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Ventas

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Employees 201-500
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FY2020 Annual Report · Ventas
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We are optimistic about Ventas’s future as we begin to look beyond 2020, a year that will forever be 
marked by the COVID-19 global pandemic and the loss it brought to so many individuals, households, 
businesses and economies. Let me express my sincere wish that you and yours remain healthy and 
secure. I am personally grateful for the trust and support that you have shown our Company during this 
tumultuous period.

The past year gave us the opportunity to demonstrate what we are made of. We enunciated and 
acted on our values, benefited from our longstanding, disciplined strategy of diversification, gained 
new insights into our business, strengthened our partnerships, demonstrated our commitment to our 
people, advanced our strategic objectives and created new businesses.

Debra A. Cafaro 
Chairman and Chief 
Executive Officer

We were challenged during the year by the COVID-19 pandemic, and by repeated and blatant acts of racial violence, floods, hurricanes, 
wildfires and political stresses. To combat those challenges, I am proud to say that Ventas rose to the occasion and: 

•  Delivered net income attributable to common stockholders of $1.17/share, Nareit Funds From Operations (FFO) of $3.37/share and 

Normalized FFO of $3.32/share, which represented 90% of the midpoint of our pre-pandemic guidance1

•  Ensured financial strength and flexibility, ending the year with $3 billion in liquidity

•  Proactively addressed the impact of the COVID-19 pandemic on our senior housing triple net (NNN) portfolio, announcing mutually 
beneficial arrangements with our two largest tenants, crafting thoughtful deals that enabled them to care for seniors and provided 
Ventas with significant up-front consideration and upside from an industry recovery  

•   Used our resources to keep people safe—our employees, the vulnerable senior housing residents in our communities, the workers  

who care for them and the physicians, patients, tenants, construction crews and others who work in or visit Ventas properties

•   Took a strong stand for racial justice, diversity, equity and inclusion and committed ourselves to driving lasting change in our  

Company, our industry and our communities

•   Raised the bar on our sustainability efforts to protect the planet and minimize the severity and frequency of climate events 

•   Supported our employees through enhanced benefits, wellness programs and training opportunities

•  Enhanced our organization, with key additions to our Board of Directors and executive team

•  Provided financial support, industry advocacy and best practices communications to our tenants and operators who were severely 

affected by the pandemic

•  Invested in growth, principally in our value creating life science, research & innovation business, through our senior housing  

partnership in Canada and by launching significant new tools to expand our platform

 OUR COVID-19 PREPAREDNESS AND RESPONSE

•  Implemented travel, work and other 
precautions to maintain health and 
safety of employees, appropriately 
flexing throughout the pandemic in 
response to evolving clinical trends

• Provided enhanced COVID-19 
related employee benefits

•  Provided access to enhanced 
mental health resources and 
training programs

•  Led senior housing industry in 

testing residents and frontline staff 
in the Company’s senior housing 
communities

•  Implemented early reporting 
process to identify, track and 
understand COVID-19 trends and 
metrics

•  Proactively acquired Personal 

Protective Equipment (PPE) for 
tenants, operators and partners 

•  Developed best-in-class online 

resource center to share information 
on financial relief availability, PPE 
resources, testing and vaccination 
with our partners

•  Served as a strong advocate for 
vulnerable seniors, with the U.S. 
Department of Health & Human 
Services ultimately making 
funding from its Provider Relief 
Fund available to assisted living 
communities to address the 
impact of COVID-19 

1  This Annual Report contains certain financial measures that are not calculated in accordance with U.S. generally accepted accounting principles (“GAAP”). Additional 

information and reconciliations of each of these non-GAAP financial measures to the most directly comparable GAAP measure are available on the Company’s website 
at https://ir.ventasreit.com/financials/annual-reports-and-supplemental-information/default.aspx. Unless otherwise indicated, financial data is as of December 31 of the 
respective year.

2020 ANNUAL REPORT  2

EMPLOYEESINDUSTRYTENANTS & OPERATORSLETTER TO STAKEHOLDERSThe power of our more than two-decade strategy of diversification was on display during 2020. That strategy has protected our 
stakeholders in downturns and provided opportunities for growth throughout cycles. Sustainable, growing demand from an aging 
population is the underlying theme that unites all of the real estate that we own, a theme that will only accelerate this decade.

It is no surprise that investors around the world continue to show strong interest in our asset classes, which have continued to support 
favorable valuations. With the 65-and-over population increasing by 10,000 baby boomers per day and the 80-and-over population 
projected to increase from under 13 million today to nearly 20 million individuals by 2030, we believe that burgeoning demand for medical 
offices, senior living communities, laboratories where researchers develop cures and therapies for chronic illness and other healthcare 
sites will fuel our performance.2 For decades, we have prized owning multiple asset classes (or verticals), created strong relationships 
with a variety of best-in-class healthcare operators and providers and invested both in large cities and throughout the United States, 
Canada and the United Kingdom. Our portfolio has remained balanced between assets that generate consumer driven, private pay 
revenues like senior living, and those where government reimbursement and insurance provide revenues from healthcare services. 
This year, our businesses supported by government funding and our Canadian senior housing communities outperformed. 

Unexpected shocks such as those caused by the Global Financial Crisis, 9/11 and the COVID-19 pandemic occur more frequently than 
we expect, perhaps even every decade. We developed our diversification strategy with that in mind. Because we cannot predict the 
precise timing or cause of these disruptors, or how they will affect specific markets, sectors or countries, we have built Ventas into a 
large, diversified enterprise that is designed to stay strong and stable through them. 

Now, we are ready to—as we have in the past—accelerate into recovery for the benefit of our stakeholders. 

A SNAPSHOT OF SUCCESS

20+ 

Years of Operation

20% 

Compound Annual Total 
Shareholder Return 
CAGR since 19993

$30B 

Enterprise Value

BBB+ 

Credit Rating

~1,200 

Properties

27M 

Square Foot 
Office Portfolio

$3B+ 

Assets Under Management 
in the Ventas Investment 
Management Platform

$3B 

Liquidity

For Ventas, 2020 began with great momentum and positive results. As the pathogen known as the “novel coronavirus” began to 
spread, our experienced team immediately grasped the potential magnitude of the event and mobilized to safeguard our enterprise. 

I could not be prouder of—or more grateful to—the Ventas team. Through challenging conditions, each individual worked tirelessly 
to protect the Company, our people and those who live in or visit our nearly 1,200 sites in North America and the United Kingdom.  
We demonstrated agility and resilience, while remaining productive and maintaining our commitment to excellence.

Our corporate employees shifted seamlessly to remote work arrangements, our medical office field teams remained onsite to 
support our physicians and their patients and our agents kept our research laboratories open and functioning for the scientists who 
needed them. Our provider partners in senior housing, hospitals and other healthcare settings and their workers were on the front 
lines truly saving lives and providing critical care to residents and patients.

2  US Census Bureau Report (2019); Organisation for Economic Co-Operation & Development (2021).
3  Bloomberg, for the period beginning 12/31/1999 and ending 12/31/2020. Ventas stock price adjusted historically for spin-off of Care Capital Properties, Inc. on August 17, 2015.

3   2020 ANNUAL REPORT

 OUR PEOPLEOur Board of Directors has always been a competitive differentiator for Ventas. A high-quality engaged Board of Directors is never 
more valuable than in an environment like last year’s continuous set of overlapping crises. At Ventas, our stakeholders and our 
management team benefit enormously from having a diverse Board of Directors with the independence, judgment and experience 
to weather the storm, stay steady and remain focused on the growth and opportunity ahead.   

We have continued to elevate and refresh our high-quality Board of Directors, maintaining institutional knowledge and continuity 
while recruiting industry leaders who provide fresh perspectives. We are continuously engaged in a multi-year-forward, thoughtful 
process to ensure our Board has the right balance of skill sets, experiences and character. In the last year, two independent 
directors joined the Board: 

Marguerite M. Nader, President and 
Chief Executive Officer, Equity LifeStyle 
Properties, Inc., is a seasoned executive 
with more than two decades of 

Maurice S. Smith, President and Chief 
Executive Officer, Health Care Service 
Corporation (HCSC), is a national leader in 
healthcare with over 25 years of experience 

experience in real estate and finance. She brings significant 
strategic acumen and a keen understanding of the REIT 
industry and its participants.

in fiscal, strategic, financial and operations leadership in health 
insurance. He brings deep insight into trends in healthcare delivery, 
data and payment models.

Refreshment of the Board of Directors can be bittersweet. At this year’s Annual Meeting of Stockholders, Richard I. Gilchrist 
will retire from the Board after a 10-year tenure. Rick has been a source of wise counsel to me, an exemplar of collegial 
temperament to his fellow Board members and an unwavering advocate for our stockholders, with whom he engaged every 
year during his tenure as Chair of our Compensation Committee. Rick also provided trusted advice and shared his “deal savvy” 
with our team in his role as Chair of our Investment Committee. We deeply appreciate Rick’s service and contributions and will 
miss him enormously. 

 CARE PROVIDERS AND PARTNERS

Atria Senior Living – Under the leadership of John Moore, Atria was one of the first in the senior living 
space to implement widespread COVID-19 testing through an innovative partnership with Mayo Clinic 
Laboratories, and led the industry in worker vaccine administration so that residents and employees can 
be secure. Atria has been consistently ahead of the curve in its planning and actions.

Brookdale Senior Living – Led by Lucinda (Cindy) Baier, Brookdale was a compelling and fact-based 
advocate, uniting the senior living industry in order to educate policy makers about the critical role that 
care providers played during the pandemic. Brookdale also effectively kept seniors safe, including during 
numerous severe natural disasters, and was relentless in its vaccination rollout.  

Ardent Healthcare Services – With a new CEO, Marty Bonick, joining Ardent early in 2020, the Company  
provided excellent patient care and strong support to clinicians and staff throughout the year. Ardent  
also focused on creating a safe environment for non-COVID procedures, benefiting both patients  
and physicians. 

Wexford Science + Technology – Wexford and its experienced team worked collaboratively with 
universities and lab tenants to keep life science, research & innovation development projects on track, 
while those clients were navigating COVID-19-induced operational challenges. Wexford was keenly 
focused on keeping our construction sites safe for workers, pausing projects when necessary and 
promoting best practices.

2020 ANNUAL REPORT  4

 BOARD OF DIRECTORSThis year, we benefited from the leadership and extraordinary efforts of the many care providers and other partners at our properties. While it is impossible to convey, or express fully my appreciation for, the lifesaving efforts made day after day during the COVID-19 pandemic, I want to recognize and thank:  Our aim is to generate reliable and growing cash flows from a diversified portfolio of high-quality assets supported by demographic 
demand coupled with a strong balance sheet. We have consistently increased our enterprise value by making wise capital allocation 
decisions that have, in turn, enabled Ventas to deliver 20% compound annual returns since 1999. Our commitment to diversification 
has protected the downside and provided myriad opportunities for growth.  

Since 2016, we have allocated capital to build a value creating life science, research & innovation business. We saw the promise 
in this asset class, which contains lab space where researchers are racing to discover cures and develop therapies for disease - 
activities that are key to extending life expectancy and treating widespread chronic healthcare conditions. Our thesis has proven 
correct, with valuations and investor interest increasing dramatically in recent years. We have successfully invested in both ground-up 
development and asset acquisitions in core life science markets and on the campuses of major research universities.   

Since establishing our high-quality independent living partnership with Quebec-based Le Groupe Maurice (LGM) in 2019, we and 
LGM have continued to invest in ground-up development of large-scale senior living communities in Canada. As an example, two new 
projects – VAST in Sainte-Julie and iVVi in downtown Laval – opened in the fourth quarter 2020, and are already over 80% occupied.

While the commercial real estate sector generates approximately 20% of GDP, only 22% of this 
massive $16 trillion dollar sector is owned by public, securitized entities like REITs. The remaining 
78% is owned by private entities such as pension funds, sovereign wealth funds, private equity 
firms and insurance companies.4  

There is a tremendous market opportunity for Ventas to attract global private capital to our 
demographically driven asset classes. Private owners of real estate seek to invest alongside us 
in order to obtain the benefit of our brand, experience, relationships and industry knowledge. 
Partnering with highly regarded domestic and international institutional sources of capital provides 
Ventas with another way to expand our footprint and generate new sources of revenue.  

22%  
Public Owned

78%  
Private Owned

During 2020, we established Ventas Investment Management (VIM), our third-party institutional 
capital investment management platform, which today has $3.7 billion in assets under 
management. VIM consolidates our pre-existing and new third-party capital vehicles under a 
single brand and umbrella. It also leverages our position as a trusted industry expert and innovator and  
extends our track record of delivering superior returns to our public stockholders. Other strategic benefits include: 

$16 Trillion Dollar 
Commercial Real 
Estate Sector4

•  Broadening and further diversifying our capital sources

•  Augmenting our significant investment capacity and accelerating life science development and acquisition opportunities 

•  Building additional recurring revenue and profit opportunities

•  Expanding our national footprint in key growth areas

•  Leveraging our team, industry knowledge, relationships and brand

•  Enabling global institutional investors to invest with Ventas in both a public or private investment structure

Today, VIM is a multi-faceted investment platform that includes the Ventas Life Science & Healthcare Real Estate Fund, L.P., 
which is one of the most successful first-time funds in the real estate sector. We launched the Ventas Life Science & Healthcare Real 
Estate Fund in March 2020 and it now has over $2 billion in assets under management. VIM also includes the VTR-GIC Research & 
Innovation Joint Venture, which has nearly $1 billion of ground-up development projects recently opened or underway and another 
$1 billion of pipeline projects. The VTR-GIC R&I JV accelerates our ability, and expands our capacity, to develop attractive R&I projects 
with leading research universities. 

4  Nareit (2018; 2021).

5   2020 ANNUAL REPORT

 VENTAS INVESTMENT MANAGEMENT GROWTH AND OPPORTUNITYSince entering the life science, research & innovation business, we have grown this vertical ambitiously through both ground-up 
development and asset acquisitions. The addition of life science, research & innovation assets to our Office portfolio has provided uplift 
to our results, our investment activity and our enterprise value.  

Demand for life science, research & innovation real estate is driven by robust and increasing capital flows into biomedical and scientific 
health research from private firms and government sources, including more than $40 billion from the National Institutes of Health in 
2020 alone. Over 170 million U.S. individuals are expected to suffer from at least one chronic condition by 2030,5 and therapies to 
manage these conditions are key to cost effective healthcare delivery, improved quality of life and longer life expectancy.   

Biomedical research and innovation has the capacity to make our aging population live longer, healthier lives, reduce the cost of care, 
improve the outcomes from chronic disease and even develop groundbreaking vaccines in the midst of a pandemic in record time. Our 
large and growing life science, research & innovation portfolio provides critical support to those efforts, and:

•   Resides on the campuses of more than 

15 top-tier research universities collectively 
ranking in the top 5% of all NIH funding  
and conducting over 10% of all university 
life science research and development in 
the nation 

•    Includes a presence in three of the top  
five life science clusters: San Francisco,  
CA, Cambridge, MA and Maryland-DC 

•   Contains 42 operating properties with  

eight million square feet 

•  Includes three in-progress developments 

that will contain over one million square feet

$40

$35

$30

$25

$20

$15

$10

$5

$0

Life Science Venture Capital Deal Activity in the United States6

2000

1800

1600

1400

1200

1000

800

600

400

200

0

5
.
7
$

7
.
9
$

3
.
9
$

2
.
8
$

9
.
7
$

7
.
8
$

8
.
8
$

2
.
0
1
$

4
.
3
1
$

5
.
5
1
$

2
.
4
1
$

0
.
8
1
$

6
.
5
2
$

1
.
3
2
$

9
.
4
3
$

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020*

Deal Value ($)

Deal Count

Entered the Cambridge,  
MA life science cluster in  
Q1 2019

Entered the Maryland-DC 
life science cluster in  
Q1 2021

Entered the South San 
Francisco life science 
cluster in Q4 2020

5  Wu, S., Green, A. Projection of Chronic Illness Prevalence and Cost Inflation, RAND Corporation (2000).
6  Pitchbook-NVCA Venture Monitor (Q4 2020).

2020 ANNUAL REPORT  6

 LIFE SCIENCE | RESEARCH & INNOVATIONSouth San Francisco,  
The Birthplace of Biotechnology

Johns Hopkins, The Intersection 
of Academic Medicine and Research

• Class A trophy portfolio of three newly developed or 

• Class A portfolio of 454,000 square feet strategically 

renovated buildings totaling nearly 800,000 square feet, 
strategically situated at the entrance to the South San 
Francisco life science cluster

located adjacent to Johns Hopkins Medical Campus and 
in the 4th ranked life science cluster 

• Anchored by Johns Hopkins Medicine and 96% leased 

• 96% leased at the time of acquisition, and now fully leased, 

with an average lease term of over seven years 

with a weighted average lease term of over six years 

• Purpose-built for advanced research functions and 
predominantly dedicated to best-in-class lab space 
supporting biotechnology and other life science research

• South San Francisco consistently ranks as one of the elite 

life science clusters in the world, with less than two percent 
lab vacancy, unparalleled access to a large concentration 
of life science firms, an extensive venture capital network 
and world-class talent pool sourced from three major 
research universities

• Johns Hopkins is a global leader in research and medicine, 
ranking #1 in NIH funding and #1 in R&D expenditures, 
with the #2 ranked medical school and #3 ranked hospital 
in the United States 

• Leverages Ventas’s unique expertise at the intersection of 
life science research and academic medicine conducted 
in and adjacent to top universities

Powerful senior housing upside opportunity

DEMOGRAPHICS

11x

SUPPLY TRENDS

(71%)

PENETRATION RATE

14bps

DEMAND DRIVERS

20%+

VACCINE DISTRIBUTION

300M+

FLU SEASON

(99%) 

Faster growth in the senior 
population vs. rest of the population

Decline in new construction starts 
since 4Q17 to 3,550 units in 4Q20  
(~9K units improvement) population7

Average penetration rate growth  
(annual) over three years prior to  
COVID-19 (2019 rate of ~10%)

Potential conversion rates on  
professional referral & respite leads

Doses projected to be administered 
by early summer 20218

Decrease in influenza activity9

GOVERNMENT SUPPORT

$50M

HHS grants received by VTR 
communities to date under  
Provider Relief Fund

7  The National Investment Center for Seniors Housing & Care (2020).
8  USA Today (March 31, 2021); based on  current rate of vaccination as reported by the 

Centers for Disease Control & Prevention.

9  Reflects year-over-year change in influenza hospitalizations as reported by the Centers for 

Disease Control & Prevention (February 2020 - February 2021).

7   2020 ANNUAL REPORT

As I look forward, I am encouraged and heartened by the 
fundamentals in senior housing, which point to a positive forward 
environment for our business after a very difficult pandemic year.

While there is considerable uncertainty regarding the continuing 
impact of the COVID-19 pandemic on our senior housing business 
and the pace and slope of recovery, our senior housing business has 
a powerful embedded upside and encouraging near-term trends with:

•  Senior population growth, with the 80-and-over population 

expected to increase from under 13 million to nearly 20 million 
individuals by 2030

•  Limited supply, with senior housing construction starts of only 3,550 

units in Q4 2020, a cyclical low that has improved by over 70% 
since the peak three years ago

•  Efficacious vaccines that have already been administered to 

substantially all residents in our communities

•  A strong value proposition that provides seniors with a healthy, 

active and social lifestyle

The COVID-19 vaccine was a precious gift delivered to our 
residents and their families. Clinical conditions in our communities 
have dramatically improved and operators have begun to 
reintroduce a robust, enriched lifestyle and enhanced activities 
for residents, allowing new move-ins and permitting visits by 
loved ones. At the same time, we are experiencing increasing 
demand for our communities. As I write this, leads and move-ins 
to our communities are once again approaching—and in some 
communities exceeding—pre-pandemic levels.  

 SENIOR HOUSINGAging Population Fuels Demand10

Customer Leads11

h
t
w
o
r
G
n
o
i
t
a
u
p
o
P

l

8%

7%

6%

5%

4%

3%

2%

1%

0%

1
0
0
2

2
0
0
2

3
0
0
2

4
0
0
2

5
0
0
2

6
0
0
2

7
0
0
2

8
0
0
2

9
0
0
2

0
1
0
2

1
1
0
2

2
1
0
2

3
1
0
2

4
1
0
2

5
1
0
2

6
1
0
2

7
1
0
2

8
1
0
2

9
1
0
2

0
2
0
2

1
2
0
2

2
2
0
2

3
2
0
2

4
2
0
2

5
2
0
2

6
2
0
2

7
2
0
2

8
2
0
2

9
2
0
2

≥80 years

Customer Leads as % of 2019

93%

47%

Apr 
2020

Feb 
2021

Consistent, resilient demand from seniors and their families throughout the pandemic has reinforced our confidence in the 
powerful upside in our senior housing business. Our operators provide need-based services and care, the value of which has 
never been more apparent. In the next five years, the 80-and-over population is projected to expand at a compound annual 
growth rate of 3-4%–and soar to 6% in 2027–well in excess of national population growth.10   

We know that improving leading indicators, coupled with the compelling underlying supply demand fundamentals, in senior 
housing should translate into happier, healthier senior residents, satisfied families and increasing occupancy and improved 
business results over time. This embedded upside represents a highly significant organic growth and value creation 
opportunity for Ventas and its investors.

Per Capita Health 
Care Spending by 
Age Cohort10

$19,100

$7,200

$3,700

0-18

19-64

65+

Medical office buildings play a key role in delivering crucial healthcare services to patients in lower cost 
settings. Outpatient visits continue to rise, fueled by the growth in the 65-and-over population, which is 
projected to represent 20% of the U.S. population by 2030.12 This group visits the doctor at nearly 3x the 
rate of the general population.13 Our MOB business is well positioned to capture this increasing demand.  

Our MOBs or outpatient facilities performed well in 2020, reinforcing their reputation as a steady, reliable 
asset class, driven by the mission-critical nature of our portfolio and by our high-quality, creditworthy 
tenancy. Our dedicated frontline staff kept our businesses open, enhancing operational protocols to 
provide the safest possible environment for the physicians, patients and hospital staff that work in and 
visit our buildings every day. 

We have purposely constructed a high-quality MOB portfolio with properties that are strategically 
located on or near the campuses of highly rated hospitals and medical centers in markets with attractive 

demographics. We own and manage approximately 20 million square feet of MOB space across 32 states, serving over 15,000 
physicians and attracting more than 35 million patient visits each year.  

Our wholly owned property management and leasing subsidiary, Lillibridge Healthcare Services, provides an additional competitive 
advantage. Lillibridge creates exceptional places of care for healthcare providers and the patients they serve. Last year, our tenant 
satisfaction scores were in the top quartile of a comprehensive real estate industry performance benchmark, with COVID-19 
response satisfaction among the highest scores available.

10  GreenStreet Health Care Sector Update (March 17, 2021).
11  As of February 28, 2021; based on 422 of VTR’s 424 1Q 2021 sequential same-store SHOP asset pool.
12  Organisation for Economic Co-Operation & Development (2021).
13  National Center for Health Statistics (January 2019).

2020 ANNUAL REPORT  8

 MEDICAL OFFICE | OUTPATIENT FACILITIES (MOB) 
Ventas is steadfastly committed to our longstanding Environmental, Social and Governance (ESG), principles. Our organizational 
resilience during COVID-19 proved the mettle of our team and the value of our investments in both people and systems and we 
retained our emphasis on our ESG commitments by deepening and accelerating our programs and initiatives. 

Maintaining strong corporate governance and ethical business practices, engaging in the communities where we operate and 
minimizing our environmental impact is beneficial to all our stakeholders—investors, partners, tenants, residents and employees 
alike. Smart environmental, social and governance policies are essential to delivering long-term superior results, resilience and 
sustained excellence.

Recognizing the business and moral imperative to preserve our planet, Ventas set ambitious, long-term new environmental goals to reduce 
the Company’s emissions, energy, water and waste. We also committed to the Science Based Targets initiative (SBTi) to set and measure 
our emissions goals in alignment with current climate science. 

PROGRESS TOWARDS  
EMISSIONS GOALS

PROGRESS TOWARDS  
ENERGY GOAL

PROGRESS TOWARDS  
WATER GOAL

PROGRESS TOWARDS  
RECYCLING GOAL

1,000,000

750,000

500,000

250,000

e
2
O
C
T
M

F
S
/

h
W
k

27

24

21

18

15

F
S
0
0
0
,
1

/

3

m

175

150

125

100

g
n

i
l

c
y
c
e
R
h
t
i

w
s
t
e
s
s
A
%

100%

80%

60%

40%

20%

0%

2018

2019

2028

Scope 1 & 2

Scope 3

2018

2019

2028

2018

2019

2028

2018

2019

2028

In support of our ongoing commitment to sustainable development and building operations, we increased our focus on obtaining 
green building certifications. These independent third-party certifications ensure our properties meet the highest standards in 
environmental responsibility and resource efficiency.  

In 2020, we received our first Institute of Real Estate Management (IREM) Certified Sustainable Property (CSP) certification. Ventas 
was also named an ENERGY STAR Partner of the Year for 2021, which recognizes our exemplary commitment and dedication to 
leadership in energy efficiency and the ENERGY STAR program.

PROPERTY TYPE

ENERGY STAR® 
CERTIFIED

LEED®  
CERTIFIED

SENIOR HOUSING 
OPERATING PORTFOLIO

MEDICAL OFFICE 
BUILDINGS

LIFE SCIENCE,  
RESEARCH & INNOVATION

NNN

TOTAL

110

N/A

N/A

7

117

* Five SHOP assets are both LEED and ENERGY STAR Certified.

9   2020 ANNUAL REPORT

IREM®  
CERTIFIED  
SUSTAINABLE  
PROPERTY

1

2

-

-

3

16

7

25

-

48

TOTAL

122*

9

25

7

163

 AMBITIOUS NEW ENVIRONMENTAL GOALS LEADERSHIP IN ESG 
 
 
 
 
 
 
In response to the death of George Floyd, we share the national sense of urgency to effectively address 
racism, injustice and inequities. We are committed to driving lasting and meaningful change within our 
Company, our industry and our communities.

Building on our longstanding commitment to gender and racial equality, we have established a 
customized diversity, equity and inclusion (DE&I) framework centered around the key areas of people, 
culture, community, investment and celebration. To put this framework into action, we have formed a DE&I 
Committee of enthusiastic volunteers from across our enterprise that I will Chair. I am inspired by the ideas 
and energy of our team and look forward to putting our DE&I goals into action. 

Gratitude and optimism are the themes of this year’s report to you.   

They are borne of the strength, resilience, courage, innovation and commitment demonstrated by so many 
colleagues, partners, caregivers, institutions and leaders. And they are supported by the rapid development and 
effective distribution of vaccines, the improving clinical data, the fiscal and monetary support provided to those 
affected by the pandemic and the real time improving trends in our businesses. As we engage in a national, 
collective effort to end COVID-19, we are likely at the beginning of a sustained recovery in the global economy that 
will restore vitality to individuals, households and businesses and revitalize personal and professional connections.

In our business, we see meaningful signs of early recovery and significant opportunities for growth. Our diversified 
business model provides us with access to multiple demographically driven asset classes, our life science, 
research & innovation business is expanding and creating value rapidly, our senior housing business has significant 
embedded upside, and we have the tools, team and experience to succeed. All of us at Ventas are committed to 
staying strong and steady, and winning the recovery, on behalf of all our stakeholders. 

Debra A. Cafaro 
Chairman and Chief Executive Officer

2020 ANNUAL REPORT  10  

 DIVERSITY, EQUITY AND INCLUSION LOOKING AHEADNamed to the 
Bloomberg Gender-
Equality Index

Selected to the DJSI 
World Index

Named to 
America’s Most 
Responsible 
Companies 2021

Awarded Gold  
at Nareit’s  
2020 Diversity, Equity 
& Inclusion Awards

CDP A- 
Leadership Band

Nareit Leader  
in the Light  
For the Fifth Time

#1 Healthcare REIT 
 in GRESB Real Estate  
Assessment

#1 Real Estate Company  
in 3BL Media’s  

100 Best Corporate Citizens

Signatory to the  
United Nations  
Global Compact,  
a voluntary leadership platform for  
responsible business practices

Signatory to the  

United Nations Women  
Empowerment Principles

Achieved ISS ESG  
Prime Status  
for Corporate ESG performance 

Named an 
ENERGY STAR 
Partner of the Year  
for 2021

Excellence. Sustained.TM

ESG RECOGNITIONSUNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

FORM 10-K 

(Mark One)
☒ ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the year ended December 31, 2020

OR

☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE 

ACT OF 1934 FOR THE TRANSITION PERIOD FROM   

TO

Commission file number: 1-10989  

Ventas, Inc. 
(Exact Name of Registrant as Specified in Its Charter)

Delaware
(State or Other Jurisdiction of Incorporation or Organization)

61-1055020
(I.R.S. Employer Identification No.)

353 N. Clark Street, Suite 3300 
Chicago, Illinois 
60654
(Address of Principal Executive Offices)

(877) 483-6827
(Registrant’s Telephone Number, Including Area Code)

Securities registered pursuant to Section 12(b) of the Act: 

Trading Symbol

VTR

Title of Each Class

Name of Exchange on Which Registered

Common Stock, $0.25 par value

New York Stock Exchange

Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes ☒    No ¨

Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes ¨	  No ☒
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 

1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing 
requirements for the past 90 days. Yes ☒    No ¨

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 

of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such 
files). Yes ☒    No ¨

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company or 

an emerging growth company.  See definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company” and “emerging growth company” 
in Rule 12b-2 of the Exchange Act.

Large accelerated filer

Smaller reporting company 

☒

☐

Accelerated filer

¨

Non-accelerated filer    

Emerging growth company  

☐

☐

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with 

any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.  ¨

Indicate by check mark whether the registrant has filed a report on and attestation to its management’s assessment of the effectiveness of its internal 
control over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the registered public accounting firm that prepared or 
issued its audit report.  ☒

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Act). Yes ☐    No ☒

The aggregate market value of shares of the registrant’s common stock held by non-affiliates of the registrant on June 30, 2020, based on a closing 

price of the common stock of $36.62 as reported on the New York Stock Exchange, was $11.7 billion. 

As of February 18, 2021, there were 374,659,068 shares of the registrant’s common stock outstanding.

Portions of the registrant’s definitive Proxy Statement for the Annual Meeting of Stockholders to be held on May 25, 2021 are incorporated by reference into 
Part III, Items 10 through 14 of this Annual Report on Form 10-K.

DOCUMENTS INCORPORATED BY REFERENCE

CAUTIONARY STATEMENTS

Unless otherwise indicated or except where the context otherwise requires, the terms “we,” “us” and “our” and other 
similar terms in this Annual Report on Form 10-K (the “Annual Report”) refer to Ventas, Inc. and its consolidated subsidiaries.

Forward-Looking Statements

This Annual Report includes forward-looking statements within the meaning of Section 27A of the Securities Act of 

1933, as amended (the “Securities Act”), and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange 
Act”).  These forward-looking statements include, among others, statements of expectations, beliefs, future plans and strategies, 
anticipated results from operations and developments and other matters that are not historical facts.  Forward-looking 
statements include, among other things, statements regarding our and our officers’ intent, belief or expectation as identified by 
the use of words such as “may,” “will,” “project,” “expect,” “believe,” “intend,” “anticipate,” “seek,” “target,” “forecast,” 
“plan,” “potential,” “estimate,” “could,” “would,” “should” and other comparable and derivative terms or the negatives thereof.  
The forward-looking statements are based on management’s beliefs as well as on a number of assumptions concerning future 
events.  You should not put undue reliance on these forward-looking statements, which are not a guarantee of performance and 
are subject to a number of uncertainties and other factors that could cause actual events or results to differ materially from those 
expressed or implied by the forward-looking statements.  You are urged to carefully review the disclosures we make concerning 
risks and uncertainties that may affect our business and future financial performance, including those made below under 
“Summary Risk Factors” and in “Item 1A, Risk Factors” in this report.

We do not undertake a duty to update these forward-looking statements, which speak only as of the date on which they 

are made.

Summary Risk Factors

COVID-19 Risks

•

•

The ongoing COVID-19 pandemic and measures intended to prevent its spread have had and may continue to have a 
material adverse effect on our business;
There is a high degree of uncertainty regarding the implementation and impact of the CARES Act and other pandemic-
related legislation and any future COVID-19 relief measures;

Our Business Operations and Strategy Risks

• Market and general economic conditions, including economic and financial market events and the actual and perceived 

•
•

•

•

•
•

•

•

•
•

•
•

state of the real estate markets and public capital markets, could negatively impact our business;
Third parties must operate our non-Office assets, limiting our control and influence over operations and results;
Our operating assets may expose us to various operational risks, liabilities and claims that could adversely affect our 
ability to generate revenues or increase our costs;
Decreases in our tenants’, borrowers’ or managers’ revenues, or increases in their expenses, could affect their ability to 
meet their financial and other contractual obligations to us, which could adversely affect our business, financial 
condition and results of operations;
Bankruptcy, insolvency or financial deterioration of our tenants, borrowers, managers and other obligors may 
adversely affect us;
A significant portion of our revenues and operating income is dependent on a limited number of tenants and managers;
If we need to replace any of our tenants or managers, we may be unable to do so on as favorable terms or at all, and we 
could be subject to delays, limitations and expenses;
Our success depends, in part, on our ability to attract and retain talented employees, and the loss of any one of our key 
personnel could adversely impact our business;
Our investments are concentrated in a variety of asset classes within healthcare real estate, making us more vulnerable 
to adverse changes in those asset classes and the real estate industry generally;
Our investments may be unsuccessful or fail to meet our expectations;
If we are unable to identify and consummate future investments and effectively manage our expansion opportunities 
and our investments in co-investment vehicles, joint ventures and minority interests, we may be adversely affected;
Development, redevelopment and construction risks could affect our profitability and expose us to liability;
In the event of borrower defaults, we may be unable to foreclose successfully on the collateral securing our loans and 
other investments or, if we are able to foreclose, realize the full value of the collateral; 

i

 
• We own certain properties subject to ground lease, air rights or other restrictive agreements that limit our uses of the 

properties and restrict our ability to sell or otherwise transfer the properties;

Environmental, Economic and Market Risks

•

•

•

Increased construction and development in the markets in which our properties are located could adversely affect our 
profitability;
General economic conditions and other events or occurrences that affect areas in which our properties are 
geographically concentrated may impact financial results; 
If we or our tenants, borrowers and managers are unable to navigate the trends impacting our or their businesses, such 
as limits on demand for site-based activities, and the industries in which we or they operate, or if our tenants fail to 
remain competitive or financially viable, we may be adversely affected;
Our life science, R&I tenants face unique levels of regulation, expense and uncertainty;

•
• Merger, acquisition and investment activity in our industries could adversely affect our business;
•

Damage from catastrophic or extreme weather and other natural events and the physical effects of climate change 
could result in significant losses;

Our Capital Structure Risks

• We may become more leveraged, which could impact our ability to obtain financing and to execute our business 

strategy;

• We are highly dependent on access to the capital markets. Limitations on our ability to access capital could have an 

adverse effect on us; 

• We are exposed to increases in interest rates and fluctuations in currency exchange rates, which could affect our 

•

•

financial results;
Changes in the method pursuant to which the LIBOR rates are determined and potential phasing out of LIBOR may 
affect our financial results; 
Covenants in the instruments governing our and our subsidiaries’ existing indebtedness limit our operational 
flexibility, and a covenant breach could materially adversely affect our operations.

Our Legal, Compliance and Regulatory Risks

•

Significant legal or regulatory proceedings could subject us or our tenants or managers to increased operating costs and 
substantial uninsured liabilities;

• We and our tenants, borrowers and managers may be adversely affected by regulation and enforcement;
•
• We could incur substantial liabilities and costs if any of our properties are found to be contaminated with hazardous 

Our investments may expose us to unknown liabilities;

substances or we become involved in any environmental disputes;
The occurrence of cyber incidents could disrupt our operations, result in the loss of confidential information or damage 
our business relationships and reputation;
The amount and scope of insurance coverage provided by our policies and policies maintained by our tenants, 
managers or other counterparties may not adequately insure against losses;
Failure to maintain effective internal controls could harm our business;

•

•

•

Our REIT Status Risks

• We are subject to certain limitations and requirements as a result of our status as a REIT, which may affect our ability 
to and impose limitations on the operation of our business and subject us to significant risk if we are not able to 
comply; 
Loss of our status as a REIT would have significant adverse consequences for us; and
Ownership limits with respect to our capital stock may delay, defer or prevent a change of control of our company;
Legislative or other actions affecting REITs could have a negative effect on our stockholders or us.

•
•
•

Many of these factors, some of which are described in greater detail under “Risk Factors” in Part I, Item 1A of this 

Annual Report, are beyond our control and the control of our management.

ii

Note Regarding Third-Party Information

This Annual Report includes information that has been derived from SEC filings made by our publicly listed tenants or 

other publicly available information or was provided to us by our tenants and managers.  We believe that such information is 
accurate and that the sources from which it has been obtained are reliable; however, we cannot guarantee the accuracy of such 
information and have not independently verified the assumptions on which such information is based.

iii

TABLE OF CONTENTS

PART I

Item 1.

Item 1A.

Item 1B.

Item 2.

Item 3.

Item 4.

Business

Risk Factors

Unresolved Staff Comments

Properties

Legal Proceedings

Mine Safety Disclosures

Item 5.

Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of 

PART II

Item 6.

Item 7.

Equity Securities
Selected Financial Data

Management’s Discussion and Analysis of Financial Condition and Results of Operations

Item 7A.

Quantitative and Qualitative Disclosures About Market Risk

Item 8.

Item 9.
Item 9A.

Item 9B.

Item 10.

Item 11.

Item 12.

Item 13.

Item 14.

Item 15.

Item 16.

Financial Statements and Supplementary Data

Changes in and Disagreements with Accountants on Accounting and Financial Disclosure
Controls and Procedures

Other Information

Directors, Executive Officers and Corporate Governance

Executive Compensation

PART III

Security Ownership of Certain Beneficial Owners and Management and Related Stockholder 

Matters

Certain Relationships and Related Transactions, and Director Independence

Principal Accountant Fees and Services

Exhibits and Financial Statement Schedules

Form 10-K Summary

PART IV

1

14

33

33

35

35

36

38

39

70

71

156

156

156

156

156

156

156

157

158

166

iv

ITEM 1.    Business 

Overview

PART I

BUSINESS

Ventas, Inc., an S&P 500 company, is a real estate investment trust (“REIT”) operating at the intersection of healthcare 

and real estate, with a highly diversified portfolio of senior housing; life science, research and innovation; and healthcare 
properties; which we generally refer to as “healthcare real estate,” located throughout the United States, Canada and the United 
Kingdom.  As of December 31, 2020, we owned or managed through unconsolidated real estate entities approximately 1,200 
properties (including properties classified as held for sale), consisting of senior housing communities, medical office buildings 
(“MOBs”), life science, research and innovation centers, inpatient rehabilitation facilities (“IRFs”) and long-term acute care 
facilities (“LTACs”), and health systems.  Our company was originally founded in 1983 and is headquartered in Chicago, 
Illinois with an additional office in Louisville, Kentucky.  

We primarily invest in a diversified portfolio of healthcare real estate assets through wholly owned subsidiaries and 

other co-investment entities.  We operate through three reportable business segments: triple-net leased properties, senior living 
operations, which we also refer to as SHOP, and office operations.  See our Consolidated Financial Statements and the related 
notes, including “Note 2 – Accounting Policies” and “Note 19 – Segment Information,” included in Part II, Item 8 of this 
Annual Report on Form 10-K (the “Annual Report”).  Our senior housing properties are either operated under triple-net leases 
in our triple-net leased properties segment or through independent third-party managers in our senior living operations segment.  

As of December 31, 2020, we leased a total of 366 properties (excluding properties within our office operations 
reportable business segment) to various healthcare operating companies under “triple-net” or “absolute-net” leases that obligate 
the tenants to pay all property-related expenses, including maintenance, utilities, repairs, taxes, insurance and capital 
expenditures.  Our three largest tenants, Brookdale Senior Living Inc. (together with its subsidiaries, “Brookdale Senior 
Living”), Ardent Health Partners, LLC (together with its subsidiaries, “Ardent”) and Kindred Healthcare, LLC (together with 
its subsidiaries, “Kindred”) leased from us 121 properties (excluding eight properties managed by Brookdale Senior Living 
pursuant to long-term management agreements), 12 properties and 32 properties, respectively, as of December 31, 2020.

As of December 31, 2020, pursuant to long-term management agreements, we engaged independent operators, such as 

Atria Senior Living, Inc. (“Atria”) and Sunrise Senior Living, LLC (together with its subsidiaries, “Sunrise”), to manage 441 
senior housing communities in our senior living operations segment for us.  

Through our Lillibridge Healthcare Services, Inc. (“Lillibridge”) subsidiary and our ownership interest in PMB Real 

Estate Services LLC (“PMBRES”), we also provide MOB management, leasing, marketing, facility development and advisory 
services to highly rated hospitals and health systems throughout the United States.  In addition, from time to time, we make 
secured and non-mortgage loans and other investments relating to senior housing and healthcare operators or properties. 

During fiscal 2020 and continuing into fiscal 2021, the world has been, and continues to be, impacted by the novel 

coronavirus (“COVID-19”) pandemic. COVID-19 and actions taken to prevent its spread have negatively affected our 
businesses in a number of ways and are expected to continue to do so. See “Risk Factors” in Part I, Item 1A, “Management’s 
Discussion and Analysis of Financial Condition and Results of Operations” in Part II, Item 7 and “Consolidated Financial 
Statements and the related notes thereto” included in Part II, Item 8, in each case, of this Annual Report.

Business Strategy

We aim to enhance shareholder value by delivering consistent, superior total returns through a strategy of 
(1) generating reliable and growing cash flows, (2) maintaining a balanced, diversified portfolio of high-quality assets and 
(3) preserving our financial strength, flexibility and liquidity. 

Generating Reliable and Growing Cash Flows

Generating reliable and growing cash flows from our senior housing and healthcare assets enables us to pay regular 

cash dividends to stockholders and creates opportunities to increase stockholder value through profitable investments.  The 

1

combination of steady contractual growth from our long-term triple-net leases, steady, reliable cash flows from our loan 
investments and stable cash flows from our office buildings with the higher growth potential inherent in our senior housing 
operating communities drives our ability to generate sustainable, growing cash flows that are resilient to economic downturns.   

Maintaining a Balanced, Diversified Portfolio of High-Quality Assets

We believe that maintaining a balanced portfolio of high-quality assets diversified by investment type, geographic 

location, asset type, tenant or operator, revenue source and operating model diminishes the risk that any single factor or event 
could materially harm our business.  Portfolio diversification also enhances the reliability of our cash flows by reducing our 
exposure to any particular asset class or market, or individual tenant, borrower or manager and making us less susceptible to 
certain risks, including risks related to regulatory changes, climate events and economic downturns or global health events.

Preserving Our Financial Strength, Flexibility and Liquidity

A strong, flexible balance sheet and excellent liquidity position us to capitalize on strategic growth opportunities in the 

senior housing and healthcare industries through acquisitions, investments and development and redevelopment projects.  We 
maintain our financial strength to pursue profitable investment opportunities by actively managing our leverage, improving our 
cost of capital and preserving our access to multiple sources of capital and liquidity, including unsecured bank debt, mortgage 
financings and public and private debt and equity markets.

Portfolio Summary

The following table summarizes our consolidated portfolio of properties and other investments, including construction 

in progress, as of and for the year ended December 31, 2020:

Asset Type

Senior housing communities
MOBs(3)

Research and innovation centers

IRFs and LTACs

Health systems

SNFs

Development properties and other

# of
Properties (1)

# of Units/
Sq. Ft./ 
Beds(2)

Real Estate Property Investments

Revenues

Real Estate 
Property 
Investment, 
at Cost

Percent of
Total Real 
Estate 
Property 
Investments

Real Estate
Property
Investment 
Per Unit/
Bed/Sq. Ft.

(Dollars in thousands)

Percent of 
Total 
Revenues

Revenue

730 

71,629 

$18,313,746

 64.4%  $ 

255.7 

$2,589,991

343 

  19,591,131 

5,704,700 

 20.1 

31 

37 

13 

16 

10 

  5,451,703 

2,031,666 

3,139 

2,064 

1,732 

496,259 

1,522,287 

193,808 

165,234 

 7.1 

 1.7 

 5.4 

 0.7 

 0.6 

0.3 

0.4 

158.1 

737.5 

111.9 

Total real estate investments, at cost

1,180 

$  28,427,700 

 100.0% 

Income from loans and investments

Interest and other income

Revenues related to assets classified as held 

for sale

Total revenues

2

597,229 

216,624 

164,239 

121,179 

17,011 

80,505 

7,609 

970 

 68.4% 

 15.7 

 5.7 

 4.3 

 3.2 

 0.4 

 2.1 

 0.2 

 0.0 

$  3,795,357 

 100.0% 

(1)

(2)

(3)

As of December 31, 2020, we also owned nine senior housing communities, nine research and innovation centers and two MOBs through investments in 
unconsolidated real estate entities.  Our consolidated properties were located in 45 states, the District of Columbia, seven Canadian provinces and the 
United Kingdom and were operated or managed by 82 unaffiliated healthcare operating companies.  
Senior housing communities are generally measured in units; MOBs and research and innovation centers are measured by square footage; and IRFs and 
LTACs, health systems and skilled nursing facilities (“SNFs”) are generally measured by licensed bed count.
As of December 31, 2020, we leased 66 of our consolidated MOBs pursuant to triple-net leases, Lillibridge or PMBRES managed 268 of our consolidated 
MOBs and nine of our consolidated MOBs were managed by five unaffiliated managers.  Through Lillibridge, we also provided management and leasing 
services for 73 MOBs owned by third parties as of December 31, 2020.  

Senior Housing Communities

Our senior housing communities include independent and assisted living communities, continuing care retirement 

communities and communities providing care for individuals with Alzheimer’s disease and other forms of dementia or memory 
loss.  These communities offer studio, one- and two-bedroom residential units on a month-to-month basis primarily to elderly 
individuals requiring various levels of assistance.  Basic services for residents of these communities include housekeeping, 

2

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
meals in a central dining area and group activities organized by the staff with input from the residents.  More extensive care and 
personal supervision, at additional fees, are also available for such needs as eating, bathing, grooming, transportation, limited 
therapeutic programs and medication administration, which allow residents certain conveniences and enable them to live as 
independently as possible according to their abilities.  These services are often met by home health providers and through close 
coordination with the resident’s physician and SNFs.  Charges for room, board and services are generally paid from private 
sources.

Medical Office Buildings

Typically, our MOBs are multi-tenant properties leased to several unrelated medical practices, although in many cases 

they may be associated with a large single specialty or multi-specialty group.  Tenants include physicians, dentists, 
psychologists, therapists and other healthcare providers, who require space devoted to patient examination and treatment, 
diagnostic imaging, outpatient surgery and other outpatient services.  MOBs are similar to commercial office buildings, 
although they require greater plumbing, electrical and mechanical systems to accommodate physicians’ requirements such as 
sinks in every room, brighter lights and specialized medical equipment.  As of December 31, 2020, we owned or managed 
through unconsolidated real estate entities for third parties approximately 21 million square feet of MOBs that are 
predominantly located on or near a health system.

Research and Innovation Centers, Life Science

Our life science, research and innovation centers contain laboratory and office space primarily for universities, 

academic medical centers, technology, biotechnology, medical device and pharmaceutical companies and other organizations 
involved in the life science, research and innovation industry.  While these properties have characteristics similar to commercial 
office buildings, they generally contain more advanced electrical, mechanical, and heating, ventilating and air conditioning 
systems.  The facilities generally have specialty equipment including emergency generators, fume hoods, lab bench tops and 
related amenities.  In many instances, research and innovation center tenants make significant investments to improve their 
leased space, in addition to landlord improvements, to accommodate biology, chemistry or medical device research initiatives.  
Our research and innovation centers are often located on or contiguous to university and academic medical campuses. As of 
December 31, 2020, we own or have investments in nearly 9 million square feet spanning 40 operating properties and three in 
progress ground-up development properties, including a presence in the top two life sciences clusters, South San Francisco, 
California and Cambridge, Massachusetts.

Inpatient Rehabilitation and Long-Term Acute Care Facilities

We have 29 properties that are operated as LTACs.  LTACs have a Medicare average length of stay of greater than 

25 days and serve medically complex, chronically ill patients who require a high level of monitoring and specialized care, but 
whose conditions do not necessitate the continued services of an intensive care unit.  The operators of these LTACs have the 
capability to treat patients who suffer from multiple systemic failures or conditions such as neurological disorders, head 
injuries, brain stem and spinal cord trauma, cerebral vascular accidents, chemical brain injuries, central nervous system 
disorders, developmental anomalies and cardiopulmonary disorders.  Chronic patients often depend on technology for 
continued life support, such as mechanical ventilators, total parenteral nutrition, respiration or cardiac monitors and dialysis 
machines, and, due to their severe medical conditions, generally are not clinically appropriate for admission to a nursing facility 
or rehabilitation hospital.  We do not own any “hospitals within hospitals.”  We also own eight IRFs devoted to the 
rehabilitation of patients with various neurological, musculoskeletal, orthopedic and other medical conditions following 
stabilization of their acute medical issues.

Health Systems

We have 13 properties that are operated as health systems.  Health systems provide medical and surgical services, 

including inpatient care, intensive care, cardiac care, diagnostic services and emergency services.  These health systems also 
provide outpatient services such as outpatient surgery, laboratory, radiology, respiratory therapy, cardiology and physical 
therapy.  In the United States, these health systems receive payments for patient services from the federal government primarily 

3

under the Medicare program, state governments under their respective Medicaid or similar programs, health maintenance 
organizations, preferred provider organizations, other private insurers and directly from patients.

Skilled Nursing Facilities

We have 16 properties that are operated as SNFs.  SNFs provide rehabilitative, restorative, skilled nursing and medical 
treatment for patients and residents who do not require the high technology, care-intensive, high-cost setting of an acute care or 
rehabilitation hospital.  Treatment programs include physical, occupational, speech, respiratory and other therapies, including 
sub-acute clinical protocols such as wound care and intravenous drug treatment.  Charges for these services are generally paid 
from a combination of government reimbursement and private sources.

Geographic Diversification of Properties

Our portfolio of assets is broadly diversified by geographic location throughout the United States, Canada and the 

United Kingdom, with properties in only one state (California) accounting for more than 10% of our total continuing revenues 
and net operating income (“NOI,” which is defined as total revenues, excluding interest and other income, less property-level 
operating expenses and office building services costs) for the year ended December 31, 2020.  

Loans and Investments

As of December 31, 2020, we had $0.9 billion of net loans receivable and investments relating to senior housing and 

healthcare operators or properties.  Our loans receivable and investments provide us with interest income, principal 
amortization and transaction fees and are typically secured by mortgage liens or leasehold mortgages on the underlying 
properties and corporate or personal guarantees by affiliates of the borrowing entity.  In some cases, the loans are secured by a 
pledge of ownership interests in the entity or entities that own the related properties.  From time to time, we also make 
investments in mezzanine loans, which are subordinated to senior secured loans held by other investors that encumber the same 
real estate.  See “Note 6 – Loans Receivable and Investments” of the Notes to Consolidated Financial Statements included in 
Part II, Item 8 of this Annual Report.  

Development and Redevelopment Projects 

We are party to certain agreements that obligate us to develop properties funded through capital that we and, in certain 
circumstances, our joint venture partners provide.  As of December 31, 2020, we had 13 properties under development pursuant 
to these agreements, including three properties that are owned through unconsolidated real estate entities.  In addition, from 
time to time, we engage in redevelopment projects with respect to our existing properties to maximize the value, increase NOI, 
maintain a market-competitive position, achieve property stabilization or change the primary use of the property.

Segment Information

We operate through three reportable business segments: triple-net leased properties, senior living operations and office 

operations.  Non-segment assets, classified as “all other,” consist primarily of corporate assets, including cash, restricted cash, 
loans receivable and investments, and miscellaneous accounts receivable.  Our chief operating decision makers evaluate 
performance of the combined properties in each reportable business segment and determine how to allocate resources to these 
segments, in significant part, based on segment NOI and related measures.  For further information regarding our business 
segments and a discussion of our definition of segment NOI, see “Note 19 – Segment Information” of the Notes to 
Consolidated Financial Statements included in Part II, Item 8 of this Annual Report.

Triple-Net Leased Properties

In our triple-net leased properties segment, we invest in and own senior housing and healthcare properties throughout 

the United States and the United Kingdom and lease those properties to healthcare operating companies under “triple-net” or 
“absolute-net” leases that obligate the tenants to pay all property-related expenses, including maintenance, utilities, repairs, 
taxes, insurance and capital expenditures, and to comply with the terms of the mortgage financing documents, if any, affecting 
the properties.

Senior Living Operations

In our senior living operations segment, we invest in senior housing communities throughout the United States and 
Canada and engage independent managers, such as Atria and Sunrise, to manage those communities. The REIT Investment 

4

Diversification and Empowerment Act of 2007 (“RIDEA”) permits us to own or partially own qualified healthcare properties in 
a structure through which we can participate directly in the cash flow of the properties’ operations (as compared to receiving 
only contractual rent payments under a triple-net lease) in compliance with REIT requirements. In a RIDEA structure, we are 
required to rely on a third-party manager to manage and operate the property, including procuring supplies, hiring and training 
all employees, entering into all third-party contracts for the benefit of the property, including resident/patient agreements, 
complying with laws, including but not limited to healthcare laws, and providing resident care, in exchange for a management 
fee. As a result, we must rely on our managers’ personnel, expertise, technical resources and information systems, risk 
management processes, proprietary information, good faith and judgment to manage our senior living operations efficiently and 
effectively.  We also rely on our managers to set appropriate resident fees, to provide accurate property-level financial results in 
a timely manner and otherwise operate our senior housing communities in compliance with the terms of our management 
agreements and all applicable laws and regulations.  

Office Operations

In our office operations segment, we primarily acquire, own, develop, lease and manage MOBs and research and 

innovation centers throughout the United States.

Significant Tenants and Managers

The following table summarizes certain information regarding our tenant and manager concentration as of and for the 

year ended December 31, 2020 (excluding properties classified as held for sale and properties owned by investments in 
unconsolidated real estate entities as of December 31, 2020):

Senior Living Operations 
Brookdale Senior Living (2)
Ardent
Kindred

Number of 
Properties Leased 
or Managed

432 
121 
12 
32 

Percent of Total 
Real Estate 
Investments (1)
 47.9% 
 8.2 
 4.9 
 1.1 

Percent of Total 
Revenues

 58.0% 
 4.4 
 3.2 
 3.5 

Percent of NOI
 29.4% 
 9.0 
 6.6 
 7.1 

(1) Based on gross book value.
(2) Excludes eight properties managed by Brookdale Senior Living pursuant to long-term management agreements and included in the senior living 

operations reportable business segment.

Triple-Net Leased Properties 

Each of our leases with Brookdale Senior Living, Ardent and Kindred is a triple-net lease.  In addition, each of our 

Brookdale Senior Living, Ardent and Kindred leases has a corporate guaranty. 

The properties we lease to Brookdale Senior Living, Ardent and Kindred accounted for a significant portion of our 

triple-net leased properties segment revenues and NOI for the year ended December 31, 2020.  See “Risk Factors—Our 
Business Operations and Strategy Risks—A significant portion of our revenues and operating income is dependent on a limited 
number of tenants and managers, including Brookdale Senior Living, Ardent, Kindred, Atria and Sunrise.” included in Part I, 
Item 1A of this Annual Report.

Brookdale Senior Living Leases 

As of December 31, 2020, we leased 121 consolidated properties (excluding eight properties managed by Brookdale 
Senior Living pursuant to long-term management agreements and included in the senior living operations reportable business 
segment) to Brookdale Senior Living. 

In July 2020, we entered into a revised master lease agreement (the “Brookdale Lease”) and certain other agreements 

(together with the Brookdale Lease, the “Agreements”) with Brookdale Senior Living.

In connection with the revised Brookdale Lease, we received up-front consideration approximating $235 million, 

which will be amortized over the remaining lease term and consisted of: (a) $162 million in cash including $47 million from the 
transfer to Ventas of deposits under the Brookdale Lease; (b) a $45 million cash pay note (the “Note”), which has an initial 
interest rate of 9.0%, increasing 50 basis points per annum, and matures on December 31, 2025; (c) warrants for 16.3 million 

5

 
 
 
 
shares of Brookdale Senior Living common stock, which are exercisable at any time prior to December 31, 2025 and have an 
exercise price of $3.00 per share.

Base cash rent under the Brookdale Lease is set at $100 million per annum starting in July 2020, with three percent 
annual escalators commencing on January 1, 2022. The Brookdale Lease is guaranteed by, and the Note is a direct obligation 
of, Brookdale Senior Living.

The warrants are classified within other assets on our Consolidated Balance Sheets. These warrants are measured at 

fair value with changes in fair value being recognized within other expense in our Consolidated Statements of Income.

As of December 31, 2020, the aggregate 2021 contractual cash rent due to us from Brookdale Senior Living was 

approximately $100.3 million, and the current aggregate contractual base rent (computed in accordance with U.S. generally 
accepted accounting principles (“GAAP”)) was approximately $148.5 million. 

Ardent Lease

As of December 31, 2020, we leased 11 properties (excluding one MOB leased to Ardent under a separate lease) to 

Ardent pursuant to a single, triple-net master lease agreement.  Per our master lease agreement, Ardent is obligated to pay base 
rent, which escalates annually by the lesser of four times the increase in the Consumer Price Index (“CPI”) for the relevant 
period and 2.5%.  The initial term of the master lease expires on August 31, 2035 and Ardent has one ten-year renewal option.

As of December 31, 2020, the aggregate 2021 contractual cash rent due to us from Ardent was approximately 

$125.9 million, and the current aggregate contractual base rent (computed in accordance with GAAP) was approximately 
$126.0 million.

We also hold a 9.8% ownership interest in Ardent, which entitles us to customary minority rights and protections, as 

well as the right to appoint one of 11 members on the Ardent Board of Directors. 

Kindred Master Leases 

As of December 31, 2020, we leased 29 properties to Kindred pursuant to a master lease agreement.  In November 

2016, Kindred extended the lease term to 2025 for all of our LTACs operated by Kindred that were scheduled to mature in 2018 
and 2020, at the current rent level.  

The aggregate annual rent we receive under each Kindred master lease is referred to as “base rent.”  Base rent escalates 

annually at a specified rate over the prior period base rent, contingent, in some cases, upon the satisfaction of specified facility 
revenue parameters.  The annual rent escalator under the Kindred master lease for 25 properties is based on year-over-year 
changes in CPI, subject to a floor and cap, and is 2.7% for four properties.  As of December 31, 2020, the aggregate 2021 
contractual cash rent due to us from Kindred was approximately $130.4 million, and the current aggregate contractual base rent 
(computed in accordance with GAAP) was approximately $132.4 million. 

Senior Living Operations 

As of December 31, 2020, Atria and Sunrise, collectively, provided comprehensive property management and 
accounting services with respect to 258 of the senior housing communities in our senior living operations segment.  Under these 
management agreements, the operators receive annual base management fees ranging from 4.5% to 7% of revenues generated 
by the applicable properties and, in some cases, additional management fees based on the achievement of specified performance 
targets.  Our management agreements with Atria have initial terms expiring between 2024 and 2027, and our management 
agreements with Sunrise have terms expiring between 2030 and 2038.  In some cases, our management agreements include 
renewal provisions. 

Because Atria and Sunrise manage our properties in exchange for the receipt of a management fee from us, we are not 
directly exposed to the credit risk of our managers in the same manner or to the same extent as our triple-net tenants. See “Risk 
Factors—Our Business Operations and Strategy Risk—A significant portion of our revenues and operating income is dependent 
on a limited number of tenants and managers, including Brookdale Senior Living, Ardent, Kindred, Atria and Sunrise.” and 
included in Part I, Item 1A of this Annual Report.

We hold a 34% ownership interest in Atria, which entitles us to customary minority rights and protections, as well as 

the right to appoint two of the six members on the Atria Board of Directors.  

6

Competition

We generally compete for investments in healthcare real estate assets with publicly traded, private and non-listed 

healthcare REITs, real estate partnerships, healthcare providers, healthcare lenders and other investors, including developers, 
banks, insurance companies, pension funds, government-sponsored entities and private equity firms, some of whom may have 
greater financial resources and lower costs of capital than we do.  Increased competition challenges our ability to identify and 
successfully capitalize on opportunities that meet our objectives, which is affected by, among other factors, the availability of 
suitable acquisition or investment targets, our ability to negotiate acceptable transaction terms and our access to and cost of 
capital.  See “Risk Factors—Our Business Operations and Strategy Risk—Our ongoing strategy depends, in part, upon 
identifying and consummating future investments and effectively managing our expansion opportunities” included in Part I, 
Item 1A of this Annual Report and “Note 10 – Senior Notes Payable and Other Debt” of the Notes to Consolidated Financial 
Statements included in Part II, Item 8 of this Annual Report.

Our tenants and managers also compete on a local and regional basis with other healthcare operating companies that 

provide comparable services.  Senior housing community, SNF and health systems operators compete to attract and retain 
residents and patients to our properties based on scope and quality of care, reputation and financial condition, price, location 
and physical appearance of the properties, services offered, qualified personnel, physician referrals and family preferences.  
With respect to MOBs and research and innovation centers, we and our third-party managers compete to attract and retain 
tenants based on many of the same factors, in addition to quality of the affiliated health system, physician preferences and 
proximity to hospital or university campuses or life science centers and quality of lab space.  The ability of our tenants, 
operators and managers to compete successfully could be affected by private, federal and state reimbursement programs and 
other laws and regulations.  See “Risk Factors—Our Legal, Compliance and Regulatory Risks—We and our tenants, borrowers 
and managers may be adversely affected by regulation and enforcement.” included in Part I, Item 1A of this Annual Report.

Human Capital Management

At Ventas, our experienced team drives our success and creates value. As of December 31, 2020, we had 448 

employees, none of which are subject to a collective bargaining agreement.

We provide a unique environment that offers opportunities for our team to use their professional skills, develop their 

talents and learn from each other as they build successful careers.  We are committed to upholding human dignity and equal 
opportunity under the principles outlined in the United Nations’ Universal Declaration of Human Rights.  Our Global Code of 
Ethics and Business Conduct, Vendor Code of Conduct and Human Rights Policy embed the responsibility to respect human 
rights in business functions across our operations as well as our supply chain.

The Executive Compensation Committee of our Board of Directors provides oversight on certain human capital 

matters, including our DE&I efforts, goals and framework.  We report on human capital matters at each regularly scheduled 
meeting of our Board of Directors.  The most significant human capital measures and objectives that we focus on include the 
topics described below.

Talent Attraction and Retention

We strive to foster a culture that attracts and retains individuals who share a passion for integrity, flawless execution, 
collaborative problem-solving and, above all, excellence.  A key component of our ability to attract and retain the top talent in 
our industry is our investment in our people and their continuous development by providing expansive professional 
opportunities, best-in-class leadership development and a broad array of workshops and training.  Ventas also prides itself in 
offering an industry-leading compensation and benefits package.  

DE&I

Ventas has a long-standing commitment to Diversity, Equity and Inclusion (“DE&I”).  We have established a DE&I 
framework centered around five key pillars of people, culture, investment and financial, changing our society and improving 
our communities and celebrating our commitments.  Development and execution of the DE&I framework is a core component 
of our 2021 short-term incentive program.  Additionally, we incorporated a metric focused on improving the Company’s 
representation of women employees into our 2020-2022 long-term equity incentive program, to further drive progress and 
accountability. As of December 31, 2020, our workforce is.  As of December 31, 2020, our workforce is 52% male and 48% 
female, with our Board of Directors being 36% female.

7

Health & Safety

Ventas is committed to the health and safety of its employees.  The responsibility is shared with each Ventas 

employee, helping to make our workplaces secure and hazard-free to protect against accidents, personal injury/illness and 
property damage.  Our commitment to health and safety is maintained by effective administration, training and education, and 
we expect our operating and development partners to comply with applicable company or legal requirements, whichever is 
more stringent.  In response to the COVID-19 pandemic, we seamlessly shifted to a remote work environment ahead of 
mandatory stay-at-home orders.

Sustainability

Ventas recognizes that sustainable practices and resilience are essential to delivering superior long-term results. Our 

integrated approach to Environment, Social and Governance (“ESG”) principles animates our actions, decisions and processes. 
In 2018, we conducted an in-depth ESG prioritization (a “materiality assessment”) using the Global Reporting Initiative (GRI) 
framework, from which we organized the eight topics identified into three strategic pillars: People, Performance, and Planet. 
This approach integrates ESG principles throughout our business, ensures focus and reporting on key issues and motivates our 
daily efforts. 

Ventas has an established cross-functional ESG Steering Committee, led by our Chairman and CEO and overseen by 

our Director of Sustainability, which provides oversight and monitoring of our ESG strategy, with reporting to our Board of 
Directors. Among other things, Ventas has set ambitious goals to reduce our greenhouse gas emissions, energy, water and 
waste, and to limit high flood risk properties in our portfolio.

For additional information regarding our ESG efforts, please visit our website at www.ventasreit.com

Insurance

We maintain or require in our lease, management and other agreements that our tenants, managers or other 
counterparties maintain comprehensive insurance coverage on our properties and their operations with terms, conditions, limits 
and deductibles that we believe are customary for similarly situated companies in each industry and we frequently review our 
insurance programs and requirements. The insurance that we maintain or require may take the form of commercial insurance, 
captive insurance or self-insurance.

We maintain the property insurance for substantially all properties in our office and senior living operations segment. 
We also maintain liability insurance for certain office properties, as well as the general and professional liability insurance for 
certain senior housing communities and related operations in our senior living operations segment.  However, some senior 
housing managers maintain the general and professional liability insurance for our senior housing communities and related 
operations that they manage in accordance with the terms of our management agreements. 

Through our office operations, we provide engineering, construction and architectural services in connection with new 
development projects, and we maintain and cause tenants, contractors, design professionals and other parties involved with such 
services to maintain property and liability insurance with respect to those activities.

In May 2020, the Company formed a wholly owned captive insurance company, which provides insurance coverage 

for losses below the deductible and within the self-insured retention of the commercial property, general and professional 
liability insurance that we maintain for certain of our Office and senior living operations locations. The Company created this 
captive as part of its overall risk management program and to stabilize insurance costs.

Additional Information

We maintain a website at www.ventasreit.com.  The information on our website is not incorporated by reference in this 

Annual Report, and our web address is included as an inactive textual reference only.

We make available, free of charge, through our website our Annual Report, Quarterly Reports on Form 10-Q, Current 
Reports on Form 8-K and amendments to those reports filed or furnished pursuant to Section 13 or 15(d) of the Exchange Act 
as soon as reasonably practicable after we electronically file such material with, or furnish it to, the SEC.  In addition, our 
Guidelines on Governance, our Global Code of Ethics and Business Conduct (including waivers from and amendments to that 

8

document) and the charters for each of our Audit and Compliance, Nominating and Corporate Governance and Executive 
Compensation Committees are available on our website, and we will mail copies of the foregoing documents to stockholders, 
free of charge, upon request to our Corporate Secretary at Ventas, Inc., 353 North Clark Street, Suite 3300, Chicago, Illinois 
60654.

Governmental Response to the COVID-19 Pandemic

GOVERNMENT REGULATION

In response to the COVID-19 pandemic, in 2020, Congress enacted a series of economic stimulus and relief measures 

through the Coronavirus Aid, Relief and Economic Security Act (the “CARES Act”), the Paycheck Protection Program and 
Health Care Enhancement Act (the “PPPHCE Act”) and the Consolidated Appropriations Act, 2021 (“CAA”). In total, the 
CARES Act, the PPPHCE Act and the CAA authorize approximately $175 billion to be distributed to healthcare providers 
through the Public Health and Social Services Emergency Fund (“Provider Relief Fund”), which is administered by the U.S. 
Department of Health & Human Services (“HHS”). These grants are intended to reimburse eligible providers for expenses 
incurred to prevent, prepare for and respond to COVID-19 and lost revenues attributable to COVID-19. Recipients are not 
required to repay distributions from the Provider Relief Fund, provided that they attest to and comply with certain terms and 
conditions, including, not using grants received from the Provider Relief Fund to reimburse expenses or losses that other 
sources are obligated to reimburse, reporting and record keeping requirements and cooperating with any government audits. 

HHS began distributing Provider Relief Fund grants in April 2020 and has made grants available to various provider 
groups in phases. We applied for and received grants under Phase 2 and Phase 3 of the Provider Relief Fund on behalf of the 
assisted living communities in our senior living operations segment and may apply for additional grants in the future. Many of 
our senior housing, hospital, health system, medical office and other tenants also received grants from the Provider Relief Fund.  
HHS continues to evaluate and provide allocations of, and issue regulations and guidance regarding, grants made under the 
CARES Act and related legislation. We continue to monitor and evaluate the terms and conditions associated with payments 
received under the Provider Relief Fund. 

The CARES Act and related legislation also make other forms of financial assistance available to healthcare providers, 
which has benefited our tenants and our senior living operations segment to varying degrees. This assistance includes Medicare 
and Medicaid payment adjustments and an expansion of the Medicare Accelerated and Advance Payment Program, which made 
available accelerated payments of Medicare funds in order to increase cash flow to providers. These payments are loans that 
providers must repay. Effective October 2020, the Centers for Medicare & Medicaid Services (“CMS”) is no longer accepting 
applications for accelerated or advance payments. The Cares Act and related legislation also suspended Medicare sequestration 
payment adjustments, which would have otherwise reduced payments to Medicare providers by 2%, from May 1, 2020 through 
March 31, 2021, but also extended sequestration through 2030. These laws also include provisions intended to expand coverage 
of COVID-19 testing and preventive services, address healthcare workforce needs and ease other legal and regulatory burdens 
on healthcare providers. Due to the recent enactment of the CARES Act, the PPPHCE Act, and the CAA, there is a high degree 
of uncertainty surrounding their implementation, and the public health emergency continues to evolve. See “Risk Factors—
COVID-19 Risks—There is a high degree of uncertainty regarding the implementation and impact of the CARES Act and other 
pandemic-related legislation and any future COVID-19 relief measures.  There can be no assurance as to the total amount of 
financial assistance we or our tenants or borrowers will receive or that we will be able to benefit from provisions intended to 
increase access to resources and ease regulatory burdens for healthcare providers.” included in Part I, Item 1A of this Annual 
Report. 

Federal, state and local governments and agencies have implemented or announced other programs to provide financial 

and other support to businesses affected by the COVID-19 pandemic, some of which have benefited our tenants, borrowers, 
managers and our senior living operations segment, but that impose significant regulatory and compliance obligations.

United States Healthcare Regulation, Licensing and Enforcement

Overview

We, along with our tenants, borrowers, and managers in the United States, are subject to or impacted by extensive and 

complex federal, state and local healthcare laws and regulations, including laws and regulations relating to quality of care, 
licensure and certificates of need (“CON”), conduct of operations, government reimbursement, such as Medicare and Medicaid, 
fraud and abuse, qualifications of personnel, appropriateness and classification of care, adequacy of plant and equipment, and 
data security and privacy. Although the effects of these laws and regulations on our business are typically indirect, some of 
these laws and regulations apply directly to us and the senior housing communities in our senior living operations segment, 

9

where we generally hold the applicable healthcare licenses and enroll in applicable reimbursement programs. Healthcare laws 
and regulations are wide-ranging, and noncompliance may result in the imposition of civil, criminal, and administrative 
penalties, including: the loss or suspension of accreditation, licenses or CONs; suspension of or non-payment for new 
admissions; denial of reimbursement; fines; suspension, decertification, or exclusion from federal and state healthcare 
programs; or facility closure. Changes in laws or regulations, reimbursement policies, enforcement activity and regulatory non-
compliance by us or our tenants, borrowers or managers could have a significant effect on our and their operations and financial 
condition, which in turn may adversely impact us, as detailed below and set forth under “Risk Factors” in Part I, Item 1A of this 
Annual Report.

Licensure, Certification and CONs

Regulation of senior housing communities consists primarily of state and local laws that may require licenses, 
certifications and permits, and may vary greatly from one jurisdiction to another. Our senior housing communities that receive 
Medicaid payments are also subject to extensive federal laws and regulation. Inpatient rehabilitation and long-term acute care 
facilities, health systems, and skilled nursing facilities, which we do not directly operate, are typically subject to extensive 
federal and state regulation and must hold various licenses, certifications, and permits. Licensure and certification may be 
conditioned on requirements related to, among other things, the quality of medical care provided by an operator, qualifications 
of the operator’s administrative personnel and clinical staff, adequacy of the physical plant and equipment and continuing 
compliance with applicable laws and regulations. Federal and state government agencies have issued additional requirements in 
connection with the COVID-19 pandemic. For example, CMS is requiring testing of skilled nursing facility staff and residents 
for COVID-19 and reporting of COVID-19 data to the Centers for Disease Control and Prevention (“CDC”).

Sanctions for failure to comply with licensure and certification laws and regulations include loss of licensure or 

certification and ability to participate in or receive payments from the Medicare and Medicaid programs, suspension of or non-
payment for new admissions, fines, and potential criminal penalties. Even if we are not the operator of a facility, imposition of 
such sanctions could adversely affect the healthcare facility operator’s ability to satisfy its obligations to us. Further, if we have 
to replace a tenant, we may experience difficulties in finding a replacement and effectively and efficiently transitioning the 
property to a new tenant. See “Risk Factors—Our Business Operations and Strategy Risks—If we need to replace any of our 
tenants or managers, we may be unable to do so on as favorable terms, or at all, and we could be subject to delays, limitations 
and expenses, which could adversely affect our business, financial condition and results of operations.” included in Part I, Item 
1A of this Annual Report.

In addition, many of our licensed facilities and tenants are subject to state CON laws, which require governmental 
approval prior to the development or expansion of licensed facilities and services. The approval process in states with CON 
laws generally requires a facility to demonstrate the need for additional or expanded licensed facilities or services.  CONs, 
where applicable, are also sometimes necessary for changes in ownership or control of licensed facilities, addition of beds, 
investment in major capital equipment, introduction of new services or termination of services previously approved through the 
CON process. CON laws and regulations may restrict our or our tenants’ ability to expand and grow in certain circumstances, 
which could have an adverse effect on our or their revenues.

Fraud and Abuse Enforcement

Participants in the U.S. healthcare industry are subject to complex federal and state civil and criminal laws and 

regulations governing healthcare provider referrals, relationships and arrangements. These laws include: (i) federal and state 
false claims acts, which generally prohibit providers from filing false claims or making false statements to receive payment 
from Medicare, Medicaid or other federal or state healthcare programs; (ii) federal and state anti-kickback and fee-splitting 
statutes, including the federal Anti-Kickback Statute, which prohibits the payment or receipt of remuneration to induce referrals 
or generate business involving healthcare items or services payable by Medicare or Medicaid; (iii) federal and state physician 
self-referral laws, which generally prohibit referrals of certain services by physicians to entities with which the physician or an 
immediate family member has a financial relationship; and (iv) the federal Civil Monetary Penalties Law, which requires a 
lower burden of proof than other fraud and abuse laws and prohibits, among other things, the knowing presentation of a false or 
fraudulent claim for certain healthcare services.

Violating these healthcare fraud and abuse laws and regulations may result in criminal and civil penalties, such as 

punitive sanctions, damage assessments, monetary penalties, imprisonment, denial of Medicare and Medicaid payments, and 
exclusion from the Medicare and Medicaid programs. These laws and regulations are enforced by a variety of federal, state and 

10

local governmental agencies, and many can also be enforced by private litigants through federal and state false claims acts and 
other laws that allow private individuals to bring whistleblower suits known as qui tam actions.

Reimbursement

Sources of revenue for us and some of our tenants include, among others, governmental healthcare programs, such as 

the federal Medicare programs and state Medicaid programs, and non-governmental third-party payors, such as insurance 
carriers and health maintenance organizations. Medicare is a federal health insurance program for persons age 65 and over, 
some disabled persons and persons with end-stage renal disease. Medicaid is a medical assistance program for eligible needy 
persons that is funded jointly by federal and state governments and administered by the states. Medicaid eligibility requirements 
and benefits vary by state. The Medicare and Medicaid programs are highly regulated and subject to frequent and substantial 
changes resulting from legislation, regulations and administrative and judicial interpretations of existing law. 

As federal and state governments face significant budgetary pressures, they continue efforts to reduce Medicare and 

Medicaid spending through methods such as reductions in reimbursement rates and increased enrollment in managed care 
programs. Private payors are typically for-profit companies and are continuously seeking opportunities to control healthcare 
costs. In some cases, private payors rely on government reimbursement systems to determine reimbursement rates, such that 
reductions in Medicare and Medicaid payment rates may negatively impact payments from private payors. These changes may 
result in reduced or slower growth in reimbursement for certain services provided by some of our tenants and managers.  
Additionally, the U.S. Congress and certain state legislatures have introduced and passed a large number of proposals and 
legislation designed to make major changes in the healthcare system, including changes that directly or indirectly affect 
reimbursement. Several of these laws, including the Patient Protection and Affordable Care Act, as amended by the Health Care 
and Education Reconciliation Act of 2010 (the “Affordable Care Act”), have promoted shifting from traditional fee-for-service 
reimbursement models to alternative payment models that tie reimbursement to quality and cost of care, such as accountable 
care organizations and bundled payments. It is difficult to predict the nature and success of future financial or delivery system 
reforms, but changes to reimbursement rates and related policies could adversely impact our and our tenants’ results of 
operations.

For the year ended December 31, 2020, approximately 7.2% of our total revenues and 15.0% of our total NOI were 

attributable to acute and post-acute healthcare facilities in which our third-party tenants receive reimbursement for their services 
under governmental healthcare programs, such as Medicare and Medicaid. We are neither a participant in, nor a direct recipient 
of, any reimbursement under these programs with respect to those leased facilities.

Data Privacy and Security

Privacy and security regulations issued pursuant to the Health Insurance Portability and Accountability Act of 1996, as 

amended ( “HIPAA”), restrict the use and disclosure of individually identifiable health information (“protected health 
information” or “PHI”), provide for individual rights, and require safeguards for PHI and notification of breaches of unsecure 
PHI. Entities subject to HIPAA include most healthcare providers, including some of our tenants and borrowers. These covered 
entities are required to implement administrative, physical and technical practices to protect the security of individually 
identifiable health information that is electronically maintained or transmitted.  Business associates of covered entities who 
create, receive, maintain or transmit PHI are also subject to certain HIPAA provisions. Violations of HIPAA may result in 
substantial civil and/or criminal fines and penalties.

There are several other laws and legislative and regulatory initiatives at the federal and state levels addressing privacy 

and security of personal information. For example, the Federal Trade Commission uses its consumer protection authority to 
initiate enforcement actions in response to data breaches. In most cases, we depend on our tenants and managers to fulfill any 
compliance obligations with respect to HIPAA and other privacy and security laws and regulations.

International Healthcare Regulation

We own senior housing communities in Canada and the United Kingdom. Senior living residences in Canada are 

provincially regulated. Within each province, there are different categories for senior living residences that are generally based 
on the level of care sought or required by a resident (e.g., assisted or retirement living, senior living residences, residential care, 
long-term care). In some of these categories and depending on the province, residences may be government funded, or the 
individual residents may be eligible for a government subsidy, while other residences are exclusively private-pay. The 

11

governing legislation and regulations vary by province, but generally impose licensing requirements and minimum standards of 
care for senior living residences. These laws empower regulators in each province to take a variety of steps to ensure 
compliance, conduct inspections, issue reports and generally regulate the industry.  Our communities in Canada are also subject 
to privacy legislation, including, in certain provinces, privacy laws specifically related to personal health information. Although 
the obligations of senior living residences in the various provinces differ, they all include the obligation to protect personal 
information. The powers of privacy regulators and penalties for violations of privacy law vary according to the applicable law 
or are left to the courts. Our senior living residences in Canada are also subject to a variety of other laws and regulations, 
including minimum wage standards and other employment laws.

In the United Kingdom, our senior housing communities are principally regulated as “care home services” under the 

Health and Social Care Act 2008. This legislation subjects service providers to standards of care and requires, among other 
things, that all persons carrying out such activities, and the managers of such persons, be registered. Providers of care home 
services are also subject (as data controllers) to laws and regulations governing their use of personal data (including in relation 
to their employees, clients and recipients of their services). These laws take the form of the U.K.’s Data Protection Act 2018.  
The Data Protection Act imposes a significant number of obligations on controllers with the potential for fines of up to 4% of 
annual worldwide turnover or €20 million, whichever is greater. Our business operations in the United Kingdom are also 
subject to a range of other regulations, such as the U.K. Bribery Act 2010, minimum wage standards and other employment 
laws.

The United Kingdom exited from the EU on January 31, 2020. The impact of Brexit on the healthcare industry will 

depend on a variety of factors, including the evolution of healthcare regulatory and immigration policy and the broader 
economic outlook in the United Kingdom.

Regulation Impacting Life Science, Research and Innovation Centers

We lease a number of our assets to tenants in the life science, research and innovation sector. These tenants consist of 
university-affiliated organizations and other private sector companies. These tenants may be dependent on private investors, the 
federal government or other sources of funding to support their activities.  Creating a new pharmaceutical product or medical 
device requires substantial investments of time and capital, in part because of the extensive regulation of the healthcare 
industry; it also entails considerable risk of failure in demonstrating that the product is safe and effective and in gaining 
regulatory approval and market acceptance. Therefore, our tenants in the life science, research and innovation industry face 
high levels of regulation, expense and uncertainty. See “Risk Factors—Environmental, Economic and Market Risks—Our life 
science, R&I tenants face unique levels of regulation, expense and uncertainty.” included in Part I, Item 1A of this Annual 
Report.

Our tenants with marketable products may be adversely affected by healthcare reform and government reimbursement 

policies, including changes under the current presidential administration or by private healthcare payors.

Tax Regulation 

We elected to be taxed as a REIT under Sections 856 through 860 of the Internal Revenue Code (the “Code”), 

commencing with our taxable year ended December 31, 1999. Provided we qualify for taxation as a REIT, we generally will 
not be required to pay U.S. federal corporate income taxes on our REIT taxable income that is currently distributed to our 
stockholders. This treatment substantially eliminates the “double taxation” that ordinarily results from investment in a C 
corporation. We will, however, be required to pay U.S. federal income tax in certain circumstances.  

The Code defines a REIT as a corporation, trust or association: 

(1)   that is managed by one or more trustees or directors; 

(2)   that issues transferable shares or transferable certificates to evidence its beneficial ownership; 

(3)   that would be taxable as a domestic corporation, but for Sections 856 through 860 of the Code;

(4)   that is not a financial institution or an insurance company within the meaning of certain provisions of the Code;

(5)   that is beneficially owned by 100 or more persons; 

12

(6)   not more than 50% in value of the outstanding stock of which is owned, actually or constructively, by five or 

fewer individuals, including certain specified entities, during the last half of each taxable year; and

(7)   that meets other tests, regarding the nature of its income and assets and the amount of its distributions. 

We believe that we have been organized and have operated in a manner that has allowed us, and will continue to allow 

us, to satisfy conditions (1) through (7) inclusive, during the relevant time periods, and we intend to continue to be organized 
and operate in this manner.  However, qualification and taxation as a REIT depend upon our ability to meet the various 
qualification tests imposed under the Code, including through actual operating results, asset composition, distribution levels and 
diversity of stock ownership. Accordingly, no assurance can be given that we will be organized or will be able to operate in a 
manner so as to qualify or remain qualified as a REIT.  

If we lose our status as a REIT (currently or with respect to any tax years for which the statute of limitations has not 
expired), we will face serious tax consequences that will substantially reduce the funds available to satisfy our obligations, to 
implement our business strategy and to make distributions to our stockholders for each of the years involved because:

• We would not be allowed a deduction for distributions to stockholders in computing our taxable income and would be 

subject to regular U.S. federal corporate income tax;

• We could be subject to increased state and local taxes; and

•

Unless we are entitled to relief under statutory provisions, we could not elect to be subject to tax as a REIT for four 
taxable years following the year during which we were disqualified.

In addition, in such event we would no longer be required to pay dividends to maintain REIT status, which could 

adversely affect the value of our common stock. See “Risk Factors—Our REIT Status Risks”.

Environmental Regulation

A wide variety of federal, state and local environmental and occupational health and safety laws and regulations affect 
our assets. We are committed to not only meeting these requirements of these laws and regulations, but exceeding them through 
our Environmental, Social and Governance activities.  See “—Sustainability.”

However, these complex federal and state statutes, and their enforcement, involve a myriad of regulations, many of 

which involve strict liability on the part of the potential offender. Some of these federal and state statutes may directly impact 
us. Under various federal, state and local environmental laws, ordinances and regulations, an owner of real property or a 
secured lender, such as us, may be liable for the costs of removal or remediation of hazardous or toxic substances at, under or 
disposed of in connection with such property, as well as other potential costs relating to hazardous or toxic substances 
(including government fines and damages for injuries to persons and adjacent property).

With respect to our properties that are operated or managed by third parties, we may be held primarily or jointly and 
severally liable for costs relating to the investigation and cleanup of any property from which there is or has been an actual or 
threatened release of a regulated material and any other affected properties, regardless of whether we knew of or caused the 
release.  Such costs typically are not limited by law or regulation and could exceed the property’s value.  In addition, we may be 
liable for certain other costs, such as governmental fines and injuries to persons, property or natural resources, as a result of any 
such actual or threatened release.  See “Risk Factors—Our Business Operations and Strategy Risks—Our operating assets may 
expose us to various operational risks, liabilities and claims that could adversely affect our ability to generate revenues or 
increase our costs and could adversely affect our business, financial condition and results of operations.” included in Part I, 
Item 1A of this Annual Report.

Under the terms of our lease, management and other agreements, we generally have a right to indemnification by the 

tenants and managers of our properties for any contamination caused by them.

In general, we have also agreed to indemnify our tenants and managers against any environmental claims (including 

penalties and cleanup costs) resulting from any condition arising in, on or under, or relating to, the leased properties at any time 
before the applicable lease commencement date.  With respect to our senior living operating portfolio, we have agreed to 
indemnify our managers against any environmental claims (including penalties and cleanup costs) resulting from any condition 
on those properties, unless the manager caused or contributed to that condition.

13

ITEM 1A.    Risk Factors

This section discusses material factors that affect our business, operations and financial condition.  It does not describe 

all risks and uncertainties applicable to us, our industry or ownership of our securities.  If any of the following risks, or any 
other risks and uncertainties that are not addressed below or that we have not yet identified, actually occur, we could be 
materially adversely affected and the value of our securities could decline.

As set forth below, we believe that the risks we face generally fall into the following categories:

•
•
•
•
•
•

COVID-19 Risks 
Our Business Operations and Strategy Risks
Environmental, Economic and Market Risks 
Our Capital Structure Risks 
Our Legal, Compliance and Regulatory Risks
Our REIT Status Risks

COVID-19 Risks

The ongoing COVID-19 pandemic and measures intended to prevent its spread have had and may continue to have a 
material adverse effect on our business, financial condition and results of operations. 

The COVID-19 pandemic and measures to prevent its spread have materially negatively impacted our businesses in a 

number of ways and is expected to continue to do so.  For instance, operating costs at our senior housing communities have 
increased as a result of the introduction of public health measures and other operational and regulatory changes affecting our 
properties and our operations, while occupancy and revenue have decreased.  Certain of our tenants and managers have incurred 
significant costs or losses as a result of the pandemic, and may continue to do so, which could adversely affect our results of 
operations. 

Although we continue to undertake extensive efforts to ensure the safety of our properties, employees and residents 

and to provide operator support in this regard, the impact of the COVID-19 pandemic on our facilities could result in additional 
operational costs.  The effects of shelter-in-place and stay-at-home orders, including remote work arrangements for an extended 
period of time, could strain our business continuity plans, introduce operational risk, including but not limited to cybersecurity 
risks, and impair our ability to manage our business.  Further, we have and may continue to implement mitigation and other 
measures to support and protect our employees, which could result in increased labor costs.

Senior housing facilities have been disproportionately impacted by COVID-19.  The ongoing COVID-19 pandemic 

has, to varying degrees during the course of the pandemic, prevented prospective occupants and their families from visiting our 
senior housing communities and limited the ability of new occupants to move into our senior housing communities due to 
heightened move-in criteria and screening.  Although the ongoing impact of the pandemic and vaccine deployment on 
occupancy remain uncertain, occupancy of our senior housing and triple-net properties could further decrease, and the effects of 
the COVID-19 pandemic could adversely affect demand for senior housing for an extended period.  Such a decrease could 
affect the net operating income of our senior housing properties and the ability of our triple-net tenants to make contractual 
payments to us, which in turn, could adversely affect our financial condition, including our ability to pay dividend distributions 
at expected levels or at all.  

Additionally, across our property types, the impact of the COVID-19 pandemic creates a heightened risk of tenant, 
borrower, manager or other obligor bankruptcy or insolvency due to factors such as decreased occupancy, medical practice 
disruptions resulting from stay-at-home orders, increased health and safety and labor expenses or litigation resulting from 
developments related to the COVID-19 pandemic.  In addition to the risks associated with such events elsewhere in these risk 
factors, various federal, state and local governments have enacted, and may continue to enact, laws regulations and moratoriums 
or take other actions that could limit our ability to evict tenants as a result of the COVID-19 pandemic.  Although many of these 
moratoriums are expected to be temporary in nature, they may be in place for a significant period of time until the COVID-19 
pandemic subsides.  While we generally have arrangements and other agreements that give us the right under specified 
circumstances to terminate a lease or evict a tenant for nonpayment, such laws, regulations and moratoriums will generally 
prohibit our ability to begin eviction proceedings even where no rent or only partial rent is being paid for so long as such law, 
regulation or moratorium remains in effect.  We may incur significant costs and it may take a significant amount of time to 
ultimately evict any tenant who is not meeting its contractual rent obligations.  If we cannot transition a leased property to a 

14

new tenant due to the effects of the COVID-19 pandemic or for other reasons, we may take possession of that property, which 
may expose us to certain successor liabilities.  

The COVID-19 pandemic and reactions to it have also adversely affected the U.S. economy and global financial 

markets and, in the longer term, could result in a global economic downturn and a recession, or inflation, which may, in turn 
negatively impact our results of operations.  The COVID-19 pandemic has increased, and may continue to increase, the 
magnitude of many of the other risks described herein.

The trajectory and future impact of the COVID-19 pandemic remains highly uncertain.  The extent of the pandemic’s 

continuing and ultimate effect on our operational and financial performance will depend on a variety of factors, including the 
speed at which available vaccines can be successfully deployed; the rate of acceptance of available vaccines, particularly among 
the residents and staff in our senior housing communities; the impact of new variants of the virus and the effectiveness of 
available vaccines against those variants; ongoing clinical experience, which may differ considerably across regions and 
fluctuate over time; and on other future developments, including the ultimate duration, spread and intensity of the outbreak, the 
availability of testing, the extent to which governments impose, rollback or re-impose preventative restrictions and the 
availability of ongoing government financial support to our business, tenants and operators.  Due to these uncertainties, we are 
not able at this time to estimate the ultimate impact of the COVID-19 pandemic on our business, results of operations, financial 
condition and cash flows.

There is a high degree of uncertainty regarding the implementation and impact of the CARES Act and other pandemic-
related legislation and any future COVID-19 relief measures.  There can be no assurance as to the total amount of financial 
assistance we or our tenants or borrowers will receive or that we will be able to benefit from provisions intended to increase 
access to resources and ease regulatory burdens for healthcare providers.

In response to the COVID-19 pandemic, the CARES Act, the PPPHCE Act, and the CAA authorize a total of $178 

billion to be distributed to healthcare providers through the Provider Relief Fund, which is administered by HHS.  These grants 
are intended to reimburse eligible providers for healthcare-related expenses or lost revenues attributable to COVID-19.  
Recipients are not required to repay distributions from the Provider Relief Fund, provided that they attest to and comply with 
certain terms and conditions, including reporting requirements, limitations on balance billing, and not using grants received 
from the Provider Relief Fund to reimburse expenses or losses that other sources are obligated to reimburse maintaining 
records, and cooperating with any government audits. 

HHS began distributing Provider Relief Fund grants in April 2020 and has made grants available to various provider 

groups in phases.  We applied for grants under Phase 2 and Phase 3 of the Provider Relief Fund on behalf of the assisted living 
communities in our senior living operations segment and may apply for additional grants in the future.  While we have received 
all amounts under our Phase 2 applications, and have begun to receive amounts under our Phase 3 applications, there can be no 
assurance that all our remaining applications will be approved or that additional grants will ultimately be received in full or in 
part.  Any grants that are ultimately received and retained by us are not expected to fully offset the losses incurred in our senior 
living operating portfolio that are attributable to COVID-19.  Further, although we continue to monitor and evaluate the terms 
and conditions associated with the Provider Relief Fund distributions, we cannot assure you that we will be in compliance with 
all requirements related to the payments received under the Provider Relief Fund.  If we or any of our tenants fail to comply 
with all of the terms and conditions, we or they may be required to repay some or all of the grants received and may be subject 
to other enforcement action, which could have a material adverse impact on our business and financial condition.

The CARES Act and related legislation also make other forms of financial assistance available to healthcare providers, 

including through Medicare and Medicaid payment adjustments and an expansion of the Medicare Accelerated and Advance 
Payment Program, which makes available accelerated payments of Medicare funds in order to increase cash flow to providers in 
the form of loans that must be repaid.  In addition to financial assistance, the CARES Act and related legislation include 
provisions intended to increase access to medical supplies and equipment and ease legal and regulatory burdens on healthcare 
providers.  Many of these measures are effective only for the duration of the federal public health emergency that was declared 
as a result of the COVID-19 pandemic.  The current public health emergency determination expires April 21, 2021, and HHS 
has indicated that it likely will be extended but the duration of the extension is unclear.  The HHS Secretary may choose to 
renew the declaration for successive 90-day periods for as long as the emergency continues to exist and may terminate the 
declaration whenever he determines that the public health emergency no longer exists.

Due to the recent enactment of the CARES Act, and other enacted legislation, there is still a high degree of uncertainty 

surrounding their implementation.  Further, the federal government is considering additional financial measures, federal 
agencies continue to issue related regulations and guidance, and the public health emergency continues to evolve.  It is difficult 
to predict the extent to which anticipated ongoing negative effects of the COVID-19 pandemic on us and our tenants and 

15

borrowers will be offset by benefits which we may recognize or receive in the future under existing or future financial 
measures.  Further, there can be no assurance that the terms and conditions of the Provider Relief Fund grants or other programs 
will not change or be interpreted in ways that affect our ability to comply with such terms and conditions (which could affect 
our ability to retain any grants that we receive), the amount of total financial grants we may ultimately receive or our eligibility 
to participate in any future funding.  We continue to assess the potential impact of the COVID-19 pandemic and government 
responses to the pandemic on our business, financial condition and results of operations.

Our Business Operations and Strategy Risks

Market conditions, including, but not limited to, economic and financial market events or conditions and the actual and 
perceived state of the real estate markets and public capital markets generally could negatively impact our business, 
financial condition and results of operations. 

We are dependent on the capital markets and any disruption to the capital markets or our ability to access such markets 

could impair our ability to fulfill our dividend requirements, make payments to our security holders or otherwise finance our 
business operations.  The markets in which we operate are affected by a number of factors that are largely beyond our control 
but may nevertheless have a significant negative impact on us. Adverse developments affecting economies throughout the 
world, including a general tightening of availability of credit (including the price, terms and conditions under which it can be 
obtained), the state of the public capital markets, decreased liquidity in certain financial markets, increased interest rates, 
foreign exchange fluctuations, declining consumer confidence, the actual or perceived state of the real estate market, sustained 
high levels of unemployment or significant declines in stock markets, as well as concerns regarding pandemics, epidemics and 
the spread of contagious diseases, could impact our business, financial condition and results of operations. For example, 
unfavorable changes in general economic conditions, including recessions, economic slowdowns, high unemployment and 
rising prices or the perception by consumers of weak or weakening economic conditions may reduce disposable income and 
impact consumer spending in healthcare or seniors housing, for example, which could adversely affect our financial results.

In addition, increased inflation may have a pronounced negative impact on the interest expense we pay in connection 

with our outstanding indebtedness, in our general and administrative expenses, as these costs could increase at a rate higher 
than our rents, or in the wages that our managers or tenants are obligated to pay.  Conversely, deflation may result in a decline 
in general price levels, often caused by a decrease in the supply of money or credit.  The predominant effects of deflation are 
high unemployment, credit contraction and weakened consumer demand.  Restricted lending practices may impact our ability to 
obtain financing for our properties, which could adversely impact our growth and profitability.

To the extent there is turmoil in the global financial markets, this turmoil has the potential to adversely affect (i) the 
value of our properties; (ii) the availability or the terms of financing that we have or may be able to obtain; (iii) our ability to 
make principal and interest payments on, or refinance when due, any outstanding debt; (iv) our ability to pay a dividend and (v) 
the ability of our tenants to enter into new leasing transactions or satisfy rental payments under existing leases.  Disruptions in 
the capital and credit markets may also adversely affect the market price of our securities.

Third parties must operate our non-Office assets, limiting our control and influence over operations and results.

Although we often have certain general oversight approval rights (e.g., with respect to budgets, material contracts, etc.) 

and the right to review operational and financial reporting information with respect to a majority of our portfolio, our third-
party managers and tenants are ultimately in control of the day-to-day business of the property.  As a result, we have limited 
rights to direct or influence the business or operations of the properties in our portfolio and we depend on third parties to 
operate these properties in a manner that complies with applicable law, minimizes legal risk and maximizes the value of our 
investment.  The failure by such third parties to operate these properties efficiently and effectively and adequately manage the 
related risks could adversely affect our business, financial condition and results of operations.

Our operating assets may expose us to various operational risks, liabilities and claims that could adversely affect our ability 
to generate revenues or increase our costs and could adversely affect our business, financial condition and results of 
operations. 

Despite our limited rights to direct or influence the business or operations of the properties in our senior living 

operations segment, as the owner and operator of senior housing operating properties, we are ultimately responsible for all 
operational risks and other liabilities of such properties, other than those arising out of certain actions by our managers, such as 
gross negligence or willful misconduct.  These risks include, and our resulting revenues are impacted by, among other things, 
fluctuations in occupancy levels, the inability to achieve economic resident fees (including anticipated increases in those fees), 
increases in the cost of food, materials, energy, labor (as a result of unionization or otherwise) or other services, rent control 

16

regulations, national and regional economic conditions, the imposition of new or increased taxes, capital expenditure 
requirements, changes in management or equity, accounting misstatements, professional and general liability claims, and the 
availability and cost of insurance.  Any one or a combination of these factors could result in deficiencies in our senior living 
operations segment, which could adversely affect our business, financial condition and results of operations. Such operational 
risks could also arise as a result of our ownership of office buildings, and which could also adversely affect our business, 
financial condition and results of operations.

Further, we generally hold the applicable healthcare license and enroll in applicable government healthcare programs 

on behalf of the properties in our senior living operations segment.  This subjects us to potential liability under various 
healthcare laws and regulations.  Healthcare laws and regulations are wide-ranging, and noncompliance may result in the 
imposition of civil, criminal, and administrative penalties, including: the loss or suspension of accreditation, licenses or CONs; 
suspension of or non-payment for new admissions; denial of reimbursement; fines; suspension, decertification, or exclusion 
from federal and state healthcare programs; or facility closure.

Decreases in our tenants’, borrowers’ or managers’ revenues, or increases in their expenses, could affect their ability to 
meet their financial and other contractual obligations to us, which could adversely affect our business, financial condition 
and results of operations.

We have limited control over the success or failure of our tenants’, borrowers’ and managers’ businesses, regardless of 
whether our relationship is structured as a triple-net lease, a management contract or as a lender to our tenants.  While we do not 
expressly take on liability on the properties in our triple-net leased or office operations segments, our business, financial 
condition and results of operations could suffer as a result of the risks outlined below.  Any of our tenants, borrowers or 
managers may experience a downturn in their business that materially weakens their financial condition.  For example, many of 
our tenants, borrowers and managers have experienced significant downturns in their businesses due to the COVID-19 
pandemic, including as a result of interruptions in their operations, lost revenues, increased costs, financing difficulties and 
labor shortages.  As a result, they may be unable or unwilling to make payments or perform their obligations when due.  
Although we generally have arrangements and other agreements that give us the right under specified circumstances to 
terminate a lease, evict a tenant or terminate our management agreements, or demand immediate repayment of outstanding loan 
amounts or other obligations to us, we may not be able to enforce such rights or we may determine not to do so if we believe 
that enforcement of our rights would be more detrimental to our business than seeking alternative approaches.

Our senior housing tenants and managers primarily depend on private pay sources consisting of the income or assets of 

residents or their family members to pay fees.  Costs associated with independent and assisted living services generally are not 
reimbursable under government reimbursement programs, such as Medicare and Medicaid.  Accordingly, our tenants and 
managers of our senior housing business depend on attracting seniors with appropriate levels of income and assets, which may 
be affected by many factors, including: (i) prevailing economic and market trends, including the ongoing economic downturn 
and high unemployment rates; (ii) consumer confidence; (iii) demographics; (iv) property condition and safety, including as a 
result of a severe cold and flu season, an epidemic or any other widespread illness, such as seen throughout the COVID-19 
pandemic; (v) public perception about such properties; and (vi) social and environmental factors.  Consequently, if our tenants 
or managers on our behalf fail to effectively conduct their operations, or to maintain and improve our properties, it could 
adversely affect our business reputation as the owner of the properties, as well as the business reputation of our tenants or 
managers and their ability to attract and retain patients and residents in our properties, which could have an adverse effect on 
our and our tenant’s or manager’s business, financial condition and results of operations.  Further, if widespread default or 
nonpayment of outstanding obligations from a large number of tenants or managers occurs at a time when terminating such 
agreement or replacing such tenants or managers may be extremely difficult or impossible, including as a result of the 
COVID-19 pandemic, we may elect instead to amend such agreements with such tenants or managers.  However, such 
amendment may be on terms that are less favorable to us than the original agreement and may have a material adverse effect on 
our results of operations and financial condition. 

Our senior housing tenants and managers may also rely on reimbursements from governmental programs for a portion 
of the revenues from certain properties.  Changes in reimbursement policies and other governmental regulation, that may result 
from actions by Congress or executive orders, may result in reductions in our tenants’ or managers’ revenues, operations and 
cash flows and affect our tenants’ or managers’ ability to meet their obligations to us.  In addition, failure to comply with 
reimbursement regulations or other laws applicable to healthcare providers could result in penalties, fines, litigation costs, lost 
revenue or other consequences, which could adversely impact our tenants’ ability to make contractual rent payments to us under 
a triple-net lease or our cash flows from operations under a management arrangement.

Our tenants and managers have, and may continue to seek to, offset losses by obtaining funds under the recently 

adopted CARES Act or other similar legislative initiatives at the state and local level.  It is indeterminable when or if these 

17

government funds will ultimately be received by our tenants and managers or whether these funds may materially offset the 
cash flow disruptions experienced by them.  If they are unable to obtain these funds within a reasonable time period or at all, or 
the conditions precedent to receiving these funds are overly burdensome or not feasible, it may substantially affect their ability 
to make payments or perform their obligations when due to us.

A significant portion of our revenues and operating income is dependent on a limited number of tenants and managers, 
including Brookdale Senior Living, Ardent, Kindred, Atria and Sunrise.

As of December 31, 2020, Atria and Sunrise, collectively, managed 258 of our consolidated senior housing 
communities pursuant to long-term management agreements.  Additionally, as of December 31, 2020, our three largest tenants, 
Brookdale Senior Living, Ardent and Kindred leased from us 121 properties, 12 properties and 32 properties respectively.  
These properties represent a substantial portion of our portfolio, based on their gross book value, and account for a significant 
portion of our revenues and NOI. 

We depend on Brookdale Senior Living, Ardent and Kindred to pay all property-related expenses, including 

maintenance, utilities, repairs, taxes, insurance and capital expenditures, and to comply with the terms of the mortgage 
financing documents, if any, affecting the properties they lease from us.  We cannot assure you that they will have sufficient 
assets, income and access to financing to enable them to satisfy their obligations to us, and any failure, inability or 
unwillingness by them to do so could adversely affect our business, financial condition and results of operations.  In addition, 
any failure by any one of Brookdale Senior Living, Ardent or Kindred to conduct effectively its operations or to maintain and 
improve the properties it leases from us could adversely affect its business reputation and its ability to attract and retain patients 
or residents in such properties, which could in turn adversely affect our business, financial condition and results of operations.  
These tenants have agreed to indemnify, defend and hold us harmless from and against various claims, litigation and liabilities 
arising in connection with their respective businesses.  We cannot assure you that they will have sufficient assets, income, 
access to financing and insurance coverage to enable them to satisfy those obligations.

We rely on a relatively small number of third-party managers, including Atria and Sunrise, to manage a significant 

number of the properties in our senior living operations segment and to set appropriate resident fees, provide accurate property-
level financial results for our properties in a timely manner and otherwise operate our senior housing communities in 
compliance with the terms of our management agreements and all applicable laws and regulations.  Any adverse developments 
in such managers’ business and affairs or financial condition could impair their ability to manage our properties efficiently and 
effectively and could adversely affect the financial performance of our properties and our business, financial condition and 
results of operations.  If any one of our managers experience financial, legal, accounting or regulatory difficulties, such 
difficulties could result in, among other adverse events, impacts to its financial stability, acceleration of its indebtedness, 
impairment of its continued access to capital, the enforcement of default remedies by its counterparties, or the commencement 
of insolvency proceedings by or against it, any one or a combination of which could adversely affect our business, financial 
condition and results of operations.  

In the event that any of our tenants or managers merge with one another, our dependence on a small group of 

significant third parties would increase, as would our exposure to the risks described above. 

If we need to replace any of our tenants or managers, we may be unable to do so on as favorable terms, or at all, and we 
could be subject to delays, limitations and expenses, which could adversely affect our business, financial condition and 
results of operations.

Our tenants may not renew their leases with us, and our managers may not renew their management agreements with 

us, beyond their current terms.  Our leases and management agreements also provide us, our tenants and our managers with 
termination rights in certain circumstances.   If our leases or management agreements are not renewed or are otherwise 
terminated, we would attempt to reposition those properties with another tenant or manager, as applicable.  We may not be 
successful in identifying suitable replacements or entering into leases, management agreements or other arrangements with new 
tenants or managers on a timely basis or on terms as favorable to us as our current leases or management agreements, if at all, 
and we may be required to fund certain expenses and obligations (e.g., real estate taxes, debt costs and maintenance expenses) 
to preserve the value of, and avoid the imposition of liens on, our properties while they are being repositioned.  

During transition periods to new tenants or managers, the attention of existing tenants or operators may be diverted 

from the performance of the properties, which could cause the financial and operational performance at those properties to 
decline.  Our ability to reposition our properties with a suitable replacement tenant or manager could be significantly delayed or 
limited by state licensing, receivership, certificates of need (“CON”) or other laws, as well as by the Medicare and Medicaid 

18

change-of-ownership rules, and we could incur substantial additional expenses in connection with any licensing, receivership or 
change-of-ownership proceedings. 

In the case of our leased properties, following expiration of a lease term or if we exercise our right to replace a tenant 
in default, rental payments on the related properties could decline or cease altogether while we reposition the properties with a 
suitable replacement tenant.  This risk could be exacerbated by new laws and regulations enacted during the COVID-19 
pandemic that limit our ability to take remedial action against defaulted tenants.  Further, our competitors may offer space at 
rental rates below current market rates or below the rental rates we currently charge, we may lose potential tenants, and we may 
be pressured to reduce our rental rates below those we currently charge to retain tenants when leases expire.  Our ability to 
locate and attract suitable replacement tenants also could be impaired by the specialized healthcare uses or contractual 
restrictions on use of the properties, and we may be forced to spend substantial amounts to adapt the properties to other uses.

In the event of borrower defaults, we may be unable to foreclose successfully on the collateral securing our loans and other 
investments, and even if we are successful in our foreclosure efforts, we may be unable to sell successfully any acquired 
equity interests or reposition any acquired properties, which could adversely affect our ability to recover our investments.

If a borrower defaults under mortgage or other loans for which we are the lender, we may attempt to foreclose on the 

collateral securing those loans, including by acquiring any pledged equity interests or acquiring title to the subject properties, to 
protect our investment.  In response, the defaulting borrower may contest our enforcement of foreclosure or other available 
remedies, seek bankruptcy protection against our exercise of enforcement or other available remedies, or bring claims against us 
for lender liability.  Any such delay or limit on our ability to pursue our rights or remedies could adversely affect our business, 
financial condition and results of operations.

Even if we successfully foreclose on the collateral securing our mortgage loans and other investments, costs related to 
enforcement of our remedies, high loan-to-value ratios or declines in the value of the collateral could prevent us from realizing 
the full amount of our loans, and we could be required to record a valuation allowance for such losses.  Moreover, the collateral 
may include equity interests that may have incurred unexpected liabilities or other limiting characteristics that may result in us 
not having full recourse to assets within that entity’s subsidiary structure.  For example, our mezzanine loan investments are 
subordinate to senior secured loans held by other investors that encumber the same real estate, and, in certain circumstances, 
affords them the ability to extinguish our rights in the collateral, subject to our rights under market and customary co-lender 
contractual arrangements.  In addition, we may not be able to sell the acquired assets or equity interests due to securities law 
restrictions or otherwise.  We may be unable to reposition the properties with new tenants, borrowers or managers on a timely 
basis, if at all, or without making improvements or repairs.  Any delay or costs incurred in selling or repositioning acquired 
collateral could adversely affect our ability to recover our investments.

Our success depends, in part, on our ability to attract and retain talented employees, and the loss of any one of our key 
personnel could adversely impact our business.

The success of our business depends, in part, on the leadership and performance of our executive management team 
and key employees.  Failure to attract, retain and motivate highly qualified employees, or failure to develop and implement a 
viable succession plan, could result in inadequate depth of institutional knowledge, an ineffective culture or lack of certain skill 
sets, significantly impacting our future performance and adversely affecting our business.  Competition for talented employees 
is intense, and we cannot assure you that we will retain our key officers and employees or that we will be able to attract and 
retain other highly qualified individuals in the future.  COVID-19 could also negatively affect the health, availability and 
productivity of our current personnel and could impact our ability to recruit and attract new employees and retain current 
employees, particularly as remote work arrangements and their impact on the market for talent remains uncertain.  In addition, 
while we have long-term compensation plans designed to retain our senior executives, if our retention and succession plans are 
not effective, or if we lose any one or more of our key officers and employees, our business could be adversely affected.  

Our investments are concentrated across a variety of assets classes within healthcare real estate, making us more vulnerable 
to adverse changes in those asset classes and the real estate industry generally. 

We invest in a variety of assets classes in healthcare real estate, including senior housing, R&I and healthcare 

properties.  While we endeavor to invest in a diversified portfolio, there can be no assurance that in a particular economic or 
operational environment that all assets will perform equally well or that our balance sheet will be appropriately balanced.  Each 
of our asset classes are subject to their own dynamics and their own specific operational, financial, compliance, regulatory and 
market risks.

19

Additionally, a broad downturn or slowdown in the healthcare real estate sector could have a greater adverse impact on 
our business than if we had investments in multiple industries and could negatively impact the ability of our tenants, borrowers 
and managers to meet their obligations to us.  A downturn or slowdown in any one of our asset classes could adversely affect 
the value of our properties in such asset class and our ability to sell such properties at prices or on terms acceptable or favorable 
to us. 

In addition, we are exposed to the risks inherent in concentrating our investments in real estate.  Real estate 
investments are relatively illiquid, and our ability to quickly sell or exchange our properties in response to changes in economic 
or other conditions is limited.  In the event we market any of our properties for sale, the value of those properties and our ability 
to sell at prices or on terms acceptable to us could be adversely affected by a downturn in the real estate industry.  In addition, 
transfers of healthcare real estate may be subject to regulatory approvals that are not required for transfers of other types of 
commercial real estate.  We cannot assure you that we will recognize the full value of any property that we sell for liquidity or 
other reasons, and the inability to respond quickly to changes in the performance of our investments could adversely affect our 
business, financial condition and results of operations.

Our investments in and acquisitions of properties may be unsuccessful or fail to meet our expectations.

We have made and expect to continue to make significant acquisitions and investments as part of our overall business 
strategy.  Investments in and acquisitions of healthcare real estate entail risks associated with real estate investments generally, 
including risks that the investment will not achieve expected returns, that the cost estimates for necessary property 
improvements will prove inaccurate or that a tenant, borrower or manager will fail to meet performance expectations.  
Investments outside the United States raise legal, economic and market risks associated with doing business in foreign 
countries, such as currency exchange fluctuations, costly regulatory requirements and foreign tax risks.  Domestic and 
international real estate development and redevelopment projects present additional risks, including construction delays or cost 
overruns that increase expenses, the inability to obtain required zoning, occupancy and other governmental approvals and 
permits on a timely basis, and the incurrence of significant costs prior to completion of the project.  Furthermore, healthcare real 
estate properties are often highly customized, and the development or redevelopment of such properties may require costly 
tenant-specific improvements.  As a result, we cannot assure you that we will achieve the economic benefit we expect from 
acquisition, investment, development and redevelopment opportunities.  Our significant acquisition and investment activity 
presents certain risks to our business and operations, including, among other things, that:

• We may be unable to integrate successfully the operations, personnel or systems of acquired companies, maintain 
consistent standards, controls, policies and procedures, or realize the anticipated benefits of acquisitions and other 
investments within the anticipated time frame, or at all;

• We may be unable to monitor and manage our expanded portfolio of properties effectively, retain key employees or 

attract highly qualified new employees;

•

•

•

•

Projections of estimated future revenues, costs savings or operating metrics that we develop during the due diligence 
and integration planning process might be inaccurate;

Our leverage could increase or our per share financial results could decline if we incur additional debt or issue equity 
securities to finance acquisitions and investments;

Acquisitions and other new investments could divert management’s attention from our existing assets; or

The value of acquired assets or the market price of our common stock may decline.

We cannot assure you that our acquisitions, developments, redevelopments and other investments will be successful or 

meet our expectations without encountering difficulties or that any such difficulties will not adversely affect our business, 
financial condition and results of operations.

Our ongoing strategy depends, in part, upon identifying and consummating future investments and effectively managing our 
expansion opportunities.

An important part of our business strategy is to continue to expand and diversify our portfolio, directly or indirectly 

with third parties, through accretive acquisition, investment, development and redevelopment activities in domestic and 
international healthcare real estate.  Our execution of this strategy by successfully identifying, securing and consummating 
beneficial transactions is made more challenging by increased competition and can be affected by many factors, including our 

20

relationships with current and prospective clients and partners, our ability to obtain debt and equity capital at costs comparable 
to or better than our competitors and lower than the yield we earn on our acquisitions or investments, and our ability to 
negotiate favorable terms with property owners seeking to sell and other contractual counterparties.  We compete for these 
opportunities with a broad variety of potential investors, including other healthcare REITs, real estate partnerships, healthcare 
providers, healthcare lenders and other investors, including developers, banks, insurance companies, pension funds, 
government-sponsored entities and private equity firms, some of whom may have greater financial resources and lower costs of 
capital than we do.  See “Business—Competition” included in Part I, Item 1 of this Annual Report.  If we are unsuccessful at 
identifying and capitalizing on investment, acquisition, development and redevelopment opportunities and otherwise expanding 
and diversifying our portfolio, our growth and profitability may be adversely affected. 

 For example, we recently expanded into R&I and life sciences.  When expanding into areas that are new to us, we face 

numerous risks and uncertainties, including risks associated with (i) the required investment of capital and other resources; (ii) 
the possibility that we have insufficient expertise to engage in such activities profitably or without incurring inappropriate 
amounts of risk; (iii) the diversion of management’s attention from our other businesses; (iv) the increasing demands on or 
issues related to operational and management systems and controls; (v) compliance with additional legal or regulatory 
requirements with which we are not familiar; and (vi) the broadening of our geographic footprint, including the risks associated 
with conducting operations in non-U.S. jurisdictions.  We cannot assure you that any new strategies, markets or businesses that 
we enter into will be successful or meet our expectations without encountering difficulties or that any such difficulties will not 
adversely affect our business, financial condition and results of operations.

Our investments in co-investment vehicles, joint ventures and minority interests may subject us to risks and liabilities that we 
would not otherwise face.  

We have and may continue to develop and acquire properties in joint ventures with other persons or entities when 

circumstances warrant the use of these structures.  In 2020, we formed the Ventas Investment Management Platform to 
consolidate our private capital management capabilities, which includes our  Ventas Life Science and Healthcare Real Estate 
Fund, L.P. (the “Ventas Fund”), our joint venture with GIC and other partnerships with institutional capital vehicles, under a 
single platform.  As of December 31, 2020, we had over $3 billion in assets under management in this platform.  In the future, 
we may enter into additional co-investments, partnerships and joint ventures, either through the Ventas Investment 
Management Platform or otherwise.  We also own minority investments in properties and unconsolidated operating entities 
which entitle us to rights and protections typical of minority investments, but that inherently involve a lesser degree of control 
over business operations.

There can be no assurance that we will be able to form new co-investment vehicles or attract third-party investment 

through additional investments or otherwise.  Further, there can be no assurance that we are able to realize value from such 
investments. 

These ventures involve risks not present with respect to our wholly owned properties, including the following: 

• We may be unable to take actions that are opposed by our partners under arrangements that require us to share 

•
•

decision-making authority over major decisions;
For ventures in which we have a noncontrolling interest, our partners may take actions that we oppose;
If our partners become bankrupt or otherwise fail to fund their share of required capital contributions, we may choose 
to or be required to contribute such capital; 

• We may be subject to transfer restrictions that apply to our interest in the venture;  
•

Our partners may have business interests or goals that conflict with our business interests and goals, including the 
timing, terms and strategies for any investments, and what levels of debt to incur or carry;
Our partners may have competing interests in our markets that could create conflicts of interest;

•
• We could experience an impasse on certain decisions where we do not have sole decision-making authority, which 

•
•

could require us to expend additional resources on resolving such impasses or potential disputes;
Disagreements with our partners could result in litigation or arbitration; 
Our partners might become insolvent, fail to fund their share of required capital contributions or fail to fulfill their 
obligations as a partner, which may require us to infuse our own capital into the venture on behalf of the partner 
despite other competing uses for such capital; and

• We may suffer other losses as a result of actions taken by our partners with respect to our venture investments. 

In some instances, our partners may have the right to cause us to sell our interest, or acquire our partner’s interest, at a 
time when we otherwise would not have initiated such a transaction.  Our ability to acquire our partner’s interest will be limited 

21

if we do not have sufficient cash, available borrowing capacity or other capital resources.  This would require us to sell our 
interest in the venture when we would otherwise prefer to retain it. 

Additionally, certain ventures require Ventas to assume the role of managing member with increased duties to the 
partnership.  In the event of certain events or conflicts, our partners may have recourse against Ventas, including monetary 
penalties, the ability to force a sale or exit the venture, as well as other remedies.

Development, redevelopment and construction risks could affect our profitability.

We invest in various development and redevelopment projects.  In deciding whether to make an investment in a 

project, we make certain assumptions regarding the expected future performance of the property.  Our assumptions are subject 
to risks generally associated with development and redevelopment projects, including, among others, that:

•

Tenants may not lease space at the quantity or rental rate levels or on the schedule projected, including due to 
increased competition in the market and other market and economic conditions;

• We may not complete the project on schedule or within budgeted amounts;
• We may not be able to recognize rental revenue in some cases although cash rent is being paid and the lease has 

commenced;

• We may encounter delays in obtaining or we may fail to obtain all necessary zoning, land use, building, occupancy, 

environmental and other governmental permits and authorizations, or underestimate the costs necessary to develop or 
redevelop the property to market standards;

• We may be unable to obtain financing for the project on favorable terms or at all, including at the maturity of an 

•

•
•

•

applicable construction loan;
Construction or other delays may provide tenants or residents the right to terminate preconstruction leases or cause us 
to incur additional costs, including through rent abatement;
Volatility in the price of construction materials or labor may increase our project costs;
In the case of our MOB and R&I developments, hospitals, health systems, or university partners may maintain 
significant decision-making authority with respect to the development schedule;
Our builders or development managers may fail to perform or satisfy the expectations of our clients or prospective 
clients; and

• We may incorrectly forecast risks associated with development in new geographic regions, including new markets 

where we may not have sufficient depth of market knowledge.

If any of the risks described above occur, our development and redevelopment projects may not yield anticipated 

returns, which could adversely affect our business, financial condition and results of operations.

We face potential adverse consequences from the bankruptcy, insolvency or financial deterioration of our tenants, 
borrowers, managers and other obligors.

We lease our properties to unaffiliated tenants or operate them through independent third-party managers.  We are also 
a direct or indirect lender to various tenants and managers.  We have limited control over the success or failure of our tenants’, 
borrowers’ and managers’ businesses, and, at any time, a tenant, borrower or manager may experience a downturn in its 
business that weakens its financial condition.  If that happens, the tenant, borrower or manager may fail to make its payments to 
us when due.  Although our lease, loan and management agreements give us the right to exercise certain remedies in the event 
of default on the obligations owing to us, we may decide not to exercise those remedies if we believe that enforcement of our 
rights would be more detrimental to our business than seeking alternative approaches.  We may also decide not to enforce other 
contractual protections, such as annual rent escalators, or the properties may not generate sufficient revenue to achieve the 
specified rent escalation parameters, which would adversely affect our business, financial condition and results of operations.  
This risk could be exacerbated by new laws and regulations enacted during the COVID-19 pandemic that limit our ability to 
enforce contractual escalators against tenants affected by the COVID-19 pandemic.

A downturn in any one of our tenants’, borrowers’ or managers’ businesses could ultimately lead to its bankruptcy if it 
is unable to timely resolve the underlying causes, which may be largely outside of its control. Bankruptcy and insolvency laws 
afford certain rights to a party that has filed for bankruptcy or reorganization that may render certain of our rights and remedies 
unenforceable, or, at the least, delay our ability to pursue such rights and remedies and realize any recoveries in connection 
therewith.  For example, we cannot evict a tenant solely because of its bankruptcy filing.  Additionally, a debtor-lessee may 
reject our lease in a bankruptcy proceeding, and any claim we have for unpaid rent might not be paid in full.  We also may be 
required to fund certain expenses and obligations (e.g., real estate taxes, debt costs and maintenance expenses) to preserve the 
value of our properties, avoid the imposition of liens on our properties or transition our properties to a new tenant or manager.

22

Bankruptcy or insolvency proceedings may result in increased costs and significant management distraction.  If we are 

unable to transition affected properties efficiently and effectively, such properties could experience prolonged operational 
disruption, leading to lower occupancy rates and further depressed revenues.  Publicity about a tenant’s, borrowers’ or 
manager’s financial condition and insolvency proceedings may also negatively impact their and our reputations, which could 
result in decreased customer demand and revenues.  Any or all of these risks could adversely affect our business, financial 
condition and results of operations.  These risks would be magnified where we lease multiple properties to a single third party 
under a master lease, as a failure or default under a master lease would expose us to these risks across multiple properties.

We own certain properties subject to ground lease, air rights or other restrictive agreements that limit our uses of the 
properties, restrict our ability to sell or otherwise transfer the properties and expose us to loss of the properties if such 
agreements are breached by us or terminated.

Our investments in MOBs, R&I buildings and facilities as well as other properties may be made through leasehold 

interests in the land on which the buildings are located, leases of air rights for the space above the land on which the buildings 
are located, or other similar restrictive arrangements.  Many of these ground lease, air rights and other restrictive agreements 
impose significant limitations on our uses of the subject properties, restrict our ability to sell or otherwise transfer our interests 
in the properties or restrict the leasing of the properties.  These restrictions may limit our ability to timely sell or exchange the 
properties, impair the properties’ value or negatively impact our ability to find suitable tenants for the properties.  In addition, 
we could lose our interests in the subject properties if the ground lease, air rights or other restrictive agreements are breached by 
us or terminated.

Environmental, Economic and Market Risks 

Increased construction and development in the markets in which our properties are located could adversely affect our future 
occupancy rates, operating margins and profitability.

The oversupply of healthcare real estate could adversely affect our business.  In many jurisdictions, limited barriers to 
entry could lead to the development of new properties that outpaces demand across our various asset classes.  If existing supply 
and development collectively outpaces demand for those assets in the markets in which our properties are located, those 
markets may become saturated and we could experience decreased occupancy, reduced operating margins and lower 
profitability, which could adversely affect our business, financial condition and results of operations. 

General economic conditions and other events or occurrences that affect areas in which our properties are geographically 
concentrated may impact financial results.

We are exposed to general economic conditions, local, regional, national and international economic conditions and 

other events and occurrences that affect the markets in which we own properties.  Our operating performance is impacted by the 
economic conditions of the specific markets in which we have concentrations of properties and could be adversely affected if 
conditions become less favorable in any such markets.  For example, a shortage of skilled workers in a particular region, 
including nurses or other trained personnel, may force our third-party managers to enhance their pay and benefits package to 
compete effectively for such personnel, but such managers may not be able to offset these added costs by increasing the rates 
charged to residents, which may result in less revenue to our business.

A substantial portion of our value is derived from properties in California, New York, Texas, Pennsylvania and 
Illinois, and as a result, we are subject to increased exposure to adverse conditions affecting these regions, including downturns 
in the local economies or changes in local real estate conditions, changing demographics, increased construction and 
competition or decreased demand for our properties, regional climate events and changes in state-specific legislation, which 
could adversely affect our business, financial condition and results of operations.

To the extent that we or our tenants, borrowers and managers are unable to navigate successfully the trends impacting our 
or their businesses and the industries in which we or they operate, we may be adversely affected.

Our tenants, borrowers and managers include senior housing operators, hospitals, post-acute facilities and other 

healthcare systems, medical offices and life sciences and technology companies that are subject to a complex set of trends 
affecting their businesses and the industries in which they operate.  If we or they are unable to successfully navigate such 
trends, our business, financial condition and results of operators could be adversely affected.  

23

There have been, and could be additional, advances or changes in technology, payment models, healthcare delivery 

models, regulation or consumer behavior or perception that could over time reduce demand for on-site activities provided at our 
properties.  For example, the effects of shelter-in-place and stay-at-home orders, including remote work arrangements for an 
extended period of time, could broadly impact market demand for real estate and could cause long term structural changes in 
the marketplace.  If our tenants and managers are not able to adapt to long-term changes in demand, their financial condition 
could be materially impacted, and our business could suffer.  In addition, our tenants, borrowers and managers face an 
increasingly competitive labor market, which has been compounded by the COVID-19 pandemic.  An inability to attract and 
retain trained personnel could negatively impact the ability of our tenants, borrowers and managers to meet their obligations to 
us.  A shortage of care givers or other trained personnel, union activities, minimum wage laws, or general inflationary pressures 
on wages may force tenants, borrowers and managers to enhance pay and benefits packages to compete effectively for skilled 
personnel, or to use more expensive contract personnel, but they may be unable to offset these added costs by increasing the 
rates charged to residents.

Additionally, controls imposed by Medicare, Medicaid and commercial third-party payors designed to reduce 

admissions and lengths of stay, commonly referred to as “utilization reviews,” have affected and are expected to continue to 
affect certain of our tenants, specifically acute care hospitals and post-acute facilities.  Telehealth and increased use of home 
healthcare may also reduce demand for activities at our properties.  The U.S. Congress and certain state legislatures have 
introduced and passed a number of proposals and legislation designed to make major changes in the healthcare system, 
including changes that directly or indirectly affect reimbursement.  Several of these laws, including the Affordable Care Act, 
have promoted shifting from traditional fee-for-service reimbursement models to alternative payment models that tie 
reimbursement to quality and cost of care, such as accountable care organizations and bundled payments.  See “Government 
Regulation—United States Healthcare Regulation, Licensing and Enforcement” included in Part I, Item 1 of this Annual 
Report.  These and other trends could significantly and adversely affect the profitability of these tenants, which could affect 
their ability to make rental payments to us or their willingness to renew their leases on terms that are as favorable to us, or at all.

The hospitals on or near the campuses where our MOBs are located and their affiliated health systems could fail to remain 
competitive or financially viable, which could adversely impact their ability to attract physicians and physician groups to our 
MOBs and our other properties that serve the healthcare industry.

Our MOBs and other properties that serve the healthcare industry depend on the competitiveness and financial 

viability of the hospitals on or near the campuses where our properties are located and their ability to attract physicians and 
other healthcare-related clients to our properties.  The viability of these hospitals, in turn, depends on factors such as the quality 
and mix of healthcare services provided, competition for patients, physicians and physician groups, demographic trends in the 
surrounding community, market position and growth potential as well as the ability of the affiliated health systems to provide 
economies of scale and access to capital.  If a hospital on or near the campus where one of our properties is located fails or 
becomes unable to meet its financial obligations, and if an affiliated health system is unable to support that hospital, that 
hospital may be unable to compete successfully or could be forced to close or relocate, which could adversely impact its ability 
to attract physicians and other healthcare-related clients.  Because we rely on proximity to and affiliations with hospitals to 
create leasing demand in our properties, a hospital’s inability to remain competitive or financially viable, or to attract physicians 
and physician groups, could adversely affect our properties and our business, financial condition and results of operations.

Our life science, R&I tenants face unique levels of regulation, expense and uncertainty. 

Our life science, R&I tenants develop and sell products and services in an industry that is characterized by rapid and 

significant changes, evolving industry standards and uncertainty over the implementation of new healthcare reform legislation, 
which may cause them to lose competitive positions and adversely affect their operation.  These tenants, particularly those 
involved in developing and marketing pharmaceutical products, require significant outlays of funds for the research and 
development, clinical testing, manufacture and commercialization of their products and technologies, as well as to fund their 
obligations, including rent payments due to us, and our tenants’ ability to raise capital depends on the viability of their products 
and technologies, their financial and operating condition and outlook, and the overall financial, banking and economic 
environment.  If private investors, the federal government, universities, public markets or other sources of funding are 
unavailable to support such development, including as a result of general economic conditions, adverse market conditions or 
government shutdowns that limit our tenants’ ability to raise capital, such as those resulting from the current COVID-19 
pandemic, a tenant may not be able to pay rent on the terms agreed or at all, its business may fail and in certain cases, its lease 
may automatically terminate without any further obligation to pay us rent. 

Additionally, the research and development, clinical testing, manufacture and marketing of some of our tenants’ 

products require federal, state and foreign regulatory approvals.  The approval process is typically long, expensive and 
uncertain.  Even if our tenants have sufficient funds to seek approvals, one or all of their products may fail to obtain the 

24

required regulatory approvals on a timely basis or at all.  Furthermore, our tenants may only have a small number of products 
under development.  If one product fails to receive the required approvals at any stage of development, it could significantly 
adversely affect such tenant’s entire business and its ability to pay rent.  Our tenants depend on the commercial success of 
certain products, and they may be unable to manufacture their products successfully or economically; may be unable to adapt to 
the rapid technological advances in the industry and to adequately protect their intellectual property under patent, copyright or 
trade secret laws or may face expiration of patent protection; may be faced with later discovery of safety concerns; may face 
competition from new products; or may not receive acceptance of their products. 

We cannot assure you that any of our life science, R&I tenants will be successful in their businesses.  Any tenant that 
is unable to avoid, or sufficiently mitigate, the risks described above may have difficulty making rental payments or satisfying 
its other lease obligations to us or may have difficulty maintaining the value of our investment, which could materially 
adversely affect our business, financial condition and results of operations.  

Merger, acquisition and investment activity in our industries resulting in a change of control of, or a competitor’s 
investment in, one or more of our tenants, borrowers or managers could adversely affect our business, financial condition 
and results of operations.

The seniors housing and healthcare industries have experienced and may continue to experience consolidation, 
including among owners of real estate, tenants and care providers.  In connection with any change of control of a tenant, 
borrower or manager, such tenant’s, borrower’s or manager’s strategy, financial condition, management team or real estate 
needs may change, any of which could adversely affect our relationship with such party and our revenues and results of 
operations.  In addition, a competitor’s investment in one of our tenants, borrowers or managers could enable our competitor to 
directly or indirectly influence that tenant’s, borrower’s or manager’s business and strategy in a manner that impairs our 
relationship with the tenant, borrower or manager or is otherwise adverse to our interests.  Depending on our contractual 
agreements and the specific facts and circumstances, we may not have the right to consent to a competitor’s investment in, a 
change of control of, or other transactions impacting a tenant, borrower or manager. 

Damage from catastrophic or extreme weather and other natural events and the physical effects of climate change could 
result in losses to the Company.

Certain of our properties are in areas particularly susceptible to revenue loss, cost increase or damage caused by 
catastrophic or extreme weather and other natural events, including fires, snow or ice storms, windstorms or hurricanes, 
earthquakes, flooding or other severe weather.  These adverse weather and natural events could cause substantial damages or 
losses to our properties which could exceed our or our tenants’, borrowers’ or managers’ property insurance coverage.  
Operationally, such events could cause a major power outage, leading to a disruption of our systems and operations.  In the 
event of a loss in excess of insured limits, we could lose our capital invested in the affected property, as well as anticipated 
future revenue from that property.  Any such loss could materially and adversely affect our business, financial condition and 
results of operations.  Climate change may also have indirect effects on our business by increasing the cost of (or making 
unavailable) property insurance on terms we find acceptable.

To the extent that significant changes in the climate occur in areas where our properties are located, we may 
experience extreme weather and changes in precipitation and temperature, all of which may result in physical damage to or a 
decrease in demand for properties located in these areas or affected by these conditions.  Should the impact of climate change 
be material in nature, including destruction of our properties, or occur for lengthy periods of time, our business, financial 
condition or results of operations may be adversely affected.

In addition, changes in federal and state legislation and regulation on climate change could result in increased capital 

expenditures to improve the energy efficiency of our existing properties and could also require us to spend more on our new 
development properties without a corresponding increase in revenue.

Our Capital Structure Risks 

We may become more leveraged.

As of December 31, 2020, we had approximately $11.9 billion of outstanding indebtedness.  The instruments 
governing our existing indebtedness permit us to incur substantial additional debt, including secured debt, and we may satisfy 
our capital and liquidity needs through additional borrowings.  A high level of indebtedness would require us to dedicate a 
substantial portion of our cash flow from operations to the payment of debt service, thereby reducing the funds available to 

25

implement our business strategy and make distributions to stockholders.  A high level of indebtedness on an absolute basis or as 
a ratio to our cash flow could also have the following consequences:

•

•

•

Potential limits on our ability to adjust rapidly to changing market conditions and vulnerability in the event of a 
downturn in general economic conditions or in the real estate or healthcare industries;

Potential impairment of our ability to obtain additional financing to execute on our business strategy; and

Potential downgrade in the rating of our debt securities by one or more rating agencies, which could have the effect of, 
among other things, limiting our access to capital and increasing our cost of borrowing.

In addition, from time to time, we mortgage certain of our properties to secure payment of indebtedness.  If we are 

unable to meet our mortgage payments, then the encumbered properties could be foreclosed upon or transferred to the 
mortgagee with a resulting loss of income and asset value.

We are highly dependent on access to the capital markets. Limitations on our ability to access capital could have an adverse 
effect on us, including our ability to make required payments on our debt obligations, make distributions to our stockholders 
or make future investments necessary to implement our business strategy.

We cannot assure you that we will be able to raise the capital necessary to meet our debt service obligations, make 
distributions to our stockholders or make future investments necessary to implement our business strategy, if our cash flow 
from operations is insufficient to satisfy these needs, and the failure to do so could adversely affect our business.  We cannot 
assure you that conditions in the capital markets will not deteriorate or that our access to capital and other sources of funding 
will not become constrained, which could adversely affect the availability and terms of future borrowings, renewals or 
refinancings and our results of operations and financial condition.  If we cannot access capital at an acceptable cost or at all, we 
may be required to liquidate one or more investments in properties at times that may not permit us to maximize the return on 
those investments or that could result in adverse tax consequences to us. 

As a public company, our access to debt and equity capital depends, in part, on the trading prices of our senior notes 

and common stock, which, in turn, depend upon market conditions that change from time to time, such as the market’s 
perception of our financial condition, our growth potential and our current and expected future earnings and cash distributions.  
Our failure to meet the market’s expectation regarding future earnings and cash distributions or a significant downgrade in the 
ratings assigned to our long-term debt could impact our ability to access capital or increase our borrowing costs.

The COVID-19 pandemic has also caused, and is likely to continue to cause, severe economic, market and other 

disruptions worldwide.  We cannot assure you that conditions in the bank lending, capital and other financial markets will not 
continue to deteriorate as a result of the pandemic, or that our access to capital and other sources of funding will not become 
constrained, which could adversely affect the availability and terms of future borrowings, renewals or refinancings.  The 
continuance of decreased revenue and NOI as a result of the COVID-19 pandemic could lead to downgrades of our long-term 
credit rating.  Such future downgrades could increase our borrowing costs, which would make it more difficult or expensive to 
obtain additional financing or refinance existing obligations and commitments.  In addition, the deterioration of global 
economic conditions as a result of the pandemic has decreased occupancy levels and pricing across our portfolio as senior 
residents and tenants reduce or defer their spending.

We also rely on the financial institutions that are parties to our revolving credit facilities.  If these institutions become 
capital constrained, tighten their lending standards or become insolvent or if they experience excessive volumes of borrowing 
requests from other borrowers within a short period of time, they may be unable or unwilling to honor their funding 
commitments to us, which would adversely affect our ability to draw on our revolving credit facilities and, over time, could 
negatively impact our ability to consummate acquisitions, repay indebtedness as it matures, fund capital expenditures or make 
distributions to our stockholders.

We may be adversely affected by fluctuations in currency exchange rates.

Our ownership of properties in Canada and the United Kingdom currently subjects us to fluctuations in the exchange 

rates between U.S. dollars and Canadian dollars or the British pound, which may, from time to time, impact our financial 
condition and results of operations.  If we continue to expand our international presence through investments in, or acquisitions 
or development of, senior housing or healthcare assets outside the United States, Canada or the United Kingdom, we may 
transact business in other foreign currencies.  Although we may pursue hedging alternatives, including borrowing in local 

26

currencies, to protect against foreign currency fluctuations, we cannot assure you that such fluctuations will not adversely affect 
our business, financial condition and results of operations.

We are exposed to increases in interest rates, which could reduce our profitability and adversely impact our ability to 
refinance existing debt, sell assets or engage in acquisition, investment, development and redevelopment activity, and our 
decision to hedge against interest rate risk might not be effective.

We receive a significant portion of our revenues by leasing assets under long-term triple-net leases that generally 

provide for fixed rental rates subject to annual escalations, while certain of our debt obligations are floating rate obligations 
with interest and related payments that vary with the movement of LIBOR, Bankers’ Acceptance or other indexes.  The 
generally fixed rate nature of a significant portion of our revenues and the variable rate nature of certain of our debt obligations 
create interest rate risk.  Although our operating assets provide a partial hedge against interest rate fluctuations, if interest rates 
rise, the costs of our existing floating rate debt and any new debt that we incur would increase.  These increased costs could 
reduce our profitability, impair our ability to meet our debt obligations, or increase the cost of financing our acquisition, 
investment, development and redevelopment activity.  An increase in interest rates also could limit our ability to refinance 
existing debt upon maturity or cause us to pay higher rates upon refinancing, as well as decrease the amount that third parties 
are willing to pay for our assets, thereby limiting our ability to promptly reposition our portfolio in response to changes in 
economic or other conditions.

We may seek to manage our exposure to interest rate volatility with hedging arrangements that involve additional 

risks, including the risks that counterparties may fail to honor their obligations under these arrangements, that these 
arrangements may not be effective in reducing our exposure to interest rate changes, that the amount of income we earn from 
hedging transactions may be limited by federal tax provisions governing REITs, and that these arrangements may cause us to 
pay higher interest rates on our debt obligations than otherwise would be the case.  Moreover, no amount of hedging activity 
can fully insulate us from the risks associated with changes in interest rates.  Failure to hedge effectively against interest rate 
risk, if we choose to engage in such activities, could adversely affect our business, financial condition and results of operations.

Changes in the method pursuant to which the LIBOR rates are determined and potential phasing out of LIBOR may affect 
our financial results. 

LIBOR and certain other interest “benchmarks” may be subject to regulatory guidance and/or reform that could cause 
interest rates under our current or future debt agreements to perform differently than in the past or cause other unanticipated 
consequences.  The United Kingdom’s Financial Conduct Authority, which regulates LIBOR, has announced that it intends to 
stop encouraging or requiring banks to submit rates for the calculation of LIBOR rates after 2021.  While there is no consensus 
on  what  rate  or  rates  may  become  accepted  alternatives  to  LIBOR,  the  Alternative  Reference  Rates  Committee,  a  steering 
committee  comprised  of  U.S.  financial  market  participants,  selected  the  Secured  Overnight  Finance  Rate  (“SOFR”)  as  an 
alternative to LIBOR.  SOFR is a broad measure of the cost of borrowing cash in the overnight U.S. treasury repo market, and 
the  Federal  Reserve  Bank  of  New  York  started  to  publish  the  SOFR  in  May  2018.    At  this  time,  it  is  impossible  to  predict 
whether  the  SOFR  or  another  reference  rate  will  become  an  accepted  alternative  to  LIBOR.    The  discontinuation,  reform  or 
replacement of LIBOR or any other benchmark rates may have an unpredictable impact on contractual mechanics in the credit 
markets or cause disruption to the broader financial markets, and could have an adverse effect on LIBOR-based interest rates on 
our current or future debt obligations.

Covenants in the instruments governing our and our subsidiaries’ existing indebtedness limit our operational flexibility, and 
a covenant breach could materially adversely affect our operations.

The terms of the instruments governing our existing indebtedness require us to comply with certain customary 
financial and other covenants, such as maintaining debt service coverage, leverage ratios and minimum net worth requirements.  
Our continued ability to incur additional debt and to conduct business in general is subject to our compliance with these 
covenants, which limit our operational flexibility.  Breaches of these covenants could result in defaults under the applicable 
debt instruments and could trigger defaults under any of our other indebtedness that is cross-defaulted against such instruments, 
even if we satisfy our payment obligations.  In addition, covenants contained in the instruments governing our subsidiaries’ 
outstanding mortgage indebtedness may restrict our ability to obtain cash distributions from such subsidiaries for the purpose of 
meeting our debt service obligations.  Financial and other covenants that limit our operational flexibility, as well as defaults 
resulting from our breach of any of these covenants, could adversely affect our business, financial condition and results of 
operations.

27

Our Legal, Compliance and Regulatory Risks

Significant legal or regulatory proceedings could subject us or our tenants or managers to increased operating costs and 
substantial uninsured liabilities, which could materially adversely affect our or their liquidity, financial condition and 
results of operations.

From time to time, we or our tenants or managers may be subject to lawsuits, investigations, claims and other legal or 
regulatory proceedings arising out of our alleged actions or the alleged actions of our tenants and managers.   These claims may 
include, among other things, professional liability and general liability claims, commercial liability claims, unfair business 
practices claims and employment claims, as well as regulatory proceedings, including proceedings related to our senior living 
operations, where we are typically the holder of the applicable healthcare license.  

In our operating assets, including those in our senior living operations and office segments, we are generally 

responsible for all liabilities of such properties, including any lawsuits, investigations, claims and other legal or regulatory 
proceedings, other than those arising out of certain actions by our managers, such as those caused by gross negligence or willful 
misconduct.  As a result, we have exposure to, among other things, professional and general liability claims, employment law 
claims and the associated litigation and other costs related to defending and resolving such claims.  In our senior living 
operations in particular, if one of our managers fails to comply with applicable law or regulation, we may be deemed 
responsible, which could subject us to the imposition of civil, criminal and administrative penalties, including: the loss or 
suspension of accreditation, licenses or CONs; suspension of or non-payment for new admissions; denial of reimbursement; 
fines; suspension, decertification, or exclusion from federal and state healthcare programs; or facility closure.

In certain circumstances, our tenants or managers may be contractually obligated to indemnify, defend and hold us 

harmless in whole or in part with respect to certain actions, legal or regulatory proceedings.  In addition, third parties from 
whom we acquired certain of our assets and, in some cases, their affiliates may be required by the terms of the related 
conveyance documents to indemnify, defend and hold us harmless against certain actions, investigations and claims related to 
the acquired assets and arising prior to our ownership or related to excluded assets and liabilities.  In some cases, a portion of 
the purchase price consideration is held in escrow for a specified period of time as collateral for these indemnification 
obligations. We cannot assure you that these third parties will be able to satisfy their defense and indemnification obligations to 
us or that any purchase price consideration held in escrow will be sufficient to satisfy claims for which we are entitled to 
indemnification. 

An unfavorable resolution of any such lawsuit, investigation, claims or other legal or regulatory proceeding could 

materially adversely affect our or our tenants’ or managers’ liquidity, financial condition and results of operations, and may not 
be subject to sufficient insurance coverage.  In addition, even with a favorable resolution of any such litigation or proceeding, 
the effect of litigation and other potential litigation and proceedings may materially increase operating costs incurred by us or 
our tenants or managers. Negative publicity with respect to any lawsuits, claims or other legal or regulatory proceedings may 
also negatively impact their or our or the properties’ reputation. 

The COVID-19 pandemic may cause our senior housing and healthcare business to face increased exposure to lawsuits 

or other legal or regulatory proceedings filed at the same time across multiple jurisdictions, such as professional or general 
liability litigation alleging wrongful death and negligence claims, some of which may result in large damage awards and not be 
indemnified or subject to sufficient insurance coverage, may require our support as a result of our indemnification agreements 
or may result in restrictions in the operations of our or our tenants’ or managers’ business.  

We and our tenants, borrowers and managers may be adversely affected by regulation and enforcement.

We and our tenants, borrowers and managers are subject to or impacted by extensive and frequently changing federal, 
state, local and international laws and regulations.  For example, the healthcare industry is subject to laws and regulations that 
relate to, among other things, licensure and CON, conduct of operations, ownership of facilities, construction of new facilities 
and addition of equipment, governmental reimbursement programs, such as Medicare and Medicaid, allowable costs, services, 
prices for services, qualified beneficiaries, appropriateness and classification of care, patient rights, resident health and safety, 
data privacy and security laws, wage and hour laws, fraud and abuse and financial and other arrangements that may be entered 
into by healthcare providers.  We generally hold the applicable healthcare licenses and enroll in applicable government 
healthcare programs on behalf of the properties in our senior living operations segment, which subjects us to potential liability 
under certain of such related healthcare laws and regulations.  See “Government Regulation—United States Healthcare 
Regulation, Licensing and Enforcement” included in Part I, Item 1 of this Annual Report.  In addition, many of our R&I tenants 

28

are subject to laws and regulations that govern the research, development, clinical testing, manufacture and marketing of drugs, 
medical devices and similar products. 

The laws and regulations that apply to us and our tenants, borrowers and managers are complex and may change 

rapidly, and efforts to comply and keep up with them require significant resources.  Any changes in scope, interpretation or 
enforcement of the regulatory framework could require us or our tenants, borrowers or managers to invest significant resources 
responding to such changes.  If we or our tenants, borrowers or managers fail to comply with the extensive laws, regulations 
and other requirements applicable to our or their businesses and the operation of our or their properties, we or they could face a 
number of remedial actions, including forced closure, loss of accreditation, bans on admissions of new patients or residents, 
imposition of fines, ineligibility to receive reimbursement from governmental and private third-party payor programs or civil or 
criminal penalties.  In any such event, our and our tenants’, borrowers’ and managers’ respective businesses, results of 
operations (including results of properties) and financial condition could be adversely affected. 

Our investments may expose us to unknown liabilities.

We may acquire or invest in properties or businesses that are subject to liabilities and without any recourse, or with 

only limited recourse, against the prior owners or other third parties with respect to unknown liabilities.  As a result, if a 
liability were asserted against us based upon ownership of those properties, we might have to pay substantial sums to settle or 
contest it, which could adversely affect our results of operations and cash flow.

We may assume or incur liabilities, including, in some cases, contingent liabilities, and be exposed to actual or 

potential claims in connection with our acquisitions that adversely affect us, such as:

•

•

•

•

•

Liabilities relating to the clean-up or remediation of environmental conditions;

Unasserted claims of vendors or other persons dealing with the sellers;

Liabilities, claims and litigation, including indemnification obligations, whether incurred in the ordinary course of 
business, relating to periods prior to or following our acquisition;

Claims for indemnification by general partners, directors, officers and others indemnified by the sellers; and

Liabilities for taxes relating to periods prior to our acquisition.

If the liabilities we assume in connection with acquisitions are greater than expected, or if we discover obligations 

relating to the acquired properties or businesses of which we were not aware at the time of acquisition, our business and results 
of operations could be materially adversely affected.

We could incur substantial liabilities and costs if any of our properties are found to be contaminated with hazardous 
substances or we become involved in any environmental disputes.

Under federal and state environmental laws and regulations, a current or former owner of real property may be liable 
for costs related to the investigation, removal and remediation of hazardous or toxic substances or petroleum that are released 
from or are present at or under, or that are disposed of in connection with such property.  Owners of real property may also face 
other environmental liabilities, including government fines and penalties imposed by regulatory authorities and damages for 
injuries to persons, property or natural resources.  Environmental laws and regulations often impose liability without regard to 
whether the owner was aware of, or was responsible for, the presence, release or disposal of hazardous or toxic substances or 
petroleum.  In certain circumstances, environmental liability may result from the activities of a current or former operator of the 
property.  Although we generally have indemnification rights against the current tenants of our properties for contamination 
caused by them, such indemnification may not adequately cover all environmental costs.  See “Government Regulation—
Environmental Regulation” included in Part I, Item 1 of this Annual Report.

The occurrence of cyber incidents could disrupt our operations, result in the loss of confidential information or damage our 
business relationships and reputation.

Cybersecurity incidents and cyber-attacks have been occurring globally at a more frequent and severe level and will 
likely continue to increase in frequency in the future.  As our reliance on technology has increased, our business is subject to 
greater risk from cyber incidents, including attempts to gain unauthorized access to our or our managers’ or venture partners’ 
systems to disrupt operations, corrupt data or steal confidential information, and other electronic security breaches.  While we, 

29

our managers and our business partners have implemented measures to help mitigate these threats, such measures cannot 
guarantee that we or they will be successful in preventing a cyber incident.  Our information technology networks and related 
systems are essential to our ability to perform day-to-day operations of our business and the occurrence of a cyber incident 
could result in a data center outage, disrupting our systems and operations, or the operations of our managers or business 
partners, compromise the confidential information of our employees, partners or the residents in our senior housing 
communities, and damage our business relationships and reputation.  Although we have implemented various measures to 
manage risks relating to these types of events, such systems could prove to be inadequate and, if compromised, could become 
inoperable for extended periods of time, cease to function properly or fail to adequately secure private information.  We do not 
control the cybersecurity plans and systems put in place by third-party providers, and such third-party providers may have 
limited indemnification obligations to us, which could cause us to be negatively impacted as a result.  Breaches such as those 
involving covertly introduced malware, impersonation of authorized users and industrial or other espionage may not be 
identified even with sophisticated prevention and detection systems, potentially resulting in further harm and preventing them 
from being addressed appropriately.  The failure of these systems or of disaster recovery plans for any reason could cause 
significant interruptions in our operations and result in a failure to maintain the security, confidentiality or privacy of sensitive 
data, including personal information, material nonpublic information and intellectual property and trade secrets and other 
sensitive information in our possession.  We could be required to make a significant investment to remedy the effects of any 
such failures, including but not limited to harm to our reputation, legal claims that we and our partners may be subjected to, 
regulatory or enforcement action arising out of applicable privacy and other laws, adverse publicity, or other events that may 
affect our business and financial performance.

The amount and scope of insurance coverage provided by our policies and policies maintained by our tenants, managers or 
other counterparties may not adequately insure against losses.

We maintain or require in our lease, management and other agreements that our tenants, managers or other 
counterparties maintain comprehensive insurance coverage on our properties and their operations with terms, conditions, limits 
and deductibles that we believe are customary for similarly situated companies in each industry.  Although we frequently 
review our insurance programs and requirements, we cannot assure you that we or our tenants, managers or other 
counterparties, will be able to procure or maintain adequate levels of insurance.   As a result of the COVID-19 pandemic, the 
cost of insurance is expected to increase, and such insurance may not cover certain claims related to COVID-19.  We also 
cannot assure you that we or our tenants, managers or other counterparties will maintain the insurance coverage required under 
our lease, management and other agreements, that we will continue to require the same levels of insurance under our lease, 
management and other agreements, that such insurance will be available at a reasonable cost in the future or at all or that the 
policies maintained will fully cover all losses on our properties upon the occurrence of a catastrophic event.  Furthermore, we 
cannot make any guaranty as to the future financial viability of the insurers that underwrite our policies and the policies 
maintained by our tenants, managers and other counterparties.  If we sustain losses in excess of our insurance coverage, we may 
be required to pay the difference and we could lose our investment in, or experience reduced profits and cash flows from our 
operations.

In certain cases, we and our tenants and managers may be subject to professional liability, general liability, 
employment, premise, privacy, environmental, unfair business practice and contracts claims brought by plaintiffs’ attorneys 
seeking significant damages and attorneys’ fees, some of which may not be insured or indemnified and some of which may 
result in significant damage awards.  Due to the historically high frequency and severity of professional liability claims against 
senior housing and healthcare providers, the availability of professional liability insurance has decreased and the premiums on 
such insurance coverage remain costly.  In addition, insurance for other claims such as wage and hour, certain environmental, 
privacy and unfair business practices may no longer be available, and the premiums on such insurance coverage, to the extent it 
is available, remain costly.  As a result, insurance protection against such claims may not be sufficient to cover all claims 
against us or our tenants or managers and may not be available at a reasonable cost or otherwise on terms that provide adequate 
coverage.  If we or our tenants and managers are unable to maintain adequate insurance coverage or are required to pay 
damages, we or they may be exposed to substantial liabilities and the adverse impact on our or our tenants’ and managers’ 
respective financial condition, results of operations and cash flows could be material, and could adversely affect our tenants’ 
and managers’ ability to meet their obligations to us.

Additionally, we and those of our tenants and managers who self-insure or who transfer risk of losses to a wholly 

owned captive insurance company could incur large funded and unfunded property and liability expenses, which could 
materially adversely affect theirs or our liquidity, financial condition and results of operations. 

Failure to maintain effective internal controls could harm our business, results of operations and financial condition.

30

Pursuant to the Sarbanes-Oxley Act of 2002, we are required to provide a report by management on internal control 

over financial reporting, including management’s assessment of the effectiveness of such control.  Because of its inherent 
limitations, including the possibility of human error, the circumvention or overriding of controls, or fraud, effective internal 
controls over financial reporting may not prevent or detect misstatement and can provide only reasonable assurance with respect 
to the preparation and fair presentation of financial statements.  If we fail to maintain the adequacy of our internal controls over 
financial reporting and our operating internal controls, including any failure to implement required new or improved controls as 
a result of changes to our business or otherwise, or if we experience difficulties in their implementation, our business, financial 
condition and results of operations could be adversely affected and we could fail to meet our reporting obligations.

Our REIT Status Risks 

Loss of our status as a REIT would have significant adverse consequences for us and the value of our common stock.

If we lose our status as a REIT (currently or with respect to any tax years for which the statute of limitations has not 
expired), we will face serious tax consequences that will substantially reduce the funds available to satisfy our obligations, to 
implement our business strategy and to make distributions to our stockholders for each of the years involved because:

• We would not be allowed a deduction for distributions to stockholders in computing our taxable income and would be 

subject to regular U.S. federal corporate income tax;

• We could be subject to increased state and local taxes; and

•

Unless we are entitled to relief under statutory provisions, we could not elect to be subject to tax as a REIT for four 
taxable years following the year during which we were disqualified.

In addition, in such event we would no longer be required to pay dividends to maintain REIT status, which could 

adversely affect the value of our common stock.

Qualification as a REIT involves the application of highly technical and complex provisions of the Internal Revenue 

Code of 1986, as amended (the “Code”) for which there are only limited judicial and administrative interpretations.  The 
determination of factual matters and circumstances not entirely within our control, as well as new legislation, regulations, 
administrative interpretations or court decisions, may adversely affect our investors or our ability to remain qualified as a REIT 
for tax purposes.  In order to maintain our qualification as a REIT, we must satisfy a number of requirements, generally 
including requirements regarding the ownership of our stock, requirements regarding the composition of our assets, a 
requirement that at least 95% of our gross income in any year must be derived from qualifying sources, and we must make 
distributions to our stockholders aggregating annually at least 90% of our net taxable income, excluding capital gains.  
Although we believe that we currently qualify as a REIT, we cannot assure you that we will continue to qualify for all future 
periods.

The 90% distribution requirement will decrease our liquidity and may limit our ability to engage in otherwise beneficial 
transactions.

To comply with the 90% distribution requirement applicable to REITs and to avoid the nondeductible excise tax, we 
must make distributions to our stockholders.  Such distributions reduce the funds we have available to finance our investment, 
acquisition, development and redevelopment activity and may limit our ability to engage in transactions that are otherwise in 
the best interests of our stockholders.

From time to time, we may not have sufficient cash or other liquid assets to satisfy the REIT distribution requirements.  

For example, timing differences between the actual receipt of income and actual payment of deductible expenses, on the one 
hand, and the inclusion of that income and deduction of those expenses in arriving at our taxable income, on the other hand, or 
non-deductible expenses such as principal amortization or repayments or capital expenditures in excess of non-cash deductions 
may prevent us from having sufficient cash or liquid assets to satisfy the 90% distribution requirement.

In the event that timing differences occur or we decide to retain cash or to distribute such greater amount as may be 
necessary to avoid income and excise taxation, we may seek to borrow funds, issue additional equity securities, pay taxable 
stock dividends, distribute other property or securities or engage in a transaction intended to enable us to meet the REIT 
distribution requirements.  Any of these actions may require us to raise additional capital to meet our obligations; however, see 
“—Our Capital Structure Risks—We are highly dependent on access to the capital markets. Limitations on our ability to access 
capital could have an adverse effect on us, including our ability to make required payments on our debt obligations, make 

31

distributions to our stockholders or make future investments necessary to implement our business strategy.”  The terms of the 
instruments governing our existing indebtedness restrict our ability to engage in certain of these transactions.

To preserve our qualification as a REIT, our certificate of incorporation contains ownership limits with respect to our 
capital stock that may delay, defer or prevent a change of control of our company.

To assist us in preserving our qualification as a REIT, our certificate of incorporation provides that if a person acquires 

beneficial ownership of more than 9.0% of our outstanding common stock or more than 9.9% of our outstanding preferred 
stock, the shares that are beneficially owned in excess of the applicable limit are considered “excess shares” and are 
automatically deemed transferred to a trust for the benefit of a charitable institution or other qualifying organization selected by 
our Board of Directors.  The trust is entitled to all dividends with respect to the excess shares and the trustee may exercise all 
voting power over the excess shares.  In addition, we have the right to purchase the excess shares for a price equal to the lesser 
of (i) the price per share in the transaction that created the excess shares or (ii) the market price on the day we purchase the 
shares.  If we do not purchase the excess shares, the trustee of the trust is required to transfer the shares at the direction of our 
Board of Directors.  These ownership limits could delay, defer or prevent a transaction or a change of control that might involve 
a premium price for our common stock or might otherwise be in the best interests of our stockholders.

Our use of TRSs is limited under the Code. 

Under the Code, no more than 20% of the value of the gross assets of a REIT may be represented by securities of one 
or more TRSs.  This limitation may affect our ability to increase the size of our TRSs’ operations and assets, and there can be 
no assurance that we will be able to comply with the applicable limitation, or that such compliance will not adversely affect our 
business.  Also, our TRSs may not, among other things, operate or manage certain healthcare facilities, which may cause us to 
forgo investments we might otherwise make.  Finally, we may be subject to a 100% excise tax on the income derived from 
certain transactions with our TRSs that are not on an arm's-length basis.  We believe our arrangements with our TRSs are on 
arm's-length terms and intend to continue to operate in a manner that allows us to avoid incurring the 100% excise tax described 
above, but there can be no assurance that we will be able to avoid application of that tax.

Complying with REIT requirements may cause us to forego otherwise attractive opportunities (including investing in our 
tenants) or liquidate otherwise attractive investments. 

To qualify as a REIT for federal income tax purposes, we must continually satisfy tests concerning, among other 

things, the sources of our income, the nature and diversification of our assets, the amounts we distribute to our stockholders and 
the ownership of our common stock.  In order to meet these tests, we may be required to forego investments we might 
otherwise make (including investments in our tenants) or to liquidate otherwise attractive investments.  This limited investment 
scope could also lead to financial risks or limit our flexibility during times of operating instability.

The lease of qualified healthcare properties to a TRS is subject to special requirements. 

We lease certain healthcare properties to TRSs, which lessees contract with third-party managers to manage the 

healthcare operations at these properties.  The rents we receive from a TRS pursuant to this arrangement are treated as 
qualifying rents from real property if the healthcare property is a qualified healthcare property (as defined in the Code), the 
rents are paid pursuant to an arm’s-length lease with a TRS and the manager qualifies as an eligible independent contractor (as 
defined in the Code).  We have structured the applicable leases and related arrangements in a manner intended to meet these 
requirements, but there can be no assurance that these conditions will be satisfied.  If any of these conditions is not satisfied 
with respect to a particular lease, then the rents we receive with respect to such lease will not be qualifying rents, which could 
have an adverse effect on our ability to comply with REIT income tests and thus on our ability to qualify as a REIT unless we 
are able to avail ourselves of certain relief provisions.

The tax imposed on REITs engaging in “prohibited transactions” may limit our ability to engage in transactions which 
would be treated as sales for federal income tax purposes.

A REIT’s net income from prohibited transactions is subject to a 100% penalty tax.  In general, prohibited transactions 

are sales or other dispositions of property, other than foreclosure property, held primarily for sale to customers in the ordinary 
course of business, unless certain safe harbor exceptions apply.  Although we do not intend to hold any properties that would be 
characterized as held for sale to customers in the ordinary course of our business, such characterization is a factual 
determination and no guarantee can be given that the IRS would agree with our characterization of our properties or that we will 
always be able to make use of the available safe harbors. 

32

Legislative or other actions affecting REITs could have a negative effect on our stockholders or us.

The rules dealing with federal income taxation are constantly under review by persons involved in the legislative 

process and by the IRS and the U.S. Treasury Department.  Changes to the tax laws, with or without retroactive application, 
could adversely affect our investors or us.  New legislation, U.S. Treasury Department regulations, administrative 
interpretations or court decisions could significantly and negatively affect our ability to qualify as a REIT, the federal income 
tax consequences of such qualification, or the federal income tax consequences of an investment in us.  Also, the law relating to 
the tax treatment of other entities, or an investment in other entities, could change, making an investment in such other entities 
more attractive relative to an investment in a REIT.

The Tax Cuts and Jobs Act of 2017 (the “2017 Tax Act”) significantly changed the U.S. federal income taxation of 

U.S. businesses and their owners, including REITs and their stockholders.  The 2017 Tax Act is unclear in many respects and 
could be subject to potential amendments and technical corrections, as well as interpretations and implementing regulations by 
the U.S. Treasury Department and IRS, any of which could lessen or increase the impact of the 2017 Tax Act.  In addition, it is 
unclear how these U.S. federal income tax changes will affect state and local taxation, which often use federal taxable income 
as a starting point for computing state and local tax liabilities.  

ITEM 1B.    Unresolved Staff Comments

None.

ITEM 2.    Properties

Senior Housing and Healthcare Properties

As of December 31, 2020, we owned or managed through unconsolidated real estate entities approximately 1,200 

properties (including properties classified as held for sale), consisting of senior housing communities, medical office buildings 
(“MOBs”), life science, research and innovation centers, inpatient rehabilitation facilities (“IRFs”) and long-term acute care 
facilities (“LTACs”), and health systems.  We had 13 properties under development, three of which are owned by 
unconsolidated real estate entities. We believe that maintaining a balanced portfolio of high-quality assets diversified by 
investment type, geographic location, asset type, tenant/operator, revenue source and operating model makes us less susceptible 
to single-state regulatory or reimbursement changes, regional climate events and local economic downturns and diminishes the 
risk that any single factor or event could materially harm our business.

As of December 31, 2020, we had $2.2 billion aggregate principal amount of mortgage loan and secured revolving 

construction credit facility indebtedness outstanding, secured by 80 of our properties.  Excluding the portion of such 
indebtedness attributable to our joint venture partners, our share of mortgage loan and secured revolving construction credit 
facility indebtedness outstanding was $2.0 billion.

The following table provides additional information regarding the geographic diversification of our consolidated 

portfolio of properties as of December 31, 2020 (excluding properties owned through investments in unconsolidated real estate 
entities and properties classified as held for sale).

33

 
Senior Housing
Communities

SNFs

MOBs

Research and 
Innovation Centers

Geographic 
Location

# of
Properties

Units

324 

302 

  2,256 

  9,494 

  1,257 

  1,587 

  — 

  4,561 

  1,695 

70 

5 

4 

26 

84 

15 

13 

— 

46 

19 

1 

25 

  2,955 

5 

8 

9 

1 

15 
5 

6 

21 

14 

2 

402 

515 

805 

58 

  1,838 
352 

452 

  1,345 

856 

154 

— 

  — 

3 

222 

22 

  1,666 

2 

1 

1 

115 

133 

126 

14 

  1,301 

4 

3 

41 

24 

7 

23 

31 

4 

6 

4 

17 

45 

3 

8 

19 

45 

2 

451 

326 

  4,729 

  1,664 

439 

  2,109 

  2,326 

399 

494 

182 

  1,247 

  3,588 

321 

655 

  1,909 

  2,218 

123 

2 
655 

169 
 58,190 

74 

 13,943 

12 

776 

741 

 72,909 

# of 
Properties

Licensed 
Beds

# of 
Properties

Square 
Feet(1)

# of 
Properties

— 

— 

— 

— 

1 

— 

— 

— 

— 

— 

1 

— 

— 

— 

— 

— 
— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

1 

— 

— 

— 

— 

— 

— 

4 

— 

— 

— 

— 

— 

— 

— 

5 

— 

4 

— 
16 

— 

— 

16 

— 

— 

— 

— 

82 

— 

— 

— 

— 

— 

82 

— 

— 

— 

— 

— 
— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

153 

— 

— 

— 

— 

— 

— 

620 

— 

— 

— 

— 

— 

— 

— 

469 

— 

326 

— 
1,732 

— 

— 

4 

1 

15 

30 

13 

— 

2 

11 

14 

— 

35 

23 

— 

3 

5 

— 
2 

— 

13 

4 

469 

5 

962 

  2,491 

896 

  — 

102 

223 

  1,187 

  — 

  1,424 

  1,603 

  — 

120 

362 

  — 
83 

  — 

589 

241 

21 

  1,168 

1 

51 

— 

  — 

17 

1 

831 

114 

— 

  — 

— 

  — 

3 

37 

— 

  — 

5 

4 

416 

244 

28 

  1,226 

1 

1 

9 

80 

105 

713 

— 

  — 

20 

— 

7 

16 

— 

5 

10 

21 

— 

— 
345 

  1,093 

  — 

278 

837 

  — 

231 

579 

  1,105 

  — 

  — 
 19,860 

— 

  — 

— 

  — 

1,732 

345 

 19,860 

— 

— 

1 

3 

— 

2 

— 

1 

— 

— 

1 

— 

— 

— 

— 

1 
5 

— 

— 

— 

5 

— 

— 

10 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

5 

3 

— 

— 

— 

— 

— 

3 

— 

— 

— 

— 
40 

— 

— 

40 

Square 
Feet(1)
  — 

  — 

  227 

  784 

  — 

  1,032 

  — 

  252 

  — 

  — 

  129 

  — 

  — 

  — 

  — 

78 
  467 

  — 

  — 

  — 

  818 

  — 

  — 

  1,712 

  — 

  — 

  — 

  — 

  — 

  — 

  — 

  — 

  — 

  — 

  953 

  580 

  — 

  — 

  — 

  — 

  — 

  453 

  — 

  — 

  — 

  — 
  7,487 

  — 

  — 

  7,487 

IRFs and LTACs

Health Systems

# of 
Properties

Licensed 
Beds

# of 
Properties

Licensed 
Beds

— 

— 

1 

6 

1 

— 

— 

6 

— 

— 

4 

1 

— 

1 

— 

— 
— 

— 

— 

— 

1 

— 

— 

1 

— 

— 

— 

— 

2 

1 

— 

1 

— 

— 

1 

— 

— 

— 

1 

9 

— 

— 

— 

— 

— 

— 
37 

— 

— 

37 

— 

— 

60 

503 

68 

— 

— 

508 

— 

— 

430 

59 

— 

384 

— 

— 
— 

— 

— 

— 

60 

— 

— 

124 

— 

— 

— 

— 

123 

52 

— 

50 

— 

— 

52 

— 

— 

— 

49 

617 

— 

— 

— 

— 

— 

— 
  3,139 

— 

— 

  3,139 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 
— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

4 

— 

— 

— 

4 

— 

— 

— 

— 

— 

— 

2 

— 

— 

— 

— 

— 

— 
10 

— 

3 

13 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 
— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

544 

— 

— 

— 

954 

— 

— 

— 

— 

— 

— 

445 

— 

— 

— 

— 

— 

— 
1,943 

— 

121 

2,064 

Alabama

Arkansas

Arizona

California

Colorado

Connecticut
District of 
Columbia

Florida

Georgia

Idaho

Illinois

Indiana

Kansas

Kentucky

Louisiana

Massachusetts
Maryland

Maine

Michigan

Minnesota

Missouri

Mississippi

Montana
North 
Carolina

North Dakota

Nebraska
New 
Hampshire

New Jersey

New Mexico

Nevada

New York

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island
South 
Carolina

South Dakota

Tennessee

Texas

Utah

Virginia

Washington

Wisconsin

West Virginia

Wyoming

Total U.S.

Canada
United 

Kingdom

Total

(1)

Square Feet are in thousands. Totals may not foot due to rounding.

34

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Corporate Offices

Our headquarters are located in Chicago, Illinois and we have an additional corporate office in Louisville, Kentucky.  

We lease all of our corporate offices.

ITEM 3.    Legal Proceedings

The information contained in “Note 14 – Commitments and Contingencies” of the Notes to Consolidated Financial 
Statements included in Part II, Item 8 of this Annual Report is incorporated by reference into this Item 3.  Except as set forth 
therein, we are not a party to, nor is any of our property the subject of, any material pending legal proceedings.

ITEM 4.    Mine Safety Disclosures

Not applicable.

35

PART II

ITEM 5.    Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities

Market Information

Our common stock, par value $0.25 per share, is listed and traded on the New York Stock Exchange (the “NYSE”) 

under the symbol “VTR.”  As of February 18, 2021, there were 374.7 million shares of our common stock outstanding, held by 
approximately 3,802 stockholders of record.

Dividends and Distributions

We pay regular quarterly dividends to holders of our common stock to comply with the provisions of the Internal 

Revenue Code of 1986, as amended (the “Code”), governing REITs.  In order to maintain our qualification as a REIT, we are 
required under the Code, among other things, to distribute annually at least 90% of our REIT taxable income, determined 
without regard to any net capital gain.  In addition, we will be subject to income tax at the regular corporate rate to the extent 
we distribute less than 100% of our REIT taxable income, including any net capital gains.  We expect to distribute at least 
100% of our taxable net income, after the use of any net operating loss carryforwards, to our stockholders for 2021.

In general, our Board of Directors makes decisions regarding the nature, frequency and amount of our dividends on a 

quarterly basis.  Because the Board considers many factors when making these decisions, including our present and future 
liquidity needs, our current and projected financial condition and results of operations and the performance and credit quality of 
our tenants, borrowers and managers, we cannot assure you that we will maintain the practice of paying regular quarterly 
dividends to continue to qualify as a REIT.  Please see “Cautionary Statements” and the risk factors included in Part I, Item 1A 
of this Annual Report for a description of other factors that may affect our distribution policy.

Director and Employee Stock Sales

Certain of our directors, executive officers and other employees have adopted or, from time to time in the future, may 

adopt non-discretionary, written trading plans that comply with Rule 10b5-1 under the Exchange Act, or otherwise monetize, 
gift or transfer their equity-based compensation.  These transactions typically are conducted for estate, tax and financial 
planning purposes and are subject to compliance with our Amended and Restated Securities Trading Policy and Procedures 
(“Securities Trading Policy”), the minimum stock ownership requirements contained in our Guidelines on Governance and all 
applicable laws and regulations.

Our Securities Trading Policy expressly prohibits our directors, executive officers and employees from buying or 

selling derivatives with respect to our securities or other financial instruments that are designed to hedge or offset a decrease in 
the market value of our securities and from engaging in short sales with respect to our securities.  In addition, our Securities 
Trading Policy prohibits our directors and executive officers from holding our securities in margin accounts or pledging our 
securities to secure loans without the prior approval of our Audit and Compliance Committee.  Each of our directors and 
executive officers has advised us that he or she is in compliance with the Securities Trading Policy and has not pledged any of 
our equity securities to secure margin or other loans.

Stock Repurchases

The table below summarizes repurchases of our common stock made during the quarter ended December 31, 2020:

Number of Shares
Repurchased (1)

Average Price
Per Share

Total Number of 
Shares Purchased as 
Part of Publicly 
Announced Plans or 
Programs

Maximum Number 
(or Approximate 
Dollar Value) of 
Shares that May Yet 
be Purchased Under 
the Plans or Programs

October 1 through October 31

November 1 through November 30  

December 1 through December 31

Total

158  $ 

138 

226 

522  $ 

42.19 

46.52 

48.79 

46.19 

— 

— 

— 

— 

— 

— 

— 

— 

(1) Repurchases represent shares withheld to pay taxes on the vesting of restricted stock granted to employees under our 2006 Incentive Plan or 2012 

36

 
 
 
 
 
 
 
 
 
 
 
 
 
Incentive Plan or restricted stock units granted to employees under the Nationwide Health Properties, Inc. (“NHP”) 2005 Performance Incentive Plan and 
assumed by us in connection with our acquisition of NHP.  The value of the shares withheld is the closing price of our common stock on the date the 
vesting or exercise occurred (or, if not a trading day, the immediately preceding trading day) or the fair market value of our common stock at the time of 
the exercise, as the case may be.

Stock Performance Graph

The following performance graph compares the cumulative total return (including dividends) to the holders of our 

common stock from December 31, 2015 through December 31, 2020, with the cumulative total returns of the NYSE Composite 
Index, the FTSE Nareit Composite REIT Index (the “Composite REIT Index”) and the S&P 500 Index over the same period. 
The comparison assumes $100 was invested on December 31, 2015 in our common stock and in each of the foregoing indexes 
and assumes reinvestment of dividends, as applicable.  We have included the NYSE Composite Index in the performance graph 
because our common stock is listed on the NYSE, and we have included the S&P 500 Index because we are a member of the 
S&P 500.  We have included the Composite REIT Index because we believe that it is most representative of the industries in 
which we compete, or otherwise provides a fair basis for comparison with us, and is therefore particularly relevant to an 
assessment of our performance.  The figures in the table below are rounded to the nearest dollar.

Ventas

NYSE Composite Index

Composite REIT Index

S&P 500 Index

12/31/2015

12/31/2016

12/31/2017

12/31/2018

12/31/2019

12/31/2020

$ 

$ 

$ 

$ 

100  $ 

100  $ 

100  $ 

100  $ 

116  $ 

112  $ 

109  $ 

112  $ 

117  $ 

133  $ 

120  $ 

136  $ 

121  $ 

122  $ 

115  $ 

130  $ 

125  $ 

153  $ 

147  $ 

171  $ 

113 

164 

138 

203 

37

Year EndedDollarsVentas Total Return PerformanceVentasNYSE Composite IndexComposite REIT IndexS&P 500 Index12/31/201512/31/201612/31/201712/31/201812/31/201912/31/2020100120140160180200ITEM 6.    Selected Financial Data

The selected financial data has been derived from our audited Consolidated Financial Statements included in Part II, 

Item 8 of this Annual Report and previous Annual Reports.  You should read the following selected financial data in 
conjunction with “Management’s Discussion and Analysis of Financial Condition and Results of Operations” included in Part 
II, Item 7 of this Annual Report and our Consolidated Financial Statements and the notes thereto included in Part II, Item 8 of 
this Annual Report, as acquisitions, dispositions, changes in accounting policies and other items may impact the comparability 
of the financial data.

Operating Data

Rental income

Resident fees and services

Interest expense

As of and For the Years Ended December 31,

2020

2019

2018

2017

2016

(Dollars in thousands, except per share data)

$  1,494,892  $  1,609,876  $  1,513,807  $  1,593,598  $  1,476,176 

  2,197,160 

  2,151,533 

  2,069,477 

  1,843,232 

  1,847,306 

469,541 

451,662 

442,497 

448,196 

419,740 

Property-level operating expenses

  1,937,443 

  1,808,208 

  1,689,880 

  1,483,072 

  1,434,762 

General, administrative and professional fees

Income from continuing operations

Net income attributable to common stockholders

130,158 

441,185 

439,149 

158,726 

439,297 

433,016 

145,978 

135,490 

415,991 

  1,361,222 

409,467 

  1,356,470 

126,875 

652,412 

649,231 

Per Share Data

Income from continuing operations:

Basic

Diluted

Net income attributable to common stockholders:

Basic

Diluted

Cash dividends declared per common share

Other Data

Net cash provided by operating activities
Net cash provided by (used in) investing 

activities

Net cash (used in) provided by financing 

activities

FFO attributable to common stockholders(1)
Normalized FFO attributable to common 

stockholders (1)
Balance Sheet Data

$ 

$ 

$ 

$ 

$ 

1.18  $ 

1.17  $ 

1.20  $ 

1.19  $ 

1.17  $ 

1.16  $ 

3.83  $ 

3.80  $ 

1.18  $ 

1.17  $ 

1.18  $ 

1.17  $ 

1.15  $ 

1.14  $ 

3.82  $ 

3.78  $ 

1.89 

1.87 

1.88 

1.86 

2.143  $ 

3.170  $ 

3.163  $ 

3.115  $ 

2.965 

$  1,450,176  $  1,437,783  $  1,381,467  $  1,428,752  $  1,354,702 

154,295 

  (1,585,299)   

324,496 

(937,107)    (1,214,280) 

  (1,300,021)   

160,674 

  (1,761,937)   

(671,327)   

96,838 

  1,269,255 

  1,436,049 

  1,308,149 

  1,512,885 

  1,440,544 

  1,249,972 

  1,423,047 

  1,462,055 

  1,491,241 

  1,438,643 

Real estate property, gross

Cash and cash equivalents

Total assets

$ 28,427,700  $ 28,826,816  $ 26,476,938  $ 26,260,553  $ 25,380,524 

413,327 

106,363 

72,277 

81,355 

286,707 

  23,929,404 

  24,692,208 

  22,584,555 

  23,954,541 

  23,166,600 

Senior notes payable and other debt

  11,895,412 

  12,158,773 

  10,733,699 

  11,276,062 

  11,127,326 

(1) We consider Funds From Operations attributable to common stockholders (“FFO”) and normalized FFO attributable to 

common stockholders to be appropriate supplemental measures of operating performance of an equity REIT.  In particular, 
we believe that normalized FFO is useful because it allows investors, analysts and our management to compare our 
operating performance to the operating performance of other real estate companies and between periods on a consistent 
basis without having to account for differences caused by non-recurring items and other non-operational events such as 
transactions and litigation.  In some cases, we provide information about identified non-cash components of FFO and 
normalized FFO because it allows investors, analysts and our management to assess the impact of those items on our 
financial results. 

38

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
FFO and normalized FFO presented in this Annual Report, or otherwise disclosed by us, may not be comparable to FFO 
and normalized FFO presented by other real estate companies due to the fact that not all real estate companies use the same 
definitions.  FFO and normalized FFO should not be considered as alternatives to net income attributable to common 
stockholders (determined in accordance with U.S. generally accepted accounting principles (“GAAP”)) as indicators of our 
financial performance or as alternatives to cash flow from operating activities (determined in accordance with GAAP) as 
measures of our liquidity, nor are FFO and normalized FFO necessarily indicative of sufficient cash flow to fund all of our 
needs. 

We use the National Association of Real Estate Investment Trusts (“Nareit”) definition of FFO.  Nareit defines FFO as net 
income attributable to common stockholders (computed in accordance with GAAP), excluding gains or losses from sales of 
real estate property, including gains or losses on remeasurement of equity method investments, and impairment write-
downs of depreciable real estate, plus real estate depreciation and amortization, and after adjustments for unconsolidated 
partnerships and joint ventures.  Adjustments for unconsolidated partnerships and joint ventures will be calculated to reflect 
FFO on the same basis.  We define normalized FFO as FFO excluding the following income and expense items (which 
may be recurring in nature): (a) merger-related costs and expenses, including amortization of intangibles, transition and 
integration expenses, and deal costs and expenses, including expenses and recoveries relating to acquisition lawsuits; (b) 
the impact of any expenses related to asset impairment and valuation allowances, the write-off of unamortized deferred 
financing fees, or additional costs, expenses, discounts, make-whole payments, penalties or premiums incurred as a result 
of early retirement or payment of our debt; (c) the non-cash effect of income tax benefits or expenses, the non-cash impact 
of changes to our executive equity compensation plan, derivative transactions that have non-cash mark-to-market impacts 
on our Consolidated Statements of Income and non-cash charges related to leases; (d) the financial impact of contingent 
consideration, severance-related costs and charitable donations made to the Ventas Charitable Foundation; (e) gains and 
losses for non-operational foreign currency hedge agreements and changes in the fair value of financial instruments; (f) 
gains and losses on non-real estate dispositions and other unusual items related to unconsolidated entities; (g) expenses 
related to the reaudit and re-review in 2014 of our historical financial statements and related matters; (h) net expenses or 
recoveries related to natural disasters; and (i) other incremental items set forth in the normalized FFO reconciliation 
included herein. 

See “Management’s Discussion and Analysis of Financial Condition and Results of Operations—Non-GAAP Financial 
Measures” included in Part II, Item 7 of this Annual Report for a reconciliation of FFO and normalized FFO to our GAAP 
earnings.

ITEM 7.    Management’s Discussion and Analysis of Financial Condition and Results of Operations

The following discussion provides information that management believes is relevant to an understanding and 
assessment of the consolidated financial condition and results of operations of Ventas, Inc.  You should read this discussion in 
conjunction with our Consolidated Financial Statements and the notes thereto included in Part II, Item 8 of this Annual Report 
and our Risk Factors included in Part I, Item 1A of this Annual Report.

Business Summary and Overview of 2020 

Ventas, Inc., an S&P 500 company, is a real estate investment trust (“REIT”) operating at the intersection of healthcare 

and real estate, with a highly diversified portfolio of senior housing; life science, research and innovation; and healthcare 
properties; which we generally refer to as “healthcare real estate,” located throughout the United States, Canada and the United 
Kingdom.  As of December 31, 2020, we owned or managed through unconsolidated real estate entities approximately 1,200 
properties (including properties classified as held for sale), consisting of senior housing communities, medical office buildings 
(“MOBs”), life science, research and innovation centers, inpatient rehabilitation facilities (“IRFs”) and long-term acute care 
facilities (“LTACs”), and health systems.  Our company was originally founded in 1983 and is headquartered in Chicago, 
Illinois with an additional office in Louisville, Kentucky.  

We primarily invest in a diversified portfolio of healthcare real estate assets through wholly owned subsidiaries and 

other co-investment entities.  We operate through three reportable business segments: triple-net leased properties, senior living 
operations, which we also refer to as SHOP, and office operations.  See our Consolidated Financial Statements and the related 
notes, including “Note 2 – Accounting Policies” and “Note 19 – Segment Information,” included in Part II, Item 8 of this 
Annual Report.  Our senior housing properties are either operated under triple-net leases in our triple-net leased properties 
segment or through independent third-party managers in our senior living operations segment.

39

We aim to enhance shareholder value by delivering consistent, superior total returns by (1) generating reliable and 
growing cash flows, (2) maintaining a balanced, diversified portfolio of high-quality assets and (3) preserving our financial 
strength, flexibility and liquidity.

Our ability to access capital in a timely and cost-effective manner is critical to the success of our business strategy 
because it affects our ability to satisfy existing obligations, including the repayment of maturing indebtedness, and to make 
future investments.  Factors such as general market conditions, interest rates, credit ratings on our securities, expectations of our 
potential future earnings and cash distributions, and the trading price of our common stock impact our access to and cost of 
external capital.  For that reason, we generally attempt to match the long-term duration of our investments in real property with 
long-term financing through the issuance of shares of our common stock or the incurrence of long-term fixed rate debt.

COVID-19 Update

During fiscal 2020 and continuing into fiscal 2021, the COVID-19 pandemic has negatively affected our businesses in 

a number of ways and is expected to continue to do so.  

Operating Results.  Our senior living operations segment, which we also refer to as SHOP, was significantly impacted 
by the COVID-19 pandemic.  Occupancy decreased over the course of 2020, while operating expenses increased as our senior 
living communities responded to the pandemic, resulting in a significant decline in NOI compared to 2019.  Our NNN senior 
housing tenants’ performance was similarly affected by COVID-19.  During the course of 2020, we modified certain NNN 
senior housing leases to reset rent and provided other modest financial accommodations to certain NNN senior housing tenants 
who needed it as a result of COVID-19.  We also wrote-off previously accrued straight-line rental income related to NNN 
senior housing tenants due to COVID-19. 

However, we benefited from our ongoing strategy of diversification, with our office and NNN healthcare businesses 

demonstrating resilience in the face of the pandemic.  The Company’s NNN healthcare tenants benefited from significant 
government financial support that was deployed early and has partially offset the direct financial impact of the pandemic. Our 
office operations segment, which primarily serves MOB and research and innovation tenants that were less impacted by the 
pandemic, delivered steady performance throughout the year. 

Provider Relief Grants.  In the third and fourth quarter of 2020, we applied for grants under Phase 2 and Phase 3 of the 

Provider Relief Fund administered by the U.S. Department of Health & Human Services (“HHS”) on behalf of the assisted 
living communities in our senior living operations segment to partially mitigate losses attributable to COVID-19.  These grants 
are intended to reimburse eligible providers for expenses incurred to prevent, prepare for and respond to COVID-19 and lost 
revenues attributable to COVID-19. Recipients are not required to repay distributions from the Provider Relief Fund, provided 
that they attest to and comply with certain terms and conditions. See “Government Regulation—Governmental Response to the 
COVID-19 Pandemic” in Part I, Item 1 of this Annual Report. 

During the fourth quarter of 2020, we received $34.3 million and $0.8 million in grants in connection with our Phase 2 

and Phase 3 applications, respectively, and recognized these grants within property-level operating expenses in our 
Consolidated Statements of Income.  Subsequent to December 31, 2020, we received $13.6 million in grants in connection with 
our Phase 3 applications, which we expect to recognize in 2021. While we have received all amounts under our Phase 2 
applications and have begun to receive amounts under our Phase 3 applications, there can be no assurance that our remaining 
applications will be approved or that additional funds will ultimately be received. Any grants that are ultimately received and 
retained by us are not expected to fully offset the losses incurred in our senior living operating portfolio that are attributable to 
COVID-19. Further, although we continue to monitor and evaluate the terms and conditions associated with the Provider Relief 
Fund distributions, we cannot assure you that we will be in compliance with all requirements related to the payments received 
under the Provider Relief Fund.  

Capital Conservation Actions.  In response to the COVID-19 pandemic, we took precautionary steps to increase 

liquidity and preserve financial flexibility in light of the resulting uncertainty. See “—Liquidity and Capital Resources; Recent 
Capital Conservation Actions.” As of February 16, 2021, we had approximately $3.0 billion in liquidity, including availability 
under our revolving credit facility and cash and cash equivalents on hand, with no borrowings outstanding under our 
commercial paper program and negligible near-term debt maturing.

Continuing Impact.  The trajectory and future impact of the COVID-19 pandemic remains highly uncertain. The extent 

of the pandemic’s continuing and ultimate effect on our operational and financial performance will depend on a variety of 
factors, including the speed at which available vaccines can be successfully deployed; the rate of acceptance of available 
vaccines, particularly among the residents and staff in our senior housing communities; the impact of new variants of the virus 

40

and the effectiveness of available vaccines against those variants; ongoing clinical experience, which may differ considerably 
across regions and fluctuate over time; and on other future developments, including the ultimate duration, spread and intensity 
of the outbreak, the availability of testing, the extent to which governments impose, roll-back or re-impose preventative 
restrictions and the availability of ongoing government financial support to our business, tenants and operators. Due to these 
uncertainties, we are not able at this time to estimate the ultimate impact of the COVID-19 pandemic on our business, results of 
operations, financial condition and cash flows.

See “Note 1 - Description of Business - COVID-19 Update” for a description of charges recognized during the year 

ended December 31, 2020 as a result of the COVID-19 pandemic.

Select 2020 and Early 2021 Highlights

COVID-19 Response

•

Since the start of the COVID-19 pandemic, in addition to actions described under “COVID-19 Update” above, we 
have consistently prioritized the health and safety of employees, residents, tenants and managers, serving as an 
important resource for information and best practices and leading our industry in testing, including through an early 
arrangement with Mayo Clinic Laboratories.

• We executed on a multi-pronged capital conservation strategy to mitigate the impact of COVID-19, including reducing 
our planned capital expenditures, reducing capital commitments, establishing a quarterly dividend of $0.45 per share 
beginning in the second quarter and adjusting the Company’s corporate cost structure.

Ventas Investment Management

• We  established  a  third  party  capital  platform,  Ventas  Investment  Management  (“VIM”),  bringing  together  our  third 
party capital ventures under one umbrella, including the Ventas Life Science and Healthcare Real Estate Fund, L.P. 
(the  “Ventas  Fund”)  and  our  research  and  innovation  (“R&I”)  development  joint  venture  with  GIC  (the  “R&I 
Development JV”) described below.  As of December 31, 2020, VIM had over $3 billion in assets under management.

•

•

In March 2020, we formed the Ventas Fund, a perpetual life investment vehicle focused on investments in research 
and  innovation  centers,  medical  office  buildings  and  senior  housing  communities  in  North  America.  We  are  the 
sponsor and general partner of the Ventas Fund. To seed the Ventas Fund, we contributed six stabilized research and 
innovation  and  medical  office  properties  and  received  cash  consideration  of  $620  million  and  a  21%  interest  in  the 
Ventas Fund. In October 2020, the Ventas Fund acquired a portfolio of three life science properties in the South San 
Francisco life science cluster for $1.0 billion.

In October 2020, we formed the R&I Development JV with GIC. To seed the R&I Development JV, we contributed 
our controlling interest in four in-progress university-based research and innovation development projects whose total 
expected cost approximates $930 million. 

Investments and Dispositions

•

•

•

During the year ended December 31, 2020, we acquired 10 properties for an aggregate consideration of 
$249.5 million.

During the year ended December 31, 2020, we recognized $262.2 million of gains on sale of real estate including  
2020, including $225.1 million for the sale of six properties to the Ventas Fund, $13.7 million for the sale of four in-
progress development projects to the R&I Development JV and and $23.4 million for the sale of 31 other properties.

During the year ended December 31, 2020, we received aggregate proceeds of $106.1 million for the full repayment of 
the principal balances of various loans receivable with a weighted average interest rate of 8.3% that were due to 
mature between 2020 and 2025, resulting in total gains of $1.4 million.

41

Liquidity and Capital 

•

•

•

•

•

•

As of December 31, 2020, we had approximately $3.3 billion in liquidity, including availability under our revolving 
credit facility and cash and cash equivalents on hand, with no borrowings outstanding under our commercial paper 
program and negligible near-term debt maturing.

In April 2020, we raised  $500.0 million through the issuance of 4.75% senior notes due 2030. 

In October 2020,we reduced near-term debt maturities by retiring $236.3 million aggregate principal amount then 
outstanding of our 3.25% senior notes due 2022 at 104.14% of par value, plus accrued and unpaid interest to the 
payment date. 

During 2020, we sold an aggregate of 1.5 million shares of common stock under our “at-the-market” equity offering 
program for average gross proceeds of $44.88 per share.

In January 2021, we entered into an amended and restated unsecured credit facility (the “New Credit Facility”) 
comprised of a $2.75 billion unsecured revolving credit facility initially priced at LIBOR plus 82.5 basis points.

In February 2021, in order to reduce near-term maturities, we issued a make whole redemption for the entirety of the 
$400 million outstanding aggregate principal amount of 3.10% senior notes due January 2023. The redemption is 
expected to settle in March 2021, principally using cash on hand.

Portfolio

•

•

In July 2020, we entered into a revised master lease agreement (the “Brookdale Lease”) and certain other agreements 
(together with the Brookdale Lease, the “Agreements”) with Brookdale Senior Living.

In April 2020, we completed a transaction with affiliates of Holiday Retirement (with its affiliates, collectively, 
“Holiday”), including entry into a new, terminable management agreement for our 26 independent living assets that 
were previously subject to a triple-net lease (the “Holiday Lease”) with Holiday.

Environmental, Social and Governance

•

During 2020, we continued our leadership in ESG, receiving numerous accolades, including the 2020 Nareit Health 
Care “Leader in the Light” award for a fourth consecutive year, the 2020 Bloomberg Gender-Equality Index for the 
second  consecutive  year,  the  2020  Dow  Jones  Sustainability  World  Index  for  the  second  consecutive  year  and 
maintaining our industry-leading position in GRESB.

Critical Accounting Policies and Estimates

Our Consolidated Financial Statements included in Part II, Item 8 of this Annual Report have been prepared in 

accordance with U.S. generally accepted accounting principles (“GAAP”) set forth in the Accounting Standards Codification 
(“ASC”), as published by the Financial Accounting Standards Board (“FASB”).  GAAP requires us to make estimates and 
assumptions regarding future events that affect the reported amounts of assets and liabilities, the disclosure of contingent assets 
and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting 
periods.  We base these estimates on our experience and assumptions we believe to be reasonable under the circumstances.  
However, if our judgment or interpretation of the facts and circumstances relating to various transactions or other matters had 
been different, we may have applied a different accounting treatment, resulting in a different presentation of our financial 
statements.  We periodically reevaluate our estimates and assumptions, and in the event they prove to be different from actual 
results, we make adjustments in subsequent periods to reflect more current estimates and assumptions about matters that are 
inherently uncertain.  We believe that the critical accounting policies described below, among others, affect our more 
significant estimates and judgments used in the preparation of our financial statements.  For more information regarding our 
critical accounting policies, see “Note 2 – Accounting Policies” of the Notes to Consolidated Financial Statements included in 
Part II, Item 8 of this Annual Report.

42

Principles of Consolidation

The Consolidated Financial Statements included in Part II, Item 8 of this Annual Report include our accounts and the 

accounts of our wholly owned subsidiaries and the joint venture entities over which we exercise control.  All intercompany 
transactions and balances have been eliminated in consolidation, and our net earnings are reduced by the portion of net earnings 
attributable to noncontrolling interests.

GAAP requires us to identify entities for which control is achieved through means other than voting rights and to 

determine which business enterprise is the primary beneficiary of variable interest entities (“VIEs”).  A VIE is broadly defined 
as an entity with one or more of the following characteristics: (a) the total equity investment at risk is insufficient to finance the 
entity’s activities without additional subordinated financial support; (b) as a group, the holders of the equity investment at risk 
lack (i) the ability to make decisions about the entity’s activities through voting or similar rights, (ii) the obligation to absorb the 
expected losses of the entity, or (iii) the right to receive the expected residual returns of the entity; and (c) the equity investors 
have voting rights that are not proportional to their economic interests, and substantially all of the entity’s activities either 
involve, or are conducted on behalf of, an investor that has disproportionately few voting rights.  We consolidate our investment 
in a VIE when we determine that we are its primary beneficiary.  We may change our original assessment of a VIE upon 
subsequent events such as the modification of contractual arrangements that affects the characteristics or adequacy of the 
entity’s equity investments at risk and the disposition of all or a portion of an interest held by the primary beneficiary.

We identify the primary beneficiary of a VIE as the enterprise that has both: (i) the power to direct the activities of the 

VIE that most significantly impact the entity’s economic performance; and (ii) the obligation to absorb losses or the right to 
receive benefits of the VIE that could be significant to the entity.  We perform this analysis on an ongoing basis. 

Accounting for Real Estate Acquisitions

When we acquire real estate, we first make reasonable judgments about whether the transaction involves an asset or a 

business.  Our real estate acquisitions are generally accounted for as asset acquisitions as substantially all of the fair value of the 
gross assets acquired is concentrated in a single identifiable asset or group of similar identifiable assets.  Regardless of whether 
an acquisition is considered a business combination or an asset acquisition, we record the cost of the businesses or assets 
acquired as tangible and intangible assets and liabilities based upon their estimated fair values as of the acquisition date.  

We estimate the fair value of buildings acquired on an as-if-vacant basis or replacement cost basis and depreciate the 
building value over the estimated remaining life of the building, generally not to exceed 35 years.  We determine the fair value 
of other fixed assets, such as site improvements and furniture, fixtures and equipment, based upon the replacement cost and 
depreciate such value over the assets’ estimated remaining useful lives as determined at the applicable acquisition date.  We 
determine the value of land either by considering the sales prices of similar properties in recent transactions or based on internal 
analyses of recently acquired and existing comparable properties within our portfolio.  We generally determine the value of 
construction in progress based upon the replacement cost.  However, for certain acquired properties that are part of a ground-up 
development, we determine fair value by using the same valuation approach as for all other properties and deducting the 
estimated cost to complete the development.  During the remaining construction period, we capitalize project costs until the 
development has reached substantial completion.  Construction in progress, including capitalized interest, is not depreciated 
until the development has reached substantial completion. 

Intangibles primarily include the value of in-place leases and acquired lease contracts.  We include all lease-related 

intangible assets and liabilities within acquired lease intangibles and accounts payable and other liabilities, respectively, on our 
Consolidated Balance Sheets.  

The fair value of acquired lease-related intangibles, if any, reflects: (i) the estimated value of any above or below 

market leases, determined by discounting the difference between the estimated market rent and in-place lease rent; and (ii) the 
estimated value of in-place leases related to the cost to obtain tenants, including leasing commissions, and an estimated value of 
the absorption period to reflect the value of the rent and recovery costs foregone during a reasonable lease-up period as if the 
acquired space was vacant.  We amortize any acquired lease-related intangibles to revenue or amortization expense over the 
remaining life of the associated lease plus any assumed bargain renewal periods.  If a lease is terminated prior to its stated 
expiration or not renewed upon expiration, we recognize all unamortized amounts of lease-related intangibles associated with 
that lease in operations over the shortened lease term. 

We estimate the fair value of purchase option intangible assets and liabilities, if any, by discounting the difference 

between the applicable property’s acquisition date fair value and an estimate of its future option price.  We do not amortize the 
resulting intangible asset or liability over the term of the lease, but rather adjust the recognized value of the asset or liability 

43

upon sale. 

In connection with an acquisition, we may assume rights and obligations under certain lease agreements pursuant to 
which we become the lessee of a given property.  We generally assume the lease classification previously determined by the 
prior lessee absent a modification in the assumed lease agreement.  We assess assumed operating leases, including ground 
leases, to determine whether the lease terms are favorable or unfavorable to us given current market conditions on the 
acquisition date.  To the extent the lease terms are favorable or unfavorable to us relative to market conditions on the 
acquisition date, we recognize an intangible asset or liability at fair value and amortize that asset or liability to interest or rental 
expense in our Consolidated Statements of Income over the applicable lease term.  Where we are the lessee, we record the 
acquisition date values of leases, including any above or below market value, within operating lease assets and operating lease 
liabilities on our Consolidated Balance Sheets. 

We estimate the fair value of noncontrolling interests assumed consistent with the manner in which we value all of the 

underlying assets and liabilities. 

We calculate the fair value of long-term assumed debt by discounting the remaining contractual cash flows on each 

instrument at the current market rate for those borrowings, which we approximate based on the rate at which we would expect 
to incur a replacement instrument on the date of acquisition, and recognize any fair value adjustments related to long-term debt 
as effective yield adjustments over the remaining term of the instrument. 

Impairment of Long-Lived and Intangible Assets

We periodically evaluate our long-lived assets, primarily consisting of investments in real estate, for impairment 
indicators.  If indicators of impairment are present, we evaluate the carrying value of the related real estate investments in 
relation to the future undiscounted cash flows of the underlying operations.  In performing this evaluation, we consider market 
conditions and our current intentions with respect to holding or disposing of the asset.  We adjust the net book value of real 
estate properties and other long-lived assets to fair value if the sum of the expected future undiscounted cash flows, including 
sales proceeds, is less than book value.  We recognize an impairment loss at the time we make any such determination.  

Estimates of fair value used in our evaluation of investments in real estate are based upon discounted future cash flow 
projections, if necessary, or other acceptable valuation techniques that are based, in turn, upon all available evidence including 
level three inputs, such as revenue and expense growth rates, estimates of future cash flows, capitalization rates, discount rates, 
general economic conditions and trends, or other available market data such as replacement cost or comparable transactions.  
Our ability to accurately predict future operating results and cash flows and to estimate and determine fair values impacts the 
timing and recognition of impairments.  While we believe our assumptions are reasonable, changes in these assumptions may 
have a material impact on our financial results. 

Revenue Recognition

We recognize rental revenues under our leases on a straight-line basis over the applicable lease term when 
collectability of substantially all rents is probable.  We assess the probability of collecting substantially all rents under our 
leases based on several factors, including, among other things, payment history, the financial strength of the tenant and any 
guarantors, the historical operations and operating trends of the property, the historical payment pattern of the tenant, the type 
of property, the value of the underlying collateral, if any, expected future performance of the property and current economic 
conditions.  If our evaluation of these factors indicates it is not probable that we will be able to collect substantially all rents 
under the lease, we record a charge to rental income.  If we change our conclusions regarding the probability of collecting rent 
payments required by a lease, we may recognize adjustments to rental income in the period we make such change in our 
conclusions.

Federal Income Tax

We have elected to be treated as a REIT under the applicable provisions of the Internal Revenue Code of 1986, as 

amended (the “Code”), for every year beginning with the year ended December 31, 1999.  Accordingly, we generally are not 
subject to federal income tax on net income that we distribute to our stockholders, provided that we continue to qualify as a 
REIT.  However, with respect to certain of our subsidiaries that have elected to be treated as taxable REIT subsidiaries (“TRS” 
or “TRS entities”), we record income tax expense or benefit, as those entities are subject to federal income tax similar to regular 
corporations.  Certain foreign subsidiaries are subject to foreign income tax, although they did not elect to be treated as TRSs.

44

We account for deferred income taxes using the asset and liability method and recognize deferred tax assets and 

liabilities for the expected future tax consequences of events that have been included in our financial statements or tax returns. 
Under this method, we determine deferred tax assets and liabilities based on the differences between the financial reporting and 
tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. 
Any increase or decrease in the deferred tax liability that results from a change in circumstances, and that causes us to change 
our judgment about expected future tax consequences of events, is included in the tax provision when such changes occur. 
Deferred income taxes also reflect the impact of operating loss and tax credit carryforwards.  A valuation allowance is provided 
if we believe it is more likely than not that all or some portion of the deferred tax asset will not be realized.  Any increase or 
decrease in the valuation allowance that results from a change in circumstances, and that causes us to change our judgment 
about the realizability of the related deferred tax asset, is included in the tax provision when such changes occur.

We recognize the tax benefit from an uncertain tax position claimed or expected to be claimed on a tax return only if it 
is more likely than not that the tax position will be sustained on examination by taxing authorities, based on the technical merits 
of the position.  The tax benefits recognized in the financial statements from such a position are measured based on the largest 
benefit that has a greater than fifty percent likelihood of being realized upon ultimate settlement.  We recognize interest and 
penalties, if applicable, related to uncertain tax positions as part of income tax benefit or expense.

Recently Issued or Adopted Accounting Standards

We adopted ASC Topic 842, Leases (“ASC 842”) on January 1, 2019, which introduced a lessee model that brings 
most leases on the balance sheet and, among other changes, eliminates the requirement in current GAAP for an entity to use 
bright-line tests in determining lease classification.

ASC 842 allows for several practical expedients which permit the following: no reassessment of lease classification or 

initial direct costs; use of the standard’s effective date as the date of initial application; and no separation of non-lease 
components from the related lease components and, instead, to account for those components as a single lease component if 
certain criteria are met.  We elected these practical expedients using the effective date as our date of initial application.  
Therefore, financial information and disclosures under ASC 842 are not provided for periods prior to January 1, 2019. 

Upon adoption, we recognized both right of use assets and lease liabilities for leases in which we lease land, real 
property or other equipment.  We now also report revenues and expenses within our triple-net leased properties reportable 
business segment for real estate taxes and insurance that are escrowed and obligations of the tenants in accordance with their 
respective leases with us.  This reporting had no impact on our net income.  Resident leases within our senior living operations 
reportable business segment and office leases also contain service elements.  We elected the practical expedient to account for 
our resident and office leases as a single lease component.  Also, we now expense certain leasing costs, other than leasing 
commissions, as they are incurred.  Prior to the adoption of ASC 842, GAAP provided for the deferral and amortization of such 
costs over the applicable lease term.  We are continuing to amortize any unamortized deferred lease costs as of December 31, 
2018 over their respective lease terms. 

As of January 1, 2019 we recognized operating lease assets of $361.7 million on our Consolidated Balance Sheets 

which includes the present value of minimum lease payments as well as certain existing above and/or below market lease 
intangible values associated with such leases.  Also upon adoption, we recognized operating lease liabilities of $216.9 million 
on our Consolidated Balance Sheets.  The present value of minimum lease payments was calculated on each lease using a 
discount rate that approximates our incremental borrowing rate primarily adjusted for the length of the individual lease terms.  
As of the January 1, 2019 adoption date, we utilized discount rates ranging from 6.15% to 7.60% for our ground leases. 

Upon adoption, we recognized a cumulative effect adjustment to retained earnings of $0.6 million primarily relating to 

certain costs associated with unexecuted leases that were deferred as of December 31, 2018. 

45

Results of Operations 

As of December 31, 2020, we operated through three reportable business segments: triple-net leased properties, senior 

living operations and office operations.  In our triple-net leased properties segment, we invest in and own senior housing and 
healthcare properties throughout the United States and the United Kingdom and lease those properties to healthcare operating 
companies under “triple-net” or “absolute-net” leases that obligate the tenants to pay all property-related expenses.  In our 
senior living operations segment, we invest in senior housing communities throughout the United States and Canada and engage 
independent operators, such as Atria and Sunrise, to manage those communities.  In our office operations segment, we primarily 
acquire, own, develop, lease and manage MOBs and research and innovation centers throughout the United States.  Information 
provided for “all other” includes income from loans and investments and other miscellaneous income and various corporate-
level expenses not directly attributable to any of our three reportable business segments.  Assets included in “all other” consist 
primarily of corporate assets, including cash, restricted cash, loans receivable and investments, and miscellaneous accounts 
receivable. 

Our chief operating decision makers evaluate performance of the combined properties in each reportable business 

segment and determine how to allocate resources to those segments, in significant part, based on segment net operating income 
(“NOI”) and related measures.  In addition to the information presented below, see “Note 19 – Segment Information” of the 
Notes to Consolidated Financial Statements included in Part II, Item 8 of this Annual Report for further information regarding 
our business segments and a discussion of our definition of segment NOI.  See “Non-GAAP Financial Measures” included 
elsewhere in this Annual Report for additional disclosure and reconciliations of net income attributable to common 
stockholders, as computed in accordance with GAAP, to NOI.

46

Years Ended December 31, 2020 and 2019 

The table below shows our results of operations for the years ended December 31, 2020 and 2019 and the effect of 

changes in those results from period to period on our net income attributable to common stockholders.

Segment NOI:

Triple-net leased properties

Senior living operations

Office operations

All other

Total segment NOI

Interest and other income

Interest expense

Depreciation and amortization

General, administrative and professional fees

Loss on extinguishment of debt, net

Merger-related expenses and deal costs

Allowance on loans receivable and investments

Other

Income before unconsolidated entities, real estate 

dispositions, income taxes, discontinued operations 
and noncontrolling interests

Income (loss) from unconsolidated entities

Gain on real estate dispositions

Income tax benefit 

Income from continuing operations

Discontinued operations

Net income

Net income attributable to noncontrolling interests

For the Years Ended
December 31,

(Decrease) Increase to Net Income

2020

2019

$

%

(Dollars in thousands)

$ 

673,105  $ 

754,337  $ 

538,489 

549,375 

87,021 

630,135 

574,157 

92,610 

(81,232) 

(91,646) 

(24,782) 

(5,589) 

1,847,990 

2,051,239 

(203,249) 

7,609 

10,984 

(469,541)   

(451,662)   

(1,109,763)   

(1,045,620)   

(130,158)   

(158,726)   

(10,791)   

(29,812)   

(24,238)   

(41,900)   

(15,235)   

— 

(707)   

10,339 

(3,375) 

(17,879) 

(64,143) 

28,568 

31,109 

(14,577) 

(24,238) 

(11,046) 

 (10.8%) 

 (14.5) 

 (4.3) 

 (6.0) 

 (9.9) 

 (30.7) 

 (4.0) 

 (6.1) 

 18.0 

 74.2 

 (95.7) 

nm

nm

80,589 

1,844 

262,218 

96,534 

441,185 

— 

441,185 

2,036 

359,419 

(278,830) 

 (77.6) 

(2,454)   

26,022 

56,310 

439,297 

— 

439,297 

6,281 

4,298 

236,196 

40,224 

1,888 

— 

1,888 

4,245 

6,133 

nm

nm

 71.4 

 0.4 

nm

 0.4 

 67.6 

 1.4 

Net income attributable to common stockholders

$ 

439,149  $ 

433,016 

nm—not meaningful

Segment NOI—Triple-Net Leased Properties

The following table summarizes results of operations in our triple-net leased properties reportable business segment, 

including assets sold or classified as held for sale as of December 31, 2020, but excluding assets whose operations were 
classified as discontinued operations:

Segment NOI—Triple-Net Leased Properties:
Rental income
Less: Property-level operating expenses

Segment NOI

nm—not meaningful

For the Years Ended
December 31,

(Decrease) Increase to Segment NOI

2020

2019

$

%

(Dollars in thousands)

$ 

$ 

695,265  $ 
(22,160)   
673,105  $ 

780,898  $ 
(26,561)   
754,337 

(85,633) 
4,401 
(81,232) 

 (11.0%) 
 16.6 
 (10.8) 

47

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
In our triple-net leased properties reportable business segment, our revenues generally consist of fixed rental amounts 

(subject to contractual escalations) received from our tenants in accordance with the applicable lease terms.  We report revenues 
and property-level operating expenses within our triple-net leased properties reportable business segment for real estate tax and 
insurance expenses that are paid from escrows collected from our tenants.  

The Triple-net leased properties segment NOI decrease in 2020 over the prior year is attributable primarily to the 

transition of 26 independent living assets at the start of the second quarter 2020 operated by Holiday from our triple-net 
portfolio to our senior housing operating portfolio, lower rental income from the Brookdale lease modification at the start of the 
third quarter of 2020, and the COVID-19 related write-off of previously accrued straight-line rental income during 2020 of 
$67.6 million (non-Holiday assets), partially offset by the $50.2 million impact of terminating the Holiday Lease.  We will 
continue to try to collect rent on a contractual basis for the tenants where straight-line rent has been written off, but we have 
determined that collectability is not probable due to COVID-19.

Occupancy rates may affect the profitability of our tenants’ operations.  The following table sets forth average 

continuing occupancy rates related to the triple-net leased properties we owned at December 31, 2020 and measured over the 
trailing 12 months ended September 30, 2020 (which is the most recent information available to us from our tenants) and 
average continuing occupancy rates related to the triple-net leased properties we owned at December 31, 2019 and measured 
over the 12 months ended September 30, 2019.  The table excludes non-stabilized properties, properties owned through 
investments in unconsolidated real estate entities, certain properties for which we do not receive occupancy information and 
properties acquired or properties that transitioned operators for which we do not have a full four quarters of occupancy results.

Senior housing communities

Skilled nursing facilities (“SNFs”)

IRFs and LTACs

Number of 
Properties at 
December 31, 
2020

Average Occupancy 
for the Trailing 12 
Months Ended 
September 30, 2020

Number of 
Properties at 
December 31, 
2019

Average Occupancy 
for the Trailing 12 
Months Ended 
September 30, 2019

290 

16 

35 

 82.1% 

 82.9 

 55.7 

326 

16 

36 

 86.0% 

 87.3 

 53.6 

Declines in occupancy are primarily the result of COVID-19 impacts to senior housing and SNF operations.  

The following table compares results of operations for our 359 same-store triple-net leased properties.  See “Non-

GAAP Financial Measures—NOI” included elsewhere in this Annual Report on Form 10-K for additional disclosure regarding 
same-store NOI for each of our reportable business segments.

Same-Store Segment NOI—Triple-Net Leased 

Properties:

Rental income

Less: Property-level operating expenses

Segment NOI

nm—not meaningful

For the Years Ended
December 31,

(Decrease) Increase to Segment NOI

2020

2019

$

%

(Dollars in thousands)

$ 

$ 

601,195  $ 

669,510  $ 

(68,315) 

 (10.2%) 

(19,166)   

(19,198)   

32 

582,029  $ 

650,312 

(68,283) 

 0.2 

 (10.5) 

The decrease in our same-store triple-net leased properties rental income in 2020 over the prior year is attributable 

primarily to the COVID-19 related write-off of previously accrued straight-line rental income of $67.6 million during 2020 and 
lower rental income from the Brookdale lease modification at the start of the third quarter of 2020, partially offset by rent 
increases due to contractual escalations pursuant to the terms of our leases.  We will continue to try to collect rent on a 
contractual basis for the tenants where straight-line rent has been written off, but we have determined that collectability is not 
probable due to COVID-19.

48

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Segment NOI—Senior Living Operations

The following table summarizes results of operations in our senior living operations reportable business segment, 

including assets sold or classified as held for sale as of December 31, 2020.

For the Years Ended
December 31,

Increase (Decrease) to Segment NOI

2020

2019

$

%

(Dollars in thousands)

Segment NOI—Senior Living Operations:

Resident fees and services

$  2,197,160  $  2,151,533  $ 

45,627 

Less: Property-level operating expenses

(1,658,671)   

(1,521,398)   

(137,273) 

Segment NOI

$ 

538,489  $ 

630,135 

(91,646) 

 2.1% 

 (9.0) 

 (14.5) 

Number of
Properties at
December 31,

Average Unit 
Occupancy
for the Years Ended
December 31,

Average Monthly Revenue Per 
Occupied Room for 
the Years Ended
December 31,

2020

2019

2020

2019

2020

2019

Total communities

432 

401 

 81.7 %

 86.6 % $ 

4,766  $ 

5,451 

Resident fees and services include all amounts earned from residents at our senior housing communities, such as rental 

fees related to resident leases, extended healthcare fees and other ancillary service income.  Property-level operating expenses 
related to our senior living operations segment include labor, food, utilities, marketing, management and other costs of 
operating the properties.  

The decrease in our senior living operations segment NOI in 2020 over the prior year is primarily attributable to lower 
occupancy resulting from the COVID-19 pandemic. In addition, NOI has been negatively impacted by increased operating costs 
as a result of the COVID-19 pandemic, which is partially offset by the receipt of $35.1 million in grants during the fourth 
quarter 2020 from HHS under the Provider Relief Fund. We also had more properties in this segment because of the transition 
of 26 independent living assets at the start of the second quarter 2020 operated by Holiday from our triple-net portfolio to our 
senior housing operating portfolio and the third quarter 2019 acquisition of 34 Canadian senior housing communities via an 
equity partnership with Le Groupe Maurice, which contributed to NOI.

The following table compares results of operations for our 335 same-store senior living operating communities.  

For the Years Ended
December 31,

(Decrease) Increase to Segment NOI

2020

2019

$

%

(Dollars in thousands)

Same-Store Segment NOI—Senior Living Operations:

Resident fees and services

$  1,796,135  $  1,967,402  $ 

(171,267) 

 (8.7%) 

Less: Property-level operating expenses

(1,385,316)   

(1,376,587)   

(8,729) 

Segment NOI

nm—not meaningful

$ 

410,819  $ 

590,815 

(179,996) 

 (0.6) 

 (30.5) 

Same-store communities

335 

335 

 79.6% 

 86.9%  $ 

5,765  $ 

5,790 

Number of
Properties at
December 31,

Average Unit 
Occupancy
for the Years Ended
December 31,

Average Monthly Revenue Per 
Occupied Room for 
the Years Ended
December 31,

2020

2019

2020

2019

2020

2019

49

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The decrease in our same-store senior living operations segment NOI is primarily attributable to lower occupancy 

resulting from the COVID-19 pandemic. In addition, NOI has been negatively impacted by increased operating costs as a result 
of the COVID-19 pandemic, which is partially offset by the receipt of $31.9 million in grants from HHS under the Provider 
Relief Fund.

Segment NOI—Office Operations

The following table summarizes results of operations in our office operations reportable business segment, including 

assets sold or classified as held for sale as of December 31, 2020.

Segment NOI—Office Operations:

Rental income

Office building services revenue

Total revenues

Less:

Property-level operating expenses

Office building services costs

Segment NOI

For the Years Ended
December 31,

(Decrease) Increase to Segment NOI

2020

2019

$

%

(Dollars in thousands)

$ 

799,627  $ 

828,978  $ 

(29,351) 

 (3.5%) 

8,675 

808,302 

7,747 

836,725 

928 

(28,423) 

(256,612)   

(260,249)   

(2,315)   

(2,319)   

3,637 

4 

$ 

549,375  $ 

574,157 

(24,782) 

 12.0 

 (3.4) 

 1.4 

 0.2 

 (4.3) 

Number of
Properties at
December 31,

Occupancy at
December 31,

Annualized Average Rent 
Per Occupied Square Foot 
for the Years Ended 
December 31,

2020

2019

2020

2019

2020

2019

Total office buildings

374 

382 

 89.7% 

 90.3%  $ 

34  $ 

34 

The decrease in our office operations segment NOI in 2020 over the prior year is attributable to assets sold to the 

Ventas Fund in the first quarter of 2020, lease termination fees received in 2019, and COVID-19 impacts including the write-
off of previously accrued straight-line rental income during 2020 and reduced parking revenues. These reduction in NOI were 
partially offset by active leasing at recently developed and redeveloped properties, improved tenant retention, contractual rent 
escalators, acquisitions and business interruption insurance proceeds.

The following table compares results of operations for our 355 same-store office buildings. 

Same-Store Segment NOI—Office Operations:

Rental income

Less: Property-level operating expenses

Segment NOI

For the Years Ended
December 31,

Increase (Decrease) to Segment NOI

2020

2019

$

%

(Dollars in thousands)

$ 

$ 

743,563  $ 

733,482  $ 

(235,789)   

(231,946)   

507,774  $ 

501,536 

10,081 

(3,843) 

6,238 

 1.4% 

 (1.7) 

 1.2 

Number of
Properties at
December 31,

Occupancy at
December 31,

Annualized Average Rent 
Per Occupied Square Foot 
for the Years Ended 
December 31,

2020

2019

2020

2019

2020

2019

Same-store office buildings

355 

355 

 91.3% 

 92.2%  $ 

34  $ 

33 

The increase in our same-store office operations segment NOI in 2020 over the prior year is attributable primarily to 
successful leasing, enhanced tenant retention, continued strong collections through the COVID-19 pandemic and contractual 
rent escalations.

50

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
All Other

Information provided for all other segment NOI includes income from loans and investments and other miscellaneous 

income not directly attributable to any of our three reportable business segments.  The $5.6 million decrease in all other 
segment NOI in 2020 over the prior year is primarily due to reduced interest income from our loans receivable investments 
from lower LIBOR-based interest rates, repayments of loans outstanding net of new issuances, partially offset by increased 
management fee revenues from investments in unconsolidated real estate entities.  See “Note 6 – Loans Receivable and 
Investments” of the Notes to Consolidated Financial Statements included in Part II, Item 8 of this Annual Report.

Interest and Other Income

The $3.4 million decrease in interest and other income in 2020 over the prior year is primarily due to 2019 income 

from the exercise of warrants related to our research and innovation properties, partially offset by a 2020 reduction of a liability 
related to an acquisition and interest income on short-term investments.

Interest Expense

The $17.9 million increase in total interest expense in 2020 over the prior year is primarily attributable to an increase 

of $53.0 million due to higher debt balances, partially offset by a decrease of $35.5 million due to a lower effective interest rate.  
Our weighted average effective interest rate was 3.5% for 2020, compared to 3.8% for 2019.  Capitalized interest for 2020 and 
2019 was $9.6 million and $9.0 million, respectively.

Depreciation and Amortization

Depreciation and amortization expense increased during 2020 compared to 2019, primarily due to an increase in real 
estate impairments during 2020 and asset acquisitions, including the 2019 acquisition of senior housing communities operated 
by LGM.  This is partially offset by the impact of dispositions during 2020.  See “Note 1 – Description of Business - 
COVID-19 Update” for information regarding 2020 real estate impairment charges.

General, Administrative and Professional Fees

The $28.6 million decrease in general, administrative and professional fees in 2020 over the prior year is primarily a 

result of the capital conservation actions taken during 2020, including the June 2020 elimination of approximately 25% of 
corporate positions and a reduction in executives’ salaries for the second half of 2020.  See “2020 Capital Conservation 
Actions” for information regarding these measures.

Loss on Extinguishment of Debt, Net

The loss on extinguishment of debt, net in 2020 is due primarily to the notice of redemption of $236.3 million of our 

3.25% senior notes due 2022.  The loss on extinguishment of debt, net in 2019 was due primarily to the redemption and 
repayment of $600.0 million aggregate principal amounts then outstanding of our 4.25% senior notes due 2022.  See “—
Liquidity and Capital Resources”.

Merger-Related Expenses and Deal Costs

The $14.6 million increase in merger-related expenses and deal costs in 2020 over the prior year is due primarily to 

costs incurred as a result of the Brookdale transaction and 2020 expenses related to severance and operator transitions.

Allowance on Loans Receivable and Investments

The allowance on loans receivable and investments in 2020 is due to credit losses on certain of our non-mortgage loans 

receivable and government-sponsored pooled loan investments, less recoveries received during the year. See “Note 1 – 
Description of Business - COVID-19 Update” for more information regarding these allowances.

51

Other

The $11.0 million change in other from income in 2019 to an expense in 2020 is primarily due to insurance recoveries 

received in 2019 and increased corporate-level insurance costs in 2020, partially offset by the change in fair value of stock 
warrants received in connection with the Brookdale transaction.

Income (Loss) from Unconsolidated Entities

The $4.3 million increase in income (loss) from unconsolidated entities for 2020 over 2019 is primarily due to our 

share of financial results from our unconsolidated entities in 2020, offset by an impairment of our investment in an 
unconsolidated operating entity in 2020. See “Note 1 – Description of Business - COVID-19 Update” for information regarding 
2020 impairment charges.

Gain on Real Estate Dispositions

The $236.2 million increase in gain on real estate dispositions for 2020 over 2019 is due primarily to our contribution 

of six properties to the Ventas Fund in 2020.

Income Tax Benefit

The $40.2 million increase in income tax benefit related to continuing operations for 2020 over 2019 is primarily due 
to a $152.9 million deferred tax benefit related to the internal restructuring of certain U.S. taxable REIT subsidiaries completed 
within the first quarter of 2020, partially offset by changes in the valuation allowance against deferred tax assets of certain of 
our TRS entities.  The restructuring benefit resulted from the transfer of assets subject to certain deferred tax liabilities from 
taxable REIT subsidiaries to the entities other than the TRS entities in this tax-free transaction.

Years Ended December 31, 2019 and 2018 

Our Annual Report for the year ended December 31, 2019, filed with the SEC on February 24, 2020, contains 

information regarding our results of operations for the years ended December 31, 2019 and 2018 and the effect of changes in 
those results from period to period on our net income attributable to common stockholders.

Non-GAAP Financial Measures

We consider certain non-GAAP financial measures to be useful supplemental measures of our operating performance.  
A non-GAAP financial measure is a measure of historical or future financial performance, financial position or cash flows that 
excludes or includes amounts that are not so excluded from or included in the most directly comparable measure calculated and 
presented in accordance with GAAP.  Described below are the non-GAAP financial measures used by management to evaluate 
our operating performance and that we consider most useful to investors, together with reconciliations of these measures to the 
most directly comparable GAAP measures.

The non-GAAP financial measures we present in this Annual Report may not be comparable to those presented by 

other real estate companies due to the fact that not all real estate companies use the same definitions.  You should not consider 
these measures as alternatives to net income attributable to common stockholders (determined in accordance with GAAP) as 
indicators of our financial performance or as alternatives to cash flow from operating activities (determined in accordance with 
GAAP) as measures of our liquidity, nor are these measures necessarily indicative of sufficient cash flow to fund all of our 
needs.  In order to facilitate a clear understanding of our consolidated historical operating results, you should examine these 
measures in conjunction with net income attributable to common stockholders as presented in our Consolidated Financial 
Statements and other financial data included elsewhere in this Annual Report.

52

 
Funds From Operations and Normalized Funds From Operations Attributable to Common Stockholders

Historical cost accounting for real estate assets implicitly assumes that the value of real estate assets diminishes 
predictably over time.  However, since real estate values historically have risen or fallen with market conditions, many industry 
investors deem presentations of operating results for real estate companies that use historical cost accounting to be insufficient 
by themselves.  For that reason, we consider Funds From Operations attributable to common stockholders (“FFO”) and 
normalized FFO to be appropriate supplemental measures of operating performance of an equity REIT.  In particular, we 
believe that normalized FFO is useful because it allows investors, analysts and our management to compare our operating 
performance to the operating performance of other real estate companies and between periods on a consistent basis without 
having to account for differences caused by non-recurring items and other non-operational events such as transactions and 
litigation.  In some cases, we provide information about identified non-cash components of FFO and normalized FFO because it 
allows investors, analysts and our management to assess the impact of those items on our financial results.

We use the National Association of Real Estate Investment Trusts (“Nareit”) definition of FFO.  Nareit defines FFO as 
net income attributable to common stockholders (computed in accordance with GAAP), excluding gains or losses from sales of 
real estate property, including gains or losses on remeasurement of equity method investments, and impairment write-downs of 
depreciable real estate, plus real estate depreciation and amortization, and after adjustments for unconsolidated partnerships and 
entities.  Adjustments for unconsolidated partnerships and entities will be calculated to reflect FFO on the same basis.  We 
define normalized FFO as FFO excluding the following income and expense items (which may be recurring in nature): (a) 
merger-related costs and expenses, including amortization of intangibles, transition and integration expenses, and deal costs and 
expenses, including expenses and recoveries relating to acquisition lawsuits; (b) the impact of any expenses related to asset 
impairment and valuation allowances, the write-off of unamortized deferred financing fees, or additional costs, expenses, 
discounts, make-whole payments, penalties or premiums incurred as a result of early retirement or payment of our debt; (c) the 
non-cash effect of income tax benefits or expenses, the non-cash impact of changes to our executive equity compensation plan, 
derivative transactions that have non-cash mark to market impacts on our Consolidated Statements of Income and non-cash 
charges related to leases; (d) the financial impact of contingent consideration, severance-related costs and charitable donations 
made to the Ventas Charitable Foundation; (e) gains and losses for non-operational foreign currency hedge agreements and 
changes in the fair value of financial instruments; (f) gains and losses on non-real estate dispositions and other unusual items 
related to unconsolidated entities; (g) expenses related to the reaudit and re-review in 2014 of our historical financial statements 
and related matters; (h) net expenses or recoveries related to natural disasters; and (i) any other incremental items set forth in 
the normalized FFO reconciliation included herein.

The following table summarizes our FFO and normalized FFO for each of the five years ended December 31, 2020. 
The decrease in normalized FFO for the year ended December 31, 2020 over the prior year is due to the impact of COVID-19 
on our senior housing business and increases in interest expense from incremental borrowings arising as a consequence of the 
impact of COVID-19, partially offset by the positive impact of our third quarter 2019 acquisition of an interest in 34 Canadian 
senior housing communities via an equity partnership with Le Groupe Maurice.  

53

Net income attributable to common 

stockholders

Adjustments:

Real estate depreciation and amortization
Real estate depreciation related to 

noncontrolling interests

Real estate depreciation related to 

unconsolidated entities

Gain on real estate dispositions related to 

unconsolidated entities

Gain on re-measurement of equity interest 

upon acquisition, net

Impairment on equity method investment
(Loss) gain on real estate dispositions 
related to noncontrolling interests

2020

2019

2018

2017

2016

For the Years Ended December 31,

(In thousands)

$ 

439,149  $ 

433,016  $ 

409,467  $  1,356,470  $ 

649,231 

1,104,114 

1,039,550 

913,537 

881,088 

891,985 

(16,767)   

(9,762)   

(6,926)   

(7,565)   

(7,785) 

4,986 

187 

1,977 

4,231 

5,754 

— 

— 

— 

(9)   

(1,263)   

(875)   

(1,057)   

(439) 

— 

— 

343 

— 

35,708 

1,508 

(3,027)   

— 

18 

— 

— 

— 

Gain on real estate dispositions

(262,218)   

(26,022)   

(46,247)   

(717,273)   

(98,203) 

Discontinued operations:

Loss on real estate dispositions

— 

— 

— 

— 

1 

FFO attributable to common stockholders

1,269,255 

1,436,049 

1,308,149 

1,512,885 

1,440,544 

Adjustments:

Change in fair value of financial 

instruments

Non-cash income tax benefit

Effect of the 2017 Tax Act

Loss on extinguishment of debt, net
Gain on non-real estate dispositions related 

to unconsolidated entities

Merger-related expenses, deal costs and re-

audit costs

Amortization of other intangibles
Other items related to unconsolidated 

entities

Non-cash impact of changes to equity plan  
Non-cash charges related to lease 

terminations

Natural disaster expenses (recoveries), net

Impact of Holiday lease termination
Write-off of straight-line rental income, net 

of noncontrolling interests

Allowance on loan investments and 

impairment of unconsolidated entities, 
net of noncontrolling interests

Normalized FFO attributable to common 

stockholders

(21,928)   

(98,114)   

(78)   

(58,918)   

— 

10,791 

— 

41,900 

(18)   

(18,427)   

(24,618)   

63,073 

(41)   

(22,387)   

(36,539)   

839 

62 

(34,227) 

— 

2,779 

(597)   

(18)   

(2)   

(39)   

(557) 

34,690 

472 

(614)   

(452)   

— 

1,247 

(50,184)   

70,863 

34,543 

18,208 

484 

3,291 

7,812 

— 

(25,683)   

— 

— 

— 

38,145 

759 

5,035 

4,830 

21,299 

63,830 

— 

— 

— 

14,823 

1,458 

3,188 

5,453 

— 

11,601 

— 

— 

— 

28,290 

1,752 

— 

— 

— 

— 

— 

— 

— 

$  1,249,972  $  1,423,047  $  1,462,055  $  1,491,241  $  1,438,643 

54

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Adjusted EBITDA

We consider Adjusted EBITDA an important supplemental measure because it provides another manner in which to 

evaluate our operating performance and serves as another indicator of our credit strength and our ability to service our debt 
obligations.  We define Adjusted EBITDA as consolidated earnings before interest, taxes, depreciation and amortization 
(including non-cash stock-based compensation expense, asset impairment and valuation allowances), excluding gains or losses 
on extinguishment of debt, our partners’ share of EBITDA of consolidated entities, merger-related expenses and deal costs, 
expenses related to the reaudit and re-review in 2014 of our historical financial statements, net gains or losses on real estate 
activity, gains or losses on remeasurement of equity interest upon acquisition, changes in the fair value of financial instruments, 
unrealized foreign currency gains or losses, net expenses or recoveries related to natural disasters and non-cash charges related 
to leases, and including Ventas’ share of EBITDA from unconsolidated entities and adjustments for other immaterial or 
identified items.  The following table sets forth a reconciliation of net income attributable to common stockholders to Adjusted 
EBITDA:

For the Years Ended December 31,

2020

2019

2018

(In thousands)

Net income attributable to common stockholders

$ 

439,149  $ 

433,016  $ 

409,467 

Adjustments:

Interest 

Loss on extinguishment of debt, net 
Taxes (including amounts in general, administrative and professional 

fees)

Depreciation and amortization 

Non-cash stock-based compensation expense

Merger-related expenses, deal costs and re-audit costs
Net income attributable to noncontrolling interests, adjusted for partners’ 

share of consolidated entity EBITDA

Loss from unconsolidated entities, adjusted for Ventas share of EBITDA 

from unconsolidated entities

Gain on real estate dispositions

Unrealized foreign currency (gains) losses 

Changes in fair value of financial instruments

Non-cash charges related to lease terminations

Natural disaster expenses (recoveries), net

Write-off of straight-line rental income from Holiday lease termination

Write-off of straight-line rental income, net of noncontrolling interests
Allowance on loan investments and impairment of unconsolidated 

entities, net of noncontrolling interests

Adjusted EBITDA

NOI

469,541 

10,791 

451,662 

41,900 

(91,389)   

(52,677)   

1,109,763 

1,045,620 

21,487 

29,811 

33,923 

15,246 

442,497 

58,254 

(37,230) 

919,639 

29,963 

33,608 

(24,381)   

(16,396)   

(10,420) 

59,631 

32,462 

(262,218)   

(26,022)   

(439)   

(21,928)   

— 

1,203 

49,611 

70,863 

(1,061)   

(104)   

— 

(25,981)   

— 

— 

23,879 
1,885,374  $ 

—   —  
1,931,588  $ 

$ 

86,278 

(46,247) 

138 

(54) 

21,299 

54,684 

— 

— 

— 

1,961,876 

We also consider NOI an important supplemental measure because it allows investors, analysts and our management to 

assess our unlevered property-level operating results and to compare our operating results with those of other real estate 
companies and between periods on a consistent basis.  We define NOI as total revenues, less interest and other income, 

55

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
property-level operating expenses and office building services costs.  Cash receipts may differ due to straight-line recognition 
of certain rental income and the application of other GAAP policies.

The following table sets forth a reconciliation of net income attributable to common stockholders to NOI:

Net income attributable to common stockholders

$ 

439,149  $ 

433,016  $ 

409,467 

For the Years Ended December 31,

2020

2019

2018

(In thousands)

Adjustments:

Interest and other income 

Interest expense

Depreciation and amortization 

General, administrative and professional fees 

Loss on extinguishment of debt, net

Merger-related expenses and deal costs

Allowance on loan receivable and investments

Discontinued operations

Other 

Net income attributable to noncontrolling interests

(Income) loss from unconsolidated entities

Income tax benefit

Gain on real estate dispositions

NOI 

(7,609)   

(10,984)   

(24,892) 

469,541 

451,662 

1,109,763 

1,045,620 

130,158 

10,791 

29,812 

24,238 

— 

707 

2,036 

(1,844)   

(96,534)   

(262,218)   

158,726 

41,900 

15,235 

— 

— 

(10,339)   

6,281 

2,454 

(56,310)   

(26,022)   

442,497 

919,639 

145,978 

58,254 

30,547 

— 

10 

72,772 

6,514 

55,034 

(39,953) 

(46,247) 

$  1,847,990  $  2,051,239  $  2,029,620 

See “Results of Operations” for discussions regarding both segment NOI and same-store segment NOI.  We define 

same-store as properties owned, consolidated and operational for the full period in both comparison periods and are not 
otherwise excluded; provided, however, that we may include selected properties that otherwise meet the same-store criteria if 
they are included in substantially all of, but not a full, period for one or both of the comparison periods, and in our judgment 
such inclusion provides a more meaningful presentation of our portfolio performance.  

Newly acquired or recently developed or redeveloped properties in our senior living operations segment will be 

included in same-store once they are stabilized for the full period in both periods presented.  These properties are considered 
stabilized upon the earlier of (a) the achievement of 80% sustained occupancy or (b) 24 months from the date of acquisition or 
substantial completion of work.  Recently developed or redeveloped properties in our office operations and triple-net leased 
properties segments will be included in same-store once substantial completion of work has occurred for the full period in both 
periods presented.  Our senior living operations and triple-net leased properties that have undergone operator or business model 
transitions will be included in same-store once operating under consistent operating structures for the full period in both periods 
presented.  

Properties are excluded from same-store if they are:  (i) sold, classified as held for sale or properties whose operations 

were classified as discontinued operations in accordance with GAAP; (ii) impacted by materially disruptive events such as 
flood or fire;  (iii) those properties that are currently undergoing a materially disruptive redevelopment; (iv) for our office 
operations, those properties for which management has an intention to institute a redevelopment plan because the properties 
may require major property-level expenditures to maximize value, increase NOI, or maintain a market-competitive position 
and/or achieve property stabilization; or (v) for the senior living operations and triple-net leased segments, those properties that 
are scheduled to undergo operator or business model transitions, or have transitioned operators or business models after the start 
of the prior comparison period. 

To eliminate the impact of exchange rate movements, all portfolio performance-based disclosures assume constant 
exchange rates across comparable periods, using the following methodology: the current period’s results are shown in actual 
reported USD, while prior comparison period’s results are adjusted and converted to USD based on the average exchange rate 
for the current period.

56

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Asset/Liability Management

Asset/liability management, a key element of enterprise risk management, is designed to support the achievement of 
our business strategy, while ensuring that we maintain appropriate and tolerable levels of market risk (primarily interest rate 
risk and foreign currency exchange risk) and credit risk.  Effective management of these risks is a contributing factor to the 
absolute levels and variability of our FFO and net worth.  The following discussion addresses our integrated management of 
assets and liabilities, including the use of derivative financial instruments.

Market Risk

We are exposed to market risk related to changes in interest rates with respect to borrowings under our unsecured 

revolving credit facility, our secured construction revolver and our unsecured term loans, certain of our mortgage loans that are 
floating rate obligations, mortgage loans receivable that bear interest at floating rates and available for sale securities.  These 
market risks result primarily from changes in LIBOR rates or prime rates.  To manage these risks, we continuously monitor our 
level of floating rate debt with respect to total debt and other factors, including our assessment of current and future economic 
conditions.  

57

The table below sets forth certain information with respect to our debt, excluding premiums and discounts.

Balance:
Fixed rate:

Senior notes

Unsecured term loans

Secured revolving construction credit facility

Mortgage loans and other

Variable rate:

Senior notes

Unsecured revolving credit facility

Unsecured term loans

Commercial paper notes

Secured revolving construction credit facility

Mortgage loans and other

Total

Percent of total debt:
Fixed rate:

Senior notes

Unsecured term loans

Secured revolving construction credit facility

Mortgage loans and other

Variable rate:

Senior notes

Unsecured revolving credit facility

Unsecured term loans

Commercial paper notes

Secured revolving construction credit facility

Mortgage loans and other

Total

Weighted average interest rate at end of period:
Fixed rate:

Senior notes

Unsecured term loans

Secured revolving construction credit facility

Mortgage loans and other

Variable rate:

Senior notes

Unsecured revolving credit facility

Unsecured term loans

Commercial paper notes

Secured revolving construction credit facility
Mortgage loans and other
Total

As of December 31,

2020

2019

2018

(Dollars in thousands)

$ 

8,869,036 

$ 

8,584,056 

$ 

7,945,598 

200,000 

— 

200,000 

160,492 

400,000 

— 

1,389,227 

1,325,854 

698,136 

235,664 

39,395 

392,773 

— 

154,098 

702,878 

231,018 

120,787 

385,030 

567,450 

— 

671,115 

— 

765,919 

500,000 

— 

90,488 

429,561 

$  11,983,071 

$  12,245,802 

$  10,829,702 

 73.9% 

 70.1% 

 73.4% 

 1.7 

 — 

 11.6 

 2.0 

 0.3 

 3.3 

 — 

 1.3 

 5.9 

 1.6 

 1.3 

 10.8 

 1.9 

 1.0 

 3.1 

 4.7 

 — 

 5.5 

 3.7 

 — 

 6.4 

 — 

 7.1 

 4.6 

 — 

 0.8 

 4.0 

 100.0% 

 100.0% 

 100.0% 

 3.7% 

 3.7% 

 3.8% 

 3.6 

 — 

 3.5 

 1.0 

 1.0 

 1.4 

 — 

 1.9 
 1.9 
 3.4 

 2.0 

 4.5 

 3.7 

 2.5 

 2.4 

 2.9 

 2.0 

 — 
 3.4 
 3.5 

 2.8 

 — 

 4.4 

 — 

 3.2 

 3.3 

 — 

 4.1 
 3.4 
 3.7 

The variable rate debt in the table above reflects, in part, the effect of $146.7 million notional amount of interest rate 
swaps with maturities ranging from March 2022 to May 2022, in each case that effectively convert fixed rate debt to variable 

58

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
rate debt.  In addition, the fixed rate debt in the table above reflects, in part, the effect of $305.9 million and C$145.7 million 
notional amount of interest rate swaps with maturities ranging from January 2023 to December 2029, in each case that 
effectively convert variable rate debt to fixed rate debt.  See “Note 10 – Senior Notes Payable and Other Debt” of the Notes to 
Consolidated Financial Statements included in Part II, Item 8 of this Annual Report.    

The decrease in our outstanding variable rate debt at December 31, 2020 compared to December 31, 2019 is primarily 
attributable to reduced borrowings on our revolving credit facility and commercial paper program, partially offset by the change 
in presentation of the secured revolving construction credit facility to variable rate debt.  The secured revolving construction 
credit facility was previously reflected as fixed rate debt due to an interest rate swap which had effectively converted the 
associated interest expense from variable to fixed until its expiration in August 2020.

Assuming a 100 basis point increase in the weighted average interest rate related to our variable rate debt and 

assuming no change in our variable rate debt outstanding as of December 31, 2020, interest expense on an annualized basis 
would increase by approximately $14.7 million, or $0.04 per diluted common share. 

As of December 31, 2020 and 2019, our joint venture partners’ aggregate share of total debt was $271.6 million and 
$228.2 million, respectively, with respect to certain properties we owned through consolidated joint ventures.  Total debt does 
not include our portion of debt related to investments in unconsolidated real estate entities, which was $213.0 million and $60.6 
million as of December 31, 2020 and 2019, respectively.  

The fair value of our fixed rate debt is based on current market interest rates at which we could obtain similar 
borrowings.  Increases in market interest rates typically result in a decrease in the fair value of fixed rate debt while decreases in 
market interest rates typically result in an increase in the fair value of fixed rate date.  While changes in market interest rates 
affect the fair value of our fixed rate debt, these changes do not affect the interest expense associated with our fixed rate debt.  
Therefore, interest rate risk does not have a significant impact on our fixed rate debt obligations until their maturity or earlier 
prepayment and refinancing.  If interest rates have risen at the time we seek to refinance our fixed rate debt, whether at maturity 
or otherwise, our future earnings and cash flows could be adversely affected by additional borrowing costs.  Conversely, lower 
interest rates at the time of refinancing may reduce our overall borrowing costs.

To highlight the sensitivity of our fixed rate debt to changes in interest rates, the following summary shows the effects 

of a hypothetical instantaneous change of 100 basis points in interest rates:

Gross book value

Fair value

Fair value reflecting change in interest rates:

-100 basis points

+100 basis points

As of December 31,

2020

2019

(In thousands)

$  10,458,262  $  10,270,402 

11,550,236 

10,784,441 

12,204,507 

11,438,507 

10,951,483 

10,196,943 

The change in fair value of our fixed rate debt from December 31, 2019 to December 31, 2020 was due primarily to 

2020 senior note issuances, net of repayments, partially offset by the change in presentation of the secured revolving 
construction credit facility to variable rate debt.  The secured revolving construction credit facility was previously reflected as 
fixed rate debt due to an interest rate swap which had effectively converted the associated interest expense from variable to 
fixed until its expiration in August 2020.

As of December 31, 2020 and 2019, the fair value of our secured and non-mortgage loans receivable, based on our 

estimates of currently prevailing rates for comparable loans, was $565.7 million and $710.5 million, respectively.  See “Note 6 
– Loans Receivable and Investments” and “Note 11 – Fair Values of Financial Instruments” of the Notes to Consolidated 
Financial Statements included in Part II, Item 8 of this Annual Report.

As a result of our Canadian and United Kingdom operations, we are subject to fluctuations in certain foreign currency 

exchange rates that may, from time to time, affect our financial condition and operating performance.  Based solely on our 
results for the year ended December 31, 2020 (including the impact of existing hedging arrangements), if the value of the U.S. 
dollar relative to the British pound and Canadian dollar were to increase or decrease by one standard deviation compared to the 
average exchange rate during the year, our normalized FFO per share for the year ended December 31, 2020 would decrease or 

59

 
 
 
 
 
 
 
 
 
increase, as applicable, by less than $0.01 per share or 1%.  We will continue to mitigate these risks through a layered approach 
to hedging looking out for the next year and continual assessment of our foreign operational capital structure. Nevertheless, we 
cannot assure you that any such fluctuations will not have an effect on our earnings.

Concentration and Credit Risk

We use concentration ratios to identify, understand and evaluate the potential impact of economic downturns and other 
adverse events that may affect our asset types, geographic locations, business models, and tenants, operators and managers.  We 
evaluate concentration risk in terms of investment mix and operations mix.  Investment mix measures the percentage of our 
investments that is concentrated in a specific asset type or that is operated or managed by a particular tenant, operator or 
manager.  Operations mix measures the percentage of our operating results that is attributed to a particular tenant, operator or 
manager, geographic location or business model.  The following tables reflect our concentration risk as of the dates and for the 
periods presented:

Investment mix by asset type(1):
Senior housing communities

MOBs

Research and innovation centers

Health systems

IRFs and LTACs

SNFs

Secured loans receivable and investments, net
Investment mix by tenant, operator and manager(1):

Atria

Sunrise

Brookdale Senior Living

Ardent

Kindred

All other

As of
December 31,

2020

2019

 63.5% 

 19.7 

 62.2% 

 19.3 

 7.1 

 5.2 

 1.7 

 0.7 

 2.1 

 20.8% 

 10.4 

 8.2 

 4.9 

 1.1 

 54.6 

 8.7 

 5.1 

 1.6 

 0.7 

 2.4 

 20.4% 

 10.3 

 7.7 

 4.7 

 1.0 

 55.9 

(1) Ratios are based on the gross book value of consolidated real estate investments (excluding properties classified as held for 

sale) as of each reporting date.

60

 
 
 
 
 
 
Operations mix by tenant and operator and business model:
Revenues(1):

Senior living operations
Brookdale Senior Living(2)
Ardent

Kindred

All others

Adjusted EBITDA:

Senior living operations
Brookdale Senior Living(2)
Ardent

Kindred

All others

NOI:

Senior living operations
Brookdale Senior Living(2)
Ardent

Kindred

All others

Operations mix by geographic location(3):

California

New York

Texas

Pennsylvania

Illinois

All others

For the Years Ended December 31,

2020

2019

2018

 58.0% 

 55.8% 

 55.3% 

 4.4 

 3.2 

 3.5 

 30.9 

 4.7 

 3.1 

 3.3 

 33.1 

 4.3 

 3.1 

 3.5 

 33.8 

 30.8% 

 32.5% 

 31.3% 

 9.5 

 7.0 

 7.5 

 45.2 

 8.1 

 5.4 

 5.8 

 48.2 

 6.7 

 5.1 

 5.6 

 51.3 

 29.4% 

 31.1% 

 30.7% 

 9.0 

 6.6 

 7.1 

 47.9 

 8.7 

 5.8 

 6.3 

 48.1 

 7.6 

 5.7 

 6.4 

 49.6 

 15.7% 

 15.9% 

 15.7% 

 8.1 

 6.1 

 4.6 

 4.1 

 61.4 

 8.8 

 6.0 

 4.7 

 4.0 

 60.6 

 8.4 

 6.2 

 4.6 

 4.4 

 60.7 

(1) Total revenues include medical office building and other services revenue, revenue from loans and investments and interest 

and other income (including amounts related to assets classified as held for sale).  

(2) Results exclude eight senior housing communities which are included in the senior living operations reportable business 
segment.  2018 results include the impact of a net non-cash charge of $21.3 million related to April 2018 lease extensions.
(3) Ratios are based on total revenues (including amounts related to assets classified as held for sale) for each period presented. 

See “Non-GAAP Financial Measures” included elsewhere in this Annual Report for additional disclosure and 
reconciliations of net income attributable to common stockholders, as computed in accordance with GAAP, to Adjusted 
EBITDA and NOI, respectively.

We derive a significant portion of our revenues by leasing assets under long-term triple-net leases in which the rental 

rate is generally fixed with escalators, subject to certain limitations.  Some of our triple-net lease escalators are contingent upon 
the satisfaction of specified facility revenue parameters or based on increases in the Consumer Price Index (“CPI”), with caps, 
floors or collars.  We also earn revenues directly from individual residents in our senior housing communities that are managed 
by independent operators, such as Atria and Sunrise, and tenants in our office buildings.  For the year ended December 31, 
2020, 61.0% of our Adjusted EBITDA was derived from our senior living operations and office operations, for which rental 
rates may fluctuate more frequently upon lease rollovers and renewals due to shorter-term leases and changing economic or 
market conditions.

The concentration of our triple-net leased properties segment revenues and operating income that are attributed to 

Brookdale Senior Living, Ardent and Kindred creates credit risk.  If any of Brookdale Senior Living, Ardent or Kindred 
becomes unable or unwilling to satisfy its obligations to us or to renew its leases with us upon expiration of the terms thereof, 
our financial condition and results of operations could decline, and our ability to service our indebtedness and to make 

61

 
 
 
 
 
 
 
 
 
 
 
 
 
 
distributions to our stockholders could be impaired.  See “Risk Factors—Our Business Operations and Strategy Risks—A 
significant portion of our revenues and operating income is dependent on a limited number of tenants and managers, including 
Brookdale Senior Living, Ardent, Kindred, Atria and Sunrise.” included in Part I, Item 1A of this Annual Report and “Note 3 – 
Concentration of Credit Risk” of the Notes to Consolidated Financial Statements included in Part II, Item 8 of this Annual 
Report.

We regularly monitor and assess any changes in the relative credit risk of our significant tenants, and in particular 

those tenants that have recourse obligations under our triple-net leases.  The ratios and metrics we use to evaluate a significant 
tenant’s liquidity and creditworthiness depend on facts and circumstances specific to that tenant and the industry or industries in 
which it operates, including without limitation the tenant’s credit history and economic conditions related to the tenant, its 
operations and the markets in which the tenant operates, that may vary over time.  Among other things, we may (i) review and 
analyze information regarding the real estate, senior housing and healthcare industries generally, publicly available information 
regarding the significant tenant, and information required to be provided by the tenant under the terms of its lease agreements 
with us, (ii) examine monthly or quarterly financial statements of the significant tenant to the extent publicly available or 
otherwise provided under the terms of our lease agreements, and (iii) participate in periodic discussions and in-person meetings 
with representatives of the significant tenant.  Using this information, we calculate multiple financial ratios (which may, but do 
not necessarily, include leverage, fixed charge coverage and tangible net worth), after making certain adjustments based on our 
judgment, and assess other metrics we deem relevant to an understanding of the significant tenant’s credit risk.

Because Atria and Sunrise manage our properties in exchange for the receipt of a management fee from us, we are not 
directly exposed to the credit risk of our managers in the same manner or to the same extent as our triple-net tenants.  However, 
we rely on our managers’ personnel, expertise, technical resources and information systems, proprietary information, good faith 
and judgment to manage our senior living operations efficiently and effectively.  We also rely on Atria and Sunrise to set 
appropriate resident fees, to provide accurate property-level financials results in a timely manner and otherwise operate our 
senior housing communities in compliance with the terms of our management agreements and all applicable laws and 
regulations.  Although we have various rights as the property owner under our management agreements, including various 
rights to terminate and exercise remedies under the agreements as provided therein, Atria’s or Sunrise’s failure, inability or 
unwillingness to satisfy its respective obligations under those agreements, to efficiently and effectively manage our properties 
or to provide timely and accurate accounting information with respect thereto could have a Material Adverse Effect on us.  See 
“Risk Factors—Our Business Operations and Strategy Risks.” included in Part I, Item 1A of this Annual Report.  

We hold a 34% ownership interest in Atria, which entitles us to customary minority rights and protections, as well as 

the right to appoint two of the six members on the Atria Board of Directors. 

Triple-Net Lease Performance and Expirations

Any failure, inability or unwillingness by our tenants to satisfy their obligations under our triple-net leases could have 

a material adverse effect on us.  Also, if our tenants are not able or willing to renew our triple-net leases upon expiration, we 
may be unable to reposition the applicable properties on a timely basis or on the same or better economic terms, if at all.  
Although our lease expirations are staggered, the non-renewal of some or all of our triple-net leases that expire in any given 
year could have a material adverse effect on us.  During the year ended December 31, 2020, we had no triple-net lease renewals 
or expirations without renewal that, in the aggregate, had a material impact on our financial condition or results of operations 
for that period.  See “Risk Factors—Our Business Operations and Strategy Risks—If we must replace any of our tenants or 
managers, we may be unable to do so on as favorable terms, or at all, and we could be subject to delays, limitations and 
expenses, which could adversely affect our business, financial condition and results of operations.” included in Part I, Item IA 
of this Annual Report.

62

The following table summarizes our lease expirations in our triple-net leased properties segment currently scheduled to 

occur over the next 10 years as of December 31, 2020:

2021

2022
2023(3)
2024

2025

2026

2027

2028

2029

Number of
Properties(1)

2020 
Annualized 
Base Rent 
(“ABR”)(2)

% of 2020 Total 
Triple-Net Leased 
Properties Segment 
Rental Income

(Dollars in thousands)

9  $ 

8 

6 

26 

179 

39 

4 

27 

21 

12,062 

5,799 

31,240 

13,970 

234,549 

53,660 

8,784 

25,196 

22,788 

 1.7% 

 0.8 

 4.5 

 2.0 

 33.7 

 7.7 

 1.3 

 3.6 

 3.3 

2030
(1) Excludes assets sold or classified as held for sale, unconsolidated entities development properties not yet operational, 

4,748 

6 

 0.7 

unconsolidated joint ventures and land parcels.

(2) ABR represents the annualized impact of the current period’s cash base rent at 100% share for consolidated entities. ABR 
does not include common area maintenance charges, the amortization of above/below market lease intangibles or other 
noncash items. ABR is used only for the purpose of determining lease expirations.

(3) Relates to 6 LTACs leased by Kindred. While the lease term expires in 2023, Kindred may extend the term for 5 years by 

delivering a renewal notice to the Company 12 to 18 months prior to expiration.

Liquidity and Capital Resources

During 2020, our principal sources of liquidity were cash flows from operations, proceeds from the issuance of debt 

and equity securities, borrowings under our unsecured revolving credit facility, and proceeds from asset sales. 

For the next 12 months, our principal liquidity needs are to: (i) fund operating expenses; (ii) meet our debt service 
requirements; (iii) repay maturing mortgage and other debt; (iv) fund acquisitions, investments and commitments and any 
development and redevelopment activities; (v) fund capital expenditures; and (vi) make distributions to our stockholders and 
unitholders, as required for us to continue to qualify as a REIT.  Depending upon the availability of external capital, we believe 
our liquidity is sufficient to fund these uses of cash.  We expect that these liquidity needs generally will be satisfied by a 
combination of the following: cash flows from operations, cash on hand, debt assumptions and financings (including secured 
financings), issuances of debt and equity securities, dispositions of assets (in whole or in part through joint venture 
arrangements with third parties) and borrowings under our revolving credit facilities and commercial paper program.  However, 
an inability to access liquidity through multiple capital sources concurrently could have a material adverse effect on us. 

While continuing decreased revenue and net operating income as a result of the COVID-19 pandemic could lead to 

downgrades of our long-term credit rating and therefore adversely impact our cost of borrowing, we currently believe we will 
continue to have access to one or more debt markets during the duration of the pandemic and could seek to enter into secured 
debt financings or issue debt and equity securities to satisfy our liquidity needs, although no assurances can be made in this 
regard.  See “COVID-19 Update.” See “Risk Factors—Our Capital Structure Risks—We are highly dependent on access to the 
capital markets. Limitations on our ability to access capital could have an adverse effect on us, including our ability to make 
required payments on our debt obligations, make distributions to our stockholders or make future investments necessary to 
implement our business strategy.” included in Part I, Item 1A of this Annual Report.

2020 Capital Conservation Actions

In 2020, we executed on a multi-pronged capital conservation strategy to mitigate the impact of COVID-19, which 

included reducing our planned capital expenditures and capital commitments. We also established a quarterly dividend of $0.45 
per share beginning in the second quarter, which was a reduction from the first quarter dividend of $0.7925 per share.  This 
action enabled us to conserve approximately $130 million of cash per quarter compared to the prior dividend level. Also, in 
June 2020, we eliminated roles representing over 25% of our corporate positions, excluding onsite field personnel. For the 

63

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
second half of 2020, the base salaries of our CEO and other executive officers were voluntarily reduced by 20% and 10%, 
respectively. Primarily as a result of these capital conservation actions, our 2020 general and administrative expenses are $29 
million lower than 2019.

See “Note 10 – Senior Notes Payable and Other Debt” of the Notes to Consolidated Financial Statements included in 

Part II, Item 8 of this Annual Report for further information regarding our significant financing activities. 

Credit Facilities, Commercial Paper and Unsecured Term Loans

 As of December 31, 2020, our unsecured credit facility was comprised of a $3.0 billion unsecured revolving credit 

facility priced at LIBOR plus 0.875% based on the Company’s debt rating, which was scheduled to mature in 2021. In January 
2021, we entered into an amended and restated unsecured credit facility (the “New Credit Facility”) comprised of a 
$2.75 billion unsecured revolving credit facility initially priced at LIBOR plus 0.825% based on the Company’s debt rating.  
The New Credit Facility matures in 2025, but may be extended at our option subject to the satisfaction of certain conditions, for 
two additional periods of six months each.  The New Credit Facility also includes an accordion feature that permits us to 
increase our aggregate borrowing capacity thereunder to up to $3.75 billion.

As of December 31, 2020, $39.4 million was outstanding under the unsecured revolving credit facility with an 
additional $24.9 million restricted to support outstanding letters of credit.  In addition, we limit our utilization of the unsecured 
revolving credit facility, to the extent necessary, to support our commercial paper program when commercial paper notes are 
outstanding.  We had $2.9 billion in available liquidity under the unsecured revolving credit facility as of December 31, 2020.  
In connection with the New Credit Facility, we paid off all amounts outstanding under the existing unsecured revolving credit 
facility as of January 29, 2021 by drawing down the same amount on the New Credit Facility.

Our wholly owned subsidiary, Ventas Realty, Limited Partnership (“Ventas Realty”), may issue from time to time 

unsecured commercial paper notes up to a maximum aggregate amount outstanding at any time of $1.0 billion.  The notes are 
sold under customary terms in the United States commercial paper note market and are ranked pari passu with all of Ventas 
Realty’s other unsecured senior indebtedness.  The notes are fully and unconditionally guaranteed by Ventas, Inc.  As of 
December 31, 2020, we had no borrowings outstanding under our commercial paper program.

As of December 31, 2020, we had a $200.0 million unsecured term loan priced at LIBOR plus 0.90% that matures in 

2023.  The term loan also includes an accordion feature that effectively permits us to increase our aggregate borrowings 
thereunder to up to $800.0 million.

As of December 31, 2020, we had a $400.0 million secured revolving construction credit facility with $154.1 million 
of borrowings outstanding.  The secured revolving construction credit facility matures in 2022 and is primarily used to finance 
the development of research and innovation centers and other construction projects.

As of December 31, 2020, we had a C$500 million unsecured term loan facility priced at Canadian Dollar Offered 

Rate (“CDOR”) plus 0.90% that matures in 2025.

Senior Notes

In April 2020, Ventas Realty issued and sold $500.0 million aggregate principal amount of 4.75% senior notes due 

2030 at an amount equal to 97.86% of par.  

In October 2020, we redeemed, pursuant to a cash tender offer, $236.3 million aggregate principal amount then 

outstanding of our 3.25% senior notes due 2022 at 104.14% of par value, plus accrued and unpaid interest to the payment date. 
As a result, we recognized a loss on extinguishment of debt of $11.1 million during the year ended December 31, 2020.

As of December 31, 2020, we had outstanding $7.7 billion aggregate principal amount of senior notes issued by 

Ventas Realty ($263.7 million of which was co-issued by Ventas Realty’s wholly owned subsidiary, Ventas Capital 
Corporation), approximately $75.2 million aggregate principal amount of senior notes issued by Nationwide Health Properties, 
Inc. (“NHP”) and assumed by our subsidiary, Nationwide Health Properties, LLC (“NHP LLC”), as successor to NHP, in 
connection with our acquisition of NHP, and C$1.7 billion aggregate principal amount of senior notes issued by our subsidiary, 
Ventas Canada Finance Limited (“Ventas Canada”).  All of the senior notes issued by Ventas Realty and Ventas Canada are 
unconditionally guaranteed by Ventas, Inc.

64

In February 2021, in order to reduce near-term maturities, we issued a make-whole redemption for the entirety of the 
$400 million outstanding aggregate principal amount of 3.10% senior notes due January 2023. The redemption is expected to 
settle in March 2021 and will be funded primarily with cash on hand.

We may, from time to time, seek to retire or purchase our outstanding senior notes for cash or in exchange for equity 

securities in open market purchases, privately negotiated transactions or otherwise.  Such repurchases or exchanges, if any, will 
depend on prevailing market conditions, our liquidity requirements, contractual restrictions, prospects for capital and other 
factors.  The amounts involved may be material.

The indentures governing our outstanding senior notes require us to comply with various financial and other restrictive 

covenants.  We were in compliance with all of these covenants at December 31, 2020.

Mortgages

At December 31, 2020 and 2019, our consolidated aggregate principal amount of mortgage debt outstanding was $2.1 

billion and $2.0 billion, respectively, of which our share was $1.8 billion for both years.

Under certain circumstances, contractual and legal restrictions, including those contained in the instruments governing 

our subsidiaries’ outstanding mortgage indebtedness, may restrict our ability to obtain cash from our subsidiaries for the 
purpose of meeting our debt service obligations, including our payment guarantees with respect to Ventas Realty’s and Ventas 
Canada Finance Limited’s senior notes. 

Derivatives and Hedging

In the normal course of our business, interest rate fluctuations affect future cash flows under our variable rate debt 

obligations, loans receivable and marketable debt securities, and foreign currency exchange rate fluctuations affect our 
operating results.  We follow established risk management policies and procedures, including the use of derivative instruments, 
to mitigate the impact of these risks.

Dividends

During 2020, we declared four dividends totaling $2.1425 per share of our common stock, including a fourth quarter 
dividend of $0.45 per share.  In order to continue to qualify as a REIT, we must make annual distributions to our stockholders 
of at least 90% of our REIT taxable income (excluding net capital gain).  In addition, we will be subject to income tax at the 
regular corporate rate to the extent we distribute less than 100% of our REIT taxable income, including any net capital gains.  
We intend to pay dividends greater than 100% of our taxable income, after the use of any net operating loss carryforwards, for 
2021. 

We expect that our cash flows will exceed our REIT taxable income due to depreciation and other non-cash deductions 
in computing REIT taxable income and that we will be able to satisfy the 90% distribution requirement.  However, from time to 
time, we may not have sufficient cash on hand or other liquid assets to meet this requirement or we may decide to retain cash or 
distribute such greater amount as may be necessary to avoid income and excise taxation.  If we do not have sufficient cash on 
hand or other liquid assets to enable us to satisfy the 90% distribution requirement, or if we desire to retain cash, we may 
borrow funds, issue additional equity securities, pay taxable stock dividends, if possible, distribute other property or securities 
or engage in a transaction intended to enable us to meet the REIT distribution requirements or any combination of the 
foregoing.

Capital Expenditures

The terms of our triple-net leases generally obligate our tenants to pay all capital expenditures necessary to maintain 
and improve our triple-net leased properties.  However, from time to time, we may fund the capital expenditures for our triple-
net leased properties through loans or advances to the tenants, which may increase the amount of rent payable with respect to 
the properties in certain cases.  We may also fund capital expenditures for which we may become responsible upon expiration 
of our triple-net leases or in the event that our tenants are unable or unwilling to meet their obligations under those leases.  We 
also expect to fund capital expenditures related to our senior living operations and office operations reportable business 
segments with the cash flows from the properties or through additional borrowings.  We expect that these liquidity needs 
generally will be satisfied by a combination of the following: cash flows from operations, cash on hand, debt assumptions and 
financings (including secured financings), issuances of debt and equity securities, dispositions of assets (in whole or in part 
through joint venture arrangements with third parties) and borrowings under our revolving credit facilities.

65

To the extent that unanticipated capital expenditure needs arise or significant borrowings are required, our liquidity 

may be affected adversely.  Our ability to borrow additional funds may be restricted in certain circumstances by the terms of the 
instruments governing our outstanding indebtedness.

We are party to certain agreements that obligate us to develop senior housing or healthcare properties funded through 

capital that we and, in certain circumstances, our joint venture partners provide.  As of December 31, 2020, we had 13 
properties under development pursuant to these agreements, including three properties that are owned by unconsolidated real 
estate entities.  In addition, from time to time, we engage in redevelopment projects with respect to our existing senior housing 
communities to maximize the value, increase NOI, maintain a market-competitive position, achieve property stabilization or 
change the primary use of the property.  

Equity Offerings

From time to time, we may sell up to an aggregate of $1.0 billion of our common stock under an “at-the-market” 

equity offering program (“ATM program”).  As of December 31, 2020, we have $755.5 million remaining under our existing 
ATM program. During the years ended December 31, 2020 and 2019, we sold 1.5 million and 2.7 million shares of our 
common stock under our ATM program for gross proceeds of $44.88 and $66.75 per share, respectively. During the year ended 
December 31, 2018, we sold no shares of common stock under our ATM program.  

In June 2019, we sold 12.7 million shares of our common stock under a registered public offering for gross proceeds of 

$62.75 per share.  We used the majority of the net proceeds to fund our LGM Acquisition.  See “Note 4 – Acquisitions of Real 
Estate Property” of the Notes to Consolidated Financial Statements included in Part II, Item 8 of this Annual Report for 
additional information regarding the LGM Acquisition.

Cash Flows

The following table sets forth our sources and uses of cash flows for the years ended December 31, 2020 and 2019:

For the Years Ended
December 31,

(Decrease) Increase
to Cash

2020

2019

$

%

(Dollars in thousands)

Cash, cash equivalents and restricted cash at beginning of 

year

$ 

146,102  $ 

131,464  $ 

Net cash provided by operating activities

1,450,176 

1,437,783 

14,638 

12,393 

Net cash provided by (used in) investing activities

154,295 

(1,585,299)   

1,739,594 

Net cash (used in) provided by financing activities

(1,300,021)   

160,674 

(1,460,695) 

 11.1 %

 0.9 

nm

nm

Effect of foreign currency translation 

1,088 

1,480 

(392) 

 (26.5) 

Cash, cash equivalents and restricted cash at end of year

$ 

451,640  $ 

146,102 

305,538 

nm

nm—not meaningful

Cash Flows from Operating Activities

Cash flows from operating activities increased $12.4 million during the year ended December 31, 2020 over the same 

period in 2019 primarily due to the up-front consideration received in connection with the Brookdale transaction, partially 
offset by lower NOI.

Cash Flows from Investing Activities

Cash flows from investing activities increased $1.7 billion during 2020 over 2019 primarily due to decreased 

acquisition and investment activity together with increased proceeds from real estate dispositions.

66

 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cash Flows from Financing Activities

Cash flows from financing activities decreased $1.5 billion during 2020 over 2019 primarily due to lower issuances of 
common stock, decreased debt borrowings during 2020, net of repayments, partially offset by lower dividends paid to common 
stockholders during 2020.

Contractual Obligations

The following table summarizes the effect that minimum debt (which includes principal and interest payments) and 
other material noncancelable commitments are expected to have on our cash flow in future periods as of December 31, 2020:

Long-term debt obligations (1) (2)
Operating obligations, including ground 

Total

Less than 1 
year(3)

1 - 3 years(4)

3 - 5 years(5)

(In thousands)

More than 5
years(6)

$  15,107,176  $ 

1,002,409  $ 

3,475,813  $ 

3,794,808  $ 

6,834,146 

lease obligations

Total

726,410 

26,968 

43,352 

36,413 

619,677 

$  15,833,586  $ 

1,029,377  $ 

3,519,165  $ 

3,831,221  $ 

7,453,823 

(1) Amounts represent contractual amounts due, including interest.
(2)

(3)

(4)

(5)

(6)

Interest on variable rate debt based on rates as of December 31, 2020.
Includes $39.4 million of borrowings outstanding on our unsecured revolving credit facility and $235.7 million outstanding 
principal amount of our floating rate senior notes, Series F due 2021.
Includes $154.1 million of borrowings outstanding on our secured revolving construction credit facility, $263.7 million 
outstanding principal amount of our 3.25% senior notes due 2022, $196.4 million outstanding principal amount of our 
3.30% senior notes, Series C due 2022, $216.0 million outstanding principal amount of our 2.55% senior notes, Series D 
due 2023, $200.0 million of borrowings outstanding on our unsecured term loan due 2023, $400.0 million outstanding 
principal amount of our 3.125% senior notes due 2023, and $400.0 million outstanding principal amount of our 3.10% 
senior notes due 2023.
Includes $400.0 million outstanding principal amount of our 3.50% senior notes due 2024, $400.0 million outstanding 
principal amount of our 3.75% senior notes due 2024, $471.3 million outstanding principal amount of our 2.80% senior 
notes, Series E due 2024, $196.4 million outstanding principal amount of our 4.125% senior notes, Series B due 2024, 
$392.8 million of borrowings outstanding on our unsecured term loan due 2025, $450.0 million outstanding principal 
amount of our 2.65% senior notes due 2025, and $600.0 million outstanding principal amount of our 3.50% senior notes 
due 2025.
Includes $4.8 billion aggregate principal amount outstanding of our senior notes maturing between 2025 and 2049.  $52.4 
million aggregate principal amount outstanding of our 6.90% senior notes due 2037 are subject to repurchase, at the option 
of the holders, at par, on October 1, 2027, and $22.8 million aggregate principal amount outstanding of our 6.59% senior 
notes due 2038 are subject to repurchase, at the option of the holders, at par, on July 7 in each of 2023 and 2028.

As of December 31, 2020, we had $6.1 million of unrecognized tax benefits that are excluded from the table above, as 

we are unable to make a reasonably reliable estimate of the period of cash settlement, if any, with the respective tax authority.

Off-Balance Sheet Arrangements

We own interests in certain unconsolidated entities as described in Note 7 – Investments in Unconsolidated Entities. 

Except in limited circumstances, our risk of loss is limited to our investment in the joint venture and any outstanding loans 
receivable. In addition, we have certain properties which serve as collateral for debt that is owed by a previous owner of certain 
of our facilities, as described under Note 10 – Senior Notes Payable and Other Debt to the Consolidated Financial Statements. 
Our risk of loss for these certain properties is limited to the outstanding debt balance plus penalties, if any. Further, we use 
financial derivative instruments to hedge interest rate and foreign currency exchange rate exposure. Finally, at December 31, 
2020, we had $24.9 million outstanding letter of credit obligations. We have no other material off-balance sheet arrangements 
that we expect would materially affect our liquidity and capital resources except those described above under “Contractual 
Obligations.”

67

 
 
 
 
 
 
Guarantor and Issuer Financial Information

Ventas, Inc. has fully and unconditionally guaranteed the obligation to pay principal and interest with respect to the 

outstanding senior notes issued by our 100%-owned subsidiary, Ventas Realty, including the senior notes that were jointly 
issued with Ventas Capital Corporation.  Ventas Capital Corporation is a direct, 100%-owned subsidiary of Ventas Realty that 
has no assets or operations, but was formed in 2002 solely to facilitate offerings of senior notes by a limited partnership.  None 
of our other subsidiaries (excluding Ventas Realty and Ventas Capital Corporation) is obligated with respect to Ventas Realty’s 
outstanding senior notes. 

Ventas, Inc. has also fully and unconditionally guaranteed the obligation to pay principal and interest with respect to 
the outstanding senior notes issued by our 100%-owned subsidiary Ventas Canada Finance Limited (“Ventas Canada”).  None 
of our other subsidiaries is obligated with respect to Ventas Canada’s outstanding senior notes, all of which were issued on a 
private placement basis in Canada.

In connection with the acquisition of Nationwide Health Properties, Inc. (“NHP”), our 100%-owned subsidiary 

Nationwide Health Properties, LLC (“NHP LLC”), as successor to NHP, assumed the obligation to pay principal and interest 
with respect to the outstanding senior notes issued by NHP.  Neither we nor any of our subsidiaries (other than NHP LLC) is 
obligated with respect to any of NHP LLC’s outstanding senior notes.

Under certain circumstances, contractual and legal restrictions, including those contained in the instruments governing 

our subsidiaries’ outstanding mortgage indebtedness, may restrict our ability to obtain cash from our subsidiaries for the 
purpose of meeting our debt service obligations, including our payment guarantees with respect to Ventas Realty’s and Ventas 
Canada’s senior notes. 

The following summarizes our guarantor and issuer balance sheet and statement of income information as of 

December 31, 2020 and December 31, 2019 and for the years ended December 31, 2020, 2019 and 2018.

Balance Sheet Information

As of December 31, 2020

Guarantor

Issuer

(In thousands)

Assets

Investment in and advances to affiliates

$ 

16,576,278  $ 

Total assets

Liabilities and equity

Intercompany loans

Total liabilities

Redeemable OP unitholder and noncontrolling interests

Total equity (deficit)

Total liabilities and equity

16,937,149 

10,691,626 

10,918,320 

89,669 

5,929,161 

16,937,149 

2,727,931 

2,844,339 

(4,532,350) 

3,577,009 

— 

(732,670) 

2,844,339 

68

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Balance Sheet Information

As of December 31, 2019

Guarantor

Issuer

(In thousands)

Assets

Investment in and advances to affiliates

$ 

15,774,897  $ 

Total assets

Liabilities and equity

Intercompany loans

Total liabilities

Redeemable OP unitholder and noncontrolling interests

Total equity (deficit)

Total liabilities and equity

15,875,910 

8,789,600 

9,133,733 

102,657 

6,639,520 

15,875,910 

2,728,110 

2,838,270 

(5,105,070) 

3,363,067 

— 

(524,797) 

2,838,270 

Statement of Income Information

For the Year Ended December 31, 2020

Guarantor

Issuer

Equity earnings in affiliates

Total revenues

$ 

(In thousands)

469,311  $ 

474,392 

Income (loss) before unconsolidated entities, real estate dispositions, 
income taxes and noncontrolling interests

Net income (loss)

Net income (loss) attributable to common stockholders

440,210 

439,149 

439,149 

Statement of Income Information

— 

143,259 

(215,406) 

(202,845) 

(202,845) 

Equity earnings in affiliates

Total revenues

Income (loss) before unconsolidated entities, real estate dispositions, 
income taxes and noncontrolling interests

Net income (loss)

Net income (loss) attributable to common stockholders

Equity earnings in affiliates

Total revenues

Income (loss) before unconsolidated entities, real estate dispositions, 
income taxes and noncontrolling interests

Net income (loss)

Net income (loss) attributable to common stockholders

$ 

$ 

For the Year Ended December 31, 2019

Guarantor

Issuer

(In thousands)

362,143  $ 

366,243 

432,020 
433,016 

433,016 

— 

142,754 

(246,929) 
(246,841) 

(246,841) 

For the Year Ended December 31, 2018

Guarantor

Issuer

(In thousands)

308,764  $ 

335,613 

400,349 
409,467 
409,467 

— 

139,062 

(269,557) 
(269,557) 
(269,557) 

69

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ITEM 7A.    Quantitative and Qualitative Disclosures About Market Risk

The information set forth in Part II, Item 7 of this Annual Report under “Management’s Discussion and Analysis of 
Financial Condition and Results of Operations—Asset/Liability Management” is incorporated by reference into this Item 7A.

70

ITEM 8.    Financial Statements and Supplementary Data

Ventas, Inc.

Index to Consolidated Financial Statements and Financial Statement Schedules

Management Report on Internal Control over Financial Reporting
Report of Independent Registered Public Accounting Firm
Report of Independent Registered Public Accounting Firm on Internal Control over Financial Reporting
Consolidated Balance Sheets as of December 31, 2020 and 2019
Consolidated Statements of Income for the Years Ended December 31, 2020, 2019 and 2018
Consolidated Statements of Comprehensive Income for the Years Ended December 31, 2020, 2019 and 2018
Consolidated Statements of Equity for the Years Ended December 31, 2020, 2019 and 2018
Consolidated Statements of Cash Flows for the Years Ended December 31, 2020, 2019 and 2018
Notes to Consolidated Financial Statements
Consolidated Financial Statement Schedules

Schedule III — Real Estate and Accumulated Depreciation

Schedule IV — Mortgage Loans on Real Estate

72
73
75
76
77
78
79
80
82

121

155

71

 
MANAGEMENT REPORT ON INTERNAL CONTROL OVER FINANCIAL REPORTING

Our management is responsible for establishing and maintaining adequate internal control over financial reporting, as 

defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act of 1934, as amended.  This system is designed to provide 
reasonable assurance regarding the reliability of financial reporting and the preparation of consolidated financial statements for 
external purposes in accordance with U.S. GAAP.  Because of its inherent limitations, internal control over financial reporting 
is not intended to provide absolute assurance that a misstatement of our financial statements would be prevented or detected.

Management, with the participation of the Company’s Chief Executive Officer and Chief Financial Officer, conducted 

an assessment of the effectiveness of the Company’s internal control over financial reporting based on the criteria set forth in 
Internal Control - Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway 
Commission (COSO).  Based on this assessment, management has concluded that our internal control over financial reporting 
was effective at the reasonable assurance level as of December 31, 2020.

The effectiveness of our internal control over financial reporting as of December 31, 2020 has been audited by KPMG 

LLP, an independent registered public accounting firm, as stated in their report included herein.

72

 
Report of Independent Registered Public Accounting Firm

To the Stockholders and Board of Directors 
Ventas, Inc.:

Opinion on the Consolidated Financial Statements

We have audited the accompanying consolidated balance sheets of Ventas, Inc. and subsidiaries (the Company) as 
of December 31, 2020 and 2019, the related consolidated statements of income, comprehensive income, equity, 
and cash flows for each of the years in the three-year period ended December 31, 2020, and the related notes and 
financial statement schedules III and IV (collectively, the consolidated financial statements). In our opinion, the 
consolidated financial statements present fairly, in all material respects, the financial position of the Company as of 
December 31, 2020 and 2019, and the results of its operations and its cash flows for each of the years in the three-
year period ended December 31, 2020, in conformity with U.S. generally accepted accounting principles.

We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United 
States) (PCAOB), the Company’s internal control over financial reporting as of December 31, 2020, based on 
criteria established in Internal Control – Integrated Framework (2013) issued by the Committee of Sponsoring 
Organizations of the Treadway Commission, and our report dated February 23, 2021 expressed an unqualified 
opinion on the effectiveness of the Company’s internal control over financial reporting.

Change in Accounting Principle

As discussed in Note 2 to the consolidated financial statements, the Company has changed its method of 
accounting for leases as of January 1, 2019 due to the adoption of Financial Accounting Standards Board’s 
Accounting Standards Codification (ASC) Topic 842, Leases.

Basis for Opinion

These consolidated financial statements are the responsibility of the Company’s management. Our responsibility is 
to express an opinion on these consolidated financial statements based on our audits. We are a public accounting 
firm registered with the PCAOB and are required to be independent with respect to the Company in accordance with 
the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange 
Commission and the PCAOB.

We conducted our audits in accordance with the standards of the PCAOB. Those standards require that we plan 
and perform the audit to obtain reasonable assurance about whether the consolidated financial statements are free 
of material misstatement, whether due to error or fraud. Our audits included performing procedures to assess the 
risks of material misstatement of the consolidated financial statements, whether due to error or fraud, and 
performing procedures that respond to those risks. Such procedures included examining, on a test basis, evidence 
regarding the amounts and disclosures in the consolidated financial statements. Our audits also included evaluating 
the accounting principles used and significant estimates made by management, as well as evaluating the overall 
presentation of the consolidated financial statements. We believe that our audits provide a reasonable basis for our 
opinion.

Critical Audit Matters

The critical audit matters communicated below are matters arising from the current period audit of the consolidated 
financial statements that were communicated or required to be communicated to the audit committee and that: (1) 
relate to accounts or disclosures that are material to the consolidated financial statements and (2) involved our 
especially challenging, subjective, or complex judgments. The communication of critical audit matters does not alter 
in any way our opinion on the consolidated financial statements, taken as a whole, and we are not, by 
communicating the critical audit matters below, providing separate opinions on the critical audit matters or on the 
accounts or disclosures to which they relate.

Probability of collection of substantially all triple-net rents

As discussed in Note 2 to the consolidated financial statements, the Company assesses the probability of collecting 
substantially all triple-net rents on a lease-by-lease basis. Whenever the results of that assessment, events, or 

73

changes in circumstances indicate that it is not probable the Company will collect substantially all triple-net rents 
under the lease, the Company records a charge to rental income.

We identified the evaluation of the probability of collection of substantially all triple-net rents as a critical audit matter. 
Complex auditor judgment was required to evaluate the various inputs and assumptions to the collectability 
assessment, including the financial strength of the tenant and any guarantors, and the operating performance of the 
leased property.

The following are the primary procedures we performed to address this critical audit matter. We evaluated the 
design and tested the operating effectiveness of certain internal controls over the Company’s evaluation of the 
inputs and assumptions used in the collectability assessment. To assess the Company’s assumptions about the 
financial strength of certain tenants and guarantors and the operating performance of the related leased properties, 
we identified and evaluated the relevance, reliability, and sufficiency of the tenant, guarantor and property financial 
information; tenant guarantees; the existence of outstanding accounts receivable; and the remaining term of the 
lease.  We compared the Company’s historical determinations to actual collections to assess the Company’s ability 
to accurately estimate probability of collections.

Impairment of real estate investments in the triple-net leased and senior living operations segments

As discussed in Notes 1, 2, and 5 to the consolidated financial statements, the Company periodically evaluates its 
long-lived assets, primarily consisting of investments in real estate, for impairment indicators. If indicators of 
impairment are present, the Company evaluates the carrying value of the related real estate investments in relation 
to the future undiscounted cash flows of the underlying operations. In performing this evaluation, the Company 
considers market conditions and current intentions with respect to holding or disposing of the asset and adjusts the 
net book value of real estate properties to fair value if the sum of the expected future undiscounted cash flows, 
including sales proceeds, is less than book value. During the year, impairment indicators arose for certain real 
estate properties. As a result, recoverability assessments were performed, estimated fair values were determined, 
and impairment losses were recognized for certain properties.

We identified the evaluation of real estate investments within the triple-net leased and senior living operations 
segments for impairment as a critical audit matter. Subjective auditor judgment was required in evaluating the 
Company’s determination of the future undiscounted cash flows and estimated fair values of properties where 
undiscounted cash flows were less than net book value. In particular, the undiscounted cash flows and fair value 
estimates were sensitive to significant assumptions, including capitalization rates, projected operating cash flows, 
and stabilization period. Additionally, subjective auditor judgment and specialized skills and knowledge were needed 
to evaluate comparable market transactions used by the Company to develop certain fair value estimates due to 
limited transactional volume.

The following are the primary procedures we performed to address this critical audit matter. We evaluated the 
design and tested the operating effectiveness of certain internal controls related to the impairment process. This 
included controls related to the Company’s impairment process and the significant assumptions and fair value 
estimates described above. To test certain of the Company’s undiscounted cash flow estimates, we evaluated the 
Company’s forecasts of projected operating cash flows by comparing actual results to the Company’s forecasts 
adjusted for current market trends. In addition, we involved valuation professionals with specialized skills and 
knowledge, who assisted in:

● 

● 

evaluating the Company’s significant assumptions by comparing the significant assumptions to publicly 
available market data, and

developing independent estimates of fair value for certain properties using comparable market transactions 
and discounted cash flows developed using the Company’s historical results and publicly available market 
data.

/s/ KPMG LLP 

We have served as the Company’s auditor since 2014.

Chicago, Illinois
February 23, 2021

74

 
Report of Independent Registered Public Accounting Firm

To the Stockholders and Board of Directors 
Ventas, Inc.:

Opinion on Internal Control Over Financial Reporting

We have audited Ventas, Inc. and subsidiaries' (the Company) internal control over financial reporting as of 
December 31, 2020, based on criteria established in Internal Control – Integrated Framework (2013) issued by the 
Committee of Sponsoring Organizations of the Treadway Commission. In our opinion, the Company maintained, in 
all material respects, effective internal control over financial reporting as of December 31, 2020, based on criteria 
established in Internal Control – Integrated Framework (2013) issued by the Committee of Sponsoring 
Organizations of the Treadway Commission.

We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United 
States) (PCAOB), the consolidated balance sheets of the Company as of December 31, 2020 and 2019, the related 
consolidated statements of income, comprehensive income, equity, and cash flows for each of the years in the 
three-year period ended December 31, 2020, and the related notes and financial statement schedules III and IV 
(collectively, the consolidated financial statements), and our report dated February 23, 2021 expressed an 
unqualified opinion on those consolidated financial statements.

Basis for Opinion

The Company’s management is responsible for maintaining effective internal control over financial reporting and for 
its assessment of the effectiveness of internal control over financial reporting, included in the accompanying Internal 
Control over Financial Reporting. Our responsibility is to express an opinion on the Company’s internal control over 
financial reporting based on our audit. We are a public accounting firm registered with the PCAOB and are required 
to be independent with respect to the Company in accordance with the U.S. federal securities laws and the 
applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.

We conducted our audit in accordance with the standards of the PCAOB. Those standards require that we plan and 
perform the audit to obtain reasonable assurance about whether effective internal control over financial reporting 
was maintained in all material respects. Our audit of internal control over financial reporting included obtaining an 
understanding of internal control over financial reporting, assessing the risk that a material weakness exists, and 
testing and evaluating the design and operating effectiveness of internal control based on the assessed risk. Our 
audit also included performing such other procedures as we considered necessary in the circumstances. We 
believe that our audit provides a reasonable basis for our opinion.

Definition and Limitations of Internal Control Over Financial Reporting

A company’s internal control over financial reporting is a process designed to provide reasonable assurance 
regarding the reliability of financial reporting and the preparation of financial statements for external purposes in 
accordance with generally accepted accounting principles. A company’s internal control over financial reporting 
includes those policies and procedures that (1) pertain to the maintenance of records that, in reasonable detail, 
accurately and fairly reflect the transactions and dispositions of the assets of the company; (2) provide reasonable 
assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance 
with generally accepted accounting principles, and that receipts and expenditures of the company are being made 
only in accordance with authorizations of management and directors of the company; and (3) provide reasonable 
assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of the company’s 
assets that could have a material effect on the financial statements.

Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. 
Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may 
become inadequate because of changes in conditions, or that the degree of compliance with the policies or 
procedures may deteriorate.

/s/ KPMG LLP 

Chicago, Illinois 
February 23, 2021

75

VENTAS, INC.
CONSOLIDATED BALANCE SHEETS

As of December 31, 

2020
2019
(In thousands, except per
share amounts)

Assets
Real estate investments:

Land and improvements
Buildings and improvements
Construction in progress
Acquired lease intangibles
Operating lease assets

Accumulated depreciation and amortization
Net real estate property
Secured loans receivable and investments, net
Investments in unconsolidated real estate entities
Net real estate investments

Cash and cash equivalents
Escrow deposits and restricted cash
Goodwill
Assets held for sale
Deferred income tax assets, net
Other assets

Total assets

Liabilities and equity
Liabilities:

Senior notes payable and other debt
Accrued interest
Operating lease liabilities
Accounts payable and other liabilities
Liabilities related to assets held for sale
Deferred income tax liabilities
Total liabilities

Redeemable OP unitholder and noncontrolling interests
Commitments and contingencies
Equity:

Ventas stockholders’ equity:
Preferred stock, $1.00 par value; 10,000 shares authorized, unissued
Common stock, $0.25 par value; 600,000 shares authorized, 374,609 and 372,811 shares 

issued at December 31, 2020 and 2019, respectively

Capital in excess of par value
Accumulated other comprehensive loss
Retained earnings (deficit)
Treasury stock, 0 and 2 shares at December 31, 2020 and 2019, respectively

Total Ventas stockholders’ equity

Noncontrolling interests

Total equity
Total liabilities and equity

  See accompanying notes.

76

$ 

2,261,415  $ 
24,323,279 
265,748 
1,230,886 
346,372 
28,427,700 
(7,877,665)   
20,550,035 
605,567 
443,688 
21,599,290 
413,327 
38,313 
1,051,650 
9,608 
9,987 
807,229 

2,285,648 
24,386,051 
461,815 
1,308,077 
385,225 
28,826,816 
(7,092,243) 
21,734,573 
704,612 
45,022 
22,484,207 
106,363 
39,739 
1,051,161 
85,527 
47,495 
877,716 
$  23,929,404  $  24,692,208 

$  11,895,412  $  12,158,773 
111,115 
251,196 
1,145,939 
5,224 
200,831 
13,873,078 
273,678 

111,444 
209,917 
1,133,066 
3,246 
62,638 
13,415,723 
235,490 

— 

— 

93,635 
14,171,262 

(54,354)   
(4,030,376)   

93,185 
14,056,453 
(34,564) 
(3,669,050) 
(132) 
10,445,892 
99,560 
10,545,452 
$  23,929,404  $  24,692,208 

— 
10,180,167 
98,024 
10,278,191 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
VENTAS, INC.
CONSOLIDATED STATEMENTS OF INCOME 

Revenues
Rental income:

Triple-net leased
Office

Resident fees and services
Office building and other services revenue
Income from loans and investments
Interest and other income

Total revenues

Expenses
Interest
Depreciation and amortization
Property-level operating expenses:

Senior living
Office
Triple-net leased

Office building services costs
General, administrative and professional fees
Loss on extinguishment of debt, net
Merger-related expenses and deal costs
Allowance on loans receivable and investments
Other

Total expenses
Income before unconsolidated entities, real estate dispositions, income 

taxes, discontinued operations and noncontrolling interests

Income (loss) from unconsolidated entities
Gain on real estate dispositions
Income tax benefit

Income from continuing operations

Discontinued operations

Net income

Net income attributable to noncontrolling interests
Net income attributable to common stockholders

Earnings per common share
Basic:

Income from continuing operations
Net income attributable to common stockholders

Diluted:

Income from continuing operations
Net income attributable to common stockholders

For the Years Ended December 31,

2020

2019
(In thousands, except per share
amounts)

2018

$ 

695,265  $ 
799,627 
1,494,892 
2,197,160 
15,191 
80,505 
7,609 

780,898  $ 
828,978 
1,609,876 
2,151,533 
11,156 
89,201 
10,984 

3,795,357 

3,872,750 

737,796 
776,011 
1,513,807 
2,069,477 
13,416 
124,218 
24,892 

3,745,810 

469,541 
1,109,763 

451,662 
1,045,620 

442,497 
919,639 

1,658,671 
256,612 
22,160 
1,937,443 
2,315 
130,158 
10,791 
29,812 
24,238 
707 
3,714,768 

80,589 
1,844 
262,218 
96,534 
441,185 
— 
441,185 

1,521,398 
260,249 
26,561 
1,808,208 
2,319 
158,726 
41,900 
15,235 
— 

(10,339)   

3,513,331 

359,419 

(2,454)   
26,022 
56,310 
439,297 
— 
439,297 

2,036 
439,149  $ 

6,281 
433,016  $ 

1,446,201 
243,679 
— 
1,689,880 
1,418 
145,978 
58,254 
30,547 
— 
72,772 
3,360,985 

384,825 
(55,034) 
46,247 
39,953 
415,991 
(10) 
415,981 

6,514 
409,467 

1.18  $ 
1.18 

1.17  $ 
1.17 

1.20  $ 
1.18 

1.19  $ 
1.17 

1.17 
1.15 

1.16 
1.14 

$ 

$ 

$ 

  See accompanying notes.

77

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
VENTAS, INC.
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME

Net income

Other comprehensive (loss) income:

Foreign currency translation

Unrealized (loss) gain on available for sale securities

Derivative instruments

Total other comprehensive (loss) income

Comprehensive income

Comprehensive income attributable to noncontrolling interests

For the Years Ended December 31,

2020

2019

2018

(In thousands)

$ 

441,185  $ 

439,297  $ 

415,981 

3,254 

(3,549)   

5,729 

11,634 

(17,918)   

(30,814)   

(18,213)   

(13,451)   

422,972 

3,613 

425,846 

7,649 

(9,436) 

14,944 

10,030 

15,538 

431,519 

6,514 

Comprehensive income attributable to common stockholders

$ 

419,359  $ 

418,197  $ 

425,005 

See accompanying notes.

78

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
VENTAS, INC.
CONSOLIDATED STATEMENTS OF EQUITY
For the Years Ended December 31, 2020, 2019 and 2018 

Common
Stock Par
Value

Capital in
Excess of
Par Value

Accumulated 
Other 
Comprehensive 
Loss

Retained
Earnings
(Deficit)

Treasury
Stock

Total Ventas
Stockholders’
Equity

Non- 
controlling
Interests

Total Equity

(In thousands, except per share amounts)

Balance at January 1, 2018

$  89,029  $  13,053,057  $ 

(35,120)  $  (2,240,698)  $ 

(42)  $  10,866,226  $  65,959  $  10,932,185 

Net income

Other comprehensive income

Net change in noncontrolling interests
Dividends to common stockholders

—$3.1625 per share

Issuance of common stock for stock 
plans, restricted stock grants and 
other

Adjust redeemable OP unitholder 
interests to current fair value

Redemption of OP Units
Cumulative effect of change in 

accounting principles

— 

— 

— 

— 

93 

— 

3 

— 

— 

— 

(7,470) 

— 

34,647 

(3,323) 

(383) 

— 

— 

409,467 

15,538 

— 

— 

— 

— 

— 

— 

— 

— 

(1,129,626) 

— 

— 

— 

30,643 

Balance at December 31, 2018

89,125 

  13,076,528 

(19,582) 

(2,930,214) 

Net income

Other comprehensive (loss) income

Net change in noncontrolling interests

Dividends to common stockholders

—$3.17 per share

Issuance of common stock
Issuance of common stock for stock 
plans, restricted stock grants and 
other

Adjust redeemable OP unitholder 
interests to current fair value

Redemption of OP Units

Cumulative effect of change in 

accounting principle

— 

— 

— 

— 

— 

— 

(12,332) 

— 

3,829 

938,509 

230 

61,875 

(7,388) 

(739) 

— 

1 

— 

— 

433,016 

(14,819) 

— 

— 

— 

— 

— 

— 

— 

— 

(1,172,653) 

— 

— 

— 

— 

Net income

Other comprehensive (loss) income

Net change in noncontrolling interests

Dividends to common stockholders

—$2.1425 per share

Issuance of common stock
Issuance of common stock for stock 
plans, restricted stock grants and 
other

Adjust redeemable OP unitholder 
interests to current fair value

Redemption of OP Units

— 

— 

— 

— 

371 

79 

— 

— 

— 

— 

8,227 

— 

65,640 

22,568 

18,638 

(264) 

— 

439,149 

(19,790) 

— 

— 

— 

— 

— 

— 

— 

— 

(800,475) 

— 

— 

— 

— 

— 

— 

— 

— 

409,467 

15,538 

6,514 

— 

415,981 

15,538 

(7,470) 

(16,736) 

(24,206) 

(1,129,626) 

— 

(1,129,626) 

— 

252 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

— 

(210) 

34,530 

(3,323) 

(128) 

30,643 

— 

— 

— 

— 

34,530 

(3,323) 

(128) 

30,643 

  10,215,857 

55,737 

  10,271,594 

433,016 

(14,819) 

6,281 

1,368 

439,297 

(13,451) 

(12,332) 

36,174 

23,842 

(1,172,653) 

942,338 

(132) 

61,973 

— 

— 

— 

(7,388) 

(738) 

638 

— 

— 

— 

— 

— 

— 

(1,172,653) 

942,338 

61,973 

(7,388) 

(738) 

638 

439,149 

(19,790) 

2,036 

1,577 

8,227 

(5,149) 

(800,475) 

66,011 

441,185 

(18,213) 

3,078 

(800,475) 

66,011 

22,779 

18,638 

(264) 

— 

— 

— 

— 

— 

132 

22,779 

— 

— 

18,638 

(264) 

Balance at December 31, 2019

93,185 

  14,056,453 

(34,564) 

(3,669,050) 

(132) 

  10,445,892 

99,560 

  10,545,452 

— 

(163) 

801 

Balance at December 31, 2020

$  93,635  $  14,171,262  $ 

(54,354)  $  (4,030,376)  $ 

—  $  10,180,167  $  98,024  $  10,278,191 

   See accompanying notes.

79

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
VENTAS, INC.
CONSOLIDATED STATEMENTS OF CASH FLOWS

2020

For the Years Ended December 31,
2019
(In thousands)

2018

$ 

441,185  $ 

439,297  $ 

415,981 

1,109,763 
(40,856) 
20,719 
24,238 
21,487 
103,082 
10,791 
(262,218) 
(167) 
(101,985) 
(1,832) 
4,920 
— 
(779) 

(68,233) 
276 
189,785 
1,450,176 

(78,648) 
(115,163) 
1,044,357 
119,011 
(380,413) 
(148,234) 
— 
(286,822) 
207 
154,295 

1,045,620 
(7,967) 
22,985 
— 
33,923 
(30,073) 
41,900 
(26,022) 
— 
(58,918) 
2,464 
1,600 
— 
13,264 

(76,693) 
9,737 
26,666 
1,437,783 

(958,125) 
(1,258,187) 
147,855 
1,017,309 
(403,923) 
(156,724) 
172 
(3,855) 
30,179 
(1,585,299) 

(88,868) 
(565,524) 
733,298 
(479,539) 
(8,239) 
(8,379) 
55,362 
(928,809) 
(7,283) 
(575) 
1,314 
(12,946) 
15,103 
(4,936) 
(1,300,021) 
304,450 
1,088 
146,102 
451,640  $ 

(569,891) 
565,524 
3,013,191 
(2,623,916) 
— 
(21,403) 
942,085 
(1,157,720) 
(9,218) 
(2,203) 
6,282 
(9,717) 
36,179 
(8,519) 
160,674 
13,158 
1,480 
131,464 
146,102  $ 

919,639 
(30,660) 
18,886 
— 
29,963 
13,396 
58,254 
(46,247) 
(13,202) 
(43,026) 
55,034 
2,934 
52,510 
3,720 

(23,198) 
4,992 
(37,509) 
1,381,467 

(265,907) 
(229,534) 
353,792 
911,540 
(330,876) 
(131,858) 
57,455 
(47,007) 
6,891 
324,496 

321,463 
— 
2,549,473 
(3,465,579) 
(4,724) 
(20,612) 
— 
(1,127,143) 
(7,459) 
(1,370) 
1,883 
(11,574) 
8,762 
(5,057) 
(1,761,937) 
(55,974) 
(815) 
188,253 
131,464 

Cash flows from operating activities:

Net income
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization 
Amortization of deferred revenue and lease intangibles, net
Other non-cash amortization
Allowance on loans receivable and investments
Stock-based compensation
Straight-lining of rental income
Loss on extinguishment of debt, net
Gain on real estate dispositions
Gain on real estate loan investments
Income tax benefit
(Income) loss from unconsolidated entities
Distributions from unconsolidated entities
Real estate impairments related to natural disasters
Other
Changes in operating assets and liabilities:
Increase in other assets
Increase in accrued interest
Increase (decrease) in accounts payable and other liabilities

Net cash provided by operating activities

Cash flows from investing activities:

Net investment in real estate property
Investment in loans receivable
Proceeds from real estate disposals
Proceeds from loans receivable
Development project expenditures
Capital expenditures
Distributions from unconsolidated entities
Investment in unconsolidated entities
Insurance proceeds for property damage claims

Net cash provided by (used in) investing activities

Cash flows from financing activities:

Net change in borrowings under revolving credit facilities
Net change in borrowings under commercial paper program
Proceeds from debt
Repayment of debt
Purchase of noncontrolling interests
Payment of deferred financing costs
Issuance of common stock, net
Cash distribution to common stockholders
Cash distribution to redeemable OP unitholders
Cash issued for redemption of OP Units
Contributions from noncontrolling interests
Distributions to noncontrolling interests
Proceeds from stock option exercises
Other

Net cash (used in) provided by financing activities

Net increase (decrease) in cash, cash equivalents and restricted cash
Effect of foreign currency translation
Cash, cash equivalents and restricted cash at beginning of year
Cash, cash equivalents and restricted cash at end of year

$ 

80

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
VENTAS, INC.
CONSOLIDATED STATEMENTS OF CASH FLOWS (Continued)

For the Years Ended December 31,

2020

2019

2018

(In thousands)

Supplemental disclosure of cash flow information:

Interest paid including payments and receipts for derivative instruments

$ 

429,636  $ 

410,854  $ 

406,907 

Supplemental schedule of non-cash activities:

Assets acquired and liabilities assumed from acquisitions and other:
Real estate investments
Other assets
Debt
Other liabilities
Deferred income tax liability
Noncontrolling interests
Equity issued
Equity issued for redemption of OP Units

$ 

170,484  $ 
1,224 
55,368 
2,707 
337 
20,259 
— 
— 

1,057,138  $ 
11,140 
907,746 
47,121 
95 
113,316 
— 
127 

94,280 
5,398 
30,508 
18,086 
922 
2,591 
30,487 
907 

See accompanying notes.

81

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS

NOTE 1–DESCRIPTION OF BUSINESS  

Ventas, Inc. (together with its subsidiaries, unless otherwise indicated or except where the context otherwise requires, 
“we,” “us” or “our”), an S&P 500 company, is a real estate investment trust (“REIT”) operating at the intersection of healthcare 
and real estate, with a highly diversified portfolio of senior housing; life science, research and innovation; and healthcare 
properties; which we generally refer to as “healthcare real estate,” located throughout the United States, Canada and the United 
Kingdom.  As of December 31, 2020, we owned or managed through unconsolidated real estate entities approximately 1,200 
properties and properties classified as held for sale, consisting of senior housing communities, medical office buildings 
(“MOBs”), life science, research and innovation centers, inpatient rehabilitation facilities (“IRFs”) and long-term acute care 
facilities (“LTACs”), and health systems.  Our company was originally founded in 1983 and is headquartered in Chicago, 
Illinois with an additional office in Louisville, Kentucky.  

We primarily invest in a diversified portfolio of healthcare real estate asset through wholly owned subsidiaries and 

other co-investment entities.  We operate through three reportable business segments: triple-net leased properties, senior living 
operations, which we also refer to as SHOP, and office operations.  See “Note 2 – Accounting Policies” and “Note 19 – 
Segment Information.”  Our senior housing properties are either operated under triple-net leases in our triple-net leased 
properties segment or through independent third-party managers in our senior living operations segment.

As of December 31, 2020, we leased a total of 366 properties (excluding properties within our office operations 
reportable business segment) to various healthcare operating companies under “triple-net” or “absolute-net” leases that obligate 
the tenants to pay all property-related expenses, including maintenance, utilities, repairs, taxes, insurance and capital 
expenditures.  Our three largest tenants, Brookdale Senior Living Inc. (together with its subsidiaries, “Brookdale Senior 
Living”), Ardent Health Partners, LLC (together with its subsidiaries, “Ardent”) and Kindred Healthcare, LLC (together with 
its subsidiaries, “Kindred”) leased from us 121 properties (excluding eight properties managed by Brookdale Senior Living 
pursuant to long-term management agreements), 12 properties and 32 properties, respectively, as of December 31, 2020. 

As of December 31, 2020, pursuant to long-term management agreements, we engaged independent managers, such as 

Atria Senior Living, Inc. (“Atria”) and Sunrise Senior Living, LLC (together with its subsidiaries, “Sunrise”), to manage the 
441 senior housing communities in our senior living operations segment for us.

Through our Lillibridge Healthcare Services, Inc. subsidiary and our ownership interest in PMB Real Estate 
Services LLC, we also provide MOB management, leasing, marketing, facility development and advisory services to highly 
rated hospitals and health systems throughout the United States.  In addition, from time to time, we make secured and non-
mortgage loans and other investments relating to senior housing and healthcare operators or properties.

COVID-19 Update

During fiscal 2020 and continuing into fiscal 2021, the COVID-19 pandemic has negatively affected our businesses in 

a number of ways and is expected to continue to do so.  

Operating Results.  Our senior living operations segment was significantly impacted by the COVID-19 pandemic.  

Occupancy decreased over the course of 2020, while operating expenses increased as our senior living communities responded 
to the pandemic, resulting in a significant decline in NOI compared to 2019.  Our NNN senior housing tenants’ performance 
was similarly affected by COVID-19.  During the course of 2020, we modified certain NNN senior housing leases to reset rent 
and provided other modest financial accommodations to certain NNN senior housing tenants who needed it as a result of 
COVID-19.  We also wrote-off previously accrued straight-line rental income related to NNN senior housing tenants due to 
COVID-19. 

However, we benefited from our ongoing strategy of diversification, with our office and NNN healthcare businesses 

demonstrating resilience in the face of the pandemic. The Company’s NNN healthcare tenants benefited from significant 
government financial support that was deployed early and has partially offset the direct financial impact of the pandemic. Our 
office operations segment, which primarily serves MOB and research and innovation tenants that were less impacted by the 
pandemic, delivered steady performance throughout the year. 

Provider Relief Grants.  In the third and fourth quarter of 2020, we applied for grants under Phase 2 and Phase 3 of the 

Provider Relief Fund administered by the U.S. Department of Health & Human Services (“HHS”) on behalf of the assisted 
living communities in our senior living operations segment to partially mitigate losses attributable to COVID-19.  These grants 

82

are intended to reimburse eligible providers for expenses incurred to prevent, prepare for and respond to COVID-19 and lost 
revenues attributable to COVID-19. Recipients are not required to repay distributions from the Provider Relief Fund, provided 
that they attest to and comply with certain terms and conditions. See “Government Regulation—Governmental Response to the 
COVID-19 Pandemic” in Part I, Item 1 of this Annual Report. 

During the fourth quarter of 2020, we received $34.3 million and $0.8 million in grants in connection with our Phase 2 

and Phase 3 applications, respectively, and recognized these grants within property-level operating expenses in our 
Consolidated Statements of Income.  Subsequent to December 31, 2020, we received $13.6 million in grants in connection with 
our Phase 3 applications, which we expect to recognize in 2021. While we have received all amounts under our Phase 2 
applications and have begun to receive amounts under our Phase 3 applications, there can be no assurance that our remaining 
applications will be approved or that additional funds will ultimately be received. Any grants that are ultimately received and 
retained by us are not expected to fully offset the losses incurred in our senior living operating portfolio that are attributable to 
COVID-19. Further, although we continue to monitor and evaluate the terms and conditions associated with the Provider Relief 
Fund distributions, we cannot assure you that we will be in compliance with all requirements related to the payments received 
under the Provider Relief Fund.  

Capital Conservation Actions.  In response to the COVID-19 pandemic, we took precautionary steps to increase 

liquidity and preserve financial flexibility in light of the resulting uncertainty. See “Management’s Discussion and Analysis of 
Financial Condition and Results of Operations—Liquidity and Capital Resources; Recent Capital Conservation Actions.” As of 
February 16, 2021, we had approximately $3.0 billion in liquidity, including availability under our revolving credit facility and 
cash and cash equivalents on hand, with no borrowings outstanding under our commercial paper program and negligible near-
term debt maturing.

Continuing Impact.  The trajectory and future impact of the COVID-19 pandemic remains highly uncertain. The extent 

of the pandemic’s continuing and ultimate effect on our operational and financial performance will depend on a variety of 
factors, including the speed at which available vaccines can be successfully deployed; the rate of acceptance of available 
vaccines, particularly among the residents and staff in our senior housing communities; the impact of new variants of the virus 
and the effectiveness of available vaccines against those variants; ongoing clinical experience, which may differ considerably 
across regions and fluctuate over time; and on other future developments, including the ultimate duration, spread and intensity 
of the outbreak, the availability of testing, the extent to which governments impose, roll back or re-impose preventative 
restrictions and the availability of ongoing government financial support to our business, tenants and operators. Due to these 
uncertainties, we are not able at this time to estimate the ultimate impact of the COVID-19 pandemic on our business, results of 
operations, financial condition and cash flows.

We have not identified the COVID-19 pandemic, on its own, as a “triggering event” for purposes of evaluating 

impairment of real estate assets, goodwill and other intangibles, investments in unconsolidated entities and financial 
instruments.  However, as of December 31, 2020, we considered the effect of the pandemic on certain of our assets (described 
below) and our ability to recover the respective carrying values of these assets.  We applied our considerations to existing 
critical accounting policies that require us to make estimates and assumptions regarding future events that affect the reported 
amounts of assets and liabilities.  We based our estimates on our experience and on assumptions we believe to be reasonable 
under the circumstances.  As a result, we have recognized the following charges for the year ended December 31, 2020:

•

•

•

Adjustment to rental income: As of December 31, 2020, we concluded that it is probable we will not collect 
substantially all rents from certain tenants, primarily within our triple-net leased properties segment.  As a result, we 
recognized adjustments to rental income of  $74.6 million for the year ended December 31, 2020.  Rental payments 
from these tenants will be recognized in rental income when received.

Impairment of real estate assets: During 2020, we compared our estimate of undiscounted cash flows, including a 
hypothetical terminal value, for certain real estate assets to the assets’ respective carrying values.  During 2020 we 
recognized $126.5 million of impairments representing the difference between the assets’ carrying value and the then-
estimated fair value of $239.9 million.  The impaired assets, primarily senior housing communities, represent 
approximately 1% of our consolidated net real estate property as of December 31, 2020.  Impairments are recorded 
within depreciation and amortization in our Consolidated Statements of Income and are primarily related to our senior 
living operations reportable business segment.

Loss on financial instruments and impairment of unconsolidated entities: As of December 31, 2020, we concluded that 
credit losses exist within certain of our non-mortgage loans receivable and government-sponsored pooled loan 
investments.  As a result, we recognized credit loss charges of $34.7 million for the year ended December 31, 2020 
within allowance on loans receivable and investments in our Consolidated Statements of Income. During the fourth 

83

quarter of 2020, we received $10.5 million as a principal payment on previously reserved loans.  No allowances are 
recorded within our portfolios of secured mortgage loans or marketable debt securities. In addition, during 2020 we 
recognized an impairment of $10.7 million in an equity investment in an unconsolidated entity also recorded within 
allowance on loans receivable and investments in our Consolidated Statements of Income.  

•

Deferred tax asset valuation allowance: During 2020, we concluded that it was not more likely than not that deferred 
tax assets (primarily US federal NOL carryforwards which begin to expire in 2032) would be realized based on our 
cumulative loss in recent years for certain of our taxable REIT subsidiaries.  As a result, we recorded a valuation 
allowance of $56.4 million against these deferred tax assets on our Consolidated Balance Sheets with a corresponding 
charge to income tax benefit (expense) in our Consolidated Statements of Income.  We maintained our conclusions 
regarding the realizability of deferred tax assets as of December 31, 2020.

NOTE 2–ACCOUNTING POLICIES 

Principles of Consolidation

The accompanying Consolidated Financial Statements include our accounts and the accounts of our wholly owned 
subsidiaries and the joint venture entities over which we exercise control.  All intercompany transactions and balances have 
been eliminated in consolidation, and our net earnings are reduced by the portion of net earnings attributable to noncontrolling 
interests. 

U.S. generally accepted accounting principles (“GAAP”) require us to identify entities for which control is achieved 

through means other than voting rights and to determine which business enterprise is the primary beneficiary of variable interest 
entities (“VIEs”).  A VIE is broadly defined as an entity with one or more of the following characteristics: (a) the total equity 
investment at risk is insufficient to finance the entity’s activities without additional subordinated financial support; (b) as a 
group, the holders of the equity investment at risk lack (i) the ability to make decisions about the entity’s activities through 
voting or similar rights, (ii) the obligation to absorb the expected losses of the entity, or (iii) the right to receive the expected 
residual returns of the entity; and (c) the equity investors have voting rights that are not proportional to their economic interests, 
and substantially all of the entity’s activities either involve, or are conducted on behalf of, an investor that has 
disproportionately few voting rights.  We consolidate our investment in a VIE when we determine that we are its primary 
beneficiary.  We may change our original assessment of a VIE upon subsequent events such as the modification of contractual 
arrangements that affects the characteristics or adequacy of the entity’s equity investments at risk and the disposition of all or a 
portion of an interest held by the primary beneficiary. 

We identify the primary beneficiary of a VIE as the enterprise that has both: (i) the power to direct the activities of the 

VIE that most significantly impact the entity’s economic performance and (ii) the obligation to absorb losses or the right to 
receive benefits of the VIE that could be significant to the entity.  We perform this analysis on an ongoing basis.

As it relates to investments in joint ventures, GAAP may preclude consolidation by the sole general partner in certain 

circumstances based on the type of rights held by the limited partner or partners.  We assess limited partners’ rights and their 
impact on our consolidation conclusions, and we reassess if there is a change to the terms or in the exercisability of the rights of 
the limited partners, the sole general partner increases or decreases its ownership of limited partnership (“LP”) interests or there 
is an increase or decrease in the number of outstanding LP interests.  We also apply this guidance to managing member interests 
in limited liability companies (“LLCs”). 

We consolidate several VIEs that share the following common characteristics: 

the VIE is in the legal form of an LP or LLC; 
the VIE was designed to own and manage its underlying real estate investments; 

•
•
• we are the general partner or managing member of the VIE; 
• we own a majority of the voting interests in the VIE; 
• a minority of voting interests in the VIE are owned by external third parties, unrelated to us; 
the minority owners do not have substantive kick-out or participating rights in the VIE; and  
•
• we are the primary beneficiary of the VIE. 

We have separately identified certain special purpose entities that were established to allow investments in research 

and innovation projects by tax credit investors (“TCIs”).  We have determined that these special purpose entities are VIEs, we 
are a holder of variable interests and we are the primary beneficiary of the VIEs, and therefore we consolidate these special 

84

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

purpose entities.  Our primary beneficiary determination is based upon several factors, including but not limited to the rights we 
have in directing the activities which most significantly impact the VIEs’ economic performance as well as certain guarantees 
which protect the TCIs from losses should a tax credit recapture event occur.  

In general, the assets of the consolidated VIEs are available only for the settlement of the obligations of the respective 
entities.  Unless otherwise required by the LP or LLC agreement, any mortgage loans of the consolidated VIEs are non-recourse 
to us.  The table below summarizes the total assets and liabilities of our consolidated VIEs as reported on our Consolidated 
Balance Sheets:

NHP/PMB L.P.

Other identified VIEs

Tax credit VIEs

Investments in Unconsolidated Entities

December 31, 2020

December 31, 2019

Total Assets

Total 
Liabilities

Total Assets

Total 
Liabilities

(In thousands)

$ 

649,128  $ 

238,168  $ 

666,404  $ 

244,934 

4,095,102 

1,653,036 

4,075,821 

1,459,830 

614,490 

204,746 

845,229 

333,809 

We report investments in unconsolidated entities over whose operating and financial policies we have the ability to 

exercise significant influence under the equity method of accounting.  Under this method of accounting, our share of the 
investee’s earnings or losses is included in our Consolidated Statements of Income.

We base the initial carrying value of investments in unconsolidated entities on the fair value of the assets at the time 

we acquired the joint venture interest.  We estimate fair values for our equity method investments based on discounted cash 
flow models that include all estimated cash inflows and outflows over a specified holding period and, where applicable, any 
estimated debt premiums or discounts.  The capitalization rates, discount rates and credit spreads we use in these models are 
based upon assumptions that we believe to be within a reasonable range of current market rates for the respective investments.

We generally amortize any difference between our cost basis and the basis reflected at the joint venture level, if any, 

over the lives of the related assets and liabilities and include that amortization in our share of income or loss from 
unconsolidated entities.  For earnings of equity method investments with pro rata distribution allocations, net income or loss is 
allocated between the partners in the joint venture based on their respective stated ownership percentages.  In other instances, 
net income or loss may be allocated between the partners in the joint venture based on the hypothetical liquidation at book value 
method (the “HLBV method”).  Under the HLBV method, net income or loss is allocated between the partners based on the 
difference between each partner’s claim on the net assets of the joint venture at the end and beginning of the period, after taking 
into account contributions and distributions.  Each partner’s share of the net assets of the joint venture is calculated as the 
amount that the partner would receive if the joint venture were to liquidate all of its assets at net book value and distribute the 
resulting cash to creditors and partners in accordance with their respective priorities.  Under the HLBV method, in any given 
period, we could record more or less income than the joint venture has generated, than actual cash distributions we receive or 
than the amount we may receive in the event of an actual liquidation.  

Redeemable OP Unitholder and Noncontrolling Interests

We own a majority interest in NHP/PMB L.P. (“NHP/PMB”), a limited partnership formed in 2008 to acquire 

properties from entities affiliated with Pacific Medical Buildings LLC (“PMB”).  Given our wholly owned subsidiary is the 
general partner and the primary beneficiary of NHP/PMB, we consolidate it as a VIE.  As of December 31, 2020, third-party 
investors owned 3.3 million Class A limited partnership units in NHP/PMB (“OP Units”), which represented 31% of the total 
units then outstanding, and we owned 7.3 million Class B limited partnership units in NHP/PMB, representing the remaining 
69%.  At any time following the first anniversary of the date of their issuance, the OP Units may be redeemed at the election of 
the holder for cash or, at our option, 0.9051 shares of our common stock per OP Unit, subject to further adjustment in certain 
circumstances.  We are party by assumption to a registration rights agreement with the holders of the OP Units that requires us, 
subject to the terms and conditions and certain exceptions set forth therein, to file and maintain a registration statement relating 
to the issuance of shares of our common stock upon redemption of OP Units. 

As redemption rights are outside of our control, the redeemable OP Units are classified outside of permanent equity on 

our Consolidated Balance Sheets.  We reflect the redeemable OP Units at the greater of cost or redemption value.  As of 
December 31, 2020 and 2019, the fair value of the redeemable OP Units was $146.0 million and $171.2 million, respectively.  

85

 
 
 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

We recognize changes in fair value through capital in excess of par value, net of cash distributions paid and purchases by us of 
any OP Units.  Our diluted earnings per share includes the effect of any potential shares outstanding from redemption of the OP 
Units.  

Certain noncontrolling interests of other consolidated joint ventures were also classified as redeemable at December 
31, 2020 and 2019.  Accordingly, we record the carrying amount of these noncontrolling interests at the greater of their initial 
carrying amount (increased or decreased for the noncontrolling interests’ share of net income or loss and distributions) or the 
redemption value.  Our joint venture partners have certain redemption rights with respect to their noncontrolling interests in 
these joint ventures that are outside of our control, and the redeemable noncontrolling interests are classified outside of 
permanent equity on our Consolidated Balance Sheets.  We recognize changes in the carrying value of redeemable 
noncontrolling interests through capital in excess of par value.  

Noncontrolling Interests

Excluding the redeemable noncontrolling interests described above, we present the portion of any equity that we do 

not own in entities that we control (and thus consolidate) as noncontrolling interests and classify those interests as a component 
of consolidated equity, separate from total Ventas stockholders’ equity, on our Consolidated Balance Sheets.  For consolidated 
joint ventures with pro rata distribution allocations, net income or loss, and comprehensive income, is allocated between the 
joint venture partners based on their respective stated ownership percentages.  In other cases, net income or loss is allocated 
between the joint venture partners based on the HLBV method.  We account for purchases or sales of equity interests that do 
not result in a change of control as equity transactions, through capital in excess of par value.  We include net income 
attributable to the noncontrolling interests in net income in our Consolidated Statements of Income and we include the 
noncontrolling interests share of comprehensive income in our Consolidated Statements of Comprehensive Income.

Accounting for Historic and New Markets Tax Credits

For certain of our research and innovation centers, we are party to certain contractual arrangements with TCIs that 

were established to enable the TCIs to receive benefits of historic tax credits (“HTCs”), new markets tax credits (“NMTCs”), or 
both.  As of December 31, 2020, we owned eight properties that had syndicated HTCs or NMTCs, or both, to TCIs.

In general, TCIs invest cash into special purpose entities that invest in entities that own the subject property and 

generate the tax credits.  The TCIs receive substantially all of the tax credits and hold only a nominal interest in the economic 
risk and benefits of the special purpose entities. 

HTCs are delivered to the TCIs upon substantial completion of the project.  NMTCs are allowed for up to 39% of a 

qualified investment and are delivered to the TCIs after the investment has been funded and spent on a qualified business. 
HTCs are subject to 20% recapture per year beginning one year after the completion of the historic rehabilitation of the subject 
property.  NMTCs are subject to 100% recapture until the end of the seventh year following the qualifying investment.  We 
have provided the TCIs with certain guarantees which protect the TCIs from losses should a tax credit recapture event occur.  
The contractual arrangements with the TCIs include a put/call provision whereby we may be obligated or entitled to repurchase 
the interest of the TCIs in the special purpose entities at the end of the tax credit recapture period.  We anticipate that either the 
TCIs will exercise their put rights or we will exercise our call rights prior to the applicable tax credit recapture periods.

The portion of the TCI’s investment that is attributed to the put is recorded at fair value at inception in accounts 
payable and other liabilities on our Consolidated Balance Sheets, and is accreted to the expected put price as interest expense in 
our Consolidated Statements of Income over the recapture period.  The remaining balance of the TCI’s investment is initially 
recorded in accounts payable and other liabilities on our Consolidated Balance Sheets and will be relieved upon delivery of the 
tax credit to the TCI, as a reduction in the carrying value of the subject property, net of allocated expenses.  Direct and 
incremental costs incurred in structuring the transaction are deferred and will be recognized as an increase in the cost basis of 
the subject property upon the recognition of the related tax credit as discussed above.

Accounting Estimates

The preparation of financial statements in accordance with GAAP requires us to make estimates and assumptions 

regarding future events that affect the reported amounts of assets and liabilities, the disclosure of contingent assets and 
liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period.  
Actual results could differ from those estimates.

86

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Accounting for Real Estate Acquisitions

When we acquire real estate, we first make reasonable judgments about whether the transaction involves an asset or a 

business.  Our real estate acquisitions are generally accounted for as asset acquisitions as substantially all of the fair value of the 
gross assets acquired is concentrated in a single identifiable asset or group of similar identifiable assets.  Regardless of whether 
an acquisition is considered a business combination or an asset acquisition, we record the cost of the businesses or assets 
acquired as tangible and intangible assets and liabilities based upon their estimated fair values as of the acquisition date. 

We estimate the fair value of buildings acquired on an as-if-vacant basis or replacement cost basis and depreciate the 
building value over the estimated remaining life of the building, generally not to exceed 35 years.  We determine the fair value 
of other fixed assets, such as site improvements and furniture, fixtures and equipment, based upon the replacement cost and 
depreciate such value over the assets’ estimated remaining useful lives as determined at the applicable acquisition date.  We 
determine the value of land either by considering the sales prices of similar properties in recent transactions or based on internal 
analyses of recently acquired and existing comparable properties within our portfolio.  We generally determine the value of 
construction in progress based upon the replacement cost.  However, for certain acquired properties that are part of a ground-up 
development, we determine fair value by using the same valuation approach as for all other properties and deducting the 
estimated cost to complete the development.  During the remaining construction period, we capitalize project costs until the 
development has reached substantial completion.  Construction in progress, including capitalized interest, is not depreciated 
until the development has reached substantial completion.

Intangibles primarily include the value of in-place leases and acquired lease contracts.  We include all lease-related 

intangible assets and liabilities within acquired lease intangibles and accounts payable and other liabilities, respectively, on our 
Consolidated Balance Sheets. 

The fair value of acquired lease-related intangibles, if any, reflects: (i) the estimated value of any above or below 

market leases, determined by discounting the difference between the estimated market rent and in-place lease rent; and (ii) the 
estimated value of in-place leases related to the cost to obtain tenants, including leasing commissions, and an estimated value of 
the absorption period to reflect the value of the rent and recovery costs foregone during a reasonable lease-up period as if the 
acquired space was vacant.  We amortize any acquired lease-related intangibles to revenue or amortization expense over the 
remaining life of the associated lease plus any assumed bargain renewal periods.  If a lease is terminated prior to its stated 
expiration or not renewed upon expiration, we recognize all unamortized amounts of lease-related intangibles associated with 
that lease in operations over the shortened lease term.

We estimate the fair value of purchase option intangible assets and liabilities, if any, by discounting the difference 

between the applicable property’s acquisition date fair value and an estimate of its future option price.  We do not amortize the 
resulting intangible asset or liability over the term of the lease, but rather adjust the recognized value of the asset or liability 
upon sale.

In connection with an acquisition, we may assume rights and obligations under certain lease agreements pursuant to 
which we become the lessee of a given property.  We generally assume the lease classification previously determined by the 
prior lessee absent a modification in the assumed lease agreement.  We assess assumed operating leases, including ground 
leases, to determine whether the lease terms are favorable or unfavorable to us given current market conditions on the 
acquisition date.  To the extent the lease terms are favorable or unfavorable to us relative to market conditions on the 
acquisition date, we recognize an intangible asset or liability at fair value and amortize that asset or liability to interest or rental 
expense in our Consolidated Statements of Income over the applicable lease term.  Where we are the lessee, we record the 
acquisition date values of leases, including any above or below market value, within operating lease assets and operating lease 
liabilities on our Consolidated Balance Sheets.

We estimate the fair value of noncontrolling interests assumed consistent with the manner in which we value all of the 

underlying assets and liabilities.

We calculate the fair value of long-term assumed debt by discounting the remaining contractual cash flows on each 

instrument at the current market rate for those borrowings, which we approximate based on the rate at which we would expect 
to incur a replacement instrument on the date of acquisition, and recognize any fair value adjustments related to long-term debt 
as effective yield adjustments over the remaining term of the instrument.

87

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Impairment of Long-Lived and Intangible Assets

We periodically evaluate our long-lived assets, primarily consisting of investments in real estate, for impairment 
indicators.  If indicators of impairment are present, we evaluate the carrying value of the related real estate investments in 
relation to the future undiscounted cash flows of the underlying operations.  In performing this evaluation, we consider market 
conditions and our current intentions with respect to holding or disposing of the asset.  We adjust the net book value of real 
estate properties and other long-lived assets to fair value if the sum of the expected future undiscounted cash flows, including 
sales proceeds, is less than book value.  We recognize an impairment loss at the time we make any such determination.  

If impairment indicators arise with respect to intangible assets with finite useful lives, we evaluate impairment by 

comparing the carrying amount of the asset to the estimated future undiscounted net cash flows expected to be generated by the 
asset.  If estimated future undiscounted net cash flows are less than the carrying amount of the asset, then we estimate the fair 
value of the asset and compare the estimated fair value to the intangible asset’s carrying value.  We recognize any shortfall from 
carrying value as an impairment loss in the current period. 

We evaluate our investments in unconsolidated entities for impairment at least annually, and whenever events or 

changes in circumstances indicate that the carrying value of our investment may exceed its fair value.  If we determine that a 
decline in the fair value of our investment in an unconsolidated entity is other-than-temporary, and if such reduced fair value is 
below the carrying value, we record an impairment.  

We test goodwill for impairment at least annually, and more frequently if indicators arise.  We first assess qualitative 

factors, such as current macroeconomic conditions, state of the equity and capital markets and our overall financial and 
operating performance, to determine the likelihood that the fair value of a reporting unit is less than its carrying amount.  If we 
determine it is more likely than not that the fair value of a reporting unit is less than its carrying amount, we proceed with 
estimating the fair value of the reporting unit.  On January 1, 2020, we adopted ASU 2017-04, Simplifying the Test for Goodwill 
Impairment, which removes the traditional “Step 2” of the goodwill impairment test that required a hypothetical purchase price 
allocation. A goodwill impairment, if any, will be recognized in the period it is determined and is now measured as the amount 
by which a reporting unit’s carrying value exceeds its fair value. 

Estimates of fair value used in our evaluation of goodwill (if necessary based on our qualitative assessment), 
investments in real estate, investments in unconsolidated entities and intangible assets are based upon discounted future cash 
flow projections or other acceptable valuation techniques that are based, in turn, upon all available evidence including level 
three inputs, such as revenue and expense growth rates, estimates of future cash flows, capitalization rates, discount rates, 
general economic conditions and trends, or other available market data such as replacement cost or comparable transactions.  
Our ability to accurately predict future operating results and cash flows and to estimate and determine fair values impacts the 
timing and recognition of impairments.  While we believe our assumptions are reasonable, changes in these assumptions may 
have a material impact on our financial results.  

Assets Held for Sale and Discontinued Operations

We sell properties from time to time for various reasons, including favorable market conditions or the exercise of 

purchase options by tenants.  We classify certain long-lived assets as held for sale once the criteria, as defined by GAAP, have 
been met.  Long-lived assets to be disposed of are reported at the lower of their carrying amount or fair value minus cost to sell 
and are no longer depreciated.

If at any time we determine that the criteria for classifying assets as held for sale are no longer met, we reclassify 

assets within net real estate investments on our Consolidated Balance Sheets for all periods presented.  The carrying amount of 
these assets is adjusted (in the period in which a change in classification is determined) to reflect any depreciation expense that 
would have been recognized had the asset been continuously classified as net real estate investments.

We report discontinued operations when the following criteria are met: (1) a component of an entity or group of 

components that has been disposed of or classified as held for sale and represents a strategic shift that has or will have a major 
effect on an entity’s operations and financial results; or (2) an acquired business is classified as held for sale on the acquisition 
date.  The results of operations for assets meeting the definition of discontinued operations are reflected in our Consolidated 
Statements of Income as discontinued operations for all periods presented.  We allocate estimated interest expense to 
discontinued operations based on property values and our weighted average interest rate or the property’s actual mortgage 
interest.

88

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Loans Receivable

We record loans receivable, other than those acquired in connection with a business combination, on our Consolidated 

Balance Sheets (either in secured loans receivable and investments, net or other assets, in the case of non-mortgage loans 
receivable) at the unpaid principal balance, net of any deferred origination fees, purchase discounts or premiums and valuation 
allowances.  We amortize net deferred origination fees, which are comprised of loan fees collected from the borrower net of 
certain direct costs, and purchase discounts or premiums over the contractual life of the loan using the effective interest method 
and immediately recognize in income any unamortized balances if the loan is repaid before its contractual maturity. 

On January 1, we adopted ASU 2016-13, Measurement of Credit Losses on Financial Instruments (“ASU 2016-13”).  

The amendments in ASU 2016-13 require us to evaluate a current estimate of all expected credit losses over the life of a 
financial instrument, which may result in earlier recognition of credit losses on loans and other financial instruments.  Under 
prior guidance, we generally only considered past events and current conditions in measuring an incurred loss.  We will 
establish a reserve for any estimated credit losses using this model with a corresponding charge to net income.  We adopted 
ASU 2016-13 using the modified retrospective method and we established no reserve upon adoption.  Our evaluation of credit 
losses of loans receivable is based on factors such as corporate and facility-level financial and operational reports, compliance 
with financial covenants set forth in the applicable loan agreement, the financial strength of the borrower and any guarantor, the 
payment history of the borrower, current economic conditions and reasonable and supportable forecasts.  

Cash Equivalents

Cash equivalents consist of highly liquid investments with a maturity date of three months or less when purchased. 

These investments are stated at cost, which approximates fair value.

Escrow Deposits and Restricted Cash

Escrow deposits consist of amounts held by us or our lenders to provide for future real estate tax, insurance 
expenditures and tenant improvements related to our properties and operations.  Restricted cash generally represents amounts 
paid to us for security deposits and other similar purposes.

Deferred Financing Costs

We amortize deferred financing costs, which are reported within senior notes payable and other debt on our 
Consolidated Balance Sheets, as a component of interest expense over the terms of the related borrowings using a method that 
approximates a level yield.  Amortized costs of approximately $23.0 million, $20.2 million and $18.1 million were included in 
interest expense for the years ended December 31, 2020, 2019 and 2018, respectively.

Available for Sale Securities

We classify available for sale securities as a component of other assets on our Consolidated Balance Sheets (other than 

our interests in government-sponsored pooled loan investments, which are classified as secured loans receivable and 
investments, net on our Consolidated Balance Sheets).  We record these securities at fair value and include unrealized gains and 
losses recorded in stockholders’ equity as a component of accumulated other comprehensive income on our Consolidated 
Balance Sheets.  If we determine that a credit loss exists with respect to individual investments, we will recognize an allowance 
against the amortized cost basis of the investment with a corresponding charge to net income.  We report interest income, 
including discount or premium amortization, on available for sale securities and gains or losses on securities sold, which are 
based on the specific identification method, in income from loans and investments in our Consolidated Statements of Income.

Derivative Instruments

We recognize all derivative instruments in other assets or accounts payable and other liabilities on our Consolidated 
Balance Sheets at fair value as of the reporting date.  We recognize changes in the fair value of derivative instruments in other 
expenses in our Consolidated Statements of Income or accumulated other comprehensive income on our Consolidated Balance 
Sheets, depending on the intended use of the derivative and our designation of the instrument.

We do not use our derivative financial instruments, including interest rate caps, interest rate swaps and foreign 

currency forward contracts, for trading or speculative purposes.  Our foreign currency forward contracts and certain of our 
interest rate swaps (including the interest rate swap contracts of consolidated and unconsolidated joint ventures) are designated 
as effectively hedging the variability of expected cash flows related to their underlying securities and, therefore, also are 

89

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

recorded on our Consolidated Balance Sheets at fair value, with changes in the fair value of these instruments recognized in 
accumulated other comprehensive income on our Consolidated Balance Sheets.  We recognize any noncontrolling interests’ 
proportionate share of the changes in fair value of swap contracts of our consolidated joint ventures in noncontrolling interests 
on our Consolidated Balance Sheets.  We recognize our proportionate share of the change in fair value of swap contracts of our 
unconsolidated joint ventures in accumulated other comprehensive income on our Consolidated Balance Sheets.  Certain of our 
other interest rate swaps and rate caps were not designated as having a hedging relationship with the underlying securities and 
therefore do not meet the criteria for hedge accounting under GAAP.  Accordingly, these interest rate swaps are recorded on our 
Consolidated Balance Sheets at fair value, and we recognize changes in the fair value of these instruments in current earnings 
(in other expenses) in our Consolidated Statements of Income. 

Fair Values of Financial Instruments

Fair value is a market-based measurement, not an entity-specific measurement, and we determine fair value based on 

the assumptions that we expect market participants would use in pricing the asset or liability.  As a basis for considering market 
participant assumptions in fair value measurements, GAAP establishes a fair value hierarchy that distinguishes between market 
participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs that 
are classified within levels one and two of the hierarchy) and the reporting entity’s own assumptions about market participant 
assumptions (unobservable inputs classified within level three of the hierarchy). 

Level one inputs utilize unadjusted quoted prices for identical assets or liabilities in active markets that we have the 

ability to access.  Level two inputs are inputs other than quoted prices included in level one that are directly or indirectly 
observable for the asset or liability.  Level two inputs may include quoted prices for similar assets and liabilities in active 
markets and other inputs for the asset or liability that are observable at commonly quoted intervals, such as interest rates, 
foreign exchange rates and yield curves.  Level three inputs are unobservable inputs for the asset or liability, which typically are 
based on our own assumptions, because there is little, if any, related market activity.  If the determination of the fair value 
measurement is based on inputs from different levels of the hierarchy, the level within which the entire fair value measurement 
falls is the lowest-level input that is significant to the fair value measurement in its entirety.  If the volume and level of market 
activity for an asset or liability has decreased significantly relative to the normal market activity for such asset or liability (or 
similar assets or liabilities), then transactions or quoted prices may not accurately reflect fair value.  In addition, if there is 
evidence that a transaction for an asset or liability is not orderly, little, if any, weight is placed on that transaction price as an 
indicator of fair value.  Our assessment of the significance of a particular input to the fair value measurement in its entirety 
requires judgment and considers factors specific to the asset or liability. 

We use the following methods and assumptions in estimating the fair value of our financial instruments whose fair 

value is determined on a recurring basis.

•

•

•

•

•

Cash and cash equivalents - The carrying amount of unrestricted cash and cash equivalents reported on our 
Consolidated Balance Sheets approximates fair value due to the short maturity of these instruments.

Escrow deposits and restricted cash - The carrying amount of escrow deposits and restricted cash reported on our 
Consolidated Balance Sheets approximates fair value due to the short maturity of these instruments.

Loans receivable - We estimate the fair value of loans receivable using level two and level three inputs.  We 
discount future cash flows using current interest rates at which similar loans with the same terms and length to 
maturity would be made to borrowers with similar credit ratings. 

Available for sale securities - We estimate the fair value of marketable debt securities using level two inputs.  We 
observe quoted prices for similar assets or liabilities in active markets that we have the ability to access.  We 
estimate the fair value of certain government-sponsored pooled loan investments using level three inputs.  We 
consider credit spreads, underlying asset performance and credit quality, and default rates.

Derivative instruments - With the assistance of a third party, we estimate the fair value of derivative instruments, 
including interest rate caps, interest rate swaps, and foreign currency forward contracts, using level two inputs. 

◦

◦

Interest rate caps - We observe forward yield curves and other relevant information.

Interest rate swaps - We observe alternative financing rates derived from market-based financing rates, 
forward yield curves and discount rates.

90

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

◦

Foreign currency forward contracts - We estimate the future values of the two currency tranches using 
forward exchange rates that are based on traded forward points and calculate a present value of the net 
amount using a discount factor based on observable traded interest rates.

•

•

•

Stock warrants - We estimate the fair value of stock warrants using level two inputs that are obtained from public 
sources.  Inputs include equity spot price, dividend yield, volatility and risk-free rate.

Senior notes payable and other debt - We estimate the fair value of senior notes payable and other debt using level 
two inputs.  We discount the future cash flows using current interest rates at which we could obtain similar 
borrowings.  For mortgage debt, we may estimate fair value using level three inputs, similar to those used in 
determining fair value of loans receivable (above).

Redeemable OP unitholder interests - We estimate the fair value of our redeemable OP unitholder interests using 
level one inputs.  We base fair value on the closing price of our common stock, as OP Units may be redeemed at 
the election of the holder for cash or, at our option, shares of our common stock, subject to adjustment in certain 
circumstances.

Revenue Recognition

Triple-Net Leased Properties and Office Operations 

Certain of our triple-net leases and most of our MOB and research and innovation centers (collectively, “office 
operations”) leases provide for periodic and determinable increases in base rent.  We recognize base rental revenues under these 
leases on a straight-line basis over the applicable lease term when collectability of substantially all rents is probable.  
Recognizing rental income on a straight-line basis generally results in recognized revenues during the first half of a lease term 
exceeding the cash amounts contractually due from our tenants, creating a straight-line rent receivable that is included in other 
assets on our Consolidated Balance Sheets.  At December 31, 2020 and 2019, this cumulative excess totaled $169.7 million and 
$278.8 million, respectively (excluding properties classified as held for sale).

Certain of our leases provide for periodic increases in base rent only if certain revenue parameters or other substantive 
contingencies are met.  We recognize the increased rental revenue under these leases as the related parameters or contingencies 
are met, rather than on a straight-line basis over the applicable lease term. 

We assess the probability of collecting substantially all rents under our leases based on several factors, including, 
among other things, payment history, the financial strength of the tenant and any guarantors, the historical operations and 
operating trends of the property, the historical payment pattern of the tenant, the type of property, the value of the underlying 
collateral, if any, expected future performance of the property and current economic conditions.  If our evaluation of these 
factors indicates it is not probable that we will be able to collect substantially all rents under the lease, we record a charge to 
rental income.  If we change our conclusions regarding the probability of collecting rent payments required by a lease, we may 
recognize adjustments to rental income in the period we make such change in our conclusions. 

Senior Living Operations 

Our resident agreements are accounted for as leases and we recognize resident fees and services, other than move-in 

fees, monthly as services are provided.  We recognize move-in fees on a straight-line basis over the average resident stay. 

Other 

We recognize interest income from loans and investments, including discounts and premiums, using the effective 

interest method when collectability is reasonably assured.  We apply the effective interest method on a loan-by-loan basis and 
recognize discounts and premiums as yield adjustments over the related loan term.  We evaluate collectability of accrued 
interest receivables separate from the amortized cost basis of our loans.  As such, we recognize interest income on an impaired 
loan to the extent we believe accrued contractual interest payments are collectable. Otherwise, interest income is recognized on 
a cash basis. 

Accounting for Leased Property

We lease real property, primarily land and corporate office space, and equipment, primarily vehicles at our senior 

housing communities. At lease inception, we establish an operating lease asset and operating lease liability calculated as the 

91

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

present value of future minimum lease payments. As our leases do not provide an implicit rate, we use a discount rate that 
approximates our incremental borrowing rate available at lease commencement to determine the present value. Our lease 
expense primarily consists of ground and corporate office leases. Ground lease expense is included in interest expense and 
corporate office lease expense is included in general, administrative and professional fees in the Company’s Consolidated 
Statements of Income.

Stock-Based Compensation

We recognize share-based payments to employees and directors, including grants of stock options and restricted stock, 
included in general, administrative and professional fees in our Consolidated Statements of Income generally on a straight-line 
basis over the requisite service period based on the grant date fair value of the award.

Gain on Sale of Assets

On January 1, 2018, we adopted the provisions of Accounting Standards Codification (“ASC”) 610-20, Gains and 
Losses from the Derecognition of Nonfinancial Assets (“ASC 610-20”).  In accordance with ASC 610-20, we recognize any 
gains when we transfer control of a property and when it is probable that we will collect substantially all of the related 
consideration.  We adopted ASC 610-20 using the modified retrospective method and recognized a cumulative effect 
adjustment to retained earnings of $31.2 million relating to deferred gains on sales of real estate assets in 2015.

Federal Income Tax

We have elected to be treated as a REIT under the applicable provisions of the Internal Revenue Code of 1986, as 

amended (the “Code”), for every year beginning with the year ended December 31, 1999.  Accordingly, we generally are not 
subject to federal income tax on net income that we distribute to our stockholders, provided that we continue to qualify as a 
REIT.  However, with respect to certain of our subsidiaries that have elected to be treated as taxable REIT subsidiaries (“TRS” 
or “TRS entities”), we record income tax expense or benefit, as those entities are subject to federal income tax similar to regular 
corporations.  Certain foreign subsidiaries are subject to foreign income tax, although they did not elect to be treated as TRSs. 

We account for deferred income taxes using the asset and liability method and recognize deferred tax assets and 

liabilities for the expected future tax consequences of events that have been included in our financial statements or tax returns. 
Under this method, we determine deferred tax assets and liabilities based on the differences between the financial reporting and 
tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. 
Any increase or decrease in the deferred tax liability that results from a change in circumstances, and that causes us to change 
our judgment about expected future tax consequences of events, is included in the tax provision when such changes occur. 
Deferred income taxes also reflect the impact of operating loss and tax credit carryforwards.  A valuation allowance is provided 
if we believe it is more likely than not that all or some portion of the deferred tax asset will not be realized.  Any increase or 
decrease in the valuation allowance that results from a change in circumstances, and that causes us to change our judgment 
about the realizability of the related deferred tax asset, is included in the tax provision when such changes occur.

We recognize the tax benefit from an uncertain tax position claimed or expected to be claimed on a tax return only if it 
is more likely than not that the tax position will be sustained on examination by taxing authorities, based on the technical merits 
of the position.  The tax benefits recognized in the financial statements from such a position are measured based on the largest 
benefit that has a greater than fifty percent likelihood of being realized upon ultimate settlement.  We recognize interest and 
penalties, if applicable, related to uncertain tax positions as part of income tax benefit or expense. 

Foreign Currency

Certain of our subsidiaries’ functional currencies are the local currencies of their respective foreign jurisdictions.  We 
translate the results of operations of our foreign subsidiaries into U.S. dollars using average rates of exchange in effect during 
the period, and we translate balance sheet accounts using exchange rates in effect at the end of the period.  We record resulting 
currency translation adjustments in accumulated other comprehensive income, a component of stockholders’ equity, on our 
Consolidated Balance Sheets, and we record foreign currency transaction gains and losses in other expense in our Consolidated 
Statements of Income.  We recognize any noncontrolling interests’ proportionate share of currency translation adjustments of 
our foreign consolidated joint ventures in noncontrolling interests on our Consolidated Balance Sheets.

92

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Segment Reporting

As of December 31, 2020, 2019 and 2018, we operated through three reportable business segments: triple-net leased 

properties, senior living operations and office operations.  Under our triple-net leased properties segment, we invest in and own 
senior housing and healthcare properties throughout the United States and the United Kingdom and lease those properties to 
healthcare operating companies under “triple-net” or “absolute-net” leases that obligate the tenants to pay all property-related 
expenses.  In our senior living operations segment, we invest in senior housing communities throughout the United States and 
Canada and engage independent operators, such as Atria and Sunrise, to manage those communities.  In our office operations 
segment, we primarily acquire, own, develop, lease and manage MOBs and research and innovation centers throughout the 
United States.  See “Note 19 – Segment Information.”   

Recently Issued or Adopted Accounting Standards

We adopted ASC Topic 842, Leases (“ASC 842”) on January 1, 2019, which introduced a lessee model that brings 
most leases on the balance sheet and, among other changes, eliminates the requirement in current GAAP for an entity to use 
bright-line tests in determining lease classification. Upon adoption, we recognized both right of use assets and lease liabilities 
for leases in which we lease land, real property or other equipment.  We now also report revenues and expenses within our 
triple-net leased properties reportable business segment for real estate taxes and insurance that are escrowed and obligations of 
the tenants in accordance with their respective leases with us.  Also, we now expense certain leasing costs, other than leasing 
commissions, as they are incurred.  Prior to the adoption of ASC 842, GAAP provided for the deferral and amortization of such 
costs over the applicable lease term.  

We used January 1, 2019 as the date of initial application. Therefore, financial information and disclosures under ASC 

842 are not provided for periods prior to January 1, 2019.  Upon adoption, we recognized a cumulative effect adjustment to 
retained earnings of $0.6 million primarily relating to certain costs associated with unexecuted leases that were deferred as of 
December 31, 2018.

Reclassifications

Certain prior year amounts have been reclassified to conform to the current year presentation. In 2020 and for all 

periods presented, certain tax and insurance related expenses have been reclassified from general, administrative and 
professional fees to other expense in our Consolidated Statements of Income.

NOTE 3–CONCENTRATION OF CREDIT RISK 

As of December 31, 2020, Atria, Sunrise, Brookdale Senior Living, Ardent and Kindred managed or operated 

approximately 20.8%, 10.4%, 8.2%, 4.9% and 1.1%, respectively, of our consolidated real estate investments based on gross 
book value (excluding properties classified as held for sale as of December 31, 2020).  Because Atria and Sunrise manage our 
properties in exchange for the receipt of a management fee from us, we are not directly exposed to the credit risk of our 
managers in the same manner or to the same extent as our triple-net tenants. 

Based on gross book value, approximately 15.6% and 47.9% of our consolidated real estate investments were senior 

housing communities included in the triple-net leased properties and senior living operations reportable business segments, 
respectively (excluding properties classified as held for sale as of December 31, 2020).  MOBs, research and innovation centers, 
IRFs and LTACs, health systems, skilled nursing facilities (“SNFs”) and secured loans receivable and investments collectively 
comprised the remaining 36.5%.  Our consolidated properties were located in 45 states, the District of Columbia, seven 
Canadian provinces and the United Kingdom as of December 31, 2020, with properties in one state (California) accounting for 
more than 10% of our total continuing revenues and net operating income (“NOI,” which is defined as total revenues, excluding 
interest and other income, less property-level operating expenses and office building services costs) for each of the years ended 
December 31, 2020, 2019 and 2018.    

93

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Triple-Net Leased Properties

The following table reflects the concentration risk related to our triple-net leased properties for the periods presented:

Revenues(1):

Brookdale Senior Living(2)
Ardent

Kindred

NOI:

Brookdale Senior Living(2)
Ardent

Kindred

For the Years Ended December 31,

2020

2019

2018

 4.4% 

 4.7% 

 4.3% 

 3.2 

 3.5 

 3.1 

 3.3 

 3.1 

 3.5 

 9.0% 

 8.7% 

 7.6% 

 6.6 

 7.1 

 5.8 

 6.3 

 5.7 

 6.4 

(1) Total revenues include office building and other services revenue, income from loans and investments and interest and 

(2)

other income.
2020 results include $21.3 million of amortization of up-front consideration received in 2020 from the Brookdale Lease.  
2018 results include the impact of a net non-cash charge of $21.3 million related to April 2018 lease extensions.

Each of our leases with Brookdale Senior Living, Ardent and Kindred is a triple-net lease that obligates the tenant to 

pay all property-related expenses, including maintenance, utilities, repairs, taxes, insurance and capital expenditures, and to 
comply with the terms of the mortgage financing documents, if any, affecting the properties.  In addition, each of our Brookdale 
Senior Living, Ardent and Kindred leases has a corporate guaranty. 

The properties we lease to Brookdale Senior Living, Ardent and Kindred accounted for a significant portion of our 

triple-net leased properties segment revenues and NOI for the years ended December 31, 2020, 2019 and 2018.  Refer to Item 
1A. Risk Factors.

Brookdale Transactions

In July 2020, we entered into a revised master lease agreement (the “Brookdale Lease”) and certain other agreements 

(together with the Brookdale Lease, the “Agreements”) with Brookdale Senior Living.  The Agreements modify our current 
arrangements with Brookdale Senior Living as follows:

We received up-front consideration approximating $235 million, which will be amortized over the remaining lease 

term and consisted of: (a) $162 million in cash including $47 million from the transfer to Ventas of deposits under the 
Brookdale Lease; (b) a $45 million cash pay note (the “Note”), which has an initial interest rate of 9.0%, increasing 50 basis 
points per annum, and matures on December 31, 2025; (c) $28 million in warrants exercisable for 16.3 million shares of 
Brookdale Senior Living common stock, which are exercisable at any time prior to December 31, 2025 and have an exercise 
price of $3.00 per share.

Base cash rent under the Brookdale Lease is set at $100 million per annum starting in July 2020, with three percent 
annual escalators commencing on January 1, 2022. The Brookdale Lease is guaranteed by, and the Note is a direct obligation 
of, Brookdale Senior Living.

The warrants are classified within other assets on our Consolidated Balance Sheets.  These warrants are measured at 

fair value with changes in fair value being recognized within other expense in our Consolidated Statements of Income.

Brookdale Senior Living transferred fee ownership of five senior living communities to us, in full satisfaction and 
repayment of a $78 million loan to Brookdale Senior Living from us that was secured by the five communities. Brookdale 
Senior Living will now manage those communities for us under a terminable management agreement. 

In April 2018, we entered into various agreements with Brookdale Senior Living that provide for, among other things: 
(a) a consolidation of substantially all of our multiple lease agreements with Brookdale Senior Living into one master lease; (b) 
extension of the term for substantially all of our Brookdale Senior Living leased properties until December 31, 2025, with 

94

 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Brookdale Senior Living retaining two successive 10-year renewal options; and (c) the guarantee of all the Brookdale Senior 
Living obligations to us by Brookdale Senior Living Inc., including covenant protections for us.  In connection with these 
agreements, we recognized a net non-cash expense of $21.3 million for the acceleration of straight-line rent receivables, net 
unamortized market lease intangibles and deferred revenues, which is included in triple-net leased rental income in our 
Consolidated Statements of Income.  We also received a fee of $2.5 million that is being amortized over the new lease term.

Holiday Transaction

In April 2020, we completed a transaction with affiliates of Holiday Retirement (collectively, “Holiday”), including (a) 

entry into a new, terminable management agreement with Holiday Management Company for our 26 independent living assets 
previously subject to a triple-net lease (the “Holiday Lease”) with Holiday; (b) termination of the Holiday Lease; and (c) our 
receipt from Holiday of $33.8 million in cash from the transfer to us of deposits under the Holiday Lease and $66 million in 
principal amount of secured notes.  As a result of the Holiday Lease termination, we recognized $50.2 million within triple-net 
leased rental income, composed of $99.8 million of cash and notes received less $49.6 million from the write-off of 
accumulated straight-line receivable.

2018 Kindred Transaction

In July 2018, Kindred closed transactions (the “Go Private Transactions”) pursuant to which (a) Kindred would be 

acquired by a consortium of TPG Capital (“TPG”), Welsh, Carson, Anderson & Stowe (“WCAS”) and Humana, Inc., and (b) 
immediately following the acquisition, (i) Kindred’s home health, hospice and community care businesses would be separated 
from Kindred and operated as a standalone company owned by Humana, Inc., TPG and WCAS, and (ii) Kindred would be 
operated as a separate healthcare company owned by TPG and WCAS.  In connection with the closing of the transactions, we 
received a payment from Kindred of $12.3 million, which was recognized in interest and other income in our Consolidated 
Statements of Income during the third quarter of 2018.

Future Contractual Rents

The following table sets forth the future contracted minimum rentals, excluding contingent rent escalations, but 

including straight-line rent adjustments where applicable, for all of our consolidated triple-net and office building leases as of 
December 31, 2020 (excluding properties classified as held for sale as of December 31, 2020):

Brookdale Senior 
Living

Ardent

Kindred

(In thousands)

Other

Total

$ 

$ 

148,454  $ 
148,016 
147,555 
147,090 
146,612 
— 
737,727  $ 

127,505  $ 
127,505 
127,505 
127,505 
127,505 
1,219,450 
1,856,975  $ 

133,824  $ 
133,828 
112,929 
102,479 
35,412 
4,228 
522,700  $ 

759,135  $ 
680,952 
617,589 
567,525 
483,069 
1,787,143 
4,895,413  $ 

1,168,918 
1,090,301 
1,005,578 
944,599 
792,598 
3,010,821 
8,012,815 

2021
2022
2023
2024
2025
Thereafter
Total

Senior Living Operations

As of December 31, 2020, Atria and Sunrise, collectively, provided comprehensive property management and 
accounting services with respect to 258 of our 432 consolidated senior housing communities, for which we pay annual 
management fees pursuant to long-term management agreements.

We rely on our managers’ personnel, expertise, technical resources and information systems, proprietary information, 
good faith and judgment to manage our senior living operations efficiently and effectively.  We also rely on our managers to set 
appropriate resident fees, provide accurate property-level financial results in a timely manner and otherwise operate our senior 
housing communities in compliance with the terms of our management agreements and all applicable laws and regulations.  

95

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 4–ACQUISITIONS OF REAL ESTATE PROPERTY 

The following summarizes our acquisition and development activities during 2020, 2019 and 2018.  We acquire and 
invest in senior housing, medical office buildings, research and innovation centers and other healthcare properties primarily to 
achieve an expected yield on our investment, to grow and diversify our portfolio and revenue base, and to reduce our 
dependence on any single tenant, operator or manager, geographic location, asset type, business model or revenue source.

2020 Acquisitions

During the year ended December 31, 2020, we acquired two research and innovation centers reported within our office 

operations reportable business segment, seven senior housing communities reported within our senior living operations 
reportable business segment and one LTAC reported within our triple-net leased properties reportable business segment for an 
aggregate consideration of $249.5 million.  Each of these acquisitions was accounted for as an asset acquisition.

2019 Acquisitions

In September 2019, we acquired an 87% interest in 34 Canadian senior housing communities (including five in-

process developments) valued at $1.8 billion through an equity partnership (the “LGM Acquisition”) with Le Groupe Maurice 
(“LGM”).  The portfolio continues to be managed by LGM.  We also have rights to fund and own all additional developments 
under an exclusive pipeline agreement with LGM. 

During  the  year  ended  December  31,  2019,  we  also  acquired  two  properties  reported  within  our  office  operations 
reportable  business  segment  (one  research  and  innovation  center  and  one  MOB),  two  senior  housing  communities  reported 
within our senior living operations reportable business segment and one vacant land parcel for an aggregate purchase price of 
$237.0 million.  

Each of our 2019 acquisitions was accounted for as an asset acquisition.

2018 Acquisitions

During the year ended December 31, 2018, we acquired five properties reported within our office operations reportable 

business segment (four MOBs and one research and innovation center) and one senior housing community reported within our 
senior living operations reportable business segment for an aggregate purchase price of $311.3 million.  Each of these 
acquisitions was accounted for as an asset acquisition.

NOTE 5–DISPOSITIONS AND IMPAIRMENTS 

2020 Activity

We recognized $262.2 million of gains on sale of real estate in 2020 as described below.

In March 2020, we formed the Ventas Life Science and Healthcare Real Estate Fund, L.P. (the “Ventas Fund”), a 

perpetual life vehicle that focuses on investments in research and innovation centers, medical office buildings and senior 
housing communities in North America. To seed the Ventas Fund, we contributed six (two of which are on the same campus) 
stabilized research and innovation and medical office properties. We received cash consideration of $620 million and a 21% 
interest in the Ventas Fund. We recognized a gain on the transactions of $225.1 million.

In October 2020, we formed a joint venture (the “R&I Development JV”) with GIC. To seed the R&I Development 

JV, we contributed our controlling ownership interest in four in-progress university-based research and innovation development 
projects (the “Initial R&I JV Projects”). At closing, GIC reimbursed Ventas for its share of costs incurred to date and we 
recognized a gain of $13.7 million. We own an over 50% interest and GIC owns a 45% interest in the Initial R&I JV Projects. 
The R&I Development JV may be expanded in the future to include other pre-identified R&I development projects. 

See “Note 7 - Investments in Unconsolidated Entities” for additional details on the Ventas Fund and the JV.  

Also during 2020, we sold four MOBs, four senior housing communities, 22 triple-net leased properties and one land 

parcel for aggregate consideration of $249.6 million, and we recognized a gain on the sale of these assets of $23.4 million.

96

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

2019 Activity

 During the year ended December 31, 2019, we sold ten triple-net leased properties, eight MOBs, six senior housing 
assets and our leasehold interest in one vacant land parcel for aggregate consideration of $147.5 million, and we recognized a 
gain on the sale of these assets of $26.0 million.

2018 Activity

During the year ended December 31, 2018, we sold seven senior housing communities included in our senior living 
operations reportable business segment, five triple-net leased properties, 11 MOBs and two vacant land parcels for aggregate 
consideration of $348.6 million.  We recognized a gain on the sale of these assets of $46.2 million for the year ended December 
31, 2018.

Assets Held for Sale

The table below summarizes our real estate assets classified as held for sale as of December 31, 2020 and 2019, 
including the amounts reported within other assets and accounts payable and other liabilities on our Consolidated Balance 
Sheets:

December 31, 2020

December 31, 2019

Number of 
Properties 
Held for Sale

Assets Held 
for Sale

Liabilities 
Held for Sale

Number of 
Properties 
Held for Sale

Assets Held 
for Sale

Liabilities 
Held for Sale

(Dollars in thousands)

Triple-net leased properties
Office operations (1)
Senior living operations

Total

1  $ 

4,960  $ 

2,690 

8  $ 

62,098  $ 

— 

1 

15 

4,633 

101 

455 

1 

5 

5,177 

18,252 

2  $ 

9,608  $ 

3,246 

14  $ 

85,527  $ 

1,623 

499 

3,102 

5,224 

(1) Balances relate to anticipated post-closing settlements of working capital.

In September 2020, one senior housing community no longer met the criteria as being classified as held for sale.  As a 
result, we adjusted the carrying amount of the asset by recognizing depreciation expense of $0.1 million and classified the asset 
within net real estate investments on our Consolidated Balance Sheets for all periods presented.

Real Estate Impairment

We recognized impairments of $153.8 million, $133.6 million and $29.5 million for the years ended December 31, 

2020, 2019 and 2018, respectively, which are recorded primarily as a component of depreciation and amortization in our 
Consolidated Statements of Income.  A significant portion of our 2020 charges resulted from the impact of COVID-19 and 
others were primarily the result of a change in our intent to hold the impaired assets (See “Note 1 – Description of Business - 
COVID-19 Update”).  In most cases, we recognized an impairment in the periods in which our change in intent was made.  

There were no impairments recorded as a result of natural disasters for the years ended December 31, 2020 and 2019; 

however, we recognized impairments of $52.5 million for the year ended December 31, 2018 as a result of natural disasters 
which are recorded as a component of other in our Consolidated Statements of Income.  

97

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 6–LOANS RECEIVABLE AND INVESTMENTS 

As of December 31, 2020 and 2019, we had $0.9 billion and $1.0 billion, respectively, of net loans receivable and 

investments relating to senior housing and healthcare operators or properties.  The following is a summary of our loans 
receivable and investments, net, including amortized cost, fair value and unrealized gains or losses on available for sale 
investments:

Amortized 
Cost

Allowance

Unrealized 
Gain
(In thousands)

Carrying 
Amount

Fair Value

As of December 31, 2020:

Secured/mortgage loans and other, net
Government-sponsored pooled loan investments, net(1)

$  555,840  $ 

—  $ 

—  $  555,840  $  508,707 

55,154 

(8,846)   

3,419 

49,727 

49,727 

Total investments reported as secured loans 

receivable and investments, net

Non-mortgage loans receivable, net
Marketable debt securities (2)

610,994 

74,700 

213,334 

(8,846)   

3,419 

605,567 

(17,623)   

— 

57,077 

— 

24,219 

237,553 

558,434 

57,009 

237,553 

Total loans receivable and investments, net

$  899,028  $ 

(26,469)  $ 

27,638  $  900,197  $  852,996 

As of December 31, 2019:

Secured/mortgage loans and other, net
Government-sponsored pooled loan investments, net(1)

Total investments reported as secured loans 

receivable and investments, net

Non-mortgage loans receivable, net
Marketable debt securities (2)

$  645,546  $ 

—  $ 

—  $  645,546  $  646,925 

52,178 

697,724 

63,724 

213,062 

— 

— 

— 

— 

6,888 

59,066 

59,066 

6,888 

704,612 

— 

63,724 

24,298 

237,360 

705,991 

63,538 

237,360 

Total loans receivable and investments, net

$  974,510  $ 

—  $ 

31,186  $ 1,005,696  $ 1,006,889 

(1) Investments in government-sponsored pool loans have contractual maturity dates in 2021 and 2023.
(2) Investments in marketable debt securities have contractual maturity dates in 2024 and 2026.

2020 Activity

During the year ended December 31, 2020, we recognized $34.7 million in expense in establishing allowances on our 
loan and investment portfolio. See “Note 1 - Description Of Business - COVID-19 Update.”  In December 2020, we received 
$10.5 million for partial repayment of previously reserved loans which was recorded within allowance on loans receivables and 
investments in our Consolidated Statements of Income.  

During the year ended December 31, 2020, we received aggregate proceeds of $106.1 million for the full repayment of 
the principal balances of various loans receivable with a weighted average interest rate of 8.3% that were due to mature between 
2020 and 2025, which resulted in total gains of $1.4 million.

In April 2020, we received as consideration $66 million of notes secured by equity pledges on real estate assets with an 

effective interest rate of 9.2% in connection with the termination of the Holiday Lease.  See “Note 3 – Concentration of Credit 
Risk.”

In July 2020, we entered into a $45 million Note from Brookdale Senior Living in connection with certain revised 
Agreements, which is included above in Non-mortgage loans receivable, net.  The Note has an initial interest rate of 9.0%, 
increasing 50 basis points per annum, and matures on December 31, 2025.  In addition, Brookdale transferred fee ownership of 
five senior living communities to us, in full satisfaction and repayment of a $78 million loan to Brookdale Senior Living from 
us that was secured by the five communities.  See “Note 3 – Concentration of Credit Risk.”

98

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

2019 Activity

In April 2019, we purchased $5.0 million and $10.5 million of senior secured notes issued by a healthcare company 
which mature in 2024 and 2026, respectively.  The 2024 and 2026 notes were purchased at a price of 102% and 98% of par, 
respectively, and have an effective interest rate of 8.1% and 8.3%, respectively.  These marketable debt securities are classified 
as available for sale and are reflected on our Consolidated Balance Sheets at fair value. 

In June 2019, we provided new secured debt financing of $490 million to certain subsidiaries of Colony Capital, Inc.  

The London Inter-bank Offered Rate (“LIBOR”) based debt financing has a five-year term (inclusive of three one-year 
extension options).  In connection with this transaction, our previous secured loan to certain subsidiaries of Colony Capital, Inc. 
of $282 million was paid in full and we recognized a gain of $0.5 million in income from loans and investments in our 
Consolidated Statements of Income.

In July 2019, we closed the first phase of the LGM Acquisition by funding C$947 million (US $723 million) to LGM 

as a bridge loan to enable LGM to buy out its former partner.  The bridge loan and all outstanding interest was fully repaid in 
September 2019 upon the closing of the LGM Acquisition.  See “Note 4 – Acquisitions of Real Estate Property.”

NOTE 7–INVESTMENTS IN UNCONSOLIDATED ENTITIES

 We report investments in unconsolidated entities over whose operating and financial policies we have the ability to 

exercise significant influence under the equity method of accounting.  We are not required to consolidate these entities because 
our joint venture partners have significant participating rights, nor are these entities considered VIEs, as they are controlled by 
equity holders with sufficient capital.  We invest in both real estate entities and operating entities which are described further 
below.

Investments in Unconsolidated Real Estate Entities

Through our newly formed Ventas Investment Management Platform, we partner with third-party institutional 
investors to invest in healthcare real estate through various joint ventures and other co-investment vehicles.  Below is a 
summary of our investment in unconsolidated real estate entities as of December 31, 2020 and 2019, respectively:

Carrying Amount
As of December 31,
2019
2020

(In thousands)

Ownership(1)

22.9%

22.8%

50.3%

34.0%-50.0%  

$ 

279,983  $ 

34,690 

123,445 

438,118 

5,570 

— 

41,739 

— 

41,739 

3,283 

45,022 

Investment in unconsolidated real estate entities:

Ventas Life Science & Healthcare Real Estate Fund

Pension Fund Joint Venture

Research & Innovation Development Joint Venture

Ventas Investment Management Platform
All other(2)

Total investment unconsolidated real estate entities

$ 

443,688  $ 

(1) The entities in which we have an ownership interest may have less than a 100% interest in the underlying real estate.  The 
ownership percentages in the table reflect Ventas’ interest in the underlying real estate.
(2) Includes investments in land parcels, parking structures and other de minimis investments in unconsolidated real estate 
entities.

In March 2020, we formed the Ventas Fund, in which we are the sponsor and general partner.  See “Note 5 – 
Dispositions and Impairments.”  In October 2020, the Ventas Fund acquired a portfolio of three life science properties in the 
South San Francisco life science cluster for $1.0 billion, which increased assets under management to $1.8 billion as of 
December 31, 2020.  The acquisition was financed with a $415 million mortgage loan bearing interest at a fixed rate of 2.6% 
per annum.   

99

 
 
 
 
 
 
 
In October 2020, we formed the R&I Development JV.  See “Note 5 – Dispositions and Impairments.”  We own an 

over 50% interest and GIC owns a 45% interest in the Initial R&I JV Projects.  We act as manager of the R&I Develoment JV, 
with customary rights and obligations, and will receive customary fees and incentives.  Our exclusive development partner, 
Wexford Science & Technology, remains the developer of, and a minority partner in, all of the projects. The R&I Development 
JV may be expanded in the future to include other pre-identified R&I development projects.

In March 2018, we recognized an impairment charge of $35.7 million relating to one of our equity investments in an 

unconsolidated real estate joint venture consisting principally of SNFs, which is recorded in loss from unconsolidated entities in 
our Consolidated Statements of Income.  We completed the sale of our 25% interest to our joint venture partner in July 2018  
and received $57.5 million at closing.

We provide various services to our unconsolidated real estate entities in exchange for fees and reimbursements.  Total 
management fees earned in connection with these services were $6.7 million, $3.4 million and $5.8 million for the years ended 
December 31, 2020, 2019 and 2018, respectively, which is included in office building and other services revenue in our 
Consolidated Statements of Income. 

Investments in Unconsolidated Operating Entities

We own investments in unconsolidated operating entities such as Ardent, Atria and Eclipse Senior Living, Inc. 

(“ESL”), which are included within other assets on our Consolidated Balance Sheets.  Our 34% ownership interest in Atria 
entitles us to customary minority rights and protections, including the right to appoint two of six members to the Atria Board of 
Directors.  Our 34% ownership interest in ESL entitles us to customary minority rights and protections, including the right to 
appoint two of six members to the ESL Board of Directors.  ESL management owns the 66% controlling interest.  Our 9.8% 
ownership interest in Ardent entitles us to customary minority rights and protections, as well as the right to appoint one of 11 
members on the Ardent Board of Directors.  

In June 2020, as a result of COVID-19, we recognized an impairment charge of $10.7 million related to our investment 

in an unconsolidated operating entity.  See “Note 1 – Description of Business - COVID-19 Update.”

NOTE 8–INTANGIBLES 

The following is a summary of our intangibles:

As of December 31, 2020

As of December 31, 2019

Intangible assets:

Above market lease intangibles
In-place and other lease intangibles
Goodwill
Other intangibles
Accumulated amortization
Net intangible assets

Intangible liabilities:

Below market lease intangibles
Other lease intangibles
Accumulated amortization
Purchase option intangibles
Net intangible liabilities

N/A—Not Applicable 

Remaining
Weighted 
Average
Amortization
Period in Years

Balance

(Dollars in thousands)

Remaining
Weighted 
Average
Amortization
Period in Years

6.4
10.7
N/A
10.0
N/A
10.3

14.3
N/A
N/A
N/A
14.3

$ 

$ 

$ 

$ 

145,891 
1,162,187 
1,051,161 
35,837 
(922,668) 
1,472,408 

349,357 
13,498 
(203,834) 
3,568 
162,589 

6.9
10.6
N/A
10.9
N/A
10.2

14.5
N/A
N/A
N/A
14.5

Balance

$ 

$ 

$ 

$ 

140,096 
1,090,790 
1,051,650 
35,870 
(941,462) 
1,376,944 

339,265 
13,498 
(212,655) 
3,568 
143,676 

100

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Above-market lease intangibles and in-place and other lease intangibles are included in acquired lease intangibles 

within real estate investments on our Consolidated Balance Sheets.  Other intangibles (including non-compete agreements, trade 
names and trademarks) are included in other assets on our Consolidated Balance Sheets.  Below market lease intangibles, other 
lease intangibles and purchase option intangibles are included in accounts payable and other liabilities on our Consolidated 
Balance Sheets.  For the years ended December 31, 2020, 2019 and 2018, our net amortization related to these intangibles was 
$45.7 million, $59.2 million and $49.2 million, respectively.  The following is a summary of the estimated net amortization 
related to these intangibles for each of the next five years: 

2021

2022

2023

2024

2025

$ 

Estimated Net 
Amortization

(In thousands)

50,421 

42,787 

31,343 

16,932 

8,977 

The table below reflects the carrying amount of goodwill, by segment, as of December 31, 2020:

Triple-net leased properties
Senior living operations
Office operations
Total goodwill

NOTE 9–OTHER ASSETS 

The following is a summary of our other assets:

Straight-line rent receivables

Non-mortgage loans receivable, net

Stock warrants

Marketable debt securities

Other intangibles, net

Investment in unconsolidated operating entities

Other

Total other assets

Goodwill

(In thousands)

$ 

$ 

322,270 
259,482 
469,898 
1,051,650 

As of December 31,

2020

2019

(In thousands)

$ 

169,711  $ 

278,833 

57,077 

50,098 

237,553 

4,659 

63,768 

224,363 

$ 

807,229  $ 

63,724 

— 

237,360 

5,149 

59,301 

233,349 

877,716 

101

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 10–SENIOR NOTES PAYABLE AND OTHER DEBT 

The following is a summary of our senior notes payable and other debt:

Unsecured revolving credit facility (1)
Commercial paper notes

Secured revolving construction credit facility due 2022
Floating Rate Senior Notes, Series F due 2021 (2)
3.25% Senior Notes due 2022
3.30% Senior Notes, Series C due 2022 (2)
Unsecured term loan due 2023

3.125% Senior Notes due 2023

3.10% Senior Notes due 2023
2.55% Senior Notes, Series D due 2023 (2)
3.50% Senior Notes due 2024

3.75% Senior Notes due 2024
4.125% Senior Notes, Series B due 2024 (2)
2.80% Senior Notes, Series E due 2024 (2)
Unsecured term loan due 2025 (2)
3.50% Senior Notes due 2025

2.65% Senior Notes due 2025

4.125% Senior Notes due 2026

3.25% Senior Notes due 2026

3.85% Senior Notes due 2027

4.00% Senior Notes due 2028

4.40% Senior Notes due 2029

3.00% Senior Notes due 2030

4.75% Senior Notes due 2030

6.90% Senior Notes due 2037

6.59% Senior Notes due 2038

5.70% Senior Notes due 2043

4.375% Senior Notes due 2045

4.875% Senior Notes due 2049

Mortgage loans and other

Total

Deferred financing costs, net

Unamortized fair value adjustment

Unamortized discounts

Senior notes payable and other debt

As of December 31,

2020

2019

(In thousands)

$ 

39,395  $ 

— 

154,098 

235,664 

263,687 

196,386 

200,000 

400,000 

400,000 

216,025 

400,000 

400,000 

196,386 

471,328 

392,773 

600,000 

450,000 

500,000 

450,000 

400,000 

650,000 

750,000 

650,000 

500,000 

52,400 

22,823 

300,000 

300,000 

300,000 

120,787 

567,450 

160,492 

231,018 

500,000 

192,515 

200,000 

400,000 

400,000 

211,767 

400,000 

400,000 

192,515 

462,036 

385,030 

600,000 

450,000 

500,000 

450,000 

400,000 

650,000 

750,000 

650,000 

— 

52,400 

22,823 

300,000 

300,000 

300,000 

2,092,106 

11,983,071 

1,996,969 

12,245,802 

(68,343)   

12,618 

(31,934)   

(79,939) 

20,056 

(27,146) 

$ 

11,895,412  $ 

12,158,773 

(1) As of December 31, 2020 and 2019, respectively, $12.2 million and $26.2 million of aggregate borrowings were 

denominated in Canadian dollars.  Aggregate borrowings of $27.2 million and $27.6 million were denominated in British 
pounds as of December 31, 2020 and 2019, respectively.
(2) Canadian Dollar debt obligations shown in US Dollars.

102

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Credit Facilities, Commercial Paper and Unsecured Term Loans

As of December 31, 2020, our unsecured credit facility was comprised of a $3.0 billion unsecured revolving credit 

facility priced at LIBOR plus 0.875% based on the Company’s debt ratings, which was scheduled to mature in 2021. Following 
December 31, 2020, we entered into an amended and restated unsecured credit facility (the “New Credit Facility”) comprised of 
a $2.75 billion unsecured revolving credit facility initially priced at LIBOR plus 0.825% based on the Company’s debt ratings.  
The New Credit Facility matures in 2025, but may be extended at our option subject to the satisfaction of certain conditions, for 
two additional periods of six months each.  The New Credit Facility also includes an accordion feature that permits us to 
increase our aggregate borrowing capacity thereunder to up to $3.75 billion. 

Our unsecured credit facility imposed certain customary restrictions on us, including restrictions pertaining to: 

(i) liens; (ii) investments; (iii) the incurrence of additional indebtedness; (iv) mergers and dissolutions; (v) certain dividend, 
distribution and other payments; (vi) permitted businesses; (vii) transactions with affiliates; (viii) agreements limiting certain 
liens; and (ix) the maintenance of certain consolidated total leverage, secured debt leverage, unsecured debt leverage and fixed 
charge coverage ratios and minimum consolidated adjusted net worth, and contains customary events of default. The New 
Credit Facility imposes similar restrictions.

As of December 31, 2020, $39.4 million was outstanding under the unsecured revolving credit facility with an 
additional $24.9 million restricted to support outstanding letters of credit.  In addition, we limit our utilization of the unsecured 
revolving credit facility, to the extent necessary, to support our commercial paper program when commercial paper notes are 
outstanding.  We had $2.9 billion in available liquidity under the unsecured revolving credit facility as of December 31, 2020.  
In connection with the New Credit Facility, we paid off all amounts outstanding under the existing unsecured revolving credit 
facility as of January 29, 2021 by drawing down the same amount under the New Credit Facility.

Our wholly owned subsidiary, Ventas Realty, Limited Partnership (“Ventas Realty”), may issue from time to time 

unsecured commercial paper notes up to a maximum aggregate amount outstanding at any time of $1.0 billion.  The notes are 
sold under customary terms in the United States commercial paper note market and are ranked pari passu with all of Ventas 
Realty’s other unsecured senior indebtedness.  The notes are fully and unconditionally guaranteed by Ventas, Inc.  As of 
December 31, 2020, we had no borrowings outstanding under our commercial paper program. 

As of December 31, 2020, we had a $200.0 million unsecured term loan priced at LIBOR plus 0.90% that matures in 

2023.  The term loan also includes an accordion feature that effectively permits us to increase our aggregate borrowings 
thereunder to up to $800.0 million.   

As of December 31, 2020, we had a $400.0 million secured revolving construction credit facility with $154.1 million 
of borrowings outstanding.  The secured revolving construction credit facility matures in 2022 and is primarily used to finance 
the development of research and innovation centers and other construction projects.

In September 2019, we entered into a new C$500 million unsecured term loan facility priced at Canadian Dollar 

Offered Rate (“CDOR”) plus 0.90% that matures in 2025.

In June 2019, we repaid $100.0 million of the balance outstanding on the $300.0 million unsecured term loan that 

matures in 2023 and repaid in full the $600.0 million unsecured term loan that was set to mature in 2024 and, as a result, we 
recognized a non-cash charge to loss on extinguishment of debt of $3.2 million during the second quarter of 2019.

Senior Notes

As of December 31, 2020, we had outstanding $7.7 billion aggregate principal amount of senior notes issued by 

Ventas Realty ($263.7 million of which was co-issued by Ventas Realty’s wholly owned subsidiary, Ventas Capital 
Corporation), approximately $75.2 million aggregate principal amount of senior notes issued by Nationwide Health Properties, 
Inc. (“NHP”) and assumed by our subsidiary, Nationwide Health Properties, LLC (“NHP LLC”), as successor to NHP, in 
connection with our acquisition of NHP, and C$1.7 billion aggregate principal amount of senior notes issued by our subsidiary, 
Ventas Canada Finance Limited (“Ventas Canada”).  All of the senior notes issued by Ventas Realty and Ventas Canada are 
unconditionally guaranteed by Ventas, Inc.

Ventas Realty’s senior notes are part of our and Ventas Realty’s general unsecured obligations, ranking equal in right 
of payment with all of our and Ventas Realty’s existing and future senior obligations and ranking senior in right of payment to 
all of our and Ventas Realty’s existing and future subordinated indebtedness.  However, Ventas Realty’s senior notes are 
effectively subordinated to our and Ventas Realty’s secured indebtedness, if any, to the extent of the value of the assets securing 

103

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

that indebtedness.  Ventas Realty’s senior notes are also structurally subordinated to the preferred equity and indebtedness, 
whether secured or unsecured, of our subsidiaries (other than Ventas Realty and, with respect to those senior notes co-issued by 
Ventas Capital Corporation, Ventas Capital Corporation).

Ventas Canada’s senior notes are part of our and Ventas Canada’s general unsecured obligations, ranking equal in 

right of payment with all of Ventas Canada’s existing and future subordinated indebtedness.  However, Ventas Canada’s senior 
notes are effectively subordinated to our and Ventas Canada’s secured indebtedness, if any, to the extent of the value of the 
assets securing that indebtedness.  Ventas Canada’s senior notes are also structurally subordinated to the preferred equity and 
indebtedness, whether secured or unsecured, of our subsidiaries (other than Ventas Canada).

NHP LLC’s senior notes are part of NHP LLC’s general unsecured obligations, ranking equal in right of payment with 

all of NHP LLC’s existing and future senior obligations and ranking senior to all of NHP LLC’s existing and future 
subordinated indebtedness.  However, NHP LLC’s senior notes are effectively subordinated to NHP LLC’s secured 
indebtedness, if any, to the extent of the value of the assets securing that indebtedness.  NHP LLC’s senior notes are also 
structurally subordinated to the preferred equity and indebtedness, whether secured or unsecured, of its subsidiaries.

Ventas Realty and Ventas Canada may redeem each series of their respective senior notes in whole at any time or in 
part from time to time, prior to maturity at the redemption prices set forth in the applicable indenture (which include, in many 
instances, a make-whole premium), plus, in each case, accrued and unpaid interest thereon to the redemption date.

NHP LLC’s 6.90% senior notes due 2037 are subject to repurchase at the option of the holders, at par, on October 1, 

2027, and its 6.59% senior notes due 2038 are subject to repurchase at the option of the holders, at par, on July 7 in each of  
2023 and 2028. 

2021 Senior Notes Activity

In February 2021, in order to reduce near-term maturities, we issued a make whole redemption for the entirety of the 
$400 million outstanding aggregate principal amount of 3.10% senior notes due January 2023. The redemption is expected to 
settle in March 2021 and will be funded primarily with cash on hand.

2020 Senior Notes Activity

In April 2020, Ventas Realty issued and sold $500.0 million aggregate principal amount of 4.75% senior notes due 

2030 at an amount equal to 97.86% of par.  

In October 2020, we redeemed, pursuant to a cash tender offer, $236.3 million aggregate principal amount then 

outstanding of our 3.25% senior notes due 2022 at 104.14% of par value, plus accrued and unpaid interest to the payment date. 
As a result, we recognized a loss on extinguishment of debt of $11.1 million during the year ended December 31, 2020.

2019 Senior Notes Activity

In January 2019, we redeemed $258.8 million aggregate principal amount then outstanding of our 5.45% senior notes 

due 2043 at a public offering price at par, plus accrued and unpaid interest to the redemption date.  Notice of the redemption 
was given in November 2018 and, as a result, we recognized a non-cash charge to loss on extinguishment of debt of $7.1 
million during the year ended December 31, 2018 and $0.4 million during the first quarter of 2019.

In February 2019, Ventas Realty issued and sold $400.0 million aggregate principal amount of 3.50% senior notes due 

2024 at a public offering price equal to 99.88% of par and $300.0 million aggregate principal amount of 4.875% senior notes 
due 2049 at a public offering price equal to 99.77% of par.

In June 2019, Ventas Realty issued $450.0 million aggregate principal amount of 2.65% senior notes due 2025 at a 

public offering price equal to 99.45% of par.  The notes were settled and proceeds were received in July 2019.

In July 2019, in connection with an announced cash tender offer for such notes, we tendered $397.1 million principal 

amount then outstanding of our 2.70% senior notes due 2020 for a tender offer consideration of 100.37% of par value, plus 
accrued and unpaid interest to the payment date.  In August 2019, we repaid the remaining balance then outstanding of our 
2.70% senior notes due 2020 of $102.9 million.  As a result of the redemption and repayment, we recognized a total loss on 
extinguishment of debt of $2.4 million.

104

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

In August 2019, Ventas Realty issued and sold $650.0 million aggregate principal amount of 3.00% senior notes due 

2030 at a public offering price equal to 99.51% of par.

In August 2019, in connection with an announced cash tender offer for such notes, we tendered $395.7 million 
principal amount then outstanding of our 4.25% senior notes due 2022 for a tender offer consideration of 105.46% of par value, 
plus accrued and unpaid interest to the payment date.  In September 2019, we repaid the remaining balance then outstanding of 
our 4.25% senior notes due 2022 of $204.3 million.  As a result of the redemption and repayment, we recognized a loss on 
extinguishment of debt of $35.9 million.

In September 2019, we repaid in full, at par, C$400.0 million principal amount then outstanding of our 3.00% senior 

notes, Series A due 2019 upon maturity.

In November 2019, Ventas Canada issued and sold C$600 million aggregate principal amount of 2.80% senior notes, 

Series E due 2024 and C$300 million aggregate principal amount of floating rate senior notes, Series F due 2021, at a public 
offering price equal to 99.99% and 100.00%, respectively, of par.

Mortgages

At December 31, 2020, we had 89 mortgage loans outstanding in the aggregate principal amount of $2.1 billion which 

is secured by 78 of our properties.  Of these loans, 66 loans in the aggregate principal amount of $1.4 billion bear interest at 
fixed rates ranging from 1.5% to 13.0% per annum, and 23 loans in the aggregate principal amount of $702.9 million bear 
interest at variable rates ranging from 0.1% to 2.9% per annum as of December 31, 2020.  At December 31, 2020, the weighted 
average annual rate on our fixed rate mortgage loans was 3.5%, and the weighted average annual rate on our variable rate 
mortgage loans was 1.9%.  Our mortgage loans had a weighted average maturity of 3.9 years as of December 31, 2020.

During the years ended December 31, 2020 and 2019, we repaid in full mortgage loans in the aggregate principal 

amount of $60.9 million and $97.7 million, respectively.

In September 2019, we assumed C$1.2 billion mortgage debt (included in the $2.1 billion above), including a fair 

value premium of C$16.6 million, in connection with the LGM Acquisition.  See “Note 4 – Acquisitions of Real Estate 
Property.”

Scheduled Maturities of Borrowing Arrangements and Other Provisions

The following summarizes the maturities of our senior notes payable and other debt as of December 31, 2020:

2021

2022

2023

2024

2025

Thereafter

Total maturities

Unsecured 
Revolving
Credit
Facility and 
Commercial 
Paper Notes (1)

Principal Amount
Due at Maturity

Scheduled 
Periodic
Amortization

Total Maturities

$ 

511,971  $ 

39,395  $ 

44,651  $ 

596,017 

(In thousands)

1,070,861 

1,609,373 

1,610,581 

1,619,872 

5,285,913 

— 

— 

— 

— 

— 

38,602 

24,821 

18,587 

14,894 

93,550 

1,109,463 

1,634,194 

1,629,168 

1,634,766 

5,379,463 

$  11,708,571  $ 

39,395  $ 

235,105  $  11,983,071 

(1) At December 31, 2020, we had unrestricted cash and cash equivalents of $413.3 million, which exceeds the borrowings

outstanding under our unsecured revolving credit facility and commercial paper program.

The instruments governing our outstanding indebtedness contain covenants that limit our ability and the ability of 
certain of our subsidiaries to, among other things: (i) incur debt; (ii) make certain dividends, distributions and investments; 
(iii) enter into certain transactions; and/or (iv) merge, consolidate or sell certain assets.  Ventas Realty’s and Ventas Canada’s
senior notes also require us and our subsidiaries to maintain total unencumbered assets of at least 150% of our unsecured debt.

105

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Our credit facilities also require us to maintain certain financial covenants pertaining to, among other things, our consolidated 
total leverage, secured debt, unsecured debt, fixed charge coverage and net worth.

As of December 31, 2020, we were in compliance with all of these covenants.

Derivatives and Hedging

In the normal course of our business, interest rate fluctuations affect future cash flows under our variable rate debt 

obligations, loans receivable and marketable debt securities, and foreign currency exchange rate fluctuations affect our 
operating results.  We follow established risk management policies and procedures, including the use of derivative instruments, 
to mitigate the impact of these risks.

We do not use derivative instruments for trading or speculative purposes, and we have a policy of entering into 
contracts only with major financial institutions based upon their credit ratings and other factors.  When considered together with 
the underlying exposure that the derivative is designed to hedge, we do not expect that the use of derivatives in this manner 
would have any material adverse effect on our future financial condition or results of operations.

As of December 31, 2020, our variable rate debt obligations of $1.5 billion reflect, in part, the effect of $146.7 million 
notional amount of interest rate swaps with maturities ranging from March 2022 to May 2022 that effectively convert fixed rate 
debt to variable rate debt.  As of December 31, 2020, our fixed rate debt obligations of $10.5 billion reflect, in part, the effect of 
$305.9 million and C$145.7 million notional amount of interest rate swaps with maturities ranging from January 2023 to 
December 2029, in each case that effectively convert variable rate debt to fixed rate debt. 

NOTE 11–FAIR VALUES OF FINANCIAL INSTRUMENTS 

The carrying amounts and fair values of our financial instruments were as follows: 

Assets:

Cash and cash equivalents

Escrow deposits and restricted cash

Stock warrants

Secured mortgage loans and other, net

Non-mortgage loans receivable, net

Marketable debt securities

Government-sponsored pooled loan investments, net

Derivative instruments

Liabilities:

As of December 31, 2020

As of December 31, 2019

Carrying
Amount

Fair Value

Carrying
Amount

Fair Value

(In thousands)

$ 

413,327  $ 

413,327  $ 

106,363  $ 

106,363 

38,313 

50,098 

555,840 

57,077 

237,553 

49,727 

2 

38,313 

50,098 

508,707 

57,009 

237,553 

49,727 

2 

39,739 

— 

645,546 

63,724 

237,360 

59,066 

738 

39,739 

— 

646,925 

63,538 

237,360 

59,066 

738 

Senior notes payable and other debt, gross

  11,983,071 

  13,075,337 

  12,245,802 

  12,778,758 

Derivative instruments

Redeemable OP Units

28,338 

145,983 

28,338 

145,983 

12,987 

171,178 

12,987 

171,178 

For a discussion of the assumptions considered, refer to “Note 2 – Accounting Policies.”  The use of different market 

assumptions and estimation methodologies may have a material effect on the reported estimated fair value amounts.  
Accordingly, the estimates presented above are not necessarily indicative of the amounts we would realize in a current market 
exchange.

NOTE 12–STOCK- BASED COMPENSATION 

Compensation Plans

We currently have: three plans under which outstanding options to purchase common stock, shares of restricted stock 
or restricted stock units have been, or may in the future be, granted to our officers, employees and non-employee directors (the 

106

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

2006 Incentive Plan, the 2006 Stock Plan for Directors, and the 2012 Incentive Plan); one plan under which executive officers 
may receive deferred common stock in lieu of compensation (the Executive Deferred Stock Compensation Plan); and one plan 
under which certain non-employee directors have received or may receive deferred common stock in lieu of director fees (the 
Nonemployee Directors’ Deferred Stock Compensation Plan).  These plans are referred to collectively as the “Plans.”

During the year ended December 31, 2020, we were permitted to issue shares and grant options, restricted stock and 

restricted stock units only under the Executive Deferred Stock Compensation Plan, the Nonemployee Directors’ Deferred Stock 
Compensation Plan and the 2012 Incentive Plan.  The 2006 Incentive Plan and the 2006 Stock Plan for Directors (collectively, 
the “2006 Plans”) expired on December 31, 2012, and no additional grants were permitted under those Plans after that date.

The number of shares initially reserved for issuance and the number of shares available for future grants or issuance 

under these Plans as of December 31, 2020 were as follows:

•

•

•

Executive Deferred Stock Compensation Plan—0.6 million shares were reserved initially for issuance to our 
executive officers in lieu of the payment of all or a portion of their salary, at their option, and 0.6 million shares 
were available for future issuance as of December 31, 2020.

Nonemployee Directors’ Deferred Stock Compensation Plan—0.6 million shares were reserved initially for 
issuance to nonemployee directors in lieu of the payment of all or a portion of their retainer and meeting fees, at 
their option, and 0.4 million shares were available for future issuance as of December 31, 2020.

2012 Incentive Plan—10.7 million shares (plus the number of shares or options outstanding under the 2006 Plans 
as of December 31, 2012 that were or are subsequently forfeited or expire unexercised) were reserved initially for 
grants or issuance to employees and non-employee directors, and 2.7 million shares (plus the number of shares or 
options outstanding under the 2006 Plans as of December 31, 2020 that were or are subsequently forfeited or 
expire unexercised) were available for future issuance as of December 31, 2020.  

Outstanding options issued under the Plans are exercisable at the market price on the date of grant, expire ten years 

from the date of grant, and vest or have vested over periods of two or three years.  If provided in the applicable Plan or award 
agreement, the vesting of stock options may accelerate upon a change of control (as defined in the applicable Plan) of Ventas, 
Inc. and other specified events.

Stock Options

The following is a summary of stock option activity in 2020:

Outstanding as of December 31, 2019

Options granted

Options exercised

Options forfeited

Options expired

Outstanding as of December 31, 2020

Exercisable as of December 31, 2020

Shares (000’s)

Weighted 
Average
Exercise Price

Weighted
Average
Remaining
Contractual
Life (years)

Intrinsic
Value
($000’s)

4,077  $ 

— 

(111)   

(9)   

(3)   

3,954 

3,954 

60.49 

— 

45.75 

60.50 

60.50 

60.90 

60.90 

4.8 $ 

4.8 $ 

462 

462 

Compensation costs for all share-based awards are based on the grant date fair value and are recognized on a straight-

line basis during the requisite service periods, with charges recorded in general, administrative and professional fees.  As of 
December 31, 2020 there was no unrecognized compensation expense relating to stock options.  Compensation costs related to 
stock options for the years ended December 31, 2019 and 2018 were $0.3 million and $2.6 million, respectively. 

Aggregate proceeds received from options exercised under the Plans for the years ended December 31, 2020, 2019 and 

2018 were $5.1 million, $36.1 million and $8.8 million, respectively.  The total intrinsic value at exercise of options exercised 
during the years ended December 31, 2020, 2019 and 2018 was $1.3 million, $12.3 million and $3.1 million, respectively.  
There was no deferred income tax benefit for stock options exercised.

107

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Restricted Stock and Restricted Stock Units

We recognize the fair value of shares of restricted stock and restricted stock units (including time-based and 

performance-based awards) on the grant date of the award as stock-based compensation expense over the requisite service 
period, with charges to general, administrative and professional fees of $21.4 million, $33.6 million and $27.3 million in 2020, 
2019 and 2018, respectively.  Restricted stock and restricted stock units generally vest over periods ranging from two to five 
years.  If provided in the applicable Plan or award agreement, the vesting of restricted stock and restricted stock units may 
accelerate upon a change of control (as defined in the applicable Plan) of Ventas and other specified events.  In addition to 
customary change in control vesting provisions, awards for executive officers will also generally vest to the executives if at a 
future termination date, they have attained a combined number of age and years of service of at least 75, with a minimum age of 
62.

A summary of the status of our non-vested restricted stock and restricted stock units (including time-based and 

performance-based awards) as of December 31, 2020, and changes during the year ended December 31, 2020, follows:

Nonvested at December 31, 2019

Granted

Vested

Forfeited

Nonvested at December 31, 2020

Restricted
Stock 
(000’s)

Weighted
Average
Grant Date
Fair Value

Restricted
Stock Units 
(000’s)

Weighted
Average
Grant Date
Fair Value

248  $ 

170 

(136)   

(49)   

233 

58.21 

44.36 

56.54 

54.08 

49.94 

539  $ 

446 

(271)   

— 

714 

56.99 

59.81 

55.14 

— 

59.46 

As of December 31, 2020, we had $19.8 million of unrecognized compensation cost related to non-vested restricted 

stock and restricted stock units under the Plans.  We expect to recognize that cost over a weighted average period of 1.80 years.  
The total fair value at the vesting date for restricted stock and restricted stock units that vested during the years ended December 
31, 2020, 2019 and 2018 was $19.8 million, $31.6 million and $15.5 million, respectively.

Employee and Director Stock Purchase Plan

We have in effect an Employee and Director Stock Purchase Plan (“ESPP”) under which our employees and directors 
may purchase shares of our common stock at a discount.  Pursuant to the terms of the ESPP, on each purchase date, participants 
may purchase shares of common stock at a price not less than 90% of the market price on that date (with respect to the 
employee tax-favored portion of the plan) and not less than 95% of the market price on that date (with respect to the additional 
employee and director portion of the plan).  We initially reserved 3.0 million shares for issuance under the ESPP.  As of 
December 31, 2020, 0.2 million shares had been purchased under the ESPP and 2.8 million shares were available for future 
issuance.   

Employee Benefit Plan

We maintain a 401(k) plan that allows eligible employees to defer compensation subject to certain limitations imposed 
by the Code.  In 2020, we made contributions for each qualifying employee of up to 3.5% of his or her salary, subject to certain 
limitations.  During 2020, 2019 and 2018, our aggregate contributions were approximately $1.6 million, $1.5 million and $1.5 
million, respectively.

NOTE 13–INCOME TAXES 

We have elected to be taxed as a REIT under the applicable provisions of the Code, as amended, for every year 

beginning with the year ended December 31, 1999.  We have also elected for certain of our subsidiaries to be treated as TRS 
entities, which are subject to federal, state and foreign income taxes.  All entities other than the TRS entities are collectively 
referred to as the “REIT” within this note.  Certain REIT entities are subject to foreign income tax.

108

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Although we intend to continue to operate in a manner that will enable us to qualify as a REIT, such qualification 

depends upon our ability to meet, on a continuing basis, various distribution, stock ownership and other tests.  Our tax treatment 
of distributions per common share was as follows:

Tax treatment of distributions:

Ordinary income

Qualified ordinary income

199A qualified business income

Long-term capital gain

Unrecaptured Section 1250 gain

Non-dividend distribution

Distribution reported for 1099-DIV purposes

Add: Dividend declared in current year and taxable in following year

For the Years Ended December 31,

2020

2019

2018

$ 

—  $ 

—  $ 

— 

0.00696 

2.14381 

0.28450 

0.04973 

— 

2.48500 

0.45000 

0.12230 

2.22898 

— 

0.03434 

0.78438 

3.17000 

0.79250 

0.00375 

2.97465 

0.05916 

0.12244 

— 

3.16000 

0.79250 

Less: Dividend declared in prior year and taxable in current year

(0.79250)   

(0.79250)   

(0.79000) 

Distribution declared per common share outstanding

$ 

2.14250  $ 

3.17000  $ 

3.16250 

We believe we have met the annual REIT distribution requirement by payment of at least 90% of our estimated taxable 

income for 2020, 2019 and 2018.  Our consolidated benefit for income taxes was as follows:

Current - Federal 

Current - State

Deferred - Federal 

Deferred - State

Current - Foreign

Deferred - Foreign

Total

For the Years Ended December 31,

2020

2019

2018

(In thousands)

$ 

402  $ 

(1,840)  $ 

(2,953) 

2,107 

(56,835)   

(35,447)   

2,929 

2,118 

1,332 

(49,532)   

(32,492) 

(3,353)   

2,335 

(825) 

1,892 

(6,907) 

(9,690)   

(6,038)   

$ 

(96,534)  $ 

(56,310)  $ 

(39,953) 

The 2020 income tax benefit is primarily due to a $95.9 million net deferred tax benefit from an internal restructuring 

of certain US taxable REIT subsidiaries completed in the first quarter, partially offset by a valuation allowance recorded against 
certain deferred tax assets in the second quarter.  During the second quarter of 2020, we determined that the future tax benefits 
of certain deferred tax assets (primarily US federal NOL carryforwards which begin to expire in 2031) were not more likely 
than not to be realized.  The 2019 income tax benefit was primarily due to the $57.7 million reversal of valuation allowances 
recorded against the net deferred tax assets of certain of our TRS entities.

Although the TRS entities and certain other foreign entities have paid minimal cash federal, state and foreign income 

taxes for the year ended December 31, 2020, their income tax liabilities may increase in future years as we exhaust net 
operating loss (“NOL”) carryforwards and as our senior living and other operations grow.  Such increases could be significant.

109

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

A reconciliation of income tax expense and benefit, which is computed by applying the federal corporate tax rate for 

the years ended December 31, 2020, 2019 and 2018, to the income tax benefit is as follows:

Tax at statutory rate on earnings from continuing operations before 
unconsolidated entities, noncontrolling interest and income taxes

State income taxes, net of federal benefit

Change in valuation allowance from ordinary operations

Decrease in ASC 740 income tax liability

For the Years Ended December 31,

2020

2019

2018

(In thousands)

$ 

27,132  $ 

77,803  $ 

80,811 

(1,967)   

2,341 

86,359 

— 

(47,227)   

— 

(253) 

(5,451) 

(4,347) 

Tax at statutory rate on earnings not subject to federal income taxes

(53,808)   

(90,862)   

(89,947) 

Foreign rate differential and foreign taxes

Change in tax status of TRS

Effect of the 2017 Tax Act

Other differences

Income tax benefit

3,342 

(150,287)   

— 

(7,305)   

1,407 

(52)   

— 

280 

1,924 

359 

(23,160) 

111 

$ 

(96,534)  $ 

(56,310)  $ 

(39,953) 

Each TRS is a tax-paying component for purposes of classifying deferred tax assets and liabilities.  The tax effects of 

temporary differences and carryforwards included in the net deferred tax liabilities are summarized as follows:

As of December 31,

2020

2019

2018

(In thousands)

Property, primarily differences in depreciation and amortization, the tax basis 

of land assets and the treatment of interests and certain costs

$ 

(60,494)  $ 

(257,373)  $ 

(269,758) 

Operating loss and interest deduction carryforwards

Expense accruals and other

Valuation allowance

Net deferred tax liabilities 

124,606 

10,516 

136,771 

7,380 

133,243 

11,910 

(127,279)   

(40,114)   

(80,614) 

$ 

(52,651)  $ 

(153,336)  $ 

(205,219) 

Our net deferred tax liability decreased $100.7 million during 2020 primarily due to a change in the tax status of 

certain of our TRS entities. This was offset by the recording of valuation allowances against $54.4 million of other deferred tax 
assets.  Our net deferred tax liability decreased $51.9 million during 2019 primarily due to the $57.7 million reversal of 
valuation allowances recorded against the net deferred tax assets of certain of our TRS entities.  Our net deferred tax liability 
decreased $44.8 million during 2018 primarily due to accounting for IRS guidance issued subsequent to the enactment of the 
2017 Tax Act, specifically a $23.2 million benefit for the reversal of a valuation allowance on deferred interest carryforwards, 
and tax losses of certain TRS entities. 

Due to uncertainty regarding the realization of certain deferred tax assets, we have established valuation allowances, 

primarily in connection with the NOL carryforwards related to certain TRSs.  The amounts related to NOLs at the TRS entities 
for 2020, 2019 and 2018 are $83.2 million, $21.2 million and $55.1 million, respectively. 

We are subject to corporate-level taxes (“built-in gains tax”) for any asset dispositions during the five year period 
immediately after the assets were owned by a C corporation (either prior to our REIT election, through stock acquisition or 
merger).  The amount of income potentially subject to built-in gains tax is generally equal to the lesser of the excess of the fair 
value of the asset over its adjusted tax basis as of the date it became a REIT asset or the actual amount of gain.  Some, but not 
all, future gains could be offset by available NOL carryforwards.

At December 31, 2020, 2019 and 2018, the REIT had NOL carryforwards of $896.4 million, $858.6 million and 
$910.7 million, respectively.  Additionally, the REIT has $10.8 million of federal income tax credits that were carried over from 
acquisitions.  These amounts can be used to offset future taxable income (or taxable income for prior years if an audit 
determines that tax is owed), if any.  The REIT will be entitled to utilize NOLs and tax credit carryforwards only to the extent 
that REIT taxable income exceeds our deduction for dividends paid.  Certain NOL and credit carryforwards are limited as to 
their utilization by Section 382 of the Code.  The remaining REIT carryforwards begin to expire in 2020.

110

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

For the years ended December 31, 2020 and 2019, the net difference between tax bases and the reported amount of 
REIT assets and liabilities for federal income tax purposes was approximately $3.6 billion and $3.5 billion, respectively, less 
than the book bases of those assets and liabilities for financial reporting purposes.

Generally, we are subject to audit under the statute of limitations by the Internal Revenue Service (“IRS”) for the year 

ended December 31, 2017 and subsequent years and are subject to audit by state taxing authorities for the year ended 
December 31, 2016 and subsequent years.  We are subject to audit generally under the statutes of limitation by the Canada 
Revenue Agency and provincial authorities with respect to the Canadian entities for the year ended December 31, 2016 and 
subsequent years.  We are also subject to audit in Canada for periods subsequent to the acquisition, and certain prior periods, 
with respect to entities acquired in 2014 from Holiday Retirement.  We are subject to audit in the United Kingdom generally for 
the periods ended in and subsequent to 2019.  

The following table summarizes the activity related to our unrecognized tax benefits:

Balance as of January 1

Additions to tax positions related to prior years

Subtractions to tax positions related to prior years

Balance as of December 31

2020

2019

(In thousands)

$ 

12,127  $ 

12,344 

74 

(6,144) 

178 

(395) 

$ 

6,057  $ 

12,127 

Included in these unrecognized tax benefits of $6.1 million and $12.1 million at December 31, 2020 and 2019, 

respectively, were $5.3 million and $10.7 million of tax benefits at December 31, 2020 and 2019, respectively, that, if 
recognized, would reduce our annual effective tax rate.  We accrued no interest or penalties related to the unrecognized tax 
benefits during 2020.  We do not expect our unrecognized tax benefits to increase or decrease materially in 2021.

As a part of the transfer pricing structure in the normal course of business, the REIT enters into transactions with 
certain TRSs, such as leasing transactions, other capital financing and allocation of general and administrative costs, which 
transactions are intended to comply with Internal Revenue Service and foreign tax authority transfer pricing rules.

NOTE 14–COMMITMENTS AND CONTINGENCIES 

From time to time, we are party to various lawsuits, investigations, claims and other legal and regulatory proceedings 

arising in connection with our business. In certain circumstances, regardless of whether we are a named party in a lawsuit, 
investigation, claim or other legal or regulatory proceeding, we may be contractually obligated to indemnify, defend and hold 
harmless our tenants, operators, managers or other third parties against, or may otherwise be responsible for, such actions, 
proceedings or claims.  These claims may include, among other things, professional liability and general liability claims, 
commercial liability claims, unfair business practices claims and employment claims, as well as regulatory proceedings, 
including proceedings related to our senior living operations, where we are typically the holder of the applicable healthcare 
license.  These claims may not be fully insured and some may allege large damage amounts.

It is the opinion of management, that the disposition of any such lawsuits, investigations, claims and other legal and 

regulatory proceedings that are currently pending will not, individually or in the aggregate, have a material adverse effect on us. 
However, regardless of the merits of a particular action, investigation or claim, we may be forced to expend significant financial 
resources to defend and resolve these matters. We are unable to predict the ultimate outcome of these lawsuits, investigations, 
claims and other legal and regulatory proceedings, and if management’s assessment of our liability with respect thereto is 
incorrect, such actions, investigations and claims could have a material adverse effect on us.

Operating Leases

We lease land, equipment and corporate office space.  At inception, we establish an operating lease asset and operating 
lease liability represented as the present value of future minimum lease payments.  As our leases do not provide an implicit rate, 
we use a discount rate that approximates our incremental borrowing rate available at lease commencement to determine the 
present value of lease payments.  The incremental borrowing rates were adjusted for the length of the individual lease term.  
The weighted average discount rate and remaining lease term of our leases are 7.25% and 36.7 years, respectively.  Operating 
lease assets and liabilities are not recognized for leases with an initial term of 12 months or less, as these short-term leases are 
accounted for similar to previous guidance.

111

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Our lease expense primarily consists of ground and corporate office leases. Ground lease expense is included in 
interest expense and corporate office lease expense is included in general and administrative expenses in the Company’s 
Consolidated Statements of Operation.  For the years ended December 31, 2020 and 2019, we recognized $32.1 million and 
$32.6 million of expense relating to our leases.  For the years ended December 31, 2020 and 2019, cash paid for leases was 
$25.4 million and $25.8 million, respectively as reported within operating cash outflows in our Consolidated Statements of 
Cash Flow.

The following table summarizes future minimum lease obligations under non-cancelable ground and other operating 

leases as of December 31, 2020 (in thousands):

2021

2022

2023

2024

2025

Thereafter

Total undiscounted minimum lease payments

Less: imputed interest

Operating lease liabilities

NOTE 15–EARNINGS PER SHARE 

$ 

$ 

24,363 

20,041 

19,725 

18,866 

16,708 

654,060 

753,763 

(543,846) 

209,917 

The following table shows the amounts used in computing our basic and diluted earnings per common share:

Numerator for basic and diluted earnings per share:

Income from continuing operations

Discontinued operations

Net income

Net income attributable to noncontrolling interests

For the Years Ended December 31,

2020

2019

2018

(In thousands, except per share amounts)

$ 

441,185  $ 

439,297  $ 

415,991 

— 

441,185 

2,036 

— 

439,297 

6,281 

(10) 

415,981 

6,514 

Net income attributable to common stockholders          

$ 

439,149  $ 

433,016  $ 

409,467 

Denominator:

Denominator for basic earnings per share—weighted average shares

373,368 

365,977 

356,265 

Effect of dilutive securities:
Stock options

Restricted stock awards

OP unitholder interests

Denominator for diluted earnings per share—adjusted weighted 

average shares

Basic earnings per share:

Income from continuing operations

Net income attributable to common stockholders          

Diluted earnings per share:

Income from continuing operations
Net income attributable to common stockholders          

— 

171 

2,964 

391 

527 

2,991 

174 

331 

2,531 

376,503 

369,886 

359,301 

$ 

$ 

1.18  $ 

1.18 

1.17  $ 
1.17 

1.20  $ 

1.18 

1.19  $ 
1.17 

1.17 

1.15 

1.16 
1.14 

There were 4.0 million, 1.1 million and 3.5 million anti-dilutive options outstanding for the years ended December 31, 

2020, 2019 and 2018, respectively.

112

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 16–PERMANENT AND TEMPORARY EQUITY 

Capital Stock

From time to time, we may sell up to an aggregate of $1.0 billion of our common stock under an “at-the-market” 

equity offering program (“ATM program”). As of December 31, 2020, we have $755.5 million remaining under our existing 
ATM program. During the years ended December 31, 2020 and 2019, we sold 1.5 million and 2.7 million shares of our 
common stock under our ATM program for gross proceeds of $44.88 and $66.75 per share, respectively.  During the year ended 
December 31, 2018, we sold no shares of common stock under our ATM program.  

In June 2019, we sold 12.7 million shares of our common stock under a registered public offering for gross proceeds of 

$62.75 per share.  We used the majority of the net proceeds to fund our LGM Acquisition.  See “Note 4 – Acquisitions of Real 
Estate Property” and “Note 6 – Loans Receivable and Investments” for additional information regarding the LGM Acquisition.

Excess Share Provision

In order to preserve our ability to maintain REIT status, our Amended and Restated Certificate of Incorporation (our 
“Charter”) provides that if a person acquires beneficial ownership of more than 9% of our outstanding common stock or 9.9% 
of our outstanding preferred stock, the shares that are beneficially owned in excess of such limit are deemed to be excess shares. 
These shares are automatically deemed transferred to a trust for the benefit of a charitable institution or other qualifying 
organization selected by our Board of Directors.  The trust is entitled to all dividends with respect to the shares, and the trustee 
may exercise all voting power over the shares.

We have the right to buy the excess shares for a purchase price equal to the lesser of the price per share in the 
transaction that created the excess shares or the market price on the date we buy the shares, and we may defer payment of the 
purchase price for the excess shares for up to five years.  If we do not purchase the excess shares, the trustee of the trust is 
required to transfer the excess shares at the direction of the Board of Directors.  The owner of the excess shares is entitled to 
receive the lesser of the proceeds from the sale or the original purchase price for such excess shares, and any additional amounts 
are payable to the beneficiary of the trust.  As of December 31, 2020, there were no shares in the trust.  

Our Board of Directors is empowered to grant waivers from the excess share provisions of our Charter.

Accumulated Other Comprehensive Loss

The following is a summary of our accumulated other comprehensive loss:

Foreign currency translation

Available for sale securities
Derivative instruments

Total accumulated other comprehensive loss

As of December 31,

2020

2019

(In thousands)

$ 

(51,947)  $ 

25,712 
(28,119) 

$ 

(54,354)  $ 

(51,743) 

27,380 
(10,201) 

(34,564) 

113

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Redeemable OP Unitholder and Noncontrolling Interests

The following is a roll-forward of our redeemable OP unitholder and noncontrolling interests for 2020:

Redeemable OP 
Unitholder Interests

Redeemable 
Noncontrolling 
Interests

(In thousands)

Total Redeemable OP 
Unitholder and 
Noncontrolling 
Interests

Balance as of December 31, 2019

$ 

171,178  $ 

102,500  $ 

New issuances

Change in valuation

Dispositions

Distributions and other

Redemptions

— 

(18,638)   

— 

(6,247)   

(310)   

Balance as of December 31, 2020

$ 

145,983  $ 

16,593 

(8,068)   

(14,350)   

1,071 

(8,239)   

89,507  $ 

273,678 

16,593 

(26,706) 

(14,350) 

(5,176) 

(8,549) 

235,490 

NOTE 17–RELATED PARTY TRANSACTIONS 

Atria provides comprehensive property management and accounting services with respect to our senior housing 

communities that Atria operates, for which we pay annual management fees pursuant to long-term management agreements. 
For the years ended December 31, 2020, 2019 and 2018, we incurred fees to Atria of $55.2 million, $62.1 million and $60.1 
million, respectively, the majority of which are recorded within property-level operating expenses in our Consolidated 
Statements of Income.

We hold a 34% ownership interest in Atria, which entitles us to customary minority rights and protections, as well as 

the right to appoint two of the six members on the Atria Board of Directors. 

As of December 31, 2020, we leased 11 hospital campuses to Ardent pursuant to a single, triple-net master lease 
agreement.  For the years ended December 31, 2020, 2019 and 2018, we recognized rental income from Ardent of $122.6 
million, $118.8 million and $114.8 million, respectively, relating to the Ardent master lease. 

In June 2018, we made a $200.0 million investment in senior unsecured notes issued by a subsidiary of Ardent at a 
price of 98.6% of par value.  The notes have an effective interest rate of 10.0% and mature in 2026.  These marketable debt 
securities are classified as available for sale and are reflected on our Consolidated Balance Sheets at fair value.  

We hold a 9.8% ownership interest in Ardent, which entitles us to customary minority rights and protections, as well 

as the right to appoint one of the 11 members on the Ardent Board of Directors. 

In January 2018, we transitioned the management of 76 private-pay senior housing communities to ESL.  These assets, 

substantially all of which were previously leased by Elmcroft Senior Living (“Elmcroft”) under triple-net leases, are now 
operated by ESL under a management contract with us and are included in the senior living operations reportable business 
segment.  Upon termination of our lease with Elmcroft, we derecognized our accumulated straight-line receivable balance and 
offsetting reserve of $75.2 million.  For the years ended December 31, 2020, 2019 and 2018, we incurred $5.2 million, $8.2 
million and $23.6 million respectively of transaction and integration costs relating to this transaction, net of property-level net 
assets assumed for no consideration, primarily included in merger-related expenses and deal costs in our Consolidated 
Statements of Income.

In January 2018, we acquired a 34% ownership interest in ESL, which entitles us to customary minority rights and 

protections, as well as the right to appoint two of the six members of the ESL Board of Directors.  ESL management owns the 
66% controlling interest.

ESL provides comprehensive property management and accounting services with respect to our senior housing 
communities that ESL operates, for which we pay annual management fees pursuant to a management agreement.  For the years 
ended December 31, 2020, 2019 and 2018, we incurred fees to ESL of $15.1 million, $14.6 million and $12.9 million, 

114

 
 
 
 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

respectively, the majority of which are recorded within property-level operating expenses in our Consolidated Statements of 
Income.

NOTE 18–QUARTERLY FINANCIAL INFORMATION (UNAUDITED) 

Summarized unaudited consolidated quarterly information is provided below:

For the Year Ended December 31, 2020

First
Quarter

Second
Quarter

Third
Quarter

Fourth
Quarter

(In thousands, except per share amounts)

Revenues

$  1,012,054  $ 

943,198  $ 

918,940  $ 

921,165 

Income (loss) from continuing operations

$ 

474,730  $ 

(159,235)  $ 

13,737  $ 

111,953 

Net income (loss)

Net income (loss) attributable to noncontrolling interests

474,730 

(159,235) 

1,613 

(2,065) 

13,737 

986 

111,953 

1,502 

Net income (loss) attributable to common stockholders 

$ 

473,117  $ 

(157,170)  $ 

12,751  $ 

110,451 

Basic earnings per share:

Income (loss) from continuing operations

Net income (loss) attributable to common stockholders

Diluted earnings per share(1):

Income (loss) from continuing operations 

$ 

$ 

1.27  $ 

(0.43)  $ 

0.04  $ 

1.27 

(0.42) 

0.03 

1.26  $ 

(0.43)  $ 

0.04  $ 

Net income (loss) attributable to common stockholders

1.26 

(0.42) 

0.03 

0.30 

0.29 

0.30 

0.29 

Dividends declared per common share

$ 

0.7925  $ 

0.4500  $ 

0.4500  $ 

0.4500 

(1) Potential common shares are not included in the computation of diluted earnings per share when a loss from continuing

operations exists, as the effect would be an antidilutive per share amount.

Revenues

Income from continuing operations

Net income

Net income attributable to noncontrolling interests

 Net income attributable to common stockholders 

Basic earnings per share:

Income from continuing operations

Net income attributable to common stockholders

Diluted earnings per share:

Income from continuing operations

$ 

$ 

$ 

$ 

$ 

For the Year Ended December 31, 2019

First
Quarter

Second
Quarter

Third
Quarter

Fourth
Quarter

(In thousands, except per share amounts)

942,874  $ 

950,717  $ 

983,155  $ 

996,004 

127,588  $ 

211,898  $ 

86,918  $ 

127,588 

1,803 

211,898 

1,369 

86,918 

1,659 

125,785  $ 

210,529  $ 

85,259  $ 

12,893 

12,893 

1,450 

11,443 

0.36  $ 

0.59  $ 

0.23  $ 

0.35 

0.58 

0.23 

0.35  $ 

0.58  $ 

0.23  $ 

0.03 

0.03 

0.03 

0.03 

Net income attributable to common stockholders

0.35 

0.58 

0.23 

Dividends declared per common share

$ 

0.7925  $ 

0.7925  $ 

0.7925  $ 

0.7925 

115

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

NOTE 19–SEGMENT INFORMATION 

As of December 31, 2020, we operated through three reportable business segments: triple-net leased properties, senior 

living operations and office operations.  In our triple-net leased properties segment, we invest in and own senior housing and 
healthcare properties throughout the United States and the United Kingdom and lease those properties to healthcare operating 
companies under “triple-net” or “absolute-net” leases that obligate the tenants to pay all property-related expenses.  In our 
senior living operations segment, we invest in senior housing communities throughout the United States and Canada and engage 
independent operators, such as Atria and Sunrise, to manage those communities.  In our office operations segment, we primarily 
acquire, own, develop, lease and manage MOBs and research and innovation centers throughout the United States.  Information 
provided for “all other” includes income from loans and investments and other miscellaneous income and various corporate-
level expenses not directly attributable to any of our three reportable business segments.  Assets included in “all other” consist 
primarily of corporate assets, including cash, restricted cash, loans receivable and investments, and miscellaneous accounts 
receivable.  

Our chief operating decision makers evaluate performance of the combined properties in each reportable business 
segment and determine how to allocate resources to those segments, in significant part, based on segment NOI and related 
measures.  We define segment NOI as total revenues, less interest and other income, property-level operating expenses and 
office building services costs.  We consider segment NOI useful because it allows investors, analysts and our management to 
measure unlevered property-level operating results and to compare our operating results to the operating results of other real 
estate companies between periods on a consistent basis.  In order to facilitate a clear understanding of our historical 
consolidated operating results, segment NOI should be examined in conjunction with net income attributable to common 
stockholders as presented in our Consolidated Financial Statements and other financial data included elsewhere in this Annual 
Report on Form 10-K.

Interest expense, depreciation and amortization, general, administrative and professional fees, income tax expense and 
other non-property-specific revenues and expenses are not allocated to individual reportable business segments for purposes of 
assessing segment performance.  There are no intersegment sales or transfers.

116

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Summary information by reportable business segment is as follows:

Revenues:

Rental income

Resident fees and services

Office building and other services revenue

Income from loans and investments

Interest and other income

Total revenues

Total revenues

Less:

Interest and other income

Property-level operating expenses

Office building services costs

Segment NOI

Interest and other income

Interest expense

Depreciation and amortization

General, administrative and professional fees

Loss on extinguishment of debt, net

Merger-related expenses and deal costs

Allowance on loans receivable and investments

Other

Income from unconsolidated entities

Gain on real estate dispositions

Income tax benefit

Income from continuing operations

Net income

Net income attributable to noncontrolling interests
Net income attributable to common stockholders

For the Year Ended December 31, 2020

Triple-Net
Leased
Properties

Senior
Living
Operations

Office
Operations

(In thousands)

All
Other

Total

$  695,265  $ 

—  $  799,627  $ 

—  $ 1,494,892 

— 

— 

— 

— 

  2,197,160 

— 

— 

— 

— 

8,675 

— 

— 

— 

  2,197,160 

6,516 

80,505 

7,609 

15,191 

80,505 

7,609 

$  695,265  $ 2,197,160  $  808,302  $ 

94,630  $ 3,795,357 

$  695,265  $ 2,197,160  $  808,302  $ 

94,630  $ 3,795,357 

— 

— 

— 

7,609 

7,609 

22,160 

  1,658,671 

256,612 

— 

— 

2,315 

— 

— 

  1,937,443 

2,315 

$  673,105  $  538,489  $  549,375  $ 

87,021 

  1,847,990 

7,609 

(469,541) 

  (1,109,763) 

(130,158) 

(10,791) 

(29,812) 

(24,238) 

(707) 

1,844 

262,218 

96,534 

441,185 

441,185 

2,036 
$  439,149 

117

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Revenues:

Rental income

Resident fees and services

Office building and other services revenue

Income from loans and investments

Interest and other income

Total revenues

Total revenues

Less:

Interest and other income

Property-level operating expenses

Office building services costs

Segment NOI

Interest and other income

Interest expense

Depreciation and amortization

General, administrative and professional fees

Loss on extinguishment of debt, net

Merger-related expenses and deal costs

Other

Loss from unconsolidated entities

Gain on real estate dispositions

Income tax benefit

Income from continuing operations

Net income

Net income attributable to noncontrolling interests

Net income attributable to common stockholders

For the Year Ended December 31, 2019

Triple-Net
Leased
Properties

Senior
Living
Operations

Office
Operations

(In thousands)

All
Other

Total

$  780,898  $ 

—  $  828,978  $ 

—  $ 1,609,876 

— 

— 

— 

— 

  2,151,533 

— 

— 

— 

— 

7,747 

— 

— 

— 

  2,151,533 

3,409 

89,201 

10,984 

11,156 

89,201 

10,984 

$  780,898  $ 2,151,533  $  836,725  $  103,594  $ 3,872,750 

$  780,898  $ 2,151,533  $  836,725  $  103,594  $ 3,872,750 

— 

— 

— 

10,984 

10,984 

26,561 

  1,521,398 

260,249 

— 

— 

2,319 

— 

— 

  1,808,208 

2,319 

$  754,337  $  630,135  $  574,157  $ 

92,610 

  2,051,239 

10,984 

(451,662) 

  (1,045,620) 

(158,726) 

(41,900) 

(15,235) 

10,339 

(2,454) 

26,022 

56,310 

439,297 

439,297 

6,281 

$  433,016 

118

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Revenues:

Rental income

For the Year Ended December 31, 2018

Triple-Net
Leased
Properties

Senior
Living
Operations

Office
Operations

(In thousands)

All
Other

Total

$  737,796  $ 

—  $  776,011  $ 

—  $ 1,513,807 

Resident fees and services

— 

2,069,477 

Office building and other services revenue

Income from loans and investments

Interest and other income

Total revenues

Total revenues

Less:

Interest and other income

Property-level operating expenses

Office building services costs

Segment NOI

Interest and other income

Interest expense

Depreciation and amortization

General, administrative and professional fees

Loss on extinguishment of debt, net

Merger-related expenses and deal costs

Other

Loss from unconsolidated entities

Gain on real estate dispositions

Income tax benefit

Income from continuing operations

Discontinued operations

Net income

Net income attributable to noncontrolling interests

Net income attributable to common stockholders

2,522 

— 

— 

— 

— 

— 

— 

7,592 

— 

— 

— 

2,069,477 

3,302 

124,218 

24,892 

13,416 

124,218 

24,892 

$  740,318  $ 2,069,477  $  783,603  $  152,412  $ 3,745,810 

$  740,318  $ 2,069,477  $  783,603  $  152,412  $ 3,745,810 

— 

— 

— 

— 

— 

24,892 

24,892 

1,446,201 

243,679 

— 

1,418 

— 

— 

1,689,880 

1,418 

$  740,318  $  623,276  $  538,506  $  127,520 

2,029,620 

24,892 

(442,497) 

(919,639) 

(145,978) 

(58,254) 

(30,547) 

(72,772) 

(55,034) 

46,247 

39,953 

415,991 

(10) 

415,981 

6,514 

$  409,467 

Assets by reportable business segment are as follows:

Assets:

Triple-net leased properties

Senior living operations

Office operations
All other assets
Total assets

As of December 31,

2020

2019

(Dollars in thousands)

$ 

5,147,503 

 21.6%  $ 

6,381,657 

10,653,428 

 44.5 

10,142,023 

6,709,602 
1,418,871 
$  23,929,404 

 28.0 
 5.9 

7,173,401 
995,127 
 100.0%  $  24,692,208 

 25.8% 

 41.1 

 29.1 
 4.0 
 100.0% 

119

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS (Continued)

Capital expenditures, including investments in real estate property and development project expenditures, by 

reportable business segment are as follows:

Capital expenditures:

Triple-net leased properties

Senior living operations

Office operations

Total capital expenditures

For the Years Ended December 31,

2020

2019

2018

(In thousands)

$ 

42,930  $ 

55,429  $ 

58,744 

191,891 

372,475 

944,214 

519,129 

337,750 

332,147 

$ 

607,296  $  1,518,772  $ 

728,641 

Our portfolio of properties and mortgage loan and other investments are located in the United States, Canada and the 

United Kingdom.  Revenues are attributed to an individual country based on the location of each property.  Geographic 
information regarding our operations is as follows:

Revenues:

United States

Canada

United Kingdom

Total revenues

Net real estate property:

United States

Canada

United Kingdom

Total net real estate property

For the Years Ended December 31,

2020

2019

2018

(In thousands)

$  3,381,357  $  3,578,341  $  3,524,875 

389,205 

24,795 

266,946 

27,463 

192,350 

28,585 

$  3,795,357  $  3,872,750  $  3,745,810 

As of December 31,

2020

2019

(In thousands)

$  17,303,816  $  18,636,838 

2,983,924 

2,830,850 

262,295 

266,885 

$  20,550,035  $  21,734,573 

120

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
VENTAS, INC.
SCHEDULE III
REAL ESTATE AND ACCUMULATED DEPRECIATION

Reconciliation of real estate:

Carrying cost:

Balance at beginning of period

Additions during period:

Acquisitions

Capital expenditures

Deductions during period:

Foreign currency translation
Other(1)

Balance at end of period

Accumulated depreciation:

Balance at beginning of period

Additions during period:

Depreciation expense

Dispositions:

Sales and/or transfers to assets held for sale

Foreign currency translation

Balance at end of period

For the Years Ended December 31,

2020

2019

2018

(In thousands)

$  27,133,514  $  24,973,983  $  24,712,478 

249,290 

485,479 

1,941,018 

575,624 

318,895 

446,490 

80,302 

107,508 

(105,192) 

(1,098,143)   

(464,619)   

(398,688) 

$  26,850,442  $  27,133,514  $  24,973,983 

$ 

6,200,230  $ 

5,492,310  $ 

4,802,917 

809,067 

811,936 

791,882 

(82,559)   

(116,771)   

40,675 

12,755 

(84,819) 

(17,670) 

$ 

6,967,413  $ 

6,200,230  $ 

5,492,310 

(1) Other may include sales, transfers to assets held for sale and impairments.

121

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
.

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1

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
VENTAS, INC.
SCHEDULE IV
MORTGAGE LOANS ON REAL ESTATE
December 31, 2020 

Location

Number of 
RE Assets

Interest 
Rate

Fixed / 
Variable

Maturity 
Date

Monthly Debt 
Service

Face Value

Net Book 
Value

Prior Liens

(In thousands)

First Mortgages

Multiple

7

9.24%

Mezzanine Loans

Multiple

156

6.58%

V

V

3/31/2025

388,310   

66,000   

66,000   

174,020 

6/9/2021

2,889,690   

487,648   

486,797   

1,020,080 

Total

$ 

3,278,000  $  553,648  $ 

552,797  $  1,194,100 

Mortgage Loan Reconciliation

Beginning Balance

Additions:

New loans

Construction draws

Total additions

Deductions:

Principal repayments

Total deductions

Effect of foreign currency translation 

Ending Balance

2020

2019

2018

(In thousands)

$ 

642,218  $ 

427,117  $ 

565,875 

66,000 

1,234,244 

— 

— 

66,000 

1,234,244 

(155,170) 

(155,170) 

(251) 

(1,011,353) 

(1,011,353) 

(7,790) 

9,900 

— 

9,900 

(148,658) 

(148,658) 

— 

$ 

552,797  $ 

642,218  $ 

427,117 

155

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ITEM 9.    Changes in and Disagreements with Accountants on Accounting and Financial Disclosure

None.

ITEM 9A.    Controls and Procedures

Evaluation of Disclosure Controls and Procedures

As required by Rules 13a-15(b) and 15d-15(b) of the Exchange Act, our management, with the participation of our 

Chief Executive Officer and Chief Financial Officer, has evaluated the effectiveness of our disclosure controls and procedures 
as of December 31, 2020.  Based on that evaluation, our Chief Executive Officer and Chief Financial Officer concluded that our 
disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Exchange Act) were effective as of 
December 31, 2020, at the reasonable assurance level.

Internal Control over Financial Reporting

The information set forth under “Management Report on Internal Control over Financial Reporting” and “Report of 
Independent Registered Public Accounting Firm on Internal Control over Financial Reporting” included in Part II, Item 8 of 
this Annual Report is incorporated by reference into this Item 9A.

Internal Control Changes

During the fourth quarter of 2020, there were no changes in our internal control over financial reporting (as defined in 

Rules 13a-15(f) and 15d-15(f) under the Exchange Act) that have materially affected, or are reasonably likely to materially 
affect, our internal control over financial reporting.

ITEM 9B.    Other Information

Not applicable.

ITEM 10.    Directors, Executive Officers and Corporate Governance

PART III

The information required by this Item 10 is incorporated by reference to the material under the headings “Elections of 

Directors,” “Our Executive Officers,” “Securities Ownership,” and “Corporate Governance and Board Matters” in our 
definitive Proxy Statement for the 2021 Annual Meeting of Stockholders, which we will file with the SEC not later than April 
30, 2021.

ITEM 11.    Executive Compensation

The information required by this Item 11 is incorporated by reference to the material under the headings “Executive 
Compensation,” “Non-Employee Director Compensation” and “Corporate Governance and Board Matters” in our definitive 
Proxy Statement for the 2021 Annual Meeting of Stockholders, which we will file with the SEC not later than April 30, 2021.

ITEM 12.    Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters

The information required by this Item 12 is incorporated by reference to the material under the headings “Equity 
Compensation Plan Information” and “Securities Ownership” in our definitive Proxy Statement for the 2021 Annual Meeting of 
Stockholders, which we will file with the SEC not later than April 30, 2021.

ITEM 13.    Certain Relationships and Related Transactions, and Director Independence

The information required by this Item 13 is incorporated by reference to the material under the heading “Corporate 
Governance and Board Matters,” in our definitive Proxy Statement for the 2021 Annual Meeting of Stockholders, which we 
will file with the SEC not later than April 30, 2021.

156

 
ITEM 14.    Principal Accountant Fees and Services

The information required by this Item 14 is incorporated by reference to the material under the heading “Audit 

Matters” in our definitive Proxy Statement for the 2021 Annual Meeting of Stockholders, which we will file with the SEC not 
later than April 30, 2021.

157

ITEM 15.    Exhibits and Financial Statement Schedules

PART IV

Financial Statements and Financial Statement Schedules

The following documents have been included in Part II, Item 8 of this Annual Report on Form 10-K:

Reports of Independent Registered Public Accounting Firm

Consolidated Balance Sheets as of December 31, 2020 and 2019

Consolidated Statements of Income for the Years Ended December 31, 2020, 2019 and 2018

Consolidated Statements of Comprehensive Income for the Years Ended December 31, 2020, 2019 and 2018

Consolidated Statements of Equity for the Years Ended December 31, 2020, 2019 and 2018

Consolidated Statements of Cash Flows for the Years Ended December 31, 2020, 2019 and 2018

Notes to Consolidated Financial Statements

Consolidated Financial Statement Schedules

Schedule III — Real Estate and Accumulated Depreciation

Schedule IV — Mortgage Loans on Real Estate

Page

73

76

77

78

79

80

82

121

155

All other schedules have been omitted because they are inapplicable or not required or the information is included 

elsewhere in the Consolidated Financial Statements or notes thereto.

158

 
 
EXHIBITS

Exhibit
Number
3.1

Description of Document
Amended and Restated Certificate of Incorporation, 
as amended, of Ventas, Inc.

3.2

Fifth Amended and Restated Bylaws, as amended, of 
Ventas, Inc.

4.1

Specimen common stock certificate.

Indenture dated as of September 19, 2006 by and 
among Ventas, Inc., Ventas Realty, Limited 
Partnership and Ventas Capital Corporation, as  
Issuer(s), the Guarantors named therein, as 
Guarantors, and U.S. Bank National Association, as 
Trustee.

Seventh Supplemental Indenture dated as of August 
3, 2012 by and among Ventas Realty, Limited 
Partnership and Ventas Capital Corporation, as 
Issuers, Ventas, Inc., as Guarantor, and U.S. Bank 
National Association, as Trustee, relating to the 
3.250% Senior Notes due 2022.

Indenture dated as of September 26, 2013 by and 
among Ventas, Inc., Ventas Realty, Limited 
Partnership, as Issuer, the Guarantors named therein, 
as Guarantors, and U.S. Bank National Association, 
as Trustee.

Second Supplemental Indenture dated as of 
September 26, 2013 by and among Ventas Realty, 
Limited Partnership, as Issuer, Ventas, Inc., as 
Guarantor, and U.S. Bank National Association, as 
Trustee, relating to the 5.700% Senior Notes due 
2043.

Fourth Supplemental Indenture dated as of April 17, 
2014 by and among Ventas Realty, Limited 
Partnership, as Issuer, Ventas, Inc., as Guarantor, and 
U.S. Bank National Association, as Trustee, relating 
to the 3.750% Senior Notes due 2024.

Fifth Supplemental Indenture dated as of January 14, 
2015 by and among Ventas Realty, Limited 
Partnership, as Issuer, Ventas, Inc., as Guarantor, and 
U.S. Bank National Association, as Trustee, relating 
to the 3.500% Senior Notes due 2025.

Sixth Supplemental Indenture dated as of January 14, 
2015 by and among Ventas Realty, Limited 
Partnership, as Issuer, Ventas, Inc., as Guarantor, and 
U.S. Bank National Association, as Trustee, relating 
to the 4.375% Senior Notes due 2045.

4.2

4.3

4.4

4.5

4.6

4.7

4.8

4.9

Location of Document
Incorporated by reference herein.  Previously filed as 
Exhibit 3.1 to our Quarterly Report on Form 10-Q 
for the quarter ended June 30, 2011, filed on August 
5, 2011, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 3.2 to our Current Report on Form 8-K, filed 
on January 11, 2017, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.1 to our Annual Report on Form 10-K for 
the fiscal year ended December 31, 2015, filed on 
February 12, 2016, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.9 to our Registration Statement on Form 
S-3, filed on April 7, 2006, File No. 333-133115.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.1 to our Quarterly Report on Form 10-Q 
for the quarter ended September 30, 2012, filed on 
October 26, 2012, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.10 to our Annual Report on Form 10-K for 
the year ended December 31, 2016, filed on February 
14, 2017, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.3 to our Current Report on Form 8-K, filed 
on September 26, 2013, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.3 to our Current Report on Form 8-K, filed 
on April 17, 2014, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.2 to our Current Report on Form 8-K, filed 
on January 14, 2015, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.3 to our Current Report on Form 8-K, filed 
on January 14, 2015, File No. 001-10989.

Indenture dated as of August 19, 1997 by and 
between Nationwide Health Properties, Inc. and The 
Bank of New York, as Trustee, relating to the 6.90% 
Series C Medium-Term Notes due 2037 and the 
6.59% Series C Medium-Term Notes due 2038.  

Incorporated by reference herein.  Previously filed as 
Exhibit 1.2 to the Nationwide Health Properties, Inc. 
Current Report on Form 8-K, filed on August 19, 
1997, File No. 001-09028 (see Exhibit 1.2 of 
complete submission text file).

159

 
 
 
 
Exhibit
Number
4.10

4.11

4.12

4.13

4.14

4.15

4.16

4.17

4.18

4.19

Description of Document

Supplemental Indenture dated July 1, 2011 among 
Nationwide Health Properties, Inc., Needles 
Acquisition LLC, and The Bank of New York 
Mellon Trust Company, N.A., as successor Trustee, 
relating to the 6.90% Series C Medium-Term Notes 
due 2037 and the 6.59% Series C Medium-Term 
Notes due 2038. 

Indenture dated as September 24, 2014 by and 
among Ventas, Inc., Ventas Canadian Finance 
Limited, the Guarantors parties thereto from time to 
time and Computershare Trust Company of Canada, 
as Trustee.

Second Supplemental Indenture dated as of 
September 24, 2014 by and among Ventas Canada 
Finance Limited, as Issuer, Ventas, Inc., as 
Guarantor, and Computershare Trust Company of 
Canada, as Trustee, relating to the 4.125% Senior 
Notes, Series B due 2024.

Third Supplemental Indenture dated as of January 
13, 2015 by and among Ventas Canada Finance 
Limited, as Issuer, Ventas, Inc., as Guarantor, and 
Computershare Trust Company of Canada, as 
Trustee, relating to the 3.30% Senior Notes, Series C 
due 2022.

Fourth Supplemental Indenture dated as of June 1, 
2017 by and among Ventas Canada Finance Limited, 
as Issuer, Ventas, Inc., as Guarantor, and 
Computershare Trust Company of Canada, as 
Trustee, relating to the 2.55% Senior Notes, Series D 
due 2023.

Fifth Supplemental Indenture dated as of November 
12, 2019 by and among Ventas Canada Finance 
Limited, as Issuer, Ventas, Inc., as Guarantor, and 
Computershare Trust Company of Canada, as 
Trustee, relating to the 2.80% Senior Notes, Series E 
due 2024.

Sixth Supplemental Indenture dated as of November 
12, 2019 by and among Ventas Canada Finance 
Limited, as Issuer, Ventas, Inc., as Guarantor, and 
Computershare Trust Company of Canada, as 
Trustee, relating to the Floating Rate Senior Notes, 
Series F due 2021.

Indenture dated as of July 16, 2015 by and among 
Ventas, Inc., Ventas Realty, Limited Partnership, as 
Issuer, the Guarantors named therein as Guarantors, 
and U.S. Bank National Association, as Trustee.

First Supplemental Indenture dated as of July 16, 
2015 by and among Ventas Realty, Limited 
Partnership, as Issuer, Ventas Inc., as Guarantor, and 
U.S. Bank National Association, as Trustee, relating 
to the 4.125% Senior Notes due 2026.

Second Supplemental Indenture dated as of June 2, 
2016 by and among Ventas Realty, Limited 
Partnership, as Issuer, Ventas Inc., as Guarantor, and 
U.S. Bank National Association, as Trustee, relating 
to the 3.125% Senior Notes due 2023.

Location of Document
Incorporated by reference herein.  Previously filed as 
Exhibit 4.17 to our Annual Report on Form 10-K for 
the year ended December 31, 2016, filed on February 
14, 2017, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.1 to our Quarterly Report on Form 10-Q 
for the quarter ended September 30, 2014, filed on 
October 24, 2014, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.3 to our Quarterly Report on Form 10-Q 
for the quarter ended September 30, 2014, filed on 
October 24, 2014, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.24 to our Annual Report on Form 10-K for 
the year ended December 31, 2014, filed on February 
13, 2015, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.1 to our Quarterly Report on Form 10-Q 
for the quarter ended June 30, 2017, filed on July 28, 
2017, File No. 001-10989.

Incorporated by reference herein. Previously filed as 
Exhibit 4.15 to our Annual Report on Form 10-K for 
the year ended December 31, 2019, filed on February 
24, 2020, File No. 001-10989.

Incorporated by reference herein. Previously filed as 
Exhibit 4.16 to our Annual Report on Form 10-K for 
the year ended December 31, 2019, filed on February 
24, 2020, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.1 to our Current Report on Form 8-K, filed 
on July 16, 2015, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.2 to our Current Report on Form 8-K, filed 
on July 16, 2015, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.2 to our Current Report on Form 8-K, filed 
on June 2, 2016, File No. 001-10989.

160

Exhibit
Number
4.20

4.21

4.22

4.23

4.24

4.25

4.26

4.27

4.28

4.29

10.1

10.2

Description of Document
Third Supplemental Indenture dated as of September 
21, 2016 by and among Ventas Realty, Limited 
Partnership, as Issuer, Ventas Inc., as Guarantor, and 
U.S. Bank National Association, as Trustee, relating 
to the 3.250% Senior Notes due 2026.

Fourth Supplemental Indenture dated as of March 29, 
2017 by and among Ventas Realty, Limited 
Partnership, as Issuer, Ventas, Inc., as Guarantor, and 
U.S. Bank National Association, as Trustee, relating 
to the 3.100% Senior Notes due 2023 and the 
3.850% Senior Notes due 2027.

Indenture dated February 23, 2018 among Ventas, 
Inc., Ventas Realty, Limited Partnership, the 
Guarantors named therein, and U.S. Bank National 
Association, as Trustee

First Supplemental Indenture dated as of February 
23, 2018 by and among Ventas Realty, Limited 
Partnership, as Issuer, Ventas, Inc., as Guarantor and 
U.S. Bank National Association, as Trustee relating 
to the 4.000% Senior Notes due 2028

Second Supplemental Indenture dated as of August 
15, 2018 by and among Ventas Realty, Limited 
Partnership, as Issuer, Ventas, Inc., as Guarantor and 
U.S. Bank National Association, as Trustee relating 
to the 4.400% Senior Notes due 2029

Third Supplemental Indenture dated as of February 
26, 2019 by and among Ventas Realty, Limited 
Partnership, as Issuer, Ventas, Inc., as Guarantor and 
U.S. Bank National Association, as Trustee relating 
to the 3.500% Senior Notes due 2024 and 4.875% 
Senior Notes due 2049

Fourth Supplemental Indenture dated as of July 3, 
2019 by and among Ventas Realty, Limited 
Partnership, as Issuer, Ventas, Inc., as Guarantor and 
U.S. Bank National Association, as Trustee relating 
to the 2.650% Senior Notes due 2025

Fifth Supplemental Indenture dated as of August 21, 
2019 by and among Ventas Realty, Limited 
Partnership, as Issuer, Ventas, Inc., as Guarantor and 
U.S. Bank National Association, as Trustee relating 
to the 3.000% Senior Notes due 2030

Sixth Supplemental Indenture dated as of April 1, 
2020 by and among Ventas Realty, Limited 
Partnership, as Issuer, Ventas, Inc., as Guarantor and 
U.S. Bank National Association, as Trustee relating 
to the 4.750% Senior Notes due 2030.

Location of Document
Incorporated by reference herein.  Previously filed as 
Exhibit 4.2 to our Current Report on Form 8-K, filed 
on September 21, 2016, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.2 to our Current Report on Form 8-K, filed 
on March 29, 2017, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.1 to our Current Report on Form 8-K, filed 
on February 23, 2018, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.2 to our Current Report on Form 8-K, filed 
on February 23, 2018, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.2 to our Current Report on Form 8-K, filed 
on August 15, 2018, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.2 to our Current Report on Form 8-K, filed 
on February 26, 2019, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.2 to our Current Report on Form 8-K, filed 
on July 3, 2019, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.2 to our Current Report on Form 8-K, filed 
on August 21, 2019, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 4.2 to our Current Report on Form 8-K, filed 
on April 1, 2020, File No. 001-10989.

Description of the Registrant’s Securities.

Filed herewith.

First Amended and Restated Agreement of Limited 
Partnership of Ventas Realty, Limited Partnership.

Credit and Guaranty Agreement dated July 26, 2018 
among Ventas Realty, Limited Partnership, as 
Borrower, Ventas, Inc., as Guarantor, The Lenders 
party thereto from time to time, and Bank of 
America, N.A., as Administrative Agent.

Incorporated by reference herein.  Previously filed as 
Exhibit 3.5 to our Registration Statement on Form 
S-4, as amended, filed on May 29, 2002, File No. 
333-89312.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.1 to our Quarterly Report on Form 10-Q 
for the quarter ended September 30, 2018, filed on 
October 26, 2018, File No. 001-10989.

161

Exhibit
Number
10.3

10.4

10.5

Description of Document

Location of Document

Filed herewith.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.3.1 to our Quarterly Report on Form 10-Q 
for the quarter ended March 31, 2017, filed on April 
28, 2017, File No. 001-10989.

Incorporated by reference herein. Previously filed as 
Exhibit 10.1 to our Current Report on Form 8-K, 
filed on February 2, 2021, File No. 001-10989.

First Amendment to the Credit and Guaranty 
Agreement, dated as of January 29, 2021, among 
Ventas Realty, Limited Partnership, as Borrower, 
Ventas, Inc., as Guarantor, the Lenders identified 
therein, and Bank of America, N.A., as 
Administrative Agent.

Second Amended and Restated Credit and Guaranty 
Agreement, dated as of April 25, 2017, among 
Ventas Realty, Limited Partnership, Ventas SSL 
Ontario II, Inc., Ventas SSL Ontario III, Inc., Ventas 
Canada Finance Limited, Ventas UK Finance, Inc., 
and Ventas Euro Finance, LLC, as Borrowers, 
Ventas, Inc., as Guarantor, the Lenders identified 
therein, and Bank of America, N.A., as 
Administrative Agent, and Alternative Currency 
Fronting Lender, Bank of America, N.A. and JP 
Morgan Chase Bank, N.A., as Swing Line Lenders 
and L/C Issuers.

Third Amended and Restated Credit and Guaranty 
Agreement, dated as of January 29, 2021, among 
Ventas Realty, Limited Partnership, Ventas SSL 
Ontario II, Inc., Ventas SSL Ontario III, Inc., Ventas 
Canada Finance Limited, Ventas UK Finance, Inc., 
and Ventas Euro Finance, LLC, as Borrowers, 
Ventas, Inc., as Guarantor, the Lenders identified 
therein, Bank of America, N.A., as Administrative 
Agent, and Bank of America, N.A. and JPMorgan 
Chase Bank, N.A., as L/C Issuers.

10.6*

Ventas, Inc. 2004 Stock Plan for Directors, as 
amended.

10.7.1*

Ventas, Inc. 2006 Incentive Plan, as amended.

10.7.2*

Form of Stock Option Agreement—2006 Incentive 
Plan.

10.7.3*

Form of Restricted Stock Agreement—2006 
Incentive Plan.

10.8.1*

Ventas, Inc. 2006 Stock Plan for Directors, as 
amended.

10.8.2*

Form of Stock Option Agreement—2006 Stock Plan 
for Directors.

10.8.3*

Form of Amendment to Stock Option Agreement—
2006 Stock Plan for Directors.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.16.1 to our Annual Report on Form 10-K 
for the year ended December 31, 2004, filed on 
March 1, 2005, File No. 33-107942.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.10.1 to our Annual Report on Form 10-K 
for the year ended December 31, 2008, filed on 
February 27, 2009, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.15.2 to our Annual Report on Form 10-K 
for the year ended December 31, 2006, filed on 
February 22, 2007, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.15.3 to our Annual Report on Form 10-K 
for the year ended December 31, 2006, filed on 
February 22, 2007, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.1 to our Quarterly Report on Form 10-Q 
for the quarter ended March 31, 2012, filed on April 
27, 2012, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.11.2 to our Annual Report on Form 10-K 
for the year ended December 31, 2008, filed on 
February 27, 2009, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.2 to our Quarterly Report on Form 10-Q 
for the quarter ended March 31, 2012, filed on April 
27, 2012, File No. 001-10989.

162

 
 
 
 
Exhibit
Number
10.8.4*

Description of Document

Form of Restricted Stock Unit Agreement—2006 
Stock Plan for Directors.

10.9.1*

Ventas, Inc. 2012 Incentive Plan.

10.9.2*

First Amendment to the Ventas, Inc. 2012 Incentive 
Plan.

10.9.3*

Form of Stock Option Agreement (Employees) under 
the Ventas, Inc. 2012 Incentive Plan.

10.9.4*

Form of Restricted Stock Agreement (Employees) 
under the Ventas, Inc. 2012 Incentive Plan.

10.9.5*

Form of Stock Option Agreement (Directors) under 
the Ventas, Inc. 2012 Incentive Plan.

10.9.6*

Form of Restricted Stock Agreement (Directors) 
under the Ventas, Inc. 2012 Incentive Plan.

10.9.7*

Form of Restricted Stock Unit Agreement (Directors) 
under the Ventas, Inc. 2012 Incentive Plan.

10.9.8*

Form of Performance-Based Restricted Stock Unit 
Agreement (CEO) under the Ventas, Inc. 2012 
Incentive Plan.

10.9.9*

Form of Restricted Stock Unit Agreement (CEO) 
under the Ventas, Inc. 2012 Incentive Plan.

10.9.10*

Form of Transition Restricted Stock Unit Agreement 
(CEO) under the Ventas, Inc. 2012 Incentive Plan.

10.9.11*

Form of Performance-Based Restricted Stock Unit 
Agreement (Non-CEO) under the Ventas, Inc. 2012 
Incentive Plan.

10.9.12*

Form of Restricted Stock Unit Agreement (Non-
CEO) under the Ventas, Inc. 2012 Incentive Plan.

10.9.13*

Form of Transition Restricted Stock Unit Agreement 
(Non-CEO) under the Ventas, Inc. 2012 Incentive 
Plan.

10.10.1*

Ventas Executive Deferred Stock Compensation 
Plan, as amended and restated on December 7, 2017.

Location of Document
Incorporated by reference herein.  Previously filed as 
Exhibit 10.11.4 to our Annual Report on Form 10-K 
for the year ended December 31, 2008, filed on 
February 27, 2009, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.1 to our Current Report on Form 8-K, 
filed on May 23, 2012, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.10.7 to our Quarterly Report on Form 10-
Q for the quarter ended March 31, 2017, filed on 
April 28, 2017, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.6.2 to our Annual Report on Form 10-K 
for the year ended December 31, 2014, filed 
February 13, 2015, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.6.3 to our Annual Report on Form 10-K 
for the year ended December 31, 2014, filed on 
February 13, 2015, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.4 to our Registration Form on S-8, filed 
on August 7, 2012, File No. 333-183121.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.5 to our Registration Form on S-8, filed 
on August 7, 2012, File No. 333-183121.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.6 to our Registration Form on S-8, filed 
on August 7, 2012, File No. 333-183121.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.10.8 to our Quarterly Report on Form 10-
Q for the quarter ended March 31, 2017, filed on 
April 28, 2017, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.10.9 to our Quarterly Report on Form 10-
Q for the quarter ended March 31, 2017, filed on 
April 28, 2017, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.10.10 to our Quarterly Report on 
Form 10-Q for the quarter ended March 31, 2017, 
filed on April 28, 2017, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.10.11 to our Quarterly Report on 
Form 10-Q for the quarter ended March 31, 2017, 
filed on April 28, 2017, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.10.12 to our Quarterly Report on 
Form 10-Q for the quarter ended March 31, 2017, 
filed on April 28, 2017, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.10.13 to our Quarterly Report on 
Form 10-Q for the quarter ended March 31, 2017, 
filed on April 28, 2017, File No. 001-10989.

Incorporated by reference herein. Previously filed as 
Exhibit 10.9.1 to our Annual Report on Form 10-K  
for the year ended December 31, 2017, filed on 
February 9, 2018, File No. 001-10989.

163

Description of Document

Location of Document

Exhibit
Number

10.10.2*

Deferral Election Form under the Ventas Executive 
Deferred Stock Compensation Plan, as amended and 
restated on December 7, 2017.

10.11.1*

Ventas Nonemployee Directors’ Deferred Stock 
Compensation Plan, as amended.

10.11.2*

Deferral Election Form under the Ventas 
Nonemployee Directors’ Deferred Stock 
Compensation Plan.

10.12.1*

Nationwide Health Properties, Inc. Retirement Plan 
for Directors, as amended and restated on April 20, 
2006.

Incorporated by reference herein. Previously filed as 
Exhibit 10.9.2 to our Annual Report on Form 10-K 
for the year ended December 31, 2017, filed on 
February 9, 2018, File No. 001-10989.
.
Incorporated by reference herein.  Previously filed as 
Exhibit 10.13.1 to our Annual Report on Form 10-K 
for the year ended December 31, 2008, filed on 
February 27, 2009, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.13.2 to our Annual Report on Form 10-K 
for the year ended December 31, 2008, filed on 
February 27, 2009, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.1 to the Nationwide Health 
Properties, Inc. Quarterly Report on Form 10-Q for 
the quarter ended March 31, 2006, filed on May 4, 
2006, File No. 001-09028.

10.12.2*

10.13*

10.14.1*

10.14.2*

Amendment dated October 28, 2008 to the 
Nationwide Health Properties, Inc. Retirement Plan 
for Directors, as amended and restated on April 20, 
2006.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.9 to the Nationwide Health 
Properties, Inc. Current Report on Form 8-K, filed on 
November 3, 2008, File No. 001-09028.

Second Amended and Restated Employment 
Agreement dated as of March 22, 2011 between 
Ventas, Inc. and Debra A. Cafaro.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.1 to our Current Report on Form 8-K, 
filed on March 24, 2011, File No. 001-10989.

Employee Protection and Noncompetition 
Agreement dated as of October 21, 2013 between 
Ventas, Inc. and John D. Cobb.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.18 to our Annual Report on Form 10-K 
for the year ended December 31, 2013, filed on 
February 18, 2014, File No. 001-10989.

Amendment dated December 8, 2017 to Employee 
Protection and Noncompetition Agreement dated as 
of October 21, 2013 between Ventas, Inc. and John 
D. Cobb.

Incorporated by reference herein. Previously filed as 
Exhibit 10.16.2 to our Annual Report on Form 10-K 
for the year ended December 31, 2017, filed on 
February 9, 2018, File No. 001-10989.

10.15.1*

Offer Letter dated September 16, 2014 from Ventas, 
Inc. to Robert F. Probst.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.1 to our Current Report on Form 8-K, 
filed on September 29, 2014, File No. 001-10989.

10.15.2*

10.15.3*

Employee Protection and Noncompetition 
Agreement dated September 16, 2014 between 
Ventas, Inc. and Robert F. Probst.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.2 to our Current Report on Form 8-K, 
filed on September 29, 2014, File No. 001-10989.

Amendment dated December 8, 2017 to Employee 
Protection and Noncompetition Agreement dated as 
of September 16, 2014 between Ventas, Inc. and 
Robert F. Probst.

Incorporated by reference herein. Previously filed as 
Exhibit 10.17.3 to our Annual Report on Form 10-K 
for the year ended December 31, 2017, filed on 
February 9, 2018, File No. 001-10989.

10.16.1*

Offer of Employment Term Sheet dated March 20, 
2018 from Ventas, Inc. to Peter J. Bulgarelli.

10.16.2*

Employee Protection and Noncompetition 
Agreement dated March 20, 2018 between Ventas, 
Inc. and Peter J. Bulgarelli.

10.17*

Ventas Employee and Director Stock Purchase Plan, 
as amended.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.1.1 to our Quarterly Report on Form 10-Q 
for the quarter ended March 31, 2018, filed on April 

Incorporated by reference herein.  Previously filed as 
Exhibit 10.1.2 to our Quarterly Report on Form 10-Q 
for the quarter ended March 31, 2018, filed on April 
27, 2018, File No. 001-10989.

Incorporated by reference herein.  Previously filed as 
Exhibit 10.18 to our Annual Report on Form 10-K 
for the year ended December 31, 2008, filed on 
February 27, 2009, File No. 001-10989.

164

   
 
   
 
   
 
   
 
   
 
 
 
 
 
 
 
 
Exhibit
Number
10.18.1*

Description of Document

Employee Protection and Restrictive Covenants 
Agreement dated January 21, 2020 between Ventas, 
Inc. and Carey Shea Roberts.

10.18.2*

Employment Bonus Agreement dated March 4, 2020 
between Ventas, Inc. and Carey Shea Roberts. 

Location of Document
Incorporated by reference herein. Previously filed as 
Exhibit 10.2.1 to our Quarterly Report on Form 10-Q 
for the quarter ended March 31, 2020, filed on May 
8, 2020, File No. 001-10989.

Incorporated by reference herein. Previously filed as 
Exhibit 10.2.2 to our Quarterly Report on Form 10-Q 
for the quarter ended March 31, 2020, filed on May 
8, 2020, File No. 001-10989.

10.18.3*

10.19.1*

Offer Letter dated December 22, 2019 from Ventas, 
Inc. to Carey Shea Roberts.

Filed herewith.

Employee Protection and Restrictive Covenants 
Agreement dated February 7, 2020 between Ventas, 
Inc. and J. Justin Hutchens.

Incorporated by reference herein. Previously filed as 
Exhibit 10.3 to our Quarterly Report on Form 10-Q 
for the quarter ended March 31, 2020, filed on May 
8, 2020, File No. 001-10989.

10.19.2*

Offer Letter dated January 30, 2020 from Ventas, 
Inc. to J. Justin Hutchens.

Filed herewith.

21

22

23

31.1

31.2

32.1

32.2

101

Subsidiaries of Ventas, Inc.

List of Guarantors and Issuers of Guaranteed 
Securities.

Consent of KPMG LLP.

Certification of Debra A. Cafaro, Chairman and 
Chief Executive Officer, pursuant to Rule 13a-14(a) 
under the Exchange Act.

Certification of Robert F. Probst, Executive Vice 
President and Chief Financial Officer, pursuant to 
Rule 13a-14(a) under the Exchange Act.

Filed herewith.

Filed herewith.

Filed herewith.

Filed herewith.

Filed herewith.

Certification of Debra A. Cafaro, Chairman and 
Chief Executive Officer, pursuant to Rule 13a-14(b) 
under the Exchange Act and 18 U.S.C. 1350.

Filed herewith.

Filed herewith.

Filed herewith.

Certification of Robert F. Probst, Executive Vice 
President and Chief Financial Officer, pursuant to 
Rule 13a-14(b) under the Exchange Act and 18 
U.S.C. 1350.

The following materials from the Company’s Annual 
Report on Form 10-K for the year ended December 
31, 2020, formatted in iXBRL (Inline Extensible 
Business Reporting Language): (i) the Consolidated 
Balance Sheets, (ii) the Consolidated Statements of 
Income, (iii) the Consolidated Statements of 
Comprehensive Income, (iv) the Consolidated 
Statements of Equity, (v) the Consolidated 
Statements of Cash Flows, (vi) Notes to the 
Consolidated Financial Statements and (vii) Schedule 
III and IV.

104

Cover Page Interactive Data File (embedded within 
the Inline XBRL document).

Filed herewith.

*   Management contract or compensatory plan or arrangement required to be filed as an exhibit pursuant to Item 15(b) of 

Form 10-K.

165

ITEM 16.    Form 10-K Summary

None.

166

 
Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, as amended, the 

Registrant has duly caused this Report to be signed on its behalf by the undersigned, thereunto duly authorized.

SIGNATURES

Date: February 23, 2021                                                                                                                                                                                                                                                                                                   

VENTAS, INC.

By:

/s/ DEBRA A. CAFARO
Debra A. Cafaro
 Chairman and Chief Executive Officer

Pursuant to the requirements of the Securities Exchange Act of 1934, as amended, this Report has been signed below by 

the following persons on behalf of the Registrant and in the capacities and on the dates indicated.

167

 
 
 
Signature

Title

Date

/s/ DEBRA A. CAFARO

Debra A. Cafaro

/s/ ROBERT F. PROBST

Robert F. Probst

/s/ GREGORY R. LIEBBE

Gregory R. Liebbe

Chairman and Chief Executive Officer                                 
(Principal Executive Officer)

February 23, 2021

Executive Vice President and Chief Financial Officer             
(Principal Financial Officer)

February 23, 2021

Senior Vice President, Chief Accounting Officer and Controller 
(Principal Accounting Officer)

February 23, 2021

/s/ MELODY C. BARNES

Director

Melody C. Barnes

/s/ JAY M. GELLERT

Director

Jay M. Gellert

/s/ RICHARD I. GILCHRIST

Director

Richard I. Gilchrist

/s/ MATTHEW J. LUSTIG

Director

Matthew J. Lustig

/s/ ROXANNE M. MARTINO

Director

Roxanne M. Martino

/s/ MARGUERITE M. NADER

Director

Marguerite M. Nader

/s/ SEAN P. NOLAN

Director

Sean P. Nolan

/s/WALTER C. RAKOWICH

Director

Walter C. Rakowich

/s/ ROBERT D. REED

Director

Robert D. Reed

/s/ JAMES D. SHELTON

Director

James D. Shelton

/s/ MAURICE S. SMITH

Director

Maurice S. Smith

168

February 23, 2021

February 23, 2021

February 23, 2021

February 23, 2021

February 23, 2021

February 23, 2021

February 23, 2021

February 23, 2021

February 23, 2021

February 23, 2021

February 23, 2021

[This page intentionally left blank] 

[This page intentionally left blank] 

DIRECTORS

Debra A. Cafaro
Chairman and Chief  
Executive Officer, Ventas

Jay M. Gellert
Former President and  
Chief Executive Officer,  
Health Net, Inc.

James D. Shelton
Presiding Director, Ventas
Former Chief Executive Officer and 
Chairman, Triad Hospitals, Inc.

Richard I. Gilchrist*
Chairman, Spirit Realty Capital, Inc.

Roxanne M. Martino
Managing Partner, OceanM19, LLC 
Former Chief Executive Officer, 
Aurora Investment, LLC

Marguerite M. Nader 
President and Chief Executive Officer, 
Equity LifeStyle Properties, Inc. 

Melody C. Barnes
Co-Director for Policy and Public 
Affairs, Democracy Initiative, 
University of Virginia  
Founder, MB2 Solutions, LLC

Matthew J. Lustig
Chairman of Investment Banking, 
North America and Head of Real 
Estate and Lodging 
Lazard Frères & Co. LLC

Sean P. Nolan
President, Nolan Capital, LLC 
Former President and Chief 
Executive Officer, AveXis, Inc.

Walter C. Rakowich
Former Chief Executive Officer, 
Prologis, Inc.

Robert D. Reed
Former Senior Vice President  
and Chief Financial Officer,  
Sutter Health

Maurice S. Smith
President and Chief Executive 
Officer, Health Care Service 
Corporation

*Richard I. Gilchrist will retire from the Ventas Board effective as of the 2021 Annual Meeting in accordance with the Company’s Director Retirement Policy.

EXECUTIVE OFFICERS

Debra A. Cafaro
Chairman and Chief  
Executive Officer

Peter J. Bulgarelli 
Executive Vice President, Office, Ventas  
President and Chief Executive Officer, 
Lillibridge Healthcare Services, Inc. 

John D. Cobb
Executive Vice President  
and Chief Investment Officer

J. Justin Hutchens 
Executive Vice President,  
Senior Housing

Robert F. Probst
Executive Vice President  
and Chief Financial Officer

Carey S. Roberts
Executive Vice President,  
General Counsel and  
Ethics & Compliance Officer

ANNUAL MEETING 
The 2021 Annual Meeting of Stockholders 
will be held virtually at 8.00 a.m. Central 
Time on Tuesday, May 25, 2021 at  
www.virtualshareholdermeeting.com/
VTR2021

STOCK INFORMATION 
NYSE Symbol: VTR
As of March 31, 2021, Ventas had  
375,053,524 million shares outstanding

TRANSFER AGENT & REGISTRAR 
EQ Shareowner Services
P.O. Box 64874
St. Paul, MN 55164-0854
+1 800 401 1957

INDEPENDENT AUDITORS
KPMG LLP 

INFORMATION 
Copies of our 2020 Form 10K 
and other filings with the Securities  
and Exchange Commission may  
be obtained without charge via our  
website at ventasreit.com

MEMBER
National Association of Real Estate 
Investment Trusts

LEADERSHIP 
 
 
 
 
 
ventasreit.com

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