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Segment Reporting
 3 Months Ended
Mar. 31, 2022
Segment Reporting [Abstract]  
Segment Reporting Segment Reporting
The disclosures below for the three months ended March 31, 2022 and 2021 are presented for the Company’s two reportable business segments for management and internal financial reporting purposes: MOBs and SHOPs. Prior to December 31, 2021, the Company had three reportable segments 1) medical office and outpatient buildings (“Former MOBs”), 2) triple-net lease healthcare properties (“Former NNN”) and 3) SHOPs. Culminating in the year ended December 31, 2021, the Company had completed several strategic property divestitures from the Company’s Former NNN segment and transitioned certain properties previously reported in the Company’s Former NNN segment into the Company’s SHOP segment. The remaining Former NNN properties are similar in nature, cash flows, and risk structure with the Former MOB segment and are managed operationally and reported collectively by the Company’s management. Accordingly, in the fourth quarter of 2021, the Company reevaluated its segments and concluded that it had two reportable segments. The Company combined the properties in its Former NNN segment with the properties in its Former MOB segment for segment reporting. Upon concluding that a change in its reporting segments has occurred, the Company retroactively restated the historical segment reporting presentation for the three years ended December 31, 2021 as presented in its Annual Report on Form 10-K for the year ended December 31, 2021. Below, the Company has restated the prior quarterly period to conform to its current segment reporting structure for comparative purposes. Hereafter, the Company will restate other prior quarterly periods for 2021 when they are subsequently reported in later filings for comparative purposes.
The Company evaluates performance and makes resource allocations based on its two business segments. The medical office building segment primarily consists of MOBs leased to healthcare-related tenants under long-term leases, which may require such tenants to pay a pro rata share of property-related expenses as well as seniors housing properties, hospitals, inpatient rehabilitation facilities and skilled nursing facilities under long-term leases, under which tenants are generally responsible to directly pay property-related expenses. The SHOP segment consists of direct investments in seniors housing properties, primarily providing assisted living, independent living and memory care services, which are operated through engaging independent third-party operators.
Net Operating Income
The Company evaluates the performance of the combined properties in each segment based on net operating income (“NOI”). NOI is defined as total revenues from tenants, less property operating and maintenance expense. NOI excludes all other items of expense and income included in the financial statements in calculating net income (loss). The Company uses NOI to assess and compare property level performance and to make decisions concerning the operation of the properties. The Company believes that NOI is useful as a performance measure because, when compared across periods, NOI reflects the impact on operations from trends in occupancy rates, rental rates, operating expenses and acquisition activity on an unleveraged basis, providing perspective not immediately apparent from net income (loss).
NOI excludes certain components from net income (loss) in order to provide results that are more closely related to a property’s results of operations. For example, interest expense is not necessarily linked to the operating performance of a real estate asset and is often incurred at the corporate level. In addition, depreciation and amortization, because of historical cost accounting and useful life estimates, may distort operating performance at the property level. NOI presented by the Company may not be comparable to NOI reported by other REITs that define NOI differently. The Company believes that in order to facilitate a clear understanding of the Company’s operating results, NOI should be examined in conjunction with net income (loss) as presented in the Company’s consolidated financial statements. NOI should not be considered as an alternative to net income (loss) as an indication of the Company’s performance or to cash flows as a measure of the Company’s liquidity or ability to pay distributions.
The following tables reconcile the segment activity to consolidated net loss for the periods presented:
Three Months Ended March 31,
2022
(In thousands)Medical Office BuildingsSeniors Housing — Operating Properties Consolidated
Revenue from tenants
$32,348 $51,302 $83,650 
Property operating and maintenance
8,689 44,401 53,090 
NOI
$23,659 $6,901 30,560 
Impairment charges
(10,644)
Operating fees to related parties
(6,318)
Acquisition and transaction related
(579)
General and administrative
(4,899)
Depreciation and amortization
(20,420)
Interest expense
(11,764)
Interest and other income
12 
Loss on sale of real estate investments(303)
Gain on non-designated derivatives994 
Income tax expense(39)
Net loss attributable to non-controlling interests49 
Allocation for preferred stock (3,450)
Net loss attributable to common stockholders$(26,801)

Three Months Ended March 31,
2021
(In thousands)Medical Office BuildingsSeniors Housing — Operating Properties Consolidated
Revenue from tenants
$30,339 $53,097 $83,436 
Property operating and maintenance
8,843 40,512 49,355 
NOI
$21,496 $12,585 34,081 
Impairment charges
(878)
Operating fees to related parties
(5,883)
Acquisition and transaction related
(132)
General and administrative
(6,052)
Depreciation and amortization
(20,102)
Interest expense
(12,322)
Interest and other income
52 
Loss on sale of real estate investments(172)
Gain on non-designated derivatives14 
Income tax benefit (expense)
(48)
Net income attributable to non-controlling interests(46)
Allocation for preferred stock(742)
Net loss attributable to common stockholders$(12,230)
The following table reconciles the segment activity to consolidated total assets as of the periods presented:
(In thousands)March 31, 2022December 31, 2021
ASSETS
Investments in real estate, net:
Medical office buildings
$1,127,945 $1,149,241 
Seniors housing — operating properties883,166 900,686 
Total investments in real estate, net
2,011,111 2,049,927 
Cash and cash equivalents66,424 59,738 
Restricted cash26,423 25,644 
Derivative assets, at fair value13,321 174 
Straight-line rent receivable, net24,252 23,858 
Operating lease right-of-use assets7,889 7,914 
Prepaid expenses and other assets30,492 32,564 
Deferred costs, net14,139 14,581 
Total assets$2,194,051 $2,214,400 
The following table reconciles capital expenditures by reportable business segment, excluding corporate non-real estate expenditures, for the periods presented:
Three Months Ended March 31,
(In thousands)20222021
Medical office buildings$1,188 $492 
Seniors housing — operating properties2,123 3,537 
Total capital expenditures$3,311 $4,029