Per Share Net Income of $0.29 and Normalized FFO of $0.44 in Third Quarter

Double-Digit Per Share NFFO and AFFO Growth Year-to-Date in 2021 Versus Prior-Year Period

Announced Transactions Expected to Provide $1.5 Billion in Capital and Reduce Leverage

Medical Properties Trust, Inc. (the “Company” or “MPT”) (NYSE: MPW) today announced financial and operating results for the third quarter ended September 30, 2021, as well as certain events occurring subsequent to quarter end.

• Net income of $0.29 and Normalized Funds from Operations (“NFFO”) of $0.44 for the 2021 third quarter on a per diluted share basis, in line with portfolio run-rate guidance;
• Completed in early August the previously announced sale-leaseback transaction totaling $900 million for five general acute hospitals in South Florida leased to Steward Health Care System (“Steward”);
• In late October:
  • Completed the previously announced $760 million sale-leaseback transaction for 18 inpatient behavioral health hospital facilities operated by Springstone, LLC (“Springstone”), as well as a $190 million investment in the operating company;
  • Acquired an €18 million cancer treatment and diagnostics center near Porto, Portugal operated by an affiliate of Atrys Health;
  • Completed the sales of the Company’s equity interest in the operations of German acute hospital operator ATOS Clinics International and separately of its equity interest in the operations of German post-acute operator MEDIAN Kliniken, both for strong double-digit internal rates of return, further validating MPT’s investing strategies;
  • Received full repayment of a short-term £250 million bridge loan extended to the buyer of Priory Group (“Priory”) in January;
• Previously announced agreements and capital markets activity:
  • Announced in early September a partnership agreement with Macquarie Infrastructure Partners V (“MIP V”) to own a portfolio of eight Massachusetts-based general acute care hospitals currently owned by MPT and operated by Steward;
  • Announced in mid-September an agreement to lease five Utah general acute care hospitals to HCA Healthcare (“HCA”);
  • Priced in late September €500 million 0.993% senior unsecured notes due 2026 and fully redeemed all outstanding 4.000% senior unsecured notes due 2022;
• Hospital tenants uniformly reporting continued strong operating and financial performance.

“We are delighted to see value creation recognized in our strong portfolio through the recent transactions in Massachusetts and Utah, as well as in Steward as a preeminent operator,” said Edward K. Aldag, Jr., Chairman, President, and Chief Executive Officer. “As I always say, our hospitals are a part of the infrastructure in their communities, but the real importance is in the value of our demonstrated ability to identify and underwrite the full potential of both individual hospitals and regional portfolios.”

Mr. Aldag continued, “We manage our business for long-term shareholder returns, supported by both a dividend well-covered by lease payments from our tenants and consistent growth in per share AFFO, while staying within certain long-term balance sheet parameters. Our shareholders should expect nothing different from us going forward, and we have never felt better about our range of attractive capital options and investment opportunities than we do today.”

Included in the financial tables accompanying this press release is information about the Company’s assets and liabilities, net income, and reconciliations of net income to NFFO, all on a basis comparable to 2020 results, and reconciliations of total assets to total pro forma gross assets and total revenues to total adjusted revenues.

PORTFOLIO UPDATE

During and subsequent to the third quarter, MPT continued to make accretive investments while taking advantage of private capital demand for hospital real estate to realize value creation from within its portfolio.

As described in more detail in the Company’s September 1, 2021 press release, MPT has entered into an agreement with MIP V, an Americas-focused $6.9 billion unlisted infrastructure fund managed by Macquarie Asset Management (“MAM”), pursuant to which a MIP V controlled subsidiary will acquire a 50% interest in a portfolio of eight Massachusetts-based general acute care hospitals currently owned by MPT and operated by Steward. The transaction values the real estate at $1.78 billion based on a 5.6% cash cap rate, a 48% increase versus MPT’s initial cost basis in 2016, and is expected to result in up to $1.3 billion in proceeds to MPT, including new secured debt on the currently unencumbered properties. This transaction, in addition to illustrating growing demand from sophisticated institutional investors for hospital real estate, will reduce MPT’s leverage, provide an attractive cost of equity capital to fund previously announced investments, and contribute to overall portfolio diversification.

In addition, as further depicted in the Company’s September 20, 2021 press release, MPT has entered into an agreement to lease five of its Utah hospitals to HCA with no change to the amount of cash rent currently being collected from current operator Steward. The new 15-year master lease will include five extension options of five years each, cash rental payments increasing at CPI within a collared range of 2.0% to 5.0%, and certain options allowing HCA to purchase the facilities beginning in 2028 or for MPT to sell the facilities to HCA. HCA will become one of MPT’s top-five tenants when the transaction closes in the first half of 2022. Proceeds from the sale will provide Steward with meaningful new liquidity to pursue strategic reinvestment initiatives.

The Company has total pro forma gross assets of approximately $22.1 billion, including $15.9 billion in general acute care hospitals, $2.4 billion in behavioral health facilities, $2.1 billion in inpatient rehabilitation hospitals, $0.3 billion in long-term acute care hospitals, and $0.3 billion in freestanding emergency room and urgent care properties. MPT’s portfolio, pro forma for the transactions described herein, includes roughly 440 properties and 46,000 licensed beds across the United States and in Germany, the United Kingdom, Switzerland, Italy, Spain, Portugal, Australia, and Colombia. The properties are leased to or mortgaged by 52 hospital operating companies. MPT continues to work with existing and new operators in the U.S. and abroad on numerous opportunities.

OPERATING RESULTS AND OUTLOOK

Net income for the third quarter ended September 30, 2021 was $171 million (or $0.29 per diluted share) compared to $131 million (or $0.25 per diluted share) in the year earlier period.

NFFO for the third quarter ended September 30, 2021 was $263 million ($0.44 per diluted share) compared to $221 million ($0.41 per diluted share) in the year earlier period.

Based on year-to-date transactions, along with an assumed capital structure pro forma for the completion of the partnership with Macquarie and no additional debt or equity transactions (resulting in a net debt to EBITDA ratio of approximately 6.0 times), MPT expects an annual run-rate of $1.16 to $1.20 per diluted share for net income and $1.81 to $1.85 per diluted share for NFFO. Included in the annual run-rate estimate, but not fully included in the actual results for the third quarter, are timing adjustments related to investment and capital markets transactions closed during and subsequent to the quarter, the impact of MPT’s binding agreement to execute the partnership, and the aggregate future earnings contribution from two hospitals under development and various expansion projects where rent has not yet commenced.

These estimates do not include the effects, if any, of unexpected real estate operating costs, changes in accounting pronouncements, litigation costs, debt refinancing costs, acquisition costs, currency exchange rate movements, changes in income tax rates, interest rate hedging activities, write-offs of straight-line rent or other non-recurring or unplanned transactions. Moreover, these estimates do not provide for the impact on MPT or its tenants and borrowers from the global COVID-19 pandemic. These estimates may change if the Company acquires or sells assets in amounts that are different from estimates, market interest rates change, debt is refinanced, new shares are issued, additional debt is incurred, other operating expenses vary, income from equity investments vary from expectations, or existing leases or loans do not perform in accordance with their terms.

CONFERENCE CALL AND WEBCAST

The Company has scheduled a conference call and webcast for Thursday, October 28, 2021 at 11:00 a.m. Eastern Time to present the Company’s financial and operating results for the quarter ended September 30, 2021. The dial-in numbers for the conference call are 844-535-3969 (U.S. and Canada) and 409-937-8903 (International); both numbers require passcode 8966934. The conference call will also be available via webcast in the Investor Relations section of the Company’s website, www.medicalpropertiestrust.com.

A telephone and webcast replay of the call will be available beginning shortly after the call’s completion. The telephone replay will be available through November 11, 2021 using dial-in numbers 855-859-2056 and 404-537-3406 for U.S. and International callers, respectively, and passcode 8966934. The webcast replay will be available for one year following the call’s completion on the Investor Relations section of the company’s website.

The Company’s supplemental information package for the current period will also be available on the Company’s website in the Investor Relations section.

The Company uses, and intends to continue to use, the Investor Relations page of its website, which can be found at www.medicalpropertiestrust.com, as a means of disclosing material nonpublic information and of complying with its disclosure obligations under Regulation FD, including, without limitation, through the posting of investor presentations that may include material nonpublic information. Accordingly, investors should monitor the Investor Relations page, in addition to following our press releases, SEC filings, public conference calls, presentations and webcasts. The information contained on, or that may be accessed through, our website is not incorporated by reference into, and is not a part of, this document.

About Medical Properties Trust, Inc.

Medical Properties Trust, Inc. is a self-advised real estate investment trust formed in 2003 to acquire and develop net-leased hospital facilities. From its inception in Birmingham, Alabama, the Company has grown to become one of the world’s largest owners of hospitals with roughly 440 facilities and 46,000 licensed beds (on a pro forma basis) in nine countries and across four continents. MPT’s financing model facilitates acquisitions and recapitalizations and allows operators of hospitals to unlock the value of their real estate assets to fund facility improvements, technology upgrades and other investments in operations. For more information, please visit the Company’s website at www.medicalpropertiestrust.com.

This press release includes forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. Forward-looking statements can generally be identified by the use of forward-looking words such as “may”, “will”, “would”, “could”, “expect”, “intend”, “plan”, “estimate”, “target”, “anticipate”, “believe”, “objectives”, “outlook”, “guidance” or other similar words, and include statements regarding our strategies, objectives, future expansion and development activities, and expected financial performance. Forward-looking statements involve known and unknown risks and uncertainties that may cause our actual results or future events to differ materially from those expressed in or underlying such forward-looking statements, including, but not limited to: (i) the economic, political and social impact of, and uncertainty relating to, the COVID-19 pandemic, including governmental assistance to hospitals and healthcare providers, including certain of our tenants; (ii) the ability of our tenants, operators and borrowers to satisfy their obligations under their respective contractual arrangements with us, especially as a result of the adverse economic impact of the COVID-19 pandemic, and government regulation of hospitals and healthcare providers in connection with same (as further detailed in our Current Report on Form 8-K filed with the SEC on April 8, 2020); (iii) our expectations regarding annual run-rate net income and NFFO per share; (iv) our success in implementing our business strategy and our ability to identify, underwrite, finance, consummate and integrate acquisitions and investments; (v) the nature and extent of our current and future competition; (vi) macroeconomic conditions, such as a disruption of or lack of access to the capital markets or movements in currency exchange rates; (vii) our ability to obtain debt financing on attractive terms or at all, which may adversely impact our ability to pursue acquisition and development opportunities and pay down, refinance, restructure or extend our indebtedness as it becomes due; (viii) increases in our borrowing costs as a result of changes in interest rates and other factors, including the potential phasing out of LIBOR after 2021; (ix) international, national and local economic, real estate and other market conditions, which may negatively impact, among other things, the financial condition of our tenants, lenders and institutions that hold our cash balances, and may expose us to increased risks of default by these parties; (x) factors affecting the real estate industry generally or the healthcare real estate industry in particular; (xi) our ability to maintain our status as a REIT for federal and state income tax purposes; (xii) federal and state healthcare and other regulatory requirements, as well as those in the foreign jurisdictions where we own properties; (xiii) the value of our real estate assets, which may limit our ability to dispose of assets at attractive prices or obtain or maintain equity or debt financing secured by our properties or on an unsecured basis; (xiv) the ability of our tenants and operators to comply with applicable laws, rules and regulations in the operation of the our properties, to deliver high-quality services, to attract and retain qualified personnel and to attract patients; (xv) potential environmental contingencies and other liabilities; (xvi) the risk that the Steward Massachusetts partnership transaction and unrelated property sales, loan repayments, and other capital recycling transactions do not occur; and (xvii) the risk that the sale by Steward of its Utah operations to HCA does not occur.

The risks described above are not exhaustive and additional factors could adversely affect our business and financial performance, including the risk factors discussed under the section captioned “Risk Factors” in our Annual Report on Form 10-K for the year ended December 31, 2020 and as updated in our quarterly reports on Form 10-Q. Forward-looking statements are inherently uncertain and actual performance or outcomes may vary materially from any forward-looking statements and the assumptions on which those statements are based. Readers are cautioned to not place undue reliance on forward-looking statements as predictions of future events. We disclaim any responsibility to update such forward-looking statements, which speak only as of the date on which they were made.

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