American Healthcare REIT Q1 Earnings Call Highlights

Key Points

• American Healthcare REIT raised its full-year 2026 outlook after another strong quarter, with total portfolio same-store NOI up 12.1% and normalized FFO per share at $0.50, up 31.6% year over year.
• Performance was led by the Trilogy integrated senior health campuses and the SHOP segment, which posted same-store NOI growth of 14.5% and 19.7%, respectively, alongside higher occupancy and margin expansion.
• The company also outlined an active growth strategy, with $249.2 million of acquisitions closed year to date, more than $650 million of awarded deals in the pipeline, and a stronger balance sheet after boosting credit capacity and reducing leverage.

American Healthcare REIT NYSE: AHR raised its 2026 outlook after reporting another quarter of double-digit same-store net operating income growth, supported by strength in its Trilogy integrated senior health campus business and senior housing operating portfolio.

On the company’s first-quarter earnings call, Chairman, Interim CEO and President Jeffrey Hanson said the REIT delivered “another exceptionally strong quarter across core metrics,” citing double-digit same-store NOI growth for the ninth consecutive quarter, continued acquisition activity, a stronger balance sheet and increased full-year guidance.

Hanson also provided an update on CEO and President Danny Prosky, who experienced a health event in February. Hanson said Prosky is recovering at home, recently underwent an important medical procedure that “went exceedingly well,” and has remained engaged in board meetings virtually. Hanson said the company does not yet have a definitive timeline for Prosky’s return but expects more clarity soon.

Same-Store NOI Growth Continues Across Key Segments

Chief Operating Officer Gabe Willhite said total portfolio same-store NOI rose 12.1% in the first quarter, marking the company’s ninth straight quarter of double-digit growth. He attributed the performance to long-term care demand, constrained new senior housing supply, operator quality and the durability of American Healthcare REIT’s platform.

Willhite said the 80-and-older population, a core user of long-term care, is growing at an accelerating pace, while senior housing supply growth remains near historic lows because new construction remains difficult for many developers to justify economically.

The company’s Integrated Senior Health Campus segment, also known as Trilogy, reported same-store NOI growth of 14.5%. Same-store occupancy averaged 91.2%, up about 220 basis points year over year, while same-store revenue rose 6.9% on rate and occupancy gains. Willhite said Trilogy’s quality mix reached 75.5% of resident days on a same-store basis, up about 60 basis points from a year earlier.

Willhite said Trilogy’s same-store NOI margins exceeded 20% for the first time since COVID, calling it “another important milestone.” In the senior housing operating portfolio, or SHOP, same-store NOI increased 19.7%, with same-store occupancy averaging 88.6%, up roughly 255 basis points from a year earlier. SHOP same-store NOI margin expanded about 215 basis points to 20.6%.

Willhite said the company is managing the SHOP business through “dynamic revenue and expense management,” including building occupancy early in the year and managing street rates as spring and summer demand improves.

Acquisition Pipeline Expands

Chief Investment Officer Stefan Oh said American Healthcare REIT has closed $249.2 million of acquisitions year to date, all within the SHOP segment. About $162.8 million closed during the first quarter, including five previously announced communities in California and Missouri for about $117.5 million and two Kansas properties totaling about $45.3 million. After quarter-end, the company closed on six additional SHOP assets in Georgia and South Carolina for about $86.4 million.

Oh said the company’s investment process begins with underwriting operators before assets, focusing on care quality, operating history and market knowledge. He said much of the company’s activity comes through off-market or limited-process channels, providing what he described as an informational advantage.

In addition to acquisitions already closed, Oh said American Healthcare REIT has more than $650 million of awarded deals that have not yet closed. He said the company expects those deals to close well before the end of 2026. During the question-and-answer session, Oh said the pipeline is “almost exclusively in SHOP,” with roughly 80% involving existing operators and 20% involving new operators. He said a majority of the $650 million pipeline is expected to close by the end of the second quarter, with the remainder closing in the third quarter.

Oh also said the company’s in-process development pipeline totals about $173.9 million in expected cost, of which approximately $52.4 million has been funded. The pipeline is primarily made up of Trilogy campus expansions and independent living villa projects.

Guidance Raised After Strong First Quarter

Chief Financial Officer Brian Peay said first-quarter normalized funds from operations were $0.50 per diluted share, up 31.6% from $0.38 per diluted share in the prior-year quarter. Peay said the results were driven mainly by double-digit same-store NOI growth and contributions from $950 million of acquisitions completed in 2025.

The company increased its full-year 2026 same-store NOI growth guidance to a range of 9% to 12%. At the midpoint, Peay said the outlook implies a third consecutive year of double-digit total portfolio same-store NOI growth.

• Trilogy same-store NOI growth guidance: 11% to 15%
• SHOP same-store NOI growth guidance: 15% to 19%
• Outpatient medical same-store NOI growth guidance: 0% to 2%
• Triple-net lease property same-store NOI growth guidance: 2% to 3%

American Healthcare REIT also raised full-year 2026 NFFO guidance to $2.03 to $2.09 per share, up $0.04 at the midpoint. Peay said that would represent 20% growth in NFFO per share over 2025. He noted the guidance includes only transactions and capital markets activity completed as of the call date.

Balance Sheet and Capital Markets Activity

Peay said net debt to annualized EBITDA improved to 3.0 times as of March 31, 2026, down from 3.4 times at the end of 2025. During the first quarter and early in the second quarter, the company entered into forward sale agreements under its at-the-market program to sell about 8.1 million shares for $412.7 million in gross proceeds.

As of the call, Peay said the company had unsettled forward agreements representing about $527.4 million in gross proceeds, assuming full physical settlement. He also said American Healthcare REIT amended its credit facility after quarter-end, increasing unsecured revolving credit facility capacity to $800 million from $600 million and extending maturity to April 2030, with two six-month extension options. No amounts were outstanding on the revolver as of the call.

Responding to an analyst question about capital sources, Peay said the company views retained earnings as its cheapest form of equity, also pointing to dispositions of smaller, less strategic assets, the ATM program and available credit facility capacity. He said the company is “happy at 3x debt to EBITDA” and is committed to running the business with “essentially investment credit-rated ratios.”

Management Highlights Operator Strategy and Supply Constraints

During the Q&A session, analysts focused on Trilogy’s growth, margins, development plans and the SHOP acquisition environment. Willhite said Trilogy benefits from high occupancy, rate management and selective Medicare Advantage relationships. He said a proposed 2.4% CMS rate was “not a surprise” and described it more as a floor than a ceiling for Trilogy’s skilled nursing rate growth, given the operator’s ability to manage private pay and Medicare Advantage relationships.

Willhite also said Trilogy’s development strategy in Wisconsin is likely to focus primarily on development rather than acquisitions, because Trilogy’s integrated model is difficult to replicate through purchased assets. He said Trilogy is committed to three to four new campuses per year, with Wisconsin growth expected to be incremental alongside opportunities in existing states.

On SHOP acquisitions, Oh said deal activity is high and that American Healthcare REIT is still buying below replacement cost. He said stabilized yields remain in the sevens through disciplined underwriting, though cap rates have generally moved 25 to 50 basis points over the past year, depending on the deal.

Peay said the company continues to sell some outpatient medical assets, particularly smaller and slower-growth buildings, but remains committed to a diversified healthcare investment strategy. He said acquisitions are currently focused on SHOP, which will make outpatient medical a smaller portion of the overall portfolio over time.

About American Healthcare REIT NYSE: AHR

American Healthcare REIT, Inc NYSE: AHR was a publicly traded real estate investment trust focused on acquiring, owning and managing healthcare‐related properties across the United States. The company's portfolio spanned senior housing communities, skilled nursing facilities, medical office buildings and outpatient care centers, all operated under long‐term net lease or triple‐net lease structures designed to provide stable, predictable rental income.

Employing a strategy of partnering with established healthcare operators, American Healthcare REIT targeted properties in both major metropolitan areas and high‐growth secondary markets to capitalize on demographic trends such as an aging population and increased demand for outpatient services.

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