Inve US ▾
AHAHR

American Healthcare REIT (AHR) Q4 FY25 earnings call: guidance and Q&A

Earnings call· Dec 2025 (Q4 FY25)· Real Estate· Feb 27, 2026

Source: earnings call transcript

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

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

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%——

AHR operating KPIs by quarter

AHR operating KPIs stated on its earnings calls, by fiscal quarter
KPI Mar 2026 Q1 FY26 Jun 2026 Q2 FY26Change vs prior quarter
Occupancy rate Trilogy
91.2% Our ISHC segment, also known as Trilogy, delivered same-store NOI growth of 14.5%, with same-store occupancy averaging 91.2%, up roughly 220 basis points year-over-year. Source: earnings call transcript
90.7% Same-store NOI grew 16.1% year-over-year and 5.4% sequentially, while same-store occupancy averaged 90.7%, up 180 basis points from a year ago. Source: earnings call transcript
-0.5 pt

Operating figures the company stated on at least two of the calls shown, checked against each call's transcript. Click a figure to read the sentence. A dash means it was not stated that quarter.

Orderbook & backlog

Awarded deals in pipeline $230M Q4 FY25

Maintained from previous periods, expected to close in 2026.

Pipeline volume (Q3 FY25) $450M Q3 FY25

Reference to prior quarter's pipeline.

Pipeline volume added $275M Q4 FY25

Added to pipeline since Q3 FY25.

Deals & partnerships

Various regional operating partners New 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 partners New 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 partners New 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.

Trilogy Recapitalization 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

Trilogy expansions and campus growth initiatives underway
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

Leadership transition due to medical leave near 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 growth FY26

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 market past 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 occupancy Q1 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 asset Q4 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

SHOP Occupancy and Pricing Power

next quarter and beyond
Current 90.6% in Q4 FY25
Target Continued 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.

Find out whether AHR delivers this. Inve re-checks your case every morning.

Q&A highlights

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 read 6 chapters

Detailed narrative

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.

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.

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.

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.

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.

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.

Summary of the company's earnings call; see how call summaries are prepared. Not investment advice.