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Real Property Acquisitions and Development
6 Months Ended
Jun. 30, 2020
Real Estate [Abstract]  
Real Property Acquisitions and Development Real Property Acquisitions and Development 
The total purchase price for all properties acquired has been allocated to the tangible and identifiable intangible assets and liabilities at cost on a relative fair value basis. Liabilities assumed and any associated noncontrolling interests are reflected at fair value. The results of operations for these acquisitions have been included in our consolidated results of operations since the date of acquisition and are a component of the appropriate segments. Transaction costs primarily represent costs incurred with acquisitions, including due diligence costs, fees for legal and valuation services, termination of pre-existing relationships computed based on the fair value of the assets acquired, lease termination fees and other acquisition-related costs. Transaction costs related to asset acquisitions are capitalized as a component of purchase price and all other non-capitalizable costs are reflected in other expenses on our Consolidated Statements of Comprehensive Income.
The following is a summary of our real property investment activity by segment for the periods presented (in thousands):
 Six Months Ended
 June 30, 2020June 30, 2019
Seniors Housing OperatingTriple-netOutpatient
Medical
TotalsSeniors Housing OperatingTriple-netOutpatient
Medical
Totals
Land and land improvements$15,758  $—  $40,847  $56,605  $103,743  $8,099  $132,154  $243,996  
Buildings and improvements132,480  765  171,457  304,702  1,109,966  96,244  1,198,608  2,404,818  
Acquired lease intangibles10,810  —  23,823  34,633  58,773  —  85,492  144,265  
Construction in progress—  —  —  —  36,174  —  —  36,174  
Right of use assets, net—  —  —  —  —  —  56,073  56,073  
Receivables and other assets257  —  139  396  4,560  —  376  4,936  
Total assets acquired (1)
159,305  765  236,266  396,336  1,313,216  104,343  1,472,703  2,890,262  
Secured debt—  —  —  —  (43,209) —  —  (43,209) 
Lease liabilities—  —  —  —  —  —  (45,287) (45,287) 
Accrued expenses and other liabilities(671) —  (2,036) (2,707) (8,677) —  (22,506) (31,183) 
Total liabilities acquired(671) —  (2,036) (2,707) (51,886) —  (67,793) (119,679) 
Noncontrolling interests (2)
(2,827) —  —  (2,827) (38,830) (1,056) —  (39,886) 
Non-cash acquisition related activity(3)
—  —  —  —  (11,889) —  —  (11,889) 
Cash disbursed for acquisitions155,807  765  234,230  390,802  1,210,611  103,287  1,404,910  2,718,808  
Construction in progress additions53,705  26,262  26,677  106,644  110,902  24,131  26,587  161,620  
Less: Capitalized interest(5,470) (1,826) (1,991) (9,287) (3,560) (908) (1,788) (6,256) 
Accruals (4)
(1,343) —  (2,983) (4,326) —  —  45  45  
Cash disbursed for construction in progress46,892  24,436  21,703  93,031  107,342  23,223  24,844  155,409  
Capital improvements to existing properties87,002  4,700  30,401  122,103  97,867  7,423  18,886  124,176  
Total cash invested in real property, net of cash acquired$289,701  $29,901  $286,334  $605,936  $1,415,820  $133,933  $1,448,640  $2,998,393  
(1) Excludes $580,000 and $1,910,000 of unrestricted and restricted cash acquired during the six months ended June 30, 2020 and 2019, respectively.
(2) Includes amounts attributable to both redeemable noncontrolling interests and noncontrolling interests.
(3) Relates to the acquisition of assets previously recognized as investments in unconsolidated entities.
(4) Represents non-cash accruals for amounts to be paid in future periods for properties that converted, off-set by amounts paid in the current period.
Construction Activity 
The following is a summary of the construction projects that were placed into service and began generating revenues during the periods presented (in thousands):
 Six Months Ended
 June 30, 2020June 30, 2019
Development projects:
Seniors Housing Operating
$93,188  $28,117  
Triple-net
33,627  —  
Outpatient Medical
43,493  —  
Total development projects
170,308  28,117  
Expansion projects
35,637  —  
Total construction in progress conversions$205,945  $28,117