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Real Estate and Lending Activities
6 Months Ended
Jun. 30, 2020
Real Estate [Abstract]  
Real Estate and Lending Activities

3. Real Estate and Lending Activities

New Investments

We acquired or invested in the following net assets (in thousands):

 

 

 

For the Six Months

Ended June 30,

 

 

 

2020

 

 

2019

 

 

 

 

 

 

 

 

 

 

Land and land improvements

 

$

265,991

 

 

$

242,682

 

Buildings

 

 

1,608,771

 

 

 

784,184

 

Intangible lease assets — subject to amortization (weighted average useful

   life 30.8 years for 2020 and 18.5 years for 2019)

 

 

231,774

 

 

 

91,050

 

Equity investments

 

 

 

 

 

284,399

 

Mortgage loans

 

 

47,641

 

 

 

 

Other assets

 

 

1,328

 

 

 

 

Other loans

 

 

205,000

 

 

 

 

Liabilities assumed

 

 

(134,203

)

 

 

 

Total

 

$

2,226,302

 

 

$

1,402,315

 

 

2020 Activity

Circle Transaction

On January 8, 2020, we acquired a portfolio of 30 acute care hospitals located throughout the United Kingdom for approximately £1.5 billion from affiliates of BMI Healthcare, Inc. (“BMI”). In a related transaction, affiliates of Circle Health Ltd. (“Circle”) entered into definitive agreements to acquire BMI and assume operations of its 52 facilities in the United Kingdom subject to customary regulatory conditions. As part of our acquisition, we inherited 30 existing leases with the operator that had initial fixed terms ending in 2050, with no renewal options but with annual inflation-based escalators. Once final regulatory approval was received in the 2020 second quarter, these 30 leases with Circle were amended (effective June 16, 2020) to include two five-year renewal options and improve the annual inflation-based escalators. These 30 leases are cross-defaulted and guaranteed by Circle.

Other Transactions

On June 24, 2020, we originated a CHF 45 million secured loan to Infracore SA (“Infracore”).

On May 13, 2020, we formed a joint venture for the purpose of investing in the operations of international hospitals. As part of the formation, we originated a $205 million acquisition loan. We have a 49% interest in this joint venture and are accounting for our investment using the fair value option election. The joint venture simultaneously purchased from Steward Health Care, Inc.

(“Steward”) the rights and existing assets related to all present and future international opportunities previously owned by Steward for strategic, regulatory, and risk management purposes.

2019 Activity

On June 10, 2019, we acquired seven community hospitals in Kansas for approximately $145.4 million. The properties are leased to an affiliate of Saint Luke’s Health System (“SLHS”) pursuant to seven individual in-place leases that had an average remaining lease term of 14 years upon our acquisition. The leases provide for fixed escalations every five years and include two five-year extension options. All seven hospitals were constructed in either 2018 or 2019, and the leases are guaranteed by SLHS.

On June 6, 2019, we acquired 11 hospitals in Australia for a purchase price of approximately AUD $1.2 billion plus stamp duties and registration fees of AUD $66.6 million. The properties are leased to Healthscope, Ltd. (“Healthscope”), pursuant to master lease agreements that had an average initial term of 20 years, upon our acquisition, with annual fixed escalations and multiple extension options. Healthscope was acquired in a simultaneous transaction by Brookfield Business Partners L.P. and certain of its institutional partners.

On May 27, 2019, we invested in a portfolio of 13 acute care campuses and two additional properties in Switzerland for an aggregate purchase price of approximately CHF 236.6 million. The investment was effected through our purchase of a stake in a Swiss healthcare real estate company, Infracore, from the previous majority shareholder, Aevis Victoria SA (“Aevis”). The facilities are leased to Swiss Medical Network, a wholly-owned Aevis subsidiary, pursuant to leases that had an average 23-year remaining term upon our acquisition and are subject to annual escalation provisions. We are accounting for our 40% interest in this joint venture under the equity method. Additionally, we purchased a 4.9% stake in Aevis for approximately CHF 47 million on June 28, 2019 that we are marking to fair value through income each quarter.

Other acquisitions throughout the first half of 2019 included two acute care hospitals and one inpatient rehabilitation hospital for an aggregate investment of approximately $80 million.

 

Development Activities

On May 15, 2020, we agreed to finance the development of and lease an inpatient rehabilitation facility in Bakersfield, California for $47.9 million. This facility will be leased to Ernest Health, Inc. (“Ernest”) and is expected to commence rent in the fourth quarter of 2021.

During the 2020 second quarter, we completed construction on one general acute care facility and one inpatient rehabilitation facility, both located in Birmingham, England. We began recognizing revenue on these two properties on June 29, 2020. These facilities are being leased to Circle pursuant to a long-term lease.

During the 2020 first quarter, we completed construction and began recording rental income on a general acute care facility located in Idaho Falls, Idaho. This facility commenced rent on January 21, 2020 and is being leased to Surgery Partners, Inc. pursuant to an existing long-term lease.

 

See table below for a status update on our current development projects (in thousands):

 

Property

 

Commitment

 

 

Costs Incurred as of

June 30, 2020

 

 

Estimated

Rent

Commencement

Date

NeuroPsychiatric Hospitals (Houston, Texas)

 

$

27,500

 

 

$

16,586

 

 

4Q 2020

Ernest (Bakersfield, California)

 

 

47,929

 

 

 

11,088

 

 

4Q 2021

 

 

$

75,429

 

 

$

27,674

 

 

 

Disposals

During the first half of 2020, we completed the disposition of five facilities and four ancillary properties for approximately $79 million. The transactions resulted in a net loss on real estate of $1.8 million.

Leasing Operations (Lessor)

We acquire and develop healthcare facilities and lease the facilities to healthcare operating companies under long-term net leases (typical initial fixed terms ranging from 10 to 20 years) and most include renewal options at the election of our tenants, generally in five year increments. More than 97% of our leases provide annual rent escalations based on increases in Consumer Price Index (or similar index outside the U.S.) and/or fixed minimum annual escalations ranging from 0.5% to 3.0%. Many of our domestic leases contain purchase options with pricing set at various terms but in no case less than our total investment. For five properties with

a carrying value of $216.3 million, our leases require a residual value guarantee from the tenant. Our leases typically require the tenant to handle and bear most of the costs associated with our properties including repairs/maintenance, property taxes, and insurance. We routinely inspect our properties to ensure the residual value of each of our assets is being maintained. Except for leases classified as financing leases, all of our leases are classified as operating leases.

At June 30, 2020, leases on 14 Ernest facilities and ten Prime Healthcare Services, Inc. (“Prime”) facilities are accounted for as direct financing leases and leases on 13 of our Prospect Medical Holdings, Inc. (“Prospect”) facilities are accounted for as a financing. The components of our total investment in financing leases consisted of the following (in thousands):

 

 

 

As of

June 30,

2020

 

 

As of

December 31,

2019

 

Minimum lease payments receivable

 

$

1,853,967

 

 

$

1,884,921

 

Estimated residual values

 

 

394,195

 

 

 

394,195

 

Less: Unearned income and allowance for credit loss

 

 

(1,584,334

)

 

 

(1,618,252

)

Net investment in direct financing leases

 

 

663,828

 

 

 

660,864

 

Other financing leases (net of allowance for credit loss)

 

 

1,414,381

 

 

 

1,399,438

 

Total investment in financing leases

 

$

2,078,209

 

 

$

2,060,302

 

 

Rent Deferrals

Due to the COVID-19 pandemic and its impact on our tenants’ business during the first six months of 2020, we agreed to defer approximately 2% of our rent. The amount of this deferral is approximately $7 million as of June 30, 2020. Pursuant to our agreements with the tenants, we expect such deferred rent to be paid over specified periods with interest. Although we expect similar deferrals for third quarter rent, all of our rent and interest is expected to be paid on time starting October 1, 2020.

Adeptus Health

Due to a decline in operating results of 20 freestanding emergency facilities and one acute care facility caused by a reduction in volumes from COVID-19 and other factors, we entered into agreements to sever the remaining leases with Adeptus Health, Inc. (“Adeptus”), despite being current on their rent obligations. As a result, we recorded an approximately $20 million net charge, primarily all of which was for the write off of straight-line rent, partially offset by approximately $9 million of proceeds received from a letter of credit in the first half of 2020. Additionally, we recorded a $9.9 million real estate impairment charge on these severed facilities in the first half of 2020. At June 30, 2020, we no longer lease any properties to Adeptus and our net book value on those properties that were previously leased to Adeptus but are currently vacant approximates less than 1% of our total assets. At June 30, 2020, we believe our investment in these real estate assets are fully recoverable, but no assurances can be given that we will not have any impairment in future periods.

Alecto Facilities

At June 30, 2020, we lease one acute care facility to Alecto Healthcare Services LLC (“Alecto”) and have a mortgage loan on a second property, representing less than 0.4% of our total assets. During the second quarter of 2020, we re-leased one acute care facility to West Virginia University and sold another facility previously leased to Alecto. In addition, we donated the Wheeling facility to a local municipality, resulting in a $9.1 million real estate impairment charge in the first quarter of 2020.

Loans

The following is a summary of our loans (net of allowance for credit loss in 2020):

 

(in thousands)

 

As of

June 30,

2020

 

 

As of

December 31,

2019

 

Mortgage loans

 

$

1,339,258

 

 

$

1,275,022

 

Acquisition loans

 

 

330,792

 

 

 

123,893

 

Other loans

 

 

461,219

 

 

 

420,939

 

Total

 

$

2,131,269

 

 

$

1,819,854

 

 

The increase in acquisition loans relates to the $205 million loan to the new joint venture described under “New Investments” in this same Note 3.

 

Other loans consist of loans to our tenants for working capital and other purposes and include our shareholder loan made to the joint venture with Primotop Holdings S.à.r.l. (“Primotop”) in the amount of €290 million.

 

Concentrations of Credit Risk

We monitor concentration risk in several ways due to the nature of our real estate assets that are vital to the communities in which they are located and given our history of being able to replace inefficient operators of our facilities, if needed, with more effective operators:

 

1)

Facility concentration – At June 30, 2020, our largest investment in any single property approximated 3% of our total assets, similar to December 31, 2019.

 

2)

Operator concentration – For the six months ended June 30, 2020, revenue from Steward, Prospect, Circle, and Prime represented 31%, 13%, 12%, and 11% of our total revenues, respectively. In comparison, Steward and Prime represented 47% and 17%, respectively, of our total revenues for the first six months of 2019, while Prospect and Circle, collectively, represented less than 1%. At June 30, 2020 and December 31, 2019, our lease concentration in any one tenant relationship was less than 20% of our total assets.

 

3)

Geographic concentration – At June 30, 2020, investments in the U.S., Europe, and Australia represented approximately 70%, 25%, and 5%, respectively, of our total assets, compared to 74%, 20%, and 6% at December 31, 2019.

 

4)

Facility type concentration – For the six months ended June 30, 2020, approximately 88% of our revenues are from our general acute care facilities, while rehabilitation and long-term acute care facilities make up 9% and 3%, respectively. These percentages are similar to those for the first six months of 2019.