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HealthcarePractice Group Medical Office Report

San Diego County

Q22017

Kelly Moriarty Associate 858-410-6359 [email protected]

Paul Braun Managing Director 858-410-6388 [email protected]

Chris Ross Senior Vice President 858-410-6377 [email protected]

JLL Healthcare Practice Group

Healthcare Real Estate Advisory | San Diego

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sdmedicalrealestate.com

If there is one word to describe the current state of the San Diego healthcare real estate market and its growth, it is steady. Large lease and build-to-suit transactions have been limited of late, as most of the large healthcare providers have already established regional ambulatory centers in most areas of the county, and nearly all of the new medical buildings being constructed on hospital campuses are projects that health systems are developing themselves. Most of the leasing activity is coming from 3- to 6-physician practices as a higher percentage of doctors coming out of school or residency are either joining large systems or existing practices.

These group practices are also more stable than smaller practices. If one doctor leaves the group unexpectedly or some other event occurs that affects revenues, the profitability of the practice is not as severely impacted since the overhead of the office can likely be sustained across the rest of the group until another provider is brought into the practice. This allows these physician groups to structure more favorable lease transactions as it is easier for them to sign long-term leases, which generally come with slightly lower rental rates and much larger tenant improvement allowances and concession packages. There are also more building purchase opportunities in this size range (±4,000-15,000 SF) – albeit still very limited – than there are for smaller offices.

The San Diego County medical office market saw net absorption of 106,986 SF over the past 12 months. At just 0.86% of the market’s total rentable building area, this is somewhat of an underwhelming number; however it represents approximately 10% of the county’s available space being absorbed, and overall vacancy is now down to 6.8%. Direct vacancy rates for higher-quality medical office buildings remain particularly low, with Class A at 5.3% and Class B at 7.7% – having dropped significantly from peak recession figures of 33.3% for Class A and 13.7% for Class B.

This fact that may surprise you: the four submarkets with the lowest vacancy rates are Kearny Mesa (4.1%), East County (5.0%), South County (5.7%) and Uptown/Hillcrest (6.2%). This is mainly due to next to nil development of multi-tenant medical office product in these communities over the past ten years.

The average asking rental rate in San Diego County has been pushed to $3.23 per square foot on a full service gross basis, up from $3.08 in Q2 2016 – a 4.9% increase over a 12-month period. This rising tide is even more pronounced in Class A and B buildings, which boast average asking rents of $4.13 and $3.63 PSF, respectively.

Market conditions and trends

The San Diego medical office market continues to exhibit solid growth.


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Health systems and multi-physician practices will continue to drive real estate activity throughout the San Diego region to keep pace with the strong local and national economy and the growth in demand for healthcare services. With quality Class A space so difficult to find, the Class B inventory has been riding the coattails, with more leasing activity and increased rents. Unless medical office development starts accelerating unexpectedly, this trend will only continue, and better located Class C buildings should see a similar “waterfall” effect over the next 12-24 months.

Escondido/San Marcos: Escondido is perhaps the most difficult-to-assess submarket in the county. JRMC’s development next to the new hospital has just broken ground (Phase 1: 75,000 SF), but will local physicians pay top-dollar rates for a brand new on-campus building in this seemingly rent-sensitive submarket? Most physicians may continue to either hunker down in their lower-rent buildings downtown or opt for an economical lease or purchase at Nordahl Medical Centre as several practices have done recently, which has contributed toward the area’s decline in vacancy from 13.7% to 11.1% over the past 12 months.

Forecast Submarkets Tips and Trends

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6.8%Countywide direct vacancy

106,98612-month net absorption (s.f.) -57,142 s.f. (Q2 2017)

4.9%12-month rent growth $3.23 FS Average Asking

Think Medical \ Millenia Office \ Chesnut Properties

Supply SF

Total availability SF / %

Direct vacancy rate %

Under construction SF

Quarterly leasing SF

2017 net absorption SF

12-mo. rent % change %

Average asking rent $3.23 FS

Key market indicators

Dem

and

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Last Qtr 12-MonthChange Forecast

Net absorption vs. direct vacancy

San Diego Medical Office Overview | Q2 2017

$4.13

$3.63

$2.75

$3.00

$3.25

$3.50

$3.75

$4.00

$4.25

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Q2 2017

Class A Direct Asking Rent Class B Direct Asking Rent

Class A and B direct asking rents*

*Asking rents weighted by available sf and grossed to FSG

0%

2%

4%

6%

8%

10%

12%

14%

16%

-200,000

-100,000

0

100,000

200,000

300,000

400,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 YTD 2017

Net absorption Direct Vacancy

Class A and B direct vacancy rates

(#%)

*#*)

-5%

5%

15%

25%

35%

20062007200820092010201120122013201420152016 Q2 2017

Class A Direct Vacancy Class B Direct Vacancy

Vacancy rates- By submarket

9.6%11.1%

6.8%

10.7%

7.0%

4.1%

6.2%5.0%

5.7%4.5%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

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Direct asking rental rates- By submarket

$2.74 $2.83

$4.15

$3.25

$3.98 $3.95

$2.80 $2.30

$3.02 $2.75

$0.00$0.50$1.00$1.50$2.00$2.50$3.00$3.50$4.00$4.50

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Net Absorption vs. Direct Vacancy

Supply SF









Dem

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Supp

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$4.13

$3.63

$2.75

$3.00

$3.25

$3.50

$3.75

$4.00

$4.25

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Q2 2017




0%

2%

4%

6%

8%

10%

12%

14%

16%

-200,000

-100,000

0

100,000

200,000

300,000

400,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 YTD 2017



(#%)

*#*)

-5%

5%

15%

25%

35%

20062007200820092010201120122013201420152016 Q2 2017



9.6%11.1%

6.8%

10.7%

7.0%

4.1%

6.2%5.0%

5.7%4.5%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

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$2.74 $2.83

$4.15

$3.25

$3.98 $3.95

$2.80 $2.30

$3.02 $2.75

$0.00$0.50$1.00$1.50$2.00$2.50$3.00$3.50$4.00$4.50

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Class A and B Direct Asking Rents*


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4.9%

Oceanside / Vista: Tri-City’s 60,000-SF outpatient building remains the big question mark as it has now been in various stages of limbo for 5+ years and no one seems to know when the litigation will ever reach the finish line. The submarket finally dipped into single-digit vacancy, which is incredibly impressive given the fact that 473,000 square feet was delivered in this relatively small service area between 2007 and 2013, a 95% increase in total inventory. What may be even more impressive is this: of the 473,000 square feet, only 20,000 SF remains available (excluding any that may come to market once Tri-City’s building is cleared); and with the exception of the Tri-City

MOB, none of these new buildings are on campus or even walking distance from campus.

North County Coastal: The recently completed North Coast Medical Plaza (still offering competitive deals on their remaining vacancy) and the three new proposed medical buildings in Encinitas and Carlsbad – which total approximately 125,000 SF – are the only buildings providing some potential relief from the otherwise tightening availability and upward pressure on rents across Coastal North County. The bar has been raised and everything of good quality is now over $3.00 NNN, with a few buildings pushing north of $4.00 NNN. It remains the higest rent submarket in the county, and its vacancy rate is equal to the countywide average of 6.8%.

I-15 corridor: I-15 vacancy has sharply risen from 5.6% to 10.7% over the past 12 months, but the numbers are deceiving – this submarket remains extremely tight. Over half of the current vacancy came from Sharp Rees-Stealy’s former 57,000-SF building on Via Tazon when they expanded and relocated to their new 100,000-SF building on West Bernardo Drive. Should the Via Tazon building be absorbed by another medical group or be converted to an office building, I-15 vacancy would be sitting at approximately 4.9%, second lowest of any submarket in the county. The area’s weighted average asking rate is also being affected by this building. In reality, I-15 rental rates are still steadily increasing.

La Jolla / UTC / Sorrento: Imagine two submarkets. One gave back 16,000 SF of space in the 2nd quarter and 56,000 SF over the past 12 months. It has six buildings with over 12,000 SF of space on the market, and its vacancy rate climbed from 4.7% to 7.0% over the past year. The other submarket boasts a nearly 15% climb in its average asking rent since the 2nd quarter of last year, has not seen a medical tenant

Supply SF









Dem

and

Pric

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Supp

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$4.13

$3.63

$2.75

$3.00

$3.25

$3.50

$3.75

$4.00

$4.25

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Q2 2017




0%

2%

4%

6%

8%

10%

12%

14%

16%

-200,000

-100,000

0

100,000

200,000

300,000

400,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 YTD 2017



(#%)

*#*)

-5%

5%

15%

25%

35%

20062007200820092010201120122013201420152016 Q2 2017



9.6%11.1%

6.8%

10.7%

7.0%

4.1%

6.2%5.0%

5.7%4.5%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

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$2.74 $2.83

$4.15

$3.25

$3.98 $3.95

$2.80 $2.30

$3.02 $2.75

$0.00$0.50$1.00$1.50$2.00$2.50$3.00$3.50$4.00$4.50

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Vacancy Rates - By Submarket

Supply SF









Dem

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$4.13

$3.63

$2.75

$3.00

$3.25

$3.50

$3.75

$4.00

$4.25

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Q2 2017




0%

2%

4%

6%

8%

10%

12%

14%

16%

-200,000

-100,000

0

100,000

200,000

300,000

400,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 YTD 2017



(#%)

*#*)

-5%

5%

15%

25%

35%

20062007200820092010201120122013201420152016 Q2 2017



9.6%11.1%

6.8%

10.7%

7.0%

4.1%

6.2%5.0%

5.7%4.5%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

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$2.74 $2.83

$4.15

$3.25

$3.98 $3.95

$2.80 $2.30

$3.02 $2.75

$0.00$0.50$1.00$1.50$2.00$2.50$3.00$3.50$4.00$4.50

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Direct Asking Rental Rates - By Submarket vacate the area during that time, and has a limited amount of Class A space available.

The two submarkets are one and the same: UTC. The spike in vacancy mentioned above came from PRA (an office/non-medical tenant) consolidating out of 27,000 SF at University Pacific Centre and UCSD relocating about 43,000 of office and research functions out of The Campus on Villa La Jolla (formerly known as La Jolla Village Professional Center) to the new ACTRI research building on UCSD’s east campus. This submarket is still going strong.

Kearny Mesa / Mission Valley: Most submarkets across California that have multiple high-grade hospitals are performing well in the medical office sector. Kearny Mesa has been no exception. Another 18,000 square feet of vacancy (nearly 25% of the total available space) was absorbed over the past 12 months, and the vacancy rate is now at 4.1%, lowest in the county. Most of that absorption came from Genesis Healthcare Partners’ and Dr. Michael Lenihan’s JV acquisition of Coast Medical Center on Kearny Villa Road and Genesis’ subsequent consolidation of several clinical and administrative functions into the building. Three buildings – the three largest MOBs in the submarket, all on Frost Street – contain 40,000

of the approximately 60,000 square feet of vacancy on the market. Owners in the area may not always feel that things are this tight since there are a few mixed office/medical buildings to which a handful of physician practices have relocated, but the true non-mixed medical buildings as a whole are experiencing strong occupancy and rent growth.

Uptown / Hillcrest: The Hillcrest submarket has been relatively quiet of late. Net absorption has been substantially flat over the past quarter and year. About 6,000 SF was absorbed during the past 12 months, bringing vacancy down 60 basis points to 6.2%, just below the county average. The weighted average asking rent ticked up slightly from $2.77 to $2.80. Most of the area’s vacancy currently lies within Mercy Medical Building (4060 4th Ave) and Hillcrest Medical Centre (4033 3rd Ave). Being two of the better located buildings in Hillcrest, this vacancy will likely not remain on the market for very long, and we may see vacancy approach the 4% mark like neighboring submarket Kearny Mesa.

East County: Two years ago, you could hear a pin drop in East County. In 2015 it went the entire calendar year without a new lease signed

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Direct Asking Rental Rates - By Submarket

93.5%Average occupancy

6.6%Average cap rate

$168MTotal sales volume

over 3,500 SF, and vacancy was just shy of 10%. If you had said that by 2017 it would have the second lowest vacancy in the county, no one would have believed you. It has now posted eight straight quarters of declining vacancy, with much of the rising occupancy coming from modest expansion of existing physician groups. Opposite the trend we are seeing in most areas of the county, most of the spaces leased in East County during the past 12 months have been between 1,000 and 2,500 SF.

South County: The South County submarket saw positive net absorption both in the second quarter (3,691 SF) and in aggregate over the past 12 months (9,513 SF). Current direct vacancy of 82,000 SF seems like a substantial amount of space for this submarket to absorb, but the buildings housing most of the vacancy are generally spread out across Chula Vista, Eastlake and Bonita; and at 5.7% vacancy it is over 100 basis points below the 6.8% countywide average. Rents ticked up from $2.95 to $3.02 on a full service basis, a result of the tightening vacancy. South County has not been as high of a priority in terms of capital investment from the larger health systems in the region, but it will be interesting to see how that evolves as the area’s population and its insurance coverage continue to expand.

News and updates

Kaiser Permanente San Diego Medical Center opened its doors and began admitting patients on April 25, ahead of schedule and under budget

at $850M. The new 617,215 square-foot hospital is certified as LEED Platinum and considered one of the most technologically advanced medical centers in the world. The hospital capacity is currently 321 beds, with the ability to expand to 461 beds with future development.

Qualcomm Inc. has partnered with Scripps Health to offer its employees and their dependents a custom health plan under the accountable care organization (ACO) model. The option will be available to Qualcomm employees starting in 2018.


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San Diego County MOB Sales - Last 12 Months


Total inventory (sf)

Q2 2017total net

absorption (sf)

12-month total net absorption (% of inventory)

Q2 2017 direct vacancy (sf)

Q2 2017 direct vacancy (%)

Q2 2016 direct vacancy (%)

Q2 2017 average asking

rent * ($ psf)

Q2 2016 average asking

rent * ($psf)

Oceanside/Vista 972,226 2,084 2.2% 93,139 9.6% 11.7% $2.74 $2.69

Escondido/San Marcos 902,283 -3,421 1.6% 100,413 11.1% 13.7% $2.83 $2.88

North County Coastal 1,411,428 -12,373 1.4% 95,696 6.8% 5.8% $4.15 $4.29

I-15 Corridor 983,466 -51,694 4.8% 105,326 10.7% 5.6% $3.25 $3.40

La Jolla/UTC/Sorrento 1,991,640 -15,988 -2.8% 138,541 7.0% 4.7% $3.98 $3.47

Kearny Mesa/ Mission Valley

1,462,243 6,562 1.3% 59,510 4.1% 5.3% $3.95 $3.30

Uptown/Hillcrest 968,556 1,064 0.6% 60,076 6.2% 6.8% $2.80 $2.77

East County 1,806,037 21,673 2.2% 89,956 5.0% 7.1% $2.30 $2.53

South County 1,445,994 3,691 0.7% 82,486 5.7% 6.4% $3.02 $2.95

Other 525,358 -8,740 -2.6% 23,877 4.5% 2.2% $2.75 $2.45

Market Totals 12,469,231 -57,142 0.9% 849,020 6.8% 6.8% $3.23 $3.08

* Asking rents weighted by available sf and grossed to FSG

Investment Sales Spotlight

A significant changing of the guard is taking place in San Diego. Ten years ago, there were only three or four MOB owners that were institutional, multi-market players who specialized in healthcare. PMB, HCP and Montecito come to mind. Even as recently as 2015, there was still a very limited amount of such institutional capital in town.

Today at least a dozen of these firms own healthcare real estate in San Diego County. Welltower, Ventas, CNL, Anchor, Carlisle, Northstar, ARC and Virtus have all acquired medical buildings recently, and nearly every other household name wants to join the party. They used to almost exclusively chase on-campus or health-system-anchored buildings, but as more investors entered the space and these core acquisition opportunities dried up, they all began chasing offerings in the next tier of MOBs: well-located off-campus properties, primarily in suburban markets where health systems and physicians are looking to provide better access to patients.

Given the number of these properties that have been developed over the past 10-12 years – most of which by local and regional developers that aren’t necessarily long-term holders – more of these properties are hitting the market than ever before, which is contributing to the changing landscape of owner profiles.

The combination of the influx of offerings, unprecedented demand for these properties and the sheer number of deep-pocket buyers hawking the San Diego market has resulted in the most consistently high annual sales volumes that San Diego has ever seen. Over the past 12 months there have been 13 sales over 10,000 SF totaling $168M. Total square footage sold: 348,000 square feet. Averages for these buildings were a 6.6% cap rate, $432/SF and 93.5% occupancy. 2017 will likely come to a close with record-setting metrics across the board in volume, cap rate and price-per-square-foot. With strong market fundamentals in this sector, both sellers and buyers are winning: it is a great time to sell healthcare property, but it is also a great time to own it.

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Tenant Use Primary Care Neurology Plastic Surgery Dentistry

Address 326 S. Melrose DrVista

3750 Convoy StKearny Mesa

3144 El Camino RealCarlsbad

3257 Camino de Los Coches, Carlsbad

Class A B A A

SF 7,998 4,948 1,571 2,460

Term 120 90 63 120

Start Rate $2.04 NNN $2.45 MG $3.00 NNN $3.30 NNN

Execution Date 04/26/2017 04/04/2017 05/26/2017 04/11/2017

Increase stepped 3% 3% 0%

Free Rent 0 months 6 months 3 months 0 months

TIA/SF $47.32 $50.00 $0 $0

Type New lease New lease New Lease Renewal

Recently completed lease transactions


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Project Address Buyer/Seller SF Price/Sale Date Cap Rate Leased at TOS

Price per SF

4765 Carmel Valley RdCarmel Valley

B: T orrey Hills MOB, LLCS: Torrey Pines Enterprises, LLC

44,156 $28,500,00006/13/2017

6.2% 92% $645

6010 Hidden Valley RdCarlsbad

B: Montecito Medical Real Estate/Heitman JV S: SSGTH LLC

49,580 $30,050,00004/19/2017

5.4% 96% $606

955 Lane AvenueChula Vista

B: AHP Aquistions, LLCS: Doctors Development Group LLC

21,500 $10,300,00003/02/2017

6.3% 100% $479

16899 W Bernardo DrSan Diego

B: Sharp HealthcareS: Rancho Bernardo LHP, LLC

100,000 $42,662,500*02/21/2017

owner- user

100% $427

Recently completed sale transactions

*Sale transaction was the result of a BTS lease with an option to purchase at cost + percentage deal structure.

I-15CORRIDOR

ESCONDIDOSAN MARCOS

OCEANSIDEVISTA

UTCSORRENTO MESA

LA JOLLA

KEARNY MESAMISSION VALLEY

OTHER

UPTOWNHILLCREST

EASTCOUNTY

SOUTH COUNTY

MEXICO

NORTH COUNTYCOASTAL

52

56

78

163

54

94

125

125

15

15

15

8

805

67

15

INTENATIONAL BORDERUSA

SUBMARKET AND HOSPITAL LOCATIONS

Scripps Memorial Hospital EncinitasScripps Green HospitalScripps Memorial Hospital La Jolla/Prebys Cardiovascular InstituteScripps Mercy Hospital San DiegoScripps Mercy Hospital Chula Vista

Sharp Memorial Hospital/Sharp Mary Birch HospitalSharp Grossmont HospitalSharp Coronado HospitalSharp Chula Vista Medical Center

Jacobs Medical CenterUC San Diego Medical Center

Palomar Medical Center Downtown EscondidoPalomar Medical Center EscondidoPalomar Medical Center Poway / Pomerado Outpatient Pavilion

Rady Children’s Hospital

21

22

19

18

Alvarado Hospital Medical CenterParadise Valley Hospital

Tri-City Medical Center

Kaiser Permanente Zion Medical CenterKaiser Permanente San Diego Medical Center

VA San Diego Healthcare System

Naval Medical Center San Diego

20

18

21

19

22

20


I-15CORRIDOR

ESCONDIDOSAN MARCOS

OCEANSIDEVISTA

UTCSORRENTO MESA

LA JOLLA

KEARNY MESAMISSION VALLEY

OTHER

UPTOWNHILLCREST

EASTCOUNTY

SOUTH COUNTY

MEXICO

NORTH COUNTYCOASTAL

52

56

78

163

54

94

125

125

15

15

15

8

805

67

15

INTENATIONAL BORDERUSA


Scripps Memorial Hospital EncinitasScripps Green HospitalScripps Memorial Hospital La Jolla/Prebys Cardiovascular InstituteScripps Mercy Hospital San DiegoScripps Mercy Hospital Chula Vista

Sharp Memorial Hospital/Sharp Mary Birch HospitalSharp Grossmont HospitalSharp Coronado HospitalSharp Chula Vista Medical Center

Jacobs Medical CenterUC San Diego Medical Center

Palomar Medical Center Downtown EscondidoPalomar Medical Center EscondidoPalomar Medical Center Poway / Pomerado Outpatient Pavilion

Rady Children’s Hospital

21

22

19

18

Alvarado Hospital Medical CenterParadise Valley Hospital

Tri-City Medical Center

Kaiser Permanente Zion Medical CenterKaiser Permanente San Diego Medical Center

VA San Diego Healthcare System

Naval Medical Center San Diego

20

18

21

19

22

20


JLL Healthcare Practice Group Healthcare Real Estate Advisory | San Diego

The JLL Healthcare Practice Group is San Diego’s leading team in healthcare real estate. With more than 35 years of combined industry experience, we specialize exclusively in local medical office properties and clients.

Expertise. Integrity.Our clients benefit from access to our unique market intel and expertise, giving them a distinct advantage in the marketplace. Our team delivers comprehensive solutions and seamless transactions to grow your practice, system or investment. Our services include:

Physicians and medical groups | Sales, leases, renewals, investments

Hospitals and health systems | Strategic consulting, transactional advisory services, portfolio optimization

Dental practices | Purchases and leases, practice sales, unique opportunities

Developers and investors | Development and asset advisory, leasing, acquisitions and dispositions

Hospitals

Health systems

Academic medical centers

Medical office buildings

Surgery centers

Large physician practices

Public institutions

Sole Practitioners

Dental Practices

JLL Expertise

Kelly Moriarty Associate 858.410.6359 [email protected] Lic. No. 01963162

Paul Braun Managing Director 858.410.6388 [email protected] Lic. No. 00891709

Chris Ross Senior Vice President 858.410.6377 [email protected] Lic. No. 01469025

About JLL

JLL is a leading professional services firm that specializes in real estate and investment management. A Fortune 500 company, JLL helps real estate owners, occupiers and investors achieve their business ambitions. More than 77,000 employees serve clients in 80 countries from 300 corporate offices. JLL stock is traded on the New York Stock Exchange, and the company’s market cap was $5.42 billion in Q1 2016. The company has acquired more than 80 companies worldwide since 2005, including 28 strategic acquisitions in 2016, eight of which were in the United States. JLL’s issuer and senior unsecured ratings from both S&P (BBB+) and Moody’s Investors Service (Baa2) are solid investment-grade ratings, reflecting the firm’s consistent financial strength and positioning it for future growth. JLL achieved record revenue and profitability in 2016 with $5.8 billion in annual gross revenue. JLL is the brand name, and a registered trademark, of Jones Lang LaSalle Incorporated. For further information, visit www.jll.com.


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