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Text: These materials are available on the Ventas website at ir.
I will now turn over the call to Debra A. Cafaro, Chairman and CEO.
Let me begin by expressing my deep gratitude and optimism borne of the strength, resilience, and innovation so many have demonstrated over the past year and the positive developments we are seeing on the ground in our portfolio virtually every day.
Our results in the fourth quarter demonstrated Ventas' resilience with normalized FFO reported at $0.83 a share and $0.74 ex much appreciated funding from HHS to our senior living communities that have been affected by COVID-19.
I've reflected on the grueling year we've all had.
I couldn't be prouder of our productive and skilled team, our enterprise, and our capable dedicated partners.
After a fast and positive start to 2020, the last year has been dominated by the COVID-19 pandemic and punctuated by extreme weather disruptions, both of which have continued into the first quarter of 2021.
Throughout, we've put the full force of our firm's resources and energy behind keeping people safe, demonstrating remarkable resilience and becoming part of the solution whether in employee testing, advocacy or assistance to tenants and operators who needed it.
Financially, through our foresight, our long-standing diversification strategy, and our decisive action, we've kept our enterprise strong and stable, generating almost the same EBITDA in 2020 as we did in 2019 and benefiting from our investments in people, systems, and preparedness, our balance sheet flexibility, and our embedded relationships with best-in-class partners.
And we found ways to grow and advance our strategic objectives, including building value through acquisition and development in life sciences, investing in Le Groupe Maurice's attractive senior housing development pipeline, creating new partnerships, and establishing a third-party investment management platform that will provide more options for future growth.
We remain committed to our core values of respect and integrity and accelerated our actions to promote sustainability, diversity, and social justice in our company, our communities, and our country.
Finally, we were very fortunate to recently add two top notch directors to the company.
One, a leader in healthcare and the other in real estate and REITs.
My gratitude and optimism also flow from the life-saving COVID-19 vaccine discovery by doctors and scientists in record time and the recent acceleration of vaccine delivery by the Biden administration.
Nationally, ending COVID-19 is foundational to spur sustained economic recovery and restore vitality to so many businesses, households, and workers.
At Ventas, we're proud that 100% of our U.S. SHOP, AL, and memory care communities have already received the vaccine and nearly 90% of them will complete their second dose by the end of this month.
Notably, senior housing vaccine delivery represents one of the shining successes in our fight against COVID-19.
In our SHOP communities, it is wonderful to know that about 30,000 vulnerable residents have already been vaccinated and are one step closer to feeling safe, seeing loved ones, and enjoying a richer life.
From our real-time data, we also know that confirmed COVID-19 cases in our communities have recently begun to improve significantly creating an enhanced sense of well-being and enabling more operators to open communities to new move-ins and leads at our communities built to their highest level since the pandemic began in January once again demonstrating the strength of the value proposition of senior housing and the resilient demand for the services our care providers deliver.
While we expect SHOP first quarter NOI and occupancy, which are lagging indicators to decline sequentially as a result of November to January extreme COVID-19 conditions, we are encouraged by the breadth and consistency of all positive leading indicators.
Conditions remain dynamic and it is too early to declare a definitive trend, but we like the picture we are starting to see.
Post-pandemic senior housing growth represents an incredibly significant value creation opportunity for our shareholders.
Turning to our investment outlook, our diversified asset base with five verticals has given us the ability to continue successfully allocating capital over time and through cycles.
For example, we've created tremendous value since our early cycle investments in our research and innovation business in 2016.
We continue to find meaningful opportunities to drive that business forward in both ground-up development and asset acquisitions with university and in cluster markets alike.
Our decision to add life sciences to our enterprise has provided uplift to our results, our investment activity, and our value.
Here are a couple of current examples.
Our $280 million life sciences project known as One uCity in this rising research sub-market of Philadelphia, which is book ended by tenant Drexel is attracting significant leasing interest.
In addition to the nearly $1 billion ground-up development projects already under way, our university based development pipeline continues to hold about another $1 billion in active potential projects with both new and existing university relationships.
In particular with Wexford, we are in the design development phase of a nearly $0.5 billion project with a major research university on the West Coast that is substantially pre-leased.
We look forward to sharing more information with you later this year.
Outside of research and innovation, we continue to allocate capital to develop large Class A independent living communities with our partner LGM in Quebec.
We've had five projects under way with investment also totaling nearly $0.5 billion and two of the projects were delivered in the fourth quarter.
We are pleased to report that the two open communities have leased up quickly and occupancy is already nearly 80%.
In addition, our pipeline of potential acquisitions and all five of our verticals is active and growing.
We continue to invest with an eye toward growing reliable cash flow and favorable risk adjusted return.
We will also continue to evaluate and execute opportunities to recycle capital as well.
Both Justin and Pete have been working with our deal team to target about $1 billion of disposition during the year to optimize our portfolio.
Finally, our institutional investment capital management platform continues to grow and succeed with well over $3 billion in assets under management.
Bringing together our pre-existing and new third-party capital vehicles under one umbrella, the Ventas Investment Management business includes our life sciences and healthcare fund.
The Ventas fund stands out as one of the most successful launches of a first-time real estate fund in any asset class.
Our investment management platform provides a significant competitive advantage to Ventas.
It broadens our capital sources, augments our investment capacity, expands our footprint, leverages our team and industry expertise, improves our financial flexibility and liquidity, and adds an incremental source of earnings.
There is tremendous market opportunity within life science, medical office, and senior housing real estate and we are well positioned to capitalize on it in multiple ways.
In closing, let me reiterate that demographically driven demand is right in front of us.
The leading indicators in senior housing are improving rapidly, vaccine delivery is accelerating, and the long-term thesis for all of our asset classes and for Ventas remains firmly positive.
All of us at Ventas have an abiding commitment to staying strong and steady and winning the recovery on behalf of all of our stakeholders.
I'd like to begin by highlighting the fourth quarter performance and first quarter performance expectations.
First, I would like to mention that we are humbled and grateful that HHS continues to recognize the crucial role senior living plays in protecting vulnerable older Americans.
Through the CARES Act, HHS has provided several rounds of funding to assisted living communities to partially mitigate losses directly suffered because of the COVID-19 pandemic.
Through this program, applicable to sequential same-store SHOP assets, our communities have received $34 million in the fourth quarter and $13 million to date in the first quarter, which has been applied as a contra expense to offset COVID-19 related expenses incurred.
After a challenging fourth quarter and January in which the national spread of COVID-19 hit all-time highs, our communities experienced an increase in resident cases and we had more communities close to move-ins.
Leading indicators have followed a similar pattern.
Leads and move-ins drifted down throughout November and December while at the same time move-outs were elevated.
Although the fourth quarter was a challenging quarter, we are pleased our occupancy hung in there with a 90 basis point decline.
Looking ahead to the remainder of the first quarter, for the forecast Q1 sequential same-store SHOP portfolio, we expect cash NOI to decline from the fourth quarter to the first quarter excluding HHS grants of $34 million and $13 million to date in each respective period.
This NOI deterioration is driven by 250 basis point to 325 basis point expected occupancy decline partially offset by modest rate increase.
We expect to see continued elevated operating expenses into the first quarter.
And while we are seeing continued high levels of COVID related costs, these are partially mitigated by $13 million of Phase 3 HHS grant money received to date in the first quarter.
I'll add that recent severe winter weather across the country could cause additional expenses as well as delays in move-ins.
We haven't included any impacts, if any, in our guidance.
While we are experiencing choppy waters at this stage of the pandemic, I would like to highlight green shoots that support a more optimistic outlook ahead.
I'll start by highlighting our improving clinical trends.
Consistent with the U.S. COVID case trends, our SHOP communities are experiencing a significant decline in new COVID cases.
In the most recent week, we are averaging nine cases per day, which is the lowest since October and down from 92 cases per day at the peak in January.
We couldn't be more relieved about this improvement knowing this means less illness and less people potentially dying from COVID.
This positive clinical trend is also important to local health departments support of our communities' ability to accept new move-ins and to offer a more robust living experience for our residents.
I'd like to comment on the early success our operators have had deploying the vaccine to residents and employees within our SHOP portfolio.
As Debbie mentioned, 100% of our assisted living and memory care communities have hosted their first vaccine clinic.
In other good news related to the vaccine, two studies from Spain and Israel have come out showing favorable data that people who are vaccinated and still contract COVID-19 are far less likely to spread the illness to others than if they were not vaccinated.
The execution of the vaccine is a massively important step toward the stabilization and growth in our senior housing platform.
I'll note that 95% of our communities are already open to move-ins, which is near pandemic high.
I'll remind you of the importance of the segments mentioned in our business update.
Currently, 80% of our communities are operating in Segment 3.
This is up from 64% a month ago.
Segment 3 is the least restrictive operating environment.
The communities in this segment offer a more robust living experience, includes a more open dining experience and small group activities.
Most importantly, it allows for less restrictive visitation between residents and their loved ones.
As more communities expand their service offering, demand for our services should improve.
Leads and move-ins started to pick up again in January with the highest number of leads we have witnessed since the beginning of the pandemic.
We have seen broad based strength in lead volume across regions and the initial indication is that this momentum has continued into February.
To summarize our optimism, new COVID cases down, vaccine distribution on track leading to a more robust living experience and all combining to support higher leads.
We continue to monitor these positive trends on a real-time basis and remain focused on supporting our operating partners as they get in position to win the recovery.
Moving on to triple-net senior housing, in the fourth quarter and through January, Ventas received all of it's expected triple-net senior housing cash rent.
Our underlying triple-net senior housing portfolio performance continues to be impacted by COVID-19.
However, due to a mix of lease resolutions executed in 2020, government subsidies including PPP loans and HHS funds and other tenant resources, our tenants have continued to pay as expected.
Our trailing 12 month cash flow coverage for senior housing is 1.3 times respectively.
I'll comment on the senior housing industry outlook.
Our competitive outlook has continued to evolve amid the pandemic.
In 2020, construction starts nationally were down 50% year-over-year and deliveries were at their lowest levels since 2013.
Our SHOP markets witnessed particularly favorable supply trends with starts down 66% versus the prior year and deliveries down over 40%.
We are optimistic about the long-term impact from lower construction starts.
Fewer starts today combined with a compelling aging demographic trends where the 80-plus population is expected to grow nearly 15% between now and 2024, which is 5 times faster than the broader population, will provide a potent tailwind over the next few years.
Moving on to final comments.
I'd like to comment on the tremendous job well done our operator partners and front line staff have done prioritizing the health and safety of our residents and employees throughout a very challenging period.
We couldn't be more proud of their focus, determination, courage, and perseverance throughout the pandemic.
I'd also like to note our excitement and support for Jack Callison, the new CEO of Sunrise Senior Living.
We know Jack to be an accomplished and charismatic leader who is extremely qualified to lead Sunrise.
I'll finish by reiterating our optimistic outlook as we consider the improving clinical trends, vaccine roll out, communities opening for move-ins with a more robust living experience and post-pandemic supply/demand tailwinds that give us continued confidence in a very strong positive growth trajectory in senior housing.
With that, I'll hand the call to Pete.
Together, these segments represent 47% of Ventas' NOI.
They continue to produce strong results showcasing their value proposition and financial strength among the pandemic.
In fact, for the full year 2020, these segments combined to generate same-store cash NOI growth of 3%.
First, I'll cover office.
MOBs and research and innovation centers, the two lines of business within our office portfolio, they play a key role in the delivery of crucial healthcare services and research for life-saving vaccines and therapeutics.
The office portfolio continues to provide steady growth, delivering $128 million of same-store cash NOI in the fourth quarter.
This represents a 1.5% sequential growth led by our R&I portfolio which generated 3.6% same-store cash NOI growth.
Moreover, full year office same-store cash NOI grew 3.3% versus 2019, near the midpoint of original 2020 office guidance of 3% to 4% despite the impacts of COVID-19.
Normalizing for a paid parking shortfall and increased cleaning costs due to COVID, same-store cash NOI grew 4.5%, surpassing our pre-COVID guidance range.
In terms of rent receipts, office tenants paid an industry-leading 99.2% of contractual rents in the fourth quarter.
For the entire period from April through December, tenants paid 99.4% of contractual rent.
This is without deducts or deferrals which were de minimis.
Substantially all granted deferrals have been repaid and new deferrals were negligible during the fourth quarter.
Continuing the trend, we have collected 98% of January contractual rents, on track to meet or exceed the fourth quarter collection rate.
February to date collection results are also strong and are on a consistent pace when compared to the fourth quarter.
This strong performance is enabled by the mission critical nature of our portfolio and by our high-quality credit-worthy tenancy.
In our medical office portfolio, nearly 85% of our NOI comes from investment grade rated tenants and HCA.
In our R&I portfolio, 76% of our revenues come directly from investment grade rated organizations and publicly traded companies.
Medical office had a record level of retention of 88% for the fourth quarter and 87% for the trailing 12 months.
Driven by this retention, total office leasing was 700,000 square feet for the quarter and 3.4 million square feet for the full year of 2020.
This includes 540,000 square feet of new leasing.
Total leasing far exceeded our pre-COVID 2020 plan.
All of our MOB properties are in elective surgery restriction free locations.
As a result, we are seeing positive utilization trends that mirror increased admissions and surgery volumes being reported by the health systems.
As an example, paid parking receipts during the second quarter of 2020 were only 46% of normal.
During the fourth quarter, however, paid parking recovered to 71% of normal.
As Debbie mentioned, we continue to be excited with the office business and particularly investment opportunities in the R&I space.
In the fourth quarter, we closed our acquisition of the three-asset, 800,000 square foot Trophy Life Sciences Portfolio in San Francisco.
Since last quarter's announcement, we have renewed a large tenant and signed two new leases, bringing the building to a 100% leased, a clear demonstration of the attractiveness of these buildings to the marketplace.
We also opened our $80 million R&I development on the campus of Arizona State located within the Phoenix Biomedical Campus, a 30-acre innovation district established by the City of Phoenix in the heart of downtown.
The building is over 50% pre-leased and is ahead of pro forma.
Now let's turn to healthcare triple-net.
During the fourth quarter, our healthcare triple-net assets showed continued strength.
We have received 100% of fourth quarter rents as well as 100% of January and 100% of February rents.
Trailing 12-month EBITDARM cash flow coverage improved sequentially for all our healthcare triple-net asset classes except skilled nursing despite COVID-19.
Acute and post-acute providers had early access to significant government funding to create liquidity and mitigate pandemic-related losses.
Acute care hospitals trailing 12-month coverage was a strong 3.3 [Phonetic] in the third quarter, a 20 basis point sequential improvement driven by a rebound in elective surgical procedures, prudent expense management as well as government funding.
Ardent continues to perform extremely well in this dynamic market condition and all of Ardent's hospitals reside in jurisdictions that are open for elective procedures.
We are excited to continue growing with Ardent.
During the fourth quarter, Ardent opened a new outpatient cancer center on the campus of their hospital in Amarillo, Texas.
The cancer center features best-in-class equipment and facilities for radiation therapy, chemotherapy, and cancer care.
We invested approximately $30 million at a near 8% stabilized yield.
IRF and LTAC coverage improved 10 basis points to 1.6 times in the third quarter buoyed by strong business results and government funding.
In particular, Kindred has demonstrated its core competency in treating complex patient cases.
Census levels continued to be very high.
And finally, within our loan portfolio, our Colony, Holiday, and Brookdale loans are all fully current.
You are all heroes.
In my remarks today, I'll cover our 2020 enterprise fourth quarter results, our expectations for the first quarter of 2021, and our recent liquidity, balance sheet, and capital activities.
Let's start with our fourth quarter financial performance.
Ventas reported fourth quarter net income attributable to common stockholders of $0.29 per share and normalized funds from operations of $0.83 per share or $0.74 excluding the $0.09 in HHS grants received in SHOP in Q4.
Other sequential fourth quarter drivers to highlight include $0.04 of income recorded in our unconsolidated entities offset by a $0.05 Q4 sequential decline in NOI principally in SHOP.
Meanwhile, office and triple-net healthcare was stable on a sequential basis in the fourth quarter.
That's a good segue to our Q1 guidance as Q4 is an appropriate start point for our first quarter 2021 expectations.
The key components of our Q1 guidance are as follows: net income attributable to common stockholders is estimated to range between minus $0.07 and minus $0.01 per fully diluted share; normalized FFO is forecast to range from $0.66 to $0.71 per share.
The midpoint of our FFO guidance $0.68 per share represents $0.15 sequential decline from the fourth quarter.
This change can be largely explained by $0.09 reduction in HHS grant income and income from unconsolidated entities.
The balance is driven by a $0.05 reduction in organic SHOP NOI performance.
A few of the key SHOP Q1 assumptions include Q1 2021 average occupancy ranging from 250 basis points to 325 basis points lower versus the fourth quarter average, sequential growth in RevPOR as a result of the annual in-place rent increases implemented at the start of 2021, and continued elevated levels of operating expenses driven by COVID labor and testing.
Outside of SHOP, we expect our property NOI to be stable on a sequential basis in the first quarter.
I'll close with our balance sheet and capital activity.
I am proud of the actions the Ventas team has taken to manage our balance sheet leverage and liquidity.
We have navigated the disruption created by COVID and kept Ventas strong and stable while protecting shareholder capital.
I'd highlight a few of our most recent actions and results.
First, some key stats from 2020.
We finished 2020 with full year net debt-to-EBITDA of 6.1 times, maintained a strong maturity profile with duration exceeding six years, held total debt to gross asset value at 37%, reduced our net debt at year-end by over $500 million year-over-year, and retained robust liquidity exceeding $3 billion.
In 2020, we also took advantage of the strong bid for healthcare real estate and realized over $1 billion in asset sales at a blended 5.3% cash yield.
In 2021, we're targeting an additional $1 billion in asset sales across our verticals in the second half of the year.
Proceeds from dispositions are expected to be used to reduce debt and to fund future growth through development and redevelopment capital spend.
In January 2021, we closed on a new four-year $2.75 billion unsecured credit facility.
We had great demand from 24 new and incumbent financial institutions and we're able to realize better pricing.
They are critical to our success.
And finally, in March 2021, Ventas will use cash on hand from recent dispositions to reduce our near-term maturities by fully repaying $400 million of our 3.1% Senior Notes due January 2023.
As a result of these and other actions, we're positioned to capitalize on the powerful upside across our business once the pandemic is finally in the rear view mirror.
Before we start with Q&A, we're limiting each caller to two questions to be respectful to everyone on the line.

user
sees q1 adjusted normalized ffo $0.66-$0.71 per share.
qtrly attributable net income per share $0.29.
qtrly normalized ffo per share $0.83.

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