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    AHR
    Earnings call· Dec 2025(Q4 FY25)

    American Healthcare REIT Q4 FY25 earnings call AHR

    Feb 27, 2026 Source

    Executive summary

    American Healthcare REIT Q4 FY25 — Double-Digit NOI Growth and Strong Acquisition Activity

    American Healthcare REIT delivered another strong quarter, capping off a second consecutive year of double-digit total portfolio same-store NOI growth, primarily driven by its operating portfolio. The company achieved significant NFFO per share growth and executed substantial acquisitions, leveraging its strong balance sheet and operator partnerships. While FY26 guidance anticipates some deceleration in same-store NOI growth for key segments, management remains confident in its strategy, emphasizing disciplined underwriting and the continued benefits of its integrated operating model and revenue management initiatives.

    Highlights

    5

    • Total portfolio same-store NOI growth of 11.8% in Q4 FY25 and 14.2% for full year FY25.

    • Normalized FFO per diluted share grew 22% year-over-year in FY25 to $1.72.

    • SHOP segment same-store NOI increased 24.6% in Q4 FY25 and 25.2% for FY25, with occupancy surpassing 90%.

    • Closed over $950 million in new investments across Trilogy and SHOP segments in FY25, including $665 million in Q4 FY25.

    • Net debt-to-EBITDA improved to 3.4x, with ample capital capacity for future acquisitions.

    Concerns

    3

    • Guidance for SHOP same-store NOI growth in FY26 implies deceleration to 15-19% from 25.2% in FY25.

    • Trilogy same-store NOI growth guidance for FY26 is 8-12%, lower than the 18.4% achieved in FY25.

    • The hospital coverage in the triple-net portfolio saw a steep decline during the quarter, though the lease is guaranteed by a AA-rated system.

    Guidance & targets

    7
    CategoryTargetConfidence
    Normalized FFO per diluted share
    $1.99 to $2.05
    high materiality
    High
    Total portfolio same-store NOI growth
    7% and 11%
    high materiality
    High
    Trilogy same-store NOI growth
    8% to 12%
    medium materiality
    High
    SHOP same-store NOI growth
    15% to 19%
    high materiality
    High
    Outpatient Medical same-store NOI growth
    0% to 2%
    medium materiality
    High
    Triple-Net Leased Properties same-store NOI growth
    2% to 3%
    medium materiality
    High
    Development spend
    planned 2026 development spend
    medium materiality
    High

    Segment performance

    6
    SegmentRevenueYoYQoQMargin
    Trilogy
    Led by occupancy gains, disciplined rate management, and expense controls. Margins expanded 130 basis points in FY25 vs FY24. Expects another year of double-digit same-store NOI growth in FY26.
    Same-store NOI growth: 14%Same-store occupancy: 90.6% in Q4Occupancy increase YoY: 275 bpsQuality mix improvement (Medicare/Medicare Advantage penetration): 220 bps in Q4 2025 vs Q4 2024
    		—14%——
    Trilogy
    Full year 2025 performance. Quality mix continues to trend favorably with increased Medicare and Medicare Advantage penetration.
    Same-store NOI growth: 18.4% for FY25NOI margin expansion: 130 bps in FY25 vs FY24
    		—18.4%—130 bps expansion
    SHOP
    Strongest growth across the portfolio. Margins expanded 280 basis points in FY25 vs FY24. Expects to lead portfolio's organic growth in FY26.
    Same-store NOI growth: 24.6% in Q4Same-store occupancy: 90.6% in Q4Occupancy increase YoY: 290 bps
    		—24.6%——
    SHOP
    Full year 2025 performance. Growth supported by dynamic revenue management and strong supply/demand imbalance.
    Same-store NOI growth: 25.2% for FY25NOI margin expansion: 280 bps in FY25 vs FY24
    		—25.2%—280 bps expansion
    Outpatient Medical
    FY26 same-store NOI growth guidance.
    		—0% to 2%——
    Triple-Net Leased Properties
    FY26 same-store NOI growth guidance.
    		—2% to 3%——

    Operational metrics

    18
    Consolidated cash NOI contribution from operating portfolio
    76.9
    Q4 FY25

    Comprised of Trilogy and SHOP segments.

    Normalized FFO per diluted share
    $0.46
    Q4 FY25

    Attributable to common stockholders.

    Normalized FFO per diluted share
    $1.72
    FY25

    Attributable to common stockholders.

    Normalized FFO per share growth
    22YoY
    FY25

    Compared to FY24.

    Net Debt to EBITDA
    3.4improved by nearly a full turn in 2025
    Q4 FY25

    Does not account for approximately $287 million of unsettled forward agreements.

    SHOP portfolio in same-store pool
    60
    Q4 FY25

    The remaining portion is non-same-store assets, many of which were acquired in 2025.

    Trilogy portfolio in same-store pool
    81-83
    Q4 FY25

    Stated as '83%; 81%, 83%, something like that'. Less non-same-store assets compared to SHOP.

    Acquisition volume closed
    $950M
    FY25

    Total new investments in FY25.

    Acquisition volume closed
    $665M
    Q4 FY25

    Approximately $665 million of new acquisitions closed in the fourth quarter, accelerating previously announced pipeline deals.

    Acquisition volume closed
    $117.5M
    YTD 2026

    New acquisitions within the SHOP segment.

    Acquisition volume closed
    $580M
    through Q3 2025

    Volume closed up to the point of the Q3 earnings call.

    Acquisition cap rates
    high 5s, low 6s
    Q4 FY25

    Aggregate pricing for current acquisitions. Some cap rate compression observed.

    Incremental occupancy flow-through to NOI
    70-80
    ongoing

    At high occupancy rates, the pull-through is dramatic.

    Incremental occupancy flow-through to NOI
    40-70
    ongoing

    Within Trilogy's assisted living segment, depending on occupancy levels and staffing.

    Incremental occupancy flow-through to NOI
    >70
    ongoing

    Within Trilogy's independent living segment.

    Trilogy 5-star rating (overall)
    >4
    Q4 FY25

    For its entire portfolio on an overall basis.

    Trilogy 5-star rating (quality measures)
    >4.8
    Q4 FY25

    For quality measures, higher than other national providers.

    Unsettled forward agreements
    $287M
    Q4 FY25

    From ATM and November 2025 follow-on offering, not accounted for in Net Debt-to-EBITDA metric.

    Industry KPIs

    9
    MetricValueDetails
    Exppor growthcontinued expense controls
    Revpor growthsolid
    Coverage ratiospretty steep decline
    Senior housing occupancy90.6%%
    Revpor minus exppor spread130 bps (Trilogy); 280 bps (SHOP)bps
    Operator tenant concentrationTrilogy 5-star rating >4 overall, >4.8 for quality measures
    Same store noi growth by segment11.8%%
    Private funds management platform—
    Investment volume and sourcing mix$950MUSD

    Orderbook & backlog

    3
    Awarded deals in pipeline$230MQ4 FY25

    Maintained from previous periods, expected to close in 2026.

    Pipeline volume (Q3 FY25)$450MQ3 FY25

    Reference to prior quarter's pipeline.

    Pipeline volume added$275MQ4 FY25

    Added to pipeline since Q3 FY25.

    Deals & partnerships

    4
    Various regional operating partnersNew investments across Trilogy and SHOP segments$950M

    Closed over $950 million of new investments in FY25, primarily in SHOP, focusing on newer assets in attractive submarkets. Many were relationship-sourced or off-market opportunities.

    Various regional operating partnersNew acquisitions closed in Q4 2025$665M

    Approximately $665 million of new acquisitions closed in the fourth quarter, accelerating several previously announced pipeline deals.

    Various regional operating partnersNew acquisitions closed in first 2 months of 2026$117.5M

    Year-to-date, closed on approximately $117.5 million in new acquisitions within the SHOP segment.

    TrilogyRecapitalization of Trilogy assets$370M

    Deployment of $370 million into Trilogy assets in 2025, often involving recapitalizing assets Trilogy was already managing for different capital.

    Capital programs

    1
    Trilogy expansions and campus growth initiativesunderway
    Period spend: $150M to $200M
    Funding: equity issuances

    Benefit: attractive incremental yields, faster cash flow

    Projects leverage existing campuses to mitigate operating losses upon opening and provide faster cash flow for recycling into new development. Annual spend.

    Risks & headwinds

    5
    Leadership transition due to medical leavenear term

    Interim CEO appointed

    Mitigation: Interim CEO is a co-founder and former CEO, ensuring continuity; original CEO is recovering and engaged; strong executive team and board alignment.

    Deceleration in same-store NOI growthFY26

    SHOP FY26 guidance 15-19% vs 25.2% in FY25; Trilogy FY26 guidance 8-12% vs 18.4% in FY25

    Mitigation: High occupancy levels already achieved, focus shifts to pricing power and dynamic revenue management; strong underlying demand dynamics.

    Cap rate compression in acquisition marketpast few months

    Pricing around high 5s, low 6s, stabilizing in 7s

    Mitigation: Focus on off-market deals and relationship-driven sourcing; disciplined underwriting to ensure long-term performance; strong capital position.

    Flu season impact on occupancyQ1 2026

    Less impact than last year in early 2026

    Mitigation: Monitoring health trends; strong operational protocols to manage health outcomes.

    Decline in hospital coverage for triple-net assetQ4 FY25

    Steep decline in coverage

    Mitigation: Lease guaranteed by AA-rated Methodist of Dallas; tenant is committed to the asset and investing in its transformation to a community hospital.

    What to watch in Q1 FY26

    5

    SHOP Occupancy and Pricing Power

    next quarter and beyond
    Current90.6% in Q4 FY25
    TargetContinued increase towards 95-100% and successful push of street rates

    Why it matters

    Sustained occupancy gains and pricing discipline are key drivers for SHOP's organic NOI growth and margin expansion, especially as growth decelerates from prior highs.

    We do know that we -- the more occupied our buildings get, the more pricing power we have. And at 90.6%, I think, is the same-store occupancy, we have more and more pricing power. You'll see us push rate for the existing residents, but you'll also see us pushing street rates far more aggressively.

    Q&A highlights

    7

    Are there any subsegments seeing cap rate compression or changes to management agreement terms? What is the focus for acquisitions?

    Stefan Oh stated that the focus remains on higher acuity SHOP assets (AL, memory care) due to long-term stability benefits. While there's some cap rate compression, pricing is around high 5s to low 6s, stabilizing in the 7s. The strategy emphasizes newer, higher-quality properties and demographic strength.

    “We continue to focus on higher acuity SHOP assets. We think that there's a real benefit to focusing on the AL, the memory care side, I think it just allows us to have more confidence in the long-term stability of that asset class.”

    asked by Wesley Golladay · answered by Stefan K. Oh

    2 min read6 chapters

    Detailed Narrative

    01

    Leadership Transition and Continuity

    Jeff Hanson stepped in as Interim CEO while Danny is on medical leave, emphasizing continuity of strategy and execution. The leadership team, including co-founders, has built the platform over two decades, ensuring stability during this period. Hanson confirmed no change in strategy, investment philosophy, capital allocation, risk management, or balance sheet posture, with the executive team working closely with the Board.

    02

    Operating Portfolio Performance

    The integrated senior health campuses (Trilogy and SHOP segments) now contribute 76.9% of consolidated cash NOI, demonstrating the benefits of scale and operating leverage. These segments drove significant NOI growth in 2025 through occupancy gains, disciplined rate management, and expense controls. Trilogy's NOI margin expanded 130 basis points and SHOP's 280 basis points in FY25 compared to FY24.

    03

    Strategic Acquisition Focus

    AHR closed over $950 million in new investments in FY25, primarily in SHOP, focusing on newer assets in attractive submarkets with existing regional operators. The strategy prioritizes relationship-driven sourcing, disciplined underwriting, and long-term cash flow durability, often through off-market opportunities. Acquisitions are typically priced around high 5s to low 6s cap rates, stabilizing in the 7s.

    04

    Revenue Management Innovation

    Trilogy has developed a proprietary dynamic revenue management platform that prices units in real-time based on attributes and micro-market data. This tool is being piloted with other SHOP operators to enhance pricing power and optimize NOI growth, particularly for highly occupied properties or those with below-market rates, leveraging Trilogy's expertise and alignment through its LTIP.

    05

    Capital Markets and Balance Sheet Strength

    The company opportunistically utilized equity markets, including ATM and a follow-on offering, to fund acquisitions and planned development, resulting in a strong net debt-to-EBITDA of 3.4x. This financial strength positions AHR to pursue increasing acquisition opportunities in 2026, with approximately $287 million of unsettled forward agreements providing additional capacity.

    06

    Development Pipeline

    The development pipeline is focused on Trilogy expansions and campus growth initiatives, designed to generate attractive incremental yields with limited market risk by leveraging existing campuses and providing faster cash flow. This includes an annual development spend of $150 million to $200 million with Trilogy, where AHR benefits from stripping out developer and general contractor economics.

    AI-generated summary of the company’s earnings call. Not investment advice.