Table of Contents
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-Q

(Mark One)
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended SeptemberJune 30, 20222023
or
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the transition period from                    to                     
Commission File Number: 000-55775
AMERICAN HEALTHCARE REIT, INC.
(Exact name of registrant as specified in its charter)
Maryland 47-2887436
(State or other jurisdiction of
incorporation or organization)
 (I.R.S. Employer
Identification No.)
18191 Von Karman Avenue, Suite 300
Irvine, California
 92612
(Address of principal executive offices) (Zip Code)

(949) 270-9200
(Registrant’s telephone number, including area code)

Not Applicable
(Former name, former address and former fiscal year, if changed since last report)
Securities registered pursuant to Section 12(b) of the Act:
Title of each classTrading Symbol(s)Name of each exchange on which registered
NoneNoneNone
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Sections 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    ☐  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 (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).    ☒  Yes    ☐  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 filerAccelerated filer
Non-accelerated filerSmaller reporting company
Emerging 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 is a shell company (as defined in Rule 12b-2 of the Exchange Act). ☐  Yes   ☒  No
As of NovemberAugust 11, 2022,2023, there were 78,140,36219,562,539 shares of Class T common stock and 186,704,08846,673,320 shares of Class I common stock of American Healthcare REIT, Inc. outstanding.


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AMERICAN HEALTHCARE REIT, INC.
(A Maryland Corporation)
TABLE OF CONTENTS
 
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PART I — FINANCIAL INFORMATION
Item 1. Financial Statements.
AMERICAN HEALTHCARE REIT, INC.
CONDENSED CONSOLIDATED BALANCE SHEETS
As of SeptemberJune 30, 20222023 and December 31, 20212022
(In thousands, except share and per share amounts) (Unaudited)
September 30,
2022
December 31,
2021
June 30,
2023
December 31,
2022
ASSETSASSETSASSETS
Real estate investments, netReal estate investments, net$3,526,591,000 $3,514,686,000 Real estate investments, net$3,482,804 $3,581,609 
Debt security investment, netDebt security investment, net82,067,000 79,315,000 Debt security investment, net84,933 83,000 
Cash and cash equivalentsCash and cash equivalents79,421,000 81,597,000 Cash and cash equivalents48,407 65,052 
Restricted cashRestricted cash44,877,000 43,889,000 Restricted cash45,343 46,854 
Accounts and other receivables, netAccounts and other receivables, net136,028,000 122,778,000 Accounts and other receivables, net145,663 137,501 
Identified intangible assets, netIdentified intangible assets, net237,969,000 248,871,000 Identified intangible assets, net210,636 236,283 
GoodwillGoodwill254,888,000 209,898,000 Goodwill234,942 231,611 
Operating lease right-of-use assets, netOperating lease right-of-use assets, net262,489,000 158,157,000 Operating lease right-of-use assets, net264,293 276,342 
Other assets, netOther assets, net134,316,000 121,148,000 Other assets, net149,363 128,446 
Total assetsTotal assets$4,758,646,000 $4,580,339,000 Total assets$4,666,384 $4,786,698 
LIABILITIES, REDEEMABLE NONCONTROLLING INTERESTS AND EQUITYLIABILITIES, REDEEMABLE NONCONTROLLING INTERESTS AND EQUITYLIABILITIES, REDEEMABLE NONCONTROLLING INTERESTS AND EQUITY
Liabilities:Liabilities:Liabilities:
Mortgage loans payable, net(1)Mortgage loans payable, net(1)$1,159,159,000 $1,095,594,000 Mortgage loans payable, net(1)$1,237,565 $1,229,847 
Lines of credit and term loans, net(1)1,292,043,000 1,226,634,000 
Lines of credit and term loan, net(1)Lines of credit and term loan, net(1)1,281,683 1,281,794 
Accounts payable and accrued liabilities(1)Accounts payable and accrued liabilities(1)235,515,000 187,254,000 Accounts payable and accrued liabilities(1)223,561 243,831 
Accounts payable due to affiliates(1)— 866,000 
Identified intangible liabilities, netIdentified intangible liabilities, net11,249,000 12,715,000 Identified intangible liabilities, net9,995 10,837 
Financing obligations(1)Financing obligations(1)20,827,000 33,653,000 Financing obligations(1)47,013 48,406 
Operating lease liabilities(1)Operating lease liabilities(1)260,380,000 145,485,000 Operating lease liabilities(1)262,718 273,075 
Security deposits, prepaid rent and other liabilities(1)Security deposits, prepaid rent and other liabilities(1)54,098,000 48,567,000 Security deposits, prepaid rent and other liabilities(1)47,574 49,545 
Total liabilitiesTotal liabilities3,033,271,000 2,750,768,000 Total liabilities3,110,109 3,137,335 
Commitments and contingencies (Note 12)
Commitments and contingencies (Note 10)Commitments and contingencies (Note 10)
Redeemable noncontrolling interests (Note 13)85,869,000 72,725,000 
Redeemable noncontrolling interests (Note 11)Redeemable noncontrolling interests (Note 11)59,873 81,598 
Equity:Equity:Equity:
Stockholders’ equity:Stockholders’ equity:Stockholders’ equity:
Preferred stock, $0.01 par value per share; 200,000,000 shares authorized; none issued and outstandingPreferred stock, $0.01 par value per share; 200,000,000 shares authorized; none issued and outstanding— — Preferred stock, $0.01 par value per share; 200,000,000 shares authorized; none issued and outstanding— — 
Class T common stock, $0.01 par value per share; 200,000,000 shares authorized; 77,895,942 and 77,176,406 shares issued and outstanding as of September 30, 2022 and December 31, 2021, respectively770,000 763,000 
Class I common stock, $0.01 par value per share; 800,000,000 shares authorized; 186,275,548 and 185,855,625 shares issued and outstanding as of September 30, 2022 and December 31, 2021, respectively1,863,000 1,859,000 
Class T common stock, $0.01 par value per share; 200,000,000 shares authorized; 19,562,539 and 19,535,095 shares issued and outstanding as of June 30, 2023 and December 31, 2022, respectivelyClass T common stock, $0.01 par value per share; 200,000,000 shares authorized; 19,562,539 and 19,535,095 shares issued and outstanding as of June 30, 2023 and December 31, 2022, respectively194 194 
Class I common stock, $0.01 par value per share; 800,000,000 shares authorized; 46,673,320 and 46,675,367 shares issued and outstanding as of June 30, 2023 and December 31, 2022, respectivelyClass I common stock, $0.01 par value per share; 800,000,000 shares authorized; 46,673,320 and 46,675,367 shares issued and outstanding as of June 30, 2023 and December 31, 2022, respectively467 467 
Additional paid-in capitalAdditional paid-in capital2,532,047,000 2,531,940,000 Additional paid-in capital2,547,135 2,540,424 
Accumulated deficitAccumulated deficit(1,064,270,000)(951,303,000)Accumulated deficit(1,209,578)(1,138,304)
Accumulated other comprehensive lossAccumulated other comprehensive loss(3,130,000)(1,966,000)Accumulated other comprehensive loss(2,444)(2,690)
Total stockholders’ equityTotal stockholders’ equity1,467,280,000 1,581,293,000 Total stockholders’ equity1,335,774 1,400,091 
Noncontrolling interests (Note 14)172,226,000 175,553,000 
Noncontrolling interests (Note 12)Noncontrolling interests (Note 12)160,628 167,674 
Total equityTotal equity1,639,506,000 1,756,846,000 Total equity1,496,402 1,567,765 
Total liabilities, redeemable noncontrolling interests and equityTotal liabilities, redeemable noncontrolling interests and equity$4,758,646,000 $4,580,339,000 Total liabilities, redeemable noncontrolling interests and equity$4,666,384 $4,786,698 

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AMERICAN HEALTHCARE REIT, INC.
CONDENSED CONSOLIDATED BALANCE SHEETS — (Continued)
As of SeptemberJune 30, 20222023 and December 31, 20212022
(In thousands) (Unaudited)
___________
(1)Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of SeptemberJune 30, 20222023 and December 31, 2021.2022. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2022 Credit Facility, as defined in Note 9,8, held by American Healthcare REIT Holdings, LP in the amount of $963,900,000$926,400 and $965,900 as of SeptemberJune 30, 20222023 and the 2018 Credit Facility and 2019 Credit Facility, each as defined in Note 9, held by American Healthcare REIT Holdings, LP in the amount of $441,900,000 and $480,000,000, respectively, as of December 31, 2021,2022, respectively, which werewas guaranteed by American Healthcare REIT, Inc.
The accompanying notes are an integral part of these condensed consolidated financial statements.

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AMERICAN HEALTHCARE REIT, INC.
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS
For the Three and NineSix Months Ended SeptemberJune 30, 20222023 and 20212022
(In thousands, except share and per share amounts) (Unaudited)
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended June 30,Six Months Ended June 30,
20222021202220212023202220232022
Revenues and grant income:Revenues and grant income:Revenues and grant income:
Resident fees and servicesResident fees and services$368,306,000 $286,882,000 $1,013,505,000 $816,260,000 Resident fees and services$410,622 $326,225 $819,252 $645,199 
Real estate revenueReal estate revenue51,323,000 29,668,000 154,371,000 90,333,000 Real estate revenue50,568 51,105 94,164 103,048 
Grant incomeGrant income6,533,000 936,000 22,716,000 10,264,000 Grant income6,381 10,969 6,381 16,183 
Total revenues and grant incomeTotal revenues and grant income426,162,000 317,486,000 1,190,592,000 916,857,000 Total revenues and grant income467,571 388,299 919,797 764,430 
Expenses:Expenses:Expenses:
Property operating expensesProperty operating expenses337,487,000 256,821,000 920,706,000 752,389,000 Property operating expenses372,549 296,059 742,695 583,219 
Rental expensesRental expenses14,850,000 8,188,000 44,800,000 24,362,000 Rental expenses14,653 14,663 29,848 29,950 
General and administrativeGeneral and administrative9,626,000 9,008,000 31,673,000 23,608,000 General and administrative11,774 10,928 24,827 22,047 
Business acquisition expensesBusiness acquisition expenses231,000 3,633,000 2,161,000 7,631,000 Business acquisition expenses888 1,757 1,220 1,930 
Depreciation and amortizationDepreciation and amortization40,422,000 26,334,000 122,704,000 78,414,000 Depreciation and amortization44,701 39,971 89,371 82,282 
Total expensesTotal expenses402,616,000 303,984,000 1,122,044,000 886,404,000 Total expenses444,565 363,378 887,961 719,428 
Other income (expense):Other income (expense):Other income (expense):
Interest expense:Interest expense:Interest expense:
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishments)(27,524,000)(18,885,000)(71,194,000)(57,740,000)
Interest expense (including amortization of deferred financing costs, debt discount/premium and gain/loss on debt extinguishments)Interest expense (including amortization of deferred financing costs, debt discount/premium and gain/loss on debt extinguishments)(40,990)(20,345)(80,001)(43,670)
Gain in fair value of derivative financial instrumentsGain in fair value of derivative financial instruments— 1,860,000 500,000 5,456,000 Gain in fair value of derivative financial instruments4,993 — 4,798 500 
Gain (loss) on dispositions of real estate investments2,113,000 276,000 2,796,000 (101,000)
(Loss) gain on dispositions of real estate investments(Loss) gain on dispositions of real estate investments(2,072)(73)(2,204)683 
Impairment of real estate investmentsImpairment of real estate investments(21,851,000)— (39,191,000)(3,335,000)Impairment of real estate investments— (17,340)— (17,340)
(Loss) income from unconsolidated entities
(344,000)384,000 1,680,000 (2,288,000)
(Loss) income from unconsolidated entities(Loss) income from unconsolidated entities(113)638 (419)2,024 
Gain on re-measurement of previously held equity interestGain on re-measurement of previously held equity interest19,567,000 — 19,567,000 — Gain on re-measurement of previously held equity interest— — 726 — 
Foreign currency loss
(3,695,000)(1,394,000)(8,689,000)(741,000)
Foreign currency gain (loss)Foreign currency gain (loss)1,068 (3,607)2,076 (4,994)
Other incomeOther income670,000 348,000 2,399,000 811,000 Other income2,589 469 4,197 1,729 
Total net other expenseTotal net other expense(31,064,000)(17,411,000)(92,132,000)(57,938,000)Total net other expense(34,525)(40,258)(70,827)(61,068)
Loss before income taxesLoss before income taxes(7,518,000)(3,909,000)(23,584,000)(27,485,000)Loss before income taxes(11,519)(15,337)(38,991)(16,066)
Income tax expense
Income tax expense
(126,000)(127,000)(499,000)(785,000)Income tax expense(348)(205)(491)(373)
Net lossNet loss(7,644,000)(4,036,000)(24,083,000)(28,270,000)Net loss(11,867)(15,542)(39,482)(16,439)
Net (income) loss attributable to noncontrolling interests
(5,861,000)(1,201,000)(9,688,000)3,508,000 
Net loss attributable to controlling interest
$(13,505,000)$(5,237,000)$(33,771,000)$(24,762,000)
Net loss per Class T and Class I common share attributable to controlling interest — basic and diluted
$(0.05)$(0.03)$(0.13)$(0.14)
Net (income) loss attributable to noncontrolling interestsNet (income) loss attributable to noncontrolling interests(316)(1,768)1,427 (3,827)
Net loss attributable to controlling interestNet loss attributable to controlling interest$(12,183)$(17,310)$(38,055)$(20,266)
Net loss per Class T and Class I common share attributable to controlling interest — basic and dilutedNet loss per Class T and Class I common share attributable to controlling interest — basic and diluted$(0.19)$(0.26)$(0.58)$(0.31)
Weighted average number of Class T and Class I common shares outstanding — basic and dilutedWeighted average number of Class T and Class I common shares outstanding — basic and diluted263,279,232 179,641,677 262,940,706 179,632,818 Weighted average number of Class T and Class I common shares outstanding — basic and diluted66,033,345 65,754,423 66,029,779 65,692,159 
Net lossNet loss$(7,644,000)$(4,036,000)$(24,083,000)$(28,270,000)Net loss$(11,867)$(15,542)$(39,482)$(16,439)
Other comprehensive loss:
Other comprehensive income (loss):Other comprehensive income (loss):
Foreign currency translation adjustmentsForeign currency translation adjustments(477,000)(207,000)(1,164,000)(96,000)Foreign currency translation adjustments124 (493)246 (687)
Total other comprehensive loss(477,000)(207,000)(1,164,000)(96,000)
Total other comprehensive income (loss)Total other comprehensive income (loss)124 (493)246 (687)
Comprehensive lossComprehensive loss(8,121,000)(4,243,000)(25,247,000)(28,366,000)Comprehensive loss(11,743)(16,035)(39,236)(17,126)
Comprehensive (income) loss attributable to noncontrolling interests
(5,861,000)(1,201,000)(9,688,000)3,508,000 
Comprehensive (income) loss attributable to noncontrolling interestsComprehensive (income) loss attributable to noncontrolling interests(316)(1,768)1,427 (3,827)
Comprehensive loss attributable to controlling interestComprehensive loss attributable to controlling interest$(13,982,000)$(5,444,000)$(34,935,000)$(24,858,000)Comprehensive loss attributable to controlling interest$(12,059)$(17,803)$(37,809)$(20,953)
The accompanying notes are an integral part of these condensed consolidated financial statements.
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AMERICAN HEALTHCARE REIT, INC.
CONDENSED CONSOLIDATED STATEMENTS OF EQUITY
For the Three and NineSix Months Ended SeptemberJune 30, 20222023 and 20212022
(In thousands, except share and per share amounts) (Unaudited)


Three Months Ended September 30, 2022
Stockholders’ Equity
Class T and Class I
Common Stock
Number
of
Shares
AmountAdditional
Paid-In
Capital
Accumulated
Deficit
Accumulated
Other
Comprehensive
Loss
Total
Stockholders’
Equity
Noncontrolling
Interests
Total Equity
BALANCE — June 30, 2022264,364,596 $2,635,000 $2,541,504,000 $(1,024,328,000)$(2,653,000)$1,517,158,000 $172,602,000 $1,689,760,000 
Issuance of common stock under the DRIP395,174 4,000 3,667,000 — — 3,671,000 — 3,671,000 
Issuance of nonvested restricted common stock19,858 — — — — — — — 
Amortization of nonvested restricted common stock and stock units— — 914,000 — — 914,000 — 914,000 
Stock based compensation— — — — — — 20,000 20,000 
Repurchase of common stock(608,138)(6,000)(5,644,000)— — (5,650,000)— (5,650,000)
Distributions to noncontrolling interests— — — — — — (3,516,000)(3,516,000)
Reclassification of noncontrolling interests to mezzanine equity— — — — — — (20,000)(20,000)
Adjustment to value of redeemable noncontrolling interests— — (8,394,000)— — (8,394,000)(2,367,000)(10,761,000)
Distributions declared ($0.10 per share)— — — (26,437,000)— (26,437,000)— (26,437,000)
Net (loss) income— — — (13,505,000)— (13,505,000)5,507,000 (7,998,000)(1)
Other comprehensive loss— — — — (477,000)(477,000)— (477,000)
BALANCE — September 30, 2022264,171,490 $2,633,000 $2,532,047,000 $(1,064,270,000)$(3,130,000)$1,467,280,000 $172,226,000 $1,639,506,000 


Three Months Ended September 30, 2021
Stockholders’ Equity
Class T and Class I
Common Stock
Number
of
Shares
AmountAdditional
Paid-In
Capital
Accumulated
Deficit
Accumulated
Other
Comprehensive
Loss
Total
Stockholders’
Equity
Noncontrolling
Interests
Total Equity
BALANCE — June 30, 2021179,658,367 $1,798,000 $1,730,002,000 $(886,983,000)$(1,897,000)$842,920,000 $163,551,000 $1,006,471,000 
Amortization of nonvested restricted common stock— — 13,000 — — 13,000 — 13,000 
Distributions to noncontrolling interests— — — — — — (9,005,000)(9,005,000)
Adjustment to value of redeemable noncontrolling interests— — 62,000 — — 62,000 27,000 89,000 
Distributions declared ($0.05 per share)— — — (9,774,000)— (9,774,000)— (9,774,000)
Net (loss) income— — — (5,237,000)— (5,237,000)1,084,000 (4,153,000)(1)
Other comprehensive loss— — — — (207,000)(207,000)— (207,000)
BALANCE — September 30, 2021179,658,367 $1,798,000 $1,730,077,000 $(901,994,000)$(2,104,000)$827,777,000 $155,657,000 $983,434,000 






Three Months Ended June 30, 2023
Stockholders’ Equity
 Class T and Class I
Common Stock
  
Number
of
Shares
AmountAdditional
Paid-In
Capital
Accumulated
Deficit
Accumulated
Other
Comprehensive
Loss
Total
Stockholders’
Equity
Noncontrolling
Interests
Total Equity
BALANCE — March 31, 202366,210,308 $661 $2,546,299 $(1,180,741)$(2,568)$1,363,651 $163,338 $1,526,989 
Issuance of nonvested restricted common stock24,200 — — — — — — — 
Vested restricted stock units(1)4,120 — (72)— — (72)— (72)
Amortization of nonvested restricted common stock and stock units— — 1,564 — — 1,564 — 1,564 
Stock based compensation— — — — — — 20 20 
Repurchase of common stock(2,769)— (87)— — (87)— (87)
Distributions to noncontrolling interests— — — — — — (3,092)(3,092)
Reclassification of noncontrolling interests to mezzanine equity— — — — — — (20)(20)
Adjustment to value of redeemable noncontrolling interests— — (569)— — (569)(52)(621)
Distributions declared ($0.25 per share)— — — (16,654)— (16,654)— (16,654)
Net (loss) income— — — (12,183)— (12,183)434 (11,749)(2)
Other comprehensive income— — — — 124 124 — 124 
BALANCE — June 30, 202366,235,859 $661 $2,547,135 $(1,209,578)$(2,444)$1,335,774 $160,628 $1,496,402 

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AMERICAN HEALTHCARE REIT, INC.
CONDENSED CONSOLIDATED STATEMENTS OF EQUITY — (Continued)
For the Three and NineSix Months Ended SeptemberJune 30, 20222023 and 20212022
(In thousands, except share and per share amounts) (Unaudited)

Nine Months Ended September 30, 2022Three Months Ended June 30, 2022
Stockholders’ EquityStockholders’ Equity
Class T and Class I
Common Stock
  Class T and Class I
Common Stock
Number
of
Shares
AmountAdditional
Paid-In
Capital
Accumulated
Deficit
Accumulated
Other
Comprehensive
Loss
Total
Stockholders’
Equity
Noncontrolling
Interests
Total EquityNumber
of
Shares
AmountAdditional
Paid-In
Capital
Accumulated
Deficit
Accumulated
Other
Comprehensive
Loss
Total
Stockholders’
Equity
Noncontrolling
Interests
Total Equity
BALANCE — December 31, 2021263,032,031 $2,622,000 $2,531,940,000 $(951,303,000)$(1,966,000)$1,581,293,000 $175,553,000 $1,756,846,000 
BALANCE — March 31, 2022BALANCE — March 31, 202265,952,428 $660 $2,538,780 $(980,613)$(2,160)$1,556,667 $174,154 $1,730,821 
Offering costs — common stockOffering costs — common stock— — (2,000)— — (2,000)— (2,000)Offering costs — common stock— — — — — 
Issuance of common stock under the DRIPIssuance of common stock under the DRIP2,820,674 28,000 26,090,000 — — 26,118,000 — 26,118,000 Issuance of common stock under the DRIP299,857 11,140 — — 11,143 — 11,143 
Issuance of nonvested restricted common stockIssuance of nonvested restricted common stock74,758 1,000 (1,000)— — — — — Issuance of nonvested restricted common stock13,725 — — — — — — — 
Amortization of nonvested restricted common stock and stock unitsAmortization of nonvested restricted common stock and stock units— — 2,705,000 — — 2,705,000 — 2,705,000 Amortization of nonvested restricted common stock and stock units— — 980 — — 980 — 980 
Stock based compensationStock based compensation— — — — — — 62,000 62,000 Stock based compensation— — — — — — 21 21 
Repurchase of common stockRepurchase of common stock(1,755,973)(18,000)(16,215,000)— — (16,233,000)— (16,233,000)Repurchase of common stock(174,865)(2)(6,447)— — (6,449)— (6,449)
Distributions to noncontrolling interestsDistributions to noncontrolling interests— — — — — — (10,568,000)(10,568,000)Distributions to noncontrolling interests— — — — — — (3,537)(3,537)
Adjustment to noncontrolling interest in connection with the Merger— — (1,173,000)— — (1,173,000)1,173,000 — 
Reclassification of noncontrolling interests to mezzanine equityReclassification of noncontrolling interests to mezzanine equity— — — — — — (62,000)(62,000)Reclassification of noncontrolling interests to mezzanine equity— — — — — — (21)(21)
Adjustment to value of redeemable noncontrolling interestsAdjustment to value of redeemable noncontrolling interests— — (11,297,000)— — (11,297,000)(3,297,000)(14,594,000)Adjustment to value of redeemable noncontrolling interests— — (976)— — (976)(1)(977)
Distributions declared ($0.30 per share)— — — (79,196,000)— (79,196,000)— (79,196,000)
Distributions declared ($0.40 per share)Distributions declared ($0.40 per share)— — — (26,405)— (26,405)— (26,405)
Net (loss) incomeNet (loss) income— — — (33,771,000)— (33,771,000)9,365,000 (24,406,000)(1)Net (loss) income— — — (17,310)— (17,310)1,986 (15,324)(2)
Other comprehensive lossOther comprehensive loss— — — — (1,164,000)(1,164,000)— (1,164,000)Other comprehensive loss— — — — (493)(493)— (493)
BALANCE — September 30, 2022264,171,490 $2,633,000 $2,532,047,000 $(1,064,270,000)$(3,130,000)$1,467,280,000 $172,226,000 $1,639,506,000 
BALANCE — June 30, 2022BALANCE — June 30, 202266,091,145 $661 $2,543,478 $(1,024,328)$(2,653)$1,517,158 $172,602 $1,689,760 


Nine Months Ended September 30, 2021
Stockholders’ Equity
 Class T and Class I
Common Stock
  
Number
of
Shares
AmountAdditional
Paid-In
Capital
Accumulated
Deficit
Accumulated
Other
Comprehensive
Loss
Total
Stockholders’
Equity
Noncontrolling
Interests
Total Equity
BALANCE — December 31, 2020179,658,367 $1,798,000 $1,730,589,000 $(864,271,000)$(2,008,000)$866,108,000 $168,375,000 $1,034,483,000 
Offering costs — common stock— — (1,000)— — (1,000)— (1,000)
Amortization of nonvested restricted common stock— — 66,000 — — 66,000 — 66,000 
Stock based compensation— — — — — — (14,000)(14,000)
Distributions to noncontrolling interests— — — — — — (9,360,000)(9,360,000)
Adjustment to value of redeemable noncontrolling interests— — (577,000)— — (577,000)(233,000)(810,000)
Distributions declared ($0.07 per share)— — — (12,961,000)— (12,961,000)— (12,961,000)
Net loss— — — (24,762,000)— (24,762,000)(3,111,000)(27,873,000)(1)
Other comprehensive loss— — — — (96,000)(96,000)— (96,000)
BALANCE — September 30, 2021179,658,367 $1,798,000 $1,730,077,000 $(901,994,000)$(2,104,000)$827,777,000 $155,657,000 $983,434,000 
7

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AMERICAN HEALTHCARE REIT, INC.
CONDENSED CONSOLIDATED STATEMENTS OF EQUITY — (Continued)
For the Three and NineSix Months Ended SeptemberJune 30, 20222023 and 20212022
(In thousands, except share and per share amounts) (Unaudited)

Six Months Ended June 30, 2023
Stockholders’ Equity
 Class T and Class I
Common Stock
  
Number
of
Shares
AmountAdditional
Paid-In
Capital
Accumulated
Deficit
Accumulated
Other
Comprehensive
Loss
Total
Stockholders’
Equity
Noncontrolling
Interests
Total Equity
BALANCE — December 31, 202266,210,462 $661 $2,540,424 $(1,138,304)$(2,690)$1,400,091 $167,674 $1,567,765 
Issuance of nonvested restricted common stock26,156 — — — — — — — 
Vested restricted stock units(1)4,120 — (72)— — (72)— (72)
Amortization of nonvested restricted common stock and stock units— — 2,615 — — 2,615 — 2,615 
Stock based compensation— — — — — — 41 41 
Repurchase of common stock(4,879)— (165)— — (165)— (165)
Distributions to noncontrolling interests— — — — — — (6,194)(6,194)
Reclassification of noncontrolling interests to mezzanine equity— — — — — — (41)(41)
Adjustment to value of redeemable noncontrolling interests— — 4,333 — — 4,333 89 4,422 
Distributions declared ($0.50 per share)— — — (33,219)— (33,219)— (33,219)
Net loss— — — (38,055)— (38,055)(941)(38,996)(2)
Other comprehensive income— — — — 246 246 — 246 
BALANCE — June 30, 202366,235,859 $661 $2,547,135 $(1,209,578)$(2,444)$1,335,774 $160,628 $1,496,402 
8

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AMERICAN HEALTHCARE REIT, INC.
CONDENSED CONSOLIDATED STATEMENTS OF EQUITY — (Continued)
For the Three and Six Months Ended June 30, 2023 and 2022
(In thousands, except share and per share amounts) (Unaudited)

Six Months Ended June 30, 2022
Stockholders’ Equity
 Class T and Class I
Common Stock
  
Number
of
Shares
AmountAdditional
Paid-In
Capital
Accumulated
Deficit
Accumulated
Other
Comprehensive
Loss
Total
Stockholders’
Equity
Noncontrolling
Interests
Total Equity
BALANCE — December 31, 202165,758,004 $658 $2,533,904 $(951,303)$(1,966)$1,581,293 $175,553 $1,756,846 
Offering costs — common stock— — (2)— — (2)— (2)
Issuance of common stock under the DRIP606,375 22,441 — — 22,447 — 22,447 
Issuance of nonvested restricted common stock13,725 — — — — — — — 
Amortization of nonvested restricted common stock and stock units— — 1,791 — — 1,791 — 1,791 
Stock based compensation— — — — — — 42 42 
Repurchase of common stock(286,959)(3)(10,580)— — (10,583)— (10,583)
Distributions to noncontrolling interests— — — — — — (7,052)(7,052)
Adjustment to noncontrolling interest in connection with the Merger— — (1,173)— — (1,173)1,173 — 
Reclassification of noncontrolling interests to mezzanine equity— — — — — — (42)(42)
Adjustment to value of redeemable noncontrolling interests— — (2,903)— — (2,903)(930)(3,833)
Distributions declared ($0.80 per share)— — — (52,759)— (52,759)— (52,759)
Net (loss) income— — — (20,266)— (20,266)3,858 (16,408)(2)
Other comprehensive loss— — — — (687)(687)— (687)
BALANCE — June 30, 202266,091,145 $661 $2,543,478 $(1,024,328)$(2,653)$1,517,158 $172,602 $1,689,760 
___________
(1)The amounts are shown net of common stock withheld from issuance to satisfy employee minimum tax withholding requirements in connection with the vesting of restricted stock units. See Note 12, Equity — AHR 2015 Incentive Plan, for further discussion.
(2)For the three months ended SeptemberJune 30, 20222023 and 2021,2022, amounts exclude $354,000$(118) and $117,000,$(218), respectively, of net incomeloss attributable to redeemable noncontrolling interests. For the ninesix months ended SeptemberJune 30, 20222023 and 2021,2022, amounts exclude $323,000$(486) and $(397,000)$(31), respectively, of net income (loss)loss attributable to redeemable noncontrolling interests. See Note 13,11, Redeemable Noncontrolling Interests, for a further discussion.
The accompanying notes are an integral part of these condensed consolidated financial statements.


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AMERICAN HEALTHCARE REIT, INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
For the NineSix Months Ended SeptemberJune 30, 20222023 and 20212022
(In thousands) (Unaudited)
Nine Months Ended September 30,
20222021
CASH FLOWS FROM OPERATING ACTIVITIES
Net loss$(24,083,000)$(28,270,000)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:
Depreciation and amortization122,716,000 78,414,000 
Other amortization21,316,000 17,312,000 
Deferred rent(5,414,000)(1,013,000)
Stock based compensation2,658,000 52,000 
Impairment of real estate investments39,191,000 3,335,000 
(Gain) loss on dispositions of real estate investments(2,796,000)101,000 
(Income) loss from unconsolidated entities(1,680,000)2,288,000 
Gain on re-measurement of previously held equity interest(19,567,000)— 
Foreign currency loss8,427,000 783,000 
Loss on extinguishments of debt5,038,000 2,293,000 
Change in fair value of derivative financial instruments(500,000)(5,456,000)
Other adjustments— 850,000 
Changes in operating assets and liabilities:
Accounts and other receivables(8,051,000)5,529,000 
Other assets(7,688,000)(4,843,000)
Accounts payable and accrued liabilities9,410,000 (27,287,000)
Accounts payable due to affiliates(184,000)(7,075,000)
Operating lease liabilities(15,638,000)(12,130,000)
Security deposits, prepaid rent and other liabilities(9,714,000)(26,376,000)
Net cash provided by (used in) operating activities113,441,000 (1,493,000)
CASH FLOWS FROM INVESTING ACTIVITIES
Acquisitions of real estate investments(75,125,000)(79,854,000)
Developments and capital expenditures(51,358,000)(61,318,000)
Acquisition of previously held equity interest(13,713,000)— 
Proceeds from dispositions of real estate investments25,622,000 4,499,000 
Investments in unconsolidated entities(4,437,000)(650,000)
Issuance of note receivable(3,000,000)— 
Real estate and other deposits(528,000)(257,000)
Net cash used in investing activities(122,539,000)(137,580,000)
CASH FLOWS FROM FINANCING ACTIVITIES
Borrowings under mortgage loans payable89,950,000 292,083,000 
Payments on mortgage loans payable(61,954,000)(30,688,000)
Borrowings under the lines of credit and term loan1,068,400,000 16,600,000 
Payments on the lines of credit and term loan(1,002,100,000)(103,500,000)
Deferred financing costs(5,829,000)(2,455,000)
Debt extinguishment costs(3,222,000)(125,000)
Payments on financing obligations(12,892,000)(10,710,000)
Distributions paid to common stockholders(35,391,000)(12,961,000)
Repurchase of common stock(16,233,000)— 
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AMERICAN HEALTHCARE REIT, INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS — (Continued)
For the Nine Months Ended September 30, 2022 and 2021
(Unaudited)
Nine Months Ended September 30,
20222021
Distributions to noncontrolling interests in total equity$(9,821,000)$(9,356,000)
Contributions from redeemable noncontrolling interests273,000 — 
Distributions to redeemable noncontrolling interests(1,918,000)(550,000)
Repurchase of redeemable noncontrolling interests and stock warrants— (88,000)
Payment of offering costs(666,000)— 
Security deposits(628,000)21,000 
Net cash provided by financing activities7,969,000 138,271,000 
NET CHANGE IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH$(1,129,000)$(802,000)
EFFECT OF FOREIGN CURRENCY TRANSLATION ON CASH, CASH EQUIVALENTS AND RESTRICTED CASH(59,000)(96,000)
CASH, CASH EQUIVALENTS AND RESTRICTED CASH — Beginning of period125,486,000 152,190,000 
CASH, CASH EQUIVALENTS AND RESTRICTED CASH — End of period$124,298,000 $151,292,000 
RECONCILIATION OF CASH, CASH EQUIVALENTS AND RESTRICTED CASH
Beginning of period:
Cash and cash equivalents$81,597,000 $113,212,000 
Restricted cash43,889,000 38,978,000 
Cash, cash equivalents and restricted cash$125,486,000 $152,190,000 
End of period:
Cash and cash equivalents$79,421,000 $109,650,000 
Restricted cash44,877,000 41,642,000 
Cash, cash equivalents and restricted cash$124,298,000 $151,292,000 
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION
Cash paid for:
Interest$60,328,000 $49,895,000 
Income taxes$653,000 $1,037,000 
SUPPLEMENTAL DISCLOSURE OF NONCASH INVESTING AND FINANCING ACTIVITIES
Accrued developments and capital expenditures$25,096,000 $17,262,000 
Capital expenditures from financing obligations$— $1,409,000 
Tenant improvement overage$605,000 $568,000 
Acquisition of real estate investment with financing obligation$— $15,504,000 
Six Months Ended June 30,
20232022
CASH FLOWS FROM OPERATING ACTIVITIES
Net loss$(39,482)$(16,439)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization89,371 82,293 
Other amortization32,647 12,178 
Deferred rent(2,083)(3,542)
Stock based compensation2,656 1,779 
Impairment of real estate investments— 17,340 
Loss (gain) on dispositions of real estate investments2,204 (683)
Loss (income) from unconsolidated entities419 (2,024)
Gain on re-measurement of previously held equity interest(726)— 
Foreign currency (gain) loss(2,125)4,848 
Loss on extinguishments of debt— 4,410 
Change in fair value of derivative financial instruments(4,798)(500)
Changes in operating assets and liabilities:
Accounts and other receivables(9,827)(14,474)
Other assets(4,449)(5,277)
Accounts payable and accrued liabilities(4,662)(5,231)
Accounts payable due to affiliates— (184)
Operating lease liabilities(18,866)(8,617)
Security deposits, prepaid rent and other liabilities3,363 (9,739)
Net cash provided by operating activities43,642 56,138 
CASH FLOWS FROM INVESTING ACTIVITIES
Proceeds from dispositions of real estate investments87,446 14,002 
Developments and capital expenditures(52,074)(35,508)
Acquisitions of real estate investments(12,333)(75,125)
Acquisition of previously held equity interest(335)— 
Investments in unconsolidated entities(12,000)(200)
Real estate and other deposits(1,017)(533)
Net cash provided by (used in) investing activities9,687 (97,364)
CASH FLOWS FROM FINANCING ACTIVITIES
Borrowings under mortgage loans payable61,077 89,712 
Payments on mortgage loans payable(55,127)(40,662)
Borrowings under the lines of credit and term loan199,300 1,009,900 
Payments on the lines of credit and term loan(199,400)(968,900)
Deferred financing costs(1,903)(5,617)
Debt extinguishment costs— (2,790)
Payments on financing and other obligations(7,779)(12,141)
Distributions paid to common stockholders(43,086)(30,247)
Repurchase of common stock(165)(10,583)
Payments to taxing authorities in connection with common stock directly withheld from employees(72)— 
Distributions to noncontrolling interests in total equity(6,612)(7,052)
10

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AMERICAN HEALTHCARE REIT, INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS — (Continued)
For the NineSix Months Ended SeptemberJune 30, 20222023 and 20212022
(In thousands) (Unaudited)
Six Months Ended June 30,
20232022
Contribution from redeemable noncontrolling interestContribution from redeemable noncontrolling interest$— $173 
Distributions to redeemable noncontrolling interestsDistributions to redeemable noncontrolling interests(1,012)(1,405)
Repurchase of redeemable noncontrolling interestsRepurchase of redeemable noncontrolling interests(15,954)— 
Payment of offering costsPayment of offering costs(781)(9)
Security depositsSecurity deposits(61)(455)
Net cash (used in) provided by financing activitiesNet cash (used in) provided by financing activities(71,575)19,924 
NET CHANGE IN CASH, CASH EQUIVALENTS AND RESTRICTED CASHNET CHANGE IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH$(18,246)$(21,302)
EFFECT OF FOREIGN CURRENCY TRANSLATION ON CASH, CASH EQUIVALENTS AND RESTRICTED CASHEFFECT OF FOREIGN CURRENCY TRANSLATION ON CASH, CASH EQUIVALENTS AND RESTRICTED CASH90 (8)
CASH, CASH EQUIVALENTS AND RESTRICTED CASH — Beginning of periodCASH, CASH EQUIVALENTS AND RESTRICTED CASH — Beginning of period111,906 125,486 
CASH, CASH EQUIVALENTS AND RESTRICTED CASH — End of periodCASH, CASH EQUIVALENTS AND RESTRICTED CASH — End of period$93,750 $104,176 
RECONCILIATION OF CASH, CASH EQUIVALENTS AND RESTRICTED CASHRECONCILIATION OF CASH, CASH EQUIVALENTS AND RESTRICTED CASH
Beginning of period:Beginning of period:
Cash and cash equivalentsCash and cash equivalents$65,052 $81,597 
Restricted cashRestricted cash46,854 43,889 
Cash, cash equivalents and restricted cashCash, cash equivalents and restricted cash$111,906 $125,486 
End of period:End of period:
Cash and cash equivalentsCash and cash equivalents$48,407 $59,101 
Restricted cashRestricted cash45,343 45,075 
Cash, cash equivalents and restricted cashCash, cash equivalents and restricted cash$93,750 $104,176 
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATIONSUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION
Cash paid for:Cash paid for:
InterestInterest$76,013 $36,348 
Income taxesIncome taxes$797 $382 
SUPPLEMENTAL DISCLOSURE OF NONCASH INVESTING AND FINANCING ACTIVITIESSUPPLEMENTAL DISCLOSURE OF NONCASH INVESTING AND FINANCING ACTIVITIES
Accrued developments and capital expendituresAccrued developments and capital expenditures$25,664 $14,055 
Tenant improvement overageTenant improvement overage$1,047 $568 
Nine Months Ended September 30,
20222021
Issuance of common stock under the DRIPIssuance of common stock under the DRIP$26,118,000 $— Issuance of common stock under the DRIP$— $22,447 
Distributions declared but not paid — common stockholdersDistributions declared but not paid — common stockholders$26,417,000 $— Distributions declared but not paid — common stockholders$16,559 $8,812 
Distributions declared but not paid — limited partnership unitsDistributions declared but not paid — limited partnership units$1,400,000 $— Distributions declared but not paid — limited partnership units$875 $467 
Distributions declared but not paid — restricted stock unitsDistributions declared but not paid — restricted stock units$54,000 $— Distributions declared but not paid — restricted stock units$123 $37 
Accrued offering costsAccrued offering costs$1,796,000 $— Accrued offering costs$1,023 $— 
Issuance of redeemable noncontrolling interests$— $132,000 
The following represents the net increase (decrease) in certain assets and liabilities in connection with our acquisitions and dispositions of investments:The following represents the net increase (decrease) in certain assets and liabilities in connection with our acquisitions and dispositions of investments:The following represents the net increase (decrease) in certain assets and liabilities in connection with our acquisitions and dispositions of investments:
Accounts and other receivablesAccounts and other receivables$2,410,000 $(153,000)Accounts and other receivables$(1,733)$(262)
Other assets$(10,967,000)$(4,036,000)
Mortgage loan payable$33,241,000 $— 
Other assets, netOther assets, net$(920)$5,480 
Mortgage loan payable, netMortgage loan payable, net$— $(12,059)
Accounts payable and accrued liabilitiesAccounts payable and accrued liabilities$14,828,000 $(160,000)Accounts payable and accrued liabilities$(461)$1,672 
Due to affiliates$— $6,000 
Financing obligationsFinancing obligations$65,000 $— Financing obligations$12 $56 
Security deposits and other liabilities$15,994,000 $— 
Security deposits, prepaid rent and other liabilitiesSecurity deposits, prepaid rent and other liabilities$28 $8,129 
The accompanying notes are an integral part of these condensed consolidated financial statements.
11

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AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited)
For the Three and NineSix Months Ended SeptemberJune 30, 20222023 and 20212022

The use of the words “we,” “us” or “our” refers to Griffin-American Healthcare REIT III, Inc., or GAHR III, and its subsidiaries, including Griffin-American Healthcare REIT III Holdings, LP, for periods prior to the Merger, as defined below, and American Healthcare REIT, Inc. (formerly known as Griffin-American Healthcare REIT IV, Inc., or GAHR IV) and its subsidiaries, including American Healthcare REIT Holdings, LP, (formerly known as Griffin-American Healthcare REIT III Holdings, LP), for periods following the Merger, except where otherwise noted. Certain historical information of GAHR IV is included for background purposes.
1. Organization and Description of Business
Overview and Background
American Healthcare REIT, Inc., a Maryland corporation, is a self-managed real estate investment trust, or REIT, that owns a diversified portfolio of clinical healthcare real estate properties, focusing primarily on medical office buildings, or MOBs, senior housing, skilled nursing facilities, senior housing,or SNFs, hospitals and other healthcare-related facilities. We also operate healthcare-related facilities utilizing the structure permitted by the REIT Investment Diversification and Empowerment Act of 2007, which is commonly referred to as a “RIDEA” structure (the provisions of the Internal Revenue Code of 1986, as amended, or the Code, authorizing the RIDEA structure were enacted as part of the Housing and Economic Recovery Act of 2008). Our healthcare facilities operated under a RIDEA structure include our senior housing operating properties, or SHOP, (formerly known as senior housing — RIDEA), and our integrated senior health campuses. We have originated and acquired secured loans and may also originate and acquire other real estate-related investments on an infrequent and opportunistic basis. We generally seek investments that produce current income; however, we have selectively developed, and may continue to selectively develop, healthcare real estate properties. We qualifiedhave elected to be taxed as a real estate investment trust, or REIT under the Code for U.S. federal income tax purposes,purposes. We believe that we have been organized and operated, and we intend to continue to qualify to be taxedoperate, in conformity with the requirements for qualification and taxation as a REIT.REIT under the Code.
Merger ofOn October 1, 2021, Griffin-American Healthcare REIT III, Inc. and Griffin-American Healthcare REIT IV, Inc.
On October 1, 2021, pursuant to an Agreement and Plan of Merger dated June 23, 2021,, or the Merger Agreement, GAHR III, merged with and into Continental Merger Sub, LLC, a Maryland limited liability company and newly formed wholly owned subsidiary, of GAHR IV, or Merger Sub, of Griffin-American Healthcare REIT IV, Inc., or GAHR IV, with Merger Sub being the surviving company, orwhich we refer to as the REIT Merger. On October 1, 2021, also pursuant to the Merger, Agreement,and our operating partnership, Griffin-American Healthcare REIT IV Holdings, LP, a Delaware limited partnership and subsidiary and operating partnership of GAHR IV, or GAHR IV Operating Partnership, merged with and into Griffin-American Healthcare REIT III Holdings, LP, a Delaware limited partnership, or our operating partnership,the Surviving Partnership, with our operating partnershipthe Surviving Partnership being the surviving entity, or the Partnership Merger. We collectivelywhich we refer to the REIT Merger andas the Partnership Merger asand, together with the REIT Merger, the Merger. Following the Merger on October 1, 2021, our company or the Combined Company, was renamed American Healthcare REIT, Inc. and our operating partnership, also referred to as the surviving partnership,Surviving Partnership was renamed American Healthcare REIT Holdings, LP. The REIT Merger qualified as a reorganization under, and within the meaning of, Section 368(a) of the Code. As a result of and at the effective time of the Merger, the separate corporate existence of GAHR III and GAHR IV Operating Partnership ceased.
At the effective time of the REIT Merger, each issued and outstanding share of GAHR III’s common stock, $0.01 par value per share, converted into the right to receive 0.9266 shares of GAHR IV’s Class I common stock, $0.01 par value per share. At the effective time of the Partnership Merger, (i) each unit of limited partnership interest inLP, or our operating partnership outstanding as of immediately prior to the effective time of the Partnership Merger was converted automatically into the right to receive 0.9266 of a Partnership Class I Unit, as defined in the agreement of limited partnership, as amended, of the surviving partnership and (ii) each unit of limited partnership interest in GAHR IV Operating Partnership outstanding as of immediately prior to the effective time of the Partnership Merger was converted automatically into the right to receive one unit of limited partnership interest of the surviving partnership of like class.
AHI Acquisitionpartnership.
Also on October 1, 2021, immediately prior to the consummation of the Merger, and pursuant to a contribution and exchange agreement dated June 23, 2021, GAHR III acquired a newly formed entity, American Healthcare Opps Holdings, LLC, or NewCo, which we refer to as the AHI Acquisition. Following the Merger and the AHI Acquisition, pursuant to a contribution and exchange agreement dated June 23, 2021, or the Contribution Agreement, between GAHR III;our company became self-managed.
Operating Partnership
We conduct substantially all of our operations through our operating partnership; American Healthcare Investors,partnership and we are the sole general partner of our operating partnership. As of both June 30, 2023 and December 31, 2022, we owned 95.0% of the partnership units, or OP units, in our operating partnership, and the remaining 5.0% limited OP units, were owned by AHI Group Holdings, LLC, or AHI; Griffin Capital Company, LLC, or Griffin Capital; Platform Healthcare Investor T-II, LLC; Flaherty Trust;which is owned and controlled by Jeffrey T. Hanson, our former Chief Executive Officer and currentthe non-executive Chairman of the Boardour board of Directors,directors, or our board, Danny Prosky, our former Chief Operating Officer and current Chief Executive Officer and President, and Mathieu B. Streiff, one of our former Executive Vice President, General Counseldirectors; Platform Healthcare Investor TII, LLC; Flaherty Trust; and Chief Operatinga wholly owned subsidiary of Griffin Capital Company, LLC, or collectively, the NewCo Sellers. See Note 11, Redeemable Noncontrolling Interests, and Note 12, Equity — Noncontrolling Interests in Total Equity, for a further discussion of the ownership in our operating partnership.
Public Offerings
As of June 30, 2023, after taking into consideration the impact of the Merger and the reverse stock split as discussed in Note 2, Summary of Significant Accounting Policies, we had issued 65,445,557 shares for a total of $2,737,716,000 of common stock since February 26, 2014 in our initial public offerings and our distribution reinvestment plan, or DRIP, offerings (includes historical offering amounts sold by GAHR III and GAHR IV prior to the Merger).
On September 16, 2022, we filed with the United States Securities and Exchange Commission, or the SEC, a Registration Statement on Form S-11 (File No. 333-267464), and on July 14, 2023, we filed with the SEC Amendment No. 1 to Registration Statement on Form S-11, with respect to a proposed public offering by us of our shares of common stock in conjunction with a contemplated listing of our common stock on the New York Stock Exchange, or the Proposed Listing. Such registration statement and contemplated listing are not yet effective.
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AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
Officer and current Executive Vice President, or collectively, the AHI Principals. NewCo owned substantially all of the business and operations of AHI, as well as all of the equity interests in (i) Griffin-American Healthcare REIT IV Advisor, LLC, or GAHR IV Advisor, a subsidiary of AHI that served as the external advisor of GAHR IV, and (ii) Griffin-American Healthcare REIT III Advisor, LLC, or GAHR III Advisor, also referred to as our former advisor, a subsidiary of AHI that served as the external advisor of GAHR III. See “Operating Partnership and Former Advisor” below for a further discussion.
Pursuant to the Contribution Agreement, AHI contributed substantially all of its business and operations to the surviving partnership, including its interest in GAHR III Advisor and GAHR IV Advisor, and Griffin Capital contributed its then-current ownership interest in GAHR III Advisor and GAHR IV Advisor to the surviving partnership. In exchange for these contributions, the surviving partnership issued limited partnership units, or surviving partnership OP units. Subject to working capital and other customary adjustments, the total approximate value of these surviving partnership OP units at the time of consummation of the transactions contemplated by the Contribution Agreement was approximately $131,674,000, with a reference value for purposes thereof of $8.71 per unit, such that the surviving partnership issued 15,117,529 surviving partnership OP units as consideration, or the Closing Date Consideration. Following the consummation of the Merger and the AHI Acquisition, the Combined Company became self-managed. Such surviving partnership OP units are owned by AHI Group Holdings, LLC, or AHI Group Holdings, which is owned and controlled by the AHI Principals, Platform Healthcare Investor T-II, LLC, Flaherty Trust and a wholly owned subsidiary of Griffin Capital, or collectively, the NewCo Sellers.
The AHI Acquisition was treated as a business combination for accounting purposes, with GAHR III as both the legal and accounting acquiror of NewCo. While GAHR IV was the legal acquiror of GAHR III in the REIT Merger, GAHR III was determined to be the accounting acquiror in the REIT Merger in accordance with Financial Accounting Standards Board, or FASB, Accounting Standards Codification, or ASC, Topic 805, Business Combinations, after considering the relative share ownership and the composition of the governing body of the Combined Company. Thus, the financial information set forth herein subsequent to the consummation of the Merger and the AHI Acquisition reflects results of the Combined Company, and the financial information set forth herein prior to the Merger and the AHI Acquisition reflects GAHR III’s results. For this reason, period to period comparisons may not be meaningful.
Operating Partnership and Former Advisor
We conduct substantially all of our operations through our operating partnership. Through September 30, 2021, we were externally advised by our former advisor pursuant to an advisory agreement, as amended, or the Advisory Agreement, between us and our former advisor. Our former advisor, subject to the oversight and review of our board of directors, or our board, provided asset management, property management, acquisition, disposition and other advisory services on our behalf consistent with our investment policies and objectives.Following the Merger and the AHI Acquisition, we became self-managed and are no longer externally advised. As a result, any fees that would have otherwise been payable to our former advisor are no longer being paid. Also, on October 1, 2021 and in connection with the AHI Acquisition, our operating partnership redeemed all 22,222 shares of our common stock owned by our former advisor and the 20,833 shares of our Class T common stock owned by GAHR IV Advisor in GAHR IV.
Prior to the Merger and the AHI Acquisition, our former advisor was 75.0% owned and managed by wholly owned subsidiaries of AHI, and 25.0% owned by a wholly owned subsidiary of Griffin Capital, or collectively, our former co-sponsors. Prior to the AHI Acquisition, AHI was 47.1% owned by AHI Group Holdings, 45.1% indirectly owned by DigitalBridge Group, Inc. (NYSE: DBRG), or DigitalBridge, and 7.8% owned by James F. Flaherty III. We were not affiliated with Griffin Capital, DigitalBridge or Mr. Flaherty; however, we were affiliated with our former advisor, AHI and AHI Group Holdings. Please see the “Merger of Griffin-American Healthcare REIT III, Inc. and Griffin-American Healthcare REIT IV, Inc.” and “AHI Acquisition” sections above for a further discussion of our operations effective October 1, 2021. See Note 13, Redeemable Noncontrolling Interests, and Note 14, Equity — Noncontrolling Interests in Total Equity, for a further discussion of the ownership in our operating partnership.
Public Offerings
Prior to the Merger, we raised $1,842,618,000 through a best efforts initial public offering that commenced on February 26, 2014, or the GAHR III initial offering, and issued 184,930,598 shares of our common stock. In addition, during the GAHR III initial offering, we issued 1,948,563 shares of our common stock pursuant to our initial distribution reinvestment plan, or the Initial DRIP, for a total of $18,511,000 in distributions reinvested. Following the deregistration of the GAHR III initial offering on April 22, 2015, we continued issuing shares of our common stock pursuant to subsequent distribution reinvestment plan offerings.
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
On September 16, 2022, we filed with the United States Securities and Exchange Commission, or the SEC, a Registration Statement on Form S-11 (File No. 333-267464), with respect to a proposed primary public offering of our shares of common stock in conjunction with a contemplated listing of our common stock on the New York Stock Exchange. Such registration statement and contemplated listing are not yet effective. The potential public offering is subject to market conditions, and there can be no assurance as to whether, or when, any such offering may be completed, or as to the size, public offering price or other terms of such offering.
See Note 14,12, Equity — Common Stock, and Note 14,12, Equity — Distribution Reinvestment Plan, for a further discussion of our public offerings.
Our Real Estate Investments Portfolio
We currently operate through six reportable business segments: integrated senior health campuses, medical office buildings, skilled nursing facilities,MOBs, SNFs, SHOP, senior housing — leased hospitals and SHOP.hospitals. As of SeptemberJune 30, 2022,2023, we owned and/or operated 312300 buildings and integrated senior health campuses, orincluding completed development and expansion projects, representing approximately 19,432,00019,142,000 square feet of gross leasable area, or GLA, for an aggregate contract purchase price of $4,548,366,000, including the fair value of the properties acquired in the Merger.$4,517,298,000. In addition, as of SeptemberJune 30, 2022,2023, we also owned a real estate-related debt investment purchased for $60,429,000.
COVID-19
Our residents, tenants, operating partners and managers, our industry and the U.S. economy continue to behave been adversely affected by the impact of the COVID-19 pandemic and related supply chain disruptions and labor shortages. Thethe economic impact of the pandemic. While the immediate effects of the COVID-19 pandemic have subsided, the timing and extent of the economic recovery from the COVID-19 pandemictowards pre-pandemic norms is dependent upon many factors, including the emergence and severity of future COVID-19 variants, the continued effectiveness and frequency of booster vaccinations, and the duration and implications of continuedongoing or future restrictions and safety measures.measures, the availability of ongoing government financial support to our tenants, operating partners and managers and the overall pace of economic recovery, among others. As the COVID-19 pandemic is still impacting the healthcare system to a certain extent, it continues to present challenges for us as an owner and operator of healthcare facilities, making it difficultwe expect to ascertaincontinue to be adversely affected by the long-term impacteffects of the COVID-19 pandemic will havefor some period of time; however, it is not possible to predict the full extent of its future impact on real estateus, the operations of our properties or the markets in which we own and/they are located, or operate properties and our portfolio of investments.the overall healthcare industry.
We have evaluated thesuch economic impacts of the COVID-19 pandemic on our business thus far and incorporated information concerning such impacts into our assessments of liquidity, impairment and collectability from tenants and residents as of SeptemberJune 30, 2022.2023. We will continue to monitor such impacts and will adjust our estimates and assumptions based on the best available information.
2. Summary of Significant Accounting Policies
The summary of significant accounting policies presented below is designed to assist in understanding our accompanying condensed consolidated financial statements. Such condensed consolidated financial statements and the accompanying notes thereto are the representations of our management, who are responsible for their integrity and objectivity. These accounting policies conform to accounting principles generally accepted in the United States of America, or GAAP, in all material respects, and have been consistently applied in preparing our accompanying condensed consolidated financial statements.
Basis of Presentation
Our accompanying condensed consolidated financial statements include our accounts and those of our operating partnership, the wholly owned subsidiaries of our operating partnership and all non-wholly owned subsidiaries in which we have control, as well as any VIEs in which we are the primary beneficiary. The portion of equity in any subsidiary that is not wholly owned by us is presented in our accompanying condensed consolidated financial statements as a noncontrolling interest. We evaluate our ability to control an entity, and whether the entity is a VIE and we are the primary beneficiary, by considering substantive terms of the arrangement and identifying which enterprise has the power to direct the activities of the entity that most significantly impacts the entity’s economic performance.
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AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
our common stock and a corresponding reverse split of the OP units, or the Reverse Splits. All numbers of common shares and per share data, as well as the OP units, in our accompanying condensed consolidated financial statements and related notes have been retroactively adjusted for all periods presented to give effect to the Reverse Splits.
We operate and intend to continue to operate in an umbrella partnership REIT structure in which our operating partnership, or wholly owned subsidiaries of our operating partnership and all non-wholly owned subsidiaries of which we have control, will own substantially all of the interests in properties acquired on our behalf. We are the sole general partner of our operating partnership and as of Septemberboth June 30, 20222023 and December 31, 2021,2022, we owned an approximatelya 95.0% and 94.9% general partnership interest therein, respectively, and the remaining 5.0% and 5.1%, respectively,limited partnership interest was owned by the NewCo Sellers. Prior to the Merger on October 1, 2021, we owned greater than a 99.99% general partnership interest in our operating partnership and our former advisor was a limited partner that owned less than a 0.01% noncontrolling limited partnership interest in our operating partnership. On October 1, 2021, in connection with the AHI Acquisition, our operating partnership redeemed our former advisor’s 222 limited partnership units in our operating partnership and the 208 limited partnership units owned by GAHR IV Advisor in GAHR IV Operating Partnership.
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AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
The accounts of our operating partnership are consolidated in our accompanying condensed consolidated financial statements because we are the sole general partner of our operating partnership and have unilateral control over its management and major operating decisions (even if additional limited partners are admitted to our operating partnership). All intercompany accounts and transactions are eliminated in consolidation.
Interim Unaudited Financial Data
Our accompanying condensed consolidated financial statements have been prepared by us in accordance with GAAP in conjunction with the rules and regulations of the SEC. Certain information and footnote disclosures required for annual financial statements have been condensed or excluded pursuant to the SEC’s rules and regulations. Accordingly, our accompanying condensed consolidated financial statements do not include all of the information and footnotes required by GAAP for complete financial statements. Our accompanying condensed consolidated financial statements reflect all adjustments which are, in our view, of a normal recurring nature and necessary for a fair presentation of our financial position, results of operations and cash flows for the interim period. Interim results of operations are not necessarily indicative of the results to be expected for the full year; such full year results may be less favorable.
In preparing our accompanying condensed consolidated financial statements, management has evaluated subsequent events through the financial statement issuance date. We believe that although the disclosures contained herein are adequate to prevent the information presented from being misleading, our accompanying condensed consolidated financial statements should be read in conjunction with our audited consolidated financial statements and the notes thereto included in our 20212022 Annual Report on Form 10-K, as filed with the SEC on March 25, 2022.17, 2023.
Use of Estimates
The preparation of our accompanying condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, as well as the disclosure of contingent assets and liabilities, at the date of our condensed consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates and assumptions include, but are not limited to, the initial and recurring valuation of certain assets acquired and liabilities assumed through property acquisitions, including through business combinations, goodwill and its impairment, revenues and grant income, allowance for credit losses, impairment of long-lived and intangible assets and contingencies. These estimates are made and evaluated on an on-going basis using information that is currently available as well as various other assumptions believed to be reasonable under the circumstances. Actual results could differ from those estimates, perhaps in material adverse ways, and those estimates could be different under different assumptions or conditions.
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AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
Revenue Recognition Resident Fees and Services Revenue
Disaggregation of Resident Fees and Services Revenue
The following tables disaggregate our resident fees and services revenue by line of business, according to whether such revenue is recognized at a point in time or over time:time (in thousands):
Three Months Ended September 30,Three Months Ended June 30,
2022202120232022
Integrated
Senior Health
Campuses
SHOP(1)TotalIntegrated
Senior Health
Campuses
SHOP(1)TotalIntegrated
Senior Health
Campuses
SHOP(1)TotalIntegrated
Senior Health
Campuses
SHOP(1)Total
Over timeOver time$265,705,000 $38,740,000 $304,445,000 $213,823,000 $20,975,000 $234,798,000 Over time$298,628 $46,600 $345,228 $232,839 $37,891 $270,730 
Point in timePoint in time63,046,000 815,000 63,861,000 51,520,000 564,000 52,084,000 Point in time64,228 1,166 65,394 54,743 752 55,495 
Total resident fees and servicesTotal resident fees and services$328,751,000 $39,555,000 $368,306,000 $265,343,000 $21,539,000 $286,882,000 Total resident fees and services$362,856 $47,766 $410,622 $287,582 $38,643 $326,225 
Nine Months Ended September 30,Six Months Ended June 30,
2022202120232022
Integrated
Senior Health
Campuses
SHOP(1)TotalIntegrated
Senior Health
Campuses
SHOP(1)TotalIntegrated
Senior Health
Campuses
SHOP(1)TotalIntegrated
Senior Health
Campuses
SHOP(1)Total
Over timeOver time$729,079,000 $113,848,000 $842,927,000 $606,811,000 $60,473,000 $667,284,000 Over time$597,479 $92,212 $689,691 $463,373 $75,107 $538,480 
Point in timePoint in time168,266,000 2,312,000 170,578,000 147,573,000 1,403,000 148,976,000 Point in time127,147 2,414 129,561 105,221 1,498 106,719 
Total resident fees and servicesTotal resident fees and services$897,345,000 $116,160,000 $1,013,505,000 $754,384,000 $61,876,000 $816,260,000 Total resident fees and services$724,626 $94,626 $819,252 $568,594 $76,605 $645,199 

The following tables disaggregate our resident fees and services revenue by payor class:class (in thousands):
Three Months Ended September 30,Three Months Ended June 30,
2022202120232022
Integrated
Senior Health
Campuses
SHOP(1)TotalIntegrated
Senior Health
Campuses
SHOP(1)TotalIntegrated
Senior Health
Campuses
SHOP(1)TotalIntegrated
Senior Health
Campuses
SHOP(1)Total
Private and other payorsPrivate and other payors$151,296,000 $36,228,000 $187,524,000 $122,467,000 $21,258,000 $143,725,000 Private and other payors$165,154 $44,996 $210,150 $137,419 $35,632 $173,051 
MedicareMedicare112,547,000 — 112,547,000 84,616,000 — 84,616,000 Medicare117,999 — 117,999 93,680 — 93,680 
MedicaidMedicaid64,908,000 3,327,000 68,235,000 58,260,000 281,000 58,541,000 Medicaid79,703 2,770 82,473 56,483 3,011 59,494 
Total resident fees and servicesTotal resident fees and services$328,751,000 $39,555,000 $368,306,000 $265,343,000 $21,539,000 $286,882,000 Total resident fees and services$362,856 $47,766 $410,622 $287,582 $38,643 $326,225 
Nine Months Ended September 30,Six Months Ended June 30,
2022202120232022
Integrated
Senior Health
Campuses
SHOP(1)TotalIntegrated
Senior Health
Campuses
SHOP(1)TotalIntegrated
Senior Health
Campuses
SHOP(1)TotalIntegrated
Senior Health
Campuses
SHOP(1)Total
Private and other payorsPrivate and other payors$420,518,000 $106,897,000 $527,415,000 $341,323,000 $60,934,000 $402,257,000 Private and other payors$334,831 $88,846 $423,677 $269,222 $70,669 $339,891 
MedicareMedicare300,744,000 — 300,744,000 256,784,000 — 256,784,000 Medicare244,466 311 244,777 188,197 — 188,197 
MedicaidMedicaid176,083,000 9,263,000 185,346,000 156,277,000 942,000 157,219,000 Medicaid145,329 5,469 150,798 111,175 5,936 117,111 
Total resident fees and servicesTotal resident fees and services$897,345,000 $116,160,000 $1,013,505,000 $754,384,000 $61,876,000 $816,260,000 Total resident fees and services$724,626 $94,626 $819,252 $568,594 $76,605 $645,199 
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
___________
(1)Includes fees for basic housing, andas well as fees for assisted living or skilled nursing care. We record revenue when services are rendered at amounts billable to individual residents. Residency agreements are generally for a term of 30 days, with resident fees billed monthly in advance. For patients under reimbursement arrangements with Medicaid, revenue is recorded based on contractually agreed-upon amounts or rates on a per resident, daily basis or as services are rendered.
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AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
Accounts Receivable, Net Resident Fees and Services Revenue
The beginning and ending balances of accounts receivable, net resident fees and services are as follows:follows (in thousands):
Private
and
Other Payors
MedicareMedicaidTotal
Beginning balanceJanuary 1, 2022
$42,056,000 $35,953,000 $16,922,000 $94,931,000 
Ending balanceSeptember 30, 2022
51,209,000 45,609,000 23,578,000 120,396,000 
Increase$9,153,000 $9,656,000 $6,656,000 $25,465,000 
Private
and
Other Payors
MedicareMedicaidTotal
Beginning balanceJanuary 1, 2023
$55,484 $45,669 $20,832 $121,985 
Ending balanceJune 30, 2023
58,199 45,477 18,708 122,384 
Increase (decrease)$2,715 $(192)$(2,124)$399 
Deferred Revenue Resident Fees and Services Revenue
Deferred revenue is included in security deposits, prepaid rent and other liabilities in our accompanying condensed consolidated balance sheets. The beginning and ending balances of deferred revenue resident fees and services, almost all of which relates to private and other payors, are as follows:follows (in thousands):
Total
Beginning balanceJanuary 1, 20222023
$14,673,00017,901 
Ending balanceSeptemberJune 30, 20222023
19,001,00022,232 
Increase$4,328,0004,331 
In addition to the deferred revenue above, as of December 31, 2021, we had approximately $12,969,000 remaining in Medicare advance payments that were received during 2020 through an expanded program of the Centers for Medicare & Medicaid Services. Such amounts were included in security deposits, prepaid rent and other liabilities in our accompanying condensed consolidated balance sheet as of December 31, 2021, and were fully applied to Medicare claims and recognized as resident fees and services revenue for the nine months ended September 30, 2022.
Resident and Tenant Receivables and Allowances
Resident receivables, which are related to resident fees and services revenue, are carried net of an allowance for credit losses. An allowance is maintained for estimated losses resulting from the inability of residents and payors to meet the contractual obligations under their lease or service agreements. Substantially all of such allowances are recorded as direct reductions of resident fees and services revenue as contractual adjustments provided to third-party payors or implicit price concessions in our accompanying condensed consolidated statements of operations and comprehensive loss. Our determination of the adequacy of these allowances is based primarily upon evaluations of historical loss experience, the residents’ financial condition, security deposits, cash collection patterns by payor and by state, current economic conditions, future expectations in estimating credit losses and other relevant factors. Tenant receivables, which are related to real estate revenue, and unbilled deferred rent receivables are reduced for uncollectible amounts where collectability is not probable, which are recognized as direct reductions of real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive loss.
As of SeptemberJune 30, 20222023 and December 31, 2021,2022, we had $14,283,000$15,046,000 and $12,378,000,$14,071,000, respectively, in allowances, which were determined necessary to reduce receivables by our expected future credit losses. For the ninesix months ended SeptemberJune 30, 20222023 and 2021,2022, we increased allowances by $16,476,000$9,090,000 and $9,098,000,$9,581,000, respectively, and reduced allowances for collections or adjustments by $5,451,000$3,596,000 and $5,828,000,$3,643,000, respectively. For the ninesix months ended SeptemberJune 30, 2023 and 2022, $4,519,000 and 2021, $9,120,000 and $3,105,000,$3,518,000, respectively, of our receivables were written off against the related allowances.
Accounts Payable and Accrued Liabilities
As of SeptemberJune 30, 20222023 and December 31, 2021,2022, accounts payable and accrued liabilities primarily include insurance reserves of $40,474,000$42,307,000 and $36,440,000,$39,893,000, respectively, reimbursement of payroll-related costs to the managers of our SHOP and integrated senior health campuses of $34,859,000$39,408,000 and $31,101,000, respectively, accrued property taxes of $29,043,000 and $22,102,000,$38,624,000, respectively, accrued developments and capital expenditures to unaffiliated third parties of $25,096,000$25,664,000 and $22,852,000,$30,211,000, respectively, accrued property taxes of $25,415,000 and $24,926,000, respectively, and accrued distributions to common stockholders of $26,417,000$16,559,000 and $8,768,000,$26,484,000, respectively.
Recently Issued Accounting Pronouncements
In July 2021, the FASB issued Accounting Standard Update, or ASU, 2021-05, Leases (Topic 842): Lessors — Certain Leases with Variable Lease Payments, or ASU 2021-05, which amends the lease classification requirements for lessors to align them with practice under the previous lease accounting standard, ASC Topic 840, Leases. Lessors should classify and account for a lease with variable lease payments that do not depend on a reference index or a rate as an operating lease if both of the
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AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
following criteria are met: (1)Recently Issued Accounting Pronouncement
In July 2023, the lease would have been classified as a sales-type leaseFinancial Accounting Standards Board, or a direct financing lease;FASB, issued Accounting Standard Update, or ASU, 2023-03, Presentation of Financial Statements (Topic 205), Income Statement-Reporting Comprehensive Income (Topic 220), Distinguishing Liabilities from Equity (Topic 480), Equity (Topic 505), and (2)Compensation-Stock Compensation (Topic 718): Amendments to SEC Paragraphs Pursuant to SEC Staff Accounting Bulletin No. 120, SEC Staff Announcement at the lessor would have otherwise recognized a day-one loss.March 24, 2022 EITF Meeting, and Staff Accounting Bulletin Topic 6.B, Accounting Series Release 280-General Revision of Regulation S-X: Income or Loss Applicable to Common Stock, or ASU 2021-05 was2023-03. ASU 2023-03 amends the Accounting Standards Codification, or ASC, for SEC updates pursuant to SEC Staff Accounting Bulletin No. 120; SEC Staff Announcement at the March 24, 2022 Emerging Issues Task Force Meeting; and Staff Accounting Bulletin Topic 6.B, Accounting Series Release 280 - General Revision of Regulation S-X: Income or Loss Applicable to Common Stock. These updates were immediately effective for fiscal years beginning after December 15, 2021. Early adoption was permitted. We adopted such accounting pronouncement on January 1, 2022, whichand did not have a material impact toon our consolidated financial statements and disclosures as we have no material sales-type or direct financing leases.
In March 2022, the FASB issued ASU 2022-02, Financial Instruments — Credit Losses (Topic 326): Troubled Debt Restructuring and Vintage Disclosures, or ASU 2022-02, which eliminates certain previously issued accounting guidance for troubled debt restructurings, or TDRs, and enhances disclosure requirements surrounding refinancings, restructurings, and write-offs. Current GAAP provides an exception to general recognition and measurement guidance for loan restructurings if they meet specific criteria to be considered TDRs. If a modification is a TDR, incremental expected losses are recorded in the allowance for credit losses upon modification and specific disclosures are required. The new amendment eliminates the TDR recognition and measurement guidance and requires the reporting entity to evaluate whether the modification represents a new loan or a continuation of an existing loan, consistent with accounting for other loan modifications. The amendment also requires public business entities to disclose current-period gross write-offs by year of origination for certain financing receivables and net investments in leases. For entities that have adopted the previously issued guidance amended by this update, ASU 2016-13, Measurement of Credit Losses on Financial Instruments, which we adopted during the year ended December 31, 2020, this update is effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. Early adoption is permitted for entities that have adopted the previously issued guidance amended by this update. We are currently evaluating this guidance to determine the impact to our condensed consolidated financial statements and disclosures.
3. Real Estate Investments, Net and Business Combinations
Our real estate investments, net consisted of the following as of SeptemberJune 30, 20222023 and December 31, 2021:2022 (in thousands):
September 30,
2022
December 31,
2021
June 30,
2023
December 31,
2022
Building, improvements and construction in processBuilding, improvements and construction in process$3,595,437,000 $3,505,786,000 Building, improvements and construction in process$3,618,097 $3,670,361 
Land and improvementsLand and improvements334,496,000 334,562,000 Land and improvements341,262 344,359 
Furniture, fixtures and equipmentFurniture, fixtures and equipment218,052,000 198,224,000 Furniture, fixtures and equipment235,159 221,727 
4,147,985,000 4,038,572,000 4,194,518 4,236,447 
Less: accumulated depreciationLess: accumulated depreciation(621,394,000)(523,886,000)Less: accumulated depreciation(711,714)(654,838)
$3,526,591,000 $3,514,686,000 $3,482,804 $3,581,609 
Depreciation expense for the three months ended SeptemberJune 30, 2023 and 2022 was $37,139,000 and 2021 was $35,327,000 and $24,769,000,$34,328,000, respectively, and for the ninesix months ended SeptemberJune 30, 2023 and 2022 was $73,038,000 and 2021 was $104,077,000 and $73,622,000,$68,750,000, respectively. For the three months ended SeptemberJune 30, 2022,2023, we incurred capital expenditures of $14,578,000 for our medical office buildings, $9,154,000$18,858,000 for our integrated senior health campuses, $1,867,000$7,268,000 for our MOBs, $2,179,000 for our SHOP and $93,500$245,000 for our hospitals.senior housing — leased. We did not incur any capital expenditures for our properties within our skilled nursing facilitieshospitals and senior housing — leasedSNFs segments for the three months ended SeptemberJune 30, 2022.2023. For the ninesix months ended SeptemberJune 30, 2022,2023, we incurred capital expenditures of $25,932,000$29,059,000 for our integrated senior health campuses, $21,156,000$10,842,000 for our medical office buildings, $4,918,000MOBs, $3,929,000 for our SHOP and $93,500$245,000 for our hospitals.senior housing — leased. We did not incur any capital expenditures for our properties within our skilled nursing facilitieshospitals and senior housing — leasedSNFs segments for the ninesix months ended SeptemberJune 30, 2022.2023.
For both the three and ninesix months ended SeptemberJune 30, 2023, we did not recognize impairment charges on real estate investments. During both the three andsix months ended June 30, 2022, we determined that five and eightfour of our SHOP respectively, were impaired and recognized an aggregate impairment charge of $21,851,000 and $39,191,000, respectively,$17,340,000, which reduced the total carrying value of such eight SHOPassets to $63,154,000 as of September 30, 2022.$19,325,000. The fair value of one of our SHOP was determined by the sales price from an executed purchase and sale agreement with a third-party buyer, which was considered a Level 2 measurement within the fair value hierarchy. The fair value of ourthe remaining seventhree SHOP were based on their projected sales prices, which were considered Level 2 measurements within the fair value hierarchy. We disposed of three of such impaired facilities during the fourth quarter of 2022 and one of such impaired facilities during the first quarter of 2023. See the “Dispositions of Real Estate Investments” section below.
Acquisitions of Real Estate Investments
On February 15, 2023, we, through a majority-owned subsidiary of Trilogy Investors, LLC, or Trilogy, acquired an integrated senior health campus located in Kentucky for a contract purchase price of $11,000,000, plus immaterial closing costs. We did not recognize impairment chargesfinanced such acquisition with cash on real estate investmentshand and a mortgage loan payable placed on the property at the time of acquisition with a principal balance of $7,700,000.
On June 30, 2023, we, through a majority-owned subsidiary of Trilogy, acquired a land parcel in Ohio for a contract purchase price of $660,000, plus closing costs, for the three months ended September 30, 2021. For the nine months ended September 30, 2021, we determined that one medical office building was impaired and recognized an impairment charge of $3,335,000, which reduced the carrying value of such asset to $2,880,000. The fair value of such property was determined based on the contract sales pricefuture expansion of an executed purchase and sale agreement with a third-party buyer, and adjusted for anticipated selling costs, which was considered a Level 2 measurement within the fair value hierarchy. Weexisting integrated senior health campus.
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disposed of such impaired medical office building in July 2021 for a contract sales price of $3,000,000 and recognized a net gain on sale of $346,000.
Acquisitions and Development of Real Estate Investments
Included in the capital expenditure amounts above are costs for the development and expansion of our integrated senior health campuses. For the nine months ended September 30, 2022, we exercised our right to purchase a leased property that cost $15,462,000 to develop and incurred $1,204,000 to expand one of our existing integrated senior health campuses. In addition, for the nine months ended September 30, 2022, we, through a majority-owned subsidiary of Trilogy Investors, LLC, or Trilogy, acquired a land parcel in Indiana for a contract purchase price of $320,000, plus closing costs.
In April and May 2022, we, through a majority-owned subsidiary of Trilogy, of which we own 72.9%, exercised the purchase options to acquire four previously leased real estate investments located in Indiana and Kentucky for an aggregate contract purchase price of $54,805,000, which investments are included in our integrated senior health campuses segment. We financed such acquisitions with cash on hand and a mortgage loan payable with a principal balance of $52,725,000.
We accounted for our acquisitionsacquisition of land and previously leased real estate investmentsinvestment completed during the ninesix months ended SeptemberJune 30, 20222023 as asset acquisitions. We incurred and capitalized direct acquisition related expenses of $292,000. The following table summarizes the purchase price of such assets acquired, adjusted for $37,464,000 operating lease right-of-use assets and $36,326,000 operating lease liabilities, andacquisitions based on their relative fair values:values (in thousands):
20222023
Acquisitions
Building and improvements$49,645,00010,139 
Land and improvements8,173,0001,575 
Total assets acquired$57,818,00011,714 
DispositionDispositions of Real Estate InvestmentInvestments
DuringFor the ninesix months ended SeptemberJune 30, 2022,2023, we disposed of one integrated senior health campus in Indiana for a contract sales price of $12,000,000five SHOP and 11 MOBs. We recognized a gaintotal aggregate net loss on salesuch dispositions of $2,092,000.$1,975,000. The following is a summary of such dispositions (dollars in thousands):
Sale
LocationNumber of
Buildings
TypeDate
Disposed
Contract
Sales Price
Pinellas Park, FL(1)1SHOP02/01/23$7,730 
Olympia Fields, IL1MOB04/10/233,750 
Auburn, CA1MOB04/26/237,050 
Pottsville, PA1MOB04/26/236,000 
New London, CT1MOB05/24/234,200 
Stratford, CT1MOB05/24/234,800 
Westbrook, CT1MOB05/24/237,250 
Lakeland, FL(1)1SHOP06/01/237,080 
Winter Haven, FL(1)1SHOP06/01/2317,500 
Acworth, GA3MOB06/14/238,775 
Lithonia, GA1MOB06/14/233,445 
Stockbridge, GA1MOB06/14/232,430 
Lake Placid, FL(1)1SHOP06/30/235,620 
Brooksville, FL(1)1SHOP06/30/237,800 
Total16$93,430 
___________
(1)See Note 11, Redeemable Noncontrolling Interests, for information about the ownership of Controlling Interests in Real Estate Investmentsthe Central Florida Senior Housing Portfolio.
Business Combinations
On February 8, 2022,15, 2023, we, sold approximately 74.0%through a majority-owned subsidiary of our ownership interestsTrilogy, acquired from an unaffiliated third party, a 60.0% controlling interest in several real estate development assets within oura privately held company, Memory Care Partners, LLC, or MCP, that operated integrated senior health campuses segment for an aggregate saleslocated in Kentucky. The contract purchase price of $19,622,000 and we recognized an aggregate gain on sale of $683,000 for the nine months ended September 30, 2022. At the timeacquisition of sale,MCP was $900,000, which was acquired using cash on hand. Prior to such acquisition, we retained approximately 26.0% ownership interestsowned a 40.0% interest in such real estate development assets. As of September 30, 2022, we own approximately 31.6% ownership interests in such real estate development assets,MCP, which interests arewas accounted for as an equity method investment and was included in investments in unconsolidated entities within other assets, net in our accompanying condensed consolidated balance sheet as of September 30,December 31, 2022. From February 8, 2022 through September 30, 2022,In connection with the acquisition of the remaining interest in MCP, we now own a 100% controlling interest in MCP. As a result, we re-measured the fair value of our interestspreviously held equity interest in the net earnings or lossesMCP and recognized a gain on re-measurement of such unconsolidated entities were included in income or loss from unconsolidated entities$726,000 in our accompanying condensed consolidated statements of operations and comprehensive loss.
4. Business Combinations
On January 3, 2022, we, through a majority-owned subsidiary of Trilogy, acquired an integrated senior health campus in Kentucky from an unaffiliated third party. The contract purchase price for such property acquisition was $27,790,000 plus immaterial closingtransaction costs. We acquired such property using cash on hand and placed a mortgage loan payable of $20,800,000 on the property at the time of acquisition.
On Further, on April 1, 2022, we, through a majority-owned subsidiary of Trilogy, acquired a 50.0% interest in a pharmaceutical business in Florida from an unaffiliated third party and incurred transaction costs of $938,000. Prior to such pharmaceutical business acquisition, we, through a majority-owned subsidiary of Trilogy, owned the other 50.0% interest in such business, which investment was included in investments in unconsolidated entities within other assets, net in our accompanying condensed consolidated balance sheet as of December 31, 2021. Therefore, through March 31, 2022, our 50.0% interest in the net earnings or losses of such unconsolidated entity was included in income or loss from unconsolidated entities in our accompanying condensed consolidated statements of operations and comprehensive loss.
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On August 1, 2022, we, through a majority-owned subsidiarytransaction costs of Trilogy, acquired the 50.0% controlling interest in a privately held company, RHS Partners, LLC, or RHS, that owns and/or operates 16 integrated senior health campuses located in Indiana, from an unaffiliated third party. The contract purchase price for the acquisition of RHS was $36,661,000 plus immaterial closing costs, which was primarily acquired using cash on hand.$938,000. Prior to such pharmaceutical business acquisition, we owned the other 50.0% interest in RHS,such business, which was accounted for as an equity method investment and was included in investments in unconsolidated entities within other assets, net in our accompanying condensed consolidated balance sheet as of December 31, 2021.investment. Therefore, through JulyMarch 31, 2022, our 50.0% equity interest in the net earnings or losses of RHSsuch unconsolidated entity was included in income or loss(loss) from unconsolidated entities in our accompanying condensed consolidated statements of operations and comprehensive loss. In connection with the acquisition of RHS, we re-measured the fair value of our previously held equity interest in RHS and recognized a gain on re-measurement of $19,567,000 in our accompanying condensed consolidated statements of operations and comprehensive loss.
We accounted for the three acquisitions for the nine months ended September 30, 2022 above as business combinations, which are included within our integrated senior health campuses segment. Based on quantitative and qualitative considerations, such business combinations were not material to us individually or in the aggregate and therefore, pro forma financial information is not provided. We did not complete any acquisitions accounted for as business combinations forAny necessary adjustments are finalized within one year from the nine months ended September 30, 2021.
date of acquisition. The table below summarizes the acquisition date fair values of the assets acquired and liabilities assumed of our business combinations during the six months ended June 30, 2023 and 2022 acquisitions accounted for as business combinations. The fair values of the assets acquired and liabilities assumed during 2022 were preliminary estimates. Any necessary adjustments will be finalized within one year from the date of acquisition.(in thousands):
2022
Acquisitions
Operating lease right-of-use assets$153,777,000 
Building and improvements80,533,000 
Goodwill44,990,000 
Accounts receivable, net19,472,000 
In-place leases10,330,000 
Land8,755,000 
Cash and restricted cash9,723,000 
Certificates of need3,567,000 
Furniture, fixtures and equipment1,936,000 
Other assets1,787,000 
Total assets acquired334,870,000 
Operating lease liabilities(161,121,000)
Mortgage loan payable(45,300,000)
Security deposits and other liabilities(15,994,000)
Accounts payable and accrued liabilities(15,060,000)
Financing obligations(65,000)
Total liabilities assumed(237,540,000)
Net assets acquired$97,330,000 
2023
Acquisition
2022
Acquisitions
Building and improvements$— $17,273 
Land— 3,060 
In-place leases— 3,420 
Goodwill3,331 2,816 
Furniture, fixtures and equipment39 1,936 
Cash and restricted cash565 971 
Certificates of need— 690 
Operating lease right-of-use assets— 646 
Other assets66 457 
Accounts receivable, net— 427 
Total assets acquired4,001 31,696 
Security deposits and other liabilities(812)(8,129)
Accounts payable and accrued liabilities(1,676)(1,802)
Operating lease liabilities— (646)
Financing obligations(12)(56)
Total liabilities assumed(2,500)(10,633)
Net assets acquired$1,501 $21,063 
5.4. Debt Security Investment, Net
On October 15, 2015, we acquiredOur investment in a commercial mortgage-backed debt security, or debt security, from an unaffiliated third party. The debt security, bears an interest rate on the stated principal amount thereof equal to 4.24% per annum, the terms of which security provide for monthly interest-only payments. The debt security matures on August 25, 2025 at a stated amount of $93,433,000, resulting in an anticipated yield-to-maturity of 10.0% per annum. The debt security was issued by an unaffiliated mortgage trust and represents a 10.0% beneficial ownership interest in such mortgage trust. The debt security is subordinate to all other interests in the mortgage trust and is not guaranteed by a government-sponsored entity.
As of SeptemberJune 30, 20222023 and December 31, 2021,2022, the carrying amount of the debt security investment was $82,067,000$84,933,000 and $79,315,000,$83,000,000, respectively, net of unamortized closing costs of $830,000$633,000 and $1,004,000,$767,000, respectively. Accretion on the
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debt security for the three months ended SeptemberJune 30, 2023 and 2022 was $1,046,000 and 2021 was $960,000 and $922,000,$986,000, respectively, and for the ninesix months ended SeptemberJune 30, 2023 and 2022 was $2,066,000 and 2021 was $2,926,000 and $2,710,000,$1,966,000, respectively, which is recorded as an increase to real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive loss. Amortization expense of closing costs for the three months ended SeptemberJune 30, 2023 and 2022 was $68,000 and 2021 was $60,000 and $52,000,$58,000, respectively, and for the ninesix months ended SeptemberJune 30, 2023 and 2022 was $133,000 and 2021 was $174,000 and $148,000,$114,000, respectively, which is recorded as a decrease to real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive loss. We evaluated credit quality indicators such as the agency ratings and the underlying collateral of such investment in order to determine expected future credit loss. NoWe did not record a credit loss was recorded for the three and ninesix months ended SeptemberJune 30, 20222023 and 2021.2022.
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5. Intangibles
Identified intangible assets, net and identified intangible liabilities, net consisted of the following as of SeptemberJune 30, 20222023 and December 31, 2021:2022 (dollars in thousands):
September 30,
2022
December 31,
2021
Intangible assets subject to amortization:
In-place leases, net of accumulated amortization of $34,036,000 and $28,120,000 as of September 30, 2022 and December 31, 2021, respectively (with a weighted average remaining life of 7.4 years and 8.2 years as of September 30, 2022 and December 31, 2021, respectively)$74,761,000 $81,538,000 
Above-market leases, net of accumulated amortization of $5,419,000 and $2,082,000 as of September 30, 2022 and December 31, 2021, respectively (with a weighted average remaining life of 9.2 years and 9.7 years as of September 30, 2022 and December 31, 2021, respectively)31,736,000 35,106,000 
Customer relationships, net of accumulated amortization of $747,000 and $635,000 as of September 30, 2022 and December 31, 2021, respectively (with a weighted average remaining life of 13.9 years and 14.7 years as of September 30, 2022 and December 31, 2021, respectively)2,093,000 2,205,000 
Internally developed technology and software, net of accumulated amortization of $399,000 as of December 31, 2021 (with a weighted average remaining life of 0.7 years as of December 31, 2021)— 70,000 
Intangible assets not subject to amortization:
Certificates of need98,592,000 99,165,000 
Trade names30,787,000 30,787,000 
$237,969,000 $248,871,000 
June 30,
2023
December 31,
2022
Amortized intangible assets:
In-place leases, net of accumulated amortization of $46,451 and $38,930 as of June 30, 2023 and December 31, 2022, respectively (with a weighted average remaining life of 7.4 years and 7.0 years as of June 30, 2023 and December 31, 2022, respectively)$59,937 $75,580 
Above-market leases, net of accumulated amortization of $6,503 and $6,360 as of June 30, 2023 and December 31, 2022, respectively (with a weighted average remaining life of 8.2 years and 9.0 years as of June 30, 2023 and December 31, 2022, respectively)20,238 30,194 
Customer relationships, net of accumulated amortization of $859 and $785 as of June 30, 2023 and December 31, 2022, respectively (with a weighted average remaining life of 13.2 years and 13.7 years as of June 30, 2023 and December 31, 2022, respectively)1,981 2,055 
Unamortized intangible assets:
Certificates of need97,693 97,667 
Trade names30,787 30,787 
Total identified intangible assets, net$210,636 $236,283 
Amortized intangible liabilities:
Below-market leases, net of accumulated amortization of $3,169 and $2,508 as of June 30, 2023 and December 31, 2022, respectively (with a weighted average remaining life of 8.1 years and 8.4 years as of June 30, 2023 and December 31, 2022, respectively)$9,995 $10,837 
Total identified intangible liabilities, net$9,995 $10,837 
Amortization expense on identified intangible assets for the three months ended SeptemberJune 30, 2023 and 2022 was $7,711,000 and 2021 was $5,534,000 and $784,000,$6,121,000, respectively, which included $1,113,000$859,000 and $67,000,$1,113,000, respectively, of amortization recorded as a decrease to real estate revenue for above-market leases in our accompanying condensed consolidated statements of operations and comprehensive loss. Amortization expense on identified intangible assets for the ninesix months ended SeptemberJune 30, 2023 and 2022 was $24,782,000 and 2021 was $19,894,000 and $3,481,000,$14,360,000, respectively, which included $3,340,000$9,942,000 and $407,000,$2,227,000, respectively, of amortization recorded as a decrease to real estate revenue for above-market leases in our accompanying condensed consolidated statements of operations and comprehensive loss. On March 1, 2023, we transitioned our SNFs within Central Wisconsin Senior Care Portfolio to a RIDEA structure, which resulted in a full amortization of $8,073,000 of above-market leases and $885,000 of in-place leases.
Amortization expense on below-market leases for the three months ended June 30, 2023 and 2022 was $404,000 and $414,000, respectively, and for the six months ended June 30, 2023 and 2022 was $812,000 and $1,023,000, respectively, which is recorded as an increase to real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive loss.
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The aggregate weighted average remaining life of the identified intangible assets was 7.8 years and 7.7 years as of June 30, 2023 and December 31, 2022, respectively. The aggregate weighted average remaining life of the identified intangible liabilities was 8.1 years and 8.88.4 years as of SeptemberJune 30, 20222023 and December 31, 2021,2022, respectively. As of SeptemberJune 30, 2022,2023, estimated amortization expense on the identified intangible assets and liabilities for the threesix months ending December 31, 20222023 and for each of the next four years ending December 31 and thereafter was as follows:follows (in thousands):
Amortization Expense
YearYearAmountYearIntangible
Assets
Intangible
Liabilities
2022$8,233,000 
2023202321,162,000 2023$12,461 $777 
2024202413,640,000 202412,638 1,470 
2025202511,001,000 20259,838 1,343 
202620269,831,000 20268,683 1,193 
202720278,110 1,158 
ThereafterThereafter44,723,000 Thereafter30,426 4,054 
$108,590,000 
TotalTotal$82,156 $9,995 
7.6. Other Assets, Net
Other assets, net consisted of the following as of SeptemberJune 30, 20222023 and December 31, 2021:2022 (dollars in thousands):
 
September 30,
2022
December 31,
2021
Deferred rent receivables$45,921,000 $41,061,000 
Prepaid expenses, deposits, other assets and deferred tax assets, net33,367,000 22,484,000 
Lease commissions, net of accumulated amortization of $5,938,000 and $4,911,000 as of September 30, 2022 and December 31, 2021, respectively19,032,000 16,120,000 
Inventory18,875,000 18,929,000 
Investments in unconsolidated entities9,431,000 15,615,000 
Deferred financing costs, net of accumulated amortization of $5,011,000 and $8,469,000 as of September 30, 2022 and December 31, 2021, respectively4,795,000 3,781,000 
Lease inducement, net of accumulated amortization of $2,105,000 and $1,842,000 as of September 30, 2022 and December 31, 2021, respectively (with a weighted average remaining life of 8.2 years and 8.9 years as of September 30, 2022 and December 31, 2021, respectively)2,895,000 3,158,000 
$134,316,000 $121,148,000 
 
June 30,
2023
December 31,
2022
Deferred rent receivables$48,508 $46,867 
Prepaid expenses, deposits, other assets and deferred tax assets, net31,121 25,866 
Investments in unconsolidated entities21,306 9,580 
Inventory — finished goods19,289 19,775 
Lease commissions, net of accumulated amortization of $6,646 and $6,260 as of June 30, 2023 and December 31, 2022, respectively18,723 19,217 
Derivative financial instrument4,798 — 
Deferred financing costs, net of accumulated amortization of $7,391 and $5,704 as of June 30, 2023 and December 31, 2022, respectively2,986 4,334 
Lease inducement, net of accumulated amortization of $2,368 and $2,193 as of June 30, 2023 and December 31, 2022, respectively (with a weighted average remaining life of 7.4 years and 7.9 years as of June 30, 2023 and December 31, 2022, respectively)2,632 2,807 
Total$149,363 $128,446 
Deferred financing costs included in other assets, net were related to the 2018 Credit Facility, 2019 Credit Facility, 2019 Trilogy Credit Facility and the senior unsecured revolving credit facility portion of the 2022 Credit Facility. See Note 9,8, Lines of Credit and Term Loans,Loan, for a further discussion. Amortization expense on lease inducement for both the three and six months ended SeptemberJune 30, 2023 and 2022 was $88,000 and 2021 was $87,000, and amortization expense on lease inducement for both the nine months ended September 30, 2022 and 2021 was $263,000,$176,000, respectively, which is recorded as a decrease to real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive loss.
8.7. Mortgage Loans Payable, Net
As of SeptemberJune 30, 20222023 and December 31, 2021,2022, mortgage loans payable were $1,177,244,000$1,260,429,000 ($1,159,159,000,1,237,565,000, net of discount/premium and deferred financing costs) and $1,116,216,000$1,254,479,000 ($1,095,594,000,1,229,847,000, net of discount/premium and deferred financing costs), respectively. As of SeptemberJune 30, 2022,2023, we had 64 fixed-rate mortgage loans payable and 13 variable-rate mortgage loans payable with effective interest rates ranging from 2.21% to 6.52% per annum based on interest rates in effect as of September 30, 2022 and a weighted average effective interest rate of 3.85%. As of December 31, 2021, we had 6671 fixed-rate mortgage loans payable and 12 variable-rate mortgage loans payable with effective interest rates ranging from 2.21% to 5.25%8.01% per annum based on interest rates in effect as of June 30, 2023 and a weighted average effective interest rate of 4.51%. As of December 31, 2022, we had 68 fixed-rate mortgage loans payable and 11 variable-rate mortgage loans payable with effective interest rates ranging from 2.21% to 7.26% per annum based on interest rates in effect as of December 31, 20212022 and a weighted average effective interest rate of 3.21%4.29%. We are required by the terms of certain loan documents to meet certain reporting requirements and covenants, such as net worth ratios, fixed charge coverage ratios and leverage ratios.
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Mortgage loans payable, net consisted of the following as of SeptemberJune 30, 20222023 and December 31, 2021:2022 (in thousands):
September 30,
2022
December 31,
2021
June 30,
2023
December 31,
2022
Total fixed-rate debtTotal fixed-rate debt$805,284,000 $845,504,000 Total fixed-rate debt$929,442 $885,892 
Total variable-rate debtTotal variable-rate debt371,960,000 270,712,000 Total variable-rate debt330,987 368,587 
Total fixed- and variable-rate debtTotal fixed- and variable-rate debt1,177,244,000 1,116,216,000 Total fixed- and variable-rate debt1,260,429 1,254,479 
Less: deferred financing costs, netLess: deferred financing costs, net(8,001,000)(8,680,000)Less: deferred financing costs, net(8,851)(8,845)
Add: premiumAdd: premium267,000 397,000 Add: premium199 237 
Less: discountLess: discount(10,351,000)(12,339,000)Less: discount(14,212)(16,024)
Mortgage loans payable, netMortgage loans payable, net$1,159,159,000 $1,095,594,000 Mortgage loans payable, net$1,237,565 $1,229,847 
The following table reflects the changes in the carrying amount of mortgage loans payable, net for the ninesix months ended SeptemberJune 30, 2023 and 2022 and 2021:(in thousands):
Nine Months Ended September 30,Six Months Ended June 30,
2022202120232022
Beginning balanceBeginning balance$1,095,594,000 $810,478,000 Beginning balance$1,229,847 $1,095,594 
Additions:Additions:Additions:
Borrowings under mortgage loans payableBorrowings under mortgage loans payable156,120,000 393,817,000 Borrowings under mortgage loans payable61,077 155,882 
Assumption of mortgage loans payable45,300,000 — 
Amortization of deferred financing costsAmortization of deferred financing costs1,701,000 3,436,000 Amortization of deferred financing costs1,136 1,191 
Amortization of discount/premium on mortgage loans payable, netAmortization of discount/premium on mortgage loans payable, net1,879,000 606,000 Amortization of discount/premium on mortgage loans payable, net632 1,528 
Deductions:Deductions:Deductions:
Scheduled principal payments on mortgage loans payableScheduled principal payments on mortgage loans payable(53,317,000)(30,688,000)Scheduled principal payments on mortgage loans payable(55,127)(40,662)
Early payoff of mortgage loans payableEarly payoff of mortgage loans payable(78,437,000)(101,734,000)Early payoff of mortgage loans payable— (78,437)
Payoff of a mortgage loan payable due to disposition of real estate investment(8,637,000)— 
Deferred financing costsDeferred financing costs(1,044,000)(2,210,000)Deferred financing costs— (1,037)
Ending balanceEnding balance$1,159,159,000 $1,073,705,000 Ending balance$1,237,565 $1,134,059 
For the three and ninesix months ended SeptemberJune 30, 2023, we did not incur any gain or loss on the early extinguishment of mortgage loans payable. For the three and six months ended June 30, 2022, we incurred an aggregate lossgain (loss) on the early extinguishment of mortgage loans payable of $628,000$181,000 and $1,877,000,$(1,249,000), respectively, which is recorded as an increasedecrease (increase) to interest expense in our accompanying condensed consolidated statements of operations and comprehensive loss. For the three and nine months ended September 30, 2022, suchSuch aggregate net loss on debt extinguishment was primarily related to the payoff of a mortgage loan payable due to the disposition of a real estate investment and the write-off of unamortized loan discount related to eight mortgage loans payable that we refinanced on January 1, 2022 that were due to mature in 2044 through 2052.
For the three and nine months ended September 30, 2021, we incurred an aggregate loss on the extinguishment of mortgage loans payable of $0 and $2,293,000, respectively, which is recorded as an increase to interest expense in our accompanying condensed consolidated statements of operations and comprehensive loss. Such loss was primarily related to the write-off of unamortized deferred financing costs of 10 mortgage loans payable that we refinanced on January 29, 2021 that were due to mature in 2053.
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As of SeptemberJune 30, 2022,2023, the principal payments due on our mortgage loans payable for the threesix months ending December 31, 20222023 and for each of the next four years ending December 31 and thereafter were as follows:follows (in thousands):
YearYearAmountYearAmount
2022$12,791,000 
20232023228,016,000 2023$24,165 
20242024229,487,000 2024332,910 
2025202529,169,000 2025166,091 
20262026155,249,000 2026155,736 
2027202735,023 
ThereafterThereafter522,532,000 Thereafter546,504 
$1,177,244,000 
TotalTotal$1,260,429 
9.8. Lines of Credit and Term Loans
2018 Credit Facility
In order to accommodate the Merger, we amended GAHR IV and its operating partnership's credit agreement, as amended, or the 2018 Credit Agreement, with Bank of America, N.A., or Bank of America; KeyBank, National Association, or KeyBank; Citizens Bank, National Association, or Citizens Bank; Merrill Lynch, Pierce, Fenner & Smith Incorporated; KeyBanc Capital Markets, Inc., or KeyBanc Capital Markets; and the lenders named therein, for a credit facility with an aggregate maximum principal amount of $530,000,000, or the 2018 Credit Facility. The 2018 Credit Facility, which was further amended on October 1, 2021 to provide for updates regarding the Combined Company subsequent to the Merger, consisted of a senior unsecured revolving credit facility in the amount of $235,000,000 and senior unsecured term loan facilities in the aggregate amount of $295,000,000. At our option, the 2018 Credit Facility bore interest at per annum rates equal to (a)(i) the Eurodollar Rate, as defined in the 2018 Credit Agreement, plus (ii) a margin ranging from 1.70% to 2.20% based on our Consolidated Leverage Ratio, as defined in the 2018 Credit Agreement, or (b)(i) the greater of: (1) the prime rate publicly announced by Bank of America, (2) the Federal Funds Rate, as defined in the 2018 Credit Agreement, plus 0.50%, (3) the one-month Eurodollar Rate plus 1.00%, and (4) 0.00%, plus (ii) a margin ranging from 0.70% to 1.20% based on our Consolidated Leverage Ratio.
The 2018 Credit Facility was due to mature on November 19, 2021; however, pursuant to the terms of the 2018 Credit Agreement, at such time we extended the maturity date for an additional 12 months and paid an extension fee of $795,000. As of December 31, 2021, borrowings outstanding totaled $441,900,000 and the weighted average interest rate on such borrowings outstanding was 2.27% per annum. On January 19, 2022, we terminated the 2018 Credit Agreement and entered into the 2022 Credit Agreement, as defined and discussed below.
2019 Credit Facility
On October 1, 2021, upon consummation of the Merger, we, through the surviving partnership, were subject to GAHR III’s credit agreement, as amended, or the 2019 Corporate Credit Agreement, with Bank of America; KeyBank; Citizens Bank; and a syndicate of other banks, as lenders, for a credit facility with an aggregate maximum principal amount of $630,000,000, or the 2019 Credit Facility. The 2019 Credit Facility consisted of a senior unsecured revolving credit facility in an aggregate amount of $150,000,000 and a senior unsecured term loan facility in an aggregate amount of $480,000,000. On October 1, 2021, upon consummation of the Merger, the previously available $150,000,000 senior unsecured revolving credit facility was cancelled and a ratable amendment to certain financial covenants was made to account for the Combined Company.
At our option, the 2019 Credit Facility bore interest at per annum rates equal to (a) (i) the Eurodollar Rate, as defined in the 2019 Corporate Credit Agreement, plus (ii) a margin ranging from 1.85% to 2.80% based on our Consolidated Leverage Ratio, as defined in the 2019 Corporate Credit Agreement, or (b) (i) the greater of: (1) the prime rate publicly announced by Bank of America, (2) the Federal Funds Rate, as defined in the 2019 Corporate Credit Agreement, plus 0.50%, (3) the one-month Eurodollar Rate plus 1.00%, and (4) 0.00%, plus (ii) a margin ranging from 0.85% to 1.80% based on our Consolidated Leverage Ratio.
As of December 31, 2021, borrowings outstanding under the 2019 Credit Facility totaled $480,000,000 and the weighted average interest rate on such borrowings outstanding was 2.60% per annum. The 2019 Corporate Credit Agreement was due to mature on January 25, 2022. On January 19, 2022, we, through our operating partnership, entered into an agreement that
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amended and restated the 2019 Corporate Credit Agreement in its entirety, or the 2022 Credit Agreement. See below for a further discussion.Loan
2022 Credit Facility
On January 19, 2022, we, through our operating partnership, as borrower, and certain of our subsidiaries, or the subsidiary guarantors, collectively as guarantors, entered into an agreement, or the 2022 Credit Agreement, that amended, restated, supersededto amend and replaced
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restate the 2019 Corporatecredit agreement for our existing credit facility with Bank of America, N.A., or Bank of America, KeyBank National Association, Citizens Bank, National Association, and the lenders named therein. The 2022 Credit Agreement and the 2018 Credit Agreementprovides for a credit facility with an aggregate maximum principal amount up to $1,050,000,000$1,050,000,000,, or the 2022 Credit Facility. The 2022 Credit Facility, which consists of a senior unsecured revolving credit facility in the initial aggregate amount of $500,000,000 and a senior unsecured term loan facility in the initial aggregate amount of $550,000,000. The proceeds of loans made under the 2022 Credit Facility may be used for refinancing existing indebtedness and for general corporate purposes including for working capital, capital expenditures and other corporate purposes not inconsistent with obligations under the 2022 Credit Agreement. We may also obtain up to $25,000,000 in the form of standby letters of credit pursuant to the 2022 Credit Facility. Unless defined herein, all capitalized terms under this “2022 Credit Facility” subsection are defined in the 2022 Credit Agreement.
Under the terms of the 2022 Credit Agreement, the revolving loans mature on January 19, 2026, and may be extended for one 12-month period, subject to the satisfaction of certain conditions, including payment of an extension fee. The term loan matures on January 19, 2027, and may not be extended. The maximum principal amount of the 2022 Credit Facility may be increased by an aggregate incremental amount of $700,000,000, subject to: (i) the terms of the 2022 Credit Agreement; and (ii) at least five business days’ prior written notice to Bank of America.
The 2022 Credit Facility bears interest at varying rates based upon, at our option, (i) the Daily Simple Secured Overnight Financing Rate, or Daily SOFR, plus the Applicable Rate for Daily SOFR Rate Loans or (ii) the Term Secured Overnight Financing Rate, or the Term SOFR, plus the Applicable Rate for Term SOFR Rate Loans. If, under the terms of the 2022 Credit Agreement, there is an inability to determine the Daily SOFR or the Term SOFR then the 2022 Credit Facility will bear interest at a rate per annum equal to the Base Rate plus the Applicable Rate for Base Rate Loans. The loans may be repaid in whole or in part without prepayment premium or penalty, subject to certain conditions.
The 2022 Credit Agreement requires us to add additional subsidiaries as guarantors in the event the value of the assets owned by the subsidiary guarantors falls below a certain threshold as set forth in the 2022 Credit Agreement. In the event of default, Bank of America has the right to terminate the commitment of each Lender to make Loans and any obligation of the L/C Issuer to make L/C Credit Extensions under the 2022 Credit Agreement, and to accelerate the payment on any unpaid principal amount of all outstanding loans and interest thereon. On March 1, 2023, we entered into an amendment to the 2022 Credit Agreement, or the First Amendment. The material terms of the First Amendment provided for revisions to certain financial covenants for a limited period of time. Except as modified by the terms of the First Amendment, the material terms of the 2022 Credit Agreement remain in full force and effect.
As of Septemberboth June 30, 2023 and December 31, 2022, our aggregate borrowing capacity under the 2022 Credit Facility was $1,050,000,000, excluding the $25,000,000 in standby letters of credit described above. As of SeptemberJune 30, 2023 and December 31, 2022, borrowings outstanding under the 2022 Credit Facility totaled $963,900,000$926,400,000 ($963,008,000,925,549,000, net of deferred financing costs related to the senior unsecured term loan facility portion of the 2022 Credit Facility) and $965,900,000 ($965,060,000, net of deferred financing costs related to the senior unsecured term loan facility portion of the 2022 Credit Facility), respectively, and the weighted average interest rate on such borrowings outstanding was 4.76%6.82% and 6.07% per annum.annum, respectively.
In January 2022, in connection with the 2022 Credit Agreement, we incurred an aggregate $3,161,000 loss on the extinguishment of a portion of senior unsecured term loans which formed part of the 2018 Credit Facility and the 2019 Credit Facility.loan related to former credit facilities. Such loss on extinguishment of debt is recorded as an increase to interest expense in our accompanying condensed consolidated statements of operations and comprehensive loss, and primarily consisted of lender fees we paid to obtain the 2022 Credit Facility.
2019 Trilogy Credit Facility
On October 1, 2021, upon consummation of the Merger,We, through Trilogy RER, LLC, we became subjectare party to an amended and restated loan agreement, or the 2019 Trilogy Credit Agreement, among certain subsidiaries of Trilogy OpCo, LLC, Trilogy RER, LLC, and Trilogy Pro Services, LLC; KeyBank; CIT Bank, N.A.; Regions Bank; KeyBanc Capital Markets, Inc.; Regions Capital Markets; Bank of America; The Huntington National Bank; and a syndicate of other banks, as lenders named therein, with respect to a senior secured revolving credit facility withthat had an aggregate maximum principal amount of $360,000,000, consisting of: (i) a $325,000,000 secured revolver supported by real estate assets and ancillary business cash flow and (ii) a $35,000,000 accounts receivable revolving credit facility supported by eligible accounts receivable, or the 2019 Trilogy Credit Facility. The proceeds of the 2019 Trilogy Credit Facility may be used for acquisitions, debt repayment and general corporate purposes. The maximum principal amount of the 2019 Trilogy Credit Facility may becould have been increased by up to $140,000,000, for a total principal amount of $500,000,000, subject to certain conditions. The 2019 Trilogy Credit Facility
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On December 20, 2022, we entered into an amendment to the 2019 Trilogy Credit Agreement, or the 2019 Trilogy Credit Amendment. The material terms of the 2019 Trilogy Credit Amendment provided for an increase to the secured revolver amount from $325,000,000 to $365,000,000, thereby increasing our aggregate maximum principal amount under the credit facility from $360,000,000 to $400,000,000. In addition, all references to the London Inter-bank Offered Rate, or LIBOR, were replaced with the Secured Overnight Financing Rate, or SOFR. On March 30, 2023, we further amended the 2019 Trilogy Credit Agreement to update the definition of Implied Debt Service, which is used to calculate the Real Estate Borrowing Base Availability, for interest rate changes and to add an annual interest-only payment calculation option. Except as modified by the terms of the amendments, the material terms of the 2019 Trilogy Credit Agreement remain in full force and effect. Unless defined herein, all capitalized terms under this “2019 Trilogy Credit Facility” subsection are defined in the 2019 Trilogy Credit Amendment.
The 2019 Trilogy Credit Facility matures on September 5, 2023 and may be extended for one 12-month period during the term of the 2019 Trilogy Credit Agreement,Amendment, subject to the satisfaction of certain conditions, including payment of an extension fee.
We intend to satisfy the conditions pursuant to the 2019 Trilogy Credit Facility and pay the required extension fee in order to exercise our option to extend the maturity date for one 12-month period. At our option, the 2019 Trilogy Credit Facility bears interest at per annum rates equal to (a) the London Inter-bank Offered Rate, or LIBOR,SOFR, plus 2.75% for LIBORSOFR Rate Loans as defined in the 2019 Trilogy Credit Agreement, and (b) for Base Rate Loans, as defined in the 2019 Trilogy Credit Agreement, 1.75% plus the greaterhighest of: (i) the fluctuating annual rate per annum of interest announcedin effect for such day as established from time to time by KeyBank as its prime rate, (ii) 0.50% above the Federal Funds Effective Rate as defined in the 2019 Trilogy Credit Agreement, and (iii) 1.00% above the one-month LIBOR.Adjusted Term SOFR.
As of both SeptemberJune 30, 20222023 and December 31, 2021,2022, our aggregate borrowing capacity under the 2019 Trilogy Credit Facility was $360,000,000.$400,000,000. As of SeptemberJune 30, 20222023 and December 31, 2021,2022, borrowings outstanding under the 2019 Trilogy Credit Facility totaled $329,035,000$356,134,000 and $304,734,000,$316,734,000, respectively, and the weighted average interest rate on such borrowings outstanding was 5.84%7.94% and 2.85%7.17% per annum, respectively.
10.9. Derivative Financial InstrumentsInstrument
We have useduse a derivative financial instrumentsinstrument to manage interest rate risk associated with our variable-rate debt. We recordedterm loan pursuant to our 2022 Credit Facility and we record such derivative financial instrumentsinstrument in our accompanying condensed consolidated balance sheets as either an asset or a liability measured at fair value. We did not have any derivative financial instruments as of September 30,December 31, 2022. The following table listsprovides information with respect to the derivative financial instrumentsinstrument held by us as of December 31, 2021,June 30, 2023, which werewas included in security deposits, prepaid rent and other liabilitiesassets, net in our accompanying condensed consolidated balance sheets:sheet (dollars in thousands):
InstrumentInstrumentNotional AmountIndexInterest RateMaturity DateFair Value
December 31, 2021
InstrumentNotional AmountIndexInterest RateMaturity DateFair Value
June 30, 2023
SwapSwap$250,000,000 one month LIBOR2.10%01/25/22$332,000 Swap$275,000 one month
Term SOFR
3.74%01/19/26$4,798 
Swap$130,000,000 one month LIBOR1.98%01/25/22162,000 
Swap$100,000,000 one month LIBOR0.20%01/25/226,000 
$500,000 
As of December 31, 2021, none ofJune 30, 2023, our derivative financial instruments were designated as hedges. Derivative financial instrumentsinstrument was not designated as hedges area hedge. The derivative financial instrument not designated as a hedge is not speculative and areis used to manage our exposure to interest rate movements, but dodoes not meet the strict hedge accounting requirements. On January 25, 2022, our interest rate swap contracts matured. For the three months ended SeptemberJune 30, 20222023 and 2021,2022, we recorded $0$4,993,000 and $1,860,000,$0, respectively, and for the ninesix months ended SeptemberJune 30, 20222023 and 2021,2022, we recorded $500,000$4,798,000 and $5,456,000,$500,000, respectively, as a decrease to interest expense in our accompanying condensed consolidated statements of operations and comprehensive loss related to the change in the fair value of our derivative financial instruments.instrument.
See Note 16,13, Fair Value Measurements, and Note 19, Subsequent Event, for a further discussion of the fair value of our derivative financial instruments.
11. Identified Intangible Liabilities, Net
As of September 30, 2022 and December 31, 2021, identified intangible liabilities, net consisted of below-market leases of $11,249,000 and $12,715,000, respectively, net of accumulated amortization of $2,113,000 and $1,047,000, respectively. Amortization expense on below-market leases for the three months ended September 30, 2022 and 2021 was $413,000 and $45,000, respectively, and for the nine months ended September 30, 2022 and 2021 was $1,436,000 and $137,000, respectively, which is recorded as an increase to real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive loss.
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The weighted average remaining life of below-market leases was 8.6 years and 9.1 years as of September 30, 2022 and December 31, 2021, respectively. As of September 30, 2022, estimated amortization expense on below-market leases for the three months ending December 31, 2022 and for each of the next four years ending December 31 and thereafter was as follows:
YearAmount
2022$411,000 
20231,596,000 
20241,475,000 
20251,347,000 
20261,198,000 
Thereafter5,222,000 
$11,249,000 
12.10. Commitments and Contingencies
Litigation
We are not presently subject to any material litigation nor, to our knowledge, is any material litigation threatened against us, which if determined unfavorably to us, would have a material adverse effect on our consolidated financial position, results of operations or cash flows.
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Environmental Matters
We follow a policy of monitoring our properties for the presence of hazardous or toxic substances. While there can be no assurance that a material environmental liability does not exist at our properties, we are not currently aware of any environmental liability with respect to our properties that would have a material effect on our consolidated financial position, results of operations or cash flows. Further, we are not aware of any material environmental liability or any unasserted claim or assessment with respect to an environmental liability that we believe would require additional disclosure or the recording of a loss contingency.
Other
Our other commitments and contingencies include the usual obligations of real estate owners and operators in the normal course of business, which include calls/puts to sell/acquire properties. In our view, these matters are not expected to have a material adverse effect on our consolidated financial position, results of operations or cash flows.
13.11. Redeemable Noncontrolling Interests
As a result of the Merger and the AHI Acquisition, as of Septemberboth June 30, 20222023 and December 31, 2021,2022, we, through our direct and indirect subsidiaries, own an approximatelyowned a 95.0% and 94.9% general partnership interest respectively, in our operating partnership and the remaining approximate 5.0% and 5.1% limited partnership interest respectively, in our operating partnership iswas owned by the NewCo Sellers. Some of the limited partnership units outstanding, which account for approximately 1.0% of our total operating partnership units outstanding, have redemption features outside of our control and are accounted for as redeemable noncontrolling interests presented outside of permanent equity in our accompanying condensed consolidated balance sheets.
As of both SeptemberJune 30, 20222023 and December 31, 2021,2022, we, through Trilogy REIT Holdings LLC, or Trilogy REIT Holdings, in which we indirectly hold a 76.0% ownership interest, owned 95.9%97.4% and 96.2%, respectively, of the outstanding equity interests of Trilogy. As of both SeptemberJune 30, 20222023 and December 31, 2021,2022, certain members of Trilogy’s management and certain members of an advisory committee to Trilogy’s board of directors owned approximately 4.1%2.6% and 3.8%, respectively, of the outstanding equity interests of Trilogy. The noncontrollingWe account for such equity interests held by such members have redemption features outside of our control and are accounted for as redeemable noncontrolling interests in our accompanying condensed consolidated balance sheets.sheets in accordance with FASB Accounting Standards Codification Topic 480-10-S99-3A given certain features associated with such equity interests. For the three and six months ended June 30, 2023, we redeemed a portion of the equity interests owned by current members of Trilogy’s management for an aggregate of $84,000 and $15,954,000, respectively. For the six months ended June 30, 2022, we did not redeem any equity interests of Trilogy.
As a result of the MergerJune 30, 2023 and December 31, 2022, we own, through our operating partnership, as of September 30, 2022 and December 31, 2021, we own approximately 98.0% of the joint ventures with an affiliate of Meridian Senior Living, LLC, or Meridian, that own Central Florida Senior Housing Portfolio, Pinnacle Beaumont ALF and Pinnacle Warrenton ALF. AlsoThe noncontrolling interests held by Meridian have redemption features outside of our control and are accounted for as a resultredeemable noncontrolling interests in our accompanying condensed consolidated balance sheets. See Note 3, Real Estate Investments, Net and Business Combinations — Dispositions of the Merger, as of September 30, 2022 and December 31, 2021, we also own approximatelyReal Estate Investments, for dispositions within our Central Florida Senior Housing Portfolio.
We previously owned 90.0% of the joint venture with Avalon Health Care, Inc., or Avalon, that ownsowned Catalina West Haven ALF and Catalina Madera ALF. The noncontrolling interests held by MeridianAvalon had redemption features outside of our control and were accounted for as redeemable noncontrolling interests until December 1, 2022, when we exercised our right to purchase the remaining 10.0% of the joint venture with Avalon for a contract purchase price of $295,000. As such, 10.0% of the net earnings of such joint venture were allocated to redeemable noncontrolling interests in our accompanying consolidated statements of operations and comprehensive loss for the three and six months ended June 30, 2022.
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and Avalon have redemption features outside of our control and are accounted for as redeemable noncontrolling interests in our accompanying condensed consolidated balance sheets. Both of our joint ventures with an affiliate of Meridian and with Avalon described above were acquired on October 1, 2021, upon consummation of the Merger.
We record the carrying amount of redeemable noncontrolling interests at the greater of: (i) the initial carrying amount, increased or decreased for the noncontrolling interests’ share of net income or loss and distributions or (ii) the redemption value. The changes in the carrying amount of redeemable noncontrolling interests consisted of the following for the ninesix months ended SeptemberJune 30, 2023 and 2022 and 2021:(in thousands):
Nine Months Ended September 30,Six Months Ended June 30,
2022202120232022
Beginning balanceBeginning balance$72,725,000 $40,340,000 Beginning balance$81,598 $72,725 
Additional redeemable noncontrolling interestAdditional redeemable noncontrolling interest273,000 132,000 Additional redeemable noncontrolling interest— 173 
Reclassification from equityReclassification from equity62,000 — Reclassification from equity41 42 
DistributionsDistributions(2,108,000)(550,000)Distributions(904)(1,405)
Repurchase of redeemable noncontrolling interestsRepurchase of redeemable noncontrolling interests— (166,000)Repurchase of redeemable noncontrolling interests(15,954)— 
Adjustment to redemption valueAdjustment to redemption value14,594,000 810,000 Adjustment to redemption value(4,422)3,833 
Net income (loss) attributable to redeemable noncontrolling interests323,000 (397,000)
Net loss attributable to redeemable noncontrolling interestsNet loss attributable to redeemable noncontrolling interests(486)(31)
Ending balanceEnding balance$85,869,000 $40,169,000 Ending balance$59,873 $75,337 
14.12. Equity
Preferred Stock
Pursuant to our charter, we are authorized to issue 200,000,000 shares of our preferred stock, par value $0.01 per share. As of both SeptemberJune 30, 20222023 and December 31, 2021,2022, no shares of preferred stock were issued and outstanding.
Common Stock
On March 12, 2015, we terminated the primary portion of our initial public offering. We continued to offer shares of our common stock in the GAHR III initial offering pursuant to the Initial DRIP, until the termination of the distribution reinvestment plan portion of the GAHR III initial offering and deregistration of the GAHR III initial offering on April 22, 2015. On March 25, 2015, we filed a Registration Statement on Form S-3 under the Securities Act of 1933, as amended, or the Securities Act, to register a maximum of $250,000,000 of additional shares of our common stock pursuant to the Initial DRIP through a subsequent offering, or the 2015 GAHR III DRIP Offering, and we commenced offering shares following the deregistration of the GAHR III initial offering until the termination and deregistration of the 2015 GAHR III DRIP Offering on March 29, 2019. Effective October 5, 2016, we amended and restated the Initial DRIP, or the GAHR III Amended and Restated DRIP, to amend the price at which shares of our common stock were issued pursuant to the 2015 GAHR III DRIP Offering.
On January 30, 2019, we filed a Registration Statement on Form S-3 under the Securities Act to register a maximum of $200,000,000 of additional shares of our common stock to be issued pursuant to the GAHR III Amended and Restated DRIP, or the 2019 GAHR III DRIP Offering, which we commenced offering on April 1, 2019, following the deregistration of the 2015 GAHR III DRIP Offering. On May 29, 2020, our board authorized the suspension of the 2019 GAHR III DRIP Offering, and consequently, ceased issuing shares pursuant to such offering following the distributions paid in June 2020 to stockholders of record on or prior to the close of business on May 31, 2020. As a result of the Merger, we deregistered the 2019 GAHR III DRIP Offering on October 4, 2021. Further, on October 4, 2021, our board authorized the reinstatement of our distribution reinvestment plan, as amended, or the AHR DRIP, to offer up to $100,000,000 of shares of our common stock pursuant to a Registration Statement on Form S-3 under the Securities Act filed by GAHR IV, or the AHR DRIP Offering. On November 14, 2022, our board suspended the AHR DRIP Offering beginning with the distributions declared, if any, for the quarter ending December 31, 2022. See Note 22, Subsequent Events. We collectively refer to the Initial DRIP portion of the GAHR III initial offering, the 2015 GAHR III DRIP Offering, the 2019 GAHR III DRIP Offering and the AHR DRIP Offering as our DRIP Offerings. See Note 1, Organization and Description of Business — Public Offering and the “Distribution Reinvestment Plan” section below for a further discussion.
At the effective time of the REIT Merger, on October 1, 2021, each issued and outstanding share of GAHR III’s common stock, $0.01 par value per share, was converted into the right to receive 0.9266 shares of GAHR IV’s Class I common stock, $0.01 par value per share, resulting in the issuance of 179,637,776 shares of Class I common stock to GAHR III’s stockholders.
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Also, on October 1, 2021, we filed the Fourth Articles of Amendment and RestatementPursuant to our charter, or the Charter Amendment, which among other things,as amended, the common stock we are authorized to issue. The Charter Amendment authorized us to issue 1,000,000,000 shares of our common stock, par value $0.01 per share, whereby 200,000,000 shares are classified as Class T common stock and 800,000,000 shares are classified as Class I common stock.
Distribution Reinvestment Plan
Following As of June 30, 2023, after taking into consideration the deregistrationMerger and the impact of the Initialreverse stock split as discussed below, we had issued 65,445,557 shares for a total of $2,737,716,000 of common stock since February 26, 2014 in our initial public offerings and DRIP on April 22, 2015,offerings (includes historical offering amounts sold by GAHR III and GAHR IV prior to the Merger). See “Distribution Reinvestment Plan” section below for further discussion.
On November 15, 2022 we continued to offereffected a one-for-four reverse split of our common stock and a corresponding reverse split of the partnership units in our operating partnership. As a result of the Reverse Splits, every four shares of our common stock, pursuantor four partnership units in our operating partnership, were automatically combined and converted into one issued and outstanding share of our common stock of like class, or one partnership unit of like class, as applicable, rounded to the 2015 GAHR IIInearest 1/100th share or unit. The Reverse Splits impacted all classes of common stock and partnership units proportionately and had no impact on any stockholder’s or partner’s ownership percentage. Neither the number of authorized shares nor the par value of the Class T common stock and Class I common stock were ultimately impacted. All numbers of common shares and per share data, as well as partnership units in our operating partnership, in our accompanying condensed consolidated financial statements and related notes have been retroactively adjusted for all periods presented to give effect to the Reverse Splits.
Distribution Reinvestment Plan
Our DRIP Offering and 2019 GAHR III DRIP Offering which resulted in a total of $308,501,000 inallowed our stockholders to elect to reinvest an amount equal to the distributions being reinvested that resulted in 33,110,893declared on their shares of common stock being issued.
As a result of the Merger, we deregistered the 2019 GAHR III DRIP Offering on October 4, 2021. Further, on October 4, 2021, our board reinstated distributions and authorized the reinstatement of the AHR DRIP Offering. As a result, beginning with the October 2021 distribution, which was paid in November 2021, stockholders who previously enrolled as participants in the AHR DRIP received distributions inadditional shares of our common stock pursuant to the termsin lieu of the AHR DRIP, instead ofreceiving cash distributions. As of September 30, 2022, a total of $80,754,000However, in distributions were reinvested that resulted in 8,575,687 shares of common stock being issued pursuant toconnection with the AHR DRIP Offering. OnProposed Listing, on November 14, 2022, our board suspended the AHR DRIP Offeringoffering beginning with the distributions declared if any, for the quarter endingended December 31, 2022. See Note 22, Subsequent Events.
Since October 5, 2016,As a result of the suspension of the DRIP offering, unless and until our board had approved and establishedreinstates the DRIP offering, stockholders who are current participants in the DRIP were or will be paid distributions in cash.
Our board has been establishing an estimated per share net asset value, or NAV, annually. Commencing with the distribution payment to stockholders paid in the month following such board approval, sharesShares of our common stock issued pursuant to our distribution reinvestment planDRIP are issued at the current estimated per share NAV until such time as our board determined an updated estimated per share NAV.
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The following is a summary of the historical estimated per share NAV for GAHR III and the Combined Company, as applicable:NAV:
Approval Date by our BoardEstimated Per Share NAV
(Unaudited)
10/03/19$9.40 
03/18/21$8.55 
03/24/22$9.2937.16 
03/15/23$31.40 
For both the three and ninesix months ended SeptemberJune 30, 2023, there were no distributions reinvested and no shares of our common stock were issued pursuant to our DRIP offerings. For the three and six months ended June 30, 2022, $3,671,000$11,143,000 and $26,118,000,$22,447,000, respectively, in distributions were reinvested and 395,174299,857 and 2,820,674606,375 shares of our common stock, respectively, were issued pursuant to our DRIP Offerings. For both the three and nine months ended September 30, 2021, there were no distributions reinvested pursuant to our DRIP Offerings.offerings.
Share Repurchase Plan
Our share repurchase plan allowed for repurchases of shares of our common stock by us when certain criteria arewere met. Share repurchases were made at the sole discretion of our board. Subject to the availability of the funds for share repurchases and other certain conditions, we generally limited the number of shares of our common stock repurchased during any calendar year to 5.0% of the weighted average number of shares of our common stock outstanding during the prior calendar year; provided however, that shares subject to a repurchase requested upon the death or “qualifying disability,” as defined in our share repurchase plan, of a stockholder were not subject to this cap. Funds for the repurchase of shares of our common stock come from the cumulative proceeds we received from the sale of shares of our common stock pursuant to our DRIP Offerings.
Pursuant to our share repurchase plan, the repurchase price is equal to the lesser of (i) the amount per share that a stockholder paid for their shares of our common stock, or (ii) the most recent estimated value of one share of our common stock, as determined by our board, except that the repurchase price with respect to repurchases resulting from the death or qualifying disability of stockholders is equal to the most recently published estimated per share NAV. On October 4, 2021, as a result of the Merger, our board authorized the partial reinstatement of our share repurchase plan with respect to requests to repurchase shares resulting from the death or qualifying disability of stockholders, effective with respect to qualifying repurchases for the fiscal quarter ending December 31, 2021. All share repurchase requests other than those requests resulting from the death or qualifying disability of stockholders were rejected. On November 14, 2022, our board suspended our share repurchase plan beginning with share repurchase requests for the quarter ending December 31, 2022. All share repurchase requests, including requests resulting from the death or qualifying disability of stockholders, received commencing with the quarter ended December 31, 2022, will not be processed, will be considered canceled in full and shallwill not be rejected.considered outstanding repurchase requests.
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
During the three and nine months ended September 30, 2022, we repurchased 608,138 and 1,755,973 shares of our common stock respectively, for an aggregate of $5,650,000 and $16,233,000, respectively, at an average repurchase price of $9.29 and $9.24 per share, respectively. During the three and nine months ended September 30, 2021, we did not repurchase any shares of common stock. In October 2022, we repurchased 478,136 shares of our common stock, for an aggregate of $4,442,000, at a repurchase price of $9.29 per share. All shares were repurchased usingderived from the cumulative proceeds we received from the sale of shares of our common stock pursuant to our DRIP Offerings. On November 14, 2022,offerings. Pursuant to our board suspended the share repurchase plan, for all repurchases, includingthe repurchase price with respect to repurchases resulting from the death or qualifying disability of stockholders beginning withwas equal to the most recently published estimated per share NAV.
We did not repurchase any shares of our common stock pursuant to our share repurchase requestsplan for the quarter ending December 31, 2022. See Note 22, Subsequent Events.three months ended June 30, 2023. For the six months ended June 30, 2023, pursuant to our share repurchase plan, we repurchased 1,681 shares of common stock for $62,000, at a repurchase price of $37.16 per share. For the three and six months ended June 30, 2022, pursuant to our share repurchase plan, we repurchased 174,865 and 286,959 shares of common stock, respectively, for an aggregate of $6,449,000 and $10,583,000, respectively, at a repurchase price of $36.88 per share. Such repurchase requests were submitted prior to the suspension of our share repurchase plan.
Noncontrolling Interests in Total Equity
As of both SeptemberJune 30, 20222023 and December 31, 2021,2022, Trilogy REIT Holdings owned approximately 95.9%97.4% and 96.2%, respectively, of Trilogy. Prior to October 1, 2021, we wereWe are the indirect owner of a 70.0%76.0% interest in Trilogy REIT Holdings pursuant to an amended joint venture agreement with an indirect, wholly owned subsidiary of NorthStar Healthcare Income, Inc., or NHI, and a wholly owned subsidiary of GAHR IV Operating Partnership.NHI. We serve as the managing member of Trilogy REIT Holdings. As part of the Merger on October 1, 2021, the whollyboth June 30, 2023 and December 31, 2022, NHI indirectly owned subsidiary of GAHR IV Operating Partnership sold its 6.0%a 24.0% membership interest in Trilogy REIT Holdings to GAHR III, thereby increasing our indirect ownership in Trilogy REIT Holdings to 76.0%. Through Septemberand as such, for the three and six months ended June 30, 2021, 30.0% 2023 and 2022, 24.0%of the net earnings of Trilogy REIT Holdings were allocated to noncontrolling interests, and since October 1, 2021, 24.0% of the net earnings of Trilogy REIT Holdings were allocated to a noncontrolling interest.interests.
In connection with our acquisition and operation of Trilogy, time-based profit interest units in Trilogy, or the Profit Interests, were issued to Trilogy Management Services, LLC and antwo independent directordirectors of Trilogy, both unaffiliated third parties that manage or direct the day-to-day operations of Trilogy. The Profit Interests consisted of time-based or performance-based commitments. The time-based Profit Interests wereare measured at their grant date fair value and vest in increments of 20.0% on each anniversary of the respective grant date over a five yearfive-year period. We amortizedamortize the time-based Profit Interests on a straight-line basis over the vesting periods, which are recorded to general and administrative expenses in our accompanying condensed consolidated statements of operations and comprehensive loss. The performance-basednonvested Profit Interests were subject to a performance commitment and would have vested upon liquidity events as defined in the Profit Interests agreements. The performance-based Profit Interests were measured at their fair value on the adoption date of ASU 2018-07, Improvements to Nonemployee Share-Based Payment Accounting, using a modified retrospective approach. The nonvested awards wereare presented as noncontrolling interests in total equity in our accompanying condensed consolidated balance sheets, and wereare re-classified to redeemable noncontrolling interests upon vesting as they had redemption features outside of our control, similar to the common stock units held by Trilogy’s management. See Note 13,11, Redeemable Noncontrolling Interests, for a further discussion.
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In December 2021, we redeemed a part of the time-based Profit Interests, and all of the performance-based Profit Interests that were included in noncontrolling interests in total equity. We redeemed such Profit Interests in cash and through the issuance of additional equity interests in Trilogy that are classified as redeemable noncontrolling interests in our accompanying condensed consolidated balance sheets.
AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
There were no canceled, expired or exercised Profit Interests during the three and ninesix months ended SeptemberJune 30, 20222023 and 2021.2022. For the three months ended SeptemberJune 30, 20222023 and 2021,2022, we recognized stock compensation expense related to the time-based Profit Interests of $20,000 and $0, respectively, and for$21,000, respectively. For the ninesix months ended SeptemberJune 30, 20222023 and 2021,2022, we recognized stock compensation expense related to the time-based Profit Interests of $62,000$41,000 and $(14,000),$42,000, respectively.
One of our consolidated subsidiaries issued non-voting preferred shares of beneficial interests to qualified investors for total proceeds of $125,000. These preferred shares of beneficial interests are entitled to receive cumulative preferential cash dividends at the rate of 12.5% per annum. We classify the value of theour subsidiary’s preferred shares of beneficial interests as noncontrolling interests in our accompanying condensed consolidated balance sheets and the dividends of the preferred shares of beneficial interests in net income or loss attributable to noncontrolling interests in our accompanying condensed consolidated statements of operations and comprehensive loss.
As of both SeptemberJune 30, 20222023 and December 31, 2021,2022, we owned an 86.0% interest in a consolidated limited liability company that owns Lakeview IN Medical Plaza. As such, 14.0% of the net earnings of Lakeview IN Medical Plaza were allocated to noncontrolling interests in our accompanying condensed consolidated statements of operations and comprehensive loss for the three and ninesix months ended SeptemberJune 30, 20222023 and 2021.2022.
As of both SeptemberJune 30, 20222023 and December 31, 2021,2022, we owned a 90.6% membership interest in a consolidated limited liability company that owns Southlake TX Hospital. As such, 9.4% of the net earnings of Southlake TX Hospital were allocated to noncontrolling interests in our accompanying condensed consolidated statements of operations and comprehensive loss for the three and ninesix months ended SeptemberJune 30, 2023 and 2022.
As of both June 30, 2023 and December 31, 2022, and 2021.
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AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
On October 1, 2021, upon consummation of the Merger, through our operating partnership, we acquired an approximateowned a 90.0% interest in a joint venture that owns the Louisiana Senior Housing Portfolio. As such, 10.0% of the net earnings of the joint venture were allocated to noncontrolling interests in our accompanying condensed consolidated statements of operations and comprehensive loss duringfor the three and ninesix months ended SeptemberJune 30, 2023 and 2022.
As discussed in Note 1, Organization and Description of Business, as a result of the Merger and the AHI Acquisition, as of Septemberboth June 30, 20222023 and December 31, 2021,2022, we, through our direct and indirect subsidiaries, own an approximatelya 95.0% and 94.9% general partnership interest respectively, in our operating partnership and the remaining approximately 5.0% and 5.1% limited partnership interest respectively, in our operating partnership is owned by the NewCo Sellers. As of Septemberboth June 30, 20222023 and December 31, 2021, approximately2022, 4.0% and 4.1% of our total operating partnership units outstanding respectively, is presented in total equity in our accompanying condensed consolidated balance sheets. See Note 13,11, Redeemable Noncontrolling Interests, for a further discussion.
AHR 2015 Incentive Plan
Upon consummation ofPursuant to the Merger, we adopted theAmended and Restated 2015 Incentive Plan, as amended and restated, or our incentive plan, pursuant to which our board (with respect to options and restricted shares of common stock granted to independent directors), or our compensation committee (with respect to any other award), may make grants ofgrant options, restricted shares of common stock, stock purchase rights, stock appreciation rights or other awards to our independent directors, officers, employees and consultants. TheOn June 15, 2023, we adopted the Second Amended and Restated 2015 Incentive Plan, or the AHR Incentive Plan, which, among other things, increased the maximum number of shares of our common stock that may be issued pursuant to our incentivesuch plan isfrom 1,000,000 to 4,000,000 shares.shares, extended the term of such plan to June 15, 2033 and made certain administrative changes to the Amended and Restated 2015 Incentive Plan.
Through SeptemberRestricted common stock
Pursuant to the AHR Incentive Plan, through June 30, 2022,2023, we granted an aggregate of 1,157,213315,459 shares of our restricted common stock, under our incentive plan. Such amount includes: (i) 222,458 shares of ouror RSAs, which include restricted Class T common stock at a weighted average grant date fair value of $9.52 per share,and restricted Class I common stock, as defined in the AHR Incentive Plan. RSAs were granted to our independent directors; (ii) 490,515 time-based sharesdirectors in connection with their initial election or re-election to our board or in consideration of our restricted Class T common stock, at a grant date fair value of $9.22 per share or $9.29 per share, as applicable, totheir past services rendered. In addition, certain executive officers and key employees; (iii) 319,149 sharesemployees received grants of our restricted Class T common stock, atstock. RSAs generally have a grant date fair value of $9.22 per share,vesting period ranging from one to certain of our key employees;four years and (iv) 125,091 shares of our restricted Class I common stock issued upon the conversion of restricted common stock that GAHR III granted prior to the Merger. Also, through September 30, 2022, we granted 117,410 performance-based restricted stock units pursuant to our incentive plan to certain executive officers representing the right to receive shares of our Class T common stock upon vesting, at a grant date fair value of $9.29 per unit, net of 46,096 performance-based restricted stock units that were forfeited during the nine months ended September 30, 2022. Further, for the nine months ended September 30, 2022, we granted 76,800 time-based restricted stock units under our incentive plan, at a grant date fair value of $9.29 per share, to certain employees representing the right to receive shares of our Class T common stock upon vesting.
For the three months ended September 30, 2022 and 2021, we recognized stock based compensation expense related to awards granted pursuant to our incentive plan of $914,000 and $13,000, respectively. For the nine months ended September 30, 2022 and 2021, we recognized stock based compensation expense related to awards granted pursuant to our incentive plan of $2,705,000 and $66,000, respectively. Such stock based compensation expense was included in general and administrative in our accompanying condensed consolidated statements of operations and comprehensive loss.
15. Related Party Transactions
Fees and Expenses Paid to Affiliates
Prior to the closing of the AHI Acquisition on October 1, 2021, our former advisor used its best efforts,are subject to continuous service through the oversight and review of our board, to, among other things, provide asset management, property management, acquisition, disposition and other advisory services on our behalf consistent with our investment policies and objectives. Our former advisor performed its duties and responsibilities under the Advisory Agreement as our fiduciary. Until September 30, 2021, all of our executive officers were officers of our former advisor and officers, limited partners and/or members of one of our former co-sponsors and other affiliates of our former advisor.
On December 20, 2021, the Advisory Agreement was assigned to NewCo and as a result, any fees that would have otherwise been payable to our former advisor are now eliminated in consolidation. Following the consummation of the Merger, we became self-managed and as a result, we no longer incur to our former advisor and its affiliates any fees or expense reimbursements arising from the Advisory Agreement.vesting dates.
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
Fees and expenses incurredRestricted stock units
Pursuant to the AHR Incentive Plan, through June 30, 2023, we granted our executive officers an aggregate 70,751 of performance-based restricted stock units, or PBUs, representing the right to receive shares of our Class T common stock upon vesting. We also granted to our former advisorexecutive officers and certain employees 169,529 time-based restricted stock units, or its affiliatesTBUs, representing the right to receive shares of our Class T common stock upon vesting. PBUs and TBUs are collectively referred to as RSUs. RSUs granted to executive officers and employees generally have a vesting period of up to three years and are subject to continuous service through the vesting dates, and any performance conditions, as applicable.
A summary of the status of our nonvested RSAs and RSUs as of June 30, 2023 and December 31, 2022 and the changes for the three and ninesix months ended SeptemberJune 30, 2021 were as follows:2023 is presented below:
Three Months Ended
September 30, 2021
Nine Months Ended
September 30, 2021
Asset management fees(1)$5,424,000 $16,187,000 
Property management fees(2)674,000 2,009,000 
Development fees(3)214,000 854,000 
Operating expenses(4)44,000 160,000 
Construction management fees(5)38,000 118,000 
Lease fees(6)25,000 410,000 
Acquisition fees(7)19,000 1,363,000 
$6,438,000 $21,101,000 
Number of 
Nonvested
RSAs

Weighted
Average
Grant Date
Fair Value -
RSAs
Number of 
Nonvested
RSUs
Weighted
Average
Grant Date
Fair Value -
RSUs
Balance — December 31, 2022183,240 $36.97 48,553 $37.16 
Granted26,156 31.83 191,728 31.40 
Vested(21,030)37.47 (6,400)(1)37.16 
Forfeited— — — — 
Balance — June 30, 2023188,366 $36.20 233,881 $32.44 
___________
(1)Asset management feesAmount includes 2,280 shares of common stock that were withheld from issuance to satisfy employee minimum tax withholding requirements associated with the vesting of RSUs during the six months ended June 30, 2023.
For the three months ended June 30, 2023 and 2022, we recognized $1,564,000 and $980,000, respectively, and for the six months ended June 30, 2023 and 2022, we recognized $2,615,000 and $1,791,000, respectively, in stock compensation expense related to awards granted pursuant to the AHR Incentive Plan based on the grant date fair value for time based awards and for performance-based awards that are probable of vesting, which grant date fair value is equal to the most recently published estimated per share NAV. Such stock compensation expense is included in general and administrative in our accompanying condensed consolidated statements of operations and comprehensive loss.
(2)Property management fees were included in rental expenses or general and administrative expenses in our accompanying condensed consolidated statements of operations and comprehensive loss, depending on the property type from which the fee was incurred.
(3)Development fees were capitalized as part of the associated investments in our accompanying condensed consolidated balance sheets.
(4)We reimbursed our former advisor or its affiliates for operating expenses incurred in rendering services to us, subject to certain limitations. For the 12 months ended September 30, 2021, our operating expenses did not exceed such limitations. Operating expenses were generally included in general and administrative in our accompanying condensed consolidated statements of operations and comprehensive loss.
(5)Construction management fees were capitalized as part of the associated asset and included in real estate investments, net in our accompanying condensed consolidated balance sheets.
(6)Lease fees were capitalized as costs of entering into new leases and included in other assets, net in our accompanying condensed consolidated balance sheets.
(7)Acquisition fees in connection with the acquisition of properties accounted for as asset acquisitions or the acquisition of real estate-related investments were capitalized as part of the associated investments in our accompanying condensed consolidated balance sheets.
Accounts Payable Due to Affiliates
We did not have any amounts outstanding to our affiliates as of September 30, 2022. The following amounts were outstanding to our affiliates as of December 31, 2021:
FeeDecember 31, 2021
Lease commissions$245,000 
Development fees229,000 
Construction management fees152,000 
Operating expenses100,000 
Asset and property management fees83,000 
Acquisition fees57,000 
$866,000 
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
16.13. Fair Value Measurements
Assets and Liabilities Reported at Fair Value
The table below presents our assets and liabilities measured at fair value on a recurring basis as of SeptemberJune 30, 2022,2023, aggregated by the level in the fair value hierarchy within which those measurements fall:fall (in thousands):
Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)
Significant Other
Observable Inputs
(Level 2)
Significant
Unobservable
Inputs
(Level 3)
Total
Liabilities:
Warrants$— $— $678,000 $678,000 
Total liabilities at fair value$— $— $678,000 $678,000 
Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)
Significant Other
Observable Inputs
(Level 2)
Significant
Unobservable
Inputs
(Level 3)
Total
Assets:
Derivative financial instrument$— $4,798 $— $4,798 
Total assets at fair value$— $4,798 $— $4,798 
The table below presents ourThere were no transfers into and out of fair value measurement levels during the six months ended June 30, 2023 and 2022. We did not have any assets and liabilities measured at fair value on a recurring basis as of December 31, 2021, aggregated by the level in the fair value hierarchy within which those measurements fall:
Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)
Significant Other
Observable Inputs
(Level 2)
Significant
Unobservable
Inputs
(Level 3)
Total
Liabilities:
Derivative financial instruments$— $500,000 $— $500,000 
Warrants— — 786,000 786,000 
Total liabilities at fair value$— $500,000 $786,000 $1,286,000 
There were no transfers into and out of fair value measurement levels during the nine months ended September 30, 2022 and 2021.
Warrants
As of September 30, 2022 and December 31, 2021, we have recorded $678,000 and $786,000, respectively, related to warrants in Trilogy common units held by certain members of Trilogy’s management, which is included in security deposits, prepaid rent and other liabilities in our accompanying condensed consolidated balance sheets. Once exercised, these warrants have redemption features similar to the common units held by members of Trilogy’s management.See Note 13, Redeemable Noncontrolling Interests, for a further discussion. As of September 30, 2022 and December 31, 2021, the carrying value is a reasonable estimate of fair value.2022.
Derivative Financial Instruments
We usedentered into an interest rate swaps and interest rate capsswap to manage interest rate risk associated with variable-rate debt. We also previously used interest rate swaps or interest rate caps to manage such interest rate risk. The valuation of these instruments was determined using widely accepted valuation techniques including a discounted cash flow analysis on the expected cash flows of each derivative. This analysisSuch valuation reflected the contractual terms of the derivatives, including the period to maturity, and used
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AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
observable market-based inputs, including interest rate curves, as well as option volatility. The fair valuesvalue of our interest rate swaps wereswap was determined by netting the discounted future fixed cash payments and the discounted expected variable cash receipts. The variable cash receipts were based on an expectation of future interest rates derived from observable market interest rate curves.
We incorporated credit valuation adjustments to appropriately reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements.measurement. In adjusting the fair value of our derivative contractscontract for the effect of nonperformance risk, we considered the impact of netting and any applicable credit enhancements, such as collateral postings, thresholds, mutual puts and guarantees.
Although we determined that the majority of the inputs used to value our derivative financial instrumentsinstrument fell within Level 2 of the fair value hierarchy, the credit valuation adjustments associated with these instrumentsthis instrument utilized Level 3 inputs, such as estimates of current credit spreads, to evaluate the likelihood of default by us and our counterparty. However, as of December 31, 2021,June 30, 2023, we assessed the significance of the impact of the credit valuation adjustments on the overall valuation of
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
our derivative positionsposition and determined that the credit valuation adjustments were not significant to the overall valuation of our derivatives.derivative. As a result, we determined that our derivative valuationsvaluation in theirits entirety werewas classified in Level 2 of the fair value hierarchy. AsOn January 25, 2022, our prior interest rate swap contracts matured and as of September 30,December 31, 2022, we did not have any derivative financial instruments.
Financial Instruments Disclosed at Fair Value
Our accompanying condensed consolidated balance sheets include the following financial instruments: debt security investment, cash and cash equivalents, restricted cash, accounts and other receivables, accounts payable and accrued liabilities, accounts payable due to affiliates, mortgage loans payable and borrowings under our lines of credit and term loans.loan.
We consider the carrying values of cash and cash equivalents, restricted cash, accounts and other receivables and accounts payable and accrued liabilities to approximate the fair value for these financial instruments based upon an evaluation of the underlying characteristics, market data and because of the short period of time between origination of the instruments and their expected realization. The fair value of accounts payable due to affiliates is not determinable due to the related party nature of the accounts payable. The fair values of the other financial instruments are classified in Level 2 of the fair value hierarchy.
The fair value of our debt security investment is estimated using a discounted cash flow analysis using interest rates available to us for investments with similar terms and maturities. The fair values of our mortgage loans payable and our lines of credit and term loansloan are estimated using discounted cash flow analyses using borrowing rates available to us for debt instruments with similar terms and maturities. We have determined that the valuations of our debt security investment, mortgage loans payable and lines of credit and term loansloan are classified in Level 2 within the fair value hierarchy. The carrying amounts and estimated fair values of such financial instruments as of SeptemberJune 30, 20222023 and December 31, 20212022 were as follows:follows (in thousands):
September 30,
2022
December 31,
2021
June 30,
2023
December 31,
2022
Carrying
Amount(1)
Fair
Value
Carrying
Amount(1)
Fair
Value
Carrying
Amount(1)
Fair
Value
Carrying
Amount(1)
Fair
Value
Financial Assets:Financial Assets:Financial Assets:
Debt security investmentDebt security investment$82,067,000 $92,831,000 $79,315,000 $93,920,000 Debt security investment$84,933 $92,998 $83,000 $93,230 
Financial Liabilities:Financial Liabilities:Financial Liabilities:
Mortgage loans payableMortgage loans payable$1,159,159,000 $1,022,541,000 $1,095,594,000 $1,075,729,000 Mortgage loans payable$1,237,565 $1,096,898 $1,229,847 $1,091,667 
Lines of credit and term loans$1,287,248,000 $1,294,231,000 $1,222,853,000 $1,226,636,000 
Lines of credit and term loanLines of credit and term loan$1,278,697 $1,283,619 $1,277,460 $1,285,205 
___________
(1)Carrying amount is net of any discount/premium and unamortized deferred financing costs.
17.14. Income Taxes
As a REIT, we generally will not be subject to U.S. federal income tax on taxable income that we distribute to our stockholders. We have elected to treat certain of our consolidated subsidiaries as taxable REIT subsidiaries, or TRS, pursuant to the Code. TRS may participate in services that would otherwise be considered impermissible for REITs and are subject to federal and state income tax at regular corporate tax rates.
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AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
Current Income Tax
Federal and state income taxes are generally a function of the level of income recognized by our TRS. Foreign income taxes are generally a function of our income on our real estate located in the United Kingdom, or UK, and Isle of Man.
Deferred Taxes
Deferred income tax is generally a function of the period’s temporary differences (primarily basis differences between tax and financial reporting for real estate assets and equity investments) and generation of tax net operating loss that may be realized in future periods depending on sufficient taxable income.
We recognize the financial statement effects of an uncertain tax position when it is more likely than not, based on the technical merits of the tax position, that such a position will be sustained upon examination by the relevant tax authorities. If the tax benefit meets the “more likely than not” threshold, the measurement of the tax benefit will be based on our estimate of the ultimate tax benefit to be sustained if audited by the taxing authority. As of both SeptemberJune 30, 20222023 and December 31, 2021,
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
2022, we did not have any tax benefits or liabilities for uncertain tax positions that we believe should be recognized in our accompanying condensed consolidated financial statements.
We assess the available positive and negative evidence to estimate if sufficient future taxable income will be generated to use the existing deferred tax assets. A valuation allowance is established if we believe it is more likely than not that all or a portion of the deferred tax assets are not realizable. As of Septemberboth June 30, 20222023 and December 31, 2021,2022, our valuation allowance fully reserves the net deferred tax assets due to historical losses and inherent uncertainty of future income. We will continue to monitor industry and economic conditions, and our ability to generate taxable income based on our business plan and available tax planning strategies, which would allow us to utilize the tax benefits of the net deferred tax assets and thereby allow us to reverse all, or a portion of, our valuation allowance in the future.
18.15. Leases
Lessor
We have operating leases with tenants that expire at various dates through 2050. For the three months ended SeptemberJune 30, 20222023 and 2021,2022, we recognized $50,041,000$49,216,000 and $28,320,000,$50,060,000, respectively, of revenues related to operating lease payments, of which $9,522,000$9,711,000 and $4,181,000,$9,663,000, respectively, was for variable lease payments. For the ninesix months ended SeptemberJune 30, 20222023 and 2021,2022, we recognized $150,860,000$91,519,000 and $86,258,000,$100,790,000, respectively, of revenues related to operating lease payments, of which $29,598,000$19,750,000 and $13,835,000,$20,076,000, respectively, was for variable lease payments. As of SeptemberJune 30, 2022,2023, the following table sets forth the undiscounted cash flows for future minimum base rents due under operating leases for the threesix months ending December 31, 20222023 and for each of the next four years ending December 31 and thereafter for properties that we wholly own:own (in thousands):
YearYearAmountYearAmount
2022$38,476,000 
20232023150,888,000 2023$75,245 
20242024141,860,000 2024143,777 
20252025128,746,000 2025131,148 
20262026118,101,000 2026120,394 
20272027114,746 
ThereafterThereafter693,229,000 Thereafter581,532 
TotalTotal$1,271,300,000 Total$1,166,842 
Lessee
We lease certain land, buildings, furniture, fixtures, campus equipment,and office equipment and automobiles. We have lease agreements with lease and non-lease components, which are generally accounted for separately. Most leases include one or more options to renew, with renewal terms that generally can extend at various dates through 2107, excluding extension options. The exercise of lease renewal options is at our sole discretion. Certain leases also include options to purchase the leased property. As of SeptemberJune 30, 2022,2023, we had future lease payments of $28,747,000$6,054,000 for an operating lease that had not yet commenced. Such operating lease will commence in fiscal year 20222023 with a lease term of 15five years.
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
The depreciable life of assets and leasehold improvements are limited by the expected lease term, unless there is a transfer of title or purchase option reasonably certain of exercise. Certain of our lease agreements include rental payments that are adjusted periodically based on the United States Bureau of Labor Statistics’ Consumer Price Index, and may also include other variable lease costs (i.e., common area maintenance, property taxes and insurance). Our lease agreements do not contain any material residual value guarantees or material restrictive covenants.
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
The components of lease costs were as follows:follows (in thousands):
Three Months Ended September 30,Three Months Ended June 30,
Lease CostLease CostClassification20222021Lease CostClassification20232022
Operating lease cost(1)Operating lease cost(1)Property operating expenses, rental expenses or general and administrative expenses$9,322,000 $5,530,000 Operating lease cost(1)Property operating expenses, rental expenses or general and administrative expenses$11,473 $5,408 
Finance lease cost:Finance lease cost:Finance lease cost:
Amortization of leased assetsAmortization of leased assetsDepreciation and amortization310,000 332,000 Amortization of leased assetsDepreciation and amortization297 316 
Interest on lease liabilitiesInterest on lease liabilitiesInterest expense43,000 81,000 Interest on lease liabilitiesInterest expense66 66 
Sublease incomeSublease incomeResident fees and services revenue or other income(156,000)(57,000)Sublease incomeResident fees and services revenue or other income(172)(234)
Total lease costTotal lease cost$9,519,000 $5,886,000 Total lease cost$11,664 $5,556 
Nine Months Ended September 30,Six Months Ended June 30,
Lease CostLease CostClassification20222021Lease CostClassification20232022
Operating lease cost(1)Operating lease cost(1)Property operating expenses, rental expenses or general and administrative expenses$21,086,000 $17,365,000 Operating lease cost(1)Property operating expenses, rental expenses or general and administrative expenses$23,396 $11,764 
Finance lease cost:Finance lease cost:Finance lease cost:
Amortization of leased assetsAmortization of leased assetsDepreciation and amortization939,000 1,125,000 Amortization of leased assetsDepreciation and amortization600 629 
Interest on lease liabilitiesInterest on lease liabilitiesInterest expense183,000 273,000 Interest on lease liabilitiesInterest expense157 140 
Sublease incomeSublease incomeResident fees and services revenue or other income(538,000)(63,000)Sublease incomeResident fees and services revenue or other income(328)(382)
Total lease costTotal lease cost$21,670,000 $18,700,000 Total lease cost$23,825 $12,151 
___________
(1)Includes short-term leases and variable lease costs, which are immaterial.
Additional information related to our leases for the periods presented below was as follows:follows (dollars in thousands):
Lease Term and Discount RateLease Term and Discount Rate
September 30,
2022
December 31,
2021
Lease Term and Discount Rate
June 30,
2023
December 31,
2022
Weighted average remaining lease term (in years):Weighted average remaining lease term (in years):Weighted average remaining lease term (in years):
Operating leasesOperating leases12.816.9Operating leases12.512.8
Finance leasesFinance leases2.53.6Finance leases1.92.3
Weighted average discount rate:Weighted average discount rate:Weighted average discount rate:
Operating leasesOperating leases5.60 %5.52 %Operating leases5.71 %5.69 %
Finance leasesFinance leases7.62 %7.68 %Finance leases7.74 %7.66 %
Nine Months Ended September 30,Six Months Ended June 30,
Supplemental Disclosure of Cash Flows InformationSupplemental Disclosure of Cash Flows Information20222021Supplemental Disclosure of Cash Flows Information20232022
Operating cash outflows related to finance leasesOperating cash outflows related to finance leases$183,000 $273,000 Operating cash outflows related to finance leases$157 $140 
Financing cash outflows related to finance leasesFinancing cash outflows related to finance leases$40,000 $159,000 Financing cash outflows related to finance leases$38 $26 
Right-of-use assets obtained in exchange for operating lease liabilitiesRight-of-use assets obtained in exchange for operating lease liabilities$— $125,000 Right-of-use assets obtained in exchange for operating lease liabilities$1,155 $646 
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
Operating Leases
As of SeptemberJune 30, 2022,2023, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for the threesix months ending December 31, 20222023 and for each of the next four years ending December 31 and thereafter, as well as the reconciliation of those cash flows to operating lease liabilities on our accompanying condensed consolidated balance sheet:sheet (in thousands):
YearYearAmountYearAmount
2022$9,137,000 
2023202336,444,000 2023$19,240 
2024202435,781,000 202437,822 
2025202535,109,000 202537,210 
2026202635,092,000 202637,256 
2027202737,890 
ThereafterThereafter244,392,000 Thereafter229,084 
Total undiscounted operating lease paymentsTotal undiscounted operating lease payments395,955,000 Total undiscounted operating lease payments398,502 
Less: interestLess: interest135,575,000 Less: interest135,784 
Present value of operating lease liabilitiesPresent value of operating lease liabilities$260,380,000 Present value of operating lease liabilities$262,718 
Finance Leases
As of SeptemberJune 30, 2022,2023, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for the threesix months ending December 31, 20222023 and for each of the next four years ending December 31 and thereafter, as well as a reconciliation of those cash flows to finance lease liabilities:liabilities (in thousands):
YearYearAmountYearAmount
2022$17,000 
2023202361,000 2023$29 
2024202475,000 202476 
2025202531,000 202531 
20262026— 2026— 
20272027— 
ThereafterThereafter— Thereafter— 
Total undiscounted finance lease paymentsTotal undiscounted finance lease payments184,000 Total undiscounted finance lease payments136 
Less: interestLess: interest20,000 Less: interest11 
Present value of finance lease liabilitiesPresent value of finance lease liabilities$164,000 Present value of finance lease liabilities$125 
19.16. Segment Reporting
As of SeptemberJune 30, 2022,2023, we evaluated our business and made resource allocations based on six reportable business segments: integrated senior health campuses, medical office buildings, skilled nursing facilities,MOBs, SNFs, SHOP, senior housing — leased hospitals and SHOP. hospitals.Our medical office buildingsMOBs are typically leased to multiple tenants under separate leases, thus requiring active management and responsibility for many of the associated operating expenses (much of which are, or can effectively be, passed through to the tenants). Our integrated senior health campuses includeeach provide a range of independent living, assisted living, memory care, independent living, skilled nursing services and certain ancillary businesses that are owned and operated utilizing a RIDEA structure. Our senior housing — leased and skilled nursing and senior housing facilities are single-tenant properties for which we lease the facilities to unaffiliated tenants under triple-net and generally master leases that transfer the obligation for all facility operating costs (including maintenance, repairs, taxes, insurance and capital expenditures) to the tenant. In addition, our senior housing —leased— leased segment includes our debt security investment. Our hospital investments are similarly structured to our leased skilled nursing and senior housing facilities. Our SHOP segment includes senior housing facilities, which may provide assisted living care, independent living, memory care or skilled nursing services, that are owned and operated utilizing a RIDEA structure.
While we believe that net income (loss), as defined by GAAP, is the most appropriate earnings measurement, we evaluate our segments’ performance based upon segment net operating income or loss, or NOI. We define segment NOI as total revenues and grant income, less property operating expenses and rental expenses, which excludes depreciation and amortization, general and administrative expenses, business acquisition expenses, interest expense, gain or loss on dispositions
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
of real estate investments, impairment of real estate investments, income or loss from unconsolidated entities, impairment of goodwill, foreign currency gain or loss, gain on re-measurement of previously held equity interest, other income and income tax benefit or expense for each segment. We believe that segment NOI serves as an appropriate supplemental performance measure to net income (loss) because it allows investors and our management to measure unlevered property-level operating results and to compare our operating results to the operating results of other real estate companies and between periods on a consistent basis.
Interest expense, depreciation and amortization and other expenses not attributable to individual properties are not allocated to individual segments for purposes of assessing segment performance. Non-segment assets primarily consist of corporate assets including cash and cash equivalents, other receivables, deferred financing costs and other assets not attributable to individual properties.
On October 1, 2021,Summary information for the reportable segments during the three and six months ended June 30, 2023 and 2022 was as part of the Merger, we acquired 92 buildings, or approximately 4,799,000 square feet of GLA, which expanded our portfolio of real estate properties and SHOP within the segments as outlined above.follows (in thousands):
Integrated
Senior Health
Campuses
SHOPMOBsSenior
Housing —
Leased
SNFsHospitals
Three Months
Ended
June 30, 2023
Revenues and grant income:
Resident fees and services$362,856 $47,766 $— $— $— $— $410,622 
Real estate revenue— — 36,640 5,392 6,090 2,446 50,568 
Grant income6,381 — — — — — 6,381 
Total revenues and grant income369,237 47,766 36,640 5,392 6,090 2,446 467,571 
Expenses:
Property operating expenses328,696 43,853 — — — — 372,549 
Rental expenses— — 13,927 229 378 119 14,653 
Segment net operating income$40,541 $3,913 $22,713 $5,163 $5,712 $2,327 $80,369 
Expenses:
General and administrative$11,774 
Business acquisition expenses888 
Depreciation and amortization44,701 
Other income (expense):
Interest expense:
Interest expense (including amortization of deferred financing costs and debt discount/premium)(40,990)
Gain in fair value of derivative financial instruments4,993 
Loss on dispositions of real estate investments(2,072)
Loss from unconsolidated entities(113)
Foreign currency gain1,068 
Other income2,589 
Total net other expense(34,525)
Loss before income taxes(11,519)
Income tax expense(348)
Net loss$(11,867)
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
Summary information for the reportable segments during the three and nine months ended September 30, 2022 and 2021 was as follows:
Integrated
Senior Health
Campuses
SHOPMedical
Office
Buildings
Senior
Housing —
Leased
Skilled
Nursing
Facilities
Hospitals
Three Months
Ended
September 30, 2022
Integrated
Senior Health
Campuses
SHOPMOBsSenior
Housing —
Leased
SNFsHospitals
Three Months
Ended
June 30, 2022
Revenues and grant income:Revenues and grant income:Revenues and grant income:
Resident fees and servicesResident fees and services$328,751,000 $39,555,000 $— $— $— $— $368,306,000 Resident fees and services$287,582 $38,643 $— $— $— $— $326,225 
Real estate revenueReal estate revenue— — 37,128,000 5,143,000 6,633,000 2,419,000 51,323,000 Real estate revenue— — 36,833 5,262 6,599 2,411 51,105 
Grant incomeGrant income5,796,000 737,000 — — — — 6,533,000 Grant income10,969 — — — — — 10,969 
Total revenues and grant incomeTotal revenues and grant income334,547,000 40,292,000 37,128,000 5,143,000 6,633,000 2,419,000 426,162,000 Total revenues and grant income298,551 38,643 36,833 5,262 6,599 2,411 388,299 
Expenses:Expenses:Expenses:
Property operating expensesProperty operating expenses299,197,000 38,290,000 — — — — 337,487,000 Property operating expenses258,934 37,125 — — — — 296,059 
Rental expensesRental expenses— — 14,155,000 160,000 437,000 98,000 14,850,000 Rental expenses— — 13,791 212 521 139 14,663 
Segment net operating incomeSegment net operating income$35,350,000 $2,002,000 $22,973,000 $4,983,000 $6,196,000 $2,321,000 $73,825,000 Segment net operating income$39,617 $1,518 $23,042 $5,050 $6,078 $2,272 $77,577 
Expenses:Expenses:Expenses:
General and administrativeGeneral and administrative$9,626,000 General and administrative$10,928 
Business acquisition expensesBusiness acquisition expenses231,000 Business acquisition expenses1,757 
Depreciation and amortizationDepreciation and amortization40,422,000 Depreciation and amortization39,971 
Other income (expense):Other income (expense):Other income (expense):
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishments)(27,524,000)
Interest expense (including amortization of deferred financing costs, debt discount/premium and gain on debt extinguishments)Interest expense (including amortization of deferred financing costs, debt discount/premium and gain on debt extinguishments)(20,345)
Gain on dispositions of real estate investments
2,113,000 
Loss on dispositions of real estate investmentsLoss on dispositions of real estate investments(73)
Impairment of real estate investmentsImpairment of real estate investments(21,851,000)Impairment of real estate investments(17,340)
Loss from unconsolidated entities
(344,000)
Gain on re-measurement of previously held equity interest19,567,000 
Foreign currency loss
(3,695,000)
Income from unconsolidated entitiesIncome from unconsolidated entities638 
Foreign currency lossForeign currency loss(3,607)
Other incomeOther income670,000 Other income469 
Total net other expenseTotal net other expense(31,064,000)Total net other expense(40,258)
Loss before income taxes
(7,518,000)
Income tax expense
(126,000)
Net loss
$(7,644,000)
Loss before income taxesLoss before income taxes(15,337)
Income tax expenseIncome tax expense(205)
Net lossNet loss$(15,542)
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AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
Integrated
Senior Health
Campuses
SHOPMedical
Office
Buildings
Senior
Housing —
Leased
Skilled
Nursing
Facilities
Hospitals
Three Months
Ended
September 30, 2021
Integrated
Senior Health
Campuses
SHOPMOBsSenior
Housing —
Leased
SNFsHospitals
Six Months
Ended
June 30, 2023
Revenues and grant income:Revenues and grant income:Revenues and grant income:
Resident fees and servicesResident fees and services$265,343,000 $21,539,000 $— $— $— $— $286,882,000 Resident fees and services$724,626 $94,626 $— $— $— $— $819,252 
Real estate revenueReal estate revenue— — 19,677,000 3,622,000 3,665,000 2,704,000 29,668,000 Real estate revenue— — 74,123 10,668 4,458 4,915 94,164 
Grant incomeGrant income936,000 — — — — — 936,000 Grant income6,381 — — — — — 6,381 
Total revenues and grant incomeTotal revenues and grant income266,279,000 21,539,000 19,677,000 3,622,000 3,665,000 2,704,000 317,486,000 Total revenues and grant income731,007 94,626 74,123 10,668 4,458 4,915 919,797 
Expenses:Expenses:Expenses:
Property operating expensesProperty operating expenses239,151,000 17,670,000 — — — — 256,821,000 Property operating expenses657,057 85,638 — — — — 742,695 
Rental expensesRental expenses— — 7,629,000 71,000 364,000 124,000 8,188,000 Rental expenses— — 28,335 428 847 238 29,848 
Segment net operating incomeSegment net operating income$27,128,000 $3,869,000 $12,048,000 $3,551,000 $3,301,000 $2,580,000 $52,477,000 Segment net operating income$73,950 $8,988 $45,788 $10,240 $3,611 $4,677 $147,254 
Expenses:Expenses:Expenses:
General and administrativeGeneral and administrative$9,008,000 General and administrative$24,827 
Business acquisition expensesBusiness acquisition expenses3,633,000 Business acquisition expenses1,220 
Depreciation and amortizationDepreciation and amortization26,334,000 Depreciation and amortization89,371 
Other income (expense):Other income (expense):Other income (expense):
Interest expense:Interest expense:Interest expense:
Interest expense (including amortization of deferred financing costs and debt discount/premium)Interest expense (including amortization of deferred financing costs and debt discount/premium)(18,885,000)Interest expense (including amortization of deferred financing costs and debt discount/premium)(80,001)
Gain in fair value of derivative financial instrumentsGain in fair value of derivative financial instruments1,860,000 Gain in fair value of derivative financial instruments4,798 
Gain on dispositions of real estate investments276,000 
Loss on dispositions of real estate investmentsLoss on dispositions of real estate investments(2,204)
Income from unconsolidated entities384,000 
Foreign currency loss(1,394,000)
Loss from unconsolidated entitiesLoss from unconsolidated entities(419)
Gain on re-measurement of previously held equity interestGain on re-measurement of previously held equity interest726 
Foreign currency gainForeign currency gain2,076 
Other incomeOther income348,000 Other income4,197 
Total net other expenseTotal net other expense(17,411,000)Total net other expense(70,827)
Loss before income taxesLoss before income taxes(3,909,000)Loss before income taxes(38,991)
Income tax expenseIncome tax expense(127,000)Income tax expense(491)
Net lossNet loss$(4,036,000)Net loss$(39,482)
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AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
Integrated
Senior Health
Campuses
SHOPMedical
Office
Buildings
Senior
Housing —
Leased
Skilled
Nursing
Facilities
Hospitals
Nine Months
Ended
September 30, 2022
Integrated
Senior Health
Campuses
SHOPMOBsSenior
Housing —
Leased
SNFsHospitals
Six Months
Ended
June 30, 2022
Revenues and grant income:Revenues and grant income:Revenues and grant income:
Resident fees and servicesResident fees and services$897,345,000 $116,160,000 $— $— $— $— $1,013,505,000 Resident fees and services$568,594 $76,605 $— $— $— $— $645,199 
Real estate revenueReal estate revenue— — 111,798,000 15,703,000 19,625,000 7,245,000 154,371,000 Real estate revenue— — 74,670 10,560 12,992 4,826 103,048 
Grant incomeGrant income21,861,000 855,000 — — — — 22,716,000 Grant income16,065 118 — — — — 16,183 
Total revenues and grant incomeTotal revenues and grant income919,206,000 117,015,000 111,798,000 15,703,000 19,625,000 7,245,000 1,190,592,000 Total revenues and grant income584,659 76,723 74,670 10,560 12,992 4,826 764,430 
Expenses:Expenses:Expenses:
Property operating expensesProperty operating expenses811,281,000 109,425,000 — — — — 920,706,000 Property operating expenses512,084 71,135 — — — — 583,219 
Rental expensesRental expenses— — 42,259,000 551,000 1,644,000 346,000 44,800,000 Rental expenses— — 28,104 391 1,207 248 29,950 
Segment net operating incomeSegment net operating income$107,925,000 $7,590,000 $69,539,000 $15,152,000 $17,981,000 $6,899,000 $225,086,000 Segment net operating income$72,575 $5,588 $46,566 $10,169 $11,785 $4,578 $151,261 
Expenses:Expenses:Expenses:
General and administrativeGeneral and administrative$31,673,000 General and administrative$22,047 
Business acquisition expensesBusiness acquisition expenses2,161,000 Business acquisition expenses1,930 
Depreciation and amortizationDepreciation and amortization122,704,000 Depreciation and amortization82,282 
Other income (expense):Other income (expense):Other income (expense):
Interest expense:Interest expense:Interest expense:
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishments)Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishments)(71,194,000)Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishments)(43,670)
Gain in fair value of derivative financial instrumentsGain in fair value of derivative financial instruments500,000 Gain in fair value of derivative financial instruments500 
Gain on dispositions of real estate investments
Gain on dispositions of real estate investments
2,796,000 Gain on dispositions of real estate investments683 
Impairment of real estate investmentsImpairment of real estate investments(39,191,000)Impairment of real estate investments(17,340)
Income from unconsolidated entities
1,680,000 
Gain on re-measurement of previously held equity interest19,567,000 
Foreign currency loss
(8,689,000)
Income from unconsolidated entitiesIncome from unconsolidated entities2,024 
Foreign currency lossForeign currency loss(4,994)
Other incomeOther income2,399,000 Other income1,729 
Total net other expenseTotal net other expense(92,132,000)Total net other expense(61,068)
Loss before income taxes
(23,584,000)
Income tax expense
(499,000)
Loss before income taxesLoss before income taxes(16,066)
Income tax expenseIncome tax expense(373)
Net loss
$(24,083,000)
Net lossNet loss$(16,439)
Total assets by reportable segment as of June 30, 2023 and December 31, 2022 were as follows (in thousands):
June 30,
2023
December 31,
2022
Integrated senior health campuses$2,159,186 $2,157,748 
MOBs1,307,564 1,379,502 
SHOP594,980 635,190 
Senior housing — leased252,658 249,576 
SNFs218,278 245,717 
Hospitals106,667 106,067 
Other27,051 12,898 
Total assets$4,666,384 $4,786,698 
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AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
Integrated
Senior Health
Campuses
SHOPMedical
Office
Buildings
Senior
Housing —
Leased
Skilled
Nursing
Facilities
Hospitals
Nine Months
Ended
September 30, 2021
Revenues and grant income:
Resident fees and services$754,384,000 $61,876,000 $— $— $— $— $816,260,000 
Real estate revenue— — 60,335,000 10,798,000 10,993,000 8,207,000 90,333,000 
Grant income10,063,000 201,000 — — — — 10,264,000 
Total revenues and grant income764,447,000 62,077,000 60,335,000 10,798,000 10,993,000 8,207,000 916,857,000 
Expenses:
Property operating expenses700,781,000 51,608,000 — — — — 752,389,000 
Rental expenses— — 22,754,000 116,000 1,108,000 384,000 24,362,000 
Segment net operating income$63,666,000 $10,469,000 $37,581,000 $10,682,000 $9,885,000 $7,823,000 $140,106,000 
Expenses:
General and administrative$23,608,000 
Business acquisition expenses7,631,000 
Depreciation and amortization78,414,000 
Other income (expense):
Interest expense:
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishment)(57,740,000)
Gain in fair value of derivative financial instruments5,456,000 
Loss on dispositions of real estate investments(101,000)
Impairment of real estate investments(3,335,000)
Loss from unconsolidated entities(2,288,000)
Foreign currency loss(741,000)
Other income811,000 
Total net other expense(57,938,000)
Loss before income taxes(27,485,000)
Income tax expense(785,000)
Net loss$(28,270,000)
Total assetsAs of and for the six months ended June 30, 2023 and 2022, goodwill by reportable segment was as of September 30, 2022follows (in thousands):
Integrated
Senior Health
Campuses
SHOPMOBsSenior
Housing —
Leased
SNFsHospitalsTotal
Balance — December 31, 2022$164,846 $— $47,812 $5,924 $8,640 $4,389 $231,611 
Goodwill acquired3,331 — — — — — 3,331 
Balance June 30, 2023
$168,177 $— $47,812 $5,924 $8,640 $4,389 $234,942 
Integrated
Senior Health
Campuses
SHOPMOBsSenior
Housing —
Leased
SNFsHospitalsTotal
Balance — December 31, 2021$119,856 $23,277 $47,812 $5,924 $8,640 $4,389 $209,898 
Goodwill acquired2,816 — — — — — 2,816 
Balance June 30, 2022
$122,672 $23,277 $47,812 $5,924 $8,640 $4,389 $212,714 
See Note 3, Real Estate Investments, Net and December 31, 2021 were as follows:
September 30,
2022
December 31,
2021
Integrated senior health campuses$2,167,850,000 $1,896,608,000 
Medical office buildings1,392,302,000 1,412,247,000 
SHOP576,181,000 625,164,000 
Skilled nursing facilities248,141,000 252,869,000 
Senior housing — leased245,429,000 255,555,000 
Hospitals106,859,000 109,834,000 
Other21,884,000 28,062,000 
Total assets$4,758,646,000 $4,580,339,000 
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AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
In connection with the AHI Acquisition, we recorded goodwill of $134,589,000, which was allocated across our reporting segments. As discussed in Note 4, Business Combinations, for a further discussion of goodwill recognized in connection with the acquisitions we completed during the nine months ended September 30, 2022 that were accounted for asour business combinations, we recorded an aggregate goodwill of $44,990,000, which was allocated to our integrated senior health campuses segment. As of September 30, 2022, goodwill of $164,846,000, $47,812,000, $23,277,000, $8,640,000, $5,924,000 and $4,389,000 was allocated to our integrated senior health campuses, medical office buildings, SHOP, skilled nursing facilities, senior housing — leased and hospitals segments, respectively. As of December 31, 2021, goodwill of $119,856,000, $47,812,000, $23,277,000, $8,640,000, $5,924,000 and $4,389,000 was allocated to our integrated senior health campuses, medical office buildings, SHOP, skilled nursing facilities, senior housing — leased and hospitals segments, respectively.combinations.
Our portfolio of properties and other investments are located in the United States, the UK and Isle of Man. Revenues and grant income and assets are attributed to the country in which the property is physically located. The following is a summary of geographic information for our operations for the periods presented:presented (in thousands):
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended June 30,Six Months Ended June 30,
2022202120222021 2023202220232022
Revenues and grant income:Revenues and grant income:Revenues and grant income:
United StatesUnited States$425,070,000 $316,192,000 $1,187,069,000 $912,964,000 United States$466,397 $387,120 $917,489 $761,999 
InternationalInternational1,092,000 1,294,000 3,523,000 3,893,000 International1,174 1,179 2,308 2,431 
$426,162,000 $317,486,000 $1,190,592,000 $916,857,000 $467,571 $388,299 $919,797 $764,430 
The following is a summary of real estate investments, net by geographic regions as of SeptemberJune 30, 20222023 and December 31, 2021:2022 (in thousands):
September 30,
2022
December 31,
2021
June 30,
2023
December 31,
2022
Real estate investments, net:Real estate investments, net:Real estate investments, net:
United StatesUnited States$3,487,451,000 $3,466,019,000 United States$3,439,139 $3,539,453 
InternationalInternational39,140,000 48,667,000 International43,665 42,156 
$3,526,591,000 $3,514,686,000 $3,482,804 $3,581,609 
20.17. Concentration of Credit Risk
Financial instruments that potentially subject us to a concentration of credit risk are primarily our debt security investment, cash and cash equivalents, restricted cash and accounts and other receivables. We are exposed to credit risk with respect to our debt security investment, but we believe collection of the outstanding amount is probable. Cash and cash equivalents are generally invested in investment-grade, short-term instruments with a maturity of three months or less when purchased. We have cash and cash equivalents in financial institutions that are insured by the Federal Deposit Insurance Corporation, or FDIC. As of SeptemberJune 30, 20222023 and December 31, 2021,2022, we had cash and cash equivalents in excess of FDIC insured limits. We believe this risk is not significant. Concentration of credit risk with respect to accounts receivable from tenants and residents is limited. We perform credit evaluations of prospective tenants and security deposits are obtained at the time of property acquisition and upon lease execution.
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AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
Based on leases in effect as of SeptemberJune 30, 2022,2023, properties in one statetwo states in the United States accounted for 10.0% or more of our total consolidated property portfolio’s annualized base rent or annualized NOI, which is based on contractual base rent from leases in effect for our non-RIDEA properties and annualized NOI for our SHOP and integrated senior health campuses as of SeptemberJune 30, 2022.2023. Properties located in Indiana and Michigan accounted for 42.3%34.6% and 10.9%, respectively, of our total consolidated property portfolio’s annualized base rent or annualized NOI. Accordingly, there is a geographic concentration of risk subject to fluctuations in sucheach state’s economy.
Based on leases in effect as of SeptemberJune 30, 2022,2023, our six reportable business segments, integrated senior health campuses, medical office buildings, skilled nursing facilities,MOBs, SNFs, SHOP, senior housing — leased hospitals and SHOPhospitals accounted for 45.3%44.4%, 37.9%35.0%, 7.8%7.3%, 3.8%6.1%, 3.0%4.1% and 2.2%3.1%, respectively, of our total consolidated property portfolio’s annualized base rent or annualized NOI. As of SeptemberJune 30, 2022,2023, none of our tenants at our properties accounted for 10.0% or more of our total consolidated property portfolio’s annualized base rent or annualized NOI.
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AMERICAN HEALTHCARE REIT, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
21.18. Per Share Data
Basic earnings (loss) per share for all periods presented are computed by dividing net income (loss) applicable to common stock by the weighted average number of shares of our common stock outstanding during the period. Net income (loss) applicable to common stock is calculated as net income (loss) attributable to controlling interest less distributions allocated to participating securities of $1,497,000$962,000 and $1,000, respectively,$1,498,000 for the three months ended SeptemberJune 30, 2023 and 2022, respectively, and 2021,$1,888,000 and $4,485,000 and $2,000, respectively,$2,988,000 for the ninesix months ended SeptemberJune 30, 2023 and 2022, and 2021.respectively. Diluted earnings (loss) per share are computed based on the weighted average number of shares of our common stock and all potentially dilutive securities, if any. Time-based restricted stock units,TBUs, nonvested shares of our restricted common stockRSAs and limited partnership units of our operating partnership are participating securities and give rise to potentially dilutive shares of our common stock.
As of SeptemberJune 30, 20222023 and 2021,2022, there were 892,258188,368 and 16,679221,740 nonvested shares, respectively, of our restricted common stockRSAs outstanding, but such shares were excluded from the computation of diluted earnings (loss) per share because such shares were anti-dilutive during these periods. As of Septemberboth June 30, 20222023 and 2021,2022, there were 14,007,903 and 2063,501,976 limited partnership units respectively, of our operating partnership outstanding, but such units were also excluded from the computation of diluted earnings (loss) per share because such units were anti-dilutive during these periods. As of SeptemberJune 30, 2023 and 2022, there were 76,800163,133 and 19,200 nonvested time-based restricted stock units outstanding, which were granted on April 1, 2022,respectively, but such units were excluded from the computation of diluted earnings (loss) per share because such restricted stock units were anti-dilutive during the period.
As of SeptemberJune 30, 2022,2023, there were 117,41070,751 nonvested performance-based restricted stock units outstanding, of which 113,205 were awarded in October 2021 and 4,205 were awarded in August 2022, with a grant date in April 2022 and August 2022, respectively, which were treated as contingently issuable shares pursuant to ASC Topic 718, Compensation — Stock Compensation. Such contingently issuable shares were excluded from the computation of diluted earnings (loss) per share because they were anti-dilutive during the period.
22.19. Subsequent EventsEvent
In connectionInterest Rate Swap
We, through our operating partnership, entered into an interest rate swap transaction, or the Swap, with Regions Bank with an effective date of August 8, 2023 and a maturity date of January 19, 2026. We entered into the Swap to mitigate the risk associated with the filing of the Registration Statement on Form S-11 for a proposed public offeringremaining $275,000,000 of our sharesfloating-rate term loan that was unhedged (without incurring substantial prepayment penalties or defeasance costs typically associated with fixed-rate indebtedness) under our existing 2022 Credit Facility. Beginning on September 1, 2023, we are required to make monthly fixed-rate payments at a rate of common stock in conjunction with a contemplated listing of our common stock4.41% while the counterparty is obligated to make monthly floating-rate payments based on the New York Stock Exchange, as discussed in Note 1, Organization and Description of Business — Public Offerings, our board approved the following:
Reverse Stock Split
On November 10, 2022, our board approved the following charter amendments to effect on November 15, 2022: (i) a one-for-four reverse stock split of each issued and outstanding share of Class T common stock, par value $0.01 per share, and Class I common stock, par value $0.01 per share,Term SOFR, which resulted in a par value of $0.04 per share for each class of shares of our common stock; and (ii) a decrease to the par value per share of each share of our common stock outstanding as a result of the reverse stock split from $0.04 to $0.01.
Suspension of DRIP
On November 14, 2022, our board approved the suspension of the AHR DRIP Offering beginning with the distributions declared, if any, for the quarter ending December 31, 2022. As a result of the suspension of the AHR DRIP, there will be no further issuances of shares of our Class T or Class I common stock pursuant to the AHR DRIP unless and until our board reinstates the AHR DRIP Offering, and stockholders who are current participants in the AHR DRIP will receive cash distributions instead.
Suspension of Share Repurchase Plan
On November 14, 2022, our board approved the suspension of our share repurchase plan beginning with share repurchase requests for the quarter ending December 31, 2022. All share repurchase requests outstandingwas 5.30% as of the quarter ending December 31, 2022, including requests resulting from the death or qualifying disability of stockholders, shall not be processed, shall be considered canceled in full and shall not be considered outstanding repurchase requests.August 8, 2023.
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Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations.
The use of the words “we,” “us” or “our” refers to Griffin-American Healthcare REIT III, Inc., or GAHR III, and its subsidiaries, including Griffin-American Healthcare REIT III Holdings, LP, for periods prior to the Merger, as defined below, and American Healthcare REIT, Inc. (formerly known as Griffin-American Healthcare REIT IV, Inc., or GAHR IV) and its subsidiaries, including American Healthcare REIT Holdings, LP, (formerly known as Griffin-American Healthcare REIT III Holdings, LP), for periods following the Merger, except where otherwise noted. Certain historical information of GAHR IV is included for background purposes.
The following Management's Discussion and Analysis of Financial Condition and Results of Operations is intended to promote understanding of our results of operations and financial condition. The followingSuch discussion is provided as a supplement to, and should be read in conjunction with our accompanying condensed consolidated financial statements and notes thereto appearing elsewhere in this Quarterly Report on Form 10-Q and in our 20212022 Annual Report on Form 10-K, as filed with the United States Securities and Exchange Commission, or SEC, on March 25, 2022.17, 2023. Such condensed consolidated financial statements and information have been prepared to reflect our financial position as of SeptemberJune 30, 20222023 and December 31, 2021,2022, together with our results of operations and cash flows for the three and ninesix months ended SeptemberJune 30, 20222023 and 2021.2022. Our results of operations and financial condition, as reflected in the accompanying condensed consolidated financial statements and related notes, are subject to management’s evaluation and interpretation of business conditions, changing capital market conditions, and other factors that could affect the ongoing viability of our tenants and residents.
In connection with the Merger (as discussed and defined below), GAHR IV was the legal acquiror of GAHR III, whereas GAHR III was the accounting acquiror of GAHR IV in accordance with accounting principles generally accepted in the United States of America, or GAAP, and as discussed in Note 1, Organization and Description of Business, to our accompanying condensed consolidated financial statements. Thus, the financial information set forth herein subsequent to the Merger reflects results of the Combined Company (as defined below), and the financial information set forth herein prior to the Merger reflects GAHR III’s results. For this reason, period to period comparisons may not be meaningful.
Forward-Looking Statements
Certain statements contained in this report, other than historical facts, may be considered forward-looking statements within the meaning of Section 27A of the Securities Act, Section 21E of the Securities Exchange Act of 1934, as amended, or the Exchange Act, and the Private Securities Litigation Reform Act of 1995 (collectively with the “Acts”“Securities Act and Exchange Act, or the Acts”). We intend for all such forward-looking statements to be covered by the applicable safe harbor provisions for forward-looking statements contained in the Acts. Such forward-looking statements generally can be identified by the use of forward-looking terminology such as “may,” “will,” “can,” “expect,” “intend,” “anticipate,” “estimate,” “believe,” “continue,” “possible,” “initiatives,” “focus,” “seek,” “objective,” “goal,” “strategy,” “plan,” “potential,” “potentially,” “preparing,” “projected,” “future,” “long-term,” “once,” “should,” “could,” “would,” “might,” “uncertainty,” or other similar words. Readers are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date this report is filed with the SEC.
Any such forward-looking statements are based on current expectations, estimates and projections about the industry and markets in which we operate, and beliefs of, and assumptions made by, our management and involve uncertainties that could significantly affect our financial results. Such statements include, but are not limited to: (1)(i) statements about our plans, strategies, initiatives and prospects; (2) statements about the impactprospects, including our proposed listing and future capital-raising initiatives and planned or future acquisitions or dispositions of the Merger; (3)properties and other assets; (ii) statements about the coronavirus, or COVID-19, pandemic, including its duration and potential or expected impact on our business and our view on forward trends;trends as well as the termination of the federally declared public health emergency; and (4)(iii) statements about our future results of operations, capital expenditures and liquidity. Such statements are subject to known and unknown risks and uncertainties, which could cause actual results to differ materially from those projected or anticipated, including, without limitation: changes in economic conditions generally and the real estate market specifically; the continuing adverse effects of the COVID-19 pandemic, including its effects on the healthcare industry, senior housing and skilled nursing facilities, or SNFs, and the economy in general; legislative and regulatory changes, including changes to laws governing the taxation of real estate investment trusts, or REITs; the availability of capital; our ability to pay down, refinance, restructure or extend our indebtedness as it becomes due; our ability to maintain our qualification as a REIT for U.S. federal income tax purposes; changes in interest rates, including uncertainties about whether and when interest rates will continue to increase, and foreign currency risk; uncertainty from the discontinuance of the London Inter-bank Offered Rate, or LIBOR, and the transition to the Secured Overnight Financing Rate, or SOFR; competition in the real estate industry; changes in GAAP policies and guidelines applicable to REITs; the success of our investment strategy; information technology security breaches; our ability to retain our executivesexecutive officers and key employees; and unexpected labor costs and inflationary pressures. These risks and uncertainties should be considered in evaluating forward-looking statements and undue reliance should not be placed on such statements. Forward-looking statements in this Quarterly Report on Form 10-Q speak only as of the date on which such statements are made, and undue reliance should not be placed on such statements. We undertake no obligation to update any such statements that may become untrue because of subsequent events. Additional information concerning us and our business, including additional factors that could materially affect our financial results, is included herein and in our other filings with the SEC.
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Overview and Background
American Healthcare REIT, Inc., a Maryland corporation, is a leading internally-managed real estate investment trust, orself-managed REIT that owns a diversified portfolio of clinical healthcare real estate properties, focusing primarily on medical office buildings, skilled nursing facilities,or MOBs, senior housing, SNFs, hospitals and other healthcare-related facilities. We have built a fully-integrated management platform, with approximately 113 employees, that operates clinical healthcare properties throughout the United States, the United Kingdom, and the Isle of Man. We also operate healthcare-related facilities utilizing the structure permitted by the REIT Investment Diversification and Empowerment Act of 2007, which is commonly referred to as a “RIDEA” structure (the provisions of the Internal Revenue Code of 1986, as amended, or the Code, authorizing the RIDEA structure were enacted as part of the Housing and Economic Recovery Act of 2008). Our healthcare facilities operated under a RIDEA structure include our senior housing operating properties, or SHOP, (formerly known as senior housing — RIDEA), and our integrated senior health campuses. We have originated and acquired secured loans and may also originate and acquire other real estate-related investments on an infrequent and opportunistic basis. We generally seek investments that produce current income; however, we have selectively developed, and may continue to selectively develop, healthcare real estate properties. We qualifiedhave elected to be taxed as a REIT under the Code for U.S. federal income tax purposes,purposes. We believe that we have been organized and operated, and we intend to continue to qualify to be taxedoperate, in conformity with the requirements for qualification and taxation as a REIT. REIT under the Code.
Merger ofOn October 1, 2021, Griffin-American Healthcare REIT III, Inc. and Griffin-American Healthcare REIT IV, Inc.
On October 1, 2021, pursuant to an Agreement and Plan of Merger dated June 23, 2021,, or the Merger Agreement, GAHR III, merged with and into Continental Merger Sub, LLC, a Maryland limited liability company and newly formed wholly owned subsidiary, of GAHR IV, or Merger Sub, of Griffin-American Healthcare REIT IV, Inc., or GAHR IV, with Merger Sub being the surviving company, orwhich we refer to as the REIT Merger. On October 1, 2021, also pursuant to the Merger, Agreement,and our operating partnership, Griffin-American Healthcare REIT IV Holdings, LP, a Delaware limited partnership and subsidiary and operating partnership of GAHR IV, or GAHR IV Operating Partnership, merged with and into Griffin-American Healthcare REIT III Holdings, LP, a Delaware limited partnership, or our operating partnership,the Surviving Partnership, with our operating partnershipthe Surviving Partnership being the surviving entity, or the Partnership Merger. We collectivelywhich we refer to the REIT Merger andas the Partnership Merger asand, together with the REIT Merger, the Merger. Following the Merger on October 1, 2021, our company or the Combined Company, was renamed American Healthcare REIT, Inc. and our operating partnership, also referred to as the surviving partnership,Surviving Partnership was renamed American Healthcare REIT Holdings, LP. The REIT Merger qualified as a reorganization under, and within the meaning of, Section 368(a) of the Code. As a result of and at the effective time of the Merger, the separate corporate existence of GAHR III and GAHR IV Operating Partnership ceased.
At the effective time of the REIT Merger, each issued and outstanding share of GAHR III’s common stock, $0.01 par value per share, converted into the right to receive 0.9266 shares of GAHR IV’s Class I common stock, $0.01 par value per share. Further, at the effective time of the Partnership Merger, (i) each unit of limited partnership interest in the surviving partnership outstanding as of immediately prior to the effective time of the Partnership Merger was converted automatically into the right to receive 0.9266 of a Partnership Class I Unit, as defined in the agreement of limited partnership, as amended, of the surviving partnership, and (ii) each unit of limited partnership interest in GAHR IV Operating Partnership outstanding as of immediately prior to the effective time of the Partnership Merger was converted automatically into the right to receive one unit of limited partnership interest of the surviving partnership of like class.
AHI AcquisitionLP, or our operating partnership.
Also on October 1, 2021, immediately prior to the consummation of the Merger, and pursuant to a contribution and exchange agreement dated June 23, 2021, GAHR III acquired a newly formed entity, American Healthcare Opps Holdings, LLC, or NewCo, which we refer to as the AHI Acquisition, pursuant to a contribution and exchange agreement dated June 23, 2021, or the Contribution Agreement, between GAHR III; our operating partnership; American Healthcare Investors, LLC, or AHI; Griffin Capital Company, LLC, or Griffin Capital; Platform Healthcare Investor T-II, LLC; Flaherty Trust; and Jeffrey T. Hanson, our former Chief Executive Officer and current non-executive Chairman of the Board of Directors, Danny Prosky, our former Chief Operating Officer and current Chief Executive Officer and President, and Mathieu B. Streiff, our former Executive Vice President, General Counsel and Chief Operating Officer and current Executive Vice President, or collectively, the AHI Principals. NewCo owned substantially all of the business and operations of AHI, as well as all of the equity interests in (i) Griffin-American Healthcare REIT IV Advisor, LLC, or GAHR IV Advisor, a subsidiary of AHI that served as the external advisor of GAHR IV, and (ii) Griffin-American Healthcare REIT III Advisor, LLC, or GAHR III Advisor, also referred to as our former advisor, a subsidiary of AHI that served as the external advisor of GAHR III. See “Operating Partnership and Former Advisor” below for a further discussion.
Pursuant to the Contribution Agreement, AHI contributed substantially all of its business and operations to the surviving partnership, including its interest in GAHR III Advisor and GAHR IV Advisor, and Griffin Capital contributed its then-current ownership interest in GAHR III Advisor and GAHR IV Advisor to the surviving partnership. In exchange for these contributions, the surviving partnership issued limited partnership units, or surviving partnership OP units. Subject to working capital and other customary adjustments, the total approximate value of these surviving partnership OP units at the time of
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consummation of the transactions contemplated by the Contribution Agreement was approximately $131,674,000, with a reference value for purposes thereof of $8.71 per unit, such that the surviving partnership issued 15,117,529 surviving partnership OP units as consideration, or the Closing Date Consideration.Acquisition. Following the consummation of the Merger and the AHI Acquisition, the Combined Companyour company became self-managed. Such surviving partnership OP units are owned by AHI Group Holdings, LLC, or AHI Group Holdings, which is owned and controlled by the AHI Principals, Platform Healthcare Investor T-II, LLC, Flaherty Trust and a wholly owned subsidiary of Griffin Capital, or collectively, the NewCo Sellers.
The AHI Acquisition was treated as a business combination for accounting purposes, with GAHR III as both the legal and accounting acquiror of NewCo. While GAHR IV was the legal acquiror of GAHR III in the REIT Merger, GAHR III was determined to be the accounting acquiror in the REIT Merger in accordance with Financial Accounting Standards Board Accounting Standards Codification, Topic 805, Business Combinations, after considering the relative share ownership and the composition of the governing body of the Combined Company. Thus, the financial information set forth herein subsequent to the consummation of the Merger and the AHI Acquisition reflects results of the Combined Company, and the financial information set forth herein prior to the Merger and the AHI Acquisition reflects GAHR III’s results. For this reason, period to period comparisons may not be meaningful.
Operating Partnership and Former Advisor
We conduct substantially all of our operations through our operating partnership, and we are the sole general partner of our operating partnership. Through SeptemberAs of both June 30, 2021, 2023 and December 31, 2022, we owned 95.0% of the partnership units, or OP units, in our operating partnership, and the remaining 5.0% limited OP units, were externally advisedowned by our former advisor pursuant to an advisory agreement, as amended, orAHI Group Holdings, LLC, which is owned and controlled by Jeffrey T. Hanson, the Advisory Agreement, between us and our former advisor. Our former advisor, subject to the oversight and reviewnon-executive Chairman of our board of directors, or our board, provided asset management, property management, acquisition, dispositionDanny Prosky, our Chief Executive Officer and other advisory services on our behalf consistent with our investment policiesPresident, and objectives.Following the Merger and the AHI Acquisition, we became self-managed and are no longer externally advised. As a result, any fees that would have otherwise been payable to our former advisor are no longer being paid. Also, on October 1, 2021 and in connection with the AHI Acquisition, our operating partnership redeemed all 22,222 sharesMathieu B. Streiff, one of our common stock owned by our former advisordirectors; Platform Healthcare Investor TII, LLC; Flaherty Trust; and the 20,833 shares of our Class T common stock owned by GAHR IV Advisor in GAHR IV.
Prior to the Merger and the AHI Acquisition, our former advisor was 75.0% owned and managed by wholly owned subsidiaries of AHI, and 25.0% owned by a wholly owned subsidiary of Griffin Capital Company, LLC, or collectively, our former co-sponsors. Prior to the AHI Acquisition, AHI was 47.1% owned by AHI Group Holdings, 45.1% indirectly owned by DigitalBridge Group, Inc. (NYSE: DBRG), or DigitalBridge, and 7.8% owned by James F. Flaherty III. We were not affiliated with Griffin Capital, DigitalBridge or Mr. Flaherty; however, we were affiliated with our former advisor, AHI and AHI Group Holdings. Please see the “Merger of Griffin-American Healthcare REIT III, Inc. and Griffin-American Healthcare REIT IV, Inc.” and “AHI Acquisition” sections above for a further discussion of our operations effective October 1, 2021.NewCo Sellers. See Note 13,11, Redeemable Noncontrolling Interests, and Note 14,12, Equity — Noncontrolling Interests in Total Equity, to our accompanying condensed consolidated financial statements for a further discussion of the ownership in our operating partnership.
Public Offerings
GAHR IV raised $754,118,000 through a best efforts initial public offering, orAs of June 30, 2023, after taking into consideration the initial offering,Merger and the impact of the reverse stock split as discussed below, we had issued 75,639,681 aggregate65,445,557 shares of its Class T and Class I common stock. In addition, during the initial offering, GAHR IV issued 3,253,535 aggregate shares of its Class T and Class I common stock pursuant to GAHR IV’s distribution reinvestment plan, as amended, or the DRIP, for a total of $31,021,000 in reinvested distributions. Following the deregistration of the initial offering, GAHR IV continued issuing shares of its common stock up to $100,000,000 pursuant to the DRIP through a subsequent offering, or the 2019 GAHR IV DRIP Offering, pursuant to a Registration Statement on Form S-3 under the Securities Act. GAHR IV commenced offering shares pursuant to the 2019 GAHR IV DRIP Offering on March 1, 2019, following the termination of the initial offering on February 15, 2019. On March 18, 2021, the GAHR IV board of directors authorized the suspension of the DRIP, effective as of April 1, 2021.
On October 4, 2021, our board authorized the reinstatement of the DRIP, as amended, or the AHR DRIP, to offer up to $100,000,000 of shares of our common stock pursuant to a Registration Statement on Form S-3 under the Securities Act previously filed by GAHR IV, or the AHR DRIP Offering. On November 14, 2022, our board suspended the AHR DRIP Offering beginning with the distributions declared, if any, for the quarter ending December 31, 2022. See Note 22, Subsequent Events, to our accompanying condensed consolidated financial statements. As of September 30, 2022, a total of $80,754,000 in distributions were reinvested that resulted in 8,575,687 shares$2,737,716,000 of common stock being issued pursuantsince February 26, 2014 in our initial public offerings and our distribution reinvestment plan, or DRIP, offerings (includes historical offering amounts sold by GAHR III and GAHR IV prior to the AHR DRIP. See Note 14, Equity — Distribution Reinvestment Plan, to our accompanying condensed consolidated financial statements for a further discussion.
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Merger).
On September 16, 2022, we filed with the SEC a Registration Statement on Form S-11 (File No. 333-267464), and on July 14, 2023, we filed with the SEC Amendment No. 1 to the Registration Statement on Form S-11, with respect to a proposed primary public offering by us of our shares of common stock in conjunction with a contemplated listing of our common stock on the New York Stock Exchange.Exchange, or the Proposed Listing. Such registration statement and contemplated listing are not yet effective. The potential public offering is subject
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On November 15, 2022 we effected a one-for-four reverse stock split of our common stock and a corresponding reverse split of the OP units, or the Reverse Splits. All numbers of common shares and per share data, as well as the OP units, in our accompanying condensed consolidated financial statements and related notes have been retroactively adjusted for all periods presented to market conditions, and there can be no assurance as to whether, or when, any such offering may be completed, or asgive effect to the size,Reverse Splits. See Note 12, Equity, to our accompanying condensed consolidated financial statements, for a further discussion of our public offering price or other terms of such offering.offerings.
On March 24, 2022,15, 2023, our board, at the recommendation of the audit committee of our board, which is comprised solely of independent directors, unanimously approved and established an updated estimated per share net asset value, or NAV, of our common stock of $9.29 as of December 31, 2021.$31.40. We provide this updated estimated per share NAV annually to assist broker-dealers in connection with their obligations under Financial Industry Regulatory Authority, or FINRA, Rule 2231 with respect to customer account statements. The updated estimated per share NAV is based on the estimated value of our assets less the estimated value of our liabilities, divided by the number of shares outstanding on a fully diluted basis, calculated as of December 31, 2021.2022. The valuation was performed in accordance with the methodology provided in Practice Guideline 2013-01, Valuations of Publicly Registered Non-Listed REITs, issued by the Institute for Portfolio Alternatives, or the IPA, in April 2013, in addition to guidance from the SEC. See our Current Report on Form 8-K filed with the SEC on March 25, 202217, 2023 for more information on the methodologies and assumptions used to determine, and the limitations and risks of, our updated estimated per share NAV.
Our Real Estate Investments Portfolio
We currently operate through six reportable business segments: integrated senior health campuses, medical office buildings, skilled nursing facilities,MOBs, SNFs, SHOP, senior housing — leased hospitals and SHOP.hospitals. As of SeptemberJune 30, 2022,2023, we owned and/or operated 312300 buildings and integrated senior health campuses, orincluding completed development and expansion projects, representing approximately 19,432,00019,142,000 square feet of gross leasable area, or GLA, for an aggregate contract purchase price of $4,548,366,000, including the fair value of the properties acquired in the Merger.$4,517,298,000. In addition, as of SeptemberJune 30, 2022,2023, we also owned a real estate-related debt investment purchased for $60,429,000.
Critical Accounting Estimates
Our accompanying condensed consolidated financial statements are prepared in conformity with GAAP, which requires management to make estimates and assumptions that affect the amounts reported in our financial statements and accompanying footnotes. These estimates are made and evaluated on an on-going basis using information that is currently available as well as various other assumptions believed to be reasonable under the circumstances. Actual results could differ from those estimates, perhaps in material adverse ways, and those estimates could be different under different assumptions or conditions. The complete listing of our Critical Accounting Estimates was previously disclosed in our 20212022 Annual Report on Form 10-K, as filed with the SEC on March 25, 2022,17, 2023, and there have been no material changes to our Critical Accounting Estimates as disclosed therein, except as included within Note 2, Summary of Significant Accounting Policies, to our accompanying condensed consolidated financial statements.
Interim Unaudited Financial Data
For a discussion of interim unaudited financial data, see Note 2, Summary of Significant Accounting Policies — Interim Unaudited Financial Data, to our accompanying condensed consolidated financial statements. Our accompanying condensed consolidated financial statements should be read in conjunction with our audited consolidated financial statements and the notes thereto included in our 20212022 Annual Report on Form 10-K, as filed with the SEC on March 25, 2022.17, 2023.
Acquisitions and Dispositions in 20222023
For a discussion of our acquisitions and dispositions of investments in 2022,2023, see Note 3, Real Estate Investments, Net and Note 4, Business Combinations, to our accompanying condensed consolidated financial statements.
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Factors Which May Influence Results of Operations
In connection with the Merger, GAHR IV was the legal acquiror and GAHR III was the accounting acquiror for financial reporting purposes, as discussed in Note 1, Organization and Description of Business, to our accompanying condensed consolidated financial statements. Thus, the financial information set forth herein subsequent to the Merger reflects results of the Combined Company, and the financial information set forth herein prior to the Merger reflects GAHR III’s results. Furthermore, as a result of the AHI Acquisition and the Merger on October 1, 2021, we employed a workforce necessary to operate as a self-managed company. The impact on our results of operations from operating as a self-managed company is predominantly an increase in general and administrative costs related to employing the necessary workforce and cost savings associated with no longer paying advisory fees to our former advisor. For these reasons, period to period comparisons may not be meaningful.
Other than the effects of the Mergerinflation and the AHI Acquisition discussed above, andlasting effects of the COVID-19 pandemic discussed below, as well as other national economic conditions affecting real estate generally, or as otherwise disclosed in our risk factors, we are not aware of any material trends or uncertainties that may reasonably be expected to have a material impact, favorable or unfavorable, on revenues or income from the acquisition, disposition, management and operation of our properties. For a further discussion of these and other factors that could impact our future results or performance, see “Forward-Looking Statements” above and Part II, Item 1A, Risk Factors, of this Quarterly Report on Form 10-Q and Part I, Item 1A,those Risk Factors previously disclosed in our 20212022 Annual Report on Form 10-K, as filed with the SEC on March 25, 2022.17, 2023.
COVID-19
Our residents, tenants, operating partners and managers, our industry and the U.S. economy continue to behave been adversely affected by the impact of the COVID-19 pandemic and related supply chain disruptions and labor shortages. Thethe economic impact of the pandemic. While the immediate effects of the
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COVID-19 pandemic have subsided, the timing and extent of the economic recovery from the COVID-19 pandemictowards pre-pandemic norms is dependent upon many factors, including the emergence and severity of future COVID-19 variants, the continued effectiveness and frequency of booster vaccinations, and the duration and implications of continuedongoing or future restrictions and safety measures.measures, the availability of ongoing government financial support to our tenants, operating partners and managers and the overall pace of economic recovery, among others. As the COVID-19 pandemic is still impacting the healthcare system to a certain extent, it continues to present challenges for us as an owner and operator of healthcare facilities, making it difficultwe expect to ascertaincontinue to be adversely affected by the long-term impacteffects of the COVID-19 pandemic will havefor some period of time; however, it is not possible to predict the full extent of its future impact on real estateus, the operations of our properties or the markets in which we own and/they are located, or operate properties and our portfolio of investments.the overall healthcare industry. COVID-19 is particularly dangerous among the senior population and results in heightened risk to our senior housing and skilled nursing facilities,SNFs, and we continue to work diligently to maintain aggressive protocols at such facilities as well as actively collaborate with our tenants, operating partners and managers to respond and take action to mitigate the impact of the COVID-19 pandemic.
We have evaluated thesuch economic impacts of the COVID-19 pandemic on our business thus far and incorporated information concerning such impacts into our assessments of liquidity, impairment and collectability from tenants and residents as of SeptemberJune 30, 2022.2023. We will continue to monitor such impacts and will adjust our estimates and assumptions based on the best available information.
The COVID-19 pandemic resulted in a significant decline in resident occupanciesoccupancy at our leased senior housing — leased facilities, and skilled nursing facilities,SNFs, SHOP and integrated senior health campuses and an increase in COVID-19 relatedCOVID-19-related operating expenses with more costly short-term hiresexpenses. Among other things, due to the shortage of healthcare personnel.personnel, the pandemic caused higher labor costs that continue to adversely affect us, including those related to greater reliance on agency staffing and more costly short-term hires. Expenses also increased due to pandemic-related costs (e.g., heightened cleaning and sanitation protocols) and the ongoing inflationary environment. This has, in general, resulted in decreased net operating income, or NOI, and margin at these properties relative to pre-pandemic levels. Therefore, our focus at such properties continues to be on residentimproving occupancy recovery and managing operating expense management.expenses. While resident occupancies at our integrated senior health campuses and leased senior housing and skilled nursing facilities have gradually improvedoccupancy has generally been improving, it has not returned to near pre-pandemic levels our SHOPacross all asset types, and labor costs remain elevated, as we have been slower to recover. We believe the operational recoveryhad difficulty filling open positions and experienced increased labor costs. The timing and extent of our SHOP and integrated senior health campusesany further improvement in occupancy or relief from the impactthese labor pressures remains unclear.
As a result of the federal government's COVID-19 pandemic will generally continuepublic health emergency declaration in January 2020 and thatits COVID-19 national emergency declaration in March 2020, certain federal and state pandemic-related relief measures, such recovery over time towards pre-pandemic levels will drive our overall portfolio performance.
To date, the impacts of the COVID-19 pandemic have been significant, rapidly evolving and may continue into the future. The information in this Quarterly Report on Form 10-Q is based on data currentlyas funding, procedural waivers and/or reimbursement increases, became available to us and some of our tenants and operators. These declarations expired on May 11, 2023 and April 10, 2023, respectively, and certain relief measures have been wound down and others are being phased out. It is unclear what pandemic related relief measures, including funding, waiver and reimbursement programs, that we and certain of our tenants and operators benefited from will likely change as the COVID-19 pandemic progresses. Future actions that maycontinue to be taken by state and local governments to mitigate the impact of COVID-19 variants that may emerge could disrupt our business, activities and operations,available or the extent to which are highly uncertain. We continue to closely monitor COVID-19 developments and are continuously assessing the implications to our business, residents, tenants, operating partners, managers and our portfolio of investments. We cannot predict with reasonable certainty when demand for healthcare services at our senior housing andthey will be available. The impact on individual skilled nursing facilitiesfacilities’ operators will returnvary, and therefore it is not possible to pre-COVID-19 pandemic levels.quantify the financial impact it will have on resident occupancies.
The lasting effect of the COVID-19 pandemic over the next 12 months will largely depend on future developments, including COVID-19 booster rates; the long term efficacy of COVID-19 vaccinations and boosters; and the potential emergence of new, more transmissible or severe variants, which cannot be predicted with confidence at this time. See the “Results of Operations” and “Liquidity and Capital Resources” sections below, for a further discussion.
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Inflation
During the ninesix months ended SeptemberJune 30, 20222023 and 2021,2022, inflation has affected our operations. The annual rate of inflation in the United States was 7.7%3.2% in October 2022,July 2023, as measured by the Consumer Price Index. We believe inflation has impacted our operations such that we have experienced, and continue to experience, increases in the cost of labor, services, energy and supplies, and therefore continued inflationary pressures on our integrated senior health campuses and SHOP could continue to impact our profitability in future periods. However, an inflationary environment has also impacted our operations at such properties in that we have the ability to seek increases in rent when relatively short-term resident leases expire (typically one year or less), which will improve our operating performance at such properties, as well as increase rent coverage and the stability of our real estate revenue in our senior housing — leased and SNF segments over time.
For properties that are not operated under a RIDEA structure, there are provisions in the majority of our tenant leases that help us mitigate the impact of inflation. These provisions include negotiated rental increases, which historically range from 2% to 3% per year, reimbursement billings for operating expense pass-through charges and real estate tax and insurance reimbursements. However, due to the long-term nature of existing leases, among other factors, the leases may not reset frequently enough to cover inflation. A period of
In addition, inflation could also causecaused an increase in the cost of our variable rate debt.variable-rate debt due to rising interest rates. See Item 3. Quantitative and Qualitative Disclosures About Market Risk — Interest Rate Risk section below, for a further discussion.
Scheduled Lease Expirations
Excluding our SHOP and integrated senior health campuses, as of SeptemberJune 30, 2022,2023, our properties were 92.6%92.5% leased, and during the remainder of 2022, 3.0%2023, 4.0% of the leased GLA is scheduled to expire. Our leasing strategy focuses on negotiating
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renewals for leases scheduled to expire during the next twelve months. In the future, if we are unable to negotiate renewals, we will try to identify new tenants or collaborate with existing tenants who are seeking additional space to occupy. As of SeptemberJune 30, 2022,2023, our remaining weighted average lease term was 7.46.9 years, excluding our SHOP and integrated senior health campuses.
Our combined SHOP and integrated senior health campuses were 81.8%82.6% leased as of SeptemberJune 30, 2022.2023. Substantially all of our leases with residents at such properties are for a term of one year or less.
Results of Operations
Comparison of Three and NineSix Months Ended SeptemberJune 30, 20222023 and 20212022
Our operating results are primarily comprised of income derived from our portfolio of properties and expenses in connection with the acquisition and operation of such properties. Our primary sources of revenue include rent generated by our leased, non-RIDEA properties, and resident fees and services revenue from our RIDEA properties. Our primary expenses include property operating expenses and rental expenses. In addition, beginning in the fourth quarter of 2021, following the AHI Acquisition that resulted in our company being self managed, general and administrative expenses include payroll and other corporate operating expenses but no longer include advisory fees to our former advisor. In general, and under a normal operating environment without the disruption of the COVID-19 pandemic, we expect amounts related to our portfolio of leased, non-RIDEA properties to increase in the future due to fixed annual rent escalations and amounts related to our portfolio of RIDEA properties to increase in the future due to an overall increase in market rents and an increase in the pricing of care services provided. The ability to compare one period to another is also impacted by the closing of the AHI Acquisition and the increase in size of our real estate portfolio as a result of the Merger. See Note 1, Organization and Description of Business, to our accompanying condensed consolidated financial statements for a further discussion.
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We segregate our operations into reporting segments in order to assess the performance of our business in the same way that management reviews our performance and makes operating decisions. As of SeptemberJune 30, 2022,2023, we operated through six reportable business segments: integrated senior health campuses, medical office buildings, skilled nursing facilities,MOBs, SNFs, SHOP, senior housing — leased hospitals and SHOP.hospitals.
Except where otherwise noted, the changes in our consolidated results of operations for 20222023 as compared to 20212022 are primarily due to the acquisitionadverse effect of GAHR IV’s portfolioinflation, which resulted in increases in the cost of 92 buildings, or approximately 4,799,000 square feetlabor, services, energy and supplies for the three and six months ended June 30, 2023 compared to the same period last year. There were also changes in our results of GLA,operations due to our acquisitions and dispositions of investments subsequent to June 30, 2022, as a resultwell as the transition of the Mergeroperations of skilled nursing facilities within our Central Wisconsin Senior Care Portfolio on OctoberMarch 1, 2021, the disruption2023 to a RIDEA structure, which facilities are included within our SHOP segment as of June 30, 2023. See Note 3, Real Estate Investments, Net and Business Combinations, to our normal operations asaccompanying condensed consolidated financial statements for a resultfurther discussion of the COVID-19 pandemicour acquisitions and grant income received.dispositions during 2023. As of SeptemberJune 30, 20222023 and 2021,2022, we owned and/or operated the following types of properties:properties (dollars in thousands):
September 30,June 30,
20222021 20232022
Number of
Buildings/
Campuses
Aggregate
Contract
Purchase Price
Leased
%
Number of
Buildings/
Campuses
Aggregate
Contract
Purchase Price
Leased
%
Number of
Buildings/
Campuses
Aggregate
Contract
Purchase Price
Leased
%
Number of
Buildings/
Campuses
Aggregate
Contract
Purchase Price
Leased
%
Integrated senior health campusesIntegrated senior health campuses121 $1,894,235,000 (1)120 $1,769,757,000 (1)Integrated senior health campuses123 $1,910,251 (1)122 $1,865,787 (1)
Medical office buildings105 1,378,995,000 89.6 %62 641,585,000 90.3 %
MOBsMOBs93 1,318,915 89.7 %105 1,378,995 90.3 %
SHOPSHOP47 706,871,000 (2)20 433,891,000 (2)SHOP47 745,567 (2)47 706,871 (2)
Senior housing — leasedSenior housing — leased20 179,285,000 100 %89,535,000 100 %Senior housing — leased20 179,285 100 %20 179,285 100 %
Skilled nursing facilities17 249,200,000 100 %119,500,000 100 %
SNFsSNFs15 223,500 100 %17 249,200 100 %
HospitalsHospitals139,780,000 100 %139,780,000 100 %Hospitals139,780 100 %139,780 100 %
Total/weighted average(3)Total/weighted average(3)312 $4,548,366,000 92.6 %219 $3,194,048,000 92.7 %Total/weighted average(3)300 $4,517,298 92.5 %313 $4,519,918 93.1 %
___________
(1)The leased percentage for the resident units of our integrated senior health campuses was 84.0%83.9% and 77.8%81.7% as of SeptemberJune 30, 20222023 and 2021,2022, respectively.
(2)The leased percentage for the resident units of our SHOP was 75.3%78.6% and 76.2%73.7% as of SeptemberJune 30, 20222023 and 2021,2022, respectively.
(3)Leased percentage includes all third-party leased space at our non-RIDEA properties (including master leases), and excludes our SHOP and integrated senior health campuses where leased percentage represents resident occupancy onof the available units/beds therein.
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Revenues and Grant Income
Our primary sources of revenue include rent generated by our leased, non-RIDEA properties, and resident fees and services revenue generated by our RIDEA properties and rent from our RIDEAleased, non-RIDEA properties. For the three and ninesix months ended SeptemberJune 30, 20222023 and 2021,2022, resident fees and services revenue primarily consisted of rental fees related to resident leases, extended health care fees and other ancillary services, and real estate revenue primarily consisted of base rent and expense recoveries. The amount of revenues generated by our RIDEA properties depends principally on our ability to maintain theresident occupancy rates. The amount of revenues generated by our non-RIDEA properties is dependent on our ability to maintain tenant occupancy rates of currently leased space and to lease available space at the then existing rental rates. We also receive grant income. Revenues and grant income by reportable segment consisted of the following for the periods then ended:ended (in thousands):
Three Months Ended September 30,Nine Months Ended September 30,Three Months Ended June 30,Six Months Ended June 30,
2022202120222021 2023202220232022
Resident Fees and Services RevenueResident Fees and Services RevenueResident Fees and Services Revenue
Integrated senior health campusesIntegrated senior health campuses$328,751,000 $265,343,000 $897,345,000 $754,384,000 Integrated senior health campuses$362,856 $287,582 $724,626 $568,594 
SHOPSHOP39,555,000 21,539,000 116,160,000 61,876,000 SHOP47,766 38,643 94,626 76,605 
Total resident fees and services revenueTotal resident fees and services revenue368,306,000 286,882,000 1,013,505,000 816,260,000 Total resident fees and services revenue410,622 326,225 819,252 645,199 
Real Estate RevenueReal Estate RevenueReal Estate Revenue
Medical office buildings37,128,000 19,677,000 111,798,000 60,335,000 
Skilled nursing facilities6,633,000 3,665,000 19,625,000 10,993,000 
MOBsMOBs36,640 36,833 74,123 74,670 
SNFsSNFs6,090 6,599 4,458 12,992 
Senior housing — leasedSenior housing — leased5,143,000 3,622,000 15,703,000 10,798,000 Senior housing — leased5,392 5,262 10,668 10,560 
HospitalsHospitals2,419,000 2,704,000 7,245,000 8,207,000 Hospitals2,446 2,411 4,915 4,826 
Total real estate revenueTotal real estate revenue51,323,000 29,668,000 154,371,000 90,333,000 Total real estate revenue50,568 51,105 94,164 103,048 
Grant IncomeGrant IncomeGrant Income
Integrated senior health campusesIntegrated senior health campuses5,796,000 936,000 21,861,000 10,063,000 Integrated senior health campuses6,381 10,969 6,381 16,065 
SHOPSHOP737,000 — 855,000 201,000 SHOP— — — 118 
Total grant incomeTotal grant income6,533,000 936,000 22,716,000 10,264,000 Total grant income6,381 10,969 6,381 16,183 
Total revenues and grant incomeTotal revenues and grant income$426,162,000 $317,486,000 $1,190,592,000 $916,857,000 Total revenues and grant income$467,571 $388,299 $919,797 $764,430 
Resident Fees and Services Revenue
For the three and nine months ended September 30, 2022, $14,601,000 and $43,144,000 respectively, in resident fees and services revenue for our SHOP segment was due to the increase in the size of our portfolio as a result of the Merger. The remaining increase in resident fees and services revenue was primarily attributable to improved resident occupancy and higher move-in fees, in addition to an increase of $1,610,000 and $4,561,000 for the three and nine months ended September 30, 2022, respectively, due to transitioning the leased senior housing facilities within Delta Valley ALF portfolio to a RIDEA structure and including such facilities within SHOP on December 1, 2021.
For our integrated senior health campuses segment, we experienced an increase of $27,311,000 for both the three and nine months ended September 30, 2022 in resident fees and services revenue of $40,636,000 and $83,754,000, respectively, for the three and six months ended June 30, 2023, as compared to the three and six months ended June 30, 2022, due toto: (i) our acquisition of the remaining 50.0% controlling interest in a privately held company, RHS Partners, LLC, or RHS. We previously held a 50.0% equity interest in RHS, on August 1, 2022, which owns and/or operates 16 integrated senior health campuses located in Indiana. ForIndiana; (ii) improved resident occupancy and higher resident fees as a result of an increase in billing rates; and (iii) an increase of $12,259,000 and $27,224,000 for the three and ninesix months ended SeptemberJune 30, 2022,2023, respectively, due to the expansion of our customer base, expansion of services offered and an increase in billing rates for such services at an ancillary business unit within Trilogy Investors, LLC, or Trilogy. Such amounts were partially offset by a decrease in total resident fees and services revenue of $4,479,000 and $8,464,000 for the three and six months ended June 30, 2023, respectively, due to dispositions within our integrated senior health campuses segment during the third and fourth quarter of 2022.
For our SHOP segment, we also experienced an increase in resident fees and services revenue of $2,995,000$6,721,000 and $8,432,000,$13,557,000, respectively, for the three and six months ended June 30, 2023, as compared to the three and six months ended June 30, 2022, due to our acquisition of a portfolio of seven senior housing facilities in Texas within our SHOP segment on December 5, 2022, as well as an integrated senior health campusincrease of $3,334,000 and $4,722,000, respectively, for the three and six months ended June 30, 2023, as compared to the three and six months ended June 30, 2022, due to transitioning the SNFs within the Central Wisconsin Senior Care Portfolio to a RIDEA structure in Kentucky on January 3, 2022. See Note 4, Business Combinations, to our accompanying condensed consolidated financial statements for a further discussion.March 2023. The remaining increase in resident fees and services revenue for our SHOP segment was primarily attributable to improved resident occupancy.
Real Estate Revenue
For the threeoccupancy and nine months ended September 30, 2022, $22,214,000 and $66,842,000, respectively, of real estate revenue was primarily due to the increase in the size of our portfoliohigher resident fees as a result of the Merger.an increase in billing rates. Such amounts were partially offset by a decrease in rental revenue for our senior housing — leased segment of $628,000$2,782,000 and $1,576,000$4,094,000, respectively, for the three and ninesix months ended SeptemberJune 30, 2023, as compared to the three and six months ended June 30, 2022, respectively, primarily due to transitioningreal estate dispositions within our SHOP segment during the leased senior housing facilities within Delta Valley ALF portfolio to a RIDEA structure and including such facilities within SHOP on December 1, 2021. In addition, for the ninethree months ended SeptemberDecember 31, 2022 and the six months ended June 30, 2022, we experienced a decrease in rental revenue for our medical office buildings segment of $552,000, primarily due to a one-time lease termination fee recognized in June 2021 for one of our medical office buildings.

2023.
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Real Estate Revenue
For the three and six months ended June 30, 2023, we experienced a decrease in real estate revenue for our SNFs segment of $444,000 and $8,233,000, respectively, due to transitioning the SNFs within the Central Wisconsin Senior Care Portfolio to a RIDEA structure in March 2023, which amount predominantly included the full amortization of $8,073,000 of above-market leases. We also experienced a net decrease in real estate revenue for our MOBs segment for both the three and six months ended June 30, 2023, primarily due to real estate dispositions of MOBs during the fourth quarter of 2022 and the second quarter of 2023, which was partially offset by fixed rent escalations.
Grant Income
For the three months ended SeptemberJune 30, 20222023 and 2021,2022, we recognized $6,533,000$6,381,000 and $936,000,$10,969,000, respectively, of grant income at our integrated senior health campuses and SHOP primarily related to government grants received through the Coronavirus Aid, Relief, and Economic Security Act, or the CARES Act, economic stimulus programs. For the ninesix months ended SeptemberJune 30, 20222023 and 2021,2022, we recognized $22,716,000$6,381,000 and $10,264,000,$16,183,000, respectively, of grant income at our integrated senior health campuses and SHOP primarily related to government grants received through the CARES Act economic stimulus programs. As of April 2023, the federal government’s COVID-19 public health emergency declaration expired and certain relief measures have been wound down and others are being phased out.
Property Operating Expenses and Rental Expenses
Property operating expenses and property operating expenses as a percentage of resident fees and services revenue and grant income, as well as rental expenses and rental expenses as a percentage of real estate revenue, by reportable segment consisted of the following for the periods then ended:ended (dollars in thousands):
Three Months Ended September 30,Nine Months Ended September 30, Three Months Ended June 30,Six Months Ended June 30,
2022202120222021 2023202220232022
Property Operating ExpensesProperty Operating ExpensesProperty Operating Expenses
Integrated senior health campusesIntegrated senior health campuses$299,197,000 89.4 %$239,151,000 89.8 %$811,281,000 88.3 %$700,781,000 91.7 %Integrated senior health campuses$328,696 89.0 %$258,934 86.7 %$657,057 89.9 %$512,084 87.6 %
SHOPSHOP38,290,000 95.0 %17,670,000 82.0 %109,425,000 93.5 %51,608,000 83.1 %SHOP43,853 91.8 %37,125 96.1 %85,638 90.5 %71,135 92.7 %
Total property operating expensesTotal property operating expenses$337,487,000 90.0 %$256,821,000 89.2 %$920,706,000 88.9 %$752,389,000 91.0 %Total property operating expenses$372,549 89.3 %$296,059 87.8 %$742,695 90.0 %$583,219 88.2 %
Rental ExpensesRental ExpensesRental Expenses
Medical office buildings$14,155,000 38.1 %$7,629,000 38.8 %$42,259,000 37.8 %$22,754,000 37.7 %
Skilled nursing facilities437,000 6.6 %364,000 9.9 %1,644,000 8.4 %1,108,000 10.1 %
MOBsMOBs$13,927 38.0 %$13,791 37.4 %$28,335 38.2 %$28,104 37.6 %
SNFsSNFs378 6.2 %521 7.9 %847 19.0 %1,207 9.3 %
Senior housing — leasedSenior housing — leased160,000 3.1 %71,000 2.0 %551,000 3.5 %116,000 1.1 %Senior housing — leased229 4.2 %212 4.0 %428 4.0 %391 3.7 %
HospitalsHospitals98,000 4.1 %124,000 4.6 %346,000 4.8 %384,000 4.7 %Hospitals119 4.9 %139 5.8 %238 4.8 %248 5.1 %
Total rental expensesTotal rental expenses$14,850,000 28.9 %$8,188,000 27.6 %$44,800,000 29.0 %$24,362,000 27.0 %Total rental expenses$14,653 29.0 %$14,663 28.7 %$29,848 31.7 %$29,950 29.1 %
Integrated senior health campuses and SHOP typically have a higher percentage of direct operating expenses to revenue than medical office buildings,MOBs, hospitals, and leased senior housing and skilled nursing facilitiesSNFs due to the nature of RIDEA-type facilities where we conduct day-to-day operations. For the three and ninesix months ended SeptemberJune 30, 2022,2023, as compared to the three and ninesix months ended September 30, 2021, rental expenses increased by $6,330,000 and $19,251,000, respectively, and property operating expenses increased by $16,602,000 and $47,273,000, respectively, for our SHOP due to the increase in the size of our portfolio as a result of the Merger. The remaining increase in total property operating expenses for our SHOP segment was due to an increase in labor costs, such as a significant increase in employee wages, agency fees and temporary labor expenses in addition to an increase of $1,302,000 and $3,795,000 for the three and nine months ended SeptemberJune 30, 2022, respectively, due to transitioning the leased senior housing facilities within Delta Valley ALF portfolio to a RIDEA structure and including such facilities within SHOP on December 1, 2021. The increase in total property operating expenses for our integrated senior health campuses segment was predominately due to an increase of $40,253,000 and $81,257,000, respectively, in property operating expenses attributable to our acquisition of the 50.0% interest in RHS on August 1, 2022. Further, we experienced higher operating expenses as a result of increased occupancy as well asand an increase of $11,993,000 and $27,198,000 in operating expenses for the three and six months ended June 30, 2023, respectively, within Trilogy’s ancillary business unit due to our acquisitionhigher labor costs associated with the expansion of services offered and inflation impacting the 50.0% controlling interestcost of goods sold. Such amounts were partially offset by a decrease in RHS on August 1, 2022total property operating expenses of $3,239,000 and $6,459,000, respectively, due to dispositions within our acquisition of an integrated senior health campuscampuses segment during the third and fourth quarters of 2022.
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For the three and six months ended June 30, 2023, as compared to the three and six months ended June 30, 2022, total property operating expenses for our SHOP segment primarily increased due to: (i) an increase of $5,707,000 and $10,889,000, respectively, due to the acquisition of a portfolio of seven senior housing facilities within our SHOP segment in Texas on January 3,December 5, 2022; (ii) an increase of $4,049,000 and $5,261,000, respectively, due to transitioning the SNFs within the Central Wisconsin Senior Care Portfolio to a RIDEA structure in March 2023; (iii) higher operating expenses as a result of increased occupancy; and (iv) higher labor costs due to an increase in employee wages. Such amounts were partially offset by a decrease in total property operating expenses for the three and six months ended June 30, 2023, as compared to the three and six months ended June 30, 2022, of $3,343,000 and $4,717,000, respectively, due to real estate dispositions within our SHOP segment during the three months ended December 31, 2022 and during the six months ended June 30, 2023.
General and Administrative
For the three months ended June 30, 2023, general and administrative expenses were $11,774,000 compared to $10,928,000 for the three months ended June 30, 2022. The increase in general and administrative expenses of $846,000 was primarily the result of an increase of $592,000 in stock compensation expenses.
For the six months ended June 30, 2023, general and administrative expenses were $24,827,000 compared to $22,047,000 for the six months ended June 30, 2022. The increase in general and administrative expenses of $2,780,000 was primarily the result of an increase of: (i) $1,247,000 in professional fees and legal fees; and (ii) $887,000 in stock compensation expenses.
Business Acquisition Expenses
For the three and six months ended June 30, 2023, we recorded business acquisition expenses of $888,000 and $1,220,000, respectively, primarily incurred in pursuit of real estate-related investment opportunities. For the three and six months ended June 30, 2022, we recorded business acquisition expenses of $1,757,000 and $1,930,000, respectively, primarily incurred in connection with $938,000 in transaction costs related to the acquisition of a pharmaceutical business in April 2022 and $596,000 and $719,000, respectively, of costs incurred in the pursuit of real estate investments that did not close. See Note 4,3, Real Estate Investments, Net and Business Combinations — Business Combinations, to our accompanying condensed consolidated financial statements for a further discussion of our acquisition of RHS.
General and Administrative
For the three months ended September 30, 2022, general and administrative expenses were $9,626,000 compared to $9,008,000 for the three months ended September 30, 2021. The increase in general and administrative expenses of $618,000 was primarily the result of an increase of: (i) $5,386,000 in payroll and compensation costs for the personnel hired as a result of the AHI Acquisition; (ii) $1,246,000 in professional and legal fees; (iii) $911,000 in corporate operating expenses; and (iv) $867,000 in stock compensation expenses. Such increases were partially offset by a decrease in our asset management and property management oversight fees of $5,747,000 as a result of the AHI Acquisition.
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For the nine months ended September 30, 2022, general and administrative expenses were $31,673,000 compared to $23,608,000 for the nine months ended September 30, 2021. The increase in general and administrative expenses of $8,065,000 was primarily the result of an increase of: (i) $16,658,000 in payroll and compensation costs for the personnel hired as a result of the AHI Acquisition; (ii) $4,379,000 in professional fees, legal fees and marketing expenses; (iii) $3,004,000 in corporate operating expenses; and (iv) $1,739,000 in stock compensation expenses. Such increases were partially offset by a decrease in our asset management and property management oversight fees of $17,148,000 as a result of the AHI Acquisition.
Business Acquisition Expenses
For the three months ended September 30, 2022 and 2021, we recorded business acquisition expenses of $231,000 and $3,633,000, respectively, and for the nine months ended September 30, 2022 and 2021, we recorded business acquisition expenses of $2,161,000 and $7,631,000, respectively. For the three and nine months ended September 30, 2022, the decrease in such expenses primarily related to a decrease of $3,614,000 and $7,296,000, respectively, in third-party legal costs and professional services incurred related to the Merger and the AHI Acquisition, partially offset by $170,000 and $1,105,000, respectively, in transaction costs related to our business combinations and $42,000 and $721,000, respectively, in dead-deal costs incurred in the pursuit of real estate investments that did not close. See Note 4, Business Combinations, to our accompanying condensed consolidated financial statements for a further discussion.pharmaceutical business.
Depreciation and Amortization
For the three months ended SeptemberJune 30, 20222023 and 2021,2022, depreciation and amortization was $40,422,000$44,701,000 and $26,334,000,$39,971,000, respectively, which primarily consisted of depreciation on our operating properties of $35,327,000$37,139,000 and $24,968,000,$34,328,000, respectively, and amortization of our identified intangible assets of $4,421,000$6,852,000 and $901,000,$5,008,000, respectively. For the ninesix months ended SeptemberJune 30, 20222023 and 2021,2022, depreciation and amortization was $122,704,000$89,371,000 and $78,414,000,$82,282,000, respectively, which primarily consisted of depreciation on our operating properties of $104,077,000$73,038,000 and $73,821,000,$68,750,000, respectively, and amortization of our identified intangible assets of $16,554,000$14,840,000 and $3,258,000,$12,133,000, respectively.
For the three and ninesix months ended SeptemberJune 30, 2023, as compared to the three and six months ended June 30, 2022, the increase in depreciation and amortization of $14,088,000$4,730,000 and $44,290,000,$7,089,000, respectively, was primarily the result of thedue to: (i) an increase in depreciable assets indepreciation and amortization within our portfolioSHOP segment and our integrated senior health campuses segment as a result of acquisitions that occurred subsequent to June 30, 2022, as well as development and capital expenditures since June 30, 2022; (ii) the Merger resultingfull amortization of $885,000 of in-place leases related to transition of SNFs within the Central Wisconsin Senior Care Portfolio to a RIDEA structure; and (iii) the full amortization of $529,000 of depreciable assets as a result of storm damage affecting our properties in Texas and Louisiana. Such amounts were partially offset by a decrease in depreciation and amortization expenseas a result of $12,386,000real estate dispositions within our SHOP segment and $39,772,000, respectively.our MOBs segment subsequent to June 30, 2022.
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Interest Expense
Interest expense, including gain or loss in fair value of derivative financial instruments, consisted of the following for the periods presented:presented (in thousands):
Three Months Ended September 30,Nine Months Ended September 30, Three Months Ended June 30,Six Months Ended June 30,
2022202120222021 2023202220232022
Interest expense:Interest expense:Interest expense:
Lines of credit and term loans and derivative financial instruments$14,806,000 $7,729,000 $31,382,000 $23,203,000 
Lines of credit and term loan and derivative financial instrumentsLines of credit and term loan and derivative financial instruments$24,420 $9,027 $47,689 $16,576 
Mortgage loans payableMortgage loans payable10,485,000 9,028,000 29,637,000 26,328,000 Mortgage loans payable13,935 9,608 27,095 19,152 
Amortization of deferred financing costs:Amortization of deferred financing costs:Amortization of deferred financing costs:
Lines of credit and term loans722,000 1,087,000 2,255,000 3,237,000 
Lines of credit and term loanLines of credit and term loan949 724 1,805 1,533 
Mortgage loans payableMortgage loans payable530,000 424,000 1,463,000 1,143,000 Mortgage loans payable559 492 1,136 933 
Amortization of debt discount/premium, netAmortization of debt discount/premium, net134,000 201,000 464,000 606,000 Amortization of debt discount/premium, net890 347 1,775 330 
Gain in fair value of derivative financial instrumentsGain in fair value of derivative financial instruments— (1,860,000)(500,000)(5,456,000)Gain in fair value of derivative financial instruments(4,993)— (4,798)(500)
Loss on extinguishments of debt628,000 — 5,038,000 2,293,000 
(Gain) loss on extinguishments of debt(Gain) loss on extinguishments of debt— (181)— 4,410 
Interest on finance lease liabilitiesInterest on finance lease liabilities43,000 81,000 183,000 273,000 Interest on finance lease liabilities66 66 157 140 
Interest expense on financing obligations and other liabilitiesInterest expense on financing obligations and other liabilities176,000 335,000 772,000 657,000 Interest expense on financing obligations and other liabilities171 262 344 596 
TotalTotal$27,524,000 $17,025,000 $70,694,000 $52,284,000 Total$35,997 $20,345 $75,203 $43,170 
For the three months ended September 30, 2022, interest expense was $27,524,000 compared to $17,025,000 for the three months ended September 30, 2021. The increase in total interest expense for the three and six months ended June 30, 2023, as compared to the three and six months ended June 30, 2022, was primarily relateddue to an increase in debt balances since June 30, 2022 and a higher weighted average effective interest rate on our variable debt, which was 7.25% and 3.59% as of June 30, 2023 and 2022, respectively. Such increases in total interest expense incurred on our lines of credit and term loans and mortgage loans payable duefor the six months ended June 30, 2023, as compared to the six months ended June 30, 2022, were primarily offset by: (i) a larger debt portfolio as a result of the Merger, as well as an$4,298,000 increase in variable interest rates and a $1,860,000 decrease in the gain in fair value recognized onof our derivative financial instrument; (ii) $895,000 of net proceeds from our interest rate swap contracts that matured on January 25, 2022. For the nine months ended September 30, 2022, interest expense was $70,694,000 compared to $52,284,000 for the nine months ended September 30, 2021. The increase in total interest expense was primarily related to an increase in interest expense incurred on our lines of creditswap; and term loans and mortgage loans payable due to(iii) a larger debt portfolio as a result of the Merger, as well as an increase in variable interest rates and a
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$4,410,000 decrease in the gain in fair value recognized on our derivative financial instruments of $4,956,000 and an increase in loss on debt extinguishmentextinguishments of $2,745,000.debt. See Note 8,7, Mortgage Loans Payable, Net, and Note 9,8, Lines of Credit and Term Loans,Loan, to our accompanying condensed consolidated financial statements for a further discussion on debt extinguishments.
ImpairmentGain or Loss on Dispositions of Real Estate Investments
For the three and nine months ended SeptemberJune 30, 2023, we recognized an aggregate net loss on dispositions of our real estate investments of $2,072,000 primarily related to the sale of four SHOP within our Central Florida Senior Housing Portfolio and 11 MOBs. For the six months ended June 30, 2023, we recognized an aggregate net loss on dispositions of our real estate investments of $2,204,000 primarily related to the sale of five SHOP within our Central Florida Senior Housing Portfolio and 11 MOBs. See Note 3, Real Estate Investments, Net and Business Combinations, to our accompanying condensed consolidated financial statements for further discussion.
For the six months ended June 30, 2022, we recognized a gain on dispositions of our real estate investments of $683,000 related to the sale of 77.0% ownership interests in several real estate assets for development in February 2022, within our integrated senior health campuses segment.
Impairment of Real Estate Investments
For both the three and six months ended June 30, 2023, we did not recognize impairment charges on real estate investments. For both the three and six months ended June 30, 2022, we recognized an impairment charge of $21,851,000 and $39,191,000$17,340,000 on four of our SHOP within the Central Florida Senior Housing Portfolio, respectively. ForPortfolio. Such SHOP were subsequently disposed in the nine months ended September 30, 2021, we recognized an impairment chargefourth quarter of $3,335,000 on a medical office building, Mount Dora Medical Center.2022 and first quarter of 2023. See Note 3, Real Estate Investments, Net and Business Combinations, to our accompanying condensed consolidated financial statements for a further discussion.
Gain on Re-measurement of Previously Held Equity Interest
For both the three and ninesix months ended SeptemberJune 30, 2022,2023, we recognized a $19,567,000$726,000 gain on re-measurement of the fair value of our previously held equity interest in RHS.Memory Care Partners, LLC, or MCP. For the ninesix months ended SeptemberJune 30, 2021,2022, we did not recognize a gain on re-measurement of previously held equity interest. See Note 4,3, Real Estate Investments, Net and Business Combinations, to our accompanying condensed consolidated financial statements for a further discussion.
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Liquidity and Capital Resources
InOur principal sources of liquidity are cash flows from operations, borrowings under our lines of credit and proceeds from dispositions of real estate investments. For the normal course of business,next 12 months, our material cash requirements consist of payment ofprincipal liquidity needs are to: (i) fund property operating expenses and general and administrative expenses; (ii) meet our debt service requirements (including principal and interest); (iii) fund development activities and capital improvement expenditures, interest on our indebtedness,expenditures; and (iv) make distributions to our stockholders, (including distributions necessaryas required for us to maintain our qualificationcontinue to qualify as a REIT) and general and administrative expenses. OurREIT. We believe that the sources of funds primarily consist of operatingliquidity described above will be sufficient to satisfy our cash flowsrequirements for the next 12 months and borrowings.the longer term thereafter. We do not have any material off-balance sheet arrangements that we expect would materially affect our liquidity and capital resources.
Material Cash Requirements
Capital Improvement Expenditures
A capital plan for each investment is established upon acquisition that contemplates the estimated capital needs of that investment, including costs of refurbishment, tenant improvements or other major capital expenditures. The capital plan also sets forth the anticipated sources of the necessary capital, which may include operating cash generated by the investment, capital reserves, a line of credit or other loan established with respect to the investment, other borrowings or additional equity investments from us and joint venture partners. The capital plan for each investment is adjusted through ongoing, regular reviews of our portfolio or as necessary to respond to unanticipated additional capital needs. As of SeptemberJune 30, 2022,2023, we had $17,434,000$16,556,000 of restricted cash in loan impounds and reserve accounts to fund a portion of such capital expenditures. Based on the budget for the properties we owned as of SeptemberJune 30, 2022,2023, we estimated that unspent discretionary expenditures for capital and tenant improvements as of such date are equal to $53,226,000$69,420,000 for the remaining threesix months of 2022,2023, although actual expenditures are dependent on many factors which are not presently known.
Contractual Obligations
The following table provides information with respect to: (i) the maturity and scheduled principal repayment of our secured mortgage loans payable and our lines of credit and term loans;loan; (ii) interest payments on our mortgage loans payable and lines of credit and term loans;loan, excluding the effect of our interest rate swap (for information on our interest rate swap, see Note 9, Derivative Financial Instrument, to our accompanying condensed consolidated financial statements); (iii) ground and other lease obligations; and (iv) financing obligations as of SeptemberJune 30, 2022:2023 (in thousands):
 Payments Due by Period
 20222023-20242025-2026ThereafterTotal
Principal payments — fixed-rate debt$12,679,000 $105,743,000 $183,849,000 $503,013,000 $805,284,000 
Interest payments — fixed-rate debt6,183,000 46,192,000 37,958,000 198,377,000 288,710,000 
Principal payments — variable-rate debt111,000 680,794,000 414,469,000 569,521,000 1,664,895,000 
Interest payments — variable-rate debt (based on rates in effect as of September 30, 2022)21,838,000 122,717,000 76,107,000 5,847,000 226,509,000 
Ground and other lease obligations9,137,000 72,225,000 70,201,000 244,392,000 395,955,000 
Financing obligations984,000 5,366,000 3,048,000 16,243,000 25,641,000 
Total$50,932,000 $1,033,037,000 $785,632,000 $1,537,393,000 $3,406,994,000 
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 Payments Due by Period
 20232024-20252026-2027ThereafterTotal
Principal payments — fixed-rate debt$9,821 $210,014 $190,394 $519,212 $929,441 
Interest payments — fixed-rate debt15,615 53,944 37,574 237,868 345,001 
Principal payments — variable-rate debt370,478 288,987 926,765 27,292 1,613,522 
Interest payments — variable-rate debt (based on rates in effect as of June 30, 2023)50,001 140,744 45,148 6,491 242,384 
Ground and other lease obligations19,240 75,032 75,146 229,084 398,502 
Financing obligations27,505 5,228 3,732 14,963 51,428 
Total$492,660 $773,949 $1,278,759 $1,034,910 $3,580,278 
Distributions and Share Repurchases
For information on distributions, see the “Distributions” section below. For information on our share repurchase plan, see Note 14,12, Equity Share Repurchase Plan, to our accompanying condensed consolidated financial statements.
Credit Facilities
On January 19, 2022, we terminated ourWe are party to a credit agreement, as amended, for our line of credit and term loans with an aggregate maximum principal amount of $530,000,000, or the 2018 Credit Facility, and, through our operating partnership, entered into an agreement that superseded and replaced our amended credit facility with a maximum principal amount of $480,000,000, or the 2019 Credit Facility, with a credit facility with an aggregate maximum principal amount of up to $1,050,000,000,$1,050,000,000, or the 2022 Credit Facility. See Note 9, Lines of Credit and Term Loans, to our accompanying condensed consolidated financial statements for a further discussion. In addition, we are subjectparty to an agreement, as amended, and restated loan agreement regarding a senior secured revolving credit facility with an aggregate maximum principal amount of $360,000,000,$400,000,000, or the 2019 Trilogy Credit Facility. Our total capacityFacility, which is scheduled to mature on September 5, 2023. See Note 8, Lines of Credit and Term Loan, to our accompanying condensed consolidated financial statements for further discussion. We intend to satisfy the conditions pursuant to the 2019 Trilogy Credit Facility and pay operating expenses, capital improvement expenditures, interest, distributions and general and administrative expenses is a function ofthe required extension fee in order to exercise our current cash position, our borrowing capacity on our lines of credit and term loans, as well as any future indebtedness that we may incur.option to extend the maturity date for one 12-month period.
As of SeptemberJune 30, 2022,2023, our aggregate borrowing capacity under the 2022 Credit Facility and the 2019 Trilogy Credit Facility was $1,410,000,000.$1,450,000,000. As of SeptemberJune 30, 2022,2023, our aggregate borrowings outstanding under our credit facilities was $1,292,935,000$1,282,534,000 and we had an aggregate of $117,065,000$167,466,000 available on such facilities. We believe that the resources described above will be sufficient to satisfy our cash requirements for the foreseeable future.
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Cash Flows
The following table sets forth changes in cash flows:flows (in thousands):
Nine Months Ended September 30,Six Months Ended June 30,
20222021 20232022
Cash, cash equivalents and restricted cash — beginning of periodCash, cash equivalents and restricted cash — beginning of period$125,486,000 $152,190,000 Cash, cash equivalents and restricted cash — beginning of period$111,906 $125,486 
Net cash provided by (used in) operating activities113,441,000 (1,493,000)
Net cash used in investing activities(122,539,000)(137,580,000)
Net cash provided by financing activities7,969,000 138,271,000 
Net cash provided by operating activitiesNet cash provided by operating activities43,642 56,138 
Net cash provided by (used in) investing activitiesNet cash provided by (used in) investing activities9,687 (97,364)
Net cash (used in) provided by financing activitiesNet cash (used in) provided by financing activities(71,575)19,924 
Effect of foreign currency translation on cash, cash equivalents and restricted cashEffect of foreign currency translation on cash, cash equivalents and restricted cash(59,000)(96,000)Effect of foreign currency translation on cash, cash equivalents and restricted cash90 (8)
Cash, cash equivalents and restricted cash — end of periodCash, cash equivalents and restricted cash — end of period$124,298,000 $151,292,000 Cash, cash equivalents and restricted cash — end of period$93,750 $104,176 
The following summary discussion of our changes in our cash flows is based on our accompanying condensed consolidated statements of cash flows and is not meant to be an all-inclusive discussion of the changes in our cash flows for the periods presented below.
Operating Activities
The increase in netFor the six months ended June 30, 2023 and 2022, cash flows provided by operating activities of $114,934,000 waswere primarily duerelated to the increase in the sizecash flows provided by our property operations, offset by payments of general and administrative expenses and interest payments on our portfolio as a result of the Merger on October 1, 2021, thereby increasing our net operating income during the nine months ended September 30, 2022, as compared to the prior year period.outstanding indebtedness. In general, cash flows from operating activities are affected by the timing of cash receipts and payments. See the “Results of Operations” section above for a further discussion.
Investing Activities
The decrease inFor the six months ended June 30, 2023, as compared to the six months ended June 30, 2022, the change from net cash used in investing activities of $15,041,000to net cash provided by investing activities was primarily due to a $21,123,000$73,444,000 increase in proceeds from dispositions of real estate investments and a $9,960,000$62,792,000 decrease in developments and capital expenditures.cash paid to acquire real estate investments. Such amounts were partially offset by a $13,713,000 payment to acquire the 50.0% controlling interest$16,566,000 increase in RHSdevelopment and capital expenditures and an $11,800,000 increase in August 2022 and the issuance of a $3,000,000 note receivableinvestments in September 2022.unconsolidated entities. See Note 4,3, Real Estate Investments, Net and Business Combinations, to our accompanying condensed consolidated financial statements for a further discussion of our acquisition of RHS.

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acquisitions and dispositions.
Financing Activities
The decrease inFor the six months ended June 30, 2023, as compared to the six months ended June 30, 2022, the change from net cash provided by financing activities of $130,302,000to net cash used in financing activities was primarily due to a decrease in net borrowings under our mortgage loans payable of $233,399,000$43,100,000 and a $22,430,000 increase in distributions paid to our common stockholders during the nine months ended September 30, 2022 as compared to the prior year period, as well as a $16,233,000 payment to repurchase our common stock for the nine months ended September 30, 2022. During the nine months ended September 30, 2022, we also paid $657,000 in offering costs in connection with the filing of our Registration Statement on Form S-11 for a proposed primary public offering of our shares of common stock in conjunction with a contemplated listing of our common stock on the New York Stock Exchange, as discussed in the “Overview and Background — Public Offerings” section above. No such costs were paid during the nine months ended September 30, 2021. Such amounts were partially offset by an increasedecrease in net borrowings under our lines of credit and term loans of $153,200,000 during the nine months ended September 30, 2022 as compared$41,100,000 and a $15,954,000 payment to the prior year period. The change in distributions paid to common stockholders was due to the suspension of all stockholder distributions on May 29, 2020 in response to the impactredeem a portion of the COVID-19 pandemic, which the boardequity interests owned by members of directors of GAHR III subsequently reinstatedTrilogy Investors, LLC management. Such amounts were partially offset by a $10,418,000 decrease in June 2021. The change in share repurchases was due to the suspension of the GAHR III share repurchase plan from May 31, 2020 through October 4, 2021, when the partial reinstatement of our share repurchase plan was approved by our board.
Distributions
The following information represents distributions of GAHR IV and GAHR III, as applicable, for the period before the consummation of the Merger between GAHR III and GAHR IV on October 1, 2021. Since October 1, 2021, the information included below represents the distributions of the Combined Company.
GAHR IV and Combined Company Distributions
Prior to March 31, 2020, the GAHR IV board authorized a daily distribution to our stockholders of record as of the close of business on each day of the period commencing on May 1, 2016 and ending on March 31, 2020. The daily distributions were calculated based on 365 days in the calendar year and were equal to $0.001643836 per share of our Class T common stock and Class I common stock, which was equal to an annualized distribution rate of $0.60 per share. These distributions were aggregated and paid in cash or shares of our common stock pursuant to the DRIP on a monthly basis, in arrears, only from legally available funds.stock.
In response to the COVID-19 pandemic and its effects to our business and operations, at the end of the first quarter of 2020, the GAHR IV board decided to take steps to protect our capital and maximize our liquidity in an effort to strengthen our long-term financial prospects by reducing our distribution payments to stockholders. Consequently, the GAHR IV board authorized a daily distribution to our stockholders of record as of the close of business on each day of the period commencing on April 1, 2020 and ending on August 31, 2021, which was calculated based on 365 days in the calendar year and was equal to $0.001095890 per share of our Class T and Class I common stock. Such daily distribution was equal to an annualized distribution rate of $0.40 per share. The distributions were aggregated and paid in cash or shares of our common stock pursuant to the DRIP on a monthly basis, in arrears, only from legally available funds.Distributions
The GAHR IV board of directors also authorized distributions to our Class T and Class I stockholders of record as of the close of business on September 17, 2021, equal to $0.0328767 per share of our common stock, which was equal to an annualized distribution rate of $0.40 per share. Further, ourOur board authorized record date distributions to our Class T common stockholders and Class I common stockholders of record as of each monthly record date from October 2021January 2022 through June 2022, equal to $0.033333333$0.133333332 per share of our common stock, which was equal to an annualized distribution rate of $0.40$1.60 per share. The distributions were paid in cash or shares of our common stock pursuant to the AHR DRIP.
DRIP offering. Effective beginning with the third quarter of 2022, distributions, if any, were or shall be authorized by our board on a quarterly basis, in such amounts as our board determined or shall determine, and each quarterly record date for the purposes of such distributions was or shall be determined and authorized by our board in the last month of each calendar quarter until such time as our board changes our distribution policy. On September 28, 2022, ourOur board authorized a quarterly distribution to our Class T common stockholders and Class I common stockholders of record as of the close of business on September 29, 2022, for the quarter commencing on July 1, 2022 and ending on September 30, 2022. TheSuch quarterly distribution was equal to $0.10$0.40 per share of our common stock, which iswas equal to an annualized distribution rate of $0.40$1.60 per share. The third quarter distribution wasshare and paid in October 2022 in cash or shares of our common stock pursuant to the AHR DRIP offering, only from legally available funds.
On March 18, 2021, in connection with the GAHR IV special committee's strategic alternative review process, the GAHR IV board of directors authorized the suspension of the DRIP, effective as of April 1, 2021. As a result, beginning with the April 2021 distributions, which were paid in May 2021, there were no further issuances of shares pursuant to the DRIP, and stockholders who were participants in the AHR DRIP received cash distributions instead. On October 4, 2021, our board authorized the reinstatement of the DRIP and as a result, beginning with the October 2021 distribution, which was paid in
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November 2021, stockholders who previously enrolled as participants in the DRIP (including former GAHR III stockholders who participated in the GAHR III distribution reinvestment plan) received distributions in shares of our common stock pursuant to the terms of the AHR DRIP, instead of cash distributions. On November 14, 2022, our board suspended the AHR DRIP Offeringoffering beginning with the distributions declared if any, for the quarter endingended December 31, 2022. Please see Note 22, Subsequent Events, to our accompanying condensed consolidated financial statements forAs a further discussion.
The amountresult of the distributions paid to our common stockholders was determined quarterly or monthly, as applicable, by our board and was dependent on a number of factors, including funds available for payment of distributions, our financial condition, capital expenditure requirements and annual distribution requirements needed to maintain our qualification as a REIT under the Code. We have not established any limit on the amount of borrowings that may be used to fund distributions, except that, in accordance with Maryland law, we may not make distributions that would: (i) cause us to be unable to pay our debts as they become due in the usual course of business or (ii) cause our total assets to be less than the sum of our total liabilities plus senior liquidation preferences.
GAHR III Distributions
On May 29, 2020 in response to the impact of the COVID-19 pandemic, the board of directors of GAHR III authorized the suspension of all stockholderthe DRIP offering, unless and until our board reinstates the DRIP offering, stockholders who are current participants in the DRIP will be paid distributions upon the completion of the payment of distributions payablein cash. Our board authorized a quarterly distribution to our Class T common stockholders and Class I common stockholders of record on or prior toas of the close of business on May 31, 2020. The boardDecember 29, 2022. Such quarterly distribution was equal to $0.40 per share of directors of GAHR III subsequently reinstated stockholder distributions in June 2021 through September 2021 atour common stock, which was equal to an annualized distribution rate of $0.20$1.60 per share.share and paid in cash, only from legally available funds.
In response to interest rates that have increased drastically since the beginning of 2022, and greater uncertainty surrounding further interest rate movements, our board elected to reduce our quarterly distribution to $0.25 per share in order to preserve our liquidity, better align distributions with available cash flows and position our company for its long-term strategic goals. Therefore, our board authorized a quarterly distribution equal to $0.25 per share to our Class T common stockholders and Class I common stockholders of record as of the close of business on each of April 4, 2023 and June 28, 2023, which distributions were paid on April 18, 2023 and July 13, 2023, respectively. Such quarterly distributions were equal to an annualized distribution rate of $1.00 per share and paid in cash, only from legally available funds. See our Current Reports on Form 8-K filed with the SEC on March 17, 2023 and June 16, 2023 for more information.
The following tables reflect distributions we paid for the ninesix months ended SeptemberJune 30, 20222023 and distributions paid by GAHR III for the nine months ended September 30, 2021,2022, along with the amount of distributions reinvested pursuant to the AHR DRIP or GAHR III distribution reinvestment plan, as applicable, and the sources of distributions as compared to cash flows from operations or funds from operations attributable to controlling interest, or FFO, a non-GAAP financial measure:measure (dollars in thousands):
AHRGAHR IIISix Months Ended June 30,
Nine Months Ended
September 30, 2022
Nine Months Ended
September 30, 2021
20232022
Distributions paid in cashDistributions paid in cash$35,391,000 $12,961,000 Distributions paid in cash$43,086 $30,247 
Distributions reinvestedDistributions reinvested26,118,000 — Distributions reinvested— 22,447 
$61,509,000 $12,961,000 $43,086 $52,694 
Sources of distributions:Sources of distributions:Sources of distributions:
Cash flows from operationsCash flows from operations$61,509,000 100 %$— — %Cash flows from operations$43,086 100 %$52,694 100 %
Proceeds from borrowingsProceeds from borrowings— — 12,961,000 100 Proceeds from borrowings— — — — 
$61,509,000 100 %$12,961,000 100 %$43,086 100 %$52,694 100 %

AHRGAHR IIISix Months Ended June 30,
Nine Months Ended
September 30, 2022
Nine Months Ended
September 30, 2021
20232022
Distributions paid in cashDistributions paid in cash$35,391,000 $12,961,000 Distributions paid in cash$43,086 $30,247 
Distributions reinvestedDistributions reinvested26,118,000 — Distributions reinvested— 22,447 
$61,509,000 $12,961,000 $43,086 $52,694 
Sources of distributions:Sources of distributions:Sources of distributions:
FFO attributable to controlling interestFFO attributable to controlling interest$61,509,000 100 %$12,961,000 100 %FFO attributable to controlling interest$39,265 91.1 %$52,694 100 %
Proceeds from borrowingsProceeds from borrowings— — — — Proceeds from borrowings3,821 8.9 — — 
$61,509,000 100 %$12,961,000 100 %$43,086 100 %$52,694 100 %
As of SeptemberJune 30, 2022,2023, any distributions of amounts in excess of our current and accumulated earnings and profits have resulted in a return of capital to our stockholders, and some portion of a distribution to our stockholders may have been paid from borrowings. For a further discussion of FFO, including a reconciliation of our GAAP net loss to FFO, see “Funds from Operations and ModifiedNormalized Funds from Operations,”Operations” below.
Financing
We anticipate that our overall leverage will not exceedapproximate 50.0% of the combined fair market value of all of our properties, and other real estate-related investments, as determined at the end of each calendar year. For these purposes, the market value of each asset will be equal to the contract purchase price paid for the asset or, if the asset was appraised subsequent to the date of
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purchase, then the market value will be equal to the value reported in the most recent independent appraisal of the asset. Our policies do not limit the amount we may borrow with respect to any individual investment. As of SeptemberJune 30, 2022,2023, our aggregate borrowings were 48.0%53.6% of the combined market value of all of our real estate and real estate-related investments.
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Mortgage Loans Payable, Net
For a discussion of our mortgage loans payable, see Note 8,7, Mortgage Loans Payable, Net, to our accompanying condensed consolidated financial statements.
Lines of Credit and Term LoansLoan
For a discussion of our lines of credit and term loans,loan, see Note 9,8, Lines of Credit and Term Loans,Loan, to our accompanying condensed consolidated financial statements.
REIT Requirements
In order to maintain our qualification as a REIT for U.S. federal income tax purposes, we are required to distribute to our stockholders a minimum of 90.0% of our REIT taxable income. Existing Internal Revenue Service, or IRS, guidance includes a safe harbor pursuant to which publicly offered REITs can satisfy the distribution requirement by distributing a combination of cash and stock to stockholders. In general, to qualify under the safe harbor, each stockholder must elect to receive either cash or stock, and the aggregate cash component of the distribution to stockholders must represent at least 20.0% of the total distribution. In the event that there is a shortfall in net cash available due to factors including, without limitation, the timing of such distributions or the timing of the collection of receivables, we may seek to obtain capital to make distributions by means of secured and unsecured debt financing through one or more unaffiliated third parties. We may also make distributions with cash from capital transactions including, without limitation, the sale of one or more of our properties.
Commitments and Contingencies
For a discussion of our commitments and contingencies, see Note 12,10, Commitments and Contingencies, to our accompanying condensed consolidated financial statements.
Debt Service Requirements
A significant liquidity need is the payment of principal and interest on our outstanding indebtedness. As of SeptemberJune 30, 2022,2023, we had $1,177,244,000$1,260,429,000 of fixed-rate and variable-rate mortgage loans payable outstanding secured by our properties. As of SeptemberJune 30, 2022,2023, we had $1,292,935,000$1,282,534,000 outstanding and $117,065,000$167,466,000 remained available under our lines of credit. The weighted average effective interest rate on our outstanding debt, factoring in our interest rate swap, was 4.47%5.69% per annum as of SeptemberJune 30, 2022.2023. See Note 8,7, Mortgage Loans Payable, Net, and Note 9,8, Lines of Credit and Term Loans,Loan, to our accompanying condensed consolidated financial statements.
We are required by the terms of certain loan documents to meet various financial and non-financial covenants, such as leverage ratios, net worth ratios, debt service coverage ratios and fixed charge coverage ratios. As of SeptemberJune 30, 2022,2023, we were in compliance with all such covenants and requirements on our mortgage loans payable and our lines of credit and term loans. While the extent and severity of the COVID-19 pandemic on our business has been subsiding, any potential future deterioration of operations in excess of management's projections as a result of COVID-19 could impact future compliance with these covenants.loan. If any future covenants are violated, we anticipate seeking a waiver or amending the debt covenants with the lenders when and if such event should occur. However, there can be no assurances that management will be able to effectively achieve such plans.
Related Party Transactions
For a summary of related party transactions, see Note 15, Related Party Transactions, to our accompanying condensed consolidated financial statements, and Note 15, Related Party Transactions, to the consolidated financial statements that are a part of our 2021 Annual Report on Form 10-K, as filed with the SEC on March 25, 2022.
Funds from Operations and ModifiedNormalized Funds from Operations
Due to certain unique operating characteristics of real estate companies, the National Association of Real Estate Investment Trusts, or NAREIT, an industry trade group, has promulgated a measure known as funds from operations, a non-GAAP financial measure, which we believe to be an appropriate supplemental performance measure to reflect the operating performance of a REIT. The use of funds from operations is recommended by the REIT industry as a supplemental performance measure, and our management uses FFO to evaluate our performance over time. FFO is not equivalent to our net income (loss) as determined under GAAP.
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We define FFO, a non-GAAP financial measure, consistent with the standards established by the White Paper on funds from operations approved by the Board of Governors of NAREIT, or the White Paper. The White Paper defines funds from operations as net income (loss) computed in accordance with GAAP, excluding gains or losses from sales of certain real estate assets, gains or losses upon consolidation of a previously held equity interest, and impairment writedowns of certain real estate assets and investments, plus depreciation and amortization related to real estate, and after adjustments for unconsolidated partnerships and joint ventures. While impairment charges are excluded from the calculation of FFO as described above, investors are cautioned that impairments are based on estimated future undiscounted cash flows. Adjustments for unconsolidated partnerships and joint ventures are calculated to reflect funds from operations. Our FFO calculation complies with NAREIT’s policy described above.
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Historical accounting for real estate involves the use of GAAP. Any other method of accounting for real estate such as the fair value method cannot be construed to be any more accurate or relevant than the comparable methodologies of real estate valuation found in GAAP. Nevertheless, we believe that the use of FFO, which excludes the impact of real estate-related depreciation and amortization and impairments, provides a further understanding of our operating performance to investors, industry analysts and to our management, and when compared year over year, reflects the impact on our operations from trends in occupancy rates, rental rates, operating costs, general and administrative expenses and interest costs, which may not be immediately apparent from net income (loss).
However,We define normalized FFO and modified funds from operations attributable to controlling interest, or MFFO,NFFO, as described below, should not be construed to be more relevant or accurate than the current GAAP methodology in calculating net income (loss) or in its applicability in evaluating our operating performance. The method utilized to evaluate the value and performance of real estate under GAAP should be construed as a more relevant measure of operational performance and considered more prominently than the non-GAAP FFO and MFFO measures and the adjustments to GAAP in calculating FFO and MFFO.
The IPA, an industry trade group, has standardized a measure known as modified funds from operations, which the IPA has recommended as a supplemental performance measure and which we believe to be another appropriate supplemental performance measure to reflect operating performance. MFFO is not equivalent to our net income (loss) as determined under GAAP, and MFFO may not be a useful measure of the impact of long-term operating performance on value if we do not continue to operate with a limited life and targeted exit strategy, as currently intended. We believe that, because MFFO excludes expensed acquisition fees and expenses that affect our operations only in periods in which properties are acquired and that we consider more reflective of investing activities, as well as other non-operating items included in FFO, MFFO can provide, on a going forward basis, an indication of the sustainability (that is, the capacity to continue to be maintained) of our operating performance after the period in which we are acquiring our properties and once our portfolio is in place. By providing MFFO, we believe we are presenting useful information that assists investors and analysts to better assess the sustainability of our operating performance after the initial offering stage has been completed and our properties have been acquired. We also believe that MFFO is a recognized measure of sustainable operating performance. Investors are cautioned that MFFO should only be used to assess the sustainability of our operating performance after the initial offering stage has been completed and properties have been acquired, as it excludes expensed acquisition fees and expenses that have a negative effect on our initial operating performance during the periods in which properties are acquired.
We define MFFO, a non-GAAP financial measure, consistent with the Practice Guideline 2010-01, Supplemental Performance Measure for Publicly Registered, Non-Listed REITs: Modified Funds from Operations, or the Practice Guideline, issued by the IPA in November 2010. The Practice Guideline defines modified funds from operations as funds from operations further adjusted for the following items included in the determination of GAAP net income (loss): expensed acquisition fees and costs;costs, which we refer to as business acquisition expenses; amounts relating to changes in deferred rent and amortization of above- and below-market leases and liabilities (which are adjusted in order to reflect such payments from a GAAP accrual basisbasis); the non-cash impact of changes to closer to an expected to be received cash basisour equity instruments; non-cash or non-recurring income or expense; the non-cash effect of disclosing the rent and lease payments); accretionincome tax benefits or expenses; capitalized interest; impairment of discounts andgoodwill; amortization of premiumsclosing costs on debt investments; mark-to-market adjustments included in net income (loss); gains or losses included in net income (loss) from the extinguishment or sale of debt, hedges, foreign exchange, derivatives or securities holdings where trading of such holdings is not a fundamental attribute of the business plan; and after adjustments for consolidated and unconsolidated partnerships and joint ventures, with such adjustments calculated to reflect modified funds from operationsNFFO on the same basis. Our MFFO calculation complies with
However, FFO and NFFO should not be construed to be more relevant or accurate than the IPA’s Practice Guideline described above.
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our operating performance or GAAP cash flows from operations as an indicator of our liquidity. The method utilized to evaluate the value and performance of real estate under GAAP should be construed as a more relevant measure of operational performance and considered more prominently than the non-GAAP FFO and NFFO measures and the adjustments to GAAP in calculating FFO and NFFO. Presentation of this information is intended to provide useful information to management, investors and industry analysts as they compare the operating performance of different REITs,used by the REIT industry, although it should be noted that not all REITs calculate funds from operations and modifiednormalized funds from operations the same way, so comparisons with other REITs may not be meaningful. Furthermore, FFO and MFFO are not necessarily indicative of cash flow available to fund cash needs and should not be considered as an alternative to net income (loss) as an indication of our performance, as an alternative to cash flows from operations, which is an indication of our liquidity, or indicative of funds available to fund our cash needs including our ability to make distributions to our stockholders. FFO and MFFO should be reviewed in conjunction with other measurements as an indication of our performance. MFFO may be useful in assisting management and investors in assessing the sustainability of operating performance in future operating periods, and in particular, after the offering and acquisition stages are complete.
None of the SEC, NAREIT, or any other regulatory body has passed judgment on the acceptability of the adjustments that we use to calculate FFO or MFFO.NFFO. In the future, the SEC, NAREIT, or another regulatory body may decide to standardize the allowable adjustments across the REIT industry and we would have to adjust our calculation and characterization of FFO.
For the three and nine months ended September 30, 2022 and 2021, we recognized government grants as grant income or as a reduction of property operating expenses, as applicable, and within loss from unconsolidated entities. Such amounts were granted through federal and state government programs, such as through the CARES Act, and which were established for eligible healthcare providers to preserve liquidity in response to the COVID-19 pandemic. See the “Results of Operations” section above for a further discussion. The government grants helped mitigate some of the negative impact that the COVID-19 pandemic had on our financial condition and results of operations. Without such relief funds, the COVID-19 pandemic would have had a material adverse impact to our FFO and MFFO. For the three months ended September 30, 2022 and 2021, FFO would have been approximately $21,574,000 and $15,996,000, respectively, excluding government grants recognized. For the nine months ended September 30, 2022 and 2021, FFO would have been approximately $74,456,000 and $37,622,000, respectively, excluding government grants recognized. For the three months ended September 30, 2022 and 2021, MFFO would have been approximately $25,326,000 and $20,619,000, respectively, excluding government grants recognized. For the nine months ended September 30, 2022 and 2021, MFFO would have been approximately $86,800,000 and $43,300,000, respectively, excluding government grants recognized.
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The following is a reconciliation of net income or loss, which is the most directly comparable GAAP financial measure, to FFO and MFFONFFO for the periods presented below:below (in thousands except for share and per share amounts):
Three Months Ended September 30,Nine Months Ended September 30,
 2022202120222021
Net loss$(7,644,000)$(4,036,000)$(24,083,000)$(28,270,000)
Depreciation and amortization related to real estate — consolidated properties40,390,000 26,334,000 122,640,000 78,414,000 
Depreciation and amortization related to real estate — unconsolidated entities197,000 768,000 1,043,000 2,336,000 
Impairment of real estate investments — consolidated properties21,851,000 — 39,191,000 3,335,000 
(Gain) loss on dispositions of real estate investments — consolidated properties(2,113,000)(276,000)(2,796,000)101,000 
Gain on re-measurement of previously held equity interest(1)(19,567,000)— (19,567,000)— 
Net (income) loss attributable to noncontrolling interests(5,861,000)(1,201,000)(9,688,000)3,508,000 
Depreciation, amortization, impairments, gain/loss on dispositions and gain on re-measurement — noncontrolling interests(757,000)(4,960,000)(14,910,000)(14,616,000)
FFO attributable to controlling interest$26,496,000 $16,629,000 $91,830,000 $44,808,000 
Business acquisition expenses(2)$231,000 $3,633,000 $2,161,000 $7,631,000 
Amortization of above- and below-market leases(3)700,000 22,000 1,904,000 270,000 
Amortization of closing costs(4)60,000 52,000 174,000 148,000 
Change in deferred rent(5)(1,029,000)1,493,000 (3,333,000)1,011,000 
Loss on debt extinguishments(6)628,000 — 5,038,000 2,293,000 
Gain in fair value of derivative financial instruments(7)— (1,860,000)(500,000)(5,456,000)
Foreign currency loss(8)3,695,000 1,394,000 8,689,000 741,000 
Adjustments for unconsolidated entities(9)33,000 133,000 223,000 452,000 
Adjustments for noncontrolling interests(9)(566,000)(244,000)(2,012,000)(1,412,000)
MFFO attributable to controlling interest$30,248,000 $21,252,000 $104,174,000 $50,486,000 
Weighted average Class T and Class I common shares outstanding — basic and diluted263,279,232 179,641,677 262,940,706 179,632,818 
Net loss per Class T and Class I common share — basic and diluted$(0.03)$(0.02)$(0.09)$(0.16)
FFO attributable to controlling interest per Class T and Class I common share — basic and diluted$0.10 $0.09 $0.35 $0.25 
MFFO attributable to controlling interest per Class T and Class I common share — basic and diluted$0.11 $0.12 $0.40 $0.28 
___________

(1)We recognized a gain upon the acquisition of the 50.0% controlling interest in RHS. Such acquisition resulted in the consolidation of RHS, which was previously accounted for as an equity method investment. We believe that adjusting for such non-recurring gains provides useful supplemental information because such gains may not be reflective of on-going business transactions and operations and is consistent with management’s analysis of our operating performance.
(2)In evaluating investments in real estate, we differentiate the costs to acquire the investment from the operations derived from the investment. By excluding business acquisition expenses that have been deducted as expenses in the determination of GAAP net income or loss, we believe MFFO provides useful supplemental information that is comparable for each type of real estate investment and is consistent with management’s analysis of the investing and operating performance of our properties. Business acquisition expenses include payments to our former advisor or its affiliates and third parties.
(3)Under GAAP, above- and below-market leases are assumed to diminish predictably in value over time and amortized, similar to depreciation and amortization of other real estate related assets that are excluded from FFO. However, because real estate values and market lease rates historically rise or fall with market conditions, including inflation, interest rates,
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the business cycle, unemployment and consumer spending, we believe that by excluding charges relating to the amortization of above- and below-market leases, MFFO may provide useful supplemental information on the performance of the real estate.
(4)Under GAAP, closing costs are amortized over the term of our debt security investment as an adjustment to the yield on our debt security investment. This may result in income recognition that is different than the contractual cash flows under our debt security investment. By adjusting for the amortization of the closing costs, MFFO may provide useful supplemental information on the realized economic impact of our debt security investment, providing insight on the expected contractual cash flows of such investment, and aligns results with management’s analysis of operating performance.
(5)Under GAAP, as a lessor, rental revenue is recognized on a straight-line basis over the terms of the related lease (including rent holidays). As a lessee, we record amortization of right-of-use assets and accretion of lease liabilities for our operating leases. This may result in income or expense recognition that is significantly different than the underlying contract terms. By adjusting such amounts, MFFO may provide useful supplemental information on the realized economic impact of lease terms, providing insight on the expected contractual cash flows of such lease terms, and aligns results with management’s analysis of operating performance.
(6)The loss associated with the early extinguishment of debt primarily relates to the write-off of unamortized deferred financing fees, write-off of unamortized debt discount or premium, penalties, or other fees incurred. We believe that adjusting for such non-recurring losses provides useful supplemental information because such charges (or losses) may not be reflective of on-going business transactions and operations and is consistent with management’s analysis of our operating performance.
(7)Under GAAP, we are required to include changes in fair value of our derivative financial instruments in the determination of net income or loss. We believe that adjusting for the change in fair value of our derivative financial instruments to arrive at MFFO is appropriate because such adjustments may not be reflective of on-going operations and reflect unrealized impacts on value based only on then current market conditions, although they may be based upon general market conditions. The need to reflect the change in fair value of our derivative financial instruments is a continuous process and is analyzed on a quarterly basis in accordance with GAAP.
(8)We believe that adjusting for the change in foreign currency exchange rates provides useful information because such adjustments may not be reflective of on-going operations.
(9)Includes all adjustments to eliminate the unconsolidated entities’ share or noncontrolling interests’ share, as applicable, of the adjustments described in notes (2) – (8) above to convert our FFO to MFFO.
Three Months Ended June 30,Six Months Ended June 30,
 2023202220232022
Net loss$(11,867)$(15,542)$(39,482)$(16,439)
Depreciation and amortization related to real estate — consolidated properties44,663 39,939 89,295 82,250 
Depreciation and amortization related to real estate — unconsolidated entities95 420 158 846 
Impairment of real estate investments — consolidated properties— 17,340 — 17,340 
Loss (gain) on dispositions of real estate investments — consolidated properties2,072 73 2,204 (683)
Net (income) loss attributable to noncontrolling interests(316)(1,768)1,427 (3,827)
Gain on re-measurement of previously held equity interest— — (726)— 
Depreciation, amortization, impairments, gain/loss on dispositions and gain on re-measurement — noncontrolling interests(7,073)(7,744)(13,611)(14,153)
FFO attributable to controlling interest$27,574 $32,718 $39,265 $65,334 
Business acquisition expenses$888 $1,757 $1,220 $1,930 
Amortization of above- and below-market leases455 699 9,130 1,204 
Amortization of closing costs68 58 133 114 
Change in deferred rent(180)(1,278)(240)(2,304)
Non-cash impact of changes to equity instruments1,593 1,001 2,665 1,779 
Capitalized interest(54)(14)(80)(78)
(Gain) loss on debt extinguishments— (181)— 4,410 
Gain in fair value of derivative financial instruments(4,993)— (4,798)(500)
Foreign currency (gain) loss(1,068)3,607 (2,076)4,994 
Adjustments for unconsolidated entities(179)70 (253)168 
Adjustments for noncontrolling interests43 (680)(590)(1,503)
NFFO attributable to controlling interest$24,147 $37,757 $44,376 $75,548 
Weighted average Class T and Class I common shares outstanding — basic and diluted66,033,345 65,754,423 66,029,779 65,692,159 
Net loss per Class T and Class I common share attributable to controlling interest — basic and diluted$(0.19)$(0.26)$(0.58)$(0.31)
FFO per Class T and Class I common share attributable to controlling interest — basic and diluted$0.42 $0.50 $0.59 $0.99 
NFFO per Class T and Class I common share attributable to controlling interest — basic and diluted$0.37 $0.57 $0.67 $1.15 
Net Operating Income
Net operating income, or NOI is a non-GAAP financial measure that is defined as net income (loss), computed in accordance with GAAP, generated from properties before general and administrative expenses, business acquisition expenses, depreciation and amortization, interest expense, gain or loss on dispositions, impairment of real estate investments, income or loss from unconsolidated entities, gain on re-measurement of previously held equity interest, foreign currency gain or loss, other income and income tax benefit or expense.
NOI is not equivalent to our net income (loss) as determined under GAAP and may not be a useful measure in measuring operational income or cash flows. Furthermore, NOI should not be considered as an alternative to net income (loss) as an indication of our operating performance or as an alternative to cash flows from operations as an indication of our liquidity, or indicative of cash flow available to fund our cash needs including our ability to make distributions to our stockholders.liquidity. NOI should not be construed to be more relevant or accurate than the current GAAP methodology in calculating net income (loss) or in its applicability in evaluating our operating performance. Investors are also cautioned that NOI should only be used to assess our operational performance in periods in which we have not incurred or accrued any business acquisition expenses.
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We believe that NOI is an appropriate supplemental performance measure to reflect the performance of our operating assets because NOI excludes certain items that are not associated with the operations of the properties. We believe that NOI is a widely accepted measure of comparative operating performance in the real estate community. However, our use of the term NOI may not be comparable to that of other real estate companies as they may have different methodologies for computing this amount.
For the three and nine months ended September 30, 2022 and 2021, we recognized government grants as grant income or as a reduction of property operating expenses, as applicable. The government grants helped mitigate some of the negative impact that the COVID-19 pandemic had on our financial condition and results of operations. Without such relief funds, the COVID-19 pandemic would have had a material adverse impact to our NOI. For the three months ended September 30, 2022 and 2021, NOI would have been approximately $67,292,000 and $51,541,000, respectively, excluding government grants
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recognized. For the nine months ended September 30, 2022 and 2021, NOI would have been approximately $202,370,000 and $129,842,000, respectively, excluding government grants recognized.
To facilitate understanding of this financial measure, the following is a reconciliation of net income or loss, which is the most directly comparable GAAP financial measure, to NOI for the periods presented below:below (in thousands):
Three Months Ended September 30,Nine Months Ended September 30, Three Months Ended June 30,Six Months Ended June 30,
20222021202220212023202220232022
Net lossNet loss$(7,644,000)$(4,036,000)$(24,083,000)$(28,270,000)Net loss$(11,867)$(15,542)$(39,482)$(16,439)
General and administrativeGeneral and administrative9,626,000 9,008,000 31,673,000 23,608,000 General and administrative11,774 10,928 24,827 22,047 
Business acquisition expensesBusiness acquisition expenses231,000 3,633,000 2,161,000 7,631,000 Business acquisition expenses888 1,757 1,220 1,930 
Depreciation and amortizationDepreciation and amortization40,422,000 26,334,000 122,704,000 78,414,000 Depreciation and amortization44,701 39,971 89,371 82,282 
Interest expenseInterest expense27,524,000 17,025,000 70,694,000 52,284,000 Interest expense35,997 20,345 75,203 43,170 
(Gain) loss on dispositions of real estate investments(2,113,000)(276,000)(2,796,000)101,000 
Loss (gain) on dispositions of real estate investmentsLoss (gain) on dispositions of real estate investments2,072 73 2,204 (683)
Impairment of real estate investmentsImpairment of real estate investments21,851,000 — 39,191,000 3,335,000 Impairment of real estate investments— 17,340 — 17,340 
Loss (income) from unconsolidated entitiesLoss (income) from unconsolidated entities344,000 (384,000)(1,680,000)2,288,000 Loss (income) from unconsolidated entities113 (638)419 (2,024)
Gain on re-measurement of previously held equity interestGain on re-measurement of previously held equity interest(19,567,000)— (19,567,000)— Gain on re-measurement of previously held equity interest— — (726)— 
Foreign currency loss3,695,000 1,394,000 8,689,000 741,000 
Foreign currency (gain) lossForeign currency (gain) loss(1,068)3,607 (2,076)4,994 
Other incomeOther income(670,000)(348,000)(2,399,000)(811,000)Other income(2,589)(469)(4,197)(1,729)
Income tax expenseIncome tax expense126,000 127,000 499,000 785,000 Income tax expense348 205 491 373 
Net operating incomeNet operating income$73,825,000 $52,477,000 $225,086,000 $140,106,000 Net operating income$80,369 $77,577 $147,254 $151,261 
Subsequent EventsEvent
For a discussion of our subsequent events,event, see Note 22,19, Subsequent Events,Event, to our accompanying condensed consolidated financial statements.
Item 3. Quantitative and Qualitative Disclosures About Market Risk.
Market risk includes risks that arise from changes in interest rates, foreign currency exchange rates, commodity prices, equity prices and other market changes that affect market sensitive instruments. In pursuing our business plan, we expect that the primary market risk to which we will be exposed is interest rate risk. There were no material changes in our market risk exposures, or in the methods we use to manage market risk, from those that were provided for in our 20212022 Annual Report on Form 10-K, as filed with the SEC on March 25, 2022.17, 2023.
Interest Rate Risk
We are exposed to the effects of interest rate changes primarily as a result of long-term debt used to acquire and develop properties and other investments. Our interest rate risk is monitored using a variety of techniques. Our interest rate risk management objectives are to limit the impact of interest rate increases on earnings, prepayment penalties and cash flows and to lower overall borrowing costs while taking into account variable interest rate risk. To achieve our objectives, we may borrow or lend at fixed or variable rates.
We have entered into, and may continue to enter into, derivative financial instruments such as interest rate swaps and interest rate caps in order to mitigate our interest rate risk on a related financial instrument, and for which we have not and may not elect hedge accounting treatment. We did not elect to apply hedge accounting treatment to these derivatives; therefore, changes in the fair value of interest rate derivative financial instruments were recorded as a component of interest expense in gain or loss in fair value of derivative financial instruments in our accompanying condensed consolidated statements of operations and comprehensive loss. As of SeptemberJune 30, 2022, we did not have any derivative financial instruments.2023, our interest rate swap is recorded in other assets, net in our accompanying condensed consolidated balance sheet at its fair value of $4,798,000. We do not enter into derivative transactions for speculative purposes.
The Financial Conduct Authority, or FCA, ceased publishing one-week and two-month LIBOR after December 31, 2021 and intends to cease publishing all remaining LIBOR after June 30, 2023. On January 19, 2022, we, through For information on our operating partnership, entered into the 2022 Credit Facility that bears interest at varying rates based upon, at our option, (1) the Daily SOFR, plus the applicable rate for Daily SOFR Rate Loans; or (2) the Term SOFR plus the applicable rate for Term SOFR Rate Loans, as such terms are defined in the 2022 Credit Facility. Pleaseswaps, see Note 9, Lines of CreditDerivative Financial Instrument, and Term LoansNote 19, Subsequent Event2022 Credit Facility,Interest Rate Swap, to our accompanying condensed consolidated financial statements for a further discussion.statements.
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We have variable rate debt outstanding and maturing on various dates from 2023 to 2031 that are indexed to LIBOR. As such, we are monitoring and evaluating the related risks of the discontinuation of LIBOR, which include possible changes to the interest on loans or amounts received and paid on derivative instruments we may enter into in the future. These risks arise in connection with transitioning contracts to a new alternative rate, including any resulting value transfer that may occur. The value of loans or derivative instruments tied to LIBOR could also be impacted when LIBOR is discontinued. For some instruments, the method of transitioning to an alternative rate may be challenging, as they may require negotiation with the respective counterparty. If a contract is not transitioned to an alternative rate when LIBOR is discontinued, the impact on our contracts is likely to vary. When LIBOR is discontinued, interest rates on our current or future indebtedness may be adversely affected. Currently we cannot estimate the overall impact of the phase-out of LIBOR on our current debt agreements, although it is possible that an alternative variable rate could raise our borrowing costs. It is not possible to predict whether LIBOR will continue to be viewed as an acceptable market “benchmark” prior to June 30, 2023, and it is possible that LIBOR will become unavailable prior to that point. This could result, for example, if a sufficient number of banks decline to make submissions to the LIBOR administrator. In that case, the risks associated with the transition to an alternative reference rate will be accelerated and magnified.
As of September 30, 2022, the table below presents the principal amounts and weighted average interest rates by year of expected maturity to evaluate the expected cash flows and sensitivity to interest rate changes.changes, excluding the effect of our interest rate swap (dollars in thousands):
Expected Maturity Date Expected Maturity Date
20222023202420252026ThereafterTotalFair Value 20232024202520262027ThereafterTotalFair Value
AssetsAssetsAssets
Debt security held-to-maturityDebt security held-to-maturity$— $— $— $93,433,000 $— $— $93,433,000 $92,831,000 Debt security held-to-maturity$— $— $93,433 $— $— $— $93,433 $92,998 
Weighted average interest rate on maturing fixed-rate debt securityWeighted average interest rate on maturing fixed-rate debt security— %— %— %4.24 %— %— %4.24 %— Weighted average interest rate on maturing fixed-rate debt security— %— %4.24 %— %— %— %4.24 %— 
LiabilitiesLiabilitiesLiabilities
Fixed-rate debt — principal paymentsFixed-rate debt — principal payments$12,679,000 $34,321,000 $71,422,000 $28,892,000 $154,957,000 $503,013,000 $805,284,000 $644,045,000 Fixed-rate debt — principal payments$9,821 $74,086 $135,928 $155,560 $34,834 $519,212 $929,441 $760,299 
Weighted average interest rate on maturing fixed-rate debtWeighted average interest rate on maturing fixed-rate debt4.03 %3.78 %3.52 %3.34 %2.98 %3.00 %3.10 %— Weighted average interest rate on maturing fixed-rate debt3.24 %3.57 %4.29 %2.99 %3.33 %3.14 %3.37 %— 
Variable-rate debt — principal paymentsVariable-rate debt — principal payments$111,000 $522,729,000 $158,065,000 $277,000 $414,192,000 $569,521,000 $1,664,895,000 $1,672,727,000 Variable-rate debt — principal payments$370,478 $258,824 $30,163 $376,576 $550,189 $27,292 $1,613,522 $1,620,218 
Weighted average interest rate on maturing variable-rate debt (based on rates in effect as of September 30, 2022)6.52 %5.68 %5.60 %5.07 %4.79 %4.75 %5.13 %— 
Weighted average interest rate on maturing variable-rate debt (based on rates in effect as of June 30, 2023)Weighted average interest rate on maturing variable-rate debt (based on rates in effect as of June 30, 2023)7.94 %7.73 %7.57 %6.85 %6.80 %7.30 %7.25 %— 
Debt Security Investment, Net
As of SeptemberJune 30, 2022,2023, the net carrying value of our debt security investment was $82,067,000.$84,933,000. As we expect to hold our debt security investment to maturity and the amounts due under such debt security investment would be limited to the outstanding principal balance and any accrued and unpaid interest, we do not expect that fluctuations in interest rates, and the resulting change in fair value of our debt security investment, would have a significant impact on our operations. See Note 16,13, Fair Value Measurements, to our accompanying condensed consolidated financial statements, for a discussion of the fair value of our investment in a held-to-maturity debt security. The effective interest rate on our debt security investment was 4.24% per annum as of SeptemberJune 30, 2022.2023.
Mortgage Loans Payable, Net and Lines of Credit and Term LoansLoan
Mortgage loans payable were $1,177,244,000$1,260,429,000 ($1,237,565,000, net of discount/premium and deferred financing costs) as of SeptemberJune 30, 2022.2023. As of SeptemberJune 30, 2022,2023, we had 6471 fixed-rate mortgage loans payable and 1312 variable-rate mortgage loans payable with effective interest rates ranging from 2.21% to 6.52%8.01% per annum and a weighted average effective interest rate of 3.85%4.51%. In addition, as of SeptemberJune 30, 2022,2023, we had $1,292,935,000$1,282,534,000 ($1,281,683,000, net of deferred financing fees) outstanding under our lines of credit and term loans,loan, at a weighted average interest rate of 5.04%7.13% per annum.
As of SeptemberJune 30, 2022,2023, the weighted average effective interest rate on our outstanding debt, factoring in our fixed-rate interest rate swaps (if any),swap, was 4.47%5.69% per annum. An increase in the variable interest rate on our variable-rate mortgage loans payable and lines of credit and term loansloan constitutes a market risk. As of SeptemberJune 30, 2022,2023, a 0.50% increase in the market rates of interest would have increased our overall annualized interest expense on all of our other variable-rate mortgage loans payable and lines of credit and unhedged term loansloan by $8,440,000,$6,786,000, or 10.7%4.6% of total annualized interest expense on our mortgage loans payable and lines of credit and term loans.loan. See Note 8,7, Mortgage Loans Payable, Net and Note 9,8, Lines of Credit and Term Loans,Loan, to our accompanying condensed consolidated financial statements.
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Other Market Risk
In addition to changes in interest rates and foreign currency exchange rates, the value of our future investments is subject to fluctuations based on changes in local and regional economic conditions and changes in the creditworthiness of tenants, which may affect our ability to refinance our debt if necessary.
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Item 4. Controls and Procedures.
(a) Evaluation of disclosure controls and procedures. We maintain disclosure controls and procedures that are designed to ensure that information required to be disclosed in our reports under the Exchange Act, is recorded, processed, summarized and reported within the time periods specified in the rules and forms, and that such information is accumulated and communicated to us, including our Chief Executive Officer and Chief Financial Officer, as appropriate, to allow timely decisions regarding required disclosure. In designing and evaluating the disclosure controls and procedures, we recognize that any controls and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving the desired control objectives, as ours are designed to do, and we necessarily are required to apply our judgment in evaluating whether the benefits of the controls and procedures that we adopt outweigh their costs.
As required by Rules 13a-15(b) and 15d-15(b) of the Exchange Act, an evaluation as of SeptemberJune 30, 20222023 was conducted under the supervision and with the participation of our management, including our Chief Executive Officer and Chief Financial Officer, of the effectiveness of our disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Exchange Act). Based on this evaluation, our Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures, as of SeptemberJune 30, 2022,2023, were effective at the reasonable assurance level.
(b) Changes in internal control over financial reporting. There were no changes in internal control over financial reporting that occurred during the fiscal quarter ended SeptemberJune 30, 20222023 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.
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PART II — OTHER INFORMATION
Item 1. Legal Proceedings.
For a discussion of our legal proceedings, see Note 12,10, Commitments and Contingencies — Litigation, to our accompanying condensed consolidated financial statements.
Item 1A. Risk Factors.
There were no material changes from the risk factors previously disclosed in our 20212022 Annual Report on Form 10-K, as filed with the SEC on March 25, 202217, 2023, except as noted below.
The COVID-19 pandemic and economic impact of the pandemic have adversely impacted, and continue to adversely impact, our business and financial results, and the ultimate long-term impact of the pandemic will depend on future developments, which are highly uncertain and cannot be predicted with accuracy.
Our residents, tenants, operating partners and managers, our industry and the U.S. economy continue to be adversely affected by the COVID-19 pandemic and related supply chain disruptions, inflation and labor shortages. While the immediate effects of the COVID-19 pandemic have subsided, the timing and extent of the recovery towards pre-pandemic norms is dependent upon many factors, including the emergence and severity of future COVID-19 variants, the effectiveness and frequency of booster vaccinations and the duration and implications of ongoing or future restrictions and safety measures. As an owner and operator of healthcare facilities, we expect to continue to be adversely affected by the long-term effects of the COVID-19 pandemic for some period of time; however, it is not possible to predict the full extent of its future impact on us, the operations of our properties or the markets in which they are located, or the overall healthcare industry.
The COVID-19 pandemic resulted in a significant decline in occupancy at our senior housing — leased facilities, SNFs, SHOP and integrated senior health campuses and an increase in COVID-19 related operating expenses. Among other things, due to the shortage of healthcare personnel, the pandemic caused higher labor costs that continue to adversely affect us, including those related to greater reliance on agency staffing and more costly short-term hires. Expenses also increased due to pandemic-related costs (e.g., heightened cleaning and sanitation protocols) and the ongoing inflationary environment. This has, in general, resulted in decreased NOI and margin at these properties relative to pre-pandemic levels. Therefore, our focus at such properties continues to be on improving occupancy and managing operating expenses. While occupancy has generally been improving, it has not returned to pre-pandemic levels across all asset types, and labor costs remain elevated, as we have had difficulty filling open positions and experienced increased labor costs. The timing and extent of any further improvement in occupancy or relief from these labor pressures remains unclear. No assurance can be given that werecent improvements in our occupancy, margin or NOI will completebe maintained or will continue at the contemplated underwritten primary offeringsame pace or at all, or that our occupancy, margin or NOI will ever return to pre-pandemic levels.
As a result of the federal government’s COVID-19 public health emergency declaration in January 2020 and its COVID-19 national emergency declaration in March 2020, certain federal and state pandemic-related relief measures, such as funding, procedural waivers and/or reimbursement increases, became available to us and some of our common stock ortenants and operators. These declarations expired on May 11, 2023 and April 10, 2023, respectively, and certain relief measures have been wound-down and others are being phased out. It is unclear what pandemic-related relief measures, including funding, waiver and reimbursement programs, that we will be successful in listing our common stock on the New York Stock Exchange. Similarly, there can be no assurance that the public offering price per share of common stock in any offering that we may complete or that the subsequent trading price per shareand certain of our common stock on the New York Stock Exchange, if we are successful in listingtenants and operators benefited from will continue to be available or to what extent.
Certain provisions of Maryland law may make it more difficult for us to be acquired and may limit or delay our common stock thereon, will exceed our current NAV per share.
In September 2022, we filed a registration statement with the SEC relatingstockholders’ ability to a proposed primary public offeringdispose of their shares of our common stock in conjunction with the contemplated listing of our common stock on the New York Stock Exchange, or NYSE. Completing a public offering will require the SEC to declare the registration statement effective, and listing on the NYSE will require approval by the NYSE. Moreover, in addition to required regulatory actions, a decision to proceed with an offering and listing depends on our evaluation of market conditions and other factors, many of which are beyond our control. Accordingly, there can be no assurance as to when, or even if, we will be able to complete the public offering or successfully list our common stock on the NYSE.stock.
We do not know the terms, including the public offering price per share, on which the contemplated underwritten primary public offering of common stock may be completed. The initial public offering priceCertain provisions of the common stock sold in anyMaryland General Corporation Law, or MGCL, such offering will be discussed between usas the business combination statute and the representativescontrol share acquisition statute, are designed to prevent, or have the effect of preventing, someone from acquiring control of us. The MGCL prohibits “business combinations” between a Maryland corporation and an interested stockholder or an affiliate of an interested stockholder. An “interested stockholder” is defined generally as:
any person who beneficially owns, directly or indirectly, 10.0% or more of the underwriters of such offering. Among the factors that we expect to consider in determining the initial public offering price, in addition to prevailing market conditions, will be our historical performance, estimates of our business potential and earnings prospects, an assessment of our management and the considerationvoting power of the above factors in relation to market valuation of companies in related businesses. Thereafter, the market price of shares of our common stock on the NYSE will depend on numerous factors and may be volatile, and corporation’s outstanding voting stock; or
an active trading market may not developaffiliate or be maintained. There can be no assurance that the public offering price per share of common stock will equal or exceed our NAV per share, which our Board determined on March 24, 2022 to be $9.29 as of December 31, 2021, and the subsequent trading price may be below the public offering price per share.
Prior to suspensionassociate of the AHR DRIPcorporation who, at any time within the two-year period prior to the date in November 2022, the purchase price per share of common stock sold under the AHR DRIPquestion, was the most recently published estimated NAV per share. No assurance can be given that the public offering price per share of common stock sold in any underwritten primary offering or that the trading price per share of our common stock on the NYSE will equal or exceed the price at which shares of common stock were sold under the AHR DRIP. The public offering price per share of common stock sold in any underwritten primary offering or the subsequent trading price per share of our common stock on the NYSE could be below our NAV per share and the price per share that investors purchased shares in the AHR DRIP.
Shares of Class T common stock and Class I common stock held by current stockholders will not initially be listed on the NYSE.
It is contemplated that we will list our common stock sold in the potential underwritten public offering on the NYSE in conjunction with any such offering. Currently, our stockholders own either Class T common stock or Class I common stock, and we do not intend to list our Class T common stock or Class I common stock on the NYSE. However, on the six-month anniversary of any listing of our common stock on the NYSE, outstanding shares of Class T common stock and Class I common stock will automatically be converted into shares of our NYSE-listed common stock. Accordingly, current stockholders will not be able to sell their Class T common stock or Class I common stock on the NYSE until such conversion occurs, and such shares will be less liquid than our listed common stock until such time as the automatic conversion occurs.
Our investments in, and acquisitions of, medical office buildings, senior housing, skilled nursing facilities, hospitals and other healthcare-related facilities may be unsuccessful or fail to meet our expectations.
Some of our acquisitions may not prove to be successful. We could encounter unanticipated difficulties and expenditures relating to any acquired properties, including contingent liabilities, and acquired properties might require significant management attention that would otherwise be devoted to our ongoing business. Such expenditures may negatively affect our results of operations. Investments in and acquisitions of medical office buildings, senior housing, skilled nursing facilities,an interested stockholder.
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hospitalsThese prohibitions last for five years after the most recent date on which the interested stockholder became an interested stockholder. Thereafter, any business combination with the interested stockholder or an affiliate of the interested stockholder must be recommended by the corporation’s board and approved by the affirmative vote of at least 80.0% of the votes entitled to be cast by holders of outstanding shares of voting stock of the corporation and two-thirds of the votes entitled to be cast by holders of voting stock of the corporation other healthcare-related facilities entail risks associatedthan shares held by the interested stockholder. These requirements could have the effect of inhibiting a change in control even if a change in control were in the best interests of our stockholders.
The control share acquisition statute of the MGCL provides that, subject to certain exceptions, holders of “control shares” of a Maryland corporation (defined as voting shares of stock that, if aggregated with real estate investments generally, including risks thatall other such shares of stock owned by the investment will not achieve expected returns, that the cost estimates for necessary property improvements will prove inaccurateacquiror or that the tenant or operator will fail to meet performance expectations. Furthermore, there can be no assurance that our anticipated acquisitions and investments, the completionin respect of which is subjectthe acquiror can exercise or direct voting power (except solely by virtue of a revocable proxy), would entitle the acquiror to various conditions, will be consummatedexercise voting power in accordance with anticipated timing, on anticipated terms, or at all. In addition, we may not be able to identify off-market investment opportunities or investment opportunities that are strategically marketed to a limited numberelecting directors within specified ranges of investors at the rate that we anticipate or at all. We may be unable to obtain or assume financing for acquisitions on favorable terms or at all. Healthcare properties are often highly customizable and the development or redevelopment of such properties may require costly tenant-specific improvements. We may experience delays and disruptions to property redevelopment as a result of supply chain issues and construction material and labor shortages. We also may be unable to quickly and efficiently integrate new acquisitions, particularly acquisitions of portfolios of properties, into our existing operations, and this could have a material adverse effect on us. Acquired properties may be located in new markets, either within or outside the United States, where we may face risks associated with a lack of market knowledge or understanding of the local economy, lack of business relationships in the area, costs associated with opening a new regional office, and unfamiliarity with local governmental and permitting procedures. As a result, we cannot provide assurances that we will achieve the economic benefit we expect from acquisitions, investment, development and redevelopment opportunities, which may lead to impairment of such assets.
Inaccuracies in our underwriting assumptions and/or delays in the selection, acquisition, expansion or development of real properties may materially and adversely affect us.
Inaccuracies in our underwriting assumptions and/or delays we encounter in the selection, acquisition, expansion and development of real properties could materially and adversely affect us. In deciding whether to acquire, expand or develop a particular property, we make assumptions regarding the expected future performance of that property. In particular, we estimate the return on our investment based on expected construction costs, lease up velocity, occupancy, rental rates, operating expenses, capital costs and future competition. If our financial projections with respect to a new property are inaccurate, the property may fail to perform as we expected in analyzing our investment. Our development/expansion and construction projects are vulnerable to the impact of material shortages and inflation. For example, shortages and fluctuations in the price of lumber or in other important raw materials could result in delays in the start or completion of, or increase the cost of, developing one or more of our projects. Pricing for labor and raw materials can be affected by various national, regional, local, economic and political factors, including changes to immigration laws that impact the availability of labor or tariffs on imported construction materials.
In connection with our development, expansion and related construction activities, we may be unable to obtain, or suffer delays in obtaining, necessary zoning, land-use, building, occupancy and other required governmental permits and authorizations, or satisfactory tax rates, incentives or abatements. Operators of new facilities we construct may need to obtain Medicare and Medicaid certification and enter into Medicare and Medicaid provider agreements and/or third-party payor contracts. In the event that the operator is unable to obtain the necessary licensure, certification, provider agreements or contracts after the completion of construction, there is a risk that we will not be able to earn any revenues on the facility until either the initial operator obtains a license or certification to operate the new facility and the necessary provider agreements or contracts or we find and contract with a new operator that is able to obtain a license to operate the facility for its intended use and the necessary provider agreements or contracts.
One of our growth strategies is to develop new and expand existing clinical healthcare real estate; we may do this directly or indirectly through joint ventures, including through Trilogy Investors, LLC, or Trilogy. In particular, Trilogy is currently engaged in six new developments, with a total estimated cost of approximately $137 million, and 14 expansions, with a total estimated cost of approximately $11 million. Expanding and, in particular, developing properties exposes us to increased risks beyond those associated with investing in stabilized, cash flowing real estate. For example, actual costs could significantly exceed estimates (particularly during periods of rapid inflation), construction and stabilization (i.e., substantial lease-up) could take longer than expected, and occupancy and/or rental rates could prove to be lower than expected or property operating expenses could be higher. Any of these events could materially reduce any returns we achieve, or result in losses, on expansion or development projects. For the developments we have completed to date, the time to stabilization has varied, in some cases significantly, and certain developments have not yet stabilized. There can be no assurance that our current or any future development or expansion projects will be completed in accordance with our budgeted expectations, that they will achieve our underwritten returns or result in yields on cost similar to those achieved on past investments, that they will be stabilized in accordance with our expectations or at all or that, if stabilization is achieved, such stabilization will be maintained. In addition, development and expansion projects undertaken indirectly through Trilogy are primarily overseen by Trilogy Management Services, LLC, or the Trilogy Manager, and we do not have the same level of day-to-day involvement or control over such projects that we dovoting power) acquired in a project we undertake directly. Accordingly, with respect to projects undertaken through Trilogy, we rely on“control share acquisition” (defined as the development expertiseacquisition of the Trilogy Manager.
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Where properties are acquired prior to the start of construction or during the early stages of construction or when an existing property is expanded, it will typically take several months to complete constructionissued and lease available space. Development and other construction projects, subject us to uncertainties associated with re-zoning for development, environmental concerns of governmental entities and/or community groups and our builder’s ability to build in conformity with plans, specifications, budgeted costs and timetables. If a builder fails to perform, we may resort to legal action to rescind the purchase or the construction contract or to compel performance. A builder’s performance may also be affected or delayed by conditions beyond the builder’s control. Delays in completion of construction could give tenants the right to terminate preconstruction leases for space at a newly developed project. We may incur additional risks if we make periodic progress payments or other advances to builders prior to completion of construction. These and other such factors can result in increased costs of a project or loss of our investment. In addition, we will be subject to normal lease-up risks relating to newly constructed projects. We also must rely on rental income and expense projections and estimates of the fair market value of property upon completion of construction when agreeing upon a price at the time we acquire the property. If our projections are inaccurate, we may pay too much for a property, and our return on our investment could suffer or result in a loss.
Bridge loans involve a greater risk of loss than traditional investment-grade mortgage loans with fully insured borrowers.
Weoutstanding control shares) have in the past, and may in the future, acquire bridge loans secured by first lien mortgages on a property to borrowers who are typically seeking short-term capital to be used in an acquisition, construction or rehabilitation of a property, or other short-term liquidity needs. The typical borrower under a bridge loan has usually identified an undervalued asset that has been under-managed and/or is located in a recovering market. If the market in which the asset is located fails to recover according to the borrower’s projections, or if the borrower fails to improve the quality of the asset’s management and/or the value of the asset, the borrower may not receive a sufficient return on the asset to satisfy the bridge loan, and we bear the risk that we may not recover some or all of our initial expenditure.
In addition, borrowers usually use the proceeds of a conventional mortgage to repay a bridge loan. A bridge loan therefore is subject to the risk of a borrower’s inability to obtain permanent financing to repay the bridge loan. Bridge loans are also subject to risks of borrower defaults, bankruptcies, fraud, losses, and special hazard losses that are not covered by standard hazard insurance. In the event of any default under bridge loans held by us, we bear the risk of loss of principal and non-payment of interest and feesno voting rights except to the extent approved by our stockholders by the affirmative vote of any deficiency betweenat least two-thirds of all the valuevotes entitled to be cast on the matter. Shares of stock owned by the acquiror, by our officers or by our employees who are also our directors are excluded from shares entitled to vote on the matter.
Pursuant to the MGCL, our bylaws contain a provision exempting from the control share acquisition provisions of the mortgage collateralMGCL any and all acquisitions by any person of shares of our stock, which eliminates voting rights for certain levels of shares that could exercise control over us, and our Board has adopted a resolution providing that any business combination between us and any other person is exempted from the principal amount and unpaid interestbusiness combination statute, provided that such business combination is first approved by our Board. However, if the bylaws provision exempting us from the control share acquisition statute or our Board resolution opting out of the bridge loan. To the extent we suffer such losses with respect to our bridge loans, we may be materially and adversely affected.
We have substantial indebtedness and may incur additional indebtednessbusiness combination statute were repealed in the future, which could materially and adversely affect us.
We have substantial indebtedness and may incur additional indebtednesswhole or in the future, which could materially and adversely affect us. Though we anticipate that our overall leverage will not exceed 50.0%part at any time, these provisions of the combined fair market value of all of our properties and other real estate-related investments, as determined at the end of each calendar year, our organizational documents do not place a limitation on the amount of leverage that we may incur, and weMGCL could incur leverage substantially in excess of this amount. We expectdelay or prevent offers to fund a portion of our cash needs, including funding investment activity, with additional indebtedness. Our ability to access additional debt capital and the cost of other terms thereof will be significantly influenced by our creditworthiness and any rating potentially assigned by a rating agency, as well as by general economic and market conditions. Significant secured and unsecured indebtedness adversely affects our creditworthiness and could preventacquire us from achieving an investment grade credit rating, if pursued, or cause a rating agency to lower a rating or to place a rating on a “watchlist” for possible downgrade. Deterioration in our creditworthiness or in any ratings that we may achieve, or the perception that any such deterioration may occur, would adversely affect our ability to access additional debt capital and increase the costdifficulty of consummating any debt capital that is available to us and may require us to accept restrictive covenants. A reduction in our access to debt capital, an increasesuch offers, even if such a transaction would be in the cost thereof or our acceptance of restrictive covenants could limit our ability to achieve our business objectives and pursue our growth strategies.
We may also incur mortgage debt and other property-level debt on properties that we already own in order to obtain funds to acquire additional properties or make other capital investments. In addition, we may borrow as necessary or advisable to ensure that we maintain our qualification as a REIT for U.S. federal income tax purposes, including borrowings to satisfy the REIT requirement that we distribute at least 90.0%best interests of our annual REIT taxable income to our stockholders. However, we cannot guarantee that we will be able to obtain any such borrowings on favorable terms or at all.
If we mortgage a property and there is a shortfall between the cash flows from that property and the cash flows needed to service mortgage debt on that property, our financial results would be negatively affected and the amount of cash available for distributions to stockholders would be reduced. In addition, incurring mortgage debt increases the risk of loss of a property since defaults on indebtedness secured by a property may result in lenders initiating foreclosure actions. If any mortgages contain cross-collateralization or cross-default provisions, a default on a single property could affect multiple properties. In
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addition, lenders may have recourse to assets other than those specifically securing the repayment of indebtedness. For tax purposes, a foreclosure on any of our properties will be treated as a disposition of the property, which could cause us to recognize taxable income on foreclosure, without receiving corresponding cash proceeds. We may give full or partial guarantees to lenders of mortgage debt on behalf of the entities that own our properties. When we give a guaranty on behalf of an entity that owns one of our properties, we will be responsible to the lender for satisfaction of the debt if it is not paid by such entity.
A significant amount of debt subjects us to many risks that, if realized, would materially and adversely affect us, including the risk that:
our cash flow from operating activities could become insufficient to make required payments of principal and interest on our debt, which would likely result in (1) acceleration of the debt (and any other debt containing a cross-default or cross-acceleration provision), increasing the likelihood of further distress if refinancing is not available on favorable terms or at all, (2) our inability to borrow undrawn amounts under other existing financing arrangements, even if we have timely made all required payments under such arrangements, further compromising our liquidity and/or (3) the loss of some or all of our assets that are pledged as collateral in connection with our financing arrangements;
our debt may increase our vulnerability to adverse economic and industry conditions with no assurance that such debt will increase our investment returns in an amount sufficient to offset the associated risks relating to leverage;
we may be required to dedicate a substantial portion of our cash flow from operating activities to payments on our debt, thereby reducing funds available for operations, future business opportunities, stockholder distributions and/or other purposes; and
to the extent the maturity of certain debt occurs prior to the maturity of a related asset pledged or transferred as collateral for such debt, we may not be able to refinance that debt on favorable terms or at all, which may reduce available liquidity and/or cause significant losses to us.
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds.
Recent Sales of Unregistered Securities
On August 8, 2022,April 3, 2023 and June 19, 2023, we granted 12,614an aggregate of 150,329 time-based RSUs to our executive officers and certain of our key employees pursuant to the Second Amended and Restated 2015 Incentive Plan, or the AHR Incentive Plan. Such time-based RSUs vest in three equal installments annually based on the date of grant (subject to continuous employment through each vesting date) and represent the right to receive shares of our restricted Class T common stock or the RSAs, and 4,205 performance-based restricted stock units, or PSUs, to one of our executive officers pursuant to our 2015 Incentive Plan. Such RSAs and PSUsupon vesting. The time-based RSUs were issued in transactions exempt from registration pursuant to Section 4(a)(2) of the Securities Act. The RSAs vest in three equal annual installments beginning on January 1,
On April 3, 2023, we granted an aggregate of 41,399 performance-based RSUs representing the right to receive up to 82,798 shares of our Class T common stock upon vesting (such number of shares assumes that we issue shares of our common stock underlying such nonvested performance-based awards at maximum levels for performance and ending on January 1, 2025 (subjectmarket conditions that have not yet been achieved; to continuous employment through each vesting date) and the PSUsextent that performance or market conditions do not meet maximum levels, the actual number of shares of our common stock issued under the AHR Incentive Plan would be less than the amount reflected above) to our executive officers pursuant to the AHR Incentive Plan. Such performance-based RSUs will cliff vest in the first quarter of 20252026 (subject to continuous employment through that vesting date), with the amount vesting dependent on certain agreed upon performance criteria. The performance-based RSUs were issued in a transaction exempt from registration pursuant to Section 4(a)(2) of vesting depending on meeting certain key performance criteria as further described in the 2015 Incentive Plan.Securities Act.
On August 30, 2022,June 15, 2023, we granted 7,244an aggregate of 24,200 shares of our restricted Class T common stock to one of our non-executive and independent directors pursuant to our 2015the AHR Incentive Plan as compensation for services in connection with his appointmenttheir re-election as independent directors to our board. Such shares of restricted stock vest on June 15, 2024 and were issued in transactions exempt from registration pursuant to Section 4(a)(2) of the Securities Act and vest on June 15, 2023.Act.
Purchase of Equity Securities by the Issuer and Affiliated Purchasers
OurIn June 2023, we repurchased 366 shares of our Class I common stock and 2,403 shares of our Class T common stock from our independent directors for an aggregate $87,000, at a repurchase price of $31.40 per share repurchase plan allowed for repurchases of shares of our common stock by us when certain criteria were met. Share repurchases were made atin order to satisfy tax obligations associated with the sole discretionaccelerated vesting of our board. Funds for the repurchase of shares of ourrestricted common stock originated exclusively from the cumulative proceeds we received from the sale of shares of our common stockissued pursuant to our DRIP Offerings.
On October 4, 2021, our board approved our amended and restated share repurchase plan that included a change in the repurchase price with respect to repurchases resulting from the death or qualifying disability (as such term is defined in our share repurchase plan) of stockholders, to the most recently published estimated per share NAV. In addition, on October 4, 2021, our board authorized the partial reinstatement of our share repurchase plan with respect to requests to repurchase shares resulting from the death or qualifying disability of stockholders, effective with respect to qualifying repurchases for the fiscal quarter ending December 31, 2021. All share repurchase requests other than those requests resulting from the death or qualifying disability of stockholders were and shall be rejected.
On November 14, 2022, our board suspended our share repurchase plan with respect to all repurchase requests, including repurchases resulting from the death or qualifying disability of stockholders, beginning with share repurchases for the quarter
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ending December 31, 2022. See Note 22, Subsequent Events, to our accompanying condensed consolidated financial statements.
During the three months ended September 30, 2022, we repurchased shares of our common stock as follows:
Period
Total Number of
Shares Purchased

Average Price
Paid per Share

Total Number of Shares
Purchased As Part of
Publicly Announced
Plan or Program
Maximum Approximate
Dollar Value
of Shares that May
Yet Be Purchased
Under the
Plans or Programs
July 1, 2022 to July 31, 2022608,138 $9.29 608,138 (1)
August 1, 2022 to August 31, 2022— $— — (1)
September 1, 2022 to September 30, 2022— $— — (1)
Total608,138 $9.29 608,138 
___________
(1)A description of the maximum number of shares that may be purchased under our share repurchase plan is included in Note 14, Equity — Share Repurchase Plan, to our accompanying condensed consolidated financial statements.AHR Incentive Plan.
Item 3. Defaults Upon Senior Securities.
None.
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Item 4. Mine Safety Disclosures.
Not applicable.
Item 5. Other Information.
In connection withDuring the filing of a Registration Statement on Form S-11 for a proposed public offeringperiod covered by this report, none of our sharesdirectors or executive officers has adopted or terminated a Rule 10b5-1 trading arrangement or a non-Rule 10b5-1 trading arrangement (each as defined in item 408 of common stock in conjunction with a contemplated listingRegulation S-K under the Securities Exchange Act of our common stock on the New York Stock Exchange,1934 as discussed in Note 1, Organization and Description of Business — Public Offerings, to our accompanying condensed consolidated financial statements, our board approved the following:
Reverse Stock Split
On November 10, 2022, our board approved the following charter amendments to effect on November 15, 2022: (i) a one-for-four reverse stock split of each issued and outstanding share of Class T common stock, par value $0.01 per share, and Class I common stock, par value $0.01 per share, which resulted in a par value of $0.04 per share for each class of shares of our common stock; and (ii) a decrease to the par value per share of each share of our common stock outstanding as a result of the reverse stock split from $0.04 to $0.01.
Suspension of DRIP
On November 14, 2022, our board approved the suspension of the AHR DRIP Offering beginning with the distributions declared, if any, for the quarter ending December 31, 2022. As a result of the suspension of the AHR DRIP, there will be no further issuances of shares of our Class T or Class I common stock pursuant to the AHR DRIP unless and until our board reinstates the AHR DRIP Offering, and stockholders who are current participants in the AHR DRIP will receive cash distributions instead.
Suspension of Share Repurchase Plan
Additionally on November 14, 2022, our board approved the suspension of our SRP beginning with share repurchase requests for the quarter ending December 31, 2022. All share repurchase requests outstanding as of the quarter ending December 31, 2022, including requests resulting from the death or qualifying disability of stockholders, shall not be processed, shall be considered canceled in full and shall not be considered outstanding repurchase requests.
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Item 6. Exhibits.
The following exhibits are included, or incorporated by reference, in this Quarterly Report on Form 10-Q for the period ended SeptemberJune 30, 20222023 (and are numbered in accordance with Item 601 of Regulation S-K).
101.INS*Inline XBRL 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.SCH*Inline XBRL Taxonomy Extension Schema Document
101.CAL*Inline XBRL Taxonomy Extension Calculation Linkbase Document
101.DEF*Inline XBRL Taxonomy Extension Definition Linkbase Document
101.LAB*Inline XBRL Taxonomy Extension Label Linkbase Document
101.PRE*Inline XBRL Taxonomy Extension Presentation Linkbase Document
104*Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101)
___________
*Filed herewith.
**Furnished herewith. In accordance with Item 601(b)(32) of Regulation S-K, this Exhibit is not deemed “filed” for purposes of Section 18 of the Exchange Act or otherwise subject to the liabilities of that section. Such certifications will not be deemed incorporated by reference into any filing under the Securities Act of 1933, as amended, or the Securities Exchange Act of 1934, as amended, except to the extent that the registrant specifically incorporates it by reference.
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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.
 
American Healthcare REIT, Inc.
(Registrant)
NovemberAugust 14, 20222023By:
/s/ DANNY PROSKY
DateDanny Prosky
Chief Executive Officer, President and Director
(Principal Executive Officer)
NovemberAugust 14, 20222023By:
/s/ BRIAN S. PEAY
DateBrian S. Peay
Chief Financial Officer
(Principal Financial Officer and Principal Accounting Officer)

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