CareTrust REIT (CTRE) 10-Q 8 Nov 21 2021 Q3 Quarterly report Financial data

Cover

Cover - shares	9 Months Ended
	Sep. 30, 2021	Nov. 05, 2021
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2021
Document Transition Report	false
Entity File Number	001-36181
Entity Registrant Name	CareTrust REIT, Inc.
Entity Central Index Key	0001590717
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q3
Amendment Flag	false
Entity Incorporation, State or Country Code	MD
Entity Tax Identification Number	46-3999490
Entity Address, Address Line One	905 Calle Amanecer
Entity Address, Address Line Two	Suite 300
Entity Address, City or Town	San Clemente
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92673
City Area Code	949
Local Phone Number	542-3130
Title of 12(b) Security	Common Stock, par value $0.01 per share
Trading Symbol	CTRE
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		97,032,846

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Assets:
Real estate investments, net	$ 1,590,418	$ 1,448,099
Other real estate investments	15,150	15,000
Assets held for sale, net	4,891	7,226
Cash and cash equivalents	17,716	18,919
Accounts and other receivables	3,474	1,823
Prepaid expenses and other assets, net	10,710	10,450
Deferred financing costs, net	1,307	2,042
Total assets	1,643,666	1,503,559
Liabilities and Equity:
Senior unsecured notes payable, net	394,063	296,669
Senior unsecured term loan, net	199,084	198,925
Unsecured revolving credit facility	80,000	50,000
Accounts payable, accrued liabilities and deferred rent liabilities	26,740	19,572
Dividends payable	26,164	24,251
Total liabilities	726,051	589,417
Commitments and contingencies
Equity:
Preferred stock, $0.01 par value; 100,000,000 shares authorized, no shares issued and outstanding as of September 30, 2021 and December 31, 2020	0	0
Common stock, $0.01 par value; 500,000,000 shares authorized, 96,296,673 and 95,215,797 shares issued and outstanding as of September 30, 2021 and December 31, 2020, respectively	963	952
Additional paid-in capital	1,191,204	1,164,402
Cumulative distributions in excess of earnings	(274,552)	(251,212)
Total equity	917,615	914,142
Total liabilities and equity	$ 1,643,666	$ 1,503,559

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Sep. 30, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Preferred stock, par value (in usd per share)	$ 0.01	$ 0.01
Preferred stock, authorized (shares)	100,000,000	100,000,000
Preferred stock, issued (shares)	0	0
Preferred stock, outstanding (shares)	0	0
Common stock, par value (in usd per share)	$ 0.01	$ 0.01
Common stock, authorized (shares)	500,000,000	500,000,000
Common stock, issued (shares)	96,296,673	95,215,797
Common stock, outstanding (shares)	96,296,673	95,215,797

Condensed Consolidated Income S

Condensed Consolidated Income Statements - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Revenues:
Rental income	$ 48,087	$ 45,036	$ 141,077	$ 130,007
Independent living facilities	$ 0	$ 634	$ 0	$ 1,874
Independent living facilities, revenue services	Health Care, Resident Service [Member]	Health Care, Resident Service [Member]	Health Care, Resident Service [Member]	Health Care, Resident Service [Member]
Interest and other income	$ 518	$ 17	$ 1,537	$ 2,314
Total revenues	48,605	45,687	142,614	134,195
Expenses:
Depreciation and amortization	13,968	13,086	41,284	39,485
Interest expense	5,692	5,519	17,988	18,082
Property taxes	1,004	857	2,466	2,179
Independent living facilities	$ 0	$ 568	$ 0	$ 1,660
Independent living facilities, cost of services	Health Care, Resident Service [Member]	Health Care, Resident Service [Member]	Health Care, Resident Service [Member]	Health Care, Resident Service [Member]
General and administrative	$ 5,196	$ 4,105	$ 16,136	$ 12,921
Total expenses	25,860	24,135	77,874	74,327
Other loss:
Loss on extinguishment of debt	(10,827)	0	(10,827)	0
Loss on sale of real estate	0	0	(192)	(56)
Total other losses	(10,827)	0	(11,019)	(56)
Net income	$ 11,918	$ 21,552	$ 53,721	$ 59,812
Earnings per common share:
Basic (in usd per share)	$ 0.12	$ 0.23	$ 0.56	$ 0.63
Diluted (in usd per share)	$ 0.12	$ 0.23	$ 0.56	$ 0.63
Weighted-average number of common shares:
Basic (in shares)	96,297	95,214	95,922	95,195
Diluted (in shares)	96,297	95,214	95,937	95,195

Condensed Consolidated Statemen

Condensed Consolidated Statements of Equity - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Cumulative Distributions in Excess of Earnings
Beginning balance at Dec. 31, 2019	$ 927,591	$ 951	$ 1,162,990	$ (236,350)
Beginning balance (in shares) at Dec. 31, 2019		95,103,270
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock, net	(90)		(90)
Vesting of restricted common stock, net of shares withheld for employee taxes	(1,986)	$ 1	(1,987)
Vesting of restricted common stock, net of shares withheld for employee taxes (in shares)		93,061
Amortization of stock-based compensation	884		884
Common dividends	(23,931)			(23,931)
Net income	19,325			19,325
Ending balance at Mar. 31, 2020	921,793	$ 952	1,161,797	(240,956)
Ending balance (in shares) at Mar. 31, 2020		95,196,331
Beginning balance at Dec. 31, 2019	927,591	$ 951	1,162,990	(236,350)
Beginning balance (in shares) at Dec. 31, 2019		95,103,270
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	59,812
Ending balance at Sep. 30, 2020	916,036	$ 952	1,163,418	(248,334)
Ending balance (in shares) at Sep. 30, 2020		95,214,080
Beginning balance at Mar. 31, 2020	921,793	$ 952	1,161,797	(240,956)
Beginning balance (in shares) at Mar. 31, 2020		95,196,331
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock, net	(314)		(314)
Vesting of restricted common stock, net of shares withheld for employee taxes (in shares)		17,749
Amortization of stock-based compensation	963		963
Common dividends	(23,931)			(23,931)
Net income	18,935			18,935
Ending balance at Jun. 30, 2020	917,446	$ 952	1,162,446	(245,952)
Ending balance (in shares) at Jun. 30, 2020		95,214,080
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Amortization of stock-based compensation	972		972
Common dividends	(23,934)			(23,934)
Net income	21,552			21,552
Ending balance at Sep. 30, 2020	916,036	$ 952	1,163,418	(248,334)
Ending balance (in shares) at Sep. 30, 2020		95,214,080
Beginning balance at Dec. 31, 2020	914,142	$ 952	1,164,402	(251,212)
Beginning balance (in shares) at Dec. 31, 2020		95,215,797
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock, net	16,191	$ 7	16,184
Issuance of common stock, net, (in shares)		702,000
Vesting of restricted common stock, net of shares withheld for employee taxes	(1,330)	$ 1	(1,331)
Vesting of restricted common stock, net of shares withheld for employee taxes (in shares)		63,265
Amortization of stock-based compensation	1,585		1,585
Common dividends	(25,633)			(25,633)
Net income	20,486			20,486
Ending balance at Mar. 31, 2021	925,441	$ 960	1,180,840	(256,359)
Ending balance (in shares) at Mar. 31, 2021		95,981,062
Beginning balance at Dec. 31, 2020	914,142	$ 952	1,164,402	(251,212)
Beginning balance (in shares) at Dec. 31, 2020		95,215,797
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	53,721
Ending balance at Sep. 30, 2021	917,615	$ 963	1,191,204	(274,552)
Ending balance (in shares) at Sep. 30, 2021		96,296,673
Beginning balance at Mar. 31, 2021	925,441	$ 960	1,180,840	(256,359)
Beginning balance (in shares) at Mar. 31, 2021		95,981,062
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock, net	6,755	$ 3	6,752
Issuance of common stock, net, (in shares)		288,000
Vesting of restricted common stock, net of shares withheld for employee taxes (in shares)		27,611
Amortization of stock-based compensation	1,810		1,810
Common dividends	(25,714)			(25,714)
Net income	21,317			21,317
Ending balance at Jun. 30, 2021	929,609	$ 963	1,189,402	(260,756)
Ending balance (in shares) at Jun. 30, 2021		96,296,673
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Amortization of stock-based compensation	1,802		1,802
Common dividends	(25,714)			(25,714)
Net income	11,918			11,918
Ending balance at Sep. 30, 2021	$ 917,615	$ 963	$ 1,191,204	$ (274,552)
Ending balance (in shares) at Sep. 30, 2021		96,296,673

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Equity (Parenthetical) - $ / shares	3 Months Ended
	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020
Statement of Stockholders' Equity [Abstract]
Common dividends (in usd per share)	$ 0.265	$ 0.265	$ 0.265	$ 0.25	$ 0.25	$ 0.25

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Cash flows from operating activities:
Net income	$ 53,721	$ 59,812
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization (including below-market ground leases)	41,328	39,529
Amortization of deferred financing costs	1,531	1,462
Loss on extinguishment of debt	10,827	0
Amortization of stock-based compensation	5,197	2,819
Straight-line rental income	(26)	(65)
Loss on sale of real estate	192	56
Interest income distribution from other real estate investment	0	1,346
Change in operating assets and liabilities:
Accounts and other receivables	(1,775)	543
Prepaid expenses and other assets, net	(20)	267
Accounts payable, accrued liabilities and deferred rent liabilities	7,388	2,616
Net cash provided by operating activities	118,363	108,385
Cash flows from investing activities:
Acquisitions of real estate, net of deposits applied	(180,323)	(42,075)
Purchases of equipment, furniture and fixtures and improvements to real estate	(4,826)	(6,294)
Investment in real estate mortgage and other loans receivable	(700)	(13,958)
Principal payments received on real estate mortgage and other loans receivable	172	80,873
Repayment of other real estate investment	0	2,327
Escrow deposits for potential acquisitions of real estate	(3,100)	(1,000)
Net proceeds from sales of real estate	6,814	2,189
Net cash (used in) provided by investing activities	(181,963)	22,062
Cash flows from financing activities:
Proceeds from (costs paid for) the issuance of common stock, net	22,946
Proceeds from (costs paid for) the issuance of common stock, net		(404)
Proceeds from the issuance of senior unsecured notes payable	400,000	0
Borrowings under unsecured revolving credit facility	220,000	15,000
Payments on senior unsecured notes payable	(300,000)	0
Payments on unsecured revolving credit facility	(190,000)	(75,000)
Payments on debt extinguishment and deferred financing costs	(14,070)	0
Net-settle adjustment on restricted stock	(1,331)	(1,986)
Dividends paid on common stock	(75,148)	(69,283)
Net cash provided by (used in) financing activities	62,397	(131,673)
Net decrease in cash and cash equivalents	(1,203)	(1,226)
Cash and cash equivalents as of the beginning of period	18,919	20,327
Cash and cash equivalents as of the end of period	17,716	19,101
Supplemental disclosures of cash flow information:
Interest paid	13,267	12,671
Supplemental schedule of noncash investing and financing activities:
Increase in dividends payable	1,913	2,513
Right-of-use asset obtained in exchange for new operating lease obligation	0	599
Transfer of pre-acquisition costs to acquired assets	358	167
Sale of real estate settled with notes receivable	$ 0	$ 32,400

Organization

Organization	9 Months Ended
	Sep. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization	ORGANIZATION Description of Business— CareTrust REIT, Inc.’s (“CareTrust REIT” or the “Company”) primary business consists of acquiring, financing, developing and owning real property to be leased to third-party tenants in the healthcare sector. As of September 30, 2021, the Company owned and leased to independent operators, 225 skilled nursing, multi-service campuses, assisted living and independent living facilities consisting of 23,541 operational beds and units located in 28 states with the highest concentration of properties by rental revenues located in California, Texas, Louisiana, Idaho and Arizona. A s of September 30, 2021, the Company also had other real estate investments consisting of one mezzanine loan receivable with a carrying value of $15.2 million. COVID-19— The COVID-19 pandemic led governments and other authorities around the world, including federal, state and local authorities in the United States, to impose measures intended to reduce its spread, including restrictions on freedom of movement and business operations such as travel bans, border closings, business limitations and closures (subject to exceptions for essential operations and businesses), quarantines and shelter-in-place orders. Although most of these governmental restrictions have since been lifted or scaled back, resurgences of COVID-19 and the emergence of new variants thereof have resulted in the reimposition of certain restrictions and requirements, including restrictions imposed on unvaccinated individuals and employee vaccine mandates, and may lead to other restrictions and requirements being reimplemented in response to efforts to reduce the spread of COVID-19. Given the dynamic nature of these circumstances and the related adverse impact these restrictions have had, and may continue to have, on the economy generally, the Company’s business, results of operations and financial condition may be adversely impacted by the COVID-19 pandemic. The duration and extent of the COVID-19 pandemic’s effect on the Company’s operational and financial performance, and the operational and financial performance of the Company’s tenants, will depend on future developments, which are highly uncertain and cannot be predicted at this time, including the rate of public acceptance and usage of vaccines and the effectiveness of vaccines in limiting the spread of COVID-19 and its variants, resurgences of COVID-19 and, in particular, new and more contagious and/or vaccine resistant variants, actions taken to contain the spread of COVID-19 and how quickly and to what extent normal economic and operating conditions can resume. The adverse impact of the COVID-19 pandemic on the Company’s business, results of operations and financial condition could be material.

Summary of Significant Accounti

Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2021
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Basis of Presentation —The accompanying condensed consolidated financial statements of the Company were prepared in accordance with accounting principles generally accepted in the United States (“GAAP”) for interim financial information and Article 10 of Regulation S-X. Accordingly, the condensed consolidated financial statements do not include all of the disclosures required by GAAP for a complete set of annual audited financial statements. The condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2020. In the opinion of management, all adjustments which are of a normal and recurring nature and considered necessary for a fair presentation of the results of the interim periods presented have been included. The results of operations for the interim periods are not necessarily indicative of results for the full year. All intercompany transactions and account balances within the Company have been eliminated. Recent Accounting Pronouncements —In March 2020, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2020-04, Reference Rate Reform (Topic 848) - Facilitation of the Effects of Reference Rate Reform on Financial Reporting (“ASU 2020-04”), that provides optional relief to applying reference rate reform to contracts, hedging relationships, and other transactions that reference the London Interbank Offered Rate (“LIBOR”). For U.S. Dollar LIBOR, the overnight, one-month, three-month, six-month and one-year LIBOR rates will be discontinued in June 2023, while other U.S. Dollar LIBOR rates will be discontinued at the end of 2021. The amendments in this update are effective immediately and may be applied through December 31, 202 2. The Company is still evaluating the impact of ASU 2020-04 and expects to take full advantage of the offered optional expedients and exceptions, but does not expect the adoption of the standard to have a material impact on the Company’s consolidated financial statements.

Real Estate Investments, Net

Real Estate Investments, Net	9 Months Ended
	Sep. 30, 2021
Real Estate [Abstract]
Real Estate Investments, Net	REAL ESTATE INVESTMENTS, NET The following table summarizes the Company’s investment in owned properties as of September 30, 2021 and December 31, 2020 (dollars in thousands): September 30, 2021 December 31, 2020 Land $ 251,347 $ 205,356 Buildings and improvements 1,609,834 1,477,849 Integral equipment, furniture and fixtures 103,739 97,836 Identified intangible assets 1,257 2,352 Real estate investments 1,966,177 1,783,393 Accumulated depreciation and amortization (375,759) (335,294) Real estate investments, net $ 1,590,418 $ 1,448,099 As of September 30, 2021 , all 225 of the Company’s facilities wer e leased to various operators under triple-net leases. All of these leases contain annual escalators based on the percentage change in the Consumer Price Index (“CPI”) (but not less than zero), some of which are subject to a cap, or fixed rent escalators. As of September 30, 2021, the Company’s total future contractual minimum rental income for all of its tenants, excluding operating expense reimbursements, was (dollars in thousands): Year Amount 2021 (three months) $ 47,765 2022 191,229 2023 191,024 2024 189,679 2025 189,650 2026 189,755 Thereafter 1,128,717 Total $ 2,127,819 Tenant Purchase Options Certain of the Company’s operators hold purchase options allowing them to acquire properties they currently lease from the Company. A summary of these purchase options is presented below (dollars in thousands): Asset Type Properties Lease Expiration Next Option Open Date Option Type (1) Current Cash Rent (2) ALF 7 October 2034 1/1/2022 A $ 3,282 SNF 11 November 2030 1/1/2022 C 4,944 SNF 1 March 2029 4/1/2022 B / C (3) 779 SNF / Campus 2 October 2032 1/1/2023 B 998 SNF 4 November 2034 12/1/2024 B 3,789 ALF 2 October 2034 1/1/2026 A 1,565 (1) Option type includes: A - Fixed base price plus a specified share on any appreciation. B - Fixed base price. C - Fixed capitalization rate on lease revenue. (2) Based on annualized cash revenue for contracts in place as of September 30, 2021. (3) Purchase option reflects two option types. Rental Income The following table summarizes components of the Company’s rental income (dollars in thousands): For the Three Months Ended September 30, For the Nine Months Ended September 30, Rental Income 2021 2020 2021 2020 Contractual rent due (1) $ 48,081 $ 42,866 $ 140,988 $ 127,789 Straight-line rent 6 17 26 65 Recovery of previously reversed rent (2) — 1,047 — 1,047 Lease termination revenue (2) — 1,106 63 1,106 Total $ 48,087 $ 45,036 $ 141,077 $ 130,007 (1) Includes initial cash rent and tenant operating expense reimbursements, as adjusted for applicable rental escalators and rent increases due to capital expenditures funded by the Company. For tenants on a cash basis, this represents the lesser of the amount that would be recognized on a straight-line basis or cash that has been received. (2) During the three and nine months ended September 30, 2020, the Company recovered approximately $1.0 million in rental revenue related to affiliates of Metron Integrated Health Systems (“Metron”) that was previously written off. In addition, in connection with the agreement to terminate its lease agreements with Metron and to sell the facilities to a third party, the Company received certain lease termination payments from Metron. During the nine months ended September 30, 2021, the Company recognized approximately $0.1 million in lease termination revenue. During the three and nine months ended September 30, 2020, the Company received approximately $1.1 million in lease termination revenue. Recent Real Estate Acquisitions The following table summarizes the Company’s acquisitions for the nine months ended September 30, 2021 (dollars in thousands): Type of Property Purchase Price (1) Initial Annual Cash Rent Number of Properties Number of Beds/Units (2) Skilled nursing $ 57,973 $ 4,499 (3) 4 509 Multi-service campuses 125,708 8,604 (4) 4 640 Total $ 183,681 $ 13,103 8 1,149 (1) Purchase price includes capitalized acquisition costs. (2) The number of beds/units includes operating beds at the acquisition date. (3) Initial annual cash rent represents initial cash rent for the first twelve months excluding any impact of straight-line rent. (4) Initial annual cash rent represents the first twelve months of rent upon commencement of the Company’s long-term net leases, which occurred during the three months ended June 30, 2021, upon the tenants’ receipt of licensing approval and increases to $9.4 million in the second year with CPI-based annual escalators thereafter. Lease Amendments Amended Noble Master Leases. During the three months ended September 30, 2021, the Company did not collect a portion of rent from affiliates of Noble Senior Services and Noble VA Holdings, LLC (collectively, “Noble”). On September 23, 2021, the Company amended its two existing triple-net master leases with Noble. The lease amendment granted a deferral for a total of $1.8 million of unpaid base rent, which represented approximately 4% of the Company’s total contractual base rent for the three months ended September 30, 2021. In connection with its agreement to the rent deferral, the Company also entered int o a purchase agreement with Noble to acquire two assisted living facilities owned by Noble, which will be leased back to Noble under a short-term lease agreement upon closing of the acquisition while the Company pursues other tenants for the long-term. The lease amendment requires the deferred rent, as well as all contractual rent for the fourth quarter of 2021, to be paid in full upon closing the purchase of the two facilities. If the closing under the purchase agreement is not consummated within the timeframe provided in the purchase agreement, all unpaid rent will become immediately due and payable under the terms of the applicable master lease agreements. During the three months ended September 30, 2021, the Company recognized $2.2 million of rental income, exclusive of operating expense reimbursements, related to Noble’s master leases and recorded a corresponding rent receivable of $1.8 million, included within accounts and other receivables on the Company’s condensed consolidated balance sheets. As of September 30, 2021, the Company had $1.1 million of cash security deposits on-hand related to Noble. Amended Ensign Master Lease . On August 1, 2021, the Company acquired two skilled nursing facilities. The facilities were leased to affiliates of The Ensign Group, Inc. (“Ensign”). In conjunction with the acquisition of the two facilities, the Company amended and extended the initial term of an existing triple-net master lease with Ensign to include the two skilled nursing facilities. The Ensign lease, as amended, has a remaining initial term of approximately 17 years, with three five-year renewal options and CPI-based rent escalators. Annual cash rent under the amended lease increased by approximately $2.2 million, with GAAP rent increasing by $2.5 million due to a $5.0 million prepayment of rent made at closing, which is being amortized on a straight-line basis over the remaining lease term. Five Oaks Lease Termination and Amended Ensign Master Lease. On June 1, 2021, operating affiliates of Ensign acquired certain operations and assets of Five Oaks Healthcare, LLC (“Five Oaks”) under an agreement with Five Oaks. The agreement granted Ensign the right to occupy and operate four of the Company’s skilled nursing facilities in Washington that were previously being operated by Five Oaks. In conjunction with consenting to the transfer, the Company terminated the existing Five Oaks master lease, and amended and extended the term of an existing triple-net master lease with Ensign to include the four skilled nursing facilities. The Ensign lease, as amended, has a remaining term of approximately 15 years, with three five-year renewal options and CPI-based rent escalators. Annual cash rent under the terminated Five Oaks master lease was approximately $2.6 million, and annual cash rent under the amended Ensign lease increased by the same amount. Premier Partial Lease Termination and Amended Noble VA Master Lease . On March 10, 2021 and July 1, 2021, two assisted living facilities in Wisconsin operated by affiliates of Premier Senior Living, LLC (“Premier”) were transferred to affiliates of Noble VA Holdings, LLC (“Noble VA”). In connection with the transfer, the Company partially terminated the Premier master lease and amended the existing triple-net master lease with Noble VA to include the two assisted living facilities. The Noble VA master lease, as amended, has a remaining term of approximately 13 years, with two five-year renewal options and CPI-based rent escalators. Initial annual cash rent under the amended Noble VA master lease increased by approximately $1.3 million on March 10, 2021 and approximately $1.0 million on July 1, 2021 and annual cash rent under the partially terminated Premier master lease decreased by approximately the same amount. See above under “Amended Noble Master Leases” for additional information regarding the Company’s leases with Noble. Twenty/20 Lease Termination and New Noble VA Master Lease . On December 1, 2020, five assisted living facilities in Virginia operated by Twenty/20 Management, Inc. (“Twenty/20”) were transferred to affiliates of Noble VA. In connection with the transfer, the Company entered into a new triple-net master lease with Noble VA. The new lease has a remaining initial term of approximately 14 years, with two five-year renewal options and CPI-based rent escalators. Initial annual cash rent under the new lease is approximately $3.2 million . See above under “Amended Noble Master Leases” for additional information regarding the Company’s leases with Noble. Assets Held for Sale and Asset Sales During the third quarter of 2021, the Company met the held for sale criteria on one assisted living facility operated by affiliates of Noble. As of September 30, 2021, the property continued to be held for sale and the carrying value of $4.9 million was primarily comprised of real estate assets. On February 14, 2020, the Company closed on the sale of six skilled nursing facilities formerly operated by affiliates of Metron. In connection with the sale for $36.0 million, the Company received $3.5 million in cash and provided subsidiaries of Cascade Capital Group, LLC (“Cascade”), the purchaser of the properties, with a short-term mortgage loan secured by these properties for $32.4 million. The mortgage loan bore interest at 7.5% and initially had a maturity date of March 31, 2020. In connection with the sale, the Company recognized a loss of approximately $0.1 million during the three months ended March 31, 2020. In April 2020, the mortgage loan was settled with $18.9 million in cash and a new mortgage loan for $13.9 million. In July 2020, the Company received prepayment in full, including accrued interest, for the new $13.9 million mortgage loan. See Note 4, Other Real Estate Investments, Net,

Other Real Estate Investments,

Other Real Estate Investments, Net	9 Months Ended
	Sep. 30, 2021
Real Estate [Abstract]
Other Real Estate Investments, Net	OTHER REAL ESTATE INVESTMENTS, NET Mezzanine Loan Receivable —In November 2020, the Company provided Next VA Star Realty Holdings, LLC a mezzanine loan for nine skilled nursing facilities secured by membership interests in affiliates of Next VA Star Realty Holdings, LLC for approximately $15.0 million, at an annual interest rate of 12%. The loan requires monthly interest payments, is set to mature on November 30, 2025, and may (subject to certain restrictions) be prepaid before the maturity date if paid in full and for an exit fee ranging from 1% to 3% of the loan plus unpaid interest payments equal to 24 months (less the amount of monthly interest pay ments made by the borrower through the date of prepayment). During the three and nine months ended September 30, 2021, the Company recognized $0.5 million and $1.4 million, respectively, of interest income related to its mezzanine loan. Mortgage Loans Receivable —In July 2019, the Company provided MCRC, LLC a real estate loan secured by a 176-bed skilled nursing facility in Manteca, California for $3.0 million, which bore a fixed interest rate of 8% and required monthly interest payments. Concurrently, the Company entered into a purchase and sale agreement to purchase the Manteca facility from MCRC, LLC for approximately $16.4 million subject to normal diligence and other contingencies. The loan documents provided for a maturity date of the earlier to occur of the closing date of the acquisition, or five In September 2019, the Company provided affiliates of CommuniCare Family of Companies (“CommuniCare”) a $26.5 million loan secured by mortgages on the three skilled nursing facilities sold to CommuniCare , which bore a fixed interest rate of 10%. The mortgage loan, which required CommuniCare to make monthly interest payments, was set to mature on February 29, 2020 and included an option to be prepaid before the maturity date. In January 2020, the Company amended the mortgage loan’s maturity date to April 30, 2020. In April 2020, the Company amended the mortgage loan’s maturity date to May 29, 2020. During the three months ended June 30, 2020, payment for the mortgage loan and accrued interest was received in full by the Company. In February 2020, the Company provided subsidiaries of Cascade a $32.4 million loan secured by mortgages on the six skilled nursing facilities formerly operated by affiliates of Metron and sold to Cascade in February 2020, as discussed in Note 3, Real Estate Investments, Net. The mortgage loan bore interest at 7.5% and initially had a maturity date of March 31, 2020. In April 2020, the mortgage loan was settled in connection with a new mortgage loan transaction between the Company and a third-party institutional lender as co-lenders, pursuant to which the Company received $18.9 million in cash and issued a new mortgage loan for $13.9 million. The new mortgage loan with Cascade was secured by the same six skilled nursing facilities purchased by Cascade and was for a combined principal amount of $33.9 million, with the Company’s $13.9 million portion of the indebtedness initially bearing interest at a variable rate equal to LIBOR plus 4.00%, subject to a LIBOR floor of 1.75%. The new mortgage loan had a maturity date of April 29, 2022 and included two six-month extension options. In July 2020, prepayment for the mortgage loan of $13.9 million and accrued interest was received in full by the Company. As of September 30, 2021, the Company had no mortgage loan receivables. During both the three and nine months ended September 30, 2021, the Company recognized no interest income related to mortgage loans. During the three and nine months ended September 30, 2020, the Company recognized zero and $2.0 million of interest income, respectively, related to its mortgage loan s. During the three and nine months ended September 30, 2021, the Company recognized $0.1 million and $0.2 million of interest income, respectively, related to its other loans receivable. Dur ing the three and nine months ended September 30, 2020, the Company recognized $17,000 and $0.2 million of interest income, respectively, related to its other loans receivable. Preferred Equity Investments —In September 2016, the Company completed a $2.3 million preferred equity investment with an affiliate of Cascadia Development, LLC. The preferred equity investment yielded a return equal to prime plus 9.5% but in no event less than 12.0% calculated on a quarterly basis on the outstanding carrying value of the investment. The investment was used to develop a 99-bed skilled nursing facility in Boise, Idaho. In connection with its investment, the Company obtained an option to purchase the development at a fixed-formula price upon stabilization, with an initial lease yield of at least 9.0%. The project was completed in the first quarter of 2018 and began lease-up during the second quarter of 2018. In January 2020, the Company purchased the skilled nursing facility for approximately $18.7 million, inclusive of transaction co sts. The Company paid $15.0 million after receiving back its initial investment of $2.3 million and cumulative contractual preferred return through January 17, 2020, the acquisition date, of $1.4 million, of which less than $0.1 million was recognized as interest income during the nine months ended September 30, 2020. The Company did not recognize any interest income during the three months ended September 30, 2020 or the three and nine months ended September 30, 2021 related to preferred equity investments. As of September 30, 2021, the Company had no preferred equity investments.

Fair Value Measurements

Fair Value Measurements	9 Months Ended
	Sep. 30, 2021
Fair Value Disclosures [Abstract]
Fair Value Measurements	FAIR VALUE MEASUREMENTS The Company determines fair value based on quoted prices when available or through the use of alternative approaches, such as discounting the expected cash flows using market interest rates commensurate with the credit quality and duration of the investment. GAAP guidance defines three levels of inputs that may be used to measure fair value: Level 1 – Quoted prices in active markets for identical assets and liabilities that the reporting entity has the ability to access at the measurement date. Level 2 – Inputs other than quoted prices included within Level 1 that are observable for the asset or liability or can be corroborated with observable market data for substantially the entire contractual term of the asset or liability. Level 3 – Unobservable inputs reflect the entity’s own assumptions about the assumptions that market participants would use in the pricing of the asset or liability and are consequently not based on market activity, but rather through particular valuation techniques. The determination of where an asset or liability falls in the hierarchy requires significant judgment and considers factors specific to the asset or liability. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input that is significant to the fair value measurement in its entirety. The Company evaluates its hierarchy disclosures each quarter and, depending on various factors, it is possible that an asset or liability may be classified differently from quarter to quarter. Changes in the type of inputs may result in a reclassification for certain assets. The Company does not expect that changes in classifications between levels will be frequent. Items Measured at Fair Value on a Recurring Basis The following table presents information about the Company’s assets and liabilities measured at fair value on a recurring basis as of September 30, 2021 and December 31, 2020, aggregated by the level in the fair value hierarchy within which those instruments fall (dollars in thousands): Level 1 Level 2 Level 3 Balance as of September 30, 2021 Assets: Mezzanine loan receivable $ — $ — $ 15,150 $ 15,150 Level 1 Level 2 Level 3 Balance as of December 31, 2020 Assets: Mezzanine loan receivable $ — $ — $ 15,000 $ 15,000 Mezzanine loan receivable: The fair value of the mezzanine loan receivable was estimated using an internal valuation model that considered the expected future cash flows of the investment, the underlying collateral value, market interest rates and other credit enhancements. As such, the Company classifies the instrument as Level 3 due to the significant unobservable inputs used in determining market interest rates for investments with similar terms. Future changes in market interest rates could materially impact the estimated discounted cash flows. As of September 30, 2021 and December 31, 2020, the Company did not have any loans that were 90 days or more past due. For the three and nine months ended September 30, 2021, there were no classification changes in assets and liabilities with Level 3 inputs in the fair value hierarchy. Items Disclosed at Fair Value Considerable judgment is necessary to estimate the fair value disclosure of financial instruments. The estimates of fair value presented herein are not necessarily indicative of the amounts that could be realized upon disposition of the financial instruments. A summary of the face values, carrying amounts and fair values of the Company’s financial instruments as of September 30, 2021 and December 31, 2020 using Level 2 inputs for the Notes and the 2025 Notes (each as defined in Note 6, Debt, below), is as follows (dollars in thousands): September 30, 2021 December 31, 2020 Level Face Carrying Fair Face Carrying Fair Financial liabilities: 2028 Senior unsecured notes payable 2 $ 400,000 $ 394,063 $ 415,000 $ — $ — $ — 2025 Senior unsecured notes payable 2 — — — 300,000 296,669 311,430 Cash and cash equivalents, accounts and other receivables, other loans receivable, accounts payable, and accrued liabilities: These balances approximate their fair values due to the short-term nature of these instruments. Unsecured revolving credit facility and senior unsecured term loan: The fair values approximate their carrying values as the interest rates are variable and approximate prevailing market interest rates for similar debt arrangements.

Debt

Debt	9 Months Ended
	Sep. 30, 2021
Debt Disclosure [Abstract]
Debt	DEBT The following table summarizes the balance of the Company’s indebtedness as of September 30, 2021 and December 31, 2020 (dollars in thousands): September 30, 2021 December 31, 2020 Principal Amount Deferred Loan Fees Carrying Value Principal Amount Deferred Loan Fees Carrying Value 2028 Senior unsecured notes payable $ 400,000 $ (5,937) $ 394,063 $ — $ — $ — 2025 Senior unsecured notes payable — — — 300,000 (3,331) 296,669 Senior unsecured term loan 200,000 (916) 199,084 200,000 (1,075) 198,925 Unsecured revolving credit facility 80,000 — 80,000 50,000 — 50,000 $ 680,000 $ (6,853) $ 673,147 $ 550,000 $ (4,406) $ 545,594 Senior Unsecured Notes Payable 2025 Senior Notes. On May 10, 2017, the Company’s wholly owned subsidiary, CTR Partnership, L.P. (the “Operating Partnership”), and its wholly owned subsidiary, CareTrust Capital Corp. (together with the Operating Partnership, the “Issuers”), completed an underwritten public offering of $300.0 million aggregate principal amount of 5.25% Senior Notes due 2025 (the “2025 Notes”). The 2025 Notes were issued at par, resulting in gross proceeds of $300.0 million and net proceeds of approximately $294.0 million after deducting underwriting fees and other offering expenses. The 2025 Notes were scheduled to mature on June 1, 2025 and bore interest at a rate of 5.25% per year. Interest on the 2025 Notes was payable on June 1 and December 1 of each year. On July 1, 2021 (the “Redemption Date”), the Issuers redeemed all $300.0 million aggregate principal amount of the 2025 Notes at a redemption price equal to 102.625% of the principal amount of the 2025 Notes, plus accrued and unpaid interest thereon up to, but not including, the Redemption Date. During the third quarter of 2021, the Company recorded a loss on extinguishment of debt of $10.8 million in the condensed consolidated income statements, including a prepayment penalty of $7.9 million and a $2.9 million write-off of deferred financing costs associated with the redemption of the 2025 Notes. 2028 Senior Notes. On June 17, 2021, the Issuers completed a private offering of $400.0 million aggregate principal amount of 3.875% Senior Notes due 2028 (the “Notes”) to persons reasonably believed to be qualified institutional buyers pursuant to Rule 144A and to non-U.S. persons outside the United States in reliance on Regulation S under the Securities Act of 1933, as amended. The Notes were issued at par, resulting in gross proceeds of $400.0 million and net proceeds of approximately $393.8 million after deducting underwriting fees and other offering expenses. The Notes mature on June 30, 2028. The Notes accrue interest at a rate of 3.875% per annum payable semiannually in arrears on June 30 and December 30 of each year, commencing on December 30, 2021. The Issuers may redeem some or all of the Notes at any time prior to March 30, 2028 at a price equal to 100% of the principal amount of the Notes redeemed plus accrued and unpaid interest on the Notes, if any, to, but not including, the redemption date, plus a “make-whole” premium. At any time on or after March 30, 2028, the Issuers may redeem some or all of the Notes at a redemption price equal to 100% of the principal amount of the Notes redeemed plus accrued interest on the Notes, if any, to, but not including, the redemption date. In addition, at any time on or prior to June 30, 2024, up to 40% of the aggregate principal amount of the Notes may be redeemed with the net proceeds of certain equity offerings at a redemption price of 103.875% of the aggregate principal amount of Notes to be redeemed plus accrued and unpaid interest on the Notes, if any, to, but not including, the redemption date. If certain changes of control of the Company occur, the Issuers will be required to make an offer to holders of the Notes to repurchase their Notes at a price of 101% of their principal amount plus accrued and unpaid interest, if any, to, but not including, the repurchase date. The obligations under the Notes are fully and unconditionally guaranteed, jointly and severally, on an unsecured basis, by the Company and all of CareTrust’s existing and future subsidiaries (other than the Issuers) that guarantee obligations under the Amended Credit Facility (as defined below); provided, however, that such guarantees are subject to automatic release under certain customary circumstances. The indenture governing the Notes contains customary covenants such as limiting the ability of the Company and its restricted subsidiaries to: incur or guarantee additional indebtedness; incur or guarantee secured indebtedness; pay dividends or distributions on, or redeem or repurchase, capital stock; make certain investments or other restricted payments; sell assets; enter into transactions with affiliates; merge or consolidate or sell all or substantially all of their assets; and create restrictions on the ability of the Issuers and their restricted subsidiaries to pay dividends or other amounts to the Issuers. The indenture governing the Notes also requires the Company and its restricted subsidiaries to maintain a specified ratio of unencumbered assets to unsecured indebtedness. These covenants are subject to a number of important and significant limitations, qualifications and exceptions. The indenture governing the Notes also contains customary events of default. As of September 30, 2021, the Company was in compliance with all applicable financial covenants under the indenture governing the Notes. Unsecured Revolving Credit Facility and Term Loan On February 8, 2019, the Operating Partnership, as the borrower, the Company, as guarantor, CareTrust GP, LLC, and certain of the Operating Partnership’s wholly owned subsidiaries entered into an amended and restated credit and guaranty agreement with KeyBank National Association, as administrative agent, an issuing bank and swingline lender, and the lenders party thereto (the “Amended Credit Agreement”). The Amended Credit Agreement provides for: (i) an unsecured revolving credit facility (the “Revolving Facility”) with revolving commitments in an aggregate principal amount of $600.0 million, including a letter of credit subfacility for 10% of the then available revolving commitments and a swingline loan subfacility for 10% of the then available revolving commitments and (ii) an unsecured term loan credit facility (the “Term Loan” and, together with the Revolving Facility, the “Amended Credit Facility”) in an aggregate principal amount of $200.0 million. Borrowing availability under the Revolving Facility is subject to no default or event of default under the Amended Credit Agreement having occurred at the time of borrowing. The proceeds of the Term Loan were used, in part, to repay in full all outstanding borrowings under the Company’s prior term loan and revolving facility under its prior credit agreement. Future borrowings under the Amended Credit Facility will be used for working capital purposes, for capital expenditures, to fund acquisitions and for general corporate purposes. The interest rates applicable to loans under the Revolving Facility are, at the Operating Partnership’s option, equal to either a base rate plus a margin ranging from 0.10% to 0.55% per annum or LIBOR plus a margin ranging from 1.10% to 1.55% per annum based on the debt to asset value ratio of the Company and its consolidated subsidiaries (subject to decrease at the Operating Partnership’s election if the Company obtains certain specified investment grade ratings on its senior long-term unsecured debt). The interest rates applicable to loans under the Term Loan are, at the Operating Partnership’s option, equal to either a base rate plus a margin ranging from 0.50% to 1.20% per annum or LIBOR plus a margin ranging from 1.50% to 2.20% per annum based on the debt to asset value ratio of the Company and its consolidated subsidiaries (subject to decrease at the Operating Partnership’s election if the Company obtains certain specified investment grade ratings on its senior long-term unsecured debt). In addition, the Operating Partnership will pay a facility fee on the revolving commitments under the Revolving Facility ranging from 0.15% to 0.35% per annum, based on the debt to asset value ratio of the Company and its consolidated subsidiaries (unless the Company obtains certain specified investment grade ratings on its senior long-term unsecured debt and the Operating Partnership elects to decrease the applicable margin as described above, in which case the Operating Partnership will pay a facility fee on the revolving commitments ranging from 0.125% to 0.30% per annum based on the credit ratings of the Company’s senior long-term unsecured debt). As of September 30, 2021, the Operating Partnership had $200.0 million outstanding under the Term Loan and $80.0 million of borrowings outstanding under the Revolving Facility. The Revolving Facility has a maturity date of February 8, 2023, and includes, at the sole discretion of the Operating Partnership, two, six-month extension options. The Term Loan has a maturity date of February 8, 2026. The Amended Credit Facility is guaranteed, jointly and severally, by the Company and its wholly owned subsidiaries that are party to the Amended Credit Agreement (other than the Operating Partnership). The Amended Credit Agreement contains customary covenants that, among other things, restrict, subject to certain exceptions, the ability of the Company and its subsidiaries to grant liens on their assets, incur indebtedness, sell assets, make investments, engage in acquisitions, mergers or consolidations, amend organizational documents and pay certain dividends and other restricted payments. The Amended Credit Agreement requires the Company to comply with financial maintenance covenants to be tested quarterly, consisting of a maximum debt to asset value ratio, a minimum fixed charge coverage ratio, a minimum tangible net worth, a maximum cash distributions to operating income ratio, a maximum secured debt to asset value ratio, a maximum secured recourse debt to asset value ratio, a maximum unsecured debt to unencumbered properties asset value ratio, a minimum unsecured interest coverage ratio and a minimum rent coverage ratio. The Amended Credit Agreement also contains certain customary events of default, including the failure to make timely payments under the Amended Credit Facility or other material indebtedness, the failure to satisfy certain covenants (including the financial maintenance covenants), the occurrence of change of control and specified events of bankruptcy and insolvency. As of September 30, 2021, the Company was in compliance with all applicable financial covenants under the Amended Credit Agreement.

Equity

Equity	9 Months Ended
	Sep. 30, 2021
Equity [Abstract]
Equity	EQUITY Common Stock At-The-Market Offering —On March 10, 2020, the Company entered into a new equity distribution agreement to issue and sell, from time to time, up to $500.0 million in aggregate offering price of its common stock through an “at-the-market” equity offering program (the “ATM Program”). In connection with the entry into the equity distribution agreement and the commencement of the ATM Program, the Company’s “at-the-market” equity offering program pursuant to the Company’s prior equity distribution agreement, dated as of March 4, 2019, was terminated (the “Prior ATM Program”). There was no ATM Program activity for the three months ended September 30, 2021 and there was no Prior ATM Program or ATM Program activity for the three and nine months ended September 30, 2020. The following table summarizes the ATM Program activity for the nine months ended September 30, 2021 (in thousands, except per share amounts). For the Nine Months Ended September 30, 2021 Number of shares 990 Average sales price per share $ 23.74 Gross proceeds (1) $ 23,505 (1) Total gross proceeds is before $0.3 million of commissions paid to the sales agents during the nine months ended September 30, 2021 under the ATM Program. As of September 30, 2021, the Company had $476.5 million available for future issuances under the ATM Program. Share Repurchase Program —On March 20, 2020, the Company’s Board of Directors authorized a share repurchase program to repurchase up to $150.0 million of outstanding shares of the Company’s common stock (the “Repurchase Program”). Repurchases under the Repurchase Program, which expires on March 31, 2023, may be made through open market purchases, privately negotiated transactions, structured or derivative transactions, including accelerated share repurchase transactions, or other methods of acquiring shares, in each case subject to market conditions and at such times as shall be permitted by applicable securities laws and determined by management. Repurchases under the Repurchase Program may also be made pursuant to a plan adopted under Rule 10b5-1 promulgated under the Exchange Act. The Company expects to finance any share repurchases under the Repurchase Program using available cash and may also use short-term borrowings under the Revolving Facility. The Company did not repurchase any shares of common stock under the Repurchase Program during the three and nine months ended September 30, 2021 and 2020 . The Repurchase Program may be modified, discontinued or suspended at any time. Dividends on Common Stock —The following table summarizes the cash dividends on the Company’s common stock declared by the Company’s Board of Directors for the first nine months of 2021 (dollars in thousands, except per share amounts): For the Three Months Ended March 31, 2021 June 30, 2021 September 30, 2021 Dividends declared per share $ 0.265 $ 0.265 $ 0.265 Dividends payment date April 15, 2021 July 15, 2021 October 15, 2021 Dividends payable as of record date $ 25,633 $ 25,714 $ 25,714 Dividends record date March 31, 2021 June 30, 2021 September 30, 2021

Stock-Based Compensation

Stock-Based Compensation	9 Months Ended
	Sep. 30, 2021
Share-based Payment Arrangement [Abstract]
Stock-Based Compensation	STOCK-BASED COMPENSATION All stock-based awards are subject to the terms of the CareTrust REIT, Inc. and CTR Partnership, L.P. Incentive Award Plan (the “Plan”). The Plan provides for the granting of stock-based compensation, including stock options, restricted stock, performance awards, restricted stock units and other incentive awards to officers, employees and directors in connection with their employment with or services provided to the Company. Restricted Stock Awards —In connection with the separation of the healthcare business and real estate business of Ensign into two separate and independent publicly traded companies (the “Spin-Off”) on June 1, 2014, employees of Ensign who had unvested shares of restricted stock were given one share of CareTrust REIT unvested restricted stock totaling 207,580 shares at the Spin-Off. These restricted shares were subject to a time vesting provision only and the Company did not recognize any stock compensation expense associated with these awards. During the year ended December 31, 2020, 1,760 shares were forfeited. At September 30, 2021, there were no unvested restricted stock awards outstanding. In January 2021 and February 2021, the Compensation Committee of the Company’s Board of Directors (the “Compensation Committee”) granted 140,514 and 99,189 shares of restricted stock, respectively, to officers and employees. Each share had a fair market value on the date of grant of $22.48 and $22.18 per share, respectively, based on the closing market price of the Company’s common stock on that date, and the shares vest in three equal annual installments beginning on the first anniversary of the grant date. In January 2021, the Compensation Committee granted 108,414 performance stock awards to officers. Each share had a fair market value on the date of grant of $22.48 per share, based on the closing market price of the Company’s common stock on that date. Performance stock awards are subject to both time and performance based conditions and vest over a one Additionally, in February 2021, the Compensation Committee granted 99,189 performance stock awards to officers. Each share had an estimated fair market value on the date of grant of $27.98 per share. Performance stock awards are subject to both time and performance based conditions and cliff vest after a three-year period. The amount of such performance awards that will ultimately vest is dependent on the Company’s total shareholder return (“TSR”) performance relative to a custom TSR peer group consisting of 16 other publicly traded healthcare REITs on the date of grant and will range from 0% to 200% of the TSR awards initially granted. Compensation expense for awards with performance-based vesting conditions is recognized based upon the grant date fair value per share multiplied by the estimated number of performance stock awards to be earned after considering the Company’s expectation of future performance and is recognized provided that the requisite service is rendered, regardless of when, if ever, the market condition is satisfied. Forfeitures of stock-based awards are recognized as they occur. The fair value of the TSR-based performance stock awards is estimated on the date of the grant using a Monte Carlo valuation model. The risk-free rate is based on the U.S. Treasury yield curve in effect at the grant date for the expected performance period. Expected volatility is based on historical volatility for the most recent 2.84 year period ending on the grant date for the Company and the selected TSR peer group, and is calculated on a daily basis. The following are the key assumptions used in this valuation: Risk-free interest rate 0.27 % Expected stock price volatility 52.93 % Expected service period 2.84 years Expected dividend yield (assuming full reinvestment) — % In April 2021, the Compensation Committee granted 20,266 shares of restricted stock to non-employee members of the Board of Directors. Each share had a fair market value on the date of grant of $24.18 per share, based on the closing market price of the Company’s common stock on that date, and the shares vest in full on the earlier to occur of April 30, 2022 or the Company’s 2022 Annual Meeting of Stockholders. The following table summarizes the stock-based compensation expense recognized during the periods presented (dollars in thousands): For the Three Months Ended September 30, For the Nine Months Ended September 30, 2021 2020 2021 2020 Stock-based compensation expense $ 1,802 $ 972 $ 5,197 $ 2,819 As of September 30, 2021, ther e was $11.3 million of unamortized stock-based compensation expense related to unvested awards and the weighted-average remaining vesting period of such awards was 2.1 years.

Earnings Per Common Share

Earnings Per Common Share	9 Months Ended
	Sep. 30, 2021
Earnings Per Share [Abstract]
Earnings Per Common Share	EARNINGS PER COMMON SHARE The following table presents the calculation of basic and diluted earnings per common share (“EPS”) for the Company’s common stock for the three and nine months ended September 30, 2021 and 2020, and reconciles the weighted-average common shares outstanding used in the calculation of basic EPS to the weighted-average common shares outstanding used in the calculation of diluted EPS (amounts in thousands, except per share amounts): For the Three Months Ended September 30, For the Nine Months Ended September 30, 2021 2020 2021 2020 Numerator: Net income $ 11,918 $ 21,552 $ 53,721 $ 59,812 Less: Net income allocated to participating securities (116) (75) (350) (224) Numerator for basic and diluted earnings available to common stockholders $ 11,802 $ 21,477 $ 53,371 $ 59,588 Denominator: Weighted-average basic common shares outstanding 96,297 95,214 95,922 95,195 Dilutive market condition stock awards — — 15 — Weighted-average diluted common shares outstanding 96,297 95,214 95,937 95,195 Earnings per common share, basic $ 0.12 $ 0.23 $ 0.56 $ 0.63 Earnings per common share, diluted $ 0.12 $ 0.23 $ 0.56 $ 0.63 Antidilutive unvested restricted stock awards and performance awards excluded from the computation 535 300 436 300 The Company’s unvest ed restricted and performance based stock awards associated with its incentive award plan and unvested restricted stock awards issued to employees of Ensign at the Spin-Off ha ve been excluded from the above calculation of earnings per diluted share for the three and nine months ended September 30, 2021 and 2020, as applicable, when their inclusion would have been anti-dilutive.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2021
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	COMMITMENTS AND CONTINGENCIES The Company and its subsidiaries are and may become from time to time a party to various claims and lawsuits arising in the ordinary course of business, which are not individually or in the aggregate anticipated to have a material adverse effect on the Company’s results of operations, financial condition or cash flows. Claims and lawsuits may include matters involving general or professional liability asserted against the Company’s tenants, which are the responsibility of the Company’s tenants and for which the Company is entitled to be indemnified by its tenants under the insurance and indemnification provisions in the applicable leases. Capital expenditures for each property leased under the Company’s triple-net leases are generally the responsibility of the tenant, except that, for the facilities leased to subsidiaries of Ensign and The Pennant Group, Inc. (“Pennant”), the tenant will have an option to require the Company to finance certain capital expenditures up to an aggregate of 20% of the Company’s initial investment in such property, subject to a corresponding rent increase at the time of funding. For the Company’s other triple-net master leases, subject to approval by the Company, the tenants may request capital expenditure funding that would generally be subject to a corresponding rent increase at the time of funding and which are subject to tenant compliance with the conditions to the Company’s approval and funding of their requests. As of September 30, 2021, the Company had committed to fund certain capital improvements at certain triple-net leased facilities totaling $11.7 million, of which $10.4 million is su bject to rent increase at the time of funding.

Concentration of Risk

Concentration of Risk	9 Months Ended
	Sep. 30, 2021
Risks and Uncertainties [Abstract]
Concentration of Risk	CONCENTRATION OF RISK Major operator concentrations – As of September 30, 2021, Ensign leased 95 skilled nursing, multi-service campuses, assisted living and independent living facilities which had a total of 10,148 beds and units and are located in Arizona, California, Colorado, Idaho, Iowa, Nebraska, Nevada, Texas, Utah and Washington. The four states in which Ensign leases the highest concentration of properties by rental revenues as of September 30, 2021 are Texas, California, Arizona and Utah. During the three and nine months ended September 30, 2021, Ensign represented 33% and 32%, respectively, of the Company’s rental income, exclusive of operating expense reimbursements. During the three and nine months ended September 30, 2020, Ensign represente d 30% and 31%, respectively, of the Company’s rental income, exclusive of operating expense reimbursements. Ensign is subject to the registration and reporting requirements of the SEC and is required to file with the SEC annual reports containing audited financial information and quarterly reports containing unaudited financial information. Ensign’s financial statements, as filed with the SEC, can be found at http://www.sec.gov. The Company has not verified this information through an independent investigation or otherwise. As of September 30, 2021, Priority Management Group (“PMG”) leased 15 skilled nursing and campus facilities which had a total of 2,144 beds and units, and are located i n Louisiana and Texas. During both the three and nine months ended September 30, 2021, PMG represented 15% of the Company’s rental income, exclusive of operating expense reimbursements. During both the three and nine months ended September 30, 2020, PMG represented 16% of the Company’s rental income, exclusive of operating expense reimbursements.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2021
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation —The accompanying condensed consolidated financial statements of the Company were prepared in accordance with accounting principles generally accepted in the United States (“GAAP”) for interim financial information and Article 10 of Regulation S-X. Accordingly, the condensed consolidated financial statements do not include all of the disclosures required by GAAP for a complete set of annual audited financial statements. The condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2020. In the opinion of management, all adjustments which are of a normal and recurring nature and considered necessary for a fair presentation of the results of the interim periods presented have been included. The results of operations for the interim periods are not necessarily indicative of results for the full year. All intercompany transactions and account balances within the Company have been eliminated.
Recent Accounting Pronouncements	Recent Accounting Pronouncements —In March 2020, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2020-04, Reference Rate Reform (Topic 848) - Facilitation of the Effects of Reference Rate Reform on Financial Reporting (“ASU 2020-04”), that provides optional relief to applying reference rate reform to contracts, hedging relationships, and other transactions that reference the London Interbank Offered Rate (“LIBOR”). For U.S. Dollar LIBOR, the overnight, one-month, three-month, six-month and one-year LIBOR rates will be discontinued in June 2023, while other U.S. Dollar LIBOR rates will be discontinued at the end of 2021. The amendments in this update are effective immediately and may be applied through December 31, 202 2. The Company is still evaluating the impact of ASU 2020-04 and expects to take full advantage of the offered optional expedients and exceptions, but does not expect the adoption of the standard to have a material impact on the Company’s consolidated financial statements.
Fair Value Measurements	The Company determines fair value based on quoted prices when available or through the use of alternative approaches, such as discounting the expected cash flows using market interest rates commensurate with the credit quality and duration of the investment. GAAP guidance defines three levels of inputs that may be used to measure fair value: Level 1 – Quoted prices in active markets for identical assets and liabilities that the reporting entity has the ability to access at the measurement date. Level 2 – Inputs other than quoted prices included within Level 1 that are observable for the asset or liability or can be corroborated with observable market data for substantially the entire contractual term of the asset or liability. Level 3 – Unobservable inputs reflect the entity’s own assumptions about the assumptions that market participants would use in the pricing of the asset or liability and are consequently not based on market activity, but rather through particular valuation techniques. The determination of where an asset or liability falls in the hierarchy requires significant judgment and considers factors specific to the asset or liability. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input that is significant to the fair value measurement in its entirety. The Company evaluates its hierarchy disclosures each quarter and, depending on various factors, it is possible that an asset or liability may be classified differently from quarter to quarter. Changes in the type of inputs may result in a reclassification for certain assets. The Company does not expect that changes in classifications between levels will be frequent.

Real Estate Investments, Net (T

Real Estate Investments, Net (Tables)	9 Months Ended
	Sep. 30, 2021
Real Estate [Abstract]
Summary of Investment in Owned Properties	The following table summarizes the Company’s investment in owned properties as of September 30, 2021 and December 31, 2020 (dollars in thousands): September 30, 2021 December 31, 2020 Land $ 251,347 $ 205,356 Buildings and improvements 1,609,834 1,477,849 Integral equipment, furniture and fixtures 103,739 97,836 Identified intangible assets 1,257 2,352 Real estate investments 1,966,177 1,783,393 Accumulated depreciation and amortization (375,759) (335,294) Real estate investments, net $ 1,590,418 $ 1,448,099
Schedule of Total Future Contractual Minimum Rental Income	As of September 30, 2021, the Company’s total future contractual minimum rental income for all of its tenants, excluding operating expense reimbursements, was (dollars in thousands): Year Amount 2021 (three months) $ 47,765 2022 191,229 2023 191,024 2024 189,679 2025 189,650 2026 189,755 Thereafter 1,128,717 Total $ 2,127,819
Schedule Of Tenant Purchase Options	Certain of the Company’s operators hold purchase options allowing them to acquire properties they currently lease from the Company. A summary of these purchase options is presented below (dollars in thousands): Asset Type Properties Lease Expiration Next Option Open Date Option Type (1) Current Cash Rent (2) ALF 7 October 2034 1/1/2022 A $ 3,282 SNF 11 November 2030 1/1/2022 C 4,944 SNF 1 March 2029 4/1/2022 B / C (3) 779 SNF / Campus 2 October 2032 1/1/2023 B 998 SNF 4 November 2034 12/1/2024 B 3,789 ALF 2 October 2034 1/1/2026 A 1,565 (1) Option type includes: A - Fixed base price plus a specified share on any appreciation. B - Fixed base price. C - Fixed capitalization rate on lease revenue. (2) Based on annualized cash revenue for contracts in place as of September 30, 2021. (3) Purchase option reflects two option types.
Schedule of Rental Income	The following table summarizes components of the Company’s rental income (dollars in thousands): For the Three Months Ended September 30, For the Nine Months Ended September 30, Rental Income 2021 2020 2021 2020 Contractual rent due (1) $ 48,081 $ 42,866 $ 140,988 $ 127,789 Straight-line rent 6 17 26 65 Recovery of previously reversed rent (2) — 1,047 — 1,047 Lease termination revenue (2) — 1,106 63 1,106 Total $ 48,087 $ 45,036 $ 141,077 $ 130,007 (1) Includes initial cash rent and tenant operating expense reimbursements, as adjusted for applicable rental escalators and rent increases due to capital expenditures funded by the Company. For tenants on a cash basis, this represents the lesser of the amount that would be recognized on a straight-line basis or cash that has been received. (2) During the three and nine months ended September 30, 2020, the Company recovered approximately $1.0 million in rental revenue related to affiliates of Metron Integrated Health Systems (“Metron”) that was previously written off. In addition, in connection with the agreement to terminate its lease agreements with Metron and to sell the facilities to a third party, the Company received certain lease termination payments from Metron. During the nine months ended September 30, 2021, the Company recognized approximately $0.1 million in lease termination revenue. During the three and nine months ended September 30, 2020, the Company received approximately $1.1 million in lease termination revenue.
Schedule of Real Estate Acquisitions	The following table summarizes the Company’s acquisitions for the nine months ended September 30, 2021 (dollars in thousands): Type of Property Purchase Price (1) Initial Annual Cash Rent Number of Properties Number of Beds/Units (2) Skilled nursing $ 57,973 $ 4,499 (3) 4 509 Multi-service campuses 125,708 8,604 (4) 4 640 Total $ 183,681 $ 13,103 8 1,149 (1) Purchase price includes capitalized acquisition costs. (2) The number of beds/units includes operating beds at the acquisition date. (3) Initial annual cash rent represents initial cash rent for the first twelve months excluding any impact of straight-line rent. (4) Initial annual cash rent represents the first twelve months of rent upon commencement of the Company’s long-term net leases, which occurred during the three months ended June 30, 2021, upon the tenants’ receipt of licensing approval and increases to $9.4 million in the second year with CPI-based annual escalators thereafter.

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	9 Months Ended
	Sep. 30, 2021
Fair Value Disclosures [Abstract]
Schedule of Items Measured at Fair Value on a Recurring Basis	The following table presents information about the Company’s assets and liabilities measured at fair value on a recurring basis as of September 30, 2021 and December 31, 2020, aggregated by the level in the fair value hierarchy within which those instruments fall (dollars in thousands): Level 1 Level 2 Level 3 Balance as of September 30, 2021 Assets: Mezzanine loan receivable $ — $ — $ 15,150 $ 15,150 Level 1 Level 2 Level 3 Balance as of December 31, 2020 Assets: Mezzanine loan receivable $ — $ — $ 15,000 $ 15,000
Summary of Face Value, Carrying Amount and Fair Value of Financial Instruments	A summary of the face values, carrying amounts and fair values of the Company’s financial instruments as of September 30, 2021 and December 31, 2020 using Level 2 inputs for the Notes and the 2025 Notes (each as defined in Note 6, Debt, below), is as follows (dollars in thousands): September 30, 2021 December 31, 2020 Level Face Carrying Fair Face Carrying Fair Financial liabilities: 2028 Senior unsecured notes payable 2 $ 400,000 $ 394,063 $ 415,000 $ — $ — $ — 2025 Senior unsecured notes payable 2 — — — 300,000 296,669 311,430

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2021
Debt Disclosure [Abstract]
Schedule of Debt Instruments	The following table summarizes the balance of the Company’s indebtedness as of September 30, 2021 and December 31, 2020 (dollars in thousands): September 30, 2021 December 31, 2020 Principal Amount Deferred Loan Fees Carrying Value Principal Amount Deferred Loan Fees Carrying Value 2028 Senior unsecured notes payable $ 400,000 $ (5,937) $ 394,063 $ — $ — $ — 2025 Senior unsecured notes payable — — — 300,000 (3,331) 296,669 Senior unsecured term loan 200,000 (916) 199,084 200,000 (1,075) 198,925 Unsecured revolving credit facility 80,000 — 80,000 50,000 — 50,000 $ 680,000 $ (6,853) $ 673,147 $ 550,000 $ (4,406) $ 545,594

Equity (Tables)

Equity (Tables)	9 Months Ended
	Sep. 30, 2021
Equity [Abstract]
Summary of the At-The-Market Offering Program	The following table summarizes the ATM Program activity for the nine months ended September 30, 2021 (in thousands, except per share amounts). For the Nine Months Ended September 30, 2021 Number of shares 990 Average sales price per share $ 23.74 Gross proceeds (1) $ 23,505
Schedule of Dividends on Common Stock	The following table summarizes the cash dividends on the Company’s common stock declared by the Company’s Board of Directors for the first nine months of 2021 (dollars in thousands, except per share amounts): For the Three Months Ended March 31, 2021 June 30, 2021 September 30, 2021 Dividends declared per share $ 0.265 $ 0.265 $ 0.265 Dividends payment date April 15, 2021 July 15, 2021 October 15, 2021 Dividends payable as of record date $ 25,633 $ 25,714 $ 25,714 Dividends record date March 31, 2021 June 30, 2021 September 30, 2021

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2021
Share-based Payment Arrangement [Abstract]
Schedule of Valuation Assumptions	The following are the key assumptions used in this valuation: Risk-free interest rate 0.27 % Expected stock price volatility 52.93 % Expected service period 2.84 years Expected dividend yield (assuming full reinvestment) — %
Schedule of Stock-Based Compensation Expense	The following table summarizes the stock-based compensation expense recognized during the periods presented (dollars in thousands): For the Three Months Ended September 30, For the Nine Months Ended September 30, 2021 2020 2021 2020 Stock-based compensation expense $ 1,802 $ 972 $ 5,197 $ 2,819

Earnings Per Common Share (Tabl

Earnings Per Common Share (Tables)	9 Months Ended
	Sep. 30, 2021
Earnings Per Share [Abstract]
Reconciliation of Weighted-Average Common Shares Outstanding Used in Calculation of Basic EPS to Diluted EPS	The following table presents the calculation of basic and diluted earnings per common share (“EPS”) for the Company’s common stock for the three and nine months ended September 30, 2021 and 2020, and reconciles the weighted-average common shares outstanding used in the calculation of basic EPS to the weighted-average common shares outstanding used in the calculation of diluted EPS (amounts in thousands, except per share amounts): For the Three Months Ended September 30, For the Nine Months Ended September 30, 2021 2020 2021 2020 Numerator: Net income $ 11,918 $ 21,552 $ 53,721 $ 59,812 Less: Net income allocated to participating securities (116) (75) (350) (224) Numerator for basic and diluted earnings available to common stockholders $ 11,802 $ 21,477 $ 53,371 $ 59,588 Denominator: Weighted-average basic common shares outstanding 96,297 95,214 95,922 95,195 Dilutive market condition stock awards — — 15 — Weighted-average diluted common shares outstanding 96,297 95,214 95,937 95,195 Earnings per common share, basic $ 0.12 $ 0.23 $ 0.56 $ 0.63 Earnings per common share, diluted $ 0.12 $ 0.23 $ 0.56 $ 0.63 Antidilutive unvested restricted stock awards and performance awards excluded from the computation 535 300 436 300

Organization (Details)

Organization (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2021USD ($)bedfacilitystate	Dec. 31, 2020USD ($)
Real Estate Properties [Line Items]
Number of states with properties | state	28
Other real estate investments | $	$ 15,150	$ 15,000
Skilled nursing, multi-service campuses, assisted living and independent living facilities
Real Estate Properties [Line Items]
Number of facilities | facility	225
Number of operational beds and units in facilities | bed	23,541

Real Estate Investments, Net -

Real Estate Investments, Net - Narrative (Details)	Sep. 30, 2021facility
Skilled nursing, multi-service campuses, assisted living and independent living facilities
Real Estate [Line Items]
Number of facilities	225

Real Estate Investments, Net _2

Real Estate Investments, Net - Investment in Owned Properties (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Real Estate [Abstract]
Land	$ 251,347	$ 205,356
Buildings and improvements	1,609,834	1,477,849
Integral equipment, furniture and fixtures	103,739	97,836
Identified intangible assets	1,257	2,352
Real estate investments	1,966,177	1,783,393
Accumulated depreciation and amortization	(375,759)	(335,294)
Real estate investments, net	$ 1,590,418	$ 1,448,099

Real Estate Investments, Net _3

Real Estate Investments, Net - Future Contractual Minimum Rental Income (Details) $ in Thousands	Sep. 30, 2021USD ($)
Future Contractual Minimum Rental Income
2021 (three months)	$ 47,765
2022	191,229
2023	191,024
2024	189,679
2025	189,650
2026	189,755
Thereafter	1,128,717
Total	$ 2,127,819

Real Estate Investments, Net _4

Real Estate Investments, Net - Tenant Purchase Options (Details) $ in Thousands	Sep. 30, 2021USD ($)property
ALF | Lease Expiration October 2034, Next option 2022
Lessor, Lease, Description [Line Items]
Properties | property	7
Current Cash Rent | $	$ 3,282
ALF | Lease Expiration October 2034, Next option 2026
Lessor, Lease, Description [Line Items]
Properties | property	2
Current Cash Rent | $	$ 1,565
SNF | Lease Expiration November 2030, Next option 2022
Lessor, Lease, Description [Line Items]
Properties | property	11
Current Cash Rent | $	$ 4,944
SNF | Lease Expiration March 2029, Next option 2022
Lessor, Lease, Description [Line Items]
Properties | property	1
Current Cash Rent | $	$ 779
SNF | Lease Expiration November 2034, Next option 2024
Lessor, Lease, Description [Line Items]
Properties | property	4
Current Cash Rent | $	$ 3,789
SNF / Campus | Lease Expiration October 2032, Next option 2023
Lessor, Lease, Description [Line Items]
Properties | property	2
Current Cash Rent | $	$ 998

Real Estate Investments, Net _5

Real Estate Investments, Net - Rental Income (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Real Estate [Abstract]
Contractual rent due	$ 48,081	$ 42,866	$ 140,988	$ 127,789
Straight-line rent	6	17	26	65
Recovery of previously reversed rent	0	1,047	0	1,047
Lease termination revenue	0	1,106	63	1,106
Total	$ 48,087	$ 45,036	$ 141,077	$ 130,007

Real Estate Investments, Net _6

Real Estate Investments, Net - Recent Real Estate Acquisitions (Details) $ in Thousands	1 Months Ended	9 Months Ended	12 Months Ended
	Jan. 31, 2020USD ($)	Sep. 30, 2021USD ($)unitproperty	Dec. 31, 2022USD ($)
Business Acquisition [Line Items]
Purchase Price		$ 183,681
Initial Annual Cash Rent		$ 13,103
Number of Properties | property		8
Number of Beds/Units | unit		1,149
Skilled nursing
Business Acquisition [Line Items]
Purchase Price	$ 18,700	$ 57,973
Initial Annual Cash Rent		$ 4,499
Number of Properties | property		4
Number of Beds/Units | unit		509
Multi-service campuses
Business Acquisition [Line Items]
Purchase Price		$ 125,708
Initial Annual Cash Rent		$ 8,604
Number of Properties | property		4
Number of Beds/Units | unit		640
Multi-service campuses | Forecast
Business Acquisition [Line Items]
Initial Annual Cash Rent			$ 9,400

Real Estate Investments, Net _7

Real Estate Investments, Net - Lease Amendments Narrative (Details) $ in Thousands	Sep. 23, 2021USD ($)facilitylease	Aug. 01, 2021USD ($)extension_optionfacility	Jul. 01, 2021USD ($)facilityextension_option	Jun. 01, 2021USD ($)facilityextension_option	Mar. 10, 2021USD ($)	Dec. 01, 2020USD ($)facilityextension_option	Sep. 30, 2021USD ($)	Sep. 30, 2020USD ($)	Sep. 30, 2021USD ($)property	Sep. 30, 2020USD ($)
Real Estate [Line Items]
Rental income							$ 48,087	$ 45,036	$ 141,077	$ 130,007
Number of properties acquired | property									8
Initial annual cash rents									$ 13,103
Noble master leases, amended
Real Estate [Line Items]
Number of leases amended | lease	2
Deferral of unpaid base rent	$ 1,800
Deferral of unpaid base rent as percentage of total contractual base rent							4.00%
Rental income							$ 2,200
Rent receivable							1,800		1,800
Ensign master lease, amended
Real Estate [Line Items]
Initial lease term (in years)		17 years
Number of renewal options | extension_option		3
Lease renewal term (in years)		5 years
Annual cash rent increase under amended lease		$ 2,200
GAAP rent increase under amended lease		$ 2,500
Ensign amended triple-net master lease
Real Estate [Line Items]
Initial lease term (in years)				15 years
Number of renewal options | extension_option				3
Lease renewal term (in years)				5 years
Initial annual cash rents				$ 2,600
Noble triple-net master lease
Real Estate [Line Items]
Initial lease term (in years)						14 years
Number of renewal options | extension_option						2
Lease renewal term (in years)						5 years
Initial annual cash rents						$ 3,200
Noble VA master lease, amended
Real Estate [Line Items]
Initial lease term (in years)			13 years
Number of renewal options | extension_option			2
Lease renewal term (in years)			5 years
Initial annual cash rents			$ 1,000		$ 1,300
Skilled nursing facility
Real Estate [Line Items]
Number of properties acquired | facility		2
Prepaid rent component		$ 5,000
Noble
Real Estate [Line Items]
Cash security deposits on-hand							$ 1,100		$ 1,100
Noble | Assisted living
Real Estate [Line Items]
Number of properties per agreement | facility	2
Ensign | Skilled nursing facility
Real Estate [Line Items]
Number of properties with right to operate | facility				4
Noble VA | Assisted living
Real Estate [Line Items]
Number of properties transferred | facility			2			5

Real Estate Investments, Net _8

Real Estate Investments, Net - Assets Held for Sale and Asset Sales Narrative (Details)	Feb. 01, 2021USD ($)bed	Feb. 14, 2020USD ($)facility	Jul. 31, 2020USD ($)	Apr. 30, 2020USD ($)	Sep. 30, 2021USD ($)facility	Mar. 31, 2021USD ($)	Sep. 30, 2020USD ($)	Mar. 31, 2020USD ($)	Sep. 30, 2021USD ($)facility	Sep. 30, 2020USD ($)	Dec. 31, 2020USD ($)facility	Feb. 29, 2020USD ($)facility
Real Estate [Line Items]
Assets held for sale, net					$ 4,891,000				$ 4,891,000		$ 7,226,000
Real estate investments, net					1,590,418,000				1,590,418,000		$ 1,448,099,000
Proceeds from sale									6,814,000	$ 2,189,000
Loss on sale of real estate					0		$ 0		192,000	$ 56,000
Mortgage loan receivable
Real Estate [Line Items]
Loan receivable					$ 0				$ 0
Mortgage loan receivable | Cascade Capital Group, LLC
Real Estate [Line Items]
Loan receivable		$ 32,400,000										$ 32,400,000
Loan receivable interest rate (percent)		7.50%										7.50%
Proceeds from settlement of loan			$ 13,900,000	$ 18,900,000
Loan receivable				$ 13,900,000
Held for sale
Real Estate [Line Items]
Number of facilities | facility					1				1
Held for sale | Five Oaks Healthcare LLC
Real Estate [Line Items]
Number of facilities | facility											1
Disposed of by sale | Five Oaks Healthcare LLC
Real Estate [Line Items]
Number of facilities | facility											1
Number of operational beds | bed	90
Real estate investments, net	$ 7,200,000
Proceeds from sale	$ 7,000,000
Loss on sale of real estate						$ 200,000
Disposed of by sale | Metron skilled nursing facilities
Real Estate [Line Items]
Number of properties sold | facility		6										6
Contract purchase price		$ 36,000,000
Proceeds from sale		$ 3,500,000
Loss on sale of real estate								$ 100,000

Other Real Estate Investments_2

Other Real Estate Investments, Net (Details)

1 Months Ended

3 Months Ended

9 Months Ended

Nov. 30, 2020USD ($)facility

Jul. 31, 2020USD ($)

Apr. 30, 2020USD ($)propertyextension_option

Jan. 31, 2020USD ($)

Jul. 31, 2019USD ($)bed

Sep. 30, 2016USD ($)bed

Sep. 30, 2021USD ($)

Sep. 30, 2020USD ($)

Sep. 30, 2021USD ($)

Sep. 30, 2020USD ($)

Feb. 29, 2020USD ($)facility

Feb. 14, 2020USD ($)facility

Sep. 30, 2019USD ($)facility

Real Estate Properties [Line Items]

Preferred equity investment

$ 0

$ 0

Aggregate purchase price

183,681,000

Payment to acquire facility

180,323,000

$ 42,075,000

Return of initial investment

0

2,327,000

Metron skilled nursing facilities | Disposed of by sale

Real Estate Properties [Line Items]

Number of properties sold | facility

6

6

Mortgage loan receivable

Real Estate Properties [Line Items]

Loan receivable

0

0

Interest income

0

$ 0

0

2,000,000

Other loans receivable

Real Estate Properties [Line Items]

Interest income

100,000

$ 17,000

200,000

200,000

Next VA Star Realty Holdings LLC | Mezzanine loan receivable

Real Estate Properties [Line Items]

Number of facilities in agreement secured by membership interests | facility

9

Loan receivable

$ 15,000,000

Loan receivable interest rate (percent)

12.00%

Period of unpaid interest payments due upon prepayment

24 months

Interest income

$ 500,000

1,400,000

Next VA Star Realty Holdings LLC | Mezzanine loan receivable | Minimum

Real Estate Properties [Line Items]

Loans receivable exit fee (percent)

1.00%

Next VA Star Realty Holdings LLC | Mezzanine loan receivable | Maximum

Real Estate Properties [Line Items]

Loans receivable exit fee (percent)

3.00%

MCRC, LLC

Real Estate Properties [Line Items]

Purchase and sale agreement amount

$ 16,400,000

Number of days after termination of purchase and sale agreement for maturity

5 days

MCRC, LLC | Mortgage loan receivable

Real Estate Properties [Line Items]

Loan receivable

$ 3,000,000

Loan receivable interest rate (percent)

8.00%

Number of beds in facility used to secure loan | bed

176

CommuniCare | Mortgage loan receivable

Real Estate Properties [Line Items]

Loan receivable

$ 26,500,000

Loan receivable interest rate (percent)

10.00%

Facilities utilized to secure mortgage loan | facility

3

Cascade Capital Group, LLC

Real Estate Properties [Line Items]

Combined principal amount of loan

$ 33,900,000

Cascade Capital Group, LLC | Mortgage loan receivable

Real Estate Properties [Line Items]

Loan receivable

$ 32,400,000

$ 32,400,000

Loan receivable interest rate (percent)

7.50%

7.50%

Facilities utilized to secure mortgage loan | property

6

Proceeds from settlement of loan

$ 13,900,000

$ 18,900,000

Loan receivable

$ 13,900,000

LIBOR floor for loan (percent)

1.75%

Number of extension options | extension_option

2

Extension option term (in months)

6 months

Cascade Capital Group, LLC | Mortgage loan receivable | LIBOR

Real Estate Properties [Line Items]

Basis spread on variable rate for loan (percent)

4.00%

Cascadia Development, Boise ID

Real Estate Properties [Line Items]

Preferred equity investment

$ 2,300,000

Preferred equity investment minimum yield

12.00%

Number of beds planned for construction | bed

99

Initial lease yield (percent)

9.00%

Return of initial investment

$ 2,300,000

Cumulative contractual preferred return through acquisition date

1,400,000

Interest income related to preferred equity investments

$ 100,000

Cascadia Development, Boise ID | Prime Rate

Real Estate Properties [Line Items]

Basis spread of preferred equity investment yield

9.50%

Skilled nursing properties

Real Estate Properties [Line Items]

Aggregate purchase price

18,700,000

$ 57,973,000

Payment to acquire facility

$ 15,000,000

Fair Value Measurements - Items

Fair Value Measurements - Items Measured at Fair Value on Recurring Basis (Details) - Recurring - Mezzanine loan receivable - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Assets:
Mezzanine loan receivable	$ 15,150	$ 15,000
Level 1
Assets:
Mezzanine loan receivable	0	0
Level 2
Assets:
Mezzanine loan receivable	0	0
Level 3
Assets:
Mezzanine loan receivable	$ 15,150	$ 15,000

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($)	Sep. 30, 2021	Dec. 31, 2020
Greater than 90 days past due
Financing Receivable, Past Due [Line Items]
Mortgage loan receivable	$ 0	$ 0

Fair Value Measurements - Face

Fair Value Measurements - Face Value, Carrying Amount and Fair Value of Financial Instruments (Details) - Notes payable - USD ($)	Sep. 30, 2021	Jun. 17, 2021	Dec. 31, 2020	May 10, 2017
2028 Senior unsecured notes payable
Financial liabilities:
Senior unsecured notes payable - face value	$ 400,000,000	$ 400,000,000	$ 0
2025 Senior unsecured notes payable
Financial liabilities:
Senior unsecured notes payable - face value	0		300,000,000	$ 300,000,000
Carrying Amount | Level 2 | 2028 Senior unsecured notes payable
Financial liabilities:
Senior unsecured notes payable	394,063,000		0
Carrying Amount | Level 2 | 2025 Senior unsecured notes payable
Financial liabilities:
Senior unsecured notes payable	0		296,669,000
Fair Value | Level 2 | 2028 Senior unsecured notes payable
Financial liabilities:
Senior unsecured notes payable	415,000,000		0
Fair Value | Level 2 | 2025 Senior unsecured notes payable
Financial liabilities:
Senior unsecured notes payable	$ 0		$ 311,430,000

Debt - Schedule of Debt (Detail

Debt - Schedule of Debt (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Principal Amount	$ 680,000	$ 550,000
Deferred Loan Fees	(6,853)	(4,406)
Carrying Value	673,147	545,594
Notes payable | 2028 Senior unsecured notes payable
Debt Instrument [Line Items]
Principal Amount	400,000	0
Deferred Loan Fees	(5,937)	0
Carrying Value	394,063	0
Notes payable | 2025 Senior unsecured notes payable
Debt Instrument [Line Items]
Principal Amount	0	300,000
Deferred Loan Fees	0	(3,331)
Carrying Value	0	296,669
Term loan | Senior unsecured term loan
Debt Instrument [Line Items]
Principal Amount	200,000	200,000
Deferred Loan Fees	(916)	(1,075)
Carrying Value	199,084	198,925
Revolving credit facility
Debt Instrument [Line Items]
Principal Amount	80,000	50,000
Deferred Loan Fees	0	0
Carrying Value	$ 80,000	$ 50,000

Debt - Senior Unsecured Notes P

Debt - Senior Unsecured Notes Payable Narrative (Details) - USD ($)	Jul. 01, 2021	Jun. 17, 2021	May 10, 2017	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2020
Debt Instrument [Line Items]
Gross proceeds from issuance						$ 400,000,000	$ 0
Loss on extinguishment of debt				$ 10,827,000	$ 0	10,827,000	$ 0
Notes payable | 5.25% Senior Notes due 2025
Debt Instrument [Line Items]
Debt instrument face amount			$ 300,000,000	0		0		$ 300,000,000
Interest rate (percent)			5.25%
Gross proceeds from issuance			$ 300,000,000
Net proceeds from issuance			$ 294,000,000
Redemption of debt	$ 300,000,000
Redemption price of notes (percent)	102.625%
Loss on extinguishment of debt				10,800,000
Loss on redemption price				7,900,000
Write off of deferred financing costs				2,900,000
Notes payable | 3.875% Senior Notes due 2028
Debt Instrument [Line Items]
Debt instrument face amount		$ 400,000,000		$ 400,000,000		$ 400,000,000		$ 0
Interest rate (percent)		3.875%
Gross proceeds from issuance		$ 400,000,000
Net proceeds from issuance		$ 393,800,000
Redemption price, percentage upon change of control (percent)		101.00%
Notes payable | 3.875% Senior Notes due 2028 | Period prior to March 30 2028
Debt Instrument [Line Items]
Redemption price of notes (percent)		100.00%
Notes payable | 3.875% Senior Notes due 2028 | Period after March 30 2028
Debt Instrument [Line Items]
Redemption price of notes (percent)		100.00%
Notes payable | 3.875% Senior Notes due 2028 | Period prior to June 30 2024
Debt Instrument [Line Items]
Redemption price of notes (percent)		103.875%
Percentage of principal amount (percent)		40.00%

Debt - Unsecured Revolving Cred

Debt - Unsecured Revolving Credit Facility and Term Loan Narrative (Details)	Feb. 08, 2019USD ($)extension_option	Sep. 30, 2021USD ($)	Dec. 31, 2020USD ($)
Line of Credit Facility [Line Items]
Outstanding amounts		$ 680,000,000	$ 550,000,000
Borrowings outstanding		80,000,000	50,000,000
Revolving credit facility
Line of Credit Facility [Line Items]
Credit facility borrowing capacity	$ 600,000,000
Outstanding amounts		80,000,000	50,000,000
Borrowings outstanding		80,000,000
Number of extension options | extension_option	2
Extension option term (in months)	6 months
Revolving credit facility | Minimum
Line of Credit Facility [Line Items]
Facility fee on revolving commitment fees (percent)	0.15%
Facility fee on revolving commitment fee based on investment grade ratings (percent)	0.125%
Revolving credit facility | Minimum | Base Rate
Line of Credit Facility [Line Items]
Basis spread on variable rate (percent)	0.10%
Revolving credit facility | Minimum | LIBOR
Line of Credit Facility [Line Items]
Basis spread on variable rate (percent)	1.10%
Revolving credit facility | Maximum
Line of Credit Facility [Line Items]
Facility fee on revolving commitment fees (percent)	0.35%
Facility fee on revolving commitment fee based on investment grade ratings (percent)	0.30%
Revolving credit facility | Maximum | Base Rate
Line of Credit Facility [Line Items]
Basis spread on variable rate (percent)	0.55%
Revolving credit facility | Maximum | LIBOR
Line of Credit Facility [Line Items]
Basis spread on variable rate (percent)	1.55%
Letter of credit
Line of Credit Facility [Line Items]
Subfacility capacity as percentage of available revolving commitments (percent)	10.00%
Swingline loan
Line of Credit Facility [Line Items]
Subfacility capacity as percentage of available revolving commitments (percent)	10.00%
Term loan | Senior unsecured term loan
Line of Credit Facility [Line Items]
Debt instrument face amount	$ 200,000,000
Outstanding amounts		$ 200,000,000	$ 200,000,000
Term loan | Senior unsecured term loan | Minimum | Base Rate
Line of Credit Facility [Line Items]
Basis spread on variable rate (percent)	0.50%
Term loan | Senior unsecured term loan | Minimum | LIBOR
Line of Credit Facility [Line Items]
Basis spread on variable rate (percent)	1.50%
Term loan | Senior unsecured term loan | Maximum | Base Rate
Line of Credit Facility [Line Items]
Basis spread on variable rate (percent)	1.20%
Term loan | Senior unsecured term loan | Maximum | LIBOR
Line of Credit Facility [Line Items]
Basis spread on variable rate (percent)	2.20%

Equity - Narrative (Details)

Equity - Narrative (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020	Mar. 20, 2020	Mar. 10, 2020
Class of Stock [Line Items]
Share repurchase program authorization					$ 150,000,000
Shares repurchased (in shares)	0	0	0	0
ATM Program
Class of Stock [Line Items]
Issuance of common stock, net, (in shares)	0	0	990,000	0
Remaining offering amount available	$ 476,500,000		$ 476,500,000
ATM Program | Maximum
Class of Stock [Line Items]
Authorized aggregate offering price of common stock						$ 500,000,000

Equity - At-The-Market Offering

Equity - At-The-Market Offering (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Class of Stock [Line Items]
Gross proceeds			$ 22,946
Commissions paid on stock issuance				$ 404
ATM Program
Class of Stock [Line Items]
Number of shares	0	0	990,000	0
Average sales price per share			$ 23.74
Gross proceeds			$ 23,505
Commissions paid on stock issuance			$ 300

Equity - Dividends on Common St

Equity - Dividends on Common Stock (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020
Dividends on common stock
Dividends declared per share	$ 0.265	$ 0.265	$ 0.265	$ 0.25	$ 0.25	$ 0.25
Dividends payment date	Oct. 15, 2021	Jul. 15, 2021	Apr. 15, 2021
Dividends payable as of record date	$ 25,714	$ 25,714	$ 25,633	$ 23,934	$ 23,931	$ 23,931
Dividends record date	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021

Stock-Based Compensation - Narr

Stock-Based Compensation - Narrative (Details) $ / shares in Units, $ in Millions	Jun. 01, 2014shares	Apr. 30, 2021$ / sharesshares	Feb. 28, 2021installmentcompany$ / sharesshares	Jan. 31, 2021installment$ / sharesshares	Feb. 28, 2021installment	Sep. 30, 2021USD ($)shares	Dec. 31, 2020shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unamortized stock-based compensation expense related to unvested awards | $						$ 11.3
Weighted average remaining vesting period related to expense recognition						2 years 1 month 6 days
Restricted stock award | Ensign employees
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock awards unvested during spin-off (in shares)	207,580
Shares forfeited (shares)							1,760
Unvested stock awards outstanding (in shares)						0
Restricted stock award | Officers and employees
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of awards granted (in shares)			99,189	140,514
Award grant date fair value (in usd per share) | $ / shares			$ 22.18	$ 22.48
Number of equal annual vesting installments | installment			3	3	3
Restricted stock award | Board of Directors
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of awards granted (in shares)		20,266
Award grant date fair value (in usd per share) | $ / shares		$ 24.18
Performance stock award
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Historical volatility term basis for expected volatility assumption					2 years 10 months 2 days
Performance stock award | Officers
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of awards granted (in shares)			99,189	108,414
Award grant date fair value (in usd per share) | $ / shares			$ 27.98	$ 22.48
Vesting period (in years)			3 years
Number of publicly traded healthcare REITs in peer group | company			16
Performance stock award | Minimum | Officers
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period (in years)				1 year
Percentage of awards to vest relative To initial grant based on TSR performance			0.00%
Performance stock award | Maximum | Officers
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period (in years)				3 years
Percentage of awards to vest relative To initial grant based on TSR performance			200.00%

Stock-Based Compensation - Valu

Stock-Based Compensation - Valuation Assumptions (Details) - Performance stock award	2 Months Ended
	Feb. 28, 2021
Valuation Assumptions
Risk-free interest rate	0.27%
Expected stock price volatility	52.93%
Expected service period	2 years 10 months 2 days
Expected dividend yield (assuming full reinvestment)	0.00%

Stock-Based Compensation - Stoc

Stock-Based Compensation - Stock-Based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Share-based Payment Arrangement [Abstract]
Stock-based compensation expense	$ 1,802	$ 972	$ 5,197	$ 2,819

Earnings Per Common Share (Deta

Earnings Per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Sep. 30, 2021	Sep. 30, 2020
Numerator:
Net income (loss)	$ 11,918	$ 21,317	$ 20,486	$ 21,552	$ 18,935	$ 19,325	$ 53,721	$ 59,812
Less: Net income allocated to participating securities	(116)			(75)			(350)	(224)
Numerator for basic earnings available to common stockholders	11,802			21,477			53,371	59,588
Numerator for basic and diluted earnings available to common stockholders	$ 11,802			$ 21,477			$ 53,371	$ 59,588
Denominator:
Weighted-average basic common shares outstanding (in shares)	96,297			95,214			95,922	95,195
Diluted market condition stock awards (in shares)	0			0			15	0
Weighted-average diluted common shares outstanding (in shares)	96,297			95,214			95,937	95,195
Earnings per common share, basic (in dollars per share)	$ 0.12			$ 0.23			$ 0.56	$ 0.63
Earnings per common share, diluted (in dollars per share)	$ 0.12			$ 0.23			$ 0.56	$ 0.63
Antidilutive unvested restricted stock awards and performance awards excluded from the computation	535			300			436	300

Commitments and Contingencies (

Commitments and Contingencies (Details) $ in Millions	Sep. 30, 2021USD ($)
Ensign and Pennant
Other Commitments [Line Items]
Aggregate required financing of capital expenditures as percentage of initial investment in property (percent)	20.00%
Certain capital improvements at triple-net leased facilities
Other Commitments [Line Items]
Funding commitment	$ 11.7
Portion of funding commitment subject to rent increase at time of funding	$ 10.4

Concentration of Risk (Details)

Concentration of Risk (Details)	3 Months Ended		9 Months Ended
	Sep. 30, 2021facilityunit_bed	Sep. 30, 2020	Sep. 30, 2021facilitystateunit_bed	Sep. 30, 2020
Skilled nursing, multi-service campuses, assisted living and independent living facilities
Concentration Risk [Line Items]
Number of facilities	225		225
Ensign
Concentration Risk [Line Items]
Number of states where Ensign leases the highest concentration of properties | state			4
Ensign | Customer concentration risk | Rental income, exclusive of operating expense reimbursements
Concentration Risk [Line Items]
Concentration risk (percent)	33.00%	30.00%	32.00%	31.00%
PMG | Customer concentration risk | Rental income, exclusive of operating expense reimbursements
Concentration Risk [Line Items]
Concentration risk (percent)	15.00%	16.00%	15.00%	16.00%
Ensign | Skilled nursing, multi-service campuses, assisted living and independent living facilities
Concentration Risk [Line Items]
Number of facilities	95		95
Number of beds and units in facilities | unit_bed	10,148		10,148
PMG | Skilled nursing and campus facilities
Concentration Risk [Line Items]
Number of facilities	15		15
Number of beds and units in facilities	2,144		2,144