Table of Contents

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 JuneSeptember 30, 2020
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)

Maryland46-1749436
(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
As of August 7,November 13, 2020, there were 193,890,060193,889,887 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

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PART I — FINANCIAL INFORMATION
Item 1. Financial Statements.
GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED BALANCE SHEETS
As of JuneSeptember 30, 2020 and December 31, 2019
(Unaudited)
September 30,
2020
December 31,
2019
ASSETS
Real estate investments, net$2,326,942,000 $2,270,421,000 
Debt security investment, net75,037,000 72,717,000 
Cash and cash equivalents133,332,000 53,149,000 
Accounts and other receivables, net127,837,000 144,130,000 
Restricted cash36,284,000 36,731,000 
Real estate deposits75,000 223,000 
Identified intangible assets, net154,672,000 160,247,000 
Goodwill75,309,000 75,309,000 
Operating lease right-of-use assets, net207,753,000 219,187,000 
Other assets, net133,948,000 140,175,000 
Total assets$3,271,189,000 $3,172,289,000 
LIABILITIES, REDEEMABLE NONCONTROLLING INTERESTS AND EQUITY
Liabilities:
Mortgage loans payable, net(1)$800,170,000 $792,870,000 
Lines of credit and term loans(1)855,634,000 815,879,000 
Accounts payable and accrued liabilities(1)170,627,000 171,394,000 
Accounts payable due to affiliates(1)4,699,000 2,321,000 
Identified intangible liabilities, net416,000 663,000 
Financing obligations(1)29,576,000 30,918,000 
Operating lease liabilities(1)196,395,000 207,371,000 
Security deposits, prepaid rent and other liabilities(1)128,144,000 48,105,000 
Total liabilities2,185,661,000 2,069,521,000 
Commitments and contingencies (Note 11)
Redeemable noncontrolling interests (Note 12)44,850,000 44,105,000 
Equity:
Stockholders’ equity:
Preferred stock, $0.01 par value per share; 200,000,000 shares authorized; 0ne issued and outstanding
Common stock, $0.01 par value per share; 1,000,000,000 shares authorized; 193,889,887 and 193,967,474 shares issued and outstanding as of September 30, 2020 and December 31, 2019, respectively1,939,000 1,939,000 
Additional paid-in capital1,727,850,000 1,728,421,000 
Accumulated deficit(861,889,000)(827,550,000)
Accumulated other comprehensive loss(2,475,000)(2,255,000)
Total stockholders’ equity865,425,000 900,555,000 
Noncontrolling interests (Note 13)175,253,000 158,108,000 
Total equity1,040,678,000 1,058,663,000 
Total liabilities, redeemable noncontrolling interests and equity$3,271,189,000 $3,172,289,000 
 
June 30,
2020
 
December 31,
2019
ASSETS
Real estate investments, net$2,288,191,000
 $2,270,421,000
Debt security investment, net74,253,000
 72,717,000
Cash and cash equivalents134,338,000
 53,149,000
Accounts and other receivables, net119,356,000
 144,130,000
Restricted cash37,343,000
 36,731,000
Real estate deposits35,000
 223,000
Identified intangible assets, net157,232,000
 160,247,000
Goodwill75,309,000
 75,309,000
Operating lease right-of-use assets, net224,806,000
 219,187,000
Other assets, net142,709,000
 140,175,000
Total assets$3,253,572,000
 $3,172,289,000
    
LIABILITIES, REDEEMABLE NONCONTROLLING INTERESTS AND EQUITY
Liabilities:   
Mortgage loans payable, net(1)$804,414,000
 $792,870,000
Lines of credit and term loans(1)842,879,000
 815,879,000
Accounts payable and accrued liabilities(1)151,784,000
 171,394,000
Accounts payable due to affiliates(1)2,178,000
 2,321,000
Identified intangible liabilities, net479,000
 663,000
Financing obligations(1)30,849,000
 30,918,000
Operating lease liabilities(1)213,695,000
 207,371,000
Security deposits, prepaid rent and other liabilities(1)116,341,000
 48,105,000
Total liabilities2,162,619,000
 2,069,521,000
    
Commitments and contingencies (Note 11)
 
    
Redeemable noncontrolling interests (Note 12)44,491,000
 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; 194,407,323 and 193,967,474 shares issued and outstanding as of June 30, 2020 and December 31, 2019, respectively1,944,000
 1,939,000
Additional paid-in capital1,733,166,000
 1,728,421,000
Accumulated deficit(862,584,000) (827,550,000)
Accumulated other comprehensive loss(2,819,000) (2,255,000)
Total stockholders’ equity869,707,000
 900,555,000
Noncontrolling interests (Note 13)176,755,000
 158,108,000
Total equity1,046,462,000
 1,058,663,000
Total liabilities, redeemable noncontrolling interests and equity$3,253,572,000
 $3,172,289,000

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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED BALANCE SHEETS — (Continued)
As of JuneSeptember 30, 2020 and December 31, 2019
(Unaudited)

___________
(1)Such liabilities of Griffin-American Healthcare REIT III, Inc. as of June 30, 2020 and December 31, 2019 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, as defined in Note 8, held by Griffin-American Healthcare REIT III Holdings, LP in the amount of $591,000,000 and $557,000,000 as of June 30, 2020 and December 31, 2019, respectively, which is guaranteed by Griffin-American Healthcare REIT III, Inc.
(1)Such liabilities of Griffin-American Healthcare REIT III, Inc. as of September 30, 2020 and December 31, 2019 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, as defined in Note 8, held by Griffin-American Healthcare REIT III Holdings, LP in the amount of $573,500,000 and $557,000,000 as of September 30, 2020 and December 31, 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.

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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME (LOSS)
For the Three and SixNine Months Ended JuneSeptember 30, 2020 and 2019
(Unaudited)


Three Months Ended June 30, Six Months Ended June 30,Three Months Ended September 30,Nine Months Ended September 30,
2020 2019 2020 20192020201920202019
Revenues and grant income:       Revenues and grant income:
Resident fees and services$254,617,000
 $272,472,000
 $544,543,000
 $540,754,000
Resident fees and services$263,931,000 $273,800,000 $808,474,000 $814,554,000 
Real estate revenue30,113,000
 32,459,000
 60,231,000
 65,235,000
Real estate revenue30,333,000 27,962,000 90,564,000 93,197,000 
Grant income29,990,000
 
 29,990,000
 
Grant income740,000 30,730,000 
Total revenues and grant income314,720,000
 304,931,000
 634,764,000
 605,989,000
Total revenues and grant income295,004,000 301,762,000 929,768,000 907,751,000 
Expenses:       Expenses:
Property operating expenses234,191,000
 239,890,000
 489,931,000
 474,842,000
Property operating expenses240,989,000 241,858,000 730,920,000 716,700,000 
Rental expenses8,147,000
 8,226,000
 16,317,000
 16,651,000
Rental expenses7,795,000 9,188,000 24,112,000 25,839,000 
General and administrative7,781,000
 6,512,000
 14,355,000
 13,429,000
General and administrative6,969,000 7,675,000 21,324,000 21,104,000 
Acquisition related expenses19,000
 400,000
 253,000
 (296,000)Acquisition related expenses54,000 4,000 307,000 (292,000)
Depreciation and amortization24,572,000
 24,743,000
 49,659,000
 50,371,000
Depreciation and amortization24,591,000 36,778,000 74,250,000 87,149,000 
Total expenses274,710,000

279,771,000
 570,515,000
 554,997,000
Total expenses280,398,000 295,503,000 850,913,000 850,500,000 
Other income (expense):       Other income (expense):
Interest expense: 
     Interest expense:
Interest expense (including amortization of deferred financing costs and debt discount/premium)(17,652,000) (19,560,000) (36,186,000) (38,619,000)
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishment)Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishment)(17,229,000)(21,046,000)(53,415,000)(59,665,000)
Gain (loss) in fair value of derivative financial instruments749,000
 (4,117,000) (7,434,000) (4,677,000)Gain (loss) in fair value of derivative financial instruments1,763,000 (1,169,000)(5,671,000)(5,846,000)
Gain on dispositions of real estate investmentsGain on dispositions of real estate investments1,037,000 1,037,000 
Impairment of real estate investments(3,233,000) 
 (8,335,000) 
Impairment of real estate investments(8,335,000)
Income (loss) from unconsolidated entities694,000
 (493,000) (210,000) (947,000)
Foreign currency loss(183,000) (1,232,000) (3,248,000) (190,000)
Loss from unconsolidated entitiesLoss from unconsolidated entities(2,855,000)(766,000)(3,065,000)(1,713,000)
Foreign currency gain (loss)Foreign currency gain (loss)1,945,000 (1,464,000)(1,303,000)(1,654,000)
Other income521,000
 246,000
 1,076,000
 454,000
Other income203,000 1,923,000 1,279,000 2,377,000 
Income before income taxes20,906,000
 4,000
 9,912,000
 7,013,000
(Loss) income before income taxes(Loss) income before income taxes(530,000)(16,263,000)9,382,000 (9,250,000)
Income tax (expense) benefit(119,000) (159,000) 3,092,000
 (310,000)Income tax (expense) benefit(150,000)(840,000)2,942,000 (1,150,000)
Net income (loss)20,787,000
 (155,000) 13,004,000
 6,703,000
Less: net income attributable to noncontrolling interests(7,027,000) (1,430,000) (9,154,000) (2,778,000)
Net (loss) incomeNet (loss) income(680,000)(17,103,000)12,324,000 (10,400,000)
Less: net loss (income) attributable to noncontrolling interestsLess: net loss (income) attributable to noncontrolling interests1,375,000 (201,000)(7,779,000)(2,979,000)
Net income (loss) attributable to controlling interest$13,760,000
 $(1,585,000) $3,850,000
 $3,925,000
Net income (loss) attributable to controlling interest$695,000 $(17,304,000)$4,545,000 $(13,379,000)
Net income (loss) per common share attributable to controlling interest — basic and diluted$0.07
 $(0.01) $0.02
 $0.02
Net income (loss) per common share attributable to controlling interest — basic and diluted$$(0.09)$0.02 $(0.07)
Weighted average number of common shares outstanding — basic and diluted194,123,913
 196,075,614
 194,484,214
 197,231,713
Weighted average number of common shares outstanding — basic and diluted193,856,887 195,669,002 194,273,579 196,705,085 
       
Net income (loss)$20,787,000
 $(155,000) $13,004,000
 $6,703,000
Other comprehensive loss:       
Net (loss) incomeNet (loss) income$(680,000)$(17,103,000)$12,324,000 $(10,400,000)
Other comprehensive income (loss):Other comprehensive income (loss):
Foreign currency translation adjustments(31,000) (239,000) (564,000) (20,000)Foreign currency translation adjustments344,000 (281,000)(220,000)(301,000)
Total other comprehensive loss(31,000) (239,000) (564,000) (20,000)
Comprehensive income (loss)20,756,000
 (394,000) 12,440,000
 6,683,000
Less: comprehensive income attributable to noncontrolling interests(7,027,000) (1,430,000) (9,154,000) (2,778,000)
Total other comprehensive income (loss)Total other comprehensive income (loss)344,000 (281,000)(220,000)(301,000)
Comprehensive (loss) incomeComprehensive (loss) income(336,000)(17,384,000)12,104,000 (10,701,000)
Less: comprehensive loss (income) attributable to noncontrolling interestsLess: comprehensive loss (income) attributable to noncontrolling interests1,375,000 (201,000)(7,779,000)(2,979,000)
Comprehensive income (loss) attributable to controlling interest$13,729,000
 $(1,824,000) $3,286,000
 $3,905,000
Comprehensive income (loss) attributable to controlling interest$1,039,000 $(17,585,000)$4,325,000 $(13,680,000)
The accompanying notes are an integral part of these condensed consolidated financial statements.

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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED STATEMENTS OF EQUITY
For the Three and SixNine Months Ended JuneSeptember 30, 2020 and 2019
(Unaudited)



Three Months Ended September 30, 2020
Stockholders’ Equity
 Common Stock  
Number
of
Shares
AmountAdditional
Paid-In
Capital
Accumulated
Deficit
Accumulated
Other
Comprehensive
Loss
Total
Stockholders’
Equity
Noncontrolling
Interests
Total Equity
BALANCE — June 30, 2020194,407,323 $1,944,000 $1,733,166,000 $(862,584,000)$(2,819,000)$869,707,000 $176,755,000 $1,046,462,000 
Amortization of nonvested common stock compensation— — 28,000 — — 28,000 — 28,000 
Stock based compensation— — — — — — 195,000 195,000 
Repurchase of common stock(517,436)(5,000)(5,116,000)— — (5,121,000)— (5,121,000)
Distributions to noncontrolling interests— — — — — — (189,000)(189,000)
Reclassification of noncontrolling interests to mezzanine equity— — — — — — (195,000)(195,000)
Fair value adjustment to redeemable noncontrolling interests— — (228,000)— — (228,000)(98,000)(326,000)
Net income (loss)— — — 695,000 — 695,000 (1,215,000)(520,000)(1)
Other comprehensive income— — — — 344,000 344,000 — 344,000 
BALANCE — September 30, 2020193,889,887 $1,939,000 $1,727,850,000 $(861,889,000)$(2,475,000)$865,425,000 $175,253,000 $1,040,678,000 

Three Months Ended September 30, 2019
Three Months Ended June 30, 2020Stockholders’ Equity
Stockholders’ Equity      Common Stock  
Common Stock             Number
of
Shares
AmountAdditional
Paid-In
Capital
Accumulated
Deficit
Accumulated
Other
Comprehensive
Loss
Total
Stockholders’
Equity
Noncontrolling
Interests
Total Equity
BALANCE — June 30, 2019BALANCE — June 30, 2019194,736,018 $1,946,000 $1,739,119,000 $(759,520,000)$(2,580,000)$978,965,000 $160,010,000 $1,138,975,000 
Number
of
Shares
 Amount 
Additional
Paid-In
Capital
 
Accumulated
Deficit
 
Accumulated
Other
Comprehensive
Loss
 
Total
Stockholders’
Equity
 
Noncontrolling
Interests
 Total Equity 
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
 
Issuance of common stock under the DRIP927,741
 10,000
 8,710,000
 
 
 8,720,000
 
 8,720,000
 Issuance of common stock under the DRIP1,471,581 15,000 13,774,000 — — 13,789,000 — 13,789,000 
Issuance of vested and nonvested restricted common stock7,500
 
 14,000
 
 
 14,000
 
 14,000
 Issuance of vested and nonvested restricted common stock15,000 — 28,000 — — 28,000 — 28,000 
Amortization of nonvested common stock compensation
 
 43,000
 
 
 43,000
 
 43,000
 Amortization of nonvested common stock compensation— — 44,000 — — 44,000 — 44,000 
Stock based compensation
 
 
 
 
 
 195,000
 195,000
 Stock based compensation— — — — — — 195,000 195,000 
Repurchase of common stock(1,893,413) (19,000) (17,967,000) 
 
 (17,986,000) 
 (17,986,000) Repurchase of common stock(1,832,625)(18,000)(17,303,000)— — (17,321,000)— (17,321,000)
Issuance of noncontrolling interest
 
 515,000
 
 
 515,000
 10,485,000
 11,000,000
 
Distributions to noncontrolling interests
 
 
 
 
 
 (145,000) (145,000) Distributions to noncontrolling interests— — — — — — (1,817,000)(1,817,000)
Reclassification of noncontrolling interests to mezzanine equity
 
 
 
 
 
 (195,000) (195,000) Reclassification of noncontrolling interests to mezzanine equity— — — — — — (195,000)(195,000)
Fair value adjustment to redeemable noncontrolling interests
 
 271,000
 
 
 271,000
 115,000
 386,000
 Fair value adjustment to redeemable noncontrolling interests— — (135,000)— — (135,000)(59,000)(194,000)
Distributions declared ($0.05 per share)
 
 
 (9,730,000) 
 (9,730,000) 
 (9,730,000) 
Net income
 
 
 13,760,000
 
 13,760,000
 6,301,000
 20,061,000
(1)
Distributions declared ($0.15 per share)Distributions declared ($0.15 per share)— — — (29,603,000)— (29,603,000)— (29,603,000)
Net (loss) incomeNet (loss) income— — — (17,304,000)— (17,304,000)184,000 (17,120,000)(1)
Other comprehensive loss
 
 
 
 (31,000) (31,000) 
 (31,000) Other comprehensive loss— — — — (281,000)(281,000)— (281,000)
BALANCE — June 30, 2020194,407,323
 $1,944,000
 $1,733,166,000
 $(862,584,000) $(2,819,000) $869,707,000
 $176,755,000
 $1,046,462,000
 
BALANCE — September 30, 2019BALANCE — September 30, 2019194,389,974 $1,943,000 $1,735,527,000 $(806,427,000)$(2,861,000)$928,182,000 $158,318,000 $1,086,500,000 

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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED STATEMENTS OF EQUITY — (Continued)
For the Three and SixNine Months Ended JuneSeptember 30, 2020 and 2019
(Unaudited)



Nine Months Ended September 30, 2020
Stockholders’ Equity
 Common Stock  
Number
of
Shares
AmountAdditional
Paid-In
Capital
Accumulated
Deficit
Accumulated
Other
Comprehensive
Loss
Total
Stockholders’
Equity
Noncontrolling
Interests
Total Equity
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 DRIP2,325,762 24,000 21,837,000 — — 21,861,000 — 21,861,000 
Issuance of vested and nonvested restricted common stock7,500 — 14,000 — — 14,000 — 14,000 
Amortization of nonvested common stock compensation— — 114,000 — — 114,000 — 114,000 
Stock based compensation— — — — — — 585,000 585,000 
Repurchase of common stock(2,410,849)(24,000)(23,083,000)— — (23,107,000)— (23,107,000)
Issuance of noncontrolling interest— — 515,000 — — 515,000 10,485,000 11,000,000 
Distributions to noncontrolling interests— — — — — — (338,000)(338,000)
Reclassification of noncontrolling interests to mezzanine equity— — — — — — (585,000)(585,000)
Fair value adjustment to redeemable noncontrolling interests— — 32,000 — — 32,000 13,000 45,000 
Distributions declared ($0.20 per share)— — — (38,884,000)— (38,884,000)— (38,884,000)
Net income— — — 4,545,000 — 4,545,000 6,985,000 11,530,000 (1)
Other comprehensive loss— — — — (220,000)(220,000)— (220,000)
BALANCE — September 30, 2020193,889,887 $1,939,000 $1,727,850,000 $(861,889,000)$(2,475,000)$865,425,000 $175,253,000 $1,040,678,000 
 Three Months Ended June 30, 2019
 Stockholders’ Equity     
 Common Stock             
 
Number
of
Shares
 Amount 
Additional
Paid-In
Capital
 
Accumulated
Deficit
 
Accumulated
Other
Comprehensive
Loss
 
Total
Stockholders’
Equity
 
Noncontrolling
Interests
 Total Equity 
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
 
Offering costs — common stock
 
 (1,000) 
 
 (1,000) 
 (1,000) 
Issuance of common stock under the DRIP1,506,395
 15,000
 14,100,000
 
 
 14,115,000
 
 14,115,000
 
Issuance of vested and nonvested restricted common stock7,500
 
 14,000
 
 
 14,000
 
 14,000
 
Amortization of nonvested common stock compensation
 
 43,000
 
 
 43,000
 
 43,000
 
Stock based compensation
 
 
 
 
 
 195,000
 195,000
 
Repurchase of common stock(1,966,636) (20,000) (18,629,000) 
 
 (18,649,000) 
 (18,649,000) 
Distributions to noncontrolling interests
 
 
 
 
 
 (1,818,000) (1,818,000) 
Reclassification of noncontrolling interests to mezzanine equity
 
 
 
 
 
 (195,000) (195,000) 
Fair value adjustment to redeemable noncontrolling interests
 
 (119,000) 
 
 (119,000) (50,000) (169,000) 
Distributions declared ($0.15 per share)
 
 
 (29,337,000) 
 (29,337,000) 
 (29,337,000) 
Net (loss) income
 
 
 (1,585,000) 
 (1,585,000) 1,283,000
 (302,000)(1)
Other comprehensive loss
 
 
 
 (239,000) (239,000) 
 (239,000) 
BALANCE — June 30, 2019194,736,018
 $1,946,000
 $1,739,119,000
 $(759,520,000) $(2,580,000) $978,965,000
 $160,010,000
 $1,138,975,000
 

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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED STATEMENTS OF EQUITY — (Continued)
For the Three and SixNine Months Ended JuneSeptember 30, 2020 and 2019
(Unaudited)



Nine Months Ended September 30, 2019
Stockholders’ Equity
 Common Stock  
Number
of
Shares
AmountAdditional
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— — (84,000)— — (84,000)— (84,000)
Issuance of common stock under the DRIP4,493,074 45,000 42,055,000 — — 42,100,000 — 42,100,000 
Issuance of vested and nonvested restricted common stock22,500 — 42,000 — — 42,000 — 42,000 
Amortization of nonvested common stock compensation— — 130,000 — — 130,000 — 130,000 
Stock based compensation— — — — — — 585,000 585,000 
Repurchase of common stock(7,682,977)(77,000)(72,379,000)— — (72,456,000)— (72,456,000)
Contributions from noncontrolling interests— — — — — — 3,000,000 3,000,000 
Distributions to noncontrolling interests— — — — — — (5,452,000)(5,452,000)
Reclassification of noncontrolling interests to mezzanine equity— — — — — — (585,000)(585,000)
Fair value adjustment to redeemable noncontrolling interests— — (77,000)— — (77,000)(33,000)(110,000)
Distributions declared ($0.45 per share)— — — (88,300,000)— (88,300,000)— (88,300,000)
Net (loss) income— — — (13,379,000)— (13,379,000)2,675,000 (10,704,000)(1)
Other comprehensive loss— — — — (301,000)(301,000)— (301,000)
BALANCE — September 30, 2019194,389,974 $1,943,000 $1,735,527,000 $(806,427,000)$(2,861,000)$928,182,000 $158,318,000 $1,086,500,000 
___________
 Six Months Ended June 30, 2020
 Stockholders’ Equity     
 Common Stock             
 
Number
of
Shares
 Amount 
Additional
Paid-In
Capital
 
Accumulated
Deficit
 
Accumulated
Other
Comprehensive
Loss
 
Total
Stockholders’
Equity
 
Noncontrolling
Interests
 Total Equity 
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 DRIP2,325,762
 24,000
 21,837,000
 
 
 21,861,000
 
 21,861,000
 
Issuance of vested and nonvested restricted common stock7,500
 
 14,000
 
 
 14,000
 
 14,000
 
Amortization of nonvested common stock compensation
 
 86,000
 
 
 86,000
 
 86,000
 
Stock based compensation
 
 
 
 
 
 390,000
 390,000
 
Repurchase of common stock(1,893,413) (19,000) (17,967,000) 
 
 (17,986,000) 
 (17,986,000) 
Issuance of noncontrolling interest
 
 515,000
 
 
 515,000
 10,485,000
 11,000,000
 
Distributions to noncontrolling interests
 
 
 
 
 
 (149,000) (149,000) 
Reclassification of noncontrolling interests to mezzanine equity
 
 
 
 
 
 (390,000) (390,000) 
Fair value adjustment to redeemable noncontrolling interests
 
 260,000
 
 
 260,000
 111,000
 371,000
 
Distributions declared ($0.20 per share)
 
 
 (38,884,000) 
 (38,884,000) 
 (38,884,000) 
Net income
 
 
 3,850,000
 
 3,850,000
 8,200,000
 12,050,000
(1)
Other comprehensive loss
 
 
 
 (564,000) (564,000) 
 (564,000) 
BALANCE — June 30, 2020194,407,323
 $1,944,000
 $1,733,166,000
 $(862,584,000) $(2,819,000) $869,707,000
 $176,755,000
 $1,046,462,000
 

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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED STATEMENTS OF EQUITY — (Continued)
(1)For the Three and Six Months Ended Junethree months ended September 30, 2020 and 2019, amounts exclude $(160,000) and $17,000, respectively, of net (loss) income attributable to redeemable noncontrolling interests. For the nine months ended September 30, 2020 and 2019, amounts exclude $794,000 and $304,000, respectively, of net income attributable to redeemable noncontrolling interests. See Note 12, Redeemable Noncontrolling Interests, for a further discussion.
(Unaudited)


 Six Months Ended June 30, 2019
 Stockholders’ Equity     
 Common Stock             
 
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
 
 (84,000) 
 
 (84,000) 
 (84,000) 
Issuance of common stock under the DRIP3,021,493
 30,000
 28,281,000
 
 
 28,311,000
 
 28,311,000
 
Issuance of vested and nonvested restricted common stock7,500
 
 14,000
 
 
 14,000
 
 14,000
 
Amortization of nonvested common stock compensation
 
 86,000
 
 
 86,000
 
 86,000
 
Stock based compensation
 
 
 
 
 
 390,000
 390,000
 
Repurchase of common stock(5,850,352) (59,000) (55,076,000) 
 
 (55,135,000) 
 (55,135,000) 
Contributions from noncontrolling interests
 
 
 
 
 
 3,000,000
 3,000,000
 
Distributions to noncontrolling interests
 
 
 
 
 
 (3,635,000) (3,635,000) 
Reclassification of noncontrolling interests to mezzanine equity
 
 
 
 
 
 (390,000) (390,000) 
Fair value adjustment to redeemable noncontrolling interests
 
 58,000
 
 
 58,000
 26,000
 84,000
 
Distributions declared ($0.30 per share)
 
 
 (58,697,000) 
 (58,697,000) 
 (58,697,000) 
Net income
 
 
 3,925,000
 
 3,925,000
 2,491,000
 6,416,000
(1)
Other comprehensive loss
 
 
 
 (20,000) (20,000) 
 (20,000) 
BALANCE — June 30, 2019194,736,018
 $1,946,000
 $1,739,119,000
 $(759,520,000) $(2,580,000) $978,965,000
 $160,010,000
 $1,138,975,000
 
___________
(1)For the three months ended June 30, 2020 and 2019, amounts exclude $726,000 and $147,000, respectively, of the net income attributable to redeemable noncontrolling interests. For the six months ended June 30, 2020 and 2019, amounts exclude $954,000 and $287,000, 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.

8
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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
For the SixNine Months Ended JuneSeptember 30, 2020 and 2019
(Unaudited)

Nine Months Ended September 30,
20202019
CASH FLOWS FROM OPERATING ACTIVITIES
Net income (loss)$12,324,000 $(10,400,000)
Adjustments to reconcile net income (loss) to net cash provided by operating activities:
Depreciation and amortization74,250,000 87,149,000 
Other amortization23,239,000 22,625,000 
Deferred rent(4,596,000)(1,909,000)
Stock based compensation585,000 585,000 
Stock based compensation — nonvested restricted common stock128,000 172,000 
Loss from unconsolidated entities3,065,000 1,713,000 
Gain on dispositions of real estate investments(1,037,000)
Foreign currency loss1,192,000 1,653,000 
Loss on extinguishment of debt2,179,000 
Deferred income taxes(3,329,000)640,000 
Change in fair value of contingent consideration(681,000)
Change in fair value of derivative financial instruments5,671,000 5,846,000 
Impairment of real estate investments8,335,000 
Changes in operating assets and liabilities:
Accounts and other receivables17,036,000 (5,963,000)
Other assets(3,848,000)(2,631,000)
Accounts payable and accrued liabilities5,062,000 6,888,000 
Accounts payable due to affiliates2,531,000 47,000 
Security deposits, prepaid rent, operating lease and other liabilities51,077,000 (16,121,000)
Net cash provided by operating activities191,685,000 91,792,000 
CASH FLOWS FROM INVESTING ACTIVITIES
Developments and capital expenditures(93,657,000)(65,740,000)
Acquisitions of real estate investments(29,447,000)(32,793,000)
Proceeds from dispositions of real estate investments12,105,000 
Investments in unconsolidated entities(810,000)(1,520,000)
Real estate and other deposits(665,000)(652,000)
Principal repayments on real estate notes receivable28,650,000 
Net cash used in investing activities(112,474,000)(72,055,000)
CASH FLOWS FROM FINANCING ACTIVITIES
Borrowings under mortgage loans payable59,033,000 182,417,000 
Payments on mortgage loans payable(49,056,000)(59,706,000)
Early payoff of mortgage loans payable(2,601,000)(6,286,000)
Borrowings under the lines of credit and term loans115,755,000 955,053,000 
Payments on the lines of credit and term loans(76,000,000)(937,822,000)
Deferred financing costs(4,065,000)(12,486,000)
Debt extinguishment costs(251,000)
Borrowing under financing obligation1,907,000 
Payments on financing obligations(4,301,000)(6,243,000)
Distributions paid(26,997,000)(46,716,000)
Repurchase of common stock(23,107,000)(72,200,000)
9
 Six Months Ended June 30,
 2020 2019
CASH FLOWS FROM OPERATING ACTIVITIES   
Net income$13,004,000
 $6,703,000
Adjustments to reconcile net income to net cash provided by operating activities:   
Depreciation and amortization49,659,000
 50,371,000
Other amortization15,534,000
 15,211,000
Deferred rent(2,526,000) (3,403,000)
Stock based compensation390,000
 390,000
Stock based compensation — nonvested restricted common stock100,000
 100,000
Loss from unconsolidated entities210,000
 947,000
Bad debt expense
 272,000
Foreign currency loss3,155,000
 189,000
Deferred income taxes(3,329,000) (110,000)
Change in fair value of contingent consideration
 (681,000)
Change in fair value of derivative financial instruments7,434,000
 4,677,000
Impairment of real estate investments8,335,000
 
Changes in operating assets and liabilities:   
Accounts and other receivables25,527,000
 (8,475,000)
Other assets(2,385,000) (1,761,000)
Accounts payable and accrued liabilities(10,532,000) 2,474,000
Accounts payable due to affiliates(76,000) 429,000
Security deposits, prepaid rent, operating lease and other liabilities44,367,000
 (13,502,000)
Net cash provided by operating activities148,867,000
 53,831,000
CASH FLOWS FROM INVESTING ACTIVITIES   
Capital expenditures(65,083,000) (38,510,000)
Acquisitions of real estate investments(1,478,000) (17,457,000)
Investments in unconsolidated entities(810,000) (1,520,000)
Real estate and other deposits(561,000) (613,000)
Principal repayments on real estate notes receivable
 28,650,000
Net cash used in investing activities(67,932,000)
(29,450,000)
CASH FLOWS FROM FINANCING ACTIVITIES   
Borrowings under mortgage loans payable17,502,000
 61,472,000
Payments on mortgage loans payable(6,348,000) (6,331,000)
Borrowings under the lines of credit and term loans77,000,000
 692,519,000
Payments on the lines of credit and term loans(50,000,000) (673,000,000)
Borrowing under financing obligation1,907,000
 
Payments under financing obligations(3,029,000) (3,731,000)
Deferred financing costs(1,318,000) (6,807,000)
Repurchase of common stock(17,986,000) (55,088,000)
Repurchase of stock warrants and redeemable noncontrolling interests(150,000) (78,000)
Issuance of noncontrolling interest11,000,000
 
Contributions from noncontrolling interests
 3,000,000
Distributions to noncontrolling interests(149,000) (3,635,000)
Distributions to redeemable noncontrolling interests(437,000) (720,000)

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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS — (Continued)
For the SixNine Months Ended JuneSeptember 30, 2020 and 2019
(Unaudited)

Nine Months Ended September 30,
20202019
Issuance of noncontrolling interest$11,000,000 $
Contributions from noncontrolling interests3,000,000 
Distributions to noncontrolling interests(334,000)(5,449,000)
Distributions to redeemable noncontrolling interests(439,000)(1,033,000)
Repurchase of stock warrants and redeemable noncontrolling interests(150,000)(475,000)
Security deposits and other(47,000)36,000 
Net cash provided by (used in) financing activities598,000 (8,161,000)
NET CHANGE IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH$79,809,000 $11,576,000 
EFFECT OF FOREIGN CURRENCY TRANSLATION ON CASH, CASH EQUIVALENTS AND RESTRICTED CASH(73,000)(108,000)
CASH, CASH EQUIVALENTS AND RESTRICTED CASH — Beginning of period89,880,000 72,705,000 
CASH, CASH EQUIVALENTS AND RESTRICTED CASH — End of period$169,616,000 $84,173,000 
RECONCILIATION OF CASH, CASH EQUIVALENTS AND RESTRICTED CASH
Beginning of period:
Cash and cash equivalents$53,149,000 $35,132,000 
Restricted cash36,731,000 37,573,000 
Cash, cash equivalents and restricted cash$89,880,000 $72,705,000 
End of period:
Cash and cash equivalents$133,332,000 $46,709,000 
Restricted cash36,284,000 37,464,000 
Cash, cash equivalents and restricted cash$169,616,000 $84,173,000 
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION
Cash paid for:
Interest$49,524,000 $52,171,000 
Income taxes$524,000 $634,000 
SUPPLEMENTAL DISCLOSURE OF NONCASH ACTIVITIES
Investing Activities:
Accrued developments and capital expenditures$30,615,000 $16,440,000 
Capital expenditures from financing obligations$1,053,000 $8,434,000 
Tenant improvement overage$4,485,000 $1,016,000 
Investments in unconsolidated entity$$5,276,000 
The following represents the increase (decrease) in certain assets and liabilities in connection with our acquisitions and dispositions of real estate investments:
Accounts and other receivables$(11,000)$
Other assets, net$(253,000)$
Accounts payable and accrued liabilities$(82,000)$46,000 
Security deposits, prepaid rent and other liabilities$(459,000)$105,000 
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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS — (Continued)
For the Nine Months Ended September 30, 2020 and 2019
(Unaudited)
 Six Months Ended June 30,
 2020 2019
Security deposits and other$(11,000) $(55,000)
Distributions paid(26,997,000) (30,886,000)
Net cash provided by (used in) financing activities984,000
 (23,340,000)
NET CHANGE IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH$81,919,000
 $1,041,000
EFFECT OF FOREIGN CURRENCY TRANSLATION ON CASH, CASH EQUIVALENTS AND RESTRICTED CASH(118,000) (23,000)
CASH, CASH EQUIVALENTS AND RESTRICTED CASH — Beginning of period89,880,000
 72,705,000
CASH, CASH EQUIVALENTS AND RESTRICTED CASH — End of period$171,681,000
 $73,723,000
    
RECONCILIATION OF CASH, CASH EQUIVALENTS AND RESTRICTED CASH   
Beginning of period:   
Cash and cash equivalents$53,149,000
 $35,132,000
Restricted cash36,731,000
 37,573,000
Cash, cash equivalents and restricted cash$89,880,000
 $72,705,000
    
End of period:   
Cash and cash equivalents$134,338,000
 $34,026,000
Restricted cash37,343,000
 39,697,000
Cash, cash equivalents and restricted cash$171,681,000
 $73,723,000
    
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION   
Cash paid for:   
Interest$33,964,000
 $34,783,000
Income taxes$189,000
 $544,000
SUPPLEMENTAL DISCLOSURE OF NONCASH ACTIVITIES   
Investing Activities:   
Accrued capital expenditures$26,929,000
 $14,332,000
Capital expenditures from financing obligations$1,053,000
 $6,735,000
Tenant improvement overage$3,720,000
 $645,000
Investments in unconsolidated entity$
 $5,276,000
The following represents the increase in certain liabilities in connection with our acquisitions of real estate investments:   
Accounts payable and accrued liabilities$
 $37,000
Prepaid rent$
 $105,000
Financing Activities:   
Issuance of common stock under the DRIP$21,861,000
 $28,311,000
Distributions declared but not paid$
 $9,689,000
Reclassification of noncontrolling interests to mezzanine equity$390,000
 $390,000
Accrued deferred financing costs$49,000
 $51,000
Payable to transfer agent$
 $47,000
Nine Months Ended September 30,
20202019
Financing Activities:
Issuance of common stock under the DRIP$21,861,000 $42,100,000 
Distributions declared but not paid$$9,673,000 
Reclassification of noncontrolling interests to mezzanine equity$585,000 $585,000 
Payable to transfer agent$$256,000 
The accompanying notes are an integral part of these condensed consolidated financial statements.

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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited)
For the Three and SixNine Months Ended JuneSeptember 30, 2020 and 2019
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, 2013.2013. 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.
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. We commenced offering shares pursuant to the 2019 DRIP Offering on April 1, 2019, following the deregistration of the 2015 DRIP Offering. On May 29, 2020, in consideration of the impact the coronavirus, or COVID-19, pandemic has had on the United States, globally and our business operations, our board of directors, or our board, authorized the suspension of the Amended and Restated DRIP until such time, if any, as our board determines to authorize new distributions and to reinstate such plan. Such suspension was effective upon the completion of all shares issued with respect to distributions payable to stockholders of record on or prior to the close of business on May 31, 2020. See Note 13, Equity, for a further discussion. As of JuneSeptember 30, 2020, a total of $63,105,000 in distributions were reinvested that resulted in 6,724,348 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.
We conduct substantially all of our operations through Griffin-American Healthcare REIT III Holdings, LP, or our operating partnership. We are externally advised byGriffin-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 11, 2020 and expires on February 26, 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, 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

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

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
12

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GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
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,our advisor, American Healthcare Investors and AHI Group Holdings.
We currently operate through six6 reportable business segments: medical office buildings, hospitals, skilled nursing facilities, senior housing, senior housing — RIDEA and integrated senior health campuses. As of JuneSeptember 30, 2020, we owned and/or operated 9897 properties, comprising 102101 buildings, and 119118 integrated senior health campuses including completed development projects, or approximately 13,907,00013,880,000 square feet of gross leasable area, or GLA, for an aggregate contract purchase price of $3,003,934,000.$3,031,654,000. In addition, as of JuneSeptember 30, 2020, we also owned a real estate-related 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 operateand intend tocontinue 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 both JuneSeptember 30, 2020 and December 31, 2019, we owned greater than a 99.99% general partnership interest therein. Our advisor is a limited partner, and as of both JuneSeptember 30, 2020 and December 31, 2019, 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 SECthe SEC’s 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 2019 Annual Report on Form 10-K, as filed with the SEC on March 26, 2020.

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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. 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, revenues and grant income, 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.
Revenue Recognition Resident Fees and Services Revenue
Disaggregation of Resident Fees and Services Revenue
The following tables disaggregate 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 June 30,Three Months Ended September 30,
 2020 201920202019
 Point in Time Over Time Total Point in Time Over Time TotalPoint in TimeOver TimeTotalPoint in TimeOver TimeTotal
Integrated senior health campuses $46,753,000
 $186,079,000
 $232,832,000
 $53,390,000
 $202,651,000
 $256,041,000
Integrated senior health campuses$48,841,000 $193,873,000 $242,714,000 $53,215,000 $203,833,000 $257,048,000 
Senior housing — RIDEA(1) 636,000
 21,149,000
 21,785,000
 735,000
 15,696,000
 16,431,000
Senior housing — RIDEA(1)673,000 20,544,000 21,217,000 737,000 16,015,000 16,752,000 
Total resident fees and services $47,389,000
 $207,228,000
 $254,617,000
 $54,125,000
 $218,347,000
 $272,472,000
Total resident fees and services$49,514,000 $214,417,000 $263,931,000 $53,952,000 $219,848,000 $273,800,000 
Nine Months Ended September 30,
20202019
Point in TimeOver TimeTotalPoint in TimeOver TimeTotal
Integrated senior health campuses$150,122,000 $593,218,000 $743,340,000 $158,948,000 $605,855,000 $764,803,000 
Senior housing — RIDEA(1)2,181,000 62,953,000 65,134,000 2,183,000 47,568,000 49,751,000 
Total resident fees and services$152,303,000 $656,171,000 $808,474,000 $161,131,000 $653,423,000 $814,554,000 
  Six Months Ended June 30,
  2020 2019
  Point in Time Over Time Total Point in Time Over Time Total
Integrated senior health campuses $101,281,000
 $399,345,000
 $500,626,000
 $105,733,000
 $402,022,000
 $507,755,000
Senior housing — RIDEA(1) 1,508,000
 42,409,000
 43,917,000
 1,446,000
 31,553,000
 32,999,000
Total resident fees and services $102,789,000
 $441,754,000
 $544,543,000
 $107,179,000
 $433,575,000
 $540,754,000
The following tables disaggregate our resident fees and services revenue by payor class:
 Three Months Ended June 30,Three Months Ended September 30,
 2020 201920202019
 
Integrated
Senior Health
Campuses
 
Senior
Housing
 — RIDEA(1)
 Total 
Integrated
Senior Health
Campuses
 
Senior
Housing
 — RIDEA(1)
 TotalIntegrated
Senior Health
Campuses
Senior
Housing
 — RIDEA(1)
TotalIntegrated
Senior Health
Campuses
Senior
Housing
 — RIDEA(1)
Total
Private and other payors $112,258,000
 $21,379,000
 $133,637,000
 $124,917,000
 $16,410,000
 $141,327,000
Private and other payors$112,601,000 $20,815,000 $133,416,000 $125,337,000 $16,741,000 $142,078,000 
Medicare 70,946,000
 
 70,946,000
 84,481,000
 
 84,481,000
Medicare79,688,000 79,688,000 81,965,000 81,965,000 
Medicaid 49,628,000
 406,000
 50,034,000
 46,643,000
 21,000
 46,664,000
Medicaid50,425,000 402,000 50,827,000 49,746,000 11,000 49,757,000 
Total resident fees and services $232,832,000
 $21,785,000
 $254,617,000
 $256,041,000
 $16,431,000
 $272,472,000
Total resident fees and services$242,714,000 $21,217,000 $263,931,000 $257,048,000 $16,752,000 $273,800,000 

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 Six Months Ended June 30,Nine Months Ended September 30,
 2020 201920202019
 
Integrated
Senior Health
Campuses
 
Senior
Housing
 — RIDEA(1)
 Total 
Integrated
Senior Health
Campuses
 
Senior
Housing
 — RIDEA(1)
 TotalIntegrated
Senior Health
Campuses
Senior
Housing
 — RIDEA(1)
TotalIntegrated
Senior Health
Campuses
Senior
Housing
 — RIDEA(1)
Total
Private and other payors $240,525,000
 $43,079,000
 $283,604,000
 $247,118,000
 $32,965,000
 $280,083,000
Private and other payors$353,126,000 $63,894,000 $417,020,000 $372,455,000 $49,706,000 $422,161,000 
Medicare 158,165,000
 
 158,165,000
 168,958,000
 
 168,958,000
Medicare237,853,000 237,853,000 250,923,000 250,923,000 
Medicaid 101,936,000
 838,000
 102,774,000
 91,679,000
 34,000
 91,713,000
Medicaid152,361,000 1,240,000 153,601,000 141,425,000 45,000 141,470,000 
Total resident fees and services $500,626,000
 $43,917,000
 $544,543,000
 $507,755,000
 $32,999,000
 $540,754,000
Total resident fees and services$743,340,000 $65,134,000 $808,474,000 $764,803,000 $49,751,000 $814,554,000 
___________
(1)Includes fees for basic housing and assisted living care. We record revenue when services are rendered 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.
(1)Includes fees for basic housing and assisted living care. We record revenue when services are rendered 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.
Accounts Receivable, Net Resident Fees and Services Revenue
The beginning and ending balances of accounts receivable, netresident fees and services are as follows:
 Medicare Medicaid 
Private
and
Other Payors
 TotalPrivate
and
Other Payors
MedicareMedicaidTotal
Beginning balanceJanuary 1, 2020
 $32,127,000
 $26,366,000
 $46,543,000
 $105,036,000
Beginning balanceJanuary 1, 2020
$46,543,000 $32,127,000 $26,366,000 $105,036,000 
Ending balanceJune 30, 2020
 26,959,000
 20,013,000
 37,994,000
 84,966,000
Ending balanceSeptember 30, 2020
Ending balanceSeptember 30, 2020
38,593,000 29,054,000 18,232,000 85,879,000 
Decrease $(5,168,000) $(6,353,000) $(8,549,000) $(20,070,000)Decrease$(7,950,000)$(3,073,000)$(8,134,000)$(19,157,000)
Deferred Revenue Resident Fees and Services Revenue
The beginning and ending balances of deferred revenueresident fees and services, almost all of which relates to private and other payors, are as follows:
  Total
Beginning balance — January 1, 2020
 $13,518,000
Ending balance — June 30, 2020
 12,042,000
Decrease $(1,476,000)
Total
Beginning balanceJanuary 1, 2020
$13,518,000 
Ending balanceSeptember 30, 2020
11,977,000 
Decrease$(1,541,000)
In addition to the deferred revenue above, we received approximately $52,322,000 of Medicare advance payments through an expanded program of the Centers for Medicare & Medicaid Services, or CMS. Such amounts will be recognized as resident fees and services revenue for actual services performed and Medicare claims billed commencingonce our recoupment period commences in August 2020.2021. See Note 11, Commitments and Contingencies — Impact of the COVID-19 Pandemic, for a further discussion.
Government Grants
We have been granted reliefstimulus funds through various federal and state government programs, such as through the Coronavirus Aid, Relief, and Economic Security Act, or the CARES Act, passed by the federal government on March 27, 2020, which were established for eligible healthcare providers to preserve liquidity in response to lost revenues and/or increased healthcare expenses (as such terms are defined in the applicable regulatory guidance) associated with the COVID-19 pandemic. Such grants are not loans and, as such, are not required to be repaid, subject to certain conditions. We recognize government grants as grant income or as a reduction of property operating expenses, as applicable, in our accompanying condensed consolidated statements of operations and comprehensive income (loss) when there is reasonable assurance that the grants will be received and theall conditions to retain the funds have beenwill be met. Further,We adjust our estimates and assumptions based on the applicable guidance provided by the government and the best available information that we recognize such grants on a systematic basis in the period that suchhave. Any stimulus or other relief funds correspond with the lost revenues and/or increased expenses that they were intended to compensate. For both the three and six months ended June 30, 2020, we recognized government grants of $29,990,000 as grant income and $276,000 as a reduction of property operating expenses. As of June 30, 2020, we deferred $7,260,000 in grant income to recognize in future periods. Such deferred amounts are included in

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received that are not expected to be used in accordance with such terms and conditions will be returned to the government, and any related deferred income will not be recognized.
For the three and nine months ended September 30, 2020, we recognized government grants of $740,000 and $30,730,000, respectively, as grant income, and $0 and $276,000, respectively, as a reduction of property operating expenses. As of September 30, 2020, we deferred approximately $20,735,000 of grant money received until such time as it is earned. Such deferred amounts are included in security deposits, prepaid rent and other liabilities in our accompanying condensed consolidated balance sheet. As of and for the three and sixnine months ended JuneSeptember 30, 2019, we did not0t recognize any government grants.
Tenant and Resident Receivables and Allowances
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 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. Substantially 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 (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 reduced for uncollectible amounts, which are recognized as direct reductions of real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive income (loss).
As of JuneSeptember 30, 2020 and December 31, 2019, we had $10,853,000$10,527,000 and $11,435,000, respectively, in allowances, which were determined necessary to reduce receivables by our expected future credit losses. For the sixnine months ended JuneSeptember 30, 2020 and 2019, we increased allowances by $7,331,000$9,841,000 and $5,289,000,$8,065,000, respectively, and reduced allowances for collections or adjustments by $4,545,000$5,942,000 and $2,407,000,$1,773,000, respectively. For the sixnine months ended JuneSeptember 30, 2020 and 2019, $3,368,000$4,807,000 and $2,587,000,$4,610,000, 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.
WeFor the nine months ended September 30, 2020, we determined that one1 skilled nursing facility and 1 medical office building and one skilled nursing facility were impaired and recognized an aggregate impairment charge of $1,905,000 and $5,616,000, for the three and six months ended June 30, 2020, respectively, which reduced the total aggregate carrying value of such assets to $7,040,000. The carrying value of such medical office building was then reclassified to properties held for sale, which is included in other assets, net in our accompanying condensed consolidated balance sheets. The fair values of such impaired properties were based on their projected sales priceprices obtained from an independent third party using comparable market information and adjusted for anticipated selling costs of such properties, which were considered Level 2 measurements within the fair value hierarchy. NoWe disposed of such impaired medical office building in July 2020 for a contract sales price of $3,500,000 and recognized a net gain on sale of $15,000. We did 0t recognize impairment charges on long-lived assets were recognized for both the three and sixnine months ended JuneSeptember 30, 2019.
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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 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 and sixnine months ended JuneSeptember 30, 2020, we determined that the fair values of two2 integrated senior health campuses that were held for sale were lower than their carrying amounts, and as such, we recognized an aggregate impairment charge of $1,328,000 and $2,719,000, respectively, which reduced the total aggregate carrying value of such assets to $807,000. The fair values of such

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properties were based on their projected sales priceprices obtained from an independent third party using comparable market information and adjusted for anticipated selling costs of such properties, which were considered Level 2 measurements within the fair value hierarchy. NoIn August 2020, we disposed of 1 such integrated senior health campus included in properties held for sale for a contract sales price of $10,000,000 and recognized a net gain on sale of $1,022,000. We did 0t recognize impairment charges on properties held for sale were recognized for both the three and sixnine months ended JuneSeptember 30, 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 both the three and sixnine months ended JuneSeptember 30, 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.
Other Assets, Net
Other assets, net consist of investments in unconsolidated entities, inventory, prepaid expenses and deposits, deferred financing costs related to our lines of credit and term loans, deferred rent receivables, deferred tax assets, derivative financial instruments, lease inducements and lease commissions.
We report investments in unconsolidated entities using the equity method of accounting when we have the ability to exercise significant influence over the operating and financial policies. Under the equity method, our share of the investee’s earnings or losses is included in our accompanying condensed consolidated statements of operations and comprehensive income (loss). We generally discontinue recognition of equity method losses when our share of the investee’s losses equals or exceeds our equity method investment balance plus any advances for such investee, unless we have committed to provide such investee additional financial support or guaranteed its obligations. To the extent that our cost basis is different from the basis reflected at the entity level, the basis difference is generally amortized over the lives of the related assets and liabilities, and such amortization is included in our share of equity in earnings of the entity. The initial carrying value of investments in unconsolidated entities is based on the amount paid to purchase the entity interest or the estimated fair value of the assets prior to the sale of interests in the entity. We have elected to follow the cumulative earnings approach when classifying distributions received from equity method investments in our condensed consolidated statements of cash flows, whereby any distributions received up to the amount of cumulative equity earnings will be considered a return on investment and classified in operating activities and any excess distributions would be considered a return of investment and classified in investing activities. We evaluate our equity method investments for impairment based upon a comparison of the estimated fair value of the equity method investment to its carrying value. When we determine a decline in the estimated fair value of such an investment below its carrying value is other-than-temporary, an impairment is recorded. For the three and sixnine months ended JuneSeptember 30, 2020 and 2019, we did not incur any impairment losses from unconsolidated entities.
Inventory consists primarily of pharmaceutical and medical supplies and is stated at the lower of cost (first-in, first-out) or market. Deferred financing costs related to our lines of credit and term loans include amounts paid to lenders and others to obtain such financing. Such costs are amortized using the straight-line method over the term of the related loan, which approximates the effective interest rate method. Amortization of deferred financing costs related to our lines of credit and term loans is included in interest expense in our accompanying condensed consolidated statements of operations and comprehensive income (loss). Lease commissions are amortized using the straight-line method over the term of the related lease. Prepaid expenses are amortized over the related contract periods.
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See Note 6, Other Assets, Net, for a further discussion.
Accounts Payable and Accrued Liabilities
As of JuneSeptember 30, 2020 and December 31, 2019, accounts payable and accrued liabilities primarily includes insurance reserves of $34,086,000 and $35,581,000, respectively, reimbursement of payroll relatedpayroll-related costs to the managers of our senior housing — RIDEA facilities and integrated senior health campuses of $29,906,000$43,555,000 and $24,118,000, respectively, insurance reserves of $33,489,000 and $35,581,000, respectively, accrued developments and capital expenditures to unaffiliated third parties of $26,754,000$30,500,000 and $25,019,000, respectively, accrued property taxes of $15,749,000$17,872,000 and $14,501,000, respectively, and accrued distributions of $0 and $9,974,000, respectively.

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Income Taxes
We qualified, and elected 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. To maintain our qualification as a REIT, we must meet certain organizational and operational requirements, including a requirement to distribute to our stockholders a minimum percentageof 90.0% of our annual taxable income, excluding net capital gains. Such distributions are required to be paid at least 20.0% in cash and 80.0% in stock. In May 2020, in response to the COVID-19 pandemic, the Internal Revenue Service, or IRS, temporarily reduced the cash distribution requirement from a minimum of 90.0% of our taxable income to a minimum of 10.0%, which is applicable with respect to the aggregate distributions declared on or after April 1, 2020 until December 31, 2020. As a REIT, we generally will not be subject to federal income tax on taxable income that we distribute to our stockholders.
If we fail to maintain our qualification as a REIT in any taxable year, we will then be subject to federal income taxes on our taxable income at regular corporate rates and will not be permitted to qualify for treatment as a REIT for federal income tax purposes for four years following the year during which qualification is lost unless the IRS grants us relief under certain statutory provisions. Such an event could have a material adverse effect on our net income and net cash available for distribution to our stockholders.
We may be subject to certain state and local income taxes on our income, property or net worth in some jurisdictions, and in certain circumstances we may also be subject to federal excise taxes on undistributed income. In addition, certain activities that we undertake are conducted by subsidiaries, which we elected to be treated as taxable REIT subsidiaries, or TRS, to allow us to provide services that would otherwise be considered impermissible for REITs. Also, we have real estate investments in the United Kingdom, or UK, and Isle of Man, which do not accord REIT status to United States REITs under their tax laws. Accordingly, we recognize an income tax benefit or expense for the federal, state and local income taxes incurred by our TRS and foreign income taxes on our real estate investments in the UK and Isle of Man.
We follow ASC Topic 740, Income Taxes,, or ASC Topic 740, to recognize, measure, present and disclose in our accompanying condensed consolidated financial statements uncertain tax positions that we have taken or expect to take on a tax return. As of and for the three and sixnine months ended JuneSeptember 30, 2020 and 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 account for deferred income taxes using the asset and liability method and recognize deferred tax assets and liabilities for the expected future tax consequences of events that have been included in our financial statements or tax returns. Under this method, we determine deferred tax assets and liabilities based on the temporary differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases using enacted tax rates in effect for the year in which the differences are expected to reverse. Deferred tax assets reflect the impact of the future deductibility of operating loss carryforwards. A valuation allowance is provided if we believe it is more likely than not that all or some portion of the deferred tax asset will not be realized. Any increase or decrease in the valuation allowance that results from a change in circumstances, and that causes us to change our judgment about the realizability of the related deferred tax asset, is included in income tax benefit or expense in our accompanying condensed consolidated statements of operations and comprehensive income (loss) when such changes occur. Any increase or decrease in the deferred tax liability that results from a change in circumstances, and that causes us to change our judgment about expected future tax consequences of events, is recorded in income tax benefit or expense in our accompanying condensed consolidated statements of operations and comprehensive income (loss).
Deferred tax assets are included in other assets, net, and deferred tax liabilities are included in security deposits, prepaid rent and other liabilities, in our accompanying condensed consolidated balance sheets.
See Note 16, Income Taxes, for a further discussion.
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Recently Issued Accounting Pronouncements
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 the London Inter-bank Offered Rate, or 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.

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In April 2020, the FASB issued a question and answer document, or the Lease Modification Q&A, to provide guidance for the application of lease accounting modifications within ASC Topic 842, Leases, or ASC Topic 842, to lease concessions granted by lessors related to the effects of the COVID-19 pandemic. Lease accounting modification guidance in ASC Topic 842 addresses routine changes or enforceable rights and obligations to lease terms as a result of negotiations between the lessor and the lessee; however, the guidance does not take into consideration concessions granted to address sudden liquidity constraints of lessees arising from the COVID-19 pandemic. The underlying premise of ASC Topic 842 requires a modified lease to be accounted for as a new lease if the modified terms and conditions affect the economics of the lease for the remainder of the lease term. Further, a lease modification resulting from lease concessions would require the application of the modification framework pursuant to ASC Topic 842 on a lease-by-lease basis. The potential large volume of contracts to be assessed due to the COVID-19 pandemic may be burdensome and complex for entities to evaluate the lease modification accounting for each lease. Therefore, the Lease Modification Q&A allows entities to elect to account for lease concessions related to the effects of the COVID-19 pandemic as if they were granted under the enforceable rights included in the original contract and are outside of the lease modification framework pursuant to ASC Topic 842. Such election is available for lease concessions that do not result in a substantial increase in the rights of the lessor or the obligations of the lessee (e.g., total payments required by the modified contract being substantially the same as or less than total payments required by the original contract) and is to be applied consistently to leases with similar characteristics and circumstances.
As a result of the COVID-19 pandemic, we have granted lease concessions to an insignificant number of tenants within our medical office building segment, such as in the form of rent abatements with lease term extensions and rent payment deferrals requiring payment within one year. Such concessions were not material to our condensed consolidated financial statements, and as such, we elected not to apply the relief from lease modification accounting provided in the Lease Modification Q&A. We evaluate each lease concession granted as a result of the COVID-19 pandemic to determine whether the concession reflects: (i) a resolution of contractual rights in the original lease and is thus outside of the lease modification framework of ASC Topic 842; or (ii) a modification for which we would be required to apply the lease modification framework of ASC Topic 842. The application of the lease modification framework of ASC Topic 842 to lease concessions granted due to the effects of the COVID-19 pandemic did not have a material impact to our condensed consolidated financial statements.
3. Real Estate Investments, Net
Our real estate investments, net consisted of the following as of JuneSeptember 30, 2020 and December 31, 2019:
 September 30,
2020
December 31,
2019
Building, improvements and construction in process$2,361,877,000 $2,262,320,000 
Land and improvements199,528,000 195,491,000 
Furniture, fixtures and equipment167,675,000 150,508,000 
2,729,080,000 2,608,319,000 
Less: accumulated depreciation(402,138,000)(337,898,000)
$2,326,942,000 $2,270,421,000 
 
June 30,
2020
 December 31,
2019
Building, improvements and construction in process$2,308,181,000
 $2,262,320,000
Land and improvements197,034,000
 195,491,000
Furniture, fixtures and equipment163,661,000
 150,508,000
 2,668,876,000
 2,608,319,000
Less: accumulated depreciation(380,685,000) (337,898,000)
 $2,288,191,000
 $2,270,421,000
Depreciation expense for the three months ended JuneSeptember 30, 2020 and 2019 was $22,518,000$22,699,000 and $21,530,000,$25,062,000, respectively, and for the sixnine months ended JuneSeptember 30, 2020 and 2019 was $45,260,000$67,959,000 and $43,734,000,$68,796,000, respectively. For the three months ended JuneSeptember 30, 2020, we incurred capital expenditures of $28,675,000$29,390,000 for our integrated senior health campuses, $7,273,000$3,997,000 for our medical office buildings, and $213,000$255,000 for our senior housing —RIDEA facilities. We did not incur any capital expenditures for our hospitals, senior housing and skilled nursing facilities for the three months ended June 30, 2020. For the six months ended June 30, 2020, we incurred capital expenditures of $59,007,000 for our integrated senior health campuses, $11,472,000 for our medical office buildings, $467,000 for our senior housing —RIDEA facilities and $15,000$19,000 for our hospitals. We did not0t incur any capital expenditures for our senior housing and skilled nursing facilities for the sixthree months ended JuneSeptember 30, 2020. For the nine months ended September 30, 2020, we incurred capital expenditures of $88,397,000 for our integrated senior health campuses, $15,469,000 for our medical office buildings, $722,000 for our senior
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housing —RIDEA facilities and $34,000 for our hospitals. We did 0t incur any capital expenditures for our senior housing and skilled nursing facilities for the nine months ended September 30, 2020.
Included in the capital expenditure amounts above are completed expansionscosts for the development and expansion of our integrated senior health campuses. For the sixnine months ended JuneSeptember 30, 2020, we completed the development of 1 integrated senior health campus for $15,621,000 and incurred $1,401,000$2,573,000 to expand 2 of our existing integrated senior health campuses. ForIn addition, for the sixnine months ended JuneSeptember 30, 2020, we, through a majority-owned subsidiary of Trilogy Investors, LLC, or Trilogy, of which we owned 67.6% at the time of acquisition, also 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.

Acquisitions of Previously Leased Real Estate Investments
19

For the nine months ended September 30, 2020, we, through a majority-owned subsidiary of Trilogy, of which we owned 67.6% at the time of acquisition, acquired 2 previously leased real estate investments located in Indiana and Kentucky. The following is a summary of such acquisitions for the nine months ended September 30, 2020, which are included in our integrated senior health campuses segment:
LocationDate
Acquired
Contract
Purchase Price
Line of Credit(1)Acquisition
Fee(2)
Monticello, IN07/30/20$10,600,000 $13,200,000 $161,000 
Louisville, KY07/30/2016,719,000 15,055,000 254,000 
Total$27,319,000 $28,255,000 $415,000 
Table___________
(1)Represents borrowings under the 2019 Trilogy Credit Facility, as defined in Note 8, Lines of ContentsCredit and Term Loans, at the time of acquisition.

(2)Our advisor was paid, as compensation for services rendered in connection with the investigation, selection and acquisition of our properties, an acquisition fee of 2.25% of the portion of the contract purchase price of the properties attributed to our ownership interest in the Trilogy subsidiary that acquired the properties.
GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.For the nine months ended September 30, 2020, we accounted for our property acquisitions as asset acquisitions. We incurred and capitalized closing costs and direct acquisition related expenses of $684,000 for such acquisitions. The following table summarizes the purchase price of the assets acquired at the time of acquisition, adjusted for $14,281,000 of operating lease right-of-use assets and $15,530,000 of operating lease liabilities, and based on their relative fair values:
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
2020
Acquisitions
Building and improvements$26,311,000 
Land3,399,000 
Total assets acquired$29,710,000 

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 JuneSeptember 30, 2020 and December 31, 2019, the carrying amount of the debt security investment was $74,253,000$75,037,000 and $72,717,000, respectively, net of unamortized closing costs of $1,294,000$1,250,000 and $1,375,000, respectively. Accretion on the debt security for the three months ended JuneSeptember 30, 2020 and 2019 was $818,000$828,000 and $742,000,$751,000, respectively, and for the sixnine months ended JuneSeptember 30, 2020 and 2019was $1,617,000$2,445,000 and $1,467,000,$2,218,000, 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 JuneSeptember 30, 2020 and 2019 was $41,000$44,000 and $35,000,$37,000, respectively, and
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for the sixnine months ended JuneSeptember 30, 2020 and 2019 was $81,000$125,000 and $68,000,$105,000, 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 both the three and sixnine months ended JuneSeptember 30, 2020.
5. Identified Intangible Assets, Net
Identified intangible assets, net consisted of the following as of JuneSeptember 30, 2020 and December 31, 2019:
September 30,
2020
December 31,
2019
Amortized intangible assets:
In-place leases, net of accumulated amortization of $21,451,000 and $21,029,000 as of September 30, 2020 and December 31, 2019, respectively (with a weighted average remaining life of 9.4 years as of both September 30, 2020 and December 31, 2019)$24,649,000 $30,407,000 
Customer relationships, net of accumulated amortization of $448,000 and $336,000 as of September 30, 2020 and December 31, 2019, respectively (with a weighted average remaining life of 15.9 years and 16.8 years as of September 30, 2020 and December 31, 2019, respectively)2,392,000 2,504,000 
Above-market leases, net of accumulated amortization of $2,106,000 and $2,057,000 as of September 30, 2020 and December 31, 2019, respectively (with a weighted average remaining life of 4.7 years and 5.0 years as of September 30, 2020 and December 31, 2019, respectively)1,127,000 1,452,000 
Internally developed technology and software, net of accumulated amortization of $282,000 and $211,000 as of September 30, 2020 and December 31, 2019, respectively (with a weighted average remaining life of 1.9 years and 2.8 years as of September 30, 2020 and December 31, 2019, respectively)188,000 259,000 
Unamortized intangible assets:
Certificates of need95,887,000 94,838,000 
Trade names30,429,000 30,787,000 
$154,672,000 $160,247,000 
 
June 30,
2020
 
December 31,
2019
Amortized intangible assets:   
In-place leases, net of accumulated amortization of $22,377,000 and $21,029,000 as of June 30, 2020 and December 31, 2019, respectively (with a weighted average remaining life of 9.3 years and 9.4 years as of June 30, 2020 and December 31, 2019, respectively)$25,901,000
 $30,407,000
Customer relationships, net of accumulated amortization of $411,000 and $336,000 as of June 30, 2020 and December 31, 2019, respectively (with a weighted average remaining life of 16.3 years and 16.8 years as of June 30, 2020 and December 31, 2019, respectively)2,429,000
 2,504,000
Above-market leases, net of accumulated amortization of $2,116,000 and $2,057,000 as of June 30, 2020 and December 31, 2019, respectively (with a weighted average remaining life of 4.8 years and 5.0 years as of June 30, 2020 and December 31, 2019, respectively)1,233,000
 1,452,000
Internally developed technology and software, net of accumulated amortization of $258,000 and $211,000 as of June 30, 2020 and December 31, 2019, respectively (with a weighted average remaining life of 2.3 years and 2.8 years as of June 30, 2020 and December 31, 2019, respectively)212,000
 259,000
Unamortized intangible assets:   
Certificates of need96,670,000
 94,838,000
Trade names30,787,000
 30,787,000
 $157,232,000
 $160,247,000
Amortization expense for the three months ended JuneSeptember 30, 2020 and 2019 was $1,777,000$1,562,000 and $3,094,000,$11,566,000, respectively, which included $107,000$106,000 and $132,000,$131,000, respectively, of amortization recorded against real estate revenue for above-market leases in our accompanying condensed consolidated statements of operations and comprehensive income (loss). Amortization expense for the sixnine months ended JuneSeptember 30, 2020and 2019 was $3,883,000$5,445,000 and $6,439,000,$18,005,000, respectively, which included $219,000$325,000 and $344,000,$475,000, 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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The aggregate weighted average remaining life of the identified intangible assets was 9.7 years as of both JuneSeptember 30, 2020 and December 31, 2019. As of JuneSeptember 30, 2020, estimated amortization expense on the identified intangible assets for the sixthree months ending December 31, 2020 and for each of the next four years ending December 31 and thereafter was as follows:
YearAmount
2020$1,237,000 
20214,626,000 
20223,896,000 
20233,127,000 
20242,710,000 
Thereafter12,760,000 
$28,356,000 
21
Year Amount
2020 $2,782,000
2021 4,624,000
2022 3,887,000
2023 3,118,000
2024 2,701,000
Thereafter 12,663,000
  $29,775,000

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6. Other Assets, Net
Other assets, net consisted of the following as of JuneSeptember 30, 2020 and December 31, 2019:
June 30,
2020
 
December 31,
2019
September 30,
2020
December 31,
2019
Deferred rent receivables$35,569,000
 $33,205,000
Deferred rent receivables$37,747,000 $33,205,000 
Prepaid expenses, deposits and other assets27,489,000
 26,816,000
Prepaid expenses, deposits and other assets17,831,000 26,816,000 
Inventory19,989,000
 23,872,000
Inventory19,936,000 23,872,000 
Investments in unconsolidated entities20,701,000
 20,176,000
Investments in unconsolidated entities17,809,000 20,176,000 
Deferred tax assets, net(1)17,224,000
 13,315,000
Deferred tax assets, net(1)17,864,000 13,315,000 
Lease commissions, net of accumulated amortization of $2,730,000 and $2,201,000 as of June 30, 2020 and December 31, 2019, respectively11,402,000
 10,794,000
Deferred financing costs, net of accumulated amortization of $3,676,000 and $2,138,000 as of June 30, 2020 and December 31, 2019, respectively(2)6,651,000
 8,137,000
Lease inducement, net of accumulated amortization of $1,316,000 and $1,140,000 as of June 30, 2020 and December 31, 2019, respectively (with a weighted average remaining life of 10.4 years and 10.9 years as of June 30, 2020 and December 31, 2019, respectively)3,684,000
 3,860,000
Lease commissions, net of accumulated amortization of $3,007,000 and $2,201,000 as of September 30, 2020 and December 31, 2019, respectivelyLease commissions, net of accumulated amortization of $3,007,000 and $2,201,000 as of September 30, 2020 and December 31, 2019, respectively11,441,000 10,794,000 
Deferred financing costs, net of accumulated amortization of $4,631,000 and $2,138,000 as of September 30, 2020 and December 31, 2019, respectively(2)Deferred financing costs, net of accumulated amortization of $4,631,000 and $2,138,000 as of September 30, 2020 and December 31, 2019, respectively(2)7,724,000 8,137,000 
Lease inducement, net of accumulated amortization of $1,404,000 and $1,140,000 as of September 30, 2020 and December 31, 2019, respectively (with a weighted average remaining life of 10.2 years and 10.9 years as of September 30, 2020 and December 31, 2019, respectively)Lease inducement, net of accumulated amortization of $1,404,000 and $1,140,000 as of September 30, 2020 and December 31, 2019, respectively (with a weighted average remaining life of 10.2 years and 10.9 years as of September 30, 2020 and December 31, 2019, respectively)3,596,000 3,860,000 
$142,709,000
 $140,175,000
$133,948,000 $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.
(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. See Note 8, 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 JuneSeptember 30, 2020 and 2019 was $773,000$955,000 and $970,000,$882,000, respectively, and for the sixnine months ended JuneSeptember 30, 2020 and 2019 was $1,533,000$2,488,000 and $2,000,000,$2,882,000, respectively. Amortization expense on deferred financing costs on our lines of credit and term loans is recorded to interest expense in our accompanying condensed consolidated statements of operations and comprehensive income (loss). Amortization expense on lease inducement for both the three months ended JuneSeptember 30, 2020 and 2019 was $88,000, and for both the sixnine months ended JuneSeptember 30, 2020 and 2019 was $176,000.$264,000. Amortization expense on lease inducement is recorded against real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive 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, three3 of which are also owned by RHS. Our effective ownership of RHS was 33.8% as of both JuneSeptember 30, 2020 and December 31, 2019. As of JuneSeptember 30, 2020 and December 31, 2019, we had a receivable of $3,533,000$3,128,000 and $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:
September 30, 2020December 31, 2019
RHSOtherTotalRHSOtherTotal
Balance Sheet Data:
Total assets$283,049,000 $17,188,000 $300,237,000 $278,297,000 $17,022,000 $295,319,000 
Total liabilities$260,526,000 $18,011,000 $278,537,000 $251,283,000 $17,245,000 $268,528,000 
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 June 30, 2020 December 31, 2019
 RHS Other Total RHS Other Total
Balance Sheet Data:           
Total assets$285,550,000
 $17,664,000
 $303,214,000
 $278,297,000
 $17,022,000
 $295,319,000
Total liabilities$257,872,000
 $17,616,000
 $275,488,000
 $251,283,000
 $17,245,000
 $268,528,000
Three Months Ended September 30,
20202019
RHSOtherTotalRHSOtherTotal
Statements of Operations Data:
Revenues$31,207,000 $3,613,000 $34,820,000 $35,669,000 $2,954,000 $38,623,000 
Grant (loss) income(948,000)30,000 (918,000)
Expenses(35,414,000)(4,514,000)(39,928,000)(36,630,000)(3,637,000)(40,267,000)
Net loss$(5,155,000)$(871,000)$(6,026,000)$(961,000)$(683,000)$(1,644,000)
Nine Months Ended September 30,
20202019
RHSOtherTotalRHSOtherTotal
Statements of Operations Data:
Revenues$95,733,000 $10,707,000 $106,440,000 $106,099,000 $4,030,000 $110,129,000 
Grant income5,300,000 30,000 5,330,000 
Expenses(105,524,000)(13,037,000)(118,561,000)(108,604,000)(5,114,000)(113,718,000)
Net loss$(4,491,000)$(2,300,000)$(6,791,000)$(2,505,000)$(1,084,000)$(3,589,000)
 Three Months Ended June 30,
 2020 2019
 RHS Other Total RHS Other Total
Statements of Operations Data:           
Revenues$28,722,000
 $3,575,000
 $32,297,000
 $35,062,000
 $1,076,000
 $36,138,000
Grant income6,169,000
 
 6,169,000
 
 
 
Expenses33,015,000
 4,313,000
 37,328,000
 35,743,000
 1,431,000
 37,174,000
Net income (loss)$1,876,000
 $(738,000) $1,138,000
 $(681,000) $(355,000) $(1,036,000)
 Six Months Ended June 30,
 2020 2019
 RHS Other Total RHS Other Total
Statements of Operations Data:           
Revenues$64,526,000
 $7,094,000
 $71,620,000
 $70,430,000
 $1,076,000
 $71,506,000
Grant income6,248,000
 
 6,248,000
 
 
 
Expenses70,110,000
 8,523,000
 78,633,000
 71,974,000
 1,477,000
 73,451,000
Net income (loss)$664,000
 $(1,429,000) $(765,000) $(1,544,000) $(401,000) $(1,945,000)
7. Mortgage Loans Payable, Net
As of JuneSeptember 30, 2020 and December 31, 2019, mortgage loans payable were $827,371,000$823,594,000 ($804,414,000,800,170,000, 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 JuneSeptember 30, 2020, we had 5860 fixed-rate mortgage loans payable and 11 variable-rate mortgage loans payable with effective interest rates ranging from 2.45% to 5.75%5.25% per annum based on interest rates in effect as of JuneSeptember 30, 2020 and a weighted average effective interest rate of 3.66%3.60%. As of December 31, 2019, we had 58 fixed-rate mortgage loans payable and seven7 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 September 30, 2020 and December 31, 2019:
September 30,
2020
December 31,
2019
Total fixed-rate debt$722,743,000 $714,786,000 
Total variable-rate debt100,851,000 101,431,000 
Total fixed- and variable-rate debt823,594,000 816,217,000 
Less: deferred financing costs, net(10,060,000)(9,362,000)
Add: premium228,000 304,000 
Less: discount(13,592,000)(14,289,000)
Mortgage loans payable, net$800,170,000 $792,870,000 
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Mortgage loans payable, net consisted of the following as of June 30, 2020 and December 31, 2019:
 
June 30,
2020
 
December 31,
2019
Total fixed-rate debt$708,468,000
 $714,786,000
Total variable-rate debt118,903,000
 101,431,000
Total fixed- and variable-rate debt827,371,000
 816,217,000
Less: deferred financing costs, net(9,387,000) (9,362,000)
Add: premium254,000
 304,000
Less: discount(13,824,000) (14,289,000)
Mortgage loans payable, net$804,414,000
 $792,870,000
The following table reflects the changes in the carrying amount of mortgage loans payable, net for the sixnine months ended JuneSeptember 30, 2020 and 2019:
Six Months Ended June 30,Nine Months Ended September 30,
2020 201920202019
Beginning balance$792,870,000
 $688,262,000
Beginning balance$792,870,000 $688,262,000 
Additions:   Additions:
Borrowings on mortgage loans payable17,502,000
 61,472,000
Borrowings under mortgage loans payableBorrowings under mortgage loans payable59,033,000 182,417,000 
Amortization of deferred financing costs811,000
 660,000
Amortization of deferred financing costs426,000 1,187,000 
Amortization of discount/premium on mortgage loans payable415,000
 338,000
Amortization of discount/premium on mortgage loans payable621,000 502,000 
Deductions:   Deductions:
Scheduled principal payments on mortgage loans payable(6,348,000) (6,331,000)Scheduled principal payments on mortgage loans payable(49,056,000)(59,706,000)
Early payoff of mortgage loans payableEarly payoff of mortgage loans payable(2,601,000)(6,286,000)
Deferred financing costs(836,000) (837,000)Deferred financing costs(1,123,000)(1,119,000)
Ending balance$804,414,000
 $743,564,000
Ending balance$800,170,000 $805,257,000 
For both the three and nine months ended September 30, 2019, we incurred a loss on the extinguishment of a mortgage loan payable of $1,393,000, which is recorded to interest expense in our accompanying condensed consolidated statements of operations and comprehensive income (loss). Such loss was primarily related to the write-off of unamortized debt discount and prepayment penalties of a mortgage loan payable that was due to mature in November 2047. The source of funds for the payoff was from the 2019 Trilogy Credit Facility, as defined in Note 8, Lines of Credit and Term Loans. For both the three and nine months ended September 30, 2020, we did not incur a gain or loss on the extinguishment of mortgage loans in 2020.
As of JuneSeptember 30, 2020, the principal payments due on our mortgage loans payable for the sixthree months ending December 31, 2020 and for each of the next four years ending December 31 and thereafter were as follows:
YearAmount
2020$3,381,000 
202173,372,000 
202262,595,000 
202360,320,000 
202476,932,000 
Thereafter546,994,000 
$823,594,000 
Year Amount
2020 $65,489,000
2021 55,936,000
2022 62,070,000
2023 50,327,000
2024 73,277,000
Thereafter 520,272,000
  $827,371,000
8. Lines of Credit and Term Loans
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, or Citizens Bank, 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 aggregate amount of $150,000,000 and a senior unsecured term loan facility in the 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.
On July 28, 2020, we entered into a First Amendment to the 2019 Corporate Credit Agreement, or the Credit Agreement Amendment, with Bank of America; KeyBank; Citizens Bank; and a syndicate of other banks, as lenders. The maximum principal amountmaterial terms of the Credit Agreement Amendment provide for, including among other things, the following, with capitalized terms having the meaning as defined in the 2019

Corporate Credit Agreement, unless otherwise defined herein: (i) revisions to financial covenant
23
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calculations to exclude the assets, liabilities and operating performance of our indirect, majority-owned subsidiary Trilogy REIT Holdings, LLC, or Trilogy REIT Holdings, or any subsidiary thereof; (ii) the inclusion of a covenant modification period beginning on June 30, 2020 continuing through the earlier of (a) June 30, 2021, or (b) the date we deliver written notice to end the covenant modification period, subject to certain conditions, or the First Amendment Period; (iii) an increased Consolidated Leverage Ratio equal to or less than 65.0% during the First Amendment Period; (iv) changes to the applicable interest rate based on revisions to the Consolidated Leverage Ratio pricing grid; (v) an increased Consolidated Unencumbered Leverage Ratio equal to or less than 65.0% during the First Amendment Period; (vi) revisions to the Consolidated Tangible Net Worth and EBITDAR coverage requirements; (vii) the inclusion of a LIBOR floor, provided that the Term Loan Hedged Portion of the Term Loans shall not be subject to such floor; (viii) our operating partnership to pledge the equity interests in each direct and indirect subsidiary that owns an unencumbered asset; (ix) the removal of swing line loans; (x) updates regarding restrictions and limitations on certain investments during the remainder of the term of the 2019 Corporate Line of Credit; (xi) clarifications regarding events triggering a Fundamental Change; (xii) a restriction on the payment of distributions and share repurchases during the First Amendment Period; and (xiii) a lender fee. Notwithstanding the foregoing, the Credit Agreement Amendment provides that we can opt out of these modifications based on our written irrevocable election to end the First Amendment Period. Except as modified by the Credit Agreement Amendment, the material terms of the 2019 Corporate Credit Agreement, as amended, remain in full force and effect.
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;Agreement, as amended; 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 one1 12-month period during the term of the 2019 Corporate Credit Agreement, as amended, 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, as defined in the 2019 Corporate Credit Agreement, as amended, plus (ii) a margin ranging from 1.50%1.85% to 2.20%2.80% based on our Consolidated Leverage Ratio, as defined in the 2019 Corporate Credit Agreement, as amended, or (b) (i) the greater of: (1) the prime rate publicly announced by Bank of America, (2) the Federal Funds Rate, as defined in the 2019 Corporate Credit Agreement, as amended, plus 0.50%, (3) the one-month Eurodollar Rate plus 1.00%, and (4) 0.00%, plus (ii) a margin ranging from 0.50%0.85% to 1.20%1.80% 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, as amended, at a per annum rate equal to 0.20% if the average daily used amount is greater than 50%50.00% of the commitments and 0.25% if the average daily used amount is less than or equal to 50%50.00% of the commitments, which fee shall be measured and payable on a quarterly basis.
As of both JuneSeptember 30, 2020 and December 31, 2019, our aggregate borrowing capacity under the 2019 Corporate Line of Credit was $630,000,000. As of JuneSeptember 30, 2020 and December 31, 2019, borrowings outstanding under the 2019 Corporate Line of Credit totaled $591,000,000$573,500,000 and $557,000,000, respectively, and the weighted average interest rate on such borrowings outstanding was 2.30%2.71% and 3.83% per annum, respectively.
On July 28, 2020, we amended the 2019 Corporate Line of Credit and entered into a First Amendment to the 2019 Corporate Credit Agreement, or the Credit Agreement Amendment. See Note 21, Subsequent Event — 2019 Corporate Credit Agreement Amendment, for a further discussion.
2019 Trilogy Credit Facility
On September 5, 2019, we, through Trilogy RER, LLC and certain subsidiaries of Trilogy OpCo, LLC, Trilogy RER, LLC, and Trilogy Pro Services, LLC, or the 2019 Trilogy Co-Borrowers, entered into an amended and restated loan agreement, or the 2019 Trilogy Credit Agreement, with KeyBank, as administrative agent; CIT Bank, N.A., as revolving agent; Regions Bank, as syndication agent; KeyBanc Capital Markets, Inc., or KeyBanc Capital Markets, as co-lead arranger and 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 senior secured revolving credit facility with an aggregate maximum principal amount of $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 Credit Facility. For the nine months ended September 30, 2019, as a result of the termination of the previous credit agreement, we incurred a loss on extinguishment of $786,000, which is recorded to interest expense in our accompanying condensed consolidated statements of operations and comprehensive income (loss) and was primarily related to the write-off of unamortized deferred financing fees. 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.
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The proceeds 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 Credit 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 one1 12-month period during the term of the 2019 Trilogy Credit Agreement subject to the satisfaction of certain conditions, including payment of an extension fee.
At our option, the 2019 Trilogy Credit Facility bears interest at per annum rates equal to (a) LIBOR plus 2.75% for LIBOR Rate Loans, as defined in the 2019 Trilogy Credit Agreement, and (b) for Base Rate Loans, as defined in the 2019 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%0.50% above the Federal Funds Effective Rate, as defined in the 2019 Trilogy Credit Agreement, and (iii) 1.00% above the one-month LIBOR. Accrued interest on the 2019 Trilogy Credit Facility is payable monthly. The loans may be repaid in whole or in part without prepayment fees or penalty, subject to certain conditions. We are required to pay fees on the unused portion 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 (a) 0.15% if the sum of the Aggregate Real Estate Revolving Credit Obligations, as defined in the 2019 Trilogy Credit Agreement, outstanding on such day is greater than 50%50.00% of the commitments or 0.20% if the sum of the Aggregate Real Estate Revolving Credit Obligations on such day is less than or equal to 50%50.00% of the commitments, and (b) 0.15% if the sum of the Aggregate A/R Revolving Credit Obligations, as defined in the 2019 Trilogy Credit Agreement, outstanding on such day is greater than 50%50.00% of the commitments or 0.20% if the sum of the Aggregate A/R

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Revolving Credit Obligations on such day is less than or equal to 50%50.00% of the commitments, which fees shall be measured and payable on a quarterly basis.
As of both JuneSeptember 30, 2020 and December 31, 2019, our aggregate borrowing capacity under the 2019 Trilogy Credit Facility was $360,000,000. As of JuneSeptember 30, 2020 and December 31, 2019, borrowings outstanding under the 2019 Trilogy Credit Facility totaled $251,879,000$282,134,000 and $258,879,000, respectively, and the weighted average interest rate on such borrowings outstanding was 2.94%2.90% and 4.52% per annum, respectively.
Both the 2019 Corporate Credit Agreement, as amended, and the 2019 Trilogy Credit Agreement contain various financial covenants. We were in compliance with such covenants as of JuneSeptember 30, 2020. 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 financial covenants. If any future financial covenants are violated, we anticipate seeking a waiver or amending the debt covenants with our lenders when and if such event should occur. However, there can be no assurances that management will be able to effectively achieve such plans.
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 JuneSeptember 30, 2020 and December 31, 2019, which are included in other assets, net, or security deposits, prepaid rent and other liabilities in our accompanying condensed consolidated balance sheets:
   Fair ValueFair Value
Instrument Notional Amount Index Interest Rate Maturity Date 
June 30,
2020
 
December 31,
2019
InstrumentNotional AmountIndexInterest RateMaturity DateSeptember 30,
2020
December 31,
2019
Cap $20,000,000
 one month LIBOR 3.00% 09/23/21 $2,000
 $
Cap$20,000,000 one month LIBOR3.00%09/23/21$$
Swap 250,000,000
 one month LIBOR 2.10% 01/25/22 (7,665,000) (2,821,000)Swap250,000,000 one month LIBOR2.10%01/25/22(6,431,000)(2,821,000)
Swap 130,000,000
 one month LIBOR 1.98% 01/25/22 (3,742,000) (1,150,000)Swap130,000,000 one month LIBOR1.98%01/25/22(3,138,000)(1,150,000)
SwapSwap100,000,000 one month LIBOR0.20%01/25/22(73,000)
 

 $(11,405,000)
$(3,971,000)$(9,642,000)$(3,971,000)
As of JuneSeptember 30, 2020 and December 31, 2019, none0ne of our derivative financial instruments were designated as hedges. For the three months ended JuneSeptember 30, 2020 and 2019, we recorded $749,000$1,763,000 and $(4,117,000)$(1,169,000), respectively, and for the sixnine months ended JuneSeptember 30, 2020 and 2019, we recorded $(7,434,000)$(5,671,000) and $(4,677,000)$(5,846,000), respectively, as a decrease/(increase) 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.
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10. Identified Intangible Liabilities, Net
As of JuneSeptember 30, 2020 and December 31, 2019, identified intangible liabilities, net consisted of below-market leases of $479,000$416,000 and $663,000, respectively, net of accumulated amortization of $1,445,000$785,000 and $1,342,000, respectively. Amortization expense on below-market leases for the three months ended JuneSeptember 30, 2020 and 2019 was $91,000$64,000 and $104,000,$91,000, respectively, and for the sixnine months ended JuneSeptember 30, 2020 and 2019 was $184,000$248,000 and $209,000,$300,000, respectively, which is recorded to real estate revenue in our accompanying condensed consolidated statements of operations and comprehensive income (loss).

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The weighted average remaining life of below-market leases was 2.82.7 years and 4.3 years as of JuneSeptember 30, 2020 and December 31, 2019, respectively. As of JuneSeptember 30, 2020, estimated amortization expense on below-market leases for the sixthree months ending December 31, 2020 and for each of the next four years ending December 31 and thereafter was as follows:
YearAmount
2020$49,000 
2021180,000 
202289,000 
202371,000 
202427,000 
Thereafter
$416,000 
Year Amount
2020 $112,000
2021 180,000
2022 89,000
2023 71,000
2024 27,000
Thereafter 
  $479,000
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 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 remains uncertain. In addition, the rapidlycontinuously 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. 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 and public health authorities and businesses.businesses to contain and combat the outbreak and spread of the virus. In particular, government-imposed business closures and re-opening restrictions have dramatically impacted the operations of our real estate investments and our tenants across the country, such as creating declines in resident occupancy. Further, our senior housing — RIDEA facilities and integrated senior health campuses arehave also experiencingexperienced dramatic increases and may continue to experience increases in costs to care for residents, particularly increased
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labor costs to maintain staffing levels to care for the aged population during this crisis, costs of COVID-19 testing of employees and residents and costs to procure the volume of personal protective equipment and other supplies required.
We have taken actions to strengthen our balance sheet and preserve liquidity in response to the COVID-19 pandemic. Since March 2020, we have postponed non-essential capital expenditures. In addition, in March 2020, we reduced stockholder distributions and partially suspended our share repurchase plan with respect to all repurchase requests other than repurchases resulting from the death or qualifying disability of stockholders. In response to the continued uncertainty and adverse effects of the COVID-19 pandemic on our operations, in May 2020, we suspended all distribution payments, the Amended and Restated DRIP and our share repurchase plan for all stockholders. In addition, in an effort to further increase our liquidity, our advisor

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deferred agreed to defer 50.0% of the asset management fees that it would otherwise be entitled to receive for services performed by our advisor or its affiliates from June 1, 2020 to November 30, 2020. See Note 14, Related Party Transactions, for a further discussion. 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. The prolonged duration and impact of the COVID-19 pandemic has materially disrupted, and may continue to materially disrupt, our business operations and impact our financial performance. See Item 2, Management’s Discussion and Analysis of Financial Condition and Results of Operations — Factors Which May Influence Results of Operations, for a further discussion of the adverse impact of the COVID-19 pandemic to our business operations.
In addition to the government grants we recognized as of JuneSeptember 30, 2020 as discussed at Note 2, Summary of Significant Accounting Policies Government Grants, we received approximately $52,322,000 of Medicare advance payments during the second quarter of 2020 through an expanded program of the CMS that was intended to expedite cash flow to qualified healthcare providers. Such advance payments were based upon a qualified healthcare provider’s estimate of Medicare services to be performed for up to three months in the future and are recovered by CMS from future Medicare claims submitted by the qualified healthcare provider during aat any time. However, any remaining unpaid balance is required to be recouped in accordance with CMS guidance issued in October 2020 such that recoupment period commencing 120 dayswill commence one year after the date of the issuance of the advance payments. We will bill Medicare claims related to such advance payments were issued. After the first year, Medicare will automatically recoup 25.0% of Medicare payments otherwise owed to the provider for services performed from August 2020 through November 2020, which is the end of our11 months. Thereafter, recoupment period under such CMS program.will increase to 50.0% for another six months. Any amounts of unutilized Medicare advance payments, which reflect funds received that are not applied to actual billings for Medicare services performed, will be repaid to CMS by November 2020.the end of 2022. The entire amount of Medicare advance payments received as of JuneSeptember 30, 2020 is included in security deposits, prepaid rent and other liabilities in our accompanying condensed consolidated balance sheets as we cannot currently estimate the future services to be performed and the amount of funds we will retain and/or return. Once theour recoupment period commences in August 2020,2021, any Medicare advance payments retained for actual services performed and Medicare claims billed will be included in resident fees and services revenue in our accompanying condensed consolidated statements of operations and comprehensive income (loss).
12. Redeemable Noncontrolling Interests
As of both JuneSeptember 30, 2020 and December 31, 2019, our advisor owned all of the 222 limited partnership units outstanding in our operating partnership. As of both JuneSeptember 30, 2020 and December 31, 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. Our 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.
As of both JuneSeptember 30, 2020 and December 31, 2019, we, through Trilogy REIT Holdings, LLC, or Trilogy REIT Holdings, in which we indirectly hold a 70.0% ownership interest, owned 96.6% of the outstanding equity interests of Trilogy. As of both JuneSeptember 30, 2020 and December 31, 2019, certain members of Trilogy’s management and certain members of an advisory committee to Trilogy’s board of directors owned approximately 3.4% of the outstanding equity interests of Trilogy. The noncontrolling interests held by such members have redemption features outside of our control and are accounted for as redeemable noncontrolling interests in our accompanying condensed consolidated balance sheets.

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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 sixnine months ended JuneSeptember 30, 2020 and 2019:
Nine Months Ended September 30,
20202019
Beginning balance$44,105,000 $38,245,000 
Reclassification from equity585,000 585,000 
Distributions(439,000)(1,033,000)
Repurchase of redeemable noncontrolling interests(150,000)(400,000)
Fair value adjustment to redemption value(45,000)110,000 
Net income attributable to redeemable noncontrolling interests794,000 304,000 
Ending balance$44,850,000 $37,811,000 
 Six Months Ended June 30,
 2020 2019
Beginning balance$44,105,000
 $38,245,000
Reclassification from equity390,000
 390,000
Distributions(437,000) (720,000)
Repurchase of redeemable noncontrolling interests(150,000) (3,000)
Fair value adjustment to redemption value(371,000) (84,000)
Net income attributable to redeemable noncontrolling interests954,000
 287,000
Ending balance$44,491,000
 $38,115,000
13. Equity
Preferred Stock
Our charter authorizes us to issue 200,000,000 shares of our preferred stock, par value $0.01 per share. As of both JuneSeptember 30, 2020 and December 31, 2019, no0 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. As of both JuneSeptember 30, 2020 and December 31, 2019, our advisor owned 22,222 shares of our common stock, which our advisor 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 commenced offering shares pursuant to the 2015 DRIP Offering 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 the 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. We commenced offering shares pursuant to the 2019 DRIP Offering on April 1, 2019, following the deregistration of the 2015 DRIP Offering. On May 29, 2020, our board authorized the suspension of the Amended and Restated DRIP, and consequently, we ceased issuing shares pursuant to the 2019 DRIP Offering following the distributions paid in June 2020 to stockholders of record on or prior to the close of business on May 31, 2020. See the “Distribution Reinvestment Plan” section below for a further discussion.
Through JuneSeptember 30, 2020, we had issued 184,930,598 shares of our common stock in connection with the primary portion of our initial public offering and 35,059,456 shares of our common stock pursuant to our DRIP Offerings. We also repurchased 25,739,95326,257,389 shares of our common stock under our share repurchase plan and granted an aggregate of 135,000 shares of our restricted common stock to our independent directors through JuneSeptember 30, 2020. As of JuneSeptember 30, 2020 and December 31, 2019, we had 194,407,323193,889,887 and 193,967,474 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 sixnine months ended JuneSeptember 30, 2020 and 2019:
Six Months Ended June 30,Nine Months Ended September 30,
2020 201920202019
Beginning balance — foreign currency translation adjustments$(2,255,000) $(2,560,000)Beginning balance — foreign currency translation adjustments$(2,255,000)$(2,560,000)
Net change in current period(564,000) (20,000)Net change in current period(220,000)(301,000)
Ending balance — foreign currency translation adjustments$(2,819,000) $(2,580,000)Ending balance — foreign currency translation adjustments$(2,475,000)$(2,861,000)
Noncontrolling Interests
As of both JuneSeptember 30, 2020 and December 31, 2019, Trilogy REIT Holdings owned approximately 96.6% of Trilogy. We are the indirect owner of a 70.0% interest in Trilogy REIT Holdings pursuant to an amended joint venture agreement with an indirect, wholly-owned subsidiary of NorthStar Healthcare Income, Inc., or NHI, and a wholly-owned subsidiary of the operating partnership of Griffin-American Healthcare REIT IV, Inc., or GAHR IV. Both GAHR IV and us are sponsored by American Healthcare Investors. We serve as the sole manager of Trilogy REIT Holdings. As of both JuneSeptember 30, 2020 and December 31, 2019, NHI and GAHR IV indirectly owned a 24.0% and 6.0% membership interest in Trilogy REIT Holdings, respectively. For the three and sixnine months ended JuneSeptember 30, 2020 and 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-yearfive 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 statements of operations and comprehensive 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 (loss). For both the three months ended JuneSeptember 30, 2020 and 2019, we recognized stock compensation expense related to the Profit Interests of $195,000 and for both the sixnine months ended JuneSeptember 30, 2020 and 2019, we recognized stock compensation expense related to the Profit Interests of $390,000.$585,000.
There were no0 canceled, expired or exercised Profit Interests during the sixnine months ended JuneSeptember 30, 2020 and 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 asin net income or loss attributable to noncontrolling interests in our accompanying condensed consolidated statements of operations and comprehensive income (loss).
As of both JuneSeptember 30, 2020 and December 31, 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 the three and sixnine months ended JuneSeptember 30, 2020 and 2019.
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On April 7, 2020, we sold a 9.4% membership interest in a consolidated limited liability company that owns Southlake TX Hospital to an unaffiliated third party for a contract purchase price of $11,000,000. Our advisor agreed to waive the disposition fee and expense reimbursements related to such disposition that may otherwise have been due to our advisor pursuant to the Advisory Agreement. Our advisor did not receive any additional securities, shares of our stock or any other form

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of consideration or any repayment as a result of the waiver of such disposition fees and expense reimbursements. For the period from April 7, 2020 through JuneSeptember 30, 2020, 9.4% of the net earnings of Southlake TX Hospital were allocated to noncontrolling interests in our accompanying condensed consolidated statements of operations and comprehensive income (loss), and the carrying amount of such noncontrolling interest is presented in total equity in our accompanying condensed consolidated balance sheet as of JuneSeptember 30, 2020.
Distribution Reinvestment Plan
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, which we deregistered 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 the 2015 DRIP Offering on March 29, 2019. We continue to offer up to $200,000,000 of additional shares of our common stock 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, asapproved and established by our board. The Amended and Restated DRIP became effective with the distribution payments to stockholders paid in the month of November 2016. In all other material respects, the terms of the 2015 DRIP Offering remained unchanged by the Amended and Restated DRIP.
On May 29, 2020, in consideration of the impact the COVID-19 pandemic has had on the United States, globally and our business operations, our board authorized the suspension of all stockholder distributions upon the completion of the payment of distributions payable to stockholders of record on or prior to the close of business on May 31, 2020. As a result, our board also approved the suspension of the Amended and Restated DRIP until such time, if any, as our board determines to authorize new distributions and to reinstate such plan. Such suspension was effective upon the completion of all shares issued with respect to distributions payable to stockholders of record on or prior to the close of business on May 31, 2020.
Since October 5, 2016, our board had previously approved and established an estimated per share NAV annually. 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 issued at the current estimated per share NAV until such time as our board determined an updated estimated per share NAV. At this time, the audit committee of our board continues to deem it prudent to delay the determination of our annual estimated per share NAV until sometime in the future when we are able to more clearly discern the short- and long-term ramifications on valuation assumptions and methodologies and resulting healthcare real estate asset values due to the impacts of the COVID-19 pandemic. As such, we did not publish an updated estimated per share NAV of our common stock in October 2020. 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
10/03/19 $9.40
Approval Date by our BoardEstimated Per Share NAV
(Unaudited)
10/05/16$9.01 
10/04/17$9.27 
10/03/18$9.37 
10/03/19$9.40 
For the three months ended JuneSeptember 30, 2020 and 2019, $8,720,000$0 and $14,115,000,$13,789,000, respectively, in distributions were reinvested and 927,7410 and 1,506,3951,471,581 shares of our common stock, respectively, were issued pursuant to our DRIP Offerings. For the sixnine months ended JuneSeptember 30, 2020 and 2019, $21,861,000 and $28,311,000,$42,100,000, respectively, in distributions were reinvested and 2,325,762 and 3,021,4934,493,074 shares of our common stock, respectively, were issued pursuant to our DRIP Offerings.
As of JuneSeptember 30, 2020 and December 31, 2019, a total of $327,012,000 and $305,151,000, respectively, in distributions were cumulatively reinvested that resulted in 35,059,456 and 32,733,694 shares of our common stock, respectively, being issued pursuant to our DRIP Offerings.
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Share Repurchase Plan
In response to the COVID-19 pandemic and its effects to our business and operations, our board decided to take steps to protect our capital and maximize our liquidity in an effort to strengthen our long-term financial prospects. As a result, on March 31, 2020, our board partially suspended our share repurchase plan with respect to all repurchase requests other than repurchases resulting from the death or qualifying disability of stockholders, beginning with share repurchase requests submitted for repurchase during the second quarter of 2020. Repurchase requests that resulted from the death or qualifying disability of

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stockholders were not suspended, but remained subject to all terms and conditions of our share repurchase plan, including our board’s discretion to determine whether we had sufficient funds available to repurchase any shares. Subsequently, on May 29, 2020, our board suspended our share repurchase plan with respect to all share repurchase requests received after May 31, 2020, including repurchases resulting from the death or qualifying disability of stockholders. On July 1, 2020, we paid the final share repurchase requests that were honored prior to the suspension of our share repurchase plan. Our board shall determine if and when it is in the best interest of our company and stockholders to reinstate our share repurchase plan.
Prior to the suspension of the share repurchase plan, our share repurchase plan, as amended, allowed for repurchases of shares of our common stock by us when certain criteria are met. Share repurchases were made at the sole discretion of our board. Subject to the availability of the funds for share repurchases, we generally limited 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.Additionally, effective with respect to share repurchase requests submitted for repurchase during the second quarter of 2019, the number of shares that were repurchased during any fiscal quarter was limited to an amount equal to the net proceeds that we received from the sale of shares issued pursuant to our 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 were not subject to this quarterly cap or to our existing cap on repurchases of 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 came from the cumulative proceeds we received from the sale of shares of our common stock pursuant to our DRIP Offerings. Furthermore, our share repurchase plan provided that if there were 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.
The Repurchase Amount, as such term is defined in our share repurchase plan, was 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. For requests submitted pursuant to a death or a qualifying disability of a stockholder, the Repurchase Amount was 100% of the amount per share the stockholder paid for their shares of common stock. Since October 5, 2016, our board hashad previously approved and established an estimated per share NAV annually. See the “Distribution Reinvestment Plan” section above for a summarydiscussion of our historical and current estimated per share NAV. Accordingly, commencing with share repurchase requests submitted during the quarter that our board approved and established an estimated per share NAV, such per share NAV served as the Repurchase Amount for stockholders who purchased their shares at a price equal to or greater than such per share NAV in our initial offering, until such time as our board determined an updated estimated per share NAV.
For the three months ended JuneSeptember 30, 2020 and 2019, we repurchased 1,893,413517,436 and 1,966,6361,832,625 shares of our common stock, respectively, for an aggregate of $17,986,000$5,121,000 and $18,649,000,$17,321,000, respectively, at an average purchase price of $9.50$9.90 and $9.48$9.45 per share, respectively. For the sixnine months ended JuneSeptember 30, 2020 and 2019, we repurchased 1,893,4132,410,849 and 5,850,3527,682,977 shares of our common stock, respectively, for an aggregate of $17,986,000$23,107,000 and $55,135,000,$72,456,000, respectively, at an average repurchase price of $9.50$9.58 and $9.42$9.43 per share, respectively.
As of JuneSeptember 30, 2020 and December 31, 2019, we cumulatively repurchased 25,739,95326,257,389 and 23,846,540 shares of our common stock, respectively, for an aggregate of $239,809,000$244,930,000 and $221,823,000, respectively, at an average repurchase price of $9.32$9.33 and $9.30 per share, respectively. In July 2020, we repurchased 517,263 shares of our common stock, under our share repurchase plan, for an aggregate of $5,120,000, at an average purchase price of $9.90 per share. Shares were repurchased using proceeds we received from the cumulative sale of shares of our common stock pursuant to our DRIP Offerings.
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.
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For both the three and sixnine months ended JuneSeptember 30, 2020 and 2019, we granted an aggregate of 7,500 and 22,500 shares of our restricted common stock, respectively, at a weighted average grant date fair value of $9.40 and $9.37 per share, respectively, to our independent directors in connection with their re-election to our board.board or in consideration for their past services rendered. Such shares vest as to 20.0% of the shares on the date of grant and on each of the first four4 anniversaries of the grant date. For both the three months ended JuneSeptember 30, 2020 and 2019, we recognized stock compensation expense related to the independent director grants of $57,000$28,000 and $72,000, respectively, and for both the sixnine months ended JuneSeptember 30, 2020 and 2019, we recognized stock compensation expense related to the independent director grants of $100,000.$128,000 and $172,000, respectively. Such stock compensation

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expense is included in general and administrative in our accompanying condensed consolidated statements of operations and comprehensive 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 and sixnine months ended JuneSeptember 30, 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 JuneSeptember 30, 2020 and 2019, we incurred $5,976,000$6,876,000 and $6,477,000,$6,105,000, respectively, and for the sixnine months ended JuneSeptember 30, 2020 and 2019, we incurred $12,151,000$19,027,000 and $12,718,000,$18,823,000, 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. 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 JuneSeptember 30, 2020 and 2019, we incurred $0$416,000 and $440,000,$277,000, respectively, and for the sixnine months ended JuneSeptember 30, 2020 and 2019, we incurred $36,000$452,000 and $798,000,$1,075,000, 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 JuneSeptember 30, 2020 and 2019, we incurred $26,000$255,000 and $13,000,$0, respectively, and for the sixnine months ended JuneSeptember 30, 2020 and 2019, we incurred $74,000$329,000 and $163,000, respectively, in development fees to our advisor or its affiliates, which are capitalized as part of the associated investments in our accompanying condensed consolidated balance sheets.
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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.

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In an effort to increase our liquidity during the ongoing uncertainty surrounding the COVID-19 pandemic, on May 29, 2020, our advisor deferredagreed to defer 50.0% of the asset management fees that it would otherwise be entitled to receive pursuant to the Advisory Agreement for services performed by our advisor or its affiliates during the period from June 1, 2020 to November 30, 2020, with the full amount of such deferred fees becoming due and payable by us on January 2, 2021. Such deferred asset management fees of $859,000$3,460,000 as of JuneSeptember 30, 2020 are included in accounts payable due to affiliates in our accompanying condensed consolidated balance sheets.
For the three months ended JuneSeptember 30, 2020 and 2019, we incurred $5,139,000$5,205,000 and $5,020,000,$5,021,000, respectively, and for the sixnine months ended JuneSeptember 30, 2020 and 2019, we incurred $10,244,000$15,449,000 and $9,997,000,$15,018,000, 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 (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 JuneSeptember 30, 2020 and 2019, we incurred $650,000$663,000 and $660,000,$636,000, respectively, and for the sixnine months ended JuneSeptember 30, 2020 and 2019, we incurred $1,303,000$1,966,000 and $1,279,000,$1,915,000, respectively, in property management fees to our advisor or its affiliates. Property management fees are included in property operatingrental expenses and rentalgeneral and administrative expenses in our accompanying condensed consolidated statements of operations and comprehensive 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 JuneSeptember 30, 2020 and 2019, we incurred $78,000$237,000 and $145,000,$68,000, respectively, and for the sixnine months ended JuneSeptember 30, 2020 and 2019, we incurred $281,000$518,000 and $169,000,$237,000, 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 JuneSeptember 30, 2020 and 2019, we incurred $25,000$39,000 and $162,000,$56,000, respectively, and for the sixnine months ended JuneSeptember 30, 2020 and 2019, we incurred $94,000$133,000 and $199,000,$255,000, 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.
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,

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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 JuneSeptember 30, 2020 and 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 June 30,12 months ended September 30,
2020 201920202019
Operating expenses as a percentage of average invested assets0.9% 0.9%Operating expenses as a percentage of average invested assets0.9 %0.9 %
Operating expenses as a percentage of net income18.8% 19.2%Operating expenses as a percentage of net income18.7 %20.1 %
For the three months ended JuneSeptember 30, 2020 and 2019, our advisor or its affiliates incurred operating expenses on our behalf of $58,000$61,000 and $37,000,$47,000, respectively, and for the sixnine months ended JuneSeptember 30, 2020 and 2019, incurred operating expenses on our behalf of $119,000$180,000 and $113,000,$160,000, respectively. Operating expenses are generally included in general and administrative in our accompanying condensed consolidated statements of operations and comprehensive 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 and sixnine months ended JuneSeptember 30, 2020 and 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 and sixnine months ended JuneSeptember 30, 2020, our advisor agreed to waive the $220,000expense reimbursements and $270,000 and $490,000, respectively, of disposition feefees that may otherwise have been due to our advisor pursuant to the Advisory Agreement. See Note 2, Summary of Significant Accounting Policies Impairment of Long-Lived Assets and Note 2, Summary of Significant Accounting Policies Properties Held for Sale, for discussions of our property dispositions, as well as Note 13, Equity Noncontrolling Interests, for a further discussion of the disposition of membership interests in a consolidated
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limited liability company. Our advisor did not receive any additional securities, shares of stock or any other form of consideration or any repayment as a result of the waiver of such disposition fees and expense reimbursements. For the three and sixnine months ended JuneSeptember 30, 2019, we did not incur any disposition fees to our advisor or its affiliates.
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 and sixnine months ended JuneSeptember 30, 2020 and 2019, we did not pay any such distributions to our advisor.
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

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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 and sixnine months ended JuneSeptember 30, 2020 and 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 JuneSeptember 30, 2020 and December 31, 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 JuneSeptember 30, 2020 and December 31, 2019:
FeeSeptember 30,
2020
December 31,
2019
Asset and property management fees$4,524,000 $1,991,000 
Construction management fees97,000 175,000 
Lease commissions49,000 143,000 
Development fees18,000 
Operating expenses11,000 12,000 
$4,699,000 $2,321,000 
36
Fee 
June 30,
2020
 
December 31,
2019
Asset and property management fees $1,914,000
 $1,991,000
Construction management fees 161,000
 175,000
Lease commissions 76,000
 143,000
Development fees 14,000
 
Operating expenses 13,000
 12,000
  $2,178,000
 $2,321,000

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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 JuneSeptember 30, 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
Assets:       
Derivative financial instrument$
 $2,000
 $
 $2,000
Total assets at fair value$
 $2,000
 $
 $2,000
Liabilities:       
Derivative financial instruments$
 $11,407,000
 $
 $11,407,000
Warrants
 
 1,178,000
 1,178,000
Total liabilities at fair value$
 $11,407,000
 $1,178,000
 $12,585,000

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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 instrument$$$$
Total assets at fair value$$$$
Liabilities:
Derivative financial instruments$$9,642,000 $$9,642,000 
Warrants1,178,000 1,178,000 
Total liabilities at fair value$$9,642,000 $1,178,000 $10,820,000 
The table below presents our assets and liabilities measured at fair value on a recurring basis as of December 31, 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)
 TotalQuoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)
Significant Other
Observable Inputs
(Level 2)
Significant
Unobservable
Inputs
(Level 3)
Total
Assets:       Assets:
Derivative financial instrument$
 $
 $
 $
Derivative financial instrument$$$$
Total assets at fair value$
 $
 $
 $
Total assets at fair value$$$$
Liabilities:       Liabilities:
Derivative financial instruments$
 $3,971,000
 $
 $3,971,000
Derivative financial instruments$$3,971,000 $$3,971,000 
Warrants
 
 1,178,000
 1,178,000
Warrants1,178,000 1,178,000 
Total liabilities at fair value$
 $3,971,000
 $1,178,000
 $5,149,000
Total liabilities at fair value$$3,971,000 $1,178,000 $5,149,000 
There were no transfers into and out of fair value measurement levels during the sixnine months ended JuneSeptember 30, 2020 and 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.
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 JuneSeptember 30, 2020, we have assessed the significance of the impact of the credit valuation adjustments on the overall valuation
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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.
Warrants
As of both JuneSeptember 30, 2020 and December 31, 2019, we have recorded $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 JuneSeptember 30, 2020 and December 31, 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: 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.

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We consider the carrying values of 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.
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 valuevalues of our mortgage loans payable and our lines of credit and term loans are estimated using a discounted cash flow analysisanalyses 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 JuneSeptember 30, 2020 and December 31, 2019 were as follows:
June 30,
2020
 
December 31,
2019
September 30,
2020
December 31,
2019
Carrying
Amount(1)
 
Fair
Value
 
Carrying
Amount(1)
 
Fair
Value
Carrying
Amount(1)
Fair
Value
Carrying
Amount(1)
Fair
Value
Financial Assets:       Financial Assets:
Debt security investment$74,253,000
 $93,361,000
 $72,717,000
 $94,026,000
Debt security investment$75,037,000 $93,364,000 $72,717,000 $94,026,000 
Financial Liabilities:       Financial Liabilities:
Mortgage loans payable$804,414,000
 $786,097,000
 $792,870,000
 $732,846,000
Mortgage loans payable$800,170,000 $824,271,000 $792,870,000 $732,846,000 
Lines of credit and term loans$836,228,000
 $847,985,000
 $807,742,000
 $816,355,000
Lines of credit and term loans$847,910,000 $859,406,000 $807,742,000 $816,355,000 
___________
(1)Carrying amount is net of any discount/premium and unamortized costs.
(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 TRS, pursuant to the Code. TRS 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 United States government enacted comprehensive tax legislation pursuant to the Tax Cuts and Jobs Act
38

Table of 2017, or the Tax Act. The Tax Act makes broad and complex changes to the United States tax code, including, but not limited to, reducing the United States 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, or NOL, 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 United States federal income taxation and REITs are constantly under review by persons involved in the legislative process, the IRS and the United States 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 tax legislation as a whole will have on us.Contents

GRIFFIN-AMERICAN HEALTHCARE REIT III, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (Unaudited) — (Continued)
On March 27, 2020, the federal government passed the CARES Act was passed into law by the federal government that contains economic stimulus provisions, including the temporary removal of limitations on the deductibility of NOL, modifications to the carryback periods of NOL, modifications to the business interest deduction limitations and technical corrections to the tax depreciation recovery period of qualified improvement property. Accordingly, tax law changes within the CARES Act may impact income taxes accrued, deferred tax assets or liabilities and the associated valuation allowances included in our condensed consolidated financial statements, if any. We do not anticipate that tax law changes in the CARES Act will materially impact the computation of our taxable income, including our TRS. We also do not expect that we will realize a material tax benefit as a result of the changes to the provisions of the Code made by the CARES Act. We will continue to evaluate the tax impact of the CARES Act and any guidance provided by the United States Treasury Department, the IRS, and other state and local regulatory authorities to our condensed consolidated financial statements.

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The components of income or loss before taxes for the three and sixnine months ended JuneSeptember 30, 2020 and 2019 were as follows:
Three Months Ended June 30, Six Months Ended June 30,Three Months Ended September 30,Nine Months Ended September 30,
2020 2019 2020 20192020201920202019
Domestic$20,984,000
 $109,000
 $10,131,000
 $7,315,000
Domestic$(444,000)$(16,211,000)$9,687,000 $(8,896,000)
Foreign(78,000) (105,000) (219,000) (302,000)Foreign(86,000)(52,000)(305,000)(354,000)
Income before income taxes$20,906,000
 $4,000
 $9,912,000
 $7,013,000
(Loss) income before income taxes(Loss) income before income taxes$(530,000)$(16,263,000)$9,382,000 $(9,250,000)
The components of income tax benefit or expense for the three and sixnine months ended JuneSeptember 30, 2020 and 2019 were as follows:
Three Months Ended June 30, Six Months Ended June 30,Three Months Ended September 30,Nine Months Ended September 30,
2020 2019 2020 20192020201920202019
Federal deferred$160,000
 $(543,000) $(427,000) $(1,091,000)Federal deferred$(2,591,000)$(1,446,000)$(3,018,000)$(2,538,000)
State deferred20,000
 (70,000) (46,000) (140,000)State deferred(532,000)(242,000)(578,000)(381,000)
Federal current
 
 (38,000) 
Federal current(38,000)
Foreign current118,000
 275,000
 275,000
 420,000
Foreign current150,000 90,000 425,000 510,000 
Valuation allowances(179,000) 497,000
 (2,856,000) 1,121,000
Valuation allowances3,123,000 2,438,000 267,000 3,559,000 
Total income tax expense (benefit)$119,000
 $159,000
 $(3,092,000) $310,000
Total income tax expense (benefit)$150,000 $840,000 $(2,942,000)$1,150,000 
Current Income Tax
Federal and state income taxes are generally a function of the level of income recognized by our TRS. Foreign income taxes are generally a function of our income on our real estate and real estate-related investments located in the 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 NOL 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 Juneboth September 30, 2020 and December 31, 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.
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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 Juneboth September 30, 2020 and December 31, 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.

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17. Leases
Lessor
We have operating leases with tenants that expire at various dates through 2050. For the three months ended JuneSeptember 30, 2020 and 2019, we recognized $28,799,000$29,004,000 and $30,898,000,$26,668,000, respectively, of revenues related to operating lease payments, of which $4,442,000$5,233,000 and $4,349,000,$4,649,000, respectively, was for variable lease payments. For the sixnine months ended JuneSeptember 30, 2020 and 2019, we recognized $57,622,000$86,626,000 and $61,951,000,$88,619,000, respectively, of revenues related to operating lease payments, of which $8,892,000$14,125,000 and $9,090,000,$13,739,000, respectively, was for variable lease payments. As of JuneSeptember 30, 2020, the following table sets forth the undiscounted cash flows for future minimum base rents due under operating leases for the sixthree months ended December 31, 2020 and for each of the next four years ending December 31 and thereafter for properties that we wholly own:
Year AmountYearAmount
2020 $43,479,000
2020$21,766,000 
2021 87,124,000
202188,432,000 
2022 81,284,000
202282,791,000 
2023 73,821,000
202375,666,000 
2024 67,279,000
202468,962,000 
Thereafter 447,420,000
Thereafter462,096,000 
Total $800,407,000
Total$799,713,000 
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 JuneSeptember 30, 2020, we had future lease payments of $17,079,000$44,307,000 for an operating leaseleases that hashad not yet commenced. Such operating leaseleases will commence in thebetween fiscal year 2021 and 2022 with a lease termterms of 10up to 15 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 United States Bureau of Labor Statistics’ Consumer Price Index, 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 June 30,Three Months Ended September 30,
Lease Cost Classification 2020
2019Lease CostClassification20202019
Operating lease cost(1) Property operating expenses and rental expenses $8,245,000
 $7,664,000
Operating lease cost(1)Property operating expenses and rental expenses$8,068,000 $7,387,000 
Finance lease cost    Finance lease cost
Amortization of leased assets Depreciation and amortization 510,000
 79,000
Amortization of leased assetsDepreciation and amortization433,000 467,000 
Accretion of lease liabilities Interest expense 162,000
 53,000
Interest on lease liabilitiesInterest on lease liabilitiesInterest expense82,000 146,000 
Total lease cost $8,917,000
 $7,796,000
Total lease cost$8,583,000 $8,000,000 
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Nine Months Ended September 30,
Lease CostClassification20202019
Operating lease cost(1)Property operating expenses and rental expenses$24,507,000 $22,507,000 
Finance lease cost
Amortization of leased assetsDepreciation and amortization1,478,000 1,520,000 
Interest on lease liabilitiesInterest expense413,000 278,000 
Total lease cost$26,398,000 $24,305,000 
    Six Months Ended June 30,
Lease Cost Classification 2020 2019
Operating lease cost(1) Property operating expenses and rental expenses $16,439,000
 $15,120,000
Finance lease cost      
Amortization of leased assets Depreciation and amortization 1,045,000
 1,053,000
Accretion of lease liabilities Interest expense 331,000
 132,000
Total lease cost   $17,815,000
 $16,305,000
___________
___________
(1)Includes short-term leases and variable lease costs, which are immaterial.
(1)Includes short-term leases and variable lease costs, which are immaterial.
Other information related to leases was as follows:
Lease Term and Discount RateSeptember 30,
2020
December 31,
2019
Weighted average remaining lease term (in years)
Operating leases13.513.5
Finance leases1.41.3
Weighted average discount rate
Operating leases5.76 %5.94 %
Finance leases5.90 %7.33 %
Lease Term and Discount Rate June 30,
2020
 December 31,
2019
Weighted average remaining lease term (in years)    
Operating leases 13.0
 13.5
Finance leases 1.6
 1.3
Weighted average discount rate    
Operating leases 5.81% 5.94%
Finance leases 6.61% 7.33%


Six Months Ended June 30,Nine Months Ended September 30,
Supplemental Disclosure of Cash Flows Information
2020
2019Supplemental Disclosure of Cash Flows Information20202019
Cash paid for amounts included in the measurement of lease liabilities:



Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows related to operating leases
$12,177,000

$11,087,000
Operating cash outflows related to operating leases$18,096,000 $16,602,000 
Operating cash outflows related to finance leases
$331,000

$131,000
Operating cash outflows related to finance leases$413,000 $277,000 
Financing cash outflows related to finance leases
$933,000

$1,772,000
Financing cash outflows related to finance leases$1,148,000 $2,490,000 
Leased assets obtained in exchange for finance lease liabilities $66,000
 $
Leased assets obtained in exchange for finance lease liabilities$66,000 $
Right-of-use assets obtained in exchange for operating lease liabilities
$12,875,000

$114,000
Right-of-use assets obtained in exchange for operating lease liabilities$14,127,000 $166,000 
Operating Leases
As of JuneSeptember 30, 2020, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for the sixthree months ending December 31, 2020 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 on our accompanying condensed consolidated balance sheet:
Year AmountYearAmount
2020 $13,293,000
2020$6,330,000 
2021 26,349,000
202123,711,000 
2022 26,878,000
202224,163,000 
2023 27,148,000
202324,351,000 
2024 26,486,000
202423,603,000 
Thereafter 194,772,000
Thereafter190,561,000 
Total operating lease payments 314,926,000
Total operating lease payments292,719,000 
Less: interest 101,231,000
Less: interest96,324,000 
Present value of operating lease liabilities $213,695,000
Present value of operating lease liabilities$196,395,000 
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Finance Leases
As of JuneSeptember 30, 2020, the following table sets forth the undiscounted cash flows of our scheduled obligations for future minimum payments for the sixthree months ending December 31, 2020 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:
YearAmount
2020$90,000 
2021151,000 
202222,000 
202316,000 
2024
Thereafter
Total finance lease payments279,000 
Less: interest11,000 
Present value of finance lease liabilities$268,000 
Year Amount
2020 $311,000
2021 151,000
2022 22,000
2023 16,000
2024 
Thereafter 
Total finance lease payments 500,000
Less: interest 17,000
Present value of finance lease liabilities $483,000
18. Segment Reporting
As of JuneSeptember 30, 2020, we evaluated our business and made resource allocations based on six6 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). Our hospital investments are primarily single-tenant properties for 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 and senior housing facilities are similarly structured to 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.
We evaluate performance based upon segment net operating income. We define segment net operating income as total revenues and grant income, 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, gain or loss on dispositions of real estate investments, impairment of real estate investments, foreign currency gain or loss, other income, income or loss from unconsolidated entities and income tax benefit 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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Summary information for the reportable segments during the three and sixnine months ended JuneSeptember 30, 2020 and 2019 was as follows:
 
Integrated
Senior Health
Campuses
 
Senior
Housing
RIDEA
 
Medical
Office
Buildings
 
Senior
Housing
 
Skilled
Nursing
Facilities
 Hospitals 
Three Months
Ended
June 30, 2020
Integrated
Senior Health
Campuses
Senior
Housing
RIDEA
Medical
Office
Buildings
Senior
Housing
Skilled
Nursing
Facilities
HospitalsThree Months
Ended
September 30, 2020
Revenues and grant income:              Revenues and grant income:
Resident fees and services $232,832,000
 $21,785,000
 $
 $
 $
 $
 $254,617,000
Resident fees and services$242,714,000 $21,217,000 $$$$$263,931,000 
Real estate revenue 
 
 19,580,000
 3,387,000
 4,376,000
 2,770,000
 30,113,000
Real estate revenue19,675,000 4,245,000 3,676,000 2,737,000 30,333,000 
Grant income 29,990,000
 
 
 
 
 
 29,990,000
Grant income740,000 740,000 
Total revenues and grant income 262,822,000
 21,785,000
 19,580,000
 3,387,000
 4,376,000
 2,770,000
 314,720,000
Total revenues and grant income243,454,000 21,217,000 19,675,000 4,245,000 3,676,000 2,737,000 295,004,000 
Expenses:              Expenses:
Property operating expenses 218,535,000
 15,656,000
 
 
 
 
 234,191,000
Property operating expenses225,199,000 15,790,000 240,989,000 
Rental expenses 
 
 7,594,000
 22,000
 420,000
 111,000
 8,147,000
Rental expenses7,304,000 9,000 369,000 113,000 7,795,000 
Segment net operating income $44,287,000
 $6,129,000
 $11,986,000
 $3,365,000
 $3,956,000
 $2,659,000
 $72,382,000
Segment net operating income$18,255,000 $5,427,000 $12,371,000 $4,236,000 $3,307,000 $2,624,000 $46,220,000 
Expenses:              Expenses:
General and administrativeGeneral and administrative      $7,781,000
General and administrative$6,969,000 
Acquisition related expensesAcquisition related expenses      19,000
Acquisition related expenses54,000 
Depreciation and amortizationDepreciation and amortization      24,572,000
Depreciation and amortization24,591,000 
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) (17,652,000)Interest expense (including amortization of deferred financing costs and debt discount/premium)(17,229,000)
Gain in fair value of derivative financial instrumentsGain in fair value of derivative financial instruments 749,000
Gain in fair value of derivative financial instruments1,763,000 
Impairment of real estate investments      (3,233,000)
Income from unconsolidated entities      694,000
Foreign currency loss       (183,000)
Gain on dispositions of real estate investmentsGain on dispositions of real estate investments1,037,000 
Loss from unconsolidated entitiesLoss from unconsolidated entities(2,855,000)
Foreign currency gainForeign currency gain1,945,000 
Other incomeOther income      521,000
Other income203,000 
Income before income taxes      20,906,000
Loss before income taxesLoss before income taxes(530,000)
Income tax expenseIncome tax expense       (119,000)Income tax expense(150,000)
Net income             $20,787,000
Net lossNet loss$(680,000)
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Integrated
Senior Health
Campuses
Senior
Housing
RIDEA
Medical
Office
Buildings
Senior
Housing
Skilled
Nursing
Facilities
HospitalsThree Months
Ended
September 30, 2019
Revenues:
Resident fees and services$257,048,000 $16,752,000 $$$$$273,800,000 
Real estate revenue19,890,000 2,601,000 2,672,000 2,799,000 27,962,000 
Total revenues257,048,000 16,752,000 19,890,000 2,601,000 2,672,000 2,799,000 301,762,000 
Expenses:
Property operating expenses230,349,000 11,509,000 241,858,000 
Rental expenses8,140,000 553,000 346,000 149,000 9,188,000 
Segment net operating income$26,699,000 $5,243,000 $11,750,000 $2,048,000 $2,326,000 $2,650,000 $50,716,000 
Expenses:
General and administrative$7,675,000 
Acquisition related expenses4,000 
Depreciation and amortization36,778,000 
Other income (expense):
Interest expense:
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishment)(21,046,000)
Loss in fair value of derivative financial instruments(1,169,000)
Loss from unconsolidated entities(766,000)
Foreign currency loss(1,464,000)
Other income1,923,000 
Loss before income taxes(16,263,000)
Income tax expense(840,000)
Net loss$(17,103,000)
44
  
Integrated
Senior Health
Campuses
 
Senior
Housing
RIDEA
 
Medical
Office
Buildings
 
Senior
Housing
 
Skilled
Nursing
Facilities
 Hospitals 
Three Months
Ended
June 30, 2019
Revenues:              
Resident fees and services $256,041,000
 $16,431,000
 $
 $
 $
 $
 $272,472,000
Real estate revenue 
 
 20,104,000
 5,931,000
 3,667,000
 2,757,000
 32,459,000
Total revenues 256,041,000
 16,431,000
 20,104,000
 5,931,000
 3,667,000
 2,757,000
 304,931,000
Expenses:              
Property operating expenses 228,319,000
 11,571,000
 
 
 
 
 239,890,000
Rental expenses 
 
 7,597,000
 127,000
 368,000
 134,000
 8,226,000
Segment net operating income $27,722,000
 $4,860,000
 $12,507,000
 $5,804,000
 $3,299,000
 $2,623,000
 $56,815,000
Expenses:              
General and administrative $6,512,000
Acquisition related expenses   400,000
Depreciation and amortization 24,743,000
Other income (expense):        
Interest expense: 
Interest expense (including amortization of deferred financing costs and debt discount/premium) (19,560,000)
Loss in fair value of derivative financial instruments(4,117,000)
Loss from unconsolidated entities (493,000)
Foreign currency loss       (1,232,000)
Other income 246,000
Income before income taxes 4,000
Income tax expense       (159,000)
Net loss             $(155,000)

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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
HospitalsNine Months
Ended
September 30, 2020
Revenues and grant income:
Resident fees and services$743,340,000 $65,134,000 $$$$$808,474,000 
Real estate revenue58,853,000 11,038,000 12,415,000 8,258,000 90,564,000 
Grant income30,730,000 30,730,000 
Total revenues and grant income774,070,000 65,134,000 58,853,000 11,038,000 12,415,000 8,258,000 929,768,000 
Expenses:
Property operating expenses683,332,000 47,588,000 730,920,000 
Rental expenses22,536,000 52,000 1,195,000 329,000 24,112,000 
Segment net operating income$90,738,000 $17,546,000 $36,317,000 $10,986,000 $11,220,000 $7,929,000 $174,736,000 
Expenses:
General and administrative$21,324,000 
Acquisition related expenses307,000 
Depreciation and amortization74,250,000 
Other income (expense):
Interest expense:
Interest expense (including amortization of deferred financing costs and debt discount/premium)(53,415,000)
Loss in fair value of derivative financial instruments(5,671,000)
Gain on dispositions of real estate investments1,037,000 
Impairment of real estate investments(8,335,000)
Loss from unconsolidated entities(3,065,000)
Foreign currency loss(1,303,000)
Other income1,279,000 
Income before income taxes9,382,000 
Income tax benefit2,942,000 
Net income$12,324,000 
45
  
Integrated
Senior Health
Campuses
 
Senior
Housing
RIDEA
 
Medical
Office
Buildings
 
Senior
Housing
 
Skilled
Nursing
Facilities
 Hospitals 
Six Months
Ended
June 30, 2020
Revenues and grant income:              
Resident fees and services $500,626,000
 $43,917,000
 $
 $
 $
 $
 $544,543,000
Real estate revenue 
 
 39,178,000
 6,793,000
 8,739,000
 5,521,000
 60,231,000
Grant income 29,990,000
 
 
 
 
 
 29,990,000
Total revenues and grant income 530,616,000
 43,917,000
 39,178,000
 6,793,000
 8,739,000
 5,521,000
 634,764,000
Expenses:              
Property operating expenses 458,133,000
 31,798,000
 
 
 
 
 489,931,000
Rental expenses 
 
 15,232,000
 43,000
 826,000
 216,000
 16,317,000
Segment net operating income $72,483,000
 $12,119,000
 $23,946,000
 $6,750,000
 $7,913,000
 $5,305,000
 $128,516,000
Expenses:              
General and administrative      $14,355,000
Acquisition related expenses      253,000
Depreciation and amortization      49,659,000
Other income (expense):        
Interest expense:  
Interest expense (including amortization of deferred financing costs and debt discount/premium) (36,186,000)
Loss in fair value of derivative financial instruments (7,434,000)
Impairment of real estate investments      (8,335,000)
Loss from unconsolidated entities��     (210,000)
Foreign currency loss       (3,248,000)
Other income      1,076,000
Income before income taxes      9,912,000
Income tax benefit       3,092,000
Net income             $13,004,000

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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 
Six Months
Ended
June 30, 2019
Integrated
Senior Health
Campuses
Senior
Housing
RIDEA
Medical
Office
Buildings
Senior
Housing
Skilled
Nursing
Facilities
HospitalsNine Months
Ended
September 30, 2019
Revenues:              Revenues:
Resident fees and services $507,755,000
 $32,999,000
 $
 $
 $
 $
 $540,754,000
Resident fees and services$764,803,000 $49,751,000 $$$$$814,554,000 
Real estate revenue 
 
 40,658,000
 11,583,000
 7,326,000
 5,668,000
 65,235,000
Real estate revenue60,548,000 14,184,000 9,998,000 8,467,000 93,197,000 
Total revenues 507,755,000
 32,999,000
 40,658,000
 11,583,000
 7,326,000
 5,668,000
 605,989,000
Total revenues764,803,000 49,751,000 60,548,000 14,184,000 9,998,000 8,467,000 907,751,000 
Expenses:              Expenses:
Property operating expenses 451,647,000
 23,195,000
 
 
 
 
 474,842,000
Property operating expenses681,996,000 34,704,000 716,700,000 
Rental expenses 
 
 15,413,000
 223,000
 730,000
 285,000
 16,651,000
Rental expenses23,553,000 776,000 1,076,000 434,000 25,839,000 
Segment net operating income $56,108,000
 $9,804,000
 $25,245,000
 $11,360,000
 $6,596,000
 $5,383,000
 $114,496,000
Segment net operating income$82,807,000 $15,047,000 $36,995,000 $13,408,000 $8,922,000 $8,033,000 $165,212,000 
Expenses:              Expenses:
General and administrativeGeneral and administrative $13,429,000
General and administrative$21,104,000 
Acquisition related expensesAcquisition related expenses   (296,000)Acquisition related expenses(292,000)
Depreciation and amortizationDepreciation and amortization 50,371,000
Depreciation and amortization87,149,000 
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) (38,619,000)
Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishment)Interest expense (including amortization of deferred financing costs, debt discount/premium and loss on debt extinguishment)(59,665,000)
Loss in fair value of derivative financial instrumentsLoss in fair value of derivative financial instruments(4,677,000)Loss in fair value of derivative financial instruments(5,846,000)
Loss from unconsolidated entitiesLoss from unconsolidated entities (947,000)Loss from unconsolidated entities(1,713,000)
Foreign currency lossForeign currency loss       (190,000)Foreign currency loss(1,654,000)
Other incomeOther income 454,000
Other income2,377,000 
Income before income taxes 7,013,000
Loss before income taxesLoss before income taxes(9,250,000)
Income tax expenseIncome tax expense       (310,000)Income tax expense(1,150,000)
Net income             $6,703,000
Net lossNet loss$(10,400,000)
Total assets by reportable segment as of JuneSeptember 30, 2020 and December 31, 2019 were as follows:
June 30,
2020
 
December 31,
2019
September 30,
2020
December 31,
2019
Integrated senior health campuses$1,878,944,000
 $1,791,868,000
Integrated senior health campuses$1,914,639,000 $1,791,868,000 
Medical office buildings620,262,000
 620,292,000
Medical office buildings616,944,000 620,292,000 
Senior housing — RIDEA354,386,000
 360,823,000
Senior housing — RIDEA351,237,000 360,823,000 
Senior housing146,518,000
 152,909,000
Senior housing149,289,000 152,909,000 
Skilled nursing facilities120,924,000
 126,606,000
Skilled nursing facilities119,366,000 126,606,000 
Hospitals111,604,000
 113,737,000
Hospitals110,545,000 113,737,000 
Other20,934,000
 6,054,000
Other9,169,000 6,054,000 
Total assets$3,253,572,000
 $3,172,289,000
Total assets$3,271,189,000 $3,172,289,000 
As of both JuneSeptember 30, 2020 and December 31, 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 grant income 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 June 30, Six Months Ended June 30,Three Months Ended September 30,Nine Months Ended September 30,
2020 2019 2020 2019 2020201920202019
Revenues and grant income:       Revenues and grant income:
United States$313,560,000
 $303,721,000
 $632,406,000
 $603,543,000
United States$293,796,000 $300,609,000 $926,202,000 $904,152,000 
International1,160,000
 1,210,000
 2,358,000
 2,446,000
International1,208,000 1,153,000 3,566,000 3,599,000 
$314,720,000
 $304,931,000
 $634,764,000
 $605,989,000
$295,004,000 $301,762,000 $929,768,000 $907,751,000 
The following is a summary of real estate investments, net by geographic regions as of JuneSeptember 30, 2020 and December 31, 2019:
June 30,
2020
 
December 31,
2019
September 30,
2020
December 31,
2019
Real estate investments, net:   Real estate investments, net:
United States$2,241,655,000
 $2,219,882,000
United States$2,278,720,000 $2,219,882,000 
International46,536,000
 50,539,000
International48,222,000 50,539,000 
$2,288,191,000
 $2,270,421,000
$2,326,942,000 $2,270,421,000 
19. Concentration of Credit Risk
Financial instruments that potentially subject us to a concentration of credit risk are primarily our 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 our debt security investment, but we believe collection of the outstanding amount is probable. 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 JuneSeptember 30, 2020 and December 31, 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 JuneSeptember 30, 2020, properties in two states1 state 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 39.7% and 10.5%, respectively,38.3% 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 eachsuch state’s economy.
Based on leases in effect as of JuneSeptember 30, 2020, our six6 reportable business segments, integrated senior health campuses, medical office buildings, senior housing —RIDEA, skilled nursing facilities, hospitals and senior housing, accounted for 53.8%52.9%, 25.0%26.1%, 10.0%10.1%, 5.1%5.5%, 3.6%2.7% and 2.5%2.7%, respectively, of our total property portfolio’s annualized base rent or annualized net operating income. As of JuneSeptember 30, 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 JuneSeptember 30, 2020.
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 $2,000$0 and $7,000, respectively, for the three months ended JuneSeptember 30, 2020 and 2019, and $9,000 and $14,000,$21,000, respectively, for the sixnine months ended JuneSeptember 30, 2020 and 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 JuneSeptember 30, 2020 and 2019, there were 33,000 and 46,500 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 JuneSeptember 30, 2020 and 2019, there were 222 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.
48
21. Subsequent Event
2019 Corporate Credit Agreement Amendment
On July 28, 2020, we entered into the Credit Agreement Amendment with Bank of America; KeyBank; Citizens Bank; and a syndicate of other banks, as lenders. The material terms of the Credit Agreement Amendment provide for, including among other things, the following, with capitalized terms having the meaning as defined in the 2019 Corporate Credit Agreement, unless otherwise defined herein: (i) revisions to financial covenant calculations to exclude the assets, liabilities and operating performance of our indirect, majority-owned subsidiary Trilogy REIT Holdings or any subsidiary thereof; (ii) the inclusion of a covenant modification period beginning on June 30, 2020 continuing through the earlier of (a) June 30, 2021, or (b) the date we deliver written notice to end the covenant modification period, subject to certain conditions, or the First Amendment Period; (iii) an increased Consolidated Leverage Ratio equal to or less than 65.0% during the First Amendment Period; (iv) changes to the applicable interest rate based on revisions to the Consolidated Leverage Ratio pricing grid; (v) an increased Consolidated Unencumbered Leverage Ratio equal to or less than 65.0% during the First Amendment Period; (vi) revisions to the Consolidated Tangible Net Worth and EBITDAR coverage requirements; (vii) the inclusion of a LIBOR floor, provided that the Term Loan Hedged Portion of the Term Loans shall not be subject to such floor; (viii) our operating partnership to pledge the equity interests in each direct and indirect subsidiary that owns an unencumbered asset; (ix) the removal of swing line loans; (x) updates regarding restrictions and limitations on certain investments during the remainder of the term of the 2019 Corporate Line of Credit; (xi) clarifications regarding events triggering a Fundamental Change; (xii) a restriction on the payment of distributions and share repurchases during the First Amendment Period; and (xiii) a lender fee. Notwithstanding the foregoing, the Credit Agreement Amendment provides that we can opt out of these modifications based on our written irrevocable election to end the First Amendment Period.


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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 2019 Annual Report on Form 10-K, as filed with the United States Securities and Exchange Commission, or SEC, on March 26, 2020. Such condensed consolidated financial statements and information have been prepared to reflect our financial position as of JuneSeptember 30, 2020 and December 31, 2019, together with our results of operations for the three and sixnine months ended JuneSeptember 30, 2020 and 2019 and cash flows for the sixnine months ended JuneSeptember 30, 2020 and 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 and 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 success 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, 2013.2013. 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 common stock to be issued pursuant to the Amended and Restated DRIP, or the 2019 DRIP Offering. We commenced offering shares pursuant to the 2019 DRIP Offering on April 1, 2019, following the deregistration of the 2015 DRIP Offering. On May 29, 2020, in consideration of the impact the COVID-19 pandemic has had on the United States, globally and our business operations, our board of directors, or our board, authorized the suspension of the Amended and Restated DRIP until such time, if any, as our board determines to authorize new distributions and to reinstate such plan. Such suspension was effective upon the completion of all shares issued with respect to distributions payable to stockholders of record on or prior to the close of business on May 31, 2020. As of JuneSeptember 30, 2020, a total of $63,105,000 in distributions were reinvested that resulted in 6,724,348 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 the “Liquidity and Capital Resources” section below for a further discussion.
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 remains uncertain. In addition, the rapidlycontinuously 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. 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 and public health authorities and businesses.businesses to contain and combat the outbreak and spread of the virus. In particular, government-imposed business closures and re-opening restrictions have dramatically impacted the operations of our real estate investments and our tenants across the country, such as creating declines in resident occupancy. Further, our senior housing — RIDEA facilities and integrated senior health campuses arehave also experiencingexperienced dramatic increases and may continue to experience increases in costs to care for residents, particularly labor costs to maintain staffing levels to care for the aged population during this crisis, costs of COVID-19 testing of employees and residents and costs to procure the volume of personal protective equipment, or PPE, and other supplies required.
We have taken actions to strengthen our balance sheet and preserve liquidity in response to the COVID-19 pandemic risks. Since March 2020, we have postponed non-essential capital expenditures. In addition, in March 2020, we reduced stockholder distributions and partially suspended our share repurchase plan with respect to all repurchase requests other than repurchases resulting from the death or qualifying disability of stockholders. In response to the continued uncertainty and adverse effects of the COVID-19 pandemic on our operations, in May 2020, we suspended all distribution payments, the Amended and Restated DRIP and our share repurchase plan for all stockholders to further conserve and preserve liquidity. Furthermore, in an effort to increase our liquidity, our advisor deferredagreed to defer 50.0% of the asset management fees that it would otherwise be entitled to receive for services performed by our advisor or its affiliates from June 1, 2020 to November 30, 2020. See Note 14, Related Party Transactions, to our accompanying condensed consolidated financial statements for a further discussion. We believe that the long-term stability of our portfolio will return once the virus has been controlled. In states where lockdown orders have been lifted, the downward trends in our portfolio appear to have somewhat moderated, but we have not yet witnessed a significant rebound. 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. The prolonged duration and impact of the COVID-19 pandemic has materially disrupted, and may continue to materially disrupt, our business operations and impact our financial performance. See the “Factors Which May Influence Results of Operations,” “Results of Operations” and “Liquidity and Capital Resources” sections below for a further discussion.
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 net asset value, or NAV, of our common stock of $9.40. We previously provided an updated estimated per share NAV annually to assist broker-dealers in connection with their obligations under Financial Industry Regulatory Authority, or FINRA, Rule 2231 with respect to customer account statements. The updated estimated per share NAV iswas 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. 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 SEC. See our Current Report on Form 8-K filed with the SEC on October 4, 2019 for more information on the methodologies and assumptions used to determine, and the limitations and risks of, our updated estimated per share NAV. A combination of economic factors driven by the COVID-19 pandemic, including the decline in property sales and the temporary closure of non-essential businesses, has drastically impacted the traditional valuation methodologies for almost all types of commercial real estate, including healthcare real estate. Because asset values are difficult to discern atAt this time, due to such market disruptions and concerns regarding the reliability of traditional valuation methodologies in the current environment, the audit committee of our board has determinedcontinues to deem it would not be practical or prudent

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to attempt to determine an updatedour annual estimated per share NAV at this time.until sometime in the future when we are able to more clearly discern the short- and long-term ramifications on valuation assumptions and methodologies and resulting healthcare real estate asset values
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due to the impacts of the COVID-19 pandemic. As such, we dodid not anticipate publishingpublish an updated estimated per share NAV of our common stock in October 2020. Our board will, however, continueSee Note 13, Equity — Distribution Reinvestment Plan, to monitor the commercial and healthcare real estate markets and will update stockholders regarding an updated estimated per share NAV when market conditions permit our board to calculate an updated estimated per share NAV with reasonable certainty. See Part II, Item 5, Other Information, of this Quarterly Report on Form 10-Q for a further discussion.accompanying condensed consolidated financial statements.
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 11, 2020 and expires on February 26, 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,our 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 JuneSeptember 30, 2020, we owned and/or operated 9897 properties, comprising 102101 buildings, and 119118 integrated senior health campuses including completed development projects, or approximately 13,907,00013,880,000 square feet of gross leasable area, or GLA, for an aggregate contract purchase price of $3,003,934,000.$3,031,654,000. In addition, as of JuneSeptember 30, 2020, we also owned a real estate-related investment purchased for $60,429,000.
Critical Accounting Policies
The complete listing of our Critical Accounting Policies was previously disclosed in our 2019 Annual Report on Form 10-K, as filed with the SEC on March 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 2019 Annual Report on Form 10-K, as filed with the SEC on March 26, 2020.
Recently Issued Accounting Pronouncements
For a discussion of recently issued accounting pronouncements, see Note 2, Summary of Significant Accounting Policies — Recently Issued Accounting Pronouncements, to our accompanying condensed consolidated financial statements.
AcquisitionAcquisitions and Dispositions in 2020
For a discussion of our acquisitionacquisitions and dispositions of a land parcelinvestments in 2020, see Note 2, Summary of Significant Accounting Policies — Impairment of Long-Lived Assets, Note 2, Summary of Significant Accounting Policies — Properties Held for Sale and Note 3, Real Estate Investments, Net, to our accompanying condensed consolidated financial statements.

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Factors Which May Influence Results of Operations
Due to the ongoing COVID-19 pandemic in the United States and globally, our residents, tenants, operating partners and managers may behave been materially impacted. The situation presentscontinues to present a meaningful challenge for us as an owner and operator of healthcare facilities, as the impact of the virus has resultedcontinues to result in a massive strain throughout the healthcare system. The COVID-19 pandemic 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 aggressive 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.
Each type of real estate asset we own has been impacted by COVID-19 to varying degrees. The COVID-19 pandemic has negatively impacted the businesses of our medical office tenants and their ability to pay rent on a timely basis. In the early months of the pandemic when many of the states had implemented “stay at home” orders, in excess of 50.0% of our tenants in medical office buildings had been classified by state governments as “non-essential” and were ordered to either shut down entirely, or significantly limit hours of operations, which prevented or significantly limited our tenants from seeing patients in their offices and thereby creating unprecedented revenue pressure on such tenants. Substantially all of our physician practices and other medical service providers of non-essential and elective services in our medical office buildings are now open. However, the number of patients returning to such offices varies across practice types and geographic markets as people continue to delay office visits indefinitely due to the fears or uncertainties associated with COVID-19 despite the availability of services. Additionally, while restrictions have been at least partially lifted in many states, there remains a risk of reclosures in states where infection rates are on thecontinue to rise, which may put additional pressure on our operations.
For our managed senior housing — RIDEA facilities and integrated senior health campuses, based on preliminary information available to management as of JulyOctober 31, 2020, we have experienced an approximate 8.4%13.3% decline in our resident occupancies since February 2020 largely due to a decline in move-ins of prospective residents because of shelter-in-place, re-opening and other quarantine restrictions imposed by government regulations and guidelines. In addition, we continue to experience challenges in attracting prospective residents into such facilities and campuses may choosebecause they are choosing to delay moving into communities until the threat posed by the virus has declined. Further, the elimination of elective hospital procedures, which drive post-acute skilled nursing admissions, has impacted our resident occupancy levels of our integrated senior health campuses. Our facilities have adopted different phased-in approaches to facility operations depending on the market in which they operate, which range from stringent restrictions of essential visitors and frequent testing of staff and residents to allowing screened visitors and limited activities. At the same time that our managed senior housing — RIDEA facilities and integrated senior health campuses are facing a reduction in revenue associated with lower resident occupancies, they are also experiencingexperienced up to a 30.0% increase in costs to care for residents, particularly increased labor costs to maintain staffing levels to care for the aged population during this crisis, costs of testing employees and residents for COVID-19 and costs to procure the volume of PPE and other supplies required.required to maintain health and safety measures and protocols. Such costs have begun to moderate somewhat during the third quarter of 2020. Our leased, non-RIDEA senior housing and skilled nursing facilities arefacility tenants have also experiencingexperienced and may continue to experience similar pressures related to occupancy declines and expense increases, which may impact their ability to pay rent and have an adverse effect on our operations. Therefore, our immediate focus iscontinues to be on resident occupancy recovery and operating expense management.
The impacts of the COVID-19 pandemic have been significant, rapidly evolving and may continue into the future. Managers of our RIDEA properties continue to evaluate their options for financial assistance, such as utilizing programs within the Coronavirus Aid, Relief, and Economic Security Act, or the CARES Act, passed by the federal government on March 27, 2020, as well as other state and local government relief programs. The CARES Act includes multiple opportunities for immediate cash relief in the form of grants, tax benefits and Medicare reimbursement programs. Some of our tenants within our non-RIDEA properties are also seekinghave sought financial assistance from the CARES Act through programs such as the Payroll Protection Program and deferral of payroll tax payments. However, these government assistance programs are not expected to fully offset the negative financial impact of the COVID-19 pandemic, and there can be no assurance that these programs will continue or the extent to which they will be expanded. Therefore, the ultimate impact of such relief from the CARES Act and other enacted and future legislation and regulation, including the extent to which relief funds from such programs will provide meaningful support for lost revenue and increasing costs, is uncertain.
We areThe information in this Quarterly Report on Form 10-Q is based on data currently available to us and will likely change as the COVID-19 pandemic progresses. As such, we continue to closely monitoringmonitor COVID-19 developments and are continuously assessing the implications to our business, residents, tenants, operating partners, managers and our portfolio of investments. We anticipate that the government-imposed or self-imposed lockdowns and restrictions have created pent-up demand for doctors’ visits, move-ins into senior housing facilities and elective procedures, which will eventually drive skilled nursing occupancies higher. While the impact of thehigher; however, we cannot predict with reasonable certainty when such demand will return to pre-COVID-19 levels. The COVID-19 pandemic has had, and may continue to have, an adverse effect on our business, and
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therefore, we are unable to predict the full extent or nature of the future impact to our financial condition and results of operations at this time. TheWe expect the trends discussed above with respect to the impact of the COVID-19 pandemic to continue. Thus, the lasting impact of the COVID-19 pandemic on our future results could be significant and will largely depend on future developments, including the duration of the crisis and the success of efforts to contain it, which are highly uncertain and cannot be predicted with confidence at this time. See the “Results of Operations” and “Liquidity and Capital Resources” sections below, as well as Part II, Item 1A, Risk Factors, of this Quarterly Report on Form 10-Q for a further discussion.

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Scheduled Lease Expirations
Excluding our senior housing— RIDEA facilities and our integrated senior health campuses, as of JuneSeptember 30, 2020, our properties were 91.0%91.5% leased and during the remainder of 2020, 3.9%2.4% 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 JuneSeptember 30, 2020, our remaining weighted average lease term was 7.47.3 years, excluding our senior housing— RIDEA facilities and our integrated senior health campuses.
Our combined senior housing— RIDEA facilities and integrated senior health campuses were 76.6%76.1% and 79.6%78.4% leased, respectively, for the three and sixnine months ended JuneSeptember 30, 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 Three and SixNine Months Ended JuneSeptember 30, 2020 and 2019
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, and under a normalizednormal operating environment, we expect amounts related to our portfolio of operating properties to increase in the future based on ongoing property expansions and developments.
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 JuneSeptember 30, 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.
The COVID-19 pandemic has had a significant impact on the operations of our real estate portfolio. Although we have experienced a delay in receiving rent payments from our tenants, as of JuneSeptember 30, 2020, we have collected 100% of contractual rent from our leased, non-RIDEA senior housing and skilled nursing facility tenants. In addition, substantially all of the contractual rent through JuneSeptember 2020 from our medical office building tenants has been received. However, given the significant uncertainty of the impact of the COVID-19 pandemic, we are unable to predict the impact it will have on such tenants’ continued ability to pay rent. Therefore, information provided regarding rent collections through June 2020 should not serve as an indication of expected future rent collections. We received lease concession requests from some of our medical office building tenants primarily during the second quarter of 2020 that resulted in an insignificant number of concessions granted, such as in the form of rent abatements, in conjunction with a lease term extension for up to seven years, andor rent payment deferrals requiring repayment within one year. Such lease concessions granted do not have a material impact to our condensed consolidated financial statements. No contractual rent for our medical office building tenants was forgiven.
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Except where otherwise noted, the changes in our consolidated results of operations for 2020 as compared to 2019 are primarily due to the disruption to our normal operations as a result of the COVID-19 pandemic and grant income received, as well as the development and expansion of our portfolio of integrated senior health campuses. In addition, there are changes in our results of operations by reporting segment due to the transitioning of the operations of seven senior housing facilities within North Carolina ALF Portfolio to a RIDEA structure on December 1, 2019. As of JuneSeptember 30, 2020 and 2019, we owned and/or operated the following types of properties:
 June 30,
 2020 2019
 
Number of
Buildings/
Campuses
 
Aggregate
Contract
Purchase Price
 
Leased
%
 
Number of
Buildings/
Campuses
 
Aggregate
Contract
Purchase Price
 
Leased
%
Integrated senior health campuses119
 $1,548,593,000
 (1) 113
 $1,513,399,000
 (1)
Medical office buildings64
 664,135,000
 87.9% 64
 664,135,000
 89.9%
Senior housing — RIDEA20
 433,891,000
 (2) 13
 320,035,000
 (2)
Senior housing9
 89,535,000
 100% 16
 203,391,000
 100%
Skilled nursing facilities7
 128,000,000
 100% 7
 128,000,000
 100%
Hospitals2
 139,780,000
 100% 2
 139,780,000
 100%
Total/weighted average(3)221
 $3,003,934,000
 91.0% 215
 $2,968,740,000
 93.0%

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September 30,
 20202019
 Number of
Buildings/
Campuses
Aggregate
Contract
Purchase Price
Leased
%
Number of
Buildings/
Campuses
Aggregate
Contract
Purchase Price
Leased
%
Integrated senior health campuses118 $1,582,563,000 (1)113$1,528,470,000 (1)
Medical office buildings63 657,885,000 88.6 %64664,135,000 89.1 %
Senior housing — RIDEA20 433,891,000 (2)13320,035,000 (2)
Senior housing89,535,000 100 %16 203,391,000 100 %
Skilled nursing facilities128,000,000 100 %7128,000,000 100 %
Hospitals139,780,000 100 %139,780,000 100 %
Total/weighted average(3)219 $3,031,654,000 91.5 %215 $2,983,811,000 92.4 %
___________
(1)For the three months ended June 30, 2020 and 2019, the leased percentage for the resident units of our integrated senior health campuses was 76.6% and 87.5%, respectively. For the six months ended June 30, 2020 and 2019, the leased percentage for the resident units of our integrated senior health campuses was 80.0% and 85.6%, respectively.
(2)For the three months ended June 30, 2020 and 2019, the leased percentage for the resident units of our senior housing — RIDEA facilities was 76.3% and 82.7%, respectively. For the six months ended June 30, 2020 and 2019, the leased percentage for the resident units of our senior housing — RIDEA facilities was 76.9% and 83.1%, respectively.
(3)Leased percentage excludes our senior housing — RIDEA facilities and integrated senior health campuses.
(1)For the three months ended September 30, 2020 and 2019, the leased percentage for the resident units of our integrated senior health campuses was 76.8% and 86.9%, respectively. For the nine months ended September 30, 2020 and 2019, the leased percentage for the resident units of our integrated senior health campuses was 79.0% and 86.1%, respectively.
(2)For the three months ended September 30, 2020 and 2019, the leased percentage for the resident units of our senior housing — RIDEA facilities was 72.6% and 82.3%, respectively. For the nine months ended September 30, 2020 and 2019, the leased percentage for the resident units of our senior housing — RIDEA facilities was 75.5% and 82.8%, respectively.
(3)Leased percentage excludes our senior housing — RIDEA facilities and integrated senior health campuses.
Revenues and Grant Income
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 and grant income by reportable segment consisted of the following for the periods then ended:
Three Months Ended September 30,Nine Months Ended September 30,
 2020201920202019
Resident Fees and Services
Integrated senior health campuses$242,714,000 $257,048,000 $743,340,000 $764,803,000 
Senior housing — RIDEA21,217,000 16,752,000 65,134,000 49,751,000 
Total resident fees and services263,931,000 273,800,000 808,474,000 814,554,000 
Real Estate Revenue
Medical office buildings19,675,000 19,890,000 58,853,000 60,548,000 
Skilled nursing facilities3,676,000 2,672,000 12,415,000 9,998,000 
Senior housing4,245,000 2,601,000 11,038,000 14,184,000 
Hospitals2,737,000 2,799,000 8,258,000 8,467,000 
Total real estate revenue30,333,000 27,962,000 90,564,000 93,197,000 
Grant Income
Integrated senior health campuses740,000 — 30,730,000 — 
Total grant income740,000 — 30,730,000 — 
Total revenues and grant income$295,004,000 $301,762,000 $929,768,000 $907,751,000 
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 Three Months Ended June 30, Six Months Ended June 30,
 2020 2019 2020 2019
Resident Fees and Services       
Integrated senior health campuses$232,832,000
 $256,041,000
 $500,626,000
 $507,755,000
Senior housing — RIDEA21,785,000
 16,431,000
 43,917,000
 32,999,000
Total resident fees and services254,617,000
 272,472,000
 544,543,000
 540,754,000
Real Estate Revenue       
Medical office buildings19,580,000
 20,104,000
 39,178,000
 40,658,000
Skilled nursing facilities4,376,000
 3,667,000
 8,739,000
 7,326,000
Senior housing3,387,000
 5,931,000
 6,793,000
 11,583,000
Hospitals2,770,000
 2,757,000
 5,521,000
 5,668,000
Total real estate revenue30,113,000
 32,459,000
 60,231,000
 65,235,000
Grant Income       
Integrated senior health campuses29,990,000
 
 29,990,000
 
Total grant income29,990,000
 
 29,990,000
 
Total revenues and grant income$314,720,000
 $304,931,000
 $634,764,000

$605,989,000
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For the three and sixnine months ended JuneSeptember 30, 2020 and 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 and sixnine months ended JuneSeptember 30, 2020 and 2019, real estate revenue primarily consisted of base rent and expense recoveries. For the three and sixnine months ended JuneSeptember 30, 2020, we recognized $29,990,000$740,000 and $30,730,000, respectively, of grant income forat our integrated senior health campuses related to government grants received through CARES Act economic relief programs, which we received as a result of lost resident fees and services revenues due to a decline in resident occupancy.programs. An additional $7,260,000$20,735,000 of such government grants were received, which we have deferred and anticipate to recognize as grant income during the remainder of 2020.through mid-year 2021. See Note 2, Summary of Significant Accounting Policies — Government Grants, to our accompanying condensed consolidated financial statements for a further discussion.

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Property Operating Expenses and Rental Expenses
Property operating expenses and property operating expenses as a percentage of resident fees and services revenue and grant income, as well as rental expenses and rental expenses as a percentage of real estate revenues, by reportable segment consisted of the following for the periods then ended:
Three Months Ended June 30, Six Months Ended June 30, Three Months Ended September 30,Nine Months Ended September 30,
2020 2019 2020 2019 2020201920202019
Property Operating Expenses               Property Operating Expenses
Integrated senior health campuses$218,535,000
 83.1% $228,319,000
 89.2% $458,133,000
 86.3% $451,647,000
 88.9%Integrated senior health campuses$225,199,000 92.5 %$230,349,000 89.6 %$683,332,000 88.3 %$681,996,000 89.2 %
Senior housing — RIDEA15,656,000
 71.9% 11,571,000
 70.4% 31,798,000
 72.4% 23,195,000
 70.3%Senior housing — RIDEA15,790,000 74.4 %11,509,000 68.7 %47,588,000 73.1 %34,704,000 69.8 %
Total property operating expenses$234,191,000
 82.3% $239,890,000
 88.0% $489,931,000
 85.3% $474,842,000
 87.8%Total property operating expenses$240,989,000 91.1 %$241,858,000 88.3 %$730,920,000 87.1 %$716,700,000 88.0 %
               
Rental Expenses               Rental Expenses
Medical office buildings$7,594,000
 38.8% $7,597,000
 37.8% $15,232,000
 38.9% $15,413,000
 37.9%Medical office buildings$7,304,000 37.1 %$8,140,000 40.9 %$22,536,000 38.3 %$23,553,000 38.9 %
Skilled nursing facilities420,000
 9.6% 368,000
 10.0% 826,000
 9.5% 730,000
 10.0%Skilled nursing facilities369,000 10.0 %346,000 12.9 %1,195,000 9.6 %1,076,000 10.8 %
Hospitals111,000
 4.0% 134,000
 4.9% 216,000
 3.9% 285,000
 5.0%Hospitals113,000 4.1 %149,000 5.3 %329,000 4.0 %434,000 5.1 %
Senior housing22,000
 0.6% 127,000
 2.1% 43,000
 0.6% 223,000
 1.9%Senior housing9,000 0.2 %553,000 21.3 %52,000 0.5 %776,000 5.5 %
Total rental expenses$8,147,000
 27.1% $8,226,000
 25.3% $16,317,000
 27.1% $16,651,000
 25.5%Total rental expenses$7,795,000 25.7 %$9,188,000 32.9 %$24,112,000 26.6 %$25,839,000 27.7 %
For the three months ended JuneSeptember 30, 2020 and 2019, property operating expenses primarily consisted of administration and benefits expense of $203,660,000$209,944,000 and $210,125,000,$212,791,000, respectively. For the sixnine months ended JuneSeptember 30, 2020 and 2019, property operating expenses primarily consisted of administration and benefits expense of $426,028,000$635,972,000 and $414,826,000,$627,617,000, respectively. Overall, property operating expenses have significantly increased due to labor costs, the single largest expense line item for skilled nursing facilities and senior housing facilities, as well as the costs of COVID-19 testing of employees and residents and the costs of PPE and other supplies required as a result of the COVID-19 pandemic. For the three and six months ended June 30, 2020, we recognized approximately $5,985,000 and $6,213,000, respectively, of additional property operating expenses for our integrated senior health campuses related to the COVID-19 pandemic. Further, we recognized approximately $619,000 and $761,000, respectively, of additional rental expenses for our senior housing — RIDEA facilities in response to the COVID-19 pandemic, which was partially offset by $276,000 in government grants for both the three and six months ended June 30, 2020 recognized through CARES Act economic relief programs. Integrated senior health campuses and senior housing — RIDEA facilities typically have a higher percentage of direct operating expenses to revenue than multi-tenant medical office buildings, hospitals, and leased, non-RIDEA senior housing and skilled nursing 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 June 30, Six Months Ended June 30,
 2020 2019 2020 2019
Asset management and property management oversight fees — affiliates$5,768,000
 $5,020,000
 $10,873,000
 $9,997,000
Professional and legal fees929,000
 631,000
 1,400,000
 1,165,000
Transfer agent services305,000
 335,000
 630,000
 657,000
Stock compensation expense195,000
 195,000
 390,000
 390,000
Bank charges164,000
 43,000
 278,000
 102,000
Postage and delivery117,000
 124,000
 162,000
 141,000
Directors’ and officers’ liability insurance83,000
 79,000
 165,000
 158,000
Board of directors fees77,000
 68,000
 154,000
 140,000
Franchise taxes60,000
 76,000
 146,000
 198,000
Restricted stock compensation57,000
 57,000
 100,000
 100,000
Bad debt expense
 (176,000) 
 272,000
Other26,000
 60,000
 57,000
 109,000
Total$7,781,000
 $6,512,000
 $14,355,000
 $13,429,000
The increase in general and administrative expense for the three and six months ended June 30, 2020 as compared to the three and six months ended June 30, 2019 was primarily due to the increase in asset management and property management oversight fees as a result of an increase in our average invested assets in 2020 as compared to 2019, partially offset by bad debt expense for our accounts receivable as a result of a change in lease accounting guidance in 2019.
 Three Months Ended September 30,Nine Months Ended September 30,
 2020201920202019
Asset management and property management oversight fees — affiliates$5,518,000 $5,021,000 $16,391,000 $15,018,000 
Professional and legal fees501,000 1,226,000 1,901,000 2,391,000 
Transfer agent services298,000 348,000 928,000 1,005,000 
Stock compensation expense195,000 195,000 585,000 585,000 
Bank charges153,000 72,000 431,000 174,000 
Directors’ and officers’ liability insurance82,000 78,000 247,000 236,000 
Board of directors fees76,000 68,000 230,000 208,000 
Postage and delivery69,000 14,000 231,000 155,000 
Restricted stock compensation28,000 72,000 128,000 172,000 
Franchise taxes22,000 56,000 168,000 254,000 
Bad debt expense— 473,000 — 745,000 
Other27,000 52,000 84,000 161,000 
Total$6,969,000 $7,675,000 $21,324,000 $21,104,000 
Depreciation and Amortization
For the three months ended JuneSeptember 30, 2020 and 2019, depreciation and amortization was $24,572,000$24,591,000 and $24,743,000,$36,778,000, respectively, which primarily consisted of depreciation on our operating properties of $22,518,000$22,699,000 and $21,530,000,$25,062,000, respectively, and amortization on our identified intangible assets of $1,670,000$1,456,000 and $2,962,000,$11,435,000, respectively.
For the sixnine months ended JuneSeptember 30, 2020 and 2019, depreciation and amortization was $49,659,000$74,250,000 and $50,371,000,$87,149,000, respectively, which primarily consisted of depreciation on our operating properties of $45,260,000$67,959,000 and $43,734,000,$68,796,000, respectively, and amortization of our identified intangible assets of $3,664,000$5,120,000 and $6,095,000,$17,530,000, respectively.
The decrease in depreciation and amortization expense for the three and nine months ended September 30, 2020, compared to the corresponding prior year periods, is primarily due to the September 2019 write-off of tenant improvements and in-place leases in connection with the termination of a management services agreement with an operator in 2019.
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 June 30, Six Months Ended June 30, Three Months Ended September 30,Nine Months Ended September 30,
2020 2019 2020 2019 2020201920202019
Interest expense:       Interest expense:
Lines of credit and term loans and derivative financial instruments$7,828,000
 $9,612,000
 $16,261,000
 $19,218,000
Lines of credit and term loans and derivative financial instruments$7,448,000 $8,757,000 $23,709,000 $27,975,000 
Mortgage loans payable8,120,000
 8,157,000
 16,458,000
 15,871,000
Mortgage loans payable8,044,000 8,383,000 24,502,000 24,254,000 
Amortization of deferred financing costs:       Amortization of deferred financing costs:
Lines of credit and term loans773,000
 970,000
 1,533,000
 2,000,000
Lines of credit and term loans955,000 882,000 2,488,000 2,882,000 
Mortgage loans payable341,000
 381,000
 636,000
 639,000
Mortgage loans payable277,000 483,000 913,000 1,122,000 
Amortization of debt discount/premium, net207,000
 169,000
 415,000
 338,000
Amortization of debt discount/premium, net206,000 164,000 621,000 502,000 
(Gain) loss in fair value of derivative financial instruments(749,000) 4,117,000
 7,434,000
 4,677,000
(Gain) loss in fair value of derivative financial instruments(1,763,000)1,169,000 5,671,000 5,846,000 
Accretion of finance lease liabilities162,000
 52,000
 331,000
 131,000
Loss on extinguishment of debtLoss on extinguishment of debt— 2,179,000 — 2,179,000 
Interest on finance lease liabilitiesInterest on finance lease liabilities82,000 146,000��413,000 277,000 
Interest expense on financing obligations and other liabilities221,000
 219,000
 552,000
 422,000
Interest expense on financing obligations and other liabilities217,000 52,000 769,000 474,000 
Total$16,903,000
 $23,677,000
 $43,620,000
 $43,296,000
Total$15,466,000 $22,215,000 $59,086,000 $65,511,000 
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The changedecrease in total interest expense for the three and sixnine months ended JuneSeptember 30, 2020, as compared to the three and sixnine months ended JuneSeptember 30, 2019, was primarily related to the decrease in interest expense as a result of the termination of an agreement for our previous credit facility, the extinguishment of a mortgage loan payable during 2019 and decrease in interest rates on our variable rate debt, partially offset by the change in loss on fair value recognizedadjustments on theour derivative financial instruments, which was due to a decrease in London Inter-bank Offered Rate, or LIBOR, rates relative to our interest rate swap contracts.
Impairment of Real Estate Investments
For the nine months ended September 30, 2020, we recognized an impairment charge of $3,711,000 on one skilled nursing facility within Fox Grape SNF Portfolio, $1,905,000 on one medical office building within Mount Olympia MOB Portfolio and $2,719,000 on two integrated senior health campuses within Trilogy Investors, LLC, or Trilogy, for an aggregate impairment charge of $8,335,000. We subsequently disposed of such impaired medical office building in July 2020 and recognized a net gain on sale of $15,000. See Note 2, Summary of Significant Accounting Policies Impairment of Long-Lived Assets and Note 2, Summary of Significant Accounting Policies Properties Held for Sale, to our accompanying condensed consolidated financial statements for a further discussion. No impairment charges on real estate investments were recognized for both the three and nine months ended September 30, 2019.
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 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. We estimate that we will require approximately $25,046,000$13,493,000 to pay interest on our outstanding indebtedness for the remainder of 2020, based on interest rates in effect as of JuneSeptember 30, 2020, and that we will require $65,489,000$3,381,000 to pay principal on our outstanding indebtedness for the remainder of 2020. On July 28, 2020, we entered into an amendment to the credit agreement entered into on January 25, 2019 for our credit facility as discussed in Note 21, Subsequent Event — 2019 Corporate Credit Agreement Amendment, to our accompanying condensed consolidated financial statements that are part of this Quarterly Report on Form 10-Q. 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 total capacity to pay operating expenses, capital improvement expenditures, interest, distributions and repurchases, as well as acquire and/or 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.
Due to the impact the COVID-19 pandemic has had on the United States and globally, and the ongoing uncertainty of the severity and duration of the COVID-19 pandemic and its effects, our board has taken steps since March 2020 to protect our capital and maximize our liquidity in an effort to strengthen our long-term financial prospects. Consequently, on March 31, 2020, our board approved a daily distribution rate for April and May 2020 equal to $0.000821918 per share of our common stock, which was 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. On March 31, 2020, our board also partially 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 were not suspended, but remained subject to all terms and conditions of our share repurchase plan, including our board’s discretion to determine whether we had sufficient funds available to repurchase any shares. Additionally, in response to the continued uncertainty of the COVID-19 pandemic and its impact to our portfolio of investments, to further maximize our liquidity, on May 29, 2020, our board approved the suspension of all stockholder distributions and the Amended and Restated DRIP until such time, if any, as our board determines to authorize new distributions and to reinstate such plan. Such suspensions were effective upon the completion of all shares issued with respect to distributions payable to stockholders of record on or prior to the close of business on May 31, 2020. See the “Distributions” section below for a further discussion. Furthermore, on May 29, 2020, our board approved the suspension of our share repurchase plan with respect to all share repurchase requests received after May 31, 2020, including repurchases resulting from death or qualifying disability of stockholders. Our board will continue to assess our distribution policy in light of our operations and future capital needs and shall determine if and when it is in the best interest of our company and our stockholders to reinstate distributions, the Amended and Restated DRIP or our share repurchase plan. In addition to the actions taken by our board described above, our advisor deferredagreed to defer 50.0% of the asset management fees that it would otherwise be entitled to receive for services performed by our advisor or its affiliates from June 1, 2020 to November 30, 2020. See Note 14, Related Party Transactions, to our accompanying condensed consolidated financial statements for a further discussion of such deferred asset management fees.
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As of JuneSeptember 30, 2020, our cash on hand was $134,338,000$133,332,000 and we had $147,121,000$134,366,000 available on our lines of credit and term loans.credit. Such cash on hand included $16,831,000$12,547,000 of government grants and $51,570,000$50,910,000 in Medicare advance payments received by Trilogy, Investors, LLC, of which we currently own 67.6%, through economic stimulus programs of the CARES Act. See Note 2, Summary of Significant Accounting Policies — Government Grants and Note 11, Commitments and Contingencies — Impact of the COVID-19 Pandemic, to our accompanying condensed consolidated financial statements for a further discussion of such relief funds. We believe that such proceeds of cash and available lines of credit 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, 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 loan established with respect to the investment, other borrowings, or additional equity

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investments from us or joint venture partners. As of JuneSeptember 30, 2020, we had $12,139,000$12,698,000 of restricted cash in loan impounds and reserve accounts to fund a portion of such capital expenditures. The capital plan for each investment is adjusted through ongoing, regular reviews of our portfolio or as necessary to respond to unanticipated additional capital needs. Based on the budget for the properties we own as of JuneSeptember 30, 2020, we originally estimatedestimate that our discretionary expenditures for developments and capital and tenant improvements could have requiredrequire up to $28,614,000$15,743,000 for the remaining sixthree months of 2020. However, in light of the COVID-19 pandemic and to further preserve cash, since March 2020, we suspended all non-essential, discretionary expenditures for capital improvements, as well as developments and/or expansions, 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 the enhancement of net operating income.income, or NOI. The duration of our suspension of developments and capital expenditures and developments are uncertain and an update to the actual amounts forecasted to be expended for the remainder of the year cannot be estimated at this time.
Cash Flows
The following table sets forth changes in cash flows:
 Six Months Ended June 30,Nine Months Ended September 30,
 2020 2019 20202019
Cash, cash equivalents and restricted cash — beginning of period $89,880,000
 $72,705,000
Cash, cash equivalents and restricted cash — beginning of period$89,880,000 $72,705,000 
Net cash provided by operating activities 148,867,000
 53,831,000
Net cash provided by operating activities191,685,000 91,792,000 
Net cash used in investing activities (67,932,000) (29,450,000)Net cash used in investing activities(112,474,000)(72,055,000)
Net cash provided by (used in) financing activities 984,000
 (23,340,000)Net cash provided by (used in) financing activities598,000 (8,161,000)
Effect of foreign currency translation on cash, cash equivalents and restricted cash (118,000) (23,000)Effect of foreign currency translation on cash, cash equivalents and restricted cash(73,000)(108,000)
Cash, cash equivalents and restricted cash — end of period $171,681,000
 $73,723,000
Cash, cash equivalents and restricted cash — end of period$169,616,000 $84,173,000 
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 sixnine months ended JuneSeptember 30, 2020 and 2019, cash flows provided by operating activities primarily related to the cash flows provided by our property operations and $29,990,000$30,730,000 of grant income, 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. In addition, for the sixnine months ended JuneSeptember 30, 2020, cash flows provided by operating activities included $7,260,000approximately $20,735,000 of government grants and $52,322,000 of Medicare advance payments that have been received and deferred in other liabilities to recognizebe recognized in the future as revenue or grant income, as applicable, commencing in the third quarter of 2020.applicable. See Note 2, Summary of Significant Accounting Policies — Government Grants and Note 11, Commitments and Contingencies — Impact of the COVID-19 Pandemic, to our accompanying condensed consolidated financial statements for a further discussion of such deferred revenue and government grants.
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Investing Activities
For the sixnine months ended JuneSeptember 30, 2020, cash flows used in investing activities primarily related to ourdevelopments and capital expenditures of $65,083,000$93,657,000 and acquisitions of previously leased real estate investments, including our acquisition of a land parcelacquisition, in the amount of $1,478,000.$29,447,000, partially offset by proceeds from real estate dispositions of $12,105,000. For the sixnine months ended JuneSeptember 30, 2019, cash flows used in investing activities primarily related to ourdevelopments and capital expenditures of $38,510,000$65,740,000 and 2019 property acquisitions in the amount of $17,457,000,$32,793,000, partially offset by principal repayments on real estate notes receivable of $28,650,000. In general, cash flows used in investing activities will be affected by the timing of capital expenditures and development projectsand the number of acquisitions we complete in future years as compared to prior years.
Financing Activities
For the sixnine months ended JuneSeptember 30, 2020, cash flows provided by financing activities primarily related to borrowings under mortgage loans payable of $59,033,000, net borrowings under our lines of credit and term loans in the amount of $27,000,000, borrowings under$39,755,000 and the sale of a 9.4% membership interest in a consolidated limited liability company that owns Southlake TX Hospital for $11,000,000, partially offset by scheduled payments on our mortgage loans payable of $17,502,000 and the issuance of a noncontrolling interest of $11,000,000, partially offset by$49,056,000, distributions to our common stockholders of $26,997,000, share repurchases of $17,986,000$23,107,000 and scheduled payments on our early payoff of mortgage loans payable of $6,348,000.$2,601,000. For the sixnine months ended JuneSeptember 30, 2019, cash flows used in financing activities primarily related to share repurchases of $55,088,000$72,200,000 and distributions to our common stockholders of $30,886,000,$46,716,000, partially offset by borrowings under mortgage loans payable in the amount of $61,472,000.$182,417,000. The decrease in share repurchases and distributions paid in 2020 compared to 2019 was primarily related to actions taken by our board to protect our capital and maximize our liquidity in response to the COVID-19

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pandemic, such as the decrease in our daily distribution rate approved by our board in March 2020 followed by the suspension of all stockholder distributions in May 2020. See the “Distributions” section below for a further discussion. Overall, we anticipate cash flows from financing activities to decrease in the future. However, we anticipate our indebtedness to increase if we acquire additional real estate and real estate-related investments.
Distributions
OurPrior to March 31, 2020, our board 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 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.
In response to the COVID-19 pandemic and its effects to our business and operations, our board decided to take steps to protect our capital and maximize our liquidity in an effort to strengthen our long-term financial prospects. Consequently, on March 31, 2020, 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 calculated based on 365 days in the calendar year and were equal to $0.000821918 per share of our common stock, which was equal to an annualized distribution of $0.30 per share, a decrease from the annualized rate of $0.60 per share previously paid by us. These daily distributions were aggregated and paid in cash or shares of our common stock pursuant to our DRIP Offerings monthly in arrears, only from legally available funds. Furthermore, in response to the continued uncertainty of the COVID-19 pandemic and its impact to our portfolio of investments, on May 29, 2020, our board authorized the suspension of all stockholder distributions upon the completion of the payment of distributions payable to stockholders of record on or prior to the close of business on May 31, 2020. Our board also approved the suspension of the Amended and Restated DRIP effective upon the completion of all shares issued pursuant to the Amended and Restated DRIP with respect to distributions payable to stockholders of record on or prior to the close of business on May 31, 2020 until such time, if any, as our board determines to authorize new distributions and to reinstate the Amended and Restated DRIP. See our Current Report on Form 8-K filed with the SEC on June 4, 2020 for more information.
The amount of any distributions paid to our stockholders is determined 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.
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The distributions paid for the sixnine months ended JuneSeptember 30, 2020 and 2019, along with the amount of distributions reinvested pursuant to our DRIP Offerings, and the sources of our distributions as compared to cash flows from operations were as follows:
Six Months Ended June 30,Nine Months Ended September 30,
2020 2019 20202019
Distributions paid in cash$26,997,000
   $30,886,000
  Distributions paid in cash$26,997,000 $46,716,000 
Distributions reinvested21,861,000
   28,311,000
  Distributions reinvested21,861,000 42,100,000 
$48,858,000
   $59,197,000
  $48,858,000 $88,816,000 
Sources of distributions:       Sources of distributions:
Cash flows from operations$48,858,000
 100% $53,831,000
 90.9%Cash flows from operations$48,858,000 100 %$88,816,000 100 %
Proceeds from borrowings
 
 5,366,000
 9.1
Proceeds from borrowings— — — — 
$48,858,000
 100% $59,197,000
 100%
$48,858,000 100 %$88,816,000 100 %
As of JuneSeptember 30, 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 net offering proceeds and borrowings have reduced the amount of capital we ultimately invested in assets and negatively impacted the amount of income available for future distributions.

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The distributions paid for the sixnine months ended JuneSeptember 30, 2020 and 2019, along with the amount of distributions reinvested pursuant to our DRIP Offerings, and the sources of our distributions as compared to funds from operations attributable to controlling interest, or FFO, were as follows:
Six Months Ended June 30,Nine Months Ended September 30,
2020 2019 20202019
Distributions paid in cash$26,997,000
   $30,886,000
  Distributions paid in cash$26,997,000 $46,716,000 
Distributions reinvested21,861,000
   28,311,000
  Distributions reinvested21,861,000 42,100,000 
$48,858,000
   $59,197,000
  $48,858,000 $88,816,000 
Sources of distributions:       Sources of distributions:
FFO attributable to controlling interest$48,858,000
 100% $46,509,000
 78.6%FFO attributable to controlling interest$48,858,000 100 %$62,244,000 70.1 %
Proceeds from borrowings
 
 12,688,000
 21.4
Proceeds from borrowings— — 26,572,000 29.9 
$48,858,000
 100% $59,197,000
 100%
$48,858,000 100 %$88,816,000 100 %
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 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 approximate 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 JuneSeptember 30, 2020, our aggregate borrowings were 45.6%46.0% of the combined market value of all of our real estate and real estate-related investments.
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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. 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 August 14,November 16, 2020 and JuneSeptember 30, 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 a minimum percentageof 90.0% of our annual taxable income, excluding net capital gains. Such distributions are required to be paid at least 20.0% in cash and 80.0% in stock. In response to the COVID-19 pandemic, in May 2020, the Internal Revenue Service temporarily reduced the cash distribution requirement from a minimum of 90.0% of our taxable income to a minimum of 10.0%, which is applicable with respect to the aggregate distributions declared on or after April 1, 2020 until December 31, 2020. 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 JuneSeptember 30, 2020, we had $827,371,000$823,594,000 ($804,414,000,800,170,000, net of discount/premium and deferred financing costs) of fixed-rate and variable-rate mortgage loans payable outstanding secured by our properties. As of JuneSeptember 30, 2020, we had $842,879,000$855,634,000 outstanding and $147,121,000$134,366,000 remained available under our lines of credit and term loans.credit. 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 various financial and non-financial covenants, such as leverage ratios, net worth ratios, debt service coverage ratios and fixed charge coverage ratios. As of JuneSeptember 30, 2020, we were in compliance with all such covenants and requirements on our mortgage loans payable and our lines of credit and term loans. 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 JuneSeptember 30, 2020, the weighted average effective interest rate on our outstanding debt, factoring in our fixed-rate interest rate swaps and interest rate cap, was 3.50%3.61% per annum.
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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; (iii) ground and other lease obligations; (iv) financing obligations; and (v) finance leases as of JuneSeptember 30, 2020:
 Payments Due by Period
 2020 2021-2022 2023-2024 Thereafter Total
Principal payments — fixed-rate debt$17,905,000
  $75,177,000
 $95,114,000
 $520,272,000
 $708,468,000
Interest payments — fixed-rate debt13,005,000
  49,642,000
 42,174,000
 259,940,000
 364,761,000
Principal payments — variable-rate debt47,584,000
 633,829,000
 280,369,000
 
 961,782,000
Interest payments — variable-rate debt (based on rates in effect as of June 30, 2020)12,041,000
 32,459,000
 5,723,000
 
 50,223,000
Ground and other lease obligations13,293,000
  53,227,000
 53,634,000
 194,772,000
 314,926,000
Financing obligations10,226,000
 18,127,000
 2,771,000
 1,194,000
 32,318,000
Finance leases311,000
 173,000
 16,000
 
 500,000
Total$114,365,000
  $862,634,000
 $479,801,000
 $976,178,000
 $2,432,978,000

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 Payments Due by Period
 20202021-20222023-2024ThereafterTotal
Principal payments — fixed-rate debt$3,329,000 $76,213,000 $96,207,000 $546,994,000 $722,743,000 
Interest payments — fixed-rate debt6,590,000 51,156,000 43,631,000 272,423,000 373,800,000 
Principal payments — variable-rate debt52,000 633,254,000 323,179,000 — 956,485,000 
Interest payments — variable-rate debt (based on rates in effect as of September 30, 2020)6,903,000 36,966,000 6,531,000 — 50,400,000 
Ground and other lease obligations6,330,000 47,874,000 47,954,000 190,561,000 292,719,000 
Financing obligations8,794,000 18,127,000 2,771,000 1,287,000 30,979,000 
Finance leases90,000 173,000 16,000 — 279,000 
Total$32,088,000 $863,763,000 $520,289,000 $1,011,265,000 $2,427,405,000 
Off-Balance Sheet Arrangements
As of JuneSeptember 30, 2020, we had no off-balance sheet transactions, nor do we currently have any such arrangements or obligations.
Inflation
During the sixnine months ended JuneSeptember 30, 2020 and 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. 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 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.
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
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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).
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.
The 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

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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 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.
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, gains or losses from early extinguishment of debt, 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 periods presented in the table below.
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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

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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.
For both the three and sixnine months ended JuneSeptember 30, 2020, we recognized government grants as grant income or as a reduction of property operating expenses, as applicable.applicable, and within loss from unconsolidated entities. Such amounts were granted through federal and state government programs, such as through the CARES Act, and which were established for eligible healthcare providers to preserve liquidity as a result of lost revenues and/or healthcare expenses incurred associated within response to the COVID-19 pandemic. See the “Results of Operations” section above for a further discussion. The government grants helped mitigate some of the negative impact that the COVID-19 pandemic had on our financial condition and results of operations, without whichoperations. Without such relief proceeds, the COVID-19 pandemic impact would have had a material adverse impact to our FFO and MFFO. For the three and sixnine months ended JuneSeptember 30, 2020, FFO would have been approximately $14,780,000$20,770,000 and $31,009,000,$51,779,000, respectively, excluding government grants recognized. For the three and sixnine months ended JuneSeptember 30, 2020, MFFO would have been approximately $13,831,000$15,989,000 and $41,379,000,$57,368,000, respectively, excluding government grants recognized.
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The following is a reconciliation of net income or loss, which is the most directly comparable GAAP financial measure, to FFO and MFFO for the periods presented below:
Three Months Ended September 30,Nine Months Ended September 30,
 2020201920202019
Net (loss) income$(680,000)$(17,103,000)$12,324,000 $(10,400,000)
Add:
Depreciation and amortization related to real estate — consolidated properties24,591,000 36,778,000 74,250,000 87,149,000 
Depreciation and amortization related to real estate — unconsolidated entities762,000 367,000 2,270,000 819,000 
Impairment of real estate investments— — 8,335,000 — 
Less:
Gain on dispositions of real estate investments(1,037,000)— (1,037,000)— 
Net loss (income) attributable to noncontrolling interests1,375,000 (201,000)(7,779,000)(2,979,000)
Depreciation, amortization, impairments and gain on dispositions — noncontrolling interests(4,061,000)(4,106,000)(13,743,000)(12,345,000)
FFO attributable to controlling interest$20,950,000 $15,735,000 $74,620,000 $62,244,000 
Acquisition related expenses(1)$54,000 $4,000 $307,000 $(292,000)
Amortization of above- and below-market leases(2)42,000 40,000 77,000 175,000 
Amortization of closing costs(3)44,000 37,000 125,000 237,000 
Change in deferred rent(4)(1,067,000)2,450,000 (1,471,000)1,136,000 
Loss on extinguishment of debt(5)— 2,179,000 — 2,179,000 
(Gain) loss in fair value of derivative financial instruments(6)(1,763,000)1,169,000 5,671,000 5,846,000 
Foreign currency (gain) loss(7)(1,945,000)1,464,000 1,303,000 1,654,000 
Adjustments for unconsolidated entities(8)200,000 344,000 754,000 1,099,000 
Adjustments for noncontrolling interests(8)(346,000)(1,110,000)(1,177,000)(2,035,000)
MFFO attributable to controlling interest$16,169,000 $22,312,000 $80,209,000 $72,243,000 
Weighted average common shares outstanding — basic and diluted193,856,887 195,669,002 194,273,579 196,705,085 
Net (loss) income per common share — basic and diluted$— $(0.09)$0.06 $(0.05)
FFO attributable to controlling interest per common share — basic and diluted$0.11 $0.08 $0.38 $0.32 
MFFO attributable to controlling interest per common share — basic and diluted$0.08 $0.11 $0.41 $0.37 
 Three Months Ended June 30, Six Months Ended June 30,
 2020 2019 2020 2019
Net income (loss)$20,787,000
 $(155,000) $13,004,000
 $6,703,000
Add:       
Depreciation and amortization related to real estate — consolidated properties24,572,000
 24,743,000
 49,659,000
 50,371,000
Depreciation and amortization related to real estate — unconsolidated entities764,000
 227,000
 1,508,000
 452,000
Impairment of real estate investments3,233,000
 
 8,335,000
 
Less:       
Net income attributable to noncontrolling interests(7,027,000) (1,430,000) (9,154,000) (2,778,000)
Depreciation, amortization and impairments related to noncontrolling interests(4,888,000) (4,108,000) (9,682,000) (8,239,000)
FFO attributable to controlling interest$37,441,000
 $19,277,000
 $53,670,000
 $46,509,000
        
Acquisition related expenses(1)$19,000
 $400,000
 $253,000
 $(296,000)
Amortization of above- and below-market leases(2)16,000
 28,000
 35,000
 135,000
Amortization of closing costs(3)41,000
 132,000
 81,000
 200,000
Change in deferred rent(4)(376,000) (610,000) (404,000) (1,314,000)
(Gain) loss in fair value of derivative financial instruments(5)(749,000) 4,117,000
 7,434,000
 4,677,000
Foreign currency loss (6)183,000
 1,232,000
 3,248,000
 190,000
Adjustments for unconsolidated entities(7)238,000
 378,000
 554,000
 755,000
Adjustments for noncontrolling interests(7)(321,000) (443,000) (831,000) (925,000)
MFFO attributable to controlling interest$36,492,000
 $24,511,000
 $64,040,000
 $49,931,000
Weighted average common shares outstanding — basic and diluted194,123,913
 196,075,614
 194,484,214
 197,231,713
Net income per common share — basic and diluted$0.11
 $
 $0.07
 $0.03
FFO attributable to controlling interest per common share — basic and diluted$0.19
 $0.10
 $0.28
 $0.24
MFFO attributable to controlling interest per common share — basic and diluted$0.19
 $0.13
 $0.33
 $0.25
___________

(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.
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(3)Under GAAP, direct closing costs are amortized over the term of our debt security investment as an adjustment to the yield on our debt security investment. This may result in income recognition that is different than the contractual cash flows under our debt security investment. By adjusting for the amortization of the closing costs related to our debt security investment, MFFO may provide useful supplemental information on the realized economic impact of our debt security investment terms, providing insight on the expected contractual cash flows of such 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 contract terms. By adjusting 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.
(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 closing costs are amortized over the term of our debt security investment as an adjustment to the yield on our debt security investment. This may result in income recognition that is different than the contractual cash flows under our debt security investment. By adjusting for the amortization of the closing costs related to our debt security investment, MFFO may provide useful supplemental information on the realized economic impact of our debt security investment terms, providing insight on the expected contractual cash flows of such 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 contract terms. By adjusting 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 include changes in fair value of our derivative financial instruments 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 noncontrolling interests’ share, as applicable, of the adjustments described in notes (1) (6) above to convert our FFO to MFFO.
(5)The loss associated with the early extinguishment of debt primarily includes the write-off of unamortized deferred financing fees, write-off of unamortized debt discount, penalties or other fees incurred. We believe that adjusting for such non-recurring losses provides useful supplemental information because such charges (or losses) may not be reflective of on-going business transactions and operations and is consistent with management’s analysis of our operating performance.
(6)Under GAAP, we are required to include changes in fair value of our derivative financial instruments 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.
(7)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.
(8)Includes all adjustments to eliminate the unconsolidated entities’ share or noncontrolling interests’ share, as applicable, of the adjustments described in notes (1) (7) 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, income or loss from unconsolidated entities, foreign currency gain or loss, other income and income tax benefit or expense.
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 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 cash flow 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.

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We believe that NOI is an appropriate supplemental performance measure to reflect the performance of our operating assets because NOI excludes certain items that are not associated with the operations 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.
For both the three and sixnine months ended JuneSeptember 30, 2020, we recognized government grants as grant income or as a reduction of property operating expenses, as applicable. The government grants helped mitigate some of the negative impact that the COVID-19 pandemic had on our financial condition, without whichcondition. Without such relief proceeds, the COVID-19 pandemic impact would have had a material adverse impact to our NOI. For the three and sixnine months ended JuneSeptember 30, 2020, NOI would have been approximately $42,116,000$45,480,000 and $98,250,000,$143,730,000, respectively, excluding government grants recognized.
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To facilitate understanding of this financial measure, the following is a reconciliation of net income or loss, which is the most directly comparable GAAP financial measure, to NOI for the periods presented below:
 Three Months Ended September 30,Nine Months Ended September 30,
2020201920202019
Net (loss) income$(680,000)$(17,103,000)$12,324,000 $(10,400,000)
General and administrative6,969,000 7,675,000 21,324,000 21,104,000 
Acquisition related expenses54,000 4,000 307,000 (292,000)
Depreciation and amortization24,591,000 36,778,000 74,250,000 87,149,000 
Interest expense15,466,000 22,215,000 59,086,000 65,511,000 
Gain on dispositions of real estate investments(1,037,000)— (1,037,000)— 
Impairment of real estate investments— — 8,335,000 — 
Loss from unconsolidated entities2,855,000 766,000 3,065,000 1,713,000 
Foreign currency (gain) loss(1,945,000)1,464,000 1,303,000 1,654,000 
Other income(203,000)(1,923,000)(1,279,000)(2,377,000)
Income tax expense (benefit)150,000 840,000 (2,942,000)1,150,000 
Net operating income$46,220,000 $50,716,000 $174,736,000 $165,212,000 
 Three Months Ended June 30, Six Months Ended June 30,
 2020 2019 2020 2019
Net income (loss)$20,787,000
 $(155,000) $13,004,000
 $6,703,000
General and administrative7,781,000
 6,512,000
 14,355,000
 13,429,000
Acquisition related expenses19,000
 400,000
 253,000
 (296,000)
Depreciation and amortization24,572,000
 24,743,000
 49,659,000
 50,371,000
Interest expense16,903,000
 23,677,000
 43,620,000
 43,296,000
Impairment of real estate investments3,233,000
 
 8,335,000
 
(Income) loss from unconsolidated entities(694,000) 493,000
 210,000
 947,000
Foreign currency loss183,000
 1,232,000
 3,248,000
 190,000
Other income(521,000) (246,000) (1,076,000) (454,000)
Income tax expense (benefit)119,000
 159,000
 (3,092,000) 310,000
Net operating income$72,382,000
 $56,815,000
 $128,516,000
 $114,496,000
Subsequent Event
For a discussion of a subsequent event, see Note 21, Subsequent Event, to our accompanying condensed consolidated financial statements.
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 2019 Annual Report on Form 10-K, as filed with the SEC on March 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 other permitted investments. 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. We have not elected to apply hedge accounting treatment to these 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 (loss). As of JuneSeptember 30, 2020, our interest rate cap and 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 their fair value of $2,000$0 and $(11,407,000)$(9,642,000), respectively. We do not enter into derivative transactions for speculative purposes.

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In July 2017, the Financial Conduct Authority, or FCA, that regulates the LIBOR, announced its intention to stop compelling banks to submit rates for the calculation of LIBOR after 2021. As a result, the Federal Reserve Board and the Federal Reserve Bank of New York organized the Alternative Reference Rates Committee, or ARRC, which identified the Secured Overnight Financing Rate, or SOFR, as its preferred alternative to United States dollar LIBOR in derivatives and other financial contracts. We are not able to predict when LIBOR will cease to be available or when there will be sufficient liquidity in the SOFR markets. Any changes adopted by the FCA or other governing bodies in the method used for determining LIBOR may result in a sudden or prolonged increase or decrease in reported LIBOR. If that were to occur, our interest payments could change. In addition, uncertainty about the extent and manner of future changes may result in interest rates and/or payments that are higher or lower than if LIBOR were to remain available in its current form.
We have variable rate debt outstanding and interest rate swap and cap agreementsderivative financial instruments maturing on various dates from 20202021 to 2024,2025, as discussed further above, that are indexed to LIBOR. As such, we are monitoring and evaluating the related risks of the discontinuation of LIBOR, which include possible changes to the interest on loans or amounts received and paid on derivative instruments. These risks arise in connection with transitioning contracts to a new alternative rate, including any resulting value
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transfer that may occur. The value of loans or derivative instruments tied to LIBOR could also be impacted if LIBOR is limited or discontinued. For some instruments, the method of transitioning to an alternative rate may be challenging, as they may require negotiation with the respective counterparty. If a contract is not transitioned to an alternative rate and LIBOR is discontinued, the impact on our contracts is likely to vary by contract. If LIBOR is discontinued or if the methods of calculating LIBOR change from their current form, interest rates on our current or future indebtedness may be adversely affected. While we expect LIBOR to be available in substantially its current form until the end of 2021, it is possible that LIBOR will become unavailable prior to that point. This could result, for example, if a sufficient number of banks decline to make submissions to the LIBOR administrator. In that case, the risks associated with the transition to an alternative reference rate will be accelerated and magnified.
As of JuneSeptember 30, 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 Date Expected Maturity Date
2020 2021 2022 2023 2024 Thereafter Total Fair Value 20202021202220232024ThereafterTotalFair Value
Assets               Assets
Debt security held-to-maturity$
 $
 $
 $
 $
 $93,433,000
 $93,433,000
 $93,361,000
Debt security held-to-maturity$— $— $— $— $— $93,433,000 $93,433,000 $93,364,000 
Weighted average interest rate on maturing fixed-rate debt security% % % % % 4.24% 4.24% 
Weighted average interest rate on maturing fixed-rate debt security— %— %— %— %— %4.24 %4.24 %— 
Liabilities               Liabilities
Fixed-rate debt — principal payments$17,905,000
 $13,107,000
 $62,070,000
 $29,127,000
 $65,987,000
 $520,272,000
 $708,468,000
 $667,488,000
Fixed-rate debt — principal payments$3,329,000 $13,618,000 $62,595,000 $29,666,000 $66,541,000 $546,994,000 $722,743,000 $723,228,000 
Weighted average interest rate on maturing fixed-rate debt5.02% 3.69% 4.15% 4.14% 3.67% 4.07% 3.72% 
Weighted average interest rate on maturing fixed-rate debt3.65 %3.66 %4.13 %4.11 %3.66 %4.00 %3.64 %— 
Variable-rate debt — principal payments$47,584,000
 $42,829,000
 $591,000,000
 $273,079,000
 $7,290,000
 $
 $961,782,000
 $966,594,000
Variable-rate debt — principal payments$52,000 $59,754,000 $573,500,000 $312,788,000 $10,391,000 $— $956,485,000 $960,449,000 
Weighted average interest rate on maturing variable-rate debt (based on rates in effect as of June 30, 2020)3.12% 3.32% 2.30% 3.00% 5.25% % 2.59% 
Weighted average interest rate on maturing variable-rate debt (based on rates in effect as of September 30, 2020)Weighted average interest rate on maturing variable-rate debt (based on rates in effect as of September 30, 2020)2.50 %2.16 %2.71 %2.96 %5.25 %— %2.83 %— 
Debt Security Investment, Net
As of JuneSeptember 30, 2020, the net carrying value of our debt security investment was $74,253,000.$75,037,000. As we expect to hold our debt security investment to maturity and the amounts due under such 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 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 investment in a held-to-maturity debt security. The effective interest rate on our debt security investment was 4.24% per annum as of JuneSeptember 30, 2020.
Mortgage Loans Payable, Net and Lines of Credit and Term Loans
Mortgage loans payable were $827,371,000$823,594,000 ($804,414,000,800,170,000, net of discount/premium and deferred financing costs) as of JuneSeptember 30, 2020. As of JuneSeptember 30, 2020, we had 5860 fixed-rate mortgage loans payable and 11 variable-rate mortgage loans payable with effective interest rates ranging from 2.45% to 5.75%5.25% per annum and a weighted average effective interest rate of 3.66%3.60%. In addition, as of JuneSeptember 30, 2020, we had $842,879,000$855,634,000 outstanding under our lines of credit and term loans, at a weighted average interest rate of 2.49%2.77% per annum.

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As of JuneSeptember 30, 2020, the weighted average effective interest rate on our outstanding debt, factoring in our fixed-rate interest rate swaps and interest rate cap, was 3.50%3.61% 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 JuneSeptember 30, 2020, we have a fixed-rate interest rate cap on one of our variable-rate mortgage loans payable and twothree fixed-rate interest rate swaps on one of our lines of credit and term loans;loan; an increase in the variable interest rate thereon would have no effect on our overall annual interest expense. As of JuneSeptember 30, 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 $2,949,000,$2,416,000, or 4.51%3.72% 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.
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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 sixnine months ended JuneSeptember 30, 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 $11,000$17,000 for the same period.
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 JuneSeptember 30, 2020 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 JuneSeptember 30, 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 JuneSeptember 30, 2020 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.For a discussion of our legal proceedings, see Note 11, Commitments and Contingencies — Litigation, to our accompanying condensed consolidated financial statements.
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 2019 Annual Report on Form 10-K, as filed with the SEC on March 26, 2020, except as noted below.
Investment Risks
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. Any such distributions may reduce the amount of capital we ultimately invest in assets and may negatively impact the value of our stockholders’ 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, 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 maintain our qualification as a REIT. As a result, our distribution rate and payment frequency may vary from time to time.
Prior to March 31, 2020, our board 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 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.
In response to the COVID-19 pandemic and its effects to our business and operations, our board decided to take steps to protect our capital and maximize our liquidity in an effort to strengthen our long-term financial prospects. Consequently, on March 31, 2020, 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 calculated based on 365 days in the calendar year and were equal to $0.000821918 per share of our common stock, which is equal to an annualized distribution of $0.30 per share, a decrease from the annualized rate of $0.60 per share previously paid by us. These daily distributions were aggregated and paid in cash or shares of our common stock pursuant to our DRIP Offerings monthly in arrears, only from legally available funds. Furthermore in response to the continued uncertainty of the COVID-19 pandemic and its impact to our portfolio of investments, on May 29, 2020, our board authorized the suspension of all stockholder distributions upon the completion of the payment of distributions payable to stockholders of record on or prior to the close of business on May 31, 2020. Our board also approved the suspension of the Amended and Restated DRIP effective upon the completion of all shares issued pursuant to the Amended and Restated DRIP with respect to distributions payable to stockholders of record on or prior to the close of business on May 31, 2020 until such time, if any, as our board determines to authorize new distributions and to reinstate the Amended and Restated DRIP. See our Current Report on Form 8-K filed with the SEC on June 4, 2020 for more information.

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The distributions paid for the sixnine months ended JuneSeptember 30, 2020 and 2019, along with the amount of distributions reinvested pursuant to our DRIP Offerings, and the sources of our distributions as compared to cash flows from operations were as follows:
Six Months Ended June 30,Nine Months Ended September 30,
2020 2019 20202019
Distributions paid in cash$26,997,000
   $30,886,000
  Distributions paid in cash$26,997,000 $46,716,000 
Distributions reinvested21,861,000
   28,311,000
  Distributions reinvested21,861,000 42,100,000 
$48,858,000
   $59,197,000
  $48,858,000 $88,816,000 
Sources of distributions:       Sources of distributions:
Cash flows from operations$48,858,000
 100% $53,831,000
 90.9%Cash flows from operations$48,858,000 100 %$88,816,000 100 %
Proceeds from borrowings
 
 5,366,000
 9.1
Proceeds from borrowings— — — — 
$48,858,000
 100% $59,197,000
 100%$48,858,000 100 %$88,816,000 100 %
As of JuneSeptember 30, 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 net offering proceeds and borrowings have reduced the amount of capital we ultimately invested in assets and negatively impacted the amount of income available for future distributions.
The distributions paid for the sixnine months ended JuneSeptember 30, 2020 and 2019, along with the amount of distributions reinvested pursuant our DRIP Offerings, and the sources of our distributions as compared to FFO were as follows:
Six Months Ended June 30,Nine Months Ended September 30,
2020 2019 20202019
Distributions paid in cash$26,997,000
   $30,886,000
  Distributions paid in cash$26,997,000 $46,716,000 
Distributions reinvested21,861,000
   28,311,000
  Distributions reinvested21,861,000 42,100,000 
$48,858,000
   $59,197,000
  $48,858,000 $88,816,000 
Sources of distributions:       Sources of distributions:
FFO attributable to controlling interest$48,858,000
 100% $46,509,000
 78.6%FFO attributable to controlling interest$48,858,000 100 %$62,244,000 70.1 %
Proceeds from borrowings
 
 12,688,000
 21.4
Proceeds from borrowings— — 26,572,000 29.9 
$48,858,000
 100% $59,197,000
 100%$48,858,000 100 %$88,816,000 100 %
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 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, dissolved or completed a merger or other sale of our company. In addition, at this time, the audit committee of our board continues to deem it prudent to delay the determination of our annual estimated per share NAV until sometime in the future when we are able to more clearly discern the short- and long-term ramifications on valuation assumptions and methodologies and resulting healthcare real estate asset values due to the impacts of the COVID-19 pandemic.
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 provided 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 was based upon a number of estimates and assumptions that may not have been accurate or complete. Different parties with different assumptions and estimates could derive a different estimated per share NAV, and these differences could be significant.
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The updated estimated per share NAV was not audited or reviewed by our independent registered public accounting firm and did not represent the fair value of our assets or liabilities according to GAAP. In addition, the updated estimated per share NAV was 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 was 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. The COVID-19 pandemic has had, and may continue to have, an adverse effect on our business. However, the lasting impact of the COVID-19 pandemic on our portfolio of investments will largely depend on future developments, which are highly uncertain and cannot be predicted with confidence, 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. Although, we generally intend to publish an updated estimated per share NAV on at least an annual basis, at this time, the audit committee of our board continues to deem it prudent to delay the determination of our annual estimated per share NAV until sometime in the future when we are able to more clearly discern the short- and long-term ramifications on valuation assumptions and methodologies and resulting healthcare real estate asset values due to the impacts of the COVID-19 pandemic. As such, we did not publish an updated estimated per share NAV of our common stock in October 2020. We cannot provide any assurance as to when our board will be able to determine an updated estimated per share NAV. Our board will, however, continue to monitor the commercial and healthcare real estate markets and will update stockholders regarding an updated estimated per share NAV when market conditions permit.
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.
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 have provided an insignificant number of rent concessions, and may continue to 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 own 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;
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;
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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 an 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 with confidence 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.
Risk Related to our Business
In light of the impact that the COVID-19 pandemic has had on our business operations, we have suspended distribution payments to our stockholders and suspended our share repurchase plan, and there is no assurance as to when we will commence the payment of distributions to our stockholders or reinstate our share repurchase plan, if at all.
In light of the impact that the COVID-19 pandemic has had on our business operations and cash flows, and the uncertainty as to the ultimate severity and duration of the outbreak and its effects, on March 31, 2020, our board reduced our monthly distributions to stockholders from an annualized rate of $0.60 per share to $0.30 per share of our common stock effective with the April 2020 distribution paid in May 2020 as well as partially suspended our share repurchase plan with respect to all repurchase requests other than repurchases resulting from the death or qualifying disability of stockholders. Additionally, on May 31, 2020, in an effort to further preserve capital and strengthen our financial position in light of the COVID-19 impact, our board suspended the payment of all distributions to stockholders, the Amended and Restated DRIP and our share repurchase plan with respect to all repurchase requests. Our board will continue to evaluate the ongoing and future effects of the COVID-19 pandemic on our financial condition, earnings, debt covenants and other possible needs for cash, and applicable law, in considering our ability to reinstate distributions and our share repurchase plan in the future. Our stockholders have no contractual or other legal right to distributions or share repurchases that have not been authorized by our board. There can be no assurance when or if distributions and share repurchases will be authorized in the future, and if authorized, whether distributions or share repurchases will be in amounts consistent with our historical levels of distributions and share repurchases.

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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, dissolved or completed a merger or completed a sale of our company. In addition, because asset values are difficult to discern at this time due to the market disruptions and concerns regarding the reliability of traditional valuation methodologies in the current environment caused by the COVID-19 pandemic the audit committee ofhas adversely impacted, and will likely continue to adversely impact, our board has determined that it would not be practical or prudent to determine an updated estimated value per share of our common stock in October 2020.
On October 3, 2019, our board, at the recommendation of the audit committee of our board, comprised solely of independent directors, unanimously approvedbusiness 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 timefinancial results, and the value of our sharesultimate impact 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. A combination of economic factors driven by the COVID-19 pandemic, including the decline in property sales and the temporary closure of non-essential businesses, has drastically impacted the traditional valuation methodologies for almost all types of commercial real estate, including healthcare real estate. 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, 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 and related shelter-in-place, business re-opening and quarantine restrictions, our property values, NOI and revenues may decline, and our tenants, operating partners and managers have been and may continue to be limited in their ability to generate income, service patients and residents and/or properly manage our properties. In addition, based on preliminary information available to management as of October 31, 2020, we have experienced an approximate 13.3% decline in resident occupancies since February 2020, as well as an up to 30.0% increase in costs to care for residents, at our senior housing — RIDEA facilities and integrated senior health campuses. Such costs have begun to moderate somewhat during the third quarter of 2020. Our leased, non-RIDEA senior housing and skilled nursing facility tenants have also experienced and may continue to experience similar pressures related to occupancy declines and expense increases, which may impact their ability to pay rent and have an adverse effect on our operations. However, through October 2020, all rents have been collected from such leased, non-RIDEA senior housing and skilled nursing facility tenants. Given the significant uncertainty of the impact of the COVID-19 pandemic, we are unable to predict the impact it will have on such tenants’ continued ability to pay rent. Therefore, information provided regarding October rent collections should not serve as an indication of expected future rent collections. As such, our immediate focus continues to be on resident occupancy recovery and operating expense management. While restrictions have been at least partially lifted in many states, there remains a risk of reclosures in states where infection rates continue to rise, which may put additional pressure on our operations. 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 facilities, particularly if focused on regions in which our properties are located, may adversely affect our business operations by
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reducing occupancy demand at our facilities. Furthermore, the COVID-19 pandemic has also adversely impacted and may continue to adversely impact the ability of our medical office building tenants, many of whom have been restricted in their ability to work and to pay their rent as and when due. We have also held discussions with our tenants, operating partners and managers and they have expressed that the ultimate impact of the COVID-19 pandemic on their business operations is uncertain.
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 debt financing 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 information in this time,Quarterly Report on Form 10-Q is based on data currently available to us and will likely change as the COVID-19 pandemic progresses. The extent to which the COVID-19 pandemic impacts our business will depend on future developments, which are highly uncertain and cannot be predicted with confidence, 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, government initiatives, such as the Payroll Protection Program and deferral of payroll tax payments program within the CARES Act, enacted to containprovide substantial financial support to businesses could provide helpful mitigation for us and certain of our tenants, operating partners and managers. However, these government assistance programs are not expected to fully offset the negative financial impact of the COVID-19 pandemic, and there can be no assurance that these programs will continue or treatthe extent to which they will be expanded. Therefore, the ultimate impact of such relief from these programs is not yet clear. Furthermore, we expect the trends discussed above with respect to the impact of the COVID-19 pandemic to continue. As such, we are continuously monitoring the impact of the COVID-19 pandemic on our business, residents, tenants, operating partners, managers, portfolio of investments and reactions by consumers, companies, governmental entitieson the United States and capital markets. We generally intend to publish an updated estimated per share NAV on at least an annual basis. However, because asset valuesglobal economies. While we are difficult to discernnot able at this time due to such market disruptions and concerns regardingestimate the reliability of traditional valuation methodologies in the current environment, the audit committee of our board has determined that it would not be practical or prudent to attempt to determine an updated estimated per share NAV at this time. As such, we do not anticipate publishing an updated estimated per share NAV of our common stock in October 2020. We cannot provide any assurance as to when our board will be able to determine an updated estimated per share NAV. Our board will, however, continue to monitor the commercial and healthcare real estate markets and will update stockholders regarding an updated estimated per share NAV when market conditions permit our board to calculate an updated estimated per share NAV with reasonable certainty.

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For a full descriptionlong-term impact of the methodologies usedCOVID-19 pandemic on our financial and operational results, it could be material.
Risks Related to value our assets and liabilitiesInvestments 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.Real Estate
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 August 14,November 16, 2020, properties located in Indiana and Ohio accounted for approximately 40.1% and 10.5%, respectively,38.3% 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.
OurTerrorist attacks, acts of violence or war, political protests and unrest or public health crises may affect the markets in which we operate and have a material adverse effect on our financial condition and results of operations,operations.
Terrorist attacks, acts of violence or war, political protests and unrest or public health crises (including the COVID-19 pandemic) may negatively affect our ability to pay distributions to our stockholdersoperations and our abilitystockholders’ investments. We may acquire real estate assets located in areas that are susceptible to disposeterrorist attacks, acts of violence or war, political protests or public health crises. These events may
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directly impact the value of our investments are subject to international, national and local economic factorsassets through damage, destruction, loss or increased security costs. Although 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 have provided an insignificant number of rent concessions, and may continue to 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,obtain terrorism insurance, we may not be able to recoverobtain sufficient coverage to fund any losses we may incur. Risks associated with potential acts of terrorism could sharply increase the carrying amountpremiums we pay for coverage against property and casualty claims. Further, certain losses resulting from these types of events are uninsurable or not insurable at reasonable costs. More generally, any terrorist attack, other act of violence or war, political protests and unrest or public health crises could result in increased volatility in, or damage to, the United States and worldwide financial markets and economy, all of which could adversely affect our properties, which may require ustenants’ ability to recognize an impairment chargepay rent on their leases or record a loss on sale in earnings;
reduced values of our properties may limit our ability to disposeborrow money or issue capital stock at acceptable prices, which could have a material adverse effect on our financial condition and results of assets at attractive pricesoperations.
Our business, tenants, residents and operators may face litigation and experience rising liability and insurance costs, which may adversely affect our financial condition, results of operations, liquidity or cash flows.
We currently intend to obtain debt financing securedpursue insurance recovery for any losses caused by the COVID-19 pandemic, but there can be no assurance that coverage will be available under our propertiesexisting policies or if such coverage is available, which and may reduce the availability of unsecured loans;
the value and liquidityhow much of our short-term investmentslosses will be covered and cash deposits could be reducedwhat other limitations may apply. Due to the likely increase in claims as a result of a deteriorationthe impact of the financial conditionCOVID-19 pandemic, insurance companies may limit or stop offering coverage to companies like ours for pandemic related claims and/or significantly increase the cost of insurance so that it is no longer available at commercially reasonable rates.
With respect to our senior housing — RIDEA facilities and integrated senior health campuses, we are ultimately responsible for operational risks and other liabilities of the institutionsfacility, other than those arising out of certain actions by our operator, such as gross negligence or willful misconduct. As such, operational risks include, and our resulting revenues therefore depend on, the availability and cost of general and professional liability insurance coverage or increases in insurance policy deductibles. Furthermore, because we bear such operational risks and liabilities related to our senior housing — RIDEA facilities and integrated senior health campuses, we may be directly adversely impacted by potential litigation related to the COVID-19 pandemic that holdhave occurred or may occur at those facilities, and our cash depositsinsurance coverage may not cover 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 ablesufficient to replace the financing commitmentcover any potential losses.
Additionally, as a result 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 resultedthe cost of insurance for our tenants, operators and may continueresidents is expected to result in lower occupancy in our facilities, increased vacancy rates for commercial real estate due to generally lower demand for rentable space,increase as well, as an oversupplyand such insurance may not cover certain claims related to COVID-19, which could impair their ability to pay rent to us. Our exposure to COVID-19 related litigation risk may be further increased if our operators or residents of rentable space;
governmental actions and initiatives, including risks associatedsuch facilities are subject to bankruptcy or insolvency. Combined with the impact of a prolonged government shutdown or budgetary reductions or impasses; and
increasedfactors above, these trends in insurance premiums, real estate taxes or utilities or other expensescoverage 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 limitadversely affect our ability to increase our returns.

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The length and severity of any economic slowdown or downturn cannot be predicted at this time. Ourfinancial condition, results of operations, our abilityliquidity or cash flows.
Risks Related 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.Debt Financing
Changes in banks’ inter-bank lending rate reporting practices or the method pursuant to which LIBOR is determined may adversely affect the value of the financial obligations to be held or issued by us that are linked to LIBOR.
LIBOR and other indices which are deemed “benchmarks” are the subject of recent national, international and other regulatory guidance and proposals for reform. Some of these reforms are already effective while others are still to be implemented. These reforms may cause such “benchmarks” to perform differently than in the past, or have other consequences which cannot be predicted. It currently appears that, over time, United States dollar LIBOR may be replaced by the SOFR published by the Federal Reserve Bank of New York. However, the manner and timing of this shift is currently unknown. Market participants are still considering how various types of financial instruments and securitization vehicles should react to a discontinuation of LIBOR. It is possible that not all of our assets and liabilities will transition away from LIBOR at the same time, or to the same alternative reference rate, in each case increasing the difficulty of hedging. For example, switching existing financial instruments and hedging transactions from LIBOR to SOFR requires calculations of a spread. Industry organizations are attempting to structure the spread calculation in a manner that minimizes the possibility of value transfer between counterparties, borrowers and lenders by virtue of the transition, but there is no assurance that the calculated spread will be fair and accurate or that all asset types and all types of securitization vehicles will use the same spread. We and other market participants have less experience understanding and modeling SOFR-based assets and liabilities than LIBOR-based assets and liabilities, increasing the difficulty of investing, hedging and risk management. The process of transition involves operational risks. It is also possible that no transition will occur for many financial instruments. At this time, it is not possible to predict the effect of any such changes, any establishment of alternative reference rates or any other reforms to LIBOR that may be implemented. Uncertainty as to the nature of such potential changes, alternative reference rates or other reforms may adversely affect the market for or value of any securities on which the interest or dividend is determined by reference to LIBOR, loans, derivatives and other financial obligations or on our overall financial condition or results of operations. More generally, any of the above changes or any other consequential changes to LIBOR or any other “benchmark” as a result of international, national or other proposals for reform or other initiatives, or any further uncertainty in relation to the timing and manner of implementation of such changes, could have a material adverse effect on the value of financial assets and return on any securitiesliabilities based on or linked to a “benchmark.”
The COVID-19 pandemic has adversely impacted, and will likely continue to adversely impact, 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.
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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 and related shelter-in-place, business re-openings and quarantine restrictions, our property values, net operating income and revenues may decline, and our tenants, operating partners and managers have been and may continue to be limited in their ability to generate income, service patients and residents and/or properly manage our properties. In addition, based on preliminary information available to management as of July 31, 2020, we have experienced an approximate 8.4% decline in resident occupancies since February 2020, as well as an up to 30.0% increase in costs to care for residents, at our senior housing — RIDEA facilities and integrated senior health campuses. Our leased, non-RIDEA senior housing and skilled nursing facilities are also experiencing and may continue to experience similar pressures related to occupancy declines and expense increases, which may impact their ability to pay rent and have an adverse effect on our operations. However, through July 2020, all rents have been collected from such leased, non-RIDEA senior housing and skilled nursing facility tenants. Given the significant uncertainty of the impact of the COVID-19 pandemic, we are unable to predict the impact it will have on such tenants’ continued ability to pay rent. Therefore, information provided regarding July rent collections should not serve as an indication of expected future rent collections. As such, we are focused on census recovery and operating expense management for the near term. While restrictions have been at least partially lifted in many states, there remains a risk of reclosures in states where infection rates are on the rise, which may put additional pressure on our operations. 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 facilities, particularly if focused on regions in which our properties are located, may adversely affect our business operations by reducing occupancy demand at our facilities. Furthermore, the COVID-19 pandemic has also adversely impacted and may continue to adversely impact the ability of our medical office building tenants, many of whom have been restricted in their ability to work and to pay their rent as and when due. We have also held discussions with our tenants, operating partners and managers and they have expressed that the ultimate impact of the COVID-19 pandemic on their business operations is uncertain.

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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 debt financing 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 long-term impact of the COVID-19 pandemic on our financial and operational results, it could be material.
Our business, tenants, residents and operators may face litigation and experience rising liability and insurance costs, which may adversely affect our financial condition, results of operations, liquidity or cash flows.
We currently intend to pursue insurance recovery for any losses caused by the COVID-19 pandemic, but there can be no assurance coverage will be available under our existing policies or if such coverage is available, which and how much of our losses will be covered and what other limitations may apply. Due to the likely increase in claims as a result of the impact of the COVID-19 pandemic, insurance companies may limit or stop offering coverage to companies like ours for pandemic related claims and/or significantly increase the cost of insurance so that it is no longer available at commercially reasonable rates.
With respect to our senior housing — RIDEA facilities and integrated senior health campuses, we are ultimately responsible for operational risks and other liabilities of the facility, other than those arising out of certain actions by our operator, such as gross negligence or willful misconduct. As such, operational risks include, and our resulting revenues therefore depend on, the availability and cost of general and professional liability insurance coverage or increases in insurance policy deductibles. Furthermore, because we bear such operational risks and liabilities related to our senior housing — RIDEA facilities and integrated senior health campuses, we may be directly adversely impacted by potential litigation related to the COVID-19 pandemic that have occurred or may occur at those facilities, and our insurance coverage may not cover or may not be sufficient to cover any potential losses.
Additionally, as a result of the COVID-19 pandemic, the cost of insurance for our tenants, operators and residents is expected to increase as well, and such insurance may not cover certain claims related to COVID-19, which could impair their ability to pay rent to us. Our exposure to COVID-19 related litigation risk may be further increased if our operators or residents of such facilities are subject to bankruptcy or insolvency. Combined with the factors above, these trends in insurance coverage may adversely affect our financial condition, results of operations, liquidity or cash flows.

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Item 2. Unregistered Sales of Equity Securities and Use of Proceeds.
Recent Sales of Unregistered Securities
On June 10, 2020, we issued an aggregate of 7,500 shares of restricted common stock to our independent directors. These shares of restricted common stock were issued pursuant to our incentive plan in a private transaction exempt from the registration requirements pursuant to Section 4(a)(2) of the Securities Act. Such shares vest as to 20.0% of the shares on the date of grant and on each of the first four anniversaries of the grant date.None.
Purchase of Equity Securities by Issuer and Affiliated Purchasers
In response to the COVID-19 pandemic and its effects to our business and operations, 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 on March 31, 2020, effective with respect to all share repurchase requests submitted for repurchase other than repurchases resulting from the death or qualifying disability of stockholders. Repurchase requests that resulted from the death or qualifying disability of stockholders were not suspended, but remained subject to all terms and conditions of our share repurchase plan, including our board’s discretion to determine whether we had sufficient funds available to repurchase any shares. Subsequently, on May 29, 2020, our board suspended our share repurchase plan with respect to all share repurchase requests received after May 31, 2020, including repurchases resulting from the death or qualifying disability of stockholders. On July 1, 2020, we paid the final share repurchase requests that were honored prior to the suspension of our share repurchase plan. Our board shall determine if and when it is in the best interest of our company and stockholders to reinstate our share repurchase plan.
Prior to the suspension of the share repurchase plan, our share repurchase plan allowed for repurchases of shares of our common stock by us when certain criteria are met. Share repurchases were 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 were 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 number of shares that we repurchased was 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. Additionally, effective with respect to share repurchase requests submitted for repurchase during the second quarter of 2019, the number of shares that were repurchased during any fiscal quarter was limited to an amount equal to the net proceeds that we received from the sale of shares issued pursuant to our 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 were not 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. Funds for the repurchase of shares of our common stock came from the cumulative proceeds we received from the sale of shares of our common stock pursuant to our DRIP Offerings. Furthermore, our share repurchase plan, as amended, provided that if there were 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.
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. For requests submitted pursuant to a death or a qualifying disability of a stockholder, the Repurchase Amount was 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 JuneSeptember 30, 2020, 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
April 1, 2020 to April 30, 2020 1,893,413
 $9.50
 1,893,413
 (1)
May 1, 2020 to May 31, 2020 
 $
 
 (1)
June 1, 2020 to June 30, 2020 
 $
 
 (1)
Total 1,893,413
 $9.50
 1,893,413
  

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PeriodTotal 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
July 1, 2020 to July 31, 2020517,263 $9.90 517,263 (1)
August 1, 2020 to August 31, 2020— $— — (1)
September 1, 2020 to September 30, 2020— $— — (1)
Total517,263 $9.90 517,263 
___________
(1)A description of the maximum number of shares that may be purchased under our share repurchase plan is included in the narrative preceding the table.
(1)A description of the maximum number of shares that may be purchased under our share repurchase plan is included in the narrative preceding the table.
Item 3. Defaults Upon Senior Securities.
None.
Item 4. Mine Safety Disclosures.
Not applicable.
Item 5. Other Information.
Estimated Per Share NAV
On October 3, 2019, our board, at the recommendation of the audit committee of our board which comprised solely of independent directors, unanimously approved and established an updated estimated per share NAV of our common stock of $9.40 to assist broker-dealers in connection with their obligations under FINRA Rule 2231 with respect to customer account statements, and also stated that we intend to publish a subsequent updated estimated per share NAV on at least an annual basis.
A combination of economic factors driven by the COVID-19 pandemic, including the decline in property sales and the temporary closure of non-essential businesses, have drastically impacted the traditional valuation methodologies for almost all types of commercial real estate, including healthcare real estate. Because asset values are difficult to discern at this time due to such market disruptions and concerns regarding the reliability of traditional valuation methodologies in the current environment, the audit committee of our board has determined that it would not be practical or prudent to attempt to determine an updated estimated per share NAV at this time. As such, we do not anticipate publishing an updated estimated per share NAV of our common stock in October 2020. We cannot provide any assurance as to when our board will be able to determine an updated estimated per share NAV. Our board will, however, continue to monitor the commercial and healthcare real estate markets and will update stockholders regarding an updated estimated per share NAV when market conditions permit our board to calculate an updated estimated per share NAV with reasonable certainty.

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 JuneSeptember 30, 2020 (and are numbered in accordance with Item 601 of Regulation S-K).
101.INS*
Inline XBRL Instance Document– the instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL Document
101.SCH*Inline XBRL Taxonomy Extension Schema Document
101.CAL*Inline XBRL Taxonomy Extension Calculation Linkbase Document
101.LAB*101.DEF*Inline XBRL Taxonomy Extension Definition Linkbase Document
101.LAB*Inline XBRL Taxonomy Extension Label Linkbase Document
101.PRE*Inline XBRL Taxonomy Extension Presentation Linkbase Document
101.DEF*XBRL Taxonomy Extension Definition Linkbase Document
___________
*104*Filed herewith.Cover Pager Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101)
___________
*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)
November 16, 2020By:
/s/ JEFFREYT. HANSON
DateJeffrey T. Hanson
Chief Executive Officer and Chairman of the Board of Directors
(Principal Executive Officer)
November 16, 2020By:
Griffin-American Healthcare REIT III, Inc./s/ BRIAN S. PEAY
(Registrant)
Date
August 14, 2020By:
/s/ JEFFREYT. HANSON
DateJeffrey T. Hanson
Chief Executive Officer and Chairman of the Board of Directors
(Principal Executive Officer)
August 14, 2020By:
/s/ BRIAN S. PEAY
DateBrian S. Peay
Chief Financial Officer
(Principal Financial Officer and Principal Accounting Officer)





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