UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-Q

(Mark One)
xQUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended March 31, 20192020
or
¨TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the transition period from                    to                     
Commission File Number: 000-55434
GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
(Exact name of registrant as specified in its charter)

Maryland 46-1749436
(State or other jurisdiction of
incorporation or organization)
 
(I.R.S. Employer
Identification No.)
   
18191 Von Karman Avenue, Suite 300,
Irvine, California
 92612
(Address of principal executive offices) (Zip Code)

(949) 270-9200
(Registrant’s telephone number, including area code)

Not Applicable
(Former name, former address and former fiscal year, if changed since last report)
Securities registered pursuant to Section 12(b) of the Act:
Title of each classTrading Symbol(s)Name of each exchange on which registered
NoneNoneNone
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Sections 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.     x  Yes    ¨  No
Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).    x  Yes    ¨  No
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.
 Large accelerated filer¨Accelerated filer¨
 Non-accelerated filerxSmaller reporting company¨
   Emerging growth company¨
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ¨
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). ¨  Yes   x  No

Securities registered pursuant to Section 12(b) of the Act:
Title of each classTrading Symbol(s)Name of each exchange on which registered
NoneNoneNone
As of May 10, 2019,8, 2020, there were 196,193,084194,166,914 shares of common stock of Griffin-American Healthcare REIT III, Inc. outstanding.
     



GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
(A Maryland Corporation)
TABLE OF CONTENTS
 
 Page
  
 
  


2


PART I — FINANCIAL INFORMATION
Item 1. Financial Statements.
GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED BALANCE SHEETS
As of March 31, 20192020 and December 31, 20182019
(Unaudited)
March 31,
2019
 
December 31,
2018
March 31,
2020
 
December 31,
2019
ASSETS
Real estate investments, net$2,223,669,000
 $2,222,681,000
$2,279,757,000
 $2,270,421,000
Real estate notes receivable and debt security investment, net99,312,000
 98,655,000
Debt security investment, net73,476,000
 72,717,000
Cash and cash equivalents34,904,000
 35,132,000
44,683,000
 53,149,000
Accounts and other receivables, net128,226,000
 122,918,000
139,848,000
 144,130,000
Restricted cash38,972,000
 37,573,000
36,831,000
 36,731,000
Real estate deposits3,119,000
 3,077,000
38,000
 223,000
Identified intangible assets, net170,671,000
 179,521,000
159,031,000
 160,247,000
Goodwill75,309,000
 75,309,000
75,309,000
 75,309,000
Operating lease right-of-use assets208,160,000
 
Operating lease right-of-use assets, net218,031,000
 219,187,000
Other assets, net122,546,000
 114,226,000
140,045,000
 140,175,000
Total assets$3,104,888,000
 $2,889,092,000
$3,167,049,000
 $3,172,289,000
      
LIABILITIES, REDEEMABLE NONCONTROLLING INTERESTS AND EQUITY
Liabilities:      
Mortgage loans payable, net(1)$691,896,000
 $688,262,000
$797,774,000
 $792,870,000
Lines of credit and term loans(1)804,049,000
 738,048,000
834,379,000
 815,879,000
Accounts payable and accrued liabilities(1)135,730,000
 139,383,000
161,829,000
 171,394,000
Accounts payable due to affiliates(1)2,014,000
 2,103,000
2,238,000
 2,321,000
Identified intangible liabilities, net947,000
 1,051,000
570,000
 663,000
Financing obligations(1)26,377,000
 25,947,000
29,303,000
 30,918,000
Operating lease liabilities(1)195,990,000
 
206,922,000
 207,371,000
Security deposits, prepaid rent and other liabilities(1)34,728,000
 37,418,000
55,361,000
 48,105,000
Total liabilities1,891,731,000
 1,632,212,000
2,088,376,000
 2,069,521,000
      
Commitments and contingencies (Note 11)
 

 
      
Redeemable noncontrolling interests (Note 12)37,839,000
 38,245,000
44,543,000
 44,105,000
      
Equity:      
Stockholders’ equity:      
Preferred stock, $0.01 par value per share; 200,000,000 shares authorized; none issued and outstanding
 

 
Common stock, $0.01 par value per share; 1,000,000,000 shares authorized; 195,188,759 and 197,557,377 shares issued and outstanding as of March 31, 2019 and December 31, 2018, respectively1,951,000
 1,975,000
Common stock, $0.01 par value per share; 1,000,000,000 shares authorized; 195,365,495 and 193,967,474 shares issued and outstanding as of March 31, 2020 and December 31, 2019, respectively1,953,000
 1,939,000
Additional paid-in capital1,743,711,000
 1,765,840,000
1,741,580,000
 1,728,421,000
Accumulated deficit(728,598,000) (704,748,000)(866,614,000) (827,550,000)
Accumulated other comprehensive loss(2,341,000) (2,560,000)(2,788,000) (2,255,000)
Total stockholders’ equity1,014,723,000
 1,060,507,000
874,131,000
 900,555,000
Noncontrolling interests (Note 13)160,595,000
 158,128,000
159,999,000
 158,108,000
Total equity1,175,318,000
 1,218,635,000
1,034,130,000
 1,058,663,000
Total liabilities, redeemable noncontrolling interests and equity$3,104,888,000
 $2,889,092,000
$3,167,049,000
 $3,172,289,000

3

Table of Contents

GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED BALANCE SHEETS — (Continued)
As of March 31, 20192020 and December 31, 20182019
(Unaudited)

___________

(1)Such liabilities of Griffin-American Healthcare REIT III, Inc. as of March 31, 20192020 and December 31, 20182019 represented liabilities of Griffin-American Healthcare REIT III Holdings, LP or its consolidated subsidiaries. Griffin-American Healthcare REIT III Holdings, LP is a variable interest entity, or VIE, and a consolidated subsidiary of Griffin-American Healthcare REIT III, Inc. The creditors of Griffin-American Healthcare REIT III Holdings, LP or its consolidated subsidiaries do not have recourse against Griffin-American Healthcare REIT III, Inc., except for the 2019 Corporate Line of Credit, and 2016 Corporate Line of Credit, respectively, as defined in Note 8, held by Griffin-American Healthcare REIT III Holdings, LP in the amount of $614,500,000$562,500,000 and $548,500,000$557,000,000 as of March 31, 20192020 and December 31, 2018,2019, respectively, which is guaranteed by Griffin-American Healthcare REIT III, Inc.
The accompanying notes are an integral part of these condensed consolidated financial statements.

4

Table of Contents

GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME (LOSS)
For the Three Months Ended March 31, 20192020 and 20182019
(Unaudited)


Three Months Ended March 31,Three Months Ended March 31,
2019 20182020 2019
Revenues:      
Resident fees and services$268,282,000
 $245,393,000
$289,926,000
 $268,282,000
Real estate revenue32,776,000
 32,499,000
30,118,000
 32,776,000
Total revenues301,058,000
 277,892,000
320,044,000
 301,058,000
Expenses:      
Property operating expenses234,952,000
 217,359,000
255,740,000
 234,952,000
Rental expenses8,425,000
 8,940,000
8,170,000
 8,425,000
General and administrative6,917,000
 6,388,000
6,574,000
 6,917,000
Acquisition related expenses(696,000) (769,000)234,000
 (696,000)
Depreciation and amortization25,628,000
 23,692,000
25,087,000
 25,628,000
Total expenses275,226,000
 255,610,000
295,805,000
 275,226,000
Other income (expense):      
Interest expense:      
Interest expense (including amortization of deferred financing costs and debt discount/premium)(19,059,000) (15,352,000)(18,534,000) (19,059,000)
(Loss) gain in fair value of derivative financial instruments(560,000) 110,000
Loss in fair value of derivative financial instruments(8,183,000) (560,000)
Impairment of real estate investments(5,102,000) 
Loss from unconsolidated entities(454,000) (1,077,000)(904,000) (454,000)
Foreign currency gain1,042,000
 1,796,000
Foreign currency (loss) gain(3,065,000) 1,042,000
Other income208,000
 295,000
555,000
 208,000
Income before income taxes7,009,000
 8,054,000
Income tax (expense) benefit(151,000) 371,000
Net income6,858,000
 8,425,000
(Loss) income before income taxes(10,994,000) 7,009,000
Income tax benefit (expense)3,211,000
 (151,000)
Net (loss) income(7,783,000) 6,858,000
Less: net income attributable to noncontrolling interests(1,348,000) (272,000)(2,127,000) (1,348,000)
Net income attributable to controlling interest$5,510,000
 $8,153,000
Net income per common share attributable to controlling interest — basic and diluted$0.03
 $0.04
Net (loss) income attributable to controlling interest$(9,910,000) $5,510,000
Net (loss) income per common share attributable to controlling interest — basic and diluted$(0.05) $0.03
Weighted average number of common shares outstanding — basic and diluted198,400,657
 200,347,084
194,844,516
 198,400,657
      
Net income$6,858,000
 $8,425,000
Other comprehensive income:   
Net (loss) income$(7,783,000) $6,858,000
Other comprehensive (loss) income:   
Foreign currency translation adjustments219,000
 446,000
(533,000) 219,000
Total other comprehensive income219,000
 446,000
Comprehensive income7,077,000
 8,871,000
Total other comprehensive (loss) income(533,000) 219,000
Comprehensive (loss) income(8,316,000) 7,077,000
Less: comprehensive income attributable to noncontrolling interests(1,348,000) (272,000)(2,127,000) (1,348,000)
Comprehensive income attributable to controlling interest$5,729,000
 $8,599,000
Comprehensive (loss) income attributable to controlling interest$(10,443,000) $5,729,000
The accompanying notes are an integral part of these condensed consolidated financial statements.

5

Table of Contents

GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED STATEMENTS OF EQUITY
For the Three Months Ended March 31, 20192020 and 20182019
(Unaudited)


Stockholders’ Equity    Stockholders’ Equity     
Common Stock            Common Stock             
Number
of
Shares
 Amount 
Additional
Paid-In
Capital
 
Accumulated
Deficit
 
Accumulated
Other
Comprehensive
Loss
 
Total
Stockholders’
Equity
 
Noncontrolling
Interests
 Total Equity
Number
of
Shares
 Amount 
Additional
Paid-In
Capital
 
Accumulated
Deficit
 
Accumulated
Other
Comprehensive
Loss
 
Total
Stockholders’
Equity
 
Noncontrolling
Interests
 Total Equity 
BALANCE — December 31, 2018197,557,377
 $1,975,000
 $1,765,840,000
 $(704,748,000) $(2,560,000) $1,060,507,000
 $158,128,000
 $1,218,635,000
Offering costs — common stock
 
 (83,000) 
 
 (83,000) 
 (83,000)
BALANCE — December 31, 2019193,967,474
 $1,939,000
 $1,728,421,000
 $(827,550,000) $(2,255,000) $900,555,000
 $158,108,000
 $1,058,663,000
 
Issuance of common stock under the DRIP1,515,098
 15,000
 14,181,000
 
 
 14,196,000
 
 14,196,000
1,398,021
 14,000
 13,127,000
 
 
 13,141,000
 
 13,141,000
 
Amortization of nonvested common stock compensation
 
 43,000
 
 
 43,000
 
 43,000

 
 43,000
 
 
 43,000
 
 43,000
 
Stock based compensation
 
 
 
 
 
 195,000
 195,000

 
 
 
 
 
 195,000
 195,000
 
Repurchase of common stock(3,883,716) (39,000) (36,447,000) 
 
 (36,486,000) 
 (36,486,000)
Contributions from noncontrolling interests
 
 
 
 
 
 3,000,000
 3,000,000
Distributions to noncontrolling interests
 
 
 
 
 
 (1,817,000) (1,817,000)
 
 
 
 
 
 (4,000) (4,000) 
Reclassification of noncontrolling interests to mezzanine equity
 
 
 
 
 
 (195,000) (195,000)
 
 
 
 
 
 (195,000) (195,000) 
Fair value adjustment to redeemable noncontrolling interests
 
 177,000
 
 
 177,000
 76,000
 253,000

 
 (11,000) 
 
 (11,000) (4,000) (15,000) 
Distributions declared ($0.15 per share)
 
 
 (29,360,000) 
 (29,360,000) 
 (29,360,000)
 
 
 (29,154,000) 
 (29,154,000) 
 (29,154,000) 
Net income
 
 
 5,510,000
 
 5,510,000
 1,208,000
(1)6,718,000
Other comprehensive income
 
 
 
 219,000
 219,000
 
 219,000
BALANCE — March 31, 2019195,188,759
 $1,951,000
 $1,743,711,000
 $(728,598,000) $(2,341,000) $1,014,723,000
 $160,595,000
 $1,175,318,000
Net (loss) income
 
 
 (9,910,000) 
 (9,910,000) 1,899,000
 (8,011,000)(1)
Other comprehensive loss
 
 
 
 (533,000) (533,000) 
 (533,000) 
BALANCE — March 31, 2020195,365,495
 $1,953,000
 $1,741,580,000
 $(866,614,000) $(2,788,000) $874,131,000
 $159,999,000
 $1,034,130,000
 
Stockholders’ Equity    Stockholders’ Equity     
Common Stock            Common Stock             
Number
of
Shares
 Amount 
Additional
Paid-In
Capital
 
Accumulated
Deficit
 
Accumulated
Other
Comprehensive
Loss
 
Total
Stockholders’
Equity
 
Noncontrolling
Interests
 Total Equity
Number
of
Shares
 Amount 
Additional
Paid-In
Capital
 
Accumulated
Deficit
 
Accumulated
Other
Comprehensive
Loss
 
Total
Stockholders’
Equity
 
Noncontrolling
Interests
 Total Equity 
BALANCE — December 31, 2017199,343,234
 $1,993,000
 $1,785,872,000
 $(598,044,000) $(1,971,000) $1,187,850,000
 $158,725,000
 $1,346,575,000
BALANCE — December 31, 2018197,557,377
 $1,975,000
 $1,765,840,000
 $(704,748,000) $(2,560,000) $1,060,507,000
 $158,128,000
 $1,218,635,000
 
Offering costs — common stock
 
 (6,000) 
 
 (6,000) 
 (6,000)
 
 (83,000) 
 
 (83,000) 
 (83,000) 
Issuance of common stock under the DRIP1,642,834
 16,000
 15,213,000
 
 
 15,229,000
 
 15,229,000
1,515,098
 15,000
 14,181,000
 
 
 14,196,000
 
 14,196,000
 
Amortization of nonvested common stock compensation
 
 43,000
 
 
 43,000
 
 43,000

 
 43,000
 
 
 43,000
 
 43,000
 
Stock based compensation
 
 
 
 
 
 195,000
 195,000

 
 
 
 
 
 195,000
 195,000
 
Repurchase of common stock(1,792,524) (18,000) (16,488,000) 
 
 (16,506,000) 
 (16,506,000)(3,883,716) (39,000) (36,447,000) 
 
 (36,486,000) 
 (36,486,000) 
Contribution from noncontrolling interest
 
 
 
 
 
 4,470,000
 4,470,000
Contributions from noncontrolling interests
 
 
 
 
 
 3,000,000
 3,000,000
 
Distributions to noncontrolling interests
 
 
 
 
 
 (1,919,000) (1,919,000)
 
 
 
 
 
 (1,817,000) (1,817,000) 
Reclassification of noncontrolling interests to mezzanine equity
 
 
 
 
 
 (195,000) (195,000)
 
 
 
 
 
 (195,000) (195,000) 
Fair value adjustment to redeemable noncontrolling interests
 
 (173,000) 
 
 (173,000) (74,000) (247,000)
 
 177,000
 
 
 177,000
 76,000
 253,000
 
Distributions declared ($0.15 per share)
 
 
 (29,647,000) 
 (29,647,000) 
 (29,647,000)
 
 
 (29,360,000) 
 (29,360,000) 
 (29,360,000) 
Net income
 
 
 8,153,000
 
 8,153,000
 243,000
(1)8,396,000

 
 
 5,510,000
 
 5,510,000
 1,208,000
 6,718,000
(1)
Other comprehensive income
 
 
 
 446,000
 446,000
 
 446,000

 
 
 
 219,000
 219,000
 
 219,000
 
BALANCE — March 31, 2018199,193,544
 $1,991,000
 $1,784,461,000
 $(619,538,000) $(1,525,000) $1,165,389,000
 $161,445,000
 $1,326,834,000
BALANCE — March 31, 2019195,188,759
 $1,951,000
 $1,743,711,000
 $(728,598,000) $(2,341,000) $1,014,723,000
 $160,595,000
 $1,175,318,000
 

6

Table of Contents

GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED STATEMENTS OF EQUITY — (Continued)
For the Three Months Ended March 31, 2019 and 2018
(Unaudited)


___________
(1)For the three months ended March 31, 20192020 and 2018,2019, amounts exclude $140,000$228,000 and $29,000,$140,000, respectively, of net income attributable to redeemable noncontrolling interests. See Note 12, Redeemable Noncontrolling Interests, for a further discussion.
The accompanying notes are an integral part of these condensed consolidated financial statements.

76

Table of Contents

GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
For the Three Months Ended March 31, 20192020 and 20182019
(Unaudited)

Three Months Ended March 31,Three Months Ended March 31,
2019 20182020 2019
CASH FLOWS FROM OPERATING ACTIVITIES      
Net income$6,858,000
 $8,425,000
Adjustments to reconcile net income to net cash provided by operating activities:   
Net (loss) income$(7,783,000) $6,858,000
Adjustments to reconcile net (loss) income to net cash provided by operating activities:   
Depreciation and amortization25,628,000
 23,692,000
25,087,000
 25,628,000
Other amortization7,577,000
 1,174,000
7,689,000
 7,577,000
Deferred rent(1,746,000) (1,068,000)(1,096,000) (1,746,000)
Stock based compensation195,000
 195,000
195,000
 195,000
Stock based compensation — nonvested restricted common stock43,000
 43,000
43,000
 43,000
Loss from unconsolidated entities454,000
 1,077,000
904,000
 454,000
Bad debt expense448,000
 126,000

 448,000
Foreign currency gain(1,042,000) (1,791,000)
Foreign currency loss (gain)3,007,000
 (1,042,000)
Deferred income taxes(3,329,000) 6,000
Change in fair value of contingent consideration(681,000) (743,000)
 (681,000)
Change in fair value of derivative financial instruments560,000
 (110,000)8,183,000
 560,000
Impairment of real estate investments5,102,000
 
Changes in operating assets and liabilities:      
Accounts and other receivables(5,756,000) (1,571,000)5,039,000
 (5,756,000)
Other assets726,000
 (2,831,000)(3,104,000) 780,000
Accounts payable and accrued liabilities(132,000) (2,404,000)(6,090,000) (132,000)
Accounts payable due to affiliates21,000
 15,000
(35,000) 21,000
Security deposits, prepaid rent, operating lease and other liabilities(7,853,000) 1,769,000
(7,929,000) (7,913,000)
Net cash provided by operating activities25,300,000
 25,998,000
25,883,000
 25,300,000
CASH FLOWS FROM INVESTING ACTIVITIES      
Acquisitions of real estate investments(16,036,000) 
(1,478,000) (16,036,000)
Investments in unconsolidated entities(1,100,000) 
(350,000) (1,100,000)
Capital expenditures(16,722,000) (12,662,000)(37,217,000) (16,722,000)
Real estate and other deposits(187,000) (2,352,000)(173,000) (187,000)
Net cash used in investing activities(34,045,000)
(15,014,000)(39,218,000)
(34,045,000)
CASH FLOWS FROM FINANCING ACTIVITIES      
Borrowings under mortgage loans payable6,080,000
 458,000
8,239,000
 6,080,000
Payments on mortgage loans payable(2,867,000) (2,506,000)(3,137,000) (2,867,000)
Borrowings under the lines of credit and term loans651,501,000
 71,531,000
28,500,000
 651,501,000
Payments on the lines of credit and term loans(585,500,000) (45,100,000)(10,000,000) (585,500,000)
Payments under financing obligations(2,133,000) (1,754,000)(1,615,000) (2,133,000)
Deferred financing costs(6,020,000) (21,000)(849,000) (6,020,000)
Repurchase of common stock(36,486,000) (16,506,000)
 (36,486,000)
Repurchase of stock warrants and redeemable noncontrolling interest(78,000) 

 (78,000)
Contributions from noncontrolling interests3,000,000
 4,470,000

 3,000,000
Distributions to noncontrolling interests(1,813,000) (1,915,000)
 (1,813,000)
Contributions from redeemable noncontrolling interests
 535,000
Distributions to redeemable noncontrolling interests(485,000) (166,000)
 (485,000)
Security deposits and other(97,000) (21,000)(3,000) (97,000)

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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS — (Continued)
For the Three Months Ended March 31, 20192020 and 20182019
(Unaudited)

Three Months Ended March 31,Three Months Ended March 31,
2019 20182020 2019
Distributions paid$(15,227,000) $(14,377,000)$(16,032,000) $(15,227,000)
Net cash provided by (used in) financing activities9,875,000
 (5,372,000)
Net cash provided by financing activities5,103,000
 9,875,000
NET CHANGE IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH$1,130,000
 $5,612,000
$(8,232,000) $1,130,000
EFFECT OF FOREIGN CURRENCY TRANSLATION ON CASH, CASH EQUIVALENTS AND RESTRICTED CASH41,000
 59,000
(134,000) 41,000
CASH, CASH EQUIVALENTS AND RESTRICTED CASH — Beginning of period72,705,000
 64,143,000
89,880,000
 72,705,000
CASH, CASH EQUIVALENTS AND RESTRICTED CASH — End of period$73,876,000
 $69,814,000
$81,514,000
 $73,876,000
      
RECONCILIATION OF CASH, CASH EQUIVALENTS AND RESTRICTED CASH      
Beginning of period:      
Cash and cash equivalents$35,132,000
 $33,656,000
$53,149,000
 $35,132,000
Restricted cash37,573,000
 30,487,000
36,731,000
 37,573,000
Cash, cash equivalents and restricted cash$72,705,000
 $64,143,000
$89,880,000
 $72,705,000
      
End of period:      
Cash and cash equivalents$34,904,000
 $37,926,000
$44,683,000
 $34,904,000
Restricted cash38,972,000
 31,888,000
36,831,000
 38,972,000
Cash, cash equivalents and restricted cash$73,876,000
 $69,814,000
$81,514,000
 $73,876,000
      
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION      
Cash paid for:      
Interest$16,345,000
 $13,774,000
$17,181,000
 $16,345,000
Income taxes$160,000
 $453,000
$111,000
 $160,000
SUPPLEMENTAL DISCLOSURE OF NONCASH ACTIVITIES      
Investing Activities:      
Accrued capital expenditures$9,309,000
 $5,957,000
$22,579,000
 $9,309,000
Capital expenditures from financing obligations$2,563,000
 $3,194,000
$
 $2,563,000
Tenant improvement overage$313,000
 $353,000
$896,000
 $313,000
The following represents the increase in certain assets and liabilities in connection with our acquisitions of real estate investments:   
The following represents the increase in certain liabilities in connection with our acquisitions of real estate investments:   
Accounts payable and accrued liabilities$37,000
 $
$
 $37,000
Prepaid rent$105,000
 $
$
 $105,000
Financing Activities:      
Issuance of common stock under the DRIP$14,196,000
 $15,229,000
$13,141,000
 $14,196,000
Distributions declared but not paid$10,125,000
 $10,233,000
$9,955,000
 $10,125,000
Reclassification of noncontrolling interests to mezzanine equity$195,000
 $195,000
$195,000
 $195,000
The accompanying notes are an integral part of these condensed consolidated financial statements.


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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited)
For the Three Months Ended March 31, 20192020 and 20182019
The use of the words “we,” “us” or “our” refers to Griffin-American Healthcare REIT III, Inc. and its subsidiaries, including Griffin-American Healthcare REIT III Holdings, LP, except where otherwise noted.
1. Organization and Description of Business
Griffin-American Healthcare REIT III, Inc., a Maryland corporation, was incorporated on January 11, 2013 and therefore, we consider that our date of inception. We were initially capitalized on January 15, 2013. We invest in a diversified portfolio of real estate properties, focusing primarily on medical office buildings, hospitals, skilled nursing facilities, senior housing and other healthcare-related facilities. We also operate healthcare-related facilities utilizing the structure permitted by the REIT Investment Diversification and Empowerment Act of 2007, which is commonly referred to as a “RIDEA” structure (the provisions of the Internal Revenue Code of 1986, as amended, or the Code, authorizing the RIDEA structure were enacted as part of the Housing and Economic Recovery Act of 2008). We also originate and acquire secured loans and may also originate and acquire other real estate-related investments on an infrequent and opportunistic basis. We generally seek investments that produce current income. We qualified to be taxed as a real estate investment trust, or REIT, under the Code for federal income tax purposes beginning with our taxable year ended December 31, 2014, and we intend to continue to qualify to be taxed as a REIT.
On February 26, 2014, we commenced a best efforts initial public offering, or our initial offering, in which we offered to the public up to $1,900,000,000 in shares of our common stock. As of April 22, 2015, the deregistration date of our initial offering, we had received and accepted subscriptions in our initial offering for 184,930,598 shares of our common stock, or $1,842,618,000, excluding shares of our common stock issued pursuant to our initial distribution reinvestment plan, or the Initial DRIP. As of April 22, 2015, a total of $18,511,000 in distributions were reinvested that resulted in 1,948,563 shares of our common stock being issued pursuant to the Initial DRIP. See Note 13, Equity — Common Stock, for a further discussion.
On March 25, 2015, we filed a Registration Statement on Form S-3 under the Securities Act of 1933, as amended, or the Securities Act, to register a maximum of $250,000,000 of additional shares of our common stock to be issued pursuant to the Initial DRIP, or the 2015 DRIP Offering. We commenced offering shares pursuant to the 2015 DRIP Offering following the deregistration of our initial offering. Effective October 5, 2016, we amended and restated the Initial DRIP, or the Amended and Restated DRIP, to amend the price at which shares of our common stock are issued pursuant to the 2015 DRIP Offering. We continued to offer shares of our common stock pursuant to the 2015 DRIP Offering until the termination and deregistration of such offering on March 29, 2019. As of March 29, 2019, a total of $245,396,000 in distributions were reinvested that resulted in 26,386,545 shares of common stock being issued pursuant to the 2015 DRIP Offering.
On January 30, 2019, we filed a Registration Statement on Form S-3 under the Securities Act to register a maximum of $200,000,000 of additional shares of our common stock to be issued pursuant to the Amended and Restated DRIP, or the 2019 DRIP Offering; however, we did not commenceOffering. We commenced offering shares pursuant to the 2019 DRIP Offering untilon April 1, 2019, following the deregistration of the 2015 DRIP Offering. As of March 31, 2020, a total of $54,385,000 in distributions were reinvested that resulted in 5,796,607 shares of common stock being issued pursuant to the 2019 DRIP Offering. We collectively refer to the Initial DRIP portion of our initial offering, the 2015 DRIP Offering and the 2019 DRIP Offering as our DRIP Offerings. See Note 13, Equity — Distribution Reinvestment Plan, for a further discussion.
We conduct substantially all of our operations through Griffin-AmericanGriffin-American Healthcare REIT III Holdings, LP, or our operating partnership. We are externally advised by Griffin-American Healthcare REIT III Advisor, LLC, or Griffin-American Advisor, or our advisor, pursuant to an advisory agreement, or the Advisory Agreement, between us and our advisor. The Advisory Agreement was effective as of February 26, 2014 and had a one-year initial term, subject to successive one-year renewals upon the mutual consent of the parties. The Advisory Agreement was last renewed pursuant to the mutual consent of the parties on February 13, 201911, 2020 and expires on February 26, 2020.2021. Our advisor uses its best efforts, subject to the oversight, review and approval of our board of directors, or our board, to, among other things, research, identify, review and make investments in and dispositions of properties and securities on our behalf consistent with our investment policies and objectives. Our advisor performs its duties and responsibilities under the Advisory Agreement as our fiduciary. Our advisor is 75.0% owned and managed by wholly owned subsidiaries of American Healthcare Investors, LLC, or American Healthcare Investors, and 25.0% owned by a wholly owned subsidiary of Griffin Capital Company, LLC, or Griffin Capital, or collectively, our co-sponsors. American Healthcare Investors is 47.1% owned by AHI Group Holdings, LLC, or AHI Group Holdings, 45.1% indirectly owned by Colony Capital, Inc. (NYSE: CLNY), or Colony Capital, and 7.8% owned by James F. Flaherty III, a former partner of Colony Capital. We are not affiliated with Griffin Capital, Griffin Capital Securities, LLC, the dealer manager for our initial offering, or our dealer manager, Colony Capital or Mr. Flaherty; however, we are affiliated with Griffin-American Advisor, American Healthcare Investors and AHI Group Holdings.

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

We currently operate through six reportable business segments: medical office buildings, hospitals, skilled nursing facilities, senior housing, senior housing — RIDEA and integrated senior health campuses. As of March 31, 2019,2020, we owned and/or operated 98 properties, comprising 102 buildings, and 113118 integrated senior health campuses including completed development projects, or approximately 13,412,00013,841,000 square feet of gross leasable area, or GLA, for an aggregate contract purchase price of $2,967,409,000.$3,002,533,000. In addition, as of March 31, 2019,2020, we had invested $89,079,000 inalso owned a real estate-related investments, net of principal repayments.investment purchased for $60,429,000.
2. Summary of Significant Accounting Policies
The summary of significant accounting policies presented below is designed to assist in understanding our accompanying condensed consolidated financial statements. Such condensed consolidated financial statements and the accompanying notes thereto are the representations of our management, who are responsible for their integrity and objectivity. These accounting policies conform to accounting principles generally accepted in the United States of America, or GAAP, in all material respects, and have been consistently applied in preparing our accompanying condensed consolidated financial statements.
Basis of Presentation
Our accompanying condensed consolidated financial statements include our accounts and those of our operating partnership, the wholly owned subsidiaries of our operating partnership and all non-wholly owned subsidiaries in which we have control, as well as any VIEs in which we are the primary beneficiary. We evaluate our ability to control an entity, and whether the entity is a VIE and we are the primary beneficiary, by considering substantive terms of the arrangement and identifying which enterprise has the power to direct the activities of the entity that most significantly impacts the entity’s economic performance.
We operate and intend to continue to operate in an umbrella partnership REIT structure in which our operating partnership, or wholly owned subsidiaries of our operating partnership and all non-wholly owned subsidiaries of which we have control, will own substantially all of the interests in properties acquired on our behalf. We are the sole general partner of our operating partnership, and as of March 31, 20192020 and December 31, 2018,2019, we owned greater than a 99.99% general partnership interest therein. AsOur advisor is a limited partner, and as of March 31, 20192020 and December 31, 2018, our advisor2019, owned less than a 0.01% noncontrolling limited partnership interest in our operating partnership.
Because we are the sole general partner of our operating partnership and have unilateral control over its management and major operating decisions (even if additional limited partners are admitted to our operating partnership), the accounts of our operating partnership are consolidated in our accompanying condensed consolidated financial statements. All intercompany accounts and transactions are eliminated in consolidation.
Interim Unaudited Financial Data
Our accompanying condensed consolidated financial statements have been prepared by us in accordance with GAAP in conjunction with the rules and regulations of the United States Securities and Exchange Commission, or SEC. Certain information and footnote disclosures required for annual financial statements have been condensed or excluded pursuant to SEC rules and regulations. Accordingly, our accompanying condensed consolidated financial statements do not include all of the information and footnotes required by GAAP for complete financial statements. Our accompanying condensed consolidated financial statements reflect all adjustments which are, in our view, of a normal recurring nature and necessary for a fair presentation of our financial position, results of operations and cash flows for the interim period. Interim results of operations are not necessarily indicative of the results to be expected for the full year; such full year results may be less favorable.
In preparing our accompanying condensed consolidated financial statements, management has evaluated subsequent events through the financial statement issuance date. We believe that although the disclosures contained herein are adequate to prevent the information presented from being misleading, our accompanying condensed consolidated financial statements should be read in conjunction with our audited consolidated financial statements and the notes thereto included in our 20182019 Annual Report on Form 10-K, as filed with the SEC on March 21, 2019.26, 2020.
Use of Estimates
The preparation of our accompanying condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, as well as the disclosure of contingent assets and liabilities, at the date of our condensed consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. These estimates are made and evaluated on an on-going basis

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

amounts of revenues and expenses during the reporting period. Significant items subject to such estimates and assumptions include, but are not limited to, the initial and recurring valuation of certain assets acquired and liabilities assumed through property acquisitions, allowance for credit losses, impairment of long-lived assets and contingencies. These estimates are made and evaluated on an on-going basis using information that is currently available as well as various other assumptions believed to be reasonable under the circumstances. Actual results could differ from those estimates, perhaps in material adverse ways, and those estimates could be different under different assumptions or conditions.
Leases
On January 1, 2019, we adopted Financial Accounting Standards Board, or FASB, Accounting Standards Codification, or ASC, Topic 842, or ASC Topic 842. ASC Topic 842 supersedes ASC Topic 840, Leases, or ASC Topic 840. We adopted ASC Topic 842 using the modified retrospective approach whereby the cumulative effect of adoption was recognized on the adoption date and prior periods were not restated. There was no net cumulative effect adjustment to retained earnings as of January 1, 2019 as a result of this adoption. Therefore, with respect to our leases as both lessees and lessors, information is presented under ASC Topic 842 as of and for the three months ended March 31, 2019 and under ASC Topic 840 as of and for the year ended December 31, 2018. In addition, ASC Topic 842 provides a practical expedient package that allows an entity to not reassess the following upon adoption (must be elected as a group): (i) whether an expired or existing contract contains a lease arrangement; (ii) the lease classification related to expired or existing lease arrangements; or (iii) whether costs incurred on expired or existing leases qualify as initial direct costs. We elected such practical expedient package upon our adoption of ASC Topic 842 on January 1, 2019. We determine if a contract is a lease upon inception of the lease. We maintain a distinction between finance leases and operating leases, which is substantially similar to the classification criteria for distinguishing between capital leases and operating leases in the previous lease guidance.
Lessee: Pursuant to ASC Topic 842, lessees are required to recognize the following for all leases with terms greater of 12 months at the commencement date: (i) a lease liability, which is a lessee’s obligation to make lease payments arising from a lease; and (ii) a right-of-use asset, which is an asset that represents the lessee’s right to use, or control the use of, a specified asset for the lease term. The lease liability is calculated by using either the implicit rate of the lease or the incremental borrowing rate. As a result of the adoption of ASC Topic 842 on January 1, 2019, we recognized an initial amount of lease liability of $198,453,000 in our condensed consolidated balance sheet for all of our operating leases for which we are the lessee, including facilities leases and ground leases. In addition, we recorded a corresponding right-of-use asset of $211,679,000, which is the lease liability, net of the existing prepaid rent asset and accrued straight-line rent liability balance and adjusted for unamortized above/below market ground lease intangibles. The accretion of lease liability and amortization expense on right-of-use assets for our operating leases are included in property operating expenses and rental expenses in our accompanying condensed consolidated statements of operations and comprehensive income. The operating lease liability was calculated using our incremental borrowing rate based on the information available as of our adoption date.
The accounting for our existing capital (finance) leases upon adoption of ASC Topic 842 remains substantially unchanged. For our finance leases, the accretion of lease liability is included in interest expense and the amortization expense on right-of-use assets is included in depreciation and amortization in our accompanying condensed consolidated statements of operations and comprehensive income. Further, finance lease liabilities are included within financing obligations in our accompanying condensed consolidated balance sheets.
Lessor: Pursuant to ASC Topic 842, lessors bifurcate lease revenues into lease components and non-lease components and separately recognize and disclose non-lease components that are executory in nature. Lease components continue to be recognized on a straight-line basis over the lease term and certain non-lease components may be accounted for under the new revenue recognition guidance in ASC Topic 606, Revenue from Contracts with Customers, or ASC Topic 606. See “Revenue Recognition” section below. ASC Topic 842 also provides for a practical expedient package that permits lessors to not separate non-lease components from the associated lease component if certain conditions are met. Such practical expedient is limited to circumstances in which (i) the timing and pattern of transfer are the same for the non-lease component and the related lease component; and (ii) the lease component, if accounted for separately, would be classified as an operating lease. In addition, such practical expedient causes an entity to assess whether a contract is predominately lease or service based, and recognize the entire contract under the relevant accounting guidance. Effective upon our adoption of ASC Topic 842 on January 1, 2019, we recognize revenue for our medical office buildings, senior housing, skilled nursing facilities and hospitals segments under ASC Topic 842 as real estate revenue. Minimum annual rental revenue is recognized on a straight-line basis over the term of the related lease (including rent holidays). Differences between real estate revenue recognized and cash amounts contractually due from tenants under the lease agreements are recorded to deferred rent receivable. Tenant reimbursement revenue, which comprises additional amounts recoverable from tenants for common area maintenance expenses and certain other recoverable expenses, are considered non-lease components. We qualified for and elected the practical expedient as outlined above to combine the non-lease component with the lease component, which is the predominant component, and therefore is recognized as part of real estate revenue. In addition as lessors, we exclude certain lessor costs (i.e., property taxes and insurance) paid

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

directly by a lessee to third parties on our behalf from our measurement of variable lease revenue and associated expense (i.e., no gross up of revenue and expense for these costs); and (ii) include lessor costs that we paid and are reimbursed by the lessee in our measurement of variable lease revenue and associated expense (i.e., gross up revenue and expense for these costs). Therefore, we no longer record revenue or expense when the lessee pays the property taxes and insurance directly to a third party.
For our senior housing — RIDEA facilities and integrated senior health campuses, we recognize revenue under ASC Topic 606 as resident fees and services, based on our predominance assessment from electing the practical expedient outlined above. See “Revenue Recognition” below.
See Note 17, Leases, for a further discussion.
Revenue Recognition
On January 1, 2018, we adopted ASC Topic 606, applying the modified retrospective method. Results for reporting periods beginning after January 1, 2018 are presented under ASC Topic 606, while prior period amounts are not adjusted and continue to be reported under the accounting standards in effect for the prior period. The adoption of ASC Topic 606 did not have a material impact on the measurement nor on the recognition of revenue as of January 1, 2018; therefore, no cumulative adjustment has been made to the opening balance of retained earnings at the beginning of 2018.
Real estate revenue
Prior to January 1, 2019, minimum annual rental revenue was recognized on a straight-line basis over the term of the related lease (including rent holidays) in accordance with ASC Topic 840, Leases, or ASC Topic 840. Differences between real estate revenue recognized and cash amounts contractually due from tenants under the lease agreements were recorded to deferred rent receivable or deferred rent liability, as applicable. Tenant reimbursement revenue, which comprises additional amounts recoverable from tenants for common area maintenance expenses and certain other recoverable expenses, was recognized as revenue in the period in which the related expenses were incurred. Tenant reimbursements were recognized and presented in accordance with ASC Subtopic 606-10-55-36, Revenue Recognition Principal Versus Agent Consideration, or ASC Subtopic 606. ASC Subtopic 606 requires that these reimbursements be recorded on a gross basis as we are generally primarily responsible to fulfill the promise to provide specified goodsResident Fees and services. We recognized lease termination fees at such time when there was a signed termination letter agreement, all of the conditions of such agreement have been met and the tenant is no longer occupying the property.Services Revenue
Effective January 1, 2019, we recognize real estate revenue in accordance with ASC Topic 842. See “Leases” section above.
Resident fees and services revenue
Disaggregation of Resident Fees and Services Revenue
The following table disaggregates our resident fees and services revenue by line of business, according to whether such revenue is recognized at a point in time or over time:
 Three Months Ended March 31, Three Months Ended March 31,
 2019 2018 2020 2019
 Point in Time Over Time Total Point in Time Over Time Total Point in Time Over Time Total Point in Time Over Time Total
Integrated senior health campuses $52,342,000
 $199,372,000
 $251,714,000
 $45,165,000
 $183,896,000
 $229,061,000
 $54,528,000
 $213,266,000
 $267,794,000
 $52,342,000
 $199,372,000
 $251,714,000
Senior housing — RIDEA(1) 711,000
 15,857,000
 16,568,000
 768,000
 15,564,000
 16,332,000
 872,000
 21,260,000
 22,132,000
 711,000
 15,857,000
 16,568,000
Total resident fees and services $53,053,000
 $215,229,000
 $268,282,000
 $45,933,000
 $199,460,000
 $245,393,000
 $55,400,000
 $234,526,000
 $289,926,000
 $53,053,000
 $215,229,000
 $268,282,000

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The following table disaggregates our resident fees and services revenue by payor class:
 Three Months Ended March 31, Three Months Ended March 31,
 2019 2018 2020 2019
 
Integrated
Senior Health
Campuses
 
Senior
Housing
 — RIDEA(1)
 Total 
Integrated
Senior Health
Campuses(2)
 
Senior
Housing
 — RIDEA(1)
 Total 
Integrated
Senior Health
Campuses
 
Senior
Housing
 — RIDEA(1)
 Total 
Integrated
Senior Health
Campuses
 
Senior
Housing
 — RIDEA(1)
 Total
Private and other payors $128,267,000
 $21,700,000
 $149,967,000
 $122,201,000
 $16,555,000
 $138,756,000
Medicare $84,477,000
 $
 $84,477,000
 $78,037,000
 $
 $78,037,000
 87,219,000
 
 87,219,000
 84,477,000
 
 84,477,000
Medicaid 45,036,000
 13,000
 45,049,000
 40,404,000
 3,000
 40,407,000
 52,308,000
 432,000
 52,740,000
 45,036,000
 13,000
 45,049,000
Private and other payors 122,201,000
 16,555,000
 138,756,000
 110,620,000
 16,329,000
 126,949,000
Total resident fees and services $251,714,000
 $16,568,000
 $268,282,000
 $229,061,000

$16,332,000

$245,393,000
 $267,794,000
 $22,132,000
 $289,926,000
 $251,714,000
 $16,568,000
 $268,282,000
___________
(1)This includes fees for basic housing and assisted living care. We record revenue when services are rendered on the date services are provided at amounts billable to individual residents. Residency agreements are generally for a term of 30 days, with resident fees billed monthly in advance. For patients under reimbursement arrangements with Medicaid, revenue is recorded based on contractually agreed-upon amounts or rates on a per resident, daily basis or as services are rendered.
(2)Medicare includes $21,881,000 of revenue that was previously disclosed as Private and other payors. There was no net change in previously disclosed total resident fees and services.
Accounts Receivable, Net Resident Fees and Services Revenue
The beginning and ending balances of accounts receivable, net resident fees and services are as follows:
  Medicare Medicaid 
Private
and
Other Payors
 Total
Beginning balance — January 1, 2019
 $29,160,000
 $18,676,000
 $39,112,000
 $86,948,000
Ending balance — March 31, 2019
 30,898,000
 18,642,000
 43,912,000
 93,452,000
Increase/(decrease) $1,738,000
 $(34,000) $4,800,000
 $6,504,000
  Medicare Medicaid 
Private
and
Other Payors
 Total
Beginning balance — January 1, 2020
 $32,127,000
 $26,366,000
 $46,543,000
 $105,036,000
Ending balance — March 31, 2020
 31,766,000
 23,095,000
 48,094,000
 102,955,000
(Decrease)/increase $(361,000) $(3,271,000) $1,551,000
 $(2,081,000)

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

Deferred Revenue Resident Fees and Services Revenue
The beginning and ending balances of deferred revenue resident fees and services, all of which relates to private and other payors, are as follows:
  Total
Beginning balance — January 1, 2019
 $12,569,000
Ending balance — March 31, 2019
 10,590,000
Decrease $(1,979,000)
  Total
Beginning balance — January 1, 2020
 $13,518,000
Ending balance — March 31, 2020
 13,529,000
Increase $11,000
Tenant and Resident Receivables and Allowance for Uncollectible AccountsAllowances
On January 1, 2020, we adopted Financial Accounting Standards Board, or FASB, Accounting Standards Codification, or ASC, Topic 326, Financial Instruments Credit Losses, or ASC Topic 326. We adopted ASC Topic 326 using the modified retrospective approach whereby the cumulative effect of adoption was recognized on the adoption date and prior periods were not restated. There was no net cumulative effect adjustment to retained earnings as of January 1, 2020.
Resident receivables are carried net of an allowance for uncollectible amounts.credit losses. An allowance is maintained for estimated losses resulting from the inability of residents and payors to meet the contractual obligations under their lease or service agreements. Upon our adoption of ASC Topic 606, substantiallySubstantially all of such allowances are recorded as direct reductions of resident fees and services revenue as contractual adjustments provided to third-party payors or implicit price concessions in our accompanying condensed consolidated statements of operations and comprehensive income.income (loss). Our determination of the adequacy of these allowances is based primarily upon evaluations of historical loss experience, the residents’ financial condition, security deposits, cash collection patterns by payor and by state, current economic conditions, future expectations in estimating credit losses and other relevant factors.
Tenant receivables and unbilled deferred rent receivables are recognized as direct reductions of real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive income (loss).
As of March 31, 2020 and December 31, 2019, we had $10,809,000 and $11,435,000, respectively, in allowances, which were determined necessary to reduce receivables by our expected future credit losses. For the three months ended March 31, 2020 and 2019, we increased allowances by $3,826,000 and $3,244,000, respectively, and reduced allowances for collections or adjustments by $2,478,000 and $1,227,000, respectively. For the three months ended March 31, 2020 and 2019, $1,974,000 and $1,243,000, respectively, of our receivables were written off against the related allowances.
Impairment of Long-Lived Assets
We periodically evaluate our long-lived assets, primarily consisting of investments in real estate that we carry at our historical cost less accumulated depreciation, for impairment when events or changes in circumstances indicate that its carrying value may not be recoverable. Indicators we consider important and that we believe could trigger an impairment review include, among others, the following:
significant negative industry or economic trends;
a significant underperformance relative to historical or projected future operating results; and
a significant change in the extent or manner in which the asset is used or significant physical change in the asset.
For the three months ended March 31, 2020, we determined that one skilled nursing facility was impaired, and as such, we recognized an impairment charge of $3,711,000 to reduce the carrying value of such asset to $3,840,000. The fair value of such property was based on its projected sales price obtained from an independent third party using comparable market information, which was considered a Level 2 measurement within the fair value hierarchy. No impairment charges on long-lived assets were recognized for the three months ended March 31, 2019.
Properties Held for Sale
A property or a group of properties is required to be reported in discontinued operations in the statements of operations and comprehensive income (loss) for current and prior periods if the disposal represents a strategic shift that has (or will have) a major effect on an entity’s operations and financial results when either: (i) the component has been disposed of or (ii) is

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classified as held for sale. At such time as a property is held for sale, such property is carried at the lower of: (i) its carrying amount or (ii) fair value less costs to sell. In addition, a property being held for sale ceases to be depreciated. For the three months ended March 31, 2020, we determined that the fair value of one integrated senior health campus that was held for sale was lower than its carrying amount, and as such, we recognized an impairment charge of $1,391,000 to reduce the carrying value of such asset to $350,000. The fair value of such asset was based on its projected sales price obtained from an independent third party using comparable market information, which was considered a Level 2 measurement within the fair value hierarchy. No impairment charges on properties held for sale were recognized for the three months ended March 31, 2019.
Debt Security Investment, Net
We classify our marketable debt security investment as held-to-maturity because we have the positive intent and ability to hold the security to maturity, and we have not recorded any unrealized holding gains or losses on such investment. Our held-to-maturity security is recorded at amortized cost and adjusted for the amortization of premiums or discounts through maturity. Prior to the adoption of ASC Topic 326, a loss was recognized in earnings when we determined declines in the fair value of marketable securities were other-than-temporary. For the three months ended March 31, 2019, we did not incur any such losses. Effective January 1, 2020, we evaluated our debt security investment for expected future credit loss in accordance with ASC Topic 326. There was no net cumulative effect adjustment to retained earnings as of January 1, 2020. See Note 4, Debt Security Investment, Net, for a further discussion.
Accounts Payable and Accrued Liabilities
As of March 31, 2020 and December 31, 2019, accounts payable and accrued liabilities primarily includes reimbursement of payroll related costs to the managers of our senior housing — RIDEA facilities and integrated senior health campuses of $33,472,000 and $24,118,000, respectively, insurance reserves of $33,237,000 and $35,581,000, respectively, accrued capital expenditures to unaffiliated third parties of $22,398,000 and $25,019,000, respectively, accrued property taxes of $15,885,000 and $14,501,000, respectively, and accrued distributions of $9,955,000 and $9,974,000, respectively.
Recently Issued Accounting Pronouncement
In March 2020, the FASB issued Accounting Standards Update, or ASU, 2020-04, Facilitation of the Effects of Reference Rate Reform of Financial Reporting, or ASU 2020-04, which provides optional expedients and exceptions for applying GAAP to contract modifications, hedging relationships and other transactions, subject to meeting certain criteria. ASU 2020-04 applies to the aforementioned transactions that reference LIBOR or another reference rate expected to be discontinued because of the reference rate reform. ASU 2020-04 is effective for fiscal years and interim periods beginning after March 12, 2020 and through December 31, 2022. We are currently evaluating this guidance to determine the impact on our disclosures.
3. Real Estate Investments, Net
Our real estate investments, net consisted of the following as of March 31, 2020 and December 31, 2019:
 
March 31,
2020
 December 31,
2019
Building, improvements and construction in process$2,282,943,000
 $2,262,320,000
Land and improvements197,187,000
 195,491,000
Furniture, fixtures and equipment159,284,000
 150,508,000
 2,639,414,000
 2,608,319,000
Less: accumulated depreciation(359,657,000) (337,898,000)
 $2,279,757,000
 $2,270,421,000
Depreciation expense for the three months ended March 31, 2020 and 2019 was $22,742,000 and $22,204,000, respectively. For the three months ended March 31, 2020, we incurred capital expenditures of $30,332,000 for our integrated senior health campuses, $4,199,000 for our medical office buildings, $254,000 for our senior housing —RIDEA facilities and $15,000 for our hospitals. We did not incur any capital expenditures for our senior housing facilities and skilled nursing facilities for the three months ended March 31, 2020.

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

For the three months ended March 31, 2020, we, through a majority-owned subsidiary of Trilogy Investors, LLC, or Trilogy, of which we owned 67.6% at the time of acquisition, acquired a land parcel in Ohio for a contract purchase price of $1,693,000 plus closing costs and paid to our advisor an acquisition fee of 2.25% of the portion of the contract purchase price of such land parcel attributed to our ownership interest.
4. Debt Security Investment, Net
On October 15, 2015, we acquired a commercial mortgage-backed debt security, or debt security, from an unaffiliated third party. The debt security bears an interest rate on the stated principal amount thereof equal to 4.24% per annum, the terms of which security provide for monthly interest-only payments. The debt security matures on August 25, 2025 at a stated amount of $93,433,000, resulting in an anticipated yield-to-maturity of 10.0% per annum. The debt security was issued by an unaffiliated mortgage trust and represents a 10.0% beneficial ownership interest in such mortgage trust. The debt security is subordinate to all other interests in the mortgage trust and is not guaranteed by a government-sponsored entity.
As of March 31, 2020 and December 31, 2019, the carrying amount of the debt security investment was $73,476,000 and $72,717,000, respectively, net of unamortized closing costs of $1,335,000 and $1,375,000, respectively. Accretion on debt security for the three months ended March 31, 2020 and 2019was $799,000 and $725,000, respectively, which is recorded to real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive income (loss). Amortization expense of closing costs for the three months ended March 31, 2020 and 2019 was $40,000 and $33,000, respectively, which is recorded against real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive income (loss). In accordance with ASC Topic 326, we evaluated credit quality indicators such as the agency ratings and the underlying collateral of such investment in order to determine expected future credit loss. No credit loss was recorded for the three months ended March 31, 2020.
5. Identified Intangible Assets, Net
Identified intangible assets, net consisted of the following as of March 31, 2020 and December 31, 2019:
 
March 31,
2020
 
December 31,
2019
Amortized intangible assets:   
In-place leases, net of accumulated amortization of $21,663,000 and $21,029,000 as of March 31, 2020 and December 31, 2019, respectively (with a weighted average remaining life of 9.3 years and 9.4 years as of March 31, 2020 and December 31, 2019, respectively)$27,550,000
 $30,407,000
Customer relationships, net of accumulated amortization of $374,000 and $336,000 as of March 31, 2020 and December 31, 2019, respectively (with a weighted average remaining life of 16.5 years and 16.8 years as of March 31, 2020 and December 31, 2019, respectively)2,466,000
 2,504,000
Above-market leases, net of accumulated amortization of $2,033,000 and $2,057,000 as of March 31, 2020 and December 31, 2019, respectively (with a weighted average remaining life of 4.9 years and 5.0 years as of March 31, 2020 and December 31, 2019, respectively)1,340,000
 1,452,000
Internally developed technology and software, net of accumulated amortization of $235,000 and $211,000 as of March 31, 2020 and December 31, 2019, respectively (with a weighted average remaining life of 2.5 years and 2.8 years as of March 31, 2020 and December 31, 2019, respectively)235,000
 259,000
Unamortized intangible assets:   
Certificates of need96,653,000
 94,838,000
Trade names30,787,000
 30,787,000
 $159,031,000
 $160,247,000
Amortization expense for the three months ended March 31, 2020 and 2019 was $2,106,000 and $3,345,000, respectively, which included $112,000 and $212,000, respectively, of amortization recorded against real estate revenue for above-market leases in our accompanying condensed consolidated statements of operations and comprehensive income (loss).

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

Prior to our adoption of ASC Topic 842, tenant receivables and unbilled deferred rent receivables were reduced for uncollectible amounts. Such amounts were charged to bad debt expense, which was included in general and administrative in our accompanying condensed consolidated statements of operations and comprehensive income. Effective upon our adoption of ASC Topic 842 on January 1, 2019, such amounts are recognized as direct reductions of real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive income.
Accounts Payable and Accrued Liabilities
As of March 31, 2019 and December 31, 2018, accounts payable and accrued liabilities primarily includes insurance payables of $31,961,000 and $32,123,000, respectively, reimbursement of payroll related costs to the managers of our senior housing — RIDEA facilities and integrated senior health campuses of $28,200,000 and $26,428,000, respectively, accrued property taxes of $14,480,000 and $15,121,000, respectively, accrued distributions of $10,125,000 and $10,189,000, respectively, and accrued capital expenditures to unaffiliated third parties of $9,252,000 and $12,490,000, respectively.
Recently Issued Accounting Pronouncements
In June 2016, the FASB issued ASU 2016-13, Measurement of Credit Losses on Financial Instruments, or ASU 2016-13, which introduces a new approach to estimate credit losses on certain types of financial instruments based on expected losses. It also modifies the impairment model for available-for-sale debt securities and provides for a simplified accounting model for purchased financial assets with credit deterioration since their origination. In addition, in November 2018, the FASB issued ASU 2018-19, which amended the scope of ASU 2016-13 to clarify that operating lease receivables should be accounted for under the new leasing standard ASC Topic 842. ASU 2016-13 is effective for fiscal years and interim periods beginning after December 15, 2019. Early adoption is permitted after December 15, 2018. We are evaluating the impact of the adoption of ASU 2016-13 on January 1, 2020 to our consolidated financial position and results of operation.
In August 2018, the FASB issued ASU 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework Changes to the Disclosure Requirements for Fair Value Measurement, orASU 2018-13, which modifies the disclosure requirements in ASC Topic 820, Fair Value Measurements and Disclosures, by removing certain disclosure requirements related to the fair value hierarchy, modifying existing disclosure requirements related to measurement uncertainty and adding new disclosure requirements, such as disclosing the changes in unrealized gains and losses for the period included in other comprehensive income for recurring Level 3 fair value measurements held at the end of the reporting period and disclosing the range and weighted average of significant unobservable inputs used to develop Level 3 measurements. ASU 2018-13 is effective for fiscal years and interim periods beginning after December 15, 2019. Early adoption is permitted for any removed or modified disclosures. We are evaluating the complete impact of the adoption of ASU 2018-13 on January 1, 2020 to our consolidated financial statement disclosures.
3. Real Estate Investments, Net
Our real estate investments, net consisted of the following as of March 31, 2019 and December 31, 2018:
 
March 31,
2019
 December 31,
2018
Building, improvements and construction in process$2,177,669,000
 $2,160,944,000
Land and improvements188,241,000
 189,446,000
Furniture, fixtures and equipment132,992,000
 126,985,000
 2,498,902,000
 2,477,375,000
Less: accumulated depreciation(275,233,000) (254,694,000)
 $2,223,669,000
 $2,222,681,000
Depreciation expense for the three months ended March 31, 2019 was $22,204,000. In addition to the acquisitions and completed development discussed below, for the three months ended March 31, 2019, we incurred capital expenditures of $13,628,000 for our integrated senior health campuses, $2,034,000 for our medical office buildings, $305,000 for our senior housing —RIDEA facilities and $34,000 for our skilled nursing facilities. We did not incur any capital expenditures for our senior housing facilities and hospitals for the three months ended March 31, 2019.

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

Acquisitions of Real Estate Investments
For the three months ended March 31, 2019, using cash on hand and debt financing, we completed the acquisition of one building from an unaffiliated third party, which we added to our existing North Carolina ALF Portfolio. The other six buildings in North Carolina ALF Portfolio were acquired between January 2015 and August 2018. The following is a summary of our property acquisition for the three months ended March 31, 2019:
Acquisition(1) Location Type 
Date
Acquired
 
Contract
Purchase Price
 
Lines of Credit
and
Term Loans(2)
 
Acquisition
Fee(3)
North Carolina ALF Portfolio Garner, NC Senior Housing 03/27/19 $15,000,000
 $15,000,000
 $338,000
___________
(1)We own 100% of our property acquired in 2019.
(2)Represents a borrowing under the 2019 Corporate Line of Credit, as defined in Note 8, Lines of Credit and Term Loans, at the time of acquisition.
(3)Our advisor was paid, as compensation for services rendered in connection with the investigation, selection and acquisition of our property, an acquisition fee of 2.25% of the contract purchase price of such property.
In addition to the property acquisition discussed above, on March 29, 2019, we, through a majority-owned subsidiary of Trilogy Investors, LLC, or Trilogy, of which we own 67.7%, acquired land in Michigan for a contract purchase price of $736,000 plus closing costs and paid to our advisor an acquisition fee of 2.25% of the portion of the contract purchase price of the land attributed to our ownership interest.
For the three months ended March 31, 2019, we accounted for our real estate acquisitions as asset acquisitions. We capitalized closing costs and direct acquisition related expenses of $441,000 for such acquisitions. The following table summarizes the purchase price of the assets acquired and liabilities assumed at the time of acquisition from our acquisitions in 2019 based on their relative fair values:
  
2019 Real Estate
Acquisitions
Building and improvements $11,698,000
Land 2,502,000
In-place leases 1,978,000
Total assets acquired $16,178,000
Completed Development
For the three months ended March 31, 2019, we completed the development of one integrated senior health campus for $10,558,000, which is included in real estate investments, net, in our accompanying condensed consolidated balance sheets.
4. Real Estate Notes Receivable and Debt Security Investment, Net
The following is a summary of our notes receivable and debt security investment, including unamortized loan and closing costs, net as of March 31, 2019 and December 31, 2018:
         Balance
 
Origination
Date
 
Maturity
Date
 
Contractual
Interest
Rate
 
Maximum
Advances
Available
 
March 31,
2019
 
December 31,
2018
Mezzanine Fixed Rate Notes(1)02/04/15 12/09/19 6.75% $28,650,000
 $28,650,000
 $28,650,000
Debt security investment(2)10/15/15 08/25/25 4.24% N/A 69,080,000
 68,355,000
         97,730,000
 97,005,000
Unamortized loan and closing costs, net        1,582,000
 1,650,000
         $99,312,000
 $98,655,000

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

___________
(1)The Mezzanine Fixed Rate Notes evidence interests in a portion of a mezzanine loan that is secured by pledges of equity interests in the owners of a portfolio of domestic healthcare properties, which such owners are themselves owned indirectly by a non-wholly owned subsidiary of Colony Capital. Balance represents the original principal balance, decreased by any subsequent principal paydowns. Such notes only require monthly interest payments and are subject to certain prepayment restrictions if repaid before the maturity date.
(2)The commercial mortgage-backed debt security, or the debt security, bears an interest rate on the stated principal amount thereof equal to 4.24% per annum, the terms of which security provide for monthly interest-only payments. The debt security matures on August 25, 2025 at a stated amount of $93,433,000, resulting in an anticipated yield-to-maturity of 10.0% per annum. The debt security was issued by an unaffiliated mortgage trust and represents a 10.0% beneficial ownership interest in such mortgage trust. The debt security is subordinate to all other interests in the mortgage trust and is not guaranteed by a government-sponsored entity. As of March 31, 2019 and December 31, 2018, the net carrying amount with accretion was $70,565,000 and $69,873,000, respectively. We classify our debt security investment as held-to-maturity and we have not recorded any unrealized holding gains or losses on such investment.
The following table reflects the changes in the carrying amount of our real estate notes receivable and debt security investment for the three months ended March 31, 2019 and 2018:
 Three Months Ended March 31,
 2019 2018
Beginning balance$98,655,000
 $97,988,000
Additions:   
Accretion on debt security725,000
 657,000
Deductions:   
Amortization of loan and closing costs(68,000) (59,000)
Ending balance$99,312,000

$98,586,000
For the three months ended March 31, 2019 and 2018, we did not record any impairment losses on our real estate notes receivable or debt security investment. Amortization expense on loan and closing costs was recorded against real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive income.

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

5. Identified Intangible Assets, Net
Identified intangible assets, net consisted of the following as of March 31, 2019 and December 31, 2018:
 
March 31,
2019
 
December 31,
2018
Amortized intangible assets:   
In-place leases, net of accumulated amortization of $25,467,000 and $23,497,000 as of March 31, 2019 and December 31, 2018, respectively (with a weighted average remaining life of 10.2 years and 9.8 years as of March 31, 2019 and December 31, 2018, respectively)$44,801,000
 $45,815,000
Leasehold interests, net of accumulated amortization of $548,000 as of December 31, 2018 (with a weighted average remaining life of 53.6 years as of December 31, 2018)(1)
 7,346,000
Customer relationships, net of accumulated amortization of $224,000 and $187,000 as of March 31, 2019 and December 31, 2018, respectively (with a weighted average remaining life of 18.5 years and 18.8 years as of March 31, 2019 and December 31, 2018, respectively)2,616,000
 2,653,000
Above-market leases, net of accumulated amortization of $1,942,000 and $2,851,000 as of March 31, 2019 and December 31, 2018, respectively (with a weighted average remaining life of 5.2 years as of both March 31, 2019 and December 31, 2018)1,847,000
 2,059,000
Internally developed technology and software, net of accumulated amortization of $141,000 and $117,000 as of March 31, 2019 and December 31, 2018, respectively (with a weighted average remaining life of 3.5 years and 3.8 years as of March 31, 2019 and December 31, 2018, respectively)329,000
 353,000
Unamortized intangible assets:   
Certificates of need88,373,000
 88,590,000
Trade names30,787,000
 30,787,000
Purchase option asset1,918,000
 1,918,000
 $170,671,000
 $179,521,000
___________
(1)Such amount related to our ownership of fee simple interests in the building and improvements of 11 of our buildings that are subject to respective ground leases. Upon our adoption of ASC Topic 842 on January 1, 2019, such amount was reclassed to operating lease right-of-use assets in our accompanying condensed consolidated balance sheet. See Note 2, Summary of Significant Accounting Policies — Leases, and Note 17, Leases, for a further discussion.
Amortization expense for the three months ended March 31, 2019 and 2018 was $3,345,000 and $3,512,000, respectively, which included $212,000 and $339,000, respectively, of amortization recorded against real estate revenue for above-market leases and $0 and $36,000, respectively, of amortization recorded to rental expenses for leasehold interests in our accompanying condensed consolidated statements of operations and comprehensive income.
The aggregate weighted average remaining life of the identified intangible assets was 10.49.6 years and 15.59.7 years as of March 31, 20192020 and December 31, 2018,2019, respectively. As of March 31, 2019,2020, estimated amortization expense on the identified intangible assets for the nine months ending December 31, 20192020 and for each of the next four years ending December 31 and thereafter was as follows:
Year Amount Amount
2019 $6,974,000
2020 6,088,000
 $4,559,000
2021 5,515,000
 4,639,000
2022 4,797,000
 3,892,000
2023 4,016,000
 3,123,000
2024 2,706,000
Thereafter 22,203,000
 12,672,000
 $49,593,000
 $31,591,000

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

6. Other Assets, Net
Other assets, net consisted of the following as of March 31, 20192020 and December 31, 2018:2019:
March 31,
2019
 
December 31,
2018
March 31,
2020
 
December 31,
2019
Deferred rent receivables$31,648,000
 $23,334,000
$34,149,000
 $33,205,000
Prepaid expenses, deposits and other assets27,053,000
 29,803,000
25,748,000
 26,816,000
Inventory18,601,000
 21,151,000
21,497,000
 23,872,000
Investment in unconsolidated entities16,078,000
 15,432,000
Investments in unconsolidated entities19,584,000
 20,176,000
Deferred tax assets, net(1)9,515,000
 9,461,000
16,743,000
 13,315,000
Lease commissions, net of accumulated amortization of $1,471,000 and $1,274,000 as of March 31, 2019 and December 31, 2018, respectively8,481,000
 8,523,000
Deferred financing costs, net of accumulated amortization of $7,751,000 and $12,487,000 as of March 31, 2019 and December 31, 2018, respectively(2)7,047,000
 2,311,000
Lease inducement, net of accumulated amortization of $877,000 and $789,000 as of March 31, 2019 and December 31, 2018, respectively (with a weighted average remaining life of 11.8 years and 12.0 years as of March 31, 2019 and December 31, 2018, respectively)4,123,000
 4,211,000
Lease commissions, net of accumulated amortization of $2,454,000 and $2,201,000 as of March 31, 2020 and December 31, 2019, respectively11,157,000
 10,794,000
Deferred financing costs, net of accumulated amortization of $2,902,000 and $2,138,000 as of March 31, 2020 and December 31, 2019, respectively(2)7,395,000
 8,137,000
Lease inducement, net of accumulated amortization of $1,228,000 and $1,140,000 as of March 31, 2020 and December 31, 2019, respectively (with a weighted average remaining life of 10.7 years and 10.9 years as of March 31, 2020 and December 31, 2019, respectively)3,772,000
 3,860,000
$122,546,000
 $114,226,000
$140,045,000
 $140,175,000
___________
(1)See Note 16, Income Taxes, for a further discussion.
(2)Deferred financing costs only include costs related to our lines of credit and term loans.
Amortization expense on deferred financing costs of our lines of credit and term loans for the three months ended March 31, 2020 and 2019 was $760,000 and 2018 was $1,030,000, respectively, and $985,000, respectively. Amortization expense on deferred financing costs of our lines of credit and term loans is recorded to interest expense in our accompanying condensed consolidated statements of operations and comprehensive income.income (loss). Amortization expense on lease commissions for the three months ended March 31, 2019 and 2018 was $291,000 and $155,000, respectively. Amortization expense on lease inducementinducements for both the three months ended March 31, 2020 and 2019 and 2018 was $88,000. Amortization expense on lease inducement$88,000 and is recorded against real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive income.income (loss).

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

Investments in unconsolidated entities primarily represents our investment in RHS Partners, LLC, or RHS, a privately-held company that operates 16 integrated senior health campuses.campuses, three of which are also owned by RHS. Our effective ownership of RHS was 33.9% and 33.8% as of both March 31, 20192020 and December 31, 2018, respectively.2019. As of March 31, 20192020 and December 31, 2018,2019, we had a receivable of $3,058,000$2,551,000 and $2,507,000,$5,133,000, respectively, due from RHS, which is included in accounts and other receivables, net, in our accompanying condensed consolidated balance sheets. The following is summarized financial information of our investments in unconsolidated entities:
March 31,
2019
 
December 31,
2018
March 31, 2020 December 31, 2019
RHS Other Total RHS Other TotalRHS Other Total RHS Other Total
Balance Sheet Data:                      
Total assets$271,118,000
 $654,000
 $271,772,000
 $48,291,000
 $100,000
 $48,391,000
$275,529,000
 $17,216,000
 $292,745,000
 $278,297,000
 $17,022,000
 $295,319,000
Total liabilities$246,952,000
 $400,000
 $247,352,000
 $25,263,000
 $
 $25,263,000
$249,727,000
 $17,430,000
 $267,157,000
 $251,283,000
 $17,245,000
 $268,528,000
 Three Months Ended March 31,
 2020 2019
 RHS Other Total RHS Other Total
Statement of Operations Data:           
Revenues$35,883,000
 $3,519,000
 $39,402,000
 $35,368,000
 $
 $35,368,000
Expenses37,095,000
 4,210,000
 41,305,000
 36,231,000
 46,000
 36,277,000
Net loss$(1,212,000) $(691,000) $(1,903,000) $(863,000) $(46,000) $(909,000)
7. Mortgage Loans Payable, Net
As of March 31, 2020 and December 31, 2019, mortgage loans payable were $821,319,000 ($797,774,000, net of discount/premium and deferred financing costs) and $816,217,000 ($792,870,000, net of discount/premium and deferred financing costs), respectively. As of March 31, 2020, we had 58 fixed-rate mortgage loans payable and 11 variable-rate mortgage loans payable with effective interest rates ranging from 2.45% to 6.08% per annum based on interest rates in effect as of March 31, 2020 and a weighted average effective interest rate of 3.82%. As of December 31, 2019, we had 58 fixed-rate mortgage loans payable and seven variable-rate mortgage loans payable with effective interest rates ranging from 2.45% to 6.21% per annum based on interest rates in effect as of December 31, 2019 and a weighted average effective interest rate of 3.85%. We are required by the terms of certain loan documents to meet certain reporting requirements and covenants, such as net worth ratios, fixed charge coverage ratios and leverage ratios.
Mortgage loans payable, net consisted of the following as of March 31, 2020 and December 31, 2019:
 
March 31,
2020
 
December 31,
2019
Total fixed-rate debt$711,664,000
 $714,786,000
Total variable-rate debt109,655,000
 101,431,000
Total fixed- and variable-rate debt821,319,000
 816,217,000
Less: deferred financing costs, net(9,768,000) (9,362,000)
Add: premium279,000
 304,000
Less: discount(14,056,000) (14,289,000)
Mortgage loans payable, net$797,774,000
 $792,870,000

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

 Three Months Ended March 31,
 2019 2018
 RHS Other Total RHS Other Total
Statement of Operations Data:           
Revenues$35,368,000
 $
 $35,368,000
 $32,475,000
 $
 $32,475,000
Expenses36,231,000
 46,000
 36,277,000
 34,628,000
 
 34,628,000
Net loss$(863,000) $(46,000) $(909,000) $(2,153,000) $
 $(2,153,000)
7. Mortgage Loans Payable, Net
Mortgage loans payable were $716,243,000 ($691,896,000, including discount/premium and deferred financing costs, net) and $713,030,000 ($688,262,000, including discount/premium and deferred financing costs, net) as of March 31, 2019 and December 31, 2018, respectively. As of March 31, 2019, we had 57 fixed-rate mortgage loans payable and seven variable-rate mortgage loans payable with effective interest rates ranging from 2.45% to 8.49% per annum based on interest rates in effect as of March 31, 2019 and a weighted average effective interest rate of 4.01%. As of December 31, 2018, we had 57 fixed-rate mortgage loans payable and six variable-rate mortgage loans payable with effective interest rates ranging from 2.45% to 8.46% per annum based on interest rates in effect as of December 31, 2018 and a weighted average effective interest rate of 3.98%. We are required by the terms of certain loan documents to meet certain covenants, such as net worth ratios, fixed charge coverage ratio, leverage ratio and reporting requirements.
Mortgage loans payable, net consisted of the following as of March 31, 2019 and December 31, 2018:
 
March 31,
2019
 
December 31,
2018
Total fixed-rate debt$622,381,000
 $624,616,000
Total variable-rate debt93,862,000
 88,414,000
Total fixed- and variable-rate debt716,243,000
 713,030,000
Less: deferred financing costs, net(8,572,000) (8,824,000)
Add: premium573,000
 663,000
Less: discount(16,348,000) (16,607,000)
Mortgage loans payable, net$691,896,000
 $688,262,000
The following table reflects the changes in the carrying amount of mortgage loans payable, net for the three months ended March 31, 20192020 and 2018:2019:
 Three Months Ended March 31,
 2019 2018
Beginning balance$688,262,000
 $613,558,000
Additions:   
Borrowings on mortgage loans payable6,080,000
 458,000
Amortization of deferred financing costs258,000
 325,000
Amortization of discount/premium on mortgage loans payable169,000
 139,000
Deductions:   
Scheduled principal payments on mortgage loans payable(2,867,000) (2,506,000)
Deferred financing costs(6,000) (14,000)
Ending balance$691,896,000
 $611,960,000

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 Three Months Ended March 31,
 2020 2019
Beginning balance$792,870,000
 $688,262,000
Additions:   
Borrowings on mortgage loans payable8,239,000
 6,080,000
Amortization of deferred financing costs395,000
 258,000
Amortization of discount/premium on mortgage loans payable208,000
 169,000
Deductions:   
Scheduled principal payments on mortgage loans payable(3,137,000) (2,867,000)
Deferred financing costs(801,000) (6,000)
Ending balance$797,774,000
 $691,896,000
As of March 31, 2019,2020, the principal payments due on our mortgage loans payable for the nine months ending December 31, 20192020 and for each of the next four years ending December 31 and thereafter were as follows:
Year Amount Amount
2019 $20,100,000
2020 82,770,000
 $68,701,000
2021 34,645,000
 55,936,000
2022 61,083,000
 62,070,000
2023 28,101,000
 41,164,000
2024 73,176,000
Thereafter 489,544,000
 520,272,000
 $716,243,000
 $821,319,000
8. Lines of Credit and Term Loans
2016 Corporate Line of Credit
On February 3, 2016, we, through certain of our subsidiaries, entered into a credit agreement, or the 2016 Corporate Credit Agreement, with Bank of America, N.A., or Bank of America, as administrative agent, a swing line lender and a letter of credit issuer; KeyBank, National Association, or KeyBank, as syndication agent, a swing line lender and a letter of credit issuer; and a syndicate of other banks, as lenders, to obtain a revolving line of credit with an aggregate maximum principal amount of $300,000,000, or the 2016 Corporate Revolving Credit Facility, and a term loan credit facility in the amount of $200,000,000, or the 2016 Corporate Term Loan Facility, and together with the 2016 Corporate Revolving Credit Facility, the 2016 Corporate Line of Credit. On February 3, 2016, we also entered into separate revolving notes, or the 2016 Corporate Revolving Notes, and separate term notes with each of Bank of America, KeyBank and a syndicate of other banks. The 2016 Corporate Line of Credit would have matured on February 3, 2019.
On August 3, 2017, we entered into a First Amendment, Waiver and Commitment Increase Agreement, or the Amendment, with Bank of America, KeyBank, and the lenders named therein, to amend the 2016 Corporate Credit Agreement. The material terms of the Amendment included: (i) an increase in the 2016 Corporate Term Loan Facility in an amount equal to $50,000,000; (ii) a revision to the definition of Term Loan Commitment (as defined in the 2016 Corporate Credit Agreement) to reflect the increase in the 2016 Corporate Term Loan Facility and specify that the aggregate principal amount of the Term Loan Commitments of all of the Term Loan Lenders (as defined in the 2016 Corporate Credit Agreement) as in effect on the effective date of the Amendment is $250,000,000; and (iii) the addition of Bank of the West, or New Lender, as a party to the 2016 Corporate Credit Agreement and a Term Loan Lender and Lender (as defined in the 2016 Corporate Credit Agreement) and New Lender’s agreement to be bound by all terms, provisions and conditions applicable to Lenders contained in the 2016 Corporate Credit Agreement. As a result of the Amendment, our aggregate borrowing capacity under the 2016 Corporate Line of Credit was increased to $550,000,000.
On December 20, 2018, we entered into a Commitment Increase Agreement with Bank of America. The material terms of the Commitment Increase Agreement provided for an increase in the 2016 Corporate Revolving Credit Facility by an aggregate amount equal to $25,000,000. On December 20, 2018, we also entered into an Amended and Restated Revolving Note with Bank of America, whereby we promised to pay the principal amount and accrued interest of each loan to the respective lender or its registered assigns, in accordance with the terms and conditions of the 2016 Corporate Credit Agreement, as amended. As a result of the Commitment Increase Agreement, our aggregate borrowing capacity under the 2016 Corporate Line Credit was increased to $575,000,000.
As of December 31, 2018, our aggregate borrowing capacity under the 2016 Corporate Line of Credit was $575,000,000. As of December 31, 2018, borrowings outstanding under the 2016 Corporate Line of Credit totaled $548,500,000 and the weighted average interest rate on such borrowings outstanding was 4.60% per annum.
On January 25, 2019, we terminated the 2016 Corporate Credit Agreement, as amended, and the 2016 Corporate Revolving Notes and entered into the 2019 Corporate Line of Credit as described below. We currently do not have any obligations under the 2016 Corporate Credit Agreement, as amended, or the 2016 Corporate Revolving Notes.


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2019 Corporate Line of Credit
On January 25, 2019, we, through our operating partnership and certain of our subsidiaries, entered into a credit agreement, or the 2019 Corporate Credit Agreement, with Bank of America, N.A., or Bank of America, as administrative agent, a swing line lender and a letter of credit issuer; KeyBank, National Association, or KeyBank, as syndication agent, a swing line lender and a letter of credit issuer; Citizens Bank, National Association, as a syndication agent, a swing line lender, a letter of credit issuer, a joint lead arranger and joint bookrunner; and a syndicate of other banks, as lenders, to obtain a credit facility with an aggregate maximum principal amount of $630,000,000, or the 2019 Corporate Line of Credit. The 2019 Corporate Line of Credit consists of a senior unsecured revolving credit facility in the initial aggregate amount of $150,000,000 and a senior unsecured term loan facility in the initial aggregate amount of $480,000,000. We may obtain up to $25,000,000 in the form of standby letters of credit and up to $25,000,000 in the form of swing line loans. The maximum principal amount of the 2019 Corporate Line of Credit may be increased by up to $370,000,000, for a total principal amount of $1,000,000,000, subject to: (i) the terms of the 2019 Corporate Credit Agreement; and (ii) at least five business days’ prior written notice to Bank of America. The 2019 Corporate Line of Credit matures on January 25, 2022, and may be extended for one 12-month period during the term of the 2019 Corporate Credit Agreement, subject to satisfaction of certain conditions, including payment of an extension fee.
At our option, the 2019 Corporate Line of Credit bears interest at per annum rates equal to (a) (i) the Eurodollar Rate, (asas defined in the 2019 Corporate Credit Agreement)Agreement, plus (ii) a margin ranging from 1.50% to 2.20% based on our Consolidated Leverage Ratio, (asas defined in the 2019 Corporate Credit Agreement),Agreement, or (b) (i) the greater of: (1) the prime rate publicly announced by Bank of America, (2) the Federal Funds Rate, (asas defined in the 2019 Corporate Credit Agreement)Agreement, plus 0.50%, (3) the one-month Eurodollar Rate plus 1.00%, and (4) 0.00%, plus (ii) a margin ranging from 0.50% to 1.20% based on our Consolidated Leverage Ratio. Accrued interest on the 2019 Corporate Line of Credit is payable monthly. The loans may be repaid in whole or in part without prepayment premium or penalty, subject to certain conditions. We are required to pay a fee on the unused portion of the lenders’ commitments under the 2019 Corporate Credit Agreement at a per annum rate equal to 0.20%

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if the average daily used amount is greater than 50% of the commitments and 0.25% if the average daily used amount is less than or equal to 50% of the commitments, which fee shall be measured and payable on a quarterly basis.
The 2019 Corporate Line of Credit matures on January 25, 2022, and may be extended for one 12-month period during the term of the 2019 Credit Agreement, subject to satisfaction of certain conditions, including payment of an extension fee. The 2019 Corporate Credit Agreement contains various affirmative and negative covenants that are customary for credit facilities and transactions of this type, including limitations on the incurrence of debt by our operating partnership and its subsidiaries and limitations on secured recourse indebtedness.
As of both March 31, 2020 and December 31, 2019, our aggregate borrowing capacity under the 2019 Corporate Line of Credit was $630,000,000. As of March 31, 2020 and December 31, 2019, borrowings outstanding under the 2019 Corporate Line of Credit totaled $614,500,000$562,500,000 and the weighted average interest rate on such borrowings outstanding was 4.43% per annum.
Trilogy PropCo Line of Credit
In connection with our acquisition of Trilogy, on December 1, 2015, we, through Trilogy PropCo Finance, LLC, a Delaware limited liability company and an indirect subsidiary of Trilogy, or Trilogy PropCo Parent, and certain of its subsidiaries, or the Trilogy PropCo Co-Borrowers, and, together with Trilogy PropCo Parent, the Trilogy PropCo Borrowers, entered into a loan agreement, or the Trilogy PropCo Credit Agreement, with KeyBank, as administrative agent; Regions Bank, as syndication agent; and a syndicate of other banks, as lenders, to obtain a line of credit with an aggregate maximum principal amount of $300,000,000, or the Trilogy PropCo Line of Credit. We also entered into separate revolving notes with each of KeyBank and Regions Bank, whereby we promised to pay the principal amount of each revolving loan and accrued interest to the respective lender or its registered assigns, in accordance with the terms and conditions of the Trilogy PropCo Credit Agreement. The proceeds of the loans made under the Trilogy PropCo Line of Credit may be used for working capital, capital expenditures, acquisition of properties and fee interests in leasehold properties and general corporate purposes. The Trilogy PropCo Line of Credit matures on December 1, 2019, unless extended for a one-year period subject to satisfaction of certain conditions, including payment of an extension fee, or otherwise terminated in accordance with the terms thereunder. Availability of the total commitment under the Trilogy PropCo Line of Credit is subject to a borrowing base based on, among other things, the appraised value of certain real estate and villa units constructed on such real estate.
In addition to paying interest on the outstanding principal under the Trilogy PropCo Line of Credit, the Trilogy PropCo Borrowers are required to pay an unused fee to the lenders in respect of the unutilized commitments at a rate equal to an initial rate of 0.25% per annum, subject to adjustment depending on usage. Outstanding amounts under the Trilogy PropCo Line of Credit may be prepaid, in whole or in part, at any time, without penalty or premium, subject to customary breakage costs. The Trilogy PropCo Credit Agreement contains various affirmative and negative covenants that are customary for credit facilities and transactions of this type, including incurrence of debt and limitations on secured recourse indebtedness.

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On October 27, 2017, we entered into an amendment to the Trilogy PropCo Credit Agreement, or the Trilogy PropCo Amendment, with KeyBank, as administrative agent, and a syndicate of other banks, as lenders, to amend the terms of the Trilogy PropCo Credit Agreement. The material terms of the Trilogy PropCo Amendment included: (i) a reduction of the total commitment under the Trilogy PropCo Line of Credit from $300,000,000 to $250,000,000; and (ii) a revision to the definition of applicable margin, pursuant to which the Trilogy PropCo Line of Credit bears interest at a floating rate based on an adjusted London Interbank Offered Rate, or LIBOR, plus an applicable margin of 4.00% per annum or an alternate base rate plus an applicable margin of 3.00% per annum, at the Trilogy PropCo Borrowers’ option.
Our aggregate borrowing capacity under the Trilogy PropCo Line of Credit was $250,000,000 as of March 31, 2019 and December 31, 2018. As of March 31, 2019 and December 31, 2018, borrowings outstanding under the Trilogy PropCo Line of Credit totaled $173,517,000 and $170,518,000,$557,000,000, respectively, and the weighted average interest rate on such borrowings outstanding was 6.49%2.99% and 6.45%3.83% per annum, respectively.
2019 Trilogy OpCo Line of Credit Facility
On March 21, 2016,September 5, 2019, we, through Trilogy Healthcare Holdings, Inc., a Delaware corporationRER, LLC and a direct subsidiarycertain subsidiaries of Trilogy OpCo, LLC, Trilogy RER, LLC, and certain of its subsidiaries,Trilogy Pro Services, LLC, or the 2019 Trilogy OpCo Borrowers,Co-Borrowers, entered into a creditan amended and restated loan agreement, or the 2019 Trilogy OpCo Credit Agreement, with Wells FargoKeyBank, as administrative agent; CIT Bank, National Association, or Wells Fargo, N.A., as administrative agentrevolving agent; Regions Bank, as syndication agent; KeyBanc Capital Markets, Inc., or KeyBanc Capital Markets, as co-lead arranger and lender;co-book runner; Regions Capital Markets, as co-lead arranger and co-book runner; Bank of America, as co-documentation agent; The Huntington National Bank, as co-documentation agent; and a syndicate of other banks, as lenders named therein, to amend and restate the terms of an existing credit agreement in order to obtain a $42,000,000senior secured revolving credit facility or the Trilogy OpCo Line of Credit. The Trilogy OpCo Line of Credit is secured primarily by residents’ receivables of the Trilogy OpCo Borrowers.
On April 1, 2016, we entered intowith an amendment to the Trilogy OpCo Credit Agreement to increase the aggregate maximum principal amount of the Trilogy OpCo Line of Credit to $60,000,000. In April 2018, we further amended the Trilogy OpCo Credit Agreement,$360,000,000, consisting of: (i) a $325,000,000 secured revolver supported by real estate assets and ancillary business cash flow and (ii) a $35,000,000 accounts receivable revolving credit facility supported by eligible accounts receivable, or the 2019 Trilogy OpCo Amendment.Credit Facility. We may obtain up to $35,000,000 in the form of swing line loans and up to $15,000,000 in the form of standby letters of credit under the 2019 Trilogy Credit Facility. The materialproceeds of the 2019 Trilogy Credit Facility may be used for acquisitions, debt repayment and general corporate purposes. The maximum principal amount of the 2019 Trilogy Credit Facility may be increased by up to $140,000,000, for a total principal amount of $500,000,000, subject to: (i) the terms of the 2019 Trilogy OpCo Amendment provided for: (i) a reduction inCredit Agreement and (ii) at least 10 business days’ prior written notice to KeyBank. The 2019 Trilogy Credit Facility matures on September 5, 2023 and may be extended for one 12-month period during the aggregate maximum principal amount from $60,000,000term of the 2019 Trilogy Credit Agreement subject to $25,000,000; (ii) a reduced floatingthe satisfaction of certain conditions, including payment of an extension fee.
At our option, the 2019 Trilogy Credit Facility bears interest rate based onat per annum rates equal to (a) LIBOR plus an applicable margin of 2.75% per annum, for LIBOR Rate Loans, as defined in the agreement, or an alternate base rate plus an applicable margin of 1.75% per annum,2019 Trilogy Credit Agreement, and (b) for Base Rate Loans, as defined in the agreement, at2019 Trilogy Credit Agreement, 1.75% plus the greater of: (i) the fluctuating annual rate of interest announced from time to time by KeyBank as its prime rate, (ii) 0.5% above the Federal Funds Effective Rate, as defined in the 2019 Trilogy OpCo Borrowers’ option;Credit Agreement, and (iii) a reduced letter of credit fee of 2.75% per annum times1.00% above the undrawn amount of outstanding letters of credit; and (iv) an updated maturity date of April 27, 2021.
one-month LIBOR. Accrued interest underon the 2019 Trilogy OpCo Line of Credit Facility is payable monthly. In additionThe loans may be repaid in whole or in part without prepayment fees or penalty, subject to paying interest on the outstanding principal under the Trilogy OpCo Line of Credit, the Trilogy OpCo Borrowerscertain conditions. We are required to pay anfees on the unused fee in an amountportion of the lenders’ commitments under the 2019 Trilogy Credit Facility, with respect to any day during a calendar quarter, at a per annum rate equal to 0.50% per annum times(a) 0.15% if the average monthly unutilized commitment. The unused fee is payable monthly in arrears, commencing on the first day of each month from and after the closing date up to the first daysum of the month prior toAggregate Real Estate Revolving Credit Obligations, as defined in the date on which the obligations are paid in full.
The2019 Trilogy OpCo Credit Agreement, as amended, contains customary events of default, covenants and other terms, including, among other things, restrictionsoutstanding on the payment of dividends and other distributions, incurrence of indebtedness, creation of liens and transactions with affiliates. Availabilitysuch day is greater than 50% of the total commitment undercommitments or 0.20% if the Trilogy OpCo Line of Credit is subject to a borrowing base based on, among other things, the eligible accounts receivable outstandingsum of the Aggregate Real Estate Revolving Credit Obligations on such day is less than or equal to 50% of the commitments, and (b) 0.15% if the sum of the Aggregate A/R Revolving Credit Obligations, as defined in the 2019 Trilogy OpCo Borrowers.Credit Agreement, outstanding on such day is greater than 50% of the commitments or 0.20% if the sum of the Aggregate A/R Revolving Credit Obligations on such day is less than or equal to 50% of the commitments, which fees shall be measured and payable on a quarterly basis.
OurAs of both March 31, 2020 and December 31, 2019, our aggregate borrowing capacity under the 2019 Trilogy OpCo Line of Credit Facility was $25,000,000 as of both March 31, 2019 and December 31, 2018, subject to certain terms and conditions.$360,000,000. As of March 31, 20192020 and December 31, 2018,2019, borrowings outstanding under the 2019 Trilogy OpCo Line of Credit Facility totaled $16,032,000$271,879,000 and $19,030,000,$258,879,000, respectively, and the weighted average interest rate on such borrowings outstanding was 4.86%3.75% and 5.17%4.52% per annum, respectively.
Both the 2019 Corporate Credit Agreement and the 2019 Trilogy Credit Agreement contain various financial covenants. We were in compliance with such covenants as of March 31, 2020. The extent and severity of the coronavirus, or COVID-19, pandemic on our business continues to evolve, and any continued future deterioration of operations in excess of management's projections as a result of COVID-19 could impact future compliance with these financial covenants. If any future financial covenants are violated, we anticipate seeking a waiver or amending the debt covenants with the lenders when and if such event should occur. However, there can be no assurances that management will be able to effectively achieve such plans.

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9. Derivative Financial Instruments
We record derivative financial instruments in our accompanying condensed consolidated balance sheets as either an asset or a liability measured at fair value. The following table lists the derivative financial instruments held by us as of March 31, 20192020 and December 31, 2018:2019, which are included in other assets, net, or security deposits, prepaid rent and other liabilities in our accompanying condensed consolidated balance sheets:
   Fair Value   Fair Value
Instrument Notional Amount Index Interest Rate Maturity Date 
March 31,
2019
 
December 31,
2018
 Notional Amount Index Interest Rate Maturity Date 
March 31,
2020
 
December 31,
2019
Cap $20,000,000
 one month LIBOR 3.00% 09/23/21 $3,000
 $
Swap $140,000,000
 one month LIBOR 0.82% 02/03/19 $
 $221,000
 250,000,000
 one month LIBOR 2.10% 01/25/22 (8,184,000) (2,821,000)
Swap 60,000,000
 one month LIBOR 0.78% 02/03/19 
 97,000
 130,000,000
 one month LIBOR 1.98% 01/25/22 (3,973,000) (1,150,000)
Swap 50,000,000
 one month LIBOR 1.39% 02/03/19 
 51,000
Cap 20,000,000
 one month LIBOR 3.00% 09/23/21 11,000
 48,000
 $270,000,000
 $11,000

$417,000
 

 $(12,154,000)
$(3,971,000)
ASC Topic 815, Derivatives and Hedging, or ASC Topic 815, permits special hedge accounting if certain requirements are met. Hedge accounting allows for gains and losses on derivatives designated as hedges to be offset by the change in value of the hedged item or items or to be deferred in other comprehensive income. As of March 31, 20192020 and December 31, 2018,2019, none of our derivative financial instruments were designated as hedges. Derivative financial instruments not designated as hedges are not speculative and are used to manage our exposure to interest rate movements, but do not meet the strict hedge accounting requirements of ASC Topic 815. Changes in the fair value of derivative financial instruments are recorded as a component of interest expense in gain or (loss) in fair value of derivative financial instruments in our accompanying condensed consolidated statements of operations and comprehensive income. For the three months ended March 31, 20192020 and 2018,2019, we recorded $(560,000)$8,183,000 and $110,000,$560,000, respectively, as an (increase) decreaseincrease to interest expense in our accompanying condensed consolidated statements of operations and comprehensive income (loss) related to the change in the fair value of our derivative financial instruments.
See Note 15, Fair Value Measurements, for a further discussion of the fair value of our derivative financial instruments.
10. Identified Intangible Liabilities, Net
As of March 31, 20192020 and December 31, 2018,2019, identified intangible liabilities, net consisted of below-market leases of $947,000$570,000 and $1,051,000,$663,000, respectively, net of accumulated amortization of $1,334,000$1,353,000 and $1,229,000,$1,342,000, respectively. Amortization expense on below-market leases for the three months ended March 31, 2020 and 2019 was $93,000 and 2018 was $105,000, and $140,000, respectively, which is recorded to real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive income.income (loss).
The weighted average remaining life of below-market leases was 2.8 years and 4.3 years as of both March 31, 20192020 and December 31, 2018,2019, respectively. As of March 31, 2019,2020, estimated amortization expense on below-market leases for the nine months ending December 31, 20192020 and for each of the next four years ending December 31 and thereafter was as follows:
Year Amount Amount
2019 $284,000
2020 260,000
 $203,000
2021 143,000
 180,000
2022 93,000
 89,000
2023 78,000
 71,000
2024 27,000
Thereafter 89,000
 
 $947,000
 $570,000

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11. Commitments and Contingencies
Litigation
We are not presently subject to any material litigation nor, to our knowledge, is any material litigation threatened against us, which if determined unfavorably to us, would have a material adverse effect on our consolidated financial position, results of operations or cash flows.
Environmental Matters
We follow a policy of monitoring our properties for the presence of hazardous or toxic substances. While there can be no assurance that a material environmental liability does not exist at our properties, we are not currently aware of any environmental liability with respect to our properties that would have a material effect on our consolidated financial position, results of operations or cash flows. Further, we are not aware of any material environmental liability or any unasserted claim or

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assessment with respect to an environmental liability that we believe would require additional disclosure or the recording of a loss contingency.
Other
Our other commitments and contingencies include the usual obligations of real estate owners and operators in the normal course of business, which include calls/puts to sell/acquire properties. In our view, these matters are not expected to have a material adverse effect on our consolidated financial position, results of operations or cash flows.
Impact of the COVID-19 Pandemic
The COVID-19 pandemic is dramatically impacting the United States and has resulted in an aggressive worldwide effort to contain the spread of the virus. These efforts have significantly and adversely disrupted economic markets and impacted commercial activity worldwide, including markets in which we own and/or operate properties, and the prolonged economic impact is uncertain. Considerable uncertainty still surrounds the COVID-19 pandemic and its effects on the population, as well as the effectiveness of any responses taken on an international, national and local level by government authorities and businesses. In addition, the rapidly evolving nature of the COVID-19 pandemic makes it difficult to ascertain the long-term impact it will have on real estate markets and our portfolio of investments. We are continuously monitoring the impact of the COVID-19 pandemic on our business, residents, tenants, operating partners, managers, portfolio of investments and on the United States and global economies. While the results of our current analyses did not result in any material adjustments to our condensed consolidated financial statements as of and during the three months ended March 31, 2020, the prolonged duration and impact of the COVID-19 pandemic could materially disrupt our business operations and impact our financial performance.
12. Redeemable Noncontrolling Interests
On January 15, 2013,As of both March 31, 2020 and December 31, 2019, our advisor made an initial capital contributionowned all of $2,000 to our operating partnership in exchange forthe 222 limited partnership units. Upon the effectiveness of the Advisory Agreemeunits outstanding in our operating partnership.nt on February 26, 2014, Griffin-American Advisor became our advisor. As of both March 31, 20192020 and December 31, 2018,2019, we owned greater than a 99.99% general partnership interest in our operating partnership, and our advisor owned less than a 0.01% limited partnership interest in our operating partnership. As ourOur advisor Griffin-American Advisor is entitled to special redemption rights of its limited partnership units. The noncontrolling interest of our advisor in our operating partnership that has redemption features outside of our control is accounted for as a redeemable noncontrolling interest and is presented outside of permanent equity in our accompanying condensed consolidated balance sheets. See Note 14, Related Party Transactions — Liquidity Stage — Subordinated Participation Interest — Subordinated Distribution Upon Listing and Note 14, Related Party Transactions — Subordinated Distribution Upon Termination, for a further discussion of the redemption features of the limited partnership units.
OnAs of both March 31, 2020 and December 1, 2015,31, 2019, we, through Trilogy REIT Holdings, LLC, or Trilogy REIT Holdings, in which we indirectly hold a 70.0% ownership interest, pursuant to an equity purchase agreement with Trilogy and other seller parties thereto, completed the acquisition of approximately 96.7%owned 96.6% of the outstanding equity interests of Trilogy. Pursuant to the equity purchase agreement, at the closingAs of the acquisition,both March 31, 2020 and December 31, 2019, certain members of Trilogy’s pre-closing management retained a portion of the outstanding equity interests of Trilogy held by suchand certain members of an advisory committee to Trilogy’s pre-closing management, representing in the aggregateboard of directors owned approximately 3.3%3.4% of the outstanding equity interests of Trilogy. The noncontrolling interests held by Trilogy’s pre-closing managementsuch members have redemption features outside of our control and are accounted for as redeemable noncontrolling interests in our accompanying condensed consolidated balance sheets. As of both March 31, 2019 and December 31, 2018, Trilogy REIT Holdings and certain members of Trilogy’s pre-closing management owned approximately 96.7% and 3.3% of Trilogy, respectively.

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We record the carrying amount of redeemable noncontrolling interests at the greater of: (i) the initial carrying amount, increased or decreased for the noncontrolling interests’ share of net income or loss and distributions or (ii) the redemption value. The changes in the carrying amount of redeemable noncontrolling interests consisted of the following for the three months ended March 31, 20192020 and 2018:2019:
Three Months Ended March 31,Three Months Ended March 31,
2019 20182020 2019
Beginning balance$38,245,000
 $32,435,000
$44,105,000
 $38,245,000
Additions
 535,000
Reclassification from equity195,000
 195,000
195,000
 195,000
Distributions(485,000) (166,000)
 (485,000)
Repurchase of redeemable noncontrolling interest(3,000) 
Repurchase of redeemable noncontrolling interests
 (3,000)
Fair value adjustment to redemption value(253,000) 247,000
15,000
 (253,000)
Net income attributable to redeemable noncontrolling interests140,000
 29,000
228,000
 140,000
Ending balance$37,839,000
 $33,275,000
$44,543,000
 $37,839,000

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13. Equity
Preferred Stock
Our charter authorizes us to issue 200,000,000 shares of our preferred stock, par value $0.01$0.01 per share. As of both March 31, 20192020 and December 31, 2018,2019, no shares of preferred stock were issued and outstanding.
Common Stock
Our charter authorizes us to issue 1,000,000,000 shares of our common stock, par value $0.01 per share. On January 15, 2013,As of both March 31, 2020 and December 31, 2019, our advisor acquired owned 22,222 shares of our common stock, for total cash consideration of $200,000 and was admitted as our initial stockholder. We used the proceeds from the sale of shares of our common stock towhich our advisor to make an initial capital contribution to our operating partnership.acquired on January 15, 2013. On March 12, 2015, we terminated the primary portion of our initial public offering. We continued to offer shares of our common stock in our initial offering pursuant to the Initial DRIP, until the termination of the DRIP portion of our initial offering and deregistration of our initial offering on April 22, 2015.
On March 25, 2015, we filed a Registration Statement on Form S-3 under the Securities Act to register a maximum of $250,000,000 of additional shares of our common stock pursuant to the 2015 DRIP Offering. We did not commencecommenced offering shares pursuant to the 2015 DRIP Offering until April 22, 2015 following the deregistration of our initial offering. We continued to offer shares of our common stock pursuant to the 2015 DRIP Offering until the termination and deregistration of our offeringthe 2015 DRIP Offering on March 29, 2019.
On January 30, 2019, we filed a Registration Statement on Form S-3 under the Securities Act to register a maximum of $200,000,000 of additional shares of our common stock to be issued pursuant to the 2019 DRIP Offering. The Registration Statement on Form S-3 was automatically effective with the SEC upon its filing; however, we did not commenceWe commenced offering shares pursuant to the 2019 DRIP Offering untilon April 1, 2019, following the deregistration of the 2015 DRIP Offering.
Through March 31, 2019,2020, we had issued 184,930,598 shares of our common stock in connection with the primary portion of our initial public offering and 28,335,10834,131,715 shares of our common stock pursuant to the Initialour DRIP and the 2015 DRIP Offering.Offerings. We also repurchased 18,204,16923,846,540 shares of our common stock under our share repurchase plan and granted an aggregate of 105,000127,500 shares of our restricted common stock to our independent directors through March 31, 2019.2020. As of March 31, 20192020 and December 31, 2018,2019, we had 195,188,759195,365,495 and 197,557,377193,967,474 shares of our common stock issued and outstanding, respectively.

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Accumulated Other Comprehensive Loss
The changes in accumulated other comprehensive loss, net of noncontrolling interests, by component consisted of the following for the three months ended March 31, 20192020 and 2018:2019:
Three Months Ended March 31,Three Months Ended March 31,
2019 20182020 2019
Beginning balance — foreign currency translation adjustments$(2,560,000) $(1,971,000)$(2,255,000) $(2,560,000)
Net change in current period219,000
 446,000
(533,000) 219,000
Ending balance — foreign currency translation adjustments$(2,341,000) $(1,525,000)$(2,788,000) $(2,341,000)
Noncontrolling Interests
As of both March 31, 20192020 and December 31, 2018,2019, Trilogy REIT Holdings owned approximately 96.7%96.6% of Trilogy. We are the indirect owner of a 70.0% interest in Trilogy REIT Holdings pursuant to aan amended joint venture agreement or the Trilogy JV Agreement, with an indirect, wholly-owned subsidiary of NorthStar Healthcare Income, Inc., or NHI. We serve as the sole manager of Trilogy REIT Holdings. Prior to October 1, 2018, NHI, was the indirect owner of the remaining 30.0% interest in Trilogy REIT Holdings. On October 1, 2018, we amended the Trilogy JV Agreement asand a result of the purchase by an indirect, wholly-owned subsidiary of the operating partnership of Griffin-American Healthcare REIT IV, Inc., or GAHR IV JV Member, of 6.0% of the total membership interests in Trilogy REIT Holdings from a wholly-owned subsidiary of NHI.IV. Both Griffin-American Healthcare REITGAHR IV Inc. and us are sponsored by American Healthcare Investors. Effective October 1, 2018,We serve as the sole manager of Trilogy REIT Holdings. As of both March 31, 2020 and December 31, 2019, NHI and GAHR IV JV Member indirectly ownowned a 24.0% and 6.0% membership interest respectively, in Trilogy REIT Holdings. As ofHoldings, respectively. For both the three months ended March 31, 20192020 and December 31, 2018,2019, 30.0% of the net earnings of Trilogy REIT Holdings were allocated to noncontrolling interests.
In connection with our acquisition and operation of Trilogy, profit interest units in Trilogy, or the Profit Interests, were issued to Trilogy Management Services, LLC and an independent director of Trilogy, both unaffiliated third parties that manage or direct the day-to-day operations of Trilogy. The Profit Interests consist of time-based or performance-based commitments. The time-based Profit Interests were measured at their grant date fair value and vest in increments of 20.0% on each anniversary of the respective grant date over a five-year period. We amortize the time-based Profit Interests on a straight-line basis over the vesting periods, which are recorded to general and administrative in our accompanying condensed consolidated

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statements of operations and comprehensive income.income (loss). The performance-based Profit Interests are subject to a performance commitment and vest upon liquidity events as defined in the Profit Interests agreements. The performance-based Profit Interests were measured at their grant date fair value and immediately expensed. The performance-based Profit Interests are subject to fair value measurements until vesting occurs with changes to fair value recorded to general and administrative in our accompanying condensed consolidated statements of operations and comprehensive income.income (loss). For both the three months ended March 31, 20192020 and 2018,2019, we recognized stock compensation expense related to the Profit Interests of $195,000.
There were no canceled, expired or exercised Profit Interests during the three months ended March 31, 20192020 and 2018.2019. The nonvested awards are presented as noncontrolling interests and are re-classified to redeemable noncontrolling interests upon vesting as they have redemption features outside of our control similar to the common stock units held by Trilogy’s pre-closing management. See Note 12, Redeemable Noncontrolling Interests, for a further discussion.
On January 6, 2016, one of our consolidated subsidiaries issued non-voting preferred shares of beneficial interests to qualified investors for total proceeds of $125,000. These preferred shares of beneficial interests are entitled to receive cumulative preferential cash dividends at the rate of 12.5% per annum. We classify the value of the subsidiary’s preferred shares of beneficial interests as noncontrolling interests in our accompanying condensed consolidated balance sheets and the dividends of the preferred shares of beneficial interests as net lossincome attributable to noncontrolling interests in our accompanying condensed consolidated statements of operations and comprehensive income.income (loss).
In addition, as of both March 31, 20192020 and December 31, 2018,2019, we owned an 86.0% interest in a consolidated limited liability company that owns Lakeview IN Medical Plaza, which we acquired on January 21, 2016. As such, 14.0% of the net earnings of Lakeview IN Medical Plaza were allocated to noncontrolling interests for both the three months ended March 31, 20192020 and 2018.

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2019.
Distribution Reinvestment Plan
We adopted the Initial DRIP that allowed stockholders to purchase additional shares of our common stock through the reinvestment of distributions at an offering price equal to 95.0% of the primary offering price of our initial offering, subject to certain conditions. We had registered and reserved $35,000,000 in shares of our common stock for sale pursuant to the Initial DRIP in our initial offering, at an offering price of $9.50 per share, which we deregistered on April 22, 2015. On March 25, 2015, we filed a Registration Statement on Form S-3 under the Securities Act to register a maximum of $250,000,000 of additional shares of our common stock pursuant to the 2015 DRIP Offering. We commenced offering shares pursuant to the 2015 DRIP Offering, following the deregistration of our initial offering on April 22, 2015. We continued to offer shares of our common stock pursuant to the 2015 DRIP Offering, which commenced offering shares following the deregistration of our initial offering, until the deregistration of such offeringthe 2015 DRIP Offering on March 29, 2019. On January 30, 2019, we filed a Registration Statement on Form S-3 under the Securities ActWe continue to register a maximum ofoffer up to $200,000,000 of additional shares of our common stock to be issued pursuant to the 2019 DRIP Offering. We commenced offering shares pursuant to the 2019 DRIP Offering, which commenced offering shares on April 1, 2019, following the deregistration of the 2015 DRIP Offering.
Effective October 5, 2016, we amended and restated the Initial DRIP to amend the price at which shares of our common stock are issued pursuant to such distribution reinvestment plan. Pursuant to the Amended and Restated DRIP, shares are issued at a price equal to the most recently estimated net asset value, or NAV, of one share of our common stock, as approved and established by our board. The Amended and Restated DRIP became effective with the distribution paymentpayments to stockholders paid in the month of November 2016. In all other material respects, the terms of the 2015 DRIP Offering remainremained unchanged by the Amended and Restated DRIP.
Since October 5, 2016, our board has approved and established an estimated per share net asset value, or NAV on at least an annual basis. Commencing with the distribution payment to stockholders paid in the month following such board approval, shares of our common stock issued pursuant to the Amended and Restated DRIP were or will be issued at the current estimated per share NAV until such time as our board determines an updated estimated per share NAV. The following is a summary of our historical and current estimated per share NAV:
Approval Date by our Board 
Estimated Per Share NAV
(Unaudited)
10/05/16 $9.01
10/04/17 $9.27
10/03/18 $9.37
For the three months ended March 31, 2019 and 2018, $14,196,000 and $15,229,000, respectively, in distributions were reinvested and 1,515,098 and 1,642,834 shares of our common stock, respectively, were issued pursuant to the 2015 DRIP Offering. As of March 31, 2019 and December 31, 2018, a total of $263,907,000 and $249,711,000, respectively, in distributions were reinvested that resulted in 28,335,108 and 26,820,010 shares of our common stock, respectively, being issued pursuant to our DRIP Offerings.
Approval Date by our Board 
Estimated Per Share NAV
(Unaudited)
10/05/16 $9.01
10/04/17 $9.27
10/03/18 $9.37
10/03/19 $9.40

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For the three months ended March 31, 2020 and 2019, $13,141,000 and $14,196,000, respectively, in distributions were reinvested and 1,398,021 and 1,515,098 shares of our common stock, respectively, were issued pursuant to our DRIP Offerings. As of March 31, 2020 and December 31, 2019, a total of $318,292,000 and $305,151,000, respectively, in distributions were reinvested that resulted in 34,131,715 and 32,733,694 shares of our common stock, respectively, being issued pursuant to our DRIP Offerings.
Share Repurchase Plan
Our board has approved a share repurchase plan, whichas amended, allows for repurchases of shares of our common stock by us when certain criteria are met. Share repurchases will be made at the sole discretion of our board. Subject to the availability of the funds for share repurchases, we will generally limit the number of shares of our common stock repurchased during any calendar year to 5.0% of the weighted average number of shares of our common stock outstanding during the prior calendar year. Funds for the repurchase of shares of our common stock will come exclusively from the cumulative proceeds we receive from the sale of shares of our common stock pursuant to our DRIP Offerings. Additionally, effective with respect to share repurchase requests submitted for repurchase during the second quarter 2019, the number of shares that we will repurchase during any fiscal quarter will be limited to an amount equal to the net proceeds that we received from the sale of shares issued pursuant to theour DRIP Offerings during the immediately preceding completed fiscal quarter; provided however, that shares subject to a repurchase requested upon the death or “qualifying disability,” as defined in our share repurchase plan, of a stockholder will not be subject to this quarterly cap or to our existing cap on repurchases toof 5.0% of the weighted average number of shares outstanding during the calendar year prior to the repurchase date. Funds for the repurchase of shares of our common stock will come from the cumulative proceeds we receive from the sale of shares of our common stock pursuant to our DRIP Offerings. Furthermore, our share repurchase plan as amended, provides that if there are insufficient funds to honor all repurchase requests, pending requests may be honored among all requests for repurchase in any given repurchase period as follows: first, repurchases in full as to repurchases that would result in a stockholder owning less than $2,500 of shares; and, next, pro rata as to other repurchase requests.
All repurchases will be subject to a one-year holding period, except for repurchases made in connection with a stockholder’s death or qualifying disability. Further, all share repurchases will be repurchased following a one-year holding period at a price between 92.5% and 100% of each stockholder’s repurchase amount, depending on the period of time their shares have been held. Until October 4, 2016, the repurchase amount for shares repurchased under our share repurchase plan was equal to the lesser of the amount a stockholder paid for their shares of our common stock or the most recent per share offering price. However, if shares of our common stock were repurchased in connection with a stockholder’s death or qualifying disability, the repurchase price was no less than 100% of the price paid to acquire the shares of our common stock from us.
Effective with respect to share repurchase requests submitted during the fourth quarter 2016, theThe Repurchase Amount, as such term is defined in our share repurchase plan, is equal to the lesser of (i) the amount per share that a stockholder paid for their shares of our common stock, or (ii) the most recent estimated value of one share of our common stock, as determined by our board. Accordingly, commencing with the share repurchase requests submitted during the fourth quarter 2016, we repurchase shares as follows: (a) for stockholders who have continuously held their shares of our common stock for at least one year, the price will be 92.5% of the Repurchase Amount; (b) for stockholders who have continuously held their shares of our common stock for at least two years, the price will be 95.0% of the Repurchase Amount; (c) for stockholders who have continuously held their shares of our common stock for at least three years, the price will be 97.5% of the Repurchase Amount; (d) for stockholders who have held their shares of our common stock for at least four years, the price will be 100% of the Repurchase Amount; and (e) forFor requests submitted pursuant to a death or a qualifying disability of a stockholder, the priceRepurchase Amount will be 100% of the amount per share the stockholder paid for their shares of common stock (in each case, as adjusted for any stock dividends, combinations, splits, recapitalizations and the like with respect to our common stock).
stock. Since October 5, 2016, our board has approved and established an estimated per share NAV on at least an annual basis. See the “Distribution Reinvestment Plan” section above for a summary of our historical and current estimated per share NAV in the “Distribution Reinvestment Plan” section above.NAV. Accordingly, commencing with share repurchase requests submitted during the quarter that our board has approved and established an estimated per share NAV, such NAV per share NAV served or will serve as the Repurchase Amount for stockholders who purchased their shares at a price equal to or greater than such NAV per share NAV in our initial offering, until such time as our board determines an updated estimated per share NAV.
Due to the impact the COVID-19 pandemic has had on the United States and globally, and the uncertainty of the severity and duration of the COVID-19 pandemic and its effects, our board decided to take steps to protect our capital and maximize our liquidity in an effort to strengthen our long-term financial prospects by partially suspending our share repurchase plan. As a result, effective with respect to share repurchase requests submitted for repurchase during the second quarter 2020, on March 31, 2020, our board suspended our share repurchase plan with respect to all repurchase requests other than repurchases resulting from the death or qualifying disability of stockholders. Repurchase requests resulting from the death or qualifying disability of stockholders are not suspended, but shall remain subject to all terms and conditions of our share repurchase plan, including our board’s discretion to determine whether we have sufficient funds available to repurchase any shares. Our board shall determine if and when it is in the best interest of our company and stockholders to reinstate our share repurchase plan for additional stockholders.
For the three months ended March 31, 2020, we did not repurchase any shares. For the three months ended March 31, 2019, and 2018, we received share repurchase requests and repurchased 3,883,716 and 1,792,524 shares of our common stock, respectively, for an aggregate of $36,486,000, and $16,506,000, respectively, at an average repurchase price of $9.39 and $9.21 per share, respectively.share. As of both March 31, 20192020 and December 31, 2018,2019, we received cumulative share repurchase requests and repurchased 18,204,169 and 14,320,45323,846,540 shares of our common stock, respectively, for an aggregate of $168,421,000 and $131,935,000, respectively,$221,823,000, at an average repurchase price of $9.25 and $9.21$9.30. In April 2020, we repurchased 1,893,413 shares of our common stock, under our share repurchase plan, for an aggregate of $17,986,000, at an average purchase price of $9.50 per share, respectively. All sharesshare. Shares were repurchased using proceeds we received from the cumulative sale of shares of our common stock pursuant to our DRIP Offerings.

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2013 Incentive Plan
We adopted the 2013 Incentive Plan, or our incentive plan, pursuant to which our board, or a committee of our independent directors, may make grants of options, shares of our common stock, stock purchase rights, stock appreciation rights or other awards to our independent directors, employees and consultants. The maximum number of shares of our common stock that may be issued pursuant to our incentive plan is 2,000,000 shares. For the three months ended March 31, 20192020 and 2018,2019, we did not issue any shares of our restricted common stock pursuant to our incentive plan and none of the previously issued shares of our restricted common stock were vested. For both the three months ended March 31, 20192020 and 2018,2019, we recognized stock compensation expense related to the independent director grants of $43,000. Such stock compensation expense is included in general and administrative in our accompanying condensed consolidated statements of operations and comprehensive income.income (loss).
14. Related Party Transactions
Fees and Expenses Paid to Affiliates
All of our executive officers and our non-independent directors are also executive officers and employees and/or holders of a direct or indirect interest in our advisor, one of our co-sponsors or other affiliated entities. We are affiliated with our advisor, American Healthcare Investors and AHI Group Holdings; however, we are not affiliated with Griffin Capital, our dealer manager, Colony Capital or Mr. Flaherty. We entered into the Advisory Agreement, which entitles our advisor and its affiliates to specified compensation for certain services, as well as reimbursement of certain expenses. Our board, including a majority of our independent directors, has reviewed the material transactions between our affiliates and us during the three months ended March 31, 2019.2020. Set forth below is a description of the transactions with affiliates. We believe that we have executed all of the transactions set forth below on terms that are fair and reasonable to us and on terms no less favorable to us than those available from unaffiliated third parties. In the aggregate, for the three months ended March 31, 20192020 and 2018,2019, we incurred $6,241,000$6,175,000 and $5,519,000,$6,241,000, respectively, in fees and expenses to our affiliates as detailed below.
Acquisition and Development Stage
Acquisition Fee
We pay our advisor or its affiliates an acquisition fee of up to 2.25% of the contract purchase price, including any contingent or earn-out payments that may be paid, for each property we acquire or 2.00% of the origination or acquisition price, including any contingent or earn-out payments that may be paid, for any real estate-related investment we originate or acquire. Since January 31, 2015, acquisition fees are and have been paid in cash. Our advisor or its affiliates are entitled to receive these acquisition fees for properties and real estate-related investments we acquire with funds raised in our initial offering including acquisitions completed after the termination of the Advisory Agreement, or funded with net proceeds from the sale of a property or real estate-related investment, subject to certain conditions.
For the three months ended March 31, 20192020 and 2018,2019, we incurred $358,000$36,000 and $0,$358,000, respectively, in acquisition fees to our advisor. Acquisition fees in connection with the acquisition of properties accounted for as asset acquisitions or the acquisition of real estate-related investments are capitalized as part of the associated investments in our accompanying condensed consolidated balance sheets.
Development Fee
In the event our advisor or its affiliates provide development-related services, our advisor or its affiliates receive a development fee in an amount that is usual and customary for comparable services rendered for similar projects in the geographic market where the services are provided; however, we will not pay a development fee to our advisor or its affiliates if our advisor or its affiliates elect to receive an acquisition fee based on the cost of such development.
For the three months ended March 31, 20192020 and 2018,2019, we incurred $150,000$48,000 and $0,$150,000, respectively, in development fees to our advisor or its affiliates, which wasare capitalized as part of the associated investments in our accompanying condensed consolidated balance sheets.
Reimbursement of Acquisition Expenses
We reimburse our advisor or its affiliates for acquisition expenses related to selecting, evaluating and acquiring assets, which are reimbursed regardless of whether an asset is acquired. The reimbursement of acquisition expenses, acquisition fees, total development costs, real estate commissions or other fees paid to unaffiliated third parties will not exceed, in the aggregate, 6.0% of the contract purchase price or real estate-related investments, unless fees in excess of such limits are approved by a

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majority of our directors, including a majority of our independent directors, not otherwise interested in the transaction. For the three months ended March 31, 2019 and 2018, such fees and expenses noted above did not exceed 6.0% of the contract purchase price of our property acquisitions or real estate-related investments.
For the three months ended March 31, 2019 and 2018, we did not incur any acquisition expenses to our advisor or its affiliates. Reimbursements of acquisition expenses in connection with the acquisition of properties accounted for as asset acquisitions or the acquisition of real estate-related investments are capitalized as part of the associated investments in our accompanying condensed consolidated balance sheets.
Operational Stage
Asset Management Fee
We pay our advisor or its affiliates a monthly fee for services rendered in connection with the management of our assets equal to one-twelfth of 0.75% of average invested assets, subject to our stockholders receiving distributions in an amount equal to 5.0% per annum, cumulative, non-compounded, of invested capital. For such purposes, average invested assets means the average of the aggregate book value of our assets invested in real estate and real estate-related investments, before deducting depreciation, amortization, bad debt and other similar non-cash reserves, computed by taking the average of such values at the end of each month during the period of calculation; and invested capital means, for a specified period, the aggregate issue price of shares of our common stock purchased by our stockholders, reduced by distributions of net sales proceeds by us to our stockholders and by any amounts paid by us to repurchase shares of our common stock pursuant to our share repurchase plan.
For the three months ended March 31, 20192020 and 2018,2019, we incurred $4,977,000$5,105,000 and $4,781,000,$4,977,000, respectively, in asset management fees to our advisor or its affiliates. Asset management fees are included in general and administrative in our accompanying condensed consolidated statements of operations and comprehensive income.income (loss).
Property Management Fee
Our advisor or its affiliates may directly serve as property manager of our properties or may sub-contract their property management duties to any third party and provide oversight of such third-party property manager. We pay our advisor or its affiliates a monthly management fee equal to a percentage of the gross monthly cash receipts of such property as follows: (i) a property management oversight fee of 1.0% of the gross monthly cash receipts of any stand-alone, single-tenant, net leased property; (ii) a property management oversight fee of 1.5% of the gross monthly cash receipts of any property that is not a stand-alone, single-tenant, net leased property and for which our advisor or its affiliates provide oversight of a third party that performs the duties of a property manager with respect to such property; or (iii) a fair and reasonable property management fee that is approved by a majority of our directors, including a majority of our independent directors, that is not less favorable to us than terms available from unaffiliated third parties for any property that is not a stand-alone, single-tenant, net leased property and for which our advisor or its affiliates will directly serve as the property manager without sub-contracting such duties to a third party.
For the three months ended March 31, 20192020 and 2018,2019, we incurred $619,000$653,000 and $611,000,$619,000, respectively, in property management fees to our advisor or its affiliates. Property management fees are included in property operating expenses and rental expenses in our accompanying condensed consolidated statements of operations and comprehensive income.income (loss).
Lease Fees
We pay our advisor or its affiliates a separate fee for any leasing activities in an amount not to exceed the fee customarily charged in arm’s-length transactions by others rendering similar services in the same geographic area for similar properties as determined by a survey of brokers and agents in such area. Such fee is generally expected to range from 3.0% to 6.0% of the gross revenues generated during the initial term of the lease.
For the three months ended March 31, 20192020 and 2018,2019, we incurred $24,000$203,000 and $69,000,$24,000, respectively, in lease fees to our advisor or its affiliates. Lease fees are capitalized as lease commissions and included in other assets, net in our accompanying condensed consolidated balance sheets.

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Construction Management Fee
In the event that our advisor or its affiliates assist with planning and coordinating the construction of any capital or tenant improvements, our advisor or its affiliates are paid a construction management fee of up to 5.0% of the cost of such improvements. For the three months ended March 31, 20192020 and 2018,2019, we incurred $37,000$69,000 and $6,000,$37,000, respectively, in construction management fees to our advisor or its affiliates.
Construction management fees are capitalized as part of the associated asset and included in real estate investments, net in our accompanying condensed consolidated balance sheets or are expensed and included in our accompanying condensed consolidated statements of operations and comprehensive income (loss), as applicable.

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Operating Expenses
We reimburse our advisor or its affiliates for operating expenses incurred in rendering services to us, subject to certain limitations. However, we cannot reimburse our advisor or its affiliates at the end of any fiscal quarter for total operating expenses that, in the four consecutive fiscal quarters then ended, exceed the greater of: (i) 2.0% of our average invested assets, as defined in the Advisory Agreement; or (ii) 25.0% of our net income, as defined in the Advisory Agreement, unless our independent directors determined that such excess expenses were justified based on unusual and nonrecurring factors which they deem sufficient.
For the 12 months ended March 31, 20192020 and 2018,2019, our operating expenses did not exceed the aforementioned limitations. The following table reflects our operating expenses as a percentage of average invested assets and as a percentage of net income for the 12 month periods then ended:
12 months ended March 31,12 months ended March 31,
2019 20182020 2019
Operating expenses as a percentage of average invested assets0.9% 0.9%0.9% 0.9%
Operating expenses as a percentage of net income19.2% 16.3%21.5% 19.2%
For the three months ended March 31, 20192020 and 2018,2019, our advisor or its affiliates incurred operating expenses on our behalf of $76,000$61,000 and $52,000,$76,000, respectively. Operating expenses are generally included in general and administrative in our accompanying condensed consolidated statements of operations and comprehensive income.income (loss).
Compensation for Additional Services
We pay our advisor and its affiliates for services performed for us other than those required to be rendered by our advisor or its affiliates under the Advisory Agreement. The rate of compensation for these services has to be approved by a majority of our board, including a majority of our independent directors, and cannot exceed an amount that would be paid to unaffiliated third parties for similar services. For the three months ended March 31, 20192020 and 2018,2019, our advisor and its affiliates were not compensated for any additional services.
Liquidity Stage
Disposition Fees
For services relating to the sale of one or more properties, we pay our advisor or its affiliates a disposition fee of up to the lesser of 2.0% of the contract sales price or 50.0% of a customary competitive real estate commission given the circumstances surrounding the sale, in each case as determined by our board, including a majority of our independent directors, upon the provision of a substantial amount of the services in the sales effort. The amount of disposition fees paid, when added to the real estate commissions paid to unaffiliated third parties, will not exceed the lesser of the customary competitive real estate commission or an amount equal to 6.0% of the contract sales price.
For the three months ended March 31, 20192020 and 2018,2019, we did not incur any disposition fees to our advisor or its affiliates.

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Subordinated Participation Interest
Subordinated Distribution of Net Sales Proceeds
In the event of liquidation, we will pay our advisor a subordinated distribution of net sales proceeds. The distribution will be equal to 15.0% of the remaining net proceeds from the sales of properties, after distributions to our stockholders, in the aggregate, of: (i) a full return of capital raised from stockholders (less amounts paid to repurchase shares of our common stock pursuant to our share repurchase plan); plus (ii) an annual 7.0% cumulative, non-compounded return on the gross proceeds from the sale of shares of our common stock, as adjusted for distributions of net sales proceeds. Actual amounts to be received depend on the sale prices of properties upon liquidation. For the three months ended March 31, 20192020 and 2018,2019, we did not pay any such distributions to our advisor.

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Subordinated Distribution Upon Listing
Upon the listing of shares of our common stock on a national securities exchange, in redemption of our advisor’s limited partnership units, we will pay our advisor a distribution equal to 15.0% of the amount by which: (i) the market value of our outstanding common stock at listing plus distributions paid prior to listing exceeds (ii) the sum of the total amount of capital raised from stockholders (less amounts paid to repurchase shares of our common stock pursuant to our share repurchase plan) and the amount of cash that, if distributed to stockholders as of the date of listing, would have provided them an annual 7.0% cumulative, non-compounded return on the gross proceeds from the sale of shares of our common stock through the date of listing. Actual amounts to be paid depend upon the market value of our outstanding stock at the time of listing, among other factors. For the three months ended March 31, 20192020 and 2018,2019, we did not pay any such distributions to our advisor.
Subordinated Distribution Upon Termination
Pursuant to the Agreement of Limited Partnership, as amended, of our operating partnership, upon termination or non-renewal of the Advisory Agreement, our advisor will also be entitled to a subordinated distribution in redemption of its limited partnership units from our operating partnership equal to 15.0% of the amount, if any, by which: (i) the appraised value of our assets on the termination date, less any indebtedness secured by such assets, plus total distributions paid through the termination date, exceeds (ii) the sum of the total amount of capital raised from stockholders (less amounts paid to repurchase shares of our common stock pursuant to our share repurchase plan) and the total amount of cash equal to an annual 7.0% cumulative, non-compounded return on the gross proceeds from the sale of shares of our common stock through the termination date. In addition, our advisor may elect to defer its right to receive a subordinated distribution upon termination until either a listing or other liquidity event, including a liquidation, sale of substantially all of our assets or merger in which our stockholders receive in exchange for their shares of our common stock, shares of a company that are traded on a national securities exchange.
As of March 31, 20192020 and December 31, 2018,2019, we did not have any liability related to the subordinated distribution upon termination.
Accounts Payable Due to Affiliates
The following amounts were outstanding to our affiliates as of March 31, 20192020 and December 31, 2018:2019:
Fee 
March 31,
2019
 
December 31,
2018
 
March 31,
2020
 
December 31,
2019
Asset and property management fees $1,872,000
 $1,856,000
 $1,956,000
 $1,991,000
Construction management fees 181,000
 175,000
Lease commissions 53,000
 94,000
 88,000
 143,000
Construction management fees 46,000
 58,000
Operating expenses 32,000
 12,000
 13,000
 12,000
Acquisition fees 11,000
 15,000
Development fees 
 68,000
 $2,014,000
 $2,103,000
 $2,238,000
 $2,321,000

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

15. Fair Value Measurements
Assets and Liabilities Reported at Fair Value
The table below presents our assets and liabilities measured at fair value on a recurring basis as of March 31, 2019,2020, aggregated by the level in the fair value hierarchy within which those measurements fall:
Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)
 
Significant Other
Observable Inputs
(Level 2)
 
Significant
Unobservable
Inputs
(Level 3)
 Total
Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)
 
Significant Other
Observable Inputs
(Level 2)
 
Significant
Unobservable
Inputs
(Level 3)
 Total
Assets:              
Derivative financial instruments$
 $11,000
 $
 $11,000
Derivative financial instrument$
 $3,000
 $
 $3,000
Total assets at fair value$
 $11,000
 $
 $11,000
$
 $3,000
 $
 $3,000
Liabilities:              
Contingent consideration obligation$
 $
 $
 $
Derivative financial instruments$
 $12,157,000
 $
 $12,157,000
Warrants
 
 1,132,000
 1,132,000

 
 1,178,000
 1,178,000
Total liabilities at fair value$
 $
 $1,132,000
 $1,132,000
$
 $12,157,000
 $1,178,000
 $13,335,000
The table below presents our assets and liabilities measured at fair value on a recurring basis as of December 31, 2018,2019, aggregated by the level in the fair value hierarchy within which those measurements fall:
Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)
 
Significant Other
Observable Inputs
(Level 2)
 
Significant
Unobservable
Inputs
(Level 3)
 Total
Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)
 
Significant Other
Observable Inputs
(Level 2)
 
Significant
Unobservable
Inputs
(Level 3)
 Total
Assets:              
Derivative financial instruments$
 $417,000
 $
 $417,000
Derivative financial instrument$
 $
 $
 $
Total assets at fair value$
 $417,000
 $
 $417,000
$
 $
 $
 $
Liabilities:              
Contingent consideration obligation$
 $
 $681,000
 $681,000
Derivative financial instruments$
 $3,971,000
 $
 $3,971,000
Warrants
 
 1,207,000
 1,207,000

 
 1,178,000
 1,178,000
Total liabilities at fair value$
 $
 $1,888,000
 $1,888,000
$
 $3,971,000
 $1,178,000
 $5,149,000
There were no transfers into and out of fair value measurement levels during the three months ended March 31, 20192020 and 2018.2019.
Derivative Financial Instruments
We use interest rate swaps and interest rate caps to manage interest rate risk associated with variable-rate debt. The valuation of these instruments is determined using widely accepted valuation techniques including a discounted cash flow analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives, including the period to maturity, and uses observable market-based inputs, including interest rate curves, as well as option volatility. The fair values of interest rate swaps are determined by netting the discounted future fixed cash payments and the discounted expected variable cash receipts. The variable cash receipts are based on an expectation of future interest rates derived from observable market interest rate curves.
We incorporate credit valuation adjustments to appropriately reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements. In adjusting the fair value of our derivative contracts for the effect of nonperformance risk, we have considered the impact of netting and any applicable credit enhancements, such as collateral postings, thresholds, mutual puts and guarantees.

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

Although we have determined that the majority of the inputs used to value our derivative financial instruments fall within Level 2 of the fair value hierarchy, the credit valuation adjustments associated with these instruments utilize Level 3 inputs, such as estimates of current credit spreads, to evaluate the likelihood of default by us and our counterparty. However, as of March 31, 2019,2020, we have assessed the significance of the impact of the credit valuation adjustments on the overall valuation of our derivative positions and have determined that the credit valuation adjustments are not significant to the overall valuation of our derivatives. As a result, we have determined that our derivative valuations in their entirety are classified in Level 2 of the fair value hierarchy.
Contingent Consideration Liability
As of March 31, 2019 and December 31, 2018, we have accrued $0 and $681,000, respectively, of a contingent consideration obligation in connection with our Clemmons facility within North Carolina ALF Portfolio. Such obligation was included in security deposits, prepaid rent and other liabilities in our accompanying condensed consolidated balance sheets and may be paid upon various conditions being met, including our tenants achieving certain operating performance metrics. In particular, the amounts may be paid based upon the computation in the lease agreement, as amended, and receipt of notification within four years after the applicable acquisition date that the tenant has increased its earnings before interest, taxes, depreciation and rent cost, or EBITDAR, as defined in the lease agreement, for the preceding three months. There is no minimum required payment but the total maximum is capped at $11,000,000 and also limited by the tenant’s ability to increase its EBITDAR. Any payment made will result in an increase in the monthly rent charged to the tenant and additional rental revenue to us. The contingent consideration obligation continues to be revised to its estimated fair value each reporting period, and as such, as of March 31, 2019, we estimate that we will not pay any contingent consideration for the Clemmons facility within North Carolina ALF Portfolio.
Warrants
As of both March 31, 20192020 and December 31, 2018,2019, we have recorded $1,132,000 and $1,207,000, respectively,$1,178,000 related to warrants in Trilogy common units held by certain members of Trilogy’s pre-closing management, which is included in security deposits, prepaid rent and other liabilities in our accompanying condensed consolidated balance sheets. Once exercised, these warrants have redemption features similar to the common units held by members of Trilogy’s pre-closing management. See Note 12, Redeemable Noncontrolling Interests, for a further discussion. As of March 31, 20192020 and December 31, 2018,2019, the carrying value is a reasonable estimate of fair value.
Financial Instruments Disclosed at Fair Value
Our accompanying condensed consolidated balance sheets include the following financial instruments: real estate notes receivable, debt security investment, cash and cash equivalents, accounts and other receivables, restricted cash, real estate deposits, accounts payable and accrued liabilities, accounts payable due to affiliates, mortgage loans payable and borrowings under our lines of credit and term loans.
We consider the carrying values of real estate notes receivable, cash and cash equivalents, accounts and other receivables, restricted cash, real estate deposits and accounts payable and accrued liabilities to approximate the fair value for these financial instruments based upon an evaluation of the underlying characteristics, market data and because of the short period of time between origination of the instruments and their expected realization. The fair value of cash and cash equivalents is classified in Level 1 of the fair value hierarchy. The fair value of accounts payable due to affiliates is not determinable due to the related party nature of the accounts payable. The fair values of the other financial instruments are classified in Level 2 of the fair value hierarchy.

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

The fair value of our debt security investment is estimated using a discounted cash flow analysis using interest rates available to us for investments with similar terms and maturities. The fair value of our mortgage loans payable and our lines of credit and term loans are estimated using a discounted cash flow analysis using borrowing rates available to us for debt instruments with similar terms and maturities. We have determined that the valuations of our debt security investment, mortgage loans payable and lines of credit and term loans are classified in Level 2 within the fair value hierarchy. The carrying amounts and estimated fair values of such financial instruments as of March 31, 20192020 and December 31, 20182019 were as follows:
 
March 31,
2020
 
December 31,
2019
 
Carrying
Amount(1)
 
Fair
Value
 
Carrying
Amount(1)
 
Fair
Value
Financial Assets:       
Debt security investment$73,476,000
 $93,992,000
 $72,717,000
 $94,026,000
Financial Liabilities:       
Mortgage loans payable$797,774,000
 $735,458,000
 $792,870,000
 $732,846,000
Lines of credit and term loans$826,984,000
 $836,392,000
 $807,742,000
 $816,355,000
___________
 
March 31,
2019
 
December 31,
2018
 
Carrying
Amount
 
Fair
Value
 
Carrying
Amount
 
Fair
Value
Financial Assets:       
Debt security investment$70,565,000
 $94,083,000
 $69,873,000
 $94,116,000
Financial Liabilities:       
Mortgage loans payable$691,896,000
 $636,795,000
 $688,262,000
 $618,886,000
Lines of credit and term loans$797,002,000
 $810,066,000
 $735,737,000
 $737,982,000
(1)Carrying amount is net of any discount/premium and unamortized costs.
16. Income Taxes
As a REIT, we generally will not be subject to federal income tax on taxable income that we distribute to our stockholders. We have elected to treat certain of our consolidated subsidiaries as taxable REIT subsidiaries, or TRSs,TRS, pursuant to the Code. TRSsTRS may participate in services that would otherwise be considered impermissible for REITs and are subject to federal and state income tax at regular corporate tax rates.
On December 22, 2017, the U.S. government enacted comprehensive tax legislation pursuant to the Tax Cuts and Jobs Act of 2017, or the Tax Act. The Tax Act makes broad and complex changes to the U.S. tax code, including, but not limited to, reducing the U.S. federal corporate tax rate from 35.0% to 21.0%, eliminating the corporate alternative minimum tax and changing rules related to uses and limitations of net operating loss carryforwards created in tax years beginning after December 31, 2017. The Tax Act is still unclear in some respects and could be subject to potential amendments and technical corrections. The federal income tax rules dealing with U.S. federal income taxation and REITs are constantly under review by persons involved in the legislative process, the IRS and the U.S. Treasury Department, which results in statutory changes as well as frequent revisions to regulations and interpretations. As a result, the long-term impact of the Tax Act on the overall economy, government revenues, our tenants, us, and the real estate industry cannot be reliably predicted at this time. We continue to work with our tax advisors to determine the full impact that the recent tax legislation as a whole will have on us.
The components of income before taxes for the three months ended March 31, 2019 and 2018 were as follows:
 Three Months Ended March 31,
 2019 2018
Domestic$7,206,000
 $8,109,000
Foreign(197,000) (55,000)
Income before income taxes$7,009,000
 $8,054,000
The components of income tax expense (benefit) for the three months ended March 31, 2019 and 2018 were as follows:
 Three Months Ended March 31,
 2019 2018
Federal deferred$(548,000) $(1,332,000)
State deferred(70,000) (267,000)
Foreign current145,000
 79,000
Valuation allowances624,000
 1,149,000
Total income tax expense (benefit)$151,000
 $(371,000)

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

The components of (loss) income before taxes for the three months ended March 31, 2020 and 2019 were as follows:
 Three Months Ended March 31,
 2020 2019
Domestic$(10,853,000) $7,206,000
Foreign(141,000) (197,000)
(Loss) income before income taxes$(10,994,000) $7,009,000
The components of income tax (benefit) expense for the three months ended March 31, 2020 and 2019 were as follows:
 Three Months Ended March 31,
 2020 2019
Federal deferred$(587,000) $(548,000)
State deferred(65,000) (70,000)
Federal current(38,000) 
Foreign current156,000
 145,000
Valuation allowances(2,677,000) 624,000
Total income tax (benefit) expense$(3,211,000) $151,000
Current Income Tax
Federal and state income taxes are generally a function of the level of income recognized by our TRSs.TRS. Foreign income taxes are generally a function of our income on our real estate and real estate-related investments located in the United Kingdom, or UK, and Isle of Man.
Deferred Taxes
Deferred income tax is generally a function of the period’s temporary differences (primarily basis differences between tax and financial reporting for real estate assets and equity investments) and generation of tax net operating losses that may be realized in future periods depending on sufficient taxable income.
We recognize the financial statement effects of an uncertain tax position when it is more likely than not, based on the technical merits of the tax position, that such a position will be sustained upon examination by the relevant tax authorities. If the tax benefit meets the “more likely than not” threshold, the measurement of the tax benefit will be based on our estimate of the ultimate tax benefit to be sustained if audited by the taxing authority. As of March 31, 20192020 and December 31, 2018,2019, we did not have any tax benefits or liabilities for uncertain tax positions that we believe should be recognized in our accompanying condensed consolidated financial statements.
We assess the available evidence to estimate if sufficient future taxable income will be generated to use the existing deferred tax assets. A valuation allowance is established if we believe it is more likely than not that all or a portion of the deferred tax assets are not realizable. As of March 31, 20192020 and December 31, 2018,2019, our valuation allowance substantially reserves the net deferred tax assets due to inherent uncertainty of future income. We will continue to monitor industry and economic conditions, and our ability to generate taxable income based on our business plan and available tax planning strategies, which would allow us to utilize the tax benefits of the net deferred tax assets and thereby allow us to reverse all, or a portion of, our valuation allowance in the future.
17. Leases
Lessor
We have operating leases with tenants that expire at various dates through 2059. We recognized $31,053,000 of revenues related to operating lease payments, of which $4,741,000 was for variable lease payments for the three months ended March 31, 2019. The following table sets forth the undiscounted cash flows for future minimum base rents due under operating leases for leases in effect for properties we wholly own for the nine months ending December 31, 2019 and for each of the next four years ending December 31 and thereafter:
Year Amount
2019 $71,941,000
2020 91,871,000
2021 89,724,000
2022 83,418,000
2023 76,070,000
Thereafter 578,517,000
Total $991,541,000

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

Future17. Leases
Lessor
We have operating leases with tenants that expire at various dates through 2050. For the three months ended March 31, 2020 and 2019, we recognized $28,823,000 and $31,053,000, respectively, of revenues related to operating lease payments, of which $4,450,000 and $4,741,000, respectively, was for variable lease payments. As of March 31, 2020, the following table sets forth the undiscounted cash flows for future minimum base rent contractuallyrents due under operating leases excluding tenant reimbursements of certain costs, as offor the nine months ended December 31, 20182020 and for each of the next fivefour years ending December 31 and thereafter was as follows:for properties that we wholly own:
Year Amount Amount
2019 $92,888,000
2020 88,536,000
 $65,975,000
2021 86,362,000
 86,734,000
2022 80,233,000
 80,462,000
2023 72,535,000
 72,527,000
2024 66,790,000
Thereafter 559,649,000
 450,439,000
Total $980,203,000
 $822,927,000
Lessee
We lease certain land, buildings, furniture, fixtures, campus equipment, office equipment and automobiles. We have lease agreements with lease and non-lease components, which are generally accounted for separately. Most leases include one or more options to renew, with renewal terms that generally can extend at various dates through 2112, excluding extension options. The exercise of lease renewal options is at our sole discretion. Certain leases also include options to purchase the leased property. As of March 31, 2020, we had future lease payments of $28,703,000 for operating leases that had not yet commenced. These operating leases will commence between fiscal year 2020 and fiscal year 2021 with lease terms of up to 10 years.
The depreciable life of assets and leasehold improvements are limited by the expected lease term, unless there is a transfer of title or purchase option reasonably certain of exercise. Certain of our lease agreements include rental payments that are adjusted periodically based on the Consumer Price Index, (CPI), and may also include other variable lease costs (i.e., common area maintenance, property taxes and insurance). Our lease agreements do not contain any material residual value guarantees or material restrictive covenants.
The components of lease costs were as follows:
    Three Months Ended March 31,
Lease Cost Classification 2020
2019
Operating lease cost(1) Property operating expenses and rental expenses $8,194,000
 $7,456,000
Finance lease cost      
Amortization of leased assets Depreciation and amortization 535,000
 974,000
Accretion of lease liabilities Interest expense 169,000
 79,000
Total lease cost   $8,898,000
 $8,509,000
Lease Cost Classification 
Three Months Ended
March 31, 2019
Operating lease cost(1) Property operating expenses and rental expenses $7,456,000
Finance lease cost    
Amortization of leased assets Depreciation and amortization 974,000
Accretion of lease liabilities Interest expense 79,000
Total lease cost   $8,509,000
___________
(1)Includes short-term leases and variable lease costs, which are immaterial.
Other information related to leases was as follows:
Supplemental Disclosure of Cash Flows Information 
Three Months Ended
March 31, 2019
Cash paid for amounts included in the measurement of lease liabilities:  
Operating cash flows from operating leases $5,511,000
Operating cash flows from finance leases $79,000
Financing cash flows from finance leases $962,000
Right-of-use assets obtained in exchange for operating lease liabilities $92,000

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

Other information related to leases was as follows:
Lease Term and Discount RateAmount
Weighted-average remaining lease term (in years)
Operating leases13.6
Finance leases1.3
Weighted-average discount rate
Operating leases6.13%
Finance leases7.87%
Lease Term and Discount Rate March 31,
2020
 December 31,
2019
Weighted average remaining lease term (in years)    
Operating leases 13.3
 13.5
Finance leases 1.2
 1.3
Weighted average discount rate    
Operating leases 5.91% 5.94%
Finance leases 7.21% 7.33%


Three Months Ended March 31,
Supplemental Disclosure of Cash Flows Information
2020
2019
Cash paid for amounts included in the measurement of lease liabilities:



Operating cash outflows related to operating leases
$6,033,000

$5,511,000
Operating cash outflows related to finance leases
$169,000

$79,000
Financing cash outflows related to finance leases
$507,000

$962,000
Right-of-use assets obtained in exchange for operating lease liabilities
$1,628,000

$92,000
Operating Leases
TheAs of March 31, 2020, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for the nine months ending December 31, 20192020 and for each of the next four years ending December 31 and thereafter, as well as the reconciliation of those cash flows to operating lease liabilities:liabilities on our accompanying condensed consolidated balance sheet:
Year Amount
2019 $17,321,000
2020 23,098,000
2021 23,568,000
2022 23,950,000
2023 23,257,000
Thereafter 189,416,000
Total operating lease payments 300,610,000
Less: interest 104,620,000
Present value of operating lease liabilities $195,990,000
Future minimum lease obligations under non-cancelable ground and other lease obligations as of December 31, 2018 for each of the next five years ending December 31 and thereafter was as follows:
Year Amount Amount
2019 $22,194,000
2020 22,564,000
 $18,804,000
2021 23,166,000
 25,292,000
2022 23,702,000
 25,798,000
2023 23,154,000
 26,042,000
2024 25,355,000
Thereafter 177,927,000
 187,962,000
Total $292,707,000
Total operating lease payments 309,253,000
Less: interest 102,331,000
Present value of operating lease liabilities $206,922,000

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

Finance Leases
TheAs of March 31, 2020, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for the nine months ending December 31, 20192020 and for each of the next four years ending December 31 and thereafter, as well as a reconciliation of those cash flows to finance lease liabilities:
Year Amount Amount
2019 $2,265,000
2020 1,266,000
 $733,000
2021 130,000
 129,000
2022 
 
2023 
 
2024 
Thereafter 
Total finance lease payments 3,661,000
 862,000
Less: interest 185,000
 22,000
Present value of finance lease liabilities $3,476,000
 $840,000
Future minimum lease payments under finance leases as of December 31, 2018 and for each of the next five years ending December 31 and thereafter was as follows:
Year Amount(1)
2019 $3,307,000
2020 1,266,000
2021 130,000
2022 
2023 
  $4,703,000
___________
(1)Amounts above represent principal of $4,438,000 and interest obligations of $265,000 under finance lease.
18. Segment Reporting
As of March 31, 2019,2020, we evaluated our business and made resource allocations based on six reportable business segments: medical office buildings, hospitals, skilled nursing facilities, senior housing, senior housing — RIDEA and integrated senior health campuses. Our medical office buildings are typically leased to multiple tenants under separate leases, thus requiring active management and responsibility for many of the associated operating expenses (much of which are, or can effectively be, passed through to the tenants). In addition, our medical office buildings segment includes the Mezzanine Fixed Rate Notes. Our hospital investments are primarily single-tenant properties thatfor which we lease the facilities to unaffiliated tenants under triple-net and generally master leases that transfer the obligation for all facility operating costs (including maintenance, repairs, taxes, insurance and capital expenditures) to the tenant. Our skilled nursing facilities and senior housing facilities are similarly structured asto our hospital investments. In addition, our senior housing segment includes our debt security investment. Our senior housing — RIDEA properties include senior housing facilities that are owned and operated utilizing a RIDEA structure. Our integrated senior health campuses include a range of assisted living, memory care, independent living, skilled nursing services and certain ancillary businesses that are owned and operated utilizing a RIDEA structure.

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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

We evaluate performance based upon segment net operating income. We define segment net operating income as total revenues, less property operating expenses and rental expenses, which excludes depreciation and amortization, general and administrative expenses, acquisition related expenses, interest expense, gain or loss in fair value of derivative financial instruments, impairment of real estate investments, foreign currency gain (loss),or loss, other income, (expense), loss from unconsolidated entities and income tax benefit (expense)or expense for each segment. We believe that net income (loss), as defined by GAAP, is the most appropriate earnings measurement. However, we believe that segment net operating income serves as an appropriate supplemental performance measure to net income (loss) because it allows investors and our management to measure unlevered property-level operating results and to compare our operating results to the operating results of other real estate companies and between periods on a consistent basis.
Interest expense, depreciation and amortization and other expenses not attributable to individual properties are not allocated to individual segments for purposes of assessing segment performance. Non-segment assets primarily consist of corporate assets including cash and cash equivalents, other receivables, deferred financing costs and other assets not attributable to individual properties.

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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

Summary information for the reportable segments during the three months ended March 31, 20192020 and 20182019 was as follows:
 
Integrated
Senior Health
Campuses
 
Senior
Housing
RIDEA
 
Medical
Office
Buildings
 
Senior
Housing
 
Skilled
Nursing
Facilities
 Hospitals 
Three Months
Ended
March 31, 2019
 
Integrated
Senior Health
Campuses
 
Senior
Housing
RIDEA
 
Medical
Office
Buildings
 
Senior
Housing
 
Skilled
Nursing
Facilities
 Hospitals 
Three Months
Ended
March 31, 2020
Revenues:                            
Resident fees and services $251,714,000
 $16,568,000
 $
 $
 $
 $
 $268,282,000
 $267,794,000
 $22,132,000
 $
 $
 $
 $
 $289,926,000
Real estate revenue 
 
 20,554,000
 5,652,000
 3,659,000
 2,911,000
 32,776,000
 
 
 19,598,000
 3,406,000
 4,363,000
 2,751,000
 30,118,000
Total revenues 251,714,000
 16,568,000
 20,554,000
 5,652,000
 3,659,000
 2,911,000
 301,058,000
 267,794,000
 22,132,000
 19,598,000
 3,406,000
 4,363,000
 2,751,000
 320,044,000
Expenses:                            
Property operating expenses 223,328,000
 11,624,000
 
 
 
 
 234,952,000
 239,598,000
 16,142,000
 
 
 
 
 255,740,000
Rental expenses 
 
 7,816,000
 96,000
 362,000
 151,000
 8,425,000
 
 
 7,638,000
 21,000
 406,000
 105,000
 8,170,000
Segment net operating income $28,386,000

$4,944,000

$12,738,000

$5,556,000

$3,297,000

$2,760,000
 $57,681,000
 $28,196,000
 $5,990,000
 $11,960,000
 $3,385,000
 $3,957,000
 $2,646,000
 $56,134,000
Expenses:                            
General and administrativeGeneral and administrative      $6,917,000
General and administrative      $6,574,000
Acquisition related expensesAcquisition related expenses      (696,000)Acquisition related expenses      234,000
Depreciation and amortizationDepreciation and amortization      25,628,000
Depreciation and amortization      25,087,000
Other income (expense):Other income (expense):        Other income (expense):        
Interest expense:Interest expense:  Interest expense:  
Interest expense (including amortization of deferred financing costs and debt discount/premium)Interest expense (including amortization of deferred financing costs and debt discount/premium) (19,059,000)Interest expense (including amortization of deferred financing costs and debt discount/premium) (18,534,000)
Loss in fair value of derivative financial instrumentsLoss in fair value of derivative financial instruments (560,000)Loss in fair value of derivative financial instruments (8,183,000)
Impairment of real estate investmentsImpairment of real estate investments      (5,102,000)
Loss from unconsolidated entitiesLoss from unconsolidated entities      (454,000)Loss from unconsolidated entities      (904,000)
Foreign currency gain       1,042,000
Foreign currency lossForeign currency loss       (3,065,000)
Other incomeOther income      208,000
Other income      555,000
Income before income taxes      7,009,000
Income tax expense       (151,000)
Net income             $6,858,000
Loss before income taxesLoss before income taxes      (10,994,000)
Income tax benefitIncome tax benefit       3,211,000
Net loss             $(7,783,000)

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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

 
Integrated
Senior Health
Campuses
 
Senior
Housing
RIDEA
 
Medical
Office
Buildings
 
Senior
Housing
 
Skilled
Nursing
Facilities
 Hospitals 
Three Months
Ended
March 31, 2018
 
Integrated
Senior Health
Campuses
 
Senior
Housing
RIDEA
 
Medical
Office
Buildings
 
Senior
Housing
 
Skilled
Nursing
Facilities
 Hospitals 
Three Months
Ended
March 31, 2019
Revenues:                            
Resident fees and services $229,061,000
 $16,332,000
 $
 $
 $
 $
 $245,393,000
 $251,714,000
 $16,568,000
 $
 $
 $
 $
 $268,282,000
Real estate revenue 
 
 20,081,000
 5,400,000
 3,739,000
 3,279,000
 32,499,000
 
 
 20,554,000
 5,652,000
 3,659,000
 2,911,000
 32,776,000
Total revenues 229,061,000
 16,332,000
 20,081,000
 5,400,000
 3,739,000
 3,279,000
 277,892,000
 251,714,000
 16,568,000
 20,554,000
 5,652,000
 3,659,000
 2,911,000
 301,058,000
Expenses:                            
Property operating expenses 206,295,000
 11,064,000
 
 
 
 
 217,359,000
 223,328,000
 11,624,000
 
 
 
 
 234,952,000
Rental expenses 
 
 7,930,000
 187,000
 421,000
 402,000
 8,940,000
 
 
 7,816,000
 96,000
 362,000
 151,000
 8,425,000
Segment net operating income $22,766,000
 $5,268,000
 $12,151,000
 $5,213,000
 $3,318,000
 $2,877,000
 $51,593,000
 $28,386,000
 $4,944,000
 $12,738,000
 $5,556,000
 $3,297,000
 $2,760,000
 $57,681,000
Expenses:                            
General and administrativeGeneral and administrative $6,388,000
General and administrative $6,917,000
Acquisition related expensesAcquisition related expenses   (769,000)Acquisition related expenses   (696,000)
Depreciation and amortizationDepreciation and amortization 23,692,000
Depreciation and amortization 25,628,000
Other income (expense):Other income (expense):        Other income (expense):        
Interest expense:Interest expense: Interest expense: 
Interest expense (including amortization of deferred financing costs and debt discount/premium)Interest expense (including amortization of deferred financing costs and debt discount/premium) (15,352,000)Interest expense (including amortization of deferred financing costs and debt discount/premium) (19,059,000)
Gain in fair value of derivative financial instruments110,000
Loss in fair value of derivative financial instrumentsLoss in fair value of derivative financial instruments(560,000)
Loss from unconsolidated entitiesLoss from unconsolidated entities (1,077,000)Loss from unconsolidated entities (454,000)
Foreign currency gainForeign currency gain       1,796,000
Foreign currency gain       1,042,000
Other incomeOther income 295,000
Other income 208,000
Income before income taxesIncome before income taxes 8,054,000
Income before income taxes 7,009,000
Income tax benefit       371,000
Income tax expenseIncome tax expense       (151,000)
Net income             $8,425,000
             $6,858,000
Total assets by reportable segment as of March 31, 20192020 and December 31, 20182019 were as follows:
March 31,
2019
 
December 31,
2018
March 31,
2020
 
December 31,
2019
Integrated senior health campuses$1,672,770,000
 $1,478,147,000
$1,805,142,000
 $1,791,868,000
Medical office buildings648,550,000
 646,784,000
616,860,000
 620,292,000
Senior housing — RIDEA270,684,000
 271,381,000
358,681,000
 360,823,000
Senior housing259,619,000
 242,686,000
146,754,000
 152,909,000
Skilled nursing facilities128,067,000
 127,809,000
122,296,000
 126,606,000
Hospitals117,003,000
 118,685,000
112,220,000
 113,737,000
Other8,195,000
 3,600,000
5,096,000
 6,054,000
Total assets$3,104,888,000
 $2,889,092,000
$3,167,049,000
 $3,172,289,000
As of both March 31, 20192020 and December 31, 2018,2019, goodwill of $75,309,000 was allocated to integrated senior health campuses, and no other segments had goodwill.

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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

Our portfolio of properties and other investments are located in the United States, Isle of Man and the UK. Revenues and assets are attributed to the country in which the property is physically located. The following is a summary of geographic information for our operations for the periods presented:
Three Months Ended March 31,Three Months Ended March 31,
2019 20182020 2019
Revenues:      
United States$299,822,000
 $276,611,000
$318,846,000
 $299,822,000
International1,236,000
 1,281,000
1,198,000
 1,236,000
$301,058,000
 $277,892,000
$320,044,000
 $301,058,000
The following is a summary of real estate investments, net by geographic regions as of March 31, 20192020 and December 31, 2018:2019:
March 31,
2019
 
December 31,
2018
March 31,
2020
 
December 31,
2019
Real estate investments, net:      
United States$2,173,158,000
 $2,173,395,000
$2,232,687,000
 $2,219,882,000
International50,511,000
 49,286,000
47,070,000
 50,539,000
$2,223,669,000
 $2,222,681,000
$2,279,757,000
 $2,270,421,000
19. Concentration of Credit Risk
Financial instruments that potentially subject us to a concentration of credit risk are primarily real estate notes receivable andour debt security investment, cash and cash equivalents, accounts and other receivables, restricted cash and real estate deposits. We are exposed to credit risk with respect to the real estate notes receivable andour debt security investment, but we believe collection of the outstanding amount is probable. We believe that the risk is further mitigated as the real estate notes receivable are secured by property and there is a guarantee of completion agreement executed between the parent company of the borrowers and us. Cash and cash equivalents are generally invested in investment-grade, short-term instruments with a maturity of three months or less when purchased. We have cash and cash equivalents in financial institutions that are insured by the Federal Deposit Insurance Corporation, or FDIC. As of March 31, 20192020 and December 31, 2018,2019, we had cash and cash equivalents in excess of FDIC insured limits. We believe this risk is not significant. Concentration of credit risk with respect to accounts receivable from tenants is limited. We perform credit evaluations of prospective tenants and security deposits are obtained at the time of property acquisition and upon lease execution.
Based on leases in effect as of March 31, 2019,2020, properties in one statetwo states in the United States accounted for 10.0% or more of our total property portfolio’s annualized base rent or annualized net operating income. Properties located in Indiana and Ohio accounted for 33.4%38.3% and 10.4%, respectively, of our total property portfolio’s annualized base rent or annualized net operating income. Accordingly, there is a geographic concentration of risk subject to fluctuations in sucheach state’s economy.
Based on leases in effect as of March 31, 2019,2020, our six reportable business segments, integrated senior health campuses, medical office buildings, senior housing — RIDEA, senior housing, skilled nursing facilities, hospitals and hospitalssenior housing, accounted for 47.7%50.9%, 27.2%26.5%, 9.0%10.6%, 7.0%5.5%, 5.4%3.8% and 3.7%2.7%, respectively, of our total property portfolio’s annualized base rent or annualized net operating income. As of March 31, 2019,2020, none of our tenants at our properties accounted for 10.0% or more of our total property portfolio’s annualized base rent or annualized net operating income, which is based on contractual base rent from leases in effect inclusive of our senior housing — RIDEA facilities and integrated senior health campuses operations as of March 31, 2019.2020.

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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

20. Per Share Data
Basic earnings (loss) per share for all periods presented are computed by dividing net income (loss) applicable to common stock by the weighted average number of shares of our common stock outstanding during the period. Net income (loss) applicable to common stock is calculated as net income (loss) attributable to controlling interest less distributions allocated to participating securities of $7,000 for both the three months ended March 31, 20192020 and 2018.2019. Diluted earnings (loss) per share are computed based on the weighted average number of shares of our common stock and all potentially dilutive securities, if any. Nonvested shares of our restricted common stock and redeemable limited partnership units of our operating partnership are participating securities and give rise to potentially dilutive shares of our common stock.

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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)

As of both March 31, 20192020 and 2018,2019, there were 46,500 and 45,000 nonvested shares respectively, of our restricted common stock outstanding, but such shares were excluded from the computation of diluted earnings per share because such shares were anti-dilutive during these periods. As of both March 31, 20192020 and 2018,2019, there were 222 units of redeemable limited partnership units of our operating partnership outstanding, but such units were also excluded from the computation of diluted earnings per share because such units were anti-dilutive during these periods.

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Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations.
The use of the words “we,” “us” or “our” refers to Griffin-American Healthcare REIT III, Inc. and its subsidiaries, including Griffin-American Healthcare REIT III Holdings, LP, except where otherwise noted.
The following discussion should be read in conjunction with our accompanying condensed consolidated financial statements and notes thereto appearing elsewhere in this Quarterly Report on Form 10-Q and in our 20182019 Annual Report on Form 10-K, as filed with the United States Securities and Exchange Commission, or SEC, on March 21, 2019.26, 2020. Such condensed consolidated financial statements and information have been prepared to reflect our financial position as of March 31, 20192020 and December 31, 2018,2019, together with our results of operations for the three months ended March 31, 2020 and 2019 and cash flows for the three months ended March 31, 20192020 and 2018.2019.
Forward-Looking Statements
Historical results and trends should not be taken as indicative of future operations. Our statements contained in this report that are not historical factual statements are “forward-looking statements.” Actual results may differ materially from those included in the forward-looking statements. Forward-looking statements, which are based on certain assumptions and describe future plans, strategies and expectations, are generally identifiable by use of the words “expect,” “project,” “may,” “will,” “should,” “could,” “would,” “intend,” “plan,” “anticipate,” “estimate,” “believe,” “continue,” “predict,” “potential,” “seek” and any other comparable and derivative terms or the negatives thereof. Our ability to predict results or the actual effect of future plans orand strategies is inherently uncertain. Factors which could have a material adverse effect on our operations on a consolidated basis include, but are not limited to: changes in economic conditions generally and the real estate market specifically; the effects of the coronavirus, or COVID-19, pandemic, including its effects on the healthcare industry, senior housing and skilled nursing facilities and the economy in general; legislative and regulatory changes, including changes to laws governing the taxation of real estate investment trusts, or REITs; the availability of capital; changes in interest and foreign currency exchange rates; competition in the real estate industry; changes in accounting principles generally accepted in the United States, or GAAP, policies or guidelines applicable to REITs; the sucesssuccess of our investment strategy; the availability of financing; and our ongoing relationship with American Healthcare Investors, LLC, or American Healthcare Investors, and Griffin Capital Company, LLC, or Griffin Capital, or collectively, our co-sponsors, and their affiliates. These risks and uncertainties should be considered in evaluating forward-looking statements and undue reliance should not be placed on such statements. Forward-looking statements in this Quarterly Report on Form 10-Q speak only as of the date on which such statements were made, and undue reliance should not be placed on such statements. We undertake no obligation to update any such statements that may become untrue because of subsequent events. Additional information concerning us and our business, including additional factors that could materially affect our financial results, is included herein and in our other filings with the SEC.
Overview and Background
Griffin-American Healthcare REIT III, Inc., a Maryland corporation, was incorporated on January 11, 2013, and therefore, we consider that our date of inception. We were initially capitalized on January 15, 2013. We invest in a diversified portfolio of real estate properties, focusing primarily on medical office buildings, hospitals, skilled nursing facilities, senior housing and other healthcare-related facilities. We also operate healthcare-related facilities utilizing the structure permitted by the REIT Investment Diversification and Empowerment Act of 2007, which is commonly referred to as a “RIDEA” structure (the provisions of the Internal Revenue Code of 1986, as amended, or the Code, authorizing the RIDEA structure were enacted as part of the Housing and Economic Recovery Act of 2008). We also originate and acquire secured loans and may also originate and acquire other real estate-related investments on an infrequent and opportunistic basis. We generally seek investments that produce current income. We qualified to be taxed as a REIT under the Code for federal income tax purposes beginning with our taxable year ended December 31, 2014, and we intend to continue to qualify to be taxed as a REIT.
On February 26, 2014, we commenced a best efforts initial public offering, or our initial offering, in which we offered to the public up to $1,900,000,000 in shares of our common stock. As of April 22, 2015, the deregistration date of our initial offering, we had received and accepted subscriptions in our initial offering for 184,930,598 shares of our common stock, or $1,842,618,000, excluding shares of our common stock issued pursuant to our initial distribution reinvestment plan, or the Initial DRIP. As of April 22, 2015, a total of $18,511,000 in distributions were reinvested that resulted in 1,948,563 shares of our common stock being issued pursuant to the Initial DRIP.
On March 25, 2015, we filed a Registration Statement on Form S-3 under the Securities Act of 1933, as amended, or the Securities Act, to register a maximum of $250,000,000 of additional shares of our common stock to be issued pursuant to the Initial DRIP, or the 2015 DRIP Offering. We commenced offering shares pursuant to the 2015 DRIP Offering following the deregistration of our initial offering. Effective October 5, 2016, we amended and restated the Initial DRIP, or the Amended and Restated DRIP, to amend the price at which shares of our common stock are issued pursuant to the 2015 DRIP Offering. We

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continued to offer shares of our common stock pursuant to the 2015 DRIP Offering until the termination and deregistration of such offering on March 29, 2019. As of March 29, 2019, a total of $245,396,000 in distributions were reinvested that resulted in 26,386,545 shares of our common stock being issued pursuant to the 2015 DRIP Offering.
On January 30, 2019, we filed a Registration Statement on Form S-3 under the Securities Act to register a maximum of $200,000,000 of additional shares of our

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common stock to be issued pursuant to the Amended and Restated DRIP, or the 2019 DRIP Offering; however, we did not commenceOffering. We commenced offering shares pursuant to the 2019 DRIP Offering untilon April 1, 2019, following the deregistration of the 2015 DRIP Offering. As of March 31, 2020, a total of $54,385,000 in distributions were reinvested that resulted in 5,796,607 shares of common stock being issued pursuant to the 2019 DRIP Offering. We collectively refer to the Initial DRIP portion of our initial offering, the 2015 DRIP Offering and the 2019 DRIP Offering as our DRIP Offerings.
The COVID-19 pandemic is dramatically impacting the United States and has resulted in an aggressive worldwide effort to contain the spread of the virus. These efforts have significantly and adversely disrupted economic markets and impacted commercial activity worldwide, including markets in which we own and/or operate properties, and the prolonged economic impact is uncertain. Considerable uncertainty still surrounds the COVID-19 pandemic and its effects on the population, as well as the effectiveness of any responses taken on a national and local level by government authorities and businesses. In addition, the rapidly evolving nature of the COVID-19 pandemic makes it difficult to ascertain the long-term impact it will have on real estate markets and our portfolio of investments at this time. We are continuously monitoring the impact of the COVID-19 pandemic on our business, residents, tenants, operating partners, managers, portfolio of investments and on the United States and global economies. While the results of our current analyses did not result in any material adjustments to our condensed consolidated financial statements as of and during the three months ended March 31, 2020, the prolonged duration and impact of the COVID-19 pandemic could materially disrupt our business operations and impact our financial performance. See the “Factors That May Influence Our Results of Operations” and “Liquidity and Capital Resources” sections below for a further discussion.
On October 3, 2018,2019, our board of directors, or our board, at the recommendation of the audit committee of our board, comprised solely of independent directors, unanimously approved and established the most recentan updated estimated per share net asset value, or NAV, of our common stock of $9.37.$9.40. We provide an updated estimated per share NAV on at least an annual basis to assist broker-dealers in connection with their obligations under National Association of Securities Dealers Conduct Rule 2340, as required by the Financial Industry Regulatory Authority, or FINRA, Rule 2231 with respect to customer account statements. The most recentupdated estimated per share NAV is based on the estimated value of our assets less the estimated value of our liabilities, divided by the number of shares outstanding on a fully diluted basis, calculated as of June 30, 2018.2019. The valuation was performed in accordance with the methodology provided in Practice Guideline 2013-01, Valuations of Publicly Registered Non-Listed REITs, or the Practice Guideline, issued by the Institute for Portfolio Alternatives, or the IPA, in April 2013, in addition to guidance from the United States Securities and Exchange Commission, or SEC. WeAlthough we intend to continue to publish an updated estimated per share NAV on at least an annual basis.basis, we may be required to reevaluate the estimated per share NAV sooner if the COVID-19 pandemic has a material adverse impact on our residents, tenants, operating partners, managers or portfolio of investments or us. See our Current Report on Form 8-K filed with the SEC on October 4, 20182019 for more information on the methodologies and assumptions used to determine, and the limitations and risks of, our most recentupdated estimated per share NAV.
We conduct substantially all of our operations through Griffin-American Healthcare REIT III Holdings, LP, or our operating partnership. We are externally advised by Griffin-American Healthcare REIT III Advisor, LLC, or Griffin-American Advisor, or our advisor, pursuant to an advisory agreement, or the Advisory Agreement, between us and our advisor. The Advisory Agreement was effective as of February 26, 2014 and had a one-year initial term, subject to successive one-year renewals upon the mutual consent of the parties. The Advisory Agreement was last renewed pursuant to the mutual consent of the parties on February 13, 201911, 2020 and expires on February 26, 2020.2021. Our advisor uses its best efforts, subject to the oversight, review and approval of our board, to, among other things, research, identify, review and make investments in and dispositions of properties and securities on our behalf consistent with our investment policies and objectives. Our advisor performs its duties and responsibilities under the Advisory Agreement as our fiduciary. Our advisor is 75.0% owned and managed by wholly owned subsidiaries of American Healthcare Investors, and 25.0% owned by a wholly owned subsidiary of Griffin Capital. American Healthcare Investors is 47.1% owned by AHI Group Holdings, LLC, or AHI Group Holdings, 45.1% indirectly owned by Colony Capital, Inc. (NYSE: CLNY), or Colony Capital, and 7.8% owned by James F. Flaherty III, a former partner of Colony Capital. We are not affiliated with Griffin Capital, Griffin Capital Securities, LLC, the dealer manager for our initial offering, Colony Capital, or Mr. Flaherty; however, we are affiliated with Griffin-American Advisor, American Healthcare Investors and AHI Group Holdings.
We currently operate through six reportable business segments: medical office buildings, hospitals, skilled nursing facilities, senior housing, senior housing — RIDEA and integrated senior health campuses. As of March 31, 2019,2020, we owned and/or operated 98 properties, comprising 102 buildings, and 113118 integrated senior health campuses including completed development projects, or approximately 13,412,00013,841,000 square feet of gross leasable area, or GLA, for an aggregate contract

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purchase price of $2,967,409,000.$3,002,533,000. In addition, as of March 31, 2019,2020, we had invested $89,079,000 inalso owned a real estate-related investments, net of principal repayments.investment purchased for $60,429,000.
Critical Accounting Policies
The complete listing of our Critical Accounting Policies was previously disclosed in our 20182019 Annual Report on Form 10-K, as filed with the SEC on March 21, 2019,26, 2020, and there have been no material changes to our Critical Accounting Policies as disclosed therein, except as noted below or included within Note 2, Summary of Significant Accounting Policies, to our accompanying condensed consolidated financial statements.
Interim Unaudited Financial Data
Our accompanying condensed consolidated financial statements have been prepared by us in accordance with GAAP in conjunction with the rules and regulations of the SEC. Certain information and footnote disclosures required for annual financial statements have been condensed or excluded pursuant to SEC rules and regulations. Accordingly, our accompanying condensed consolidated financial statements do not include all of the information and footnotes required by GAAP for complete financial statements. Our accompanying condensed consolidated financial statements reflect all adjustments, which are, in our view, of a normal recurring nature and necessary for a fair presentation of our financial position, results of operations and cash flows for the interim period. Interim results of operations are not necessarily indicative of the results to be expected for the full year; such full year results may be less favorable. Our accompanying condensed consolidated financial statements should be read in conjunction with our audited consolidated financial statements and the notes thereto included in our 20182019 Annual Report on Form 10-K, as filed with the SEC on March 21, 2019.

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26, 2020.
Recently Issued Accounting PronouncementsPronouncement
For a discussion of recently issued accounting pronouncements,pronouncement, see Note 2, Summary of Significant Accounting Policies — Recently Issued Accounting Pronouncements,Pronouncement, to our accompanying condensed consolidated financial statements.
AcquisitionsAcquisition in 20192020
For a discussion of our property acquisitionsacquisition of a land parcel for development in 2019,2020, see Note 3, Real Estate Investments, Net, to our accompanying condensed consolidated financial statements.
Factors Which May Influence Results of Operations
We are not aware of any material trends or uncertainties, other than national economic conditions affecting real estate generally, including the ongoing COVID-19 pandemic, that may reasonably be expected to have a material impact, favorable or unfavorable, on revenues or income from the acquisition, management and operation of our properties other than those listed in Part II, Item 1A. Risk Factors, of this Quarterly Report on Form 10-Q and those Risk Factors previously disclosed in our 20182019 Annual Report on Form 10-K, as filed with the SEC on March 21, 2019.26, 2020.
RevenuesDue to the ongoing COVID-19 pandemic in the United States and globally, our residents, tenants, operating partners and managers may be materially impacted. The situation presents a meaningful challenge for us as an owner and operator of healthcare facilities, as the impact of the virus has resulted in a massive strain throughout the healthcare system. COVID-19 is particularly dangerous among the senior population and results in heightened risk to our senior housing and skilled nursing facilities, and we continue to work diligently to implement appropriate protocols at such facilities in line with the Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services guidelines to limit the exposure and spread of COVID-19. However, we have experienced a decline in our occupancies at our senior housing — RIDEA facilities and integrated senior health campuses due in large part to decreased move-ins of prospective residents because of shelter in place and other quarantine restrictions. Our operators have also experienced increased costs to procure personal protective equipment and other supplies for which there are shortages and to maintain staffing levels to care for the aged population during this crisis. Managers of our RIDEA properties are evaluating their options for financial assistance utilizing programs within the Coronavirus Aid, Relief, and Economic Security (CARES) Act passed by the federal government on March 27, 2020, as well as other state and local government programs. Some of our tenants within our non-RIDEA properties are also seeking financial assistance from the CARES Act through programs such as the Payroll Protection Program and deferral of payroll tax payments. However, there is no assurance that our managers and tenants will receive approval under such financial assistance programs and the ultimate impact of such relief from the CARES Act and other enacted and future legislation and regulation is uncertain. The COVID-19 pandemic has also negatively impacted the businesses of our medical office tenants, including physician practices and other medical service providers of non-essential and elective services, and their ability to pay rent on a timely basis.

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We are closely monitoring COVID-19 developments and continuously assessing the implications to our business, residents, tenants, operating partners, managers and portfolio of investments. While we have yet to experience a material impact to our operations as a result of the COVID-19 pandemic, we anticipate that this may change as the virus continues to spread. The amountimpact of revenues generated by our properties depends principallythe COVID-19 pandemic on our abilityfuture results could be significant and will largely depend on future developments, including the duration of the crisis and the success of efforts to maintaincontain it, which are highly uncertain and cannot be predicted at this time. While impacts of COVID-19 have had an adverse effect on our business, financial condition and results of operations, we are unable to predict the occupancy rates of currently leased space and to lease available space at the then existing rental rates. Negative trends in onefull extent or morenature of these factors could adversely affect our revenue in future periods.impacts at this time. See the “Liquidity and Capital Resources” section below and Part II, Item 1A, Risk Factors, of this Quarterly Report on Form 10-Q for a further discussion.
Scheduled Lease Expirations
Excluding our senior housing — RIDEA facilities and our integrated senior health campuses, as of March 31, 2019,2020, our properties were 93.1%90.7% leased and during the remainder of 2019, 5.5%2020, 5.8% of the leased GLA is scheduled to expire. Our leasing strategy focuses on negotiating renewals for leases scheduled to expire during the next twelve months. In the future, if we are unable to negotiate renewals, we will try to identify new tenants or collaborate with existing tenants who are seeking additional space to occupy. As of March 31, 2019,2020, our remaining weighted average lease term was 8.47.6 years, excluding our senior housing — RIDEA facilities and our integrated senior health campuses.
Our senior housing — RIDEA facilities and integrated senior health campuses were 83.6%82.5% and 83.8%83.5% leased, respectively, for the three months ended March 31, 2019.2020. Substantially all of our leases with residents at such properties are for a term of one year or less.
Results of Operations
Comparison of the Three Months Ended March 31, 20192020 and 20182019
Our primary sources of revenue include rent and resident fees and services from our properties. Our primary expenses include property operating expenses and rental expenses. In general, we expect amounts related to our portfolio of operating properties to increase in the future based on ongoing developments of properties, as well as the result of any additional real estate and real estate-related investments we may acquire or originate.
We segregate our operations into reporting segments in order to assess the performance of our business in the same way that management reviews our performance and makes operating decisions. As of March 31, 2019,2020, we operated through six reportable business segments: medical office buildings, hospitals, skilled nursing facilities, senior housing, senior housing — RIDEA and integrated senior health campuses.

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Except where otherwise noted, the changes in our consolidated results of operations for 20192020 as compared to 20182019 are primarily due to the development and expansion of our portfolio of integrated senior health campuses, as well as growthcampuses. In addition, there are changes in our pharmaceutical and rehabilitation businessesresults of operations by reporting segment due to the transitioning of the operations of seven senior housing facilities within our integrated senior health campuses segment.North Carolina ALF Portfolio to a RIDEA structure on December 1, 2019. As of March 31, 20192020 and 2018,2019, we owned and/or operated the following types of properties:
March 31,March 31,
2019 20182020 2019
Number of
Buildings/
Campuses
 
Aggregate
Contract
Purchase Price
 
Leased
%
 
Number of
Buildings/
Campuses
 
Aggregate
Contract
Purchase Price
 
Leased
%
Number of
Buildings/
Campuses
 
Aggregate
Contract
Purchase Price
 
Leased
%
 
Number of
Buildings/
Campuses
 
Aggregate
Contract
Purchase Price
 
Leased
%
Integrated senior health campuses113
 $1,512,068,000
 (1) 108
 $1,441,058,000
 (1)118
 $1,547,192,000
 (1) 113
 $1,512,068,000
 (1)
Medical office buildings64
 664,135,000
 90.0% 64
 663,835,000
 90.1%64
 664,135,000
 87.5% 64
 664,135,000
 90.0%
Senior housing — RIDEA20
 433,891,000
 (2) 13
 320,035,000
 (2)
Senior housing16
 203,391,000
 100% 14
 173,391,000
 100%9
 89,535,000
 100% 16
 203,391,000
 100%
Senior housing — RIDEA13
 320,035,000
 (2) 13
 320,035,000
 (2)
Skilled nursing facilities7
 128,000,000
 100% 7
 128,000,000
 100%7
 128,000,000
 100% 7
 128,000,000
 100%
Hospitals2
 139,780,000
 100% 2
 139,780,000
 100%2
 139,780,000
 100% 2
 139,780,000
 100%
Total/weighted average(3)215
 $2,967,409,000
 93.1% 208
 $2,866,099,000
 93.0%220
 $3,002,533,000
 90.7% 215
 $2,967,409,000
 93.1%
___________
(1)For the three months ended March 31, 2019 and 2018, theThe leased percentage for the resident units of our integrated senior health campuses was 83.5% and 83.8% for the three months ended March 31, 2020 and 82.3%,2019, respectively.

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(2)For the three months ended March 31, 2019 and 2018, theThe leased percentage for the resident units of our senior housing — RIDEA facilities was 82.5% and 83.6% for the three months ended March 31, 2020 and 85.5%,2019, respectively.
(3)Leased percentage excludes our senior housing — RIDEA facilities and integrated senior health campuses.
Revenues
The amount of revenues generated by our properties depends principally on our ability to maintain the occupancy rates of currently leased space and to lease available space at the then existing rental rates. Revenues by reportable segment consisted of the following for the periods then ended:
 Three Months Ended March 31,
 2020 2019
Resident Fees and Services   
Integrated senior health campuses$267,794,000
 $251,714,000
Senior housing — RIDEA22,132,000
 16,568,000
Total resident fees and services289,926,000
 268,282,000
Real Estate Revenue   
Medical office buildings19,598,000
 20,554,000
Skilled nursing facilities4,363,000
 3,659,000
Senior housing3,406,000
 5,652,000
Hospitals2,751,000
 2,911,000
Total real estate revenue30,118,000
 32,776,000
Total revenues$320,044,000
 $301,058,000
For the three months ended March 31, 20192020 and 2018,2019, resident fees and services primarily consisted of rental fees related to resident leases, extended health care fees and other ancillary services. For the three months ended March 31, 20192020 and 2018,2019, real estate revenue primarily consisted of base rent and expense recoveries.
Revenues by reportable segment consisted of the following for the periods then ended:
 Three Months Ended March 31,
 2019 2018
Resident Fees and Services   
Integrated senior health campuses$251,714,000
 $229,061,000
Senior housing — RIDEA16,568,000
 16,332,000
Total resident fees and services268,282,000
 245,393,000
Real Estate Revenue   
Medical office buildings20,554,000
 20,081,000
Senior housing5,652,000
 5,400,000
Skilled nursing facilities3,659,000
 3,739,000
Hospitals2,911,000
 3,279,000
Total real estate revenue32,776,000
 32,499,000
Total revenues$301,058,000
 $277,892,000

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Property Operating Expenses and Rental Expenses
For the three months ended March 31, 2019 and 2018, property operating expenses primarily consisted of administration and benefits expense of $204,701,000 and $189,436,000, respectively. Property operating expenses and property operating expenses as a percentage of resident fees and services, as well as rental expenses and rental expenses as a percentage of real estate revenue, by reportable segment consisted of the following for the periods then ended:
Three Months Ended March 31,Three Months Ended March 31,
2019 20182020 2019
Property Operating Expenses              
Integrated senior health campuses$223,328,000
 88.7% $206,295,000
 90.1%$239,598,000
 89.5% $223,328,000
 88.7%
Senior housing — RIDEA11,624,000
 70.2% 11,064,000
 67.7%16,142,000
 72.9% 11,624,000
 70.2%
Total property operating expenses$234,952,000
 87.6% $217,359,000
 88.6%$255,740,000
 88.2% $234,952,000
 87.6%
              
Rental Expenses              
Medical office buildings$7,816,000
 38.0% $7,930,000
 39.5%$7,638,000
 39.0% $7,816,000
 38.0%
Skilled nursing facilities362,000
 9.9% 421,000
 11.3%406,000
 9.3% 362,000
 9.9%
Hospitals151,000
 5.2% 402,000
 12.3%105,000
 3.8% 151,000
 5.2%
Senior housing96,000
 1.7% 187,000
 3.5%21,000
 0.6% 96,000
 1.7%
Total rental expenses$8,425,000
 25.7% $8,940,000
 27.5%$8,170,000
 27.1% $8,425,000
 25.7%
For the three months ended March 31, 2020 and 2019, property operating expenses primarily consisted of administration and benefits expense of $222,368,000 and $204,701,000, respectively. Integrated senior health campuses and senior housing — RIDEA facilities typically have a higher percentage of operating expenses to revenue than multi-tenant medical office buildings, hospitals, senior housing facilities and skilled nursing facilities.facilities due to the nature of RIDEA facilities where we conduct day-to-day operations. We anticipate that the percentage of operating expenses to revenue may fluctuate based on the types of property we own and/or operate in the future.

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General and Administrative
General and administrative consisted of the following for the periods then ended:
Three Months Ended March 31,Three Months Ended March 31,
2019 20182020 2019
Asset management fees — affiliates$4,977,000
 $4,781,000
$5,105,000
 $4,977,000
Professional and legal fees534,000
 390,000
471,000
 534,000
Bad debt expense448,000
 126,000
Transfer agent services322,000
 339,000
325,000
 322,000
Stock compensation expense195,000
 195,000
195,000
 195,000
Bank charges114,000
 59,000
Franchise taxes122,000
 175,000
86,000
 122,000
Directors’ and officers’ liability insurance79,000
 79,000
82,000
 79,000
Board of directors fees72,000
 61,000
77,000
 72,000
Bank charges59,000
 117,000
Restricted stock compensation43,000
 43,000
43,000
 43,000
Bad debt expense
 448,000
Other66,000
 82,000
76,000
 66,000
Total$6,917,000
 $6,388,000
$6,574,000
 $6,917,000
The increasedecrease in general and administrative expensesexpense for the three months ended March 31, 20192020 as compared to the three months ended March 31, 20182019 was primarily due to the decrease in bad debt expense for our accounts receivable as a result of a change in lease accounting guidance in 2019, partially offset by an increase in asset management fees and professional and legal fees as a result of an increase in our average invested assets through capital expenditures and property acquisitions in 20192020 as compared to 2018.
Acquisition Related Expenses
For the three months ended March 31, 2019 and 2018, we recorded negative acquisition related expenses of $(696,000) and $(769,000), respectively, which primarily related to fair value adjustments to contingent consideration obligations. See Note 15, Fair Value Measurements —Assets and Liabilities Reported at Fair Value — Contingent Consideration Liability, for a further discussion. For the three months ended March 31, 2019, we completed $15,736,000 in property acquisitions that we

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accounted for as asset acquisitions; however, the direct acquisition related expenses of $441,000 associated with such property acquisitions were capitalized in our condensed consolidated balance sheets. We did not complete any property acquisitions for the three months ended March 31, 2018.2019.
Depreciation and Amortization
For the three months ended March 31, 20192020 and 2018,2019, depreciation and amortization was $25,628,000$25,087,000 and $23,692,000,$25,628,000, respectively, which primarily consisted of depreciation on our operating properties of $22,204,000$22,742,000 and $20,400,000,$22,204,000, respectively, and amortization ofon our identified intangible assets of $3,133,000$1,994,000 and $3,137,000,$3,133,000, respectively.
Interest Expense
Interest expense, including gain or loss in fair value of derivative financial instruments, consisted of the following for the periods then ended:
 Three Months Ended March 31,
 2019 2018
Interest expense — lines of credit and term loans and derivative financial instruments$9,606,000
 $6,464,000
Interest expense — mortgage loans payable7,714,000
 7,097,000
Amortization of deferred financing costs — lines of credit and term loans1,030,000
 985,000
Amortization of deferred financing costs — mortgage loans payable258,000
 325,000
Amortization of debt discount/premium, net169,000
 139,000
Loss (gain) in fair value of derivative financial instruments560,000
 (110,000)
Accretion of finance lease liabilities79,000
 
Interest expense on financing obligations and other liabilities203,000
 342,000
Total$19,619,000
 $15,242,000
 Three Months Ended March 31,
 2020 2019
Interest expense:   
Lines of credit and term loans and derivative financial instruments$8,433,000
 $9,606,000
Mortgage loans payable8,338,000
 7,714,000
Amortization of deferred financing costs:   
Lines of credit and term loans760,000
 1,030,000
Mortgage loans payable295,000
 258,000
Amortization of debt discount/premium, net208,000
 169,000
Loss in fair value of derivative financial instruments8,183,000
 560,000
Accretion of finance lease liabilities169,000
 79,000
Interest expense on financing obligations and other liabilities331,000
 203,000
Total$26,717,000
 $19,619,000
The increase in total interest expense for the three months ended March 31, 2020, as compared to the three months ended March 31, 2019, was primarily related to the increase in debt balances as well as the increase in loss on fair value recognized on the derivative financial instruments, which was due to a decrease in LIBOR rates relative to our interest rate swap contracts.

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Liquidity and Capital Resources
Our sources of funds primarily consist of operating cash flows and borrowings. In the normal course of business, our principal demands for funds are for our payment of operating expenses, capital improvement expenditures, development of real estate investments, interest on our indebtedness, distributions to our stockholders and repurchases of our common stock and development of real estate investments.
Our total capacity to pay operating expenses, capital improvement expenditures, interest, distributions and repurchases, as well as develop real estate investments, is a function of our current cash position, our borrowing capacity on our lines of credit and term loans, as well as any future indebtedness that we may incur. As of March 31, 2019, our cash on hand was $34,904,000 and we had $100,951,000 available on our lines of credit and term loans. In April 2019, we obtained a $50,380,000 mortgage loan with KeyBank, National Association, secured by three of our senior housing facilities and used the proceeds from such loan to pay down our line of credit, thereby increasing the availability of our line of credit.We believe that these resources will be sufficient to satisfy our cash requirements for the foreseeable future, and we do not anticipate a need to raise funds from other sources within the next 12 months.
stock. We estimate that we will require approximately $30,604,000$43,689,000 to pay interest on our outstanding indebtedness infor the remainder of 2019,2020, based on interest rates in effect and borrowings outstanding as of March 31, 2019. In addition, we estimate2020, and that we will require $193,617,000$68,701,000 to pay principal on our outstanding indebtedness infor the remainder of 2019.2020. We also require resources to make certain payments to our advisor and its affiliates. See Note 14, Related Party Transactions, to our accompanying condensed consolidated financial statements for a further discussion of our payments to our advisor and its affiliates. Generally, cash needs for such items will be met from operations and borrowings.
Our advisor evaluates potential investmentstotal capacity to pay operating expenses, capital improvement expenditures, interest, distributions and engages in negotiations withrepurchases, as well as acquire and/or develop real estate sellers, developers, brokers, investment managers, lenders and othersinvestments, is a function of our current cash position, our borrowing capacity on our behalf. Whenlines of credit and term loans, as well as any future indebtedness that we acquiremay incur. As of March 31, 2020, our cash on hand was $44,683,000 and we had $155,621,000 available on our lines of credit and term loans.
Due to the impact the COVID-19 pandemic has had on the United States and globally, and the uncertainty of the severity and duration of the COVID-19 pandemic and its effects, our board decided to take steps to protect our capital and maximize our liquidity in an effort to strengthen our long-term financial prospects by decreasing our distributions to stockholders and partially suspending our share repurchase plan. Consequently, our board approved a property,daily distribution rate for April and May 2020 equal to $0.000821918 per share of our advisor preparescommon stock, which was or will be equal to an annualized distribution rate of $0.30 per share, a decrease from the annualized rate of $0.60 per share previously paid by us. See the “Distributions” section below for a further discussion. In addition, effective with respect to share repurchase requests submitted for repurchase during the second quarter 2020, on March 31, 2020 our board suspended our share repurchase plan with respect to all repurchase requests other than repurchases resulting from the death or qualifying disability of stockholders. Our board shall determine if and when it is in the best interest of our company and stockholders to reinstate our share repurchase plan.
Furthermore, subsequent to March 31, 2020, Trilogy Investors, LLC, of which we currently own 67.6%, received approximately $51,750,000 in Medicare advance payments and approximately $14,534,000 in Medicare grants through CARES Act programs in connection with its operation of integrated senior health campuses. We believe that such proceeds of cash will be sufficient to satisfy our cash requirements for the foreseeable future, and we do not anticipate a need to raise funds from other sources within the next 12 months.
A capital plan for each investment is established upon acquisition that contemplates the estimated capital needs of that investment. In addition to operating expenses, capital needs may also includeinvestment, including costs of refurbishment, tenant improvements or other major capital expenditures. The capital plan also sets forth the anticipated sources of the necessary capital, which may include operating cash generated by the investment, capital reserves, a line of credit or other loansloan established with respect to the investment, operating cash generated by the investment,other borrowings, or additional equity investments from us or joint venture partners or, when necessary,partners. As of March 31, 2020, we had $12,910,000 of restricted cash in loan impounds and reserve accounts to fund a portion of such capital reserves. Any capital reserve would be established from proceeds from sales of other investments, borrowings, operating cash generated by other investments or other cash on hand. In some cases, a lender may require us to establish capital reserves for a particular investment.expenditures. The capital plan for each investment will beis adjusted through ongoing, regular reviews of our portfolio or as necessary to respond to unanticipated additional capital needs.

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Based on the budget for the properties we ownedown as of March 31, 2019,2020, we estimateoriginally estimated that our discretionary expenditures for capital improvement and tenant improvement expenditures will requireimprovements could have required up to $96,782,000$130,695,000 for the remaining nine months of 2019. As2020. However, in light of March 31, 2019,the COVID-19 pandemic and to further preserve cash, we had $13,210,000 of restricted cash in loan impounds and reserve accounts for capital expenditures, some of which may be used to fund our estimatedsuspended all non-essential, discretionary expenditures for capital improvements, as well as developments, that were anticipated during 2020 throughout our real estate investment portfolio. In particular, we suspended capital expenditures that are not directly associated with the maintenance or expansion of tenant occupancy and tenant improvements. Wethe enhancement of net operating income. The duration of our suspension of capital expenditures and developments are uncertain and an update to the actual amounts forecasted to be expended for the remainder of the year cannot provide assurance, however, that we will not exceed thesebe estimated expenditure and distribution levels or be able to obtain additional sources of financing on commercially favorable terms or at all.this time.
Other Liquidity Needs
In the event that there is a shortfall in net cash available due to various factors, including, without limitation, the timing of distributions and share repurchases or the timing of the collection of receivables, we may seek to obtain capital to pay distributions and share repurchases by means of secured or unsecured debt financing through one or more third parties, or our advisor or its affiliates. There are currently no limits or restrictions on the use of proceeds from our advisor or its affiliates which would prohibit us from making the proceeds available for distribution. We may also pay distributions and share repurchases from cash from capital transactions, including, without limitation, the sale of one or more of our properties.
IfIn addition, we experience lower occupancy levels, reduced rental rates, reduced revenues as a resultare continuously monitoring the impact the COVID-19 pandemic is having on our business, residents, tenants, operating partners, managers and on the United States and global economies. Due to the COVID-19 pandemic, there is risk and uncertainty in the financial and debt markets. The impact of asset sales,the COVID-19 pandemic on the value of our investment portfolio may be significant and its impact on our operations and liquidity will largely depend on future developments, which

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are highly uncertain and cannot be predicted at this time, including new information which may emerge concerning the severity of the COVID-19 pandemic, the success of actions taken to contain or increasedtreat COVID-19 and reactions by consumers, companies, governmental entities and capital expendituresmarkets. The COVID-19 pandemic has also negatively impacted the businesses of our medical office tenants, including physician practices and leasing costs compared to historical levels due to competitive market conditions for newother medical service providers of non-essential and renewed leases, the effect would be a reduction of net cash provided by operating activities. If such a reduction of net cash provided by operating activities is realized, we may have a cash flow deficit in subsequent periods. Our estimate of net cash available is based on various assumptions which are difficult to predict, including the levels of leasing activityelective services, and related leasing costs. Any changes in these assumptions could impact our financial results and ourtheir ability to fund working capitalpay rent on a timely basis. To the extent that our residents, tenants, operating partners and unanticipated cash needs.managers continue to be impacted by the COVID-19 pandemic, or by the risks disclosed in our SEC filings, this could materially disrupt our business operations.
Cash Flows
The following table sets forth changes in cash flows:
 Three Months Ended March 31, Three Months Ended March 31,
 2019 2018 2020 2019
Cash, cash equivalents and restricted cash — beginning of period $72,705,000
 $64,143,000
 $89,880,000
 $72,705,000
Net cash provided by operating activities 25,300,000
 25,998,000
 25,883,000
 25,300,000
Net cash used in investing activities (34,045,000) (15,014,000) (39,218,000) (34,045,000)
Net cash provided by (used in) financing activities 9,875,000
 (5,372,000)
Net cash provided by financing activities 5,103,000
 9,875,000
Effect of foreign currency translation on cash, cash equivalents and restricted cash 41,000
 59,000
 (134,000) 41,000
Cash, cash equivalents and restricted cash — end of period $73,876,000
 $69,814,000
 $81,514,000
 $73,876,000
The following summary discussion of our changes in our cash flows is based on our accompanying condensed consolidated statements of cash flows and is not meant to be an all-inclusive discussion of the changes in our cash flows for the periods presented below.
Operating Activities
For the three months ended March 31, 20192020 and 2018,2019, cash flows provided by operating activities primarily related to the cash flows provided by our property operations, offset by the payment of general and administrative expenses. See the “Results of Operations” section above for a further discussion. In general, cash flows provided by operating activities will be affected by the timing of cash receipts and payments.
Investing Activities
For the three months ended March 31, 2020, cash flows used in investing activities primarily related to our capital expenditures of $37,217,000 and our acquisition of a land parcel in the amount of $1,478,000. For the three months ended March 31, 2019, cash flows used in investing activities primarily related to our capital expenditures of $16,722,000 and 2019 property acquisitions in the amount of $16,036,000 and capital expenditures of $16,722,000. For the three months ended March 31, 2018, cash flows used in investing activities primarily related to capital expenditures of $12,662,000 and real estate and other deposits $2,352,000.$16,036,000. In general, cash flows used in investing activities will be affected by a decrease inthe the timing of capital expenditures and development projectsand the number of acquisitions we complete in future years as compared to prior years and the timing of capital expenditures.years.
Financing Activities
For the three months ended March 31, 2020, cash flows provided by financing activities primarily related to net borrowings under our lines of credit and term loans in the amount of $18,500,000 and borrowings under mortgage loans payable of $8,239,000, partially offset by distributions to our common stockholders of $16,032,000 and scheduled payments on our mortgage loans payable of $3,137,000. For the three months ended March 31, 2019, cash flows provided by financing activities primarily related to net borrowings under our lines of credit and term loans in the amount of $66,001,000, partially offset by share repurchases of $36,486,000 and distributions to our common stockholders of $15,227,000. For the three months ended March 31, 2018, cash flows used in financing activities primarily related to net borrowings under our lines of credit and term loans in the amount of

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$26,431,000, partially offset by share repurchases of $16,506,000 and distributions to our common stockholders of $14,377,000. Overall, we anticipate cash flows from financing activities to decrease in the future. However, we anticipate borrowings under our lines of credit and term loans and other indebtedness to increase if we acquire additional real estate and real estate-related investments.
Distributions
Our board has authorized, on a quarterly basis, a daily distribution to our stockholders of record as of the close of business on each day of the quarterly periods commencing on May 14, 2014 and ending on June 30, 2019.March 31, 2020. The distributions were or will be calculated based on 365 days in the calendar year and arewere equal to $0.001643836 per share of our common stock, which iswas equal to an annualized distribution of $0.60 per share. The daily distributions were or will be aggregated and paid monthly in arrears in cash or shares of our common stock pursuant to our DRIP Offerings, only from legally available funds.

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Due to the impact the COVID-19 pandemic has had on the United States and globally, and the uncertainty of the severity and duration of the COVID-19 pandemic and its effects, our board decided to take steps to protect our capital and maximize our liquidity in an effort to strengthen our long-term financial prospects by decreasing our distributions to stockholders. Consequently, our board authorized a daily distribution to our stockholders of record as of the close of business day on each day of the period commencing on April 1, 2020 and ending on May 31, 2020. The daily distributions were or will be calculated based on 365 days in the calendar year and are equal to $0.000821918 per share of our common stock, which is equal to an annualized distribution of $0.30 per share. These daily distributions were or will be aggregated and paid in cash or shares of our common stock pursuant to our DRIP Offerings monthly in arrears, only from legally available funds.
The amount of the distributions paid to our stockholders is determined quarterly by our board and is dependent on a number of factors, including funds available for payment of distributions, our financial condition, capital expenditure requirements and annual distribution requirements needed to maintain our qualification as a REIT under the Code. We have not established any limit on the amount of offering proceeds that may be used to fund distributions, except that, in accordance with our organizational documents and Maryland law, we may not make distributions that would: (i) cause us to be unable to pay our debts as they become due in the usual course of business or (ii) cause our total assets to be less than the sum of our total liabilities plus senior liquidation preferences.
The distributions paid for the three months ended March 31, 20192020 and 2018,2019, along with the amount of distributions reinvested pursuant to the 2015our DRIP Offering,Offerings, and the sources of our distributions as compared to cash flows from operations were as follows:
Three Months Ended March 31,Three Months Ended March 31,
2019 20182020 2019
Distributions paid in cash$15,227,000
   $14,377,000
  $16,032,000
   $15,227,000
  
Distributions reinvested14,196,000
   15,229,000
  13,141,000
   14,196,000
  
$29,423,000
   $29,606,000
  $29,173,000
   $29,423,000
  
Sources of distributions:              
Cash flows from operations$25,300,000
 86.0% $25,998,000
 87.8%$25,883,000
 88.7% $25,300,000
 86.0%
Proceeds from borrowings4,123,000
 14.0
 3,608,000
 12.2
3,290,000
 11.3
 4,123,000
 14.0
$29,423,000
 100% $29,606,000
 100%$29,173,000
 100% $29,423,000
 100%
AnyAs of March 31, 2020, any distributions of amounts in excess of our current and accumulated earnings and profits have resulted in a return of capital to our stockholders, and all or any portion of a distribution to our stockholders may have been paid from net offering proceeds and borrowings. The payment of distributions from our initialnet offering proceeds and borrowings could have reduced the amount of capital we ultimately invested in assets and negatively impacted the amount of income available for future distributions.
As of March 31, 2019,2020, we had an amount payable of $1,957,000$2,057,000 to our advisor or its affiliates primarily for asset and property management fees, which will be paid from cash flows from operations in the future as it becomes due and payable by us in the ordinary course of business consistent with our past practice.
As of March 31, 2019, no amounts due See Note 14, Related Party Transactions — Operational Stage, to our advisor or its affiliates had been deferred, waived or forgiven other than $37,000 in asset management fees waived by our advisor in 2014, which was equal to the amount of distributions payable to our stockholdersaccompanying condensed consolidated financial statements, for the period from May 14, 2014, the date we received and accepted subscriptions aggregating at least the minimum offering of $2,000,000 required pursuant to our initial offering, through June 5, 2014, the date we acquired our first property. In addition, our advisor agreed to waive the disposition fees that may otherwise have been due to our advisor pursuant to the Advisory Agreement for the dispositions of investments within our integrated senior health campuses segment in 2017. Our advisor did not receive any additional securities, shares of our stock, or any other form of consideration or any repayment as a result of the waiver of such asset management fees and disposition fees. Other than the waiver of such asset management fees in 2014 and disposition fees in 2017 by our advisor discussed above, our advisor and its affiliates, including our co-sponsors, have no obligation to defer or forgive fees owed by us to our advisor or its affiliates or to advance any funds to us. In the future, if our advisor or its affiliates do not defer, waive or forgive amounts due to them, this would negatively affect our cash flows from operations, which could result in us paying distributions, or a portion thereof, using borrowed funds. As a

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result, the amount of proceeds from borrowings available for investment and operations would be reduced, or we may incur additional interest expense as a result of borrowed funds.further discussion.
The distributions paid for the three months ended March 31, 20192020 and 2018,2019, along with the amount of distributions reinvested pursuant to the 2015our DRIP Offering,Offerings, and the sources of our distributions as compared to funds from operations attributable to controlling interest, or FFO, were as follows:
Three Months Ended March 31,Three Months Ended March 31,
2019 20182020 2019
Distributions paid in cash$15,227,000
   $14,377,000
  $16,032,000
   $15,227,000
  
Distributions reinvested14,196,000
   15,229,000
  13,141,000
   14,196,000
  
$29,423,000
   $29,606,000
  $29,173,000
   $29,423,000
  
Sources of distributions:              
FFO attributable to controlling interest$27,232,000
 92.6% $28,318,000
 95.6%$16,229,000
 55.6% $27,232,000
 92.6%
Proceeds from borrowings2,191,000
 7.4
 1,288,000
 4.4
12,944,000
 44.4
 2,191,000
 7.4
$29,423,000
 100% $29,606,000
 100%$29,173,000
 100% $29,423,000
 100%

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The payment of distributions from sources other than FFO may reduce the amount of proceeds available for investment and operations or cause us to incur additional interest expense as a result of borrowed funds. For a further discussion of FFO, a non-GAAP financial measure, including a reconciliation of our GAAP net income (loss) to FFO, see the “Funds from Operations and Modified Funds from Operations” section below.
Financing
We intend to continue to finance all or a portion of the purchase price of our investments in real estate and real estate-related investments by borrowing funds. We anticipate that our overall leverage will not exceed 45.0% of the combined fair market value of all of our properties and other real estate-related investments, as determined at the end of each calendar year. For these purposes, the market value of each asset will be equal to the contract purchase price paid for the asset or, if the asset was appraised subsequent to the date of purchase, then the market value will be equal to the value reported in the most recent independent appraisal of the asset. Our policies do not limit the amount we may borrow with respect to any individual investment. As of March 31, 2019,2020, our aggregate borrowings were 43.8%45.2% of the combined market value of all of our real estate and real estate-related investments.
Under our charter, we have a limitation on borrowing that precludes us from borrowing in excess of 300% of our net assets without the approval of a majority of our independent directors. Net assets for purposes of this calculation are defined to be our total assets (other than intangibles), valued at cost prior to deducting depreciation, amortization, bad debt and other similar non-cash reserves, less total liabilities. Generally, the preceding calculation is expected to approximate 75.0% of the aggregate cost of our real estate and real estate-related investments before depreciation, amortization, bad debt and other similar non-cash reserves. In addition, we may incur mortgage debt and pledge some or all of our real properties as security for that debt to obtain funds to acquire additional real estate or for working capital. We may also borrow funds to satisfy the REIT tax qualification requirement that we distribute at least 90.0% of our annual taxable income, excluding net capital gains, to our stockholders. Furthermore, we may borrow if we otherwise deem it necessary or advisable to ensure that we maintain our qualification as a REIT for federal income tax purposes. As of May 15, 20192020 and March 31, 2019,2020, our leverage did not exceed 300% of the value of our net assets.
Mortgage Loans Payable, Net
For a discussion of our mortgage loans payable, net, see Note 7, Mortgage Loans Payable, Net, to our accompanying condensed consolidated financial statements.
Lines of Credit and Term Loans
For a discussion of our lines of credit and term loans, see Note 8, Lines of Credit and Term Loans, to our accompanying condensed consolidated financial statements.

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REIT Requirements
In order to maintain our qualification as a REIT for federal income tax purposes, we are required to make distributions to our stockholders of at least 90.0% of our annual taxable income, excluding net capital gains. In the event that there is a shortfall in net cash available due to factors including, without limitation, the timing of such distributions or the timing of the collection of receivables, we may seek to obtain capital to pay distributions by means of secured and unsecured debt financing through one or more unaffiliated third parties. We may also pay distributions from cash from capital transactions including, without limitation, the sale of one or more of our properties or from the proceeds of our initial offering.
Commitments and Contingencies
For a discussion of our commitments and contingencies, see Note 11, Commitments and Contingencies, to our accompanying condensed consolidated financial statements.
Debt Service Requirements
A significant liquidity need is the payment of principal and interest on our outstanding indebtedness. As of March 31, 2019,2020, we had $716,243,000$821,319,000 ($691,896,000, including797,774,000, net of discount/premium and deferred financing costs, net)costs) of fixed-rate and variable-rate mortgage loans payable outstanding secured by our properties. As of March 31, 2019,2020, we had $804,049,000$834,379,000 outstanding and $100,951,000$155,621,000 remained available under our lines of credit and term loans. See Note 7, Mortgage Loans Payable, Net and Note 8, Lines of Credit and Term Loans, to our accompanying condensed consolidated financial statements.
We are required by the terms of certain loan documents to meet certainvarious financial and non-financial covenants, such as leverage ratios, net worth ratios, debt service coverage ratios and fixed charge coverage ratios and reporting requirements.ratios. As of May 15, 2019,March 31, 2020, we were in compliance with all such covenants and requirements on our mortgage loans payable and our lines of credit and term loans.

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The extent and severity of the COVID-19 pandemic on our business continues to evolve, and any continued future deterioration of operations in excess of management's projections as a result of COVID-19 could impact future compliance with these covenants. If any future covenants are violated, we anticipate seeking a waiver or amending the debt covenants with the lenders when and if such event should occur. However, there can be no assurances that management will be able to effectively achieve such plans. As of March 31, 2019,2020, the weighted average effective interest rate on our outstanding debt, factoring in our fixed-rate interest rate swaps and interest rate cap, was 4.45%3.80% per annum.
Contractual Obligations
The following table provides information with respect to: (i) the maturity and scheduled principal repayment of our secured mortgage loans payable and our lines of credit and term loans; (ii) interest payments on our mortgage loans payable, lines of credit and term loans and interest rate cap;loans; (iii) ground and other lease obligations; (iv) financing and other obligations; and (v) finance leases as of March 31, 2019:2020:
Payments Due by PeriodPayments Due by Period
2019 2020-2021 2022-2023 Thereafter Total2020 2021-2022 2023-2024 Thereafter Total
Principal payments — fixed-rate debt$8,691,000
  $34,962,000
 $89,184,000
 $489,544,000
 $622,381,000
$21,101,000
  $75,177,000
 $95,114,000
 $520,272,000
 $711,664,000
Interest payments — fixed-rate debt17,374,000
  43,802,000
 38,750,000
 280,933,000
 380,859,000
19,641,000
  49,642,000
 42,174,000
 259,940,000
 371,397,000
Principal payments — variable-rate debt184,926,000
 98,485,000
 614,500,000
 
 897,911,000
47,600,000
 605,329,000
 291,105,000
 
 944,034,000
Interest payments — variable-rate debt (based on rates in effect as of March 31, 2019)13,230,000
 5,205,000
 
 
 18,435,000
Interest payments — variable-rate debt (based on rates in effect as of March 31, 2020)24,048,000
 42,619,000
 7,614,000
 
 74,281,000
Ground and other lease obligations17,321,000
  46,666,000
 47,207,000
 189,416,000
 300,610,000
18,804,000
  51,090,000
 51,397,000
 187,962,000
 309,253,000
Financing and other obligations4,772,000
 19,097,000
 1,583,000
 
 25,452,000
Financing obligations11,324,000
 17,238,000
 1,882,000
 
 30,444,000
Finance leases2,265,000
 1,396,000
 
 
 3,661,000
733,000
 129,000
 
 
 862,000
Total$248,579,000
  $249,613,000
 $791,224,000
 $959,893,000
 $2,249,309,000
$143,251,000
  $841,224,000
 $489,286,000
 $968,174,000
 $2,441,935,000
Off-Balance Sheet Arrangements
As of March 31, 2019,2020, we had no off-balance sheet transactions, nor do we currently have any such arrangements or obligations.

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Inflation
During the three months ended March 31, 20192020 and 2018,2019, inflation has not significantly affected our operations because of the moderate inflation rate; however, we expect to be exposed to inflation risk as income from future long-term leases will be the primary source of our cash flows from operations. There are provisions in the majority of our tenant leases that will protect us from the impact of inflation. These provisions include negotiated rental increases, reimbursement billings for operating expense pass-through charges, and real estate tax and insurance reimbursements on a per square foot allowance.reimbursements. However, due to the long-term nature of the anticipated leases, among other factors, the leases may not re-set frequently enough to cover inflation.
Related Party Transactions
For a discussion of related party transactions, see Note 14, Related Party Transactions, to our accompanying condensed consolidated financial statements.
Funds from Operations and Modified Funds from Operations
Due to certain unique operating characteristics of real estate companies, the National Association of Real Estate Investment Trusts, or NAREIT, an industry trade group, has promulgated a measure known as funds from operations, a non-GAAP measure, which we believe to be an appropriate supplemental performance measure to reflect the operating performance of a REIT. The use of funds from operations is recommended by the REIT industry as a supplemental performance measure, and our management uses FFO to evaluate our performance over time. FFO is not equivalent to our net income (loss) as determined under GAAP.
We define FFO, a non-GAAP measure, consistent with the standards established by the White Paper on funds from operations approved by the Board of Governors of NAREIT, or the White Paper. The White Paper defines funds from operations as net income (loss) computed in accordance with GAAP, excluding gains or losses from sales of certain real estate assets and impairment writedowns of certain real estate assets and investments, plus depreciation and amortization related to real estate, and after adjustments for unconsolidated partnerships and joint ventures. While impairment charges are excluded

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from the calculation of FFO as described above, investors are cautioned that impairments are based on estimated future undiscounted cash flows. Adjustments for unconsolidated partnerships and joint ventures are calculated to reflect funds from operations. Our FFO calculation complies with NAREIT’s policy described above.
The historical accounting convention used for real estate assets requires straight-line depreciation of buildings and improvements, which implies that the value of real estate assets diminishes predictably over time, which is the case if such assets are not adequately maintained or repaired and renovated as required by relevant circumstances and/or as requested or required by lessees for operational purposes in order to maintain the value disclosed. We believe that, since real estate values historically rise and fall with market conditions, including inflation, interest rates, the business cycle, unemployment and consumer spending, presentations of operating results for a REIT using historical accounting for depreciation may be less informative. In addition, we believe it is appropriate to exclude impairment charges, as this is a fair value adjustment that is largely based on market fluctuations and assessments regarding general market conditions, which can change over time. Testing for an impairment of an asset is a continuous process and is analyzed on a quarterly basis. If certain impairment indications exist in an asset, and if the asset’s carrying, or book value, exceeds the total estimated undiscounted future cash flows (including net rental and lease revenues, net proceeds on the sale of the property, and any other ancillary cash flows at a property or group level under GAAP) from such asset, an impairment charge would be recognized. Investors should note, however, that determinations of whether impairment charges have been incurred are based partly on anticipated operating performance, because estimated undiscounted future cash flows from a property, including estimated future net rental and lease revenues, net proceeds on the sale of the property, and certain other ancillary cash flows, are taken into account in determining whether an impairment charge has been incurred. While impairment charges are excluded from the calculation of FFO as described above, investors are cautioned that due to the fact that impairments are based on estimated future undiscounted cash flows and that we intend to have a relatively limited term of our operations, it could be difficult to recover any impairment charges through the eventual sale of the property.
Historical accounting for real estate involves the use of GAAP. Any other method of accounting for real estate such as the fair value method cannot be construed to be any more accurate or relevant than the comparable methodologies of real estate valuation found in GAAP. Nevertheless, we believe that the use of FFO, which excludes the impact of real estate-related depreciation and amortization and impairments, provides a further understanding of our performance to investors and to our management, and when compared year over year, reflects the impact on our operations from trends in occupancy rates, rental rates, operating costs, general and administrative expenses and interest costs, which may not be immediately apparent from net income (loss).

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However, FFO and modified funds from operations attributable to controlling interest, or MFFO, as described below, should not be construed to be more relevant or accurate than the current GAAP methodology in calculating net income (loss) or in its applicability in evaluating our operating performance. The method utilized to evaluate the value and performance of real estate under GAAP should be construed as a more relevant measure of operational performance and considered more prominently than the non-GAAP FFO and MFFO measures and the adjustments to GAAP in calculating FFO and MFFO.
Changes in the accounting and reporting rules under GAAP that were put into effect and other changes to GAAP accounting for real estate subsequent to the establishment of NAREIT’s definition of FFO have prompted an increase in cash-settled expenses, specifically acquisition fees and expenses, as items that are expensed as operating expenses under GAAP. We believe these fees and expenses do not affect our overall long-term operating performance. Publicly registered, non-listed REITs typically have a significant amount of acquisition activity and are substantially more dynamic during their initial years of investment and operation. While other start up entities may also experience significant acquisition activity during their initial years, we believe that publicly registered, non-listed REITs are unique in that they have a limited life with targeted exit strategies within a relatively limited time frame after the acquisition activity ceases. We have used the proceeds raised in our initial offering to acquire properties, and we intend to begin the process of achieving a liquidity event (i.e., listing of our shares of common stock on a national securities exchange, a merger or sale, the sale of all or substantially all of our assets, or another similar transaction) within five years after the completion of our offering stage, which is generally comparable to other publicly registered, non-listed REITs. Thus, we do not intend to continuously purchase assets and intend to have a limited life. Due to the above factors and other unique features of publicly registered, non-listed REITs, theThe IPA, an industry trade group, has standardized a measure known as modified funds from operations, which the IPA has recommended as a supplemental performance measure for publicly registered, non-listed REITs and which we believe to be another appropriate supplemental performance measure to reflect the operating performance of a publicly registered, non-listed REIT having the characteristics described above. MFFO is not equivalent to our net income (loss) as determined under GAAP, and MFFO may not be a useful measure of the impact of long-term operating performance on value if we do not continue to operate with a limited life and targeted exit strategy, as currently intended. We believe that, because MFFO excludes expensed acquisition fees and expenses that affect our operations only in periods in which properties are acquired and that we consider more reflective of investing activities, as well as other non-operating items included in FFO, MFFO can provide, on a going forward basis, an indication of the sustainability (that is, the capacity to continue to be maintained) of our operating performance after the period in which we are acquiring our properties and once our portfolio is in place. By providing MFFO, we believe we are presenting useful information that assists investors and analysts to better assess the sustainability of our operating performance after our offering stage has been completed and our properties have been acquired. We also believe that MFFO is a recognized measure of sustainable operating performance by the publicly registered, non-listed REIT industry. Further, we believe MFFO is useful in comparing the sustainability of our operating performance after our offering stage and acquisitions are completed with the sustainability of the operating performance of other real estate companies that are not as involved in acquisition activities. Investors are cautioned that MFFO should only be used to assess the sustainability of our operating performance after our offering stage has been completed and properties have been acquired, as it excludes expensed acquisition fees and expenses that have a negative effect on our operating performance during the periods in which properties are acquired.
We define MFFO, a non-GAAP measure, consistent with the IPA’s Guideline 2010-01, Supplemental Performance Measure for Publicly Registered, Non-Listed REITs: Modified Funds from Operations, or the Practice Guideline issued by the IPA in November 2010. The Practice Guideline defines modified funds from operations as funds from operations further adjusted for the following items included in the determination of GAAP net income (loss): acquisition fees and expenses; amounts relating to deferred rent and amortization of above- and below-market leases and liabilities (which are adjusted in order to reflect such payments from a GAAP accrual basis to closer to an expected to be received cash basis of disclosing the rent and lease payments); accretion of discounts and amortization of premiums on debt investments; mark-to-market adjustments included in net income (loss); gains or losses included in net income (loss) from the extinguishment or sale of debt, hedges, foreign exchange, derivatives or securities holdings where trading of such holdings is not a fundamental attribute of the business plan; unrealized gains or losses resulting from consolidation from, or deconsolidation to, equity accounting; and after adjustments for consolidated and unconsolidated partnerships and joint ventures, with such adjustments calculated to reflect modified funds from operations on the same basis. The accretion of discounts and amortization of premiums on debt investments, unrealized gains and losses on hedges, foreign exchange, derivatives or securities holdings, unrealized gains and losses resulting from consolidations, as well as other listed cash flow adjustments are adjustments made to net income (loss) in calculating cash flows from operations and, in some cases, reflect gains or losses which are unrealized and may not ultimately be realized. We are responsible for managing interest rate, hedge and foreign exchange risk, and we do not rely on another party to manage such risk. In as much as interest rate hedges will not be a fundamental part of our operations, we believe it is appropriate to exclude such gains and losses in calculating MFFO, as such gains and losses are based on market fluctuations and may not be directly related or attributable to our operations.

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Our MFFO calculation complies with the IPA’s Practice Guideline described above. In calculating MFFO, we exclude acquisition related expenses (which include gains or losses on contingent consideration), amortization of above- and below-market leases, amortization of loan and closing costs, change in deferred rent, fair value adjustments of derivative financial instruments, gains or losses on foreign currency transactions and the adjustments of such items related to unconsolidated entities and noncontrolling interests. The other adjustments included in the IPA’s Practice Guideline are not applicable to us for the three months ended March 31, 2019 and 2018. Certain acquisition related expenses under GAAP, such as expenses incurred in connection with property acquisitions accounted for as business combinations, are considered operating expenses and as expenses includedperiods presented in the determination of net income (loss), which is a performance measure under GAAP. All paid and accrued acquisition fees and expenses will have negative effects on returns to investors, the potential for future distributions and cash flows generated by us, unless earnings from operations or net sales proceeds from the disposition of other properties are generated to cover the purchase price of the property, these fees and expenses and other costs related to such property. By excluding expensed acquisition fees and expenses, the use of MFFO provides information consistent with management’s analysis of the operating performance of the properties.table below.
Further, under GAAP, certain contemplated non-cash fair value and other non-cash adjustments are considered operating non-cash adjustments to net income (loss) in determining cash flows from operations. We view fair value adjustments of derivatives and gains and losses from dispositions of assets as items which are unrealized and may not ultimately be realized or as items which are not reflective of on-going operations and are therefore typically adjusted for when assessing operating performance. By excluding such charges that may reflect anticipated and unrealized gains or losses, we believe MFFO provides useful supplemental information.
Our management uses MFFO and the adjustments used to calculate it in order to evaluate our performance against other publicly registered, non-listed REITs which intend to have limited lives with short and defined acquisition periods and targeted exit strategies shortly thereafter. As noted above, MFFO may not be a useful measure of the impact of long-term operating performance if we do not continue to operate in this manner. We believe that our use of MFFO and the adjustments used to calculate it allow us to present our performance in a manner that reflects certain characteristics that are unique to publicly registered, non-listed REITs, such as their limited life, limited and defined acquisition period and targeted exit strategy, and hence, that the use of such measures may be useful to investors.
Presentation of this information is intended to provide useful information to investors as they compare the operating performance of different REITs, although it should be noted that not all REITs calculate funds from operations and modified funds from operations the same way, so comparisons with other REITs may not be meaningful. Furthermore, FFO and MFFO are not necessarily indicative of cash flow available to fund cash needs and should not be considered as an alternative to net income (loss) as an indication of our performance, as an alternative to cash flows from operations, which is an indication of our liquidity, or indicative of funds available to fund our cash needs including our ability to make distributions to our stockholders. FFO and MFFO should be reviewed in conjunction with other measurements as an indication of our performance. MFFO may be useful in assisting management and investors in assessing the sustainability of operating performance in future operating periods, and in particular, after the offering and acquisition stages are complete. FFO and MFFO are not useful measures in evaluating net asset value because impairments are taken into account in determining net asset value but not in determining FFO and MFFO.
Neither the SEC, NAREIT nor any other regulatory body has passed judgment on the acceptability of the adjustments that we use to calculate FFO or MFFO. In the future, the SEC, NAREIT or another regulatory body may decide to standardize the allowable adjustments across the publicly registered, non-listed REIT industry and we would have to adjust our calculation and characterization of FFO or MFFO.

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The following is a reconciliation of net income or loss, which is the most directly comparable GAAP financial measure, to FFO and MFFO for the three months ended March 31, 2019 and 2018:periods presented below:
Three Months Ended March 31,Three Months Ended March 31,
2019 20182020 2019
Net income$6,858,000
 $8,425,000
Net (loss) income$(7,783,000) $6,858,000
Add:      
Depreciation and amortization related to real estate — consolidated properties25,628,000
 23,692,000
25,087,000
 25,628,000
Depreciation and amortization related to real estate — unconsolidated entities225,000
 288,000
744,000
 225,000
Impairment of real estate investments5,102,000
 
Less:      
Net income attributable to redeemable noncontrolling interests and noncontrolling interests(1,348,000) (272,000)
Depreciation and amortization related to redeemable noncontrolling interests and noncontrolling interests(4,131,000) (3,815,000)
Net income attributable to noncontrolling interests(2,127,000) (1,348,000)
Depreciation, amortization and impairment related to noncontrolling interests(4,794,000) (4,131,000)
FFO attributable to controlling interest$27,232,000
 $28,318,000
$16,229,000
 $27,232,000
      
Acquisition related expenses(1)$(696,000) $(769,000)$234,000
 $(696,000)
Amortization of above- and below-market leases(2)107,000
 199,000
19,000
 107,000
Amortization of loan and closing costs(3)68,000
 59,000
Amortization of closing costs(3)40,000
 68,000
Change in deferred rent(4)(704,000) (1,068,000)(28,000) (704,000)
Loss (gain) in fair value of derivative financial instruments(5)560,000
 (110,000)
Foreign currency gain(6)(1,042,000) (1,796,000)
Loss in fair value of derivative financial instruments(5)8,183,000
 560,000
Foreign currency loss (gain)(6)3,065,000
 (1,042,000)
Adjustments for unconsolidated entities(7)377,000
 439,000
316,000
 377,000
Adjustments for redeemable noncontrolling interests and noncontrolling interests(7)(482,000) (401,000)
Adjustments for noncontrolling interests(7)(510,000) (482,000)
MFFO attributable to controlling interest$25,420,000
 $24,871,000
$27,548,000
 $25,420,000
Weighted average common shares outstanding — basic and diluted198,400,657
 200,347,084
194,844,516
 198,400,657
Net income per common share — basic and diluted$0.03
 $0.04
Net (loss) income per common share — basic and diluted$(0.04) $0.03
FFO attributable to controlling interest per common share — basic and diluted$0.14
 $0.14
$0.08
 $0.14
MFFO attributable to controlling interest per common share — basic and diluted$0.13
 $0.12
$0.14
 $0.13
___________
(1)In evaluating investments in real estate, we differentiate the costs to acquire the investment from the operations derived from the investment. Such information would be comparable only for publicly registered, non-listed REITs that have completed their acquisition activity and have other similar operating characteristics. By excluding expensed acquisition related expenses, we believe MFFO provides useful supplemental information that is comparable for each type of real estate investment and is consistent with management’s analysis of the investing and operating performance of our properties. Acquisition fees and expenses include payments to our advisor or its affiliates and third parties.
(2)Under GAAP, above- and below-market leases are assumed to diminish predictably in value over time and amortized, similar to depreciation and amortization of other real estate-related assets that are excluded from FFO. However, because real estate values and market lease rates historically rise or fall with market conditions, including inflation, interest rates, the business cycle, unemployment and consumer spending, we believe that by excluding charges relating to the amortization of above- and below-market leases, MFFO may provide useful supplemental information on the performance of the real estate.
(3)Under GAAP, direct loan and closing costs are amortized over the term of our notes receivable and debt security investment as an adjustment to the yield on our notes receivable or debt security investment. This may result in income recognition that is different than the contractual cash flows under our notes receivable and debt security investment. By adjusting for the amortization of the loan and closing costs related to our real estate notes receivable and debt security investment, MFFO may provide useful supplemental information on the realized economic impact of our notes receivable and debt security investment terms, providing insight on the expected contractual cash flows of such notes receivable and debt security investment, and aligns results with our analysis of operating performance.
(4)Under GAAP, as a lessor, rental revenue is recognized on a straight-line basis over the terms of the related lease (including rent holidays). As a lessee, we record amortization of right-of-use assets and accretion of lease liabilities for our operating leases. This may result in income or expense recognition that is significantly different than the underlying

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contract terms. By adjusting for the change in deferred rent,such amounts, MFFO may provide useful supplemental information on the realized economic impact of lease terms, providing insight on the expected contractual cash flows of such lease terms, and aligns results with our analysis of operating performance.
(5)Under GAAP, we are required to recordinclude changes in fair value of our derivative financial instruments at fair value at each reporting period.in the determination of net income or loss. We believe that adjusting for the change in fair value of our derivative financial instruments to arrive at MFFO is appropriate because such adjustments may not be reflective of on-going operations and reflect unrealized impacts on value based only on then current market conditions, although they may be based upon general market conditions. The need to reflect the change in fair value of our derivative financial instruments is a continuous process and is analyzed on a quarterly basis in accordance with GAAP.
(6)We believe that adjusting for the change in foreign currency exchange rates provides useful information because such adjustments may not be reflective of on-going operations.
(7)
Includes all adjustments to eliminate the unconsolidated entities’ share or redeemable noncontrolling interests and noncontrolling interests’ share, as applicable, of the adjustments described in notes (1) (6) above to convert our FFO to MFFO.
Net Operating Income
Net operating income, or NOI, is a non-GAAP financial measure that is defined as net income (loss), computed in accordance with GAAP, generated from properties before general and administrative expenses, acquisition related expenses, depreciation and amortization, interest expense, gain or loss on dispositions, impairment of real estate investments, loss from unconsolidated entities, foreign currency gain or loss, other income and income tax benefit (expense). Certain acquisition related expenses under GAAP, such as expenses incurred in connection with property acquisitions accounted for as business combinations, are considered operating expenses and as expenses included in the determination of net income (loss), which is a performance measure under GAAP. All paid and accrued acquisition fees and expenses have negative effects on returns to investors, the potential for future distributions and cash flows generated by us, unless earnings from operations or net sales proceeds from the disposition of other properties are generated to cover the purchase price of the property, these fees and expenses and other costs related to such property.
NOI is not equivalent to our net income (loss) as determined under GAAP and may not be a useful measure in measuring operational income or cash flows. Furthermore, NOI is not necessarily indicative of cash flow available to fund cash needs and should not be considered as an alternative to net income (loss) as an indication of our performance, as an alternative to cash flows from operations, as an indication of our liquidity, or indicative of funds available to fund our cash needs including our ability to make distributions to our stockholders. NOI should not be construed to be more relevant or accurate than the current GAAP methodology in calculating net income (loss) or in its applicability in evaluating our operating performance. Investors are also cautioned that NOI should only be used to assess our operational performance in periods in which we have not incurred or accrued any acquisition related expenses.
We believe that NOI is an appropriate supplemental performance measure to reflect the operating performance of our operating assets because NOI excludes certain items that are not associated with the managementoperations of the properties. We believe that NOI is a widely accepted measure of comparative operating performance in the real estate community. However, our use of the term NOI may not be comparable to that of other real estate companies as they may have different methodologies for computing this amount.

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To facilitate understanding of this financial measure, the following is a reconciliation of net income or loss, which is the most directly comparable GAAP financial measure, to NOI for the three months ended March 31, 2019 and 2018:periods presented below:
Three Months Ended March 31,Three Months Ended March 31,
2019 20182020 2019
Net income$6,858,000
 $8,425,000
Net (loss) income$(7,783,000) $6,858,000
General and administrative6,917,000
 6,388,000
6,574,000
 6,917,000
Acquisition related expenses(696,000) (769,000)234,000
 (696,000)
Depreciation and amortization25,628,000
 23,692,000
25,087,000
 25,628,000
Interest expense19,619,000
 15,242,000
26,717,000
 19,619,000
Impairment of real estate investments5,102,000
 
Loss from unconsolidated entities454,000
 1,077,000
904,000
 454,000
Foreign currency gain(1,042,000) (1,796,000)
Foreign currency loss (gain)3,065,000
 (1,042,000)
Other income(208,000) (295,000)(555,000) (208,000)
Income tax expense (benefit)151,000
 (371,000)
Income tax (benefit) expense(3,211,000) 151,000
Net operating income$57,681,000
 $51,593,000
$56,134,000
 $57,681,000

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Item 3. Quantitative and Qualitative Disclosures About Market Risk.
Market risk includes risks that arise from changes in interest rates, foreign currency exchange rates, commodity prices, equity prices and other market changes that affect market sensitive instruments. In pursuing our business plan, we expect that the primary market risk to which we will be exposed is interest rate risk. There were no material changes in our market risk exposures, or in the methods we use to manage market risk, from those that were provided for in our 20182019 Annual Report on Form 10-K, as filed with the SEC on March 21, 2019. In pursuing our business plan, we expect that the primary market risk to which we will be exposed is interest rate risk.26, 2020.
Interest Rate Risk
We are exposed to the effects of interest rate changes primarily as a result of long-term debt used to acquire properties and make loans and other permitted investments. We are also exposed to the effects of changes in interest rates as a result of our investments in real estate notes receivable. Our interest rate risk is monitored using a variety of techniques. Our interest rate risk management objectives are to limit the impact of interest rate changes on earnings, prepayment penalties and cash flows and to lower overall borrowing costs while taking into account variable interest rate risk. To achieve our objectives, we may borrow or lend at fixed or variable rates.
We have entered into, and in the future may continue to enter into, derivative financial instruments such as interest rate swaps and interest rate caps in order to mitigate our interest rate risk on a related financial instrument, and for which we have not and may not elect hedge accounting treatment. Because weWe have not elected to apply hedge accounting treatment to these derivatives,derivatives; therefore, changes in the fair value of interest rate derivative financial instruments are recorded as a component of interest expense in gain or loss in fair value of derivative financial instruments in our accompanying condensed consolidated statements of operations and comprehensive income.income (loss). As of March 31, 2019,2020, our interest rate cap isand interest rate swaps are recorded in other assets, net and security deposits, prepaid rent and other liabilities, in our accompanying condensed consolidated balance sheets at itstheir fair value of $11,000.$3,000 and $(12,157,000), respectively. We do not enter into derivative transactions for speculative purposes.

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As of March 31, 2019,2020, the table below presents the principal amounts and weighted average interest rates by year of expected maturity to evaluate the expected cash flows and sensitivity to interest rate changes.
Expected Maturity DateExpected Maturity Date
2019 2020 2021 2022 2023 Thereafter Total Fair Value2020 2021 2022 2023 2024 Thereafter Total Fair Value
Assets                              
Fixed-rate notes receivable — principal payments$28,650,000
 $
 $
 $
 $
 $
 $28,650,000
 $28,747,000
Weighted average interest rate on maturing fixed-rate notes receivable6.75% % % % % % 6.75% 
Debt security held-to-maturity$
 $
 $
 $
 $
 $93,433,000
 $93,433,000
 $94,083,000
$
 $
 $
 $
 $
 $93,433,000
 $93,433,000
 $93,992,000
Weighted average interest rate on maturing fixed-rate debt security% % % % % 4.24% 4.24% 
% % % % % 4.24% 4.24% 
Liabilities                              
Fixed-rate debt — principal payments$8,691,000
 $22,803,000
 $12,159,000
 $61,083,000
 $28,101,000
 $489,544,000
 $622,381,000
 $541,817,000
$21,101,000
 $13,107,000
 $62,070,000
 $29,127,000
 $65,987,000
 $520,272,000
 $711,664,000
 $626,528,000
Weighted average interest rate on maturing fixed-rate debt3.72% 4.84% 3.67% 4.15% 4.15% 3.61% 3.74% 
4.82% 3.69% 4.15% 4.14% 3.67% 4.07% 3.72% 
Variable-rate debt — principal payments$184,926,000
 $59,967,000
 $38,518,000
 $614,500,000
 $
 $
 $897,911,000
 $905,044,000
$47,600,000
 $42,829,000
 $562,500,000
 $283,916,000
 $7,189,000
 $
 $944,034,000
 $945,322,000
Weighted average interest rate on maturing variable-rate debt (based on rates in effect as of March 31, 2019)4.97% 6.07% 4.86% % % % 5.00% 
Weighted average interest rate on maturing variable-rate debt (based on rates in effect as of March 31, 2020)4.53% 4.35% 2.99% 3.77% 5.25% % 3.39% 
Real Estate Notes Receivable and Debt Security Investment, Net
As of March 31, 2019,2020, the net carrying value of our real estate notes receivable and debt security investment net was $99,312,000.$73,476,000. As we expect to hold our fixed-rate notes receivable and debt security investment to maturity and the amounts due under such notes receivable and debt security investment would be limited to the outstanding principal balance and any accrued and unpaid interest, we do not expect that fluctuations in interest rates, and the resulting change in fair value of our fixed-rate notes receivable and debt security investment, would have a significant impact on our operations. See Note 15, Fair Value Measurements, to our accompanying condensed consolidated financial statements, for a discussion of the fair value of our real estate notes receivable and our investment in a held-to-maturity debt security. The weighted average effective interest rate on our outstanding real estate notes receivable and debt security investment net was 4.83%4.24% per annum as of March 31, 2019.2020.

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Mortgage Loans Payable, Net and Lines of Credit and Term Loans
Mortgage loans payable were $716,243,000$821,319,000 ($691,896,000, including797,774,000, net of discount/premium and deferred financing costs, net)costs) as of March 31, 2019.2020. As of March 31, 2019,2020, we had 5758 fixed-rate mortgage loans payable and seven11 variable-rate mortgage loans payable with effective interest rates ranging from 2.45% to 8.49%6.08% per annum and a weighted average effective interest rate of 4.01%3.82%. In addition, as of March 31, 2019,2020, we had $804,049,000$834,379,000 outstanding under our lines of credit and term loans, at a weighted-averageweighted average interest rate of 4.85%3.24% per annum.
As of March 31, 2019,2020, the weighted average effective interest rate on our outstanding debt, factoring in our fixed-rate interest rate swaps and interest rate cap, was 4.45%3.80% per annum. An increase in the variable interest rate on our variable-rate mortgage loans payable and lines of credit and term loans constitutes a market risk. As of March 31, 2019,2020, we have a fixed-rate interest rate cap on one of our variable-rate mortgage loans payable for a notional amountand two fixed-rate interest rate swaps on one of $20,000,000,our lines of credit and term loans; an increase in the variable interest rate thereon would have no effect on our overall annual interest expense. As of March 31, 2019,2020, a 0.50% increase in the market rates of interest would have increased our overall annualized interest expense on all of our other variable-rate mortgage loans payable and lines of credit and term loans by $4,266,000,$2,859,000, or 17.2%4.26% of total annualized interest expense on our mortgage loans payable and lines of credit and term loans. See Note 7, Mortgage Loans Payable, Net, and Note 8, Lines of Credit and Term Loans, to our accompanying condensed consolidated financial statements.
Foreign Currency Exchange Rate Risk
Foreign currency exchange rate risk is the possibility that our financial results could be better or worse than planned because of changes in foreign currency exchange rates. Based solely on our results for the three months ended March 31, 2019,2020, if foreign currency exchange rates were to increase or decrease by 1.00%, our net income from these investments would decrease or increase, as applicable, by approximately $5,000 for the same period.

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Other Market Risk
In addition to changes in interest rates and foreign currency exchange rates, the value of our future investments is subject to fluctuations based on changes in local and regional economic conditions and changes in the creditworthiness of tenants, which may affect our ability to refinance our debt if necessary.
Item 4. Controls and Procedures.
(a) Evaluation of disclosure controls and procedures. We maintain disclosure controls and procedures that are designed to ensure that information required to be disclosed in our reports under the Securities Exchange Act of 1934, as amended, or the Exchange Act, is recorded, processed, summarized and reported within the time periods specified in the rules and forms, and that such information is accumulated and communicated to us, including our chief executive officer and chief financial officer, as appropriate, to allow timely decisions regarding required disclosure. In designing and evaluating the disclosure controls and procedures, we recognize that any controls and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving the desired control objectives, as ours are designed to do, and we necessarily are required to apply our judgment in evaluating whether the benefits of the controls and procedures that we adopt outweigh their costs.
As required by Rules 13a-15(b) and 15d-15(b) of the Exchange Act, an evaluation as of March 31, 20192020 was conducted under the supervision and with the participation of our management, including our chief executive officer and chief financial officer, of the effectiveness of our disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Exchange Act). Based on this evaluation, our chief executive officer and chief financial officer concluded that our disclosure controls and procedures, as of March 31, 2019,2020, were effective at the reasonable assurance level.
(b) Changes in internal control over financial reporting. There were no changes in internal control over financial reporting that occurred during the fiscal quarter ended March 31, 20192020 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.

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PART II — OTHER INFORMATION
Item 1. Legal Proceedings.
None.
Item 1A. Risk Factors.
The use of the words “we,” “us” or “our” refers to Griffin-American Healthcare REIT III, Inc. and its subsidiaries, including Griffin-American Healthcare REIT III Holdings, LP, except where otherwise noted.
There were no material changes from the risk factors previously disclosed in our 20182019 Annual Report on Form 10-K, as filed with the SEC on March 21, 2019,26, 2020, except as noted below.
We have not had sufficient cash available from operations to pay distributions, and therefore, we have paid a portion of distributions from the net proceeds of our initial offering and borrowings, and in the future, may continue to pay distributions from borrowings or from other sources in anticipation of future cash flows or from other sources.flows. Any such distributions may reduce the amount of capital we ultimately invest in assets and may negatively impact the value of our stockholders’ investment and may cause subsequent investors to experience dilution.investment.
We have used the net proceeds from our initial offering, borrowings and certain fees payable to our advisor which have been waived, and in the future, may use borrowed funds or other sources, to pay cash distributions to our stockholders, which may reduce the amount of proceeds available for investment and operations, cause us to incur additional interest expense as a result of borrowed funds or cause subsequent investors to experience dilution. Further, if the aggregate amount of cash distributed in any given year exceeds the amount of our current and accumulated earnings and profits, the excess amount will be deemed a return of capital. Therefore, distributions payable to our stockholders may partially include a return of capital, rather than a return on capital.capital, and we have paid a portion of our distributions from the net proceeds of our initial offering. We have not established any limit on the amount of net proceeds from our initial offering or borrowings that may be used to fund distributions, except that, in accordance with our organizational documents and Maryland law, we may not make distributions that would: (i) cause us to be unable to pay our debts as they become due in the usual course of business; or (ii) cause our total assets to be less than the sum of our total liabilities plus senior liquidation preferences. The actual amount and timing of distributions is determined by our board, in its sole discretion and typically depends on the amount of funds available for distribution, which will depend on items such as our financial condition, current and projected capital expenditure requirements, tax considerations and annual distribution requirements needed to qualifymaintain our qualification as a REIT. As a result, our distribution rate and payment frequency may vary from time to time.
OurPrior to March 31, 2020, our board has authorized, on a quarterly basis, a daily distribution to our stockholders of record as of the close of business on each day of the quarterly periods commencing on May 14, 2014 and ending on June 30, 2019.March 31, 2020. The distributions were calculated based on 365 days in the calendar year and were equal to $0.001643836 per share of our common stock, which was equal to an annualized distribution of $0.60 per share. The daily distributions were aggregated and paid monthly in arrears in cash or shares of our common stock pursuant to our DRIP Offerings, only from legally available funds.
Due to the impact the COVID-19 pandemic has had on the United States and globally, and the uncertainty of the severity and duration of the COVID-19 pandemic and its effects, our board decided to take steps to protect our capital and maximize our liquidity in an effort to strengthen our long-term financial prospects by decreasing our distributions to stockholders. Consequently, our board authorized a daily distribution to our stockholders of record as of the close of business day on each day of the period commencing on April 1, 2020 and ending on May 31, 2020. The daily distributions were or will be calculated based on 365 days in the calendar year and are equal to $0.001643836$0.000821918 per share of our common stock, which is equal to an annualized distribution of $0.60$0.30 per share. These daily distributions were or will be aggregated and paid in cash or shares of our common stock pursuant to our DRIP Offerings monthly in arrears, only from legally available funds.

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The distributions paid for the three months ended March 31, 20192020 and 2018,2019, along with the amount of distributions reinvested pursuant to the 2015our DRIP OfferingOfferings, and the sources of our distributions as compared to cash flows from operations were as follows:
Three Months Ended March 31,Three Months Ended March 31,
2019 20182020 2019
Distributions paid in cash$15,227,000
   $14,377,000
  $16,032,000
   $15,227,000
  
Distributions reinvested14,196,000
   15,229,000
  13,141,000
   14,196,000
  
$29,423,000
   $29,606,000
  $29,173,000
   $29,423,000
  
Sources of distributions:              
Cash flows from operations$25,300,000
 86.0% $25,998,000
 87.8%$25,883,000
 88.7% $25,300,000
 86.0%
Proceeds from borrowings4,123,000
 14.0
 3,608,000
 12.2
3,290,000
 11.3
 4,123,000
 14.0
$29,423,000
 100% $29,606,000
 100%$29,173,000
 100% $29,423,000
 100%
Under GAAP, certain acquisition related expenses, such as expenses incurred in connection with property acquisitions accounted for as business combinations, are expensed, and therefore, subtracted from cash flows from operations. However, these expenses may be paid from debt.

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AnyMarch 31, 2020, any distributions of amounts in excess of our current and accumulated earnings and profits have resulted in a return of capital to our stockholders, and all or any portion of a distribution to our stockholders may have been paid from net offering proceeds and borrowings. The payment of distributions from our initialnet offering proceeds and borrowings could have reduced the amount of capital we ultimately invested in assets and negatively impacted the amount of income available for future distributions.
As of March 31, 2019,2020, we had an amount payable of $1,957,000$2,057,000 to our advisor or its affiliates primarily for asset and property management fees, which will be paid from cash flows from operations in the future as it becomes due and payable by us in the ordinary course of business consistent with our past practice.
As of March 31, 2019, no amounts due See Note 14, Related Party Transactions — Operational Stage, to our advisor or its affiliates had been deferred, waived or forgiven other than $37,000 in asset management fees waived by our advisor in 2014, which was equal to the amount of distributions payable to our stockholdersaccompanying condensed consolidated financial statements, for the period from May 14, 2014, the date we received and accepted subscriptions aggregating at least the minimum offering of $2,000,000 required pursuant to our initial offering, through June 5, 2014, the day prior to the date we acquired our first property. In addition, our advisor agreed to waive the disposition fees that may otherwise have been due to our advisor pursuant to the Advisory Agreement for the dispositions of investments within our integrated senior health campuses segment in 2017. Our advisor did not receive any additional securities, shares of our stock, or any other form of consideration or any repayment as a result of the waiver of such asset management fees and disposition fees. Other than the waiver of asset management fees in 2014 and disposition fees in 2017 by our advisor discussed above, our advisor and its affiliates, including our co-sponsors, have no obligation to defer or forgive fees owed by us to our advisor or its affiliates or to advance any funds to us. In the future, if our advisor or its affiliates do not defer, waive or forgive amounts due to them, this would negatively affect our cash flows from operations, which could result in us paying distributions, or a portion thereof, using borrowed funds. As a result, the amount of proceeds from borrowings available for investment and operations would be reduced, or we may incur additional interest expense as a result of borrowed funds.further discussion.
The distributions paid for the three months ended March 31, 20192020 and 2018,2019, along with the amount of distributions reinvested pursuant the 2015our DRIP OfferingOfferings, and the sources of our distributions as compared to FFO were as follows:
Three Months Ended March 31,Three Months Ended March 31,
2019 20182020 2019
Distributions paid in cash$15,227,000
   $14,377,000
  $16,032,000
   $15,227,000
  
Distributions reinvested14,196,000
   15,229,000
  13,141,000
   14,196,000
  
$29,423,000
   $29,606,000
  $29,173,000
   $29,423,000
  
Sources of distributions:              
FFO attributable to controlling interest$27,232,000
 92.6% $28,318,000
 95.6%$16,229,000
 55.6% $27,232,000
 92.6%
Proceeds from borrowings2,191,000
 7.4
 1,288,000
 4.4
12,944,000
 44.4
 2,191,000
 7.4
$29,423,000
 100% $29,606,000
 100%$29,173,000
 100% $29,423,000
 100%
The payment of distributions from sources other than FFO may reduce the amount of proceeds available for investment and operations or cause us to incur additional interest expense as a result of borrowed funds. For a further discussion of FFO, a non-GAAP financial measure, including a reconciliation of our GAAP net income (loss) to FFO, see Part I, Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations — Funds from Operations and Modified Funds from Operations.
The declaration, amount and payment of future cash distributions to our stockholders are subject to uncertainty due to current market conditions.
All distributions will be declared at the discretion of our board and will depend on our earnings, our financial condition, REIT distribution requirements, and other factors as our board may deem relevant from time to time. The economic impact resulting from the COVID-19 pandemic could adversely affect our ability to pay distributions to our stockholders. Our board is under no obligation or requirement to declare a distribution and will continue to assess our distribution rate on an ongoing basis, as market conditions and our financial position continue to evolve. We cannot assure our stockholders that we will achieve results that will allow us to pay distributions on our common stock or that the current level of distributions will be maintained or increased.

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The estimated value per share of our common stock may not be an accurate reflection of fair value of our assets and liabilities and likely will not represent the amount of net proceeds that would result if we were liquidated or dissolved or completed a merger or other sale of our company.
On October 3, 2019, our board, at the recommendation of the audit committee of our board, comprised solely of independent directors, unanimously approved and established an updated estimated per share NAV of our common stock of $9.40. We are providing this updated estimated per share NAV to assist broker-dealers in connection with their obligations under FINRA Rule 2231, with respect to customer account statements. The valuation was performed in accordance with the methodology provided in the Practice Guideline issued by the IPA in April 2013, in addition to guidance from the SEC.
The updated estimated per share NAV was determined after consultation with our advisor and an independent third-party valuation firm, the engagement of which was approved by the audit committee of our board. FINRA rules provide no guidance on the methodology an issuer must use to determine its estimated per share NAV. As with any valuation methodology, our independent valuation firm’s methodology is based upon a number of estimates and assumptions that may not be accurate or complete. Different parties with different assumptions and estimates could derive a different estimated per share NAV, and these differences could be significant.
The updated estimated per share NAV was not audited or reviewed by our independent registered public accounting firm and does not represent the fair value of our assets or liabilities according to GAAP. In addition, the updated estimated per share NAV is an estimate as of a given point in time and the value of our shares will fluctuate over time as a result of, among other things, developments related to individual assets and changes in the real estate and capital markets. Accordingly, with respect to the updated estimated per share NAV, we can give no assurance that:
a stockholder would be able to resell his or her shares at our updated estimated per share NAV;
a stockholder would ultimately realize distributions per share equal to our updated estimated per share NAV upon liquidation of our assets and settlement of our liabilities or a sale of the company;
our shares of common stock would trade at our updated estimated per share NAV on a national securities exchange;
an independent third-party appraiser or other third-party valuation firm, other than the third-party valuation firm engaged by our board to assist in its determination of the updated estimated per share NAV, would agree with our estimated per share NAV; or
the methodology used to estimate our updated per share NAV would be acceptable to FINRA or comply with reporting requirements under the Employee Retirement Income Security Act of 1974, the Code, other applicable law, or the applicable provisions of a retirement plan or individual retirement account.
Further, the updated estimated per share NAV is based on the estimated value of our assets less the estimated value of our liabilities, divided by the number of shares outstanding on a fully diluted basis, calculated as of June 30, 2019, prior to the reported emergence of COVID-19 in the United States. We are continuously monitoring the impact the COVID-19 pandemic is having on our business, residents, tenants, operating partners, managers and on the United States and global economies. The impact of the COVID-19 pandemic on our portfolio of investments may be significant and will largely depend on future developments, which are highly uncertain and cannot be predicted at this time, including new information which may emerge concerning the severity of the COVID-19 pandemic, the success of actions taken to contain or treat COVID-19, and reactions by consumers, companies, governmental entities and capital markets. Therefore, although we intend to publish an updated estimated per share NAV on an annual basis, we may be required to reevaluate the estimated per share NAV sooner if the COVID-19 pandemic has a material adverse impact on us, our tenants, our operators, our managers or our portfolio of investments.
For a full description of the methodologies used to value our assets and liabilities in connection with the calculation of the updated estimated per share NAV, see our Current Report on Form 8-K filed with the SEC on October 4, 2019.
A high concentration of our properties in a particular geographic area would magnify the effects of downturns in that geographic area.
We have a concentration of properties in particular geographic areas; therefore, any adverse situation that disproportionately effects one of those areas would have a magnified adverse effect on our portfolio. As of May 15, 2019,2020, properties located in Indiana and Ohio accounted for approximately 33.4%38.3% and 10.3%, respectively, of our total property portfolio’s annualized base rent or annualized net operating income. Accordingly, there is a geographic concentration of risk subject to fluctuations in such state’s economy.

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Our results of operations, our ability to pay distributions to our stockholders and our ability to dispose of our investments are subject to international, national and local economic factors we cannot control or predict.
Our results of operations are subject to the risks of an international or national economic slowdown or downturn and other changes in international, national and local economic conditions. The following factors may have affected and may continue to affect income from our properties, our ability to acquire and dispose of properties, and yields from our properties:
poor economic times may result in defaults by tenants of our properties due to bankruptcy, lack of liquidity, or operational failures. We may provide rent concessions, tenant improvement expenditures or reduced rental rates to maintain or increase occupancy levels;
fluctuations in property values as a result of increases or decreases in supply and demand, occupancies and rental rates may cause the properties that we acquire to decrease in value. Consequently, we may not be able to recover the carrying amount of our properties, which may require us to recognize an impairment charge or record a loss on sale in earnings;
reduced values of our properties may limit our ability to dispose of assets at attractive prices or to obtain debt financing secured by our properties and may reduce the availability of unsecured loans;
the value and liquidity of our short-term investments and cash deposits could be reduced as a result of a deterioration of the financial condition of the institutions that hold our cash deposits or the institutions or assets in which we have made short-term investments, the dislocation of the markets for our short-term investments, increased volatility in market rates for such investment or other factors;
our lenders under a line of credit could refuse to fund their financing commitment to us or could fail and we may not be able to replace the financing commitment of such lender on favorable terms, or at all;
increases in index rates and lender spreads or other regulatory or market factors affecting the banking and commercial mortgage-backed securities industries may increase overall borrowing costs;
one or more counterparties to our interest rate swaps could default on their obligations to us or could fail, increasing the risk that we may not realize the benefits of these instruments;
constricted access to credit may result in tenant defaults or non-renewals under leases;
layoffs may lead to a lower demand for medical services and cause vacancies to increase and a lack of future population and job growth may make it difficult to maintain or increase occupancy levels;
future disruptions in the financial markets, deterioration in economic conditions or a public health crisis, such as the COVID-19 pandemic, have resulted and may continue to result in lower occupancy in our facilities, increased vacancy rates for commercial real estate due to generally lower demand for rentable space, as well as oversupply of rentable space;
governmental actions and initiatives, including risks associated with the impact of a prolonged government shutdown or budgetary reductions or impasses; and
increased insurance premiums, real estate taxes or utilities or other expenses may reduce funds available for distribution or, to the extent such increases are passed through to tenants, may lead to tenant defaults. Also, any such increased expenses may make it difficult to increase rents to tenants on turnover, which may limit our ability to increase our returns.
The length and severity of any economic slowdown or downturn cannot be predicted at this time. Our results of operations, our ability to continue to pay distributions to our stockholders and our ability to dispose of our investments have been and we expect that we may continue to be negatively impacted to the extent an economic slowdown or downturn is prolonged or becomes more severe.
The COVID-19 pandemic has adversely impacted our business and financial results, and the ultimate impact will depend on future developments, which are highly uncertain and cannot be predicted, including the scope and duration of the pandemic and actions taken by governmental authorities in response to the pandemic.
In December 2019, COVID-19 was identified in Wuhan, China. This virus continues to spread globally including in the United States. As a result of the COVID-19 pandemic, we have experienced a decline in occupancy rates at our senior housing — RIDEA facilities and integrated senior health campuses. In addition, due to the shelter in place and quarantine restrictions, our property values, net operating income and revenues may decline, and our tenants, operating partners and managers may be limited in their ability to properly maintain our properties, generate income and/or service patients and residents. Additionally, the public perception of a risk of a pandemic or media coverage of the COVID-19 pandemic and related deaths or confirmed cases, or public perception of health risks linked to perceived regional healthcare safety in our senior housing or skilled nursing

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facilities, particularly if focused on regions in which our properties are located, may adversely affect us by reducing occupancy demand at our facilities. In addition, the COVID-19 pandemic has adversely impacted and may continue to adversely impact the ability of our medical office tenants, many of whom have been restricted in their ability to work, to pay their rent as and when due. We have also held discussions with our tenants, operating partners and managers and they have expressed their general concern about the uncertain economic condition. We believe that it is premature to determine the magnitude of the impact at this point.
Issues related to financing also are exacerbated in times of significant dislocation in the financial markets, such as those being experienced now related to the COVID-19 pandemic. It is possible our lenders will become unwilling or unable to provide us with financing, and we may not be able to replace the financing commitment of such lender on favorable terms, or at all. In addition, if the regulatory capital requirements imposed on our lenders change, they may be required to significantly increase the cost of the financing that they provide to us. As a result, our lenders may revise the terms of such financings to us, which could adversely impact our liquidity and our ability to make payments on our existing obligations.
Furthermore, we and our co-sponsors and their employees that provide services to us rely on processes and activities that largely depend on people and technology, including access to information technology systems as well as information, applications, payment systems and other services provided by third parties. In response to the COVID-19 pandemic, business practices have been modified with all or a portion of our co-sponsors’ employees working remotely from their homes to have our operations uninterrupted as much as possible. Additionally, technology in such employees’ homes may not be as robust as in our co-sponsors’ offices and could cause the networks, information systems, applications and other tools available to such employees to be more limited or less reliable than in our co-sponsors’ offices. The continuation of these work-from-home measures may introduce increased cybersecurity risk. These cybersecurity risks include greater phishing, malware, and other cybersecurity attacks, vulnerability to disruptions of our information technology infrastructure and telecommunications systems for remote operations, increased risk of unauthorized dissemination of confidential information, greater risk of a security breach resulting in destruction or misuse of valuable information and potential impairment of our ability to perform certain functions, all of which could expose us to risks of data or financial loss, litigation and liability and could disrupt our operations and the operations of any impacted third-parties.
The extent to which the COVID-19 pandemic impacts our business will depend on future developments, which are highly uncertain and cannot be predicted at this time, including new information which may emerge concerning the severity of the COVID-19 pandemic and the actions to contain the COVID-19 pandemic or treat its impact, among others. We expect the significance of the COVID-19 pandemic, including the extent of its effect on our financial and operational results, to be dictated by, among other things, its duration, the success of efforts to contain it and the impact of actions taken in response. For instance, recent government initiatives, such as the Payroll Protection Program and deferral of payroll tax payments program within the CARES Act, enacted to provide substantial financial support to businesses could provide helpful mitigation for us and certain of our tenants, operating partners and managers. The ultimate impact of the CARES Act, however, is not yet clear. While we are not able at this time to estimate the impact of the COVID-19 pandemic on our financial and operational results, it could be material.
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds.
Recent Sales of Unregistered Securities
None.

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Purchase of Equity Securities by the Issuer and Affiliated Purchasers
Our share repurchase plan allows for repurchases of shares of our common stock by us when certain criteria are met. Share repurchases will be made at the sole discretion of our board. All share repurchases are subject to a one-year holding period, except for repurchases made in connection with a stockholder’s death or “qualifying disability,” as defined in our share repurchase plan, and will be repurchased at a price between 92.5% and 100% of each stockholder’s “Repurchase Amount,” as defined in our share repurchase plan, depending on the period of time their shares have been held. The numbers of shares that we will repurchase is generally limited during any calendar year to 5.0% of the weighted average number of shares of our common stock outstanding during the prior calendar year. Funds for the repurchase of shares of our common stock will come exclusively from the cumulative proceeds we receive from the sale of shares of our common stock pursuant to our DRIP Offerings. Additionally, effective with respect to share repurchase requests submitted for repurchase during the second quarter 2019, the number of shares that we will repurchase during any fiscal quarter will be limited to an amount equal to the net proceeds that we received from the sale of shares issued pursuant to the DRIP Offerings during the immediately preceding completed fiscal quarter; provided however, that shares subject to a repurchase requested upon the death or qualifying disability of a stockholder will not be subject to this quarterly cap or to our existing cap on repurchases to 5.0% of the weighted average number of shares outstanding during the calendar year prior to the repurchase date.
Effective with respect to share repurchase requests submitted during the fourth quarter 2016, the Repurchase Amount is equal to the lesser of (i) the amount per share that a stockholder paid for their shares of our common stock, or (ii) the most recent estimated value of one share of our common stock, as determined by our board. Accordingly, we repurchase shares as follows: (a) for stockholders who have continuously held their shares of our common stock for at least one year, the price will be 92.5% of the Repurchase Amount; (b) for stockholders who have continuously held their shares of our common stock for at least two years, the price will be 95.0% of the Repurchase Amount; (c) for stockholders who have continuously held their shares of our common stock for at least three years, the price will be 97.5% of the Repurchase Amount; (d) for stockholders who have held their shares of our common stock for at least four years, the price will be 100% of the Repurchase Amount; and (e) for requests submitted pursuant to a death or a qualifying disability, the repurchase price will be 100% of the amount per share the stockholder paid for their shares of common stock (in each case, as adjusted for any stock dividends, combinations, splits, recapitalizations and the like with respect to our common stock).
During the three months ended March 31, 2019, we repurchased shares of our common stock as follows:
Period 

Total Number of
Shares Purchased
 

Average Price
Paid per Share
 

Total Number of Shares
Purchased As Part of
Publicly Announced
Plan or Program
 
Maximum Approximate
Dollar Value
of Shares that May
Yet Be Purchased
Under the
Plans or Programs
January 1, 2019 to January 31, 2019 5,000
 $10.00
 5,000
 (1)
February 1, 2019 to February 28, 2019 
 $
 
 (1)
March 1, 2019 to March 31, 2019 3,878,716
 $9.39
 3,878,716
 (1)
Total 3,883,716
 $9.39
 3,883,716
  
___________
(1)Subject to funds being available, we will limit the number of shares of our common stock repurchased during any calendar year to 5.0% of the weighted average number of shares of our common stock outstanding during the prior calendar year; provided however, shares of our common stock subject to a repurchase requested upon the death or a qualifying disability of a stockholder will not be subject to this cap.
Item 3. Defaults Upon Senior Securities.
None.
Item 4. Mine Safety Disclosures.
Not applicable.
Item 5. Other Information.
None.

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Item 6. Exhibits.
The following exhibits are included, or incorporated by reference, in this Quarterly Report on Form 10-Q for the period ended March 31, 20192020 (and are numbered in accordance with Item 601 of Regulation S-K).
  
  
  
  
  
  
  
101.INS*XBRL Instance Document
  
101.SCH*XBRL Taxonomy Extension Schema Document
  
101.CAL*XBRL Taxonomy Extension Calculation Linkbase Document
  
101.LAB*XBRL Taxonomy Extension Label Linkbase Document
  
101.PRE*XBRL Taxonomy Extension Presentation Linkbase Document
  
101.DEF*XBRL Taxonomy Extension Definition Linkbase Document
___________
*Filed herewith.
**Furnished herewith. In accordance with Item 601(b)(32) of Regulation S-K, this Exhibit is not deemed “filed” for purposes of Section 18 of the Exchange Act or otherwise subject to the liabilities of that section. Such certifications will not be deemed incorporated by reference into any filing under the Securities Act of 1933, as amended, or the Securities Exchange Act of 1934, as amended, except to the extent that the registrant specifically incorporates it by reference.



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SIGNATURES
Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.
 
     
Griffin-American Healthcare REIT III, Inc.
(Registrant)
       
May 15, 20192020 By: 
/s/ JEFFREY T. HANSON
 
Date    Jeffrey T. Hanson 
     Chief Executive Officer and Chairman of the Board of Directors
     (Principal Executive Officer) 
       
May 15, 20192020 By: 
/s/ BRIAN S. PEAY
 
Date    Brian S. Peay 
     Chief Financial Officer
     (Principal Financial Officer and Principal Accounting Officer)



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