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Real Property Acquisitions and Development
9 Months Ended
Sep. 30, 2020
Real Estate [Abstract]  
Real Property Acquisitions and Development Real Property Acquisitions and Development 
The total purchase price for all properties acquired has been allocated to the tangible and identifiable intangible assets and liabilities at cost on a relative fair value basis. Liabilities assumed and any associated noncontrolling interests are reflected at fair value. The results of operations for these acquisitions have been included in our consolidated results of operations since the date of acquisition and are a component of the appropriate segments. Transaction costs primarily represent costs incurred with acquisitions, including due diligence costs, fees for legal and valuation services, termination of pre-existing relationships computed based on the fair value of the assets acquired, lease termination fees and other acquisition-related costs. Transaction costs related to asset acquisitions are capitalized as a component of purchase price and all other non-capitalizable costs are reflected in other expenses on our Consolidated Statements of Comprehensive Income.
The following is a summary of our real property investment activity by segment for the periods presented (in thousands):
 Nine Months Ended
 September 30, 2020September 30, 2019
Seniors Housing OperatingTriple-netOutpatient
Medical
TotalsSeniors Housing OperatingTriple-netOutpatient
Medical
Totals
Land and land improvements$15,758 $— $43,252 $59,010 $107,945 $14,172 $187,301 $309,418 
Buildings and improvements132,481 765 171,630 304,876 1,138,484 125,763 1,324,371 2,588,618 
Acquired lease intangibles10,810 — 23,823 34,633 61,163 — 104,309 165,472 
Construction in progress— — — — 36,174 — — 36,174 
Real property held for sale— — — — 17,435 — — 17,435 
Right of use assets, net— — — — — — 58,377 58,377 
Total net real estate assets159,049 765 238,705 398,519 1,361,201 139,935 1,674,358 3,175,494 
Receivables and other assets257 — 139 396 6,742 — 419 7,161 
Total assets acquired (1)
159,306 765 238,844 398,915 1,367,943 139,935 1,674,777 3,182,655 
Secured debt— — — — (43,209)— — (43,209)
Lease liabilities— — — — — — (47,740)(47,740)
Accrued expenses and other liabilities(671)— (2,043)(2,714)(9,639)(100)(23,483)(33,222)
Total liabilities acquired(671)— (2,043)(2,714)(52,848)(100)(71,223)(124,171)
Noncontrolling interests (2)
(2,827)— — (2,827)(39,570)(1,056)(1,201)(41,827)
Non-cash acquisition related activity(3)
— — — — (11,889)— — (11,889)
Cash disbursed for acquisitions155,808 765 236,801 393,374 1,263,636 138,779 1,602,353 3,004,768 
Construction in progress additions75,617 33,021 33,593 142,231 188,178 37,978 42,316 268,472 
Less: Capitalized interest(7,760)(2,569)(2,905)(13,234)(5,972)(1,565)(2,867)(10,404)
Accruals (4)
(1,376)— (922)(2,298)— — 45 45 
Cash disbursed for construction in progress66,481 30,452 29,766 126,699 182,206 36,413 39,494 258,113 
Capital improvements to existing properties130,465 5,971 46,888 183,324 160,260 10,337 35,816 206,413 
Total cash invested in real property, net of cash acquired$352,754 $37,188 $313,455 $703,397 $1,606,102 $185,529 $1,677,663 $3,469,294 
(1) Excludes $580,000 and $1,910,000 of unrestricted and restricted cash acquired during the nine months ended September 30, 2020 and 2019, respectively.
(2) Includes amounts attributable to both redeemable noncontrolling interests and noncontrolling interests.
(3) Relates to the acquisition of assets previously recognized as investments in unconsolidated entities.
(4) Represents non-cash accruals for amounts to be paid in future periods for properties that converted, off-set by amounts paid in the current period.
Construction Activity 
The following is a summary of the construction projects that were placed into service and began generating revenues during the periods presented (in thousands):
 Nine Months Ended
 September 30, 2020September 30, 2019
Development projects:
Seniors Housing Operating
$93,188 $28,117 
Triple-net
59,201 — 
Outpatient Medical
43,493 — 
Total development projects
195,882 28,117 
Expansion projects
48,600 — 
Total construction in progress conversions$244,482 $28,117