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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) | 12 Months Ended
--- | ---
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021
CASH FLOWS FROM OPERATING ACTIVITIES: |  |  |
Net (loss) income | $ (293,572,000) | $ (15,774,000) | $ 179,926,000
Adjustments to reconcile net (loss) income to cash provided by (used in) operating activities: |  |  |
Depreciation and amortization | 284,083,000 | 239,280,000 | 271,131,000
Net amortization of debt premiums, discounts and issuance costs | 11,811,000 | 8,658,000 | 13,408,000
Straight line rental income | 1,095,000 | (8,916,000) | (5,846,000)
Amortization of acquired real estate leases and assumed real estate lease obligations, net | (242,000) | 245,000 | (7,211,000)
Loss on modification or early extinguishment of debt | 2,468,000 | 30,043,000 | 2,410,000
Impairment of assets | 18,380,000 | 0 | (174,000)
Gain on sale of properties | (1,205,000) | (321,862,000) | (492,272,000)
Gains and losses on equity securities, net | (8,126,000) | 25,660,000 | 42,232,000
Other non-cash adjustments, net | (1,932,000) | (2,038,000) | (1,811,000)
Unconsolidated joint venture distributions | 5,100,000 | 8,769,000 | 0
Equity in net losses (earnings) of investees | 20,461,000 | (6,055,000) | 0
Change in assets and liabilities: |  |  |
Deferred leasing costs, net | (9,834,000) | (7,874,000) | (20,701,000)
Other assets | 10,672,000 | 10,946,000 | (51,201,000)
Accrued interest | (6,570,000) | (428,000) | 7,654,000
Other liabilities | (22,106,000) | (1,007,000) | (868,000)
Net cash provided by (used in) operating activities | 10,483,000 | (40,353,000) | (63,323,000)
CASH FLOWS FROM INVESTING ACTIVITIES: |  |  |
Real estate acquisitions and deposits | 0 | (75,105,000) | 0
Real estate improvements | (235,007,000) | (299,387,000) | (227,605,000)
Proceeds from sale of properties, net | 18,356,000 | 822,000 | 103,257,000
Proceeds from sale of properties to joint venture, net | 0 | 638,488,000 | 0
Proceeds from sale of interest in joint venture, net | 0 | 108,424,000 | 367,033,000
Proceeds from insurance recoveries | 534,000 | 14,466,000 | 0
Proceeds from AlerisLife Inc. tender offer | 14,006,000 | 0 | 0
Distributions in excess of earnings from Affiliates Insurance Company | 0 | 0 | 11,000
Net cash (used in) provided by investing activities | (202,111,000) | 387,708,000 | 242,696,000
CASH FLOWS FROM FINANCING ACTIVITIES: |  |  |
Proceeds from issuance of senior unsecured notes, net | 0 | 0 | 492,500,000
Proceeds from issuance of senior secured notes, net | 750,001,000 | 0 | 0
Proceeds from borrowings on secured credit facility | 0 | 0 | 800,000,000
Repayments of borrowings on secured credit facility | (700,000,000) | (100,000,000) | 0
Redemption of senior unsecured notes | (250,000,000) | (500,000,000) | (300,000,000)
Repayment of term loan | 0 | 0 | (200,000,000)
Repayment of other debt | (17,049,000) | (39,067,000) | (3,159,000)
Loss on early extinguishment of debt settled in cash | (978,000) | (24,375,000) | 0
Payment of debt issuance costs | (21,699,000) | (2,817,000) | (10,347,000)
Repurchase of common shares | (393,000) | (171,000) | (383,000)
Distributions to noncontrolling interest | 0 | 0 | (22,348,000)
Distributions to shareholders | (9,595,000) | (9,568,000) | (9,540,000)
Net cash (used in) provided by financing activities | (249,713,000) | (675,998,000) | 746,723,000
(Decrease) increase in cash and cash equivalents and restricted cash | (441,341,000) | (328,643,000) | 926,096,000
Cash and cash equivalents and restricted cash at beginning of period | 688,302,000 | 1,016,945,000 | 90,849,000
Cash and cash equivalents and restricted cash at end of period | $ 246,961,000 | $ 688,302,000 | $ 1,016,945,000

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