For information with respect to our 2018 activity, see "Item 7 - Management's Discussion and Analysis of Financial Condition and Results of Operations" of our

10-K for the year ended December 31, 2019 filed with the SEC on February 28, 2020 (the "2019 Form 10-K"), which is available free of charge on the SEC's website at www.sec.gov and the Company's website at www.omegahealthcare.com.

Forward-Looking Statements and Factors Affecting Future Results



The following discussion should be read in conjunction with the financial
statements and notes thereto appearing elsewhere in this document. This document
contains "forward-looking statements" within the meaning of the federal
securities laws. These statements relate to our expectations, beliefs,
intentions, plans, objectives, goals, strategies, future events, performance and
underlying assumptions and other statements other than statements of historical
facts. In some cases, you can identify forward-looking statements by the use of
forward-looking terminology including, but not limited to, terms such as "may,"
"will," "anticipates," "expects," "believes," "intends," "should" or comparable
terms or the negative thereof. These statements are based on information
available on the date of this filing and only speak as to the date hereof and no
obligation to update such forward-looking statements should be assumed. Our
actual results may differ materially from those reflected in the forward-looking
statements contained herein as a result of a variety of factors, including,
among other things:

(1) those items discussed under "Risk Factors" in Part I, Item 1A to our annual

report on Form 10-K;

uncertainties relating to the business operations of the operators of our

(2) assets, including those relating to reimbursement by third-party payors,


     regulatory matters and occupancy levels;


     the impact of the novel coronavirus ("COVID-19") on our business and the
     business of our operators, including without limitation, the extent and

duration of the COVID-19 pandemic, increased costs and decreased occupancy

(3) levels experienced by operators of skilled nursing facilities ("SNFs") and

assisted living facilities ("ALFs") in connection therewith, the ability of

operators to comply with new infection control and vaccine protocols, and the

extent to which continued government support may be available to operators to


     offset such costs and the conditions related thereto;


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the ability of any of Omega's operators in bankruptcy to reject unexpired

lease obligations, modify the terms of Omega's mortgages and impede the

(4) ability of Omega to collect unpaid rent or interest during the pendency of a

bankruptcy proceeding and retain security deposits for the debtor's

obligations, and other costs and uncertainties associated with operator

bankruptcies;

our ability to re-lease, otherwise transition, or sell underperforming assets

(5) or assets held for sale on a timely basis and on terms that allow us to

realize the carrying value of these assets;

(6) the availability and cost of capital to us;

(7) changes in our credit ratings and the ratings of our debt securities;

(8) competition in the financing of healthcare facilities;

(9) competition in long-term healthcare industry and shifts in the perception of

various types of long-term care facilities, including SNFs and ALFs;

(10) additional regulatory and other changes in the healthcare sector;

(11) changes in the financial position of our operators;

(12) the effect of economic and market conditions generally and, particularly, in

the healthcare industry;

(13) changes in interest rates;

(14) the timing, amount and yield of any additional investments;

(15) changes in tax laws and regulations affecting real estate investment trusts

("REITs");

the potential impact of changes in the skilled nursing facility ("SNF") and

assisted living facility ("ALF") markets or local real estate conditions on

(16) our ability to dispose of assets held for sale for the anticipated proceeds

or on a timely basis, or to redeploy the proceeds therefrom on favorable

terms;

(17) our ability to maintain our status as a REIT; and

the effect of other factors affecting our business or the businesses of our

(18) operators that are beyond our or their control, including natural disasters,

other health crises or pandemics and governmental action; particularly in


      the healthcare industry.




Overview and Outlook



The Company has one reportable segment consisting of investments in
healthcare-related real estate properties located in the United States ("U.S.")
and the United Kingdom ("U.K."). Our core business is to provide financing and
capital to the long-term healthcare industry with a particular focus on skilled
nursing facilities ("SNFs"), assisted living facilities ("ALFs"), and to a
lesser extent, independent living facilities ("ILFs"), rehabilitation and acute
care facilities ("specialty facilities") and medical office buildings ("MOBs").
Our core portfolio consists of long-term leases and mortgage agreements. All of
our leases to our healthcare operators are "triple-net" leases, which require
the operators (we use the term "operator" to refer to our tenants and mortgagors
and their affiliates who manage and/or operate our properties) to pay all
property-related expenses. Our mortgage revenue derives from fixed rate mortgage
loans, which are secured by first mortgage liens on the underlying real estate
and personal property of the mortgagor. Our other investment income is derived
from fixed and variable rate loans to our operators and/or their principals to
fund working capital and capital expenditures. These loans, which may be either
unsecured or secured by the collateral of the borrower, are classified as other
investments.



Our portfolio of investments at December 31, 2020, included 967 healthcare
facilities, located in 40 states and the U.K. that are operated by 69
third-party operators. Our real estate investment in these facilities totaled
approximately $9.7 billion at December 31, 2020, with approximately 97% of our
real estate investments related to long-term healthcare facilities. The
portfolio is made up of (i) 738 SNFs, (ii) 115 ALFs, (iii) 28 specialty
facilities, (iv) two medical office buildings, (v) fixed rate mortgages on 56
SNFs, three ALFs and three specialty facilities and (vi) 22 facilities that are
held for sale. At December 31, 2020, we held other investments of approximately
$467.4 million, consisting primarily of secured loans to third-party operators
of our facilities and $200.6 million of investment in five unconsolidated joint
ventures.

Omega's consolidated financial statements include the accounts of (i) Parent,
(ii) Omega OP, and (iii) all direct and indirect wholly owned subsidiaries of
Omega and (iv) other entities in which Omega or Omega OP has a majority voting
interest and control.  All intercompany accounts and transactions have been
eliminated in consolidation, and Omega's net earnings are reduced by the portion
of net earnings attributable to noncontrolling interests.

As healthcare delivery continues to evolve, we continuously evaluate potential
investments, our assets, operators and markets to position our portfolio for
long-term success. Our strategy includes applying data analytics to our
investment underwriting and asset management, as well as selling or
transitioning assets that do not meet our portfolio criteria.

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COVID-19 Pandemic Update

For the year ended December 31, 2020, we have collected substantially all of the
contractual rents owed to us from our operators. However, the COVID-19 pandemic
continues to have a significant impact on our operators. As of February 9, 2021,
our operators have reported cases of COVID-19 within 535, or 56.4%, of our 949
operating facilities as of December 31, 2020, which includes cases involving
employees and residents. We caution that we have not independently validated
such facility virus incidence information, it may be reported on an inconsistent
basis by our operators, and we can provide no assurance regarding its accuracy
or that there have not been any changes since the time the information was
obtained from our operators; we also undertake no duty to update this
information. It remains uncertain when and to what extent vaccination programs
for COVID-19, which have been implemented in many of our facilities, will
mitigate the effects of COVID-19 in our facilities; the impact of these programs
will depend in part on the speed, distribution, and delivery of the vaccine in
our facilities, as well as participation levels in vaccination programs among
the residents and employees of our operators. Our operators have reported
considerable variation in participation levels among both employees and
residents, which may change over time as additional vaccination clinics are
held.

In addition to experiencing outbreaks of positive cases and deaths of residents
and employees during the pandemic, our operators have been required to, and
continue to, adapt their operations rapidly throughout the pandemic to manage
the spread of the COVID-19 virus as well as the implementation of new treatments
and vaccines, and to implement new requirements relating to infection control,
personal protective equipment ("PPE"), quality of care, visitation protocols,
staffing levels, and reporting, among other regulations, throughout the
pandemic. Many of our operators have reported incurring significant cost
increases as a result of the COVID-19 pandemic, with dramatic increases for
facilities with positive cases. We believe these increases primarily stem from
elevated labor costs, including increased use of overtime and bonus pay, as well
as a significant increase in both the cost and usage of PPE, testing equipment
and processes and supplies, as well as implementation of new infection control
protocols and vaccination programs. In addition, many of our operators have
reported experiencing declines, in some cases that are material, in occupancy
levels as a result of the pandemic. We believe these declines may be in part due
to COVID-19 related fatalities at the facilities, the delay of SNF placement
and/or utilization of alternative care settings for those with lower level of
care needs, the suspension and/or postponement of elective hospital procedures,
fewer discharges from hospitals to SNFs and higher hospital readmittances from
SNFs.

While substantial government support, primarily through the federal CARES Act in
the U.S. and distribution of PPE, vaccines and testing equipment by the federal
government, has been allocated to SNFs and to a lesser extent to ALFs, further
government support will likely be needed to continue to offset these impacts and
it is unclear whether and to what extent such government support has been and
will continue to be sufficient and timely to offset these impacts.  Further, to
the extent these impacts continue or accelerate and are not offset by additional
government relief that is sufficient and timely, the operating results of our
operators are likely to be adversely affected, some may be unwilling or unable
to pay their contractual obligations to us in full or on a timely basis and we
may be unable to restructure such obligations on terms as favorable to us as
those currently in place. Citing in part the impact of the COVID-19 pandemic and
uncertainties regarding the continuing availability of sufficient government
support, during the third and fourth quarters of 2020, four of our operators
indicated in their financial statements substantial doubt regarding their
ability to continue as going concerns.

There are a number of uncertainties we face as we consider the potential impact
of COVID-19 on our business, including how long census disruption and elevated
COVID-19 costs will last, the impact of vaccination programs and participation
levels in those programs in reducing the spread of COVID-19 in our facilities,
and the extent to which funding support from the federal government and the
states will continue to offset these incremental costs as well as lost revenues.
Notwithstanding vaccination programs, we expect that heightened clinical
protocols for infection control within facilities will continue for some period;
however, we do not know if future reimbursement rates or equipment provided by
governmental agencies will be sufficient to cover the increased costs of
enhanced infection control and monitoring.



While we continue to believe that longer term demographics will drive increasing
demand for needs-based skilled nursing care, we expect the uncertainties to our
business described above to persist at least for the near term until we can gain
more visibility into the costs our operators will experience and for how long,
and the level of additional governmental support that will be available to them,
the potential support our operators may request from us and the future demand
for needs-based skilled nursing care and senior living facilities. We continue
to monitor the impact of occupancy declines at many of our operators, and it
remains uncertain whether and when demand and occupancy levels will return

to
pre-COVID-19 levels.



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We continue to monitor the impacts of other regulatory changes, as discussed in
Item 1. Business - Government Regulation and Reimbursement, including any
significant limits on the scope of services reimbursed and on reimbursement
rates and fees, which could have a material adverse effect on an operator's
results of operations and financial condition, which could adversely affect the
operator's ability to meet its obligations to us.

2020 and Recent Highlights

Acquisition and Other Investments



On January 20, 2021, we acquired 24 senior living facilities from Healthpeak
Properties, Inc. for $510 million. The acquisition involved the assumption of an
in-place master lease with Brookdale Senior Living. The master lease provides
for 2021 contractual rent of approximately $43.5 million, and includes 24
facilities representing 2,552 operating units located in located in Arizona (1),
California (1), Florida (1), Illinois (1), New Jersey (1), Oregon (6),
Pennsylvania (1), Tennessee (1), Texas (6), Virginia (1), and Washington (4).



In February 2021, we sold 16 facilities for approximately $149.6 million in cash
proceeds and recorded a gain on sale of approximately $94.4 million.  These 16
facilities were held for sale as of December 31, 2020 with a carrying value of
approximately $49.3 million.

See "Portfolio and Other Developments" below for a description of 2020 acquisitions and other developments.

Financing Highlights

$700 Million 3.375% Senior Notes due 2031





On October 9, 2020, we issued $700 million aggregate principal amount of our
3.375% Senior Notes due 2031 (the "2031 Senior Notes"). The 2031 Senior Notes
mature on February 1, 2031. The 2031 Senior Notes were sold at an issue price of
98.249% of their face value before the underwriters' discount. Our net proceeds
from the 2031 Senior Notes offering, after deducting underwriting discounts and
expenses, were approximately $680.5 million. We used the net proceeds from the
2031 Senior Notes offering to repay the outstanding balance on our U.S. term
loan, our 2015 term loan and pay down the Omega OP term loan and revolving

line
of credit.



As a result of the repayment of the 2015 term loan and the partial paydown of
the Omega OP term loan, on October 14, 2020, we settled certain interest rate
swaps (interest rate swaps originated in 2015 and/or assumed in 2019) with an
aggregate notional value of $275 million related to the 2015 term loan and the
Omega OP term loan and paid our swap counterparties approximately $11 million.



Portfolio and Other Developments





2020 Acquisitions and Other



The following table summarizes the significant asset acquisitions that occurred
in 2020:




           Number of                       Total            Initial
           Facilities     Country/      Investment           Annual
Period     SNF    ALF      State       (in millions)     Cash Yield(1)
  Q1           -     2      U.K.      $          12.1              8.00 %
  Q1           1     -       IN                   7.0              9.50 %
  Q2           1     -       OH                   6.9              9.50 %
  Q4           6     1       VA                  78.4              9.50 %
Total          8     3                $         104.4

(1) Initial annual cash yield reflects the initial annual contractual cash rent

divided by the purchase price.

In 2020, the Company also invested $43 million in two SNF mortgages and $111 million in capital expenditure and construction projects.



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2019 Acquisitions and Other



The following table summarizes the significant transactions that occurred in
2019:


                        Number of                                            Total                 Initial
                        Facilities                  Country/              Investment                Annual
   Period        SNF  ALF  Specialty MOB              State              (in millions)          Cash Yield(1)
     Q1             1    -         -    -              OH               $          11.9 (3)              12.00 %
                                             CA, CT, IN, NV, SC, TN,
     Q2            20    1        11    1              TX                         440.7 (2)               9.82 %
     Q2             7    1         3    -            PA, VA                       131.8 (3)               9.35 %
     Q3             3    -         -    -            NC, VA                        24.9                   9.50 %
                                             FL, ID, KY, LA, MS, MO,
     Q4            58    2         -    -            MT, NC                       735.2                   8.71 %
    Total          89    4        14    1                               $       1,344.5

(1) Initial annual cash yield reflects the initial annual contractual cash rent

divided by the purchase price.

(2) The acquisition was accounted for as a business combination. The other

acquisitions were accounted for as asset acquisitions.

(3) Acquired via a deed-in-lieu of foreclosure.






Encore Portfolio Acquisition



On October 31, 2019, we completed the approximate $757 million portfolio
acquisition of 60 facilities (the "Encore Portfolio").  Consideration consisted
of approximately $369 million of cash and the assumption of approximately $389
million in mortgage loans guaranteed by the HUD.



MedEquities Merger



On May 17, 2019, we completed our merger (the "MedEquities Merger") with
MedEquities Realty Trust, Inc. ("MedEquities") and its subsidiary operating
partnership and the general partner of its subsidiary operating partnership. In
connection with the MedEquities Merger, we issued approximately 7.5 million
shares of Omega common stock and paid approximately $63.7 million of cash
consideration to former MedEquities stockholders. We borrowed approximately $350
million under our existing senior unsecured revolving credit facility to fund
the cash consideration and the repayment of MedEquities' previously outstanding
debt. As a result of the MedEquities Merger, we acquired 33 facilities subject
to operating leases, four mortgages, three other investments and an investment
in an unconsolidated joint venture. We also acquired other assets and assumed
debt and other liabilities. Based on the closing price of our common stock on
May 16, 2019, the fair value of the consideration exchanged approximated $346
million.

The MedEquities facilities acquired in 2019 are included in our results of
operations from the date of acquisition. For the period from May 17, 2019
through December 31, 2019, we recognized approximately $35.2 million of total
revenue from the assets acquired in connection with the MedEquities Merger. For
the year ended December 31, 2019, we incurred approximately $5.1 million of
acquisition and merger related costs associated with the MedEquities Merger.



Asset Sales, Impairments, Contractual Receivables and Other Receivables and Lease Inducements





Asset Sales



During the fourth quarter of 2020, we sold 16 facilities (12 were previously
held for sale at September 30, 2020) for approximately $63.7 million in net cash
proceeds recognizing a gain on sale of approximately $5.2 million.

In 2020, we sold 43 facilities (six were previously held for sale at December
31, 2019) for approximately $180.9 million in net cash proceeds recognizing a
net gain of approximately $19.1 million.

In 2019, we sold 34 facilities (one was previously held for sale at December 31,
2018) for approximately $219.3 million in net cash proceeds recognizing a net
gain of approximately $55.7 million.

As of December 31, 2020, 22 facilities, totaling approximately $81.5 million are
classified as assets held for sale. We expect to sell these facilities over

the
next twelve months.

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Impairments


During the fourth quarter of 2020, we recorded impairments on real estate properties of approximately $30.2 million on seven facilities (none of which were subsequently reclassified to held for sale).



For the year ended December 31, 2020, we recorded impairments on real estate
properties of approximately $76.0 million on 25 facilities. After considering
the impairments recorded and facilities sold during the year, the total net
recorded investment in these properties was approximately $12.3 million as of
December 31, 2020, with approximately $0.2 million related to properties
classified as assets held for sale. Our impairments were offset by approximately
$3.5 million of insurance proceeds received related to a facility that was
previously destroyed and impaired.

For the year ended December 31, 2019, we recorded net impairments on real estate
properties of approximately $45.3 million on 23 facilities. After considering
the impairments recorded and facilities sold during the year, the total net
recorded investment in these properties was approximately $23.4 million as of
December 31, 2019, with approximately $4.6 million related to properties
classified as assets held for sale. Our impairments were offset by approximately
$3.7 million of insurance proceeds received related to two facilities that were
previously destroyed and impaired.

Our recorded impairments were primarily the result of decisions to exit certain
non-strategic facilities and/or operators. We reduced the net book value of the
impaired facilities to their estimated fair values or, with respect to the
facilities reclassified to assets held for sale, to their estimated fair values
less costs to sell. To estimate the fair value of the facilities, we utilized a
market approach which considered binding sale agreements (a Level 1 input)
and/or non-binding offers from unrelated third parties and/or broker quotes (a
Level 3 input).

Contractual Receivables and Other Receivables and Lease Inducements




                                            December 31,       December 31,
                                                2020               2019

                                                     (in thousands)

Contractual receivables - net              $        10,408    $        27,122

Effective yield interest receivables $ 12,195 $ 12,914 Straight-line rent receivables

                     139,046            

275,549


Lease inducements                                   83,425             

92,628

Other receivables and lease inducements $ 234,666 $ 381,091






In 2020, we wrote-off approximately $143.0 million of contractual receivables,
straight-line rent receivables, and lease inducements to rental income as a
result of placing four operators on a cash basis resulting from a change in our
evaluation of the collectibility of future rent payments due under the
respective lease agreements as further discussed in Note 2 - Summary of
Significant Accounting Policies. In part, our conclusions were based on
information the Company received from these four operators during the third and
fourth quarters of 2020 regarding substantial doubt as to their ability to
continue as a going concern. Of the $143.0 million, $64.9 million related to
Genesis Healthcare, Inc. ("Genesis"), $75.3 million related to Agemo Holdings,
LLC ("Agemo") and $2.8 million related to two other operators which lease five
facilities from the Company. During 2020, we also wrote-off approximately $3.6
million of straight-line rent receivables to rental income as a result of
transitioning facilities to other existing operators. In addition, during 2020,
we received a one-time rent payment of approximately $55.4 million from
Maplewood Real Estate Holdings, LLC ("Maplewood"), in conjunction with the
restructuring of its master lease and loans with Omega.  This payment was
accounted for as an adjustment to straight-line rent receivables and is being
amortized over the remaining term of the master lease. During 2020, we also
provided approximately $34.1 million of funding to four operators, which was
accounted for as lease inducements. Of the $34.1 million, $23.9 million was
funded to Maplewood for development and start-up related costs.



For the years ended December 31, 2020 and 2019, we recorded rental (loss) income of approximately $(22.4) million and $60.6 million, respectively, and other investment income of $4.9 million and $4.5 million, respectively, from Agemo.



For the years ended December 31, 2020 and 2019, we recorded rental income of
approximately $2.3 million and $64.0 million, respectively, and other investment
income of $10.6 million and $9.7 million, respectively, from Genesis.

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Other investments

Agemo



On September 30, 2016, we acquired and amended a term loan with a fair value of
approximately $37.0 million with Agemo. A $5.0 million tranche of the term loan
that bore interest at 13% per annum was repaid in August 2017. The remaining
$32.0 million tranche of the term loan bears interest at 9% per annum and
currently matures on December 31, 2024. The $32.0 million term loan is secured
by a security interest in certain collateral of Agemo. During the third quarter
of 2020, we concluded that the $32.0 million term loan was impaired, based in
part on our consideration of information we received in the quarter from the
operator regarding substantial doubt as to its ability to continue as a going
concern. We recorded a provision for credit loss of $22.7 million to reduce the
carrying value of this loan to the fair value of the underlying collateral,
which was limited to our $9.3 million letter of credit and placed the loan on a
cash basis. We also fully reserved approximately $3.8 million of contractual
interest receivable related to the $32.0 million term loan (see Note 2 - Summary
of Significant Accounting Policies). As of December 31, 2020, the carrying
amount of the loan, net of allowances is approximately $9.3 million.

On May 7, 2018, we provided Agemo a $25.0 million secured working capital loan
bearing interest at 7% per annum that matures on April 30, 2025. The working
capital loan is primarily secured by a collateral package that includes a second
lien on the accounts receivable of the borrowers. The proceeds of the working
capital loan were used to pay operating expenses, settlement payments, fees,
taxes and other costs approved by Omega. As of December 31, 2020, approximately
$25.0 million is outstanding on this working capital loan. During 2020, no
incremental provision for credit loss was recorded for this loan given the
underlying collateral value.



On November 5, 2019, we provided Agemo a $1.7 million term loan (which was added
to the $32.0 million term loan) bearing interest at a fixed rate of 9% per annum
with a scheduled maturity in January 2021. This loan was repaid in 2020.



On February 28, 2020, we provided an affiliate of Agemo a $3.5 million term loan
bearing interest at a fixed rate of 10% per annum (with the interest
paid-in-kind) with a scheduled maturity in February 2021. This loan was repaid
in 2020.



At December 31, 2020, the total carrying value of our loans outstanding with
Agemo and its affiliates, net of allowances for credit losses, is approximately
$34.3 million.



Genesis

On March 6, 2018, we amended certain terms of our $48.0 million secured term
loan with Genesis. The $48.0 million term loan bears interest at a fixed rate of
14% per annum, of which 9% per annum is paid-in-kind and was initially scheduled
to mature on July 29, 2020. The maturity date of this loan was extended to
January 1, 2022. This term loan (and the $16.0 million term loan discussed
below) are secured by a first priority lien on and security interest in certain
collateral of Genesis. As of December 31, 2020, approximately $65.2 million is
outstanding on this term loan.



Also on March 6, 2018, we provided Genesis an additional $16.0 million secured
term loan bearing interest at a fixed rate of 10% per annum, of which 5% per
annum is paid-in-kind, and was initially scheduled to mature on July 29, 2020.
The maturity date of this loan was extended to January 1, 2022. As of December
31, 2020, approximately $18.4 million is outstanding on this term loan.



As of December 31, 2020, our total other investments outstanding with Genesis
was approximately $83.6 million. We evaluated our loans with Genesis for
impairment during 2020, with no incremental provision for credit loss recognized
given the underlying collateral value.

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Orianna



On January 11, 2019, pursuant to a bankruptcy court order, affiliates of Orianna
Health Systems ("Orianna") purchased the remaining 15 SNFs (during 2018 we
recorded $27.2 million of additional impairment to reduce the remaining
investment in direct financing lease covering 15 facilities located in the
Southeast region of the U.S. to their estimated fair values) subject to the
direct financing lease with Orianna for $176 million of consideration, comprised
of $146 million in cash received by Orianna and a $30.0 million seller note held
by the Company. The $30.0 million note bears interest at 6% per annum and
matures on January 11, 2026.  Interest on the unpaid principal balance is due
quarterly in arrears. Commencing on January 11, 2022, quarterly principal
payments are due based on a 15-year amortization schedule on the then
outstanding principal balance of the loan. On the same date, Orianna repaid
$25.0 million of our then outstanding debtor in possession financing, including
all related interest.



On January 16, 2019, the bankruptcy court confirmed Orianna's plan of
reorganization, creating a Distribution Trust (the "Trust") to distribute the
proceeds from Orianna's sale of the remaining 15 SNFs, as well as the Trust's
collections of Orianna's accounts receivable portfolio. In January 2019, we
reclassified our net investment in direct financing lease of $115.8 million from
the Trust to other assets on our Consolidated Balance Sheets. For the period
from January 16, 2019 through December 31, 2019, we received approximately $94
million from the Trust as a partial liquidation.



In March 2019, we received updated information from the Trust indicating
diminished collectibility of the accounts receivable owed to us. As a result, we
recorded an additional $7.7 million allowance. As of December 31, 2019, our
remaining receivable from the Trust was approximately $14.1 million which was
recorded in other assets on our Consolidated Balance Sheets. During 2020, we
received approximately $17.2 million from the Trust of which approximately $3.1
million is recorded in (recovery) impairment of direct financing leases on our
Consolidated Statements of Operations.



Daybreak



During the third quarter of 2017, we placed Daybreak on a cash basis for revenue
recognition as a result of nonpayment of funds owed to us. During the fourth
quarter of 2017, we executed a Settlement and Forbearance Agreement with
Daybreak which permitted Daybreak to defer payments up to 23% of their
contractual rent until January 2018, subject to certain conditions.  During the
fourth quarter of 2018, Daybreak was no longer in compliance with the 2017
Settlement and Forbearance Agreement.



On January 30, 2019, we entered into a Second Amendment to the Settlement and
Forbearance Agreement under which we agreed to defer approximately $4.2 million
of rent in the fourth quarter of 2018 and approximately $2.5 million (or
approximately one month's rent) in each of the first two quarters of 2019.
Except for $1.1 million in required real estate tax escrows, Daybreak met their
contractual payment obligations through the second quarter of 2019; however,
during the second half of 2019, Daybreak did not meet their full contractual
payment obligations to us as we received approximately $1.3 million of cash
rent.



During 2020, as part of our plan to transition and sell our Daybreak facilities,
we transitioned 31 Daybreak facilities to existing operators. The total annual
contractual rent from the 31 transitioned facilities is approximately $12.4
million. In 2021, we expect to transition 14 additional facilities to existing
operators with annual contractual rent of approximately $4.0 million. We
currently plan to sell the remaining four Daybreak facilities (with a net book
value as of December 31, 2020 of approximately $1.6 million) in 2021. The
transition or sale of these facilities will complete our exit from our
relationship with Daybreak.



During 2020 and 2019, we recorded impairments of approximately $41.2 million and $28.3 million on 16 facilities and 11 facilities with Daybreak, respectively.


 During 2020 and 2019, we sold seven Daybreak facilities and a parcel of land
and two Daybreak facilities, respectively for gains on sale of $1.3 million and
$0.5 million, respectively. Daybreak did not pay any rent to us in 2020.



Upon conclusion of the restructuring of the Daybreak portfolio, we expect to
receive rent or rent equivalents of between $15 million to $17 million annually
related to that portfolio.



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Results of Operations



The following is our discussion of the consolidated results of operations for
the year ended December 31, 2020 as compared to the year ended December 31,
2019.  For a discussion of our results of operation for the year ended December
31, 2019 as compared to the year ended December 31, 2018, see "Item 7 -
Management's Discussion and Analysis of Financial Condition and Results of
Operations" of our   2019 Form 10-K  .

Revenues

Our revenues for the year ended December 31, 2020 totaled $892.4 million, a decrease of $36.4 million over the same period in 2019. Following is a description of certain of the changes in revenues for the year ended December 31, 2020 compared to 2019:

Rental income was $753.4 million, a decrease of $50.6 million over the same

period in 2019. The decrease was primarily the result of (i) $144.7 million

related to placing four operators on a cash basis of revenue recognition due to

information we received from them regarding substantial doubt as to their

ability to continue as a going concern and reserving for our contractual

? receivables, straight-line rent receivables and lease inducements related to

these operators, (ii) $4.7 million related to certain other operators on cash

basis, (iii) $13.1 million from facility transitions and sales in 2019 and

2020, offset by (i) $12.3 million from facilities placed in service during 2019

and 2020, (ii) $83.9 million related to facility acquisitions and (iii) $8.3

million related to the acceleration of in-place leases resulting from facility


   transitions, lease terminations and acquired leases.



Mortgage interest income totaled $89.4 million, an increase of $12.9 million

? over the same period in 2019. The increase was primarily due to the new

mortgages and additional funding to existing operators made throughout 2019 and


   2020 and mortgages acquired in the MedEquities Merger.




Expenses

Our expenses for the year ended December 31, 2020, totaled $735.0 million, an
increase of approximately $93.5 million over the same period in 2019.  Following
is a description of certain of the changes in our expenses for the year ended
December 31, 2020 compared to 2019:

Our depreciation and amortization expense was $329.9 million for the year ended

December 31, 2020, compared to $301.7 million for the same period in 2019. The

? increase was primarily resulting from the MedEquities Merger and Encore

Portfolio acquisition, other facility acquisitions, capital additions and

assets placed in-service offset by a reduction in depreciation expense related


   to facility sales and facilities reclassified to assets held for sale.

Our general and administrative expense was $59.9 million, compared to $57.9

? million for the same period in 2019. The increase primarily related to the


   increase in stock based compensation expense offset by a reduction in
   professional service and other costs.

Our real estate taxes decreased $2.6 million compared to the same period in

? 2019. The decrease primarily resulted from lease amendments, facility sales and

transitions.

? Our $3.1 million decrease in acquisition, merger and transition related costs

primarily resulted from the MedEquities Merger.




?Our impairment on real estate properties was $72.5 million, compared to $45.3
million for the same period in 2019. The 2020 impairments primarily related to
25 facilities to reduce their net book value to their estimated fair value less
costs to sell or fair value. The 2019 impairments primarily related to 23
facilities to reduce their net book value to their estimated fair value less
costs to sell or fair value. The 2020 and 2019 impairments were primarily the
result of decisions to exit certain non-strategic facilities and/or operators.



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?Our (recovery) impairment on direct financing leases was approximately $(3.1)
million, compared to $7.9 million for the same period in 2019. Our (recovery)
impairment on direct financing leases primarily relates to the Orianna
bankruptcy and proceeds received from the Trust.



?Our $38.0 million increase in provision for credit losses was the result of
adopting Accounting Standards Update ("ASU") 2016-13, Financial Instruments -
Credit Losses (Topic 326) on January 1, 2020 and includes reserves related to
our other investments with Agemo.

Our interest expense was $223.4 million, compared to $208.7 million for the

same period in 2019. The increase primarily related to (i) interest on the $700

? million senior notes issued in October 2020, (ii) interest on the $500 million

senior notes issued in September 2019 and (iii) interest on the HUD debt that

we assumed in the Encore Portfolio acquisition, partially offset by paydowns of

certain term loans and the credit facility.

Other Income (Expenses)


For the year ended December 31, 2020, total other income was $4.9 million, a
decrease of approximately $51.6 million over the same period in 2019. The
decrease was primarily due to (i) a $13.3 million loss on debt extinguishment
primarily resulting from the termination of certain interest rate swaps, the
write-off of unamortized deferred costs related to the repayment of certain term
loans and the prepayment of two mortgage loans guaranteed by HUD and (ii) a
$36.6 million decrease in gain on assets sold - net resulting from the sale of
43 facilities and 34 facilities during 2020 and 2019, respectively, as we
continue to exit certain facilities, operator relationships and/or states to
improve the strength of our overall portfolio.

2020 Taxes


As a REIT, we generally are not subject to federal income taxes on the REIT
taxable income that we distribute to stockholders, subject to certain
exceptions.  For tax year 2020, we made common dividend payments of $612.3
million to satisfy REIT requirements relating to qualifying income. We have
elected to treat certain of our active subsidiaries as TRSs. Our domestic TRSs
are subject to federal, state and local income taxes at the applicable corporate
rates. Our foreign TRSs are subject to foreign income taxes. As of December 31,
2020, one of our TRSs that is subject to income taxes at the applicable
corporate rates had a net operating loss ("NOL") carry-forward of approximately
$5.7 million. The loss carry-forward is fully reserved as of December 31, 2020
with a valuation allowance due to uncertainties regarding realization.

Under current law, our NOL carry-forwards generated up through December 31, 2017
may be carried forward for no more than 20 years, and our NOL carry-forwards
generated in our taxable years ended December 31, 2020, December 31, 2019 and
December 31, 2018 may be carried forward indefinitely. The Coronavirus Aid,
Relief, and Economic Security Act (the "CARES Act") modified the NOL carryback
rules to limit recovery of taxes paid in prior tax periods. We do not anticipate
that such changes will materially impact the computation of Omega's taxable
income, or the taxable income of any Omega entity, including our TRSs. We also
do not expect that Omega or any Omega entity, including our TRSs, will realize a
material tax benefit as a result of the changes to the provisions of the Code
made by the CARES Act.



For the year ended December 31, 2020, we recorded approximately $1.3 million of
federal, state and local income tax provision and approximately $3.6 million of
tax provision for foreign income taxes.  These amounts do not include any income
or franchise taxes payable to certain states and municipalities.

National Association of Real Estate Investment Trusts Funds From Operations

Our funds from operations ("Nareit FFO"), a non-GAAP financial measure as further described below, for the year ended December 31, 2020 was $555.9 million compared to $640.0 million for the same period in 2019.



                                       39

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We calculate and report Nareit FFO in accordance with the definition of Funds
from Operations and interpretive guidelines issued by the National Association
of Real Estate Investment Trusts ("Nareit"), and, consequently, Nareit FFO is
defined as net income (computed in accordance with GAAP), adjusted for the
effects of asset dispositions and certain non-cash items, primarily depreciation
and amortization and impairment on real estate assets, and after adjustments for
unconsolidated partnerships and joint ventures and changes in the fair value of
warrants. Adjustments for unconsolidated partnerships and joint ventures are
calculated to reflect funds from operations on the same basis. We believe that
Nareit FFO is an important supplemental measure of our operating performance.
Because the historical cost accounting convention used for real estate assets
requires depreciation (except on land), such accounting presentation implies
that the value of real estate assets diminishes predictably over time, while
real estate values instead have historically risen or fallen with market
conditions. Nareit FFO was designed by the real estate industry to address this
issue. Nareit FFO herein is not necessarily comparable to Nareit FFO of other
REITs that do not use the same definition or implementation guidelines or
interpret the standards differently from us.

Nareit FFO is a non-GAAP financial measure. We use Nareit FFO as one of several
criteria to measure the operating performance of our business. We further
believe that by excluding the effect of depreciation, amortization, impairment
on real estate assets and gains or losses from sales of real estate, all of
which are based on historical costs and which may be of limited relevance in
evaluating current performance, Nareit FFO can facilitate comparisons of
operating performance between periods and between other REITs. We offer this
measure to assist the users of our financial statements in evaluating our
financial performance under GAAP, and Nareit FFO should not be considered a
measure of liquidity, an alternative to net income or an indicator of any other
performance measure determined in accordance with GAAP. Investors and potential
investors in our securities should not rely on this measure as a substitute for
any GAAP measure, including net income.

The following table presents our Nareit FFO results for the year ended December
31, 2020 and 2019:



                                                               Year Ended December 31,
                                                                 2020             2019

                                                                    (in thousands)
Net income                                                   $     163,545     $  351,947

Deduct gain from real estate dispositions                         (19,113) 

(55,696)


Deduct gain from real estate dispositions -
unconsolidated joint ventures                                      (5,894) 

(9,345)


                                                                   138,538  

286,906

Elimination of non-cash items included in net income: Depreciation and amortization

                                      329,924  

301,683


Depreciation - unconsolidated joint ventures                        14,000 

6,513


Add back impairments on real estate properties                      72,494 

45,264


Add back (deduct) unrealized loss (gain) on warrants                   988 

        (410)
Nareit FFO                                                   $     555,944     $  639,956

Liquidity and Capital Resources

At December 31, 2020, we had total assets of $9.5 billion, total equity of $4.0 billion and total net debt of $5.2 billion, with such debt representing approximately 56.4% of total capitalization.



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The following table shows the amounts due in connection with the contractual obligations described below as of December 31, 2020:




                                                            Payments due by period
                                                   Less than                                    More than
                                       Total         1 year       Years 2-3      Years 4-5       5 years

                                                                (in thousands)
Debt(1)                             $ 5,227,382    $  130,876    $   902,274    $   816,537    $ 3,377,695
Interest payments on long-term
debt                                  1,419,326       211,832        422,384        319,610        465,500
Operating lease and other
obligations(2)                           42,155         1,904          3,943          4,121         32,187
Total                               $ 6,688,863    $  344,612    $ 1,328,601    $ 1,140,268    $ 3,875,382

The $5.2 billion of debt outstanding includes: (i) $101 million in borrowings

under the Revolving Credit Facility due in May 2021, (ii) $137 million under

the British Pound Sterling term loan facility due May 2022, (iii) $50 million

under the Omega OP Term Loan Facility due May 2022, (iv) $700 million of

4.375% Senior Notes due August 2023, (v) $400 million of 4.95% Senior Notes

due April 2024, (vi) $400 million of 4.50% Senior Notes due January 2025,

(vii) $600 million of 5.25% Senior Notes due January 2026, (viii) $700

million of 4.5% Senior Notes due April 2027, (ix) $550 million of 4.75%

(1) Senior Notes due January 2028, (x) $500 million of 3.625% Senior Notes due

October 2029, (xi) $700 million of 3.375% Senior Notes due February 2031,

(xii) $20 million of 9.0% per annum subordinated debt maturing in December

2021, (xiii) $2.3 million of 3.25% per annum debt held at a consolidated

joint venture due February 2021 and (xiv) $367 million of HUD debt at a 3.01%

weighted average interest rate due between 2046 and 2052. Other than the $50

million outstanding under the Omega OP Term Loan Facility, the $367 million


     of HUD debt and the $2.3 million of debt held at a consolidated joint
     venture, the Parent is the obligor of all outstanding debt.

In connection with the adoption of Topic 842, we recognized lease liabilities

in connection with ground and/or facility leases. Certain operators pay

(2) these obligations directly to the landlord. We recognize rental income for

ground and/or facility leases where the operator reimburses us, or pays the


     obligation directly to the landlord on our behalf.



Financing Activities and Borrowing Arrangements

$700 Million 3.375% Senior Notes due 2031





On October 9, 2020, we issued $700 million aggregate principal amount of our
3.375% Senior Notes due 2031 (the "2031 Senior Notes"). The 2031 Senior Notes
mature on February 1, 2031. The 2031 Senior Notes were sold at an issue price of
98.249% of their face value before the underwriters' discount. Our net proceeds
from the 2031 Senior Notes offering, after deducting underwriting discounts and
expenses, were approximately $680.5 million. We used the net proceeds from the
2031 Senior Notes offering to repay the outstanding balance on our U.S. term
loan, our 2015 term loan and pay down the Omega OP term loan and revolving

line
of credit.



As a result of the repayment of the 2015 term loan and the partial paydown of
the Omega OP term loan, on October 14, 2020, we settled certain interest rate
swaps (interest rate swaps originated in 2015 and/or assumed in 2019) with an
aggregate notional value of $275 million related to the 2015 term loan and the
Omega OP term loan and paid our swap counterparties approximately $11 million.



HUD Mortgage Loan Payoffs

On August 26, 2020, we paid approximately $13.7 million to retire two mortgage
loans guaranteed by HUD. The loans were assumed in 2019 and had an average
interest rate of 3.08% per annum with maturities in 2051 and 2052. The payoff
included a $0.9 million prepayment fee which is included in loss on debt
extinguishment on our Consolidated Statements of Operations.



Subordinated Debt



In connection with a 2010 acquisition, we assumed five separate $4.0 million
subordinated notes bearing interest at 9% per annum that mature on December 21,
2021.  Interest on these notes is due quarterly with the principal balance due
at maturity.  These subordinated notes may be prepaid at any time without
penalty.  To the extent that the operator of the facilities fails to pay rent
when due to us under our existing master lease, we have the right to offset the
amounts owed to us against the amounts we owe to the lender under the notes. In
the fourth quarter of 2019, we had recorded a reserve of $6.5 million in
connection with the operator's failure to pay rent, and we began offsetting
certain interest and principal amounts payable by us against this reserve.
During 2020, expressly subject to our reservation of rights under the terms of
the notes and related agreement, we reversed this reserve, and ceased offsetting
amounts against our note payments, as a result of the operator's payment of

all
current and past due rent.



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$400 Million Forward Starting Swaps



On March 27, 2020, we entered into five forward starting swaps totaling $400
million. We designated the forward starting swaps as cash flow hedges of
interest rate risk associated with interest payments on a forecasted issuance of
long-term debt, initially expected to occur within the next five years. The
swaps are effective on August 1, 2023 and expire on August 1, 2033 and were
issued at a fixed rate of approximately 0.8675%. In October 2020, we issued $700
million aggregate principal amount of our 3.375% Senior Notes due 2031 and
discontinued hedge accounting. Amounts reported in accumulated other
comprehensive loss related to these discontinued cash flow hedging relationships
will be reclassified to interest expense as interest payments are made on the
Company's debt. Simultaneously, we re-designated these swaps in new cash flow
hedging relationships of interest rate risk associated with interest payments on
another forecasted issuance of long-term debt. We are hedging our exposure to
the variability in future cash flows for forecasted transactions over a maximum
period of 46 months (excluding forecasted transactions related to the payment of
variable interest on existing financial instruments).



Revolving Credit Facility



We have a $1.25 billion senior unsecured revolving credit facility that matures
on May 25, 2021, subject to Omega's option to extend such maturity date for two,
six-month periods (subject to compliance with a notice requirement and other
customary conditions). As of December 31, 2020, $101.2 million of borrowings
were outstanding under our revolving credit facility. We currently plan to
refinance our credit facility or exercise our option to extend the maturity of
the existing facility by May 25, 2021. Our ability to refinance our credit
facilities on favorable terms or at all is subject to prevailing market
conditions.

General



Certain of our other secured and unsecured borrowings are subject to customary
affirmative and negative covenants, including financial covenants. As of
December 31, 2020 and 2019, we were in compliance with all affirmative and
negative covenants, including financial covenants, for our secured and unsecured
borrowings.

Supplemental Guarantor Information


Parent has issued approximately $4.6 billion aggregate principal of senior notes
outstanding at December 31, 2020 that were registered under the Securities Act
of 1933, as amended. The senior notes are guaranteed by Omega OP.

The SEC adopted amendments to Rule 3-10 of Regulation S-X and created Rule 13-01
to simplify disclosure requirements related to certain registered securities,
such as our senior notes. As a result of these amendments, registrants are
permitted to provide certain alternative financial and non-financial
disclosures, to the extent material, in lieu of separate financial statements
for subsidiary issuers and guarantors of registered debt securities.
Accordingly, separate consolidated financial statements of Omega OP have not
been presented. Parent and Omega OP, on a combined basis, have no material
assets, liabilities or operations other than financing activities (including
borrowings under the senior unsecured revolving and term loan credit facility,
Omega OP term loan and the outstanding senior notes) and their investments in
non-guarantor subsidiaries.

Omega OP is currently the sole guarantor of our senior notes. The guarantees by
Omega OP of our senior notes are full and unconditional and joint and several
with respect to the payment of the principal and premium and interest on our
senior notes. The guarantees of Omega OP are senior unsecured obligations of
Omega OP that rank equal with all existing and future senior debt of Omega OP
and are senior to all subordinated debt. However, the guarantees are effectively
subordinated to any secured debt of Omega OP. As of December 31, 2020, there
were no significant restrictions on the ability of Omega OP to make
distributions to Omega.

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Commitments

We have committed to fund the construction of new leased and mortgaged
facilities, capital improvements and other commitments. We expect the funding of
these commitments to be completed over the next several years.  Our remaining
commitments at December 31, 2020, are outlined in the table below (in
thousands):



Total commitments             $   557,119
Amounts funded to date (1)      (450,766)
Remaining commitments (2)     $   106,353

(1) Includes finance costs.

(2) This amount excludes our remaining commitments to fund under our other


    investments of approximately $95.7 million.



$200 Million Stock Repurchase Program


On March 20, 2020, Omega's Board of Directors authorized the repurchase of up to
$200 million of its outstanding common stock from time to time over the twelve
months ending March 20, 2021. We are authorized to repurchase shares of our
common stock in open market and privately negotiated transactions or in any
other manner as determined by Omega's management and in accordance with
applicable law. The timing and amount of stock repurchases will be determined,
in management's discretion, based on a variety of factors, including but not
limited to market conditions, other capital management needs and opportunities,
and corporate and regulatory considerations. Omega has no obligation to
repurchase any amount of its common stock, and such repurchases, if any, may be
discontinued at any time. Omega did not repurchase any of its outstanding common
stock during 2020.


$500 Million Equity Shelf Program





On September 3, 2015, we entered into separate Equity Distribution Agreements
(collectively, the "Equity Shelf Agreements") to sell shares of our common stock
having an aggregate gross sales price of up to $500 million (the "2015 Equity
Shelf Program") with several financial institutions, each as a sales agent
and/or principal (collectively, the "Managers"). Under the terms of the Equity
Shelf Agreements, we may sell shares of our common stock, from time to time,
through or to the Managers having an aggregate gross sales price of up to $500
million. Sales of the shares, if any, are made by means of ordinary brokers'
transactions on the New York Stock Exchange at market prices, or as otherwise
agreed with the applicable Manager. We pay each Manager compensation for sales
of the shares up to 2% of the gross sales price per share for shares sold
through such Manager under the applicable Equity Shelf Agreements.

The table below presents information regarding the shares issued under the Equity Shelf Program for each of the years ended December 31, 2018, 2019, and 2020:




                  Shares issued  Average Price   Net Proceeds
   Year Ended     (in millions)    Per Share    (in millions)
December 31, 2018           2.3 $         33.18 $         75.5
December 31, 2019           3.1           34.79          109.0
December 31, 2020           4.2           36.16          152.6

Dividend Reinvestment and Common Stock Purchase Plan



We have a Dividend Reinvestment and Common Stock Purchase Plan (the "DRSPP")
that allows for the reinvestment of dividends and the optional purchase of our
common stock.  On March 23, 2020, we temporarily suspended the DRSPP and on
December 17, 2020, we reinstated the DRSPP. The table below presents information
regarding the shares issued under the DRSPP for each of the years ended December
31, 2018, 2019, and 2020:


                  Shares issued  Gross Proceeds
   Year Ended     (in millions)  (in millions)
December 31, 2018           1.5 $           46.8
December 31, 2019           3.0            115.1
December 31, 2020           0.1              3.7


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Dividends



As a REIT, we are required to distribute dividends (other than capital gain
dividends) to our stockholders in an amount at least equal to (A) the sum of (i)
90% of our "REIT taxable income" (computed without regard to the dividends paid
deduction and our net capital gain), and (ii) 90% of the net income (after tax),
if any, from foreclosure property, minus (B) the sum of certain items of
non-cash income. In addition, if we dispose of any built-in gain asset during a
recognition period, we will be required to distribute at least 90% of the
built-in gain (after tax), if any, recognized on the disposition of such asset.
Such distributions must be paid in the taxable year to which they relate, or in
the following taxable year if declared before we timely file our tax return for
such year and paid on or before the first regular dividend payment after such
declaration. In addition, such distributions are required to be made pro rata,
with no preference to any share of stock as compared with other shares of the
same class, and with no preference to one class of stock as compared with
another class except to the extent that such class is entitled to such a
preference. To the extent that we do not distribute all of our net capital gain
or do distribute at least 90%, but less than 100% of our "REIT taxable income"
as adjusted, we will be subject to tax thereon at regular ordinary and capital
gain corporate tax rates.

In 2020, we paid dividends of $612.3 million to our common stockholders.

The Board has declared common stock dividends as set forth below:




                                          Dividend per
  Record Date         Payment Date        Common Share
January 31, 2020    February 14, 2020    $         0.67
 April 30, 2020       May 15, 2020                 0.67
 July 31, 2020       August 14, 2020               0.67
November 2, 2020    November 16, 2020              0.67
February 8, 2021    February 16, 2021              0.67


Liquidity



We believe our liquidity and various sources of available capital, including
cash from operations, existing availability under our credit facilities,
proceeds from our DRSPP and the 2015 Equity Shelf Program, facility sales and
expected proceeds from mortgage and other investment payoffs are adequate to
finance operations, meet recurring debt service requirements and fund future
investments through the next twelve months.

We regularly review our liquidity needs, the adequacy of cash flow from operations, and other expected liquidity sources to meet these needs. We believe our principal short-term liquidity needs are to fund:





 ? normal recurring expenses;


 ? debt service payments;

? capital improvement programs;

? common stock dividends; and

? growth through acquisitions of additional properties.






The primary source of liquidity is our cash flows from operations.  Operating
cash flows have historically been determined by: (i) the number of facilities we
lease or have mortgages on; (ii) rental and mortgage rates; (iii) our debt
service obligations; (iv) general and administrative expenses and (v) our
operators' ability to pay amounts owed. The timing, source and amount of cash
flows provided by or used in financing activities and in investing activities
are sensitive to the capital markets environment, especially to changes in
interest rates. Changes in the capital markets environment may impact the
availability of cost-effective capital and affect our plans for acquisition

and
disposition activity.



Cash, cash equivalents and restricted cash totaled $167.6 million as of December
31, 2020, an increase of $134.2 million as compared to the balance at December
31, 2019. The following is a discussion of changes in cash, cash equivalents and
restricted cash due to operating, investing and financing activities, which are
presented in our Consolidated Statements of Cash Flows.



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Operating Activities - Operating activities generated $708.3 million of net cash
flow for the year ended December 31, 2020, as compared to $553.7 million for the
same period in 2019, an increase of $154.5 million which is primarily due to the
MedEquities Merger, the Encore portfolio acquisition, facility transitions and
investments in mortgages and other investments.



Investing Activities - Net cash flow from investing activities was an outflow of
$89.1 million for the year ended December 31, 2020, as compared to an outflow of
$379.0 million for the same period in 2019. The $289.9 million change in cash
used by investing activities related primarily to (i) a $272.2 million decrease
in real estate acquisitions, primarily related to the Encore portfolio
acquisition in the fourth quarter of 2019, (ii) $101.5 million decrease in
investments in unconsolidated joint ventures primarily related to new joint
venture investments in 2019, (iii) a $86.4 million decrease in capital
improvements to real estate investments and construction in progress and (iv) a
$54.6 million decrease in business acquisitions, primarily related to the
MedEquities Merger in the second quarter of 2019. Offsetting these changes were:
(i) a $9.0 million change in other investments - net, (ii) a $86.4 million
change in mortgages - net which is primarily the result of new mortgages in 2020
and fewer mortgage payoffs in 2020 as compared to 2019, (iii) a $78.3 million
decrease in proceeds from sale of direct financing lease assets and related
trust and (iv) a $38.4 million decrease in proceeds from the sales of real
estate investments.



Financing Activities - Net cash flow from financing activities was an outflow of
$485.5 million for the year ended December 31, 2020, as compared to an outflow
of $154.0 million for the same period in 2019. The $331.6 million change in cash
used in financing activities was primarily related to (i) a $351.2 million
change in other long-term borrowings - net which is the result of greater other
long-term debt repayments in 2020 offset by additional long-term borrowings in
2020 as compared to 2019, (ii) a $252.1 million decrease in cash proceeds from
the issuance of common stock in 2020, as compared to the same period in 2019,
(iii) a $111.3 million decrease in net proceeds from our dividend reinvestment
plan in 2020, as compared to the same period in 2019, and (iv) a $48.2 million
increase in dividends paid primarily resulting from additional share issuances
throughout 2019 and 2020, offset by (i) a $444.6 million change in our credit
facility borrowings - net.


Critical Accounting Policies and Estimates





The preparation of financial statements in conformity with GAAP in the United
States requires management to make estimates and assumptions that affect the
reported amounts of assets and liabilities and the reported amounts of revenues
and expenses.  Our significant accounting policies are described in Note 2 -
Summary of Significant Accounting Policies.  These policies were followed in
preparing the consolidated financial statements for all periods presented.

Actual results could differ from those estimates.



We have identified the following significant accounting policies that we believe
are critical accounting policies.  These critical accounting policies are those
that have the most impact on the reporting of our financial condition and those
requiring significant assumptions, judgments and estimates.  With respect to
these critical accounting policies, we believe the application of assumptions,
judgments and estimates is consistently applied and produces financial
information that fairly presents the results of operations for all periods
presented.  The following table presents information about our critical
accounting policies, as well as the material assumptions used to develop each
estimate:


Nature of Critical Accounting


           Estimate                        Assumptions/Approach Used
Revenue Recognition
Rental income from our         We assess the probability of collecting
operating leases is generally  substantially all payments under our leases based
recognized on a straight-line  on several factors, including, among other
basis over the lease term when things, payment history of the lessee, the
we have determined that the    financial strength of the lessee and any
collectability of              guarantors, historical operations and 

operating


substantially all of the lease trends, current and future economic conditions
payments are probable. If we   and expectations of performance (which includes
determine that it is not       known substantial doubt about an operator's
probable that substantially    ability to continue as a going concern). If our

all of the lease payments will evaluation of these factors indicates it is
be collected, we account for   probable that we will be unable to collect
the revenue under the lease on substantially all rents, we place that operator
a cash basis.                  on a cash basis and limit our rental income to
                               the lesser of lease income on a straight-line
                               basis plus variable rents when they become
                               accruable or cash collected. As a result of
                               placing an operator on a cash basis, we may
                               recognize a charge to rental income for any
                               contractual rent receivable, straight-line rent
                               receivable and lease inducements. If we change
                               our conclusion regarding the probability of
                               collecting rent payments required by a lessee, we
                               may recognize an adjustment to rental income in
                               the period we make a change to our prior
                               conclusion. Changes in the assessment of
                               probability are accounted for on a cumulative
                               basis as if the lease had always been accounted
                               for based on the current determination of the
                               likelihood of collection, potentially resulting
                               in increased volatility of rental income.


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Nature of Critical Accounting


           Estimate                        Assumptions/Approach Used
Real Estate Investment
Impairment
Assessing impairment of real   We evaluate our real estate investments for
property involves subjectivity impairment indicators at each reporting period,
in determining if indicators   including the evaluation of our assets' useful
of impairment are present and  lives. The judgment regarding the existence of
in estimating the future       impairment indicators is based on factors such
undiscounted cash flows. The   as, but not limited to, market conditions,
estimated future undiscounted  operator performance including the current
cash flows are generally based payment status of contractual obligations and
on the related lease which     expectations of the ability to meet future
relates to one or more         contractual obligations, legal structure, as well
properties and may include     as our intent with respect to holding or
cash flows from the eventual   disposing of the asset. If indicators of
disposition of the asset. In   impairment are present, we evaluate the carrying
some instances, there may be   value of the related real estate investments in
various potential outcomes for relation to our estimate of future undiscounted
a real estate investment and   cash flows of the underlying facilities to
its potential future cash      determine if an impairment charge is necessary.
flows. In these instances, the This analysis requires us to use judgment in
undiscounted future cash flows determining whether indicators of impairment
used to assess the             exist, probabilities of potential outcomes and to
recoverability are             estimate the expected future undiscounted 

cash


probability-weighted based on  flows or estimated fair values of the facility
management's best estimates as which impact our assessment of impairment, if
of the date of evaluation.     any.
These estimates can have a
significant impact on the
undiscounted cash flows.
Asset Acquisitions
We believe that our real       The allocation of the purchase price to the
estate acquisitions are        related real estate acquired (tangible assets and
typically considered asset     intangible assets and liabilities) involves
acquisitions. The assets       subjectivity as such allocations are based on a
acquired and liabilities       relative fair value analysis. In determining the
assumed are recognized by      fair values that drive such analysis, we estimate
allocating the cost of the     the fair value of each component of the real
acquisition, including         estate acquired which generally includes land,
transaction costs, to the      buildings and site improvements, furniture and
individual assets acquired and equipment, and the above or below market
liabilities assumed on a       component of in-place leases. Significant
relative fair value basis.     assumptions used to determine such fair values
Tangible assets consist        include comparable land sales, capitalization
primarily of land, building    rates, discount rates, market rental rates and
and site improvements and      property operating data, all of which can be
furniture and equipment.       impacted by expectations about future market or
Identifiable intangible assets economic conditions. Our estimates of the values
and liabilities primarily      of these components affect the amount of
consist of the above or below  depreciation and amortization we record over the
market component of in-place   estimated useful life of the property or the term
leases.                        of the lease.
Allowance for Losses on
Mortgages, Other Investments
and Direct Financing Leases
The allowances for losses on   We assess the probability of collecting
mortgage notes receivable,     substantially all payments due under our loans
other investments and direct   based on several factors, including, among other
financing leases               things, payment history, the financial 

strength


(collectively, our "loans")    of the lessee and/or borrower and any guarantors,
are maintained at a level that historical operations and operating trends,
we believe are adequate to     current and future economic conditions,
absorb potential losses. The   expectations of performance (which includes known
determination of the allowance substantial doubt about an operator's ability to
is based on a quarterly        continue as a going concern) and the value of the
evaluation of all outstanding  underlying collateral of the agreement, if any.
loans. If facts and            When we identify a loan impairment, the loan is
circumstances indicate that    written down to the present value of the expected
there is greater risk of loan  future cash flows which requires the judgement of
charge-offs, additional        management. In cases where expected future cash
allowances, impairments or     flows are not readily determinable, the loan is
placement on non-accrual       written down to the fair value of the underlying
status may be required. A loan collateral. We may base our valuation on a loan's
is impaired when, based on     observable market price, if any, or the fair
current information and        value of collateral, net of sales costs, if the
events, it is probable that we repayment of the loan is expected to be provided
will be unable to collect all  solely by the sale of the collateral.
amounts due as scheduled
according to the contractual
terms of the loan agreements.

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