have no significant debt maturities until June 2025 when $500,000 of our senior notes will become due, and as of December 31, 2023, we had $245,939 of cash and cash equivalents. Additionally, as of December 31, 2023, our ratio of consolidated income available for debt service to debt service is above the 1.5x incurrence requirement under our debt covenants, on a pro forma basis. As a result, we are able to refinance existing or maturing debt and issue new debt as long as this ratio continues to be at or above 1.5x on a pro forma basis at the time of such refinancing or issuance. With a significant amount of unencumbered assets, including our entire SHOP segment properties, we believe we can refinance existing or maturing debt as maturities near or we believe the terms of any new debt are satisfactory. Our management has concluded that these transactions have successfully alleviated the conditions that raised the substantial doubt about our ability to continue as a going concern and that no substantial doubt about our ability to continue as going concern exists as of the date of issuance of these financial statements, or February 26, 2024.
Note 2. Summary of Significant Accounting Policies
BASIS OF PRESENTATION.  Our consolidated financial statements include the accounts of Diversified Healthcare Trust, we, us or our, and our subsidiaries, all of which except for the joint venture discussed below, are 100% owned directly or indirectly by us.us as of December 31, 2023. All intercompany transactions and balances with or among our consolidated subsidiaries have been eliminated. Accounting principles generally accepted in the United States, or GAAP, require us to make estimates and assumptions that may affect the amounts reported in these financial statements and related notes. The actual results could differ from these estimates. 
In March 2017, we entered a joint venture arrangement with an institutional investor for 1 of our life science properties located in Boston, Massachusetts. We have determined that this joint venture is a variable interest entity, or VIE, as defined under the Consolidation Topic of the Financial Accounting Standards Board, or FASB, Accounting Standards Codification, or the Codification. We concluded that we must consolidate this VIE because we are the entity with the power to direct the activities that most significantly impact the VIE's economic performance and we have the obligation to absorb losses of, and the right to receive benefits from, the VIE that could be significant to the VIE, and therefore are the primary beneficiary of the VIE. The assets of this VIE were $970,142 and $1,015,661 as of December 31, 2020 and 2019, respectively, and consist primarily of the net real estate owned by the joint venture. The liabilities of this VIE were $697,129 and $704,344 as of December 31, 2020 and 2019, respectively, and consist primarily of mortgage debts secured by the property. The investor's interest in this consolidated entity is reflected as a noncontrolling interest in our consolidated financial statements. See Note 11 for further information about this joint venture.
REAL ESTATE PROPERTIES.  We record properties at our cost and calculate depreciation on real estate investments on a straight line basis over estimated useful lives generally up to 40 years.
F-9

Table of Contents

We allocate the purchase prices of our properties to land, building and improvements based on determinations of the fair values of these assets assuming the properties are vacant. We determine the fair value of each property using methods similar to those used by independent appraisers, which may involve estimated cash flows that are based on a number of factors, including capitalization rates and discount rates, among others. In some circumstances, we engage independent real estate appraisal firms to provide market information and evaluations which are relevant to our purchase price allocations and determinations of depreciable useful lives; however, we are ultimately responsible for the purchase price allocations and determinations of useful lives. We allocate a portion of the purchase price to above market and below market leases based on the present value (using an interest rate which reflects the risks associated with acquired in place leases at the time each property was acquired by us) of the difference, if any, between (i) the contractual amounts to be paid pursuant to the acquired in place leases and (ii) our estimates of fair market lease rates for the corresponding leases, measured over a period equal to the terms of the respective leases. The terms of below market leases that include bargain renewal options, if any, are further adjusted if we determine that renewal is probable. We allocate a portion of the purchase price to acquired in place leases and tenant relationships based upon market estimates to lease up the property based on the leases in place at the time of purchase. In making these allocations, we consider factors such as estimated carrying costs during the expected lease up periods, including real estate taxes, insurance and other operating income and expenses and costs, such as leasing commissions, legal and other related expenses, to execute similar leases in current market conditions at the time a property was acquired by us. We allocate this aggregate value between acquired in place lease values and tenant relationships based on our evaluation of the specific characteristics of each tenant's lease. However, we have not separated the value of tenant relationships from the value of acquired in place leases because such value and related amortization expense is immaterial to our consolidated financial statements. If the value of tenant relationships becomes material in the future, we may separately allocate those amounts and amortize the allocated amount over the estimated life of the relationships.
We amortize capitalized above market lease values (included in acquired real estate leases and other intangible assets, net in our consolidated balance sheets) as a reduction to rental income over the remaining non-cancelable terms of the respective leases. We amortize capitalized below market lease values (presented as assumed real estate lease obligations(included in other liabilities in our
F-10

Table of Contents
consolidated balance sheets) as an increase to rental income over the non-cancelable periods of the respective leases. For the years ended December 31, 2020, 20192023, 2022 and 2018,2021, such amortization resulted in a net increase in rental income of $7,405, $6,791$242, $(245) and $5,787,$7,211, respectively. We amortize the value of in place leases exclusive of the value of above market and below market in place leases to expense over the remaining non-cancelable periods of the respective leases. During the years ended December 31, 2020, 20192023, 2022 and 2018,2021, such amortization included in depreciation and amortization expense totaled $48,669, $64,203$10,996, $11,524 and $72,925,$42,783, respectively. If a lease is terminated prior to its stated expiration, the unamortized amount relating to that lease is written off.
As of December 31, 20202023 and 2019,2022, our acquired real estate leases and assumed real estate lease obligations, excluding properties held for sale, if any, were as follows:
December 31,
20202019
December 31,
December 31,
December 31,
2023
Acquired real estate leases:
Acquired real estate leases:
Acquired real estate leases:Acquired real estate leases:
Capitalized above market lease valuesCapitalized above market lease values$12,304 $34,587 
Capitalized above market lease values
Capitalized above market lease values
Less: accumulated amortizationLess: accumulated amortization(9,236)(30,039)
Less: accumulated amortization
Less: accumulated amortization
Capitalized above market lease values, net
Capitalized above market lease values, net
Capitalized above market lease values, netCapitalized above market lease values, net3,068 4,548 
Lease origination valueLease origination value551,141 642,158 
Lease origination value
Lease origination value
Less: accumulated amortization
Less: accumulated amortization
Less: accumulated amortizationLess: accumulated amortization(267,696)(308,831)
Lease origination value, netLease origination value, net283,445 333,327 
Lease origination value, net
Lease origination value, net
Acquired real estate leases and other intangible assets, net
Acquired real estate leases and other intangible assets, net
Acquired real estate leases and other intangible assets, netAcquired real estate leases and other intangible assets, net$286,513 $337,875 
Assumed real estate lease obligations:Assumed real estate lease obligations:
Assumed real estate lease obligations:
Assumed real estate lease obligations:
Capitalized below market lease values
Capitalized below market lease values
Capitalized below market lease valuesCapitalized below market lease values$128,991 $134,225 
Less: accumulated amortizationLess: accumulated amortization(61,161)(57,520)
Less: accumulated amortization
Less: accumulated amortization
Assumed real estate lease obligations, netAssumed real estate lease obligations, net$67,830 $76,705 
Assumed real estate lease obligations, net
Assumed real estate lease obligations, net

As of December 31, 2020,2023, the weighted average amortization periods for capitalized above market lease values, lease origination value and capitalized below market lease values were 3.74.8 years, 7.47.3 years and 7.93.7 years, respectively. Future amortization of net intangible acquired real estate lease assets and liabilitiesobligations to be recognized over the current terms of the
F-10

Table of Contents

associated leases as of December 31, 20202023 are estimated to be $36,770 in 2021, $32,959 in 2022, $31,961 in 2023, $27,108$7,501 in 2024, $23,724$5,167 in 2025, $4,473 in 2026, $3,506 in 2027, $2,553 in 2028 and $66,161$10,280 thereafter.
CASH AND CASH EQUIVALENTS.  We consider highly liquid investments with original maturities of three months or less at the date of purchase to be cash equivalents.
RESTRICTED CASH.  Restricted cash consists of amounts escrowed for real estate taxes, insurance and capital expenditures at certain of our mortgaged propertiesproperties. Prior to our repayment in full of the $450,000 outstanding under our then secured credit facility and cash held for the operations of 1termination of our life science properties that is ownedcredit agreement in a joint venture arrangement in which we own a 55% equity interest.December 2023, restricted cash also consisted of amounts held as collateral pursuant to our credit agreement.
INVESTMENTS IN EQUITY SECURITIES. We previously owned 2,637,408 shares of class A common stock of The RMR Group Inc., or RMR Inc., that we sold on July 1, 2019. Prior to July 1, 2019, our equity securities were recorded at fair value based on their quoted market price at the end of each reporting period. We classifyclassified the common shares we ownformerly owned of Five Star Senior LivingAlerisLife Inc., or Five Star,AlerisLife, as an equity securities and carry them at fair valuemethod investment. This equity method investment was included in investments ofin equity securities in our consolidated balance sheets. Effective January 1, 2018, changes
In February 2023, in connection with the acquisition by ABP Trust of all of the publicly held outstanding AlerisLife common shares, at a price of $1.31 per share, or the Tender Offer Price, by tender offer, or the AlerisLife Transaction, we agreed to tender all the AlerisLife common shares that we and our subsidiary then owned into the tender offer at the Tender Offer Price, subject to the right, but not the obligation, to purchase, on or before December 31, 2023, AlerisLife common shares at the Tender Offer Price, and otherwise pursuant to a stockholders agreement to be entered into at the time of any such purchase. On December 20, 2023, we and ABP Trust extended our right to purchase AlerisLife common shares until March 31, 2024.
At December 31, 2023 and 2022, our investment in AlerisLife had a fair value of our equity securities were recorded through earnings in accordance with FASB Accounting Standards Update, or ASU, No. 2016-01, Recognition$0 and Measurement of Financial Assets and Financial Liabilities. Prior to the adoption of ASU No. 2016-01, unrealized gains and losses were recorded as a component of cumulative other comprehensive income (loss) in shareholder's equity.
On April 1, 2019, we entered into a transaction agreement with Five Star, or the Transaction Agreement, to restructure our business arrangements with Five Star, or the Restructuring Transaction. At December 31, 2019, we owned 423,500 Five Star common shares after giving effect to the one-for-ten reverse stock split effected by Five Star with respect to its common shares on September 30, 2019. Pursuant to the Restructuring Transaction, on January 1, 2020, Five Star issued 10,268,158 common shares to us. The fair value and initial cost basis of the Five Star common shares issued to us on January 1, 2020 was $38,095. At December 31, 2020, we owned 10,691,658 Five Star common shares. Our adjusted cost basis for our Five Star common shares was $44,448 as of December 31, 2020. At December 31, 2020 and 2019, our investment in Five Star had a fair
F-11

Table of Contents
value of $73,772 and $1,571,$5,880, respectively, including an unrealizeda realized gain of $34,106$8,126 and an unrealized loss of $462,$25,660, respectively. Based on the terms of the Transaction Agreement, including the issuance of additional Five Star shares to us, weWe concluded that we havehad significant influence, but not control, over Five StarAlerisLife's most significant activities and therefor accounttherefore we determined that AlerisLife was not a variable interest entity, or VIE, and accounted for our former investment in Five StarAlerisLife as an equity method investment starting January 1, 2020.investment. We have elected the fair value option for our investment in Five Star. We continue to present our investment in Five Star in Investments in equity securities in our consolidated balance sheets due to the comparable accounting treatment of the shares we owned in Five Star as of December 31, 2020 and 2019.AlerisLife.
See Notes 6 andNote 8 for further information regarding our investment in Five Star and former investment in RMR Inc.AlerisLife.
EQUITY METHOD INVESTMENTS.  As of December 31, 2023, we owned a 10% equity interest in an unconsolidated joint venture that owns a life science property located in Boston, Massachusetts, or the Seaport JV, and a 20% equity interest in an unconsolidated joint venture for 10 medical office and life science properties, or the LSMD JV. The property owned by the Seaport JV is encumbered by an aggregate $620,000 of mortgage debts. The properties owned by the LSMD JV are encumbered by an aggregate $456,625 of mortgage debts. We do not control the activities that are most significant to these joint ventures and, as a result, we account for our investment in Affiliates Insurance Company, or AIC, until AIC was dissolved as described in Note 8, usingthese joint ventures under the equity method of accounting. Significant influence was present through common representation on our Board of Trusteesaccounting under the fair value option. See Notes 3, 10 and the board of directors of AIC until February 13, 2020. The Chair of our Board of Trustees and one of our Managing Trustees, Adam D. Portnoy, as the sole trustee of ABP Trust, is the controlling shareholder of RMR Inc. He is also a managing director and an executive officer of RMR Inc. Substantially all of the business of RMR Inc. is conducted by its majority owned subsidiary, The RMR Group LLC, or RMR LLC, which is our manager and provided management and administrative services to AIC. Most of our Trustees were directors of AIC. See Note 811 for more information about our investment in AIC. Refer to the above section for further details on our equity method investment in Five Star.
We periodically evaluate our equity method investments for possible indicators of other than temporary impairment whenever events or changes in circumstances indicate the carrying amount of the investment might not be recoverable. These indicators may include the length of time and the extent to which the market value of our investment is below our carrying value, the financial condition of our investees, our intent and ability to be a long term holder of the investment and other considerations. If the decline in fair value is judged to be other than temporary, we record an impairment charge to adjust the basis of the investment to its estimated fair value.regarding these joint ventures.
DEBT ISSUANCE COSTS.  Debt issuance costs include issuance or assumption costs related to borrowings and we amortize those costs as interest expense over the terms of the respective loans. During 2023, we repaid all amounts outstanding under our then secured credit facility, including repayment in full of $450,000 under such credit facility in December 2023, and terminated the agreement governing such credit facility. As a result, we expensed unamortized debt issuance costs and recorded an aggregate loss on early extinguishment of debt of $1,389 during the year ended December 31, 2023. Debt issuance costs for our revolvingformer credit facility totaled $19,332$0 and $17,170$29,717 at December 31, 20202023 and 2019,2022, respectively, and accumulated amortization of debt issuance costs totaled $16,201$0 and $13,944$26,315 at December 31, 20202023 and 2019,2022, respectively, and are included in other assets, net in our consolidated balance sheets. Debt issuance costs for our term loans, senior secured and unsecured notes and mortgage notes payableother secured debt totaled $53,496$67,475 and $41,452$47,661 at December 31, 20202023 and 2019,2022, respectively, and accumulated amortization of debt issuance costs totaled $15,589$22,065 and $16,887,$19,791, respectively, and are presented in our consolidated balance sheet as a direct deduction from the associated debt liability. Future amortization of debt issuance costs to be recognized with respect to our loans as of December 31, 20202023 are estimated to be $8,956 in 2021, $5,683 in 2022, $5,142 in 2023, $5,008$14,226 in 2024, $3,038$13,279 in 2025, $2,417 in 2026, $1,955 in 2027, $1,581 in 2028 and $13,211$11,952 thereafter.
DEFERRED LEASING COSTS.  Deferred leasing costs include capitalized brokerage costs and other feesinducements associated with the successful negotiation of leases,leases. We amortize deferred leasing costs, which are amortized toincluded in depreciation and amortization expense, and inducements, which are included as a reduction in rental income, on a straight line basis over the terms of the respective leases. Deferred leasing costs are included in other assets, net in our consolidated balance sheets. Deferred leasing costs totaled $44,506$62,980 and $42,014$55,043 at December 31, 20202023 and 2019,2022, respectively, and accumulated amortization of deferred leasing costs totaled $15,605$19,985 and $14,922$15,482 at December 31, 20202023 and 2019,2022, respectively. At December 31, 2020,2023, the remaining weighted average amortization period is approximately 7.68.2 years. Future amortization of
F-11

Table of Contents

deferred leasing costs to be recognized during the current terms of our existing leases as of December 31, 2020,2023 are estimated to be $5,464 in 2021, $4,468 in 2022, $3,894 in 2023, $3,403$7,090 in 2024, $2,933$6,613 in 2025, $6,059 in 2026, $5,032 in 2027, $4,344 in 2028 and $8,739$13,857 thereafter.
REVENUE RECOGNITION.  We are a lessor of medical office and life science properties, senior living communities and other healthcare related properties. Our leases provide our tenants with the contractual right to use and economically benefit from all of the premises demised under the leases; therefore, we have determined to evaluate our leases as lease arrangements.
In February 2016, the FASB issued Accounting Standards Update, or ASU, No. 2016-02, Leases. In July 2018, the FASB issued ASU No. 2018-10, Codification Improvements to Topic 842, Leases and ASU No. 2018-11, Leases (Topic 842): Targeted Improvements. In December 2018, the FASB issued ASU No. 2018-20 Leases (Topic 842), Narrow-Scope Improvements for Lessors. Collectively, these standards set out the principles for the recognition, measurement, presentation and disclosure of leases for both parties to a contract (i.e., lessees and lessors). ASU No. 2016-02 requires lessees to apply a dual approach, classifying leases as either finance or operating leases based on the principle of whether or not the lease is effectively a financed purchase of the leased asset by the lessee. This classification will determine whether the lease expense is recognized based on an effective interest method or on a straight line basis over the term of the lease. ASU No. 2016-02 requires lessors to account for leases using an approach that is substantially equivalent to existing guidance for sales type leases, direct financing leases and operating leases. These standards were effective as of January 1, 2019. Upon adoption, we applied
F-12

Table of Contents
the package of practical expedients that has allowed us to not reassess (i) whether any expired or existing contracts are or contain leases, (ii) lease classification for any expired or existing leases and (iii) initial direct costs for any expired or existing leases. Furthermore, we applied the optional transition method in ASU No. 2018-11, which has allowed us to initially apply the new leases standard at the adoption date and recognize a cumulative effect adjustment to the opening balance of retained earnings in the adoption period, although we did not have an adjustment. Additionally, our leases met the criteria in ASU No. 2018-11 to not separate non-lease components from the related lease component; therefore, the accounting for these leases remained largely unchanged from the previous standard. The adoption of ASU No. 2016-02 and the related improvements did not have a material impact in our consolidated financial statements. Upon adoption, (i) allowances for bad debts are now recognized as a direct reduction of rental income, and (ii) legal costs associated with the execution of our leases, which were previously capitalized and amortized over the life of their respective leases, are expensed as incurred. Subsequent to January 1, 2019, provisions for credit losses are now included in rental income in our consolidated financial statements for our leased properties. Provisions for credit losses prior to January 1, 2019 were previously included in property operating expenses in our consolidated financial statements for our leased properties and prior periods were not reclassified to conform to the current presentation. We completed our assessment of predominance as it relates to our contracts with residents for housing services at properties leased to our taxable REIT subsidiaries, or TRSs, and have recognized revenue from these properties under Codification Topic 606, Revenue from Contract with Customers, which did not have any impact to the timing or amount of our revenue recognized. For leases where we are the lessee, we recognized a right of use asset and a lease liability equal to the present value of the minimum lease payments with rental payments being applied to the lease liability and the right of use asset being amortized over the term of the lease. The adoption of this standard resulted in an increase in total assets and liabilities of $4,507. The right of use asset and related lease liability are included within other assets, net and other liabilities, respectively, within our consolidated balance sheets. In addition, we lease equipment at certain of our managed senior living communities. These leases are short term in nature, are cancelable with no fee or do not result in an annual expense in excess of our capitalization policy and, as a result, will not be recorded on our consolidated balance sheets.
Certain of ourOur leases provide for base rent payments and in addition may include variable payments. Rental income from operating leases, including any payments derived by index or market based indices, is recognized on a straight line basis over the lease term when we have determined that the collectability of substantially all of the lease payments is probable. Some of our leases have options to extend or terminate the lease exercisable at the option of our tenants, which are considered when determining the lease term. We do not include in our measurement of our lease receivables certain variable payments, including changes in the index or market based indices after the inception of the lease, certain tenant reimbursements and other income until the specific events that trigger the variable payments have occurred.
Certain of our leases contain non-lease components, such as property level operating expenses and capital expenditures reimbursed by our tenants as well as other required lease payments. We have determined that all of our leases qualify for the practical expedient to not separate the lease and non-lease components because (i) the lease components are operating leases and (ii) the timing and pattern of recognition of the non-lease components are the same as those of the lease components. We apply Codification Topic 842, Leases, to the combined component. Income derived by our leases is recorded in rental income in our consolidated statements of comprehensive income (loss).operations.
Certain tenants are obligated to pay directly their obligations under their leases for insurance, real estate taxes and certain other expenses. These obligations, which have been assumed by the tenants under the terms of their respective leases, are not reflected in our consolidated financial statements. To the extent any tenant responsible for any such obligations under the applicable lease defaults on such lease or if it is deemed probable that the tenant will fail to pay for such obligations, we would record a liability for such obligations.
For the years ended December 31, 2020, 20192023, 2022 and 2018,2021, we recognized the rental income from our operating leases on a straight line basis over the term of each lease agreement. We recognized percentage rents when realizable and earned, which was generally during the fourth quarter of the year. For the years ended December 31, 2020, 20192023, 2022 and 2018,2021, percentage rents earned aggregated $2,144, $2,958$2,949, $2,978 and $8,443,$1,993, respectively.
For leases where we are the lessee, we recognized a right of use asset and a lease liability equal to the present value of the minimum lease payments with rental payments being applied to the lease liability and the right of use asset being amortized over the term of the lease. The right of use assets and related lease liabilities are included within other assets, net and other liabilities, respectively, within our consolidated balance sheets. In addition, we lease equipment at certain of our managed senior living communities. These leases are short term in nature, are cancelable with no fee or do not result in an annual expense in excess of our capitalization policy and, as a result, are not recorded on our consolidated balance sheets.
As of December 31, 2020,2023, we owned 235232 senior living communities that are managed by Five Starthird party managers for our account. We derive our revenues at these managed senior living communities primarily from services Five Star providesour managers provide to residents on our behalf and we record revenues when the services are provided. We use the taxable REIT subsidiary, or TRS, structure authorized by the REIT Investment Diversification and Empowerment Act for nearly all of our managed senior living communities.
Under the Coronavirus Aid, Relief, and Economic Security Act, or the CARES Act, the U.S. Department of Health and Human Services established a Provider Relief Fund. Subsequently, the American Rescue Plan Act, or ARPA, was enacted. Retention and use of the funds received under the CARES Act and ARPA are subject to certain terms and conditions. The terms and conditions require that the funds be utilized to compensate for lost revenues that are attributable to the COVID-19 pandemic and for eligible costs to prevent, prepare for and respond to the COVID-19 pandemic that are not covered by other sources. Further, fund recipients are required to be participating in Medicare at the time of distribution and are subject to certain other terms and conditions, including quarterly reporting requirements. In addition, fund recipients are required to have billed Medicare during 2019 and to continue to provide care after January 31, 2020 for diagnosis, testing or care for individuals with possible or actual COVID-19 cases. Any funds not used in accordance with the terms and conditions must be returned. We recognize income from government grants on a systematic and rational basis over the period in which we recognize the related expenses or loss of revenues for which the grants are intended to compensate when there is reasonable assurance that we will comply with the applicable terms and conditions of the grant and there is reasonable assurance that the grant will be received. During the years ended December 31, 2023, 2022 and 2021, we received $1,581, $605 and $20,800, respectively, in funds to be
F-12

Table of Contents

used to support the operations of our managed senior living communities; we have currently determined that $1,581, $4,327 and $19,554, of such funds meet the required terms and conditions. We have recognized $1,581, $4,327 and $19,554 as interest and other income in our consolidated statements of operations with respect to our SHOP segment for the years ended December 31, 2023, 2022 and 2021, respectively. As of December 31, 2023 and 2022, we have recognized all funds and no amount remained in other liabilities in our consolidated balance sheets.
PER COMMON SHARE AMOUNTS.  We calculate basic earnings per common share by dividing net income (loss) by the weighted average number of our common shares of beneficial interest, $.01 par value, or our common shares, outstanding during the period. We calculate diluted earnings per common share using the more dilutive of the two class method
F-13

Table of Contents
or the treasury stock method. Unvested share awards and other potentially dilutive common shares and the related impact on earnings, are considered when calculating diluted earnings per share.
INCOME TAXES.  We have elected to be taxed as a REIT under the United States Internal Revenue Code of 1986, as amended, and, as such, are generally not subject to federal and most state income taxation on our operating income provided we distribute our taxable income to our shareholders and meet certain organization and operating requirements. We do, however, lease our managed senior living communities to our wholly owned TRSs that, unlike most of our subsidiaries, file a separate consolidated federal corporate income tax return and are subject to federal and state income taxes. Our consolidated income tax provision includes the income tax provision related to the operations of our TRSs and certain state income taxes we incur despite our taxation as a REIT. Our current income tax expense (or benefit) fluctuates from period to period based primarily on the timing of our income, including gains on the disposition of properties or losses in a particular quarter.
The Income Taxes Topic of the Codification prescribes how we should recognize, measure and present in our financial statements uncertain tax positions that have been taken or are expected to be taken in a tax return. Tax benefits are recognized to the extent that it is “more likely than not” that a particular tax position will be sustained upon examination or audit. To the extent the “more likely than not” standard has been satisfied, the benefit associated with a tax position is measured as the largest amount that has a greater than 50% likelihood of being realized upon settlement. We classify interest and penalties related to uncertain tax positions, if any, in our financial statements as a component of general and administrative expense.
USE OF ESTIMATES. Preparation of these financial statements in conformity with accounting principles generally accepted in the United States, or GAAP, requires us to make estimates and assumptions that affect the amounts reported in these consolidated financial statements and related notes. The actual results could differ from these estimates. Significant estimates in the consolidated financial statements include purchase price allocations, useful lives of fixed assets and assessment of impairment of real estate and the related intangibles.
SEGMENT REPORTING.  As of December 31, 2020,2023, we operate in, and report financial information for, the following 2two segments: our portfolio of medical office and life science properties, or our Office Portfolio, and our senior housing operating portfolio, or SHOP. We aggregate eachthe operating results of our properties in these 2two reporting segments based on their similar operating and economic characteristics. See Note 12 for further information regarding our reportable operating segments.
NEWRECENT ACCOUNTING PRONOUNCEMENTS. In June 2016,On November 27, 2023, the Financial Accounting Standards Board, or FASB, issued Accounting Standards Update, or ASU, No. 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, or ASU No. 2023-07, which requires public entities to: (i) provide disclosures of significant segment expenses and other segment items if they are regularly provided to the Chief Operating Decision Maker, or the CODM, and included in each reported measure of segment profit or loss; (ii) provide all annual disclosures about a reportable segment’s profit or loss and assets currently required by ASC 280, Segment Reporting, or ASC 280, in interim periods; and (iii) disclose the CODM’s title and position, as well as an explanation of how the CODM uses the reported measures and other disclosures. Public entities with a single reportable segment must apply all the disclosure requirements of ASU No. 2023-07, as well as all the existing segment disclosures under ASC 280. The amendments in ASU No. 2023-07 are incremental to the requirements in ASC 280 and do not change how a public entity identifies its operating segments, aggregates those operating segments, or applies the quantitative thresholds to determine its reportable segments. ASU No. 2023-07 should be applied retrospectively to all prior periods presented in the financial statements and 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. We are currently evaluating the impact ASU No. 2023-07 will have on our consolidated financial statements and disclosures.
On December 14, 2023, the FASB issued ASU No. 2016-13, 2023-09,Financial Instruments - Credit Losses Income Taxes (Topic 326)740): Measurement of Credit Losses on Financial InstrumentsImprovements to Income Tax Disclosures, or ASU No. 2023-09, which requires thatpublic entities use a new forward-looking “expected loss” model that generally will resultto enhance its annual income tax disclosures by requiring: (i) consistent categories and greater disaggregation of information in the earlier recognitionrate reconciliation, and (ii) income taxes paid disaggregated by jurisdiction. ASU No. 2023-09 should be applied prospectively but entities have the option to apply it retrospectively to all prior periods presented in the financial statements. ASU No. 2023-09 is effective for annual periods
F-13

Table of allowance for credit losses. The measurement of expected credit losses is based upon historical experience, current conditions, and reasonable and supportable forecasts that affectContents

beginning after December 15, 2024, with early adoption permitted. We are currently evaluating the collectability of the reported amount. We adopted this standard on January 1, 2020 using the modified retrospective approach. The implementation of this standard did notimpact ASU No. 2023-09 will have a material impact on our consolidated financial statements.statements and disclosures.
Note 3. Real Estate PropertiesInvestments
Our real estate properties, excluding those classified as held for sale, consisted of land of $789,125 and buildings and improvements of $6,621,605 asAs of December 31, 2020, and land of $793,123 and buildings and improvements of $6,668,463 as of December 31, 2019. Accumulated depreciation was $1,561,751 and $133,150 for buildings and improvements, respectively, as of December 31, 2020; and $1,428,850 and $141,951 for buildings and improvements, respectively, as of December 31, 2019.
Our portfolio as of December 31, 2020 includes: 1232023, our owned properties include: 102 medical office and life science properties with approximately 11.38.6 million rentable square feet; 264259 senior living communities, including independent living (including active adult), assisted living, memory care and skilled nursing facilities, or SNFs, with 29,33527,271 living units; and 10 wellness centers with approximately 812,000 square feet of interior space plus outdoor developed facilities.
We have accounted for our 2020, 2019 and 2018 acquisitions as acquisitions of assets. We funded these acquisitions using cash on hand and borrowings under our revolving credit facility, unless otherwise noted.
F-14

Table of Contents
Acquisitions:
The table below represents the purchase price allocations (including net closing adjustments) of acquisitions for the years ended December 31, 2020, 20192023, 2022 and 2018:2021:
DateLocationType of PropertyNumber of PropertiesSquare Feet or Number of Units
Cash Paid
plus
Assumed
Debt (1)
LandBuildings
and
Improvements
FF&EAcquired
Real Estate
Leases / Resident Agreements
Acquired
Real Estate
Lease
Obligations
Assumed
Debt
Premium on 
Assumed Debt
Acquisitions during the year ended December 31, 2020:
We did not acquire any properties during the year ended December 31, 2020.
Acquisitions during the year ended December 31, 2019:
December 2019TexasIL169 units$50,506 $3,463 $44,189 $652 $2,202 $$$
Acquisitions during the year ended December 31, 2018:
January 20183 StatesMedical Office / Life Science400,000 sq. ft.$91,698 $16,873 $54,605 $$20,220 $$$
January 2018 (2)
TennesseeAL88 units19,868 580 14,884 1,209 3,195 
February 2018 (2)
ArizonaIL127 units22,622 2,017 17,123 390 4,451 (16,748)(1,359)
March 2018VirginiaMedical Office135,000 sq. ft.23,275 2,863 11,105 9,307 (11,050)
June 2018 (2)
TennesseeIL151 units23,860 965 17,910 1,628 3,843 (16,588)(486)
Total 2018 Acquisitions$181,323 $23,298 $115,627 $3,227 $41,016 $$(44,386)$(1,845)
DateLocationType of PropertyNumber of PropertiesSquare Feet
Cash Paid (1)
LandBuildings
and
Improvements
Acquired
Real Estate
Leases
Acquisitions during the year ended December 31, 2023:
We did not acquire any properties during the year ended December 31, 2023.
Acquisitions during the year ended December 31, 2022 (2):
July 2022CaliforniaLife Science188,508 $75,105 $15,774 $45,249 $14,082 
Acquisitions during the year ended December 31, 2021:
We did not acquire any properties during the year ended December 31, 2021.
(1)Cash paid plus assumed debt, if any, includes closing costs.
(2)Acquired from Five Star.

In January 2020, we acquired a vacant land parcel adjacent to a life science property we own located in Tempe, ArizonaWe have accounted for $2,600, excludingour 2022 acquisition costs.
Pursuant to the Restructuring Transaction, effective January 1, 2020, our previously existing master leases and management and pooling agreements with Five Star were terminated and replaced with new management agreements and a related omnibus agreement, or collectively, the Five Star management agreements, for allas an acquisition of our senior living communities operated by Five Star. See Notes 6 and 8 for further information regarding the Restructuring Transaction and the Transaction Agreement.assets. We funded this acquisition using cash on hand.
Impairment:
We regularly evaluate our assets for indicators of impairment. Impairment indicators may include declining tenant or resident occupancy, weak or declining profitability from the property, decreasing tenant cash flows or liquidity, our decision to dispose of an asset before the end of its estimated useful life and legislative, market or industry changes that could permanently reduce the value of an asset. If indicators of impairment are present, we evaluate the carrying value of the affected assets by comparing it to the expected future undiscounted cash flows to be generated from those assets. The future cash flows are subjective and are based in part on assumptions regarding hold periods, market rents and terminal capitalization rates. If the sum of these expected future cash flows is less than the carrying value, we reduce the net carrying value of the asset to its estimated fair value. See Note 10 for further information on impairment.
During 2020,2023, we recorded impairment charges of $98,414$14,034 to adjust the carrying valuesvalue of 28 senior living communitiesfour life science and medical office properties to their aggregate estimated fair value. These 28 senior living communities included 9 senior living communities which weWe sold three of these life science and medical office properties in 2020, 7 senior living communities which we closed in 2020 and 10 senior living communities which are2023. One of these medical office properties was classified as held for sale in our consolidated balance sheet as of December 31, 2020.2023. During 2020,2023, we also recorded impairment charges of $8,558$4,346 to adjust the carrying valuevalues of 7 medical office propertiestwo senior living communities to their aggregate estimated fair value. We sold 4one of these medical office propertiessenior living communities in 2020. NaN of these medical office properties is classified as held for sale in our consolidated balance sheet as of December 31, 2020.2023. These impairment charges, in aggregate, are included in impairment of assets in our consolidated statements of comprehensive income (loss).operations.
During 2019, we recorded2022, no impairment charges of $72,166 to adjust the carrying values of 25 senior living communities to their aggregate estimated fair value. These 25 senior living communities included 15 SNFs which we sold in September 2019 and 8 senior living communities which we sold in 2020. NaN of these 25 senior living communities were
F-15

Table of Contents
classified as held for sale in our consolidated balance sheet as of December 31, 2019. During 2019, we also recorded impairment charges of $43,035 to adjust the carrying value of 20 medical office properties and 1 life science property to their estimated fair value. We sold 5 of these medical office properties, along with the life science property, in 2019. The remaining 15 medical office properties were classified as held for sale in our consolidated balance sheet as of December 31, 2019. In 2020, we sold 10 of these 15 medical office properties classified as held for sale. These impairment charges, in aggregate, are included in impairment of assets in our consolidated statements of comprehensive income (loss).
During 2018, we recorded impairment charges of $46,797 to adjust the carrying values of 13 medical office properties to their aggregate estimated fair value. NaN of these medical office properties were classified as held for sale as of December 31, 2018. We sold all 13 of these medical office properties during 2019. During 2018, we also recorded impairment charges of $19,549 to write off unamortized lease assets related to lease defaults at 3 of our triple net leased senior living communities located in California, Colorado and Oregon that were leased to third party operators. As a result of these leases being terminated, or during the termination process, we concluded that there was no value to the unamortized lease assets and wrote them off completely during 2018. In June 2018, we reached an agreement with the tenant leasing the senior living community located in California and its guarantor to settle past due amounts, terminate the lease and transfer operations, and in connection with this agreement, we received $2,150 of settlement proceeds. In November 2018, we reached an agreement with the tenant leasing the senior living community in Colorado to terminate the lease and transfer operations. In April 2019, we reached an agreement with the tenant leasing the senior living community in Oregon to terminate the lease and transfer operations. We entered management agreements with Five Star to operate these communities for our account under TRS structures. These impairment charges, in aggregate, are included in impairment of assets in our consolidated statements of comprehensive income (loss).recorded.
Dispositions:
During the years ended December 31, 2020, 20192023 and 2018,2021, we sold 27, 46,eight and 5five properties, respectively, for aggregate sales prices of $152,893, $260,783,$18,880 and $334,865,$104,500, respectively, excluding closing costs, as presented in the table below. During the year ended December 31, 2022, we did not dispose of any properties. The sales of these properties do not represent significant dispositions, individually or in the aggregate, norand we do wenot believe theythese sales represent a strategic shift in our business. As a result, the results of the operationoperations for these properties are included in continuing operations through the date of sale of such properties in our consolidated statements of comprehensive income (loss).operations.
F-16F-14

Table of Contents

Date of SaleLocationType of PropertyNumber of PropertiesSquare Feet or Number of Units
Sales Price (1)
Gain (loss) on Sale
Dispositions during the year ended December 31, 2020:
January 2020LouisianaMedical Office640,575 sq. ft.$5,925 $(81)
February 2020PennsylvaniaMedical Office150,000 sq. ft.2,900 
March 2020TexasMedical Office170,229 sq. ft.8,779 2,863 
April 2020 (2)
CaliforniaIL / AL3599 units47,000 (256)
June 2020South CarolinaMedical Office149,242 sq. ft.3,550 
July 2020TexasMedical Office16,849 sq. ft.2,072 (30)
July 2020ConnecticutMedical Office132,162 sq. ft.625 (25)
August 2020 (2)
MississippiAL2116 units2,500 (42)
September 2020MississippiMedical Office178,747 sq. ft.7,250 (114)
October 2020VariousAL3239 units46,000 4,292 
November 2020 (2)
NebraskaAL1131 units3,000 (26)
December 2020New YorkMedical Office164,060 sq. ft.3,875 (273)
December 2020OhioLife Science2232,016 sq. ft.7,917 257 
December 2020 (2)
WisconsinSNF / AL3537 units11,500 (303)
27$152,893 $6,262 
Dispositions during the year ended December 31, 2019:
February 2019FloridaLife Science160,396 sq. ft.$2,900 $(69)
March 2019MassachusettsMedical Office14,400 sq. ft.75 (58)
May 2019 (2)
CaliforniaSNF3278 units21,500 15,207 
May 2019ColoradoMedical Office115,647 sq. ft.2,590 1,029 
June 2019MassachusettsMedical Office7164,121 sq. ft.8,042 1,590 
July 2019MassachusettsMedical Office3103,484 sq. ft.4,955 2,332 
August 2019MassachusettsMedical Office149,357 sq. ft.2,221 812 
September 2019 (2)
VariousSNF15964 units8,000 
September 2019MassachusettsMedical Office141,065 sq. ft.2,750 1,044 
October 2019South DakotaSNF / IL3245 units10,500 6,661 
October 2019New JerseyLife Science1205,439 sq. ft.47,500 
December 2019GeorgiaMedical Office195,010 sq. ft.14,000 (63)
December 2019WashingtonIL1150 units32,500 7,618 
December 2019VariousAL7566 units103,250 3,593 
46$260,783 $39,696 
Dispositions during the year ended December 31, 2018:
March 2018 (3)
VariousIL2843 units$217,000 $181,154 
May 2018 (3)
MarylandIL1354 units96,000 78,856 
June 2018 (2)
CaliforniaSNF198 units6,500 3,699 
June 2018 (4)
OregonAL199 units15,365 (1,793)
5$334,865 $261,916 
Date of SaleLocationType of PropertyNumber of PropertiesSquare Feet or Number of Units
Sales Price (1)
Gain (Loss) on Sale
Dispositions during the year ended December 31, 2023:
February 2023Pennsylvania and South CarolinaSenior Living3— 
units (2)
$2,800 $293 
October 2023PennsylvaniaMedical Office130,866 sq. ft.1,800 15 
October 2023TennesseeSenior Living1— 
units (2)
2,830 627 
October 2023MarylandLife Science158,880 sq. ft.6,200 (360)
November 2023VirginiaSenior Living1— 
units (2)
1,800 945 
December 2023South CarolinaMedical Office1115,108 sq. ft.3,450 (1,255)
8$18,880 $265 
Dispositions during the year ended December 31, 2022:
We did not dispose of any properties during the year ended December 31, 2022.
Dispositions during the year ended December 31, 2021:
February 2021PennsylvaniaMedical Office192,000 sq. ft.$9,000 $(122)
April 2021FloridaLife Science / Medical Office4263,656 sq. ft.95,500 30,760 
5$104,500 $30,638 
(1)Sales price excludes closing costs.
(2)These senior living communities were previously operated by Five Star.
(3)These senior living communities were leasedclosed prior to Sunrise Senior Living LLC.
(4)This senior living community was leased to a third-party operator, where the tenant exercised its purchase option.their respective dispositions.
During the year ended December 31, 2020,2023, we recognized $225a gain of $940 related to the sales of skilled nursing bed saleslicenses at onecertain of our senior living communities.
We classify all properties as held for sale in our consolidated balance sheets that meet the applicable criteria for that treatment as set forth in the Property, Plant and Equipment Topic of the Codification. As of December 31, 2020,2023, we had 10 senior living communities with 820 units and 5one medical office and life science properties with 355,656 square feetproperty classified as held for sale. As of December 31, 2019,2022, we had 21 medical office and life science properties with 875,617 square feet and 12one closed senior living communities with 1,670 unitscommunity classified as held for sale. As of December 31, 2018, we had 2 medical office properties with 32,604 square feet classified as held for sale.
F-17

Table of Contents
In February 2021, we sold 1 medical office property classified as held for sale as of December 31, 2020 for a sales price of $9,000, excluding closing costs.
As of February 23, 2021, we had 4 properties under an agreement to sell for a sales price of approximately $95,500, excluding closing costs. We may not complete the sales of any or all of the properties we currently plan to sell. Also, we may sell some or all of these properties at amounts that are less than currently expected and/or less than the carrying values of such properties and we may incur losses on any such sales as a result.
Investments and Capital Expenditures:
During 2020 and 2019, pursuant to the terms of our existing leases, we invested $2,138 and $1,739, respectively, in revenue producing capital improvements at certain of our senior living communities leased to third-party operators. As a result of these investments, annual rental income payable to us increased by approximately $135 and $90, respectively, pursuant to the terms of the applicable leases. Under our previously existing leases with Five Star, Five Star could request that we purchase certain improvements to the leased communities and, until we entered into the Transaction Agreement, the annual rent payable to us by Five Star would increase in accordance with a formula specified in the applicable lease in return for such purchases. During the year ended December 31, 2018, we purchased $17,956 of such improvements and Five Star's annual rent payable to us increased by $1,433 in accordance with the terms of the applicable leases. Pursuant to the Transaction Agreement, the $111,603 of improvements to communities leased to Five Star, including $49,155 of fixed assets and improvements that were purchased pursuant to the Transaction Agreement, that we funded during the year ended December 31, 2019 did not result in increased rent payable by Five Star. See Note 6 for further information regarding the Restructuring Transaction and the Transaction Agreement.
During 2020,2023, we committed $17,901an aggregate $62,180 for capital expendituresleasing related costs related to 1.00.9 million and 0.2 million square feet of leases executed at our medical office and life science properties.properties and wellness centers, respectively. During 2019,2022, we committed $30,135$22,911 for capital expendituresleasing related costs related to 1.50.9 million square feet of leases executed at our medical office and life science properties.
Committed and unspent tenant related obligations based on executed leases as of December 31, 20202023 and 20192022 were $19,159$54,124 and $23,994,$39,314, respectively.
ForOther:
In September 2022, certain of our managed senior living communities located in Florida experienced hurricane related damage. We carry comprehensive property, casualty, flood and business interruption insurances that we anticipate will cover our losses at these senior living communities, subject to a deductible. During the yearsyear ended December 31, 2020, 20192022, we incurred total losses of $11,253 related to the property damage sustained and 2018,deductible incurred. For the year ended December 31, 2022, we recorded capitalized interestrecognized a loss of $1,833, $1,124$7,635 for the involuntary conversion of nonmonetary assets and $124, respectively.
In July 2019,wrote off a tenantportion of the net book value of the damaged assets and included this amount in our Office Portfolio segment vacated 3 buildings with an aggregateconsolidated statements of 164,091 square feetoperations. During the year ended December 31, 2022, we received $14,466 in California. After evaluatingcash from our options,insurance provider, and as such, we determined to,have recovered the total losses of $11,253 incurred during the year ended December 31, 2022. The loss of $7,635 for the involuntary conversion of nonmonetary assets, recovery of those $7,635 in losses and have since substantially completed, a full redevelopmentthe deductible of these buildings.$3,618 are included in property operating expenses in our consolidated statements of operations. We received $534 and $3,213 in cash in excess of our losses during the
F-18F-15

Table of Contents

years ended December 31, 2023 and 2022, respectively. These amounts are included in other liabilities in our consolidated balance sheets.
Unconsolidated Joint Venture Investments:
As of December 31, 2023, we had equity investments in unconsolidated joint ventures as follows:
Equity Method Investments in Joint VentureDHC OwnershipDHC Carrying Value of Investment at December 31, 2023Number of PropertiesLocationSquare Feet
Seaport Innovation LLC10%$85,699 1MA1,134,479 
The LSMD Fund REIT LLC20%44,217 10CA, MA, NY, TX, WA1,068,763 
$129,916 112,203,242 
The following table provides a summary of the mortgage debts of these joint ventures:
Joint VentureCoupon RateMaturity Date
Principal Balance at December 31, 2023 (1)
Mortgage Notes Payable (secured by one property in Massachusetts) (2)
3.53%8/6/2026$620,000 
Mortgage Notes Payable (secured by nine properties in five states) (3)
3.46%2/11/2032189,800 
Mortgage Notes Payable (secured by one property in California) (3)(4)
5.90%2/9/2025266,825 
Weighted Average / Total4.10%$1,076,625 
(1)Amounts are not adjusted for our minority equity interest.
(2)Following the deconsolidation in December 2021 of the net assets of the Seaport JV, we no longer include this $620,000 of secured debt financing in our consolidated balance sheet; however, we continue to provide certain guaranties on this debt.
(3)The debt securing these properties is non-recourse to us.
(4)The joint venture exercised its option to extend the maturity date of this mortgage loan by one year to February 9, 2025, and this mortgage loan requires interest to be paid at an annual rate of SOFR, plus a premium of 1.90%. The interest rate is as of December 31, 2023. This joint venture has also purchased an interest rate cap through February 2025 with a SOFR strike rate equal to 4.48% and an initial premium of $1,200. The maturity date of this mortgage loan is subject to two remaining one-year extension options.

In March 2017, we entered into the Seaport JV with an institutional investor. The investor owned a 45% equity interest in the joint venture, and we owned the remaining 55% equity interest in the joint venture. We determined that, while we owned a 55% equity interest in this joint venture, this joint venture was a VIE as defined under the Consolidation Topic of the Financial Accounting Standards Board Codification. We concluded that we must consolidate this VIE, and we did so, until we sold an additional 35% equity interest in the joint venture in December 2021. We reached this determination because we were the entity with the power to direct the activities that most significantly impacted the VIE's economic performance and we had the obligation to absorb losses of, and the right to receive benefits from, the VIE that could be significant to the VIE, and therefore were the primary beneficiary of the VIE. The joint venture investor's interest in this consolidated entity was reflected as noncontrolling interest in our consolidated financial statements.
In December 2021, we sold an additional 35% equity interest from our then remaining 55% equity interest in the Seaport JV to another third party institutional investor for $378,000, before closing costs and other adjustments. Effective as of the date of the sale, we deconsolidated the net assets of this joint venture and recognized a net gain on sale of $461,434 related to this transaction during the year ended December 31, 2021, which is included in gain on sale of properties in our consolidated statements of operations. After giving effect to the sale, we owned a 20% equity interest in this joint venture but determined that we were no longer the primary beneficiary. Effective as of the date of the sale, we deconsolidated this joint venture, and we now account for this joint venture using the equity method of accounting under the fair value option. Prior to the deconsolidation of the net assets of this joint venture, the joint venture investor's interest in this consolidated entity was reflected as noncontrolling interest in our consolidated financial statements. In June 2022, we sold an additional 10% equity interest from our then remaining 20% equity interest in the Seaport JV to an existing joint venture investor for $108,000, before closing costs and other adjustments. We received net proceeds of $108,424 from this transaction, which included working capital prorations and formation costs. We recognized a net loss on sale of $1,428 related to this transaction during the year ended December 31, 2022, which is included in gain on sale of properties in our consolidated statements of operations. After giving effect to these sales, we continue to own a 10% equity interest in this joint venture. Our initial investment amount was based on a property valuation of $1,700,000, less $620,000 of existing mortgage debts on the property that this joint venture assumed. See Note 10 for more information regarding the valuation of our investment in this joint venture.
F-16

Table of Contents

In January 2022, we entered into the LSMD JV with two unrelated third party institutional investors. We sold equity interests in this joint venture to those investors for aggregate proceeds, before closing costs and other adjustments, of approximately $653,300. We deconsolidated the net assets of these properties effective as of the date of the sale and recognized a net gain on sale of $322,468 related to this transaction during the year ended December 31, 2022, which is included in gain on sale of properties in our consolidated statements of operations. The equity interests that the investors acquired from us equaled 41% and 39%, respectively, of the total equity interests in the joint venture, and we retained a 20% equity interest in the joint venture. Following the sale, we account for this joint venture using the equity method of accounting under the fair value option. The initial investment amounts were based upon a property valuation of approximately $702,500, less approximately $456,600 of secured debt on the properties incurred by this joint venture. See Note 10 for more information regarding the valuation of our investment in this joint venture.
Note 4. Leases
We are a lessor of medical office and life science properties, senior living communities and other healthcare related properties. Our leases provide our tenants with the contractual right to use and economically benefit from all of the premises demised under the leases; therefore, we have determined to evaluate our leases as lease arrangements.
Certain of ourOur leases provide for base rent payments and, in addition, may include variable payments. Rental income from operating leases, including any payments derived by index or market based indices, is recognized on a straight line basis over the lease term when we have determined that the collectability of substantially all of the lease payments is probable. Some of our leases have options to extend or terminate the lease exercisable at the option of our tenants, which are considered when determining the lease term.
We increased rental income to record revenue on a straight line basis by $6,069, $4,508$(1,095), $8,916 and $10,227$5,846 for the years ended December 31, 2020, 20192023, 2022 and 2018,2021, respectively. Rents receivable, excluding receivables related to our properties classified as held for sale, if any, include $104,803$75,306 and $99,297$76,363 of straight line rent receivables at December 31, 20202023 and 2019,2022, respectively, and are included in other assets, net in our consolidated balance sheets.
We do not include in our measurement of our lease receivables certain variable payments, including changes in the index or market based indices after the inception of the lease, certain tenant reimbursements and other income until the specific events that trigger the variable payments have occurred. We recognized suchSuch payments totaling $77,599, $78,668totaled $51,367, $47,669 and $82,001$74,860 for the years ended December 31, 2020, 20192023, 2022 and 2018,2021, respectively, of which tenant reimbursements totaled $4,722, $4,904$48,215, $44,470 and $5,048,$72,690, respectively.
The following table presents our operating lease maturity analysis, excluding lease payments from properties classified as held for sale, if any, as of December 31, 2020:2023:
YearAmount
2021$305,174 
2022286,369 
2023268,999 
2024248,631 
2025209,866 
Thereafter813,307 
Total$2,132,346 
Certain of our tenants have requested relief from their obligations to pay rent due to us in response to the current economic conditions resulting from the COVID-19 pandemic. As of February 23, 2021, we granted requests for certain of our tenants to defer rent payments totaling $2,117. These tenants are obligated to pay, in most cases, the deferred rents in 12 equal monthly installments commencing in September 2020. We have elected to use the FASB relief package regarding the application of lease accounting guidance to lease concessions provided as a result of the COVID-19 pandemic. The FASB relief package provides entities with the option to account for lease concessions resulting from the COVID-19 pandemic outside of the existing lease modification guidance if the resulting cash flows from the modified lease are substantially the same as the original lease. Because the majority of the deferred rents referenced above are required to be repaid, the cash flows from the respective leases are substantially the same as before the rent deferrals. These deferred amounts did not negatively impact our operating results for the year ended December 31, 2020 and, as of December 31, 2020, we recognized $1,486 in our accounts receivable related to these deferred amounts.
YearAmount
2024$191,360 
2025182,672 
2026174,881 
2027153,170 
2028131,872 
Thereafter597,208 
Total$1,431,163 
Right of Use Asset and Lease Liability. For leases where we are the lessee, we recognized a right of use asset and a lease liability equal to the present value of the minimum lease payments with rental payments being applied to the lease liability and the right of use asset being amortized over the term of the lease. The values of the right of use assetassets and related liabilityliabilities representing our future obligation under the respective lease arrangementarrangements for which we are the lessee were $4,237$23,366 and $4,410,$23,748, respectively, as of December 31, 2020,2023, and $4,319$26,508 and $4,461,$26,889, respectively, as of December 31, 2019.2022. The right of use assetassets and related lease liabilityliabilities are included within other assets, net and other liabilities, respectively, within our consolidated balance sheets. In addition, we lease equipment at certain of our managed senior living communities. These leases are short term in nature, are cancelable with no fee or do not result in an annual expense in excess of our capitalization policy and, as a result, are not recorded on our consolidated balance sheets.
F-19F-17

Table of Contents

Note 5. Shareholders' Equity
We have common shares available for issuance under the terms of our equity compensation plan adopted in 2012, as amended, or the 2012 Plan. During the years ended December 31, 2020, 20192023, 2022 and 2018,2021, we awarded to our officers and other employees of The RMR Group LLC, or RMR, annual share awards of 360,000, 187,500800,000, 707,000 and 105,800718,000 of our common shares, respectively, valued at $1,357, $1,633$1,864, $919 and $2,022,$2,448, in aggregate, respectively. In accordance with our Trustee compensation arrangements, we also awarded each of our then Trustees 10,00020,000 common shares with an aggregate value of $176$244 ($2935 per Trustee), 3,00020,000 common shares with an aggregate value of $119$300 ($2443 per Trustee) and 3,00020,000 common shares with an aggregate value of $248$444 ($5074 per Trustee) in 2020, 20192023, 2022 and 2018,2021, respectively. In addition,Also in accordance with our trustee compensation arrangements, we awarded 3,000 common shares with a value of $47September 2023, in connection with the election of one of our Managing Trustees, in March 2018.we awarded 20,000 of our common shares to this Trustee with a value of $45. The values of the share awards were based upon the closing price of our common shares trading on The Nasdaq Stock Market LLC, or Nasdaq, on the dates of awards. The common shares awarded to our Trustees vested immediately. The common shares awarded to our officers and certain other employees of RMR LLC(in those capacities) vest in five equal annual installments beginning on the date of award. We include the value of awarded shares in general and administrative expenses in our consolidated statements of comprehensive income (loss)operations ratably over the vesting period. At December 31, 2020, 1,843,6172023, 1,938,197 of our common shares remain available for issuance under the 2012 Plan.
A summary of shares awarded, forfeited, vested and unvested under the terms of the 2012 Plan from January 1, 20182021 to December 31, 20202023 is as follows:
 Number of SharesWeighted Average
Award Date
Fair Value
Unvested shares at December 31, 2017148,010 $19.71 
Shares awarded in 2018123,800 $18.72 
Shares vested / forfeited in 2018(109,820)$18.31 
Unvested shares at December 31, 2018161,990 $19.41 
Shares awarded in 2019202,500 $8.65 
Shares vested / forfeited in 2019(137,150)$8.94 
Unvested shares at December 31, 2019227,340 $12.52 
Shares awarded in 2020420,000 $3.65 
Shares vested / forfeited in 2020(212,790)$7.04 
Unvested shares at December 31, 2020434,550 $6.15 
 Number of SharesWeighted Average
Award Date
Fair Value
Unvested shares at December 31, 2020434,550 $6.15 
Shares awarded in 2021838,000 $3.45 
Shares vested / forfeited in 2021(426,930)$4.98 
Unvested shares at December 31, 2021845,620 $4.07 
Shares awarded in 2022847,000 $1.44 
Shares vested / forfeited in 2022(576,620)$3.24 
Unvested shares at December 31, 20221,116,000 $2.50 
Shares awarded in 2023960,000 $2.24 
Shares vested / forfeited in 2023(847,800)$2.53 
Unvested shares at December 31, 20231,228,200 $2.28 
The 434,5501,228,200 unvested shares as of December 31, 20202023 are scheduled to vest as follows: 158,330428,200 shares in 2021, 111,9202024, 377,200 shares in 2022, 97,9002025, 270,400 shares in 20232026 and 66,400152,400 shares in 2024.2027. As of December 31, 2020,2023, the estimated future compensation for the unvested shares was $2,205$2,489 based on the adjusted award date fair value of these shares. At December 31, 2020,2023, the weighted average period over which the compensation expense will be recorded is approximately 1.91.8 years. We recorded share based compensation expense of $1,568$1,840 in 2020, $1,3882023, $1,733 in 20192022 and $2,224$1,960 in 2018.2021. We recognize forfeitures as they occur.
During 2020, 20192023, 2022 and 2018,2021, we purchased an aggregate of 47,375, 31,747184,344, 133,752 and 22,999,109,384, respectively, of our common shares from certain of our Trustees and officers and certain other current and former officers and employees of RMR LLC in satisfaction of tax withholding and payment obligations in connection with the vesting of awards of our common shares. See Note 8 for further information regarding these purchases.
A summary of cash distributions paid to common shareholders, for federal income tax purposes, are as are follows for the periods presented:
Annual PerCharacterization of Distribution
ShareTotalOrdinaryCapitalReturn of
YearDistributionDistributionIncomeGainCapital
2020$0.18 $42,825 %%100.0 %
2019$0.84 $199,719 %25.7 %74.3 %
2018$1.56 $370,746 38.1 %61.9 %%
Annual PerCharacterization of Distribution
ShareTotalOrdinaryCapitalReturn of
YearDistributionDistributionIncomeGainCapital
2023$0.04 $9,595 — %— %100.0 %
2022$0.04 $9,568 — %14.0 %86.0 %
2021$0.04 $9,540 — %100.0 %— %
F-20F-18

Table of Contents

On January 14, 2021,11, 2024, we declared a regular quarterly distribution payable to our common shareholders of record on January 25, 2021 in the amount22, 2024 of $0.01 per share, or approximately $2,383.$2,403 in aggregate. We paid this distribution on February 18, 2021,15, 2024, using cash on hand.
As described in Note 6, pursuant to the Restructuring Transaction, on January 1, 2020, Five Star issued an aggregate of 16,118,849 common shares, with an aggregate value of $59,801, to our shareholders of record as of December 13, 2019. We recorded this issuance as a non-cash distribution in our consolidated financial statements.
Note 6. Leases andSenior Living Community Management Agreements with Five Star
As of December 31, 2019, we leased 166Our managed senior living communities are operated by third parties pursuant to Five Star. As of that date, we also leased to our TRSs 78 communities that we owned and that were managed bymanagement agreements. Five Star, for our account.
Restructuringwhich is an operating division of AlerisLife, manages many of our Business Arrangements with Five Star
The Transaction Agreement with Five Star. Pursuant to the Transaction Agreement, effective January 1, 2020, or the Conversion Time:
our previously existing master leases with Five Star forSHOP communities, and we lease nearly all of our senior living communities managed by third party managers, to our TRSs.
Management Arrangements with Five Star. On June 9, 2021, we and Five Star entered into an amended and restated master management agreement, or the Master Management Agreement, for the senior living communities that Five Star leased, as well as our previously existingmanages for us and interim management agreements for the senior living communities that we and poolingFive Star agreed to transition to other third party managers. In addition, AlerisLife delivered to us an amended and restated guaranty agreement pursuant to which AlerisLife is continuing to guarantee the payment and performance of each of its applicable subsidiary’s obligations under the applicable management agreements. The principal changes to the management arrangements included:
that Five Star agreed to cooperate with us in transitioning 108 of our senior living communities with approximately 7,500 living units to other third party managers without our payment of any termination fee to Five Star;
that we no longer have the right to sell up to an additional $682,000 of senior living communities currently managed by Five Star and terminate Five Star's management of those communities without our payment of a fee to Five Star upon sale;
that Five Star is continuing to manage 119 of the 120 of our senior living communities that were included as part of the management arrangements (the management for one active adult community was terminated by mutual agreement effective October 31, 2022), and that the skilled nursing units in all of our continuing care retirement communities that Five Star is continuing to manage, which then included approximately 1,500 living units, were closed and are being evaluated and repositioned;
that beginning in 2025, we will have the right to terminate up to 10% of the senior living communities that Five Star is continuing to manage, based on total revenues per year for failure to meet 80% of a target earnings before interest, taxes, depreciation and amortization, or EBITDA, for the applicable period;
that the incentive fee that Five Star may earn in any calendar year for the senior living communities that Five Star is continuing to manage is no longer subject to a cap and that any senior living communities that are undergoing a major renovation or repositioning are excluded from the calculation of the incentive fee;
that RMR will oversee any major renovation or repositioning activities at the senior living communities that Five Star is continuing to manage; and
that the term of our management agreements with Five Star for our senior living communities that Five Star managed, were terminated and replaced with the Five Star management agreements;
Five Star issuedis continuing to us 10,268,158 common shares and an aggregate of 16,118,849 common sharesmanage was extended by two years to our shareholders of record as of December 13, 2019; and
as consideration for these share issuances, we provided Five Star with $75,000 of additional consideration by assuming certain of Five Star's working capital liabilities and cash payments to Five Star, resulting in a gain on lease termination of $22,896 for the year ended December 31, 2020 in our consolidated statements of comprehensive income (loss).2036.
Also pursuant to the Transaction Agreement: (1) commencing February 1, 2019, the aggregate amount of monthly minimum rent payable to us by Five Star under our previously existing master leases with Five Star was set at $11,000 as of February 1, 2019, subject to adjustment, and subsequently reduced in accordance with the Transaction Agreement as a result of our subsequent sales of certain of the leased senior living communities, and no additional rent was payable to us by Five Star from such date until the Conversion Time; and (2) as of April 1, 2019, we purchased from Five Star $49,155 of unencumbered Qualifying PP&E (as defined in the Transaction Agreement) related to our senior living communities leased and operated by Five Star.
Pursuant to the Five Star management agreements,Master Management Agreement, Five Star receives a management fee equal to 5% of the gross revenues realized at the applicable senior living communities plus reimbursement for its direct costs and expenses related to such communities. Commencing with calendar year 2021, Five Star may receive an annual incentive fee equal to 15% of the amount by which the annual earnings before interest, taxes, depreciation and amortization, or EBITDA of all communities on a combined basis exceeds the target EBITDA for all communities on a combined basis for such calendar year, provided that in no event shall the incentive fee be greater than 1.5% of the gross revenues realized at all communities on a combined basis for such calendar year. The target EBITDA for those senior living communities on a combined basis is increased annually based on the greater of the annual increase of the consumer price index, or CPI, or 2%, plus 6% of any capital investments funded at the managed senior living communities on a combined basis in excess of the target capital investment. Unless otherwise agreed, the target capital investment increases annually based on the greater of the annual increase of CPI or 2%. Any senior living communities that are undergoing a major renovation or repositioning are excluded from the calculation of the incentive fee.
The Five Star management agreements expireMaster Management Agreement expires in 2034,2036, subject to Five Star's right to extend for 2two consecutive five year terms if Five Star achieves certain performance targets for the combined managed communities portfolio, unless earlier terminated. The Five Star management agreements also provide us withPursuant to the Master Management Agreement, beginning in 2025, we have the right to terminate up to 10% of the senior living communities that Five Star management agreementis continuing to manage, based on total revenues per year for any community that does not earn 90%failure to meet 80% of thea target EBITDA for such community for two consecutive calendar years or in any two of three consecutive calendar years, with the measurement period commencing January 1, 2021 (and the first termination not possible until the beginning of calendar year 2023), provided we may not in any calendar year terminate communities representing more than 20% of the combined revenues for all communities for the calendar year prior to such termination. Pursuant to a guaranty agreement dated as of January 1, 2020 made by Five Star in favor of our applicable period.
F-21F-19

Table of Contents

subsidiaries, Five Star has guaranteedIn connection with ABP Trust’s acquisition of AlerisLife on March 20, 2023, we amended the payment and performanceMaster Management Agreement to eliminate any change of eachcontrol default or event of its applicable subsidiary's obligations underdefault provisions effective upon the applicable Five Star management agreements.
On April 1, 2019, we concluded that the Restructuring Transaction constituted a reconsideration event requiring us to assess whether we held a controlling financial interest in Five Star. As a result of this assessment, we determined that Five Star was a VIE effective asconsummation of the dateAlerisLife acquisition by ABP Trust. See Note 8 for further information regarding ABP Trust’s acquisition of AlerisLife.
In 2021, we completed the transition of 107 of the Transaction Agreement. We determined not to consolidate Five Star in our consolidated financial statements, as we do not have the power to direct the activities of Five Star that most significantly impact Five Star's economic performance and therefore are not the primary beneficiary of Five Star. Effective January 1, 2020, we determined that Five Star is not a VIE and we will account for our equity investment in Five Star using the equity method of accounting because we are deemed to exert significant influence, but not control, over Five Star's most significant activities. We have elected to use the fair value option to account for our investment in Five Star.
Our Senior Living Communities Formerly Leased by Five Star. Prior to the Conversion Time, we leased108 senior living communities, to Five Star pursuant to 5 master leases with Five Star, each of which was terminated as of January 1, 2020 pursuant to the Transaction Agreement.
Under our previously existing leases with Five Star, Five Star paid us annual rent plus percentage rent equal to 4.0% of the increase in gross revenues at certain of our seniorcontaining 7,340 living communities over base year gross revenues as specified in the applicable leases. Pursuant to the Transaction Agreement, commencing February 1, 2019, no percentage rent was payable to us by Five Star and annual rent payable to us by Five Star was adjusted as noted above. We previously determined percentage rent due under these leases annually and recognized it when all contingencies were met, which was typically at year end. We recognized total rental incomeunits, from Five Star of $137,898to other third party managers. The remaining senior living community was closed in February 2022 and $212,622 (including percentage rent of $538we are assessing opportunities to redevelop that property. We recorded $0, $2,096 and $5,525)$17,363 for the years ended December 31, 20192023, 2022 and 2018, respectively. As2021, respectively, of December 31, 2019costs that we incurred related to retention and 2018, our net receivables from Five Star were $1,989other transition costs to acquisition and $18,697, respectively, and those amounts are included in due from affiliatecertain other transaction related costs in our consolidated balance sheets. No rent or percentage rent is payable to us by Five Star asstatements of December 31, 2020.
Our previously existing leases with Five Star were “triple net” leases, which generally required Five Star to pay rent and all property operating expenses, to indemnify us from liability which may arise by reason of our ownership of the properties, to maintain the properties at Five Star's expense, to remove and dispose of hazardous substances on the properties in compliance with applicable law and to maintain insurance on the properties for Five Star's and our benefit.
Under our previously existing leases with Five Star, Five Star could request that we purchase certain improvements to the leased communities and, until we entered into the Transaction Agreement, the annual rent payable to us by Five Star would increase in accordance with a formula specified in the applicable lease in return for such purchases. During the year ended December 31, 2018, we purchased $17,956 of such improvements and Five Star's annual rent payable to us increased by $1,433, in accordance with the terms of the applicable leases. Pursuant to the Transaction Agreement, the $111,603 of improvements to communities leased to Five Star, including $49,155 of fixed assets and improvements that were purchased pursuant to the Transaction Agreement as discussed above, that we funded during the year ended December 31, 2019 did not result in increased rent payable by Five Star.
As of December 31, 2019, Five Star was our most significant tenant. The following is a summary of the assets leased to and revenues earned from Five Star as a tenant as of and for the years ended December 31, 2019 and 2018 compared to all our other assets and revenues from all sources:
 As of December 31, 2019As of December 31, 2018
 
Gross Book Value of Real Estate Assets (1)
% of Total
Gross Book Value of Real Estate Assets (1)
% of Total
Five Star (2)
$2,286,951 27.2 %$2,253,853 26.7 %
All others (3)
6,133,672 72.8 %6,174,791 73.3 %
 $8,420,623 100.0 %$8,428,644 100.0 %
(1)    Represents the gross book value of real estate assets at cost plus certain acquisition costs, before depreciation and purchase price allocations, less impairment write downs, if any. Five Star also manages our managed senior living communities. The gross book value of real estate assets of $1,920,070 as of December 31, 2019 for those managed senior living communities Five Star then managed is included in the "All others" category.
(2)    Includes gross book value of real estate assets of $50,951 classified as held for sale in our consolidated balance sheet as of December 31, 2019.
(3)    Includes gross book value of real estate assets of $213,416 and $3,752 classified as held for sale in our consolidated balance sheets as of December 31, 2019 and 2018, respectively.
F-22

Table of Contents
 Year EndedYear Ended
 December 31, 2019December 31, 2018
 
Total Revenues(1)
% of Total
Total Revenues (1)
% of Total
Five Star$137,898 13.3 %$212,622 19.0 %
All others902,257 86.7 %904,542 81.0 %
 $1,040,155 100.0 %$1,117,164 100.0 %
(1)    Five Star also manages our managed senior living communities. Our revenues of $433,597 and $416,523 for the years ended December 31, 2019 and 2018, respectively, from those communities are included in the “All others” category.operations.
Our Senior Living Communities Managed by Five StarStar.. Five Star managed 235, 78119, 119 and 76120 of our senior living communities for our account as of December 31, 2020, 20192023, 2022 and 2018,2021, respectively. We lease our senior living communities that are managed by Five Star to our TRSs, and Five Star manages these communities pursuant to long termthe Master Management Agreement. Effective October 31, 2022, Five Star ceased managing an active adult community we own located in Plano, TX, and RMR assumed management agreements. As described above,of that community pursuant to the Restructuring Transaction, effective January 1, 2020, we replaced our long termproperty management and pooling agreementsagreement with RMR. We paid Five Star a termination fee of $350 in connection with the termination of Five StarStar's management agreements, the terms of which are described above.this community.
We incurred management fees payable to Five Star of $62,880, $15,327$40,119, $37,037 and $14,426$47,479 for the years ended December 31, 2020, 20192023, 2022 and 2018,2021, respectively. These amounts are included in property operating expenses or have been capitalized, as appropriate, in our consolidated financial statements. For the yearyears ended December 31, 2020, $60,4132023, 2022 and 2021, $37,436, $33,737 and $43,864, respectively, of the total management fees were expensed to property operating expenses in our consolidated statements of income (loss)operations and $2,467$2,683, $3,300 and $3,615, respectively, were capitalized in our consolidated balance sheets.
The following table presents residents fees and services revenue disaggregated by typeamounts capitalized are being depreciated over the estimated useful lives of contract and payer:
Year Ended December 31,
Revenue from contracts with customers:20202019
Basic housing and support services$856,687 $353,699 
Medicare and Medicaid programs173,878 31,324 
Private pay and other third party payer SNF services174,246 48,574 
Total residents fees and services$1,204,811 $433,597 
the related capital assets.
In addition to providing management services to us, Five Star also provides certain other services to residents at some of the senior living communities it manages for us, such as rehabilitation services. At senior living communities Five Star manages for us where Five Star provides rehabilitation services on an outpatient basis, the residents, third party payers or government programs pay Five Star for those rehabilitation services. At senior living communities Five Star manages for us where Five Star provides both inpatient and outpatient rehabilitation services, we generally pay Five Star for those rehabilitation services and charges for these services are included in amounts charged to residents, third party payers or government programs. During 2023, Five Star closed all inpatient clinics and as such we do not expect to incur these fees to Five Star in the future. We incurred fees of $25,687, $5,920$1,213, $6,289 and $6,442$11,233 for the years ended December 31, 2020, 20192023, 2022 and 2018,2021, respectively, with respect to rehabilitation services Five Star provided at our senior living communities it manages for us that are payable by us. These amounts are included in property operating expenses in our consolidated statements of comprehensive income (loss).
As a result of routine monitoring protocols that are a part of Five Star's compliance program activities related to Medicare billing, Five Star discovered potentially inadequate documentation at 1 of our senior living communities that Five Star manages. This monitoring was not initiated in response to any specific complaint or allegation but rather was of the type that Five Star periodically undertakes to test its compliance with applicable Medicare billing rules. We and Five Star voluntarily disclosed this matter to the United States Department of Health and Human Services, Office of the Inspector General, or the OIG, pursuant to the OIG's Provider Self-Disclosure Protocol. In January 2021, we and Five Star settled this matter with the OIG and we agreed to pay approximately $5,763 in exchange for a customary release, but we and Five Star did not admit any liability. We paid that amount to the OIG in January 2021. Five Star refunded to us $115 of management fees it previously received relating to the Medicare payments we refunded to the OIG. With respect to this settlement amount, we accrued a revenue reserve of $3,842 at December 31, 2020 for historical Medicare payments we received and agreed to repay to the OIG and we recorded expenses of $1,921 for the year ended December 31, 2020 for OIG-imposed penalties.
F-23

Table of Contents
operations.
Since January 1, 2020,2021, we sold certain senior living communities that were then managed by Five Star. We and Five Star terminated our management agreements for these senior living communities in connection with these sales. We and Five Star have also identified additional senior living communities for sale that are currently managed by Five Star. If these sales are consummated, we and Five Star will terminate the management agreements for these senior living communities. See Note 3 for further information regarding these sales.
We lease to Five Star space at certain of our senior living communities, that Five Star manages that Five Starwhich it uses to provide certain inpatient and outpatient rehabilitation and wellness services.
Our Senior Living Communities Managed by Other Third Party Managers. As of December 31, 2023, 2022 and 2021, respectively, our other third party managers managed 113, 111 and 107 of our senior living communities. The terms of the management agreements with the other third party managers are generally as follows: the other third party managers will receive a management fee equal to 5% to 6% of the gross revenues realized at the applicable senior living communities plus reimbursement for direct costs and expenses related to such communities. These agreements generally also provide for the other third party managers to earn a minimum base fee for a portion of the term of the agreement. Additionally, the other third party managers have the ability to earn incentive fees equal to 15% to 25% of the amount by which EBITDA of the applicable communities exceeds the target EBITDA for the applicable communities. The other third party managers can also earn a construction supervision fee ranging between 3% and 5% of construction costs.
The initial terms of the management agreements with the other third party managers are generally five years, subject to automatic extensions of successive terms of two years each unless earlier terminated or timely notice of nonrenewal is delivered. The management agreements with the other third party managers also generally provide us with the right to terminate the management agreements for communities that do not earn 70% to 80% of the target EBITDA for such communities, after an agreed upon stabilized period.
In December 2023, we notified one of our third party managers which manages certain of our communities located in Wisconsin and Illinois that we will be terminating our management agreement with respect to these communities. We recognizedexpect to
F-20

Table of Contents

transition these communities during the first half of 2023 to another third party manager which we have an existing relationship with. We expect the terms of the management agreement for these communities to be generally consistent with the terms outlined above. We expect to pay a reductiontermination fee of approximately $1,000 in connection with this transition.
We incurred management fees payable to our other third party managers of $21,863, $20,739 and $6,239 for the years ended December 31, 2023, 2022 and 2021, respectively. These amounts are included in property operating expenses in our consolidated statements of $1,561 foroperations.
The following table presents residents fees and services revenue from all of our managed senior living communities disaggregated by the year ended December 31, 2020, with respect to these leases.type of contract and payer:
Year Ended December 31,
Revenue from contracts with customers:202320222021
Basic housing and support services$915,528 $806,500 $750,644 
Medicare and Medicaid programs89,613 82,106 98,273 
Private pay and other third party payer SNF services146,767 134,220 125,706 
Total residents fees and services$1,151,908 $1,022,826 $974,623 
Note 7. Business and Property Management Agreements with RMR LLC
We have 0no employees. The personnel and various services we require to operate our business are provided to us by RMR LLC.RMR. We have 2two agreements with RMR LLC to provide management services to us: (1) a business management agreement, which relates to our business generally,generally; and (2) a property management agreement, which relates to the property level operations of many of our properties, including our medical office and life science properties. We also have a subsidiary level management agreement withproperties, and major renovation or repositioning activities at our senior living communities that we may request RMR LLC related to one of our life science properties located in Boston, Massachusetts, which we entered in connection with the joint venture arrangement for that life science property. Under that agreement, our subsidiary pays RMR LLC certain business management fees directly, which fees are credited against the business management fees payable by usmanage from time to RMR LLC.time. See Note 8 for further information regarding our relationship, agreements and transactions with RMR LLC.RMR.
Management Agreements with RMR LLC. RMR.Our management agreements with RMR LLC provide for an annual base management fee, an annual incentive management fee and property management and construction supervision fees, payable in cash, among other terms:
Base Management Fee. The annual base management fee payable to RMR LLC by us for each applicable period is equal to the lesser of:
the sum of (a) 0.5% of the daily weighted average of the aggregate book value of our real estate assets owned by us or our subsidiaries as of October 12, 1999, or the Transferred Assets, plus (b) 0.7% of the average aggregate historical cost of our real estate investments excluding the Transferred Assets up to $250,000, plus (c) 0.5% of the average aggregate historical cost of our real estate investments excluding the Transferred Assets exceeding $250,000; and
the sum of (a) 0.7% of the average closing price per share of our common shares on the stock exchange on which such shares are principally traded during such period, multiplied by the average number of our common shares outstanding during such period, plus the daily weighted average of the aggregate liquidation preference of each class of our preferred shares outstanding during such period, plus the daily weighted average of the aggregate principal amount of our consolidated indebtedness during such period, or, together, our Average Market Capitalization, up to $250,000, plus (b) 0.5% of our Average Market Capitalization exceeding $250,000.
The average aggregate historical cost of our real estate investments includes our consolidated assets invested, directly or indirectly, in equity interests in or loans secured by real estate and personal property owned in connection with such real estate (including acquisition related costs and costs which may be allocated to intangibles or are unallocated), all before reserves for depreciation, amortization, impairment charges or bad debts or other similar non cashnon-cash reserves.
Incentive Management Fee. The incentive management fee which may be earned by RMR LLC for an annual period is calculated as follows:
F-21

Table of Contents

An amount, subject to a cap, based on the value of our common shares outstanding, equal to 12.0% of the product of:
our equity market capitalization on the last trading day of the year immediately prior to the relevant three year measurement period, and
the amount (expressed as a percentage) by which the total return per share, as defined in the business management agreement and further described below, of our common shareholders (i.e., share price
F-24

Table of Contents
appreciation plus dividends) exceeds the total shareholder return of the SNL U.S. REIT Healthcare Index,applicable market index, or the benchmark return per share, for the relevant measurement period. The MSCI U.S. REIT/Health Care REIT Index is the benchmark index for periods on or after August 1, 2021, and the SNL U.S. REIT Healthcare Index is the benchmark index for periods prior to August 1, 2021.
For purposes of the total return per share of our common shareholders, share price appreciation for a measurement period is determined by subtracting (1) the closing price of our common shares on Nasdaq on the last trading day of the year immediately before the first year of the applicable measurement period, or the initial share price, from (2) the average closing price of our common shares on the 10 consecutive trading days having the highest average closing prices during the final 30 trading days in the last year of the measurement period.
The calculation of the incentive management fee (including the determinations of our equity market capitalization, initial share price and the total return per share of our common shareholders) is subject to adjustments if we issue or repurchase our common shares, or if our common shares are forfeited, during the measurement period.
NaNNo incentive management fee is payable by us unless our total return per share during the measurement period is positive.
The measurement periods are three year periods ending with the year for which the incentive management fee is being calculated.
If our total return per share exceeds 12.0% per year in any measurement period, the benchmark return per share is adjusted to be the lesser of the total shareholder return of the SNL U.S. REIT Healthcare Indexapplicable market index for such measurement period and 12.0% per year, or the adjusted benchmark return per share. In instances where the adjusted benchmark return per share applies, the incentive management fee will be reduced if our total return per share is between 200 basis points and 500 basis points below the SNL U.S. REIT Healthcare Indexapplicable market index in any year, by a low return factor, as defined in the business management agreement, and there will be 0no incentive management fee paid if, in these instances, our total return per share is more than 500 basis points below the SNL U.S. REIT Healthcare Index.applicable market index in any year, determined on a cumulative basis (i.e. between 200 basis points and 500 basis point per year multiplied by the number of years in the measurement period and below the applicable market index).
The incentive management fee is subject to a cap. The cap is equal to the value of the number of our common shares which would, after issuance, represent 1.5% of the number of our common shares then outstanding multiplied by the average closing price of our common shares during the 10 consecutive trading days having the highest average closing prices during the final 30 trading days of the relevant measurement period.
Incentive management fees we paid to RMR LLC for any period may be subject to “clawback” if our financial statements for that period are restated due to material non-compliance with any financial reporting requirements under the securities laws as a result of the bad faith, fraud, willful misconduct or gross negligence of RMR LLC and the amount of the incentive management fee we paid was greater than the amount we would have paid based on the restated financial statements.
Pursuant to our business management agreement with RMR, LLC, we recognized net business management fees of $20,629, $27,399$13,965,$16,646 and $35,874$23,378 for the years ended December 31, 2020, 20192023, 2022 and 2018,2021, respectively. The net business management fees we recognized are included in general and administrative expenses in our consolidated statements of comprehensive income (loss)operations for these periods. The net business management fees we recognized for the years ended December 31, 2020, 20192023, 2022 and 20182021 reflect a reduction of $2,974, for each of those years for the amortization of the liability we recorded in connection with our former investment in RMR Inc., as further described in Note 8.
F-22

Table of Contents
Pursuant to our business management agreement with RMR LLC, in January 2019 and 2018, we paid RMR LLC an incentive management fee of $40,642 and $55,740 for the years ended December 31, 2018 and 2017, respectively.
We did not recognize an incentive management fee payable to RMR LLC for the years ended December 31, 20202023, 2022 or 2019. In calculating the incentive management fee payable by us, our total shareholder return per share was adjusted in accordance with the business management agreement to reflect aggregate net increases in the number of our common shares outstanding as a result of certain share issuances and repurchases by us during the applicable three year measurement period. In addition, the calculation of our benchmark return per share was also adjusted for these issuances and repurchases in accordance with the business management agreement during the applicable three year measurement period.
F-25

Table of Contents
2021.
Property Management and Construction Supervision Fees. The property management fees payable to RMR LLC by us for each applicable period are equal to 3.0% of gross collected rents and the construction supervision fees payable to RMR LLC by us for each applicable period are equal to 5.0% of construction costs.
Pursuant to In connection with our entry into the Master Management Agreement, on June 9, 2021, we and RMR amended our property management agreement withto, among other things, provide for RMR's oversight of any major capital projects and repositionings at our senior living communities, including our senior living communities which Five Star is continuing to manage, and that RMR LLC, wereceives the same fee previously paid to Five Star for such services, which is equal to 3.0% of the cost of any such major capital project or repositioning.
We recognized aggregate net property management and construction supervision fees of $13,802, $13,141$8,886, $10,329 and $12,214$12,504 for the years ended December 31, 2020, 20192023, 2022 and 2018,2021, respectively. The net property management and construction supervision fees we recognized for the years ended December 31, 2020, 20192023, 2022 and 20182021 reflect a reduction of $797 for each of those years for the amortization of the liability we recorded in connection with our former investment in RMR Inc., as further described in Note 8. For the years ended December 31, 2020, 20192023, 2022 and 2018, $10,084, $10,7052021, $5,686, $5,657 and $10,832,$9,684, respectively, of the total net property management and construction supervision fees were expensed to property operating expenses in our consolidated statements of income (loss)operations and $3,718, $2,436$3,200, $4,672 and $1,382,$2,820, respectively, were capitalized as building improvements in our consolidated balance sheets. The amounts capitalized are being depreciated over the estimated useful lives of the related capital assets.
Expense Reimbursement. We are generally responsible for all our operating expenses, including certain expenses incurred or arranged by RMR LLC on our behalf. We are generally not responsible for payment of RMR LLC'sRMR's employment, office or administrative expenses incurred to provide management services to us, except for the employment and related expenses of RMR LLC'sRMR's employees assigned to work exclusively or partly at our medical office and life science properties, our share of the wages, benefits and other related costs of RMR LLC'sRMR's centralized accounting personnel, our share of RMR LLC'sRMR's costs for providing our internal audit function, or as otherwise agreed. Our Audit Committee appoints our Director of Internal Audit and our Compensation Committee approves the costs of our internal audit function. Our property level operating expenses are generally incorporated into the rents charged to our tenants, including certain payroll and related costs incurred by RMR LLC.RMR. We reimbursed RMR LLC $13,805, $13,373$14,587, $12,901 and $11,891$13,161 for these costsexpenses and expensescosts for the years ended December 31, 2020, 20192023, 2022 and 2018,2021, respectively. These amounts are included in property operating expenses or general and administrative expenses, as applicable, in our consolidated statements of comprehensive income (loss)operations for these periods.
Term. Our management agreements with RMR LLC have terms that end on December 31, 2040,2043, and automatically extend on December 31st of each year for an additional year, so that the terms of our management agreements thereafter end on the 20th anniversary of the date of the extension.
Termination Rights. We have the right to terminate one or both of our management agreements with RMR LLC:RMR: (i) at any time on 60 days' written notice for convenience, (ii) immediately on written notice for cause, as defined therein, (iii) on written notice given within 60 days after the end of an applicable calendar year for a performance reason, as defined therein, and (iv) by written notice during the 12 months following a change of control of RMR, LLC, as defined therein. RMR LLC has the right to terminate the management agreements for good reason, as defined therein.
Termination Fee. If we terminate 1one or both of our management agreements with RMR LLC for convenience, or if RMR LLC terminates 1one or both of our management agreements for good reason, we have agreed to pay RMR LLC a termination fee in an amount equal to the sum of the present values of the monthly future fees, as defined therein, for the terminated management agreement(s) for the term that was remaining prior to such termination, which, depending on the time of termination would be between 19 and 20 years. If we terminate 1one or both of our management agreements with RMR LLC for a performance reason, we have agreed to pay RMR LLC the termination fee calculated as described above, but assuming a 10 year term was remaining prior to the termination. We are not required to pay any termination fee if we terminate our management agreements with RMR LLC for cause or as a result of a change of control of RMR LLC.RMR.
Transition Services. RMR LLC has agreed to provide certain transition services to us for 120 days following an applicable termination by us or notice of termination by RMR, LLC, including cooperating with us and using commercially reasonable efforts to facilitate the orderly transfer of the management and real estate investment services provided under our business management agreement and to facilitate the orderly transfer of the management of the managed properties under our property management agreement, as applicable.
Vendors. Pursuant to our management agreements with RMR, LLC, RMR LLC may from time to time negotiate on our behalf with certain third party vendors and suppliers for the procurement of goods and services to us. As part of this arrangement, we
F-23

Table of Contents

may enter agreements with RMR LLC and other companies to which RMR LLC or its subsidiaries provide management services for the purpose of obtaining more favorable terms from such vendors and suppliers.
Investment Opportunities. Under our business management agreement with RMR, LLC, we acknowledge that RMR LLC may engage in other activities or businesses and act as the manager to any other person or entity (including other REITs) even though such person or entity has investment policies and objectives similar to ours and we are not entitled to preferential treatment in receiving information, recommendations and other services from RMR LLC.RMR.
F-26
Management Agreements between our Joint Ventures and RMR. We have two separate joint venture arrangements with third party institutional investors, the Seaport JV and the LSMD JV. RMR provides management services to both of these joint ventures. Our joint ventures are not our consolidated subsidiaries and, as a result, we are not obligated to pay management fees to RMR under our management agreements with RMR for the services it provides regarding the joint ventures. Prior to December 23, 2021, the Seaport JV was our consolidated subsidiary and, as such, we were previously obligated to pay management fees to RMR under our management agreements with RMR for the services it provided that joint venture; however, that joint venture paid management fees directly to RMR, and those fees were credited against the fees payable by us to RMR. In addition, we wholly owned the 10 medical office and life science properties included in the LSMD JV until the contribution of these properties to the LSMD JV in January 2022, and we paid management fees to RMR for the management services it provided to us for those properties until the contribution of those properties to the LSMD JV.

Table of Contents
Note 8. Related Person Transactions
We have relationships and historical and continuing transactions with AlerisLife (including Five Star), RMR, LLC, RMR Inc., Five Star and others related to them, including other companies to which RMR LLC or its subsidiaries provide management services and some of which have trustees, directors or officers who are also our Trustees or officers. RMR Inc. is the managing member of RMR LLC.RMR. The Chair of our Board of Trustees and one of our Managing Trustees, Adam D. Portnoy, is the sole trustee, an officer and the controlling shareholder of ABP Trust, which is the controlling shareholder of RMR Inc., chair of the board of directors, a managing director and the president and chief executive officer of RMR Inc., an officer and employee of RMR LLC and, until the acquisition of AlerisLife by ABP Trust on March 20, 2023, the chair of the board of directors and a managing director of Five Star.AlerisLife, and currently a director of AlerisLife. Jennifer F. Francis, our other Managing Trustee, our former President and Chief Executive Officer and a former managing director of AlerisLife served as an officer of RMR until December 31, 2023 and will remain an employee of RMR until her retirement on July 1, 2024. Our current President and Chief Executive Officer and our Chief Financial Officer and Treasurer are also employees and officers of RMR. Jennifer B. Clark, our otherSecretary and former Managing Trustee, and our Secretary, also serves as a managing director and the executive vice president, general counsel and secretary of RMR Inc., an officer and employee of RMR, LLC, an officer of ABP Trust and secretary of AlerisLife and, until March 20, 2023, a managing director and the secretary of Five Star. Jennifer F. Francis, our President and Chief Operating Officer is an executive vice president of RMR Inc. and she and our Chief Financial Officer and Treasurer are also employees and officers of RMR LLC.AlerisLife. Certain of Five Star'sAlerisLife's officers are officers and employees of RMR LLC.RMR. Some of our Independent Trustees also serve as independent trustees or independent directors of other public companies to which RMR LLC or its subsidiaries provide management services. Adam D. Portnoy serves as the chair of the boards of trustees or boards of directors of several of these public companiesboard and as a managing director or managing trustee of these companies. Other officers of RMR, LLC, including Ms. Clark and certain of our officers, serve as managing trustees, managing directors or officers of certain of these companies.
Five Star. We are currently Five Star's largest stockholder. In addition, officers of RMR and RMR Inc. serve as our officers and officers of other companies to which RMR or its subsidiaries provide management services. As of December 31, 2020,2023, ABP Trust and Adam D. Portnoy owned 9.8% of our outstanding common shares.
AlerisLife. Until March 20, 2023, we owned 10,691,658 Five Starwere AlerisLife's largest stockholder, owning approximately 31.9% of AlerisLife's outstanding common shares, and ABP Acquisition LLC, or ABP Acquisition, a subsidiary of ABP Trust, together with ABP Trust, owned approximately 33.7%6.1% of Five Star'sAlerisLife's outstanding common shares. As of December 31, 2019, Five Star was our largest tenant and the manageris an operating division of our managed senior living communities. Pursuant to the Restructuring Transaction, as of January 1, 2020, all of our senior living communities that Five Star operates are managed pursuant to the Five Star management agreements.AlerisLife. Five Star manages for us mostcertain of the senior living communities we own.own pursuant to the Master Management Agreement. RMR LLC provides management services to both us and Five Star. Five StarAlerisLife. AlerisLife participates in our property insurance program for the senior living communities Five Star owns and leases.AlerisLife owns. The premiums Five StarAlerisLife pays for this coverage are allocated pursuant to a formula based on the profiles of the properties included in the program. Five Star's program cost for the policy year ending June 30, 2021 is $500. See Note 6 for further information regarding our relationships, agreements and transactions with AlerisLife (including Five StarStar) and Note 10 for further information regarding our investment in Five Star.AlerisLife.
AsOn February 2, 2023, AlerisLife entered into an Agreement and Plan of December 31, 2020, ABP Acquisition LLC, a subsidiaryMerger, or the ALR Merger Agreement, with certain subsidiaries of ABP Trust, pursuant to which ABP Trust acquired all of the controlling shareholderpublicly held outstanding AlerisLife common shares at a price of RMR Inc.,$1.31 per share by tender offer.
In connection with the ALR Merger Agreement, on February 2, 2023, we agreed to tender all the AlerisLife common shares that we and our subsidiary then owned into the tender offer at the Tender Offer Price, subject to the right, but not the obligation, to purchase, on or before December 31, 2023, AlerisLife common shares at the Tender Offer Price, and otherwise
F-24

Table of Contents

pursuant to a stockholders agreement to be entered into at the time of any such purchase. On December 20, 2023, we and ABP Trust extended our right to purchase AlerisLife common shares until March 31, 2024.
On February 16, 2024, we exercised this purchase right and acquired, together with our applicable TRS, approximately 34.0% of the currently outstanding AlerisLife common shares from ABP Trust owned approximately 6.3%at the Tender Offer Price, for a total purchase price of Five Star's outstanding common shares.
In order to effect$14,890, and we, our distributionapplicable TRS, ABP Trust and AlerisLife entered into a stockholders agreement. Following this acquisition, ABP Trust owns the remaining approximate 66.0% of Five Star common shares to our shareholders in 2001 and to govern our relations with Five Star thereafter, Five Star entered agreements with us and others, including RMR LLC. Since then, we have entered various leases, management agreements and other agreements with Five Star that include provisions that confirm and modify these undertakings. Among other things, these agreements provide that:
so long as we remain a REIT, Five Star may not waive the share ownership restrictions in its charter that prohibit any person or group from acquiring more than 9.8% (in value or number of shares, whichever is more restrictive) of the outstanding shares of any class of Five Star stock without our consent;
so long as Five Star is our tenant or manager, Five Star will not permit nor take any action that, in our reasonable judgment, might jeopardize our qualification for taxation as a REIT;
we have the right to terminate our management agreements with Five Star upon the acquisition by a person or group of more than 9.8% of Five Star's voting stock or other change in control events, as defined therein affecting Five Star, including the adoption of any shareholder proposal (other than a precatory proposal) or the election to Five Star's board of directors of any individual, if such proposal or individual was not approved, nominated or appointed, as the case may be, by a majority of Five Star's directors in office immediately prior to the making of such proposal or the nomination or appointment of such individual; and
so long as Five Star is our tenant or manager or has a business management agreement with RMR LLC, Five Star will not acquire or finance any real estate of a type then owned or financed by us or any other company managed by RMR LLC without first giving us or such company managed by RMR LLC, as applicable, the opportunity to acquire or finance that real estate.AlerisLife.
See Note 6 for further information regarding our relationships, agreements and transactions with AlerisLife (including Five Star.Star) and Note 10 for further information regarding our investment in AlerisLife.
F-27

TableTermination of Contentsthe Merger Agreement with Office Properties Income Trust.
As previously disclosed, on April 11, 2023, we and Office Properties Income Trust, or OPI, entered into an Agreement and Plan of Merger, or the Merger Agreement, pursuant to which we and OPI agreed that we would merge with and into OPI, with OPI as the surviving entity in the merger. On September 1, 2023, we and OPI mutually terminated the Merger Agreement, effective September 1, 2023. Neither we nor OPI were required to pay any termination fee as a result of the mutual decision to terminate the Merger Agreement, and we and OPI bore our and its respective costs and expenses related to the Merger Agreement in accordance with the terms of the Merger Agreement. We recorded $9,900 of expenses during the year ended December 31, 2023 related to the terminated merger with OPI, which is included in acquisition and certain other transaction related costs in our consolidated statement of operations.
Our Manager, RMR LLC.RMR. We have 2two agreements with RMR LLC to provide management services to us: (1) a business management agreement, which relates to our business generally,generally; and (2) a property management agreement, which relates to the property level operations of many of our properties, including our medical office and life science properties.properties, and major renovation or repositioning activities at our senior living communities that we may request RMR to manage from time to time. See Note 7 for further information regarding our management agreements with RMR.
Our Joint Ventures. In connection with our entering into the LSMD JV in January 2022, we paid mortgage escrow amounts and closing costs that were payable by that joint venture. The remaining costs totaled $6,080 as of December 31, 2023 and are included in other assets, net, in our consolidated balance sheet. RMR LLC.provides management services to each of the Seaport JV and the LSMD JV. See Note 7 for further information regarding those management agreements with RMR.
Leases with RMR LLC. We lease office space to RMR LLC in certain of our properties for RMR LLC'sRMR's property management offices. We recognized rental income from RMR LLC for leased office space of $163, $256$196, $303 and $228$190 for the years ended December 31, 2020, 20192023, 2022 and 2018,2021, respectively. Our office space leases with RMR LLC are terminable on 30 days' notice, subject to certain conditions.by RMR if our management agreements with RMR are terminated.
Share Awards to RMR LLC Employees. As described in Note 5, we award shares to our officers and other employees of RMR LLC annually. Generally, one fifth of these awards vest on the awardgrant date and one fifth vests on each of the next four anniversaries of the awardgrant dates. In certain instances, we may accelerate the vesting of an award, such as in connection with the award holder's retirement as an officer of us or an officer or employee of RMR LLC.RMR. These awards to RMR LLC employees are in addition to the share awards to our Managing Trustees, as Trustee compensation, and the fees we paid to RMR LLC.RMR. See Note 5 for information regarding our share awards and activity as well as certain share purchases we made in connection with share award recipients satisfying tax withholding obligation on vesting share awards.
RMR Inc. On July 1, 2019, we sold all of the 2,637,408 shares of class A common stock of RMR Inc. that we owned in an underwritten public offering at a price to the public of $40.00 per share pursuant to the underwriting agreement among us, RMR Inc., certain other REITs managed by RMR LLC that also sold their class A common stock of RMR Inc. in the offering, and the underwriters named therein. We received net proceeds of $98,557 from this sale, after deducting the underwriting discounts and commissions and other offering expenses.
AIC. Until its dissolution on February 13, 2020, we, ABP Trust, Five Star and 4 other companies to which RMR LLC provides management services owned AIC in equal portions. We and the other AIC shareholders historically participated in a combined property insurance program arranged and insured or reinsured in part by AIC until June 30, 2019.
We also had a one year standalone insurance policy that provided coverage for one of our life science properties located in Boston, Massachusetts that is owned in our joint venture arrangement, which we obtained as a part of this insurance program. We (including our consolidated joint venture) paid aggregate annual premiums, including taxes and fees, of $4,413 and $2,433 in connection with this insurance program for the policy years ended June 30, 2019 and 2018, respectively.
In connection with AIC's dissolution, we and each other AIC shareholder received an initial liquidating distribution of $9,000 from AIC in December 2019 and an additional liquidating distribution of approximately $287 in June 2020.
As of December 31, 2020, 2019 and 2018, our investment in AIC had a carrying value of $11, $298 and $8,632, respectively. These amounts are included in other assets in our consolidated balance sheets. We recognized income of $0, $400 and $516 related to our investment in AIC for the years ended December 31, 2020, 2019 and 2018, respectively. These amounts are presented as equity in earnings of an investee in our consolidated statements of comprehensive income (loss). Our other comprehensive income (loss) includes our proportionate part of unrealized gains (losses) on securities which were owned and held for sale by AIC of $91 and $(68) related to our investment in AIC for the years ended December 31, 2019 and 2018, respectively.
Note 9. Indebtedness
At December 31, 20202023 and 2019,2022, our outstanding indebtedness consisted of the following:
  Principal Balance as of December 31,
Floating Rate Debt (1)
Maturity20202019
Revolving credit facility (2)
January 2022$$537,500 
Term loanJune 2020250,000 
Term loan (3)
September 2022200,000 200,000 
Total floating rate debt $200,000 $987,500 
  Principal Balance as of December 31,
Floating Rate DebtMaturity20232022
Credit facility (1)
N/A$— $700,000 
Total floating rate debt $— $700,000 
(1)AsIn December 2023, we repaid the remaining principal balance of December 31, 2020our then credit facility which had an original maturity date of January 2024 and 2019,terminated the unamortized net debt issuance costs on certain of these debts were $951 and $1,259, respectively.agreement.
F-28F-25

Table of Contents

(2)Outstanding borrowings under our revolving credit facility.
(3)We prepaid this term loan in February 2021.
  December 31, 2020December 31, 2019  December 31, 2023December 31, 2022
Senior Unsecured Notes (1)
Senior Unsecured Notes (1)
CouponMaturityFace
Amount
Unamortized
Discount
Face
Amount
Unamortized
Discount
Senior Unsecured Notes (1)
CouponMaturityFace
Amount
Unamortized
Discount
Face
Amount
Unamortized
Discount
Senior unsecured notesSenior unsecured notes6.750 %April 2020$$$200,000 $59 
Senior unsecured notes (2)
Senior unsecured notes (2)
6.750 %December 2021300,000 490 300,000 1,024 
Senior unsecured notesSenior unsecured notes4.750 %May 2024250,000 263 250,000 342 
Senior unsecured notes9.750 %June 20251,000,000 
Senior unsecured notes4.750 %February 2028500,000 6,013 500,000 6,857 
Senior unsecured notes (2)
Senior unsecured notesSenior unsecured notes5.625 %August 2042350,000 350,000 
Senior unsecured notesSenior unsecured notes6.250 %February 2046250,000 250,000 
Total senior unsecured notesTotal senior unsecured notes  $2,650,000 $6,766 $1,850,000 $8,282 
(1)As of December 31, 20202023 and 2019,2022, the unamortized net debt issuance costs on certain of these notes were $35,045$23,899 and $21,037,$27,870, respectively.
(2)In February 2021, we issued $500,000 aggregate principal amount of 4.375% seniorThese notes due 2031. We used net proceeds from this offering to prepay our $200,000 term loanare fully and expect to use the remaining net proceeds to redeemunconditionally guaranteed, on a joint, several and unsecured basis, by all of our outstanding 6.75% seniorsubsidiaries, except for certain excluded subsidiaries. The notes due 2021 in June 2021, when those notes become redeemable with no prepayment premium.and the guarantees are effectively subordinated to all of our and the subsidiary guarantors' secured indebtedness, respectively, to the extent of the value of the collateral securing such secured indebtedness, and are structurally subordinated to all indebtedness and other liabilities and any preferred equity of any of our subsidiaries that do not guarantee the notes.
 Principal Balance as of
December 31,
  Number of
Properties as
Collateral
Net Book Value of Collateral
as of December 31,
  
Secured and Other Debt
2020 (1)
2019 (1)
Interest
Rate
MaturityAt December 31, 202020202019
Mortgage note (2) (3)
$$1,426 7.49 %January 2022$$11,469 
Mortgage note11,838 12,513 6.28 %July 202223,500 23,662 
Mortgage note10,724 10,958 4.85 %October 202219,675 20,139 
Mortgage note15,805 16,131 5.75 %October 202219,180 19,751 
Mortgage note15,646 16,056 6.64 %June 202323,023 22,854 
Mortgage notes (4)
620,000 620,000 3.53 %August 2026705,096 724,715 
Mortgage note (3) (5)
1,589 6.25 %March 20264,226 
Mortgage note10,470 10,688 4.44 %July 204313,582 13,756 
Finance Leases7,811 8,874 7.70 %April 202618,097 18,432 
Total secured$692,294 $698,235 $822,153 $859,004 

 Principal Balance as of
December 31,
  Number of
Properties as
Collateral
Net Book Value of Collateral
as of December 31,
  
Secured and Other Debt
2023 (1)
2022 (1)
Interest
Rate
MaturityAt December 31, 202320232022
Mortgage note$— $14,732 6.64 %June 2023$— $24,645 
Senior secured notes (2)(3)(4)
940,534 — 0.00 %January 202695 1,075,889 — 
Mortgage note9,109 9,997 6.44 %July 204313,589 13,234 
Finance Leases3,911 5,339 7.70 %April 202622,765 20,624 
Total secured$953,554 $30,068 99 $1,112,243 $58,503 
(1)The principal balances are the amounts stated in the contracts. In accordance with GAAP, our carrying values and recorded interest expense may be different because of market conditions at the time we assumed certain of these debts. As of December 31, 20202023 and 2019,2022, the unamortized net premiums and debt issuance costs on certain of these mortgages were $721$0 and $506,$(109), respectively.
(2)We prepaid this debtThese notes are fully and unconditionally guaranteed, on a joint, several and senior secured basis by certain of our subsidiaries that own 95 properties, or the Collateral Guarantors, and on a joint, several and unsecured basis, by all our subsidiaries other than the Collateral Guarantors, except for certain excluded subsidiaries, or the Non-Collateral Guarantors. These notes and the guarantees provided by the Collateral Guarantors are secured by a first priority lien and security interest on each of the collateral properties and 100% of the equity interests in May 2020.each of the Collateral Guarantors. The guarantees provided by the Non-Collateral Guarantors are effectively subordinated to all of the subsidiary guarantors' secured indebtedness to the extent of the value of the collateral securing such secured indebtedness, and the notes and the guarantees are structurally subordinated to all indebtedness and other liabilities and any preferred equity of any of our subsidiaries that do not guarantee the notes.
(3)The properties encumbered by these mortgages were classified as held for sale asThese notes require no cash interest to accrue prior to maturity and will accrete at a rate of December 31, 2019. The associated mortgages, along with $2511.25% per annum compounded semiannually on January 15 and July 15 of each year, such that the accreted value will equal the principal amount at maturity. These notes have an unamortized discount balance of $187,813 and unamortized net debt issuance costs are included in liabilities of properties held for sale in our consolidated balance sheet$21,510 as of December 31, 2019.2023, respectively.
(4)The property encumbered by these mortgages is owned in a joint venture arrangement in which we own a 55% equity interest. The principal amounts listed in the table for these debts have not been adjusted to reflect the equity interests in the joint venture that we do not own.
(5)We prepaid this debt in February 2020.
We have a $800,000 revolving credit facility that is available for general business purposes. The maturity date of our revolving credit facility is January 2022, and, subject to the payment of an extension fee and meeting other conditions, we have two, one year optionsone-time option to extend the maturity date of the facilitythese notes by one year, to January 2024. Our revolving15, 2027, subject to satisfaction of certain conditions and payment of an extension fee. If we exercise this option, interest payments will be due semiannually during the extension period at an initial interest rate of 11.25% with increases of 50 basis points every 90 days these notes remain outstanding.

Until its repayment in full on December 21, 2023, we had a $450,000 credit facility provides that we can borrow, repay and re-borrow funds available underwas fully drawn. At December 21, 2023, our revolving credit facility until maturity, and no principal repayment is due until maturity. As of December 31, 2020, our revolvingformer credit facility required interest to be paid on borrowings at the annual rate of 2.6%8.4%, plus a facility fee of 30 basis points$338 per annum on the total amountquarter. As of lending commitments under the
F-29

Table of Contents
facility. Certain of these terms have been amended pursuant to the June 2020 and January 2021 amendments to the agreements governingDecember 31, 2023, our revolvingformer credit facility is fully paid off and term loan, or collectively, our credit and term loan agreements, discussed below.
agreement is terminated. The weighted average annual interest rates for borrowings under our revolving credit facility were 2.2%7.9%, 3.4%4.5% and 3.0%2.9% for the years ended December 31, 2020, 2019 and 2018, respectively. The interest rate premium and facility fee are each subject to adjustment based upon changes to our credit ratings. As of December 31, 2020, we had 0 outstanding borrowings and $1,000,000 available for borrowing under our revolving credit facility. As of February 22, 2021, we had 0 outstanding borrowings and $800,000, which is the maximum capacity as a result of the January 2021 amendments to our credit and term loan agreements described below, available for borrowing under our revolving credit facility.
As of December 31, 2020, we had a $200,000 term loan outstanding that was scheduled to mature in September2023, 2022 and was prepayable without penalty at any time. At December 31, 2020, the annual interest rate payable on amounts outstanding under this term loan was 2.8%. The weighted average annual interest rate for amounts outstanding under this term loan was 2.7%, 3.7% and 3.4% for the years ended December 31, 2020, 2019 and 2018,2021, respectively. The interest rate premium was subject to adjustment based upon changes to our credit ratings. We repaid this term loan in February 2021 using net proceeds from our February 2021 issuance of 4.375% senior notes due 2031.
In June 2020, we amended our credit and term loan agreements through June 30, 2021 in order to provide us with certain flexibility in light of the uncertainties related to the COVID-19 pandemic. In January 2021, we further amended our credit and term loan agreements to, among other things, obtain waivers from compliance with certain financial covenants through June 2022. Pursuant to the January 2021 amendments:
certain of the financial covenants under our credit and term loan agreements, including covenants that require us to maintain certain financial ratios, have been waived through June 2022;
the revolving credit facility commitments have been reduced from $1,000,000, to $800,000;
we pledged certain equity interests of subsidiaries owning properties to secure our obligations under our credit and term loan agreements and agreed to provide first mortgage liens on 91 medical office and life science properties with an aggregate gross book value of real estate assets of $1,429,612 as of December 31, 2020 to secure our obligations, which pledges and/or mortgage liens may be removed or new ones may be added during the Amendment Period based on outstanding debt amounts, among other things;
we have the ability to fund $250,000 of capital expenditures per year, which increased to $350,000 per year following the repayment of our term loan in February 2021, and are restricted in our ability to acquire real property as defined in the agreement governing our revolving credit facility, or our credit agreement;
the interest rate premium over LIBOR under our revolving credit facility and term loan increased by 30 basis points;
certain covenants and restrictions on distributions to common shareholders, share repurchases, capital expenditures, acquiring additional properties and incurring additional indebtedness (in each case subject to various exceptions), and the minimum liquidity requirement of $200,000 will remain in place during the Amendment Period; and
we are generally required to apply the net cash proceeds from the disposition of assets, capital markets transactions, and debt financings to the repayment of our $300,000 senior notes due in 2021, or maintain sufficient cash for such payment of these senior notes until they can be paid at par, our $200,000 term loan and any amounts outstanding under our revolving credit facility. In February 2021, we prepaid our $200,000 term loan using proceeds from our February 2021 issuance of $500,000 aggregate principal amount of 4.375% senior notes due 2031. We expect to use the remaining net proceeds from this offering to redeem all of our outstanding 6.75% senior notes due 2021 in June 2021, when those notes become redeemable with no prepayment premium.
In February 2018, we issued $500,000 of 4.75% senior unsecured notes due 2028. We used the net proceeds of this offering to reduce amounts outstanding under our revolving credit facility.
In February 2018, in connection with our acquisition of 1 senior living community, we assumed a $16,748 mortgage note with an annual interest rate of 6.64% and a maturity date in June 2023.
In March 2018, in connection with our acquisition of 1 medical office property, we assumed a $11,050 mortgage note with an annual interest rate of 4.44% and a maturity date in July 2043.
F-30F-26

Table of Contents

In June 2018, in connection with our acquisitionAs of 2 senior living communities, we assumed a $16,588 mortgage note with an annual interest rate of 5.75% and a maturity date in October 2022.
In January 2018, we prepaid, at par plus accrued interest, a mortgage note secured by 1 of our properties with an outstanding principal balance of approximately $4,338, a maturity date in September 2043 and an annual interest rate of 4.4%. In July 2018, we prepaid, at par plus accrued interest, mortgage notes secured by 12 of our properties with an aggregate outstanding principal balance of approximately $90,602, maturity dates in October 2018 and a weighted average annual interest rate of 5.0%. In September 2018, we prepaid, at par plus accrued interest, a mortgage note secured by 1 of our properties with an outstanding principal balance of approximately $6,325, a maturity date in January 2019 and an annual interest rate of 4.7%. As a result of these prepayments, we recorded a loss on early extinguishment of debt of $22 for the year ended December 31, 2018. We prepaid these mortgages using cash on hand and borrowings under our revolving credit facility.
In May 2019, we redeemed at par2023, all of our outstanding 3.25% senior notes due 2019 for a redemption price equal to the principal amount of $400,000, plus accrued and unpaid interest of $6,500. We funded this redemption with cash on hand and borrowings under our revolving credit facility.
Also in May 2019, we prepaid, at par plus accrued interest, a mortgage note secured by 4$940,534 of our senior living communities with an outstanding principal balance of approximately $42,211, a maturity date in July 2019 and an annual interest rate of 3.79%. As a result of this prepayment, we recorded a loss on early extinguishment of debt of $17 for the year ended December 31, 2019. We prepaid this mortgage using cash on hand and borrowings under our revolving credit facility.
In December 2019, we obtained a $250,000 term loan with a maturity date in June 2020, which we have prepaid in full as discussed further below. The weighted average annual interest rate for amounts outstanding under this term loan was 2.9% for the year ended December 31, 2019. We used the net proceeds from our $250,000 term loan, together with proceeds from our dispositions, borrowings under our revolving credit facility and cash on hand, to prepay in full our $350,000 term loan that was scheduled to mature on January 15, 2020. As a result of this prepayment, we recorded a loss on early extinguishment of debt of $27 for the year ended December 31, 2019.
In February 2020, we prepaid a mortgage note secured by 1 of our life science properties with an outstanding principal balance of approximately $1,554, a maturity date in March 2026 and an annual interest rate of 6.25%. As a result of this prepayment, we recorded a loss on early extinguishment of debt of $246 for the year ended December 31, 2020. We prepaid this mortgage using cash on hand and borrowings under our revolving credit facility.
In April 2020, we redeemed all of our outstanding 6.75% senior notes due 2020 for2026 are fully and unconditionally guaranteed, on a redemption price equal tojoint, several and senior secured basis by the principal amount of $200,000 plus accruedCollateral Guarantors and unpaid interest of $6,750. We funded this redemption with cash on handa joint, several and borrowings under our revolving credit facility.
In May 2020, we prepaid a mortgage note securedunsecured basis by 1 of our medical office properties with an outstanding principal balance of approximately $1,213, a maturity date in January 2022the Non-Collateral Guarantors, and an annual interest rate of 7.49%. As a result of the prepayment of this mortgage note, we recorded a loss on early extinguishment of debt of $155 for the year ended December 31, 2020. We prepaid this mortgage using cash on hand and borrowings under our revolving credit facility.
In June 2020, we issued $1,000,000 aggregate principal amountall $500,000 of our 9.75% senior notes due 2025 in an underwritten public offering raising net proceedsand all $500,000 of $982,300, after deducting estimated offering expensesour 4.375% senior notes due 2031 were fully and underwriters' discounts. These notes areunconditionally guaranteed, on a joint, several and unsecured basis, by all of our subsidiaries, except for certain excluded subsidiaries. The notes and the guarantees (other than our senior secured notes and the guarantees provided by the Collateral Guarantors) are effectively subordinated to all of our and the subsidiary guarantors' secured indebtedness, respectively, to the extent of the value of the collateral securing such secured indebtedness, and the notes and the guarantees are structurally subordinated to all indebtedness and other liabilities and any preferred equity of any of our subsidiaries including pledged subsidiariesthat do not guarantee the notes. Our remaining $1,100,000 of senior unsecured notes do not have the benefit of any guarantees as of December 31, 2023.
In February 2022, we and our lenders amended our credit agreement. Pursuant to the amendment, among other things, the facility commitments were reduced from $800,000 to $700,000 following our repayment of $100,000. In February 2022, we exercised our option to extend the maturity date of our former credit facility by one year to January 2024. In January 2023, pursuant to our credit agreement, we repaid $113,627 in outstanding borrowings under our former credit facility and term loan agreements. Priorthe facility commitments were reduced to June 15, 2022,$586,373. In February 2023, we may, atand our option, redeem all or a portion of these notes at a redemption price equallenders further amended our credit agreement. Pursuant to the amendment the facility commitments were reduced from $586,373 to $450,000 following our repayment of $136,373 in then outstanding principal amount of these notes, plus accruedborrowings, and unpaid interest, plus the make-whole amount set forth in the indenture which governs these notes, as supplemented, or our 2025 Notes Indenture. Prior to June 15, 2022, we may also, at our option, redeem up to 40% of the aggregate principal amount of these notes with the net proceeds of certain equity offerings at the redemption price set forth in the 2025 Notes Indenture, so long as at least 50% of the original aggregate principal amount of these notes remains outstanding after each such redemption. In addition, we have the option to redeem all or a portion of these notes at any time on or after June 15, 2022 at the redemption prices set forth in the 2025 Notes Indenture. We used the net proceeds from this offering to prepay in full our $250,000 term loan which was scheduled to mature in June 2020 and to reduce amounts outstanding under our revolving credit facility. The weighted average interest rate under our $250,000 term loan was 2.4% for the period from January 1, 2020 to June 2, 2020. As a result of the repayment of our $250,000 term loan,reduction in commitments, we recorded a loss on modification or early extinguishment of debt of $26$1,075 for the year ended December 31, 2020.2023.
In February 2021, we issued $500,000 aggregate principal amount of our 4.375% senior notes due 2031 in an underwritten public offering raising net proceeds of $491,100,$491,357, after deducting estimated offering expenses and underwriters'
F-31

Table of Contents
discounts. These notes are guaranteed by all of our subsidiaries, except for certain excluded subsidiaries, including pledged subsidiaries under our credit and term loan agreements.require semi-annual interest payments through maturity. We used the net proceeds from this offering to prepay in full in February 2021 our $200,000 term loan and expectwhich was scheduled to usemature in September 2022. The weighted average interest rate under our $200,000 term loan was 2.9% for the period from January 1, 2021 to February 7, 2021. As a result of the prepayment of our $200,000 term loan, we recorded a loss on early extinguishment of debt of $1,477 for the year ended December 31, 2021. In June 2021, we used the remaining net proceeds from this offering and cash on hand to redeem all of our outstanding 6.75% senior notes due 2021 in June 2021,for a redemption price equal to the principal amount of $300,000 plus accrued and unpaid interest of $10,125, when thosethese notes becomebecame redeemable with no prepayment premium. In connection with this redemption, we recorded a loss on early extinguishment of debt of $370 for the year ended December 31, 2021.
In April 2022, we prepaid a mortgage note secured by one of our medical office properties with an outstanding principal balance of approximately $10,934, a maturity date in July 2022 and an annual interest rate of 6.28%, using cash on hand.
In June 2022, we redeemed $500,000 of our outstanding 9.75% senior notes due 2025 for a redemption price equal to 104.875% of the $500,000 principal amount of the notes being redeemed plus accrued and unpaid interest of $1,083, using restricted cash on hand. As a result of this redemption, we recorded a loss on early extinguishment of debt of $29,576 for the year ended December 31, 2022.
In July 2022, we prepaid a mortgage note secured by two of our senior living communities with an outstanding principal balance of approximately $15,273, a maturity date in October 2022 and an annual interest rate of 5.75%, using cash on hand.
In October 2022, we repaid at maturity a mortgage note secured by one of our life science properties with an outstanding principal balance of approximately $10,287 and an annual interest rate of 4.85%, using cash on hand.
In April 2023, we prepaid a mortgage note secured by one of our senior living communities with an outstanding principal balance of approximately $14,565, a maturity date in June 2023 and an annual interest rate of 6.64% using cash on hand.
In December 2023, we issued $940,534 in aggregate principal amount at maturity of our senior secured notes due 2026 in a private offering, raising net proceeds of $730,359, after deducting initial purchaser discounts and estimated offering costs. These notes are fully and unconditionally guaranteed, on a joint, several and senior secured basis, by the Collateral Guarantors, and on a joint, several and unsecured basis, by the Non-Collateral Guarantors. These notes and the guarantees provided by the Collateral Guarantors are secured by a first priority lien and security interest on each of the collateral properties and 100% of the equity interests in each of the Collateral Guarantors. These notes require no cash interest payments to accrue prior to maturity. The accreted value of these secured notes will increase at a rate of 11.25% per annum compounded semiannually on
F-27

Table of Contents

January 15 and July 15 of each year. We used the net proceeds from this offering to repay in full and terminate our then $450,000 secured credit facility and to redeem all $250,000 of our outstanding 4.750% senior notes, which were scheduled to mature in January 2024 and May 2024, respectively. As a result of the prepayment in full of our credit facility and redemption of our 4.750% senior notes, we recorded a loss on modification or early extinguishment of debt of $314 and $1,079 for the year ended December 31, 2023, respectively.
Interest on our senior unsecured notes are payable either semi-annually or quarterly in arrears; however, no principal repayments are due until maturity. No interest is payable on our senior secured notes with the full principal amount due at maturity. Required monthly payments on our mortgages include principal and interest. Payments under our finance leases are due monthly. We include amortization of finance lease assets in depreciation and amortization expense.
Our credit agreement and our senior unsecured notes indentures and their supplements provide for acceleration of payment of all amounts due thereunderoutstanding upon the occurrence and continuation of certain events of default, such as, in the case of our credit agreement, a change of control of us, as defined, which includes RMR LLC ceasing to act as our business and property manager.default. Our credit agreement and our senior unsecured notes indentures and their supplements also contain covenants including covenants that restrict our ability to incur debts, including debts secured by mortgages on our properties, in excess of calculated amounts and generally require us to maintain certainvarious financial ratios, and our credit agreement restricts our ability to make distributions under certain circumstances. We believe we were in compliance with the terms and conditions of the respective covenants under our credit and term loan agreements and our senior unsecured notes indentures and their supplements at December 31, 2020. Although we have taken steps to enhance our ability to maintain sufficient liquidity, a protracted negative economic impact resulting from the COVID-19 pandemic may cause increased pressure on our ability to satisfy financial and other covenants. We may fail to satisfy covenants and conditions under our credit agreement or fail to satisfy our public debt covenants. We expect the ratio of consolidated income available for debt service to debt service could fall below the 1.5x requirement under our revolving credit facility and our public debt covenants in the first half of 2021. We will not be allowed to incur additional debt while this ratio is below 1.5x.ratios.
Required principal payments on our outstanding debt as of December 31, 2020, are2023, were as follows:
YearYearPrincipal Payment
2021$303,159 
2022239,067 
202316,413 
2024
2024
20242024251,834 
202520251,002,001 
2025
2025
2026
2026
2026
2027
2027
2027
2028
2028
2028
Thereafter
Thereafter
ThereafterThereafter1,729,820 (1)1,107,740 (1)(1)
 
(1) The carrying value of our total debt outstanding as of December 31, 2020,2023, including unamortized debt issuance costs, premiums and discounts was $3,498,811.$2,816,849.
Note 10. Fair Value of Assets and Liabilities
The following table presents certain of our assets that are measured at fair value at December 31, 2020,2023 and 2022, categorized by the level of inputs as defined in the fair value hierarchy under GAAP, used in the valuation of each asset.
 Fair Value at Reporting Date Using
 Quoted Prices in 
Active Markets for Identical Assets
Significant Other Observable InputsSignificant Unobservable Inputs
DescriptionTotal(Level 1)(Level 2)(Level 3)
Recurring Fair Value Measurements Assets:    
Investment in Five Star (1)
$73,772 $73,772 $$
Non-Recurring Fair Value Measurements Assets:
Real estate properties held for sale (2)
$47,848 $$47,848 $
 As of December 31, 2023As of December 31, 2022
DescriptionCarrying AmountEstimated Fair ValueCarrying AmountEstimated Fair Value
Recurring Fair Value Measurements Assets:    
Investment in AlerisLife (Level 1) (1)
$— $— $5,880 $5,880 
Investment in unconsolidated joint venture (Level 3) (2)
$85,699 $85,699 $104,697 $104,697 
Investment in unconsolidated joint venture (Level 3) (3)
$44,217 $44,217 $50,780 $50,780 
(1)OurOn February 2, 2023, in connection with the proposed acquisition of AlerisLife by a subsidiary of ABP Trust, which is the controlling shareholder of RMR Inc., we agreed to tender all of the 10,691,658 Five StarAlerisLife common shares arewe owned at a price of $1.31 per share, and the acquisition was completed on March 20, 2023. Prior to March 20, 2023, these AlerisLife common shares were included in investments in equity securities in our consolidated balance sheets and arewere reported at fair value, which iswas based upon quoted market prices on Nasdaq (Level 1 inputs). Pursuant to the Restructuring Transaction, on January 1, 2020, Five Star issued 10,268,158 common shares to us. The fair value and initial cost basis of the Five Star common shares issued to us on January 1, 2020 was $38,095. Our adjusted cost
F-32

Table of Contents
basis inclusive of the 423,500 Five Star common shares we owned as of December 31, 2019 and the 10,268,158 Five Star common shares issued to us on January 1, 2020 was $44,448 as of December 31, 2020. During the yearyears ended December 31, 2020,2023 and 2022, we recorded an unrealized gaingains (losses) of $34,106,$8,126 and $25,660, respectively, which isare included in gains and losses on equity securities, net in our consolidated statements of comprehensive income (loss),operations, to adjust the carrying value of our former investment in Five StarAlerisLife common shares to their fair value. See Notes 26 and 8 for further information about our investment in Five Star.AlerisLife.
(2)We have assetsThe 10% equity interest we own in the Seaport JV is included in investments in unconsolidated joint ventures in our consolidated balance sheets that are measuredsheet, and is reported at fair value, which is based on significant unobservable inputs (Level 3 inputs). The significant unobservable inputs used in the fair value analysis are a nonrecurring basis. Duringdiscount rate of 8.00%, an exit
F-28

Table of Contents

capitalization rate of 6.00%, a holding period of 10 years and market rents. The assumptions made in the year ended December 31, 2020, we recorded impairment charges of $3,378 to reduce the carryingfair value of 1 medical office property that is classified as held for sale to its estimated sales price, less estimated costs to sell of $275,analysis are based on the sales price under a purchaselocation, type and sale agreement that we have entered into with a third party buyer for this medical officenature of the property, of $9,000. We also recorded impairment charges of $25,797 to reduce the carrying value of 10 senior living communities thatand current and anticipated market conditions, which are classified as held for sale to their estimated sales price, less estimated costs to sell of $477, based on the sales price under a purchase and sale agreement that we have entered into with a third party buyer for these senior living communities of $39,600.derived from appraisers. See Note 3 for further information about impairment chargesregarding this joint venture.
(3)The 20% equity interest we own in the LSMD JV is included in investments in unconsolidated joint ventures in our consolidated balance sheet, and theseis reported at fair value, which is based on significant unobservable inputs (Level 3 inputs). The significant unobservable inputs used in the fair value analysis are discount rates of between 6.25% and other properties8.00%, exit capitalization rates of between 4.75% and 7.00%, holding periods of 10 years and market rents. The assumptions we have classified as heldmade in the fair value analysis are based on the location, type and nature of each property, and current and anticipated market conditions, which are derived from appraisers. See Note 3 for sale.further information regarding this joint venture.
In addition to the assets described in the table above, our financial instruments at December 31, 20202023 and December 31, 20192022 included cash and cash equivalents, restricted cash, certain other assets, our revolvingformer credit facility, term loans, senior unsecured notes, secured debt and finance leases and certain other unsecured obligations and liabilities. The fair values of these financial instruments approximated their carrying values in our consolidated financial statements as of such dates, except as follows:
 As of December 31, 2020As of December 31, 2019
Description
Carrying Amount (1)
Estimated Fair Value
Carrying Amount (1)
Estimated Fair Value
Senior unsecured notes, 6.750% coupon rate, due in 2020$$$199,862 $200,306 
Senior unsecured notes, 6.750% coupon rate, due in 2021 (2)
299,273 303,891 298,486 318,042 
Senior unsecured notes, 4.750% coupon rate, due in 2024249,068 256,258 248,788 260,683 
Senior unsecured notes, 9.750% coupon rate, due in 2025984,359 1,135,800 
Senior unsecured notes, 4.750% coupon rate, due in 2028490,925 502,648 489,652 506,155 
Senior unsecured notes, 5.625% coupon rate, due in 2042341,802 330,120 341,421 346,500 
Senior unsecured notes, 6.250% coupon rate, due in 2046242,762 245,000 242,472 258,700 
Secured debts (3) (4) (5)
691,573 716,185 697,729 697,142 
 $3,299,762 $3,489,902 $2,518,410 $2,587,528 
 As of December 31, 2023As of December 31, 2022
Description
Carrying Amount (1)
Estimated Fair Value
Carrying Amount (1)
Estimated Fair Value
Senior unsecured notes, 4.750% coupon rate, due 2024$— $— $249,628 $211,250 
Senior unsecured notes, 9.750% coupon rate, due 2025497,454 490,750 495,710 478,985 
Senior secured notes, zero coupon rate, due 2026731,211 771,981 — — 
Senior unsecured notes, 4.750% coupon rate, due 2028494,746 384,110 493,473 284,375 
Senior unsecured notes, 4.375% coupon rate, due 2031493,845 375,000 492,986 317,130 
Senior unsecured notes, 5.625% coupon rate, due 2042342,946 211,400 342,565 151,200 
Senior unsecured notes, 6.250% coupon rate, due 2046243,627 154,000 243,338 115,300 
Secured debts (2)
13,020 12,284 30,177 28,275 
 $2,816,849 $2,399,525 $2,347,877 $1,586,515 
(1)Includes unamortized net debt issuance costs, premiums and discounts.
(2)In February 2021, we issued $500,000 aggregate principal amount of 4.375% senior notes due 2031. We used net proceeds from this offering to prepay our $200,000 term loan and expect to use the remaining net proceeds to redeem all of our outstanding 6.75% senior notes due 2021 in June 2021, when those notes become redeemable with no prepayment premium.
(3)We assumed certain of these secured debts in connection with our acquisition of certain properties. We recorded the assumed mortgage notes at estimated fair value on the date of acquisition and we are amortizing the fair value adjustments, if any, to interest expense over the respective terms of the mortgage notes to adjust interest expense to the estimated market interest rates as of the date of acquisition.
(4)Includes secured debts for our life science property we own in a joint venture arrangement in which we own a 55% equity interest. The amounts listed in the table for these debts have not been adjusted to reflect the equity interests in the joint venture that we do not own.
(5)Includes $3,015 of principal mortgage obligations and $25 of unamortized debt issuance costs for properties classified as held for sale as of December 31, 2019. These debts are included in liabilities of properties held for sale in our consolidated balance sheet as of December 31, 2019.
We estimated the fair valuevalues of our 2two issuances of senior unsecured notes due 2042 and 2046 based on the closing price of our common shares trading on Nasdaq (Level 1 input)inputs as defined in the fair value hierarchy under GAAP) as of December 31, 2020.2023 and 2022. We estimated the fair values of our 4four issuances of senior unsecured notes due 2021, 2024, 2025, 2028 and 20282031 and our senior secured notes due 2026 using an average of the bid and ask price on Nasdaq on or about December 31, 20202023 and 2022 (Level 2 inputs as defined in the fair value hierarchy under GAAP). We estimated the fair values of our secured debts by using discounted cash flows analyses and currently prevailing market terms as of the
F-33

Table of Contents
measurement date (Level 3 inputs as defined in the fair value hierarchy under GAAP). Because Level 3 inputs are unobservable, our estimated fair values may differ materially from the actual fair values.
Realized and unrealized gains and losses for our equity securities for the years ended December 31, 2020 and 2019 were as follows:
 For the Year Ended December 31,
 20202019
Realized gains and losses on equity securities sold (1)
$$(41,436)
Unrealized gains and losses on equity securities held34,106 (462)
Gains and losses on equity securities, net$34,106 $(41,898)
(1)See Note 8 for further information about our former investment in RMR Inc.
Note 11. Noncontrolling Interest
We have a joint venture arrangement with an institutional investor for 1 of our life science properties located in Boston, Massachusetts.In March 2017, we entered into the Seaport JV. The investor ownsowned a 45% equity interest in the joint venture, and we ownowned the remaining 55% equity interest in the joint venture. We determined that, while we owned a 55% equity interest in this entity isjoint venture, this joint venture was a VIE and that we controlcontrolled the activities that most significantly impactimpacted the economic performance of this entity; we therefore continue to consolidateconsolidated the results of this propertyjoint venture in our financial statements. In December 2021, we sold an additional 35% equity interest in the Seaport JV to another third party institutional investor. After giving effect to the sale, we owned a 20% equity interest in this joint venture but determined that we are no longer the primary beneficiary. Effective as of the date of the sale, we deconsolidated these properties and accounted for this joint venture using the equity method of accounting under the fair value option. In June 2022, we sold an additional 10% equity interest from our then remaining 20% equity interest in this joint venture to an existing joint venture investor and continue to account for this joint venture using the equity method of accounting under the fair value option. The portion of the joint venture's net income and comprehensive income not attributable to us, or $5,146, $5,356 and $5,542$5,411 for the yearsyear ended December 31, 2020, 2019 and 2018, respectively,2021, is reported as a
F-29

Table of Contents

noncontrolling interest in our consolidated statements of comprehensive income (loss). Theoperations. This joint venture made aggregate cash distributions to the other joint venture investor of $22,292, $21,583 and $21,022$22,348 for the yearsyear ended December 31, 2020, 2019 and 2018, respectively,2021, which are reflected as a decrease in total equity attributable to noncontrolling interest in our consolidated balance sheets. Asstatements of December 31, 2020, this joint venture held real estate assets with an aggregate net book value of $705,096, subject to mortgage notes of $620,000.
    In assessing whether we have a controlling interest in this joint venture arrangement and are required to consolidate the accounts of the joint venture entity, we considered the members' rights to residual gains and obligations to absorb losses, which activities most significantly impact the economic performance of the entity and which member has the power to direct those activities.shareholders' equity.
Note 12. Segment Reporting
In connection with the Restructuring Transaction, we determined to redefine our reportable segments to better reflect our current operating environment. As of December 31, 2020, weWe operate in, and report financial information for, the following 2two segments: Office Portfolio and SHOP. We aggregate eachthe operating results of our properties in these 2two reporting segments based on their similar operating and economic characteristics. Our Office Portfolio segment consists of medical office properties leased to medical providers and other medical related businesses, as well as life science properties leased to biotech laboratories and other similar tenants. Our SHOP segment consists of managed senior living communities that provide short term and long term residential living and, in some instances, care and other services for residents where we pay fees to the operatormanagers to manageoperate the communities foron our account. In addition, prior to January 1, 2020, our SHOP segment included triple net leased senior living communities that provided short term and long term residential living and in some instances care and other services for residents and from which we received rents from Five Star. Pursuant to the Restructuring Transaction, effective January 1, 2020, our previously existing master leases and management and pooling agreements with Five Star were terminated and replaced with the Five Star management agreements for all of our senior living communities operated by Five Star. Prior periods have been recast to reflect these reportable segments for all periods presented.behalf.
We also report “non-segment” operations, which consists of triple net leased senior living communities whichand wellness centers that are leased to third party operators other than Five Star from which we receive rents, and wellness centers, which we do not consider to be sufficiently material to constitute a separate reporting segment, and any other income or expenses that are not attributable to a specific reporting segment.
 For the Year Ended December 31, 2023
 Office Portfolio
SHOP
Non-SegmentConsolidated
Revenues:    
Rental income$220,530 $— $37,870 $258,400 
Residents fees and services— 1,151,908 — 1,151,908 
Total revenues220,530 1,151,908 37,870 1,410,308 
Expenses:    
Property operating expenses97,964 1,075,091 1,096 1,174,151 
Depreciation and amortization98,205 175,926 9,952 284,083 
General and administrative— — 26,131 26,131 
Acquisition and certain other transaction related costs— — 10,853 10,853 
Impairment of assets14,034 4,346 — 18,380 
Total expenses210,203 1,255,363 48,032 1,513,598 
(Loss) gain on sale of properties(1,600)2,805 — 1,205 
Gains on equity securities, net— — 8,126 8,126 
Interest and other income— 1,581 13,955 15,536 
Interest expense(449)(551)(190,775)(191,775)
Loss on modification or early extinguishment of debt— — (2,468)(2,468)
Income (loss) from continuing operations before income tax expense and equity in net losses of investees8,278 (99,620)(181,324)(272,666)
Income tax expense— — (445)(445)
Equity in net losses of investees(20,461)— — (20,461)
Net loss$(12,183)$(99,620)$(181,769)$(293,572)
As of December 31, 2023
Office PortfolioSHOPNon-SegmentConsolidated
Total assets$1,866,422 $3,134,978 $444,736 $5,446,136 
F-34
F-30

Table of Contents

 For the Year Ended December 31, 2020
 Office Portfolio
SHOP
Non-SegmentConsolidated
Revenues:    
Rental income$383,365 $$43,850 $427,215 
Residents fees and services1,204,811 1,204,811 
Total revenues383,365 1,204,811 43,850 1,632,026 
Expenses:    
Property operating expenses129,756 1,106,601 1,236,357 
Depreciation and amortization129,321 129,124 11,702 270,147 
General and administrative30,593 30,593 
Acquisition and certain other transaction related costs814 814 
Impairment of assets8,558 98,414 106,972 
Total expenses267,635 1,334,139 43,109 1,644,883 
Gain (loss) on sale of properties2,597 (627)4,517 6,487 
Gains on equity securities, net34,106 34,106 
Interest and other income17,485 736 18,221 
Interest expense(24,188)(2,223)(175,072)(201,483)
Gain on lease termination22,896 22,896 
Loss on early extinguishment of debt(401)(26)(427)
Income (loss) from continuing operations before income tax expense93,738 (114,693)(112,102)(133,057)
Income tax expense(1,250)(1,250)
Net income (loss)93,738 (114,693)(113,352)(134,307)
Net income attributable to noncontrolling interest(5,146)(5,146)
Net income (loss) attributable to common shareholders$88,592 $(114,693)$(113,352)$(139,453)
As of December 31, 2020
Office PortfolioSHOPNon-SegmentConsolidated
Total assets$3,092,289 $2,912,570 $471,565 $6,476,424 
Under the Coronavirus Aid, Relief, and Economic Security Act, or the CARES Act, the U.S. Department of Health and Human Services, or HHS, established a Provider Relief Fund. Retention and use of the funds received under the CARES Act are subject to certain terms and conditions. The terms and conditions require that the funds be utilized to compensate for lost revenues that are attributable to the COVID-19 pandemic and for eligible costs to prevent, prepare for and respond to the COVID-19 pandemic that are not covered by other sources. Further, fund recipients are required to be participating in Medicare at the time of distribution and are subject to certain other terms and conditions, including quarterly reporting requirements. In addition, fund recipients are required to have billed Medicare during 2019 and to continue to provide care after January 31, 2020 for diagnosis, testing or care for individuals with possible or actual COVID-19 cases. Any funds not used in accordance with the terms and conditions must be returned to HHS. As of December 31, 2020, we had received $19,961 in funds from the Provider Relief Fund to be used to support the operations of our managed senior living communities; we have currently determined that $17,485 of such funds meet the required terms and conditions. We have recognized $17,485 as other income with respect to our SHOP segment for the year ended December 31, 2020. We currently expect to return the remaining $2,476 of such funds to HHS in 2021 unless and to the extent we determine that such funds meet the required terms and conditions and have therefore included that amount in other liabilities in our consolidated financial statements as of December 31, 2020. We have applied for additional funds that may be available under the CARES Act Provider Relief Fund; however, we may not receive any additional funding.
 For the Year Ended December 31, 2022
 Office PortfolioSHOPNon-SegmentConsolidated
Revenues:    
Rental income$222,390 $— $38,350 $260,740 
Residents fees and services— 1,022,826 — 1,022,826 
Total revenues222,390 1,022,826 38,350 1,283,566 
Expenses:    
Property operating expenses94,299 1,014,100 671 1,109,070 
Depreciation and amortization76,007 151,930 11,343 239,280 
General and administrative— — 26,435 26,435 
Acquisition and certain other transaction related costs— — 2,605 2,605 
Total expenses170,306 1,166,030 41,054 1,377,390 
Gain on sale of properties321,040 822 — 321,862 
Losses on equity securities, net— — (25,660)(25,660)
Interest and other income— 4,327 11,602 15,929 
Interest expense(913)(1,534)(206,936)(209,383)
Gain (loss) on modification or early extinguishment of debt16 — (30,059)(30,043)
Income (loss) from continuing operations before income tax expense and equity in net earnings of investees372,227 (139,589)(253,757)(21,119)
Income tax expense— — (710)(710)
Equity in net earnings of investees6,055 — — 6,055 
Net income (loss)$378,282 $(139,589)$(254,467)$(15,774)
As of December 31, 2022
Office PortfolioSHOPNon-SegmentConsolidated
Total assets$1,967,244 $3,147,785 $887,064 $6,002,093 
F-35F-31

Table of Contents
 For the Year Ended December 31, 2019
 Office PortfolioSHOPNon-SegmentConsolidated
Revenues:    
Rental income$405,016 $137,898 $63,644 $606,558 
Residents fees and services433,597 433,597 
Total revenues405,016 571,495 63,644 1,040,155 
Expenses:    
Property operating expenses132,348 356,722 489,070 
Depreciation and amortization137,611 132,637 18,777 289,025 
General and administrative37,028 37,028 
Acquisition and certain other transaction related costs13,102 13,102 
Impairment of assets43,035 65,822 6,344 115,201 
Total expenses312,994 555,181 75,251 943,426 
Gain on sale of properties6,617 15,207 17,872 39,696 
Dividend income1,846 1,846 
Losses on equity securities, net(41,898)(41,898)
Interest and other income941 941 
Interest expense(24,399)(3,058)(152,655)(180,112)
Loss on early extinguishment of debt(17)(27)(44)
Income (loss) from continuing operations before income tax expense and equity in earnings of an investee74,240 28,446 (185,528)(82,842)
Income tax expense(436)(436)
Equity in earnings of an investee400 400 
Net income (loss)74,240 28,446 (185,564)(82,878)
Net income attributable to noncontrolling interest(5,356)(5,356)
Net income (loss) attributable to common shareholders$68,884 $28,446 $(185,564)$(88,234)
As of December 31, 2019
Office PortfolioSHOPNon-SegmentConsolidated
Total assets$3,165,577 $3,044,989 $443,260 $6,653,826 
F-36

Table of Contents
For the Year Ended December 31, 2018 For the Year Ended December 31, 2021
Office PortfolioSHOPNon-SegmentConsolidated Office PortfolioSHOPNon-SegmentConsolidated
Revenues:Revenues:    Revenues: 
Rental incomeRental income$412,813 $212,622 $75,206 $700,641 
Residents fees and servicesResidents fees and services416,523 416,523 
Total revenuesTotal revenues412,813 629,145 75,206 1,117,164 
Expenses:Expenses:    
Expenses:
Expenses: 
Property operating expensesProperty operating expenses127,732 323,849 451,581 
Depreciation and amortizationDepreciation and amortization141,477 121,303 23,455 286,235 
General and administrativeGeneral and administrative85,885 85,885 
Acquisition and certain other transaction related costsAcquisition and certain other transaction related costs194 194 
Impairment of assetsImpairment of assets46,797 19,549 66,346 
Total expensesTotal expenses316,006 445,152 129,083 890,241 
Gain on sale of properties
Gain on sale of properties
Gain on sale of properties
Gain on sale of properties3,699 258,217 261,916 
Dividend income2,901 2,901 
Losses on equity securities, net
Losses on equity securities, net
Losses on equity securities, netLosses on equity securities, net(20,724)(20,724)
Interest and other incomeInterest and other income667 667 
Interest expenseInterest expense(24,360)(5,214)(149,713)(179,287)
(Loss) gain on early extinguishment of debt(98)76 (22)
Income from continuing operations before income tax expense and equity in earnings of an investee72,447 182,380 37,547 292,374 
Loss on modification or early extinguishment of debt
Loss on modification or early extinguishment of debt
Loss on modification or early extinguishment of debt
Income (loss) before income tax expense
Income tax expenseIncome tax expense(476)(476)
Equity in earnings of an investee516 516 
Net income (loss)
Net income (loss)
Net income (loss)
Net income attributable to noncontrolling interest
Net income (loss) attributable to common shareholders
Net income72,447 182,380 37,587 292,414 
Net income attributable to noncontrolling interest(5,542)(5,542)
Net income attributable to common shareholders$66,905 $182,380 $37,587 $286,872 
As of December 31, 2018
Office PortfolioSHOPNon-SegmentConsolidated
As of December 31, 2021
As of December 31, 2021
As of December 31, 2021
Office PortfolioOffice PortfolioSHOPNon-SegmentConsolidated
Total assetsTotal assets$3,344,581 $2,984,333 $831,512 $7,160,426 
 
Note 13. Income Taxes
Our provision for income taxes consists of the following:
For the Year Ended December 31, For the Year Ended December 31,
202020192018 202320222021
Current:Current:   Current:  
FederalFederal$$$
StateState1,250 436 476 
1,250 436 476 
Deferred:Deferred:   Deferred:  
FederalFederal
StateState
Income tax provisionIncome tax provision$1,250 $436 $476 
F-37F-32

Table of Contents

A reconciliation of our effective tax rate and the U.S. federal statutory income tax rate is as follows:
For the Year Ended December 31, For the Year Ended December 31,
202020192018 202320222021
Taxes at statutory U.S. federal income tax rateTaxes at statutory U.S. federal income tax rate21.0 %21.0 %21.0 %Taxes at statutory U.S. federal income tax rate21.0 %21.0 %21.0 %
Nontaxable incomeNontaxable income(21.0)%(21.0)%(21.0)%Nontaxable income(21.0)%(21.0)%(21.0)%
Federal excise taxFederal excise tax0.1 %— %0.1 %
State and local income taxes, net of federal tax benefitState and local income taxes, net of federal tax benefit(1.3)%0.5 %0.1 %State and local income taxes, net of federal tax benefit(0.2)%(4.5)%0.8 %
Effective tax rateEffective tax rate(1.3)%0.5 %0.1 %
Effective tax rate
Effective tax rate(0.1)%(4.5)%0.9 %
Deferred income tax balances reflect the net tax effects of temporary differences between the carrying amounts of assets and liabilities in our consolidated balance sheets and the amounts used for income tax purposes and are stated at enacted tax rates expected to be in effect when taxes are actually paid or recovered. Significant components of our deferred tax assets and liabilities arewere as follows:
For the Year Ended December 31, For the Year Ended December 31,
20202019 20232022
Deferred tax assets:Deferred tax assets:    Deferred tax assets:    
Deferred incomeDeferred income$3,252 $1,891 
Fair market value adjustmentFair market value adjustment10,856 
Fair market value adjustment
Fair market value adjustment
OtherOther758 149 
Tax loss carryforwardsTax loss carryforwards28,358 32,487 
43,224 34,527 
Valuation allowanceValuation allowance(43,224)(34,527)
Net deferred income taxesNet deferred income taxes$$
Because of our TRSs' history of losses, we are not able to conclude that it is more likely than not we will realize the future benefit of our deferred tax assets; thus we have provided a 100% valuation allowance as of December 31, 20202023 and 2019.2022. If and when we believe it is more likely than not that we will recover our deferred tax assets, we will reverse the valuation allowance as an income tax benefit in our consolidated statements of comprehensive income (loss).operations. As of December 31, 2020,2023, our consolidated TRSs had net operating loss carry forwards for federal income tax purposes of approximately $112,239,$316,314, which if unused, begin to expire in 2031.do not expire. As of December 31, 2023, we, excluding our subsidiaries, had net operating loss carry forwards for federal income tax purposes of approximately $403,477, which do not expire. In the normal course of business, income tax authorities in various income tax jurisdictions conduct routine audits of our income tax returns filed in prior years. Income tax years subsequent to 20152019 may be open to examination in some of the income tax jurisdictions in which we operate.
Note 14. Weighted Average Common Shares (share amounts in thousands)
The following table provides a reconciliation ofWe calculate basic earnings per common share using the weighted average number of common shares used in the calculation of basic andtwo class method. We calculate diluted earnings per share (in thousands):
 Year Ended December 31,
 202020192018
Weighted average common shares for basic earnings per share237,739 237,604 237,511 
Effect of dilutive securities: restricted share awards35 
Weighted average common shares for diluted earnings per share (1)
237,739 237,604 237,546 
(1) Forusing the years ended December 31, 2020more dilutive of the two class method or the treasury stock method. Unvested share awards and 2019, 223 and 36, respectively, of our unvestedother potentially dilutive common shares, were not included intogether with the calculation ofrelated impact on earnings, are considered when calculating diluted earnings per share because to do so would have been antidilutive.share.
F-38F-33

Table of Contents
DIVERSIFIED HEALTHCARE TRUST
SCHEDULE III
REAL ESTATE AND ACCUMULATED DEPRECIATION
DECEMBER 31, 20202023
(dollars in thousands)
 Initial Cost to Company Cost at December 31, 2020   Initial Cost to Company Cost at December 31, 2023 
AddressAddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
AddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
2184 Parkway Lake Drive2184 Parkway Lake DriveBirminghamAL$0$580$5,980$2,139$0$0$580$8,119$8,699$2,3828/1/200820012184 Parkway Lake DriveBirminghamAL$—$580$5,980$2,838$—$580$8,818$9,398$3,2098/1/20082001
2634 Valleydale Road2634 Valleydale RoadBirminghamAL06007,5742,193001,5598,80810,3672,7238/1/200820002634 Valleydale RoadBirminghamAL6007,5742,988(83)1,5599,52011,0793,5268/1/20082000
2021 Dahlke Drive NE2021 Dahlke Drive NECullmanAL02873,4156480(301)2873,7624,0491,40111/19/200419982021 Dahlke Drive NECullmanAL2873,4151,015(301)2874,1294,4161,85711/19/20041998
101 Tulip Lane101 Tulip LaneDothanAL03,54314,619413003,54315,03218,5751,55412/27/20172000101 Tulip LaneDothanAL3,54314,6192,825(80)3,54317,36420,9073,33112/27/20172000
49 Hughes Road49 Hughes RoadMadisonAL03343,9818520(243)3344,5904,9241,74711/19/2004199849 Hughes RoadMadisonAL3343,9811,377(243)3345,1155,4492,29211/19/20041998
200 Terrace Lane200 Terrace LanePricevilleAL01,3009,4475670(110)1,3659,83911,2042,4692/1/20122006200 Terrace LanePricevilleAL1,3009,4472,919(202)1,36512,09913,4643,5662/1/20122006
413 Cox Boulevard413 Cox BoulevardSheffieldAL03944,6845830(294)3944,9735,3671,97811/19/20041998413 Cox BoulevardSheffieldAL3944,6842,151(294)3946,5416,9352,61211/19/20041998
2435 Columbiana Road2435 Columbiana RoadVestavia HillsAL084323,4722,6190090226,03226,9344,5927/12/201619912435 Columbiana RoadVestavia HillsAL84323,4725,010(379)90228,04428,9467,0697/12/20161991
4461 N Crossover Road4461 N Crossover RoadFayettevilleAR073310,4321320073310,56411,2971,7245/1/201520114461 N Crossover RoadFayettevilleAR73310,4321,57273312,00412,7372,8425/1/20152011
4210 S Caraway Road4210 S Caraway RoadJonesboroAR06539,515128006539,64310,2961,5765/1/201520084210 S Caraway RoadJonesboroAR6539,51573365310,24810,9012,6015/1/20152008
672 Jones Road672 Jones RoadSpringdaleAR05729,3647300057210,09410,6661,6325/1/20152007672 Jones RoadSpringdaleAR5729,3642,42757211,79112,3632,8555/1/20152007
13840 North Desert Harbor Drive13840 North Desert Harbor DrivePeoriaAZ02,68715,8436,9760(2,192)2,69320,62123,3148,7281/11/2002199013840 North Desert Harbor DrivePeoriaAZ2,68715,84311,561(2,481)2,69324,91727,61011,8401/11/20021990
11209 N. Tatum Boulevard11209 N. Tatum BoulevardPhoenixAZ01,3806,3493,9690(303)1,5739,82211,3952,3949/30/2011198711209 N. Tatum BoulevardPhoenixAZ1,3806,3496,927(711)1,58612,35913,9454,1439/30/20111987
2444 West Las Palmaritas Drive2444 West Las Palmaritas DrivePhoenixAZ03,8206,6692,018003,8318,67612,5071,76312/22/201019822444 West Las Palmaritas DrivePhoenixAZ3,8206,6693,459(170)3,8319,94713,7784,29912/22/20101982
4121 East Cotton CenterPhoenixAZ05,16612,724534005,19813,22618,4241,9401/29/20152000
3850 North US Hwy 89 (5)
PrescottAZ15,6462,01717,5135,307002,01722,82024,8371,8142/1/20181986
4121 East Cotton Center (5)
4121 East Cotton Center (5)
PhoenixAZ5,16612,7244,0915,20516,77621,9813,0341/29/20152000
3850 North US Hwy 893850 North US Hwy 89PrescottAZ2,01717,5139,599(221)2,01726,89128,9085,3472/1/20181986
6001 East Thomas Road6001 East Thomas RoadScottsdaleAZ09418,8074,8590(294)94613,36714,3137,2199/1/201219906001 East Thomas RoadScottsdaleAZ9418,8076,602(971)94614,43315,3798,4779/1/20121990
7090 East Mescal Street7090 East Mescal StreetScottsdaleAZ02,31513,65010,6570(1,917)2,34922,35624,7058,4371/11/200219847090 East Mescal StreetScottsdaleAZ2,31513,65027,818(2,257)2,34939,17741,52612,7451/11/20021984
17225 North Boswell Boulevard17225 North Boswell BoulevardSun CityAZ01,18910,5692,8620(124)1,18913,30714,4967,7979/1/2012199017225 North Boswell BoulevardSun CityAZ1,18910,5695,225(836)1,18914,95816,1478,7509/1/20121990
14001 W. Meeker BoulevardSun City WestAZ03953,30700(192)3953,1153,5101,3922/28/20031998
14001 W. Meeker Boulevard (5)
14001 W. Meeker Boulevard (5)
Sun City WestAZ3953,307(192)3953,1153,5101,6252/28/20031998
1415 West 3rd Street1415 West 3rd StreetTempeAZ02,18613,4463,492004,89614,22819,1242,0451/29/201519811415 West 3rd StreetTempeAZ2,18613,4464,3344,89615,07019,9663,1951/29/20151981
2500 North Rosemont Boulevard2500 North Rosemont BoulevardTucsonAZ04,42926,1197,0850(3,079)4,57629,97834,55413,1671/11/200219892500 North Rosemont BoulevardTucsonAZ4,42926,11911,276(3,197)4,57634,05138,62717,0431/11/20021989
710 North Euclid710 North EuclidAnaheimCA02,8506,9641,549(1,350)(2,405)2,5185,0907,6082107/9/20081992710 North EuclidAnaheimCA2,8506,9642,586(1,350)(2,405)2,5186,1278,6451,1797/9/20081992
5000 Marina BoulevardBrisbaneCA07,95713,430745007,95714,17522,1321,13511/14/20172000
5000 Marina Boulevard (5)
5000 Marina Boulevard (5)
BrisbaneCA7,95713,4307527,96514,17422,1392,37011/14/20172000
5770 Armada Drive (5)
5770 Armada Drive (5)
CarlsbadCA10,7243,87518,5430003,87518,54322,4182,7431/29/20151997
5770 Armada Drive (5)
CarlsbadCA3,87518,5431003,87518,64322,5184,1341/29/20151997
1350 South El Camino Real1350 South El Camino RealEncinitasCA01,51018,042824001,51718,85920,3765,9983/31/200819991350 South El Camino RealEncinitasCA1,51018,0424,126(53)1,51722,10823,6257,9563/31/20081999
47071 Bayside Parkway47071 Bayside ParkwayFremontCA15,77445,2499,64815,77454,89770,6712,3177/27/20221991
47201 Lakeview Boulevard(5)47201 Lakeview Boulevard(5)FremontCA03,20010,17736003,20010,21313,4132,3689/30/2011199047201 Lakeview Boulevard(5)FremontCA3,20010,1778053,22610,95614,1823,1529/30/20111990
47211/47215 Lakeview Boulevard(5)47211/47215 Lakeview Boulevard(5)FremontCA03,75012,656270003,75012,92616,6762,9349/30/2011198547211/47215 Lakeview Boulevard(5)FremontCA3,75012,6563,8913,78216,51520,2974,8949/30/20111985
47900 Bayside ParkwayFremontCA04,58010,3701,001004,58011,37115,9512,6019/30/20111991
577 South Peach StreetFresnoCA07382,5774,1750(211)7386,5417,2792,49512/28/19901963
577 South Peach Street (5)
577 South Peach Street (5)
FresnoCA7382,5774,175(211)7386,5417,2793,28512/28/19901963
6075 North Marks Avenue6075 North Marks AvenueFresnoCA088012,7515220088913,26414,1534,2093/31/200819966075 North Marks AvenueFresnoCA88012,7512,01488914,75615,6455,6463/31/20081996
8631 West 3rd StreetLos AngelesCA024,64088,27717,0440(554)25,391104,016129,40724,96911/22/20101979
8635 West 3rd StreetLos AngelesCA024,64090,35214,3800(583)25,331103,458128,78925,20911/22/20101979
1319 Brookside Avenue1319 Brookside AvenueRedlandsCA1,7709,9822,4371,77012,41914,1894,5923/31/20081999
110 Sterling Court110 Sterling CourtRosevilleCA1,62010,2623,4201,62013,68215,3024,9183/31/20081998
S-1

Table of Contents
DIVERSIFIED HEALTHCARE TRUST
SCHEDULE III
REAL ESTATE AND ACCUMULATED DEPRECIATION
DECEMBER 31, 20202023
(dollars in thousands)
 Initial Cost to Company Cost at December 31, 2020   Initial Cost to Company Cost at December 31, 2023 
AddressAddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
AddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
1319 Brookside AvenueRedlandsCA01,7709,982776001,77010,75812,5283,3343/31/20081999
110 Sterling CourtRosevilleCA01,62010,2622,088001,62012,35013,9703,5383/31/20081998
16925 & 16916 Hierba Drive16925 & 16916 Hierba DriveSan DiegoCA09,14253,90418,4320(6,416)9,18065,88275,06228,0661/11/2002198716925 & 16916 Hierba DriveSan DiegoCA9,14253,90432,832(7,115)9,18079,58388,76335,1691/11/20021987
3030 Science ParkSan DiegoCA02,46646,47325,655002,46672,12874,59413,2638/6/20091986
3040 Science ParkSan DiegoCA01,22523,07714,395001,22537,47238,6976,5868/6/20091986
3050 Science ParkSan DiegoCA01,50828,75315,519001,50844,27245,7808,2068/6/20091986
2904 Orchard ParkwaySan JoseCA010,7888,8902,5890010,80411,46322,2671,2751/25/20181979
3030 Science Park (5)
3030 Science Park (5)
San DiegoCA2,46646,47345,393(15,755)2,46676,11178,57719,1588/6/20091986
3040 Science Park (5)
3040 Science Park (5)
San DiegoCA1,22523,07724,8231,22547,90049,12511,0208/6/20091986
3050 Science Park (5)
3050 Science Park (5)
San DiegoCA1,50828,75336,0571,53564,78366,31814,5358/6/20091986
3530 Deer Park Drive3530 Deer Park DriveStocktonCA067014,4191,8490068216,25616,9384,8533/31/200819993530 Deer Park DriveStocktonCA67014,4193,34568217,75218,4346,5113/31/20081999
877 East March Lane877 East March LaneStocktonCA01,17611,1716,5060(1,535)1,41115,90717,3186,4349/30/20031988877 East March LaneStocktonCA1,17611,1718,427(2,159)1,41117,20418,6157,7779/30/20031988
28515 Westinghouse PlaceValenciaCA0$4,66941,44045004,68941,46546,1546,1311/29/20152008
28515 Westinghouse Place (5)
28515 Westinghouse Place (5)
ValenciaCA4,66941,4401,5364,68942,95647,6459,2701/29/20152008
1866 San Miguel Drive1866 San Miguel DriveWalnut CreekCA0$2,0109,2905,0730(930)3,41712,02615,4432,87412/1/201119961866 San Miguel DriveWalnut CreekCA2,0109,2906,937(1,421)3,41713,39916,8163,95612/1/20111996
1950 South Dayton Street1950 South Dayton StreetAuroraCO0$3,06246,1951,993003,12048,13051,2508,0645/1/201519871950 South Dayton StreetAuroraCO3,06246,19511,422(340)3,12057,21960,33913,3555/1/20151987
515 Fairview Avenue515 Fairview AvenueCanon CityCO0$2926,2281,686(3,512)(517)2993,8784,1771,8319/26/19971970515 Fairview AvenueCanon CityCO2926,2284,298(3,512)(517)2996,4906,7892,9089/26/19971970
110 West Van Buren Street110 West Van Buren StreetColorado SpringsCO0$2455,2362,038(3,031)(701)2453,5423,7871,6049/26/19971972110 West Van Buren StreetColorado SpringsCO2455,2365,556(3,031)(810)2456,9517,1962,8939/26/19971972
3920 East San Miguel Street3920 East San Miguel StreetColorado SpringsCO0$1,3808,8944,0360(34)1,60712,66914,2763,1257/31/201219773920 East San Miguel StreetColorado SpringsCO1,3808,8944,315(370)1,61212,60714,2194,4177/31/20121977
2050 South Main Street2050 South Main StreetDeltaCO0$1673,5709710(415)1674,1264,2932,2849/26/199719632050 South Main StreetDeltaCO1673,5703,261(415)1676,4166,5833,1539/26/19971963
2501 Little Bookcliff Drive2501 Little Bookcliff DriveGrand JunctionCO0$2043,8751,8790(828)2074,9235,1302,91812/30/199319682501 Little Bookcliff DriveGrand JunctionCO2043,8754,078(974)2076,9767,1833,67312/30/19931968
2825 Patterson Road2825 Patterson RoadGrand JunctionCO0$1732,5832,6360(786)1734,4334,6062,58912/30/199319782825 Patterson RoadGrand JunctionCO1732,5834,831(786)1736,6286,8013,63912/30/19931978
1599 Ingalls Street1599 Ingalls StreetLakewoodCO0$2323,7663,3440(860)2326,2506,4824,08612/28/199019721599 Ingalls StreetLakewoodCO2323,7668,014(1,339)23210,44110,6735,09212/28/19901972
5555 South Elati Street5555 South Elati StreetLittletonCO0$1855,0433,8770(997)1917,9178,1084,67012/28/199019655555 South Elati StreetLittletonCO1855,0437,019(1,409)19110,64710,8385,76312/28/19901965
8271 South Continental Divide RoadLittletonCO0$4003,50700(202)4003,3053,7051,4772/28/20031998
9005 Grant StreetThorntonCO0$96110,8671,035001,15611,70712,8632,27012/28/20122001
7809 W. 38th AvenueWheat RidgeCO0$4703,3736004753,3743,8499084/1/20102004
40 Sebethe DriveCromwellCT0$5705,3041,7590(424)5966,6137,2091,48812/22/20101998
8271 South Continental Divide Road (5)
8271 South Continental Divide Road (5)
LittletonCO4003,507(202)4003,3053,7051,7242/28/20031998
9005 Grant Street (5)
9005 Grant Street (5)
ThorntonCO96110,8671,2031,26911,76213,0313,40812/28/20122001
7809 W. 38th Avenue (5)
7809 W. 38th Avenue (5)
Wheat RidgeCO4703,373864753,4543,9291,1784/1/20102004
40 Sebethe Drive (5)
40 Sebethe Drive (5)
CromwellCT5705,3042,071(424)7986,7237,5212,27812/22/20101998
1145 19th Street NW1145 19th Street NWWashingtonDC0$13,60024,88036,2880(375)13,60060,79374,39310,1675/20/200919761145 19th Street NWWashingtonDC13,60024,88037,553(1,580)13,60060,85374,45317,0075/20/20091976
2141 K Street, NW2141 K Street, NWWashingtonDC0$13,7008,4005,2480(300)13,70013,34827,0484,01212/22/200819662141 K Street, NWWashingtonDC13,7008,4007,174(1,353)13,70014,22127,9214,74612/22/20081966
255 Possum Park Road255 Possum Park RoadNewarkDE0$2,01011,8527,9650(1,680)2,76117,38620,1476,4631/11/20021982255 Possum Park RoadNewarkDE2,01011,85214,103(1,903)2,76123,30126,0628,3391/11/20021982
4175 Ogletown Stanton Rd4175 Ogletown Stanton RdNewarkDE0$1,50019,4471,317001,56320,70122,2646,6073/31/200819984175 Ogletown Stanton RdNewarkDE1,50019,4473,1581,56322,54224,1058,5563/31/20081998
1212 Foulk Road1212 Foulk RoadWilmingtonDE0$1,1796,9502,4400(1,212)1,2028,1559,3573,6281/11/200219741212 Foulk RoadWilmingtonDE1,1796,95010,870(1,460)1,20216,33717,5394,7011/11/20021974
1912 Marsh Road1912 Marsh RoadWilmingtonDE04,36525,7394,8750(2,241)4,43128,30732,73812,7331/11/200219881912 Marsh RoadWilmingtonDE4,36525,73910,752(2,436)4,43133,98938,42016,4381/11/20021988
2723 Shipley Road2723 Shipley RoadWilmingtonDE08695,1265,2350(1,528)9788,7249,7023,5461/11/200219892723 Shipley RoadWilmingtonDE8695,12613,168(1,934)1,03416,19517,2294,5021/11/20021989
407 Foulk Road407 Foulk RoadWilmingtonDE0382272,5330(369)842,3452,4296571/11/20021965407 Foulk RoadWilmingtonDE382272,838(531)842,4882,5721,0131/11/20021965
22601 Camino Del Mar22601 Camino Del MarBoca RatonFL03,20046,8004,4440(1,694)3,20449,54652,75012,46612/15/2011199022601 Camino Del MarBoca RatonFL3,20046,80011,991(3,307)3,20455,48058,68416,33912/15/20111990
1325 S Congress Avenue1325 S Congress AvenueBoynton BeachFL1,6205,3412,623(207)1,6287,7499,3772,2747/27/20121985
1425 Congress Avenue1425 Congress AvenueBoynton BeachFL2,39014,7685,497(1,370)2,39018,89521,2855,8568/9/20111994
1416 Country Club Blvd. (5)
1416 Country Club Blvd. (5)
Cape CoralFL4002,907(173)4002,7343,1341,4262/28/20031998
S-2

Table of Contents
DIVERSIFIED HEALTHCARE TRUST
SCHEDULE III
REAL ESTATE AND ACCUMULATED DEPRECIATION
DECEMBER 31, 20202023
(dollars in thousands)
 Initial Cost to Company Cost at December 31, 2020   Initial Cost to Company Cost at December 31, 2023 
AddressAddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
AddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
1325 S Congress AvenueBoynton BeachFL01,6205,3411,4000(121)1,6286,6128,2401,4227/27/20121985
1425 Congress AvenueBoynton BeachFL02,39014,7683,3240(567)2,39017,52519,9154,4918/9/20111994
1416 Country Club Blvd.Cape CoralFL04002,90700(173)4002,7343,1341,2222/28/20031998
8500 Royal Palm Boulevard8500 Royal Palm BoulevardCoral SpringsFL03,41020,10430,1540(3,006)3,42147,24150,66216,2551/11/200219848500 Royal Palm BoulevardCoral SpringsFL3,41020,10435,126(4,015)3,42151,20454,62522,0101/11/20021984
1208 South Military Trail1208 South Military TrailDeerfield BeachFL01,69014,97228,6190(1,467)1,77742,03743,81416,92310/1/201219861208 South Military TrailDeerfield BeachFL1,69014,97236,321(5,778)1,77745,42847,20518,72710/1/20121986
3001 DC Country Club Boulevard3001 DC Country Club BoulevardDeerfield BeachFL03,19618,84820,2110(2,557)3,22236,47639,69813,7101/11/200219903001 DC Country Club BoulevardDeerfield BeachFL3,19618,84825,317(3,198)3,22240,94144,16318,3021/11/20021990
12780 Kenwood Lane12780 Kenwood LaneFort MyersFL03692,1743,5310(330)8594,8855,7441,9521/11/2002199012780 Kenwood LaneFort MyersFL3692,1745,302(1,148)8595,8386,6972,2151/11/20021990
2525 First Street2525 First StreetFort MyersFL02,38521,13719,4870(729)2,57739,70342,28019,57610/1/201219842525 First StreetFort MyersFL2,38521,13745,642(13,880)2,57752,70755,28416,77110/1/20121984
1825 Ridgewood Avenue1825 Ridgewood AvenueHolly HillFL070016,7003,050(2,636)(4,649)68412,48113,1659887/22/20111926/20061825 Ridgewood AvenueHolly HillFL70016,7006,818(2,636)(8,866)68412,03212,7161,5287/22/20111926/2006
2480 North Park Road2480 North Park RoadHollywoodFL04,50040,50016,4050(1,486)4,55655,36359,91913,85512/15/201119862480 North Park RoadHollywoodFL4,50040,50025,358(3,431)4,55662,37166,92719,24312/15/20111986
8901 Tamiami Trail East8901 Tamiami Trail EastNaplesFL03,2002,89814,7550(837)3,20016,81620,0165,0418/31/200619848901 Tamiami Trail EastNaplesFL3,2002,89816,214(837)3,20018,27521,4757,0848/31/20061984
12780 Waterford Lakes ParkwayOrlandoFL09773,946438001,0524,3095,36171512/18/20132002
12780 Waterford Lakes Parkway (5)
12780 Waterford Lakes Parkway (5)
OrlandoFL9773,9468201,0524,6915,7431,21812/18/20132002
1603 S. Hiawassee Road1603 S. Hiawassee RoadOrlandoFL04882,6213060(81)4882,8463,33447212/18/201320031603 S. Hiawassee RoadOrlandoFL4882,621434(81)4882,9743,46279412/18/20132003
1825 N. Mills AvenueOrlandoFL05191,799415005802,1532,73369412/22/20081997
1911 N. Mills AvenueOrlandoFL01,9467,197866002,0427,96710,0092,66912/22/20081997
1925 N. Mills AvenueOrlandoFL01355322310019870089825512/22/20081997
250 N. Alafaya TrailOrlandoFL09674,362288009674,6505,61782312/18/20131999
1825 N. Mills Avenue (5)
1825 N. Mills Avenue (5)
OrlandoFL5191,799670(117)5802,2912,87176812/22/20081997
1911 N. Mills Avenue (5)
1911 N. Mills Avenue (5)
OrlandoFL1,9467,1972,903(538)2,0429,46611,5082,77912/22/20081997
1925 N. Mills Avenue (5)
1925 N. Mills Avenue (5)
OrlandoFL135532307(107)19966886723912/22/20081997
250 N. Alafaya Trail (5)
250 N. Alafaya Trail (5)
OrlandoFL9674,3624779674,8395,8061,29112/18/20131999
45 Katherine Boulevard45 Katherine BoulevardPalm HarborFL03,37929,9457,6310(518)3,39237,04540,43722,84410/1/2012199245 Katherine BoulevardPalm HarborFL3,37929,94512,316(2,428)3,39239,82043,21226,07110/1/20121992
900 West Lake Road900 West Lake RoadPalm HarborFL03,44920,33610,4800(2,987)3,49327,78531,27811,4141/11/20021989900 West Lake RoadPalm HarborFL3,44920,33615,210(3,395)3,49332,10735,60015,6621/11/20021989
8500 West Sunrise Boulevard8500 West Sunrise BoulevardPlantationFL04,70024,3007,3000(2,120)4,71729,46334,1808,97012/15/201119898500 West Sunrise BoulevardPlantationFL4,70024,30012,975(5,391)4,71731,86736,5849,84012/15/20111989
1371 South Ocean Boulevard1371 South Ocean BoulevardPompano BeachFL02,50015,50014,9530(1,227)2,56029,16631,7267,78412/15/201119911371 South Ocean BoulevardPompano BeachFL2,50015,50018,386(3,554)2,56030,27232,8329,88812/15/20111991
2701 North Course Drive2701 North Course DrivePompano BeachFL07,7002,12740,7970(1,103)7,70041,82149,52113,5988/31/200619852701 North Course DrivePompano BeachFL7,7002,12744,391(2,857)7,70043,66151,36117,3718/31/20061985
20480 Veterans Boulevard20480 Veterans BoulevardPort CharlotteFL040011,9341,9630(448)44013,40913,8493,7167/22/2011199620480 Veterans BoulevardPort CharlotteFL40011,9343,729(3,147)44012,47612,9163,8397/22/20111996
1699 S.E. Lyngate Drive1699 S.E. Lyngate DrivePort St. LucieFL01,24211,0094,1440(167)1,24914,97916,2288,57210/1/201219931699 S.E. Lyngate DrivePort St. LucieFL1,24211,0095,634(1,055)1,24915,58116,8309,76810/1/20121993
501 N.W. Cashmere Boulevard501 N.W. Cashmere BoulevardPort St. LucieFL08909,3452,7210(135)1,67311,14812,8212,7387/22/20112007501 N.W. Cashmere BoulevardPort St. LucieFL8909,3453,760(463)1,67311,85913,5323,6807/22/20112007
900 South Harbour Island Blvd.TampaFL04,8506,3497004,8506,35611,2062,09810/30/20071986
900 South Harbour Island Blvd. (5)
900 South Harbour Island Blvd. (5)
TampaFL4,8506,3496,1684,85012,51717,3672,57410/30/20071986
111 Executive Center Drive111 Executive Center DriveWest Palm BeachFL02,06112,15317,9110(2,479)2,07527,57129,6469,2151/11/20021988111 Executive Center DriveWest Palm BeachFL2,06112,15324,463(3,077)2,07533,52535,60014,1851/11/20021988
2347 Cedarcrest Road2347 Cedarcrest RoadAcworthGA1,674881,674881,7625/1/20162008
2351 Cedarcrest Road2351 Cedarcrest RoadAcworthGA02,0006,674178002,0006,8528,8521,1315/1/201620142351 Cedarcrest RoadAcworthGA3266,674832(511)3276,9947,3211,4095/1/20162014
1200 Bluegrass Lakes Parkway1200 Bluegrass Lakes ParkwayAlpharettaGA01,68915,9360001,68915,93617,6252,3571/29/201520011200 Bluegrass Lakes ParkwayAlpharettaGA1,68915,9362011,76116,06517,8263,5941/29/20152001
855 North Point PkwyAlpharettaGA05,39026,7120005,39026,71232,1028,2648/21/20082006
855 North Point Pkwy (5)
855 North Point Pkwy (5)
AlpharettaGA5,39026,7125,39026,71232,10210,2668/21/20082006
253 N. Main Street253 N. Main StreetAlpharettaGA01,32512,377613001,22113,09414,3152,2125/1/20151997253 N. Main StreetAlpharettaGA1,32512,3771,320(155)1,22113,64614,8673,4485/1/20151997
1291 Cedar Shoals Drive1291 Cedar Shoals DriveAthensGA03374,0061,2430(290)3684,9285,2961,77211/19/200419981291 Cedar Shoals DriveAthensGA3374,0061,844(290)3685,5295,8972,43311/19/20041998
1515 Sheridan RoadAtlantaGA05,8009,3053005,8009,30815,1083,05411/30/20071978
1515 Sheridan Road (5)
1515 Sheridan Road (5)
AtlantaGA5,8009,3053,2255,80012,53018,3303,75111/30/20071978
240 Marietta Highway240 Marietta HighwayCantonGA8068,5553,445(378)80611,62212,4283,23710/1/20131997
4500 South Stadium Drive4500 South Stadium DriveColumbusGA2943,5051,161(225)2984,4374,7351,91011/19/20041999
S-3

Table of Contents
DIVERSIFIED HEALTHCARE TRUST
SCHEDULE III
REAL ESTATE AND ACCUMULATED DEPRECIATION
DECEMBER 31, 20202023
(dollars in thousands)
 Initial Cost to Company Cost at December 31, 2020   Initial Cost to Company Cost at December 31, 2023 
AddressAddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
AddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
240 Marietta HighwayCantonGA08068,5551,206008069,76110,5672,19010/1/20131997
4500 South Stadium DriveColumbusGA02943,5054940(225)2983,7704,0681,44311/19/20041999
1352 Wellbrook Circle1352 Wellbrook CircleConyersGA3424,0681,994(1,366)(2,032)2062,8003,00641611/19/20041997
1501 Milstead Road1501 Milstead RoadConyersGA07507,796706007508,5029,2522,2419/30/201020081501 Milstead RoadConyersGA7507,7961,204(116)7778,8579,6342,9999/30/20102008
3875 Post Road3875 Post RoadCummingGA095412,7962230095813,01513,9732,2375/1/201520073875 Post RoadCummingGA95412,79644696013,23614,1963,6105/1/20152007
4960 Jot Em Down Road4960 Jot Em Down RoadCummingGA01,54818,66612,6090(73)3,41629,33432,7506,0888/1/201320114960 Jot Em Down RoadCummingGA1,54818,66613,418(1,057)3,41629,15932,5758,0898/1/20132011
5610 Hampton Park Drive5610 Hampton Park DriveCummingGA03,47914,771218003,48114,98718,4682,5769/3/201520145610 Hampton Park DriveCummingGA3,47914,771330(938)3,49814,14417,6423,0109/3/20152014
7955 Majors Road7955 Majors RoadCummingGA01,3257,770531001,3258,3019,6261,3715/1/201520097955 Majors RoadCummingGA1,3257,7701,107(115)1,3258,76210,0872,2175/1/20152009
2470 Dug Gap Road2470 Dug Gap RoadDaltonGA02623,1197220(133)2623,7083,9701,37711/19/200419972470 Dug Gap RoadDaltonGA2623,1191,434(133)2624,4204,6821,94711/19/20041997
101 West Ponce De Leon Avenue101 West Ponce De Leon AvenueDecaturGA03,50013,179442003,50013,62117,1212,8345/30/20121992101 West Ponce De Leon AvenueDecaturGA3,50013,17912,0073,50025,18628,6864,3465/30/20121992
2801 North Decatur RoadDecaturGA03,1004,4362,005003,1006,4419,5411,7987/9/20081986
2801 North Decatur Road (5)
2801 North Decatur Road (5)
DecaturGA3,1004,4363,084(519)3,2606,84110,1012,4307/9/20081986
114 Penland Street114 Penland StreetEllijayGA04967,107795004967,9028,3981,64510/1/20132008114 Penland StreetEllijayGA4967,1071,625(157)4968,5759,0712,41910/1/20132008
353 North Belair Road353 North Belair RoadEvansGA02302,6636750(244)2303,0943,3241,22611/19/20041998353 North Belair RoadEvansGA2302,6631,608(244)2304,0274,2571,69411/19/20041998
1294 Highway 54 West1294 Highway 54 WestFayettevilleGA08539,9037800094310,59311,5361,7865/1/201519991294 Highway 54 WestFayettevilleGA8539,9031,542(148)94311,20712,1502,9875/1/20151999
2435 Limestone Parkway2435 Limestone ParkwayGainesvilleGA02683,1861,1860(224)2684,1484,4161,44311/19/200419982435 Limestone ParkwayGainesvilleGA2683,1861,694(224)2684,6564,9241,94111/19/20041998
3315 Thompson Bridge Road3315 Thompson Bridge RoadGainesvilleGA093430,9621,5280095632,46833,4245,2505/1/201519993315 Thompson Bridge RoadGainesvilleGA93430,9623,436(352)95634,02434,9808,2045/1/20151999
5373 Thompson Mill Road5373 Thompson Mill RoadHoschtonGA094412,1712030094912,36913,3182,0405/1/201520115373 Thompson Mill RoadHoschtonGA94412,17150995912,66513,6243,2865/1/20152011
8080 Summit Business Parkway8080 Summit Business ParkwayJonesboroGA01,80020,6643,1490(456)1,80023,35725,1576,1006/20/201120078080 Summit Business ParkwayJonesboroGA1,80020,6646,676(1,579)1,80025,76127,5618,2616/20/20112007
1360 Upper Hembree RoadRoswellGA01,0806,138248001,0676,3997,4661,3515/7/20122007
6191 Peake Road6191 Peake RoadMaconGA1832,1791,540(848)(1,142)1101,8021,91227011/19/20041998
1360 Upper Hembree Road (5)
1360 Upper Hembree Road (5)
RoswellGA1,0806,1388431,0956,9668,0612,0915/7/20122007
1 Savannah Square Drive1 Savannah Square DriveSavannahGA1,20019,09010,362(6,993)(8,926)83513,89814,7332,16610/1/20061987
5200 Habersham Street5200 Habersham StreetSavannahGA8007,8002,821(3,082)(2,754)4765,1095,5856986/23/20112005
7410 Skidaway Road7410 Skidaway RoadSavannahGA4005,6702,319(1,870)(2,626)2523,6413,89352011/1/20061989
2078 Scenic Highway2078 Scenic HighwaySnellvilleGA08704,030625008704,6555,5251,39912/10/200919972078 Scenic HighwaySnellvilleGA8704,0301,791(256)8705,5656,4351,84312/10/20091997
475 Country Club Drive475 Country Club DriveStockbridgeGA05129,5606500055110,17110,7221,7525/1/20151998475 Country Club DriveStockbridgeGA5129,5601,312(206)55110,62711,1782,7545/1/20151998
1300 Montreal Road1300 Montreal RoadTuckerGA06906,2101,2610(469)6946,9987,6922,5676/3/200519971300 Montreal RoadTuckerGA6906,2102,366(469)6948,1038,7973,4316/3/20051997
1100 Ward AvenueHonoluluHI0$11,20055,6186,5550011,24762,12673,37313,4076/18/20121961
1100 Ward Avenue (5)
1100 Ward Avenue (5)
HonoluluHI11,20055,6189,811(304)11,24765,07876,32519,3816/18/20121961
2340 West Seltice Way2340 West Seltice WayCoeur d'AleneID0$9107,1703,282001,04710,31511,3622,4097/31/201219932340 West Seltice WayCoeur d'AleneID9107,1703,687(214)1,05210,50111,5533,4547/31/20121993
850 Lincoln Drive850 Lincoln DriveIdaho FallsID0$5106,6402,530007328,9489,6802,0957/31/20121978850 Lincoln DriveIdaho FallsID5106,6403,599(147)7609,84210,6023,1617/31/20121978
1250 West Central Road1250 West Central RoadArlington HeightsIL0$3,66532,5879,4250(258)3,78141,63845,41924,97911/1/201219861250 West Central RoadArlington HeightsIL3,66532,58717,225(1,932)3,78147,76451,54528,46811/1/20121986
1450 Busch Parkway1450 Busch ParkwayBuffalo GroveIL0$3,80011,456929003,81512,37016,1853,1689/16/201020091450 Busch ParkwayBuffalo GroveIL3,80011,4561,173(122)3,83712,47016,3074,1599/16/20102009
2601 Patriot BoulevardGlenviewIL0$2,2859,5930002,2859,59311,8781,4191/29/20152005
2601 Patriot Boulevard (5)
2601 Patriot Boulevard (5)
GlenviewIL2,2859,5932,2859,59311,8782,1391/29/20152005
1373 D'Adrian Professional Park1373 D'Adrian Professional ParkGodfreyIL0$28115,0886200028115,70815,9892,6425/1/201520101373 D'Adrian Professional ParkGodfreyIL28115,0881,986(210)28116,86417,1453,9885/1/20152010
900 43rd Avenue900 43rd AvenueMolineIL0$4827,651430004828,0818,5631,2795/1/20152003 / 2012900 43rd AvenueMolineIL4827,651746(76)4828,3218,8031,9725/1/20152003 / 2012
221 11th Avenue221 11th AvenueMolineIL0$1617,2441,500001618,7448,9051,4485/1/20152008221 11th AvenueMolineIL1617,2441,759(54)1618,9499,1102,2905/1/20152008
2700 14th StreetPekinIL0$17111,4753370017211,81111,9831,9685/1/20152009
7130 Crimson Ridge DriveRockfordIL0$2007,3002,127001,5968,0319,6272,0625/1/20111999
1220 Lakeview DriveRomeovilleIL0$1,12019,582(61)001,05819,58320,6416,0588/21/20082005
S-4

Table of Contents
DIVERSIFIED HEALTHCARE TRUST
SCHEDULE III
REAL ESTATE AND ACCUMULATED DEPRECIATION
DECEMBER 31, 20202023
(dollars in thousands)
 Initial Cost to Company Cost at December 31, 2020   Initial Cost to Company Cost at December 31, 2023 
AddressAddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
AddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
2700 14th Street2700 14th StreetPekinIL17111,475747(280)17211,94112,1132,9565/1/20152009
7130 Crimson Ridge Drive7130 Crimson Ridge DriveRockfordIL2007,3003,135(389)1,5968,65010,2462,6245/1/20111999
1220 Lakeview Drive (5)
1220 Lakeview Drive (5)
RomeovilleIL1,12019,582(61)1,05819,58320,6417,5268/21/20082005
1201 Hartman Lane1201 Hartman LaneShilohIL0$7437,2321,732001,2378,4709,7071,08412/8/201620031201 Hartman LaneShilohIL7437,2322,369(620)1,2378,4879,7241,66912/8/20162003
900 Southwind Road900 Southwind RoadSpringfieldIL0$3006,7441,9080(403)3008,2498,5492,7408/31/20061990900 Southwind RoadSpringfieldIL3006,7443,227(403)3009,5689,8683,9498/31/20061990
2705 Avenue E2705 Avenue ESterlingIL0$34114,3314460034314,77515,1182,4675/1/201520082705 Avenue ESterlingIL34114,3311,030(144)34315,21515,5583,8305/1/20152008
39 Dorothy Drive39 Dorothy DriveTroyIL0$1,0027,0101,158001,0028,1689,1701,05812/8/2016200339 Dorothy DriveTroyIL1,0027,0101,781(626)1,0028,1659,1671,59012/8/20162003
100 Grand Victorian Place100 Grand Victorian PlaceWashingtonIL0$24112,0463690024112,41512,6562,0585/1/20152009100 Grand Victorian PlaceWashingtonIL24112,046542(57)24112,53112,7723,1135/1/20152009
1615 Lakeside DriveWaukeganIL0$2,7009,5903,077003,47811,88915,3673,3069/30/20111990
1675 Lakeside DriveWaukeganIL0$2,4209,3822,572002,87311,50114,3743,1629/30/20111998
1615 Lakeside Drive (5)
1615 Lakeside Drive (5)
WaukeganIL2,7009,5904,262(944)3,51512,09315,6083,7609/30/20111990
1675 Lakeside Drive (5)
1675 Lakeside Drive (5)
WaukeganIL2,4209,3823,568(957)2,90611,50714,4133,5109/30/20111998
406 Smith Drive406 Smith DriveAuburnIN0$3808,2464220(253)5248,2718,7952,5239/1/20081999406 Smith DriveAuburnIN3808,246874(253)5248,7239,2473,3289/1/20081999
6990 East County Road 100 North6990 East County Road 100 NorthAvonIN0$85011,8887200(333)85012,27513,1253,7299/1/200819996990 East County Road 100 NorthAvonIN85011,8881,905(333)85013,46014,3105,0259/1/20081999
2455 Tamarack Trail2455 Tamarack TrailBloomingtonIN0$5,40025,12929,1400(62)6,33953,26859,60711,18211/1/200819832455 Tamarack TrailBloomingtonIN5,40025,12934,518(621)6,33958,08764,42617,84611/1/20081983
2460 Glebe StreetCarmelIN0$2,10857,741866002,12558,59060,7159,2245/1/20152008
701 East County Line RoadGreenwoodIN0$1,83014,3031,172001,84815,45717,3053,65012/1/20112007
2460 Glebe Street (5)
2460 Glebe Street (5)
CarmelIN2,10857,7411,493(148)2,13359,06161,19414,2525/1/20152008
701 East County Line Road (5)
701 East County Line Road (5)
GreenwoodIN1,83014,3031,410(305)1,87715,36117,2384,79312/1/20112007
8505 Woodfield Crossing Boulevard8505 Woodfield Crossing BoulevardIndianapolisIN02,78516,3966,8100(2,127)2,83821,02623,8648,9621/11/200219868505 Woodfield Crossing BoulevardIndianapolisIN2,78516,3969,462(2,183)2,83823,62226,46011,5281/11/20021986
2501 Friendship Boulevard2501 Friendship BoulevardKokomoIN051213,0099750051213,98414,4961,24012/27/201719972501 Friendship BoulevardKokomoIN51213,0092,286(58)51215,23715,7492,75212/27/20171997
603 Saint Joseph Drive603 Saint Joseph DriveKokomoIN02205,8999860(256)2206,6296,8491,9209/1/20081998603 Saint Joseph DriveKokomoIN2205,8991,413(256)2207,0567,2762,6479/1/20081998
1211 Longwood Drive1211 Longwood DriveLa PorteIN07705,5501,1990(288)9236,3087,2311,7869/1/200819981211 Longwood DriveLa PorteIN7705,5501,772(288)9236,8817,8042,5869/1/20081998
1590 West Timberview Drive1590 West Timberview DriveMarionIN04105,4098910(267)4106,0336,4431,6919/1/200820001590 West Timberview DriveMarionIN4105,4091,691(267)4106,8337,2432,4289/1/20082000
1473 East McKay Road1473 East McKay RoadShelbyvilleIN01905,3284130(236)1905,5055,6951,6369/1/200819991473 East McKay RoadShelbyvilleIN1905,3281,550(236)1906,6426,8322,3139/1/20081999
17441 State Road 23South BendIN04003,107(38)0(182)3632,9243,2871,3072/28/20031998
17441 State Road 23 (5)
17441 State Road 23 (5)
South BendIN4003,107(38)(182)3632,9243,2871,5262/28/20031998
222 South 25th Street222 South 25th StreetTerra HauteIN030013,1159570(492)30013,58013,8804,0589/1/20082005222 South 25th StreetTerra HauteIN30013,1151,527(492)30014,15014,4505,2959/1/20082005
150 Fox Ridge Drive150 Fox Ridge DriveVincennesIN01103,6031,4820(208)1104,8774,9871,4999/1/20081985150 Fox Ridge DriveVincennesIN1103,6032,380(208)1105,7755,8852,3499/1/20081985
1501 Inverness Drive1501 Inverness DriveLawrenceKS01,60018,5652,739001,75821,14622,9046,42110/1/200919881501 Inverness DriveLawrenceKS1,60018,5655,131(1,232)1,75822,30624,0647,89610/1/20091988
5799 Broadmoor StreetMissionKS01,5227,2461,791001,5309,02910,5591,1021/17/20171986
5799 Broadmoor Street (5)
5799 Broadmoor Street (5)
MissionKS1,5227,2462,8461,53010,08411,6142,2711/17/20171986
3501 West 95th Street3501 West 95th StreetOverland ParkKS02,56815,1405,9400(2,079)2,58018,98921,5697,9691/11/200219893501 West 95th StreetOverland ParkKS2,56815,14012,521(2,232)2,58025,41727,99710,9781/11/20021989
6555 West 75th Street6555 West 75th StreetOverland ParkKS01,2741,12614,9260(1,102)1,48714,73716,2245,94910/25/200219856555 West 75th StreetOverland ParkKS1,2741,12617,556(1,102)1,48717,36718,8548,00310/25/20021985
6700 W. 115th Street6700 W. 115th StreetOverland ParkKS04,50329,387169004,50329,55634,0592,2291/3/201820066700 W. 115th StreetOverland ParkKS4,50329,3875014,53729,85434,3914,4941/3/20182006
981 Campbell Lane981 Campbell LaneBowling GreenKY03654,3451,4560(203)3655,5985,9631,90511/19/20041999981 Campbell LaneBowling GreenKY3654,3451,987(203)3656,1296,4942,62011/19/20041999
102 Leonardwood Drive102 Leonardwood DriveFrankfortKY05608,2822,0140(299)5799,97810,5573,6208/31/20061989102 Leonardwood DriveFrankfortKY5608,2824,134(605)57911,79212,3714,6048/31/20061989
4190 Lafayette Road4190 Lafayette RoadHopkinsvilleKY03163,7615810(193)3164,1494,4651,57311/19/200419994190 Lafayette RoadHopkinsvilleKY3163,7611,348(246)3164,8635,1792,05411/19/20041999
690 Mason Headley Road (6)
690 Mason Headley Road (6)
LexingtonKY6,314010,84812,6850(1,257)4222,23422,27611,3941/11/20021985
690 Mason Headley Road (6)
LexingtonKY3,14410,84818,298(1,441)4227,66327,70513,2601/11/20021985
700 Mason Headley Road (6)
LexingtonKY1,49706,3947,9570(951)5213,34813,4006,1851/11/20021980
200 Brookside DriveLouisvilleKY03,52420,7799,1370(3,120)3,54926,77130,32011,1951/11/20021984
1517 West BroadwayMayfieldKY02682,7301,2750(221)2683,7844,0521,39911/19/20041999
S-5

Table of Contents
DIVERSIFIED HEALTHCARE TRUST
SCHEDULE III
REAL ESTATE AND ACCUMULATED DEPRECIATION
DECEMBER 31, 20202023
(dollars in thousands)
 Initial Cost to Company Cost at December 31, 2020   Initial Cost to Company Cost at December 31, 2023 
AddressAddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
AddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
700 Mason Headley Road (6)
700 Mason Headley Road (6)
LexingtonKY7676,39410,364(1,061)5215,64515,6977,3771/11/20021980
200 Brookside Drive200 Brookside DriveLouisvilleKY3,52420,77913,048(3,357)3,54930,44533,99414,8281/11/20021984
1517 West Broadway1517 West BroadwayMayfieldKY2682,7302,197(305)2684,6224,8901,98611/19/20041999
1700 Elmdale Road1700 Elmdale RoadPaducahKY04505,3581,3210(319)4516,3596,8102,41011/19/200420001700 Elmdale RoadPaducahKY4505,3582,034(416)4516,9757,4263,10811/19/20042000
100 Neighborly Way100 Neighborly WaySomersetKY02004,919622002005,5415,7411,88611/6/20062000100 Neighborly WaySomersetKY2004,9191,3152006,2346,4342,55811/6/20062000
1295 Boylston StreetBostonMA07,60018,1403,198007,62521,31328,9385,3531/26/20111930
11 Fan Pier Boulevard / 50 Northern Avenue (5)
BostonMA620,00052,643784,954(1,382)0052,643783,572836,215131,1195/7/20142013
1295 Boylston Street (5)
1295 Boylston Street (5)
BostonMA7,60018,1403,166(109)7,62521,17228,7977,3661/26/20111930
549 Albany Street549 Albany StreetBostonMA04,57645,0290004,56945,03649,6058,2588/22/20131895549 Albany StreetBostonMA4,57645,0294,56945,03649,60511,6388/22/20131895
330 Baker AvenueConcordMA03,77519,9060003,77519,90623,6812,9451/29/20152013
4 Maguire Road4 Maguire RoadLexingtonMA03,60015,5552,961(7,255)(1,003)3,8849,97413,8582,74612/22/200819944 Maguire RoadLexingtonMA3,60015,55534,794(7,255)(1,003)3,88441,80745,6916,59512/22/20081994
100 Hampshire Street(5)100 Hampshire Street(5)MansfieldMA02,0908,2151,664002,4869,48311,9692,33112/22/20101975100 Hampshire Street(5)MansfieldMA2,0908,2154,0792,48611,89814,3843,33912/22/20101975
15 Hampshire Street(5)15 Hampshire Street(5)MansfieldMA01,3607,326507001,7487,4459,1931,97612/22/2010198815 Hampshire Street(5)MansfieldMA1,3607,3269921,7487,9309,6782,67612/22/20101988
5 Hampshire Street(5)5 Hampshire Street(5)MansfieldMA01,1905,7371,704001,4647,1678,6311,80912/22/201019885 Hampshire Street(5)MansfieldMA1,1905,7372,962(143)1,4778,2699,7462,94912/22/20101988
30 New Crossing RoadReadingMA01,44314,153183001,45514,32415,7792,9889/27/20121986
299 Cambridge Street299 Cambridge StreetWinchesterMA03,21818,98811,4970(1,855)3,21828,63031,84811,8211/11/20021991299 Cambridge StreetWinchesterMA3,21818,98815,791(2,473)3,21832,30635,52414,5571/11/20021991
2717 Riva Road2717 Riva RoadAnnapolisMD01,29012,373788001,29013,16114,4514,2233/31/200820012717 Riva RoadAnnapolisMD1,29012,3733,828(150)1,29016,05117,3415,3813/31/20082001
658 Boulton StreetBel AirMD04,75016,5042004,75016,50621,2565,41511/30/20071980
658 Boulton Street (5)
658 Boulton Street (5)
Bel AirMD4,75016,50424,75016,50621,2566,65111/30/20071980
7600 Laurel Bowie Road7600 Laurel Bowie RoadBowieMD04083,4219770(393)4084,0054,4131,72110/25/200220007600 Laurel Bowie RoadBowieMD4083,4212,730(464)4085,6876,0952,25010/25/20022000
8100 Connecticut Avenue8100 Connecticut AvenueChevy ChaseMD015,17092,8307,9420(1,656)15,17799,109114,28624,06212/15/201119908100 Connecticut AvenueChevy ChaseMD15,17092,83017,817(3,997)15,177106,643121,82032,36512/15/20111990
8220 Snowden River Parkway8220 Snowden River ParkwayColumbiaMD01,39010,303905001,39011,20812,5983,5203/31/200820018220 Snowden River ParkwayColumbiaMD1,39010,3032,0351,39012,33813,7284,4833/31/20082001
700 Port Street700 Port StreetEastonMD03834,5553,6290(473)3947,7008,0942,88710/25/20022000700 Port StreetEastonMD3834,5554,506(633)3948,4178,8113,75110/25/20022000
3004 North Ridge Road3004 North Ridge RoadEllicott CityMD01,40922,6919,5300(2,266)1,61329,75131,36411,4623/1/200419973004 North Ridge RoadEllicott CityMD1,40922,69114,819(2,730)1,61334,57636,18915,5523/1/20041997
1820 Latham Drive1820 Latham DriveFrederickMD03853,4441,0340(391)3854,0874,4721,72010/25/200219981820 Latham DriveFrederickMD3853,4442,158(444)3855,1585,5432,24710/25/20021998
2100 Whittier Drive2100 Whittier DriveFrederickMD01,2609,4641,484001,26010,94812,2083,4943/31/200819992100 Whittier DriveFrederickMD1,2609,4644,088(109)1,26013,44314,7034,7713/31/20081999
10116 Sharpsburg Pike10116 Sharpsburg PikeHagerstownMD01,0407,4714,621001,04412,08813,1323,7813/31/2008199910116 Sharpsburg PikeHagerstownMD1,0407,4716,270(661)1,04413,07614,1204,7803/31/20081999
4000 Old Court Road4000 Old Court RoadPikesvilleMD02,0004,9748020(82)2,0005,6947,6941,73812/22/200819874000 Old Court RoadPikesvilleMD2,0004,9741,190(82)2,1255,9578,0822,37412/22/20081987
12725 Twinbrook ParkwayRockvilleMD06,1386,5267180(148)6,1787,05613,2348367/12/20171968
715 Benfield Road715 Benfield RoadSeverna ParkMD02299,7982,3250(865)24611,24111,4874,96810/25/20021998715 Benfield RoadSeverna ParkMD2299,7983,261(1,258)24611,78412,0305,82010/25/20021998
14400 Homecrest Road14400 Homecrest RoadSilver SpringMD01,2009,2887,6260(1,509)1,20715,39816,6056,00910/25/2002199614400 Homecrest RoadSilver SpringMD1,2009,28810,440(1,568)1,20718,15319,3607,82910/25/20021996
801 Roeder RoadSilver SpringMD01,90012,8581,9380(193)1,90014,60316,5033,2376/27/20121976
720 & 734 N. Pine RoadHamptonMI03002,40600(142)3002,2642,5641,0112/28/20031998
4004 & 4012 Waldo RoadMidlandMI04002,60600(162)4002,4442,8441,0922/28/20031998
1605 & 1615 Fredericks DriveMonroeMI03002,50600(152)3002,3542,6541,0522/28/20031998
3150 & 3100 Old Centre RoadPortageMI03002,20600(133)3002,0732,3739262/28/20031998
2445 & 2485 Mc Carty RoadSaginawMI06005,21200(305)6004,9075,5072,1932/28/20031998
11855 Ulysses Street NEBlaineMN02,7749,276409002,7819,67812,4592,05212/21/20122007
720 & 734 N. Pine Road (5)
720 & 734 N. Pine Road (5)
HamptonMI3002,406(142)3002,2642,5641,1812/28/20031998
4004 & 4012 Waldo Road (5)
4004 & 4012 Waldo Road (5)
MidlandMI4002,606(162)4002,4442,8441,2752/28/20031998
1605 & 1615 Fredericks Drive (5)
1605 & 1615 Fredericks Drive (5)
MonroeMI3002,506(152)3002,3542,6541,2282/28/20031998
3150 & 3100 Old Centre Road (5)
3150 & 3100 Old Centre Road (5)
PortageMI3002,206(133)3002,0732,3731,0822/28/20031998
2445 & 2485 Mc Carty Road (5)
2445 & 2485 Mc Carty Road (5)
SaginawMI6005,212(305)6004,9075,5072,5602/28/20031998
11855 Ulysses Street NE (5)
11855 Ulysses Street NE (5)
BlaineMN2,7749,2762,274(190)2,78111,35314,1342,77312/21/20122007
1305 Corporate Center Drive1305 Corporate Center DriveEaganMN2,30013,10512,996(72)2,73525,59428,3297,61312/22/20101986
8301 Golden Valley Road (5)
8301 Golden Valley Road (5)
Golden ValleyMN1,2564,6801,2021,2885,8507,1381,1452/10/20161998
S-6

Table of Contents
DIVERSIFIED HEALTHCARE TRUST
SCHEDULE III
REAL ESTATE AND ACCUMULATED DEPRECIATION
DECEMBER 31, 20202023
(dollars in thousands)
 Initial Cost to Company Cost at December 31, 2020   Initial Cost to Company Cost at December 31, 2023 
AddressAddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
AddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
1305 Corporate Center DriveEaganMN02,30013,1056,630002,73519,30022,0354,21812/22/20101986
8301 Golden Valley RoadGolden ValleyMN01,2564,680390001,2565,0706,3266512/10/20161998
8401 Golden Valley RoadGolden ValleyMN01,5105,7422,012001,5107,7549,2641,0062/10/20161998
8501 Golden Valley RoadGolden ValleyMN01,2634,288925001,2635,2136,4766662/10/20161998
1201 Northland DriveMendota HeightsMN01,22010,2081,257001,46811,21712,6853,1231/25/20111989
12700 Whitewater DriveMinnetonkaMN05,4538,1088,300005,45316,40821,8611,82910/2/20171998
8401 Golden Valley Road (5)
8401 Golden Valley Road (5)
Golden ValleyMN1,5105,7423,6721,5439,38110,9242,1672/10/20161998
8501 Golden Valley Road (5)
8501 Golden Valley Road (5)
Golden ValleyMN1,2634,2882,3561,2956,6127,9071,3942/10/20161998
1201 Northland Drive (5)
1201 Northland Drive (5)
Mendota HeightsMN1,22010,2081,294(771)1,49610,45511,9513,4841/25/20111989
12700 Whitewater Drive (5)
12700 Whitewater Drive (5)
MinnetonkaMN5,4538,1088,4155,45316,52321,9764,77610/2/20171998
20600 South Diamond Lake Road20600 South Diamond Lake RoadRogersMN02,76045,7892,626(20,359)(15,686)1,19513,93515,1303353/1/2008199920600 South Diamond Lake RoadRogersMN2,76045,7894,465(20,359)(15,686)1,19515,77416,9694,4553/1/20081999
2200 County Road C WestRosevilleMN05907025630(82)7929811,7732539/30/20111991
2200 County Road C West (5)
2200 County Road C West (5)
RosevilleMN590702731(82)7921,1491,9414369/30/20111991
4166 Lexington Avenue N4166 Lexington Avenue NShoreviewMN01,3004,5471,246001,5025,5917,0931,1995/20/201119884166 Lexington Avenue NShoreviewMN1,3004,5471,2851,5085,6247,1321,8635/20/20111988
1365 Crestridge LaneWest St. PaulMN04002,50600(292)4002,2142,6149892/28/20031998
305 & 315 Thompson AvenueWest St. PaulMN04003,608990(402)4003,3053,7051,4772/28/20031998
1365 Crestridge Lane (5)
1365 Crestridge Lane (5)
West St. PaulMN4002,506(292)4002,2142,6141,1552/28/20031998
305 & 315 Thompson Avenue (5)
305 & 315 Thompson Avenue (5)
West St. PaulMN4003,60899(402)4003,3053,7051,7242/28/20031998
5351 Gretna Road5351 Gretna RoadBransonMO074310,9733650075411,32712,0811,9155/1/201520025351 Gretna RoadBransonMO74310,9731,395(288)75412,06912,8232,9645/1/20152002
845 N New Ballas Court845 N New Ballas CourtCreve CoeurMO01,58216,328783001,58217,11118,6931,2691/22/20182006845 N New Ballas CourtCreve CoeurMO1,58216,3282,5342,18118,26320,4443,0101/22/20182006
3828 College View Drive3828 College View DriveJoplinMO026011,3825020(14)26011,87012,1302,8818/31/201220033828 College View DriveJoplinMO26011,3822,182(136)26013,42813,6884,2118/31/20122003
14100 Magellan Plaza14100 Magellan PlazaMaryland HeightsMO03,71937,3044,835003,17942,67945,8587,7401/29/2015200314100 Magellan PlazaMaryland HeightsMO3,71937,3045,4493,17943,29346,47212,3711/29/20152003
640 E Highland Avenue640 E Highland AvenueNevadaMO03115,703297003116,0006,3119805/1/20151997640 E Highland AvenueNevadaMO3115,7038883116,5916,9021,6295/1/20151997
2410 W Chesterfield Blvd2410 W Chesterfield BlvdSpringfieldMO092412,7723010092413,07313,9972,0815/1/201519992410 W Chesterfield BlvdSpringfieldMO92412,7721,10092413,87214,7963,3615/1/20151999
3540 East Cherokee Street3540 East Cherokee StreetSpringfieldMO01,08411,339935001,12912,22913,3581,9675/1/201519963540 East Cherokee StreetSpringfieldMO1,08411,3391,611(123)1,12912,78213,9113,2585/1/20151996
4700 North Hanley Road4700 North Hanley RoadSt. LouisMO05,16641,587131005,16641,71846,8846,2061/29/201520144700 North Hanley RoadSt. LouisMO5,16641,5871505,16641,73746,9039,3931/29/20152014
118 Alamance Road118 Alamance RoadBurlingtonNC05759,6971,0320(190)57510,53911,1142,7276/20/20111998118 Alamance RoadBurlingtonNC5759,6972,632(449)57511,88012,4553,7246/20/20111998
1050 Crescent Green Drive1050 Crescent Green DriveCaryNC07134,6282,6000(922)7136,3067,0192,74610/25/200219991050 Crescent Green DriveCaryNC7134,6284,438(1,123)7137,9438,6563,53610/25/20021999
2220 & 2230 Farmington DriveChapel HillNC08006,41400(375)8006,0396,8392,6982/28/20031996
2220 & 2230 Farmington Drive (5)
2220 & 2230 Farmington Drive (5)
Chapel HillNC8006,414(375)8006,0396,8393,1512/28/20031996
2101 Runnymede Lane2101 Runnymede LaneCharlotteNC02,47511,4511,1440(228)2,45812,38414,8423,4666/20/201119992101 Runnymede LaneCharlotteNC2,47511,4513,345(1,122)2,45813,69116,1494,1216/20/20111999
5920 McChesney Drive & 6101 Clarke Creek Parkway5920 McChesney Drive & 6101 Clarke Creek ParkwayCharlotteNC01,32021,7501,879001,32023,62924,9497,23511/17/20091999 / 20015920 McChesney Drive & 6101 Clarke Creek ParkwayCharlotteNC1,32021,7503,977(1,310)1,32024,41725,7378,40911/17/20091999 / 2001
500 Penny Lane NE500 Penny Lane NEConcordNC01,68717,603517001,68718,12019,8072,6086/29/20161997500 Penny Lane NEConcordNC1,68717,6032,1241,68719,72721,4144,6586/29/20161997
1002 Highway 541002 Highway 54DurhamNC05955,2004080(114)5955,4946,0891,3646/20/201119881002 Highway 54DurhamNC5955,2001,853(212)5956,8417,4361,9236/20/20111988
4505 Emperor BoulevardDurhamNC01,28516,932377001,28517,30918,5941,49710/11/20172001
4505 Emperor Boulevard (5)
4505 Emperor Boulevard (5)
DurhamNC1,28516,9321,6721,47418,41519,8893,15110/11/20172001
5213 South Alston Avenue5213 South Alston AvenueDurhamNC01,09331,37758001,09331,43532,5284,6551/29/201520105213 South Alston AvenueDurhamNC1,09331,3775591,09331,93633,0297,1031/29/20152010
2755 Union Road2755 Union RoadGastoniaNC01,10417,8346490(1,133)1,10417,35018,4542,0306/29/201619982755 Union RoadGastoniaNC1,10417,8341,766(1,133)1,10418,46719,5713,8276/29/20161998
1001 Phifer Road1001 Phifer RoadKings MountainNC06558,2838690(210)6578,9409,5972,2826/23/201119981001 Phifer RoadKings MountainNC6558,2831,875(497)6579,65910,3163,0296/23/20111998
128 Brawley School Road128 Brawley School RoadMooresvilleNC05957,3051,2500(151)6018,3988,9992,1296/23/20111999128 Brawley School RoadMooresvilleNC5957,3051,766(467)6138,5869,1992,7216/23/20111999
1309 , 1321, & 1325 McCarthy Boulevard1309 , 1321, & 1325 McCarthy BoulevardNew BernNC01,24520,8981,0730(159)1,24521,81223,0575,3516/20/20112001/2005/20081309 , 1321, & 1325 McCarthy BoulevardNew BernNC1,24520,8983,309(507)1,24523,70024,9457,5546/20/20112001/2005/2008
13150 & 13180 Dorman Road13150 & 13180 Dorman RoadPinevilleNC01,18022,8001,959001,18024,75925,9397,59011/17/2009199813150 & 13180 Dorman RoadPinevilleNC1,18022,8004,440(1,338)1,18025,90227,0829,00811/17/20091998
801 Dixie Trail801 Dixie TrailRaleighNC3,23317,7882,558(1,114)3,23619,22922,4653,8676/29/20161992
2744 South 17th Street2744 South 17th StreetWilmingtonNC1,13414,7712,301(1,290)1,13915,77716,9163,4944/18/20161998
S-7

Table of Contents
DIVERSIFIED HEALTHCARE TRUST
SCHEDULE III
REAL ESTATE AND ACCUMULATED DEPRECIATION
DECEMBER 31, 20202023
(dollars in thousands)
 Initial Cost to Company Cost at December 31, 2020   Initial Cost to Company Cost at December 31, 2023 
AddressAddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
AddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
801 Dixie TrailRaleighNC03,23317,7885160(1,114)3,23617,18720,4232,0136/29/20161992
2744 South 17th StreetWilmingtonNC01,13414,7711,306001,13916,07217,2112,9034/18/20161998
1730 Parkwood Boulevard West1730 Parkwood Boulevard WestWilsonNC061014,7878450(163)61015,46916,0793,8006/20/20112004/20061730 Parkwood Boulevard WestWilsonNC61014,7872,763(465)61017,08517,6955,2256/20/20112004/2006
17007 Elm PlazaOmahaNE04,68022,0220004,68022,02226,7026,8138/21/20082007
17007 Elm Plaza (5)
17007 Elm Plaza (5)
OmahaNE4,68022,0224,68022,02226,7028,4648/21/20082007
3030 South 80th Street3030 South 80th StreetOmahaNE06505,8501,5300(419)6506,9617,6112,4836/3/200519923030 South 80th StreetOmahaNE6505,8502,580(419)6508,0118,6613,3496/3/20051992
490 Cooper Landing Road490 Cooper Landing RoadCherry HillNJ01,0018,1753,307(6,080)(4,163)2,24002,240012/29/20031999490 Cooper Landing RoadCherry HillNJ1,0018,1753,344(6,080)(4,163)2,240372,27712/29/20031999
1400 Route 701400 Route 70LakewoodNJ04,88528,8036,1730(2,611)4,90532,34537,25014,0241/11/200219871400 Route 70LakewoodNJ4,88528,80320,018(2,965)4,90545,83650,74118,5071/11/20021987
2 Hillside Drive2 Hillside DriveMt. ArlingtonNJ01,37511,2321,2490(399)1,39312,06413,4575,02312/29/200320012 Hillside DriveMt. ArlingtonNJ1,37511,2322,786(471)1,39313,52914,9226,30112/29/20032001
655 Pomander Walk655 Pomander WalkTeaneckNJ04,95044,5505,5340(1,628)4,98448,42253,40612,17712/15/20111989655 Pomander WalkTeaneckNJ4,95044,55017,236(3,897)4,98457,85562,83914,80312/15/20111989
10500 Academy Road NE10500 Academy Road NEAlbuquerqueNM03,82822,5728,4870(2,166)3,82828,89332,72112,0751/11/2002198610500 Academy Road NEAlbuquerqueNM3,82822,57210,440(2,603)3,82830,40934,23714,8041/11/20021986
4100 Prospect Avenue NEAlbuquerqueNM054010,10580054010,11310,6533,33910/30/20071977
4300 Landau Street NEAlbuquerqueNM01,0609,8758001,0609,88310,9433,26310/30/20071973
4411 The 25 WayAlbuquerqueNM03,48025,2454,5820(572)3,93128,80432,7357,80612/22/20101970
4420 The 25 WayAlbuquerqueNM01,4302,6099740(152)1,6143,2474,86174912/22/20101970
9190 Coors Boulevard NWAlbuquerqueNM01,6609,1738001,6609,18110,8413,03110/30/20071983
4100 Prospect Avenue NE (5)
4100 Prospect Avenue NE (5)
AlbuquerqueNM54010,105854010,11310,6534,09610/30/20071977
4300 Landau Street NE (5)
4300 Landau Street NE (5)
AlbuquerqueNM1,0609,87581,0609,88310,9434,00310/30/20071973
4411 The 25 Way (5)
4411 The 25 Way (5)
AlbuquerqueNM3,48025,2456,864(1,980)4,10329,50633,6099,38412/22/20101970
4420 The 25 Way (5)
4420 The 25 Way (5)
AlbuquerqueNM1,4302,6091,519(152)1,7113,6955,4061,16612/22/20101970
9190 Coors Boulevard NW (5)
9190 Coors Boulevard NW (5)
AlbuquerqueNM1,6609,17381,6609,18110,8413,71910/30/20071983
2200 East Long Street2200 East Long StreetCarson CityNV062217,9004740062218,37418,9963,0405/1/201520092200 East Long StreetCarson CityNV62217,9001,517(213)62219,20419,8264,7535/1/20152009
3201 Plumas Street3201 Plumas StreetRenoNV02,42049,5807,0880(1,004)2,42055,66458,08412,85912/15/201119893201 Plumas StreetRenoNV2,42049,58010,179(1,648)2,42058,11160,53117,18812/15/20111989
6300 Eighth AvenueBrooklynNY03,8708,545211003,8708,75612,6262,6498/8/20081971
4939 Brittonfield ParkwayEast SyracuseNY072017,0841,673(2,826)(5,312)90010,43911,3392429/30/20082001
5008 Brittonfield ParkwayEast SyracuseNY042018,4071,637(3,144)(5,393)58611,34111,9272387/9/20081999
4939 Brittonfield Parkway (5)
4939 Brittonfield Parkway (5)
East SyracuseNY72017,0842,256(2,826)(5,312)1,00410,91811,9221,7829/30/20082001
5008 Brittonfield Parkway (5)
5008 Brittonfield Parkway (5)
East SyracuseNY42018,4072,080(3,144)(5,393)58611,78412,3701,6517/9/20081999
200 Old County Road200 Old County RoadMineolaNY04,92024,05614,6330(153)4,92038,53643,4568,4419/30/20111971200 Old County RoadMineolaNY4,92024,05617,255(851)4,92040,46045,38012,8149/30/20111971
15 North BroadwayWhite PlainsNY04,90013,5944,720004,90018,31423,2144,4131/26/20091952
537 Riverdale Avenue537 Riverdale AvenueYonkersNY08,46090,56111,5830(305)8,465101,834110,29924,1378/31/20122000537 Riverdale AvenueYonkersNY8,46090,56116,695(2,978)8,463104,275112,73831,8888/31/20122000
4590 Knightsbridge Boulevard4590 Knightsbridge BoulevardColumbusOH03,62327,77816,5090(3,568)3,73240,61044,34216,0551/11/200219894590 Knightsbridge BoulevardColumbusOH3,62327,77822,843(4,233)3,73246,27950,01120,3941/11/20021989
3929 Hoover RoadGrove CityOH03323,081871003323,9524,2842,4516/4/19931965
7555 Innovation WayMasonOH01,02512,8830001,02512,88313,9081,36910/6/20162015
3929 Hoover Road (5)
3929 Hoover Road (5)
Grove CityOH3323,0811,0153324,0964,4282,7866/4/19931965
7555 Innovation Way (5)
7555 Innovation Way (5)
MasonOH1,02512,8831,02512,88313,9082,33410/6/20162015
8709 S.E. Causey Avenue8709 S.E. Causey AvenuePortlandOR03,30377,428487(26,073)(9,749)2,20143,19545,3961,4755/1/20151985 / 19918709 S.E. Causey AvenuePortlandOR3,30377,4284,813(26,073)(9,815)2,20147,45549,6566,4985/1/20151985 / 1991
71 Darlington Road71 Darlington RoadBeaver FallsPA01,50013,5008820(879)1,52313,48015,0035,03210/31/2005199771 Darlington RoadBeaver FallsPA1,50013,5002,679(879)1,52315,27716,8006,38110/31/20051997
950 Morgan Highway950 Morgan HighwayClarks SummitPA01,0018,2338500(277)1,0178,7909,8073,60012/29/20032001950 Morgan HighwayClarks SummitPA1,0018,2332,355(277)1,01710,29511,3124,56412/29/20032001
145 Broadlawn DriveElizabethPA06966,304672(4,280)(3,017)3750375010/31/20051986
600 N. Pottstown Pike600 N. Pottstown PikeExtonPA01,0018,2331,7680(308)1,0019,69310,6943,86912/29/20032000600 N. Pottstown PikeExtonPA1,0018,2333,748(395)1,00111,58612,5874,92112/29/20032000
242 Baltimore Pike242 Baltimore PikeGlen MillsPA01,0018,2337140(382)1,0018,5659,5663,60012/29/20032001242 Baltimore PikeGlen MillsPA1,0018,2334,183(382)1,00112,03413,0354,56412/29/20032001
20 Capital DriveHarrisburgPA03979,3330003979,3339,7301,3811/29/20152013
20 Capital Drive (5)
20 Capital Drive (5)
HarrisburgPA3979,333153979,3489,7452,0841/29/20152013
210 Mall Boulevard210 Mall BoulevardKing of PrussiaPA1,5404,7432,7571,9527,0889,0402,8438/8/20081970
5300 Old William Penn Highway (5)
5300 Old William Penn Highway (5)
MurrysvillePA3002,506(272)3002,2342,5341,1652/28/20031998
800 Manor Drive800 Manor DriveNew Britain (Chalfont)PA9798,0523,469(440)98111,07912,0604,81412/29/20031998
7151 Saltsburg Road (5)
7151 Saltsburg Road (5)
Penn HillsPA200904(103)2008011,0014182/28/20031997
5750 Centre Avenue5750 Centre AvenuePittsburghPA3,00011,8285,879(354)3,78816,56520,3536,4816/11/20081991
S-8

Table of Contents
DIVERSIFIED HEALTHCARE TRUST
SCHEDULE III
REAL ESTATE AND ACCUMULATED DEPRECIATION
DECEMBER 31, 20202023
(dollars in thousands)
 Initial Cost to Company Cost at December 31, 2020   Initial Cost to Company Cost at December 31, 2023 
AddressAddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
AddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
210 Mall BoulevardKing of PrussiaPA01,5404,7432,311001,5637,0318,5941,9998/8/20081970
216 Mall BoulevardKing of PrussiaPA08802,8712,211009784,9845,9629941/26/20111970
5300 Old William Penn HighwayMurrysvillePA03002,50600(272)3002,2342,5349982/28/20031998
800 Manor DriveNew Britain (Chalfont)PA09798,0521,2710(361)9818,9609,9413,66712/29/20031998
7151 Saltsburg RoadPenn HillsPA020090400(103)2008011,0013582/28/20031997
5750 Centre AvenuePittsburghPA03,00011,8284,2090(259)3,77815,00018,7784,5366/11/20081991
730 Holiday Drive730 Holiday DrivePittsburghPA02,4806,3955,5120(854)2,71110,82213,5332,42612/22/20101985730 Holiday DrivePittsburghPA2,4806,3956,123(1,445)2,75110,80213,5533,84112/22/20101985
1400 Riggs RoadSouth ParkPA08988,1021,361(5,192)(3,499)1,67001,670010/31/20051995
700 Northampton Street700 Northampton StreetTiffany Court (Kingston)PA05,6821,9950(359)07,3182,83012/29/20031997700 Northampton StreetTiffany Court (Kingston)PA5,6822,764(499)7,9473,53612/29/20031997
5250 Meadowgreen Drive5250 Meadowgreen DriveWhitehallPA01,59914,4013,6250(1,106)1,59916,92018,5195,84610/31/200519875250 Meadowgreen DriveWhitehallPA1,59914,4014,882(1,106)1,59918,17719,7767,65710/31/20051987
1304 McLees Road1304 McLees RoadAndersonSC02953,5095520(253)2953,8084,1031,42811/19/200419991304 McLees RoadAndersonSC2953,5091,961(253)2955,2175,5122,10411/19/20041999
109 Old Salem Road109 Old Salem RoadBeaufortSC1882,2341,714(807)(1,514)1041,7111,81543811/19/20041999
1119 Pick Pocket Plantation Drive1119 Pick Pocket Plantation DriveBeaufortSC1,20010,8101,940(3,927)(3,270)7336,0206,7536816/20/20112005
719 Kershaw Highway719 Kershaw HighwayCamdenSC03223,6971,3400(376)3224,6614,9831,81511/19/20041999719 Kershaw HighwayCamdenSC3223,6972,114(432)3245,3775,7012,50311/19/20041999
2333 Ashley River Road2333 Ashley River RoadCharlestonSC084814,0002,181(7,118)(4,301)3775,2335,6101376/20/201119992333 Ashley River RoadCharlestonSC84814,0003,483(7,118)(4,761)3776,0756,4521,5386/20/20111999
320 Seven Farms Drive320 Seven Farms DriveCharlestonSC01,0926,6051,5200(144)1,0927,9819,0731,8375/29/20121998320 Seven Farms DriveCharlestonSC1,0926,6051,856(333)1,0928,1289,2202,5955/29/20121998
251 Springtree DriveColumbiaSC03001,90500(112)3001,7932,0938012/28/20031998
3 Summit TerraceColumbiaSC06107,900887(6,314)(2,698)3850385011/17/20092002
7909 Parklane RoadColumbiaSC01,5804,5201,4380(314)1,5805,6447,2241,1639/30/20111990
251 Springtree Drive (5)
251 Springtree Drive (5)
ColumbiaSC3001,905(112)3001,7932,0939352/28/20031998
355 Berkmans Lane355 Berkmans LaneGreenvilleSC7007,2402,139(2,593)(2,456)4174,6135,03055011/17/20092002
116 Enterprise Court116 Enterprise CourtGreenwoodSC03102,7908700(213)3103,4473,7571,1926/3/20051999116 Enterprise CourtGreenwoodSC3102,7901,445(213)3104,0224,3321,7086/3/20051999
1901 West Carolina Avenue1901 West Carolina AvenueHartsvilleSC04014,7758800(302)4015,3535,7542,09411/19/200419991901 West Carolina AvenueHartsvilleSC4014,7752,671(302)4017,1447,5452,92811/19/20041999
218 Old Chapin Road218 Old Chapin RoadLexingtonSC03634,3229070(346)3634,8835,2461,88011/19/20041999218 Old Chapin RoadLexingtonSC3634,3221,549(400)3635,4715,8342,53511/19/20041999
491 Highway 17491 Highway 17Little RiverSC07509,0181,1490(103)75010,06410,8142,6946/23/20112000491 Highway 17Little RiverSC7509,0182,746(562)75011,20211,9523,4416/23/20112000
1010 Anna Knapp Boulevard1010 Anna Knapp BoulevardMt. PleasantSC01,7976,1321100(458)1,7975,7847,5816726/29/201619971010 Anna Knapp BoulevardMt. PleasantSC1,7976,132759(3,618)(1,486)8062,7783,5841836/29/20161997
601 Mathis Ferry Road601 Mathis Ferry RoadMt. PleasantSC01,68712,612706(10,794)(2,021)2,19002,19006/29/20161999601 Mathis Ferry RoadMt. PleasantSC1,68712,612706(10,794)(2,021)2,1902,1906/29/20161999
937 Bowman Road937 Bowman RoadMt. PleasantSC03,89831,6137,5570(773)3,90738,38842,2959,4027/1/20121997 / 1983937 Bowman RoadMt. PleasantSC3,89831,6139,928(2,245)3,83039,36443,19412,3137/1/20121997 / 1983
9547 Highway 17 North9547 Highway 17 NorthMyrtle BeachSC5433,20212,360(3,192)(4,437)3338,1438,4761,1371/11/20021980
2306 Riverbank Drive2306 Riverbank DriveOrangeburgSC03033,6078400(358)3034,0894,3921,61911/19/200419992306 Riverbank DriveOrangeburgSC3033,6071,530(358)3034,7795,0822,19111/19/20041999
1920 Ebenezer RoadRock HillSC03001,70500(162)3001,5431,8436892/28/20031998
1920 Ebenezer Road (5)
1920 Ebenezer Road (5)
Rock HillSC3001,705(162)3001,5431,8438052/28/20031998
15855 Wells Highway15855 Wells HighwaySenecaSC03964,7148800(247)3965,3475,7432,10711/19/2004200015855 Wells HighwaySenecaSC3964,7141,629(417)3965,9266,3222,65411/19/20042000
One Southern CourtWest ColumbiaSC05203,831594005574,3884,9451,35012/22/20102000
One Southern Court (5)
One Southern Court (5)
West ColumbiaSC5203,831765(557)5574,0024,5591,26812/22/20102000
6716 Nolensville Road6716 Nolensville RoadBrentwoodTN01,5286,037175001,5286,2127,7401,29211/30/201220106716 Nolensville RoadBrentwoodTN1,5286,0374181,5286,4557,9831,82411/30/20122010
207 Uffelman Drive207 Uffelman DriveClarksvilleTN03202,9941,2730(161)3204,1064,4261,26712/31/20061997207 Uffelman DriveClarksvilleTN3202,9942,368(161)3205,2015,5211,87512/31/20061997
51 Patel Way51 Patel WayClarksvilleTN080010,3226,5420(188)83316,64317,4763,24112/19/2012200551 Patel WayClarksvilleTN80010,3229,261(619)83318,93119,7645,18212/19/20122005
2900 Westside Drive NW2900 Westside Drive NWClevelandTN03053,6271,1150(284)3054,4584,7631,68311/19/200419982900 Westside Drive NWClevelandTN3053,6272,533(284)3055,8766,1812,26311/19/20041998
1010 East Spring Street1010 East Spring StreetCookevilleTN03223,8281,2000(230)3224,7985,1201,78311/19/200419981010 East Spring StreetCookevilleTN3223,8282,226(230)3225,8246,1462,47611/19/20041998
105 Sunrise Circle105 Sunrise CircleFranklinTN3223,8331,588(268)3295,1465,4752,25011/19/20041997
1085 Hartsville Pike1085 Hartsville PikeGallatinTN2803,3272,293(212)2825,4065,6882,15411/19/20041998
2025 Caldwell Drive (5)
2025 Caldwell Drive (5)
GoodlettsvilleTN4003,5078,547(202)40011,85212,2524,3442/28/20031998
1200 North Parkway1200 North ParkwayJacksonTN2953,5062,004(300)2995,2065,5051,94111/19/20041999
550 Deer View Way550 Deer View WayJefferson CityTN9408,0572,546(228)94810,36711,3152,82110/15/20132001
S-9

Table of Contents
DIVERSIFIED HEALTHCARE TRUST
SCHEDULE III
REAL ESTATE AND ACCUMULATED DEPRECIATION
DECEMBER 31, 20202023
(dollars in thousands)
 Initial Cost to Company Cost at December 31, 2020   Initial Cost to Company Cost at December 31, 2023 
AddressAddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
AddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
105 Sunrise CircleFranklinTN03223,8331,1040(268)3294,6624,9911,76611/19/20041997
1085 Hartsville PikeGallatinTN02803,3278060(212)2803,9214,2011,43111/19/20041998
2025 Caldwell DriveGoodlettsvilleTN04003,5078,5470(202)40011,85212,2522,8132/28/20031998
1200 North ParkwayJacksonTN02953,5065130(300)2993,7154,0141,47411/19/20041999
550 Deer View WayJefferson CityTN09408,0571,484009489,53310,4811,90410/15/20132001
10914 Kingston Pike (5)
KnoxvilleTN10,03961312,4102390061312,64913,2621,1436/29/20182008
3020 Heatherton WayKnoxvilleTN03043,6183,199(2,697)(2,357)1,4406272,067611/19/20041998
3030 Holbrook Drive (5)
KnoxvilleTN5,7663527,128255003607,3757,7356746/29/20181999
10914 Kingston Pike10914 Kingston PikeKnoxvilleTN61312,4101,41461313,82414,4372,6736/29/20182008
3030 Holbrook Drive3030 Holbrook DriveKnoxvilleTN3527,1281,9853609,1059,4651,7986/29/20181999
100 Chatuga Drive West100 Chatuga Drive WestLoudonTN058016,09331,1630058047,25647,8362,0181/19/20182003100 Chatuga Drive WestLoudonTN58016,09333,06558049,15849,7385,3061/19/20182003
511 Pearson Springs RoadMaryvilleTN03003,2071000(192)3003,1153,4151,3922/28/20031998
511 Pearson Springs Road (5)
511 Pearson Springs Road (5)
MaryvilleTN3003,207100(192)3003,1153,4151,6252/28/20031998
1710 Magnolia Boulevard1710 Magnolia BoulevardNashvilleTN07506,75013,2580(478)75019,53020,2804,2646/3/200519791710 Magnolia BoulevardNashvilleTN7506,75018,680(1,190)75024,24024,9906,8766/3/20051979
350 Volunteer Drive350 Volunteer DriveParisTN011012,1005180(905)11011,71311,8231,3406/29/20161997350 Volunteer DriveParisTN11012,1002,011(905)11013,20613,3162,4696/29/20161997
971 State Hwy 121AllenTX02,59017,9120002,59017,91220,5025,5418/21/20082006
1111 W. 34th StreetAustinTX040021,0211,9330069422,66023,3546,9696/25/20081975
6818 Austin Center BoulevardAustinTX01,54027,4672,190001,58529,61231,1979,31310/31/20081994
971 State Hwy 121 (5)
971 State Hwy 121 (5)
AllenTX2,59017,9122,59017,91220,5026,8848/21/20082006
6818 Austin Center Boulevard (5)
6818 Austin Center Boulevard (5)
AustinTX1,54027,4674,283(862)1,62030,80832,42811,25410/31/20081994
7600 N Capital Texas Highway7600 N Capital Texas HighwayAustinTX03004,5571,420003005,9776,2771,21412/22/201019967600 N Capital Texas HighwayAustinTX3004,5571,6083006,1656,4651,98012/22/20101996
4620 Bellaire Boulevard4620 Bellaire BoulevardBellaireTX01,23811,0104,4320(165)1,32515,19016,5158,92310/1/201219914620 Bellaire BoulevardBellaireTX1,23811,0107,166(1,011)1,32517,07818,40310,26010/1/20121991
120 Crosspoint Drive120 Crosspoint DriveBoerneTX02204,926598002275,5175,7441,7022/7/20081990120 Crosspoint DriveBoerneTX2204,9261,8732276,7927,0192,4802/7/20081990
4015 Interstate 454015 Interstate 45ConroeTX062014,0741,2700(64)62015,28015,9003,94410/26/201020094015 Interstate 45ConroeTX62014,0742,285(373)62015,98616,6065,14210/26/20102009
5455 La Sierra Drive5455 La Sierra DriveDallasTX02,30025,2007,2590(807)2,32431,62833,9527,50812/15/201119895455 La Sierra DriveDallasTX2,30025,20011,156(1,822)2,32434,51036,83410,83312/15/20111989
7831 Park Lane7831 Park LaneDallasTX04,70927,76822,0730(2,621)5,43246,49751,92916,9591/11/200219907831 Park LaneDallasTX4,70927,76826,448(3,163)5,43250,33055,76222,7341/11/20021990
1575 Belvidere Street1575 Belvidere StreetEl PasoTX02,30113,5675,7450(1,537)2,31617,76020,0766,9321/11/200219871575 Belvidere StreetEl PasoTX2,30113,56710,846(1,779)2,31622,61924,9359,9321/11/20021987
96 Frederick Road96 Frederick RoadFredericksburgTX02804,8666,3070028011,17311,4532,5112/7/2008199996 Frederick RoadFredericksburgTX2804,8666,976(182)28011,66011,9403,5802/7/20081999
6435 S.F.M. 5496435 S.F.M. 549HeathTX01,1357,892827(288)(1,493)1,1086,9658,07313612/31/201220046435 S.F.M. 549HeathTX1,1357,8921,152(288)(1,493)1,1927,2068,3981,09412/31/20122004
13215 Dotson RoadHoustonTX099013,8871,1680099015,05516,0453,4637/17/20122007
13215 Dotson Road (5)
13215 Dotson Road (5)
HoustonTX99013,8872,338(735)99015,49016,4804,4037/17/20122007
777 North Post Oak Road777 North Post Oak RoadHoustonTX05,53732,64724,6580(4,272)5,54053,03058,57019,7391/11/20021989777 North Post Oak RoadHoustonTX5,53732,64736,370(4,749)5,54064,26569,80527,1181/11/20021989
10030 North MacArthur Boulevard10030 North MacArthur BoulevardIrvingTX02,18615,869734002,18616,60318,7892,4141/29/2015199910030 North MacArthur BoulevardIrvingTX2,18615,8693,3192,18619,18821,3743,9121/29/20151999
4770 Regent BoulevardIrvingTX02,83015,0824,467002,83019,54922,3796,0336/25/20081995
9812 Slide RoadLubbockTX01,1109,798335001,11010,13311,2432,6076/4/20102009
9812 Slide Road (5)
9812 Slide Road (5)
LubbockTX1,1109,7986801,11010,47811,5883,4746/4/20102009
605 Gateway Central605 Gateway CentralMarble FallsTX01,4407,1251,2280(34)1,4408,3199,7592,05112/19/20121994 / 2002605 Gateway CentralMarble FallsTX1,4407,1252,319(502)1,4408,94210,3822,71312/19/20121994 / 2002
7150 N. President George Bush TurnpikeNorth GarlandTX01,9818,548778(346)(1,557)1,9417,4639,40415412/31/20122006
7150 N. President George Bush Turnpike (5)
7150 N. President George Bush Turnpike (5)
North GarlandTX1,9818,5481,203(346)(1,616)1,9417,8299,7701,17912/31/20122006
500 Coit Road500 Coit RoadPlanoTX03,46344,84167003,46844,90348,3711,23612/20/20192016500 Coit RoadPlanoTX3,46344,8413243,46845,16048,6284,84412/20/20192016
2265 North Lakeshore DriveRockwallTX04973,5820004973,5824,0795301/29/20152013
2265 North Lakeshore Drive (5)
2265 North Lakeshore Drive (5)
RockwallTX4973,582114973,5934,0907981/29/20152013
18302 Talavera Ridge18302 Talavera RidgeSan AntonioTX6,85530,6301606,85530,79037,6456,8281/29/20152008
21 Spurs Lane21 Spurs LaneSan AntonioTX3,14123,1425,271(68)3,19228,29431,4866,8514/10/20142006
311 West Nottingham Place311 West Nottingham PlaceSan AntonioTX4,28325,25617,068(3,823)4,35938,42542,78418,2831/11/20021989
511 & 575 Knights Cross Drive511 & 575 Knights Cross DriveSan AntonioTX2,30020,4004,573(1,150)2,30623,81726,1238,25711/17/20092003
5055 West Panther Creek Drive5055 West Panther Creek DriveWoodlandsTX3,69421,78212,628(3,490)3,70630,90834,61414,7331/11/20021988
491 Crestwood Drive491 Crestwood DriveCharlottesvilleVA6417,6333,473(732)64610,36911,0154,56911/19/20041998
1005 Elysian Place1005 Elysian PlaceChesapeakeVA2,37023,7053,823(791)2,38126,72629,1078,4766/20/20112006
4027 Martinsburg Pike (5)
4027 Martinsburg Pike (5)
Clear BrookVA3,77521,7683,77521,76825,5434,8531/29/20152013
S-10

Table of Contents
DIVERSIFIED HEALTHCARE TRUST
SCHEDULE III
REAL ESTATE AND ACCUMULATED DEPRECIATION
DECEMBER 31, 20202023
(dollars in thousands)
    Initial Cost to Company Cost at December 31, 2020  
AddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
18302 Talavera RidgeSan AntonioTX06,85530,6305006,85530,63537,4904,5311/29/20152008
21 Spurs Lane (5)
San AntonioTX11,8383,14123,1421,408003,19224,49927,6914,1904/10/20142006
311 West Nottingham PlaceSan AntonioTX04,28325,25612,6320(2,838)4,35934,97439,33314,4751/11/20021989
511 & 575 Knights Cross DriveSan AntonioTX02,30020,4001,221002,30621,61523,9216,88011/17/20092003
5055 West Panther Creek DriveWoodlandsTX03,69421,7826,4790(3,308)3,70624,94128,64710,9901/11/20021988
491 Crestwood DriveCharlottesvilleVA06417,6332,2930(585)6469,3369,9823,48511/19/20041998
1005 Elysian PlaceChesapeakeVA02,37023,7051,6170(153)2,38125,15827,5396,1646/20/20112006
2856 Forehand DriveChesapeakeVA01601,4982,398(1,427)(1,159)1,47001,47005/30/20031987
4027 Martinsburg PikeClear BrookVA03,77521,7680003,77521,76825,5433,2201/29/20152013
4001 Fair Ridge DriveFairfaxVA02,5007,1472,8140(222)2,6469,59312,2392,69212/22/20081990
20 HeartFields LaneFredericksburgVA02878,4801,8100(781)2879,5099,7964,19710/25/20021998
2800 Polo ParkwayMidlothianVA01,10313,1264,1330(757)1,10816,49717,6056,08911/19/20041996
655 Denbigh BoulevardNewport NewsVA05816,9211,9830(438)5848,4639,0473,06111/19/20041998
6160 Kempsville CircleNorfolkVA03,2637,6153,2850(115)3,31310,73514,04893612/22/20171987
6161 Kempsville RoadNorfolkVA01,5309,5312,1600(73)1,53011,61813,1483,40312/22/20081999
6311 Granby StreetNorfolkVA01,92016,5381,8550(188)1,93218,19320,1254,3566/20/20112005
885 Kempsville RoadNorfolkVA01,7808,3542,2980(601)1,78010,05111,8312,9295/20/20091981
531 Wythe Creek RoadPoquosonVA02202,0419410(275)2202,7072,9271,0845/30/20031987
10800 Nuckols Road (5)
Glen AllenVA10,4702,86311,105527002,86311,63214,4959133/28/20182000
3000 Skipwith RoadRichmondVA07328,7171,0390(519)7329,2379,9693,67211/19/20041999
9900 Independence Park DriveRichmondVA03263,16638003263,2043,53085911/22/20112005
9930 Independence Park DriveRichmondVA06044,975249006045,2245,8281,17911/22/20112005
5620 Wesleyan DriveVirginia BeachVA08937,9261,9630(124)8939,76510,6585,9829/1/20121990
440 McLaws CircleWilliamsburgVA01,46617,3405700(1,040)1,46616,87018,3361,8676/29/20161998
21717 30th Drive SEBothellWA03,01212,5820003,01212,58215,5942,4892/14/20131998
21823 30th Drive SEBothellWA02,62712,6570002,62712,65715,2842,5042/14/20132000
516 Kenosia Avenue SouthKentWA01,3008,4583,453001,35811,85313,2112,7327/31/20121971
555 16th AvenueSeattleWA02564,869680(513)2564,4244,6803,00011/1/19931964
3003 West Good Hope RoadGlendaleWI01,50033,7470001,50033,74735,2479,4919/30/20091963
7007 North Range Line RoadGlendaleWI02503,7970002503,7974,0471,0689/30/20091964
215 Washington StreetGraftonWI050010,05800050010,05810,5582,8299/30/20092009
N168W22022 Main StreetJacksonWI01885,962587001926,5456,7371,18812/1/20142005
8351 Sheridan RoadKenoshaWI07507,669334007587,9958,7532,5901/1/20082000
    Initial Cost to Company Cost at December 31, 2023  
AddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
4001 Fair Ridge Drive (5)
FairfaxVA2,5007,1473,769(222)2,64610,54813,1943,98512/22/20081990
20 HeartFields LaneFredericksburgVA2878,4802,661(884)28710,25710,5445,04810/25/20021998
2800 Polo ParkwayMidlothianVA1,10313,1265,611(1,340)1,10817,39218,5007,41011/19/20041996
655 Denbigh BoulevardNewport NewsVA5816,9212,649(553)5849,0149,5983,93911/19/20041998
6160 Kempsville Circle (5)
NorfolkVA3,2637,6154,771(115)3,37412,16015,5342,66012/22/20171987
6161 Kempsville Road (5)
NorfolkVA1,5309,5314,336(686)1,53013,18114,7114,69012/22/20081999
6311 Granby StreetNorfolkVA1,92016,5385,430(595)1,93221,36123,2936,8746/20/20112005
885 Kempsville Road (5)
NorfolkVA1,7808,3543,857(976)2,01411,00113,0153,8935/20/20091981
531 Wythe Creek RoadPoquosonVA2202,0411,671(275)2203,4373,6571,3375/30/20031987
10800 Nuckols Road (7)
Glen AllenVA9,1092,86311,1051,6872,86312,79215,6552,0663/28/20182000
3000 Skipwith RoadRichmondVA7328,7172,253(655)73210,31511,0474,50811/19/20041999
9900 Independence Park DriveRichmondVA3263,166636(226)3263,5763,90298311/22/20112005
9930 Independence Park DriveRichmondVA6044,9751,194(84)7005,9896,6891,82311/22/20112005
5620 Wesleyan DriveVirginia BeachVA8937,9264,409(283)89312,05212,9457,3079/1/20121990
4132 Longhill RoadWilliamsburgVA2702,4681,875(945)(1,583)1621,9232,0852705/30/20031987
440 McLaws CircleWilliamsburgVA1,46617,340859(1,040)1,46617,15918,6253,2986/29/20161998
516 Kenosia Avenue SouthKentWA1,3008,4583,835(304)1,36811,92113,2893,9237/31/20121971
555 16th Avenue (5)
SeattleWA2564,86968(513)2564,4244,6803,33311/1/19931964
3003 West Good Hope Road (5)
GlendaleWI1,50033,7471,50033,74735,24712,0239/30/20091963
7007 North Range Line RoadGlendaleWI2503,7972503,7974,0471,3539/30/20091964
215 Washington Street (5)
GraftonWI50010,05850010,05810,5583,5839/30/20092009
N168W22022 Main StreetJacksonWI1885,9621,383(308)1927,0337,2251,74112/1/20142005
8351 Sheridan RoadKenoshaWI7507,6691,6217589,28210,0403,3281/1/20082000
5601 Burke RoadMadisonWI7007,4612,0867129,53510,2473,4361/1/20082000
7707 N. Brookline DriveMadisonWI2,61535,5454,605(509)2,63139,62542,2569,97812/1/20141999 / 2004
10803 North Port Washington RoadMequonWI8008,3883,922(221)80512,08412,8893,6331/1/20081999
701 East Puetz RoadOak CreekWI65018,3963,331(213)1,37520,78922,1648,3301/1/20082001
W231 N1440 Corporate Court (5)
PewaukeeWI3,90041,1403,90041,14045,04014,6569/30/20091994
8348 & 8400 Washington Avenue (5)
RacineWI1,15022,4361,15022,43623,5867,9939/30/20091986
1221 North 26th Street (5)
SheboyganWI3009753009751,2753489/30/20091987
1222 North 23rd Street (5)
SheboyganWI1204,0141204,0144,1341,4309/30/20091987
2414 Kohler Memorial Drive (5)
SheboyganWI1,40035,1681,40035,16836,56812,5299/30/20091986
S-11

Table of Contents
DIVERSIFIED HEALTHCARE TRUST
SCHEDULE III
REAL ESTATE AND ACCUMULATED DEPRECIATION
DECEMBER 31, 20202023
(dollars in thousands)
    Initial Cost to Company Cost at December 31, 2020  
AddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
5601 Burke RoadMadisonWI07007,461706007128,1558,8672,5021/1/20082000
7707 N. Brookline DriveMadisonWI02,61535,5452,0450(51)2,63137,52340,1546,33012/1/20141999 / 2004
10803 North Port Washington RoadMequonWI08008,3888650(25)8059,22310,0282,9521/1/20081999
701 East Puetz RoadOak CreekWI065018,3962,054001,37519,72521,1006,3321/1/20082001
W231 N1440 Corporate CourtPewaukeeWI03,90041,1400003,90041,14045,04011,5719/30/20091994
8348 & 8400 Washington AvenueRacineWI01,15022,4360001,15022,43623,5866,3109/30/20091986
1221 North 26th StreetSheboyganWI03009750003009751,2752749/30/20091987
1222 North 23rd StreetSheboyganWI01204,0140001204,0144,1341,1299/30/20091987
2414 Kohler Memorial DriveSheboyganWI01,40035,1680001,40035,16836,5689,8919/30/20091986
1125 N Edge TrailVeronaWI01,3659,5811,474001,37211,04812,4202,48511/1/20132001
3289 North Mayfair RoadWauwatosaWI02,3006,2450002,3006,2458,5451,7579/30/20091964
503 South 18th StreetLaramieWY01913,6321,2230(800)2024,0444,2462,54812/30/19931964
1901 Howell AvenueWorlandWY01322,5081,9800(571)1323,9174,0492,14612/30/19931970
Total$692,294$762,616$5,771,138$1,201,831$(114,722)$(210,133)$789,125$6,621,605$7,410,730$1,694,901
15 Properties Held for Sale016,388130,54027,889(29,175)(32,585)13,66299,395113,0578,286
Grand Total$692,294$779,004$5,901,678$1,229,720$(143,897)$(242,718)$802,787$6,721,000$7,523,787$1,703,187
    Initial Cost to Company Cost at December 31, 2023  
AddressCityState
Encumbrances (1)
LandBuildings,
Improvements &
Equipment
Cost
Capitalized
Subsequent to
Acquisition
Impairment
Cost Basis Adjustment (2)
LandBuildings,
Improvements &
Equipment
Total (3)
Accumulated
Depreciation (4)
Date
Acquired
Original
Construction
Date
1125 N Edge TrailVeronaWI1,3659,5812,095(458)1,37211,21112,5833,12611/1/20132001
3289 North Mayfair Road (5)
WauwatosaWI2,3006,2452,3006,2458,5452,2259/30/20091964
503 South 18th StreetLaramieWY1913,6324,623(941)2027,3037,5053,87912/30/19931964
1901 Howell AvenueWorlandWY1322,5085,502(649)1327,3617,4933,17812/30/19931970
Total$13,020$630,902$4,726,568$1,941,514$(124,053)$(356,464)$652,977$6,165,490$6,818,467$2,020,843
Property Held for Sale1,90012,8581,943(2,790)(4,534)1,4647,9139,377
Grand Total$13,020$632,802$4,739,426$1,943,457$(126,843)$(360,998)$654,441$6,173,403$6,827,844$2,020,843
(1)    Represents mortgage debts and finance leases, excluding the unamortized balance of fair value adjustments totaling approximately $721.leases.
(2)    Represents reclassifications between accumulated depreciation and buildings, improvements and equipment made to record certain properties at fair value in accordance with GAAP.
(3)    Aggregate cost for federal income tax purposes is approximately $8,600,531.$7,189,441.
(4)    We depreciate buildings and improvements over periods ranging up to 40 years and equipment over periods ranging up to 12 years.
(5)    These properties are collateral for our $684,483 of mortgage debts. Includes mortgage debts for our life science property we own in a joint venture arrangement in which we own a 55% equity interest. The amounts listed in the table for these mortgages have not been adjusted to reflect the equity interests in the joint venture that we do not own.$940,534 senior secured notes due 2026.
(6)    These properties are subject to our $7,811$3,911 of finance leases.leases.
(7)    These properties are collateral for our $9,109 of mortgage notes.


S-12

Table of Contents
DIVERSIFIED HEALTHCARE TRUST
SCHEDULE III
REAL ESTATE AND ACCUMULATED DEPRECIATION
DECEMBER 31, 20202023
(dollars in thousands)
Analysis of the carrying amount of real estate and equipment and accumulated depreciation during the period:
Real Estate and
Equipment
Accumulated
Depreciation
Real Estate and
Equipment
Accumulated
Depreciation
Balance as of December 31, 2017$7,824,763 $1,454,477 
Balance as of December 31, 2020
AdditionsAdditions242,270 205,117 
DisposalsDisposals(17,923)(1,101)
ImpairmentImpairment(46,797)
Cost basis adjustment (1)
Cost basis adjustment (1)
(122,711)(122,711)
Reclassification of assets held for sale, netReclassification of assets held for sale, net(3,302)(1,390)
Balance as of December 31, 20187,876,300 1,534,392 
Balance as of December 31, 2021
Additions
Disposals
Cost basis adjustment (1)
Cost basis adjustment (1)
Cost basis adjustment (1)
Reclassification of assets held for sale, net
Balance as of December 31, 2022
AdditionsAdditions277,350 221,165 
DisposalsDisposals(250,996)(54,816)
ImpairmentImpairment(114,786)
Cost basis adjustment (1)
Cost basis adjustment (1)
(77,642)(77,642)
Reclassification of assets held for sale, netReclassification of assets held for sale, net(248,640)(52,298)
Balance as of December 31, 20197,461,586 1,570,801 
Additions192,124 216,418 
Disposals(145,430)(10,228)
Impairment(106,972)
Cost basis adjustment (1)
(126,127)(126,127)
Reclassification of assets held for sale, net135,549 44,037 
Balance as of December 31, 2020$7,410,730 $1,694,901 
Balance as of December 31, 2023
(1)    Represents reclassifications between accumulated depreciation and buildings, improvements and equipment made to record certain properties at fair value in accordance with GAAP.

S-13

Table of Contents
SIGNATURES
Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.
 DIVERSIFIED HEALTHCARE TRUST
   
 By:  /s/ Jennifer F. (Francis) MintzerChristopher J. Bilotto
 
Jennifer F. (Francis) MintzerChristopher J. Bilotto
President and Chief OperatingExecutive Officer
 Dated: February 25, 202126, 2024
Pursuant to the requirements of the Securities Exchange Act of 1934, this report has been signed below by the following persons on behalf of the registrant and in the capacities and on the dates indicated.
SignatureTitleDate
/s/ Jennifer F. (Francis) MintzerChristopher J. BilottoPresident and Chief OperatingExecutive OfficerFebruary 25, 202126, 2024
Jennifer F. (Francis) MintzerChristopher J. Bilotto
   
/s/ Richard W. Siedel, Jr.Matthew C. BrownChief Financial Officer and Treasurer
(principal financial and accounting officer)
February 25, 202126, 2024
Richard W. Siedel, Jr.Matthew C. Brown
   
/s/ Jennifer B. ClarkF. FrancisManaging TrusteeFebruary 25, 202126, 2024
Jennifer B. ClarkF. Francis
/s/ John L. HarringtonIndependent TrusteeFebruary 25, 202126, 2024
John L. Harrington
  
/s/ Phyllis M. HollisIndependent TrusteeFebruary 26, 2024
Phyllis M. Hollis
/s/ Lisa Harris JonesIndependent TrusteeFebruary 25, 202126, 2024
Lisa Harris Jones
/s/ Daniel F. LePageIndependent TrusteeFebruary 25, 2021
Daniel F. LePage
/s/ Adam D. PortnoyManaging TrusteeFebruary 25, 202126, 2024
Adam D. Portnoy
   
/s/ Jeffrey P. SomersIndependent TrusteeFebruary 25, 202126, 2024
Jeffrey P. Somers
S-14