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Investment and Disposition Activity
 12 Months Ended
Dec. 31, 2021
Business Combinations [Abstract]  
Investment and Disposition Activity Investment and Disposition ActivityDuring 2021, the Company completed the acquisition of 24 operating health care properties, which includes the remaining 51% membership interest in the Eden Hill Joint Venture, and three medical condominium units located in 14 states, for an aggregate purchase price of approximately $973.2 million, excluding the conversion of a previously outstanding construction loan of $15.5 million. The Company also paid $0.3 million of additional purchase consideration on one property
under an earn-out agreement. Additionally, the Company funded three mezzanine loans for $8.9 million, and closed on a $10.5 million construction loan, funding $7.3 million as of December 31, 2021. The Company also acquired membership interests in one joint venture for approximately $7.3 million, resulting in total investment activity of approximately $997.0 million. As part of these investments, the Company incurred approximately $5.9 million of capitalized transaction costs.

Investment activity for the year ending December 31, 2021 is summarized below:
InvestmentLocationAcquisition
Date		Investment Amount
(in thousands)
Earnout - TOPA Fort Worth MOBFort Worth, TXJanuary 11, 2021$298 
AdventHealth Wesley Chapel MOB IIWesley Chapel, FLApril 21, 202135,251 
TOPA Denton(1)Denton, TXJune 11, 2021— 
InterMed MOB - Davis Joint Venture(2)Portland, MEAugust 18, 20217,291 
Atkins Portfolio (5 MOBs)VariousAugust 30, 202154,090 
HonorHealth - Sonoran MOBPhoenix, AZSeptember 23, 202131,750
Eden Hill Medical Center(3)Dover, DEOctober 15, 202133,180 
HonorHealth - Neuroscience InstituteScottsdale, AZOctober 27, 202167,250 
Landmark Portfolio (14 MOBs)(4)VariousDecember 20, 2021750,000 
Atlanta Medical Condominium InvestmentAtlanta, GAVarious1,653 
Loan InvestmentsVariousVarious16,214 
  $996,977 
(1)The Company funded this investment through the conversion and satisfaction of a previously outstanding construction loan of $15.5 million.
(2)The Company purchased a 49% membership interest in this property through the Davis Joint Venture.
(3)The Company purchased the remaining 51% membership interest in the MedCore Realty Eden Hill, LLC joint venture, and as of December 31, 2021 owns 100% of this property.
(4)This portfolio was funded through an aggregate 6,561,521 OP Units and 672,978 Series A Preferred Units issued by the Operating Partnership valued at approximately $116.5 million and $146.5 million, respectively, on the date of issuance. The Company also financed an aggregate $100.0 million through three new mortgages and paid $386.3 million of cash. On December 28, 2021, all of the Series A Preferred Units were redeemed for a total value of $146.5 million and as a result of this redemption, there are no Series A Preferred Units outstanding.

During 2021, the Company recorded revenues and net loss of $8.7 million and $1.3 million, respectively, from its 2021 acquisitions.

During 2020, the Company completed acquisitions of seven operating health care properties located in six states, for an aggregate purchase price of approximately $74.5 million, excluding the conversion of a previously outstanding term loan of $47.0 million and the satisfaction of one construction loan of $29.1 million. The Company also paid $1.1 million of additional purchase consideration on two properties under earn-out agreements and acquired one land parcel through the conversion and satisfaction of a previously outstanding term loan for $0.2 million. Additionally, the Company funded twelve mezzanine loans for $79.6 million, one term loan for $10.0 million, $25.4 million of previous construction loan commitments, which includes the final funding on the Denton and Sacred Heart ASC construction loans, and an additional $0.3 million to an existing term loan. The Company also acquired a membership interest in one joint venture for approximately $18.3 million, resulting in total investment activity of approximately $209.3 million. As part of these investments, we incurred approximately $1.3 million of capitalized costs.
Investment activity for the year ending December 31, 2020 is summarized below:
InvestmentLocationAcquisition
Date
Purchase Price
 (in thousands)
El Paso, Texas Land(1)El Paso, TXJanuary 17, 2020$215 
Westerville MOBWesterville, OHFebruary 28, 202010,683 
TOPA Fort Worth(2)Fort Worth, TXMarch 16, 20201,500 
Ascension St. Vincent Cancer CenterNewburgh, INSeptember 11, 202021,085 
Health Center at EastonEaston, PANovember 23, 202015,775 
Hartford HealthCare Cancer CenterManchester, CTDecember 8, 202016,855 
Davis Joint Venture(3)VariousDecember 11, 202018,252 
Sacred Heart Summit Medical Office and ASC(4)Pensacola, FLDecember 18, 20203,264 
Westerville II MOBWesterville, OHDecember 23, 20205,350 
Landmark Mezzanine Loan PortfolioVariousVarious54,250 
Loan InvestmentsVariousVarious60,971 
Earn-out Investments(5)VariousVarious1,136 
  $209,336 
(1)This investment was funded through the conversion and satisfaction of a previously outstanding term loan of $1.3 million and additional cash consideration of $0.2 million.
(2)This investment was funded through the conversion and satisfaction of a previously outstanding term loan of $47.0 million and additional cash consideration of $1.5 million.
(3)The Company purchased a 49% membership interest in this joint venture.
(4)This investment was funded through the conversion and satisfaction of a previously outstanding construction loan of $29.1 million and additional consideration of $3.3 million consisting of an aggregate 167,779 OP Units issued by the Operating Partnership valued at approximately $3.1 million on the date of issuance and $0.2 million of cash.
(5)The Company completed the settlement of acquisitions related earn-out payments upon execution of leases at two properties. All earn-out payments are considered to be additional purchase price upon each respective property.

For 2020, the Company recorded revenues and net income of $5.3 million and $0.7 million, respectively, from its 2020 acquisitions.
The following table summarizes the preliminary purchase price allocations of the assets acquired and the liabilities assumed, which the Company determined using Level 2 and Level 3 inputs (in thousands):

December 31, 2021December 31, 2020
Land$15,497 $8,841 
Building and improvements840,591 128,594 
In-place lease intangibles90,336 18,165 
Above market in-place lease intangibles13,804 118 
Below market in-place lease intangibles(16,326)(1,962)
Right-of-use asset100,589 444 
Receivables— 140 
Prepaid expenses129 (771)
Lease liability(39,400)— 
Net assets acquired (1)$1,005,220 $153,569 
Issuance of Series A Preferred Units(146,541)— 
Issuance of OP Units(116,467)(3,067)
Satisfaction of real estate loans receivable and conversion of JV interest(24,033)(77,462)
Cash used in acquisition of investment property$718,179 $73,040 
(1) Net assets acquired does not include acquisition credits of $6.8 million for the year ended December 31, 2021 and $1.0 million for the year ended December 31, 2020, which consist primarily of future tenant improvements and capital expenditure commitments received as credits at the time of acquisition.

Dispositions

For the year ended December 31, 2021, the Company sold seven properties and five adjacent parcels of vacant land located in five states for approximately $94.4 million and recognized a net gain of approximately $24.2 million.
For the year ended December 31, 2020, the Company sold two medical office buildings for approximately $20.5 million and recognized a net gain on the sales of approximately $5.8 million.