American Healthcare REIT (NYSE:AHR) executives used the company’s fourth-quarter 2025 earnings call to highlight another year of double-digit same-store NOI growth, continued acquisition activity focused on its operating portfolio, and 2026 guidance that implies further earnings and NOI expansion. Management also addressed a temporary leadership change as CEO Danny Prosky remains on medical leave.
Leadership update and strategy continuity
Chairman Jeff Hanson said he has stepped in as interim CEO and president while Prosky recovers at home. Hanson said Prosky remains engaged, speaking with him weekly and attending board meetings virtually, though Hanson noted it is “too early” to provide timing on Prosky’s return.
2025 operating performance led by Trilogy and SHOP
Chief Operating Officer Gabe Wilhite said the fourth quarter “capped off another exceptional year” of NOI growth. AHR reported total portfolio same-store NOI growth of 11.8% in the fourth quarter and 14.2% for full-year 2025, marking a second consecutive year of double-digit same-store NOI growth.
Wilhite said performance was led by the operating portfolio—integrated senior health campuses (Trilogy) and SHOP—which now contributes 76.9% of consolidated cash NOI. He attributed 2025 same-store growth in the operating portfolio to:
- Occupancy gains
- Disciplined rate management
- Continued expense controls
He added that rising occupancy contributed to NOI growth and margin expansion, with margins up 130 basis points in Trilogy and 280 basis points in SHOP for 2025 versus 2024. Wilhite said occupancies are “sitting near 90%” entering 2026, which he said positions the company well.
Trilogy: Wilhite said same-store NOI increased 14% in Q4 and 18.4% for 2025. Same-store occupancy reached 90.6% in Q4, up 275 basis points year over year. He noted revenue growth was supported by rate and “quality mix improvements,” with Medicare and Medicare Advantage penetration rising. He said Medicare and Medicare Advantage improvements contributed 220 basis points of quality-mix improvement in Q4 2025 compared with Q4 2024 (measured both as a percentage of resident days and revenue). Management said it expects another year of double-digit same-store NOI growth for the segment in 2026.
SHOP: The SHOP segment delivered the strongest growth, with same-store NOI up 24.6% in Q4 and 25.2% for 2025. Same-store occupancy averaged 90.6% in Q4, up about 290 basis points year over year. Wilhite said the company has not had to “meaningfully compromise” on revenue levers such as rate or occupancy, citing supply-demand imbalance in long-term care. He also pointed to a “dynamic revenue management” effort the company is piloting with some operators using a platform developed with Trilogy.
Acquisitions and development: focus on operating portfolio and higher-acuity SHOP
Chief Investment Officer Stefan Oh said 2025 was “highly active,” with more than $950 million of new investments across Trilogy and SHOP, primarily within SHOP. Oh said this positioned SHOP as AHR’s second-largest segment by cash NOI. He said most SHOP acquisitions were relationship-sourced or off-market, emphasizing a “know the operator first” approach.
Oh also said industry data shows new construction and supply growth remain historically low, with deliveries below 1% of existing inventory. He cited demand from demographics, noting the baby boomer generation is turning 80 this year.
In the first two months of 2026, AHR closed about $117.5 million of SHOP acquisitions and maintains more than $230 million of awarded deals in its pipeline. Oh described the pipeline as dynamic and said deal activity has increased, including both marketed and off-market opportunities.
When asked about where the company is seeing the most opportunity, Oh said AHR continues to focus on higher-acuity SHOP assets, particularly assisted living and memory care, while independent living generally represents a smaller portion of units acquired (he said roughly 20%). In response to another question on pricing, Oh said recent acquisition pricing has been around the high-5% to low-6% range on an aggregate basis, “stabilizing in the 7s,” and he noted some cap rate compression over the past few months.
On development, Oh said the pipeline is focused primarily on Trilogy expansions and campus growth initiatives designed to generate incremental yields with limited market risk by leveraging existing campuses.
Financial results, guidance, and balance sheet
Chief Financial Officer Brian Peay reported normalized FFO attributable to common stockholders (NFFO) of $0.46 per diluted share for Q4 2025 and $1.72 per diluted share for full-year 2025, representing 22% year-over-year growth in NFFO per share. Peay said the company improved its debt-to-EBITDA by nearly a full turn in 2025.
Peay attributed 2025 earnings growth primarily to double-digit same-store NOI growth, accretion from the September 2024 buyout of the minority interest in Trilogy, and accretion from 2025 acquisitions. He said acquisitions were funded through retained earnings and equity raised via the ATM program and a November 2025 follow-on offering.
AHR issued 2026 NFFO guidance of $1.99 to $2.05 per diluted share, which management said implies another year of double-digit growth and includes only the $117.5 million of acquisitions closed year-to-date in 2026. For 2026 same-store NOI growth, the company guided to 7% to 11% for the total portfolio, with segment ranges of:
- Trilogy: 8% to 12%
- SHOP: 15% to 19%
- Outpatient medical: 0% to 2%
- Triple net lease: 2% to 3%
On the balance sheet, Peay said the company used “accretively priced equity” to fully fund Q4 acquisitions, recent 2026 investments, and planned 2026 development spending. He reported 3.4x net debt to EBITDA, noting the metric does not include approximately $287 million of unsettled forward equity agreements from the ATM and follow-on offering.
During Q&A, management also commented that many SHOP assets acquired in 2025 will not be included in the company’s same-store pool in 2026 due to how the same-store pool is updated annually, meaning performance from those assets would not be reflected in same-store metrics despite contributing to overall results.
In the triple net portfolio, management addressed a decline in hospital coverage at a facility in Southlake, Texas, leased to Methodist of Dallas. Management said the tenant is a double A-minus rated system that guarantees the lease and is committed to the asset as it transitions from a surgical hospital to a community hospital, adding service lines that can create quarter-to-quarter volatility.
About American Healthcare REIT (NYSE:AHR)
American Healthcare REIT, Inc (NYSE: AHR) was a publicly traded real estate investment trust focused on acquiring, owning and managing healthcare‐related properties across the United States. The company’s portfolio spanned senior housing communities, skilled nursing facilities, medical office buildings and outpatient care centers, all operated under long‐term net lease or triple‐net lease structures designed to provide stable, predictable rental income.
Employing a strategy of partnering with established healthcare operators, American Healthcare REIT targeted properties in both major metropolitan areas and high‐growth secondary markets to capitalize on demographic trends such as an aging population and increased demand for outpatient services.
