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Segment Reporting
 3 Months Ended
Mar. 31, 2024
Segment Reporting [Abstract]  
Segment Reporting Segment Reporting
We invest in seniors housing and health care real estate. We evaluate our business and make resource allocations on our three operating segments: Seniors Housing Operating, Triple-net and Outpatient Medical. Our Seniors Housing Operating properties include seniors apartments, assisted living, independent living/continuing care retirement communities, independent supportive living communities (Canada), care homes with and without nursing (U.K.) and combinations thereof that are generally owned and/or operated through RIDEA structures (see Note 19). Our Triple-net properties include the property types described above as well as long-term/post-acute care facilities. Under the Triple-net segment, we invest in seniors housing and health care real estate through acquisition and financing of primarily single tenant properties. Properties acquired are primarily leased under triple-net leases and we are not involved in the management of the property. Our Outpatient Medical properties are typically leased to multiple tenants and generally require a certain level of property management by us.
We evaluate performance based upon consolidated NOI of each segment. We define NOI as total revenues, including tenant reimbursements, less property operating expenses. We believe NOI provides investors relevant and useful information as it measures the operating performance of our properties at the property level on an unleveraged basis. We use NOI to make decisions about resource allocations and to assess the property level performance of our properties.
Non-segment revenue consists mainly of interest income on cash investments recorded in other income. Non-segment assets consist of corporate assets including cash, deferred loan expenses and corporate offices and equipment among others. Non-property specific revenues and expenses are not allocated to individual segments in determining NOI.
The accounting policies of the segments are the same as those described in the summary of significant accounting policies (see Note 2 to the financial statements included in our Annual Report on Form 10-K for the year ended December 31, 2023). The results of operations for all acquisitions described in Note 3 are included in our consolidated results of operations from the acquisition dates and are components of the appropriate segments. All inter-segment transactions are eliminated.
Summary information for the reportable segments (which excludes unconsolidated entities) is as follows (in thousands): 
Three Months Ended March 31, 2024Seniors Housing OperatingTriple-netOutpatient MedicalNon-segment/CorporateTotal
Resident fees and services$1,360,274 $— $— $— $1,360,274 
Rental income— 221,744 195,908 — 417,652 
Interest income5,023 46,789 852 — 52,664 
Other income1,463 1,199 2,402 24,087 29,151 
Total revenues1,366,760 269,732 199,162 24,087 1,859,741 
Property operating expenses1,019,347 10,817 62,463 4,286 1,096,913 
Consolidated net operating income (loss)347,413 258,915 136,699 19,801 762,828 
Depreciation and amortization236,796 62,535 66,532 — 365,863 
Interest expense11,186 358 1,718 134,056 147,318 
General and administrative expenses— — — 53,318 53,318 
Loss (gain) on derivatives and financial instruments, net— (3,054)— — (3,054)
Loss (gain) on extinguishment of debt, net6 — — — 6 
Provision for loan losses, net1,568 (567)13 — 1,014 
Impairment of assets43,331 — — — 43,331 
Other expenses8,757 1,205 609 3,560 14,131 
Income (loss) from continuing operations before income taxes and other items45,769 198,438 67,827 (171,133)140,901 
Income tax (expense) benefit— — — (6,191)(6,191)
Income (loss) from unconsolidated entities(4,267)(3,153)(363)— (7,783)
Gain (loss) on real estate dispositions, net4,602 26 79 — 4,707 
Income (loss) from continuing operations46,104 195,311 67,543 (177,324)131,634 
Net income (loss)$46,104 $195,311 $67,543 $(177,324)$131,634 
Total assets$25,009,470 $9,883,758 $7,414,657 $2,245,700 $44,553,585 
Three Months Ended March 31, 2023Seniors Housing OperatingTriple-netOutpatient MedicalNon-segment/CorporateTotal
Resident fees and services$1,131,685 $— $— $— $1,131,685 
Rental income— 202,419 181,640 — 384,059 
Interest income2,551 33,763 91 — 36,405 
Other income2,445 1,883 3,100 1,152 8,580 
Total revenues1,136,681 238,065 184,831 1,152 1,560,729 
Property operating expenses883,784 11,723 58,365 3,881 957,753 
Consolidated net operating income (loss)252,897 226,342 126,466 (2,729)602,976 
Depreciation and amortization220,407 54,528 64,177 — 339,112 
Interest expense11,487 (15)4,104 128,827 144,403 
General and administrative expenses— — — 44,371 44,371 
Loss (gain) on derivatives and financial instruments, net— 930 — — 930 
Loss (gain) on extinguishment of debt, net— — 5 — 5 
Provision for loan losses, net(73)850 — — 777 
Impairment of assets12,629 — — — 12,629 
Other expenses17,579 2,467 

547 2,152 22,745 
Income (loss) from continuing operations before income taxes and other items(9,132)167,582 57,633 (178,079)38,004 
Income tax (expense) benefit— — — (3,045)(3,045)
Income (loss) from unconsolidated entities(15,589)8,432 86 — (7,071)
Gain (loss) on real estate dispositions, net833 520 (606)— 747 
Income (loss) from continuing operations(23,888)176,534 57,113 (181,124)28,635 
Net income (loss)$(23,888)$176,534 $57,113 $(181,124)$28,635 
Our portfolio of properties and other investments are located in the United States, the United Kingdom and Canada. Revenues and assets are attributed to the country in which the property is physically located. The following is a summary of geographic information for the periods presented (dollars in thousands): 
 Three Months Ended
 March 31, 2024March 31, 2023
Revenues:Amount%Amount%
United States$1,546,896 83.2 %$1,296,022 83.0 %
United Kingdom161,508 8.7 %147,876 9.5 %
Canada151,337 8.1 %116,831 7.5 %
Total$1,859,741 100.0 %$1,560,729 100.0 %
Three Months Ended
March 31, 2024March 31, 2023
Resident Fees and Services:Amount%Amount%
United States$1,097,339 80.7 %$908,944 80.4 %
United Kingdom116,879 8.6 %109,012 9.6 %
Canada146,056 10.7 %113,729 10.0 %
Total$1,360,274 100.0 %$1,131,685 100.0 %
 As of
 March 31, 2024December 31, 2023
Assets:Amount%Amount%
United States$37,428,967 84.0 %$36,929,186 83.9 %
United Kingdom3,526,025 7.9 %3,587,230 8.2 %
Canada3,598,593 8.1 %3,495,750 7.9 %
Total$44,553,585 100.0 %$44,012,166 100.0 %