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2018 Annual Report | Global Growth Sustained Growth 495 742 1,305 1,306 1,344 1,609 3,720 5,609 307 6,419 9,020 2,880 8,844 1,045 2,162 $ $

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2018 Annual Report | Global Growth Sustained Growth 495 742 1,305 1,306 1,344 1,609 3,720 5,609 307 6,419 9,020 2,880 8,844 1,045 2,162 $ $ 2018 Annual Report | Global Growth (Amounts inmillions) ancient Navajo nation. ancient Navajo mountains defining theboundariesof oneoffoursacred Mountain,” or“Yellow Peaks Arizona looksoutontheSanFrancisco of Northern On thecover: Sustained Growth Sustained $ 6.1 $ 2.3 $ 307 NORMALIZED FUNDSFROMOPERATIONS 24 9.8 495 TOT 37 TOT 26 742 52 65 (2004-2018) AL ASSETS 1,045 AL REVENUE(2004-2018) MPT’s new Rehabilitation Hospital Rehabilitation Hospital new MPT’s 70 92 1,305 (2004 - 2018) (2004- 62 102 1,306 67 104 1,344 78 132 1,609 119 198 2,162 147 243 2,880 182 313 3,720 275 442 5,609 335 541 6,419 475 705 9,020 $ 501 $ 785 $ 8,844 $ 307 495 TOT 742 AL ASSETS (2004-2018) AL ASSETS 1,045 1,305 1,306 1,344 1,609 2,162 2,880 3,720 5,609 6,419 9,020 $ 8,844 $ 2.3 9.8 TOT 26 65 AL REVENUE(2004-2018) 92 102 104 132 198 243 313 442 541 705 $ 785 $ 6.1 NORMALIZED FUNDSFROMOPERATIONS 24 37 52 70 (2004 - 2018) (2004- 62 67 78 119 147 182 275 335 475 $ 501 The World’s Preeminent Source of Hospital Capital Founded in 2003, Medical Properties Trust is the only real estate investment trust in the world focused exclusively on investments in acute care hospitals. From the cornerstone of a single idea – that the embedded value in hospital real estate can be “unlocked” through innovative sale and leaseback transactions to meet a hospital’s capital needs – MPT has grown from zero capital and no assets 16 years ago, to an international enterprise valued today at more than $10 billion. During 2018, we grew our portfolio to nearly 300 hospitals on three continents and achieved record results through well-planned strategic transactions, while delivering market-leading returns to our shareholders and positioning the company for continued global growth. “An Accurate Map of The World, Drawn from the best Authorities” Engraving by George Rollos c.1766, when Australia was known as “New Holland.” Preeminent Performance Medical Properties Trust continued to grow in size and return of more than 25 percent in 2018, significantly DIVIDEND GROWTH reputation throughout 2018 as the global leader in hospital outperforming our peers, major REIT indices and the PER COMMON SHARE real estate and the preeminent source of capital. Advancing the broader market. As of the end of 2018, MPT’s 10-year positive momentum of 2017, we worked to harness the value of total shareholder return was 446%, the highest of any $1.00 our existing portfolio while also taking strategic steps to ensure healthcare REIT and more than 2.5 times that of the $0.96 we have the financial strength to drive accretive growth into the SNL U.S. REIT Healthcare Index. $0.91 future. As a result of this strategy, we delivered another year of Over the course of the year, we executed several $0.88 $0.84 preeminent performance – with record profitability, liquidity asset sales to deliver record proceeds of $1.5 billion, for and financial flexibility. a gain on our original By focusing exclusively on licensed hospital facilities, MPT investments of more has created one of the strongest hospital real estate portfolios in than $700 million. We the world, and achieved unprecedented financial results during grew normalized funds 32,000+ the past year. Specifically, we achieved a total shareholder from operations (FFO) to HOSPITAL BEDS $1.37 per share and our WORLDWIDE 2014 2015 2016 2017 2018 total portfolio to $10.0 billion, encompassing more than 275 properties and more than 32,000 hospital beds across the U.S. and Europe. We continue to create a balanced portfolio that provides Unlocking and Proving diversity in geographies, operators and property types and the Value of Our Investments that creates predictable, inflation–protected cash returns After completing a highly competitive bidding process for our shareholders. that attracted multiple sophisticated investors, we As we look ahead, we remain announced in June the sale of one-half of our interests confident in our strategic plan and in 71 German rehabilitation hospitals to Primonial our ability to deliver accretive growth. Group, the highly respected French asset management For 2019, we expect acquisitions of 287 PROPERTIES firm, recognizing gains of more than €500 million $2.5 billion. Simply put, Medical and cash proceeds of approximately €1.14 billion. Properties Trust has never been in a stronger position The outstanding and visible success of this joint than it is today, and we are excited about the future. venture transaction has attracted new acquisition MPT is well positioned to drive additional opportunities and provided additional sources of opportunities to generate returns to shareholders low-cost capital for future investment. through our well-covered dividend. This year marks our In early October, we sold our ownership interest sixth consecutive year of increasing our cash dividend, in Ernest Healthcare, the operator of 25 post acute currently $1.00 per share, and we expect to increase it hospitals that we continue to lease to Ernest at very further as we complete future acquisitions. attractive rates. The sale of this operating entity resulted in double-digit returns for our shareholders and cash proceeds of approximately $176 million. This transaction proved the value of MPT’s unparalleled knowledge of hospitals and demonstrated our unique ability to identify and acquire high quality hospital real estate that simply is not available to other healthcare real estate investors. 2 Industry-Leading Total Shareholder Returns 446% MEDICAL PROPERTIES TRUST, INC. MSCI U.S. REIT INDEX 204% SNL U.S. REIT HEALTHCARE INDEX 145% 165% 160% 116% 76% 91% 216% 101% 58% 81% 86% 73% 49% 176% 46% 51% 14% 55% 32% 41% 25% 6% 9% 12% 6% 0.3% 6% -4.6% 1-YEAR 2-YEAR 3-YEAR 4-YEAR 5-YEAR 6-YEAR 7-YEAR 8-YEAR 9-YEAR 10-YEAR We also sold other hospital assets during the year that immediate positive financial impact and long-term value for similarly demonstrated the substantial increases in value shareholders. we have created in the years since we acquired the assets. We are pleased with the success our team achieved in One sale in particular – of a single acute care hospital to 2018 and proud that our proven track record and renowned the largest for-profit operator in the United States for $148 hospital expertise continue to attract premier healthcare million – resulted in a gain of more than 100 percent on our institutions. We look forward to continuing our progress in original investment and an unlevered internal rate of return 2019 and remain optimistic about the future. of 17 percent. On behalf of the Board of Directors, our senior These and other strategic actions achieved exactly management team and all the employees of Medical what we intended: 1) gaining access to inexpensive growth Properties Trust, I want to thank you for your continued capital; 2) improving our already strong financial position; support and encouragement. and 3) proving to our investors and others the value of our investments. As a result, Medical Properties Trust began Sincerely, 2019 in the best position we have been in to continue our sector-leading growth. Achieving the Next Phase of Growth Our recently announced agreement to acquire and lease back 11 premier hospitals in Australia for approximately Edward K. Aldag, Jr. $859 million is the first of what we expect to be several Chairman, President and Chief Executive Officer major acquisitions in 2019. We will continue to pursue additional acquisitions that will diversify our risks and REHABILITATION HOSPITAL deliver immediately accretive FFO growth. As always, we OF NORTHERN ARIZONA will carefully evaluate each opportunity to ensure that it adds to the value and strength of our portfolio and creates 3 Unlocking Value For Continued Growth By every measure, Medical Properties Trust lifted the world of hospital finance to new heights during 2018, proving the validity of its innovative business model and paving the way for the company’s continued global growth. Consider just three examples that resoundingly trumpeted the inherent value of MPT’s hospital-focused real estate portfolio and clearly confirmed the strength of the company’s specialized knowledge and careful underwriting process: Creating a Joint Venture with Primonial Group At the end of a highly competitive selection process, Medical Properties Trust chose Primonial Group as its partner in a 50/50 joint venture arrangement for 71 rehabilitation hospitals throughout Germany, which had all been part of MPT’s pioneering European hospital investments. Management of Primonial, a highly regarded French asset manager with more than €23 billion in assets under managment, sought MPT’s unique hospital real estate expertise when they decided to invest in hospital assets in Germany and across Western Europe. Starting in late 2013, MPT had created the largest and most attractive portfolio of post-acute hospitals in Europe and the sophisticated institutional investors that bid to be MPT’s partner were attracted to the credit strength and inflation- protected long-term rental stream that MPT’s master leases provided. Primonial and others valued MPT’s initial €1.2 billion investment at more than €1.6 billion, resulting in a recognized gain to MPT in excess of €500 million five years later. “Investor interest in this JV opportunity was strong and came from funds based in Asia, Europe, Canada and the U.S.,” said MPT Chairman, President and CEO Edward K. Aldag, Jr. “As one of Europe’s real estate leaders, Primonial Group 4 committed to a long-term investment in hospital real estate that demonstrates the importance of hospitals as an asset sector in general, and MPT’s portfolio in particular.” Proving the Value of MPT’s Business Model “A great benefit of this transaction is that Primonial proved the value of Medical Properties Trust’s business model once again,” said Kevin Hanna, MPT’s Vice President, Controller and Chief Accounting Officer.
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