Global Medical REIT Inc.

Greetings, and welcome to the Global Medical REIT third quarter 2024 earnings conference call. At this time, all participants are in a listen-only mode. A brief question and answer session will follow the formal presentation. If anyone should require operator assistance during the conference, please press star zero on your telephone keypad. As a reminder, this conference is being recorded. It is now my pleasure to introduce your host, Steve Sweat, Investor Relations. Thank you, sir. You may begin.

Thank you. Good morning, everyone, and welcome to Global Medical REIT's third quarter 2024 earnings conference call. On the call today are Jeff Bush, Chief Executive Officer, Alfonso Leon, Chief Investment Officer, and Bob Kiernan, Chief Financial Officer. Please note the use of forward-looking statements by the company on this conference call. Statements made on this call may include statements which are not historical facts and are considered forward-looking. The company intends these forward-looking statements to be covered by the safe harbor provisions of forward-looking statements contained in the Private Security Litigation Reform Act of 1995 and is making this statement for purposes of complying with those safe harbor provisions. Furthermore, actual results may differ materially from those described in the forward-looking statements and will be affected by a variety of risks and factors that are beyond the company's control, including, without limitation, Those contained in the company's 10-K for the year ended December 31, 2023, and its other SEC filings. The company assumes no obligation to update publicly any forward-looking statements, whether as a result of new information, future events, or otherwise. Additionally, on this call, the company may refer to certain non-GAAP financial measures, such as funds from operations, adjusted funds from operations, EBITRE, and adjusted EBITRE. You can find a tabular reconciliation of these non-GAAP financial measures in the most currently comparable GAAP numbers in the company's earnings release and in filings with the SEC. Additional information will be found on the investor relations page of the company's website at www.globalmedicalread.com. I would now like to turn the call over to Jeff Bush, Chief Executive Officer of Global Medical Read. Jeff?

Thank you, Steve. Good morning, and thank you for joining our third quarter 2024 earnings call. Our high-quality diversified portfolio continues to produce strong results. At the end of the third quarter, portfolio occupancy was 96.1% with a weighted average lease term of 5.6 years. and portfolio average rent coverage ratio of 4.6 times. For the third quarter, net income attributable to common shareholders was $1.8 million or 3 cents per share compared to $3.1 million or 5 cents per share in the third quarter of 2023. FFO attributable to common shareholders and non-controlling interest in the third quarter was 19 cents per share and unit, down 3 cents from the prior quarter. AFFO, attributable to common shareholders and non-controlling interest, was 22 cents per share and unit, down 1 cent from the prior year quarter. The decrease is due primarily to the impact of cash basis tenants, including Stuart, at our Beaumont facility. Regarding our acquisition activity early this year, we announced that we had entered into a purchase agreement to acquire a 15 property portfolio of outpatient medical real estate properties for an aggregate purchase price of $80.3 million. These properties are fully leased under triple net or absolute triple net leases, with a cap rate of 8%. During the third quarter, we closed on the first tranche of this acquisition, consisting of five properties for $30.8 million, and a subsequent two-quarter end in October, we completed the acquisition of the remaining 10 properties. Looking ahead, we currently have $500 property portfolio of medical outpatient facilities under contract to purchase for just under $70 million. These properties are 94% leased to high quality medical tenants and have a 9% cap rate. We remain optimistic about the acquisition market with our asset class, are encouraged by our recent successes in adding quality assets to our portfolio. As we continue to focus on our growth, we remain committed to staying disciplined in maintaining a strong balance sheet. In the third quarter, we issued 1.2 million shares of our common stock to our ATM at an average offering price of $9.95 per share, generating gross proceeds of $12 million. In addition, asset recycling continues to be a key element in financing our growth initiatives. During the third quarter, we closed on the sale of two medical facilities at a cap rate of 7% that generated aggregate gross proceeds of $12.1 million, resulting in an aggregate gain of $1.8 million. We expect to continue to both issue common equity and sell assets as we move forward in order to maintain a strong balance sheet. In terms of tenant-related items, in September, we announced that we entered into a new 15-year triple net lease with an affiliate of Christus Health at our healthcare facility in Beaumont, Texas, replacing Stewart Healthcare. We are excited to begin our new relationship with Christus, and I'm pleased with our team's ability to release this property to a high-quality tenant, achieving a great outcome for shareholders. Overall, I am pleased with our third quarter results and want to thank the entire team for hard work and contributions to our results. With that, I turn the call over to Alfonso to discuss our investment activity and current market conditions in more detail.

Thank you, Jeff. The transaction market for medical facilities that align with our investment criteria continues to evolve. We remain actively engaged with a diverse range of physician groups, brokers, and corporate sellers to source acquisition opportunities that will help us continue growing our portfolio. In anticipation of Fed rate cuts, volume and quality has picked up. However, the increase in mortgage rates has tempered demand in the past month. As Jeff mentioned, In July, we closed on the first tranche of our 15 property portfolio of outpatient medical real estate, acquiring five properties encompassing approximately 95,000 leasable square feet. In early October, we completed the acquisition of the remaining 10 properties encompassing approximately 160,000 leasable square feet. In total, the 15 property portfolio had an aggregate purchase price of $80.3 million, with an aggregate of approximately 254,000 leasable square feet and aggregate annualized base rent of $6.4 million, equating to an ACAP. We view this transaction as reflective of current market trends, where sellers are increasingly accepting higher cap rate deals in response to ongoing challenges in the refinancing market and pressure on real estate funds to sell. Looking ahead on acquisitions, as Jeff previously stated, we have a $70 million portfolio of five medical outpatient facilities under contract to purchase at a nine cap rate. Similar to our 2024 acquisitions, we have anticipated closing on this acquisition in two tranches during the first half of 2025. These five properties are located in three states, are 94% occupied, have an aggregate of approximately 487,000 leaseable square feet, and an aggregate in-place NLI of approximately $6.3 million. We are purchasing these properties at $143 per square feet, well below replacement cost. Most tenants in these buildings have invested significant capital in their own suite, resulting in rents averaging $14 to $15 per square foot triple net. These properties have been very well maintained and are mission critical assets to the corresponding health systems. Tenancy in these buildings includes a comprehensive mix of providers offering primary care and urgent care, specialists like neuro, cardio, ortho, and cancer, as well as diagnostics, radiology, and lab. In addition, all of these properties are subject to ground leases with an average remaining term of 60 years and approximately two-thirds of the property square footage is on campus. Approximately 60% and 82% of the on and off campus properties, respectively, are leased to investment-grade tenants. Note that our Obligation to close this acquisition is subject to certain customary terms and conditions, including due diligence reviews and tenant interviews. Accordingly, there is no assurance that we will close this acquisition on a timely basis or at all. On a dispositions front, pursuant to our normal capital recycling process, during the quarter, we closed on the sale of a medical facility in Panama City, Florida, receiving gross proceeds of $11 million, resulting in a gain of $1.7 million. Later in the quarter, we also sold another medical facility located in Panama City Beach, Florida, receiving gross proceeds of $1.1 million, resulting in a gain of $100,000. In total, the cap rate on these dispositions was 7%. As always, we remain committed to a disciplined approach to investments that align with our strategy and disciplined underwriting standards. By leveraging our competitive advantages, our scale, access to capital, and the potential use of OP unit deal structures, we intend to unlock opportunities and drive value. I'd now like to turn the call over to Bob to discuss our financial results. Bob?

Thank you, Alfonso. At the end of the third quarter of 2024, our portfolio consisted of gross investments in real estate of $1.4 billion and included $4.8 million of total leaseable square fee, 96.1% occupancy, 5.6 years of weighted average lease term, 4.6 times rent coverage with 2.2% weighted average contractual rent escalation. In the third quarter of 2024, our total revenues decreased by approximately 3.5% compared to the prior year quarter to $34.3 million due primarily to changes in our portfolio, including a lower occupancy in 2024 compared to 2023 and the impact of tenants being placed on cash basis accounting subsequent to the end of the third quarter of 2023. Total expenses for the third quarter of 2024 were $32.7 million compared to $33 million in the prior year quarter. The decrease is due to reduced depreciation and amortization expenses, primarily related to disposition transactions that were completed during 2024, partially offset by increased operating expenses and interest expense. Our operating expenses for the third quarter of 2024 were $7.4 million compared to $7.2 million in the prior year quarter. Regarding the third quarter 2024 expenses, $4.8 million related to net leases, where the company recognized a comparable amount of expense recovery revenue, and $1.6 million related to gross leases. Relative to the increase in expense in 2024, this reflects increased costs from properties acquired in 2024, as well as the impact of tenants placed on cash basis accounting subsequent to the end of the third quarter of 2023, partially offset by a net reduction in costs at other properties. G&A expenses were $4.4 million in both the third quarter of 2024 and the prior year quarter. We continue to expect our quarterly G&A expenses to be in the range of $4.4 million and $4.6 million. In the third quarter of 2024, we completed two dispositions that generated aggregate gross proceeds of $12.1 million, resulting in an aggregate gain of $1.8 million. In the third quarter of 2023, we completed one disposition receiving gross proceeds of $10.1 million, resulting in a gain of $2.3 million. Net income attributable to common stockholders for the third quarter of 2024 was $1.8 million, or 3 cents per share, compared to $3.1 million, or 5 cents per share, in the third quarter of 2023. FFO attributable to common stockholders and non-controlling interest in the third quarter of 2024 was $13.7 million, or 19 cents per share and unit, compared to $15.3 million, or 22 cents per share and unit, in the third quarter of 2023. AFFO, attributable to common stockholders and non-controlling interests in the third quarter of 2024, was $15.3 million, or 22 cents per share and unit, compared to $16.5 million, or 23 cents per share and unit, in the third quarter of 2023. Moving on to the balance sheet. As of September 30, 2024, our gross investment in real estate was $1.4 billion. At September 30, 2024, we had $634 million of total gross debt with a weighted average remaining term of 2.2 years. At quarter end, 81% of our total debt was fifth grade debt. Our leverage ratio was 44.1%, and our weighted average interest rate was 3.79%. Lastly, as of today, The current unutilized borrowing capacity under the credit facility is $221 million. Relative to equity, in the third quarter, we generated gross proceeds of $12 million through ATM issuances of 1.2 million shares of common stock at an average price of $9.95 per share. As we consider funding options for the acquisitions that we have closed or are expected to close next year, we will continue to be disciplined and consider both potential asset dispositions and equity issuances as we seek to maintain leverage in our target range of 40 to 45%. With respect to our investment portfolio and our 2024 lease expirations, we are pleased with our progress on renewals, and based on activity to date, we are currently trending towards an 85% retention rate on this year's expiring leaseable square feet. Regarding capital expenditures on the portfolio, during this third quarter, our cash spend was approximately $4.8 million. Year-to-date through September 30th, our cash outpost for capital expenditures were approximately $10 million, with approximately 42% of that related to tenant improvements. For the full year of 2024, we're projecting total capital expenditures of $12 to $14 million. As previously mentioned, earlier in the year, we discussed Stewart Healthcare's bankruptcy announcement and their exposure in the company's portfolios. At the time of the bankruptcy announcement, Stewart represented 2.8% or $3.1 million of the company's annualized base rent, of which 86% related to our facility located in Beaumont, Texas. Post-bankruptcy, the company received base rent payments on its lease at the Beaumont facility for the months of June, July, and August. During the quarter, Stewart rejected our lease at the Beaumont facility, and we entered into a new, 15-year triple net lease with an affiliate of Christus Health at this property. We are pleased to have secured a long-term lease with Christus, affirming the quality of this property, and we expect rent to commence on this lease in March or April 2025. In conclusion, we continue to believe that we are well-positioned to execute on our acquisition and overall business strategy and look forward to sharing our progress in the quarters to come. This concludes our prepared remarks. Operator, please open the call for questions.

Thank you. We will now be conducting a question and answer session. If you would like to ask a question, please press star 1 on your telephone keypad. A confirmation tone will indicate your lines in the question queue. You may press star 2 if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment, please, while we poll for questions. Thank you. Our first question comes from the line of Austin Werschmitt with KeyBank. Please proceed with your question.

Great. Thank you, and good morning. Jeff or Bob, you both kind of referenced that you're committed to maintaining a strong balance sheet. I guess when you look at the, you know, the options available, you mentioned equity and dispositions. Which do you view as kind of more attractive source today? And can you just remind us how much you have left the fund to sustain your leverage target?

Thanks, Austin.

Good morning. So right now, you know, we ended the quarter at leverage of 44%. If we, you know, if we don't do sell any assets or raise equity in the fourth quarter, we would end the year at 46%. So we would be just outside the range that we've talked about. And we're not uncomfortable going above the range. Ideally, we want to stay in our range. But from the 46%, I mean, coming back down into the target range doesn't require a lot of asset sales or equity issuances to bring it down. And so we have potential sales opportunities, but again, there's lead time that's involved in sales. And so we're always looking at the portfolio and considering potential just normal capital recycling disposition activity. And so those are the things we look at. And again, if equity markets are there, we would tap into those as well. But we're not far outside our range would be the main point I'd make.

Are there any assets you're marketing today? And I guess with the move higher in long-term interest rates, has there been any change in sort of level of interest from buyers or the cap rates that are being negotiated versus a few months ago?

There's assets that we're considering, and Alfonso, you can speak to the pressure on pricing, but yes, there's definitely the market is always evolving.

Yeah, and I'd say in expectation of the rate cuts, there was increased optimism in the pricing that was beginning to increase and cap rates beginning to decrease. But in the last month, in October, with debt rates on mortgages going up, that has subdued the interest. And so there's mixed messages right now, and it's not settled. Previously, I thought that maybe year-end would be a pretty meaningful pickup in volume as a result of the Fed rate cuts. But I'm beginning to think the question is how much that's going to materialize.

So I guess given kind of your optimistic about the acquisition market today, but still have some funding to do, I guess how comfortable are you moving forward with any additional deals prior to funding, you know, what you've announced here for?

I mean, we take it step by step.

So we're focused on this next acquisition and are, you know, routinely observing kind of where we are and looking at our portfolio and as Bob said, for things that we can sell in the market and looking for assets that either we think can achieve optimal pricing in the current market or just assets that we feel long-term are not ones we want to continue owning and want to just recycle capital. But it's something that we evaluate almost on a weekly basis.

Thank you. Appreciate the time.

Our next question comes from the line of Brian Mayer with B. Riley. Please proceed with your question.

Great. Thank you, and good morning. Thanks for all that color on the new set of assets that you're acquiring. I don't think that you gave us the states, though. Can you give us kind of where in the country you're buying these?

Yeah, so, you know, given the fact that we just put these under contract and we're working through diligence, I mean, we've opted to not mention the states. really for confidentiality purposes. But as we move forward, I mean, yes, of course, we're going to provide more color and more detail around the transaction. But at this point, we wanted to be more confidential.

Okay. Maybe following on Austin's questioning on equity, you've talked about this in the past a little bit about the ability to do accretive transactions, even with your stock kind of here in the nines. But, you know, why, should we think about it that you're going to issue you know high nines tens on these new deals or you know at what level is it a creative to do this second you know transaction that's forthcoming you know to raise equity yeah um as you know nine cap asset purchases you know the and again depending on where the uh the debt side of the forward curve is and that side of the cost of capital

You know, when we look at that, you know, we can be accretive, you know, anywhere from, say, $950 and above when you look at those purchases.

Okay. And then on the disposition side, you know, what's kind of driving the selectivity of the assets that you sell? Is it just, you know, there's slower growers? Are there known vacates coming? I mean, what's driving that side of the equation?

I mean, it's a variety of things. I mean, the, the ones you mentioned, I mean, uh, also, uh, properties that we feel, um, can get optimal pricing. Uh, so it, it kind of covers the full spectrum. Um, but yes, I mean, properties that are, you know, just given our current company and, uh, where we want to, uh, what, you know, where we want to go forward properties that are just too small or locations that are just not ideal. Um, But also properties that we feel have renewals that are not as high as we would want. And so we're getting ahead of those expirations with trying to sell these things with term on them.

Okay. And then just last from me. And correct me if I'm wrong, you talked a little bit about Stewart and Beaumont and that you had collected rents for, I guess, you know, June, July, August, or July, August, September. Did you guys somehow feel like you didn't collect March, April, May? Am I thinking about that right? And has that since changed? You said that right.

That's right, Brian. We did not collect for March, April, and up to that point in bankruptcy. And we just, we did collect, you know, the month subsequent to bankruptcy, but we still have a claim in, in, in, in pursuant to the bankruptcy that we would, we, we, we do have a claim in bankruptcy court to collect any rent. And other expenses that are due during the period post bankruptcy up until the point where they rejected the lease. So that's something that we're actively working on and would be pursuing with, um, you know, with, with the court.

Okay, thank you. That's all for me.

Our next question comes from the line of Rob Stevenson with Jannie. Please proceed with your question.

Good morning, guys. Can you talk about where the Christus rent is versus Stewart? And do you have Christus elsewhere in the portfolio today?

The annual rent for the new lease is $2.9 million. And it's slightly above the previous rent that Stuart was paying. They were right around $2.8 million.

Okay. And is this going to be your only location at present with them when this lease starts?

Yes, I'm pretty sure. I mean, there might be a small lease, but to my knowledge, I mean, nothing material. This would be a new relationship.

Okay. So your exposure to them will be less than 3%. in terms of tenant as percentage of AVR. And then I guess, do you have any CapEx on this asset prior to them moving in that you'll have to complete?

Yes, Rob. So part of the process of just getting the asset in the condition for Christus and getting it all situated involved a fair amount of CapEx we've been spending. you know, upwards of, you know, probably before it's all said and done, close to $900,000 in capex specific to the property. A lot of that will be costs that we will claim in the bankruptcy court, you know, as a claim against Stewart for things that should have been or, you know, been maintained as part of the lease. And so these are mainly infrastructure-type items, and some of them have lead times in terms of getting the equipment and selling the equipment, things of that nature. And so there's definitely a process involved in just delivering that asset.

Okay. And then on the $70 million portfolio acquisition, is there a specific reason why the closing is further out and in two tranches? Is that just to allow you guys to finance it? Is it something on the seller's part? Is there something... that needs to happen before you can close? Can you just talk about that?

Yeah. So, I mean, a variety of things, but preliminarily it's just flexibility, you know, and actually with our experience on the most recent transaction, when we stage, when we put it in a couple of tranches, it resulted in, in some efficiencies as well. And so if we can do it again, it's something that we want to do on this transaction as well. But I mean, it, Uh, it's flexibility, uh, that can go either way. And, um, you know, if we changed our minds later on and we want to do it all at once, that's something that we consider. Um, but having said that, I mean, there's also diligence items that we have to, uh, dig into and, and it just made more sense to, um, uh, spread it out over a couple of tranches.

Okay. And is there any significant tenant concentration in that portfolio that's going to push into your top 10? post deal?

Yes, there is. And so the biggest change would be Trinity. So that one would bump up from number 10 to potentially number three.

Okay. That's helpful. Thanks, guys. Appreciate the time this morning. Thank you.

Our next question comes from the line of Alex Fagan with Baird. Please proceed with your question.

Hi, thanks for taking my question. First one is, what is the plan to fund the portfolio deal and future acquisition opportunities? Is it just the dispositions and equity, or are you going to potentially raise debt as well?

Right now, the plan to do dispositions and equity, we raised a little bit of equity, $12 million in the last quarter. and we do have some sales already in process. So we're realigning our acquisitions. We're taking a look at some of our assets that are not performing as well, and we've been able to sell them at pretty attractive prices. So we're looking more towards equity and dispositions than debt. But it may go slightly and temporarily above on the debt that we target.

And how much more runway does GMRE have with its asset recycling program? Is this something you can do for quarters on end, years?

It's probably not going to be a permanent solution. The market tends to adjust. So, for instance, you know, the market tends to adjust. We've been buying, as you notice, our average buying is somewhere in the mid-eighths right now. So, for instance, if the rates do not come down, the market always adjusts because groups have to sell. So we will be buying higher cap rates, which means that we can go to equity also.

And are you planning to issue a term loan to reduce the line balance anytime soon?

Not currently. That's something we'll look at probably in the first half of next year. Thanks, guys. That's it for me. Thank you.

Our next question comes from the line of Juan Sinabrio with BMO Capital Markets. Please proceed with your question.

Good morning. This is Robin Haneland sitting in for Juan. I'm not sure if this was touched on already, but on Christus, How much, if any, did rents decline on the B-month assets under the transition? And should we model any other modest sequential declines in the non-B-month assets post the Stewart bankruptcy?

The rent at the Beaumont facility, yeah. Go ahead, Bob.

Well, the rent at the Beaumont facility is just marginally higher. than the previous steward rent, so 2.9 million of annual rent. And we talked about that cash rent starting in March or April of next year is our current outlook. And so that asset, again, is kind of net above. The other steward leases have not been rejected with the exception of one very small lease in multi-tenant building that we have in Hialeah, Florida. The lease was protected at the end of October, and again, it's a very small lease. It's under 4,000 square feet of space, so not anything noteworthy from an overall perspective.

Okay. And your dividend payout ratio, inclusive of CapEx, is north of 100% of FAD. How does the board and management think about this dividend sustainability in particular with leverage generally elevated?

Yeah, right now we could maintain our dividend and we're looking in the future that we can maintain our dividend. We do see accretive deals coming through and we get the rent increases regularly. We had a very big two years of releasing. It's an unusual amount of releasing in the last two years, which causes a bit more capital, a bit more TI type of thing. So we do see that TI and capital starting to reduce given proportionally we don't have so many releases coming up. So we do look like to maintain our dividend.

Okay, and this has been combed over quite a bit, but is there a dollar size of the pool of assets that are targeted for future dispositions?

It's a fluid number. It's not a targeted number. It's something we look at all the time in assessing potential sales opportunities, and sometimes they're inbound. inquiries about assets that people want to purchase that we are dealing with as well. So I think it's not a set number. I would think of it more as a fluid situation.

Yeah, we've had a few LOIs that have come in on assets that were attractively priced, which forced us to reconsider whether we wanted to sell it or not. And a couple of those we've moved forward on.

That makes sense. And just curious on your lease expiration exposure for 2025, it just increased a little bit. Could you maybe just elaborate on that?

Increasing could be from, again, from assets that we've acquired that would have impacted the number. But from an outlook on our 2025 expirations, I mean, we're, you know, currently, you know, again, looking at this very similar to how our experience was, you know, in this year in calendar 24 relative to releasing. So I think we're optimistic about our occupancy and leasing activity looking ahead into 2025. Okay.

And last one for me, the pipeline, how big is it today? What assets are you looking at and what types of yields should investors expect? Is this 9% a good run rate going forward?

Yeah. So, I mean, the market is continually evolving. And what we're focused on primarily is medical office. And that's typically where the bulk of the volume is in the market anyways. But cap rates in the market for the type of assets that we're looking at, they're more in the high sevens to mid eights range, depending also on whether it's single tenant or multi-tenant. And so there are not that many opportunities that are nine and above, but we're always looking for unique situations, and they do occur. And there's a couple opportunities that I've heard of that might be coming down the road where, you know, you are getting into that, you know, high eights, low sevens range. But the bulk of the market is in the high sevens to mid eights.

Thank you.

Our next question comes from the line of Guarav Mehta with Alliance Global Partners. Please proceed with your question.

Yeah, thank you. Good morning. I wanted to ask you on the portfolio acquisition that you have in the contract and your comments about market cap rates in high seven to mid eight. What was specific about this portfolio that drove the cap rate to 9%, which is higher than where the market is?

Variety of factors, but one of the things that drives cap rates, a big one, is properties that are attractive to funds that have short lifespans, five-year hold periods. What they're looking for are properties that are ideal for flipping, for putting within a portfolio and getting a premium on the exit. Given the fact that these properties are on campus and just given the profile of the properties and its location. I mean, it's not ideal for that kind of strategy. And so, you know, you're getting extra yield for, for, for that reason. But the other one too, is this was, A relationship deal, one that the parties involved, we have connections with that span many, many years. And there was a process that they employed to find somebody to partner with for this. And I think that contributed as well to some of the yield.

Okay, thank you. That's all I had.

Thank you. We have reached the end of the question and answer session. I would now like to turn the floor back over to management for closing comments.

Thank you, everybody. I think we had a good quarter. We've acquired nice properties with good rates, and we have good contracts on future properties. And thank you very much for attending.

Ladies and gentlemen, this does conclude today's teleconference. You may disconnect your lines at this time. Thank you for your participation, and have a wonderful day.