Per Share Net Income of $0.34 and Normalized FFO of $0.47 in Fourth Quarter

Robust Double-Digit Growth in Full-Year Net Income, NFFO and AFFO per Share

$3.9 Billion of Investments Completed in 2021

Medical Properties Trust, Inc. (the “Company” or “MPT”) (NYSE: MPW) today announced financial and operating results for the fourth quarter and full-year ended December 31, 2021, as well as certain events occurring subsequent to quarter end.

• Net income of $0.34 and Normalized Funds from Operations (“NFFO”) of $0.47 for the 2021 fourth quarter and net income of $1.11 and NFFO of $1.75 for the full-year 2021, all on a per diluted share basis;
• Acquired in early December for an incremental investment of approximately €46 million the 50% interest formerly owned by MPT’s joint venture partner in a general acute hospital operated by IMED Hospitales in Valencia, Spain;
• Completed in December the previously announced $135 million sale of Capital Medical Center in Olympia, WA, as well as $46 million of other property dispositions, for an aggregate real estate gain of nearly $44 million;
• Commenced in the fourth quarter the construction of a replacement hospital for Steward Health Care System’s (“Steward”) Wadley Regional Medical Center in Texarkana, TX for a total expected investment of roughly $169 million;
• Agreed in February to sell a 99-bed general acute care hospital in Dodge City, Kansas for $63 million;
• Previously announced partnership transaction with Macquarie Infrastructure Partners V (“MIP V”) related to eight Steward-operated hospitals in Massachusetts expected to close by the end of the first quarter;
• Previously announced lease agreement with HCA Healthcare for five Utah hospitals currently operated by Steward expected to close in the first half of 2022; and
• Hospital tenants uniformly reporting continued strong operating and financial performance.

“2021 was truly a signature year for MPT, made possible through the tenacity, dedication, and foresight of our people and the innovative culture we have built which are all evidenced in so many of our accomplishments,” said Edward K. Aldag, Jr., Chairman, President, and Chief Executive Officer. “We achieved far broader recognition of our U.S. hospitals as essential community infrastructure after nearly 20 years of acting on that core belief, made new investments in hospitals in urban Los Angeles and South Florida where our operators are making important new investments to raise the bar for patient care, and established crucial footholds in the accelerating inpatient behavioral hospital segment.”

Mr. Aldag continued, “We enter 2022 with tremendous confidence in our operators, expected transactions that will result in our most diversified portfolio ever, a robust pipeline of new opportunities, and an expanding array of attractive funding options.”

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 fourth quarter, MPT continued to execute on its expansive growth pipeline while considering several funding options that are expected to achieve accretive spreads while normalizing leverage.

MPT invested €46 million in the fourth quarter to acquire its partner’s interest in IMED Valencia at a yield enhanced by MPT’s internalization of management responsibilities. The facility is a state-of-the-art private hospital in Valencia, Spain for which MPT made an initial unconsolidated investment in September of 2015. The role of private hospital operators is expanding throughout Spain, and MPT is excited to increase its presence.

Also in the fourth quarter, construction began on a replacement hospital for Steward’s existing Wadley Medical Center in Texarkana, TX, a facility in which MPT has no investment interest. MPT’s total investment in the new facility is anticipated to be $169 million, and construction is expected to be completed in 2024. The state-of-the-art, approximately 120-bed facility will be located at a separate location from Steward’s existing hospital in downtown Texarkana and will significantly expand the array of services provided to the community.

In the fourth quarter, MPT completed the previously announced sale of Capital Medical Center in Olympia, WA for $135 million, solidifying both a mid-teens internal rate of return and a real estate gain of roughly $33 million. The Company also sold one inpatient rehabilitation property in Fort Lauderdale and five vacant freestanding emergency department facilities for combined proceeds of $46 million and an aggregate real estate gain of approximately $11 million.

In addition, MPT agreed in February to sell Western Plains Medical Complex in Dodge City, KS, operated by LifePoint Health, for approximately $63 million and expects to recognize a real estate gain in excess of $7 million.

The Company has total pro forma gross assets of approximately $22.3 billion, including $16.2 billion in general acute care hospitals, $2.6 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 53 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 fourth quarter and year ended December 31, 2021 was $207 million ($0.34 per diluted share) and $656 million ($1.11 per diluted share), respectively, compared to $110 million ($0.20 per diluted share) and $431 million ($0.81 per diluted share) in the year earlier periods.

NFFO for the fourth quarter and year ended December 31, 2021 was $279 million ($0.47 per diluted share) and $1,036 million ($1.75 per diluted share), respectively, compared to $220 million ($0.41 per diluted share) and $831 million ($1.57 per diluted share) in the year earlier periods.

Based on year-to-date transactions, along with an assumed capital structure pro forma for the completion of the partnership with Macquarie and other 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 fourth quarter, are the impact of CPI-based rent escalators, timing adjustments related to investment and capital markets transactions closed during and/or subsequent to the quarter, the impact of MPT’s binding agreement to execute the partnership with MIP V, and the aggregate future earnings contribution from hospitals under development and various expansion projects where rent has not yet commenced.

These estimates do not include the effects, among others, 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, February 3, 2022 at 11:00 a.m. Eastern Time to present the Company’s financial and operating results for the quarter and year ended December 31, 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 2415467. 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 February 17, 2022 using dial-in numbers 855-859-2056 and 404-537-3406 for U.S. and International callers, respectively, and passcode 2415467. 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; (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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