U.S. Markets closed

Edited Transcript of WELL earnings conference call or presentation 13-Feb-20 2:00pm GMT

Q4 2019 Welltower Inc Earnings Call

Toledo Feb 17, 2020 (Thomson StreetEvents) -- Edited Transcript of Welltower Inc earnings conference call or presentation Thursday, February 13, 2020 at 2:00:00pm GMT

TEXT version of Transcript

================================================================================

Corporate Participants

================================================================================

* Keith Konkoli

Welltower Inc. - Senior VP of Real Estate Services & Head of Outpatient Medical

* Matthew Grant McQueen

Welltower Inc. - Senior VP, General Counsel & Corporate Secretary

* Shankh Mitra

Welltower Inc. - Executive VP & CIO

* Thomas J. DeRosa

Welltower Inc. - Chairman & CEO

* Tim McHugh

Welltower Inc. - Senior VP, CFO & Treasurer

================================================================================

Conference Call Participants

================================================================================

* Chad Christopher Vanacore

Stifel, Nicolaus & Company, Incorporated, Research Division - Senior Analyst

* Daniel Marc Bernstein

Capital One Securities, Inc., Research Division - Research Analyst

* Derek Charles Johnston

Deutsche Bank AG, Research Division - Research Analyst

* Jonathan Hughes

Raymond James & Associates, Inc., Research Division - Senior Research Associate

* Jordan Sadler

KeyBanc Capital Markets Inc., Research Division - MD and Equity Research Analyst

* Joshua Dennerlein

BofA Merrill Lynch, Research Division - Research Analyst

* Lukas Michael Hartwich

Green Street Advisors, LLC, Research Division - Senior Analyst

* Michael Bilerman

Citigroup Inc, Research Division - MD and Head of the US Real Estate and Lodging Research

* Michael Albert Carroll

RBC Capital Markets, Research Division - Analyst

* Michael William Mueller

JP Morgan Chase & Co, Research Division - Senior Analyst

* Nicholas Gregory Joseph

Citigroup Inc, Research Division - Director & Senior Analyst

* Nicholas Philip Yulico

Scotiabank Global Banking and Markets, Research Division - Analyst

* Omotayo Tejamude Okusanya

Mizuho Securities USA LLC, Research Division - MD & Senior Equity Research Analyst

* Richard Charles Anderson

SMBC Nikko Securities Inc., Research Division - Research Analyst

* Stephen Thomas Sakwa

Evercore ISI Institutional Equities, Research Division - Senior MD & Senior Equity Research Analyst

* Steven James Valiquette

Barclays Bank PLC, Research Division - Research Analyst

* Vikram Malhotra

Morgan Stanley, Research Division - VP

================================================================================

Presentation

--------------------------------------------------------------------------------

Operator [1]

--------------------------------------------------------------------------------

Ladies and gentlemen, thank you for standing by, and welcome to the Welltower Fourth Quarter 2019 Earnings Conference Call. (Operator Instructions) Please be advised that today's conference may be recorded. (Operator Instructions) I'd now like to hand the conference over to your speaker today, Mr. Matt McQueen, Senior Vice President, General Counsel. Please go ahead, sir.

--------------------------------------------------------------------------------

Matthew Grant McQueen, Welltower Inc. - Senior VP, General Counsel & Corporate Secretary [2]

--------------------------------------------------------------------------------

Thank you, Liz, and good morning. As a reminder, certain statements made during this call may be deemed forward-looking statements in the meaning of the Private Securities Litigation Reform Act. Although Welltower believes any forward-looking statements are based on reasonable assumptions, the company can give no assurances that its projected results will be attained. Factors that could cause actual results to differ materially from those in the forward-looking statements are detailed in the company's filings with the SEC.

And with that, I'll hand the call over to Tom for his remarks. Tom?

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [3]

--------------------------------------------------------------------------------

Thanks, Matt, and good morning. I'm pleased to announce our Q4 and annual results to you today, as they reflect the strategic path to growth that we outlined in our Investor Day in December 2018. Simply put, in 2019, we did what we told you we would do. As the clear market leader and dominant provider of real estate capital to the health and wellness care delivery sector, Welltower has redefined this asset class in terms of quality, operating models, technologically advanced building design, data insight, deal structure and transparency. This has placed us on a sustainable growth path that has generated $4.16 in FFO per share in 2019. A 3.2% increase over 2018 and fuels the optimistic outlook for 2020 we report to you today. The $5 billion we deployed into new investments between January 1, 2019 and today was not generated by playing the old game of overpaying for real estate through auctions or being the passive takeout for old school senior housing operators, more focused on their personal development profits than running an operating business.

For Welltower, that game is over. We are the partner of choice for a next generation of residential senior care operators who enter into aligned structures that reward strong performance, yet don't leave REIT shareholders holding the bag when things don't go according to plan. And in business, as in life, things don't always go according to plan.

We have also become the partner of choice for health systems. I'm sure you saw Jefferson Health's recent announcement of a broad partnership with Welltower. Jefferson, one of the nation's largest urban academic health systems has elected to work with Welltower to advance its strategy of health care with no address. This partnership will help recapitalize Jefferson's existing ambulatory assets, build and capitalize their next generation of ambulatory assets, connect Jefferson Health delivery capabilities into our existing greater Philadelphia senior population of over 20,000 lives and together conceive new models of housing and wellness care that can drive better outcomes for an aging and at-risk urban population. We are honored to be working with Dr. Steve Klasko, his team and the Board of Jefferson. They are truly redefining the future of health care delivery.

Our platform approach is demonstrating that there is value that can be captured in our real estate beyond collecting rent checks. Our CareMore Anthem collaboration is a great example of this and illustrates that third parties can bring clinical care models into assisted living communities and with modern Medicare Advantage products reduce out-of-pocket costs for our residents, enhance resident experience, improve outcomes and increase occupancy and length of stay. What was a California pilot last year, is now being rolled out into other markets. Stay tuned for other innovative models like this one.

For an example of how Welltower is driving the next generation of residential care design, I'd point you to our building on East 56th Street on Lexington Avenue opening in late spring. When this building opens, it will be the most technologically advanced residential care facility in the world for seniors suffering with conditions of frailty to memory care. Not only is this purpose-built building designed to meet the needs of this population, but it will incorporate state-of-the-art Philips technology that will enable more effective and efficient care as well as enhance the experience for our residents and their families.

Welltower conceived this project and has driven the development process from day 1. This will be followed by our next Manhattan project on Broadway at 85th Street, new urban models we will deliver in Hudson Yards and San Francisco as part of our related Atria joint venture and in Boston with Balfour.

These are just a few examples of how we have positioned Welltower to redefine and reimagine the built environment that can deliver better health outcomes and lower costs, particularly in view of the aging in the population. We have largely moved beyond the issues that would have slowed our growth and that enables the optimism you hear from me this morning. It is our job to deliver a path of sustainable growth. And our 2020 outlook of $4.20 to $4.30 in FFO per share illustrates that. And I will remind you this does not include any new net acquisitions or investments that have not been announced.

Now Shankh Mitra will give you a closer look at our Q4 operating performance as well as discuss new investments. Shankh?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [4]

--------------------------------------------------------------------------------

Thank you, Tom, and good morning, everyone. I will now review our quarterly and annual operating results, provide additional details on performance, trends and recent investment activity and new operator relationships. A year ago, when we set our guidance for 2019, we told you that we felt cautiously optimistic about our senior housing operating portfolio or SHOP and set the same store guidance at 0.5% to 2%. We are delighted to inform you that we have achieved 2.7% growth for the year, primarily driven by stronger pricing power and better-than-expected labor cost inflation. We want to remind you that our show portfolio consists of 600 communities spread across 25 portfolios of different operating partners focused on different price points, acuity level, geographies and operating models. We quantitatively manage our SHOP portfolio to drive low cross-correlation which creates real diversification benefits. We have added a new disclosure on Slide 39 of our corporate presentation that gives you a snapshot of our ability to do this. If you compare it to randomly chosen operator from that disclosure and compared the long-term NOI growth rate per occupied room, you will get a median correlation of 0.23. This remarkably low statistical correlation in a business where casual observers believe all operators in the same generic business called senior housing is debugged. We provide further context using 2019 performance, we had 3 operating partners that experienced mid-single-digit to double-digit NOI decline, and we had 4 operating partners that experienced double-digit NOI growth, with all other operators were in between. This demonstrates our unique business model and portfolio that is able to absorb downside volatility of certain operating partners with the contribution of others.

Other specific highlights of 2019 include significant outperformance of assisted living over independent living and outperformance of large core U.S. markets above smaller markets. We have built a highly differentiated and uncorrelated portfolio of assets by using a barbell approach of portfolio construction, focusing on high-end senior housing and more affordable communities with limited services while exiting the product in the middle. 2019 saw addition of several new operators to the Welltower family: Atria, Balfour, Clover, Frontier and LCB. We are delighted to mention you that we're off to a great start in 2020 and have already welcomed 3 new operators to our family who we have been working with to come to terms for last 6 months.

Let me give you some details here. We're delighted to partner with Michael Glynn, Andrew Teeters, [Ross Dignan] along with Mark [Shaver] to offer a lower acuity, differentiated, lifestyle-based, highly amenitized and stunning housing solution to seniors under the Monarch brand. We also partnered with Arun Paul of Priya Living to offer a highly differentiated and relatively affordable product targeting (inaudible) and tremendously underserved market in large core U.S. MSAs.

In both cases, our exclusive relationship spans multiple years and will provide a multibillion-dollar investment opportunity in the next decade.

Reflecting on the fourth quarter specifically, I will mention that we are positively surprised by few trends. First, with respect to the seasonality within senior housing business, occupancy typically peaks in late fall and trends down through the winter months. However, we did not see that seasonal drop-off this year and occupancy has been pretty much flat sequentially through the year and into this year. Second, I'm cautiously optimistic about what we have seen on the labor inflation side. While couple of quarters does not make a trend, sequentially, compensation per occupied room was flat in Q4 and is the best we have seen in last 5 years. This, taken together with consistent pricing power, gives us the confidence to provide a guidance of 1% to 2.5% in SHOP relative to 0.5% to 2% this time last year. We have a long year ahead and we need to execute diligently, but we remain relatively optimistic today as compared to this time last year. We believe demand is increasing in assisted living business and impact of deliveries is improving on the margin.

A couple of other notable items from Q4 would be significant increase in insurance cost that I discussed during Q2 call as well as $2.4 million increase in incentive management fee in Q4 due to significant outperformance one of our operating partners in a RIDEA 3.0 construct that was previously not contemplated.

In terms of our 2020 guidance, we assume a $4 million increase relative to the incentive management fees. I would like to now shift to our health system portfolio. On our last quarter call, we told you that we're expecting $300 million of EBITDAR in our HCR ManorCare, ProMedica portfolio for 2019. I'm delighted to inform you that HCR has achieved $307 million of EBITDAR in 2019. This resulted in a full year 2019 EBITDAR coverage of 2.13x. More importantly, for the first time in 7 years, all 3 business lines of HCR ManorCare had year-over-year increase in EBITDAR in Q4. While the Q-Mix shift in skilled nursing continues to be a headwind for the business, we're seeing length of stay flattening, occupancy starting to build, cost remains under check, synergies are getting realized and Arden Court and home health and hospice business is firing with all cylinders.

In addition, HCR is in active negotiation with several health systems to help meet them their post-acute needs. I'm optimistic I'll be able to share with you some of the success stories in 2020.

ProMedica, which is an absolute pioneer in the social determinant of health side will drive significant value from the HCR platform for years to come. On the MOB side, we have significantly upgraded both our operating platform and asset portfolio in the last few quarters as we have acquired or announced roughly $4 billion of high-quality MOBs under Keith and Ryan's leadership. We now own the largest commercial platform of medical office real estate in the U.S. We have used an air pocket in the capital markets to scale up this business in the last few quarters. However, it appears that some of the pricing frenzy of 2017 is resurfacing. If our reading of tea leaves is correct, we will be largely absent from the acquisition of MOBs this year, and instead, focus on privately negotiated deals with the owners such as our health system partners. Overall, on the transaction side, we had the most active year in the company's history with $4.8 billion of high-quality investments and $2.9 billion of dispositions. We have discussed this transaction with you in details and they are listed on our earnings release.

I would like to note a few general observations that drive our capital allocation strategy and market trends. One, we invest capital to make money on per share basis for existing shareholders as opposed to solving for any exposure or chasing the latest and greatest asset class. To the contrary, we buy assets when they're out of favor at the right price in the right structure. Our investment in HCR skilled assets at $57,000 per bed just 18 months ago and the disposition this quarter of 3 older noncore assets at $156,000 per bed reflect our philosophy and our laser-focused execution. The same goes for our assets in MOBs market in 2017 and a rapid growth in '18 and '19. Two, we invest capital when we can match the timing, cost and duration of capital. We do not speculate what our cost of capital will be in future years and fund transaction on a granular and current basis. Three, we think in real estate basis and unlevered IRR matters significantly more than cap rate. Four, we invest granularly with our operating partners. In this model, it is critical to work with well-aligned partners focused on methodical and smart growth. We have grown with all 5 2019 class of operators since our first deal earlier in the year. For example, I hope you noticed our press release on our development Hudson Yards with our partner, Related and Atria. The second major development -- this is the second major development we announced in last 6 months after 1001 Van Ness project in San Francisco.

Five, we engage in marketed transactions only when we believe that we have a significant edge due to our data analytics platform or our relationship with health systems or payers. Six, we see an incredible demand of U.S. senior housing product amongst the most highly sophisticated institutional investors today. We cannot be happier with our benchmark transaction in 2019. We started this year with another significant senior housing transaction that we reported last night with our earnings release at a very attractive price to our investors.

Our guidance of $1.7 billion of 2020 disposition includes this transaction though we have a $1.1 billion of announced acquisition built into our guidance that Tim will discuss in detail, needless to say that we feel very optimistic that we'll have a very strong year of net investments.

With that, I'll pass it over to Tim McHugh, our CFO. Tim?

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [5]

--------------------------------------------------------------------------------

Thank you, Shankh. My comments today will focus on our fourth quarter and full year 2019 results, our balance sheet and our initial guidance for full year 2020. Welltower returned to growth in 2019, reporting normalized FFO of $1.05 per share for the quarter and $4.16 per share for full year 2019, representing positive 4% and positive 3.2% year-over-year growth, respectively. Results for the year can be categorized by 3 main themes. The consistency of our internal growth engine, the volume of accretive capital deployment activity as we invested $4.8 billion across high-quality senior housing and outpatient medical opportunities, and the discipline of our capital recycling efforts as we had $2.7 billion of property dispositions including $560 million of high-yielding LTAC and post-acute assets and at $192 million of loan payoffs, reducing our loan investment portfolio to its smallest size since 2015. The result of all this was a year in which Welltower returned to earnings growth while also significantly improving the quality of our asset base.

Now let me provide some details around our portfolio's performance. First, our seniors housing triple-net portfolio posted another consistent quarter with positive 2.9% year-over-year same store growth. Sequential occupancy was flat in the quarter and EBITDA coverage declined by 0.1x. Next, our long-term post-acute portfolio generated positive 4.3% year-over-year same store growth, driven in part by an easier 4Q '18 comp which included partial rent mechanician from a tenant that is now current on rent. We also benefited from fair market value step-ups in a well-covered constant healthcare lease acquired in the acquisition of QCP.

EBITDAR coverage declined by 0.3x driven in part by the addition of 4 development assets, the trailing 12-month pool. As a reminder, we report our coverage a quarter in arrears. So the September 30 trailing 12-month coverage does not reflect any impact from the new PDPM Medicare reimbursement system, which is implemented at the start of October.

Turning to medical office. Our outpatient medical portfolio had another solid quarter delivering 2.3% same store growth, bringing the full year average to positive 2.1%. We continue to make meaningful progress in our same store occupancy as well, ending the year at 94%, 60 basis points ahead of fourth quarter of 2018.

Next, health systems, which comprises of our HCR ManorCare joint venture with ProMedica. This portfolio entered the same store pool for the first time this quarter with 1.375% year-over-year growth and EBITDAR and EBITDARM coverages of 206x and 277x, respectively.

Lastly, our senior housing operating portfolio continued to perform above our expectations with total same store growth of positive 1.5% in the quarter bringing full year average total senior housing operating growth to 2.7%. As with prior practice, I will now provide details on pool changes in our senior housing operating portfolio. In the fourth quarter, we had 9 asset sequential change in our senior housing operating same store pool. There was an 11 asset West Coast portfolio removed and moved to held for sale, offset by 2 assets entering the pool. At year-end 2019, we had total 77 senior housing operating assets classified as transition properties, a net increase of 2 properties since the end of 3Q, driven by 3 assets that transitioned from triple-net to RIDEA and 1 form of Brookdale asset that transitioned to a triple-net lease. The remaining 74 former Brookdale and Silverado transition assets, 71 have been successfully transitioned and will all reenter the same store pool by or during the fourth quarter of 2020. Our guidance assumes a slightly positive impact on results from transition properties in 2020 and we will provide more color on this as we progress through the year.

Turning to capital market activity in the quarter. We continue to take advantage of a very strong bond market issuing debt across 2 geographies in December. First, we issued our inaugural Green bond, raising $500 million of 7-year debt at 2.7%. Welltower's ESG team, led by Kirby Brendsel, put a lot of time and effort in preparing for the reporting requirements that come with Green bond financing and is paid off with tremendous support received from ESG investors. Welltower is committed to staying at the forefront of ESG initiatives and we look forward to growing this part of our capital stack going forward.

Secondly, we returned the Canadian debt market for the first time since our inaugural offering in 2015, refinancing our 2021 Canadian dollar maturity through the issuance of $300 million of 7-year debt at 2.95%. In terming out our last remaining unsecured 2021 maturity, we removed all major unsecured maturities through 2022, meaningfully de-risking our balance sheet for the next 3 years and increasing the weighted average maturity of our unsecured debt stack to 8.8 years.

Additionally, we continued to access equity markets during the quarter via our DRIP and ATM programs. In the quarter, we issued approximately 4.3 million shares at a weighted average price of $85.19 per share for estimated proceeds of $364 million. As of today's call through our forward ATM program, we have raised -- we've sold 6.8 million shares of common stock that have yet to settle, representing $583 million of estimated proceeds.

Turning to leverage. We ended the quarter at 6.37x net debt to adjusted EBITDA, temporarily above our long-term target range. This is due to the timing of capital recycling and more specifically to the fact that $1 billion of our previously announced acquisitions closed in mid-December. When adjusted for a full quarter of acquisition cash flow and for the updated investment and disposition guidance along with raised but not settled forward equity, leverage is expected to return to the mid- to high 5s by the middle of this year.

Lastly, before walking you through our 2020 initial outlook, I want to address 3 items pertaining to our total portfolio same-store policy, an outline of which can be found on the Investors section of our website. First, we use duration based qualifiers as frequently as possible in our policies in order to eliminate as much subjectivity from our disclosure decisions as possible. For developments, properties under the same store pool following 5 full quarters of being in service. Development plays an important role in our senior housing investment strategy and although lower development pipeline represents a small fraction of our total senior housing portfolio, we've determined it's useful to provide more insight in contribution to our same-store growth by providing a stabilized senior housing operating growth metric as a complement to our total portfolio of senior housing growth metric.

Stabilized is defined as 9 quarters after being placed into service. Given the broad range of products we develop, from senior apartments to assisted living, we believe that using a duration-based metric that is representative of the entire pool stabilization pattern is more straightforward for investors than attempting to create rules for each bucket.

Second, on normalizers. We normalized our same store results for changes in currency and ownership as well as for unusual and nonrecurring items such as property tax refunds and insurance reimbursements. We believe this to be beneficial to investors in understanding our run rate business. We've disclosed all normalization amounts in the back of our supplement since 2016. Per our supplemental disclosure, 2019 average full year SHOP NOI growth would have been 50 basis points higher without normalizing out unusual and nonrecurring items that benefited us in 2019.

Lastly, in 2020, we will continue our efforts to further align the reporting of our same store and our quarterly filings with our same store and our supplemental presentation with an intent to reach full alignment.

Now on to our 2020 outlook. As indicated in our press release, we are initiating full year 2020 FFO guidance to a range of $4.20 to $4.30, with total portfolio same-store growth -- NOI growth of 1.5% to 2.5%. At the segment level, this NOI is comprised of outpatient medical growth of positive 2.25% to 2.75%, long-term post-acute growth of positive 2% to 2.5%, health systems growth of positive 1.95% and senior housing triple-net growth of positive 2.25% to 2.75% and total portfolio senior housing operating growth of 1% to 2.5%. At the midpoint of total portfolio senior housing operating growth, stabilized same-store NOI growth is estimated at positive 1.25%.

On to guidance investment activity. Our initial FFO guidance assumes we are net sellers for the full year with initial disposition guidance for the year of $1.7 billion at Welltower share, with an average yield of 5.1%. This includes a little over $1 billion of previously announced dispositions, including $740 million from our Invesco MOB joint venture and $675 million of under contract dispositions announced last night in our earnings release.

On acquisitions, as always, our initial guidance only includes acquisitions closed or announced which totaled $1.1 billion as of today's call, made up of $320 million that has already closed and approximately $820 million of remaining MOB transactions that will close in the first half. Lastly, on developments, we are approaching an inflection point with our development pipeline as it pertains to spend relative to deliveries. We are relatively light year on the delivery fund for the first 3 quarters of the year before delivering $210 million of our $302 million of full year deliveries in the fourth quarter.

In 2020, we will deliver another $714 million of deliveries against $468 million of spend. So as this development portfolio starts to run out a little bit, we'll feel a bit of near term dilution, specifically from the show part of our development pipeline as you will have $400 million of deliveries from the fourth quarter of '19 through year-end 2020, creating $0.02 per share of drag on FFO for 2020 before stabilizing over the next 2 years at positive 6% to 8% of FFO contribution per share.

Development pipeline upside beyond 2020 along with upside from transitions and the continued recovery in senior housing are what makes us optimistic well beyond 2020 as our portfolio is positioned exceptionally well to benefit from the demographic trends across all of our geographies.

And with that, I'll turn the call back over to Tom.

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [6]

--------------------------------------------------------------------------------

Thanks, Tim. So you've heard us repeat the word, optimism throughout our prepared remarks this morning. This is sincere. The green shoots from our core portfolio we saw in late '18 that grew in 2019 are fueling this optimism. Our singular strategy to align with major health systems have been validated and we are mining many interesting investment opportunities that will enable accretive growth and drive shareholder value. We look forward to talking more about this with you throughout the year. Now Liz, please open up the line for questions.

================================================================================

Questions and Answers

--------------------------------------------------------------------------------

Operator [1]

--------------------------------------------------------------------------------

(Operator Instructions) Our first question comes from the line of Steve Sakwa with Evercore ISI.

--------------------------------------------------------------------------------

Stephen Thomas Sakwa, Evercore ISI Institutional Equities, Research Division - Senior MD & Senior Equity Research Analyst [2]

--------------------------------------------------------------------------------

I guess, Shankh, first on just the acquisition environment and kind of the pipeline, could you sort of give us a sense for how big the pipeline is today versus, say, 6 to 12 months ago? And in what areas is it sort of most robust?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [3]

--------------------------------------------------------------------------------

Thank you, Steve. The pipeline is as big as we have felt this time, really throughout the year, but particularly relative to last 12 months, the pipeline is significantly bigger. As I told you in my prepared remarks that the pipeline is focused on 2 areas, one is on the senior housing side, the other is our deals that are sourced through our relationship with health systems where mostly you will see that this year other than the transaction that we have made or we have shaken hands 12 months ago or 6 months ago plus will be mostly out of the MOB market this year. So senior housing and health system transactions directly with the systems.

--------------------------------------------------------------------------------

Stephen Thomas Sakwa, Evercore ISI Institutional Equities, Research Division - Senior MD & Senior Equity Research Analyst [4]

--------------------------------------------------------------------------------

And is there anything without getting specific, can you share anything just about pricing trends or cap rates kind of as you look to deploy capital versus maybe where you spent capital in 2019? Are things better, getting tighter?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [5]

--------------------------------------------------------------------------------

So on the senior housing side, if you look at sort of the top end, really pretty assets, really good markets, very good operators, cap rates are extremely tight and they have gotten really tighter in the last, say, 12, 18 months, particularly last 6 months, the transaction we announced yesterday sort of shows you that. On the other hand, we're seeing the emergence of distress in memory care and in markets where you saw the first burst of supply in '15, '16, '17. Everything in the middle is sort of -- it depends, right? If you look at our pipeline and look at our history, you will see that we grow with our operating partners with a development to our off-market acquisition, 1 or 2 assets at a time and that market remains extremely favorable. So we have a lot of either very small portfolios or a lot of one-off assets, 2 asset, 3 asset that in the pipeline that adds up to a big volume, but that's where we get our pricing and that becomes very accretive. So we're very, very optimistic. Very, very optimistic about the deal pipeline this year.

--------------------------------------------------------------------------------

Stephen Thomas Sakwa, Evercore ISI Institutional Equities, Research Division - Senior MD & Senior Equity Research Analyst [6]

--------------------------------------------------------------------------------

Okay. And then just one follow-up for Tim. I appreciate all that commentary. I couldn't quite get all the numbers. So I might have missed an exact spread. I think you said that the developments do help boost same store a little bit and that you're almost putting a second number out there. Can you -- so can you just quantify what same store, I guess, is being boosted by in 2020 just from the developments?

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [7]

--------------------------------------------------------------------------------

Yes. So Steve, the numbers that I gave were 1% to -- 1% to 2.5% range for our total show portfolio, so 1.75% midpoint. And at that midpoint, it assumes the stable portfolio grows at 1.25%.

--------------------------------------------------------------------------------

Operator [8]

--------------------------------------------------------------------------------

Our next question comes from Jonathan Hughes with Raymond James.

--------------------------------------------------------------------------------

Jonathan Hughes, Raymond James & Associates, Inc., Research Division - Senior Research Associate [9]

--------------------------------------------------------------------------------

Tim, thanks for walking through your same-store definition policy and providing the slide deck on the site. I was hoping you could give us maybe this REVPOR occupancy and expense growth components embedded in your SHOP NOI growth guidance?

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [10]

--------------------------------------------------------------------------------

Jonathan, I'll take that. So as we talked to you about this before, the 3 big variables which moves where we land on the same-store NOI growth, obviously that's occupancy, that's pricing and obviously labor, right? I mean, they are the 3 major components. Without getting into too much on how those things will obviously change each other or influence each other, I want you to sort of think about is what we have seen in last, call it, 4 to 6 quarters, you will see flattish to slightly down occupancy and you will see 3-plus percent growth in the rates and we will see what we get on the labor side. As I said, 2 quarters doesn't make a trend. We're not assuming that trend will continue. But if we do get some help on the labor side what we have seen in fourth quarter, if that continues, obviously, that will be upside.

--------------------------------------------------------------------------------

Jonathan Hughes, Raymond James & Associates, Inc., Research Division - Senior Research Associate [11]

--------------------------------------------------------------------------------

Okay. And so we can kind of extrapolate maybe the past couple of quarters and roll that forward and that gets to your embedded guidance. Any difference in the noncore portfolio?

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [12]

--------------------------------------------------------------------------------

No. We have the noncore portfolio. Obviously, there's a significant difference of performance. I'll give you an example. Just in fourth quarter -- again, don't take one quarter and run with it. But just if you look at U.S., in fourth quarter, large core U.S. markets were up 3.5%, 3.4% to be specific in NOI and other smaller markets were down 2.5%. There's a significant difference of performance between large core U.S. markets versus smaller markets and we're seeing that. So I don't know exactly where that will get to. But I suspect that you will see a big difference between the 2 as we roll through 2020.

--------------------------------------------------------------------------------

Jonathan Hughes, Raymond James & Associates, Inc., Research Division - Senior Research Associate [13]

--------------------------------------------------------------------------------

Got it. That's great. And then just one more for me. Tom, you talked about your partnerships with health care providers and capabilities in the prepared remarks, but was hoping you could talk about how your new partners, specifically the senior housing partners describe value to gaining access to your data analytics platform. I mean, the world's awash in capital. I think a lot of these operators can go out and admittedly find cheaper sources, but clearly, they come to you to gain something others don't provide. So I'm just trying to figure out how us as outside analysts and investors ascribe value to this part of your business because it is so unique?

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [14]

--------------------------------------------------------------------------------

Well, thanks, Jonathan. I'd say that it's helping our senior housing operators understand where to focus because we can provide them such granular information about their target populations. It really helps them become much more efficient and effective senior housing operators. And we're now taking this expertise and bringing it to health systems. Health systems are now working with us to figure out how they can build market share in certain markets that are important to them. And this is a tool that they've really not had in their arsenal before. So we see it as truly a differentiator. And I'd also say that our senior housing operators are also seeing the other capabilities we bring. I talked about the CareMore Anthem collaboration. That is a win-win for everyone involved including the resident, their families, the operator and from a senior housing operator standpoint, we see expanding the operating model of a senior housing facility by collaborating with third parties like a CareMore can drive occupancy and increase length of stay and may offer opportunities to enhance revenue. So we think that we're always focused on alignment, that you hear -- that's a word other than optimism you hear from us a lot, which is alignment. And it's not just talk, it's real. It's happening. And that's what's driving the senior housing industry. The people that see the future and know that the future of the senior housing industry is not what exists today for the most part and they want to be -- work with Welltower.

--------------------------------------------------------------------------------

Jonathan Hughes, Raymond James & Associates, Inc., Research Division - Senior Research Associate [15]

--------------------------------------------------------------------------------

Okay. Yes, I mean, from us and the outside, it's just trying to understand how maybe we price that into the metrics that we see in terms of the yield on new partnerships.

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [16]

--------------------------------------------------------------------------------

Yes. And Jonathan, it's early days. I think you'll start to see, it's going to help you, I think and over time, we'll point you to where we're expanding the service model in senior housing through these types of collaborations. And there -- you should be able to see better performance. So that will -- again, it's early days. But as I said earlier, we're starting to roll these programs out into multiple markets across the country. And I think that's when it will be more tangible.

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [17]

--------------------------------------------------------------------------------

Jonathan, just -- these things are hard to model. But I would -- just one way could -- to think about it could be that if you look at just in the last 18 months, we've talked to you about 8 new operators. Right? I mean -- and to your point, they're coming to work with us because of our -- these capabilities, not of our cost of capital, right? Where there's significant cheap sources of capital. The world is awash with capital, it is our -- these capabilities. So you can -- one way is to think about it, you can think, like how many of those operating partners that we may or may not be able to get over a period of time and then think about how our ongoing investment with them, as I mentioned, in 2019, earlier in the year, we sort of announced our batch of 2019 partners. And so far today, as of today, we have invested more with every one of them. So that's sort of what gives you a sense of, if you're trying to get a sense of what the platform is what, as Tom talked about, the platform is what more than just the asset and obviously that's the way you can get to the platform well. So that might be one way to think about that.

--------------------------------------------------------------------------------

Operator [18]

--------------------------------------------------------------------------------

Our next question comes from Nick Joseph with Citi.

--------------------------------------------------------------------------------

Nicholas Gregory Joseph, Citigroup Inc, Research Division - Director & Senior Analyst [19]

--------------------------------------------------------------------------------

Maybe just sticking with partnerships. Tom, what should we expect in 2020 from the Jefferson one?

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [20]

--------------------------------------------------------------------------------

Well, we're hopeful in 2020, you will see kind of the first stage of a joint venture around some of their ambulatory assets. That is something that we are currently working with them on, they've identified some of the assets that will go into that joint venture. So I would expect you will see that this year. And then the next piece of it is bringing Jefferson's services into our senior housing and post-acute portfolio in the greater Philadelphia region. We have a concentration there. We have 20,000 lives, particularly 20,000 lives of people that are mostly paying out-of-pocket to live in high-end senior housing is a very important population to Jefferson. And that's one of the keys here. I think you're going to start to see more health system presence in this -- in our senior housing portfolio. It's happened already. But I think with respect to Jefferson, it will start to be -- it will start to be driven at scale because there's such a large system and we have a large portfolio. So I'd expect you'll see that in 2020. Some of the other aspects of our relationship are a little bit more longer term focused. I talked about -- you've heard us talk about our Clover housing model, concepts like that, that might include Jefferson clinical from -- particularly from a primary care standpoint, being co-located in those types of communities is something that we are very actively looking on because again, Jefferson talks about health care with no address. That is allowing them to push out their products and services outside the hospital campus, and that's very much a focus of what we're doing together.

--------------------------------------------------------------------------------

Nicholas Gregory Joseph, Citigroup Inc, Research Division - Director & Senior Analyst [21]

--------------------------------------------------------------------------------

That's helpful. And then, Shakh, just on MOB cap rate compression that you've seen there. Can you put some numbers around that? And then who are those incremental buyers that are driving cap rates down?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [22]

--------------------------------------------------------------------------------

I mean, I'm not going to give you numbers. You have seen some very aggressive trades in recent times. Again, if you look at our -- what we're closing that I've talked about in real estate transaction, you should take everything with a 6 to 9-month delay. So think about the announcement sort of we made during NAREIT and you should -- we should date that back 6, 9 months ago, right? So the cap rates are tight, they're coming down, a lot of public REITS, institutional owners, private equity, I don't want to specifically name someone, but the whole point is we -- as we said several times, we think that our bogey that we have to hit on an unlevered IRR basis is 7% or pretty close to that. And we think that asset class -- if that asset class gets priced somewhere in the 5% close -- low 5s or 5%, that makes absolutely no sense for our investors. So if the pricing gets there, we'll stay away. If the pricing remains sort of mid- 5s, we will be active.

--------------------------------------------------------------------------------

Operator [23]

--------------------------------------------------------------------------------

Our next question comes from Rich Anderson with SMBC.

--------------------------------------------------------------------------------

Richard Charles Anderson, SMBC Nikko Securities Inc., Research Division - Research Analyst [24]

--------------------------------------------------------------------------------

So want to talk about your peers and you and the same-store discussion, Tim, that you went through. I'm just reading the tea leaves, and it seems like maybe you were involved in a kind of cooperative process to get on an equal playing field. I don't know, maybe were involved. Could you just describe if in fact, you weren't -- what were the holdups that didn't sort of get you to a point where you wouldn't end exact agreement with your peers, namely Ventas and PEAK? And is there a chance that we'll get there at some point in the future, so that we do have this sort of more agreeable sort of environment among the 3 of you on that topic, specifically?

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [25]

--------------------------------------------------------------------------------

Rich, it's Tom. Let me jump in on that first, then we'll see if Tim has any additional comments. Look, I'd say that Welltower has had a same-store policy for years. In that policy, and our adherence to that policy is reviewed quarterly by our audit committee. By the way, this policy applies across all asset types at Welltower beyond senior housing to triple net, MOB and the others. So yes, you refer to the chatter about same-store senior housing policy, which I suspect has much to do with the significantly stronger performance of our assets versus the others you mentioned. Look, I hope our earnings results that we report today that we've reported throughout the year, and the fact that we proactively dealt with our problem children over the last 3 years, speaks to the quality differential. And so you saw that we posted the policy that we've had in place for a number of years. You can have -- take a close look at that. You can talk to Tim about that. We're a very different business. We are a very development focused business. The type of senior housing assets that we'd like to buy don't exist, so we have to build them, and we're the ones who are driving that process. So I don't think we're talking apples-to-oranges here necessarily in terms of senior housing portfolios. And I hope that we are putting this matter to rest because it's not a productive discussion.

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [26]

--------------------------------------------------------------------------------

Yes, Rich, and I would also like add to that. The intent of the conversation, I think the alignment around it is that the intent to bring more information to investors, transparency, comparability and the rest of it. And I think you're seeing some positive outcomes from that. And I think from our presentation or the outline of our historical policies that we put out last night, I think you'll see there's a lot of familiarities between policies and what our commitment is to continue to provide investors with information they need, particularly as it pertains to kind of differentiating quality between portfolios.

--------------------------------------------------------------------------------

Richard Charles Anderson, SMBC Nikko Securities Inc., Research Division - Research Analyst [27]

--------------------------------------------------------------------------------

Okay. So like total portfolio versus just the SHOP portfolio?

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [28]

--------------------------------------------------------------------------------

Well, I think that's -- part of it is part of our thought is that total portfolio is the focus, right? And having what we posted last night is our total portfolio approach. And that's -- I think the idea is that you buy Welltower because of our -- the exposure we have across all of our asset types and what that does to the consistency of our cash flow. And so just say a more wholesome approach gives you a better view of how that entire business is operating.

--------------------------------------------------------------------------------

Richard Charles Anderson, SMBC Nikko Securities Inc., Research Division - Research Analyst [29]

--------------------------------------------------------------------------------

Okay. Tom, early in the conversation, you said sometimes things don't work out, that's life in business and generally. Can you give an example where something didn't quite work out the way you'd hoped, but that you had dialed in protection mechanisms at the point of the negotiation to protect the downside and protect your investors? Do you have 1 or 2 in mind where that, in fact, has happened?

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [30]

--------------------------------------------------------------------------------

Yes, but I wouldn't be able to tell you specifically about that. But yes, that's one of the reasons why our performance is better. But I'm not going to call out specific operators on this call, but I will tell you that we give our operators an incentive to outperform. And that -- when you work with the right people, it's -- hopefully, that's driving the performance versus the downside protection. We don't go into any arrangement hoping that we're going to be able to pull the downside protection lever.

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [31]

--------------------------------------------------------------------------------

We -- Rich, this is inappropriate conversation to call people out on the call, but we're happy to talk to you offline, but think about how we have changed the business on how -- what our RIDEA 3.0 structure is, it's very much laid out for that downside protection. It also significantly provides upside participation. If you think about how we have moved away from -- I'll give you another example, which is, obviously, it's very easy to think about senior housing, but just think about what we have done on our loan books, right, which essentially we have cut it in half. We don't make OpCo loans anymore. We don't make this kind of lending money to operators or lending money at the OpCo level. Why is that? It's because the downside protection will be that if you are a lender in a specific asset or a box, you should be able to take over that box, if things don't go right. We are a REIT, we're not allowed to own an OpCo, right, completely. So the fundamental idea behind these kind of loans are flawed, so we don't do that anymore. So that's why you see that our loan book has come down. But anyway, I hope that those 2 examples sort of gives you some idea as to in what line to think about. We're happy to just speak with you offline.

--------------------------------------------------------------------------------

Richard Charles Anderson, SMBC Nikko Securities Inc., Research Division - Research Analyst [32]

--------------------------------------------------------------------------------

Yes. I didn't mean to put you on the spot there. But I thought the good example is ProMedica, which had its downgrades and all that, but yet here you are producing or they're producing over 2x coverage versus the 1.8x starting point. So I think that would be one example, no fault to them. It just was a function of you guys setting that up well. So I just wanted to...

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [33]

--------------------------------------------------------------------------------

That's a credit transaction that we're protected by the credit at the parent level.

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [34]

--------------------------------------------------------------------------------

And it's a very good example of this organization, which is not-for-profit health system, but has an extraordinary business mind. If you've seen just in what happened in the insurance business last year, they have taken really tough calls and exited business. You don't generally see that in a not-for-profits, right? They said they made that promise to their bondholders and they did it. They executed. If you go back and look at the presentation that they presented at the JPMorgan Healthcare Conference, that lays it all out. So a very, very good example. That's where our interests are aligned, and you will see that we'll continue to grow with them.

--------------------------------------------------------------------------------

Richard Charles Anderson, SMBC Nikko Securities Inc., Research Division - Research Analyst [35]

--------------------------------------------------------------------------------

That's coming from a guy who didn't like it very much at the outset, so good for you.

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [36]

--------------------------------------------------------------------------------

We honestly have that.

--------------------------------------------------------------------------------

Operator [37]

--------------------------------------------------------------------------------

Our next question comes from the line of Derek Johnston with Deutsche Bank.

--------------------------------------------------------------------------------

Derek Charles Johnston, Deutsche Bank AG, Research Division - Research Analyst [38]

--------------------------------------------------------------------------------

The $740 million SHOP portfolio that is subsequent to quarter's end slated for sale, can you give us some more details, including what percentage of these assets were already converted to the RIDEA 3.0 structure or have they not been? And then also, what percentage of your going forward SHOP operators have been converted to the new structure?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [39]

--------------------------------------------------------------------------------

Thank you very much. Very good question. It's a transaction in process. So I'm not going to get into too much of what the transaction is. I will tell you that this is not a portfolio in RIDEA 3.0. And the second thing I will tell you about this is, the buyer of this portfolio is an extraordinarily smart and very well-known institutional investors. We have a tremendous amount of respect for them, and we do a lot of business with them in different places. So we think not only that this is a great transaction for us, we think this is going to be a fantastic transaction for their investors. About 80-plus percent of our operators today, a number of operators today are in that RIDEA 3.0 operating system.

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [40]

--------------------------------------------------------------------------------

Derek, what I'll add to that is, perhaps when you see high-quality portfolios being sold by Welltower, that may be an indication that, that operator was not interested in a RIDEA 3.0 structure, perhaps.

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [41]

--------------------------------------------------------------------------------

As a general comment.

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [42]

--------------------------------------------------------------------------------

As a general comment. So that's something you should consider as to why we might choose to sell some portfolios that look to be and are very, very strong portfolios of real estate.

--------------------------------------------------------------------------------

Derek Charles Johnston, Deutsche Bank AG, Research Division - Research Analyst [43]

--------------------------------------------------------------------------------

Okay, very helpful. Just switching gears quickly to health systems. I noticed the same-store NOI assumption of 2% growth. I mean, I think this is the first time you're including this in guidance. So I guess, while the health system build-out is in the early days and the growth rates may be initially lower and possibly ramp over time, the question is, what do you feel will be the long-term growth rate of the health systems?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [44]

--------------------------------------------------------------------------------

So Derek, so that is -- obviously, that bucket is, if you think about it, it's the ProMedica bucket. As you know, the first year, the escalator was 1.35% -- 1.375% and going forward it's 2.75%. I believe we closed the transaction on July 26, so you have a mix of 1.375% and 2.75%, but when you get the full year, you will get to 2.75%. So part of the year is 1.375%, part of the year 2.75%, going forward 2.75%.

--------------------------------------------------------------------------------

Operator [45]

--------------------------------------------------------------------------------

Our next question comes from Vikram Malhotra with Morgan Stanley.

--------------------------------------------------------------------------------

Vikram Malhotra, Morgan Stanley, Research Division - VP [46]

--------------------------------------------------------------------------------

Shankh, you referred to sort of the senior housing barbell approach. And obviously, in other asset classes, you can think of multifamily as ABC and other asset classes different breakups. But just curious, as you described, the part of the barbell that you've just started building, can you talk about how competitive that market is pricing? What type of structures you may be employing similar to sort of the RIDEA 3.0 that you've done for the existing portfolio. Just kind of walk us through how to think about that market from -- in terms of differences, in terms of pricing and structure?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [47]

--------------------------------------------------------------------------------

Yes. I'll be sort of describing to you on a high-level basis what I meant by barbell approach. If you think about just purely from a pricing perspective, on the high end, you can pass the labor inflation that's been happening and across the market. But if you think about, generally speaking, across all markets, wages have been going up, whether that's sort of a move -- a minimum wage somewhere closer to $15 or whatever that metric is for a given market or just general sort of a lift in wage because of low unemployment, that is happening across the board. In certain markets, in high end markets, you can pass that to your consumers and your consumer understand that's the case, right, that you are not just jacking up rate because you want to jack up rate, they understand there's so many people who serve them and the wages are going up meaningfully.

In other markets where I'm talking about is the lower end, sort of, we call, lower rent market where you don't have a lot of people, it's a low service model. So higher margin, you don't -- you're not impacted by sort of the people and of the inflation that much. So we think somewhere in the middle the problem is, you were still facing the labor and a move towards that $13, $14, $15, yet you don't have the price to justify that. That's sort of a dichotomy today, is the first time we're seeing, irrespective of markets, labor growth has been pretty much towards a much higher number than they have been. So you've got to concentrate on the market where you can do pass that pricing or you have to be in markets where you are not providing that 1:1 hands-on-hands care, and you are sort of a low service model. So that's sort of we're focused on.

Now just addressing your next question, sort of what you're asking for, what are we doing on the lower service model side? Remember, these are apartment assets, effectively seniors apartment. And as a REIT, we can own apartments and have complete control. We don't have to get into a RIDEA 3.0 type structure where there is what we're allowed to own as part of the OpCo or not, that does not apply for those kind of assets. You have a much higher level of control there.

--------------------------------------------------------------------------------

Vikram Malhotra, Morgan Stanley, Research Division - VP [48]

--------------------------------------------------------------------------------

Great. And then, Tim, could you just clarify the -- you mentioned the 50 basis point delta between the same-store portfolio growth, and then applying that sort of stabilized layer on to it. Can you just clarify, I may have missed this, I dialed in late, when you say stabilize, what are you sort of excluding because the development properties, I think you laid out, they come in post 5 quarters?

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [49]

--------------------------------------------------------------------------------

Correct. So the development properties come into the pool post 5 quarters, so we've got a duration based rule on that. And they don't -- what we said is, we -- they don't stabilize for this metric purposes until they're in for 9 quarters. And in my prepared remarks, I went through some of the reasons for that. So the nonstabilized portion or the -- of the same-store portfolio is made up of those assets that have entered the pool, but haven't hit that stabilization point.

--------------------------------------------------------------------------------

Vikram Malhotra, Morgan Stanley, Research Division - VP [50]

--------------------------------------------------------------------------------

For 9 quarters. Okay. And what is the stabilized number for 2019?

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [51]

--------------------------------------------------------------------------------

The stabilized number to 2019 is 150 basis points lower than our 2.7%.

--------------------------------------------------------------------------------

Vikram Malhotra, Morgan Stanley, Research Division - VP [52]

--------------------------------------------------------------------------------

Okay. Great. And then, Tom, just one last one. You've talked a lot about the partnerships with the health systems kind of how -- what shape Jefferson may take. I'm just sort of curious as to how long that sort of partnership took? What were sort of the pushbacks? And do you see this as being -- what type of systems do you think would be more open to this sort of partnership?

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [53]

--------------------------------------------------------------------------------

Very good question, Vik. These partnerships take a long time because you have a myriad of people internally that you need to deal with and establish credibility with, and there's also boards involved. And I think one of the things that made Jefferson successful is that we had established relationships and credibility amongst the management team as well as with the Board of Jefferson. But these are not quick, they put an RFP out and you're responding to it. These are very nuanced relationships that take time. And so there are a number of them simmering on the stove right now that look like Jefferson. I mean, the fact is that truly the high AA+ health systems for the most part will believe that they're better served by raising debt in the capital markets. We try to remind them that debt has to be paid back. We have a -- we're offering them a long-term solution to help them grow, not that they won't take advantage of low interest rates in the debt market, but we're just another oar in the water of capital. So I would tell you that there are some relationships we have been developing that some may look like the Jefferson partnership and some might look a bit different. So I would just say stay tuned, but we're actively -- this is an area that we've been very actively engaged in for many years.

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [54]

--------------------------------------------------------------------------------

I'll just add one thing, Vikram, if you think about, there are health systems who still believes that health care should be delivered primarily within the confined 4 walls of the hospital. And so they probably will have a different tact versus a lot of health systems believe that health care needs to be out in the community or in where people live and sort of they have more of a comprehensive approach to health and wellness. And you will see more of them will be our partner.

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [55]

--------------------------------------------------------------------------------

Yes. It's beyond cost of capital. If it's just cost of capital, some health systems have a very low cost of capital. This is broader than that. And I think that is an element of why anyone does business with Welltower. There's a broader value proposition that we present. It's not just about cost of capital, and that's why we're growing the way we're growing through off-market transactions because if someone's going to put out an RFP and wants to get the lowest priced capital, well, sometimes maybe that might be us, but that's not how we're thinking about growing our business.

--------------------------------------------------------------------------------

Operator [56]

--------------------------------------------------------------------------------

Our next question comes from Jordan Sadler with KeyBanc Capital Markets.

--------------------------------------------------------------------------------

Jordan Sadler, KeyBanc Capital Markets Inc., Research Division - MD and Equity Research Analyst [57]

--------------------------------------------------------------------------------

Just moving to the SHOP portfolio for a second. Can you talk about the new lease spreads versus renewal increase that are baked -- renewal increases that are baked into the guide for 2020?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [58]

--------------------------------------------------------------------------------

We'll just tell you, Jordan, that we think that we're going to get overall pricing above -- our expectation is our pricing trends will remain very strong. The spread between new lease and renewal differs from operating partners to operating partners, building to building. So it will be an impossible task to get into that. But generally speaking, people usually don't leave our exceptional communities, which provide exceptional care, just for a small increase of price that is justified by what is happening in the labor market.

--------------------------------------------------------------------------------

Jordan Sadler, KeyBanc Capital Markets Inc., Research Division - MD and Equity Research Analyst [59]

--------------------------------------------------------------------------------

So I mean, I know there's -- obviously, there's a pretty broad disparity probably also in terms of same-store NOI performance across the portfolio. But I'm just kind of thinking blended across the portfolio, if there's any granularity you could offer in terms of what's sort of happening on a mark-to-market basis upon re-leasing?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [60]

--------------------------------------------------------------------------------

Yes. So let me tell you about the disparity. I talked about the disparity of operators from an NOI perspective, right, mid single-digit negative to double-digit positive. And not just -- I'm not speaking the endpoints here, just give you a pretty big granular difference there. Let's talk about pricing. We had 1 operator who has seen pricing in the mid-5% range, bunch of operators have seen pricing in the sort of the 4% to 5% range, and a lot of people have seen that sort of 2% to 3%, 3.5% range. That sort of gives you the broad spectrum. I've seen one that has the sort of the lowest of 1%, 1.5%, but that sort of gives you the range.

The second question you asked is on a mark-to-market, remember, what happens on an overall cost basis, you come in at an assessment level, over a period of time, that assessment goes up, right? So from a care revenue perspective and eventually to say there are care levels of 1% to 5%, I'm making this up to make a point. You come in at a 2%, but you leave at 4%, 4.5%, there's always a difference of pricing on care on a mark-to-market basis because the next person coming in is at 2% to 2.5%, right? So -- but from a -- so what we are seeing, and we have seen, this is no secret to anyone. We try to keep the level same. So we -- the higher acuity people leave, low acuity residents come in. So mark-to-market on the care side is always negative.

On the real estate side, remember, there's 2 price, right? The rent side, we're seeing rental increases across the board pretty much that sort of mirrors what I told you, the market rent, I'm talking about, mirrors what I've talked about on the pricing side. So that gives you a sense of what happened.

--------------------------------------------------------------------------------

Jordan Sadler, KeyBanc Capital Markets Inc., Research Division - MD and Equity Research Analyst [61]

--------------------------------------------------------------------------------

Shankh, I'm sure you've done this work with your data team. Would you share what the seasoning impact, if you will, is on same-store NOI growth from just basically folks aging in place across the portfolio? Acuity of care rising?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [62]

--------------------------------------------------------------------------------

Yes, I will take that up with my team and talk to you offline.

--------------------------------------------------------------------------------

Jordan Sadler, KeyBanc Capital Markets Inc., Research Division - MD and Equity Research Analyst [63]

--------------------------------------------------------------------------------

Okay. And then one other, just PDPM. Tim, obviously, you pointed out, nothing in the quarter. Any early comments in terms of what you're seeing across the health system portfolio and/or with Genesis, just basically in your conversations with these tenants/partners? And then perhaps expectations coming from CMS regarding recommendations for reimbursement come April?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [64]

--------------------------------------------------------------------------------

Yes. So first is, I think it's too early to comment on what the impact of PDPM. So we -- first, sort of that's something it will take time for everybody to understand, and it will have different impact on different platforms, very different impact. So that's sort of -- I'm not going to engage into that and pretend I know exactly what's going on. I will tell you that this is exactly why we don't want to do, and that's why we structured the HCR ManorCare lease in the way that we did. We do not pretend that we are an expert in CMS rate increases on an annual basis, we're just not. Second, categorically, given that I told you that we are obviously not an expert, we'll stay away from what might or might not be coming. I will just remind you that, generally speaking, as I said, across the board, we're seeing stabilization of that business. That business has been pretty much under attack for years and years. I think our regulators understand that. There's a lot of bankruptcy filings in that sector over the last 2 years. I think regulators understand that, that is very much of a needed sector, and our health system partners will tell you that, that is very much of a needed sector. I think whatever happens, I have zero insight and whatever happens will be reasonable and will have an impact, positive or negative, differently on different platforms.

--------------------------------------------------------------------------------

Operator [65]

--------------------------------------------------------------------------------

Our next question comes from Joshua Dennerlein with Bank of America Merrill Lynch.

--------------------------------------------------------------------------------

Joshua Dennerlein, BofA Merrill Lynch, Research Division - Research Analyst [66]

--------------------------------------------------------------------------------

Curious, how involved are you guys in the site selection of the new related Atria development in the Hudson Yards?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [67]

--------------------------------------------------------------------------------

The specific one or in general?

--------------------------------------------------------------------------------

Joshua Dennerlein, BofA Merrill Lynch, Research Division - Research Analyst [68]

--------------------------------------------------------------------------------

I guess, just with that partnership, like, is it your data team kind of leading the charge on, like, "Hey, these are good sites. These are what you should consider?" Just curious on that front.

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [69]

--------------------------------------------------------------------------------

So generally, the way it works that you have an extraordinary related team of professionals that led by Bryan Cho related who leads this particular vertical. Bryan interacts with my team and works with the data team directly, it's a 2-way process. They are extraordinarily good developer who look at whether they find a site or we find a site, we look at it. Then what we do is we run that through our analytics process, see demographically, psychographically, what it looks like, why this is different. And this is a 2-way process. So -- but you're correct that every site -- possible site we look at, we do it through our -- that goes through our analytics process and we then debate. I'll give you an example. For example, in D.C., we have so far passed on several pieces of parcels because we couldn't get to what we're actually trying to build. So there is a lot of sausage making goes on. And obviously, our data analytics team is very much part of that in the front end from the very beginning.

--------------------------------------------------------------------------------

Operator [70]

--------------------------------------------------------------------------------

Our next question comes from Daniel Bernstein with Capital One.

--------------------------------------------------------------------------------

Daniel Marc Bernstein, Capital One Securities, Inc., Research Division - Research Analyst [71]

--------------------------------------------------------------------------------

I want to go back to the comment you made about owning, operating, your -- the lower end businesses, the senior apartments, maybe independent living. There's a lot of competition in the apartment space, Greystar, other private equities, Carlyle. How do you think about the risk of that sector, given the competition versus the opportunities? And maybe how do you think about creating and building your own Welltower brand within that segment?

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [72]

--------------------------------------------------------------------------------

So Dan, 85% of seniors have incomes of less than $50,000 a year. And surprisingly, there's very little product for that population. A lot of the independent living you've been referring to sells at a premium to other multifamily in the market. And that is not what we are doing at Welltower. There may be markets where we will bring a premium independent living product because the demand is there for that type of a product. But when we talk about some of the markets in this country, that we're -- that we currently own assets in, these are addressing a tremendous unmet need. And the opportunity for people to live in safe housing that is designed to accommodate a long arc of aging with rents of $900 to $1,200 a month, that is -- there's a tremendous opportunity there. And what we're doing is, when we can connect that housing concept with a payer because these are people that are on Medicare Advantage plans, and when you can work together with the Medicare Advantage plan, you can really help them reduce risk and hopefully create better environments for this population to live in. This is a population that's never going to be able to afford to live in seniors housing, at least the seniors housing that we own. This is a new asset class. And your point about will Welltower brand this sector? Stay tuned for that. You'll hear more about that this year.

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [73]

--------------------------------------------------------------------------------

Dan, if you have time, come over to New York at some point and sit down with our leader, who runs that business, Ayesha Menon, and understand how we are working and thinking through the exact same problems we talked about. But we're not focused on the high, high end of that business. So if you think about -- you talked about Greystar and others, I don't pretend to be an expert in Greystar's business. But my understanding is that they are focused on the higher end of that product, very high price point, $3,000, $2,500, something like that, if I understand correctly. We're focused on the lower end of that product, $1,000, $1,200, $1,500, so it's a different product.

--------------------------------------------------------------------------------

Daniel Marc Bernstein, Capital One Securities, Inc., Research Division - Research Analyst [74]

--------------------------------------------------------------------------------

Okay. That's actually really helpful to understand that. And I will take you up on your offer to come up to New York. One other quick question. MOBs have shown some improving occupancy. To get that occupancy, are you giving away any extra TI? Anything that might cause a little bit of drag on FAD AFFO? Or is that simply the MOB's locations next to a hospital and there's demand there, and that's driving the occupancy? Just trying to understand that a little bit better.

--------------------------------------------------------------------------------

Keith Konkoli, Welltower Inc. - Senior VP of Real Estate Services & Head of Outpatient Medical [75]

--------------------------------------------------------------------------------

Dan, this is Keith Konkoli. I would say we're -- or actually, our capital expenditures are below our historic experiences. So we're really not giving away any additional CapEx or improvements to get tenants into the spaces. We're really just very focused. Our team is really in the market canvassing the market. And it's really just driving activity through focus on the business, I would say, is what's really resulted in our increase in our occupancy.

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [76]

--------------------------------------------------------------------------------

Dan, one thing I'll tell you that your sort of question implies that a building being right next to the hospital is what gets them leased? I saw you at Revista. You probably have heard me saying that in the panel. We do not believe that on-campus MOBs are where the industry is and where the industry is going. We have sort of no horse in this race. We -- our portfolio is roughly half on-campus and roughly half off-campus. We do believe the consumerism in health care is real, and health care is moving to where people live. So it is asset by asset, system by system, relationship by relationship, but I want to make sure that you understand our view. Right or wrong, that's our view, and we do not believe that on-campus MOBs as sort of this asset class that we need to strive for. We just don't. We just don't think that's the model of health care, what the future is going to be.

--------------------------------------------------------------------------------

Daniel Marc Bernstein, Capital One Securities, Inc., Research Division - Research Analyst [77]

--------------------------------------------------------------------------------

That was certainly the view of Revista as well, I think so.

--------------------------------------------------------------------------------

Operator [78]

--------------------------------------------------------------------------------

Our next question comes from Michael Carroll with RBC Capital Markets.

--------------------------------------------------------------------------------

Michael Albert Carroll, RBC Capital Markets, Research Division - Analyst [79]

--------------------------------------------------------------------------------

Tom or Shankh, could you provide some color on that low acuity senior housing product that you guys have been talking about throughout the call. What type of investments should we expect out of there? Does this product exist today or do you need to really build most of it?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [80]

--------------------------------------------------------------------------------

We have invested significantly in last, call it, 12 months. We have invested close to $0.5 billion. Some of the products do exist, and our team has actually just closed a transaction of 3 assets in Vegas recently, actually the last couple of weeks. The products do exist, but not in terms of the acquisition volume that you'd expect from us because just what we are trying to address, you will see acquisition, you will see development, but I'm not willing to give you a number that would suggest that we have a target, which we don't, which is the most important point of the call. I read so much about -- 2 years ago, we were targeting RIDEA. We didn't. We actually -- you saw that when the price was right, we sold a lot RIDEA portfolio. These days, I see people say, we're targeting to buy MOBs. We don't. And we have been absent from that market. I already indicated to you, we'll be absent from the market probably this year. There is no target portfolio in our head that we're trying to get to. It is all an IRR-driven model. So I just want you to understand that it's a very important point, we're not trying to solve for an exposure. We're trying to invest capital. We're investors, not deal processor.

--------------------------------------------------------------------------------

Michael Albert Carroll, RBC Capital Markets, Research Division - Analyst [81]

--------------------------------------------------------------------------------

That makes sense. How many operators do you have right now that are focused on this. I know Clover is. And I think you mentioned, Mark. I guess, how many operators do you have that are focused on this type of product?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [82]

--------------------------------------------------------------------------------

We have a bunch of relationships that we are in discussions. You mentioned, obviously, Clover, but there are others. Too early to comment on how many people that we'll be doing business with. You will see more of this conversation as the year rolls. But I can assure you that we're in conversation. As I offered to Dan, come over to New York, sit down with Ayesha, she will be able to give you a much broader and more sort of accurate view of what's going on in the business.

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [83]

--------------------------------------------------------------------------------

Mike, I would say, at our Investor Day later this year, this will be an area of focus that we'll present. So you'll get a deeper dive on this business line later this year.

--------------------------------------------------------------------------------

Operator [84]

--------------------------------------------------------------------------------

Our next question comes from the line of Omotayo Okusanya with Mizuho.

--------------------------------------------------------------------------------

Omotayo Tejamude Okusanya, Mizuho Securities USA LLC, Research Division - MD & Senior Equity Research Analyst [85]

--------------------------------------------------------------------------------

So your initial guidance in regards to acquisitions and dispositions, actually has you guys set up as a net seller, at least to start the year. And I think, again, just kind of given your cost of capital, that's somewhat surprising to a lot of people. But at the same time, seeing the amazing prices you're getting on some of these sales also makes perfect sense. So the question I have for you, 12 months from now, do you guys kind of still see yourselves -- if you kind of look at the -- through the mirror and backwards looking, do you still see yourselves as a net seller for the year? Or do you kind of think, given your positive commentary on the acquisition front that you still kind of see yourselves as a net buyer by the end of 2020?

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [86]

--------------------------------------------------------------------------------

Tayo, we just gave 2020 guidance this morning, now you want 2021?

--------------------------------------------------------------------------------

Omotayo Tejamude Okusanya, Mizuho Securities USA LLC, Research Division - MD & Senior Equity Research Analyst [87]

--------------------------------------------------------------------------------

No. I'm trying to look at 2020 backwards, is what I mean?

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [88]

--------------------------------------------------------------------------------

Yes, I know. I'm kidding. No, I think you know this from how we give guidance, we're not going to speculate on acquisitions. And big reason for that is because acquisitions are cost of capital dependent. And so Shankh spoke to the optimism we have on that side of the business. But we're not going to -- certainly not going to put things in our numbers before they've been funded. So part of the reason you're correct in saying we're net sellers. We certainly -- we control the sales and we control the buy process of stuff under contract. But there's a reason we don't kind of put anything speculative in there, and so you've got an idea of what's driving our numbers. And I think you're likely correct that it would be surprising, given the current backdrop, that we would be net sellers. But that's what's currently driving our FFO outlook is that net seller.

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [89]

--------------------------------------------------------------------------------

If this current capital market stays where it is, I will be very, very surprised if we're not significant net buyer by the end of the year. Again, but it is capital-markets-dependent, it is opportunity-dependent, it is return-dependent.

--------------------------------------------------------------------------------

Omotayo Tejamude Okusanya, Mizuho Securities USA LLC, Research Division - MD & Senior Equity Research Analyst [90]

--------------------------------------------------------------------------------

Got you. That's helpful. And then ProMedica, again, great pricing there, in fact, amazing pricing there. Any thoughts around maybe monetizing more of the portfolio going forward?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [91]

--------------------------------------------------------------------------------

We are extremely, extremely happy with the relationship. That was an opportunistic sale. If there are more like that comes up, where ProMedica and we come to the same conclusion that we should take advantage of that, we'll do that. But in generally speaking, we're very happy with that relationship, and we will continue the relationship. But obviously, it's not get unnoticed and that sort of was the point that even Rich was trying to point to remember, we own this real estate. We're just not the only owner of this real estate. We own this real estate with ProMedica, we're 80% owner, they're 20% owner. They're as happy with this pricing as we are, and they are very sophisticated business people. So they are thinking about the same thing that you and I are. So we'll see where we'll get to.

--------------------------------------------------------------------------------

Operator [92]

--------------------------------------------------------------------------------

Our next question comes from Steven Valiquette with Barclays.

--------------------------------------------------------------------------------

Steven James Valiquette, Barclays Bank PLC, Research Division - Research Analyst [93]

--------------------------------------------------------------------------------

Just to come back to your comment on the flat trend for compensation per occupied room in senior housing, which is obviously encouraging. It kind of sounds like you were hopeful that the improving trend would stick, but you didn't have perfect visibility on it. I just wanted to drill in a little bit deeper on what you think are the primary drivers of that improvement, whether it's just serendipitous or is it related to some specific programs where you're getting some early traction, but maybe it's just too early to declare victory on sustaining those trends? Just any extra color would help.

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [94]

--------------------------------------------------------------------------------

I wanted to understand my comment. I said sequential trend on the labor cost was flat. It is a sequential comment, not a year-over-year comment. I will -- I do not want you to think that labor cost is being flat. My whole point was, on a sequential basis, and perhaps, just perhaps the second derivative of that growth is somewhat flattening. So it is still a big number that's going big time. Maybe the rate of growth what we have seen in last 3, 4, 5 years, hopefully, that is not going to be as bad as we have seen. It is a combination, and that is a hope. I specifically said that we did not put that in our guidance. So if we do get that, it will be an upside to our numbers, but we did not obviously model that because it could just be something serendipitous, as you said. There's a lot going on. If you go back about 4 quarters ago, I talked about different technologies that we're experimenting with and rolling out in different operating platforms. I think I specifically mentioned the use of one such that has helped one -- our largest operator, Sunrise, to reduce the turnover 30%. So we are not sitting on our hands and trying to get to -- somehow trying to outperform the market. We're trying to add alpha through technology and sort of that's where I will end. Tom?

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [95]

--------------------------------------------------------------------------------

Steve, you saw that Philips put out a press release a few months ago about the collaboration with Welltower at 56th Street. This building will have technology that no one in the senior housing industry has ever seen. We're hoping that this technology, which will help monitor the needs of that population and anticipate their needs, will, over time, be able to have -- allow us to have more efficient labor models around how we manage this population. When I took this job at -- when I came off the board to be the CEO here, I remember the management team saying, "Wow, this is such a great operator. They have 2 FTEs to every resident." And I remember thinking, "that's a good thing? That's not a good thing. That is not sustainable." And so we're looking for how do we improve resident experience in care and do it at a lower cost of labor. And the only answer we can think of is technology. And the fact is we're going to have a great example to look at, which I know is just a few blocks from where you work, Steve. So we'll have a chance in the later part of the spring, early summer to have you see what's happening there. But we're excited about that. That's part of what we think we need to do as a company. This is -- we're advancing this. This is not happening in the industry. It's happening because Welltower is using its tentacles and relationships to challenge the historic operating model in what was essentially a hospitality business, which has really become part of the health care continuum. That has been something we've done. That's not happening in the industry. So stay tuned for more of that.

--------------------------------------------------------------------------------

Steven James Valiquette, Barclays Bank PLC, Research Division - Research Analyst [96]

--------------------------------------------------------------------------------

Okay. Also, I mean, I definitely got the sequential part, by the way. I mean, on Page 3 in the supplement, you can see kind of the raw dollar numbers on compensation, flat sequentially and then up about 3.5% year-over-year, which is a little bit better than the 4% to 5% that gets talked about. Also just final thing on this subject, I was going to suggest a little bit tongue in cheek that perhaps you're grabbing all of the therapists that are being laid off in the skilled nursing sector because of PDPM, and you're reemploying them at lower wages into assisted living, but obviously it's not that simple. But could that at least be a general factor in supply/demand dynamics around skilled labor overall or do you think that's not really a factor?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [97]

--------------------------------------------------------------------------------

Steve, I'll just -- I'm not an expert in that area, and I'll stay away from making any comments. I'm happy to connect with you -- connect you with our operating partners and the CEO of those operating partners. But by no means, I want to pretend that I'm an expert in that area. We'll stay away from that. Tom?

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [98]

--------------------------------------------------------------------------------

But just to answer that, what I have seen is as the senior housing concept moves more in the direction of being part of the health care continuum, it attracts a different caliber of labor force. And you see that when you see -- there are a few health systems in this country that actually have their names on senior housing properties and also they also own skilled nursing properties. And they will tell you that there's an extra level of credibility because these properties are associated with a highly respected health system. So it does attract a better labor force. And oftentimes, they have to pay them less because people see a broader value proposition being associated. So I think as we, at Welltower, start to move our portfolio more in that direction towards the health system, the types of collaborations that you understand we have with payers, just legitimizes this business from the old age homes that exist all over the country, they're still being built and still being invested in by REITs, that's not what we do. We're in a much higher value part of the chain here, and we're driving that. So again, I always say this, but stay tuned. I mean, we're so excited about where this is headed.

--------------------------------------------------------------------------------

Operator [99]

--------------------------------------------------------------------------------

Our next question comes from Nick Joseph with Citi.

--------------------------------------------------------------------------------

Michael Bilerman, Citigroup Inc, Research Division - MD and Head of the US Real Estate and Lodging Research [100]

--------------------------------------------------------------------------------

It's Michael Bilerman, here with Nick. I had a couple of, hopefully, just quick follow-ups. In terms of, Tim, in your opening comments, you talked about the balance sheet being a little bit more highly adhered today, given the timing of the deals in the fourth quarter, and then you have the forward and then the disposition effective guidance that's there, which, by the summer, if you take them forward, would get you do the mid- to high 5s. How should we think about -- because it sounds like there's a lot of optimism here on the investment pipeline that you're not going to end up with a $600 million net disposer, how should we think about the funding of that net investment from this point forward?

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [101]

--------------------------------------------------------------------------------

Yes. I think that's the -- my prior comment on kind of where our acquisition guidance is relative to where it may end up is my intention in saying that is directly towards this question, which is, if we are -- end up being a larger net acquirer or end up being a net acquirer, we will fund that all in real time. So on the capital recycling side, particularly as you kind of report that leverage metric, 4x a year, you can have a bit of choppiness in it. But there is just a bit more of choppiness in general when you're talking about selling and buying assets. If we are not selling any more assets, you can count on us being capitalizing any further investment in lockstep. So you should assume that kind of leverage. My language around leverage holds our list of where we end up on the net disposition or acquisition side for the year.

--------------------------------------------------------------------------------

Michael Bilerman, Citigroup Inc, Research Division - MD and Head of the US Real Estate and Lodging Research [102]

--------------------------------------------------------------------------------

So is there -- I guess, based on the acquisition pipeline you know today, would you -- should we expect you would do a big forward equity offering, so that you can take down those proceeds as those deals close? Or you're more apt today to sort of look at your portfolio and say, "You know what, let's push more into the sales market today." Because obviously, selling assets and raising equity, given where your stock trades, has very different accretion implications. And so I just didn't know which way you were leaning?

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [103]

--------------------------------------------------------------------------------

Yes. And I think that the way that we think about that is the sale of assets is being driven by the value that we are seeing in the market for them. And so it's been opportunistic. And if we don't think there's kind of value there for assets, we'll continue to sell equity. Your point on accretion is dead on, that we have not been selling assets because it's been more accretive to fund through disposition of assets. We've been selling assets because it's creating a much more sustainable and high-quality earnings stream for the long term. So the decision to sell has not been driven by where the capital markets kind of are at. In fact, it's been counter to that. And that was part of my opening remarks, is try to get that point that we are -- there's a drag from how we've been continuing the capital recycle. But we think that's the right move. And this is -- the cycle is -- we're not calling the cycle, but it certainly is closer to the end than the beginning. And we're very aware of that. So that plays into the way that we capitalize in lockstep and certainly plays in the way that when we see bids for our assets, we're not trying to real-time value that relative to where our stock trades.

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [104]

--------------------------------------------------------------------------------

I'll just add one thing to that, and I think you're now tired of hearing it from me. Accretion is a question of -- near-term accretion is a question of cap rate. And we're not a cap rate buyer or a cap rate seller, right? We're total return buyer and a total return seller. So there are still -- there are assets on a total return basis that make sense to sell that will not make sense to sell, if you just look at cap rate-driven near-term accretion.

--------------------------------------------------------------------------------

Michael Bilerman, Citigroup Inc, Research Division - MD and Head of the US Real Estate and Lodging Research [105]

--------------------------------------------------------------------------------

Right. Tim, just going back to the same-store policy, and thank you for the presentation, remind me between the 10-Q, 10-K and supplemental? I know currency plays into it pro rata in terms of the Q and the K doing 100% and 0% of the unconsolidated. But how does the stabilization on development methodology or guideline differ between the same-store that you put in the Q versus the supplemental? Is there a difference in methodology?

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [106]

--------------------------------------------------------------------------------

Yes, no difference. There will be no difference in methodology there. And the 2 points you made, FX and pro rata are -- explain probably 80-plus percent of that delta. And then we talk about -- when I talk about aligning our policy and our SEC docs more with kind of how we look at in the supplement, part of that is that we -- things like transitions, things impact same-store, that we don't -- those policies differ between those 2 docs at this point. So that's -- the idea is that we'll align those more as the year goes on.

--------------------------------------------------------------------------------

Michael Bilerman, Citigroup Inc, Research Division - MD and Head of the US Real Estate and Lodging Research [107]

--------------------------------------------------------------------------------

Right. But historically, the stabilization methodology this 5 quarter that you -- or 4 quarter and it rolls into fifth, that application was identical between the number in the sup and the number in the 10-Q and 10-K. There is no difference in guideline or methodology or rule that you were using specifically on that item?

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [108]

--------------------------------------------------------------------------------

Correct. We've always -- that's the -- I mean, the commentary upfront, which was supposed to kind of give you an idea, the reason why we've approached it from a duration based test is because we think it's the simplest and the least subjective way. And I think what's come out of this conversation has been continuing. We think we provide ample disclosure to see how that impacts our results, and we're committed to continuing to do that. But those -- that 5 quarters in is in both of those pools.

--------------------------------------------------------------------------------

Michael Bilerman, Citigroup Inc, Research Division - MD and Head of the US Real Estate and Lodging Research [109]

--------------------------------------------------------------------------------

And then, Tom, maybe just finish with you just on this topic. And it sounded like from your answer to Rich's question that you guys have had a policy for the last number of years, you've -- it's checked by the audit committee, you've had discussions with the other 2, the other 2 clearly came out consistent on Tuesday night. It seems as though there are differences or else you guys would have all come out at the same time. I'm reading from your comments, if I read the tea leaves, that, I guess, they weren't willing to come to you versus you not willing to go to them in terms of agreeing to a disclosure. Is that fair?

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [110]

--------------------------------------------------------------------------------

This is Tim. I wouldn't say that. I don't think that -- one, I think that we want to avoid kind of getting into how that conversation played out. I think that -- as I said in my comments earlier, I think that's the positive parts of this is for investors and analysts. I think there's alignment in getting more information out there. That certainly is our first and foremost goal here. But I think what was stressed there was that we want to -- our approach to this is on a total portfolio basis. So the idea is, metrics matter, all of our metrics matter to investors. It's a way to value the entire portfolio. And I don't think there's anything to read into if who would come one way versus the other. It's just an approach, different approaches the management considers.

--------------------------------------------------------------------------------

Thomas J. DeRosa, Welltower Inc. - Chairman & CEO [111]

--------------------------------------------------------------------------------

And Michael, as I said earlier, we believe, with respect to senior housing, we're a very different business than those other companies. And so we -- our policy is what we believe is the best representation of how our assets are performing. What I would say is that our policy also has some downside risk to it for us as well. Because something moves into a same-store pool, a new development moves into a same-store pool, doesn't mean that in a year, the occupancy might drop 10%. So it's not just an upside game we're trying to play. I mean, this is -- we have thought very long and hard and with other -- taking advice from others who we respect to build the same-store policy that we think gives the best indication to our shareholders about how the assets are performing. So we stand by that. And given that the scale and the dominance that we have, we think we're in the best position to dictate what a policy should be.

--------------------------------------------------------------------------------

Michael Bilerman, Citigroup Inc, Research Division - MD and Head of the US Real Estate and Lodging Research [112]

--------------------------------------------------------------------------------

Right. And that 150 basis points, the 2.75% down to the 1.25%, the impact of the stabilization from the development, that's for 2019. Tim, are you saying that the effect of 1.25% that you would report for a stable portfolio, is that supposed to be mimicking what PEAK and Ventas are now reporting as their same-store definition? Or do we believe there's still differences even on that measure?

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [113]

--------------------------------------------------------------------------------

Yes, I'm going to be clear to say that we're not -- we're certainly not trying to mimic anyone else's disclosure. We're trying to provide disclosure to investors that allow them to compare and do what they need to do. But that -- your question on kind of the mimicking side is, our intention is to get more disclosure around it, so you can make adjustments or kind of view the numbers how you want to across different companies. And -- but most importantly, this is for our investors in the way we think investors should view our numbers. So I'm not going to comment on kind of how that compares to others' policies.

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [114]

--------------------------------------------------------------------------------

One thing I would say, Michael, if you just -- you took the 150 basis points comment, but the other difference, salient point that Tim laid out is the normalizers, right? So you -- I would -- if you are trying to get to a specific type of disclosure, I would not just take one. I would take both. So the net difference would be 100 basis points, not 150 basis points. And obviously, Tim laid out the impact that could be for next year.

--------------------------------------------------------------------------------

Michael Bilerman, Citigroup Inc, Research Division - MD and Head of the US Real Estate and Lodging Research [115]

--------------------------------------------------------------------------------

Right. I was just trying to -- by going to producing this, what you call, stable, whether that was supposed to get closer to a comparable number, I understand the normalizing being a headwind this year, I'm just trying to put all the pieces together to try to see whether there's commonality or not.

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [116]

--------------------------------------------------------------------------------

Yes. I mean, that's where I said that the intent of it is to provide more enhancement of disclosure, to give you more information. And I think that's what we're hearing -- we've heard from you, investors, et cetera, and that's what we'll continue to provide.

--------------------------------------------------------------------------------

Operator [117]

--------------------------------------------------------------------------------

Our next question comes from Chad Vanacore with Stifel.

--------------------------------------------------------------------------------

Chad Christopher Vanacore, Stifel, Nicolaus & Company, Incorporated, Research Division - Senior Analyst [118]

--------------------------------------------------------------------------------

All right. Since the call's rolling along, I'll just keep it to one question. Just thinking about your ManorCare, it seems that it hit your expectations. And since you'll be absent from the MOB market, can we see any expansion in the SNF portfolio this year? Maybe add some details about how you're viewing the market for SNFs in terms of risk and returns.

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [119]

--------------------------------------------------------------------------------

Yes. Thank you very much. ManorCare portfolio did not hit our expectation. It exceeded our expectation significantly. If you go back and look at last call transcript, we talked about $300 million EBITDAR. As you look at, what, in my prepared remarks, I said they achieved $307 million EBITDAR. So that's sort of point number one. Point number two is, we're a buyer of any asset class, skilled nursing included, at a price we think that today's skilled nursing market pricing is so hot that we should be a seller, not a buyer.

--------------------------------------------------------------------------------

Operator [120]

--------------------------------------------------------------------------------

Our next question comes from the line of Michael Mueller with JPMorgan.

--------------------------------------------------------------------------------

Michael William Mueller, JP Morgan Chase & Co, Research Division - Senior Analyst [121]

--------------------------------------------------------------------------------

Just a quick one. Same-store policy aside, what has been the average time to stabilize your senior housing developments? And as you look at these urban projects that are going into the pipeline, do you think they'll stabilize faster or at a similar pace?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [122]

--------------------------------------------------------------------------------

We underwrite 3 years to stabilization. It depends on -- obviously, product to product, it's different. Market to market, it's different. Usually, we have seen sort of between, call it, 18 months to 36 months of stabilization. It does matter in a different product at a different place. I will tell you an example of a product that would have taken a long time to stabilize, but has stabilized in 18 months. We have an asset that's -- with our partner, Belmont Village, in Westwood that opened weeks after Lehman Brothers collapsed. We thought that's -- obviously, that product will probably take 3 to 4 years to stabilize, it stabilized in 8 months. So it really depends what the product is, what the offering is, what the demand of the market is. But a 3-year stabilization is, on average, what we underwrite.

--------------------------------------------------------------------------------

Operator [123]

--------------------------------------------------------------------------------

Our next question comes from Lukas Hartwich with Green Street Advisors.

--------------------------------------------------------------------------------

Lukas Michael Hartwich, Green Street Advisors, LLC, Research Division - Senior Analyst [124]

--------------------------------------------------------------------------------

Just one left for me. The year-over-year growth from the Belmont Village portfolio has been pretty volatile. Can you provide a little color there?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [125]

--------------------------------------------------------------------------------

It's actually not volatile. What you see on the sup is an annualized number. So if you look at -- in any given quarter, you're looking at year-over-year, you have to divide that by 4. And it is actually not volatile. It is one of our most consistent outperformer of all assets we own.

--------------------------------------------------------------------------------

Lukas Michael Hartwich, Green Street Advisors, LLC, Research Division - Senior Analyst [126]

--------------------------------------------------------------------------------

Right. I guess, I am doing that. I'm comparing 4Q '18 versus 4Q '19.

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [127]

--------------------------------------------------------------------------------

That's what I'm saying. You can't do that because that's an annualized number. What you see on the top is -- multiplied by 4 is what you get. You understand why I'm saying that is the...

--------------------------------------------------------------------------------

Lukas Michael Hartwich, Green Street Advisors, LLC, Research Division - Senior Analyst [128]

--------------------------------------------------------------------------------

Yes. But I guess, my question is, if the methodology is consistent throughout the years, wouldn't the trends be comparable?

--------------------------------------------------------------------------------

Shankh Mitra, Welltower Inc. - Executive VP & CIO [129]

--------------------------------------------------------------------------------

No, it wouldn't be. I can tell you exactly. I don't want to get into these discussions of different operators, but I can tell you that Belmont actually had a very, very good year. And the NOI was up for the year. Again, it's not a quarter-to-quarter business. It was up in the mid-single digits.

--------------------------------------------------------------------------------

Operator [130]

--------------------------------------------------------------------------------

Our next question comes from the line of Nick Yulico with Scotiabank.

--------------------------------------------------------------------------------

Nicholas Philip Yulico, Scotiabank Global Banking and Markets, Research Division - Analyst [131]

--------------------------------------------------------------------------------

Okay. I'm going to avoid some of the philosophical discussion on same store. But instead, I just had a question about for the guidance on 2020 senior housing operating. What percentage of the senior housing operating business is actually captured by that same store number? If you had it on NOI or number of assets, right? In the fourth quarter, it was 80% of your senior housing NOI, was in same store, 67% of the properties. What is it for 2020?

--------------------------------------------------------------------------------

Tim McHugh, Welltower Inc. - Senior VP, CFO & Treasurer [132]

--------------------------------------------------------------------------------

So it will grow throughout the year. By the end of the year, we'll be back at -- more than 90% of the pool is going to be in -- or of our assets will be in the pool. So one of the reasons, as you know, that it dipped below that kind of historical number has been the transition piece. And importantly, that's not what -- those assets weren't in senior housing operating, they were in triple net. So it's -- we've added. We've added assets to that show pool. But you'll see as the year progresses, that number will grow and you'll be back above kind of 90%, and the delta at that point will be primarily just acquisition activity. So in reality, we don't buy anything if it probably is well above 90%. But just thinking about kind of where it sat historically, we'll be back at or above kind of historical trends by the fourth quarter.

--------------------------------------------------------------------------------

Operator [133]

--------------------------------------------------------------------------------

And I'm showing no further questions in queue at this time. Ladies and gentlemen, this concludes today's conference call. Thank you for participating. You may now disconnect.