American Healthcare REIT, Inc. (Form: 10-Q, Received: 05/15/2023 13:20:33)

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1 US_ACTIVE\123311097\V-1 FOURTH AMENDMENT TO FIRST AMENDED AND RESTATED SENIOR SECURED CREDIT AGREEMENT THIS FOURTH AMENDMENT TO FIRST AMENDED AND RESTATED SENIOR SECURED CREDIT AGREEMENT (this “Amendment”), dated as of March 30, 2023, by and among the undersigned parties executing this Amendment as “Borrowers” (collectively, “Borrowers”), the undersigned parties executing this Amendment as “Guarantors” (collectively, “Guarantors”), KEYBANK NATIONAL ASSOCIATION (“KeyBank”) and the other Lenders party hereto (collectively, the “Lenders”), and KeyBank as Administrative Agent for itself and the other Lenders from time to time a party to the Credit Agreement (as hereinafter defined) (KeyBank, in its capacity as Administrative Agent, is hereinafter referred to as “Administrative Agent”). W I T N E S S E T H: WHEREAS, Borrowers, Administrative Agent and the Lenders are parties to that certain First Amended and Restated Senior Secured Credit Agreement dated as of September 5, 2019, as amended by that certain First Amendment to First Amended and Restated Senior Secured Credit Agreement dated as of April 30, 2021, that certain Second Amendment to First Amended and Restated Senior Secured Credit Agreement dated as of September 29, 2021, and that certain Third Amendment to First Amended and Restated Senior Secured Credit Agreement and Amendment to Unconditional Guaranty of Payment and Performance (the “Third Amendment”) dated as of December 20, 2022 (as the same has been and may be further varied, extended, supplemented, consolidated, replaced, increased, renewed, modified or amended from time to time, the “Credit Agreement”); WHEREAS, in connection with the Credit Agreement, the Guarantors executed and delivered to Agent and Lenders that certain Unconditional Guaranty of Payment and Performance dated as of September 5, 2019, as amended by the Third Amendment (as varied, extended, supplemented, consolidated, replaced, increased, renewed, modified or amended from time to time, the “Guaranty”) WHEREAS, Borrowers have requested that Administrative Agent and the Lenders make certain modifications to the Credit Agreement, and Administrative Agent and the Lenders have consented to such modifications, subject to the execution and delivery of this Amendment. NOW, THEREFORE, for and in consideration of the sum of TEN and NO/100 DOLLARS ($10.00), and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto do hereby covenant and agree as follows: 1. Definitions. Capitalized terms used in this Amendment, but which are not otherwise expressly defined in this Amendment, shall have the respective meanings given thereto in the Credit Agreement. 2. Amendment of the Credit Agreement. Borrowers, Administrative Agent and the Lenders do hereby modify and amend the Credit Agreement by deleting in its entirety the definition of “Implied Debt Service” appearing in Section 1.1 thereof and inserting in lieu thereof the following new definition: “Implied Debt Service” means, on any date of determination, the amount which is the greater of (a) an amount equal to the annual principal and interest payment sufficient to amortize in full during a thirty (30) year period, a loan in an amount equal to the sum of the aggregate outstanding principal balance of the Real Estate Revolving Loans, Letter of Credit Liabilities and Real Estate Swing Loans obtained pursuant to clause (a) or clause (b) of the definition of Real Estate Exhibit 10.2 2 US_ACTIVE\123311097\V-1 Borrowing Base Availability, as applicable, as of such date, calculated using an interest rate equal to the greater of (i) the then current annual yield on ten (10) year obligations issued by the United States Treasury most recently prior to the date of determination as determined by Administrative Agent plus two and one-half percent (2.50%) or (ii) six and one-half percent (6.50%) per annum, or (b) an amount equal to the annual interest-only payment on the aggregate outstanding principal balance of the Real Estate Revolving Loans, Letter of Credit Liabilities and Real Estate Swing Loans obtained pursuant to clause (a) or clause (b) of the definition of Real Estate Borrowing Base Availability, as applicable, as of such date, calculated using the actual interest rate(s) then applicable to such Real Estate Revolving Loans, Letter of Credit Liabilities and Real Estate Swing Loans. 3. References to Credit Agreement. All references in the Loan Documents to the Credit Agreement shall be deemed a reference to the Credit Agreement as modified and amended herein. 4. Consent and Acknowledgment of Borrowers and Guarantors. By execution of this Amendment, Guarantors hereby expressly consent to the modifications and amendments relating to the Credit Agreement as set forth herein and any other agreements or instruments executed in connection herewith, and Borrowers and Guarantors hereby acknowledge, represent and agree that (a) the Credit Agreement, as modified and amended herein, and the other Loan Documents remain in full force and effect and constitute the valid and legally binding obligation of Borrowers and Guarantors, as applicable, enforceable against such Persons in accordance with their respective terms, (b) that the Guaranty extends to and applies to the Credit Agreement as modified and amended herein, and (c) that the execution and delivery of this Amendment and any other agreements or instruments executed in connection herewith does not constitute, and shall not be deemed to constitute, a release, waiver or satisfaction of any Borrower’s or any Guarantor’s obligations under the Loan Documents. 5. Representations. Borrowers and Guarantors represent and warrant to Administrative Agent and the Lenders as follows: (a) Authorization. The execution, delivery and performance of this Amendment and the transactions contemplated hereby (i) are within the authority of Borrowers and Guarantors, (ii) have been duly authorized by all necessary proceedings on the part of such Persons, (iii) do not and will not conflict with or result in any breach or contravention of any provision of law, statute, rule or regulation to which any of such Persons is subject or any judgment, order, writ, injunction, license or permit applicable to such Persons, (iv) do not and will not conflict with or constitute a default under any provision of the partnership agreement, articles of incorporation or other charter documents or bylaws of such Person, (v) do not and will not conflict with or constitute a default (whether with the passage of time or the giving of notice, or both) under any provision of any material agreement or other instrument binding upon, such Person or any of its properties, and (vi) do not and will not result in or require the imposition of any lien or other encumbrance on any of the properties, assets or rights of such Person other than the liens and encumbrances in favor of Administrative Agent contemplated by the Credit Agreement and the other Loan Documents. (b) Enforceability. This Amendment and any other agreements or instruments executed in connection herewith to which any of Borrowers or Guarantors is a party are the valid and legally binding obligations of such Person enforceable in accordance with the respective terms and provisions hereof, except as enforceability is limited by bankruptcy, insolvency, reorganization, moratorium or other laws relating to or affecting generally the enforcement of creditors’ rights and the effect of general principles of equity. 3 US_ACTIVE\123311097\V-1 (c) Approvals. The execution, delivery and performance of this Amendment and the transactions contemplated hereby do not require the approval or consent of or approval of any Person or the authorization, consent, approval of or any license or permit issued by, or any filing or registration with, or the giving of any notice to, any court, department, board, commission or other governmental agency or authority other than those already obtained and delivered to Administrative Agent. (d) Reaffirmation. Borrowers and Guarantors reaffirm and restate as of the date hereof each and every representation and warranty made by such Persons in the Loan Documents or otherwise made by or on behalf of such Persons in connection therewith except for representations or warranties that expressly relate to an earlier date. The representations and warranties made by Borrowers, Guarantors or their respective Subsidiaries in the Loan Documents or otherwise made by or on behalf of such Persons in connection therewith or after the date of the Credit Agreement were true and correct in all material respects when made and are true and correct in all material respects as of the hereof, except to the extent of changes in the facts and circumstances after the date such representation and warranty was made that resulted from actions or inactions not prohibited by the Credit Agreement (it being understood and agreed that any representation or warranty which by its terms is made as of a specified date shall be required to be true and correct only as of such specified date). (e) No Default. By execution hereof, Borrowers and Guarantors certify that such Persons are and will be in compliance with all covenants under the Loan Documents after the execution and delivery of this Amendment and the other documents executed in connection herewith, and that no Default or Event of Default has occurred and is continuing. 6. Waiver of Claims. Borrowers and Guarantors acknowledge, represent and agree that such Persons as of the date hereof have no defenses, setoffs, claims, counterclaims or causes of action of any kind or nature whatsoever with respect to the Loan Documents, the administration or funding of the Loans or with respect to any acts or omissions of Administrative Agent or any Lender, or any past or present officers, agents or employees of Administrative Agent or any Lender, and each of Borrowers and Guarantors does hereby expressly waive, release and relinquish any and all such defenses, setoffs, claims, counterclaims and causes of action, if any. 7. Ratification. Except as hereinabove set forth or in any other document previously executed or executed in connection herewith, all terms, covenants and provisions of the Credit Agreement and the other Loan Documents remain unaltered and in full force and effect, and the parties hereto do hereby expressly ratify and confirm the Credit Agreement, the Guaranty and the other Loan Documents. Nothing in this Amendment shall be deemed or construed to constitute, and there has not otherwise occurred, a novation, cancellation, satisfaction, release, extinguishment or substitution of the indebtedness evidenced by the Notes or the other obligations of Borrowers and Guarantors under the Loan Documents. 8. Counterparts. This Amendment may be executed in any number of counterparts which shall together constitute but one and the same agreement. 9. Miscellaneous. THIS AMENDMENT SHALL, PURSUANT TO NEW YORK GENERAL OBLIGATIONS LAW SECTION 5-1401, BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK. This Amendment shall be binding upon and shall inure to the benefit of the parties hereto and their respective permitted successors, successors-in-title and assigns as provided in the Credit Agreement. This Amendment shall constitute a Loan Document. 10. Effective Date. The effectiveness of this Amendment is subject to confirmation by the Administrative Agent of the satisfaction of the following conditions: 4 US_ACTIVE\123311097\V-1 (a) Execution and delivery of this Amendment by Borrowers, Guarantors, Administrative Agent and the Required Lenders; (b) Receipt by Administrative Agent of evidence that the Borrower shall have paid all fees due and payable with respect to this Amendment (which shall include, without limitation, receipt by the Administrative Agent of a modification fee of $10,000.00 for each Lender that executes this Amendment, which fee shall be for the account of each such Lender); (c) Receipt by Administrative Agent of (i) a Real Estate Borrowing Base Certificate and (ii) a Compliance Certificate evidencing compliance with the covenants described in §9 of the Credit Agreement and the other covenants described in such Compliance Certificate, in each case, after giving effect to this Amendment, calculated in good faith based on the pro forma consolidated financial statements of Trilogy Investors and its Subsidiaries for the calendar quarter ended December 31, 2022; and (d) Receipt by Administrative Agent of such other resolutions, certificates, documents, customary searches (credit, judgment, lien, bankruptcy, etc.), instruments and agreements as the Agent may reasonably request on or prior to the date of this Amendment. 11. Fees and Expenses. Borrowers will pay the reasonable fees and expenses of Administrative Agent in connection with this Amendment and the transactions contemplated hereby in accordance with Section 15 of the Credit Agreement. 12. Electronic Signatures. Delivery of an executed counterpart of a signature page to this Amendment by facsimile or as an attachment to an electronic mail message in .pdf, .jpeg, .TIFF or similar electronic format shall be effective as delivery of a manually executed counterpart of this Amendment for all purposes. The words “execution,” “signed,” “signature,” “delivery,” and words of like import in or relating to this Amendment and any other Loan Document to be signed in connection with this Amendment, the other Loan Documents and the transactions contemplated hereby and thereby shall be deemed to include Electronic Signatures, deliveries or the keeping of records in electronic form, each of which shall be of the same legal effect, validity or enforceability as manually executed signature, physical delivery thereof or the use of a paper-based recordkeeping system, as the case may be, to the extent and as provided for in any Applicable Law, including the Federal Electronic Signatures in Global and National Commerce Act, the New York State Electronic Signatures and Records Act, or any other similar state laws based on the Uniform Electronic Transactions Act; provided that nothing herein shall require the Agent to accept electronic signatures in any form or format without its prior written consent. For the purposes hereof, “Electronic Signatures” means an electronic sound, symbol, or process attached to, or associated with, a contract or other record and adopted by a Person with the intent to sign, authenticate or accept such contract or record. Each of the parties hereto represents and warrants to the other parties hereto that it has the corporate capacity and authority to execute the Amendment through electronic means and there are no restrictions for doing so in that party’s constitutive documents. Without limiting the generality of the foregoing, each Borrower and Guarantor hereby (i) agrees that, for all purposes, including without limitation, in connection with any workout, restructuring, enforcement of remedies, bankruptcy proceedings or litigation among any of the Agent or the Lenders and any of the Borrowers or Guarantors, electronic images of this Amendment or any other Loan Document (in each case, including with respect to any signature pages thereto) shall have the same legal effect, validity and enforceability as any paper original, and (ii) waives any argument, defense or right to contest the validity or enforceability of any Loan Document based solely on the lack of paper original copies of such Loan Document, including with respect to any signature pages thereto. [CONTINUED ON NEXT PAGE]

Internal Use ADMINISTRATIVE AGENT AND LENDERS: KEYBANK NATIONAL ASSOCIATION, individually as a Lender and as Administrative Agent By: Name: Laura Conway Title: Senior Vice President FIRST-CITIZENS BANK & TRUST COMPANY (Successor-By-Merger to CIT Bank, N.A.), as a Lender By: Name: Title: REGIONS BANK, as a Lender By: Name: John E. Boudler Title: Senior Vice President BANK OF AMERICA, N.A., as a Lender By: Name: Title: THE HUNTINGTON NATIONAL BANK, as a Lender By: Name: Title: [SIGNATURES CONTINUED ON NEXT PAGE] Signature Page to Fourth Amendment to First Amended and Restated Senior Secured Credit Agreement (KeyBank/Trilogy) Signature Page to Fourth Amendment to First Amended and Restated Senior Secured Credit Agreement (KeyBank/Trilogy) ADMINISTRATIVE AGENT AND LENDERS: KEYBANK NATIONAL ASSOCIATION, individually as a Lender and as Administrative Agent By: Name: Laura Conway Title: Senior Vice President FIRST-CITIZENS BANK & TRUST COMPANY (Successor-By-Merger to CIT Bank, N.A.), as a Lender By: Name: Title: REGIONS BANK, as a Lender By: Name: Title: BANK OF AMERICA, N.A., as a Lender By: Name: Title: THE HUNTINGTON NATIONAL BANK, as a Lender By: Name: Title: [SIGNATURES CONTINUED ON NEXT PAGE] Aaron Vagelatos Sr. Vice President

Signature Page to Fourth Amendment to First Amended and Restated Senior Secured Credit Agreement (KeyBank/Trilogy) SYNOVUS FINANCIAL CORPORATION, as a Lender By: Name: Title: PACIFIC WESTERN BANK, a California state chartered bank, as a Lender By: Name: Title: CIBC BANK USA, as a Lender By: Name: Title: BOKF, NA dba BANK OF OKLAHOMA, as a Lender By: Name: Title: BANK OF THE WEST, as a Lender By: Name: Title: Michael Velazquez Managing Director Signature Page to Fourth Amendment to First Amended and Restated Senior Secured Credit Agreement (KeyBank/Trilogy) SYNOVUS FINANCIAL CORPORATION, as a Lender By: Name: Title: PACIFIC WESTERN BANK, a California state chartered bank, as a Lender By: Name: Title: CIBC BANK USA, as a Lender By: Name: Title: BOKF, NA dba BANK OF OKLAHOMA, as a Lender By: Name: Title: BMO Harris Bank N.A., Successor in Interest to BANK OF THE WEST, as a Lender By: Name: Mary Smith Title: Managing Director


Maryland						47-2887436
(State or other jurisdiction of incorporation or organization)						(I.R.S. Employer Identification No.)

18191 Von Karman Avenue, Suite 300 Irvine, California						92612
(Address of principal executive offices)						(Zip Code)


			Page
PART I — FINANCIAL INFORMATION

Item 1. Financial Statements (Unaudited)			3
Condensed Consolidated Balance Sheets as of March 31, 2023 and December 31, 2022			3
Condensed Consolidated Statements of Operations and Comprehensive Loss for the Three Months Ended March 31, 2023 and 2022			5
Condensed Consolidated Statements of Equity for the Three Months Ended March 31, 2023 and 2022			6
Condensed Consolidated Statements of Cash Flows for the Three Months Ended March 31, 2023 and 2022			8
Notes to Condensed Consolidated Financial Statements			10
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations			34
Item 3. Quantitative and Qualitative Disclosures About Market Risk			48
Item 4. Controls and Procedures			50

PART II — OTHER INFORMATION

Item 1. Legal Proceedings			51
Item 1A. Risk Factors			51
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds			51
Item 3. Defaults Upon Senior Securities			51
Item 4. Mine Safety Disclosures			52
Item 5. Other Information			52
Item 6. Exhibits			52
Signatures			53


	March 31, 2023		December 31, 2022
ASSETS
Real estate investments, net	$	3,568,117,000	$	3,581,609,000
Debt security investment, net	83,955,000		83,000,000
Cash and cash equivalents	41,346,000		65,052,000
Restricted cash	46,883,000		46,854,000
Accounts and other receivables, net	143,740,000		137,501,000

Identified intangible assets, net	219,279,000		236,283,000
Goodwill	234,942,000		231,611,000

Operating lease right-of-use assets, net	270,939,000		276,342,000
Other assets, net	138,480,000		128,446,000
Total assets	$	4,747,681,000	$	4,786,698,000

LIABILITIES, REDEEMABLE NONCONTROLLING INTERESTS AND EQUITY
Liabilities:
Mortgage loans payable, net(1)	$	1,233,745,000	$	1,229,847,000
Lines of credit and term loan, net(1)	1,313,222,000		1,281,794,000
Accounts payable and accrued liabilities(1)	231,469,000		243,831,000
Identified intangible liabilities, net	10,429,000		10,837,000
Financing obligations(1)	47,684,000		48,406,000
Operating lease liabilities(1)	268,587,000		273,075,000
Security deposits, prepaid rent and other liabilities(1)	55,672,000		49,545,000
Total liabilities	3,160,808,000		3,137,335,000

Commitments and contingencies (Note 11)

Redeemable noncontrolling interests (Note 12)	59,884,000		81,598,000

Equity:
Stockholders’ equity:
Preferred stock, $0.01 par value per share; 200,000,000 shares authorized; none issued and outstanding	—		—
Class T common stock, $0.01 par value per share; 200,000,000 shares authorized; 19,536,622 and 19,535,095 shares issued and outstanding as of March 31, 2023 and December 31, 2022, respectively	194,000		194,000
Class I common stock, $0.01 par value per share; 800,000,000 shares authorized; 46,673,686 and 46,675,367 shares issued and outstanding as of March 31, 2023 and December 31, 2022, respectively	467,000		467,000
Additional paid-in capital	2,546,299,000		2,540,424,000
Accumulated deficit	(1,180,741,000)		(1,138,304,000)
Accumulated other comprehensive loss	(2,568,000)		(2,690,000)
Total stockholders’ equity	1,363,651,000		1,400,091,000
Noncontrolling interests (Note 13)	163,338,000		167,674,000
Total equity	1,526,989,000		1,567,765,000
Total liabilities, redeemable noncontrolling interests and equity	$	4,747,681,000	$	4,786,698,000


	Three Months Ended March 31,
	2023		2022
Revenues and grant income:
Resident fees and services	$	408,630,000	$	318,974,000
Real estate revenue	43,596,000		51,943,000
Grant income	—		5,214,000
Total revenues and grant income	452,226,000		376,131,000
Expenses:
Property operating expenses	370,146,000		287,160,000
Rental expenses	15,195,000		15,287,000
General and administrative	13,053,000		11,119,000
Business acquisition expenses	332,000		173,000
Depreciation and amortization	44,670,000		42,311,000
Total expenses	443,396,000		356,050,000

Other income (expense):
Interest expense:
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishments)	(39,011,000)		(23,325,000)
(Loss) gain in fair value of derivative financial instruments	(195,000)		500,000
(Loss) gain on dispositions of real estate investments	(132,000)		756,000


(Loss) income from unconsolidated entities	(306,000)		1,386,000
Gain on re-measurement of previously held equity interest	726,000		—
Foreign currency gain (loss)	1,008,000		(1,387,000)
Other income	1,608,000		1,260,000
Total net other expense	(36,302,000)		(20,810,000)
Loss before income taxes	(27,472,000)		(729,000)
Income tax expense	(143,000)		(168,000)
Net loss	(27,615,000)		(897,000)
Net loss (income) attributable to noncontrolling interests	1,743,000		(2,059,000)
Net loss attributable to controlling interest	$	(25,872,000)	$	(2,956,000)
Net loss per Class T and Class I common share attributable to controlling interest — basic and diluted	$	(0.39)	$	(0.05)
Weighted average number of Class T and Class I common shares outstanding — basic and diluted	66,026,173		65,629,204

Net loss	$	(27,615,000)	$	(897,000)
Other comprehensive income (loss):
Foreign currency translation adjustments	122,000		(194,000)
Total other comprehensive income (loss)	122,000		(194,000)
Comprehensive loss	(27,493,000)		(1,091,000)
Comprehensive loss (income) attributable to noncontrolling interests	1,743,000		(2,059,000)
Comprehensive loss attributable to controlling interest	$	(25,750,000)	$	(3,150,000)


	Three Months Ended March 31, 2023
	Stockholders’ Equity
	Class T and Class I Common Stock
	Number of Shares	Amount		Additional Paid-In Capital		Accumulated Deficit		Accumulated Other Comprehensive Loss		Total Stockholders’ Equity		Noncontrolling Interests		Total Equity
BALANCE — December 31, 2022	66,210,462	$	661,000	$	2,540,424,000	$	(1,138,304,000)	$	(2,690,000)	$	1,400,091,000	$	167,674,000	$	1,567,765,000



Issuance of nonvested restricted common stock	1,956	—		—		—		—		—		—		—
Amortization of nonvested restricted common stock and stock units	—	—		1,051,000		—		—		1,051,000		—		1,051,000


Stock based compensation	—	—		—		—		—		—		21,000		21,000
Repurchase of common stock	(2,110)	—		(78,000)		—		—		(78,000)		—		(78,000)

Distributions to noncontrolling interests	—	—		—		—		—		—		(3,102,000)		(3,102,000)


Reclassification of noncontrolling interests to mezzanine equity	—	—		—		—		—		—		(21,000)		(21,000)
Adjustment to value of redeemable noncontrolling interests	—	—		4,902,000		—		—		4,902,000		141,000		5,043,000
Distributions declared ($0.25 per share)	—	—		—		(16,565,000)		—		(16,565,000)		—		(16,565,000)
Net loss	—	—		—		(25,872,000)		—		(25,872,000)		(1,375,000)		(27,247,000)		(1)
Other comprehensive income	—	—		—		—		122,000		122,000		—		122,000
BALANCE — March 31, 2023	66,210,308	$	661,000	$	2,546,299,000	$	(1,180,741,000)	$	(2,568,000)	$	1,363,651,000	$	163,338,000	$	1,526,989,000


☒			QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended March 31, 2023


☐			TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the transition period from to


	Three Months Ended March 31, 2022
	Stockholders’ Equity
	Class T and Class I Common Stock
	Number of Shares	Amount		Additional Paid-In Capital		Accumulated Deficit		Accumulated Other Comprehensive Loss		Total Stockholders’ Equity		Noncontrolling Interests		Total Equity
BALANCE — December 31, 2021	65,758,004	$	658,000	$	2,533,904,000	$	(951,303,000)	$	(1,966,000)	1,581,293,000		$	175,553,000	$	1,756,846,000

Offering costs — common stock	—	—		(3,000)		—		—		(3,000)		—		(3,000)
Issuance of common stock under the DRIP	306,518	3,000		11,301,000		—		—		11,304,000		—		11,304,000

Amortization of nonvested restricted common stock	—	—		811,000		—		—		811,000		—		811,000
Stock based compensation	—	—		—		—		—		—		21,000		21,000
Repurchase of common stock	(112,094)	(1,000)		(4,133,000)		—		—		(4,134,000)		—		(4,134,000)



Distributions to noncontrolling interests	—	—		—		—		—		—		(3,515,000)		(3,515,000)
Adjustment to noncontrolling interest in connection with the Merger	—	—		(1,173,000)		—		—		(1,173,000)		1,173,000		—

Reclassification of noncontrolling interests to mezzanine equity	—	—		—		—		—		—		(21,000)		(21,000)
Adjustment to value of redeemable noncontrolling interests	—	—		(1,927,000)		—		—		(1,927,000)		(929,000)		(2,856,000)
Distributions declared ($0.40 per share)	—	—		—		(26,354,000)		—		(26,354,000)		—		(26,354,000)
Net (loss) income	—	—		—		(2,956,000)		—		(2,956,000)		1,872,000		(1,084,000)		(1)
Other comprehensive loss	—	—		—		—		(194,000)		(194,000)		—		(194,000)
BALANCE — March 31, 2022	65,952,428	$	660,000	$	2,538,780,000	$	(980,613,000)	$	(2,160,000)	$	1,556,667,000	$	174,154,000	$	1,730,821,000


	Private and Other Payors		Medicare		Medicaid		Total
Beginning balance — January 1, 2023	$	55,484,000	$	45,669,000	$	20,832,000	$	121,985,000
Ending balance — March 31, 2023	60,233,000		43,155,000		18,824,000		122,212,000
Increase (decrease)	$	4,749,000	$	(2,514,000)	$	(2,008,000)	$	227,000


	Total
Beginning balance — January 1, 2023	$	17,901,000
Ending balance — March 31, 2023	22,214,000
Increase	$	4,313,000


	March 31, 2023		December 31, 2022
Building, improvements and construction in process	$	3,682,324,000	$	3,670,361,000
Land and improvements	346,005,000		344,359,000
Furniture, fixtures and equipment	229,477,000		221,727,000
	4,257,806,000		4,236,447,000
Less: accumulated depreciation	(689,689,000)		(654,838,000)
	$	3,568,117,000	$	3,581,609,000


	2023 Acquisition
Building and improvements	$	10,139,000
Land and improvements	912,000




Total assets acquired	$	11,051,000


	2023 Acquisition		2022 Acquisition

Building and improvements	$	—	$	17,235,000
Goodwill	3,331,000		1,827,000

In-place leases	—		3,420,000
Land	—		3,060,000
Cash and restricted cash	565,000		588,000
Certificates of need	—		690,000
Furniture, fixtures and equipment	39,000		1,558,000
Other assets	66,000		—
Total assets acquired	4,001,000		28,378,000


Security deposits and other liabilities	(812,000)		(7,747,000)
Accounts payable and accrued liabilities	(1,676,000)		(109,000)
Financing obligations	(12,000)		(56,000)
Total liabilities assumed	(2,500,000)		(7,912,000)
Net assets acquired	$	1,501,000	$	20,466,000


	March 31, 2023		December 31, 2022
Amortized intangible assets:
In-place leases, net of accumulated amortization of $43,513,000 and $38,930,000 as of March 31, 2023 and December 31, 2022, respectively (with a weighted average remaining life of 7.1 years and 7.0 years as of March 31, 2023 and December 31, 2022, respectively)	$	67,684,000	$	75,580,000
Above-market leases, net of accumulated amortization of $6,094,000 and $6,360,000 as of March 31, 2023 and December 31, 2022, respectively (with a weighted average remaining life of 8.3 years and 9.0 years as of March 31, 2023 and December 31, 2022, respectively)	21,111,000		30,194,000
Customer relationships, net of accumulated amortization of $822,000 and $785,000 as of March 31, 2023 and December 31, 2022, respectively (with a weighted average remaining life of 13.4 years and 13.7 years as of March 31, 2023 and December 31, 2022, respectively)	2,018,000		2,055,000

Unamortized intangible assets:
Certificates of need	97,679,000		97,667,000
Trade names	30,787,000		30,787,000
	$	219,279,000	$	236,283,000


Year	Amount
2023	$	20,289,000
2024	12,861,000
2025	10,037,000
2026	8,867,000
2027	8,230,000
Thereafter	30,529,000
Total	$	90,813,000


	Three Months Ended March 31,
	2023						2022
	Integrated Senior Health Campuses		SHOP(1)		Total		Integrated Senior Health Campuses		SHOP(1)		Total
Over time	$	298,850,000	$	45,613,000	$	344,463,000	$	230,534,000	$	37,216,000	$	267,750,000
Point in time	62,920,000		1,247,000		64,167,000		50,478,000		746,000		51,224,000
Total resident fees and services	$	361,770,000	$	46,860,000	$	408,630,000	$	281,012,000	$	37,962,000	$	318,974,000


	Three Months Ended March 31,
	2023						2022
	Integrated Senior Health Campuses		SHOP(1)		Total		Integrated Senior Health Campuses		SHOP(1)		Total
Private and other payors	$	169,678,000	$	43,850,000	$	213,528,000	$	131,803,000	$	35,037,000	$	166,840,000
Medicare	126,466,000		311,000		126,777,000		94,517,000		—		94,517,000
Medicaid	65,626,000		2,699,000		68,325,000		54,692,000		2,925,000		57,617,000
Total resident fees and services	$	361,770,000	$	46,860,000	$	408,630,000	$	281,012,000	$	37,962,000	$	318,974,000


Approval Date by our Board	Estimated Per Share NAV



03/24/22	$	37.16
03/15/23	$	31.40


	Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)		Total



Liabilities:
Derivative financial instrument	$	—	$	195,000	$	—	$	195,000

Total liabilities at fair value	$	—	$	195,000	$	—	$	195,000


	March 31, 2023		December 31, 2022
Deferred rent receivables	$	47,911,000	$	46,867,000
Prepaid expenses, deposits, other assets and deferred tax assets, net	31,219,000		25,866,000
Inventory	19,053,000		19,775,000
Lease commissions, net of accumulated amortization of $6,636,000 and $6,260,000 as of March 31, 2023 and December 31, 2022, respectively	18,384,000		19,217,000

Investments in unconsolidated entities	15,399,000		9,580,000
Deferred financing costs, net of accumulated amortization of $6,503,000 and $5,704,000 as of March 31, 2023 and December 31, 2022, respectively	3,795,000		4,334,000
Lease inducement, net of accumulated amortization of $2,281,000 and $2,193,000 as of March 31, 2023 and December 31, 2022, respectively (with a weighted average remaining life of 7.7 years and 7.9 years as of March 31, 2023 and December 31, 2022, respectively)	2,719,000		2,807,000
	$	138,480,000	$	128,446,000


	March 31, 2023		December 31, 2022
Total fixed-rate debt	$	880,770,000	$	885,892,000
Total variable-rate debt	376,287,000		368,587,000
Total fixed- and variable-rate debt	1,257,057,000		1,254,479,000
Less: deferred financing costs, net	(8,410,000)		(8,845,000)
Add: premium	215,000		237,000
Less: discount	(15,117,000)		(16,024,000)
Mortgage loans payable, net	$	1,233,745,000	$	1,229,847,000


	March 31, 2023				December 31, 2022
	Carrying Amount(1)		Fair Value		Carrying Amount(1)		Fair Value
Financial Assets:

Debt security investment	$	83,955,000	$	93,248,000	$	83,000,000	$	93,230,000
Financial Liabilities:
Mortgage loans payable	$	1,233,745,000	$	1,097,904,000	$	1,229,847,000	$	1,091,667,000
Lines of credit and term loan	$	1,309,427,000	$	1,315,836,000	$	1,277,460,000	$	1,285,205,000


		Three Months Ended March 31,
Lease Cost	Classification	2023		2022
Operating lease cost(1)	Property operating expenses, rental expenses or general and administrative expenses	$	11,923,000	$	6,356,000
Finance lease cost:
Amortization of leased assets	Depreciation and amortization	303,000		312,000
Interest on lease liabilities	Interest expense	91,000		74,000
Sublease income	Resident fees and services revenue or other income	(156,000)		(147,000)
Total lease cost		$	12,161,000	$	6,595,000


Lease Term and Discount Rate	March 31, 2023		December 31, 2022
Weighted average remaining lease term (in years):
Operating leases	12.6		12.8
Finance leases	2.0		2.3
Weighted average discount rate:
Operating leases	5.70	%	5.69	%
Finance leases	7.61	%	7.66	%


	Three Months Ended March 31,
Supplemental Disclosure of Cash Flows Information	2023		2022

Operating cash outflows related to finance leases	$	91,000	$	74,000
Financing cash outflows related to finance leases	$	16,000	$	13,000

Right-of-use assets obtained in exchange for operating lease liabilities	$	1,155,000	$	—


	Integrated Senior Health Campuses		SHOP		MOBs		Senior Housing — Leased		SNFs		Hospitals		Three Months Ended March 31, 2023
Revenues:
Resident fees and services	$	361,770,000	$	46,860,000	$	—	$	—	$	—	$	—	$	408,630,000
Real estate revenue	—		—		37,483,000		5,276,000		(1,632,000)		2,469,000		43,596,000

Total revenues	361,770,000		46,860,000		37,483,000		5,276,000		(1,632,000)		2,469,000		452,226,000
Expenses:
Property operating expenses	328,361,000		41,785,000		—		—		—		—		370,146,000
Rental expenses	—		—		14,408,000		199,000		469,000		119,000		15,195,000
Segment net operating income (loss)	$	33,409,000	$	5,075,000	$	23,075,000	$	5,077,000	$	(2,101,000)	$	2,350,000	$	66,885,000
Expenses:
General and administrative													$	13,053,000
Business acquisition expenses													332,000
Depreciation and amortization													44,670,000
Other income (expense):
Interest expense:
Interest expense (including amortization of deferred financing costs and debt discount/premium)													(39,011,000)
Loss in fair value of derivative financial instruments													(195,000)
Loss on disposition of real estate investment													(132,000)

Loss from unconsolidated entities													(306,000)
Gain on re-measurement of previously held equity interest													726,000
Foreign currency gain													1,008,000
Other income													1,608,000
Total net other expense													(36,302,000)
Loss before income taxes													(27,472,000)
Income tax expense													(143,000)


Net loss													$	(27,615,000)


	March 31, 2023		December 31, 2022
Integrated senior health campuses	$	2,159,537,000	$	2,157,748,000
MOBs	1,360,364,000		1,379,502,000
SHOP	640,159,000		635,190,000
Senior housing — leased	250,468,000		249,576,000
SNFs	219,382,000		245,717,000
Hospitals	106,345,000		106,067,000
Other	11,426,000		12,898,000
Total assets	$	4,747,681,000	$	4,786,698,000


	March 31, 2023		December 31, 2022
Real estate investments, net:
United States	$	3,525,352,000	$	3,539,453,000
International	42,765,000		42,156,000
	$	3,568,117,000	$	3,581,609,000


	March 31,
	2023					2022
	Number of Buildings/ Campuses	Aggregate Contract Purchase Price		Leased %		Number of Buildings/ Campuses	Aggregate Contract Purchase Price		Leased %
Integrated senior health campuses	122	$	1,909,591,000	(1)		122	$	1,795,199,000	(1)
MOBs	104	1,369,596,000		88.7	%	105	1,378,996,000		89.7	%
SHOP	51	804,367,000		(2)		47	706,871,000		(2)
Senior housing — leased	20	179,285,000		100	%	20	179,285,000		100	%
SNFs	15	223,500,000		100	%	17	249,200,000		100	%
Hospitals	2	139,780,000		100	%	2	139,780,000		100	%
Total/weighted average(3)	314	$	4,626,119,000	91.7	%	313	$	4,449,331,000	92.7	%


	Payments Due by Period
	2023		2024-2025		2026-2027		Thereafter		Total
Principal payments — fixed-rate debt	$	14,270,000	$	208,919,000	$	189,173,000	$	468,408,000	$	880,770,000
Interest payments — fixed-rate debt	21,319,000		48,168,000		31,924,000		183,891,000		285,302,000
Principal payments — variable-rate debt	450,203,000		234,681,000		978,298,000		27,239,000		1,690,421,000
Interest payments — variable-rate debt (based on rates in effect as of March 31, 2023)	76,739,000		141,235,000		43,580,000		6,125,000		267,679,000
Ground and other lease obligations	29,017,000		74,975,000		75,146,000		229,083,000		408,221,000
Financing obligations	28,422,000		5,228,000		3,732,000		14,963,000		52,345,000
Total	$	619,970,000	$	713,206,000	$	1,321,853,000	$	929,709,000	$	3,584,738,000


	Expected Maturity Date
	2023			2024			2025			2026			2027			Thereafter			Total			Fair Value
Assets
Debt security held-to-maturity	$	—		$	—		$	93,433,000		$	—		$	—		$	—		$	93,433,000		$	93,248,000
Weighted average interest rate on maturing fixed-rate debt security	—		%	—		%	4.24		%	—		%	—		%	—		%	4.24		%	—
Liabilities
Fixed-rate debt — principal payments	$	14,270,000		$	73,554,000		$	135,365,000		$	154,966,000		$	34,207,000		$	468,408,000		$	880,770,000		$	716,622,000
Weighted average interest rate on maturing fixed-rate debt	3.18		%	3.55		%	4.28		%	2.98		%	3.29		%	2.97		%	3.24		%	—
Variable-rate debt — principal payments	$	450,203,000		$	204,502,000		$	30,179,000		$	428,092,000		$	550,206,000		$	27,239,000		$	1,690,421,000		$	1,697,118,000
Weighted average interest rate on maturing variable-rate debt (based on rates in effect as of March 31, 2023)	7.60		%	7.24		%	7.06		%	6.60		%	6.55		%	6.90		%	6.94		%	—


Period	Total Number of Shares Purchased	Average Price Paid per Share		Total Number of Shares Purchased As Part of Publicly Announced Plan or Program	Maximum Approximate Dollar Value of Shares that May Yet Be Purchased Under the Plans or Programs
January 1, 2023 to January 31, 2023	—	$	—	—	(1)
February 1, 2023 to February 28, 2023	—	$	—	—	(1)
March 1, 2023 to March 31, 2023(2)	1,681	$	37.16	1,681	(1)
Total	1,681	$	37.16	1,681


3.1			Fourth Articles of Amendment and Restatement of Griffin-American Healthcare REIT IV, Inc., dated October 1, 2021 (included as Exhibit 3.1 to our Current Report on Form 8-K (File No. 000-55775) filed October 1, 2021 and incorporated herein by reference)

3.2			Amended and Restated Bylaws of American Healthcare REIT, Inc. (included as Exhibit 3.1 to our Current Report on Form 8-K (File No. 000-55775) filed February 17, 2023 and incorporated herein by reference)

10.1			First Amendment to Amended and Restated Credit Agreement dated as of March 1, 2023, among American Healthcare REIT Holdings, L.P., American Healthcare REIT, Inc. and certain subsidiaries and Bank of America, N.A., KeyBank, National Association, Citizens Bank, National Association and certain lenders named therein (included as Exhibit 10.1 to our Current Report on Form 8-K (File No. 000-55775) filed March 7, 2023 and incorporated herein by reference)

10.2*			Fourth Amendment to the First Amended and Restated Senior Secured Credit Agreement, dated as of March 30, 2023, among Trilogy RER, LLC and certain subsidiaries of Trilogy RER, LLC, Trilogy Investors, LLC, Trilogy Healthcare Holdings, Inc., Trilogy OpCo, LLC and Trilogy Pro Services, LLC, KeyBank National Association and the other lenders which are parties thereto from time to time

31.1*			Certification of Chief Executive Officer, pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

31.2*			Certification of Chief Financial Officer, pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

32.1**			Certification of Chief Executive Officer, pursuant to 18 U.S.C. Section 1350, as created by Section 906 of the Sarbanes-Oxley Act of 2002

32.2**			Certification of Chief Financial Officer, pursuant to 18 U.S.C. Section 1350, as created by Section 906 of the Sarbanes-Oxley Act of 2002

101.INS*			Inline XBRL Instance Document – the instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL Document

101.SCH*			Inline XBRL Taxonomy Extension Schema Document

101.CAL*			Inline XBRL Taxonomy Extension Calculation Linkbase Document

101.DEF*			Inline XBRL Taxonomy Extension Definition Linkbase Document

101.LAB*			Inline XBRL Taxonomy Extension Label Linkbase Document

101.PRE*			Inline XBRL Taxonomy Extension Presentation Linkbase Document

104*			Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101)


*			Filed herewith.
**			Furnished herewith. In accordance with Item 601(b)(32) of Regulation S-K, this Exhibit is not deemed “filed” for purposes of Section 18 of the Exchange Act or otherwise subject to the liabilities of that section. Such certifications will not be deemed incorporated by reference into any filing under the Securities Act of 1933, as amended, or the Securities Exchange Act of 1934, as amended, except to the extent that the registrant specifically incorporates it by reference.