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| Medical Properties Trust | 2016 Annual Report

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| Medical Properties Trust | 2016 Annual Report SUSTAINED STRENGTH | MEDICAL PROPERTIES TRUST | 2016 ANNUAL REPORT NORMALIZED FUNDS FROM OPERATIONS NORMALIZED FUNDS FROM $ 6.1 $ 2.3 $ 307 +331% +290% +61% STRENGTH INNUMBERS 9.8 495 24 +1 +50% +57% 61 % 26 742 37 +42% +41% +1 52 55% 65 1,045 TOT +34% +41% +25% TOT (IN MILLIONS) (2004 -20 70 92 (2004 -20 1,305 (2004 - 20 (2004 - +11% AL REVENUE -13% +0% 62 102 AL ASSETS 1,306 +8% +3% +3% 67 104 1,344 +20% +17% +26% 16 16 16 ) 78 132 ) 1,609 ) +50% +53% +34% 119 198 2,162 +22% +33% +23% 147 243 2,880 +29% +29% +23% 182 313 3,720 +51% +41% +51% 442 5,609 275 +22% +22% +14% $335 $541 $ 6,419 Healthcare and RegionalCare in April 2016 –amerger inAprilHealthcare 2016 andRegionalCare Hartsville, SC,ispart ofRCCH HealthCare Partners, MPT helped facilitate. RCCH currently operates 16 MPT helpedfacilitate. RCCH currently operates 16 which was created by thewhich created by merger ofCapella was Carolina Pines Regional MedicalCenter in PinesRegional Carolina regional health systems across 12 states. healthregional systems 12 across ON THECOVER : IT WAS A VERY GOOD YEAR. e began 2016 by creating yet properties, proving the value of our assets low fixed-rate debt and negotiated a new W another valuable relationship and the strength of our underwriting team. credit facility with lower rates and more with one of the leading hospital flexible terms. operators in the United States – RCCH Then we pivoted to create a new relationship Perhaps most importantly, we continued our HealthCare Partners – welcoming them with Boston-based Steward Health Care, long-standing tradition of in April through a transaction that another industry-leading operator. Our doing what we say generated $600 million for MPT. And $1.25 billion investment in nine community we will do. that relationship continues to grow as hospitals included a right of first refusal to As we move forward, we know that – no we complete additional sale/leaseback acquire the next $1 billion of Steward’s matter what changes may occur in the transactions together. growth beyond Massachusetts. Like our Affordable Care Act, the stock market or the relationship with RCCH, this has already capital market – hospitals will continue to be That marked only the first of several resulted in attractive additional the centerpiece of any healthcare system. strategic transactions designed to acquisition opportunities. improve our capital structure and position “People will always need hospitals,” as our MPT for continued growth. By mid-year, We also refinanced MPT’s long-term debt chairman Ed Aldag is fond of saying. And we had committed to the profitable with lower rate borrowings, replaced short- that is where MPT’s focus will remain – sales of $800 million worth of hospital term, variable rate loans with long-term, “At the very heart of healthcare.” further strengthen our balance sheet. Through a STRENGTH combination of strategic asset sales, opportunistic refinancing of long-term debt and the solid execution 247 of our strategy, we reduced our leverage, improved ACROSS THE BOARD PROPERTIES liquidity and positioned MPT for long-term growth. In the first half of 2016, we executed approximately Medical Properties Trust’s preeminent position of hospitals and $0.4 billion in long- $800 million in very profitable asset sales and we strength is the result of faithful execution of our term acute care hospitals. Despite recently secured a new $1.7 billion unsecured credit unique business plan, and our performance in our profitable disposition of more facility at historically low interest rates. We also 2016 provided yet more evidence of the benefits than $750 million in assets in 2016, completed unsecured bond offerings during the year of that consistent execution. Year after year, we have grown our total assets by whose proceeds were used to repay borrowings your company continues to demonstrate $2.7 billion over the past two years under our revolving credit facility and substantially operational success while delivering exceptional and, just as importantly, increased reduce ongoing interest expense. shareholder value. normalized funds from operations per In 2016, we cemented our position as the leading diluted share by 21 percent. Since our We currently have no meaningful scheduled debt provider of real estate capital to experienced founding in 2003, we have created maturities until 2022. Our year-end leverage metric hospital operators across the United States and a hospital portfolio that includes 247 of approximately 5.1 times net debt to EBITDA is Western Europe, helping them take advantage properties representing more than one of the lowest leverage levels in the healthcare of growth opportunities by unlocking the value of 27,000 licensed beds across 30 U.S. REIT sector. We are committed to maintaining our their real estate assets. In the process, we achieved states and in Germany, the United conservative debt metrics and to continuing to all of the operational and strategic goals we set Kingdom, Italy and Spain. manage the company’s capital structure to increase value for the long term. for ourselves. Over the past year, we not only With a focus on strengthening our portfolio, our maintained our position as “the SUSTAINING STRENGTH balance sheet and our team, we successfully and established leader” in the hospital THROUGH ACQUISITIONS profitably enhanced our portfolio by capturing REIT sector, but also reinforced our strong foundation The purchase of Capella Healthcare for $900 inexpensive capital from asset sales in the first for growth and success in 2017 and beyond. Across million in 2015 marked what was then the largest half of the year and allocating that capital to the board, we are excited about what our team ND acquisition in MPT’s history, and it brought an compelling new investment opportunities in the accomplished in 2016 and what it means for 2 outstanding operator and increased diversification second half. our future. to our portfolio. LARGEST U.S.- In the first quarter of 2016, as we repositioned Our team made commitments of approximately PRESERVING OUR BASED OWNER MPT’s portfolio for accretive growth, we agreed $1.8 billion in new investments in 2016, growing STRONG BALANCE SHEET OF FOR-PROFIT to facilitate the merger of Capella Healthcare with MPT’s total gross asset base to $7.1 billion, We have always operated MPT with a strong, HOSPITAL BEDS including $4.7 billion in general acute care long-term capital structure including prudent RegionalCare, which created RCCH HealthCare hospitals, $1.7 billion in inpatient rehabilitation levels of debt. During 2016, we took steps to even Partners. Following the merger, MPT maintained ownership of six facilities and our new relationship 2 A STRONG YEAR opportunities and other transactions as a means FOR ACQUISITIONS: of maintaining our prudent capital structure. We Properties by Type will continue to carefully evaluate each strategic (in billions) opportunity for immediate positive financial impact Acute Care and long-term value creation. Rehabilitation Long Term Acute Care ENHANCING A Net Other Assets $7.1B STRONG PORTFOLIO In addition to growing our company, the transactions we completed throughout 2016 also allowed us to further develop and diversify our portfolio. We improved our tenant concentration levels to the best levels in MPT’s history. At the end of the year, our largest tenant represented $1.8B only 17.5 percent of our total portfolio and the largest investment in our portfolio represented only 3.3 percent of our total portfolio. MPT’s with RCCH has only grown stronger. Backed by In the fourth quarter of 2016, we also completed properties are now leased to, or mortgaged by, 2016 Total Portfolio Apollo Global Management, RCCH currently the acquisition of 12 post-acute hospitals to 30 different hospital operating companies and operates 16 regional health systems in 12 states be operated by Median and its affiliates in INVESTOR RETURNS: MPT is represented in 30 different states. and we continue to look for opportunities to invest Germany and we expect to complete additional MPW vs. S&P 500 On behalf of the Board of Directors, as well as in RCCH’s growth. investments in the first half of 2017. and U.S. REIT Index our senior management team and the dedicated On the heels of the RCCH merger, we turned our Our ability to complete transactions such as Source: FactSet. 231% employees of MPT, I want to thank you for your Returns assume attention to Steward Health Care as part of our these demonstrates the significant value of our dividend reinvestment. continued support. We remain committed to being strategic plan to sustain MPT’s trajectory of highly assets as well as the strength of our underwriting the leading provider of capital to the hospital and immediately accretive growth. In October, we process, and we are confident that each of industry and delivering value to all of acquired the real estate assets of nine Steward these opportunities has created value for our 152% 133% our shareholders as we continue to build acute care facilities in a $1.25 billion transaction – shareholders. Looking ahead, we are pleased on MPT’s abiding strengths. currently our largest ever. to see significant acquisition opportunities as Sincerely, This investment not only aligned MPT with another operators with proven healthcare delivery industry-leading acute care provider, but also models look to expand into new markets with the expanded our acquisition pipeline by providing assistance of MPT. S&P 500 MSCI U.S. REIT Index MSCI U.S. the right of first refusal to purchase an additional During 2017, we expect to complete between MPW Edward K. Aldag, Jr. billion dollars in real estate from Steward in $500 million and $1 billion in acquisitions and From MPW’s IPO on July 7, 2005 Chairman, President and Chief Executive Officer the future.
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