Sabra Health Care REIT, Inc.

Ladies and gentlemen, this is the operator. Today's conference is scheduled to begin momentarily. Until that time, your lines will remain on music hold. Thank you for your patience.

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Good day, everyone. My name is Kathleen, and I will be your conference operator today. At this time, I would like to welcome everyone to the Sabra Healthcare REIT first quarter earnings call. All lines have been placed on mute to prevent any background noise. After the speaker's remarks, there will be a question and answer session. If you would like to ask a question during this time, simply press star followed by the number one on your telephone keypad. If you would like to withdraw your question, press the star 1 again. And now, I would like to turn the call over to Lucas Hartwich, SVP Finance. Please go ahead, Mr. Hartwich.

Thank you, and good morning. Before we begin, I want to remind you that we will be making forward-looking statements in our comments and in response to your questions concerning our expectations regarding our future financial position and results of operations, including reiterating our earnings guidance for 2024 expectations regarding our tenants and operators, and our expectations regarding our acquisition, disposition, and investment plans. These forward-looking statements are based on management's current expectations and are subject to risks and uncertainties that could cause actual results to differ materially, including the risks listed in our Form 10-K for the year ended December 31, 2023. as well as in our earnings press release included as Exhibit 99.1 to the Form 8K we furnished the SEC yesterday. We undertake no obligation to update our forward-looking statements to reflect subsequent events or circumstances, and you should not assume later in the quarter that the comments we made today are so valid. In addition, references will be made during this call to non-GAAP financial results. Investors are encouraged to review these non-GAAP financial measures as well as the explanation and reconciliation of these measures to the comparable gap results, included on the financials page of the investor section of our website at sovereignhealth.com. Our form 10Q, earnings release, and supplement can also be accessed in the investor section of our website. And with that, let me turn the call over to Rick Matros, CEO, President, and Chair of Sovereign Healthcare REIT.

Thanks, Lucas. Thanks, everybody, for joining us. Hope you're all having a good day. So this quarter is really just a continuation of the last couple of quarters. Our operating performance continues to improve. Our balance sheet strength has us in a position to grow. Our skilled nursing EBITDOM coverage continues to nudge up, exceeding pre-pandemic coverage. Our senior housing triple net lease coverage continues to improve and is near pre-pandemic levels. Our top 10 is stronger than it's ever been. Our skilled occupancy is up 110 basis points sequentially, and our skilled mix is higher than it's been in several quarters. Our senior housing triple net occupancy is higher than pre-pandemic occupancy. Our shop growth continues with occupancy higher than it's been since the early months of the pandemic. Contract labor continues to improve, dropping to where we were three years ago, well below peak levels, although still higher than we want to see. Our deal flow is improving, and though it's primarily shop, we are finally starting to see some skilled nursing opportunities. In both skilled and shop, seller's pricing has moved towards buyers. Well, we don't have new investments to announce this quarter. Based on current activity, we expect to be in a position to announce new deals on our second quarter earnings call. We are running better than anticipated on our forecast, including our shop performance. But since it's still very early in the year, we're going to wait until Q2 to reassess our guidance. And with that, I'll turn the call over to Talia.

Thank you, Rick. Sabra's managed senior housing portfolio, including joint ventures at SHARE, continues to perform well. The portfolio grew by five communities during the quarter and seven communities year over year, which were all properties previously leased to other operators, and I underscore leased. While the added communities had a limited contribution to the totals, Saudra's managed portfolio saw 16.5% quarterly revenue growth and just over 26% quarterly cash net operating income growth on a year-over-year basis. This is driven by the trends that we've been noting for the past several quarters, growing demand, driving occupancy, and and moderating expenses. Wage growth has decelerated. as open positions are filling together, reducing overtime needs, and even eliminating agency usage. Sabra's same-store managed senior housing portfolio, including joint ventures at SHARE, includes 64 properties, 43 of which are in the U.S. and the balance in Canada. Excluding non-stabilized assets and government stimulus, the headline numbers are Same-store portfolio revenue for the quarter grew 5.8% year-over-year, with our Canadian communities growing revenue by 9.2%. Cash and Y for the quarter grew 9.5% over the first quarter of 2023, skewed down by a lower-than-usual expense item in the first quarter of 2023. Cash and Y for the quarter increased 16.7% in our Canadian communities. Rev4 in the first quarter of 2024 increased by 3.4% year-over-year, with Rev4 in our Canadian portfolio growing by 5.1% in the period. The senior housing recovery in Canada has been lacking in the U.S. and is now catching up. Drivers of revenue growth in our Canadian community outpaced our U.S. communities this past quarter on a year-over-year basis, while expense growth has come into line with our U.S. community, particularly on a sequential order basis. Our net lead stabilized senior housing portfolio continues to thrive with occupancy for the past quarter at about 90%, as Rick said, above pre-pandemic levels and steadily improving rent coverage. SABRA's total investment in behavioral health remained approximately $800 million as we provide time for our assets to complete conversion and lease up and reach stabilization. You will note that we have combined specialty hospitals and behavioral health in our coverage disclosure and our supplemental because combined, these categories represent 21 stabilized properties contributing about 10.5% of SABR's NOI with only six behavioral properties in there. And with that, I will turn the call over to Michael Costa, SABR's Chief Financial Officer.

Thanks, Dahlia. For the first quarter of 2024, we recognized normalized FFO per share of $0.34 and normalized ASFO per share of $0.35, both up $0.02 from our fourth quarter 2023 results. Year over year, both normalized FFO per share and normalized ASFO per share increased 3%, representing the first year over year increase in both since before the pandemic. This sequential increase was driven by the following. A $1.8 million sequential increase in cash rents received with the majority coming from stronger collections from cash basis tenants compared to the fourth quarter. A $1.3 million reduction in normalized cash G&A expense primarily related to performance-based compensation true-ups that occurred in the fourth quarter. $900,000 of business interruption insurance income related to a property that suffered fire damage last year. and a $600,000 improvement in NOI from our managed senior housing portfolio due to improved performance, as well as the transition of five facilities to our managed portfolio that were previously leased on a triple net basis. This was partially offset by a $500,000 increase in cash interest expense due to higher outstanding borrowings under our revolving credit facility. As Rick noted earlier, our first quarter performance came in slightly better than what we had forecast in our 2024 guidance estimate. While we are pleased with this outperformance, given it is early in the year, we feel it's most prudent to reaffirm our full year 2024 guidance ranges at this time, and we will revisit these ranges for our second quarter earnings call. Our full year 2024 guidance ranges on a diluted per share basis are as follows. Net income, 53 cents to 57 cents. FFO, $1.33 to $1.37. Normalized FFO, $1.34 to $1.38. Adjusted FFO, $1.38 to $1.42. Normalized adjusted FFO, $1.39 to $1.43. As a reminder, our guidance does not assume any acquisition or disposition activity. Now briefly turning to our balance sheet. Our net debt to adjusted EBITDA ratio was 5.55 times as of March 31st, 2024. As our portfolio continues its recovery from the pandemic, we expect this to result in improvements to both our earnings as well as our leverage. As of March 31st, 2024, we are in compliance with all of our debt covenants and have ample liquidity of $914 million, consisting of unrestricted cash and cash equivalents of $60 million and available borrowings of $854 million under a revolving credit facility. Finally, On May 8, 2024, Solvers Board of Directors declared a quarterly cash dividend of 30 cents per share of common stock. The dividend will be paid on May 31, 2024, to common stockholders of record after the close of business on May 20, 2024. The dividend is adequately covered and represents a payout of 86% of our first quarter normalized ASFO per share, and this payout percentage is expected to improve over the course of 2024. And with that, we'll open up the lines for Q&A.

At this time, I would like to remind everyone, in order to ask a question, please press star, then the number one on your telephone keypad. We'll pause for just a moment to compile the Q&A roster. Your first question comes from the line of Austin Werschmeet from KeyBank. Please go ahead.

Hey, good morning, everybody. Just wanted to hit on the shop and just respect to that. I wanted to clarify the low to mid-teens that you said kind of felt right last quarter. I know you didn't provide explicit guidance, but kind of pointed towards that low to mid-teens growth. Does that include the contribution from the unconsolidated joint venture portfolio? And is that a same store figure?

It does include the contribution from the joint ventures. And it's not a same-store number. It's a year-over-year number on a comparative basis.

Got it. So this includes the benefit from the transition of these five facilities that are now moved from a triple net lease to a, you know, the RIDEA structure?

That's right. And if you also think about it, these were triple net assets before the re-transition. They weren't performing as triple net assets. They weren't contributing anything to our NLI in 2023.

Got it. That's helpful. And then just another one for me, clarification. So has there been any change to the cash NOI contribution from Signature Healthcare? It looked like the quarterly cash NOI number came down a bit. So just curious if there's anything there.

Yeah, it was just a timing issue, really. Excuse me. It was just a timing issue in the first quarter. Since we're on a cash basis, we record revenues when the cash comes in the door, and part of the March payment came in shortly after March 31st, but that's simply it.

So there'll be a catch-up payment that gets them on par with the prior kind of quarterly run rate in the second quarter that we should expect?

Yeah, we would expect the on-balance second quarter to be a little bit higher because of the fact that you have that catch-up payment plus the regular payments during the quarter. Got it. Thank you.

Your next question comes from the line of Joshua Tannerlin of Bank of America. Your line is open.

Yeah. Hey, guys. Thanks for the time. Rick, just wanted to kind of get your take on the final minimum staffing ruling from the CMS. How do you think this plays out from here? And then just curious, like, how we should – I know it's a couple years out with the phase, and just, like, how should we think about potential impact on your portfolio?

I think the same is. the same as we've been saying all along, and that is the rule is ludicrous on its face simply because the labor isn't available. And as I think I've stated in the past, but now it's been publicly stated by the industry and the trade association, you can expect to see both legal and legislative action to overturn this.

Okay. And if If it doesn't get overturned or it stays as is, is there any kind of thought process on how it might impact your portfolio, your operators? Or are you just saying they just wouldn't be able to even find the labor?

Well, it depends on the market. Most of our buildings are actually in pretty good shape relative to it. And I think higher than national average. from a staffing perspective. But as you noted, even if this were to stay in place, it's a phase-in process that's not going to start for two years. It's not going to start for another couple of years. And labor has been improving. Certainly contract labor, as I noted, has improved dramatically. And so presumably things will improve more. So it's a little bit hard to anticipate. But it isn't just a matter of putting a number out there that's going to leave a lot of operators in certain markets completely unable to fill positions. And so it's really got nothing to do with quality of care. It's got everything to do with punishing nursing homes. That's really what it's about. And the other point that's really critical here is it's a one-size-fits-all. And even in the final rule, they really didn't address the criticisms about the lack of inclusion of LPNs, which are a backbone to every operator in the business. They left that one number out there that you could fill with LPNs, but that's not the same thing. But operators staff buildings based on acuity, both in terms of total hours and in terms of the mix of those hours between RNs, LPNs, nursing assistants. You've got facilities that bring in NPs. So any evidence that you look at, will tell you pretty clearly that one size fits all does not work and does not lead to better quality outcomes. And in addition to that, putting an arbitrary number on what staffing should be does not, there's no correlation between that and quality outcomes as well. So that's probably more than you needed to hear, but I wanted to make sure I covered all aspects of it.

Good call. I appreciate the time. I'll jump back in the queue. Thanks.

Your next question comes from the line of Michael Griffin of Citigroup. Your line is open.

Great, thanks. I wanted to touch a bit on the acquisition pipeline and sort of what you're seeing out there. Obviously, you're not giving any speculative acquisitions in guidance, but if you annualize the midpoint of earnings this quarter, it gets you to kind of that low end. So how are you thinking about acquisitions, whether from a yield perspective, and how much do you think they contribute to earnings on a stabilized basis this year?

Well, I'll tell you what we're seeing. I'll just elaborate on what Rick had said earlier. Deal flow is a backup that we're seeing a lot. I think we've said this in the past that the best deals we're seeing are the ones that are coming to us off market, and I suspect that's true for our peers as well. We are focused more on acquiring assets, although we're open to doing some loans. You know, that's not where we're focused. So we're seeing quite a bit, and we're seeing quite a bit from operators who would like to do repeat business. And that's really the key piece. How much we get done. the weights to be seen. We'll keep everyone apprised of that, but the contribution to 2024 is really going to be dependent on when we close, rather than anything else. Rick mentioned that buyers and sellers pricing expectations have come much closer. That's generally true. And so the opportunity to do deals exists, and we're managing our balance sheet carefully, but we see opportunities that are worthwhile.

The only other point of emphasis I'd make is that our guidance, as you know, doesn't include any assumptions about acquisitions in my statement and my opening remarks. about revisiting guidance in the second quarter, because we're ahead of where we thought we'd be already, has nothing to do with any assumptions about acquisitions this year. So that would just be great on top of that. But to Talia's point, the reality is if you're closing most of your stuff in the last five or six months of the year, it's going to have more of a muted impact and just serves more to fuel growth going into 2025.

Great, that's helpful. And then just a quick follow-up on that, Talia. Are you seeing any more appetite in the financing environment for SNFs? Is there any bridge to HUD or HUD financing that's out there at favorable terms?

We are seeing non-bank lenders interested in lending on a bridge to HUD basis. In theory, it's bridge to HUD. We've not been targeting that segment. We've looked at it quite a bit in the past. Yeah, and it's, you know, it's not cheap. The challenge that was different now than it was called a year and a half ago is that a year and a half ago people were doing bridge to HUD lending based on forward valuation. That's pretty much gone now. The cost of capital, everyone's cost of capital is too expensive to do that.

Yeah, and also to reiterate, our philosophy on loans haven't changed. That is, we do loans really specifically in relation to the relationships we have with operators. So how is it helpful in a current relationship when an operator is trying to grow? Is there a loan to own opportunity here? So we really don't have interest, even though we know there are opportunities up here to doing it. and building a portfolio of loans.

Gotcha. That's helpful, Rick. And then one last one, if I may. I know you touched on the implications of the minimum staffing mandate in a question earlier, but can you give any maybe concrete initiatives that the industry is looking at, whether it's lobbying certain committees, trying to take litigation into different courts, just kind of hard things that you're seeing on the ground as the industry gears up to fight this thing?

Yeah, so I really can't talk about that too much other than to say that everything is in place. There's a bill on the Hill. It's not broad bipartisan support in terms of legal action. Much of the groundwork's been done there as well. So, but beyond that, you know, I can't really tell publicly about about anything else, and most of our focus, or most of the industry's focus, the trade association specifically, is gonna be on the legislative strategy. Great, that's it for me. Thanks for the time.

Your next question comes from the line of Vikram Malhotra from Missoula. Your line is now open.

Afternoon, thanks for taking the question. Just maybe going back to the first quarter results, I just want to understand kind of how the shop growth cadence trended. I think last call you mentioned January you saw 20 plus percent year-over-year growth and ended up at nine. So I'm just wondering like what happened in Feb and March? And if you could, could you just give us a sense of how April has trended?

Well, I have some spot occupancies on April. And the spot occupancies for the end of April versus first quarter are probably about 1% to 1.5% higher. So occupancies continue to grow. I don't have a spot number for RevPort, but we've seen continued growth there. And I think the big piece that we're seeing finally happen is expenses. specifically labor decelerates its growth. So while we're still seeing some incremental growth, largely it's the filling of vacant positions as opposed to labor rate growth. So I don't have an April cash NOI number for you to share at this point.

The other thing I'd say is, as we mentioned earlier and noted in the press release, it wasn't as if there was a big drop-off in the quarter. It was simply a comp issue to the prior year quarter where repairs and maintenance were exceedingly low, and they're running at a normal run rate right now. And so normalizing for that comp and those lower expenses, we would have been in mid-teens for our...

I also want to underscore another thing just to clarify. The same store managed portfolio that I spoke about a few minutes ago has 64 assets in it, okay? Because it also includes the joint venture, unconsolidated joint ventures at SHARE. The portfolio we talked about last quarter, a same store, had 51 assets. So we're also talking about different pools here.

So just to add to the challenge. Would it be fair to say that given your team's comment about adjusted team's comment, like for the balance of the year, I'm not asking for a specific number, but that team's comment should hold true as we go through the year? Whether it's 12 or 18, I don't know. But, like, do you see an accelerating trajectory, decelerating? How should we think about the cadence of growth for the balance of the year?

Yeah, I mean, it's going to be dependent on occupancy recovery. But I think what we have to continue to pivot back to, Vikram, is we reaffirm guidance. And what we reported for first quarter is in line with what we had forecast for guidance. So I think that should provide you all the information you need.

We don't see any trends that are going to get in the way of either meeting or exceeding guidance.

Yeah, I mean, it just sounded like you had earlier mentioned you exceeded kind of your expectations, but you were being conservative, I guess, just early on. And then it seems like the shop comp should get easier through the year, given what you mentioned about expenses. So it sounds like you're, I mean, I'm not putting words in your mouth, but it sounds like if you take those components numbers could go higher, but that's just the way I was thinking about it. Just to clarify on the acquisitions, let's just say you do see in the U.S. portfolios you like more real estate portfolios as opposed to loans. Can you just talk about how you're thinking about funding these going forward?

Sure. I think it's going to be dependent on a couple of things. I think First off, if we're looking at SNF deals, you know, given where our stock is trading, you know, currently, you know, relative to our NAV and just on a yield basis, that is a source of capital we could use to fund SNF deals, you know, use that to match fund with our line of credit. To the extent there's any, you know, sales proceeds that come in, you know, there's not a ton out there still, but there's always some sales proceeds. in the normal course of business, that'll also be capital that's available for us to redeploy into other assets. And if we see shop deals or we see senior housing deals that we could pair up with, you know, skilled nursing deals, when we look at that on a blended basis, it would have to make sense on a blended basis, on a blended yield basis for us to use the ATM. But we think there's opportunities there as well when you look at the totality of our investment pipeline.

Got it. Okay. And then just, sorry, one last, just to clarify, Any sense of the final, the Medicare ruling that I think comes out in June or July from the initial proposal? Any sense of how the comments, how the kind of push to get a number higher, how that plays out?

We're still in the comment period, and it won't come out until August. It's usually around the first week of August. So we'll see, but I would anticipate it to be where it is now. I don't anticipate it being lower, but I think the odds are greater that it stays where it is as opposed to going higher, but not lower.

Got it. Okay, thank you.

Your next question comes from the line of Rich Anderson of Wedbush. Please go ahead.

Hey, thanks. Good morning, everyone. So back to minimum staffing, you know, we had 46,000 comments CMS said thanks for that and went ahead with it anyway. I know a lot of your peers in the REITs and, you know, operators are saying we hope that, you know, they'll come to their senses and we can all agree it's crazy what the requests are here, what the mandate would be. But what could possibly change CMS's direction now? Another thousand comments? I mean, I don't understand what more the industry could do to change the direction or does it, is it more of a political thing where if we have a change of administration, maybe that, uh, incites a change, but separate from that, how, how does this not go through as it stands today?

We believe we can successfully address the issue legislatively because you're right. They essentially ignored all the comments and they rushed to get this out because there's no way given. you know, 40 to 50,000 comments that they could have thoughtfully reviewed all of those and not in this final rule out what they did. So it's left the industry with no position, with no option rather than to take legislative action and potentially legal action as well.

Okay. And then as it relates to your portfolio, have you done any work to say, well, this, this, percentage is subject to the three-year phase, and this is five years, and this percentage might actually be exempt from the legislation as it currently stands. Have you done that work yet? Do you have an idea of what it might be from a geographic standpoint?

No, I think it's premature to do that work, Rich, not just because people are still recovering, but The impact of this, if it doesn't go away, is two to five years out. So we've got some time right now to see if the remedies, if you will, that the industry is going to undertake to get rid of this mandate takes hold. I think there'll be plenty of time. If we succeed in that, great. If we don't succeed in that effort, we'll still have plenty of time to do as you suggest.

Okay. And then last for me, switching to shop, same store. I understand comps in February and March and all that. But you said, you know, off to a good start in the first quarter, going to take a look at guidance next quarter. Does SHOP figure into that as well? Is that outperforming? I think you said in line.

Yes, our SHOP is somewhat ahead of our internal forecast guidelines.

Okay. And your internal forecast guidance are for what on a same store, if you can remind me? I just don't remember.

Sorry, you're asking what our same store NOI assumption or guidance is? Yeah, for shop. Yeah, I mean, like I answered earlier on the call, Rich, what we had talked about on previous calls was, you know, we didn't put that number out, right? But what other folks are saying is, you know, mid-teens growth on an NOI basis year-over-year, and that feels reasonable given our portfolio.

Okay, I'm sorry. I missed that part of it. Okay, that's all right. Thanks very much.

Your next question comes from the line of Alex Fahy. Your line is now open.

Hello, and thank you for taking my question. First one for me, can you talk a little bit, give some color on maybe the NOI growth between IL and AL and where that's been trending?

Well, we're not going to give the specific numbers, but I would say, as we've talked about in the past, they're fundamentally different businesses. So the AL growth is going to be stronger than the IL growth, simply because you've got more tools to impact the revenue line than you do in an IL, which effectively isn't really a healthcare facility, even though there's been acuity creep, which is why we got the PLR letter back in 2020. So, and the other point I would make is that the IL portfolio never got hit as hard during the pandemic as the AL, so there's less recovery to be had there.

Got it. And we noticed, you know, you combined the two and that occupancy was down quarter over quarter. Was that driven by any one of them more or less?

No, I think that was really just, you know, we go through all of our disclosures periodically and especially in our supplement. And what we saw was that we were an outlier and given that level of granular detail. So we basically made our disclosures conform to what our peers show.

Got it. That's it for me. Thank you.

Your next question comes from the line of Michael Stroik of Queen Street. Please go ahead.

Thanks, and good morning. Could you just share where spot occupancy and coverage levels for the SNF portfolio sit today? And then just assuming the company can get spot occupancy back to pre-COVID levels in that call it 82% range, how sizable of an impact would you expect for that to have on coverages?

It's going to be pretty sizable. On the last call, on our year-end call, Rich Anderson asked us, given that dynamic that you're talking about, is it possible we're going to get to a consolidated two times coverage? And I'm not going to say a definitive yes there, but it's clearly going to have a material impact on coverage, with coverage higher now than pre-pandemic occupancy. our margins are back to where they were pre-pandemic occupancy, which means the pull-through on that operational leverage is actually settled in at a lower occupancy level. So that's all positive for us. So it's hard to sit here and say this is what the exact impact is going to be on coverage two years from now if occupancy is 300 basis points higher, but it's clearly going to have a material impact.

Got it. Okay. And then maybe just one more on the shop portfolio. How much labor vacancy is there in that portfolio? Or maybe said differently, is there still quite a bit of staffing in terms of headcount needed in order to be able to achieve the occupancy upside there?

I think the answer is no. I think that the opportunity to actually hire labor full-time reduce overtime and eliminate agency has been very important and has been very actionable. So I would say that based on what I've seen, our operators are already, you know, kind of 80 to 90% occupancy, sort of the range, on stabilized assets. And so your And they're all positioned to take advantage of operating leverage, and it's polluting to what Rick just said, because they've staffed up to actually be able to fill.

So, no one's holding back on admissions because of labor issues in the SHOP portfolio.

Okay, great. Thanks for the time.

Again, if you would like to ask a question, please press star 1 on your telephone keypad. There are no further questions at this time. I turn the call back over to Rick Mitros.

Thank you all for joining us. As always, we're available for additional conversations if you want to talk offline. And in the meantime, hope you all have a great day. Thank you.

This concludes today's conference call. You may now disconnect.