Business Wire | Oct 28, 2021 08:00AM EDT

Medical Properties Trust, Inc. Reports Third Quarter Results

Oct. 28, 2021

BIRMINGHAM, Ala.--(BUSINESS WIRE)--Oct. 28, 2021--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 (euro)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 (euro)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 atwww.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.

MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES Consolidated Balance Sheets(Amounts in thousands, except for per share September 30, December 31,data) 2021 2020Assets (Unaudited) (A)Real estate assetsLand, buildings and improvements, intangible $ 13,244,403 $ 12,078,927 lease assets, and otherInvestment in financing leases 2,042,585 2,010,922

Real estate held for sale 1,096,475 -

Mortgage loans 200,285 248,080

Gross investment in real estate assets 16,583,748 14,337,929

Accumulated depreciation and amortization (936,289 ) (833,529 )

Net investment in real estate assets 15,647,459 13,504,400

Cash and cash equivalents 349,652 549,884

Interest and rent receivables 64,622 46,208

Straight-line rent receivables 661,429 490,462

Equity investments 1,170,171 1,123,623

Other loans 1,502,677 858,368

Other assets 315,977 256,069

Total Assets $ 19,711,987 $ 16,829,014

Liabilities and EquityLiabilitiesDebt, net $ 10,581,023 $ 8,865,458

Accounts payable and accrued expenses 595,003 438,750

Deferred revenue 19,739 36,177

Obligations to tenants and other lease 157,488 144,772 liabilitiesTotal Liabilities 11,353,253 9,485,157

EquityPreferred stock, $0.001 par value. Authorized10,000 shares; no sharesoutstanding - -

Common stock, $0.001 par value. Authorized750,000 shares; issued andoutstanding - 596,145 shares at September 30, 596 541 2021 and 541,419shares at December 31, 2020Additional paid-in capital 8,541,092 7,461,503

Distributions in excess of net income (117,733 ) (71,411 )

Accumulated other comprehensive loss (69,843 ) (51,324 )

Treasury shares, at cost (777 ) (777 )

Total Medical Properties Trust, Inc. 8,353,335 7,338,532 Stockholders' Equity Non-controlling interests 5,399 5,325

Total Equity 8,358,734 7,343,857

Total Liabilities and Equity $ 19,711,987 $ 16,829,014

(A) Financials have been derived from the prior year auditedfinancial statements.MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES

Consolidated Statements of Income

(Unaudited)

(Amounts in thousands, except for per share data)For the Three Months EndedFor the Nine Months EndedSeptember 30, 2021September 30, 2020September 30, 2021September 30, 2020RevenuesRent billed$

242,211

$

192,953

$

672,425

$

538,277

Straight-line rent64,637

51,125

174,975

103,697

Income from financing leases50,667

52,544

151,898

157,469

Interest and other income33,264

32,836

136,038

115,989

Total revenues390,779

329,458

1,135,336

915,432

ExpensesInterest94,132

82,263

273,409

243,538

Real estate depreciation and amortization85,039

69,665

237,050

192,049

Property-related (A)7,128

5,897

31,265

19,178

General and administrative36,694

31,718

107,312

97,121

Total expenses222,993

189,543

649,036

551,886

Other income (expense)Gain (loss) on sale of real estate9,294

(927

)

8,896

(2,703

)

Real estate impairment charges-

-

-

(19,006

)

Earnings from equity interests7,193

5,893

21,633

15,263

Debt refinancing and unutilized financing costs-

-

(2,339

)

(611

)

Other (including mark-to-market adjustments on equity securities)(2,276

)

2,461

4,747

(9,499

)

Total other income (expense)14,211

7,427

32,937

(16,556

)

Income before income tax181,997

147,342

519,237

346,990

Income tax expense(10,602

)

(15,985

)

(69,141

)

(24,824

)

Net income171,395

131,357

450,096

322,166

Net income attributable to non-controlling interests(258

)

(251

)

(611

)

(600

)

Net income attributable to MPT common stockholders$

171,137

$

131,106

$

449,485

$

321,566

Earnings per common share - basic and diluted:Net income attributable to MPT common stockholders$

0.29

$

0.25

$

0.76

$

0.61

Weighted average shares outstanding - basic595,119

531,095

586,291

526,651

Weighted average shares outstanding - diluted597,320

532,436

587,971

527,832

Dividends declared per common share$

0.28

$

0.27

$

0.84

$

0.81

MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES

Consolidated Statements of Income

(Unaudited)

(Amounts in thousands, For the Three Months For the Nine Months Endedexcept for per share data) Ended September September September 30, September 30, 2021 30, 2020 2021 30, 2020 RevenuesRent billed $ 242,211 $ 192,953 $ 672,425 $ 538,277

Straight-line rent 64,637 51,125 174,975 103,697

Income from financing 50,667 52,544 151,898 157,469 leasesInterest and other income 33,264 32,836 136,038 115,989

Total revenues 390,779 329,458 1,135,336 915,432

ExpensesInterest 94,132 82,263 273,409 243,538

Real estate depreciation 85,039 69,665 237,050 192,049 and amortizationProperty-related (A) 7,128 5,897 31,265 19,178

General and administrative 36,694 31,718 107,312 97,121

Total expenses 222,993 189,543 649,036 551,886

Other income (expense)Gain (loss) on sale of 9,294 (927 ) 8,896 (2,703 )real estateReal estate impairment - - - (19,006 )chargesEarnings from equity 7,193 5,893 21,633 15,263 interestsDebt refinancing and - - (2,339 ) (611 )unutilized financing costsOther (including (2,276 ) 2,461 4,747 (9,499 )mark-to-market adjustmentson equity securities)Total other income 14,211 7,427 32,937 (16,556 )(expense) Income before income tax 181,997 147,342 519,237 346,990

Income tax expense (10,602 ) (15,985 ) (69,141 ) (24,824 )

Net income 171,395 131,357 450,096 322,166

Net income attributable to (258 ) (251 ) (611 ) (600 )non-controlling interestsNet income attributable to $ 171,137 $ 131,106 $ 449,485 $ 321,566 MPT common stockholders Earnings per common share- basic and diluted:Net income attributable to $ 0.29 $ 0.25 $ 0.76 $ 0.61 MPT common stockholders Weighted average shares 595,119 531,095 586,291 526,651 outstanding - basicWeighted average shares 597,320 532,436 587,971 527,832 outstanding - diluted Dividends declared per $ 0.28 $ 0.27 $ 0.84 $ 0.81 common share (A) Includes $4.0 million and $23.1 million of ground lease and other expenses (such as property taxes and insurance) paid directly by us and reimbursed by our tenants for the three and nine months ended September 30, 2021, respectively.(A) Includes $4.0 million and $23.1 million of ground lease and other expenses(such as property taxes and insurance) paid directly by us and reimbursed byour tenants for the three and nine months ended September 30, 2021,respectively.MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIESReconciliation of Net Income to Funds From Operations(Unaudited)(Amounts in thousands, except for per share data)For the Three Months EndedFor the Nine Months EndedSeptember 30, 2021September 30, 2020September 30, 2021September 30, 2020FFO information:Net income attributable to MPT common stockholders$

171,137

$

131,106

$

449,485

$

321,566

Participating securities' share in earnings(328

)

(435

)

(1,088

)

(1,386

)

Net income, less participating securities' share in earnings$

170,809

$

130,671

$

448,397

$

320,180

Depreciation and amortization98,492

80,841

277,089

223,166

(Gain) loss on sale of real estate(9,294

)

927

(8,896

)

2,703

Real estate impairment charges-

-

-

19,006

Funds from operations$

260,007

$

212,439

$

716,590

$

565,055

Write-off (recovery) of straight-line rent and other3,650

1,266

(1,601

)

27,098

Non-cash fair value adjustments(819

)

(1,575

)

(2,763

)

9,030

Tax rate and other changes-

8,535

42,746

9,661

Debt refinancing and unutilized financing costs-

-

2,339

611

Normalized funds from operations$

262,838

$

220,665

$

757,311

$

611,455

Share-based compensation13,555

12,372

38,590

34,600

Debt costs amortization4,584

3,552

12,693

10,389

Rent deferral, net559

(5,420

)

2,198

(12,660

)

Straight-line rent revenue and other(79,973

)

(66,554

)

(215,169

)

(167,028

)

Adjusted funds from operations$

201,563

$

164,615

$

595,623

$

476,756

Per diluted share data:Net income, less participating securities' share in earnings$

0.29

$

0.25

$

0.76

$

0.61

Depreciation and amortization0.17

0.15

0.48

0.42

(Gain) loss on sale of real estate(0.02

)

-

(0.02

)

0.01

Real estate impairment charges-

-

-

0.03

Funds from operations$

0.44

$

0.40

$

1.22

$

1.07

Write-off (recovery) of straight-line rent and other-

-

-

0.05

Non-cash fair value adjustments-

-

-

0.02

Tax rate and other changes-

0.01

0.07

0.02

Debt refinancing and unutilized financing costs-

-

-

-

Normalized funds from operations$

0.44

$

0.41

$

1.29

$

1.16

Share-based compensation0.02

0.02

0.07

0.06

Debt costs amortization0.01

0.01

0.02

0.02

Rent deferral, net-

(0.01

)

-

(0.02

)

Straight-line rent revenue and other(0.13

)

(0.12

)

(0.37

)

(0.32

)

Adjusted funds from operations$

0.34

$

0.31

$

1.01

$

0.90

MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES Reconciliation of Net Income to Funds From Operations(Unaudited) (Amounts in thousands, For the Three Months For the Nine Months Endedexcept for per share data) Ended September September September September 30, 2021 30, 2020 30, 2021 30, 2020 FFO information:Net income attributable to $ 171,137 $ 131,106 $ 449,485 $ 321,566 MPT common stockholdersParticipating securities' (328 ) (435 ) (1,088 ) (1,386 )share in earningsNet income, less $ 170,809 $ 130,671 $ 448,397 $ 320,180 participating securities'share in earnings Depreciation and 98,492 80,841 277,089 223,166 amortization(Gain) loss on sale of (9,294 ) 927 (8,896 ) 2,703 real estateReal estate impairment - - - 19,006 chargesFunds from operations $ 260,007 $ 212,439 $ 716,590 $ 565,055

Write-off (recovery) of 3,650 1,266 (1,601 ) 27,098 straight-line rent andotherNon-cash fair value (819 ) (1,575 ) (2,763 ) 9,030 adjustmentsTax rate and other changes - 8,535 42,746 9,661

Debt refinancing and - - 2,339 611 unutilized financing costsNormalized funds from $ 262,838 $ 220,665 $ 757,311 $ 611,455 operations Share-based compensation 13,555 12,372 38,590 34,600

Debt costs amortization 4,584 3,552 12,693 10,389

Rent deferral, net 559 (5,420 ) 2,198 (12,660 )

Straight-line rent revenue (79,973 ) (66,554 ) (215,169 ) (167,028 )and otherAdjusted funds from $ 201,563 $ 164,615 $ 595,623 $ 476,756 operations Per diluted share data:Net income, less $ 0.29 $ 0.25 $ 0.76 $ 0.61 participating securities'share in earningsDepreciation and 0.17 0.15 0.48 0.42 amortization(Gain) loss on sale of (0.02 ) - (0.02 ) 0.01 real estateReal estate impairment - - - 0.03 chargesFunds from operations $ 0.44 $ 0.40 $ 1.22 $ 1.07

Write-off (recovery) of - - - 0.05 straight-line rent andotherNon-cash fair value - - - 0.02 adjustmentsTax rate and other changes - 0.01 0.07 0.02

Debt refinancing and - - - - unutilized financing costsNormalized funds from $ 0.44 $ 0.41 $ 1.29 $ 1.16 operations Share-based compensation 0.02 0.02 0.07 0.06

Debt costs amortization 0.01 0.01 0.02 0.02

Rent deferral, net - (0.01 ) - (0.02 )

Straight-line rent revenue (0.13 ) (0.12 ) (0.37 ) (0.32 )and otherAdjusted funds from $ 0.34 $ 0.31 $ 1.01 $ 0.90 operations Notes:

(A) Certain line items above (such as depreciation and amortization) include our share of such income/expense from unconsolidated joint ventures. These amounts are included with the activity of all of our equity interests in the "Earnings from equity interests" line on the consolidated statements of income.

(B) Investors and analysts following the real estate industry utilize funds from operations, or FFO, as a supplemental performance measure. FFO, reflecting the assumption that real estate asset values rise or fall with market conditions, principally adjusts for the effects of GAAP depreciation and amortization of real estate assets, which assumes that the value of real estate diminishes predictably over time. We compute FFO in accordance with the definition provided by the National Association of Real Estate Investment Trusts, or Nareit, which represents net income (loss) (computed in accordance with GAAP), excluding gains (losses) on sales of real estate and impairment charges on real estate assets, plus real estate depreciation and amortization and after adjustments for unconsolidated partnerships and joint ventures.

In addition to presenting FFO in accordance with the Nareit definition, we also disclose normalized FFO, which adjusts FFO for items that relate to unanticipated or non-core events or activities or accounting changes that, if not noted, would make comparison to prior period results and market expectations less meaningful to investors and analysts. We believe that the use of FFO, combined with the required GAAP presentations, improves the understanding of our operating results among investors and the use of normalized FFO makes comparisons of our operating results with prior periods and other companies more meaningful. While FFO and normalized FFO are relevant and widely used supplemental measures of operating and financial performance of REITs, they should not be viewed as a substitute measure of our operating performance since the measures do not reflect either depreciation and amortization costs or the level of capital expenditures and leasing costs necessary to maintain the operating performance of our properties, which can be significant economic costs that could materially impact our results of operations. FFO and normalized FFO should not be considered an alternative to net income (loss) (computed in accordance with GAAP) as indicators of our results of operations or to cash flow from operating activities (computed in accordance with GAAP) as an indicator of our liquidity.

We calculate adjusted funds from operations, or AFFO, by subtracting from or adding to normalized FFO (i) non-cash revenue, (ii) non-cash share-based compensation expense, and (iii) amortization of deferred financing costs. AFFO is an operating measurement that we use to analyze our results of operations based on the receipt, rather than the accrual, of our rental revenue and on certain other adjustments. We believe that this is an important measurement because our leases generally have significant contractual escalations of base rents and therefore result in recognition of rental income that is not collected until future periods, and costs that are deferred or are non-cash charges. Our calculation of AFFO may not be comparable to AFFO or similarly titled measures reported by other REITs. AFFO should not be considered as an alternative to net income (calculated pursuant to GAAP) as an indicator of our results of operations or to cash flow from operating activities (calculated pursuant to GAAP) as an indicator of our liquidity.

Notes:

(A) Certain line items above (such as depreciation and amortization) includeour share of such income/expense from unconsolidated joint ventures. Theseamounts are included with the activity of all of our equity interests in the"Earnings from equity interests" line on the consolidated statements of income.

(B) Investors and analysts following the real estate industry utilize fundsfrom operations, or FFO, as a supplemental performance measure. FFO, reflectingthe assumption that real estate asset values rise or fall with marketconditions, principally adjusts for the effects of GAAP depreciation andamortization of real estate assets, which assumes that the value of real estatediminishes predictably over time. We compute FFO in accordance with thedefinition provided by the National Association of Real Estate InvestmentTrusts, or Nareit, which represents net income (loss) (computed in accordancewith GAAP), excluding gains (losses) on sales of real estate and impairmentcharges on real estate assets, plus real estate depreciation and amortizationand after adjustments for unconsolidated partnerships and joint ventures.



In addition to presenting FFO in accordance with the Nareit definition, we alsodisclose normalized FFO, which adjusts FFO for items that relate tounanticipated or non-core events or activities or accounting changes that, ifnot noted, would make comparison to prior period results and marketexpectations less meaningful to investors and analysts. We believe that the useof FFO, combined with the required GAAP presentations, improves theunderstanding of our operating results among investors and the use ofnormalized FFO makes comparisons of our operating results with prior periodsand other companies more meaningful. While FFO and normalized FFO are relevantand widely used supplemental measures of operating and financial performance ofREITs, they should not be viewed as a substitute measure of our operatingperformance since the measures do not reflect either depreciation andamortization costs or the level of capital expenditures and leasing costsnecessary to maintain the operating performance of our properties, which can besignificant economic costs that could materially impact our results ofoperations. FFO and normalized FFO should not be considered an alternative tonet income (loss) (computed in accordance with GAAP) as indicators of ourresults of operations or to cash flow from operating activities (computed inaccordance with GAAP) as an indicator of our liquidity.



We calculate adjusted funds from operations, or AFFO, by subtracting from oradding to normalized FFO (i) non-cash revenue, (ii) non-cash share-basedcompensation expense, and (iii) amortization of deferred financing costs. AFFOis an operating measurement that we use to analyze our results of operationsbased on the receipt, rather than the accrual, of our rental revenue and oncertain other adjustments. We believe that this is an important measurementbecause our leases generally have significant contractual escalations of baserents and therefore result in recognition of rental income that is notcollected until future periods, and costs that are deferred or are non-cashcharges. Our calculation of AFFO may not be comparable to AFFO or similarlytitled measures reported by other REITs. AFFO should not be considered as analternative to net income (calculated pursuant to GAAP) as an indicator of ourresults of operations or to cash flow from operating activities (calculatedpursuant to GAAP) as an indicator of our liquidity.

MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIESAnnual Run?Rate Guidance Reconciliation(Unaudited)Annual Run-Rate Guidance - Per Share(1)LowHighNet income attributable to MPT common stockholders$

1.16

$

1.20

Participating securities' share in earnings-

-

Net income, less participating securities' share in earnings$

1.16

$

1.20

Depreciation and amortization0.65

0.65

Funds from operations$

1.81

$

1.85

Other adjustments-

-

Normalized funds from operations$

1.81

$

1.85

MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES Annual Run?Rate Guidance Reconciliation(Unaudited) Annual Run-Rate Guidance - Per Share^(1) Low High Net income attributable to MPT common $ 1.16 $ 1.20stockholdersParticipating securities' share in earnings - -

Net income, less participating securities' $ 1.16 $ 1.20share in earnings Depreciation and amortization 0.65 0.65

Funds from operations $ 1.81 $ 1.85

Other adjustments - -

Normalized funds from operations $ 1.81 $ 1.85

(1) The guidance is based on current expectations and actual results or future events may differ materially from those expressed in this table, which is a forward-looking statement within the meaning of the federal securities laws. Please refer to the forward-looking statement included in this press release and our filings with the Securities and Exchange Commission for a discussion of risk factors that affect our performance.

(1) The guidance is based on current expectations and actual results or futureevents may differ materially from those expressed in this table, which is aforward-looking statement within the meaning of the federal securities laws.Please refer to the forward-looking statement included in this press releaseand our filings with the Securities and Exchange Commission for a discussion ofrisk factors that affect our performance.

Total Pro Forma Gross Assets(Unaudited)(Amounts in thousands)September 30, 2021December 31, 2020Total Assets$

19,711,987

$

16,829,014

Add:Real estate commitments on new investments(1)990,002

1,901,087

Unfunded amounts on development deals and commencedcapital improvement projects(2)180,529

166,258

Accumulated depreciation and amortization936,289

833,529

Incremental gross assets of our joint ventures and other(3)1,752,842

1,287,077

Less:Cash used for funding the transactions above(4)(1,445,329

)

(587,384

)

Total Pro Forma Gross Assets(5)$

22,126,320

$

20,429,581

Total Pro Forma Gross Assets(Unaudited) (Amounts in thousands) September 30, December 31, 2021 2020 Total Assets $ 19,711,987 $ 16,829,014

Add:Real estate commitments on new investments^(1) 990,002 1,901,087

Unfunded amounts on development deals andcommencedcapital improvement projects^(2) 180,529 166,258

Accumulated depreciation and amortization 936,289 833,529

Incremental gross assets of our joint ventures 1,752,842 1,287,077 and other^(3)Less:Cash used for funding the transactions above^ (1,445,329 ) (587,384 )(4)Total Pro Forma Gross Assets^(5) $ 22,126,320 $ 20,429,581

(1) The 2021 column reflects investments made or committed to subsequent to September 30, 2021, including the commitment to invest $950 million in a behavioral health platform across nine states and the commitment to acquire one facility in Portugal for (eu)18 million. The 2020 column reflects investments made in 2021, including the acquisition of 35 facilities in the United Kingdom on January 19, 2021.

(2) Includes $31.1 million and $65.5 million of unfunded amounts on ongoing development projects and $149.4 million and $100.8 million of unfunded amounts on capital improvement projects, as of September 30, 2021 and December 31, 2020, respectively.

(3) Adjustment to reflect our share of our joint ventures' gross assets.

(4) Includes cash available on-hand plus cash generated from activities subsequent to period-end including loan repayments or dispositions, if any.

(5) Total pro forma gross assets is total assets before accumulated depreciation/amortization and assumes all real estate commitments on new investments and unfunded amounts on development deals and commenced capital improvement projects are fully funded using cash on hand (if available). We believe pro forma total gross assets is useful to investors as it provides a more current view of our portfolio and allows for a better understanding of our concentration levels as our commitments close and our other commitments are fully funded.

(1) The 2021 column reflects investments made or committed to subsequent toSeptember 30, 2021, including the commitment to invest $950 million in abehavioral health platform across nine states and the commitment to acquire onefacility in Portugal for (eu)18 million. The 2020 column reflects investmentsmade in 2021, including the acquisition of 35 facilities in the United Kingdomon January 19, 2021.

(2) Includes $31.1 million and $65.5 million of unfunded amounts on ongoingdevelopment projects and $149.4 million and $100.8 million of unfunded amountson capital improvement projects, as of September 30, 2021 and December 31,2020, respectively.

(3) Adjustment to reflect our share of our joint ventures' gross assets.

(4) Includes cash available on-hand plus cash generated from activitiessubsequent to period-end including loan repayments or dispositions, if any.

(5) Total pro forma gross assets is total assets before accumulateddepreciation/amortization and assumes all real estate commitments on newinvestments and unfunded amounts on development deals and commenced capitalimprovement projects are fully funded using cash on hand (if available). Webelieve pro forma total gross assets is useful to investors as it provides amore current view of our portfolio and allows for a better understanding of ourconcentration levels as our commitments close and our other commitments arefully funded.

Adjusted Revenues(Unaudited)For the ThreeMonths Ended(Amounts in thousands)September 30, 2021Total Revenues$

390,779

Revenue from real estate properties owned throughjoint venture arrangements33,129

Total Adjusted Revenues(1)$

423,908

Adjusted Revenues(Unaudited) For the Three Months Ended(Amounts in thousands) September 30, 2021 Total Revenues $ 390,779

Revenue from real estate properties owned throughjoint venture arrangements 33,129

Total Adjusted Revenues^(1) $ 423,908

(1) Adjusted revenues are total revenues adjusted for our pro rata portion of similar revenues in our real estate joint venture arrangements. We believe adjusted revenue is useful to investors as it provides a more complete view of revenue across all of our investments and allows for better understanding of our revenue concentration.

View source version on businesswire.com: https://www.businesswire.com/news/home/20211028005617/en/

CONTACT: Drew Babin, CFA Senior Managing Director of Corporate Communications Medical Properties Trust, Inc. (646) 884-9809 dbabin@medicalpropertiestrust.com