June 23, 2022- DST Education Series B- Part 9 Medical Office

Editor’s note- this is part nine of a ten-part series on the various asset types of DST offerings.
Part 9: Medical Office Building Asset Classification Discussion

By Al DiNicola, AIF®
June 23, 2022
DST 1031 Specialist
NAMCOA® – Naples Asset Management Company®, LLC
Securities offered through MSC-BD, LLC, member of FINRA/SIPC

Why Investing in Medical Office Buildings Makes Sense
Delaware Statutory Trusts (DSTs) continue to gain in popularity among cash investors and 1031 tax deferred exchange investors. Investors seeking diversification may include Medical Office Buildings (MOB) in their portfolio. The need for medical services continues throughout the United States. Large and medium hospitals service the needs of a vast amount of the population. For the purposes of this article, we will focus on the smaller medical facilities that handle outpatient services that do not require an overnight stay. There are a variety of outpatient services that include kidney centers, surgery centers, orthopedic offices and many more. There has been growth in many areas of the country and not just in southern states where many retirees tend to relocate. The performance of this asset class has been consistent. The MOBs may be single site offering or there may be a portfolio of locations in an offering. Specific performance of the MOBs asset class may be hard to zero in on because many MOB have been included in the overall office asset class. Some typical office asset class offerings may have concerns for occupancy with the ability for employees to work from home. However, the MOB require full staffing to handle the growing needs of patient services. The MOB provide medical professionals facilities to handle the variety of needs of patients including surgery centers. When the facilities are professionally managed physicians and medical specialist can focus on the needs of the patient. Investing in DST as well as MOB are not for everyone. However, there are reasons to consider investing in the asset class. Based on the variety of medical services, procedures and requirements of the population of the US, the medical office asset class may be worth considering.

Strong Historical Performance
There has been a steady growth of the medical real estate space when compared with the general office space. In addition, long-term occupancy rates in MOB have steadily increased when compared to other office space. According to the CBRE 2021 Healthcare Real Estate Investor & Developer Survey Results, 90% of CRE firms stated that between 2020 and 2021 the occupancy of their medical office portfolios either remained stable or increased from the year prior.
When you visit a medical office building you may be aware of the amount of equipment that has been installed and other specialty build out components. The features of certain buildout include not only the waiting room and offices but all high-tech testing devises, monitors, plumbing needs, operating rooms, recovery rooms, special wiring for electronics, specialty gases and many more features. With all these tenant improvements it is easy to understand tenants staying longer than traditional office renters who may be running a business such as a law firm. There would be a tremendous cost involved with moving equipment and switching to a new location. For this and other reasons there is a stable occupancy rate for MOBs and have demonstrated consistent rent growth over the past years. This stability has also enabled landlords to increase the dollar per square foot rents.

DST sponsors recognize Investor Demand
DST sponsors recognize the strength of the MOBs historical performance over the past few years. Especially in the sun belts (southwest and southeast US) where there is an expansion of the medical office asset class. For this reason, sponsors are seeking opportunities to offer cash investors as well as 1031 exchange investors quality offerings. However, the task to bring on offerings is more difficult than you would imagine. There is competition for the assets for institutional investors and private investors. There are more REIT offerings than DST offerings.
Even during the Great Recession, the medical office building sector demonstrated resistance to the market slowdown. This may have provided an indication of how the asset class would perform in future turndowns as well as the COVID pandemic. The resilience to a downturn and the performance of the MOB drove the increase in investor interest.

Outpatient Locations
Many Americans have experienced taking someone to an outpatient center or going yourself. The innovations in technology and efficiencies in surgery centers provide exceptional care and results for patients. There are also several other specialty services such as kidney dialysis centers, orthopedic centers and a variety of other facilities. Numbers of outpatient centers continue to increase and do not show any signs of slowing down. The rationale for the increase may be connected to the patient looking for more access to healthcare (potentially being more affordable) and convenient locations. The traditional “in hospital” locations tend to be more expensive and by patients utilizing outpatient centers it may reduce the patients out of pocket expenses.

MOBs Asset Class may be recession resistant
COVID 19 accelerated the virtual or telehealth alternative to the traditional office visit. However, as well executed this new technology performed this type of online medicine is not an acceptable substitution for traditional medical services. The use of telehealth also prompts other questions such as what is the long-term efficiencies, quality and safety not to mention all the in person needs such as lab work, x-rays, and physical exams. As with any new technology the medical professionals need to monitor the effectiveness for the safety and health of the patients. Not to be overlooked would be the COVID-related elective surgery centers being closed.

Tenant Credibility & Responsibility
In a DSTs there will be a master lease that reflects underlying credibility and credit worthiness of the tenant occupying the space. The tenant may occupy a single site location or may have multiple locations in a portfolio. In many MOBs, including DST offering, the tenant typically enters into a triple net lease (NNN). This limits the investor exposure to escalation of expenses. The secure distributions may not have as much upside elasticity but will offer consistent returns. The Private Placement Memorandum (PPM) that all DST investors need to receive prior to investing will layout many aspects of the offering including the potential risks associated with the investment. Also, the background of the tenant leasing the space, terms of the lease, rental increases and other analysis would be illustrated.
Potential Distributions & Exit Strategies
The PPM would also illustrate the projected annual distribution (typically paid monthly) and the exit strategy for the potential sale of the asset. The exit strategy as with other DST offerings include receiving potential proceeds from the sale (at which time the investor would be responsible for their capital gains taxes to be paid), execute another 1031 into DST offerings, or execute another 1031 into a traditional brick and mortar real estate. Recently some sponsors have introduced an alternative in a 721 UPREIT. Details on the IRS 721 will be featured in future articles.

DSTs are not for all investors. The acquisition of a DST is for accredited investors only. Contact your investment adviser for additional details on how a DST may be a solution to your 1031 Exchange and suited for your investment future. For more information on how to properly set up an IRC 1031Tax Deferred Exchange or if you are an accredited investor and would like additional information on a DST contact Al DiNicola at 239-691-8098 or email adinicola@namcoa.com.

This is not an offer to purchase or solicitation to purchase any security, as such be made only through an offering memorandum or prospectus. Investing in securities, real estate, or any investment, whether public or private, involves risk, including but not limited to the potential of losing some or all of your investment dollars when you invest in securities. You should review any planned financial transactions that may have tax or legal implications with your personal tax or legal advisor. NAMCOA, LLC is a Registered Investment Advisor, regulated by SEC (Securities and Exchange Commission).

NAMCOA’s corporate office is located at 999 Vanderbilt Beach Road, Suite 200, Naples Florida 34108. Securities Offered through MSC-BD, LLC, Member of FINRA/SIPC. 410 Peachtree Parkway Suite 4245, Cumming, GA 30041. MSC-BD, LLC and NAMCOA are independently owned and are not affiliated.
Thank you.
NAMCOA® – Naples Asset Management Company®, LLC