AHTR American Healthcare REIT Inc (PK)

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1. Organization and Description of Business

Overview and Background

American Healthcare REIT, Inc., a Maryland corporation, is a self-managed real estate investment trust, or REIT, that acquires, owns and operates a diversified portfolio of clinical healthcare real estate properties, focusing primarily on outpatient medical buildings, senior housing, skilled nursing facilities, or SNFs, and other healthcare-related facilities. We also operate healthcare-related facilities utilizing the structure permitted by the REIT Investment Diversification and Empowerment Act of 2007, which is commonly referred to as a “RIDEA” structure (the provisions of the Internal Revenue Code of 1986, as amended, or the Code, authorizing the RIDEA structure were enacted as part of the Housing and Economic Recovery Act of 2008). Our healthcare facilities operated under a RIDEA structure include our senior housing operating properties, or SHOP, and our integrated senior health campuses. We have originated and acquired secured loans and may also originate and acquire other real estate-related investments on an infrequent and opportunistic basis. We generally seek investments that produce current income; however, we have selectively developed, and may continue to selectively develop, healthcare real estate properties. We have elected to be taxed as a REIT for U.S. federal income tax purposes. We believe that we have been organized and operated, and we intend to continue to operate, in conformity with the requirements for qualification and taxation as a REIT under the Code.

Operating Partnership

We conduct substantially all of our operations through our operating partnership, and we are the sole general partner of our operating partnership. As of March 31, 2024 and December 31, 2023, we owned 97.4% and 95.0%, respectively, of the partnership units, or OP units, in our operating partnership, and the remaining 2.6% and 5.0%, respectively, limited OP units were owned by AHI Group Holdings, LLC, which is owned and controlled by Jeffrey T. Hanson, the non-executive Chairman of our board of directors, or our board, Danny Prosky, our Chief Executive Officer, President and director, and Mathieu B. Streiff, one of our directors; Platform Healthcare Investor TII, LLC; Flaherty Trust; and a wholly owned subsidiary of Griffin Capital Company, LLC, or collectively, the Limited Partners. See Note 11, Redeemable Noncontrolling Interests, and Note 12, Equity — Noncontrolling Interests in Total Equity, for a further discussion of the ownership in our operating partnership.

Public Offerings and Listing

We issued an aggregate 65,445,557 shares of Class T common stock and Class I common stock, for a total of $2,737,716,000 in gross offering proceeds, since February 26, 2014 in our initial public offerings and our distribution reinvestment plan, or DRIP, offerings. Our initial public offerings were terminated as of April 2019.

On February 9, 2024, pursuant to a Registration Statement filed with the United States Securities and Exchange Commission, or SEC, on Form S-11 (File No. 333-267464), as amended, we closed our underwritten public offering, or the 2024 Offering, through which we issued 64,400,000 shares of Common Stock, for a total of $772,800,000 in gross offering proceeds. Such amounts include the exercise in full of the underwriters’ overallotment option to purchase up to an additional 8,400,000 shares of Common Stock. These shares are listed on the New York Stock Exchange, or NYSE, under the trading symbol “AHR” and began trading on February 7, 2024.

Following the closing of the 2024 Offering, we are presenting Common Stock, Class T common stock and Class I common stock, or collectively, common stock, as separate classes within our condensed consolidated balance sheets and condensed consolidated statements of equity. Any references to “Common Stock” in this Quarterly Report on Form 10-Q refer to our NYSE-listed shares sold through the 2024 Offering, whereas Class T common stock and Class I common stock refer to our classes of common stock that are not NYSE-listed. This applies to all historical periods presented herein.

See Note 12, Equity — Common Stock, and Note 12, Equity — Distribution Reinvestment Plan, for a further discussion of our public offerings.

Our Real Estate Investments Portfolio

We currently operate through four reportable business segments: integrated senior health campuses, outpatient medical, or OM, SHOP and triple-net leased properties. As of March 31, 2024, we owned and/or operated 318 buildings and integrated senior health campuses, representing approximately 19,451,000 square feet of gross leasable area, for an aggregate contract

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purchase price of $4,566,829,000. In addition, as of March 31, 2024, we also owned a real estate-related debt investment purchased for $60,429,000.

2. Summary of Significant Accounting Policies

The summary of significant accounting policies presented below is designed to assist in understanding our accompanying condensed consolidated financial statements. Such condensed consolidated financial statements and the accompanying notes thereto are the representations of our management, who are responsible for their integrity and objectivity. These accounting policies conform to accounting principles generally accepted in the United States of America, or GAAP, in all material respects, and have been consistently applied in preparing our accompanying condensed consolidated financial statements.

Basis of Presentation

Our accompanying condensed consolidated financial statements include our accounts and those of our operating partnership, the wholly-owned subsidiaries of our operating partnership and all non-wholly owned subsidiaries in which we have control, as well as any VIEs in which we are the primary beneficiary. The portion of equity in any subsidiary that is not wholly owned by us is presented in our accompanying condensed consolidated financial statements as a noncontrolling interest. We evaluate our ability to control an entity, and whether the entity is a VIE and we are the primary beneficiary, by considering substantive terms of the arrangement and identifying which enterprise has the power to direct the activities of the entity that most significantly impacts the entity’s economic performance.

We operate and intend to continue to operate in an umbrella partnership REIT structure in which our operating partnership, wholly-owned subsidiaries of our operating partnership and all non-wholly owned subsidiaries of which we have control will own substantially all of the interests in properties acquired on our behalf. We are the sole general partner of our operating partnership, and as of March 31, 2024 and December 31, 2023, we owned a 97.4% and 95.0%, respectively, general partnership interest therein, and the remaining 2.6% and 5.0%, respectively, limited partnership interest was owned by the Limited Partners.

The accounts of our operating partnership are consolidated in our accompanying condensed consolidated financial statements because we are the sole general partner of our operating partnership and have unilateral control over its management and major operating decisions (even if additional limited partners are admitted to our operating partnership). All intercompany accounts and transactions are eliminated in consolidation.

Interim Unaudited Financial Data

Our accompanying condensed consolidated financial statements have been prepared by us in accordance with GAAP in conjunction with the rules and regulations of the SEC. Certain information and footnote disclosures required for annual financial statements have been condensed or excluded pursuant to the SEC’s rules and regulations. Accordingly, our accompanying condensed consolidated financial statements do not include all of the information and footnotes required by GAAP for complete financial statements. Our accompanying condensed consolidated financial statements reflect all adjustments which are, in our view, of a normal recurring nature and necessary for a fair presentation of our financial position, results of operations and cash flows for the interim period. Interim results of operations are not necessarily indicative of the results to be expected for the full year; such full-year results may be less favorable.

In preparing our accompanying condensed consolidated financial statements, management has evaluated subsequent events through the financial statement issuance date. We believe that although the disclosures contained herein are adequate to prevent the information presented from being misleading, our accompanying condensed consolidated financial statements should be read in conjunction with our audited consolidated financial statements and the notes thereto included in our 2023 Annual Report on Form 10-K, as filed with the SEC on March 22, 2024.

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Use of Estimates

The preparation of our accompanying condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, as well as the disclosure of contingent assets and liabilities, at the date of our condensed consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates and assumptions include, but are not limited to, the initial and recurring valuation of certain assets acquired and liabilities assumed through property acquisitions including through business combinations, goodwill and its impairment, revenues and grant income, allowance for credit losses, impairment of long-lived and intangible assets and contingencies. These estimates are made and evaluated on an ongoing basis using information that is currently available, as well as various other assumptions believed to be reasonable under the circumstances. Actual results could differ from those estimates, perhaps in material adverse ways, and those estimates could be different under different assumptions or conditions.

Revenue Recognition — Resident Fees and Services Revenue

Disaggregation of Resident Fees and Services Revenue

The following tables disaggregate our resident fees and services revenue by line of business, according to whether such revenue is recognized at a point in time or over time (in thousands):

						Three Months Ended March 31,
						2024																		2023
						Integrated Senior Health Campuses						SHOP(1)						Total						Integrated Senior Health Campuses						SHOP(1)						Total
Over time						$	324,517					$	57,620					$	382,137					$	298,850					$	45,613					$	344,463
Point in time						68,605						1,376						69,981						62,920						1,247						64,167
Total resident fees and services						$	393,122					$	58,996					$	452,118					$	361,770					$	46,860					$	408,630

The following tables disaggregate our resident fees and services revenue by payor class (in thousands):

						Three Months Ended March 31,
						2024																		2023
						Integrated Senior Health Campuses						SHOP(1)						Total						Integrated Senior Health Campuses						SHOP(1)						Total
Private and other payors						$	184,322					$	51,176					$	235,498					$	169,678					$	43,850					$	213,528
Medicare						120,349						1,243						121,592						126,466						311						126,777
Medicaid						88,451						6,577						95,028						65,626						2,699						68,325
Total resident fees and services						$	393,122					$	58,996					$	452,118					$	361,770					$	46,860					$	408,630

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(1)Includes fees for basic housing, as well as fees for assisted living or skilled nursing care. We record revenue when services are rendered at amounts billable to individual residents. Residency agreements are generally for a term of 30 days, with resident fees billed monthly in advance. For patients under reimbursement arrangements with Medicaid, revenue is recorded based on contractually agreed-upon amounts or rates on a daily, per resident basis or as services are rendered.

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Accounts Receivable, Net — Resident Fees and Services Revenue

The beginning and ending balances of accounts receivable, net — resident fees and services are as follows (in thousands):

						Private and Other Payors						Medicare						Medicaid						Total
Beginning balance — January 1, 2024						$	66,218					$	51,260					$	30,799					$	148,277
Ending balance — March 31, 2024						73,716						71,142						31,529						176,387
Increase						$	7,498					$	19,882					$	730					$	28,110

Deferred Revenue — Resident Fees and Services Revenue

Deferred revenue is included in security deposits, prepaid rent and other liabilities in our accompanying condensed consolidated balance sheets. The beginning and ending balances of deferred revenue — resident fees and services, almost all of which relates to private and other payors, are as follows (in thousands):

						Total
Beginning balance — January 1, 2024						$	23,372
Ending balance — March 31, 2024						22,590
Decrease						$	(782)

Resident and Tenant Receivables and Allowances

Resident receivables, which are related to resident fees and services revenue, are carried net of an allowance for credit losses. An allowance is maintained for estimated losses resulting from the inability of residents and payors to meet the contractual obligations under their lease or service agreements. Substantially all of such allowances are recorded as direct reductions of resident fees and services revenue as contractual adjustments provided to third-party payors or implicit price concessions in our accompanying condensed consolidated statements of operations and comprehensive loss. Our determination of the adequacy of these allowances is based primarily upon evaluations of historical loss experience, the residents’ financial condition, security deposits, cash collection patterns by payor and by state, current economic conditions, future expectations in estimating credit losses and other relevant factors. Tenant receivables, which are related to real estate revenue, and unbilled deferred rent receivables are reduced for amounts where collectability is not probable, which are recognized as direct reductions of real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive loss.

The following is a summary of our adjustments to allowances for the three months ended March 31, 2024 and 2023 (in thousands):

						Three Months Ended March 31,
						2024						2023
Beginning balance						$	17,037					$	14,071
Additional allowances						6,603						4,037
Write-offs						(3,258)						(1,890)
Recoveries collected or adjustments						(1,856)						(1,827)
Ending balance						$	18,526					$	14,391

Properties Held for Sale

We classify a property or group of operating properties as held for sale in the period when certain criteria are met, such as we commit to a plan to sell the property and have determined that the sale is probable. Upon classification of a property as held for sale, we record the property at the lower of its carrying amount or fair value less costs to sell. In addition, a property being held for sale ceases to be depreciated.

Our properties held for sale are included in other assets, net in our accompanying condensed consolidated balance sheets. On January 25, 2024, we disposed of one of our SHOP that was held for sale for a contract sales price of $4,500,000 and recognized a gain on sale of $645,000. For the three months ended March 31, 2023, we did not dispose of any held for sale properties. See Note 3, Real Estate Investments, Net and Business Combinations — Dispositions of Real Estate Investments, for a further discussion of our property dispositions.

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Accounts Payable and Accrued Liabilities

As of March 31, 2024 and December 31, 2023, accounts payable and accrued liabilities primarily include reimbursement of payroll-related costs to the managers of our SHOP and integrated senior health campuses of $46,931,000 and $42,698,000, respectively, insurance reserves of $44,691,000 and $44,548,000, respectively, accrued distributions to common stockholders of $32,900,000 and $16,557,000, respectively, and accrued property taxes of $24,374,000 and $23,549,000, respectively.

Recently Issued Accounting Pronouncements

In November 2023, the Financial Accounting Standards Board, or FASB, issued Accounting Standards Update, or ASU, 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, or ASU 2023-07, which is intended to improve reportable segment disclosure requirements, primarily through enhanced disclosures about significant expenses. Such disclosure amendments include the requirement for public entities to disclose significant segment expenses that are regularly provided to the chief operating decision maker and included within each reported measure of segment profit or loss. ASU 2023-07 is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted and should be applied retrospectively to all prior periods presented in the financial statements. We are currently evaluating this guidance to determine the impact to our consolidated financial statements and disclosures.

In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures, or ASU 2023-09, which includes amendments that further enhance income tax disclosures, primarily through standardization and disaggregation of rate reconciliation categories and income taxes paid by jurisdiction. ASU 2023-09 is effective for annual periods beginning after December 15, 2024. Early adoption is permitted and should be applied prospectively; however, retrospective application is permitted. We are currently evaluating this guidance to determine the impact to our consolidated financial statements and disclosures.

In March 2024, the SEC adopted final rules, The Enhancement and Standardization of Climate-Related Disclosures for Investors. The final rules require a registrant to disclose, among other things: material climate-related risks; activities to mitigate or adapt to such risks, as well as a quantitative and qualitative description of material expenditures incurred and material impacts on financial estimates and assumptions that directly result from such mitigation or adaptation activities; material capitalized costs, expenses and losses incurred as a result of severe weather events and other natural conditions; information about the registrant’s board of directors’ oversight of climate-related risks and management’s role in managing material climate-related risks; and information on any climate-related targets or goals that are material to the registrant’s business, results of operations or financial condition. The rules require registrants to provide such climate-related disclosures in their annual reports, beginning with annual reports for the year ending December 31, 2025 for calendar-year-end large accelerated filers. In April 2024, the SEC stayed the final rules in response to legal challenges to the rules. As a result, it is not clear whether current compliance deadlines will be extended once the litigation is resolved. We are currently evaluating this guidance to determine the impact to our consolidated financial statement disclosures.

3. Real Estate Investments, Net and Business Combinations

Our real estate investments, net consisted of the following as of March 31, 2024 and December 31, 2023 (in thousands):

			March 31, 2024						December 31, 2023
Building, improvements and construction in process			$	3,666,999					$	3,604,299
Land and improvements			349,061						335,946
Furniture, fixtures and equipment			245,278						237,350
			4,261,338						4,177,595
Less: accumulated depreciation			(782,565)						(752,157)
			$	3,478,773					$	3,425,438

Depreciation expense for the three months ended March 31, 2024 and 2023 was $37,135,000 and $35,899,000, respectively.

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The following is a summary of our capital expenditures by reportable segment for the three months ended March 31, 2024 (in thousands):

									Three Months Ended March 31, 2024
Integrated senior health campuses									$	5,766
OM									4,934
SHOP									2,937
Triple-net leased properties									—
Total									$	13,637

Included in the capital expenditure amounts above are costs for the development and expansion of our integrated senior health campuses. For the three months ended March 31, 2024, we completed the development of one integrated senior health campus for $18,969,000.

Dispositions of Real Estate Investments

For the three months ended March 31, 2024, we disposed of two OM buildings that were included in real estate investments in our accompanying condensed consolidated balance sheets. We recognized a total aggregate net gain on such dispositions of $1,618,000. The following is a summary of such dispositions (dollars in thousands):

Location						Number of Buildings						Type						Date Disposed						Contract Sales Price
Marietta, GA						1						OM						01/16/24						$	6,674
Homewood, AL						1						OM						03/18/24						4,462
Total						2																		$	11,136

Business Combinations

On February 1, 2024, we acquired a portfolio of 14 senior housing properties in Oregon from an unaffiliated third party, which properties are included in our SHOP segment. These properties are part of the underlying collateral pool of real estate assets securing our debt security investment, as defined and described in Note 4. We acquired such properties by assuming the outstanding principal balance of each related mortgage loan payable from one of the borrowers since such borrower was in default. The aggregated principal balance of such assumed mortgage loans payable was $94,461,000 at the time of acquisition. No cash consideration was exchanged as part of the transactions; however, we incurred transaction costs of $3,112,000 related to the acquisition of such properties. See Note 4, Debt Security Investment, Net, for a further discussion.

On February 15, 2023, we, through a majority-owned subsidiary of Trilogy, acquired from an unaffiliated third party, a 60.0% controlling interest in a privately held company, Memory Care Partners, LLC, or MCP, that operated integrated senior health campuses located in Kentucky. The contract purchase price for the acquisition of MCP was $900,000, which was acquired using cash on hand. Prior to such acquisition, we owned a 40.0% interest in MCP, which was accounted for as an equity method investment and was included in investments in unconsolidated entities within other assets, net in our accompanying condensed consolidated balance sheet as of December 31, 2022. In connection with the acquisition of the remaining interest in MCP, we now own a 100% controlling interest in MCP. As a result, we re-measured the fair value of our previously held equity interest in MCP and recognized a gain on re-measurement of $726,000 in our accompanying condensed consolidated statements of operations and comprehensive loss for the three months ended March 31, 2023.

Based on quantitative and qualitative considerations, such business combinations were not material to us individually or in the aggregate and therefore, pro forma financial information is not provided. The fair values of the assets acquired and liabilities assumed were preliminary estimates at acquisition. Any necessary adjustments are finalized within one year from the date of acquisition.

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The table below summarizes the acquisition date fair values of the assets acquired and liabilities assumed of our business combinations during the three months ended March 31, 2024 and 2023 (in thousands):

						2024 Acquisition						2023 Acquisition
Building and improvements						$	64,350					$	—
Land						14,210						—
In-place leases						12,912						—
Goodwill						—						3,331
Furniture, fixtures and equipment						—						39
Cash and restricted cash						—						565
Accounts receivable, net						343						—
Other assets						9						66
Total assets acquired						91,824						4,001
Mortgage loans payable (including debt discount of $2,989)						(91,472)						—
Accounts payable and accrued liabilities						(352)						(1,676)
Financing obligations						—						(12)
Security deposits and other liabilities						—						(812)
Total liabilities assumed						(91,824)						(2,500)
Net assets acquired						$	—					$	1,501

4. Debt Security Investment, Net

Our investment in a commercial mortgage-backed debt security, or debt security, bears an interest rate on the stated principal amount thereof equal to 4.24% per annum, the terms of which security provide for monthly interest-only payments. The debt security matures on August 25, 2025 at an aggregate stated amount of $93,433,000, resulting in an anticipated yield-to-maturity of 10.0% per annum. The debt security was issued by an unaffiliated mortgage trust and represents a 10.0% beneficial ownership interest in such mortgage trust. The debt security is subordinate to all other interests in the mortgage trust and is not guaranteed by a government-sponsored entity.

On February 1, 2024, we acquired a portfolio of 14 senior housing properties in Oregon from an unaffiliated third party, which properties are included in the underlying collateral pool of real estate assets securing our debt security investment. We acquired such properties by assuming the outstanding principal balance of each related mortgage loan payable from one of the borrowers since such borrower was in default. We did not grant any concessions to such borrower, and the carrying value of our debt security investment at the time of acquisition did not exceed the fair value of such properties. See Note 3, Real Estate Investments, Net and Business Combinations, for a further discussion of such acquisition.

As of March 31, 2024 and December 31, 2023, the carrying amount of the debt security investment was $87,984,000 and $86,935,000, respectively, net of unamortized closing costs of $413,000 and $489,000, respectively. Accretion on the debt security for the three months ended March 31, 2024 and 2023 was $1,125,000 and $1,020,000, respectively, which is recorded as an increase to real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive loss. Amortization expense of closing costs for the three months ended March 31, 2024 and 2023 was $76,000 and $65,000, respectively, which is recorded as a decrease to real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive loss. We evaluated credit quality indicators such as the agency ratings and the underlying collateral of such investment in order to determine expected future credit loss. No credit loss was recorded for the three months ended March 31, 2024 and 2023.

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5. Identified Intangible Assets and Liabilities

Identified intangible assets, net and identified intangible liabilities, net consisted of the following as of March 31, 2024 and December 31, 2023 (dollars in thousands):

			March 31, 2024						December 31, 2023
Amortized intangible assets:
In-place leases, net of accumulated amortization of $37,431 and $35,437 as of March 31, 2024 and December 31, 2023, respectively (with a weighted average remaining life of 6.2 years and 7.7 years as of March 31, 2024 and December 31, 2023, respectively)			$	50,552					$	42,615
Above-market leases, net of accumulated amortization of $7,462 and $7,079 as of March 31, 2024 and December 31, 2023, respectively (with a weighted average remaining life of 7.4 years and 7.5 years as of March 31, 2024 and December 31, 2023, respectively)			15,189						15,905
Customer relationships, net of accumulated amortization of $972 and $934 as of March 31, 2024 and December 31, 2023, respectively (with a weighted average remaining life of 12.4 years and 12.7 years as of March 31, 2024 and December 31, 2023, respectively)			1,868						1,906
Unamortized intangible assets:
Certificates of need			99,938						99,777
Trade names			20,267						20,267
Total identified intangible assets, net			$	187,814					$	180,470
Amortized intangible liabilities:
Below-market leases, net of accumulated amortization of $2,950 and $2,831 as of March 31, 2024 and December 31, 2023, respectively (with a weighted average remaining life of 7.0 years and 7.2 years as of March 31, 2024 and December 31, 2023, respectively)			$	5,805					$	6,095
Total identified intangible liabilities, net			$	5,805					$	6,095

Amortization expense on identified intangible assets for the three months ended March 31, 2024 and 2023 was $5,713,000 and $17,071,000, respectively, which included $716,000 and $9,083,000, respectively, of amortization recorded as a decrease to real estate revenue for above-market leases in our accompanying condensed consolidated statements of operations and comprehensive loss. In March 2023, we transitioned our SNFs within Central Wisconsin Senior Care Portfolio from triple-net leased properties to a RIDEA structure, which resulted in a full amortization of $8,073,000 of above-market leases and $885,000 of in-place leases.

Amortization expense on below-market leases for the three months ended March 31, 2024 and 2023 was $290,000 and $408,000, respectively, which is recorded as an increase to real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive loss.

The aggregate weighted average remaining life of the identified intangible assets was 6.7 years and 7.8 years as of March 31, 2024 and December 31, 2023, respectively. The aggregate weighted average remaining life of the identified intangible liabilities was 7.0 years and 7.2 years as of March 31, 2024 and December 31, 2023, respectively. As of March 31, 2024, estimated amortization expense on the identified intangible assets and liabilities for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31, and thereafter was as follows (in thousands):

						Amortization Expense
Year						Intangible Assets						Intangible Liabilities
2024						$	18,094					$	(782)
2025						9,522						(956)
2026						7,727						(840)
2027						7,203						(825)
2028						6,150						(709)
Thereafter						18,913						(1,693)
Total						$	67,609					$	(5,805)

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6. Other Assets, Net

Other assets, net consisted of the following as of March 31, 2024 and December 31, 2023 (dollars in thousands):

			March 31, 2024						December 31, 2023
Deferred rent receivables			$	48,541					$	47,540
Prepaid expenses, deposits, other assets and deferred tax assets, net			32,729						33,204
Inventory — finished goods			20,741						19,472
Investments in unconsolidated entities			19,411						20,611
Lease commissions, net of accumulated amortization of $7,500 and $7,231 as of March 31, 2024 and December 31, 2023, respectively			17,442						17,565
Derivative financial instruments			5,491						1,463
Deferred financing costs, net of accumulated amortization of $7,117 and $8,494 as of March 31, 2024 and December 31, 2023, respectively			5,207						3,830
Lease inducement, net of accumulated amortization of $2,632 and $2,544 as of March 31, 2024 and December 31, 2023, respectively (with a weighted average remaining life of 6.7 years and 6.9 years as of March 31, 2024 and December 31, 2023, respectively)			2,368						2,456
Total			$	151,930					$	146,141

7. Mortgage Loans Payable, Net

Mortgage loans payable, net consisted of the following as of March 31, 2024 and December 31, 2023 (dollars in thousands):

			March 31, 2024						December 31, 2023
Total fixed-rate debt (90 loans and 76 loans as of March 31, 2024 and December 31, 2023, respectively)			$	1,082,865					$	990,325
Total variable-rate debt (5 loans and 13 loans as of March 31, 2024 and December 31, 2023, respectively)			172,255						335,988
Total fixed- and variable-rate debt			1,255,120						1,326,313
Less: deferred financing costs, net			(10,864)						(9,713)
Add: premium			151						167
Less: discount			(15,972)						(14,371)
Mortgage loans payable, net			$	1,228,435					$	1,302,396

Based on interest rates in effect as of March 31, 2024 and December 31, 2023, effective interest rates on mortgage loans payable ranged from 2.21% to 8.18% per annum and 2.21% to 8.46% per annum, respectively, with a weighted average effective interest rate of 4.27% and 4.72%, respectively. We are required by the terms of certain loan documents to meet certain reporting requirements and covenants, such as net worth ratios, fixed charge coverage ratios and leverage ratios.

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The following table reflects the changes in the carrying amount of mortgage loans payable, net for the three months ended March 31, 2024 and 2023 (in thousands):

			Three Months Ended March 31,
			2024						2023
Beginning balance			$	1,302,396					$	1,229,847
Additions:
Borrowings under mortgage loans payable			15,535						7,700
Assumption of mortgage loans payable due to acquisition of real estate investments, net			91,472						—
Amortization of deferred financing costs			780						577
Amortization of discount/premium on mortgage loans payable, net			1,374						885
Deductions:
Scheduled principal payments on mortgage loans payable			(5,045)						(5,122)
Early payoff of mortgage loans payable			(176,145)						—
Deferred financing costs			(1,932)						(142)
Ending balance			$	1,228,435					$	1,233,745

For the three months ended March 31, 2024, we incurred an aggregate loss on the early extinguishment of a mortgage loan payable of $715,000, which is recorded as an increase to interest expense in our accompanying condensed consolidated statements of operations and comprehensive loss. Such aggregate loss was primarily related to the payoff of approximately $176,145,000 of mortgage loans payable using the net proceeds from the 2024 Offering. For the three months ended March 31, 2023, we did not incur any gain or loss on the extinguishment of mortgage loans payable.

As of March 31, 2024, the principal payments due on our mortgage loans payable for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31, and thereafter were as follows (in thousands):

Year						Amount
2024						$	177,717
2025						168,275
2026						158,331
2027						55,125
2028						105,126
Thereafter						590,546
Total						$	1,255,120

8. Lines of Credit and Term Loan

2022 Credit Facility

We, through our operating partnership, as borrower, and certain of our subsidiaries, or the subsidiary guarantors, collectively as guarantors, were party to an amended agreement, or the 2022 Credit Agreement, with Bank of America, N.A., or Bank of America, KeyBank National Association, or KeyBank, Citizens Bank, National Association, or Citizens Bank, and the lenders named therein, which provided for a credit facility with an aggregate maximum principal amount up to $1,050,000,000, or the 2022 Credit Facility. The 2022 Credit Facility consisted of a senior unsecured revolving credit facility in the initial aggregate amount of $500,000,000 and a senior unsecured term loan facility in the initial aggregate amount of $550,000,000.

As of December 31, 2023, borrowings outstanding under the 2022 Credit Facility totaled $914,900,000, and the weighted average interest rate on such borrowings outstanding was 7.08% per annum. Under the terms of the 2022 Credit Agreement, the revolving loans would have matured on January 19, 2026, and the term loan would have matured on January 19, 2027. On February 14, 2024, the 2022 Credit Agreement was amended and restated in its entirety. See below for a further discussion.

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2024 Credit Facility

On February 14, 2024, we, through our operating partnership, as borrower, and certain of our subsidiaries, or the subsidiary guarantors, and our company, collectively as guarantors, entered into an agreement, or the 2024 Credit Agreement, that amended, restated, superseded and replaced the 2022 Credit Agreement with Bank of America, KeyBank, Citizens Bank and a syndicate of other banks, as lenders, to obtain a credit facility with an aggregate maximum principal amount up to $1,150,000,000, or the 2024 Credit Facility. The 2024 Credit Facility consists of a senior unsecured revolving credit facility in the initial aggregate amount of $600,000,000 and a senior unsecured term loan facility in the initial aggregate amount of $550,000,000. The proceeds of loans made under the 2024 Credit Facility may be used for general corporate purposes including for working capital, capital expenditures, refinancing existing indebtedness and other corporate purposes not inconsistent with obligations under the 2024 Credit Agreement. We may also obtain up to $25,000,000 in the form of standby letters of credit pursuant to the 2024 Credit Facility. Unless defined herein, all capitalized terms under this “2024 Credit Facility” subsection are defined in the 2024 Credit Agreement.

Under the terms of the 2024 Credit Agreement, the Revolving Loans mature on February 14, 2028, and may be extended for one 12-month period, subject to the satisfaction of certain conditions, including payment of an extension fee. The Term Loan matures on January 19, 2027, and may not be extended. The maximum principal amount of the 2024 Credit Facility may be increased by an aggregate incremental amount of $600,000,000, subject to: (i) the terms of the 2024 Credit Agreement and (ii) at least five business days’ prior written notice to Bank of America.

At our option, the 2024 Credit Facility bears interest at varying rates based upon (i) Daily SOFR, plus the Applicable Rate for Daily SOFR Rate Loans or (ii) Term SOFR, plus the Applicable Rate for Term SOFR Rate Loans. If, under the terms of the 2024 Credit Agreement, there is an inability to determine the Daily SOFR or the Term SOFR, then the 2024 Credit Facility will bear interest at a rate per annum equal to the Base Rate plus the Applicable Rate for Base Rate Loans. The loans may be repaid in whole or in part without prepayment premium or penalty, subject to certain conditions.

We are required to pay a fee on the unused portion of the lenders’ commitments under the 2024 Credit Agreement computed at (a) 0.25% per annum if the actual daily Commitment Utilization Percentage for such quarter is less than or equal to 50% and (b) 0.20% per annum if the actual daily Commitment Utilization Percentage for such quarter is greater than 50%, which fee shall be computed on the actual daily amount of the Available Commitments during the period for which payment is made and payable in arrears on a quarterly basis.

The 2024 Credit Agreement requires us to add additional subsidiaries as guarantors in the event the value of the assets owned by the subsidiary guarantors falls below a certain threshold as set forth in the 2024 Credit Agreement. In the event of default, Bank of America has the right to terminate the commitment of each Lender to make Loans and any obligation of the L/C Issuer to make L/C Credit Extensions under the 2024 Credit Agreement and to accelerate the payment on any unpaid principal amount of all outstanding loans and all interest accrued and unpaid thereon.

As of March 31, 2024, our aggregate borrowing capacity under the 2024 Credit Facility was $1,150,000,000, excluding the $25,000,000 standby letters of credit described above. As of March 31, 2024, borrowings outstanding under the 2024 Credit Facility totaled $550,000,000 ($549,308,000, net of deferred financing costs related to the senior unsecured term loan facility portion of the 2024 Credit Facility), and the weighted average interest rate on such borrowings outstanding was 6.66% per annum.

Trilogy Credit Facility

We, through Trilogy RER, LLC, are party to an amended loan agreement, or the Trilogy Credit Agreement, among certain subsidiaries of Trilogy OpCo, LLC, Trilogy RER, LLC, and Trilogy Pro Services, LLC; KeyBank; CIT Bank, N.A.; Regions Bank; KeyBanc Capital Markets, Inc.; Regions Capital Markets; Bank of America; The Huntington National Bank; and a syndicate of other banks, as lenders named therein, with respect to a senior secured revolving credit facility that had an aggregate maximum principal amount of $400,000,000, consisting of: (i) a $365,000,000 secured revolver supported by real estate assets and ancillary business cash flow and (ii) a $35,000,000 accounts receivable revolving credit facility supported by eligible accounts receivable, or the Trilogy Credit Facility. The proceeds of the Trilogy Credit Facility may be used for acquisitions, debt repayment and general corporate purposes. The maximum principal amount of the Trilogy Credit Facility could be increased by up to $100,000,000, for a total principal amount of $500,000,000, subject to certain conditions. Unless defined herein, all capitalized terms under this “Trilogy Credit Facility” subsection are defined in the Trilogy Credit Agreement, as amended.

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The Trilogy Credit Facility is due to mature on June 5, 2025. At our option, the Trilogy Credit Facility bears interest at per annum rates equal to (a) SOFR, plus 2.75% for SOFR Rate Loans and (b) for Base Rate Loans, 1.75% plus the highest of: (i) the fluctuating rate per annum of interest in effect for such day as established from time to time by KeyBank as its prime rate, (ii) 0.50% above the Federal Funds Effective Rate and (iii) 1.00% above one-month Adjusted Term SOFR.

9. Derivative Financial Instruments

We use derivative financial instruments to manage interest rate risk associated with variable-rate debt. We recorded such derivative financial instruments in our accompanying condensed consolidated balance sheets as either an asset or a liability, as applicable, measured at fair value. The following table lists the derivative financial instruments held by us as of March 31, 2024 and December 31, 2023, which were included in other assets and other liabilities in our accompanying condensed consolidated balance sheets (dollars in thousands):

																																				Fair Value
Instrument						Notional  Amount						Index						Interest Rate						Effective Date						Maturity Date						March 31, 2024						December 31, 2023
Swap						$	275,000					One Month Term SOFR						3.74%						02/01/23						01/19/26						$	3,868					$	1,463
Swap						275,000						One Month Term SOFR						4.41%						08/08/23						01/19/26						642						(2,178)
Swap						200,000						One Month Term SOFR						4.40%						01/05/24						06/05/25						981						(211)
						$	750,000																													$	5,491					$	(926)

As of both March 31, 2024 and December 31, 2023, none of our derivative financial instruments were designated as hedges. Derivative financial instruments not designated as hedges are not speculative and are used to manage our exposure to interest rate movements, but do not meet the strict hedge accounting requirements. For the three months ended March 31, 2024 and 2023, we recorded a net gain (loss) in the fair value of derivative financial instruments of $6,417,000 and ($195,000), respectively, as a decrease (increase) to total interest expense in our accompanying condensed consolidated statements of operations and comprehensive loss related to the change in the fair value of our derivative financial instruments.

See Note 13, Fair Value Measurements, for a further discussion of the fair value of our derivative financial instruments.

10. Commitments and Contingencies

Litigation

We are not presently subject to any material litigation nor, to our knowledge, is any material litigation threatened against us, which, if determined unfavorably to us, would have a material adverse effect on our consolidated financial position, results of operations or cash flows.

Environmental Matters

We follow a policy of monitoring our properties for the presence of hazardous or toxic substances. While there can be no assurance that a material environmental liability does not exist at our properties, we are not currently aware of any environmental liability with respect to our properties that would have a material adverse effect on our consolidated financial position, results of operations or cash flows. Further, we are not aware of any material environmental liability or any unasserted claim or assessment with respect to an environmental liability that we believe would require additional disclosure or the recording of a loss contingency.

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Other

Our other commitments and contingencies include the usual obligations of real estate owners and operators in the normal course of business, which include calls/puts to sell/acquire properties. In our view, these matters are not expected to have a material adverse effect on our consolidated financial position, results of operations or cash flows.

11. Redeemable Noncontrolling Interests

As of March 31, 2024 and December 31, 2023, we, through our direct and indirect subsidiaries, owned a 97.4% and 95.0%, respectively, general partnership interest in our operating partnership, and the remaining 2.6% and 5.0%, respectively, limited partnership interest in our operating partnership was owned by the Limited Partners. Some of the limited partnership units outstanding, which accounted for approximately 1.0% of our total operating partnership units outstanding as of December 31, 2023, had redemption features outside of our control and were accounted for as redeemable noncontrolling interests presented outside of permanent equity in our accompanying condensed consolidated balance sheet. Upon the closing of the 2024 Offering and listing of our Common Stock on the NYSE, such redemption features are no longer outside of our control, and the carrying amount of such interests is now presented within noncontrolling interests in total equity in our accompanying condensed consolidated balance sheet as of March 31, 2024. Further, additional paid-in capital was adjusted to reflect such change in presentation of the Limited Partners interests. See Note 12, Equity — Noncontrolling Interests in Total Equity, for a further discussion.

As of March 31, 2024 and December 31, 2023, we, through Trilogy REIT Holdings LLC, or Trilogy REIT Holdings, in which we indirectly hold a 76.0% ownership interest, owned approximately 99.3% and 97.5%, respectively, of the outstanding equity interests of Trilogy Investors, LLC, or Trilogy. As of March 31, 2024 and December 31, 2023, certain members of Trilogy’s management and certain members of an advisory committee to Trilogy’s board of directors owned approximately 0.7% and 2.5%, respectively, of the outstanding equity interests of Trilogy. We accounted for such equity interests as redeemable noncontrolling interests or other liabilities in our accompanying condensed consolidated balance sheets in accordance with FASB, Accounting Standards Codification, or ASC, Topic 480-10-S99-3A, given certain features associated with such equity interests. In January 2024, we redeemed equity interests in Trilogy that were accounted for as other liabilities and owned by a current member of Trilogy’s advisory committee for $25,312,000 in cash. In April 2024, we redeemed all the remaining equity interests in Trilogy owned by members of Trilogy management and certain members of Trilogy’s advisory committee, including the redemption of Trilogy Profit Interests, as defined and described at Note 12, Equity — Noncontrolling Interests in Total Equity — Other Noncontrolling Interests, for an aggregate $10,771,000 in cash. For the three months ended March 31, 2023, we redeemed a portion of the equity interests owned by certain members of Trilogy’s management for an aggregate of $15,870,000.

As of March 31, 2024 and December 31, 2023, we own, through our operating partnership, approximately 98.0% of the joint ventures with an affiliate of Meridian Senior Living, LLC, or Meridian, that own Pinnacle Beaumont ALF and Pinnacle Warrenton ALF. The noncontrolling interests held by Meridian have redemption features outside of our control and are accounted for as redeemable noncontrolling interests in our accompanying condensed consolidated balance sheets.

We record the carrying amount of redeemable noncontrolling interests at the greater of: (i) the initial carrying amount, increased or decreased for the noncontrolling interests’ share of net income or loss and distributions or (ii) the redemption value. The changes in the carrying amount of redeemable noncontrolling interests consisted of the following for the three months ended March 31, 2024 and 2023 (in thousands):

			Three Months Ended March 31,
			2024						2023
Beginning balance			$	33,843					$	81,598
Reclassification from equity			21						21
Reclassification to equity			(15,303)						—
Distributions			(3)						(454)
Redemption of redeemable noncontrolling interests			—						(15,870)
Adjustment to redemption value			(6,901)						(5,043)
Net loss attributable to redeemable noncontrolling interests			(21)						(368)
Ending balance			$	11,636					$	59,884

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12. Equity

Preferred Stock

Pursuant to our charter, we are authorized to issue 200,000,000 shares of our preferred stock, $0.01 par value per share. As of both March 31, 2024 and December 31, 2023, no shares of preferred stock were issued and outstanding.

Common Stock

Pursuant to our charter, as amended, we are authorized to issue 1,000,000,000 shares of our common stock, $0.01 par value per share, whereby 200,000,000 shares are classified as Class T common stock, 100,000,000 shares are classified as Class I common stock and 700,000,000 shares are classified as Common Stock without any designation as to class or series. We issued an aggregate 65,445,557 shares of Class T common stock and Class I common stock, for a total of $2,737,716,000 in gross offering proceeds, since February 26, 2014 in our initial public offerings and our DRIP offerings. Our initial public offerings were terminated as of April 2019.

On February 9, 2024, we closed the 2024 Offering and issued 64,400,000 shares of Common Stock, $0.01 par value per share, for a total of $772,800,000 in gross offering proceeds, including the exercise in full of the underwriters’ overallotment option to purchase up to an additional 8,400,000 shares of Common Stock. In conjunction with the 2024 Offering, such shares of Common Stock were listed on the NYSE and began trading on February 7, 2024. We received $724,625,000 in net proceeds, after deducting the underwriting discount, which was primarily used to repay $176,145,000 of mortgage loans payable and $545,010,000 on our lines of credit in February 2024. The underwriting discount and other costs related to the 2024 Offering were offset against gross proceeds received and included as a component of additional paid-in capital in our accompanying condensed consolidated balance sheet as of March 31, 2024.

Our Class T common stock and Class I common stock are identical to our Common Stock, except that such shares are not currently listed on the NYSE or any other national securities exchange. Six months after the listing of our Common Stock for trading on the NYSE, on August 5, 2024, each share of our Class T common stock and Class I common stock will automatically, and without any stockholder action, convert into one share of our listed Common Stock.

Distribution Reinvestment Plan

Our DRIP allowed our stockholders to elect to reinvest an amount equal to the distributions declared on their shares of common stock in additional shares of our common stock in lieu of receiving cash distributions. However, on November 14, 2022, our board suspended the DRIP offering beginning with the distributions declared for the quarter ended December 31, 2022. As a result of the suspension of the DRIP offering, unless and until our board reinstates the DRIP offering, stockholders who are current participants in the DRIP will be paid distributions in cash.

Share Repurchase Plan

Our share repurchase plan allowed for repurchases of shares of our common stock by us when certain criteria were met. Share repurchases were made at the sole discretion of our board. On November 14, 2022, our board suspended our share repurchase plan beginning with share repurchase requests for the quarter ending December 31, 2022. All share repurchase requests, including requests resulting from the death or qualifying disability of stockholders, commencing with the quarter ended December 31, 2022, will not be processed, will be considered canceled in full and will not be considered outstanding repurchase requests.

We did not repurchase any shares of our common stock pursuant to our share repurchase plan for the three months ended March 31, 2024. For the three months ended March 31, 2023, we repurchased 1,681 shares of common stock for an aggregate of $62,000 at a repurchase price of $37.16 per share, pursuant to our share repurchase plan. Such repurchase requests were submitted prior to the suspension of our share repurchase plan.

Noncontrolling Interests in Total Equity

Membership Interest in Trilogy REIT Holdings

As of March 31, 2024 and December 31, 2023, Trilogy REIT Holdings owned approximately 99.3% and 97.5%, respectively, of Trilogy. We are the indirect owner of a 76.0% interest in Trilogy REIT Holdings pursuant to an amended joint venture agreement with an indirect, wholly-owned subsidiary of NorthStar Healthcare Income, Inc., or NHI. We serve as the managing member of Trilogy REIT Holdings. As of both March 31, 2024 and December 31, 2023, NHI indirectly owned a

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24.0% membership interest in Trilogy REIT Holdings, and as such, for the three months ended March 31, 2024 and 2023, 24.0% of the net earnings of Trilogy REIT Holdings were allocated to noncontrolling interests.

On November 3, 2023, we entered into a Membership Interest Purchase Agreement, or the MIPA, with subsidiaries of NHI, which provides us with the option to purchase their 24.0% minority membership interest in Trilogy REIT Holdings. If we exercise this purchase option, we will own 100% of Trilogy REIT Holdings, which will in turn result in us indirectly owning 100% of Trilogy. Subject to our first satisfying certain closing conditions, the option is exercisable for a closing before September 30, 2025 assuming that we exercise both extension options described below. If we exercise our purchase option, the all-cash purchase price would be $247,000,000 if we consummate the purchase from April 1, 2024 to and including December 31, 2024 and would increase to $260,000,000 if we consummate the purchase on or after January 1, 2025.

The MIPA also allows us (at our election), instead of paying all cash, to consummate the purchase transaction by using a combination of cash and the issuance of new Series A Cumulative Convertible Preferred Stock, $0.01 par value per share, or our Convertible Preferred Stock, as purchase price consideration. We must pay at least a minimum amount of the purchase price in cash, in which case we would pay the remaining amount in shares of our Convertible Preferred Stock. The minimum cash amount will be $24,700,000 if we consummate the purchase from April 1, 2024 to and including December 31, 2024, or $26,000,000 if we consummate the purchase on or after January 1, 2025. If issued, our Convertible Preferred Stock will be perpetual, will have a cumulative cash dividend with an initial annual rate of 4.75% (on the liquidation preference per share of $25.00 of our Convertible Preferred Stock) and will be redeemable by us at any time. The annual dividend rate will increase over time, and the redemption price will vary based on the date of redemption. In addition, holders of shares of our Convertible Preferred Stock will have the right, at any time on or after July 1, 2026 and from time to time, to convert some or all of such shares into shares of our common stock, subject to certain customary exceptions. As of March 31, 2024, we did not exercise the purchase option pursuant to the MIPA.

Other Noncontrolling Interests

In connection with our acquisition and operation of Trilogy, profit interest units in Trilogy, or the Profit Interests, were issued to Trilogy Management Services, LLC and independent directors of Trilogy, both unaffiliated third parties that manage or direct the day-to-day operations of Trilogy. The Profit Interests consisted of time-based or performance-based commitments. The time-based Profit Interests were measured at their grant date fair value and vested in increments of 20.0% on each anniversary of the respective grant date over a five-year period. We amortized the time-based Profit Interests on a straight-line basis over the vesting periods, which were recorded to general and administrative expenses in our accompanying condensed consolidated statements of operations and comprehensive loss. The performance-based Profit Interests were measured at their fair value on the adoption date of ASU 2018-07, Improvements to Nonemployee Share-Based Payment Accounting, using a modified retrospective approach, were subject to a performance commitment and would have vested upon liquidity events as defined in the Profit Interests agreements. The nonvested awards were presented as noncontrolling interests in total equity in our accompanying condensed consolidated balance sheets, and were re-classified to redeemable noncontrolling interests upon vesting as they had redemption features outside of our control, similar to the common stock units held by Trilogy’s management. See Note 11, Redeemable Noncontrolling Interests, for a further discussion.

For both the three months ended March 31, 2024 and 2023, we recognized stock compensation expense related to the time-based Profit Interests of $21,000. In April 2024, we redeemed all the remaining Profit Interests for cash. See Note 11, Redeemable Noncontrolling Interests, for a further discussion of our redemption of the Profit Interests.

As of December 31, 2023, we owned an 86.0% interest in a consolidated limited liability company that owned Lakeview IN Medical Plaza. On February 6, 2024, we purchased the remaining 14.0% membership interest in the consolidated limited liability company that owned Lakeview IN Medical Plaza from an unaffiliated third party for a contract purchase price of $441,000. In connection with such purchase and as of such date, we own a 100% interest in such limited liability company. As such, from January 1, 2024 through February 5, 2024, and for the three months ended March 31, 2023, 14.0% of the net earnings of Lakeview IN Medical Plaza were allocated to noncontrolling interests in our accompanying condensed consolidated statements of operations and comprehensive loss.

As discussed in Note 1, Organization and Description of Business, as of March 31, 2024 and December 31, 2023, we, through our direct and indirect subsidiaries, owned a 97.4% and 95.0%, respectively, general partnership interest in our operating partnership and the remaining 2.6% and 5.0%, respectively, limited OP units in our operating partnership were owned by the Limited Partners. Some of the limited partnership units outstanding, which accounted for approximately 1.0% of our total operating partnership units outstanding as of December 31, 2023, had redemption features outside of our control and were accounted for as redeemable noncontrolling interests presented outside of permanent equity in our accompanying condensed

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consolidated balance sheets. Upon the closing of the 2024 Offering and listing of our Common Stock on the NYSE, such redemption features are no longer outside of our control and we reclassed the remaining carrying amount of such redeemable noncontrolling interests as of such date to noncontrolling interests in total equity. Therefore, as of March 31, 2024, 2.6% of our total operating partnership units outstanding is presented as noncontrolling interests in total equity in our accompanying condensed consolidated balance sheet. See Note 11, Redeemable Noncontrolling Interests, for a further discussion.

AHR Incentive Plan

Pursuant to our Second Amended and Restated 2015 Incentive Plan, or the AHR Incentive Plan, our board (with respect to options and restricted shares of common stock granted to independent directors) or our compensation committee (with respect to any other award) may grant options, restricted shares of common stock, stock purchase rights, stock appreciation rights or other awards to our independent directors, officers, employees and consultants. The AHR Incentive Plan terminates on June 15, 2033, and the maximum number of shares of our common stock that may be issued pursuant to such plan is 4,000,000 shares.

Restricted common stock

Pursuant to the AHR Incentive Plan, through March 31, 2024, we granted an aggregate of 1,287,681 shares of our restricted common stock, or RSAs, as defined in the AHR Incentive Plan, which included restricted Common Stock, restricted Class T common stock and restricted Class I common stock. RSAs were granted to our independent directors in connection with their initial election or re-election to our board or in consideration of their past services rendered, as well as to certain executive officers and key employees. The number of RSAs granted through March 31, 2024 above includes an aggregate of 972,222 RSAs we granted in February 2024 to independent directors, executive officers and certain employees upon completion of the 2024 Offering. RSAs generally have a vesting period of up to four years and are subject to continuous service through the vesting dates.

Restricted stock units

Pursuant to the AHR Incentive Plan, through March 31, 2024, we granted to our executive officers an aggregate 320,780 of performance-based restricted stock units, or PBUs, representing the right to receive shares of our common stock upon vesting. We also granted to our executive officers and certain employees 408,033 time-based restricted stock units, or TBUs, representing the right to receive shares of our common stock upon vesting. PBUs and TBUs are collectively referred to as RSUs. RSUs granted to executive officers and employees generally have a vesting period of up to three years and are subject to continuous service through the vesting dates and any performance conditions, as applicable.

A summary of the status of our nonvested RSAs and RSUs as of March 31, 2024 and December 31, 2023, and the changes for the three months ended March 31, 2024 is presented below:

						Number of  Nonvested RSAs						Weighted Average Grant Date Fair Value - RSAs						Number of  Nonvested RSUs						Weighted Average Grant Date Fair Value - RSUs
Balance — December 31, 2023						147,044						$	35.99					228,081						$	32.43
Granted						972,222						$	13.12					477,008						$	14.57
Vested						(1,051)						$	37.16					—						$	—
Forfeited						—						$	—					(725)						$	37.16
Balance — March 31, 2024						1,118,215						$	16.11					704,364						$	20.33

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13. Fair Value Measurements

Assets and Liabilities Reported at Fair Value

The table below presents our assets and liabilities measured at fair value on a recurring basis as of March 31, 2024, aggregated by the level in the fair value hierarchy within which those measurements fall (in thousands):

			Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1)						Significant Other Observable Inputs (Level 2)						Significant Unobservable Inputs (Level 3)						Total
Assets:
Derivative financial instruments			$	—					$	5,491					$	—					$	5,491
Total assets at fair value			$	—					$	5,491					$	—					$	5,491

The table below presents our assets and liabilities measured at fair value on a recurring basis as of December 31, 2023, aggregated by the level in the fair value hierarchy within which those measurements fall (in thousands):

			Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1)						Significant Other Observable Inputs (Level 2)						Significant Unobservable Inputs (Level 3)						Total
Assets:
Derivative financial instrument			$	—					$	1,463					$	—					$	1,463
Total assets at fair value			$	—					$	1,463					$	—					$	1,463
Liabilities:
Derivative financial instruments			$	—					$	2,389					$	—					$	2,389
Total liabilities at fair value			$	—					$	2,389					$	—					$	2,389

There were no transfers into and out of fair value measurement levels during the three months ended March 31, 2024 and 2023.

Derivative Financial Instruments

We entered into interest rate swaps to manage interest rate risk associated with variable-rate debt. The valuation of these instruments was determined using widely accepted valuation techniques including a discounted cash flow analysis on the expected cash flows of each derivative. Such valuation reflected the contractual terms of the derivatives, including the period to maturity, and used observable market-based inputs, including interest rate curves, as well as option volatility. The fair values of our interest rate swaps were determined by netting the discounted future fixed cash payments and the discounted expected variable cash receipts. The variable cash receipts were based on an expectation of future interest rates derived from observable market interest rate curves.

We incorporated credit valuation adjustments to appropriately reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements. In adjusting the fair value of our derivative contracts for the effect of nonperformance risk, we considered the impact of netting and any applicable credit enhancements, such as collateral postings, thresholds, mutual puts and guarantees.

Although we determined that the majority of the inputs used to value our derivative financial instruments fell within Level 2 of the fair value hierarchy, the credit valuation adjustments associated with this instrument utilized Level 3 inputs, such as estimates of current credit spreads, to evaluate the likelihood of default by us and our counterparty. However, as of March 31, 2024, we assessed the significance of the impact of the credit valuation adjustments on the overall valuation of our derivative positions and determined that the credit valuation adjustments were not significant to the overall valuation of our derivatives. As a result, we determined that our derivative valuations in their entirety were classified in Level 2 of the fair value hierarchy.

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Financial Instruments Disclosed at Fair Value

Our accompanying condensed consolidated balance sheets include the following financial instruments: debt security investment, cash and cash equivalents, restricted cash, accounts and other receivables, accounts payable and accrued liabilities, mortgage loans payable and borrowings under our lines of credit and term loan.

We consider the carrying values of cash and cash equivalents, restricted cash, accounts and other receivables and accounts payable and accrued liabilities to approximate the fair value for these financial instruments based upon an evaluation of the underlying characteristics and market data, in light of the short period of time between origination of the instruments and their expected realization. The fair values of the other financial instruments are classified in Level 2 of the fair value hierarchy.

The fair value of our debt security investment is estimated using a discounted cash flow analysis using interest rates available to us for investments with similar terms and maturities. The fair values of our mortgage loans payable and our lines of credit and term loan are estimated using discounted cash flow analyses using borrowing rates available to us for debt instruments with similar terms and maturities. We have determined that the valuations of our debt security investment, mortgage loans payable and lines of credit and term loan are classified in Level 2 within the fair value hierarchy. The carrying amounts and estimated fair values of such financial instruments as of March 31, 2024 and December 31, 2023 were as follows (in thousands):

			March 31, 2024												December 31, 2023
			Carrying Amount(1)						Fair Value						Carrying Amount(1)						Fair Value
Financial Assets:
Debt security investment			$	87,984					$	93,323					$	86,935					$	93,304
Financial Liabilities:
Mortgage loans payable			$	1,228,435					$	1,090,173					$	1,302,396					$	1,185,260
Lines of credit and term loan			$	754,101					$	759,966					$	1,220,137					$	1,225,890

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(1)Carrying amount is net of any discount/premium and unamortized deferred financing costs.

14. Income Taxes

As a REIT, we generally will not be subject to U.S. federal income tax on taxable income that we distribute to our stockholders. We have elected to treat certain of our consolidated subsidiaries as taxable REIT subsidiaries, or TRS, pursuant to the Code. TRS may participate in services that would otherwise be considered impermissible for REITs and are subject to federal and state income tax at regular corporate tax rates.

Current Income Tax

Federal and state income taxes are generally a function of the level of income recognized by our TRS. Foreign income taxes are generally a function of our income on our real estate located in the United Kingdom, or UK, and Isle of Man.

Deferred Taxes

Deferred income tax is generally a function of the period’s temporary differences (primarily basis differences between tax and financial reporting for real estate assets and equity investments) and generation of tax net operating loss that may be realized in future periods depending on sufficient taxable income.

We recognize the effects of an uncertain tax position on the financial statements, when it is more likely than not, based on the technical merits of the tax position, that such a position will be sustained upon examination by the relevant tax authorities. If the tax benefit meets the “more likely than not” threshold, the measurement of the tax benefit will be based on our estimate of the ultimate tax benefit to be sustained if audited by the taxing authority. As of both March 31, 2024 and December 31, 2023, we did not have any tax benefits or liabilities for uncertain tax positions that we believe should be recognized in our accompanying condensed consolidated financial statements.

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We assess the available positive and negative evidence to estimate if sufficient future taxable income will be generated to use the existing deferred tax assets. A valuation allowance is established if we believe it is more likely than not that all or a portion of the deferred tax assets are not realizable. As of both March 31, 2024 and December 31, 2023, our valuation allowance fully reserves the net deferred tax assets due to historical losses and inherent uncertainty of future income. We will continue to monitor industry and economic conditions and our ability to generate taxable income based on our business plan and available tax planning strategies, which would allow us to utilize the tax benefits of the net deferred tax assets and thereby allow us to reverse all, or a portion of, our valuation allowance in the future.

15. Leases

Lessor

We have operating leases with tenants that expire at various dates through 2050. For the three months ended March 31, 2024 and 2023, we recognized $46,008,000 and $42,303,000, respectively, of revenues related to operating lease payments, of which $9,659,000 and $10,040,000, respectively, was for variable lease payments. As of March 31, 2024, the following table sets forth the undiscounted cash flows for future minimum base rents due under operating leases for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31 and thereafter for properties that we wholly own (in thousands):

Year						Amount
2024						$	101,827
2025						127,211
2026						117,487
2027						111,745
2028						100,456
Thereafter						486,642
Total						$	1,045,368

Lessee

We lease certain land, buildings, furniture, fixtures, campus and office equipment and automobiles. We have lease agreements with lease and non-lease components, which are generally accounted for separately. Most leases include one or more options to renew, with renewal terms that generally can extend at various dates through 2107, excluding extension options. The exercise of lease renewal options is at our sole discretion. Certain leases also include options to purchase the leased property.

The depreciable life of assets and leasehold improvements are limited by the expected lease term, unless there is a transfer of title or purchase option reasonably certain of exercise. Certain of our lease agreements include rental payments that are adjusted periodically based on the United States Bureau of Labor Statistics’ Consumer Price Index and may also include other variable lease costs (i.e., common area maintenance, property taxes and insurance). Our lease agreements do not contain any material residual value guarantees or material restrictive covenants.

The components of lease costs were as follows (in thousands):

												Three Months Ended March 31,
Lease Cost						Classification						2024						2023
Operating lease cost(1)						Property operating expenses, rental expenses or general and administrative expenses						$	10,776					$	11,923
Finance lease cost:
Amortization of leased assets						Depreciation and amortization						561						303
Interest on lease liabilities						Interest expense						157						91
Sublease income						Resident fees and services revenue or other income						(144)						(156)
Total lease cost												$	11,350					$	12,161

___________

(1)Includes short-term leases and variable lease costs, which are immaterial.

---

Additional information related to our leases for the periods presented below was as follows (dollars in thousands):

Lease Term and Discount Rate						March 31, 2024						December 31, 2023
Weighted average remaining lease term (in years):
Operating leases						12.1						12.2
Finance leases						1.2						1.5
Weighted average discount rate:
Operating leases						5.77		%				5.76		%
Finance leases						7.79		%				7.78		%

						Three Months Ended March 31,
Supplemental Disclosure of Cash Flows Information						2024						2023
Operating cash outflows related to finance leases						$	157					$	91
Financing cash outflows related to finance leases						$	11					$	16
Right-of-use assets obtained in exchange for operating lease liabilities						$	—					$	1,155

Operating Leases

As of March 31, 2024, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31 and thereafter, as well as the reconciliation of those cash flows to operating lease liabilities on our accompanying condensed consolidated balance sheet (in thousands):

Year						Amount
2024						$	26,936
2025						35,153
2026						35,074
2027						35,617
2028						35,707
Thereafter						166,314
Total undiscounted operating lease payments						334,801
Less: interest						115,034
Present value of operating lease liabilities						$	219,767

Finance Leases

As of March 31, 2024, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31 and thereafter, as well as a reconciliation of those cash flows to finance lease liabilities (in thousands):

Year						Amount
2024						$	63
2025						31
2026						—
2027						—
2028						—
Thereafter						—
Total undiscounted finance lease payments						94
Less: interest						5
Present value of finance lease liabilities						$	89

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16. Segment Reporting

We evaluate our business and make resource allocations based on four reportable business segments: integrated senior health campuses, OM (which was formerly known as medical office buildings, or MOBs), SHOP and triple-net leased properties. Prior to the quarter ended December 31, 2023, we evaluated our business and made resource allocations based on six reportable business segments. All segment information included in this Quarterly Report on Form 10-Q has been recast for all periods presented to reflect four reportable business segments and the change in segment name from MOBs to OM. The segment name change from MOBs to OM did not result in any changes to the composition of such segment or information reviewed by management, and therefore, had no impact on the historical results of operations.

Our OM buildings are typically leased to multiple tenants under separate leases, thus requiring active management and responsibility for many of the associated operating expenses (much of which are, or can effectively be, passed through to the tenants). Our integrated senior health campuses each provide a range of independent living, assisted living, memory care, skilled nursing services and certain ancillary businesses that are owned and operated utilizing a RIDEA structure. Our triple-net leased properties segment includes senior housing, skilled nursing facilities and hospital investments, which are single-tenant properties for which we lease the properties to unaffiliated tenants under triple-net and generally master leases that transfer the obligation for all property operating costs (including maintenance, repairs, taxes, insurance and capital expenditures) to the tenant. In addition, our triple-net leased properties segment includes our debt security investment. Our SHOP segment includes senior housing, which may provide assisted living care, independent living, memory care or skilled nursing services, that are owned and operated utilizing a RIDEA structure.

While we believe that net income or loss, as defined by GAAP, is the most appropriate earnings measurement, our chief operating decision maker evaluates performance of our combined properties in each reportable business segment and determines how to allocate resources to those segments, primarily based on net operating income, or NOI, for each segment. We define segment NOI as total revenues and grant income, less property operating expenses and rental expenses, which excludes depreciation and amortization, general and administrative expenses, business acquisition expenses, interest expense, gain or loss on dispositions of real estate investments, impairment of real estate investments, impairment of intangible assets and goodwill, income or loss from unconsolidated entities, gain on re-measurement of previously held equity interest, foreign currency gain or loss, other income and income tax benefit or expense for each segment. We believe that segment NOI serves as an appropriate supplemental performance measure to net income (loss) because it allows investors and our management to measure unlevered property-level operating results and to compare our operating results to the operating results of other real estate companies and between periods on a consistent basis.

Interest expense, depreciation and amortization and other expenses not attributable to individual properties are not allocated to individual segments for purposes of assessing segment performance. Non-segment assets primarily consist of corporate assets, including cash and cash equivalents, other receivables, deferred financing costs and other assets not attributable to individual properties.

---

Summary information for the reportable segments during the three months ended March 31, 2024 and 2023 was as follows (in thousands):

						Integrated Senior Health Campuses						SHOP						OM						Triple-Net Leased Properties						Three Months Ended March 31, 2024
Revenues:
Resident fees and services						$	393,122					$	58,996					$	—					$	—					$	452,118
Real estate revenue						—						—						34,067						13,348						47,415
Total revenues						393,122						58,996						34,067						13,348						499,533
Expenses:
Property operating expenses						351,142						52,487						—						—						403,629
Rental expenses						—						—						13,089						638						13,727
Segment net operating income						$	41,980					$	6,509					$	20,978					$	12,710					$	82,177
Expenses:
General and administrative																														$	11,828
Business acquisition expenses																														2,782
Depreciation and amortization																														42,767
Other income (expense):
Interest expense:
Interest expense (including amortization of deferred financing costs, debt discount/premium, and loss on debt extinguishments)																														(36,438)
Gain in fair value of derivative financial instruments																														6,417
Gain on dispositions of real estate investments, net																														2,263
Loss from unconsolidated entities																														(1,205)
Foreign currency loss																														(426)
Other income																														1,863
Total net other expense																														(27,526)
Loss before income taxes																														(2,726)
Income tax expense																														(278)
Net loss																														$	(3,004)

---

						Integrated Senior Health Campuses						SHOP						OM						Triple-Net Leased Properties						Three Months Ended March 31, 2023
Revenues:
Resident fees and services						$	361,770					$	46,860					$	—					$	—					$	408,630
Real estate revenue						—						—						37,483						6,113						43,596
Total revenues						361,770						46,860						37,483						6,113						452,226
Expenses:
Property operating expenses						328,361						41,785						—						—						370,146
Rental expenses						—						—						14,408						787						15,195
Segment net operating income						$	33,409					$	5,075					$	23,075					$	5,326					$	66,885
Expenses:
General and administrative																														$	13,053
Business acquisition expenses																														332
Depreciation and amortization																														44,670
Other income (expense):
Interest expense:
Interest expense (including amortization of deferred financing costs and debt discount/premium)																														(39,011)
Loss in fair value of derivative financial instruments																														(195)
Loss on dispositions of real estate investments, net																														(132)
Loss from unconsolidated entities																														(306)
Gain on re-measurement of previously held equity interest																														726
Foreign currency gain																														1,008
Other income																														1,608
Total net other expense																														(36,302)
Loss before income taxes																														(27,472)
Income tax expense																														(143)
Net loss																														$	(27,615)

Total assets by reportable segment as of March 31, 2024 and December 31, 2023 were as follows (in thousands):

			March 31, 2024						December 31, 2023
Integrated senior health campuses			$	2,241,792					$	2,197,762
OM			1,213,664						1,232,310
SHOP			716,923						630,373
Triple-net leased properties			499,824						502,836
Other			31,227						14,652
Total assets			$	4,703,430					$	4,577,933

As of both March 31, 2024 and December 31, 2023, goodwill of $168,177,000, $47,812,000 and $18,953,000 was allocated to our integrated senior health campuses, OM and triple-net leased properties segments, respectively.

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Our portfolio of properties and other investments are located in the United States, the UK and Isle of Man. Revenues and assets are attributed to the country in which the property is physically located. The following is a summary of geographic information for our operations for the periods presented (in thousands):

									Three Months Ended March 31,
															2024						2023
Revenues:
United States															$	497,646					$	451,092
International															1,887						1,134
															$	499,533					$	452,226

The following is a summary of real estate investments, net by geographic regions as of March 31, 2024 and December 31, 2023 (in thousands):

			March 31, 2024						December 31, 2023
Real estate investments, net:
United States			$	3,436,208					$	3,382,115
International			42,565						43,323
			$	3,478,773					$	3,425,438

17. Concentration of Credit Risk

Financial instruments that potentially subject us to a concentration of credit risk are primarily our debt security investment, cash and cash equivalents, restricted cash and accounts and other receivables. We are exposed to credit risk with respect to our debt security investment, but we believe collection of the outstanding amount is probable. Cash and cash equivalents are generally invested in investment-grade, short-term instruments with a maturity of three months or less when purchased. We have cash and cash equivalents in financial institutions that are insured by the Federal Deposit Insurance Corporation, or FDIC. As of March 31, 2024 and December 31, 2023, we had cash and cash equivalents in excess of FDIC insured limits. We believe this risk is not significant. Concentration of credit risk with respect to accounts receivable from tenants and residents is limited. We perform credit evaluations of prospective tenants and security deposits are obtained at the time of property acquisition and upon lease execution.

Based on leases as of March 31, 2024, properties in two states in the United States accounted for 10.0% or more of our total consolidated property portfolio’s annualized base rent or annualized NOI, which is based on contractual base rent from leases in effect for our non-RIDEA properties and annualized NOI for our SHOP and integrated senior health campuses as of March 31, 2024. Properties located in Indiana and Ohio accounted for 33.2% and 13.9%, respectively, of our total consolidated property portfolio’s annualized base rent or annualized NOI. Accordingly, there is a geographic concentration of risk subject to fluctuations in each state’s economy.

18. Per Share Data

Basic earnings (loss) per share for all periods presented are computed by dividing net income (loss) applicable to common stock by the weighted average number of shares of our common stock outstanding during the period. Net income (loss) applicable to common stock is calculated as net income (loss) attributable to controlling interest less distributions allocated to participating securities of $1,095,000 and $926,000 for the three months ended March 31, 2024 and 2023, respectively. Diluted earnings (loss) per share are computed based on the weighted average number of shares of our common stock and all potentially dilutive securities, if any. TBUs, nonvested shares of our RSAs and limited partnership units of our operating partnership are participating securities and give rise to potentially dilutive shares of our common stock.

As of March 31, 2024 and 2023, there were 1,118,215 and 184,145 nonvested shares, respectively, of our RSAs outstanding, but such shares were excluded from the computation of diluted earnings (loss) per share because such shares were

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anti-dilutive during these periods. As of both March 31, 2024 and 2023, there were 3,501,976 limited partnership units of our operating partnership outstanding, but such units were also excluded from the computation of diluted earnings (loss) per share because such units were anti-dilutive during these periods. As of March 31, 2024 and 2023, there were 395,108 and 19,200 nonvested TBUs outstanding, respectively, but such units were excluded from the computation of diluted earnings (loss) per share because such restricted stock units were anti-dilutive during the period.

As of March 31, 2024 and December 31, 2023, there were 309,256 and 70,751, respectively, nonvested PBUs outstanding, which were treated as contingently issuable shares pursuant to ASC Topic 718, Compensation — Stock Compensation. Such contingently issuable shares were excluded from the computation of diluted earnings (loss) per share because they were anti-dilutive during the period.

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v3.24.1.1.u2

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2024	May 08, 2024
Document Information [Line Items]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2024
Document Transition Report	false
Entity File Number	001-41951
Entity Registrant Name	AMERICAN HEALTHCARE REIT, INC.
Entity Incorporation, State or Country Code	MD
Entity Tax Identification Number	47-2887436
Entity Address, Address Line One	18191 Von Karman Avenue
Entity Address, Address Line Two	Suite 300
Entity Address, City or Town	Irvine
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92612
City Area Code	949
Local Phone Number	270-9200
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Amendment Flag	false
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q1
Entity Central Index Key	0001632970
Current Fiscal Year End Date	--12-31
Title of 12(b) Security	Common Stock, $0.01 par value per share
Trading Symbol	AHR
Security Exchange Name	NYSE
Common Stock
Document Information [Line Items]
Entity Common Stock, Shares Outstanding		65,372,222
Common Class T
Document Information [Line Items]
Entity Common Stock, Shares Outstanding		19,601,476
Common Class I
Document Information [Line Items]
Entity Common Stock, Shares Outstanding		46,673,320

v3.24.1.1.u2

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands		Mar. 31, 2024	Dec. 31, 2023
ASSETS
Real estate investments, net		$ 3,478,773	$ 3,425,438
Debt security investment, net		87,984	86,935
Cash and cash equivalents		77,026	43,445
Restricted cash		47,505	47,337
Accounts and other receivables, net		215,881	185,379
Identified intangible assets, net		187,814	180,470
Goodwill		234,942	234,942
Operating lease right-of-use assets, net		221,575	227,846
Other assets, net		151,930	146,141
Total assets		4,703,430	4,577,933
Liabilities:
Mortgage loans payable, net	[1]	1,228,435	1,302,396
Lines of credit and term loan, net	[1]	759,308	1,223,967
Accounts payable and accrued liabilities	[1]	257,283	242,905
Identified intangible liabilities, net		5,805	6,095
Financing obligations	[1]	41,101	41,756
Operating lease liabilities	[1]	219,767	225,502
Security deposits, prepaid rent and other liabilities	[1]	48,933	76,134
Total liabilities		2,560,632	3,118,755
Commitments and contingencies
Redeemable noncontrolling interests		11,636	33,843
Stockholders’ equity:
Preferred stock, $0.01 par value per share; 200,000,000 shares authorized; none issued and outstanding		0	0
Additional paid-in capital		3,275,252	2,548,307
Accumulated deficit		(1,313,190)	(1,276,222)
Accumulated other comprehensive loss		(2,468)	(2,425)
Total stockholders’ equity		1,960,899	1,270,321
Noncontrolling interests		170,263	155,014
Total equity		2,131,162	1,425,335
Total liabilities, redeemable noncontrolling interests and equity		4,703,430	4,577,933
Common Stock
Stockholders’ equity:
Common stock		644	0
Common Class T
Stockholders’ equity:
Common stock		194	194
Common Class I
Stockholders’ equity:
Common stock		$ 467	$ 467
[1] Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of March 31, 2024 and December 31, 2023. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2024 Credit Facility, as defined in Note 8, held by American Healthcare REIT Holdings, LP in the amount of $550,000 as of March 31, 2024 and the 2022 Credit Facility, as defined in Note 8, held by American Healthcare REIT Holdings, LP in the amount of $914,900 as of December 31, 2023, which were guaranteed by American Healthcare REIT, Inc.

v3.24.1.1.u2

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($)		Mar. 31, 2024	Dec. 31, 2023
Preferred stock, par value (usd per share)		$ 0.01	$ 0.01
Preferred stock, shares issued		0	0
Preferred stock, shares authorized		200,000,000	200,000,000
Preferred stock, shares outstanding		0	0
Common Stock, shares authorized		1,000,000,000	1,000,000,000
Lines of credit and term loan, net	[1]	$ 759,308,000	$ 1,223,967,000
Common Stock
Common stock, par value (usd per share)		$ 0.01
Common Stock, shares authorized		700,000,000	0
Common stock, shares issued (in shares)		65,372,222	0
Common stock, shares outstanding		65,372,222	0
Common Class T
Common stock, par value (usd per share)		$ 0.01	$ 0.01
Common Stock, shares authorized		200,000,000	200,000,000
Common stock, shares issued (in shares)		19,552,425	19,552,856
Common stock, shares outstanding		19,552,425	19,552,856
Common Class I
Common stock, par value (usd per share)		$ 0.01	$ 0.01
Common Stock, shares authorized		100,000,000	800,000,000
Common stock, shares issued (in shares)		46,673,320	46,673,320
Common stock, shares outstanding		46,673,320	46,673,320
2024 Credit Agreement | Line of Credit
Lines of credit and term loan, net		$ 550,000,000
2022 Credit Agreement | Line of Credit
Lines of credit and term loan, net			$ 914,900,000
[1] Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of March 31, 2024 and December 31, 2023. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2024 Credit Facility, as defined in Note 8, held by American Healthcare REIT Holdings, LP in the amount of $550,000 as of March 31, 2024 and the 2022 Credit Facility, as defined in Note 8, held by American Healthcare REIT Holdings, LP in the amount of $914,900 as of December 31, 2023, which were guaranteed by American Healthcare REIT, Inc.

v3.24.1.1.u2

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME (LOSS) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Revenues:
Resident fees and services	$ 452,118	$ 408,630
Real estate revenue	47,415	43,596
Total revenues	499,533	452,226
Expenses:
Property operating expenses	403,629	370,146
Rental expenses	13,727	15,195
General and administrative	11,828	13,053
Business acquisition expenses	2,782	332
Depreciation and amortization	42,767	44,670
Total expenses	474,733	443,396
Other income (expense):
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishments)	(36,438)	(39,011)
Gain (loss) in fair value of derivative financial instruments	6,417	(195)
Gain (loss) on dispositions of real estate investments, net	2,263	(132)
Loss from unconsolidated entities	(1,205)	(306)
Gain on re-measurement of previously held equity interest	0	726
Foreign currency (loss) gain	(426)	1,008
Other income	1,863	1,608
Total net other expense	(27,526)	(36,302)
Loss before income taxes	(2,726)	(27,472)
Income tax expense	(278)	(143)
Net loss	(3,004)	(27,615)
Net (income) loss attributable to noncontrolling interests	(888)	1,743
Net loss attributable to controlling interest	$ (3,892)	$ (25,872)
Net loss per share of Common Stock, Class T common stock and Class I common stock attributable to controlling interest — basic (in dollars per share)	$ (0.04)	$ (0.39)
Net loss per share of Common Stock, Class T common stock and Class I common stock attributable to controlling interest — diluted (in dollars per share)	$ (0.04)	$ (0.39)
Weighted average number of shares of Common Stock, Class T common stock and Class I common stock outstanding — basic (in shares)	104,295,142	66,026,173
Weighted average number of shares of Common Stock, Class T common stock and Class I common stock outstanding — diluted (in shares)	104,295,142	66,026,173
Other comprehensive (loss) income:
Foreign currency translation adjustments	$ (43)	$ 122
Total other comprehensive (loss) income	(43)	122
Comprehensive loss	(3,047)	(27,493)
Comprehensive (income) loss attributable to noncontrolling interests	(888)	1,743
Comprehensive loss attributable to controlling interest	$ (3,935)	$ (25,750)

v3.24.1.1.u2

CONDENSED CONSOLIDATED STATEMENTS OF EQUITY - USD ($) $ in Thousands		Total	Total Stockholders' Equity	Common Stock Common Class I	Common Stock Common Class T	Common Stock Common Stock	Additional Paid-In Capital	Accumulated Deficit	Accumulated Other Comprehensive Loss	Noncontrolling Interests
Beginning balance, shares at Dec. 31, 2022				46,675,367	19,535,095
Beginning balance Stockholders' Equity at Dec. 31, 2022		$ 1,567,765	$ 1,400,091	$ 467	$ 194		$ 2,540,424	$ (1,138,304)	$ (2,690)	$ 167,674
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of nonvested restricted common stock, shares					1,956
Amortization of nonvested restricted common stock and stock units		1,051	1,051				1,051
Stock based compensation		21								21
Repurchase of common stock, shares				(1,681)	(429)
Repurchase of common stock		(78)	(78)				(78)
Distributions to noncontrolling interests		(3,102)								(3,102)
Reclassification of noncontrolling interests to or from equity mezzanine equity		(21)								(21)
Adjustment to value of redeemable noncontrolling interests		5,043	4,902				4,902			141
Distributions declared		(16,565)	(16,565)					(16,565)
Net (loss) income	[1]	(27,247)	(25,872)					(25,872)		(1,375)
Other comprehensive income (loss)		122	122						122
Ending balance, shares at Mar. 31, 2023				46,673,686	19,536,622
Ending balance Stockholders' Equity at Mar. 31, 2023		1,526,989	1,363,651	$ 467	$ 194		2,546,299	(1,180,741)	(2,568)	163,338
Beginning balance, shares at Dec. 31, 2023				46,673,320	19,552,856	0
Beginning balance Stockholders' Equity at Dec. 31, 2023		1,425,335	1,270,321	$ 467	$ 194	$ 0	2,548,307	(1,276,222)	(2,425)	155,014
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock (in shares)						64,400,000
Issuance of common stock		772,800	772,800			$ 644	772,156
Offering costs — common stock		(53,542)	(53,542)				(53,542)
Issuance of nonvested restricted common stock, shares						972,222
Amortization of nonvested restricted common stock and stock units		1,914	1,914				1,914
Stock based compensation		21								21
Repurchase of common stock, shares					(431)
Repurchase of common stock		(14)	(14)				(14)
Purchase of noncontrolling interest		(441)	(478)				(478)			37
Distributions to noncontrolling interests		(992)								(992)
Reclassification of noncontrolling interests to or from equity mezzanine equity		15,282								15,282
Adjustment to value of redeemable noncontrolling interests		6,901	6,909				6,909			(8)
Distributions declared		(33,076)	(33,076)					(33,076)
Net (loss) income	[1]	(2,983)	(3,892)					(3,892)		909
Other comprehensive income (loss)		(43)	(43)						(43)
Ending balance, shares at Mar. 31, 2024				46,673,320	19,552,425	65,372,222
Ending balance Stockholders' Equity at Mar. 31, 2024		$ 2,131,162	$ 1,960,899	$ 467	$ 194	$ 644	$ 3,275,252	$ (1,313,190)	$ (2,468)	$ 170,263
[1] For the three months ended March 31, 2024 and 2023, amounts exclude $(21) and $(368), respectively, of net (loss) attributable to redeemable noncontrolling interests. See Note 11, Redeemable Noncontrolling Interests, for further discussion.

v3.24.1.1.u2

CONDENSED CONSOLIDATED STATEMENTS OF EQUITY (Parenthetical) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Statement of Stockholders' Equity [Abstract]
Distribution per share (in usd per share)	$ 0.25	$ 0.25
Net income (loss) attributable to redeemable noncontrolling interest	$ (21)	$ (368)

v3.24.1.1.u2

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
CASH FLOWS FROM OPERATING ACTIVITIES
Net loss	$ (3,004)	$ (27,615)
Adjustments to reconcile net loss to net cash (used in) provided by operating activities:
Depreciation and amortization	42,767	44,670
Other amortization	11,799	20,370
Deferred rent	(1,132)	(1,090)
Stock based compensation	1,935	1,072
(Gain) loss on dispositions of real estate investments, net	(2,263)	132
Loss from unconsolidated entities	1,205	306
Gain on re-measurement of previously held equity interest	0	(726)
Foreign currency loss (gain)	434	(1,063)
Loss on extinguishments of debt	1,280	0
Change in fair value of derivative financial instruments	(6,417)	195
Changes in operating assets and liabilities:
Accounts and other receivables	(32,116)	(7,119)
Other assets	(9,736)	(3,489)
Accounts payable and accrued liabilities	(1,866)	1,790
Operating lease liabilities	(8,893)	(9,328)
Security deposits, prepaid rent and other liabilities	53	5,757
Net cash (used in) provided by operating activities	(5,954)	23,862
CASH FLOWS FROM INVESTING ACTIVITIES
Developments and capital expenditures	(19,886)	(21,500)
Proceeds from dispositions of real estate investments	14,522	6,901
Acquisitions of real estate investments	(352)	(11,680)
Acquisition of previously held equity interest	0	(335)
Investments in unconsolidated entities	0	(6,000)
Issuance of real estate notes receivable	(7,753)	0
Principal repayments on real estate notes receivable	8,383	0
Real estate and other deposits	(137)	(705)
Net cash used in investing activities	(5,223)	(33,319)
CASH FLOWS FROM FINANCING ACTIVITIES
Borrowings under mortgage loans payable	15,535	7,700
Payments on mortgage loans payable	(181,190)	(5,122)
Borrowings under the lines of credit and term loan	147,600	113,600
Payments on the lines of credit and term loan	(612,323)	(82,100)
Payments on financing and other obligations	(782)	(733)
Deferred financing costs	(5,838)	(1,048)
Proceeds from issuance of common stock	772,800	0
Payment of offering costs	(47,534)	(3)
Distributions paid to common stockholders	(16,596)	(26,492)
Repurchase of common stock	(14)	(78)
Purchase of noncontrolling interest	(441)	0
Distributions to noncontrolling interests	(991)	(4,076)
Redemption of noncontrolling interests	(25,312)	(15,803)
Security deposits	48	(145)
Net cash provided by (used in) financing activities	44,962	(14,300)
NET CHANGE IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH	33,785	(23,757)
EFFECT OF FOREIGN CURRENCY TRANSLATION ON CASH, CASH EQUIVALENTS AND RESTRICTED CASH	(36)	80
CASH, CASH EQUIVALENTS AND RESTRICTED CASH — Beginning of period	90,782	111,906
CASH, CASH EQUIVALENTS AND RESTRICTED CASH — End of period	124,531	88,229
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents	124,531	88,229
Cash and cash equivalents at beginning of period	43,445	65,052
Restricted cash at beginning of period	47,337	46,854
Cash and cash equivalents at end of period	77,026	41,346
Restricted cash at end of period	47,505	46,883
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION
Cash paid for: Interest	35,617	37,424
Cash paid for: Income taxes	157	383
SUPPLEMENTAL DISCLOSURE OF NONCASH INVESTING AND FINANCING ACTIVITIES
Accrued developments and capital expenditures	24,127	26,102
Capital expenditures from financing and other obligations	353	0
Tenant improvement overage	1,553	0
Acquisition of real estate investments with assumed mortgage loans payable, net of debt discount	91,472	0
Reclassification of noncontrolling interest from mezzanine equity, net	15,282	0
Distributions declared but not paid to common stockholders	32,900	16,554
Distributions declared but not paid — limited partnership units	875	875
Distributions declared but not paid — restricted stock units	294	68
Accrued offering costs	2,446	1,255
The following represents the net increase (decrease) in certain assets and liabilities in connection with our acquisitions and dispositions of investments:
Accounts and other receivables	343	(952)
Other assets, net	(3,749)	162
Accounts payable and accrued liabilities	(12)	548
Financing obligations	0	12
Security deposits and other liabilities	$ (236)	$ 312

v3.24.1.1.u2

Organization and Description of Business	3 Months Ended
	Mar. 31, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Description of Business	1. Organization and Description of Business Overview and Background American Healthcare REIT, Inc., a Maryland corporation, is a self-managed real estate investment trust, or REIT, that acquires, owns and operates a diversified portfolio of clinical healthcare real estate properties, focusing primarily on outpatient medical buildings, senior housing, skilled nursing facilities, or SNFs, and other healthcare-related facilities. We also operate healthcare-related facilities utilizing the structure permitted by the REIT Investment Diversification and Empowerment Act of 2007, which is commonly referred to as a “RIDEA” structure (the provisions of the Internal Revenue Code of 1986, as amended, or the Code, authorizing the RIDEA structure were enacted as part of the Housing and Economic Recovery Act of 2008). Our healthcare facilities operated under a RIDEA structure include our senior housing operating properties, or SHOP, and our integrated senior health campuses. We have originated and acquired secured loans and may also originate and acquire other real estate-related investments on an infrequent and opportunistic basis. We generally seek investments that produce current income; however, we have selectively developed, and may continue to selectively develop, healthcare real estate properties. We have elected to be taxed as a REIT for U.S. federal income tax purposes. We believe that we have been organized and operated, and we intend to continue to operate, in conformity with the requirements for qualification and taxation as a REIT under the Code. Operating Partnership We conduct substantially all of our operations through our operating partnership, and we are the sole general partner of our operating partnership. As of March 31, 2024 and December 31, 2023, we owned 97.4% and 95.0%, respectively, of the partnership units, or OP units, in our operating partnership, and the remaining 2.6% and 5.0%, respectively, limited OP units were owned by AHI Group Holdings, LLC, which is owned and controlled by Jeffrey T. Hanson, the non-executive Chairman of our board of directors, or our board, Danny Prosky, our Chief Executive Officer, President and director, and Mathieu B. Streiff, one of our directors; Platform Healthcare Investor TII, LLC; Flaherty Trust; and a wholly owned subsidiary of Griffin Capital Company, LLC, or collectively, the Limited Partners. See Note 11, Redeemable Noncontrolling Interests, and Note 12, Equity — Noncontrolling Interests in Total Equity, for a further discussion of the ownership in our operating partnership. Public Offerings and Listing We issued an aggregate 65,445,557 shares of Class T common stock and Class I common stock, for a total of $2,737,716,000 in gross offering proceeds, since February 26, 2014 in our initial public offerings and our distribution reinvestment plan, or DRIP, offerings. Our initial public offerings were terminated as of April 2019. On February 9, 2024, pursuant to a Registration Statement filed with the United States Securities and Exchange Commission, or SEC, on Form S-11 (File No. 333-267464), as amended, we closed our underwritten public offering, or the 2024 Offering, through which we issued 64,400,000 shares of Common Stock, for a total of $772,800,000 in gross offering proceeds. Such amounts include the exercise in full of the underwriters’ overallotment option to purchase up to an additional 8,400,000 shares of Common Stock. These shares are listed on the New York Stock Exchange, or NYSE, under the trading symbol “AHR” and began trading on February 7, 2024. Following the closing of the 2024 Offering, we are presenting Common Stock, Class T common stock and Class I common stock, or collectively, common stock, as separate classes within our condensed consolidated balance sheets and condensed consolidated statements of equity. Any references to “Common Stock” in this Quarterly Report on Form 10-Q refer to our NYSE-listed shares sold through the 2024 Offering, whereas Class T common stock and Class I common stock refer to our classes of common stock that are not NYSE-listed. This applies to all historical periods presented herein. See Note 12, Equity — Common Stock, and Note 12, Equity — Distribution Reinvestment Plan, for a further discussion of our public offerings. Our Real Estate Investments Portfolio We currently operate through four reportable business segments: integrated senior health campuses, outpatient medical, or OM, SHOP and triple-net leased properties. As of March 31, 2024, we owned and/or operated 318 buildings and integrated senior health campuses, representing approximately 19,451,000 square feet of gross leasable area, for an aggregate contract purchase price of $4,566,829,000. In addition, as of March 31, 2024, we also owned a real estate-related debt investment purchased for $60,429,000.

v3.24.1.1.u2

Summary of Significant Accounting Policies	3 Months Ended
	Mar. 31, 2024
Accounting Policies [Abstract]
Significant Accounting Policies	2. Summary of Significant Accounting Policies The summary of significant accounting policies presented below is designed to assist in understanding our accompanying condensed consolidated financial statements. Such condensed consolidated financial statements and the accompanying notes thereto are the representations of our management, who are responsible for their integrity and objectivity. These accounting policies conform to accounting principles generally accepted in the United States of America, or GAAP, in all material respects, and have been consistently applied in preparing our accompanying condensed consolidated financial statements. Basis of Presentation Our accompanying condensed consolidated financial statements include our accounts and those of our operating partnership, the wholly-owned subsidiaries of our operating partnership and all non-wholly owned subsidiaries in which we have control, as well as any VIEs in which we are the primary beneficiary. The portion of equity in any subsidiary that is not wholly owned by us is presented in our accompanying condensed consolidated financial statements as a noncontrolling interest. We evaluate our ability to control an entity, and whether the entity is a VIE and we are the primary beneficiary, by considering substantive terms of the arrangement and identifying which enterprise has the power to direct the activities of the entity that most significantly impacts the entity’s economic performance. We operate and intend to continue to operate in an umbrella partnership REIT structure in which our operating partnership, wholly-owned subsidiaries of our operating partnership and all non-wholly owned subsidiaries of which we have control will own substantially all of the interests in properties acquired on our behalf. We are the sole general partner of our operating partnership, and as of March 31, 2024 and December 31, 2023, we owned a 97.4% and 95.0%, respectively, general partnership interest therein, and the remaining 2.6% and 5.0%, respectively, limited partnership interest was owned by the Limited Partners. The accounts of our operating partnership are consolidated in our accompanying condensed consolidated financial statements because we are the sole general partner of our operating partnership and have unilateral control over its management and major operating decisions (even if additional limited partners are admitted to our operating partnership). All intercompany accounts and transactions are eliminated in consolidation. Interim Unaudited Financial Data Our accompanying condensed consolidated financial statements have been prepared by us in accordance with GAAP in conjunction with the rules and regulations of the SEC. Certain information and footnote disclosures required for annual financial statements have been condensed or excluded pursuant to the SEC’s rules and regulations. Accordingly, our accompanying condensed consolidated financial statements do not include all of the information and footnotes required by GAAP for complete financial statements. Our accompanying condensed consolidated financial statements reflect all adjustments which are, in our view, of a normal recurring nature and necessary for a fair presentation of our financial position, results of operations and cash flows for the interim period. Interim results of operations are not necessarily indicative of the results to be expected for the full year; such full-year results may be less favorable. In preparing our accompanying condensed consolidated financial statements, management has evaluated subsequent events through the financial statement issuance date. We believe that although the disclosures contained herein are adequate to prevent the information presented from being misleading, our accompanying condensed consolidated financial statements should be read in conjunction with our audited consolidated financial statements and the notes thereto included in our 2023 Annual Report on Form 10-K, as filed with the SEC on March 22, 2024. Use of Estimates The preparation of our accompanying condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, as well as the disclosure of contingent assets and liabilities, at the date of our condensed consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates and assumptions include, but are not limited to, the initial and recurring valuation of certain assets acquired and liabilities assumed through property acquisitions including through business combinations, goodwill and its impairment, revenues and grant income, allowance for credit losses, impairment of long-lived and intangible assets and contingencies. These estimates are made and evaluated on an ongoing basis using information that is currently available, as well as various other assumptions believed to be reasonable under the circumstances. Actual results could differ from those estimates, perhaps in material adverse ways, and those estimates could be different under different assumptions or conditions. Revenue Recognition — Resident Fees and Services Revenue Disaggregation of Resident Fees and Services Revenue The following tables disaggregate our resident fees and services revenue by line of business, according to whether such revenue is recognized at a point in time or over time (in thousands): Three Months Ended March 31, 2024 2023 Integrated Senior Health Campuses SHOP(1) Total Integrated Senior Health Campuses SHOP(1) Total Over time $ 324,517  $ 57,620  $ 382,137  $ 298,850  $ 45,613  $ 344,463  Point in time 68,605  1,376  69,981  62,920  1,247  64,167  Total resident fees and services $ 393,122  $ 58,996  $ 452,118  $ 361,770  $ 46,860  $ 408,630  The following tables disaggregate our resident fees and services revenue by payor class (in thousands): Three Months Ended March 31, 2024 2023 Integrated Senior Health Campuses SHOP(1) Total Integrated Senior Health Campuses SHOP(1) Total Private and other payors $ 184,322  $ 51,176  $ 235,498  $ 169,678  $ 43,850  $ 213,528  Medicare 120,349  1,243  121,592  126,466  311  126,777  Medicaid 88,451  6,577  95,028  65,626  2,699  68,325  Total resident fees and services $ 393,122  $ 58,996  $ 452,118  $ 361,770  $ 46,860  $ 408,630  ___________ (1)Includes fees for basic housing, as well as fees for assisted living or skilled nursing care. We record revenue when services are rendered at amounts billable to individual residents. Residency agreements are generally for a term of 30 days, with resident fees billed monthly in advance. For patients under reimbursement arrangements with Medicaid, revenue is recorded based on contractually agreed-upon amounts or rates on a daily, per resident basis or as services are rendered. Accounts Receivable, Net — Resident Fees and Services Revenue The beginning and ending balances of accounts receivable, net — resident fees and services are as follows (in thousands): Private and Other Payors Medicare Medicaid Total Beginning balance — January 1, 2024 $ 66,218  $ 51,260  $ 30,799  $ 148,277  Ending balance — March 31, 2024 73,716  71,142  31,529  176,387  Increase $ 7,498  $ 19,882  $ 730  $ 28,110  Deferred Revenue — Resident Fees and Services Revenue Deferred revenue is included in security deposits, prepaid rent and other liabilities in our accompanying condensed consolidated balance sheets. The beginning and ending balances of deferred revenue — resident fees and services, almost all of which relates to private and other payors, are as follows (in thousands): Total Beginning balance — January 1, 2024 $ 23,372  Ending balance — March 31, 2024 22,590  Decrease $ (782) Resident and Tenant Receivables and Allowances Resident receivables, which are related to resident fees and services revenue, are carried net of an allowance for credit losses. An allowance is maintained for estimated losses resulting from the inability of residents and payors to meet the contractual obligations under their lease or service agreements. Substantially all of such allowances are recorded as direct reductions of resident fees and services revenue as contractual adjustments provided to third-party payors or implicit price concessions in our accompanying condensed consolidated statements of operations and comprehensive loss. Our determination of the adequacy of these allowances is based primarily upon evaluations of historical loss experience, the residents’ financial condition, security deposits, cash collection patterns by payor and by state, current economic conditions, future expectations in estimating credit losses and other relevant factors. Tenant receivables, which are related to real estate revenue, and unbilled deferred rent receivables are reduced for amounts where collectability is not probable, which are recognized as direct reductions of real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive loss. The following is a summary of our adjustments to allowances for the three months ended March 31, 2024 and 2023 (in thousands): Three Months Ended March 31, 2024 2023 Beginning balance $ 17,037  $ 14,071  Additional allowances 6,603  4,037  Write-offs (3,258) (1,890) Recoveries collected or adjustments (1,856) (1,827) Ending balance $ 18,526  $ 14,391  Properties Held for Sale We classify a property or group of operating properties as held for sale in the period when certain criteria are met, such as we commit to a plan to sell the property and have determined that the sale is probable. Upon classification of a property as held for sale, we record the property at the lower of its carrying amount or fair value less costs to sell. In addition, a property being held for sale ceases to be depreciated. Our properties held for sale are included in other assets, net in our accompanying condensed consolidated balance sheets. On January 25, 2024, we disposed of one of our SHOP that was held for sale for a contract sales price of $4,500,000 and recognized a gain on sale of $645,000. For the three months ended March 31, 2023, we did not dispose of any held for sale properties. See Note 3, Real Estate Investments, Net and Business Combinations — Dispositions of Real Estate Investments, for a further discussion of our property dispositions. Accounts Payable and Accrued Liabilities As of March 31, 2024 and December 31, 2023, accounts payable and accrued liabilities primarily include reimbursement of payroll-related costs to the managers of our SHOP and integrated senior health campuses of $46,931,000 and $42,698,000, respectively, insurance reserves of $44,691,000 and $44,548,000, respectively, accrued distributions to common stockholders of $32,900,000 and $16,557,000, respectively, and accrued property taxes of $24,374,000 and $23,549,000, respectively. Recently Issued Accounting Pronouncements In November 2023, the Financial Accounting Standards Board, or FASB, issued Accounting Standards Update, or ASU, 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, or ASU 2023-07, which is intended to improve reportable segment disclosure requirements, primarily through enhanced disclosures about significant expenses. Such disclosure amendments include the requirement for public entities to disclose significant segment expenses that are regularly provided to the chief operating decision maker and included within each reported measure of segment profit or loss. ASU 2023-07 is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted and should be applied retrospectively to all prior periods presented in the financial statements. We are currently evaluating this guidance to determine the impact to our consolidated financial statements and disclosures. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures, or ASU 2023-09, which includes amendments that further enhance income tax disclosures, primarily through standardization and disaggregation of rate reconciliation categories and income taxes paid by jurisdiction. ASU 2023-09 is effective for annual periods beginning after December 15, 2024. Early adoption is permitted and should be applied prospectively; however, retrospective application is permitted. We are currently evaluating this guidance to determine the impact to our consolidated financial statements and disclosures. In March 2024, the SEC adopted final rules, The Enhancement and Standardization of Climate-Related Disclosures for Investors. The final rules require a registrant to disclose, among other things: material climate-related risks; activities to mitigate or adapt to such risks, as well as a quantitative and qualitative description of material expenditures incurred and material impacts on financial estimates and assumptions that directly result from such mitigation or adaptation activities; material capitalized costs, expenses and losses incurred as a result of severe weather events and other natural conditions; information about the registrant’s board of directors’ oversight of climate-related risks and management’s role in managing material climate-related risks; and information on any climate-related targets or goals that are material to the registrant’s business, results of operations or financial condition. The rules require registrants to provide such climate-related disclosures in their annual reports, beginning with annual reports for the year ending December 31, 2025 for calendar-year-end large accelerated filers. In April 2024, the SEC stayed the final rules in response to legal challenges to the rules. As a result, it is not clear whether current compliance deadlines will be extended once the litigation is resolved. We are currently evaluating this guidance to determine the impact to our consolidated financial statement disclosures.

v3.24.1.1.u2

Real Estate Investments, Net and Business Combinations	3 Months Ended
	Mar. 31, 2024
Real Estate [Abstract]
Real Estate Investments, Net and Business Combinations	3. Real Estate Investments, Net and Business Combinations Our real estate investments, net consisted of the following as of March 31, 2024 and December 31, 2023 (in thousands):   March 31, 2024 December 31, 2023 Building, improvements and construction in process $ 3,666,999  $ 3,604,299  Land and improvements 349,061  335,946  Furniture, fixtures and equipment 245,278  237,350  4,261,338  4,177,595  Less: accumulated depreciation (782,565) (752,157) $ 3,478,773  $ 3,425,438  Depreciation expense for the three months ended March 31, 2024 and 2023 was $37,135,000 and $35,899,000, respectively. The following is a summary of our capital expenditures by reportable segment for the three months ended March 31, 2024 (in thousands): Three Months Ended March 31, 2024 Integrated senior health campuses $ 5,766  OM 4,934  SHOP 2,937  Triple-net leased properties —  Total $ 13,637  Included in the capital expenditure amounts above are costs for the development and expansion of our integrated senior health campuses. For the three months ended March 31, 2024, we completed the development of one integrated senior health campus for $18,969,000. Dispositions of Real Estate Investments For the three months ended March 31, 2024, we disposed of two OM buildings that were included in real estate investments in our accompanying condensed consolidated balance sheets. We recognized a total aggregate net gain on such dispositions of $1,618,000. The following is a summary of such dispositions (dollars in thousands): Location Number of Buildings Type Date Disposed Contract Sales Price Marietta, GA 1 OM 01/16/24 $ 6,674  Homewood, AL 1 OM 03/18/24 4,462  Total 2 $ 11,136  Business Combinations On February 1, 2024, we acquired a portfolio of 14 senior housing properties in Oregon from an unaffiliated third party, which properties are included in our SHOP segment. These properties are part of the underlying collateral pool of real estate assets securing our debt security investment, as defined and described in Note 4. We acquired such properties by assuming the outstanding principal balance of each related mortgage loan payable from one of the borrowers since such borrower was in default. The aggregated principal balance of such assumed mortgage loans payable was $94,461,000 at the time of acquisition. No cash consideration was exchanged as part of the transactions; however, we incurred transaction costs of $3,112,000 related to the acquisition of such properties. See Note 4, Debt Security Investment, Net, for a further discussion. On February 15, 2023, we, through a majority-owned subsidiary of Trilogy, acquired from an unaffiliated third party, a 60.0% controlling interest in a privately held company, Memory Care Partners, LLC, or MCP, that operated integrated senior health campuses located in Kentucky. The contract purchase price for the acquisition of MCP was $900,000, which was acquired using cash on hand. Prior to such acquisition, we owned a 40.0% interest in MCP, which was accounted for as an equity method investment and was included in investments in unconsolidated entities within other assets, net in our accompanying condensed consolidated balance sheet as of December 31, 2022. In connection with the acquisition of the remaining interest in MCP, we now own a 100% controlling interest in MCP. As a result, we re-measured the fair value of our previously held equity interest in MCP and recognized a gain on re-measurement of $726,000 in our accompanying condensed consolidated statements of operations and comprehensive loss for the three months ended March 31, 2023. Based on quantitative and qualitative considerations, such business combinations were not material to us individually or in the aggregate and therefore, pro forma financial information is not provided. The fair values of the assets acquired and liabilities assumed were preliminary estimates at acquisition. Any necessary adjustments are finalized within one year from the date of acquisition. The table below summarizes the acquisition date fair values of the assets acquired and liabilities assumed of our business combinations during the three months ended March 31, 2024 and 2023 (in thousands): 2024 Acquisition 2023 Acquisition Building and improvements $ 64,350  $ —  Land 14,210  —  In-place leases 12,912  —  Goodwill —  3,331  Furniture, fixtures and equipment —  39  Cash and restricted cash —  565  Accounts receivable, net 343  —  Other assets 9  66  Total assets acquired 91,824  4,001  Mortgage loans payable (including debt discount of $2,989) (91,472) —  Accounts payable and accrued liabilities (352) (1,676) Financing obligations —  (12) Security deposits and other liabilities —  (812) Total liabilities assumed (91,824) (2,500) Net assets acquired $ —  $ 1,501

v3.24.1.1.u2

Debt Security Investment, Net	3 Months Ended
	Mar. 31, 2024
Debt Security Investment [Abstract]
Debt Security Investment, Net	4. Debt Security Investment, Net Our investment in a commercial mortgage-backed debt security, or debt security, bears an interest rate on the stated principal amount thereof equal to 4.24% per annum, the terms of which security provide for monthly interest-only payments. The debt security matures on August 25, 2025 at an aggregate stated amount of $93,433,000, resulting in an anticipated yield-to-maturity of 10.0% per annum. The debt security was issued by an unaffiliated mortgage trust and represents a 10.0% beneficial ownership interest in such mortgage trust. The debt security is subordinate to all other interests in the mortgage trust and is not guaranteed by a government-sponsored entity. On February 1, 2024, we acquired a portfolio of 14 senior housing properties in Oregon from an unaffiliated third party, which properties are included in the underlying collateral pool of real estate assets securing our debt security investment. We acquired such properties by assuming the outstanding principal balance of each related mortgage loan payable from one of the borrowers since such borrower was in default. We did not grant any concessions to such borrower, and the carrying value of our debt security investment at the time of acquisition did not exceed the fair value of such properties. See Note 3, Real Estate Investments, Net and Business Combinations, for a further discussion of such acquisition. As of March 31, 2024 and December 31, 2023, the carrying amount of the debt security investment was $87,984,000 and $86,935,000, respectively, net of unamortized closing costs of $413,000 and $489,000, respectively. Accretion on the debt security for the three months ended March 31, 2024 and 2023 was $1,125,000 and $1,020,000, respectively, which is recorded as an increase to real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive loss. Amortization expense of closing costs for the three months ended March 31, 2024 and 2023 was $76,000 and $65,000, respectively, which is recorded as a decrease to real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive loss. We evaluated credit quality indicators such as the agency ratings and the underlying collateral of such investment in order to determine expected future credit loss. No credit loss was recorded for the three months ended March 31, 2024 and 2023.

v3.24.1.1.u2

Intangibles	3 Months Ended
	Mar. 31, 2024
Intangible Assets and Liabilities [Abstract]
Intangibles	5. Identified Intangible Assets and Liabilities Identified intangible assets, net and identified intangible liabilities, net consisted of the following as of March 31, 2024 and December 31, 2023 (dollars in thousands): March 31, 2024 December 31, 2023 Amortized intangible assets: In-place leases, net of accumulated amortization of $37,431 and $35,437 as of March 31, 2024 and December 31, 2023, respectively (with a weighted average remaining life of 6.2 years and 7.7 years as of March 31, 2024 and December 31, 2023, respectively) $ 50,552  $ 42,615  Above-market leases, net of accumulated amortization of $7,462 and $7,079 as of March 31, 2024 and December 31, 2023, respectively (with a weighted average remaining life of 7.4 years and 7.5 years as of March 31, 2024 and December 31, 2023, respectively) 15,189  15,905  Customer relationships, net of accumulated amortization of $972 and $934 as of March 31, 2024 and December 31, 2023, respectively (with a weighted average remaining life of 12.4 years and 12.7 years as of March 31, 2024 and December 31, 2023, respectively) 1,868  1,906  Unamortized intangible assets: Certificates of need 99,938  99,777  Trade names 20,267  20,267  Total identified intangible assets, net $ 187,814  $ 180,470  Amortized intangible liabilities: Below-market leases, net of accumulated amortization of $2,950 and $2,831 as of March 31, 2024 and December 31, 2023, respectively (with a weighted average remaining life of 7.0 years and 7.2 years as of March 31, 2024 and December 31, 2023, respectively) $ 5,805  $ 6,095  Total identified intangible liabilities, net $ 5,805  $ 6,095  Amortization expense on identified intangible assets for the three months ended March 31, 2024 and 2023 was $5,713,000 and $17,071,000, respectively, which included $716,000 and $9,083,000, respectively, of amortization recorded as a decrease to real estate revenue for above-market leases in our accompanying condensed consolidated statements of operations and comprehensive loss. In March 2023, we transitioned our SNFs within Central Wisconsin Senior Care Portfolio from triple-net leased properties to a RIDEA structure, which resulted in a full amortization of $8,073,000 of above-market leases and $885,000 of in-place leases. Amortization expense on below-market leases for the three months ended March 31, 2024 and 2023 was $290,000 and $408,000, respectively, which is recorded as an increase to real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive loss. The aggregate weighted average remaining life of the identified intangible assets was 6.7 years and 7.8 years as of March 31, 2024 and December 31, 2023, respectively. The aggregate weighted average remaining life of the identified intangible liabilities was 7.0 years and 7.2 years as of March 31, 2024 and December 31, 2023, respectively. As of March 31, 2024, estimated amortization expense on the identified intangible assets and liabilities for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31, and thereafter was as follows (in thousands): Amortization Expense Year Intangible Assets Intangible Liabilities 2024 $ 18,094  $ (782) 2025 9,522  (956) 2026 7,727  (840) 2027 7,203  (825) 2028 6,150  (709) Thereafter 18,913  (1,693) Total $ 67,609  $ (5,805)

v3.24.1.1.u2

Other Assets, Net	3 Months Ended
	Mar. 31, 2024
Other Assets [Abstract]
Other Assets, Net	6. Other Assets, Net Other assets, net consisted of the following as of March 31, 2024 and December 31, 2023 (dollars in thousands):   March 31, 2024 December 31, 2023 Deferred rent receivables $ 48,541  $ 47,540  Prepaid expenses, deposits, other assets and deferred tax assets, net 32,729  33,204  Inventory — finished goods 20,741  19,472  Investments in unconsolidated entities 19,411  20,611  Lease commissions, net of accumulated amortization of $7,500 and $7,231 as of March 31, 2024 and December 31, 2023, respectively 17,442  17,565  Derivative financial instruments 5,491  1,463  Deferred financing costs, net of accumulated amortization of $7,117 and $8,494 as of March 31, 2024 and December 31, 2023, respectively 5,207  3,830  Lease inducement, net of accumulated amortization of $2,632 and $2,544 as of March 31, 2024 and December 31, 2023, respectively (with a weighted average remaining life of 6.7 years and 6.9 years as of March 31, 2024 and December 31, 2023, respectively) 2,368  2,456  Total $ 151,930  $ 146,141  Deferred financing costs included in other assets, net were related to the Trilogy Credit Facility, as defined in Note 8, as well as the senior unsecured revolving credit facility portions of the 2022 Credit Facility and 2024 Credit Facility. For the three months ended March 31, 2024, in connection with the replacement of the 2022 Credit Facility with the 2024 Credit Facility, we incurred an aggregate loss of $565,000 on the extinguishment of part of the senior unsecured revolving credit facility, which formed part of the 2022 Credit Facility. Such loss on extinguishment of debt is recorded as an increase to interest expense in our accompanying condensed consolidated statements of operations and comprehensive loss, and was due to the partial write-off of unamortized deferred financing costs related to the senior unsecured revolving credit facility portion of the 2022 Credit Facility. See Note 8, Lines of Credit and Term Loan, for further discussion of our lines of credit. Amortization expense on lease inducement for both the three months ended March 31, 2024 and 2023 was $88,000, which is recorded as a decrease to real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive loss.

v3.24.1.1.u2

Mortgage Loans Payable, Net	3 Months Ended
	Mar. 31, 2024
Mortgage Loans Payable, Net [Abstract]
Mortgage Loans Payable, Net	7. Mortgage Loans Payable, Net Mortgage loans payable, net consisted of the following as of March 31, 2024 and December 31, 2023 (dollars in thousands): March 31, 2024 December 31, 2023 Total fixed-rate debt (90 loans and 76 loans as of March 31, 2024 and December 31, 2023, respectively) $ 1,082,865  $ 990,325  Total variable-rate debt (5 loans and 13 loans as of March 31, 2024 and December 31, 2023, respectively) 172,255  335,988  Total fixed- and variable-rate debt 1,255,120  1,326,313  Less: deferred financing costs, net (10,864) (9,713) Add: premium 151  167  Less: discount (15,972) (14,371) Mortgage loans payable, net $ 1,228,435  $ 1,302,396  Based on interest rates in effect as of March 31, 2024 and December 31, 2023, effective interest rates on mortgage loans payable ranged from 2.21% to 8.18% per annum and 2.21% to 8.46% per annum, respectively, with a weighted average effective interest rate of 4.27% and 4.72%, respectively. We are required by the terms of certain loan documents to meet certain reporting requirements and covenants, such as net worth ratios, fixed charge coverage ratios and leverage ratios. The following table reflects the changes in the carrying amount of mortgage loans payable, net for the three months ended March 31, 2024 and 2023 (in thousands): Three Months Ended March 31, 2024 2023 Beginning balance $ 1,302,396  $ 1,229,847  Additions: Borrowings under mortgage loans payable 15,535  7,700  Assumption of mortgage loans payable due to acquisition of real estate investments, net 91,472  —  Amortization of deferred financing costs 780  577  Amortization of discount/premium on mortgage loans payable, net 1,374  885  Deductions: Scheduled principal payments on mortgage loans payable (5,045) (5,122) Early payoff of mortgage loans payable (176,145) —  Deferred financing costs (1,932) (142) Ending balance $ 1,228,435  $ 1,233,745  For the three months ended March 31, 2024, we incurred an aggregate loss on the early extinguishment of a mortgage loan payable of $715,000, which is recorded as an increase to interest expense in our accompanying condensed consolidated statements of operations and comprehensive loss. Such aggregate loss was primarily related to the payoff of approximately $176,145,000 of mortgage loans payable using the net proceeds from the 2024 Offering. For the three months ended March 31, 2023, we did not incur any gain or loss on the extinguishment of mortgage loans payable. As of March 31, 2024, the principal payments due on our mortgage loans payable for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31, and thereafter were as follows (in thousands): Year Amount 2024 $ 177,717  2025 168,275  2026 158,331  2027 55,125  2028 105,126  Thereafter 590,546  Total $ 1,255,120

v3.24.1.1.u2

Lines of Credit and Term Loan	3 Months Ended
	Mar. 31, 2024
Line of Credit Facility [Abstract]
Lines Of Credit and Term Loan	8. Lines of Credit and Term Loan 2022 Credit Facility We, through our operating partnership, as borrower, and certain of our subsidiaries, or the subsidiary guarantors, collectively as guarantors, were party to an amended agreement, or the 2022 Credit Agreement, with Bank of America, N.A., or Bank of America, KeyBank National Association, or KeyBank, Citizens Bank, National Association, or Citizens Bank, and the lenders named therein, which provided for a credit facility with an aggregate maximum principal amount up to $1,050,000,000, or the 2022 Credit Facility. The 2022 Credit Facility consisted of a senior unsecured revolving credit facility in the initial aggregate amount of $500,000,000 and a senior unsecured term loan facility in the initial aggregate amount of $550,000,000. As of December 31, 2023, borrowings outstanding under the 2022 Credit Facility totaled $914,900,000, and the weighted average interest rate on such borrowings outstanding was 7.08% per annum. Under the terms of the 2022 Credit Agreement, the revolving loans would have matured on January 19, 2026, and the term loan would have matured on January 19, 2027. On February 14, 2024, the 2022 Credit Agreement was amended and restated in its entirety. See below for a further discussion. 2024 Credit Facility On February 14, 2024, we, through our operating partnership, as borrower, and certain of our subsidiaries, or the subsidiary guarantors, and our company, collectively as guarantors, entered into an agreement, or the 2024 Credit Agreement, that amended, restated, superseded and replaced the 2022 Credit Agreement with Bank of America, KeyBank, Citizens Bank and a syndicate of other banks, as lenders, to obtain a credit facility with an aggregate maximum principal amount up to $1,150,000,000, or the 2024 Credit Facility. The 2024 Credit Facility consists of a senior unsecured revolving credit facility in the initial aggregate amount of $600,000,000 and a senior unsecured term loan facility in the initial aggregate amount of $550,000,000. The proceeds of loans made under the 2024 Credit Facility may be used for general corporate purposes including for working capital, capital expenditures, refinancing existing indebtedness and other corporate purposes not inconsistent with obligations under the 2024 Credit Agreement. We may also obtain up to $25,000,000 in the form of standby letters of credit pursuant to the 2024 Credit Facility. Unless defined herein, all capitalized terms under this “2024 Credit Facility” subsection are defined in the 2024 Credit Agreement. Under the terms of the 2024 Credit Agreement, the Revolving Loans mature on February 14, 2028, and may be extended for one 12-month period, subject to the satisfaction of certain conditions, including payment of an extension fee. The Term Loan matures on January 19, 2027, and may not be extended. The maximum principal amount of the 2024 Credit Facility may be increased by an aggregate incremental amount of $600,000,000, subject to: (i) the terms of the 2024 Credit Agreement and (ii) at least five business days’ prior written notice to Bank of America. At our option, the 2024 Credit Facility bears interest at varying rates based upon (i) Daily SOFR, plus the Applicable Rate for Daily SOFR Rate Loans or (ii) Term SOFR, plus the Applicable Rate for Term SOFR Rate Loans. If, under the terms of the 2024 Credit Agreement, there is an inability to determine the Daily SOFR or the Term SOFR, then the 2024 Credit Facility will bear interest at a rate per annum equal to the Base Rate plus the Applicable Rate for Base Rate Loans. The loans may be repaid in whole or in part without prepayment premium or penalty, subject to certain conditions. We are required to pay a fee on the unused portion of the lenders’ commitments under the 2024 Credit Agreement computed at (a) 0.25% per annum if the actual daily Commitment Utilization Percentage for such quarter is less than or equal to 50% and (b) 0.20% per annum if the actual daily Commitment Utilization Percentage for such quarter is greater than 50%, which fee shall be computed on the actual daily amount of the Available Commitments during the period for which payment is made and payable in arrears on a quarterly basis. The 2024 Credit Agreement requires us to add additional subsidiaries as guarantors in the event the value of the assets owned by the subsidiary guarantors falls below a certain threshold as set forth in the 2024 Credit Agreement. In the event of default, Bank of America has the right to terminate the commitment of each Lender to make Loans and any obligation of the L/C Issuer to make L/C Credit Extensions under the 2024 Credit Agreement and to accelerate the payment on any unpaid principal amount of all outstanding loans and all interest accrued and unpaid thereon. As of March 31, 2024, our aggregate borrowing capacity under the 2024 Credit Facility was $1,150,000,000, excluding the $25,000,000 standby letters of credit described above. As of March 31, 2024, borrowings outstanding under the 2024 Credit Facility totaled $550,000,000 ($549,308,000, net of deferred financing costs related to the senior unsecured term loan facility portion of the 2024 Credit Facility), and the weighted average interest rate on such borrowings outstanding was 6.66% per annum. Trilogy Credit Facility We, through Trilogy RER, LLC, are party to an amended loan agreement, or the Trilogy Credit Agreement, among certain subsidiaries of Trilogy OpCo, LLC, Trilogy RER, LLC, and Trilogy Pro Services, LLC; KeyBank; CIT Bank, N.A.; Regions Bank; KeyBanc Capital Markets, Inc.; Regions Capital Markets; Bank of America; The Huntington National Bank; and a syndicate of other banks, as lenders named therein, with respect to a senior secured revolving credit facility that had an aggregate maximum principal amount of $400,000,000, consisting of: (i) a $365,000,000 secured revolver supported by real estate assets and ancillary business cash flow and (ii) a $35,000,000 accounts receivable revolving credit facility supported by eligible accounts receivable, or the Trilogy Credit Facility. The proceeds of the Trilogy Credit Facility may be used for acquisitions, debt repayment and general corporate purposes. The maximum principal amount of the Trilogy Credit Facility could be increased by up to $100,000,000, for a total principal amount of $500,000,000, subject to certain conditions. Unless defined herein, all capitalized terms under this “Trilogy Credit Facility” subsection are defined in the Trilogy Credit Agreement, as amended. The Trilogy Credit Facility is due to mature on June 5, 2025. At our option, the Trilogy Credit Facility bears interest at per annum rates equal to (a) SOFR, plus 2.75% for SOFR Rate Loans and (b) for Base Rate Loans, 1.75% plus the highest of: (i) the fluctuating rate per annum of interest in effect for such day as established from time to time by KeyBank as its prime rate, (ii) 0.50% above the Federal Funds Effective Rate and (iii) 1.00% above one-month Adjusted Term SOFR. As of both March 31, 2024 and December 31, 2023, our aggregate borrowing capacity under the Trilogy Credit Facility was $400,000,000. As of March 31, 2024 and December 31, 2023, borrowings outstanding under the Trilogy Credit Facility totaled $210,000,000 and $309,823,000, respectively, and the weighted average interest rate on such borrowings outstanding was 8.17% and 8.20% per annum, respectively.

v3.24.1.1.u2

Derivative Financial Instruments	3 Months Ended
	Mar. 31, 2024
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivative Financial Instruments	9. Derivative Financial Instruments We use derivative financial instruments to manage interest rate risk associated with variable-rate debt. We recorded such derivative financial instruments in our accompanying condensed consolidated balance sheets as either an asset or a liability, as applicable, measured at fair value. The following table lists the derivative financial instruments held by us as of March 31, 2024 and December 31, 2023, which were included in other assets and other liabilities in our accompanying condensed consolidated balance sheets (dollars in thousands): Fair Value Instrument Notional  Amount Index Interest Rate Effective Date Maturity Date March 31, 2024 December 31, 2023 Swap $ 275,000  One Month Term SOFR 3.74% 02/01/23 01/19/26 $ 3,868  $ 1,463  Swap 275,000  One Month Term SOFR 4.41% 08/08/23 01/19/26 642  (2,178) Swap 200,000  One Month Term SOFR 4.40% 01/05/24 06/05/25 981  (211) $ 750,000  $ 5,491  $ (926) As of both March 31, 2024 and December 31, 2023, none of our derivative financial instruments were designated as hedges. Derivative financial instruments not designated as hedges are not speculative and are used to manage our exposure to interest rate movements, but do not meet the strict hedge accounting requirements. For the three months ended March 31, 2024 and 2023, we recorded a net gain (loss) in the fair value of derivative financial instruments of $6,417,000 and ($195,000), respectively, as a decrease (increase) to total interest expense in our accompanying condensed consolidated statements of operations and comprehensive loss related to the change in the fair value of our derivative financial instruments. See Note 13, Fair Value Measurements, for a further discussion of the fair value of our derivative financial instruments.

v3.24.1.1.u2

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2024
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	10. Commitments and Contingencies Litigation We are not presently subject to any material litigation nor, to our knowledge, is any material litigation threatened against us, which, if determined unfavorably to us, would have a material adverse effect on our consolidated financial position, results of operations or cash flows. Environmental Matters We follow a policy of monitoring our properties for the presence of hazardous or toxic substances. While there can be no assurance that a material environmental liability does not exist at our properties, we are not currently aware of any environmental liability with respect to our properties that would have a material adverse effect on our consolidated financial position, results of operations or cash flows. Further, we are not aware of any material environmental liability or any unasserted claim or assessment with respect to an environmental liability that we believe would require additional disclosure or the recording of a loss contingency. Other Our other commitments and contingencies include the usual obligations of real estate owners and operators in the normal course of business, which include calls/puts to sell/acquire properties. In our view, these matters are not expected to have a material adverse effect on our consolidated financial position, results of operations or cash flows.

v3.24.1.1.u2

Redeemable Noncontrolling Interests	3 Months Ended
	Mar. 31, 2024
Temporary Equity [Abstract]
Redeemable Noncontrolling Interests	11. Redeemable Noncontrolling Interests As of March 31, 2024 and December 31, 2023, we, through our direct and indirect subsidiaries, owned a 97.4% and 95.0%, respectively, general partnership interest in our operating partnership, and the remaining 2.6% and 5.0%, respectively, limited partnership interest in our operating partnership was owned by the Limited Partners. Some of the limited partnership units outstanding, which accounted for approximately 1.0% of our total operating partnership units outstanding as of December 31, 2023, had redemption features outside of our control and were accounted for as redeemable noncontrolling interests presented outside of permanent equity in our accompanying condensed consolidated balance sheet. Upon the closing of the 2024 Offering and listing of our Common Stock on the NYSE, such redemption features are no longer outside of our control, and the carrying amount of such interests is now presented within noncontrolling interests in total equity in our accompanying condensed consolidated balance sheet as of March 31, 2024. Further, additional paid-in capital was adjusted to reflect such change in presentation of the Limited Partners interests. See Note 12, Equity — Noncontrolling Interests in Total Equity, for a further discussion. As of March 31, 2024 and December 31, 2023, we, through Trilogy REIT Holdings LLC, or Trilogy REIT Holdings, in which we indirectly hold a 76.0% ownership interest, owned approximately 99.3% and 97.5%, respectively, of the outstanding equity interests of Trilogy Investors, LLC, or Trilogy. As of March 31, 2024 and December 31, 2023, certain members of Trilogy’s management and certain members of an advisory committee to Trilogy’s board of directors owned approximately 0.7% and 2.5%, respectively, of the outstanding equity interests of Trilogy. We accounted for such equity interests as redeemable noncontrolling interests or other liabilities in our accompanying condensed consolidated balance sheets in accordance with FASB, Accounting Standards Codification, or ASC, Topic 480-10-S99-3A, given certain features associated with such equity interests. In January 2024, we redeemed equity interests in Trilogy that were accounted for as other liabilities and owned by a current member of Trilogy’s advisory committee for $25,312,000 in cash. In April 2024, we redeemed all the remaining equity interests in Trilogy owned by members of Trilogy management and certain members of Trilogy’s advisory committee, including the redemption of Trilogy Profit Interests, as defined and described at Note 12, Equity — Noncontrolling Interests in Total Equity — Other Noncontrolling Interests, for an aggregate $10,771,000 in cash. For the three months ended March 31, 2023, we redeemed a portion of the equity interests owned by certain members of Trilogy’s management for an aggregate of $15,870,000. As of March 31, 2024 and December 31, 2023, we own, through our operating partnership, approximately 98.0% of the joint ventures with an affiliate of Meridian Senior Living, LLC, or Meridian, that own Pinnacle Beaumont ALF and Pinnacle Warrenton ALF. The noncontrolling interests held by Meridian have redemption features outside of our control and are accounted for as redeemable noncontrolling interests in our accompanying condensed consolidated balance sheets. We record the carrying amount of redeemable noncontrolling interests at the greater of: (i) the initial carrying amount, increased or decreased for the noncontrolling interests’ share of net income or loss and distributions or (ii) the redemption value. The changes in the carrying amount of redeemable noncontrolling interests consisted of the following for the three months ended March 31, 2024 and 2023 (in thousands): Three Months Ended March 31, 2024 2023 Beginning balance $ 33,843  $ 81,598  Reclassification from equity 21  21  Reclassification to equity (15,303) —  Distributions (3) (454) Redemption of redeemable noncontrolling interests —  (15,870) Adjustment to redemption value (6,901) (5,043) Net loss attributable to redeemable noncontrolling interests (21) (368) Ending balance $ 11,636  $ 59,884

v3.24.1.1.u2

Equity	3 Months Ended
	Mar. 31, 2024
Equity [Abstract]
Equity	12. Equity Preferred Stock Pursuant to our charter, we are authorized to issue 200,000,000 shares of our preferred stock, $0.01 par value per share. As of both March 31, 2024 and December 31, 2023, no shares of preferred stock were issued and outstanding. Common Stock Pursuant to our charter, as amended, we are authorized to issue 1,000,000,000 shares of our common stock, $0.01 par value per share, whereby 200,000,000 shares are classified as Class T common stock, 100,000,000 shares are classified as Class I common stock and 700,000,000 shares are classified as Common Stock without any designation as to class or series. We issued an aggregate 65,445,557 shares of Class T common stock and Class I common stock, for a total of $2,737,716,000 in gross offering proceeds, since February 26, 2014 in our initial public offerings and our DRIP offerings. Our initial public offerings were terminated as of April 2019. On February 9, 2024, we closed the 2024 Offering and issued 64,400,000 shares of Common Stock, $0.01 par value per share, for a total of $772,800,000 in gross offering proceeds, including the exercise in full of the underwriters’ overallotment option to purchase up to an additional 8,400,000 shares of Common Stock. In conjunction with the 2024 Offering, such shares of Common Stock were listed on the NYSE and began trading on February 7, 2024. We received $724,625,000 in net proceeds, after deducting the underwriting discount, which was primarily used to repay $176,145,000 of mortgage loans payable and $545,010,000 on our lines of credit in February 2024. The underwriting discount and other costs related to the 2024 Offering were offset against gross proceeds received and included as a component of additional paid-in capital in our accompanying condensed consolidated balance sheet as of March 31, 2024. Our Class T common stock and Class I common stock are identical to our Common Stock, except that such shares are not currently listed on the NYSE or any other national securities exchange. Six months after the listing of our Common Stock for trading on the NYSE, on August 5, 2024, each share of our Class T common stock and Class I common stock will automatically, and without any stockholder action, convert into one share of our listed Common Stock. Distribution Reinvestment Plan Our DRIP allowed our stockholders to elect to reinvest an amount equal to the distributions declared on their shares of common stock in additional shares of our common stock in lieu of receiving cash distributions. However, on November 14, 2022, our board suspended the DRIP offering beginning with the distributions declared for the quarter ended December 31, 2022. As a result of the suspension of the DRIP offering, unless and until our board reinstates the DRIP offering, stockholders who are current participants in the DRIP will be paid distributions in cash. Share Repurchase Plan Our share repurchase plan allowed for repurchases of shares of our common stock by us when certain criteria were met. Share repurchases were made at the sole discretion of our board. On November 14, 2022, our board suspended our share repurchase plan beginning with share repurchase requests for the quarter ending December 31, 2022. All share repurchase requests, including requests resulting from the death or qualifying disability of stockholders, commencing with the quarter ended December 31, 2022, will not be processed, will be considered canceled in full and will not be considered outstanding repurchase requests. We did not repurchase any shares of our common stock pursuant to our share repurchase plan for the three months ended March 31, 2024. For the three months ended March 31, 2023, we repurchased 1,681 shares of common stock for an aggregate of $62,000 at a repurchase price of $37.16 per share, pursuant to our share repurchase plan. Such repurchase requests were submitted prior to the suspension of our share repurchase plan. Noncontrolling Interests in Total Equity Membership Interest in Trilogy REIT Holdings As of March 31, 2024 and December 31, 2023, Trilogy REIT Holdings owned approximately 99.3% and 97.5%, respectively, of Trilogy. We are the indirect owner of a 76.0% interest in Trilogy REIT Holdings pursuant to an amended joint venture agreement with an indirect, wholly-owned subsidiary of NorthStar Healthcare Income, Inc., or NHI. We serve as the managing member of Trilogy REIT Holdings. As of both March 31, 2024 and December 31, 2023, NHI indirectly owned a 24.0% membership interest in Trilogy REIT Holdings, and as such, for the three months ended March 31, 2024 and 2023, 24.0% of the net earnings of Trilogy REIT Holdings were allocated to noncontrolling interests. On November 3, 2023, we entered into a Membership Interest Purchase Agreement, or the MIPA, with subsidiaries of NHI, which provides us with the option to purchase their 24.0% minority membership interest in Trilogy REIT Holdings. If we exercise this purchase option, we will own 100% of Trilogy REIT Holdings, which will in turn result in us indirectly owning 100% of Trilogy. Subject to our first satisfying certain closing conditions, the option is exercisable for a closing before September 30, 2025 assuming that we exercise both extension options described below. If we exercise our purchase option, the all-cash purchase price would be $247,000,000 if we consummate the purchase from April 1, 2024 to and including December 31, 2024 and would increase to $260,000,000 if we consummate the purchase on or after January 1, 2025. The MIPA also allows us (at our election), instead of paying all cash, to consummate the purchase transaction by using a combination of cash and the issuance of new Series A Cumulative Convertible Preferred Stock, $0.01 par value per share, or our Convertible Preferred Stock, as purchase price consideration. We must pay at least a minimum amount of the purchase price in cash, in which case we would pay the remaining amount in shares of our Convertible Preferred Stock. The minimum cash amount will be $24,700,000 if we consummate the purchase from April 1, 2024 to and including December 31, 2024, or $26,000,000 if we consummate the purchase on or after January 1, 2025. If issued, our Convertible Preferred Stock will be perpetual, will have a cumulative cash dividend with an initial annual rate of 4.75% (on the liquidation preference per share of $25.00 of our Convertible Preferred Stock) and will be redeemable by us at any time. The annual dividend rate will increase over time, and the redemption price will vary based on the date of redemption. In addition, holders of shares of our Convertible Preferred Stock will have the right, at any time on or after July 1, 2026 and from time to time, to convert some or all of such shares into shares of our common stock, subject to certain customary exceptions. As of March 31, 2024, we did not exercise the purchase option pursuant to the MIPA. Other Noncontrolling Interests In connection with our acquisition and operation of Trilogy, profit interest units in Trilogy, or the Profit Interests, were issued to Trilogy Management Services, LLC and independent directors of Trilogy, both unaffiliated third parties that manage or direct the day-to-day operations of Trilogy. The Profit Interests consisted of time-based or performance-based commitments. The time-based Profit Interests were measured at their grant date fair value and vested in increments of 20.0% on each anniversary of the respective grant date over a five-year period. We amortized the time-based Profit Interests on a straight-line basis over the vesting periods, which were recorded to general and administrative expenses in our accompanying condensed consolidated statements of operations and comprehensive loss. The performance-based Profit Interests were measured at their fair value on the adoption date of ASU 2018-07, Improvements to Nonemployee Share-Based Payment Accounting, using a modified retrospective approach, were subject to a performance commitment and would have vested upon liquidity events as defined in the Profit Interests agreements. The nonvested awards were presented as noncontrolling interests in total equity in our accompanying condensed consolidated balance sheets, and were re-classified to redeemable noncontrolling interests upon vesting as they had redemption features outside of our control, similar to the common stock units held by Trilogy’s management. See Note 11, Redeemable Noncontrolling Interests, for a further discussion. For both the three months ended March 31, 2024 and 2023, we recognized stock compensation expense related to the time-based Profit Interests of $21,000. In April 2024, we redeemed all the remaining Profit Interests for cash. See Note 11, Redeemable Noncontrolling Interests, for a further discussion of our redemption of the Profit Interests. As of December 31, 2023, we owned an 86.0% interest in a consolidated limited liability company that owned Lakeview IN Medical Plaza. On February 6, 2024, we purchased the remaining 14.0% membership interest in the consolidated limited liability company that owned Lakeview IN Medical Plaza from an unaffiliated third party for a contract purchase price of $441,000. In connection with such purchase and as of such date, we own a 100% interest in such limited liability company. As such, from January 1, 2024 through February 5, 2024, and for the three months ended March 31, 2023, 14.0% of the net earnings of Lakeview IN Medical Plaza were allocated to noncontrolling interests in our accompanying condensed consolidated statements of operations and comprehensive loss. As discussed in Note 1, Organization and Description of Business, as of March 31, 2024 and December 31, 2023, we, through our direct and indirect subsidiaries, owned a 97.4% and 95.0%, respectively, general partnership interest in our operating partnership and the remaining 2.6% and 5.0%, respectively, limited OP units in our operating partnership were owned by the Limited Partners. Some of the limited partnership units outstanding, which accounted for approximately 1.0% of our total operating partnership units outstanding as of December 31, 2023, had redemption features outside of our control and were accounted for as redeemable noncontrolling interests presented outside of permanent equity in our accompanying condensed consolidated balance sheets. Upon the closing of the 2024 Offering and listing of our Common Stock on the NYSE, such redemption features are no longer outside of our control and we reclassed the remaining carrying amount of such redeemable noncontrolling interests as of such date to noncontrolling interests in total equity. Therefore, as of March 31, 2024, 2.6% of our total operating partnership units outstanding is presented as noncontrolling interests in total equity in our accompanying condensed consolidated balance sheet. See Note 11, Redeemable Noncontrolling Interests, for a further discussion. AHR Incentive Plan Pursuant to our Second Amended and Restated 2015 Incentive Plan, or the AHR Incentive Plan, our board (with respect to options and restricted shares of common stock granted to independent directors) or our compensation committee (with respect to any other award) may grant options, restricted shares of common stock, stock purchase rights, stock appreciation rights or other awards to our independent directors, officers, employees and consultants. The AHR Incentive Plan terminates on June 15, 2033, and the maximum number of shares of our common stock that may be issued pursuant to such plan is 4,000,000 shares. Restricted common stock Pursuant to the AHR Incentive Plan, through March 31, 2024, we granted an aggregate of 1,287,681 shares of our restricted common stock, or RSAs, as defined in the AHR Incentive Plan, which included restricted Common Stock, restricted Class T common stock and restricted Class I common stock. RSAs were granted to our independent directors in connection with their initial election or re-election to our board or in consideration of their past services rendered, as well as to certain executive officers and key employees. The number of RSAs granted through March 31, 2024 above includes an aggregate of 972,222 RSAs we granted in February 2024 to independent directors, executive officers and certain employees upon completion of the 2024 Offering. RSAs generally have a vesting period of up to four years and are subject to continuous service through the vesting dates. Restricted stock units Pursuant to the AHR Incentive Plan, through March 31, 2024, we granted to our executive officers an aggregate 320,780 of performance-based restricted stock units, or PBUs, representing the right to receive shares of our common stock upon vesting. We also granted to our executive officers and certain employees 408,033 time-based restricted stock units, or TBUs, representing the right to receive shares of our common stock upon vesting. PBUs and TBUs are collectively referred to as RSUs. RSUs granted to executive officers and employees generally have a vesting period of up to three years and are subject to continuous service through the vesting dates and any performance conditions, as applicable. A summary of the status of our nonvested RSAs and RSUs as of March 31, 2024 and December 31, 2023, and the changes for the three months ended March 31, 2024 is presented below: Number of  Nonvested RSAs Weighted Average Grant Date Fair Value - RSAs Number of  Nonvested RSUs Weighted Average Grant Date Fair Value - RSUs Balance — December 31, 2023 147,044  $ 35.99  228,081  $ 32.43  Granted 972,222  $ 13.12  477,008  $ 14.57  Vested (1,051) $ 37.16  —  $ —  Forfeited —  $ —  (725) $ 37.16  Balance — March 31, 2024 1,118,215  $ 16.11  704,364  $ 20.33  For the three months ended March 31, 2024 and 2023, we recognized stock compensation expense related to awards granted pursuant to the AHR Incentive Plan of $1,914,000 and $1,051,000, respectively. Such expense was based on the grant date fair value for time-based awards and for performance-based awards that are probable of vesting, which fair value calculation used the most recently published estimated per share net asset value for awards granted prior to the 2024 Offering, and the closing market price of our listed Common Stock commencing with awards granted effective as of the 2024 Offering date. Stock compensation expense is included in general and administrative expenses in our accompanying condensed consolidated statements of operations and comprehensive loss.

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Fair Value Measurements	3 Months Ended
	Mar. 31, 2024
Fair Value Disclosures [Abstract]
Fair Value Measurements	13. Fair Value Measurements Assets and Liabilities Reported at Fair Value The table below presents our assets and liabilities measured at fair value on a recurring basis as of March 31, 2024, aggregated by the level in the fair value hierarchy within which those measurements fall (in thousands): Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Total Assets: Derivative financial instruments $ —  $ 5,491  $ —  $ 5,491  Total assets at fair value $ —  $ 5,491  $ —  $ 5,491  The table below presents our assets and liabilities measured at fair value on a recurring basis as of December 31, 2023, aggregated by the level in the fair value hierarchy within which those measurements fall (in thousands): Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Total Assets: Derivative financial instrument $ —  $ 1,463  $ —  $ 1,463  Total assets at fair value $ —  $ 1,463  $ —  $ 1,463  Liabilities: Derivative financial instruments $ —  $ 2,389  $ —  $ 2,389  Total liabilities at fair value $ —  $ 2,389  $ —  $ 2,389  There were no transfers into and out of fair value measurement levels during the three months ended March 31, 2024 and 2023. Derivative Financial Instruments We entered into interest rate swaps to manage interest rate risk associated with variable-rate debt. The valuation of these instruments was determined using widely accepted valuation techniques including a discounted cash flow analysis on the expected cash flows of each derivative. Such valuation reflected the contractual terms of the derivatives, including the period to maturity, and used observable market-based inputs, including interest rate curves, as well as option volatility. The fair values of our interest rate swaps were determined by netting the discounted future fixed cash payments and the discounted expected variable cash receipts. The variable cash receipts were based on an expectation of future interest rates derived from observable market interest rate curves. We incorporated credit valuation adjustments to appropriately reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements. In adjusting the fair value of our derivative contracts for the effect of nonperformance risk, we considered the impact of netting and any applicable credit enhancements, such as collateral postings, thresholds, mutual puts and guarantees. Although we determined that the majority of the inputs used to value our derivative financial instruments fell within Level 2 of the fair value hierarchy, the credit valuation adjustments associated with this instrument utilized Level 3 inputs, such as estimates of current credit spreads, to evaluate the likelihood of default by us and our counterparty. However, as of March 31, 2024, we assessed the significance of the impact of the credit valuation adjustments on the overall valuation of our derivative positions and determined that the credit valuation adjustments were not significant to the overall valuation of our derivatives. As a result, we determined that our derivative valuations in their entirety were classified in Level 2 of the fair value hierarchy. Financial Instruments Disclosed at Fair Value Our accompanying condensed consolidated balance sheets include the following financial instruments: debt security investment, cash and cash equivalents, restricted cash, accounts and other receivables, accounts payable and accrued liabilities, mortgage loans payable and borrowings under our lines of credit and term loan. We consider the carrying values of cash and cash equivalents, restricted cash, accounts and other receivables and accounts payable and accrued liabilities to approximate the fair value for these financial instruments based upon an evaluation of the underlying characteristics and market data, in light of the short period of time between origination of the instruments and their expected realization. The fair values of the other financial instruments are classified in Level 2 of the fair value hierarchy. The fair value of our debt security investment is estimated using a discounted cash flow analysis using interest rates available to us for investments with similar terms and maturities. The fair values of our mortgage loans payable and our lines of credit and term loan are estimated using discounted cash flow analyses using borrowing rates available to us for debt instruments with similar terms and maturities. We have determined that the valuations of our debt security investment, mortgage loans payable and lines of credit and term loan are classified in Level 2 within the fair value hierarchy. The carrying amounts and estimated fair values of such financial instruments as of March 31, 2024 and December 31, 2023 were as follows (in thousands): March 31, 2024 December 31, 2023   Carrying Amount(1) Fair Value Carrying Amount(1) Fair Value Financial Assets: Debt security investment $ 87,984  $ 93,323  $ 86,935  $ 93,304  Financial Liabilities: Mortgage loans payable $ 1,228,435  $ 1,090,173  $ 1,302,396  $ 1,185,260  Lines of credit and term loan $ 754,101  $ 759,966  $ 1,220,137  $ 1,225,890  ___________ (1)Carrying amount is net of any discount/premium and unamortized deferred financing costs.

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Income Taxes	3 Months Ended
	Mar. 31, 2024
Income Tax Disclosure [Abstract]
Income Taxes	14. Income Taxes As a REIT, we generally will not be subject to U.S. federal income tax on taxable income that we distribute to our stockholders. We have elected to treat certain of our consolidated subsidiaries as taxable REIT subsidiaries, or TRS, pursuant to the Code. TRS may participate in services that would otherwise be considered impermissible for REITs and are subject to federal and state income tax at regular corporate tax rates. Current Income Tax Federal and state income taxes are generally a function of the level of income recognized by our TRS. Foreign income taxes are generally a function of our income on our real estate located in the United Kingdom, or UK, and Isle of Man. Deferred Taxes Deferred income tax is generally a function of the period’s temporary differences (primarily basis differences between tax and financial reporting for real estate assets and equity investments) and generation of tax net operating loss that may be realized in future periods depending on sufficient taxable income. We recognize the effects of an uncertain tax position on the financial statements, when it is more likely than not, based on the technical merits of the tax position, that such a position will be sustained upon examination by the relevant tax authorities. If the tax benefit meets the “more likely than not” threshold, the measurement of the tax benefit will be based on our estimate of the ultimate tax benefit to be sustained if audited by the taxing authority. As of both March 31, 2024 and December 31, 2023, we did not have any tax benefits or liabilities for uncertain tax positions that we believe should be recognized in our accompanying condensed consolidated financial statements. We assess the available positive and negative evidence to estimate if sufficient future taxable income will be generated to use the existing deferred tax assets. A valuation allowance is established if we believe it is more likely than not that all or a portion of the deferred tax assets are not realizable. As of both March 31, 2024 and December 31, 2023, our valuation allowance fully reserves the net deferred tax assets due to historical losses and inherent uncertainty of future income. We will continue to monitor industry and economic conditions and our ability to generate taxable income based on our business plan and available tax planning strategies, which would allow us to utilize the tax benefits of the net deferred tax assets and thereby allow us to reverse all, or a portion of, our valuation allowance in the future.

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Leases	3 Months Ended
	Mar. 31, 2024
Leases [Abstract]
Lessee, Finance Leases	15. Leases Lessor We have operating leases with tenants that expire at various dates through 2050. For the three months ended March 31, 2024 and 2023, we recognized $46,008,000 and $42,303,000, respectively, of revenues related to operating lease payments, of which $9,659,000 and $10,040,000, respectively, was for variable lease payments. As of March 31, 2024, the following table sets forth the undiscounted cash flows for future minimum base rents due under operating leases for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31 and thereafter for properties that we wholly own (in thousands): Year Amount 2024 $ 101,827  2025 127,211  2026 117,487  2027 111,745  2028 100,456  Thereafter 486,642  Total $ 1,045,368  Lessee We lease certain land, buildings, furniture, fixtures, campus and office equipment and automobiles. We have lease agreements with lease and non-lease components, which are generally accounted for separately. Most leases include one or more options to renew, with renewal terms that generally can extend at various dates through 2107, excluding extension options. The exercise of lease renewal options is at our sole discretion. Certain leases also include options to purchase the leased property. The depreciable life of assets and leasehold improvements are limited by the expected lease term, unless there is a transfer of title or purchase option reasonably certain of exercise. Certain of our lease agreements include rental payments that are adjusted periodically based on the United States Bureau of Labor Statistics’ Consumer Price Index and may also include other variable lease costs (i.e., common area maintenance, property taxes and insurance). Our lease agreements do not contain any material residual value guarantees or material restrictive covenants. The components of lease costs were as follows (in thousands): Three Months Ended March 31, Lease Cost Classification 2024 2023 Operating lease cost(1) Property operating expenses, rental expenses or general and administrative expenses $ 10,776  $ 11,923  Finance lease cost: Amortization of leased assets Depreciation and amortization 561  303  Interest on lease liabilities Interest expense 157  91  Sublease income Resident fees and services revenue or other income (144) (156) Total lease cost $ 11,350  $ 12,161  ___________ (1)Includes short-term leases and variable lease costs, which are immaterial. Additional information related to our leases for the periods presented below was as follows (dollars in thousands): Lease Term and Discount Rate March 31, 2024 December 31, 2023 Weighted average remaining lease term (in years): Operating leases 12.1 12.2 Finance leases 1.2 1.5 Weighted average discount rate: Operating leases 5.77  % 5.76  % Finance leases 7.79  % 7.78  % Three Months Ended March 31, Supplemental Disclosure of Cash Flows Information 2024 2023 Operating cash outflows related to finance leases $ 157  $ 91  Financing cash outflows related to finance leases $ 11  $ 16  Right-of-use assets obtained in exchange for operating lease liabilities $ —  $ 1,155  Operating Leases As of March 31, 2024, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31 and thereafter, as well as the reconciliation of those cash flows to operating lease liabilities on our accompanying condensed consolidated balance sheet (in thousands): Year Amount 2024 $ 26,936  2025 35,153  2026 35,074  2027 35,617  2028 35,707  Thereafter 166,314  Total undiscounted operating lease payments 334,801  Less: interest 115,034  Present value of operating lease liabilities $ 219,767  Finance Leases As of March 31, 2024, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31 and thereafter, as well as a reconciliation of those cash flows to finance lease liabilities (in thousands): Year Amount 2024 $ 63  2025 31  2026 —  2027 —  2028 —  Thereafter —  Total undiscounted finance lease payments 94  Less: interest 5  Present value of finance lease liabilities $ 89
Lessor, Operating Leases	15. Leases Lessor We have operating leases with tenants that expire at various dates through 2050. For the three months ended March 31, 2024 and 2023, we recognized $46,008,000 and $42,303,000, respectively, of revenues related to operating lease payments, of which $9,659,000 and $10,040,000, respectively, was for variable lease payments. As of March 31, 2024, the following table sets forth the undiscounted cash flows for future minimum base rents due under operating leases for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31 and thereafter for properties that we wholly own (in thousands): Year Amount 2024 $ 101,827  2025 127,211  2026 117,487  2027 111,745  2028 100,456  Thereafter 486,642  Total $ 1,045,368  Lessee We lease certain land, buildings, furniture, fixtures, campus and office equipment and automobiles. We have lease agreements with lease and non-lease components, which are generally accounted for separately. Most leases include one or more options to renew, with renewal terms that generally can extend at various dates through 2107, excluding extension options. The exercise of lease renewal options is at our sole discretion. Certain leases also include options to purchase the leased property. The depreciable life of assets and leasehold improvements are limited by the expected lease term, unless there is a transfer of title or purchase option reasonably certain of exercise. Certain of our lease agreements include rental payments that are adjusted periodically based on the United States Bureau of Labor Statistics’ Consumer Price Index and may also include other variable lease costs (i.e., common area maintenance, property taxes and insurance). Our lease agreements do not contain any material residual value guarantees or material restrictive covenants. The components of lease costs were as follows (in thousands): Three Months Ended March 31, Lease Cost Classification 2024 2023 Operating lease cost(1) Property operating expenses, rental expenses or general and administrative expenses $ 10,776  $ 11,923  Finance lease cost: Amortization of leased assets Depreciation and amortization 561  303  Interest on lease liabilities Interest expense 157  91  Sublease income Resident fees and services revenue or other income (144) (156) Total lease cost $ 11,350  $ 12,161  ___________ (1)Includes short-term leases and variable lease costs, which are immaterial. Additional information related to our leases for the periods presented below was as follows (dollars in thousands): Lease Term and Discount Rate March 31, 2024 December 31, 2023 Weighted average remaining lease term (in years): Operating leases 12.1 12.2 Finance leases 1.2 1.5 Weighted average discount rate: Operating leases 5.77  % 5.76  % Finance leases 7.79  % 7.78  % Three Months Ended March 31, Supplemental Disclosure of Cash Flows Information 2024 2023 Operating cash outflows related to finance leases $ 157  $ 91  Financing cash outflows related to finance leases $ 11  $ 16  Right-of-use assets obtained in exchange for operating lease liabilities $ —  $ 1,155  Operating Leases As of March 31, 2024, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31 and thereafter, as well as the reconciliation of those cash flows to operating lease liabilities on our accompanying condensed consolidated balance sheet (in thousands): Year Amount 2024 $ 26,936  2025 35,153  2026 35,074  2027 35,617  2028 35,707  Thereafter 166,314  Total undiscounted operating lease payments 334,801  Less: interest 115,034  Present value of operating lease liabilities $ 219,767  Finance Leases As of March 31, 2024, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31 and thereafter, as well as a reconciliation of those cash flows to finance lease liabilities (in thousands): Year Amount 2024 $ 63  2025 31  2026 —  2027 —  2028 —  Thereafter —  Total undiscounted finance lease payments 94  Less: interest 5  Present value of finance lease liabilities $ 89
Lessee, Operating Leases	15. Leases Lessor We have operating leases with tenants that expire at various dates through 2050. For the three months ended March 31, 2024 and 2023, we recognized $46,008,000 and $42,303,000, respectively, of revenues related to operating lease payments, of which $9,659,000 and $10,040,000, respectively, was for variable lease payments. As of March 31, 2024, the following table sets forth the undiscounted cash flows for future minimum base rents due under operating leases for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31 and thereafter for properties that we wholly own (in thousands): Year Amount 2024 $ 101,827  2025 127,211  2026 117,487  2027 111,745  2028 100,456  Thereafter 486,642  Total $ 1,045,368  Lessee We lease certain land, buildings, furniture, fixtures, campus and office equipment and automobiles. We have lease agreements with lease and non-lease components, which are generally accounted for separately. Most leases include one or more options to renew, with renewal terms that generally can extend at various dates through 2107, excluding extension options. The exercise of lease renewal options is at our sole discretion. Certain leases also include options to purchase the leased property. The depreciable life of assets and leasehold improvements are limited by the expected lease term, unless there is a transfer of title or purchase option reasonably certain of exercise. Certain of our lease agreements include rental payments that are adjusted periodically based on the United States Bureau of Labor Statistics’ Consumer Price Index and may also include other variable lease costs (i.e., common area maintenance, property taxes and insurance). Our lease agreements do not contain any material residual value guarantees or material restrictive covenants. The components of lease costs were as follows (in thousands): Three Months Ended March 31, Lease Cost Classification 2024 2023 Operating lease cost(1) Property operating expenses, rental expenses or general and administrative expenses $ 10,776  $ 11,923  Finance lease cost: Amortization of leased assets Depreciation and amortization 561  303  Interest on lease liabilities Interest expense 157  91  Sublease income Resident fees and services revenue or other income (144) (156) Total lease cost $ 11,350  $ 12,161  ___________ (1)Includes short-term leases and variable lease costs, which are immaterial. Additional information related to our leases for the periods presented below was as follows (dollars in thousands): Lease Term and Discount Rate March 31, 2024 December 31, 2023 Weighted average remaining lease term (in years): Operating leases 12.1 12.2 Finance leases 1.2 1.5 Weighted average discount rate: Operating leases 5.77  % 5.76  % Finance leases 7.79  % 7.78  % Three Months Ended March 31, Supplemental Disclosure of Cash Flows Information 2024 2023 Operating cash outflows related to finance leases $ 157  $ 91  Financing cash outflows related to finance leases $ 11  $ 16  Right-of-use assets obtained in exchange for operating lease liabilities $ —  $ 1,155  Operating Leases As of March 31, 2024, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31 and thereafter, as well as the reconciliation of those cash flows to operating lease liabilities on our accompanying condensed consolidated balance sheet (in thousands): Year Amount 2024 $ 26,936  2025 35,153  2026 35,074  2027 35,617  2028 35,707  Thereafter 166,314  Total undiscounted operating lease payments 334,801  Less: interest 115,034  Present value of operating lease liabilities $ 219,767  Finance Leases As of March 31, 2024, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31 and thereafter, as well as a reconciliation of those cash flows to finance lease liabilities (in thousands): Year Amount 2024 $ 63  2025 31  2026 —  2027 —  2028 —  Thereafter —  Total undiscounted finance lease payments 94  Less: interest 5  Present value of finance lease liabilities $ 89

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Segment Reporting	3 Months Ended
	Mar. 31, 2024
Segment Reporting [Abstract]
Segment Reporting	16. Segment Reporting We evaluate our business and make resource allocations based on four reportable business segments: integrated senior health campuses, OM (which was formerly known as medical office buildings, or MOBs), SHOP and triple-net leased properties. Prior to the quarter ended December 31, 2023, we evaluated our business and made resource allocations based on six reportable business segments. All segment information included in this Quarterly Report on Form 10-Q has been recast for all periods presented to reflect four reportable business segments and the change in segment name from MOBs to OM. The segment name change from MOBs to OM did not result in any changes to the composition of such segment or information reviewed by management, and therefore, had no impact on the historical results of operations. Our OM buildings are typically leased to multiple tenants under separate leases, thus requiring active management and responsibility for many of the associated operating expenses (much of which are, or can effectively be, passed through to the tenants). Our integrated senior health campuses each provide a range of independent living, assisted living, memory care, skilled nursing services and certain ancillary businesses that are owned and operated utilizing a RIDEA structure. Our triple-net leased properties segment includes senior housing, skilled nursing facilities and hospital investments, which are single-tenant properties for which we lease the properties to unaffiliated tenants under triple-net and generally master leases that transfer the obligation for all property operating costs (including maintenance, repairs, taxes, insurance and capital expenditures) to the tenant. In addition, our triple-net leased properties segment includes our debt security investment. Our SHOP segment includes senior housing, which may provide assisted living care, independent living, memory care or skilled nursing services, that are owned and operated utilizing a RIDEA structure. While we believe that net income or loss, as defined by GAAP, is the most appropriate earnings measurement, our chief operating decision maker evaluates performance of our combined properties in each reportable business segment and determines how to allocate resources to those segments, primarily based on net operating income, or NOI, for each segment. We define segment NOI as total revenues and grant income, less property operating expenses and rental expenses, which excludes depreciation and amortization, general and administrative expenses, business acquisition expenses, interest expense, gain or loss on dispositions of real estate investments, impairment of real estate investments, impairment of intangible assets and goodwill, income or loss from unconsolidated entities, gain on re-measurement of previously held equity interest, foreign currency gain or loss, other income and income tax benefit or expense for each segment. We believe that segment NOI serves as an appropriate supplemental performance measure to net income (loss) because it allows investors and our management to measure unlevered property-level operating results and to compare our operating results to the operating results of other real estate companies and between periods on a consistent basis. Interest expense, depreciation and amortization and other expenses not attributable to individual properties are not allocated to individual segments for purposes of assessing segment performance. Non-segment assets primarily consist of corporate assets, including cash and cash equivalents, other receivables, deferred financing costs and other assets not attributable to individual properties. Summary information for the reportable segments during the three months ended March 31, 2024 and 2023 was as follows (in thousands): Integrated Senior Health Campuses SHOP OM Triple-Net Leased Properties Three Months Ended March 31, 2024 Revenues: Resident fees and services $ 393,122  $ 58,996  $ —  $ —  $ 452,118  Real estate revenue —  —  34,067  13,348  47,415  Total revenues 393,122  58,996  34,067  13,348  499,533  Expenses: Property operating expenses 351,142  52,487  —  —  403,629  Rental expenses —  —  13,089  638  13,727  Segment net operating income $ 41,980  $ 6,509  $ 20,978  $ 12,710  $ 82,177  Expenses: General and administrative $ 11,828  Business acquisition expenses 2,782  Depreciation and amortization 42,767  Other income (expense): Interest expense: Interest expense (including amortization of deferred financing costs, debt discount/premium, and loss on debt extinguishments) (36,438) Gain in fair value of derivative financial instruments 6,417  Gain on dispositions of real estate investments, net 2,263  Loss from unconsolidated entities (1,205) Foreign currency loss (426) Other income 1,863  Total net other expense (27,526) Loss before income taxes (2,726) Income tax expense (278) Net loss $ (3,004) Integrated Senior Health Campuses SHOP OM Triple-Net Leased Properties Three Months Ended March 31, 2023 Revenues: Resident fees and services $ 361,770  $ 46,860  $ —  $ —  $ 408,630  Real estate revenue —  —  37,483  6,113  43,596  Total revenues 361,770  46,860  37,483  6,113  452,226  Expenses: Property operating expenses 328,361  41,785  —  —  370,146  Rental expenses —  —  14,408  787  15,195  Segment net operating income $ 33,409  $ 5,075  $ 23,075  $ 5,326  $ 66,885  Expenses: General and administrative $ 13,053  Business acquisition expenses 332  Depreciation and amortization 44,670  Other income (expense): Interest expense: Interest expense (including amortization of deferred financing costs and debt discount/premium) (39,011) Loss in fair value of derivative financial instruments (195) Loss on dispositions of real estate investments, net (132) Loss from unconsolidated entities (306) Gain on re-measurement of previously held equity interest 726  Foreign currency gain 1,008  Other income 1,608  Total net other expense (36,302) Loss before income taxes (27,472) Income tax expense (143) Net loss $ (27,615) Total assets by reportable segment as of March 31, 2024 and December 31, 2023 were as follows (in thousands): March 31, 2024 December 31, 2023 Integrated senior health campuses $ 2,241,792  $ 2,197,762  OM 1,213,664  1,232,310  SHOP 716,923  630,373  Triple-net leased properties 499,824  502,836  Other 31,227  14,652  Total assets $ 4,703,430  $ 4,577,933  As of both March 31, 2024 and December 31, 2023, goodwill of $168,177,000, $47,812,000 and $18,953,000 was allocated to our integrated senior health campuses, OM and triple-net leased properties segments, respectively. Our portfolio of properties and other investments are located in the United States, the UK and Isle of Man. Revenues and assets are attributed to the country in which the property is physically located. The following is a summary of geographic information for our operations for the periods presented (in thousands): Three Months Ended March 31,   2024 2023 Revenues: United States $ 497,646  $ 451,092  International 1,887  1,134  $ 499,533  $ 452,226  The following is a summary of real estate investments, net by geographic regions as of March 31, 2024 and December 31, 2023 (in thousands):   March 31, 2024 December 31, 2023 Real estate investments, net: United States $ 3,436,208  $ 3,382,115  International 42,565  43,323  $ 3,478,773  $ 3,425,438

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Concentration of Credit Risk	3 Months Ended
	Mar. 31, 2024
Concentration of Credit Risk [Abstract]
Concentration of Credit Risk	17. Concentration of Credit Risk Financial instruments that potentially subject us to a concentration of credit risk are primarily our debt security investment, cash and cash equivalents, restricted cash and accounts and other receivables. We are exposed to credit risk with respect to our debt security investment, but we believe collection of the outstanding amount is probable. Cash and cash equivalents are generally invested in investment-grade, short-term instruments with a maturity of three months or less when purchased. We have cash and cash equivalents in financial institutions that are insured by the Federal Deposit Insurance Corporation, or FDIC. As of March 31, 2024 and December 31, 2023, we had cash and cash equivalents in excess of FDIC insured limits. We believe this risk is not significant. Concentration of credit risk with respect to accounts receivable from tenants and residents is limited. We perform credit evaluations of prospective tenants and security deposits are obtained at the time of property acquisition and upon lease execution. Based on leases as of March 31, 2024, properties in two states in the United States accounted for 10.0% or more of our total consolidated property portfolio’s annualized base rent or annualized NOI, which is based on contractual base rent from leases in effect for our non-RIDEA properties and annualized NOI for our SHOP and integrated senior health campuses as of March 31, 2024. Properties located in Indiana and Ohio accounted for 33.2% and 13.9%, respectively, of our total consolidated property portfolio’s annualized base rent or annualized NOI. Accordingly, there is a geographic concentration of risk subject to fluctuations in each state’s economy. Based on leases in effect as of March 31, 2024, our integrated senior health campuses, OM, SHOP and triple-net leased properties segments accounted for 46.7%, 29.1%, 12.4% and 11.8%, respectively, of our total consolidated property portfolio’s annualized base rent or annualized NOI. As of March 31, 2024, none of our tenants at our properties accounted for 10.0% or more of our total consolidated property portfolio’s annualized base rent or annualized NOI.

v3.24.1.1.u2

Per Share Data	3 Months Ended
	Mar. 31, 2024
Earnings Per Share [Abstract]
Per Share Data	18. Per Share Data Basic earnings (loss) per share for all periods presented are computed by dividing net income (loss) applicable to common stock by the weighted average number of shares of our common stock outstanding during the period. Net income (loss) applicable to common stock is calculated as net income (loss) attributable to controlling interest less distributions allocated to participating securities of $1,095,000 and $926,000 for the three months ended March 31, 2024 and 2023, respectively. Diluted earnings (loss) per share are computed based on the weighted average number of shares of our common stock and all potentially dilutive securities, if any. TBUs, nonvested shares of our RSAs and limited partnership units of our operating partnership are participating securities and give rise to potentially dilutive shares of our common stock. As of March 31, 2024 and 2023, there were 1,118,215 and 184,145 nonvested shares, respectively, of our RSAs outstanding, but such shares were excluded from the computation of diluted earnings (loss) per share because such shares were anti-dilutive during these periods. As of both March 31, 2024 and 2023, there were 3,501,976 limited partnership units of our operating partnership outstanding, but such units were also excluded from the computation of diluted earnings (loss) per share because such units were anti-dilutive during these periods. As of March 31, 2024 and 2023, there were 395,108 and 19,200 nonvested TBUs outstanding, respectively, but such units were excluded from the computation of diluted earnings (loss) per share because such restricted stock units were anti-dilutive during the period. As of March 31, 2024 and December 31, 2023, there were 309,256 and 70,751, respectively, nonvested PBUs outstanding, which were treated as contingently issuable shares pursuant to ASC Topic 718, Compensation — Stock Compensation. Such contingently issuable shares were excluded from the computation of diluted earnings (loss) per share because they were anti-dilutive during the period.

v3.24.1.1.u2

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Pay vs Performance Disclosure
Net Income (Loss) Attributable to Parent	$ (3,892)	$ (25,872)

v3.24.1.1.u2

Insider Trading Arrangements	3 Months Ended
	Mar. 31, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

v3.24.1.1.u2

Summary of Significant Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2024
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation Our accompanying condensed consolidated financial statements include our accounts and those of our operating partnership, the wholly-owned subsidiaries of our operating partnership and all non-wholly owned subsidiaries in which we have control, as well as any VIEs in which we are the primary beneficiary. The portion of equity in any subsidiary that is not wholly owned by us is presented in our accompanying condensed consolidated financial statements as a noncontrolling interest. We evaluate our ability to control an entity, and whether the entity is a VIE and we are the primary beneficiary, by considering substantive terms of the arrangement and identifying which enterprise has the power to direct the activities of the entity that most significantly impacts the entity’s economic performance. We operate and intend to continue to operate in an umbrella partnership REIT structure in which our operating partnership, wholly-owned subsidiaries of our operating partnership and all non-wholly owned subsidiaries of which we have control will own substantially all of the interests in properties acquired on our behalf. We are the sole general partner of our operating partnership, and as of March 31, 2024 and December 31, 2023, we owned a 97.4% and 95.0%, respectively, general partnership interest therein, and the remaining 2.6% and 5.0%, respectively, limited partnership interest was owned by the Limited Partners. The accounts of our operating partnership are consolidated in our accompanying condensed consolidated financial statements because we are the sole general partner of our operating partnership and have unilateral control over its management and major operating decisions (even if additional limited partners are admitted to our operating partnership). All intercompany accounts and transactions are eliminated in consolidation.
Interim Unaudited Financial Data	Interim Unaudited Financial Data Our accompanying condensed consolidated financial statements have been prepared by us in accordance with GAAP in conjunction with the rules and regulations of the SEC. Certain information and footnote disclosures required for annual financial statements have been condensed or excluded pursuant to the SEC’s rules and regulations. Accordingly, our accompanying condensed consolidated financial statements do not include all of the information and footnotes required by GAAP for complete financial statements. Our accompanying condensed consolidated financial statements reflect all adjustments which are, in our view, of a normal recurring nature and necessary for a fair presentation of our financial position, results of operations and cash flows for the interim period. Interim results of operations are not necessarily indicative of the results to be expected for the full year; such full-year results may be less favorable. In preparing our accompanying condensed consolidated financial statements, management has evaluated subsequent events through the financial statement issuance date. We believe that although the disclosures contained herein are adequate to prevent the information presented from being misleading, our accompanying condensed consolidated financial statements should be read in conjunction with our audited consolidated financial statements and the notes thereto included in our 2023 Annual Report on Form 10-K, as filed with the SEC on March 22, 2024.
Use of Estimates	Use of Estimates The preparation of our accompanying condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, as well as the disclosure of contingent assets and liabilities, at the date of our condensed consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates and assumptions include, but are not limited to, the initial and recurring valuation of certain assets acquired and liabilities assumed through property acquisitions including through business combinations, goodwill and its impairment, revenues and grant income, allowance for credit losses, impairment of long-lived and intangible assets and contingencies. These estimates are made and evaluated on an ongoing basis using information that is currently available, as well as various other assumptions believed to be reasonable under the circumstances. Actual results could differ from those estimates, perhaps in material adverse ways, and those estimates could be different under different assumptions or conditions.
Resident and Tenant Receivables and Allowances	Resident and Tenant Receivables and Allowances Resident receivables, which are related to resident fees and services revenue, are carried net of an allowance for credit losses. An allowance is maintained for estimated losses resulting from the inability of residents and payors to meet the contractual obligations under their lease or service agreements. Substantially all of such allowances are recorded as direct reductions of resident fees and services revenue as contractual adjustments provided to third-party payors or implicit price concessions in our accompanying condensed consolidated statements of operations and comprehensive loss. Our determination of the adequacy of these allowances is based primarily upon evaluations of historical loss experience, the residents’ financial condition, security deposits, cash collection patterns by payor and by state, current economic conditions, future expectations in estimating credit losses and other relevant factors. Tenant receivables, which are related to real estate revenue, and unbilled deferred rent receivables are reduced for amounts where collectability is not probable, which are recognized as direct reductions of real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive loss.
Properties Held for Sale	Properties Held for Sale We classify a property or group of operating properties as held for sale in the period when certain criteria are met, such as we commit to a plan to sell the property and have determined that the sale is probable. Upon classification of a property as held for sale, we record the property at the lower of its carrying amount or fair value less costs to sell. In addition, a property being held for sale ceases to be depreciated. Our properties held for sale are included in other assets, net in our accompanying condensed consolidated balance sheets.
Accounts Payable and Accrued Liabilities	Accounts Payable and Accrued Liabilities As of March 31, 2024 and December 31, 2023, accounts payable and accrued liabilities primarily include reimbursement of payroll-related costs to the managers of our SHOP and integrated senior health campuses of $46,931,000 and $42,698,000, respectively, insurance reserves of $44,691,000 and $44,548,000, respectively, accrued distributions to common stockholders of $32,900,000 and $16,557,000, respectively, and accrued property taxes of $24,374,000 and $23,549,000, respectively.
Recently Issued Accounting Pronouncements	Recently Issued Accounting Pronouncements In November 2023, the Financial Accounting Standards Board, or FASB, issued Accounting Standards Update, or ASU, 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, or ASU 2023-07, which is intended to improve reportable segment disclosure requirements, primarily through enhanced disclosures about significant expenses. Such disclosure amendments include the requirement for public entities to disclose significant segment expenses that are regularly provided to the chief operating decision maker and included within each reported measure of segment profit or loss. ASU 2023-07 is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted and should be applied retrospectively to all prior periods presented in the financial statements. We are currently evaluating this guidance to determine the impact to our consolidated financial statements and disclosures. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures, or ASU 2023-09, which includes amendments that further enhance income tax disclosures, primarily through standardization and disaggregation of rate reconciliation categories and income taxes paid by jurisdiction. ASU 2023-09 is effective for annual periods beginning after December 15, 2024. Early adoption is permitted and should be applied prospectively; however, retrospective application is permitted. We are currently evaluating this guidance to determine the impact to our consolidated financial statements and disclosures. In March 2024, the SEC adopted final rules, The Enhancement and Standardization of Climate-Related Disclosures for Investors. The final rules require a registrant to disclose, among other things: material climate-related risks; activities to mitigate or adapt to such risks, as well as a quantitative and qualitative description of material expenditures incurred and material impacts on financial estimates and assumptions that directly result from such mitigation or adaptation activities; material capitalized costs, expenses and losses incurred as a result of severe weather events and other natural conditions; information about the registrant’s board of directors’ oversight of climate-related risks and management’s role in managing material climate-related risks; and information on any climate-related targets or goals that are material to the registrant’s business, results of operations or financial condition. The rules require registrants to provide such climate-related disclosures in their annual reports, beginning with annual reports for the year ending December 31, 2025 for calendar-year-end large accelerated filers. In April 2024, the SEC stayed the final rules in response to legal challenges to the rules. As a result, it is not clear whether current compliance deadlines will be extended once the litigation is resolved. We are currently evaluating this guidance to determine the impact to our consolidated financial statement disclosures.

v3.24.1.1.u2

Summary of Significant Accounting Policies (Tables)	3 Months Ended
	Mar. 31, 2024
Accounting Policies [Abstract]
Disaggregation of Revenue	The following tables disaggregate our resident fees and services revenue by line of business, according to whether such revenue is recognized at a point in time or over time (in thousands): Three Months Ended March 31, 2024 2023 Integrated Senior Health Campuses SHOP(1) Total Integrated Senior Health Campuses SHOP(1) Total Over time $ 324,517  $ 57,620  $ 382,137  $ 298,850  $ 45,613  $ 344,463  Point in time 68,605  1,376  69,981  62,920  1,247  64,167  Total resident fees and services $ 393,122  $ 58,996  $ 452,118  $ 361,770  $ 46,860  $ 408,630  The following tables disaggregate our resident fees and services revenue by payor class (in thousands): Three Months Ended March 31, 2024 2023 Integrated Senior Health Campuses SHOP(1) Total Integrated Senior Health Campuses SHOP(1) Total Private and other payors $ 184,322  $ 51,176  $ 235,498  $ 169,678  $ 43,850  $ 213,528  Medicare 120,349  1,243  121,592  126,466  311  126,777  Medicaid 88,451  6,577  95,028  65,626  2,699  68,325  Total resident fees and services $ 393,122  $ 58,996  $ 452,118  $ 361,770  $ 46,860  $ 408,630  ___________ (1)Includes fees for basic housing, as well as fees for assisted living or skilled nursing care. We record revenue when services are rendered at amounts billable to individual residents. Residency agreements are generally for a term of 30 days, with resident fees billed monthly in advance. For patients under reimbursement arrangements with Medicaid, revenue is recorded based on contractually agreed-upon amounts or rates on a daily, per resident basis or as services are rendered.
Receivables and Deferred Revenue - Resident Fees and Services	Accounts Receivable, Net — Resident Fees and Services Revenue The beginning and ending balances of accounts receivable, net — resident fees and services are as follows (in thousands): Private and Other Payors Medicare Medicaid Total Beginning balance — January 1, 2024 $ 66,218  $ 51,260  $ 30,799  $ 148,277  Ending balance — March 31, 2024 73,716  71,142  31,529  176,387  Increase $ 7,498  $ 19,882  $ 730  $ 28,110  Deferred Revenue — Resident Fees and Services Revenue Deferred revenue is included in security deposits, prepaid rent and other liabilities in our accompanying condensed consolidated balance sheets. The beginning and ending balances of deferred revenue — resident fees and services, almost all of which relates to private and other payors, are as follows (in thousands): Total Beginning balance — January 1, 2024 $ 23,372  Ending balance — March 31, 2024 22,590  Decrease $ (782)
Summary of Adjustments to Allowance for Credit Loss	The following is a summary of our adjustments to allowances for the three months ended March 31, 2024 and 2023 (in thousands): Three Months Ended March 31, 2024 2023 Beginning balance $ 17,037  $ 14,071  Additional allowances 6,603  4,037  Write-offs (3,258) (1,890) Recoveries collected or adjustments (1,856) (1,827) Ending balance $ 18,526  $ 14,391

v3.24.1.1.u2

Real Estate Investments, Net and Business Combinations (Tables)	3 Months Ended
	Mar. 31, 2024
Real Estate [Abstract]
Real Estate Investments, Net	Our real estate investments, net consisted of the following as of March 31, 2024 and December 31, 2023 (in thousands):   March 31, 2024 December 31, 2023 Building, improvements and construction in process $ 3,666,999  $ 3,604,299  Land and improvements 349,061  335,946  Furniture, fixtures and equipment 245,278  237,350  4,261,338  4,177,595  Less: accumulated depreciation (782,565) (752,157) $ 3,478,773  $ 3,425,438
Schedule of Capital Expenditures Incurred	The following is a summary of our capital expenditures by reportable segment for the three months ended March 31, 2024 (in thousands): Three Months Ended March 31, 2024 Integrated senior health campuses $ 5,766  OM 4,934  SHOP 2,937  Triple-net leased properties —  Total $ 13,637
Schedule of Asset Dispositions	The following is a summary of such dispositions (dollars in thousands): Location Number of Buildings Type Date Disposed Contract Sales Price Marietta, GA 1 OM 01/16/24 $ 6,674  Homewood, AL 1 OM 03/18/24 4,462  Total 2 $ 11,136
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed	The table below summarizes the acquisition date fair values of the assets acquired and liabilities assumed of our business combinations during the three months ended March 31, 2024 and 2023 (in thousands): 2024 Acquisition 2023 Acquisition Building and improvements $ 64,350  $ —  Land 14,210  —  In-place leases 12,912  —  Goodwill —  3,331  Furniture, fixtures and equipment —  39  Cash and restricted cash —  565  Accounts receivable, net 343  —  Other assets 9  66  Total assets acquired 91,824  4,001  Mortgage loans payable (including debt discount of $2,989) (91,472) —  Accounts payable and accrued liabilities (352) (1,676) Financing obligations —  (12) Security deposits and other liabilities —  (812) Total liabilities assumed (91,824) (2,500) Net assets acquired $ —  $ 1,501

v3.24.1.1.u2

Intangibles (Tables)	3 Months Ended
	Mar. 31, 2024
Intangible Assets and Liabilities [Abstract]
Schedule of Intangible Assets and Liabilities	Identified intangible assets, net and identified intangible liabilities, net consisted of the following as of March 31, 2024 and December 31, 2023 (dollars in thousands): March 31, 2024 December 31, 2023 Amortized intangible assets: In-place leases, net of accumulated amortization of $37,431 and $35,437 as of March 31, 2024 and December 31, 2023, respectively (with a weighted average remaining life of 6.2 years and 7.7 years as of March 31, 2024 and December 31, 2023, respectively) $ 50,552  $ 42,615  Above-market leases, net of accumulated amortization of $7,462 and $7,079 as of March 31, 2024 and December 31, 2023, respectively (with a weighted average remaining life of 7.4 years and 7.5 years as of March 31, 2024 and December 31, 2023, respectively) 15,189  15,905  Customer relationships, net of accumulated amortization of $972 and $934 as of March 31, 2024 and December 31, 2023, respectively (with a weighted average remaining life of 12.4 years and 12.7 years as of March 31, 2024 and December 31, 2023, respectively) 1,868  1,906  Unamortized intangible assets: Certificates of need 99,938  99,777  Trade names 20,267  20,267  Total identified intangible assets, net $ 187,814  $ 180,470  Amortized intangible liabilities: Below-market leases, net of accumulated amortization of $2,950 and $2,831 as of March 31, 2024 and December 31, 2023, respectively (with a weighted average remaining life of 7.0 years and 7.2 years as of March 31, 2024 and December 31, 2023, respectively) $ 5,805  $ 6,095  Total identified intangible liabilities, net $ 5,805  $ 6,095
Amortization Expense on Identified Intangible Assets and Liabilities	As of March 31, 2024, estimated amortization expense on the identified intangible assets and liabilities for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31, and thereafter was as follows (in thousands): Amortization Expense Year Intangible Assets Intangible Liabilities 2024 $ 18,094  $ (782) 2025 9,522  (956) 2026 7,727  (840) 2027 7,203  (825) 2028 6,150  (709) Thereafter 18,913  (1,693) Total $ 67,609  $ (5,805)

v3.24.1.1.u2

Other Assets, Net (Tables)	3 Months Ended
	Mar. 31, 2024
Other Assets [Abstract]
Other Assets, Net	Other assets, net consisted of the following as of March 31, 2024 and December 31, 2023 (dollars in thousands):   March 31, 2024 December 31, 2023 Deferred rent receivables $ 48,541  $ 47,540  Prepaid expenses, deposits, other assets and deferred tax assets, net 32,729  33,204  Inventory — finished goods 20,741  19,472  Investments in unconsolidated entities 19,411  20,611  Lease commissions, net of accumulated amortization of $7,500 and $7,231 as of March 31, 2024 and December 31, 2023, respectively 17,442  17,565  Derivative financial instruments 5,491  1,463  Deferred financing costs, net of accumulated amortization of $7,117 and $8,494 as of March 31, 2024 and December 31, 2023, respectively 5,207  3,830  Lease inducement, net of accumulated amortization of $2,632 and $2,544 as of March 31, 2024 and December 31, 2023, respectively (with a weighted average remaining life of 6.7 years and 6.9 years as of March 31, 2024 and December 31, 2023, respectively) 2,368  2,456  Total $ 151,930  $ 146,141

v3.24.1.1.u2

Mortgage Loans Payable, Net (Tables)	3 Months Ended
	Mar. 31, 2024
Mortgage Loans Payable, Net [Abstract]
Mortgage Loans Payable, Net	Mortgage loans payable, net consisted of the following as of March 31, 2024 and December 31, 2023 (dollars in thousands): March 31, 2024 December 31, 2023 Total fixed-rate debt (90 loans and 76 loans as of March 31, 2024 and December 31, 2023, respectively) $ 1,082,865  $ 990,325  Total variable-rate debt (5 loans and 13 loans as of March 31, 2024 and December 31, 2023, respectively) 172,255  335,988  Total fixed- and variable-rate debt 1,255,120  1,326,313  Less: deferred financing costs, net (10,864) (9,713) Add: premium 151  167  Less: discount (15,972) (14,371) Mortgage loans payable, net $ 1,228,435  $ 1,302,396
Schedule of Activity Related to Mortgage Loans Payable	The following table reflects the changes in the carrying amount of mortgage loans payable, net for the three months ended March 31, 2024 and 2023 (in thousands): Three Months Ended March 31, 2024 2023 Beginning balance $ 1,302,396  $ 1,229,847  Additions: Borrowings under mortgage loans payable 15,535  7,700  Assumption of mortgage loans payable due to acquisition of real estate investments, net 91,472  —  Amortization of deferred financing costs 780  577  Amortization of discount/premium on mortgage loans payable, net 1,374  885  Deductions: Scheduled principal payments on mortgage loans payable (5,045) (5,122) Early payoff of mortgage loans payable (176,145) —  Deferred financing costs (1,932) (142) Ending balance $ 1,228,435  $ 1,233,745
Principal Payments Due on Mortgage Loans Payable	As of March 31, 2024, the principal payments due on our mortgage loans payable for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31, and thereafter were as follows (in thousands): Year Amount 2024 $ 177,717  2025 168,275  2026 158,331  2027 55,125  2028 105,126  Thereafter 590,546  Total $ 1,255,120

v3.24.1.1.u2

Derivative Financial Instruments (Tables)	3 Months Ended
	Mar. 31, 2024
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Schedule of Derivative Financial Instruments	The following table lists the derivative financial instruments held by us as of March 31, 2024 and December 31, 2023, which were included in other assets and other liabilities in our accompanying condensed consolidated balance sheets (dollars in thousands): Fair Value Instrument Notional  Amount Index Interest Rate Effective Date Maturity Date March 31, 2024 December 31, 2023 Swap $ 275,000  One Month Term SOFR 3.74% 02/01/23 01/19/26 $ 3,868  $ 1,463  Swap 275,000  One Month Term SOFR 4.41% 08/08/23 01/19/26 642  (2,178) Swap 200,000  One Month Term SOFR 4.40% 01/05/24 06/05/25 981  (211) $ 750,000  $ 5,491  $ (926)

v3.24.1.1.u2

Redeemable Noncontrolling Interests (Tables)	3 Months Ended
	Mar. 31, 2024
Temporary Equity [Abstract]
Redeemable Noncontrolling Interests	The changes in the carrying amount of redeemable noncontrolling interests consisted of the following for the three months ended March 31, 2024 and 2023 (in thousands): Three Months Ended March 31, 2024 2023 Beginning balance $ 33,843  $ 81,598  Reclassification from equity 21  21  Reclassification to equity (15,303) —  Distributions (3) (454) Redemption of redeemable noncontrolling interests —  (15,870) Adjustment to redemption value (6,901) (5,043) Net loss attributable to redeemable noncontrolling interests (21) (368) Ending balance $ 11,636  $ 59,884

v3.24.1.1.u2

Equity (Tables)	3 Months Ended
	Mar. 31, 2024
Equity [Abstract]
Schedule of Nonvested RSAs and RSUs	A summary of the status of our nonvested RSAs and RSUs as of March 31, 2024 and December 31, 2023, and the changes for the three months ended March 31, 2024 is presented below: Number of  Nonvested RSAs Weighted Average Grant Date Fair Value - RSAs Number of  Nonvested RSUs Weighted Average Grant Date Fair Value - RSUs Balance — December 31, 2023 147,044  $ 35.99  228,081  $ 32.43  Granted 972,222  $ 13.12  477,008  $ 14.57  Vested (1,051) $ 37.16  —  $ —  Forfeited —  $ —  (725) $ 37.16  Balance — March 31, 2024 1,118,215  $ 16.11  704,364  $ 20.33

v3.24.1.1.u2

Fair Value Measurements (Tables)	3 Months Ended
	Mar. 31, 2024
Fair Value Disclosures [Abstract]
Assets and Liabilities Measured at Fair Value on Recurring Basis	The table below presents our assets and liabilities measured at fair value on a recurring basis as of March 31, 2024, aggregated by the level in the fair value hierarchy within which those measurements fall (in thousands): Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Total Assets: Derivative financial instruments $ —  $ 5,491  $ —  $ 5,491  Total assets at fair value $ —  $ 5,491  $ —  $ 5,491  The table below presents our assets and liabilities measured at fair value on a recurring basis as of December 31, 2023, aggregated by the level in the fair value hierarchy within which those measurements fall (in thousands): Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Total Assets: Derivative financial instrument $ —  $ 1,463  $ —  $ 1,463  Total assets at fair value $ —  $ 1,463  $ —  $ 1,463  Liabilities: Derivative financial instruments $ —  $ 2,389  $ —  $ 2,389  Total liabilities at fair value $ —  $ 2,389  $ —  $ 2,389
Fair Value, by Balance Sheet Grouping	The carrying amounts and estimated fair values of such financial instruments as of March 31, 2024 and December 31, 2023 were as follows (in thousands): March 31, 2024 December 31, 2023   Carrying Amount(1) Fair Value Carrying Amount(1) Fair Value Financial Assets: Debt security investment $ 87,984  $ 93,323  $ 86,935  $ 93,304  Financial Liabilities: Mortgage loans payable $ 1,228,435  $ 1,090,173  $ 1,302,396  $ 1,185,260  Lines of credit and term loan $ 754,101  $ 759,966  $ 1,220,137  $ 1,225,890  ___________ (1)Carrying amount is net of any discount/premium and unamortized deferred financing costs.

v3.24.1.1.u2

Leases (Tables)	3 Months Ended
	Mar. 31, 2024
Leases [Abstract]
Schedule of Lease Payments to be Received	As of March 31, 2024, the following table sets forth the undiscounted cash flows for future minimum base rents due under operating leases for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31 and thereafter for properties that we wholly own (in thousands): Year Amount 2024 $ 101,827  2025 127,211  2026 117,487  2027 111,745  2028 100,456  Thereafter 486,642  Total $ 1,045,368
Schedule of Lease Costs	The components of lease costs were as follows (in thousands): Three Months Ended March 31, Lease Cost Classification 2024 2023 Operating lease cost(1) Property operating expenses, rental expenses or general and administrative expenses $ 10,776  $ 11,923  Finance lease cost: Amortization of leased assets Depreciation and amortization 561  303  Interest on lease liabilities Interest expense 157  91  Sublease income Resident fees and services revenue or other income (144) (156) Total lease cost $ 11,350  $ 12,161  ___________ (1)Includes short-term leases and variable lease costs, which are immaterial. Additional information related to our leases for the periods presented below was as follows (dollars in thousands): Lease Term and Discount Rate March 31, 2024 December 31, 2023 Weighted average remaining lease term (in years): Operating leases 12.1 12.2 Finance leases 1.2 1.5 Weighted average discount rate: Operating leases 5.77  % 5.76  % Finance leases 7.79  % 7.78  % Three Months Ended March 31, Supplemental Disclosure of Cash Flows Information 2024 2023 Operating cash outflows related to finance leases $ 157  $ 91  Financing cash outflows related to finance leases $ 11  $ 16  Right-of-use assets obtained in exchange for operating lease liabilities $ —  $ 1,155
Schedule of Operating Lease Liabilities	As of March 31, 2024, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31 and thereafter, as well as the reconciliation of those cash flows to operating lease liabilities on our accompanying condensed consolidated balance sheet (in thousands): Year Amount 2024 $ 26,936  2025 35,153  2026 35,074  2027 35,617  2028 35,707  Thereafter 166,314  Total undiscounted operating lease payments 334,801  Less: interest 115,034  Present value of operating lease liabilities $ 219,767
Schedule of Finance Lease Liabilities	As of March 31, 2024, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for the remaining nine months ending December 31, 2024 and for each of the next four years ending December 31 and thereafter, as well as a reconciliation of those cash flows to finance lease liabilities (in thousands): Year Amount 2024 $ 63  2025 31  2026 —  2027 —  2028 —  Thereafter —  Total undiscounted finance lease payments 94  Less: interest 5  Present value of finance lease liabilities $ 89

v3.24.1.1.u2

Segment Reporting (Tables)	3 Months Ended
	Mar. 31, 2024
Segment Reporting [Abstract]
Summary Information by Reportable Segment	Summary information for the reportable segments during the three months ended March 31, 2024 and 2023 was as follows (in thousands): Integrated Senior Health Campuses SHOP OM Triple-Net Leased Properties Three Months Ended March 31, 2024 Revenues: Resident fees and services $ 393,122  $ 58,996  $ —  $ —  $ 452,118  Real estate revenue —  —  34,067  13,348  47,415  Total revenues 393,122  58,996  34,067  13,348  499,533  Expenses: Property operating expenses 351,142  52,487  —  —  403,629  Rental expenses —  —  13,089  638  13,727  Segment net operating income $ 41,980  $ 6,509  $ 20,978  $ 12,710  $ 82,177  Expenses: General and administrative $ 11,828  Business acquisition expenses 2,782  Depreciation and amortization 42,767  Other income (expense): Interest expense: Interest expense (including amortization of deferred financing costs, debt discount/premium, and loss on debt extinguishments) (36,438) Gain in fair value of derivative financial instruments 6,417  Gain on dispositions of real estate investments, net 2,263  Loss from unconsolidated entities (1,205) Foreign currency loss (426) Other income 1,863  Total net other expense (27,526) Loss before income taxes (2,726) Income tax expense (278) Net loss $ (3,004) Integrated Senior Health Campuses SHOP OM Triple-Net Leased Properties Three Months Ended March 31, 2023 Revenues: Resident fees and services $ 361,770  $ 46,860  $ —  $ —  $ 408,630  Real estate revenue —  —  37,483  6,113  43,596  Total revenues 361,770  46,860  37,483  6,113  452,226  Expenses: Property operating expenses 328,361  41,785  —  —  370,146  Rental expenses —  —  14,408  787  15,195  Segment net operating income $ 33,409  $ 5,075  $ 23,075  $ 5,326  $ 66,885  Expenses: General and administrative $ 13,053  Business acquisition expenses 332  Depreciation and amortization 44,670  Other income (expense): Interest expense: Interest expense (including amortization of deferred financing costs and debt discount/premium) (39,011) Loss in fair value of derivative financial instruments (195) Loss on dispositions of real estate investments, net (132) Loss from unconsolidated entities (306) Gain on re-measurement of previously held equity interest 726  Foreign currency gain 1,008  Other income 1,608  Total net other expense (36,302) Loss before income taxes (27,472) Income tax expense (143) Net loss $ (27,615)
Assets by Reportable Segment	Total assets by reportable segment as of March 31, 2024 and December 31, 2023 were as follows (in thousands): March 31, 2024 December 31, 2023 Integrated senior health campuses $ 2,241,792  $ 2,197,762  OM 1,213,664  1,232,310  SHOP 716,923  630,373  Triple-net leased properties 499,824  502,836  Other 31,227  14,652  Total assets $ 4,703,430  $ 4,577,933
Revenues and Real Estate Investments by Geographical Areas	The following is a summary of geographic information for our operations for the periods presented (in thousands): Three Months Ended March 31,   2024 2023 Revenues: United States $ 497,646  $ 451,092  International 1,887  1,134  $ 499,533  $ 452,226  The following is a summary of real estate investments, net by geographic regions as of March 31, 2024 and December 31, 2023 (in thousands):   March 31, 2024 December 31, 2023 Real estate investments, net: United States $ 3,436,208  $ 3,382,115  International 42,565  43,323  $ 3,478,773  $ 3,425,438

v3.24.1.1.u2

Organization and Description of Business (Details)					3 Months Ended	121 Months Ended	135 Months Ended
	Mar. 31, 2024 ft² campus shares	Feb. 09, 2024 USD ($) shares	Dec. 31, 2023 shares	Sep. 30, 2023 segment	Mar. 31, 2024 ft² segment campus shares	Mar. 31, 2024 USD ($) ft² campus shares	Mar. 31, 2024 USD ($) ft² campus shares
Schedule of Capitalization, Equity [Line Items]
Number of reportable segments | segment				6	4
Number Of Buildings And Integrated Senior Health Campuses Owned And/Or Operated | campus	318				318	318	318
GLA (Sq Ft) | ft²	19,451,000				19,451,000	19,451,000	19,451,000
Acquisition aggregate cost of acquired properties purchase price, net of dispositions | $							$ 4,566,829,000
Acquisition aggregated cost of acquired real estate related investment purchase price | $							$ 60,429,000
General Partnership
Schedule of Capitalization, Equity [Line Items]
Percentage of ownership in operating partnership	97.40%		95.00%
NewCo Sellers
Schedule of Capitalization, Equity [Line Items]
Percentage of limited partnership interest	2.60%		5.00%
Common Stock
Schedule of Capitalization, Equity [Line Items]
Common stock, shares issued (in shares) | shares	65,372,222		0		65,372,222	65,372,222	65,372,222
Common Stock
Schedule of Capitalization, Equity [Line Items]
Common stock, shares issued (in shares) | shares		64,400,000
Proceeds from Issuance or Sale of Equity | $		$ 772,800,000
Common Stock | Over-Allotment Option
Schedule of Capitalization, Equity [Line Items]
Common stock, shares issued (in shares) | shares		8,400,000
Class T Common Stock and Class I Common Stock
Schedule of Capitalization, Equity [Line Items]
Common stock, shares issued (in shares) | shares	65,445,557				65,445,557	65,445,557	65,445,557
Proceeds from Issuance or Sale of Equity | $						$ 2,737,716,000

v3.24.1.1.u2

Summary of Significant Accounting Policies (Details)				3 Months Ended
	Mar. 31, 2024 USD ($)	Jan. 25, 2024 USD ($) facility	Dec. 31, 2023 USD ($)	Mar. 31, 2024 USD ($)	Mar. 31, 2023 USD ($) campus
Accounting Policies [Line Items]
Payroll related costs to the managers of our SHOP and integrated senior health campuses	$ 46,931,000		$ 42,698,000	$ 46,931,000
Number of Buildings				2	0
Contract Sales Price				$ 11,136,000
Gain (loss) on dispositions of real estate investments, net				2,263,000	$ (132,000)
Insurance reserves	44,691,000		44,548,000	44,691,000
Accrued property taxes	24,374,000		23,549,000	24,374,000
Distributions declared but not paid to common stockholders	$ 32,900,000		$ 16,557,000	$ 32,900,000	$ 16,554,000
SHOP
Accounting Policies [Line Items]
Number of Buildings | facility		1
Contract Sales Price		$ 4,500,000
Gain (loss) on dispositions of real estate investments, net		$ 645,000
General Partnership
Accounting Policies [Line Items]
Percentage of ownership in operating partnership	97.40%		95.00%
NewCo Sellers
Accounting Policies [Line Items]
Percentage of limited partnership interest	2.60%		5.00%

v3.24.1.1.u2

Summary of Significant Accounting Policies - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Disaggregation of Revenue [Line Items]
Resident fees and services	$ 452,118	$ 408,630
SHOP
Disaggregation of Revenue [Line Items]
Resident fees and services	58,996	46,860
Integrated senior health campuses
Disaggregation of Revenue [Line Items]
Resident fees and services	393,122	361,770
Resident Fees and Services [Member]
Disaggregation of Revenue [Line Items]
Resident fees and services	452,118	408,630
Resident Fees and Services [Member] | Over Time [Member]
Disaggregation of Revenue [Line Items]
Resident fees and services	382,137	344,463
Resident Fees and Services [Member] | Point in Time [Member]
Disaggregation of Revenue [Line Items]
Resident fees and services	69,981	64,167
Resident Fees and Services [Member] | Private and Other Payors [Member]
Disaggregation of Revenue [Line Items]
Resident fees and services	235,498	213,528
Resident Fees and Services [Member] | Medicare [Member]
Disaggregation of Revenue [Line Items]
Resident fees and services	121,592	126,777
Resident Fees and Services [Member] | Medicaid [Member]
Disaggregation of Revenue [Line Items]
Resident fees and services	95,028	68,325
Resident Fees and Services [Member] | SHOP
Disaggregation of Revenue [Line Items]
Resident fees and services	58,996	46,860
Resident Fees and Services [Member] | SHOP | Over Time [Member]
Disaggregation of Revenue [Line Items]
Resident fees and services	57,620	45,613
Resident Fees and Services [Member] | SHOP | Point in Time [Member]
Disaggregation of Revenue [Line Items]
Resident fees and services	1,376	1,247
Resident Fees and Services [Member] | SHOP | Private and Other Payors [Member]
Disaggregation of Revenue [Line Items]
Resident fees and services	51,176	43,850
Resident Fees and Services [Member] | SHOP | Medicare [Member]
Disaggregation of Revenue [Line Items]
Resident fees and services	1,243	311
Resident Fees and Services [Member] | SHOP | Medicaid [Member]
Disaggregation of Revenue [Line Items]
Resident fees and services	6,577	2,699
Resident Fees and Services [Member] | Integrated senior health campuses
Disaggregation of Revenue [Line Items]
Resident fees and services	393,122	361,770
Resident Fees and Services [Member] | Integrated senior health campuses | Over Time [Member]
Disaggregation of Revenue [Line Items]
Resident fees and services	324,517	298,850
Resident Fees and Services [Member] | Integrated senior health campuses | Point in Time [Member]
Disaggregation of Revenue [Line Items]
Resident fees and services	68,605	62,920
Resident Fees and Services [Member] | Integrated senior health campuses | Private and Other Payors [Member]
Disaggregation of Revenue [Line Items]
Resident fees and services	184,322	169,678
Resident Fees and Services [Member] | Integrated senior health campuses | Medicare [Member]
Disaggregation of Revenue [Line Items]
Resident fees and services	120,349	126,466
Resident Fees and Services [Member] | Integrated senior health campuses | Medicaid [Member]
Disaggregation of Revenue [Line Items]
Resident fees and services	$ 88,451	$ 65,626

v3.24.1.1.u2

Summary of Significant Accounting Policies - Accounts Receivable and Deferred Revenue (Details) - Resident Fees and Services [Member] - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Dec. 31, 2023
Accounts Receivable, Net - Resident Fees and Services
Accounts Receivable, Net - Resident Fees and Services	$ 176,387	$ 148,277
Increase	28,110
Deferred Revenue - Resident fees and Services
Deferred Revenue	22,590	23,372
Decrease	(782)
Private and Other Payors [Member]
Accounts Receivable, Net - Resident Fees and Services
Accounts Receivable, Net - Resident Fees and Services	73,716	66,218
Increase	7,498
Medicare [Member]
Accounts Receivable, Net - Resident Fees and Services
Accounts Receivable, Net - Resident Fees and Services	71,142	51,260
Increase	19,882
Medicaid [Member]
Accounts Receivable, Net - Resident Fees and Services
Accounts Receivable, Net - Resident Fees and Services	31,529	$ 30,799
Increase	$ 730

v3.24.1.1.u2

Summary of Significant Accounting Policies - Allowance for Credit Loss (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 17,037	$ 14,071
Additional allowances	6,603	4,037
Write-offs	(3,258)	(1,890)
Recoveries collected or adjustments	(1,856)	(1,827)
Ending balance	$ 18,526	$ 14,391

v3.24.1.1.u2

Real Estate Investments, Net and Business Combinations - Investments in Consolidated Properties (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Real Estate Properties [Line Items]
Real estate investment, at cost	$ 4,261,338	$ 4,177,595
Less: accumulated depreciation	(782,565)	(752,157)
Real estate investments, net	3,478,773	3,425,438
Building, improvements and construction in process
Real Estate Properties [Line Items]
Real estate investment, at cost	3,666,999	3,604,299
Land and Land Improvements
Real Estate Properties [Line Items]
Real estate investment, at cost	349,061	335,946
Furniture, fixtures and equipment
Real Estate Properties [Line Items]
Real estate investment, at cost	$ 245,278	$ 237,350

v3.24.1.1.u2

Real Estate Investments, Net and Business Combinations - Additional Information (Details)			3 Months Ended
	Jan. 25, 2024 USD ($) facility	Feb. 15, 2023 USD ($)	Mar. 31, 2024 USD ($) campus	Mar. 31, 2023 USD ($) campus	Feb. 01, 2024 USD ($) facility	Feb. 14, 2023
Real Estate Properties [Line Items]
Depreciation			$ 37,135,000	$ 35,899,000
Number of real estate investments disposed of			2	0
Gain (loss) on dispositions of real estate investments, net			$ 2,263,000	$ (132,000)
Gain on re-measurement of previously held equity interest			$ 0	726,000
Senior Housing Facility
Real Estate Properties [Line Items]
Number of Housing Facilities Acquired | facility					14
Total liabilities assumed					$ 94,461,000
Acquisition-related costs					$ 3,112,000
Memory Care Partners, LLC
Real Estate Properties [Line Items]
Equity interest in acquiree, percentage		60.00%				40.00%
Total purchase consideration		$ 900,000
Percentage of interests acquired		100.00%
Gain on re-measurement of previously held equity interest				$ 726,000
OM
Real Estate Properties [Line Items]
Number of real estate investments disposed of | campus			2
Gain (loss) on dispositions of real estate investments, net			$ 1,618,000
SHOP
Real Estate Properties [Line Items]
Number of real estate investments disposed of | facility	1
Gain (loss) on dispositions of real estate investments, net	$ 645,000

v3.24.1.1.u2

Real Estate Investments, Net and Business Combinations - Summary of Capital Expenditures (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2024 USD ($) campus
Real Estate Properties [Line Items]
Capital expenditures incurred	$ 13,637
Integrated senior health campuses
Real Estate Properties [Line Items]
Capital expenditures incurred	5,766
Development costs	$ 18,969
Number Of Properties Developed | campus	1
OM
Real Estate Properties [Line Items]
Capital expenditures incurred	$ 4,934
SHOP
Real Estate Properties [Line Items]
Capital expenditures incurred	2,937
Triple-net leased properties
Real Estate Properties [Line Items]
Capital expenditures incurred	$ 0

v3.24.1.1.u2

Real Estate Investments, Net and Business Combinations - Schedule of Dispositions of Real Estate (Details)	3 Months Ended
	Mar. 31, 2024 USD ($)	Mar. 31, 2023 campus
Real Estate Properties [Line Items]
Number of Buildings	2	0
Contract Sales Price	$ 11,136,000
Marietta, GA
Real Estate Properties [Line Items]
Number of Buildings	1
Contract Sales Price	$ 6,674,000
Homewood, AL
Real Estate Properties [Line Items]
Number of Buildings	1
Contract Sales Price	$ 4,462,000

v3.24.1.1.u2

Real Estate Investments, Net and Business Combinations - Schedule of Asset Acquisitions (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023	Mar. 31, 2023
Business Acquisitions [Line Items]
Goodwill	$ 234,942	$ 234,942
Debt discount	15,972	$ 14,371
2023 Acquisitions
Business Acquisitions [Line Items]
Building and improvements			$ 0
Land			0
In-place leases			0
Goodwill			3,331
Furniture, fixtures and equipment			39
Cash and restricted cash			565
Accounts receivable, net			0
Other assets			66
Total assets acquired			4,001
Mortgage loans payable (including debt discount of $2,989)			0
Accounts payable and accrued liabilities			(1,676)
Financing obligations			(12)
Security deposits and other liabilities			(812)
Total liabilities assumed			(2,500)
Net assets acquired			$ 1,501
2024 Acquisitions
Business Acquisitions [Line Items]
Building and improvements	64,350
Land	14,210
In-place leases	12,912
Goodwill	0
Furniture, fixtures and equipment	0
Cash and restricted cash	0
Accounts receivable, net	343
Other assets	9
Total assets acquired	91,824
Mortgage loans payable (including debt discount of $2,989)	(91,472)
Accounts payable and accrued liabilities	(352)
Financing obligations	0
Security deposits and other liabilities	0
Total liabilities assumed	(91,824)
Net assets acquired	0
Debt discount	$ 2,989

v3.24.1.1.u2

Debt Security Investment, Net - Additional Information (Details) $ in Thousands		3 Months Ended
	Dec. 31, 2023 USD ($)	Mar. 31, 2024 USD ($)	Mar. 31, 2023 USD ($)	Feb. 01, 2024 facility	Oct. 15, 2015 USD ($)
Debt Security Investment, Net
Debt security investment, net	$ 86,935	$ 87,984
Held-to-Maturity, debt securities, unamortized closing costs	$ 489	413
Accretion on debt security		1,125	$ 1,020
Amortization of closing costs		$ 76	$ 65
Senior Housing Facility
Debt Security Investment, Net
Number of Housing Facilities Acquired | facility				14
Debt security investment [Member]
Debt Security Investment, Net
Stated interest rate					4.24%
Stated amount after maturity					$ 93,433
Yield to maturity interest rate					10.00%
Beneficial ownership interest in mortgage trust					10.00%

v3.24.1.1.u2

Intangibles - Intangible Assets and Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Finite-Lived Intangible Assets [Line Items]
Identified intangible assets, net	$ 187,814	$ 180,470
Identified intangible liabilities, net	5,805	$ 6,095
Finite-Lived Intangible Assets, Net
Amortized intangible assets	$ 67,609
Weighted average remaining life	6 years 8 months 12 days	7 years 9 months 18 days
Below-Market Lease [Member]
Finite-Lived Intangible Assets [Line Items]
Identified intangible liabilities, net	$ 5,805	$ 6,095
Finite-Lived Intangible Liabilities, Net
Intangible liabilities accumulated amortization	$ 2,950	$ 2,831
Weighted average remaining life	7 years	7 years 2 months 12 days
Certificates Of Need [Member]
Unamortized intangible assets
Unamortized intangible assets	$ 99,938	$ 99,777
Trade Names [Member]
Unamortized intangible assets
Unamortized intangible assets	20,267	20,267
In-Place Leases [Member]
Finite-Lived Intangible Assets, Net
Amortized intangible assets	50,552	42,615
Intangible assets accumulated amortization	$ 37,431	$ 35,437
Weighted average remaining life	6 years 2 months 12 days	7 years 8 months 12 days
Above-Market Leases [Member]
Finite-Lived Intangible Assets, Net
Amortized intangible assets	$ 15,189	$ 15,905
Intangible assets accumulated amortization	$ 7,462	$ 7,079
Weighted average remaining life	7 years 4 months 24 days	7 years 6 months
Customer Relationships [Member]
Finite-Lived Intangible Assets, Net
Amortized intangible assets	$ 1,868	$ 1,906
Intangible assets accumulated amortization	$ 972	$ 934
Weighted average remaining life	12 years 4 months 24 days	12 years 8 months 12 days

v3.24.1.1.u2

Intangibles - Additional Information (Details) - USD ($) $ in Thousands		3 Months Ended
	Mar. 01, 2023	Mar. 31, 2024	Mar. 31, 2023
Finite-Lived Intangible Assets [Line Items]
Amortization expense		$ 5,713	$ 17,071
Below-Market Lease [Member]
Finite-Lived Intangible Assets [Line Items]
Amortization expense		290	408
Above-Market Leases [Member]
Finite-Lived Intangible Assets [Line Items]
Amortization expense		$ 716	$ 9,083
Write-Off Of Amortization Of Intangible Assets	$ 8,073
In-Place Leases [Member]
Finite-Lived Intangible Assets [Line Items]
Write-Off Of Amortization Of Intangible Assets	$ 885

v3.24.1.1.u2

Intangibles - Summary of Amortization Expense on Identified Intangible Assets and Liabilities, Net (Details) $ in Thousands	Mar. 31, 2024 USD ($)
Finite-Lived Intangible Assets, Net
2024	$ 18,094
2025	9,522
2026	7,727
2027	7,203
2028	6,150
Thereafter	18,913
Finite-lived intangible assets, net	67,609
Finite-Lived Intangible Liabilities, Net
2024	(782)
2025	(956)
2026	(840)
2027	(825)
2028	(709)
Thereafter	(1,693)
Finite-lived intangible liabilities, net	$ (5,805)

v3.24.1.1.u2

Other Assets, Net - Other Assets, Net (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2024	Dec. 31, 2023
Other Assets [Abstract]
Deferred rent receivables	$ 48,541	$ 47,540
Prepaid expenses, deposits, other assets and deferred tax assets, net	32,729	33,204
Inventory — finished goods	20,741	19,472
Investments in unconsolidated entities	19,411	20,611
Lease commissions, net of accumulated amortization of $7,500 and $7,231 as of March 31, 2024 and December 31, 2023, respectively	17,442	17,565
Derivative financial instruments	5,491	1,463
Deferred financing costs, net of accumulated amortization of $7,117 and $8,494 as of March 31, 2024 and December 31, 2023, respectively	5,207	3,830
Lease inducement, net of accumulated amortization of $2,632 and $2,544 as of March 31, 2024 and December 31, 2023, respectively (with a weighted average remaining life of 6.7 years and 6.9 years as of March 31, 2024 and December 31, 2023, respectively)	2,368	2,456
Other assets, net	151,930	146,141
Accumulated amortization of lease commissions	7,500	7,231
Accumulated amortization of deferred financing costs	7,117	8,494
Accumulated amortization of lease inducement	$ 2,632	$ 2,544
Lease inducement, weighted average remaining life	6 years 8 months 12 days	6 years 10 months 24 days

v3.24.1.1.u2

Other Assets, Net - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Debt Instrument:
Amortization of deferred lease inducement	$ 88	$ 88
Loss on extinguishments of debt	1,280	$ 0
2022 Corporate Line of Credit | Line of Credit
Debt Instrument:
Loss on extinguishments of debt	$ 565

v3.24.1.1.u2

Mortgage Loans Payable, Net - Mortgage Loans Payable (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2024 USD ($) MortgageLoan		Mar. 31, 2023 USD ($)	Dec. 31, 2023 USD ($) MortgageLoan
Debt Instrument:
Total debt	$ 1,255,120			$ 1,326,313
Add: premium	151			167
Less: discount	$ (15,972)			$ (14,371)
Number of fixed-rate mortgage loans payable | MortgageLoan	90			76
Number of variable-rate mortgage loans payable | MortgageLoan	5			13
Change in Carrying Amount of Mortgage Loans Payable [Roll Forward]
Beginning balance	$ 1,302,396	[1]	$ 1,229,847
Additions:
Borrowings under mortgage loans payable	15,535		7,700
Assumption of mortgage loans payable due to acquisition of real estate investments, net	91,472		0
Amortization of deferred financing costs	780		577
Amortization of discount/premium on mortgage loans payable, net	1,374		885
Deductions:
Scheduled principal payments on mortgage loans payable	(5,045)		(5,122)
Early payoff of mortgage loans payable	(176,145)		0
Deferred financing costs	(1,932)		(142)
Ending balance	1,228,435	[1]	$ 1,233,745
Fixed-Rate Debt
Debt Instrument:
Total debt	1,082,865			$ 990,325
Variable-Rate Debt
Debt Instrument:
Total debt	172,255			335,988
Mortgage Loans Payable, Net
Debt Instrument:
Deferred financing costs, net	$ (10,864)			$ (9,713)
[1] Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of March 31, 2024 and December 31, 2023. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2024 Credit Facility, as defined in Note 8, held by American Healthcare REIT Holdings, LP in the amount of $550,000 as of March 31, 2024 and the 2022 Credit Facility, as defined in Note 8, held by American Healthcare REIT Holdings, LP in the amount of $914,900 as of December 31, 2023, which were guaranteed by American Healthcare REIT, Inc.

v3.24.1.1.u2

Mortgage Loans Payable, Net - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Mortgage Loans Payable, Net [Line Items]
Loss on extinguishment of debt	$ 1,280	$ 0
Early payoff of mortgage payable	176,145	$ 0
Secured Debt [Member]
Mortgage Loans Payable, Net [Line Items]
Loss on extinguishment of debt	$ 715
Mortgage Loans Payable, Net
Mortgage Loans Payable, Net [Line Items]
Debt, weighted average interest rate	4.27%		4.72%
Minimum
Mortgage Loans Payable, Net [Line Items]
Debt, effective interest rate	2.21%		2.21%
Maximum
Mortgage Loans Payable, Net [Line Items]
Debt, effective interest rate	8.18%		8.46%

v3.24.1.1.u2

Mortgage Loans Payable - Principal Payments Due on Mortgage Loans Payable (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Mortgage Loans Payable, Net [Abstract]
2024	$ 177,717
2025	168,275
2026	158,331
2027	55,125
2028	105,126
Thereafter	590,546
Total debt	$ 1,255,120	$ 1,326,313

v3.24.1.1.u2

Lines of Credit and Term Loan (Details)		Feb. 14, 2024 USD ($) Extension	Dec. 20, 2022 USD ($)	Mar. 31, 2024 USD ($)	Dec. 31, 2023 USD ($)	Jan. 19, 2022 USD ($)
Line of Credit Facility [Line Items]
Lines of credit and term loan	[1]			$ 759,308,000	$ 1,223,967,000
Minimum | Commitment Utilization Scenario 1
Line of Credit Facility [Line Items]
Commitment Utilization Percentage		0.25%
Minimum | Commitment Utilization Scenario 2
Line of Credit Facility [Line Items]
Commitment Utilization Percentage		0.20%
Maximum | Commitment Utilization Scenario 1
Line of Credit Facility [Line Items]
Commitment Utilization Percentage		50.00%
Maximum | Commitment Utilization Scenario 2
Line of Credit Facility [Line Items]
Commitment Utilization Percentage		50.00%
2019 Trilogy Credit Facility | Line of Credit | Secured Overnight Financing Rate (SOFR)
Line of Credit Facility [Line Items]
Variable rate			2.75%
2019 Trilogy Credit Facility | Line of Credit | Base Rate [Member]
Line of Credit Facility [Line Items]
Variable rate			1.75%
2019 Trilogy Credit Facility | Line of Credit | Federal Funds Effective Rate [Member]
Line of Credit Facility [Line Items]
Variable rate			0.50%
2019 Trilogy Credit Facility | Line of Credit | One-Month SOFR
Line of Credit Facility [Line Items]
Variable rate			1.00%
2019 Trilogy Credit Facility | Revolving Credit Facility
Line of Credit Facility [Line Items]
Line of credit facility, maximum borrowing capacity			$ 400,000,000
Increase to maximum borrowing capacity			100,000,000
Potential maximum borrowing capacity			500,000,000
Current borrowing capacity				400,000,000	400,000,000
Lines of credit and term loan				$ 210,000,000	$ 309,823,000
Debt, weighted average interest rate				8.17%	8.20%
2022 Credit Agreement | Line of Credit
Line of Credit Facility [Line Items]
Line of credit facility, maximum borrowing capacity						$ 1,050,000,000
2022 Credit Agreement | Line of Credit
Line of Credit Facility [Line Items]
Lines of credit and term loan					$ 914,900,000
Debt, weighted average interest rate					7.08%
2022 Credit Agreement | Senior Unsecured Term Loan Facility
Line of Credit Facility [Line Items]
Line of credit facility, maximum borrowing capacity						550,000,000
2022 Credit Agreement | Senior Unsecured Revolving Credit Facility
Line of Credit Facility [Line Items]
Line of credit facility, maximum borrowing capacity						$ 500,000,000
2024 Credit Agreement
Line of Credit Facility [Line Items]
Line of Credit Facility, Number of Business Days		5 days
2024 Credit Agreement | Line of Credit
Line of Credit Facility [Line Items]
Line of credit facility, maximum borrowing capacity		$ 1,150,000,000
Increase to maximum borrowing capacity		600,000,000
Current borrowing capacity		1,150,000,000
Lines of credit and term loan				$ 550,000,000
2024 Credit Agreement | Revolving Credit Facility
Line of Credit Facility [Line Items]
Debt, weighted average interest rate				6.66%
2024 Credit Agreement | Standby Letters of Credit [Member]
Line of Credit Facility [Line Items]
Line of credit facility, maximum borrowing capacity		25,000,000
2024 Credit Agreement | Senior Unsecured Term Loan Facility
Line of Credit Facility [Line Items]
Line of credit facility, maximum borrowing capacity		$ 550,000,000
Long-term Debt				$ 549,308,000
Line Of Credit Facility, Number Of Potential Extensions | Extension		0
Line Of Credit Facility, Potential Extension Term		0 months
2024 Credit Agreement | Senior Unsecured Revolving Credit Facility
Line of Credit Facility [Line Items]
Line of credit facility, maximum borrowing capacity		$ 600,000,000
Line Of Credit Facility, Number Of Potential Extensions | Extension		1
Line Of Credit Facility, Potential Extension Term		12 months
Real Estate Assets and Ancillary Business Cash Flow [Member] | 2019 Trilogy Credit Facility | Revolving Credit Facility
Line of Credit Facility [Line Items]
Line of credit facility, maximum borrowing capacity			365,000,000
Eligible Accounts Receivable [Member] | 2019 Trilogy Credit Facility | Revolving Credit Facility
Line of Credit Facility [Line Items]
Line of credit facility, maximum borrowing capacity			$ 35,000,000
[1] Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of March 31, 2024 and December 31, 2023. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2024 Credit Facility, as defined in Note 8, held by American Healthcare REIT Holdings, LP in the amount of $550,000 as of March 31, 2024 and the 2022 Credit Facility, as defined in Note 8, held by American Healthcare REIT Holdings, LP in the amount of $914,900 as of December 31, 2023, which were guaranteed by American Healthcare REIT, Inc.

v3.24.1.1.u2

Derivative Financial Instruments (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Dec. 31, 2023
Fair Value, Recurring [Member]
Derivative [Line Items]
Derivative financial instruments	$ 5,491	$ 1,463
Total assets at fair value	5,491	1,463
Derivative financial instruments		2,389
Total liabilities at fair value		2,389
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Fair Value, Recurring [Member]
Derivative [Line Items]
Derivative financial instruments	0	0
Total assets at fair value	0	0
Derivative financial instruments		0
Total liabilities at fair value		0
Significant Other Observable Inputs (Level 2) [Member] | Fair Value, Recurring [Member]
Derivative [Line Items]
Derivative financial instruments	5,491	1,463
Total assets at fair value	5,491	1,463
Derivative financial instruments		2,389
Total liabilities at fair value		2,389
Significant Unobservable Inputs (Level 3) [Member] | Fair Value, Recurring [Member]
Derivative [Line Items]
Derivative financial instruments	0	0
Total assets at fair value	0	0
Derivative financial instruments		0
Total liabilities at fair value		0
Not Designated as Hedging Instrument
Derivative [Line Items]
Notional  Amount	750,000
Fair Value	$ 5,491	(926)
Not Designated as Hedging Instrument | Swap, 3.74% Interest Rate
Derivative [Line Items]
Instrument	Swap
Notional  Amount	$ 275,000
Index	One Month Term SOFR
Interest Rate	3.74%
Maturity Date	Jan. 19, 2026
Fair Value	$ 3,868	1,463
Not Designated as Hedging Instrument | Swap 4.41% Interest Rate
Derivative [Line Items]
Instrument	Swap
Notional  Amount	$ 275,000
Index	One Month Term SOFR
Interest Rate	4.41%
Maturity Date	Jan. 19, 2026
Fair Value	$ 642	(2,178)
Not Designated as Hedging Instrument | Swap 4.40% Interest Rate
Derivative [Line Items]
Instrument	Swap
Notional  Amount	$ 200,000
Index	One Month Term SOFR
Interest Rate	4.40%
Maturity Date	Jun. 05, 2025
Fair Value	$ 981	$ (211)

v3.24.1.1.u2

Derivative Financial Instruments - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Derivative [Line Items]
Increase (decease) to interest expense	$ (6,417)	$ 195
Not Designated as Hedging Instrument
Derivative [Line Items]
Fair Value	$ 5,491		$ (926)

v3.24.1.1.u2

Redeemable Noncontrolling Interests (Details) - USD ($) $ in Thousands			1 Months Ended		3 Months Ended
	Mar. 31, 2024	Dec. 31, 2023	Apr. 30, 2024	Jan. 31, 2024	Mar. 31, 2024	Mar. 31, 2023
Redeemable Noncontrolling Interests [Line Items]
Ownership interest with redemption features outstanding	1.00%	1.00%
Payments for Repurchase of Redeemable Noncontrolling Interest					$ 0	$ 15,870
Changes in the carrying amount of redeemable noncontrolling interests [Roll Forward]
Beginning balance			$ 11,636	$ 33,843	33,843	81,598
Reclassification from equity					21	21
Reclassification to equity					(15,303)	0
Distributions					(3)	(454)
Redemption of redeemable noncontrolling interests					0	(15,870)
Adjustment to redemption value					(6,901)	(5,043)
Net income (loss) attributable to redeemable noncontrolling interest					(21)	(368)
Ending balance	$ 11,636	$ 33,843			$ 11,636	59,884
Trilogy REIT Holdings, LLC [Member]
Redeemable Noncontrolling Interests [Line Items]
Joint venture ownership interest	76.00%	76.00%			76.00%
Trilogy Investors, LLC
Redeemable Noncontrolling Interests [Line Items]
Ownership percentage equity interest	99.30%	97.50%			99.30%
Proceeds From Redeemable Noncontrolling Interest				$ 25,312		$ 15,870
Trilogy Investors, LLC | Subsequent Event
Redeemable Noncontrolling Interests [Line Items]
Proceeds From Redeemable Noncontrolling Interest			$ 10,771
General Partnership
Redeemable Noncontrolling Interests [Line Items]
Percentage of ownership in operating partnership	97.40%	95.00%
Trilogy Investors, LLC
Redeemable Noncontrolling Interests [Line Items]
Noncontrolling interest, ownership percentage by noncontrolling owners	0.70%	2.50%			0.70%
NewCo Sellers
Redeemable Noncontrolling Interests [Line Items]
Percentage of limited partnership interest	2.60%	5.00%
Meridan
Redeemable Noncontrolling Interests [Line Items]
Joint Venture Acquired, Percent	98.00%	98.00%

v3.24.1.1.u2

Equity (Details) $ / shares in Units, $ in Thousands								1 Months Ended		3 Months Ended		9 Months Ended	121 Months Ended
	Jan. 01, 2025 USD ($)	Mar. 31, 2024 $ / shares shares	Feb. 09, 2024 USD ($) $ / shares shares	Feb. 06, 2024 USD ($)	Dec. 31, 2023 $ / shares shares	Nov. 03, 2023 $ / shares	Dec. 01, 2015	Feb. 29, 2024 shares	Feb. 05, 2024	Mar. 31, 2024 USD ($) $ / shares shares	Mar. 31, 2023 USD ($) $ / shares shares	Dec. 31, 2024 USD ($)	Mar. 31, 2024 $ / shares shares	Aug. 05, 2024	Jun. 15, 2023 shares
Class of Stock [Line Items]
Number of shares of preferred stock, authorized to be issued		200,000,000			200,000,000					200,000,000			200,000,000
Par value of preferred stock, authorized to be issued (in dollars per share) | $ / shares		$ 0.01			$ 0.01					$ 0.01			$ 0.01
Preferred stock, shares issued (in shares)		0			0					0			0
Preferred stock, shares outstanding (in shares)		0			0					0			0
Number of shares of common stock, authorized to be issued		1,000,000,000			1,000,000,000					1,000,000,000			1,000,000,000
Par value of common stock to be offered and sold to the public | $ / shares			$ 0.01
Sale of Stock, Consideration Received on Transaction | $			$ 724,625
Repayments of Long-Term Debt | $			176,145
Repayments of Lines of Credit | $			$ 545,010							$ 612,323	$ 82,100
Repurchase of common stock | $										$ 14	$ 78
Stock acquired average cost per share | $ / shares											$ 37.16
Ownership interest with redemption features outstanding		1.00%			1.00%
Operating Partnership Units Outstanding Presented in Total Equity, Percent		2.60%								2.60%			2.60%
Trilogy Joint Venture [Member]
Class of Stock [Line Items]
Joint venture ownership interest		76.00%			76.00%					76.00%			76.00%
Over-Allotment Option
Class of Stock [Line Items]
Sale of Stock, Number of Shares Issued in Transaction			8,400,000
Forecast [Member]
Class of Stock [Line Items]
Common stock, conversion ratio														1
Share Repurchase Plan
Class of Stock [Line Items]
Stock repurchased during the period (in shares)										0	1,681
Repurchase of common stock | $											$ 62
Common Stock
Class of Stock [Line Items]
Number of shares of common stock, authorized to be issued		700,000,000			0					700,000,000			700,000,000
Par value of common stock to be offered and sold to the public | $ / shares		$ 0.01								$ 0.01			$ 0.01
Common stock, shares issued (in shares)		65,372,222			0					65,372,222			65,372,222
Common Stock | Two Thousand Fifteen Incentive Plan
Class of Stock [Line Items]
Share-based compensation arrangement by share-based payment award, number of shares authorized															4,000,000
Common Class I
Class of Stock [Line Items]
Number of shares of common stock, authorized to be issued		100,000,000			800,000,000					100,000,000			100,000,000
Par value of common stock to be offered and sold to the public | $ / shares		$ 0.01			$ 0.01					$ 0.01			$ 0.01
Common stock, shares issued (in shares)		46,673,320			46,673,320					46,673,320			46,673,320
Common Class T
Class of Stock [Line Items]
Number of shares of common stock, authorized to be issued		200,000,000			200,000,000					200,000,000			200,000,000
Par value of common stock to be offered and sold to the public | $ / shares		$ 0.01			$ 0.01					$ 0.01			$ 0.01
Common stock, shares issued (in shares)		19,552,425			19,552,856					19,552,425			19,552,425
Class T Common Stock
Class of Stock [Line Items]
Par value of common stock to be offered and sold to the public | $ / shares					$ 0.01
Series A Preferred Stock
Class of Stock [Line Items]
Par value of preferred stock, authorized to be issued (in dollars per share) | $ / shares						$ 0.01
Preferred shares, dividend rate						4.75%
Liquidation preference for preferred stock (in dollars per share) | $ / shares		$ 25.00								$ 25.00			$ 25.00
Restricted Stock
Class of Stock [Line Items]
Granted (in shares)										972,222
Restricted Stock | Two Thousand Fifteen Incentive Plan
Class of Stock [Line Items]
Granted (in shares)								972,222					1,287,681
Stock based compensation | $										$ 1,914	1,051
Restricted Stock | Two Thousand Fifteen Incentive Plan | Maximum
Class of Stock [Line Items]
Award vesting period										4 years
Restricted Stock Units (RSUs)
Class of Stock [Line Items]
Granted (in shares)										477,008
Restricted Stock Units (RSUs) | Two Thousand Fifteen Incentive Plan | Maximum
Class of Stock [Line Items]
Award vesting period										3 years
Performance Based Unit | Two Thousand Fifteen Incentive Plan
Class of Stock [Line Items]
Granted (in shares)													320,780
Time Based Unit | Two Thousand Fifteen Incentive Plan
Class of Stock [Line Items]
Granted (in shares)													408,033
Common Stock
Class of Stock [Line Items]
Common stock, shares issued (in shares)			64,400,000
Proceeds from Issuance or Sale of Equity | $			$ 772,800
Common Stock | Over-Allotment Option
Class of Stock [Line Items]
Common stock, shares issued (in shares)			8,400,000
Lakeview IN Medical Plaza
Class of Stock [Line Items]
Joint venture ownership interest					86.00%
Joint Venture Ownership Interest				100.00%
Purchase price for additional interest in subsidiary | $				$ 441
Membership interest percentage purchased				14.00%
Trilogy Joint Venture [Member] | Profits Interests [Member]
Class of Stock [Line Items]
Award vesting percentage							20.00%
Award vesting period							5 years
Stock based compensation | $										$ 21	$ 21
Lakeview IN Medical Plaza | Lakeview IN Medical Plaza
Class of Stock [Line Items]
Percentage of ownership in operating partnership									14.00%		14.00%
NorthStar Healthcare Income, Inc. | Trilogy Joint Venture [Member]
Class of Stock [Line Items]
Joint venture ownership interest		24.00%			24.00%					24.00%	24.00%		24.00%
General Partnership
Class of Stock [Line Items]
Percentage of ownership in operating partnership		97.40%			95.00%
NewCo Sellers
Class of Stock [Line Items]
Percentage of limited partnership interest		2.60%			5.00%
Trilogy Joint Venture [Member]
Class of Stock [Line Items]
Ownership percentage in subsidiary		100.00%								100.00%			100.00%
Trilogy Joint Venture [Member] | NHI
Class of Stock [Line Items]
Noncontrolling interest, ownership percentage by noncontrolling owners						24.00%
Trilogy Joint Venture [Member] | Forecast [Member]
Class of Stock [Line Items]
Purchase price for additional interest in subsidiary | $	$ 260,000											$ 247,000
Trilogy Joint Venture [Member] | Minimum | Forecast [Member]
Class of Stock [Line Items]
Purchase price for additional interest in subsidiary | $	$ 26,000											$ 24,700
Trilogy Investors, LLC
Class of Stock [Line Items]
Noncontrolling interest, ownership percentage by noncontrolling owners		0.70%			2.50%					0.70%			0.70%
Ownership percentage in subsidiary						100.00%

v3.24.1.1.u2

Equity - RSAs and RSUs (Details)	3 Months Ended
	Mar. 31, 2024 $ / shares shares
Restricted Stock
Equity - Status and Changes of Nonvested Shares of Restricted Common Stock [Roll Forward]
Number of Nonvested Units, beginning balance (in shares) | shares	147,044
Granted (in shares) | shares	972,222
Vested (in shares) | shares	(1,051)
Forfeited (in shares) | shares	0
Number of Nonvested Units, ending balance (in shares) | shares	1,118,215
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Nonvested, Weighted Average Grant Date Fair Value [Abstract]
Nonvested, Weighted Average Grant Date Fair Value, beginning balance (in usd per share) | $ / shares	$ 35.99
Granted (in usd per share) | $ / shares	13.12
Vested (in usd per share) | $ / shares	37.16
Forfeited (in usd per share) | $ / shares	0
Nonvested, Weighted Average Grant Date Fair Value, ending balance (in usd per share) | $ / shares	$ 16.11
Restricted Stock Units (RSUs)
Equity - Status and Changes of Nonvested Shares of Restricted Common Stock [Roll Forward]
Number of Nonvested Units, beginning balance (in shares) | shares	228,081
Granted (in shares) | shares	477,008
Vested (in shares) | shares	0
Forfeited (in shares) | shares	(725)
Number of Nonvested Units, ending balance (in shares) | shares	704,364
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Nonvested, Weighted Average Grant Date Fair Value [Abstract]
Nonvested, Weighted Average Grant Date Fair Value, beginning balance (in usd per share) | $ / shares	$ 32.43
Granted (in usd per share) | $ / shares	14.57
Vested (in usd per share) | $ / shares	0
Forfeited (in usd per share) | $ / shares	37.16
Nonvested, Weighted Average Grant Date Fair Value, ending balance (in usd per share) | $ / shares	$ 20.33

v3.24.1.1.u2

Fair Value Measurements - Assets and Liabilities Measured at Fair Value on Recurring Basis (Details) - Fair Value, Recurring [Member] - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Assets:
Derivative financial instruments	$ 5,491	$ 1,463
Total assets at fair value	5,491	1,463
Liabilities:
Derivative financial instruments		2,389
Total liabilities at fair value		2,389
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member]
Assets:
Derivative financial instruments	0	0
Total assets at fair value	0	0
Liabilities:
Derivative financial instruments		0
Total liabilities at fair value		0
Significant Other Observable Inputs (Level 2) [Member]
Assets:
Derivative financial instruments	5,491	1,463
Total assets at fair value	5,491	1,463
Liabilities:
Derivative financial instruments		2,389
Total liabilities at fair value		2,389
Significant Unobservable Inputs (Level 3) [Member]
Assets:
Derivative financial instruments	0	0
Total assets at fair value	$ 0	0
Liabilities:
Derivative financial instruments		0
Total liabilities at fair value		$ 0

v3.24.1.1.u2

Fair Value Measurements Fair Value by Balance Sheet Grouping (Details) - USD ($) $ in Thousands	Mar. 31, 2024		Dec. 31, 2023		Mar. 31, 2023	Dec. 31, 2022
Financial Assets:
Debt security investment, net	$ 87,984		$ 86,935
Debt security investment, fair value	93,323		93,304
Financial Liabilities:
Mortgage loans payable, net	1,228,435	[1]	1,302,396	[1]	$ 1,233,745	$ 1,229,847
Mortgage loans payable, net fair value	1,090,173		1,185,260
Lines of credit and term loan, net	754,101		1,220,137
Lines of credit and term loan, net fair value	$ 759,966		$ 1,225,890
[1] Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of March 31, 2024 and December 31, 2023. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2024 Credit Facility, as defined in Note 8, held by American Healthcare REIT Holdings, LP in the amount of $550,000 as of March 31, 2024 and the 2022 Credit Facility, as defined in Note 8, held by American Healthcare REIT Holdings, LP in the amount of $914,900 as of December 31, 2023, which were guaranteed by American Healthcare REIT, Inc.

v3.24.1.1.u2

Leases - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Lessee, Lease, Description [Line Items]
Operating lease revenue	$ 46,008	$ 42,303
Variable lease payments	$ 9,659	$ 10,040

v3.24.1.1.u2

Leases - Lessor, Future Minimum Rents Due (Details) $ in Thousands	Mar. 31, 2024 USD ($)
Future Minimum Rent [Abstract]
2024	$ 101,827
2025	127,211
2026	117,487
2027	111,745
2028	100,456
Thereafter	486,642
Total	$ 1,045,368

v3.24.1.1.u2

Leases - Components of Lease Cost (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Leases [Abstract]
Operating lease cost	$ 10,776	$ 11,923
Amortization of leased assets	561	303
Interest on lease liabilities	157	91
Sublease income	(144)	(156)
Total lease cost	$ 11,350	$ 12,161

v3.24.1.1.u2

Leases - Lease Term and Discount Rate (Details)	Mar. 31, 2024	Dec. 31, 2023
Leases [Abstract]
Operating leases, weighted average remaining lease term	12 years 1 month 6 days	12 years 2 months 12 days
Finance leases, weighted average remaining lease term	1 year 2 months 12 days	1 year 6 months
Operating leases, weighted average discount rate	5.77%	5.76%
Finance leases, weighted average discount rate	7.79%	7.78%

v3.24.1.1.u2

Leases - Supplemental Disclosure of Cash Flows Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Leases [Abstract]
Operating cash outflows related to finance leases	$ 157	$ 91
Financing cash outflows related to finance leases	11	16
Right-of-use assets obtained in exchange for operating lease liabilities	$ 0	$ 1,155

v3.24.1.1.u2

Leases - Future Minimum Rent Payments, Operating Leases (Details) - USD ($) $ in Thousands		Mar. 31, 2024	Dec. 31, 2023
Lessee, Operating Lease, Description [Abstract]
2024		$ 26,936
2025		35,153
2026		35,074
2027		35,617
2028		35,707
Thereafter		166,314
Total undiscounted operating lease payments		334,801
Less: interest		115,034
Present value of operating lease liabilities	[1]	$ 219,767	$ 225,502
[1] Such liabilities of American Healthcare REIT, Inc. represented liabilities of American Healthcare REIT Holdings, LP or its consolidated subsidiaries as of March 31, 2024 and December 31, 2023. American Healthcare REIT Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of American Healthcare REIT, Inc. The creditors of American Healthcare REIT Holdings, LP or its consolidated subsidiaries do not have recourse against American Healthcare REIT, Inc., except for the 2024 Credit Facility, as defined in Note 8, held by American Healthcare REIT Holdings, LP in the amount of $550,000 as of March 31, 2024 and the 2022 Credit Facility, as defined in Note 8, held by American Healthcare REIT Holdings, LP in the amount of $914,900 as of December 31, 2023, which were guaranteed by American Healthcare REIT, Inc.

v3.24.1.1.u2

Leases - Future Minimum Rent Payments, Finance Leases (Details) $ in Thousands	Mar. 31, 2024 USD ($)
Lessee, Finance Lease, Description [Abstract]
2024	$ 63
2025	31
2026	0
2027	0
2028	0
Thereafter	0
Total undiscounted finance lease payments	94
Less: interest	5
Present value of finance lease liabilities	$ 89

v3.24.1.1.u2

Segment Reporting - Summary Information for Reportable Segments (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Revenues:
Resident fees and services	$ 452,118	$ 408,630
Real estate revenue	47,415	43,596
Total revenues	499,533	452,226
Expenses:
Property operating expenses	403,629	370,146
Rental expenses	13,727	15,195
Segment net operating income (loss)	82,177	66,885
Operating Expenses
General and administrative	11,828	13,053
Business acquisition expenses	2,782	332
Depreciation and amortization	42,767	44,670
Other income (expense):
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishments)	(36,438)	(39,011)
Gain (loss) in fair value of derivative financial instruments	6,417	(195)
Gain (loss) on dispositions of real estate investments, net	2,263	(132)
Loss from unconsolidated entities	(1,205)	(306)
Gain on re-measurement of previously held equity interest	0	726
Foreign currency (loss) gain	(426)	1,008
Other income	1,863	1,608
Total net other expense	(27,526)	(36,302)
Loss before income taxes	(2,726)	(27,472)
Income tax expense	(278)	(143)
Net loss	(3,004)	(27,615)
Assets by Reportable Segment
Total assets	4,703,430		$ 4,577,933
Segments, Geographical Areas
Real estate investments, net	3,478,773		3,425,438
United States [Member]
Revenues:
Total revenues	497,646	451,092
Segments, Geographical Areas
Real estate investments, net	3,436,208		3,382,115
International [Member]
Revenues:
Total revenues	1,887	1,134
Segments, Geographical Areas
Real estate investments, net	42,565		43,323
Integrated senior health campuses
Revenues:
Resident fees and services	393,122	361,770
Real estate revenue	0	0
Total revenues	393,122	361,770
Expenses:
Property operating expenses	351,142	328,361
Rental expenses	0	0
Segment net operating income (loss)	41,980	33,409
Assets by Reportable Segment
Total assets	2,241,792		2,197,762
SHOP
Revenues:
Resident fees and services	58,996	46,860
Real estate revenue	0	0
Total revenues	58,996	46,860
Expenses:
Property operating expenses	52,487	41,785
Rental expenses	0	0
Segment net operating income (loss)	6,509	5,075
Assets by Reportable Segment
Total assets	716,923		630,373
OM
Revenues:
Resident fees and services	0	0
Real estate revenue	34,067	37,483
Total revenues	34,067	37,483
Expenses:
Property operating expenses	0	0
Rental expenses	13,089	14,408
Segment net operating income (loss)	20,978	23,075
Assets by Reportable Segment
Total assets	1,213,664		1,232,310
Triple-net leased properties
Revenues:
Resident fees and services	0	0
Real estate revenue	13,348	6,113
Total revenues	13,348	6,113
Expenses:
Property operating expenses	0	0
Rental expenses	638	787
Segment net operating income (loss)	12,710	$ 5,326
Assets by Reportable Segment
Total assets	499,824		502,836
Other
Assets by Reportable Segment
Total assets	$ 31,227		$ 14,652

v3.24.1.1.u2

Segment Reporting - Narrative (Details) $ in Thousands		3 Months Ended
	Sep. 30, 2023 segment	Mar. 31, 2024 USD ($) segment	Dec. 31, 2023 USD ($)
Segment Reporting [Abstract]
Number of reportable segments | segment	6	4
Goodwill [Line Items]
Goodwill		$ 234,942	$ 234,942
Triple-net leased properties
Goodwill [Line Items]
Goodwill		18,953	18,953
Integrated senior health campuses
Goodwill [Line Items]
Goodwill		168,177	168,177
OM
Goodwill [Line Items]
Goodwill		$ 47,812	$ 47,812

v3.24.1.1.u2

Concentration of Credit Risk - Additional Information (Details)	Mar. 31, 2024 tenant State
Concentration of Credit Risk
Number of states that generated at least 10% of annualized base rent | State	2
Minimum percent share of each state annualized base rent that company owned	10.00%
Number Of Tenants With More Than Ten Percent Of Annual Base Rent | tenant	0
Minimum percent share of annualized base rent accounted by tenants	10.00%
Integrated senior health campuses
Concentration of Credit Risk
Percentage of annual base rent	46.70%
OM
Concentration of Credit Risk
Percentage of annual base rent	29.10%
SHOP
Concentration of Credit Risk
Percentage of annual base rent	12.40%
Triple-net leased properties
Concentration of Credit Risk
Percentage of annual base rent	11.80%
Indiana
Concentration of Credit Risk
Percentage of annual base rent	33.20%
Ohio
Concentration of Credit Risk
Percentage of annual base rent	13.90%

v3.24.1.1.u2

Per Share Data (Details) - USD ($) $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Anti-dilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Participating securities, distributed and undistributed earnings (loss), basic	$ 1,095	$ 926
Restricted Common Stock [Member]
Anti-dilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities excluded from computation of earnings per share	1,118,215	184,145
Redeemable Limited Partnership Units
Anti-dilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities excluded from computation of earnings per share	3,501,976	3,501,976
Restricted Stock Units (RSUs) | Performance Based Unit
Anti-dilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities excluded from computation of earnings per share	309,256		70,751
Restricted Stock Units (RSUs) | Time Based Unit
Anti-dilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities excluded from computation of earnings per share	395,108	19,200

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