Transaction Feasibility Forum Not One-Size-Fits-All: Understanding the Spectrum of Seniors Housing Needs

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1 Transaction Feasibility Forum Not One-Size-Fits-All: Understanding the Spectrum of Seniors Housing Needs Larry Rouvelas Senior Housing Analytics

2 SPECTRUM OF SENIORS HOUSING & CARE Low Acuity High Active Adult Senior apts Independent Living Assisted Living Memory Care Skilled nursing This presentation focuses on this slice of the spectrum

3 THE DEBATE OVER NET NEED Pro From an actual feasibility study Con Why these penetration rates? Which penetration rate will it be? (That s a wide range.) By definition, not all markets can be net importers of seniors. Why is this one? In fairness, this consultant (unlike others) doesn t overly depend on this one statistic to make market assessments plus he-or-she does excellent field work.

4 Penetration Large metro mkts 4.0% Miami, FL 2.0% Detroit, MI 2.6% New York, NY 2.6% St. Louis, MO 2.9% San Antonio, TX 3.0% Chicago, IL 3.3% Philadelphia, PA 3.4% Cleveland, OH 3.5% Kansas City, MO 3.5% Las Vegas, NV 3.5% Cincinnati, OH 3.5% San Jose, CA 3.6% Washington, DC 3.6% Houston, TX 3.7% Phoenix, AZ 3.9% Riverside, CA 3.9% Orlando, FL 4.0% San Diego, CA 4.2% Baltimore, MD 4.3% Boston, MA 4.4% Tampa, FL 4.6% Los Angeles, CA 4.7% Sacramento, CA 4.8% San Francisco, CA 4.8% Pittsburgh, PA 4.9% Denver, CO 5.5% Dallas, TX 5.6% Seattle, WA 5.8% Atlanta, GA 7.0% Minneapolis, MN 7.2% Portland, OR 10.6% CRITIQUE OF NET NEED - PART I But the Net need approach has some limitations: If demand could be estimated through a simple penetration rate, then low penetration markets would have high occupancies Penetration = Units in Majority AL communities as % of households aged 75+ Source: NICMAP 4Q12

5 Occupany (Stabilized Majority AL) Majority AL occupancy (stabilized) Penetration Stabilized Occupancy Large metro mkts 4.0% 90% Miami, FL 2.0% 87% Detroit, MI 2.6% 89% New York, NY 2.6% 94% St. Louis, MO 2.9% 91% San Antonio, TX 3.0% 88% Chicago, IL 3.3% 87% Philadelphia, PA 3.4% 88% Cleveland, OH 3.5% 90% Kansas City, MO 3.5% 93% Las Vegas, NV 3.5% 82% Cincinnati, OH 3.5% 92% San Jose, CA 3.6% 92% Washington, DC 3.6% 92% Houston, TX 3.7% 91% Phoenix, AZ 3.9% 89% Riverside, CA 3.9% 91% Orlando, FL 4.0% 93% San Diego, CA 4.2% 92% Baltimore, MD 4.3% 89% Boston, MA 4.4% 94% Tampa, FL 4.6% 91% Los Angeles, CA 4.7% 87% Sacramento, CA 4.8% 89% San Francisco, CA 4.8% 89% Pittsburgh, PA 4.9% 94% Denver, CO 5.5% 93% Dallas, TX 5.6% 87% Seattle, WA 5.8% 91% Atlanta, GA 7.0% 89% Minneapolis, MN 7.2% 90% Portland, OR 10.6% 91% 96% 94% 92% 90% 88% 86% 84% 82% 80% 78% CRITIQUE OF NET NEED - PART II instead, different markets generate different rates of demand, often for historical reasons. 96% 94% 92% 90% 88% 86% 84% 82% 80% Low penetration high occupancy Each dot is a metro market Top 31 MSAs, NICMAP 4Q10 Each dot is a metro market 0% 2% 4% 6% 8% 10% 12% 0% 2% 4% Penetration 6% rate 8% 10% Penetration = Units in Majority AL communities as % of households aged 75+ Source: NICMAP 4Q12 Penetration rate (AL/MC supply as % of households aged 75+

6 SENIOR HOUSING ANALYTICS MARKET ANALYSIS CHECKLIST MSA-level performance Demand density and proximity to demand Location & site competitiveness Supply penetration Notes Income-qualified seniors: Income-qualified children-of-seniors: IL AL MC Current occupancy Current rates Competitive positioning Threat from new entrants Summary:

7 KEY INDUSTRY RESOURCES

8 EXAMPLE Commons at Elk Grove City Elk Grove Year Opened 2009 Primary Payment Type Rent Profit Status Not For Profit Corporate Owner Premiera Care Communities Units 71 AL/24 MC Note: this example is excerpted from an acquisition case study SHA led for a class at the Erickson School. Please excuse certain timing issues with using it as a example of development feasibility. Sources: Google Maps; community website.

9 REGIONAL SETTING: FIVE-MILE RING 9

10 LOCAL SETTING: ONE MILE RING

11 1Q2008 2Q2008 3Q2008 4Q2008 1Q2009 2Q2009 3Q2009 4Q2009 1Q2010 2Q2010 3Q2010 4Q2010 1Q2011 2Q2011 3Q2011 4Q2011 1Q2009 2Q2009 3Q2009 4Q2009 1Q2010 2Q2010 3Q2010 4Q2010 1Q2011 2Q2011 3Q2011 4Q2011 Occupancy Annual Rate Growth AL/MC feasibility example Sacramento County Sacramento-- Arden-Arcade-- Roseville, CA U.S. Large- MSA avg. MSA PERFORMANCE TRENDS 93% 92% 91% 90% 89% 88% 87% 86% 85% 84% 83% 82% Occupancy Top 31 MSAs Pacific Sacramento Source: NICMAP 4Q11 Majority AL 2,307 3, ,167 Stabilized Occ. 90.3% 88.6% 89.7% YoY Occ. Change +1%pts +0.4%pts AL Avg. Rent/Unit $ 3,721 $ 3,798 $ 3,565 MC Avg. Rent/Unit $ 4,758 YoY Rent Growth -0.1% -0.3% 1.1% Median Age Penetration 5.1% 5.0% 3.8% Yearly Absorption ,903 Yearly Inventory Growth ,682 Pct. Inventory Growth -0.1% 1.9% 1.5% Construction units/beds 0 3,850 Construction vs. inventory 0.0% 0.0% 2.1% Majority AL rental communities 3% 3% 2% 2% 1% 1% 0% -1% -1% -2% -2% -3% Rate growth "Large MSAs" are ranked 1-31 in the U.S. Top 31 MSAs Pacific Sacramento

12 PRIMARY MARKET AREA 15 minute drive from sites 5 mi. Sources: Mappoint

13 FACTORS IN ESTIMATING DEMAND DENSITY Income-qualified senior households ( Qualified Seniors, or QS): here defined as households with head aged 75+ with incomes over $35,000. Income-qualified adult children households ( Qualified Caregivers or QCG): here defined as households with head age and income over $75,000. This group often drives the assisted living purchase decision and in some cases funds part of the cost. Prior analysis of large datasets by Senior Housing Analytics principals established that the density of qualified caregivers is more strongly correlated to AL and MC performance than is the density of qualified seniors. AFFLUENCE Median Home Value Prior analysis of large datasets by Senior Housing Analytics principals established a positive correlation between home values & achieved rates, all else equal. Median Household Income Helps normalize affluence metrics for markets with extraordinarily high home values (like coastal California and Long Island) or low home values (like Texas)

14 DENSITY & AFFLUENCE: Children-of-seniors and incomes Sources: AGS 2011; NICMAP 4Q11 14

15 To assess market feasibility, SHA weighs a range of demand & supply statistics using, among other methods, deciles comparisons to large samples of senior housing peers. HOW DECILES WORK 125, ,000 75,000 50,000 25,000 - How does a community's surrounding median incomes stack up against those of its peers? 10th decile 9th decile 8th decile 7th decile 6th decile 5th decile 4th decile 3rd decile 2nd decile 1st decile If an AL community has a surrounding (5-mi) median household income of $75,000. then it is has higher income than between 70-80% of similar AL communities, putting it in the 8 th decile. Peer data set: Majority AL communities nationwide (n=3,929) Sources: AGS 2011, NICMAP 2Q11; Senior Housing Analytics decile analysis 1

16 MARKET DEMAND (surrounding 5mi ring) Commons at Elk Grove Decile vs (higher = better) Income-qualified demand Affluence Growth Sources: AGS 2011; NICMAP 4Q11; Senior Housing Analytics decile analysis row 2011 Majority AL nationwide Majority AL Top 31 MSAs Majority AL Sacramento 1 COMMUNITIES IN DECILE SET 3,929 2, DEMAND 3 POPULATION 198,370 7th 5th 3rd 4 Age ,701 7th 6th 4th 5 Age ,971 7th 6th 4th 6 HOUSEHOLDS 71,598 6th 5th 4th 7 Age ,265 6th 5th 4th 8 Age 75+ 6,308 6th 5th 3rd 9 Age 45-64, income $75k+ (QCG$75k) 15,858 8th 6th 4th 10 Age 45-64, income $100k+ 10,743 8th 6th 4th 11 Age 75+, income $35k+ (QS$35k) 4,516 7th 6th 4th 12 ETHNICITY 14 % Hispanic 17% 16 % Asian 19% 18 % Black 14% 19 MEDIAN HOUSEHOLD INCOME 78,138 8th 8th 9th 20 Age ,109 8th 8th 9th 21 Age ,843 9th 9th 10th 22 MEDIAN HOME VALUE 168,848 7th 6th 7th 23 GROWTH RATES (Annual) 24 Households 1.5% 8th 8th 9th 25 Age % 9th 8th 10th 26 Age % 8th 8th 8th MSA

17 SUPPLY Source: NICMAP 4Q11

18 Note: this example is excerpted from an acquisition case study SHA led for a class at the Erickson School. Please excuse certain timing issues with using it as a example of development feasibility. COMPETITOR DETAIL Sources: NICMAP 4Q11 Primary Total Total Total Distance Year Payment Primary Total IL Total AL Total MC Total NC Property Name to Distance target City Opened Year Type Payment Corporate Owner Total units IL units AL units MC beds NC Commons Property Name at Elk Grove to target 0.0 Elk CityGrove 2009 Opened Rent Type Premiera Corporate Owner Care Communities units 0 units 71 units 24 beds0 Meadows Commons Senior at Elk Grove Living, The Elk Grove Rent Lifestyles, Premiera Care LLCCommunities Carlton Meadows Plaza Senior Elk Living, Grove The Elk Grove Rent Carlton Lifestyles, Senior LLC Living Emeritus Carlton Plaza at Laguna Elk Grove Creek Elk Grove Rent Emeritus Carlton Senior Assisted Living Living Camden Emeritus Springs at Laguna Gracious Creek Retirement Living Elk Grove Rent Hawthorn Emeritus Assisted Retirement Living Group Windsor Camden Springs Elk Grove Gracious Care and Retirement Rehab Center Living Elk Grove Rent Windsor Hawthorn Retirement Group Bruceville Windsor Elk Terrace Grove Care and Rehab Center Sacramento Elk Grove Rent Methodist Windsor Hospital Regency Bruceville Place Terrace Sacramento EF Rent Intergrated Methodist Hospital Senior Living - ISL St Regency Francis Place Senior Residence Sacramento Rent EF American Intergrated Healthcare Senior Living - ISL Sky St Francis Park Gardens Senior Residence Assisted Living Center Sacramento Rent Individual American Healthcare Florin Sky Park Health Gardens Care Assisted Center Living Center Sacramento Rent Family Individual Senior Care Grand Florin Health River Care Care Center Sacramento Rent Individual Family Senior Care Briarwood Grand River Healthcare Care Center Sacramento Rent Riverside IndividualHealth System Emerald Briarwood Gardens Healthcare Nursing Center Sacramento Rent Covenant Riverside Health Care System Sterling Emerald Suites Gardens Lemon Nursing Hill Center Sacramento Rent Dr. Covenant Cheema Care Greenhaven Sterling Suites Estates Lemon Hill Sacramento Rent LaVida Dr. Cheema Communities Asian Greenhaven Community EstatesNursing Home Sacramento Rent Individual LaVida Communities Primrose Asian Community Nursing Home Sacramento Rent Primrose Individual Alzheimer's Living Inc Primrose 8.6 Sacramento 1999 Rent Primrose Alzheimer's Living Inc According to NICMAP, at the time this case study was prepared, the only construction within 10 miles was at Carlton Plaza Elk Grove.

19 Note: this example is excerpted from an acquisition case study SHA led for a class at the Erickson School. Please excuse certain timing issues with using it as a example of development feasibility. MARKET SUPPLY-Before project (surrounding 5mi ring) row 2011 Commons at Elk Grove Decile vs (higher = better) Majority AL nationwide Majority AL Top 31 MSAs Majority AL Sacramento 1 COMMUNITIES IN DECILE SET 3,929 2, SUPPLY 29 Total IL units 243 6th 7th 7th 30 Total AL units 174 8th 8th 9th 31 Total MC units 88 5th 6th 7th 32 Total NC beds 307 8th 8th 9th 33 SUPPLY PENETRATION 35 AL as % of 75+ population 1.3% 10th 10th 10th 36 AL as % of QCG$75k 1.1% 10th 10th 10th 37 AL as % of QS$35k 3.9% 10th 10th 10th 38 MC as % of 75+ population 0.7% 6th 6th 8th 39 MC as % of QCG$75k 0.6% 6th 6th 8th 40 MC as % of QS$35k 1.9% 6th 6th 8th MSA Sources: AGS 2011; NICMAP 4Q11; Senior Housing Analytics decile analysis

20 Note: this example is excerpted from an acquisition case study SHA led for a class at the Erickson School. Please excuse certain timing issues with using it as a example of development feasibility. MARKET SUPPLY-After project (surrounding 5mi ring) row 2011 Commons at Elk Grove Decile vs (higher = better) Majority AL nationwide Majority AL Top 31 MSAs Majority AL Sacramento 1 COMMUNITIES IN DECILE SET 3,929 2, SUPPLY 43 IF A PROJECT ADDS: 44 SUPPLY New units/beds: Then deciles (with new+ existing supply): 46 Total AL units 71 7th 7th 8th 47 Total MC units 24 4th 5th 6th 49 THEN THE RESULT IS: 50 SUPPLY PENETRATION 53 AL as % of QCG$75k (2014) 1.4% 9th 9th 10th 54 AL as % of QS$35k (2014) 5.2% 9th 9th 10th 55 MC as % of QCG$75k (2014) 0.7% 6th 5th 8th 56 MC as % of QS$35k (2014) 2.4% 6th 5th 7th MSA To assess whether proposed supply growth would simply be keeping up with demand growth, post-project deciles are calculated versus current penetration rates of peer groups Sources: AGS 2011; NICMAP 4Q11; Senior Housing Analytics decile analysis

21 Source: Google Maps; community website RELEVANT COMPS Meadows Senior Living, The Distance to target 0.8 City Elk Grove Year Opened 2003 Primary Payment Type Rent Profit Status For Profit Corporate Owner Lifestyles, LLC Units 70 AL/24 MC

22 RELEVANT COMPS Carlton Plaza Elk Grove Distance to target 1.3 City Elk Grove Year Opened 2012 Primary Payment Type Rent Profit Status For Profit Corporate Owner Carlton Senior Living Units 100 IL/36 MC Sources: Elk Grove Planning Commission report, Dec. 2009; Google Maps

23 RELEVANT COMPS Emeritus at Laguna Creek Distance to target 1.6 City Year Opened 1999 Primary Payment Type Elk Grove Rent Profit Status For Profit Corporate Owner Emeritus Assisted Living Units 60 AL/28 MC One of six cottages on the campus Sources: Google Maps community website.

24 RELEVANT COMPS Distance to target 3.8 City Year Opened 1993 Primary Payment Type Regency Place Sacramento Rent Profit Status For Profit Corporate Owner Integrated Senior Living - ISL Units 28 IL/44 AL Sources: Google Maps community website.

25 Note: this example is excerpted from an acquisition case study SHA led for a class at the Erickson School. Please excuse certain timing issues with using it as a example of development feasibility. LOCAL MARKET PERFORMANCE: Older version of the NIC MAP Local system Local comps for performance averages Payment Dist. (mi.) IL AL MC NC Total Occ. Avg Rate Meadows Senior Living, The Rent Emeritus at Laguna Creek Rent Regency Place EF Greenhaven Estates Rent Total/Average % $ 3,272 $ 4,100 Sacramento County-Maj. AL 2, % $ 3,721 $ 4,759 Sacramento MSA-Maj. AL 3, % $ 3,798 $ 4,788 Source: NICMAP 4Q11 (C) (D) Useful information, but to assess market performance & product positioning, there is no substitute for on-the-ground fact gathering: (A) Collect more accurate & detailed price data (B) Unbundle occupancy across segments and communities (C) Double-check NICMAP data (D) Determine performance in a better-defined PMA (E) Assess competitor offerings to understand positioning AL (B) MC (A)

26 Occupancy Occupancy AL/MC feasibility example INDUSTRY EXPERIENCE IN LEASE-UP The National Investment Center for the Seniors Housing Industry s MAP division (NIC MAP) and Senior Housing Analytics (SHA) recently collaborated in a ground-breaking analysis of the actual lease-up experience of seniors housing communities. The work evaluated over 800 communities which have opened since 2006 across the top 100 metro areas. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% The chart below is for AL projects with 40+ units, which is typical for a new Majority AL development. Some results: After 24 months, 56% of projects had reached 85%+ AL occupancy, 44% had reached 90%+ occupancy, and 30% were 95%+ occupancy. After 48 months, the proportions were 80%, 68%, and 49% respectively. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Assisted Living Quarters after opening Independent Living Median Quarters after Opening 25th Percentile 75th Percentile

27 KEY TAKEAWAYS Importance of occupancy & achieved absorption, not net need, in market-rate feasibility. For AL & MC: children-of-seniors, not only seniors Proforma lease-up of 24+ months PMA is function of: drive-time/distance psychographic barriers how many competitors people need to pass to get to you but since net need is not a rigid formula, don t get hung up on PMA Importance of product positioning & location: it s not a commodity.

28 APPENDIX 28

29 SHA PRINCIPALS Phil Downey, Principal Phil has played a seminal role in the birth and maturation of the American seniors housing industry, and was a pivotal leader in the national rollout of multi-brand businesses for Sunrise and Marriott. He has expertise in strategic planning, product conceptualization, market feasibility analysis, site selection, and project programming. While with Sunrise and Marriott he directed product development, market selection/location strategy, and projectspecific market analysis initiatives resulting in the creation and roll-out of over $2 billion of multi-branded seniors housing communities in all major markets in the U.S. & Canada. He has also served as Chairman of the American Seniors Housing Association as well as on executive committees in the Assisted Living Federation of America and the National Investment Center for the Senior Living Industries, and is also guest faculty at the Erickson School of Aging at the University of Maryland, Baltimore County. Phil holds a BA from the University of Illinois, a Masters in City and Regional Planning from Rutgers University and is a certified urban planner (AICP). Larry Rouvelas, Principal Larry has unusually broad experience in senior housing, with roles ranging from operations to development to finance to sales & marketing. He also brings unique external perspective to the industry. From 2003 to 2009, he was at Sunrise Senior Living, a large operator & developer of senior housing. He was the Executive Director of an assisted living community, among other operations roles. At various times, he also assessed feasibility of real estate developments, sold corporate subsidiaries, and strengthened sales productivity. Among senior housing activities, he led the rewrite of the Real Estate Development section of "The Investment Case for Senior Housing," published by the industry's primary financier group, the National Investment Center for Seniors Housing & Care Industry (NIC). He serves on the Arlington County Long-Term Care Residences Commission. Prior to Sunrise, he was a consultant at McKinsey & Co. He has a BA from Yale College and an MBA from Harvard Business School.

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