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Medical Properties Trust, Inc. Reports Fourth Quarter and Full-Year Results

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Medical Properties Trust, Inc. (MPW) announces financial results for Q4 and full-year 2023, with a net loss of ($1.11) and NFFO of $0.36 for Q4, and a net loss of ($0.93) and NFFO of $1.59 for the full year. The company executed asset divestiture strategies, generating over $480 million in liquidity transactions. They entered agreements to divest five hospitals to Prime Healthcare and sold their syndicated term loan investment in MEDIAN for $115 million. The CEO aims to accelerate capital allocation strategy to generate $2 billion of liquidity in 2024.
Positive
  • Medical Properties Trust, Inc. (MPW) reported a net loss of ($1.11) and NFFO of $0.36 for the fourth quarter of 2023.
  • Full-year 2023 results showed a net loss of ($0.93) and NFFO of $1.59 for the company.
  • MPW executed asset divestiture strategies, resulting in over $480 million in liquidity transactions.
  • The company entered into agreements to divest five hospitals to Prime Healthcare and sold their remaining noncontrolling interest in a tenant and two under-leased hospitals in South Carolina.
  • MPW also executed the sale of its syndicated term loan investment in MEDIAN for approximately $115 million.
  • CEO Edward K. Aldag, Jr. aims to accelerate the capital allocation strategy to generate at least $2 billion of incremental liquidity in 2024.
Negative
  • None.

The divestiture strategy undertaken by Medical Properties Trust, Inc. (MPT) is a significant financial maneuver, indicating a shift in the company's capital allocation strategy. The net loss reported, along with the Normalized Funds from Operations (NFFO), reflects a mixed financial performance. The non-recurring write-offs and impairments, primarily related to Steward Health Care System, are substantial and warrant a closer examination of the company's asset quality and investment decisions.

The sale of hospital real estate to Prime Healthcare at a 7.4% economic cap rate, which is above the company's historical cost, suggests a strategic move to optimize the asset portfolio and improve liquidity. This could potentially lead to a revaluation of the company's assets and impact the stock price. The divestiture of non-core assets, including the sale of a noncontrolling interest and under-leased hospitals, along with the syndicated term loan investment in MEDIAN, aligns with the strategy to streamline operations and focus on core competencies.

Investors should monitor the company's ability to execute its capital allocation strategy effectively, as it could influence future earnings potential and debt management. The interest from other hospital operators in Steward's mission-critical facilities implies a robust demand for healthcare real estate, which could be favorable for MPT in terms of both earnings contributions and liquidity enhancement.

The healthcare real estate industry is witnessing a consolidation trend, with operators like MPT actively managing their portfolios to focus on high-performing assets. The divestiture at a cap rate higher than the implied market capitalization rate could be indicative of the premium value associated with healthcare properties, especially given the current economic environment where capitalization rates are closely scrutinized by investors.

The strategic sale of assets and subsequent liquidity generation is a response to the broader market's demand for financial flexibility and operational efficiency. MPT's focus on accelerating capital allocation could be seen as a proactive measure to capitalize on the robust healthcare real estate market and to position itself favorably for future growth opportunities. The market will likely react to these developments based on the perceived effectiveness of MPT's strategy in driving shareholder value.

Stakeholders should consider the potential long-term benefits of a more focused investment strategy, which may include enhanced portfolio quality and improved financial metrics. However, the short-term impact of the non-recurring write-offs and impairments on the company's financial statements cannot be overlooked, as it may affect investor sentiment and the company's valuation.

MPT's strategy of divesting non-core assets and focusing on liquidity generation is a common tactic among Real Estate Investment Trusts (REITs) aiming to optimize their portfolios. The economic cap rate of 7.4% on the sale to Prime Healthcare is particularly noteworthy, as it reflects the income-generating potential of the assets relative to their sale price. This rate is a critical metric for assessing the profitability of real estate investments and is an important indicator for REIT investors.

The transition to cash basis accounting for Steward's revenue suggests a more conservative approach to revenue recognition, which could impact the NFFO—a key performance indicator for REITs. Investors typically look for stability and growth in NFFO as it represents the cash flow available for distribution to shareholders.

The mentioned liquidity transactions and the focus on generating $2 billion of incremental liquidity in 2024 highlight MPT's commitment to financial strength and flexibility. This strategy could potentially lead to an improved credit profile and better access to capital, which are crucial for REITs to fund acquisitions and development projects. It is essential for stakeholders to assess how these strategic moves will affect the REIT's dividend payouts and overall investment appeal in the long-term.

Accelerated Asset Divestiture Strategy with More Than $480 million of Liquidity Transactions

BIRMINGHAM, Ala.--(BUSINESS WIRE)-- 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, 2023, as well as certain events occurring subsequent to quarter end.

  • Net loss of ($1.11) and Normalized Funds from Operations (“NFFO”) of $0.36 for the 2023 fourth quarter and net loss of ($0.93) and NFFO of $1.59 for the full-year 2023, all on a per share basis. Included in NFFO is approximately $0.12 per share of revenue from Steward Health Care System (“Steward”) recognized prior to moving to cash basis accounting effective January 1, 2024;
  • Fourth quarter 2023 net loss includes approximately $772 million ($1.29 per share) in non-recurring write-offs and impairments, primarily related to Steward;
  • Entered into agreements in February to divest of five hospitals to Prime Healthcare (“Prime”) at a 7.4% economic cap rate for $350 million and the sale of MPT’s remaining noncontrolling interest in a tenant and two under-leased hospitals in South Carolina for combined proceeds of approximately $17 million; and
  • Executed the sale of its syndicated term loan investment in MEDIAN, the parent of Priory Group (“Priory”), in January for approximately $115 million (£90 million).

Edward K. Aldag, Jr., Chairman, President and Chief Executive Officer, said, “Our primary focus is on accelerating our capital allocation strategy by pursuing transactions expected to generate at least $2 billion of incremental liquidity in 2024. We are making progress as evidenced by our recent agreement to sell hospital real estate to Prime at pricing well above our historical cost and substantially better than estimates of our implied market capitalization rate.”

Mr. Aldag continued, “With regard to Steward, we are encouraged by the amount of interest received to date from other hospital operators for these mission-critical facilities, and we expect this real estate portfolio will either resume its contributions to earnings or become additional sources of liquidity as the year progresses.”

Included in the financial tables accompanying this press release is information about the Company’s assets and liabilities, operating results, and reconciliations of net income (loss) to NFFO, including per share amounts, all on a basis comparable to 2022 results.

PORTFOLIO UPDATE

Medical Properties Trust has total assets of approximately $18.3 billion, including $12.0 billion of general acute facilities, $2.6 billion of behavioral health facilities and $1.7 billion of post-acute facilities. As of December 31, 2023, MPT’s portfolio included 439 properties and approximately 43,000 licensed beds leased to or mortgaged by 54 hospital operating companies across the United States as well as in the United Kingdom, Switzerland, Germany, Spain, Finland, Colombia, Italy and Portugal.

As of December 31, 2023, the Company’s assets include approximately $5.0 billion of leased real estate and other investments which will be subject to cash basis accounting in 2024, with rent and interest only to be recognized as cash is received. More specifically, effective January 1, 2024, Steward and the International Joint Venture will become part of this portfolio, which already included Prospect and other smaller operators. For much of this portfolio, MPT has started a process to transition real estate to new tenants, sell, or otherwise monetize these assets in the near-term. To assist investors in more accurately assessing MPT’s portfolio, the commentary and tables included below segregate the fourth quarter operating performance of these “Cash Basis” assets from the Company’s “Stabilized Portfolio” with approximately $11.0 billion of total assets and for which accrual method accounting is appropriate. It is possible that the size and earnings contribution of these portfolios could be impacted by future asset sale and other transactions.

Stabilized / Accrual Method Portfolio (approximately $11.0 billion total assets)

Europe (approximately $6.0 billion)

Across MPT’s European portfolio, operators continue to benefit from improving occupancy rates, growing reimbursement revenue, normalization of labor costs, and the rapid growth of behavioral health services.

Circle Health (“Circle”) ($2.1 billion) has maintained its performance, as the private healthcare market continues to attract patients in the United Kingdom who are seeking to minimize diagnostic and surgical waiting times. As previously announced, in January, Centene completed its sale of Circle’s operations to Pure Health for $1.2 billion. This transaction provides third-party validation of the inherent value of MPT’s UK hospital real estate portfolio and demonstrates that the business of running private hospitals in the United Kingdom is attractive to a broad, global investor base.

MEDIAN maintained EBITDARM coverage in the 1.5-2.0x range and successfully achieved its 2023 financial targets given steadily improving occupancy, negotiated reimbursement rate increases, and stabilization of energy expenses. Priory ($1.4 billion) continues to operate profitably with improving EBITDARM coverage of 2.2x driven by increases to its already high utilization rate, reimbursement rate increases, and efficient cost management.

Americas (approximately $5.0 billion)

In MPT’s Americas portfolio, operators have largely maintained hospital volumes while making significant progress in reducing contract labor. Behavioral health facilities continue to perform well driven primarily by revenues from increasing inpatient volume.

In February, the Company agreed to sell Saint Francis Medical Center in Lynwood, CA and four properties within the St. Clare’s system in New Jersey to Prime for $250 million in immediate cash and a $100 million interest-bearing mortgage note due to MPT in nine months, representing an approximate $50 million gain on sale of real estate. Completion of the transaction is subject to customary conditions and notice provisions.

MPT and Prime have also agreed to combine three hospitals in Michigan and Missouri previously subject to a lease maturing in early 2025 with its only other remaining Prime facility (Newark, NJ) to form a new 20-year master lease with a double-digit prevailing cash rental yield and inflation-based escalators collared between 2% and 4%. Further, Prime has agreed to an approximately $5 million increase in annual escalating cash rents. Including this increase in rent for the remaining leased facilities, the St. Francis and St. Clare’s facilities were transacted at an economic cap rate of 7.4%.

The new lease also includes an option for Prime to repurchase the facilities at any time for a value of at least $260 million. Should Prime choose to exercise this purchase option, MPT would expect to record an additional gain on sale of real estate of approximately $95 million on the remaining four facilities leased to Prime.

Cash Basis Portfolio

Steward ($3.5 billion)

As announced in early January, MPT has worked with Steward to develop an action plan designed to strengthen Steward’s liquidity and restore its balance sheet, optimize MPT’s ability to recover unpaid rent and ultimately reduce MPT’s exposure to Steward. MPT and certain of Steward’s asset backed lenders are negotiating a new bridge facility whereby it is expected, but there is no assurance, that each party will fund an initial $37.5 million to Steward, based on its achievement of certain milestones previously established in January. MPT has already funded $20 million of such amount. Any subsequent loan fundings would be contingent on Steward achieving further significant milestones that optimize the amount and timing of recoveries for MPT and Steward’s ABL lenders.

Prospect Medical (“Prospect”) ($1.1 billion)

In California, Prospect is current on all rent and interest due through the end of 2023, and EBITDARM improved year-over-year as a result of improved admissions, increased Medi-Cal reimbursement rates and lower supplies costs. Further, the $75 million delayed draw term loan MPT extended to Prospect in May 2023 was fully drawn as of December 31, 2023.

OPERATING RESULTS AND OUTLOOK

Net loss for the fourth quarter and year ended December 31, 2023 was ($664 million) (($1.11) per share) and ($556 million) (($0.93) per share), respectively, compared to ($140 million) (($0.24) per share) and net income of $903 million ($1.50 per share) in the year earlier periods. Net loss for the quarter ended December 31, 2023 included several non-recurring write-offs and impairments detailed in the tables below.

NFFO for the fourth quarter and year ended December 31, 2023 was $218 million ($0.36 per share) and $951 million ($1.59 per share), respectively, compared to $258 million ($0.43 per share) and $1,088 million ($1.82 per share) in the year earlier periods.

MPT has expanded its disclosure related to non-cash revenue, providing information allowing investors to adjust NFFO for non-cash components of accrued revenue not limited to deferred rent and payment-in-kind (“PIK”) interest, as well as cash recoveries of such items. These adjustments as they relate to fourth quarter and full-year 2023, as well as prior-year reporting, are included in this release and in the earnings supplemental.

Due to uncertainty regarding its hospitals leased to Steward and the timing of liquidity transactions, the Company is not providing an estimate of full-year 2024 net income or normalized funds from operations.

Q4 2023 Non-Recurring Accounting Adjustment Summary ($ amounts in millions)

Income Statement: Line Item Impacted

Amount

Description

Rent billed

$

(154

)

Write-off of Steward rent receivable, including deferred rent on Norwood Hospital, and lease incentive assets

Straight-line rent

 

(224

)

Write-off of Steward consolidated straight-line rent

Interest and other income

 

(81

)

Write-off of previously disclosed non-cash interest receivable on loans to Steward and International JV

Real estate and other impairment charges, net

 

(112

)

Steward and other real estate impairments

Real estate and other impairment charges, net

 

(171

)

Steward non-real estate impairments

Loss from equity interests

 

(30

)

Massachusetts partnership straight-line rent and other receivables

Q4 2023 Consolidated Revenue Attribution ($ amounts in millions)

 

Stabilized/
Accrual|
Portfolio

Steward1

Prospect and Other Cash-Basis2

Non-
Recurring
Charges

Total

Rent billed

$

183

$

48

$

1

$

(154

)

$

78

 

Straight-line rent

 

44

13

-

(224

)

 

(167

)

Income from financing leases

 

10

-

10

-

 

 

20

 

Interest and other income

 

15

8

5

(81

)

 

(53

)

Total revenues

$

252

$

69

$

16

$

(459

)

$

(122

)

Q4 2023 Unconsolidated FFO and NFFO Attribution ($ amounts in millions)

 

Stabilized/
Accrual
Portfolio

Steward1

Non-
Recurring
Charges

Total

Earnings from equity interests

$

5

$

4

$

(30

)

$

(21

)

Depreciation and amortization3

 

13

 

5

 

-

 

 

18

 

MPT share of unconsolidated FFO

 

18

 

9

 

(30

)

 

(3

)

Normalizing adjustments

 

-

 

-

 

30

 

 

30

 

MPT share of unconsolidated NFFO

$

18

$

9

 

-

 

$

27

 

1 MPT will account for Steward revenue on a cash basis, effective January 1, 2024

2 In addition to Prospect, includes revenue from other smaller tenants, as well as interest income from MPT’s loan to the International Joint Venture for which interest will only be recognized as cash is received effective January 1, 2024

3 MPT share of unconsolidated depreciation and amortization

A reconciliation of net (loss) income to FFO and NFFO, including per share amounts, can be found in the financial tables accompanying this press release.

ANNUAL MEETING OF STOCKHOLDERS

Medical Properties Trust also announced that its annual meeting of stockholders will be at 10:30 a.m. Central Time on May 30, 2024, in Birmingham, Alabama. Stockholders of record as of March 20, 2024, will be invited to attend.

CONFERENCE CALL AND WEBCAST

The Company has scheduled a conference call and webcast for February 21, 2024 at 12:00 p.m. Eastern Time to present the Company’s financial and operating results for the quarter and year ended December 31, 2023. The dial-in numbers for the conference call are 877-883-0383 (U.S.) and 412-902-6506 (International) along with passcode 4099233. 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 March 6, 2024, using dial-in numbers 877-344-7529 (U.S.), 855-669-9658 (Canada) and 412-317-0088 (International) along with passcode 1685767. 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 hospital real estate with 439 facilities and approximately 43,000 licensed beds in nine countries and across three continents as of December 31, 2023. 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.

Forward-Looking Statements

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, asset sales and other liquidity transactions, expected returns on investments 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) macroeconomic conditions, including due to geopolitical conditions and instability, which may lead to a disruption of or lack of access to the capital markets, disruptions and instability in the banking and financial services industries, rising inflation and movements in currency exchange rates; (ii) the risk that MPT is not able to recover deferred rent or its other investments in Steward at full value, within a reasonable time period or at all; (iii) the risk that property sales, loan repayments, and other capital recycling transactions do not occur as anticipated or at all; (iv) the risk that MPT is not able to attain its leverage, liquidity and cost of capital objectives within a reasonable time period or at all; (v) MPT’s ability to obtain debt financing on attractive terms or at all, as a result of changes in interest rates and other factors, which may adversely impact its ability to pay down, refinance, restructure or extend its indebtedness as it becomes due, or pursue acquisition and development opportunities; (vi) the ability of our tenants, operators and borrowers to satisfy their obligations under their respective contractual arrangements with us; (vii) the economic, political and social impact of, and uncertainty relating to, the potential impact from health crises (like COVID-19), which may adversely affect MPT’s and its tenants’ business, financial condition, results of operations and liquidity; (viii) our success in implementing our business strategy and our ability to identify, underwrite, finance, consummate and integrate acquisitions and investments; (ix) the nature and extent of our current and future competition; (x) 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; (xi) factors affecting the real estate industry generally or the healthcare real estate industry in particular; (xii) our ability to maintain our status as a REIT for income tax purposes in the U.S. and U.K.; (xiii) federal and state healthcare and other regulatory requirements, as well as those in the foreign jurisdictions where we own properties; (xiv) 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; (xv) the ability of our tenants and operators to operate profitably and generate positive cash flow, comply with applicable laws, rules and regulations in the operation of our properties, to deliver high-quality services, to attract and retain qualified personnel and to attract patients; (xvi) potential environmental contingencies and other liabilities; (xvii) the risk that the expected sale of three Connecticut hospitals currently leased to Prospect does not occur; (xviii) the risk that MPT is unable to monetize its investment in PHP at full value within a reasonable time period or at all; and (xix) the risks and uncertainties of litigation or other regulatory proceedings.

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 most recent Annual Report on Form 10-K, as may be updated in our other filings with the SEC. 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 data)
December 31, 2023 December 31, 2022
Assets (Unaudited) (A)
Real estate assets
Land, buildings and improvements, intangible lease assets, and other

$

13,237,187

 

$

13,862,415

 

Investment in financing leases

 

1,231,630

 

 

1,691,323

 

Mortgage loans

 

309,315

 

 

364,101

 

Gross investment in real estate assets

 

14,778,132

 

 

15,917,839

 

Accumulated depreciation and amortization

 

(1,407,971

)

 

(1,193,312

)

Net investment in real estate assets

 

13,370,161

 

 

14,724,527

 

 
Cash and cash equivalents

 

250,016

 

 

235,668

 

Interest and rent receivables

 

45,059

 

 

167,035

 

Straight-line rent receivables

 

635,987

 

 

787,166

 

Investments in unconsolidated real estate joint ventures

 

1,474,455

 

 

1,497,903

 

Investments in unconsolidated operating entities

 

1,778,640

 

 

1,444,872

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FAQ

What were the financial results for Medical Properties Trust, Inc. (MPW) in the fourth quarter of 2023?

Medical Properties Trust, Inc. (MPW) reported a net loss of ($1.11) and NFFO of $0.36 for the fourth quarter of 2023.

What were the full-year 2023 financial results for Medical Properties Trust, Inc. (MPW)?

Full-year 2023 results showed a net loss of ($0.93) and NFFO of $1.59 for Medical Properties Trust, Inc. (MPW).

What was the total amount of liquidity transactions generated by MPW through their asset divestiture strategy?

MPW generated over $480 million in liquidity transactions through their asset divestiture strategy.

Who did MPW divest five hospitals to?

MPW divested five hospitals to Prime Healthcare.

What was the amount of the sale of MPW's syndicated term loan investment in MEDIAN?

MPW executed the sale of its syndicated term loan investment in MEDIAN for approximately $115 million.

What is CEO Edward K. Aldag, Jr.'s goal regarding capital allocation strategy for 2024?

CEO Edward K. Aldag, Jr. aims to accelerate the capital allocation strategy to generate at least $2 billion of incremental liquidity in 2024.

Medical Properties Trust, Inc.

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