Executive Summary

Q4 2023 delivered accelerating top-line and operational momentum: Total GAAP revenue was $482.58M, up both sequentially and year over year; NFFO per share held at $0.38 and FFO per share improved to $0.13 .
Same-Store NOI growth was robust across segments, led by SHOP (+44.9% YoY) and ISHC (+13.9% YoY), reflecting occupancy gains and moderating expense growth in RIDEA-operated assets .
2024 guidance sets mid-single-digit growth: NAREIT FFO/share $1.13–$1.19 (midpoint $1.16), NFFO/share $1.18–$1.24 (midpoint $1.21), and total portfolio SS NOI growth of 5%–7% (midpoint 6%) .
Post-quarter catalysts: January 2024 equity offering of 64.4M shares at $12 (gross proceeds $772.8M), ~$721M debt repaid (weighted avg rate ~7.53%), ~$54M annualized interest savings; management targets low-6x net-debt-to-adjusted-EBITDA by 3/31/24 .

What Went Well and What Went Wrong

What Went Well
- Strong operating momentum: “Our portfolio continues to recover… with the trajectory of revenue growth drivers all heading in the right direction.” COO cited occupancy surpassing pre-pandemic levels in ISHC .
- SHOP recovery: Same-Store NOI growth +44.9% YoY (Q4), with occupancy rising to 80.4% and Cash NOI margin improving to 13.4% as agency labor usage normalized .
- Balance sheet actions: CFO emphasized the “transformative” offering and debt repayment, estimating low-6x net-debt-to-adjusted-EBITDA by March 31, 2024 and ~$54M annual interest savings .
What Went Wrong
- GAAP net loss persisted: Q4 net loss per share was -$0.42, though improved vs -$0.72 in Q4 2022; FY 2023 net loss per share was -$1.08 .
- Outpatient Medical softness: Same-Store NOI growth was modest (+2.3% YoY), and revenue per square foot dipped sequentially in Q4 to $29.65 from $30.44 in Q3 .
- Elevated interest burden pre-deleveraging: Q4 interest expense was $41.19M; YTD interest coverage at 1.8x highlights sensitivity to rates prior to the January paydown .

Financial Results

Metric	Q4 2022	Q3 2023	Q4 2023
Total GAAP Revenue ($USD Millions)	$452.58	$464.24	$482.58
Net Loss per Share (GAAP)	-$0.72	N/A (not disclosed)	-$0.42
NAREIT FFO per Share	$0.04	N/A (not disclosed)	$0.13
Normalized FFO per Share	$0.38	N/A (not disclosed)	$0.38
Pro-Rata Cash NOI ($USD Millions)	$70.97	$72.91	$76.84

Segment Same-Store NOI and Margins (Q4)

Segment	Q4 2022 Same-Store NOI ($USD Millions)	Q3 2023 Same-Store NOI ($USD Millions)	Q4 2023 Same-Store NOI ($USD Millions)	Q4 2022 NOI Margin	Q3 2023 NOI Margin	Q4 2023 NOI Margin
ISHC	$21.99	$22.07	$25.05	15.5%	15.2%	16.7%
Outpatient Medical	$20.35	$20.97	$20.81	62.9%	62.3%	63.5%
SHOP	$3.04	$4.43	$4.41	9.7%	13.8%	13.2%
Triple-Net Leased	$9.26	$9.52	$9.58	94.7%	94.3%	94.3%

KPIs

KPI	Q4 2022	Q3 2023	Q4 2023
ISHC Average Occupancy	84.3%	86.2%	85.0%
SHOP Average Occupancy	76.1%	79.3%	80.4%
Outpatient Medical Spot Occupancy	89.0%	89.7%	89.2%
Triple-Net Average Operator Occupancy	83.7%	86.3%	87.4%
SHOP RevPOR ($)	$4,231	$4,529	$4,631

Guidance Changes

Metric	Period	Previous Guidance	Current Guidance	Change
NAREIT FFO per Share	FY 2024	N/A	$1.13–$1.19; Midpoint $1.16	Initiated
Normalized FFO per Share	FY 2024	N/A	$1.18–$1.24; Midpoint $1.21	Initiated
Total Portfolio Same-Store NOI Growth	FY 2024	N/A	5%–7%; Midpoint 6%	Initiated
Quarterly Cash Distribution	Q1 2024	N/A	$0.25 per share	Initiated

Earnings Call Themes & Trends

Topic	Previous Mentions (Q2 2023 and Q3 2023)	Current Period (Q4 2023)	Trend
Occupancy recovery (SHOP/ISHC)	ISHC occupancy 84.8%→86.2%; SHOP 76.8%→79.3%	ISHC 85.0%; SHOP 80.4%	Improving sequentially QoQ and YoY
Expense moderation (agency labor)	Early signs of moderation (RIDEA assets)	Management notes continued normalization and operator transitions aiding margins	Positive margin trend
Capital markets & deleveraging	No large offerings noted in Q2/Q3 data	Largest REIT offering/listing since 2018; ~$721M debt repaid; ~$54M annual interest savings; low-6x net-debt-to-adj-EBITDA targeted	Material balance sheet improvement
Outpatient Medical stability	NOI margins ~62%–63% with steady occupancy	Same-Store NOI +2.3% YoY; occupancy 89.2%	Stable-to-modest growth
Segment mix (ISHC/SHOP lead)	ISHC and SHOP driving NOI growth	ISHC +13.9% and SHOP +44.9% SS NOI growth YoY	Mix shift toward operating segments

References: Conference call held March 22, 2024 with listed participants .

Management Commentary

Strategic message: “We are proud of our 2023 operating results… As a publicly listed company, we are committed to being responsible stewards of capital” – CEO .
Operating strength: “Our unique investment in Integrated Senior Health Campuses remains the most attractive part of our portfolio… occupancy already surpassing pre-pandemic levels” – COO .
2024 outlook confidence: “We believe 2024 should be another year of occupancy gains within our SHOP segment… mid-single-digit NOI growth across our entire diversified healthcare portfolio,” – CEO .
Capital structure: “We estimate… low 6x net-debt-to-adjusted-EBITDA… The offering and debt repayment were transformative” – CFO .

Q&A Highlights

Analysts focused on occupancy trajectories, SHOP margin expansion drivers, the use of IPO proceeds for deleveraging, and the durability of SS NOI guidance midpoints; management reiterated continued occupancy gains and disciplined external growth, with select operator partnerships to drive execution .
Call participants included BofA, Morgan Stanley, KeyBanc, Citi, RBC, Barclays, Green Street, and Colliers, underscoring broad sell-side engagement .
Management clarified benefits from interest rate swaps ($750M fixed SOFR at ~4.16%) and expected interest savings from debt repayment, supporting FY 2024 FFO/NFFO guidance framing .

Estimates Context

S&P Global consensus estimates for AHTR were unavailable due to mapping constraints; therefore, direct comparisons to Wall Street consensus are not provided. Values retrieved from S&P Global.*
Public transcript pages reference an EPS miss and revenue beat versus third-party compiled estimates, but we anchor our analysis on company-reported figures and the declared FY24 guidance .

Key Takeaways for Investors

Operating momentum is broad-based, with SHOP and ISHC driving outsized Same-Store NOI growth; occupancy gains and labor normalization are tailwinds to margins in 2024 .
FY 2024 guide implies continued recovery with mid-single-digit SS NOI growth and improving FFO/NFFO per share; monitor execution against occupancy and margin assumptions .
Post-IPO deleveraging materially reduces interest expense and near-term maturities; the portfolio’s fixed-rate swaps and debt paydown support cash flow resilience as rates fluctuate .
Outpatient Medical remains stable with high margins and steady occupancy; renewal activity and retention underpin durable NOI despite minor sequential revenue/sq ft softness .
Segment mix is shifting toward operating platforms where AHR has clear levers (operator transitions, RIDEA structures, RevPOR management); this should sustain NOI momentum into 2024 .
Watch for additional non-core dispositions and disciplined external growth to further optimize the balance sheet and portfolio quality .
Near-term trading: catalysts include quarterly distribution continuity ($0.25/share), execution on guidance midpoints, and evidence of continued occupancy gains in SHOP/ISHC; medium-term, deleveraging plus embedded growth should support multiple and estimate revisions over time .

Additional Relevant Q4 2023 Press Releases

Quarterly distribution authorized for Q4 period at $0.25 per share (paid Jan 16, 2024 to record date Dec 27, 2023) .

Appendix: Segment Revenue and Cash NOI (Q4 Snapshot)

Segment	Cash Revenue Q4 2023 ($USD Millions)	Cash NOI Q4 2023 ($USD Millions)	Notes
ISHC	$285.12	$37.43	Occupancy 85.0%; SS NOI +13.9% YoY
Outpatient Medical	$32.82	$20.81	Spot occupancy 89.2%; SS NOI +2.3% YoY
SHOP	$48.05	$6.46	Occupancy 80.4%; SS NOI +44.9% YoY
Triple-Net Leased	$12.74	$12.14	Avg operator occupancy 87.4%
Debt Security Investment	$2.01 (interest)	N/A	Contributes to revenue

Notes: Company-reported GAAP revenue and non-GAAP reconciliations (FFO, NFFO, Cash NOI) are provided in the Q4 2023 earnings release and supplemental .

American Healthcare REIT, Inc. (AHTR)·Q4 2023 Earnings Summary