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Real Estate and Other Activities (Tables)
 12 Months Ended
Dec. 31, 2024
Real Estate [Abstract]  
Net Assets Acquired

For the years ended December 31, 2024, 2023, and 2022, we acquired or invested in the following net assets (in thousands):

 

 

2024

 

 

2023

 

 

2022

 

Land and land improvements

 

$

—

 

 

$

28,916

 

 

$

135,301

 

Buildings

 

 

—

 

 

 

114,966

 

 

 

487,698

 

Intangible lease assets — subject to amortization
   (weighted-average useful life of 24.8 years in 2023
    and 21.3 years in 2022)

 

 

—

 

 

 

16,305

 

 

 

45,394

 

Mortgage loans

 

 

—

 

 

 

—

 

 

 

159,735

 

Investments in unconsolidated real estate joint ventures

 

 

107,908

 

 

 

—

 

 

 

399,456

 

Investments in unconsolidated operating entities

 

 

—

 

 

 

50,000

 

 

 

131,105

 

Other loans

 

 

—

 

 

 

25,000

 

 

 

—

 

Liabilities assumed

 

 

(2,290

)

 

 

—

 

 

 

(25,727

)

 

$

105,618

 

 

$

235,187

 

 

$

1,332,962

 

Loans repaid(1)

 

 

—

 

 

 

(22,900

)

 

 

—

 

Total net assets acquired

 

$

105,618

 

 

$

212,287

 

 

$

1,332,962

 

 

(1)
The 2023 column includes a $23 million mortgage loan that was converted to fee simple ownership of one property as described under the Lifepoint Transaction below.
Summary of Status on Current Development and Capital Addition Projects

See table below for a status summary of our current development and capital addition projects (in thousands):

 

Property

 

Commitment

 

 

Costs
Paid as of
December 31, 2024

 

 

Cost Remaining

 

Lifepoint Behavioral (Arizona)

 

$

10,504

 

 

$

5,411

 

 

$

5,093

 

Lifepoint Behavioral (Kansas)

 

 

20,183

 

 

 

11,584

 

 

 

8,599

 

Surgery Partners (Idaho)

 

 

15,993

 

 

 

5,590

 

 

 

10,403

 

Lifepoint Behavioral (Arizona)

 

 

10,659

 

 

 

470

 

 

 

10,189

 

IMED Hospitales (Spain)

 

 

49,749

 

 

 

21,355

 

 

 

28,394

 

IMED Hospitales (Spain)

 

 

36,294

 

 

 

29,261

 

 

 

7,033

 

Other (Various)

 

 

799

 

 

 

494

 

 

 

305

 

 

$

144,181

 

 

$

74,165

 

 

$

70,016

 
Summary of Operating Results from Properties

The following represents the operating results from properties sold for 2024 and properties designated as held for sale at December 31, 2024 (in thousands):

 

 

 

For the Year Ended December 31,

 

 

 

2024

 

 

2023

 

 

2022

 

Revenues(1)

 

$

72,362

 

 

$

88,938

 

 

$

220,183

 

Real estate depreciation and amortization(2)

 

 

(26,476

)

 

 

(331,099

)

 

 

(53,350

)

Property-related expenses

 

 

(8,277

)

 

 

(4,697

)

 

 

(1,759

)

Real estate impairment charges(3)

 

 

(129,159

)

 

 

—

 

 

 

—

 

Other (expense) income(4)

 

 

480,416

 

 

 

(90

)

 

 

(19

)

(Loss) income from real estate dispositions, net

 

$

388,866

 

 

$

(246,948

)

 

$

165,055

 
(1)
The 2023 column includes an approximate $95 million write-off of straight-line rent receivables related to the hospital operations of the five Utah facilities that were acquired by CommonSpirit on May 1, 2023.
(2)
The 2023 column includes approximately $286 million of lease intangible amortization acceleration related to the hospital operations of the five Utah facilities that were acquired by CommonSpirit on May 1, 2023.
(3)
Includes the charge associated with the three Space Coast facilities in the third quarter of 2024 due to the global settlement reached with Steward and its lenders.
(4)
The 2024 column includes approximately $24 million of gains (net of approximately $16 million write-off of straight line receivables) related to the UCHealth disposal and $65 million of gains (net of approximately $20 million write-off of straight-line rent receivables) related to the Dignity disposal. In addition, the 2024 column includes $360 million of gains (net of approximately $20 million write-off of straight-line rent receivables) related to the Utah Transaction and $23 million of gains (net of $30 million write-off of straight-line rent receivables) related to the sale of five Prime properties.
Amortization Expense from Existing Lease Intangible Assets

We recorded amortization expense related to intangible lease assets of $205.6 million (including $170 million for accelerating the amortization of the in-place lease intangibles associated with two master leases, including the Steward master lease that was terminated effective September 11, 2024), $332.5 million (including $286 million for accelerating the amortization of the in-place lease intangibles related to re-leasing the Utah properties to CommonSpirit as described in this same Note 3), and $55.9 million in 2024, 2023, and 2022, respectively, and expect to recognize amortization expense from existing lease intangible assets as follows (amounts in thousands):

 

For the Year Ended December 31:

 

 

 

2025

 

$

29,201

 

2026

 

 

29,052

 

2027

 

 

28,730

 

2028

 

 

28,566

 

2029

 

 

26,726

 
Summary of Total Future Contractual Minimum Lease Payments to be Received

The following table summarizes total future contractual minimum lease payments, excluding operating expense reimbursements, tenant recoveries, and other lease/loan-related adjustments to revenue (i.e., straight-line rents, deferred revenues, or reserves/write-offs), from tenants under noncancelable leases as of December 31, 2024 (amounts in thousands):

 

 

 

Total Under
Operating Leases

 

 

Total Under
Financing Leases

 

 

Total

 

2025

 

$

721,305

 

 

$

118,855

 

 

$

840,160

 

2026

 

 

810,002

 

 

 

121,289

 

 

 

931,291

 

2027

 

 

856,426

 

 

 

123,772

 

 

 

980,198

 

2028

 

 

868,390

 

 

 

126,304

 

 

 

994,694

 

2029

 

 

869,681

 

 

 

128,887

 

 

 

998,568

 

Thereafter

 

 

20,744,147

 

 

 

3,075,567

 

 

 

23,819,714

 

 

$

24,869,951

 

 

$

3,694,674

 

 

$

28,564,625

 
Components of Total Investment in Financing Leases The components of our total investment in financing leases consisted of the following (in thousands):

 

 

 

As of December 31, 2024

 

 

As of December 31, 2023

 

Minimum lease payments receivable

 

$

591,142

 

 

$

611,669

 

Estimated unguaranteed residual values

 

 

203,818

 

 

 

203,818

 

Less: Unearned income and allowance for credit loss

 

 

(547,770

)

 

 

(571,059

)

Net investment in direct financing leases

 

 

247,190

 

 

 

244,428

 

Other financing leases (net of allowance for credit loss)

 

 

810,580

 

 

 

987,202

 

Total investment in financing leases

 

$

1,057,770

 

 

$

1,231,630

 

 
Schedule of Real Estate and Other Impairment Charges, Net

Due to the events discussed above, we recorded various impairment charges during 2024 and 2023, which included the following (in millions):

 

 

For the Years Ended December 31,

 

 

 

Description

 

2024

 

 

2023

 

 

Income Statement
Classification

Reserve for unpaid rent and interest and straight-line
   rent receivables

 

$

—

 

 

$

413

 

 

Total revenues

Working capital and other loans(1)

 

 

787

 

 

 

—

 

 

Real estate and other
impairment charges, net

Investment in Massachusetts partnership(2)

 

 

445

 

 

 

30

 

 

(Loss) earnings from
equity interests

Real estate(2)

 

 

277

 

 

 

100

 

 

Real estate and other
impairment charges, net

Equity investment and other(1)

 

 

54

 

 

 

171

 

 

Real estate and other
impairment charges, net

Total

 

$

1,563

 

 

$

714

 

 

 
(1)
For our non-real estate investments in Steward, we compared our carrying value of all such investments to the fair value of the underlying collateral, which was no value after the global settlement and our release of claims against Steward as discussed above.
(2)
The three Space Coast properties and certain excess properties previously leased to Steward were deemed held for sale in the 2024 third quarter. We recognized a real estate impairment charge of approximately $180 million to adjust our net book value to align with fair value less cost to sell based on expected proceeds, including from a binding agreement for the Space Coast properties. For the other real estate held for use, we made a comparison of the projected undiscounted future cash flows with the net book value of each asset. For those properties where the carrying value was deemed not recoverable, we recorded an impairment charge to reduce the carrying value to its estimated fair value. For the real estate in the Massachusetts partnership, there was no fair value as we transitioned those properties to the mortgage lender to satisfy the mortgage debt. For the remaining properties (less than 10 in total in 2024 and 2023), we, along with assistance from a third-party, independent valuation firm, estimated fair value using a combination of cost, market, and income approaches using Level 3 inputs. The cost approach used comparable sales to value the land and cost manuals to value the improvements. The value derived from the market approach was based on sale prices of similar properties. For the income approach, we divided the expected operating income (rent revenue less expenses, if any) from the property by a market capitalization rate (range from 8% to 10%).
Summary of Investments in Unconsolidated Operating Entities

The following is a summary of our investments in unconsolidated real estate joint ventures by operator (amounts in thousands):

 

Operator

 

Ownership Percentage

 

As of December 31, 2024

 

 

As of December 31, 2023

 

Swiss Medical Network

 

70%

 

$

483,770

 

 

$

472,434

 

MEDIAN

 

50%

 

 

431,964

 

 

 

471,336

 

CommonSpirit (Utah partnership)

 

25%

 

 

113,202

 

 

 

—

 

Policlinico di Monza

 

50%

 

 

77,592

 

 

 

80,562

 

HM Hospitales

 

45%

 

 

49,869

 

 

 

56,071

 

Steward (Macquarie partnership)

 

50%

 

 

—

 

 

 

394,052

 

Total

 

 

 

$

1,156,397

 

 

$

1,474,455

 

The following is a summary of our investments in unconsolidated operating entities (amounts in thousands):

 

Operator

 

As of December 31,
2024

 

 

As of December 31,
2023

 

Swiss Medical Network

 

$

172,453

 

 

$

186,113

 

PHP Holdings

 

 

149,027

 

 

 

699,535

 

Aevis Victoria SA ("Aevis")

 

 

63,409

 

 

 

77,345

 

Priory

 

 

38,739

 

 

 

163,837

 

Aspris Children's Services ("Aspris")

 

 

15,950

 

 

 

15,986

 

Steward (loan investment)

 

 

—

 

 

 

361,591

 

International joint venture

 

 

—

 

 

 

225,960

 

Steward (equity investment)

 

 

—

 

 

 

35,696

 

Lifepoint Behavioral

 

 

—

 

 

 

11,429

 

Caremax

 

 

—

 

 

 

1,148

 

Total

 

$

439,578

 

 

$

1,778,640

 
Schedule of Concentrations of Credit Risk See below for our concentration details (dollars in thousands):

Total Assets by Operator

 

 

 

As of December 31, 2024

 

 

As of December 31, 2023

 

Operators

 

Total Assets (1)

 

 

Percentage of
Total Assets

 

 

Total Assets (1)

 

 

Percentage of
Total Assets

 

Circle

 

$

2,026,778

 

 

 

14.2

%

 

$

2,119,392

 

 

 

11.6

%

Priory

 

 

1,233,462

 

 

 

8.6

%

 

 

1,391,005

 

 

 

7.6

%

Healthcare Systems of America

 

 

1,187,006

 

 

 

8.3

%

 

 

—

 

 

 

—

 

Lifepoint Behavioral

 

 

813,584

 

 

 

5.7

%

 

 

813,527

 

 

 

4.4

%

Swiss Medical Network

 

 

719,632

 

 

 

5.1

%

 

 

735,891

 

 

 

4.0

%

Steward

 

 

—

 

 

 

—

 

 

 

3,518,537

 

 

 

19.2

%

Other operators

 

 

6,624,256

 

 

 

46.3

%

 

 

7,709,095

 

 

 

42.2

%

Other assets

 

 

1,689,876

 

(2)

 

11.8

%

 

 

2,017,397

 

(2)

 

11.0

%

Total

 

$

14,294,594

 

 

 

100.0

%

 

$

18,304,844

 

 

 

100.0

%
(1)
Total assets by operator are generally comprised of real estate assets, mortgage loans, investments in unconsolidated real estate joint ventures, investments in unconsolidated operating entities, and other loans.
(2)
Includes our investment in PHP Holdings of approximately $150 million and $700 million as of December 31, 2024 and 2023, respectively — see Prospect Transaction and tenant update described previously in this same Note 3 for more information.

Total Assets by U.S. State and Country (1)

 

 

 

As of December 31, 2024

 

 

As of December 31, 2023

 

U.S. States and Other Countries

 

Total Assets

 

 

Percentage of
Total Assets

 

 

Total Assets

 

 

Percentage of
Total Assets

 

Texas

 

$

1,394,296

 

 

 

9.8

%

 

$

1,891,482

 

 

 

10.3

%

California

 

 

935,470

 

 

 

6.4

%

 

 

1,252,674

 

 

 

6.8

%

Florida

 

 

840,876

 

 

 

5.9

%

 

 

1,348,210

 

 

 

7.4

%

Arizona

 

 

379,801

 

 

 

2.7

%

 

 

547,789

 

 

 

3.0

%

Ohio

 

 

327,577

 

 

 

2.3

%

 

 

349,140

 

 

 

1.9

%

All other states

 

 

2,636,587

 

 

 

18.5

%

 

 

4,385,814

 

 

 

24.0

%

Other domestic assets

 

 

951,486

 

 

 

6.6

%

 

 

1,397,170

 

 

 

7.6

%

Total U.S.

 

$

7,466,093

 

 

 

52.2

%

 

$

11,172,279

 

 

 

61.0

%

United Kingdom

 

$

3,985,672

 

 

 

27.9

%

 

$

4,261,944

 

 

 

23.3

%

Switzerland

 

 

719,632

 

 

 

5.0

%

 

 

735,891

 

 

 

4.0

%

Germany

 

 

672,343

 

 

 

4.7

%

 

 

734,630

 

 

 

4.0

%

Spain

 

 

247,996

 

 

 

1.7

%

 

 

252,529

 

 

 

1.4

%

Finland

 

 

199,721

 

 

 

1.4

%

 

 

218,322

 

 

 

1.2

%

All other countries

 

 

264,747

 

 

 

1.9

%

 

 

309,022

 

 

 

1.7

%

Other international assets

 

 

738,390

 

 

 

5.2

%

 

 

620,227

 

 

 

3.4

%

Total international

 

$

6,828,501

 

 

 

47.8

%

 

$

7,132,565

 

 

 

39.0

%

Grand total

 

$

14,294,594

 

 

 

100.0

%

 

$

18,304,844

 

 

 

100.0

%

 

Total Assets by Facility Type (1)

 

 

 

As of December 31, 2024

 

 

As of December 31, 2023

 

Facility Types

 

Total Assets

 

 

Percentage of
Total Assets

 

 

Total Assets

 

 

Percentage of
Total Assets

 

General acute care hospitals

 

$

8,493,331

 

 

 

59.4

%

 

$

11,764,151

 

 

 

64.3

%

Behavioral health facilities

 

 

2,376,460

 

 

 

16.7

%

 

 

2,576,983

 

 

 

14.1

%

Post acute care facilities

 

 

1,617,596

 

 

 

11.3

%

 

 

1,716,248

 

 

 

9.4

%

Freestanding ER/urgent care facilities

 

 

117,331

 

 

 

0.8

%

 

 

230,065

 

 

 

1.2

%

Other assets

 

 

1,689,876

 

 

 

11.8

%

 

 

2,017,397

 

 

 

11.0

%

Total

 

$

14,294,594

 

 

 

100.0

%

 

$

18,304,844

 

 

 

100.0

%
(1)
For geographic and facility type concentration metrics in the tables above, we allocate our investments in unconsolidated operating entities pro rata based on the gross book value of the real estate. Such pro rata allocations are subject to change from period to period.

On a revenue basis, concentration for the year ended December 31, 2024 as compared to the two prior years is as follows:

The following shows those tenants that represented 10% or more of our total revenues by year (in thousands):

 

2024

 

Operator

 

Total Revenues

 

 

Percentage of
Total Revenues

 

Circle

 

$

205,582

 

 

 

20.7

%

Priory

 

 

101,675

 

 

 

10.2

%

 

2023

 

Operator

 

Total Revenues

 

 

Percentage of
Total Revenues

 

Circle

 

$

194,390

 

 

 

22.3

%

Priory

 

 

107,557

 

 

 

12.3

%

 

2022

 

Operator

 

Total Revenues

 

 

Percentage of
Total Revenues

 

Steward

 

$

427,912

 

 

 

27.7

%

Circle

 

 

189,565

 

 

 

12.3

%

Prospect

 

 

169,335

 

 

 

11.0

%
Total Revenues by Geographic Location

 

 

 

For the Years Ended December 31,

 

 

 

2024

 

 

2023

 

 

2022

 

Geographic Location

 

Total Revenues

 

 

Percentage of
Total Revenues

 

 

Total Revenues

 

 

Percentage of
Total Revenues

 

 

Total Revenues

 

 

Percentage of
Total Revenues

 

Total U.S.

 

$

561,673

 

 

 

56.4

%

 

$

407,329

 

 

 

46.7

%

 

$

1,096,465

 

 

 

71.1

%

United Kingdom

 

 

359,991

 

 

 

36.2

%

 

 

352,594

 

 

 

40.4

%

 

 

317,013

 

 

 

20.5

%

All other countries

 

 

73,883

 

 

 

7.4

%

 

 

111,876

 

 

 

12.9

%

 

 

129,373

 

 

 

8.4

%

Grand total

 

$

995,547

 

 

 

100.0

%

 

$

871,799

 

 

 

100.0

%

 

$

1,542,851

 

 

 

100.0

%

 

 

Total Revenues by Facility Type

 

 

 

For the Years Ended December 31,

 

 

 

2024

 

 

2023

 

 

2022

 

Facility Types

 

Total Revenues

 

 

Percentage of
Total Revenues

 

 

Total Revenues

 

 

Percentage of
Total Revenues

 

 

Total Revenues

 

 

Percentage of
Total Revenues

 

General acute care hospitals

 

$

628,622

 

 

 

63.1

%

 

$

541,888

 

 

 

62.2

%

 

$

1,167,233

 

 

 

75.7

%

Behavioral health facilities

 

 

209,668

 

 

 

21.1

%

 

 

213,292

 

 

 

24.5

%

 

 

204,420

 

 

 

13.2

%

Post acute care facilities

 

 

139,859

 

 

 

14.0

%

 

 

92,787

 

 

 

10.6

%

 

 

146,780

 

 

 

9.5

%

Freestanding ER/urgent care
   facilities

 

 

17,398

 

 

 

1.8

%

 

 

23,832

 

 

 

2.7

%

 

 

24,418

 

 

 

1.6

%

Total

 

$

995,547

 

 

 

100.0

%

 

$

871,799

 

 

 

100.0

%

 

$

1,542,851

 

 

 

100.0

%