Healthy by the Square Foot: Development Strategies for a New Era of Healthcare A P R I L 1,

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1 Healthy by the Square Foot: Development Strategies for a New Era of Healthcare A P R I L 1,

2 Event & Venue Sponsors A Very Special thank you to Our Event & Venue Sponsors: White Plains Hospital & SL Green & Company

3 Gold Annual Sponsors Spinnaker Real Estate Partners

4 Silver Annual Sponsors AKRF Benchmark The Chazen Company Collins Enterprises Divney Tung Schwalbe GDC Properties JMC Langan Engineering & Environmental Sciences McLaren Engineering Northmarq Capital Perkins Eastman Stewart Title VHB

5 Healthy By the Square Foot: Development Strategies for a New Era of Healthcare David Becker - KPMG J. Michael Divney Divney Strategic Advisors Lloyd Mallah Seavest Healthcare Properties, LLC Joel E. Papo Northwell Health (NSLIJ) Kyle Marden CBRE Healthcare Vincent J. Tufo Charter Oak Communities Pamela Koprowski Stamford Hospital

6 ULI W-F April 1, 2016 White Plains Hospital

7 New Six-Story Tower

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13 New Center for Cancer Care

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18 A r m o n k, N Y Outpatient Locations A r m o n k NEW! W h i te P l a i n s N e w Ro c h e l l e L a rc h m o nt R y e Bro o k H a r t s d a l e

19 ULI Westchester/Fairfield: Healthy by the Square Foot April 1, 2016 PROPRIETARY AND CONFIDENTIAL

20 Seavest Healthcare Properties Overview Seavest Healthcare Properties, is a White Plains, New York based investment management firm focused exclusively on healthcare real estate assets. Since 1986, Seavest has acquired / developed 42 MOBs totaling over $865 million in gross asset value 1 Having been developing and investing in healthcare real estate assets since 1986 Historic Investments in 42 medical office buildings totaling 3.2 million square feet across 15 states Seavest Invests in MOBs that are Strategic to Health Systems in Delivering Services Current Portfolio Realized Investments PROPRIETARY AND CONFIDENTIAL 20

21 A quick review of the fundamentals driving the healthcare real estate market Why Healthcare Real Estate? Executive Summary Growth in Healthcare Expenditures: Healthcare expenditures in the United States (18% of GDP) are forecast to increase approximately 6% annually through Demographically Driven Demand: Individuals 65 or older, which visit physician offices nearly 2x more than the age cohort, are forecasted to increase 14% annually over the next decade. Measured Supply Growth: Due to limited hospital / health system ( Provider ) appetite for expansion following the economic downturn and minimal speculative development, the increase in MOB supply has only averaged ~1.0% annually since Resilient Fundamentals: MOBs demonstrate sticky tenancy with stable long-term cash flow, as renewal rates often exceed 85% and anchor tenants execute long-term leases (10+ years) with contractual rent growth. PROPRIETARY AND CONFIDENTIAL 21

22 Recent trends likely to shape the future of healthcare real estate Recent Key Trends in Healthcare Real Estate Executive Summary Shift to Outpatient Services The most strategic projects are shifting off campus in many instances Consolidation! Physician Groups Manage costs and compete more effectively in environment of tightening reimbursements Hospital Mergers Gain the critical mass necessary to impact population health Lease Accounting Rules All leases to be capitalized PROPRIETARY AND CONFIDENTIAL 22

23 Total Number of Visits or Days (M) Shift toward Outpatient Services Industry Shift Toward Outpatient Services in MOBs Materially lower healthcare delivery cost in MOBs vs. traditional hospital bed tower Advances in technology allow more procedures in outpatient facilities Consumer preference towards convenient locations Substantial health system focus on comprehensive, larger outpatient facilities 800 Outpatient Visits vs. Inpatient Days Outpatient Visits Inpatient Days Source: American Hospital Association, Center for Medicare and Medicaid Services. PROPRIETARY AND CONFIDENTIAL 23

24 Shift toward Outpatient Services Examples of how hospital are moving into the outpatient setting Highly strategic outpatient facility Beaumont Medical Center in West Bloomfield, MI Littleton Adventist Hospital in Colorado recently opened a state of the art cancer center in an existing medical office building on campus PROPRIETARY AND CONFIDENTIAL 24

25 Consolidation Executive Summary Consolidation continues at all levels of the healthcare industry and can create both benefits and challenges to owners and operators of medical office buildings Consolidation among hospital systems Reimbursement methodology changing under healthcare reform o Hospitals must shift focus to medical outcomes and population health Consolidation among physician community Manage costs and compete more effectively in environment of tightening reimbursements Benefits Stable well capitalized tenants Stronger credit tenants Challenges Reliance on large anchor tenants shifts negotiation power More sophisticated tenant base in regards to real estate PROPRIETARY AND CONFIDENTIAL 25

26 New Lease Accounting Rules New lease accounting rules will lead to the capitalization of all leases longer than one year Executive Summary Big impact on healthcare industry due to reliance on real estate to provide service All leases, for both equipment and real estate, that are longer than one year, will go on hospital balance sheets New liability created and increase in on-balance sheet leverage Impact on financial covenants that hospitals may be subject to More complex financial reporting Manage costs and compete more effectively in environment of tightening reimbursements The new lease accounting rules will result in a significant shift in perceived financial strength of many hospital systems. PROPRIETARY AND CONFIDENTIAL 26

27 Market Overview Pricing Analysis Average Price ($) Per sf United States Medical OFF North America OFF 0 Q1 '13 Q1 '14 Q1 '15 PSF/PPU Quartile Distribution ($) Average Cap Rate (Yield) United States Medical OFF 12% North America OFF 11% 10% 9% 8% 7% 6% 5% 4% 3% Q1 '13 Q1 '14 Q1 '15 Cap Rate Quartile Distribution Bottom 25% Median 75% Top Bottom 25% Median 75% Top ,158 United States Medical OFF 11.63% 7.60% 6.88% 6.13% 1.57% Investment Activity Buyer Types Unit ed St at es Medical OFF 15% 9% 1% 11% 2% 4% 36% 15% 38% 27% 0% 8% 55% 41% 47% 54% Nort h America OFF Institutional Cross-Border Public Listed/REITs Private User/Other 49% 11% 2% 23% ,331 North America OFF 12.62% 7.55% 6.68% 5.80% 1.57% * Data based on past 12 months * Data based on past 12 months 13% 11% 10% 15% 2% (YTD) 2016 (YTD) Source: 2016 Real Capital Analytics, Inc. All data based on properties & portfolios ~$2.5mil or greater PROPRIETARY AND CONFIDENTIAL 27

28 ULI Westchester/Fairfield April 1, 2016

29 New York s largest private employer The nation s 14th-largest healthcare system 21 hospitals, 6,600 hospital and longterm care beds, 2,750 employed physicians and 15,000 nurses More than 450 ambulatory and physician practices Hofstra Northwell School of Medicine Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies 29

30 Off-Campus Real Estate: ,000,000 SF 2,080,000 SF + 2.9M SF (+15.7% per year) Owned Leased Excludes Staten Island, Phelps, Northern Westchester, Maimonides 30

31 22 locations in New York City, Long Island, Westchester Joint venture with GoHealth 22 centers opened in 16 months; additional 28 planned over the next 20 months. 31

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